[Cefminox versus cefotaxime in the treatment of complicated urinary tract infection]. / Cefminox versus cefotaxima en el tratamiento de la infección urinaria complicada.

A comparative study of Cefminox, a new cefamicin, and Cefotaxime was conducted to evaluate the efficacy and safety of the former in the treatment of complicated urinary infection, and to correlate in both cases the bacteriological response with isolates MICs. To this end a phase III, randomized, blind and controlled clinical trial was conducted in 22 patients who met the study's preestablished criteria, 19 of which were evaluable. Both treatments achieved 100% clinical efficacy, while microbiological eradication was accomplished in 90.9% patients treated with Cefminox and 75% patients who received the comparator. Cefminox shows greater in vivo activity than that expected for the MICs, excellent efficacy and safety.

Genitourinary malakoplakia.

Between 1973 and 1991, 13 patients with malakoplakia (MKP) have been diagnosed and treated. The lesions involved all sites in the genitourinary tract; 2 patients had multiple and 11 had single lesions. Treatment was based on 2 criteria: (a) pharmacological treatment with trimethoprim-sulphamethoxazole and/or ascorbic acid and/or bethanechol chloride; (b) excision of the MKP lesion either endoscopically or by open surgery. Two patients died (1 from multiple MKP and the other from a myocardial infarct); the remainder did well. The pathogenic, diagnostic and therapeutic aspects of the disease are discussed.

[Multilocular cystic renal adenocarcinoma]. / Adenocarcinoma renal quístico multilocular.

On detecting a complex cystic renal mass, we are faced with the problem of making the differential diagnosis from a variety of diseases, some of very distinct nature and prognosis. Surgical exploration may occasionally be warranted to make the diagnosis since no radiological or analytical method, including cytological analysis of its content, is absolutely reliable. A 46-year-old male patient with multicystic renal adenocarcinoma is described. We discuss the diagnostic and therapeutic dilemmas that arise on detecting a multilocular renal mass in an adult patient.

[A Foley-type catheter with a steerable tip]. / Sonda de tipo Foley con extremo dirigido.

Permanent bladder catheterization for medical or social reasons increases the risk of complications, especially urinary infection. We evaluated the usefulness of the balloon catheter with a steerable intravesical tip in reducing the volume of residual urine between the bladder neck and the balloon of the conventional Foley catheter. The results show that this new catheter affords no additional advantage over the conventional catheter.

[Incidence of different types of hypercalciuria in the Madrid area. Demographic features]. / Incidencia de los distintos tipos de hipercalciuria en el área de Madrid. Características demográficas.

A study to determine the incidence of idiopathic hypercalciuria was performed in 110 patients (59 females, 51 males). Classification of this metabolic disorder according to its different types revealed the following incidence: 50% for absorptive hypercalciuria, 14.5% for hypercalciuria from loss of renal phosphates, and 30% for renal hypercalciuria. Insufficient biochemical data with a significant value did not permit classification of 6.3%. Analysis of distribution according to sex revealed a similar incidence (50%) for males and females for absorptive hypercalciuria, a prevalence in men (71%) for hypercalciuria due to loss of renal phosphates, and a prevalence in females (64.7%) for renal hypercalciuria. However, correction of these data according to the male to female ratio of our study population revealed renal hypercalciuria to be more prevalent in females whereas absorptive hypercalciuria and hypercalciuria from loss of renal phosphates were more prevalent in men. Analysis of distribution according to age revealed a direct relationship between the increased incidence of renal hypercalciuria and patient age.

[Complications in kidney transplant: our experience in 107 cases]. / Complicaciones en el trasplante renal: nuestra experiencia en 107 casos.

We introduce our case material on urological complications occurred in 107 renal transplants, 102 of which were from corpse donors and 5 form live donors. The techniques used for the reconstruction of the urinary tract were: extravesical ureterocystoneostomy (91 = 85%), pyelo-pyelic anastomosis (15 = 14%) and uretero-ureteral anastomosis (1 = 0.9%). Sixteen cases presented urinary fistula (15%), emphasizing the high percentage of extravasations occurred in the pyelo-pyelic anastomosis (5/15). The resolution of the problem with graft preservation was achieved in 11 cases (68.75%). We encountered 6 ureteral obstructions that resolved favourably in 100% if the cases. Other important complications were: appearance of lymphocele in 8 cases, detection of post-grafting ureteral stenosis in 5 patients, finding asymptomatic vesicoureteral reflux in 16 grafts, and presence of urinary lithiasis in 2 cases. Similarly, we analyzed our series of 16 vascular complications, emphasizing that 15 out of 107 grafts had arterial or venous vascular abnormalities (14.1%), that forced to perform bench surgery in two occasions. Our statistical analysis showed that arterial thrombosis was more frequent than stenosis (8.49% versus 4.71%), and in nearly 80% of the cases (7/9) it happened in grafts concerning more than one arterial vessel, including in this series thrombosis of any of the ramus. The largest loss of grafting were due to this complication, since in 5 out of 9 cases of arterial thrombosis (55.5%) a transplantectomy had to be performed. With regard to venous complications thrombosis is a relatively rare complication, representing in our series less than 1%, usually associated to uncontrollable vascular acute rejection.

[Is it necessary to combine the surgical treatment of kidney adenocarcinoma with ipsilateral adrenalectomy?]. / Es necesario asociar en el tratamiento quirúrgico del adenocarcinoma renal la adrenalectomía ipsilateral?

We analyzed a series of 202 renal adenocarcinomas, 164 of which were submitted to radical nephrectomy. Pathological analyses of 150 adrenal glands revealed ipsilateral adrenal metastasis in 4 cases, 3 of these coexisting with other distant metastases. The primary tumors in these 4 cases were highly undifferentiated and in the advanced local tumor stage; the only case with solitary adrenal metastasis survived 15 months. The present study and data reported in the literature indicate that ipsilateral adrenalectomy should be performed in addition to radical nephrectomy only in renal tumors of the upper pole, those localized at other sites but whose size indicate the possibility of tumor spreading to the adjacent adrenal gland, or when a suspicious mass in the adrenal gland is evidenced by the preliminary workup or during surgery.

[Evaluation of extravesical ureteroneocystostomy in kidney transplantation]. / Evaluación de la ureterocistoneostomía extravesical en el trasplante renal.

The present study evaluates extravesical ureteroneocystostomy, the technique used for reconstruction of the urinary tract in 120 kidney transplants. The urological complications ascribable to this technique were observed in 10% (12/120) and consisted of urinary extravasation (10), and ureteric obstruction (2). The treatment of the foregoing complications, which was successful in 8 cases, is described. The indications and advantages afforded by this technique in renal transplantation are discussed.