[Percutaneous kidney lithotripsy. Clinical course, indications, and current methodology in our Lithotripsy Unit]. / Litotricia renal percutánea. Evolución, indicaciones y metodología actual en nuestra Unidad de Litotricia.

OBJECTIVE: To review the history, development, indications and current methods of percutaneous renal lithotripsy. METHODS: The history and development of PNL is briefly reviewed. Its indications are analyzed, starting with large calculi and covering all the indications over the last 15 years of development of this technique and its current use. The PNL technique currently performed in our Lithotripsy Unit is described step by step. Technical details, equipment, instruments, complications and solutions are discussed. RESULTS/CONCLUSIONS: In our view, PNL continues to be the technique of choice for most of the calculi that are more than 2 cm in size. It is fundamental for the new generation of urologists to be familiar with all endourologic techniques since current technological advancements will allow us to perform procedures throughout the urinary tract using endoscopic methods.

[Surgical treatment of hypospadias. Our experience and follow up in 1993-1998]. / Tratamiento quirúrgico del hipospadias. Nuestra experiencia y seguimiento durante el período 1993-1998.

OBJECTIVE: To review our series of hypospadias. The incidence of the different types of hypospadias and the complication rates according to the different surgical techniques and materials utilized are analyzed. METHODS: We reviewed our series of 130 patients with hypospadias who underwent surgical correction at the Department of Pediatric Urology from 1993-1998. RESULTS: The patients presented the following types of hypospadias: glandular (13 cases), balano-preputial (56), distal penile (42), mid-penile (9), proximal penile (2) and penoscrotal hypospadias (8). The surgical techniques utilized were the Mickulitz meatotomy procedure (6 cases), MAGPI (24), Mathieu (77), Crawford (5), onlay (7), Duckett (3), Retik (4), Duplay (1), Denis-Brown (2) and penoscrotal transposition (1). The complications commonly observed were fistula (20 cases), hematoma (4), stricture of urethral meatus (4), infection (3), megaurethra (3), skin necrosis (1). CONCLUSIONS: Surgical repair of this developmental anomaly is performed when the patient is approximately 18 months old. In our series 15% of the patients developed fistula, which is similar to the complication rate reported in the literature. However, since we started using monofilament resorbable material, the incidence of fistula has dropped from 20% to approximately 5%. Although other factors are involved, the lower incidence of fistula formation may be largely due to a reduced tissue reaction to foreign body.

[Renal hematomas after extracorporeal lithotripsy with the lithotriptor "lithostar multiline de Siemens"]. / Hematomas renales tras litotricia extracorpórea con el litotriptor "lithostar multiline de siemens".

OBJECTIVE: Renal haematomas after extracorporeal shockwave lithotrity are an immediate and potentially serious complication. The incidence of post-ESWL renal haematoma with the new Siemens' Lithostar Multiline lithotripter is analyzed in an attempt to know its occurrence, predisposing factors and presentations signs and symptoms. MATERIAL AND METHODS: Between January and December 1998, a total of 1313 extracorporeal shockwave lithotrity sessions were performed on lithiasis located at any level of the urinary tract in 686 patients. Treatment were performed with a Lithostar Multiline lithotripter (electromagnetic generator). The power used ranged from 4 to 9 units, which are power steps based on load tension in Kv, pressure peaks in bars and energy flow density in mJ/mm2, with an average of 3800 pulses/session. A radiological study (ultrasound-tomography) was conducted when faced with clinical suspicion of complications. RESULTS: A total of 7 clinical renal haematomas (1.02%) were diagnosed. A conservative attitude was taken in most cases. One patient presented hemodynamic instability and required surgery to empty the haematoma and haemostasia of the renal unit, though no nephrectomy was finally required. As predisposing factors: presence of HBP, prior ESWL and hypercholesterolemia are all emphasized. In rare cases several factors concurred simultaneously in the same patient. CONCLUSIONS: Renal haematoma should be suspected in the presence of continuous or unjustified pain after ESWL treatment. Any likely coagulation disorder should be corrected, urinary infections ruled out and pressure figures controlled.

