[Spermatic cord leiomyosarcoma. Case report and bibliographic review]. / Leiomiosarcoma de cordón espermático. Aportación de un caso y revisión de la literatura.

OBJECTIVE: To report one new case of paratesticular leiomyosarcoma. METHODS: We describe the case of a 68-year-old male patient consulting for right groin pain over two years with a physical examination corresponding to right inguinal hernia. During surgery for hernia correction a paratesticular mass was discovered. RESULTS: Right radical orchiectomy was performed. After the operation there was a recurrence at the scar which was operated and finally the disease progressed both locally and systemically. CONCLUSIONS: We point out the scarce frequency of this type of tumours. We believe that orchiectomy and excision of the cord is the treatment of choice. The use of adjuvant therapies doesn't influence survival significantly.

[Brucellar orchitis. Case report and bibliographic review]. / Orquitis brucelar. A propósito de un nuevo caso y revisión de la literatura.

OBJECTIVE: We report one case of unilateral epididymo-orchitis secondary to Brucella and perform a bibliographic review. METHODS: We report the case of a 5 1-year-old male with fever, predominantly in the evening hours, over one month associated with a subacute inflammatory process on the right testicle and osteoarticular pain on the left ribs. RESULTS: Treatment was performed with rifampicin 600 mg/day for 45 days and doxicilin 100 mg/12 hours for 45 days. CONCLUSIONS: The brucellar etiology should be taken into consideration in front of an epididymo- orchitis with torpid outcome, mainly in areas of endemic Brucella and patients that have had contact with cattle or non controlled milk derivatives. We emphasize that contact could have been several months before the appearance of clinical epididymoorchitis.

[Inverted papilloma. Report of two cases and bibliographic review]. / Papiloma invertido. Aportación de dos casos y revisión de la literatura.

OBJECTIVE: Inverted papilloma is a rare polypoid lesion of the urothelium, known as a different entity since 1963. Not many more than 100 cases have been published. Although its malignant potential is still unknown, several scientific publications have noted it. METHODS: We report to cases of inverted papilloma and perform a detailed bibliographic review. RESULTS: Both patients were diagnosed by the Pathology Department and entered periodic follow-up visits, being free of recurrence at 24 and 18 months respectively. CONCLUSIONS: The possibility that inverted papilloma is a lesion with malignant potential should be considered in every case, and we suggest that patients with this diagnosis should enter a follow-up protocol like any bladder neoplasia.

[Bladder leiomyoma. Report of two new cases and bibliographic review]. / Leiomioma vesical. A propósito de dos nuevos casos y revisión de la literatura.

OBJECTIVE: Primary mesothelial tumors of the bladder are rare entities, being leiomyoma the most frequent of them. It may grow without any clinical symptoms or with very unspecific ones. METHODS: We report two cases of bladder leiomyoma in 2 patients, and performed a bibliographic review. RESULTS: They were treated by transurethral resection, with an excellent outcome, without incidences over five years of follow-up. CONCLUSIONS: Surgical treatment continues to be the best solution; it is easy to perform and has a very limited number of complications. Prognosis is good in any case and progression is anecdotic.

[Renal metastases of a squamous cell carcinoma of the lung. Case report and bibliographic review]. / Metástasis renal de carcinoma escamoso de pulmón. A propósito de un nuevo caso y revisión de la literatura.

OBJECTIVE: We report a new case of renal metastasis of a lung carcinoma. METHODS: 59-year-old male presenting to the outpatient clinic with a clinical picture compatible with renal colic and hematuria. RESULTS: Ultrasound showed a solid-cystic tumor in the lower pole of the kidney without hydronephrosis. Abdominal-pelvic CT scan reported retroperitoneal adenopathies > 1 cm in the area of the aorta-cava and a 5 cm heterogeneous mass. CONCLUSIONS: Renal metastatic lesions of patients with lung cancer present more frequently due to the higher accuracy of radiological tests and have, as well as the primary tumors, very poor survival rates.

[Primary bladder neck obstruction in males]. / Obstrucción primaria del cuello vesical en el varon.

