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Introduction: Josep Trueta i Raspall, born in Barcelona in 1897, was one of the most outstanding european surgeons of his time. In 1936, after the military coup and during the subsequent Spanish civil war, he was in charge of the Surgery Service at the Hospital de la Santa Creu y Sant Pau and begins to performe a closed method to treat open fractures of the limbs, dramatically lowering the number of gangrenes and amputations between troops and civilians. At the end of the war came the exile, and he was invited by the british Health Service, he teach in Oxford and applies his knowledge on war surgery, was named PhD (Hon) and professor of ortopedics, and creates an school of clinical investigation that generates important findings in bone growing and pathology and, amont other areas, in the knowledge of renal function and kidney injuries induced by shock and blood hypertension. One of the most outstanding fruits of this investigation is the book "Studies on renal circulation", first published in English in 1947 (Oxford), then in Spanish in 1949 (Barcelona)., Material and Method: Study of Josep Trueta's biography and works on kidney function, especially the book "Studies on the renal circulation", relating them to the state-of- the- art of nephrologic studies of his time., Results: Trueta and his group were pioneers in the study of the causes of postraumatic oliguria in war wounds. On the basis of the first studies on crush syndrome, published in 1941, were the kidney failure that followed the extended injuries of the limbs was pointed out, they could demonstrated the changes in renal circulation that followed different injuries to the limbs, such as ischemia, haemorrhage and infections. "Studies on the renal circulation" and other papers published in journals of high scientific impact, shown the renal cortical ischemia with preservation or increase of the medullar and yuxtamedullar circulation that takes place in those pathological situations (Trueta shunt). Although their contributions and hypothesis were not definitives, they served as the basis to studies performed later on, on acute kidney failure secondary to shock, glomerulonephritis, transplant rejection and blood hypertension., Comment: Trueta's works are unusual examples of investigations directed to answer clinical questions. What may calls one's attention is the wide field of investigation he moves on, that today would involved several medical specialities, different to his task as orthopedic surgeon. On the other hand, his love by Catalonia, his country, moves him to write "The spirit of Catalonia" (1946), a short text for English-speaking people, on the political and scientific history of Catalonia. Trueta was in the end, an humanistic intellectual with broad interests, reflected on his books on travels or on the life of classic sages such as Luis Vives, Miguel Servet or Cajal. He returned back to Catalonia in 1966 and died in 1977. His book "Studies on the renal circulation", exquisitely illustrated and edited deserves a distinguished place in the European medical and urological historiography.

Introduction: Research in Medicine is essentially based on three knowledge resources: diseased people (natural and primary), cadaveric bodies (Pathology primary resource) and experimental animals, whom constitutes physiopathologic knowledge resource. Experimental advances reached in the last century have determined the change of the concept "experimental animal" to a wider term: "experimental model"., Objectives: This paper tryes to clarify this concept. To attain this goal, we must define previous considerations in the meaning of the concept "experimental models" and its two key-elements: statistics and design of experiments.

Introduction: Laparoscopic surgery requires a long training period of time in which the complexity of the training is increased., Goals: The technique presented in this paper has been developed in order to find an experimental model that allows us to improve the learning of the vascular suture. Our main goal was to evaluate this technique as an experimental model for the vacular anastomosis, not to obtain a functional autotransplant. In this regard, here we summarize our experience during the first two cases performed., Material and Methods: Laparoscopic renal autotransplant was perfomed in female lab pigs weighing 15-20 kg. International Experimental Animal Care rules were accomplished., Results: After sacrifizing the animals, only one case of vascular thrombosis was observed. The other cases showed normal arterial and venous flow., Conclusions: Experimental Renal Laparoscopic autotransplant constitutes a good surgical model. We are trying to implement the technique in the clinics in the next future.

An update on aspects and use of different experimental models applied in kidney transplant research is presented . This paper includes qualities, as long as similarities between most frequently used animal models and human clinical standards. Contributions of those models based on microsurgical or laparoscopic techniques are revised. The physiological consequences (hemodynamic, immunologic) of surgical technique (laparoscopy), applied in experimental models as long as non-heart beating organ donor models and organ preservation methods are also reviewed. Finally, an update of those models applied in research in prothocols of either immunosupression or xenotransplant is done.

