[Surgical treatment of urethral stenosis. Results of 100 urethroplasties]. / Tratamiento quirúrgico de la estenosis uretral. Resutado de 100 uretroplastias.

BACKGROUND: We report our results after 100 urethroplasties for the treatment of urethral stricture both at the bulbar and penile urethra, using different techniques. METHODS: 100 patients with the diagnosis of anterior urethral stricture, that were submitted for urethroplasty in the period 1997-2007. Of them, 57 treated by end to end urethroplasty. 4 patients underwent augmented free graft anastomotic urethroplasty. Buccal mucosa free graft was used in 16 patients and penile skin onlay flap in 23. RESULTS: We have obtained 84% good results overall. In patients undergoing end to end urethroplasty we obtained 91.2% success rate. We had 75 % of good results with the free graft anastomosis. In the cases in which we used buccal mucosa patch we obtained 90% success in bulbar urethra and 67 % in penile urethra. When we used onlay flaps good results were 70.6% in penile urethra and 66,7% in bulbar urethra. CONCLUSIONS: Open surgery is the best form of treatment for urethral strictures. The anastomotic urethroplasty is the technique that, applied in bulbar urethra, enables better results. For strictures over two centimeters we have other procedures of choice in penile urethra, pediculated skin flaps, except in cases with Lichen Esclerosus, in which the use of buccal mucosa as a graft is preferable, and in the bulbar urethra in which augmented onlay graft urethroplasty or free grafts, mainly buccal mucosa, are preferred. In long and complex strictures, the option that we must contemplate is two-stage surgery. Any type of urethroplasty can fail, and this risk increases as the time passes.

[Polyorchidism]. / Poliorquidismo.

OBJECTIVE: To report one case of supernumerary testicle, a rare entity with around 100 cases published. METHODS: 44-year-old male patient consulting for incidental discovering of a right scrotal mass. The diagnosis of polyorchidism was suspected after physical examination, ultrasound, and CT scan, and confirmed subsequently on surgical exploration and biopsy. Due to the absence of pathology and complete normal seminal lines decision was taken to not perform orchiectomy of the supernumerary testicle. RESULTS: There are classifications for proper evaluation of polyorchidism, which state the relation between site of the testicle in relation to scrotum, existence or absence of independent epididymis and vasa deferentia for both testicles. CONCLUSIONS: Although remotely, there is a possibility of malignant degeneration of these testicles, so that surgical exploration and excision of the supernumerary testicles when their biopsy is doubtful in terms of dysplasia or if they present carcinoma in situ or they are a source of pain.

Tratamiento quirúrgico de la estenosis uretral. Resutado de 100 uretroplastias / Surgical treatment of urethral stenosis. Results of 100 urethroplasties

OBJETIVO: Presentar nuestros resultados tras realizar 100 uretroplastias como tratamiento de estenosis uretral tanto a nivel peneano como bulbar, utilizando distintas técnicas.MÉTODOS: 100 pacientes diagnosticados de estenosis uretral, que fueron sometidos a uretroplastia en el período 1997-2007. De ellos, 57 tratados mediante anastómosis término terminal. 4 pacientes en los que se utilizó una técnica de anastómosis ampliada con un injerto libre. En 16 pacientes se realizó un injerto libre de mucosa bucal y en 23 la técnica usada fue el colgajo pediculado.RESULTADOS: En conjunto hemos obtenido un 84% de buenos resultados en la totalidad de los pacientes. En aquellos a los que realizamos una anástomosis término terminal obtuvimos un 91,2% de buenos resultados. De cuatro pacientes con técnica combinada de anastómosis con injerto libre, tuvimos un 75% de buenos resultados. En los casos en que utilizamos mucosa bucal en forma de parche obtuvimos un 90% en uretra bulbar y un 67% en uretra peneana. Cuando se utilizaron colgajos pediculados los buenos resultados fueron del 70,6% en uretra peneana y del 66,7% en uretra bulbar.CONCLUSIONES: La cirugía abierta es la mejor forma de tratamiento de la estenosis de uretra. La uretroplastia término terminal es la técnica que, aplicada en uretra bulbar, permite obtener mejores resultados. Para estenosis mayores de dos centímetros disponemos de otros procedimientos, siendo de elección, en uretra peneana, los colgajos pediculados, salvo que exista Liquen Escleroatrófico, en que la preferencia seran los injertos libres extragenitales y en uretra bulbar los injertos libres, preferentemente con mucosa bucal. En estenosis largas y complejas la opción que debemos contemplar es la cirugía en dos tiempos. Cualquier tipo de uretroplastia puede recidivar, y ese riesgo aumenta conforme pasa el tiempo(AU)

