[Urinary lithiasis. The patient also plays.] / Urolitiasis: el paciente también juega.

Renal lithiasis is known for its high incidence and prevalence, but mainly for its morbidity and recurrence. Despite a good indication and appropriate surgical treatment, the essential problem, the origin of the formation of the stones, generally persists and it is not uncommon that patients suffer multiple treatments and discomfort secondary to ancillary measures normally used to prevent complications. It is widely known, for consistency, that a prophylactic treatment with general or, in a smaller group of patients, specific measures are appropriate to diminish recurrences. Nevertheless, prophylaxis is not usually used by many urologists and, on top of that, in the majority of those cases when it is taken into consideration, it is the patient who fails for inadequate treatment compliance. It is very important, in any of our conversations with the urinary lithiasis' patient in relation with the disease, that the urologist provides a proper and detailed information about all its features, from diagnosis to active treatment and possible complications and, of course in those cases where prophylaxis is going to be essential to avoid new unpleasant episodes of pain and associated surgical interventions, emphasizing that improving his/her quality of life depends, to a great extent, on the patient himself. In this article, considering the existing evidence and personal experience, we intend to detail those behaviors we should take into consideration to facilitate the patient both therapeutic decisions and a positive attitude towards his/her disease, with the aim to control it in the best possible way.

Urolitiasis: el paciente también juega / Urinary lithiasis. The patient also plays

La litiasis renal es conocida por su alta incidencia y prevalencia, pero sobre todo por su morbilidad y recurrencia. A pesar de una buena indicación y un tratamiento quirúrgico apropiado, el problema de fondo, es decir el origen la formación de los cálculos, normalmente sigue existiendo y no es raro que los pacientes sufran múltiples tratamientos y molestias secundarias a las maniobras auxiliares que normalmente empleamos para prevenir complicaciones. Es de sobra sabido, por coherente, que un tratamiento profiláctico con medidas generales o, en un menor grupo de pacientes, específicas son convenientes para disminuir las recidivas. Sin embargo, la profilaxis no suele ser empleada por una buena parte de los urólogos y, por si fuera poco, en una buena parte de aquellos casos en los que sí se tiene en cuenta, es el paciente el que falla por inadecuada adherencia al tratamiento. Es de gran importancia, en cualquiera de las conversaciones con el paciente litiásico relacionadas con su enfermedad, que el urólogo le proporcione una correcta y detallada información sobre todos los aspectos de la misma, desde el diagnóstico al tratamiento activo y posibles complicaciones y, desde luego en aquellos casos en los que la profilaxis vaya a ser fundamental para evitar nuevos episodios desagradables de dolor e intervenciones quirúrgicas asociadas, haciendo hincapié en que del propio paciente depende, en buena medida, que mejore su calidad de vida. En este artículo se pretende enumerar aquellas actitudes que debemos tener en cuenta, contando con la evidencia existente y la experiencia personal, para facilitar al paciente tanto las decisiones terapéuticas como una actitud positiva del mismo hacia su propia enfermedad, con el propósito de controlarla de la mejor manera posible

Renal lithiasis is known for its high incidence and prevalence, but mainly for its morbidity and recurrence. Despite a good indication and appropriate surgical treatment, the essential problem, the origin of the formation of the stones, generally persists and it is not uncommon that patients suffer multiple treatments and discomfort secondary to ancillary measures normally used to prevent complications. It is widely known, for consistency, that a prophylactic treatment with general or, in a smaller group of patients, specific measures are appropriate to diminish recurrences. Nevertheless, prophylaxis is not usually used by many urologists and, on top of that, in the majority of those cases when it is taken into consideration, it is the patient who fails for inadequate treatment compliance. It is very important, in any of our conversations with the urinary lithiasis´ patient in relation with the disease, that the urologist provides a proper and detailed information about all its features, from diagnosis to active treatment and possible complications and, of course in those cases where prophylaxis is going to be essential to avoid new unpleasant episodes of pain and associated surgical interventions, emphasizing that improving his/her quality of life depends, to a great extent, on the patient himself. In this article, considering the existing evidence and personal experience, we intend to detail those behaviors we should take into consideration to facilitate the patient both therapeutic decisions and a positive attitude towards his/her disease, with the aim to control it in the best possible way

