Validación psicométrica de la versión en castellano del cuestionario USS-PROM para pacientes sometidos a cirugía de uretra anterior / Psychometric validation of the Spanish version of the USS-PROM questionnaire for patients who undergo anterior urethral surgery

Objetivo: Traducir y validar en lengua castellana el cuestionario Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM), evaluar sus propiedades psicométricas y determinar su idoneidad para su uso clínico en nuestro medio. Adicionalmente, se valoraron los posibles cambios en la función eyaculatoria mediante el Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD). Material y métodos: Se realizó una traducción sistemática de la versión británica. De forma prospectiva, entre septiembre 2014 y septiembre 2015 se incluyeron pacientes programados para cirugía de estenosis de uretra anterior. Todos los pacientes completaron el cuestionario antes y después de la cirugía. Se realizó un estudio psicométrico en profundidad del cuestionario. Resultados: Se evaluaron las respuestas de un total de 40 pacientes. El cuestionario demostró su validez presentando excelente correlación negativa entre las puntuaciones de los síntomas de vaciado y el flujo máximo (r = −0,6, p < 0,001), y mostrando también mejoría significativa en el EQ5D-visual analogue scale (VAS) y el time trade-off (TTO). Para la consistencia interna, el alfa de Cronbach fue de 0,701. Para la fiabilidad test-retest el coeficiente de correlación intraclase (CCI) global fue de 0,974 y los CCI de cada ítem por separado oscilaron entre 0,799 y 0,980. Se observaron mejoras significativas en todos los ítems de síntomas miccionales y calidad de vida relacionada con la salud (CVRS) (p < 0,001), quedando demostrada la capacidad de respuesta al cambio del cuestionario. No observamos cambios significativos en el MSHQ-EjD. Conclusiones: La versión en castellano del cuestionario USS-PROM es un instrumento válido para cuantificar los cambios en los síntomas de vaciado y la CVRS de los pacientes sometidos a cirugía de uretra anterior

Ojective: To translate into Spanish and validate the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) questionnaire, assessing its psychometric properties and determining its suitability for clinical use in our community. We also assessed the potential changes in ejaculatory function using the Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD). Material and methods: A systematic translation of the British version was performed. Patients scheduled for anterior urethral stricture surgery between September 2014 and September 2015 were prospectively included in the study. All patients completed the questionnaire before and after the surgery. We conducted an in-depth psychometric study of the questionnaire. Results: We assessed the responses of a total of 40 patients. The questionnaire showed its validity, presenting an excellent negative correlation between the voiding symptom scores and the maximum flow (r = −0.6,P < .001), and also showed significant improvement in the EQ5D-VAS (visual analogue scale) and the time trade-off. For internal consistency, the Cronbach's alpha was 0.701. For the test-retest reliability, the overall intraclass correlation coefficient (ICC) was 0.974, and the ICC for each item separately ranged from 0.799 to 0.980. We observed significant improvement in all items regarding urinary symptoms and health-related quality of life (P < .001), thereby demonstrating the response capacity to changing the questionnaire. There were no significant changes in the MSHQ-EjD. Conclusions: The Spanish version of the USS-PROM questionnaire is a valid instrument for quantifying changes in voiding symptoms and the health-related quality of life of patients undergoing anterior urethral surgery

Psychometric validation of the Spanish version of the USS-PROM questionnaire for patients who undergo anterior urethral surgery. / Validación psicométrica de la versión en castellano del cuestionario USS-PROM para pacientes sometidos a cirugía de uretra anterior.

