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Ever since Hippocrates, physicians have managed patients that suffered from urethral stricture. To that end, genius and imagination put to the service of scientific knowledge, have produced numerous apparatus, instruments and methods of a varied nature, with the aim of allowing urine passage through the strictured urethra. Illustrious names such as Andrés Laguna or Francisco Díaz, and other not so well known. Spanish and foreigners, are mentioned in this paper in an intent to contribute a brief view on the evolution of the methods used to treat urethral stricture up to the end of the 19th Century.

Bellini's collecting ducts carcinoma represent a subgroup within renal carcinoma with an incidence of 0.4 to 2% of all renal tumours. The collecting ducts share their embryological origin in Wölf's duct with the calices, renal pelvis and ureter. This common embryological origin could justify the association of carcinoma originated in the collecting ducts with transitional urothelial carcinoma. This paper contributes two patients with Bellini's collecting ducts carcinoma associated to "in situ" carcinoma and transitional papillar carcinoma in the adjacent renal pelvis respectively. The authors review the diagnostic, pathoanatomical and therapeutical aspects found in the literature. A high index of suspicion is required to diagnose a case of Bellini's carcinoma in the face of predominantly central-medullar renal solid lesions, with infiltrating growth that causes morphological changes in the excretory system without deforming the external renal outline. The authors highlight the value of immunohistochemical studies to reach a diagnosis, considering the natural history and the sombre prognosis of this uncommon renal neoplasia.

Objective: Retrospective study of urological complications in our series of reno-pancreatic transplants., Material and Methods: Between February 1983 and May 1994 our group has conducted 93 RPT, 80 of which, mean age 36 +/- 6 years (24-54 years), are studied in this paper: 57 male and 23 female with an average time in dialysis of 20 +/- 15 months (0-84 months) and diabetes evolution of 21 +/- 5 years (11-37 years)., Results: Actuarial annual survival of patient, renal graft and pancreatic graft has been 85%, 79% and 74% respectively. Haematuria: 25% incidence, with graft pancreatitis etiology in 16 cases, rejection in 8 and urinary fistula in 6. Urinary infection: 85% incidence, symptomatic in 23 patients (29%) and asymptomatic in the remaining cases. Dysuria, urethritis and urethral stenosis: 14 patients, all male, most with both conditions associated. Reconversion of pancreatic exocrine secretion by intestinal route was performed in 7 patients. Urinary fistula: secondary to surgery in 9 cases and rejection in 4. Etiology of one case remained unknown. In 4 cases it was resolved with conservative treatment, and with surgical correction in 8. One patient required pancreatic transplantectomy and one patient died of AMI., Conclusions: Urological complication in RPT account for a significant morbidity, urinary fistula being the one with greater repercussion on the patient and pancreatic graft survival.

Stenosis of the ileal loop itself in the urinary diversion performed with the technique described by Bricker is uncommon, particularly in adults, and nowadays is basically managed through non-invasive methods. This paper contributes one case of stenosis of the ileal loop in a patient with urinary diversion performed with Bricker's technique, which was treated by partial resection of the ileal loop, since use of non-invasive techniques was not possible due to technical hindrances. The pathoanatomical study showed the different etiopathogeny of this type of stenosis relative to others related to the ileal loop (stoma and ureteroileal attachment stenosis). A review is made of the etiopathogeny, signs and symptoms, diagnosis and treatment of this type of stenosis. Occurrence of stenosis as late complication has lead us to consider the convenience for late revisions in this type of surgery.

Over the last few years a number of testicular tumours in seropositive patients or patients with AIDS-diagnostic factors have been described in the literature with no clear relationship having been established between both conditions. Most authors believe management should not differ from that being given to non-immunodeficient patients. The paper presents one case of non-seminomatous germinal tumour in a 41-year old homosexual patient, HIV positive, with unfavourable evolution in spite of the treatment received.

Primary prostatic carcinoma accounts for 2% to 4.5% of all neoplasias to this organ, and it has been observed in 2.8% of all radical cystoprostatectomies performed in the Mayo clinic. It originates in the poorly differentiated reservoir cells of the prostatic periurethral ductus which explains why diagnosis is most often obtained in advanced stages (stromal involvement), thus limiting its management to radical surgery. This paper contributes one case report of a patient diagnosed by transrectal biopsy of a primary prostatic transitional carcinoma presenting with incoercible rectorrahges and urinary obstruction symptoms. Treatment was through pelvic exenteration, and urinary and gut by-pass.

