Multilocular cystic nephroma: A clinical case.

OBJECTIVE: To describe the clinical presentation, preoperative diagnostic possibilities, and treatment of cystic nephroma. METHODS: We describe a case of cystic nephroma in an adult male and show that, both in our patient and in the literature, a definitive diagnosis can only be obtained postoperatively, even when there is a reasonable clinical suspicion. CONCLUSIONS: Cystic nephroma is rare, and some authors consider it a questionable entity. However, it should be distinguished from renal cystic neoplasms, which can resemble the condition.

Adrenal ganglioneuroma.

OBJECTIVE: To present one case of adrenal ganglioneuroma incidentally diagnosed in an adult. METHODS/RESULTS: 44-year-old woman with a 2.3 cm incidentaloma in the left adrenal gland diagnosed by CT scan. At 6 months, MRI was performed and a left adrenal nodule 3.7 cm was shown. Due to the progressive growth of the mass, surgery was indicated and left laparoscopic adrenalectomy was carried out. The final pathologic diagnosis was adrenal ganglioneuroma. CONCLUSIONS: The ganglioneuroma is a tumor composed of Schwann cells and ganglion cells. Its location in the adrenal gland is unusual, most frequently affecting other regions. Being asymptomatic lesions, they are often detected incidentally when performing imaging tests. There are radiological features that differentiate them from other adrenal masses. The treatment of choice is surgery, with adrenalectomy.

46,XX T testicular disorder of sex development. Case report.

OBJECTIVE: We present a case of X-Y translocation with male phenotype (46,XX testicular disorder of sex development) and review the literature. METHODS: Disorders of sex development with mismatch of genetic, gonadal and phenotypic sex are quite rare, and some are due to genetic or chromosomal abnormalities. The karyotype was investigated by a cytogenetic study of peripheral blood (phytohemagglutinin-timulated lymphocyte culture over 72 hours). G-banding analysis of 25 metaphases showed a 46,XX chromosome constitution (46 chromosomes with XX sexual composition). Fluorescence in situ hybridization (FISH) analysis with probes for X centromeres and the sex-determining region of the Y chromosome (SRY) (testis-determining factor gene) showed two X chromosomes. The analysis also showed the SRY signal in the telomeric region of the short arm of one of the chromosomes. RESULTS: In recent years, a number of other genes involved in disorders of sex development in animals and humans have also been identified. Genetic defects in the peptide hormone receptors, members of the steroid receptor superfamily, and other transcription factors, as well as any of a series of enzymes and cofactors involved in steroid biosynthesis can cause abnormal determination and differentiation. CONCLUSIONS: Although chromosomal abnormalities are rarely present in patients with apparently normal external genitalia, they should be considered in urology consultations by adolescents and adults, particularly in the investigation of gynecomastia or infertility.

Tumor inside an inguinoscrotal bladder hernia.

OBJECTIVE: To describe two cases of urothelial tumors in inguinoscrotal bladder hernias and comment on the low incidence of this condition. METHODS: Two patients were diagnosed and treated by partial cystectomy and hernia repair. RESULTS: The clinical outcome of both patients was good at two and three years, respectively, and neither patient experienced hernia or tumor recurrence. CONCLUSIONS: Inguinal bladder hernias are relatively common. However, few reports of tumor in the herniated bladder have been published. Treatment consists of tumor removal, hernia repair and treatment of any associated urethroprostatic condition.

[Bladder leiomyomas.] / Leiomiomas vesicales.

Bladder leiomyomas are rare benign tumors; their common presentation are irritative and obstructive urinary symptoms. The treatment is complete surgical resection. OBJECTIVE: To present our experience in the diagnosis and the treatment of bladder leiomyoma. METHODS: A series of three clinical cases. RESULTS: In our series, two patients were women and one was man. The mean age was 33 years. Two women presented with irritative urinary symptoms and palpation of a pelvic mass, and the man was asymptomatic. Ultrasound showed the presence of an adnexal mass with left hydronephrosis in a female patient, bladder tumor in another female patient and pelvic mass of unknown etiology in the male patient. CT scan and MRI demonstrated the bladder origin of the lesion. A biopsy confirmed a bladder leiomyoma. Surgical treatment was partial cystectomy in all patients, and in one of them, nephrectomy was performed. During follow-up, all patients were asymptomatic and without recurrence. CONCLUSIONS: Imaging studies guide to diagnosis. Transurethral resection is recommended in lesions smaller than 3 cm. and enucleation or partial cystectomy in larger lesions. Prognosis is good.

