[Our experience in high-flow priapism due to uni-or bilateral arterio-lacunar fistula]. / Nuestra experiencia en el priapismo de alto flujo por fístula arterio-lacunar uni y bilateral.

OBJECTIVE: To present our experience in both uni-and bilateral priapism, highlighting good results obtained with supraselective embolisation. MATERIAL AND METHODS: We present 5 cases of high-flow priapism secondary to perineal trauma, with a mean age of 31 years (24-43 years). The mean time to presentation from the moment of the trauma was 18, 6 days (1-60 days). Diagnosis was confirmed through gasometry of the corpora cavernosa, penile Doppler ultrasound (2 cases) and selective arteriography of the pudendal artery. In all cases treatment was by supralective embolisation with gelatin sponge. In the two bilateral cases, embolisation was performed in the same act. RESULTS: In the short-term was a recovery of flaccidity and in the long-term (3-4 months) a recovery of erection with no fibrotic sequelae of the corpora cavernosa. CONCLUSIONS: Embolisation of the lacerated artery, in a single procedure in cases of bilateral lacerations, provides excellent results.

[Intracavernosal methoxamine self-injection for the treatment of low-flow recurrent priapism]. / Tratamiento del priapismo recurrente de bajo flujo mediante autoinyección intracavernosa domiciliaria de metoxamina.

We report the case of a young man with a recurrent idiopathic priapism, successfully treated with methoxamine intracarvenosal self-injections. The patient was instructed in intracorporeal self-injection of this pure alpha-1 adrenergic agonist, which provided complete detumescence. The patient became asymptomatic after one month of domiciliary treatment. We conclude that intracavernosal self-administered methoxamine can be a useful treatment of recurrent idiopathic priapism.

[Incomplete urethral duplication]. / Duplicidad uretral incompleta.

Urethral duplicity is a rare congenital malformation. We report a case of one 25 years old male suffering recurrent urinary infections. The diagnostic of uncompleted urethral duplicity was performed by retrograde urethrography and micturating cystourethrogram. The accessory channel was excised by a perineal approach. Clinical results were satisfactory, remaining an asintomatic patient two years after surgery, with normal mictional behavior.

Comparison between different bone treatments on areal bone mineral density (aBMD) and bone microarchitectural texture as assessed by the trabecular bone score (TBS).

PURPOSE: The objective of the study was to assess longitudinal effects of different osteoporosis treatments on TBS and aBMD at lumbar spine. METHOD: We analyzed 390 patients (men: 72; women: 318; age>40 years; mean follow-up of 20 months and BMI<37 kg/m(2)). We stratified the cohort by treatments: Naive of treatment (Naive, n=67), Calcium and Vitamin D (CaVitD, n=87), Testosterone (Te, n=36), Alendronate (AL, n=88), Risedronate (Ri, n=39), Denosumab (Dmb, n=43) and Teriparatide (PTH, n=30). The follow-up changes from baseline were normalized at 24 months. RESULTS: After 24 months, Naive group TBS decreased by 3.1% (p<0.05) whereas a non-significant increase was observed for spine aBMD (Δ=+0.5%). Compared to the Naive group, significant improvement (p<0.05) was observed in both TBS and aBMD for Te, AL, Ri, Dmb and PTH groups and in the CaVitD group for TBS. At the end of the follow-up, significant improvement have been observed for aBMD in Te (+4.4%), AL (+4.1%), Ri (+4.8), D (+8.8%) and PTH (+8.8%) groups. Significant improvement was observed only in the AL (+1.4%), Dmb (+2.8%) and PTH (+3.6%) groups for TBS. CONCLUSION: As expected, TBS of Naive subjects decreased with age. As expected a TBS preservation has been observed under AL and Ri. Te and CaVitD effects on TBS were evaluated for the first time: a similar preservation effect has been observed. A significant TBS increase was observed under Denosumab and PTH. TBS could be a useful tool to monitor treatment effects.

Salivary testosterone in cryptorchid pubertal boys: a parameter to assess the gonadal function.

