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Resumen Introduccion La enfermedad de La Peyronie es un trastorno de la albuginea que condiciona incurvacion peneana, y que precisa correccion quirurgica cuando la deformidad dificulta la penetracion. Material y metodos Analisis retrospectivo de los resultados a corto plazo (longitud del pene, angulo de incurvacion y funcion erectil) del tratamiento de la enfermedad de La Peyronie en 10 pacientes mediante cavernoplastia con injerto de mucosa oral. En esencia, el tratamiento incluyo la incision de la placa fibrotica con bisturi electrico y el posterior recubrimiento del defecto cavernoso mediante un parche de mucosa oral. Al sexto mes medimos la longitud e incurvacion peneanas, y recogimos la funcion erectil mediante el cuestionario IIEF-5. Finalmente, se planteo a los pacientes la pregunta «?volveria a repetir la misma intervencion?». Resultados La edad media fue de 53,4 anos. El seguimiento promedio fue de 22,7 meses y la mediana de 24. La incurvacion media preoperatoria fue de 68,5° (50-90°); la longitud media del pene de 11,2 cm (9-15) y el IIEF-5 medio de 16,1 (8-25). La longitud peneana media postoperatoria fue de 10,7 cm y el IIEF-5 medio de 18,9. Las diferencias entre los registros pre- y postoperatorios no alcanzaron significacion estadistica (p = ns). Un paciente desarrollo disfuncion erectil. En todos los casos la incurvacion residual fue Conclusiones Los resultados a corto plazo senalan que la cavernoplastia con injerto de mucosa oral puede ser una alternativa a los injertos tradicionales para la correccion quirurgica de la enfermedad de La Peyronie.

Background Peyronie's disease is a disorder of the tunica albuginea and causes penile curvature, requiring surgical correction when the deformity impedes penetration. Material and methods Retrospective analysis of the short-term results (penile length, angle of curvature and erectile function) of treating Peyronie's disease in 10 patients through cavernoplasty with oral mucosa graft. Essentially, the treatment included the incision of the fibrotic plaque with electrical scalpel and the subsequent coating of the cavernous defect using a patch of oral mucosa. At month 6, we measured the penile length and curvature and recorded the erectile function using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Finally, the patients were asked “Would you undergo the same operation again?”. Results The mean age was 53.4 years. The average and median follow-up was 22.7 months and 24 months, respectively. The mean preoperative curvature was 68.5° (50°–90°), the mean penile length was 11.2 cm (9–15) and the mean IIEF-5 score was 16.1 (8–25). The mean postoperative penile length was 10.7 cm, and the mean IIEF-5 score was 18.9. The differences between the preoperative and postoperative values were not statistically significant ( p = ns). One patient developed erectile dysfunction. In all cases, the residual curvature was Conclusions The short-term results suggest that cavernoplasty with oral mucosa graft can be an alternative to traditional grafts for surgically correcting Peyronie's disease.

Resumen Introduccion La incurvacion peneana congenita (IPC) esta originada por una alteracion en el desarrollo embrionario de la uretra y los cuerpos cavernosos. Condiciona dificultad para la penetracion, precisando correccion quirurgica cuando imposibilita el coito. Material y metodos Presentamos 2 varones en la 4.a decada de la vida que presentan incurvacion ventral superior a 60° de 2 anos de evolucion con erecciones mantenidas. Los pacientes fueron sometidos a cirugia de rotacion de los cuerpos cavernosos. Tras la denudacion completa del pene se realiza la liberacion atermica del paquete vasculonorvioso del pene desde la cara ventral hasta la dorsal. Una vez evidenciada la incurvacion mediante una ereccion artificial se realiza una incision en la albuginea de ambos cuerpos cavernosos, suturando de forma continua con monofilamento reabsorbible ambos bordes internos y externos. Posteriormente se comprueba la rectificacion de la incurvacion y se reconstruye el plano mucocutaneo. Resultados El tiempo quirurgico fue de 120 min, no existiendo complicaciones intraoperatorias. Ambos pacientes fueron dados de alta a las 24 h de la intervencion. A la semana presentaban erecciones nocturnas espontaneas, pudiendo mantener relaciones sexuales al mes de la intervencion. A los 6 meses la incurvacion residual era inferior a 20°, el acortamiento peneano inferior al centimetro y el IIEF-5 de 25 en ambos casos. Conclusiones La cirugia de rotacion de los cuerpos cavernosos permite corregir la IPC sin acortamiento peneano significativo ni disfuncion erectil. En nuestra opinion constituye un tratamiento adecuado en pacientes con IPC, necesitandose estudios con seguimientos a largo plazo para considerarla la tecnica de eleccion.

