Estrangulación de la base peneana por aros metálicos / Penile strangulation by metallic rings

Presentamos dos casos clínicos recientes de pacientes que acuden al Servicio de Urgencias por presentar lesión en base de pene por estrangulación de aro metálico (Doble anilla de llavero) que se resolvieron mediante sección del cuerpo metálico. Revisamos la literatura sobre esta patología excepcional y su manejo terapéutico. (AU)

[Strangulation of penile base by metallic rings]. / Estrangulación de la base peneana por aros metálicos.

We report two cases of patients who went to the emergency department complaining of penile strangulation due to metallic rings (Double key ring) at the base of the penis which was resolved by cutting the metallic rings. We look trough the scientific literature about this unusual pathology and its management.

[Effect of potassium citrate in the prophylaxis of urinary lithiasis]. / Efecto del citrato potásico en la profilaxis de la litiasis urinaria.

OBJECTIVE: The physiologic effects of potassium citrate on urinary solubility have led to their use to facilitate stone passage after lithotripsy. The aim of our study is to evaluate the foregoing effects and the efficacy of long-term treatment with potassium citrate to prevent stone recurrence in patients undergoing extracorporeal shock wave lithotripsy. METHODS: A prospective study was conducted on 100 patients with calcium oxalate or calcium phosphate nephrolithiasis that had undergone treatment by extracorporeal shock wave lithotripsy (ESWL). The patients were divided into 4 groups: patients that were stone-free treated with potassium phosphate (25 cases) or fluid diet (25 cases) and patients with persistent residual lithiasis treated with potassium citrate (25 cases) or fluid diet (25 cases). Calculi were classified according to the changes observed during the study compared with the pre-study status as stable (no changes from the pre-study status, with or without residual stone), increased (increase in number or size of the residual stone or recurrence), and decreased (decrease in number or size or passage of the residual stone). RESULTS: Of the 50 patients treated with potassium citrate, 35 (70%) remained stable, 10 cases (20%) showed a decrease and 5 (10%) showed an increase. Of the 50 patients on fluid diet, 19 (38%) remained stable throughout the study, 4 (8%) showed a decrease and 27 (54%) showed an increase in stone size or number. The number of stone recurrence throughout the study in the 100 patients was 25 (25%); of these, 8 were in patients treated with potassium citrate and 17 of those that did not receive potassium citrate. CONCLUSIONS: Potassium citrate therapy has been found to be statistically significantly effective in the control of post-lithotripsy residual stone and stone recurrence.

[Renal cell carcinoma in patient with situs inversus and Kartagener syndrome]. / Carcinoma de células renales en paciente con situs inversus y síndrome de Kartagener.

A case of a adenocarcinoma renal in a patient with situs inversus complete to which was associated bronchiectasis and chronic sinusitis (kartagener's syndrome) is reported. It is the third case described in the international literature of a renal cells carcinoma in a patient with situs inversus totalis and the first in patient the one which has the triada classic of the kartagener's syndrome plus sterility. The tumor was discovered in a way incidental upon accomplishing a TAC toracoabdominal and was solved through nefrectomia for lumbotomy approach.

[Renoureteral malformation and lithiasis. Therapeutic approach]. / Malformaciones renoureterales y litiasis. Enfoque terapéutico.

