[Validation of the modified IMPROVE scale in patients undergoing primary total hip arthroplasty]. / Validación de la escala IMPROVE modificada en pacientes sometidos a artroplastía total de cadera primaria.

INTRODUCTION: Major orthopedic surgery such as total hip arthroplasty (THA) is associated with an increased risk of postoperative complications. Candidates for THA are often older adults, with comorbidities that increase the risk of major bleeding, the IMPROVE scale has independent actors on the risk of bleeding according to the characteristics of the patients at hospital admission. It foresees the possibility of hemorrhage and the need for blood transfusion, being support in decision-making in the planning of a safe THA with the provision of the necessary resources. OBJECTIVE: To evaluate the sensitivity, validity and reliability of the modified IMPROVE scale in patients undergoing primary total hip arthroplasty. MATERIAL AND METHODS: Study of processes with a sample of 131 patients undergoing primary THA, in the period from January 01, 2018 to July 01, 2018. RESULTS: The scale presents good reliability, as for the performance of the scale, a good sensitivity was obtained, classifying 96.9% of the patients correctly; which is suitable for the type of scale. CONCLUSIONS: The modified IMPROVE scale is a discretely adequate and useful tool for the prognosis of bleeding risk in patients who undergo THA, compared with other assessment scales developed in other geographical areas. It is recommended to continue with the study of risk factors for major bleeding in this specific population.

INTRODUCCIÓN: La cirugía ortopédica mayor, como la artroplastía total de cadera (ATC), se asocia con mayor riesgo de complicaciones postoperatorias. Los candidatos a ATC con frecuencia son adultos mayores, con comorbilidades que aumentan el riesgo de hemorragia mayor. La escala IMPROVE tiene factores independientes sobre el riesgo de sangrado según las características de los pacientes al ingreso hospitalario, prevé la posibilidad de hemorragia y la necesidad de transfusión sanguínea, siendo apoyo en la toma de decisiones en la planeación de ATC seguras con la probabilidad de prever los recursos necesarios. OBJETIVO: Evaluar la sensibilidad, validez y confiabilidad de la escala IMPROVE modificada en los pacientes sometidos a artroplastía total de cadera primaria. MATERIAL Y MÉTODOS: Estudio de procesos con una muestra de 131 pacientes sometidos a ATC primaria, en el período del 01 de Enero al 01 de Julio de 2018. RESULTADOS: La escala presenta una buena confiabilidad, en cuanto al rendimiento se obtuvo una buena sensibilidad, clasificando al 96.9% de los pacientes correctamente, lo cual es adecuado para el tipo de escala. CONCLUSIONES: La escala IMPROVE modificada es una herramienta discretamente adecuada y útil para el pronóstico del riesgo hemorrágico en pacientes que se someten a una ATC primaria comparada con otras escalas de valoración desarrolladas en otras zonas geográficas. Se recomienda seguir con el estudio de los factores de riesgo de sangrado mayor en esta población en específico.

[Adenomatoid tumor of the epididymis]. / Tumor adenomatoide de epididimo.

OBJECTIVE: Paratesticular tumors are very rare and mostly bening. Wa aport a new case of adenomatoid tumor of epididymis METHOD: Male of 40 years old with solid lesion in epidididymis tale treated with mass exéresis RESULTS: Adenoamotid tumor of the epididymis confirmed with hystopathologic technique CONCLUSION: Adenomatoid tumor of epididymis is the most frequent paratesticular tumors and when is suspected, conservative surgery must be performed.

Tumor adenomatoide de epididimo / Adenomatoid tumor of the epydidimis

Objetivo: Los tumores paratesticulares son poco habituales siendo en la mayoría de los casos benignos. Aportamos un nuevo caso de tumor adenomatoide de epidídimo. Método: Varón de 40 años con masa sólida en cola epidídimo tratada mediante exéresis de la misma Resultados: Tumor adenomatoide confirmado mediante inmunohistoquímica Conclusión: El tumor adenomatoide es el más frecuente de los tumores paratesticulares y su sospecha permite realizar cirugía conservadora

Objective: Paratesticular tumors are very rare and mostly bening. Wa aport a new case of adenomatoid tumor of epididymis Method: Male of 40 years old with solid lesion in epidididymis tale treated with mass exéresis Results. Adenoamotid tumor of the epididymis confirmed with hystopathologic technique Conclusion: Adenomatoid tumor of epididymis is the most frequent paratesticular tumors and when is suspected, conservative surgery must be performed

[Predictive model for prostate cancer in patients with biopsy indication]. / Modelo predictivo de cáncer de próstata en pacientes con indicación de biopsia.

