Tumor adenomatoide de epidídimo: Aportación de 5 casos y revisión de la literatura / Adenomatoid paratesticular tumor: report of 5 new cases and literature review

OBJETIVO: Presentar los 5 casos de tumor adenomatoide epididimario, diagnosticados en los últimos 11 años en nuestro centro. Revisión bibliográfica y discusión del diagnóstico diferencial y tratamiento de este tipo de lesiones poco frecuentes en la práctica clínica. MÉTODO: Se realiza un análisis retrospectivo de los casos de tumor adenomatoide epididimario diagnosticados durante los últimos 11 años en nuestro hospital, desde enero de 2001 a febrero de 2012. RESULTADOS: La edad media de la serie fue de 44 años. El motivo de consulta predominante fue masa escrotal no dolorosa de larga evolución, con nódulo palpable, generalmente dependiente del epidídimo. En el 60% de los casos se realizó ecografía abdominal, en la cual se observó lesión paratesticular nodular de ecogenicidad compatible con tejido sólido. En el 60 % de los casos se analizaron los marcadores tumorales relacionados con tumores testiculares: alfafetoproteína (AFP), beta-gonadotropina coriónica humana (b-HCG) y lactato deshidrogenasa (LDH), que resultaron normales. Se realizaron 3 tumorectomías, 1 epididimectomía y 1 orquiectomía radical. CONCLUSIONES: El hallazgo de una masa sólida epididimaria es infrecuente en la práctica clínica. La exploración física y pruebas de imagen deben confirmar el origen paratesticular de la lesión, siendo entonces la epididimectomía transescrotal el tratamiento de elección. Ante duda diagnóstica, el abordaje quirúrgico por vía inguinal con biopsia intraoperatoria de la tumoración es mandatorio

OBJECTIVE: To report 5 cases of adenomatoid tumor of the epididymis that have been diagnosed in the last 11 years at our hospital. We performed a bibliographic review with discussion of diagnosis, differential diagnosis and treatment of this rare type of lesion. METHOD: We have performed a retrospective analysis of epididymal adenomatoid tumors diagnosed during the last 11 years in our hospital, from January 2001 to June 2012. RESULTS: The average age of the series was 44 years. The predominant reason for consultation was long duration painless scrotal mass, with palpable nodule, usually dependent of the epididymis. 60% of the patients have been studied with abdominal ultrasound, which showed a nodular paratesticular lesion, with an echogenicity compatible with solid tissue. Tumor markers associated with testicular tumors (alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (b-HCG) and lactate dehydrogenase (LDH)) were analyzed in 60% of the cases, being normal in all patients. 3 lumpectomies, 1 epididymectomy and 1 radical orchiectomy have been performed. CONCLUSIONS : The discovery of a solid epididymal mass is uncommon in clinical practice. Physical examination and imaging tests should confirm the paratesticular origin of the lesion, being then trans---scrotal epididymectomy the treatment of choice. If diagnosis is uncertain, inguinal approach and intraoperative biopsy are mandatory

Bladder endometriosis: report of 7 new cases and review of the literature.

OBJECTIVE: To describe our experience with bladder endometriosis at the Department of Urology of Complejo Hospitalario Universitario de Santiago de Compostela. METHODS: We performed a retrospective analysis of the cases of bladder endometriosis diagnosed during the last 11 years in our hospital, from January 2000 to December 2011. RESULTS: A total of 7 women, with a mean age of 32-year-old have been diagnosed by biopsy of bladder endometriosis. The most common symptoms were dysuria, suprapubic pain, urinary urgency and hematuria. All patients have undergone surgery (5 transurethral resection, 2 partial cystectomy), 6 of them were also treated with post-operative LHRH analogues. CONCLUSIONS: Endometriosis is a common disease in young women, but the involvement of the urinary tract is unusual. There are multiple therapeutic options; despite this there exists a high probability of recurrence.

Endometriosis vesical: aportación de 7 nuevos casos y revisión de la literatura / Bladder endometriosis: report of 7 new cases and review of the literature

OBJETIVO: Describir nuestra experiencia en el Departamento de Urología del Complejo Hospitalario Universitario de Santiago de Compostela en endometriosis vesical. MÉTODOS: Se realiza un análisis retrospectivo de los casos de endometriosis de vejiga diagnosticados durante los últimos 11 años en nuestro hospital, desde enero de 2000 a diciembre de 2011. RESULTADOS: Un total de 7 mujeres, con un promedio de 32 años de edad, ha sido diagnosticadas por biopsia de endometriosis vesical. Los síntomas más frecuentes han sido disuria, dolor suprapúbico, urgencia urinaria y hematuria. Todas ellas han sido tratadas con cirugía (5 con resección transuretral, 2 con cistectomía parcial), en 6 de ellas se asociaron análogos de LHRH en el post-operatorio. CONCLUSIONES: La endometriosis es una enfermedad común en mujeres jóvenes, pero la afectación de las vías urinarias es inhabitual. Existen múltiples posibilidades terapéuticas, pero a pesar de ello es alta la probabilidad de recurrencia

