Hemorragia suprarrenal espontánea unilateral / Spontaneous unilateral adrenal hemorrhage

Hombre de 73 años que acude al servicio de urgencias por dolor abdominal. Al examen físico se palpa masa que ocupa hipocondrio derecho. Angio TAC muestra masa abdominal de 12 cm dependiente de glándula suprarrenal derecha. Analítica de orina muestra elevación de metanefrinas y normetanefrinas. La gamagrafía fue compatible con feocromocitoma. Se realiza extirpación quirúrgica de masa y la anatomía patológica describe hemorragia suprarrenal sin malignidad.

A 73 year old man, came to the emergency department referring abdominal pain. A palpable mass occupying right upper quadrant on physical examination was identified. CT angiography showed a 12 cm abdominal mass dependent of the right adrenal. Urinalysis showed elevation of metanephrines and normetanephrines. Gamagraphy scan was compatible with pheochromocytoma. Surgical resection of the mass was performed and pathology described an adrenal hemorrhage without malignancy.

[Lymphocele after renal transplantation: case report and bibliographic review]. / Linfocele gigante tras trasplante renal. A propósito de un caso y revisión de la literatura.

OBJECTIVES: To report the case and iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and the treatment of this surgical complication. METHODS: 69 year-old woman status post renal transplantation who presents right lower extremity edema and worsening renal function. A liquid collection was demonstrated by ultrasound and computerized tomography, compatible with lymphocele after biochemical study of the liquid obtained by percutaneous puncture. RESULTS: The patient underwent laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcome. CONCLUSION: Lymphocele is a common pathology after a renal transplantation which needs to be treated depending on its clinical manifestations. There mainly are two therapeutic alternatives depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from very selected cases, laparoscopic approach is currently considered, because of its security and effectiveness, the first choice when a surgical treatment is prescribed.

Linfocele gigante tras trasplante renal. A propósito de un caso y Revisión de la literatura / Giant lymphocele after renal transplantation. Case report and bibliographic review

OBJETIVOS: Comunicar el caso y la iconografía de un linfocele postrasplante renal y revisar la literatura sobre diagnóstico y tratamiento de esta complicación quirúrgicaMÉTODOS: Mujer de 69 años sometida a trasplante renal, que se presenta con edema en miembro inferior derecho y deterioro de función renal. Se demostró con ecografía y TAC una colección líquida, compatible con linfocele tras estudio bioquímico del líquido obtenido por punción percutánea. RESULTADOS: Se somete a la paciente a una marsupialización del linfocele por vía laparoscópica, con buenos resultados quirúrgicos.CONCLUSIONES: El linfocele es una entidad frecuente tras el trasplante renal, precisando tratamiento según las manifestaciones clínicas. Existen fundamentalmente dos alternativas terapéuticas, dependiendo del tamaño: escleroterapia y marsupialización quirúgica. Salvo casos muy seleccionados, el abordaje laparoscópico se considera actualmente, por su seguridad y eficacia, de primera elección cuando se indica tratamiento quirúrgico(AU)

OBJECTIVES: To report the case and iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and the treatment of this surgical complication.METHODS: 69 year-old woman status post renal transplantation who presents right lower extremity edema and worsening renal function. A liquid collection was demonstrated by ultrasound and computerized tomography, compatible with lymphocele after biochemical study of the liquid obtained by percutaneous puncture.RESULTS: The patient underwent laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcome.CONCLUSION: Lymphocele is a common pathology after a renal transplantation which needs to be treated depending on its clinical manifestations. There mainly are two therapeutic alternatives depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from very selected cases, laparoscopic approach is currently considered, because of its security and effectiveness, the first choice when a surgical treatment is prescribed(AU)

[Giant lymphocele after renal transplantation. Case report and bibliographic review]. / Linfocele gigante tras trasplante renal. A propósito de un caso y revisión de la literatura.

