Collateral urethral duplication in an adult.

OBJECTIVE: Congenital anomalies or malformations of the urethra that involve number are extremely rare and only 7 cases of trifurcation of the urethra and under 500 cases of urethral duplication have been described. METHODS: In the case we present, urethral duplication was diagnosed in adulthood, even though glans malformation with 2 urethral orifices was clearly evident and only 1 was functional. RESULTS: The condition is usually diagnosed in childhood due to the presence of 2 urethral meatus or from double stream if both are functional; at other times, the condition is diagnosed from complications that trigger infections or obstruction or if it is associated with more extensive malformations. CONCLUSIONS: Urethral duplication is an extremely rare birth defect, and diagnosis in adulthood is even more uncommon. No single embryologic argument explains all the anatomic variants of urethral duplication. The treatment of the urethral duplication should be individualized according to the type of duplication and the clinical symtoms.

Penile foreign bodies.

OBJECTIVE: To describe 8 cases of penile foreign bodies. METHODS/RESULTS: We provide an essentially visual overview of various objects or foreign bodies affecting the penis. CONCLUSIONS: The presence of penile foreign bodies is rarely due to an accident. These objects are placed for a wide variety of reasons, but primarily for erotic or self-arousal purposes. The consequences of penile foreign bodies can be mild or very severe, resulting in penile amputation.

[Femoral neuropathy in urological surgery]. / Neuropatía femoral en cirugía urológica.

We present four cases of femoral neuropathy due to urological surgery, first case happened after right lumbotomy twenty years ago and the other three cases in the last four years after iliac incision. We review lesion production mecanism, evolution, treatment and prevention of this rare neurological complication. We do a literature review about this pathology related with urological activity.

[Hemoperitoneum and death due to hepatoesplenic metastasis rupture in a testicular tumor]. / Hemoperitoneo y muerte por rotura de metástasis hepatoesplénicas de tumor testicular.

We present a case of a mix germinal testicular tumor, in III-C (AJCC-UICC) stage, at a terminal phase due to massive methastasis rupture at hepatic and splenic methastasis locations.

[Entero-neobladder ileal fistula: two cases report]. / Fístula entero-neovejiga ileal: a propósito de dos casos.

Fistulas between the orthotopic reservoir and the gastrointestinal tract have low incidence (1.5-2%). Simptomatology is variable, but it's frecuent to find fecaluria. Among 90 new intestinal bladders we show two fistule of new bladder to ileo, with nest postoperatory diagnosis, using retrograde cystografy; one was resolved with next postoperative treatment and the other with open surgery.

[Problem-based learning in urology training. The Faculty of Medicine of the Universidad de Castilla-La Mancha model]. / El aprendizaje basado en problemas en la enseñanza de la urologia. Modelo de la Facultad de Medicina de la Universidad de Castilla-La Mancha.

Ongoing changes in the social, economic, technological and scientific realms have generated new needs and led various organizations to suggest that educational institutions should reorient their educational strategies toward developing effective professionals with the skills to meet these needs. These "modern" strategies include problem-based learning, in which the student seeks and selects information, analyzes the data obtained, integrates both prior and newly acquired knowledge, and, finally, offers diagnostic and therapeutic options to resolve the problem posed, as would occur in professional practice. With this approach, prior skills and practical experience form the foundation of learning. Problem-based learning incorporates some aspects of cognitive psychology, a model that mainly centers on the nature of the knowledge structures found in active memory, the processes involved in information storage and retrieval and the various factors that activate these processes. At the Faculty of Medicine of the Universidad de Castilla-La Mancha, urology is part of a core subject (Medical and Surgical Pathology II) taught in the fifth year of coursework together with nephrology. Each course includes approximately 75 students, divided into five groups. The rotation lasts six weeks, with students spending a mean of two hours a day on theory (nephrology and/or urology) and the remaining time on rotations in the various activities: three weeks in nephrology and three weeks in urology. Upon completion of the rotation, the students write a combined theoretical examination with 100 multiple-choice questions (50 on urology) and take a practical skills examination. At the end of the course, another practical test consisting of an objective, structured clinical examination is taken, in which standard patients are used and the professor directly assesses the level of skills acquired with a "real" case.

An unusual retroperitoneal cystic tumor.

