Retrograde intrarenal surgery and micro-percutaneous nephrolithotomy for renal lithiasis smaller than 2 CM. / Cirugía retrógrada intrarrenal y micro-nefrolitectomía percutánea en la litiasis renal menor de 2 cm.

INTRODUCTION: Microperc is the upgraded form of percutaneous nephrolithotomy miniaturization. The aim of this study is to compare prospectively microperc and retrograde intrarenal surgery for the treatment of renal stones smaller than 2 cm. MATERIAL AND METHODS: A comparative prospective study of both techniques was carried out between January 2014 and June 2015. Thirty-five patients were divided in two groups: Group A, 17 patients treated by retrograde intrarenal surgery and Group B, 18 patients treated by microperc. Stone clearance was assessed using CT scan 3 months after surgery. RESULTS: Both groups were statistically comparable as demographic variables and stone size was similar (16.76 mm Group A vs 15.72 mm Group B). Success rate, hospital stay and JJ stenting were similar for both groups. There was no statistically significant difference regarding post-operatory complications: 17.64% Group A vs 5.56% Group B (p=0,062), all of them Clavien I and II. Surgical time was statistically different (63.82 min Group A vs 103.24 min Group B) as well as hemoglobin drop (0.62 g/dl Group A and 1.89 g/dl Group B). CONCLUSION: Microperc is an effective and safe procedure for the treatment of renal lithiasis smaller than 2 cm, which makes it a good alternative to retrograde intrarenal surgery for this stone size. However, more prospective studies that include a larger cohort are necessary to confirm our results.

Influence of barbed suture in laparoscopic radical prostatectomy. / Influencia de la sutura barbada en la prostatectomía radical laparoscópica.

OBJECTIVES: To determine the influence of barbed suture in laparoscopic radical prostatectomy. METHODS: A retrospective study of 150 patients who underwent laparoscopic radical prostatectomy was carried out by our department. The patients were divided in two groups according to the kind of suture used during the vesicourethral anastomosis: conventional 3-0 absorbable multifilament running suture (group 1) and bidirectional barbed suture (Quill®) (group 2). Operating time, postoperatory urinary fistula, hospital stay and catheter duration were analyzed in both groups. RESULTS: After the analysis of all the preoperative variables, such as age, PSA, prostate volume, Gleason and stage on biopsy, no statistically significant differences were found in both groups. Operating time was significantly shorter in Group 2 (169±43 min vs 215±45 min, p=0.00). Statistically significant differences were found regarding postoperative urinary fistula rate, hospital stay and urethral catheterization duration, favourable to Group 2. CONCLUSIONS: The use of bidirectional barbed suture (Quill®) for vesicourethral anastomosis in laparoscopic radical prostatectomy, when compared with the conventional suture, shortens surgical time, reduces urinary fistula rate, catheter duration and hospital stay, as the anastomosis is easily performed and prevents leakage.

Flexible ureteroscopy for renal stones.

OBJECTIVES: The objectives of this prospective study are to present our experience with retrograde intrarenal surgery (RIRS), and to analyze its results and complications. MATERIAL AND METHODS: 150 patients with renal stones were treated with RIRS. 111 cases showed single stones whilst multiple stones were observed in 39 cases. The mean size was 19.12mm (r: 5-74). Success rate was defined as the absence of residual stones or the presence of fragments ≤2mm. RESULTS: in 21 (14%) patients RIRS could not be performed on first attempt because it was impossible to place the ureteral access sheath. The immediate success rate was 85.7%, and 91.6% at three months later. The average operating time was 85min (r: 25-220). Postoperative complications were observed in 22 cases (14.6%), although most of them were classified as Clavien 1 and 2 (19 cases), and only 2% (3 cases) showed Clavien 4 complications (sepsis requiring admission in the intensive care unit). 10 patients underwent a second procedure in order to complete the treatment. Thus, the number of procedures per patient was 1.06. There were no late complications. CONCLUSIONS: the treatment of renal stones with flexible ureteroscopy using the ureteral access sheath shows a high successful rate with a low complication rate. In order to define its indication more precisely, randomized studies comparing RIRS with minimally invasive percutaneous nephrolithotomy procedures (miniperc and microperc) would be necessary.

Predicting results of daily-practice cystoscopies.

