[Gunshot bladder trauma: case report and literature review]. / Traumatismo vesical por arma de fuego: presentación de un caso y revisión de la literatura.

OBJECTIVE: To report one case of gunshot bladder trauma and to review its diagnosis and treatment in the related literature. METHODS: We report the case of a 43-year-old-male with an abdominal firearm wound and gross haematuria. Imaging diagnosis by abdominal and pelvic CT and CT-cystography. Surgical treatment. RESULTS: CT-cystography showed extraperitoneal bladder rupture. Exploratory laparotomy to evaluate for other associated injuries. Bladder wall surgical closure and ureteroneocystostomy with transvesical technique because of complete distal ureter tear. Broad spectrum antibiotherapy. Favourable progress. The patient was discharged at 14th day. CONCLUSIONS: Firearm bladder traumas are a rare entity. Surgical exploration and closure is mandatory. In haemodynamicaly stable patients, abdomen and pelvis CT and CT-cystography allow us to rule out associated injuries and to classify the bladder trauma type. Ureteral damage associated in 5-8,9%, diagnosed during surgical exploration. Broad-spectrum antibiotherapy in all patients.

Traumatismo vesical por arma de fuego: presentación de un caso y revisión de la literatura / Gunshot bladder trauma: case report and literature review

Objetivo: Presentar un caso de traumatismo vesical por arma de fuego y revisar aspectos diagnósticos y terapéuticos en la literatura relacionada. Material y métodos: Presentamos el caso de un varón de 43 años con herida abdominal por arma de fuego y hematuria macroscópica. Diagnóstico de imagen mediante TC abdómino-pélvico y TC-cistografía. Tratamiento quirúrgico. Resultados: Rotura vesical extraperitoneal en TC-cistografía. Laparotomía exploradora para descartar lesiones asociadas. Cierre quirúrgico de la pared vesical y ureteroneocistostomía con técnica transvesical por desinserción ureteral distal. Antibioterapia de amplio espectro. Evolución favorable. Alta al 14º día. Conclusiones: Los traumatismos vesicales por arma de fuego son una entidad poco frecuente. Debe realizarse exploración y cierre quirúrgico de la perforación vesical en todos los casos. En pacientes estables hemodinámicamente, TC abdómino-pélvico y TC-cistografía permiten descartar lesiones asociadas y clasificar el tipo de traumatismo vesical. Daño ureteral asociado en 5-8,9%, diagnosticado intraoperatoriamente. Antibioterapia intravenosa de amplio espectro en todos los pacientes

Objetive: To report one case of gunshot bladder trauma and to review its diagnosis and treatment in the related literature. Methods: We report the case of a 43-year-old-male with an abdominal firearm wound and gross haematuria. Imaging diagnosis by abdominal and pelvic CT and CT-cystography. Surgical treatment. Results: CT-cystography showed extraperitoneal bladder rupture. Exploratory laparotomy to evaluate for other associated injuries. Bladder wall surgical closure and ureteroneocystostomy with transvesical technique because of complete distal ureter tear. Broad spectrum antibiotherapy. Favourable progress. The patient was discharged at 14th day. Conclusions: Firearm bladder traumas are a rare entity. Surgical exploration and closure is mandatory. In haemodynamicaly stable patients, abdomen and pelvis CT and CT-cystography allow us to rule out associated injuries and to classify the bladder trauma type. Ureteral damage associated in 5- 8,9%, diagnosed during surgical exploration. Broad-spectrum antibiotherapy in all patients

[Atypical sites of metastatic renal carcinoma. Literature review]. / Carcinoma renal metastásico de localización atípica. Revisión de la literatura.

OBJECTIVE: To review in the literature atypical sites of metastatic renal cell carcinoma, its onset, clinical features, diagnosis, treatment and prognosis. METHODS: To review, using Medline database, atypical sites of metastatic renal cell carcinoma in the last five years Spanish literature. RESULTS: There have been published 15 spanish articles about atypical metastatic renal cell carcinoma in the last five years. Most patients were male with a mean age of 62,3 years and methacronous metastases. Imaging and pathological diagnosis. Main sites: ocular, renal graft, larynx, suprarenal, brain, penis, gastric and pancreatic. Surgical treatment if the surgeon is able to remove the lesion. Inmunotherapy and radiotherapy in the rest of cases. CONCLUSIONS: Renal cell carcinoma represents about 3% of all adult malignancy neoplasms. Its metastatic sites, in order of frequency, are lung, bone and liver, whether synchronic or methacronic. Its location, clinical features, onset, evolution and prognosis is very variable. Individualized diagnostic and therapeutic approach, according to prognostic factors. The knowledge of this atypical sites in patients with renal cell carcinoma in the past can lead us to an earlier diagnosis and treatment which could change the evolution of the illness.

