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Assessment of urethral stricture (US) management seems important to evaluate the quality of attention and plan educational interventions. We aim to investigate the practice patterns on diagnostic and therapeutic approaches to adult male anterior US among urologists in Spain.23-question on-line survey conducted among all members of AEU (Spanish Urological Association). Demography data and practices on evaluation and treatment of US were included. 1737 invitation letters sent by email, with 21.7% response rate. Data were prospectively collected during 2016. Descriptive analysis and univariate comparisons conducted using XResponders were mainly from Tertiary and Teaching University Hospitals. 63.2% treated≥10 patients/year with US. Retrograde urethrogram (RUG) was the commonest diagnostic tool followed by uroflowmetry (UF), and internal urethrotomy under direct vision (DVIU) the most frequent treatment. 84.4% limited DVIU for US≤1.5cm. 62.3% performed≤5 urethroplasties/year. Anastomotic urethroplasties were performed by 75.7% and graft repairs by 68.9%. Dorsal grafting was preferred rather than ventral. Non-transecting techniques were used by 23.9%. UF was the most common follow-up tool. 88.4% felt that referral units were required. Tertiary hospitals used Patient Reported Outcome Measure (PROM) questionnaires more frequently than secondary centres. High-volume urologists were more likely to use non-transecting techniques and to choose urethroplasty as first choice procedure.Male anterior US in Spain are treated by many urologists, mainly using endoscopic procedures. RUG is preferred for diagnosis, and UF for follow-up. A high percentage of urologists perform urethroplasties, mainly anastomotic repairs, but in low volume.

The posterior urethral lesions are associated with pelvis fractures in 5-10% of cases. The posterior urethra is attached to the pelvis bone by puboprostatic ligaments and the perineal membrane, which explains why disruption of the pelvic ring can injure the urethra at this level.To identify suspected cases of posterior urethral trauma and to perform the diagnosis and its immediate or deferred management.Search in PubMed of articles related to traumatic posterior urethral lesions, written in English or Spanish. We reviewed the relevant publications including literature reviews and chapters from books related to the topic.With patients with pelvis fractures, we must always rule out posterior urethral lesions. The diagnostic examination of choice is retrograde urethrography, which, along with the severity of the condition, will determine the management in the acute phase and whether the treatment will be performed immediately or deferred. Early diagnosis and proper acute management decrease the associated complications, such as strictures, urinary incontinence and erectile dysfunction.Despite the classical association between posterior urethral lesions and pelvic fractures, the management of those lesions (whether immediate or deferred) remains controversial. Thanks to the growing interest in urethral disease, there are an increasing number of studies that help us achieve better management of these lesions.

Posterior urethral stenoses and contractures are complications after treatment of benign prostatic hyperplasia (BPH), localised prostate cancer (PCa), and orthotopic neobladder formation, compromising prognosis and functional outcomes.To identify factors related to aetiology, prevention and treatment of non-traumatic posterior urethral stenosis and contractures.Review of the published evidence related to posterior urethral stenosis and contractures after PCa treatment, BPH therapies and orthotopic neobladder formation. PubMed database search with English and Spanish papers considered. Cohort studies, case series, prospective and retrospective studies and review papers were included.Posterior urethral stenoses and contractures are common, leading to significant morbidity. A worsening on voiding quality should rise some concerns. Careful surgical and/or radiotherapic techniques prevent their development. Endoscopic therapies are the initial approach, with complex urethroplasties often required. Subsequent urinary incontinence, the most important sequelae, may need artificial sphincters.Non-traumatic posterior urethral stenoses could be important complications, potentially compromising the outcomes of initial therapy. They could require complex surgeries leading to urinary incontinence.

Improvement in surgical and organ preservation techniques and immunosuppressive therapy has permitted multiorganic transplants in patients needing both heart and kidney organs in a synchronous or asynchronous way.To review our results in renal transplants in those patients with both heart and kidney transplants.Retrospective study of the 7 patients with heart and kidney transplants performed in our Hospital. We have reviewed patients main characteristics, heart and renal failure causes, renal graft and patient outcome and complications related to renal transplant.Between 1985 and 2006 we performed 411 heart transplants; in 7 out of those 411 patients (1.7%) we performed 9 renal transplants, 2 simultaneously and 7 non-simultaneously. All patients were male; their average age at heart transplant was 51.3+/-12.2 years (24-60); the causes of the heart transplant were dilated myocardiopathy in 4 cases (57.2%), rheumatic cardiopathy in 1 (14.3%) and ischemic cardiopathy in 2 (28.5%). The average age at renal transplant was 57.5+/-11.2 years (32-68); the causes of the end renal failure were cyclosporine nephrotoxicity in 3 cases (33.3%), nephroangiosclerosis in 1 (11.1%), chronic interstitial nephropathy in 2 (22.2%), membranoproliferative glomerulonephritis in 1 (11.1%) and chronic rejection in 2 (22.2%). In the 2 simultaneous heart-kidney transplants cold ischemia was 4 hours long, immediate diuresis was seen in 1 case (50%) and there were no complications related to the kidney transplants. The time between the heart and kidney transplants in the 7 non-simultaneous heart-kidney transplants was 105.9+/-51.8 months (23-201 months), cold ischemia was 20.3+/-1.5 hours (18-22) and there was immediate diuresis in 5 cases (71.5%); 2 patients had no complications, 2 cases had acute renal rejection episodes, 1 case of perirenal haematoma, 1 renal polar infarction, lymphocele, 1 case of wound infection, 1 urinary infection and 2 pulmonary infections. Medium follow-up is 52.2+/-33.9 months (12-93); all patients are alive with functioning grafts with creatinine level of 1.8+/-0.43 mg/100 (1.4-2.4). Two renal grafts were lost due to chronic rejection 138 and 270 days after the kidney transplants. The immunotherapy was based on mycophenolate mofetil acid and tacrolimus, though it varied.The final renal failure associated to cardiopathies needing or having needed heart transplant does not preclude the transplants of both organs.

