[Fournier's gangrene. Descriptive analysis of 20 cases and literature review]. / Gangrena de Fournier. Análisis descriptivo de 20 casos y revisión de la bibliografía científica.

BACKGROUND: Fournier's gangrene is a necrotising fasciitis that usually affects the external genitalia and perineal area and may extend to the abdomen, lower limbs and chest. It hasa high fatality rate and must be treated aggressively within a few hours of being diagnosed. It is believed that debilitating diseases such as diabetes mellitus or obesity are conducive to its appearance. A perianal abscess is the most common trigger. OBJECTIVE: To conduct a thorough descriptive analysis of risk factors and predisposing conditions for Fournier's gangrene based on our institution's experience over the past 12 years and reveal the mortality rate for those factors as well as the average number of reoperations performed. MATERIAL AND METHODS: This observational retrospective study examines 20 patients, according to clinical inclusion criteria, who were diagnosed with Fournier's gangrene, and treated in J.M. Morales Meseguer Hospital between 1997 and 2008. RESULTS: The vast majority of patients reviewed were males, with an average age of 61 years. All patients had a significant history of organic pathology, particularly diabetes mellitus. The average hospital stay was 25.7 days. 2 patients died, and the overall mortality rate was 10%. CONCLUSIONS: Fournier's gangrene is an entity that can be lethal and it is favoured by several debilitating factors. It is triggered by a urogenital or perirectal disease that has not been treated properly. Because of its poor prognosis, early diagnosis and an appropriate early and aggressive multidisciplinary intervention are essential for proper recovery.

[Video endoscopic inguinal lymphadenectomy in penile cancer: Systematic review.] / Linfadenectomía inguinal videoendoscópica en cáncer de pene: revisión sistemática.

OBJECTIVES: Penile cancer is not very frequent. To control the disease oncologically, we must perform inguinal lymphadenectomy in cases of high-risk histology, poor prognosis and palpable lymph nodes. The open inguinal lymphadenectomy has a high rate of morbidity. Consequently, this systematic review intends to summarize the published literature regarding the oncologic and post-surgery outcomes in video-endoscopic inguinal lymphadenectomy (VEIL). METHODS: A literature search has conducted through Pubmed, EMBASE and Cochrane library for English and Spanish articles. RESULTS: Our literature search identified 12 articles. In total, 161 patients have been subjected to 226 VEIL. Their average age was 55.66 years. In the case of open inguinal lymphadenectomy, 90 patients have been subjected to 106 operations. The rate of cutaneous complications was 6% for VEIL and 55.6% for open lymphadenectomy. The rate of lymphatic complications was very similar in both types of lymphadenectomy. The average number of lymph nodes obtained was 9.12 for VEIL and 7.02 lymph nodes for the open approach. CONCLUSION: Video-endoscopic inguinal lymphadenectomy contributes to less morbidity with a lower- rate of cutaneous complications and less severity. Furthermore, VEIL gives lower hospital stay without changing in initial oncologic outcomes. Although we need longer series to stablish the oncologic long-term results.

OBJETIVO: El cáncer de pene es una entidad poco frecuente. Para realizar un buen control oncológico, se recomienda la realización de linfadenectomía inguinal en casos de factores de riesgo de mal pronóstico, grado histológico alto o ganglios palpables o positivos. La linfadenectomía inguinal abierta presenta una alta tasa de morbilidad, por lo que en esta revisión se pretende resumir la literatura publicada en cuanto a los resultados oncológicos y postquirúrgicos en la linfadenectomía inguinal videoendoscópica (VEIL).MATERIAL Y MÉTODOS: Se realiza revisión sistemática de la literatura obtenida en "Pubmed", "EMBASE" y Cochrane library para artículos en inglés y español. RESULTADOS: Se han analizado un total de 12 artículos, que globalmente incluyen a 161 pacientes con 226 VEIL y una edad media de 55,66 años y 90 pacientes a los que se les ha realizado 106 linfadenectomías abiertas. En el caso del VEIL se han presentado 6% de complicaciones cutáneas y del 55,6% en el caso de la vía abierta. En cuanto a las complicaciones linfáticas, no hay diferencias significativas. La media de ganglios extraídos en el caso de VEIL de 9,12 ganglios y de 7,09 ganglios en abordaje abierto. CCONCLUSIONES: La linfadenectomía inguinal videoendoscópica aporta una menor morbilidad, con una menor tasa de complicaciones cutáneas, y de menor gravedad. Asimismo, aporta menor estancia hospitalaria, sin afectación de los resultados oncológicos iniciales. Aunque se necesitan series con mayor tiempo de seguimiento para valoración de resultados oncológicos a largo plazo.