Carcinoma renal metastásico de localización atípica. Revisión de la literatura / Atypical sites of metastatic renal carcinoma. Literature review

Objetivo: Revisar en la literatura localizaciones metastásicas atípicas de carcinoma de células renales, su momento de presentación, características clínicas, diagnóstico, tratamiento y pronóstico. Material y Métodos: Revisión, en la literatura en lengua castellana de los últimos cinco años, de localizaciones atípicas de metástasis de carcinoma de células renales. Búsqueda realizada en la base bibliográfica Medline. Resultados: En los últimos cinco años se han publicado 15 artículos en lengua castellana sobre metástasis atípicas de carcinoma de células renales. Pacientes de predominio masculino con edad media de 62,3 años. Metástasis en su mayoría metacrónicas diagnosticadas mediante pruebas de imagen con confirmación histológica. Localizaciones principales: intraocular, injerto renal, laríngea, suprarrenal, etmoidal, escrotal, cerebral, peneana, gástrica y pancreática. Tratamiento quirúrgico en lesiones resecables. Paliativo con inmuno-radioterapia en el resto. Conclusiones: El carcinoma de células renales representa el 3% de todas las neoplasias malignas del adulto. Metastatiza, por orden de frecuencia, a pulmones, hueso e hígado, pudiendo ser sincrónicas o metacrónicas. El carcinoma de células renales metastásico tiene una amplia variabilidad en cuanto a localización, clínica, momento de presentación, evolución y pronóstico. El abordaje diagnóstico-terapéutico debe ser individualizado, en función de factores pronósticos. El conocimiento de estas localizaciones atípicas en pacientes con antecedentes de carcinoma de células renales influirá en un diagnóstico y tratamiento precoces pudiendo modificar el curso evolutivo de la enfermedad (AU)

Objective: To review in the literature atypical sites of metastatic renal cell carcinoma, its onset, clinical features, diagnosis, treatment and prognosis. Methods: To review, using Medline database, atypical sites of metastatic renal cell carcinoma in the last five years Spanish literature. Results: There have been published 15 spanish articles about atypical metastatic renal cell carcinoma in the last five years. Most patients were male with a mean age of 62,3 years and methacronous metastases. Imaging and pathological diagnosis. Main sites: ocular, renal graft, larynx, suprarenal, brain, penis, gastric and pancreatic. Surgical treatment if the surgeon is able to remove the lesion. Inmunotherapy and radiotherapy in the rest of cases. Conclusions: Renal cell carcinoma represents about 3% of all adult malignancy neoplasms. Its metastatic sites, in order of frequency, are lung, bone and liver, whether synchronic or methacronic. Its location, clinical features, onset, evolution and prognosis is very variable. Individualized diagnostic and therapeutic approach, according to prognostic factors. The knowledge of this atypical sites in patients with renal cell carcinoma in the past can lead us to an earlier diagnosis and treatment which could change the evolution of the illness (AU)

[Female urinary stress incontinence: transobsturator technique]. / Cabestrillo suburetral transobturatriz en el tratamiento de la incontinencia urinaria de esfuerzo femenina.

The wide use of retropubic TVT has been associated with various complications. To avoid these, alternative procedures have been developed and continence rates obtained with these new routes have been quite similar to those after classic TVT. In the transobsturator technique (TOT) described by Delorme and colleagues in 2001, the tape is inserted through the obturator foramens from outside to inside and is positioned without tension under the urethra. Another surgical technique allows the passage of a tape from inside to outside. The aim of this paper is to describe a new, simple surgical technique for the treatment of female urinary stress incontinence and to evaluate its feasibility.

[Ureteral implantation in peritoneum. Exceptional complication in renal transplantation]. / Implantación ureteral en peritoneo. Una complicación excepcional en el trasplante renal.

