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A case of spontaneous perirenal hematoma in pelvic kidney in an HIV(+) patient is described.The literature on the etiology of spontaneous perirenal hematoma in pelvic kidney is reviewed, with special reference to the three cases reported in HIV(+) patients.The patient presented none of the features described in the literature. The "watchful waiting" approach was adopted and the outcome was favourable.

Carcinoma of the bladder is the sixth most frequent tumor worldwide. It is more prevalent in the male and has been associated with exogenous triggering factors such as smoking, aromatic amines, etc. Its classification into superficial or infiltrating tumor is a simplification since there are four groups by clinical behaviour that require different therapeutic approaches. The epidemiological, clinical and pathological aspects of carcinoma of the bladder reviewed.

To describe an additional case of cutaneous penile horn, an uncommon lesion that has been associated with penile neoplasia, particularly epidermoid carcinoma.Herein we describe a patient with cutaneous horn of the penis that had presented several years earlier. The patient underwent wide resection and biopsy of the tumor site. To date, no signs of tumor recurrence have been observed. The literature is reviewed.Cutaneous horn of the penis is an uncommon lesion, but it must be emphasized that it can progress to squamous cell carcinoma. Biopsy of the tumor site should be performed carefully and patients should undergo regular control evaluation.

The formation of calculus in the transplanted kidney is an uncommon complication. Metabolic derangements, infectious or obstructive processes, factors related with the surgical technique and the presence of ureteral catheters have been implicated in its etiopathogenesis. The therapeutic possibilities have changed in the last decade. The different factors related with stone formation in the transplanted kidney, the indications and treatment utilized in each case are analyzed.We analyzed the cases of lithiasis following renal transplantation in our series of 800 renal transplants. The metabolic anomalies and other associated lithogenic factors in 5 cases that required treatment are described.All 5 patients were treated by ESWL. Complete resolution of the lithiasis was achieved in 4 cases whose kidney graft is currently stone free with preserved renal function, except one patient with hyperuricemia and hyperuricosuria who is again on hemodialysis for chronic rejection. In the fifth case fragmentation of the caliceal stone was not achieved after 4 sessions of ESWL. Subsequem ultrasound control evaluations have disclosed no changes in stone size or location.In our view, the approach to renal lithiasis in the transplanted kidney is similar to that of patients with solitary kidney, although stone size for treatment by ESWL should be limited to 2 cms. If stone size is between 1 and 2 cms, placement of a double-J catheter prior to ESWL is recommended, whenever possible. For stones larger than 2 cms, percutaneous nephrolithotomy is more effective and has less complications. Surgery is reserved for those patients in whom these techniques are unamenable or have failed.

We report two cases of urinary schistosomiasis that had been diagnosed and treated during the early stages of the disease. These cases are presented to provide further insight into this disease, which is uncommon in our setting.The presenting features, diagnostic methods and the treatment currently available are discussed.Urinary bilharziasis is a parasitic disease caused by Schistosoma haematobium that may involve the entire urogenital tract. Schistosomiasis causes important lesions in the early stages and complications in the long term if treatment is not instituted early. Although it is uncommon in our area, it must be suspected in patients with GU dysfunction, particularly in those presenting with hematuria and/or have traveled to countries where this disease is endemic.

From 1973 to 1991, 13 patients [4 females (30%) and 9 males (70%)] were diagnosed with adrenal carcinoma at our hospital. The mean age at the time of diagnosis was 47.4 years (range 29 to 72 yrs). Eleven patients (85%) presented with abdominal symptoms and 8 (61%) with paraneoplastic syndrome. At the time of diagnosis, 3 (23%) had clinical or radiological signs of metastasis. Five patients (38.5%) had regional involvement and 5 (38.5%) had localized disease. The preoperative imaging studies disclosed an abnormal IVP in 8 of 13 patients (61%); 7 of 10 (70%) had an abnormal ultrasound scan and the CT scan was abnormal in 9 out of 9 patients (100%). Seventy-three percent of the tumors were classified as anaplastic or poorly differentiated carcinoma and 27% as differentiated carcinoma. Complete surgical excision was performed in 8 cases and op'DDD was administered in 4 cases. The five-year survival rate was 30%. We can conclude that early diagnosis, staging and histopathology have a significant effect on survival and surgical excision is the only treatment associated with medium or long-term survival.

