[Giant calcifications of a double-J ureteral catheter]. / Calcificaciones gigantes de cateter ureteral doble J.

We present a case of recurring gigantic calcifications of both extreme of a double-J ureteral catheter, with long permanency of the same. We expose the technical maneuvers that were specified for the managing of so important complication. We emphasize the renal functional conservation found in spite of the magnitude of the calcifications. We check the national literature in this regard of this complication and we expose the etiological mechanisms, prophylactic recommendations and therapeutic managing of this complication to the extended use of ureteral catheters.

[Complications of the lower urinary tract secondary to urethral stenosis]. / Complicaciones del tracto urinario inferior secundarias a estenosis uretral.

Among the complications from urethral stenosis those derived from obstructive uropathy of the lower urinary tract and genitalia should be pointed out for their high frequency, the low attention they are given and their potential seriousness. Such complications are related to urinary infection and favoured by the anatomical and functional changes stenosis causes on urinary and genital organs. This paper analyzes the complications in the lower urinary tract in a group of 175 male patients with urethral stenosis, diagnosed at the General Teaching Hospital in Alicante between January 1977 and January 1990. 154 complications of the lower urinary tract (LUT) were reported in 124 patients (71%) out of the initial 175. In 86 patients (49%) these complications were isolated, whereas in 38 patients (22%) they coexisted with other in the genitalia. Frequency ranking of LUT complications was: fight bladder (68% patients), vesical diverticulosis (19%), chronic prostatitis (13%), megabladder (10%), vesical lithiasis (6%), urethral lithiasis (4%), urethral diverticulum (4%) and chronic periurethritis (2%). Renal failure developed in 25 patients (20%), and progressed to CRI in 3 (2%). Urinary infection occurred in 59 (48%) patients, primarily by urolithic germs (24%). Management of the 124 urethral stenosis required a total of 159 procedures, but only 20 (13%) of the 154 complications required surgery. We conclude that patients with urethral stenosis have frequent LUT complications, and that long-term male stenosis associated to urinary infection is a risk factor. Surgery tends to be the preferred treatment option for both stenosis and some of the complications.

[Epidemiology of urethral stenosis in the province of Alicante]. / Epidemiología de la estenosis uretral en la provincia de Alicante.

Urethral stenosis is the most frequently acquired disease of the male urethra. Currently there is a progressive increase of this condition's occurrence due to: improved living standard, increased number of permanent catheter bearers, surge of STDs incidence, and abuse of transurethral diagnostic or therapeutical instrumentation. However, and in spite of such increased incidence, the epidemiological features have been forgotten by most authors consulted who now focus more attention in the therapeutical aspects. This paper analyzes the most outstanding epidemiological aspects, in the province of Alicante, of 180 urethral stenosis corresponding to 175 males and 5 females, making some final considerations on the relevance of certain factors in the genesis of urethral stenosis: advanced age, depressed social class, active sexual life, STD history, urinary or genital infections.

[Renal and ureteral complications of urethral stenosis]. / Complicaciones renales y ureterales de la estenosis uretral.

This paper analyzes the renal and ureteral complications caused by urethral stenosis. A total of 180 patients with stenosis, 175 males and 5 females, were reviewed. There were 55 renal-ureteral complications in 37 patients (20.55%). In order of frequency, complications were as follows: renal failure (36%), ureterohydronephrosis (33%), chronic pyelonephritis (16%), vesico-ureteral reflux (11%), and post-obstructive renal annulment (4%). Most complications were reversible. However, renal function impairment was irreversible in 3 cases due to I.R.C., as well as in 2 cases due to post-obstructive renal atrophy-annulment. Nine patients showed chronic pyelonephritis morphological changes. Urinary infection occurred in 28 patients (76%), and in 50% of them was due to ureolytic germs. The best procedure to treat these complications is based on a correct prevention, eradicating the associated urinary infection and correcting the causative obstructive problem. Nonetheless, surgery was required in 5 patients (13.50%) and extracorporeal lithotripsy for the lithiasis associated to stenosis in other 5 patients (13.50%). We conclude that although those complications have a high incidence, their ultrasound diagnosis is easy and the prognosis reversible once the stenosis is corrected. Risk factors for development are: male sex, the sixth decade of life and a long evolution stenosis associated to urinary infection. Finally, a review of the scarce literature on this frequent but forgotten chapter of obstructive uropathy is made.

