Search

Midline prostatic cysts are infrequent and mostly asymptomatic. We presented a striking case of a giant midline cyst and detailed its diagnosis, evolution, and treatment. From this case, we offered a comparison of congenital intraprostatic midline cysts, namely, Müller's cysts and utricle cysts. A 40-year-old male experienced recurrent urinary retention. A 10 × 11 mm 2 cyst in the mid-prostatic region was diagnosed through transrectal ultrasound, leading to a transperineal puncture as a minimally invasive intervention. Seven years later, the cyst recurred, manifesting obstructive symptoms such as a weak urinary stream, frequent urination, and residual urine sensation. Laparoscopic surgery was then performed for the confirmed 98 × 13 mm 2 cystic recurrence. The postoperative course was favourable with no complications. Symptoms were completely resolved, which was maintained over a three-year follow-up period. The therapeutic approach to midline cysts targets symptomatic cases or infertility, ranging from cyst puncture to transurethral endoscopic treatment. Recurrence after minimally invasive interventions is a challenge, with laparoscopic surgery as an alternative post-failed conservative approach. Although total cyst removal risks adjacent structure damage, marsupialisation improves the clinical outcomes. In summary, symptomatic midline prostatic cysts present challenges owing to recurrences after minimally invasive approaches. Enhanced laparoscopic techniques offer a solution, particularly in highly symptomatic cases requiring definitive treatment, as illustrated by this outstanding case report., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s).)

Objective: The World Health Organizationdeclared a pandemic status due to the COVID-19 disease caused by the new coronavirus SARS-Cov-2 in March 2020. This caused high health pressure that hashad an impact on the Spanish National Health System and Granada has been one of the most affected provincesnationwide. The high healthcare pressure derived from it has had an impact on the National Health System throughout the Spanish territory, with Granada beingone of the most affected provinces nation wide. The increase in the admissions of patients with COVID-19 in such a short time has forced us to optimize hospital resources, prioritizing them in patients with COVID-19 and oncological or urgent pathology. In this context, the increasingly frequent and recurrent lithiasis is treated conservatively. However, the prolongation of the pandemic situation poses the challenge of offering definitive treatment to these patients., Material and Methods: We present the rearrangement performed in our Lithotripsy Unit with the aim of developing a comprehensive and alternative protocol for performing ureteroscopies on an outpatient basis, assuming the patient from admission to hospital discharge, with the collaboration of the Anesthesiology service., Results: In this new protocol, 35 ureteroscopies were performed without noticing intraoperative complications or during the recovery period developed in the Day Hospital integrated within the Lithotripsy Unit., Conclusions: The redistribution of our resources has allowed us to continue performing ureterorenoscopies on an outpatient basis without the need to use hospital beds and reducing the traffic of patients within the hospital itself with an adequate safety profile.

Introduction: The nutritional supplement called Fagolitos plus® contains hydroxycitric acid as main component, in addition to zinc, magnesium, vitamin A and vitamin B6. It is necessary to study new molecules as chemolytic treatment in calcium lithiasis or that facilitate its fragmentation with the help of other instrumental treatments., Objective: The objective of this study is to evaluate the effectiveness of the combined treatment of Fagolitos plus® and extracorporeal lithotripsy in the fragmentation of the lithiasis., Material and Methods: Retrospective case-control study includes 88 patients with lithiasis. Group 1: Treated with 1 session of extracorporeal lithotripsy and Fagoliths plus®. Group 2: Treated with 1 session of extracorporeal lithotripsy. The variables analyzed were: Age, sex, body mass index, maximum diameter of the stone, area of the stone, hounsfield units of the stone measured by axial tomography, location of the stone, result after 1 session of extracorporeal wave lithotripsy shock [complete fragmentation, partial fragmentation (presence of a fragment greater than 5 mm) and absence of fragmentation (same size of the lithiasis)], adverse effects that occurred after taking Fagolitos plus®, days of treatment with Fagolitos plus® and energy shock wave applied to lithiasis. Results were analyzed with SPSS 20.0, p≤0.05., Results: The mean age of the patients included in the study is 53.81 ± 12.62 years in group 1 compared to 56.53 ± 12.37 years in group 2, p=0.31. According to the distribution by sex, there were no statistically significant differences (p=0.5), including 24 men and 24 women in group 1 and 23 men and 17 women in group 2. The mean of body mass index of the patients in group 1 was 28.39 ± 2.27 kg/m2 in group 1 versus 28.39 ± 3.03 kg/m2 in group 2, p=0.9. The maximum diameter of the stone was 11.5 ± 3.91 mm in group 1 compared to 13.15 ± 5.49 mm in group 2, p=0.1. The area of the lithiasis measured by tomography was 104.74 ± 70.56 mm2 in group 1 compared to 141.91 ± 80.95 mm2 in group 2, p=0.3. The Hounsfield units measured by tomography of the lithiasis in group 1 was 1061.98 ± 213.68 compared to 1143.15 ± 172.24 in group 2, p=0.06. Relation to fragmentation, complete fragmentation was observed in 66.7% of group 1 patients, compared to 41% of group 2 patients (p=0.02), between 20-30 days after the first session of Extracorporeal Lithotripsy evaluated by means of a simple X-ray of the Abdomen., Conclusions: The administration of Fagolitos plus® concomitant to extracorporeal lithotripsy could increase its effectiveness in lithiasis fragmentation, requiring clinical trials and prospective studies to confirm these findings.

