Severe oligoasthenoteratozoospermias, secretory and obstructive azoospermias: motility as a criterion of sperm viability.

PURPOSE: Comparison of pregnancy rates in cases of Secretory Azoospermias (SA), Obstructive Azoospermias (OA) and severe Oligoasthenoteratozoospermias (OATZ). Evaluation of sperm motility as a quality criterion. METHODS: In SA cases (n = 35), 9 samples were cryopreserved. In OA cases (epididymal aspiration: n = 91; testicular biopsy: n = 206), all samples were cryopreserved. 596 OATZ ejaculates were included. RESULTS: In SA cases, 2 pregnancies were achieved from 9 ICSI cycles. In OA, motile sperm rates were higher in testicular biopsies. After thawing sperm motility was not different between testicular and epididymal origin. 2 pregnancies were achieved with immotile testicular sperm after thawing, but none with immotile epididymal sperm. In OATZ cases, one pregnancy was obtained from the 9 cryopreserved ejaculates and 35.3% with fresh motile sperm. CONCLUSIONS: In SA cases, the use of donor sperm is recommended due to the lower pregnancy rate achieved. Motility, before and after cryopreservation, as a criterion of sperm viability is discussed and its use should be reconsidered in some cases.

[Treatment of males with post-prostatectomy stress urinary incontinence by a mesh anchored to the ischio-pubic bones]. / Tratamiento de la incontinencia urinaria de esfuerzo post-prostatectomía radical mediante malla anclada a ramas isquiopubianas.

We presented the results of an alternative in the treatment of the stress urinary incontinence of male radical postprostatectomy. Is a technique of renewed interest in the last years, cradle in the procedure of Stamey, consisting of placing an on guard suburetral polypropylene mesh, anchored by means of screws to the isquiopubian branches. We have applied the procedure in 4 patients and with stress urinary incontinence of long evolution. After an average pursuit of 12.5 months, two patients present total continence, one has improved significantly and in the other the incontinence persists. There have been no postoperating complications nor rejection of the mesh. From these preliminary results and the reviewed bibliography, we thought that this technique can constitute an alternative to the artificial urinary sphincter, dices its clinical results, its facility of execution, the good tolerance and his low cost.

Tratamiento de la incontinencia urinaria de esfuerzo post-prostatectomía radical mediante malla anclada a ramas isquiopubianas / Treatment of the stress urinary incontinence of male radical postprostatectomy anchored by means of screws to the isquiopubian branches

Presentamos los resultados de una alternativa en el tratamiento de la incontinencia urinaria de esfuerzo masculina post-prostatectomía radical. Se trata de una técnica de renovado interés en los últimos años, basada en el procedimiento de Stamey, consistente en colocar una malla de polipropileno en posición suburetral, anclada mediante tornillos a las ramas isquiopubianas. Hemos aplicado el procedimiento en 4 pacientes oncológicamente estables y con incontinencia urinaria de larga evolución. Tras un seguimiento medio de 12,5 meses, dos pacientes presentan continencia total, uno ha mejorado significativamente y en el otro persiste la incontinencia. No ha habido complicaciones postoperatorias ni rechazo de la malla. A partir de estos resultados preliminares y la bibliografía revisada, pensamos que esta técnica puede constituir una alternativa al esfínter urinario artificial, dados sus resultados clínicos, su facilidad de realización, la buena tolerancia y su bajo coste (AU)

We presented the results of an alternative in the treatment of the stress urinary incontinence of male radical postprostatectomy. Is a technique of renewed interest in the last years, cradle in the procedure of Stamey, consisting of placing an on guard suburetral polypropylene mesh, anchored by means of screws to the isquiopubian branches. We have applied the procedure in 4 patients and with stress urinary incontinence of long evolution. After an average pursuit of 12.5 months, two patients present total continence, one has improved significantly and in the other the incontinence persists. There have been no postoperating complications nor rejection of the mesh. From these preliminary results and the reviewed bibliography, we thought that this technique can constitute an alternative to the artificial urinary sphincter, dices its clinical results, its facility of execution, the good tolerance and his low cost (AU)

[Necrosis of the skin of the penis as a complication of the use of a urine collector]. / Necrosis de piel de pene como complicación al uso de colector urinario.