This report describes a case of textiloma (term given to an inflammatory swelling caused by a retained textile foreign body) in a 60-year-old patient who had undergone surgery for a perforated gastroduodenal ulcer 17 years earlier. On examination the presence of a large mass was detected on the left hypochondria. A CT scan confirmed a cystic tumor with images suggesting detritus or necrosis in its lower part, as well as calcifications. Transperitoneal midline laparotomy was performed with extension by thoracophrenolaparotomy. Splenectomy was necessary. Macroscopic examination showed a spherical mass. After opening the tumor, retained surgical gauze was found. The histopathological diagnosis was granulomatosis reaction to a foreign body.

[Rupture of the corpora cavernosa: its therapeutic assessment and management]. / Rotura de cuerpos cavernosos: evaluación y manejo terapéutico.

INTRODUCTION: The traumatic rupture of cavernous bodies is an uncommon condition that always takes place with an erected penis, the most frequent etiology being an untimely vaginal intercourse, due to the greater vulnerability of the penis in such situation, resulting from contained trauma by direct external forces. The distinctive presenting signs are a "snap", immediate detumescence, pain, deformity, bruise and deviation contralateral to the lesion. The bruises will be limited to the penis in the presence of Buck's fascia integrity. This paper contributes one case of rupture of right cavernous body, explaining its typical etiology, signs and symptoms, and examination of the patients who underwent emergency surgery. MATERIAL AND METHODS: 27-year-old patient who turns up into the emergency service with penile haematoma and local pain, reporting an earlier snap and detumescence. The examination reveals a hose-type haematoma with a "wringer" mark. The ultrasound shows haematoma, albuginea interruption and Buck's fascia integrity. The patient undergoes emergency surgery that involves whole penis denudation, haematoma evacuation and suture of impaired cavernous body. No incidence is reported during the post-operative. The patient is now asymptomatic and holds successful erections. DISCUSSION: The differential diagnosis should be done versus rupture of the penis dorsal vein, which causes identical signs and symptoms. NMR is considered as the best imaging test, although is still quite unaffordable. Standard ultrasounds do not rule out the diagnosis. Under suspicion of associated urethral damage, retrograde urethrography is warranted. Cavernosonography has very specific indications and should be avoided whenever possible. Choice treatment will be emergency revision and surgical repair. Suture of involved cavernous body must be done with loose stitches of absorbable material. Antibiotic prophylaxis is indicated in cases of concomitant urethral involvement.

[Retroperitoneal cystic mesothelioma and lymphangioma]. / Mesotelioma y linfangioma quísticos retroperitoneales.

Retroperitoneal cysts are uncommon entities of difficult diagnosis because of their insidious symptomatology. Urinary apparatus involvement is quite often the mode of presentation and the reason for calling on the urologist. The origin of many of these retroperitoneal cysts remains practically unknown. Surgery with exeresis is the choice management method. Follow-up is necessary for cystic mesothelioma because of the highly frequent relapses. The outlook of hormonal conservative therapy for relapses appears as a future alternative to treatment.

[Survival of patients with upper urothelial tumor]. / Estudio de supervivencia en pacientes con tumor de urotelio superior.

OBJECTIVE: A descriptive analysis of 35 patients with transitional cell carcinoma of the upper urinary tract is presented. The actuarial survival was analyzed to determine which circumstances associated with superficial bladder cancer had a prognostic significance. METHODS: The records of 35 patients with upper urothelial tumor diagnosed from 1987 to 1993 were retrospectively analyzed. A descriptive statistical analysis was performed on all the variables. Correlation was determined by Pearson's Xi2 test, Yates' and Fisher's exact test. McNemar's test was used to determine which diagnostic method had the highest yield. The actuarial survival data were analyzed with the Kaplan-Meier and Mantel-Haenzel test. RESULTS: Patient mean age was 67.74 yrs, mean follow up was 26.83 months, 40% were ureteral tumors, 25.7% were pelvic tumors, 60.6% were superficial tumors and 62.6% were GI and GII, 48.5% were associated with bladder tumors and no correlation was found between the grade and stage of bladder relapses and the upper urinary tract tumors. Intravenous urography demonstrated function was abolished in 45.5%. Cytology gave the highest diagnostic yield (84.6%). Nephroureterectomy with perimeatal cystectomy was the surgical technique most frequently used (57.1%). To date, 71.4% of the patients have survived. Significantly women demonstrated the most undifferentiated cellular grade (p < 0.001), although no prognostic value was found for sex. 95% of the patients with non-infiltrating tumor stages and 95% of the patients with GI-GII tumors survived, whereas 61.5% of the patients with infiltrating tumors and 58.3% of those with GIII tumors did not survive (p < 0.002). Evidently, the grade of cellular differentiation and the stage of infiltration were interrelated (p < 0.002). Analysis of the actuarial survival data showed that the probability of survival after 24 months (mean follow up) was 67.07% and the probability of reaching 74 months (maximum follow up) was 60.04%. CONCLUSIONS: After a comparative analysis of the survival with the Mantel-Haenzel test, it was found that the grade of cellular differentiation (p < 0.001) and stage of infiltration (p < 0.01) had significant differences in the survival curves.

