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The cystographic study of patients who have undergone radiotherapy (RT) and pelvic surgeries is uncommon in the literature, not described in patients without complications, and mostly related to urinary fistulae.The study of the lower urinary tract (LUT) by cystography in these patients, with a description of some other types of radiation lesions.127 cystographies have been performed (88 men and 39 women) in consecutive patients undergoing radiotherapy (RT) (48 monotherapy and 79 cases combined with surgery), with a mean age of 69.6 years, and a mean time from radiation of 215 months (17 years). A General Electric X ray equipment has been used. We studied: behavior of the bladder neck at rest and during micturition, assessment of vesicoureteral reflux (VUR), bladder morphology (BM), urethral strictures (UE) and fistulas (F).We observed: Filling phase bladder neck incompetence (BNI) (37.8%), bladder smooth morphology (60.6%), coughing urinary incontinence (UI) (26.4%), basal cystocele (64.7%) and Valsalva cystocele (96.6%), a normal opening bladder neck (96,1%), reduction of the urethral diameter during voiding (41.3%), and vesicoureteral reflux (VUR) (13.2%). Five cases of filling BNI, were all related to prostate cancer (PC) (one of them with colon cancer as well). There were six cases of fistulae (4.14%), five of them women. Forty two patients (28.96%) had reduced urethral lumen, thirty five of them affecting the posterior urethra (83%), five (11.9%) the anterior and, finally, two cases of mixed lesion (5%). 95% were patients with PC without concurrent interventions (67%). Significant differences were found regarding the gender and the background of pelvic surgery. The filling BNI (p=0.007), the irregular bladder morphology (p=0.004) and the reduction of the urethral lumen (p0.001) have been found to be more common in male patients, while the coughing UI was more common in women (p=0.007). The study shows that BNI (p=0.046), VUR (p=0.02) and the IU due to cough (p=0.03) were more frequent in operated patients, while reduced urethral lumen was less common (p0.01). Patients with VUR present more time from radiotherapy, but not in other cystography variables. There was a relationship between RT and the BNI, stress urinary incontinence, anterior urethral stricture and VUR. The risk factor was increased by surgery.Bladder neck incompetence, stress UI, anterior urethral stricture and VUR have been related to radiotherapy. Surgery increased the risk factor in operated patients.

Objetivos. Estudiar las características y evolución de los tumores epidermoides de pene. Material y métodos. Se realizó un estudio retrospectivo sobre los tumores epidermoides de pene tratados en nuestro centro entre 1981 y 2005. Resultados. Se diagnosticaron 16 tumores epidermoides de pene. La edad media de los pacientes fue de 71,7 años (intervalo entre 54 y 90 años). En el 80% de los casos se diagnostican en estadios avanzados (T3 y T4). Las formas de presentación más habituales son las lesiones ulcerosas (53%) y papilares (33%), siendo el diámetro medio de la lesión de 2,3 cm, y la localización más frecuente el glande (53%) y el surco balano prepucial (33%). Se realizaron 7 escisiones locales, 8 penectomías parciales, una penectomía total, y una escisión más tratamiento local con 5-fluoracilo. Con una media de seguimiento de 24 meses se produjeron 5 recidivas, principalmente en pacientes sometidos a escisión local de la lesión (p = 0,06 test de log-rank). Conclusiones. El carcinoma epidermoide de pene es una lesión tumoral propia de edades avanzadas que se diagnostica tardíamente y se trata de manera poco agresiva, por lo que son frecuentes los estadios avanzados y las recidivas. Objetives. To study the characteristics and evolution of the epidermoid penis tumours. Material and methods. It was carried out a retrospective study on the epidermoid penis tumours treated in our center between 1981 and 2005. Results. 16 tumours penis epidermoides were diagnosed. The average age of the patients was of 71,7 years (interval between 54 and 90 years). In 80% of the cases they are diagnosed in advanced stadiums (T3 and T4). The most habitual presentation forms are the ulcerous lesions (53%) and papilar (33%). The average diameter of the lesion was 2,3 cm, and the most frequent localization the glands (53%) and balano prepucial (33%). They were carried out 7 local scissions, 8 partial penectomies, onetotal penectomy, and an local scission pluslocal treatment with 5-fluoracile. With a followup of 24 months 5 relapses took place, mainly in patients subjected to local excision of the lesion (p = 0,06 log-rank test). Conclusions. The epidermoid carcinoma of the penis is a tumoral lesion characteristic of advancedages that is diagnosed later and treated in not very aggressive way. Therefore it is frequent the advanced stadiums and the tumour relapses.