OBJECTIVE: Attemp to determine the probability of developing prostate carcinoma taking into acc age, digital rectal examination and PSA once a transrectal biopsy has been indicated, so that both doctors and patients have mor information to face such pathology. MATERIAL AND METHODS: Retrospective study of 633 biopsies, taken into acc the patient's age, digital rectal examination, PSA level and histology. The data were included in a database created with Access and were put a logistic regression by mens the software program SPSS. RESULTS: Once the biopsy is indicated, digital rectal examination is the parameter offesing a higher discriminatory valuer with an odd ratio of 5.9 (CI 95%, 3.9-8.9). The mathematical model obtained shows a sensitivity level of 57% and a level of specificity of 84%. Pre-test probability is 36%, the probability post-test increasing up to 70%, and a negative predictive value of 77% and a positive predictive value of 67%. CONCLUSIONS: The mathematical model obtained individually determines the probability of suffering from prostatic carcinoma. Moreover, using this model the probabilities obtained re more precise than those derived from the fact of fulfilling the criteria for a prostatic biopsy. Once a biopsy is indicated, the rectal examination becomes the parameter with a higher predictive value of PC, irrespective of PSA and age. The PPV of the model is higher than of the PSA or the digital recta examination used separately.

Modelo predictivo de cáncer de próstata en pacientes con indicación de biopsia / Predictive model for prostate cancer in patients with biopsy indication

OBJETIVO: Intentar conocer la probabilidad de padecer un carcinoma de próstata (CP) en base a la edad, tacto rectal (TR) y PSA, una vez indicada la realización de biopsia, con el fin de poseer mayor información a la hora de enfrentarnos, médico y paciente, a dicho problema. MATERIAL Y MÉTODO: Estudio retrospectivo de 633 biopsias prostáticas, analizando edad, TR, nivel de PSA y resultado histológico. Los datos fueron incluidos en una base de datos de Access, analizándolos mediante el programa SPSS con el que se realizó un análisis de regresión logística. RESULTADOS: Una vez indicada la biopsia, el TR es la variable con mayor poder de discriminación, con una odd ratio ajustada de 5,9 (IC 95 por ciento, 3,9-8,9). El modelo matemático obtenido posee una sensibilidad del 57 por ciento y una especificidad del 84 por ciento. La probabilidad pretest fue del 36 por ciento, pasando al 70 por ciento postest, con un valor predictivo negativo del 77 por ciento y positivo del 67 por ciento. CONCLUSIONES: El modelo matemático obtenido determina de forma individualizada la probabilidad de padecer un CP, y a su vez, más ajustada que la derivada de cumplir los criterios de biopsia. Una vez indicada la biopsia, la variable con mayor peso en la probabilidad de padecer CP es el TR, con independencia del PSA y la edad. El valor predictivo positivo del modelo es superior al del PSA o del TR utilizados de forma aislada (AU)

[Validation of ESCAP-CD as an instrument of measure for the evaluation of the quality of life in prostatic cancer. Part 2a]. / Validación del ESCAP-CDV como instrumento de medida para la valoración de la calidad de vida en el cáncer de próstata. 2a Parte.

