[Trombosis of the dorsal penis vein (of Mondor's phlebitis). Presentation of a new case]. / Trombosis de la vena dorsal del pene (Flebitis de Mondor). Aportación de un nuevo caso.

OBJECTIVE: We present a new case of trombosis of the superficial dorsal penis vein called Penile Mondor's disease. The characteristics of the disease are reviewed and the most usual diagnostic and therapeutic methods. METHODS: The case of a 41 year old man is reviewed who consulted for pain and induration on the proximal part of the penis. RESULTS: After phisical examination and Eco-doppler was made the diagnosis of Mondor's disease. He receibed treatment with non steroidal antiinflamatories and antibiotics. CONCLUSIONS: The dorsal vein thrombosis is a rare disease with pain an induration of the dorsal part of the penis. The ethiology can be traumatic, neoplasic, excesive sexual activity or abstinence. Is necesary the diferencial diagnosis with esclerosant linphangitis and the most important imaging is the Eco-doppler. The treatment is based in non steroidal antiinflamatories and antibiotics wit infection. The local aplication of heparine can be useful and the surgery with thrombectomy and resection is for persistent cases.

Trombosis de la vena dorsal del pene (Flebitis de Mondor). Aportación de un nuevo caso / Trombosis of the dorsal penis vein (of Mondor´s phlebitis). Presentation of a new case

Objetivo: Presentamos un nuevo caso de trombosis de la vena dorsal superficial del pene o “flebitis de Mondor”. Revisamos las características de la enfermedad y los métodos diagnósticos y terapéuticos actuales. Métodos: Revisamos el caso de un varón de 41 años que consultó por dolor e induración dorsal del pene. Resultados: Después de realizar exploración física y Eco-doppler fue diagnosticado de Trombosis de la vena dorsal superficial o flebitis de Mondor. Recibió tratamiento con antiinflamatorios no esteroideos y antibióticos experimentando mejoría clínica. Conclusiones: La trombosis de la vena dorsal del pene es una rara entidad que cursa con dolor e induración dorsal, la etiología puede ser traumática, neoplásica, por excesiva actividad sexual o prolongada abstinencia. Puede cursar de forma aguda, subaguda o crónica. Es necesario realizar diagnóstico diferencial con la linfangitis esclerosante, el estudio de imagen ideal es el Eco-doppler y el tratamiento se basa en antiinflamatorios y antibióticos en caso de infección. Pueden ser útiles sustancias heparinizantes locales reservándose el manejo quirúrgico con trombectomía o resección de la vena dorsal para casos persistentes

Objective: We present a new case of trombosis of the superficial dorsal penis vein called Penile Mondor´s disease. The characteristics of the disease are reviewed and the most usual diagnostic and therapeutic methods. Methods: The case of a 41 year old man is reviewed who consulted for pain and induration on the proximal part of the penis. Results: After phisical examination and Eco-doppler was made the diagnosis of Mondor´s disease. He receibed treatment with non steroidal antiinflamatories and antibiotics. Conclusions: The dorsal vein thrombosis is a rare disease with pain an induration of the dorsal part of the penis. The ethiology can be traumatic, neoplasic, excesive sexual activity or abstinence. Is necesary the diferencial diagnosis with esclerosant linphangitis and the most important imaging is the Eco-doppler. The treatment is based in non steroidal antiinflamatories and antibiotics wit infection. The local aplication of heparine can be useful and the surgery with thrombectomy and resection is for persistent cases

[Clinical experience and results of ESWL treatment for 1.000 consecutive patients with the Siemens Lithostar Modularis]. / Lithostar Modularis de Siemens: exposición de los resultados de los 1.000 primeros pacientes.

PATIENTS AND METHODS: We describe the outcome of the treatment of 1.000 consecutive patients treated since may 2000 to december 2003 with Siemens Lithostar Modularis to evaluate the efficacy of this new lithotripter RESULTS: 60.5% male and 39.5% female's patients were treated. Average age of 53.5 years old. 44.1% of the urinary stones were located on the right side and 55.9% on the left. The mean size of the stones was 1.22 +/- 0.74 cm with 59% lesser than 1 cm, 27.6% between 1 and 2 cm and 13.4% bigger than 2 cm. Mean number of sessions required were 1.6. There were differences in the number of sessions related to the size of the lithiasis, 1.3 session in the group of lithiasis smaller than 1 cm and 2.01 sessions in the group bigger than 1 cm. The stones that required less number of sessions were located in the ureter and upper calyx. 71.2% of the patients were stone free after one treatment. CONCLUSIONS: Siemens Lithostar Modularis has the adventages of a great confort of the patient during the procedure, better image because of a very good cuality of the fluoroscopy and the main point is a great comminution of the stone doing very easy the elimination of the fragments achieving a stone free rate of more than 90% in our experience, decreasing the need of auxiliary manoeuvres and the leng of the treatment.

