Ruptura espontánea de quiste renal simple en el sistema pielocalicial. Evolucion desde Bosniak I a IIF / Spontaneous rupture of a simple renal cyst to the pyelocalyceal system. Evolution from Bosniak I to IIF

Objetivo: Comunicar un caso de ruptura espontánea de quiste renal simple en el sistema pielocalicial. Métodos: Exponemos el caso de una paciente de 47 años afecta de un quiste renal simple (Bosniak I) de 17 centímetros y de una litiasis renal ipsilateral. La paciente presentó una infección urinaria acompañada de fiebre y dolor lumbar, comprobándose después mediante TAC el drenaje espontáneo del quiste a la vía urinaria. Resultados: El quiste una vez drenado, se redujo en tamaño y se calcificó. Las calcificaciones son gruesas y nodulares. Actualmente presenta un quiste clasificable como Bosniak IIF. Conclusión: Los quistes renales simples pueden, bajo distintas circunstancias, romperse y drenar hacia la vía urinaria (AU)

Objective: To report the spontaneous rupture of a renal cyst into the adjacent pyelocalyceal collec-ting system. Methods: We present the case of a 47 year old woman with a 17 centimeter simple renal cyst (Bosniak I) as well as ipsilateral nephrolithiasis. The patient had a febrile urinarytract infection with flank pain. A subsequent CT scan revealed that this cyst spontaneously ruptured into the renal pelvis. Results: Follow up evaluations showed the former cyst has decreased in size and contain thick and nodular calcifications. At present it is a Bosniak IIF cyst. Conclusion: Simple renal cysts can spontaneously rupture and drain into the adjacent renal collecting system (AU)

[Testicular epidermoid cyst: uncommon lesion of difficult preoperative diagnosis]. / Quiste epidermoide testicular: una rara entidad de dificil diagnostico preoperatorio.

Intratesticular epidermoid cysts are rare tumours that constitute one percent of all testicular masses. They are bening lesions that make differential diagnosis from malignant testicular tumours difficult. The absence of serum markers elevation and ultrasound imaging could support these lesions being bening epidermoid cysts, and in that case, conservative surgery is adequate. We present the case of a 22 years old patient who complains of a left testicular mass. In this case ultrasound diagnosis was non-specific and a left radical inguinal orchiectomy was performed.

[Upper urinary tract tumours]. / Tumores de urotelio superior.

OBJECTIVE: To evaluate diagnostic techniques, treatment and follow-up in 94 patients affected of upper urinary tract tumor. PATIENTS AND METHOD: From 1978 to december 2002 we operated 105 patients due to upper urinary tract tumor, although only 94 are valid for analysis. Mean age was 65 years and 85% were man. Haematuria was the most frequent symptom. RESULTS: Urography (93%), ecography (77%) and CT (67%) were the most used diagnostic techniques. Pelvic tumor was the most frequent (71%) and total nephroureterectomy including bladder cuff the chosen treatment (76.4%). Previous or simultaneous bladder tumor was observed in 23% cases and delayed in 30%. With a mean follow-up of 76 months the patient survival is 53%. CONCLUSIONS: Due to the high frequence of previous, simultaneous or delayed bladder tumors, the upper urinary tract tumor should be considered as a panurothelial disease, worsening the outcome of this kind of tumors.

[Leydig cell tumor. Report of 2 cases and review of the literature]. / Tumor de células de Leydig. Aportación de dos casos y revisión de la literatura.

The Leydig cell tumor is the most frequent of non-germ cell tumors of the testis. Clinical findings depend on the age of presentation. We present two cases of Leydig Cell tumors of the testis, diagnosed in a 8 years old child with isosexual precocity, and a 42 years old adult with Gynaecomastia. After reviewing the existing literature on this uncommon pathology we consider that the iconography presented is very interesting for furthering the knowledge on this subject.

[Correlation between imaging findings and anatomopathologic results in radical prostatectomy. Data from our series]. / Correlación de los hallazgos por imagen y resultados anatomopatológicos en la prostatectomía radical. Datos de nuestra serie.

