[Inguinoscrotal bladder hernias]. / Hernias Vesicales inguinoescrotales.

OBJECTIVES: Despite the high incidence of inguinal hernias. In the general population, only a small percentage of them involve the bladder. Bladder wall weakness and bladder outlet obstruction are involved in its pathogenesis. We present our experience in the diagnosis and treatment of this rare disease. METHODS: A total of eight patients have been diagnosed of inguinoscrotal bladder hernia and treated in our center over the last 18 years. In most cases, retrograde and voiding cystourethrograms, prostatic and bladder ultrasound, and uroflowmetry have been performed. The treatment varied depending on the characteristics of the herniated bladder tissues and bladder capacity. The treatment of bladder outlet obstruction varied depending on the etiology. RESULTS: Two patients presented at the emergency room of our centre, the others were diagnosed at the outpatient clinics of our department. Resection of the herniated bladder tissue was carried out in four patients due to the quality of the tissue; bladder-pexy to the abdominis rectus muscles was performed in one patient; hernia repair with bladder reintroduction was the treatment in the other four cases. Bladder outlet obstruction was treated in six cases. Seven patients showed clinical improvement, showing normal bladder morphology on post operative cystogram. CONCLUSIONS: Bladder hernia is a rare pathology often presenting in mid age males. It should be suspected in every male with lower urinary tract obstructive symptoms and associated inguinal hernia. Retrograde and voiding cystourethrogram are the radiological diagnostic tests of choice to evaluate this disease. The treatment of choice is that of the hernia and bladder outlet obstruction.

Hernias vesicales inguinoescrotales / Inguinoscrotal bladder hernias

Objetivo: A pesar de la elevada incidencia de hernia inguinal en la población general, tan solo un pequeño porcentaje de estas incluye una porción vesical. En su patogenia están implicadas, la debilidad de la pared abdominal y la obstrucción de salida del tracto urinario inferior. En este trabajo presentamos nuestra experiencia en el diagnóstico y tratamiento de esta infrecuente patología. Métodos: Un total de 8 pacientes han sido diagnosticados y tratados en nuestro centro, con el diagnóstico de hernia vesical inguinoescrotal en los últimos 18 años. Para alcanzar el diagnóstico se realizó uretrocistografía retrógrada y permiccional, ecografía renovesical y prostática y flujometría en la mayoría de los casos. El tratamiento realizado varió en función de las características del tejido vesical herniado y la capacidad vesical. En cuanto al tratamiento de la obstrucción infravesical, varió en función de la etiología de la misma. Resultados: Dos pacientes debutaron de forma aguda acudiendo al servicio de urgencias de nuestro centro, siendo el resto diagnósticados en las consultas externas de nuestro servicio. En 4 pacientes se realizó resección del tejido vesical herniado debido fundamentalmente a las características del mismo, realizando pexia vesical a los músculos rectos del abdomen en un caso y cura herniaria con reintroducción vesical en los cuatro restantes. En 6 pacientes se realizó tratamiento de la causa de obstrucción infravesical subyacente. Siete pacientes presentaron mejoría clínica, mostrando morfología vesical normal en la cistografía de control postoperatorio. Conclusiones: Le hernia vesical es una patología infrecuente que suele presentarse en varones de mediana edad. Ha de sospecharse en todo varón con sintomatología obstructiva del tracto urinario inferior y hernia inguinal asociada. La prueba de diagnóstico radiológico de elección para valorar esta patología es la cistografía retrógada y permiccional, y el tratamiento de elección es el propio de la hernia y el de la obstrucción infravesical (AU)

Objectives: Despite the high incidence of inguinal hernias. In the general population, only a small percentage of them involve the bladder. Bladder wall weakness and bladder outlet obstruction are involved in its pathogenesis. We present our experience in the diagnosis and treatment of this rare disease. Methods: A total of eight patients have been diagnosed of inguinoscrotal bladder hernia and treated in our center over the last 18 years. In most cases, retrograde and voiding cystourethrograms, prostatic and bladder ultrasound, and uroflowmetry have been performed. The treatment varied depending on the characteristics of the herniated bladder tissues and bladder capacity. The treatment of bladder outlet obstruction varied depending on the etiology. Results: Two patients presented at the emergency room of our centre, the others were diagnosed at the outpatient clinics of our department. Resection of the herniated bladder tissue was carried out in four patients due to the quality of the tissue; bladder-pexy to the abdominis rectus muscles was performed in one patient; hernia repair with bladder reintroduction was the treatment in the other four cases. Bladder outlet obstruction was treated in six cases. Seven patients showed clinical improvement, showing normal bladder morphology on post operative cystogram. Conclusions: Bladder hernia is a rare pathology often presenting in mid age males. It should be suspected in every male with lower urinary tract obstructive symptoms and associated inguinal hernia. Retrograde and voiding cystourethrogram are the radiological diagnostic tests of choice to evaluate this disease. The treatment of choice is that of the hernia and bladder outlet obstruction (AU)

[The usefulness of virtual endoscopy and CT urography in the diagnosis of upper urinary tract tumors]. / Utilidad de la endoscopia virtual y el Uro-Tc en el diagnóstico de tumores del tracto urinario superior.

