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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.

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

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

Dielt's syndrome is generally known as nephritic colic due to the dilation of the urinary tract that results from a renal ptosis. In spite of renal ptosis being a commonly seen occurrence, sometimes it can be the cause of a serious painful clinical manifestation. This paper presents one case successfully treated through laparoscopic nephropexy. It also includes a discussion on the various diagnostic and therapeutical techniques.

Renal and perirenal abscesses are rare infections of the urinary tract traditionally caused by Staphylococcus aureus. Today however there is a predominance of abscesses secondary to coliform bacteria such as E. coli. This paper presents a revision of our series over the last ten years (1987-1996). A total of 11 abscesses (3 renal and 8 perinephritic) were recorded. The most frequent symptom for visiting the clinic was back pain. All patients had predisposing associated conditions. The microbiological analysis revealed E. coli in most abscesses. An HIV+ patient had bilateral renal abscess secondary to Aspergillus fumigatus. CAT appears to be the most specific method for imaging diagnosis, and ultranosography is useful not only to guide percutaneous puncture but also in the follow-up of abscesses after antibiotic treatment. Two renal abscesses resolved with parenteral antibiotic therapy and subsequent observation. Three cases required ultrasound guided percutaneous puncture and intravenous antibiotic therapy. Surgical drainage was required in four. A revision of our experience and the recent literature verified the changes that have taken place in the last few years both in the etiopathogenesis as well as the diagnostic and therapeutical methodology of renal and perinephritic abscesses.

Spontaneous renal haemorrhage or Wünderlich syndrome is a rare condition; it is however of great significance given the emergency, sometimes vital, situation that it creates. The etiology of the condition is varied, the most frequent being tumoral. The clinical manifestations and the use of imaging techniques are of great interest to establish the diagnosis. The choice treatment is controversial. This paper presents eight cases of Wünderlich syndromes seen in our urology service. The background, etiology, clinical manifestations, diagnostic methods and treatment used in each case are analyzed.

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.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.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.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.

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 determination and quantification of grey levels in the echography scale, designated by some authors Echodensitometry, is viewed as a new method for diagnosis using ultrasound techniques. This paper advances the results from a study conducted with an echographer equipped with an echographic density measuring device. This model analyzes the number of pixels in the image showing the most frequent level of grey. Normal and pathological parenchymatous urological organs (kidney, prostate and testicle) have been examined. Normal organs show a gaussian distribution of grey with a predominant level of typical grey for each of them. When affected by an acute inflammatory process the organs maintain their gaussian distribution but the predominant grey is lower (darker) due to the edema and the hyperaemia. When the inflammatory process becomes chronic, distribution, although somewhat irregular, is still gaussian but with higher predominance of grey (lighter) probably due to the fibrosis. The tumoral cases of our study also showed a gaussian curve even more irregular and with levels of variable grey. When specific areas of the tumour are analyzed the findings are very distinct depending on whether the areas are hypo or hyperechoic. Hyperechoic areas produce highly irregular maps. Research should be directed to provide more complex, although easy to perform systems of analysis which can correlate adequately with the histological study. It would be desirable that the equipment would be standardized to allow analysis of 'in vitro' images. If and when these objectives can be accomplished we would be able to venture into an echography histological diagnosis, something nowadays yet impossible.

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.

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.

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.