OBJECTIVES: We report our results after 100 urethroplasties for the treatment of urethral stricture both at the bulbar and penile urethra, using different techniques.METHODS: 100 patients with the diagnosis of anterior urethral stricture, that were submitted for urethroplasty in the period 1997-2007. Of them, 57 treated by end to end urethroplasty. 4 patients underwent augmented free graft anastomotic urethroplasty. Buccal mucosa free graft was used in 16 patients and penile skin onlay flap in 23.RESULTS: We have obtained 84% good results overall.In patients undergoing end to end urethroplasty we obtained 91.2% success rate. We had 75 % of good re-sults with the free graft anastomosis. In the cases in which we used buccal mucosa patch we obtained 90% success in bulbar urethra and 67 % in penile urethra. When we used onlay flaps good results were 70.6% in penile urethra and 66,7 % in bulbar urethra.CONCLUSIONS: Open surgery is the best form of treatment for urethral strictures. The anastomotic urethroplasty is the technique that, applied in bulbar urethra, enables better results. For strictures over two centimeters we have other procedures of choice in penile urethra, pediculated skin flaps, except in cases with Lichen Esclerosus, in which the use of buccal mucosa as a graft is preferable, and in the bulbar urethra in which augmented onlay graft urethroplasty or free grafts, mainly buccal mucosa, are preferred. In long and complex strictures, the option that we must contemplate is two-stage surgery. Any type of urethroplasty can fail, and this risk increases as the time passes(AU)

Pliorquidismo / Polyorchidism

OBJETIVO: Presentamos un caso de teste supernumerario, rara entidad, de la que hay recogidos y fundamentados unos 100 casos.MÉTODOS: Se trata de un varón de 44 años, que consultó por descubrimiento casual de masa escrotal derecha. A la exploración física, ecográfica y tomográfica ya se sospechó el diagnóstico de poliorquidia, refrendándose posteriormente mediante exploración quirúrgica y biopsia. Dada la ausencia de patología y la completa normalidad de la línea seminal se optó por no actuar, no extirpando el teste supernumerario.RESULTADOS: Existen clasificaciones para una correcta evaluación de la poliorquidia, que relacionan la localización respecto a escroto, y la existencia o no de epidídimo y deferentes independientes para las dos gónadas.CONCLUSIONES: Aunque remota, existe la posibilidad de degeneración maligna en estos testes, por lo que se impone la exploración quirúrgica y la extirpación de los testes supernumerarios cuando la biopsia arroje dudas, en cuanto a displasia o presencia de carcinoma in situ, o cuando sean origen de dolor(AU)

OBJECTIVE: To report one case of supernumerary testicle, a rare entity with around 100 cases published.METHODS: 44-year-old male patient consulting for incidental discovering of a right scrotal mass. The diagnosis of polyorchidism was suspected after physical examination, ultrasound, and CT scan, and confirmed subsequently on surgical exploration and biopsy.Due to the absence of pathology and complete normal seminal lines decision was taken to not perform orchiectomy of the supernumerary testicle.RESULTS: There are classifications for proper evaluation of polyorchidism, which state the relation between site of the testicle in relation to scrotum, existence or absence of independent epididymis and vasa deferentia for both testicles.CONCLUSIONS: Although remotely, there is a possibility of malignant degeneration of these testicles, so that surgical exploration and excision of the supernumerary testicles when their biopsy is doubtful in terms of dysplasia or if they present carcinoma in situ or they are a source of pain(AU)

[Neurological metastases secondary to germ cell testicular tumor]. / Metástasis neurológicas secundarias a tumor testicular germinal.