OBJECTIVES: Upper urinary tract (UUT) tumors are a relatively low incidence pathology which often represents a diagnostic challenge for the urologist, because several imaging tests are usually necessary to achieve the final diagnosis. Over the last years CT scan has suffered a notable development and nowadays, with the arrival of new image processing hardware and software, it is possible to detect small urothelial lesions and to perform 3-D urinary tract reconstruction and virtual endoscopic navigation. METHODS: Between January 2004 and June 2005 we performed a total of 15 examinations in 15 patients for the study of asymptomatic hematuria of probable upper urinary tract origin. The technique included three phases to obtain images: basal phase, vascular phase and excretory phase. Processing and image analysis was performed by one radiologist. RESULTS: A total of 10 tumors were diagnosed, with pathological confirmation in all cases. We did not register any complication secondary to the technique, and all patients tolerated well the exam. CONCLUSIONS: The CT urography is a safe, well-tolerated, highly sensitive and efficient imaging test, very useful in the diagnosis of renal and UUT pathology. It may become the only imaging test performed in the study of asymptomatic hematuria and the test of choice for the study of urological tumoral pathology.

Utilidad de la endoscopia virtual y el uro-tc en el diagnóstico de tumores del tracto urinario superior / The usefulness of virtual endoscopy and CT urography in the diagnosis of upper urinary tract tumors

OBJETIVO: Los tumores del tracto urinario superior (TTUS) conforman una patología de incidencia relativamente baja que a menudo suponen un reto diagnóstico para el urólogo ya que, suelen ser necesarias varias pruebas de imagen para alcanzar el diagnóstico definitivo. En los últimos años la tomografía computerizada ha alcanzado un notable desarrollo, y gracias a la aparición de nuevo hardware y software de procesamiento de imágenes actualmente es posible detectar lesiones uroteliales de pequeño tamaño, así como realizar reconstrucciones tridimensionales del tracto urinario y navegación endoscópica virtual por el interior del mismo. MÉTODOS: Entre enero del 2004 y junio de 2005 hemos realizado un total de 15 exploraciones a 15 pacientes durante el estudio de hematuria asintomática de probable origen en el tracto urinario superior, todas ellas indicadas por el Servicio de Urología de nuestro hospital. La técnica incluyó tres fases en la adquisición de imágenes: fase basal, fase vascular y fase excretora. El procesado y análisis de las imágenes fue realizado por un solo radiólogo. RESULTADOS: Un total de 10 tumores fueron diagnosticados, obteniendo en todos los casos confirmación anatomopatológica. No registramos ninguna complicación derivada de la propia técnica, y todos los pacientes toleraron bien la exploración. CONCLUSIÓN: El Uro-TC es una prueba segura, bien tolerada, con una elevada sensibilidad y eficiencia, muy útil en el diagnóstico de la patología renal y del TUS, susceptible de ser utilizada en el futuro como única prueba de imagen radiológica en el estudio de hematuria asintomática y como prueba de elección en el estudio de patología tumoral urológica

OBJECTIVES: Upper urinary tract (UUT) tumors are a relatively low incidence pathology which often represents a diagnostic challenge for the urologist, because several imaging tests are usually necessary to achieve the final diagnosis. Over the last years CT scan has suffered a notable development and nowadays, with the arrival of new image processing hardware and software, it is possible to detect small urothelial lesions and to perform 3-D urinary tract reconstruction and virtual endoscopic navigation. performed a total of 15 examinations in 15 patients for the study of asymptomatic hematuria of probable upper urinary tract origin. The technique included three phases to obtain images: basal phase, vascular phase and excretory phase. Processing and image analysis was performed by one radiologist. RESULTS: A total of 10 tumors were diagnosed, with pathological confirmation in all cases. We did not register any complication secondary to the technique, and all patients tolerated well the exam. CONCLUSIONS: The CT urography is a safe, well- tolerated, highly sensitive and efficient imaging test, very useful in the diagnosis of renal and UUT pathology. It may become the only imaging test performed in the study of asymptomatic hematuria and the test of choice for the study of urological tumoral pathology

Evolución del conocimiento en patología uretral en Valencia desde finales del siglo XIX hasta mediados del siglo XX. Análisis documental histórico / Evolution of knowledge of urethral pathology in Valencia from the end of the XIX century to the middle of XX century. Historical documentary analysis

