[Renal carcinoma with vena cava invasion. A new case]. / Carcinoma renal con invasión de vena cava. Un nuevo caso.

It is well known that the renal carcinoma can progress to the renal vein and cava. The MRI is the most accurate study in order to assay the extension of the thrombus. The surgical management is based on the extension and location of the thrombus. New immunologic-based treatment is now being tested. We describe our experience with surgical management of the one case of renal carcinoma with cava vein thrombus. No evidence of progression is noted after 18 month follow up.

Carcinoma renal con invasión de vena cava. Un nuevo caso / Renal carcinoma with vena cava invasion. A case report

El tumor de células renales presenta una intensa predisposición a crecer hacia la vena renal y vena cava. Cuando existe trombo tumoral en la vena cava es fundamental delimitar su extensión, y para ello contamos con la R.M.N. como la exploración más precisa. La vía de acceso quirúrgico y la técnica utilizada para la exéresis viene radicalmente determinada por la localización y extensión del tumor. En los últimos años se ha abierto una nueva esperanza terapéutica con los tratamientos de base inmunológica. Presentamos un caso de tumor de células renales con trombo en la vena cava tratado quirúrgicamente, y con un seguimiento de 18 meses, sin evidencia de recidiva ni extensión a distancia (AU)

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[Albuginea plication in the treatment of penile curvature]. / Plicatura de la albugínea como tratamiento para la incurvación de pene.

Presentation of the results obtained by our team in the treatment of 22 cases of penial incurvation (11 congenital and 11 secondary to Peyronie's Disease) using the albuginea plication technique. Evaluation of post-operative results taking into account both subjective (extent of satisfaction, comfort during the post-operative etc.) and objective (post-operative complications, degree of correction, reincurvation or failure etc.) factors was done by a follow-up programme through the out-patients practices using a Questionnaire-Survey system. Presentation of results obtained and detailed discussion of each case. The conclusions were as follows: Albuginea plication is a safe technique that achieves total penis redressment, with no post-operative complications. The extent of satisfaction and success obtained exceed 85%, and can be increased by improving the pre-operative selection and providing correct and precise information on what can be resolved with this technique.

[Paratesticular adenomatoid tumor]. / Tumor adenomatoide paratesticular.

OBJECTIVE: To report a case of paratesticular tumor involving the right testis. METHODS/RESULTS: A middle-aged male with a small paratesticular tumor involving the right testis is described. Treatment was by transscrotal surgical excision. The histological analysis of the surgical specimen disclosed a mesothelial tumor and no evidence of malignancy. CONCLUSION: Although the preoperative diagnosis of adenomatoid tumor is relatively simple when the epididymis is involved, localization in the testis is relatively difficult to determine. Surgical exploration of all intrascrotal and intratesticular tumors are advocated due to the risk of malignancy.

[Non-instrumental traumatism of the urethra: our experience]. / Traumatismos no instrumentales de la uretra: nuestra experiencia.

OBJECTIVES: To report our experience in the diagnosis and treatment of this type of urologic trauma. The results are analyzed in order to determine the best therapeutic approach and the literature reviewed. METHODS: The series comprised 9 males; 6 had rupture of the posterior urethra and 3 had anterior urethral trauma. Four cases underwent suprapubic drainage and delayed definitive treatment; early realignment of the urethra was performed in 3 cases, and the only patient with a penetrating injury immediately underwent a repair procedure. Urethral urethrotomy sufficed in one patient with partial rupture of the anterior urethra. Delayed treatment consisted of end-to-end anastomosis; one patient required pubic partial resection. RESULTS: Good results were achieved by end-to-end anastomosis; 3 patients have been discharged and one required internal urethrotomy. Two of these patients have remained impotent. The patients submitted to early realignment of the urethra are managed well with regular dilatation and internal urethrotomy in some cases. CONCLUSIONS: We found suprapubic drainage and delayed repair superior to early realignment in those cases with posterior urethral injury. In our view, delayed end-to-end anastomosis, with or without pubic resection can be performed in virtually all cases. We advocate immediate repair of penetrating injuries to the anterior urethra.

[Intraprostatic blue nevus]. / El nevus azul intraprostático.

OBJECTIVES: The present article describes an additional case of blue nevus of the prostate, a rare benign lesion which must be distinguished from the more aggressive lesions. METHODS/RESULTS: This lesion was incidentally discovered in a patient who had a biopsy of the prostate. The microscopic examination disclosed the presence of melanin in the epithelium of the prostate gland. CONCLUSIONS: Extracutaneous blue nevus does not progress to malignancy and must be distinguished from the more aggressive lesions.

[Renal cystic mass: the diagnostic dilemma]. / Masa quística renal: el dilema diagnóstico.

OBJECTIVE: To determine the best diagnostic approach and management of cystic renal mass. METHODS: Four cases are described and the literature reviewed. RESULTS: Of the 4 cases of cystic renal mass, 2 had a previous history of renal trauma. Puncture and aspiration of the cystic content were performed in three cases; cytology was positive for malignancy in one, which was confirmed by the histologic analysis. Two cases underwent nephrectomy although one of the post-traumatic cases had a preoperative diagnosis of pararenal pseudocyst. The literature review showed a significant controversy exists concerning the diagnostic approach and treatment. CONCLUSIONS: We advocate an approach free from tenets, where all the appropriately chosen diagnostic tools may be valid. If doubts persist after diagnostic evaluation, nephrectomy should be performed.

