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Objectives: To report one case of collecting duct (Bellini) carcinoma and to review the national bibliography. To analyze the clinical, diagnostic, and therapeutic features of this malignant renal tumor., Methods/results: A 36-year-old male presenting with monosymptomatic hematuria and clot retention was diagnosed of left renal mass suggestive of renal carcinoma. Radical nephrectomy with interaortocaval lymphadenectomy through an "L" abdominal incision (inverted Makuuchi) and postoperative radiotherapy were carried out. The pathologic report showed a collecting duct (Bellini) carcinoma. The patient died 34 months after surgery, having been treated with two courses of chemotherapy and palliative vertebral radiotherapy., Conclusions: The collecting duct (Bellini) carcinoma is an infrequent malignant renal tumor. It does not differ from the clear cell adenocarcinoma either clinically or epidemiologically. However, it presents its own embryological, pathologic, immunohistochemical, and cytogenetic characteristics. Radical nephrectomy is the treatment of choice. Prognosis is ominous because of the aggressive behaviour and diagnosis in advanced stages.

Introduction: Since the description of the TVT technique as a therapy to stress urinary incontinence, in 1996, about 150000 subjects have undergone it. This technique was first used in our centre in november 1998. This article is aimed to contain our view of its evolution in the past three years., Materials and Methods: 142 patients of an average of 59 years old have been operated on. In 57% of the cases, we also focused on the solutions to anatomic pelvis disorders., Results: After a follow-up of 17 months and a mean of 14 months, 93% of the cases succeeded. Failures arose during the first six months of therapy. We found the following complications: 4.8% of bladder perforations, 17% of postoperative retentions of no longer than 30 days, 2% of long-term retentions, 2.7% of postsurgical hematomas, and 9% of urge incontinence. Surgery was performed on 10 patients who had undergone surgery against bladder incontinence before, and all the cases proved success., Conclusions: This technique is simple and only requires a short surgical time, and it can be applied for major ambulatory surgery. Although it is possible to encounter complications, they rarely occur and results are still encouraging. However, it is now necessary to verify that our long-term studies match with the success rates of 84.7%.

Scrotal leiomyoma is a benign rare tumour, asymptomatic, which origin is the dartos muscle and the election treatment is surgical. We report a new case in a 68-year-old patients with a 10 years history of a scrotal tumour and anatomopathological diagnostic post surgery was leiomyoma.

Objectives: To report a case of renal artery embolism. To review the clinical, diagnostic and therapeutic features of this disease interesting for the urologist., Methods/results: Case of a 47 year old male with history of cardiovascular disease who presents in the emergency room with left flank pain. Radiological studies (Intravenous pyelogram (IVP) and ultrasound) ruled out urinary tract obstruction and oriented to renal vascular disease. Arteriography was performed showing left renal artery embolism. Fibrinolytic therapy was successful., Conclusions: Renal artery embolism is an unusual non traumatic vascular urologic emergency. Generally, it appears in patients with emboligenous heart diseases, mainly auricular fibrillation associated with mitral stenosis. More than half the cases are asymptomatic; if they have symptoms, the most common presentation is sudden onset of intense flank pain, resistive to analgesia. Laboratory tests show hematuria, pyuria, proteinuria, leucocytosis, increased LDH, GOT and alkaline phosphatase, and variable renal function impairment. An ultrasound showing no signs of obstructive uropathy and absent function in the IVP lead to diagnosis. In the case of early diagnosis, intra-arterial fibinolysis is the treatment of choice, leaving surgery for cases where renal function is in danger. Main complications are vasculorenal hypertension and renal failure.

