Hemorragia suprarrenal espontánea unilateral / Spontaneous unilateral adrenal hemorrhage

Hombre de 73 años que acude al servicio de urgencias por dolor abdominal. Al examen físico se palpa masa que ocupa hipocondrio derecho. Angio TAC muestra masa abdominal de 12 cm dependiente de glándula suprarrenal derecha. Analítica de orina muestra elevación de metanefrinas y normetanefrinas. La gamagrafía fue compatible con feocromocitoma. Se realiza extirpación quirúrgica de masa y la anatomía patológica describe hemorragia suprarrenal sin malignidad.

A 73 year old man, came to the emergency department referring abdominal pain. A palpable mass occupying right upper quadrant on physical examination was identified. CT angiography showed a 12 cm abdominal mass dependent of the right adrenal. Urinalysis showed elevation of metanephrines and normetanephrines. Gamagraphy scan was compatible with pheochromocytoma. Surgical resection of the mass was performed and pathology described an adrenal hemorrhage without malignancy.

[Lymphocele after renal transplantation: case report and bibliographic review]. / Linfocele gigante tras trasplante renal. A propósito de un caso y revisión de la literatura.

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.

[Giant lymphocele after renal transplantation. Case report and bibliographic review]. / Linfocele gigante tras trasplante renal. A propósito de un caso y revisión de la literatura.

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

[Metastasis of a renal cell carcinoma in the corpora cavernosum of the penis. Case report and bibliographic review]. / Metastasis de carcinoma renal en cuerpo cavernoso, a propósito de un caso y revisión de la literatura.

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.

[Prevalence of incidental prostatic adenocarcinoma after suprapubic adenomectomy with or without previous prostatic biopsy]. / Prevalencia de adenocarcinoma prostático incidental tras adenomectomía suprapúbica con o sin biopsia prostática previa.

OBJECTIVES: To establish the prevalence of incidental prostate cancer after transrectal ultrasound guided prostatic biopsy and subsequent suprapubic prostatic adenomectomy and to compare it with a similar group of patients who did not underwent biopsy before surgery. To evaluate treatment, outcomes, and disease progression in patients with incidental prostate cancer. METHODS: Retrospective study of 549 suprapubic adenomectomy performed between 1996-2001 (6 yr.), comparing the group of patients with biopsies before surgery vs. the group of patients without biopsies. RESULTS: 291 (53%) patients did not undergo biopsy before adenomectomy. 258 (47%) underwent biopsies. 25 incidental prostate cancers were detected, 19 (76%) in the group of no biopsy and 6 (24%) in the biopsy group. 88% pT1a and 12%pT1b. Mean Gleason score 4.5 (3-7). 84% of the patients did not receive treatment (21) ("wait and see"); 8% (2) androgen blockade; 8% (2) finasteride (2). Three patients (12%) in the group of no biopsy had disease progression. Mean follow-up was 48.1 months (22-96). No case of cancer-specific mortality was detected. CONCLUSIONS: Global prevalence of incidental prostate cancer in our series of patients undergoing suprapubic prostatic adenomectomy was 4.55%. Prevalence was higher in the group of patients without previous biopsy (3.46%) than in the biopsy group (1.09%). Tumor progression was 12% and cancer specific survival 100% after a mean follow-up of 48.1 months (22-92). Previous prostatic biopsy in patients with suspicions digital rectal examination or elevated PSA diminishes the prevalence of incidental prostate cancer. Watchful waiting may be a valid option in some cases.

[Urologic damage of the primary antiphospholipid syndrome]. / Manifestaciones urológicas del síndrome antifosfolípido primario. Vejiga neurógena.