Radomiosarcoma paratesticular: a propósito de un caso / Paratesticular phabdomyosarcoma: a case report

OBJETIVO: Presentar un caso de radomiosarcoma paratesticular y revisión de la literatura. MÉTODOS: Describimos el caso de un varón de 16 años remitido a nuestro servicio por masa paratesticular izquierda de crecimiento progresivo, con imagen ecográfica de tumoración paratesticular heterogénea con flujo Doppler en su interior. RESULTADOS: Se realizó orquiectomía izquierda, con diagnóstico de rabdomiosarcoma. El paciente rechazó el tratamiento quimioterápico adyuvante. Tras 13 meses libre de enfermedad, reingresó por dolor cólico izquierdo detectándose en ecografía y TC una masa retroperitoneal paraaórtica izquierda que condicionaba uréterohidronefrosis grado III, y metástasis pulmonares. A pesar de instaurarse quimioterapia de rescate, no respondió presentando rápida progresión de la masa abdominal con importante deterioro general que no permitió el abordaje quirúrgico, siendo éxitus a las pocas semanas. CONCLUSIÓN: Los sarcomas paratesticulares son tumores infrecuentes y de mal pronóstico(AU)

OBJECTIVE: To report a case of paratesticular rhadomyosarcoma and to perform a bibliographic review. METHODS: We report the case of a 16-year-old male referred to our Department because of a left paratesticular hard tumor with progressive growth. Ultrasound examination showed a paratesticular heterogeneous mass with Internal flow on Doppler. RESULTS: The patient underwent left inguinal orchiectomy, with pathological diagnosis of rhabdomyosarcoma. He refused adjuvant chemotherapy. After being disease-free for 13 months, he presented with left colic pain. Ultrasound and CT examinations showed a left paraaortic retroperitoneal mass causing grade III ureterohydronephrosis, and lung metastases. Despite rescue chemotherapy treatment, there was no response and the abdominal mass progressed. A surgical approach was not possible since patient showed a rapid clinical worsening leading to his death a few weeks later. CONCLUSIONS: Paratesticular sarcomas are very uncommon tumors with poor prognosis(AU)

[Idiopathic scrotal edema: report of two cases]. / Edema del escroto agudo idiopático: presentación de dos casos.

OBJECTIVE: To report two cases of acute idiopathic scrotal edema. METHODS: We describe the cases of two 12-year-old male patients presenting at the emergency department of our hospital with pain, edema and erythema in one hemiscrotum without history of trauma. RESULTS: On physical examination both patients showed red hemiscrotum skin and increase of the size with normal testicles and epididymis. With the diagnosis of acute scrotum testicular ultrasound were performed and showed heterogeneous edema of the scrotal skin with increased in Doppler flows and normal testicles. CONCLUSIONS: Acute idiopathic scrotal edema is a self-limited pathology which basically affects children before puberty and should be included in the differential diagnosis of acute scrotum to avoid aggressive interventions.

Edema del escroto agudo idiopático: presentación de dos casos / Idiopathic scrotal edema: report of two cases

OBJETIVO: Presentar dos casos de edema de escroto agudo idiopático. MÉTODOS: Describimos los casos de dos varones de 12 años que acudieron al Servicio de Urgencias de nuestro hospital presentando dolor, edema y eritema en un hemiescroto sin recordar antecedente traumático previo. RESULTADOS: A la exploración de ambos pacientes se puede observar los hemiescrotos enrojecidos y aumentados de tamaño pero con testes y epidídimos normales. Con el diagnóstico de escroto agudo se les efectuaron unas ecografías en las que se pudo ver un edema heterogéneo en piel escrotal con flujo Doppler aumentado y testes ecográficamente normales. CONCLUSIONES: El edema de escroto agudo idiopático es una patología autolimitada que afecta básicamente a niños prepúberes que debe ser incluida en el diagnostico diferencial del escroto agudo para evitar intervenciones más agresivas innecesarias