Los leiomiomas vesicales son tumores benignos infrecuentes, causan sintomatología miccional y su tratamiento es quirúrgico. OBJETIVO: Presentar nuestra experiencia en el diagnóstico y tratamiento del leiomioma vesical. MATERIAL Y METODO: Serie de 3 casos clínicos. RESULTADOS: De los 3 casos, 2 fueron mujeres y 1 fue hombre. La edad media fue 33 años. Las dos mujeres presentaron síntomas miccionales irritativos y palpación de una masa pélvica, y el hombre cursó asintomático. La ecografía halló una masa anexial e hidronefrosis izquierdas en una paciente, tumoración vesical en otra paciente y masa pélvica de etiología no definida en el paciente varón. La tomografía y la resonancia magnética demostraron el origen vesical de la lesión. La biopsia confirmó el diagnóstico de leiomioma. Se realizó cistectomía parcial en todos los casos, con nefrectomía en uno de ellos. Durante el seguimiento no ocurrió recidiva tumoral. CONCLUSIONES: Los estudios de imagen nos orientan al diagnóstico. La resección transuretral está indicada en lesiones menores de 3 cm. y la enucleación o cistectomía parcial en lesiones de mayor tamaño. Su pronóstico es bueno.

Testicular adrenal rest tumors.

We report a case of congenital adrenal hyperplasia in a 29 year old patient, who presented with testicular pain, bilateral testicular masses, and oligospermia. Ultrasonography confirmed, in both testis, the presence of heterogeneous and hypoechoic lesions with irregular borders and internal and peripheral vascularization. Seric tumor markers were negative. The patient was scheduled for perioperative testicular biopsy and bilateral orchiectomy. Perioperative biopsy was suggestive of testicular adrenal rest tumor and not additional procedure was performed. Treatment was initiated with high doses of glucocorticoids, decreasing the size of testicular masses and testicular pain was alleviated.

[The second kidney transplantation in Spain]. / El segundo trasplante renal en España.

The first two living donor kidney transplants in our country (isotransplant and homotransplant respectively) were reported in 1961. We reviewed the clinical history of the renal homotransplant performed between father and son, more than half a century ago, by Carlos Younger de la Peña and Ramiro Rivera at "La Paloma' Clinic in Madrid. We comment on the organizational, legal, immunobiological and technical difficulties in those times when the successful future of transplantation was barely in sight. From the XXI Century we can see the long path of renal transplantation during the XX century. Despite all the initial troubles and failures our present must recognize, and so does it, the work and dedication of the pioneers.

[Spermatic cord sarcomas: current status and report of four cases]. / Sarcomas de cordón espermático: estado actual y presentación de cuatro casos clínicos.

OBJECTIVE: To study and review spermatic cord sarcomas, including symptoms, diagnosis, and treatment. METHODS/RESULTS: We review the Spanish and international literature and report 4 new cases: 2 patients with well-differentiated spermatic cord liposarcomas (1 treated by simple tumorectomy), 1 patient with liposarcomatous degeneration of a previously excised atypical lipoma, and 1 patient operated for a malignant retroperitoneal fibrous histiocytoma with subsequent local recurrence in the paratesticular region. CONCLUSIONS: Spermatic cord sarcomas are rare entities that usually appear as painless paratesticular mass. They are diagnosed by imaging studies (ultrasound, computed tomography, magnetic resonance) and confirmed by histological examination. Spermatic cord sarcomas are treated surgically; the efficacy of adjuvant treatments such as chemotherapy or radiation therapy is still under debate.

[Impact of surgical treatment of female stress urinary incontinence on the quality of life of patients]. / Impacto de la cirugía de la incontinencia urinaria de esfuerzo en la calidad de vida de las pacientes.