OBJETIVO: La patología de la uretra hasuido siempre un interesante tema de estudio, apareciendoya en los textos de 600 años a.C., donde sedescriben los dilatadores de madera y metal. En laépoca judeo-musulmana aparecen las primeras uretrotomíasexternas, y Francisco Díaz describe en 1588 eltratamiento de las carnosidades de la verga. ConCiviale y Maisoneuve, entre 1700 y 1800, aparece ladescripción del uretrotomo, y finalmente a mediadosdel siglo XIX, se comienza con la búsqueda de tejidoscapaces de sustituir a la uretra.MÉTODOS: Revisamos todos los artículos de los autoresvalencianos de la época referidos a la patologíauretral, publicados fundamentalmente la RevistaValenciana de Ciencias Médicas. RESULTADOS: Destacamos el uso de las bujías y sondasen el abordaje de la patología estenótica uretral,por varios autores, con sus ventajas e inconvenientes.Asimismo, la descripción de una uretrotomía externapor el Prof. Mollá. Finalmente destacamos el tratamientode una rotura de uretra posterior mediante tunelizaciónpor el Dr. Alfredo Tramoyeres.CONCLUSIONES: A pesar de no ser una patologíacon un alto volumen de publicaciones, ha interesadodesde siempre a los autores. Exponemos todos los tratamientos,técnicas de sondaje y la dilatación como primeraopción

OBJECTIVES: Urethral pathology has ;;always been an interesting topic for study, being present ;;in texts from 600 years B.C, where wood and metallic ;;dilators are described. First external urethrotomies ;;appear in the Jewish-Muslim period, and Francisco Diaz ;;describes in 1588 the treatment of the prostate in his ;;book “Tratamiento de las carnosidades de la verga”. ;;With Civiale and Maisoneuve, between 1700 and ;;1800, appears the description of the urethrotome, and ;;finally in the middle XIX century starts the search for ;;adequate tissues to replace urethra. ;;METHODS: We review all articles on the topic of urethral ;;pathology from authors from Valencia in that period, mainly published in the journal “Revista Valenciana de ;;Ciencias Médicas”. ;;RESULTS: We emphasize the use of bulbs and sounds ;;in the approach to urethral stenosis by several authors, ;;with their advantages and limitations. We also emphasize ;;the description of external urethrotomy by Prof. Molla. ;;Finally, we point out the treatment of a posterior urethra ;;fracture by tunneling reported by Dr. Alfredo ;;Tramoyeres. ;;CONCLUSIONS: Despite not being a topic with a high ;;volume of publications, it has always interested authors. ;;We describe all treatments, and sound insertion and ;;dilation techniques as first option

[Valencia's scientific contribution to the consolidation of Urology as a speciality. Bibliometric classification by subject, author and journal. Historical documentary analysis]. / Aportación cientifica valenciana en la consolidación de la Urología como especialidad. Bibliometría por materias, autores y revistas. Análisis documental histórico.

OBJECTIVES: Urology, as other medical-surgical specialities, had its consolidation process in the mid 19th century. This phenomenon in the history of medicine occurs around certain authors, which in the case of urology in Valencia was Dr. Raphael Molla Rodrigo, and several key elements such as development of lithotripsy and cystoscopy, as cited by prestigious authors in the second national meeting of history of medicine in Salamanca in 1965. For this process a spreading media is necessary, either regional or national, for posterior bibliometric analysis. METHODS: We performed a retrospective study of urological publications in the area of Valencia to know the main areas of knowledge, main authors and publications. Regarding this latter we point out Cronica medica, Revista Valenciana de Ciencias Médicas, Archivos Españoles de Urología y Policlínica. As authors, Rafael Molla Rodrigo, Victor Molla Fambuena and Rafael Alcalá Santaella stand out. Genitourinary tuberculosis and surgical procedures with their complications are among the most commonly treated topics. RESULTS: Dr. Rafael Molla Rodrigo is the author with the highest number of articles and the one who contributed to the consolidation of the speciality nationwide with his extensive scientific contributions. Genitourinary tuberculosis is extensively treated, and surgical procedures and their complications are in second place. The journal in which we were able to find more articles was Cronica Medica, due to its greater diffusion among general practitioners. CONCLUSIONS: We emphasize Dr. Rafael Molla as the main author, genitourinary-tuberculosis as the main topic and the journal Cronica Médica as the most commonly used media.

Aportación científica valenciana en la consolidación de la urología como especialidad. Bibliometría por materias, autores y revistas. Análisis documental histórico / Valencia´s scientific contribution to the consolidation of Urology as a speciality. Bibliometric classification by subject, author and journal. Historical documentary analysis