Objectives: Extracorporeal shock wave lithotripsy is a minimally invasive therapeutic option for the treatment of renal-ureteral lithiasis. The aim of this study was to analyze the results and complications of shock wave extracorporeal lithotripsy treatment with the Dornier Gemini® Generator EMSE 220f-XXP device in patients with renal and ureteral lithiasis., Material and Methods: Retrospective study including 377 patients with renal or ureteral lithiasis with indication for treatment with extracorporeal shock wave lithotripsy. The following variables were analyzed, age, sex, body mass index, lithiasis size, lithiasis location, presence of urinary diversion, number of lithotripsy sessions, number of shock waves, fluoroscopy time, wave energy, applied focal energy coefficient, efficiency coefficient, lithiasic fragmentation, lithiasic clearance, residual lithiasis, presence of lithiasis and complications. The results were analyzed with SPSS 17.0 considering statistical significance p≤0.05., Results: Of the 377 patients, 213 were men and 164 women, with a mean age of 51.28 ± 12.77 years. The mean size of the stones in maximum diameter was 11.77 ± 6.13 mm. Lithiasis fragmentation occurred in 81.9% of cases, with a percentage of residual lithiasis after the first session of 58.7% and a total or partial expulsion rate of lithiasis fragments of 68.3%, with global success at the end of sessions of lithotripsy of 69.8%. The overall Efficiency Ratio was 0.42, higher in upper calyx 0.51 and lower in medium calyx 0.35, with significant differences (p<0.05). The only differences were found in relation to the success of lithotripsy treatment (75% versus 64.6%, p=0.02), according to lithiasis size (≤10 mm maximum diameter in comparison to >10 mm). In patients with a DJ catheter there is a higher percentage of residual lithiasis (p=0.006)., Conclusions: Treatment with extracorporeal lithotripsy in small lithiasis and in well-selected patients obtains good results with a low rate of complications regardless of sex and body mass index.

Objectives: Androgen deprivation therapy (ADT) in prostate cancer is associated with the appearance of different adverse effects. Among these effects, notable ones that may affect metabolism are osteoporosis and metabolic syndrome. The aim of this study is to analyse lithogenic risk markers three months after initiating treatment with LHRH analogue., Methods: Pilot study encompassing 15 prostate cancer patients who were candidates for ADT, which they received in the form of quarterly doses of goserelin 10.8 mg. A blood and urine analyses for lithogenic risk, bone and metabolic markers were carried out, as was a study of metabolic syndrome criteria. Statistical analysis was performed with SPSS 17.0, taking P≤.05 to be statistically significant., Results: Patients included in the study had a mean age of 72.46 ± 6.61 years. We observed a significant increase in the percentage of metabolic syndrome (20% versus 46.7%; P<.05) and insulin resistance index (1.87 versus 2.96; P=.01) at 3 months treatment. There was a notable increase in bone remodelling markers and significant increases in 24 h urinary calcium values (9.46 versus 14.57 mg/dl; P=.008), 24 h urinary calcium excretion index (0.10 versus 0.13 mg/dl GF [glomerular filtration]; P=.01) and the fasting calcium/ creatinine ratio (0.107 versus 0.195; P=.007), without any changes to other lithogenous risk markers., Conclusions: Androgen deprivation therapy can lead to the short-term appearance, primarily when fasting, of hypercalciuria in prostate cancer patients, possibly in association with bone metabolism.

In this review, we analyze the etiopathogenic principles of urinary lithiasis formation. In the kidney, calcifications that may cause renal lithiasis are produced as a consequence of processes that injury the urothelium at the papilla and Bellini's ducts. With the improvement of imaging techniques, mainly micro CT scan, it is possible to detect them and we may be able to anticipate to the formation of lithiasis. As we well know, there are different factors that influence the formation of the calculi depending on their composition. In calcium lithiasis it is key to review the modification of the categories of hypercalciuria, we currently distinguish two types instead of three, thanks to the fasting calcium/ creatinine ratio, differentiating absorptive hypercalciuria and fasting hypercalciuria. In the fasting hypercalciuria, it is important to emphasize the relationship between this factor and the loss of bone mineral density in patients with recurrent renal calcic lithiasis, so that in this kind of patients it is compulsory the study of bone metabolism by bone remodelling markers and bone densitometry. Regarding the other factors that participate in the formation of calcium lithiasis we should specially emphasize on hypercalciuria and its growing increase because of its relationship with obesity and metabolic syndrome, as well as hipocitraturia, present in an important percentage of patients and related in some cases with metabolic acidosis and osteopenia-osteoporosis too. In relation to uric acid lithiasis it should be highlighted that urinary pH is the most determinant factor and, therefore, its control and modifications would be paramount for prevention of this type of lithiasis. In the infectious lithiasis, the presence of germs that split urea is mandatory. They generate ammonia ions with the ability to injure the urothelium and to form magnesium ammonium phosphate lithiasis mainly. Regarding cystine lithiasis, rare, it was classically divided in three types and now passed to be classified in type A and B depending on the muted gene, and it is more useful to perform direct 24-hour urine measurement than screening tests which have low sensitivity. In general, we tried to give a comprehensive view of the various types of lithiasis emphasizing the most interesting clinical points for the urologist.