UNLABELLED: In order to make a measure of quality of life related to health (QLRH) useful in the investigation, it must fulfill the psychometric properties (validity, reliability and sensibility). The selection of an instrument is a job for the clinic that must choose the most effective for each proposed objective. We set out the objectives to validate the ESCAP-CDV in a multicentric study in Andalusia. We studied 88 patients who were submitted to the instrument presented to validation and two more tests recognized already: the QLQ-C30 from EORTC gold standard in Europe in the valuation of the neoplastic patients' quality of life and the KARNOFSKY the most clinic utility index in neoplastic patients, used to correlate the items. RESULTS: Questionnaire acceptance analysis: The difficulty of understanding was greater for QLQ C30 items (6.81%) than ESCAP items (1.98%). The lapse of time needed to carry out the test was shorter in the ESCAP test (9.84 min) than in the QLQ C30 (13.13), test. Structural analysis or internal validity analysis: The homogeneity index of the items is high (alfa of Cronbach = 0.93). The dimensionality proposed is not accepted, due to the existence of some modifications pund in the factorial analysis. Finally, the established dimensions: Physical and Emotional Capacity (PEC), 5 items; General Symptoms (GS), 4 items; Pain (P), 3 items; Ligh Functional Capcity (LFC), 4 items; Serious Functional Capacity (SFC), 2 items; Economic State (ES), 3 items; Social and Family State (SFE), 5 items; Capacity Sexual (CSX), 2 items; Isolated Variables (IV), 2 items; and Specific Questionnaire (P), 6 items. The ESCAP is a scale with a normal distribution. Approach or external validity analysis: The ESCAP test is well correlated with the other two scales. Reliability test retest: The interclass correlation coefficient is 0.94 in the ESCAP, not so in the KARNOFSKY that is 0.77. CONCLUSIONS: The ESCAP-CDV is a new instrument of valuation of the QLRH composed of a general questionnaire and other specific test of prostate cancer. It has turned out to be a very homogeneous scale due to its internal consistence (alfa of Cronbach of 0.93), showing that it has a normal distribution, that correlates correctly with the scales compared and it is a valid scale to measure the prostate cancer patients' quality of life. The ESCAP-CDV has shown to be a scale with a high reliability (0.94), setting up as an instrument not only useful for investigation, but to clinical use, as well.

[Development of the ESCAP-CDV as measuring tool for the assessment of quality of life in prostatic cancer]. / Desarrollo del ESCAP-CDV como instrumento de medida para la valoración de la calidad de vida en el cáncer de próstata. Primera parte.

The current following of oncological patients is based in a biopsychosocial model where in addition to evaluate the response to treatment, the interval free of illness and the global survival it includes the functional capacity and the psychosocial charge the illness causes in patients. Nowadays, different treatments have improved the survival, therefore the number of years of inability increase. It creates a new variable, the quality of life related to health (QLRH) that valves the individual respond to the physical, mental and social effects that health or illness produces on patients daily life. To establish the QLRH as an instrument of measure is needed. In Spain there isn't any validated instrument for the evaluation of it in patients with prostate cancer. We have developed the ESCAP-CDV (Quality of Life study on prostate cancer) an instrument elaborated by an interdisciplinary group made of urologist, psichologists and a doctor specialized in family medicine expert in psychometric validation of scales. We evaluate multiple dimensions of quality of life in a questionnaires autoadministed.

Validación del escap-cdv como instrumento de medida para la valoración de la calidad de vida en el cáncer de próstata. 2ª parte / Validation of SCAP-CDV as an instrument of measure for the valuation of the quality of life on the prostate cancer

Para que una medida de calidad de vida relacionada con la salud (CVRS) sea útil en la investigación debe de cumplir las propiedades psicométricas (validez, fiabilidad y sensibilidad). La selección de un instrumento es tarea del clínico que debe escoger aquel más efectivo para cada objetivo propuesto. Nos marcamos unos objetivos para validar el ESCAP-CDV en un estudio multicéntrico andaluz. Se recogieron 88 pacientes que se someten al instrumento presentado a validación y dos test más reconocidos en la actualidad: el QLQ C30 de la EORTC gold estándar en Europa en la valoración de la calidad de vida del paciente neoplásico y el KARNOFSKY, índice de mayor utilidad clínica en los pacientes neoplásicos que sirven para correlacionar los ítems entre sí. RESULTADOS: Análisis de aceptación de los cuestionarios: La dificultad de compresión fue mayor para los ítems del QLQ C30 (6,81 per cent) que para el ESCAP (1,98 per cent). El tiempo necesario para cumplimentar el test fue menor en el ESCAP (9,84 min) que en el QLQ C30 (13.13).Análisis estructural o de validez interna: El índice de homogeneidad de los ítems es alto (alfa de Cronbach = 0,93). La dimensionalidad propuesta no se acepta, existiendo una serie de modificaciones que se pone de manifiesto en el análisis factorial. Las dimensiones definitivas quedan establecidas: Capacidad Psíquica y Emocional (CPS), 5 ítems; Síntomas Generales (SG), 4 ítems; Dolor (D), 3 ítems; Capacidad Funcional Leve (CFL), 4 ítems; Capacidad Funcional Grave (CFG), 2 ítems; Estado Económico (EE), 3 ítems; Estado Social y Familiar (ESF), 5 ítems; Capacidad sexual (CSX), 2 ítems; Variables Aisladas (VA), 2 ítems y Cuestionario Específico (P), 6 ítems. El ESCAP es una escala con distribución normal. Análisis de criterio o validez externa: El ESCAP se correlaciona bien con las otras dos escalas. Fiabilidad test retest : El coeficiente de correlación interclase es de 0,94 en el ESCAP, no así en el KARNOFSKY que es de 0,77. CONCLUSIONES: El ESCAP-CDV es un instrumento nuevo de valoración de la CVRS constituido por un cuestionario general y otro específico del cáncer de próstata. Ha resultado ser una escala muy homogénea debido a su consistencia interna (alfa de Crombach de 0,93), demostrándose que posee una distribución normal, que se correlaciona muy bien con las escalas comparadas y que es escala válida para medir la calidad de vida de los pacientes con cáncer de próstata. El ESCAP-CDV ha mostrado ser una escala con una alta fiabilidad (0,94), constituyéndose en un intrumento no sólo útil para investigación sino para uso clínico (AU)