OBJECTIVE: Neurological metastases secondary to urological tumors account for 12% overall. The ones derived from germ cells testicular tumors are exceptional in the age of cisplatin. METHODS: We report one case of mixed germ cell tumor in a 49-year-old male patient treated with systemic chemotherapy during 18 months before presenting with severe central and peripheral neurological symptoms leading to death due to massive cerebral hemorrhage. RESULTS: We describe three types of presentation of cerebral metastases in patients with testicular cancer. Type I present synchronically with the primary tumor. Type 2 are diagnosed after a period of remission after conventional cytostatic treatment. Type 3 metastases are diagnosed during the course of the disease and its treatment. CONCLUSIONS: Except unique metastases classified in groups 1 and 2, which are susceptible of surgery or radiosurgery, in which in response may be expected; the rest of lesions secondary to germ cell tumors have an ominous prognosis and outcomes, with short survivals.

[Adenomatoid tumor of the epididymis. Report of five cases]. / Tumor adenomatoide epididimario. Aportación de 5 casos.

OBJECTIVE: Adenomatoid tumor of the epididymis is unfrequent, benign, with no malignant outcomes described. METHODS: We report five cases, with patient's ages varying from 31 to 76 years, and tumor sizes from 6 to 30 mm. All patients underwent surgery with excision of the mass, some of them after several months of growing. In one of the cases the evolution reached six years. RESULTS: None of the cases presented recurrence or bad outcome after surgery. Pathology confirmed the benign adenomatoid character in all cases. CONCLUSIONS: Despite the clinical, ultrasound and physical examination findings suggest the localization in the epididymis and its benign character, surgical exploration is mandatory with surgical excision of the paratesticular mass.

[Sertoli cell malignant tumor]. / Tumor de células de Sertoli maligno.

OBJECTIVE: We report a new case of Sertoli cell testicular tumor with malignant characteristics. METHODS: 77 year-old male patient, suffering a general wasting syndrome presenting with a left solid testicular mass with the diagnosis of malignant Sertoli cell tumor after orchyectomy, without local, regional or distant dissemination, and a benign outcome after 18 months of follow-up. RESULTS: Sertoli cell tumor or androblastoma is classified as non-germ cell tumor derived from the stroma of the sexual cords. There are three types depending on its cellular composition: calcified big cell, sclerotic cell, and the most frequent of all, the classic type. CONCLUSIONS: Being the Sertoli cell testicular tumor rare, its malignant type is even rarer, accounting for not more than 10% of all. Despite the pathological characteristics related to malignancy, its posterior behaviour is unpredictable and not much known, the some than follow-up and treatment, because it is not sensible to cytostatic drugs. The existence of metastases continues to be the only valid parameter with prognostic value.

Metástasis neurológicas secundarias a tumor testicular germinal / Neurological metastases secondary to germ cell testicular tumor

Objetivo: Las metástasis neurológicas secundarias a tumores urológicos suponen un 12% del total. Las derivadas de los tumores germinales testiculares en la época del cisplatino son excepcionales. Métodos: Presentamos un caso de tumor germinal mixto en un varón de 49 años tratado mediante quimioterapia sistémica desde 18 meses antes que presentó severa clínica neurológica central y periférica, que le condujo a la muerte por hemorragia cerebral masiva. Resultados: Se describen 3 tipos de presentación de las metástasis cerebrales en pacientes con cáncer testicular. El tipo 1 en el que se presentan sincrónicamente al tumor primario. El tipo 2 en el que se diagnostican tras un período de remisión luego del tratamiento citostático convencional. En el tipo 3 las metástasis se diagnostican durante el curso de la enfermedad y durante su tratamiento. Conclusiones: Salvo en caso de metástasis únicas encuadradas en el grupo 1 y 2 susceptibles de cirugía o radiocirugía, en el que cabe esperar respuesta, en el resto de lesiones secundarias a tumores germinales la evolución y el pronóstico son ominosos, con supervivencias escasas (AU)

