Scrotal tumors. / Tumores escrotales.

OBJECTIVE: Basal cell carcinoma and leiomyoma of the scrotum are rare. We describe three cases of scrotal tumors and provide information regarding this disease. METHODS: 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.

Collateral urethral duplication in an adult.

OBJECTIVE: Congenital anomalies or malformations of the urethra that involve number are extremely rare and only 7 cases of trifurcation of the urethra and under 500 cases of urethral duplication have been described. METHODS: In the case we present, urethral duplication was diagnosed in adulthood, even though glans malformation with 2 urethral orifices was clearly evident and only 1 was functional. RESULTS: The condition is usually diagnosed in childhood due to the presence of 2 urethral meatus or from double stream if both are functional; at other times, the condition is diagnosed from complications that trigger infections or obstruction or if it is associated with more extensive malformations. CONCLUSIONS: Urethral duplication is an extremely rare birth defect, and diagnosis in adulthood is even more uncommon. No single embryologic argument explains all the anatomic variants of urethral duplication. The treatment of the urethral duplication should be individualized according to the type of duplication and the clinical symtoms.

[Renal epithelioid angiomyolipoma]. / Angiomiolipoma epitelioide renal.

Epithelioid angiomyolipoma of renal origin are a very rare variant of the classic angiomyolipomas but with the peculiarity to present malignant potential. Its diagnosis is usually after surgery because the tumor simulates both clinical and radiological features of renal cell carcinoma. We report a case of a 14 year old patient who was diagnosed with this disease as an incidental finding, and that after she underwent partial nephrectomy for three years is currently asymptomatic with no signs of disease recurrence.

[Saturation biopsy in prostate cancer diagnosis]. / Biopsia por saturación en el diagnóstico de cáncer de próstata.

AIMS: To analyze the results obtained after doing saturation prostate biopsy to a series of patients with high level of PSA. SUBJECTS, MATERIAL AND METHOD: Among 2006 and 2007 saturation biopsies have been realized in our Service to 32 patients with high PSA, previous biopsies without diagnosis of prostate cancer and high suspicion of malignant disease. RESULTS: The mean age was 65.81 years, with an average of previous biopsies of 2.41 (range: 1 to 5). Mean of PSA was 15.45 ng/dl (range: 5.63 to 35.47 ng/ml). The mean number of cores obtained in the saturation biopsies was of 20.78 (range: 16-26). 13 were diagnosed prostate adenocarcinomas (40.63%), of which 10 had previous diagnosis of PIN or atipia. 8 patients underwent radical prostatectomy, 3 cases were treated with radiotherapy, 1 case was treated with hormonetherapy and the remaining one is kept in watchful waiting. Concordance of Gleason grade was in 6 of 8 patients treated surgically. CONCLUSIONS: Saturation biopsy is an effective method for the diagnosis of prostate cancer after several negative biopsies and a strong clinical suspicion of malignant pathology. Saturation biopsy is not a first choice procedure for the diagnosis of prostate cancer.

[Fracture of the penis: a case series]. / Fractura de cuerpos cavernosos. Serie de casos.

Penile fracture is an uncommon urological emergency with a typical presentation, which needs early surgery to avoid aesthetic and functional sequelaes. We have analyzed all the patients with a discharge diagnosis of fractures penis among 1997 to 2007, attended in the emergency service of Complejo Hospitalario Universitario de Albacete, showing its clinical features, attributed mechanism of injury, treatment and main complications.

VHL protein alterations in sporadic renal cell carcinoma.

