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

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

The etiological diagnosis of an erectile dysfunction usually requires a study of penis vascularization. The arterial origin involves a high percentage of erectile dysfunctions. The eco-doppler allows to perform the study in a fast, non-invasive and effective way, providing information on the morphological aspects of arteries and flow parameters. This paper reports on a study conducted in 151 subjects, aged 27-80 years, where the cause of impotence was arterial; the existence of clinical signs of vascular deficit in other domains had already suggested the condition in a group (36 subjects), while the another group (115) had no clinical symptoms and was diagnosed through eco-doppler. 75.5% were smokers and 83.1% hypertensive. All subjects underwent a baseline study, repeated in 148 after intracavitary injection (ICI). The arteries were difficult to identify at rest, but easier after ICI, presenting morphological features which were suggestive of disease: twisted course, irregular lumen, thickened walls. Flow parameters at rest presented no differences between groups, both speed (p < 0.001) and flow time (p < 0.05) being lower than in subjects with no vascular disease. Only 25.7% reached full erection with ICI, beats being noticed in 44 (91.9%). After administration of the drug there was a significant increase in systolic speed (p < 0.001), rising to 16 +/- 4.9 cm/s vs 34.7 +/- 9.3 cm/s in subjects with no vascular disease (p < 0.001). Flow time increases after ICI, reaching 345 +/- 215 msec, less than in healthy subjects (p < 0.001). RI, highly variable at rest, does not change significantly after ICI, 0.71 +/- 0.11, lower than subjects with no disease (p < 0.001). The increases seen in flow speed are greater in subjects with no ischaemic symptomatology (p < 0.01), same as RI (p < 0.05), and reveals a better arterial response. Those who obtain full erection reach greater RI (0.77 +/- 0.13) than those without full erection (0.68 +/- 0.08) (p < 0.001).

Non-ischaemic high flow priapism resulting from trauma of the genito-perineal area is an uncommon occurrence. Resolution by selective embolization of the internal pudendal artery is currently the choice treatment. This paper presents the case of a 9 year-old patient where embolization with autologous coagulation achieved healing.

The association of insipidus diabetes, diabetes mellitus, optic atrophy and deafness is known as the Wolfram syndrome. This paper contributes two case reports with significant urological sings and symptoms associated (ureterohydronephrosis, neurogenic bladder) both studied from a radiological and urodynamic point of view, with comments on the probable origin of the urological alternatives as well as their evolution, which was favourable after treatment with antibiotics and intermittent vesical catheterism.

The currently growing importance of prostate cancer (PC) is given by the large increase in the number of cases diagnosed with this condition, to a great extent due to the diffusion of the most recent diagnostic techniques. Together with the traditional rectal examination, we have available today the PSA (prostate specific antigen) and the transrectal ultrasound, which allow to diagnose tumours undetectable with palpation. This paper presents the case of a male patient with high levels of PSA (in metastatic values), normal rectal examination and three series of negative prostate biopsies in spite of a high suspicion of PC, the diagnosis being confirmed after adenomectomy, with a subsequent PSA levels normalization, these levels remaining below 3 ng/ml after 22 months follow-up, which allows to think of a "recovery" (?) with just the removal of the prostate adenoma.

Incidence of post-renal transplant (RT) lymphocele varies between 0.6% to 41% depending on the author. Therapeutical management of these entities is controversial. (Open or laparoscopic) surgical marsupialization of the peritoneal cavity, percutaneous drainage, and percutaneous sclerosis with povidone-iodine are all valid options to treat post-RT lymphocele. This paper presents two cases of symptomatic post-RT lymphocele not suitable for laparoscopic treatment, which were resolved by intracavitary instillation of Sodium Amidotrizoate 76%. The first case had been previously treated with povidone-iodine with no resolution, also maintaining a 500 ml/24h deficit. In the second case, instillation with Sodium Amidotrizoate 76% was considered first choice approach. In both instances the lymphocele deficit ceased with instillation intervals of 6 and 14 days, respectively. In brief, percutaneous sclerosis with Amidotrizoate can be a valid alternative for the treatment of post-RT lymphocele.

