[Genital autoaggression. An unusual presentation]. / Autoagresión genital. Una forma de presentación poco habitual.

Self-injuries are relatively common and usually consist in incisive injuries on the penis and the scrotum. This paper presents one case of genital self-injury by injection of petrol on the back of the penis. A description is offered of the clinical form of presentation, as well as the good evolution following medical treatment. Finally, a revision of likely complications is included.

[Ureteral tamponade in the treatment of urinary fistula: our experience]. / Taponamiento ureteral en el tratamiento de las fístulas urinarias: nuestra experiencia.

Surgical correction is the treatment of choice for urinary fistulas. However, there are circumstances that advise against the use of this approach, basically when patient general condition is poor or life expectancy short; i. e., in the presence of an underlying malignant pelvic disease. In these cases, urinary diversion by percutaneous nephrostomy will suffice, although sepsis or derangement of electrolyte balance may sometimes develop due to the fistulous defect. Occlusion of the pyelo-ureteric junction and percutaneous drainage is a solution that causes no major complications. Two patients who could not be submitted to conventional surgery were treated by the foregoing procedure. Both patients have been followed for more than two years. The first case was a male who had undergone abdominoperineal resection due to carcinoma of the sigmoid colon. He developed stress ulcers, pulmonary thromboembolism, sepsis, paralytic ileus and bilateral ureteral fistula. The second case was an insulin-dependent female diabetic who had previously received radiotherapy to the pelvis. She developed a large vesicocutaneous fistula and public osteomyelitis after drainage of an inguinal abscess. Patient tolerance was good and no major complications were observed. In our view this palliative procedure should be considered in the management of patients with urinary fistula whose life expectancy is short. Its application can be extended to patients with inoperable carcinoma of the bladder or prostate and important symptoms.

[Nephrogenic adenoma of the upper and lower urinary tract. Apropos of 22 cases]. / Adenoma nefrogénico del tracto urinario superior e inferior. A propósito de 22 casos.

Nephrogenic adenoma (NA) is a lesion that can present in the urothelium--from the renal pelvis to the urethra-, and is considered to be immature metaplasia arising from chronic aggression. We report 22 cases of NA in 21 patients that had been diagnosed and treated in our service from 1975 to 1990. The lesion was found at all levels of the urinary tract: renal pelvis (1 case), ureter (1 case), bladder (16 cases) and urethra (4 cases). The present series was comprised of 15 males (one with bladder NA and recurrence in urethra) and 6 females, with ages ranging from 24 to 79 years (mean 55). The diagnosis was made on the histological findings in all cases and the etiology of the lesion was multiple: previous surgery (11 cases), previous or coexisting urothelial carcinoma (8 cases), intracavitary chemotherapy and/or pelvic radiotherapy (3 cases), previous history of tuberculosis (5 cases), interstitial cystopathy (4 cases), lithiasis (2 cases), permanent catheter (3 cases) and urethral stenosis (1 case). Treatment and prognosis was influenced by the underlying urological disease. NA per se does not carry an unfavourable prognosis.

[Giant lithiasis in left ureterocele. Its endoscopic resolution]. / Litiasis gigante en ureterocele izquierdo. Resolución endoscópica.

Herein we describe a case of giant calculus in an orthotopic ureterocele in a female patient who had consulted for recurrent left-sided nephritic colic. A plain film of the urinary tract prompted us to suspect a giant calculus, which was confirmed by IVP. Treatment was by endoscopic surgery. The patient has remained asymptomatic one year postoperatively.

[Our experience with the diagnosis and treatment of 429 renal traumatisms]. / Nuestra experiencia en el diagnóstico y tratamiento de 429 traumatismos renales.

We studied 429 cases (3 bilateral) of renal injuries in 426 patients diagnosed and treated at our service from 1965 to 1990. Four-hundred twenty (98.59%) were blunt and 6 (1.41%) were penetrating injuries. In 313 the renal lesions were grade I (72.96%), 69 grade II (16.08%), 27 grade III (6.29%) and 20 were traumatic injuries to pathologic kidney (4.66%). Surgery was performed immediately in 67 cases (15.61%) (35 grade II, 21 grade III, and 11 previously pathological kidneys). Surgery was delayed in 34 cases (7.92%) (1 grade I, 23 grade II, 5 grade III and 5 pathological kidneys). Three-hundred twenty-eight cases (76.45%) were managed conservatively (312 grade I, 11 grade II, 1 grade III and 4 cases of traumatic injury to previously pathological kidney). Preservation of the renal unit was achieved in 100% of those with grade I lesions and in 91.17% of those with grade II that had been treated conservatively or submitted to delayed surgery. Of the grade II lesions that were immediately treated, 22.58% required a nephrectomy procedure. Of the grade III lesions and the cases of traumatic injury to previously pathological kidney, nephrectomy was required in 72% and 65%, respectively, although delayed surgery permitted more precise indication in a hemodynamically stable patient. The mortality rate in our series was 1.87 (8/426).