OBJECTIVE: Our objective was to elaborate a predictive model of bladder cancer, in an unselected clinical population submitted to cystoscopy. MATERIALS AND METHODS: We recruited consecutive patients that underwent cystoscopy due to suspicion of bladder cancer or surveillance of a previously diagnosed bladder cancer. Urine cytology and a BTA-stat® (BTA) test were carried out for all patients. To avoid an assessment bias, the BTA-tests, cytologies and cystoscopies were conducted in a blinded fashion. We used logistic regression to predict cystoscopy results from cytology, BTA-test and clinical variables. RESULTS: From August 2011 to July 2012, we recruited 244 patients and 237 were valid for analysis. Newly diagnosed and surveillance cases were 13% and 87% respectively. Cytology and BTA-test sensitivities were 57.9% (CI 95: 42.2-72.1) and 63.2% (CI 95: 47.3-76.6) with specificities of 84.4% (CI 95: 78.7-88.8) and 82.9% (CI 95: 77.1-87.5). The predictive model included the BTA-test, cytology, time since previous tumour, and treatment with mitomicin or BGC during the last three months. The model predictive accuracy (AUC) was .85 (.78-.92), and dropped to 0.79 when excluding the BTA-test (P=.026). For the surveillance of bladder cancer, a 10% threshold on the model predicted probabilities resulted in an overall negative predictive value of 95.7%, and 95.0% in low grade tumours. CONCLUSION: In a cost containment environment, our prediction model could be used to space out cystoscopies in patients with previous, low grade tumours, resulting in a more efficient use of resources in the healthcare system.

[Retrograde intrarenal surgery (RIRS). Technical complement for cases of acute lithiasis]. / Cirugía retrógrada intrarrenal (CRIR). Complemento técnico para casos con excesiva carga litiásica.

INTRODUCTION: Washing the renal cavities using minipercutaneous surgery shaft is an ideal technical procedure for retrograde intrarenal surgery (RIRS) when lithiasic fragmentation is significant or if the anatomy of the renal cavities may obstruct the spontaneous elimination of fragments. MATERIALS AND METHODS: we performed 37 RIRS on 35 patients with renal lithiasis (14 men, 21 women) with a mean age of 56 (range 33-72) years, divided into two groups in accordance with the size of their kidney stones. Group A, 23 patients with lithiasis <1.5 cm; Group B, 12 cases with lithiasis >1.5 cm. 28 patients had a single kidney stone and 7 had multiple stones. APPROACH: Flexible uretrorenoscopy, 7.5 Fr (Flex-X(®, Karl Storz) by means of a ureteral access sheath. Holmium laser lithotripsy (Calculase®, Karl Storz) using 200 and 365 micrometer fibres. Fragment extraction with 1.7 Fr nitinol baskets (N-gage, Cook). In cases of significant fragmented stone burden, the renal cavities were washed with low-pressure fluid irrigation using a ureteral access sheath, which was collected together with the stone fragments carried by the "mini-perc" sheath (Ultrax-x® 18Fr, Cook; Rusch, 14 Fr) placed under radiologic and endoscopic control at the level of the calyx-papilla selected for fragment drainage. RESULTS: the mean diameter for group A was 9.13 (range 5-13) mm and 20.25 (range 16-28) mm for group B. The overall mean operating time was 81 (range 30-160) min. Group A required 66.43±35.18 min. and group B 107.5±46.73 min. (p=0.006). The rate of absence of stones immediately after surgery was 83.2%, 93.1% at 3 months (95.6% for A and 83.3% for B; p=0.217). In no case was ureteral stenosis observed as a result of the use of ureteral access sheaths. In 7 group B patients (58.3%) with acute lithiasis and/or alteration in their pyelocaliceal anatomy, we performed active lavage of the renal cavities applying the aforementioned percutaneous technique. The mean post-surgery hospital stay was 2.1 (range 1-4) days. There were post-surgery complications (Clavien 1) in 7 patients (20%). Two patients required a second FURS. CONCLUSIONS: RIRS can be effective treatment for renal lithiasis >1.5 cm. Lavage of the renal cavities helps to eliminate stone fragments, reducing the possibility of retreatment.