OBJECTIVE: To report the case and the iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and treatment of this surgical complication. METHODS: 69 year-old woman who undergone renal transplantation and presented right lower extremity edema and worsening renal function. It was demonstrated by ultrasound and computerized tomography a liquid collection, compatible with lymphocele after biochemical study of the liquid which was obtained by percutaneous puncture. RESULTS: The patient underwent a laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcomes. CONCLUSION: Lymphocele is a common pathology after a renal transplantation, which needs to be treated depending on its clinical manifestations. There are mainly two therapeutic alternatives, depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from highly selected cases, laparoscopic approach is currently considered first choice when a surgical treatment is prescribed due to its security and effectiveness.

Linfocele gigante tras trasplante renal. A propósito de un caso y revisión de la literatura / Giant lymphocele after renal transplantation. Case report and bibliographic review

OBJETIVO: Comunicar el caso y la iconografía de un linfocele postrasplante renal y revisar la literatura sobre diagnóstico y tratamiento de esta complicación quirúrgicaMÉTODOS: Mujer de 69 años sometida a trasplante renal, que se presenta con edema en miembro inferior derecho y deterioro de función renal. Se demostró con ecografía y TAC una colección líquida, compatible con linfocele tras estudio bioquímico del líquido obtenido por punción percutánea.RESULTADOS: Se somete a la paciente a una marsupialización del linfocele por vía laparoscópica, con buenos resultados quirúrgicos.CONCLUSIONES: El linfocele es una entidad frecuente tras el trasplante renal, precisando tratamiento según las manifestaciones clínicas. Existen fundamentalmente dos alternativas terapéuticas, dependiendo del tamaño: escleroterapia y marsupialización quirúgica. Salvo casos muy seleccionados, el abordaje laparoscópico se considera actualmente, por su seguridad y eficacia, de primera elección cuando se indica tratamiento quirúrgico(AU)

OBJECTIVE: To report the case and the iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and treatment of this surgical complication.METHODS: 69 year-old woman who undergone renal trans-plantation and presented right lower extremity edema and worsening renal function. It was demonstrated by ultrasound and computerized tomography a liquid collection, compatible with lymphocele after biochemical study of the liquid which was obtained by percutaneous puncture.RESULTS: The patient underwent a laparoscopic intraperito-neal drainage of the lymphocele, with good surgical outco-mes.CONCLUSION: Lymphocele is a common pathology after a renal transplantation, which needs to be treated depending on its clinical manifestations. There are mainly two therapeu-tic alternatives, depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from highly selected cases, laparoscopic approach is currently considered first choice when a surgical treatment is prescribed due to its security and effectiveness(AU)

Leiomiosarcoma de cava inferior. Hallazgo incidental / Leiomyosarcoma of the inferior vena cava. Incidental finding

Objetivo: El leiomiosarcoma de cava inferior es una entidad poco frecuente, clínicamente insidiosa o silente y detectable en muchas ocasiones únicamente mediante estudios de imagen. Se presenta un caso intervenido en nuestro servicio y se revisa la literatura al respecto. Método: Mujer de 58 años con una masa suprarrenal derecha de 6 cm evidenciando su origen en la pared de vena cava durante el acto quirúrgico. Se realiza exeresis completa de la tumoración, y posteriormente , radioterapia adyuvante sobre el lecho quirúrgico. Resultados: Tras más de 2 años de evolución, la paciente se encuentra libre de enfermedad. Conclusiones: Esta entidad presenta una escasa prevalencia, y en muchas ocasiones su hallazgo es incidental. La resección quirúrgica completa es la clave del tratamiento, aunque la probabilidad de recidiva local es elevada (AU)

Objective: Leiomyosarcoma of the inferior vena cava is a rare tumor, clinically silent which often remains undiagnosed for much longer. Imaging methods allow us to detect these entities. We report a single case and perform a bibliographic review. Methods: 58-year-old woman with a 6 cm adrenal mass, which during surgery was found to be a tumor from the wall of the vena cava. We performed complete removal of the mass. Radiotherapy of the surgical area was applied within three months following surgery. Results: Two years later, there is no evidence of disease recurrence. Conclusion: This is a rare entity, with low prevalence. Complete surgical excision is the gold standard for treatment. Local recurrence is a common finding during follow up (AU)

[Metastasis of a renal cell carcinoma in the corpora cavernosum of the penis. Case report and bibliographic review]. / Metastasis de carcinoma renal en cuerpo cavernoso, a propósito de un caso y revisión de la literatura.

