[Ureteral triplication whitout other associates malformations]. / Triplicidad ureteral sin otras malformaciones asociadas.

We report a case of ureteral type III triplication according to Smith's classification, without associated anomalies of the urinary tract. The revision of the bibliography indicates the rarity of this maldformacion and its frequent association with other urinary and extraurinary malformations. The absence of associate malformations in this case increases his exceptionality.

Triplicidad ureteral sin otras malformaciones asociadas / Ureteral triplication whitout other associates malformations

Se presenta un caso de triplicidad ureteral tipo III según la clasificación de Smith, sin anomalías del tracto urinario asociadas. La revisión de la bibliografía indica la rareza de esta malformación y su frecuente asociación con otras malformaciones urinarias y extraurinarias, por lo que la ausencia de malformaciones asociadas hace más excepcional el caso presentado (AU)

We report a case of ureteral type III triplication according to Smith’s classification, without associated anomalies of the urinary tract. The revision of the bibliography indicates the rarity of this maldformacion and its frequent association with other urinary and extra urinary malformations. The absence of associate malformations in this case increases his exceptional (AU)

[Evaluation of the irrigation and drainage capacity of 3 bladder irrigation catheters]. / Evaluación de la capacidad de irrigación y drenaje de tres sondas de lavado vesical.

OBJECTIVES: To perform a comparative evaluation of three types of continuous bladder irrigation catheters with the aim of determining which of them allows greater irrigation solution inflow and bladder outflow. METHODS: We compared three types of three-way catheters, 22F in caliber, being the material the main difference between them: latex, silicone, or polyvinyl. RESULTS: The polyvinyl catheter showed significant differences both in inflow and outflow in comparison with the other two types of catheters (p = 0.000, ANOVA test with Sheffe's post hoc). Additionally, the latex catheter showed a significant outflow decrease with the insufflation of the self retentive balloon. CONCLUSIONS: The polyvinyl catheter, due to material rigidity, is the one that allows better bladder irrigation.

[Urodynamic factors associated to vesicoureteral reflux in adults]. / Factores urodinámicos asociados al reflujo vesicoureteral en el adulto.

OBJECTIVES: Lower urinary tract dysfunction may affect the upper urinary tract with development of vesicoureteral reflux. The objective of our study is to evaluate what lower urinary tract dysfunctions are associated with vesicoureteral reflux in adults. METHODS: We performed a cross-sectional study in a sample of 236 patients (149 males and 87 females) with a mean age of 45.5 yr. (typical deviation 19.0 yr.) submitted for videourodynamic study for lower urinary tract functional symptoms. History and neurourologic physical examination, filling cystometry associated with videocystography, pressure/flow study associated with voiding videocystography and selective electromyography of the periurethral sphincter were done in all patients. The chi-square test was used for statistical analysis. RESULTS: The presence of vesicoureteral reflux was observed in 19 patients (8.1% of the sample). Fifteen cases (79%) showed reflux during the filling phase, 3 cases (16%) during the voiding phase, and in 1 (5%) in both. The existence of a vesicourethral neurogenic dysfunction was confirmed in 8 cases (42%); there was no neurogenic dysfunction in 11 cases (58%). The vesicoureteral reflux was classified as primary passive (without any urodynamic anomaly) in one case (5%), passive with diminished compliance in 4 cases (21%), passive evolutive in 3 cases (16%), active involuntary in 7 cases (38%), active associated with organic obstruction of the lower urinary tract in one case (5%), active associated with increased contractile potency in one case (5%), and secondary to abdominal press in 2 cases (10%). The only urodynamic anomalies associated with a significant increase of the prevalence of vesicoureteral reflux were: a filling pressure at maximum capacity greater than 12.5 H2O cm (prevalence of reflux 7 times) and voiding with abdominal press which increased the prevalence of reflux 2.8 times. CONCLUSIONS: Most patients with functional symptoms of the lower urinary tract and associated vesicoureteral reflux present lower urinary tract dysfunctions that may justify their reflux. Nevertheless, a statistically significant increase of the prevalence of vesicoureteral reflux was only found in patients with filling pressures at maximum capacity greater than 12.5 cm H2O and those voiding with the help of abdominal press.

