[Adrenal pseudocyst. Report of a new case and review of the literature]. / Pseudoquiste adrenal. Aportación de un nuevo caso y revisión de la literatura.

Adrenal pseudocyst is the commonest type of benign lesions of adrenal gland althought is a very rare entity. Most of them are found as "incidentalomas" during imaging studies. A case of a patient with a left non-functioning and asymptomatic adrenal pseudocyst is reported. The diagnostic and therapeutic options are discussed and the literature is reviewed.

[Synchronous primary urologic triple neoplasia. Report of a new case and review of the literature]. / Triple neoplasia urológica primaria sincrónica. Aportación de un nuevo caso y revisión de la literatura.

Herein we present the case of a patient who went to the emergency department complaining of haematuria. With a conservative management, the radiologic and endoscopic studies show a bladder tumour and an incidental left renal mass. After several radical procedures, the last a cystoprostatectomy, it was shown that the patient had a new tumour inside his prostate gland. We comment the surgical procedures, the clinical evolution and the five years follow-up. We review the few cases described in the literature.

[Primary adenocarcinoma of the bladder as single tumor. Study of 7 cases and review of the literature]. / Adenocarcinoma vesical primario como tumor único. Estudio de siete casos y revisión de la literatura.

Primary vesical adenocarcinoma is an extremely uncommon tumour, representing 0.5 to 2% of all the urothelial vesical neoplasias. Its behaviour is aggressive and its prognosis poor, especially in the seal ring cell variety. We present our experience in seven cases of vesical adenocarcinoma: one of urachal origin, two of the seal ring cell type, and four of the urothelial type with no other specificity. All were advanced stage tumours at diagnosis. There is no unified therapeutic strategy, and poor results were obtained with the various treatments used. Survival eight months after diagnosis was 42.8%. Longest survival is 15 months, corresponding to the adenocarcinoma of urachal origin.

[Abscess of the seminal vesicle. Clinico-therapeutic review apropos of a case]. / Absceso de vesícula seminal. Revisión clínico-terapéutica a propósito de un caso.

Reporting the case of a patient diagnosed with an abscess of the seminal vesicle, treated successfully through parasacral transgluteal percutaneous aspiration lead by computerized axial tomography (CAT). This represents the first case in the literature of percutaneous access to the seminal vesicles through this route. CAT is an effective diagnostic test which makes non-surgical treatment for this type of abscess simpler. A review is made of the literature with regard to the etiology, diagnosis and therapy of seminal vesicle abscesses.

[Wunderlich syndrome caused by the rupture of a simple cyst in a patient treated with acetyl salicylic acid]. / Síndrome de Wunderlich por rotura de quiste simple en paciente tratada con ácido acetil salicílico.

Report case of a Wunderlich syndrome due to spontaneous rupture of a simple renal cyst. The patient is a 77-year old, hypertensive female who was on routine treatment with Aspirin. The rarity of retroperitoneal haemorrhage with this origin is documented; also the influence of aspirin as predisposing factor for this condition is ruled out. Brief evaluation of the various diagnostic means available. An accurate evaluation that may allow to adopt a conservative aptitude is recommended.

[Rupture of the graft in kidney transplant. Our caseload]. / Rotura del injerto en el trasplante renal. Nuestra casuística.

316 kidney transplants were carried out in the Ramón y Cajal Hospital between November 1979 and December 1988. The number of breakages was 7. In this paper we analyse the incidence of this complication as well as the etiopathogeny of the process, highlighting the relationship between the appearance of acute rejection, alterations in coagulation, and instrumental manoeuvres carried out on the graft, especially in the first days after transplant. The clinical pattern usually displayed was pain with swelling and pasting in the area of the implant, along with hypotension, oliguria and deterioration of kidney function. We underline the importance of echography as the follow-up method in the early detection of hematomas, perirenal collections, etc., which, together with the preceding clinical data, will orientate us towards an early diagnosis. We study the possible relationship of this complication with different factors, singling out the reduced frequency of appearance after the advent of cyclosporin and its use as an immunosuppressive drug. We advocate the conservation of the implant with three dimensional corsseting, provided this is feasible and the general conditions of the patient so permit.