[Digestive hemorrhage in renal cell carcinoma]. / Hemorragia digestiva en el carcinoma de células renales.

We report a rare case of a young male patient with a single duodenal metastasis from a renal cell tumor nine years after nephrectomy that presented as upper GI tract hemorrhage. The clinical and pathological aspects of this uncommon intestinal metastasis are briefly discussed.

[Bladder inverted papilloma. Report of a new case]. / Papiloma invertido vesical. A propósito de un nuevo caso.

Herein we describe an additional case of inverted papilloma of the bladder that had been incidentally discovered. Cystoscopy was required to make the diagnosis, which was confirmed anatomo-pathologically. The clinical and histological features of this disease entity are briefly discussed.

[The psoas bladder-hitch. An illustrative case]. / Vejiga psoica. Caso ilustrativo.

The psoas bladder hitch is an invaluable surgical procedure in the treatment of lesions of the lower ureteral third and transplantation with short ureters. We briefly review this procedure and describe an illustrative case of ureteroneocystostomy of the right lumbar ureter.

[Testicular metastasis of renal adenocarcinoma. Report of a case]. / Metástasis testicular de adenocarcinoma renal. Presentación de un caso.

Metastatic tumors of the testis are extremely rare, if we exclude leukemias and lymphomas. The present article reports a case of renal adenocarcinoma metastatic to the testis that presented with paraneoplastic syndrome, hematuria and a palpable testicular mass. The literature on metastatic tumors of the testis is briefly reviewed.

[Retroaortic renal vein. Report of a case]. / Vena renal retroaórtica. Presentación de un caso.

The retroaortic renal vein is a malformation characterized by the presence of a vessel that drains the left renal blood up to the inferior vena cava crossing behind the aortic artery. Unfamiliarity with this condition may lead to an incorrect diagnosis of adenopathy in patients with testicular and/or renal neoplasia and increases the number of complications of surgery of the left renal pedicle. Herein we describe a 71-year-old male with a retroaortic renal vein that had been detected during radical surgery for a left renal tumor.

[Lipoma of the spermatic cord. Report of a case]. / Lipoma de cordón espermático. A propósito de un caso.

Thirty per cent of spermatic cord tumors are malignant and the remaining 70% are benign, lipoma being the most common benign lesion. Although it is the most common tumor of the spermatic cord, its clinical presentation is rare. It is an extratesticular intrascrotal mass that grows relatively rapidly, with no other clinical symptoms or signs. The clinical diagnosis is confirmed by US, CT and, occasionally, by exploratory scototomy. Treatment is by surgical excision.

[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.

[Urethral metastases of prostatic adenocarcinoma]. / Metástasis uretrales por adenocarcinoma prostático.

Although the penis is highly vascularized, secondary penile tumors are rare and 28% of these metastasize from prostatic tumors. Urethral metastases are uncommon and may be caused by seeding following manipulation of the prostate with instruments or spread directly from the adjacent structures. This condition can be controlled and treated effectively with first or second line hormone therapy. Herein we describe a 65-year-old male with disseminated prostatic adenocarcinoma who presented multiple urethral metastases that were successfully treated with stramustine phosphate.

[Fraley's syndrome: a case report]. / Síndrome de Fraley: presentación de un caso.

A case of Fraley's syndrome is described. Intermittent nephralgia was the presenting symptom. The diagnosis was made on the radiologic finding of obstruction of the infundibulum arising from vascular compression. The diagnostic and therapeutic aspects of this uncommon cause of obstruction of the infundibulum are 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.

[Exceptional tumor: primary renal osteosarcoma. Review of 18 cases and report of a new one]. / Tumor excepcional: osteosarcoma renal primario. Revisión de 18 casos y aportación de uno nuevo.

Primary renal osteosarcoma is an uncommon tumor type. To our knowledge, only 18 such cases have been reported to date. This tumor is very aggressive and may be localized or distant, the survival rate being less than 18 months despite a radical surgical procedure. Polichemotherapy has been attempted. We report on a 47-year-old patient with primary osteosarcoma of the right kidney, 8 cm x 8 cm in diameter, which was not amenable to surgical excision due to invasion of the adjacent structures. Systemic polichemotherapy was unsuccessful, and the patient died 3 months following diagnosis with multiple pulmonary metastases.

[Fournier's gangrene. Presentation of 11 cases and review of the literature]. / Gangrena de Fournier. Presentación de 11 casos y revisión de la literatura.

Fournier's gangrene is an infectious necrotizing cellulitis of the penis and/or perineoscrotal region, which rapidly progresses and carries a high mortality. Eleven cases of Fournier's gangrene that had undergone an emergency procedure from 1985 to 1992 are described. Excellent results were achieved, with a survival rate of 91%. In our view, treatment of this disease entity is fundamentally based on early diagnosis, wide radical debridement of the affected area, frequent local treatment, debridement at the least sign of recurrence and early antibiotic therapy with three agents.

[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.