[Usefulness of renal resistive index in the diagnosis and evolution of the obstructive uropathy. Experimental study]. / Utilidad del indice de resistencia renal en la valoración y evolución de la uropatía obstructiva. Estudio experimental.

OBJECTIVE: The study was focused on determining the effectiveness and reliability of using the renal resistance index as a method of diagnosing and monitoring the evolution of obstructive uropathy treatment. For this purpose, we conducted an experimental study on a homogenous group of animals that all had the same level of obstruction. MATERIAL AND METHODS: 15 healthy female pigs were used. The experiment was divided into three phases: phase I consisted of a study prior to unilateral pyeloureteral junction obstruction, performing retrograde ureteropyelography, renal B-mode ultrasound and duplex-Doppler (of both kidneys) at a level of the arcuate arteries. Then, the obstruction was performed on the animals. Phase II commenced by diagnosing the lesion, 6 weeks after the previous phase, by means of the aforementioned diagnostic methods. Finally, the endourological treatment was completed. Animals were monitored (Phase III) 15 weeks after the endopyelotomy, using the same methods as in the study, by assessing the urinary tract (fluoroscopy) and both kidneys by determining the renal resistance index and ratio. RESULTS: All the animals in the study showed signs of urinary obstruction on radiology and renal ultrasound 6 weeks after ureteral ligature. After treatment and follow-up, all animals showed signs of having recovered from the obstructive uropathy. Values of deltaRI during the 3 phases are detailed below. Fase I deltaIR = 0.01, Fase II deltaIR = 0.11, Fase III deltaIR = 0.02. CONCLUSION: RI determination using duplex-Doppler is effective for distinguishing obstructive dilatation using non-invasive techniques. However, this parameter provides very slight differences and it can also be influenced by too many direct and indirect factors (observational, patient age, anaesthesia, haemodynamic parameters, etc.), to supplant the classic diagnostic methods.

Utilidad del índice de resistencia renal en la valoración y evolución de la uropatía obstructiva. Estudio experimental / Usefulness of renal resistive index in the diagnosis and evolution of the obstructive uropathy. Experimental study

Objetivo: El planteamiento del estudio va enfocado a determinar la efectividad y fiabilidad de la medición del índice de resistencia renal (IR) para el diagnóstico y evolución tras el tratamiento de la uropatía obstructiva. Para ello realizamos un estudio experimental con un grupo homogéneo y con un grado de obstrucción uniforme. Material y métodos: Se emplean 15 animales de la especie porcina, todas hembras sanas. El planteamiento experimental está vertebrado en tres fases; la primera consiste en el estudio previo a la obstrucción de la unión pieloureteral unilateral mediante ureteropielografía retrógrada, nefrosonografía en modo B y dúplex-Doppler (ambos riñones) al nivel de las arterias arciformes. Posteriormente se procede a la creación del modelo animal de obstrucción. La Fase II comienza con el diagnóstico de la lesión 6 semanas después de la anterior fase, mediante los medios diagnósticos citados. Finalmente se completa el tratamiento endourológico. El seguimiento de los animales (Fase III) se realiza transcurridas 15 semanas tras la endopielotomía, valorando al igual que durante el estudio, la vía urinaria (fluoroscopia) y la afectación en ambos riñones mediante la determinación del índice de resistencia renal y su ratio. Resultados: Todos los animales del estudio mostraron signos radiológicos y nefrosonográficos de obstrucción urinaria tras 6 semanas de la ligadura ureteral. Tras el tratamiento y seguimiento todos los animales mostraron signos de recuperación de la uropatía obstructiva. Los valores del DeltaIR a lo largo de las 3 fases se detallan a continuación. Fase I DeltaIR = 0.01, Fase II DeltaIR = 0.11, Fase III DeltaIR = 0.02. Conclusiones: La valoración del IR mediante dúplex-Doppler es efectiva para la diferenciación de la dilatación obstructiva mediante técnicas no invasivas. Pero este parámetro aporta unas diferencias muy leves y además puede verse afectado por demasiados factores de modo directo o indirecto (observador, edad del paciente, anestesia, parámetros hemodinámicos, etc.), como para relegar los métodos de diagnóstico clásicos