Introduction Congenital penile curvature (CPC) is caused by a disorder in the embryonic development of the urethra and corpora cavernosa. The condition causes difficulty for penetration, requiring surgical correction when it prevents intercourse. Material and methods We present the cases of 2 men in their 40s who had ventral curvature greater than 60° of 2 years of evolution, with maintained erections. The patients underwent surgery for rotation of the corpora cavernosa. After the complete denudation of the penis, athermal release of the neurovascular bundle of the penis from the ventral side to the dorsal was performed. Once the curvature was verified using artificial erection, an incision was performed in the tunica albuginea of both corpora cavernosa, continuously suturing both internal and external margins with resorbable monofilament. The rectification of the curvature was then checked, and the mucocutaneous plane was reconstructed. Results The surgical time was 120 min and there were no intraoperative complications. Both patients were discharged 24 h after the surgery. At 1 week, the patients experienced spontaneous night-time erections and were able to maintain sexual relations 1 month after the surgery. At 6 months, the residual curvature was less than 20°, the penile shortening was less than 1 cm and the International Index of Erectile Function-5 was 25 for both cases. Conclusions Surgery for rotation of the corpora cavernosa helps correct CPC without significant penile shortening or erectile dysfunction. In our opinion, the procedure is an appropriate treatment for patients with CPC but requires studies with long-term follow-up in order to consider it the technique of choice.

El tratamiento médico, la litotricia y la ureteroscopia son opciones terapéuticas para el tratamiento de la litiasis ureteral. La ureteroscopia y la litotricia son altamente resolutivas, si bien no están exentas de riesgos quirúrgicos y anestésicos. El tratamiento médico expulsivo es menos efectivo pero carece de esos riesgos. La selección de enfermos para el tratamiento médico debe ser cuidadosa, atendiendo a factores como el tamaño, la composición y la localización de la litiasis. Objetivos: Analizar retrospectivamente el papel de las características litiásicas y de la medicación (alfabloqueantes, antiinflamatorios no esteroideos [AINE] o la combinación de ambos) como factores predictivos de la expulsión de cálculos ureterales. Material y métodos: Para el estudio se encontraron disponibles 278 litiasis ureterales correspondientes a 260 enfermos. La variable principal del estudio fue el «resultado clínico» (expulsión o persistencia de la litiasis). Se analizaron la influencia de la localización, el tamaño, la composición y la medicación administrada (alfabloqueantes, AINE o la combinación de ambos) con el test de la chi cuadrado. A continuación, se llevó a cabo un análisis multivariante con un modelo de regresión logística para estudiar la influencia de cada una de las variables en presencia del resto de las covariables. Resultados: Se produjo la expulsión del 34,2% de las litiasis. La localización (uréter pelviano, odds ratio [OR]= 1,823; p=0,02), el tamaño (

Peyronie's disease is a disorder of the tunica albuginea and causes penile curvature, requiring surgical correction when the deformity impedes penetration.Retrospective analysis of the short-term results (penile length, angle of curvature and erectile function) of treating Peyronie's disease in 10 patients through cavernoplasty with oral mucosa graft. Essentially, the treatment included the incision of the fibrotic plaque with electrical scalpel and the subsequent coating of the cavernous defect using a patch of oral mucosa. At month 6, we measured the penile length and curvature and recorded the erectile function using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Finally, the patients were asked "Would you undergo the same operation again?".The mean age was 53.4 years. The average and median follow-up was 22.7 months and 24 months, respectively. The mean preoperative curvature was 68.5° (50°-90°), the mean penile length was 11.2cm (9-15) and the mean IIEF-5 score was 16.1 (8-25). The mean postoperative penile length was 10.7cm, and the mean IIEF-5 score was 18.9. The differences between the preoperative and postoperative values were not statistically significant (P=ns). One patient developed erectile dysfunction. In all cases, the residual curvature was20°. Nine patients (90%) stated that they would undergo the same operation.The short-term results suggest that cavernoplasty with oral mucosa graft can be an alternative to traditional grafts for surgically correcting Peyronie's disease.

