[Vesical hemangioma]. / Hemangioma vesical.

Bladder hemangiomas are mesenquimal tumors, generally benign and of difficult diagnosis, representing only 0.6% primary bladder tumors. Fundamental diagnosis is histological, since imaging test can't differenciate this from other bladder tumors. We present a case of a 60-year-old male who came to our service with macroscopic hematuria. RTU of one blue mass in the bladder was performed and the histological examination showed to be cavernous hemangioma. A review of literature was realized, commenting on the most typical clinical aspects, the diagnostic methods and the last therapeutic techniques in this type of lesions.

[Spermatic cord liposarcoma. Association with prostate cancer. Report of a case and review of literature]. / Liposarcoma de cordón espermático. Asociación con carcinoma de próstata. Comunicación de un caso y revisión de la literatura.

Spermatic Cord Liposarcoma are uncommon soft tissue neoplasm. Association with others tumors is so exceptional. We describe and relation between liposarcoma and prostate cancer in a 66 years old patient who had a left paratesticular tumor with low speed growth and 12 cm of length; nodule in prostate gland was detected. Ecography demostrate an hipoecoic tumor in the spermatic cord; Prostate Specific Antigen (PSA) was 1276 ng./ml. and bone gammagraphy reported metastatic lesions. We made an radical orquiectomy and pathological diagnosis including inmunohistoquimical process was sclerosing dedifferenciated liposarcoma. We discuss clinical and pathologic behaviour of this lesions and diagnosis and treatment options.

[Right renal agenesis and ureter ectopic abouchement in cystic dilation of seminal vesicle]. / Agenesia renal derecha y abocamiento ectópico del uréter en dilatación quística de la vesícula seminal.

The association of a seminal vesicle cyst with ipsilateral renal agenesis was initially reported in 1914 by Zinner, and it is a very rare congenital anomaly. The association of this anomaly with an ectopic ureter entering the seminal vesicle cyst is even less common. In these cases, clinical symptoms appear in patients 15 years or older due to the distention of the seminal vesicle caused by the secretions of the reproductive tract. Perineal discomfort and recurrent epididymitis are the most often presentations. Urogenital upper tract image studies are mandatory in the management of a cystic pelvic mass and magnetic resonance imaging (MRI) is the best of this radiographic studies, that also reveals the ectopic ureter draining into the seminal vesicle. We report an additional case of this rare congenital anomaly where only MRI provided a correct preoperative diagnosis and a right surgical approach.

[Hypertension emergency during surgery of renal carcinoma associated with non-diagnosed pheochromocytoma]. / Emergencia hipertensiva durante la cirugía de un carcinoma renal asociado a feocromocitoma no diagnosticado.

OBJECTIVE: To present an uncommon association of renal carcinoma with an undiagnosed ipsilateral pheochromocytoma that caused severe cardiovascular disorders during surgical treatment of the renal carcinoma, and emphasize the need for careful assessment of these adrenal nodules before resection although they may appear to be clinically irrelevant. METHODS: A 61-year-old male with mild arterial hypertension controlled with drug therapy for 40 years was diagnosed as having a right renal hypernephroma and a probable adrenal adenoma by IVP, abdominal ultrasound, CT, bone scintiscan and renal arteriography. Preoperative values were within the normal limits. The patient developed severe hypertension intraoperatively, which was controlled by administration of lidocaine, nitroglycerine, sodium nitroprusside and labetalol. Surgery was interrupted and completed when the patient was stable. RESULTS: The pathological analysis showed clear cell renal adenocarcinoma and pheochromocytoma. Postoperative evaluation showed dopamine, adrenaline, noradrenaline and vanilmandelic acid were normal. A 131 MIBG scan was normal. CONCLUSION: Although an adrenal mass may appear to be clinically irrelevant, a careful study should be performed to discard a functioning tumor and to avoid the serious complications that might arise during surgery.

[Hypercalcemia, leukemoid reaction, and thrombocytosis as paraneoplastic presentation of transitional cell carcinoma of the kidney]. / Hipercalcemia, reacción leucemoide y trombocitosis como presentación paraneoplásica del carcinoma renal de células transicionales.

The most common etiologies of hypercalcemia are hyperparathyroidism or malignancy, most often of the lung, breast or hematological system, but rarely occur in transitional cell carcinoma. The appearance of this metabolic disorder and other paraneoplastic signs like leukemoid reaction or thrombocytosis is a potential marker for malignant behaviour and poor prognosis in advanced tumours. Simultaneous presentation of that three paraneoplastic signs have only been described in two patients with wellknown bladder carcinoma. Most paraneoplastic syndromes appear only during the late stages of malignancy when the diagnosis has long been established, but sometimes may be an early sign of the malignancy. We describe a case of a previously unknown infiltrating transitional cell carcinoma of the kidney without bony metastasis, that presented itself with hypercalcemia, hyperleukocytosis resembling a leukemoid reaction and thrombocytosis. We think recognizing the paraneoplastic syndrome is very important because it is an alarm sign of malignancy.