We illustrate a case of penile skin necrosis in a patient suffering from urinary incontinence caused by a secondary neurogenic bladder that, in turn, results from a spinal cord injury. The skin necrosis developed out of continuous pressure from the condom catheter. We report the case bearing into consideration that these complications are extremely rare and that references in the literature to the topic are likewise scarce. However, due to the high frequency of patients suffering from incontinence who use these devices, we believe it necessary to account for the possible consequences which might derive from an incorrect use of them.

Necrosis de piel de pene como complicación al uso de colector urinario / Skin penile necrosis as a complication from urinary condom catheter uses

Presentamos un caso de necrosis de la piel del pene en un paciente con incontinencia por vejiga neurógena secundaria a lesión medular traumática. Ésta se produjo como consecuencia de un exceso de presión provocado por un colector urinario. Presentamos el caso considerando que este tipo de complicaciones son poco frecuentes, siendo escasas las referencias en la literatura sin embargo dada la elevada frecuencia de pacientes incontinentes que emplean este tipo de dispositivos, es necesario conocer las posibles consecuencias derivadas de un uso incorrecto de los mismos (AU)

Anticoncepción hormonal masculina. Realidades y futuro / Male hormonal contraception. Facts and future

Los métodos anticonceptivos masculinos por excelencia son el preservativo y la vasectomía. La anticoncepción hormonal masculina se reduce, en la actualidad, a meros ensayos clínicos, que hasta la fecha no han mostrado utilidad práctica. La falta de eficacia y los efectos secundarios variables e irreversibles en muchos casos, impiden que los métodos clásicos se vean desplazados del arsenal terapéutico del urólogo. En este artículo desarrollamos una revisión de la literatura de las distintas sustancias ensayadas y las características de cada una de ellas. (AU)

Drugs for the treatment of impotence.

Penile erection is a complex neurovascular event that represents a balance between corporal smooth muscle relaxation and contraction. This balance is determined by the interaction between proerectile and antierectile neurotransmitters. It is believed that nitric oxide is the primary erectogenic neurotransmitter and that noradrenaline (norepinephrine) is the primary erectolytic neurotransmitter. There are a number of pharmacological approaches to the management of erectile dysfunction and manipulation of the neurotransmitter systems. These involve direct delivery of drugs into the erectile chambers (intracavernosal injection therapy), administration of medications into the urethra (transurethral delivery), application of medications to the skin (transdermal delivery) and it is hoped that oral agents will be available in the very near future. This article reviews the world literature on the medications that have been investigated to date and their delivery routes.

[Prostatism in patients with chronic renal failure and in renal transplant recipients. Comparative study]. / Prostatismo en pacientes con fracaso renal crónico y trasplantados renales. Estudio comparativo.

Though hypogonadism is part of the clinical picture of chronic renal failure, its etiology remains unknown. Because of the consequences it may have on the prostate gland, it was decided to conduct a prospective evaluation on its influence on prostatic signs and symptoms and glandular growth in a group of patients with chronic renal failure undergoing dialysis and a second group with renal transplantation. To this end, the presence of symptoms was assessed in 78 subjects over 50 years of age: 22 healthy controls (group C) (28.2%), 28 in haemodialysis (Group HD) (35.0%) and 28 with renal transplantation (Group RT) (35.9%). All subjects were aged between 53 and 80 years (mean 58.29 +/- 5.45). Determination of degree of prostatism was done by the International Prostate Symptoms Score (IPSS-S and L), flowmetry, ultrasound postmictional residue, transrectal ultrasound with 3 prostatic diameters (cross-sectional, antero-posterior and longitudinal), prostate weight and plasma levels of PSA, testosterone, FSH, LH, PRL and oestradiol. In 26 of 28 patients in the HD group IPSS-L, flowmetry and post-mictional residue was not assessed as they had no spontaneous miction. There were significant differences in IPSS between C and RT (p = 0.003), Qmax between C and RT (p = 0.009), post-mictional residue between C and RT (p = 0.045), cross-sectional diameter between C and HD (p = 0.036), prostate weight between C and HD (p = 0.001), and between HD and RT (p = 0.001), PSA between C and RT (p = 0.026), FSH between C and HD (p = 0.005), LH between HD and RT (p = 0.020), PRL between HD and RT (p = 0.023), Oestradiol between C and HD (p = 0.032). We conclude that hypogonadism is a factor which, in patients with chronic renal failure and renal transplantation, contributes to prevent prostate growth thus minimizing the symptoms of prostatism.

