[The figure of the head of service (Chairman): what profile should have?]. / La figura del Jefe de Servicio: qué perfil debe de tener?

Great social-health care changes in the short term have been predicted that will seriously affect the departmental structure and care hierarchy of future hospital, universitary, public or private. The Spanish Association of Urology (AEU) wondered whether in these circumstances, in which the welfare and economic management of the hospital so-called "industrial" will dominate over other traditional aspects of the scientific hierarchy, social welfare and teaching of head Urology of service, will change his image, goals, functions, and ultimately its authority. Likewise which must be the attributes of this new generation of department heads. To this end the AEU call a roundtable requesting opinions and comments which are reflected in the enclosed text.

[Proceedings in the implantation of a laparoscopic radical prostatectomy program]. / Implantación de un programa de prostatectomia radical laparoscópica.

OBJECTIVE: To describe our proceedings in the implatation of our laparoscopic radical prostatectomy program (LRP). METHODS: Our working agenda and step-oriented implementation of our LRP program are shown. RESULTS: Four main steps were scheduled to acomplish this goal. These were: Preparatory phase, programed open conversion, development and analysis. Overlapping of each of these phase occured although their major content run on a time-basis. After basic skills acquisition and updating of our equipment we moved into the fixed-time open conversion we allowed us to progresively improve our performance without putting our patients into risks. Operative time of this phase exceeds that of our open cases in 63 minutes and no major complications took place. A rapid decrease in the operative time was noted after the first 15 cases (197' vs 264'). CONCLUSION: Implantation of a program of LRP can be done safely with a pre-planned program tailored to the needs and characteristics of each group and institution.

[Giant renal oncocytoma]. / Oncocitoma renal gigante.

Renal oncocytoma is a benign neoplasms arising from cells of the distal renal tubule. They acount for 3-7% of all renal tumors. most are incidental findings. Differential diagnosis with renal cells carcinoma is often difficult. Here we report a case of big renal oncocytoma as an incidental finding while performing an abdominal ultrasound in a patient with low abdominal pain. We also review the diagnostic an therapeutic approach in this kind of malignancies.

[Continent urinary diversion]. / Derivación urinaria continente.

Even recognising that no suitable method of urinary by-pass is yet available, continent by-passes provide the still valid cutaneous ureteroilestomy with the possibility of not having to carry a collector pouch as well as better long-term preservation of renal function. This paper reviews the different techniques used nowadays, explaining their advantages and disadvantages. Kock's is presented as a versatile method which allows its use as a reservoir or a vesical orthotropic substitution, with low complications rate in ureteroileal anastomosis, but at the expense of a greater difficulty of execution. Indiana's Pouch is an easy-to-perform technique with good results and low reoperations rate. The possibility of long-term metabolic complications and, even more, the need of the patient's collaboration who must fulfil some minimum requirements of manual ability and understanding of the intervention carried out, are crucial items in the conduct of continent urinary by-passes.

[Hydrodynamic and biochemical effects of hypothermic perfusion of isolated kidney according to the type of pump]. / Efectos hidrodinámicos y bioquímicos de la perfusión hipotérmica de riñón aislado según el tipo de bomba utilizada.

OBJECTIVE: To study on isolated kidney perfusions by means of a self-designed computer-controlled organ perfusion system the hydrodynamic and biochemical effects of two types of pumps: a self-designed vacuum powered tubular pump and a classical roller pump. BASIC PROCEDURES: Experimental study performed on 12 right mini-pig kidneys. After transperitoneal bilateral nephrectomy, organs are perfused with Eurocollins solution in a randomised manner with one type of pump. The system records continuously perfusion pressure, flow and renal resistance. RESULTS: Medium renal vascular resistance was significantly lower in vacuum powered tubular pump perfusions. LDH level in the solution showed correlation with perfusion flow. CONCLUSIONS: Vacuum powered tubular pump increases renal flow and lowers renal vascular resistance significantly in comparison to roller pump. LDH level in the solution is related to good-quality hydrodynamic perfusion parameter values.

[Non-surgical treatment of testicular cancer: guidelines for the urologist]. / Aspectos no quirúrgicos del cáncer testicular: guía práctica para el urólogo.

Near 70% of patients diagnosed with testicular seminoma make their presentation without metastasis. Although spread at the time of diagnosis is the rule, 25% of non-seminomatous germ-cell tumours are found confined to the testicle at presentation. Standardization of diagnostic and follow-up methods -within reach of most urology services- should allow a closer relationship between urologists and testicular tumours. Observation of "aggressive" surveillance schedules for stage I non-seminomatosous tumours confined with no risk factors, and use of radiotherapy to treat low degree (I,IIa and IIb) seminomas should allow urologists an initial control of up to 50% of patients. Occurrence of relapse or presentation in advanced stages force the use of chemotherapy. The present paper outlines the most basic aspects of non-surgical treatment of patients with testicular tumours.