OBJECTIVE: To translate into Spanish and validate the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) questionnaire, assessing its psychometric properties and determining its suitability for clinical use in our community. We also assessed the potential changes in ejaculatory function using the Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD). MATERIAL AND METHODS: A systematic translation of the British version was performed. Patients scheduled for anterior urethral stricture surgery between September 2014 and September 2015 were prospectively included in the study. All patients completed the questionnaire before and after the surgery. We conducted an in-depth psychometric study of the questionnaire. RESULTS: We assessed the responses of a total of 40 patients. The questionnaire showed its validity, presenting an excellent negative correlation between the voiding symptom scores and the maximum flow (r=-0.6, P<.001), and also showed significant improvement in the EQ5D-VAS (visual analogue scale) and the time trade-off. For internal consistency, the Cronbach's alpha was 0.701. For the test-retest reliability, the overall intraclass correlation coefficient (ICC) was 0.974, and the ICC for each item separately ranged from 0.799 to 0.980. We observed significant improvement in all items regarding urinary symptoms and health-related quality of life (P<.001), thereby demonstrating the response capacity to changing the questionnaire. There were no significant changes in the MSHQ-EjD. CONCLUSIONS: The Spanish version of the USS-PROM questionnaire is a valid instrument for quantifying changes in voiding symptoms and the health-related quality of life of patients undergoing anterior urethral surgery.

Eficacia y perfil de seguridad del arándano americano en lactantes y niños con infección urinaria recurrente / Efficacy and safety profile of cranberry in infants and children with recurrent urinary tract infection

Objetivo: La profilaxis con arándano americano de la infección de orina recurrente infantil se ha mostrado eficaz en el modelo experimental del adulto. Existen pocos datos sobre su eficacia, seguridad y dosis recomendadas en la población pediátrica. Métodos: Se desarrolla un ensayo clínico controlado, doble ciego en fase III en niños mayores de un mes de edad para evaluar la eficacia y seguridad del arándano americano en la infección urinaria recurrente infantil. Se parte del supuesto de no inferioridad del arándano americano frente a trimetoprima. El análisis estadístico se realiza mediante un análisis de Kaplan Meier. Resultados Se reclutan 85 pacientes menores de un año de edad y 107 mayores de un año. Setenta y cinco pacientes reciben arándano y 117 trimetoprima. El porcentaje acumulado de infección de orina asociado a la profilaxis con arándano en menores de un año fue de 46% (IC 95%: 23-70) en niños y del 17% (IC 95%: 0-38) en niñas, con eficacia a las dosis utilizadas inferior a trimetoprima. En los niños mayores de un año de edad el arándano se mostró no inferior a trimetoprima, con un porcentaje acumulado de infección de orina de 26% (IC 95%: 12-41). El arándano americano fue bien tolerado, no registrándose efectos adversos. Conclusiones: Nuestro estudio confirma que el arándano americano es seguro y eficaz en la profilaxis de infección urinaria recurrente en lactantes y niños. Con las dosis utilizadas su eficacia no es inferior a la observada para trimetoprima entre los mayores de un año de edad (AU)

Objective: Cranberry prophylaxis of recurrent urinary tract infection in infants has proven effective in the experimental model of the adult. There are few data on its efficacy, safety and recommended dose in the pediatric population. Methods: A controlled, double-blind Phase III clinical trial was conducted on children older than 1 month of age to evaluate the efficacy and safety of cranberry in recurrent urinary tract infection. The assumption was of the non-inferiority of cranberry versus trimethoprim. Statistical analysis was performed using Kaplan Meier analysis. Results: A total of 85 patients under 1 year of age and 107 over 1 year were recruited. Trimethoprim was prescribed to 75 patients and 117 received cranberry. The cumulative rate of urinary infection associated with cranberry prophylaxis in children under 1 year was 46% (95% CI; 23-70) in children and 17% (95% CI; 0-38) in girls, effectively at doses inferior to trimethoprim. In children over 1 year-old cranberry was not inferior to trimethoprim, with a cumulative rate of urine infection of 26% (95% CI; 12-41). The cranberry was well tolerated and with no new adverse effects. Conclusions: Our study confirms that cranberry is safe and effective in the prophylaxis of recurrent urinary tract infection in infants and children. With the doses used, their efficiency is not less than that observed for trimethoprim among those over 1 year-old (AU)

[Efficacy and safety profile of cranberry in infants and children with recurrent urinary tract infection]. / Eficacia y perfil de seguridad del arándano americano en lactantes y niños con infección urinaria recurrente.