Microsurgical penis replantation after self-mutilation.

The microsurgical reattachment of a penis following self-amputation by a psychiatric patient is discussed. This is the 15th case reported in the literature. We have reviewed the previous reports and outline the management of penis amputation. The importance of using microsurgical techniques in order to achieve better functional and cosmetic results is discussed.

[Sexual dysfunction in Parkinson's disease]. / Disfunción sexual en la enfermedad de Parkinson.

Sexual activity, function and libido in 50 patients with idiopathic Parkinson's disease and no signs of mental deterioration were evaluated by an estructured questionnaire. The sample included 36 men and 14 women with a mean age of 57.9 +/- 10.1 years and a mean time elapsed since onset of 7.01 +/- 3.9 years. We found decreased sexual activity in 68% and a lack of libido admitted by 26%. Although the decrease in sexual activity was found more often in women, this dysfunction was not statistically significant. Decreased sexual desire, however, was statistically significant. Erectile dysfunction was found in 38.8% and was more frequent in patients over 61 years of age.

[Neo-adjuvant M-VAC in the treatment of infiltrating bladder tumors]. / M-VAC neo-adyuvante en el tratamiento de los tumores vesicales infiltrantes.

Between June 1987 and December 1990, systemic chemotherapy following an M-VAC protocol was applied to 38 patients with infiltrant vesical carcinoma (T2-T4). Eight of them (21.05%) were excluded for treatment response evaluation (four due to withdrawal and four to severe toxicity, one of whom died). Of the 30 evaluable patients, 63.3% (19 patients) showed complete response (pT0) after three complete courses of chemotherapy. Of this group, 11 have relapsed within an average interval of 21 +/- 18 months, 5 cases infiltrant (three with cystectomy) and 6 superficial. Mean survival of these 11 patients was 32.9 +/- 16.3 months. Of those showing complete response, 4 (13.3%) developed systemic tumoral progression in an average time of 12.5 +/- 4.2 months, to the point of being impossible to perform any kind of rescue surgery, with a mean survival of 13 +/- 4.5 months. In five patients, 16.6% of sample, stage at post-MVAC biopsy was lower than the initial one, requiring a new TUR (survival, 25.2 +/- -- months). Of these, 4 relapsed with 3 requiring rescue surgery. The remaining 6 patients in the sample (20%) showed no response to chemotherapy, and radical surgery was indicated which was only possible in three of them (survival, 14 +/- 6.8 months). The poor results of this series question the effectiveness of the MVAC protocol for chemotherapy in infiltrant vesical tumours. Only in low stages (T2) good results are observed, while in other cases it delays radical surgery, presumably curative if performed timely.

[Is radical surgery indicated in patients with infiltrating bladder carcinoma and involved regional lymph nodes?]. / Está indicada la cirugía radical en los pacientes con carcinoma vesical infiltrante y ganglios regionales afectos?

To evaluate the efficacy of radical vesical surgery in Infiltrant Vesical Carcinoma affecting the regional nodes, a retrospective study of a group of 75 patients who underwent radical cystectomy and lymphadenectomy was conducted. Based on the degree of node affectation patients were classified as follows: 49 pN(-) (65.3); 22 pN(+) (29.3); and 4 pN(x) (5.3) in which the pathological anatomy was inconclusive. In the pN(-) group, 8 (8.16%) died during the immediate postoperative due to surgical complications. Of the remaining 45, 5 cases were lost to follow-up; 31 (63.26%) died (all of them as a result of the tumour (M+)); whereas 9 (18.36%) are still alive and disease-free. Overall mean survival is 35.91% 10.3 months (4-65 months). Of them, 3 (13.6%) were lost while in poor performance status; 13 (59.09%) died for neoplasia-related causes (M+), and only one (4.5%) is alive and disease free. In this group, neoadjuvant chemotherapy was used in 10 cases, neoadjuvant radiotherapy in 4 and adjuvant radiotherapy in 5. Local relapse was seen in 8 (36.6%) cases. In our experience, a clear improvement in quality of live and mean survival at one year (up to 65 months) was noted in patients with Vesical Infiltrant Carcinoma and regional node affectation. Such situation encourages the use of radical surgery when faced, during surgical examination, with node infiltration by neoplastic cells.