[Primary renal lymphoma in a patient with IgM monoclonal gammapathy]. / Linfoma renal primario en paciente con gammapatía monoclonal IgM.

Reports on primary renal lymphoma are scarce in the urological literature, the most part of them are secondary on a lymphomatous infiltration of the kidneys. We report the case of a 77 year old man with an incidental mass on the kidney. After radiological studies (CT), we practise nephrectomy with a pathological result of a non-Hodgking B primary lymphoma. The patient present a IgM monoclonal gammapathy who need complementary treatment with chemotherapy. A literature review on currently recommended diagnostic and treatment practices in presented.

[Extracorporeal shock wave lithotripsy of urolithiasis in patients with urinary diversion]. / Litotricia extracorpórea en litiasis en pacientes con derivación urinaria.

We evaluate the efficacy of ESWL in the management of calculi in patients with urinary diversion. We treated 5 patients who suffered from urinary lithiasis after urinary diversion post cistectomy. We managed the patients with extracorporeal shock wave lithotripsy in monotherapy with a Siemens Lithostar Modularis device. Mean stone size (long axis) was 1.95 cm (range 1 to 3.5 cm). The mean shockwave number per session was 2.6 per patient. Stone free result was 100%. We conclude that ESWL technique can provide acceptable results in patients with urinary diversion and can be used as first choice treatment in these type of patients due to its minimal morbidity and excellent results, equivalent to those achieved in patients without urinary diversion.

Linfoma renal primario en paciente con gammapatía monoclonal IgM / Primary renal lymphoma in a patient with IgM monoclonal gammapathy

Son infrecuentes los casos de linfoma renal primario, ya que la afectación renal por un proceso linfoproliferativo es, por lo general, secundaria a una enfermedad sistémica. Presentamos el caso de un paciente varón de 77 años que acude por hallazgo ecográfico incidental de una masa en su riñón izquierdo. Después de realizar estudios (TC), se practica nefrectomía cuyo resultado anatomopatológico fue de linfoma no-hodking B primario renal. Asimismo el paciente presentaba una gammapatía monoclonal IgM asociada, por lo que precisó tratamiento quimioterápico sistémico. Realizamos una revisión bibliográfica centrándonos en los criterios diagnósticos y terapéuticos actuales (AU)

Reports on primary renal lymphoma are scarce in the urological literature, the most part of them are secondary on a lymphomatous infiltration of the kidneys. We report the case of a 77 year old man with an incidental mass on the kidney. After radiological studies (CT), we practise nephrectomy with a pathological result of a non-hodking B primary lymphoma. The patient present a IgM monoclonal gammapathy who need complementary treatment with chemotherapy. A literature review on currently recommended diagnostic and treatment practices in presented (AU)

Litotricia extracorpórea en litiasis en pacientes con derivación urinaria / Extracorporeal shock wave lithotripsy of urolithiasis in patients with urinary diversion

Exponemos nuestra experiencia en el tratamiento de litiasis en pacientes con derivación urinaria. Hemos tratado 5 pacientes con litiasis en el tracto urinario superior tras cistectomía y derivación urinaria. El tratamiento se ha hecho con monoterapia por ondas de choque con el litotritor Lithostar Modularis de Siemens. El tamaño medio de las litiasis fue de 1,95 cm (rango 1 a 3,5 cm). El número medio de sesiones ha sido 2,6, con 3961 ondas de choque de media por sesión. Hemos conseguido un 100% de pacientes libres de litiasis, indicando que la litotricia extracorpórea tiene unos buenos resultados en el tratamiento de las litiasis en pacientes con derivación urinaria, siendo el tratamiento de elección en estos pacientes, con muy baja morbilidad y alta eficacia, comparable a los pacientes sin derivación urinaria (AU)

We evaluate the efficacy of ESWL in the management of calculi in patients with urinary diversion. We treated 5 patients who suffered from urinary lithiasis after urinary diversion post cistectomy. We managed the patients with extracorporeal shock wave lithotripsy in monotherapy with a Siemens Lithostar Modularis device. Mean stone size (long axis) was 1.95 cm (range 1 to 3.5 cm). The mean shockwave number per session was 2.6 per patient. Stone free result was 100%. We conclude that ESWL technique can provide acceptable results in patients with urinary diversion and can be used as first choice treatment in these type of patients due to its minimal morbidity and excellent results, equivalent to those achieved in patients without urinary diversion (AU)

[Utility of prostate-specific antigen in pleural fluid for the diagnosis of metastatic effusion secondary to prostate cancer]. / Utilidad del antígeno prostático específico en líquido pleural para el diagnóstico del derrame metastático por cáncer de próstata.

