[Surgical procedures of the urinary tract and male genital organs. Rates of surgical intervention: variability and its relationship with distance and income]. / Procedimientos quirúrgicos sobre aparato urinario y órganos genitales masculinos. Tasas de frecuentación quirúrgica: variabilidad y su relación con la distancia y renta.

OBJECTIVE: To valorate the existence of the variability, in surgical rates on urinary tract and masculine genital organs, between the population of Health Centres (HC) adscribed to the Hospital of Ciudad Real. It so, quantify the influence of the distance (from Health Center to Hospital) or the income have in the variability of these rates. MATERIAL AND METHOD: Surgical activity of the period 1996-98. It has been analyzed for every procedure: residence, sex, age and type (coded by CIE 9th MC). The surgical rates, standardized for age and sex, (TFQ) for every HC has been compared whit the mean (t alpha/2 n-1 alpha = 0.99) of the distribution of rates by HC. The relation between the TFQ and distance or income has been analyzed by lineal regression and ANOVA test for one variable, using the Newman Keuls test to assess the difference of the rates between the HC at different distance or income. It has been considered as significative every p < 0.05. RESULTS: The population studied has a TFQ significatively different (p < 0.01). significant relationship exists between the TFQ and the distance. There were no relations between the TFQ for HC and the income. CONCLUSIONS: 42% of the variance (variability) of the distribution of TFQ for HC is due to the distance.

Procedimientos quirúrgicos sobre aparato urinario y órganos genitales masculinos. Tasas de frecuentación quirúrgica: variabilidad y su relación con la distancia y renta / Surgical procedures on urinary tract and masculine genital organs. Surgical rates frequency: variability based on the distance and the income

OBJETIVO: Valorar la existencia de variabilidad en las tasas de frecuentación quirúrgica sobre aparato urinario y órganos genitales masculinos, entre los centros de salud adscritos al Complejo Hospitalario de Ciudad Real. Y en caso afirmativo, cuantificar la influencia que la distancia (desde el centro de salud al hospital) o la renta tiene en la variabilidad de estas tasas. MATERIAL Y MÉTODO: Actividad quirúrgica del periodo 1996-1998; discriminando según residencia, edad, sexo, o tipo de intervención realizada. La comparación de Tasas de Frecuentación Quirúrgica (TFQ) para cada grupo de procedimientos (CIE 91 MC) se ha realizado, tras ajustadas por edad y sexo, con la media poblacional (t/2 n-1 = 0,99) de la distribución de tasas por centro de salud. La relación entre la TFQ con la distancia o la renta se ha analizado mediante los modelos de regresión, Anova y prueba de Newman-Keuls. Se ha considerado como significativo todo resultado p < 0,05.RESULTADOS: Las poblaciones estudiadas presentan TFQ significativamente diferentes (p < 0,01). Existe relación significativa entre la TFQ y la distancia. No se ha encontrado esta relación entre la TFQ por centro de salud y la renta. CONCLUSIONES: El 42 por ciento de la varianza (variabilidad) de la distribución de TFQ por centro de salud es debida a la limitación que, para el acceso a este tipo de prestaciones, supone la distancia desde el centro de salud al hospital. El nivel de renta de la población no parece condicionar significativamente el uso de los servicios quirúrgicos en la población estudiada (AU)

[Urodynamics rationale. The flow curve]. / Fundamentos de Urodinámica. La curva de flujo.

OBJECTIVE: To describe the mathematical representation of a common phenomenon: the urinary flow curve. METHODS: The statistical adjustment for minimum squares was the method employed in the study. RESULTS: A mathematical expression was obtained with a goodness of fit for each flow curve and an acceptable margin of error. CONCLUSIONS: The model which considers the flow curve as a parabola is not useful since this is an expression of a statistical phenomenon that varies from case to case. We utilized the minimum squares fit to obtain a regression curve that provides the nearest possible representation of urinary flow. Furthermore, we consider the flow curve to be the result of forces that develop in the detrusor, which produces the complex phenomenon of voiding. This study is the first step toward the development of a mathematical representation of the urinary flow mechanics.

[Adrenal pseudocysts. Therapeutic attitude]. / Pseudoquistes suprarrenales. Actitud terapéutica.