Objective: The goal of this study is to analyze whether there is a need for antibiotic prophylaxis in this outpatient procedure., Methods: Prospective observational non-randomized study including 100 patients divided into two groups: - Group 1: 48 patients receiving 500 mg of ciprofloxacin prophylaxis 1 hour before urethrocystoscopy; - Group 2: 52 patients without antibiotic prophylaxis. Before inclusion of the patients in the study, we checked the absence of urinary tract infection by means of a urinalysis obtained 3 days before the procedure. We analyze: cystoscopy indication, cystoscopy results, presence of comorbidities, urinalysis 7 days after the procedure, and urinary symptoms within 7 days of the procedure. The statistical analysis was performed using SPSS 20.0 and the statistical significance was p=0.05., Results: The average age of patients in group 1 was 66.7±12.4 versus 65.6±10.8 years in group 2 (p=0.6). There are no differences in the percentage of men/women included in the groups. 14% of patients of group 1 and 12% of group 2 presented bacteriuria, without showing any significant differences. In the multivariate study, it is observed that neither age, nor diabetes, smoking, lower urinary tract symptoms, nor immunosuppression are related with the onset of bacteriuria in the groups., Conclusion: We do not consider the use of ciprofloxacin as prophylaxis for flexible cystoscopy is appropriate in this area of health, since it does not reduce the presence of urinary infection or bacteriuria.

Objective: The aim of this study is to evaluate the efficacy of a local intraurethral anesthetic on the pain perceived by the patient during flexible cystoscopy., Methods: An observational, prospective, nonrandomized, study was conducted on 142 males subjected to a flexible cystoscopy. The patients were divided into two groups: Group 1: 70 patients with intraurethral anesthetic (lidocaine 2%), and Group 2:72 patients without intraurethral anesthetic. The results were scored on a visual analog scale and a pain questionnaire and analyzed. The statistical analysis was performed using SPSS 17.0 and with a statistical significance of p≤0.05., Results: The mean age of Group 1 was 64.7±10.3 years compared to 66.7±10.8 years in Group 2, with no significant differences. The score on the visual analog scale in Group 1 was 2.23±2.20 versus 1.69±1.74 in Group 2 (p=0.1). The overall and current pain intensity in the pain questionnaire was 1.81±0.87 and 1.66±1.65, respectively, in Group 1, and 1.72±0.72 and 1.21±1.45, respectively, in Group 2 (no significant differences). After dividing the patients into groups according to a visual analog scale score ≤2, it was observed that the cause that led to cystoscopy was an independent factor associated with the perception of pain, increasing the risk of perceiving more pain by 1.89., Conclusion: The use of local anesthetic as a lubricant prior to flexible cystoscopy does not appear to reduce pain, and we consider that its routine use is not indicated.

Objective: To determine the importance of fasting calcium/creatinine ratio in patients with calcium stones and its relation with hypercalciuria and phospho-calcium metabolism., Methods: Cross-sectional study including 143 patients divided into two groups according to fasting calcium/creatinine. Group 1: 66 patients (calcium/ creatinine<0.11); Group 2: 77 patients (calcium/ creatinine>0.11). A comparative study is performed between groups including phospho-calcium metabolism parameters and excretion of urinary lithogenic markers. Linear correlation studying calciuria and fasting calcium/ creatinine was performed. SPSS 17.0 statistical analysis software was used, considering p≤0.05., Results: It is noteworthy that group 2 had increased 24 h urine calcium excretion in comparison to group 1 (229.3 vs 158.1; p=0.0001) and calcium/citrate (0.47 vs 0.34; p=0.001). There is a positive and significant correlation between calcium levels in 24 h urine and fasting calcium/creatinine (R=0.455; p=0.0001) and a cutoff is set at 0.127 (sensitivity 72%, specificity 66%) to determine hypercalciuria (>260 mg in 24 h)., Conclusion: Increased fasting calcium/creatinine determines increased 24 hours calcium excretion, although the sensitivity and specificity to determine hypercalciuria is not high.

Objectives: Treatment of calcium stones is based on diet and pharmacological measures such as the use of thiazides and other drugs. The aim of this study is to assess the effect of alendronate on hydrochlorothiazide on urinary calcium and bone mineral density in patients with calcium stones., Methods: Prospective observational study involving 77 patients with relapsing calcium stones divided into 2 groups according to treatment received. Group 1: 36 patients treated with alendronate 70 mg/week; Group 2: 41 patients treated with hydrochlorothiazide 50 mg/day. All patients receive diet recommendations and fluid intake. Studied and analyzed among other variables were bone mineral density, bone turnover markers and calciuria before and after 2 years of treatment. Statistical study with SPSS 17.0, statistical significance p<0.05., Results: No statistically significant differences in the distribution by sex or age of the patients between groups. In group 1 statistically a significant decrease was observed in the Β-crosslaps and improvement in bone mineral density, along with decreased urinary calcium after 2 years of treatment. In Group 2 statistically significant decrease in urinary calcium and fasting calcium/creatinine was seen, along with improvement in bone mineral density after 2 years of treatment. In group 1, there is a more obvious and significant improvement in bone mineral density compared to 2 and Β-crosslaps decrease. However, in group 2 the decrease in urinary calcium and calcium/creatinine was more significant than in group 1., Conclusion: Treatment with thiazide decrease calciuria and produces an improvement in bone mineral density, although not in the same range as treatment with alendronate.