OBJECTIVE: We describe a rare case, the metastasis of a renal clear cell carcinoma in the corpora cavernosum of the penis. METHODS: 53-year-old patient presenting with a painful, hard tumor in the penis three months after right radical nephrectomy with cavotomy and thrombus excision. RESULTS/CONCLUSIONS: Imaging tests and biopsy led to the diagnosis of metastasis of a renal carcinoma in the corpus cavernosum, which was confirmed on the pathologic study of the specimen after penectomy. The appearance of renal carcinoma metastases in the penis is generally associated with advanced tumor stage, therefore associated with bad prognosis as in the reported case.

Metástasis de carcinoma renal en cuerpo cavernoso. A propósito de un caso y revisión de la literatura / Metastasis of a renal cell carcinoma in the corpora cavernosum of the penis. Case report and bibliographic review

OBJETIVO: Describimos un caso infrecuente, la metástasis en cuerpo cavernoso de un carcinoma renal de células claras. MÉTODOS: Se trata de un paciente de 53 años, que a los tres meses tras realizarle nefrectomía radical derecha con cavotomía y exéresis de trombo, presenta una tumoración localizada en pene, indurada y dolorosa. RESULTADOS/CONCLUSIONES: Con pruebas de imagen y biopsia, se llegó al diagnóstico de metástasis de carcinoma renal en cuerpo cavernoso que se confirmó con la anatomía patológica de la pieza tras penectomía. La aparición de metástasis de carcinoma renal en pene está generalmente asociada a un estadio avanzado del tumor y por lo tanto, con mal pronóstico, como el caso relatado

OBJECTIVE: We describe a rare case, the metastasis of a renal clear cell carcinoma in the corpora cavernosum of the penis. METHODS: 53-year-old patient presenting with a painful, hard tumor in the penis three months after right radical nephrectomy with cavotomy and thrombus excision. RESULTS/ CONCLUSIONS: Imaging tests and biopsy led to the diagnosis of metastasis of a renal carcinoma in the corpus cavernosum, which was confirmed on the pathologic study of the specimen after penectomy. The appearance of renal carcinoma metastases in the penis is generally associated with advanced tumor stage, therefore associated with bad prognosis as in the reported case

[Prevalence of incidental prostatic adenocarcinoma after suprapubic adenomectomy with or without previous prostatic biopsy]. / Prevalencia de adenocarcinoma prostático incidental tras adenomectomía suprapúbica con o sin biopsia prostática previa.

OBJECTIVES: To establish the prevalence of incidental prostate cancer after transrectal ultrasound guided prostatic biopsy and subsequent suprapubic prostatic adenomectomy and to compare it with a similar group of patients who did not underwent biopsy before surgery. To evaluate treatment, outcomes, and disease progression in patients with incidental prostate cancer. METHODS: Retrospective study of 549 suprapubic adenomectomy performed between 1996-2001 (6 yr.), comparing the group of patients with biopsies before surgery vs. the group of patients without biopsies. RESULTS: 291 (53%) patients did not undergo biopsy before adenomectomy. 258 (47%) underwent biopsies. 25 incidental prostate cancers were detected, 19 (76%) in the group of no biopsy and 6 (24%) in the biopsy group. 88% pT1a and 12%pT1b. Mean Gleason score 4.5 (3-7). 84% of the patients did not receive treatment (21) ("wait and see"); 8% (2) androgen blockade; 8% (2) finasteride (2). Three patients (12%) in the group of no biopsy had disease progression. Mean follow-up was 48.1 months (22-96). No case of cancer-specific mortality was detected. CONCLUSIONS: Global prevalence of incidental prostate cancer in our series of patients undergoing suprapubic prostatic adenomectomy was 4.55%. Prevalence was higher in the group of patients without previous biopsy (3.46%) than in the biopsy group (1.09%). Tumor progression was 12% and cancer specific survival 100% after a mean follow-up of 48.1 months (22-92). Previous prostatic biopsy in patients with suspicions digital rectal examination or elevated PSA diminishes the prevalence of incidental prostate cancer. Watchful waiting may be a valid option in some cases.