Pulmonary or pleural involvement from prostate cancer is an uncommon clinical finding. We report on a patient with prostate cancer and a diagnosis of malignant pleural effusion made by determination of pleural fluid prostate specific antigen.

[Ectopic prostatic tissue in the bladder]. / Tejido prostático ectópico en vejiga urinaria.

We report the case of a 58-year-old man with ectopic prostatic tissue at the bladder trigone. The diagnosis was by chance during study and treatment of benign prostatic hyperplasia. The appearance was pseudocystic. It occupied completely the bladder trigone. On histology, the lesion was formed by prostatic type-glands, which were positive for the presence of prostatic specific antigen by using inmunoperoxidase technique. It was partially covered by normal urothelium. Ten months later, no trace of recurrence has been evidenced.

Utilidad del antígeno prostático específico en líquido pleural para el diagnóstico del derrame metastático por cáncer de próstata / Use of pleural fluid prostate specific antigen in the diagnosis of malignant effusion from metastatic prostate cancer

La afectación metastática pulmonar o pleural por adenocarcinoma de próstata es un hallazgo clínico infrecuente. Se aporta un caso de derrame pleural mestastático por adenocarcinoma de próstata, diagnosticado mediante determinación de antígeno prostático específico en el líquido pleural. (AU)

Tejido prostático ectópico en vejiga urinaria / Ectopic prostatic tissue in urinary bladder

Se presenta un caso de tejido prostático ectópico localizado en trígono vesical, en un paciente de 58 años. El hallazgo fue casual durante el estudio y tratamiento de un paciente con hipertrofia benigna de próstata. Se manifestó como lesiones seudoquísticas que ocupaban la totalidad del trígono vesical. El tejido de recubrimiento, obtenido por resección transuretral, estaba formado por focos de revestimiento urotelial y glándulas de aspecto prostático que presentaron positividad en el estudio inmunohistoquímico frente a PSA. No existe evidencia de recurrencia a los diez meses del diagnóstico (AU)

No disponible

[Urologic disease emergency. Clinico-epidemiologic analysis at a district hospital]. / Patología urológica urgente. Análisis clínico-epidemiológico en un hospital comarcal.

OBJECTIVE: To present the results of a one-year retrospective study that analyzed the clinical and epidemiological aspects of urological emergencies, which is not a negligible percentage of all hospital emergencies. METHODS: Data on all the urological emergencies of the emergency department of our hospital were collected during a one-year period by filling out a form that included sex, age, whether referred or not, disease, etc. RESULTS: There were 1504 urological emergencies; the urologist was required in 458 of these cases (30.45%). There were more men (837) than women (667). Patient ages ranged from 1-101 years (mean 53 years); a higher incidence was found for those aged 65 years. By age groups, there were more patients aged 61-80 years (575 patients). Most of the patients came to the hospital on their own initiative (1114) and 390 had been referred by their primary care physician. Renal colic (670 cases) was the most common diagnosis in both males and females, followed by cystitis, which was prevalent in the females (67.35%). Other conditions seen were urinary retention, hematuria, etc. CONCLUSIONS: There was a higher prevalence of males that consulted for urological conditions at the emergency department and there was a higher incidence in patients in the 6th and 7th decades of life, which is similar to the findings reported in other studies. Renal colic was the main reason for consultation for both genders and for all age groups, except those younger than 20 who presented more scrotal and penile involvement. Infective conditions involving the lower urinary tract (cystitis) and pyelonephritis were prevalent in the females. The large number of patients that were discharged from the emergency department and who consulted on their own initiative shows their confidence in the emergency services and that they could have been attended to at other health centers and did not have to come and unnecessarily strain the hospital emergency services.

[Sugar: treatment of choice in irreducible paraphimosis]. / Azúcar: tratamiento de elección en la parafimosis irreductible.

PURPOSE: To evaluate the effectivity of granulated sugar in the treatment of irreductable paraphimosis. CLINICAL CASES: During last year three patients have been treated by application of granulated sugar on prepuce and glands penis during 1-2 hours until edema reduction was observed. Paraphimosis could be reducted in all three cases. CONCLUSIONS: Sugar application reduce local edema permitting reduce paraphimosis in an incruent, cheap and without side effects way.

[Reabsorption syndrome. Report of a case]. / Síndrome de reabsorción. Presentación de un caso.

OBJECTIVE: To report a case of TURP syndrome and emphasize the importance of early diagnosis. METHODS: A case of reabsorption syndrome in a patient that underwent transurethral resection under spinal anesthesia is presented. RESULTS: Reabsorption syndrome (TURP syndrome) is manifested by neurological and hemodynamic changes resulting from absorption of irrigating fluid used during transurethral resection of the prostate. This complication presented in a patient undergoing elective surgery and with no additional risk factors. CONCLUSIONS: Since it is impossible to prevent this complication of TUR, spinal anesthesia should be utilized whenever possible because it permits early detection before important complications develop.