The rate of surgical site infection is a good indicator of the quality of care in surgical departments. Antibiotic prophylaxis represents a measure of proven efficiency in preventing the infection in a surgical site, and its fulfilment is a main goal in management contracts of health services. The efficiency of this preventive measure requires the existence of updated protocols and performance evaluation.To evaluate the compliance of this antibiotic protocol in our Urology Department with the global analysis of the causes of inadequate prophylaxis and by procedures.The Department of Preventive Medicine as an outside observer, through a retrospective study, analyzed 695 urological surgical procedures (inpatient and outpatient) during the years 2003 and 2006 for its annual assessment of compliance with the antibiotic prophylaxis protocol. Administration of non-indicated prophylaxis, non-administration of indicated prophylaxis and incorrect dosage are considered as inappropriate prophylaxis.The compliance of the protocol was appropriate in 83.16% of the operations. The cause of the most frequent inadequacy was an incorrect pattern in 15.3%. Within this incorrect pattern the main reason was the delay of administration of prophylactic antibiotic and to a lesser extent an incorrect length of the antibiotic regime.The percentage of compliance with the antibiotic protocol in our Urology Department is high. The evaluation detected two problems of a different nature and solution: to adapt the timing of antibiotics is a functional, structural and organizational problem to be resolved in accordance with the Anaesthesiology Department. The number of doses of antibiotics in open prostate surgery requires knowledge and strict adherence to the guidelines by the surgeons. The efficiency of antibiotic prophylaxis requires the existence of appropriated and updated protocols for the unifications of criteria among professionals to detect new problems as well as to find solutions for its adequate compliance.

A case of retroperitoneal hemorrhage due to the rupture of a multiple angiomyolipoma in a female with a unique kidney is described. Hipovolemic shock was the first symptom, being possible to perform on her a successful conservative surgery. Etiology, diagnostic methods and treatment of the spontaneous retroperitoneal hemorrhage are discussed.

Crossed renal ectopia its a rare congenital malformation and in most cases it presents with fusion of both kidneys. Patients should be asynptomatic until 4a-5a decade and at that time they unfold urinary infection, urolithiasis, abdominal mass or pain that simulates a gastric disease. We report a case of renal cell carcinoma in a patient with crossed fused renal ectopia, showed in a Scan that was performed for gastric disease suspicion.

Intratesticular epidermoid cysts are rare tumours that constitute one percent of all testicular masses. They are bening lesions that make differential diagnosis from malignant testicular tumours difficult. The absence of serum markers elevation and ultrasound imaging could support these lesions being bening epidermoid cysts, and in that case, conservative surgery is adequate. We present the case of a 22 years old patient who complains of a left testicular mass. In this case ultrasound diagnosis was non-specific and a left radical inguinal orchiectomy was performed.

The goal of this work tries to evaluate the utility of the qualitative determination of NMP-22 in the evaluation of the superficial bladder carcinoma in asymptomatic patients, comparing it with its quantitative determination, the cytology and the cystoscopy.A simple of urine just voided was taken in 88 asymptomatic patient follow-up for superficial bladder cell carcinoma. This dose was distributed in 3 parts, for performed cytology, for determination of NMP-22, and 4 drops of the third part are added to device bladder chek. Later, we performed cystoscopy and transurethral resection in patients with a suspicion of bladder cancer.26 patients had tumor relapse and 62 patients were free of disease. The sensitivity for the bladder chek was of 28%, 34.62% for NMP-22, 34.62% for cytology and 100% for cystoscopy. The specificity was of 93.55%, 80.33%, 87.10% and 87.10% respectively. The sensitivity by degree was 25 in G1, 28.57 in G2 and 50 in G3 for Bladder chek; 29.41, 42.86 and 50 for NMP-22; 23.53, 71.43 and 0 for cytology. The sensitivity by stages was 27.7 in Ta-1 and 50 in T2 for Bladder chek; 34.78 and 50 for NMP-22; 39.13 and 0 for the cytology.The low sensitivity of bladder chek invalidates it like alternative method to the cystoscopy in the follow-up of the superficial asymptomatic bladder cell carcinoma.

A quarter of patients waiting for kidney transplantation are patients with previous graft failure. Outcome of first and second renal transplant make these the gold standard for end renal stage disease, but this is not so clear in the case of third and further renal transplant, especially at the time of organ shortage. We revise our experience in patients with three or more kidney transplants focusing on surgical aspects and graft outcome.1364 renal transplants have been carried out in our centre since 1975 until December 2003. We have retrospectively revised the 34 patients with three renal transplants and the 5 with four. We analyse the surgical technique, surgical complications and graft outcome.Mean age was 42 years (21-65). Average mismatches between donor and recipient was 3.2. All kidneys, but one case of living donor, were harvested from cadaver donors, mostly in multiple organ-procurement. Average time from the last renal transplant was 5 years (3 days-17 years) and from the last transplant carried out in the iliac fossa reused until the new transplant was 9 years (3 days- 17.5 years). All implants were performed through an iterative lumboliliac incision (25 on the right side, 11 on the left one and in 3 cases where side was not registered). Mean average duration of the procedure was 166 minutes (100-300). Nephrectomy of previous graft at the moment of the implant was carried out in 13 patients (33%). Vascular anastomosis was made on the common iliac vessels (50%) or on the external ones (50%) in end to side way, Ureteroneocystostomy was performed in an extravesical way except in 1 patient with cutaneous diversion. Vascular complications were 4 haemorrages (1 patient died), 3 venous and 2 arterial thrombosis. We had an abscess secondary to intestinal fistulae. Other surgical complications were 4 lymphoceles, three of them needed surgical treatment, and one perirenal haematoma treated in a conservative way. No urological complications were seen. In total 6 grafts (15%) were lost due to surgical complications. Graft actuarial survival rate at 1 year was 65%, 40% at 5 and 28% at 10 years.Three and four renal transplant survival rates are shorter than first and second ones. Iterative access through lumboiliac incision is associated with a higher vascular complication rate, probably in these patients a transperitoneal access would be better. Multicentric studies with higher numbers of patients are needed to define more clearly which patients would benefit from multiple kidney retransplants.

To analyse our results about continence in the treatment of female urinary incontinence with the tension-free vaginal tape (TVT) procedure based on abdominal leak point pressure(ALPP).Retrospective study of the fifty two patients who had urodynamic study and abdominal leak point pressure determination and were operated on between 1999 and 2002 for stress urinary incontinence. We reviewed the data of clinical history, physical examination and urodynamic report, surgery, complications, and objective and subjective results. Those patients having ALPP100 are included in group 1, between 61 and 100 in group 2 and less than 60 in group 3.There were 19 patients in group 1, 17 in group 2 and 16 in group 3. We found no difference between the three groups regarding age, delivery, menopause, hysterectomy, evolution, previous surgery, grade of cystocele, association of anterior colporraphy to TVT and type of anaesthesia. The Obrink clinical grade increased as the ALPP decreased (grade 3 in 26.32% of group 1, 31.58% in group 2 and 68.71% in group 3). 100% of patients in groups 1 and 2 were continent with effort and 93.75% in group 3. Complications, especially de novo instability or urgency-frequency episodes or persistence of instability in patients having mixed incontinence, caused a decrease in the satisfaction degree to 79% in group 1, 76.5% in 2 and 62.5% in 3.Abdominal leak point pressure determination does not change our decision of perform a TVT procedure but permits us to differentiate one group in which results could be worse.

