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STHAPYLOCOCCUS AUREUS PROSTATIC ABSCESS AND SUBDURAL EMPYEMA: A CASE REPORT. Introduction and objectives: To report one case of prostatic abscess and subdural empyema by Staphylococcus aureus. Methods: We describe the case of a 51 year old male patient who was diagnosed of prostatic abscess and subdural empyema by Staphilococcus aureus. We use clinical presentation and physical exploration based on rectal digital examination, as diagnostic approach method. And computerized axial tomography and transrectal ultrasonography, which allows the guided needle drainage of the abscess, as diagnostic confir- mation methods. Results: The clinical picture resolved with the transrectal ultrasonography guided needle aspiration of the abscess and conservative treatment with antibiotics and urinary diversion. Conclusions: Prostatic abscess is an uncommon entity nowadays. Provided the great variety of symp- toms, a great degree of clinical suspicion is needed for the diagnosis, and once it is got it, immediate aggres- sive treatment must be initiated. Transrectal ultrasonography allows not only the diagnosis, but also the drainage of the abscess. The culture of the obtained material identifies the etiological agent and the most specific antibiotic therapy.

Resumen La brucelosis es una zoonosis poco frecuente, aunque es endemica en Espana. Suele manifestarse como una enfermedad sistemica con presentacion aguda o cronica, en ocasiones lo hace de manera localizada afectando a uno o varios aparatos La presentacion focal mas frecuente es la forma osteoarticular. Esta se puede complicar en ocasiones con abscesos para-perivertebrales, la afectacion del psoas unilateral es rara y en casos excepcionales existe extension a ambos musculos bilateralmente Las manifestaciones clinicas de los abscesos de psoas(AP) suelen ser insidiosas, es infrecuente la aparicion de la triada clasica de fiebre, dolor lumbar e impotencia funcional. Para el diagnostico son necesarias las pruebas serologicas y medios de cultivo. El uso extendido de la Ecografia (ECO) y la Tomografia Axial Computerizada (TAC) ha mejorado el diagnostico y tratamiento de las complicaciones. El tratamiento de eleccion es antibiotico y se basa en el uso de tetraciclinas y estreptomicina. En ocasiones se hace necesaria la puncion percutanea o drenaje abierto de los abscesos. Presentamos un caso de AP brucelosico bilateral y revisamos la bibliografia

Abdominal trauma is relatively frequent and around 5% of the cases correspond to renal trauma. At present, a large percentage of cases can be managed conservatively. Generalised use of CT and cumulative experience have defined the cases that can be treated with good prospects. The currently accepted indications for imaging techniques and the most frequent ratings used are described. Similarly, the indications for surgical renal examination are listed and the principles for renal reconstruction described in the most recent publications of the most experienced medical centres.

Leydig cell tumor is the most frequent non-germ cell tumors of testis, included in the group of specialized gonadal stromal neoplasms. It has a low incidence, accounting for 1-3% of testicular neoplasms. This tumor is characterized by its endocrine manifestations, due to the tumor's capacity to secrete hormones. We report eight cases, including the description of their clinical, diagnosis and therapeutic features, as well as their follow-up. We also make a review of the literature about this rare testicular tumor.

Resumen Introduccion Y Objetivo La expresion del oncogen bcl-2 se relaciona con una resistencia aumentada de las celulas tumorales a la apoptosis, lo que prolonga su supervivencia y contribuye a su transformacion neoplasica. En el adenocarcinoma renal todavia no se ha podido establecer su importancia en cuanto a la evolucion de estas neoplasias. Nuestra intencion es determinar la expresion de la proteina bcl-2 y su relacion con diferentes variables clinicas y anatomopatologicas, estableciendo su valor pronostico Metodo 58 adenocarcinomas renales, estadios pT 1-T 3a N 0 M 0 (TNM 1997), tratados mediante nefrectomia radical o parcial con intencion curativa. Analizamos diferentes variables clinicas y anatomopatologicas, asi como la expresion de bcl-2 en tejido parafinado, mediante tecnicas de inmunohistoquimica, obteniendo una tincion citoplasmatica que se valoro de forma cualitativa Resultados La tincion para bcl-2 fue positiva en 44 de los 58 tumores analizados (62,1%), en distintos grados de intensidad. En cuanto a la relacion de la expresion de bcl-2 con otras variables histopatologicas, no encontramos asociacion estadisticamente significativa con el grado nuclear, tamano, estadio o posibilidad de recidiva tumoral. Agrupando los tumores segun la intensidad de la tincion en dos grupos, tincion negativa y debil positiva, frente a tincion de intensidad moderada e intensa, tampoco obtuvimos relacion entre bcl-2 y la supervivencia Conclusiones La expresion de bcl-2 no se relaciono con ninguna de las variables histopatologicas analizadas; tamano, grado y estadio, ni con la supervivencia, por lo que esta proteina no parece relacionarse con la evolucion del adenocarcinoma renal