Se presenta un caso de leiomiosarcoma de escroto en un paciente de 87 años que debuta como una lesión en hemiescroto izquierdo indolora, y de un año de evolución. En el momento del diagnóstico se observa la presencia de metástasis óseas. Se realiza una revisión de la literatura comprobándose la rareza de este tipo de lesión (sólo se han descrito 27 casos), y que a diferencia de otro tipo de leiomiosarcomas, su evolución agresiva no es habitual en esta localización. A case of scrotum leiomyosarcoma is presented in a 87 year-old patient. It debuts as a painless lesion in left hemiescrotum, of one year of evolution. Bony metástasis were observed in the moment of the diagnosis. We carried out a literature revision proving the rarity of this lesion type (only 27 cases have been described), and that, contrary to another leiomiosarcomas type, their aggressive evolution is not habitual in this localization.

Introducción: La litroticia por ondas de choque (LEOC) es fundamental en el tratamiento de las litiasis. Sin embargo, existen evidencias de que puede producir daño renal. El objetivo de nuestro estudio es determinar el grado de afectación de la función glomerular y tubular tras LEOC, y si influye la localización litiásica en el tipo de daño renal. Material y métodos: Se realizó un estudio longitudinal prospectivo en 14 pacientes con función renal normal sometidos a LEOC. Se determinó el nivel basal, y a las 24 horas, al 4º y al 10º día post LEOC, de microalbuminuria (MA) (que valora la función glomerular), y de N-acetil glucosamida (NAG) y la alanina aminopeptidasa (AAP) (que valoran la función tubular). Resultados: Los niveles de basales de MA, NAG y AAP no mostraron diferencias significativas en relación con la localización de los cálculos. Se observó un aumento significativo de los tres parámetros sólo a las 24 horas post LEOC. No se observaron diferencias significativas en la variación de los niveles de microalbuminuria, AAP y NAG con el tratamiento en relación a la localización de los cálculos. Conclusiones: Existe un daño glomerular y tubular tras LEO. Este daño es independiente de la localización pélvica o calicial del cálculo. En pacientes con función renal normal previa, el daño renal se recupera al 4º día post LEOC. Introduction: The Extracorporeal shock waves lithotripsy (ESWL) is fundamental in the treatment of lithiasis. However, there are evidences that it can produce renal damage. The objective of our study is to determine the degree of affectation of the glomerular and tubular function after LEOC, and the influence of the lithiasis location on the type of renal damage. Material and methods: A prospective longitudinal study was carried out in 14 patients with normal renal function subjected to ESWL. We determined the basal level, and the levels at the 24 hours, at the 4th and the 10th day post ESWL of: microalbuminuria (MA) (that values the glomerular function), and N-acetil glucosamide (NAG) and alanine aminopeptidase (AAP), (that value the tubular function). Results: The basal levels of of MA, NAG and AAP didn’t show significant differences in connection with the localization of the stones. A significant increase was observed of the three parameters only 24 hours post ESWL No significant differences were observed between the variation of the microalbuminuria levels, AAP and NAG and the treatment in relation to the localization of the stones. Conclusions: It exists a glomerular and tubular damage after ESWL. This damage is not related with the pelvic or calicial location of the stones. In patient with previous normal renal function, the renal damage recovers at the 4º day post ESWL.