Objective: Neurological metastases secondary to urological tumors account for 12% overall. The ones derived from germ cells testicular tumors are exceptional in the age of cisplatin. Methods: We report one case of mixed germ cell tumor in a 49-year-old male patient treated with systemic chemotherapy during 18 months before presenting with severe central and peripheral neurological symptoms leading to death due to massive cerebral hemorrhage. Results: We describe three types of presentation of cerebral metastases in patients with testicular cancer. Type 1 present synchronically with the primary tumor. Type 2 are diagnosed after a period of remission after conventional cytostatic treatment. Type 3 metastases are diagnosed during the course of the disease and its treatment. Conclusions: Except unique metastases classified in groups I and 2, which are susceptible of surgery or radiosurgery, in which in response may be expected; the rest of lesions secondary to germ cell tumors have an ominous prognosis and outcomes, with short survivals (AU)

Tumor adenomatoide epididimario. Aportación de 5 casos / Adenomatoid tumor of the epididimys. Report of five cases

Objetivo: El tumor adenomatoide de epidídimo es infrecuente, de carácter benigno, no habiéndose descrito evoluciones malignas. Método: Presentamos 5 casos, con edades variopintas entre los 31 y los 76 años, y también con tamaños diversos entre los 6 y los 30 mm. Todos fueron intervenidos realizándose exéresis de la masa, tras varios meses de crecimiento. En un caso la evolución era de 6 años. Resultado: Ninguno presentó ni recidiva ni evolución tórpida tras la cirugía. La histología confirmó el carácter adenomatoide benigno en todos ellos. Conclusiones: A pesar de que los hallazgos clínicos, ecográficos y exploratorios sugieren la localización epididimaria y la benignidad, es mandatoria la exploración y extirpación quirúrgica de toda masa sólida paratesticular (AU)

Objective: Adenomatoid tumor of the epididymis is unfrequent, benign, with no malignant outcomes described. Methods: We report five cases, with patient's ages varying from 31 to 76 years, and tumor sizes from 6 to 30 mm. All patients underwent surgery with excision of the mass, some of them after several months of growing. In one of the cases the evolution reached six years. Results: None of the cases presented recurrence or bad outcome after surgery. Pathology confirmed the benign adenomatoid character in all cases. Conclusions: Despite the clinical, ultrasound and physical examination findings suggest the localization in the epididymis and its benign character, surgical exploration is mandatory with surgical excision of the paratesticular mass (AU)

Tumor de células de Sertoli maligno / Sertoli cell malignant tumor

Objetivo: Aportamos a la literatura un nuevo caso de tumor testicular compuesto por células de Sertoli de características histológicas malignas. Métodos: Se trata de un varón de 77 años, afecto de un síndrome general constitucional y una masa sólida testicular izquierda en la que tras la orquiectomía se diagnostica de tumor de células de Sertoli maligno, sin diseminación locorregional ni a distancia, con una benigna evolución tras 18 meses de seguimiento. Resultados: El tumor de células de Sertoli o androblastoma se encuadra en la clasificación de tumores no germinales derivados del estroma de los cordones sexuales. Se reconocen 3 tipos dependiendo de su composición celular: de célula grande calcificada, de célula esclerosada, y la más frecuente de todas, la variante clásica. Conclusiones: Siendo el tumor de células de Sertoli un tumor testicular poco común, la forma maligna lo es menos aún, no más del 10% del total. A pesar de las características patológicas que se relacionan con la malignidad, su comportamiento posterior es imprevisible y poco conocido, al igual que la forma de seguimiento y tratamiento, pues no es sensible a citostáticos. La presencia de metástasis sigue siendo hoy en día el único parámetro válido como valor pronóstico (AU)