Introduction and Objectives: Organ transplant is nowadays a usual and succesful practice, although with limited application due to the lack of organs. Yearly thousands of patients get access to the waiting list and finally will death while they are waiting for an organ. In the U.S.A., 2005 waiting list for kidneys, heart, liver lung and pancreas was around 94.419. Number of transplants performed was 27.966 and died patients while waiting for an organ, 41.392 (1). Pig xenotransplant is one of the possibilities to ameliorate the lack of organs for transplant. Arrangement of pigs with different genetic modifications generated great expectatives on the use of these organs in clinics. Although preclinical experimental studies with kidneys reached prolonged survivals, these are really insufficient to go on with the clinical appliance. Hyperacute rejection produces destruction of the organ immediately. This problem could be pharmacologically precluded in xeno-transplant. However, acute rejection or vascular rejection usually produces the lost of the implant. New inmunosuppresive schedules delay significantly rejection, but not definitively. Xenotransplant as a therapeutic option introduces important scientific problems, as well as ethical and social. This paper reports a summary of our experience in renal xenotransplant and the management of acute rejection., Material and Methods: Twenty xenotransplants from transgenic pig (hDAF) as donor to babuine as receptor. Average weight of the animals ranged 11.4-75 kgrs and babuines 10-26 kg. Xenograft average weight ranged 39-160 grs. Implant was performed to aorta and cava. Four inmunosupressive schedules were used., Results: Average survival was 7-9 days. Final Histological findings are described. Changes observed were secondary to acute tubular necrosis mixed with changes due to acute rejection. Three grafts were lost due to technical major problems., Conclusions: Although we have observed some promising results, xenotransplant is a very difficult problem to solve in the long-term. A lot of research is still needed-.

Introduction: Stress urinary incontinence (SUI) has a high incidence and important morbidity. Multiple surgical techniques have been described to treat it, with despair results. Suburethral slings have become, in recent years, a simpler and less invasive method to treat SUI surgically., Material and Method: The purpose of this paper is to review, retrospectively, 86 patients treated at our institution, from 10/01 to 12/05 of SUI, with a suprapubic suburethral sling (SPARC)., Results: Medium (range) age is 58.7 (39-80), hospital stay was 2.43 d (1-8) and catheter was removed 1.52 d (1-10). 14.5% of patients underwent other vaginal surgeries at same time, most frequently anterior colpoperineoplasty (10.7%). Complications are not very frequent; bladder perforation (5.8%), acute urinary retention (7%), chronic urinary retention (3.5%) and UTI (15.3%). Sling release was performed in 3.5% of women with chronic urinary retention. Total continence was found in 71.4% of patients with 10.1 months medium follow up (1-32). De novo urge symptoms were found in 26.2% of women, with urge incontinence in 54.5% of them. (p < 0.002; OR 5.0 (IC 95% 1.75-14.28)., Conclusions: Suprapubic suburethral SPARC sling is a simple method, with few complications and fast social recovery. Outcome can be measured soon, with a high continence rate. De novo urge symptoms are high and they worsen functional results. It is necessary longer follow-up to evaluate long term outcomes.

This paper reviews the morphological cancer diagnosis criteria on needle biopsies, the predictive meaning of the pathological lesions of HGPIN, HAA, and P.I.A and the peculiar histopathological patterns in prostatic adenocarcinoma. We present the histological parameters that the pathologist has to informe in the diagnositic, on the routine prostate needle biopsy: Gleason histological degree, histological type, number of invaded cilindres, percentage of tumor in each cylinder, location of the biopsy and ymphovascular invasion. We also emphasize the importance of new predictive biomarkers nowadays in study and probably involved in tumor progression.

Most of urothelial carcinomas (UC) have a pattern of histological growth of papillary or solid type; nevertheless, in some cases there are histological types that significantly differ from these habitual patterns In this paper we have selected those UC variants that by its diagnosis difficulty and therapeutical or prognosis implications have to be perfectly identified and known by pathologists and urologist. The variants that we have considered of greater clinical and pathological interest have been: tubular and/or nested UC, microcystic UC, micropapillary UC, lymphoepithelioma like UC, plasmacytoid UC and sarcomatoid UC. A revision of the literature has been made of each one of these patterns evaluating the criteria diagnoses, clinical behavior and the present therapeutic options. In addition, we suggest that these UC variants must be explicitly reflected in the pathology report, due to its clinical implications.

