[The usefulness of virtual endoscopy and CT urography in the diagnosis of upper urinary tract tumors]. / Utilidad de la endoscopia virtual y el Uro-Tc en el diagnóstico de tumores del tracto urinario superior.

OBJECTIVES: Upper urinary tract (UUT) tumors are a relatively low incidence pathology which often represents a diagnostic challenge for the urologist, because several imaging tests are usually necessary to achieve the final diagnosis. Over the last years CT scan has suffered a notable development and nowadays, with the arrival of new image processing hardware and software, it is possible to detect small urothelial lesions and to perform 3-D urinary tract reconstruction and virtual endoscopic navigation. METHODS: Between January 2004 and June 2005 we performed a total of 15 examinations in 15 patients for the study of asymptomatic hematuria of probable upper urinary tract origin. The technique included three phases to obtain images: basal phase, vascular phase and excretory phase. Processing and image analysis was performed by one radiologist. RESULTS: A total of 10 tumors were diagnosed, with pathological confirmation in all cases. We did not register any complication secondary to the technique, and all patients tolerated well the exam. CONCLUSIONS: The CT urography is a safe, well-tolerated, highly sensitive and efficient imaging test, very useful in the diagnosis of renal and UUT pathology. It may become the only imaging test performed in the study of asymptomatic hematuria and the test of choice for the study of urological tumoral pathology.

[Primary bladder neck obstruction in males]. / Obstrucción primaria del cuello vesical en el varon.

OBJECTIVES: To report our experience on the diagnosis and treatment of this rare type of infravesical functional obstruction. METHODS: Over the last ten years we diagnosed and treated 32 males with this entity. We evaluate previous treatments and time to diagnosis. Clinical, radiological, endoscopic, and urodynamic features are evaluated, as well as results obtained with the administration of alpha-adrenergic blockers and endoscopic transurethral incision of the bladder neck. RESULTS: Patient age ranged from 26 to 48 years (Mean 38.2). All patients presented significant long-lasting lower urinary tract symptoms, having received various non-specific treatments. Uroflowmetry showed a peak of mean flow of 9.8 +/- 3.2 cc/s, being the voiding detrusor pressure 98 +/- 25 cm H2O, with significant post void residual volume in 21 patients (188 +/- 62 cc). Medical treatment with alpha-adrenergic blockers only achieved significant subjective improvement in four patients. Twenty one patients underwent unilateral endoscopic bladder neck incision, obtaining objective and subjective improvements all of them. CONCLUSIONS: Endoscopic bladder neck incision is the treatment of choice of this dysfunction, being imperative to inform the patient of the risk of retrograde ejaculation as a postoperative sequel, since this entity appears in young males, for whom fertility may be a priority.

[Orthotopic bladder substitution in the treatment of interstitial cystitis]. / Sustitución vesical ortotópica en el tratamiento de la cistitis intersticial.

OBJECTIVES: To point out the efficacy of supra trigonal cystectomy with orthotopic substitution iliocystoplasty in the treatment of advanced interstitial cystitis (IC). METHODS: We study the results obtained in four women suffering IC nonrespondent to conservative treatment who underwent the procedure. All patients comply with classic diagnostic criteria of IC, presenting long-lasting symptoms, between 4 and 8 years (mean 5.6), and voiding frequency of near one-hour day and night. RESULTS: Mean postoperative follow-up was 32 months (18 to 56); post operative evaluation included clinical evaluation, ultrasound, urodynamic studies, and radiological tests. Suprapubic pain disappeared in all cases, as well as pre-op lower urinary tract symptoms, with good control of urinary frequency day and night being evident in the immediate postoperative period. All patients referred high satisfaction with the outcome. CONCLUSIONS: When conservative treatment fails, supratrigonal cystectomy with orthotopic neobladder substitution is a valid therapeutic option in IC patients who comply with classic diagnostic criteria.

[The treatment of hydrocele as ambulatory surgery]. / Tratamiento del hidrocele en cirugia mayor ambulatoria.

