[Malignant fibrous histiocytoma of the spermatic cord. Presentation of one case and literature revision]. / Histiocitoma fibroso maligno de cordón espermático. Presentación de un caso y revisión de la literatura.

We present a case of malignant fibrous histiocytoma (MFH) of the spermatic cord. An 80-years-old man was admitted to the hospital with a left scrotal mass, related to a genital traumatism several months ago. Under the suspicion of a testicular tumor, left radical orchiectomy was performed. Histological examination of the tumoral mass revealed a malignant fibrous histiocytoma. The tumor was firmly adhered to the spermatic cord. MFH is an extremely rare, highly malignant connective tissue tumor, which may, occasionally, affect the male genital tract. There are no agreed treatment principles. The overall prognosis is poor.

[Low-grade collecting duct carcinoma of the kidney in a patient treated by dialysis]. / Carcinoma renal de los conductos colectores de bajo grado en un paciente en tratamiento con hemodiálisis.

Patient treated by dialysis for end-stage renal disease are at increased risk of many cancers, especially those of kidney and urinary tract. A 56 years old man who undergoing chronic dialysis, presented in ultrasonography a 2 cm complex cystic mass in the left kidney what was confirmed by computed tomography and magnetic resonance. A laparoscopic left nephrectomy was performed. Histological examination showed a low grade collecting duct carcinoma of the kidney. An infrequent variant of kidney tumor.

[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.

[Diagnosis and treatment of urological complications in kidney transplants]. / Diagnóstico y tratamiento de las complicaciones uroógicas del trasplante renal.

OBJECTIVE: To analyze the incidence of urological complications, like fistula and stenosis in our series of 282 renal transplants and their management. MATERIALS AND METHODS: Between December 1995 and October 2005, 282 adult recipients underwent renal transplant. The most common urological complication was urinary fistula. This complication was observed in 24 cases (8.5%), ureteral stenosis in 18 cases (6.4%) and both of them in 5 (1.7%). The items recorded on these patients included the time to diagnosis, the image technique, the type of ureteral stents and the clinical evolution. RESULTS: Endourologic treatment with percutaneos nefrostomy, double-J catheter and metalic endoprotesis was performed successfully in 76.4% of urinary fistula, in 66.7% of ureteral obstruction and in 60% of patients who developed both of them. CONCLUSION: Endourologic procedures have replaced open reconstructive surgery in most patients with ureteral obstruction or urinary fistula after renal transplant, because they may offer a definitive treatment with low morbidity.

[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.

[Spontaneous hemorrhage and arterial hypertension as complication of Adrenal Pseudocyst. Report of a case]. / Hemorragia espontánea e hipertensión arterial como complicaciones de un pseudoquiste suprarrenal. Presentación de un caso.

Adrenal Pseudocyst are uncommon and asymptomatic tumors. We report an unusual case who had previous high blood pressure and acute hemorrhage presented with abdominal pain and shock. Diagnosis was made with ultrasonography and computed tomography revealed the presence of large retroperitoneal hematoma around the superior pole of the left kidney. Urgent surgery was made with a complete excision of a 10 cm. tumor with preservation of adrenal tissue and the left kidney. Histopathological diagnosis was: Adrenal Pseudocyst. Blood pressure normalized after surgery.

[Urogenital alterations in hereditary and sporadic neurodegenerative ataxias]. / Alteraciones urogenitales en las ataxias neurodegenerativas hereditarias y esporádicas.

INTRODUCTION: Sporadic and hereditary ataxias (HA) represent a group of clinically and genetically heterogeneous syndromes characterized by spinocerebellar degeneration producing a motoneuron coordination disorder. In these diseases urinary and sexual symptoms are commonly associated to the neurological alterations. OBJECTIVE: To define the prevalence of functional low urinary tract symptoms in an ataxic population and to compare them with the symptomatology control a group of in healthy subjects. PATIENTS AND METHODS: An observational, descriptive, transversal study of 491 subjects recruited from the HA regional associations of Spain was conducted. In addition, a case-control study of prevalent ataxic patients and healthy subjects matched by sex and age was also performed. RESULTS: Among 195 patients included, 138 (70.8 %) had Friedreich ataxia (FA) and 57 (29.2 %) non-Friedreich ataxia (nFA). Global mean age was 32.3 years in FA and 43.7 in nFA patients (p < 0.05). Combined irritative and obstructive symptoms were present in 48.7 %, only irritative in 16.4 % and obstructive in 15 % of patients. Erectile dysfunction in 30.3 % (p < 0.01) and decreased libido in 13.4 % (p < 0.01), were the most common sexual problems. CONCLUSIONS: In HA, urinary symptoms are present in 80 % of patients, with mainly irritative symptoms in 2/3 of them. A complete urodynamic evaluation in symptomatic patients is recommended in order to characterize potential neurogenic vesico-urethral dysfunction. Even though sexual dysfunction may be related to neurological causes, additional etiologic organic factors should be excluded.