Objective: Cryosurgical ablation (CSA) is one treatment option that has been developed and it is now recognised as a true therapeutic alternative in the treatment of localised disease. The aim of this paper is to present the preliminary experience with CSA in prostate cancer from the centre in Norway., Materials and Methods: A total of 132 patients with prostate cancer have been treated with CSA since September 2003. In 90 patients, CSA was the primary therapy used and these patients included those with low (LR; n=27), intermediate (IR; n=37) and high risk (HR: n=26) disease. Low risk patients were defined as those with T1a-T2a, NO, MO, Gleason score < or = 6 and prostate-specific antigen (PSA) <10 ng/ml. Intermediate risk were patients with T2b tumours or a PSA level of 10-20 ng/ml or Gleason score 7. High risk were defined as those with T2c tumours or Gleason score >7 or PSA >20 ng/ml. The remaining 42 patients either had locally advanced disease or had received salvage treatment after previous external beam radiation (EBRT), cryotherapy or hormone treatment. Patients were evaluated at 3 and 6 months and thereafter at 6 month intervals. A voiding history was taken and the following tests conducted: uroflowmetry, residual urine., Results: Results are presented for those patients receiving CSA as a primary therapy. Currently, the longest follow-up period is 42 months. The median observation period is 21 months and 39% of patients have been seen at the 24-month follow-up visit. No evidence of clinical progression has been observed in patients in the LR or HR group. Two patients in the IR group had clinical evidence of progression. The most common side effects seen during the first year post CSA were urinary tract obstruction and the need for removal of dead prostatic tissue or calcifications. Histological examination of the removed tissue did not shown evidence of prostate cancer. All patients in the LR and IR group that were sexually active before treatment were also sexually active on last follow-up, 37% using some kind of aid. 86% of patients in the LR and IR groups reported no bother as to sexual function., Conclusions: CSA is now recognised by the EAU as a true therapeutic alternative for the treatment of prostate cancer. Many institutions offer CSA only to older patients due to the lack of long-term data. If longer follow-up data confirm the short-term effect seen in my series, and if comparable side effects are reported in other studies, CSA might also be offered as primary treatment to younger patients.

Treatment of locally advanced prostate cancer remains controversial. Treatment options include radical prostatectomy (PR), radiotherapy (RT) and hormonotherapy (HT). A Medline database search with key words "prostate cancer", "locally advanced", "high risk" and "treatment" in articles published during the last 15 years was done. Fifty one out of 329 papers were selected and reviewed. Selection criteria were a minimum of scientific evidence level of IIa, except for some specific level IV reference. Numerous randomized studies show that patients may benefit of a combined therapy with RT and HT. RP has shown its usefulness in selected cases of locally advanced prostate cancer. Results of long follow-up series are similar to those obtained with RT and HT. Furthermore, the possibility of clinical over staging is an argument in favour of RP. We perform an updated revision of every possible choice available in the treatment of these tumours.

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.

Introduction: VUR in spinal cord injured patients is cause of important morbidity and mortality. The aim of this paper is to make a statistical, retrospective and descriptive study to analyze VUR treatment results, in neurogenic bladder SCI patients., Material and Method: We study 40 patients (80 renal units) with VUR in neurogenic bladders and SCI, between March, 1990 and November, 2004. Median age is 43.05 y (9-76). 77.5% of patients are males (3.4:1). Time from injury to VUR is 24.7m (0.2-87). Median follow up is 8.23a (0.5-29). Traumatic lesions are most frequent (70%). Median bladder capacity is 244.9 ml (43-555) and median bladder compliance is 16.12 ml/cm H2O (0.3-61.6). Detrusor overactivity is found in 72.2% and detrusor-sphincter dyssynergia in 71.8%. Initial conservative treatment is done with indwelling catheter and anticholinergics, Results: Complete remission was found in 57.5% of RU, descending VUR a 23.7% (66.2% previously to 42.5% after; p<0.02), and predominant in unilateral reflux. Partial response was found in 3.8%, progression in 12.5% and recidiva post CR in 10.9%. Younger patients have better remission rates (39.4 to 47.6 y; p=0.04). Urodinamycs variables don't found any significant differences in treatment results. Endoscopic treatment with bulking agents gets a good response rate (56.3%) (p=0.18)., Conclusions: Initial conservative treatment gets a 23.7% reduction of VUR, especially in men, young and unilateral reflux patients. Anyhow, we observe some progression and recidiva. Detrusor overactivity and detrusor-sphincter dyssynergia didn't influence in treatment results, but they are found in all patients with recidiva. With longer reflux evolution, we observe better responses, but also a higher recidiva rate (p=0.007). Endoscopic bulky injection techniques found out a good response rate (56.3%), also in patients with recidiva after conservative treatment.

This paper checks typical aspects of Paruresis or Shy Bladder Syndrome, disease defined as the impossibility or difficulty to urinate in public toilets. We analyze the definition, differences, degrees, nature, etiology, traditional treatments, myths about the origin, and so on; but two are the main contributions of this transdisciplinary research: first, the description of the paruretic's daily life, which main core is the concealment of paruresis; and second: we offer an alternative to paruretic community, that is beneficial to other stigmatized groups, Coming out of the closet, process that starts in self-help groups.