OBJECTIVES: To evaluate the results of this surgical treatment of hydrocele over the first four years of integration of the Urology Department in the Major Ambulatory Surgery Unit in our Hospital. METHODS: From January 2000 to July 2004 we have performed 167 hydrocelectomies as ambulatory surgery in 152 patients (15 cases bilateral) with ages ranging from 16-87 years (mean 52.6). All procedures were performed under local anesthesia, using between 10-15ml of 1% lidocaine. The Lord's vaginalis plication technique was employed in 92% of the cases, leaving resection techniques for the remaining 8%, which presented certain degree of enlargement of the tunica vaginalis. We evaluated inclusion and discharge criteria, results, and degree of satisfaction by means of a questionnaire. RESULTS: Results are equivalent to those of inpatient surgery. Only one patient required admission to the hospital due to a postoperative complication, which was clearly independent of the ambulatory character of the process. Satisfaction with treatment was higher than 95%. CONCLUSIONS: Almost all patients with hydrocele are candidates to ambulatory surgery, significantly improving the cost-efficacy rate, without diminishing the quality of care or patient satisfaction.

[Genitourinary tuberculosis in the urologic works of Professor Rafael Mollá Rodrigo]. / La tuberculosis genitourinaria en la obra urológica del profe- sor Rafael Mollá Rodrigo (1862--1930). Análisis documental histórico de su obra.

OBJECTIVES: Professor Rafael Molla Rodrigo is considered by some the author who contributed with his scientific work and solid technique to consolidate Urology as a speciality in Valencia. Such importance is also perceived in a national level, as demonstrated by the fact that he belonged to the first board of the Spanish Association of Urology and contributed to its foundation in the two-year period 1910--1911, from his position of head of the department of Surgical Therapy and Operations at the Central University. Genitourinary tuberculosis is one of the most outstanding chapters of his extensive works. METHODS: We reviewed all his works, selecting all original articles about genitourinary tuberculosis. Original articles have been obtained from the journals Revista de Higiene y Tuberculosis, La Medicina Valenciana, Revista Valenciana de Ciencias Médicas y Policínica, and from his two most important books, Clinical Lessons In Urology and Clinical Lessons in Urology and Genitourinary Surgery. RESULTS: Throughout his work he analyzes features of relevance about this disease, such as diagnosis, about which he emphasizes the clinical and bacteriological difficulties, and treatment, which was only feasible by precocious nephrectomy. CONCLUSIONS: He dedicates a great part of his work to the study of this pathology and defends a precocious diagnosis in order to perform the only treatment that had demonstrated efficacy. He also exposes the symptoms and variety of clinical presentations, as well as diagnosis through separate kidney catheterization with the aim to determine unilateral involvement.

[Management of male sterility in patients taking anabolic steroids]. / Manejo de la esterilidad masculina en pacientes consumidores de esteroides anabolizantes.

OBJECTIVES/METHODS: To review the incidence of male infertility secondary to intake of anabolic products and our experience and outcomes with treatment. There is a variety of such substances (testosterone, nandrolone, stanozolol, etc.) in their intake may be unique or combinations, both orally or parenterally. Comparisons between patients and case series are difficult because of the hiding of this practice and various consumption practices and doses employed. RESULTS/CONCLUSIONS: Most of the patients recover normal spermatogenesis does by stopping intake of anabolic substances. The period of time until recovery is 6.35 months. Patients not recovering after six months were given tamoxifen 20 mg/24-hour, if having a normal or inhibited hypothalamus-hypophysis axis. Duration of abuse, doses, and anarchical consumption maderesponse to treatment with antiestrogen drugs or gonadotropins unpredictable in patients not responding to conservative treatment.

[Bladder squamous metaplasia: report of one case and bibliographic review]. / Metaplasia escamosa vesical, a propósito de un caso. Revisión de la uteratura.