Cirugía retrógrada intrarrenal (CRIR). Complemento técnico para casos con excesiva carga litiásica / Retrograde intrarenal surgery (RIRS). Technical complement for cases of acute lithiasis

Introducción: El lavado de las cavidades renales mediante una vaina de cirugía minipercutánea es un procedimiento técnico ideal para la cirugía retrógrada intrarrenal (CRIR) cuando la carga litiásica fragmentada es grande o si la anatomía de las cavidades renales puede dificultar la eliminación espontánea de los fragmentos. Material y métodos: hemos realizado 37 CRIR en 35 pacientes con litiasis renal (14 hombres, 21 mujeres) con edad media de 56 años (rango 33-72), divididos en dos grupos de acuerdo al tamaño litiásico: grupo A, 23 pacientes con litiasis < 1,5cm; grupo B, 12 casos con litiasis >1,5cm. En 28 pacientes la litiasis fue única y en 7 múltiple. Técnica empleada: ureterorrenoscopia flexible 7,5 Fr (FlexX(®, Karl Storz) a través de vaina de acceso ureteral. Litotricia con láser holmium (Calculase®, Karl Storz) utilizando fibras de 200 y 365 micras. Extracción de fragmentos mediante cestas de nitinol de 1,7 Fr (N-gage, Cook). Ante una carga litiásica fragmentada abundante se lavaron cavidades renales introduciendo líquido de irrigación a baja presión a través de la vaina de acceso ureteral y recogiéndolo, junto con los fragmentos litiásicos arrastrados, por una vaina de “miniperc” (Ultraxx® 18Fr, Cook; Rusch, 14 Fr) colocada bajo control radiológico y endoscópico a nivel de la papila de un cáliz, a modo de sumidero de fragmentos. Resultados: el diámetro medio para el grupo A fue 9,13 (rango: 5-13) mm y 20,25 (rango 16-28) mm para el grupo B. El tiempo medio operatorio global fue 81min (rango 30-160). El grupo A precisó 66,43±35,18 minutos y el grupo B 107,5±46,73 minutos (p=0,006). La tasa de limpieza de litiasis en el postoperatorio inmediato fue 83,2%, a los 3 meses 93,1% (95,6% para A y 83,3% para B; p=0,217). En ningún caso se observó estenosis ureteral como consecuencia del empleo de vainas de acceso al uréter. En 7 pacientes del grupo B (58,3%) con excesiva carga litiásica y/o alteración en la anatomía pielocalicial se realizó lavado activo de las cavidades renales con la maniobra percutánea descrita. La estancia media postoperatoria fue 2,1 (rango 1-4) días. En 7 pacientes (20%) hubo complicaciones postoperatorias (Clavien 1). Dos pacientes precisaron una segunda URF. Conclusiones: la CRIR puede ser un tratamiento eficaz en la litiasis renal >1,5cm. El lavado de cavidades renales ayuda a eliminar los fragmentos litiásicos disminuyendo la posibilidad de retratamiento (AU)

Introduction: Washing the renal cavities using minipercutaneous surgery shaft is an ideal technical procedure for retrograde intrarenal surgery (RIRS) when lithiasic fragmentation is significant or if the anatomy of the renal cavities may obstruct the spontaneous elimination of fragments. Materials and methods: we performed 37 RIRS on 35 patients with renal lithiasis (14 men, 21 women) with a mean age of 56 (range 33-72) years, divided into two groups in accordance with the size of their kidney stones. Group A, 23 patients with lithiasis <1.5cm; Group B, 12 cases with lithiasis >1.5cm. 28 patients had a single kidney stone and 7 had multiple stones. Approach: Flexible uretrorenoscopy, 7.5 Fr (Flex-X(®, Karl Storz) by means of a ureteral access sheath. Holmium laser lithotripsy (Calculase®, Karl Storz) using 200 and 365 micrometer fibres. Fragment extraction with 1.7 Fr nitinol baskets (N-gage, Cook). In cases of significant fragmented stone burden, the renal cavities were washed with low-pressure fluid irrigation using a ureteral access sheath, which was collected together with the stone fragments carried by the “mini-perc” sheath (Ultrax-x® 18Fr, Cook; Rusch, 14 Fr) placed under radiologic and endoscopic control at the level of the calyx-papilla selected for fragment drainage. Results: the mean diameter for group A was 9.13 (range 5-13) mm and 20.25 (range 16-28) mm for group B. The overall mean operating time was 81 (range 30-160) min. Group A required 66.43±35.18min. and group B 107.5±46.73min. (p=0.006). The rate of absence of stones immediately after surgery was 83.2%, 93.1% at 3 months (95.6% for A and 83.3% for B; p=0.217). In no case was ureteral stenosis observed as a result of the use of ureteral access sheaths. In 7 group B patients (58.3%) with acute lithiasis and/or alteration in their pyelocaliceal anatomy, we performed active lavage of the renal cavities applying the aforementioned percutaneous technique. The mean post-surgery hospital stay was 2.1 (range 1-4) days. There were post-surgery complications (Clavien 1) in 7 patients (20%). Two patients required a second FURS. Conclusions: RIRS can be effective treatment for renal lithiasis >1.5cm. Lavage of the renal cavities helps to eliminate stone fragments, reducing the possibility of retreatment (AU)

[Quality of life in patients treated with orthotopic bladder substitution versus cutaneous ileostomy]. / Estudio de la calidad de vida en pacientes sometidos a sustitución vesical ortotópica versus ileostomía cutánea.