Objective: To investigate the manner to increase specificity in the decision-making process for the performance of prostate biopsy., Methods: We include in this study men with PSA between 4 and 10 ng/ml and free/total PSA < 20%, candidates for prostate biopsy. Patients receiving 5 alpha reductase inhibitors or with previous biopsies were excluded. Analyzed variables: total PSA, total testosterone, free and bioavailable testosterone, FSH, LH, SHBG, 17 hydroxyprogesterone, Androstenedione, prostatic volume measured by transrectal ultrasound, total testosterone/PSA, testosterone/free PSA, bio available testos-terone/PSA and PSA density, total testosterone/prostate volume, free testosterone/prostate volume and bioavailable testosterone/prostate volume., Results: A total 109 patients have been included, divided into 2 groups according to the results of the biopsy. Significant differences were observed in prostatic volume (Group 1: 36.6cc and Group 2: 52.8 cc; p=0.04), PSA density (Group 1: 0.24 Group 2: 0.17; p=0.002), total testosterone/prostate volume (Group 1: 0.15 and Group 2: 0.10; p=0.02) free testosterone/prostate volume (Group 1: 0.002 Group 2: 0.001; p=0.01) and bioavailable testosterone/prostate volume (Group 1: 0.06 Group 2: 0.04; p=0.007)., Conclusion: The decision for a prostate biopsy on patients with a PSA between 4-10 ng/ml with free/total ratio < 20% continues to be an issue, however, we can optimize decision using other parameters such as prostate volume, PSA density and bioavailable testosterone/prostate volume.

Objectives: Minimally invasive techniques for the surgical treatment of prostate cancer have aimed to achieve the same functional and oncological outcomes of open surgery with a significant decrease in postoperative morbidity and a subsequent decreasing hospital stay. These improvements are important in the current economic context. Our aim was to evaluate the feasibility and safety of hospital discharge 24 h after laparoscopic radical prostatectomy (LRP)., Methods: A total of 266 consecutive patients with clinical diagnosis of localized prostate cancer consecutively treated with extraperitoneal LRP between May 2007 and December 2010 were analyzed. There were no exclusion criteria for the surgical procedure. Patients were discharged in less than 24 h only in the case of absence of medical complications, with drainage of less than 50 mL allowing its removal before discharge, normal oral feeding tolerance, no significant hematuria by bladder catheter and good functional recovery of the patient. All surgery-related complications that occurred within 90 days after surgery were recorded and were classified according to the modified Clavien scale., Results: A total of 266 patients who underwent LRP were studied with a median follow-up of 34 months. 80 (30.1%) patients were discharged from the hospital in less than 24h. 89 (33.4%) patients were discharged within 48 h and 97 (36.5%) after 48 h.The mean hospital stay of the entire case series was 2.9 days (SD 3.08). The mean hospital stay of patients who were discharged after 48 h was 5,5 days (SD 3.94) Thirty-one patients (10.7%). experienced post-surgical complications. 25 (9.31%). of them were classified as Clavien I or II, and 6 (2.2%). Clavien III or IV. A total of 9 (3.3%) patients were readmitted. Of the group of patients who were discharged within 24h only one was readmitted due to hematuria., Conclusions: Extraperitoneal LRP is the standard treatment for localized prostate cancer in our institution. This treatment reliably and safely allows a hospital stay shorter than 24 h in a significant percentage of our patients.

Objective: To describe a case of para-urethral leiomyoma and to review the literature., Methods: The usual preoperative diagnostic procedures and clinical manifestations are discussed., Results: The mass was resected and, 6 years later, the patient remains asymptomatic and with no recurrence., Conclusions: Urethral or paraurethral leiomyomas are benign tumors that arise from the urethral or vaginal smooth muscle. Radiological findings (particularly magnetic resonance imaging) may suggest the origin of the tumor before surgery; however, the final diagnosis is determined by histology.

Objectives: The aim of the study is to compare the use of PSA testing among general practitioners (GPs)., Methods: The number of PSA tests ordered by general practitioners in the years 2008-2009 was examined in a cross-sectional study of nine health districts of Spain. The percentage of PSA ordered to men younger than 50 (PSA<50/PSAtotal) and 40 years (PSA<40/PSAtotal) was calculated. The percentage of men over 50 years who were attended was also calculated and this data was compared with the number of PSA ordered to this population. For two of the departments, these data were also compared between GPs and urologists., Results: PSA testing in 2009 is higher than 2008 in seven health districts. PSA testing in men younger than 50 years was increased along the period of the study and in men younger than 40 years remained steady. The differences between the values of the indicators for urologists and GPs are significant., Conclusions: The number of PSA tests and the percentage performed to men younger 50 years has been increasing and the variability is high. These data are suggestive for interventions focused on PSA testing and prostate cancer screening in primary care settings.

Objective: The commonest indications for ureteral stent placement are: obstructive nephrolithiasis, renoureteral surgery, urologic oncology, endourology and extrinsic ureteral compression., Methods: We report the case of a 77-year-old male patient with a DJ ureteral catheter placed for an 8-month period and history of nephrolithiasis; the stent showed a 60 mm x 30 mm calcification on its distal end., Results: Open cystolithotomy and removal of stent resolved the clinic symptomatology., Conclusion: A prolonged indwell time of stents, as well as a history of nephrolithiasis and urinary infections may on many occasions result in calcification and encrustation of ureteral stents, and will lead to the use of endourology techniques, extracorporeal lithotripsy or open surgery to resolve these conditions.

