Ultrastructural study of the kidney subjected to warm ischemia and perfused with inosine.

OBJECTIVES: Renal ischemia, depending on its duration, results in organ function loss to a greater or lesser extent, due to the depletion of the energy cells need for their vital functions. The method of supplying an external energy source that may act as a precursor of ATP, such as inosine, has proved to be protective from a functional point of view. In this work, we aim to reveal the histological ultrastructural bases that underlie this protective effect. METHODS: We studied two groups of rats subjecting the kidneys to different durations of warm ischemia, and compared the histological findings at various parts of the nephron after perfusion with saline or inosine. These findings were compared, in turn, with the normal morphology of a third control group. RESULTS: The histological findings were: 1. No significant lesions after 60 and 120 min of warm ischemia in animals perfused with inosine; and 2. Glomerular and tubular injury after 60 min of warm ischemia in animals perfused with saline. CONCLUSIONS: The saline-perfused animals showed very significant injury at the glomerular and tubular levels after 60 and 120 min of warm ischemia. These lesions were not seen in animals perfused with inosine. The similarity of the morphological findings between the inosine-infused group and the control group suggests that inosine has a protective effect on the morphology of the rat nephron under conditions of warm ischemia for periods shorter than 120 min.

Estudio ultraestructural del riñón sometido a isquemia normotérmica y perfundido con inosina / Ultrastructural study of the kidney subjected to warm ischemia and perfused with inosine

OBJETIVO: La isquemia renal da lugar a la pérdida de función del órgano, en mayor o menor medida, dependiendo del tiempo de la misma como consecuencia del agotamiento de las reservas energéticas que la célula utiliza para sus funciones vitales. El aporte externo de una fuente de energía en forma de un precursor de ATP, como es la INOSINA, ha demostrado ser un método protector desde el punto de vista funcional. Pretendemos en éste trabajo poner de manifiesto las bases histológicas ultraestructurales en las que se basa dicho efecto protector. MÉTODO: Se estudian básicamente dos grupos de ratas y se comparan los hallazgos histològicos de las distintas partes de la nefrona después de perfundirlos con suero fisiológico ó inosina y someter los riñones a distintos tiempos de isquemia normotérmica. Dichos hallazgos se comparan a su vez con la morfología normal de un tercer grupo testigo. RESULTADOS: Los hallazgos histológicos se concretan en: 1- Ausencia de lesiones significativas en los animales perfundidos con inosina a los 60 y 120 min. de isquemia normotérmica. 2- Lesiones glomerulares y tubulares a partir de los 60 min de isquemia normotérmica en los animales perfundidos con suero fisiológico. CONCLUSIONES: Los animales perfundidos con suero fisiológico mostraron lesiones muy importantes a nivel glomerular y tubular a los 60 y 120 min de isquemia normotérmica. Dichas lesiones no se aprecian en los animales perfundidos con inosina. La similitud de los hallazgos morfológicos del grupo perfundido con inosina y el grupo testigo, permite atribuir a la inosina un efecto protector de la morfología de la nefrona de rata bajo condiciones de isquemia normotérmica en periodos inferiores a 120 min (AU)

OBJECTIVES: Renal ischemia, depending on its duration, results in organ function loss to a greater or lesser extent, due to the depletion of the energy cells need for their vital functions. The method of supplying an external energy source that may act as a precursor of ATP, such as inosine, has proved to be protective from a functional point of view. In this work, we aim to reveal the histological ultrastructural bases that underlie this protective effect. METHODS: We studied two groups of rats subjecting the kidneys to different durations of warm ischemia, and compared the histological findings at various parts of the nephron after perfusion with saline or inosine. These findings were compared, in turn, with the normal morphology of a third control group. RESULTS: The histological findings were: 1 ) No significant lesions after 60 and 120 min of warm ischemia in animals perfused with inosine; and 2) Glomerular and tubular injury after 60 min of warm ischemia in animals perfused with saline. CONCLUSIONS: The saline-perfused animals showed very significant injury at the glomerular and tubular levels after 60 and 120 min of warm ischemia. These lesions were not seen in animals perfused with inosine. The similarity of the morphological findings between the inosine-infused group and the control group suggests that inosine has a protective effect on the morphology of the rat nephron under conditions of warm ischemia for periods shorter than 120 min (AU)

