[Infrequent left renal pseudomass: ectopic spleen]. / Pseudomasa renal izquierda infrecuente: ectopia esplénica.

Ectopic splenic tissue is uncommon in clinical practice, usually asymptomatic and generally unsuspected diagnosed. Interest from urological point of view is due to the possibility of mimicking left renal, adrenal and retroperitoneal tumours; as well as intrapelvic, inguinal and genital masses. We report a 42-years-old female patient with pseudotumoral upper pole left kidney mass with final diagnosis of ectopic spleen. Ethiopathogenic, diagnostic and therapeutical aspects are briefly reviewed in literature. We emphasized opportunity to include ectopic splenic tissue in differential diagnosis of left renal, adrenal and retroperitoneal masses. We recommend imaging studies as CT and MRI, complemented if necessary with liver/spleen radionuclide scan. We advocate for non-aggressive attitude in selected cases with asymptomatic extrapelvic ectopic spleen under confirmed diagnosis, deferring splenectomy in symptomatic instances or secondary portal hypertension cases.

[Suburethral sling in the treatment of urinary incontinence: our experience]. / Cabestrillo suburetral en el tratamiento de la incontinencia urinaria: nuestra experiencia.

Review of 17 female patients who underwent placing of Suburethral Sling as anti-incontinence procedure with the purpose of assessing the results obtained. The most frequent complications were urinary retention and post-surgical urgency. A larger proportion of patients with Stress Urinary Incontinence had retention and during more days than those with Mixed Urinary Incontinence. In most cases of mixed urinary incontinence, asymptomatic prior to surgery, the placing of a suburethral sling provokes signs and symptoms of urgency, and even of post-surgical urgency-incontinence. Both complications were attenuated in all cases using measures such as conservation of urinary by-pass or administration of anti-cholinergics. Results at 2 years have been successful in 68.75% cases, thus encouraging us to reduce the number of indications for this technique.

[Cysts of the ejaculatory ducts. Diagnosis and clinical course after treatment]. / Quistes de conducto eyaculador. Diagnóstico y evolución tras tratamiento.

Confusion surrounding diagnosis of central prostate cysts is explained for the rarity of the condition. Deferento-vesiculography is diagnostic and must be performed independently (right-left) for a better anatomical evaluation of the area. The endoscopic images do not allow differential diagnosis from other prostate cysts. Recovery of bearer's fertile ability following endoscopic resection does not result, in our experience, as effective as it could be expected from resolving the obstructive cause.

[Meningeal carcinomatosis in bladder tumor]. / Carcinomatosis meníngea en un tumor vesical.

We report a strange case of a bladder whose first metastasic manifestation, after two years of the diagnosis, was a peripheric polyneuropathia. This patient was treated with immunotherapy with BCG for superficial carcinoma of the bladder during one year. Gradually central neurological symptoms appeared and the patient died one month later. A meningeal carcinomatosis was identify as the cause. No bone metastases existed, which is the most frequent way of tumours extension towards leptomeninges. We argue about the way to arrive at meninges.

[Large renal leiomyoma]. / Leiomioma renal voluminoso.

Renal leiomyomas are uncommon between renal tumors, and they have a benign mesenchymatous origin. Because of their low incidence, unspecific symptomatology an not well-defined iconographic semiology, they often raise problems with differential diagnosis from kidney masses, although they are often big size lessions. We report a patients with incidentally diagnosis of big solid left renal mass, who underwent radical nephrectomy resulting kidney pelvis leiomyoma. Diagnostic, histological and therapeutic aspects are briefly review in literature. Emphasis is made on the relevance of a high index suspicion considering big solid asymptomatic renal masses in middle-age women. Specially in renal tumors with well-defined limits and abscence of locoregional and systemic dissemination. We emphasized usefulness of Magnetic Angioresonance, immunohystochemical test and conservative surgery opportunity in small renal leiomyomas preoperatively confirmed.

[Metachronous contralateral Leydig cell tumor of the testis: conservative treatment]. / Tumor testicular de células de Leydig contralateral metacrónico: tratamiento conservador.

Leydig cell tumors are the primary nongerm cell tumors of the testis, comprising approximately 1 to 3% of all testicular neoplasms. These tumors are bilateral in 5 to 10% of cases. Hypoechoic testicular nodule associated to a child virilising syndrome or adult gynecomastia with negative testis tumor markers (AFP, B-HCG) show a high index suspicion for this entity. We report a case of metachronous contralateral Leydig cell tumor in a 32 years old man with a 9 year interval between presentations, in which we performed local excision of the lesion. Diagnostic an therapeutic aspects are reviewed in literature. Since preoperative diagnosis of Leydig cell tumors in difficult and clinical course unpredictible, radical orchiectomy has been the standard treatment. Emphasis is made on conservative management opportunity in patients with only one testis, small tumors (less than 2.5 cm) with biopsies from tumor bed negative and wishes to remain fertile and/or refuses androgen supplementation. Follow-up is mandatory by performing scrotal ultrasounds. CT scan, Chest X-Ray, tumor markers and hormone determinations (testosterone, estradiol, progesterone, LH and FSH).

[Epistaxis as initial manifestation of disseminated renal adenocarcinoma]. / Epístaxis como primera manifestación de un adenocarcinoma renal diseminado.