Seminal vesicle biopsies: an useful staging procedure-exposure of seminal vesicle biopsies protocol and review of the literature.

BACKGROUND AND OBJECTIVES: Although new MRI techniques have a high sensitivity but varying specificity with regard to diagnosing the seminal vesicle invasion (SVI) of prostate cancer, the low availability and high cost involved demands incorporating an inexpensive and accessible technique that might support adequate staging. Currently, uniformity does not exist with regard to the indication criteria of seminal vesicle biopsies (SVBs). Our objective is to analyse the protocol of SVBs at Morales Meseguer Hospital and conduct an exhaustive review of the literature in this field. METHODS AND MATERIALS: SVBs were performed in patients who were amenable to a curative treatment and who showed at least one of the following indication criteria: prostate-specific antigen greater than or equal to 15 ng/ml, a prostate cancer nodule in the base of the prostate, or ultrasound abnormalities suggestive of vesicular involvement. SVBs were performed in 70 patients. RESULTS: These results revealed a rate of SVI of 15.7 and 25.58 % among all patients and patients diagnosed with prostate cancer, respectively. All biopsied patients who tested positive for the three indication criteria had T3b prostate cancer. Patients with a prostate cancer that altered the base of the prostate according to either digital rectal examination or ultrasound showed a T3b rate of 53.8 %. CONCLUSIONS: SVBs should be considered a complementary procedure for prostate cancer staging because provide important information and it is easy, inexpensive and has few complications.

[Frontal mass simulating lipoma as a clinical presentation of prostatic adenocarcinoma]. / Bultoma frontal simulando lipoma como manifestación de adenocarcinoma de próstata.

OBJECTIVE: To report one case of metastatic prostatic carcinoma with a gaudy presentation as a lump which resulted to be a cutaneous metastasis. METHODS: We describe the debut in a patient, who thanks to the pathologic analysis of a lesion mimicking a lipoma, which was reported as adenocarcinoma, was worked up for prostatic adenocarcinoma and diagnosis was reached. We performed a bibliographic review using an electronic bibliographic search in PubMed (MEDLINE) using the terms "Prostatic Neoplasm" (MesH) AND "Neoplasm Metastasis" (MesH) AND "cutaneous" (free text). Most publications are case reports reviewing the probable dissemination way and localization. RESULTS: Positive immunohistochemical staining for PSA confirmed the origin of the metastasis, although PSA value did not offer doubts due to its value over 1100 ng/ml. Regarding the bibliographic search we obtained more than 26 papers, and selected only 8 that were adjusted to the objectives of our work. Cutaneous metastasis of prostatic origin appear in less than 0.3% of the cases, because bone, lymph node, and visceral disease are more frequent. Cases appearing during the evolution of the disease and metastasis after laparoscopic procedures are described. CONCLUSIONS: Cutaneous metastases of prostatic adenocarcinoma are very rare, but even rarer is it being the debut of the disease.

[Diagnostic and therapeutic management of renal hydatidosis]. / Manejo diagnóstico y terapéutico de la hidatidosis renal.

OBJECTIVE: Renal hydatidosis is caused by Echinococcus granulosus and is extremely rare, accounting for 3-4% of the cases of hydatidosis, being the third site after liver and lungs. It generally remains asymptomatic for years and the most frequent symptoms are pain, feeling of flank heaviness, and dysuria. In front of a compatible clinical picture, we studied the diagnostic, therapeutic, and follow-up schemes reviewing the literature. METHODS: We performed an electronic bibliographic search in PubMed (MEDLINE) which MESH terms "Echinococcosis" [MeSH] AND "urinary tract" [MeSH] and bibliographic citations. We perform a review on epidemiology, vital cycle of the parasite and management of patients with hydatidosis. Most published papers correspond to case reports from different localisations, although we found some reviews. RESULTS: We found a total of 137 papers, we selected 23 of them because they were related; five were reviews, but we only include 10 of them in our references. Although most were case reports, the reviews analyse the cycle of the Echinococcus and its various host sites (organs) in the human host. The human being may become an intermediary host through contact with the definitive host (dogs) or by taking contaminated water or vegetables. CONCLUSIONS: Thanks to the combination of history, imaging tests and serology we get close to the diagnosis in up to 80%. In many cases conservative surgery is possible, but after suspicion we should always sterilise with albendazole before surgical treatment, and monitor serum titles of anti-Echinococcus antibodies.