OBJETIVO: La urología, al igual que otras especialidades médico-quirúrgicas asisten a su proceso de consolidación a mediados del siglo XIX. Este fenómeno en la historia de la medicina se produce en torno a determinados autores, que en el caso de esta especialidad en Valencia fue en torno a Rafael Mollá Rodrigo y citándose elementos clave como fueron el desarrollo de la litotricia y la cistoscopia, según citan prestigiosos autores en el segundo congreso nacional de historia de la medicina celebrado en Salamanca en 1965. Para este proceso es necesario un medio de difusión, bien de carácter regional o nacional, para el posterior análisis bibliométrico. MÉTODOS: Hemos realizado un estudio retrospectivo de las publicaciones urológicas en el ámbito geográfico valenciano, para conocer las principales áreas del conocimiento, los principales autores y los principales medios de difusión. En cuanto a estas últimas destacamos Crónica Médica, Revista Valenciana de Ciencias Médicas, Archivos Españoles de Urología y Policlínica. En cuanto a los autores destacamos a Rafael Mollá Rodrigo, Víctor Mollá Fambuena y Rafael Alcalá Santaella. De entre los temas más tratados hemos podido constatar que se tratan de la tuberculosis genitourinaria y los procedimientos quirúrgicos y sus complicaciones. RESULTADOS: El Dr. Rafael Mollá Rodrigo es el autor del que más artículos se han localizado y el que, con sus amplias aportaciones científicas, contribuye a la consolidación de la especialidad en el ámbito nacional. Se tratan ampliamente las áreas de tuberculosis genitourinaria y procedimientos quirúrgicos y sus complicaciones en segundo lugar. La revista en que mayor número de artículos hemos podido localizar ha sido Crónica Médica, por su mayor difusión entre médicos generales. CONCLUSIONES: Destacamos a Rafael Mollá como el principal autor, la tuberculosis genitourinaria como tema principal y la revista Crónica Médica como medio de difusión mas usado (AU)

OBJECTIVES: Urology, as other medicalsurgical specialities, had its consolidation process in the mid 19th century. This phenomenon in the history of medicine occurs around certain authors, which in the case of urology in Valencia was Dr. Raphael Molla Rodrigo, and several key elements such as development of lithotripsy and cystoscopy, as cited by prestigious authors in the second national meeting of history of medicine in Salamanca in 1965. For this process a spreading media is necessary, either regional or national, for posterior bibliometric analysis. METHODS: We performed a retrospective study of urological publications in the area of Valencia to know the main areas of knowledge, main authors and publications. Regarding this latter we point out Cronica medica, Revista Valenciana de Ciencias Médicas, Archivos Españoles de Urología y Policlínica. As authors, Rafael Molla Rodrigo, Victor Molla Fambuena and Rafael Alcalá Santaella stand out. Genitourinary tuberculosis and surgical procedures with their complications are among the most commonly treated topics. RESULTS: Dr. Rafael Molla Rodrigo is the author with the highest number of articles and the one who contributed to the consolidation of the speciality nationwide with his extensive scientific contributions. Genitourinary tuberculosis is extensively treated, and surgical procedures and their complications are in second place. The journal in which we were able to find more articles was Cronica Medica, due to its greater diffusion among general practitioners. CONCLUSIONS: We emphasize Dr. Rafael Molla as the main author, genitourinary tuberculosis as the main topic and the journal Cronica Médica as the most commonly used media (AU)

[Genitourinary tuberculosis in the urologic works of Professor Rafael Mollá Rodrigo]. / La tuberculosis genitourinaria en la obra urológica del profe- sor Rafael Mollá Rodrigo (1862--1930). Análisis documental histórico de su obra.

OBJECTIVES: Professor Rafael Molla Rodrigo is considered by some the author who contributed with his scientific work and solid technique to consolidate Urology as a speciality in Valencia. Such importance is also perceived in a national level, as demonstrated by the fact that he belonged to the first board of the Spanish Association of Urology and contributed to its foundation in the two-year period 1910--1911, from his position of head of the department of Surgical Therapy and Operations at the Central University. Genitourinary tuberculosis is one of the most outstanding chapters of his extensive works. METHODS: We reviewed all his works, selecting all original articles about genitourinary tuberculosis. Original articles have been obtained from the journals Revista de Higiene y Tuberculosis, La Medicina Valenciana, Revista Valenciana de Ciencias Médicas y Policínica, and from his two most important books, Clinical Lessons In Urology and Clinical Lessons in Urology and Genitourinary Surgery. RESULTS: Throughout his work he analyzes features of relevance about this disease, such as diagnosis, about which he emphasizes the clinical and bacteriological difficulties, and treatment, which was only feasible by precocious nephrectomy. CONCLUSIONS: He dedicates a great part of his work to the study of this pathology and defends a precocious diagnosis in order to perform the only treatment that had demonstrated efficacy. He also exposes the symptoms and variety of clinical presentations, as well as diagnosis through separate kidney catheterization with the aim to determine unilateral involvement.

[Management of male sterility in patients taking anabolic steroids]. / Manejo de la esterilidad masculina en pacientes consumidores de esteroides anabolizantes.