OBJECTIVE: Cranberry prophylaxis of recurrent urinary tract infection in infants has proven effective in the experimental model of the adult. There are few data on its efficacy, safety and recommended dose in the pediatric population. METHODS: A controlled, double-blind Phase III clinical trial was conducted on children older than 1 month of age to evaluate the efficacy and safety of cranberry in recurrent urinary tract infection. The assumption was of the non-inferiority of cranberry versus trimethoprim. Statistical analysis was performed using Kaplan Meier analysis. RESULTS: A total of 85 patients under 1 year of age and 107 over 1 year were recruited. Trimethoprim was prescribed to 75 patients and 117 received cranberry. The cumulative rate of urinary infection associated with cranberry prophylaxis in children under 1 year was 46% (95% CI; 23-70) in children and 17% (95% CI; 0-38) in girls, effectively at doses inferior to trimethoprim. In children over 1 year-old cranberry was not inferior to trimethoprim, with a cumulative rate of urine infection of 26% (95% CI; 12-41). The cranberry was well tolerated and with no new adverse effects. CONCLUSIONS: Our study confirms that cranberry is safe and effective in the prophylaxis of recurrent urinary tract infection in infants and children. With the doses used, their efficiency is not less than that observed for trimethoprim among those over 1 year-old. (Clinical Trials Registry ISRCTN16968287).

Fournier gangrene: description of 37 cases and analysis of associated health care costs.

BACKGROUND AND OBJECTIVES: Fournier gangrene is a urological emergency associated with a high mortality. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department. MATERIAL AND METHODS: We carried out a retrospective study of 37 patients diagnosed with Fournier gangrene between January 2001 and October 2010. RESULTS: All the patients were men, 43.2% had diabetes, and the mean age of the patients was 57.68 years. Statistically significant differences were observed between the age of surviving patients and that of patients who died (55.8 and 69.6 years, respectively). The mean hospital stay was 27.54 days and 32.4% of patients required admission to the intensive care unit. Etiology was unknown in 39.8% of cases. Polymicrobial infection was observed in 59.5% of cases. The mean health care cost associated with a patient diagnosed with Fournier gangrene admitted to intensive care and requiring at least 1 procedure in the operating room was €25,108.67. Mortality was 13.5%. Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay. CONCLUSIONS: Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented.

Gangrena de Fournier. Análisis descriptivo y coste económico-sanitario de nuestra serie de 37 casos / Fournier Gangrene: Description of 37 Cases and Analysis of Associated Health Care Costs

Introducción: La gangrena de Fournier es una urgencia urológica definida como una fascitis necrotizante, con una alta mortalidad, resultado de una infección polimicrobiana que se origina en la región anorrectal y/o genitourinaria. El objetivo de este estudio es analizar las características epidemiológicas y clínicas, así como las variables que han influido en la evolución y mortalidad de los pacientes tratados en nuestro Servicio. Material y métodos: El estudio analiza retrospectivamente 37 pacientes diagnosticados de gangrena de Fournier en el periodo de tiempo comprendido entre enero del 2001 a octubre de 2010. Resultados: Todos los pacientes son hombres, con una edad media de 57, 68 años, existiendo diferencias estadísticas en la edad de los fallecidos respecto a los que sobreviven, 69,6 años frente a 55,8 años. El 43,2% eran diabéticos. La estancia media hospitalaria fue de 27,54 días. El 32,4% precisó de ingreso en la UCI. En el 39,8% se desconoce su etiología. La infección fue polimicrobiana en el 59,5% de los casos. El coste sanitario medio de un paciente diagnosticado de gangrena de Fournier que ingresa en la Unidad de Cuidados Intensivos (UCI) y requiere de al menos una cura en quirófano es de 25.108,67 euros. La mortalidad fue del 13,5%. Al estratificar las patologías estudiadas de forma independiente se observa que sólo la cardiopatía isquémica se relacionó de forma significativa con la mortalidad y una mayor estancia hospitalaria. Conclusión: La gangrena de Fournier es una patología con una alta mortalidad, a pesar de un tratamiento adecuado precoz. Es una patología con una baja incidencia, pero supone un coste elevado para el sistema sanitario, por lo que serían necesarias medidas de prevención primaria y secundaria (AU)