Objectives: Our goal is to analyze the degree of concordance between the Gleason score (GS) obtained in prostate biopsies and the one after radical prostatectomy. The intention is to know whether 12-core biopsy, instead of 6 (sextant biopsy), improves, or not, this correlation., Methods: A Cohort/prevalence study was conducted on 128 patients who underwent prostate biopsy and subsequent radical prostatectomy. Patients showing biopsy Gleason values greater or equal to 6 were selected as candidates for radical prostatectomy., Results: Mean age of the group of 128 patients was 62.9 years, with a mean PSA value of 8.53ng/ml. There was concordance between biopsy Gleason score and that obtained after radical prostatectomy in 63.28% of cases, while discordance was found in 36.72% of cases. There were not significant statistical differences after comparing results obtained between Gleason score concordance after 6 or 12-core biopsies and that obtained after radical prostatectomy., Conclusions: We have noticed a low correlation between Gleason score after biopsy when it was compared with that obtained after radical prostatectomy, while these results are similar to those found in the literature. We did not find better results regarding Gleason score correlation after biopsies performed with 12 cores instead of 6.

Objectives: The relationship between hyperparathyroidism and lithiasis is quite known, so the study of parathyroid glands is especially mandatory in the face of relapses. Our objective is to analyze both primary hyperparathyroidism (PHPT) associated with renal lithiasis and the evolution of this condition after parathyroidectomy, as well as to study factors associated with the presence of lithiasis or bone pathology, and carry out a review on bibliography., Methods: We describe a retrospective study of a series comprising 287 cases of hyperparathyroidism: 237 of them were primary and the remaining 50, secondary. We have included: sex, age, evolution time and symptoms, diagnostic tests (biochemical, radiological and histological). Factors such as number of episodes prior to diagnosis and treatments were analyzed in patients with symptomatic lithiasis to know whether patients exhibited residual lithiasis after the management of calculi or whether patients underwent episodes after parathyroidectomy, or whether or not they were treated. Statistical analysis was carried out through SPSS 15.0 for Windows., Results: Forty five percent of the patients had suffered lithiasis episodes; 50%, osteopenia/osteoporosis; 23%, musculoskeletal pain; 23%, asthenia and/or depressive syndrome. In 13.5% of cases, diagnosis was supported by the presence of hypercalcemia; no other symptoms were detected. We have analyzed factors that favor or inhibit renal lithiasis formation and compared biochemical parameters from the group of primary hyperthyroidism that exhibited lithiasis (41 patients) with those patients who did not (49). We noted that lithiasis patients showed higher values of calcium, alkaline phosphatase, intact PTH, mean PTH, osteocalcin, and chlorine/phosphate, calciuria and phosphaturia indexes. Student's t test on two independent samples revealed significant statistical differences in calcium levels (p<0.05), intact PTH (<.05) and osteocalcin., Conclusions: Primary hyperparathyroidism patients with lithiasis presented higher values of parathormone, alkaline phosphatase, osteocalcin, and Cl/P and calciuria indexes than lithiasis-free PHPT patients. These patients exhibit objective improvement of symptoms after parathyroidectomy, and rarely a recurrence of lithiasis, a factor that generally coincides with persistence of residual lithiasis.

Objectives: To report the case and iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and the treatment of this surgical complication., Methods: 69 year-old woman status post renal transplantation who presents right lower extremity edema and worsening renal function. A liquid collection was demonstrated by ultrasound and computerized tomography, compatible with lymphocele after biochemical study of the liquid obtained by percutaneous puncture., Results: The patient underwent laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcome., Conclusion: Lymphocele is a common pathology after a renal transplantation which needs to be treated depending on its clinical manifestations. There mainly are two therapeutic alternatives depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from very selected cases, laparoscopic approach is currently considered, because of its security and effectiveness, the first choice when a surgical treatment is prescribed.

Objective: To report our experience with clinical presentation, appearance, diagnosis and treatment of Xanthogranulomaous pyelonephritis (XP)., Methods: Multicenter, observational, descriptive and retrosprospective study carried out during six years., Results: We studied 10 patients, 8 women and 2 males, with an average age of 50 years. All cases presented with lumbar and abdominal pain, loss of weight, conjuntival pallor, renal lithiasis and chronic evolution Fever and palpable abdominal mass, were present in 80% of cases and 60% presented history of urinary tract infection. Initial diagnosis, in most cases, was pyonephrosis. Two cases (20 %). were associated with cancer and other 2 (20 %)with Psoriasis. Mortality was of (10 %).Laboratory hallmark were anemia, high SGV rate and leukocytosis. Urinary sediment showed pyuria. Urine culture was positive in the 50 % of the patients. On the other hand urine cultures obtained from nephrostomy tube were always positive. The onset was unilateral and diffuse in all cases without predominance in the location. Direct abdominal x-ray showed lithiasis, ultrasound showed increased renal size, with a pattern of hydronephrosis and/or intraparenchymatous abscesses. CT scan was useful to demonstrate disease extension., Conclusions: Xanthogranulomatous pyelonephritis (XP) is a chronic and unusual inflammatory-infectious disease with acute episodes involving renal parenchyma. Most cases appear in medium aged women. Histopathologic study offers the accurate diagnosis. Antibiotic therapy avoids septic complications. Total or partial nephrectomy is the definitive treatment. We propose nephrostomy because it facilitates the microbiological diagnosis and surgery (nephrectomy).