OBJECTIVES: To evaluate the quality of life of patients with stress urinary incontinence (SUI) operated in the Department of Urology at the Complejo Hospitalario Universitario in Albacete (CHUA). METHODS: Between November 2001 and December 2005, 126 patients with SUI have completed a questionnaire in our centre, before and after undergoing surgery with sling techniques. The questionnaire was the King's Health Questionnaire (KHQ), which is a specific instrument for the measurement of quality of life in patients with urinary incontinence. RESULTS: Mean patient's age was 57.09 years (DE: 9.57). Twelve women (9.5%) had history of previous urinary incontinence surgery. Mean urinary incontinence evolution time was 114.48 months, with a median of 96 months. 38 patients (30.2%) did not present cystocele, 61 (48.4%) presented grade III cystocele, 25 (19.8%) grade II, and 2 (1.6%) grade I. Before surgery, the scale with best score was Personal relationships, with a mean score of 26.8, whereas the scale with worst scores was Impact of urinary incontinence, with a mean score of 82.96. All operations performed consisted in various techniques of transvaginal slings, except one case (0.8%) in which the Kelly technique was performed. Impact of urinary incontinence was the scale with a greater number of patients improving after surgery; 82.9% of the patients (101 cases) gave a better score. The scales showing greater differences of the mean value comparing before/after surgery were impact of urinary incontinence, limitation on the daily life activity, and limitation on social activity. Personal relationships and General health were the two with the smallest improvements. CONCLUSIONS: Surgery demonstrated to improve the symptoms secondary to this disease, therefore, it results in an improvement of the quality of life that is evident in all scales of the questionnaire, mainly in the impact of urinary incontinence, limitations on physical activity, limitations on daily life, and limitation on social activity scales.

Testicular adrenal rest tumors / Tumores testiculares de restos adrenales

We report a case of congenital adrenal hyperplasia in a 29 year old patient, who presented with testicular pain, bilateral testicular masses, and oligospermia. Ultrasonography confirmed, in both testis, the presence of heterogeneous and hypoechoic lesions with irregular borders and internal and peripheral vascularization. Seric tumor markers were negative. The patient was scheduled for perioperative testicular biopsy and bilateral orchiectomy. Perioperative biopsy was suggestive of testicular adrenal rest tumor and not additional procedure was performed. Treatment was initiated with high doses of glucocorticoids, decreasing the size of testicular masses and testicular pain was alleviated

Presentamos el caso de un varón de 29 años diagnosticado de hiperplasia suprarrenal congénita, que fue derivado a nuestra consulta por dolor testicular, masas testiculares bilaterales y oligospermia. La ecografía confirmó la existencia de lesiones heterogéneas e hipoecoicas con bordes irregulares y vascularización interna y periférica en ambos testículos. Los marcadores tumorales séricos fueron negativos. El paciente fue programado para biopsia testicular perioperatoria y orquiectomía bilateral. La biopsia perioperatoria fue sugestiva de tumor testicular de restos suprarrenales y no se realizó ningún procedimiento adicional. Se inició tratamiento con altas dosis de glucocorticoides, disminuyó el tamaño de las masas testiculares y se alivió el dolor testicular

[Ambulatory surgery in a urology department. Analysis of the period 2003-2006]. / Cirugía ambulatoria en un Servicio de Urología. Análisis del período 2003-2006.

OBJECTIVES: When talking about day surgery we have to differentiate between minor and major ambulatory surgery. Ambulatory surgery enables the patient to stay in the hospital not more than a few hours, showing similar safety and efficacy than conventional surgery. The objective of this paper is to evaluate the results of an ambulatory surgery program. METHODS: Descriptive retrospective study of the results of the Ambulatory Surgery in a Urology Department, including 4,185 patients in a four-year period, from January 1st 2003 to December 31st 2006. RESULTS: In the study period the global substitution rate was 83.6%. The hospital admission rate was 2.5%, most of which were early admissions. Major complications appeared in 26 patients (0.6%), being major bleeding the predominant one. Most complications were minor or mild, and pain at the site of the surgical wound was the most frequent problem found. CONCLUSIONS: The increase and continuous promotion of ambulatory surgery are more than justified. The high satisfaction among patients undergoing this type of surgery, with a very low number of complications registered, provides us with a valuable tool for health-care expenditure control.

[Carlos Younger de la Peña (1920-1996). "Urology in Madrid during the second half of the 20th century"]. / Carlos Younger de la Peña (1920-1996). "La Urología Madrileña en la segunda mitad del siglo XX".