Objective: We report a new case of Sertoli cell testicular tumor with malignant characteristics. Methods: 77-year-old male patient, suffering a general wasting syndrome presenting with a left solid testicular mass with the diagnosis of malignant Sertoli cell tumor after orchyectomy, without local, regional or distant dissemination, and a benign outcome after 18 months of follow-up. Results: Sertoli cell tumor or androblastoma is classified as non-germ cell tumor derived from the stroma of the sexual cords. There are three types depending on its cellular composition: calcified big cell, sclerotic cell, and the most frequent of all, the classic type. Conclusions: Being the Sertoli cell testicular tumor rare, its malignant type is even rarer, accounting for not more than 10% of all. Despite the pathological characteristics related to malignancy, its posterior behaviour is unpredictable and not much known, the same than follow-up and treatment, because it is not sensible to cytostatic drugs. The existence of metastases continues to be the only valid parameter with prognostic value (AU)

[Metachronic testicular metastasis secondary to clear cell renal adenocarcinoma]. / Metástasis testicular metacrónica secundaria a adenocarcinoma renal de células claras.

OBJECTIVE: To report one case of unusual testicular metastasis from a renal origin. METHODS: 57 year-old patient with disseminated right renal cancer under treatment who presented bone metastasis and a painful nodule in the upper pole of the right testicle during his follow-up with medical therapy, making surgery necessary. The pathology result was clear cell adenocarcinoma. RESULTS: Six months later the patient continues under oral Sorafenib without evidence of new metastatic implants. CONCLUSIONS: Testicular secondary metastatic tumors account for less than 1% of old testicular tumors. In patients in the fifth and sixth decades, mainly if they are affected by other neoplasias, testicular masses use to be metastatic implants. The most frequent origin is prostate.

[Epithelioid renal angiomyolipoma]. / Angiomiolipoma epitelioide renal.

OBJECTIVE: To issue the existence of a variety of angiomyolipoma, named epithelioid, with different histological and clinic properties. METHODS: We report the case of a 17 year old female, with Bourneville's disease, who was discovered to have a solid renal mass suggestive of carcinoma in a control CT scan, adjacent to other smaller masses identified as angiomyolipomas. RESULTS: After several tumorectomies, the suspicious mass, 4 cm in size, was diagnosed as epithelioid angiomyolipoma, with immunohistochemical confirmation of capacity for HMB45, and negative vimentin and keratin. CONCLUSIONS: Despite the possibility of coexistence of adenocarcinoma and angiomyolipoma, the existence of an epithelioid variety cannot be discarded, mainly in patients with phakomatosis. The indications for surgery are the same than for the rest of renal masses. Nevertheless, follow-up criteria must be stricter due to the possibility of torpid outcome in terms of dissemination of this infrequent variety of angiomyolipoma.

[Metastases in the paranasal sinuses secondary to prostatic adenocarcinoma]. / Metástasis en senos paranasales secundaria a adenocarcinoma prostático.

OBJECTIVE: To report a new case of exceptional metastases from a prostatic carcinoma. METHODS: 64-year-old male with nine months history of disseminated prostate cancer, taking hormonal treatment and biphosphonates, who presents with rising PSA, facial dysesthesia and left exophtalmos. MRI recognizes the existence of a solid mass in the right maxillary sinus with involvement of the ipsilateral orbital floor, and another one in the left frontal sinus invading the roof of the ipsilateral orbit and also with orbital extraconal involvement. RESULTS: Once the diagnosis was established hormonal maneuvers were performed and chemotherapy with docetaxel was administered achieving at the start of treatment measurable disease stabilization with biochemical remission of PSA levels, followed posteriorly by progression without changes in the metastatic images. Currently new cytoreductive therapy with docetaxel has been initiated. CONCLUSIONS: 1% of the prostatic tumors involve the head in their evolution. Most frequent metastases are localized in the brain and meninges, being the involvement of paranasal sinuses and ocular orbit extraordinary. The importance of these comes from the extension to the orbit and the eye in vicinity. Second line hormonal maneuvers, local radiotherapy and systemic chemotherapy will be necessary for control, although results are discouraging. In general, prognosis is poor, with short survival.

