First Case Described in the Medical Literature: Male Urethral Sarcoidosis. Description of a Case and Review of the Literature

Objective: Although the sarcoidosis is a multisystemic disease that theoretically can affect almost any organ, the presence of sarcoidosis in the male urethra has not been described in the medical literature. We present the first male case of urethral sarcoidosis. Method: A 46 years old male undergoing follow up due to lower urinary tract symptoms was diagnosed of endobronchial sarcoidosis during the preoperative study for internal urethrotomy. After surgery, he presented clinical improvement for one year. Given the worsening, a new internal urethrotomy was tried. As it was impossible due to complexity they took a biopsy of the urethra. The pathology report described non-caseating granulomas compatible with sarcoidosis. After that, medical and endoscopic management of the urethral sarcoidosis was attempted. As it didn't achieve an adequate control, the patient was derivate to the "complex urethral unit" of the Cruces University Hospital. Once it was valuated, it was decided to start immunotherapy and subsequently an urethroplasty with a double oral mucosa graft was performed. Outcomes: During the postoperative period, a urethral catheter was maintained for two weeks. It was removed after no urinary leakage was observed in de cystourethrography. After that the patient remains with good evolution until today. Conclusions: Urethral affectation by sarcoidosis is a therapeutic challenge itself. For a better symptom control and to reduce the recurrences, a dual approach using systemic treatment in combination with local surgical treatment seems necessary (AU)

Objetivo: Pese a que la sarcoidosis es una enfermedad multisistémica que teóricamente puede afectar a casicualquier órgano, no ha sido descrita en la literatura médicala presencia de sarcoidosis en uretra masculina. Presentamos el diagnóstico y tratamiento del primer caso masculinode sarcoidosis uretral.Método: Varón de 46 años en seguimiento por clínicamiccional de vaciado al que se le diagnosticó de sarcoidosis endobronquial durante el estudio preoperatorio para larealización de una uretrotomía interna. Tras la intervenciónpresentó mejoría clínica durante un año. Ante el empeoramiento, se intentó repetir una nueva uretrotomía internasiendo esta imposible y decidiéndose realizar una biopsia.El informe anatomopatológico describió granulomas no caseificantes compatibles con sarcoidosis. Posteriormente seintentó un manejo médico y endoscópico de la sarcoidosis uretral que no logró un adecuado control por lo que sederivó a la unidad de uretra compleja del Hospital Universitario Cruces. Ante los hallazgos se decidió comenzar coninmunoterapia y posteriormente se realizó una uretroplastiacon doble injerto de mucosa oral.Resultado: Durante el postoperatorio se mantuvo unasonda uretral durante dos semanas. Posteriormente se retirótras la realización de una cistouretrografía miccional seriada donde no se apreciaba fuga urinaria permaneciendo elpaciente con buena evolución hasta hoy en día.Conclusiones: La afectación uretral por sarcoidosissupone actuar ante una patología que de por sí es un retoterapéutico. Para un mejor control sintomatológico y reducir las recidivas parece necesario un abordaje doble mediante un tratamiento sistémico farmacológico en combinación con tratamiento quirúrgico local (AU)

Anterior urethral trauma in childhood: presentation of two cases. / Traumatismos uretrales en la infancia: presentación de dos casos.

INTRODUCTION: The incidence of urethral trauma in children is low given that they have a short, mobile urethra, largely protected by the pubis. CLINICAL CASE: We describe two clinical cases illustrating the variety of presentations anterior urethral lesions can have. The first child had acute urinary retention two months after falling astride, with subsequent diagnosis of urethral stricture following serial voiding cystourethrogram (SVCU). The second child had urinary incontinence after falling off a horse. SVCU showed a urethral diverticulum, characterized through ultrasound imaging. Both were treated with deferred surgery. REMARKS: Urethral lesion should always be suspected after perineal trauma. SVCU is the gold standard diagnostic technique. Deferred urethroplasty is the treatment of choice, with good results, but there is a risk of incontinence and impotence.