AIMS: The vhl gene is a tumour suppressor gene implicated in renal tumorigenesis in both familial and sporadic renal cell carcinoma (RCC). Alterations in the gene may modify its suppressor function and allow the formation of renal tumours. The purpose of this study was to determine the existence of vhl gene mutations in renal tumour tissue among patients with sporadic RCC and to assess the effects on the structure of the VHL protein. MATERIALS AND METHODS: This was an observational, analytical and descriptive study of 96 patients who had undergone surgery for sporadic RCC. In surgical specimens of tumour tissue, the three exons of the vhl gene were amplified by polymerase chain reaction and subjected to automatic sequencing. The consequences of the mutations detected on the VHL protein were analysed, taking into account the physical and chemical properties of the amino acids changed by the mutations, the location of the alterations in the protein sequence, the degree of conservation throughout evolution, and prediction of the secondary structure of the protein. RESULTS: In total, 22 vhl gene mutations were detected in 21 (21.9%) patients; in particular, 13 exonic point mutations consisting of 11 sense mutations, one silent mutation and one missense mutation, plus five exon deletions and one insertion. The remaining three were intronic mutations. All changes occurred in protein functional domains and in regions that have been well conserved throughout evolution. Two-thirds of the intronic mutations were considered relevant for protein function. Among the mutations detected, 72.7% were considered capable of compromising the VHL protein suppressor function. CONCLUSIONS: Mutations in the vhl gene result in amino acid changes in the protein that usually occur at important functional sites that have been conserved throughout evolution and where the binding domains for other proteins are located and exert their suppressor function.

Late recurrence of ovarian granulosa cell tumor at the retroperitoneal and renal hilum level in a single-kidney patient--case report.

BACKGROUND: Ovarian granulosa cell tumors are rare tumors characterized by a long natural history and a tendency to late recurrence. Surgical resection, radiotherapy, chemotherapy and hormone therapy are possible options to treat recurrent disease. The choice will depend on the patient's condition and the site of recurrence. CASE: We describe the case of a 72-year-old patient with a single left kidney who presented retroperitoneal recurrence of ovarian granulosa cell tumor at the left renal hilum ten years after primary treatment. CONCLUSION: This case illustrates an example of very late recurrence and emphasizes the importance of extended follow-up for these patients.

[Femoral neuropathy in urological surgery]. / Neuropatía femoral en cirugía urológica.

We present four cases of femoral neuropathy due to urological surgery, first case happened after right lumbotomy twenty years ago and the other three cases in the last four years after iliac incision. We review lesion production mecanism, evolution, treatment and prevention of this rare neurological complication. We do a literature review about this pathology related with urological activity.

[Hemoperitoneum and death due to hepatoesplenic metastasis rupture in a testicular tumor]. / Hemoperitoneo y muerte por rotura de metástasis hepatoesplénicas de tumor testicular.

We present a case of a mix germinal testicular tumor, in III-C (AJCC-UICC) stage, at a terminal phase due to massive methastasis rupture at hepatic and splenic methastasis locations.

[Giant adrenal myelolipoma: hypertension, renal failure and spontaneous rupture]. / Mielolipoma suprarrenal gigante: hipertensión, insuficiencia renal y rotura espontánea.

Adrenal myelolipoma is a rare, benign, slow-growing tumor composed of adipose tissue and hematopoietic elements. It is usually diagnosed incidentally, although there are reports of patients with symptoms and descriptions of retroperitoneal hemorrhage due to rupture of large tumors. The condition has been associated with obesity, high blood pressure and adrenal dysfunction. We present a patient with retroperitoneal hemorrhage due to spontaneous rupture of a myelolipoma, hypertension, and renal failure secondary to nephroangiosclerosis.

[Vesical schistosomiasis, case report and Spanish literature review]. / Esquistosomiasis vesical, aportación de un caso y revisión de la literatura española.

Urinary schistosomiasis is an infection caused by parasite, Schistosoma haematobium. Squistosomiasis is an endemic disease in Africa and Middle East. We are presenting a case of a young immigrant male from Mali that came to our clinic with hematuria and miccional irritative syndrome during a year. Parasitological study reported Schimosoma's eggs and ecography showed a possible vesical newformation. After RTU, anatomopatological study confirms the presence of a vesical esquistosomiasis. Now pacient is asyntomatic after he was treated with Praziquantel.

[Growing incidence in renal cell carcinoma]. / Incidencia creciente en el carcinoma de células renales.