OBJECTIVE: To report two cases of acute idiopathic scrotal edema. METHODS: We describe the cases of two 12-year-old male patients presenting at the emergency department of our hospital with pain, edema and erythema in one hemiscrotum without history of trauma. RESULTS: On physical examination both patients showed red hemiscrotum skin and increase of the size with normal testicles and epididymis. With the diagnosis of acute scrotum testicular ultrasound were performed and showed heterogeneous edema of the scrotal skin with increased in Doppler flows and normal testicles. CONCLUSIONS: Acute idiopathic scrotal edema is a self-limited pathology which basically affects children before puberty and should be included in the differential diagnosis of acute scrotum to avoid aggressive interventions

[Bilateral synchronic testicular tumor with germ cell intratubular neoplasia foci: case report]. / Tumor testicular bilateral sincrónico con focos de neoplasia intratubular de células germinales: presentación de un caso.

OBJECTIVE: To report one case of bilateral synchronic testicular tumor with germ cell intratubular neoplasia foci affecting both testicles. METHODS: We describe the case of a 29-year-old male presenting with a painless tumor in the left testicle for a month. With the suspect of testicular tumor scrotal ultrasound, tumor markers and extension study to rule out metastasis were performed. RESULTS: Ultrasound showed a hypertrophic left testicle with a lesion suspect for neoplasia, and incidental diagnosis of a hypoechoic lesion with augmented Doppler flow within the right testicle. Bilateral orchyectomy was performed with the pathologic diagnosis of classic seminoma with germ cell intratubular neoplasia foci in both testicles. Treatment was completed with two cycles of chemotherapy. CONCLUSIONS: Bilateral synchronic testicular tumors are very rare. The most frequent histological type is classic seminoma. The diagnosis and treatment are similar to unilateral testicular tumors except certain cases in which partial excision of the testicle may be considered.

[Results of the surgical treatment of benign prostatic hyperplasia in geriatric patients]. / Resultados del tratamiento quirúrgico de la patología prostática benigna en pacientes geriátricos.

OBJECTIVES: To evaluate the effect of age in morbidity-mortality and outcomes of the surgical treatment of benign prostatic hyperplasia (BPH). METHOD: We performed a retrospective analysis of the medical records of 305 patients over 70 years undergoing surgery for BPH between 1999-2003, grouped in four categories depending on ages 70-80 years and over 80, and type of surgery (transurethral resection or open prostatectomy). The variables evaluated were: American society of anesthesiologists (ASA) operative risk classification, surgical indication, preoperative factors, postoperative outcome and follow-up. Statistical analysis was carried out with the Anova and chi-square tests (p = 0.05). RESULTS: Open prostatectomy was performed in 59.1% of the cases and transurethral resection in the other 40.9%. 98.4% of the patients showed some degree of comorbidity. Indwelling transurethral catheter was the main clinical feature of patients undergoing surgery over 80 years of age; the main characteristic in patients between 70-80 years was the existence of severe symptoms. Urological complications appeared more frequently than general complications (14% vs. 10.1%). The most frequent urological complications were mild, mainly inflammatory-infectious diseases. Urological and general complications were more frequently observed in the open prostatectomy group, with no differences between ages. Patient satisfaction was high in the four groups (84.8%-96.2%). No case of perioperative mortality happened and only one patient died in the immediate post operative period. CONCLUSIONS: We think the differences observed cannot be attributed to chronological age as clinical risk factor. Therefore, these patients could benefit of a definitive surgical treatment which will improve their quality of life.