Objective: Radical prostatectomy (RP) is an elective therapeutical procedure for localized prostate cancer. The paper describes the critical analysis of our 10-year series., Material and Methods: A total of 216 RP have been performed between June 1986 and December 1996 (60 of them in the last year); with the purpose of securing a minimum follow-up of 4 months, the 204 procedures performed up to October 1996 were studied. Mean age was 64.9 years and PSA median 10.8 ng/ml. Intraglandular clinical stage was found in 192 cases versus 12 cases extraglandular. Up to the end of 1993 Walsh's technique with erectors' preservation was being used although the poor results obtained with regard to potency as well as the existence of positive borders have compelled us to perform the standard extracapsular technique since beginning of 1994., Results: Mean follow-up in our series has been 29.62 months. Post-operative complications reached 29.9%, anastomosis fistula (21 cases) among the early ones and anastomosis stenosis (16 cases) among the late ones. 82.04% patients have total continence or minimal incontinence, the percentage of obstruction being 3.58%. Total impotence is estimated at 92.77%. One patient (0.49%) died in the immediate post-operative. Understaging was observed in 36.7%. 84 patients had extracapsular disease. Our percentage of positive surgical borders is of around 43.13%. Progression has been seen in 47 of 204 patients (23.03%): 8 local relapses, 12 metastasis, 3 with both conditions and 24 biological progression. Progression has been related to pathological stage, pre-operative PSA and Gleason's sum of the specimen. Difference was statistically significant. Overall survival at 1 and 5 years is 99.2% and 95.5% respectively while tumour specific survival is 97.8% and 75.8% at 1 and 5 years., Conclusions: RP is a surgery with minimal mortality but noticeable morbidity (incontinence 14.35%; impotence 92.77%; other complications from surgical technique 29.9%). Our clinical understaging is of around 36.7%. Progression is related to the specimen's pathological stage, and pre-operative PSA and Gleason. Our overall survival at 1 and 5 years is 99.2% and 95.5% respectively while tumour specific survival is 97.8% and 75.8%.

Objective: Renal haematomas after shock wave extracorporeal lithotripsy (SWEL) represent a potentially serious complication. This paper examines those cases of post-SWEL renal haematoma seen in our Centre, analyzing the likely risk factors., Patients and Methods: Between May 1988 and June 1996, 12,800 patients were treated with 15100 lithiasis at some level of the urinary tract requiring 16,000 SWEL sessions. All treatments were done with a Dornier HM-4 lithotripter. Voltage applied ranged from 18 to 26 Kv, averaging 2500 waves/session. Complementary testing (ultrasound/computerised tomography) was requested immediately after treatment if clinical complications were suspected., Results: A total of 10 renal haematomas (0.078%) were diagnosed. Six cases were mild, but 4 presented extensive haematoma with significant haemodynamic consequence. Although in one case nephrectomy was undertaken to control haemorrhage, death finally occurred by disseminated intravascular coagulation. Four patients who developed haematoma were hypertensive and 3 had a previously corrected haemostasis alteration., Conclusions: The possibility of renal haematoma should be taken into account in the face of persistent and unjustified pain after SWEL treatment. Normalization of blood pressure values, correction of urinary infection as well as adequate correction of haemostatic disorders is advisable.

Surgical treatment of severe renal trauma usually ends in loss of high percentage of kidneys. In consequence of this, in the last decade several authors prefer a conservative management of kidneys severely injured. There include stabilization in Intensive Care Unit, with the goal of preservation the most possible functioning renal tissue. The purpose of this paper is to present the results of conservative management of severe renal trauma in our Center in the last five years. We conclude that this type of management is accurate and effective.