The authors studied salivary and serum testosterone (T) levels in basal conditions and at 6 and 12 months after orchidopexy in 36 pubertal boys with unilateral or bilateral cryptorchidism. Boys were divided into two groups according to Tanner classification. Salivary and serum T levels were significantly lower in the group with scanty or absent sexual development than those obtained in the group with normal development. Both groups exhibited similar saliva and serum testosterone values at 12 months of the follow-up study. The data shown indicate that salivary T seems a good index for evaluating the androgenic status of these patients.

[Treatment with the Newbit technique in patients with Peyronie's disease]. / Tratamiento con la técnica de Nesbit en pacientes con la enfermedad de Peyronie.

OBJECTIVE: Evaluate the results of Nesbit's technique in patients with Peyronie's disease. METHODS AND MATERIALS: Between 1990 and 2002, 45 patients were treated using the Nesbit's procedure to correct Peyronie's disease curvature. Mean age was 57.6 (range 41-73). Dorso lateral incurvation was the most common. RESULTS: Total correction of the curvature in 40 patients (88%). High grade of satisfaction in 39 patients (86.66%). CONCLUSION: Nesbit's operation is an easy and effective surgical technique in the peyronie's disease for curvature correction.

[Renal angioscopy]. / Angioscopia renal.

Presentation as a novelty of the application of endoscopic methods in the display of the renal artery (angioscopy). Review of findings seen in the renal artery of a donor corpse with polytraumatism using direct view with a MiniScope-type rigid urethroscopy and the possible future application of this technique.

[Penile erectile dysfunction secondary to hypophyseal adenoma]. / Disfunción erectil peneana secundaria a adenoma hipofisario.

Increased production of prolactin by the pituitary is a factor to be taken into account as a cause of peneal erectile dysfunction (PED), which varies depending on the series from 1 to 16%. 1,2,7 We contribute in this paper one patient with infertility and erectile dysfunction secondary to a prolactin-producing pituitary tumour, prolactin plasma levels returning to normal after treatment with bromocriptine, which also achieved a remission of the clinical picture.

[Our experience with the implant of single component integrated prostheses (Hydroflex-Dynaflex)]. / Nuestra experiencia en el implante de prótesis integradas de un solo componente (Hydroflex--Dynaflex).

INTRODUCTION AND OBJECTIVES: To present our experience with Hydroflex and Dynaflex self-contained inflatable penile prosthesis. MATERIAL AND METHODS: Between october 1988 and december 2000 a total of 63 men underwent implantation of 8 Hydroflex and 55 Dynaflex penile prosthesis. The follow-up period ranged from 12 and 127 months (mean 54.5). RESULTS: A total of 124 cylinders were implanted (in 2 cases only 1 cylinder was implanted). During implantation 3 corpora cavernosun ruptures were present, but implantation was possible in 2. Specific complication rates after implantation were as follow: early infection, 3 patients (4.7%); late infection, 1 patient (1.6%); pain that needed readmission 2 cases (3.2%); mechanical device failure, 7 cylinders in 6 men (mean time 83.5 months). 7 men (11.1%) needed prolonged teaching time to operate the prosthesis. Only 6 men (9.5%) wer dissatisfied with the prosthesis. It was possible to change only 1 cylinder when needed. CONCLUSIONS: Self-contained inflatable prosthesis brings good results on long time use. The mechanical malfunction rate is low and it is possible to change only one cylinder if needed. An important number of patients need intensive and prolonged teaching time to obtain a successful result.

[Cyst of the prostatic utricle]. / Quiste de utrículo prostático.

Presentation of a case of prostatic utriculus cyst which due to its size and the patient's history suggested a differential diagnosis with a urethral or vesical diverticulum. Awareness of frequent association to urethral malformations and azoospermia would be very useful when choosing a treatment strategy in such cases.

[Urethral foreign body]. / Cuerpo extraño uretral.

A case is described of a urethral foreign body of long evolution, introduced for masturbatory purposes and which had its clinical origins as a periurethral abscess. We comment on the diagnostic steps and the therapeutic attitude followed.

[Renal hydatid cyst]. / Quiste hidatídico renal.