Tumor testicular bilateral sincrónico con focos de neoplasia intratubular de células germinales: presentación de un caso / Bilateral synchronic testicular tumor with germ cell intratubular neoplasia foci: case report

OBJETIVOS: Presentar un caso de tumor testicular bilateral sincrónico con focos de Neoplasia Intratubular de Células Germinales (NICG) en ambos testículos. METODOS: Describimos el caso de un varón de 29 años que presenta tumoración indolora de un mes de evolución en teste izquierdo. Bajo la sospecha de tumor testicular se le realiza una ecografía escrotal, una determinación de marcadores tumorales y un estudio de extensión tumoral. RESULTADOS: En la ecografía se puede ver un teste izquierdo hipotrófico con lesión sospechosa de neoplasia e, incidentalmente, un testículo derecho con una lesión hipoecoica y aumento de flujo doppler. Se le practicó una orquiectomía bilateral con el diagnóstico de anatomía patológica de seminoma clásico con focos de Neoplasia Intratubular de Células Germinales (NICG) en ambos testículos y se completó el tratamiento con 2 ciclos de quimioterapia. CONCLUSIONES: Los tumores testiculares bilaterales sincrónicos son muy infrecuentes. El tipo histológico más frecuente es el seminoma clásico. El diagnóstico y tratamiento es similar al de los tumores testiculares unilaterales excepto en determinados casos en los que se puede plantear la resección parcial del testículo (AU)

OBJECTIVE: To report one case of bilateral synchronic testicular tumor with germ cell intratubular neoplasia foci affecting both testicles. METHODS: We describe the case of a 29-year-old male presenting with a painless tumor in the left testicle for a month. With the suspect of testicular tumor scrotal ultrasound, tumor markers and extension study to rule out metastasis were performed. RESULTS: Ultrasound showed a hypertrophic left testicle with a lesion suspect for neoplasia, and incidental diagnosis of a hypoechoic lesion with augmented Doppler flow within the right testicle. Bilateral orchyectomy was performed with the pathologic diagnosis of classic seminoma with germ cell intratubular neoplasia foci in both testicles. Treatment was completed with two cycles of chemotherapy. CONCLUSIONS: Bilateral synchronic testicular tumors are very rare. The most frequent histological type is classic seminoma. The diagnosis and treatment are similar to unilateral testicular tumors except certain cases in which partial excision of the testicle may be considered

Resultados del tratamiento quirúrgico de la patología prostática benigna en pacientes geriátricos / Results of the surgical treatment of benign prostatic hyperplasia in geriatric patients

OBJETIVOS: Valorar el efecto de la edad en la morbi-mortalidad y en el resultado del tratamiento quirúrgico de la hiperplasia benigna de próstata. METODOS: Se ha realizado un estudio retrospectivo, 1999-2003, con una muestra de 305 pacientes mayores de 70 años de edad, con diagnóstico histológico de hiperplasia benigna de próstata intervenidos por resección transuretral de próstata o cirugía abierta. Valorando en cuatro grupos de pacientes, entre 70-80 años de edad y mayores de 80 años de edad para ambas técnicas quirúrgicas, las siguientes variables: ASA, indicación quirúrgica, factores relacionados con la cirugía, la evolución postoperatoria y en el seguimiento. Se ha utilizado como estadísticos el test Anova y χ2 con un nivel de confianza del 95%. RESULTADOS: En nuestra serie se llevó a cabo cirugía abierta en el 59.1% de los casos y resección transuretral de próstata en el 40.9%. El 98.4% de los pacientes presentaba algún grado de comorbilidad. La sonda vesical permanente era la principal indicación quirúrgica en pacientes mayores de 80 años de edad, mientras que el prostatismo severo lo era para los pacientes entre 70-80 años de edad. Las complicaciones urológicas son más frecuentes que las complicaciones generales, 14% y 10.1% respectivamente. Las complicaciones urológicas más frecuentes son las menos graves, sobre todo inflamatorio-infecciosas. Además se observa que las complicaciones urológicas y las generales se dan sobre todo en el grupo de cirugía abierta sin encontrar diferencias significativas según el grupo de edad. La satisfacción es elevada en todos los grupos (84.8%-96.2%). No ocurrió ningún éxitus perioperatorio, y sólo un paciente falleció en el postoperatorio inmediato. CONCLUSIONES: Pensamos que las diferencias observadas no deben atribuirse a la edad cronológica per se entendida como factor de riesgo clínico. Por lo tanto, estos pacientes pueden beneficiarse de un tratamiento quirúrgico resolutivo consiguiendo mejorar su calidad de vida (AU)