INTRODUCCION: La incidencia de traumatismos uretrales en niños es baja dado que su uretra es corta, móvil y está protegida en gran parte por el pubis. CASOS CLINICOS: Exponemos dos casos clínicos que ilustran la variedad de presentaciones de las lesiones en uretra anterior. Primer niño con retención aguda de orina dos meses después de sufrir una caída a horcajadas. Posterior diagnóstico de estenosis uretral con cistouretrografía miccional seriada (CUMS). Segundo niño con incontinencia urinaria tras caída de un caballo. Hallazgo de divertículo uretral en CUMS y caracterización mediante ecografía. Ambos son tratados con cirugía diferida. COMENTARIOS: Es importante sospechar una lesión de uretra después de un traumatismo perineal. La CUMS es la prueba diagnóstica estándar. El tratamiento de elección implica uretroplastia diferida con buenos resultados aunque presenta riesgo de incontinencia e impotencia.

[Pelvic lipomatosis: contribution of a new case to the literature]. / Lipomatosis pelviana: aportación de un nuevo caso a la literatura.

OBJECTIVE: To describe an additional case of pelvic lipomatosis, a rare condition that can be encountered by the urologist. METHODS/RESULTS: A 66-year-old patient consulted for irritative voiding syndrome and fever. Patient evaluation by IVP and CT demonstrated pelvic lipomatosis. CONCLUSIONS: Pelvic lipomatosis is a disease with variable clinical and radiological features. Careful follow-up is warranted for prevention and treatment of possible complications.

[Methods of endoluminal treatment of urethral stenosis up to the end of the 19th Century]. / Métodos de tratamiento endoluminal de la estenosis de uretra hasta finales del Siglo XIX.

Ever since Hippocrates, physicians have managed patients that suffered from urethral stricture. To that end, genius and imagination put to the service of scientific knowledge, have produced numerous apparatus, instruments and methods of a varied nature, with the aim of allowing urine passage through the strictured urethra. Illustrious names such as Andrés Laguna or Francisco Díaz, and other not so well known. Spanish and foreigners, are mentioned in this paper in an intent to contribute a brief view on the evolution of the methods used to treat urethral stricture up to the end of the 19th Century.

[Testicular tumors: our follow-up and treatment protocol. Report of 30 cases]. / Tumores testiculares: nuestra pauta de seguimiento y tratamiento. A propósito de 30 casos.

The high incidence of testicular tumors seen in our setting prompted us to review our therapeutic and follow-up protocols and assess patient survival and course within the period spanning June, 1989 to August, 1992. During this 38-month period, we diagnosed a total of 30 cases (15 seminoma, 2 pure embryonal carcinoma, 8 mixed embryonal, 3 lymphoma and 2 Leydig cell tumors). Apart from orchidectomy, we utilized radiotherapy, chemotherapy and resection of residual tumor mass, according to the histological type and tumor stage. Of the 15 seminomas, there was 1 death (6%), 9 cases (60%) are tumor free with a mean survival of 25 months, and 5 cases (34%) are in partial remission at 11.3 months mean follow-up. Of the 10 nonseminomatous tumors, there was 1 death (10%), 5 patients (50%) are in complete remission at 23.6 months (mean), 3 (30%) are in partial remission at 19.3 months (mean) and 1 (10%) is in frank progression as manifested by the unresectable masses of the retroperitoneal lymph nodes. The survival rate for the seminoma group was 94% and 90% for the nonseminomatous tumors.

[Calcified renal oncocytoma]. / Oncocitoma renal calcificado.

The appearance of calcifications in a renal oncocytoma is uncommon since they appear in a scanty proportion of solid renal tumors. Nine cases of renal calcified oncocytomas have been previously reported; three of these had microscopic calcic deposits. The calcifications can be either central or peripheric. Their size or localization in the tumor mass does not alter the good prognosis of this type of renal tumor. We report on a 40-year-old man who presented a solid renal mass with central and peripheral linear calcifications. The histological analysis following nephrectomy disclosed a renal oncocytoma.

[Cytology positive for malignant cells in hydrocele secondary to testicular seminoma]. / Citología positiva a células malignas en hidrocele secundario a seminona testicular.