OBJECTIVE: To analyze the diagnostic methods utilized in prostate cancer and the preoperative information on the extent of the tumor, and compare these results with those obtained from anatomopathological analyses of the radical prostatectomy specimen. METHODS: Data on the radical prostatectomies performed during the study period were obtained from the Admissions and Clinical Records services and were analyzed using the SPSS statistical analysis software for Windows. RESULTS: From 1991 to 1998, 109 radical prostatectomies were performed. Evaluation by transrectal US was carried out in 89 patients (81.6%) and detected a tumor (unilateral or bilateral) in 77, for a sensitivity of 86% (CI 78.8-93.2). A CT study was performed in 94 patients and was positive in 25, for a sensitivity of 26.5% (CI 17.6-35.4). The sensitivity for transrectal US and CT were 4.17% and 3.33% for capsular involvement, 5.88% and 5.26% for seminal vesicle involvement, and 0% and 0% for node involvement, respectively. CONCLUSIONS: Transrectal ultrasound is a reliable diagnostic imaging method, although it has a low sensitivity when used to determine the extent of the tumor. In our series, the radiological methods showed a low sensitivity when they were utilized to determine the extent of the prostate cancer. Routine preoperative assessment by CT can be obviated in prostate cancer.

[Mucinous adenocarcinoma of the prostate. Report of a new case]. / Adenocarcinoma mucinoso de próstata. Aportación de un nuevo caso.

OBJECTIVE: To describe a case of mucinous adenocarcinoma of the prostate, an uncommon variant of prostatic carcinoma of which few cases have been reported in the literature. This tumor type is briefly reviewed with special reference to the controversial issues that remain unresolved due to the small number of cases. METHODS/RESULTS: A case of mucinous adenocarcinoma of the prostate is presented. An extraprostatic origin had been discarded. The diagnosis was made by DRE, transrectal US and histological confirmation by transrectal biopsy. PSA values were normal. Studies to determine the extent of the lesion showed advanced locoregional dissemination. Surgery was therefore not indicated and hormonal therapy was administered. Patient outcome was poor with no apparent clinical response to hormone blockade. Radiotherapy was attempted. The patient rapidly became worse and died. CONCLUSIONS: Mucinous adenocarcinoma of the prostate is characterized by the presence of significant amounts of extra and intracellular mucin. Its clinical features are not unlike those of classical adenocarcinoma and in general terms, it is considered to carry a worse prognosis and refractory to hormone therapy.

[Genital wound caused by low-speed fire arm]. / Herida genital por arma de fuego de baja velocidad.

OBJECTIVE: To report a case of genital gunshot injuries and review the literature. METHODS: A case of low velocity multiple gunshot penile injuries is described. Surgical exploration was performed, gunshot removed and the albuginea repaired. A broad spectrum antibiotic was administered prophylactically for infection. RESULTS: Good cosmetic and functional results, including sexual potency and voiding, were achieved. CONCLUSIONS: Surgical exploration is mandatory in genital gunshot injuries. The best approach to the albuginea is by a crown incision and denudation of the penile skin, which permits surgical repair with excellent cosmetic results.

[Synchronous renal oncocytoma and asymptomatic pheochromocytoma. Report of a case]. / Oncocitoma renal y feocromocitoma asintomático sincrónicos. A propósito de un caso.

OBJECTIVE: To report a rare case of coexisting renal oncocytoma and pheochromocytoma. To our knowledge, only one such case has been reported in the literature. METHODS: The findings of the imaging studies of this rare case and the unsuspected anatomopathological findings are presented. RESULTS/CONCLUSIONS: Despite its very low frequency, coexisting renal ocnocytoma and pheochromocytoma should be taken into account in patients with synchronous renal and adrenal masses. Unfortunately, there are no radiological patterns that allow us to suspect this rare condition.

[Retroperitoneal benign schwannoma. Report of a new case]. / Schwannoma benigno retroperitoneal. Aportación de un nuevo caso.

The schwannoma is a tumor resulting from the Schwann cells of neural shwath, being its retroperitoneal localization quite unusual. This tumor is clinically unspecified and in most of the cases it originates symptoms coming from the compression of the close structures when its localization is retroperitoneal. Its diagnosis is quite often fortuitous being confirmed by anatomopathological study afterwards. The treatment is surgical radical exeresis with subsequent followup. We report a new case of this uncommon retroperitoneal pathology in a female patient showing a nonspecific clinic. Two years after the surgery she remains asymptomatic without any radiological evidence of recidive.