Congenital penile curvature (CPC) is caused by a disorder in the embryonic development of the urethra and corpora cavernosa. The condition causes difficulty for penetration, requiring surgical correction when it prevents intercourse.We present the cases of 2 men in their 40s who had ventral curvature greater than 60° of 2 years of evolution, with maintained erections. The patients underwent surgery for rotation of the corpora cavernosa. After the complete denudation of the penis, athermal release of the neurovascular bundle of the penis from the ventral side to the dorsal was performed. Once the curvature was verified using artificial erection, an incision was performed in the tunica albuginea of both corpora cavernosa, continuously suturing both internal and external margins with resorbable monofilament. The rectification of the curvature was then checked, and the mucocutaneous plane was reconstructed.The surgical time was 120minutes and there were no intraoperative complications. Both patients were discharged 24h after the surgery. At 1 week, the patients experienced spontaneous night-time erections and were able to maintain sexual relations 1 month after the surgery. At 6 months, the residual curvature was less than 20°, the penile shortening was less than 1 centimeter and the International Index of Erectile Function-5 was 25 for both cases.Surgery for rotation of the corpora cavernosa helps correct CPC without significant penile shortening or erectile dysfunction. In our opinion, the procedure is an appropriate treatment for patients with CPC but requires studies with long-term follow-up in order to consider it the technique of choice.

Ta bladder tumors constitute 53% of primary bladder neoplasms, 70% of them being low-grade (G1). These tumors present a 15- 38% chance of recurrence during the first year. The aim of this paper is to identify the predicting factors of the first recurrence in a series of TaG1 primary bladder tumors.We have retrospectively analyzed patients who were diagnosed with TaG1 primary bladder tumor by transurethral resection between 2004 and 2012. We established their tumor grade and pathological stage according to the WHO's classification guides for 1973 and 2004 as well as 2009's TNM. Those patients who were diagnosed before 2009 did not receive any adjuvant treatment. Those who were diagnosed later on received 40 mg of endovesical Mitomycin C during their immediate post operative period as their only treatment. We define recurrence as the presence of tumor after the first cystoscopy and relapse-free survival (RFS) as the period of time (in months) until the first recurrence appeared. Follow up constitutes the period of time (in months) until the last check-up or first recurrence. We also analyzed different variables: age, gender, smoking habits, muscular representation in the sample, size of the tumor (or1 cm), multiple or single tumors and adjuvant treatment. The survival analysis was performed by the Kaplan-Meier method, using the long-rank test to evaluate the differences between groups.68 patients were included in the study (73.5% men, 75% smokers). The average age was 61.9 years (the median being 58.5). Average follow up was 33.2 months (median 28.4). 35.3% of patients experienced recurrence. Average RFS was 19.2 ± 12.7 months (median 13.5). The majority of tumors were of a single nature (77.9%), with a size of less than 1 cm (55.9%) and with muscle representation (52.9%). 57.4% of patients did not receive adjuvant treatment. Only the absence of adjuvant treatment was associated with recurrence in uni and multivariate analysis (p0,001), with a relative risk of 17,5 IC95% (7,6-30,2).The absence of adjuvant therapy with Mitomycin C is the only factor that, in a statistically significant way, increases the risk of recurrence, regardless of demographic factors and the characteristics of the tumor.

