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Purpose: This study aims to establish the ability of the Uroflex® external artificial sphincter to reduce the severity of male urinary incontinence and improve the quality of life of patients with male urinary incontinence., Methods: A pre-post pilot study was carried out on a sample of 30 patients with male urinary incontinence. Tolerability and satisfaction were assessed by comparing the results of the Pad test, and EQ-5D and KHQ questionnaires before and after 3 months of using Uroflex®., Results: At 3 months, 76.6% of patients continued using Uroflex®. The median score for overall satisfaction with the device was 8 out of 10. Pad test showed a significant reduction in the severity of male urinary incontinence at 3 months (p < 0.001), with resolution of all symptoms in 31% of patients. The KHQ showed a significant improvement in global quality of life (p = 0.003). This was also significant for five of the nine specific dimensions assessed. There was also an improvement in self-rated health using the EQ-5D questionnaire, although not significant (p = 0.075)., Conclusion: The Uroflex® external urinary sphincter seems to improve the severity of urinary incontinence and quality of life of patients with male urinary incontinence after prostate surgery. These encouraging results will need to be confirmed in larger controlled studies., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: Hypoandrogenism may have an association with urethral stricture. This study aimed to identify and quantify the association between testosterone levels and urethral stricture., Materials and Methods: A case-control study was conducted from January 2019 to January 2021. The case group included patients diagnosed with anterior urethral stricture who visited our urethral office of the urology department, while the control group included patients who visited our practice due to clinical conditions unrelated to voiding. In both groups, a 10 cc blood sample collection was scheduled between 7:30 and 9:30 a.m. The outcome was case/control status. The exposure variables were total testosterone, free testosterone, bioavailable testosterone, and hypoandrogenism (total testosterone < 300 ng/dL). The adjusted ORs were calculated for each exposure. Age, body mass index, hypertension, diabetes, smoking, and thyroxine levels were considered possible confounding factors., Results: A total of 149 cases (mean age 59.5) were compared to 67 controls (64.3). Urethral stricture cases showed significantly lower mean total testosterone than controls (394 ng/dL vs 488 ng/dL). Similarly, the hypoandrogenism rate was significantly higher in the urethral stricture group (26% vs 7.5%). Each 100 unit increase in total testosterone was related to a 34% decrease in the odds of urethral stricture (adjusted OR 0.66, 95% CI: 0.51-0.86). Similarly, each increase of 1 unit of free testosterone and 10 units of bioavailable testosterone was associated with a decrease of 18% and 10%, respectively. A strong direct relationship was observed between hypoandrogenism and urethral stricture (adjusted OR 4.01, 95% CI: 1.37-11.7)., Conclusions: Our study demonstrates an independent association between hypoandrogenism and anterior urethral stricture.

Objective: To shed light on the current controversy regarding the best treatment option for managing urachal anomalies in children., Patients and Methods: A retrospective follow-up of a case series comprising 13 children who were diagnosed with urachal anomalies was performed. All cases were diagnosed between 2000 and 2011 and followed up at the Pediatric Urology Unit of San Cecilio University Hospital in Granada (Spain). Information about the baseline and follow-up variables was collected from clinical records., Results: Nine of the 13 patients were symptomatic (6 patients with urachal cysts and 3 patients with urachal persistency). Conservative management was originally used in all but one case. During follow-up, reinfection appeared in two cases, and these patients were treated surgically. Spontaneous resolution was achieved in eight cases (61.5%). Two children with persistent urachal cysts are still being followed (4 and 6 years after the diagnosis), although ultrasound monitoring reveals a gradual reduction in the size of the cysts. The median time between diagnosis and resolution was 16.5 months., Conclusion: With the exception of cases in which there is a clear indication for surgery (i.e. reinfection), a conservative approach based on regular monitoring may be useful., (Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Introduction: We analyze the outcomes of patients with urethral stricture who underwent surgical treatment within the past 5 years., Methods: This is a retrospective study of male patients who underwent surgery for urethral stricture at our service from January 2008 to June 2012. We analyzed the comorbidities, type, length and location of the stricture and the surgical treatment outcome after endoscopic urethrotomy, urethroplasty or both., Results: In total, 45 patients with a mean age of 53.7 ± 16.7 years underwent surgical treatment for urethral stricture. Six months after surgery, 46.7% of the patients had a maximum urinary flow greater than 15 mL/s, whereas 87.3% of the patients exhibited no stricture by urethrography after the treatment. The success rate in the patients undergoing urethrotomy was 47.8% versus 86.4% in those undergoing urethroplasty (p = 0.01). Twenty percent of the patients in whom the initial urethrotomy had failed subsequently underwent urethroplasty, thereby increasing the treatment success., Conclusion: In most cases, the treatment of choice for urethral stricture should be urethroplasty. Previous treatment with urethrotomy does not appear to produce adverse effects that affect the outcome of a urethroplasty if urethrotomy failed, so urethrotomy may be indicated in patients with short strictures or in patients at high surgical risk.