Testicular neoplasms. Evaluation of the experience during 25 years in a military hospital.

INTRODUCTION: Testicular tumors are frequent in young adults, coinciding with incorporation to military service. The present study evaluates the tumor characteristics, time course and results obtained with the treatments used in our center for this type of neoplasms. MATERIAL AND METHODS: A retrospective longitudinal study was conducted in a cohort of 98 patients with an average age of 28.6 years, subjected to orchiectomy for testicular tumors in our center between 1979 and 2004. Data were collected relating to patient age, tumor characteristics, the outcome of treatment, and the course of the disease. RESULTS: The right testicle was affected in 61% (with significant differences versus the left side). The most common histological type corresponded to non-seminomatous germ cell tumors (NSGCTs) (65.3%), followed by pure seminomas (27.6%) and non-germinal cell tumors (NGCs) (7.1%). NSGCT was diagnosed at a significantly younger average age (23.2 years) than the other two tumor types. Stage I was the most frequent presentation (58%). Seminomas presented in stage I significantly more often (80%) than the others tumors. The data collected over the 25-year study period showed no significant variations in tumor characteristics. The log-rank test showed a significant difference in terms of patient survival according to the tumor cell line (p = 0.000) and stage (p = 0.000), except between stages I and II, where no significant differences were observed in terms of survival. CONCLUSIONS: Non-seminomatous germ cell tumors (NSGCTs) are the most frequent testicular tumors in young adults. Most neoplasms are diagnosed in early stages, the prognosis being better in the case of seminomas and tumor stages I and II.

Factores urodinámicos asociados al reflujo vesicoureteral en el adulto / Urodynamic factors associated to vesicoureteral reflux in adults

OBJETIVO: La disfunción del tracto urinario inferior puede repercutir sobre el tracto urinario superior con la producción de reflujo vesicoureteral. El objetivo de nuestro estudio es valorar qué tipo de alteraciones del tracto urinario inferior se asocian a reflujo vesicoureteral en el adulto. MÉTODOS. Se realizó un estudio transversal (“cross sectional study”) en una muestra de 236 pacientes (149 varones y 87 mujeres), de edad media 45, 5 años (desviación típica 19,0 años), remitidos para estudio videourodinámico por síntomas funcionales del tracto urinario inferior. Los pacientes fueron sometidos a una historia clínica, exploración neurourológica, cistomanometría asociada a videocistografía de llenado, estudio presión/ flujo asociado a videocistografía miccional y electromiografía selectiva del esfínter periuretral. El análisis estadístico se realizó mediante el test de la chi-cuadrado. RESULTADOS: Se observó la presencia de reflujo vesicoureteral en 19 pacientes (8,1 % de la muestra). En 15 casos (79%) el reflujo tuvo lugar durante el llenado, en 3 casos (16%) durante la micción, y en 1 caso (5%) en ambas fases. Se comprobó la existencia de una disfunción neurógena vesicouretral en 8 casos (42 %), no existió disfunción neurógena vesicouretral en 11 casos (58%). El reflujo vesicoureteral se clasificó como pasivo primario (sin alteración urodinámica que lo justifique) en 1 caso (5%), pasivo con acomodación disminuida en 4 casos (21%), pasivo evolutivo en 3 casos (16%), activo involuntario en 7 casos (38%), activo asociado a obstrucción orgánica del TUI en 1 caso (5%), activo asociado a potencia contráctil elevada en 1 caso (5%), y por prensa abdominal en 2 casos (10%). Se comprobó que las únicas alteraciones urodinámicas asociadas a un aumento significativo de la prevalencia de reflujo vesicoureteral fueron: una presión de llenado, a máxima capacidad, superior a 12,5 cm H2O (que aumentó la prevalencia de reflujo 7 veces) y la micción con prensa abdominal que aumentó la prevalencia de reflujo 2,8 veces. CONCLUSIONES: La mayoría de los pacientes con síntomas funcionales del tracto urinario inferior y reflujo vesicoureteral asociado, presentan disfunciones del tracto urinario inferior que podrían justificar su reflujo. Sin embargo, sólo se comprobó un aumento estadísticamente significativo de la prevalencia de reflujo vesicoureteral en los pacientes con presión de llenado a máxima capacidad superior a 12,5 cm H2O y en aquellos que realizaban la micción con prensa abdominal