Resumen Objetivo La proteina p21ras es codificada por los tres genes de la familia ras (H-, K- y N-ras), participando en la regulacion del crecimiento y la diferenciacion celular. El objetivo de este estudio es determinar la expresion de esta proteina en el adenocarcinoma renal localmente confinado, asi como sus relaciones con diferentes variables histopatologicas y sus implicaciones pronosticas. Metodo 58 adenocarcinomas renales, estadios pT1-T3a N0 M0 (TNM 1997), tratados mediante nefrectomia radical o parcial con intencion curativa. Analizamos diferentes variables clinicas y anatomopatologicas, asi como la expresion de p21ras en tejido parafinado, mediante tecnicas de inmunohistoquimica. Resultados El porcentaje medio de nucleos tenidos fue de 6,1%, con un rango comprendido entre 0 y 45%. No obtuvimos asociacion estadisticamente significativa de la expresion de p21ras y el tamano tumoral (p=0,698), el grado nuclear (p=0,676) o el estadio histopatologico (p=0,095). El analisis de supervivencia tampoco demostro diferencias significativas cuando estratificamos a los pacientes utilizando como punto de referencia el valor medio de la muestra (p=0,134). Conclusiones La expresion de p21ras no ha demostrado relacionarse con ninguna de las variables histopatologicas analizadas; tamano, grado y estadio, ni con la supervivencia, por lo que esta proteina no parece relacionarse con la evolucion del adenocarcinoma renal.

Resumen Presentamos un caso de linfoma testicular primario en un paciente de 62 anos que debuto como masa testicular indolora. Se realizo orquiectomia izquierda, diagnosticandose de linfoma B no Hodgkin linfocitico difuso. Recibio tratamiento con quimioterapia tipo CHOP, presentando mala evolucion, con metastasis cerebrales, falleciendo 25 meses despues del diagnostico.

The spontaneous extraperitoneal bladder rupture is an uncommon event and the diagnosis is very difficult. It is defined like the rupture of bladder wall in absence of traumatism or iatrogenic techniques. The extravasation usually is produced into the peritoneal cavity, because of the greater weakness of the vesical dome. The diagnosis is based on the retrograde cystography, being necessary the surgical treatment in the intraperitoneal rupture, while the extraperitoneal one, could be treated in a conservative way with a vesical catheter. Here we present a case of sponteneus extraperitoneal bladder rupture, with oliguria, abdominal pain and a righ hypochondrius mass as clinic presentation. Due to this, the diagnosis was made by the TAC, in which it was appreciated a continuity solution in the anterior bladder wall, with a contrast extravasation through the anterior abdominal wall. The retrograde cystography confirmed the definitive diagnosis. The treatment followed was based on the keeping of the vesical catheter and antibiotherapy

Resumen El absceso retroperitoneal es una entidad clinica poco frecuente, cuyo tratamiento se basa en el drenaje. La introduccion progresiva de las tecnicas percutaneas de drenaje, bien mediante control ecografico o bien utilizando la tomografia axial computerizada (TAC), ha modificado su abordaje terapeutico, siendo alternativas validas al tratamiento quirurgico tradicional. Presentamos una serie de 16 pacientes diagnosticados de absceso retroperitoneal entre 1986 y 1998, que fueron tratados mediante puncion percutanea (en 14 casos dirigida por TAC y en 2 mediante control ecografico). Se consiguio la resolucion del absceso en 13 casos, recurriendo en 2 (ambos fueron tratados mediante nueva puncion) y falleciendo 1 paciente que presentaba una sepsis grave. En 12 de los pacientes fue el unico tratamiento aplicado, practicandose en los 4 restantes nefrectomia tras la mejoria del estado de los pacientes. Conclusiones El tratamiento percutaneo de los abscesos retroperitoneales supone una alternativa valida al tratamiento quirurgico tradicional, bien como tratamiento definitivo, bien como tratamiento paliativo que nos permite mejorar el estado clinico del paciente de forma previa a la cirugia.