Divertículo uretral tras uretroplastia de sustitución. A propósito de seis casos / Urethral diverticulum after substitution urethroplasty. Report of six cases

OBJETIVO: Mostrar la patogenia, diag- nóstico y posibilidades de tratamiento de los divertículos uretrales que pueden producirse tras realizar una uretroplastia de sustitución. Comentamos los seis casos que hemos recogido en una serie de 34 pacientes y las técnicas que pueden ser útiles para tratar de evitar esta complicación. MÉTODOS: Sobre un total de 34 uretroplastias, 20 con colgajo pediculado y 14 con injerto de mucosa bucal hemos recogido seis casos de formación de un divertículo o saculación uretral. De ellos cinco han sido intervenidos y en un caso optamos por la abstención dado que no presentaba síntomas. RESULTADOS: Cuatro pacientes permanecen asintomáticos en la actualidad tras el tratamiento. Los dos restantes están pendientes de cierre uretral en un segundo tiempo. CONCLUSIONES: La aparición de pseudodivertículos uretrales tras cirugía de sustitución uretral por estenosis no es una complicación infrecuente. Existen técnicas que buscan reforzar la resistencia de ésta zona de la uretra debilitada y que es importante conocer en la práctica de esta cirugía reconstructiva (AU)

OBJECTIVES: To expose the pathogenesis, diagnosis and therapeutic options for urethral diverti- cula appearing after substitution urethroplasty. METHODS: Over a total of 34 urethroplasties, 20 with pediculated flap and 14 with buccal mucosa, we collected six cases of urethral diverticula/sacculation develop- ment. Five of them underwent surgery, and in one case without symptoms we opted for therapeutic abstention. RESULTS: Currently four patients remain asymptomatic after treatment. The other two are waiting for a second- time urethral closure. CONCLUSIONS: The development of urethral pseudo- diverticula secondary to stenosis after urethral substitution surgery is not an infrequent complication. For the practice of reconstructive surgery it is important to know that there are techniques to reinforce the resistance of this weakened area of the urethra (AU)

Metástasis en senos paranasales secundaria a adenocarcinoma prostático / Metastases in the paranasal sinuses secondary to prostatic adenocarcinoma

Objetivo: Presentar un nuevo caso de metástasis excepcional por carcinoma de próstata. Método: Varón de 64 años diagnosticado 9 meses antes de carcinoma prostático diseminado, en tratamiento hormonal además de bifosfonatos, que debuta con elevación de las cifras de PSA, disestesia facial y exoftalmos izquierdo. En RMN se reconoce la existencia de una masa sólida en seno maxilar derecho con afectación del suelo orbitario del mismo lado, y de otra de las mismas características localizada en seno frontal izquierdo con invasión del techo de la órbita homolateral y afectación extraconal orbitaria. Resultados: Una vez establecido el diagnóstico se sometió al paciente a maniobras hormonales y se administró quimioterapia con docetaxel obteniendo una estabilización de la enfermedad mensurable con una remisión bioquímica de los niveles del PSA al principio del tratamiento, para progresar posteriormente, sin observarse cambios en las imágenes metastásicas. En la actualidad se ha iniciado de nuevo terapia citorreductora con docetaxel. Conclusiones: El 1% de los tumores prostáticos afectarán la cabeza en su evolución. Las metástasis más frecuentes se localizan en cerebro y meninges, siendo la afectación de senos paranasales y órbita ocular extraordinaria. La importancia de éstas viene dada por la afectación en vecindad de la órbita y del ojo. Serán precisas para su control las maniobras hormonales de 2ª línea, la radioterapia local y la quimioterapia sistémica, aunque con resultados desalentadores. En general el pronóstico es malo, con sobrevivas cortas (AU)