OBJECTIVES: To report our experience on the diagnosis and treatment of this rare type of infravesical functional obstruction. METHODS: Over the last ten years we diagnosed and treated 32 males with this entity. We evaluate previous treatments and time to diagnosis. Clinical, radiological, endoscopic, and urodynamic features are evaluated, as well as results obtained with the administration of alpha-adrenergic blockers and endoscopic transurethral incision of the bladder neck. RESULTS: Patient age ranged from 26 to 48 years (Mean 38.2). All patients presented significant long-lasting lower urinary tract symptoms, having received various non-specific treatments. Uroflowmetry showed a peak of mean flow of 9.8 +/- 3.2 cc/s, being the voiding detrusor pressure 98 +/- 25 cm H2O, with significant post void residual volume in 21 patients (188 +/- 62 cc). Medical treatment with alpha-adrenergic blockers only achieved significant subjective improvement in four patients. Twenty one patients underwent unilateral endoscopic bladder neck incision, obtaining objective and subjective improvements all of them. CONCLUSIONS: Endoscopic bladder neck incision is the treatment of choice of this dysfunction, being imperative to inform the patient of the risk of retrograde ejaculation as a postoperative sequel, since this entity appears in young males, for whom fertility may be a priority.

[Leydig cell tumor. Case report and review of the literature]. / Tumor de células de Leydig. A propósito de un nuevo caso y revisión de la literatura.

OBJECTIVE: To report a new case of the rare Leydig cell tumor, and to perform bibliographic review. METHODS: We report the case of a 38-year-old male with the clinical and ultrasound diagnosis of testicular tumor, and normal hormonal and extension studies. He underwent inguinal radical orchyectomy and the pathology report of the specimen showed a Leydig cell tumor. It was staged as T1N0M0, not receiving any further treatment with chemotherapy or radiotherapy. Five years after surgery there is no evidence of disease on follow-up. RESULTS: The patient does not show evidence of recurrence after chest x-rays, abdominal-pelvic CT scan, ultrasound of the contralateral testis, and tumor markers. CONCLUSIONS: We recommend a long-term follow-up with contralateral testicle ultrasound, CT scan, chest x-ray, and tumor markers.

[Bladder endometriosis. Case report and review of the literature]. / Endometriosis vesical. A propósito de un nuevo caso y revisión de la literatura.

OBJECTIVE: To report a new case of bladder endometriosis and to perform a bibliographic review. METHODS: We report the case of a 34-year-old female with the diagnosis of bladder endometriosis treated by transurethral resection and subsequent hormonal therapy with good outcome one year after diagnosis. RESULTS: Treatment with analogs was started after TUR, in conjunction with the Gynecology Department, and maintained six months. The patient remained asymptomatic one year after diagnosis, with a negative cystoscopic study. CONCLUSIONS: We emphasize the need of early diagnosis due to the increased morbidity and health-care expenses; also the need of surgical treatment of all urological lesions before any hormonal therapy, mainly ureteral lesions. We finally emphasize that definitive treatment should be performed by the gynecologist.

[Urological works and biography of Dr. Felipe Alcalá Santaella Nuñez (1927-1977). Historical documentary analysis]. / Obra urológica y biografía del doctor Felipe Alcala-Santaella Núnez (1927-1977). Análisis documental histórico.

OBJECTIVES: In the middle of the 20th century, Urology in Valencia was fully consolidated as a surgical speciality since Prof. Molla started it about the end of the 19th century; Dr. Felipe Alcala Santaella Nuñez stands out as the chairman of the Department of Urology of the "Hospital Provincial de Valencia", after his father Dr. Rafael Alcalá Santaella. He achieved to form a group of renowned professionals, some of which still are in active practice. METHODS: We reviewed all his scientific work and the journals it was published in, mainly Archivos Espaioles de Urologia, through the Department of Medical History of the University of Valencia. His biography was reconstructed using the "Biographic and Bibliographic History of Spanish Urology" by Drs. E. Maganto Pavón and M. Pérez Albacete, as well as direct interviews with family members. DISCUSSION: We emphasize the magnificent approach to the clinical presentations of tuberculosis he does in his doctoral thesis, analyzing its types by location, main features, and most adequate treatment. He also emphasized the importance of relapse in lithiasic patients and recommendations to be follow, as well as the condition of bladder neoplasias. CONCLUSIONS: We consider Dr. Felipe Alcalá Santaella Nuñez as a wide-experience-professional who mode solid contributions to the regional urology in his times, thanks to his excellent surgical abilities and dedication.

[Valencia's scientific contribution to the consolidation of Urology as a speciality. Bibliometric classification by subject, author and journal. Historical documentary analysis]. / Aportación cientifica valenciana en la consolidación de la Urología como especialidad. Bibliometría por materias, autores y revistas. Análisis documental histórico.