OBJECTIVES/METHODS: To review the incidence of male infertility secondary to intake of anabolic products and our experience and outcomes with treatment. There is a variety of such substances (testosterone, nandrolone, stanozolol, etc.) in their intake may be unique or combinations, both orally or parenterally. Comparisons between patients and case series are difficult because of the hiding of this practice and various consumption practices and doses employed. RESULTS/CONCLUSIONS: Most of the patients recover normal spermatogenesis does by stopping intake of anabolic substances. The period of time until recovery is 6.35 months. Patients not recovering after six months were given tamoxifen 20 mg/24-hour, if having a normal or inhibited hypothalamus-hypophysis axis. Duration of abuse, doses, and anarchical consumption maderesponse to treatment with antiestrogen drugs or gonadotropins unpredictable in patients not responding to conservative treatment.

[Bladder squamous metaplasia: report of one case and bibliographic review]. / Metaplasia escamosa vesical, a propósito de un caso. Revisión de la uteratura.

OBJECTIVES: We report a new case of squamous metaplasia because of its interest and subtle differential diagnosis with other bladder pathologies. METHODS: We report the case of a male patient with history of previous neoplasia with an exophytic lesion of the bladder wall discovered on follow-up. Pathological diagnosis after TUR was bladder squamous metaplasia. RESULTS: Follow-up is performed by ultrasound, cystoscopy, and urine cytology in adherence to clinical guidelines due to the possibility of transformation into squamous cell carcinoma. CONCLUSIONS: Urothelium is able to develop non neoplastic transformations such as squamous metaplasia. The importance of such transformations depends on proper diagnosis and follow-up due to their ability to transform into a neoplastic process.

La tuberculosis genitourinaria en la obra urológica del profesor Rafael Mollá Rodrigo (1862-1930). Análisis documental histórico de su obra / Genitourinary tuberculosis in the urologic works of Professor Rafael Molla Rodrigo

OBJETIVO: El profesor Rafael Mollá Rodrigo está considerado por diversos autores, el autor que contribuyó con su obra científica y solidez técnica a consolidar la urología como especialidad en Valencia. Dicha importancia también se percibe a nivel nacional, como demuestra el hecho que perteneciese a la primera junta directiva de la Asociación Española de Urología y contribuyese a su fundación en el bienio 1910-1911, desde su cátedra de terapéutica quirúrgica y operaciones en la universidad central. La tuberculosis genitourinaria es uno de los capítulos más destacados de su extensa obra. MÉTODOS: Hemos revisado toda su obra, extrayendo todos los artículos originales en materia de tuberculosis genitourinaria. Los artículos originales han sido obtenidos de la Revista de Higiene y Tuberculosis, La Medicina Valenciana, Revista Valenciana de Ciencias Médicas y Policlínica, y de sus dos libros más importantes, Lecciones Clínicas de Urología y Lecciones Clínicas de Urología y Cirugía Genitourinaria. RESULTADOS: Analiza a lo largo de su obra aspectos tan relevantes como el diagnóstico, donde resalta las dificultades tanto clínicas como bacteriológicas y tratamiento de esta enfermedad, por entonces solo factible mediante la nefrectomía precoz. CONCLUSIONES: Dedica gran parte de su obra al estudio de esta patología y defiende un diagnóstico precoz para aplicar el único tratamiento que ha demostrado su efectividad. También expone la sintomatología y sus variadas formas clínicas, así como el diagnóstico a través del cateterismo de ambos riñones, con la finalidad de determinar la unilateralidad de la lesión (AU)

OBJECTIVES: Professor Rafael Molla Rodrigo is considered by some the author who contributed with his scientific work and solid technique to consolidate Urology as a speciality in Valencia. Such importance is also perceived in a national level, as demonstrated by the fact that he belonged to the first board of the Spanish Association of Urology and contributed to its foundation in the two-year period 1910-1911, from his position of head of the department of Surgical Therapy and Operations at the Central University. Genitourinary tuberculosis is one of the most outstanding chapters of his extensive works. METHODS: We reviewed all his works, selecting all original articles about genitourinary tuberculosis. Original articles have been obtained from the journals Revista de Higiene y Tuberculosis, La Medicina Valenciana, Revista Valenciana de Ciencias Médicas y Policínica, and from his two most important books, Clinical Lessons In Urology and Clinical Lessons in Urology and Genitourinary Surgery. RESULTS: Throughout his work he analyzes features of relevance about this disease, such as diagnosis, about which he emphasizes the clinical and bacteriological difficulties, and treatment, which was only feasible by precocious nephrectomy. CONCLUSIONS: He dedicates a great part of his work to the study of this pathology and defends a precocious diagnosis in order to perform the only treatment that had demonstrated efficacy. He also exposes the symptoms and variety of clinical presentations, as well as diagnosis through separate kidney catheterization with the aim to determine unilateral involvement (AU)

Manejo de la esterilidad masculina en pacientes consumidores de esteroides anabolizantes / Management of male sterility in patients taking anabolic steroids