[In vitro study of urinary calculi fragmentation with 4 different systems of lithofragmentation]. / Estudio in vitro de la fragmentación de los cálculos urinarios con cuatro sistemas de litofragmentación diferentes.

The results of shockwave lithofragmentation are conditioned by stone composition. Similarly, the different types of lithofragmenting energy can have different effects on the calculi. The purpose of this experimental study is to establish a relationship between calculi composition and type of energy used for fragmentation, with the results of the lithotriptsy treatment. 60 calculi, 12 for each pure composition selected (calcium oxalate mono and dihydrate, phosphocarbonate, ammonium magnesium phosphate and uric acid) underwent in vitro lithofragmentation with 4 different lithofragmenting sources (electrohydraulic, piezoelectric, ultrasound and pulsed laser). It was carried out a study of fragmentation in particles under 3 mm and pulverization in particles under 0.5 mm, analyzing post-lithotriptsy fragments with scanning electron microscopy associated to X-ray dispersion energy. No relationship was shown between calculi composition and amount of energy supplied for the fragmentation. The lithiasic composition correlates to the fragmentation pattern, so that oxalocalcium calculi undergoes good fragmentation and poor pulverization, infective calculi have poor fragmentation but good pulverization and uric acid calculi show poor fragmentation and pulverization.

[The proximal migration of a double-J catheter. A review of the predisposing factors. Apropos a case]. / Migración proximal del catéter doble-J. Revisión de factores predisponentes. A propósito de un caso.

Case report of a patient bearer of a double-J ureteral catheter due to ureteral lithiasis. After persistent renoureteral pain and fever, the proximal migration of the catheter is confirmed radiologically. The predisposing factors for this complication, described in the literature, are reviewed.

[Instability of the detrusor. Treatment with oxybutynin chloride (Ditropan) in children]. / Inestabilidad del detrusor. Tratamiento con cloruro de oxibutinina (Ditropan) en niños.

We study the effect of oxybutynin chloride (Ditropan) in a random sample of 24 children with ages ranging from 5 to 14 years, diagnosed as having vesical instability from both the clinical and urodynamic standpoints. These effects were evaluated after a period of treatment that ranged from 10 to 36 months (x = 20). We obtained overall clinical improvement in 87.5%, and improvement of urodynamic alterations in 83.3% of the patients. We single out the beneficial effect of oxybutynin chloride with prolonged treatments, in instability of the detrusor, as well as its good tolerance.

[Paratesticular rhabdomyosarcoma]. / Rabdomiosarcoma paratesticular.

Presentation of one case of embryonic paratesticular rhabdomyosarcoma in a 19-year old male. Following high inguinal radical orchiectomy, he required hemiscrotectomy, and it was found to be a foreign body granuloma. Prior to staging lymphadenectomy, therapy was complemented with radiotherapy and polychemotherapy according to a VAC protocol. The patient shows clinical remission at two and a half years after being diagnosed and one and a half years after completion of treatment.

[True value of the liquid supply and its quality, in the lithiasic population]. / Valor real del aporte de líquidos y sus cualidades, en la población litiásica.

The chemical composition of 29 of the bottled mineral waters available in the Spanish market are analyzed, including composition of the tap water supplied by Canal de Isabel II, which provides drinkable water to Madrid with a population close to 5 million inhabitants. The literature relevant to the influence water and its composition may have on the lithiatic prophylaxis is reviewed, exploring data related to our waters, and offering an approach on their use in the different types of lithiasis.

[Treatment of recurrent bladder surface tumors with laser Nd:Yag: a single-year experience]. / Tratamiento de los tumores vesicales superficiales recidivantes con laser Nd:Yag: un año de experiencia.

Management of surface vesical tumours using laser photocoagulation has proven to be a safe and effective method. The technique can be performed under anaesthetic sedation and in the outpatient clinic environment thus allowing a considerable cost saving and the reduction of hospital's waiting lists. Throughout 1990, 47 patients with relapsing vesical tumours were treated in 55 sessions. Most cases were performed on ambulatory patients with a low complications rate and an estimated saving of 18,326,400 pesetas as compared to transurethral resection.