Considering the scarcity of organs for transplantation, one possible solution is the use of grafts from aged donors (over 50 years). We have reviewed our experience in the case of kidney transplantation considering the period from 1989-1994 in order to attain a minimum follow-up of 36 months. We compare three groups: donors aged between 50-60 years (n = 32), donors aged over 60 years (n = 25) and a control group formed by donors of "ideal" ages. The results show that kidneys from donors over 60 years evidence, as compared to the control group, a higher incidence of acute tubular necrosis (p = 0.032), significantly higher blood creatinine levels in all the intervals considered, and a graft survival which is 14% less at 12 months and 40% less at 36 months (p = 0.0009). These differences are most probably to be attributed to the changes caused in these organs by advancing age and by previous pathological situations, as we have not detected a higher incidence of immunologic or surgical complications.

Resumen En el momento actual se conocen algunos factores predictivos de la evolucion del segundo trasplante renal de cadaver, especialmente la influencia de la respuesta del receptor frente al primer injerto. No obstante, no sabemos si el mantenimiento o la extirpacion de un organo no funcionante ejercen alguna repercusion sobre siguientes trasplantes. Este es el objetivo del presente trabajo. Material y metodos Se analizan retrospectivamente los registros clinicos de 80 receptores de un segundo trasplante renal de cadaver en la era CyA, entre 1985 y 1995 en el Hospital 12 de Octubre de Madrid. Se recogieron las caracteristicas y evolucion de primer y segundo trasplantes, variables que fueron empleadas en la construccion de un modelo de analisis multivariante de la supervivencia del segundo injerto. La trasplantectomia del primer injerto no funcionante solo se llevo a cabo en caso de ser estrictamente necesaria, circunstancia que ocurrio en el 72% de nuestros pacientes (n = 58). Resultados El analisis multivariante demostro que la nefrectomia del injerto no funcionante no modificaba el riesgo de sensibilizacion del receptor o la probabilidad de desarrollar rechazo agudo o cronico en el segundo injerto; sin embargo, redujo significativamente el riesgo de perdida del mismo a medio y largo plazo (p = 0,009). CONCLUSIONES: Estos datos constituyen el primer argumento solido a favor de la trasplantectomia electiva en los pacientes candidatos a un segundo trasplante renal de cadaver. Sin embargo, es preciso una investigacion profunda de los mecanismos involucrados en esta observacion antes de recomendar la generalizacion del procedimiento.

Report on one case of prostate leiomyosarcoma, an infrequent and usually highly aggressive urologic neoplasia. Emphasis on the imaging and pathoanatomical diagnosis, highlighting the high value of the later as immunohistochemistry is usually essential to establish its nature. Choice treatment is oncologically radical surgery. Quite often this is impossible to carry out and so chemo- and radiotherapy schedules are commonly associated as neoadjuvant, adjuvant or palliative therapies. The reported case showed aggressive evolution unresponsive to management. Also, during the condition development a rare complication such as occurrence of an exophytic tumoral mass in the perineum appeared.

Resumen La fractura de pene es una entidad clinica poco frecuente que se produce por la rotura traumatica de la albuginea de los cuerpos cavernosos. Presentamos nuestra experiencia en 9 casos atendidos en nuestro Servicio entre 1989 y 1998. La mayoria de los casos se produjeron por traumatismos sobre el pene durante el coito, siendo suficiente la presentacion clinica y la exploracion fisica para su diagnostico. El tratamiento llevado a cabo fue quirurgico en todos ellos, procediendose a la evacuacion del hematoma y posterior reparacion de la rotura con suturas reabsorbibles. El resultado estetico y funcional fue excelente en todos los casos. No hemos encontrado en el seguimiento ningun caso de incurvacion peneana, refiriendo todos los pacientes una recuperacion total de la funcion erectil. Conclusiones En nuestra experiencia, el tratamiento quirurgico de la fractura de pene ofrece unos buenos resultados, con recuperacion de la funcion erectil de forma completa, sin aparicion de incurvaciones peneanas.

Se presenta una variante técnica de la desinserción endoscópica ureteral, con la que se intenta evitar el contacto de la orina con el lecho quirúrgico, condición preceptiva para evitar la posible diseminación tumoral local, al realizar la nefroureterectomía radical en tumores de urotelio superior.