Description of our modification of the detubulized ureterosigmoidostomy surgical technique (Castiñeiras-Ferragut-Camacho). In an attempt to shorten the surgery time, we used for these changes absorbable mechanical sutures (Poli Gia and T.A.). This paper analyzes the technical details of interest as well as the anatomicosurgical considerations that should be known prior to carry out this type of by-pass. The anatomicophysiological principles on which our developments are based are those referred by N.G. Kock15 and used by R. Hohenfellner and R. Fisch14, when they described the detubulized ureterosigmoidostomy performed manually. We believe that both surgical procedures, R. Hohenfellner & R. Fisch14 and ours (detubulized ureterosigmoidostomy, C.F.C.), are suitable alternatives to conventional ureterosigmoidostomy.

The negative role of smoking on circulation is widespread knowledge and it has been rated as a vascular risk factor. This paper evaluates the influence of smoking on the arterial supply to the erectile tissue, establishing the flow speed parameters in cavernous arteries with eco-doppler both at rest and after intracavernous PgE1 injection. Four groups were studied: non-smokers, without arterial disease and with arterial disease of non-smoking etiology; smokers with vascular disease, and another group where smoking was the only verified etiological factor. No significant differences were detected in flow speed parameters at rest among smokers and non smokers both in individuals with preserved erectile potency or with erectile dysfunction. Following drug therapy, impotent smokers showed the worse erectile response. With regard to flow speed parameters, although the differences were not significant, it can be seen that smokers, whether potent or not, show less differential speed, flow time, and acceleration, exhibiting a certain degree of arterial rigidity. That flow speed parameters, in cases with erectile dysfunction, can be superposed in individuals with arterial-origin impotence and those where smoking is the sole risk factor, indicates that this is a factor which causes erectile dysfunction due to vascular damage, as severe as any other caused by other factors such as arteriosclerosis, diabetes, or hypertension.

The erectil dysfunction is a common disorder in diabetic patients resulting from neurological, arterial and endocrine factors. This paper presents an eco-doppler evaluation of the arterial factor in 88 diabetics: 17 controlled with diet, 38 with oral anti-diabetic agents and 33 with insulin. Age, ranging from 23 to 70 years old, was similar in subjects controlled with diet (55.6 +/- 6.4) or anti-diabetic agents (57.6 +/- 7.9), but greater in insulin-treated subjects (46.8 +/- 10.5) (p < 0.01). Fifty-six subjects (63.6%) has nocturnal and 43 (48.9%) diurnal erections, 45 (51.1%) achieving penetration. There was 65 (73.9%) smokers, 28 (31.8%) hypertensives, and 24 (27.3%) reported stress. A baseline evaluation was performed in all cases, in 87 after I.I.C (papaverin 26 and PgL1 61), full erection being achieved in 18 cases, non-rigid erection in 15, tumescence in 50 and with no response in 4. No differences were seen by type of diabetes. The variance analysis showed no differences in the flow speed indicators among the three groups, both at rest and after I.I.C., the sample being therefore homogeneous, superposable to arterial dysfunctions and significantly lower than those of the control group (p < 0.01). We conclude that diabetes induces arterial changes which are superposable to those caused by other vascular risk factors and independent for the type of diabetes.

Treatment of infiltrant vesical cancer has traditionally been the grounds for intense controversy. Transurethral resection (TUR) followed by high voltage radiotherapy (RT) in selected cases of locally advanced vesical urothelial tumours can be a valid alternative for the treatment of this condition. This paper discloses the experience of our center in the treatment of this type of tumours over the last few years (1979-1993) on 85 selected patient, with a considerable percentage of living patients and with no evidence of disease after the follow-up period; taking into account the influence on these results of the cytologic grade, tumoral size, gross appearance of the tumour, and tumoral stage. Additionally, these results are compared with those from other authors using similar therapeutic method as well as with the results from different therapeutical approaches, illustrating one more the intense controversy that exists relative to the management of these patients.