Carlos Younger de la Peña (1920-1996) was one of the representative urologists of his time, both in urology as a whole and particularly in urology in Madrid, during the 40 years between 1945 to 1985. His professional training was linked to the department of urology in the "La Princesa" Hospital chaired by Dr. Pedro Cifuentes Díaz first and Luis Cifuentes Delatte posteriorly. The important influence of French urology led Carlos Younger to complete his studies in the departments of urology chaired by professors J. Cibert (Lyon), Truc (Montpellier) and Couvelaire (Paris). When he returned from France he completed his doctoral thesis with the title "Experimental study on the ureterosigmoidostomy type Coffey I" directed by Prof. J. Garcia Orcoyen in 1957. His first publications started in 1946 and he ended with almost 100, including communications to various speciality congresses and meetings. Established in his private clinic in the Ferraz Street in Madrid he alternated his professional practice between Social Security patients and the Red Cross Central Hospital. At the end of his life he had collected near to 10.000 patients' clinical records. He was member of various scientific societies (among them the International Society Of Nephrology) and received various awards such as the one from the Pediatric Surgeons Association for his work on "bladder exstrophy "and the one from the Medical Academy of Valladolid for his study "Vascular renal hypertension". In 1961 he performed the second renal transplant in Spain. His professional interest was preferentially focused on uro-oncology, pediatric urology, gynecologic urology, and endoscopic surgery. He left many disciples with the same interests. The professional life of Carlos Younger de la Peña, in the period of time under analysis, is much significant as a reflex of the evolution of urology and urologists over half a century.

[Late lymph node metastasis in renal cell carcinoma. Case report]. / Metástasis ganglionar tardía de carcinoma de células renales. Aportación de un caso.

OBJECTIVE: To report one case of late metastasis of a clear cell carcinoma treated by radical surgery. METHODS/RESULTS: Patient with history of radical nephrectomy and lymphadenectomy six years before presenting with regional lymph node metastasis in a followup diagnostic test. After treatment with immunotherapy, stopped because of intolerance, surgery of the metastatic lymph node mass was decided. CONCLUSIONS: Renal cancer is an unpredictable tumor in terms of oncological behaviour, so that it may metastasize any time in its evolution, even after radical surgery and several years free of disease. Surgery for the metastases of renal cancer is a good therapeutic option, with good long-term results, when they are isolated and accessible to surgery.

[Voiding symptoms changes after vaginal sling surgery for female stress urinary incontinence]. / Cambios en la sintomatología miccional de la incontinencia urinaria de esfuerzo tras la cirugía con técnicas de cabestrillo transvaginal.

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.

Tumores escrotales / Scrotal tumors

OBJETIVO: El carcinoma basocelular y el leiomioma escrotal son de presentación excepcional. Nuestro objetivo es describir tres casos de tumores escrotales y aportar información respecto a esta patología. MÉTODO: Entre 2000 y 2014, 3 pacientes fueron diagnosticados y tratados de tumor escrotal en nuestro servicio. Se revisaron las historias clínicas de dichos pacientes. RESULTADOS: Presentamos dos casos de carcinoma basocelular en varones de 72 y 71 años de edad respectivamente, que se presentaron con una lesión escrotal izquierda cuyo diagnóstico anatomopatológico tras su exerésis fue carcinoma basocelular. En un paciente, estaba afectado el borde quirúrgico y cursó con un carcinoma basocelular recurrente que fue extirpado con ampliación de bordes quirúrgicos. Describimos también un caso de leiomioma escrotal en un varón de 48 años con una lesión escrotal derecha excrecente, indolora y de bordes lisos. En el seguimiento, los pacientes continuaban clínicamente asintomáticos. CONCLUSIONES: Las lesiones escrotales en un adulto mayor deben ser extirpadas y enviadas para estudio histológico. El carcinoma basocelular de escroto se presenta como una placa, nódulo o úlcera. Precisa seguimiento y su pronóstico es bueno. El leiomioma se presenta como un nódulo no ulcerativo y su tratamiento es la extirpación completa de la lesión

OBJECTIVE: Basal cell carcinoma and leiomyoma of the scrotum are rare. We describe three cases of scrotal tumors and provide information regarding this disease. Methos: Between 2000 and 2014, 3 patients with scrotal tumors were diagnosed and treated at our institution. A review was performed using the clinical records of these patients. RESULTS: We describe two cases of basal cell carcinoma of the scrotum in men 72 and 71 year old, who presented with a left scrotal lesion that was excised and the pathological diagnosis was basal cell carcinoma. In one patient, surgical margin was affected and a recurrent basal cell carcinoma appeared. It was excised with enlargement of surgical margin. We also describe a case of scrotal leiomyoma in a 48 year old man with an elastic, firm and nontender lesion in the right scrotum. During follow-up the patients remain clinically asymptomatic. CONCLUSIONS: Scrotal lesions in the elderly should be excised and submitted for pathological examination. The basal cell carcinoma of the scrotum appears as a plaque, nodule or ulcer. Long-term surveillance is recommended for these patients. Leiomyoma of the scrotum is presented as a non-ulcerative nodule and his treatment is complete surgical excision

[Bladder endometriosis. Report of two cases and bibliographic review, with special focus on Spanish articles]. / Endometriosis vesical. Revisión de la literatura, con especial referencia a la española y aportacion de dos nuevos casos.