OBJECTIVES: To analyze the change in the behavior of renal cell carcinoma for its presentation, treatment, histology and mortality during a 17 year period. MATERIAL AND METHOD: Retrospective study on 212 patients diagnosed with renal cell carcinoma in our Department from the year 1988 up to 2004, analyzing the clinical and demographic data and comparing them to each other according to two periods: 1988-1996 and 1997-2004. RESULTS: An increase has been appreciated in the incidence of renal tumors in the second period and in a same way an increase in the incidental diagnosis and in the practice of nephron sparing surgery. Clear cell type was the most frequent in both periods and tumoral size was higher in the first period than in second. TNM stage I was the most frequent, although in first period it was higher percentage of stage IV. Cause-specific mortality has increased in the last years. CONCLUSION: An increase is appreciated in the incidence of renal cell tumors. Although the diagnosis is in earlier stages, a descent in the mortality has not been found.

[Entero-neobladder ileal fistula: two cases report]. / Fístula entero-neovejiga ileal: a propósito de dos casos.

Fistulas between the orthotopic reservoir and the gastrointestinal tract have low incidence (1.5-2%). Simptomatology is variable, but it's frecuent to find fecaluria. Among 90 new intestinal bladders we show two fistule of new bladder to ileo, with nest postoperatory diagnosis, using retrograde cystografy; one was resolved with next postoperative treatment and the other with open surgery.

[Problem-based learning in urology training. The Faculty of Medicine of the Universidad de Castilla-La Mancha model]. / El aprendizaje basado en problemas en la enseñanza de la urologia. Modelo de la Facultad de Medicina de la Universidad de Castilla-La Mancha.

Ongoing changes in the social, economic, technological and scientific realms have generated new needs and led various organizations to suggest that educational institutions should reorient their educational strategies toward developing effective professionals with the skills to meet these needs. These "modern" strategies include problem-based learning, in which the student seeks and selects information, analyzes the data obtained, integrates both prior and newly acquired knowledge, and, finally, offers diagnostic and therapeutic options to resolve the problem posed, as would occur in professional practice. With this approach, prior skills and practical experience form the foundation of learning. Problem-based learning incorporates some aspects of cognitive psychology, a model that mainly centers on the nature of the knowledge structures found in active memory, the processes involved in information storage and retrieval and the various factors that activate these processes. At the Faculty of Medicine of the Universidad de Castilla-La Mancha, urology is part of a core subject (Medical and Surgical Pathology II) taught in the fifth year of coursework together with nephrology. Each course includes approximately 75 students, divided into five groups. The rotation lasts six weeks, with students spending a mean of two hours a day on theory (nephrology and/or urology) and the remaining time on rotations in the various activities: three weeks in nephrology and three weeks in urology. Upon completion of the rotation, the students write a combined theoretical examination with 100 multiple-choice questions (50 on urology) and take a practical skills examination. At the end of the course, another practical test consisting of an objective, structured clinical examination is taken, in which standard patients are used and the professor directly assesses the level of skills acquired with a "real" case.

[Julián Gutiérrez de Toledo and his book "Cure of the stone and pain in the loin and/or renal colic" in 1498]. / Julián Gutiérrez de Toledo y su libro "Cura de la piedra y dolor de yjada o/y colica renal" en 1498.

The physician Julián Gutiérrez de Toledo, born in the Imperial Town halfway through the Fifteenth Century and deceased around 1520, has a great relevance in the History of Urology for being the first writer of a treatise on urological topics in the Castilian language with his work "Cure of the stone and loin pain or/and renal colic" (Editor Melchor Gorricio, Printer Pedro de Hagembach, Toledo 1498). His work marks the transit from The Middle Ages to the Modern Times in what refers to awareness of the urinary tract diseases. The book "Cure of the stone..." has 85 pages written in two columns of 40 lines each with gothic characters. On the cover there is an engraving of the saint physicians Cosme and Damian, and on the last page is the printer's coat-of-arms. The book consists of five parts as all books from late Middle Ages: Of the Causes, Signs and Prognosis, Preservation, Of the Cure, Misgivings. The value of the treaty is that it compiles all that was known at the time on urinary lithiasis showing a marked Avicenna-like Galenism to which the author adds his own observations that show the Renaissance man. An exceptional witness of the reign of the Catholic King and Queen, this incunabular should be known by the Spanish speaking urologist as illustrious predecessor.