[Bellini's carcinoma. Our experience]. / Carcinoma de Bellini. Nuestra experiencia.

OBJECTIVE: To present our experience with Bellini duct carcinoma, a rare form of renal adenocarcinoma with well-defined histological, cytogenetic and immunohistochemical characteristics. The literature is reviewed. METHODS/RESULTS: We reviewed the records of 430 patients with renal tumor that had been treated over a 10-year period. Only 6 cases with Bellini duct carcinoma were found. The mean age was 60 years, all patients were male and hematuria and lumbar pain were the most common clinical manifestations. Diagnosis was made by imaging techniques (US, urography, CT). The definitive diagnosis was based on the histological and immunohistochemical findings following nephrectomy. The one-year and three-year survival rates were 50% and 0%, respectively, indicating the aggressive nature of this variant of renal adenocarcinoma. CONCLUSIONS: Bellini duct carcinoma is an uncommon variant of renal carcinoma with nonspecific clinical features. It is a very aggressive tumor type whose treatment is only by nephrectomy and the outcome is poor.

[Comparative study of BTA stat test, NMP-22, and cytology in the diagnosis of bladder cancer]. / Estudio comparativo entre el BTA stat test, NMP-22 y citología en el diagnóstico del cáncer vesical.

OBJECTIVE: To compare the sensitivity and specificity of the BTA stat test, NMP-22 and voided urine cytology in the diagnosis of bladder cancer. METHODS: The study comprised 100 patients or follow-up or with a suspicion of bladder cancer. A voided urine sample was obtained and alliquoted in three samples for the BTA stat test, NMP-22 and cytology. The patients were subsequently evaluated by cystoscopy and TUR was performed when cancer was suspected. The bladder cancer was classified according to TNM stage and WHO grade. The McNemar test was utilized to compare the results. The cut-off level used for NMP-22 was 10 U/ml. ROC curves were plotted to determine the NMP-22 values for optimal sensitivity and specificity in our seires. RESULTS: Two patients were excluded from the study. The overall sensitivity was 76.47% for cytology, 78.43% for the BTA stat test and 84.31% for NMP-22 (p = n.s.). The specificity was 91.49%, 87.23% and 87.23% respectively (p = n.s.). By grade and stage, NMP-22 showed the best results followed by the BTA stat test and lastly cytology, although the differences were not significant. The ideal cut-off for NMP-22 in our series was 6 U/ml and not the generally recognized 10 U/ml. CONCLUSIONS: NMP-22 is superior to the BTA stat test and cytology in the diagnosis of bladder cancer, although the differences were not significant. The ideal cut-off in our series was 6 U/ml. The BTA stat test has the advantage of being easy to perform and provides the results in 5 minutes. In our view, NMP-22 and BTA stat test can replace cytology in the diagnosis of bladder cancer.

[Trazodone-induced priapism]. / Priapismo por trazodona.

We present a 41 years old male, treated with trazodone because of depression. He was seen at our Andrology unit for a 72 hours evolutioned priapism. We review the literature and submit this paper for publication because it is an uncommon pathology.

[Massive lymphatic involvement secondary to prostatic adenocarcinoma]. / Macroafectación linfática secundaria a adenocarcinoma de próstata.

Prostatic carcinoma may be diagnosed by the clinic manifestations or by the symptoms for locoregional disemination and distance metastasis. The lymphatic system is the first metastatic station, which is affected in a high percentage of cases. Event it may simulate lymphoproliferatives process and it si uncommon the lymphatic macroaffectation at first. In theses cases, the histologic and immunohistochemical study by the determination of prostatic specific antigen in lymph nodes can provice the diagnosis. Treatment of these tumors is palliative with hormonotherapy. Prognosis is bad with a low survival at five years.

[NMP-22 in the diagnosis of bladder cancer]. / El NMP-22 en el diagnóstico del cáncer vesical.

