[Extensive ureteral lesions: management with substitution with small intestine]. / Lesiones ureterales extensas: manejo mediante sustitución por intestino delgado.

Wide ureteral injuries are unusual but not exceptional and have few conservative therapeutic options, specially those that involve the upper ureter. Autotransplantation, ureteral substitution by intestine and combined Boari bladder flap-psoas bladder hitch are basically the only chances to avoid nephrectomy. In this paper we report five cases in which ileum was used to substitute the ureter and review the most outstanding literature about this subject.

[Liposarcoma of the spermatic cord: a report of a new case and a review of the literature]. / Liposarcoma de cordón espermático: aportación de un nuevo caso y revisión de la literatura.

Malignant paratesticular tumors are uncommon. Of these, liposarcoma of the spermatic cord constitutes a rare tumor. Only a hundred cases have been reported. They are typically presented in elderly people. The usually have a good prognosis because of their low level of malignancy and their relapses tend to be localized. It has a high rate of survival over 5 years. Preoperative diagnosis is infrequent, it is suggested by the appearance of a progressively enlarging mass in the scrotum and the ultrasonography which shows a solid mass of the spermatic cord that is independent of the testicle. The choice treatment is radical orchidectomy, while long-term follow-up of these patients is mandatory because of local relapses. When local relapses become evident, the choice treatment is extensive local excision followed by adjuvant radiotherapy. In the present study we report a new case of a recurring, well differentiated spermatic cord liposarcoma of the type sclerotic, in a 50-year-old man. An exhaustive review of the literature has been made.

[Spontaneous renal hemorrhage. Report of 8 cases]. / Hemorragia renal espontánea. A propósito de ocho casos.

Spontaneous renal haemorrhage or Wünderlich syndrome is a rare condition; it is however of great significance given the emergency, sometimes vital, situation that it creates. The etiology of the condition is varied, the most frequent being tumoral. The clinical manifestations and the use of imaging techniques are of great interest to establish the diagnosis. The choice treatment is controversial. This paper presents eight cases of Wünderlich syndromes seen in our urology service. The background, etiology, clinical manifestations, diagnostic methods and treatment used in each case are analyzed.

[Renal hematomas secondary to extracorporeal shockwave lithotripsy]. / Hematomas renales secundarios a litotricia extracorpórea por ondas de choque.

OBJECTIVE: 0.6% of the patients submitted to extracorporeal shock wave lithotripsy (ESWL) present symptomatic renal hematoma that can permanently alter renal function and morphology. The present study analyzes the risk factors, types of renal hematoma secondary to shock waves and treatment. METHODS: The study comprised 9 patients with ESWL-induced renal hematoma that had been diagnosed by renal ultrasound and/or urography. Patient evaluation included CT and an isotopic renogram. Two patients had associated arterial hypertension and ischemic coronary heart disease treated with antiaggregants. In 4 patients the renal calculi had produced partial obstruction of the urinary tract. RESULTS: In 4 patients the ESWL-induced renal hematoma was less than 1/3 of the renal volume and did not alter renal function. These patients have been classified as having type I renal hematoma and have been successfully managed conservatively. In 5 patients the hematoma was more than 1/3 of the renal volume and renal function was impaired. These patients have been classified as having type II renal hematoma. Spontaneous reabsorption of the hematoma facilitated recovery of renal function in one patient, two had persistent hematoma and progressive renal function impairment, and the remaining two patients underwent delayed evacuation of the hematoma on days 30-45. Decompression renal surgery preserved renal function of the two kidneys. CONCLUSION: Advanced arteriosclerosis, arterial hypertension, primary coagulation disorders or secondary to antiaggregation therapy and obstruction of the urinary tract increase the risk of ESWL-induced renal hematoma. Renal hematoma following ESWL has been classified as type I or type II. In the latter, renal decompression surgery facilitates recovery of renal function.

Self-expanding wallstent endoprosthesis for malignant ureteral obstruction.

We present our experience with the self-expanding Wallstent endoprosthesis for ureteral recanalization in obstructive uropathy secondary to malignant pelvic disease. In total, 19 stents were inserted in 14 ureters. The follow-up included 100% of the patients. To date, except for one case, the patency of the stent has always persisted for the period of the survival of the patients, the longest ones being 4 and 4.1 years.

[Premalignant and benign lesions in nodules of adenomatous hyperplasia]. / Lesiones premalignas y otras benignas en nódulos de hiperplasia adenomatosa.

OBJECTIVES: Currently, two premalignant lesions have been recognized: prostatic intraepithelial neoplasia (PIN) and atypical adenomatous hyperplasia (AAH). Due to the possible clinical implications of these lesions, we attempted to determine their incidence in specimens of benign prostatic hyperplasia (BPH), the most frequent pathology of the prostate. METHODS: A pathological and immunohistochemical study using several markers was performed to detect premalignant lesions in 156 specimens obtained by adenomectomy and TUR from 1990 to 1992. RESULTS: 20 PIN and 8 AAH (20.6%) were found. There were other equivocal prostatic lesions, not only with respect to premalignant lesions but prostatic carcinoma as well. CONCLUSIONS: Premalignant lesions within BPH nodules are frequent (20.6%). Furthermore, other lesions were also found that caused difficulty in making the differential diagnosis.

[Laparoscopic treatment of the symptomatic renal cyst: the indications and a bibliographic review]. / Tratamiento por vía laparoscópica del quiste renal sintomático: indicaciones y revisión bibliográfica.