Hematomas renales tras litotricia extracorpórea con el litotriptor "lithostar multiline de siemens" / Renal haematoma after extracorporeal lithotrity using the siemens "lithostar multiline" lithotripter

OBJETIVO: Los hematomas renales tras litotricia extracorpórea por ondas de choque representan una complicación inmediata y potencialmente grave. Analizamos los casos de hematoma renal post-SWL con el nuevo litotriptor Lithosthar Multiline de Siemens, intentando conocer la incidencia, los factores predisponentes y la clínica de presentación. MATERIAL Y MÉTODOS: Entre Enero y Diciembre de 1998 se han realizado un total de 1.313 sesiones de litotricia extracorpórea por ondas de choque, sobre litiasis alojadas a cualquier nivel del tracto urinario en 686 pacientes. Los tratamientos fueron realizados con el litotriptor Lithostar Multiline (Generador Electromagnético). La potencia aplicada osciló entre 4-9 unidades, que son etapas de energía en base a tensión de carga en Kv, picos de presión en bares y densidad de flujo energético en mJ/mm2, con una media de 3.800 impulsos/sesión. Ante la sospecha clínica de complicaciones se realizó estudio radiológico (ecografía-tomografía). RESULTADOS: Se diagnosticaron un total de 7 hematomas renales clínicos (1,02 por ciento). En la mayoría de los casos se tomó una actitud conservadora. En un caso debido a la inestabilidad hemodinámica que presentó el paciente fue preciso intervención quirúrgica, evacuando el hematoma y realizando hemostasia de la unidad renal sin que fuera preciso realizar nefrectomía. Como factores predisponentes destacamos la presencia de HTA, ESWL previa e hipercolesterolemia, confluyendo en ocasiones varios factores en un mismo paciente. CONCLUSIONES: Debemos sospechar la presencia de un hematoma renal ante un dolor continuado o no justificado tras el tratamiento con ESWL. Es preciso corregir los posibles trastornos de la coagulación, descartar infección urinaria y control de las cifras tensionales (AU)

[Renal carcinoma and von Hippel-Lindau disease]. / Carcinoma renal y enfermedad de Von Hippel Lindau.

Von Hippel Lindau disease is a highly uncommon autosomic dominant condition characterised by the presence of cerebellar hemangioblastomas, retina angioma, pancreas, kidney and epididymal cysts, and renal cells carcinoma. This article describes the case report of a male patient with Von Hippel Lindau disease which presented as a jaundice secondary to biliary obstruction due to pancreatic cystic mass. After urological examination, bilateral cystic lesions and right renal solid lesion were detected requiring surgical treatment. A review is made of the diagnostic and therapeutic aspects, highlighting the significance of early diagnosis and treatment.

[Skin metastasis as first manifestation of prostatic adenocarcinoma]. / Metástasis cutáneas como primera manifestación de un adenocarcinoma prostático.

Incidence of prostate disease has seen a sudden boost over the last few years as a result of an increase in male life expectancy. Prostate carcinoma is the third most common cause of cancer mortality in Spain. Post-mortem studies reveal that this is the most prevalent neoplasia in the elderly. 30% of all males over 50 years could host malignant cells in their prostate, although only 20% of these neoplasias have clinical manifestations. Prostate carcinoma expansion occurs by local spreading, as well as lymph and blood dissemination. Local spreading to the urethra, bladder neck, trigonous and seminal vesicles is frequent. Lymph dissemination to obturating, hypogastric, iliac, presacral and paraaortic nodes is a major path for metastasis. Bone metastasis with increased acid phosphatase is the most illustrative sign of prostate adenocarcinoma expansion. Visceral metastasis occur more frequently in lungs, liver and renal glands. There is a 0.3% likelihood of skin metastasis from prostate adenocarcinoma. Considering the rareness of skin metastasis from prostate adenocarcinoma, the case reported in the present paper, first evidence of a prostate carcinoma, is even more exceptional.

[Advanced tubercular disease of urogenital tract]. / Enfermedad tuberculosa avanzada del tracto urogenital.

OBJECTIVE: The genitourinary tract is one of the most common sites of extrapulmonary tuberculosis (30%-33%), followed by the lymphatic tissue, skeletal system and gut. Due to the diagnostic methods and therapeutic modalities currently available, it is infrequent to find advanced tuberculosis with extensive genitourinary involvement. METHODS/RESULTS: Herein we describe a patient with advanced genitourinary tuberculosis characterized by loss of right renal unit, left hydronephrosis due to ureterovesical junction stricture, contracted bladder, prostatic caseation and urethral stricture. Right nephrectomy and bladder substitution ileocystoplasty were performed. The clinical features, diagnostic and therapeutic aspects are discussed and the literature briefly reviewed. CONCLUSION: Extensive genitourinary tuberculosis is uncommon. The importance of early diagnosis and treatment is emphasized in order to avoid the irreversible sequelae.