Objective: We describe one case of recurrent lithiasis associated with anatomical alteration of the renal pelvis related to previous surgery., Methods/results: The patient presented a urinary tract infection episode, complicated with pyonephrosis and septicemia. In the intravenous urography, infectious radiopaque pyelocaliceal multiple and complex lithiasis can be seen, as well as kidney hydronephrosis grade III-IV. Important pyelic sclerosis secondary to previous surgery on the renal unit was seen. Nephrectomy was performed with lower pole nephro-lithotomy and reconstruction of the upper urinary tract through ureterocalicostomy. Two and a half years after surgery, control urogram shows absence of urolithiasis and a slight delay of renal function., Conclusions: Ureterocalicostomy is indicated in cases of ureteropelvic junction obstruction associated with intrarenal pelvis caused by alterations of fusion, rotation or location of kidney. It is also indicated in cases of severe peripyelic fibrosis secondary to previous pyeloplasty failure or renal surgery. In our case, in addition to the infectious component of lithiasis, an anatomical alteration, probably secondary to previous surgery, caused the chronification of lithiasis. Facing such suspicion a surgical management was undertaken to eliminate the lithiasis and get a correct derivation of the working area of the kidney, in order to prevent further recurrences.

Objectives: The use of laser for endoscopic lithotripsy started in 1968 when Mulvaney tried a ruby laser without success; Later on, the CO2 laser and the Nd:YAG were tried. With the pulsed dye and alexandrite lasers energetic performances between 30 and 200 mJ are obtained, their capacity of fragmentation is not universal and is limited to small stones, generally ureteral stones, so that it has not been a therapeutic alternative for bladder lithiasis. The holmium laser generates energy pulses of 400-2500 mJ, it is able to fragment every type of stone. The objective of this work is to analyze the results of endoscopic bladder lithotripsy with holmium-YAG laser., Methods: In the period between 2006-2008 we treated 21 cases of bladder lithiasis, with a stone size between 1 and 4 cm in patients from 8-76 years, six women and 15 men, which correspond to: four cases of infantile lithiasis, 3 of uric acid, one case of cystine, seven cases of calcium oxalate and/or phosphate, five cases of bladder lithiasis growing around a double J catheter, and one case of lithiasis within on intravesical ureterocele. Treatment was performed with a 20W Dornier Medilas holmium-YAG equipment, applied using children/adult cystoscopes or 7-8.5 Ch ureteroscopes, both semirigid and flexible. Post operative control included KUB x-ray and ultrasound. We performed a study of lithogenic risk factors and stone fragments analysis., Results: The 21 cases described are all secondary or type II bladder lithiasis. In all cases the absence of residual lithiasis was checked with imaging studies and the lithogenic risk factors were corrected with medical or surgical procedures., Conclusions: We consider that today bladder endoscopic lithotripsy with holmium laser is a therapeutic alternative. Despite there are multiple options for endoscopic treatment, transurethral lithotripsy with holmium laser offers good results with a low complication rate.

Objectives: With the popularisation of laparoscopic radical prostatectomy, the above technique has once again taken on an important role in the work of urology departments. Our extensive experience in laparoscopy means that we are performing increasingly more interventions using this approach. In the context of minimally invasive surgical procedures, this is probably bringing clearer benefits to retroperitoneal surgery than to prostatic surgery. In this article, we describe our series over nearly 4 years., Methods: The period analysed covers June 2004 to March 2008, during which time 288 retroperitoneal operations were performed (184 nephrectomies, 113 other procedures). In the majority of cases, the route of approach was transperitoneal., Results: The mean hospital stay was 3.6 days for the nephrectomies and 3 days for the other procedures. The transfusion rate for the nephrectomies was 5% and there was a conversion rate of in 2%. In the other types of surgery, the transfusion rate was 6% and there were no conversions., Conclusions: The expansion of laparoscopy in Urology has to be accompanied good patient selection and the progressive acquiring of experience on the part of the surgeon. Certain interventions should only be tackled in cases where there is extensive experience.

Objective: To report one case of melanoma of the glans penis., Methods/results: We present the case of a patient diagnosed and treated in our department describing diagnosis and therapeutic management., Conclusions: Melanoma of the penis is an uncommon presentation form of this kind of cutaneous tumor. We especially emphasize its diagnosis, clinical presentation and therapeutic management due to its prompt metastatic dissemination requiring early diagnosis and treatment.

Objective: We report two cases of collecting duct carcinoma that were diagnosed in our hospital in a six-month period., Methods/results: The first case was a 75years-old woman showing in CT scan a mass in the left kidney which infiltrated perinephric fat. The second case was a 72-years-old that showed in a CT scan a right renal pelvis lesion, involving inferior vena cava and renal vein. After surgical resection by radical nephrectomy in both cases, we confirmed the histological diagnosis of collecting duct carcinoma., Conclusions: Collecting duct carcinoma is a rare variant of renal cell carcinoma which originates from the epithelium of the collecting tubule. It is characterized by both its aggressiveness and peculiar histological and immunohistochemical diagnosis, that separates it from the rest of renal tumors.

Objectives: To review the current diagnosis and treatment of Leydig cell testicular tumors, with special attention to conservative treatment., Methods: We report two cases of Leydig cell tumor in young adults, diagnosed two years after the appearance of bilateral gynecomastia as first clinical symptom., Results: One year and eight months after orchyectomy, respectively, clinical symptoms completely disappear in the first case and significantly improved in the second., Conclusions: Around 10% of the cases, and only in adult patients, these tumors may be malignant, being radical orchyectomy the treatment of choice, although conservative surgery may be performed. Independently of the operation, follow-up must be prolonged.