Use of antimuscarinic agents in male patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and with symptoms of overactive bladder (OAB) has become increasingly relevant over the last few years. Prescription of these drugs is in conflict with a long-established concept learnt in Medical School: antimuscarinics are contraindicated in patients with BPH. Several factors, however, have placed this issue under constant review. The description of OAB syndrome and the scientific research carried out over recent years have provided epidemiological and pathophysiological data worthwhile reviewing, most importantly in order to understand why a review of such a solidly established concept has been raised. This paper reviews the prevalence of OAB in men with BPH, the role of urodynamics to evaluate men with OAB and the existing evidence on the effect antimuscarinics have in terms of efficacy and safety on male patients with detrusor obstruction and overactivity.

Introduction and Objectives: Laparoscopic adrenalectomy has gained rapid recognition since publication of the first case in 1992. Currently it is the technique of choice for the surgical treatment of the adrenal gland. Our objective in this paper is to share our experience with this technique and offer some practical advice on how to approach it., Materials and Methods: Between May 1998 and August 2006 we did a total of 24 laparoscopic adrenalectomies in 22 patients (15 men, 7 women). The right gland was removed in 13 cases and the left in 11. Surgery was bilateral in two cases (one was MEN II, the other bilateral cortical hyperplasia). Average age was 49.5 +/- 14.3 years (range 24 to 78). Clinical diagnosis was: Pheochromocytoma (n = 10), Cushing (n = 6), Conn (n = 4), metastases from lung carcinoma (n = 2) and non-functioning tumor (n = 2). For surgery, all patients were in total lateral decubitus with a pillow to increase the costal-iliac space. We used four trocars on the right side and three on the left. Abdominal access was by Hasson trocar after minilaparotomy. We kept pneumoperitoneal pressure below 12 mmHg; a Veress needle was not used for this procedure., Results: Open surgery was required in one case. Time operation was between 59 and 400 minutes (mean 182 +/- 98 min.). In the first 12 cases average time was 261 +/- 77 minutes and in the final 12 cases was 103 +/- 21 minutes (p < 0.001). Tumour diameter was between 1.3 and 6 cm (mean 3.08 +/- 1.25 cm) and tumour weight was between 8 and 92g (mean 30.13 +/- 21 g). Except in one case with 600 ml blood loss, bleeding was less than 100 ml (n = 23, range: 10-100, mean 43.26 +/- 25ml). We only had intraoperative complications in two cases: perforation of the liver by the laparoscope retractor (at the beginning of the series) and injury to the spleen capsule. Both complications were resolved laparoscopically. Cases by histologic type were: nine cortical adenomas, nine pheochromocytomas, three nodular hyperplasias, two metastases from lung carcinoma, and one adrenal pseudocyst. Discharge from hospital was between three and five days (mean 3.62 +/- 0.82) with a statistical difference (p < 0.001) between twelve first cases and the last ones., Conclusions: The adrenal laparoscopic approach is currently the technique of choice for removing adrenal tumours although with malign tumours or over 7 cm in diameter there are some contraindications and disadvantages relative to open surgery. There is inevitably a learning curve but satisfactory results are quickly attainable.

Objective: [corrected] To assess the usefulness of pelvic lymphadenectomy in bladder cancer., Methods and Results: With the followings key words: "bladder cancer, lymphadenectomy, lymph node metastasis" we search in Medline/PubMed database for papers published during the last ten years. Thirty three papers fulfilling the search criteria were selected., Conclusions: It does not exist any randomized prospective study comparing different pelvic lymphadenectomy techniques. Nodal metastasis in bladder cancer after radical cystectomy and pelvic lymphadenectomy ranged between 18% and 28%. Standard lymphadenectomy could improve tumor staging and probably survival in selected patients. It is advisable to remove, as a quality parameter, at least 10 to 14 nodes in a pelvic lymphadenectomy. Lymph node density seems to predict survival better than TNM staging system. It is advisable to perform separate lymph node dissection rather than en-bloc.

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.

Laparoscopic radical prostatectomy has been established and adopted by specialized urologic centers around the world as the primary approach to the surgical management of localized prostate cancer. Urologists are on a continuous search for development of technical modifications and refinements, to reduce morbidity and ameliorate clinical and quality of life outcome. In 2002 we have initially reported our technique and experience with the totally extraperitoneal endoscopic radical prostatectomy (EERPE). In the present review paper we present the evolution of the technique and the latest results.

The adenocarcinoma of the urachus is very rare tumor, with an incidence of 1/5.000.000 inhabitants, represents less than 0.001 of all types of bladder cancer. Peritoneal pseudomixoma is a rare neoplasm characterized by mucinous acites that involvement the peritoneal surface and omentum. Usually is associated with benign o malignant mucinous tumor of the appendix or ovary. In this paper, we present a case of peritoneal pseudomixoma caused by a mucinous adenocarcinoma of the urachus.