[Endometriosis of the bladder muscular layer as a cause of acute abdomen]. / Endometriosis de la capa muscular vesical como causa de abdomen agudo.

OBJECTIVES: A case of acute abdomen arising from endometriosis of the bladder is described. The rarity of this condition prompted us to report on the present case and the problems encountered in making the differential diagnosis. METHODS/RESULTS: A patient with endometriosis of the muscle layer of the bladder mimicking acute gynecological abdomen is described. CONCLUSIONS: Endometriosis of the bladder is extremely rare and usually presents as urinary problems and rarely as acute abdomen.

[Urethral stenosis. Conceptual review and classification]. / Estenosis uretral. Revisión conceptual y clasificación.

In an extensive review focused on male urethral stenosis, where more than 1,200 publications relative to this problem were evaluated, we found a lack of conceptual precision when it comes to qualify the varied terminology used to define concepts such as normal urethra, urethral stenosis, relapsing urethral stenosis, spongiofibrosis and urethral callus. The lack of precision may be due to the fact that we surgeons are more interested in reporting our surgical successes than in semantic appraisals. No publications have either been commented with a global approach to the problem of the various and potential classifications of urethral stenosis in the various etiological, clinical, radiological, endoscopic, ultrasonic or therapeutic aspects. The current paper is an update of this old urological problem. The guidelines outlined below are neither entirely original, nor the only or even the most correct approach of all those that can be used to address this issue. They are simply the result of the cumulative surgical and medical experience as well as of the enthusiasm we feel toward this part of urology.

[Urologic emergencies: our difficult experience with care services]. / Urgencias urológicas: nuestra experiencia problemática de una labor asistencial.

Urological emergencies, except those occurring in children, seen in a General Hospital were studied for one year. The retrospective study, both descriptive and comparative, conducted has allowed to know that there had been 3,244 emergencies (4.2% of total cases) though the urologist acted only in 1,410 (43.4%). A predominance of males (76.10%) in their sixth and seventh decade (33% of total) was seen. Presentation increased slightly (2%) above average during the summer months. 80.9% came to the Emergency Ward of their own accord and 70% were discharged soon after assistance. Nephritic colic (19.08%), haematuria (14.04%) and U.T.I. (13.83%) were the most common causes for presentation. A total of 284 patients (20.14%) required hospitalization. 96.6% were given medical and/or instrumental treatment, versus 3.4% (49) who underwent surgery basically due to testicular disease (34.69%), sepsis (24.50%), traumatic injury of male genitalia (20.3%), etc. The most frequent conditions were analyzed by age, sex, and seasonal distribution. Also, an analysis was made on the concept of "Urological Emergency" to evaluate incidence and types in our environment.

[Torsion and seminoma in a cryptorchid testis]. / Torsión y seminoma en testículo criptorquídico.

Presentation of one case of seminoma on cryptorchid testicle which presented with torsion of spermatic cord clinically mimicking an inguinal incarcerated hernia. Despite the infrequency of the picture, the high association rate of neoplastic disease in cryptorchid testis which become twisted and force the adoption of oncological criteria for their treatment is highlighted.

[Leydig cell tumor associated with gynecomastia]. / Tumor de células de Leydig acompañado de ginecomastia.

Presentation of one case of testicular Leydig's cells tumour in a young adult who presented with gynaecomastia. The clinical and diagnostic aspects of this entity in which, in the absence of confirmed metastasis, we lack the criteria to sustain a definite prognostic judgement are commented. Finally, the different therapeutic attitudes revealed in the literature are assembled.

[Mixed "organoid" tumor or the testis: general considerations. Report of a case]. / Tumor "organoide" mixto de testículo: consideraciones generales. A propósito de un caso.

Presentation of one case of mixed testicular tumour in a 31-year-old male patient. Since this is the association in the same organ of an "organoid" teratoma plus a seminoma, the histological diversity, frequency, as well as the analysis of the controversies and criteria for its therapeutical approach are all discussed. Also, several histological theories on the genesis of mixed testicular tumours are explained. Prognosis and evolution after treatment of the present case is included.

[Historic review of the treatment of urethral stenosis]. / Reseñas históricas sobre el tratamiento de la estenosis uretral.

