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Evidence of the effectiveness of rehabilitation interventions in spinocerebellar ataxia is scarce and variable. OBJECTIVES: The aim of this systematic review was to gather the existing evidence on the effectiveness of these interventions. MATERIAL AND METHODS: To do this, we analysed all the clinical trials published to date and assessed their results in terms of improved balance, gait, and performance of daily activities after treatment. Significant improvements were found for posture (P<.008) and gait (P<.02), as well as a reduction in the scores for the SARAg&p subscale (gait and posture) and SCAFI 8MW index (gait speed) (P=.02). We also observed improvements in speech disorders (P=.02), depressive symptoms (P<.0001) and accidental falls (P<.005)., (Copyright © 2020 Sociedad Española de Rehabilitación y Medicina Física. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Diabetes and cardiovascular disease are risk factors for erectile dysfunction (ED). Selective inhibitors of the type 5 phosphodiesterase are the first option for treating ED. However, it is unknown why there are patients with low response to this treatment. Polymorphisms in the PDE5A gene may influence the response to PDE5 inhibitors treatment., Aim: The aim of this study is to analyze the relationship between PDE5A polymorphisms, diabetes, and the efficacy of sildenafil treatment., Methods: A Spanish prospective cohort of 170 Caucasian male patients diagnosed with ED and ischemic heart disease treated with angioplasty was studied., Main Outcome Measures: ED was evaluated according to the 5-item version of the International Index for Erectile Function before and after treatment with sildenafil 50 mg. The gene sequence of the PDE5A gene was analyzed for the presence of rs12646525 and rs3806808 polymorphisms. Glucose and glycosylated hemoglobin levels were measured in blood serum samples. The relationship between treatment response, genotype, and glycemic status was analyzed., Results: Patients with G-allele of rs3806808 polymorphism showed a worse response to the treatment compared to TT-homozygote patients. Nondiabetic G-allele carriers showed a worse treatment response than TT-homozygotes patients. These differences were not seen in diabetic patients. There were no significant differences in treatment response according to the rs12646525 polymorphism in total population or according to the glycemic status. Logistic regression analysis showed that nondiabetic carriers of the major allele of both the rs12646525 and rs3806808 polymorphism had a significantly higher likelihood to respond to the treatment than diabetic patients carriers of the minor allele (P < .05)., Conclusion: The response to sildenafil treatment depends on polymorphisms in the PDE5A gene and the glycemic status of the patients., (Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Testicular epidermoid cyst is a rare clinical entity that accounts for 1% of testicular neoplasias., Methods and Results: We report two cases of testicular epidermoid cysts in a 18 and 19 year old males with a painless testicular lesion. Testicular US was carried out showing a hypoechoic nodule in both cases. With the suspicion of testicular neoplasm inguinal orchiectomy was carried out with placement of testicular prostheses in the same act. The pathology report was testicular epidermoid cyst in both cases., Conclusions: Testicular epidermoid cysts are an uncommon benign entity. When there is a suspicion of this diagnosis, based on tumor markers and ultrasound or MRI images, testicular parenchyma-sparing surgery must be attempted.

Objective: To report a case of GIST type retroperitoneal tumor with spontaneous rupture to the abdominal cavity causing acute abdomen secondary to hemoperitoneum., Methods/results: We report the case of an 84 year-old man with history of BPH and chronic atrial fibrillation. He presented to the Emergency Department with diffuse abdominal pain, syncope and accompanying vegetative symptoms. Diagnostic work up showed a 19 cm retroperitoneal mass dependent of the left kidney with active bleeding and secondary hemoperitoneum. Left radical nephrectomy was performed with pathology report of gastrointestinal stromal tumor attached to the renal capsule., Conclusions: Spontaneous hemoperitoneum is a rare entity and it has various etiologies. It is rarely described in retroperitoneal tumors.

