Fulguración ambulatoria con láser Holmium: Un procedimiento seguro para el tratamiento de la recidiva del carcinoma vesical no músculo infiltrante / Outpatient Holmium laser fulguration: A safe procedure for treatment of recurrence of nonmuscle invasive bladder cancer

Introducción y objetivo: Los tumores vesicales no musculo-invasivos presentan una elevada tasa de recurrencias y una baja tasa de progresión. El objetivo del estudio es evaluar la efectividad, seguridad y factibilidad de la fulguración con láser Holmium en régimen ambulatorio en tumores seleccionados. Material y método: Estudio prospectivo, longitudinal, de cohortes (enero de 2009 hasta diciembre de 2016). Se realizaron 79 procedimientos de fulguración con láser Holmium + instilación posterior de MMC en régimen ambulatorio en 59 pacientes con historia de neoplasia vesical de bajo riesgo y recidivas papilares de pequeño tamaño. Se realiza un análisis descriptivo de los datos y se analiza el tiempo libre de recidiva mediante curvas de Kaplan-Meier. Resultados: Todos los procedimientos se completaron en el día y sólo un paciente precisó ingreso posterior por hematuria. El 87.2% de los pacientes presentó dolor con EVA ≤ 3. Se objetivó recidiva tras el 49.4% de los procedimientos (27.3% a los 12 meses). La mediana de seguimiento fue de 17 meses (rango 2-65). La aparición de recidiva fue significativamente más precoz tras la segunda fulguración que tras la primera (mediana: 10 meses vs 56 meses). Conclusiones: La fulguración con láser Holmium + instilación posterior de MMC en régimen ambulatorio es una alternativa segura y factible a la RTUv en pacientes con tumores seleccionados. Probablemente sea recomendable realizar una RTUv en los pacientes con recidiva tras fulguración, dado que posiblemente el riesgo de progresión en estos pacientes es superior

Background and Objective: Nonmuscle invasive bladder cancer has a high recurrence rate and a low progression rate. The aim of this study was to assess the effectiveness, safety and feasibility of Holmium laser fulguration in an outpatient regimen for selected tumours. Material and Method: A prospective, longitudinal cohort study was conducted between January 2009 and December 2016. Seventy-nine Holmium laser fulguration procedures with subsequent instillation of mitomycin C were performed in an outpatient regimen on 59 patients with a history of low-risk bladder cancer and recurrence of small papillary tumours. We performed a descriptive data analysis and analysed the relapse-free time using Kaplan-Meier curves. Results: All procedures were completed in one day, and only one patient required subsequent hospitalisation due to haematuria. Some 87.2% of the patients presented pain with a visual analogue score ≤3. Recurrence occurred after 49.4% of the procedures (27.3% at 12 months). The median follow-up time was 17 months (range, 2-65). The onset of recurrence was significantly earlier after the second fulguration than after the first (median, 10 months vs. 56 months). Conclusions: Holmium laser fulguration and subsequent mitomycin C instillation in an outpatient regimen is a safe and feasible alternative to transurethral resection of bladder tumours in selected patients. Transurethral resection of the bladder tumour is recommended for patients with recurrence after fulguration, given the possibly higher risk of progression in these patients

Seguimiento a largo plazo del cabestrillo AdVance(R)/AdVanceXP(R). ¿Qué piensa el cirujano?, ¿qué piensa el paciente? / Long-term follow-up of the AdVance(R)/AdVanceXP(R) sling. What are the surgeons' impressions? What are the patients'?