Objective: The study was focused on determining the effectiveness and reliability of using the renal resistance index as a method of diagnosing and monitoring the evolution of obstructive uropathy treatment. For this purpose, we conducted an experimental study on a homogenous group of animals that all had the same level of obstruction. Material and methods: 15 healthy female pigs were used. The experiment was divided into three phases: phase I consisted of a study prior to unilateral pyeloureteral junction obstruction, performing retrograde ureteropyelography, renal Bmode ultrasound and duplex-Doppler (of both kidneys) at a level of the arcuate arteries. Then, the obstruction was performed on the animals. Phase II commenced by diagnosing the lesion, 6 weeks after the previous phase, by means of the aforementioned diagnostic methods. Finally, the endourological treatment was completed. Animals were monitored (Phase III) 15 weeks after the endopyelotomy, using the same methods as in the study, by assessing the urinary tract (fluoroscopy) and both kidneys by determining the renal resistance index and ratio. Results: All the animals in the study showed signs of urinary obstruction on radiology and renal ultrasound 6 weeks after ureteral ligature. After treatment and follow-up, all animals showed signs of having recovered from the obstructive uropathy. Values of DeltaRI during the 3 phases are detailed below. Fase I DeltaIR = 0.01, Fase II DeltaIR = 0.11, Fase III DeltaIR = 0.02. Conclusion: RI determination using duplex-Doppler is effective for distinguishing obstructive dilatation using non-invasive techniques. However, this parameter provides very slight differences and it can also be influenced by too many direct and indirect factors (observational, patient age, anaesthesia, haemodynamic parameters, etc.), to supplant the classic diagnostic methods

[Endourologic treatment of ureteral strictures. Experimental comparative study]. / Tratamiento endourológico de estenosis ureterales. Estudio experimental comparativo.

OBJECTIVES: To compare efficacy and efficiency of two different endourological therapies for ureteral stricture, and to evaluate pathological reactions of the ureters following both endourological techniques. MATERIAL AND METHODS: Ten pigs underwent experimental induction of ureteral stricture. Four weeks later, ureteral strictures were demonstrated by imaging techniques. Animals were divided in two groups, according to the received therapy: -Group I. (5 pigs), endoballoon rupture endoureterotomy. -Group II (5 pigs), Acucise balloon endoureterotomy. Ureteral stents were placed for 3 weeks following endoureterotomy. Animals were followed up four weeks after ureteral stents retrieval. RESULTS: In all cases, ureteral stricture was proved four weeks after model induction. In one case from each group, it was needed a second balloon dilatation to achieve complete endoureterotomy. Leading to ureteral restenosis, stent migration occurred in one animal from group I. Success was achieved in 80% of cases from group I, and 100% of cases from group II. CONCLUSIONS: Our results suggest that both endourological therapies are effective. Nevertheless, a higher efficiency was proved with Acucise endoureterotomy. Our pathological evidences do not support Davis's studies on ureteral healing following endoureterotomy.

Tratamiento endourológico de estenosis ureterales. Estudio experimental comparativo / Endourologic treatment of ureteral strictures. Experimental comparative study

Objetivo: Los objetivos de este estudio son la comparación de la eficacia y la eficiencia entre dos técnicas endourológicas para el tratamiento de estenosis ureterales en modelo animal, así como la valoración histológica de la cicatrización ureteral. Material y métodos: Se emplearon 10 animales de la sp. porcina. A los que se les sometió a un modelo experimental de estenosis ureteral. Transcurridas 4 semanas se realiza el diagnóstico de la obstrucción urinaria. Dividimos a los animales en 2 grupos:-Grupo I. (5 animales), endoureterotomía con balón hasta la ruptura ureteral.-Grupo II (5 animales), tratamiento mediante Acucise®. Se disponen catéteres doble pigtail durante 3 semanas. Realizándose el seguimiento a las 4 semanas de la extracción de los mismos. Resultados: Todos los animales del estudio mostraron signos de obstrucción urinaria tras 4 semanas de la ligadura ureteral. De los 10 animales, uno de cada grupo necesitó una segunda aplicación de la técnica en la misma sesión. Encontramos en el Grupo I, la migración en sentido vesical de un catéter ureteral que provoca la restenosis. Tras la valoración de los resultados determinamos que el porcentaje de éxito es de un 80% en el grupo I y de un 100% en el II. Conclusiones: A la vista de los resultados obtenidos en nuestro estudio las dos técnicas se muestran efectivas, aunque el Acucise® se mostró más eficiente. No encontramos evidencias histológicas que avalen los estudios de cicatrización de Davis tras la endoureterotomía (AU)