Desarrollo del escap-CDV como instrumento de medida para la valoración de la calidad de vida en el cáncer de próstata. Primera parte / Development of escap-DCV as an instrument of measure for the valuation of the quality of life on the prostate cancer

El seguimiento actual de los pacientes oncológicos está basado en un modelo biopsicosocial donde además de valorar la respuesta al tratamiento, el intervalo libre de enfermedad y la supervivencia global se incluye la capacidad funcional y la carga psicosocial que la enfermedad desarrolla en los pacientes. Los distintos tratamientos actuales han hecho mejorar la supervivencia, por lo que el número de años con incapacidad aumenta. Se crea una nueva variable, la Calidad de Vida Relacionada con la Salud (CVRS) que valora las respuestas individuales a los efectos físicos, mentales y sociales que la salud o la enfermedad produce sobre la vida diaria de los pacientes. Para establecer la CVRS hace falta un instrumento de medida. En España no existe ningún instrumento validado para la valoración de ésta en los pacientes con cáncer de próstata. Hemos desarrollado el ESCAP-CDV (Estudio sobre la Calidad de Vida en el Cáncer de Próstata), un instrumento elaborado por un grupo interdisciplinar compuesto por urólogos, psicólogos y médico especialista en medicina de familia experto en validación psicométrica de escala. Valoramos múltiple dimensiones de la calidad de vida en un cuestionario auto-administrado (AU)

[Radical prostatectomy or radiotherapy? A qualitative structured review]. / Prostatectomía radical o radioterapia? Una revisión estructurada cualitativa.

We performed a structured literature review to define de effectiveness of radical prostatectomy and external radiotherapy for treatment of localized prostate cancer. We identified 463 articles in MEDLINE for January 1990 through april 2000. As judged from our analysis, prostatectomy radical has marginal benefit in terms of supervivency and disease free respect to external radiotherapy with the same quality of life.

¿Prostatectomía radical o radioterapia? Una revisión estructurada cualitativa / Radical prostatectomy or radiotherapy? An structured literature

Desarrollamos una revisión bibliográfica estructurada cualitativa para definir las evidencias que soportan la prostatectomía radical y la radioterapia como tratamiento del carcinoma de próstata localizado. Identificamos 463 artículos que cumplían los criterios de inclusión en MEDLINE desde enero de 1990 hasta abril del 2000. Las evidencias, con un nivel moderado-bajo concluyen que la prostatectomía radical ofrece ciertos beneficios en términos de supervivencia e intervalo libre de progresión respecto a la radioterapia externa sin perjuicio de la calidad de vida (AU)

[Renal cancer: descriptive analysis of a series of 267 intervened cases]. / Cáncer renal: análisis descriptivo de una serie de 267 casos intervenidos.