[Intestinal obstruction secondary to peritoneal carcinomatosis after iatrogenic perforation during TUR for transitional cell carcinoma of the bladder]. / Obstrucción intestinal secundaria a carcinomatosis peritoneal tras perforación yatrogénica durante RTU de carcinoma de células transicionales de vejiga.

OBJECTIVE: A case of intestinal obstruction following transurethral resection (TUR) of a locally advanced transitional cell carcinoma of the bladder is presented. METHODS/RESULTS: The unique features of the present case are described. Laparotomy was performed and peritoneal carcinomatosis was found. Renal function became impaired and the abdominal condition persisted. The patient died five days postoperatively. CONCLUSIONS: Intestinal obstruction following TUR of transitional cell carcinoma of the bladder is an uncommon complication that is mainly due to peritoneal seeding following iatrogenic perforation of the tumor or the bladder wall during resection. Still, TUR is undeniably useful in the diagnosis, staging and treatment of bladder neoplasm.

[Self-expanding metallic endoprosthesis in the treatment of recurrent ureteral stenosis]. / Endoprótesis metálicas autoexpandibles en el tratamiento de las estenosis ureterales recidivantes.

OBJECTIVE: To describe two cases of recurrent fibrotic stricture of the uretero-vesical junction treated with a metallic self-expanding endoprosthesis which has successfully achieved patency of the stenotic area in the medium-term. METHODS: Two cases of difficult ureteral stricture are described. Both cases presented obstruction of the terminal ureter by abundant fibrotic tissue in the bladder wall following radical prostatectomy in one case and TUR in the other for non-infiltrating bladder carcinoma. Several attempts to recover patency by endoscopic resection and placement of a double-J stent in these patients had previously failed. The patients were therefore submitted to resection of the fibrotic area and insertion of a self-expanding endoprosthesis (Wallstent), which was eventually enclosed by fibrous tissue at its vesical portion. Both cases underwent resection again and another endoprosthesis (Memotherm) was inserted to extend the previous prosthesis 1 cm within the bladder lumen. RESULTS/CONCLUSIONS: When the endoprosthesis is placed in the uretero-vesical junction with its tip flush with the bladder wall, it is eventually enclosed by fibrous tissue, which invariably leads to recurrent obstruction. We have found that extending the prosthesis 1 cm within the bladder lumen can overcome the foregoing complication, although the long-term results have as yet to be established.

[Nesbit's cavernoplasty in the treatment of congenital curvature of the penis. Our own cases]. / Cavernoplastia de Nesbit en el tratamiento de la incurvación congénita de pene. Nuestra casuística.

OBJECTIVES: The present study was conducted to evaluate the results of Nesbit cavernoplasty in the treatment of congenital penile curvature without hypospadias and the sexual performance in relation with the minimum subsequent shortening of the penis and the discomfort caused by the cavernous scar. METHODS: 21 patients were followed by means of case history and consultations. This was completed with a questionnaire and, in some cases, long-term postoperative photographs taken by the patients of their erections. RESULTS: No complications were observed. Good cosmetic results were achieved in all cases and both erection and sexual performance were completely satisfactory. CONCLUSIONS: Nesbit cavernoplasty is a completely satisfactory technique for the correction of congenital penile curvature without hypospadias. The results obtained show that all the objectives pursued are achieved and, moreover, that the patient feels cured and completely satisfied with the results.

[Endoscopic pyelotomy with the "ACUCISE" probe]. / Pielotomía endoscópica por sonda "ACUCISE".

OBJECTIVES: The aims of the present study were to assess the results achieved by the newly designed ACUCISE cutting probe in the treatment of the PUJ syndrome, to describe its advantages and disadvantages and to determine the possibility of its replacing other previously utilized techniques. METHODS: The ACUCISE cutting probe was utilized in 10 patients with pyeloureteral stricture. After the stent had been left indwelling for two months, it was removed and the patients had regular control evaluations two months thereafter. RESULTS: The results have been optimal to date, with complete resolution of the pyeloureteral stricture in 100% of the cases. No significant complications have been observed. Some of the control images are presented. CONCLUSIONS: In our view, the availability of the ACUCISE cutting probe represents a major contribution to minimally invasive surgery in the treatment of the PUJ syndrome. Its advantages far surpass its disadvantages, some of which can be overcome by the skill acquired from more experience. Its only major drawback is that it cannot be used in children under thirteen because of its caliber. When positioned correctly, the ACUCISE cutting probe achieves a clean, precise and an even cut of the same diameter and extent. It is a useful alternative to the other techniques utilized in the treatment of PUJ stricture.