Dysuria and acute urinary retencion as initial presentation of primary vaginal lymphoma. Case report and bibliographic review.

OBJECTIVE: We report a case of primary vaginal lymphoma. The clinical presentation was an episode of dysuria and acute urinary retention. We performed a bibliographic review. METHODS: Thirty-six year-old patient who consulted in the urology clinic for hesitancy that triggered an episode of acute urinary retention. Physical examination revealed thickening of the vaginal wall. Biopsy was performed and diagnosis of diffuse large B-cell primary vaginal non-Hodgkin's lymphoma was obtained. RESULTS: Primary lymphomas of the female genital tract are rare. The third most frequent location is vagina. The most common manifestation is vaginal bleeding. Urinary symptoms are rarely the first sign. Diagnosis requires a biopsy. The first choice for treatment is Rituximab- CHOP immuno-chemotherapy. CONCLUSIONS: Vaginal lymphoma is a rare disease. Unfrequently, the first clinical manifestations are urinary tract symptoms, and even less acute urinary retention.

[Multilocular cystic nephroma. Report of three new cases]. / Nefroma quístico multilocular. Aportación de 3 nuevos casos.

OBJECTIVE: To analyze the presentation of multilocular cystic nephroma and its diagnostic-therapy scheme. METHODS: We report the three last new cases presenting in our department in a period of three years. RESULTS: Multilocular cystic nephroma is a benign lesion, rare that appears both in adult age, generally asymptomatic, and in children, frequently as a palpable mass. Differential diagnosis with malignant tumours is required. CONCLUSIONS: The great variety of clinical presentations, differential diagnosis and places of origin of the cases is demonstrated, being this a reflection of our daily medical practice, in which we cannot reach definitive diagnosis with imaging tests, being the Bosniak's classification very useful for the setting of indication for surgery, which will give definitive diagnosis of multilocular cystic nephroma or what is more important will rule out malignancy.

[The use of laser for percutaneous nephrolithotomy]. / Aplicación del láser en nefrolitotomía percutánea.

OBJECTIVES: The non negligible number of residual stones after extracorporeal lithotripsy is leading to a revision of the indications of percutaneous nephrolithotomy (PCNL). The laser, managed with flexible nephroscopes, plays an important role in this field. Pulsed Nd: YAG, dye and alexandrite lasers have given way to the holmium:yag laser in the endourological treatment of urinary lithiasis. METHODS: More than one lithotripter are often required for percutaneous nephrolithotomy of great volume stones, and ballistic and electrokinetic lithotripters are generally preferred due to their high performance. The best indications for Holmium laser is the treatment of caliceal stones far from the pelvis, only accessible through flexible nephroscopes. Midi and minipercs, renal lithiasis in children and some earthy calculi, of low consistency, are also good indications for it. Depending on the anatomical characteristics of the kidney and localization, number, size and hardness of the stone 200, 365, or 500 nanometer fibers may be employed. Due to the fact that the laser drills a hole in the stone like if it is a thermal barrier, it may break in different ways: applying the quartz fiber in between the layers, drilling all the interior before breaking the surface, or drilling multiple points to weaken it and creating broad fracture lines. To accelerate the breaking process one can choose to use larger fibers or to modify the settings of the equipment increasing the potency, although this has some potential risk for the kidney. RESULTS: The theoretical 100% of good results is reduced due to multiple technical and anatomical factors: size, number, localization, and hardness of the stone, as well as the possibility of reaching and seeing the calculus and being able to place the tip of the fiber against it. CONCLUSIONS: Although the holmium laser develops on excellent role at the time of avoiding leaving residual calculi or diminishing the number of them, sometimes the electrohydraulic lithotripsy is more effective.