OBJECTIVE: Cystic tumors of the adrenal gland are uncommon, but are being increasingly more frequently diagnosed during routine radiological evaluation as "incidentalomas". We discuss the differential diagnosis, therapeutic approach and the existing controversies concerning the management of this tumor type. METHODS: Two additional cases of adrenal pseudocyst in two women aged 47 and 38 years are presented. In one case the tumor was discovered incidentally, whereas the other case presented with acute pain arising from intracystic hemorrhage. RESULTS: The fist patient had a cystic tumor of 8 cm with some inner walls. Fine needle aspiration biopsy revealed a benign cystic lesion of the right adrenal gland. At laparotomy, an 8.5 x 4.5 cm multiloculated cystic lesion was excised. The second patient presented with abdominal pain due to intracystic hemorrhage. A Doppler US did not disclose any vessel inside the lesion. We performed a lumbotomy and excised a 7.5 x 6 cm cystic tumor located in the right adrenal gland. Both lesions were diagnosed as adrenal pseudocyst; the second case was a hemorrhagic one. CONCLUSIONS: The therapeutic approach in adrenal cystic tumors can be based upon the radiological and cytological findings since malignant cystic tumors are uncommon. A clear liquid and a negative cytology practically discard malignant tumors. Furthermore, cystic adenocarcinomas are usually large and the cystic liquid is cloudy with abundant cellularity. Surgical treatment is justified in the symptomatic, big or complex tumors (mixed, non-homogeneous).

[New contributions to the study of chromophobe-cell renal carcinoma]. / Nuevas aportaciones en el estudio del carcinoma renal de células cromófobas.

OBJECTIVE: The present study describes a case of the recently discovered chromophobe cell carcinoma of the kidney. Additional findings that have not been previously reported are presented and the importance of the clinical and anatomopathological diagnosis of this tumor type is underscored. METHODS: The tumor presented in a 72-year-old female with symptoms and signs that were not distinct from those of other more common renal tumors. She underwent a right radical nephrectomy. Histopathological, immunohistochemical and ultrastructural studies were performed and the findings were compared with those reported in the literature. RESULTS: The foregoing studies disclosed a chromophobe cell renal carcinoma, with some findings-chiefly ultrastructural-that have not been previously described. CONCLUSION: Chromophobe cell renal carcinoma, a tumor type that has recently been identified, is the subject of several studies that have been conducted to permit its clinical and anatomopathological characterization. The present study describes some observations which, to our knowledge, have not been previously described elsewhere.

[A giant bladder hernia. Apropos a case]. / Hernia vesical gigante. A propósito de un caso.

From a clinical point of view, vesical hernia is an uncommon condition. Occurrence is more frequent in male. In most cases diagnosis follows surgical repair of inguinal hernia, to which it may be associated (1-10% depending on the series). Unless complications arise, it evolves asymptomatically or reveals its presence by the distinctive two-stroke miction. Although infrequent, the most significant complications are incarcerations and strangulation with secondary necrosis of the vesical wall. Diagnosis is confirmed by radiological techniques: intravenous urography (IVU), retrograde cystography or computerised axial tomography (CAT). Treatment is always surgical. This paper presents one case of massive vesical hernia and a review of the relative literature.

[The dissolution of cystine lithiasis with n-acetylcysteine]. / Disolución de una litiasis cistínica con n-acetilcisteína.

OBJECTIVE: The results of in situ dissolution of a cystine calculus is described. This approach was attempted in a female patient for whom surgery was not considered to be the best therapeutic option. METHODS: An obstructive cystine calculus was treated by in situ litholysis using N-acetylcysteine applied locally via two percutaneous nephrostomies and adjuvant oral metaphylaxis. The patient had a long clinical history of lithiasis that had also required surgery and a family history of cystinuria. RESULTS: In situ litholysis completely dissolved the cystine calculus and avoided the need for a complex surgery. The procedure and a pharmacological analysis are presented. CONCLUSIONS: In our view, this procedure is practical, carries minimal morbidity and should be considered in the management of cystine calculus.

[Fibroepithelial polyp of the ureter]. / Pólipo fibroepitelial de uréter.

