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Resumen Objetivo Describir los tipos de protesis de pene y sus componentes, revisar el protocolo de adquisicion adecuado en resonancia magnetica (RM), describir los hallazgos de imagen normales y las posibles complicaciones en pacientes con protesis hidraulica de pene. Conclusion Las protesis hidraulicas tricompartimentales de pene son el ultimo eslabon en la cadena terapeutica de la disfuncion erectil. Pueden presentar complicaciones, que se clasifican en no infecciosas vinculadas a la tecnica quirurgica, infecciosas y por fallo mecanico del dispositivo. La RM es la tecnica de imagen mas adecuada en la evaluacion postquirurgica de las protesis de pene. Se realiza con secuencias de alta resolucion espacial con la protesis en reposo y en los tres planos del espacio, y se repite la adquisicion triplanar con la protesis activada.

Objective To describe the types of penile prostheses and their components, to review the appropriate magnetic resonance imaging (MRI) acquisition protocol, and to describe the normal imaging findings and possible complications in patients with inflatable penile implants. Conclusion Three-piece inflatable penile prostheses are the last link in the treatment chain for erectile dysfunction. They can develop complications, which are classified as non-infectious related to the surgical technique, infectious, or due to mechanical failure of the device. MRI is the most appropriate imaging technique for the postsurgical evaluation of penile prostheses. Images are acquired in three planes using sequences with high spatial resolution, first with the prosthesis at rest and then with the prosthesis activated.

Resumen Objetivo Estimar el riesgo de muerte cancer especifica (MCE) frente al riesgo competitivo de mortalidad por otras causas (MOC) en pacientes con cancer de prostata localizado (CaP-Lo) tratados mediante prostatectomia radical (PR). Material y metodo Estudio observacional de una cohorte de 982 pacientes con CaP-Lo tratados mediante PR seleccionados de la base de datos del registro de CaP de nuestro servicio. Se ha realizado un analisis de riesgos competitivos calculando la probabilidad de MCE en presencia del riesgo competitivo por MOC. Se han construido curvas de incidencia acumulada y se han llevado a cabo estimaciones puntuales a 5, 10 y 15 anos. El analisis se ha estratificado por edad (≤ 65 vs. > 65 anos) y por grupos de riesgo: bajo (Gleason ≤ 6 y pT2abc); intermedio (Gleason = 7 y pT2abc) y elevado (Gleason 8-10 o pT3ab). Resultados Con una mediana de seguimiento de 60 meses, la probabilidad global de fallecer por CaP fue del 3,5% y la de fallecer por otras causas del 9%. Se evidencio un efecto competitivo por MOC. El riesgo de MOC fue de casi 3 veces superior al de MCE. Este efecto se mantuvo para todos los grupos de riesgo, si bien su magnitud disminuyo progresivamente conforme aumento el nivel del grupo de riesgo. A 10 anos, la MCE fue unicamente de 0, 1 y 2% para los grupos de riesgo bajo, intermedio y elevado respectivamente, mientras que la probabilidad MOC fue de 4, 4 y 10%. El riesgo de fallecer se evidencio a partir de 10 anos de seguimiento y fue mas frecuente por otras causas no atribuibles al CaP y en pacientes de edad > 65 anos. Conclusiones El beneficio de la PR puede estar sobreestimado, ya que el riesgo de MOC es superior al de MCE independientemente del grupo de edad y grupo de riesgo, sobre todo a partir de los 10 anos de seguimiento. Lo unico que varia es la magnitud de la razon MCE/MOC. Esta informacion puede ayudar a decidir el tratamiento activo en pacientes con CaP-Lo y corta expectativa de vida.

