[Priapism secondary to testosterone administration in the treatment of delayed puberty]. / Priapismo secundario a la administración de testosterona en el tratamiento del retraso puberal.

OBJECTIVE: To describe a case of priapism following testosterone administration. METHODS/RESULTS: A 14-year-old boy treated with testosterone for delayed puberty presented with priapism after the administration of a single depot dose of 100 mg testosterone. Punction-aspiration of the corpora cavernosa was required to resolve the priapism. CONCLUSION: Administration of testosterone for delayed male puberty is safe but may occasionally cause priapism.

[Vaginal wall sling in the treatment of female stress urinary incontinence. Analysis of 27 cases]. / Cabestrillo con pared vaginal en el tratamiento de la incontinencia urinaria de esfuerzo femenina. Análisis de 27 casos.

OBJECTIVE: To evaluate the results of the vaginal wall sling procedure in the treatment of stress incontinence. METHODS: A retrospective study was conducted to evaluate the clinical outcome of the vaginal wall sling procedure in the treatment of genuine stress incontinence. The study comprised 27 women with a mean follow-up of 15 months postoperatively. RESULTS: Of the 27 patients who underwent this surgical procedure, 12 (44%) are continent and 9 (33%) have improved, accounting for 77% overall cure and improvement rate. Six patients (22%) remained incontinent. Mean operating time was 90 minutes and mean length of hospital stay was 8 days. CONCLUSION: In our experience, the vaginal wall sling procedure for genuine stress incontinence did not achieve the good results obtained in other series.

[Renal infarct in the adult: apropos of a case]. / Infarto renal en el adulto: a propósito de un caso.

OBJECTIVE: To report a case of renal infarction in a patient on anticoagulant therapy for aortic and tricuspid valvulopathy, with special reference to the diagnostic difficulty. METHODS: The most common causes of this condition, its forms of presentation, diagnostic methods, and therapeutic approaches are discussed. RESULTS/CONCLUSIONS: Renal infarction should be suspected in the presence of abdominal pain of sudden onset that is refractory to treatment with analgesics, especially in patients with a history of embolism, recent surgery or trauma. It is frequent to find increased levels of SGOT, SGPT, LDH, alkaline phosphatase and micro or gross hematuria and proteinuria. Arteriography or isotopic renogram is utilized to confirm the diagnosis, although IVP or CT is useful if the foregoing are not available. Early treatment is important for achieving recovery of the compromised renal parenchyma. In recent years, surgery has been displaced by the good results obtained with intraarterial infusion of fibrinolytics.

[Solitary pulmonary nodule in a patient with treated carcinoma of the renal pelvis: metastatic disease?]. / Nódulo pulmonar solitario en paciente con carcinoma de pelvis renal tratado: enfermedad metastásica?

OBJECTIVE: To describe a case of a solitary pulmonary nodule in a patient that had been treated for carcinoma of the renal pelvis. METHODS: A solitary pulmonary nodule was detected on the chest film of a patient that had been treated for carcinoma of the renal pelvis. The characteristics of the nodule are described and its diagnosis, with special reference to metastasis and primary pulmonary carcinoma, is discussed. RESULTS: The anatomopathological study demonstrated a chondroid hamartoma. CONCLUSIONS: A metastatic or a primary tumor is suspected when a solitary pulmonary nodule is detected in a patient that has been previously treated for urothelial carcinoma. However, other types of lesions with a more favourable outcome cannot be discarded, such as chondroid hamartoma as in the case described herein.

[Extra-adrenal pheochromocytoma. Report of a case]. / Feocromocitoma extraadrenal. Descripción de un caso.

OBJECTIVE: To report a case of extraadrenal pheochromocytoma with special reference to the diagnostic and therapeutic aspects. METHODS: A case of extraadrenal pheochromocytoma in a 20-year-old female with severe hypertension is presented. The clinical and biochemical aspects are reviewed with special reference to the diagnostic imaging methods. RESULTS: Plasma noradrenaline and urinary normetanephrine levels were elevated. CT and MRI showed a well-defined mass, 6 cm in diameter, adjacent to the left kidney, abdominal aorta and psoas muscle. Angiography demonstrated a high vascularization in the area of the tumor. MIBG scintigraphy revealed a well-defined mass, but no other distant lesions. Surgical treatment was performed with preoperative alpha and beta adrenergic blockade. Currently the patient has a normal blood pressure and catecholamine levels, with no evidence of lesions on the MIBG scintiscan. CONCLUSIONS: Plasma catecholamine and urinary normetanephrine levels levels confirmed the presumptive diagnosis of pheochromocytoma. MIBG is the technique of choice for the localization of the mass and suspected metastases. CT, MRI and angiography demonstrated the anatomic relationships of the tumor. The best results are achieved with complete resection and preoperative adrenergic blockade.