There are extreme situations in the clinical treatment of intractable hematuria (fortunately not a common disease nowadays), in which even benign process may represent a serious risk to the life of the patient and where certain aggressive procedures like cystectomy have to be considered. Our objective in this paper is to review the different existing therapeutic alternatives for the treatment of an intense type of hematuria which does not yield to continuous saline serum irrigation. This study is partly based on a recent real clinical case in which, after the administration of cyclophosphamide to a young patient with recurrent and intense hematuria, the excretion was controlled through intravesical alum irrigation of thus avoiding cystectomy, a very aggressive surgical procedure with many after-effects.

Objective: The aim of this paper is to evaluate the evolution in the clinical, echographic and pathological characteristics of patients undergoing transrectal ultrasound and prostate biopsy over a 10 year period (1994-2003)., Material and Methods: Patients undergoing a first biopsy of the prostate between 1994-2003 were studied retrospectively. Since the biopsy criteria have changed several times over this period, results were analysed for four different periods: 1994-1997, 1998, 1999-2003 (the latter was further divided into two periods--1999-2001 and 2002-2003--to observe the temporal evolution with the same biopsy criteria). Patients were assigned to risk groups according to D'Amico., Results: We observed that individuals referred for biopsy and those diagnosed with prostate cancer (PC) had a lower mean age (p=0.0001 and p=0.01), there were more patients with a PSA from 4.1-10 ng/ml (p=0.0001 and p=0.0001), more patients had no significant DRE findings (p=0.0001 and p=0.0001) or ultrasound findings (p=0.0001 and p=0.0001). The incidence of cancer diagnosis has decreased from 39.4% to 34.3% (p=0.03). There was an increased incidence of score 7, at the expense of a decline in scores 5-6 and 8-10 and disappearance of score 2-4 (p=0.0001). Patients assigned to the low risk group increased from 9% to 18.1%, those assigned to the intermediate risk group from 20.2% to 43.1% and there was a reduction in those assigned to the high risk group from 70.7% to 38.7% (p=0.0001). Analysis of the final two time periods revealed that the evolution of the series remained the same except for a decrease in age at biopsy and diagnosis of cancer., Conclusions: Nowadays, the risk factors of patients with an indication of biopsy have less weight than ten years ago. We currently diagnose patients with PC with more favourable prognostic factors. However, the price we pay for this earlier diagnosis is reflected in a less effective biopsy, a larger proportion of the population without PC having to experience the physical complications and psychological stress of a biopsy, a greater number of patients having to undergo a second biopsy and, therefore, a greater and more costly use of resources to diagnose PC.

Objective: Sacral root neuromodulation is an effective technique for the treatment of Chronic Micturition Dysfunction (CMD) refractory to conventional therapy. New indications such as chronic pelvic pain and interstitial cystitis are currently making their way within the urologic setting. Several groups of gastric surgeons are now choosing this technique for the management of rectal diseases (constipation, sphincter dysfunction). This paper contributes our experience in the treatment of patients with CMD and the comparative results at one year from implant in all patients., Material and Methods: From December 1998 through July 2003, 18 neuromodulation definite implants were performed. The main indication was CMD in 62.5% patients. Follow up of patients was done at one month and three months, and every six months thereafter. Follow up is conducted through a micturition diary and QoL questionnaire. Electrode implant in the first 16 patients was achieved by open surgery. The next 2 patients had the electrode placed by a percutaneous technique using the "Tined Lead" kit., Results: Results at one year after implant were compared in all patients. The total number of neuromodulation implants placed was 18, 14 (77.7%) of which were women and 4 (22.3%) men. Mean age was 52.56 years. Implant indication was CMD in 72.2% patients, mixed incontinence (urinary and faecal) in 22.1%, and interstitial cystic disease in 5.5%. Symptoms improvement at one year from implant, as determined by a micturition diary and QoL questionnaire was 76.4%. Clinical improvement was greater in patients with urgency symptoms than in patients with predominance of voiding symptoms.

Since 1996, when Ulmsten described the TVT procedure (Tension-free Vaginal Tape) for correction of women urinary stress incontinence, a large number of different devices have been manufactured with that purpose. Results depend not only of the surgical procedure but also of two principal factors: 1. Characteristics and properties of the mesh. 2. System and way for the implantation. Properties of the mesh used are probably as important as surgical technique. It's not possible to assume that results achieved with the TVT device will be similar with other meshes. Further randomized studies will be necessary to make these affirmations. In this paper we analyse properties of the mesh, characteristics of the implantation system and the influence of those factors in the surgical results. Finally, we describe some of the devices available and the mesh characteristics of each one.