Uretroplastias con cirugía en dos tiempos y uretrostomias perineales / Two-stage urethroplasties and perineal urethrostomy

OBJETIVO: Las estenosis de uretra bulbar complejas, así como las de uretra peneana largas, son muy problemáticas de resolver. No estan claras las técnicas quirúrgicas que se deben aplicar en estos casos.Los objetivos fueron definir si las uretroplastias en dos tiempos y la uretrostomia perineal definitiva son técnicas válidas para resolver estos casos en la actualidad y aclarar cual es el grado de aceptación de la uretrostomía perineal por parte de los pacientes.MÉTODO: Se revisan 167 casos de estenosis uretral, de los que 73 corresponden a estenosis largas peneanas, bulbopeneanas, múltiples o panuretrales.Se analizan los procedimientos quirúrgicos llevados a cabo en estos 73 casos que consistieron esencialmente en uretrostomía perineal definitiva o cirugía en dos tiempos con implante de injerto cutaneo en el primero.Se evalúa el buen o mal resultado en función de la calidad miccional medida por el grado de satisfacción, y por la uretrocistografía.RESULTADOS: Lejos de ser unas técnicas obsoletas, se pone de manifiesto, por una parte, la idoneidad de ambas técnicas en la actualidad, con buenos resultados entre el 96´1% en las estenosis de uretra peneana, y el 71´4% en las estenosis panuretrales, y por otra, la oportunidad de la derivación perineal definitiva que eligieron voluntariamente el 55% de los pacientes a los que se les había programado un segundo tiempo.Se constatan las complicaciones más frecuentes en este tipo de cirugía, como son la necrosis del injerto y la retracción del meato perineal.Se admite la escasa representatividad del nº de casos estudiados, para sacar conclusiones estadísticas, pero se justifica por la infrecuencia de los mismos y la necesidad de aportar experiencia(AU)

CONCLUSIONES: La cirugía de la estenosis uretral en dos tiempos y la uretrostomía perineal definitiva, son técnicas muy aceptables en determinados casos complejos.En la cirugia en dos tiempos de la estenosis uretral, los injertos a nivel de uretra peneana tienen mejores resultados y son más fáciles de implantar que los de uretra bulbopeneana. Las uretrostomias perineales definitivas son bien aceptadas por los pacientes(AU)

OBJECTIVES: Complex stenoses of the bulbar urethra and long stenoses of the penile urethra are very difficult to solve. Which surgical techniques must be applied in these cases is not clear.The objectives of this work were to define whether two-stage urethroplasties and definitive perineal urethrostomies are currently valid techniques for these cases and to clarify to what extent patients accept perineal urethrostomy.METHOD: 167 cases of urethral stenosis are reviewed: 73 of them correspond to long penile, both bulbar and penile, multiple or panurethral stenosis.The surgical procedures carried out in these 73 cases, essentially definitive perineal urethrostomy or two-stage surgery with a cutaneous graft implant, are analyzed.The results are evaluated as positive or negative according to the quality of voiding measured by the degree of satisfaction and urethrocystogram.RESULTS: Far from being obsolete, these techniques are shown on the one hand to be ideal nowadays, with good results between 96.1% in penile urethra stenosis and 71.4% in panurethral stenosis, and, on the other to be an opportunity for a definitive perineal derivation chosen voluntarily by 55% of patients who were programmed for a second stage.The most frequently-occurring complications in this type of surgery, like graft necrosis and retraction of the perineal meatus, are confirmed.We recognize the number of cases studied is limited to make representative statistical conclusions, but the work is justified by their infrequency and the need to contribute with our experience.CONCLUSIONS: Two-stage urethral stenosis surgery and definitive perineal urethrostomy are highly acceptable techniques in certain complex cases.In two-stage urethral stenosis the grafts at the level of penile urethra produce better results and are easier to implant than bulbar-penile urethra grafts. Patients accept definitive perineal urethrostomies well(AU)