Background: Benign obstructive pathology of the ureterovesical junction includes congenital and acquired illnesses. The objective of this study was to describe the endoscopic oblique meatotomy technique using scissors and cold cutting to treat benign obstructive pathology of the ureterovesical junction., Methods: From 2007 to 2012, we treated 18 patients with obstructive pathology of the ureterovesical junction (5 megaureters [3 with lithiasis], 4 iatrogenic stenoses, and 9 ureteroceles with lithiasis). In all cases, oblique meatotomy was performed using endoscopic scissors through an 8.5 Ch ureteroscope. The mean follow-up for all patients was 3 years. Pain, grade of hydronephrosis, and occurrence of vesicoureteral reflux were evaluated before and after treatment., Results: The mean endoscopic treatment time was 13.4 minutes. The procedure was performed on an outpatient basis with 6 hours of hospital admission, and a double J stent was inserted for 6 weeks. We achieved treatment success in 94.5% of patients after 3 years of follow-up. Only 1 patient presented with vesicoureteral reflux at 12 months after treatment; however, this condition did not require further treatment. Overall, 100% of patients remained free from lithiasis. There are 2 main limitations: the small number of patients and the lack of another group to compare the results of this technique; however, the aim of this work was to communicate a new technique to treat ureterovesical junction stricture., Interpretation: Oblique ureteral meatotomy is a safe and effective treatment for benign obstructive pathology of the ureterovesical junction and has a low index of complications.

Objective: Overactive bladder may have a neurogenic or non neurogenic origin. Sometimes, as a result of detrusor overactivity, disorders of the upper urinary tract function may appear. One of these alterations may be the appearance of associated vesicoureteral reflux. The treatment of overactive bladder may be done with anticholinergic drugs and if there is not response the use of botulin toxin type A is approved. The aim of this case report is to demonstrate the effect of botulin toxin type A in the treatment of overactive bladder and vesicoureteral reflux secondary to the overactive bladder., Method: We present the case of a 10-year-old patient without significant past medical history. When he was one year old he had a urinary infection and voiding cystourethrogram showed grade 1 right vesicoureteral reflux. When he was 4 year old he presented several episodes of pyelonephritis and then he was diagnosed of severe bilateral vesicoureteral reflux, which did not respond to treatment with Macroplastic ® or Deflux ®. Urodynamic study was performed showing overactive bladder with decreased bladder compliance., Results: We performed intravesical injection of 200 U of botulin toxin type A and vesicoureteral reflux disappeared and urodynamic study improved. One year later we re-injected botulin toxin type A (300 U) and we repeated the injection after one year (300 U). The patient is currently well, without changes in the urodynamic study and without vesicoureteral reflux., Conclusion: Repeated injections of botulin toxin type A has shown great efficacy in the treatment of overactive bladder in children with vesicoureteral reflux improved secondary.