Acquired cystic renal disease (A.C.R.D.) is a risk factor for the development of renal carcinoma in the patient's own kidney after renal transplant (R.T.), development of a primitive tumor in the renal graft is infrequent, but the presence of metastasis of an epithelial tumor is very rare. This is the second case reported in the literature of metastasis of an epithelial tumor in the renal graft and the first case described of renal cell carcinoma metastasis (R.C.C.) in the renal graft. This paper describes the case of a patient with a normally functioning renal transplant and A.C.R.D. who develops RCC in his own kidney, with metastasis in the renal graft.

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.

Laparoscopic surgery requires a long training period of time in which the complexity of the training is increased. The technique presented in this paper has been developed in order to find an experimental model that allows us to improve the learning of the vascular suture. Our main goal was to evaluate this technique as an experimental model for the vascular anastomosis, not to obtain a functional autotransplant. In this regard, here we summarize our experience during the first two cases performed.

Objective: For effective empiric therapy of urinary tract infections in the extra-hospital setting the susceptibility pattern of uropathogens should be considered. Moreover, the evolution in sensitivity can be observed when comparing with susceptibility patterns in the previous years. This paper presents an analysis of our experience with Escherichia coli., Material and Methods: During 2002 and 1998, 895 and 595 strains of Escherichia coli respectively, isolated from extrahospitalary bacteriurias were collected in ten health centers in Bierzo (León, Spain). Sensitivity to nine most commonly antibiotics used in the clinical practise was determined. The existence of significant differences of susceptibility among years (2002-1998) was analyzed by the chi square test., Results: Escherichia coli accounted for 63.4% of all isolates in 2002 and 50.8% in 1998. The prevalence of in-vitro susceptibilities to antibiotics were (2002-1998): fosfomycin (99.2%-99.3%; p = NS*), cefixime (98.3%-92.9%; p < 0.001), cefuroxime (96.5%-94.1%; p < 0.05), nitrofurantoin (94.5%-86.9%; p < 0.001), amoxycillin-clavulanic acid (93.1%-90.1%; p < 0.05), ciprofloxacin (77.1%-81.6%; p < 0.05), norfloxacin (75.8%-80.3%; p < 0.05), cotrimoxazole (71.5%-73.4%; p = NS*) and ampicillin (44%-41.4%; p = NS*). (*NS = No significant differences)., Conclusion: The knowledge of the sensitivity of uropathogens to antimicrobians in a specific medium can allow us to use antibiotics rationally and initiate empirical therapy.

Inflammatory pseudotumours are rare lesions that may appear in several organs, and sporadically in the bladder and the renal pelvis. Aetiology is unknown and they show a non-malignant behaviour although differential diagnosis with other neoplasia such as leiomyosarcoma and rabdomyosarcoma must be established. Electron microscopy and immunohistochemistry are commonly used techniques to achieve diagnosis. The aim of this paper is to examine the second case report of intrarenal inflammatory pseudotumour.

Spermatic cord sarcomas are rare tumours. Dedifferentiated liposarcoma accounts for only 10% of all spermatic cord sarcomas. These are usually large-sized tumours histologically characterised for being well-differentiated liposarcomas with some high grade sarcoma areas. Volume, location, mass homogeneity as well as presence of pelvic and retroperitoneal adenopathies are reported by CT and ultrasound techniques. These are useful for post-treatment follow-up. This paper presents one spermatic cord, dedifferentiated liposarcoma from which lipomas from the same spermatic cord had been previously removed in three occasions. We believe this is a degeneration of the earlier resected lipoma. Management is by extended inguinal radical orchiectomy. Value of adjuvant radio- and chemotherapy is uncertain. Post-surgery local relapses are common, and haematogenous and pelvic nodes metastasis likely. Survival at 5 and 10 years is 75% and 63% respectively.

Introduction: It has been observed that in healthy individuals the increase in urinary flow induced by water overload may be enough to alter the urinary Ph to obtain values considered safe in the prophylaxis of lithogenesis. The aim of the present paper is to determine the effects of water diuresis on the urinary Ph of patients suffering from relapsing lithiasis., Material and Method: 26 patients were included in the present study. The urinary Ph of all patients was measured along two consecutive days, at 8.30 and again at 12.30, under normal conditions (the first day) and once they had received a water load equivalent to 1.5% of their weight (the second day)., Results: The altered mean value of the Ph induced on the first day by the circadian rhythm showed a mean of 0.13 units of Ph, which lacks statistical significance (p > 0.05). However, on the second day we obtained a value of 0.42, which is statistically significant (p < 0.01). The normal tendency after the water overload was towards a positive increase of the Ph in those patients whose urine showed a preload Ph value < 6.1, whereas those individuals with a preload Ph value > 6.48 suffered negative increases., Conclusions: The increase of diuresis induced by water load proved enough to provoke an increase of urinary Ph when its baseline value is < 6.1, or either a decrease when its baseline value is > 6.48. In both cases, Ph values ranged between 6-6.5 which are considered safe values in the prophylaxis of lithogenesis. The more separated the baseline urinary Ph is from the 6.1-6.48 range, the greater the effect of the water load.