OBJECTIVES: We report a new case of squamous metaplasia because of its interest and subtle differential diagnosis with other bladder pathologies. METHODS: We report the case of a male patient with history of previous neoplasia with an exophytic lesion of the bladder wall discovered on follow-up. Pathological diagnosis after TUR was bladder squamous metaplasia. RESULTS: Follow-up is performed by ultrasound, cystoscopy, and urine cytology in adherence to clinical guidelines due to the possibility of transformation into squamous cell carcinoma. CONCLUSIONS: Urothelium is able to develop non neoplastic transformations such as squamous metaplasia. The importance of such transformations depends on proper diagnosis and follow-up due to their ability to transform into a neoplastic process.

[Symptomatic hydronephrosis during pregnancy]. / Acerca de la hidronefrosis sintomática en la gestante.

OBJECTIVES: Hydronephrosis is common during pregnancy, affecting 90% of pregnant women. It is usually asymptomotic, but a small percentage of patients show clinical symptoms requiring treatment. We want to report our experience in the diagnosis and treatment of symptomatic obstructive uropathy in pregnant women. METHODS: We retrospectively evaluate the results obtained in 162 pregnant women suffering symptomatic hydronephrosis who received care at our department over the last 12 years. RESULTS: Conservative treatment was effective in most patients, 39 patients required more aggressive therapy. Thirty-five patients underwent insertion of a doubleJ catheter, 2 patients percutaneous nephrostomy, and another 2 ureteroscopy and extraction of ureteral lithiasis. CONCLUSIONS: The most frequent etiology of symptomatic hydronephrosis during pregnancy is external compression by the gravid uterus, followed by ureteral lithiasis. We consider conservative treatment as the treatment of choice, leaving ureteral double J cotheter insertion or percutaneous nephrostomy for the refractory cases. Ureteroscopy is a new diagnostic and therapeutic option when other less aggressive meosures fail.

[Outpatient surgical treatment of female stress urinary incontinence]. / Tratamiento quirúrgico ambulatorio de la incontinencia urinaria de esfuerzo femenina.

OBJECTIVES: To evaluate the results of the outpatient surgical treatment of genuine female stress urinary incontinence (SUI) over a five year period since the integration of the Department of Urology in the Ambulatory Surgery Unit at our hospital "Consorcio Hospital General Universitario de Valencia" (CHGUV). METHODS: Between January 2000 and December 2004 26 patients (ages 49-78; mean age 69.8 yr) with the diagnosis of SUI underwent tension-free suburethral mesh sling (TVT) outpatient operations under local anesthesia-sedation at the ambulatory surgery unit of the CHGUV. All patients had clinical and urodynamic evaluation, excluding those presenting genital prolapse or non compliance with the social requirements for ambulatory surgery. Previous anti-incontinence surgery was not an exclusion criterion. We evaluate inclusion and discharge criteria, results and satisfaction degree measured by a questionnaire. RESULTS: 22 patients (85%) had genuine SUI and 4 (15%) had mixed UI with predominance of the stress component. 54% (14) of the patients were ASA I, 31% (8) ASA II, and 15% (4) well compensated ASA III. Operation tolerance under local anesthesia (20-30 ml 1% lidocaine) was good in all patients, having used additional sedation-analgesia (propofol-remifentanil IV perfusion) in 10 of them (38%). Mean operative time was 30 minutes (25-45) and stay at the unit discharge was 100 min. (80-140). All patients were discharged the same day. None of them required readmission or presented urinary retention after catheter removal. SUI disappeared in all of them. Three patients presented postoperative urge incontinence responsive to oral anticolinergic drugs. Our results are similar to those obtained with epidural anesthesia and hospital admission, being the degree of satisfaction with treatment higher than 95%. CONCLUSIONS: The development of new, revolutionary systems for the treatment of SUI has simplified the surgical treatment of this entity, so that we can say a high percentage of patients may be included in an ambulatory surgery program, significantly improving cost-efficacy without diminishment of health-care quality or patient satisfaction.