OBJECTIVE: To analyze our results in the treatment of calculi in renoureteral malformations with extracorporeal shock wave lithotripsy (ESWL) alone and the efficacy of ESWL and adjuvant methods in the resolution of calculi in different types of renoureteral malformations. METHODS: The study comprised 141 cases of renoureteral malformations with urinary calculi; 68 were renal, 69 ureteral and 4 in the Bricker urinary diversion. All patients had been diagnosed by IVP and treated by ESWL. These patients were compared with a control group of 125 patients with calculi and a normal renoureteral system that were treated similarly. RESULTS: The malformations accounted for 2.61% of the 5,400 patients that had been treated in our unit from 1990-1998. The mean number of sessions for the patients with malformations was 1.5 versus 1.2 for the control group. The results of treatment were significantly lower for the group of patients with renal malformations than for the control group (54% vs. 87.2%, respectively). Similar results were obtained for the group of patients with ureteral malformations and the control group (87% vs. 75%). CONCLUSIONS: ESWL can be the first treatment option for calculi in patients with renal malformations, although they should be individually evaluated for status of the excretory system, urinary flow dynamics and size of the calculus in order to select the best treatment option. In patients with ureteral malformations, the same criteria utilized for those with a normal excretory system should be applied.

Carcinoma de células renales en paciente con situs inversus y síndrome de Kartagener / Renal cell carcinoma in a patient with situs inversus and Kartagener's syndrome

Se presenta el caso de un adenocarcinoma renal en un paciente con situs inversus completo al que se asociaban bronquiectasias y sinusitis crónica (síndrome de Kartagener). Es el tercer caso descrito en la literatura internacional de un carcinoma de células renales en un paciente con situs inversus total y el primer en el que el paciente tiene la triada clásica del síndrome de Kartagener más esterilidad. El tumor se descubrió de forma incidental al realizar un TAC toraco-abdominal y se resolvió mediante nefrectomía por vía lumbotómica (AU)

[Spontaneous renal hemorrhage. Report of 8 cases]. / Hemorragia renal espontánea. A propósito de ocho casos.

Spontaneous renal haemorrhage or Wünderlich syndrome is a rare condition; it is however of great significance given the emergency, sometimes vital, situation that it creates. The etiology of the condition is varied, the most frequent being tumoral. The clinical manifestations and the use of imaging techniques are of great interest to establish the diagnosis. The choice treatment is controversial. This paper presents eight cases of Wünderlich syndromes seen in our urology service. The background, etiology, clinical manifestations, diagnostic methods and treatment used in each case are analyzed.

[Relationship between female stress urinary incontinence intensity and the data of urethral pressure profile]. / Relación entre la intensidad de la incontinencia urinaria de esfuerzo femenina y los datos del perfil de presión uretral.

OBJECTIVE: To determine the utility of the urethral pressure profile in the diagnosis of stress urinary incontinence and its possible correlation with the degree of severity of incontinence. METHODS: 175 female patients with a clinical history of urinary incontinence were evaluated; of these, 50 cases with bladder instability demonstrated by the urodynamic studies were excluded. Patient evaluation included clinical history, physical examination, analytical studies, radiological evaluation and complete urodynamic assessment, including uroflowmetry, filling and voiding cystometry, and static and dynamic urethral pressure profiles. A 10 Fr microtransducer catheter was utilized for the urethral pressure profile studies. ICS recommendations were observed. Patients were classified into three groups according to the severity of urinary incontinence based on the clinical data, physical examination and urodynamic findings. The Wilcoxson test and 2 x 2 contingency table were employed for the statistical analysis. RESULTS: Of the parameters analyzed for the static urethral pressure profile, statistically significant differences were found only for the maximum urethral pressure and maximum closing urethral pressure in the different groups of patients. No differences in total length or functional urethral length were observed. Comparison of the dynamic urethral pressure profiles of the different groups showed a statistically significantly higher proportion of patients with a negative dynamic urethral closing pressure in the group of patients with urodynamically and clinically demonstrated urinary incontinence than in those with no urodynamically or clinically demonstrable incontinence. CONCLUSIONS: The urethral pressure profile is sufficiently reliable to confirm the diagnosis of urinary incontinence and its degree of severity. As a diagnostic test in urinary stress incontinence, it has a sensitivity of 89% and a specificity of 95%.

[Myasthenia gravis as paraneoplastic syndrome in small cell tumor of the bladder]. / Miastenia gravis como síndrome paraneoplásico en tumor vesical de células pequeñas.

