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Introducción: El síndrome de dolor miofascial de suelo pélvico es una entidad nosológica muy frecuente en el campo urológico y suele ser ignorada o mal diagnosticada. Objetivos: Dar a conocer la prevalencia de este síndrome a los profesionales de la urología a través de una revisión sistemática de la bibliografía existente y sus posibilidades de diagnóstico y tratamiento. Materiales y métodos: Realizamos una búsqueda bibliográfica a través de la base de datos «Pubmed» utilizando los términos «trigger points», «myofascial pain», «referred pain», «infiltrations» y «physical therapy», a los que añadimos el término «pelvic floor». Entonces, seleccionamos los trabajos en lengua inglesa, española y francesa que nos podrían interesar. Resultados: Se desarrollan los aspectos más destacados del síndrome: anatomía, etiología, correlación anatomoclínica, epidemiología, factores de perpetuación, diagnóstico, terapéutica médica y tratamiento con fisioterapia. Conclusión: Es la causa más frecuente de dolor en el suelo pélvico y afecta, en gran medida, la calidad de vida de los pacientes. Hoy, disponemos de herramientas diagnósticas y terapéuticas que nos permiten tratar este síndrome invalidante con buenos resultados. Introduction: Myofascial pain syndrome in the pelvic floor is a very common condition in the urological field and is often ignored or misdiagnosed. Objectives: To present the prevalence of this syndrome to professionals of urology through a systematic review of existing literature and its potentials for diagnosis and treatment. Materials and methods: We performed a literature search through the database "Pubmed" using the terms "Trigger points", "myofascial pain", "referred pain", "infiltrations" and "physical therapy", to which we add the term "pelvic floor". Then, we select the works in English, Spanish and French that we might like. Results: We develop the highlights of the syndrome: anatomy, etiology, anatomical-clinical correlation, epidemiology, perpetuating factors, diagnosis, medical therapy and physiotherapy treatment. Conclusion: It is the most common cause of pain in the pelvic floor and greatly affects quality of life of patients. Nowadays, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.

Introducción: En bien conocido que la prostatectomía radical (PR) es una opción excelente como tratamiento del cáncer de próstata localizado, desde el punto de vista de control oncológico. Desde hace décadas los esfuerzos de la comunidad urológica en este campo, se centran en intentar mejorar los resultados funcionales (morbilidad urinaria y sexual) tras este procedimiento. Desde el inicio de este siglo, conviven tres abordajes (abierto, robótico y laparoscópico) que hasta nuestros días pugnan por intentar alcanzar y demostrar los mejores resultados. El objetivo de esta revisión ha sido hacer una puesta al día lo más exhaustiva, rigurosa y objetiva posible, sobre los resultados oncológicos y funcionales que consiguen las tres técnicas (abordajes) de PR. Material y métodos: Hemos centrado la comparativa en cuatro apartados: resultados perioperatorios, resultados oncológicos, resultados funcionales y costes económicos. Para ellos se realizó unas búsqueda sistemática en los siguientes registros: PubMed, OVID, EMBASE y Cochrane Library, con los siguiente términos: PR Retropúbica, PR Abierta, PR Laparoscópica, PR Robótica, Función Sexual, Incontinencia Urinaria, Calidad de Vida, Costes Económicos. Se seleccionaron un total de 73 referencias, a criterio de los autores, que fueron analizadas individualmente. Resultados: La mortalidad relacionada con el procedimiento es extremadamente baja con cualquiera de las técnicas, con poco dolor postoperatorio y mínimos requerimientos analgésicos. Los resultados oncológicos, medidos en términos de márgenes quirúrgicos son comparables: PR Abierta (14-20%), PR Laparoscópica (7,4-21,9%) y PR Robótica (5,7-17,3%). En relación a resultados funcionales (función sexual y continencia urinaria) es difícil establecer comparaciones debidos a la multitud de sesgos existentes (estudios no randomizados, diferentes métodos y escalas de medida, diferentes definiciones, etc). En los estudios uni-institucionales, los resultados parecen ser equivalentes. Conclusiones: Las series de PR Laparoscópica y Robótica aún carecen de resultados maduros en términos de control bioquímico y resultados funcional a largo plazo. Parece que con estos abordajes la pérdida sanguínea y la necesidad de transfusión es menor que en cirugía abierta. La tecnología robótica aporta ventajas muy interesantes, que podrían tener un papel en homogeneizar los resultados del abordaje mínimamente invasivo, pero que aguardan validación a medio y largo plazo.

El leiomioma renal es un tumor mesenquimatoso benigno poco frecuente que, no obstante, se debe tener en cuenta ante el diagnóstico de una masa renal. Esta neoplasia puede originarse en cualquier órgano del aparato genitourinario que contenga músculo liso, siendo la cápsula renal la localización más frecuente. Dado el comportamiento benigno de la lesión, es subsidiario de la realización de una cirugía renal conservadora. No obstante, ante la dificultad para distinguirlo del adenocarcinoma, no será infrecuente que el diagnóstico se produzca tras el análisis histológico de una pieza de nefrectomía radical.