OBJECTIVES: The indications and usefulness of laparoscopic renal cystectomy are analyzed. METHODS: Five patients with symptomatic or recurrent simple renal cyst were submitted to laparoscopic cystectomy; section of the posterior peritoneum, dissection of the cyst, puncture-aspiration and resection of the cyst wall. RESULTS: Complete removal of the cyst wall was achieved with minimum morbidity, the cyst and symptoms disappeared and the hospital stay was short. There was one case of hematoma in the lumbar fossa that resolved with conservative management. CONCLUSIONS: Laparoscopic resection of the cyst wall appears to be a useful therapeutic approach for symptomatic or recurrent simple renal cysts.

[Renal trauma in children: our experience and review of the literature]. / Traumatismos renales en la infancia: nuestra experiencia y revisión de la literatura.

Twenty-seven cases of kidney injury in children under 15 years old are reviewed. All of them were diagnosed, treated and subsequently followed in our Service between 1979 and 1992. Clinical evaluation, blood and urine analyses, and imaging techniques are the three basic tools in the management of kidney injuries. Regarding imaging techniques, dynamic CT is currently the best diagnostic method, mainly due to its high anatomic resolution and because it permits evaluation of renal function and of possible associated lesions in other organs. Kidney injuries were classified into three categories: I (18 cases), II (4 cases), and III (4 cases). The last injury affected a pathological kidney. Emergency surgical procedures were performed in 7 cases (25.9%): 2 were category II, 4 category III, and the pathologic kidney that suffered trauma. Surgery was deferred in one case (category II) and the remaining 19 cases (74.1%) were treated conservatively: 18 were category I and 1 category II. Nephrectomy was required only for the pathologic kidney. All the other kidneys were preserved.

[Examination of Doppler color ultrasound in patients with ESWL]. / Examen mediante US Doppler color en enfermos tratados con ESWL.

Although treatment by shock waves has been proven useful in destroying calculi, it is not free from complications and may cause lesions to the kidney whose importance has not been completely elucidated. The present study utilized color Doppler US to determine the changes produced by ESWL on the kidney and its vessels in particular. The results achieved by Doppler evaluation of 25 patients immediately before ESWL, 2, 7 and 30 days post-ESWL show an increased resistance index 2 days after treatment which tended to return to normal at 30 days. We discuss the different results obtained depending on stone location and the complications.

[Carcinoma of the penis: our experience in 24 cases and review of the literature]. / Carcinoma de pene: nuestra experiencia en 24 casos y revisión de la literatura.

Squamous cell carcinoma of the penis has a very scant incidence in our setting and evolves slowly. From 1978 to 1991, 24 cases of penile carcinoma had been treated and followed at our service. The results achieved with partial amputation of the penis have been highly satisfactory for stages T1 and T2, which was combined with postoperative radiotherapy for the latter tumor stage. Since carcinoma of the penis generally presents with infection, if lymphadenectomy is performed, it has to be performed after the amputation. The peculiar features of this disease, patient characteristics and the diversity of the therapeutical approaches make penile carcinoma a lesion whose treatment is controversial and, in many cases, difficult to follow.

[Stress urinary incontinence. Our results with the Burch's technique]. / Incontinencia urinaria de esfuerzo. Nuestros resultados con la técnica de Burch.

The aim of the surgical procedures utilized in the treatment of stress urinary incontinence (SUI) is to correct the posterior ureterovesical angle defect, thereby improving transmission of intraabdominal pressures to the urethra. We report our experience on 61 patients that had been diagnosed with SUI at our service from June 1984 to December 1990. Treatment was by the same operative procedure (Burch Technique) in all patients. The methods of exploration and the prognostic factors that might influence the outcome of the procedure are described. The short-term (3 months) success rate was 95%, the medium-term (1 year) 85.7% and the long-term (5 years) 77.1%. We underscore the convenience of prophylactic heparin therapy to prevent possible thromboembolic complications.

[Localized renal adenocarcinoma. Prognostic factors and influence of postoperative irradiation on survival]. / Adenocarcinoma renal localizado. Factores de pronóstico e influencias de la irradiación postoperatoria en la supervivencia.

Presentation of our experience and results in the treatment of localized renal adenocarcinoma with radiotherapy supplementary to surgery. The influence of post-operative radiotherapy in the subsequent occurrence of relapse and survival is analyzed. Also, the predictive value in our series of pre-surgery VSG, FA and LDH determinations is analyzed.

[Tuberculous microbladder. Ileocystoplasty for enlargement]. / Microvejiga tuberculosa. Iliocistoplastia de aumento.

We have had occasion to treat 8 patients suffering from tuberculous microbladder on whom we carried out augmentation plasty with a segment of ileum according to Ring-plasty technique in 6 cases, and with U-morphology in the other two, all displayed as the main symptom increase in mictional frequency. Six patients were subjected to prior tuberculostatic treatment. Mictional frequency improved in all patients. We observed morphological improvement in seven patients and functional improvement in four, there was one death, in a patients who had only been having prior tubculostatic treatment for one month. Daytime continence was achieved in al cases and there was nocturnal incontinence in five patients. U or ring ileocystoplasties are simple fast techniques displaying good capacity with low pressures and residua of less than 80 cc. No vesicourethral reflux was observed when we carried out the reimplantation.

[Ureterovesical reimplantation. Our results]. / Reimplantaciones ureterovesicales. Nuestros resultados.

We evaluated the results and complications of 85 ureteroneocystostomies performed from 1978 to 1987. These varied according to the etiology of the disorder; the success rate was 100% for malformations, 87.5% for gynecologic ureters, and 80% for stenosis of the end of the ureter. Several surgical techniques were employed. The Politano-Leadbetter procedure was the most widely-used (40% of cases), and the Cohen technique achieved the best results (100% success rate). All the failures (7.1% of the cases) were due to stenosis of the reimplanted ureter.