We report a case of a rare congenital malformation, a urogenital sinus cyst in a young patient with non-specific symptoms for several months. A 21-year-old male presented with vague and intermittent abdominal pain. Ultrasound scan showed a retrovesical hypoechoic collection (approximately 6 cm) and left renal agenesis, compatible with a possible congenital malformation. These findings were confirmed by MRI. A laparoscopic excision of the cyst was performed with no complications. Pathology report confirmed a urogenital sinus cyst. The postoperative recovery was uneventful and the patient was discharged within 48 h. Urogenital sinus cysts are rare entities with few cases described in the literature. Imaging techniques such as ultrasound, CT or MRI may help with diagnosis. Therapeutic modalities range from observation to needle aspiration or surgical removal. In our case, we chose a laparoscopic approach to minimize morbidity and achieve an early recovery.

Objective: To describe one case of syringocele in an adult patient., Methods/results: We report the case of a 26 year old man who presented frequency, hematuria and fever during one year, mictional cystourethrography showed a syringocele. Treatment consisted in endoscopic surgery, with good results in the follow-up., Conclusions: The syringocele is a relatively infrequent entity, that is necessary to study in a young patient with voiding symptoms, accompanied or not of haematuria and fever. The diagnosis is based on the cystourethrography, and treatment consisted, usually, in endoscopic surgery.

Introduction: In 1996 we made a rate frequency analysis of attended pathologies in extern office. Along these years, we have made different actuations about some pathologies like HBP and vasectomy., Objectives: To know the results of these measures after 6 years, in 2002., Material and Methods: Different pathologies frequency is analyzed in extern office of Urology in 2002 and the results are compared with those we got before making the remake of the action about the mentioned cases., Results: The remake in the treatment of the vasectomy and HBP let us to have a 15% and 1.2% more of first visits in extern office respectively. While the first visits because of suspicion of prostatic cancer has been increased in 25%. Visits because of pathologies like hematuria, renal colic, cystitis and impotency have been increased importantly (56.4%, 51.9%, 61.1% and 17.8%)., Conclusions: The remake of actions on pathologies is a efficacious tool in the management of an Urology Area. Its analysis let us to value the benefits we have got and to detect new problems that appear.

Introduction: The prostate cancer is an important cause of men's mortality in our society., Purpose: To know the time of delay in to realise the surgical treatment of the prostate cancer., Materials and Methods: Analysis of 30 cases of patients treated with radical prostatectomy, cuantifying the time of delay in all the periods of the process., Results: Appointment in general practitioner-first appointment in urology: 21.7 days. First appointment in urology-biopsy: 22.8. Biopsy-diagnosis: 34.3. Diagnosis-appointment of anesthesiology: 28.5. Anesthesiology-radical prostatectomy: 25.7., Conclusions: There are actions for to reduce the delay in to perform the diagnosis or treatment, where we can act how an improvement plan: to give poblational education in general and information to the patient in particular, to analyze the rules of medical action, to improve the coordination between level, to improve the flexibility in outpatients appointment and time waiting for diagnosis test and treatment, to correct the temporality, to create clinical units of many specialties and to improve the politics of health.

Objectives: Delays in the diagnosis and treatment of bladder cancer may change survival rates (6). We present the application of a plan for quality control in the management of primary bladder cancer, studying delays globally, and for individual indicators, as well as the impact of implemented improvement measures., Methods: We performed a retrospective chart review to detect problems appeared through the whole clinical management process in a population of patients undergoing surgery for primary bladder cancer in the Hospital Costa del Sol during 2001. Causes were studied and corrective measures established, application of which has been evaluated during the first semester of 2002. Study indicators encompass from delay time for first visit to delay time for radical surgical treatment., Results: Excessive average global delays for radical treatment of bladder tumor (208.3 days), and variability in the time to transurethral resection (one to 73.42 days) and to postoperative revision (54.4 days), were the most significant results. Evaluation of implemented measures shows a descent in global delays (134.2 days) and time to postoperative revision variability (32.4 days)., Conclusions: Application of quality control procedures for clinical management is essential in daily clinical practice, for systematic, continuous, and rigorous evaluation will allow us to offer patients a product that satisfies their personal and social expectations.