Objectives: In 30-40% patients, prostate adenocarcinoma is diagnosed already in the metastatic phase, a percentage that will depend on the number of patients with localized cancer that we are unable to detect. Hormonal suppression is the most widely accepted therapeutical option, although there are doubts on the value of rescue treatment after the hormone-refractive stage. This paper analyses those parameters as well as the main prognostic factors in a series of 135 patients with metastatic prostate cancer at diagnosis., Material and Methods: Between 1983 and 1996, 414 patients were diagnosed with prostate adenocarcinoma in the Urology Unit. Móstoles Hospital, 135 of which (32.6%) were metastatic at the time of diagnosis and were managed as follows: 113 (84%) were treated with maximum androgenic blockade (MAB). 13 (9.6%) with orchiectomy and antiandrogens, 5 (3.7%) with various treatments, and only 4 received symptomatic treatment. Of those treated with MAB, 97 (72%) continued treatment after the hormone-refractive stage and 16 (12%) were given stramustine phosphate instead of the antiandrogen. Response monitoring was done basically by means of serial PSA determination. The parameters analyzed included survival and the following potential prognostic factors: age, performance status, metastatic bone pain, tumour diagnosis based on number of metastasis, prior PSA level, Gleason, local stage, M1 type at diagnosis based on the 1992 TNM classification, and response to the various treatment applied., Results: Mean age: 72 years. Over an average of 25 (0-127) months, 80 (59%) patients have died; mean follow-up of patients alive at end of study: 24 months (3-111). Lost to follow-up: 6 patients (4.4%). Up to 1991, the proportion of patients with metastasis was 48%; since 1992, 24%. Percentage of patients diagnosed due to clinical manifestations of the metastasis (25 patients) over these two periods increased, mean age decreased and the proportion of patients with highly aggressive tumours increased. Mean overall survival, 26 months: influential prognostic factors: diagnosis due to metastasis and Gleason greater than 7; very poor prognosis for those receiving no hormonal therapy, with no differences between drug versus surgical treatment. Tumour-dependent mean survival, 32 months; influential prognostic factors: performance status, metastatic bone pain, diagnosis due to metastasis and Gleason greater than 7; very poor prognosis for those receiving no hormonal therapy. Progression-free interval, 19 months; influential prognostic factors: metastatic bone pain, PSA higher or lower than 90. Gleason greater than 7 and local stage: no differences between treatments. Mean survival after progression, 6 months; influential prognostic factors: diagnosis due to metastasis, M1b versus M1c patients: increased survival in patients rescued with stramustine phosphate., Conclusions: The proportion of prostate adenocarcinomas with metastasis at diagnosis shows a trend to decrease, although the percentage of patients who are diagnosed by the sings and symptoms of their metastasis is increasing. These patients should be treated with pharmacological or surgical hormone-suppression. Rescue treatment with stramustine phosphate prolongs survival. Influential prognostic factors: Gleason greater than 7, metastatic bone pain, tumour extent and previous PSA.

Swyer's syndrome is a pure gonadal dysgenesis with female external genitalia. A likely complication is the appearance of tumour's dysgenetic gonads. This paper studies a case report of gonadoblastoma in a female patient with this syndrome.

Contribution of what we believe to be the first case of successful reutilization of the same renal graft by a second receptor after functioning for some time in other patient. Transplantectomy was performed 8 days after initial RT, subsequent to the recipient suffering a fatal AVC. The purpose of this paper is to underline the sequence and technical methodology of this procedure which may become a resource to be taken into account in similar cases.

Vesical hernias occur in a significant number of patients with inguinal hernia, though massive inguinoscrotal vesical hernias are uncommon. This paper presents a case report of a male patient where massive inguinoscrotal vesical hernia, and scrotum-located multiple vesical lithiasis was associated to a large amount of lithiasic mass and bilateral ureterohydronephrosis. We consider this association of urinary conditions extremely rare, since to our knowledge bilateral ureterohydronephrosis has only been formerly documented in one case.

Primary melanoma of the female urethra is very rare. Early diagnosis is very difficult and thus involves a long-term non-resolutive therapeutic approach. This paper presents the case of a 61-year old female patient with this type of tumour and nodular dissemination at the time of diagnosis. The patient developed lung and cranial metastasis with 5-year survival.

