[Epidemiology of urinary lithiasis in our Unit. Clinical course in time and predictive factors]. / Epidemiología de la litiasis urinaria en nuestra Unidad. Evolución en el tiempo y factores predictivos.

OBJECTIVES: To analyze the incidence of lithiasis and stone composition in our setting. The trend is compared with the results of the majority of studies on urinary calculi reported in the literature based on the number and composition of stones. METHODS: The study comprised patients referred to the Urolithiasis Unit of our hospital over the last 21 years. Stone composition was analyzed by infra-red spectroscopy. The study period was divided into 4 time intervals: 1977-1979, 1977-1980, 1977-1987 and 1977-1998 in order to determine the trends of the incidence of lithiasis in our setting. RESULTS: A total of 5516 patients were reviewed; of these, 766 had recurrence. The distribution was 385, 995, 3378 and 5516, respectively. Calcium oxalate calculi showed an incidence of 61.3%, calcium phosphate 18.5%, uric acid 11.2%, infectious calculi (ammonium urate and ammonium magnesium phosphate) 6.6%, and finally the incidence of cysteine calculi was 0.77%. Concerning the distribution according to sex, 62% of the males had calcium oxalate stones, 68% uric acid, 42.5% phosphate and 45% infectious lithiasis. The trends for uric acid, infectious, oxalate and phosphate calculi changed over time. CONCLUSIONS: There is a clear trend of calculi prevalence in the male, particularly oxalate and uric acid calculi. There is a trend for cysteine calculi to remain the same, calcium phosphate and oxalate calculi to increase, and uric and infectious calculi to decrease. The changes observed may be due to dietary changes and improvement in the quality of life.

Epidemiología de la litiasis urinaria en nuestra Unidad. Evolución en el tiempo y factores predictivos / Epidemiology of urinary calculi in our setting: Trends and predictive factors

OBJETIVO: Analizar la incidencia de la litiasis en nuestro medio considerando el número de pacientes así como la composición de sus litiasis, valorando la evolución en el tiempo, en contra de la mayoría de los estudios reflejados en la literatura, referentes a la litiasis urinaria, que se basan en el número y composición de los cálculos.MÉTODO: Para ello hemos considerado los pacientes remitidos a la Unidad de Urolitiasis de nuestro Servicio en los últimos 21 años, analizando la composición litiásica mediante espectroscopia de radiación infrarroja. El periodo estudiado se ha jalonado en cuatro, 1977-79, 197780, 1977-87 y 1977-98, con el objeto de determinar la tendencia evolutiva de la incidencia de la litiasis en nuestro medio.RESULTADOS: El número total de pacientes analizados fue de 5516 de los que 766 eran recidivantes. La distribución por series fue de 385, 995, 3378 y 5516 pacientes respectivamente. La incidencia de litiasis de Oxalato Cálcico fue del 61,3 por ciento; la de Fosfato Cálcico del 18,5 por ciento; la del Acido Úrico del 11,2 por ciento; la de la litiasis infectiva, considerando el Urato Amónico y el Fosfato Amónico Magnésico, fue del 6,6 por ciento; y por último, la incidencia de la Litiasis Cistínica, del 0,77 por ciento. En cuanto a la distribución por sexos hemos observado un 62 por ciento de varones con litiasis oxálica, 68 por ciento con litiasis úrica, 42,5 por ciento con litiasis de fosfato y un 45 por ciento de varones con litiasis infectiva. En el tiempo, hemos visto variación en las litiasis úrica, infectiva, oxálica y fosfática.CONCLUSIÓN: Existe una tendencia general clara de la litiasis hacia el sexo masculino, y en concreto de la litiasis oxálica y úrica. La tendencia evolutiva de la litiasis cistínica es a mantenerse en el tiempo, siendo la del Fosfato Cálcico y, en un futuro, la oxálica ascendentes, y la de la litiasis úrica e infectiva decreciente. Probablemente los cambios en la dieta, desarrollo y mejora de la calidad de vida han influido en los cambios registrados (AU)

[Adenomatoid tumor of testicular tunica albuginea: a case report. Histogenetic and therapeutic considerations]. / Tumor adenomatoide de la albuginea testicular: aportación de un nuevo caso. Consideraciones histogenéticas y terapéuticas.

OBJECTIVE: To describe a rare case of adenomatoid tumor of the testicular tunica albuginea and to discuss the clinical, histogenetic and therapeutic aspects. METHODS/RESULTS: A rare case of adenomatoid tumor of the testicular tunica albuginea is presented. The clinical, histogenetic and therapeutic aspects are discussed. CONCLUSIONS: Adenomatoid tumors of the testicular tunica albuginea are rare and are therefore rarely considered. Although 99% of testicular tumors are malignant, it must be emphasized that there are benign testicular tumors, such as adenomatoid tumor, that initially do not require aggressive surgical treatment but intraoperative biopsy and tumor resection.

[Conservative surgery in metanephric renal adenoma]. / Cirugía conservadora en el adenoma metanéfrico renal.