Objectives: to compare efficacy and efficiency of two different endourological therapies for ureteral stricture, and to evaluate pathological reactions of the ureters following both endourological techniques. Material and methods: Ten pigs underwent experimental induction of ureteral stricture. Four weeks later, ureteralstrictures were demonstrated by imaging techniques. Animals were divided in two groups, according to the received therapy:-Group I. (5 pigs), endoballoon rupture endoureterotomy.-Group II (5 pigs), Acucise® balloon endoureterotomy. Ureteral stents were placed for 3 weeks following endoureterotomy. Animals were followed up four weeks after ureteral stents retrieval. Results. In all cases, ureteral stricture was proved four weeks after model induction. In one case from each group, itwas needed a second balloon dilatation to achieve complete endoureterotomy. Leading to ureteral restenosis, stent migration occurred in one animal from group I. Success was achieved in 80% of cases from group I, and 100% of cases from group II. Conclusions. Our results suggest that both endourological therapies are effective. Nevertheless, a higher efficiency was proved with Acucise® endoureterotomy. Our pathological evidences do not support Davis’s studies on ureteral healing following endoureterotomy (AU)

[Tumor recurrence in the resected area of the ureteral meatus after endoscopic disinsertion during radical nephroureterectomy]. / Recidiva tumoral en la zona de resección del meato ureteral tras desinserción endoscópica en la nefroureterectomía radical.

The endoscopical resection of the urether in the radical nephroureterectomy is an easy way to treat transitional cell carcinoma of the upper urinary tract. We want to present a complication derived from this surgical technique: the tumor implantation in the resected ureteral meatus zone.

Recidiva tumoral en la zona de resección del meato ureteral tras desinfección endoscópica en la nefrourectomía / Tumor implantation in resecated uretheral meatus zone after endoscopic resection of the urether in radical nephroureterectomy

La resección endoscópica del uréter en la nefroureterectomía radical es una forma sencilla en el tratamiento del carcinoma de células transicionales del tracto urinario superior. Queremos presentar una complicación derivada de la técnica quirúrgica: la recidiva tumoral en la zona de resección del meato ureteral (AU)

The endoscopical resection of the urether in the radical nephroureterectomy is an easy way for the treatment of the transicional cell carcinoma of the upper urinary tract. We want to present a complication derivated of this chirurgical technique: the tumor implantation in the resecated ureteral meatus zone (AU)

[Laparoscopic diagnosis of Hodgkin's disease. Report of a case]. / Diagnóstico mediante laparoscopia de enfermedad de Hodgkin. A propósito de un caso.

Laparoscopic Surgery with diagnosis objectives in Urology, has many others indications related with different medical specialties, apart from the ones for the urologic area (ectopic test, linfadenectomy, etc...). In our case, the Services of Urology and Hematology, diagnosed a Hodgkin's disease case. The Service of Hematology realized treatment and evolution. Sometimes, the unspecific clinical presentations of the Hodgkin's disease, shows adenopatics masses, detected by Ecografy or TAC. Treatment and prognosis of the Hodgkin's disease, are related with the histological subtype and its spreading.

[Endoscopic ureteral resection in radical nephroureterectomy: report of our experience]. / Desinserción ureteral endoscópica en la nefroureterectomía radical: presentación de nuestra experiencia.

We want to present our clinic and chirurgical experience in eight patients, using the radical nephroureterectomy with endoscopical resection of the ureter, as a safe and valid technique, in urothelial tumours localized in the upper urinary tract.