OBJECTIVES: To evaluate the effect of age in morbidity-mortality and outcomes of the surgical treatment of benign prostatic hyperplasia (BPH). METHOD: We performed a retrospective analysis of the medical records of 305 patients over 70 years undergoing surgery for BPH between 1999-2003, grouped in four categories depending on ages 70-80 years and over 80, and type of surgery (transurethral resection or open prostatectomy). The variables evaluated were: American society of anesthesiologists (ASA) operative risk classification, surgical indication, preoperative factors, postoperative outcome and follow-up. Statistical analysis was carried out with the Anova and chi-square tests (p = 0.05). RESULTS: Open prostatectomy was performed in 59.1% of the cases and transurethral resection in the other 40.9%. 98.4% of the patients showed some degree of comorbidity. Indwelling transurethral catheter was the main clinical feature of patients undergoing surgery over 80 years of age; the main characteristic in patients between 70-80 years was the existence of severe symptoms. Urological complications appeared more frequently than general complications (14% vs. 10.1%). The most frequent urological complications were mild, mainly inflammatory-infectious diseases. Urological and general complications were more frequently observed in the open prostatectomy group, with no differences between ages. Patient satisfaction was high in the four groups (84.8%-96.2%). No case of perioperative mortality happened and only one patient died in the immediate post operative period. CONCLUSIONS: We think the differences observed cannot be attributed to chronological age as clinical risk factor. Therefore, these patients could benefit of a definitive surgical treatment which will improve their quality of life

[Fournier's gangrene]. / Gangrena de Fournier.

OBJECTIVES: We report a retrospective review of the case series of Fournier's gangrene treated in our department from November 1996 to October 2004. METHODS/RESULTS: We studied nine male patients with ages between 21 and 85 years (mean 55 years). 66% of the patients had associated risk factors, and the underlying cause was identified in 56% of the cases. Mean hospital stay was 21 days and two of the patients died from the disease. CONCLUSIONS: Fournier's gangrene is an infection with a very fast evolution, producing necrotizing fascitis of the external genitalia and perineum. It has a high mortality rate, mainly if diagnosis and treatment are deferred. This last includes wide spectrum antibiotic coverage, surgical treatment with debridement and drainage, and, in many cases, a second surgical intervention for reconstructive plasties.

Gangrena de Fournier / No disponible

OBJETIVOS: Presentamos una revisión de los casos de gangrena de Fournier tratados en nuestro servicio desde noviembre de 1996 hasta octubre de 2004. MÉTODO/RESULTADOS: Estudiamos nueve pacientes, todos varones, con edad comprendida entre 21 y 85 años (media 55). En el 66% tenían factores de riesgo y en el 56% de los casos se identificó la causa subyacente. Su estancia media fue de 21 días y destacamos que se produjeron dos defunciones. CONCLUSIÓN: La gangrena de Fournier es una infección de muy rápida evolución que cursa con fascitis necrotizante de los genitales externos y el periné. Tiene una alta mortalidad, sobre todo, si se demora su diag- nóstico y tratamiento. Éste se basa en una cobertura antibiótica agresiva de amplio espectro, en un tratamiento quirúrgico con desbridamiento y drenaje, y, en muchos casos, un segundo tiempo quirúrgico para las plastias correctoras (AU)