Severe vesicouretheral reflux sometimes causes terminal renal failure which then requires renal transplantation. In these patients it may be necessary to perform bilateral nephrectomy when associated to serious hypertension or urinary infections with a significant clinical impact. This paper presents the clinical picture of a patient with a corpse renal transplantation, due to terminal renal failure secondary to reflex nephropathy, in whom it was necessary to perform bilateral nephrectomy due to the uncommon urinary infections requiring hospitalization for treatment. The bilateral nephrectomy was done through transperitoneal laparoscopic approach, using seven points for trocars introduction. The procedure lasted 4 hours and the patients was discharged within 48 hours with no complications. Accumulate experience in the use of laparoscopy in urology has allowed this technique to be feasible. After designing the experimental model, our group has had the chance to accomplish laparoscopic nephrectomies in humans. We believe that this is the first case of bilateral nephrectomy conducted in our country using the laparoscopic approach.

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

The paper sums up our experience with kidneys which have undergone "bench" extracorporeal arterial surgery. The reasons making this procedure necessary were: renal graft from corpse donor presenting multiple arteries or arterial lesions (12 cases); orthoptic kidneys with stenotic lesions or arterial aneurism (5 cases); transplanted grafts which developed renal artery stenosis (2 cases). Incidence of arterial thrombosis and ureteral fistula was significantly higher in the first group than in grafts where no "bench" surgery had been performed. Medium- and long-term actuarial survival, however, showed no difference. In the second and third groups, extracorporeal arterial reconstructive surgery is a technique with a high risk for the loss of the involved renal unit.

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

The treatment of ureteral lithiasis has undergone a revolution since the arrival of new techniques offering different therapeutical choices for which time is gradually elucidating the indications for each of the new procedures; although, to a large extent, a degree of controversy still persists. This paper reviews the different methods for ureteral lithiasis; spontaneous ejection and medical treatment, surgery, early endoscopic manoeuvres, backward and forward urethroscopy and, finally, extracorporeal lithority. This therapeutical experience in 3 series of ureteral lithiasis addressed with different criteria are revised together with 182 obstructive calculi of the lumbar ureter. We believe that grading the ureteral calculi according to their anatomical and functional features improves the results, since improved adjustment can be achieved for the indications of the various methods. Also it is noted that support endourology for extracorporeal lithotrity does not improve the results of treatment in lumbar calculi under 2 cm, and therefore our current approach is towards "in situ" treatment without complementary manoeuvres. Finally we show the therapeutic algorithm we are following actually to manage ureteral litiasis.

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

Adrenal gland haemangioma is an uncommon tumour which finding usually occurs by chance. This paper presents one case of cavernous haemangioma in this location on which surgery was performed successfully. The basic aspects of the case are revised from a pathohistological and diagnostic point of view intended to attempt to suspect its presence preoperatively.

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

This paper reports two cases of vesical schistosomiasis in two black patients treated in this Service over the last three years. A description is made of the different anatomo-clinical presentations of these two cases, commenting on the characteristics of this disease, its pathogenesis, diagnosis and treatment, and stressing the slight increase in its frequency in our environment as a consequence of the increased migratory movements of people from endemic regions into our country.

Presentation of two cases of congenital diverticula of the bulbar urethra. The objective of this paper is to discuss the etiopathogenic theories, sings and symptoms, current diagnostic methods and therapeutic indications, and to conclude that this type of diverticula do not present a florid symptomatology, endoscopy being the best diagnostic and therapeutic method. Finally, a review of the literature is made based on two clinical cases.

Despite of prostate abscesses having become an uncommon disease, a number of cases has been described lately specially in immunodepressed patients caused by infrequent agents, such as Mycobacterium tuberculosis. This paper describes the case of one HIV-positive patient, diagnosed with a prostate abscess within a tuberculous dissemination. The best diagnostic method is considered to be the transrectal ultrasound (TRU), the choice therapy being drainage by ultrasound-guided transperineal percutaneous puncture.