To evaluate diagnostic techniques, treatment and follow-up in 94 patients affected of upper urinary tract tumor.From 1978 to december 2002 we operated 105 patients due to upper urinary tract tumor, although only 94 are valid for analysis. Mean age was 65 years and 85% were man. Haematuria was the most frequent symptom.Urography (93%), ecography (77%) and CT (67%) were the most used diagnostic techniques. Pelvic tumor was the most frequent (71%) and total nephroureterectomy including bladder cuff the chosen treatment (76.4%). Previous or simultaneous bladder tumor was observed in 23% cases and delayed in 30%. With a mean follow-up of 76 months the patient survival is 53%.Due to the high frequence of previous, simultaneous or delayed bladder tumors, the upper urinary tract tumor should be considered as a panurothelial disease, worsening the outcome of this kind of tumors.

To evaluate the corporoplasty techniques performed on 59 patients to correct congenital penile curvature and Peyronie's disease.From april 1991 to december 2001, 39 Nesbit technique, 12 Ruiz-Castañé method and 8 Essed-Schröeder procedure were performed on forty-four congenital curvatures and fifteen Peyronie's diseases. The mean age was 24 years old. Trying to hide the knots, in all patients except five a nonabsorbable inverting sutures were placed.The mean follow-up was 12 months. Postoperatively, 53 patients (86%) had satisfactory cosmetic and functional results. Four patients of five with absorbable sutures had residual curvature which needed another successful surgical correction. One patient complained of penile shortening, one of glans hypoaesthesia, one of foreskin oedema and five of palpable plication sutures. No differences were found depending on the applied surgical technique.The results reported are in accordance with the literature showing a higher recurrence rate with the absorbable sutures. The outcome is very similar with the three described techniques.

To report a rare case of coexisting renal oncocytoma and pheochromocytoma. To our knowledge, only one such case has been reported in the literature.The findings of the imaging studies of this rare case and the unsuspected anatomopathological findings are presented.Despite its very low frequency, coexisting renal ocnocytoma and pheochromocytoma should be taken into account in patients with synchronous renal and adrenal masses. Unfortunately, there are no radiological patterns that allow us to suspect this rare condition.

To evaluate the surgical complications of radical prostatectomy in our hospital.From august 1991 to december 1999, 138 patients with clinically localized prostate cancer underwent Walsh technique radical prostatectomy. The follow-up is known from 133 patients with a mean age of 64.8% and a mean PSA of 17.6 ng/ml.The mean follow-up is 43 months. Urinary fistula (9%), lymphatic leakage (5.22%) and rectal injury (2.2%) are the most common early complications. Urinary incontinence (27%), erectile dysfunction (98%) and urethrovesical junction stenosis (12%) are the delay complications. Only three patients have died due to prostate cancer. Our results are compared with another series.The morbidity of radical prostatectomy is very similar to the compared series. Urinary incontinence and erectile dysfunction are the most worrying complications which the patient must know to have the opportunity to choose another therapeutic option.

The Leydig cell tumor is the most frequent of non-germ cell tumors of the testis. Clinical findings depend on the age of presentation. We present two cases of Leydig Cell tumors of the testis, diagnosed in a 8 years old child with isosexual precocity, and a 42 years old adult with Gynaecomastia. After reviewing the existing literature on this uncommon pathology we consider that the iconography presented is very interesting for furthering the knowledge on this subject.

Our experience in the management of priapism, its etiology, blood gas changes, treatment and outcome are presented.The records of patients that had been treated at the Urology services of our hospital over the last 8 years were reviewed. During this period, patients with erectile dysfunction were treated according to a protocol.There were 9 episodes of priapism in 8 patients; all cases were low flow and the patients were aged 37-71 years. The duration of the prolonged erection ranged from 4 to 72 hours. Of these 9 cases, the etiology was intracavernosal PGE in 7, after trazodone administration in one case, and unknown in one case. Intracavernosal metoxamine was administered in all cases with excellent results, except one case that required a saphenous-cavernosal shunt and another case that was initially treated with adrenalin also with good results.Since intracavernosal agents have been utilized in the treatment of erectile dysfunction, priapism has become a more frequent urological emergency. Although a lower incidence has been reported for PGE, the dose should be well adjusted to avoid a higher incidence.

To analyze the diagnostic methods utilized in prostate cancer and the preoperative information on the extent of the tumor, and compare these results with those obtained from anatomopathological analyses of the radical prostatectomy specimen.Data on the radical prostatectomies performed during the study period were obtained from the Admissions and Clinical Records services and were analyzed using the SPSS statistical analysis software for Windows.From 1991 to 1998, 109 radical prostatectomies were performed. Evaluation by transrectal US was carried out in 89 patients (81.6%) and detected a tumor (unilateral or bilateral) in 77, for a sensitivity of 86% (CI 78.8-93.2). A CT study was performed in 94 patients and was positive in 25, for a sensitivity of 26.5% (CI 17.6-35.4). The sensitivity for transrectal US and CT were 4.17% and 3.33% for capsular involvement, 5.88% and 5.26% for seminal vesicle involvement, and 0% and 0% for node involvement, respectively.Transrectal ultrasound is a reliable diagnostic imaging method, although it has a low sensitivity when used to determine the extent of the tumor. In our series, the radiological methods showed a low sensitivity when they were utilized to determine the extent of the prostate cancer. Routine preoperative assessment by CT can be obviated in prostate cancer.

To describe a case of mucinous adenocarcinoma of the prostate, an uncommon variant of prostatic carcinoma of which few cases have been reported in the literature. This tumor type is briefly reviewed with special reference to the controversial issues that remain unresolved due to the small number of cases.A case of mucinous adenocarcinoma of the prostate is presented. An extraprostatic origin had been discarded. The diagnosis was made by DRE, transrectal US and histological confirmation by transrectal biopsy. PSA values were normal. Studies to determine the extent of the lesion showed advanced locoregional dissemination. Surgery was therefore not indicated and hormonal therapy was administered. Patient outcome was poor with no apparent clinical response to hormone blockade. Radiotherapy was attempted. The patient rapidly became worse and died.Mucinous adenocarcinoma of the prostate is characterized by the presence of significant amounts of extra and intracellular mucin. Its clinical features are not unlike those of classical adenocarcinoma and in general terms, it is considered to carry a worse prognosis and refractory to hormone therapy.