The present paper reviews the various therapeutical schemes with which urologists have approached the difficult problem of urethral stenosis. It pictures a brief history of one particular chapter of Urology that has troubled men since the dawn of mankind and of which many questions still remain unresolved.

[Testicular germinal cell tumors. Authors' case load. Treatment review]. / Tumores testiculares germinales. Nuestra casuística. Revisión del tratamiento.

This article reports our case series of testicle germinal cell tumours, consisting of 14 cases, between 1974-1991. 42.85% (6 cases) were seminomas, 4 (66.6%) in Stage I. There was one case (16.6%) in Stage III and another one in Stage IV. 14.29% (2 cases) were embryonic carcinomas, one in Stage I and one in Stage II. Teratomas represented 14.29% (2 cases), in Stages I and IV respectively. There were 4 cases of mixed tumours (2 cases) in which teratomatous components (3 out of 4) were predominant. 50% were in Stage I and 50% in Stage III. Inguinal orchiectomy was performed in all cases, and three received radiotherapy (seminomas in Stages I (2 cases) and III), with survival ranging from 1 to 7 years. Two cases (seminoma and embryonic carcinoma) received chemotherapy under different regimes depending on the time of diagnosis. One patient has survived 11 years following rescue lymphadenectomy while the other one died 14 months later from pulmonary metastasis. Among the mixed tumours, 50% (2 cases in Stages II and III) died 5 and 11 months afterwards without further treatment due to overall affectation at diagnosis. An abstentionist approach in Stage I (seminomas and non-seminomas), which was "strictly" applied in 5 cases showing disease-free survival ranging from 1 to 5 years, is defended. Follow-up was not feasible in 2 cases (14.2%). Both the diagnostic means and a review of treatment by Stages, reflecting the evolution of chemotherapy and the results obtained, are analyzed. Also the most widely accepted approaches in the management of these tumours.

[The complete testicular feminization syndrome: apropos 2 new cases]. / Síndrome de feminización testicular completo: a propósito de dos nuevos casos.

Two additional cases of complete testicular feminization syndrome or Morris syndrome are described. The patients had consulted for primary amenorrhea. Patient work up revealed a female phenotype, hormone profile and 46,XY karyotype. They were submitted to abdominal surgical exploration and orchidectomy of the cryptorchid male gonads. The potential etiologic factors, pathogenesis, incidence and clinical features of this syndrome are discussed. Furthermore, the surgical treatment and outcome are described, highlighting the incidence of gonadal malignancy if these are not removed early.

45,X/46,XY gonadal dysgenesis in an infertile adult male.

A 33-year-old male was referred for infertility. Examination revealed bilateral scrotal gonads of soft consistency and small size. Semen analysis showed azoospermia. Elevated serum follicle-stimulating hormone levels and normal testosterone values were found. Surgical exploration and histopathology diagnosed dysgenetic testes with complete epididymis, and remnants of Fallopian tubes attached to the albuginea, with normal vas deferens and seminal vesicles showed on deferentovesiculography. Karyotype was 45,X/46,XY del(Y)(q11) with only 15% of 46XY cells in gonadal tissue. The clinical spectrum of 45,X/46,XY mosaicism and significance of this chromosomic anomaly is discussed.

[Calcified bladder lesions secondary to the instillation of mitomycin C]. / Lesiones vesicales calcificadas secundarias a instilación de mitomicina C.

We report on 10 cases of bladder wall calcification after mitomycin C instillation. The cystoscopic and microscopic features of these lesions are described. In our view, these lesions can be ascribed to the use of mitomycin C instillation therapy immediately after TUR. Because they are asymptomatic and occasionally present features of tumor recurrence, biopsy is advocated to determine the true nature of these lesions.

[Statistical study of outpatient urologic care]. / Estudio estadístico de la asistencia urológica extrahospitalaria.

Attendance generated in an urology outpatients office, reaching up to 6564 visits, was studied for a complete year. Considering only the initial visits handled during that period (1968), we evaluated the following parameters: age, sex, mode of remission, data presented, type of consultation, most common type of urological pathology. No particular period of life has come out as showing greater incidence of urological pathology. Males represented twice as many visits as women. 84.29% patients had been correctly referred to the office. Sixty percent of visits happened without appropriate clinical data to support the case. Emergencies represented 13.31%, but 90% of those actually lacked such condition. Renal-ureteral lithiasis (25.57%) was the most frequently present pathology in our office, followed by benign hypertrophy of the prostate (16.07%). Urinary lower tract infections (15.59%) and inflammatory and/or congenital prepuce pathologies (14.09%) were the second most frequent ones. In this paper, we emphasize the increasing prevalence of male-related sterility visits in the outpatients environment, as well as nephrological.