OBJECTIVES: Urology, as other medical-surgical specialities, had its consolidation process in the mid 19th century. This phenomenon in the history of medicine occurs around certain authors, which in the case of urology in Valencia was Dr. Raphael Molla Rodrigo, and several key elements such as development of lithotripsy and cystoscopy, as cited by prestigious authors in the second national meeting of history of medicine in Salamanca in 1965. For this process a spreading media is necessary, either regional or national, for posterior bibliometric analysis. METHODS: We performed a retrospective study of urological publications in the area of Valencia to know the main areas of knowledge, main authors and publications. Regarding this latter we point out Cronica medica, Revista Valenciana de Ciencias Médicas, Archivos Españoles de Urología y Policlínica. As authors, Rafael Molla Rodrigo, Victor Molla Fambuena and Rafael Alcalá Santaella stand out. Genitourinary tuberculosis and surgical procedures with their complications are among the most commonly treated topics. RESULTS: Dr. Rafael Molla Rodrigo is the author with the highest number of articles and the one who contributed to the consolidation of the speciality nationwide with his extensive scientific contributions. Genitourinary tuberculosis is extensively treated, and surgical procedures and their complications are in second place. The journal in which we were able to find more articles was Cronica Medica, due to its greater diffusion among general practitioners. CONCLUSIONS: We emphasize Dr. Rafael Molla as the main author, genitourinary-tuberculosis as the main topic and the journal Cronica Médica as the most commonly used media.

[Secondary bladder amyloidosis with severe recurrent hematuria: transurethral Mickuliz procedure as hemostatic option]. / Hematuria grave recidivante por amiloidosis vesical secundaria. Mikulicz transuretral como opción hemostática.

OBJECTIVES: Primary localized amyloidosis of the urinary bladder generally has a benign course. On the contrary, secondary amyloidosis, a consequence of systemic amyloidosis, may have massive bleeding and produce complications such as bladder rupture or life-threatening hemodynamic problems requiring desperate hemostatic procedures such as hypogastric artery embolization or ligature, or cystectomy. We report one case in which hemostasis was achieved by a Mickulicz transurethral bladder tamponage. METHODS: 58 year old female with very aggressive rheumatoid arthritis and secondary renal amyloidosis under chronic hemodialysis presenting with severe hematuria after hip replacement. An inflamed bladder was found, the biopsy of which showed edema in all layers with blood vessel walls enlarged by amiloyd deposits. After several unsuccessful transurethral hemostatic procedures, intravesical formalin irrigation was carried out together with a Mikulicz type gauze packaging after urethral dilation. The gauze was withdrawn three days later without bleeding recurrence; however she presented subsequent neurological impairment and finally died 14 days after the last urological procedure. CONCLUSIONS: Transurethral packaging of the urinary bladder in a woman with massive hematuria is a hemostatic option that we recommend to be used before other more dramatic or invasive options are chosen.

[Genitourinary tuberculosis in the urologic works of Professor Rafael Mollá Rodrigo]. / La tuberculosis genitourinaria en la obra urológica del profe- sor Rafael Mollá Rodrigo (1862--1930). Análisis documental histórico de su obra.

OBJECTIVES: Professor Rafael Molla Rodrigo is considered by some the author who contributed with his scientific work and solid technique to consolidate Urology as a speciality in Valencia. Such importance is also perceived in a national level, as demonstrated by the fact that he belonged to the first board of the Spanish Association of Urology and contributed to its foundation in the two-year period 1910--1911, from his position of head of the department of Surgical Therapy and Operations at the Central University. Genitourinary tuberculosis is one of the most outstanding chapters of his extensive works. METHODS: We reviewed all his works, selecting all original articles about genitourinary tuberculosis. Original articles have been obtained from the journals Revista de Higiene y Tuberculosis, La Medicina Valenciana, Revista Valenciana de Ciencias Médicas y Policínica, and from his two most important books, Clinical Lessons In Urology and Clinical Lessons in Urology and Genitourinary Surgery. RESULTS: Throughout his work he analyzes features of relevance about this disease, such as diagnosis, about which he emphasizes the clinical and bacteriological difficulties, and treatment, which was only feasible by precocious nephrectomy. CONCLUSIONS: He dedicates a great part of his work to the study of this pathology and defends a precocious diagnosis in order to perform the only treatment that had demonstrated efficacy. He also exposes the symptoms and variety of clinical presentations, as well as diagnosis through separate kidney catheterization with the aim to determine unilateral involvement.