[Single center experience with Siemens Lithostar Modularis for treatment of 1500 solitiary urinary stones]. / Resultado del tratamiento con Lithostar Modularis de Siemens de 1500 pacientes con litiasis unica.

OBJECTIVES: the aim of the study was to evaluate the results of extracorporeal shock wave lithotripsy (ESWL) treatment with Siemens Lithostar Modularis in urinary stones. PATIENTS AND METHODS: from May 2000 until September 2006, 1500 patients, 62% men and 38% women, ages 15 to 89 years (mean age 53), underwent ESWL as treatment of urinary stones at the Lithotripsy Unit of León. Data were analized retrospectively. More than half (56%) had left urinary stones. The most frequent ureteral localization (55%) was proximal (420 patients), and the most frecuent renal was renal pelvis (345 patients). The mean stone diameter was 1.3 cm. (1.01 ureteral and 1.7 renal). All patients received ESWL-session under i.v. analgesia with alfentanil and midazolam. RESULTS: Mean number of sessions per lithiasis was 1.5 (ureteral stones 1.4 and renal stones 1.7). The retreatment rate was 33%, 28% for ureteral stones and 39% for renal stones with a cumulative success of 86% with two sessions. 22% of the patients required auxiliary manouvers, 24% of the patients with ureteral stones and 18% of the renal stones patients. Stone free rate was 91%, 97% in ureteral stones and 82% in renal stones. CONCLUSIONS: treatment of urinary stones with Siemens Lithostar Modularis showed good results, with a stone free patient rate of more than 90%, although 33% of the patients need multiple ESWL treatment sessions and 20% of the patient required auxiliary procedures.

Resultado del tratamiento con Lithostar Modularis de Siemens de 1500 pacientes con litiasis única / Single center experience with Siemens Lithostar Modularis 1500 solitary urinary stones

Objetivos: Valoración de la eficacia de la litotricia extracorpórea en litiasis urinaria con el litotritor Lithostar Modularis de Siemens. Pacientes y Métodos: de junio del 2000 a Septiembre de 2006 se trataron 1.500 pacientes, 62% varones y 38%mujeres, con edades comprendidas entre 15 y 89 años, media 53 años, en la Unidad de Litotricia de León. Los datos se analizaron de forma retrospectiva. En el 56 % de los enfermos la localización de la litiasis fue izquierda. En el uréter, el 55% de las litiasis, la localización más frecuente fue proximal (420 pacientes) y la localización más frecuente renal fue en la pelvis (345 pacientes). El tamaño medio de las litiasis fue de 1,3 cm (1,01 cm en urétery 1,7 cm renal). Todos los pacientes se trataron con sedación con alfentanil y midazolan. Resultados: La media de sesiones por litiasis fue de 1,5 (1,4 en las ureterales y 1,7 en las renales) La tasa de retratamiento fue de 33% (28% en el caso de las litiasis ureterales y 39% en las renales. La eficacia acumulada tras 2 sesiones fue de 86%. El 22% precisó maniobras auxiliares (el 24% de las ureterales y el 18% de las renales).El porcentaje de pacientes libre de litiasis fue del 91% (97 % en el caso de las ureterales y el 82% en el caso de las renales).Conclusiones: El tratamiento de las litiasis urinarias mediante litotricia con el Lithostar Modularis de Siemens muestra unos buenos resultados, con más de un 90% de los pacientes libres de litiasis, aunque con un 33% de retratamientos y más de un 20% de los pacientes precisan maniobras auxiliares (AU)

