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Introduction: San Antonio, Somacarrera (1977) and Rousaud-Inmark (1984) studies established the first data of incidence and prevalence about urolithiasis in Spain. Other regional or national epidemiologic details were given for several authors from 1977 to 2002., Material and Method: Sixteen papers with original data about incidence or prevalence have been selected, 5 of them are about incidence, 8 about prevalence and 3 include both. Ten papers are based on poblational research (San Antonio, Martin, Pedrajas, Rousaud-Inmark, Torres, Ripa, Romero, Grases, Alapont, Aíbar), 5 on subjective estimations (Solé-Balcells, Cifuentes, Puigvert, Serrallach, Conte) and one include both (Somacarrera). Seven papers are nationwide and 9 are about local areas. A map with different location studies is presented and a data register show incidence and prevalence medians., Results: The Spanish median urolithiasis incidence is 0.73%, corresponding to 325,079 new cases per year; and the prevalence is 5.06%, corresponding to 2,233,214 cases., Discussion: Methodologically the best epidemiologic studies about lithiasis are based on general population survey. The commonest slant is extract data from retrospective clinical registers. Most studies have significant methodological difficulties, but they reflected interest about epidemiology of stone disease in Spain. There is a concordance between Spanish results and international published data.

Objectives: To study the mortality due to genitourinary diseases in mercury miners., Population and Methods: 3.998 workers exposed to mercury in Minas de Almadén y Arrayanes S.A. were studied. The follow-up period was a century, since 1,895 to 1,994. It was completed assessing the vital status and the basic cause of death, in case of fatalities. Standardized Mortality Ratios by age, sex and calendar period were calculated. Expected deaths were obtained from age, sex and calendar period specific rates for the Spanish and Castilla-La Mancha populations., Results: A significant increase in mortality due to genitourinary diseases was found (CIE-9 codes 580 to 629), being significant with respect to the total population for nephritis, nephrotic syndrome and nephrosis, with SMR of 1.69 an 95% CI 1.18 to 2.34. Mortality excesses due to nephritis, nephrotic syndrome and nephrosis were higher in the metallurgy workers than in miners. A Poisson multivariate regression detected a positive trend in the mortality due to nephritis and nephrosis associated to the exposure length, with the risk increasing fivefold after 30 years of exposure to mercury., Conclusions: This paper shows an excess in the mortality due to genitourinary diseases, specially in nephritis, nephrotic syndrome and nephrosis, whose estimation and significance increases when compared to the population of Castilla-La Mancha.

Objectives: The aims of this paper are: 1. To study the demand and reasons why of the vasectomy in area 12 of Valencian Community. 2. To analyse the adverse effects of our series and the predictable risk factors. 3. To review the adverse effects in the national series. 4. To review the adverse effects referred to in international publications., Patients and Methods: A retrospective study was made of 300 patients who had submitted themselves to a vasectomy between january 1992 and december 2000. All the clinical dossiers were reviewed according to 10 pre-established variables. age, number of offspring, reasons why, pre-vasectomy anticontraceptives; date of operation, type of anaesthesia used, pathologic anatomy, semen analysis after vasectomy, adverse effects and their possible causes (risk factors). The basic statistic study was done using a data base of Microsoft Access and the interpretations of the different variables using a table of Excel., Results: The demand for contraceptive attention (vasectomy) is the 8th cause for external urological consulting and the 4th for urological local ambulatory surgery of our area. 300 operations were done during that period. The average age of the patients was 37.5 years old (ranging from 25 to 51). The number of offspring ranged from 1 to 7, with a promedia of 2.41 children/patient. The reasons why were: voluntary family planning (86%), medical illnesses of the female which contraindicated gestation (9%), genetic reasons (4.33%) and social-sanitary problems (0.66%). Contraceptive methods used by 71.63% are known: The widest-used method being IUD (49.74%) and the preservative (25.88%). 30 patients (10%) had adverse effects, 29 patients having light adverse effects. The most frequent were: 12 orchiepididymitis (4%), 5 spermatic granulomas (1.66%), 3 chronic scrotal pain (1%), 2 scrotal haematoma (0.66%) and 2 bleeding (0.66%). There was one serious complications and of all the cases mentioned above only one needed hospitalization (impetigo-sepsis) and another needed surgery due to a spermatic granuloma. There were no pregnancies or post-vasectomy court cases. 81% of the patients had been declared azoospermic within 45 to 60 days after the vasectomy in one or two consecutive semen analysis., Conclusions: The vasectomy is a safe and simple way for male sterilization. It's the most widely done urologic operation in Spain. The technique isn't extent of adverse effects (0 to 18%) and its seriousness varies from a simple ecchymosis to Fournier's gangrene, endocarditis or sepsis. A doctor would be considered negligent if he/she didn't inform the patient about the remote possibility of a spontaneous recanalisation of the vas deferens leading to renewed fertility (failure of the vasectomy). It is imperative to give post-vasectomy information where the patient must continue using his habitual anticonceptive method until the azoospermia shown in 2 semen analysis confirm the sterility of the patient so that the urologist has no legal problem.