Unilateral hydronephrosis can complicate a far from negligible number of patients with Crohn's disease. Bilateral hydronephrosis associated with Crohn's disease is a much more unusual entity. In the other hand, the treatment for this condition is still controversial. We present the case of a 44 year old female with several bowel obstruction episodes caused by ileocolic Crohn's disease. During the last episode she was also diagnosed of bilateral hydroureter and hydronephrosis. After the resolution of the bowel obstruction and the placement of a double J catheter in both ureters, the patient was operated. Ileocolic resection and bilateral ureterolysis with omental wrapping were performed. Although urinary and wound infection complicated the postoperative course, and a enterocutaneous fistula had to be medically treated one year later, the patient is now free of symptoms and her renal function is normal.

Unlabelled: The prostate cancer is one of the most frequent cancers in the male sex and its incidence is increasing progresively in a population that every time has a more increased age., Objective: To know the crude rate of prostate cancer in our population and if there is an increase., Material and Methods: Knowing the number of habitants under our assistance, we analyze the cases diagnosed of prostate cancer., Results: The crude rate of the incidence of prostate cancer in our medium is 28.7 cases/100.000 habitants/year and this increases progressively in 3 cases/100.000 habitants/year., Conclusions: There is an increase of the crude rate of the incidence of prostate cancer probably by the influence of the increase of the population's age and the generalization of the measure of PSA in simtomatic patients of prostatic disease.

Introduction: Considering that BPH is a highly common condition in the urological practice, that demographic changes further emphasise this feature and that the analysis of costs, funding and health care management are becoming increasingly under scrutiny, it is important to know the cost per procedure of the most commonly used therapeutical approaches and the impact of the complications on such cost., Objectives: 1. To know the cost per procedure of prostate TUR as PBH treatment. 2. To know the percentage of complications involved and the way in which they impinge on cost., Material and Method: Considering all data gathered from the annual surgical activity in our service with regard to this procedure and the percentage of complications after studying 105 cases over an evolution period of 6 to 50 months, the Planning and Management control Unit at the H.C.S. reported on the expenditure generated by this activity., Results: The cost per procedure in prostate TUR due to BPH in our environment is 191.030 pesetas at 1997 value. Morbidity affects 23% patients. Diagnosis and treatment of complications increases the overall cost by 7% thus reaching 205.096 pesetas., Conclusions: The knowledge of the above results provides important data on the expenditure generated by the activity of our Service for funding and management purposes. It also allows us to perceive therapeutical results as a measure of quality control, and to redefine those actions that will allow us to improve our results.

Epidermoid cysts os the testes have an incidence between 1-2% of total tumours in that organ. The embryonary origin of this benign neoplasia is unknown, although the most widely accepted theory is they are monodermal teratomas. Differential diagnosis with germinal cells is established through the characteristic dartboard-like ultrasound image, which allows testicular conservant surgery though only in the case of certainty about the lesion. Since that was not the case and given the ultrasound variability recorded in the literature, radical orchiectomy was performed to overcome the persistent doubt at staging the tumour's benignancy.

Meatal stricture is not an uncommon condition in the clinical practice, the classical treatment being meatotomy. The failure of the technique and the changes in the quality of the urinary stream have forced us to perform a meatoplasty procedure with pedicle flap from penial skin as described by Jordan, using intravenous local anaesthetics, thus avoiding hospitalization and reducing the overall cost of the procedure. From a total of 23 patients who (between May 1995 and April 1998) required surgery due to meatal stricture, 11 patients underwent meatoplasty and the rest meatotomy. None of the patients in the former group developed re-stenosis, and achieved a mean improvement of Q max in the flowmetry performed three months after the procedure of 23 mL/sg. vs the 10.5 mL/sg. of patients undergoing meatotomy. This difference is statistically significant at p = 0.02. Cost saving when surgery is conducted in the day hospital is 122,302 pts/procedure vs 215,182 pts/procedure if the patient had to remain in hospital for 3 or 7 days. Compared to the lower cost of meatotomy (39,308 pts/proc.) or meatoplasty (57,525 pts/proc.), it must be emphasised that the management of complications in the first case is 6,816 pts/patient vs 1,724 pts/patient required for cures in the case of Jordan's technique. It was concluded that pedicle flap meatoplasty is an efficient and definitive technique in the treatment of meatal stricture.