The urinary fistulas are not a frequent problem in our urological rutinary work, being the vesicovaginal ones the most common. However, it will be neccessary to know them to be able to diagnose and treat them in the best way. In this article we clasificate the different urinary fistulas (uro-gynecologicals, uro-vasculars, uro-cutaneous and entero-urinarys), explaining the posible etiologies and the correct management.

In spite of the development of non-invasive strategies, surgical treatment of the prostate (TURP) and, mostly transurethral resection, is the most effective choice for patients suffering from benign prostatic hyperplasia who do not respond properly to pharmacological treatment. Absorption of hypotonic fluids used during TURP may cause hemodynamic and central nervous system disturbances. These symptoms, both taken separately or as a whole, are best known as “Transurethral prostatic resection syndrome” or “TURP syndrome”. The original description of this syndrome dates from half a century ago; however, a number of items regarding its physiopathology and treatment remain unclear. We present a review of this pathological entity, compiling diagnostic and therapeutical approaches.

Resumen Objetivo Analizar la serie de pacientes sometidos entre los anos 1990 y 1999 a sustitucion de su protesis de pene debido a la aparicion de algun tipo de complicacion. Material y metodos 85 pacientes fueron sometidos a implante, siendo utilizados 13 modelos diferentes de protesis. En 15 de estos pacientes (17,64%) esta tuvo que ser sustituida una vez o mas. La edad media en el momento de la sustitucion fue de 51,5 anos. El acceso quirurgico mas frecuente fue el infrapubico. Resultados Se realizaron en total 32 intervenciones de sustitucion protesica. Las causas principales fueron: fallo mecanico (13 casos, 40,62%); infeccion (10 casos, 31,25%); y perforacion de cuerpos cavernosos (cinco casos, 15,62%). No se observo incremento progresivo en la incidencia de complicaciones en relacion con el numero ordinal de la protesis implantada. Mejores resultados globales: Mentor Mark II y AMS 700 Ultrex Plus. Actualmente solo ocho (53,33%) de los 15 pacientes reimplantados hacen uso normal de su protesis. Conclusiones Los pacientes sometidos a sustitucion de su protesis de pene son fuente potencial de complicaciones posteriores. Su conocimiento y correcto manejo es importante, de cara a una mejora progresiva en los resultados finales, (sobre todo si estos -como en uestro caso- no son aptos para el conformismo).

Resumen Objetivo Analizar la serie de pacientes sometidos en nuestro Centro a linfadenectomia inguinal por carcinoma escamoso de pene, entre los anos 1984 y 1999. Material y metodos La linfadenectomia fue realizada en 19 pacientes, con una media de edad de 61 anos. El tipo de intervencion mas frecuente fue la ilioinguinal bilateral (42,1 %). Solo cuatro pacientes fueron sometidos simultaneamente a penectomia y linfadenectomia. Presentamos los resultados clinicos y anatomopatologicos, segun la clasificacion TNM de 1997. Resultados Las adenopatias inguinales palpables persistieron tras antibioterapia en siete de 12 pacientes. La correlacion global de nuestra serie entre estadio N y pN fue de 68,42 %. Presentamos asimismo los resultados anatomopatologicos segun categorias pT y pN. Las complicaciones postoperatorias se presentaron en 13 casos (68,42 %), (siendo el linfedema la mas frecuente). Se obtuvo una supervivencia global a uno y cinco anos de 90 y 80 % en pacientes con dos o menos ganglios pN(+); frente al 11,11 y 0 % cuando mas de dos estuvieron presentes. Conclusiones La importancia del control de los ganglios linfaticos metastaticos en el carcinoma escamoso de pene, situa a la linfadenectomia inguinal como herramienta esencial en los casos apropiados. Su incidencia de complicaciones hace necesario, no obstante, un progresivo consenso en cuanto a sus indicaciones.

Background: The number of robotic-assisted procedures offered in Spain is rapidly increasing despite a lack of consensus criteria for training and credentialling. Objective: This national multicentre study was designed to analyze the different areas of the robotic urological surgery learning curve. Material and Methods: A questionnaire was sent to all 13 urology units in Spain with an active robotics programme requesting information on training and problems encountered. Results: In most centres (n = 11, 84.6%), training programmes were animal-based; cadavers were used at only 2 (15.4%). Proctoring in initial procedures was practiced by 12 groups (92.3%). When initiating the robotics programme, the console was shared at 8 units (61.5%). Prior experience in open and/or laparoscopic surgery was reported by 10 of the groups (76.9%), and experience in open surgery only by 2 (15.4%) or robotic surgery alone by 1 (7.7%). The procedure with which the robotics programme was started in all 13 participating units was radical prostatectomy. The number of cases needed to complete the learning curve for this procedure was 20–25 cases according to 8 (61.5%) surgery teams. Conclusions: Up until March 26, 2010, 1,692 operations, mostly radical prostatectomies, were conducted using the da Vinci robot in our country.

The relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED)is the result of their greater association in advanced age. Nevertheless, several investigations show that urinary tract symptoms have an independent relationship with sexual dysfunction and lower satisfaction. Likewise, the severity of LUTS correlates with the magnitude of sexual dysfunction in all age groups, which suggests a possible causal relationship. A series of hypothesis have been posed to explain the existence of a common physiopathology for LUTS and ED. Currently, this relationship between LUTS and ED is supported on four theories, which are not mutually excluding, (a) autonomic hyperactivity and metabolic syndrome hypothesis, (b) changes in nitric oxide/nitric oxide (NOS/NO) synthetase in the guanine monophosphatase pathway in penis and prostate, (c) the activation of Rho kinase and the endothelin pathway, and (d) the physiopathological consequences of pelvic arteriosclerosis. Given the contribution of sexual function to keep the quality of life, possible negative effects on sexual function should be taken into consideration when choosing treatment for benign prostatic hyperplasia. The combined therapeutic approach of these two entities (ED and LUTS)brings a benefit to the patient both in urinary symptoms and sexual sphere, although placebo controlled studies are required to confirm these data and to ascertain the role of combination therapy in the treatment of both conditions.

La relación entre los síntomas del tracto urinario inferior (STUI) y la disfunción eréctil (DE) es el resultado de su mayor asociación en edades avanzadas. Sin embargo, varias investigaciones demuestran que los síntomas urinarios se relacionan en forma independiente con disfunción sexual y menor satisfacción. Asimismo, la gravedad de los STUI se correlaciona con la magnitud de la disfunción sexual en todos los grupos etarios, lo cual sugiere una posible relación causal. Una serie de hipótesis se han formulado para explicar la existencia de una fisiopatología común entre STUI y DE. En la actualidad, esta relación entre STUI y DE está apoyada por cuatro teorías, no mutuamente excluyentes, que incluyen (a) la hiperactividad autonómica y la hipótesis de síndrome metabólico, (b) los cambios en la sintetasa de óxido nítrico / óxido nítrico (NOS / NO) de la vía guanina monofosfatasa en la próstata y el pene, (c) la activación de Rho-kinasa y la vía de la endotelina, y (d) las consecuencias fisiopatológicas de la aterosclerosis pélvica. Dada la contribución del funcionamiento sexual en el mantenimiento de la calidad de vida, en la elección del tratamiento para el paciente con hiperplasia prostática benigna deben tomarse en cuenta los posibles efectos negativos sobre la función sexual. El enfoque terapéutico combinado de estas dos entidades (DE y STUI) provoca un beneficio sobre el paciente tanto en la sintomatología urinaria como en la esfera sexual, aunque se precisan estudios controlados con placebo para confirmar estos datos y dilucidar el papel de la terapia de combinación para el tratamiento de estas dos condiciones. Objectives: The relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) is the result of their greater association in advanced age. Nevertheless, several investigations show that urinary tract symptoms have an independent relationship with sexual dysfunction and lower satisfaction. Likewise, the severity of LUTS correlates with the magnitude of sexual dysfunction in all age groups, which suggests a possible causal relationship. A series of hypothesis have been posed to explain the existence of a common physiopathology for LUTS and ED. Currently, this relationship between LUTS and ED is supported on four theories, which are not mutually excluding, (a) autonomic hyperactivity and metabolic syndrome hypothesis, (b) changes in nitric oxide/nitric oxide (NOS/NO) synthetase in the guanine monophosphatase pathway in penis and prostate, (c) the activation of Rho kinase and the endothelin pathway, and (d) the physiopathological consequences of pelvic arteriosclerosis. Given the contribution of sexual function to keep the quality of life, possible negative effects on sexual function should be taken into consideration when choosing treatment for benign prostatic hyperplasia. The combined therapeutic approach of these two entities (ED and LUTS) brings a benefit to the patient both in urinary symptoms and sexual sphere, although placebo controlled studies are required to confirm these data and to ascertain the role of combination therapy in the treatment of both conditions.

Introducción: El síndrome de atrapamiento del nervio pudendo (SANP) es un gran desconocido y suele ser mal diagnosticado o confundido con otras patologías. Fue descrito por primera vez por Amarenco en 1987. La manifestación clínica clásica es la neuralgia del pudendo, un dolor neuropático del área genital. Objetivos: Dar a conocer su existencia a los profesionales de la urología a través de una revisión sistemática de la bibliografía existente y sus posibilidades de diagnostico y tratamiento. Material y método: Realizamos una búsqueda bibliográfica a través de la base de datos «Pubmed» utilizando los términos «Pudendal nerve», «Pudendal nerve entrapment síndrome», «Pelvic floor neuropathic pain», «Pelvic floor myofascial síndrome», «Pudendal nerve decompression». Asimismo, seleccionamos los trabajos en lengua inglesa, española y francesa, revisando también los artículos que dichos trabajos refieren. Resultados: Se desarrollan los aspectos más destacados del síndrome: anatomía, etiología, fisiopatología, diagnostico clínico, ecodoppler de la arteria pudenda interna, estudios electrofisiológicos, criterios diagnósticos, terapéutica médica, tratamiento con fisioterapia y tratamiento quirúrgico. Conclusión: Es una causa poco frecuente de dolor en el suelo pélvico y afecta en gran medida la calidad de vida de los pacientes. Hoy, disponemos de herramientas diagnósticas y terapéuticas que nos permiten tratar este síndrome invalidante con buenos resultados. Introduction: The syndrome of pudendal nerve entrapment (SANP) is widely unknown and often misdiagnosed or confused with other diseases. It was first described by Amarenco in 1987. The classic clinical manifestation is pudendal neuralgia, a neuropathic pain in the genital area. Objectives: To make known its existence to the urology professionals through a systematic review of existing literature and its potential for diagnosis and treatment. Materials and methods: We performed a literature search through the database "Pubmed" using the terms "Pudendal nerve", "Pudendal nerve entrapment syndrome", "Pelvic floor neuropathic pain", "Pelvic floor myofascial syndrome," "Pudendal nerve decompression". Also, selected works in English, Spanish and French, also reviewing the articles relate this work. Results: We develop the highlights of the syndrome: anatomy, etiology, pathophysiology, clinical diagnosis, ecodoppler of internal pudendal artery, electrophysiological studies, diagnostic criteria, medical therapy, physical therapy treatments and surgery. Conclusion: It is an uncommon cause of pain in the pelvic floor and greatly affects quality of life of patients. Today, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.