Prevalencia de adenocarcinoma prostático incidental tras adenomectomía suprapúbica con o sin biopsia prostátic previa / Prevalence of incidental prostatic adenocarcinoma after suprapubic adenomectomy with or without previous prostatic biopsy

OBJETIVO: Determinar la prevalencia de cáncer de próstata incidental tras biopsia prostática transrectal ecodirigida y posterior adenomectomía prostáticasuprapúbica, y compararlo con la prevalencia de un grupo similar de pacientes que no fueron biopsiados previamente a la cirugía. Evaluar el tratamiento, la evolucióny las progresiones de la enfermedad tumoral en los pacientes con cáncer de próstata incidental.MÉTODOS: Estudio retrospectivo de 549 adenomectomíassuprapúbicas realizadas entre 1996-2001 (6 años), comparando el grupo de pacientes biopsiados previamente a la adenomectomía con el grupo no biopsiado.RESULTADOS: 291 (53%) pacientes no fueron biopsiadospreviamente a la adenomectomía. 258 (47%) fueronbiopsiados. 25 cánceres de próstata incidentales detectados, 19 (76%) en el grupo de los no biopsiados y 6 (24%) en el de los biopsiados. 88% pT1a y 12% pT1b. Gleason medio 4,5 (3-7). No fueron tratados el 84% de los pacientes (21) (“esperar y ver”); bloqueo hormonal 8% (2); finasteride 8% (2). Progresaron 3 pacientes (12%), todos del grupo de los no tratados. Media de seguimiento de 48,1 meses (22-96). No se detectó ningún caso de mortalidad cáncer de próstata específico.CONCLUSIONES: La prevalencia global de cáncer de próstata incidental en nuestra serie en pacientes a los que se les realizo adenomectomía prostática suprapúbicafue del 4,55%. La prevalencia fue mayor en el grupo de pacientes no biopsiados previamente a la adenomectomía (3,46%) que en el grupo de los biopsiados(1,09%). La progresión tumoral fue del 12% y la supervivencia cáncer de próstata específica del 100% tras una media de seguimiento de 48,1 meses (22-92). La biopsia prostática previa a la adenomectomía en pacientescon tacto rectal sospechoso o PSA elevado disminuyela prevalencia de cáncer prostático incidental. El seguimiento expectante activo puede ser una actitud valida en determinados casos

OBJECTIVES: To establish the prevalence of incidental prostate cancer after transrectal ultrasound guided prostatic biopsy and subsequent suprapubic prostatic adenomectomy and to compare it with a similar group of patients who did not underwent biopsy before surgery. To evaluate treatment, outcomes, and disease progression in patients with incidental prostate cancer. METHODS: Retrospective study of 549 suprapubicadenomectomy performed between 1996-2001 (6 yr.), comparing the group of patients with biopsies before surgery vs. the group of patients without biopsies.RESULTS: 291 (53%) patients did not undergo biopsy before adenomectomy. 258 (47%) underwent biopsies. 25 incidental prostate cancers were detected, 19 (76%) in the group of no biopsy and 6 (24%) in the biopsy group. 88% pT1a and 12%pT1b. Mean Gleason score 4.5 (3-7). 84% of the patients did not receive treatment (21) (“wait and see”); 8% (2) androgen blockade; 8% (2) finasteride (2). Three patients (12%) in the group of no biopsy had disease progression. Mean follow-up was 48.1 months (22-96). No case of cancer-specific mortality was detected.CONCLUSIONS: Global prevalence of incidental prostate cancer in our series of patients undergoing suprapubic prostatic adenomectomy was 4.55%. Prevalence was higher in the group of patients without previous biopsy (3.46%) than in the biopsy group (1.09%). Tumorprogression was 12% and cancer specific survival 100% after a mean follow-up of 48.1 months (22-92).Previous prostatic biopsy in patients with suspicionsdigital rectal examination or elevated PSA diminishes the prevalence of incidental prostate cancer. Watchful waiting may be a valid option in some cases

Tácticas y trucos de endourología en el aparato urinario superior. Trucos en ureter: ureteroscopia / No disponible

No disponible

[Urologic damage of the primary antiphospholipid syndrome]. / Manifestaciones urológicas del síndrome antifosfolípido primario. Vejiga neurógena.