[Surgical treatment of female urethral diverticula. Our experience. Bibliographic review]. / Tratamiento quirúrgico del divertículo uretral femenino. Nuestra experiencia. Revisión de la literatura.

OBJECTIVES: Female urethral divertilum is a rare disease; its diagnosis has increased with the use of new diagnostic technologies. It must be suspected in women consulting for chronic irritative symptoms without response to conventional treatments. Transvaginal surgical excision is the most accepted therapeutic option. We reviewed their clinical presentations, diagnostic findings, and therapeutic options and report our experience. METHODS/RESULTS: We retrospectively reviewed our case series, finding 4 patients with the diagnosis of female urethral diverticulum; we performed a bibliographic review. CONCLUSIONS: Urethral diverticulum is a rare clinical entity which has to be included in the differential diagnosis of women with chronic lower urinary tract symptoms. Clinical presentation may vary from asymptomatic to rich voiding symptoms. The most frequently used diagnostic method is voiding cystourethrogram; other techniques such as transvaginal ultrasound or MRI are very useful for complicated cases. Surgical treatment by transvaginal diverticulectomy with closure in several layers is the most frequent approach. Postoperative complications are rare.

[Bladder squamous metaplasia: report of one case and bibliographic review]. / Metaplasia escamosa vesical, a propósito de un caso. Revisión de la uteratura.

OBJECTIVES: We report a new case of squamous metaplasia because of its interest and subtle differential diagnosis with other bladder pathologies. METHODS: We report the case of a male patient with history of previous neoplasia with an exophytic lesion of the bladder wall discovered on follow-up. Pathological diagnosis after TUR was bladder squamous metaplasia. RESULTS: Follow-up is performed by ultrasound, cystoscopy, and urine cytology in adherence to clinical guidelines due to the possibility of transformation into squamous cell carcinoma. CONCLUSIONS: Urothelium is able to develop non neoplastic transformations such as squamous metaplasia. The importance of such transformations depends on proper diagnosis and follow-up due to their ability to transform into a neoplastic process.

[Symptomatic hydronephrosis during pregnancy]. / Acerca de la hidronefrosis sintomática en la gestante.

OBJECTIVES: Hydronephrosis is common during pregnancy, affecting 90% of pregnant women. It is usually asymptomotic, but a small percentage of patients show clinical symptoms requiring treatment. We want to report our experience in the diagnosis and treatment of symptomatic obstructive uropathy in pregnant women. METHODS: We retrospectively evaluate the results obtained in 162 pregnant women suffering symptomatic hydronephrosis who received care at our department over the last 12 years. RESULTS: Conservative treatment was effective in most patients, 39 patients required more aggressive therapy. Thirty-five patients underwent insertion of a doubleJ catheter, 2 patients percutaneous nephrostomy, and another 2 ureteroscopy and extraction of ureteral lithiasis. CONCLUSIONS: The most frequent etiology of symptomatic hydronephrosis during pregnancy is external compression by the gravid uterus, followed by ureteral lithiasis. We consider conservative treatment as the treatment of choice, leaving ureteral double J cotheter insertion or percutaneous nephrostomy for the refractory cases. Ureteroscopy is a new diagnostic and therapeutic option when other less aggressive meosures fail.

[Spontaneous recanalization of the vas deferent after vasectomy: report of 2 new cases. Bibliographic review]. / Recanauzación espontánea tras vasectomía: a propósito de 2 nuevos casos. Revisión de la literatura.

OBJECTIVES: Vasectomy is a low morbidity and high efficacy surgical method. A small percentage of cases may have paternity after surgery as a complication. METHODS: We reviewed all patients who underwent vasectomy at our department from 1995 to 1999 (n = 1492), defining technical failure as pregnancy or no disappearance of spermatozoids in the follow-up sperm analysis. RESULTS: We found 2 cases; one of them did not have a negative sperm test after three months, the other one's wife became pregnant after previous azoospermia. Both patients showed granulomas in the pathologic report after a second operation. CONCLUSIONS: Vasectomy is a surgical technique that may have a failure rate close to 2%. Paternity after the operation may appear even after several years. Several authors report the existence of granulomas in those cases in which spontaneous recanalization appears. In our series it was a constant.

[Urologic work and biography of Prof. Rafael Alcalá Santaella (1896-1959). Historical document analysis]. / Obra urológica y biografía del Profesor Rafael Alcalá Santaella (1896-1959). Análisis documental histórico.