The syndrome of pudendal nerve entrapment (SANP) is widely unknown and often misdiagnosed or confused with other diseases. It was first described by Amarenco in 1987. The classic clinical manifestation is pudendal neuralgia, a neuropathic pain in the genital area.To make known its existence to the urology professionals through a systematic review of existing literature and its potential for diagnosis and treatment.We performed a literature search through the database Pubmed using the terms Pudendal nerve, Pudendal nerve entrapment syndrome, Pelvic floor neuropathic pain, Pelvic floor myofascial syndrome, Pudendal nerve decompression. Also, selected works in English, Spanish and French, also reviewing the articles relate this work.We develop the highlights of the syndrome: anatomy, etiology, pathophysiology, clinical diagnosis, ecodoppler of internal pudendal artery, electrophysiological studies, diagnostic criteria, medical therapy, physical therapy treatments and surgery.It is an uncommon cause of pain in the pelvic floor and greatly affects quality of life of patients. Today, we have diagnostic and therapeutic tools that allow us to treat this disabling syndrome with good results.

Resumen Introduccion El sindrome de atrapamiento del nervio pudendo (SANP) es un gran desconocido y suele ser mal diagnosticado o confundido con otras patologias. Fue descrito por primera vez por Amarenco en 1987. La manifestacion clinica clasica es la neuralgia del pudendo, un dolor neuropatico del area genital. Objetivos Dar a conocer su existencia a los profesionales de la urologia a traves de una revision sistematica de la bibliografia existente y sus posibilidades de diagnostico y tratamiento. Material y metodo Realizamos una busqueda bibliografica a traves de la base de datos «Pubmed» utilizando los terminos «Pudendal nerve», «Pudendal nerve entrapment sindrome», «Pelvic floor neuropathic pain», «Pelvic floor myofascial sindrome», «Pudendal nerve decompression». Asimismo, seleccionamos los trabajos en lengua inglesa, espanola y francesa, revisando tambien los articulos que dichos trabajos refieren. Resultados Se desarrollan los aspectos mas destacados del sindrome: anatomia, etiologia, fisiopatologia, diagnostico clinico, ecodoppler de la arteria pudenda interna, estudios electrofisiologicos, criterios diagnosticos, terapeutica medica, tratamiento con fisioterapia y tratamiento quirurgico. Conclusion Es una causa poco frecuente de dolor en el suelo pelvico y afecta en gran medida la calidad de vida de los pacientes. Hoy, disponemos de herramientas diagnosticas y terapeuticas que nos permiten tratar este sindrome invalidante con buenos resultados.

Resumen Introduccion El sindrome de dolor miofascial de suelo pelvico es una entidad nosologica muy frecuente en el campo urologico y suele ser ignorada o mal diagnosticada. Objetivos Dar a conocer la prevalencia de este sindrome a los profesionales de la urologia a traves de una revision sistematica de la bibliografia existente y sus posibilidades de diagnostico y tratamiento. Materiales y metodos Realizamos una busqueda bibliografica a traves de la base de datos «Pubmed» utilizando los terminos «trigger points», «myofascial pain», «referred pain», «infiltrations» y «physical therapy», a los que anadimos el termino «pelvic floor». Entonces, seleccionamos los trabajos en lengua inglesa, espanola y francesa que nos podrian interesar. Resultados Se desarrollan los aspectos mas destacados del sindrome: anatomia, etiologia, correlacion anatomoclinica, epidemiologia, factores de perpetuacion, diagnostico, terapeutica medica y tratamiento con fisioterapia. Conclusion Es la causa mas frecuente de dolor en el suelo pelvico y afecta, en gran medida, la calidad de vida de los pacientes. Hoy, disponemos de herramientas diagnosticas y terapeuticas que nos permiten tratar este sindrome invalidante con buenos resultados.