Prostatic carcinoma may be diagnosed by the clinic manifestations or by the symptoms for locoregional disemination and distance metastasis. The lymphatic system is the first metastatic station, which is affected in a high percentage of cases. Event it may simulate lymphoproliferatives process and it si uncommon the lymphatic macroaffectation at first. In theses cases, the histologic and immunohistochemical study by the determination of prostatic specific antigen in lymph nodes can provice the diagnosis. Treatment of these tumors is palliative with hormonotherapy. Prognosis is bad with a low survival at five years.

We present a 41 years old male, treated with trazodone because of depression. He was seen at our Andrology unit for a 72 hours evolutioned priapism. We review the literature and submit this paper for publication because it is an uncommon pathology.

To evaluate the usefulness of the NMP-22 test in the diagnosis of bladder cancer; to calculate the ideal cutoff and to compare the results among NMP-22, voided urine cytology and cystoscopy.166 patients having clinical suspicious of bladder cancer or in follow-up due to a previous one. The exclusions criteria were: other urological conditions, radiotherapy in the last three months, systemic chemotherapy in the last month, recent vesical trauma or indwelling catheter. Prior cystoscopy a recent voided urinary sample was sent to the pathology and biochemistry laboratory to perform cytology and NMP-22. A TUR was performed in patients with bladder tumour. The cutoff was calculated with ROC curves. For each test we calculate sensitivity, specificity, positive and negative predictive value. We use the McNemar test to compare the results, all of which are expressed with a confidence interval of 95%.The ideal cutoff was 6 U/ml. We have a global sensitivity of 82.75% for NMP-22 and 67.9 for cytology (p = 0.0118); the specificity was 80% and 94.12% respectively (p = 0.0018). By grade the sensitivity was 72.22% G1, 70.97% G2 and 100% G3 for NMP-22 and 44.44%, 58.06% and 90.62% for cytology. By stage it was 68.42% Ta, 83.33% T1 and 100 T2 or more for NMP-22 and 36.84%, 75% and 85.71% for cytology. With the cystoscopy we obtained a 100% sensitivity and 89.41% specificity.The NMP-22 is a useful test for the diagnosis of bladder cancer; is more sensitive and less specific than cytology. We think it can replace the cytology in the diagnosis and follow-up of bladder cancer. The ideal cutoff is 6 U/ml.

The schwannoma is a tumor resulting from the Schwann cells of neural shwath, being its retroperitoneal localization quite unusual. This tumor is clinically unspecified and in most of the cases it originates symptoms coming from the compression of the close structures when its localization is retroperitoneal. Its diagnosis is quite often fortuitous being confirmed by anatomopathological study afterwards. The treatment is surgical radical exeresis with subsequent followup. We report a new case of this uncommon retroperitoneal pathology in a female patient showing a nonspecific clinic. Two years after the surgery she remains asymptomatic without any radiological evidence of recidive.

To present our experience with Bellini duct carcinoma, a rare form of renal adenocarcinoma with well-defined histological, cytogenetic and immunohistochemical characteristics. The literature is reviewed.We reviewed the records of 430 patients with renal tumor that had been treated over a 10-year period. Only 6 cases with Bellini duct carcinoma were found. The mean age was 60 years, all patients were male and hematuria and lumbar pain were the most common clinical manifestations. Diagnosis was made by imaging techniques (US, urography, CT). The definitive diagnosis was based on the histological and immunohistochemical findings following nephrectomy. The one-year and three-year survival rates were 50% and 0%, respectively, indicating the aggressive nature of this variant of renal adenocarcinoma.Bellini duct carcinoma is an uncommon variant of renal carcinoma with nonspecific clinical features. It is a very aggressive tumor type whose treatment is only by nephrectomy and the outcome is poor.

An uncommon case of Fournier's gangrene following vasectomy is described.A 35-year-old male with no remarkable previous history, who underwent vasectomy in another hospital, developed a clinical picture compatible with Fournier's gangrene 7-8 days later. The patient required wide, aggressive surgical debridement on several occasions with broad spectrum antibiotic coverage. After a long stay at the hospital, the patient was finally discharged and referred to another hospital for plastic surgery.Fournier's gangrene is a polymicrobial infection of the perineoscrotal region that manifests as a rapidly progressive necrotizing fasciitis. Most of the cases have a predisposing and/or triggering factor. Fournier's gangrene following vasectomy is uncommon. The morbidity and mortality in this severe complication depend on early diagnosis and aggressive surgical management.

To compare the sensitivity and specificity of the BTA stat test, NMP-22 and voided urine cytology in the diagnosis of bladder cancer.The study comprised 100 patients or follow-up or with a suspicion of bladder cancer. A voided urine sample was obtained and alliquoted in three samples for the BTA stat test, NMP-22 and cytology. The patients were subsequently evaluated by cystoscopy and TUR was performed when cancer was suspected. The bladder cancer was classified according to TNM stage and WHO grade. The McNemar test was utilized to compare the results. The cut-off level used for NMP-22 was 10 U/ml. ROC curves were plotted to determine the NMP-22 values for optimal sensitivity and specificity in our seires.Two patients were excluded from the study. The overall sensitivity was 76.47% for cytology, 78.43% for the BTA stat test and 84.31% for NMP-22 (p = n.s.). The specificity was 91.49%, 87.23% and 87.23% respectively (p = n.s.). By grade and stage, NMP-22 showed the best results followed by the BTA stat test and lastly cytology, although the differences were not significant. The ideal cut-off for NMP-22 in our series was 6 U/ml and not the generally recognized 10 U/ml.NMP-22 is superior to the BTA stat test and cytology in the diagnosis of bladder cancer, although the differences were not significant. The ideal cut-off in our series was 6 U/ml. The BTA stat test has the advantage of being easy to perform and provides the results in 5 minutes. In our view, NMP-22 and BTA stat test can replace cytology in the diagnosis of bladder cancer.