Introduction of a new approach for uretero-ileal implantation when only one kidney is available. The technique follows the same approach as the Wallace-type re-implantation but in this case the uretero- ileal anastomosis plate is formed with the far en 2-3 cm of ureter. all cases performed with this technique have been highly sucessful as reported in this clinical account.

This study evaluates the risk factors and prognostic variables that affect survival of patients with gangrene of Fournier.The study retrospectively analyzed 90 consecutive patients with gangrene of Fournier treated in our institution between 1975 and 2008. We evaluated the average age, associated systemic diseases, and the source, time of evolution and extent of necrotizing fasciitis. The outcomes were assessed according to whether the patient survived or died. All patients had aggressive surgical debridement, and received parenteral antibiotic therapy.The mortality rate was 34.4%. The mean age was 63.0 years (range 33-95), a statistically significant difference was found between the age of the survivors (median age, 59.84 years) and those who died (median age, 70.20 years) (p = 0.001). Medical comorbidities were identified in 51 patients; the death rate was higher in patients who had any medical disease, especially those who suffered from cancer. Although diabetes mellitus was the most common associated pathology, it was not related to a statistically significant worst prognosis. The source of the infection was identified in 62 patients, who showed a higher mortality (p = 0.015), the mortality rate when a urological source is identified was 50%. Moreover, patients suffering from a more extensive necrotizing infection showed a worst prognosis.The gangrene of Fournier has a high mortality rate. Large series are required to study prognostic variables of this disease. The patient age, the presence of systemic risk factors, especially cancer, a urological source of infection and the extent of the disease have impact on the prognosis of Fournier's gangrene.

We show a technical modification of the ureteral endoscopic resection with which we try to avoid comunication between urine and surgical bed in order to prevent tumor local spread of upper urotelial tumor.

To report one case of prostatic abscess and subdural empyema by Staphylococcus aureus.We describe the case of a 51 year old male patient who was diagnosed of prostatic abscess and subdural empyema by Staphilococcus aureus. We use clinical presentation and physical exploration based on rectal digital examination, as diagnostic approach method. And computerized axial tomography and transrectal ultrasonography, which allows the guided needle drainage of the abscess, as diagnostic confirmation methods.The clinical picture resolved with the transrectal ultrasonography guided needle aspiration of the abscess and conservative treatment with antibiotics and urinary diversion.Prostatic abscess is an uncommon entity nowadays. Provided the great variety of symptoms, a great degree of clinical suspicion is needed for the diagnosis, and once it is got it, immediate aggressive treatment must be initiated. Transrectal ultrasonography allows not only the diagnosis, but also the drainage of the abscess. The culture of the obtained material identifies the etiological agent and the most specific antibiotic therapy.

The Brucellosis is a zoonotic and unfrequent infection but it is endemic in Spain. It is a well documented cause of fever of unknown origin with varied and nonspecific symptoms. The onset of symptoms of brucellosis may be abrupt or insidious, developing over several days to weeks. Virtually any organ system can be involved with brucellosis and localization of the process may cause focal symptoms. The most frequent focal presentation is the osteoarthicular. Some times it can complicates with para-perivertebral abscess. The unilateral psoas abscess(PA) is uncommon and the bilateral afection is exceptional. The manifestations of PA usually are insidious, the classic tiad of: feber, lumbar pain and functional impotence is rare. For the diagnosis the serology c tests and cultures are necesary. The imaging techniques like: Ultrasonography and Tomography have improved the diagnosis and treatment of this pathologies' complications. The recommended therapy is the use of doxycicline and streptomicine. Some times the use of percutaneous drainage or open surgery is necessary.