OBJECTIVES: Lower urinary tract dysfunction may affect the upper urinary tract with development of vesicoureteral reflux. The objective of our study is to evaluate what lower urinary tract dysfunctions are associated with vesicoureteral reflux in adults. METHODS: We performed a cross-sectional study in a sample of 236 patients (149 males and 87 females) with a mean age of 45.5 yr. (typical deviation 19.0 yr.) submitted for videourodynamic study for lower urinary tract functional symptoms. History and neurourologic physical examination, filling cystometry associated with videocystography, pressure/flow study associated with voiding videocystography and selective electromyography of the periurethral sphincter were done in all patients. The chi-square test was used for statistical analysis. RESULTS: The presence of vesicoureteral reflux was observed in 19 patients (8.1% of the sample). Fifteen cases (79%) showed reflux during the filling phase, 3 cases (16%) during the voiding phase, and in 1 (5%) in both. The existence of a vesicourethral neurogenic dysfunction was confirmed in 8 cases (42%); there was no neurogenic dysfunction in 11 cases (58%). The vesicoureteral reflux was classified as primary passive (without any urodynamic anomaly) in one case (5%), passive with diminished compliance in 4 cases (21%), passive evolutive in 3 cases (16%), active involuntary in 7 cases (38%), active associated with organic obstruction of the lower urinary tract in one case (5%), active associated with increased contractile potency in one case (5%), and secondary to abdominal press in 2 cases (10%). The only urodynamic anomalies associated with a significant increase of the prevalence of vesicoureteral reflux were: a filling pressure at maximum capacity greater than 12.5 H2O cm (prevalence of reflux 7 times) and voiding with abdominal press which increased the prevalence of reflux 2.8 times. CONCLUSIONS: Most patients with functional symptoms of the lower urinary tract and associated vesicoureteral reflux present lower urinary tract dysfunctions that may justify their reflux. Nevertheless, a statistically significant increase of the prevalence of vesicoureteral reflux was only found in patients with filling pressures at maximum capacity greater than 12.5 cm H2O and those voiding with the help of abdominal press

[The usefulness of clinical history for the diagnosis of lower urinary tract obstruction in patients with acute urinary retention]. / Utilidad de la historia clínica para el diagnóstico de obstrucción del tracto urinario inferior en pacientes con retención aguda de orina.

OBJECTIVES: To determine the diagnostic usefulness of data provided by clinical history for the diagnosis of lower urinary tract obstruction in patients with acute urinary retention. METHODS: We performed a transversal study in a series of 70 patients (19 women and 51 men) with a mean age of 61.5 years (typical deviation 20.7 years), who underwent urodynamic study due to acute urinary retention. Past medical history was recorded in all patients. Physical exam was also carried out, evaluating prostate size in males, presence of genital prolapse in females, and neurourological examination. Urodynamic tests consisted on flowmetry, pressure/flow studies with simultaneous perineal electromyography, and voiding cystourethrogram or videocystogram. Student's t mean comparison and chi-square tests were used for the statistical analysis. RESULTS: The only clinical data that showed a statistically significant relationship with obstruction of the lower urinary tract were: age, sex, prostate size, and existence of infrasacral neurological lesion (absence of bulbocavernous reflex). Age > 74 years showed a sensitivity of 71 % for lower urinary tract obstruction and a specificity of 60%. Male sex showed a sensitivity of 88% and specificity of 36%. Prostate size > or ='3d grade II sensitivity was 58% and specificity 82%; and absence of infrasacral lesion a sensitivity of 77% and specificity of 48%. CONCLUSIONS: Provided that a negative result in a test with high sensitivity makes the likelihood of disease low, in women the presence of infrasacral neurogenic dysfunction or age < or ='3d74 years diminish the probability of obstruction in patients with acute urinary retention. On the other side, if a negative result of a test with high specificity increases the probability of having the disease, a prostate size > or ='3d grade II and age > 74 years favour the likelihood of having urinary tract obstruction for a patient with acute urinary retention.