[Computer-controlled isolated kidney hypothermic perfusion system]. / Sistema de perfusión hipotérmica de riñón aislado controlado por ordenador.

OBJECTIVE: To evaluate at the laboratory a self-designed computer-controlled kidney perfusion system. A vacuum powered tubular pump with active valves developed by our group is used. This pump is able to produce a flow and pressure patterns very similar to the pulse wave in the human circulatory system. BASIC PROCEDURES: This is an experimental study performed with mini-pig kidneys. After transperitoneal bilateral nephrectomy, both organs are sorted either to immediate perfusion or to perfusion after a period of 24 hours of cold storage in Eurocollins solution. The system is able to record continuously perfusion pressure, flow and intrarenal resistance. RESULTS: A progressive decrease in renal vascular resistance along with an increase in the flow value were observed during the procedures. These dynamic changes become evident both in immediate and deferred renal perfusions. CONCLUSIONS: Computer-controlled kidney perfusion system provide us the opportunity of recording in real time renal microcirculatory state modifications during a perfusion. Vascular system seems to be actively modified by the perfusion. This fact should be researched in the next future.

[Limitations of ultrasonography in the clinical course monitoring of bladder tumors]. / Limitaciones de la ecografía en el control evolutivo de los tumores vesicales.

Ultrasonography is a fairly innocuous test in the follow-up of bladder tumours. Its results, however, can not be superposed to those of cystoscopy. This study aims to identify the risk factors for failure of transabdominal ultrasonography in the FU of bladder tumors. The influence of the primary tumour, sex and age of patients on the ability of ultrasonography to detect relapses was analyzed. Chi square and Student's t tests were used to associate the characteristics of primary tumours and patients to the results of ultrasonography. Student's t test was used to estimate the effect of diagnostic oversight in terms of annual recurrence rate and progression. The characteristics of primary tumours where relapse was detected or overlooked had no influence on the results of ultrasound follow-up as neither did age and sex. No differences were detected in recurrence rate of patients with anticipated (0.57) or overlooked (0.58) tumours. Although differences in progression rates (4.76% and 9% for overlooked and identified tumours, respectively) were substantial, they did not reach statistical significance. There are no features in the original tumour or the patient to anticipate the failure of ultrasound monitoring. Multiple and/or small relapses are overlooked more frequently that single and/or large ones, and tumours located in lateral walls, base and dome may be unnoticed. In spite of oversights, alternate ultrasound/cystoscopic monitoring does not compromise the outcome of the disease.

[Analysis of the reliability of ultrasonic estimates of the posturination+ residue]. / Análisis de la fiabilidad de la estimacion ecográfica del residuo postmiccional.

OBJECTIVES: The most precise procedure for the measurement of residual urine volume is bladder catheterization; nevertheless, it takes real associated morbidity. Our objective is to define the accuracy of bladder ultrasonography when residual volume estimation is performed. METHODS: Thirty patients were studied. Ultrasound estimation of residual volume was undertaken with Simpson's method V = (pi/6) x L x T x AP. Obtained values were contrasted with the post-catheterization registered ones. RESULTS: The mean ultrasound estimated residual urine volume was 82.1 ml., versus 156.5 after catheterization. The mean difference was 74.4 ml. (significant, p < 0.001). Correlation coefficient was 0.93. Regression equation was calculated, a well as the corrected formula that, according to the outputs of our study, offers greater reliability in the estimate of the aforementioned volume. Ultrasound sensitivity when proper estimation of volumes equal or greater to 100 cc. is carried out was only 47%, opposite to the elevated specificity (100%) for this purpose. CONCLUSIONS: Transabdominal ultrasound underestimates, to a large extent, the values of residual urine volume. We consider that ultrasound estimation of residual volume constitutes an alternative to be kept in mind; nevertheless, the formula to calculate this volume through bladder diameters introduces an important error and so, it should be corrected.

[Prostatic adenocarcinoma associated with incidental intestinal carcinoid]. / Asociación de adenocarcinoma prostático y carcinoide intestinal incidental.

The association of a carcinoid tumour with non-endocrine urologic neoplasms is an infrequent finding. This paper contributes one case of multiple primary neoplasm where a prostatic adenocarcinoma coexists with an intestinal carcinoid tumour in a 63-year old asymptomatic patient. Diagnosis of prostate cancer was achieved during a screening for this conditions whereas the intestinal carcinoid tumour was found in the extension study.

[Renal hematoma as a result of internal ureteral catheterization]. / Hematoma renal como consecuencia de la cateterización ureteral interna.