Leiomyosarcoma of the prostate is a very uncommon malignant tumor arising from the smooth muscle cells of the prostate gland. We report on a 72-year-old patient who underwent surgery for benign prostatic hyperplasia. The pathological analysis following retropubic resection, however, revealed a leiomyosarcoma and an extended cystectomy and pelvic tumorectomy were performed after preoperative radiotherapy. The patient is alive with local recurrence at four years follow up.

Primary adenocarcinoma of the bladder is a rare tumor type. Histologically it can be mucinous, signet ring cell or clear cell. When diagnosed, it is in the advanced stages and carries a poor prognosis because of its aggressive nature. We report on 9 cases with primary adenocarcinoma of the bladder (2 signet ring cell and 7 mucinous tumors). Those with the advanced stage had a mean survival of 13 months. Of the remaining 4, one survived up to 6 years. This patient had a medium stage tumor and had undergone radical treatment.

Today it is possible to restore the continuity of the urinary tract and to correct the underlying condition that had prompted the diversion procedure. Patients with a Bricker cutaneous ureteroileostomy will essentially benefit from this possibility. However, they must be carefully evaluated and meet the following criteria: patients with upper urinary tract disorders and/or symptoms arising from a malfunctioning urinary diversion, those who refuse a stoma for social or personal reasons, those requiring renal transplantation and those who had undergone urinary diversion for pathologies that can be resolved otherwise today. Undiversion, however, is not free from complications, which may present early (wound infection, suprapubic or intestinal fistula, irritation syndromes, mucus secretion) or late (diminished renal function, incontinence or urinary obstruction, electrolyte imbalance or problems arising from the artificial sphincter. In carefully selected patients, therefore, undiversion permits amending a surgical indication which, in the light of current knowledge and possibilities, can be resolved otherwise.

The evaluation of erectile dysfunction by popliteal and pudendal evoked potentials is not widely utilized in our country, although the foregoing has proved to be a useful technique in the evaluation of a possible neurological etiology. This study describes this simple, fast and low cost method of evaluation and reports the normal ranges. The study comprised 40 subjects; 15 were healthy volunteers and the remaining had consulted for impotence and referred antecedents suggesting a neurological etiology. The results show that a latency of 40.9 +/- 2.1 msec in P1 for the pudendal evoked potentials is normal. Concerning the popliteal evoked potentials, the normal latency for P1 is 38.07 +/- 2.8 msec.

Four cases with high flow priapism are described herein. Patient evaluation included intracavernal blood-gasmetry, echo Doppler, selective arteriography of the pudendal artery. Three patients had a previous history of trauma and one patient was on psychotropics. The alpha-agonist drugs and the different shunt techniques did not achieve detumescence. Two embolization procedures of the internal pudendal artery were performed with good long-term results. The other two cases achieved spontaneous detumescence. No complications or secondary erectile dysfunction were observed.

Acute scrotum is a frequent reason for consultation at the urological emergency service. The most common causes, apart from trauma, are acute orchiepididymitis, torsion of the hydatids of Morgagni and torsion of the spermatic cord. Apart from a detailed examination of patient history and a careful physical examination, few diagnostic techniques can be utilized. To date, only the Doppler ultrasound has proved useful in corroborating the suspicion of vascular involvement, although this technique is very limited. With the availability of the duplex ultrasound, the possibility of making the differential diagnosis in the acute scrotum is enhanced. This technique permits morphological and functional assessment and avoids unnecessary exploration surgery within the scrotum.

Since Caine demonstrated the presence of alpha-adrenergic receptors in prostate tissue in 1975, an alpha-blocker capable of producing maximum relaxation of prostatic tissue with minimum side effects has been sought. Prazosin, a selective alpha-1 blocking agent, must meet these requirements. We report the results of a study undertaken in 28 patients with benign hyperplasia of the prostate demonstrated by flowmetry, clinically and by ultrasound. A significant improvement was observed in all patients except for the ultrasound measured prostate size, which remained unchanged. Undesired effects were observed in 36% of the patients. Despite the initial improvement, 89.3% had abandoned treatment at 1 year principally owing to deterioration of the clinical picture and because they were submitted to surgery (the majority) or treatment with other drugs. We can conclude from our results that prazosin is useful for short-term therapy; i.e., until the patient can be referred for surgery.