[Spontaneous recanalization of the vas deferent after vasectomy: report of 2 new cases. Bibliographic review]. / Recanauzación espontánea tras vasectomía: a propósito de 2 nuevos casos. Revisión de la literatura.

OBJECTIVES: Vasectomy is a low morbidity and high efficacy surgical method. A small percentage of cases may have paternity after surgery as a complication. METHODS: We reviewed all patients who underwent vasectomy at our department from 1995 to 1999 (n = 1492), defining technical failure as pregnancy or no disappearance of spermatozoids in the follow-up sperm analysis. RESULTS: We found 2 cases; one of them did not have a negative sperm test after three months, the other one's wife became pregnant after previous azoospermia. Both patients showed granulomas in the pathologic report after a second operation. CONCLUSIONS: Vasectomy is a surgical technique that may have a failure rate close to 2%. Paternity after the operation may appear even after several years. Several authors report the existence of granulomas in those cases in which spontaneous recanalization appears. In our series it was a constant.

[Biography and analysis of the urologic works of Dr. Nicasio Benlloch Giner (1888-1957) (I)]. / Biografía y análisis de la obra urológica del Dr. Nicasio Benlloch Giner (1888-1957) (I).

OBJECTIVES: The practice of Urology in our country has a long tradition, as demonstrated by several treaties of surgery from the Renaissance; it was the end of the XIX century when the scientific basis of the speciality were established separate from Surgery, as some authors demonstrated, with the notorious contribution of Prof. Rafael Mollá Rodrigo. Dr. Nicasio Benlloch Giner (1888-1957) did the same at the beginning of the XX century when he came back from the professional school of George Marion, contributing to the consolidation of this speciality. METHODS: We reconstructed his biography and analyzed all his bibliography, both in regional and national journals. RESULTS: According to Nicasio Benlloch, renal lithiasis and its treatment were under controversy. Renal lithiasis might demand three indications: nephrectomy, pyelolithectomy and nephrolithectomy. In his chapter on intravenous pyelography he describes its absolute and relative indications. In his work about urinary catheterization and endoscopy he describes in detail the exploratory catheterization of urethra, bladder, and ureters, as well as the catheterization for evacuation and dilatation, and the most frequently used instruments. Finally, he talks about the benefits of endoscopic resection for bladder neck diseases and describes a resectoscope. CONCLUSIONS: Dr. Nicasio Benlloch contributes with his works to the consolidation of Urology as a speciality in Valencia, mainly in the field of lithiasis, a topic in which his works were fundamental.

[Biography and analysis of the urologic works of Dr. Nicasio Benlloch Giner (1888-1957) (II)]. / Biografía y análisis de la obra urológica del Dr. Nicasio Benlloch Giner (1888-1957) (II).

OBJECTIVES: The practice of Urology in our country has a long tradition, as demonstrated by several treaties of surgery from the Renaissance; it was the end of the XIX century when the scientific basis of the speciality were established separate from Surgery, as some authors demonstrated, with the notorious contribution of Prof. Rafael Mollá Rodrigo. Dr. Nicasio Benlloch Giner (1888-1957) did the same at the beginning of the XX century when he came back from the professional school of George Marion, contributing to the consolidation of this speciality. METHODS: We reconstructed his biography and analyzed all his bibliography, both in regional and national journals. RESULTS: According to Nicasio Benlloch, renal lithiasis and its treatment were under controversy. Renal lithiasis might demand three indications: nephrectomy, pyelolithectomy and nephrolithectomy. In his chapter on intravenous pyelography he describes its absolute and relative indications. In his work about urinary catheterization and endoscopy he describes in detail the exploratory catheterization of urethra, bladder, and ureters, as well as the catheterization for evacuation and dilatation, and the most frequently used instruments. Finally, he talks about the benefits of endoscopic resection for bladder neck diseases and describes a resectoscope. CONCLUSIONS: Dr. Nicasio Benlloch contributes with his works to the consolidation of Urology as a speciality in Valencia, mainly in the field of lithiasis, a topic in which his works were fundamental.