The Internet has been a breakthrough for Professional Medical Training. Medline databases are increasingly being used by the scientific community at large. Patients have also started to use the Internet as a source of information on their illnesses, and look in the web for a second opinion. This paper shows the advantages derived for the patients from using the Internet as well as the risks involved from a poorly understood, even not scientifically validated information. The Urology Associations themselves should take responsibility of the web sites in a unambiguous way, by including evidence-based medicine, offering assistance to those patients who want to compare their specialist's opinion with that obtainable in the Internet, and with the doctors themselves directing those who show a real interest to the most suitable web sites.

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.

Development of urodynamics particularly during the past decade are highlighted, as well as a number of issues to be faced in the near future: research into the etiopathogenesis of different conditions, finding more sensitive and specific diagnostic procedures to overcome the current ones, establishing more comprehensive indications for urodynamics examinations and, as a result of all the above achieving greater improvement of certain surgical procedures. Both the technique and interpretation of the different urodynamic examinations, as well as the more recent innovations, implementation issues and controversies are detailed to a highly up-to-date level. Neuromodulation and ambulatory urodynamics deserve thoughtful consideration in this paper. Finally, attention is given to the controversies and future challenges such as urodynamic research providing accurate diagnosis of lower urinary tract obstruction in women, establishing the indication of urodynamic studies in women with urinary exertional incontinence, outlining the indications of neuromodulation and ambulatory urodynamics, applicability of artificial intelligence systems, improvement of artificial sphincter materials, tissue growth for bladder enlargement and actual prevention of myelodysplasia.

Unlabelled: The kidney as an apo-exocrine organ has two important functions: the control of homeostasis and arterial blood pressure. Any pathological disorders witch alters the renal blood flow results in two consequences: renovascular hypertension and renal insufficiency. Renal revascularization looks for with priority the improvement of renal function; the good response and control of hypertension shall come after. The goals of this paper is to actualize the sophisticated diagnostic methods (Angiography, Eco-Doppler, AngioCT, AngioMR, Angioscopy; and the use of contrast potential-mediums), functionality tests (RN and MR with Captopril) and management (Percutaneous transluminal angioplasty, simple or covered Stents, Embolizations, Occlusive balloons, Fibrinolysis and Trombus Aspiration; direct Arterial Surgery and renal Autotransplantation) of different renovascular diseases. (Blunt renal injuries, Stenosis, Aneurysms. A-V fistuls, Acute Occlusions or arterial and venous, Thrombosis. Nutcraker Syndrome). The possibility of the presence of an inverse venous Fraley's Syndrome is presented and discussed., Conclusions: A controversy of the last technical methods are established and discussed and a Guideline is recommended for each renal vascular disease.

Penile carcinoma is a tumoral condition of inconsistent incidence. Its biological and etiological features are under permanent scientific review. Such circumstance is increased by the growing awareness of a greater demand of anything related with the patients' quality of life. This paper reviews the latest controversies guiding current therapeutic approaches in penile cancer. An analysis is made through a revision of the lymphadenectomy indication and its therapeutic value, criteria related to technical aspects and indications. At the same time, the criteria that should preside over the choice between conservative or radical options are established and emphasis is placed on the growing role of prevention in tumoral conditions and the contribution of innovative gene therapy regimes.

Predominantly during the past century. This review paper addresses the most relevant issues in the historic evolution of renal surgery and establishes the criteria that guide the current situation in the most prevalent and relevant renal conditions (neoplasia, lithiasis, infections and transplantation). Eventually, the attitudes which in the author's opinion will guide the future of renal surgery are established.

We report a case of bladder leiomyosarcoma treated at our department. We review the published papers about this entity. We emphasize the low incidence of that pathology and the lack of consensus about treatment.

Objective: To review the incidence, clinical features and management guidelines for patients with isolated prostatic intraepithelial neoplasia (PIN) diagnosed through prostate transrectal biopsy., Methods and Results: Search in Medline database for papers published between 1990 and 2000 based on the following key words: "prostatic intraepithelial neoplasia and needle biopsy". Nineteen papers fulfilling the search criteria were selected., Conclusions: The incidence of PIN in patients seen as part of an early diagnosis program is much lower than in patients attending standard Urology practices. PSA level and ultrasound changes are poor predictors of PIN presence in the biopsy. Prostate cancer incidence in successive biopsies ranges between 13.3% and 100%. None of the clinical variables used to diagnose prostate cancer (DRE, PSA and transrectal ultrasound) can predict accurately the existence of cancer associated to PIN, and only prostatic intraepithelial neoplasia grading is considered a good cancer predictor. There is no consensus with regard to diagnostic and therapeutic management in these patients.