Introduction and Objectives: Non-transitional cell tumours of the bladder are both a diagnostic challenge for the pathologist and a therapeutic challenge for the urologist, because although uncommon (less than 5% of all malignancies of the bladder) they show different biological behaviours each requiring a unique approach. The most significant pathoanatomical types are: primary epidermoid carcinoma, primary adenocarcinoma and primary sarcoma. This paper presents an analysis of our experience in these types of tumours., Material and Methods: A retrospective study of unusual cases of cancer of the bladder seen in our hospital between 1988-2001. Their biological behaviour and the therapies applied are analysed. The extravesical origin of the tumour was ruled out in all cases., Results: We found 21 cases of the following pathoanatomical varieties: 13 epidermoid carcinomas, 7 adenocarcinomas (3 urachal) and 1 sarcoma. Mean age was very different between epidermoid carcinomas (69.2 +/- 9.1 years) and adenocarcinomas (50.3 +/- 8.1). Tumour behaviour was very aggressive in all three histological varieties. At the time of diagnosis 19 patients had locally advanced stages (> or = T2). Although elective therapy was cystectomy, this was only feasible in 10 cases. Systemic chemotherapy (most frequently M-VAC) and/or local radiotherapy was used in 7 cases. 14 patients have died after a mean survival of 15.7 +/- 11.6 months., Conclusions: Late diagnosis of these tumours and their aggressive biological behaviour involve a gloomy prognosis. Only early diagnosis and radical therapy could improve the prognosis.

The high prevalence of Benign Prostate Hyperplasia and the increased demand for care of this condition, should compel us to plan for shared care models in parallel to Primary Care, in the way it has happened with entities such as HBP and Diabetes. The set of measurements to be adopted when sharing services with primary care is known as "shared care". This paper presents the first national experience of "shared care" with primary care in BPH. The project has consisted in a series of steps to increase awareness, train and make available for family physicians, a clinical practice guide defining the criteria for initial evaluation, medical treatment and referral of patients to Urology surgeries, including with the referral document the appropriate diagnostic tests. A Quality Commission has been created to study the level of compliance of the documentation used for referral to the specialist and the clinical histories of patients treated in primary care. The results obtained are significant and most studies carried out fulfill the requirements in 60% cases, which has allowed to reduce overcrowding in the Urology outpatient offices (4200 surgery visits saved/year in our environment), has provided easy access of patients to adequate diagnosis and treatment, as well as significant financial savings (30 million pesetas/year). In short "shared care" is a reality in our environment that allows a more effective, fast medical assistance and improved access to specialist care by reducing the demand of specialized surgery hours.

In May 1911, four months after the founding of the Spanish Association of Urology, the new medical association already had 53 founding and numerary members and held with dignity its first National Congress in Madrid. The success of this first meeting and its sessions was described not only by all the specialized journals of the time but also by the non-medical press, the chronicles and gossip news of which we broadly review in this paper. The reading of the Book of Proceedings of the I Congress of the S.A.U., considered today a bibliographic rarity, allows us to discover a large part of the historical background of the foundation; to know the name of the pioneers and inspirators of the Society; and to glimpse the splendid future of an entity that in less than a year and through the vigour of its promoters, would reach enormous notoriety within the country's health-care environment.