Objetivos: Analizar la seguridad, la eficacia y la calidad de vida del paciente con incontinencia urinaria de esfuerzo masculina tras una prostatectomía radical, tratados con el cabestrillo AdVance(R) y AdvanceXP(R). Pacientes y método: Se han incluido en el estudio 92 pacientes con incontinencia urinaria de esfuerzo tras una prostatectomía radical tratados mediante cabestrillo AdVance(R) y AdVanceXP(R) entre mayo de 2008 y diciembre de 2015. Se realizó en todos los casos test de reposición perineal con coaptación esfinteriana ≥ 1,5cm. Se definió incontinencia urinaria de esfuerzo leve como el uso de 1-2 absorbentes/24 h; moderada: 3-5 absorbentes/24 h, y grave más de 5 absorbentes/24 h. Como curación se definió la ausencia total de uso de absorbentes, mejoría cuando la reducción fue mayor del 50% en el número de estos y fracaso cuando la reducción fue menor del 50%, no se obtuvo mejoría o se produjo un empeoramiento de la incontinencia. Se realizaron controles a los 3, 12 y 36 meses tras la cirugía. El índice de calidad de vida utilizado fue el International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Las complicaciones se reflejaron según la clasificación de Clavien-Dindo. Resultados: El grado de incontinencia preoperatoria fue de tipo leve en el 23,9%, moderada en el 67,4% y grave en el 8,7%. El uso medio de absorbentes preoperatorio fue de 3,1 (rango 1-6, IC 95%). La puntuación media preoperatoria del test ICIQ-SF fue de 16,5 (15-20). La coaptación esfinteriana ≥ 1,5cm mediante el test de reposicionamiento perineal estaba presente en 87 pacientes (94,6%). El seguimiento medio desde la inserción del cabestrillo fue de 42,1 meses. El porcentaje de pacientes curados a los 3 meses fue del 89,1%, a los 12 meses del 70,7% y a los 36 meses del 70,4%. La puntuación del ICQ-SF a los 3, 12 y 36 meses mostró una mejoría significativa (p < 0,001) respecto a la puntuación preoperatoria. Conclusiones: Los sistemas Advance(R) y AdvanceXP(R) se muestran eficaces en el tiempo en cuanto a la continencia urinaria y la satisfacción del paciente

Objectives: To analyse the safety, efficacy and quality of life of patients with male stress urinary incontinence after radical prostatectomy treated with the AdVance(R) and AdvanceXP(R) slings. Patients and method: The study included 92 patients with stress urinary incontinence after radical prostatectomy treated with the AdVanc(R) and AdVanceXP(R) sling between May 2008 and December 2015. A perineal repositioning test was performed in all cases with sphincter coaptation of ≥ 1.5 cm. Mild stress urinary incontinence was defined as the use of 1-2 absorbers/24 h; moderate was defined as 3-5 absorbers/24 h; and severe was defined as more than 5 absorbers/24 h. Healing was defined as the total absence of using pads; improvement was defined as a reduction > 50% in the number of pads; and failure was defined as a reduction < 50, no improvement or worsened incontinence. Check-ups were conducted at 3, 12 and 36 months after the surgery. We employed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) for the quality of life index. The complications are listed according to the Clavien-Dindo classification. Results: The degree of preoperative incontinence was mild in 23.9%, moderate in 67.4% and severe in 8.7% of the patients. The mean use of preoperative pads was 3.1 (range 1-6, 95% CI). The mean preoperative ICIQ-SF score was 16.5 (15-20). Sphincter coaptation ≥ 1.5cm using the perineal repositioning test was present in 87 patients (94.6%). The mean follow-up from insertion of the sling was 42.1 months. Some 89.1% of the patients were healed at 3 months, 70.7% were healed at 12 months, and 70.4% were healed at 36 months. The ICIQ-SF score at 3, 12 and 36 months showed significant improvement (P < .001) compared with the preoperative score. Conclusions: The Advance(R) and AdvanceXP(R) system are effective over time in terms of urinary continence and patient satisfaction

Outpatient Holmium laser fulguration: A safe procedure for treatment of recurrence of nonmuscle invasive bladder cancer. / Fulguración ambulatoria con láser Holmium: Un procedimiento seguro para el tratamiento de la recidiva del carcinoma vesical no músculo infiltrante.

BACKGROUND AND OBJECTIVE: Nonmuscle invasive bladder cancer has a high recurrence rate and a low progression rate. The aim of this study was to assess the effectiveness, safety and feasibility of Holmium laser fulguration in an outpatient regimen for selected tumours. MATERIAL AND METHOD: A prospective, longitudinal cohort study was conducted between January 2009 and December 2016. Seventy-nine Holmium laser fulguration procedures with subsequent instillation of mitomycin C were performed in an outpatient regimen on 59 patients with a history of low-risk bladder cancer and recurrence of small papillary tumours. We performed a descriptive data analysis and analysed the relapse-free time using Kaplan-Meier curves. RESULTS: All procedures were completed in one day, and only one patient required subsequent hospitalisation due to haematuria. Some 87.2% of the patients presented pain with a visual analogue score ≤3. Recurrence occurred after 49.4% of the procedures (27.3% at 12 months). The median follow-up time was 17 months (range, 2-65). The onset of recurrence was significantly earlier after the second fulguration than after the first (median, 10 months vs. 56 months). CONCLUSIONS: Holmium laser fulguration and subsequent mitomycin C instillation in an outpatient regimen is a safe and feasible alternative to transurethral resection of bladder tumours in selected patients. Transurethral resection of the bladder tumour is recommended for patients with recurrence after fulguration, given the possibly higher risk of progression in these patients.