Objective: Literature review about arterial priapism cases secondary to bilateral postraumatic arterial-lacunar fistula, with special attention to therapeutic management by bilateral supraselective embolization., Methods: Bibliographic search using MEDLINE. A new case of high flow priapism secondary to bilateral postraumatic arterial-lacunar fistula is reported., Results: There are a total of ten cases of arterial priapism secondary to bilateral postraumatic arterial-lacunar fistula. Only one patient was treated by embolization in two steps with reabsorbable material; non reabsorbable material was used for embolization in three patients; in four cases embolization was performed as a single procedure and the remainder two cases resolved spontaneously. Erectile function was recovered independently of the therapeutic option performed., Conclusions: Embolization in two steps with reabsorbable material has been postulated as the treatment for arterial priapism secondary to bilateral postraumatic arterial-lacunar fistula or in cases of high flow status and drepanocytosis which do not resolve with other therapeutic measures. Nevertheless, if supraselective embolization is performed, it could not be mandatory to follow this therapeutic criteria, as it is suggested by erectile function results obtained.

Introduction: The first Surgery Ambulatory Unit was created in 1990, at the Hospital de Viladecans although in 1982 Polo et al. had commenced a programme of strictly ambulatory surgery. The Spanish Services of Urology are going to be incorporated to this new style of labour, and, by the moment, with excellent results., Material and Methods: We realize a description of the functioning of our service inside the Unit of Ambulatory Major Surgery, and a descriptive analysis of our activity in above mentioned unit since February 2000(creation date) to May 2001., Results: 118 patients were operated, being 15% women and 85% men. The most frequent surgery done were: hydrocelectomy, orchiopexy, varicocelectomy, vesical distensions, Nesbit technique and internal urethrotomy. From the whole of the patients, none was increased, and the complication tax was similar to the conventional surgery patients. This kind of surgery suppose 17% in 2000 and 19% in 2001 of the whole of surgery, with clear increasing tendency in the last months., Conclusions: The Ambulatory Major Surgery is an effective and efficient care pattern in which Urology Services are included, so that the degree of satisfaction of the patients and the quality offered is similar to the inpatient surgery.

Objective: To report a case of extrinsic ureteral obstruction arising from mucocele of the appendix and review the clinical, diagnostic and therapeutic aspects of this appendiceal pathology of interest in urology., Methods: A 71-year-old female patient that had previously undergone radical gynecological surgery and postoperative radiotherapy presented with right lumbar pain. Patient evaluation by ultrasound, IVP and CT showed a pelvic mass causing right extrinsic ureteral obstruction. Release and reinsertion of the right ureter and appendectomy were performed., Results: The anatomopathological study showed an appendiceal mucinous cystadenoma. The patient is asymptomatic after surgery., Conclusions: Appendiceal mucocele is a dilatation of the vermiform appendix due to collection of mucoid material that is frequently produced by a cystadenoma. The presenting feature is usually that of acute appendicitis. The definitive diagnosis is based on the anatomopathological findings. Treatment is by appendectomy for the benign tumors and by right hemicolectomy in a second stage procedure for malignant tumors. This appendiceal pathology should be taken into account in the differential diagnosis of right extrinsic ureteral obstruction.

Objective: To report an additional case of syringocele of Cowper's glands and briefly review its etiopathogenesis, diagnosis and treatment., Methods/results: A 26-year-old male consulted for a recent voiding syndrome and chronic postvoid dribbling. A voiding cystourethrogram demonstrated a syringocele, which was confirmed during endoscopic treatment., Conclusions: Syringocele or cystic dilatation of Cowper's gland duct usually has a congenital etiology. There are four morphological types: simple, perforated, imperforate and ruptured. Diagnosis is made by voiding cystourethrography and confirmed by endoscopy. Transperineal ultrasound was also utilized for the diagnosis. Treatment is by endoscopic incision.

Benign bladder tumors of mesenchymal origin have a very low appearance incidence, being the most frequent the leiomyoma. We report new case, making a discussion about the complementary tests needed for the diagnose.