[Adrenocortical carcinoma with inferior vena cava thrombosis]. / Carcinoma cortico suprarrenal con trombosis de vena cava inferior.

Presentation of one case of a large non-functional left corticosuprarenal carcinoma with associated thrombosis of the left renal vein and abdominal cava vein, a location rarely reported in the literature. Correct pre-operative magnitude diagnosis was possible, thus allowing the use of the appropriate surgical technique leaving no need for improvisation. In spite of the overall poor prognosis of this malignant tumoration, even more when there is a venous extension, the patient is now free of relapse or tumoral metastasis three years after surgery.

[Structural changes in the ileal mucosa of urinary conduits]. / Cambios estructurales en la mucosa ileal de los conductos urinarios.

OBJECTIVES: To study the changes found in the terminal ileum mucosa in contact with urine in patients with skin ureteroileostomy following cystectomy due to infiltrant carcinoma of the bladder. MATERIAL AND METHODS: 21 biopsies of gut mucosa were performed in as many patients. Measurements included height of intestinal villi (average values -AV-: 350-300 mu), height of crypts (AV: 70-100 mu), crypt/villus ratio (AV: 0.2), goblet cells/enterocytes ratio, presence of lymphangiectasis and inflammatory infiltrate. Also the existence of lab changes were measured with ionogram and venous gasometry. RESULTS: Mean age of patients was 65.2 years +/- 7.4 SD. Males 66.7%. Time of evolution with urinary by-pass was 59.5 months +/- 53.2 SD. Mean height of villi 178.2 mu +/- 70.2 SD, mean height of crypts 290.9 mu +/- 114.4 SD and mean crypt/villus ratio 4.2 +/- 9.2 SD. Submucous inflammatory infiltrate was mild in 57.1%, moderate in 23.8%, and severe in 19.0%. Only 2 cases had lymphangiectasis images. Goblet cells/enterocytes ratio was 3.3 +/- 1.3 SD. No correlation was seen between time of evolution of urinary by-pass with the various changes in gut mucosa or between degree of mucosal atrophy and existence of metabolic disorders. CONCLUSIONS: Changes in the terminal ileum mucosa in patients with skin ureteroileostomy-like urinary by-pass are characterised by a marked atrophy of intestinal villi with increased crypt length, increased crypt/villus ratio and presence of mild-to-moderate inflammatory infiltrate. There is also an increase of goblet cells in detriment of enterocytes. All these changes are independent from the time of evolution of patients with urinary by-pass.

[Adrenal cortex carcinoma with right atrium involvement. Surgery with cardiopulmonary bypass]. / Carcinoma corticosuprarrenal con afectación de aurícula derecha. Cirugía mediante by-pass cardiopulmonar.

INTRODUCTION: Primary adrenal carcinoma is a low incidence tumour. About 50% are functional and the majority result in Cushing's syndrome, while detection of the rest is commonly incidental. Surgical management is through radical surgery. CASE REPORT: A 36-year old female who presented with a one-month old abdominal pain in the hypochondrium and the right lumbar fossa. Physical examination found a discretely painful mobile mass. Adrenal hormones values were normal. Ultrasound and CT studies detected a 14-cm adrenal tumour with cava vein thrombosis up to the right auricle. The surgical procedure included laparotomy, liver mobilisation and cardiopulmonary by-pass. The thrombus was completely removed by auriculotomy. Therapy with mitotane and 5-fluorouracil was then instituted. Thirteen months after surgery the patient is asymptomatic and tumour free. REMARKS: Dissemination of adrenal tumours to veins ranges between 6 to 30%. Clinical manifestation of cava vein and auricle involvement is variable but it may develop with no symptoms due to collateral circulation. Pre-operative diagnosis is critical to plan for adequate surgical approach. Ultrasound and computerised tomography can adequately diagnose the process, but nuclear magnetic resonance provides more information on the thrombus extension and location. In the absence of node spread, local extension, or invasion of the cava wall prognosis is similar to that of patients with no vein involvement. The best therapeutic option is surgery with removal of the lesion and cardiopulmonary by-pass. Survival at 5 years is 43%. Post-operative administration of chemotherapy with mitotane is a useful and recommendable choice.