Linfadenectomía inguinal videoendoscópica en cáncer de pene: revisión sistemática / Video endoscopic inguinal lymphadenectomy in penile cancer: Systematic review

OBJETIVO: El cáncer de pene es una entidad poco frecuente. Para realizar un buen control oncológico, se recomienda la realización de linfadenectomía inguinal en casos de factores de riesgo de mal pronóstico, grado histológico alto o ganglios palpables o positivos. La linfadenectomía inguinal abierta presenta una alta tasa de morbilidad, por lo que en esta revisión se pretende resumir la literatura publicada en cuanto a los resultados oncológicos y postquirúrgicos en la linfadenectomía inguinal videoendoscópica (VEIL). MATERIAL Y MÉTODOS: Se realiza revisión sistemática de la literatura obtenida en "Pubmed", "EMBASE" y Cochrane library para artículos en inglés y español. RESULTADOS: Se han analizado un total de 12 artículos, que globalmente incluyen a 161 pacientes con 226 VEIL y una edad media de 55,66 años y 90 pacientes a los que se les ha realizado 106 linfadenectomías abiertas. En el caso del VEIL se han presentado 6% de complicaciones cutáneas y del 55,6% en el caso de la vía abierta. En cuanto a las complicaciones linfáticas, no hay diferencias significativas. La media de ganglios extraídos en el caso de VEIL de 9,12 ganglios y de 7,09 ganglios en abordaje abierto. CONCLUSIONES: La linfadenectomía inguinal videoendoscópica aporta una menor morbilidad, con una menor tasa de complicaciones cutáneas, y de menor gravedad. Asimismo, aporta menor estancia hospitalaria, sin afectación de los resultados oncológicos iniciales. Aunque se necesitan series con mayor tiempo de seguimiento para valoración de resultados oncológicos a largo plazo

OBJECTIVES: Penile cancer is not very frequent. To control the disease oncologically, we must perform inguinal lymphadenectomy in cases of high-risk histology, poor prognosis and palpable lymph nodes. The open inguinal lymphadenectomy has a high rate of morbidity. Consequently, this systematic review intends to summarize the published literature regarding the oncologic and post-surgery outcomes METHODS: A literature search has conducted through Pubmed, EMBASE and Cochrane library for English and Spanish articles. RESULTS: Our literature search identified 12 articles. In total, 161 patients have been subjected to 226 VEIL. Their average age was 55.66 years. In the case of open inguinal lymphadenectomy, 90 patients have been subjected to 106 operations. The rate of cutaneous complications was 6% for VEIL and 55.6% for open lymphadenectomy. The rate of lymphatic complications was very similar in both types of lymphadenectomy. The average number of lymph nodes obtained was 9.12 for VEIL and 7.02 lymph nodes for the open approach. CONCLUSION: Video-endoscopic inguinal lymphadenectomy contributes to less morbidity with a lower-rate of cutaneous complications and less severity. Furthermore, VEIL gives lower hospital stay without changing in initial oncologic outcomes. Although we need longer series to stablish the oncologic long-term results

[Voiding symptoms as presentation of an intravesical foreign body]. / Clínica miccional como síntoma por cuerpo extraño intravesical.

OBJECTIVES: The presence of intravesical foreign bodies is exceptional; it is not a common emergency. Most foreign bodies have a sexual-erotic origin, although we cannot forget others such as elements left by the surgeon in the surgical field. We performed a bibliographic review on the topic. METHODS: We performed a PubMed (MEDLINE) electronic bibliographic search with the mesh terms "foreign-body migration" [MESH] AND "Urinary Bladder" [MESH] and bibliographic citations. We performed a bibliographic review establishing a classification depending on the origin and diagnosis, as well as treatment. Most publications are case reports. We described the most frequent presentation which was the same than we have in our Center. RESULTS: We found a total of 122 works, nine of which were reviews; we selected 20 works. Although most are case reports, the reviews establish a classification depending on the origin: so, they refer to those foreign bodies directly introduced into the bladder: 1. By the patient: hairpins, safety pins, pencils, copper wires, hairs; 2. Accidentally: bullets; 3. Iatrogenic: fragments of bladder or ureteral catheters, staples, sutures. Foreign bodies migrated from other places: urological, gynecological, gastrointestinal, or vascular origin. We established a diagnostic and therapeutic algorithm. CONCLUSIONS: Bladder foreign bodies are not as frequent as it is believed. Most are found incidentally. Lower urinary tract symptoms are the most frequent, as the antecedent of manipulation by the patient or others in the genital-urologic sphere. The treatment of choice is extraction using the least invasive and most simple method for the patient.

