[Priapism as an initial presentation of chronic myeloid leukaemia]. / Priapismo como presentación inicial de leucemia mieloide crónica.

We report the case of a 29 years old patient who presented, in the last three moths, four episodes of priapism without any other symptoms and any previous traumatism. An hemogram reveled that the repeted episodes of priapism were caused by a chronic myeloid leukaemia.

Priapismo como presentación inicial de leucemia mieloide crónica / Priapism as an inicial presentation of chronic myeloid leukaemia

Se presenta el caso de un paciente de 29 años de edad que presentó cuatro episodios de priapismo en los últimos tres meses, sin asociarse a ningún otro síntoma y sin traumatismo previo. Tras la realización de un hemograma se demuestra que la aparición de estos repetidos episodios de priapismo se debe una leucemia mieloide crónica (AU)

We report the case of a 29 years old patient who presented, in the last three moths, four episodes of priapism without any other symptoms and any previous traumatism. An hemogram reveled that the repeted episodes of priapism were caused by a chronic myeloid leukaemia (AU)

[Cervico-urethro-suspension by the Raz's technique in the treatment of stress urinary incontinence in women]. / Cervicouretrosuspensión según técnica de Raz en el tratamiento de la incontinencia urinaria de esfuerzo en la mujer.

Presentation of our results in the treatment of urinary exertional incontinence in women using Raz's cervicourethral suspension. From January 1991 through December 1995, 87 patients were operated (mean age: 55.64 years; range 36-74). Mean follow-up was 29.4 months. Recovery from incontinence or permanence of minimal occasional leaks due to major exertion were rated as good results and were achieved in 75 cases (86.20%). Percentage of success in patients with mild incontinence was 93.33%; 88.88% in moderate incontinence; and 58.33% in severe incontinence, differences being statistically significant (p < 0.01). No statistical significance was found relative to age, prior incontinence corrective surgery, hysterectomy or association with urgency incontinence. Prior to surgery, 21 patients also had a component of urgency incontinence which disappeared post-surgery in 18 (85.71%) cases. De novo urgency incontinence appeared in 4 (6.06%) cases. Complications seen were 3 vesical perforations (3.44%). 1 urethrovaginal perforation (1.15%), 2 enterocele (3.44%) and 24 patients with transient urinary retention (27.58%). We believe this technique offers long-term successful results with a moderate morbidity rate.

[Analysis of a series of radical prostatectomies]. / Análisis de una serie de prostatectomías radicales.

OBJECTIVE: Radical prostatectomy (RP) is an elective therapeutical procedure for localized prostate cancer. The paper describes the critical analysis of our 10-year series. MATERIAL AND METHODS: A total of 216 RP have been performed between June 1986 and December 1996 (60 of them in the last year); with the purpose of securing a minimum follow-up of 4 months, the 204 procedures performed up to October 1996 were studied. Mean age was 64.9 years and PSA median 10.8 ng/ml. Intraglandular clinical stage was found in 192 cases versus 12 cases extraglandular. Up to the end of 1993 Walsh's technique with erectors' preservation was being used although the poor results obtained with regard to potency as well as the existence of positive borders have compelled us to perform the standard extracapsular technique since beginning of 1994. RESULTS: Mean follow-up in our series has been 29.62 months. Post-operative complications reached 29.9%, anastomosis fistula (21 cases) among the early ones and anastomosis stenosis (16 cases) among the late ones. 82.04% patients have total continence or minimal incontinence, the percentage of obstruction being 3.58%. Total impotence is estimated at 92.77%. One patient (0.49%) died in the immediate post-operative. Understaging was observed in 36.7%. 84 patients had extracapsular disease. Our percentage of positive surgical borders is of around 43.13%. Progression has been seen in 47 of 204 patients (23.03%): 8 local relapses, 12 metastasis, 3 with both conditions and 24 biological progression. Progression has been related to pathological stage, pre-operative PSA and Gleason's sum of the specimen. Difference was statistically significant. Overall survival at 1 and 5 years is 99.2% and 95.5% respectively while tumour specific survival is 97.8% and 75.8% at 1 and 5 years. CONCLUSIONS: RP is a surgery with minimal mortality but noticeable morbidity (incontinence 14.35%; impotence 92.77%; other complications from surgical technique 29.9%). Our clinical understaging is of around 36.7%. Progression is related to the specimen's pathological stage, and pre-operative PSA and Gleason. Our overall survival at 1 and 5 years is 99.2% and 95.5% respectively while tumour specific survival is 97.8% and 75.8%.

[Urodynamic basis and findings in detubularised intestine neobladders: bladder substitutions and continent urinary reservoirs]. / Fundamentos y hallazgos urodinámicos en las neovejigas de intestino destubulizado: sustituciones vesicales y reservorios urinarios continentes.