OBJECTIVE: To present the results of a descriptive analysis of 267 surgically treated renal tumors. METHODS: From January 1986 to October 1999, 267 patients (153 males and 114 females) with renal tumor were treated in our department. All data were introduced into the Access data base program and analyzed using the SPSS software. Descriptive analysis was performed and life expectancy was calculated with the Kaplan-Meier survival curve. Mean follow-up was 42.72 months. RESULTS: 56.4% were in the right and 43.6% were in the left kidney. 41.2% of the cases were incidentally discovered. In the symptomatic patients, the most common presenting feature was hematuria (51.8%). Radical nephrectomy was performed in 94.2%, partial in 3.1% and tumor resection in 2.7%. The lumbar approach was used in 75.5% of the cases. In regard to the histology, 88.7% were carcinomas. Clear cell was the most frequent cell type (91.5%). By grade, 55.8% were GI, 32.9% GII and 11.3% were GIII. By stage (according to the 1992 TNM classification), 64.3% were stage I, 15.4% stage II, 17% stage III and 3.3% stage IV. 80.5% showed no vascular involvement. The 5-year overall survival was 71.93% (mean 114 months; median 167 months). Currently, 76% of the patients are alive. CONCLUSIONS: Distribution by sex in our series was different to that reported in most of the studies. The tumor was incidentally discovered in a high proportion of the cases. The lumbar access was the most widely used surgical approach. The overall survival is similar to that reported by other groups.

[Incidental diagnosis of renal carcinoma. Does it imply a better prognosis?]. / Diagnóstico incidental del carcinoma renal. Implica un mejor pronóstico?

OBJECTIVE: We present 267 patients undergoing surgery for renal carcinoma, comparing the incidental tumour and symptomatic tumour with different parameters and evaluating the prognostic significance of the incidental diagnosis. MATERIAL AND METHODS: Of the 267 patients, 110 (41.2%) were diagnosed incidentally. The different variables analysed were: age, sex, tumour size, if unilateral or bilateral, histological type, stage, degree of cellular differentiation and survival. The mean follow-up period was of 43.32 mos in the symptomatic patients and 41.85 mos in the patients diagnosed incidentally. The data obtained was analysed with the SPSS statistic pack. RESULTS: No significant difference was detected between both groups in regards to age, sex, if unilateral or bilateral and histological type. Comparing tumour size, a statistic difference was observed with slices at 6 cm. When analysing the stage and degree of cellular differentiation, a significant difference is found with tumours diagnosed incidentally presenting better differentiation and a lower stage at the moment of diagnosis. Survival after 5 yrs was of 65.7% for symptomatic patients in comparison to 81.7% for the incidental group, which implies high statistical signification (log rank = 0.0018). CONCLUSIONS: In our series no significant differences were detected between incidental and symptomatic tumours when comparing age, sex, anatomic side and histological type. Significant differences were indeed detected in relation to size, degree of cellular differentiation, tumour stage and survival.

Diagnóstico incidental del carcinoma renal. ¿Implica un mejor pronóstico? / Incidental diagnosis of renal carcinoma. Does this imply a better prognosis?

OBJETIVO: Se analizan 267 pacientes intervenidos quirúrgicamente de carcinoma renal, comparando el tumor incidental y el sintomático en relación a diversos parámetros, y valorando la significación pronostica del diagnóstico incidental. MATERIAL Y MÉTODOS: De los 267 pacientes, 110 (41,2 por ciento) fueron diagnosticados de forma incidental. Las variables analizadas fueron edad, sexo, tamaño tumoral, lateralidad, tipo histológico, estadio, grado de diferenciación celular y supervivencia. La media de seguimiento ha sido de 43,32 meses en los sintomáticos y 41,85 meses en los incidentales. Los datos obtenidos fueron analizados mediante el paquete estadístico SPSS.RESULTADOS: No se ha encontrado diferencia significativa entre los dos grupos en relación a la edad, sexo, lateralidad o tipo histológico. Comparando el tamaño tumoral, se encontró diferencia estadísticamente significativa situando el punto de corte en 6 cm. Al analizar el estadio y grado de diferenciación celular, existe una diferencia significativa, resultando los tumores incidentales mejor diferenciados y en menor estadio al diagnóstico. La supervivencia a los cinco años ha sido del 65,7 por ciento en los sintomáticos frente al 81,7 por ciento de los incidentales, lo que supone una alta significación estadística (log rank = 0,0018).CONCLUSIONES: En nuestra serie, no existe diferencia significativa entre tumores incidentales y sintomáticos al comparar la edad, sexo, lateralidad y tipo histológico. Sí existe en relación al tamaño, grado de diferenciación celular, estadio tumoral y supervivencia (AU)

[Urinary lithiasis secondary to indinavir in an HIV-positive patient]. / Litiasis urinaria secundaria a Indinavir en enfermo HIV positivo.