OBJECTIVES: To study and review the etiopathogenic hypothesis for endometriosis and the clinical features, diagnosis and treatment of bladder endometriosis. METHODS/RESULTS: We report two cases and review the international bibliography, collecting the cases published by Spanish authors. CONCLUSIONS: Bladder endometriosis is a rare pathological entity, but its diagnosis should be considered in fertile women with urinary tract symptoms during menstruation. Diagnosis is obtained by various imaging tests (ultrasound, CT scan, MRI), and is confirmed with cystoscopy and biopsy. The treatment may be surgical (TUR, partial cystectomy) and/or medical (hormonal).

El segundo trasplante renal en España / The second kidney transplantation in Spain

En 1961 se comunicaron en nuestro país los dos primeros trasplantes renales de donante vivo (isotrasplante y homotrasplante respectivamente). La historia clínica recogida se refiere al homotrasplante renal efectuado entre padre e hijo, hace más de medio siglo, por Carlos Younger de la Peña y Ramiro Rivera en la Clínica madrileña de "La Paloma". Se comentan las dificultades organizativas, jurídicas, inmunobiológica y técnicas de aquellos momentos en los que apenas se vislumbraba el exitoso futuro de los trasplantes de órganos. Desde el siglo XXI podemos contemplar el largo camino del trasplante renal durante todo el siglo XX. A pesar de todos los inconvenientes y fracasos iniciales nuestro presente debe y cumple con el reconocimiento al trabajo y dedicación de los pioneros

The first two living donor kidney transplants in our country (isotransplant and homotransplant respectively) were reported in 1961. We reviewed the clinical history of the renal homotransplant performed between father and son, more than half a century ago, by Carlos Younger de la Peña and Ramiro Rivera at "La Paloma" Clinic in Madrid. We comment on the organizational, legal, immunobiological and technical difficulties in those times when the successful future of transplantation was barely in sight. From the XXI Century we can see the long path of renal transplantation during the XX century. Despite all the initial troubles and failures our present must recognize, and so does it, the work and dedication of the pioneers

Tumor en hernia vesical inguinoescrotal / Tumor inside an inguinoscrotal bladder hernia

OBJETIVO: Mostramos dos casos de neoplasia urotelial en hernias vesicales inguinoescrotales y referimos su escasa incidencia.METODOS: Se describe el diagnóstico y tratamiento efectuado con cistectomía parcial y herniorrafia.RESULTADOS: Ambos pacientes al cabo de dos y tres años respectivamente han tenido buena evolución clínica, sin recidiva herniaria ni del tumor.CONCLUSIONES: Las hernias vesicales inguinales son relativamente frecuentes, pero los casos de tumor en la vejiga herniada son escasos en la literatura. El tratamiento persigue eliminar el tumor, reparar la hernia y tratar si existe la patología uretroprostática (AU)

OBJECTIVE: To describe two cases of urothelial tumors in inguinoscrotal bladder hernias and comment on the low incidence of this condition.METHODS: Two patients were diagnosed and treated by partial cystectomy and hernia repair.RESULTS: The clinical outcome of both patients was good at two and three years, respectively, and neither patient experienced hernia or tumor recurrence.CONCLUSIONS: Inguinal bladder hernias are relatively common. However, few reports of tumor in the herniated bladder have been published. Treatment consists of tumor removal, hernia repair and treatment of any associated urethroprostatic condition (AU)

[Penile incarceration by a steel ring]. / Incarceración de pene por anillo de acero.

OBJECTIVES: To report a new case of penile incarceration by a metallic object. METHODS: 28-year-old male presenting to the emergency room with a ring at the medial part of the penis that he was unable to remove. The ring was placed 16 hours before. Such incarcerating object was causing important oedema, a small plate of necrosis, and hypoesthesia of the glans penis. RESULTS: After many unsuccessful attempts the penis was finally released using a strong cutting tool. The wound was cleaned with removal of devitalized tissue and sutured. Twenty-four hours later the penis looked almost normal, although patient complained of slight hypoesthesia at the glans penis. CONCLUSIONS: Incarceration of the penis by a metallic object is an unusual clinical situation causing a vascular emergency and an incredible therapeutic challenge to remove the constructive object.