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

Tumours derived from sex cords and primitive gonadal stroma account for 4% of total testicular tumours. The low frequency of Sertoli's cells tumour (SCT) and the uneven study and follow-up of patients makes analysis of this tumoral entity difficult. This paper contributes one case report of a Sertoli's giant cell tumour calcified in a 13-year old patient, and reviews the clinical aspects, clinico-pathological varieties believed to require assessment in patients with this type of disease. This type of tumour is considered benign in its biological behaviour, although some malignant forms have also been described. SCT is actually an heterogeneous tumoral pathogenic entity with regard to pathogenic and prognostic aspects. Our final conclusions show that the clinico-pathological variety, age, size and associated clinical manifestations appear to be related to the prognosis.

Contribution of a new case of vesical haemangioma in a 65-year old male. This is a benign and very rare tumour with not even 90 cases described in the urology literature to date. Haematuria was reported in all cases. This paper presents a review of the literature and a discussion of clinical and pathological features as well as diagnostic methods and recent changes in management approach.

Genitourinary involvement by the Echinococcus granulosus larvae (urinary hydatidosis) ranks third in order of frequency after liver and lung involvement. The finding of a primary hydatidic cyst with retroperitoneal location is an uncommon fact. This paper presents once case of this infrequent disease. A revision of the different etiopathogenic mechanisms, as well as diagnostic and therapeutic approaches is made.

From a clinical point of view, vesical hernia is an uncommon condition. Occurrence is more frequent in male. In most cases diagnosis follows surgical repair of inguinal hernia, to which it may be associated (1-10% depending on the series). Unless complications arise, it evolves asymptomatically or reveals its presence by the distinctive two-stroke miction. Although infrequent, the most significant complications are incarcerations and strangulation with secondary necrosis of the vesical wall. Diagnosis is confirmed by radiological techniques: intravenous urography (IVU), retrograde cystography or computerised axial tomography (CAT). Treatment is always surgical. This paper presents one case of massive vesical hernia and a review of the relative literature.

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.

Secondary or metastatic vesical tumours are a very uncommon condition (less than 1% of vesical tumours). Dissemination routes are usually through blood and lymph, and diagnosis occurs typically in advanced stages. This paper presents one case of metastatic vesical neoplasia that developed 5 years after diagnosis of the primary lung tumour.

Objectives: Surface carcinoma of the bladder shows a high incidence of tumour recurrence that require frequent examinations associated to potential morbidity. This paper analyses our series of patients with vesical tumours with no known unfavourable clinical prognostic factors, aiming to detect low risk groups where it may be feasible to change the usual follow-up criteria., Material and Methods: Between 1983 and 1996, 503 patients with vesical cancer, 388 of which 388 were primarily surface tumours, were monitored. The study analyzed 24 patients with surface transitional carcinoma with no unfavourable prognostic factor, i.e. Ta tumours, grade 1, single, under 1 cm, negative urine cytology and multiple negative vesical biopsies. This group was then compared to a control group comprising all other patients with surface tumours in our series (364 patients), and the prognostic factors were assessed based on the disease-free interval, progression-free interval, and overall and tumour-specific survival. Also the recurrence-free interval from the first endoscopic control at 3 months after transurethral resection, were studied according to Parmar's criteria., Results: With a mean follow-up of 53 months, 37% patients in the study group have relapsed versus 41% in the control group (n = 0.9), after 2 years on average. Actuarial curves in the control group reveal statistical significance for higher degree tumours recurrence. No grade progression has occurred in the study group versus 9% in the control group. No patient evolved to T2 versus 5% in the control group; also in this group, 5% patients died because of their tumour versus none in the study group. The 24 patients in the study belong to group 1 in Parmar's low risk, while the remainder of patients in the control group ranked according to these criteria have demonstrated an unfavourable statistical significance (p < 0.01) in patients with early relapse., Conclusions: Good results obtained in the evolution of patients with surface tumours with no unfavourable prognostic factors are due to the strict monitoring they undergo in order to detect early relapses. However, 37% of recurrences in this group does not allow to modify the usual follow-up schedule. In our experience, Parmar's criteria does not contribute any benefit over classical criteria to evaluate prognostic factors in surface vesical cancer.

