[Vesicoureteral reflux in adults]. / Reflujo vesicoureteral en el adulto.

Primary vesicoureteral reflux is defined as the dysfunction of the vesicoureteral junction in the absence of any other bladder pathology. Most works in the literature focus on pediatric vesicoureteral reflux, paying little attention to reflux in adults. There is not much knowledge about the real incidence of this pathology in adults and there are few published papers about what are the situations in which we should suspect, perform a diagnostic work up and treat reflux in adult patients. It is article we perform a bibliographic review on topics as important as epidemiology, diagnosis and treatment of reflux in adults. The objective of this article is to transmit what are the clinical manifestations in front of which we should look for adult reflux and when to treat when it is diagnosed.

Reflujo vesicoureteral en el adulto / Vesicoureteral reflux in adults

El reflujo vesicoureteral primario se define como la disfunción de la unión vesicoureteral en ausencia de otra patología vesical subyacente. La mayoría de la literatura aborda el reflujo vesicoureteral en la infancia, prestando poca atención al reflujo del adulto. Poco se sabe sobre la incidencia real de esta patología en adultos y poco se ha publicado sobre en que situaciones debemos sospechar, buscar y tratar un reflujo en adultos. En este capítulo se ha hecho una revisión de la literatura sobre cuestiones tan importantes como la epidemiología, diagnóstico y tratamiento del reflujo en adultos. El objetivo de este artículo es trasmitir ante que manifestaciones clínicas debemos buscar un reflujo del adulto y si este es diagnosticada cuando debe ser tratado (AU)

Primary vesicoureteral reflux is defined as the dysfunction of the vesicoureteral junction in the absence of any other bladder pathology. Most works in the literature focus on pediatric vesicoureteral reflux, paying little attention to reflux in adults. There is not much knowledge about the real incidence of this pathology in adults and there are few published papers about what are the situations in which we should suspect, perform a diagnostic work up and treat reflux in adult patients. It is article we perform a bibliographic review on topics as important as epidemiology, diagnosis and treatment of reflux in adults. The objective of this article is to transmit what are the clinical manifestations in front of which we should look for adult reflux and when to treat when it is diagnosed (AU)

[Infertility and varicocele through history]. / La infertilidad y el varicocele a través de la historia.

OBJECTIVES: To perform a historical review of varicocele and male infertility with the aim to find descriptions that first related them. In parallel, we review the evolution of treatment for varicocele up to date. METHODS/RESULTS: We refer to multiple authors and their treaties on Medicine, from first to 20th Century, in which descriptions of these pathologies are found, focusing on descriptions of the surgical technique for treatment of varicocele and their application in Spain. CONCLUSIONS: Varicocele was already described in treaties from the first century having bee of n its treatment predominantly surgical from the first description to our days. Not identified as a cause of infertility until late, by the end of the 19th century, it is the main indication for treatment nowadays. The surgical technique has suffered many modifications over time, both in the approach as in the "radicality" of a vascular ligature applied.

[Extrarenal retroperitoneal angiomyolipoma: bibliography review and report of a new case]. / Angiomiolipoma pararrenal: "revisión de la bibliografía" y presentación de un nuevo caso.

OBJECTIVES: To report the 7th case of pararenal angiomyolipoma published in the world literature and to review the international bibliography. METHODS: We report the case of a 46-year-old female with history of renal colic and a complex mass on radiological tests. RESULTS/CONCLUSIONS: Extrarenal retroperitoneal angiomyolipoma is a rare pathology with no more than 7 published cases. The diagnostic difficulty and radiological similarities with liposarcoma make surgery the treatment of choice.

[AMS-800 artificial sphincter. Our experience in the last 20 years]. / Esfinter artificial AMS-800. Nuestra experiencia en los últimos 20 años.

OBJECTIVE: To present a series of 63 patients with urinary incontinence due to sphincteric incompetence who underwent the implantation of an AMS-800 artificial sphincter. METHODS: From 1984 to December 2002 a total of 69 patients received this prosthesis, 63 of which were available for review. The cause of incontinence was sphincter incompetence in all cases, said secondary to prostate surgery, neurogenic bladder, post-traumatic urethral lesion, and epispadias. 52 of them were placed in the bulbar urethra, and 11 in the bladder neck. The cuff diameters varied from 4 to 10 cm and reservoir pressures from 51-60 to 71-18 H2O cm. RESULTS: The complications that appeared, ordered by frequency, were: malfunction, infection and rejection or exteriorization, fistula, and unappropriate size. The total number of reoperations was 39 in 28 patients. Functional results were successful in 48 cases and failure in 15. CONCLUSIONS: The use of an AMS-800 prosthesis for the treatment of urinary incontinence due to sphincteric incompetence is effective but not without complications. The most frequent indication was following prostate surgery, being this group the one that obtains the best results. Patients with incontinence of neurogenic origin have the highest complication rate, and the worst results in relation to vascularization and tissue trophism abnormalities. In female patients we prefer other techniques that have similar results, are technically easier and more economic.

Esfínter artificial AMS-800. Nuestra experiencia en los últimos 20 años / AMS-800 artificial sphincter. Our experience over the last 20 years

OBJETIVO: Presentar una serie de 63 pacientes con incontinencia urinaria por incompetencia esfinteriana que han sido tratados mediante la implantación del esfínter artificial AMS-800. MÉTODOS: Desde 1984 hasta diciembre del año 2002 se ha implantado esta prótesis a un total de 69 pacientes de los cuales se ha podido revisar a 63. La causa de la incontinencia siempre ha sido incompetencia esfinteriana secundaria a cirugía prostática, vejiga neurógena, lesión uretral postraumática y epispadias. De ellos 52 se han colocado en uretra bulbar y 11 en cuello, los tamaños del manguito han variado entre 4 y 10 centímetros y las presiones del reservorio de 51-60 a 71-80 centímetros de agua. RESULTADOS: Las complicaciones detectadas fueron por orden de frecuencia: mal funcionamiento, infección y rechazo o exteriorización, fístula y tamaño no adecuado. El número total de reintervenciones fue de 39, en 28 pacientes. El resultado funcional fue de éxito en 48 y fracaso en 15. CONCLUSÌÓN: El uso de la prótesis AMS-800 para el tratamiento de la incontinencia por incompetencia esfinteriana es eficaz pero no exento de complicaciones. La indicación más frecuente es tras cirugía prostática, siendo en este grupo donde se obtienen los mejores resultados. En pacientes con incontinencia de origen neurógeno la tasa de complicaciones es mayor y los resultados peores dadas las alteraciones de la vascularización y trofismo tisular. En mujeres preferimos la utilización de otras técnicas con las que se obtienen resultados similares, técnicamente más sencillas y más económicas (AU)