Hypospadias is one of the most frequent male congenital anomalies. Its surgical correction is under permanent review and it is always controversial. The best surgical technique can only be chosen intraoperatively, since it is the level of corpus spongiosum division what marks the severity of the case, although it is essential to evaluate position of the meatus, penile curvature, quality of the preputial skin and penile size. It is recommended treatment age between 6-12 months. Nowadays, The most frequently used technique for hypospadias repair is the Snodgrass tubularized incised urethral plate (TIP). Moreover, distal and medial hypospadias may be treated with urethral advance or flap techniques and proximal hypospadias with modifications of these in one-step or two-step procedures. Nevertheless, there are other controversies about hypospadias, such as to preserve or not the prepuce, the use of central or peripheral anesthesia blockade, or the use of wound dressings.

Medical treatment, extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are therapeutic options for ureteral stones. EWSL and endoscopic treatment of ureteral stones have a high success rate. However it has surgical as well as anaesthetic risks. For many patients, a medicinal treatment without invasive procedures is an option. Watchful waiting does not always result in stone clearance and may be associated with recurrent renal colic. The study of the prognostic factors for expulsion and the medical therapy will help us to select candidates for medical expulsive treatment.To evaluate the characteristics of the stones and the medication administered (alpha blockers, NSAIDs or a combination of both) as predictors of spontaneous passage of the stone.A retrospective observational study of 260 patients with 278 ureteral stones was conducted. Primary endpoint was stone expulsion. Univariate and multivariate analysis were conducted testing the effect of stone location, size and composition, and medication (alpha-blockers, NSAIDs, or combination) on stone clearance.34,2% of the stones studied were spontaneously eliminated. Stone location (pelvic ureter, OR=1.823, p=0.013), size (5 mm, OR=3.37, p0.02), and medication (combination of alpha blockers and NSAIDs, OR=8.70,0.001) were predictors of spontaneous clearance. Multivariate analysis confirmed size (p=0.006) and medication (p0.001) as independent predictive factors.The use of the combination of NSAIDs and alpha-blockers versus observation multiplied times 8.21 (95%CI 3.37-20.01) the possibilities of spontaneous expulsion.Size of stone and medication were confirmed as independent factors for spontaneous expulsion of ureteral stones.

Objetivos: Crear una base de datos relacional orientada al seguimiento de la litiasis urinaria. Se presentan los detalles del diseño y los resultados iniciales de su explotación. Material y métodos: Se realiza base de datos desarrollada en el entorno de Microsoft Access® 2002, cuya información se ha distribuido en 4 tablas interrelacionadas: una tabla inicial donde se recogen los datos demográficos, una tabla de consulta, una tabla litiasis y una tabla procedimientos. Para la evaluación de la base de datos se realiza estudio observacional prospectivo desde mayo de 2004 hasta agosto de 2009 sobre 171 enfermos libres de litiasis tras tratamiento (médico, quirúrgico o LEOC), de un total de 511 introducidos en la base de datos. Se utilizó como variable indicadora la presencia o ausencia de recidiva litiasica. Se realizó análisis univariante para el estudio de la influencia de los factores demográficos (edad y sexo), aspectos relativos a la historia personal (antecedentes personales de litiasis o alteraciones de la vía urinaria) y características del cálculo (lateralidad, localización, tamaño y composición), mediante el test de la chi cuadrado, completándose con el cálculo de la probabilidad de recidiva litiásica en función del tiempo, mediante el método de Kaplan Meier. Posteriormente se realizó análisis multivariante mediante la regresión de Cox para estudiar la influencia cada una de las variables en presencia del resto de covariables. Resultados: Desde la puesta en marcha de la aplicación informática (septiembre de 2007), se han recogido datos de 702 consultas correspondientes a 511 enfermos. El análisis de los 171 enfermos disponibles para el análisis de supervivencia demostró una probabilidad de recidiva litiásica del 85,38% (146/171) con una mediana de tiempo a la recidiva de 608 días (rango 70-1.758). En el análisis univariante ningún factor estudiado resultó ser predictivo. El análisis multivariante tampoco confirmó ningún factor predictivo independiente para la recidiva litiásica. Conclusiones: La base de datos relacional es útil para el seguimiento de los enfermos con litiasis urinaria. Permite un control fácil y actualizado de los enfermos, así como un almacenamiento de datos para su posterior explotación. El estudio realizado para la evaluación de la misma no demostró influencia estadísticamente significativa de ninguno de los factores predictivos estudiados en la recidiva litiásica. Objectives: To create a relational database for monitoring lithiasic patients. We describe the architectural details and the initial results of the statistical analysis. Methods and materials: Microsoft Accesss® 2002 was used as template. Four different tables were constructed to gather demographic data (table 1), clinical and laboratory findings (table 2), stone features(table 3) and therapeutic approach (table 4). For a reliability analysis of the database the number of correctly stored data was gathered. To evaluate the performance of the database, a prospective analysis was conducted, from May 2004 to August 2009, on 171 stone free patients after treatment (EWSL, surgery or medical) from a total of 511 patients stored in the database. Lithiasic status (stone free or stone relapse) was used as primary end point, while demographic factors (age, gender), lithiasic history, upper urinary tract alterations and characteristics of the stone (side, location, composition and size) were considered as predictive factors. An univariate analysis was conducted initially by chi square test and supplemented by Kaplan Meier estimates for time to stone recurrence. A multiple Cox proportional hazards regression model was generated to jointly assess the prognostic value of the demographyc factors and the predictive value of stones characteristics. Results: For the reliability analysis 22,084 data were available corresponding to 702 consultations on 511 patients. Analysis of data showed a recurrence rate of 85.4% (146/171, median time to recurrence 608 days, range 70-1758). In the univariate and multivariate analysis, none of the factors under consideration had a significant effect on recurrence rate (p=ns). Conclusions: The relational database is useful for monitoring patients with urolithiasis. It allows easy control and update, as well as data storage for later use. The analysis conducted for its evaluation showed no influence of demographyc factors and stone features on stone recurrence.

