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A case of lithiasic pyonephrosis evolving with intrapyelic gas formation, with positive urinary culture for Escherichia coli, is presented. Original clinical presentation was a picture of acute peritonitis with pneumoperitoneum. Clinical and radiological findings were indicative of exploratory laparotomy. The picture was resolved surgically, the procedure adopted being nephrectomy with retroperitoneal space drainage and empirically chosen antibiotics. The paper establishes the uncommon nature of this complication, and includes a literature review.

The paper presents the results obtained from a study of 28 patients with high urothelial tumour, treated with radical surgery (total nephroureterectomy). Multivariable study of survival rates (Cox models) indicates that cellular differentiation is the most significant prognostic factor. Single variable study indicates that tumour stage has some significance mainly due to the large relationship to the degree of cellular anaplasty.

The paper presents our initial experience in the treatment of urethral stenosis through implantation of a "Wallstent" self expanding resident prosthesis. A total of eleven prosthesis were placed in 10 patients with excellent results, from a clinical, urodynamic, radiological and endoscopic point of view, in 9 of them after 5 months. We believe that this kind of prosthesis can be a valid alternative to other established therapeutic options in the management of urethral stenosis. Long-term monitoring, however, will be necessary in order to corroborate the excellent results obtained in this short/medium-term observation.

The paper presents our initial experience with endoscopic suspension of the vesical neck, as per the modification introduced by Gittes and based on incorporation through the vaginal mucosa of non-absorbable single-filament sutures. In this way it is feasible to use a simple non-incisive vaginal surgery with minimum morbidity. Good results have been obtained so far in six of the seven patients operated on. No complications have presented following tube retrieval on the second day. It is our belief that these initial results can be a reasonable basis to a wider use of this technique and to know its long-term results in treating stress incontinency through urethral hypermobility.

This paper reviews the surgical procedure performed in 119 kidneys (114 children), diagnosed with congenital hydronephrosis due to pyeloureteral juncture stenosis (PUJS). Approaches used for diagnosis and choice of surgical techniques are commented. Puncture/nephrostomy with functional kidney assessment has been the method selected in extreme cases. Nephrectomy was the chosen option in 8 cases (6.7%) while conservative surgery was indicated in the others. Anderson-Hynes dismembered pyeloureteral plasty was the technique used in 110 cases with a 97.28% rate of success. Post-operative occurrences are commented and are related to the presence of pre- and post-operative derivation.

Renal adenocarcinomas are tumours which sometimes tend to remain clinically silent, and initially become evident through distant metastasis. This paper presents the case of a 54 year-old patient whose initial clinical evidence was parotid metastasis from kidney clear cells adenocarcinoma. The patient had a metastasis and renal tumour exeresis with application of supplementary chemotherapy and immunotherapy, presenting early pulmonary metastasis which remains currently unchangeable. Some comments apropos of distant metastasis, its prognosis and regression in renal tumours are made.

This paper presents a retrospective study of the incidence and evolution of Penis Verruciform Carcinoma, covering a series of 101 cases of primitive penis carcinomas. Incidence reaches 7.9% of all cases. Analysis of tumour evolution is made and compared with Epidermoid Carcinoma. The findings are that there is neither loco-regional nor distant gangliar dissemination and that no patient dies due to this tumour as apposed to 38% deaths in epidermoid cases. Similarly, the survival likelihood at 5 years is 100% for verruciform carcinomas against 54% for epidermoid ones. All the above confirms the benignancy of Penis Verruciform Carcinoma, which makes it recommendable for conservative therapy, whenever volume and location would allow it. Thus, performance of lymphadenectomies is not generally justified since there is no tumoral dissemination, and adoption of an expectant attitude in presence of inguinal ganglia should be advisable.

An AIDS case, with a Candida urinary infection causing papillary necrosis and accompanied by occurrence of fungal lumps is reported. The paper remarks on the incidence and peculiarities of urinary affectation in these patients, emphasizing the usefulness of percutaneous nephrostomy as a diagnostic, and above all as a therapeutic procedure, in cases of expanded urinary tract.