The overall objective of this study was to carry out a prospective investigation of the usefulness of the IMMUNOCYT commercial kit in the follow-up of patients treated for bladder cancer and to evaluate its utility as a complement to urinary cytology and a possible tool for reducing the number of follow-up cystoscopies required.From September 2001 to December 2002, the ImmunoCyt test and urinary cytology were performed in urine simples from a total of 136 patients (115 with a history or suspicion of bladder cancer and 21 patients with other urological pathologies). Urine simples were fixed with an equal volume of 50% alcohol. Urinary cytology and the ImmunoCyt test were interpreted by a cytopathologist unacquainted with the result of the corresponding cytology and bladder biopsy report. Samples were staged and graded using the 1997 TNM classification of the UICC and the 1998 WHO/ISUP classification. Histopathological confirmation of lesions was available for 111 patients (81.6%).The gender distribution was 89% men and 11% women. Mean age was 71.68 years (range 27 to 98 years). Overall sensitivity and specificity were 77.9% and 92.3% for the ImmunoCyt test and 47.9% and 100% for urinary cytology, respectively. The positive (PPV) and negative predictive values (NPV) were 96.4% and 61.7%, respectively, for the ImmunoCyt test and 100% and 36.7% for cytology. In Ta and low-grade carcinomas, the sensitivity of the ImmunoCyt test was 70% (n=20) and 76.4% (n=34) respectively, whereas it was 25% (n=28) and 29.7% (n=37), respectively, for urinary cytology. The differences observed between the sensitivities of the ImmunoCyt test and cytology were statistically significant (X2 p0.05) overall and for Ta and low-grade carcinomas. The sensitivity and specificity of the combination of both tests were 86.8% and 96.2%, respectively. The sensitivity of the combination of both tests for Ta and low-grade carcinomas was 80% (n=20) and 82.3% (n=34), respectively. The ImmunoCyt test was diagnostic in 36.2% of tumors overall.In view of the results obtained, we decided to change our follow-up protocol to reduce the number of follow-up cystoscopies by 32.2% in the first 5 years of postoperative follow-up (in a cohort of 140 patients who undergo surgery annually). This benefits patients by reducing the number of urinary infections and iatrogenesis originated by follow-up cystoscopy. In addition, this 32.2% reduction in the number of cystoscopies in 5 years will yield a savings of approximately 35,560 EUR to the health care system in 5 years.

Radical cystoprostatectomy is accepted as the standard treatment for muscle-invasive bladder cancer. During last years the indications for orthotopic neobladders have increased due to their advantages over other kind of diversions. Hautmann neobladder is one of the most commonly used. Several modifications have been later described. For example, after perform the W-shape pouch ureters can be anastomosed to a not-detubularized bowel segment (chimney modification). Here is described a modification of the Hautmann neobladder with two chimneys. Each ureter is spatulated in a golf club manner and anastomosed to the open end of each bowel loop. This kind of anastomosis provides several advantages. It is possible to use shorter ureteral segments by increasing the length of bowel used. It allows an anastomosis without tension, and less ischemia so the risk of stenosis and fistula is decreased. It is not necessary to perform additional enterothomies and in case of reintervention it is easier to access each anastomosis without damaging the other one.

Adenocarcinoma of the bladder is an uncommon neoplasm. Depending on its origin it is classified in: primary, secondary and urachal. Generally it grows to the density of the wall, so its clinical appearence is delayed, with the subsequent delayed diagnosis and although an agressive treatment is performed, it frequently has a very bad prognosis. Since there are very few publications of this kind of neoplasm in the literature the lines of actuation in this pathology are not well established. We report the eleven cases of adenocarcinoma neoplasm of the bladder treated in our centre and review the literature.

Objectivos: El objetivo global de este trabajo es el de determinar en un estudio prospectivo la utilidad del kit comercial IMMNUNOCYT‘ para el seguimiento de pacientes tratados de cáncer de vejiga y la evaluación de su utilidad como complemento de la citología urinaria y posible herramienta en la reducción del número de cistoscopias de revisión. Material y Métodos: Entre Septiembre/01 a Diciembre/02 se recogió la orina de un total de 136 pacientes (115 con antecedentes de neoplasia vesical o sospecha de la misma y 21 pacientes con otras patologías urológicas) para realizarles el test del InmunoCyt® (uCyt+) y la citología urinaria. La orina recogida era fijada con alcohol al 50% en un volumen igual. La citología urinaria y el InmunoCyt® fueron informados por un citopatólogo que desconocía tanto el resultado de su correspondiente citología como el informe de la biopsia vesical. Para el estadiaje y grado de las muestras se utilizaron la clasificación TNM de la UICC de 1997 y la de la WHO/ISUP de 1998. Se dispuso de confirmación histopatológica de las lesiones en 111 pacientes (81,6% de los pacientes). Resultados: La distribución por sexos fue del 89% para varones y del 11% mujeres. La edad media fue de 71,68 años [27-98]. La sensibilidad y especificidad globales fueron del 77,9% y 92,3% para el InmunoCyt® y del 47,9% y 100% para la citología urinaria respectivamente. Los valores predictivos positivos (VPP) y negativos (VPN) fueron del 96,4% y 61,7% respectivamente para el InmunoCyt® y del 100% y 36,7% para la citología. En los Ta y carcinomas de bajo grado la sensibilidad del InmunoCyt® fue del 70% (n=20) y 76,4% (n=34) respectivamente, mientras que para la citología urinaria fue del 25% (n=28) y 29,7% (n=37) respectivamente. Las diferencias observadas entre las sensibilidades del InmunoCyt® y de su citología fueron estadísticamente significativas (X² p