[In vitro study with techniques of imaging of the composition of urinary calculi]. / Estudio in vitro mediante técnicas de imagen de la composición de los cálculos urinarios.

Pre-treatment knowledge of the lithiasic composition can be useful to design the most appropriate therapeutic scheme for each kind of stone. The relationship between the stone's densitometry information provided by the different imaging techniques, conventional radiology (RX), computerized axial tomography (CAT) and dual energy radiographic densitometry (DO) is analyzed, as well as the elemental composition determined by the microanalysis of fragments obtained post-lithotrity using a scanning electronic microscope (SEM) associated to X-ray dispersion energy (XDE). 60 stones, 12 for each pure composition selected (calcium oxalate mono and dihydro, phosphocarbonate, magnesium ammonium phosphate and uric acid), were studied with XR, CAT and DO and were later subjected to lithofragmentation in vitro. Fragments analysis was carried out post-lithotrity with SEM associated to XDE. The X-ray does not allow to establish the composition of some calculi. CAT quantifies the mineral contents of the oxalocalcic and infective calculi and differentiates the uric acid from the other compositions because the mean density values are under 500 Hounsfield Units. DO evaluates the lithiasic content in phosphocarbonate salts which are structurally similar to bone hydroxyapatite.

[In vitro study of the process of urinary calculi fragmentation with endoscopy, light microscopy, and scanning electron microscopy]. / Estudio in vitro del proceso de fragmentación de los cálculos urinarios con endoscopia, microscopio óptico y microscopio electrónico de barrido.

Stones with different compositions respond differently to shock wave lithofragmentation. Likewise, the various lithotrity systems used may have different effects on the stones. To determine the relationships between stone composition and their fragmentation patterns, we conducted an in vitro study using endoscopy, magnifying glass, light microscope and scanning electron microscope on fragments obtained after lithotrity of 60 pure stone with different compositions: calcium oxalate monohydrate and dihydrate (OXMH and OXDH), phosphocarbonate (PC), ammonium magnesium phosphate (AMF) and uric acid (UA). Fragmentation was carried out with 4 different lithofragmenting sources (electrohydraulic, piezoelectric, ultrasound and pulse laser). No morphologic differences in the fractures induced by the various lithofragmenting sources were demonstrated. OXMH and UA stones basically break up by intercrystalline fracture and splitting of their concentric plates. OXDH breaks up mainly by intercrystalline fractures aided by the fibrillar organic material and phosphocarbonates found in the intercrystalline spaces. Fragmentation in infective stones (AMF and PC) occurs across the intercrystalline surfaces and by intracrystalline fracture. Ammonium urate fragments break up by intracrystalline fractures that run across the equatorial plane of its characteristic acicular microspheres.

[Treatment of urethral stenosis with endoscopic urethrotomy with local anesthesia]. / Tratamiento de la estenosis de uretra mediante uretrotomía endoscópica con anestesia local.

We evaluated the efficacy of local anesthesia for endoscopic urethrotomy in 20 cases of urethral stricture. Patient clinical features and maximum urine flow data before and after the procedure were compared. The technical difficulties encountered are described. Bladder neck sclerosis and/or stricture of the posterior urethra complicated the procedure. Endoscopic urethrotomy using local anesthesia is effective in the treatment of urethral stricture.

[Usefulness of endourologic catheters in the treatment of urinary lithiasis]. / Utilidad de los catéteres endourológicos en el tratamiento de la litiasis urinaria.

OBJECTIVE: To review the indications and complications of the use of endourological catheters in the treatment of urinary lithiasis and choice of catheter based on its physical and hydrodynamic characteristics and biocompatibility. METHODS: Data from our experimental and clinical studies, as well as those published in the literature are summarized. RESULTS: Polyurethane, C-flex and Percuflex catheters have the highest retaining capacity, while the silicone, Urosoft and Wiruthan catheters have the lowest. The tensile strength of polyurethane and copolymers is superior to that of silicone. The friction coefficient, which varies within the same material, influences the facility of catheter insertion. The number and size of the side vents are essential to catheter hydrodynamic behavior. Silicone is the most biocompatible material, followed by Urosoft. The polyurethanes and C-flex catheters cause important urothelial hyperplasia and edema of the lamina propia. CONCLUSIONS: The choice of endourological catheter should be individualized and based on the clinical indication. For prevention of obstruction from steinstrasse post-lithotripsy, a catheter with a high extraluminal flow and high retaining capacity is indicated to facilitate passage of stone fragments and to avoid catheter migration.