Transitional cell tumours of the bladder in children are exceptionally rare. This paper presents a new case in an 11-year old patient. The benignity of these tumours during the paediatric age can be verified due to the low infiltration incidence; some authors, however, describe cases of relapses which are commented upon. The careful follow-up that has to be done in this type of patients is underlined.

Vesical leiomyoma is a benign mesenchymal tumor that rarely involves the bladder and makes about 1.5% of all vesical tumors. A new case is presented and aspects concerning clinical, diagnostic and surgical issues are examined. The paper includes a revision of the available literature on the topic.

Renal carcinoma natural history is unpredictable. Spontaneous metastases regression after nephrectomy, as well as late recurrence are suggestive of this peculiar human neoplasm. tumor metastases localized to thyroid gland are uncommon in clinical practice; and carcinoma of the kidney, breast, lung, melanoma and gastrointestinal tract tumors are responsible for the majority of them. This paper reports on a patient with metachronous thyroid gland metastases after fourteen years of renal carcinoma nephrectomy, with one year after hemithyroidectomy recurrence on cervical striated muscle followed by surgical excision. Therapeutical aspects are briefly reviewed in literature, emphasizing surgical treatment and the need of all-life follow-up, with more alert attitude toward thyroid gland after renal cell carcinoma nephrectomy.

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

This paper analyzes the renal and ureteral complications caused by urethral stenosis. A total of 180 patients with stenosis, 175 males and 5 females, were reviewed. There were 55 renal-ureteral complications in 37 patients (20.55%). In order of frequency, complications were as follows: renal failure (36%), ureterohydronephrosis (33%), chronic pyelonephritis (16%), vesico-ureteral reflux (11%), and post-obstructive renal annulment (4%). Most complications were reversible. However, renal function impairment was irreversible in 3 cases due to I.R.C., as well as in 2 cases due to post-obstructive renal atrophy-annulment. Nine patients showed chronic pyelonephritis morphological changes. Urinary infection occurred in 28 patients (76%), and in 50% of them was due to ureolytic germs. The best procedure to treat these complications is based on a correct prevention, eradicating the associated urinary infection and correcting the causative obstructive problem. Nonetheless, surgery was required in 5 patients (13.50%) and extracorporeal lithotripsy for the lithiasis associated to stenosis in other 5 patients (13.50%). We conclude that although those complications have a high incidence, their ultrasound diagnosis is easy and the prognosis reversible once the stenosis is corrected. Risk factors for development are: male sex, the sixth decade of life and a long evolution stenosis associated to urinary infection. Finally, a review of the scarce literature on this frequent but forgotten chapter of obstructive uropathy is made.

The introduction of self-expandable urethral endoprotheses for the management of relapsing urethral stenosis has required the development of a minimally invasive therapeutical approach of widespread acceptance by the urological community. The reason for its success is the simplicity of implantation and the low rate of complications up to date. This paper reports on a patient carrying a ¿Urolume¿ urethral endoprothesis for a relapsing bulbar urethral stenosis, which two years after implantation presents re-stenosis secondary to endoluminal inflammatory tissue growth. After two failure endoscopic resections, endoscopic removal of the prosthesis was required. Currently the patient carries a ¿Urocoil¿ spiral endoprosthesis to avoid tissular reaction. The therapeutical aspects found in the literature are reviewed, emphasizing the need of follow-up to detect complications, to improve indications and to select those patients that may be candidates for this treatment.

Male feminization is an uncommon and complex phenomenon which occurs as a consequence of an imbalance in the effective oestrogen/androgen relationship. One of the many approaches used in the treatment of idiopathic male infertility is hCG/hMG stimulation. This paper reports one case of an infertile male treated with hCG/hMG after surgical correction of a varicocele, which resulted in a feminization effect evidenced by gynaecomastia and severe spermatogenesis blockade. When therapy was discontinued the feminization disappeared, a rebound phenomenon with normalization of most of the seminal parameters being seen. No other fully documented cases were found in the literature. Finally, the pathoetiological mechanisms involved in the feminization are analyzed and a revision is made of the causes that may cause it.