Objectives: One of the main drawbacks of flexible urethrocystoscopy is the risk of urinary tract infection (UTI). In order to reduce this risk, antimicrobial prophylaxis has been considered, however there is not a unanimous view regarding indications, dosage, type of antibiotic, and so on. To clarify this uncertainty, we practiced a pilot and experimental study aimed at assessing the effectiveness of chemoprophylaxis with 3 grams of fosfomycin trometamol in the prevention of UTI after urethrocystoscopy., Methods: Sixty patients were entered into a pilot randomized clinical trial between March and August 2011. Thirty patients were assigned to a control group without receiving any antibiotic dose, and the intervention group (30 patients) received 3 g fosfomycin trometamol. Ten days later urine culture and sediment analysis were performed in all patients. Significant bacteriuria was considered from > 105 CFU /ml. One month later a telephone survey was developed to assess urinary symptoms, and assistance to the family doctor. We estimated the cumulative incidence of bacteriuria, pyuria and microhematuria in both groups, and we compared the results using a strategy of analysis per protocol and intention to treat., Results: The incidence of bacteriuria, pyuria and microhematuria in the control group was 10%, 23.3% and 26.7% respectively and in the intervention groups the values differed depending on the type of analysis. Considering only the 27 patients (per protocol analysis), the incidence would be 11.1%, 37.0% and 29.6% respectively. If we include the three patients who did not completed the study (per intention to treat analysis) and considering their results as negative, the results were 10%, 33.3% and 26.7% respectively. Finally, in the case the three cultures not performed in this group had produced a positive result, the impact would have been 20.0%, 43.3% and 36.7%. In any of the three cases, the differences with the control group were not statistically significant., Conclusions: In a selected population and with appropriate aseptic measures, antibiotic chemoprophylaxis does not appear to show a clinically relevant reduction in the incidence of UTI in patients undergoing flexible urethrocystoscopy.

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.

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: According to our experience, we present a proposal for the treatment of vesicoureteral reflux, based on both clinical and radiological evidences. We also describe how the introduction of endoscopic procedures has influenced the evolution of treatment indications as well as the time intervals for treatment., Methods: We have analysed all cases of vesicoureteral reflux treated in our Department in two periods of similar length: The first one (106 patients) comprised from 1995 to March 2001 (when endoscopic procedures were introduced). The second one (138 patients), comprised from March, 2001 to March 2007. Clinical, diagnostic, therapeutic and outcome-related variables were studied for all cases., Results: The number of patients was higher in the second period. In this period the number of cases requiring ureteral reimplantation decreased with respect to the first one (from 24 to 7). The success rate with endoscopic treatment reached 94.9%, with no significant differences regarding age or grade of reflux, although higher rates of failures were observed in children aged less than 3 years old and in high-grade reflux. The association of reflux with other malformations was not related with a worse evolution after treatment., Conclusions: Endoscopic treatment, due to its similar efficacy and low aggressiveness, should be considered a valid alternative to open surgery (which offers good results but non-negligible comorbidity) for persistent reflux in which medical treatment has not been useful. We propose a tentative therapeutic scheme to establish the indications for each type of treatment depending on the grade of reflux and its clinical evolution.

Objectives: To evaluate the efficacy of JJ catheter as urinary diversion in the treatment of lumbar ureteral lithiasis by ESWL., Methods: Results obtained in our ESWL unit between january 1990 and October 2000 are compared. 680 cases of lithiasis are divided into 5 groups for analysis: Group A: Lumbar ureter non obstructive lithiasis. 200 cases. Group B: Lumbar ureter obstructive lithiasis without urinary diversion. 307 cases. Group C: Lumbar ureter obstructive lithiasis with JJ catheter. 90 cases. Group D: Lumbar ureter lithiasis with percutaneous nephrostomy. 32 cases. Group E: Lumbar ureter lithiasis pushed up to renal cavities by JJ catheter. 51 cases., Results: Groups are compared for stone size, number of ESWL sessions and average number of shock waves. Repeated ESWL, complications and success rates are also analyzed. Statistical analysis of these results and its comparison by 2 proportion comparison tests show that groups B and C are homogeneous in size. We analyze these groups for complete success rate, partial success, and fragmentation index; it is derived from this analysis that Group C maintains the same level of fragmentation but not fragment expulsion, being this due to the only difference between groups B and C, which is the JJ catheter., Conclusions: In our series JJ catheter makes fragment expulsion difficult after treatment of the lumbar ureter lithiasis although it minimises the incidence of renal colic, the most frequent post-ESWL complication.