Only 0.48% of vesical tumours are of the small cells epithelial type with positive neuroendocrine immunohistochemical markers, although the description of new cases is becoming increasingly common. These tumours may be associated to paraneoplastic syndromes of the endocrine and neurological types. This paper contributes one case report of a female patient diagnosed with a small cells epithelial vesical tumour associated to myasthenia gravis. The histological and histochemical features as well as the differential diagnosis with other tumours of vesical location are explained. Clinically, these entities evolve with acute haematuria and have a highly aggressive evolution. Quite frequently the tumour is associated to neuromuscular syndromes such as Lamber-Eaton's, myasthenia-like syndromes, and in rare occasions to myasthenia gravis. Different studies have reported anti-acetylcholine receptors in cells of this tumoral class that may stimulate the formation of antibodies against the neuromotor plaque. Diagnosis of this neurological syndrome and other similar ones may be attributed to early treatment and better prognosis of this tumoral entity.

Flutamide is a non-steroidal anti-androgen used in the treatment of prostate cancer, usually in combination with LHRH-analogs. Incidence of hepatotoxicity associated to Flutamide in the literature is very low and does not exceed 0.18%. Between February 1989 and December 1994, the FDA was reported 20 cases of patients who had died and 26 who had been hospitalized due to hepatotoxicity secondary to Flutamide. We contribute two cases of patients diagnosed with prostate adenocarcinoma following treatment with flutamide and LHRH-analogs who presented liver failure; one with signs and symptoms of acute hepatitis that recovered after discontinuation of the drug, and a second one who developed micronodular cirrhosis and later died of icteroascitic decompensation and hepatorenal syndrome. Including a review of the literature, the paper comments on the likely biological mechanisms for liver toxicity caused by Flutamide. The authors conclude that clinical and laboratory monitoring of patients who either will receive or are receiving treatment with Flutamide is necessary, and withdrawal of drug imperative as soon as certain symptoms of hepatic dysfunction become apparent.

Malacoplakia is a chronic inflammatory disease the etiology of which remains obscure. It has a very low incidence and affects primarily the genitourinary tract, although it has been described in some other organs. This paper presents a historic insight of the clinical cases diagnosed in this centre, and includes a review and update of several issues related to this entity such as pathogenesis, pathological anatomy and treatment. Also, the peculiarities related to the involvement of each separate organ with regard to diagnosis, prognosis and treatment are described.

The epidermoid cyst of the penis is an uncommon benign intratesticular tumour. This paper presents two cases that were diagnosed and operated in our centre. It also describes the most significant clinical, radiological and histological aspects.

We are currently witnessing a lively controversy over which should be the optimal treatment for patients with infiltrant urothelial carcinoma with muscle location (stage B Jewett's Grading or T2-T3 on the TNM Rating Scale, UICC 1992). This paper reports a randomized, prospective study in 37 patients with T2-T3a tumours. Arm A (n = 20) received systemic chemotherapy with cisplatin, methotrexate and vinblastine (CMV) after TUR, and was carefully followed aiming for vesical preservation. Arm B (n = 17) was given chemotherapy with CMV after TUR and then underwent cystectomy. Disease-free survival at 5 years for the overall series is 69%, 47% for group A and 88% for group B (log-rank, p = 0.14). No statistically significant differences in survival were detected relative to age (under or over 65 years), growth patterns (papillary or plain), histological grade (G2 or G3), and size (smaller or greater than 5 cm). Survival was different depending on the clinical suspicion of nodular involvement (log-rank, p < 0.001). In summary, although the number of patients in the series does not allow to draw conclusions in terms of statistical significance, there is enough evidence to consider that vesical preservation based on TUR and systemic chemotherapy as definitive treatment is a dangerous option without the good survival rates achieved by T2/T3a patients undergoing cystectomy.

Paragangliomas are rare tumours of the bladder accounting for 0.06% of all vesical tumours. This paper reports one case of vesical paraganglioma in a young female patient that has the singularity of being associated to melanin pigmentation. A review is made of cases treated in Spain, adding some comments on the signs and symptoms presented, as well as the diagnostic and therapeutical methods used in this unusual condition.

Brief report on the case report of a young female diagnosed and treated (TUR) of a low grade transitional vesical tumour. The reason behind this paper is the early presentation of this tumoral species. Although this neoplasia used to be practically anecdotal, this is no longer the case. This fact prompted our concern and urged us to continue to investigate the reasons for vesical tumours having an increasingly higher incidence in our environment. In order to manage these neoplasias will shall merge data from ultrasonography with that obtained from urinary cytology. Cystoscopies shall be avoided as far as possible. References used to prepare this paper come from a brief review of the relevant Spanish urological literature. We believe this to be sufficient to prepare a "Clinical report" type original.