In an extensive review focused on male urethral stenosis, where more than 1,200 publications relative to this problem were evaluated, we found a lack of conceptual precision when it comes to qualify the varied terminology used to define concepts such as normal urethra, urethral stenosis, relapsing urethral stenosis, spongiofibrosis and urethral callus. The lack of precision may be due to the fact that we surgeons are more interested in reporting our surgical successes than in semantic appraisals. No publications have either been commented with a global approach to the problem of the various and potential classifications of urethral stenosis in the various etiological, clinical, radiological, endoscopic, ultrasonic or therapeutic aspects. The current paper is an update of this old urological problem. The guidelines outlined below are neither entirely original, nor the only or even the most correct approach of all those that can be used to address this issue. They are simply the result of the cumulative surgical and medical experience as well as of the enthusiasm we feel toward this part of urology.

The introduction of self-expandable urethral endoprostheses for the management of relapsing urethral stenosis has required the development of a minimally invasive therapeutical approach of widespread acceptance by the urological community. The reason for its success is the simplicity of implantation and the low rate of complications up to date. This paper reports on a patient carrying a ¿Urolume¿ urethral endoprosthesis for a relapsing bulbar urethral stenosis, which two years after implantation presents re-stenosis secondary to endoluminal inflammatory tissue growth. After two failure endoscopic resections, endoscopic removal of the prosthesis was required. Currently the patient carries a ¿Urocoil¿ spiral endoprosthesis to avoid tissular reaction. The therapeutical aspects found in the literature are reviewed, emphasizing the need of follow-up to detect complications, to improve indications and to select those patients that may be candidates for this treatment.

Sarcomas are a rare entity among malignant tumours of the bladder. This paper presents the case of a male patient with leiomyosarcoma within a vesical diverticulum. The approach undertaken was diverticulectomy and, since the tumour was limited to the diverticulum and no metastatic disease was present, no other adjuvant therapy was considered.

Presentation of results obtained in 50 procedures of retrograde ureterorenoscopy (URS), and discussion based on the literature and our results, on the current indications for URS with regard to extracorporeal lithofragmentation (ECL) for the treatment of pelvic ureteral lithiasis and the diagnosis and/or treatment of other conditions. Fifty URS were performed in 47 patients between February 1992 and March 1994: 35 were conducted to treat ureteral lithiasis, achieving a 97% success rate and a mean post-surgery hospital stay of 48 hours; and for diagnostic and/or therapeutic reasons. There were no major complications, and a description is made of minors cases. We prefer to use URS in those cases of distal ureteral lithiasis, as compared to ECL, because of its level of efficacy (higher than or equal to ECL), low cost/benefit ratio, low morbidity and shorter hospital stay involved. The paper emphasizes the major diagnostic and therapeutical indications for URS, and finally, it is noted that URS can avoid undertaking other more aggressive urinary by-passes, since it allows to catheterize the ureters where a false intramural route is conducted.

Genital prolapse is associated to a greater concurrence of repeat urinary infections, stress urinary incontinence, arterial hypertension and obstructive uropathy with a higher or lower degree of renal impairment. Incidence of uropathy in the genital prolapse setting ranges between 4 and 13%. This paper presents a female patient with renal insufficiency secondary to bilateral obstructive uropathy caused by a concomitant genital prolapse. A brief revision is made of the pathophysiological, diagnostic and therapeutic aspects in the literature. The need to perform both prone and standing urographic studies is emphasized; also a study of the renal function should be performed in these patients in order to establish the appropriate treatment and avoid major complications and renal function impairment.