[Extracorporeal shock-wave lithotripsy in polycystic kidneys]. / Litotricia extracorporea por ondas de choque en riñones poliquísticos.

Presentation of 6 cases (8 renal units) of lithiasis in polycystic kidneys treated with extracorporeal shockwave lithotrity (ESWL). One patient required puncture of a compressing cyst, prior to ESWL, to facilitate the stones removal. No complications were seen in any of the cases. Therefore, stones in polycystic kidneys can be safely and effectively treated by ESWL.

[Antimicrobial prophylaxis in urologic endoscopic surgery: pefloxacin versus ceftriaxone]. / Profilaxis antimicrobiana en cirugía endoscópica urológica: pefloxacino versus ceftriaxona.

Prospective, randomized study in 96 patients undergoing urologic endoscopic surgery to assess the efficacy of two antimicrobials, pefloxacin and ceftriaxone, in the prevention of urinary tract infections. The disease most frequently prompting surgery was vesical tumour and prostate adenoma. All patients had sterile pre-operative urine. Drugs were given endovenously two hours prior surgery in one single dose. Prophylactic efficacy was measured through urine culture before removal of the catheters. Incidence of bacteriuria greater than 100,000 colonies/ml was 20% for the pefloxacin group compared to 15.2% for ceftriaxone. These differences were not statistically significant (Squared-chi test). These results show that pefloxacin is as effective as ceftriaxone in the prophylaxis of endoscopic urological surgery. A single dose schedule was not entirely suitable to reduce post-operative bacteriuria.

[Extracorporeal shockwave lithotripsy: an alternative treatment for lithiasis of caliceal diverticula]. / Litotricia extracorpórea por ondas de choque: una alternativa al tratamiento de las litiasis de divertículos caliciales.

Among all the patients treated in our Lithotrity Unit, 13 of them had lithiasis inside the calyceal diverticulum. They were all treated by extracorporeal shockwaves. In none of the cases complete expulsion of lithiasic mass was achieved. In 3 (23%) cases it was reduced to half. In 2 (15.3%), 75% of the initial mass remained; and in 8 (61.5%) stones were fragmented but none of their debris was eliminated. Out of all the patients who were symptomatic before starting treatment, only 36.6% become asymptomatic. Extracorporeal lithotrity is, therefore, an approach with limited results in the calyceal intradiverticular lithiasis.

[Duplex echography in acute scrotum. Diagnostic possibilities]. / El eco duplex en el escroto agudo. Posibilidades diagnósticas.

Acute scrotum is a frequent reason for consultation at the urological emergency service. The most common causes, apart from trauma, are acute orchiepididymitis, torsion of the hydatids of Morgagni and torsion of the spermatic cord. Apart from a detailed examination of patient history and a careful physical examination, few diagnostic techniques can be utilized. To date, only the Doppler ultrasound has proved useful in corroborating the suspicion of vascular involvement, although this technique is very limited. With the availability of the duplex ultrasound, the possibility of making the differential diagnosis in the acute scrotum is enhanced. This technique permits morphological and functional assessment and avoids unnecessary exploration surgery within the scrotum.

[Diagnosis and treatment of coital penile injury]. / Diagnóstico y tratamiento del traumatismo peneano coital.

Two cases are presented of non-penetrating coital trauma of erect penis. This is a rare pathology. No prospective studies are therefore available, but instead there is much controversy. We review the existing literature as well as the various diagnostic and therapeutic attitudes and we propose an algorithm to systematize its management.