Diagnóstico mediante laparoscopia de enfermedad de hodgkin. A propósito de un caso / Laparoscopic diagnosis of Hodgkin disease. A clinical report

La práctica de cirugía laparoscópica con fines diagnósticos en Urología, aparte de las consabidas indicaciones (búsqueda de teste ectópico, linfadenectomía, etc.), tiene otra serie de indicaciones diagnosticas en conjunción con otras especialidades médicas. En el caso que presentamos, los Servicios de Urología y de Hematología llevan a cabo la diagnosis en un paciente de Enfermedad de Hodgkin, con el posterior tratamiento y seguimiento por parte de este último Servicio. La Enfermedad de Hodgkin, con una presentación clínica inespecífica, debuta en diversas ocasiones con la aparición de conglomerados adenopáticos detectados mediante la Ecografía o el TAC.El tratamiento y el pronóstico de la enfermedad vienen determinados por el subtipo histológico y por la extensión del proceso (AU)

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[Urethral amyloidosis]. / Amiloidosis localizada de la uretra.

Localized amyloidosis of the urethra is a rare pathological entity. Biopsy is required to make the appropriate diagnosis. Although localized therapy is available for obstructing, symptomatic lesions, asymptomatic lesions may be followed with conservative management and spontaneous regression has been reported. An appropriate medical evaluation should be performed to determine the presence of systemic amyloidosis.

Desinserción ureteral endoscópica en la nefroureterectomía radical: presentación de nuestra experiencia / Endoscopical ureteral resection in radical nefrouterectomy: presentation of our experience

Queremos presentar nuestra experiencia clínica y quirúrgica en ocho pacientes, utilizando la nefroureterectomía radical con desinserción endoscópica del uréter, como una técnica válida y segura en tumores uroteliales del tracto urinario superior (AU)

Amiloidosis localizada de la uretra / Amyloidosis localized at the uretra

La amiloidosis localizada de la uretra es una rara entidad patológica. La biopsia es necesaria para realizar un diagnóstico correcto. Aunque el tratamiento local puede ser necesario en caso de obstrucción y lesiones sintomáticas, las lesiones asintomáticas pueden ser seguidas con tratamiento conservador, pues se ha descrito la regresión espontánea. Siendo necesaria una evaluación médica general para descartar la presencia de amiloidosis sistémica (AU)

[Urethral nephrogenic adenoma in a young male. Report of a case]. / Adenoma nefrogénico uretral en varón joven. Aportación de un caso.

Nephrogenic adenoma is a rare urothelial neoformation. It is well known the association to infective diseases and stones; the most common localization is in the bladder. We report the case of a young male without previous disease who showed a nephrogenic adenoma in the urethra, it was managed with transurethral resection and surveillance.

Adenoma nefrogénico uretral en varón joven. Aportación de un caso / Urethral nephrogenic adenoma in young male. Case report

El adenoma nefrogénico es una extraña neoformación de origen urotelial. Se conoce su asociación con procesos infectivos y litiásicos; es común su localización vesical. Comunicamos el caso de un varón joven sin ningún antecedente, que presentó un adenoma nefrogénico a nivel uretral. Fue tratado con resección de la lesión y vigilancia (AU)

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[The early diagnosis of prostate cancer in a selected population. The usefulness of PSAD, PSAD ad. and age-adjusted PSA in patients with a PSA between 4-10 ngr./ml]. / Diagnóstico precoz del cáncer de próstata en población seleccionada. Utilidad del PSAD, PSAD ad. Y PSA ajustado a la edad en pacientes con PSA entre 4-10 ngr./ml.