Long-term follow-up of the AdVance®/AdVanceXP® sling. What are the surgeons' impressions? What are the patients'? / Seguimiento a largo plazo del cabestrillo AdVance®/AdVanceXP®. ¿Qué piensa el cirujano?, ¿qué piensa el paciente?

OBJECTIVES: To analyse the safety, efficacy and quality of life of patients with male stress urinary incontinence after radical prostatectomy treated with the AdVance® and AdvanceXP® slings. PATIENTS AND METHOD: The study included 92 patients with stress urinary incontinence after radical prostatectomy treated with the AdVance® and AdVanceXP® sling between May 2008 and December 2015. A perineal repositioning test was performed in all cases with sphincter coaptation of≥1.5cm. Mild stress urinary incontinence was defined as the use of 1-2 absorbers/24h; moderate was defined as 3-5 absorbers/24h; and severe was defined as more than 5 absorbers/24h. Healing was defined as the total absence of using pads; improvement was defined as a reduction>50% in the number of pads; and failure was defined as a reduction<50, no improvement or worsened incontinence. Check-ups were conducted at 3, 12 and 36 months after the surgery. We employed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) for the quality of life index. The complications are listed according to the Clavien-Dindo classification. RESULTS: The degree of preoperative incontinence was mild in 23.9%, moderate in 67.4% and severe in 8.7% of the patients. The mean use of preoperative pads was 3.1 (range 1-6, 95% CI). The mean preoperative ICIQ-SF score was 16.5 (15-20). Sphincter coaptation≥1.5cm using the perineal repositioning test was present in 87 patients (94.6%). The mean follow-up from insertion of the sling was 42.1 months. Some 89.1% of the patients were healed at 3 months, 70.7% were healed at 12 months, and 70.4% were healed at 36 months. The ICIQ-SF score at 3, 12 and 36 months showed significant improvement (P<.001) compared with the preoperative score. CONCLUSIONS: The Advance® and AdvanceXP® system are effective over time in terms of urinary continence and patient satisfaction.

[Use of statistical analysis in original articles in "Actas Urológicas Españolas." Accessibility for the reader]. / Uso de los análisis estadísticos en los artículos originales de Actas Urológicas Españolas. Accesibilidad para el lector.

OBJECTIVES: To describe the use of statistical methods employed in original articles published in Actas Urológicas Españolas as the first step to quantify the accessability for the readers. METHODS: Observational, retrospective, descriptive and transversal study to analize all the original articles published in Actas Urológicas Españolas during the year 2000. Once the anectotic cases were excluded, 55 original studies were selected. In each article it was minuciously reviewed the methods and results sections, tables and figures included, to identify the statistical analysis used and to classify them into 18 categories with three accessability levels as Emerson and Colditz and Mora y cols, previously reported: descriptive statistics, bivariables analysis and complex analysis. A randomized sample of the originals were reviewed again by the same investigator three months later to evaluate the criteria liability. The accessability was defined as a) article dependent (rate of originals that readers with different statistical knowledge are able to understand) and b) analysis dependent (rate of statistical methods respect to the total performed overall the articles that readers are able to understand). RESULTS: Our major findings are that the more frequently used technics are descriptive analysis (39.3%), bivariable tables (12.1%), survival analysis (10%), t Student and z tests (6%), and nonparametric tests (8.6%). The accessability for a reader which statistical konowledge includes bivariable methods is 63.6% (IC 95% 49%-76%) and 79% (IC 95% 71%-85), article and analysis dependent respectively, rates that are similar to the reported for biomedical journals in our country. CONCLUSIONS: A great percentage of original articles in Actas Urológicas Españolas includes complex analysis. It could be good that readers were able to increase our statistical and methodological knowledge to perform a critical approach to our publication.