The high prevalence of Benign Prostate Hyperplasia and the increased demand for care of this condition, should compel us to plan for shared care models in parallel to Primary Care, in the way it has happened with entities such as HBP and Diabetes. The set of measurements to be adopted when sharing services with primary care is known as "shared care". This paper presents the first national experience of "shared care" with primary care in BPH. The project has consisted in a series of steps to increase awareness, train and make available for family physicians, a clinical practice guide defining the criteria for initial evaluation, medical treatment and referral of patients to Urology surgeries, including with the referral document the appropriate diagnostic tests. A Quality Commission has been created to study the level of compliance of the documentation used for referral to the specialist and the clinical histories of patients treated in primary care. The results obtained are significant and most studies carried out fulfill the requirements in 60% cases, which has allowed to reduce overcrowding in the Urology outpatient offices (4200 surgery visits saved/year in our environment), has provided easy access of patients to adequate diagnosis and treatment, as well as significant financial savings (30 million pesetas/year). In short "shared care" is a reality in our environment that allows a more effective, fast medical assistance and improved access to specialist care by reducing the demand of specialized surgery hours.

Metastatic involvement of the ureter due to renal parenchyma neoplasia has been reported in a total of 53 cases in the literature, the described mechanisms for tumoral spread being: haematogenic, lymphatic, canalicular and direct. Time to appearance of metastasis is far from prompting agreement among the authors in terms of its synchronous or metachronous nature. The most frequently reported symptoms are total and painless haematuria, and obstructive uropathy: CAT, percutaneous nephrostomy (for locally advanced disease) and endoscopy, are the most frequently used diagnostic tools. The only available therapy is nephrouretectomy for a diagnosis synchronous with the primitive tumour, and uretectomy for metachronous emergence. This paper reports on a case of sarcomatoid renal tumour with ipsilateral synchronous involvement of the ureter, which caused an obstructive uropathy treated by nephrouretectomy.

Introduction: The frequency of visits to an outpatients office is indicative of the proportion of population to be served at that location., Material and Method: Analysis of the frequency of new cases to an outpatients office over one year and correlation with the conditions treated over the corresponding period., Objectives: To know the overall frequency of new cases, by condition, affected organ and group of diseases. To know the percentage of surgical resolution of those conditions. To infer from these data the resources necessary in terms of offices, operating theatres and staff, Results: The outpatients office shows an overall frequency of new cases of 124/10000 people/year. The highest frequencies by condition, affected organ and group of diseases correspond to BPH, inguinoscrotal area and andrology. 35% of all new cases are managed surgically. 17.5% BPHs and 16.4% prostate carcinomas undergo surgery. The necessary resource are inferred to be: 1.5 ambulatory operating theatres/week, 2-2.5 central operating theatres/week. 5-6 office visits/week and 3 urologists., Conclusions: The study on the frequency of visits to the outpatients office is a useful tool for the organization and management of the Urology Service.

Background: The Urology Unit at the Costa del Sol Hospital works in coordination with the primary health care network using diagnostic and therapeutic protocols., Objectives: To know whether the system is effective based on the analysis of the quality of patient referral to Hospital according to the performance of family doctors., Material and Method: The referral document summarising the study conducted by the family doctor is analyzed. 578 correspond to conditions already coordinated and 269 to other situations not yet covered by the system., Results: For the coordinated conditions, 29% referrals are high quality and 45.9% are poor. For non-coordinated conditions however, 9.2% are high quality and 57.7% poor. The difference is statistically significant (p < 0.001)., Conclusions: Work in coordination with primary health care is feasible, effective and probably cost-efficient.

Objective: To report a case of spontaneous rupture of adrenal pheochromocytoma., Methods/results: A patient previously diagnosed as having arterial hypertension and chronic renal failure secondary to adult polycystic renal disease was admitted to the emergency services with abdominal pain, signs of peripheral vasoconstriction and syncope. A CT scan showed a large perirenal hematoma. The patient underwent an extended left radical nephrectomy and evacuation of the hematoma. The histopathological analysis showed a polycystic kidney and a ruptura adrenal pheochromocytoma. The clinical features, diagnosis and treatment of this condition are discussed.