Internal urethrotomy is the endoscopic technique most commonly performed in order to resolve urethral stenosis. This paper describes a new technique which associates transrectal ultrasound to internal endoscopic urethrotomy for the resolution of unsurmountable stenosis of the urethra. Presentation of 6 cases, with a 100% success rate. The authors believe that the association of transrectal ultrasound with internal endoscopic urethrotomy is a simple technique, and very useful for the resolution of unsurmountable stenosis of the urethra.

Pseudosarcomatous tumour of the bladder is a benign neoforming process of uncommon occurrence, consisting in a fibroblastic proliferation originated in the vesical wall and the perivesical fat, with unknown etiology, that given its cellular pleomorphism and the infiltrative nature of the injury can be incorrectly diagnosed as a sarcoma. This paper presents one case of pseudosarcomatous tumour of the bladder in a 9 year-old child, with no history of local traumatism or previous surgery, consisting in a tumoration affecting the vesical wall associated with a significant perivesical fibrosis with extension towards the area of the iliac veasels. Microscopically, the injury shows proliferation of spindle cells, arranged in a myxoid stroma with a prominent vascular net. No cytologic atypia is demonstrated or increase in the number of mitosis. The immunohistochemical study shows features of myofibroblasts in the proliferant cell. A review of the literature is made on 40 cases of inflammatory pseudosarcoma, evaluating the clinical characteristics, morphologic findings and treatment involved, as well as the postoperative evolution of the patient.

Lately, nuclear morphometry methods are being used to analyze the malignant potential of tumoral cells. This paper presents a retrospective study of a series of 163 patients with the three histological grades (WHO), of superficial papillary transitional cell carcinoma (pTa-pT1) of the bladder with a mean follow-up of 60 months. A morphometric analysis of the initial tumour biopsies was made. Mean nuclear area (NA) and its standard deviation (NASD) were measured in a semi-automatic image analyzer (MOP-videoplan, Kontron). NA and NASD show increasingly higher values with increased grade (p < or = 0.0001). NA and NASD values raise in those progressing to muscle-infiltrant stage; tumours were, then, divided into two morphometric groups: small NA (< 50 microns 2) and large NA (> 50 microns 2); the difference between them being statistically significant. The likelihood of no tumoral progression at 30, 60 and 90 months was, respectively, 96, 94 and 92 percent, form small NAs, and 76, 65 and 64 percent for large NA (p < or = 0.0001).

Accurate diagnosis of "suspect" lesions from the Upper Urinary Tract (U.U.T.) is of major significance for implementing an appropriate treatment. There are many diseases and situations which may condition the occurrence of a suspect image, i.e., of a repletion defect of the U.U.T., in the U.I.V., the vascular imprints being just one of them. This paper contributes two cases where the suspect lesion was due to this cause and vascular radiology was decisive to reach a diagnosis.

Comparison of the effect of the Wisconsin University (WU) conservation solution in the graft's functional evolution and survival, and its cost-benefit relationship versus the Eurocollins (EC) solution with regard to cold ischaemia duration in a series of 142 consecutive adults renal transplantations from corpse donor, removed with beating heart. Of 142 kidneys, 92 (64.7%) were kept in WU and 50 (35.2%) in EC. Of the WU group, 62 (67.3%) kidneys were transplanted after a cold ischaemia of under 24 hours and 30 (32.6%) after cold ischaemia of more than 24 hours. In the EC group, 23 (46%) were kept in cold ischaemia for an interval shorter than or equal to 24 hours and 27 (54%) for more than 24 hours. Incidence of initial graft dysfunction (IGD) was greater in the EC groups (65% and 78%) versus the WU groups (39% and 50%), the difference being statistically significant (p). The graft function, as indicated by the creatinine levels was always better in the WU groups. There was a decreased need for complementary dialysis sessions, less days of oliguria and shorter hospitalization in the WU groups (p). There were no significant differences in the four series with regard to rejection episodes, cyclosporin-related nephrotoxicity, and vascular and urinary tract complications. All of which turn cost-effective the higher cost per litre of the WU versus the EC solution. Graft survival at 12 and 24 months was also significantly (p) higher for grafts kept in WU. This paper presents the results obtained in the analysis of our transplanted patients. In our experience, the WU solution allows better conservation of renal grafts, with less IGD and better graft survival at 12 and 24 months. These results turn cost-effective the higher cost per litre of the WU versus the EC solution.