Background and objectives: Fournier gangrene is a urological emergency associated with a high mortality. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department. Material and methods: We carried out a retrospective study of 37 patients diagnosed with Fournier gangrene between January 2001 and October 2010. Results: All of the patients were men, 43.2% had diabetes, and the mean age of the patients was 57.68 years. Statistically significant differences were observed between the age of surviving patients and that of patients who died (55.8 and 69.6 years, respectively). The mean hospital stay was 27.54 days and 32.4% of patients required admission to the intensive care unit. Etiology was unknown in 39.8% of cases. Polymicrobial infection was observed in 59.5% of cases. The mean health care cost associated with a patient diagnosed with Fournier gangrene admitted to intensive care and requiring at least 1 procedure in the operating room was €25 108.67. Mortality was 13.5%. Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay. Conclusions: Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented (AU)

[Fournier gangrene: description of 37 cases and analysis of associated health care costs]. / Gangrena de Fournier. Análisis descriptivo y coste económico-sanitario de nuestra serie de 37 casos.

BACKGROUND AND OBJECTIVES: Fournier gangrene is a urological emergency associated with a high mortality. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department. MATERIAL AND METHODS: We carried out a retrospective study of 37 patients diagnosed with Fournier gangrene between January 2001 and October 2010. RESULTS: All of the patients were men, 43.2% had diabetes, and the mean age of the patients was 57.68 years. Statistically significant differences were observed between the age of surviving patients and that of patients who died (55.8 and 69.6 years, respectively). The mean hospital stay was 27.54 days and 32.4% of patients required admission to the intensive care unit. Etiology was unknown in 39.8% of cases. Polymicrobial infection was observed in 59.5% of cases. The mean health care cost associated with a patient diagnosed with Fournier gangrene admitted to intensive care and requiring at least 1 procedure in the operating room was €25,108.67. Mortality was 13.5%. Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay. CONCLUSIONS: Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented.

Valor de la ecografía en el diagnóstico del divertículo uretral congénito asociado con válvula uretral anterior en el recién nacido / Value of sonography in the diagnosis of congenital urethral diverticulum associated to an anterior urethral valve in the newborn

El propósito de este artículo es mostrar la utilidad de la ecografía como método diagnóstico de imagen no invasivo en el diagnóstico del divertículo uretral congénito asociado a válvula uretral anterior. Presentamos un caso de un varón de 6 días de edad, en cuyos estudios de imagen se determina el diagnóstico de divertículo uretral congénito asociado a válvula uretral así como la valoración de la afección renal secundaria a este proceso. Se realizó una ecografía renal, de vejiga y uretra, así como una cistouretrografía. En el estudio ecográfico se utilizó un equipo Toshiba Power Vision 6000 con un transductor lineal de entre 7,5 y 12 MHz. También presentamos y discutimos la etiopatogenia, características clínicas y las técnicas radiológicas usadas, así como los distintos hallazgos encontrados en ellas. Como resultado podemos concluir que el diagnóstico de divertículo uretral congénito, aunque de manera convencional se realiza mediante cistouretografía, también puede llevarse a cabo por ultrasonidos, con todas las ventajas de esta técnica de imagen para el paciente (AU)

Estrangulación de la base peneana por aros metálicos / Penile strangulation by metallic rings

Presentamos dos casos clínicos recientes de pacientes que acuden al Servicio de Urgencias por presentar lesión en base de pene por estrangulación de aro metálico (Doble anilla de llavero) que se resolvieron mediante sección del cuerpo metálico. Revisamos la literatura sobre esta patología excepcional y su manejo terapéutico. (AU)

[Risk factors for cryptorchidism]. / Factores de riesgo de criptorquidia.