Objective: To report a new case of exceptional metastases from a prostatic carcinoma. Methods: 64-year-old male with nine months history of disseminated prostate cancer, taking hormonal treatment and biphosphonates, who presents with rising PSA, facial dysesthesia and left exophtalmos. MRI recognizes the existence of a solid mass in the right maxillary sinus with involvement of the ipsilateral orbital floor, and another one in the left frontal sinus invading the roof of the ipsilateral orbit and also with orbital extraconal involvement. Results: Once the diagnosis was established hormonal maneuvers were performed and chemotherapy with docetaxel was administered achieving at the start of treatment measurable disease stabilization with biochemical remission of PSA levels, followed posteriorly by progression without changes in the metastatic images. Currently new cytoreductive therapy with docetaxel has been initiated. Conclusions: 1% of the prostatic tumors involve the head in their evolution. Most frequent metastases are localized in the brain and meninges, being the involvement of paranasal sinuses and ocular orbit extraordinary. The importance of these comes from the extension to the orbit and the eye in vicinity. Second line hormonal maneuvers, local radiotherapy and systemic chemotherapy will be necessary for control, although results are discouraging. In general, prognosis is poor, with short survival (AU)

[Surgical treatment of urethral stenosis: update]. / Cirugía de la estenosis de uretra. Actualización.

OBJECTIVES: To compile the main methods of surgical treatment of penile and bulbar urethral stenosis. METHODS: We review the most updated bibliography, focusing on authors with large experience in the treatment of urethral stenosis, and we use our own experience to contrast or reaffirm some of the techniques. RESULTS/CONCLUSIONS: The base of the treatment of urethral stenosis remains in the stenosis itself (localization, etiology and length) and also in patient's characteristics (age, past medical history). Among the techniques of urethroplasty we have techniques in one step, as the technique of excision and anastomosis, and the use of free grafts or vascularized flaps. The techniques in two steps like Johannson's or perineostomy are very useful in certain cases of complex stenosis. We should keep an eye on the development of new techniques and the use of new materials that will help, once consolidated, to improve results.

[Metachronic thyroid metastasis secondary to renal carcinoma. Case report]. / Metástasis tiroidea metacrónica secundaria a carcinoma renal. A propósito de un caso.

OBJECTIVE: We report the case of the patient with metachronic thyroid metastasis of a renal adenocarcinoma. METHODS: 61-year-old patient with the diagnosis of renal adenocarcinoma treated by radical nephrectomy (stage pT3bpN0M0) and subsequent interleukin-2 for twelve months presenting four years after surgery with a thyroid nodule displacing the trachea laterally, requiring left hemithyroidectomy. RESULTS: Pathology reported a lesion made of clear cytoplasm tumor cells, with marked atypia and anaplastic areas, compatible with clear cell renal adenocarcinoma. CONCLUSIONS: Thyroid metastases are extremely rare, being renal tumors the most frequent origin. They present as painless nodules, cold in gammagram, with normal thyroid hormones. The treatment of choice is surgical excision, with a better prognosis the longer the time between the primary and the appearance of metastasis.

[Nephroblastoma or Wilms tumor. Adult presentation. Report of two cases]. / Nefroblastoma o tumor de Wilms. Presentación en adultos. Estudio de dos casos.

OBJECTIVES: To present to new cases of nephroblastoma or Wilms tumor diagnosed in adult age. METHODS: The first case we report is a 16-year-old female with the diagnosis of stage I nephroblastoma after radical nephrectomy for a right renal mass. She underwent systemic polychemotherapy. The second case is a 33-year-old female with the diagnosis of nephroblastoma after percutaneous biopsy of a right renal mass. Due to the presence of lymph node, hepatic and lung dissemination systemic polychemotherapy (ACTD-VCR-DOX) was given. Right nephrectomy with regional lymph node dissection and hepatic metastasis excision were performed after confirmation of mass reduction. After that, the patient continued receiving systemic polychemotherapy with the same drugs. After resection of a lung nodule which did not disappear, and after confirmation of tumoral presence CB and VP 16 were added. RESULTS: Both patients are disease-free after 58 and 46 months respectively. CONCLUSIONS: This type of tumor typical of childhood is extremely rare in adult age, and despite worse survivals and more aggressiveness are described, they may be treated with the same protocols used in children, following any of the two big co-operative groups: American NWTS or European SIOP.