Castleman's disease is a disorder of the lymph tissue, of undetermined etiology and with preferentially mediastinal location, although other lymphatic and extra-lymphatic locations are also possible. This entry appears under two varieties: the most frequent, hyalovascular type which generally does not have associated systemic symptoms, and the plasmocellular type associated to multisystemic symptoms in up to 50% cases, such as fever, anaemia, hypergammaglobulinemia, etc. Additional examinations beyond those usually available are not enough to establish a certainty diagnosis against other types of tumours, so an histopathological study is required prior to arrive to this definite diagnosis. Surgery is the choice therapy, although sometimes a favourable response to radiotherapy, used as alternating or adjuvant therapy, can be obtained. Corticoid therapy can be an effective option when dealing with systemic symptoms. The paper submits one case of Castleman's disease of the hyalinovascular type with retroperitoneal location which forced us to establish a differential diagnosis with other disorders in that region more frequent in our specialty. Definite clinical diagnosis was not possible surgery was chosen and the entire lesion removed. As certainty diagnosis was therefore histologic and, up to this point, the patient has shown no signs or symptoms of relapsing.

Fitting a penial prosthesis has become an effective procedure to treat sexual impotence. However, its main complication, infection, remains a relatively frequent problem which forces the implant removal with the resulting treatment failure. This paper summarizes our early experience in 4 patients with infected penial prosthesis, who were treated by correcting the patient's general status, adequate antibiotic treatment, and deep and regular curing of the infected area. In these 4 patients, we managed to preserve the implant, achieving an adequate functional and cosmetic result. The paper discusses the pathophysiological mechanisms which would explain these improvements and points to the eventual indications and contraindications of the treatment. Finally, a recommendation is made to use this treatment with caution since our experience was still preliminary.

Leydig's cells tumours are a variant of testicular tumours. Its has a low incidence, accounting for just 1-3% of all testicular tumours. This tumour is characterized by its endocrine manifestations, and it is an element in the differential diagnosis of many endocrine sexual dysfunctions both in adults and children, due to the tumour's capacity to secrete hormones. This paper contributes 5 cases of Leydig's cells tumours diagnosed in our hospital between 1977 and 1993.

Adrenal hypertension is an uncommon phenomenon. When seen in association with hypokalemia the existence of primary aldosteronism, the most frequent cause of which is an adenoma of the adrenal gland cortex, should be suspected. This paper contributes one case of primary aldosteronism treated by unilateral resection of the adrenal adenoma, with no surgical complications and good medium-term results.

The higher risk of developing malignant tumours in transplanted patients is a fact widely acknowledged over the last decade. This paper includes an analysis of our series and a review of the literature. Cancers developed by the transplanted patient or "de novo" cancers and, within this group skin and lip cancer (58%), are by far the most frequent ones. Their biological behaviour is, in general, more aggressive than similar ones in non-transplanted population. Also, different incidence rates and behaviour have been established depending on the immunosuppressive regime given to the patient. Most common pre-existing carcinoma was renal cancer (one third of cases). When these patients had been adequately treated before the transplant, the minimum disease-free interval that has to elapse to be included in a waiting list will depend on the type of tumour. Transferred tumours are the least frequent but more worrying ones due to both their clinical and legal implications. In view of the existing evidence, it is of particular relevance to insure the primitive nature of any CNS tumour as well as the absence of tumoral disease in young females who die of brain haemorrhage.