Although the background and major details concerning the events that in 1911 culminated with the creation of the Spanish Association of Urology are well known as they have been published earlier in several papers, until now and as far as we know, no paper had presented the dates and particulars of the preparatory and constituent meetings of the Society, the first Regulations, and the semblance and biographies of the project's main inspirators and initiators. This article, prepared with abundant material from newspapers and literature of the period, extricated from the resources of the National Library and the archives of the Royal Academy of Medicine in Madrid, uncovers some unpublished data on the foundation and its advocates, and rediscovers other that although published in journals at the beginning of the century, remained forgotten or were unknown for most urologists. In this way, we complete the history of a part of our past, perhaps the most interesting one, and that of its main players.

The paper presents the results of a survey distributed to 15,000 primary care physicians (PCP) asking about their management of prostate conditions. From the 3.265 surveys completed, the following information was obtained. The number of visits for "prostatism" is low, 3.92 + 3.99 per week. Most PCPs inquired for symptoms related to prostate conditions regardless the initial reason for the visit. 95% refer the patient directly to the urologist, either with no further investigation or after a diagnostic evaluation or initial therapy. Vegetable extracts are the pharmacological group most commonly used by PCPs. They would accept to monitor the patient's evolution, after diagnosis and treatment by the urologist, and always with the specialist's regular supervision. Most show little sensitivity toward prostatic conditions and are aware of slight of null urological education received during their graduation. They are by a majority also ready for a retraining in urology permitting them one active participation in this pathology.

Until, at the beginning of our Century, the Spanish Urology finally achieved the acknowledgement that it was due to it as a specialty different from General Surgery, surgical practice of urinary tract disorders remained, all through the 19th Century, in the hands of general surgeons. As from the last quarter of the century, however, a clear trend can be glimpsed in some professionals in Spain towards specialization in this branch of surgery. Albeit the influence of the French School and French publications on the first specialists is manifest, since most of them were training in Paris, it is obvious that the genesis and progress of specialization on genitourinary organs disorders, as well as other areas, in Spain would have not been possible without the concourse and political support received from relevant personalities such as Dr. Federico Rubio y Gali and Dr. Angel Pulido Fernández, both with partial dedication to the urinary tract and to whom the Spanish Association of Urology still owns further recognition for the role they played in the promotion of these earlier specialists and the establishment of centres and hospital services where their work could be carried out. Since, during the final third of last century, the number of Spanish publications, journals and monographs devoted to urological topics, a extensive revision of which is covered in this paper, is increasingly profuse, the boom of the specialty in genitourinary tract disorders will determine its ultimate consolidation at the beginning of the 20th Century.

The urological work of Alejandro Settier (1858-1915), written between 1883 and 1890, surpasses both in quantity and quality that of all his Spanish contemporaries and colleagues. At a time when most works written by the first generation of specialist in genitourinary tract diseases in our country focused on lithotrity, litholapaxy, dissections, urethral stenosis, or minor surgery, the Settier's works comprise, apart from the common topics, such new issues as tumours of the bladder, treatment with electric currents of urine incontinence, local anaesthetics in urological surgery, or specific infections of the genitourinary tract. Although some of the more than 40 articles of Settier appeared in the most prestigious Spanish journals: "El Siglo Médico", "La Medicina Práctica", "Gaceta de enfermedades de los órganos génito-urinarios", etc. (revised in this paper), can be considered educational works, the precociousness and scientific value of the majority, endorsed by his experience, personal case records and acknowledgment by his contemporaries, grants the greatest interest over time for the written work of this urologist.

Objective: To study the number of authors of papers published in Actas Urologicas Españolas, and to assess the consequences on multiple authorship of the restriction to 6 of the number of authors for paper, established in the instructions for authors since January 1995., Methods: The authors and papers appearing on sections "Originals". "Reviews" and "Case reports" from 1992 to 1995, were counted., Results: Five hundred and forty eight papers were reviewed. The mean (+/- standard deviation) number of authors (6.1 +/- 2; 95% IC = 5.9-6.3) didn't show a statistically significant change between the 4 studied years (ANOVA, F = 1.42; p = 0.23). Fifty percent of the Originals and Reviews and 36% of Case reports had more than 6 authors and these proportions didn't change significantly between years (chi 2 = 3.48; p = 0.32), even considering that more than one third of papers published in 1995 were accepted that year., Conclusions: A great number of authors should modify their habits of co-authorship on papers submitted to Actas Urologicas Españolas, in order to fulfill the new instructions for authors.