Construction of a neobladder utilizing intestine is currently considered to be the ideal option for the cystectomized patient. We reviewed the history as well as the physical and urodynamic principles of the substitution neobladders and continent reservoirs. In our series of patients who underwent cystectomy from January 1988 to December 1991, we have performed bladder substitution using detubularized ileum in 37 patients (18 Camey II and 16 Hautmann) and 13 patients had a continent reservoir (Mainz pouch). Patient ages ranged from 33 to 72 years (mean 60.4). The functional behaviour of the intestinal neobladders was analyzed clinically, radiologically and urodynamically. Eleven of the 18 patients with a Camey II (61.8%) and 3 of the 16 with a Hautmann (18.7%) neobladder were incontinent during the night, the difference being statistically significant (p < 0.05). Incontinence correlated manometrically with high pressure peaks in the Camey II neobladders and waves with a lower intensity were recorded in the Hautmann neobladders. Flowmetry revealed a normal peak flow in all but one Camey II that required internal urethrotomy due to urethroileal stenosis. The maximum capacity was 215-500 cc for the Camey II (mean 340 cc), 310-850 cc for the Hautmann (mean 590 cc) and 350-925 cc (mean 675) for the Mainz pouch. Intermittent catheterization was required in 3 of the Camey II and 1 of the Hautmann neobladder with important postmicturition residual urine. The patients who received the Mainz pouch had good continence, with pressure recordings less than 55 cm H2O), which is lower than the continent closing pressure. Only one case was incontinent due to failure of the intussusception mechanism. The good functional results achieved with the Hautmann procedure are underscored. The pressure recordings and the incidence of night incontinence for the foregoing procedure were lower than the Camey II. For the unviable urethra, the Mainz pouch achieves moderate pressures and is socially acceptable.

[Diagnostic and therapeutic management of testicular tumors. Review of 15 years]. / Manejo diagnóstico y terapéutico de los tumores testiculares. Revisión de quince años.

We reviewed our data on the diagnosis and treatment of testicular tumors during the period spanning January, 1975 to December, 1989 and compared them with the data reported in the literature. The records of 26 cases of germ cell tumors were analyzed. These had a follow-up ranging from 6 to 162 months (mean 36 months). We highlight the usefulness of CT and tumor markers in the diagnosis, staging and follow-up. We consider radical inguinal orchiectomy to be the initial treatment. The therapeutic approach thereafter depends on the histological findings and tumor stage. Currently, patients are followed very carefully after orchiectomy of stage I tumors. Multiple chemotherapy of tumors in the advanced stages has increased the incidence of survival and complete remission. Furthermore, this chemotherapeutic approach has occasionally converted surgery into and adjuvant treatment modality.

[Diagnostic and therapeutic aspects in Klinefelter's syndrome. Our experience]. / Aspectos diagnósticos y terapéuticos en el síndrome de Klinefelter. Nuestra experiencia.

We present a retrospective study of 30 new cases of Klinefelter's syndrome and set forth our customary diagnostic and therapeutic schedule. We analyse the results obtained and single out the fact that 100% of the patients displayed high gonadotropins and 45% apparent plasmatic testosterone normality at the time of diagnosis. There is a relationship between lower semen fructose concentration, smaller volume of semen and higher degree of hypoandrogenism in Klinefelter's syndrome. Long duration hormonal treatment with testosterone esters is effective in improving the physical psychic and sexual state of patients. The interval between the last administration and the control hormone determination should be uniform for correct result evaluation.

[Treatment of reno-ureteral calculi using ESWL and endourologic technics]. / Tratamiento de los cálculos renoureterales mediante ESWL y técnicas endourológicas.

In recent years, there has been a complete change in the treatment of reno-ureteral lithiasis due to the availability of new endourological techniques (percutaneous nephrolithotomy, ureteroscopy) and particularly due to the development of extracorporeal shock wave lithotripsy (ESWL). The present study assessed the combination of endourological procedures and ESWL in the treatment of calculi localized in the kidney and lumbar ureter. A prospective study was undertaken to assess 1,500 renal units with calculi in the renal cavity and lumbar ureter that had been submitted to treatment by ESWL and endourological techniques. The results demonstrate that ESWL combined with percutaneous and endoscopic techniques affords effective treatment without major complications in 85.4% of calculi in the renal cavity and lumbar ureter. Treatment with ESWL as monotherapy was successful in 45.6% of the cases and endourological management prior to ESWL was successful in 39.8% of the cases. The most common complication of ESWL was colic and/or kidney referred discomfort (28.6%) and the most important complication was urinary tract obstruction following ESWL (9.67%). These required maneuvers to remove post-ESWL obstruction in 6.1% of the renal units treated. The number of shock waves employed and the kV utilized were associated to intense hematuria and perirenal hematoma. The combination of endourological techniques with extracorporeal shock wave lithotripsy completely eliminated calculi in 80.5% of the renal units at 3 months. 10.5% had remaining stone fragments that could be spontaneously passed, and 7.6% had larger residual fragments that could not be passed.

[Radical prostatectomy in cancer of the prostate. Preliminary adjuvant therapy and previous considerations]. / Prostatectomía radical en el cáncer de próstata. Tratamiento adyuvante previo y consideraciones previas.

We report our early results in the treatment of nonmetastatic prostate cancer (stages A, B, C) by radical surgery. All but two patients classified as stage A1 received adjuvant treatment with hormone blockade using LH-RH analogues and an antiandrogen for a period of two to six months. A favorable local response was observed in almost all patients. Adjuvant therapy achieved reduction of prostate size and most of the cases could be staged down from the initial clinical staging to fall within the indication of radical surgery, including stage C2 tumors reclassified as local tumor stage C1 or lower. Staging lymphadenectomy prior to radical prostatectomy revealed multiple lymph node involvement in 3 patients who were consequently not submitted to radical surgery. In the remaining 14 cases, definitive postsurgical staging revealed minimum invasion of the capsule without seminal vesicle involvement (stage C1) in only two cases with A2 and B2 tumor in the initial staging. There were no operative deaths and morbidity was scant. Some modifications aimed at enhancing exposure of the surgical field and thereby reducing complications are described. Although a longer patient follow-up is warranted, to date all patients are alive and no local recurrence or distant metastases have been observed.