[Bladder tumors in patients under 40 yr of age. Our experience and review of the literature]. / Tumores vesicales en pacientes menores de cuarenta años. Nuestra experiencia y revisión de la literatura.

During a period spanning 11 years, 392 patients diagnosed as having tumor of the bladder were treated at our department. Of these, 9 were patients under age 40. We compared the anatomopathological features and course of the disease. The foregoing condition was suspected on the basis of the urographic findings. We emphasize the need to perform endoscopic inspection and urinary cytology before discarding the presence of a bladder tumor. The anatomopathologic conditions of anaplasia and infiltration are frequently more favourable in this younger patient group, indicating a better prognosis. However, the natural history of tumors with histopathologically similar features is not influenced by age.

[Hematoma of the iliac psoas secondary to anticoagulant treatment. Urological implications]. / Hematoma del psoas ilíaco secundario a tratamiento anticoagulante. Implicaciones urológicas.

We describe the urological manifestations arising from hematoma of the left iliac psoas that developed in the course of anticoagulant therapy in a 54-year-old patient with a mitral prosthesis. The onset of the clinical picture was acute and mimicked left reno-ureteral colic. Ultrasound and CT were decisive in making the diagnosis, revealing a left retroperitoneal mass in the anterolateral aspect of the left psoas muscle. Intravenous urography evidenced the urological repercussions of the disease process consisting of medialization of the left ureter, ureterohydronephrosis, and anterior and lateral displacement of the kidney. Although this condition is considered by most to be a surgical emergency, we opted for conservative treatment because the patient had no hemodynamic instability, severe obstructive uropathy or signs or crural paralysis. The literature on the urological repercussions of psoas hematomas due to anticoagulant therapy is briefly reviewed.

[Clinical and bacteriological aspects of urinary infections associated with male urethral stenosis]. / Aspectos clínicos y bacteriológicos de las infecciones urinarias asociadas a estenosis uretral masculina.

Urinary infections are extremely frequent in male urethral stenosis. We analyse in the present work its real incidence, clinical and microbiological aspects, complications and morbidity, in a group of 175 male patients presenting urethral stenosis evaluated in our hospital during a period of time of 11 year. We point out the high incidence of urinary infections which in our study affected 36% of patients. It was caused in 90% of cases by a single bacteria, 44% of which were due to Escherichia Coli. It had a high morbidity with complications appearing in 42 of the patients presenting urethral stenosis and urinary infection (67%), and requiring surgery in 19 cases. On the other hand, urinary infection is an important etiological factor in the genesis of urinary stenosis, finding a direct post-infection etiology in 19% of the studied stenosis. To conclude the present study, we can deduce that when presented with a case of a male patient affected of urethral stenosis, we must think of a possible infective mechanism, existing also a great probability that his urine is still infected by the causing or other micro-organism.

[Exophthalmos caused by orbital metastasis of prostatic carcinoma]. / Exoftalmos por metástasis orbitaria de carcinoma prostático.

A case of orbital metastasis from Whitmore stage D adenocarcinoma of the prostate is described. Clinically, it presented as rapidly progressing exophthalmos of the right eye with elevation (ptosis) and abduction paralysis. The associated clinical picture of a one-year history of prostatism prompted patient referral to our department. When a patient presents with an orbital tumor and a history of cancer localized to another site, the metastatic origin of the condition should be suspected and metastasis to other sites sought. A negative finding warrants performing orbital biopsy to confirm the diagnosis. Although excision of single metastatic tumors in this site has been described, coexisting metastasis to bone and lymph nodes, the hormone dependence that these present and prostatic cancer contraindicate resection of the orbital metastatic tumor. Following bilateral orchiectomy and hormone therapy with antiandrogens micturitional symptomatology improved, tumor size was reduced, and exophthalmos disappeared. The case described herein is not the first case of this type of metastatic lesion reported in the literature; 28 cases have been reported to date. This uncommon clinical presentation with extraurological manifestations gives us an idea of the broad clinical spectrum the biological behaviour of this tumor type can adopt.