Relación de los factores clínicos, ecográficos e inmunoserológicos preoperatorios con la histología y el estadío de las neoplasias testiculares / Testicular tumors: association between preoperative clinical, radiological and immuno-serological factors, and histology and stage

OBJETIVO: Determinar y cuantificar larelación que existe entre los datos clínicos ecográficose inmunoserológicos y el tipo histológico y estadío delas neoplasias testiculares.MÉTODOS: Se analizó una cohorte de 80 casos sometidosa orquiectomía por neoplasia testicular. La mediade edad de los pacientes fue de 30,4 años. Se recogióde manera retrospectiva los antecedentes delpacientes, la naturaleza del primer síntoma, el tiempodesde el primer síntoma hasta la intervención, los datosde la exploración clínica y ecografía y los niveles preoperatoriosde alfa-fetoproteína y beta HCG.RESULTADOS: Los pacientes con Tumor de NoSeminmatoso de Células Germinales (TNSCG) teníanuna edad media (23,7 años) significativamente menorque la de los pacientes con seminoma puro (41,3años), y ésta, a su vez, significativamente menor que laedad de los pacientes con Tumores No Germinales(TNG) (50,7 años). La presencia como síntoma inicialde malestar general o dolor lumbar aumentó el riesgorelativo de padecer un tumor en un estadío avanzado(superior al estadío I) 2,56 veces. La existencia de ginecomástiaaumentó 16,5 veces el riesgo relativo depadecer un TNG, debido a la presencia en este grupode los tumores de Leydig. La observación de nódulosheterogéneos en la ecografía incrementó el riesgo depadecer un TGNS 4,5 veces. La elevación preoperatoriade la alfa-fetoproteína descartó la existencia de unseminoma y de un TNG, mientras que la elevación preoperatoriade la beta HCG aumentó el riesgo depadecer un TGNS 3,21 veces. No se observó unarelación significativa entre los niveles preoperatorios deambos marcadores y el estadío tumoral.CONCLUSIONES: La existencia de ginecomastia, laedad, la visualización de nódulos heterogéneos en laecografía y los niveles preoperatorios de alfa-fetoproteinay beta HCG son datos relevantes relacionadoscon el tipo histológico de tumor. La sensación de dolorlumbar o malestar general es un dato clínico relacionadocon el estadío tumoral

OBJECTIVES: To evaluate and quantify the ;;association between clinical, ultrasound and immunoserological ;;data and histologic type and stage of ;;testicular tumors. ;;METHODS: We analyze a cohort of 80 patients who ;;underwent orchiectomy for testicular neoplasia. Mean ;;patient age was 30.4 years. Past medical history, first ;;symptoms, time from first symptom to operation, physical ;;examination and ultrasound data, and preoperative ;;serum levels of alpha-fetoprotein and beta HCG were ;;retrospectively collected. ;;RESULTS: Patients with non seminomatous germ cell ;;tumor (NSGCT) had a significantly lower mean age ;;(23.7 yr.) than patients with pure seminoma (41.3 yr.), ;;and these latter a significantly lower age than patients ;;with non germinal tumors (50.7 yr.). Initial presentation ;;with general malaise or lumbar pain increased 2.56 ;;times the relative risk of having a tumor in advanced ;;stage (higher than stage I) . Presence of gynecomastia ;;increased 16.5 times the relative risk of having a non ;;germ cell tumor, due to the inclusion of Leydig`s tumors ;;in this group. Detection of heterogeneous nodules by ;;ultrasound increased 4.5 times the risk of having a non ;;seminomatous germ cell tumor. Preoperative elevation ;;of alpha-fetoprotein ruled out the existence of seminoma ;;and non germ cell tumor; whereas preoperative elevation ;;of beta HCG increased 3.21 times the risk of having ;;a non seminomatous germ cell tumor. No significant ;;association was shown between preoperative tumor ;;markers and tumor stage. ;;CONCLUSIONS: The existence of gynecomastia, age, ;;detection of heterogeneous nodules on ultrasound, and ;;preoperative alpha-fetoprotein and beta HCG are relevant ;;data in relation to histological type of tumor. Lumbar ;;pain or malaise are clinical data associated with tumor ;;stage