OBJECTIVES: To perform a review and update of the antiphospholipid syndrome summarizing its urological presentations. METHODS: A complete bibliographic search was performed through PubMed MEDLINE and articles were reviewed with special attention to those bibliographic references about urological presentations. We document the unique and unpublished case of a patient with neurogenic bladder secondary to antiphospholipid syndrome. RESULTS/CONCLUSIONS: The antiphospholipid syndrome is an acquired autoimmune systemic disease generating a permanent hypercoagulability status with recurrent multiorgan thrombotic events due to circulating antiphospholipid antibodies. It may be secondary to a heterogeneous group of diseases (mainly lupus) and drugs, or primary if it appears isolated without any demonstrable systemic disease or concomitant medication. It is mainly characterized by venous or arterial recurrent thrombosis, recurrent abortion, thrombocytopenia, and circulating antiphospholipid auto-antibodies. Treatment with anticoagulants and correction of the hypercoagulable status contributing factors, arterial or venous thrombosis, and vascular risk aim to avoid new thrombosis episodes. Genitourynary system may be affected in any of its parts, generally by arterial or venous thrombosis. Kidney is the most frequently affected organ, in addition to transplanted kidney grafts, adrenal glands, bladder and testicles. There is a relationship between antiphospholipid syndrome and infertility. For the first time, we describe bladder involvement presenting as hyperreflexic neurogenic bladder with detrusor-sphincter dyssynergia after spontaneous spinal cord thrombosis in an asymptomatic adolescent with primary antiphospholipid syndrome which was unknown before.

[Staging of infiltrating bladder cancer. Role of C.T. scan]. / Estadiaje del cáncer de vejiga infiltrante. Papel de la T.A.C.

OBJECTIVES: To analyse the role of CT-scan on preoperative determination of bladder and lymph node involvement of infiltrative bladder cancer, and its possible impact on the surgical management of these patients. METHODS: Retrospective study including 115 patients with the diagnosis of infiltrative bladder cancer between 1984 and 1999. The ability of CT-scan for bladder and lymph node staging was evaluated comparing results with the findings after radical surgery. Potential impact of this imaging technique on change of surgical attitudes was evaluated. RESULTS: Perivesical involvement estimation by CT-scan was right in 36.5%, underestimated in 49.6% and overestimated in 14%. The more advanced the perivesical involvement the lower the sensitivity for CT-scan in perivesical staging. The more locally advanced tumour the higher specificity, oscillating between 44% for pT2 and 94% for pT4. In reference to lymph node staging, it was correct in 71.3% of the cases, although this percentage depended almost exclusively on patients with negative nodes (N-). However, there was a 24.3% understaging rate which corresponded to the majority of N+ patients. These data offer a 28% sensitivity, 93% specificity, 68% positive predictive value, and 72% negative predictive value. Finally, the reliability of bladder staging in patients with lymph node involvement (N+) (39 patients) was established; it was correctly estimated in as low as 30% of the cases with a 70% understaging rate. CT-scan would have modified surgical attitudes in only 6 patients (5%), all of them with advanced tumours. CONCLUSIONS: The impact of CT-scan on infiltrative bladder cancer clinical staging is relatively low. The highest benefit is obtained in patients suspect of having advanced disease. Limitation to this group would result in significative cost reductions with low risk for unappropriate surgical management.

Estadiaje del cáncer de vejiga infiltrante. Papel de la T.A.C / Infiltrative bladder cancer staging: The role of CT-scan