OBJECTIVES: To identify the main risk factors for cryptorchidism in southeast Spain, and their possible association with environmental factors. METHODS: In this retrospective case-control study, the target population consisted of babies born in the University of Granada Hospital (UGH) in Granada, Spain, between 1 January 1992 and 31 December 1999, both inclusive. All boys from the target population aged 1 year or more diagnosed at the Pediatric Urology or Endocrinology Services of the UGH as having cryptorchidism (n = 70) were included, and a random sample of 144 baby boys born without cryptorchidism or any other related genitourinary abnormality or disease formed the control group. The mother's hospital record in the obstetrics clinic was checked to record information on potential risk factors, such as residence (specific health care district), parents' occupation, obstetric antecedents, diseases during pregnancy, gestational age at birth, birth weight and type of delivery. To search for associations between cryptorchidism and each of the variables we calculated crude and adjusted odds ratios with unconditional logistic regression analysis. RESULTS: Low gestational age at birth (37 weeks) and cesarian section were significantly associated with cryptorchidism. We also found an association with residence of the mother in the Costa-Alpujarra health care district, but its magnitude decreased when the association was adjusted for the father's occupation in agriculture. This last factor was also associated with cryptorchidism, although the association was not statistically significant. CONCLUSIONS: Our findings are consistent with those of other studies, except for the absence of association between low birth weight and cryptorchidism. Geographic variations in our study population suggested that environmental factors possibly related with farm work are involved in cryptorchidism.

Factores de riesgo de criptorquidia / Risk factors for cryptorchidism

Objetivos: Identificar los principales factores de riesgo de criptorquidia en nuestro ámbito geográfico y la posible asociación de ésta con factores ambientales. Métodos: Se realizó un estudio retrospectivo de casos y controles. La población diana estuvo constituida por los varones nacidos en el Hospital Universitario San Cecilio de Granada entre el 1 de enero de 1992 y el 31 de diciembre de 1999.Se seleccionaron todos los casos (n = 70) diagnosticados decriptorquidia a partir del primer año de vida en las historias clínicas de urología y endocrinología pediátrica del hospital, así como una muestra de 144 controles sin esta enfermedad, ni ninguna otra genitourinaria relacionada. A partir de la historia obstétrica materna se recogió información sobre los potenciales factores de riesgo considerados: factores previos al embarazo (p. ej., lugar de residencia, profesión de los padres);factores del embarazo (p.ej., enfermedades y tratamiento hormonal durante la gestación); y factores del parto y neonatales(p. ej., tipo de parto, edad gestacional y peso del neonato).Para cada uno de ellos se calculó su odds ratio cruda (ORc) y ajustada (ORa) mediante regresión logística no condicionada. Resultados: La baja edad gestacional 37 (..) (AU)

Objectives: To identify the main risk factors for cryptorchidism in southeast Spain, and their possible association with environmental factors. Methods: In this retrospective case-control study, the target population consisted of babies born in the University of Granada Hospital (UGH) in Granada, Spain, between 1 January1992 and 31 December 1999, both inclusive. All boys from the target population aged 1 year or more diagnosed at the Pediatric Urology or Endocrinology Services of the UGH as having cryptorchidism (n = 70) were included, and a random sample of 144 baby boys born without cryptorchidism or any other related genitourinary abnormality or disease formed the control group. The mother’s hospital record in the obstetrics clinic was checked to record information on potential risk factors, such as residence (specific health care district), parents’ occupation, obstetric antecedents, diseases during pregnancy, gestational age at birth, birth weight and type of delivery. To (..) (AU)

Estudio clínico-radiológico del riñón displásico multiquístico / Clinical and radiologic study of the multicystic kidney displasia

El Riñón Displásico Multiquístico es una anomalía relativamente frecuente en el recién nacido, y es considerada como una de las causas más comunes de masa abdominal en el neonato. El continuo avance en las técnicas diagnósticas de imagen (especialmente la ecografía) ha contribuido a facilitar el diagnóstico y la toma de decisiones en el manejo de estos niños. En este artículo profundizamos en las características radiológicas del Riñón Displásico Multiquístico y revisamos distintos aspectos relevantes de dicha anomalía (AU)

[Distal ureteral lithiasis. ESWL versus ambulatory URS]. / Litiasis ureteral distal. LEOC versus URN ambulatoria.