OBJECTIVES: We report a retrospective review of the case series of Fournier’s gangrene treated in our department from November 1996 to October 2004. METHODS/RESULTS: We studied nine male patients with ages between 21 and 85 years (mean 55 years). 66% of the patients had associated risk factors, and the underlying cause was identified in 56% of the cases. Mean hospital stay was 21 days and two of the patients died from the disease. CONCLUSIONS: Fournier’s gangrene is an infection with a very fast evolution, producing necrotizing fascitis of the external genitalia and perineum. It has a high mortality rate, mainly if diagnosis and treatment are deferred. This last includes wide spectrum antibiotic coverage, surgical treatment with debridement and drainage, and, in many cases, a second surgical intervention for reconstructive plasties (AU)

[Leydig cell tumor: our experience. Bibliographic review]. / Tumor de células de Leydig: nuestros casos y revisión de la literatura.

OBJECTIVES: To report the case-series of Leydig cell tumors diagnosed at our center, and to perform a bibliographic review on the topic. METHODS: Retrospective review of the clinical records of all patients with the diagnosis of Leydig cell tumor in our center over the last 12 years. We evaluated the clinical, diagnostic and therapeutic features, as well as outcomes. RESULTS: Four patients were diagnosed and treated in our department over this period. Mean patient age of the time of diagnosis was 51 years. Each of our cases have a different presentation. The two patients who underwent sperm analysis had azoospermia. None of the cases showed anomalous hormonal studies. Seventy-five percent of the cases showed ultrasound signs compatible with testicular neoplasia. In all of them surgical treatment was undertaken (inguinal orchyectomy); one of the patients underwent chemotherapy due to metastasis, having a good response. Mean follow-up is 76 months. CONCLUSIONS: It is a rare testicular tumor. Inguinal orchyectomy is the treatment of choice. Its good outcome is remarkable.

Tumor de células de Leyding: nuestros casos y revisión de la literatura / Leydig cell tumor: our experience. Bibliographic review

OBJETIVO: Aportar los casos de tumores de células de Leydig diagnosticados en nuestro Centro, revisando la literatura del tema. MÉTODOS: Estudio retrospectivo de las historias clínicas de los pacientes diagnosticados de tumor de células de Leydig en nuestro Centro en los 12 últimos años. Se valoran los aspectos clínicos, diagnósticos y terapéuticos, así como su evolución. RESULTADOS: Cuatro pacientes fueron diagnosticados y tratados en nuestro Servicio durante este periodo. La edad media de los pacientes en el momento del diagnóstico fue de 51 años. Cada uno de nuestros casos debutó con una manifestación diferente. Los dos casos en los que se realizó espermiograma presentaban azoospermia total. Ningún caso mostró alteraciones en el estudio hormonal. El 75 % presentaba signos ecográficos compatibles con neoplasia testicular. En todos ellos se llevó a cabo tratamiento quirúrgico (orquiectomía vía inguinal), siendo necesario en uno de los pacientes llevar a cabo tratamiento con poliquimioterapia por metástasis, con buena respuesta a la misma. La media de seguimiento ha sido de 76 meses. CONCLUSIONES: Se trata de un tumor testicular poco frecuente. La orquiectomía inguinal es el tratamiento de elección. Destaca su buena evolución

OBJECTIVES: To report the case-series of Leydig cell tumors diagnosed at our center, and to perform a bibliographic review on the topic. METHODS: Retrospective review of the clinical records of all patients with the diagnosis of Leydig cell tumor in our center over the last 12 years. We evaluated the clinical, diagnostic and therapeutic features, as well as outcomes. RESULTS: Four patients were diagnosed and treated in our department over this period. Mean patient age of the time of diagnosis was 51 years. Each of our cases have a different presentation. The two patients who underwent sperm analysis had azoospermia. None of the cases showed anomalous hormonal studies. Seventy-five percent of the cases showed ultrasound signs compatible with testicular neoplasia. In all of them surgical treatment was undertaken (inguinal orchyectomy); one of the patients underwent chemotherapy due to metastasis, having a good response. Mean follow-up is 76 months. CONCLUSIONS: It is a rare testicular tumor. Inguinal orchyectomy is the treatment of choice. Its good outcome is remarkable

[Ureteral actinomycosis. Case report]. / Actinomicosis ureteral. A propósito de un caso.