Primary prostatic carcinoma accounts for 2% to 4.5% of all neoplasias to this organ, and it has been observed in 2.8% of all radical cystoprostatectomies performed in the Mayo clinic. It originates in the poorly differentiated reservoir cells of the prostatic periurethral ductus which explains why diagnosis is most often obtained in advanced stages (stromal involvement), thus limiting its management to radical surgery. This paper contributes one case report of a patient diagnosed by transrectal biopsy of a primary prostatic transitional carcinoma presenting with incoercible rectorrahges and urinary obstruction symptoms. Treatment was through pelvic exenteration, and urinary and gut by-pass.

Objectives: The study proposes the analysis of the influence of gross, microscopical and clinical pathoanatomical prognostic factors in the survival of patients with RCC through univariance and multivariance statistical analysis, and its global evaluation as a predictive model., Patients and Method: The study involved 218 RCC cases operated on over 20 years, with a mean follow-up of 60 months., Results and Conclusions: All prognostic factors studied have a significant influence on the survival. When studied jointly, they include separately and in order of significance the metastatic involvement, mitotic index, cava vein involvement, nuclear grade and sarcomatoid histologic pattern. Also, we confirm that considered jointly they conform a valid predictive model.

Polycystic disease of the adult is the most common presentation of renal cystic disease and is transmitted by dominant autosomic heredity. Development of renal cell carcinoma has been reported within this cystic disease, but the frequency of such coincidence is not higher than in the remaining population. Most of these tumours are found incidentally and may involve a diagnostic problem due to the marked distortion of the kidney's architecture produced by the polycystic disease of the adult.

Molluscum contagiosum is a skin lesion caused by a poxviridae virus. Infection in children takes place through cutaneous contact while in adults results from sexual contact or under immunosuppression conditions. In immunosuppressed patients this infection is caused by opportunistic microorganisms and, basically, its appears when CD4 levels reach a certain decline, therefore its presence can be considered as a marker for poor prognosis or advanced stage of the disease.

Fungal urinary infections are becoming increasingly frequent as a result of widespread use of broad spectrum antibiotics, an increased number of immunocompromised patients and the greater longevity of chronic patients. Urinary tract infections by Toruplosis glabrata only come second in frequency after those caused by Candida albicans, accounting for 5 to 25% of all infections caused by fungi. The paper presents one case of pyonephrosis by Toruplosis glabrata in a female patient treated with fluconazole who later underwent nephrectomy. A description is made of the clinical picture, diagnosis and treatment of these infections.

The p53 protein, of the core protein group, was initially considered an oncogene but it was later noted to be included in the group of tumour-suppressive genes, the function of which seems to be focused in the control of cell growth, regulation of DNA transcription, and inhibition of certain oncogenes. A mutant protein variety has been observed with longer than normal mean life and altered function, so that it is not effective for the inhibitory control of cell growth. Mutations of that protein's gene, located in the short arm of chromosome 17, have been discovered in a large variety of tumours in humans, and in the urogenital region they have been consistently seen in both vesical and prostate tumours. The objective of the study was to confirm the need of this gene mutation, so that the vesical transitional cell tumour develops an infiltrant nature. The presence of mutations in this gene's exons 5 and 8 in infiltrant transitional cell tumours (28.5% cases) was demonstrated using as controls either surface transitional cell tumours, non-transitional tumours and healthy vesical tissue obtained together with the tumour specimen in each surgical procedure. The methods used were PCR (polymerase chain reaction) and the identification of the mutated specimen through TGGE (temperature gradient electrophoresis). The absence of mutations in the control strips together with the observation of mutations in the specimens from infiltrant tumours confirms the above hypothesis.