[Kidney injuries in childhood: our experience in 64 cases]. / Traumatismos renales en la infancia: nuestra experiencia en 64 casos.

From 1969 to 1988, 64 children under 5 years of age with renal trauma were treated at our Urology service. Trauma was classified as grade I in 34, grade II in 23, grade III in 3, and 4 patients presented with trauma to pathologic kidney. Eight patients were submitted to immediate surgery (3 grade II, 3 grade III, and 2 with trauma to pathologic kidney). Twelve were initially treated conservatively and were deferred for surgery (11 with grade II trauma and 1 with trauma to pathologic kidney). The remaining 44 patients (34 grade 1, 9 grade II, and 1 with trauma to pathologic kidney) only received medical treatment. The renal unit could be salvaged in 34 cases with grade I trauma (100%) and in 2 of 3 (66.6%) with grade III trauma who underwent immediate surgery. In patients with grade II trauma submitted to immediate surgery, 1 out of 3 patients (33.3%) required a nephrectomy procedure, whereas in those patients submitted to conservative treatment and or deferred surgery, only 1 out of 20 (5%) required a nephrectomy procedure. The results reported in the literature are discussed and compared with our results.

[Complications in kidney transplant: our experience in 107 cases]. / Complicaciones en el trasplante renal: nuestra experiencia en 107 casos.

We introduce our case material on urological complications occurred in 107 renal transplants, 102 of which were from corpse donors and 5 form live donors. The techniques used for the reconstruction of the urinary tract were: extravesical ureterocystoneostomy (91 = 85%), pyelo-pyelic anastomosis (15 = 14%) and uretero-ureteral anastomosis (1 = 0.9%). Sixteen cases presented urinary fistula (15%), emphasizing the high percentage of extravasations occurred in the pyelo-pyelic anastomosis (5/15). The resolution of the problem with graft preservation was achieved in 11 cases (68.75%). We encountered 6 ureteral obstructions that resolved favourably in 100% if the cases. Other important complications were: appearance of lymphocele in 8 cases, detection of post-grafting ureteral stenosis in 5 patients, finding asymptomatic vesicoureteral reflux in 16 grafts, and presence of urinary lithiasis in 2 cases. Similarly, we analyzed our series of 16 vascular complications, emphasizing that 15 out of 107 grafts had arterial or venous vascular abnormalities (14.1%), that forced to perform bench surgery in two occasions. Our statistical analysis showed that arterial thrombosis was more frequent than stenosis (8.49% versus 4.71%), and in nearly 80% of the cases (7/9) it happened in grafts concerning more than one arterial vessel, including in this series thrombosis of any of the ramus. The largest loss of grafting were due to this complication, since in 5 out of 9 cases of arterial thrombosis (55.5%) a transplantectomy had to be performed. With regard to venous complications thrombosis is a relatively rare complication, representing in our series less than 1%, usually associated to uncontrollable vascular acute rejection.

[Ultrasonic diagnosis of the complications of renal transplantation]. / Diagnóstico ultrasónico de las complicaciones del transplante renal.

To evaluate the usefulness of ultrasound in the diagnosis of urologic complications in renal transplants, we reviewed the ultrasonographic studies performed in 107 renal transplants. Ultrasound disclosed 13 perirenal collection of fluid without hydronephrosis, 4 hydronephrosis without perirenal mass, 2 hydronephrosis from a perirenal fluid mass, 2 urinomas from polar infarction, 1 subcapsular hematoma, and 1 graft vascular atrophy. Ultrasound proved to be the most efficient technique in the diagnosis of hydronephrosis and perirenal fluid collection. Although it does not distinguish the nature of the latter, it permits control of diagnostic or therapeutic (75%) puncture. Moreover, it is useful in controlling percutaneous nephrostomy in transplant obstruction and permits its noninvasive follow-up.