Objectives: To analyze the survival rate in a series of patients with the diagnosis of renal cell carcinoma over a 19 year period based on prognostic factors usually employed in clinical practice., Methods: Retrospective study of 259 consecutive patients with the diagnosis of renal cell carcinoma undergoing surgery in our department between 1988 and 2006. From clinical, pathological, and follow-up data we performed a survival study comparing the impact of usual prognostic factors: stage, tumor size, nuclear grade, etc., Results: 264 surgical procedures were performed in 259 patients, with a mean age of 6 1.91 yr. The most frequent way of diagnosis was incidental finding (52.12% of the cases); radical nephrectomy was performed in 72.97% of the cases in comparison with 26.25% partial nephrectomies. Clear cell carcinoma was the most frequent histological diagnosis (69.88%). Patients with clear cell carcinoma, symptomatic tumors, bigger size, and greater Fuhrman nuclear grade presented worse survivals, mainly in tumors with stage >pT3a. The presence of involved lymph nodes or distant metastases is associated with a much lower cancer-specific survival. Global five-year cancer-specific survival was over 80%., Conclusions: The classical prognostic factors used to predict survival in renal cancer are still useful, mainly pathological stage pT. We observed a better survival in comparison with older series, but this kind of tumors continue generating important morbidity-mortality.

Objective: Leiomyosarcoma of the inferior vena cava is a rare tumor, clinically silent which often remains undiagnosed for much longer. Imaging methods allow us to detect these entities. We report a single case and perform a bibliographic review., Methods: 58-year-old woman with a 6 cm adrenal mass, which during surgery was found to be a tumor from the wall of the vena cava. We performed complete removal of the mass. Radiotherapy of the surgical area was applied within three months following surgery., Results: Two years later, there is no evidence of disease recurrence., Conclusion: This is a rare entity, with low prevalence. Complete surgical excision is the gold standard for treatment. Local recurrence is a common finding during follow up.

Objectives: Current treatment of hypercalciuria is still controversial, not being recommended calcium restriction since it may cause a negative balance with important consequences to bone metabolism. In adults, the use of biphosphonates (sodium alendronate) has shown a good response. Biphosphonates are synthetic analogs of the endogenous pirophosphate. Pirophosphate is the simplest form of phosphate. In 1968, Fleisch demonstrated that inorganic pirophosphate inhibits the precipitation of calcium phosphate. The differences between various biphosphonates are in the safety margin between their inhibitor effect for bone resorption and the inhibitor effect for mineralization; bone resorption inhibition has been their most widely spread application. The objective of this work is to analyze the clinical and biochemical effect of biphosphonates in patients with hypercalciuria, osteopenia and renal lithiasis., Methods: From 1996 to 2006 we treated 25 cases of recurrent renal lithiasis associated with hypercalciuria and primary or secondary bone mass loss. All cases were treated with sodium alendronate and oral calcium (1000-1200 mg/day). We analyze tolerance and treatment compliance, side effects, biochemical effects on blood and urine, effect on bone mineralization, and the outcome of lithiasic disease before and after treatment., Results: All patients have followed the recommendations for the administration of the drug (sodium alendronate 10 mg/day or 70 mg/week), have had good tolerance without relevant side effects, and no one quit treatment. 76% of the cases have had remission of the lithogenesis activity and 24% reduction, and all cases have had an increase of bone mineralization., Conclusions: In this group of selected patients with recurrent lithiasis and osteopenia the treatment with biphosphonates alone or associated with thiazide diuretics has given good results in renal lithiasis control and bone demineralization. The extension of indications should be analyzed in a multicentric randomized study.

Objectives: To evaluate the changes in voiding symptoms in female patients with stress urinary incontinence (SUI) undergoing transvaginal sling techniques over a five-year period in the Department of Urology at the University Hospital of Albacete., Methods: Between November 2001 and December 2005 126 patients with SUI (mean age 57.09 years; 36-78) underwent transvaginal sling techniques (Sling in Fast, TVK TOT). All patients were evaluated clinically and urodynamically., Results: Average body mass index (BMI) was 28.14 kg/m2 (SD 4.66; 95% CI: 27.32-28.96). 92 patients (73%) presented between 2-4 previous pregnancies. 99 patients (80.9%) have had birth labour between 2 and 4 times. All of them were vaginal birth labours except 12 cases (9.5%) in which caesarean section had been performed. Daytime voiding frequency after surgery was over 120 minutes in 112 patients (88.9%). Night-time voiding frequency was equal or less than twice in 110 patients (87.3%). 104 patients (82.5%) presented at least two leaking episodes per day, and 105 patients (83.3%) needed to wear one pad per day or less during the last week before follow-up visit. The number of urinary leak episodes per day diminished in 114 patients (90.5%) with a mean decrease of 9.65 episodes (95% CI: 8.56-10.79) (p < 0.0001). Ninety-four patients (76.4%) were completely dry., Conclusions: Development of new surgical techniques for the treatment of SUI have improved results and diminished the number of complications, an expression of which is the favourable evolution of voiding changes after surgery.

Objectives: The use of nanoparticules for drug transport is one of the topics with priority interest within the field of biomedical research. Our objective is to show the initial results of an innovative method to focalize drug carrier ferro-carbon nanoparticules to solid organs. We obtained and characterized various types of ferrous magnetic nanoparticules and studied their behaviour in vitro and in vivo in laboratory animals with intrarenal magnetic targets laparoscopically implanted., Methods: Using a plasma arch we obtained ferro-carbon nanoparticules with the ability to absorb and deliver doxorubicin, showing an excellent behaviour in in vitro rheological studies. Under general anesthesia and control we inserted a gold covered magnetic microharpoon in the left kidney of New Zealand rabbits. At the same time we injected intravenously different doses of various types of nanoparticules. The animals were sacrified ofter pre-established times and pathologic studies of their kidneys, spleens, livers, lungs and bone marrow were carried out., Results: After selection of the most adequafe nanoparticules for our purposes, we ascertained significant differences in the distribution of nanoparticules in postmortem studies, with accumulation in the magnetic target and surrounding renal parenchyma. Nevertheless, the reticuloendothelial system retains a great amount of the injected dose., Conclusions: Although our magnetic focalization system is effective, nanoparticule temporary protection systems should be tested to allow us avoid the action of the immune system.