Objective: To determine the risk of cancer-specific mortality (CSM) versus the competing risk of mortality by other causes (MOC) in patients with localised prostate cancer (LPC) treated with radical prostatectomy (RP). Material and method: An observational cohort study of 982 patients with LPC treated with RP selected from our department's PC registry database. A competing risk analysis was performed, calculating the probability of CSM in the presence of the competing risk of MOC. Cumulative incidence curves were constructed, and point estimates were performed at 5, 10 and 15 years. The analysis was stratified by age ( 65 years) and risk group: low (Gleason score

To describe the types of penile prostheses and their components, to review the appropriate magnetic resonance imaging (MRI) acquisition protocol, and to describe the normal imaging findings and possible complications in patients with inflatable penile implants.Three-piece inflatable penile prostheses are the last link in the treatment chain for erectile dysfunction. They can develop complications, which are classified as non-infectious related to the surgical technique, infectious, or due to mechanical failure of the device. MRI is the most appropriate imaging technique for the postsurgical evaluation of penile prostheses. Images are acquired in three planes using sequences with high spatial resolution, first with the prosthesis at rest and then with the prosthesis activated.

To determine the risk of cancer-specific mortality (CSM) versus the competing risk of mortality by other causes (MOC) in patients with localised prostate cancer (LPC) treated with radical prostatectomy (RP).An observational cohort study of 982 patients with LPC treated with RP selected from our department's PC registry database. A competing risk analysis was performed, calculating the probability of CSM in the presence of the competing risk of MOC. Cumulative incidence curves were constructed, and point estimates were performed at 5, 10 and 15 years. The analysis was stratified by age (≤65 vs.65 years) and risk group: low (Gleason score ≤6 and pT2abc); intermediate (Gleason score of 7 and pT2abc) and high (Gleason score of 8-10 or pT3ab).With a median follow-up of 60 months, the overall probability of dying from PC was 3.5%, and the probability of dying from other causes was 9%. A competing effect for MOC was observed. The risk of MOC was almost 3 times greater than that of CSM. This effect remained for all risk groups, although its magnitude decreased progressively according to the risk group level. At 10 years, CSM was only 0%, 1% and 2% for the low, intermediate and high-risk groups, respectively, while the likelihood of MOC was 4%, 4% and 10%, respectively. The mortality risk was shown after 10years of follow-up and was higher for other causes not attributable to PC and for patients older than 65years.The benefit of RP might be overestimated, given that the risk of MOC is greater than that of CSM, regardless of the age group and risk group, especially after 10years of follow-up. The only parameter that varied was the magnitude of the CSM/MOC ratio. This information could help in choosing the active treatment for patients with LPC and short life expectancies.

Introduction Immunosuppressive treatment promotes development of neoplasms in kidney transplant patients. Cancer prevalence in these patients is 4 to 5 times higher as compared to the general population. Tumors are also known to behave more aggressively in transplant patients. Objective To perform a descriptive analysis of de novo urological tumors in kidney transplant patients and to analyze patient survival. Materials and methods A retrospective study was conducted in 1751 transplant patients from January 1980 to December 2006. Patients in whom the tumor occurred in the first year after transplantation were excluded. The primary variables considered included sex, age at transplant, age at cancer diagnosis, site, clinical stage, treatment, and outcome. A Chi-square test was used for univariate statistical analysis. Survival was assessed using the Kaplan-Meier method. Results Twenty-nine de novo tumors (1.6%) were diagnosed in the 1751 transplanted patients, with a median follow-up of 35.28 months (2–121) from tumor diagnosis. Tumors were found in 24 males (82%) and 5 females (18%). Median age at transplantation was 50.8 (17–70) years, and median age at tumor diagnosis was 56.4 (19–79) years. Eleven patients (38%) were diagnosed with prostate cancer, seven (24%) with bladder tumors, 4 (60%) with non-muscle invasive tumors, and 3 (40%) with muscle invasive tumors. A renal adenocarcinoma in the primitive kidney was diagnosed in 6 patients (20%). Five patients (18%) were detected a tumor in the transplanted kidney. Median survival was 75 months for patients with bladder tumors, 82 months for prostate cancer, 59 months for tumors in the native kidney, and 86 months for graft tumors. Conclusions In our series, de novo urological tumors in kidney transplant recipients were more common in males. Prostate cancer is the most common tumor and renal cell carcinoma of the native kidney has the worst survival rate.

