[Osseous lithiasis: an unusual condition]. / Litiasis ósea: patología excepcional.

Bone lithiasis is an uncommon disease unfrequent reported in the literature. Its origin is supported on urothelium and conjuctive tissue bone metaplasia. High suspicious index is needed to establish its diagnosis; where radiological signs and extracorporeal lithotripsy resistence drive to these uncommon entity. Definitive diagnosis is based on histological exam. We report a 49-year-old patient with left obstructive uropathy due to a high ureteral lumbar lithiasis who precised ureterolithectomy and partial ureterectomy after extracorporeal litotripsy failure. Histological exam confirmed bone lithiasis and squamous metaplasia. Epidemiologic, diagnostic and therapeutic aspects are briefly reviewed in literature. Bone calculus treatment includes lithectomy and urothelium resection to avoid posterior recurrence. Possible association to tumoral transformation suggests close evolutive follow-up.

[Mixed urogenital schistosomiasis]. / Esquistosomiasis genitourinaria mixta.

Urinary schistosomiasis is a parasitosis caused by Schistosoma Haematobium which affect in a diffuse manner all the genitourinary tract. Presentation of 5 patients (4 male, 1 female) with mixed Bilharziosis that was detected after the study of a young male that came to the clinic with a complaint of haematuria and who underwent transurethral resection under the suspicion of a vesical urothelial neoformation. Sch. Hameatobium eggs were detected in the urine and Sch. Mansoni in the semen of all 4 male. All of them evolved favourably with Praziquantel. Considering the rarity of schistosomiasis in our environment and its increased incidence in endemic areas, this process should be included in the algorithm of differential diagnosis in young patients reporting dysuric syndromes associated to haematuria; the relevance of an epidemiological anamnesis so as to institute early treatment and avoid the consequences of chronic infection is pointed out.

[Usefulness of magnetic resonance angiography in the diagnosis of polar vessel in stenosis of the pyeloureteral junction]. / Utilidad de la angioresonancia magnética en el diagnóstico del vaso polar en la estenosis de la unión pieloureteral.

OBJECTIVES: To present the results of a prospective study that had been conducted to determine the accuracy of magnetic resonance angiography (MRA) in the detection of accessory or polar vessels associated with ureteropelvic junction (UPJ) stricture, in order to utilize the most appropriate surgical procedure in the management of this condition. METHODS: From October, 1994 to September, 1996, 30 MRA procedures were done in 12 males and 18 females, aged 14 to 73 years (mean 38.12), with symptomatic UPJ obstruction. When the MRA was positive for polar vessels, the patients underwent open dismembered pyeloplasty; surgical correlation and a true positive result could be established. Percutaneous endopyelotomy was offered when the MRA was negative. The findings at open surgery and an unremarkable clinical course and radiological findings at one year follow-up established a true negative result. RESULTS: Accessory or polar vessels (11 arteries; 4 veins) were found in 11 patients (36.4%). MRA had a sensitivity of 92.3% (15/16) for detection of accessory vessels. Fourteen patients underwent open surgery (11 dismembered pyeloplasties; 3 nephrectomies) and the MRA findings were confirmed in each case (8 positive; 6 negative). Surgery disclosed an accessory vein that had not been detected on MRA in only one patient. This patient also had a polar artery that had been observed on MRA and demonstrated at surgery; thus, the sensitivity of MRA for detection of UPJ stenosis with polar vessel is 100% (11/11). Each vessel described on MRA was confirmed at surgery; there were therefore no false positives and the specificity was 100%. CONCLUSIONS: Although this is a preliminary study with a short follow-up and with some limitations, the results indicate that MRA is a simple, non-invasive technique with a high sensitivity and specificity for detection of polar vessels associated with UPJ stenosis, and appears to be a useful preoperative diagnostic procedure due to the surgical implications.

[Synchronous manifestation of bladder inverted papilloma and transitional carcinoma of the renal pelvis]. / Presentación sincrónica de papiloma invertido vesical y carcinoma transicional de pelvis renal.

OBJECTIVE: To review briefly the histological and biological aspects of inverted papilloma and to determine whether it is a benign tumor or low-grade malignant lesion. METHOD/RESULTS: We report a patient with synchronous presentation of bladder inverted papilloma and renal pelvis transitional cell carcinoma. After endoscopic resection of the bladder tumor and left ureteral meatus, a radical nephroureterectomy was carried out with success. The clinical features, diagnostic and therapeutic aspects are briefly reviewed. CONCLUSIONS: Inverted papilloma accounts for 2.2% of all urothelial tumors; the bladder is most commonly involved. It is frequently a single lesion with endophytic growth pattern. The clinical significance remains a controversy. Most investigators consider them as benign neoplastic tumors, although in one third of the patients it may be associated with synchronous urothelial carcinomas, implying a malignant condition. Therapeutic management and follow-up are emphasized.

[Multiple matrix lithiasis: integral endourological treatment]. / Litiasis matricial múltiple: terapéutica endourológica integral.

OBJECTIVES: Matrix stone, characterized by mucoproteic urinary deposits, is an uncommon lithiasic disease. The low frequency of this disease and the interest in its therapeutic management prompted us to report on the present case. METHODS/RESULTS: A case of multiple nephroureteral matrix calculi is described. Treatment was by integral strategic lithoreductive therapy: ureterorenoscopy, percutaneous nephrolithotomy and N-acetylcysteine prophylactic chemolysis. The clinical features, diagnostic and therapeutic aspects described in the literature are briefly reviewed. CONCLUSIONS: Complete stone removal to avoid recurrence is emphasized. Regular follow up and adequate treatment of the urinary infections are recommended.

[Obstruction of the urethral conduct following implantation of the endoprosthesis Urolume: therapeutic management]. / Obliteración de la luz uretral tras implante de endoprotesis urolume: manejo terapéutico.

The introduction of self-expandable urethral endoprostheses for the management of relapsing urethral stenosis has required the development of a minimally invasive therapeutical approach of widespread acceptance by the urological community. The reason for its success is the simplicity of implantation and the low rate of complications up to date. This paper reports on a patient carrying a ¿Urolume¿ urethral endoprosthesis for a relapsing bulbar urethral stenosis, which two years after implantation presents re-stenosis secondary to endoluminal inflammatory tissue growth. After two failure endoscopic resections, endoscopic removal of the prosthesis was required. Currently the patient carries a ¿Urocoil¿ spiral endoprosthesis to avoid tissular reaction. The therapeutical aspects found in the literature are reviewed, emphasizing the need of follow-up to detect complications, to improve indications and to select those patients that may be candidates for this treatment.

[Megacalycosis and lithiasis]. / Megacalicosis y enfermedad litiásica.

OBJECTIVES: Megacalycosis or Puigvert's disease is a clinical entity characterized by dilatation of all renal calyces without dilatation of the renal pelvis or ureter in the absence of any obstructive factor. To date, its pathogenesis remains unclear. The rarity of this disease and the importance of making a correct differential diagnosis prompted us to report on the present case. METHODS/RESULTS: Two patients with urolithiasis associated with ipsilateral megacalyces who were successfully treated by ESWL are described. The clinical, diagnostic and therapeutic aspects reported in the literature are briefly reviewed. CONCLUSIONS: There is a greater lithogenic predisposition in these patients. Intravenous urography has proved to be very accurate in making the differential diagnosis from other disorders such as obstructive uropathy and intermittent hydronephrosis. The efficacy of ESWL in the treatment of lithiasis associated with megacalycosis is underscored. A yearly control follow up by analyses and intravenous urography is advocated.