OBJETIVOS La relacion entre los sintomas del tracto urinario inferior (STUI) y la disfuncion erectil (DE) es el resultado de su mayor asociacion en edades avanzadas. Sin embargo, varias investigaciones demuestran que los sintomas urinarios se relacionan en forma independiente con disfuncion sexual y menor satisfaccion. Asimismo, la gravedad de los STUI se correlaciona con la magnitud de la disfuncion sexual en todos los grupos etarios, lo cual sugiere una posible relacion causal. Una serie de hipotesis se han formulado para explicar la existencia de una fisiopatologia comun entre STUI y DE. En la actualidad, esta relacion entre STUI y DE esta apoyada por cuatro teorias, no mutuamente excluyentes, que incluyen (a) la hiperactividad autonomica y la hipotesis de sindrome metabolico, (b) los cambios en la sintetasa de oxido nitrico / oxido nitrico (NOS / NO) de la via guanina monofosfatasa en la prostata y el pene, (c) la activacion de Rho-kinasa y la via de la endotelina, y (d) las consecuencias fisiopatologicas de la aterosclerosis pelvica. Dada la contribucion del funcionamiento sexual en el mantenimiento de la calidad de vida, en la eleccion del tratamiento para el paciente con hiperplasia prostatica benigna deben tomarse en cuenta los posibles efectos negativos sobre la funcion sexual. El enfoque terapeutico combinado de estas dos entidades (DE y STUI) provoca un beneficio sobre el paciente tanto en la sintomatologia urinaria como en la esfera sexual, aunque se precisan estudios controlados con placebo para confirmar estos datos y dilucidar el papel de la terapia de combinacion para el tratamiento de estas dos condiciones.

Resumen Presentamos el infrecuente caso de una metastasis renal unica procedente de una neoplasia esofagica primaria. Describimos los principales aspectos clinicos y diagnosticos. Estos nos hicieron considerar al paciente como un buen candidato para cirugia. El estudio anatomopatologico de la pieza de nefrectomia fue sorprendente. El periodo postoperatorio fue, sin embargo, desafortunado.

We report one case of renal angiomyolipoma with three characteristics: renal sinus origin, inferior vena cava tumor thrombus reaching the right atrium and Budd-Chiari syndrome.The characteristics of the case are presented and discussed.Renal angiomyolipoma is a benign mesenchymal tumor. It is an uncommon tumor (2-6.4% of all kidney tumors), with a female predominance. Angiomyolipoma most often originate from the renal parenchyma but they can rarely originate from the renal sinus. They can involve the renal vein, the inferior vena cava and even the right atrium as a tumor thrombus. Angiomyolipoma commonly present as an incidental finding on radiographic studies, but the clinical presentation varies from flank pain to fatal pulmonary tumor embolism. The Budd-Chiari syndrome is an extremely rare presentation. Because of the risk of potentially fatal cardiopulmonary embolism and death, surgical treatment (radical nephrectomy plus tumor thrombectomy) of these lesions is indicated even when they are asymptomatic.

Objetivo: Se aporta un caso de angiomiolipoma renal con tres peculiaridades: origen en seno renal, trombo en cava hasta ostium de aurícula derecha y presentación clínica en forma de síndrome de Budd-Chiari. Métodos: Se realiza una presentación y comentarios de las características del caso clínico. Resultados/Conclusiones: El angiomiolipoma renal es un tumor benigno mesenquimal, poco frecuente (2-6.4% de los tumores renales), de predominio en el sexo femenino. Habitualmente surge en el parénquima renal, siendo infrecuente su origen en el seno renal. Puede afectar a estructuras venosas formando trombo tumoral en vena renal y en vena cava inferior, llegando incluso a aurícula derecha. Habitualmente es asintomático, constituyendo un hallazgo incidental en técnicas diagnósticas de imagen, pero su presentación clínica varía desde el dolor en flanco (lo más frecuente) hasta el TEP fatal, siendo excepcional su presentación como síndrome de Budd-Chiari. Debido al riesgo de TEP y muerte, el tratamiento quirúrgico (nefrectomía radical y trombectomía) del AML con trombo en cava está indicado aún cuando sea asintomático. Objective: We report one case of renal angiomyolipoma with three characteristics: renal sinus origin, inferior vena cava tumor thrombus reaching the right atrium and Budd-Chiari syndrome. Methods: The characteristics of the case are presented and discussed. Results/Conclusions: Renal angiomyolipoma is a benign mesenchymal tumor. It is an uncommon tumor (2-6.4% of all kidney tumors), with a female predominance. Angiomyolipoma most often originate from the renal parenchyma but they can rarely originate from the renal sinus. They can involve the renal vein, the inferior vena cava and even the right atrium as a tumor thrombus. Angiomyolipoma commonly present as an incidental finding on radiographic studies, but the clinical presentation varies from flank pain to fatal pulmonary tumor embolism. The Budd-Chiari syndrome is an extremely rare presentation. Because of the risk of potentially fatal cardiopulmonary embolism and death, surgical treatment (radical nephrectomy plus tumor thrombectomy) of these lesions is indicated even when they are asymptomatic.