Resumen La cistoprostatectomia radical es el tratamiento de eleccion para el cancer vesical infiltrante. En los ultimos anos las indicaciones de sustitucion vesical se han ampliado debido a las ventajas que aportan sobre otros tipos de derivaciones siendo la neovejiga ileal descrita por Hautmann una de las mas utilizadas. Posteriormente se han descrito diversas modificaciones de la tecnica original como la utilizacion de un segmento de asa sin detubulizar a modo de chimenea a la cual se anastomosan los ureteres. Presentamos una variante tecnica de la neovejiga de Hautmann utilizando dos “chimeneas” anastomosando cada ureter a la luz previamente abierta de cada asa espatulando el ureter a modo de “palo de golf” para adaptar los calibres. Entre las ventajas de este tipo de anastomosis destacan la utilizacion de segmentos ureterales mas cortos adaptando la longitud del asa lo que posibilita una anastomosis sin tension y minimiza la isquemia disminuyendo por tanto la aparicion de fistulas y estenosis. No precisa la reali acion de enterotomias adicionales y se facilita el acceso a cada anastomosis por separado en caso de necesidad de reintervencion.

PRIMARY ADENOCARCINOMA OF THE URINARY BLADDER:OUR EXPERIENCE Adenocarcinoma of the bladder is an uncommon neoplasm. Depending on its origin it is classified in: primary, secondary and urachal. Generally it grows to the density of the wall, so its clinical aparience is delayed, with the subsequent delayed diagnosis and although an agressive treatment is performed, it frequently has a very bad prognosis. Since there are very few publications of this kind of neoplasm in the literature the lines of actuation in this pathology are not well established. We report the eleven cases of adenocarcinoma neoplasm of the bladder treated in our centre and review the literature.

Considering the scarcity of organs for transplantation, one possible solution is the use of grafts from aged donors (over 50 years). We have reviewed our experience in the case of kidney transplantation considering the period from 1989-1994 in order to attain a minimum follow-up of 36 months. We compare three groups: donors aged between 50-60 years (n = 32), donors aged over 60 years (n = 25) and a control group formed by donors of "ideal" ages. The results show that kidneys from donors over 60 years evidence, as compared to the control group, a higher incidence of acute tubular necrosis (p = 0.032), significantly higher blood creatinine levels in all the intervals considered, and a graft survival which is 14% less at 12 months and 40% less at 36 months (p = 0.0009). These differences are most probably to be attributed to the changes caused in these organs by advancing age and by previous pathological situations, as we have not detected a higher incidence of immunologic or surgical complications.

INTRODUCCION Desde que hace unos 100 anos, la Urologia se individualizo de la Cirugia, se ha consolidado como especialidad por la relevancia de las patologias que aborda y por nuevas tecnicas especificas como la urografia, la endoscopia, los trasplantes renales o la litotricia, entre otros. En Espana, la Urologia ha experimentado importantes cambios a lo largo de los ultimos anos, y es de esperar que continue este proceso en el futuro previsible. La innovacion tecnologica, los avances cientificos, los cambios organizativos en el Sistema Nacional de la Salud, los cambios sociales, y los cambios demograficos, de alguna manera afectaran la organizacion de la asistencia urologica, la demanda asistencial, incluso la prevalencia de algunas enfermedades urologicas. La oferta de servicios asistenciales tambien puede ser cambiante en funcion de los urologos que se jubilan, residentes que se forman, servicios que se crean, y otros factores. La inadecuacion de la oferta a la demanda puede crear desajustes, tanto en el ambito nacional como regional. Los desajustes pueden dar lugar a tiempos de espera inaceptables, variabilidad en la carga de trabajo, variabilidad en la calidad, desigualdad en el acceso, o ineficiencia en la prestacion de la atencion urologica. Con estos antecedentes, la Asociacion Espanola de Urologia (AEU) se formulo diversas preguntas centradas en el numero de urologos que realmente hay en Espana, y en estimar los urologos que podrian ser necesarios en el futuro. Para responder a estas cuestiones, la AEU encargo un estudio a Tecnicas Avanzadas de Investigacion en Servicios de Salud (TAISS) en Julio de 2002. Abbott Laboratories S.A. (Abbott), patrono de la AEU, patrocino el estudio. En este articulo se presenta un resumen del estudio y sus hallazgos fundamentales. En un futuro proximo se publicara el estudio completo en distintos formatos, incluidas versiones accesibles en la pagina web de la AEU.