Because of the extraperitoneal location, generally used for renal grafting, intraperitoneal urine leaks are a rare complication after transplantation. We report a patient on peritoneal dialysis who developed ascites, abdominal pain, anuria and shock suddenly after renal transplantation. The patient was immediately taken back to the operating room. An abnormal implantation of ureter into the peritoneum overlying the bladder when carrying out an unstented parallel incision extravesical ureterone-ocystostomy was identified. After correcting ureter implantation the patient had immediate diuresis, renal function rapidly improved, with no further complications. Contributing causes were poor exposure, thickened peritoneum secondary to recurrent peritonitis, and the presence of residual peritoneal dialysis fluid.

Priapismo

El priapismo es una urgencia urológica poco frecuente que puede estar en relación con dos mecanismos fisiopatológicos claramente diferenciados: obstrucción de la salida venosa de los cuerpos cavernosos(priapismo venooclusivo) o bien por la llegada a aquéllos de un exceso de flujo arterial (priapismo arterial). En el abordaje inicial es fundamental distinguir si nos enfrentamos a un tipo u otro: el primero, mucho más frecuente, requiere una actuación urgente ya que, a medida que pasen las horas, se asociará a un mayor riesgo de disfunción eréctil permanente, mientras que el segundo, al no provocar isquemia, permite diferir el tratamiento (AU)

[Carcinosarcoma of the renal pelvis: report of a case and review of the literature]. / Carcinosarcoma de pelvis renal: aportación de un caso y revisión de la literatura.

Carcinosarcomas arising in the renal pelvis are uncommon neoplasms. All previously reported cases are isolated reports and have shown to carry a poor prognosis. We report a new case of a 59-year-old man, describing the clinical, radiological and histopathological features.

Implantación ureteral en peritoneo. Una complicación excepcional en el trasplante renal / Ureteral implantation into periotoneum. An unusual complication of kidney transplantation

En el trasplante renal la fuga de orina intraperitoneal es una complicación rara, debido a la implantación habitual en retroperitoneo. Informamos del caso de un paciente en diálisis peritoneal que inmediatamente al trasplante presenta ascitis, dolor abdominal, anuria y shock. Con rapidez es llevado de nuevo a quirófano. Se identificó una implantación del uréter en peritoneo y no en vejiga, en el curso de una ureteroneocistostomía extravesical no tutorizada. Después de corregir la implantación ureteral el paciente recuperó la diuresis, mejoró rápidamente su función renal, sin más complicaciones. Fueron factores contribuyentes la limitada exposición, el engrosamiento peritoneal secundario a peritonitis recurrente y la presencia de fluido de diálisis peritoneal residual (AU)

Carcinosarcoma de pelvis renal: aportación de un caso y revisión de la literatura / Carcinosarcoma of the renal pelvis: report of a case and literature review

Los carcinosarcomas que se originan en la pelvis renal son neoplasias infrecuentes. Todos los casos previamente publicados han sido casos aislados y se caracterizaron por su mal pronóstico. Nosotros aportamos un nuevo caso en un hombre de 59 años de edad, describiendo los aspectos clínicos, radiológicos e histopatológicos (AU)

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Histiocitoma fibroso maligno vesicoprostático / Malignant fibrous histiocytoma of bladder and prostate

Dentro de los sarcomas vesicales del adulto, el histiocitoma fibroso maligno constituye una variedad histológica extremadamente rara. Presentamos un caso con afectación simultánea de vejiga y próstata en un varón de 25 años, que fue tratado favorablemente con cirugía radical y poliquimioterapia. Así mismo, revisamos la bibliografía existente hasta la fecha sobre estas neoplasias (AU)

Hemangiopericitoma retroperitoneal gigante / Giant retroperitoneal hemangiopericytoma

Presentamos un nuevo caso de hemangiopericitoma retroperitoneal con la peculiaridad del gran tamaño de la tumoración. Debido a esto y al llamativo aporte vascular se procedió a una embolización arterial preoperatoria, que facilitó su extirpación completa. Realizamos una revisión bibliográfica reflejando los aspectos clínicos, patológicos y terapéuticos fundamentales de estos tumores (AU)

[Malignant vesico-prostatic fibrous histiocytoma]. / Histiocitoma fibroso maligno vesicoprostático.

Among the adult bladder sarcomas it's extremely rare as an histological variety the malignant fibrous histiocytoma. We present a case of a 25 years old young male with bladder and prostate both affected, successfully treated with radical surgery and poliquimiotherapy. We also reviewed the bibliography about this neoplasias up to now.