Tumor paratesticular atípico. Mesotelioma papilar bien diferenciado / Paratesticular atypical tumor. Well differentiated papillary mesothelioma

Los tumores paratesticulares son poco frecuentes: suponen menos del 5% de las neoplasias intraescrotales. El mesotelioma testicular es un tumor raro paratesticular de la línea de células no germinales. Presentamos el caso de un varón de 69 años de edad que consulta por tumoración testicular derecha y al que, tras exploraciones complementarias, se realiza orquiectomía radical con resultado anatomopatológico de mesotelioma de túnica albugínea (AU)

Paratesticular tumors are rare, less than 5% of intrascrotal neoplasms. Testicular mesothelioma is a rare paratesticular not germ cell tumor. We report the case of a 69 year-old man after attending Urology consultation due to the appearance of a right testicular tumor. He is diagnosed of mesothelioma of tunica albuginea after surgical treatment by radical right orchiectomy (AU)

Cáncer de próstata de bajo riesgo e intermedio: opciones de tratamiento / Low and intermediate risk prostate cancer: Treatment options

Los pacientes con cáncer de próstata de bajo riesgo e intermedio constituyen el grupo más frecuentemente diagnosticado en la actualidad. En aquellos con una esperanza de vida inferior a 10 años es muy probable que cualquier tratamiento sea innecesario por lo que la observación debe ser la aproximación más apropiada. En los pacientes en los que esté indicada alguna forma de terapia activa es necesario llevar a cabo un balance entre los riesgos de morir o desarrollar metástasis por la enfermedad y los efectos adversos de los tratamientos radicales comúnmente aceptados, como la prostatectomía radical y la radioterapia externa o intersticial. La significativa incidencia de morbilidad asociada, fundamentalmente disfunción eréctil e incontinencia urinaria, de alto impacto en la calidad de vida, exige esta aproximación en el ámbito de decisiones compartidas con los pacientes. El riesgo de sobretratamiento en este grupo de pacientes ha dado lugar a la introducción de abordajes más conservadores como el seguimiento activo y la terapia focal. El primero, trata de demorar los tratamientos radicales en tanto no existan criterios de agresividad suficiente por parte del tumor o el paciente los solicite. El segundo, que está llamado a ocupar un lugar entre el seguimiento activo y los tratamientos radicales, consiste en llevar a cabo una ablación parcial de la próstata para evitar los efectos adversos de los tratamientos radicales, tratando de lograr un control oncológico lo más similar posible al obtenido con estos

Patients with low and intermediate risk prostate cancer are the most frequently diagnosed group currently. In those with a life expectancy inferior to 10 years it is highly likely that treatment is not necessary so that observation must be the most appropriate approach. In patients in whom active therapy, in any of its forms, is indicated, it is necessary to balance between risk of dying or developing metastases from the disease and adverse effects of commonly accepted radical treatments, such as radical prostatectomy and external beam or interstitial radiotherapy. The significant incidence of associated morbidity, mainly erectile dysfunction and urinary incontinence, with high impact on quality of life, demands this approach in the field of decisions shared with patients. The risk of overtreatment in this group of patients has generated the introduction of more conservative approaches such as active surveillance and focal therapy. The first one tries to differ radical treatments as far as there are not enough aggressiveness criteria on the tumor or the patient requests them. The second, called to have a place between active surveillance and radical treatments, involves the performance of a partial ablation of the prostate to avoid the adverse effects of radical treatments, trying to achieve the closest oncological control to the radical options. We perform a review of the therapeutic options and their results in this type of patients

La importancia de exploración física en la incontinencia urinaria: Urocolpos / The importance of physical examination in urinary incontinence: Urocolpos