Resumen Objetivos: Crear una base de datos relacional orientada al seguimiento de la litiasis urinaria. Se presentan los detalles del diseno y los resultados iniciales de su explotacion. Material y metodos Se realiza base de datos desarrollada en el entorno de Microsoft Access® 2002, cuya informacion se ha distribuido en 4 tablas interrelacionadas: una tabla inicial donde se recogen los datos demograficos, una tabla de consulta, una tabla litiasis y una tabla procedimientos. Para la evaluacion de la base de datos se realiza estudio observacional prospectivo desde mayo de 2004 hasta agosto de 2009 sobre 171 enfermos libres de litiasis tras tratamiento (medico, quirurgico o LEOC), de un total de 511 introducidos en la base de datos. Se utilizo como variable indicadora la presencia o ausencia de recidiva litiasica. Se realizo analisis univariante para el estudio de la influencia de los factores demograficos (edad y sexo), aspectos relativos a la historia personal (antecedentes personales de litiasis o alteraciones de la via urinaria) y caracteristicas del calculo (lateralidad, localizacion, tamano y composicion), mediante el test de la chi cuadrado, completandose con el calculo de la probabilidad de recidiva litiasica en funcion del tiempo, mediante el metodo de Kaplan Meier. Posteriormente se realizo analisis multivariante mediante la regresion de Cox para estudiar la influencia cada una de las variables en presencia del resto de covariables. Resultados Desde la puesta en marcha de la aplicacion informatica (septiembre de 2007), se han recogido datos de 702 consultas correspondientes a 511 enfermos. El analisis de los 171 enfermos disponibles para el analisis de supervivencia demostro una probabilidad de recidiva litiasica del 85,38% (146/171) con una mediana de tiempo a la recidiva de 608 dias (rango 70–1.758). En el analisis univariante ningun factor estudiado resulto ser predictivo. El analisis multivariante tampoco confirmo ningun factor predictivo independiente para la recidiva litiasica. Conclusiones La base de datos relacional es util para el seguimiento de los enfermos con litiasis urinaria. Permite un control facil y actualizado de los enfermos, asi como un almacenamiento de datos para su posterior explotacion. El estudio realizado para la evaluacion de la misma no demostro influencia estadisticamente significativa de ninguno de los factores predictivos estudiados en la recidiva litiasica.