Immunosuppressive treatment promotes development of neoplasms in kidney transplant patients. Cancer prevalence in these patients is 4 to 5 times higher as compared to the general population. Tumors are also known to behave more aggressively in transplant patients.To perform a descriptive analysis of de novo urological tumors in kidney transplant patients and to analyze patient survival.A retrospective study was conducted in 1751 transplant patients from January 1980 to December 2006. Patients in whom the tumor occurred in the first year after transplantation were excluded. The primary variables considered included sex, age at transplant, age at cancer diagnosis, site, clinical stage, treatment, and outcome. A Chi-square test was used for univariate statistical analysis. Survival was assessed using the Kaplan-Meier method.Twenty-nine de novo tumors (1.6%) were diagnosed in the 1751 transplanted patients, with a median follow-up of 35.28 months (2-121) from tumor diagnosis. Tumors were found in 24 males (82%) and 5 females (18%). Median age at transplantation was 50.8 (17-70) years, and median age at tumor diagnosis was 56.4 (19-79) years. Eleven patients (38%) were diagnosed with prostate cancer, seven (24%) with bladder tumors, 4 (60%) with non-muscle invasive tumors, and 3 (40%) with muscle invasive tumors. A renal adenocarcinoma in the primitive kidney was diagnosed in 6 patients (20%). Five patients (18%) were detected a tumor in the transplanted kidney. Median survival was 75 months for patients with bladder tumors, 82 months for prostate cancer, 59 months for tumors in the native kidney, and 86 months for graft tumors.In our series, de novo urological tumors in kidney transplant recipients were more common in males. Prostate cancer is the most common tumor and renal cell carcinoma of the native kidney has the worst survival rate.

Introducción: el tratamiento inmunosupresor en pacientes que reciben un trasplante renal favorece el desarrollo de neoplasias. La prevalencia de neoplasias en trasplantados es de 4 a 5 veces mayor que en la población general. Además se sabe que los tumores en trasplantados se comportan con una mayor agresividad. Objetivo: evaluar mediante un análisis descriptivo las neoplasias de novo urológicas en pacientes trasplantados renales y analizar la supervivencia de los mismos. Material y métodos: estudio retrospectivo desde enero de 1980 hasta diciembre de 2006 sobre 1.751 pacientes trasplantados. Se excluyeron aquellos en los que la neoplasia apareció durante el primer año tras el trasplante. Se consideraron las principales variables: sexo, edad al trasplante, edad al diagnóstico de la neoplasia, localización, estadio clínico, tratamiento y evolución. Para el análisis estadístico univariante se utilizó la prueba de Chi cuadrado. La supervivencia fue evaluada mediante el método de Kaplan Meier. Resultados: se diagnosticaron 29 (1,6%) neoplasias de novo en un total de 1.751 trasplantados, con una mediana de seguimiento de 35,28 meses (2-121) desde el diagnóstico de la neoplasia. La distribución por sexos fue de 24 varones (82%) frente a 5 mujeres (18%). La mediana de edad en el momento del trasplante fue de 50,8 (17-70) años y la mediana de edad en el diagnóstico de neoplasia fue de 56,4 (19-79) años. Se diagnosticó a 11 pacientes (38%) de cáncer próstata, a 7 pacientes (24%) de neoplasias de vejiga a 4 (60%) no músculo invasivas y a tres (40%) de tumor músculo invasivo y en 6 pacientes (20%) se diagnosticó un adenocarcinoma renal sobre el riñón primitivo. En 5 sujetos (18%) se detectó una neoplasia del riñón trasplantado. La mediana de supervivencia fue de 75 meses para tumores de vejiga, 82 meses en el cáncer de próstata, 59 meses en el riñón primitivo y 86 meses para el riñón trasplantado. Conclusiones: en nuestra serie las neoplasias urológicas de novo en trasplantados renales son más frecuentes en varones. El cáncer de próstata es la neoplasia más frecuente y el adenocarcinoma renal del riñón primitivo es la de menor supervivencia.