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Gangrena de Fournier. Análisis descriptivo de 20 casos y revisión de la bibliografía científica / Fournier’s gangrene. Descriptive analysis of 20 cases and literature review

Introducción: La gangrena de Fournier es una fascitis necrosante que afecta habitualmente a la zona genital externa y perineal, con eventual extensión al abdomen, los miembros inferiores e incluso el tórax, con alta letalidad, que debe tratarse de manera agresiva en las primeras horas tras el diagnóstico. Se considera que enfermedades debilitantes como la diabetes mellitus u la obesidad favorecen su aparición. El factor desencadenante más frecuente es el absceso perianal. Objetivo: Realizar un profundo análisis descriptivo sobre los factores de riesgo y las afecciones predisponentes de la gangrena de Fournier durante toda la historia de nuestro centro, durante los últimos 12 años, así como revelar la tasa de mortalidad de éstos y el número medio de reintervenciones realizadas. Material y métodos: El estudio realizado analiza, de manera observacional y retrospectiva, a 20 pacientes diagnosticados de gangrena de Fournier, según criterios de inclusión clínicos, en el Hospital General Universitario J.M. Morales Meseguer entre 1997 y 2008. Resultados: La gran mayoría de los pacientes revisados eran varones, con una edad media de 61 años. Todos tenían una importante afección orgánica de base; destacaba la diabetes mellitus. La estancia media hospitalaria fue de 25,7 días. Fallecieron 2 pacientes y la mortalidad global fue del 10%. Conclusiones: La gangrena de Fournier es una entidad que puede ser letal, que está favorecida por distintos factores debilitantes, cuya causa desencadenante es una enfermedad perirrectal o urogenital que no ha sido tratada correctamente. Debido a su pronóstico grave, un diagnóstico temprano y una intervención multidisciplinaria adecuada, temprana y agresiva son esenciales para una buena evolución (AU)

Background: Fournier’s gangrene is a necrotising fasciitis that usually affects the external genitalia and perineal area and may extend to the abdomen, lower limbs and chest. It has a high fatality rate and must be treated aggressively within a few hours of being diagnosed. It is believed that debilitating diseases such as diabetes mellitus or obesity are conducive to its appearance. A perianal abscess is the most common trigger. Objective: To conduct a thorough descriptive analysis of risk factors and predisposing conditions for Fournier’s gangrene based on our institution’s experience over the past 12 years and reveal the mortality rate for those factors as well as the average number of reoperations performed. Material and methods: This observational retrospective study examines 20 patients, according to clinical inclusion criteria, who were diagnosed with Fournier’s gangrene, and treated in J.M. Morales Meseguer Hospital between 1997 and 2008. Results: The vast majority of patients reviewed were males, with an average age of 61 years. All patients had a significant history of organic pathology, particularly diabetes mellitus. The average hospital stay was 25.7 days. 2 patients died, and the overall mortality rate was 10%.Conclusions: Fournier’s gangrene is an entity that can be lethal and it is favoured by several debilitating factors. It is triggered by a urogenital or perirectal disease that has not been treated properly. Because of its poor prognosis, early diagnosis and an appropriate early and aggressive multidisciplinary intervention are essential for proper recovery (AU)

Bultoma frontal simulando lipoma como manifestación de adenocarcinoma de próstata / Frontal mass simulating lipoma as a clinical presentation of prostatic adenocarcinoma

OBJETIVO: Presentar un caso llamativo por la forma de presentación de un carcinoma de próstata metastátizado con la aparición de un “bultoma” que correspondía a una metástasis cutánea.MÉTODOS: Describimos la forma de debút de un paciente que gracias al análisis de la lesión que informó de un adenocarcinoma, que aparentaba un Lipoma, se investigó la posibilidad de ser un adenoca de próstata y se estableció el diagnóstico.Se ha realizado una revisión de la literatura mediante una búsqueda bibliográfica electrónica en PubMed (MEDLINE) utilizando los términos “Prostatic Neoplasm”(MesH) AND “Neoplasm Metastasis” (MesH) AND “cutaneous”(texto libre). La gran mayoría de las publicaciones corresponden a aportación de casos nuevos con revisión de la probable vía de diseminación y la localización.RESULTADOS: La tinción inmunohistoquímica con PSA positiva fue la que confirmó el origen de la Metástasis, aunque el valor del PSA no ofrecía dudas por valor superior a 1100 ng/ml. En relación con la búsqueda obtenemos mas de 26 trabajos, seleccionando para nuestra trabajo sólo 8 ya que se ajustan al objetivo del mismo. La aparición de metástasis cutáneas con origen prostático es inferior al 0,3%, ya que es mas frecuente la afectación ósea, en ganglios y visceras. Se describen casos en la evolución de la enfermedad y metástasis tras procedimientos laparoscópicos.CONCLUSIONES: La metástasis cutánea de una adenocarcinoma de próstata es muy rara, pero más aún que ésta sea el debut de la enfermedad (AU)