Uso de los análisis estadísticos en los artículos originales de Actas Urológicas Españolas.Accesibilidad para el lector / Use of statistical analysis in original articles published in Actas Urológicas Españolas: accessibility for the reader

OBJETIVOS: Descripción de los tipos de análisis estadísticos realizados en los trabajos de la Sección "Originales" de Actas Urológicas Españolas, cuantificando la accesibilidad estadística para el lector. MATERIAL Y MÉTODO: Estudio observacional, retrospectivo, descriptivo y transversal, analizando todos los Originales de Actas Urológicas Españolas publicados consecutivamente durante el año 2000 (muestreo aleatorio de conveniencia). Se excluyeron revisiones de casos anecdóticos, recogiéndose 55 originales. Fueron estudiadas detalladamente las secciones de Material y Método y Resultados, identificando los análisis efectuados para clasificarlos en 18 categorías jerárquicas con tres niveles de accesibilidad (Emerson-Colditz): estadística descriptiva, análisis bivariables y análisis complejos incluidos los multivariables. La concordancia intraobservador (fiabilidad de los criterios) fue evaluada mediante una nueva revisión de una muestra aleatoria de los originales seleccionados. La accesibilidad se definió: a) artículo dependiente (proporción de artículos accesibles para lectores con diferentes niveles de conocimiento estadístico) y b) análisis dependiente (proporción del total de técnicas estadísticas realizadas en todos los originales y que son accesibles a dichos lectores). RESULTADOS: Categorías más frecuentes: estadística descriptiva (39,3 por ciento), tablas bivariables (12,1 por ciento), análisis de supervivencia (10 por ciento), test t de Student y pruebas z (8,6 por ciento) y tests no paramétricos (8,6 por ciento). Globalmente, el 78,6 por ciento de los análisis estadísticos y el 63,6 por ciento de los artículos fueron accesibles para un lector con conocimientos básicos (análisis bivariables), cifras similares a las de otras revistas biomédicas. CONCLUSIONES: Un porcentaje considerable de los artículos originales de Actas Urológicas Españolas incorpora actualmente análisis complejos en su desarrollo. Parece así aconsejable que los lectores profundicemos en nuestros conocimientos estadísticos (AU)

OBJETIVES: To describe the use of statistical methods employed in original articles published in Actas Urológicas Españolas as the first step to cuantify the accesibility for the readers. METHODS: Observational, retrospective, descriptive and transversal study to analize all the original articles published in Actas Urológicas Españolas during the year 2000. Once the anectotic cases were excluded, 55 original studies were selected. In each article it was minuciously reviewed the methods and results sections, tables and figures included, to identify the statistical analisys used and to clasify them into 18 cathegories with three accesibilty levels as Emerson and Colditz and Mora y cols. previosly reported: descriptive statistics, bivariables analysis and complex analysis. A randomized sample of the originals were reviewed again by the same investigator three months later to evaluate the criteria fiability. The accesibility was defined as a) article dependent (rate of originals that readers with different statistical knowledge are able to understand) and b) analisys dependent (rate of statistical methods respect to the total performed overall the articles that readers are able to understand). RESULTS: Our major findings are that the more frecuently used technics are descriptive analysis (39.3%), bivariable tables (12.1%), survival analysis (10%), t Student and z tests (6%), and nonparametric tests (8.6%). The accesibility for a reader which statistical konowledge includes bivariable methods is 63.6% (IC 95% 49%-76%) and 79% (IC 95% 71%-85), article and analysis dependent respectively, rates that are similar to the reported for biomedical journals in our country. CONCLUSIONS: A great percentaje of original articles in Actas Urológicas Españolas includes complex analysis. It could be good that readers were able to increase our statistical and methodological konwledge to perform a critical approach to our publication (AU)

[Extramedullary hematopoiesis, a simulator difficult to diagnose]. / Hematopoyesis extramedular, un simulador de difícil diagnóstico.

The extramodular hematopoiesis is the result of the bone marrow sever chronical hypofunction, being the genitourinary affection very unusual. We are presenting a singular case by its own clinicopathology consequences and exceptional incidence in context of a upper tract urothelial tumor.