Only 0.48% of vesical tumours are of the small cells epithelial type with positive neuroendocrine immunohistochemical markers, although the description of new cases is becoming increasingly common. These tumours may be associated to paraneoplastic syndromes of the endocrine and neurological types. This paper contributes one case report of a female patient diagnosed with a small cells epithelial vesical tumour associated to myasthenia gravis. The histological and histochemical features as well as the differential diagnosis with other tumours of vesical location are explained. Clinically, these entities evolve with acute haematuria and have a highly aggressive evolution. Quite frequently the tumour is associated to neuromuscular syndromes such as Lamber-Eaton's, myasthenia-like syndromes, and in rare occasions to myasthenia gravis. Different studies have reported anti-acetylcholine receptors in cells of this tumoral class that may stimulate the formation of antibodies against the neuromotor plaque. Diagnosis of this neurological syndrome and other similar ones may be attributed to early treatment and better prognosis of this tumoral entity.

[Profiles of urethral pressure, measured with microtransducers, in the assessment of female stress urinary incontinence]. / Perfiles de presión uretral, medidos con microtransductores, en la valoración de la incontinencia urinaria de stress femenina.

OBJECTIVES: This study was conducted to evaluate the usefulness of urethral pressure profiles in the diagnosis of urinary stress incontinence and to determine the possible correlation of such profiles with the degree of incontinence. METHODS: An initial group of 92 female patients were studied; 29 that presented vesical instability in the urodynamic studies were posteriorly discarded from the study. Patient evaluation included clinical history, physical examination, analytical, radiological and urodynamic studies, including uroflowmetry, filling and emptying cystometry and static and dynamic urethral pressure profiles. A Phoenix 5 and a 10 F microtransducter catheter were used to carry out the necessary evaluations. ICS recommendations were observed. In the statistical analysis of the results, the Wilconson test and contingency table of 2x2 were employed. RESULTS: In the different groups, the parameters analyzed in the static urethral pressure profiles revealed only statistically significant differences in maximum pressure urethral values and maximum closing urethral pressure. No differences in either total length or in functional urethral length were observed. The values of the dynamic urethral pressure profiles of the different groups were compared. There was a statistically significantly higher proportion of patients that presented a negative closing urethral pressure dynamics in the group of women with urodynamically and clinically demonstrated urinary incontinence in comparison to the group of women whose incontinence was not demonstrated either by urodynamic or physical explorations. CONCLUSIONS: The urethral pressure profile is sufficiently reliable in confirming both the diagnosis of urinary incontinence and its degree of severity. As a diagnostic test for urinary stress incontinence, it has a sensitivity of 82% and a specificity of 90%.

[Clinico-flowmetric analysis of patients being surgically treated for BPH]. / Análisis clínico-flujométrico en pacientes sometidos a tratamiento quirúrgico por H.B.P.

Benign prostatic hypertrophy (BPH) is a common urological disease with a standard surgical approach, transurethral resection (TUR) or open adenectomy (OA), but the flowmetric clinical results are controversial. Fifty-five patients were evaluated; in 23 of them TUR was performed and 32 underwent OA. The Boyarsky clinical questionnaire was filled in, and a flow evaluation conducted prior and subsequent to the procedure to measure maximum and average flow (Qmax and Qave) which was correlated to mictional volume according to Siroky's nomogram. The purpose is to compare the flowmetric clinical results of TUR and OA, and to evaluate flowmetry as a prognostic factor. Correlation of obstructive symptoms and Qmax is low (r = 0.49) and minor for irritative symptoms. Both groups of patients achieve significant clinical improvement (p < 0.001). OA obtains a 248% increase in Qmax, while this figure is 76% with TUR. Patients with post-treatment obstruction after OA are 9.3%, and 26.9% for TUR. Results are better when Qmax prior to surgery is < 5 ml/s than when it is > 10 ml/s.