Basis: To evaluate the complications on patients undergoing radical cystectomy with Camey II ileal orthotopic neobladder., Methods: To review our series of 61 radical cystectomies performed between 1990 and 1999 for bladder cancer. The complications were divided in early (30 days or less) and late., Results: A patient died at the immediate postoperative. It appeared 35 early complications on 30 patients: 8 related with neobladder (urinary fistula and urinary infection) and 27 not related, being the most frequent those appearing at bowel site, with 10 early surgeries (16.4%). After evaluating 55 patients for late complications, 39 presented some kind of complication: 38 related with neobladder and 13 not related, 30 patients underwent surgery, being 19 of them under endoscopic way. 74.4% of continents by day and 31.4% at night., Conclusions: Despite the acceptable functional results, the orthotopic bladder substitution presents a not comptemtible rate of complications. In other way, a lack of standard criteria make difficult the comparation with other series and types of bladder substitution.

Introduction: The postoperative spindle cell nodule of the urinary tract is a being proliferative lesion similar to sarcoma in the microscopic exam. We present a case of modulein renal pelvis location., Case: A woman presenting a stag horn lithiasis in left kidney was treated by LOC and percutaneous nephroscopy. Because of the large size of the stone a second intervention was required four weeks later. Then we discovered a 2 cm exophytic lesion in renal pelvis and removed it easily with a forceps., Discussion: This kind lesion belong to the group of iatrogenic inflammatory pseudotumours, which are secondary to an injury that leads to a tissular repairing response. Differential diagnostic includes sarcomas., Conclusion: It is important that Urology and pathology specialist think of this tumour in patients having a recent surgical intervention. A mistake in the diagnosis would lead us to an unnecessary radical surgery.

Objective: To report a case of retroperitoneal bronchogenic cyst, an anomaly during the development of the primitive anterior intestine from which the bronchi and lungs are developed., Methods/results: A 38-year-old male presented with left lumbar pain. Patient evaluation disclosed a left adrenal polycystic mass which was removed by surgery. Pathological analysis of the surgical specimen demonstrated a bronchogenic cyst. This case is compared with some of the few cases reported in the literature., Conclusions: Retroperitoneal bronchogenic cyst is a cause of retroperitoneal tumors in the splenic or hepato-renal region. Although it is uncommon, it should be taken into account when making the differential diagnosis.

The inverted papilloma is a rare urothelial tumor, and its localization at the prosthatic urethra is also exceptional. We present a case of inverted papilloma of the prostatic urethra in a 72 years-old male, with symptoms of urinary flow obstruction. The diagnose is obtained after urethrocistoscopy and transurethral resection at the same time. We discuss about the etiology, clinical presentation, diagnose and treatment of this rare tumor, making special attention to its malignancy ability.

Objectives: To describe the tension-free vaginal tape procedure (TVT) for treatment of female stress urinary incontinence and the short-term results., Methods/results: From November 1998 to May 1999, the TVT procedure was performed in 20 patients with genuine stress urinary incontinence. All patients had a bladder catheter for 24 hours after surgery. Only one patient required intermittent catheterization for one month due to high quantities of post-void residual urine. There were no intraoperative complications. Early postoperatively one patient presented a hematoma in the posterior rectal aspect which was managed conservatively. At 4.5 months mean follow-up, 95% of the patients are continent and one is incontinent due to incorrect positioning of the prolene band., Conclusions: Although the initial results appear to be encouraging, further studies are warranted to determine the long-term efficacy of this technique.

Objective: To review the literature on high flow priapism in children and analyze the etiology, pathophysiological mechanism, diagnostic tests, treatment and complications., Methods: The literature is reviewed and an additional case of posttraumatic arterial priapism in an 11 year-old boy treated at our hospital is presented., Results: 24 cases of high flow priapism in children were found; 18 had a history of genitoperineal trauma, 5 had sickle cell anemia and one child had Fabry's disease. Diagnosis was based on patient history, intracavernous blood gases and echo doppler findings. Fourteen patients with posttraumatic priapism, one patient with sickle cell anemia and the child with Fabry's disease were treated by pudendal arteriography with embolization. The immediate results and erectile function were good., Conclusions: Genitoperineal trauma is the most common cause of arterial priapism in children. High flow must be considered in children with sickle cell disease and priapism that do not respond to conventional treatment. Pudendal arteriography with embolization is the treatment of choice. Erectile function is recovered after treatment.