OBJECTIVE: To evaluate the usefulness of the NMP-22 test in the diagnosis of bladder cancer; to calculate the ideal cutoff and to compare the results among NMP-22, voided urine cytology and cystoscopy. MATERIAL AND METHODS: 166 patients having clinical suspicious of bladder cancer or in follow-up due to a previous one. The exclusions criteria were: other urological conditions, radiotherapy in the last three months, systemic chemotherapy in the last month, recent vesical trauma or indwelling catheter. Prior cystoscopy a recent voided urinary sample was sent to the pathology and biochemistry laboratory to perform cytology and NMP-22. A TUR was performed in patients with bladder tumour. The cutoff was calculated with ROC curves. For each test we calculate sensitivity, specificity, positive and negative predictive value. We use the McNemar test to compare the results, all of which are expressed with a confidence interval of 95%. RESULTS: The ideal cutoff was 6 U/ml. We have a global sensitivity of 82.75% for NMP-22 and 67.9 for cytology (p = 0.0118); the specificity was 80% and 94.12% respectively (p = 0.0018). By grade the sensitivity was 72.22% G1, 70.97% G2 and 100% G3 for NMP-22 and 44.44%, 58.06% and 90.62% for cytology. By stage it was 68.42% Ta, 83.33% T1 and 100 T2 or more for NMP-22 and 36.84%, 75% and 85.71% for cytology. With the cystoscopy we obtained a 100% sensitivity and 89.41% specificity. CONCLUSIONS: The NMP-22 is a useful test for the diagnosis of bladder cancer; is more sensitive and less specific than cytology. We think it can replace the cytology in the diagnosis and follow-up of bladder cancer. The ideal cutoff is 6 U/ml.

[The BTA stat test in the follow-up for bladder cancer]. / El BTA stat test en el seguimiento del cáncer vesical.

OBJECTIVE: To evaluate the utility of the BTA stat test in the follow-up of asymptomatic patients with superficial carcinoma of the bladder. METHODS: In 122 asymptomatic patients on follow-up for superficial bladder carcinoma, a sample of recently voided urine was obtained prior to cystoscopy and BTA stat test and cytology were performed. Thereafter we performed cystoscopy and TUR in those patients suspected of having recurrent bladder carcinoma. RESULTS: 51 patients had bladder cancer and 71 were tumor free. The sensitivity was 60.78% for the BTA stat test, 45% for cytology and 98% for cystoscopy. The specificity was 87.32%, 94.36% and 90.14%, respectively. The positive predictive value and negative predictive value were 77.5 and 75.6, 85.16 and 70.5, and 87.7 and 98.46, respectively for each test. The sensitivity by grade was 23% for G1, 71.4% for G2 and 92.8% for G3 for the BTA test versus 15.3%, 37.5% and 85.7% for cytology. The sensitivity by stage was 46.6% for Ta, 52% T1 and 100% for T2-4 and Tis for the BTA test versus 26.6%, 40% and 80% for cytology. CONCLUSIONS: The BTA stat test is superior to cytology in the follow-up of patients with bladder cancer. However, it has a low sensitivity in G1 and Ta and T1 tumors, therefore cystoscopy cannot be avoided.

[Retroperitoneal mass secondary to Bellini carcinoma]. / Masa retroperitoneal secundaria a carcinoma de Bellini.

Bellini Collecting Duct carcinoma is a rare and aggresive histological variety of renal adenocarcinoma which originates from the epithelium of the collecting tubule, with a well established histological, cytogenetic and inmunohistochemic characterization. It allows us to differenciate this tumor type from the rest of renal adenocarcinomas. There are 7 cases already published in the national literature. We introduce a new case with a particularity that is to show an unusual presentation form. It appears clinically without a specific urological symptomatology and radiologically it present a retroperitoneal mass shape with explains the patient's clinical manifestations.

[Raz's technics in the surgical treatment of stress urinary incontinence in women]. / Las técnicas de Raz en el tratamiento quirúrgico de la incontinencia urinaria de esfuerzo en la mujer.

OBJECTIVES: To analyze our results in the surgery of the stress urinary incontinence in women with the Raz's techniques, to assess the association among continence and factors like surgical technique, grade of incontinence and urethral pressure profile. MATERIAL AND METHODS: We do a retrospective study of 88 operations in 81 patients between the first of January 1990 and the thirty-one of December 1998. We describe the patients, previous treatments, grade of incontinence ans urodynamics data. We analyze the pre and post-operative complications. The outcome is evaluated by the Kaplan-Meier method, and the results are compared by the log rank test. RESULTS: 11 patients had a previous surgery and 7 had done physiotherapy; the grade of incontinence was 1 in 7 patients, 2 in 56 and 3 in 18. There were neither significative difference between UPP and abdominal leak point pressure and grade of incontinence nor between those parameters and continence. We did the Raz 1 technique in 67 patients, Raz 2 in 3, Raz 3 in 18. There were no significant difference among them. There are a progressive loose in the continence rate along the two first years; after that the continence rates are stabilized about 75%. The complications rate was scarce, except for the postoperative urinary retention, that reached the 20.45%. CONCLUSIONS: Our results are similar to those cited in the bibliography, mainly in the Spanish one. The highest rate of failure is in the two first years.