One of the anomalies affecting the ureter is the blind bifid cranial ureter, which is truly an uncommon alteration. Clinical signs and symptoms are very ambiguous, and sometimes the condition is diagnosed accidentally while conducting an urographic examination. The aim of this paper is simply to contribute a new case to the existing literature.

The purpose of this paper is to report one case of left pyelic Wilms' tumour in a 17-year old male patient. Pre-operative diagnosis was complicated by a background of prior surgery on the same kidney due to a benign fibroepithelial polyp. The possible concomitences are analyzed while the relevance of an extensive pathoanatomical study to avoid possible diagnostic errors is emphasized.

Female stress urinary incontinence is a highly prevalent disease with a broad range of surgical approaches with different percentages of success depending on the severity of the condition and the appropriateness of the technique in the indication. A few years ago, laparoscopy was introduced as another therapeutical possibility. The paper presents the Burch-like colposuspension through an extraperitoneal laparoscopic approach for the first time in our country, describing the technique and the preliminary results with a mean follow-up of over 6 months. Our preliminary results, as well as the more numerous from other authors seem to indicate that when a Burch-like colposuspension is indicated, extraperitoneal laparoscopic approach may be the ideal one once the learning curve for laparoscopic surgery is overcome.

The kidney is frequently involved in penetrating abdominal injuries, and less so in closed abdominal traumatism. This paper presents one case of major renal trauma with total renal fracture and development of urinoma that separated both segments that, after a minimally invasive manoeuvre (percutaneous drainage), evolved favourably thus avoiding a surgical procedure which, quite reasonably, would have led to nephrectomy.

Benign epididymal epithelial tumours are very uncommon. Their frequency rating is as follows: adenomatoid tumour, leiomyoma and papilliferous cystoadenoma. This paper contributes a new case of epididymal adenomatoid tumour in a 29-year old male who presented with testicular pain. Diagnosis was achieved through physical examination and echography. A simple tumourectomy was performed. As a result of this case, a review was made of the Spanish literature.

Primary retroperitoneal tumours represent a very uncommon group of neoplasias that account for 0.1%-0.6% of all tumours. Interest in these tumorations arises from the therapeutical and diagnostic concerns they rise. These tumorations are of late diagnosis due to the high insidiousness of their symptoms and, generally, are quite large in size. Widespread use of echography and CAT, however, have increased the possibilities of an occasional asymptomatic diagnosis. Treatment is basically surgical, very much depending on the prognosis of the surgery aggressiveness and the degree of radicality achieved. This paper presents our series of primary retroperitoneal tumours diagnosed between 1978 and 1994.

The purpose of this paper is to present the changes that take place in testicular microcirculation measured by DLF during systemic administration of LHRH agonists. The essay includes a comparison with the variations registered in the volume of testicular interstitial fluid, the anatomopathological changes and the associated leucocyte demyeloperoxidase levels. We also examine the relationship between testicular microcirculation changes and plasma testosterone levels. To do this, 50 male Wistar rats were randomly divided into 5 groups, using 10 as control group and the remaining 40 distributed in 4 groups. Measurements were done at 2, 4, 8 and 24 hours after administration of Tryptorelin 0.4 mg i.v. We found that acute administration of an LHRH agonist causes a series of significant changes on testicular microcirculation. Testicular rhythmic microcirculatory flow, i.e., vasomotion, disappears. In turn, accumulation of PMN leucocytes associated to increased venular permeability takes places. Such pre- and postcapillary vascular changes lead to increased vascular permeability which results in increased volume of testicular interstitial fluid. This increased capillary permeability is responsible for the extensive interstitial oedema that would explain the serious histological changes seen on the seminiferous tubule with these drugs.