[Hydrodynamic behavior of endourologic catheters]. / Comportamiento hidrodinámico de los catéteres endourológicos.

OBJECTIVE: The present study analyzed the hydrodynamic behaviour of the double-J stent. METHODS: Thirty-two double-J stents of different sizes and biomaterials (16 new and 16 removed from patients) were hydrodynamically evaluated using two models: a) nephroureterocystectomy surgical blocks harvested from pigs and b) an in vitro experimental model of the upper urinary tract. The following parameters were measured: initial and final weights, encrusted material weight, inside and outside diameters, number, size and distribution of sideholes, wall thickness, drainage area and length of time the catheter was indwelling in the patient. RESULTS: Double-J stent placement in a normal upper urinary tract constitutes a partial obstruction that is proportional to the caliber of the catheter. Ureteral-flow reduction is 83%, 61% and 58% for 5FR, 6FR, and 7FR catheters, respectively. Extraluminal obstruction of the catheter reduces ureteral flow more than intraluminal obstruction (74%, 43% and 25% for extraluminal versus 83%, 66%, 57% for intraluminal for 5FR, 6FR and 7FR, respectively). Vesicoureteral and vesicorenal reflux pressures were 6.2 +/- 0.3 cm H2O and 35.2 +/- 2 cm H2O, respectively. CONCLUSION: Selection of a double-J stent must be individualized on the basis of indication, time indwelling, sex and route of insertion.

[Endoscopic cervicotomy: elective treatment in bladder neck sclerosis]. / Cervicotomía endoscópica: tratamiento de elección en la esclerosis del cuello vesical.

OBJECTIVES: The present study compared the efficacy of perimetric resection of the sclerotic ring (TR) and two-incision endoscopic cervicotomy (TC) for bladder neck sclerosis. METHODS: Fourteen cases (11 primary and 3 recurrence) underwent perimetric TR using a conventional 24 F curved loop resectoscope to excise the sclerotic diaphragm completely. In 11 cases (9 primary and 2 recurrence following previous perimetric (TR) two deep incisions were made at 5 and 7 o'clock with the Collins blade. Occasionally, the Sachse urethrotome had to precede the insertion of the conventional 24 F sheath. RESULTS: Of the 14 cases with bladder neck sclerosis that underwent perimetric TR, 5 (36%) recurred, while no recurrence was observed in the 11 patients treated by double TC. The results were assessed on the basis of the clinical findings and control flowmetry. CONCLUSIONS: Dysuria was the most common clinical symptom and was confirmed by flowmetry. Confirmation must be done endoscopically and preferably under anesthesia to permit treatment, if required, during the same session. TC is more reliable and TR is not advocated because of the high recurrence rate.

[Changes in physical characteristics of endourologic catheters caused by shock waves]. / Modificaciones de las características físicas de los catéteres endourológicos inducidas por la onda de choque.

OBJECTIVE: To analyze the shock wave effects on double-J stent. METHODS: Retention strength modifications induced by shock waves were analyzed: a) 60 double-J stents obtained from patients were compared (20 had not been treated by ESWL; 20 had been treated by piezoelectric-ESWL and 20 by electrohydraulic-ESWL; b) the effects of piezoelectric-ESWL were determined in vitro using 36 stress-tested double-J stent segments (Urosoft, C-Flex and silicone) vs. a control group. RESULTS: The retention strength of the stents from ESWL-treated patients, especially those that had been submitted to piezoelectric-ESWL, was lower than in stents from patients that had not undergone ESWL (p < 0.05). The foregoing has been corroborated by the in vitro findings. The impact frequency causing maximum damage is specific for each material. Microphotographic studies revealed fracture lines on the surfaces of the ESWL-treated stents (Urosoft and C-Flex). CONCLUSIONS: The foregoing findings may explain the high incidence of double-J stent migration observed in ESWL-treated patients.