OBJECTIVE: To confirm that metanephric adenoma is a benign tumor with no potential to malignancy, observing its course 6 years after conservative surgical management. METHODS: A light microscopic, immunohistochemical and electron microscopic study of the surgical specimen were performed and the DNA euploidy and proliferation index were determined. RESULTS: Metanephric adenoma is comprised of tubular epithelial structures of small diameter or with virtual lumen, with or without calcifications, psammoma bodies and bony trabeculae. No cell atypia or mitosis was observed. The immunohistochemical study is useful to discard the unlikely metastatic nature of the tumor. It has a euploid DNA distribution and there is practically no proliferation. Electron microscopy showed a scanty amount of microvilli and abundant material between the tubules that appeared to be similar to that of the basement membrane. CONCLUSIONS: Knowledge about this benign disease entity is emphasized in order to avoid unnecessary radical nephrectomies.

[Is there a role for partial cystectomy in the treatment of infiltrating bladder cancer? (2nd part)]. / Tiene cabida la cistectomía parcial en el tratamiento del cáncer infiltrante de vejiga? (2a parte).

Experimental studies and the clinical course have shown that bladder cancer is confined to the bladder wall for some time, during which optimal treatment by complete surgical excision can be achieved. Failures are most often due to the presence of distant metastasis at the time of surgery and most patients invariably die although local and regional control of the tumor have been achieved. It is difficult to evaluate the benefits that neoadjuvant measures (radio and chemotherapy) contribute to surgery, basically due to the difficulty in classifying the tumor with precision. Preoperative chemotherapy in patients with less than a 40% likelihood of metastasis is unreasonable since 60% will not require it and will be unnecessarily exposed to the side effects of the cytostatic agents, which are not negligible. Furthermore, a considerable number of candidates to partial surgery have no metastasis at the time of diagnosis, therefore preoperative chemotherapy is not useful. It would be more reasonable to give chemotherapy postoperatively to those that are more likely to require it. Radiotherapy will not prevent tumor recurrence and is ineffective in carcinoma in situ. Furthermore, surgery is sufficiently aggressive in regard to the tumor and the possible dissemination to the lymphatics to require adjunctive measures with locoregional effects.

[Definitive endourological treatment in urothelial tumors of the upper urinary tract]. / Tratamiento endourológico con intención resolutiva en tumores uroteliales del tracto urinario superior.

OBJECTIVES: We reviewed our series of upper urinary tract tumors submitted to endoscopic management as definitive treatment. METHODS: The series comprised 18 patients with transitional cell carcinoma of the upper urinary tract; 14 were treated by the percutaneous approach and 4 by ureteroscopy. All of them were single, papillary and low grade tumors. In 17 patients we analyzed the nephrostomy track for local tumoral seeding. RESULTS: The mean follow up was 29 months. Fourteen patients remain free of recurrent disease (5-84 months); 2 patients recurred and 2 others were diagnostic errors. No evidence of tumoral seeding was observed. CONCLUSIONS: Percutaneous or ureteroscopic surgery can achieve cure in selected cases. Local recurrence outside the urinary tract ascribable to percutaneous surgery appears to be unlikely.

[Percutaneous nephrolithotomy for coralliform lithiasis in a patient with bilateral triplicated ureters]. / Nefrolitotomía percutánea por litiasis coraliforme en paciente con triplicidad ureteral bilateral.

We report on a rare case of bilateral ureteral triplicity with a definitive urinary diversion (Brickner loop ureteroileostomy) who presented a staghorn stone in the upper calyx of the left kidney. The patient was submitted to percutaneous nephrolithotomy with direct access to the upper calyx of the anomalous kidney. We discuss the indication for this treatment, which resolved the lithiasis in a single session and with no complications. Furthermore, this treatment modality is compared with ESWL and open surgery, which we reserve for failures or those cases where the percutaneous approach is contraindicated. Percutaneous nephrolithotomy can be considered a therapeutic alternative for lithiasis in patients with congenital malformation and/or urinary diversion.

[Laparoscopic transplantectomy of renal graft. Experimental model]. / Trasplantectomía laparoscópica del injerto renal. Modelo experimental.

Renal transplant nephrectomy carries a high morbidity and mortality. Conceptually, graft removal by laparoscopy is a logical less invasive alternative. We have developed an experimental model for renal autotransplantation in the pig, with laparoscopic graft removal eight weeks following autotransplantation. Although the clinical indication for laparoscopic nephrectomy of a failed graft will provoke controversy, a nonfunctioning renal graft with intolerance and no rupture or infection late post-transplantation theoretically could be the indication for this procedure.

[Comparative analysis of lithiasic fragmentation induced by extracorporeal and direct contact sources]. / Análisis comparativo de la fragmentación litiásica inducida por las fuentes extracorpóreas y de contacto directo.

An in vitro experimental study on stone fragmentation was conducted on 114 calculi analyzed by infrared spectrophotometry. Four energy sources were utilized: electrohydraulic, piezoelectric, ultrasound and pulsed laser. We analyzed stone susceptibility to fragmentation (particles < 3 mm), pulverization (particles < 1 mm) and stone fragility (amount of energy/mg of calculus fragmented into particles < 3 mm) for each type of energy source of each of the following 6 stone compositions: calcium oxalate monohydrate, calcium oxalate dihydrate, magnesium ammonium phosphate, phosphate carbonate, uric acid and phosphate oxalate. The calcium oxalate dihydrate calculi were the most susceptible to fragmentation and the infective calculi (magnesium ammonium phosphate and phosphate carbonate) were the most susceptible to pulverization. The piezoelectric energy showed the highest capacity for fragmentation and pulverization of calculi. Stone fragility depended on each stone type and the energy source utilized.