[Migration of an intrauterine device. An unusual cause of bladder foreign body]. / Emigración de dispositivo intrauterino. Una rara causa de cuerpo extraño vesical.

The origin of vesical and lower urinary tract foreign bodies is very wide, the specialized literature descriptions ranging from urethral dilators to coffee spoons handles through wires, cables and surgical instrumentation. The most frequent entry route of foreign bodies to the lower urinary tract is through the urethra usually by self-introduction or during transurethral surgical procedures. Another access route is that occurring during open or traumatic surgical manoeuvres. Less frequent is that the foreign body migrates from another anatomical structure. These patients present an heterogeneous clinical picture which depends on the location of the foreign body in the urinary tract. Thus, it can be acute if located in the urethra or subacute or chronic if found at vesical level.

[Enterovesical fistula in Crohn disease. An infrequent presentation]. / Fístula enterovesical en enfermedad de Crohn. Una presentación poco frecuente.

Herein we describe a case of enterovesical fistula in a patient with Crohn's disease that presented exclusively as urinary symptoms. The patient had no known history of GI disorders. The clinical features, natural history and treatment of enterovesical fistula in Crohn's disease are discussed.

[Eosinophilic cystitis. Study of the clinical course in 6 new cases and review of the recent literature]. / Cistitis eosinofílica. Estudio clínico-evolutivo de 6 nuevos casos y revisión de la literatura reciente.

Presentation of a series of 6 cases of eosinophilic cystitis diagnosed in our hospital and recorded in 1988-1993, with an average follow-up of 2 years from time of diagnosis. The actual trend with regard to this particular form of chronic cystitis is to abandon the idea of considering it a "benign" disease, basically due to its increasingly less uncommon association to bladder and/or prostate tumoral pathology (in the recent literature and most particular in the present series). Also, a relative increase in the frequency of occurrence of this disease is noted, because of chemoprophylaxis of surface bladder tumour with Mitomycin-C, an association which is increasingly frequent. Based on these 6 cases, a review of the most recent literature on this topic is made.

[Clinico-therapeutic classification of urinary lithiasis]. / Clasificación clínico-terapéutica de la litiasis urinaria.

Urinary lithiasis is a millenary disease for which different classifications have been developed: clinical, etiopathogenic, crystallographic, etc. The introduction of endoscopic surgery and extracorporeal lithotripsy in the last decade has created the need for a clinicotherapeutic classification as manifested by Rocco, Griffith, Tisselius, and other authors. We have developed the CEP/LTS-X classification, which evaluates the stone characteristics (C) [location and form (L), size (T), consistency (S) and number (X)], the excretory tract (E) and the renal parenchyma (P), and permits classifying the urinary calculus as LTS renal calculus types I, II, III, IV; LTS ureteral calculus types I, II, III; and LTS vesical and ureteral calculi types I and II, with related general characteristics that permit indicating treatment for each type: in situ ESWL or complementary endourological techniques, endoscopic or open surgery, alone or in combination.

[Ureteral lithiasis. Analysis of 3 series]. / Tratamiento de la litiasis ureteral. Análisis de tres series.

Presentation of our experience on 1000 cases of ureteral lithiasis treated over the last five years with ESWL, ureteroscopy and ureterolitotomy, distributed in three series of 396, 265 and 339 cases respectively. In the first series (396 cases), lumbar ureter calculi were treated with ESWL (dornier HM3) and iliopelvian calculi with ureteroscopy. In the second series (265 cases), all calculi were treated with ESWL (Siemens Lithostar). The third series was in turn subdivided in three groups: in the first group, comprising simple ureteral calculi, 'in situ' ESWL was performed; in the second group, of lumbar ureter complex calculi, ESWL was performed assisted by simple endourological techniques; ureteroscopy was performed in the third group, iliopelvian ureter complex calculi. Calculi characteristics (site, size, consistency and number), excretory tract and renal function, designated as CEP/LTS-X were assessed. These parameters allow us to grade ureteral lithiasis in Types I, II and III. A comparative study of the results in the three series was made reaching an overall conclusion that simple or Type I ureteral lithiasis can be treated with 'in situ' ESWL as first choice; in Type II or lumbar ureter complex lithiasis, 'in situ' ESWL is insufficient and other endoeurological support techniques are required, while in Type III, iliopelvian ureter complex lithiasis, ureteroscopy should be recommended.

[Distal tubular renal acidosis with nephrocalcinosis]. / Acidosis tubular renal distal con nefrocalcinosis.

Nephrocalcinosis and distal tubular acidosis are two infrequent processes caused by several etiologies which can present in association. This paper describes a clinical case of tubular acidosis and explains the differential diagnosis of both entities.

[Prevention of recurrence of superficial tumors of the bladder with intravesical epirubicin]. / Profilaxis de la recidiva en tumores vesicales superficiales con epirrubicina endovesical.

Twenty-six patients with surface vesical tumor receiving epirubicin are included for prophylaxis of relapse following surgical exeresis. The dosage used was 15 endovesical instillations of 50 mg in 50 cc sterile water, one instillation a week during the first month followed by once monthly to complete a year. After an average follow-up of 14 months a percentage of 19% relapses were observed with a relapse are of 1.3. Toxic events were seen in 46.1% of cases, and were almost exclusively chemical cystitis. Due to intractable vesical intolerance 5 patients were withdrawn from the study. Epirubicin was shown to be effective in reducing the relapse rate but showed a high incidence of chemical cystitis.

[Double-J ureteral catheter: its application in patients with complex renal lithiasis as a support measure during extracorporeal lithotripsy. Analysis of 441 consecutive cases]. / Catéter ureteral doble J: su aplicación en pacientes con litiasis renal compleja como maniobra de apoyo para litofragmentación extracorpórea. Análisis de 441 casos consecutivos.

Between August, 1986 and February, 1988, double J ureteral catheters were placed in 441 renal units of 419 patients (22 were bilateral) with complex renal stones prior to ESWL. Catheter placement was achieved in all but 3.8% of the cases using several techniques, mainly via the retrograde route. Placement of the double J catheter was indicated in almost 75% of cases with a large stone mass (staghorn or pseudo staghorn). Only 11% of post-ESWL "Steinstrasse" were obstructive; of these, 80% resolved spontaneously. The complication rate was 21%. Most of these cases were mild complications. All cases were resolved satisfactorily. We believe that the double J catheter is useful in patients with complex renal stones. Placement of a double J catheter involves a simple maneuver with a low morbidity. It aids ESWL, reduces complications, and avoids more important endourologic maneuvers.

[Chronic obstructive renal lithiasis. Extracorporeal lithotripsy or percutaneous renal surgery? Analysis of 2 series]. / Litiasis renal obstructiva crónica. Litotricia extracorpórea o cirugía renal percutánea? Análisis de dos series.

Experience has demonstrated that obstructive renal calculi with inferior infundibulocaliceal dilatation is not an indication for extracorporeal shock wave lithotripsy due to a high incidence of residual fragments in the lower calyx. These fragments are generally not spontaneously passed and become compact and form a new stone. We analyzed two groups of patients: 56 had been submitted to ESWL, and 53 to PCN. The results show that for obstructive renal lithiasis with dilatation of the lower calyx treatment is by percutaneous renal surgery first. This approach permits doing an ESWL procedure if stone fragments are observed in the early post-PCN radiologic work up. Similarly, if ESWL as monotherapy fails, we can resort to PCN.