INTRODUCTION AND OBJECTIVE: Urinary catheterization by means of an internal ureteral catheter in an usual procedure that may present complications. In this article we presented a case of perforation and later renal subcapsular hematoma after the placement of a "double-J" catheter. CONCLUSIONS: This complication, although rare, should be kept in mind. The manner of avoiding it is to maintain the tightness of the guidewire while inserting the ureteral catheter. Usually, the consequences are not life-threatening and are solved with conservative treatment. The administration of LFRE should be delayed until the resolution of the hematoma.

[Ureteral resection of ureteral inflammatory polyp associated with lithiasis]. / Ureteroresección de un pólipo inflamatorio ureteral asociado a litiasis.

We report on a fibroepithelial polyp case with inflammatory characteristics located in the pelvian ureter, and related with an ureteral calculus, which was treated in a conservative way with ureteroscopic resection, after the pincer extraction of the stone. Our team found two fibroepithelial polyp cases in the bibliography reviewed treated with ureteroscopic resection. We consider that the polyp's reactive inflammatory nature is due to the urothelial chronic irritation caused by the calculus.

[Treatment with sildenafil of cold glands syndrome after inflatable penile prosthesis]. / Tratamiento con sildenafilo del síndrome de glande frío tras implante de prótesis hidráulica de pene.

OBJECTIVE: To evaluate the effect of sildenafil on the response of glans penis during sexual intercourse in patients with penile prosthesis who show cold glans syndrome symptoms. MATERIAL AND METHODS: Fourteen patients who had undergone three-piece inflatable penile prosthesis implantation were evaluated. In spite of the normal functioning of the device all of them complained of a degree of dissatisfaction during SI due to a lack of engorgement in the glans penis. The patients were advised to have a dose of 100 mg VO sildenafil about 45 minutes before activating the PP and starting SI. All of them followed this scheme at least three times. They ticked questions 7, 8, 13 and 14 of the International Index of Erectile Function (IIEF) questionnaire with/without having had sildenafil. RESULTS: Twelve out of thirteen patients (85.7%) indicated a more pleasant SI on sildenafil. It was related to an increase in penile glans engorgement and sensitivity. The scores obtained in the IIEF questions showed a significant increase on taking sildenafil. The partners also talked of a more comfortable SI that they related to a less painful penetration. Sildenafil-related morbidity was not found. CONCLUSIONS: Sildenafil could be used to improve functional results of the penile prosthesis in those patients with CGS and seems to increase satisfaction during SI.

[Is it possible to do without bone gammagraphy in the staging of prostatic cancer?]. / Es posible prescindir de la gammagrafía ósea en el estadiaje del cáncer de próstata?

Since the discovery of the prostate specific antigen, and its use as tumoral marker, not only this has been shown to have a significant application for the diagnosis and evaluation of prostate cancer management, but also to be an eventual help to predict occurrence of bone metastasis. A retrospective study was conducted in 50 patient with prostate cancer, with mean age of 74 years (range 56-90), where PSA levels were analyzed and then correlated with the results obtained with bone scintigraphy. Our work results were that, given a 40% prevalence of the metastatic disease, no patient had PSA values under 10 ng/ml and, at the same time, bone dissemination, i.e., a 100% negative predictive value. Thus, we can state that in our group, we could have given a PSA cut-off value over 10 ng/ml to perform bone scintigraphy, without making any staging mistake.

[Effect of cell differentiation in prostatic cancer on basal PSA]. / Influencia de la diferenciación celular del cáncer de próstata sobre el PSA basal.

The effect of cell differentiation on PSA production in patients with prostate cancer has been evaluated. With this intention 70 patients were included and were analyzed for age, T stage, cell differentiation, bone scan involvement and PSA level prior to therapy. In well-differentiated tumours mcan PSA was 31.3 ng/mL, 56.6 in those with moderate differentiation and 31.6 in poorly differentiated ones (p > 0.05). Multivariate analysis shows no significant differences between both variables, but and inverse relationship between cell differentiation and PSA production (r = -0.27, p > 0.05) can be seen. The most influential variable on PSA levels was de extent of bone scan involvement. Cell differentiation as confusion variable to interpret PSA values in poorly differentiated tumours deserves further study to know the exact role of this protein as a treatment response criterion in prostate cancer.

[Antimicrobial prophylaxis in urology]. / Profilaxis antimicrobiana en urología.

UNLABELLED: Antimicrobial prophylaxis in surgery has proven to be effective in controlled randomized trials. Usage in Urology is known at least since the '30s although its effectiveness has only become known since 1979. METHODS: Review of literature related to surgical antibiotic prophylaxis, more specifically urological surgery, basically from 1991 to 1995, but without overlooking those papers that have become classics due to their impact. RESULTS AND CONCLUSIONS: Efficacy of antimicrobial prophylaxis in urological surgery is nowadays beyond all doubt. Usage is indicated in the presence of sterile urine and dosage must be short, in single dosis in the immediate pre-operative or within 24 hours after the procedure. However, there is a number of issues that deserve to be treated in more detail for better understanding. Those are the establishment of adequate prophylactic regimes in renal transplantation and the use of antimicrobials based on their pharmacokinetic characteristics to optimize the prophylactic purpose.