Six patients carrying bulky renal cysts located in the kidney lower pole were treated by percutaneous resection of the cystic wall. No complications were observed during the peri and postoperational period. In all cases disappearance of symptoms was observed, and the total success rate (absence of residual cavity) recorded was 4/6, two cases presenting persistence of a small residual cavity which originated one case of relapse. The paper presents the technique used, and the indications and possible therapeutic actions for the treatment of simple kidney cysts are discussed.

Presence of polyps in the posterior urethra are a rare cause of childhood obstructive uropathy. The diagnosis is done through clinical and mictional cistouretrography findings, and the choice therapy during paediatric age is transurethral resection. In this paper, a review of the literature is made discussing the major aspects regarding this pathology.

After reviewing all of our hospital admittances, this paper presents two cases of nephrobronchial fistula (NBF) occurring in two patients, one with renal abscess-like granulomatous pathology and one with xantogranulomatous pyelonephritis (XGP). After commenting on these cases and including iconography, among which a fistulography, very rare in this type of cases, should be emphasized, the coincidence of the three microorganisms (and the presence of Morganella morganii) in lung cultures, and kidney in one case, is recorded. The paper remarks on the hidden clinical development, modes of presentations and the time of diagnosis which was pre-operative. Also clinical, diagnostic and behaviour of the NBFs and etiological diseases is reviewed.

This paper presents our experience with 237 primary renal cadaveric transplants and analyzes related factors to Initial Non-Function, its influence on graft and patient survival as well as the impact of cyclosporin A on graft survival. Our study shows better graft survival rates in patients treated with cyclosporin A and in patients with Immediate Initial Function.

The present paper analyzes the incidence of vascular complications and their treatment, in a series of 500 consecutive Heterotopical Kidney Transplants (KT), performed in our Service between January 1978 and December 1988. There was a total of 14 (2.8%) complications of which 8 (1.6%) correspond to renal artery stenosis. Of the 8 cases with renal artery stenosis, in 2 of them primary surgical treatment was indicated. The first one was a transplantectomy (TRX) and the second one reconstructive direct surgery. In the 6 remaining patients a Percutaneous Transluminal Angioplasty (PTA) was indicated. In three of these patients the stenosis resolved although one of them needed a second dilatation. In the last three there was: a thrombosis requiring TRX, a post dilatation anuria added to failure in the treatment of HT and which, finally, had to undergo surgery, and a third failure that could not be resolved by surgery and had to be subjected to graft nephrectomy. One of the patients in the surgical group died.

The paper explains the results obtained in 90 female patients with stress urine incontinence (90% in grade II at medium stress) who have undergone surgery through the vagina to free the urethra, cervix vesicae and bladder, raising them with a silk transversal suture anchored to the pubourethral ligament residues as well as anal and pubococcygeal ligaments. All the operations were performed by the author, achieving good results in 88.8% of the cases and with a post-operational follow-up ranging from 5 months to 13 years. These results can be overlapped with those obtained through optional routes, either abdominal and combined.

Between 1974 and 1988, 35 testicle germinal tumours, 16 seminomas and 19 non seminomas, were studied. Mean age in seminoma cases was 34 years and 26 in non seminoma cases; the former were mainly presented as located stages at the time of diagnosis (75%) while the latter were, on the contrary, mostly stages II and III. Following orchiectomy, all histologically pure seminomas received radiotherapy with the exception of two cases. All of them are presently free from the disease with an average follow-up of 2.8 years (range 0.5-5 Yr.) Radiotherapy continues to be proposed as first choice therapeutic action for siminomas in located stages, although we do not disagree with other more conservative possibilities. In the non seminoma group, all three patients diagnosed in stage I were clinically controlled without supplementary therapy, two of them having a recurrence during the first year of follow-up, but currently free of the disease after chemotherapy and surgery of residual masses. Of the three non seminoma patients in stage II, with negative post-orchiectomy markers, two underwent lymphadenectomy and the other one only chemotherapy. In the remaining group of non seminoma patients, and always after an orchiectomy, chemotherapy was performed as first choice therapy, although rescue lymphadenectomy was required in eight cases. Chemotherapy schemes with cisplatin have relegated to a second level any other therapy for the non seminoma patients. The excellent response and reduction of side effects allow the adoption of more conservative attitudes. This paper explains our retrospective study and, following a wide review of exiting literature, discussed any conflictive prognostic and therapeutic items.