Objectives: the aim of the study was to evaluate the results of extracorporeal shock wave lithotripsy (ESWL) treatment with Siemens Lithostar Modularis in urinary stones. Patients and Methods: from may 2000 until September 2006, 1500 patients, 62% men and 38% women, ages 15 to 89 years (mean age 53), underwent ESWL as treatment of urinary stones at the Lithotripsy Unit of León. Data were analized retrospectively. More than half (56%) had left urinary stones. The most frequent ureteral localization (55%) was proximal (420 patients), and the most frecuent renal was renal pelvis (345 patients). The meanstone diameter was 1.3 cm. (1.01 ureteral and 1.7 renal). All patients received ESWL-session under i.v. analgesia with alfentanil and midazolam. Results: Mean number of sessions per lithiasis was 1.5 (ureteral stones 1.4 and renal stones 1.7). The retreatment rate was 33%, 28% for ureteral stones and 39 % for renal stones with a cumulative success of 86% with two sessions. 22% of the patients required auxiliary man ouvers, 24% of the patients with ureteral stones and 18% of the renal stones patients. Stone free rate was 91%, 97% in ureteral stones and 82% in renal stones. Conclusions: treatment of urinary stones with Siemens Lithostar Modularis showed good results, with a stone free patient rate of more than 90%, although 33% of the patients need multiple ESWL treatment sessions and 20%of the patient required auxiliary procedures (AU)

[Bladder endometriosis. Diagnostic and treatment]. / Endometriosis vesical. Diagnóstico y tratamiento.

Endometriosis is a common gynecologic disease in which endometrial tissue is deposited outside the normal confines of the uterine cavity. Rarely endometriosis involves urinary tract. The bladder is the most frequent organ affected into this tract. A delay in detection can result in months or years of morbidity.

Endometriosis vesical. Diagnóstico y tratamiento / Bladder endometriosis. Diagnostic and treatment

La endometriosis es una enfermedad ginecológica muy frecuente en la que el tejido endometrial aparece fuera de la cavidad uterina. En raras ocasiones la endometriosis afecta al tracto urinario, siendo la vejiga el órgano más frecuentemente afectado. Un retraso en su detección puede condenar a la paciente a meses de morbilidad innecesaria (AU)

[Laparoscopy as essential method in the diagnosis of nonpalpable testis]. / La laparoscopia como método imprescindible en el diagnóstico del testículo no palpable.

OBJECTIVE: To analyze the utility of laparoscopic evaluation in the diagnosis of the nonpalpable testis versus conventional imaging techniques based on our experience with 51 cases and data reported in the literature. METHODS/RESULTS: Testicular tumors were found in both intra-abdominal testes in one patient, as well as 7 cases of evanescent testis and 39 testicular rests in the inguinal canal. Four other intra-abdominal testes showed no changes. CONCLUSIONS: The possibility of an existing intra-abdominal testis and its possible progression to malignancy warrant exploration of the nonpalpable testis by laparoscopy, a very simple and effective procedure.

[Xanthogranulomatous cystitis: report of a case]. / Cistitis xantogranulomatosa: presentación de un caso.

OBJECTIVE: To report a case of xanthogranulomatous cystitis, a rare disease especially in the western countries (12 of the 16 cases reported were Japanese and Korean). METHODS: A case of xanthogranulomatous cystitis in a 34-year-old female is presented. Patient evaluation included histological, histochemical and immunohistochemical studies. RESULTS/CONCLUSIONS: The lesion was localized to the bladder dome, anatomically related with the urachus. It consisted of collections of histiocytes with lymphoplasmocytic infiltrate. The adhesions observed in the omentum in this case indicate a possible relationship with a previous inflammatory process. Surgery is advocated in most of the cases with good results.

[Analysis of 109 urethroplasties for hypospadias]. / Análisis de 109 uretroplastias por hipospadias.