Cirugía de la estenosis de uretra. Actualización / Surgical treatment of urethral stenosis: update

Objetivo: Llevar a cabo una recopilación de los principales métodos de tratamiento quirúrgico de la estenosis de uretra peneana y bulbar. Métodos: Revisamos la bibliografía más actualizada, centrándonos en autores con gran experiencia en el tratamiento de la estenosis uretral, y utilizamos nuestra experiencia para contrastar o reafirmar alguna de las técnicas. Resultados/Conclusiones: La base del tratamiento de la estenosis uretral radica en la propia estenosis, es decir, localización, etiología y longitud, así como en las características del paciente (edad, historia clínica). Entre las uretroplastias disponemos de técnicas en un tiempo, como la excisión y anastomosis, y el uso de injertos libres o colgajos pediculados. Las técnicas en dos tiempos como la de Johanson o la perineostomía son de gran utilidad en determinados casos de estenosis complejas. Debemos permanecer atentos al desarrollo de nuevas técnicas y al empleo de nuevos materiales que ayudaran, una vez consolidados a obtener mejores resultados (AU

Objectives: To compile the main methods of surgical treatment of penile and bulbar urethral stenosis. Methods: We review the most updated bibliography, focusing on authors with large experience in the treatment of urethral stenosis, and we use our own experience to contrast or reaffirm some of the techniques. Results/Conclusions: The base of the treatment of urethral stenosis remains in the stenosis itself (localization, etiology and length) and also in patient’s characteristics (age, past medical history). Among the techniques of urethroplasty we have techniques in one step, as the technique of excision and anastomosis, and the use of free grafts or vascularized flaps. The techniques in two steps like Johannson's or perineostomy are very useful in certain cases of complex stenosis. We should keep an eye on the development of new techniques and the use of new materials that will help, once consolidated, to improve results (AU)

Metástasis tiroidea matacrónica secundaria a carcinoma renal. A propósito de un caso / Metachronic thyroid metastasis secondary to renal carcinoma. Case report

Objetivo: Presentamos el caso de una paciente con metástasis tiroidea metacrónica de un adenocarcinoma renal. Métodos: Paciente de 61 años, tratada mediante nefrectomía radical y posteriormente con interleukina-2 durante 12 meses por un adenocarcinoma renal, en estadío pT3b pN0 M0, que 4 años después desarrolla un nódulo tiroideo con desplazamiento tráqueal, que obligó a realizar una hemitiroidectomía izquierda. Resultados/Conclusiones: Histopatológicamente se informó como una lesión constituida por células tumorales con citoplasma claro, con acusada atipia y zonas anaplásicas compatible con adenocarcinoma renal de células claras. El estudio de extensión fue negativo. Conclusiones: Las metástasis tiroideas son extraordinariamente raras, siendo su origen renal el más frecuente. Se presentan como un nódulo indoloro, gammagráficamente frío, y niveles de hormonas tiroideas normales. Su tratamiento es la exéresis quirúrgica, con un pronóstico mejor cuanto mayor sea el tiempo trascurrido entre el tumor primario y la aparición de metástasis (AU)

Objective: We report the case of the patient with metachronic thyroid metastasis of a renal adenocarcinoma. Methods: 61-year-old patient with the diagnosis of renal adenocarcinoma treated by radical nephrectomy (stage pT3bpN0M0) and subsequent interleukin-2 for twelve months presenting four years after surgery with a thyroid nodule displacing the trachea laterally, requiring left hemithyroidectomy. Results: Pathology reported a lesion made of clear cytoplasm tumor cells, with marked atypia and anaplastic areas, compatible with clear cell renal adenocarcinoma. Conclusions: Thyroid metastases are extremely rare, being renal tumors the most frequent origin. They present as painless nodules, cold in gammagram, with normal thyroid hormones. The treatment of choice is surgical excision, with a better prognosis the longer the time between the primary and the appearance of metastasis (AU)