Utilidad de la historia clínica para el diagnóstico de obstrucción del tracto urinario inferior en pacientes con retención aguda de orina / The usefulness of clinical history for the diagnosis of lower urinary tract obstruction in patients with acute urinary retention

OBJETIVO: Determinar la utilidad diagnósticade los datos aportados por la historia clínicapara el diagnóstico de obstrucción del tracto urinarioinferior (OTUI) en los pacientes con retención aguda deorina (RAO).MÉTODOS: Se realizó un estudio transversal en unaserie de 70 pacientes (19 mujeres y 51 varones) deedad media 61, 5 años (desviación típica 20,7 años),sometidos a estudio urodinámico por presentar RAO.Los pacientes fueron interrogados sobre sus antecedentespatológicos. Se les realizó además una exploraciónclínica, valorando el tamaño prostático en varones, presenciade prolapsos genitales en mujeres, y una exploraciónneurourológica. El estudio urodinámico consistióen una flujometría libre, un estudio de presión/ flujocon registro simultaneo de la actividad electromiográficaperineal, y una cistografía o videocistografía mic-cionales. La pruebas estadísticas utilizadas fueron el testde comparación de medias de la t de Student y el testde la Chi-cuadrado.RESULTADOS: Los únicos datos clínicos que mostraronuna relación estadísticamente significativa con la OTUIfueron: la edad, el sexo, el tamaño prostático y la presenciade lesión neurológica infrasacral (ausencia delreflejo bulbocavernoso). Los pacientes con edad superiora 74 años presentaron una sensibilidad respecto ala presencia de OTUI del 71% y una especificidad del60%. El sexo masculino mostró una sensibilidad del88% y una especificidad del 36%. El tamaño prostáticosuperior o igual a un grado II, una sensibilidad del58% y una especificidad del 82%, y la ausencia delesión infrasacral una sensibilidad del 77% y una especificidaddel 48%.CONCLUSIONES: Dado que, un resultado negativoen una prueba con una alta sensibilidad, hace pocoprobable la presencia de la enfermedad, en el sexofemenino, la presencia de una disfunción neurógenainfrasacral y una edad menor o igual a 74 años, disminuyenla probabilidad de obstrucción en pacientescon RAO. Por otra parte, como un resultado negativopara una prueba con una alta especificidad, aumentala probabilidad de padecer la enfermedad; una próstatade tamaño mayor o igual a un grado II y una edadsuperior a los 74 años, favorecen la probabilidad depadecer obstrucción urinaria en un paciente con RAO

OBJECTIVES: To determine the diagnostic usefulness of data provided by clinical history for the diagnosis of lower urinary tract obstruction in patients with acute urinary retention. METHODS: We performed a transversal study in a series of 70 patients (19 women and 51 men) with a mean age of 61.5 years (typical deviation 20.7 years), who underwent urodynamic study due to acute urinary retention. Past medical history was recorded in all patients. Physical exam was also carried out, evaluating prostate size in males, presence of genital prolapse in females, and neurourological examination. Urodynamic tests consisted on flowmetry, pressure/flow studies with simultaneous perineal electromyography, and voiding cystourethrogram or videocystogram. Student’s t mean comparison and chi-square tests were used for the statistical analysis. RESULTS: The only clinical data that showed a statistically significant relationship with obstruction of the lower urinary tract were: age, sex, prostate size, and existence of infrasacral neurological lesion (absence of bulbocavernous reflex). Age > 74 years showed a sensitivity of 71% for lower urinary tract obstruction and a specificity of 60%. Male sex showed a sensitivity of 88% and specificity of 36%. Prostate size >=3d grade II sensitivity was 58% and specificity 82%; and absence of infrasacral lesion a sensitivity of 77% and specificity of 48%. CONCLUSIONS: Provided that a negative result in a test with high sensitivity makes the likelihood of disease low, in women the presence of infrasacral neurogenic dysfunction or age =3d grade II and age > 74 years favour the likelihood of having urinary tract obstruction for a patient with acute urinary retention