OBJECTIVE: To review our experience in hypospadias surgery in order to determine the most appropriate technique for each particular case. METHODS: 109 uretroplasty procedures for hypospadias repair in 102 patients that were performed by the same surgeon from 1992-1998 were analyzed. Eighty-five patients were treated for the first time and 17 had previously undergone surgery. The patients were children aged 2-12 years and 4 adults. There were 28 balanic, 45 subcoronal, 10 distal penile, 12 mid penile and 7 penoscrotal hypospadias. Twenty-two cases had an associated ventral penile curvature. The Magpi technique was utilized for the balanic hypospadias, the Mathieu for the subcoronal and distal penile hypospadias without curvature, the Duckett technique was utilized for the middle penile third and some penoscrotal hypospadias, and the two-stage procedure with extragenital free skin graft in some of the cases with penoscrotal hypospadias. RESULTS: The overall complication rate was 6.4%. Good results were achieved in all patients treated with the Magpi technique. Two patients treated with the Mathieu technique developed fistula that was corrected in a second procedure, and one patient developed a stricture at 6 years, which required another reconstruction procedure. Three patients treated with the Duckett technique developed fistula that required another repair procedure. There was one case of stricture along the entire length of the graft in the patients treated with the two-stage procedure and extragenital free skin graft, and satisfactory results were achieved in the remaining patients. CONCLUSIONS: As in any other urethroplasty procedure, hypospadias repair requires a correct choice of technique for each particular case. Success depends on good tissue vascularization, which a surgeon with experience in these techniques can achieve better than one that is less experienced. It is therefore advisable not to overdiversify.

[Current role of percutaneous renal surgery at a service of general urology]. / El papel actual de la cirugía percutánea renal en un Servicio de Urología General.

OBJECTIVE: To evaluate the utility and need for percutaneous surgery in the General Urology Department according to its applicability and efficacy. METHODS: 40 percutaneous surgery procedures were performed over a period of 11 years (average 3.6 procedures/year), which accounts for 0.60% of all surgical procedures performed. These were carried out for pyelic stone (10), caliceal stone (12), pyelic stone in horseshoe kidney (2), pyelic stone + UPJ stricture (4), UPJ stricture (7), UPJ re-stenosis post-pyeloplasty (1), cystectomy (3), diagnostic percutaneous surgery (1). RESULTS: Good results were achieved in 89.2% of the cases with lithiasis and there were 3 failed attempts (10.7%). Cystectomy achieved a 100% success rate; residual cavity persists in all the cases but there has been no recurrence at 5 years. Endopyelotomy was successful in 41.6% of the cases and stricture recurred in 58.3%. Overall, there were 4 complications without major consequences, although the procedure could not be completed in two cases. CONCLUSIONS: Although there is little opportunity to apply the technique, it is currently necessary because it achieves unquestionably good results in specific cases.

[Conservative surgery of renal carcinoma in a case of synchronic bilateral involvement, with large size tumors and different histological type]. / Cirugía conservadora del carcinoma renal en un caso de afectación bilateral sincrónica, con tumoraciones de gran tamaño y extirpe histológica diferente.

OBJECTIVE: To report a case of a large, bilateral, synchronous renal tumor. METHODS/RESULTS: Treatment by conservative surgery achieved good results. The histological analysis showed two different carcinomas. The most most important steps of the surgical procedure are described. Renal preservation in patients with malignant tumors is discussed. CONCLUSIONS: The case described herein is rare since the tumors were synchronous and of uncommon histological type (one of the tumors was a chromophobic carcinoma). Despite the large size of the tumors, they were successfully managed by conservative surgery.

[Analysis of 83 urethroplasties for urethral stenosis]. / Análisis de 83 uretroplastias por estenosis uretral.