OBJETIVO Y MÉTODOS: Revisamos laincidencia de esterilidad masculina secundaria al consumode productos anabolizantes (CPA) y cual ha sidonuestra experiencia y resultados en el tratamiento de lamisma. Dichas sustancias son muy variadas (testosterona,nandrolona, estanozolol, etc) y su consumo puedeser único o combinado, tanto por vía oral como parenteral.La ocultación de dicha práctica y los diferentespatrones de consumo y dosis utilizados hacen que seadifícil la comparación entre pacientes y series publicadaspor diferentes autores.RESULTADO Y CONCLUSIONES: La mayoría de lospacientes recuperan una espermatogénesis normal contan sólo el cese en la toma de los anabolizantes. Elperíodo de tiempo medio transcurrido hasta esta recuperaciónes de 6,35 meses. En los pacientes que nomejoran a los seis meses iniciamos una pauta de tratamientocon Tamoxifeno 20 mg/24 h, previa comprobaciónanalítica de un perfil hormonal hipotalamo-hipofisarionormal o inhibido. El abuso en tiempo, en dosisy la anarquía del consumo hacen imprevisible la respuestaal tratamiento con antiestrógenos o gonadotropinasque podemos ofrecer a los pacientes que nomejoran con actitud conservadora

OBJECTIVES/METHODS: To review the ;;incidence of male infertility secondary to intake of anabolic ;;products and our experience and outcomes with treatment. ;;There is a variety of such substances (testosterone, ;;nandrolone, stanozolol, etc.) in their intake may be ;;unique or combinations, both orally or parenterally. ;;Comparisons between patients and case series are ;;difficult because of the hiding of this practice and ;;various consumption practices and doses employed. ;;RESULTS/CONCLUSIONS: Most of the patients recover ;;normal spermatogenesis does by stopping intake of ;;anabolic substances. The period of time until recovery ;;is 6.35 months. Patients not recovering after six months ;;were given tamoxifen 20 mg/24-hour, if having a normal ;;or inhibited hypothalamus-hypophysis axis. Duration of ;;abuse, doses, and anarchical consumption maderesponse ;;to treatment with antiestrogen drugs or gonadotropins ;;unpredictable in patients not responding to conservative ;;treatment

Metaplasia escamosa vesical, a propósito de un caso. Revisión de la literatura / Bladder squamous metaplasia: report of one case and bibliographic review

OBJETIVO: Presentamos un nuevo caso demetaplasia escamosa por su interés y sutileza en el diagnósticodiferencial con otras patologías vesicales.MÉTODOS: El caso que presentamos se trata de un varóncon antecedentes de otras neoplasias durante cuyo seguimientoaparece la sospecha de una lesión excrecente en lapared vesical. Tras realizarse RTU el diagnóstico histopatológicofue de metaplasia escamosa vesical.RESULTADOS: Se ha realizado un seguimiento mediante ecografía,cistoscopia y citología urinaria, con la frecuencia indicadaen las guías clínicas dada la posibilidad de transformaciónen un carcinoma epidermoide.CONCLUSIONES: El urotelio es capaz de desarrollar transformacionesno neoplásicas como la metaplasia escamosa.La importancia de estas transformaciones radica en su correctodiagnóstico y su seguimiento, dada su capacidad de transformarseen un proceso neoplásico

OBJECTIVES: We report a new case ofsquamous metaplasia because of its interest and subtledifferential diagnosis with other bladder pathologies.METHODS: We report the case of a male patient withhistory of previous neoplasia with an exophytic lesion ofthe bladder wall discovered on follow-up. Pathologicaldiagnosis after TUR was bladder squamous metaplasia.RESULTS: Follow-up is performed by ultrasound, cystoscopy,and urine cytology in adherence to clinical guidelinesdue to the possibility of transformation into squamouscell carcinoma.CONCLUSIONS: Urothelium is able to develop nonneoplastic transformations such as squamous metaplasia.The importance of such transformations depends onproper diagnosis and follow-up due to their ability totransform into a neoplastic process

[Evolution of the knowledge of urethral pathology in Valencia from the end of the XIX century to the middle of XX century. Historical documentary analysis]. / Evolución del conocimiento en patología uretral en Valencia desde finales del siglo XIX hasta mediados del siglo XX. Análisis documental histórico.

OBJECTIVES: Urethral pathology has always been an interesting topic for study, being present in texts from 600 years B.C, where wood and metallic dilators are described. First external urethrotomies appear in the Jewish-Muslim period, and Francisco Diaz describes in 1588 the treatment of the prostate in his book "Tratamiento de las carnosidades de la verga". With Civiale and Maisoneuve, between 1700 and 1800, appears the description of the urethrotome, and finally in the middle XIX century starts the search for adequate tissues to replace urethra. METHODS: We review all articles on the topic of urethral pathology from authors from Valencia in that period, mainly published in the journal "Revista Valenciana de Ciencias Médicas". RESULTS: We emphasize the use of bulbs and sounds in the approach to urethral stenosis by several authors, with their advantages and limitations. We also emphasize the description of external urethrotomy by Prof. Molla. Finally, we point out the treatment of a posterior urethra fracture by tunneling reported by Dr. Alfredo Tramoyeres. CONCLUSIONS: Despite not being a topic with a high volume of publications, it has always interested authors. We describe all treatments, and sound insertion and dilation techniques as first option.