OBJECTIVES: To report one case of pseudotumoral lesion of the iliac ureter with obstructive uropathy leading to loss of function of the renal unit. METHODS: 66-year-old male being studied for BPH who presents with a self-limited monosymptomatic hematuria. RESULTS: Renal ultrasound detected grade II pyelocaliectasis of the right kidney. IVU showed absence of function of the right kidney. Urine cytology was consistent with low-grade transitional cell carcinoma. Percutaneous nephrostomy was performed confirming irreversible function loss. Antegrade pyelography showed a filling defect in the right iliac ureter. Radical nephroureterectomy with bladder cuff was carried out with good results. Pathology reported chronic pyelonephritis and parietal inflammatory lesion of the ureter obliterating the lumen with inflammatory infiltrates, urothelial erosion and presence of actinomyces. CONCLUSIONS: Actinomycosis is a chronic bacterial infection, with A. israeli being the most common pathogen. It is part of the normal flora of the oral cavity and GI tract, and cervical-facial region is the most frequent clinical involvement (60% of the cases). Urinary tract infection is exceptional. No other focus was found in the long-term follow-up.

Actinomicosis ureteral. A propósito de un caso / Ureteral actinomycosis. Case report

OBJETIVO: Comunicar un caso de uropatíaobstructiva que evolucionó a anulación funcional renalpor lesión pseudotumoral en uréter iliaco.METODOS: Varón de 66 años en estudio por HBP, presentaepisodio autolimitado de hematuria monosintomática.RESULTADOS: En estudio ecográfico se detecta ureteropielocaliectasiagrado II RD; U.I.V. demuestra anulaciónfuncional RD.Citología de orina compatible con carcinomade células transicionales de bajo grado. Se realizanefrostomía percutánea que confirma la pérdida funcionalirreversible. La pielografía descendente muestra defectode replección a nivel de uréter iliaco derecho. El pacientees intervenido quirúrgicamente practicándosele nefroureterectomíaradical con cistectomía perimeática, con buenaevolución postoperatoria. El dictamen histopatológico dela pieza es de pielonefritis crónica y lesión inflamatoriaparietal ureteral que oblitera la luz con infiltrado inflamatorio,erosión de urotelio y presencia de actinomices.CONCLUSIONES: La actinomicosis es una infección bacterianacrónica cuyo patógeno más común es A.israelii.Se encuentra como comensal en la cavidad oral y tubodigestivo y la. afectación clínica más frecuente es laregión cervicofacial (60% casos) La infección del tractourinario es excepcional y en la evolución del paciente alargo plazo no se ha constatado ningún otro foco

OBJECTIVES: To report one case of pseudotumoral lesion of the iliac ureter with obstructive uropathy leading to loss of function of the renal unit. METHODS: 66-year-old male being studied for BPH who presents with a self-limited monosymptomatic hematuria. RESULTS: Renal ultrasound detected grade II pyelocaliectasis of the right kidney. IVU showed absence of function of the right kidney. Urine cytology was consistent with low-grade transitional cell carcinoma. Percutaneous nephrostomy was performed confirming irreversible function loss. Antegrade pyelography showed a filling defect in the right iliac ureter. Radical nephroureterectomy with bladder cuff was carried out with good results. Pathology reported chronic pyelonephritis and parietal inflammatory lesion of the ureter obliterating the lumen with inflammatory infiltrates, urothelial erosion and presence of actinomyces. CONCLUSIONS: Actinomycosis is a chronic bacterial infection, with A. israeli being the most common pathogen. It is part of the normal flora of the oral cavity and GI tract, and cervical-facial region is the most frequent clinical involvement (60% of the cases). Urinary tract infection is exceptional. No other focus was found in the long-term follow-up