[Cystic testicular lesions in infancy]. / Lesiones quísticas testiculares en la infancia.

The present article reports a case 11 month-old infant with a right intratesticular cyst. We analyze the etiology, differential diagnosis and management off all cystic lesions of the pediatric testis. Patient age at presentation, examination features, tumor markers and sonographic appearance may assist in making a presumptive and occasionally definitive diagnosis preoperatively. The differential diagnosis include intratesticular simple cyst, epidermoid cyst, tunica albuginea cyst, testicular teratoma, juvenil granulosa cell tumor-gonadal stromal tumor, cystic dysplasia of the rete testis, cystic lymphangioma, and testicular torsion. Usually enucleation is the best treatment. A thorough understanding of potentially cystic testis lesions in children leads to the best management choices and often to preservation of a substantial portion of the affected testis.

[Adult Wilms' tumor]. / Tumor de Wilms del adulto.

Wilms' tumor is a malignant embryonic renal neoplasm that is exceptional in adults. There are not clinical data or radiographic investigations that can distinguish it from renal cell carcinoma. So the diagnostic is based in the pathological evaluation. It may be cystic and must be consider in the differential diagnosis of cystic lesions of the kidney. The prognosis of Wilms' tumor in adults is worse than in children because of the high recurrence, the lower response rate to chemotherapy regimens and the advanced stage at the time of clinical presentation, like an asymptomatic abdominal mass in 75% of the cases. We report a new case of nephroblastoma in a 29 years old woman presenting like a renal colic, with a cystic configuration by abdominal ultrasound initially, that changed into a solid renal mass later. There is not a definitive treatment protocol currently but some authors suggest a combination chemotherapy with carboplatin and etoposide because it is very effective in recurrent or refractory adult Wilms' tumor. Our patient remains asymptomatic and without evidence of recurrence 18 months after the surgery.

[Intrascrotal metastasis in a renal cell carcinoma]. / Metástasis intraescrotal de un carcinoma renal.

The present article reports a case of intrascrotal metastasis of renal adenocarcinoma. This is an unusual case. A 66-year-old male patient undewent right radical nephrectomy and cavotomy for renal cell carcinoma with renal vein infiltration and thrombus in cava. Six months later the patient present with a nodulous enlargement intrascrotal and roots of penis. And he died 15 moths after nephrectomy. Usually intrascrotal metastases are a late event in the course after detection of a renal carcinoma.

Self-expanding polytetrafluoroethylene covered nitinol stents for the treatment of ureteral stenosis: preliminary report.

PURPOSE: We evaluated the treatment of ureteral stenosis using a self-expanding nitinol stent covered with expanded polytetrafluoroethylene (ePTFE). MATERIALS AND METHODS: Between January 2001 and April 2003, 37 ePTFE covered metal stents were implanted in 20 patients with a total of 29 ureteral stenoses due to various causes. In general the stents were introduced by using a retrograde approach under combined endoscopic and fluoroscopic guidance with patients under spinal block and sedation. Followup assessments in 18 patients, including urography, were done 3, 6, 12, 18 and 24 months after the procedure. Followup endoscopic examinations were performed at 6 and 12 months in 8 patients. RESULTS: Immediate ureteral patency was achieved during all insertion procedures and maintained in most patients. Four patients died of the neoplastic process 3 to 12 months after implantation. Four stent migrations occurred in 3 patients (22.2%), which was resolved by implanting a new stent. Nonobstructive mucous hyperplasia was observed in 5 patients (27.7%) at the end of the stent, although there was no internal calcification. In all cases the stents remained patent until the current time or until patient death. CONCLUSIONS: We found that ePTFE covered nitinol stents were safe and effective for ureteral stenosis. Their resistance to calcification was high with nonobstructive hyperplasia developing in only a few cases and only at the stent ends. The ideal material for covering stents would produce no mucous hyperplasia.

[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.

[Giant retroperitoneal liposarcoma]. / Liposarcoma retroperitoneal gigante.