PURPOSE: Nowadays, psychcological and social aspects of treatment of urinary diversion after cystectomy, have become of utmost importance. Body image, potency, continence, emotional distress and dissatisfaction, functional and social activities are majors factors to improve quality of life after surgery. The aim of this study is to compare health-related quality of life after bladder substitution with ileal conduit diversion. MATERIALS AND METHODS: We developed a questionnaire based upon a literature review, to compare health related quality of life between bladder substitution and ileal conduit (45 multiple choice mailed questionnaire). We examined functional and social activities, sexual dysfunction, urinary problems, and body image dissatisfaction. RESULTS: 78 male patients with bladder cancer, were interviewed. 91% of the questionnaires were answered, 48.7% by patients' family and 42.3% by the patients themselves. 6 patients underwent ileal conduit and 27 underwent bladder substitution. Patients with ileal consuit presented higher body image dissatisfaction than those who underwent bladder substitution. When urine leakage occurred it caused more distress to the conduit patients, indicating urinary leakage as their main problem. Bladder substitution patients did not consider continence problems as very important, they had not interrupted social activities such as travelling or seeing friends. 100% of bladder substitution patients would not mind to undergo this operation again, while only 66% of ileal conduit patients would. CONCLUSION: Health-related quality of life is higher after bladder substitution. In our opinion we should use bladder substitution as the standard method of diversion after radical cystectomy for bladder cancer.

Estudio de la calidad de vida en pacientes sometidos a sustitución vesical ortotópica versus ileostomía cutánea / Quality of life after cystectomy and bladder substitution versus ileal conducit

La calidad de vida se define como el grado de satisfacción con la vida y las circunstancias personales percibidas por la propia persona. Pretendemos comparar la calidad de vida entre los pacientes sometidos a derivación urinaria externa y sustitución vesical ortotópica, en ambos casos tras cistectomía radical. MATERIAL Y MÉTODOS: Se ha empleado un cuestionario basado en los publicados previamente, con 45 preguntas de múltiple respuesta estudiando los aspectos sociodemográficos, continencia y potencia pre y post-cirugía, estado psicológico, sexual, imagen corporal e imagen corporal percibida. RESULTADOS: Los pacientes con derivación externa sufren una grave alteración de su imagen corporal, la fuga de orina, sobre todo nocturna es la mayor causa de estrés en estos pacientes. Los pacientes con sustitución ortotópica no se encuentran preocupados por el grado de continencia que poseen, viajan más, se sienten menos cansados y ansiosos, creen que han sido mejor informados y se volverían a someter a la intervención en un 100 por ciento de los casos. CONCLUSIÓN: Creemos que en la medida de lo posible es preferible realizar una derivación continente frente a una incontinente, en base al mayor impacto de esta última en la calidad de vida de los pacientes (AU)

[Treatment of psoas abscess: percutaneous drainage or open surgery]. / Traitement de l'abcès du psoas: drainage percutané ou chirurgie ouverte.

OBJECTIVE: Psoas abscess is currently an uncommon disease and is often difficult to diagnose because of its minor initial symptoms. We compare treatment by percutaneous drainage and surgery. MATERIAL AND METHODS: Five patients, all immunodepressed, which appears to be an important factor in the aetiology and pathogenesis of psoas abscess. Computed tomography appears to be the best diagnostic method. RESULTS: Three subjects underwent open surgery and developed serious complications in contrast with two patients treated by CT-guided percutaneous drainage, preceded by antibiotics. CONCLUSION: First-line percutaneous drainage appears to be the best approach at the present time, reserving open surgery for very large abscesses.

[Ureteral stenosis of uretero-ileal anastomosis]. / Estenosis ureterales de las anastomosis urétero-ileales.