We present a case of urinary way fistulized renal hydatid cyst, which displayed itself clinically by repeated nephritic colics caused by the expulsion of calcified daughter vesicles. We make special mention of the diagnostic process and the surgical technique used, which included cystopericystectomy and anterograde ureteroscopy for the extraction of the calcified daughter vesicles at ureteral level.

[Rigid ureteroscopy: results and complications]. / Ureteroscopia rígida: resultados y complicaciones.

We make an evaluation of 66 ureteroscopies (URS) carried out in our Service over a period of 18 months. In 55 cases it was done for therapeutic purposes in ureteral lithiasis, and in 11 cases it was for diagnostic purposes. In the treatment of lithiasis resolutive effectivity at the first attempt was 68%, in 9% ureterolithotomy had to be performed due to the impossibility of approaching the calculus, and in 23% supplementary treatment was carried out by means of external litrotripsy. In the diagnostic field, effectivity was 72%. Notable complications arose in 6 cases (9%), 6 ureteral perforations, in three of which a urinoma was formed, all settled with a double J catheter. Open surgery was not resorted to in any case. No sequelae were observed and this technique therefore showed itself to be safe and effective.

Effects of testosterone treatment on bone mineral density in men with testosterone deficiency syndrome.

The decline in testosterone levels found in men with testosterone deficiency syndrome (TDS) is associated with a decrease in bone mineral density (BMD). To study the safety profile and efficacy of testosterone treatment on BMD in patients with TDS. In this 2-year prospective open-label study, patients were administered 50 mg of testosterone gel daily (adjustable after 3 months up to 75-100 mg or down to 25 mg) for 12 months, followed by treatment with 1000 mg of testosterone undecanoate every 2-3 months from months 12-24. Outcome measures were as follows: (i) Changes in clinical chemistry safety parameters and total testosterone, sex hormone binding globulin and calculated free testosterone (cFT) levels; (ii) Changes in Aging Males' Symptoms Scale (AMS) and International Prostate Symptom Score scores; and (iii) Changes in lumbar spine and hip BMD. A total of 50 men aged 50-65 years with TDS (AMS >26 and cFT <0.250 nmol/mL) took part in the study. There was no significant impact of testosterone on safety. Prostate-specific antigen and haematopoietic parameters increased significantly, although the changes were not clinically significant. Total and cFT increased significantly after 3 months (p < 0.001) and there were significant improvements after 3 months in AMS scores (p < 0.001). BMD improved significantly in L2-L4 (2.90 and 4.5%), total femur (0.74 and 3%) and trochanter (1.09 and 3.2%) at 12 and 24 months respectively. Testosterone treatment in men with TDS has a good safety profile, leads to significant improvement in lumbar spine and hip BMD, and improves symptoms, as assessed by the AMS questionnaire.

[Testosterone-deficiency as a risk factor for hip fracture in eldery men]. / Déficit de testosterona como factor de riesgo de fractura de cadera en hombres de edad avanzada.

OBJECTIVES: Progressive loss of bone mineral density weakens the bones and increases the probability of osteoporotic fractures. It is well known that sex steroids play a role in the maintenance of bone density. This fact makes us think there might be a correlation between sex steroid levels and osteoporotic hip fractures. MATERIAL AND METHODS: A case-control study was performed. The cases were 54 men who suffered from hip fracture. They were compared with 54 age-matched male control subjects. Levels of total testosterone, sex hormone binding globuline, albumin and oestradiol were measured in all subjects in order to calculate free testosterone and bio-testosterone levels. RESULTS: Men who suffered from hip fracture had lower serum total testosterone (8.74 nmol/L versus 11.16 nmol/L; p=0.116) and lower free testostenone (155.1pmol/L versus 204.4pmol/L; p=0.02) than control subjects. Bio-testosterone levels were lower in patients with hip fracture (2.69 nmol/L versus 3.89 nmol/L; p=0.002), being the latter the best fracture predictor (OR: 1.58). CONCLUSIONS: In our study population, men with hip fractures had significantly lower levels of calculated free testosterone and bio-testosterone. These findings suggest that free testosterone and bio-testosterone levels are independent predictors for osteoporotic hip fracture in eldery men.