Hematopoyesis extramedular, un simulador de difícil prognóstico / Extramedular hematopoyesis, a difficult diagnosis simulator

La hematopoyesis extramedular es el resultado de la hipofunción severa crónica de la médula ósea, siendo muy infrecuente la presentación en órganos del aparato génito-urinario. Presentamos un caso importante por sus implicaciones clínicopatológicas y rareza en el contexto de un tumor de urotelio alto superficial (AU)

Tumor renal neuroendocrino. Un caso de rara presentación. Revisión de la literatura / Neuroendocrine renal tumor, a case of exceptional presentation. Review of the literature

Los tumores renales neuroendocrinos son de presentación extremadamente rara. Presentamos un caso clínico y revisamos la literatura sobre esta patología (AU)

No disponible

[Neuroendocrine renal tumor. An unusual case. Review of the literature]. / Tumor renal neuroendocrino. Un caso de rara presentación. Revisión de la literatura.

The neuroendocrine renal tumors are of extremely strange presentation. We present a review of the literature published on this pathology.

Tratamiento conservador del tumor testicular de células germinales / Conservative treatment of malignant germ cell tumors of the testis

El tumor de células germinales de testículo es la lesión neoplásica más frecuente en los varones de entre 15 y 35 años. Los resultados terapéuticos obtenidos gracias a la orquiectomía radical y, especialmente, a la poliquimioterapia neoadyuvante permiten obtener supervivencias libres de enfermedad en torno al 90 por ciento en el momento actual. Esta gran quimiosensibilidad está abriendo nuevas puertas a opciones terapéuticas alternativas, encaminadas a conservar la cantidad suficiente de parénquima que permita evitar los problemas derivados de la insuficiencia testicular. Tales alternativas quedan plenamente justificadas en los casos de tumores germinales bilaterales o de asiento en órgano único. En este artículo aportamos un caso de seminoma puro desarrollado en testículo único funcionante tratado mediante cirugía conservadora de parénquima. Asimismo, analizamos las indicaciones y resultados del manejo conservador del tumor primario basándonos en criterios de revisión bibliográfica metodológicamente estrictos, encaminados a ofrecer las mejores evidencias disponibles al respecto (AU)

[Conservative treatment of germ cell tumor of the testis]. / Tratamiento conservador del tumor testicular de células germinales.

Testis germ cell tumor is the most frequent cancer in men between 15 and 35 years old. The therapeutic results of radical orchiectomy and chemotherapy reaches 90% free disease survival al the present time. This great chemosensibility is opening new doors to alternative therapeutic options, directed to preserve the sufficient amount of tissue to avoid the problems derived from testicular insufficiency. Such alternatives are clearly beneficial in bilateral germinal tumors or in solitary testis. In this article we describe a case of seminoma developed in a solitary functional testis managed in a conservative approach: organ preserving surgery and surveillance. We analyzed the indications and international results of such approach based on the best evidences now available.

[Bromocriptine monotherapy of a prolactinoma causing erectile dysfunction]. / Monoterapia con bromocriptina de prolactinoma causante de disfunción eréctil.

OBJECTIVE: A case of erectile dysfunction in a patient with prolactinoma is described herein. METHODS/RESULTS: The literature on the incidence, diagnosis and therapeutic management of this condition is reviewed. Impotence may arise from several causes. It is widely accepted that 30-50% have an organic etiology, with vascular involvement being more prevalent than other causes (neurological, endocrinological, urological, iatrogenic, pharmacological, systemic diseases). Hyperprolactinemia, arising from a prolactinoma, is one of the endocrinological conditions causing impotence. In men, this endocrinological disorder is rarely accompanied by other clinical anomalies, such as gynecomastia, galactorrhea or signs of a pituitary tumor. The patient described herein presented with erectile dysfunction. During evaluation, he was found to be hyperprolactinemic. Subsequent assessment disclosed a pituitary adenoma. The patient was successfully treated with bromocriptine. CONCLUSION: Erectile dysfunction arising from hyperprolactinemia is uncommon. Serum prolactin levels, a lateral skull x-ray and CT/MRI are essential in the diagnosis and treatment of this condition. Treatment must be directed at the underlying cause. Bromocriptine has proved to be effective and carries a low risk of undesired effects.

Corino-Andrade disease (familial amyloidotic polineuropathy type I) in Spain: urological and andrological disorders.