Objetivo: Se aporta un caso de angiomiolipoma renal con tres peculiaridades: origen en seno renal, trombo en cava hasta ostium de aurícula derecha y presentación clínica en forma de síndrome de Budd-Chiari. Métodos: Se realiza una presentación y comentarios de las características del caso clínico. Resultados/Conclusiones: El angiomiolipoma renal es un tumor benigno mesenquimal, poco frecuente (2-6.4% de los tumores renales), de predominio en el sexo femenino. Habitualmente surge en el parénquima renal, siendo infrecuente su origen en el seno renal. Puede afectar a estructuras venosas formando trombo tumoral en vena renal y en vena cava inferior, llegando incluso a aurícula derecha. Habitualmente es asintomático, constituyendo un hallazgo incidental en técnicas diagnósticas de imagen, pero su presentación clínica varía desde el dolor en flanco (lo más frecuente) hasta el TEP fatal, siendo excepcional su presentación como síndrome de Budd-Chiari. Debido al riesgo de TEP y muerte, el tratamiento quirúrgico (nefrectomía radical y trombectomía) del AML con trombo en cava está indicado aún cuando sea asintomático.

Radical prostatectomy (RP) is today, in any of its four approaches (perineal (PRP), retropubic (ARP), laparoscopic (LRP) or robotic (RRP), the standard surgical treatment in localized prostate cancer. It looks clear that the minimum invasive approaches (laparoscopy and robotics) are able to reduce hospital stay as well as blood loss and therefore transfusion requirement. Also, laparoscopic results at mid and robotics at short term, seem to indicate, that both are safe oncologically and able to obtain same or even superior, functional results. Our objective has been to evaluate the economic impact that these techniques have to consider their definitive implantation, as well as the advantages and disadvantages of its potential implementation in our health system.

It is well known that radical prostatectomy (RP) is an excellent option in localized prostatic cancer especially from oncological control point of view. The efforts, during last decades, of the urological community in this field have been addressed in trying to improve functional outcomes (urinary and sexual morbidity) after the procedure. From the beginning of this century, three managements (open, robotic and laparoscopic) have been coexisting trying to get and prove the best results. The objective of this review has been to make the most exhaustive, rigorous and objective updating with the functional and oncological outcomes from the three (RP) techniques.We have centered the comparison in four sections: perioperative, oncological outcomes, functional results and economic costs. With this purpose a systematic search was made in the following registers: PubMed, OVID, EMBASE and Cochrane Library, with the following terms: Retropubic RP. open RP, laparoscopic RP, robotic RP, Sexual function, urinary incontinence, quality of life, economic costs. At author's criteria, a total of 73 references were selected, that were individually analyzed.Whatever the technique is, the mortality related to the procedure is extremely low, with little postoperative pain and minimum analgesic requirements. The oncological results are similar, measured in surgical margin terms: Open RP (14-20%), Laparoscopic RP (7.4-21.9%) and robotic RP (5.7-17.3%). Concerning functional results (sexual function and urinary continence), it is difficult to establish comparisons due to the multitude of existing byas (non randomized studies, different methods and measurement scales, different definitions, etc.) In the uni-insitutional studies, results seem to be equivalent.Laparoscopic and robotic RP series are still pending of mature outcomes, related to long term biochemical control and functional results. It seems that with these managements, blood loss and transfusion needs are minor compared to open surgery. Robotic technology adds very interesting advantages that could have an important role in homogenize the minimally invasive management, but are still pending of validation at medium and long term.

Robotic surgery is expanding little by little in urology. At present only few centers have incorporated this new technology in Spain but it is predictable that this number will exponentially increase in a near future. We described the experience of our center establishing and developing a program of robotic surgery that it is operating since July 2006. It is important to know some basic premises that it is compulsory to fulfill to reach optimal results.

La cirugía robótica se va abriendo paso poco a poco en la urología. Por el momento son pocos los centros que se han incorporado a esta nueva tecnología en España pero es previsible que este número aumente exponencialmente en los próximos años. Describimos la experiencia de nuestro centro para el establecimiento y desarrollo de un programa de cirugía robótica que lleva en funcionamiento desde julio de 2006. Es importante conocer alguna serie de premisas básicas que se deben cumplir para alcanzar unos resultados óptimos. Robotic surgery is expanding little by little in urology. At present only few centers have incorporated this new technology in Spain but it is predictable that this number will exponentially increase in a near future. We described the experience of our center establishing and developing a program of robotic surgery that it is operating since July 2006. It is important to know some basic premises that it is compulsory to fulfill to reach optimal results.

La cirugía robótica se va abriendo paso poco a poco en la urología. Por el momento son pocos los centros que se han incorporado a esta nueva tecnología en España pero es previsible que este número aumente exponencialmente en los próximos años. Describimos la experiencia de nuestro centro para el establecimiento y desarrollo de un programa de cirugía robótica que lleva en funcionamiento desde julio de 2006. Es importante conocer alguna serie de premisas básicas que se deben cumplir para alcanzar unos resultados óptimos.

TECHNICAL AND ECONOMIC REASONS TO SET UP ROBOTIC SURGERY IN A PUBLIC HEALTH SYSTEM (SPANISH MODEL) Radical prostatectomy (RP) is today, in any of its four approaches (perineal (PRP), retropubic (ARP), laparoscopic (LRP) or robotic (RRP), the standard surgical treatment in localized prostate cancer. It looks clear that the minimum invasive approaches (laparoscopy and robotics) are able to reduce hospital stay as well as blood loss and therefore transfusion requirement. Also, laparoscopic results at mid and robotics at short term, seem to indicate, that both are safe oncologically and able to obtain same or even superior, functional results. Our objective has been to evaluate the economic impact that these techniques have to consider their definitive implantation, as well as the advantages and disadvantages of its potential implementation in our Health System. Keyword: Radical prostatectomy. Robotic. Laparoscopic. Open prostatectomy. Analysis of costs. Economics.