Among the complications from urethral stenosis those derived from obstructive uropathy of the lower urinary tract and genitalia should be pointed out for their high frequency, the low attention they are given and their potential seriousness. Such complications are related to urinary infection and favoured by the anatomical and functional changes stenosis causes on urinary and genital organs. This paper analyzes the complications in the lower urinary tract in a group of 175 male patients with urethral stenosis, diagnosed at the General Teaching Hospital in Alicante between January 1977 and January 1990. 154 complications of the lower urinary tract (LUT) were reported in 124 patients (71%) out of the initial 175. In 86 patients (49%) these complications were isolated, whereas in 38 patients (22%) they coexisted with other in the genitalia. Frequency ranking of LUT complications was: fight bladder (68% patients), vesical diverticulosis (19%), chronic prostatitis (13%), megabladder (10%), vesical lithiasis (6%), urethral lithiasis (4%), urethral diverticulum (4%) and chronic periurethritis (2%). Renal failure developed in 25 patients (20%), and progressed to CRI in 3 (2%). Urinary infection occurred in 59 (48%) patients, primarily by urolithic germs (24%). Management of the 124 urethral stenosis required a total of 159 procedures, but only 20 (13%) of the 154 complications required surgery. We conclude that patients with urethral stenosis have frequent LUT complications, and that long-term male stenosis associated to urinary infection is a risk factor. Surgery tends to be the preferred treatment option for both stenosis and some of the complications.

The endoscopically-guided lateral discharge laser (VLAP) has been considered an alternative in the management of benign prostate hyperplasia (BPH). The purpose of this paper is to describe the technique, results obtained in 20 treated patients, and pathoanatomical findings in those later treated with prostate transurethral resection. Four patients were carriers of an indwelling catheter, while IPSS/QL mean values in the other 16 patients were 23/4. Mean maximum flow was 7.01 mL/s. Assessment after one and two years shows a fall of mean IPSS/QL to 5/1 and mean maximum flow to 15.2 mL/s and 21 mL/s, respectively, but the difference is not significant. This paper also describes the morbidity affecting 65% patients, which is comparable to the retreatment rate (15%) obtained in other series published. The results are similar to those described in the literature although, in our view, the high rate of complications undermines this choice as an alternative in BPH management.

Objective: The objective of this paper is to compare the hormonal changes and sexual activity between transplanted patients and patients in regular haemodialysis (HD)., Material and Methods: 130 patients, 98 RT carriers and 32 with CRF were evaluated with regard to the sexual function. The etiology of CRF is similar in both groups. All patients underwent hormonal determinations (FSH, LH, Prolactin, Testosterone, Oestradiol and PTH), complete serum testing and other diagnostic studies done selectively, 38 of 130 patients (14 in HD and 24 transplants) answered a personal questionnaire on sexual activity., Results: Oestradiol and prolactin levels are higher in the HD group compared to transplanted patients (p < 0.05). 70% of RT patients maintain their libido versus 35% of those in dialysis (p < 0.01). The former group refers good erection in 55% cases versus 21% of dialysis patients (p < 0.01). Intercourse frequency and degree of overall satisfaction is higher in the RT group (N.S.)., Conclusions: No significant differences were found in FSH, LH and testosterone levels. The normality of FSH levels may be a reflection of the integrity of the germinal line. 65% HD patients refer decreased or absent libido, to which the higher levels of prolactin and oestradiol found could contribute. No relationship was found between sexual function with the type of immunosuppression or the graft function.

The traumatic fracture of the ureter is a very uncommon entity, which accounts for 1-5% of all urological traumatism. In most cases it is secondary to penetrating lesions, endoscopic or open surgery iatrogeny, its occurrence as secondary to closed traumatism being very rare. The paper presents four patients with partial ureteral fractures caused by closed traumatism. Management was in all cases conservative with endourological methods, using backward ureteral intubation, and no case required the use of other types of complementary surgical approaches; functional recovery of urinary tract was complete in all four patients.

Fungal urinary infections are becoming increasingly frequent as a result of widespread use of broad spectrum antibiotics, an increased number of immunocompromised patients and the greater longevity of chronic patients. Urinary tract infections by Toruplosis glabrata only come second in frequency after those caused by Candida albicans, accounting for 5 to 25% of all infections caused by fungi. The paper presents one case of pyonephrosis by Toruplosis glabrata in a female patient treated with fluconazole who later underwent nephrectomy. A description is made of the clinical picture, diagnosis and treatment of these infections.