OBJECTIVES: We find that Urology at the end of the 20th century was a consolidated speciality as a result of years of evolution and development, and the studies and works of authors whose contributions are considered today the basements of our speciality. So we think that Urology should be understood with its historical references, because, as Aristotle said "... thinks are better understood when one has got to clearly see how they were formed..." Numerous specialists contributed to this; among them we can cite Prof. Rafael Alcala Santaella, the object of this bibliographic and scientific works compilation paper. METHODS: We reviewed all his scientific works. Original articles have been obtained from Medicina Ibera, Revista Española de Cirugía y Urología, and Cirugía, Urología y Ginecología. His most important urologic work is Clinic Urology (1942), divided in 3 volumes. For his biography we used the biographic and bibliographic historical source of Spanish urology over the 20th-century and direct family members interviews. RESULTS: He analyzed topics as important as voiding disorders and the study of urine pyuria. He gave special importance to the study of prostatic pathology, its diagnosis by means of cystourethrography, and the modification of surgical techniques, as well as the results of urinary diversions performed in his department. CONCLUSIONS: Due to his extensive scientific and technical contributions he is one of the most outstanding figures of Valencia's Urology over the first half of the 20th century, together with Rafael Molla Rodrigo and Nicasio Benlloch Giner.

[Biography and analysis of the urologic works of Dr. Nicasio Benlloch Giner (1888-1957) (I)]. / Biografía y análisis de la obra urológica del Dr. Nicasio Benlloch Giner (1888-1957) (I).

OBJECTIVES: The practice of Urology in our country has a long tradition, as demonstrated by several treaties of surgery from the Renaissance; it was the end of the XIX century when the scientific basis of the speciality were established separate from Surgery, as some authors demonstrated, with the notorious contribution of Prof. Rafael Mollá Rodrigo. Dr. Nicasio Benlloch Giner (1888-1957) did the same at the beginning of the XX century when he came back from the professional school of George Marion, contributing to the consolidation of this speciality. METHODS: We reconstructed his biography and analyzed all his bibliography, both in regional and national journals. RESULTS: According to Nicasio Benlloch, renal lithiasis and its treatment were under controversy. Renal lithiasis might demand three indications: nephrectomy, pyelolithectomy and nephrolithectomy. In his chapter on intravenous pyelography he describes its absolute and relative indications. In his work about urinary catheterization and endoscopy he describes in detail the exploratory catheterization of urethra, bladder, and ureters, as well as the catheterization for evacuation and dilatation, and the most frequently used instruments. Finally, he talks about the benefits of endoscopic resection for bladder neck diseases and describes a resectoscope. CONCLUSIONS: Dr. Nicasio Benlloch contributes with his works to the consolidation of Urology as a speciality in Valencia, mainly in the field of lithiasis, a topic in which his works were fundamental.

[Biography and analysis of the urologic works of Dr. Nicasio Benlloch Giner (1888-1957) (II)]. / Biografía y análisis de la obra urológica del Dr. Nicasio Benlloch Giner (1888-1957) (II).

OBJECTIVES: The practice of Urology in our country has a long tradition, as demonstrated by several treaties of surgery from the Renaissance; it was the end of the XIX century when the scientific basis of the speciality were established separate from Surgery, as some authors demonstrated, with the notorious contribution of Prof. Rafael Mollá Rodrigo. Dr. Nicasio Benlloch Giner (1888-1957) did the same at the beginning of the XX century when he came back from the professional school of George Marion, contributing to the consolidation of this speciality. METHODS: We reconstructed his biography and analyzed all his bibliography, both in regional and national journals. RESULTS: According to Nicasio Benlloch, renal lithiasis and its treatment were under controversy. Renal lithiasis might demand three indications: nephrectomy, pyelolithectomy and nephrolithectomy. In his chapter on intravenous pyelography he describes its absolute and relative indications. In his work about urinary catheterization and endoscopy he describes in detail the exploratory catheterization of urethra, bladder, and ureters, as well as the catheterization for evacuation and dilatation, and the most frequently used instruments. Finally, he talks about the benefits of endoscopic resection for bladder neck diseases and describes a resectoscope. CONCLUSIONS: Dr. Nicasio Benlloch contributes with his works to the consolidation of Urology as a speciality in Valencia, mainly in the field of lithiasis, a topic in which his works were fundamental.