RATIONALE: Exposition of our experience in the early diagnosis of prostate cancer, based on the initial selection of patients. METHODS: Evaluation of patients from within the area covered by our hospital and seen for signs and symptoms of prostatism. Those with suspicion rectal examination (RE) or PSA greater than 4 ng/ml were further evaluated with transrectal ultrasound and prostate biopsy. RESULTS: Based on the biopsies of 700 patients, prostate carcinoma was diagnosed in 294/700 (42%). 55.72% patients with suspicion RE, and 47.5% with PSA > 4 had cancer. In patients with PSA > 4 and non-suspicion RE, cancer was detected in 16.44%. The percentage of neoplasia in patients with PSA 4-10 ng/ml and non-suspicion RE was 10%. As a result of these findings, 88 radical prostatectomies were performed. PASD and PASD ad. showed significant differences between patients with and without cancer, whether with (+)RE (p = 0.0001) or (-)RE (p < 0.0004), unlike PSA that showed no differences. The diagnostic value shown by PSAD ad. in ROC curves was similar to that of PSAD. Value of age-adjusted PSA was not higher than PSAD. CONCLUSION: Performance of prostate biopsy with a suspicion RE is recommended. If RE shows no suspicion, biopsy should be performed when PSA is > 10 ng/ml, and with PSA 4-10 ng/ml a biopsy is advocated with PSAD > 0.15.

[Value and sequence of the biopsy of the seminal vesicles and laparoscopic pelvic lymphadenectomy in the staging of cancer of the prostate]. / Valor y secuencia de la biopsia de vesículas seminales y la linfadenectomía pelviana laparoscopica en el estadiaje del cáncer de próstata.

OBJECTIVE: To establish the current indication in our milieu of seminal vesicles (s.v.) biopsy and laparoscopic pelvic lymphadenectomy in prostate cancer. MATERIAL AND METHODS: The prospective study of s.v. biopsy includes 128 patients. Overall efficacy of the technical procedure, incidence of seminal infiltration in relation to clinical staging, PSA, Gleason or the association of both are all analyzed. The second part of the project involves a retrospective statistical study applied to the lymphadenectomy series over a period of 10 years on 202 cases (69 laparoscopic and 133 open ceiling), analyzing several risk factors for nodular invasion. RESULTS: Seminal and nodular infiltration was related to clinical stage, PSA and Gleason. PSA > 20 and Gleason > or = 7 is clinically the most useful association for the diagnosis of seminal infiltration. Increased PSA and Gleason involved greater nodular infiltration; the optimal cut-off point is 40 and 7 respectively. CONCLUSIONS: S.V. biopsy should be performed in T3 stage or in earlier stages with PSA greater or equal to 20 and/or Gleason greater or equal to 7. If biopsy is tumour negative, laparoscopic lymphadenectomy should be performed at T3 stage (regardless of PSA or Gleason), and in < T3 with PSA greater or equal to 40, Gleason greater or equal to 8 and when Gleason is 7 and PSA > 20.

[Quality of life after radical prostatectomy]. / Calidad de vida tras prostatectomía radical.

OBJECTIVE: To evaluate the quality of life of our prostatectomized patients relative to the following factors: continence, mictional quality, sexual potency and psychological repercussion. MATERIAL AND METHODS: The study includes a series of 204 patients undergoing radical prostatectomy between June 1986 and October 1996, where a personal questionnaire was administered to 112 of them. The questionnaire consisted of 25 questions dealing with various aspects related to their quality of life. RESULTS: The overall rating on continence shows the following results: total continence 59.8%, minimal incontinence grade I 17.8%, moderate incontinence grade II 13.3% and total incontinence grade III 8%. Only 2.6% retains sexual potency after surgery. 29.3% of impotent patients consulted for their dysfunction. 91% declared to be satisfied with the results of the surgical procedure. CONCLUSIONS: In our experience, continence (total + grade I incontinence) is acceptable for 77.6%, the level of mictional satisfaction being very high. There is a high index of impotence after surgery. However, most patients appear to be impervious to this fact. Overall, quality of life of our patients has not changed significantly as a result of the intervention.

[Endoscopic internal urethrotomy guided with transrectal echography]. / Uretrotomía interna endoscópica dirigida por ecografía transrectal.

Internal urethrotomy is the endoscopic technique most commonly performed in order to resolve urethral stenosis. This paper describes a new technique which associates transrectal ultrasound to internal endoscopic urethrotomy for the resolution of unsurmountable stenosis of the urethra. Presentation of 6 cases, with a 100% success rate. The authors believe that the association of transrectal ultrasound with internal endoscopic urethrotomy is a simple technique, and very useful for the resolution of unsurmountable stenosis of the urethra.