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Objective: To review the different salvage chemotherapy regimens according to the prognostic factors based on the response to the different therapeutic alternatives., Methods: The conventional rescue chemotherapy regimens, as well as the role of surgery, new drugs and therapeutic modalities, particularly high dose second and third line chemotherapy, were reviewed., Results/conclusions: Germ cell testicular tumor is the paradigm of curable tumors of the adult. Whereas the cure rate for stage I tumors is higher than 98%, patients with advanced stage tumors have a lower cure rate. Approximately 10% of the patients with good-prognosis factors and 30%-50% of those with poor-prognosis factors show tumor progression or recurrence after first line chemotherapy using cisplatin-based combinations. Patients who have recurrence after first line chemotherapy have a 40% probability of achieving second complete remission with second line chemotherapy, but will be sustained in only 20% of the patients, although rare cases of advanced pure seminoma that recurred have shown a cure rate of 55% with second line chemotherapy. New strategies have been developed using new drugs such as taxanes or high doses of well-known chemotherapeutic agents with autologous hematopoietic rescue that have been utilized with success in patients with refractory germ cell testicular tumors. A global analysis of the patients treated with third line chemotherapy shows a sustained complete remission rate of 22%. However, this percentage can only be increased to up to 50% for patients with no adverse factors.

Objectives: The present study reviewed the records of patients with Wilms' tumor treated at the University Hospital of Zaragoza from January, 1980 to January, 1995., Methods: A retrospective study was conducted in 12 patients (5 boys and 7 girls) with Wilms' tumor, aged 9 months to 9.5 years, with special reference to the clinical symptoms and signs., Results: In 9 of the 12 cases, the tumor was localized to the left kidney and 3 cases had right-sided involvement. No patient showed an unfavorable histological finding, intraoperative rupture or the associated phenotypic manifestations that are frequently described in cases with this tumor type., Conclusion: The mortality and survival rates are comparable with those reported by other authors in our country.

Objectives: Considerations on a case of prenatal torsion of the spermatic cord., Methods: Review of cases reported in the literature., Results: Testicular torsion rarely occurs in the perinatal period. Nearly a hundred cases with surgical confirmation have been reported., Conclusions: Prenatal torsion is almost exclusively extravaginal, while postnatal extravaginal torsion is extremely rare. The possibility of finding a viable testis is extremely remote. The treatment should be directed at minimizing any potential perioperative complications by scheduling an elective operation after the neonate is medically stable.

We report a case of subclinical retroperitoneal tumor in a young patient. Although different diagnostic techniques were utilized (US, urography, CT, etc.), the tumor type could not be determined preoperatively. A malignant tumor was suspected, therefore surgical excision was warranted. The pathological analysis disclosed an angiomyolipoma in the psoas muscle, a benign tumor in an uncommon site. The foregoing finding prompted us to report the present case.

We report on two adolescent girls with imperforate hymen that had presented clinically as urinary retention. In the second case described herein, hydrocolpos could have resulted from the imperforate hymen and might have caused the congenital hydronephrosis incorrectly diagnosed during the neonatal period and childhood as such.

A minimally invasive surgical technique that remarkably simplifies the Stamey procedure is described herein. The technique shortens the operating time and achieves a success rate of over 80%. Thus, we believe this technique should be considered in the treatment of stress urinary incontinence in females.

Endoscopic ureterectomy is a minimally invasive surgical technique indicated in cases warranting ureterectomy to complement extended nephrectomy for pyelocaliceal urothelial carcinoma. The results achieved are identical to those of conventional ureterectomy (open surgery) without the inconvenience or sequelae that usually present with the latter procedure. In 1982, the authors developed the modified Dell'Adami and Breda endoscopic ureterectomy technique. To date, they have performed their modified technique in 10 cases: 9 with infiltrating urothelial or highly malignant pyelic or caliceal tumor and 1 with diffuse leukoplasia and cholesteatoma of renal pelvis. The technique described herein permits intussusception of the ureter into the bladder by transurethral traction of a Chevassu ureteral catheter to which that cephalad end of the ureter is attached during the extended nephrectomy procedure. Once intussusception of the ureter has been achieved, a resectoscope is used to cut the ureter at the level of the ureteral meatus. Thereafter the mucosa of the corresponding trigonal horn is completely resected. The results are highly satisfactory in patients whose ureter has not previously been submitted to open surgery and is not compromised by tumor spread.

The authors report on two male neonates who underwent transurethral resection of urethral valves in one case and a polyp in the posterior urethra in the other case, via antegrade percutaneous cystostomy. The percutaneous antegrade approach to the urethra is described in detail. The advantages afforded by this procedure are emphasized, particularly that of avoiding iatrogenic stenosis resulting from the conventional retrograde transurethral approach or the morbidity of transvesical or retropubic open surgery.

Urological surgery is rapidly developing towards less invasive and more conservative approaches without detriment to its proven efficacy. The authors, who perform endourologic surgery in 60% of the cases, have sought to enhance endoscopic suture techniques in the bladder using the triangulation procedure. Investigation was undertaken in experimental animals (large breed of female dogs) to assess various endosuture techniques and to develop the most appropriate instrument for this purpose. Following completion of the project's first phase, the authors claim that reconstructive endoscopic surgery of the bladder is already a reality and mechanical endoscopic suture of the bladder is forthcoming.

Following a brief discussion of the different factors that assigned only a palliative role to transurethral resection, a procedure considered applicable in the advanced stages of prostate carcinoma, it is suggested that in the light of current knowledge and the experience of many urologists relative to resection, as well as the possibilities afforded by currently available instruments, transurethral resection should, in certain cases, aim at surgical cure and complete removal of all cancer tissue should be attempted. Patients are described in whom only urethral "funneling" was performed, others in whom resection aimed at creating a wide concave and regular prostate lodge leaving the capsular tissue exposed, and those who underwent subradical resection of prostate. In view of the fact that sub-radical resection of the prostate does not significantly increase morbidity and mortality in comparison with simple transurethral resection of prostate hyperplasia, this technique is proposed as a valid alternative in patients with prostatic carcinoma who either refuse or are unamenable to open radical prostatectomy.

We report on a series of 32 patients with urethral strictures of different etiology, site, and morphology that were submitted to treatment by balloon dilatation. The results achieved corroborate the usefulness of this procedure. It is easy to perform and there are no complications. Furthermore, it affords economic advantages since it can be performed with simple local anesthesia on an outpatient basis. For all the foregoing reasons, we believe that balloon dilatation is a useful procedure in the treatment of urethral strictures that permits raising the success rate in well-selected cases of urethral strictures untreated previously by other surgical procedures. Balloon dilatation and endoscopic internal urethrotomy are the procedures of choice in the treatment of a vast majority of strictures.

The authors present 15 cases of calicial ectopias. They then review some of the names frequently given to this illness and discuss certain theories which link this anomaly with other kidney cystoses, taking special care to point out the difficulties involved in the correct performing of a differential diagnosis with calculous hollows, particularly those situated in lower calices.

The author carries out a sonographic study on 200 expansive kidney processes, in which he assess the possibilities of this method of diagnosis at the same time offering the echographic semiology of the different disorders being studied. Finally, he explains the limitations and drawbacks of this technique.

We report on a case of Wilms tumor associated with segmental, focal membranous glomerulonephritis in the contralateral kidney of a 4-year-old boy. The possible etiopathogenesis and outcome of this rare disease entity are discussed. Except for rare cases, this condition usually progresses to end-stage renal failure.