OBJECTIVE: Indinavir is a protease inhibitor used in the treatment of HIV with a lithogenic capacity as a urological side effect. The pathogenesis, diagnosis and treatment of indinavir urolithiasis are briefly reviewed. METHODS: A 37-year-old male, seropositive for HIV on treatment with indinavir, lamiduvine and zidovudine, consulted for colicky left lumbar pain, nausea, vomiting and dark urine for the past three days. RESULTS: Patient evaluation showed a nonfunctioning left kidney and ureterohydronephrosis of unknown origin. URS showed a yellowish, friable material with a mucinous appearance that occupied the entire lumen of the ureter. Fragmentation was achieved with the lithotriptor probe. Six months later the patient had fully recovered and was asymptomatic. CONCLUSIONS: The incidence of protease inhibitor-induced urolithiasis is increasing. This condition should be distinguished from uric acid calculi whose treatment will aggravate the indinavir urolithiasis.

[Hydatid cyst and horseshoe kidney: an exceptional association]. / Quiste hidatidico y riñón en herradura: una asociación excepcional.

We report on a case of kidney ecchinococosis associated with a horseshoes renal anomaly. The diagnostic procedures used to confirm this association were serological tests, pyelography and computerized tomography. Periquistectomy was done with good recovery of the left renal unit. We believe to report on a pathological association extremely infrequent.

[Approximation to conservative surgery of Leydig cell tumor]. / Aproximación a la cirugía conservadora del tumor de células de Leydig.

OBJECTIVES: To analyze the clinical and histological characteristics of 5 cases of Leydig cell tumor in order to establish the criteria for conservative surgical management. METHODS: Of 31 testicular tumors diagnosed from 1982-1993, 5(16.1%) were Leydig cell tumors. We analyzed patient general characteristics, the prevalent feminizing (60%) and hypogonadal features and the histopathological characteristics that might indicate a non aggressive course of the tumor. RESULTS: No metastasis was observed at 522.9 months mean follow up. Three patients underwent orchidectomy through the inguinal approach; one case had been incidentally discovered after subalbuginea resection due to a disseminated prostatic carcinoma and the fifth patient was treated conservatively by tumorectomy and is tumor-free at more than 120 months follow up. CONCLUSIONS: Parenchyma-sparing surgery may have a place in the treatment of interstitial cell tumor, with evident endocrinological and psychological benefits, especially in the young males that meet the clinical and histological criteria for conservative surgical management.

[Renal incidentaloma and pregnancy]. / Incidentaloma renal y embarazo.

OBJECTIVES: To report a case of a renal mass that had been incidentally discovered during the first month of pregnancy. METHODS: The difficulties in determining the nature of such masses when they are small and the appropriate timing for surgical intervention are discussed. RESULTS: A presumptive diagnosis of angiomyolipoma was made from the findings of the imaging techniques, especially Doppler ultrasound. Histological examination confirmed the diagnosis. CONCLUSIONS: Ultrasound evaluation during pregnancy may incidentally discover an undetected pathology and should therefore systematically include the entire abdominal cavity. It is difficult to determine the appropriate time for surgery.

[Implantation of definitive pacemakers: experience with 500 patients]. / Implantacion de marcapasos definitivos: nuestra experiencia en 500 pacientes.

Five hundred patients to whom definitive cardiac pacemakers were implanted from June, 1978 to June, 1992 were studied. A predominance of males and the age group of 61-80 years was observed. The most frequent reason for seeking medical care was syncope, and III grade atrioventricular block is the most frequent cause requiring this kind of treatment whose etiology was associated with the sclerodegenerative disease of the conduction system. The right cephalic vein was the most used via of approach; among the complications recorded only 2 resulted in death of the patient (perforation of the left ventricle and traumatic pneumotorax.)

[Angiomyolipoma of the kidney. Comments on 3 recent cases]. / Angiomiolipoma renal. Comentarios sobre tres recientes observaciones.

We report another three cases of renal angiomyolipoma with different modes of presentation and treatment. Two cases are considered to be of particular interest; one patient presented chyluria in the course of the disease and Wunderlich's syndrome posteriorly, and in the other patient the presenting features were extrarenal. The diagnostic and therapeutic possibilities are discussed and attention is focussed on the conservative approach whenever possible.