OBJECTIVE: To report one case of metastatic prostatic carcinoma with a gaudy presentation as a lump which resulted to be a cutaneous metastasis.METHODS: We describe the debut in a patient, who thanks to the pathologic analysis of a lesion mimicking a lipoma, which was reported as adenocarcinoma, was worked up for prostatic adenocarcinoma and diagnosis was reached.We performed a bibliographic review using an electronic bibliographic search in PubMed (MEDLINE) using the terms “Prostatic Neoplasm” (MesH) AND “Neoplasm Metastasis” (MesH) AND “cutaneous” (free text). Most publications are case reports reviewing the probable dissemination way and localization.RESULTS: Positive immunohistochemical staining for PSA confirmed the origin of the metastasis, although PSA value did not offer doubts due to its value over 1100 ng/ml. Regarding the bibliographic search we obtained more than 26 papers, and selected only 8 that were adjusted to the objectives of our work. Cutaneous metastasis of prostatic origin appear in less than 0.3% of the cases, because bone, lymph node, and visceral disease are more frequent. Cases appearing during the evolution of the disease and metastasis after laparoscopic procedures are described.CONCLUSIONS: Cutaneous metastases of prostatic adenocarcinoma are very rare, but even rarer is it being the debut of the disease (AU)

Manejo diagnóstico y terapéutico de la hidatidosis renal / Diagnostic and therapeutic management of renal hydatidosis

OBJETIVO: La hidatidosis renal está causado por Echinococcus granulosus y es extremadamente infrecuente, constituyendo el 3-4% de los casos de hidatidosis, siendo la tercera localización tras el hígado y pulmones. Habitualmente permanece asintomático durante años y los síntomas más comunes son dolor, sensación de pesadez en flanco y disuria. Ante la aparición de un cuadro compatible, estudiamos la pauta diagnóstica, terapéutica y de seguimiento revisando la literatura.MÉTODOS: Realizamos una búsqueda bibliográfica electrónica PubMed (MEDLINE) con términos MESH “Equinococcosis”[MeSH] AND “Urinary Tract”[MeSH] y de citas bibliográficas. Hacemos una revisión de la epidemiología, el ciclo vital del parásito y del manejo del paciente afecto de Hidatidosis. La gran mayoría de las publicaciones corresponden a aportación de casos con diferentes localizaciones, aunque encontramos algunas revisiones.RESULTADOS: Encontramos un total de 137 trabajos de los cuales, seleccionamos veintitres por estar relacionados; cinco correspondían a revisiones, referenciamos en el texto sólo diez. Aunque la mayoría son aportación de casos, las revisiones analizan el ciclo del Echinococcus y los diferentes lugares de asentamiento (órganos) en el huésped hombre. El hombre puede llegar a ser huésped intermedio a través de contacto con huésped definitivo (perros...) o por ingesta de agua contaminada o vegetales.CONCLUSIONES: Gracias a la combinación de anamnesis, estudios de imagen y serología nos aproximamos al diagnóstico hasta en un 80%. En muchos casos es posible la cirugía conservadora pero tras la sospecha debemos siempre esterilizar con Albendazol antes del tratamiento quirúrgico y tras el tratamiento monitorizar mediante serología la titulación de Anticuerpos anti-echinococcus(AU)

