[Renal hematoma after shockwave extracorporeal lithotripsy]. / Hematomas renales tras litotricia extracorpórea por ondas de choque.

OBJECTIVE: Renal haematomas after shock wave extracorporeal lithotripsy (SWEL) represent a potentially serious complication. This paper examines those cases of post-SWEL renal haematoma seen in our Centre, analyzing the likely risk factors. PATIENTS AND METHODS: Between May 1988 and June 1996, 12,800 patients were treated with 15100 lithiasis at some level of the urinary tract requiring 16,000 SWEL sessions. All treatments were done with a Dornier HM-4 lithotripter. Voltage applied ranged from 18 to 26 Kv, averaging 2500 waves/session. Complementary testing (ultrasound/computerised tomography) was requested immediately after treatment if clinical complications were suspected. RESULTS: A total of 10 renal haematomas (0.078%) were diagnosed. Six cases were mild, but 4 presented extensive haematoma with significant haemodynamic consequence. Although in one case nephrectomy was undertaken to control haemorrhage, death finally occurred by disseminated intravascular coagulation. Four patients who developed haematoma were hypertensive and 3 had a previously corrected haemostasis alteration. CONCLUSIONS: The possibility of renal haematoma should be taken into account in the face of persistent and unjustified pain after SWEL treatment. Normalization of blood pressure values, correction of urinary infection as well as adequate correction of haemostatic disorders is advisable.

[Conservative treatment in major kidney trauma]. / Tratamiento conservador en traumatismo renal mayor.

The kidney is frequently involved in penetrating abdominal injuries, and less so in closed abdominal traumatism. This paper presents one case of major renal trauma with total renal fracture and development of urinoma that separated both segments that, after a minimally invasive manoeuvre (percutaneous drainage), evolved favourably thus avoiding a surgical procedure which, quite reasonably, would have led to nephrectomy.

[Penile erectile dysfunction secondary to hypophyseal adenoma]. / Disfunción erectil peneana secundaria a adenoma hipofisario.

Increased production of prolactin by the pituitary is a factor to be taken into account as a cause of peneal erectile dysfunction (PED), which varies depending on the series from 1 to 16%. 1,2,7 We contribute in this paper one patient with infertility and erectile dysfunction secondary to a prolactin-producing pituitary tumour, prolactin plasma levels returning to normal after treatment with bromocriptine, which also achieved a remission of the clinical picture.