[Giant retroperitoneal hemangiopericytoma]. / Hemangiopericitoma retroperitoneal gigante.

We present a new case of retroperitoneal hemangiopericytoma with the special feature of a big size tumour. Due to this feature and also to the hypervascularitation we proceeded a preoperative arterial embolization that made possible its complete removal. We did a bibliographic review showing the fundamental clinic pathologic and therapeutical basic aspects of this tumours.

Torsión testicular: ¿qué sutura utilizar? / Testicular torsion: wich type of suture must be used?

Presentamos un caso de torsión testicular izquierda ocurrida cuatro meses después de un cuadro similar homolateral en el que se realizó detorsión y fijación bilateral de ambos testículos. La orquidopexia previa se realizó con seda 3-0 y fijación transeptal del testículo contralateral. El antecedente de orquidopexia bilateral no debe influir en el diagnóstico diferencial en el escroto agudo. La fijación creemos que debe realizarse con sutura irreabsorbible en tres localizaciones entre el testículo y el músculo dartos, y se debe realizar exploración del hemiescroto contralateral (AU)

[Testicular torsion: which suture should be used?]. / Torsión testicular: qué sutura utilizar?

We report a case of left testicular torsion four months after a similar homolateral case in which we did detorsion and bilateral fixation of both testicles. The antecedent orchiopexy was accomplished using 3-0 silk and transseptal fixation of the contralateral testicle. A history of bilateral orchiopexy should nor interfere with diagnosing torsion in the acute scrotum. We recommend the use of nonabsorbable suture material joining the testis to the dartos muscle in 3 locations and the contralateral hemiscrotum must be explored.

[Penile fracture involving cavernous bodies and urethra]. / Fractura de pene con afectación de cuerpos cavernosos y uretra.

Reports on fracture of the penis are scarce in the spanish urological literature and in most cases injury appear limited to the corpora cavernosa. In this report a case of rupture of both corpora cavernosa and the urethra during sexual intercourse is presented. Early surgical treatment rendered good results. A literature review on currently recommended diagnostic and treatment practices is presented.

[Current overview of the treatment of postmyelomeningocele neurogenic bladder]. / Panorama actual del tratamiento de la vejiga neurogénica postmielomeningocele.

OBJECTIVE: The present article reviews the current therapeutic modalities for neurogenic bladder secondary to myelomeningocele. METHODS: The procedures utilized in the treatment of neurogenic bladder are described. The results achieved by the artificial urinary sphincter in 43 patients are presented. RESULTS: Most of the patients were 8 to 20 years of age at the time the artificial urinary sphincter was implanted. A complementary surgical procedure was required in 11 patients and 10 have been included in the program of intermittent catheterization. Few complications have been observed. CONCLUSION: The implantation of an artificial sphincter can enhance the quality of life of incontinent patients that meet the appropriate clinical and urodynamic criteria.

[New report of epididymal adenomatoid tumor. Infrequent pathology]. / Nueva aportación de un tumor adenomatoide de epididimo. Una patología poco frecuente.

Case report of a 42-year old patient with an epididymal adenomatoid tumour found after a three-month history of increased left hemiscrotum and scrotal discomfort. Definite diagnosis was arrived at following surgical exeresis and pathoanatomical study. The etiopatogenesis, clinical presentation and management are all analyzed. Since urological incidence is very low within intrascrotal processes, we believe it is important to understand the condition so that a differential diagnosis from other inflammatory processes can be established; also the convenience of a much more aggressive attitude in scrotal diseases is restated due to the low morbidity of this type of surgery.

[A fibroepithelial polyp of the ureter. A report of 2 new cases]. / Pólipo fibroepitelial del ureter. Aportación de dos nuevos casos.

Primal neoplasias of the ureter are very rare and account for less than 1% of all genitourinary tumours. Only 20% of them are benign, and the fibroepithelial lineage is the more frequent. We contribute two cases of fibroepithelial polyps of the ureter; a brief comment on the etiology of these lesions, the routine diagnosis procedures and current therapeutical options is presented. Due to breakthroughs in radiologic and endoscopic techniques for the upper urinary tract, a more precise pre-operative diagnosis of these lesions has been achieved as well as a more conservative therapy which avoids incorrect and unnecessary nephroureterectomies, so frequent in past times, considering the benign nature of this unusual pathology.