[The results of open surgery in the ureteropelvic junction syndrome]. / Resultados de la cirugía abierta en el síndrome de la unión pieloureteral.

OBJECTIVE: To evaluate the efficacy of the Anderson-Hynes pyeloplasty in 47 patients with pelviureteric junction syndrome and to compare our results with the reported results for open surgery and other techniques. METHODS: The records of 47 patients (21 males, 26 females) with pelviureteric junction syndrome treated at the Marqués de Valdecilla University Hospital from 1979-1997 were reviewed. Twenty-eight patients had right-sided involvement and two were bilateral. Mean age at the time of surgery was 35 years. Pain was the most common presenting feature (nephric colic, 28 pts; chronic lumbar pain, 11 pts). RESULTS: The Anderson-Hynes technique was performed in 43 of the 47 patients. IVP showed good results in 74.5%. CONCLUSION: In our experience the success rate achieved with the Anderson-Hynes technique is comparable to those reported elsewhere, which ranges from 65%-100%. Although currently there is considerably less experience with endoscopic and laparoscopic techniques, the results achieved to data appear to be similar to those of open surgery.

[Intrascrotal lithiasis: an infrequent finding?]. / Litiasis intraescrotal: un hallazgo infrecuente?

OBJECTIVE: To report on 10 additional cases of intrascrotal calculi and briefly review the literature and pathogenesis of this benign lesion. METHODS: 10 patients that had consulted for diverse testicular conditions were evaluated by ultrasound using the 7.5 MHz probe. RESULTS: All patients were found to have a hydrocele of a larger or smaller volume with a mobile hyperechoic focus that produced acoustic shadows. CONCLUSIONS: The ultrasound finding of intrascrotal calculi is becoming increasingly more frequent. In our view, this is due to the fact that more sonographic studies are currently performed. The possibility to diagnose this condition obviates the need for subsequent explorations or surgery.

[Usefulness of BTA Stat test (Bard) in the diagnosis of bladder cancer. Preliminary results and comparison with cytology and cystoscopy]. / Utilidad del BTA Stat TEST (Bard) en el diagnóstico del cáncer vesical. Resultados preliminares y comparación con citología y cistoscopia.

OBJECTIVE: The Bard BTA test is an immunochromatographic reaction to detect the bladder tumor antigen in patients with bladder cancer. The sensitivity, specificity and predictive values of this test are analyzed and compared with the standard methods of bladder cancer diagnosis (cystoscopy and cytology). METHODS: In 120 patients with symptoms suggestive of bladder cancer or who came for follow-up control evaluation for bladder cancer, we performed the BTA test and cytology in a voided urine sample prior to cystoscopy. TUR and randomized biopsies were performed in patients with a suspicion of bladder cancer. RESULTS: 76 patients had bladder cancer and 44 were free of cancer. The sensitivity was 76.36% for the BTA test, 61.84% for cytology and 98.5% for cystoscopy. The specificity was 77.7% for the BTA test, 86.36% for cytology and 86.36% for cystoscopy. The positive and negative predictive values were 85.29% and 65.38%, 88.68% and 56.72%, and 91.5% and 97.4%, respectively, for each of the foregoing tests. The sensitivity by grade was 43.75% for G1, 78.38% for G2, 95.65% for G3 for the BTA test; 18.75%, 59.46% and 95.65% for G1, G2 and G3, respectively, for cytology. The sensitivity by stage was 53.8% for Ta, 76% for T1, and 100% for T2-4 and Tis for the BTA test, whereas the sensitivity for cytology was 23.08%, 62% and 100%, respectively, for the foregoing tumor stages. CONCLUSIONS: The BTA test is simple, fast and useful in bladder cancer diagnosis. Our results show that the BTA test is superior to cytology.