OBJECTIVE: To describe our experience with bladder endometriosis at the Department of Urology of Complejo Hospitalario Universitario de Santiago de Compostela. METHODS: We performed a retrospective analysis of the cases of bladder endometriosis diagnosed during the last 11 years in our hospital, from January 2000 to December 2011. RESULTS: A total of 7 women, with a mean age of 32-year-old have been diagnosed by biopsy of bladder endometriosis. The most common symptoms were dysuria, suprapubic pain, urinary urgency and hematuria. All patients have undergone surgery (5 transurethral resection, 2 partial cystectomy), 6 of them were also treated with post-operative LHRH analogues. CONCLUSIONS: Endometriosis is a common disease in young women, but the involvement of the urinary tract is unusual. There are multiple therapeutic options; despite this there exists a high probability of recurrence

Rupture of the superficial vein of penis: therapeutic options.

OBJECTIVE: To report an uncommon clinical case of spontaneous rupture of the superficial dorsal vein of penis. METHOD: A 27-year-old male patient attended the emergency room following spontaneous occurrence of a large hematoma and deformity in the penis. Rupture of cavernous bodies was initially suspected. RESULTS: Surgical examination revealed rupture of the superficial dorsal vein of penis, which was ligated. The patient was admitted to hospital for 24 hours, and showed total cosmetic and functional recovery at 2 weeks. CONCLUSIONS: Rupture of the superficial dorsal vein of penis is an uncommon condition considered in differential diagnosis of penile hematoma. Doppler ultrasound of the penis may allow for its diagnosis and for excluding rupture of corpora cavernosa. Although conservative management appears to be of choice, surgical examination, providing good cosmetic and functional postoperative results, is indicated when a reasonable doubt exists about diagnosis.

Rotura de la vena superficial del pene: opciones terapéuticas / Rupture of the superficial vein of penis: therapeutic options

OBJETIVO: Presentar un caso clínico poco frecuente de rotura de vena dorsal superficial del pene, producida de forma espontánea.MÉTODO: Paciente de 27 años que acude a urgencias tras la aparición espontánea de gran hematoma y deformidad peneana. La sospecha diagnóstica inicial fue rotura de cuerpos cavernosos.RESULTADOS: Se realiza exploración quirúrgica, evidenciando la rotura de la vena dorsal superficial del pene, que se liga. Ingreso hospitalario de 24 horas. Completa recuperación estética y funcional a las 2 semanas.CONCLUSIONES: La rotura de la vena dorsal superficial del pene es una entidad poco frecuente, incluida dentro del diagnóstico diferencial de los hematomas peneanos. La ecografía-doppler peneana puede permitir su diagnóstico y excluir la rotura de cuerpos cavernosos. Aunq-ue el tratamiento conservador parece de elección, ante la duda diagnóstica razonable, está indicada la exploración quirúrgica, la cual ofrece buenos resultados postoperatorios estéticos y funcionales (AU)

OBJECTIVE: To report an uncommon clinical case of spontaneous rupture of the superficial dorsal vein of penis.METHOD: A 27-year-old male patient attended the emergency room following spontaneous occurrence of a large hematoma and deformity in the penis. Rupture of cavernous bodies was initially suspected.RESULTS: Surgical examination revealed rupture of the superficial dorsal vein of penis, which was ligated. The patient was admitted to hospital for 24 hours, and showed total cosmetic and functional recovery at 2 weeks.CONCLUSIONS: Rupture of the superficial dorsal vein of penis is an uncommon condition considered in differential diagnosis of penile hematoma. Doppler ultrasound of the penis may allow for its diagnosis and for excluding rupture of corpora cavernosa. Although conservative management appears to be of choice, surgical examination, providing good cosmetic and functional postoperative results, is indicated when a reasonable doubt exists about diagnosis (AU)

Bilateral percutaneous nephrostomy as treatment for severe hemorrhagic cystitis.