Unlabelled: We report our motivation, technique, results and the current status of penile prosthesis implantation under local anesthesia at our institution. The lack of anesthetists to cope with the surgical demands and the conflicting views on the priority assigned to the different pathologies prompted us to seek an alternative approach., Technique: Anesthetic blockade with mepivacaine (2%) for the pudendal nerve branches (dorsal and perineal, in some cases; cavernous, in the first one) responsible for penile innervation, and anesthetic blockade of the genitofemoral and ilioinguinal nerves that innervate the scrotum and its contents. Of the five patients, 80% had excellent and 20% had good tolerance of the procedure. The definition of the foregoing categories are discussed herein. Currently, we have no waiting list or conflicts relative to treatment priorities. We reserve the technique for patients with anesthetic contraindications, as case number five.

Focal acute bacterial nephritis is an uncommon form of renal acute infection with a clinical presentation that, although similar to other acute infections of the renal parenchyma, must be taken into account in order to reach a correct differential diagnosis with other processes which have very similar radiological images but highly different management approaches, such as the renal carcinoma. This paper present one case in which the sings and symptoms were crucial to establish the diagnosis.

Hernia of the ureter is an uncommon condition and may classified into two types in relation to the peritoneum: extraperitoneal (without hernial sac) and paraperitoneal (with permeable peritoneum and redundant sac). This condition is generally asymptomatic and may be detected incidentally during urography or herniorrhaphy. We report on a case that had been detected during radiologic control evaluation of a left percutaneous nephrostomy prior to treatment with ESWL of a calculus in the ipsilateral lumbar ureter.

Percutaneous nephrostomy has emerged as a substitute for surgical nephrostomy. The complication rate is low, hematuria being one of the most common. Treatment should be conservative while possible since the clot plays an important role in the tamponade of hemorrhage. Arteriovenous fistulas following percutaneous nephrostomy are rare. Diagnosis is by arteriography and treatment is by selective embolization.

Metastatic lesions of the penis are uncommon, only some 200 cases having been reported in the literature. Priapism is the most frequent symptom, although increased penis size, ulceration and nodes formation have also been described; metastasis happens simultaneously in 20% cases while in 50% of cases they appear 2 years after initial diagnosis. Survival of untreated patients has not exceed 24 weeks, whereas treated patients have survived 47 weeks.

Lymphadenectomy is mandatory in vesical and prostatic tumours for a precise staging of candidates to radical surgery. Presentation of our series of 18 ilioobturative lymphadenectomies between May 1992 and February 1993, performed in 14 prostate carcinoma and 4 vesical tumours. As most interesting results, the average number of nodes removed, which was 8, and the discovery of nodular affectation in 5 cases, understaged by the non-invasive procedures, are highlighted; likewise, the reduction in surgery duration up to the current frame of 80 to 120 minutes must be emphasized. Mortality due to the procedure was null. We believe that laparoscopic lymphadenectomy should be the choice technique in the staging of tumoral dissemination in the ilioobturative domain.

During the '80s, laparoscopy in general has undergone an enormous boom as representative of minimally invasive surgery, urology standing out in that progression as the specialty leading the endoscopic approach both for the tradition and profusion of techniques developed. In Spain, major scope laparoscopic surgery started with lymphadenectomy in which we are the second Spanish and first Andalusian group to perform it. The experience accumulated by our group has allowed us to perform and present one case of laparoscopic nephrectomy, this being the first time in Andalusia and second in Spain that an Urology Unit develops this technique, the distinct feature being the presence of complete duplicity of the kidney. The procedure had no peri or post-operative complications and the patient was discharged four days later. We conclude that although presently the indications of renal exeresis for this procedure are limited, these will soon be expanded thanks to the urologists' concern, the accumulation of experience and the improvement of the instrumentarium.