OBJECTIVES: To perform a review and update of the antiphospholipid syndrome summarizing its urological presentations. METHODS: A complete bibliographic search was performed through PubMed MEDLINE and articles were reviewed with special attention to those bibliographic references about urological presentations. We document the unique and unpublished case of a patient with neurogenic bladder secondary to antiphospholipid syndrome. RESULTS/CONCLUSIONS: The antiphospholipid syndrome is an acquired autoimmune systemic disease generating a permanent hypercoagulability status with recurrent multiorgan thrombotic events due to circulating antiphospholipid antibodies. It may be secondary to a heterogeneous group of diseases (mainly lupus) and drugs, or primary if it appears isolated without any demonstrable systemic disease or concomitant medication. It is mainly characterized by venous or arterial recurrent thrombosis, recurrent abortion, thrombocytopenia, and circulating antiphospholipid auto-antibodies. Treatment with anticoagulants and correction of the hypercoagulable status contributing factors, arterial or venous thrombosis, and vascular risk aim to avoid new thrombosis episodes. Genitourynary system may be affected in any of its parts, generally by arterial or venous thrombosis. Kidney is the most frequently affected organ, in addition to transplanted kidney grafts, adrenal glands, bladder and testicles. There is a relationship between antiphospholipid syndrome and infertility. For the first time, we describe bladder involvement presenting as hyperreflexic neurogenic bladder with detrusor-sphincter dyssynergia after spontaneous spinal cord thrombosis in an asymptomatic adolescent with primary antiphospholipid syndrome which was unknown before.

[Staging of infiltrating bladder cancer. Role of C.T. scan]. / Estadiaje del cáncer de vejiga infiltrante. Papel de la T.A.C.

OBJECTIVES: To analyse the role of CT-scan on preoperative determination of bladder and lymph node involvement of infiltrative bladder cancer, and its possible impact on the surgical management of these patients. METHODS: Retrospective study including 115 patients with the diagnosis of infiltrative bladder cancer between 1984 and 1999. The ability of CT-scan for bladder and lymph node staging was evaluated comparing results with the findings after radical surgery. Potential impact of this imaging technique on change of surgical attitudes was evaluated. RESULTS: Perivesical involvement estimation by CT-scan was right in 36.5%, underestimated in 49.6% and overestimated in 14%. The more advanced the perivesical involvement the lower the sensitivity for CT-scan in perivesical staging. The more locally advanced tumour the higher specificity, oscillating between 44% for pT2 and 94% for pT4. In reference to lymph node staging, it was correct in 71.3% of the cases, although this percentage depended almost exclusively on patients with negative nodes (N-). However, there was a 24.3% understaging rate which corresponded to the majority of N+ patients. These data offer a 28% sensitivity, 93% specificity, 68% positive predictive value, and 72% negative predictive value. Finally, the reliability of bladder staging in patients with lymph node involvement (N+) (39 patients) was established; it was correctly estimated in as low as 30% of the cases with a 70% understaging rate. CT-scan would have modified surgical attitudes in only 6 patients (5%), all of them with advanced tumours. CONCLUSIONS: The impact of CT-scan on infiltrative bladder cancer clinical staging is relatively low. The highest benefit is obtained in patients suspect of having advanced disease. Limitation to this group would result in significative cost reductions with low risk for unappropriate surgical management.

[Bladder choriocarcinoma: retrospective analysis of the de-differentiation of a transitional-cell papillary bladder carcinoma. Apropos of a case]. / Coriocarcinoma vesical; análisis retrospectivo de la desdiferenciación de un carcinoma vesical papilar de células transicionales a propósito de un caso.

OBJECTIVE: To report a case of choriocarcinoma of the bladder during the different periods of its evolution. The anatomopathological study showing dedifferentiation of a transitional cell tumor is presented and the histogenesis of this rare tumor is discussed. METHODS: A case of a rapidly progressing transitional cell tumor of the bladder that dedifferentiated into choriocarcinoma is presented. The pathological findings of the first resections of the transitional cell tumor that progressed to choriocarcinoma are presented and the histogenesis is discussed. RESULTS/CONCLUSIONS: Choriocarcinoma of the bladder is very rare, highly malignant and carries a poor prognosis. Its origin is widely accepted to be in the dedifferentiation of a transitional cell tumor. The use of immunohistochemistry and the positivity of HCG support the diagnosis.

[Ureteroplasty using the appendix: apropos of a case]. / Ureteroplastia con apéndice: a propósito de un caso.

OBJECTIVE: To report a case of ureteroplasty using the vermiform appendix. METHODS: Herein we describe a patient who underwent partial resection of the ureter due to a neoplasm. The ureteral defect was repaired using the vermiform appendix. The surgical technique and the results achieved are presented and the literature is briefly reviewed. RESULTS/CONCLUSIONS: The few cases reported in the literature and the case described herein show the utility of the vermiform appendix for ureteral substitution in specific cases where this procedure is indicated.