Between 1970 and 1993, five children with paratesticular rhabdomyosarcoma (PR) and age ranging from 3 to 10 years were treated by our group. Following radical orchidectomy and clinical staging, 4 were rates as Group I-IRS (completely resected local disease) and 1 in Group IV-IRS (distant metastasis). All patients in Group I underwent intensive chemotherapy with vincristine, actynomicin D and cyclophosphamide (VAC) for 18 months, while no case of retroperitoneal lymphadenectomy was performed. Currently, all patients are disease free with a mean follow-up of 8 years and 5 months. The single patient included in Group IV received radiotherapy (800 rads in abdominal field) and chemotherapy with VAC + prednisone (PDR), and retroperitoneal lymphadenectomy of residual masses was performed. The patient developed liver metastasis and died 20 months later. The purpose of this paper is to convey the reader our experience in the treatment of PR in children, making a special reference to the excellent prognosis when the disease is limited to the scrotum and recommending in such cases the use of intensive chemotherapy with VAC after performing radical orchidectomy.

Abdominal-scrotal hydrocele is an uncommon lesion, most specially during childhood. It is an entity, though, that should be included in the differential diagnosis of abdominal masses in children, and also considered as a likely cause of ureterohydronephrosis. Diagnosis is arrived at through ultrasound, CAT and occasional excretory urography. Radical surgical excision using inguinal access is the recommended approach, but sometimes the inguinoabdominal or pure abdominal approaches can be performed. Following surgical ablation the cure is complete, and includes remission of the ureterohydronephrosis when present. This paper reviews the literature, presents one case and discusses both the diagnostic possibilities and therapeutic alternatives.

The nutcracker phenomenon consists in the compression of the left renal vein by the aortomesenteric clamp. This is an infrequent cause of haematuria. The present paper presents one case of nutcracker phenomenon showing haematuria after mild accidental lumbar bruising, with arteriographic diagnosis. CAT assessment showed a mark in the lumbar ureter as well as peripyelic and periureteral varices.

The paper reviews the various prophylaxis modalities in surface vesical tumours in order to define the degree of toxicity caused by each of them. Also, a prophylaxis diagram is prepared, having into account each substance's toxicity, the benefit awarded to each of then and the tumour prognosis. The agents under assessment are Thiotepa, Adriamycin, Epirubicin, Cisplatin, oral Methotrexate, Mitomycin-C, Mitoxantrone, Interferon and BCG, at doses of 40, 120 and 150 mg. Two groups of prophylactic agents can be identified with regard to toxicity. The first one is constituted by Interferon, Adriamycin, Epirubicin and Mitomycin-C, with side-effects lower than or close to the net benefit estimated for each. The second group comprises cytostatic and immunomodulatory compounds with toxic effects greater than their net benefit. In this group, three different situations can be distinguished: a) BCG with high toxicity and high net benefit; b) Cisplatin, Thiotepa and Mitoxantrone with high toxicity and net benefit similar to that of Adriamycin, Epirubicin and Mitomycin C; and c) Oral Methotrexate, with high toxicity and no benefit. According to their toxicity levels, Interferon, Adriamycin, Epirubicin and Mitomycin C are indicated in the prophylaxis of medium-risk tumours, while BCG only in high-risk tumours. Thiotepa, Cisplatin, Mitoxantrone and oral Methotrexate have to be eliminated due to their negative benefit-toxicity relationship.

From the assumption that prophylaxis of oxalocalcium lithiasis is feasible with an the intake of citrate-rich food, this paper presents a prospective, medium-term research in two groups of patients with a background of this type of lithiasis; the first group was treated with diet and increased fluid intake exclusively, while the second group had to follow similar dietetic measures and take also one litre of orange juice daily. Orange juice raises citraturia and pH, decreasing the rate of lithiasis formation and crystallization risk indicators for calcium phosphate. No significant differences are obtained in the number of relapse ratio reductions for the second group as compared to controls.

The paper describes the experience accumulated over a 9- year period on surgical treatment of coralliform lithiasis. The treatment implied the use of an original technique inspired in the surgical concepts divulged by Gil-Vernet, Kelly and Dufour. Ninety-four patients have been effectively treated with this technique, known as the Bivalve Transinusal Anathropic Nephrothomy. The surgical technique applied is described and analyzed.