[Segmental testicular infarction]. / Infarto segmentario de testículo.

We report the case of a 47 years old man previously diagnosed of left hidrocele. After having a recent mild left testicular pain, an ultrasonografic study revealed a solid hipoecoic testicular lesion rounded by a big hidrocele, suggesting a testicular neoplasm. Radical inguinal orchiectomy was made and pathologic study showed segmental testicular infarction. No malignancy was found. We review the literature of the topic.

[TVT our experience five years and six months later]. / Nuestra experiencia a cinco años y medio en TVT.

OBJECTIVE: We present the outcome of urinary incontinence surgery after TVT more than five year of follow-up. Efficacy was evaluated in terms of complete cure of incontinence, complications, and patient satisfaction. MATERIAL AND METHODS: A sample of 369 female with genuine stress incontinence or mixed incontinence who had a TVT performed in our hospital between 1998-2003 were evaluated. Sample average age was 59.9 years. A total of 326 patients (85%) had genuine stress incontinence and 56 (15%) mixed incontinence. Preoperative evaluation was base on: clinical history and physical examination, stress test, flowmetry and post voided residual. Cistometry was indicated only in patients with previous surgery and mixed incontinence. Severity of incontinence was graded clinically. Primary outcome measure was complete cure of incontinence defined as lack of objective and subjective leakage. In addition a phone survey about patient satisfaction with the surgery was carried out. RESULTS: The average follow up was 35 months (6-67). A total of 317 were complete continent (86%). By contrast, 52 patients (14%) had leakages jet. The novo urgency rate was 7% and a 5.7% of patients were reoperated to cut the mesh because of obstruction. Nevertheless, the reoperation rate was low and only a patient showed a massive haematoma which needed to be evacuated. CONCLUSION: Bursch Technique through suprapubic route has been classically considered the gold standard procedure for stress urinary incontinence for the last decades, having been substituted nowadays by tension-free suburethral mesh sling whose most important advantages are: Simplicity of the method, lower cost and higher comfort for the patient due to the fact that we have chaged in-patient surgery program for ambulatory one with similar results in order to sanation. Anyway we will have to check if the preliminary good results and no complications persist in the follow-up.

[Micropapillary carcinoma of the bladder: case report and review of the literature]. / Carcinoma micropapilar de vejiga: aportación de un caso y revisión de la bibliografía.

Micropapillary carcinoma is an uncommon pathologic variant of bladder carcinoma with aggressive behavior. Its usual presentation is like a high grade and high stage carcinoma and associated with other histologic types in different proportion. It doesn't differ clinically from normal transitional cell carcinoma of the bladder. Studies of molecular markers are still contradictories. Treatment should be early and aggresive, based on surgical therapy as radiotherapy and chemotherapy have shown limited results. We report a 72 year old man suffering from low urinary tract symptoms for years and recently presented gross hematuria. He was diagnosed as high stage micropapillary carcinoma. One year after radical cystectomy and subsequent chemotherapy based on carboplatin and gemcitabine, progression of the disease was shown on CT and the patient died 14 months after the diagnosis.

[Minimal prostatic adenocarcinomas in the biopsy treated with radical prostatectomy]. / Adenocarcinomas minimos de próstata en la biopsia sometidos a prostatectomía radical.

FUNDAMENTALS: Valuation about clinical pathologyc facts of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy. METHODS: Retrospective analysis of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy in front of the remaining radical prostatectomies. RESULTS: In 20 patients (7.6%) out of the 260 having undergone a radical prostatectomy between 1992 and 2004 the biopsy was informed as "minimal adenocarcinoma". These patients ranged 58 to 73 years with PSA levels from 5.2 to 17.1 ng/ml. Everyone except one were clinically T1c. At the definitive pathological study the Gleason was 6, 4, 3 and 2 in 3, 3, 8 and 4 patients respectively, with one having a minimal adenocarcinoma not graded and another one with a PIN ?. 3 showed only 1 focus with a tumoral volume less than 5% of the tissue (84.2% with significant tumor or multifocal). The final staging was 1 pT0 (PIN ?), 7 pT2a, 11 pT2b and 1 pT3a (62.5% bilaterals). Relating to the remaining patients under prostatectomy, patients with minimal adenocarcinoma presented significative differences in Gleason sum (p < 0.029) and staging (p = 0.02); no in PSA mean (p = 0.243). SUMMARY: Minimal adenocarcinomas of the prostate at the biopsy are significant but do present lower staging and grading in relation with the rest of patients.

[Primary signet cell adenocarcinoma of the bladder]. / Adenocarcinoma de células en anillo de sello primario de vejiga.

The primary signet-ring cell adenocarcinoma of the bladder is a rare tumor, with great biological aggressivity and bad prognosis. We report a clinical case of a 65 years old patient, starting with bladder irritative symptoms and suffering from advanced disease at the initial diagnosis. We review clinical and etiopathogenic aspects about this entity.