Peculiar renal carcinoma tendency to unusual distant metastases suggest this primary neoplasm to be accounted in differential diagnosis of metastases as first clinical symptom of cancer. Renal cell carcinoma present metastases in 26-30% of cases at the time of diagnosis. Head and neck metastases from renal carcinoma are said to be present in 8% (6-15.2%) of patients, and half of them are asented on paranasal sinuses. We report a 70-years-old patient with recurrent epistaxis as first clinical sign of a nasosinusal metastases from renal disseminated carcinoma, who precised selective embolization. Epidemyologic, diagnostic and therapeutical aspects are briefly reviewed in literature. Nasosinusal metastases are uncommon in clinical practice. We emphasized the need of primary tumor investigation in the organs most often responsible for these metastasic deposits as: kidney (50%), lungs, breast, gastrointestinal tract, urogenital ridge and thyroid gland. Individualized treatment depends on leasions number and localization. On routine follow up of hipernephroma nephrectomized patients a high suspect index has to be considered as paranasal metastases can eventually occur.

[Bladder leiomyoma: report of a case]. / Leiomioma vesical: a propósito de un caso.

We report a case of leiomyoma of the bladder in a male patient who presented with cystitic syndrome and hematuria. The literature is briefly reviewed and the benign nature of this condition is underscored. The prognosis is excellent with correct treatment.

[Renal-cell adenocarcinoma as an incidental finding. Its diagnosis and tumor evolution]. / Adenocarcinoma renal como hallazgo incidental. Diagnóstico y evolución tumoral.

OBJECTIVES: We attempted to determine whether or not incidental renal cell carcinoma had a better prognosis. METHODS: We reviewed 53 cases of renal cell carcinoma that had been surgically treated over the periods 1985-1988 and 1989-1993. The form of presentation, stage of the incidental tumors, sex, compromised side and the diagnostic imaging technique utilized were analyzed. RESULTS: GI pathology most frequently led to the diagnosis of the tumor. Tumor stages were A or B with a slightly higher prevalence for the incidental tumors. However, the prognosis was not better than that of clinically suspected renal cell carcinoma. The male to female ratio was 1.17:1, the mean age was 63 years, the tumors were frequently right-sided and ultrasound was superior in the diagnosis of incidental tumors. CONCLUSIONS: No prognostic difference was observed between clinically suspected and incidental renal cell carcinoma of the same tumor stage.

[Bladder hernia. Report of 4 cases]. / Hernias vesicales. Aportación de cuatro casos.

Four cases of vesicoscrotal herniation are described. The different etiology and forms of presentation (from an incidental finding to one requiring emergency treatment) of this condition are discussed. Surgical treatment is based on its size, location and coexisting pathology (prostatic hyperplasia, calculus, bladder tumor, etc.).

[Trigono-cervico-prostatotomy (TCP) versus transurethral resection of the prostate (TURP). Our experience]. / Trigonocervicoprostatotomía (TCP) versus resección transuretral de próstata (RTU). Nuestra experiencia.

OBJECTIVE: Trigonocervicoprostatotomy (TCP) has been considered up to now an alternative treatment to transurethral resection of the prostate (TURP) when evaluating the size of the prostate. This paper demonstrates that endoscopic visualization is more important when choosing the surgical procedure and that both techniques can achieve satisfactory results. METHODS: The prostate volume is evaluated by ultrasound and according to the endoscopic findings, TURP or TCP is performed. The prostatic lobes are routinely biopsied if the latter procedure is chosen. RESULTS: We compared the results of 34 TCP and 30 TURP procedures using the values of I-PSS and uroflowmetry before and after surgery. In 86.2% of the TCPs and 80% of the TURPs, the patients are asymptomatic with I-PSS less than 7 and significantly improved uroflowmetry data. Biopsy disclosed adenocarcinoma in one patient submitted to TCP. CONCLUSIONS: TCP represents an alternative to TURP not only for small prostates (30 gm) but also for medium-sized prostates (50-60 gms), depending on the endoscopic findings. TCP is not indicated for lateral lobes that fall on the prostate floor. Performing a biopsy routinely in TCP does not prolong the operating time significantly and permits detecting subclinical adenocarcinoma of the prostate.

[Medical treatment of bladder instability. Our experience]. / Tratamiento médico de la inestabilidad vesical. Nuestra experiencia.

OBJECTIVE: To identify the factors that influence response to treatment of vesical instability. METHODS: A retrospective study was conducted to assess the efficacy of drug therapy with oxybutinin and imipramine in 89 patients with urodynamically demonstrated detrusor hyperreactivity. Control evaluations were performed at 2, 5 and 8 months. Evaluation of the results took into account the etiology, pressure and volume at which the wave of instability appeared. RESULTS: The results were evaluated according to patient subjective criteria. We observed a positive response (cure and improvement) to treatment with oxybutinin alone or oxybutinin+imipramine in 66.25% of the cases; side effects were observed in 44%. There was a 20% improvement in the positive response rate when the wave intensity was greater than 55 cm H2O and the bladder volume at which this occurred was greater than 150 ml. No patient treated with second line drug therapy (flavoxate, nifedipine and trospium chloride) cured. CONCLUSIONS: The etiology of vesical instability did not influence response to therapy. Waves with a greater intensity and those that appeared at higher volumes responded better to treatment. Nearly half of the patients with side effects required a reduction of the dosage or withdrawal of the drug. Our results and those reported elsewhere indicate that non-responders to treatment with oxybutinin alone or in combination with imipramine are unlikely to improve with currently available drug therapy.