Objective: Genitalia trauma are relatively frequent pediatric emergencies. There is a wide spectrum of lesions that can be produced. The purpose of this study is to descriptively analyse our experience with pediatric urologic trauma over the last five years., Methods: We review 152 cases of male children ages 1 to 15 years old who presented with external genitalia trauma at our hospital's paediatric emergency room and required urologic evaluation or treatment. All cases were evaluated for type of lesion, mechanism of trauma production, complementary diagnostic tests performed and treatment: conservative or surgery., Results: 33.5% of lesions were prepucial or penile, and the remainder 66.5% were to the scrotum or its content. In 60 cases (61.2% of scrotal trauma) a scrotal ultrasound was performed. Treatment was conservative in 73.1% cases, and in the remainder 41 boys primary suture or surgical exploration were performed in cases of hematoma, parenchymal rupture, important penile-scrotal tears, and in one case of suprapubic cellulitis secondary to a prepucial wound. A deferred orchiectomy was necessary in one case only: a case with hematocele in which an initial surgical examination was not performed., Conclusions: External genitalia trauma during childhood are usually mild and the majority of cases do not request surgical treatment. When in doubt about parenchymal involvement or existence of hematocele surgical exploration must be performed trying to preserve testicular integrity.

Objective: To present the results achieved in the treatment of 1802 distal ureteral stones treated at the Lithotripsy Unit of the San Cecilio University Hospital over the last 10 years (1990-2000)., Methods: Stones were treated by extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy (URS). ESWL was the initial treatment in 81% of the cases (1460 calculi) and URS in the remaining 19% (342 stones). URS was performed for complication or failed ESWL (102 stones) and ESWL was performed for failed URS, basically due to stone migration (24 stones). Ureterolithotomy was required on 7 occasions. Sedation-analgesia with fentanyl and midazolam was routinely used in URS. Sedation was required in only 55% of the ESWL procedures., Results: Elective ESWL resolved 93% of the cases, a percentage which is similar to that achieved with URS as first treatment. The ESWL retreatment rate was 1.3. URS was successful in 98% of the cases of failed ESWL., Conclusions: There are two treatment modalities for stones in the distal ureter: ESWL and URS. We advocate the use of outpatient URS with sedation preferably in the female patient, impacted stones, obstructive uropathy, stones larger than 2 cm and radiotransparent stones.

Objectives: 1.--Investigate the bacteriuria preoperative in patients who will be operate on for Being Prostatic Hyperplasia (BPH). 2.--Define the prevalence of the prostatic colonization or infection. 3.--Try to correlate the bacteriological findings of urine and prostate, and find the degree of concordance between the microorganisms which can be commonly found in urine and prostatic tissue., Method and Materials: Prospective series of 175 patients undergoing prostatectomy for obstructive symptoms. The protocol revealed, among others variables: the preoperative urine culture; the presence or the absence of catheter; and the quantitative bacteriological culture of prostatic tissue. The information could be analised and its results could be obtained later on. The analysis stages consisted of both a descriptive and an analytic study., Results and Conclusions: 1.--Only 36 patients (20.6%) presented bacteriological increase of microorganisms (> or = 10(4) UFC/ml) in the preoperative urine culture. The Escherichia coli was the most common microorganism, followed by the Enterococcus faecalis, coagulase-negative Staphylococcus and the Pseudomona aeruginosa. A single microorganism grew in 31 out of the 36 positive cultures. 2.--The prevalence of the infection or colonization of the prostatic tissue was 25.1% (44 patients). The most common isolated microorganism was the coagulase-negative Staphylococcus followed by the Escherichia coli and the Enterococcus faecalis, in concentrations of at least 10(4) UFC/gr of tissue in the 79.6%. A single microorganism was isolated in 32 out of 44 patients. 3.--The proportion of positive prostatic cultures, in patients with positive urine culture (38.3%), was significantly higher than the one obtained in patients with negative urine cultures (16.5%) (p < 0.0001). Nevertheless, 52.3% of the 44 patients with positive prostatic cultures had negative urine culture, and only 21 (58.3%) out of the 36 patients with positive urine cultures presented a bacteriological growth in prostate. The degree of concordance (Kappa index) between the microorganisms which were found in preoperative urine and prostatic tissue is low or none for the majority of them.

Malignant paratesticular tumors are uncommon. Of these, liposarcoma of the spermatic cord constitutes a rare tumor. Only a hundred cases have been reported. They are typically presented in elderly people. The usually have a good prognosis because of their low level of malignancy and their relapses tend to be localized. It has a high rate of survival over 5 years. Preoperative diagnosis is infrequent, it is suggested by the appearance of a progressively enlarging mass in the scrotum and the ultrasonography which shows a solid mass of the spermatic cord that is independent of the testicle. The choice treatment is radical orchidectomy, while long-term follow-up of these patients is mandatory because of local relapses. When local relapses become evident, the choice treatment is extensive local excision followed by adjuvant radiotherapy. In the present study we report a new case of a recurring, well differentiated spermatic cord liposarcoma of the type sclerotic, in a 50-year-old man. An exhaustive review of the literature has been made.