In this paper, we present a case of huge renal hydatic cyst. We review the literature with regard the clinical presentation, diagnosis methods and surgical technique of treatment.

We present a 41 years old male, treated with trazodone because of depression. He was seen at our Andrology unit for a 72 hours evolutioned priapism. We review the literature and submit this paper for publication because it is an uncommon pathology.

Granulomatous orchitis is an inflammatory change of the testis. This is a rare lesion of unknown etiology. Usually are unilateral. The clinical appearance varies, and it is difficult to differentiate from testicular cancer. The diagnosis usually being made on histological examination after orchiectomy. Our paper report one case of granulomatous orchitis in a 27 year old patient. A review of the literature is made on the diagnosis and pathogenesis.

High grade (PIN AG) intraepithelial neoplasia of the prostate is a likely precursor of prostate adenocarcinoma (PA) because of their association. Since the risk to suffer PA increases in patients with no previous PIN AG, its finding requires an arduous search for PA. This paper reviews the incidence of PIN AG in 499 histological studies in prostate transrectal biopsies, prostate TUR and adenomectomy specimens and radical prostatectomy (RP) sections. Evaluation of data obtained, type of presentation and association to prostate carcinoma, indicating the approach taken in the various cases.

Contribution of one case report of a 69-year old diabetic male patient with neurogenic bladder. The patient developed emphysematous cystitis and peritonitis secondary to intraperitoneal perforation of the bladder. Emphysematous cystitis is an uncommon clinico-radiologic entity more frequent in diabetic and female patients and the elderly. Early diagnosis and treatment may avoid a fatal outcome. The paper includes a review of this condition.

Abdomino-pelvic actinomycosis is a condition caused by Actinomyces israelii, a Gram-positive opportunistic bacteria that triggers and develops the infection only in previously injured tissues, and then slowly progresses and spreads until it extrinsically affects the urinary tract. Use of an intrauterine device is a known risk factor to suffer from this disease. Relative risk in IUD users is two- to four-fold higher compared to IUD non-users. Risk increased with prolonged IUD use. Treatment is by removal of the causative agent, surgical resection of necrotic tissues and administration of intravenous Penicillin G, 4 million units every 4 hours for 30 days, followed by Amoxicillin 500 mg every 8 hours for 12 months. This paper contributes two cases of abdomino-pelvic actinomycosis with urinary tract involvement in IUD users. Standard treatment was employed with good evolution.

We present a case of pure prostatic leiomyoma, benign and rare entity, diagnosed in a patient with prostatism. We review the published papers about this disease and the different subjects about etiology, clinic, histopathology, diagnosis and treatment.

This paper reports a case of bladder bilharziasis with histopathological exam and different patterns of urodynamic evaluation. The need for urodynamics is emphasized in order to avoid diagnostic and therapeutic mistakes.

The emergence of acquired immunodeficiency syndrome has changed the natural history of tuberculosis which has now become the second most common infection associated to human immunodeficiency virus infection. It is only rarely that a tuberculous infection has an urogenital location, and extrapulmonary locations are generally related to severe immunosuppression. This paper presents one case of tuberculous orchitis that presented as the clinical onset of acquired immunodeficiency syndrome. Discussion of the clinical evolution and the therapeutic approach that consisted in orchiectomy associated to treatment with tuberculostatics.

The "burned-out" phenomenon in germ-cell neoplasias is defined by the presence of an extragonadal germ-cell tumour with no tumour at the testis level where a series of distinctive histological lesions can be detected indicative of the earlier presence of an already disappeared testicle tumoration. Extragonadal germ-cell tumours with "burned-out" phenomenon show better evolution than their primary counterparts and are treated similarly to primary tumours of the testis. Currently, in the presence of retroperitoneal tumoration, a scrotal ultrasound study with high frequency transducers can lead to a suspected picture of tumoral involution. This paper contributes one retroperitoneal seminoma with "burned-out" phenomenon in the homolateral testis in a 35-year old patient. Available clinical and radiological criteria were enough to reach a suspected diagnosis. Homolateral orchiectomy and biopsy of retroperitoneal tumoration were performed, rounding treatment up with polychemotherapy. Evolution was good with immediate complete response.

Lower urinary tract obstruction in women is an uncommon condition resulting from multiple either organic or functional disorders. This paper contributes one case of obstructive uropathy secondary to presence of almost complete vulvar synechia due to extreme genital atrophy, a rare entity that may appear in postmenopausal women. Partial and incomplete vulvar fusion usually occurs in significant postmenopausal atrophies, sometimes associated to urethral meatus stricture; this, however, has no significant repercussion on urination dynamics. No other comparable case was found in the reviewed literature.