[Keratinizing squamous metaplasia (cholesteatoma) of the upper urinary tract]. / Metaplasia escamosa queratinizante (colesteatoma) del tracto urinario superior.

Presentation of four cases of keratinizing squamous metaplasia (KSM), two of the renal pelvis, one pyelocaliceal and one ureteral. Nephrouretetectomy was performed in all cases. All our patients showed good evolution. A review of the literature is made discussing all the etiological, diagnostic and therapeutical aspects of the condition. Its benign evolution is highlighted as well as the current need, once a better knowledge of the condition's natural history is available, of using a conservative approach.

[Wunderlich syndrome. Report of 3 cases]. / Síndrome de Wunderlich. Aportación de tres casos.

Contribution of three cases of Wunderlich Syndrome, two of which caused by an angiomyolipoma, and the third one encountered in an anticoagulated patient. We reflect on the obscure pathoetiogenesis of this uncommon disease and on the need to establish the appropriate diagnosis through different radiological examinations (ultrasound, CAT, arteriography) in order to apply the correct therapeutic approach, which in most cases will have an emergency nature, trying to adopt the most conservative attitude possible.

[Immunoprophylaxis of recurrence of T1 G2 bladder tumors with interferon alpha-2b]. / Inmunoprofilaxis de recidivas de tumores vesicales T1 G2 con interferón alpha-2b.

Assessment of results with -2b Interferon used as prophylaxis in 20 patients who underwent surgery for T1,G2 urothelial vesical tumours. Dosage was weekly intravesical instillation of 50 x 10(6) IU for three months and then monthly up to one year treatment. Mean follow-up was 17.20 months (4-41 months). Relapse rate over this time was 50%, all before 15 months, a relapsing ratio of 2.82% patients/month and a disease-free interval of 27.5 months. Chances of being disease-free at 30 months is 48.21%. Progression of disease, whether in grade or stage, was observed in 25% cases. No patient showed relevant changes or side effects during treatment, except for 5 patients who reported mictional symptoms mainly during the first 3 months, none of which required discontinuation of treatment. From the data obtained, it can be deduced that for the time being no reason justifies the use of -2b Interferon versus other conventional chemotherapeutical or immunotherapeutical (BCG) agents in the prophylaxis of this type of tumours.

[Vesico-intestinal fistulae]. / Fístulas vesicointestinales.

Review of vesicointestinal fistulae cases treated in the Urology Unit at our hospital over the last few years. Most frequently seen cause was colorectal cancer (66%) and most frequent location was vesicosigmoideal (50%). Clinical signs and symptoms were varied, mainly urinary infection in 100% cases, pneumaturia in 66% and fecaluria in 50%. Opaque enema and cystography were great diagnostic aids as complementary methods. Also U.I.V., cystoscopy, rectoscopy and C.A.T. were used. Treatment was surgical in all cases where the patient's general health status allowed it.

[Transitional cell tumor of the bladder in childhood]. / Tumor transicional de vejiga en la infancia.

Presentation of one case of transitional cells tumour of the urinary bladder in a 10-year old patient. We emphasize the rarity of such tumours during the first decade of life as well as their good prognosis, the only management required being just an endoscopic resection.

[Chyluria of non-parasitic origin. Presentation of a case and review of the literature]. / Quiluria de origen no parasitario. Presentación de un caso y revisión de la literatura.

Chyluria is defined as the lymph reflux to the urinary collecting system through fistulous communications secondary to lymphatic stasis caused by obstruction of the lymphatic flow. Filariasis is the most frequent cause of chyluria, which is endemic in some areas, mainly in the Asian continent. In our environment chyluria is extremely rare, most cases being due to non-parasitical causes: tumours, abscesses, trauma, tuberculosis, congenital, etc. A patient case of chyluria in a 39 year-old male with background of chest trauma in which the source of chyluria was discovered to be an obstruction of the chest duct due to post-traumatic aneurysm of the aortic notch. The picture of chyluria ceased immediately after surgery, an aneurysmal resection with replacement with an aortic prosthesis. Considering the infrequency of chyluria in our environment, a literature review is made, explaining the most frequent etiological data, as well as accompanying clinical signs, diagnostic means and conservative and surgical procedures in the treatment of this process.