Wide ureteral injuries are unusual but not exceptional and have few conservative therapeutic options, specially those that involve the upper ureter. Autotransplantation, ureteral substitution by intestine and combined Boari bladder flap-psoas bladder hitch are basically the only chances to avoid nephrectomy. In this paper we report five cases in which ileum was used to substitute the ureter and review the most outstanding literature about this subject.

The abnormal persistence of the patent processus vaginalis determines the appearance of four types of pathology, depending on the grade and sort of communication: communicating hydrocele, hydrocele of cord, scrotal hydrocele and intrafunicular hernia. We have revised our casuistry of children with patent processus vaginalis pathology for the two last years (1995-1996), and we have found 75 communicating hydrocele cases, 5 hydrocele of cord and 16 scrotal hydrocele cases, on children between 1 month and 13 years old. The diagnostic was done after physical exploration with transillumination and inguino-scrotal ultrasound. Initially, conservative treatment was followed, which was enough for 58 patients (60.4%). In the 38 cases (39.6%) in which there were no improvement, surgical treatment via inguinal was carried out, with good results in nearly all cases. As a conclusion, we can assert that ultrasound is an excellent diagnostical method for patent processus vaginalis pathology and conservative treatment must have priority upon surgery, since a great number of spontaneous resolutions are observed, most of all on children aged less than two years old.

Contribution of two new cases of vesicouterine fistula secondary to a cesarean incision. In one case, diagnosis was achieved through cystography and cystoscopy, while in the second case cystography, cystoscopy and stain testing (methylene blue) were used. In both cases management was through transperitoneal and transvesical fistulorrhaphy. The two cases showed favourable post-operative evolution with no relapse.

Objective: To determine the utility of the urethral pressure profile in the diagnosis of stress urinary incontinence and its possible correlation with the degree of severity of incontinence., Methods: 175 female patients with a clinical history of urinary incontinence were evaluated; of these, 50 cases with bladder instability demonstrated by the urodynamic studies were excluded. Patient evaluation included clinical history, physical examination, analytical studies, radiological evaluation and complete urodynamic assessment, including uroflowmetry, filling and voiding cystometry, and static and dynamic urethral pressure profiles. A 10 Fr microtransducer catheter was utilized for the urethral pressure profile studies. ICS recommendations were observed. Patients were classified into three groups according to the severity of urinary incontinence based on the clinical data, physical examination and urodynamic findings. The Wilcoxson test and 2 x 2 contingency table were employed for the statistical analysis., Results: Of the parameters analyzed for the static urethral pressure profile, statistically significant differences were found only for the maximum urethral pressure and maximum closing urethral pressure in the different groups of patients. No differences in total length or functional urethral length were observed. Comparison of the dynamic urethral pressure profiles of the different groups showed a statistically significantly higher proportion of patients with a negative dynamic urethral closing pressure in the group of patients with urodynamically and clinically demonstrated urinary incontinence than in those with no urodynamically or clinically demonstrable incontinence., Conclusions: The urethral pressure profile is sufficiently reliable to confirm the diagnosis of urinary incontinence and its degree of severity. As a diagnostic test in urinary stress incontinence, it has a sensitivity of 89% and a specificity of 95%.

Tumours derived from sex cords and primitive gonadal stroma account for 4% of total testicular tumours. The low frequency of Sertoli's cells tumour (SCT) and the uneven study and follow-up of patients makes analysis of this tumoral entity difficult. This paper contributes one case report of a Sertoli's giant cell tumour calcified in a 13-year old patient, and reviews the clinical aspects, clinico-pathological varieties believed to require assessment in patients with this type of disease. This type of tumour is considered benign in its biological behaviour, although some malignant forms have also been described. SCT is actually an heterogeneous tumoral pathogenic entity with regard to pathogenic and prognostic aspects. Our final conclusions show that the clinico-pathological variety, age, size and associated clinical manifestations appear to be related to the prognosis.