Liposarcoma is a malignant tumor that has an embryologic origin from mesodermal tissue depending on fatty tissue. Although liposarcoma is only 0.1% of all human neoplasms, it is the most common histology subtype of retroperitoneal soft tissue sarcomas. This tumor grows slowly. Diffuse abdominal pain is its most frequent symptom and abdominal mass is the most common sign. Aggressive surgical treatment is basic to get a complete resection and a local disease control. This objective is difficult because of the large tumor size it gets in the retroperitoneal location and the multiorgan involvement that require the resection of a high percentage of contiguous organs. We report a case of a giant retroperitoneal liposarcoma presenting like continuous left hemiabdominal pain because of the visceral compression. The right kidney was involved and suffering from renal vessel enlargement without renal function. There is a high probability of microscopic residual disease and a good follow-up of the patients is necessary as well as an adjuvant radiation therapy in some cases.

[Primary renal lymphoma]. / Linfoma renal primario.

OBJECTIVE: To describe a case of primary renal lymphoma. MATERIAL AND METHODS: We presents a patient with a right renal mass which histological analysis revealed a non-Hodgkin Lymphoma. RESULTS: A 78-year-old male patient with right flank pain mass was referred to our Service. He was diagnosed of renal mass by imaging studies. Inmunohistochemical investigations revealed a B-cell-type lymphoma. He received combination chemotherapy with CHOP. CONCLUSIONS: Primary renal lymphoma is a rare disease whose existence has been questioned, because the kidney does not normally contain lymphoid tissue. Its clinical presentation is like any other renal tumor and its definitive diagnosis is by histology. Elective treatment is chemotherapy (CHOP).

[Traumatic intrathoracic herniation of the left kidney]. / Herniación intratorácica traumática del riñón izquierdo.

The detection of a intrathoracic kidney is an exceptional discovery. There is a large period of time between the injury and its clinical presentation revising the literature, so it is possible that the herniation of the kidney into the chest was caused by a rise in intra-abdominal pressure but going through a preexistent congenital way not caused by the traumatism. In order to dismiss this possibility and to prove the traumatic origin of the diaphragmatic rupture, surgeons have examined the intraoperative characteristics of the rupture's borders. The elevation of the kidney has been said to be progressive because of the positive intra-thoracic pressure and the negative intra-abdominal one. Our objective is to report an extraordinary case of abdominal traumatism whose clinic and radiological proofs let us get a rapid diagnosis and surgical demonstration of the direct herniation of the left kidney into the chest through a diaphragmatic rupture caused by the same traumatism.

[Intra-sinusal renal angiomyolipoma. Differential diagnosis from renal artery aneurysm]. / Angiomiolipoma renal intrasinusal. Diagnóstico diferencial con el aneurisma de arteria renal.

We report a case of atypical renal angiomyolipoma (AML) because of its clinic presentation like colic renal pain, its uncommon intrasinusal location, its low fatty content, and especially because of the diagnostic doubt with a renal artery aneurysm that could not be resolved before the surgery in spite of making Doppler ultrasound, renal one sided arteriography, computed tomography (CT) and magnetic resonance imaging (MRI). We gave up doing a percutaneous needle biopsy because of the location, the association with hematoma and the possibility of a vascular origin. It has been said that diagnostic images, mainly ultrasound and CT, have a high capacity to get a renal AML diagnosis before the surgery. However when there is an atypical characteristics association like we have talked about, dismissing other pathologies is necessary. We believe AML must be considered one of these because of its difficult differential diagnosis.

[Endoscopic treatment of ureteral lithiasis. Our experience with 360 retrograde uretero-renal endoscopies in the last ten years]. / Tratamiento endoscópico de la litiasis ureteral. Nuestra experiencia en 360 ureterorrenoscopias retrógradas en los últimos 10 años.

Presentation of results and complications obtained in 360 procedures of transuretral ureterorenoscopy (URS) in ureteral lithiasis performed in our unit from january 1990 to august 2000 in 354 patients: 55% female and 45% male. A rigid ureteroscopy Storz 10.5 Ch. was used and intracorporeal lithotripsy was necessary in 17.31% of cases. URS indications were always treatment of ureteral lithiasis, pelvic ureter localization in most cases (70.33%) being 93.05% the percentage of overall success and with a significant decrease when the calculus was located in the upper third of the ureter. Serious complications were only 3.05% of cases and endoscopic surgery was necessary in three cases of ureteral stenosis. In our experience, URS is our technique of choice for treatment of lower and medium third of the ureter where the percentage of success we have obtained were 98.99% and 95.83% respectively.