The study of impotentia coeundi requires separating the organic from the psychogenic cause. Arteriogenic impotence falls within the first group and has been assessed with the papaverine test, simple Doppler and arteriography. Currently, more sophisticated techniques such as the pulsed Doppler permit noninvasive assessment of the blood supply to the penile arteries. Intracavernous injection of vasoactive substances such as papaverine cause vascular changes. Evaluation of these changes permits making the diagnosis of arterial insufficiency without recurring to more invasive diagnostic techniques such as arteriography. Currently, this invasive technique is only justified in revascularization surgery but not for diagnosis. The availability of color Doppler facilitates arterial evaluation even further.

We report on two cases of renal liposarcoma. The clinical features of this tumor type are described and diagnostic and therapeutic considerations are put forward. The usefulness of CT in the diagnosis of this disease entity is underscored. This permits us to evaluate the response to treatment and furthermore, it permits early detection of recurrence.

We report a case of retroperitoneal ganglioneuroma that had been incidentally discovered during ultrasound evaluation in a young female patient. The plain X-ray, IVP and ultrasonography only revealed the presence of a retroperitoneal mass and its approximate size. CT and arteriography provided further information relative to the location, nature of the extrarenal mass, its borders, and size although these did not permit us to determine its origin.

We report on a case of tuberculous ureteral stricture submitted to balloon dilatation, a procedure currently advocated by many authors as an alternative to surgical correction in benign ureteral stricture. Transluminal balloon dilatation of ureteral strictures is not a standardized technique, although it follows some essential maneuvers. The procedure can be performed antero or retrogradely and always with temporary internal or external diversion. It is not a harmless procedure, but the complications are scant. However, many aspects have yet to be elucidated.

Despite the cases reported in the literature, anterior urethral valves continue to be an uncommon condition. The foregoing has to be considered when evaluating children with urinary obstruction or recurrent infections. A case of anterior urethral valves associated with segmental saccular dilatation of the urethra is described and the diagnostic methods are highlighted.

The evolution of the ultrasonographic images of 25 patients with advanced carcinoma of the prostate receiving antiandrogen (cyproterone acetate) and LH-RH analogue therapy were studied. Thirteen patients were on daily LH-RH analogue therapy while the remaining patients received a monthly depot dose. At 6 months, the ultrasound follow-up revealed a 20.4% reduction of the transverse and a 19.8% reduction of the anteroposterior diameter for the first patient group. Similar results were observed for the second group comprised of 12 patients who received depot therapy; a mean reduction of the diameters of 119.9% and 18.7%, respectively. At 6 months, 66% of the patients in the first group and 59% of the second group showed an improvement of ultrasound patterns. Infiltration of the seminal vesicles improved for both groups, 41% and 38% of patients, respectively. However, at 12 months this rose to 50% improvement for the group on the daily treatment regimen. The follow-up data after 6 months are as yet unavailable for the group on depot therapy. Transrectal ultrasound is an easy, reproducible method that is very useful in the follow-up of patients with advanced cancer of the prostate receiving hormone therapy.

We report a case of perirenal hematoma from spontaneous rupture of the upper urinary tract associated with parenchymal rupture due to a calculus lodged in the pelvic ureter. The clinical features were pain confined to the renal fossa, leukocytosis and Hct of 36%. Diagnosis was made by percutaneous punction pyelography.

To evaluate the risk of tumor recurrence, we have studied the prognostic significance of the clinical features and chemoprophylaxis following transurethral resection (TUR) in 155 patients with primary superficial bladder carcinoma (Ta, T1, Tis). Thiotepa, adriamycin and cisplatin instillations in the bladder were utilized. The mean follow-up was 44 months (range 6-106). Considering the first tumor recurrence as an indication of failure of chemoprophylactic therapy, thiotepa was shown to afford better control. The significance of each variable (age, sex, drug, tumor stage, grade, number and size) was determined for each individual patient relative to the risk of recurrence after TUR and prophylactic treatment and the significant variables were then subjected to multivariant analyses (multiple logistic linear regression). Tumor number, stage and the drug utilized were shown to be significant prognostic factors (p = 0.04, 0.04 and 0.008, respectively). Based on the results of the multivariant analyses, mathematical models of prediction were assigned combining the more favourable individual prognostic values. The use of the mathematical models obtained to calculate the recurrence risk for each individual patient allowed us to classify these cases as being at high, medium or low risk for tumor recurrence.