Spinal cord ischemia is a circulatory disorder of acute or subacute establishment and neurological clinic of medullar section, usually incomplete. We describe clinical and anatomical characteristics, as well as diagnostic methods and therapeuthic used in these patients.Since 1987 to 2007, 65 patients were diagnosed of spinal cord ischemia in our hospital. Clinical interview, neurological examination and image study were performed. Urodynamic study was performed after medullar shock phase, including cystometry, pressure flow study and external urinary sphincter electromyography. We have reviewed treatment applied in these patients.65 patients (27 women and 38 men), median age 63 years (15-87). 28 patients (43%) presented high lesion (upper to T7), 32 (49%) middle (T7-L2) and 4 (6%) low lesion (below L2). Flaccid paraplegia and acute urinary retention were the most frequent clinical findings at the begining. Aetiology was determined mainly by Magnetic Resonance. Urodynamic study revealed: 9 patients (47.4%) with high spinal cord lesion and detrusor overactivity (with or without dyssynergia), and 6 (31.5%) with arreflexia; 11 patients (47.8%) with middle spinal cord lesion and detrusor overactivity and 7 patients with arreflexia (30.4%); one patient with low spinal cord lesion and detrusor overactivity, and another one with arreflexia (33%).There is a good correlation among lesion level and clinical findings in traumatic spinal cord injuries, but this is not the same in spinal cord ischemia. Probably, incomplete and patched lesions in vascular spinal cord injuries could explain this lack of correlation. Therefore, it is mandatory to performe an exhaustive neurological and urological evaluation of these patients in order to select the best treatment and prevent upper urinary tract damage in the future.

Resumen Introduccion Nuestro objetivo es describir las caracteristicas anatomoclinicas de los accidentes vasculomedulares, asi como los metodos diagnosticos y terapeuticos empleados. Material y Metodos Estudio retrospectivo desde 1982 hasta 2007, que incluye a 65 pacientes diagnosticados de AVM. Se realizo anamnesis general con exploracion neurologica completa y estudio diagnostico por imagen. La evaluacion urodinamica consistio en cistomanometria, estudio de presion flujo y electromiografia del esfinter externo tras la fase de shock medular. Resultados De los 65 pacientes (27 mujeres-38 hombres), con una mediana de edad de 63 anos (15-87 anos), 28 pacientes (43%) presentaron lesion alta (superior a T7), 32 (49%)lesion media (entre T7-L2) y 4 (6%) baja (inferior a L2). El debut clinico mas frecuente fue la paraplejia flaccida con retencion aguda de orina. La etiologia del AVM se determino mediante pruebas de imagen, principalmente Resonancia Magnetica. El estudio urodinamico mostro los siguientes resultados: lesion medular alta con hiperactividad vesical (asociando o no disinergia) 9 pacientes (47,4%) y 6 pacientes (31,5%) con arreflexia; lesion medular media con hiperactividad 11 pacientes (47,8%) y con arreflexia 7 pacientes (30,4%); lesion medular baja con hiperactividad un paciente (33%), arreflexia en otro (33%). Conclusiones No existe una clara correlacion entre el nivel anatomico lesionado y el comportamiento vesicoesfinteriano. Esto es debido a que las lesiones medulares de origen vascular suelen ser incompletas y parcheadas, afectandose diferentes niveles. Es necesario, por tanto, realizar una exhaustiva exploracion neurologica y urologica en estos pacientes, para poder establecer el patron funcional que nos permita indicar el tratamiento idoneo.

Resumen Se describe el caso de una mujer de 43 anos con sintomatologia de llenado y vaciado tras realizacion de histerectomia con estudio urodinamico compatible con obstruccion infravesical. Se diagnostico un hidrosalpinx izquierdo que fue tratado quirurgicamente tras el cual la paciente quedo asintomatica.

Testicular dislocation is an uncommon injury after blunt scrotal trauma (with only 150 cases reported) that must be properly diagnosed and treat in order to avoid a testicular atrophy. We presented a case report of traumatic dislocation of right testicle after a motorcycle accident. This type of testicular injury should be included in the whole evaluation of every polytrauma patient and usually requires a surgical treatment. The aim of this report is to clarify some aspects of the management of such rare entity.

Presentamos el caso clínico de un paciente politraumatizado, conductor de motocicleta, con dislocación testicular derecha. Se trata de una lesión infrecuente tras traumatismo contuso que requiere diagnóstico y tratamiento precoz con el fin de evitar la atrofia testicular. Esta lesión deberá tenerse en cuenta en toda evaluación del politraumatizado, requiriendo tratamiento quirúrgico. El objetivo del caso clínico es aportar un nuevo caso a la literatura, siendo este el sexto caso publicado por autores españoles, con el fin de clarificar el manejo y tratamiento.