Alfredo Tramoyeres Cases (1910-2002): primer jefe de servicio de urología de la Ciudad Sanitaria "La Fe". Análisis documental histórico de su obra / Alfredo Tramoyeres Cases (1910-2002): first chairman of the Department of Urology at the Ciudad Sanitaria La Fe. Documentary-historical analysis of his work

OBJETIVO: A mediados del S. XX encontramos la especialidad de Urología, durante siglos en manos de los cirujanos generales, plenamente consolidada, fruto de años de evolución y desarrollo, y de los estudios y trabajos de autores que contribuyen hoy a ser cimientos de nuestra especialidad. En Valencia, a mediados del siglo XX, asistimos al nacimiento de nuevos hospitales, entre ellos la Ciudad Sanitaria "La Fe", de la que sería su primer Jefe de Servicio de Urología, Alfredo Tramoyeres Cases, cuya larga y fértil singladura profesional es el objeto de nuestro trabajo. MÉTODOS: Hemos revisado a través toda su obra científica. Los artículos originales han sido obtenidos de la Medicina Española, Revista Española de Cirugía Traumatológica y Ortopedia y Archivos Españoles de Urología. Su obra urológica más importante es su tesis mía: mi modificación personal, publicada en Valencia en 1976. Para su biografía hemos utilizado la fuente Historia biográfica y bibliográfica de la Urología Española en el siglo XX y entrevista con familiares directos. RESULTADO: Destacamos la extensa revisión que hace e las formas de derivación urinaria. Trata los divertículos vesicales y la enfermedad del cuello vesical, donde defiende el tratamiento quirúrgico. Finalmente expone la rotura uretral posterior y los diversos tratamientos del cáncer de próstata por entonces. CONCLUSIONES: Alfredo Tramoyeres Cases fue un profesional que con lo dilatada de su trayectoria profesional, así como sus interesantes aportaciones al mundo científico, una persona que contribuyó a la consolidación definitiva de la especialidad en el ámbito geográfico valenciano, desde principios de la segunda mitad del siglo XX (AU)

[Urologic work and biography of Prof. Rafael Alcalá Santaella (1896-1959). Historical document analysis]. / Obra urológica y biografía del Profesor Rafael Alcalá Santaella (1896-1959). Análisis documental histórico.

OBJECTIVES: We find that Urology at the end of the 20th century was a consolidated speciality as a result of years of evolution and development, and the studies and works of authors whose contributions are considered today the basements of our speciality. So we think that Urology should be understood with its historical references, because, as Aristotle said "... thinks are better understood when one has got to clearly see how they were formed..." Numerous specialists contributed to this; among them we can cite Prof. Rafael Alcala Santaella, the object of this bibliographic and scientific works compilation paper. METHODS: We reviewed all his scientific works. Original articles have been obtained from Medicina Ibera, Revista Española de Cirugía y Urología, and Cirugía, Urología y Ginecología. His most important urologic work is Clinic Urology (1942), divided in 3 volumes. For his biography we used the biographic and bibliographic historical source of Spanish urology over the 20th-century and direct family members interviews. RESULTS: He analyzed topics as important as voiding disorders and the study of urine pyuria. He gave special importance to the study of prostatic pathology, its diagnosis by means of cystourethrography, and the modification of surgical techniques, as well as the results of urinary diversions performed in his department. CONCLUSIONS: Due to his extensive scientific and technical contributions he is one of the most outstanding figures of Valencia's Urology over the first half of the 20th century, together with Rafael Molla Rodrigo and Nicasio Benlloch Giner.

[Spontaneous recanalization of the vas deferent after vasectomy: report of 2 new cases. Bibliographic review]. / Recanauzación espontánea tras vasectomía: a propósito de 2 nuevos casos. Revisión de la literatura.

OBJECTIVES: Vasectomy is a low morbidity and high efficacy surgical method. A small percentage of cases may have paternity after surgery as a complication. METHODS: We reviewed all patients who underwent vasectomy at our department from 1995 to 1999 (n = 1492), defining technical failure as pregnancy or no disappearance of spermatozoids in the follow-up sperm analysis. RESULTS: We found 2 cases; one of them did not have a negative sperm test after three months, the other one's wife became pregnant after previous azoospermia. Both patients showed granulomas in the pathologic report after a second operation. CONCLUSIONS: Vasectomy is a surgical technique that may have a failure rate close to 2%. Paternity after the operation may appear even after several years. Several authors report the existence of granulomas in those cases in which spontaneous recanalization appears. In our series it was a constant.