[Renal oncocytoma: infrequent presentation form]. / Oncocitoma renal: una forma infrecuente de presentación.

Case report describing a solid renal mass as an incidental finding while evaluating a different condition. This is an oncocytoma infiltrating perirenal fat. The various aspects of the process are described.

[Scrotal leiomyoma: report of a case]. / Leiomioma de escroto: aportación de un caso.

Scrotal leiomyoma is a benign rare tumour, asymptomatic, which origin is the dartos muscle and the election treatment is surgical. We report a new case in a 68-year-old patients with a 10 years history of a scrotal tumour and anatomopathological diagnostic post surgery was leiomyoma.

[TVT: three years of experience]. / TVT: 3 años de experiencia.

INTRODUCTION: Since the description of the TVT technique as a therapy to stress urinary incontinence, in 1996, about 150000 subjects have undergone it. This technique was first used in our centre in november 1998. This article is aimed to contain our view of its evolution in the past three years. MATERIALS AND METHODS: 142 patients of an average of 59 years old have been operated on. In 57% of the cases, we also focused on the solutions to anatomic pelvis disorders. RESULTS: After a follow-up of 17 months and a mean of 14 months, 93% of the cases succeeded. Failures arose during the first six months of therapy. We found the following complications: 4.8% of bladder perforations, 17% of postoperative retentions of no longer than 30 days, 2% of long-term retentions, 2.7% of postsurgical hematomas, and 9% of urge incontinence. Surgery was performed on 10 patients who had undergone surgery against bladder incontinence before, and all the cases proved success. CONCLUSIONS: This technique is simple and only requires a short surgical time, and it can be applied for major ambulatory surgery. Although it is possible to encounter complications, they rarely occur and results are still encouraging. However, it is now necessary to verify that our long-term studies match with the success rates of 84.7%.

[Adrenal gland myelolipoma. Report of a new case]. / Mielolipoma suprarrenal. Aportación de un nuevo caso.

OBJECTIVE: We report a new case of symptomatic myelolipoma of the adrenal gland. We analyse clinical, diagnostic, histopathologic and therapeutic aspects. METHOD AND RESULTS: Surgical excision was performed by lumbotomy. The patient was asymptomatic after surgery. DISCUSSION: Adrenal myelolipoma is norfunctioning benign tumour constituted by fat tissue and small islands of haemathopoyetic in a variable rate. The patients are usually asymptomatic. In symptomatic patients the most common symptoms are nonspecific abdominal pain, haematuria and hypertension. The diagnosis is achieved by ultrasound, CT and PAFF. The management is controversial: Surgical treatment or watching are options depending on the size and/or symptoms.

[Post-surgical spindle cell nodule in kidney pelvis]. / Nódulo fusocelular post-quirúrgico en pelvis renal.

INTRODUCTION: The postoperative spindle cell nodule of the urinary tract is a being proliferative lesion similar to sarcoma in the microscopic exam. We present a case of modulein renal pelvis location. CASE: A woman presenting a stag horn lithiasis in left kidney was treated by LOC and percutaneous nephroscopy. Because of the large size of the stone a second intervention was required four weeks later. Then we discovered a 2 cm exophytic lesion in renal pelvis and removed it easily with a forceps. DISCUSSION: This kind lesion belong to the group of iatrogenic inflammatory pseudotumours, which are secondary to an injury that leads to a tissular repairing response. Differential diagnostic includes sarcomas. CONCLUSION: It is important that Urology and pathology specialist think of this tumour in patients having a recent surgical intervention. A mistake in the diagnosis would lead us to an unnecessary radical surgery.

[Camey II type orthotopic bladder replacement and its complications: 10-year experience]. / Sustitución vesical ortotópica tipo Camey II y sus complicaciones: 10 años de experiencia.

BASIS: To evaluate the complications on patients undergoing radical cystectomy with Camey II ileal orthotopic neobladder. METHODS: To review our series of 61 radical cystectomies performed between 1990 and 1999 for bladder cancer. The complications were divided in early (30 days or less) and late. RESULTS: A patient died at the immediate postoperative. It appeared 35 early complications on 30 patients: 8 related with neobladder (urinary fistula and urinary infection) and 27 not related, being the most frequent those appearing at bowel site, with 10 early surgeries (16.4%). After evaluating 55 patients for late complications, 39 presented some kind of complication: 38 related with neobladder and 13 not related, 30 patients underwent surgery, being 19 of them under endoscopic way. 74.4% of continents by day and 31.4% at night. CONCLUSIONS: Despite the acceptable functional results, the orthotopic bladder substitution presents a not comptemtible rate of complications. In other way, a lack of standard criteria make difficult the comparation with other series and types of bladder substitution.