[Ambulatory surgery in urology. Analysis of our experience]. / Cirugia mayor ambulatoria en urología. Análisis de nuestra experiencia.

OBJECTIVES: To show the results of our four-year experience since starting urologic procedures in the Ambulatory Surgery Unit in our hospital. The progressively increasing demand of surgery has showed up the limitations of sanitary resources. Ambulatory Surgery arises with the aim to optimize such resources, because it improves surgical procedures and rationalizes the increasing sanitary expenditures. METHODS: We study the results obtained after operating on 415 patients, showing inclusion criteria, relationship between surgical procedure and anesthetic drug employed, as well as discharge criteria. RESULTS: Among all patients operated on, 4 (11%) required hospital admission, and 12 presented with complications in the immediate postoperative period (3%), all of them minor. Satisfaction with treatment was around 95%. CONCLUSIONS: A great percentage of patients with urologic diseases who need surgery are candidates to be included in an ambulatory surgery program, without compromise of the quality of care or patient's satisfaction.

[Seminal vesicle cyst. Report of one case and bibliography review]. / Quiste de vesícula seminal. A propósito de un caso y revisión de la literatura.

OBJECTIVES: We report one case of seminal vesicle cyst with ectopic drainage of the left ureter. We performed a bibliographic review of this pathology. METHODS: 23-year-old patient who presented several episodes of acute epididymitis. Complementary study showed a retroprostatic cystic structure on transrectal ultrasound. Surgical treatment with resection of the cystic structure was proposed. RESULTS: The clinical picture which caused the process was solved and the patient keeps his fertility. CONCLUSIONS: This is a rather infrequent pathology that urologists should know. We bring up the need of performing complementary studies in pathologies that in spite of seeming banal do not progress satisfactorily.

[Treatment of urethral stenosis by self expandable endourethral prosthesis. Long-term results]. / Tratamiento de la estenosis de uretra mediante prótesis endouretral autoexpansible. Resultados a largo plazo.

OBJECTIVES: Urethral stenosis is a frequent disease in males. The variable results of its treatment have prompted the surgeon to search for new therapeutic alternatives. We propose to treat it by self expandable endourethral prosthesis. METHODS: Since February 1993 to March 2000 48 patients with urethral stenosis previously treated with endoscopic urethrotomy have undergone the procedure. RESULTS: All patients completed a minimum of 3 years of follow-up. Patients lost to follow-up for any cause were not included in the final study description. All patients had satisfactory micturition at the time of discharge. Mean flow on uroflowmetry at three years was higher than 14 ml/ s in 87.5% (42/48 patients evaluated). CONCLUSIONS: The use of self expandable endourethral prosthesis is a valid alternative in the treatment of recurrent urethral strictures due to its good long-term results and low morbidity. We recommend not using it in cases of traumatic etiology.

[Our experience with simplified vasovasostomy. Review of our results during the last 5 years]. / Nuestra experiencia en vasovasostomia simplificada. Revisión de los resultados obtenidos en los ultimos 5 años.

OBJECTIVES: We currently see an increase of demand of vasectomy reversion, mainly due to the wish of recovering fertility. METHODS: We review 21 cases of vasovasostomy performed at our department over the last 5 years with the single layer technique under optical magnification, comparing our results with those from bibliography for both vasovasostomy and in vitro fecundation techniques used in patients with obstructive azoospermia, specifically intracytoplasmic spermatozoids injection (ICSI). RESULTS: Success rates obtained for permeability, pregnancy, and births were 80%, 33%, and 26.66% respectively. CONCLUSIONS: Our results in terms of pregnancies are equivalent to those obtained by ICSI. These data, together with the disadvantage of greater rates of multiple pregnancies associated with in vitro fecundation techniques, moved us to choose vasovasostomy as the initial option for treatment of male infertility secondary to vasectomy.

