[Transitional cell carcinoma of the bladder metastatic to bone marrow presenting as isolated anaemia and thrombocytopenia]. / Anemia y trombopenia aisladas por infiltración de médula ósea de un carcinoma urotelial de vejiga.

OBJECTIVES: Transitional cell carcinomas (TCC) of the bladder are usually aggressive and may produce bone metastases that infiltrate the bone marrow. Most of these cases present with bone symptoms and metastases and are detected with imaging tests. It is extremely rare for asymptomatic patients with a normal bone scan to have bone marrow involvement (anaemia and thrombocytopenia) due to tumour infiltration. We aim to examine that state with a case report. METHODS: We present the case of a 41-year old male with infiltrating TCC of the bladder, who presented with isolated, unexplained anaemia and thrombocytopenia after radical cystoprostatectomy. A bone marrow puncture was required, in which metastatic infiltration was revealed. We performed a literature search of similar cases. RESULTS: There are very few cases of TCC with bone marrow infiltration which become apparent only through haematological changes and have normal imaging tests. CONCLUSIONS: Patients with infiltrating carcinoma of the bladder with isolated haematological changes and a negative extension study should be assessed by bone marrow puncture for correct staging and to be able to offer the best treatment.

[Percutaneous treatment of calyceal diverticulum associated with lithiasis]. / Tratamiento percutáneo de divertículo calicial asociado a litiasis.

OBJECTIVES: To report the case of a 47-years-old woman with several small stones located inside a calyceal diverticulum of the right kidney and to highlight the importance of minimally invasive endourological treatment in these cases. METHODS: Owing to the presence of diverticular calculi and clinical symptoms of recurrent infection, we decided to perform percutaneous nephrolithotomy (PNL). After Holmium-YAG laser calculi fragmentation and removal of all stone material, we fulgurated the diverticular lining and infundibulum with a resectoscope and a rollerball electrode. RESULTS: The patient is free of symptoms after 6 months follow-up. The disappearance of the calculi and diverticulum is confirmed with excretory urogram. CONCLUSIONS: Endourological approach for diverticular calculi, such as percutaneous nephrolithotomy (PNL), is a minimally invasive treatment with excellent results and low morbidity. Using this procedure we are able to perform stone removal and cavity fulguration. According to this, we think that endourological techniques, and specially PNL could be the first option for treatment in selected cases of this pathology.

[Lower calyx lithiasis: usefulness of the laser]. / Litiasis en cáliz inferior: utilidad del láser.

There is controversy yet about which is the best treatment modality for lithiasis of the lower calyx. The range of lithiasis clearance of the stones localized in the lower calyx will depend on various factors such as size, composition of the stone, type of lithotripter employed, type of urinary transport, and anatomy of the lower calyx. The role of flexible ureteroscopy in the treatment of intrarenal pathology has experimented a dramatic evolution, impulsed by the improvements in design of flexible ureterscopes, their degree of deflection, and better quality of image, in the great diversification of small calibre accessory instruments, and the use of the holmium laser for lithotripsy. Its development makes possible to offer it as a therapeutic option for the failures of extracorporeal lithotripsy in stones smaller than 1 cm and as first-line treatment for stones smaller than 1 cm in size if they are cystine stones or they have an attenuation level over 1000 HU; also in obese patients or those with coagulation problems.

[Antimigration devices during endoscopic lithotripsy with holmium: yag laser]. / Dispositivos antimigración durante la litotricia endoscópica con láser de holmium:yag.

OBJECTIVES: Lithiasic pathology continues being very prevalent in our environment. There are multiple approaches and treatments to solve it in current urology. Lately, endourological techniques have suffered a spectacular advance which has permitted to increase their success rates, diminishing also their comorbidity very much. Nevertheless, despite all improvements we still face a series of complications that may reduce the success of the procedure. Among all of them, we emphasize stone retropulsion during endoscopic lithotripsy, because it appears in an important number of procedures and, it does not only diminish the range of stone free patients, but also is associated with a longer surgical time, and occasionally will make necessary the employment of additional procedures that increase cost and treatment morbidity. To reduce the incidence of this retropulsion classical manoeuvres have been employed: antitrendelenburg, decrease of the intensity of the irrigaton flow, modification of laser parameters, or pneumatic balloons. Currently, we have other more effective mechanisms to combat it, among them: the devices that occlude the ureteral lumen, and nitinol baskets/forceps. Adequate selection of the stone extraction device may be definitive for completion of the ureterorenoscopic procedure with success, and in the programmed time. The election of an inadequate device may make the procedure impossible or cause iatrogenic damage to the urinary tract. For all it, specific instruments to entrap and extract stones (baskets and ureteral lumen occlusion devices) is an armamentarium that every endourologist should be familiar with.