Abdominal trauma is relatively frequent and around 5% of the cases correspond to renal trauma. At present, a large percentage of cases can be managed conservatively. Generalised use of CT and cumulative experience have defined the cases that can be treated with good prospects. The currently accepted indications for imaging techniques and the most frequent ratings used are described. Similarly, the indications for surgical renal examination are listed and the principles for renal reconstruction described in the most recent publications of the most experienced medical centres.

The p21ras protein is encoded by the three ras genes (H-, K- and N-ras) and participate in the regulation of normal cell growth and cell differentiation. The objective of this study is to determine the expression of this protein in locally confined renal cell carcinoma, as well as its relations with different histopathological variables and their prognostic implications.58 renal cell carcinomas, in pT1-T3a N0 M0 (TNM 1997) stages, treated by radical or partial nephrectomy with curative intention. We analysed different clinical and anatomopathological variables, as well as expression of p21ras in paraffinated tissue, using immunohistochemical techniques.The mean percentage of stained nuclei was 6.1%, with a range lying between 0 and 45%. We did not obtain statistically significant association between expression of p21ras and the tumour size (p = 0.698), the nuclear grade (p = 0.676) or the histopathological stage (p = 0.095). The survival analysis also did not show significant differences when we stratified the patients using the mean value of the sample as reference point (p = 0.134).Expression of p21ras was not demonstrated to be related to any of the histopathological variables analysed: size, grade and stage, or with survival. Therefore, this protein does not appear to be related to the evolution of renal cell carcinoma.

Case report of a primary testicular lymphoma in a sixty-two years old man, presenting initially as an enlargement of the testicle as the only symptom. Orchiectomy of left testicle was performed, with the diagnosis of Non-Hodgkin B lymphocytic lymphoma. The treatment applied was CHOP, presenting poor evolution with cerebral metastasis. He dead twenty-five months later diagnosis.

Bcl-2 is a proto-oncogene known to be a negative regulator of apoptosis, whose expression conferring prolonged cell survival and contributing to tumorigenesis. Inconsistent results concerning bcl-2 expression and the frequency of apoptosis were noted in renal cell carcinoma. To investigate a possible role of bcl-2 protein in renal cell carcinomas, we analyzed its expression and relationship with clinical and pathological parameters, including prognostic impact.58 patients diagnosed of renal cell carcinoma stage pT1, pT2 and pT3a N0 M0 (TNM 1997) were treated by radical or partial nephrectomy. We analyzed clinical and pathological parameters including bcl-2 expression in paraffin-embedded tumor samples using immunohistochemical technique.Bcl-2 immunopositivity was detected in 44/58 of the samples in different grades of intensity. There was no correlation of nuclear grade, tumoral size, stage or recurrency with bcl-2 immunopositivity. Bcl-2 expression was not related to prognosis if we divided all cases into subgroups according of stain intensity.Bcl-2 expression was not related with any pathological parameters; size, nuclear grade and stage or prognostic.

Leydig cell tumor is the most frequent non-germ cell tumors of testis, included in the group of specialized gonadal stromal neoplasms. It has a low incidence, accounting for 1-3% of testicular neoplasms. This tumor is characterized by its endocrine manifestations, due to the tumor's capacity to secrete hormones. We report eight cases, including the description of their clinical, diagnosis and therapeutic features, as well as their follow-up. We also make a review of the literature about this rare testicular tumor.