Obra urológica y biografía del profesor Rafael Alcalá Santaella (1896-1959). Análisis documental histórico / Urologic work and biography of Prof. Rafael Alcalá Santaell (1896-1959). Historical analysis

OBJETIVO: A principios del siglo XX encontramos la especialidad de Urología consolidada, fruto de años de evolución y desarrollo, y de los estudios y trabajos de autores que contribuyen hoy a ser cimientos de nuestra especialidad. Por ello entendemos que la Urología debe ser entendida con su referencia histórica, ya que como decía Aristóteles "...Las cosas se entienden mejor cuando uno ha logrado ver con claridad como se formaron..." A ello contribuyeron numerosos especialistas, entre los que podemos citar al objeto de nuestro trabajo de recopilación de su biografía y rica obra científica. MÉTODOS: Hemos revisado toda su obra científica.Los artículos originales han sido obtenidos de la Medicina Ibera, Revista Española de Cirugía y Urología, Archivos Españoles de Urología, y Cirugía, Urología y Ginecología. Su obra urológica más importante es Urología Clínica (1942), que divide en tres tomos. Para su biografía hemos utilizado la fuente Historia biográfica y bibliográfica de la Urología Española en el siglo XX y entrevista con familiares directos. RESULTADOS: Analiza temas tan importantes como los trastornos de la evacuación de la orina y el estudio de las orinas piúricas. Concede especial importancia al estudio de la patología prostática, su diagnóstico mediante la uretrocistografía y las modificaciones de las técnicas operatorias, así como los resultados de las derivaciones urinarias practicadas en su servicio. CONCLUSIONES: Constituye junto a Rafael Mollá Rodrigo y Nicasio Benlloch Giner una de las figuras más destacadas de la Urología valenciana de la primera mitad de S. XX por sus extensas aportaciones tanto científicas como técnicas (AU)

[Biography and analysis of the urologic works of Dr. Nicasio Benlloch Giner (1888-1957) (I)]. / Biografía y análisis de la obra urológica del Dr. Nicasio Benlloch Giner (1888-1957) (I).

OBJECTIVES: The practice of Urology in our country has a long tradition, as demonstrated by several treaties of surgery from the Renaissance; it was the end of the XIX century when the scientific basis of the speciality were established separate from Surgery, as some authors demonstrated, with the notorious contribution of Prof. Rafael Mollá Rodrigo. Dr. Nicasio Benlloch Giner (1888-1957) did the same at the beginning of the XX century when he came back from the professional school of George Marion, contributing to the consolidation of this speciality. METHODS: We reconstructed his biography and analyzed all his bibliography, both in regional and national journals. RESULTS: According to Nicasio Benlloch, renal lithiasis and its treatment were under controversy. Renal lithiasis might demand three indications: nephrectomy, pyelolithectomy and nephrolithectomy. In his chapter on intravenous pyelography he describes its absolute and relative indications. In his work about urinary catheterization and endoscopy he describes in detail the exploratory catheterization of urethra, bladder, and ureters, as well as the catheterization for evacuation and dilatation, and the most frequently used instruments. Finally, he talks about the benefits of endoscopic resection for bladder neck diseases and describes a resectoscope. CONCLUSIONS: Dr. Nicasio Benlloch contributes with his works to the consolidation of Urology as a speciality in Valencia, mainly in the field of lithiasis, a topic in which his works were fundamental.

[Biography and analysis of the urologic works of Dr. Nicasio Benlloch Giner (1888-1957) (II)]. / Biografía y análisis de la obra urológica del Dr. Nicasio Benlloch Giner (1888-1957) (II).

OBJECTIVES: The practice of Urology in our country has a long tradition, as demonstrated by several treaties of surgery from the Renaissance; it was the end of the XIX century when the scientific basis of the speciality were established separate from Surgery, as some authors demonstrated, with the notorious contribution of Prof. Rafael Mollá Rodrigo. Dr. Nicasio Benlloch Giner (1888-1957) did the same at the beginning of the XX century when he came back from the professional school of George Marion, contributing to the consolidation of this speciality. METHODS: We reconstructed his biography and analyzed all his bibliography, both in regional and national journals. RESULTS: According to Nicasio Benlloch, renal lithiasis and its treatment were under controversy. Renal lithiasis might demand three indications: nephrectomy, pyelolithectomy and nephrolithectomy. In his chapter on intravenous pyelography he describes its absolute and relative indications. In his work about urinary catheterization and endoscopy he describes in detail the exploratory catheterization of urethra, bladder, and ureters, as well as the catheterization for evacuation and dilatation, and the most frequently used instruments. Finally, he talks about the benefits of endoscopic resection for bladder neck diseases and describes a resectoscope. CONCLUSIONS: Dr. Nicasio Benlloch contributes with his works to the consolidation of Urology as a speciality in Valencia, mainly in the field of lithiasis, a topic in which his works were fundamental.