Presentation of a review of vesico-vaginal fistulae diagnosed and treated in our Hospital between 1978-1992. There has been 20 cases. Etiology is varied, with predominance of cases due to gynaecological surgery. Considerations on diagnostic tests used in each case and the various therapeutical approaches applied, as well as on the results obtained. A revision is made of literature available on this condition.

Twenty-seven cases of kidney injury in children under 15 years old are reviewed. All of them were diagnosed, treated and subsequently followed in our Service between 1979 and 1992. Clinical evaluation, blood and urine analyses, and imaging techniques are the three basic tools in the management of kidney injuries. Regarding imaging techniques, dynamic CT is currently the best diagnostic method, mainly due to its high anatomic resolution and because it permits evaluation of renal function and of possible associated lesions in other organs. Kidney injuries were classified into three categories: I (18 cases), II (4 cases), and III (4 cases). The last injury affected a pathological kidney. Emergency surgical procedures were performed in 7 cases (25.9%): 2 were category II, 4 category III, and the pathologic kidney that suffered trauma. Surgery was deferred in one case (category II) and the remaining 19 cases (74.1%) were treated conservatively: 18 were category I and 1 category II. Nephrectomy was required only for the pathologic kidney. All the other kidneys were preserved.

Although treatment by shock waves has been proven useful in destroying calculi, it is not free from complications and may cause lesions to the kidney whose importance has not been completely elucidated. The present study utilized color Doppler US to determine the changes produced by ESWL on the kidney and its vessels in particular. The results achieved by Doppler evaluation of 25 patients immediately before ESWL, 2, 7 and 30 days post-ESWL show an increased resistance index 2 days after treatment which tended to return to normal at 30 days. We discuss the different results obtained depending on stone location and the complications.

Squamous cell carcinoma of the penis has a very scant incidence in our setting and evolves slowly. From 1978 to 1991, 24 cases of penile carcinoma had been treated and followed at our service. The results achieved with partial amputation of the penis have been highly satisfactory for stages T1 and T2, which was combined with postoperative radiotherapy for the latter tumor stage. Since carcinoma of the penis generally presents with infection, if lymphadenectomy is performed, it has to be performed after the amputation. The peculiar features of this disease, patient characteristics and the diversity of the therapeutical approaches make penile carcinoma a lesion whose treatment is controversial and, in many cases, difficult to follow.

Herein we describe a case of spontaneous rupture of the fornix with urinary extravasation, an uncommon urological condition arising from a sudden increase of intraluminal pressure due to a calculus in the terminal ureter. The etiopathogenesis, follow-up and therapeutic approach are discussed.

The aim of the surgical procedures utilized in the treatment of stress urinary incontinence (SUI) is to correct the posterior ureterovesical angle defect, thereby improving transmission of intraabdominal pressures to the urethra. We report our experience on 61 patients that had been diagnosed with SUI at our service from June 1984 to December 1990. Treatment was by the same operative procedure (Burch Technique) in all patients. The methods of exploration and the prognostic factors that might influence the outcome of the procedure are described. The short-term (3 months) success rate was 95%, the medium-term (1 year) 85.7% and the long-term (5 years) 77.1%. We underscore the convenience of prophylactic heparin therapy to prevent possible thromboembolic complications.

Presentation of our experience and results in the treatment of localized renal adenocarcinoma with radiotherapy supplementary to surgery. The influence of post-operative radiotherapy in the subsequent occurrence of relapse and survival is analyzed. Also, the predictive value in our series of pre-surgery VSG, FA and LDH determinations is analyzed.

The discomfort caused by cystoscopy to the patient with superficial bladder tumor has led to the routine use of other less invasive but similarly reliable procedures. We performed a two-year comparative study of cystoscopy versus abdominal ultrasonography/cytology in 90 patients. Two hundred procedures were performed for each method of evaluation. Together, the sensitivity and specificity of both procedures were 61% and 98%, respectively. The positive and negative predictive values were 94% and 87%, respectively. These good results have permitted us to change the follow-up protocol of these patients such that currently ultrasonography and cytology are performed once every 6 months, and cystoscopy is used only for those cases with clinical features suggestive of recurrence and a negative work up of those with a negative scan and positive cytology.

Ten cases of multicystic kidney in newborn infants are described herein. The diagnostic value of ultrasound during the prenatal period and postnatal follow-up is highlighted. The therapeutic approach in this condition is discussed.