[Leiomyoma of the bladder. Report of a case]. / Leiomioma de vejiga. A propósito de un caso.

Benign bladder tumors of mesenchymal origin have a very low appearance incidence, being the most frequent the leiomyoma. We report new case, making a discussion about the complementary tests needed for the diagnose.

[Inverted papilloma of the prostatic urethra]. / Papiloma invertido de uretra prostática.

The inverted papilloma is a rare urothelial tumor, and its localization at the prosthatic urethra is also exceptional. We present a case of inverted papilloma of the prostatic urethra in a 72 years-old male, with symptoms of urinary flow obstruction. The diagnose is obtained after urethrocistoscopy and transurethral resection at the same time. We discuss about the etiology, clinical presentation, diagnose and treatment of this rare tumor, making special attention to its malignancy ability.

[Ambulatory major surgery: our experience]. / Cirugía mayor ambulatoria: nuestra experiencia.

INTRODUCTION: The first Surgery Ambulatory Unit was created in 1990, at the Hospital de Viladecans although in 1982 Polo et al. had commenced a programme of strictly ambulatory surgery. The Spanish Services of Urology are going to be incorporated to this new style of labour, and, by the moment, with excellent results. MATERIAL AND METHODS: We realize a description of the functioning of our service inside the Unit of Ambulatory Major Surgery, and a descriptive analysis of our activity in above mentioned unit since February 2000(creation date) to May 2001. RESULTS: 118 patients were operated, being 15% women and 85% men. The most frequent surgery done were: hydrocelectomy, orchiopexy, varicocelectomy, vesical distensions, Nesbit technique and internal urethrotomy. From the whole of the patients, none was increased, and the complication tax was similar to the conventional surgery patients. This kind of surgery suppose 17% in 2000 and 19% in 2001 of the whole of surgery, with clear increasing tendency in the last months. CONCLUSIONS: The Ambulatory Major Surgery is an effective and efficient care pattern in which Urology Services are included, so that the degree of satisfaction of the patients and the quality offered is similar to the inpatient surgery.

[Colonic perforation in percutaneous surgery of the kidney. Report of two cases]. / Perforación colónica en la cirugía renal percutánea. Presentación de dos casos.

We show our experience about iatrogenic damage of colon secondarily to percutaneous surgery of the kidney. One of them treated by means of open surgery, the other by conservative procedures. Making discussion on risk factors, as well as the diagnostic therapeutical aspects.

[Stress urinary incontinence surgery with MiniArc swing system: our experience]. / Nuestra experiencia con minicintas MiniArc en la cirugía de la incontinencia urinaria de esfuerzo.

OBJECTIVE: To describe the surgical technique of AMS MiniArc swing system for the treatment of female urinary incontinence, evaluate its results and complications. METHOD: We performed a retrospective study of surgery with AMS Miniarc swing system. From august 2007 to march 2009, 135 patients with urinary incontinence (UI) underwent AMS MiniArc swing system surgery in hammock way. 110 patients (81.5%) suffered from stress urinary incontinence (SUI) and 25 (18.5) from mixed (MUI). The average age was 55 years-old. All these procedures were performed wigh local anesthesia and in <>. We evaluate every patient a month later, between 3-6 months later, and a year after surgery. During the following up, clinical history was made in every women with ICIQ-SF questionnaire, that included a fourth question to evaluate the degree of satisfaction after surgery, as well as physical examination. We considered objective cure when negative stress test with full bladder. We use the SPSS program (V 14.0) for statistical analysis of the results (Student's t-test). RESULTS: With a mean follow-up of 495 days (range from 181 to 777), early complications included: 2 bladder perforations during sling placement, inguinal pain in 4 patients and one obturator hematoma (resolved spontaneously). The long-term postoperative complications were: 4 tape exposures in vagina (2.9%), urethral obstruction in 3 patients (2.2%) that required urethrolysis and net section, and irritative symptoms of frequency and urgency reported in 9 patients (6.6%), 5 out of 9 were temporary (between 2 and 6 months) whereas the remaining 4 required anticholinergic agents due to persistent symptoms. When evaluating the success rates of anti-incontinence surgery, 91.9% of patients showed objective cure (88% with MUI and 92.7% with SUI) since we demonstrated no loss of urine by physical examination with full bladder. The ICIQ-SF score (fourth question included) decreased an average of 12.7 points. 90% of patients were very or fairly satisfied. CONCLUSION: The AMS Minarc swing system is an optim anti-incontinence procedure. Its main advantage might be the possibility of performing this procedure under local anesthesia, in order to test and adjust the sling's tension according to the person's needs. Despite its promising results, further studies are required in order to arrive at more precise conclusions, taking into account that the TVT remains the gold standard surgical technique of SUI.