Objective: To report the case of an epididymal and spermatic cord metastasis of a colon adenocarcinoma., Methods/results: We present the case of a 67 years old man, who presents several months after subtotal left colectomy for a left colon adenocarcinoma (pT3 NoMo), with a symptomatic right palpable testicular tumour. Right orchiectomy was done, demonstrating colon adenocarcinoma metastasis., Conclusions: Epididymal and spermatic cord metastases are very infrequent and they usually are found incidentally after prostate cancer orchyectomy.

Objectives: Urinary lithiasis has a multifactorial origin with participation of physical, chemical and anatomical factors. Physical-chemical factors of renal-prerenal origin are the consequence of exogenous or endogenous agents, which are integrated under the name of systemic diseases associated with urinary lithiasis. The objective of the urinary metabolic study is to know and to analyze the physical-chemical factors by which each of these diseases or clinical entities participate in the lithogenesis., Methods: We performed a study on 320 cases distributed in two groups: Group A: 70 healthy subjects without past medical history or family history of urinary lithiasis. Group B: 250 patients with history of renal lithiasis who had passed calculi spontaneously, after extracorporeal shock wave lithotripsy or surgery. Computerized urinary metabolic study (EMUSYS) was performed in all cases., Results: 24% of the patients in the control group presented one metabolic abnormality and 52% more than one; in group B, 17% of the patients presented one metabolic abnormality and 81% more than one. There were statistically significant differences in the percentage of hyperoxaluria, hipocitraturias and hyperalciurias. There were no differences in the subtypes of type III absorptive and excretory-resorptive hyperalciuria, hipomagnesiuria, and tubular acidosis, but these abnormalities were not detected in the control group. Moreover, some abnormalities were frequently observed in the control group, similarly to the patients group: enterorenal hyperuricosuria 34%, calcium supersaturation 13%, elevated excretion of sodium chloride 14%, type II absorptive hyperalciuria 8%, alimentary abnormalities, and low diuresis., Conclusions: People without lithiasis present biochemical urinary abnormalities in relation with life and alimentary habits similar to those found in patients, what concedes a role to the anatomical and hydrodynamical factors in lithogenesis. Patients with lithiasis present biochemical abnormalities such as calcium supersaturation, type II absorptive hyperalciuria, marginal absorptive hyperuricosuria, enterorenal hyperuricosuria, deficit of inhibitors, which may be controlled with adequate diet. Non dietetic hyperalciurias and hyperoxalurias, abnormalities of the urinary pH, and endogenous hyperuricosuria may be subject of diagnosis and treatment.

Objective: We describe a rare case, the metastasis of a renal clear cell carcinoma in the corpora cavernosum of the penis., Methods: 53-year-old patient presenting with a painful, hard tumor in the penis three months after right radical nephrectomy with cavotomy and thrombus excision., Results/conclusions: Imaging tests and biopsy led to the diagnosis of metastasis of a renal carcinoma in the corpus cavernosum, which was confirmed on the pathologic study of the specimen after penectomy. The appearance of renal carcinoma metastases in the penis is generally associated with advanced tumor stage, therefore associated with bad prognosis as in the reported case.

Objectives: To demonstrate the efficacy of ambulatory ureteroscopy under sedation-analgesia as diagnostic and/or therapeutic procedure for the upper urinary tract diseases, neoplasias, stenosis, stones., Methods: We analyze the results of a series of diagnostic and/or therapeutic procedures in 1243 patients divided into five groups: 1. Work up for filling defects with positive cytology and hematuria, 36 cases. 2. Treatment of urinary stones, 1135 cases. 3. Treatment and follow-up of upper urinary tract tumors, 19 cases. 4. Foreign body extraction, 27 cases. 5. Dilation/ section of ureteral stenosis, 26 cases. We perform the procedure under local anesthesia (urethral xylocaine gel), sedation with midazolam and analgesia with remifentanil perfusion (0.08-0.20 mcg kg/minute); the operation is subdivided into three steps: access to the ureter, progression/ureteral examination, and diagnostic and/or therapeutic actions., Results: Fifteen percent of the patients presented pain or intolerance at the start or during the procedure, and they progress to general anesthesia. 10% of the cases have a hospital admission longer than six hours. Ureteroscopy was effective as a diagnostic procedure in 30/36 cases. Ureteroscopy was indicated as elective treatment in 833 cases of ureteral stones (54 lumbar; 248 iliac; 531 pelvic), achieving good results in 93% of the patients; it was indicated for failures or complications of extracorporeal shockwave lithotripsy in 302 cases (73 lumbar; 83 iliac; 146 pelvic), with good results in 98% of the patients. Ureteroscopy was used to treat conservatively low-grade ureteral tumors of the pelvic ureter in 12 cases, or as palliative therapy (7 cases). From the 26 cases of ureteral stenosis, 8 underwent ureterotomy and 18 balloon dilation, leaving a ureteral catheter for 4-6 weeks, obtaining good results in 21 cases., Conclusions: Ureteroscopy is an effective technique in 94% of the cases, and it can be performed as an outpatient procedure for diagnosis or treatment of urinary stones and ureteral stenosis.