OBJECTIVE: To present the results achieved in the treatment of 1802 distal ureteral stones treated at the Lithotripsy Unit of the San Cecilio University Hospital over the last 10 years (1990-2000). METHODS: Stones were treated by extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy (URS). ESWL was the initial treatment in 81% of the cases (1460 calculi) and URS in the remaining 19% (342 stones). URS was performed for complication or failed ESWL (102 stones) and ESWL was performed for failed URS, basically due to stone migration (24 stones). Ureterolithotomy was required on 7 occasions. Sedation-analgesia with fentanyl and midazolam was routinely used in URS. Sedation was required in only 55% of the ESWL procedures. RESULTS: Elective ESWL resolved 93% of the cases, a percentage which is similar to that achieved with URS as first treatment. The ESWL retreatment rate was 1.3. URS was successful in 98% of the cases of failed ESWL. CONCLUSIONS: There are two treatment modalities for stones in the distal ureter: ESWL and URS. We advocate the use of outpatient URS with sedation preferably in the female patient, impacted stones, obstructive uropathy, stones larger than 2 cm and radiotransparent stones.

[Relationship between preoperative urine cultures and prostatic gland cultures in patients treated for benign prostatic hyperplasia]. / Relación entre los cultivos de orina preoperatorios y los cultivos de la glándula prostática en pacientes intervenidos de HBP.

OBJECTIVES: 1.--Investigate the bacteriuria preoperative in patients who will be operate on for Being Prostatic Hyperplasia (BPH). 2.--Define the prevalence of the prostatic colonization or infection. 3.--Try to correlate the bacteriological findings of urine and prostate, and find the degree of concordance between the microorganisms which can be commonly found in urine and prostatic tissue. METHOD AND MATERIALS: Prospective series of 175 patients undergoing prostatectomy for obstructive symptoms. The protocol revealed, among others variables: the preoperative urine culture; the presence or the absence of catheter; and the quantitative bacteriological culture of prostatic tissue. The information could be analised and its results could be obtained later on. The analysis stages consisted of both a descriptive and an analytic study. RESULTS AND CONCLUSIONS: 1.--Only 36 patients (20.6%) presented bacteriological increase of microorganisms (> or = 10(4) UFC/ml) in the preoperative urine culture. The Escherichia coli was the most common microorganism, followed by the Enterococcus faecalis, coagulase-negative Staphylococcus and the Pseudomona aeruginosa. A single microorganism grew in 31 out of the 36 positive cultures. 2.--The prevalence of the infection or colonization of the prostatic tissue was 25.1% (44 patients). The most common isolated microorganism was the coagulase-negative Staphylococcus followed by the Escherichia coli and the Enterococcus faecalis, in concentrations of at least 10(4) UFC/gr of tissue in the 79.6%. A single microorganism was isolated in 32 out of 44 patients. 3.--The proportion of positive prostatic cultures, in patients with positive urine culture (38.3%), was significantly higher than the one obtained in patients with negative urine cultures (16.5%) (p < 0.0001). Nevertheless, 52.3% of the 44 patients with positive prostatic cultures had negative urine culture, and only 21 (58.3%) out of the 36 patients with positive urine cultures presented a bacteriological growth in prostate. The degree of concordance (Kappa index) between the microorganisms which were found in preoperative urine and prostatic tissue is low or none for the majority of them.

Dilatation of the rete testis: ultrasound study.