In our hospital, we have followed a group of patients with familial amyloidotic polyneuropathy (FAP), type I. This disease is characterized by a progressive sensitive-motor and autonomic polyneuropathy. The amyloid fibrils of FAP I contain a mutant transthyretin (TTR) molecule. More than 90% of TTR production occurs in the liver. Thus, therapy with liver transplantation has proved useful. All our patients received this treatment. In this study we describe the urological and andrological disorders caused by FAP type I in 12 patients with low bladder pressure and bladder neck obstruction with micturition disorders. In some males, it was accompanied by impotence and retrograde ejaculation produced by autonomic neuropathy. We believe hepatic transplantation may be the best treatment for this disease.

Primary retroperitoneal tumors. Comments on 22 cases. / Tumores retroperitoneales primarios. Comentarios sobre 22 casos.

Primary retroperitoneal tumours represent a very uncommon group of neoplasias that account for 0.1%-0.6% of all tumours. Interest in these tumorations arises from the therapeutical and diagnostic concerns they rise. These tumorations are of late diagnosis due to the high insidiousness of their symptoms and, generally, are quite large in size. Widespread use of echography and CAT, however, have increased the possibilities of an occasional asymptomatic diagnosis. Treatment is basically surgical, very much depending on the prognosis of the surgery aggressiveness and the degree of radicality achieved. This paper presents our series of primary retroperitoneal tumours diagnosed between 1978 and 1994.

[Wünderlich syndrome. Review of its diagnosis and therapy. Report of 7 cases]. / Síndrome de Wünderlich. Revisión diagnóstica y terapéutica. A propósito de siete observaciones.

Spontaneous renal haemorrhage in the subcapsular and perirenal regions of non-traumatic etiology, or Wünderlich syndrome, is an uncommon but significant condition consisting in the sudden formation of an haematic collection in the renal cell. A retrospective evaluation of clinical data and radiological findings in 7 patients with spontaneous subcapsular and/or perirenal haemorrhage seen in our service between 1991 and 1995 has been conducted excluding from the study all those patients with a history of trauma, renal biopsy, anticoagulant therapy or renal failure undergoing treatment with haemodialysis or renal transplantation. The etiology of Wünderlich syndrome in our patients was heterogeneous but basically responded to a tumoral cause. CT was the method most frequently used and the one providing more information. The conservative approach appears to be the most acceptable option, unless malignant tumoral pathology can be demonstrated.

[Leydig cell tumor. Comments on 5 cases]. / Tumor de células de Leydig. Comentarios sobre cinco casos.

Leydig's cells tumours are a variant of testicular tumours. Its has a low incidence, accounting for just 1-3% of all testicular tumours. This tumour is characterized by its endocrine manifestations, and it is an element in the differential diagnosis of many endocrine sexual dysfunctions both in adults and children, due to the tumour's capacity to secrete hormones. This paper contributes 5 cases of Leydig's cells tumours diagnosed in our hospital between 1977 and 1993.

[Malignant fibrohistiocytoma coexisting with papillary tumor of the kidney pelvis: report of a case]. / Fibrohistiocitoma maligno coexistente con tumor papilar de pelvis renal: a propósito de un caso.

Presentation of one case of malignant fibrohistiocytoma in one patient seen for gross clotting haematuria during the study of which the coexistence of this tumour with a renal pelvis papillary one was discovered. The disease's clinical and diagnostic aspects are commented, with special emphasis on histological diagnosis. A review of the existing literature is also made.

[Inguinal bladder hernia. Report of 4 cases]. / Hernias vesicales inguinales. A propósito de cuatro casos.

Vesical hernias are, in general, a rare condition, except when they have an inguinal location. These are common, although their diagnosis is not so, and it is not infrequent that they are a chance finding of an inguinal herniorrhaphy procedure, during which relevant, but rare, complications have been described when the bladder has not been suitably identified. We present four cases of inguino-vesical hernia (three, massive hernia), and include a literature review.

[Matrix lithiasis. Apropos a case of staghorn lithiasis]. / Litiasis blandas. A propósito de un caso de litiasis coraliforme.

Presentation of one case of soft lithiasis in a child which was treated by pyelolithectomy with good results and which has not relapsed after a 20-year follow-up. A commented revision is made of related literature.