[Mixed urogenital schistosomiasis]. / Esquistosomiasis genitourinaria mixta.

Urinary schistosomiasis is a parasitosis caused by Schistosoma Haematobium which affect in a diffuse manner all the genitourinary tract. Presentation of 5 patients (4 male, 1 female) with mixed Bilharziosis that was detected after the study of a young male that came to the clinic with a complaint of haematuria and who underwent transurethral resection under the suspicion of a vesical urothelial neoformation. Sch. Hameatobium eggs were detected in the urine and Sch. Mansoni in the semen of all 4 male. All of them evolved favourably with Praziquantel. Considering the rarity of schistosomiasis in our environment and its increased incidence in endemic areas, this process should be included in the algorithm of differential diagnosis in young patients reporting dysuric syndromes associated to haematuria; the relevance of an epidemiological anamnesis so as to institute early treatment and avoid the consequences of chronic infection is pointed out.

[Ureteral obstruction secondary to inflammatory iliac aneurysm]. / Obstrucción ureteral secundaria a aneurisma ilíaco inflamatorio.

Inflammatory iliac aneurysms are uncommon and account for 1-2% of total abdominal aneurysms. These aneurysms are more susceptible to present urological symptoms and are difficult to diagnose because of their uncommon incidence and location in the deep pelvis which makes them little accessible to physical examination. This case report presents one patient with right obstructive uropathy secondary to extrinsic ureteral trapping due to inflammatory iliac aneurysm which evolved favourably after ureterolysis, endoaneurysmectomy and interposition of aortoiliac graft. A brief review of diagnostic and therapeutic aspects in the literature is included. The relevance of a high degree of suspicion to diagnose this entity in patients with otherwise explainable vesical irritative symptoms, haematuria or renal failure is highlighted.

[Primary prostatic infiltration by Burkitt's lymphoma]. / Infiltración prostática primaria por linfoma de Burkitt.

OBJECTIVE: Genitourinary tract involvement arising from non-Hodgkin lymphoma occurs in 10% of patients; prostatic infiltration is uncommon and accounts for less than 0.1%. The uncommon clinical onset of this infrequent condition prompted us to report on the present case. METHODS/RESULTS: A 41-year-old male patient with lower urinary tract outflow obstruction arising from prostatic enlargement secondary to non-Hodgkin lymphoma (Burkitt's lymphoma) is described. Treatment with chemotherapy achieved good results. The clinical features, diagnostic and therapeutic aspects are discussed and the literature briefly reviewed. CONCLUSION: The present case emphasizes the need to include non-Hodgkin lymphoma in the differential diagnosis of lower urinary tract outflow obstructive symptoms in young men with prostatic enlargement.

[Usefulness of magnetic resonance angiography in the diagnosis of polar vessel in stenosis of the pyeloureteral junction]. / Utilidad de la angioresonancia magnética en el diagnóstico del vaso polar en la estenosis de la unión pieloureteral.

OBJECTIVES: To present the results of a prospective study that had been conducted to determine the accuracy of magnetic resonance angiography (MRA) in the detection of accessory or polar vessels associated with ureteropelvic junction (UPJ) stricture, in order to utilize the most appropriate surgical procedure in the management of this condition. METHODS: From October, 1994 to September, 1996, 30 MRA procedures were done in 12 males and 18 females, aged 14 to 73 years (mean 38.12), with symptomatic UPJ obstruction. When the MRA was positive for polar vessels, the patients underwent open dismembered pyeloplasty; surgical correlation and a true positive result could be established. Percutaneous endopyelotomy was offered when the MRA was negative. The findings at open surgery and an unremarkable clinical course and radiological findings at one year follow-up established a true negative result. RESULTS: Accessory or polar vessels (11 arteries; 4 veins) were found in 11 patients (36.4%). MRA had a sensitivity of 92.3% (15/16) for detection of accessory vessels. Fourteen patients underwent open surgery (11 dismembered pyeloplasties; 3 nephrectomies) and the MRA findings were confirmed in each case (8 positive; 6 negative). Surgery disclosed an accessory vein that had not been detected on MRA in only one patient. This patient also had a polar artery that had been observed on MRA and demonstrated at surgery; thus, the sensitivity of MRA for detection of UPJ stenosis with polar vessel is 100% (11/11). Each vessel described on MRA was confirmed at surgery; there were therefore no false positives and the specificity was 100%. CONCLUSIONS: Although this is a preliminary study with a short follow-up and with some limitations, the results indicate that MRA is a simple, non-invasive technique with a high sensitivity and specificity for detection of polar vessels associated with UPJ stenosis, and appears to be a useful preoperative diagnostic procedure due to the surgical implications.