Bellini Collecting Duct carcinoma is a rare and aggresive histological variety of renal adenocarcinoma which originates from the epithelium of the collecting tubule, with a well established histological, cytogenetic and inmunohistochemic characterization. It allows us to differenciate this tumor type from the rest of renal adenocarcinomas. There are 7 cases already published in the national literature. We introduce a new case with a particularity that is to show an unusual presentation form. It appears clinically without a specific urological symptomatology and radiologically it present a retroperitoneal mass shape with explains the patient's clinical manifestations.

To evaluate the utility of the BTA stat test in the follow-up of asymptomatic patients with superficial carcinoma of the bladder.In 122 asymptomatic patients on follow-up for superficial bladder carcinoma, a sample of recently voided urine was obtained prior to cystoscopy and BTA stat test and cytology were performed. Thereafter we performed cystoscopy and TUR in those patients suspected of having recurrent bladder carcinoma.51 patients had bladder cancer and 71 were tumor free. The sensitivity was 60.78% for the BTA stat test, 45% for cytology and 98% for cystoscopy. The specificity was 87.32%, 94.36% and 90.14%, respectively. The positive predictive value and negative predictive value were 77.5 and 75.6, 85.16 and 70.5, and 87.7 and 98.46, respectively for each test. The sensitivity by grade was 23% for G1, 71.4% for G2 and 92.8% for G3 for the BTA test versus 15.3%, 37.5% and 85.7% for cytology. The sensitivity by stage was 46.6% for Ta, 52% T1 and 100% for T2-4 and Tis for the BTA test versus 26.6%, 40% and 80% for cytology.The BTA stat test is superior to cytology in the follow-up of patients with bladder cancer. However, it has a low sensitivity in G1 and Ta and T1 tumors, therefore cystoscopy cannot be avoided.

To evaluate the efficacy of the Anderson-Hynes pyeloplasty in 47 patients with pelviureteric junction syndrome and to compare our results with the reported results for open surgery and other techniques.The records of 47 patients (21 males, 26 females) with pelviureteric junction syndrome treated at the Marqués de Valdecilla University Hospital from 1979-1997 were reviewed. Twenty-eight patients had right-sided involvement and two were bilateral. Mean age at the time of surgery was 35 years. Pain was the most common presenting feature (nephric colic, 28 pts; chronic lumbar pain, 11 pts).The Anderson-Hynes technique was performed in 43 of the 47 patients. IVP showed good results in 74.5%.In our experience the success rate achieved with the Anderson-Hynes technique is comparable to those reported elsewhere, which ranges from 65%-100%. Although currently there is considerably less experience with endoscopic and laparoscopic techniques, the results achieved to data appear to be similar to those of open surgery.

To analyze our results in the surgery of the stress urinary incontinence in women with the Raz's techniques, to assess the association among continence and factors like surgical technique, grade of incontinence and urethral pressure profile.We do a retrospective study of 88 operations in 81 patients between the first of January 1990 and the thirty-one of December 1998. We describe the patients, previous treatments, grade of incontinence ans urodynamics data. We analyze the pre and post-operative complications. The outcome is evaluated by the Kaplan-Meier method, and the results are compared by the log rank test.11 patients had a previous surgery and 7 had done physiotherapy; the grade of incontinence was 1 in 7 patients, 2 in 56 and 3 in 18. There were neither significative difference between UPP and abdominal leak point pressure and grade of incontinence nor between those parameters and continence. We did the Raz 1 technique in 67 patients, Raz 2 in 3, Raz 3 in 18. There were no significant difference among them. There are a progressive loose in the continence rate along the two first years; after that the continence rates are stabilized about 75%. The complications rate was scarce, except for the postoperative urinary retention, that reached the 20.45%.Our results are similar to those cited in the bibliography, mainly in the Spanish one. The highest rate of failure is in the two first years.

To carry out a revision of iatrogenic ureteral damage during open surgery occurred in our hospital over a 10-year period, to review the literature and to contrast the results.Between January 1987 and December 1996, 19 cases of iatrogenic ureteral damage were reported in 18 patients. Ureteral damage was the result of gynaecological surgery in 8 cases (42%), general surgery in 5 cases (26.5%), vascular surgery in 4 cases (21.1%) and urological surgery in 2 cases (10.5%). Four patients had been given radiotherapy. In 15 of the ureteral units involved, reconstructive open surgery was performed while the remaining 4 units received conservative therapy.In 11 cases of open surgery the results were good, 2 cases are nephrostomy carriers and 2 underwent nephrectomy. Conservative treatment was resolutive in all instances.Gynaecological and general surgery are the major causes of ureteral iatrogeny in our media. In more than half the cases, diagnosis is late. Radiotherapy was associated to late diagnosis in all cases. When diagnosed early, both surgical and conservative therapy achieve good results.

Analysis of early and late post-surgical complications in 44 cases of Studer's type bladder replacement due to carcinoma of the bladder performed over a 6-year period. Follow-up ranges between 6 months and 6 years. 4 patients died during the post-operative (9.09%): 1 myocardial infarction, 1 pulmonary embolism and 2 intestinal fistula. 28 patients (63.64%) had post-operative complications: 4 GI fistula (9.09%) 5 ileus (11.36%), 2 GI bleeding (4.54%), 1 ureteral fistula (2.27%), 1 ureteral stenosis, 6 urethro-intestinal fistula (13.36%), 1 tubular necrosis, 1 ruptured ureteral catheter, 5 wound infections (11.36%), 12 urine infections (27.27%), 6 sepsis (13.63%), 1 lymphocele, 1 evisceration and 2 eventrations. Repeat surgery was required in 6 cases. Within 6 months from discharge, 7 of 40 patients (17.5%) had some complication: 3 acute pyelonephritis, 4 episodes of acidosis-dehydration and 1 ureter stenosis. After 6 months, 7 of 38 patients (18.4%) had complications: 1 acidosis, 3 vesical lithiasis, 2 ureteral stenosis and 1 urethro-intestinal, plus 2 cases of chronic urinary retention. Daytime continence was 97.2% and nighttime continence 30%; after 6 months evolution, no further changes were seen.

To review our series of urethral diverticulum in the male, an uncommon condition whose etiology continues to be a subject of discussion. The clinical features, diagnostic methods and treatment are analyzed.A 10-year retrospective study was conducted at our hospital. The etiopathogenic factors, risk factors, presenting features, methods of diagnosis, treatment, postoperative and non-surgical complications (lithiasis, intradiverticular tumors...) were analyzed.Only six cases of diverticulum of the male urethra were found and were mainly of acquired origin. Recurrent infection was the most common clinical presentation. Patients were evaluated by voiding and retrograde cystourethrography. All patients underwent surgery. Postoperative control evaluation was performed by cystourethrography. The surgical complication rate was low.Diverticulum of the male urethra is an uncommon urological disease whose etiopathogenesis has as yet to be established, although it is accepted to be predominantly of acquired origin. Its clinical features are unspecific, for which reason it should be considered when making a diagnosis. Although transrectal ultrasound appears to be useful, diverticulum of the male urethra is usually diagnosed by conventional cystourethrography. Treatment is by endoscopic or open surgery, which achieves good results.