[Adenomatoid tumor of the epididymis. Report of two cases]. / Tumor adenomatoide de epidídimo. Aportación de dos casos.

OBJECTIVE: Tumors of the epididymis are rare. They are unusually benign and adenomatoid tumors are the most frequent. Report of two cases of this kind of tumor of the epididymis. METHODS/RESULTS: We report two cases of adenomatoid tumor of the epididymis diagnosed at our hospital during last year. Two males, 35 and 54 years old respectively asked for urology consultation about a palpable scrotal mass. They didn't have any other symptoms. Imaging techniques revealed a solid epididymal mass. Epididymectomy was performed. Pathological diagnosis was adenomatoid tumor. CONCLUSIONS: The majority of epididymal tumors follow a benign course. In the finding of an epididymal mass, after palpation and imaging tests, organ sparing surgery (epididymectomy) is recommended. We will avoid unnecessary orchiectomies.

[Blue prostatic nevus. Case report]. / Nevus azul prostático. Aportación de un nuevo caso.

OBJECTIVE: To state the scarce incidence of this prostatic pathology and the relative confusion with terminology applied to the presence of intraprostatic melanin pigments. METHODS/RESULTS: 66-year-old patient with elevated serum PSA with the diagnosis of prostatic blue nevus after biopsy. CONCLUSIONS: This diagnostic finding has not clinical or prognostic significance. They are benign lesions that must not be confused with other similar more aggressive lesions.

[The use of the Stone Sweeper catheter for stone disease of the upper urinary tract]. / Utilización del catéter "Stone Sweeper" en la patología litiásica del tracto urinario superior.

OBJECTIVES: The treatment of patients with a great burden of stones is very difficult and often requires complex treatments including different kinds of surgery, associated in some cases with ureteral stents. METHODS: We present the case of a patient with complex renoureteral stone disease in whom we used the stone sweeper stent before SWL. The catheter is a 6.5 Fr radial expanding stent with small baskets, a special structure designed to extract small stones < 5mm. RESULTS: The placement and retrieval of bilateral stents were performed without complications, extracting several small stones inside the baskets. CONCLUSIONS: The Stone Sweeper stent may play an important role in the treatment of patients with great stone burden; by dilating the ureter and helping the passage of stones and capturing small residual fragments it may decrease the need of new treatments. Currently, more clinic and research tests with this stent are necessary to determine proper indications and associated complications.

[Bladder leiomyoma in a male patient]. / Leiomioma vesical en un varón.

OBJECTIVES: Bladder leiomyoma is an uncommon mesenchymal benign tumor. It is generally asymptomatic and incidentally detected. METHODS: We report a new case managed with transurethral resection without evidence of relapse. A bibliographic search was performed to evaluate the diagnostic techniques, clinical features and treatment options of this rare disease. CONCLUSIONS: Bladder leiomyoma is a benign mesenchymal tumor originating from smooth muscle. Biopsy and histological study are required for definitive diagnosis. Surgery is the treatment of choice, and it has an excellent prognosis if resection is complete.

[Penile fracture]. / Fractura de pene.

OBJECTIVES: Rupture of the corpora cavernosum is an uncommon pathology requiring immediate treatment. We performed a bibliographic search, and analyzed different diagnostic and therapeutic methods. METHODS/RESULTS: Two cases of traumatic rupture of the corpus cavernosum are described. The clinical features, penile ultrasound findings and immediate surgical treatment are discussed. CONCLUSIONS: Penile fracture is an uncommon pathology. Generally, history and physical examination are enough to establish the diagnosis. Penile ultrasound can help in case of doubt. Most urologists deem immediate surgery the standard therapy.