Traditional management of vaginal fluid collections has always been surgery. The benignancy of this disease does not correspond with the morbidity caused by the anaesthetic techniques used. Over the last few years, sclerotherapy has become increasingly attractive as an alternative to hydrocelectomy. Indications are, nonetheless, restricted, presenting a relapse rate which varies according to the substance used and the operating team. The study proposes the use of local anaesthetics for the surgery of vaginal fluid collections so as to minimize the immediate postoperative period and thus the hospital stay. Between May and October 1991, 55 patients, 49 with hydrocele (4 bilateral) and 6 with sperm cord cyst, were treated in our Unit. Patients were monitored in the theatre (EKG, blood pressure and oximeter) to supervise their life constants, and 2% Mepivacaine (10-20 cc) was infiltrated into the sperm cord and the area of scrotal wall to be cut. Surgical techniques range from dissection to scission of the bag until partial eversion, requiring the use of reabsorbable suture and a careful haemostasis to avoid drainage. Anaesthetics tolerance has been highly satisfactory in 52 patients (94%), good in one patient (2%) and unsatisfactory in two cases (4%). Recorded complications include: severe bradycardia and hypotension in one case (2%), persistent right renoureteral pain in one case (2%), scrotal haematoma in 5 cases (9%) and suture dehiscence in another patient (2%). It is concluded that surgical management of vaginal collection with local anaesthetics is feasible, and reduces the immediate postoperative period also avoiding morbidity derived from a more aggressive anaesthetic technique.

The authors have experimented in the pig the possibility of endoscopic treatment of cryptorchidism. Sixteen orchidopexy procedures were performed utilizing 12 Large White pigs weighing 10 to 15 kg. The procedure is described herin, including some details of anesthetic induction. The animal is placed in the Trendelenburg position and three trocars are inserted, in a position which corresponds to that of the umbilicus in humans (through which a laparoscope is passed), in the hypogastrium and in the hypochondrium of the corresponding side. The spermatic vessels are dissected all the way up to their origin and the vas deferens up to a short distance from the bladder. Then an incision is made in the inguinal canal, from the epigastric vessels up to the conjoined tendon. Pressure is applied outside until the testis is introduced into the peritoneal cavity where it is released by sectioning the sustenaculum testis. The cord is then pulled and passed in front of the epigastric vessels and taken out through the deep orifice of the inguinal canal. Once it is free in the peritoneum and after the vessels and the vas have been dissected, it is brought to the bottom of the scrotum with the grasping forceps and the aid of the hand outside. Then it is fixed with a suture through the skin. Finally, the incision in the inguinal canal is sutured with atraumatic nylon 0 suture as in the McVay technique for inguinal hernia repair. The procedure has started to be employed in the clinical setting.

The dermatomyositis is a connective tissue disease characterized by changes affecting both the skin and the muscle, appearing most frequently around the fifth and sixth decades and which association to a vesical tumour is very rare. This paper contributes one case of paraneoplastic dermatomyositis associated to infiltrant vesical tumour, presenting erythematous damage in face, nape of the neck and upper thorax, as well as periorbital heliotrope erythema and fingernails base and sides telangiectasia, all of which are typical signs of dermatomyositis.

Renal traumatism is a relevant entity, its early and precise diagnosis having great weight in the initiation of appropriate treatment and its success. All 189 contained renal traumatisms seen in our service between 1981 and 1989, are studied. The purpose of the present work is to determine the diagnostic reliability of the different tests available, chiefly comparing echography versus urography, as well as CT. The method used is measurement of Sensitivity, Specificity and Predictive values, arranged by grades and compared using the squared-chi method (Fisher's exact test). Regarding the primary results we must emphasise the rejection of a void hypothesis in grades II and III with an error level lower than 0.01 for positive predictive values in echography vs. urography; as well as the high values of sensitivity and specificity of CT in high degree traumatisms. To conclude, those traumas where a complementary study is necessary urography may provide more information than echography; although in traumatisms where high degree lesions are suspected, CT will provided the most valuable information.

Our experience in the use of the double-J catheter in the prevention and treatment of urinary obstruction in stone disease is presented. This retrospective study spans the period January, 1985 to June 1989. Fifty-five double-J catheters were placed in 51 patients (catheter replacement was required in 4). Catheter placement was done antegradely in 17, retrogradely in 34 and intraoperatively in 4 cases. The indications were for treatment post-ESWL in 45 patients, stone remnants following percutaneous nephrolithotomy in 1, post-ureteroscopy in 2, and after open surgery in 2 patients. Complications were observed in 24% of the cases, hematuria being the most common complication. The foregoing agrees with the 20-40% complication rate reported in the literature. Thus, we can conclude that the double-J catheter is well-tolerated and is a simple yet useful endourologic tool in the prevention and treatment of urinary obstruction in stone disease.