To review our series of urethral diverticulum in the female, an uncommon condition whose etiology continues to be a subject of discussion. The etiopathogenic hypotheses are briefly reviewed. The clinical features, current diagnostic methods and treatment are analyzed.A 10-year retrospective study was conducted at our hospital. The risk factors, presenting features and postoperative complications were analyzed.Only six cases of diverticulum of the female urethra were found. Recurrent infection and the presence of a palpable mass were the most common clinical features. Diagnosis was made by voiding and retrograde cystourethrography and urethroscopy. All patients underwent surgery. Postoperative control evaluation was performed by cystourethrography.Diverticulum of the female urethra is an uncommon urological disease which should be taken into account when making a diagnosis. Its etiopathogenesis has as yet to be established, although it is accepted to be predominantly of acquired origin and related with paraurethral gland pathology. Its clinical features are unspecific or it may cause florid urinary symptoms. Our patients were diagnosed by cystourethrography, although other diagnostic imaging techniques are currently available. Treatment is by surgery, which achieves good results and the complication rate is low.

The Bard BTA test is an immunochromatographic reaction to detect the bladder tumor antigen in patients with bladder cancer. The sensitivity, specificity and predictive values of this test are analyzed and compared with the standard methods of bladder cancer diagnosis (cystoscopy and cytology).In 120 patients with symptoms suggestive of bladder cancer or who came for follow-up control evaluation for bladder cancer, we performed the BTA test and cytology in a voided urine sample prior to cystoscopy. TUR and randomized biopsies were performed in patients with a suspicion of bladder cancer.76 patients had bladder cancer and 44 were free of cancer. The sensitivity was 76.36% for the BTA test, 61.84% for cytology and 98.5% for cystoscopy. The specificity was 77.7% for the BTA test, 86.36% for cytology and 86.36% for cystoscopy. The positive and negative predictive values were 85.29% and 65.38%, 88.68% and 56.72%, and 91.5% and 97.4%, respectively, for each of the foregoing tests. The sensitivity by grade was 43.75% for G1, 78.38% for G2, 95.65% for G3 for the BTA test; 18.75%, 59.46% and 95.65% for G1, G2 and G3, respectively, for cytology. The sensitivity by stage was 53.8% for Ta, 76% for T1, and 100% for T2-4 and Tis for the BTA test, whereas the sensitivity for cytology was 23.08%, 62% and 100%, respectively, for the foregoing tumor stages.The BTA test is simple, fast and useful in bladder cancer diagnosis. Our results show that the BTA test is superior to cytology.

To describe a case of tethered cord syndrome, with special reference to the diagnostic and therapeutic difficulties.A case of an adult patient with tethered cord syndrome after the complications post-TURP is described. The most relevant radiological and urodynamic features are presented.The tethered cord syndrome in the adult has a wide variety of symptoms. The age of onset depends on the level of cord involvement and the precipitationg factors. The urological symptoms are as varied as the urodynamic features, therefore each case must be treated independently. Treatment is a controversy; untethering offers little benefit to the patients. The incidence of the tethered cord syndrome in the adult may be higher than the reported incidence, particularly in patients with progressive and unexplained neurological, orthopedic or urological symptoms.

Nitric oxide (NO) is a gas considered to have two roles: cytoprotective, derived from its vasodilating and anti-platelet aggregation effects, and cytotoxic, due to its free oxygen radical. It is produced by NO synthase; nitrites and nitrates are its end products. We investigated the role of NO in ischemia-perfusion injury.For the study, we utilized dogs weighing 15 to 25 kg. Autotransplantation of the left kidney and right nephrectomy were performed. Group I comprised 9 dogs submitted to renal autotransplantation; group II comprised 6 dogs submitted to renal autotransplantation after 24 h cold ischemia; group III comprised 6 dogs submitted to renal autotransplantation after 24 h cold ischemia and subsequent warm ischemia of 30 min; group IV comprised 9 dogs submitted to renal autotransplantation after 24 h cold ischemia and 60 min warm ischemia.A significant fall in nitrite levels was observed in dogs that had some type of surgical injury. Nitrate levels increased significantly in dogs that had warm ischemia. At 30 min reperfusion, a significant increase in the production of constitutive enzyme was observed in all groups. A significant increase in inducible enzyme at 30 min reperfusion was observed in the first three groups and no inducible enzyme was produced in the group that had more injury from ischemia (group IV).Nitrites are markers of the injury produced by surgery. Nitrates clearly express the injury to the organs caused by warm ischemia-reperfusion. The cNOS enzyme increases after surgery in response to surgical insult or stress. The iNOS enzyme increases in the kidneys that have suffered ischemia and are viable. Non-viable kidneys express no enzymatic activity (cNOS, iNOS).

To analyze the characteristics of renal adenocarcinoma less than 3 cm in size and to determine the therapeutic approach in these tumors.286 cases with a histological diagnosis of renal adenocarcinoma that had undergone surgery at our hospital over the last 25 years were reviewed.The study showed 11 cases had renal tumors less than 3 cm in size. Six had been incidentally diagnosed. Two patients presented metastasis during the course of the disease and one patient had massive lymph node invasion (N3) at the time of diagnosis. Seven patients had a low tumor stage and grade.Renal tumors less than 3 cm in size have been considered to have a low potential for malignancy. However, the availability of more sophisticated diagnostic imaging techniques have led to earlier detection of renal masses, when the tumor is of a smaller size. Therefore determining whether the tumor is benign or malignant should be based exclusively on the histopathological findings. Treatment of this type of lesions is by surgery and performing a partial nephrectomy should be considered.