[Multiple giant ureteral lithiasis]. / Litiasis ureteral gigante múltiple.

OBJECTIVES: Ureteral calculi are usually small and arise from the kidney. The term 'giant' has been applied to ureteral stones that are more than 5 cms in length and/or 50 gms or more in weight. The low incidence of this condition prompted us to report this case. METHODS/RESULTS: Herein we describe a patient with multiple giant ureteral calculi with no evidence of underlying ureteral lesion, who required nephroureterectomy due to the damage caused to the renal unit by the obstructive uropathy. The literature is briefly reviewed, with special reference to the diagnostic and therapeutic aspects. CONCLUSIONS: Giant ureteral calculi are uncommon. They may cause scanty urological symptoms and might therefore be missed. If undiagnosed, renal function may be compromised by the obstructive uropathy.

[Inappropriate antidiuretic hormone secretion syndrome: a rare manifestation of prostatic adenocarcinoma]. / Síndrome de secreción inadecuada de hormona antidiurética: una rara manifestación de adenocarcinoma prostático.

OBJECTIVE: Prostatic cancer can produce signs and symptoms by local growth, direct invasion or distant metastases. In rare occasions, these tumors can show a clinical variance due to trophic factors, biologically active, secreted in neoplastic environment but with systemic relevance. These syndromes are called paraneoplastic syndromes. This uncommon condition is described herein. METHOD/RESULTS: We report a case of inappropriate antidiuretic hormone secretion as the presenting feature of advanced prostatic carcinoma. The pathogenic features, diagnostic and therapeutic aspects are reviewed. CONCLUSIONS: Although its frequency is low, we must consider prostatic carcinoma in patients with inappropriate antidiuretic hormone secretion syndrome. When the acute situation is resolved, hormonal treatment in disseminated carcinomas will return to normal the clinical and analytical parameters derived from this syndrome.

[Synchronous manifestation of bladder inverted papilloma and transitional carcinoma of the renal pelvis]. / Presentación sincrónica de papiloma invertido vesical y carcinoma transicional de pelvis renal.

OBJECTIVE: To review briefly the histological and biological aspects of inverted papilloma and to determine whether it is a benign tumor or low-grade malignant lesion. METHOD/RESULTS: We report a patient with synchronous presentation of bladder inverted papilloma and renal pelvis transitional cell carcinoma. After endoscopic resection of the bladder tumor and left ureteral meatus, a radical nephroureterectomy was carried out with success. The clinical features, diagnostic and therapeutic aspects are briefly reviewed. CONCLUSIONS: Inverted papilloma accounts for 2.2% of all urothelial tumors; the bladder is most commonly involved. It is frequently a single lesion with endophytic growth pattern. The clinical significance remains a controversy. Most investigators consider them as benign neoplastic tumors, although in one third of the patients it may be associated with synchronous urothelial carcinomas, implying a malignant condition. Therapeutic management and follow-up are emphasized.

[Cryptorchidism and testicular cancer]. / Criptorquidia y cáncer testicular.

OBJECTIVE: This report underscores the higher risk of testicular cancer in cryptorchidism. METHODS/RESULTS: A patient undergoing evaluation for sterility, who was submitted to orchidopexy 15 years earlier for cryptorchidism, developed a seminoma-like tumor one year following a testicular biopsy that was compatible with testicular atrophy, but with no signs of dysplasia. The literature on the epidemiology, pathogenesis, diagnosis, and treatment is briefly reviewed. CONCLUSIONS: Cryptorchidism is the single factor that carries a higher risk of testicular cancer. This condition has been reported to have 3.5 to 5 times greater risk of progressing to malignancy compared to normal descended testes. Although orchiopexy does not prevent the risk of malignancy, it permits earlier detection. The need to follow these patients closely is underscored.

