[Our experience with adrenalectomy (1994-2000). Overall review]. / Nuestra experiencia en adrenalectomías (1994-2000). Revisión de conjunto.

OBJECTIVE: Thirty cases of adrenalectomy are presented. The diagnostic and therapeutic aspects of adrenal disease are reviewed. METHODS: Over the last 6 years, 30 adrenalectomies were performed in 28 patients (20 females and 8 males) aged 16-83 years (mean age 51 years). The lesion was incidentally discovered in 18.5%, 33.3% presented abdominal or lumbar pain, 18.5% had Cushing's syndrome, 18.5% presented headache and hypertension, and 7.4% virilization. Diagnostic evaluation included laboratory studies, ultrasound and CT assessment. Scintigraphic localization with MIBG, MRI or arteriography was performed in specific cases. The flank approach was utilized in 53% of the cases. RESULTS: The postoperative period ranged from 7-23 days (mean 11). Postoperative complications (38.4%) following adrenalectomy were splenectomy, hemorrhage, hypertensive episodes, vascular complications, wound infection and pneumonia. Fifty percent of the masses were pheochromocytomas, 10% carcinomas and 5% adenomas. The rest were two neural crest derived tumors, one calcified cyst, one myelolipoma and one metastatic renal carcinoma. CONCLUSION: The diagnostic and therapeutic aspects of adrenal disease are reviewed.

[DNA ploidy and cell cycle phase analysis with flow cytometry in bladder wash. Preliminary experience]. / Análisis de ploidía de ADN y fases del ciclo celular por citometría de flujo en el lavado vesical. Experiencia preliminar.

OBJECTIVE: To analyze the prognostic significance in bladder carcinoma of DNA ploidy and cell phase fractions measured by bladder wash flow cytometry. METHODS: Samples were obtained from 25 patients by bladder irrigation; 16 before surgery and 9 during follow-up cystoscopic examination. Cells were stained with propidium iodide and analyzed with the FacScan flow cytometer and Cellfit 2.01 (Becton-Dickinson). RESULTS: The number of cells obtained was sufficient for flow cytometric analysis in all cases. In 13 tumor samples (8 superficial and 5 invasive tumors), aneuploidy cells were detected in 3 cases that had a worse outcome; the only superficial tumor in which aneuploidy was detected presented a recurrent bladder carcinoma 15 months later. Of the 5 patients with invasive tumors, two patients with aneuploidy died within 6 months from tumor metastases. Of the patients without macroscopic tumor, only one showed an increase in the percentage of the S phase fraction (19.5% of cells in S phase). A recurrent bladder carcinoma was detected in this patient 6 months after the analysis. In patients with macroscopic tumor, analysis of the S phase fraction was not relevant for prognosis. CONCLUSIONS: Analysis of DNA ploidy and cell phase fractions by flow cytometry of bladder washings can increase the prognostic information in bladder carcinoma. Aneuploidy was associated with a worse prognosis and an increase in the S phase fraction predicted a recurrent bladder carcinoma months before it manifested clinically.

[Etiology and treatment of penoscrotal skin defects]. / Etiología y tratamiento de las pérdidas cutáneas penoescrotales.

OBJECTIVE: The influence of the type and extent of debridement on survival of patients with Fournier's gangrene and the efficacy of reconstruction with grafts and residual skin are analyzed. METHODS: The study comprised 43 patients; 35 Fournier's gangrene, 7 trauma and one tumor. The patients with gangrene were treated by debridement, drainage, amputation and antibiotics. Cutaneous grafts and residual skin were used to repair the defect in a second stage procedure. No testicular avulsion was found in the trauma cases. The penile and scrotal injuries were sutured. One burial and one local flap were performed in two penoscrotal avulsions. Skin from the penis was used to repair partial scrotal defects and grafts were applied on the penis. RESULTS: Mortality (21%) was high in partially debrided Fournier's gangrene, penis amputation and in cases undergoing only drainage. Skin grafts for total loss of penoscrotal cover and penile skin flaps for partial scrotal defects achieved good results. Tension suture was unfavorable in the penis, but was well-tolerated in the scrotum. Burial and local skin flaps were not good solutions. Poor results were obtained by conserving residual skin and grafting only the defect. CONCLUSIONS: Early, wide and repeated debridement procedures reduced the mortality in patients with gangrene, and the best results of reconstruction were obtained with split-thickness skin grafts for total loss of penoscrotal cover and penile skin flaps for partial defects of the scrotum.

[Acute scrotum: unusual presentation of Schönlein-Henoch purpura]. / Escroto agudo: un modo de presentación insólito de la púrpura de Schönlein-Henoch.

Being a systemic vasculitis, Schöenlein-Henoch purpura may affect the scrotum and its content. According to the series studied, this occurs in about 10% patients (2-38%) and sometimes requires a differential diagnosis with the spermatic cord torsion. An isotopic study with 99Tc may avoid a surgical procedure quite often unnecessary. In the case reported here, vasculitis presented as an acute scrotum, which is highly infrequent in the literature and makes a correct presumption diagnosis extraordinary difficult.