OBJECTIVE: Renal hydatidosis is caused by Echinococcus granulosus and is extremely rare, accounting for 3-4% of the cases of hydatidosis, being the third site after liver and lungs. It generally remains asymptomatic for years and the most frequent symptoms are pain, feeling of flank heaviness, and dysuria. In front of a compatible clinical picture, we studied the diagnostic, therapeutic, and follow-up schemes reviewing the literature.METHODS: We performed an electronic bibliographic search in PubMed (MEDLINE) which MESH terms “ Echinococcosis”[MeSH] AND “urinary tract”[MeSH] and bibliographic citations. We perform a review on epidemiology, vital cycle of the parasite and management of patients with hydatidosis. Most published papers correspond to case reports from different localisations, although we found some reviews.RESULTS: We found a total of 137 papers, we selected 23 of them because they were related; five were reviews, but we only include 10 of them in our references. Although most were case reports, the reviews analyse the cycle of the Echinococcus and its various host sites (organs) in the human host. The human being may become an intermediary host through contact with the definitive host (dogs) or by taking contaminated water or vegetables.CONCLUSIONS: Thanks to the combination of history, imaging tests and serology we get close to the diagnosis in up to 80%. In many cases conservative surgery is possible, but after suspicion we should always sterilise with albendazole before surgical treatment, and monitor serum titles of anti- Echinococcus antibodies(AU)

Clínica miccional como síntoma por cuerpo extraño intravesical / Voiding symptoms as presentation of an intravesical foreign body

OBJETIVO: La presencia de cuerpos extraños intravesicales aparecen excepcionalmente, no siendo una urgencia habitual. La mayoría de cuerpos extraños son de origen erótico-sexual aunque no podemos olvidar otros como el abandono en el campo quirúrgico de algún elemento utilizado. A propósito de ello, revisamos la literatura. MÉTODOS: Realizamos una búsqueda bibliográfica electrónica PubMed (MEDLINE) con términos MESH «Foreign-Body Migration» [MeSH] AND «Urinary Bladder» [MeSH] y de citas bibliográficas. Hacemos una revisión de la literatura estableciendo una clasificación atendiendo al origen y diagnóstico así como tratamiento. La gran mayoría de las publicaciones corresponden a aportación de casos nuevos. Describimos la forma de presentación más habitual que coincidía con el que tuvimos en nuestro Centro. RESULTADOS: Encontramos un total de 122 trabajos de los cuales nueve correspondían a una revisión; seleccionamos en total 20. Aunque la mayoría son aportación de casos, las revisiones, establece una clasificación en función del origen: así, hacen referencia a los introducidos directamente a la vejiga: -por la propia persona: horquillas, imperdibles, lápices, hilos de cobre, pelos; -accidentales: balas; -iatrógenos: fragmentos de sonda o catéteres, grapas, suturas. Migrados desde otros lugares:de origen urológicos, ginecológico, digestivo, vascular. Estableceremos un algoritmo diagnóstico y terapéutico. CONCLUSIONES: Los cuerpos extraños dentro de la vejiga no son tan infrecuentes como se cree. El hallazgo casual es lo más frecuentes. Los síntomas urinarios son los mas frecuentes y el antecedente de manipulación propia o de otros en esa esfera genito urológica y el tratamiento es la extracción utilizando el menos cruento y mas sencillo para el paciente (AU)

OBJECTIVES: The presence of intravesical foreign bodies is exceptional; it is not a common emergency. Most foreign bodies have a sexual-erotic origin, although we cannot forget others such as elements left by the surgeon in the surgical field. We performed a bibliographic review on the topic. METHODS: We performed a PubMed (MEDLINE) electronic bibliographic search with the mesh terms «foreign-body migration» [MESH] AND «Urinary Bladder» [MESH] and bibliographic citations. We performed a bibliographic review establishing a classification depending on the origin and diagnosis, as well as treatment. Most publications are case reports. We described the most frequent presentation which was the same than we have in our Center. RESULTS: We found a total of 122 works, nine of which were reviews; we selected 20 works. Although most are case reports, the reviews establish a classification depending on the origin: so, they refer to those foreign bodies directly introduced into the bladder: 1. By the patient: hairpins, safety pins, pencils, copper wires, hairs; 2. Accidentally: bullets; 3. Iatrogenic: fragments of bladder or ureteral catheters, staples, sutures. Foreign bodies migrated from other places: urological, gynecological, gastrointestinal, or vascular origin. We established a diagnostic and therapeutic algorithm. CONCLUSIONS: Bladder foreign bodies are not as frequent as it is believed. Most are found incidentally. Lower urinary tract symptoms are the most frequent, as the antecedent of manipulation by the patient or others in the genital-urologic sphere. The treatment of choice is extraction using the least invasive and most simple method for the patient (AU)