[Alfredo Tramoyeres Cases (1910-2002): first chairman of the Department of Urology at the Ciudad Sanitaria La Fe. Documentary-historical analysis of his works]. / Alfredo Tramoyeres Cases (1910-2002): primer jefe de Servicio de Urología de la Ciudad Sanitaria "La Fe". Análisis documental histórico de su obra.

OBJECTIVES: Urology, having been part of general surgery for centuries, was completely consolidated as a medical speciality in the middle of the XX Century as the result of years of evolution and development, and all the studies and works of certain authors that represent today the mainstays of our speciality. Valencia in the middle of the 20th century saw the birth of new hospitals including the "Ciudad Sanitaria La Fe". Alfredo Tramoyeres Cases was the first chairman of the Department of Urology. This article reviews his long and fertile professional life. METHODS: We have reviewed all his scientific works. The articles have been obtained from Medicina Española, Revista Española de Cirugía Traumatológica y Ortopedia, and Archivos Españoles de Urología. His most important urological work is his doctoral thesis with the title "Sigmoid-procto-ureterostomy: personal modification" published in Valencia in 1976. For his biography we used the" Biographic and bibliographic history of the Spanish Urology over the XX century" and interviews with family members. RESULTS: We emphasize his thorough description of the various types of urinary diversion. He covers the topics of bladder diverticula and bladder neck disorders, in which he supports surgical treatment. Finally, he sets out the rupture of the posterior urethra and various treatments for prostate cancer at that time. CONCLUSIONS: Alfredo Tramoyeres Cases contributed to the definitive consolidation of our speciality in the area of Valencia during the second half of the XX century, through his long professional life, with his interesting scientific contributions.

[Mesonephroid adenocarcinoma. Apropos of a new case and review of the literature]. / Adenocarcinoma mesonefroide. A propósito de un nuevo caso y revisión de la literatura.

OBJECTIVES: Mesonephric adenocarcinoma is a rare clinical entity, predominantly appearing in women, involved in great controversy about its histogenesis. Reported cases to date were not diagnosed in their initial stages and they were treated by radical surgery with poor results. METHODS: We report the case of a 71-year-old male with previous diagnosis of nephrogenic adenoma two years before. RESULTS: After the diagnosis of mesonephric adenocarcinoma was established, patient underwent radical surgery despite its poor prognosis. CONCLUSIONS: Differential diagnosis between these tumors should be made with primary or metastatic adenocarcinoma and nephrogenic adenoma. We highlight the ongoing controversy in the literature in relation to malignant evolution of the nephrogenic adenoma as etiology of the rare mesonephric adenocarcinoma. In this case, previous finding of a nephrogenic adenoma would support that theory.

[Primary psoas abscess: report of 5 new cases. Review of the literature]. / Absceso de psoas primario: a propósito de 5 nuevos casos. Revisión de la literatura.

OBJECTIVES: We report 5 new cases of primary psoas abscess in this review. We describe the various pathogen agents involved in the development of this disease, as well as the etiopathogenesis, which is explained by several theories, being the most commonly accepted hematogenous dissemination from a septic focus. In the same way, we refer the most interesting clinical data and the value of current diagnostic tests, among which are abdominal x-ray (KUB), ultrasound, isotope scan, and CT scan, being this latter the ideal diagnostic test for these processes. METHODS: Retrospective study from 1985 to 2000, including a total of 5 patients with an average age of 48.2 years. RESULTS: 4 of these 5 patients were males, and two of them had documented history of addiction to parenteral drugs and chronic alcoholism respectively. All patients presented with lumbar pain, four of them with fever, 2 functional impotence and 1 mass effect. Four of them had increased white blood cells count; ultrasound was diagnostic in one case only, and CT scan in all 5. Blood cultures were positive in three cases, being Staphylococcus Aureus the germ isolated from the pus in four cases. The four patients treated had a positive outcome without recurrence to date. CONCLUSIONS: The reappearance of primary abscesses in young population with history of alcoholism or addiction to parenteral drugs. CT scan is the diagnostic tests of choice. Percutaneous drainage has good results and is less aggressive therapeutic option for this disease.