OBJECTIVE: To report a case of severe hemorrhagic cystitis successfully treated by bilateral percutaneous nephrostomy. METHODS: The case of a 67-year-old female patient who had monosymptomatic gross hematuria with clots is reported. RESULTS: Standard conservative treatments failed and the patient developed a clot-retention plugged bladder. Endoscopic evacuation and electrocoagulation of bleeding areas was unsuccessful. Due to persistent hematuria and development of renal failure and hemodynamic instability, bilateral percutaneous nephrostomy was performed. At 24 hours, hematuria ceased, patient recovered hemodynamic stability, and no additional blood transfusions were required. CONCLUSIONS: Bilateral percutaneous nephrostomy may be a valuable option for the treatment of hemorrhagic cystitis when standard conservative measures have failed and as a prior step to performance of other more invasive procedures.

Nefrostomía percutánea bilateral como tratamiento de las cistitis hemorrágica severa / Bilateral percutaneous nephrostomy as treatment for severe hemorrhagic cystitis

OBJETIVO: Presentar un caso de cistitis hemorrágica severa tratada exitosamente mediante nefrostomía percutánea bilateral.MÉTODO: Presentamos el caso de una mujer de 67 años que presenta hematuria macroscópica monosintomática con coágulos.RESULTADOS: Fracaso de los tratamientos conservadores habituales y desarrollo de vejiga coagulada. Evacuación endoscópica y electrocoagulación de las áreas sangrantes sin éxito. Dada la persistencia de hematuria y desarrollo de insuficiencia renal e inestabilidad hemodinámica se decide nefrostomía percutánea bilateral. A las 24 horas cesa la hematuria, la paciente recupera la estabilidad hemodinámica y no requiere nuevas transfusiones sanguíneas.CONCLUSIONES: La realización de nefrostomía percutánea bilateral puede ser una opción útil en el tratamiento de la cistitis hemorrágica ante el fracaso de las medidas conservadoras habituales y como paso previo a la realización de otros tratamientos más invasivos(AU)

OBJECTIVE: To report a case of severe hemorrhagic cystitis successfully treated by bilateral percutaneous nephrostomy.METHODS: The case of a 67-year-old female patient who had monosymptomatic gross hematuria with clots is reported.RESULTS: Standard conservative treatments failed and the patient developed a clot-retention plugged bladder. Endoscopic evacuation and electrocoagulation of bleeding areas was unsuccessful. Due to persistent hematuria and development of renal failure and hemodynamic instability, bilateral percutaneous nephrostomy was performed. At 24 hours, hematuria ceased, patient recovered hemodynamic stability, and no additional blood transfusions were required.CONCLUSIONS: Bilateral percutaneous nephrostomy may be a valuable option for the treatment of hemorrhagic cystitis when standard conservative measures have failed and as a prior step to performance of other more invasive procedures(AU)

[Splenosis simulating a renal mass]. / Esplenosis simulando una masa renal izquierda.

OBJECTIVE: To report a case of splenosis and to review its diagnosis and treatment in the related literature. METHOD: We report the case of an asymptomatic 49-year-old man with splenectomy performed when he was 22. Lumbo-sacral MRI showed a left perirenal mass probably with renal origin. RESULTS: CT scan ruled out the renal origin. Due to previous splenectomy, splenosis was suspected. 99mTc-labeled heat-damaged erythrocytes scan confirmed the diagnosis. No treatment was applied. CONCLUSIONS: Clinicians should be aware that unknown origin masses, mainly in the peritoneal cavity, with a history of previous splenic trauma or splenectomy, might represent splenosis. A non-invasive diagnosis can be achieved with 99mTc-sulphur colloid scan, 99mTc-labeled heat-damaged erythrocytes or ferrumoxide-enhanced MRI, thus avoiding unnecessary surgical explorations.

Esplenosis simulando una masa renal izquierda / Splenosis simulating a renal mass

OBJETIVO: Presentar un caso de esplenosis y revisar aspectos diagnósticos y terapéuticos en la literatura relacionada.MÉTODO: Presentamos el caso de un varón de 49 años, esplenectomizado a los 22 años. Hallazgo incidental de una masa perirrenal izquierda en RM lumbo-sacra, de probable origen renal. RESULTADOS: Se realiza TC abdómino-pélvico descartando el origen renal de la masa. Dado el antecedente de esplenectomía la sospecha diagnóstica fue de esplenosis. Se realizó gammagrafía hepato-esplénica con hematíes desnaturalizados marcados con 99mTc confirmando el diagnóstico. Se decidió abstención terapéutica.CONCLUSIONES: Ante el hallazgo de masas de origen desconocido, fundamentalmente en la cavidad peritoneal, debe ser tenida en cuenta la posibilidad diagnóstica de esplenosis, sobre todo si existe un antecedente de lesión esplénica traumática o quirúrgica. Para su diagnóstico se pueden emplear pruebas no invasivas elevada especificidad, como la gammagrafía hepato-esplénica, la gammagrafía esplénica con hematíes desnaturalizados, o la RM con ferumóxido, evitando exploraciones quirúrgicas innecesarias(AU)