The spontaneous extraperitoneal bladder rupture is an uncommon event and the diagnosis is very difficult. It is defined like the rupture of bladder wall in absence of traumatism or iatrogenic techniques. The extravasation usually is produced into the peritoneal cavity, because of the greater weakness of the vesical dome. The diagnosis is based on the retrograde cystography, being necessary the surgical treatment in the intraperitoneal rupture, while the extraperitoneal one, could be treated in a conservative way with a vesical catheter. Here we present a case of spontaneous extraperitoneal bladder rupture, with oliguria, abdominal pain and a right hypochondrius mass as clinic presentation. Due to this, the diagnosis was made by the TAC, in which it was appreciated a continuity solution in the anterior bladder wall, with a contrast extravasation through the anterior abdominal wall. The retrograde cystography confirmed the definitive diagnosis. The treatment followed was based on the keeping of the vesical catheter and antibiotherapy.

The retroperitoneal abscess is an uncommon disease, that must be treated by drainage. The progressive use of the percutaneous drainage, under ultrasound or computed tomography guidance (CT), has changed the therapeutical management and has demonstrated to be a valid alternative to surgical drainage. From 1986 to 1998, 16 patients with retroperitoneal abscesses were treated by percutaneous drainage (14 with CT and 2 with ultrasound guidance). This method eradicated the abscess in 13 cases, in 2 was necessary a new function to cure the abscess, and 1 patient, with a severe sepsis, died. Percutaneous drainage was the unique treatment used in 12 patients. In the remaining four, the patients' clinical status improved after percutaneous drainage, and they were able to undergo subsequent elective nephrectomy.Percutaneous drainage of retroperitoneal abscesses has been established as a viable alternative to surgical intervention. This method can resolve the abscess or improve the patient' clinical status to undergo elective surgery.

Introduction of a new approach for uretero-ileal implantation when only one kidney is available. The technique follows the same approach as the Wallace-type re-implantation but in this case the uretero-ileal anastomosis plate is formed with the far en 2-3 cm of ureter. All cases performed with this technique have been highly successfull as reported in this clinical account.

Report on one case of prostate leiomyosarcoma, an infrequent and usually highly aggressive urologic neoplasia. Emphasis on the imaging and pathoanatomical diagnosis, highlighting the high value of the later as immunohistochemistry is usually essential to establish its nature. Choice treatment is oncologically radical surgery. Quite often this is impossible to carry out and so chemo- and radiotherapy schedules are commonly associated as neoadjuvant, adjuvant or palliative therapies. The reported case showed aggressive evolution unresponsive to management. Also, during the condition development a rare complication such as occurrence of an exophytic tumoral mass in the perineum appeared.

The fracture of the penis is an uncommon injury that is defined as a rupture of the tunica albuginea of the corpus cavernosum. We present our experience in 9 cases admitted to our department between 1989 and 1998. Most of the cases were caused by traumatism during sexual intercourse. Clinical presentation and physical examination were enough to make the diagnosis. The treatment was surgery in all cases, with evacuation of the hematoma and reconstruction of the rupture with absorbable suture. The result about penile function and curvature was excellent in all cases. There was no cases of penile incurvation nor erectil disfunction.In our experience, surgical management of the penile fracture has good results, with no erectil disfunction, nor penile incurvation.

Prospective, randomized, multicenter study in 267 patients with complicated urinary infection from 9 hospitals nationwide. Drug treatment was either Ceftriaxone 1 g once daily parenterally or Cefotaxime parenteral 1 g 8 hourly for a minimum of 7 days. Patients were clinically, analytically and microbiologically evaluated before and after treatment to assess the efficacy and tolerance of both drug products. To evaluate treatment cost, we used the price of both drugs and the material required for their administration (syringe and disposable needle). 119 patients were excluded from the cost-efficacy evaluation and 148 remained in the study (75 assigned to treatment with Ceftriaxone and 73 to Cefotaxime). Clinical efficacy of treatment was 93% and 87.6% for Ceftriaxone and Cefotaxime respectively (p0.05). Cost per patient was 27,347 pesetas for Ceftriaxone and 34,490 for Cefotaxime (p0.05).

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.

The study proposes the analysis of the influence of gross, microscopical and clinical pathoanatomical prognostic factors in the survival of patients with RCC through univariance and multivariance statistical analysis, and its global evaluation as a predictive model.The study involved 218 RCC cases operated on over 20 years, with a mean follow-up of 60 months.All prognostic factors studied have a significant influence on the survival. When studied jointly, they include separately and in order of significance the metastatic involvement, mitotic index, cava vein involvement, nuclear grade and sarcomatoid histologic pattern. Also, we confirm that considered jointly they conform a valid predictive model.

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 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.