[Recurrent neobladder rupture: conservative management]. / Rotura recurrente de neovejiga ileal: manejo conservador.

PURPOSE: To present a case of recurrent neobladder rupture treated in a conservative fashion. To review the articles on conservative management of cases like this one published from 1985. RESULTS: Nineteen articles have been published since 1985 on spontaneous neobladder rupture, 4 of which describe the possibility of a successful conservative management, provided that the patients are carefully selected. CONCLUSIONS: Faced to abdominal pain in patients with neobladder, it is essential to suspect spontaneous perforation and, if possible, to confirm such suspicions by means of cystography or CT. An exploratory laparotomy may be necessary in many instances, sometimes due to lack of a diagnosis and sometimes because the patient's status rules out any other procedure, but in selected and precisely diagnosed cases a conservative management can be resolvent.

[Small renal mass. Diagnostic management]. / Masa renal pequeña. Manejo diagnóstico.

OBJECTIVE: The detection of renal masses < 3 cm has continually increased over the last few years due to the improvements and wide use of imaging techniques that have made early diagnosis of renal carcinoma possible and therefore to directly influence patient survival. The approach to small renal lesions based on our experience and the data published in the literature are analyzed. METHODS/RESULTS: The small renal lesion is problematic and indeterminate because of its size, which makes it difficult to measure its density before and after contrast administration on CT assessment, and is the main diagnostic factor in this disease. Small renal masses constitute a diagnostic challenge whose resolution may lead to disproportionate surgery. This has led us to utilize multiphasic helical CT with specific protocols and to look for data in the natural history of the renal tumor to complement the radiological findings. Series have been published that demonstrate that the slow growth and degree of malignancy of small renal tumors warrant a regular helical CT control evaluation because it allows comparison of the findings and detects growths > 1 cm, which is a sign of malignancy and consequently an indication for surgery. CONCLUSION: Due to the natural course of small renal tumors and the reproducibility of multiphasic CT, the correct approach is to perform close follow-up of patients at surgical risk or with an equivocal diagnosis using this imaging technique.

[Assessment of erectile dysfunction with Doppler-duplex ultrasonography]. / Valoración de la disfunción eréctil mediante ecografía Doppler-duplex.

OBJECTIVE: To evaluate the penile echo Doppler study and review the anatomy, perfusion, innervation and physiology of erection. METHODS: The technique, spectral morphological changes of the cavernous arteries after drug-induced erection, modifications and normal values are described. RESULTS/CONCLUSION: Impotence or erectile dysfunction, which is defined as the inability of the male to achieve or sustain an erection sufficient for successful sexual intercourse, is a benign condition with an important impact on the wellbeing of the patient. Statistical studies have shown a high age-dependent prevalence in healthy subjects and an association with different conditions in patients. To establish whether impotence is organic or not and to identify its underlying cause require submitting the patient to not a few diagnostic tests. Since most of the cases of organic impotence are of vascular origin, it is necessary to utilize a diagnostic method that can identify patients with an underlying vascular disorder (the most common cause) and distinguish those with arteriogenic impotence from those with insufficiency of the complex corporeal veno-occlusive system.

[Analysis and clinical course of residual lithiasis after shock wave renal treatment]. / Análisis y evolución de la litiasis residual tras la aplicación renal de ondas de choque.

OBJECTIVE: Although residual lithiasis after the application of shock waves is a situation that coexists with the procedure, in some cases it can be considered to be a failure of ESWL. The natural history and outcome of 244 cases of residual renal stone followed over a 5-year period are analyzed, and the approach based on a pre-established classification is discussed. METHODS: Of 1,407 patients treated by ESWL for renal lithiasis during 1995, 244 cases with a renal calculus larger than 3 mm were followed for a period of 5 years after treatment and evaluated by clinical, radiological, ultrasound and analytical methods. RESULTS: At 3 months post-ESWL, 1,013 cases (72%) were completely stone-free and 394 (28%) showed residual stone; of these, 244 (62%) had residual stone fragments greater than 3 mm. At 5 years, 190 (78%) remained stable and the remaining 54 (22%) showed stone regrowth that warranted additional treatments: 52 ESWL, 1 PNL and 1 partial nephrectomy. Despite the retreatments, only 42% became completely stone-free. CONCLUSIONS: A classification of residual renal stone can be established based on the data obtained to orient the approach in each case, although the frequency of residual stone can be reduced by the appropriate indication of ESWL. Once a renal stone has formed retreatments with ESWL cannot ensure complete elimination of the stone.

[Testicular tumor. Ultrasonography study]. / Tumor testicular. Estudio por ecografía.

OBJECTIVE: The present study reviews the diagnostic criteria of testicular ultrasonography. METHODS: Our experience and data available at our institution and in the literature were reviewed. The US patterns directly or indirectly related to testicular tumors and the lesions that may mimic these tumors are analyzed. The utility of CT and MRI is also discussed. RESULTS: The sensitivity of US in testicular tumors was 100%. Its specificity was lower and was limited by the technique which is operator-dependent. Most of the testicular tumors were hypoechoic and this was a common feature of seminoma. CONCLUSIONS: The rational use of the US patterns together with the clinical and biological findings are useful in making the diagnosis in tumors with atypical patterns or those found in special groups of patients.

Conventional CT signs in staging transitional cell tumors of the upper urinary tract.

OBJECTIVES: To determine conventional computed tomography (CT) signs in the diagnosis and staging of upper urinary tract tumors (UUTTs). METHODS: Retrospective study was made of the CTs of 82 patients diagnosed with UUTTs. Nine CT signs were defined and compared with the pathology of the surgical specimen. A chi2 test was used for statistical analyses. RESULTS: We reviewed the CTs of 93 UUTTs in 82 patients, of which 36% were invasive and 12% had positive lymph nodes. Renal parenchymal invasion was found in 82% of high-grade and in 18% of low-grade tumors (p = 0.001). 94% of the tumors with signs of renal parenchymal invasion were invasive (p < 0.001), as well as 88% of those appearing as renal masses (p = 0.005), with a global sensitivity of 64% and specificity of 97%. The CT sensitivity and specificity of detecting infiltration of the ureter was 67 and 77%, respectively, and no sign was statistically significant. The detection of lymph node involvement had a sensitivity of 87.5% and a specificity of 98%. CONCLUSIONS: CT offers good sensitivity (87.5%) and specificity (98%) in the detection of lymph node involvement, and 64% sensitivity and 97% specificity for the detection of renal tumor invasion.

[Emphysematous pyelonephritis associated with splenic infarction: conservative approach. Apropos of a case and review of the literature]. / Pyélonéphrite emphysémateuse associée à un infarctus splénique: attitude conservatrice. A propos d'un cas avec revue de la littérature.

A case report of a emphysematous pyelonephritis associated with a splenic infarction is presented. The point of this case is the association of two rare pathologies and their management by the placement of a percutaneous nephrostomy. A review of the literature could not find any similar case.