Summary.- OBJECTIVE: To report a case of splenosis and to review its diagnosis and treatment in the related literature.METHOD: We report the case of an asymptomatic 49-year-old man with splenectomy performed when he was 22. Lumbo-sacral MRI showed a left perirenal mass probably with renal origin.RESULTS: CT scan ruled out the renal origin. Due to previous splenectomy, splenosis was suspected. 99mTc-labeled heat-damaged erythrocytes scan confirmed the diagnosis. No treatment was applied.CONCLUSIONS: Clinicians should be aware that unknown origin masses, mainly in the peritoneal cavity, with a history of previous splenic trauma or splenectomy, might represent splenosis. A non-invasive diagnosis can be achieved with 99mTc-sulphur colloid scan, 99mTc-labeled heat-damaged erythrocytes or ferrumoxide-enhanced MRI, thus avoiding unnecessary surgical explorations(AU)

[Appendiceal mucocele misdiagnosed with infected urachal cyst: a differential diagnosis to keep in mind]. / Mucocele apendicular confundido con quiste de uraco infectado: un diagnóstico diferencial a tener en cuenta.

OBJECTIVE: To report one case of appendiceal mucocele misdiagnosed with an infected urachal cyst and to review their differential diagnosis, treatment and prognosis. PATIENT: We report the case of a 74-year-old-male with abdominal pain, fever and dysuria. Hypogastric abscess image in ultrasonography and CT. Percutaneous drainage and antibiotic therapy. Opaque enema, colonoscopy and cystoscopy were normal. RESULTS: Exploratory laparotomy and resection of a large cecum-fixed mass, independent to the bladder. Appendectomy and cecectomy. Pathology showed an appendiceal mucinous cystoadenoma (mucocele). CONCLUSIONS: Appendiceal mucoceles and urachal cysts are uncommon, mostly asymptomatic. Cystoadenoma or cystoadenocarcinoma mucoceles are large and can reach the midline, confounding with urachal cysts. Diagnosis by ultrasonography and/or CT. Surgical treatment in both, keeping the mucocele intact during operation to avoid the risk of pseudomyxoma peritonei.

Mucocele apendicular confundido con quiste de uraco infectado: un diagnóstico diferencial a tener en cuenta / Appendiceal mucocele misdiagnosed with infected urachal cyst: a differential diagnosis to keep in mind

Objetivo: Presentar un caso de mucocele apendicular confundido con un quiste de uraco infectado. Revisar su diagnóstico diferencial, tratamiento y pronóstico. Paciente: Presentamos el caso de un varón de 74 años, con dolor abdominal, fiebre y disuria. Imagen compatible con absceso hipogástrico en ecografía y TC. Drenaje percutáneo y tratamiento antibiótico. Enema opaco, colonoscopia y cistoscopia normales. Resultados: Laparotomía exploradora y exéresis de gran masa adherida a ciego, independiente de vejiga. Resección segmentaria apéndice-cecal. Diagnóstico anátomo-patológico de cistoadenoma mucinoso (mucocele) apendicular. Conclusiones: Mucocele apendicular y quiste de uraco son patologías poco frecuentes, asintomáticas en la mayoría de los casos. Los mucoceles secundarios a cistoadenoma o cistoadenocarcinoma suelen ser de gran tamaño, llegando hasta la línea media, confundiéndose con quistes de uraco. Diagnóstico mediante ecografía y/o TC. Tratamiento final quirúrgico en ambos, evitando en el caso del mucocele su apertura, debido al riesgo de pseudomixoma peritoneal (AU)

Objective: To report one case of appendiceal mucocele misdiagnosed with an infected urachal cyst and to review their differential diagnosis, treatment and prognosis. Patient: We report the case of a 74 year-old-male with abdominal pain, fever and dysuria. Hypogastric abscess image in ultrasonography and CT. Percutaneous drainage and antibiotic therapy. Opaque enema, colonoscopy and cystoscopy were normal. Results: Exploratory laparotomy and resection of a large cecum-fixed mass, independent to the bladder. Appendectomy and cecectomy. Pathology showed an appendiceal mucinous cystoadenoma (mucocele). Conclusions: Appendiceal mucoceles and urachal cysts are uncommon, mostly asymptomatic. Cystoadenoma or cystoadenocarcinoma mucoceles are large and can reach the midline, confounding with urachal cysts. Diagnosis by ultrasonography and/or CT. Surgical treatment in both, keeping the mucocele intact during operation to avoid the risk of pseudomyxoma peritonei (AU)