El tratamiento médico, la litotricia y la ureteroscopia son opciones terapéuticas para el tratamiento de la litiasis ureteral. La ureteroscopia y la litotricia son altamente resolutivas, si bien no están exentas de riesgos quirúrgicos y anestésicos. El tratamiento médico expulsivo es menos efectivo pero carece de esos riesgos. La selección de enfermos para el tratamiento médico debe ser cuidadosa, atendiendo a factores como el tamaño, la composición y la localización de la litiasis. Objetivos: Analizar retrospectivamente el papel de las características litiásicas y de la medicación (alfabloqueantes, antiinflamatorios no esteroideos [AINE] o la combinación de ambos) como factores predictivos de la expulsión de cálculos ureterales. Material y métodos: Para el estudio se encontraron disponibles 278 litiasis ureterales correspondientes a 260 enfermos. La variable principal del estudio fue el «resultado clínico» (expulsión o persistencia de la litiasis). Se analizaron la influencia de la localización, el tamaño, la composición y la medicación administrada (alfabloqueantes, AINE o la combinación de ambos) con el test de la chi cuadrado. A continuación, se llevó a cabo un análisis multivariante con un modelo de regresión logística para estudiar la influencia de cada una de las variables en presencia del resto de las covariables. Resultados: Se produjo la expulsión del 34,2% de las litiasis. La localización (uréter pelviano, odds ratio [OR]= 1,823; p=0,02), el tamaño (

To analyze the prevalence of neoplasms in renal transplant patients and the relative risk for each tumor type according to the immunosuppression regimen.609 renal transplants were reviewed. The risk index was determined by the ratio of the cases observed and predicted.Tumor prevalence was 4.9% (30/609); 6.3% (25/393) were males and 2.3% (5/216) were females. The most common tumors were cutaneous tumors other than melanoma, accounting for 2.4% (15/609), followed by Kaposi's sarcoma, pulmonary epidermoid carcinoma and genitourinary tumors (0.5%) and non-Hodgkin lymphoma (0.3%). Tumor prevalence was 6.8% for the group treated with azathioprine-prednisone and 3.9% for the cyclosporine A-prednisone-treated group. The estimated relative risk of having a neoplasm was 10-fold higher for the males and 4.2-fold higher for the females vs the general population. The mortality rate was 36.6%; specifically tumor-related in 82%. The mortality rate for those with solid tumors was 77.7%. The long-term survival rate for the group that developed a tumor was significantly lower than that of the general population, 75% vs 53%, respectively (p0.05).In this series no significant differences were observed relative to tumor prevalence or type according to the immunosuppression regimen. A recipient of a renal graft has a higher risk of developing a tumor. Cutaneous tumors were the most frequent. The long-term survival is lower for recipients of renal grafts who develop a tumor.

Verrucous carcinoma of the penis accounts for 5-17.8% of total carcinomas in the referred location that are diagnosed in our environment. Six cases of this rare neoplasia have been treated in our service and revised retrospectively. The epidemiological, clinical, diagnostic and therapeutic aspects of our series are analyzed and the issues around them discussed. Eventually, the benign biological behaviour of this tumour warranting conservative surgical treatment is ratified. In selected cases where the therapeutic modalities used do not yield material for histopathological analysis (laser, cryotherapy, etc.) prior obtention of a deep biopsy of the lesion to identify the likely presence of a well differentiated epidermoid carcinoma is imperative. Also, every effort should be made to monitor the cases of associated premalignant conditions.

Urological complications in renal transplantation occasionally denote the failure of a technique intended to provide the patient on hemodialysis a significant improvement of quality of life. Our experience in the management of these complicated cases which could not be resolved by conventional measures is described.Since the transplantation program began, our department has performed 530 renal transplants. There have been 40 fistulae (7.5%) and 23 stenoses (4.3%) of graft urinary tract. All the foregoing complications had been treated by endourological procedures (nephrostomy or ureteral stent) and/or simple ureteral reinsertion. There were 5 unresolved or recurrent fistulae (0.9%) and 2 stenoses (0.4%) that were repaired using the recipient's ipsilateral urinary tract (6 pyeloureterostomies and 1 pyelopyelostomy).Good results were achieved in all of the cases with adequate urinary tract function.Urological complications following renal transplantation can be successfully treated by surgical correction (pyeloureterostomy or pyelopyelostomy).