[Intraparenchymatous vascular tumors of the testicle: report of a new case of cavernous hemangioma]. / Tumores vasculares intraparenquimatosos de testículo: aportación de un nuevo caso de hemangioma cavernoso.

The occurrence of a vascular tumour at the intraparenchymatous testicular level is a fact little reported in the literature. Searching for such events, 19 cases were found all of which showed benign clinical behaviour. The most commonly seen histological pattern is cavernous haemangioma (11 patients). Mean age at presentation is 19 years old and the most usual pre-operative diagnosis, germinal cell neoplasia. Since there are no specific ultrasound patterns that may allow to differentiate benign from malignant masses, inguinal orchiectomy is the choice treatment in this type of lesions. Furthermore, the case of a 44-year old patient with hypoechogenic solid mass in left testis who consulted for sporadic episodes of long-standing scrotal pain is presented. After radical exeresis of the gonad, the histological analysis showed existence of testicular cavernous haemangioma.

[Pyeloureterostomy in stenosis of the pyeloureteral junction of an incomplete collecting system]. / Pieloreterostomía en estenosis de la unión pieloureteral de un doble sistema colector incompleto.

OBJECTIVES: The possible solutions to a case of ureteral duplication complicated by obstruction of one of the collecting systems are reviewed. METHODS/RESULTS: We report an uncommon case of ureteropelvic junction obstruction in the lower system of an incomplete duplication of the collecting systems that was resolved by pyeloureterostomy. CONCLUSIONS: Anastomosis of the lower renal pelvis to the upper ureter may provide a simple solution for the functional recovery of an important renal segment.

[Our experience with renal adenocarcinoma (III): results of surgical treatment, other treatments. Survival analysis]. / Nuestra experiencia en adenocarcinomas renales (III): Resultados del tratamiento quirúrgico, otros tratamientos. Análisis de la supervivencia.

OBJECTIVES: Evaluation of survival and results of treatment of renal cell carcinoma. METHODS: We reviewed the records of 229 consecutive cases of renal cell carcinoma diagnosed at our hospital. In 178 surgical treatment was done to achieve cure and in 6 patients it was palliative. RESULTS: No statistical differences in survival were found according to the surgical approach, or extensive vs hilar lymphadenectomy, or in the presence or absence of venous involvement. There were statistical differences in survival depending on the tumor stage and an inverse correlation between survival and tumor size. Sixty-nine cases received complementary treatments. Radiotherapy, alpha 2b interferon and vinblastine, resection of metastasis, or gestagen therapy failed to improve survival. No improvement in survival was achieved with palliative embolization, but it ameliorated local symptoms. The mean survival in patients with metastasis and without treatment was 5.5 months and there was no statistical difference in survival relative to the number of site of metastasis, or the number of affected viscera. The mean survival in patients that were not operated and had no metastasis was greater: 23.5 months. CONCLUSIONS: Surgery, regardless of the surgical approach or type of lymphadenectomy, is the only treatment that improves survival in renal cell carcinoma. Patients with metastasis receiving no treatment have a worse prognosis.

[Our experience with renal adenocarcinoma (II): clinical course, diagnosis, and prognostic factors before surgical treatment]. / Nuestra experiencia en adenocarcinomas renales (II): Clínica, diagnóstico y factores pronósticos antes del tratamiento quirúrgico.

OBJECTIVES: We evaluated the form of presentation, clinical features and analytical values and their relationship with survival in renal cell carcinoma patients and analyzed the efficiency of different diagnostic and staging procedures. METHODS: We reviewed the form of presentation, clinical features, staging procedures and analytical values of 229 consecutive renal cell carcinomas diagnosed at our hospital between 1975 and 1991. RESULTS: Malaise and weight loss or symptoms different from those of the classical triad (hematuria, pain and a flank mass) are factors of poor prognosis and lower survival. The time of presentation of symptoms does not influence prognosis. Computerized tomography was found to be the best imaging technique, with a low sensitivity and a high specificity in our experience. We have found a correlation between hypercalcemia and lower survival, but not for the more advanced tumoral stage. There was a correlation between the levels of hemoglobin and alkaline phosphatase and survival: patients with hemoglobin levels less than 14 g/dl or alkaline phosphatase levels greater than 85 U/l had a lower survival rate and a more advanced tumoral stage. CONCLUSIONS: Computerized tomography was found to be the best imaging technique. Symptoms different from those of the classical triad, malaise and weight loss, hypercalcemia, low levels of hemoglobin or high levels of alkaline phosphatase are factors of poor prognosis.

[Our experience with renal adenocarcinoma (I): epidemiologic data]. / Nuestra experiencia en adenocarcinomas renales (I): Datos epidemiológicos.