OBJECTIVE: To determine the appropriate technique for each case of urethral stricture, according to its length, depth, localization, etiology and age of the patient. METHODS: 83 urethroplasties for urethral stricture performed from 1992-1998 were reviewed. The strictures involved different levels of the urethra. The techniques utilized were analyzed (substitution urethroplasty with pedicle skin graft and free grafts using buccal mucosa and extragenital skin, excision and anastomotic repair, regeneration techniques with internal urethrotomy and placement of intraluminal prosthesis, and two-stage repair procedures). RESULTS: The overall functional results were good in 93% of the cases (78 good, 5 poor), but the morphological results demonstrated by the radiological findings were not as good in 24% of the cases, which corresponded to those that had received preputial pedicle grafts and buccal mucosa free grafts. CONCLUSION: Using the appropriate urethroplasty technique is essential to achieve good functional results. The substitution techniques require well-vascularized grafts and/or recipient sites. The foregoing must be taken into account in the selection of the appropriate graft and deciding on the stricture length and localization.

[Evaluation of megestrol acetate as monotherapy in disseminated prostatic carcinoma]. / Valoración del Megestrol Acetato como monoterapia en el carcinoma prostático diseminado.

OBJECTIVE: To determine the effects of megestrol acetate on testosterone, dehydroepiandrosterone and PSA levels in patients with disseminated prostatic carcinoma. METHODS: 26 patients with disseminated prostatic carcinoma treated with megestrol acetate were followed for 21 months to determine its effects on testosterone, dehydroepiandrosterone and PSA levels. RESULTS/CONCLUSIONS: We observed a testicular and adrenal antiandrogenic effect. Patient clinical course improved when PSA levels dropped, although this improvement was not related with changes in androgen levels.

[Adjuvant therapy with systemic JM-8 (carboplatin) in superficial bladder tumors. Results after 3 years of use]. / Tratamiento adyuvante con JM-8 (carboplatino), por vía sistémica, en los tumores superficiales de vejiga. Resultados después de tres años de utilización.

We evaluated the 3-year efficacy of adjuvant treatment (after complete TUR) with systemic carboplatin in 34 patients with transitional cell bladder tumors in the superficial stages. Twenty-six patients with a one-year follow-up had a recurrence rate of 23%. Twenty-three patients with a two-year follow-up had a recurrence rate of 65.3%. Six patients with a three-year follow-up had a recurrence rate of 83.3%. Seventeen patients with tumor recurrence within three years had "minimal" recurrence. The course of the disease was very stable and remained unchanged in 4 cases that required no other treatment for one year. This treatment modality indicates a therapeutic effect; however, further studies and changes are warranted in order to obtain better results.

[Use of systemic carboplatin in superficial tumors of the bladder. Preliminary phase II study (toxicity)]. / Empleo de carboplatino sistémico en los tumores superficiales de vejiga. Estudio preliminar en fase II (toxicidad).

The high recurrence rate of superficial bladder tumors, its frequent association with premalignant tumors, and its evolution into infiltrating tumors in 15% of the cases justify the use of tumoricidal agents as adjuvant therapy. For the past 20 years, several agents have been used intravesically with limited efficacy (+/- 40% recurrence/year), high local morbidity (cystitis, urethral stenosis), and excessively long duration of treatment (+/- 1 year). The efficacy of CDDP in the treatment of bladder tumors has been reported elsewhere. An objective response of +/- 50% (RC + RP) at a dose of 50-70 mg/m2 has been observed. The new generations of platinum, less toxic and easier to use, have raised hopes vis-à-vis its efficacy in the treatment of this tumor type. To date, we have evaluated 26 patients with superficial tumor of the bladder over a period of one year. These patients had been submitted to a treatment protocol with systemic carboplatinum following complete TUR and assessment of bone marrow; renal function, WHO, audiometry, urinary cytology, determination of tumor cell markers (CEA, çGT). Treatment consisted of 3 cycles of i.v. carboplatinum at a dose of 300 mg/m2 (1/30 days). We have corroborated the following features: ease of use, good patient tolerance and scant toxicity. However, its efficacy has as yet to be determined through the disease-free interval.(ABSTRACT TRUNCATED AT 250 WORDS)