The Virus of the Human Papiloma (HPV), classically he/she has been related with infections of sexual transmission and processes wicked oncologists of the feminine genital apparatus and with less frequency of the masculine one. The new technical diagnostics, based on molecular biology (by means of polymerase chain reaction), they help to a better epidemic approach, an improvement in the I diagnose viral, and a correct therapeutic focus. The object of this work is to revise the current state of the HPV from the points of view etiopathogenics, epidemic, clinical, diagnosis, therapeutic and preservative.

Resumen El Virus del Papiloma Humano (VPH), clasicamente se ha relacionado con infecciones de transmision sexual y procesos oncologicos malignos del aparato genital femenino y con menos frecuencia del masculino. Las nuevas tecnicas diagnosticas, basadas en biologia molecular (mediante reaccion en cadena de la polimerasa), ayudan a una mejor aproximacion epidemiologica, una mejora en el diagnostico viral, y un correcto enfoque terapeutico. El objeto de este trabajo es revisar el estado actual del VPH desde los puntos de vista etiopatogenico, epidemiologico, clinico, diagnostico, terapeutico y profilactico.

To report the 7th case of pararenal angiomyolipoma published in the world literature and to review the international bibliography.We report the case of a 46-year-old female with history of renal colic and a complex mass on radiological tests.Extrarenal retroperitoneal angiomyolipoma is a rare pathology with no more than 7 published cases. The diagnostic difficulty and radiological similarities with liposarcoma make surgery the treatment of choice.

To report one case of metachronous recurrence of idiopathic high flow priapism. METHODS. We describe the case of a 28-year-old male patient who presents with penile partial tumescence which started 10 hours before and history of a similar episode seven years before. Physical examination confirmed the clinical picture, with mild local discomfort on palpation. Blood tests were normal. Cavernous blood gases were compatible with arterial blood O2 saturation levels. The patient had a satisfactory progressive response to oral administration of diazepam. No pathologic findings were seen at the time of arteriography.Complete resolution of the episode. Erectile function was satisfactorily preserved. There was no relapse after one year of follow-up.We remark the validity of a deferred therapeutic attitude in front of pictures of high flow priapism, as well as the possibility of resolution with conservative measures. We emphasize the peculiarities of this case, mainly its idiopathic character and the metachronous recurrence.

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.

Renal leiomyoma is a benign mesenchymal tumour that, albeit very rare, has to be ruled out when a renal mass has been diagnosed. This tumour can arise from any organ of the genitourinary tract with smooth muscle cells, being the renal capsule the most frequent origin. As its behaviour is not aggressive, nephron-sparing surgery is indicated. However, as it is difficult to preoperatively differentiate the leiomyoma from the adenocarcinoma, the former is commonly diagnosed after examination of the entire organ surgically removed.

El leiomioma renal es un tumor mesenquimatoso benigno poco frecuente que, no obstante, se debe tener en cuenta ante el diagnóstico de una masa renal. Esta neoplasia puede originarse en cualquier órgano del aparato genitourinario que contenga músculo liso, siendo la cápsula renal la localización más frecuente. Dado el comportamiento benigno de la lesión, es subsidiario de la realización de una cirugía renal conservadora. No obstante, ante la dificultad para distinguirlo del adenocarcinoma, no será infrecuente que el diagnóstico se produzca tras el análisis histológico de una pieza de nefrectomía radical. Renal leiomyoma is a benign mesenchymal tumour that, albeit very rare, has to be ruled out when a renal mass has been diagnosed. This tumour can arise from any organ of the genitourinary tract with smooth muscle cells, being the renal capsule the most frequent origin. As its behaviour is not aggressive, nephron-sparing surgery is indicated. However, as it is difficult to preoperatively differentiate the leiomyoma from the adenocarcinoma, the former is commonly diagnosed after examination of the entire organ surgically removed.

To test the concordance between clinical and neurophysiologic data of the various types of erectile dysfunction, and to describe a diagnostic algorithm based on corpus cavernosum electromyography (cc-EMG).32 patients with a mean age of 50.6 years (typical deviation 13.2 years) referred with the diagnosis of erectile dysfunction underwent medical history, neuroandrologic physical exam, neurophysiologic studies (bulbocavernous muscle electromyography, S2-S4 latency period, threshold and latency of pudendal nerve somatosensory potentials, as well as genital sympathetic evoked potentials-SSR-), and corpus cavernosum electromyography(cc-EMG) both in basal conditions and after administration of 20 micrograms of E-1 prostaglandin (PGE-1).1--A significative relationship was shown between clinical data of arterial or corpus cavernosum intrinsic origin erectile dysfunction and patients with vascular or structural lesion on cc-EMG data. 2--A significative relationship was shown between patients without previous pathologic history and patients with normal or anxiety cc-EMG. 3--No significative relationship was shown between patients with neurologic lesion and patients with autonomic lesion on cc-EMG. 4--No significative relationship was found between patients with peripheric neurologic lesion and patients with inferior autonomic lesion on cc-EMG. 5--A significative relationship was shown between patients with suprasacral neurologic lesion and patients with superior autonomical lesion on cc-EMG.Isolated application of pudendal nerve neurophysiologic techniques for the diagnosis of erectile dysfunction is not enough. Autonomic innervation studies should be included, with a cc-EMG dichotomic qualitative interpretation.