We performed a comparative study between the monobactam antibiotic aztreonam and the aminoglycoside tobramycin in patients diagnosed as having acute pyelonephritis. The respective doses were 1 gr. IM daily for 7 days, and 100 mgr. IM q 12 h for the same period of time. Clinically, 100% of uncomplicated acute pyelonephritis and 87.5% of complicated infections cured with aztreonam. Tobramycin achieved an 80% cure rate for both types of infections. Microbiologically aztreonam was effective in all uncomplicated acute pyelonephritis, and in 69.56% of the complicated cases (overall microbiological cure rate = 78.7%). The therapeutic failures were ascribable to infections from S. faecalis, an organism naturally resistant to aztreonam. Thus, the microbiological cure rate was 84.2% in complicated pyelonephritis from organisms sensitive to this antimicrobial. The microbiological cure rate for tobramycin was 70% in acute uncomplicated, and 80% in complicated infections. We observed a good clinical and biological tolerance to both antimicrobials. No side effects were observed. Serum and blood biochemical analyses, and coagulation tests revealed no changes.

We reviewed 382 bone scans from 161 patients with prostatic adenocarcinoma submitted to scintigraphic evaluation over the period 1980 to 1988. Each patient had a mean of 2.37 bone scans (1 to 9 scans). Seventy-three patients had positive scans (64 initially and 9 in the course of patient follow-up). Sixty-four presented bone pain (56 initially and 8 in the course of the disease). The remaining 17 patients were asymptomatic throughout follow-up; however, bone metastasis was undemonstrable. In our view, pain is a reliable indicator of the appearance or progression of bone metastasis. Routine follow-up bone scans are unnecessary in patients with positive or negative scintiscans who remain asymptomatic.

Fourteen cases of angiomyolipoma have been diagnosed and treated at our center since it opened 19 years ago. The diagnostic methods and therapeutic approach have changed since then. Noninvasive imaging techniques like CT and ultrasound have significantly enhanced the accuracy of diagnosis. The mode of presentation, number, size and the differential diagnosis may decide between conservative or surgical management of these tumors. A small tumor mass only requires observation. For larger ones, the treatment of choice is preferably by conservative surgery or highly selective embolization if permitted by the severity of the disease. Surgery is warranted when doubt exists on CT and ultrasonography.

We present the results of a study undertaken to assess the echo patterns and prostate size in 13 patients with prostatic carcinoma treated with Lh-rh agonists. The study revealed a gradual reduction of the anteroposterior and transverse diameters. After 12 months, these were 28% and 22% of their respective initial values. Furthermore, the prostatic echo patterns changed significantly in 66% of the patients, and infiltration of the seminal vesicle improved or became stable in 50%. These findings suggest that transrectal ultrasonography may be useful in the follow up of prostatic carcinoma patients receiving hormone therapy.

We evaluated the transrectal echo patterns in 140 infertile men using the following parameters: the transverse and anteroposterior diameters of the prostate, the presence of periprostatic venus plexus, and the transverse diameter of the seminal vesicles. Patients were classified according to data gleaned from semen analyses following the criteria recommended by the WHO. Microbiological analyses using the Meares and Stamey technics, as well as semen analyses, were performed in those patients who presented with leukospermia. These were considered a separate, homogeneous group classified as "inflammatory". The following patient groups comprised the study: azoospermia (18 patients), oligospermia (4), astenozoospermia (43), oligoastenozosermia (48), and inflammatory (27). Statistical analyses of the ultrasound data for the infertile males and those of the control group were performed using the Mann-Whitney U. test and compared. Data were statistically significant for the following parameters: the transverse diameter for the infertile males with azoospermia, the anteroposterior diameter of the prostate for those patients with leukospermia, and the periprostatic plexus for those in the oligoastenozoospermia and inflammatory patient groups.

The horseshoe kidney is useful as a graft and should be transplanted. The technical difficulties can be avoided by en bloc removal, perfusion in situ with Collins solution, and bench surgery during graft preparation.

A study was undertaken on 57 patients diagnosed as having disseminated renal adenocarcinoma. The interval between the onset of symptomatology and diagnosis ranged from 1 to 48 months. The tumor frequently metastasized to lungs and bone. To evaluate survival, this patient population was divided into two groups: those who underwent nephrectomy, 17 patients (9 patients also underwent lymphadenectomy), and those who were put on drug therapy alone. No significant difference was observed with respect to survival for both patient groups.