[Renal hydatidosis: importance of preoperative diagnosis]. / Hidatidosis renal: importancia del diagnóstico preoperatorio.

OBJECTIVE: We report on a patient who underwent a right nephrectomy for a mass suggesting hypernephroma, which was shown to be renal hydatid disease on pathological examination. METHODS/RESULTS: The epidemiological, diagnostic and therapeutic aspects described in the literature are briefly reviewed. CONCLUSIONS: Although uncommon, renal cystic lesions should be suspected in the presence of a renal mass and a differential diagnosis should be made. CT is the most useful diagnostic imaging technique. The importance of preoperative diagnosis for the surgical strategy is underscored.

[Ectopic ureter in prostatic urethra. Unusual discovery in an adult]. / Uréter ectópico en uretra prostática. Descubrimiento inusual en adulto.

OBJECTIVE: Ectopic ureter is a congenital anomaly more frequent in the female, in the pediatric age and is commonly left-sided. The present article reports an uncommon case without the common features of this anomaly. METHODS/RESULTS: We report on a 67-year-old man with complete duplex system and ectopic obstructive megaureter in the prostatic urethra with a silent onset. The diagnostic and therapeutic aspects in the literature are briefly discussed. CONCLUSION: Because this anomaly is asymptomatic and incidentally discovered because of contralateral disease, the approach is conservative.

["Sand-clock" lithiasis on prostatic transurethral resection bed]. / Litiasis en "reloj de arena" sobre celda de resección transuretral prostática.

OBJECTIVES: Although uncommon, prostatic surgical bed lithiasis may present among post-TURP complications. The present study underscores the importance of diagnosis and treatment. METHODS/RESULTS: We report on a patient with magnesium ammonium phosphate hourglass lithiasis in the prostatic surgical bed one year and a half following transurethral resection due to adenomyomatous prostatic hyperplasia that was successfully treated by intracorporeal lithotripsy with the Lithoclast. The physiopathological, clinical, diagnostic and therapeutic aspects are discussed. CONCLUSIONS: This condition should be suspected in patients with dysuric syndrome post-TURP. The importance of simple complementary diagnostic procedures as DRE and plain abdominal films in discarding lithiasis in underscored. We consider retrograde endoscopic manipulation and ultrasonic lithotripsy or penumatic lithotripsy with the Lithoclast to be the safest procedures for this type of lithiasis.

[Metachronous metastasis in ureteral stump secondary to ipsilateral renal adenocarcinoma]. / Metástasis metacrónica en muñón ureteral secundaria a adenocarcinoma renal ipsilateral.

OBJECTIVES: Ureteral metastasis from renal adenocarcinoma is uncommon. The rarity of this disease prompted us to report on the present case, with special reference to diagnosis. METHODS/RESULTS: A patient with metachronous metastasis in the ureteral stump from clear cell renal adenocarcinoma resected three years earlier is described. The etiopathogenic, clinical, diagnostic and therapeutic aspects are briefly reviewed. CONCLUSIONS: Ureteral metastases, although uncommon, are generally ipsilateral to the renal tumor and arise from aggressive renal carcinomas that are locally advanced with vascular and/or lymphatic spread. We underscore the importance of retrograde pyelography and ureterorenoscopy in the diagnostic workup of all patients with gross hematuria following nephrectomy due to hypernephroma.

[Late metastasis in thyroid gland after nephrectomy for renal clear cell carcinoma]. / Metástasis tardía en glándula tiroidea tras nefrectomia por carcinoma renal de células claras.

Renal carcinoma natural history is unpredictable. Spontaneous metastases regression after nephrectomy, as well as late recurrence are suggestive of this peculiar human neoplasm. tumor metastases localized to thyroid gland are uncommon in clinical practice; and carcinoma of the kidney, breast, lung, melanoma and gastrointestinal tract tumors are responsible for the majority of them. This paper reports on a patient with metachronous thyroid gland metastases after fourteen years of renal carcinoma nephrectomy, with one year after hemithyroidectomy recurrence on cervical striated muscle followed by surgical excision. Therapeutical aspects are briefly reviewed in literature, emphasizing surgical treatment and the need of all-life follow-up, with more alert attitude toward thyroid gland after renal cell carcinoma nephrectomy.