OBJECTIVES: The present study was conducted to review the epidemiological factors of patients with renal cell carcinoma. METHODS: We reviewed the familial, social, cultural, toxic, occupational and pathological factors of 229 patients who were diagnosed as having renal cell carcinoma between 1975 and 1992 at our hospital. RESULTS: As in other series, we found a greater predisposition in male patients around the seventh decade. However, unlike other studies, we observed a greater predisposition in the lower social and cultural levels and rural population. Of the epidemiological factors related to adenocarcinoma of the kidney, smoking was the most common in this series (41.8%), followed by high blood pressure (15.7%) and toxic-occupational factors (8.2%). We found no correlation between these factors and tumor stage or survival. CONCLUSIONS: Our data show a greater predisposition for renal cell carcinoma in male patients, around the seventh decade, in the lower social and cultural levels and rural population. Smoking, high blood pressure and occupational exposure to toxic agents were the most common epidemiological factors.

[Renal autotransplantation in a case of idiopathic retroperitoneal fibrosis refractory to other treatments]. / Autotrasplante renal en un caso de fibrosis retroperitoneal idiopática refractaria a otros tratamientos.

We report a case of renal autotransplantation in a patient with right retroperitoneal fibrosis that had been previously treated by ureterolysis with intraperitonization and corticoid therapy without success. The literature is briefly reviewed and the therapeutic possibilities in refractory retroperitoneal fibrosis are discussed, with special reference to renal autotransplantation.

[Penile incarceration at its base with metallic object]. / Incarceración de pene por objeto metálico en su base.

Herein we describe a case of penile incarceration due to a nut at the base of the penis which was resolved by cutting the metallic object. The literature on penile strangulation describes different foreign bodies and methods of management of constrictive penile band injury.

[Iatrogenic lesions of the urinary tract. II. Bladder and urethra]. / Lesiones yatrógenas del apartado urinario. II. Vejiga y uretra.

Ureteral iatrogenic lesions occur with variable frequency in the different types of surgery, mainly in uncomplicated abdominal hysterectomy. This paper contributes 29 patients (2 male and 27 female) with several types of lesions, secondary to gynaecological, intestinal and vascular surgery. The series produced 16 cases of clamping, 6 ureterovaginal fistulae, 6 ureteral sections (5 total and 1 partial) and 1 ureterouterine fistula. The terminal ureter was the most frequently damaged. The diagnostic and therapeutical methods used in this type of lesions are analyzed.

[A new case of ectopic ureteral outlet into the seminal vesicle]. / Nuevo caso de desembocadura ectópica de uréter en vesícula seminal.

We report an additional case of ectopic ureter opening into the seminal vesicle in a patient who had consulted for nephric colic from calculus in dysplastic kidney and urinary tract infection. The clinical features, the diagnostic and therapeutic aspects of this rare malformation are briefly reviewed.

[Rupture of the cavernous body: report of 2 new cases]. / Rotura de cuerpos cavernosos: aportación de dos nuevos casos.

Review of two new cases of fracture of the cavernous body, one treated with early surgery and the other one conservatively. In both cases, the patients preserved good erections after one year.

[Adrenal gland surgery. Review of 34 cases]. / Cirugía de las suprarrenales. Revisión de 34 casos.

Over the last few years, a better anatomical and functional knowledge of the adrenal glands has allowed us to diagnose and treat optimally most of these gland's conditions. A variety of medical (endocrinology, anaesthesiology) and surgical specialties have been used to this aim. This paper reviews the adrenal gland's diseases treated in our unit over the last 9 years. Pre-operative management, ways of approach, morbidity and mortality as well as results are analyzed and compared with those obtained by other authors.

[Vesico-uterine fistula: report of 2 new cases]. / Fístula vesico-uterina: a propósito de dos nuevos casos.

Presentation of two new cases of vesico-uterine fistulae secondary to cesarean operation. In one case our route for surgical approach is explained as a novelty; also, the time-frame within which it was performed, one month, since it is usual to recommend a minimum of three months. In the second case an in-dwelling vesical catheter was sufficient to achieve closure. The article also reviews the existing literature on the different aspects: signs, symptoms and therapy, of this infrequent pathology.

[Renal adenocarcinomas associated with other malignant neoplasms]. / Asociación de adenocarcinomas renales y otras neoplasias malignas.

The renal adenocarcinoma is not a frequent tumour within the scope of multiple neoplasias, at least in the clinical series. Conversely, it appears at a higher relative rate in the post-mortem series. This paper submits a review of renal adenocarcinoma associated in life to other malignant neoplasias, enumerating their major clinical and epidemiological data. Also, it reviews the literature with regard to frequency and etiology, applying the data to our series. The paper concludes that hypernephroma is not a tumour frequently associated with others in life, given its tendency to be secondary to other primary ones, therefore its development depending on survival to the initial tumour. It also emphasizes the need for adequate anamnesis aimed to detect multi-cancer syndromes and the etiology of multiple neoplasias. Further studies are needed to understand the scope of multiple neoplasias and their relative risk.