OBJETIVOS: Analizar el papel de la T.A.C. en la determinación prequirúrgica de afectación vesical y ganglionar, del cáncer vesical infiltrante, así como su posible impacto en el manejo quirúrgico de estos pacientes. MÉTODOS: Se realizó un estudio retrospectivo en 115 pacientes con cáncer vesical infiltrante diagnosticados en el período 1984-1999. Se determinó la capacidad de la T.A.C. para el estadiaje vesical y ganglionar y se compararon los resultados con los obtenidos tras la cirugía radical. Se evaluó el posible impacto de esta técnica de imagen en el cambio de actitud quirúrgica en estos pacientes. RESULTADOS: La estimación de afectación perivesical con T.A.C. fue correcta en 36,5 per cent, fue subestadiada en 49,6 per cent, y sobreestadiada en 14 per cent. La T.A.C. para el estadiaje perivesical posee una sensibilidad más baja cuanto más avanzada es dicha afectación. Su especificidad es más elevada cuanto más avanzado localmente sea el tumor, oscilando entre 44 per cent en los pT2 y el 94 per cent en los pT4.En lo referente al estadiaje ganglionar, es correcto en 71,3 per cent de los casos, aunque este porcentaje depende casi exclusivamente de los pacientes con ganglios negativos (N-). Existe, sin embargo, una tasa de subestadiaje de 24,3 per cent que corresponde a la mayoría de los pacientes N+. Estos datos nos ofrecen una sensibilidad del 28 per cent, especificidad de 93 per cent, valor predictivo positivo de 68 per cent, y predictivo negativo de 72 per cent.Por último, se establece la fiabilidad del estadiaje vesical en los pacientes con afectación ganglionar (N+) (39 pacientes), habiendo estimado correctamente un escaso 30 per cent con una tasa de subestadiaje del 70 per cent. Esta prueba solo habría modificado la actitud quirúrgica en 6 pacientes (5 per cent), todos en estadios avanzados. CONCLUSIONES: El impacto de la T.A.C. en el estadiaje clínico del cáncer vesical infiltrante es relativamente bajo. El mayor beneficio se obtiene en pacientes con sospecha de enfermedad avanzada. Su limitación a este grupo supondría una significativa reducción de costes con bajo riesgo de un manejo quirúrgico inapropiado (AU)

[Bladder choriocarcinoma: retrospective analysis of the de-differentiation of a transitional-cell papillary bladder carcinoma. Apropos of a case]. / Coriocarcinoma vesical; análisis retrospectivo de la desdiferenciación de un carcinoma vesical papilar de células transicionales a propósito de un caso.

OBJECTIVE: To report a case of choriocarcinoma of the bladder during the different periods of its evolution. The anatomopathological study showing dedifferentiation of a transitional cell tumor is presented and the histogenesis of this rare tumor is discussed. METHODS: A case of a rapidly progressing transitional cell tumor of the bladder that dedifferentiated into choriocarcinoma is presented. The pathological findings of the first resections of the transitional cell tumor that progressed to choriocarcinoma are presented and the histogenesis is discussed. RESULTS/CONCLUSIONS: Choriocarcinoma of the bladder is very rare, highly malignant and carries a poor prognosis. Its origin is widely accepted to be in the dedifferentiation of a transitional cell tumor. The use of immunohistochemistry and the positivity of HCG support the diagnosis.

[Ureteroplasty using the appendix: apropos of a case]. / Ureteroplastia con apéndice: a propósito de un caso.

OBJECTIVE: To report a case of ureteroplasty using the vermiform appendix. METHODS: Herein we describe a patient who underwent partial resection of the ureter due to a neoplasm. The ureteral defect was repaired using the vermiform appendix. The surgical technique and the results achieved are presented and the literature is briefly reviewed. RESULTS/CONCLUSIONS: The few cases reported in the literature and the case described herein show the utility of the vermiform appendix for ureteral substitution in specific cases where this procedure is indicated.

Ureteroplastia con apéndice: a propósito de un caso / Uteroplasty with vermiform appendix: A case report

Objetivo: Comunicar un caso de uso de apéndice para reparar un defecto ureteral. Dado el escaso número de referencias en la literatura nos parece interesante aportar una más para recordar este procedimiento.Métodos: Se presenta un caso clínico en el cual por proceso neoplásico es necesario resecar parcialmente uréter, y su posterior reconstrucción. Se expone la técnica quirúrgica y la evolución.Resultados/conclusiones: Haciendo una breve revisión de la literatura y demostrando como ejemplo nuestra propia experiencia nos parece que el apéndice vermiforme es un buen sustituto ureteral en casos determinados y bajo ciertas indicaciones clínicas (AU)

No disponible