Fürhman's nuclear grading was used to compare the prognostic value of nuclear morphometry (represented by the nuclear area) in 95 renal adenocarcinomas treated by radical nephrectomy with a 11 to 25 years follow-up. The morphometric study was conducted by measuring 100 randomly selected nuclei, with a x1000 MOP-Videoplan morphometer and a light chamber adapted to a microscope. Based on the nuclear area, 2 prognostic groups were made up, one for area values below 35 microns2 and another one for areas over 35 microns2. The nuclear grade was reassigned in all cases according to Fürhman's rating, assembling G1-2s as low grade and G3-4s as high grade for statistical convenience. Staging was done using Tonson's classification; stage II was divided into III-A (venous involvement) and III B + C (presence of adenopathy). The survival analysis was included in the sample overall analysis and in each stage. Survival showed significant differences between groups with areas over and below 35, and between high and low grade. Only 2 cases in stage III B + C and none in stage IV had areas below 35. When comparing survival between under 35 and low grade cases, and between over 35 and high grade cases, no significant difference was obtained. It was therefore conclude that, although nuclear morphometry is a good prognostic factor in renal carcinoma, it contributes little to nuclear grading and it has the drawback of being too elaborate.

To analyze the main epidemiological, clinical and pathological features of cystic renal carcinoma in comparison with those of solid tumors. To determine the reliability of the preoperative diagnostic methods to distinguish these cysts from other cystic renal disease.The study comprised 286 carcinomas that had been treated over a period of 25 years. These cases were divided into two groups; 268 solid tumors and 18 cystic lesions. We analyzed patient age at onset, sex, tumor location and intrarenal status, clinical features, tumor size, cellular type, grade, stage and survival rate. In the group with cystic lesions, we analyzed the diagnostic methods used and the diagnosis made preoperatively.6.29% were cystic carcinomas. There were no differences between the solid and cystic lesions except for the slightly larger size of the latter (9.88 cm versus 8.01 cm). No significant differences were found for survival. The IVP and arteriograms only disclosed an expansive renal process suggestive of a neoplasm in 9 and 3 cases, respectively. Ten cases were evaluated by US and 13 by CT, which revealed a complicated cystic lesion. The fine needle punction aspiration biopsy, which was done in 3 cases, was negative. On the basis of the findings, a diagnosis of cystic carcinoma was made in 11 cases and multilocular cystic nephroma in 3 cases. The older cases that had been seen when US or CT were unavailable had been diagnosed as having renal carcinoma.Similar results, with special reference to the high rate of false negatives of the cytological study, have been reported in the literature.

To analyze the sensitivity and specificity of high resolution ultrasound in testicular tumors.The study comprised 18 histologically confirmed testicular tumors. Patient ages ranged from 19 to 79 years (mean 41). The ultrasound and the anatomopathological findings were compared.12 of 18 were primary testicular tumors: 5 classical seminomas, 1 spermatocytic seminoma, 1 anaplastic seminoma, 3 embryonary carcinoma, 1 mixed teratoma and 1 immature teratoma. Ultrasound detected all tumors, accounting for a sensitivity of 100%. All tumors were hypoechoic. Substantial differences were observed between the classical seminomas and the other tumor types: the echo structure was homogeneous in 60% of the classical seminomas vs 50% for the other tumor types; 80% of the former and none of the other tumor types had well- or partially well-defined tumor margins; and finally, cystic or hyperechoic areas were not observed in the classical seminomas but in 30% of the other tumors.High resolution ultrasound should be performed if testicular tumor is suspected. This technique will confirm or discard this condition and, furthermore, if the ultrasound findings show a solid, hypoechoic lesion, regardless of the degree of definition of the tumor margins, with no cystic or hyperechoic areas, a presumptive diagnosis of classical seminoma can be made.

A revision has been made of 286 renal adenocarcinoma treated in the Urology service at the Hospital marqués de Valdecilla, Santander, during the period from January 1970 through December 1994, dividing the study in two groups based on diagnosis being incidental or clinically suspected, and comparing the following parameters: 5-year intervals incidence, age, gender, intrarenal location, tumoral diameter, histology, nuclear grade, tumour stage and survival. The objective was to analyze the possible differences between renal cell neoplasias diagnosed based on clinical behaviour and those diagnosed incidentally over a 25 year period. Of the 286 renal adenocarcinomas, 217 (77.5%) were symptomatic at diagnosis, 63 (22.5% were found accidentally, while presentation in 6 cases is unknown. The percentage of incidental diagnosis increases gradually from 0% during the 1970-75 period to 44.2% from 1990 to 1994. No significant differences were found between incidental and clinical cases with regard to gender, age at presentation, affected side or intrarenal location of the tumours. The tumoral diameter of incidental cases was 6.74 +/- 3.31 cm, and 8.53 +/- 3.66 in the clinical ones, the difference being significant (p0.001). Nuclear grade is lower in incidental cases than in clinical ones, with a significant difference (p0.01). Asymptomatic tumours occur with higher proportion at low Robson stages, 60.3% stage I vs. 30.5% of symptomatic cases (p0.001). A comparison of survival shows the existence of significant differences (p0.001) between incidentalomas and clinical adenocarcinomas, the significance in this differences fading when both groups are compared based on the stage. Relative to suspected cases, incidental tumours present less size, lower nuclear grade, lower stage and better survival, all these differences being highly significant. No significant differences are seen in survival between incidentalomas and symptomatic ones when compared by stage at tumour presentation.

To analyze the incidence of tumoral satellite nodules in renal carcinoma, study the main features of the primary tumor and establish an approach to determine the risk of multicentricity.We analyzed 286 radical nephrectomies due to renal carcinoma. Twenty-nine cases (10.13%) that had intrarenal tumoral nodules were chosen; 5 cases (17.2%) had adenoma and 24(82.8%) had carcinoma. All but one case with von Hippel Lindau disease were sporadic tumors. The main features of the principal tumor (size, cellular type, architectural features, grade and stage) in both groups with and without nodules, were analyzed and compared.The mean diameter was 7.89 +/- 4.091 cm (range 3.5-20) for the tumor and 0.85 +/- 0.65 cm (range 0.1-3) for the nodule. The mean tumor diameter was not significantly different from that of the group with no nodules (mean tumor diameter 8.16 +/- 3.58, range 2-25). Ten cases had only 1 nodule (34.48%), 4 had 2 (13.79%), 2 had 3 (6.89%), 3 had 4 (10.34%) and 10 had 5 or more nodules (34.48%). The mean age was 56.89 +/- 11.46 (range 22-76); 24 were males (82.75%) and 5 females (17.14%); 14 cases were located in the right (28.27%) and 15 in the left side (51.72%). The foregoing data were not significantly different from those of the group with no nodules. Nineteen cases had clear cell, 5 granular, 4 mixed and 1 had the fusiform cell type. Seventeen cases were grade 2 (68%) and 8 cases grade 3 (32%); there were no G1 or G4. Ten were Robson stage I (34.48%), 2 were stage II (6.89%), 11 stage III (37.93%) and 6 stage IV (20.68%). Three cases had local recurrence (10.34%). No differences were observed for survival between the two groups. A 3 cm nodule was diagnosed preoperatively in only one case. Assuming the following criteria of a localized tumor, stage I, with a diameter less than 5 cm for performing elective nephron-sparing surgery, only 8 of the 43 cases that met the foregoing criteria had nodules (16.18%). Of these, 4 (2 of which were adenomas) had a single nodule (9.3%). If the criterion of low grade (G1-G2) tumor is also considered, only 5 of the 27 cases that met the foregoing additional criterion had nodules (14.7%).When nephron-sparing surgery is performed, it should be remembered that there is an approximately 10% risk of leaving tumor nodules of small size in the kidney which may cause local recurrence. Consequently, these patients should be followed very closely.