Replacement plasty allows to perform oncology surgery while maintaining body image and preserving renal function. Entero-ureteral anastomosis is a significant element in this procedure where the main responsible for the loss of renal function are stenosis, infection and reflux. Our group has performed 206 orthotopical vesical replacements (November 1981-November 1998), using a direct Wallace-type uretero-ileal anastomosis. An intussusception valve system was used as antireflux mechanism. The number of obstructions, rate of stenosis at the uretero-ileal junction and incidence of valve stenosis were all analyzed as part of the complications occurred over a follow-up period of 54 months (6-183). Findings included 6 stenosis at the uretero-intestinal junction and 2 at the intussusception valve. Two (3.8%) of the uretero-ileal stenosis were earlier and associated to fistula; one was treated with open surgery and one had a double J placed through antegrade percutaneous access. Of the remaining late four, only one was treated with a double J catheter while the other three had to be re-operated. Stenoses of the valvular system (1.2%) were solved with open surgery. From our experience, we believe that direct uretero-ileal implantation with scraping of the ureter is a safe technique with little risk for stenosis at the uretero-ileal junction. Intussusception was used a antireflux system in all cases.

Estenosis ureterales de las anastomosis urétero-ileales / Ureteral stenosis of uretero-ileal anastomosis

Con la plastia de sustitución pretendemos una cirugía oncológica y a la vez mantener la imagen corporal y preservar la función renal. La anastomosis enteroureteral es un punto muy importante de esta cirugía, ya que los principales responsables de la pérdida de dicha función renal son la estenosis, la infección y el reflujo. Hemos realizado 206 sustituciones vesicales ortotópicas (noviembre 1981 - noviembre 1998). Se realizó anastomosis uréteroileal directa tipo Wallace. Como mecanismo antirreflujo se empleó un sistema valvular mediante intususcepción. Analizamos los casos de obstrucción, la frecuencia de estenosis de la unión uré-teroileal y las estenosis valvulares ocurridos en nuestra serie como parte de las complicaciones, cuyo periodo de seguimiento fue de 54 meses (6-183).Se han hallado 6 estenosis de la unión uréterointestinal y 2 de la válvula de intususcepción. De las estenosis uréteroileales (3,8 por ciento), 2 han sido precoces asociadas a fístula, tratadas una por cirugía abierta y otra por la colocación de un doble J por vía anterógrada percutánea. De las cuatro restantes, que han sido tardías, sólo una se pudo solucionar mediante catéter doble J, el resto tuvieron que ser reintervenidas. Las estenosis del sistema valvular (1,2 por ciento) se solucionaron mediante cirugía abierta. Desde nuestra experiencia, pensamos que el implante uréteroileal directo con espatulación del uréter, es una técnica segura con poco riesgo de estenosis de la unión uréteroileal. Confiamos el sistema antirreflujo a la intususcepción (AU)

[Stenosis following a direct uretero-ileal anastomosis technique in substitutive enterocystoplasty]. / Sténoses après une technique d'anastomose urétéro-iléale directe dans les entérocystoplasties de substitution.

OBJECTIVES: Stenosis of the uretero-ileal anastomosis and reflux are the commonest causes of secondary deterioration of renal function following enterocystoplasty. Various direct anastomosis and antireflux techniques have been proposed in order to reduce the risk of stenosis and reflux. In this retrospective study, the authors evaluated the risk of stenosis and reflux after right uretero-ileal anastomosis on an invaginated ileal loop. MATERIAL AND METHODS: The authors evaluated the uretero-ileal anastomosis stenosis and reflux rate and problems of the invaginated ileo-ileal valve in 157 patients after bladder replacement enterocystoplasty. RESULTS: The anastomosis stenosis rate was 3.8% (6/157 patients) and all 6 patients were reoperated. Stenotic complications on the valve were observed in 1.2% of cases (2/157 patients). The total stenosis morbidity was 5% (8/157 patients). CONCLUSION: Direct end-to-end uretero-ileal anastomosis is the simplest technique associated with the lowest risk of stenosis. The low stenosis rate associated with invaginated valves is due to a modification of the valvular system (limitation of the mesenteric exclusion manoeuvre, external anchorage of the invagination and fixation by two lines of resorbable staples).

[Percutaneous renal surgery]. / Cirugía renal percutánea.