The aim of this study was to show the US findings in mode B and color Doppler duplex of the dilatation of the rete testis, in order to analyze its association with other scrotal processes and to confirm their inclusion into the benign testicular lesions. We present seven diagnosed cases (mean age 61 years) of dilatation of the rete testis to which a clinical control and US was accomplished up to 1 year. The scrotal sonography study was carried out with a linear probe of 7.5 Mhz. In the US examination we observed in all cases an intratesticular image located in the mediastinum testis constituted by anechoic and serpiginous tubular structures, which do not show any blood flow with the color Doppler. In one case the mentioned observations were bilateral. Five cases had cysts in epididymis and the last case showed an increase in size in the epididymis head. Color Doppler duplex examination did not detected flow dots in the seven patients. The dilatation of the rete testis is a benign entity frequently associated with pathology in epididymis, with specific US findings which permit avoidance of invasive tests.

[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.

[Pathology of the peritoneo-vaginal complex in the child. Communicating hydrocele, cord cyst, simple hydrocele]. / Patologá del conjunto peritoneo-vaginal en el niño. Hidrocele comunicante, quiste de cordon, hidrocele simple.

The abnormal persistence of the patent processus vaginalis determines the appearance of four types of pathology, depending on the grade and sort of communication: communicating hydrocele, hydrocele of cord, scrotal hydrocele and intrafunicular hernia. We have revised our casuistry of children with patent processus vaginalis pathology for the two last years (1995-1996), and we have found 75 communicating hydrocele cases, 5 hydrocele of cord and 16 scrotal hydrocele cases, on children between 1 month and 13 years old. The diagnostic was done after physical exploration with transillumination and inguino-scrotal ultrasound. Initially, conservative treatment was followed, which was enough for 58 patients (60.4%). In the 38 cases (39.6%) in which there were no improvement, surgical treatment via inguinal was carried out, with good results in nearly all cases. As a conclusion, we can assert that ultrasound is an excellent diagnostical method for patent processus vaginalis pathology and conservative treatment must have priority upon surgery, since a great number of spontaneous resolutions are observed, most of all on children aged less than two years old.

[Vesico-uterine fistula: report of 2 new cases]. / Fístula vésico-uterina: aportación de dos nuevos casos.

Contribution of two new cases of vesicouterine fistula secondary to a cesarean incision. In one case, diagnosis was achieved through cystography and cystoscopy, while in the second case cystography, cystoscopy and stain testing (methylene blue) were used. In both cases management was through transperitoneal and transvesical fistulorrhaphy. The two cases showed favourable post-operative evolution with no relapse.

[Relationship between female stress urinary incontinence intensity and the data of urethral pressure profile]. / Relación entre la intensidad de la incontinencia urinaria de esfuerzo femenina y los datos del perfil de presión uretral.

OBJECTIVE: To determine the utility of the urethral pressure profile in the diagnosis of stress urinary incontinence and its possible correlation with the degree of severity of incontinence. METHODS: 175 female patients with a clinical history of urinary incontinence were evaluated; of these, 50 cases with bladder instability demonstrated by the urodynamic studies were excluded. Patient evaluation included clinical history, physical examination, analytical studies, radiological evaluation and complete urodynamic assessment, including uroflowmetry, filling and voiding cystometry, and static and dynamic urethral pressure profiles. A 10 Fr microtransducer catheter was utilized for the urethral pressure profile studies. ICS recommendations were observed. Patients were classified into three groups according to the severity of urinary incontinence based on the clinical data, physical examination and urodynamic findings. The Wilcoxson test and 2 x 2 contingency table were employed for the statistical analysis. RESULTS: Of the parameters analyzed for the static urethral pressure profile, statistically significant differences were found only for the maximum urethral pressure and maximum closing urethral pressure in the different groups of patients. No differences in total length or functional urethral length were observed. Comparison of the dynamic urethral pressure profiles of the different groups showed a statistically significantly higher proportion of patients with a negative dynamic urethral closing pressure in the group of patients with urodynamically and clinically demonstrated urinary incontinence than in those with no urodynamically or clinically demonstrable incontinence. CONCLUSIONS: The urethral pressure profile is sufficiently reliable to confirm the diagnosis of urinary incontinence and its degree of severity. As a diagnostic test in urinary stress incontinence, it has a sensitivity of 89% and a specificity of 95%.