In this paper, data obtained through bone gammagraphia, prostatic specific antigen and prostatic acid phosphatase in 159 measurements carried out in 76 patients with treated prostate cancer, 41 locoregional and 35 metastatic, is compared. Sensitivity to detect progression was higher for PSA (89% in LR and 92% in M) versus bone GF (22% in LR an 83% in M) and PAP (11% in LR and 79% in M). The results indicate that it is possible to use bone gammagraphia optimizing its efficacy.

Nephrogenic adenoma is a benign metaplasic lesion of uncertain aetiology. The tenth case of this curious entity in a diverticulum of urethra in women is presented here. The probable factors which intervene in its pathogenesis are discussed in this paper, including a short review of the literature.

This paper present the case of a patient with orchioepidimiditis quickly evolving to scrotal fistulization. The study of the orchiectomy piece showed testicle malacoplakia.

This paper presents one case of cholesteatoma of the left renal pelvis of a horseshoe kidney. This is quite an unusual process presenting an uncertain etiology and originated from a escamour metaplasia of the urothelium. Diagnosis can be made by X-rays and unlike leukoplasia it is not considered to be a pre-malignant condition. Probable etiologies, diagnosis and treatment are commented.

We present in this paper a series of cases from our Service of primary abscesses in psoas. We consider the appearance of immunosuppressed patients as a relevant factor of its etiopathogenicity. We believe that a C.A.T. is the best diagnostic method. All three patients that underwent open surgery have had complications. The patients treated with percutaneous puncture has shown a favourable evolution.

This paper present the case of a man 72 year old with secondary penis cancer, as a late manifestation of a earlier well differentiated prostate focus, identified by P.A.A.F., which determined the rarity of the presentation and the choice of diagnostic method by puncture-aspiration with a thin needle. Treatment is very complex and neither radiotherapy nor estrogens therapy produced satisfactory results, leaving de choice of total penectomy only for those cases with intractable pain and if there is no pelvic extension.

This paper is a review of 63 cases of congenital Pyeloureteral Union Syndrome. A total of 47 patients were treated using the Anderson-Hynes reconstructive technique with 3-4 years follow-up. Incidence was analyzed by sex, age and side affected, without a clear predominance of one over the others being shown. Mean age at the time of diagnosis was 39-43 years. The predominant symptom is the presence of lumbo-abdominal pain (36.5%) but the lack of clinical symptoms is also frequent (25.3%). Pyelocalyceal lithiasis is the most frequent secondary pathology (28.5%). U.I.V. appears to be an irreplaceable means for diagnosis, achieving with this technique 93.6% of diagnosis. Hydronephrosis, in different degrees, and absence of ureteral contrast are the urographic signs most commonly found: 66% and 61% respectively. Using the Anderson-Hynes technique a rete of 85% good results can be obtained, with few complications and achieving disappearance of clinical symptoms and morphofunctional normality in a high percentage. Anderson-Hynes dismembered ureteropyeloplasty seems to be the choice technique for conservative surgical treatment of the P.U.U. syndrome.

The paper presents the case of a patient with isolated testicular relapse (ITR), after a period of complete continuous remission (CCR) following chemotherapy, cobalt-therapy and bone marrow transplant (BMT) due to diagnosis of acute type T lymphoblastic leukemia L1. A review of literature regarding treatment of these patients is made.

This paper presents the case of a 19 year old patient with a well defined under palpation testicular tumor where surgical examination allowed a simple enucleation. Histological analysis during the operation reported it as a Leydig cells tumor but definitive analysis indicated tumor by adrenal residues. This histological argument illustrates the difficulty of making a differential diagnosis between both tumors, difficulty that goes beyond morphological and even clinical appreciation.

This paper describes a case of liposarcoma of exceptional paratesticular location (first in the literature described in infancy). The case corresponds to a 5-year-old boy. The influence of the histology, location of the tumour and possibility of complete surgical exeresis is fundamental with regard to prognosis and evolution. Pediatric experience is extremely limited and we may superimpose the treatment in children of that carried out in adults (more case histories), in whom multimodal therapy (surgery, radiotherapy, chemotherapy) concludes with encouraging results. The updating of previously published cases reveals the predominance of myxoid histology, a lower index of relapses in infancy and a high peak of incidence in early infancy.

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