RATIONALE: Analysis of complications resulting from the renal percutaneous approach. METHODS: Between 1990 and 1996, 175 percutaneous surgical procedures were performed by our group. In 69.2% cases, the reason was a lithiasic condition. We also carried out: 35 endopyelotomies, 12 renal cyst resections, 4 stenosis of uretero-ileal anastomosis, 2 diagnostic nephroscopies and 1 pyelic tumour resection. RESULTS: Total rate of complications was 22.2%. Mortality was 0.5% (one case). Surgery had to be terminated in 13 cases for different reasons. Blood transfusions were required in 9 cases. 3 cases of route perforation required extended maintenance of nephrostomy. Infectious problems developed in 9 cases. There were also 2 renocutaneous fistula, one renocolic fistula and one pneumothorax. No significant differences were found between the total number of complications and the type of treatment carried out. There is however a relationship between the lithiasic condition and the haemorrhagic complications and also with the failure of the approach. There are no significant differences between the number of complications and other variables such as age, sex, side, calix approached or duration of surgery. CONCLUSIONS: The percutaneous approach to the kidney can be considered as a technique with a low morbidity-mortality ratio.

[Agenesis of vas deferens and cystic fibrosis]. / Agenesia de conductos deferentes y fibrosis quística.

Congenital bilateral absence of vasa deferens appears in 6% of obstructive azoospermia, and 60-70% of these patients also have cystic fibrosis mutations. Unilateral aplasia or agenesia of vasa deferens occurs in less than 1% male individuals and some studies have found that up to 43% cases show mutations in the cystic fibrosis gen. We contribute four case reports of bilateral agenesia who were seen for infertility, all of which showed presence of mutation. In none of the two cases of unilateral agenesia, who consulted for vasectomy, a mutation in the cystic fibrosis gen was found. Patients with bilateral agenesia and their partners should be screened for cystic fibrosis, prior to spermatic microaspiration and assisted fecundation.

[Renal agenesis, cranial blind ureter and ureterocele. Report of a case]. / Agenesia renal, uréter ciego craneal y ureterocele. A propósito de un caso.

OBJECTIVES: We report a case of associated malformations in a young male with recurrent epididymitis. METHODS: In our study we used the following techniques: ultrasound, intravenous urography, retrograde pyelography, computed tomography and cystoscopy. RESULTS: We observed three coexisting congenital malformations: renal agenesis, cranial blind-ending ureter and ureterocele. CONCLUSIONS: Different urologic malformations are usually found in association. In our view only symptomatic ureteroceles require treatment.

[Renal hydatidosis. Our experience]. / Hidatidosis renal. Nuestra experiencia.

Presentation of five cases of renal hydatidic cysts. Revision of literature with regard to their clinical presentation form, diagnostic methods and surgical approach for management.

[Endopyelotomy. A definitive alternative to pyeloplasty?]. / Endopielotomía. Alternativa definitiva a la pieloplastia?

Endopyelotomy is a minimally invasive surgical alternative to the classic open surgery in the treatment of stenosis of the pyelo-ureteral attachment with similar success rates. This paper presents the results from 38 endopyelotomies performed between February 1989 and December 1993 in equal number of patients, 36 of them using percutaneous approach, 29 through the medium calix and 7 through the lower calix. Acucise's catheter was used in both cases. With the total of 38 endopyelotomies performed the complications and results obtained are presented as well as the results assessed by clinical, radiological and renographic criteria. The overall rate of success for endopyelotomy was 77.8%. When only improvement of urographic signs was evaluated, the success rate was lower (66.7%). In 4 clinically asymptomatic patients who showed no radiological improvement, a good response to diuretic therapy was seen in the renogram which was shown to be a basic test in the diagnosis, evaluation of results and follow-up of these patients. It is concluded that currently, endopyelotomy represents a choice technique in the treatment of stenosis of the pyelo-ureteral attachment with a low rate of intraoperative complications (3.4%). Also, it must be established that failure of this minimally invasive technique does not condition any added surgical difficulties to perform pyeloplasty.

[Bladder leiomyosarcoma. Report of a case]. / Leiomiosarcoma vesical. Aportación de un caso.

Presentation of a new case of vesical leiomyosarcoma, a malignant and uncommon tumour. Pre-operative diagnosis is practically impossible. Review of the literature and remarks on management approaches.

[Why is intussusception an antireflux mechanism?]. / Por qué la intususcepción como mecanismo antirreflujo?

One of the aims of bladder substitution or augmentation using the intestine is to preserve renal function. If reflux impairs renal function, an antireflux mechanism should be attempted. Direct ureteroileal reimplantation with spatulation of the ureter is safer and carries a lower risk of stenosis. The antireflux mechanism is created by ileoileal or ileocecal intussusception without involvement of the ureter. Thus we can diminish the risk of stenosis and reflux at the same time.