Finding tumor cells in the fluid of hydrocele secondary to testicular tumor is rare and may be due to the fact that hydrocele fluid cytology has not been studied systematically. The presence of malignant cells in the hydrocele fluid may be ascribed to two mechanisms: retrograde lymphatic flow from the infiltrated retroperitoneal lymph nodes or from tumor directly invading the tunica albuginea and vaginalis testis, with cells passing into the cavity of the vaginalis. Only two cases of hydrocele secondary to testicular seminoma with vaginalis fluid cytology positive for malignant seminomatous cells have been previously reported in the literature. To our knowledge, the case reported herein is the third. These three cases are briefly discussed.

[Multifocal renal adenocarcinoma. Considerations regarding a case]. / Multifocalidad en el adenocarcinoma renal. Consideraciones a propósito de una observación.

There is scant reference to the clinicopathological feature of multifocality in renal adenocarcinoma. Inadvertently disregarding this feature may result in local recurrence in those patients in whom partial nephrectomy is contemplated.

[Impotence caused by venous leakage: surgical treatment. Short- and mid-term results]. / Impotencia por fuga venosa: tratamiento quirúrgico. Resultados a corto y medio plazo.

We reviewed the results achieved by ligation of the deep dorsal vein of the penis in 14 males with erectile dysfunction secondary to venous leakage. Prostaglandin E1 injection, echo Doppler and cavernosometry were utilized for the diagnosis. Surgical correction was performed when the cavernosometric flow required for erection was more than 200 cc/minute. The patients had a follow-up evaluation at 3, 6 and 12 months postoperatively. At one year, 4 (28.5%) patients showed good results and 10 (71.4%) poor. The factors that may influence the short, medium and long-term results are briefly described.

[Rectal involvement secondary to prostatic adenocarcinoma]. / Afectación rectal secundaria a adenocarcinoma prostático.

Rectal involvement secondary to adenocarcinoma of the prostate is uncommon and carries a poor prognosis. Distinguishing secondary from primary rectal tumors is mandatory, since each condition warrants a completely different treatment. There are at least five forms of clinicopathological involvement, depending on the rectal wall invasion and its consequences. We report on 6 cases, 4 had been diagnosed when rectal invasion was present, the enteric involvement appeared during the process in 1 patients and the other had prostate carcinoma coexisting with squamous cell carcinoma of the anus.

[Leydig cell tumor in a patient with type I multiple endocrine neoplasm: study of a case and review of the literature]. / Tumor de células de Leydig en paciente con neoplasia endocrina múltiple tipo I: estudio de un caso y revisión de la literatura.

Presentation of the case of a 42-year old male patient with Type I Multiple Endocrine Neoplasia, known as the Wermer Syndrome, who developed Leydig's cells tumour. No association was found between both processes and therefore a fortuitus, though worthwhile mentioning given the characteristics and hormonal implications of both pathologies, can be presumed.

[Symptomatic treatment of benign hypertrophy of the prostate. Comparative study of prazosin and serenoa repens]. / Tratamiento sintomático de la hipertrofia benigna de próstata. Estudio comparativo entre Prazosin y Serenoa repens.

Forty-five patients diagnosed as having BPH and clinically diagnosed micturition disorders were entered in a therapeutic protocol. Twenty-five patients received Prazosin and the remaining 20 patients were treated with Serenoa Repens for a period of 12 weeks. The symptomatology was assessed by flowmetry and the patients were questioned as to the irritative symptoms. It can be concluded from the study that Prazosin is slightly more effective in controlling the irritative symptoms produced by BPH.

[Spontaneous renocolic fistula secondary to pyonephrosis of lithiasic etiology]. / Fistula renocólica espontánea secundaria a pionefrosis de etiología litiásica.

Description of one case of spontaneous fistulization between a renal calix and a descending colon, secondary to lithiasic pyonephrosis. Diagnosis was carried out by means of ascending pyelography without it being clinically suspected. Treatment is surgical, combining nephrectomy, fistula resection and closure of the colic gap. Etiology, favouring factors, diagnosis and treatment are explained.

[Keratinizing desquamative squamous metaplasia. Massive involvement of vesical mucosa]. / Metaplasia escamosa descamativa queratinizante. Afectación masiva de mucosa vesical.

We report on a case of squamous metaplasia involving the entire bladder mucosa. Diagnosis was established from multiple biopsies and urinary cytology. We discuss the term used to define lesions whose potential to become malignant is the subject of controversy, and the currently available treatment modalities used to achieve cure.