Unsuspected multicentricity in single Renal Adenocarcinoma (RAC) together with the prospects of incomplete neoplasia removal are the 2 major disadvantages for the acceptance of traditional renal surgery in birenal carriers of medium size, low grade single RAC. This paper is a retrospective review of our series of RAC patients who underwent radical nephrectomy between January 1986 and October 1994 with the following purpose: 1) To evaluate our incidence of unsuspected multicentricity. 2) To evaluate the characteristics of such multicentricity. 3) To evaluate, in the assumption that traditional surgery had been indicated for patients with small size RAC, in how many patients tumoral resection would have been incomplete due to existence of satellite tumoral nodes in the preserved renal parenchyma. Of 110 patients undergoing radical nephrectomy, 11.8% (13/110) had unsuspected multicentricity. In 10 patients there was multiple satellite nodes with size ranging from 0.3 to 3 cm. We conclude that there is not relationship between multicentricity and size or stage of primary tumour and that, by applying strict criteria (size, location, well defined tumoral wall and form of presentation) to select the patients who can be candidates to traditional renal surgery, the probability to perform it in patients with multicentric RAC would be considerably reduced.

Urethral stenosis is the most frequently acquired disease of the male urethra. Currently there is a progressive increase of this condition's occurrence due to: improved living standard, increased number of permanent catheter bearers, surge of STDs incidence, and abuse of transurethral diagnostic or therapeutical instrumentation. However, and in spite of such increased incidence, the epidemiological features have been forgotten by most authors consulted who now focus more attention in the therapeutical aspects. This paper analyzes the most outstanding epidemiological aspects, in the province of Alicante, of 180 urethral stenosis corresponding to 175 males and 5 females, making some final considerations on the relevance of certain factors in the genesis of urethral stenosis: advanced age, depressed social class, active sexual life, STD history, urinary or genital infections.

An epidemiological study on the lithiatic disease (LD) was conducted in 'La Ribera de Navarra' over a two year-period, based on the series from the Reina Sofia Hospital in Tudela. Between May 1988 and May 1990 we gathered 785 cases. This paper analyzes the hospitalization incidence, risk factors such as age, sex, familial and personal background of lithiasis, consumption of drugs., etc. A description is made of the geographical, geological, climatic conditions, composition of water, and other characteristics, as well as the clinical features. Incidence of LE in this Area V of Navarra is high, 5.1 per thousand inhabitants/year, being uncommon in children but frequent in adults: 7.92 per thousand men/year and 4.97 per thousand women/year, with a male/female ratio of 1.52. There is a predominance of women over the early decades of life, the M/F ratio being 0.40 for the 15-24 years range. 19.61% of patients have a familial background of LE, the father being the most affected relation. Around 53.79% have been affected by LE. The factor most commonly correlated to frequency is the distance to the hospital and the rate of admission to the emergency service by area. No correction was noted to water hardness or weather differences. The greater incidence takes place during the summer and the lowest in the autumn.

The science of urology emerged as a specialty in Spain three centuries earlier than in the rest of Europe. Publication of the Treaty of Urology by Francisco Díaz in 1588 and the founding of a permanent professorship in Madrid in 1612 for the teaching and treatment of urological conditions, represent the most relevant background for the future and still distant development of the specialty. In this paper we disclose new biographical data on the scholar Martín de Castellanos, first professor 'of Urology' in the history of Medicine and briefly discuss the innovation that the founding of the chair meant for the future regulations of this surgical specialty.

The publication of the Treaty of Urology of Francisco Díaz towards the end of the sixteenth Century, was a milestone in the History of medicine. The originality and precociousness of his doctrine entailed a true revolution in the genesis of medicosurgical literature, considering that the text constitutes an inspired anticipation to the specialization age. Ever since the last century, all historians and annotators of this work have asked themselves whether there was an earlier edition to that of 1588 since the title "Newly printed treaty ..." invites such a inference. So far, every investigation searching for the original or a copy of the first edition have been in vain. This paper, based on documents and old works from the Archive of Protocols in Madrid, Library of the Royal Palace and Library of El Escorial Monastery, reveals certain data until now unpublished on the destiny of most of the copies belonging to the second edition presented and brings into light old references on which account is given that the original "Treaty of Urology" by Francisco Díaz, considered to be a Sixteenth Century Codex was lost in the fire of the El Escorial Monastery in 1671.