The urinary fistulas are not a frequent problem in our urological rutinary work, being the vesicovaginal ones the most common. However, it will be necessary to know them to be able to diagnose and treat them in the best way. In this article we classificate the different urinary fistulas (uro-gynecologicals, uro-vasculars, uro-cutaneous and entero-urinarys), explaining the possible etiologies and the correct management.

To report a case of priapism secondary to leukemia, with special reference to the initial treatment in the emergency services.A 53-year-old male with chronic myeloid leukemia presented with prolonged involuntary painful erection of 12 hours' duration. The physical examination and particularly the cavernosal blood gas study, indicated low flow priapism. Punction-lavage of the corpora cavernosa was performed. Because complete response was not achieved with this procedure, adjuvant intracavernous methoxamine was administered.Complete detumescence was achieved after the third dose of methoxamine. There was no recurrence and erectile function was preserved.We underscore the utility of combined cavernous lavage + adjuvant alpha-1 adrenergic agonist as initial therapy in priapism with this special etiology.

To determine the degree of association of detrusor-periurethral dyssynergia and detrusor-bladder neck dyssynergia and if the voiding periurethral electromyographic (EMG) activity is also a valid method for diagnosing detrusor-bladder neck dyssynergia.A clinical, videourodynamic and selective periurethral EMG study was performed in 24 patients (mean age 33 years) with spinal cord injury and hyperreflexia of the bladder.The prevalence of bladder neck dyssynergia was 12.5% (3 cases) in this series. All patients with dyssynergic bladder neck also showed intermittent or sustained periurethral sphincter EMG activity. However, 15 patients showed increased intermittent or sustained voiding periurethral EMG activity that was not associated with detrusor-bladder neck dyssynergia. Utilizing the videourodynamic demonstration of detrusor-bladder neck dyssynergia as reference, selective periurethral EMG showed a sensitivity of 100% and a specificity of 29% for the diagnosis of detrusor-bladder neck dyssynergia.The finding of bladder neck dyssynergia indicates the existence of detrusor-periurethral dyssynergia. However, not all cases of detrusor-periurethral sphincter dyssynergia is associated with bladder neck dyssynergia; therefore a videourodynamic study should be performed to rule out bladder neck dyssynergia in those patients with detrusor-periurethral sphincter dyssynergia. This is important in making the differential diagnosis and also has significant therapeutic repercussions.

To report an additional case of paratesticular leiomyosarcoma.Herein we describe a 68-year-old male patient that presented with a growing, indolent, right inguinoscrotal lesion that he had noted several weeks earlier. Physical examination showed a mass involving the distal right spermatic cord and was confirmed by ultrasound and CT. Analyses were normal. Radical orchidectomy with high ligation of the right spermatic cord was performed.Histopathological and immunohistochemical studies demonstrated a well-differentiated paratesticular leiomyosarcoma. Local recurrence was observed at 3 1/2 years' follow-up. Complete excision of the tumorous tissue was performed with no other adjuvant therapy. Six months thereafter, there is no evidence of local recurrence or distant metastasis.This tumor type is uncommon. Like other authors, we believe that orchifuniculectomy is the treatment of choice. Furthermore, adjuvant radio or chemotherapy does not significantly influence survival in these patients.

In spite of the development of non-invasive strategies, surgical treatment of the prostate (TURP) and, mostly transurethral resection, is the most effective choice for patients suffering from benign prostatic hyperplasia who do not respond properly to pharmacological treatment. Absorption of hypotonic fluids used during TURP may cause hemodynamic and central nervous system disturbances. These symptoms, both taken separately or as a whole, are best known as "Transurethral prostatic resection syndrome" or "TURP syndrome". The original description of this syndrome dates from half a century ago; however, a number of items regarding its physiopathology and treatment remain unclear. We present a review of this pathological entity, compiling diagnostic and therapeutical approaches.

To analyze the series of patients who underwent replacement of their penile prosthesis between years 1990 to 1999, due to any kind of complication.85 patients underwent implantation, 13 different prosthesis models being utilized. It was replaced (once or more) in 15 of these patients (17.64%). The mean age at the moment of the replacement was 51.5 years. The most frequent surgical approach was the infrapubic one.A total of 32 prosthesis-replacement interventions were carried out. The main causes were: mechanical failure (13 cases, 40.62%); infection (10 cases, 31.25%); and corpus cavernosum perforation (five cases, 15.62%). Progressive increase of complications incidence with regard to the ordinal number of the implanted prosthesis was not observed. Best overall results: Mentor Mark II and AMS 700 Ultrex Plus. At present day, only eight (53.33%) out of 15 reimplanted patients use their prosthesis with normality.Those patients who undergo replacement of their penile prosthesis are potential sources for later complications. Their knowledge and proper handling is important in order to a progressive improvement of the final results, (above all if--such as our case--these ones are not suitable for conformity).