Exposition of one case of fibroepithelial polyp of the ureter in a young male patient. The interest of the case lies in the rarity of this entity. Review of all likely etiologies, clinical presentations and differential diagnosis, mainly with malignant tumours whose prognosis and treatment are entirely different. Endoscopic approach and surgical removal of the polyp and its base are the therapeutical choice for this type of neoformations.

[Primary epidermoid carcinoma of the bladder. Its diagnosis and treatment and a review of the literature]. / Carcinoma epidermoide primario de vejiga. Diagnóstico, tratamiento y revisión de la literatura.

Presentation of four patients with primary plain epidermoid carcinoma of the bladder. The patients, three men and one woman, aged 50-74 years, presented clinically with gross haematuria and irritative mictional syndrome; their background was prostatism with in-dwelling vesical catheter and repeat urinary infections. Revision of the immunohistochemical pattern and the clinico-pathological differential diagnosis, as well as the pathoetiology, biological behaviour and management of this uncommon type of tumour.

[Right hematocolpos and hematometra with left renal agenesis. A rare association. Apropos a case]. / Hematocolpos y hematometra derechos con agenesia renal izquierda. Una rara asociación. A propósito de un caso.

Although this anomaly is seen more frequently, the present case is unique in that the genital anomaly (imperforate vagina with the subsequent hematocolpos and hematometra) was associated with contralateral renal agenesis, whereas the cases reported in the literature have all been ipsilateral. Like most of the cases, the presenting symptom was acute urinary retention arising from extrinsic compression of the genital mass on the lower urinary tract. The embryological aspects of the genitourinary system concerning the present case are discussed, as well as some of the hypotheses that have been put forward to explain the etiology of these anomalies, although these have been developed on the basis of the associated ipsilateral anomalies observed.

[The Fabian prosthesis: our experience in 13 cases]. / Prótesis de Fabian: nuestra experiencia en 13 casos.

The spiral intraurethral prosthesis is a device that maintains the urinary tract expedite and overcomes the prostatic obstacle. It is used as an alternative in patients requiring permanent bladder catheters due to prostatic obstruction syndrome that are at high risk for surgery and in those patients that are on the waiting list for surgery. We report the results of a one-year follow-up of 13 patients in whom a prosthesis had been implanted. The spiral prosthesis had to be removed in 6 cases (one due to calcification two months after placement); the remaining 7 patients are still being followed. We briefly analyze the micturition hydrodynamics and the changes of the continence mechanisms and attempt to explain the poor flowmetry results and incontinence observed in these patients with the urological spiral prosthesis. We have recently abandoned the metal prosthesis and now use the so-called "intraureteral catheter" which has become available. However, further experience is warranted in order to determine its results.

[Early diagnosis of cancer of the prostate. Is is useful?]. / El diagnóstico precoz del cáncer de próstata. Es útil?

Endorectal sonography (ES) + fine needle aspiration biopsy (FNAB) constitute a considerable advancement in the diagnosis of prostate cancer (PC). With ES we can detect lesions less than 0.5 cm, and FNAB permits us to know its histologic nature. Both techniques complement each other and together permit accuracy and early diagnosis while other available methods do not. Cure of this tumor type, the second most frequent in men, is based on early diagnosis. Since early tumor staging is mandatory for adequate treatment, this can only be achieved if the tumor is diagnosed in the asymptomatic phase. The present study reviews the scant epidemiologic studies available reporting a prevalence of up to 30% in males over 50 years old. In our own study, our statistical data reveal a prevalence of 9.97/1000 which is no doubt lower than the true prevalence of this disease. We discuss the ultrasound features of prostate disease with a special focus on prostate cancer. Hypothetically, we compare the cost of screening or not screening for early diagnosis and conclude that this method is of the highest diagnostic value in early, correct treatment of this disease entity.

[Incrusted alkaline cystitis. Physiopathological basis for treatment with acetohydroxamic acid]. / Cistitis incrustada alcalina. Bases fisiopatológicas del tratamiento con ácido acetohidroxámico.

Alkaline incrusting cystitis is an uncommon clinical condition that usually presents in the course of bladder disease. It has characteristic presenting features and is difficult to treat despite currently available therapeutic measures. Three such cases that had been diagnosed and treated at our department is described herein. The literature is reviewed and the pathologic mechanisms of this condition are analyzed.