[Prevalence and risk factors for erectile dysfunction in the Region of Bierzo]. / Prevalencia y factores de riesgo de disfunción eréctil en la Comarca del Bierzo.

OBJECTIVE: To analyze the prevalence and risk factors for erectile dysfunction in Bierzo (León, Spain). METHODS: A study was conducted based on a self-administered survey in males aged 19 to 90 years that consulted at the urology and family medicine services of 10 health centers in Bierzo (León, Spain). To determine the existence or absence of erectile dysfunction, the male sexual health questionnaire (SHIM) was included, and those with a score of 21 or less were considered to have some degree of erectile dysfunction. Distribution of the questionnaire began in September 1999 and ended in May 2000. Submission of the questionnaires concluded on May 31, 2000. Of 935 questionnaire that were received, 830 were valid. RESULTS: The overall prevalence of erectile dysfunction in this study was 63.9%, which increased with age and was markedly higher after age 50 years (38.6% for age 41-50 years and 72.6% for age 51-60 years). The age-adjusted analysis showed the risk factors for erectile dysfunction were depression and arterial hypertension on treatment with drugs. Diabetes mellitus on treatment with oral glucose lowering agents or insulin, heart disease and hypercholesterolemia were also associated with the more severe forms. CONCLUSIONS: The prevalence of erectile dysfunction in patients consulting at the primary care and general urological services in Bierzo (León, Spain) was outstandingly high. The present study showed erectile dysfunction to be an age-dependent disease that caused concern in slightly more than half of the patients with this condition. Apart from age, depression and vascular disease were found to be risk factors.

[Scrotal leiomyoma]. / Leiomioma de escroto.

A case of a 32-year-old patient with a diagnosis of leiomyoma of the scrotum was studied. Histologic analyses did not yield evidence of malignancy. Full excision of tumor was achieved and the postoperative period was uneventful.

Azúcar: tratamiento de elección en la parafimosis irreductible / Sugar: elective treatment of irreducible para phimosis

PROPÓSITO: Evaluar la efectividad del uso del azúcar granulado en el tratamiento de la parafimosis irreductible. CASOS CLÍNICOS: Durante el último año han sido tratados 3 pacientes mediante la aplicación de azúcar sobre glande y prepucio durante 1-2 horas, hasta observar la reducción del edema. Se ha conseguido la reducción de la parafimosis en todos los casos. CONCLUSIONES: La aplicación de azúcar local reduce el edema de la parafimosis permitiendo reducir ésta de forma incruenta, barata y carente de efectos secundarios (AU)

[Prostatic syndrome and pleural effusion: are they different diseases?]. / Síndrome prostático y derrame pleural: enfermedades diferentes?

OBJECTIVE: To report an uncommon association of prostate and lung cancer. METHODS: The characteristics of both tumors, their association with tumors in other sites and the time of presentation are analyzed. RESULTS: Both tumors were in the advanced stages. Metastatic carcinoma of the prostate was discarded due to the form of presentation. CONCLUSIONS: Although the association of prostate and lung cancer is uncommon, the possibility of synchronous tumors should be considered in patients with urinary and pulmonary symptoms suggestive of neoplasm. It is important to determine if the lesion is a metastasis, since the prognosis depends on the second tumor.

Tratamiento de las fístulas vesicovaginales no complicadas posthisterectomía / Management of uncomplicated vesicovaginal fistulas after hysterectomy

Objetivo: Aportamos nuestra experiencia en el tratamiento de las fístulas vesicovaginales no complicadas.Material y métodos: Analizamos retrospectivamente a 7 pacientes con fístulas vesicovaginales no complicadas tras histerectomía tratadas en nuestro centro entre 1995 y 2000. La forma más común de presentación fue la incontinencia urinaria constante. Tres casos se acompañaron de hematuria macroscópica en el postoperatorio inmediato.Resultados: Tras fracaso del tratamiento conservador, se realizó reparación transvesical en todos los casos, con un porcentaje de éxito del 100 por ciento y una mediana de seguimiento de 21 meses (límites, 5-35 meses).Conclusiones: Se debe sospechar la existencia de una fístula vesicovaginal tras cirugía ginecológica ante la presencia de hematuria macroscópica, débito importante de líquido de aspecto urinoso por drenaje vaginal o incontinencia urinaria constante postoperatorios. El diagnóstico y tratamiento temprano evita el estrés prolongado de la paciente sin comprometer los resultados. (AU)

Leiomioma de escroto / Leiomyoma of the scrotum

Se presenta un caso de leiomioma escrotal en un paciente de 32 años que consultó por masa escrotal. El estudio histológico no demostró signos de malignidad. El tumor fue extirpado por completo, con evolución posterior favorable (AU)