[A diagnostic algorithm based on transrectal echography in failure of surgery correcting stress urinary incontinence]. / Algoritmo diagnóstico basado en la ecografía transrectal en los fracasos de la cirugía correctora de la incontinencia urinaria de stress.

Transrectal ultrasound is a dynamic imaging diagnostic technique for the study of stress urinary incontinence (SUI). The highest efficiency is obtained in the study of failed corrective surgery of SUI. Our group studied 23 patients reporting clinical SUI after undergoing corrective surgery, 23.3% patients with transrectal ultrasound showed no condition that could justify it (bladder neck hypermobility, intrinsic sphincteral incompetence, calcification of suspension threads, urethra diverticulum...); 34.8% showed bladder neck hypermobility, indicative of failed corrective surgery; 34.8% showed presence of open urethra at rest, an echographic sign of intrinsic sphincteral incompetence; and in 4.3% cases the existence of intravesical calcifications of the suspension threads was diagnosed. Transrectal ultrasound can become the choice test to perform in this group of patients, leading to the performance of other diagnostic tests and offering an adequate customized solution for each patient's problem.

[Obstructive nature of the "double-J" ureteral catheter in idiopathic retroperitoneal fibrosis]. / El carácter obstructivo del catéter ureteral en "doble-J" en la fibrosis retroperitoneal idiopática.

INTRODUCTION AND OBJECTIVES: "Double-J" ureteral stents are commonly used for ureteral diversion, Obstruction of these devices is rare in the absence of certain circumstances. The objective of this article is to discuss the origin of stent obstruction in the Idiopathic Retroperitoneal Fibrosis (IRF) context, and to suggest the most suitable type of urinary diversion. METHODS AND RESULTS: We presented three cases of extrinsic ureteral compression due to IRF who were inserted soft polyurethance "double-J" stents (Urosoft, Angiomed brand), 7 Fr. with multiple side holes. These stents finally turned out as obstructive ones, and needed to be changed for other types of diversion. CONCLUSIONS: Steroid treatment constitutes the first option for these patients, but if ureteral obstruction occurs, diversion should be carried out. We prefer internal ureteral diversion with spiral-reinforced ureteral stents, being also valid options percutaneous nephrostomy or external ureteral stents made of a more rigid type of polyurethane, according to the case. When a soft polyurethane stent is used in a patient with FRI, we should perform a very strict follow-up with appropriate image studies, since the possibility of being not effective always exists.

[Diagnostic and therapeutic retrograde ureterorenoscopy (URS)]. / Ureterorrenoscopia retrograda (URS) diagnostica y terapeutica.

Presentation of results obtained in 50 procedures of retrograde ureterorenoscopy (URS), and discussion based on the literature and our results, on the current indications for URS with regard to extracorporeal lithofragmentation (ECL) for the treatment of pelvic ureteral lithiasis and the diagnosis and/or treatment of other conditions. Fifty URS were performed in 47 patients between February 1992 and March 1994: 35 were conducted to treat ureteral lithiasis, achieving a 97% success rate and a mean post-surgery hospital stay of 48 hours; and for diagnostic and/or therapeutic reasons. There were no major complications, and a description is made of minors cases. We prefer to use URS in those cases of distal ureteral lithiasis, as compared to ECL, because of its level of efficacy (higher than or equal to ECL), low cost/benefit ratio, low morbidity and shorter hospital stay involved. The paper emphasizes the major diagnostic and therapeutical indications for URS, and finally, it is noted that URS can avoid undertaking other more aggressive urinary by-passes, since it allows to catheterize the ureters where a false intramural route is conducted.

[Expectant treatment of superficial bladder tumors: preliminary results]. / Tratamiento expectante de los tumores vesicales superficiales: resultados preliminares.

A group of patients presenting with superficial bladder tumors (Ta-T1, G1-G3) was entered in a surveillance program following TUR. A standard univariative analysis was used to study tumor and patient prognostic factors to recurrence and progression. To define further the importance of each variable, a multivariative analysis was performed. Regardless of stage, grade and sex, patients with multiple tumors and/or size > or = 2 cm were particularly exposed to frequent recurrences. Early recurrences (before month 9) were associated with high recurrence rates. Considering the results of topical chemotherapy and toxicity of BCG immunotherapy, surveillance could be and option for superficial bladder tumors, reserving adjuvant therapy for large, multiple or early recurrence.