42 cases of penile carcinoma were retrospectively analyzed to determine the overall survival and the influence of treatment and inguinal lymph node metastasis on survival.The clinical records of 42 patients with penile carcinoma that had been treated at our hospital over a 17-year period were reviewed, with special reference to the epidemiological aspects, diagnosis, staging, treatment and overall survival.The overall 5 and 10-year survival were 73% and 43%, respectively. Inguinal dissection was performed in 24% of the patients. The overall survival was better in those with no lymph node involvement.Following local surgery of penile cancer, inguinal lymphadenectomy of palpable nodes is recommended to improve survival, if antibiotic treatment is not effective. Randomized and cooperative studies are necessary to assess the efficacy of prophylactic lymph node dissection and its influence on survival.

This is a comparative study of the various subtypes of renal carcinoma (divided according to their microscopic features in classic, papillary, Bellini's, sarcomatoid, chromophobe, small cells) on the 286 renal carcinomas removed in the Valdecilla Hospital over the last 25 years. For each type of presentation, age, gender, location, intrarenal status, tumoral diameter, clinical signs and symptoms, presence of metastasis, Fuhrman's core grade, Robson stage and survival, have been analyzed. No cases of small cells or chromophobe tumours were seen. Of the total 286 renal tumours, 253 (88.64%) showed a classical pattern, 21 (7.34%) were papillary, 10 (3.49%) sarcomatoid, and 2 (0.69%) Bellini's carcinomas. In the analysis by mean age at presentation, distribution by sex, involvement site and intrarenal location, no statistically significant differences were found between the different tumoral subtypes. In our series, the sarcomatoid type presents a larger average tumoral diameter than both the papillary and the classical ones (p0.01, p0.001, respectively). The most frequent clinical manifestation in all tumoral types was haematuria. The sarcomatoid tumours showed a statistically significant trend to present with higher core grade (G4) and higher tumoral stage (E IV) than papillary and classical tumours. Overall survival at 3 years was 72% for the papillary type, 65% for the classical and 22% for the sarcomatoid subtype, the latter being significantly worse than the first two (a0.001).

Presentation of our experience in the surgical treatment of urinary stress incontinence, with transvaginal colposuspension techniques, specifically those described by S. Raz and known as Raz I and Raz II. Over a 24-month period, 25 transvaginal colposuspensions (22 Raz I and 3 Raz II) were performed. The results achieved were 21 patients (84%) have recovered, while 4 (16%) remain incontinent, 3 of them referring improvement and 1 without improvement, after a follow-up of 12 to 36 months. With regard to complications, there has been 5 cases (20%) of postoperative retention, one vesical perforation while passing the needles, and a vesicle perforation during vaginal dissection of the retropubic space.

The results of the Studer enterocystoplasty technique is analyzed, with special reference to the early and late complications and urinary continence.We reviewed the records of 20 patients that underwent bladder substitution according to the Studer technique due to bladder carcinoma from 1990-1993. Patient follow-up ranged from 6-36 months. The ureteroileal anastomosis was done by the single stitch technique onto a tubularized ileal chimney.The median age was 57.2 +/- 11.86 yrs (range 33-73). The preoperative stay for intestinal preparation ranged from 1-29 days (median 4.4 +/- 5.84) and the postoperative stay ranged from 1-60 days (median 26 +/- 11.44). The average operating time was 5.30 +/- 0.7 hours (range 4.15-7). There were two postoperative deaths; one from acute myocardial infarction and the other from pulmonary embolism. Three patients died from tumor progression during follow-up and one from leg ischemia 17 months postoperatively. Early complications: 2 cases of prolonged ileus, 1 wound infection, 7 urinary infections, 1 low debit intestinal fistula which resolved with parenteral nutrition, 3 patients had leakage at the ileourethral anastomosis which resolved with prolonged catheter drainage of 3-15 days, 1 hemorrhage from acute lesions to the gastric mucosa, 3 fascial dehiscence and 1 ureteroileal fistula that required reimplantation into the neobladder. Late complications: 1 ureteroileal stenosis that progressed to renal atrophy, 1 enterourethral stenosis that resolved with internal urethrotomy and 2 cases of severe metabolic acidosis and dehydration that resolved with fluid therapy. No differences were observed between the creatinine, pH and ion levels preoperatively and during follow-up. Continence was assessed in 17 cases: 100% were continent during the day, 41.2% were continent during the night, 4 had occasional nocturnal leakage and 6 required collecting devices during the night.The Studer technique provides good results and quality of life to patients undergoing cystectomy. Although it carries a high morbidity, conservative management will suffice in a high percentage of cases.

Another case of adenocarcinoma of the rete testis is described and the literature on this uncommon tumor type reviewed.The clinical features, pathological findings and treatment of adenocarcinoma of the rete testis in a 72-year-old male are presented.Adenocarcinoma of the rete testis is a rare tumor type; few cases have been reported in the literature. Although treatment is primarily by surgery, recognition of new cases will provide further insight into this primary tumor of the rete testis.

This study reviews the clinical features, methods and treatment of renal trauma (RT).The epidemiological study was conducted using data from 340 cases of RT that had been treated in the Department of Urology of the Marqués de Valdecilla University Hospital in Santander. All the information was filed in a data base specifically for the purpose.Statistical analyses of the data showed the incidence of the symptoms, diagnosis and treatment of RT.Radiological and ultrasound evaluation are still fundamental for the diagnosis of RT. Only 4% of these patients have died. Abdominal, thoracic and cranial injuries cause the most severe lesions. Concerning treatment, only 17% of the cases with RT required surgery.