Presentation of a case-control study on 755 subjects with the purpose of defining whether the development of a neoplasia on any organ and of any histological type, either synchronous or metachronous, occurs more frequently in patients who already have vesical carcinoma (338 cases) versus other populations of similar epidemiological characteristics comprising subjects who do not present that condition (417 controls). The evaluation of the difference between both groups establishes a cause-effect relationship expressed in terms of an odds ratio of 2:11 which allows to claim that presence of a second neoplasia is more frequent in patients with vesical carcinoma (p < 0.001). The paper also includes a discussion on the distribution to organs and systems. Once the cases with urothelial site (renal pelvis, ureter or urethra) are excluded, prostate adenocarcinoma is the most frequent form associated to vesical carcinoma, followed at a distance by renal adenocarcinoma, epidermoid carcinoma of the larynx and bronchopulmonary carcinoma. Cumulative incidence of secondary neoplasias, including tumours diagnosed synchronically is 12% at 54 months.

Urethral duplication is a very rare malformation which occurs almost exclusively in males. Associated genital and urinary malformations are frequent, and the approach in symptomatic cases in surgical management. This paper presents one case of a full double urethra in a 9-year old girl with repeat urinary infections and incontinence. The accessory urethra was surgically removed using perianal and abdominal access. Evolution has been favourable with disappearance of symptomatology.

Since Ishii et al.2 first described in 1986 the use of PGE1 in erectile dysfunction, a number of studies have been conducted using this vasoactive drug. Use in self-injecting programs, without additional drugs associated due to the ease of use and minimal complications, is currently becoming increasingly common as the choice therapy for erectile dysfunction. The paper analyzes our series of 66 patients included in self-injecting programs with PGE1 with no other drugs associated. Follow-up time has been 9.8 months (1-39). Mean age of our patients was 55. Our larger etiological groups were vascular (42%), diabetic (19%) and psychological (21%) patients. Dose increase over time has been significant in vascular and diabetic patients relative to the other groups. It has been found that program compliance has basically depended on the severity of the causative disease, which was significant in vascular and diabetic patients. Local complications have been: pain (19.6%), prolonged erection (3%), and priapism (1.5%).

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.

It is true that appearance of prostate abscesses is currently not so frequent due to the antibiotic therapy available to stop any kind of infectious process which may trigger abscess formation. Even so, it is important to channel right from the beginning the correct diagnosis and treatment in order to avoid, as far as possible, any complications that may derive from the process. This paper deals with the case of a young patient diagnosed in our service with a prostate abscess, and faced with that suspicion we advocated the use of transrectal ultrasound (TRU) as the method for diagnostic imaging. Also, TRU offers great help as guidance in the transperineal puncture, so as to drain the purulent content. It should not be forgotten the valuable information provided by ultrasound to confirm that the treatment used was effective.

Presentation of results of treatment using Biofeedback in two conditions which quite frequently associate vesical instability and incontinence: 65 cases of enuresis and 39 of urinary stress incontinence in females. The method was effective and achieved disappearance of detrusor instability in 78.2% of enuretic cases and 58.9% of urinary stress female incontinence. Outcome for incontinence was less favourable since disappearance was only achieved in 70.5% of enuretics and 20.5% cases of female incontinence. A brief description of the method and instrumentation used is done, which can be easily conveyed to any electromiographic device with real time output. The paper substantiates the authors' views relative to the likely pathogeny of the instability in both processes and the mechanism of action of Biofeedback techniques.

Paratesticular vascular lesions are very uncommon. One of them, the epithelioid hemangioendothelioma, is a vascular tumour which grows around a vessel and in characterized for presenting epithelioid endothelial cells. Is very rare and it has good prognosis. This paper reports one case of paratesticular epithelioid hemangioendothelioma.

Burned-out testicular tumour is an uncommon entity defined by the spontaneous regression of the testicular tumoral site after spread to metastasis, leaving behind a scarring lesion with typical histological changes. This paper reports one case of burned-out testicular tumour diagnosed and treated initially as an embryonic carcinoma with areas of extragonadal malignant immature teratoma that after nine years of follow-up reveals the primary testicular site. Physical examination and detailed ultrasound study of the testes is of the greatest significance in stem cells tumours with extragonadal location, given the prospect of identifying the primary testicular lesion as a burned-out tumoral site and performing radical treatment of these tumours.