[Suprarenal cysts]. / La suprarrenal quística.

OBJECTIVE: To emphasize that adrenal cysts are an uncommon finding and in most cases incidentally discovered during evaluation for nonspecific abdominal pain or even at outopsy. METHODS: We report a case of a non-hypers-creting right adrenal cyst in a middle-aged woman. RESULTS: A complete hormone, radiological and sometimes isotopic evaluation are required to make an accurate diagnosis and to determine the adequate treatment. CONCLUSION: Surgical resection is usually prompted by an inaccurate diagnosis and failed conservative treatments.

[Multilocational cystic nephroma. Review of a case with reference to echographically observed changes]. / Nefroma quístico multilocular. Aportación de un caso con referencia a los cambios ecográficos observados.

OBJECTIVE: To describe an additional case of multilocular cystic nephroma, with special reference to the sonographic features of a renal cystic lesion. METHODS: The clinical and radiological features of a kidney tumor in a 61-year-old female patient were retrospectively analyzed. RESULTS: The preoperative diagnosis was that of a complex multicystic renal mass suggestive of a renal carcinoma. Radical nephrectomy was performed; histopathological analysis of the surgical specimen disclosed a multilocular cystic nephroma. An ultrasound scan 18 months earlier had demonstrated a simple renal cyst in the same site. CONCLUSIONS: Multilocular cystic nephroma is a tumor that is difficult to diagnose preoperatively. Making an accurate differential diagnosis is of interest, since it will permit conservative treatment. The case described herein supports the hypothesis with regard to the pathogenesis of this lesion, since it had previously showed sonographic features of a simple renal cyst.

[Mumps orchitis; review of 8 cases]. / Orquitis urliana; revisión de 8 casos.

OBJECTIVE: To determine the incidence of mumps orchitis in young males in the area of El Bierzo (Ponferrada, Spain) and the complications arising from this condition. METHODS: The cases of mumps orchitis referred by the primary care services to the emergency services of Hospital del Bierzo referral center were reviewed. We analyzed patient age, unilateral or bilateral testicular involvement, whether the patients had been vaccinated against mumps and the changes observed in the semen analysis. RESULTS: The diagnosis of mumps orchitis was confirmed in 8 patients, aged 15 to 19 years. Two patients had bilateral testicular involvement. Seven patients had not been vaccinated against parotiditis. Three patients had oligoasthenospermia and are currently being followed at the Urology services. CONCLUSIONS: The utility of large scale vaccination against mumps is emphasized. Long-term follow-up is recommended for all patients with abnormal semen analysis, particularly those with bilateral testicular involvement, since they may develop oligoasthernospermia several years after the infection or improve with item. A high incidence of mumps orchitis was found for this 12-month study period.

[Transitional cell bladder carcinoma in patients younger than 40 years of age]. / Carcinoma vesical de células transicionales en pacientes menores de 40 años.

OBJECTIVE: The clinical and pathological characteristics of bladder cancer in young patients were analyzed to determine if patients with bladder cancer under the age of 30 have a better prognosis than older adults and if transitional cell carcinoma of the bladder in patients aged 30 to 40 years has a similar behaviour to that observed in the higher risk population. METHODS: A retrospective review of transitional cell carcinoma of the bladder in patients less than 40 years old that had been treated between January, 1993 to August, 1997 was undertaken. RESULTS: We found 8 patients (5 men and 3 women) with urothelial tumor, accounting for an incidence of 4%. Four cases were diagnosed and staged TaG1, 2 T1G1 and 2 T1G2. Recurrence was observed in one case (12.5%) and progression in none. CONCLUSIONS: Transitional cell carcinoma of the bladder in patients under the age of 40 is usually associated with low grade and low stage tumors. The foregoing finding is certainly observed in those aged less than 30 years old. Bladder cancer is relatively rare in this age group, although we have found a higher incidence than that reported elsewhere. Treatment and follow-up depend on tumor grade and stage, regardless of age.

[Perineal tuberculous abscess. Presentation of a clinical case]. / Absceso tuberculoso perineal. Presentación de un caso clínico.

OBJECTIVE: To describe a case of perineal abscess caused by Koch's bacillus in a patient with a history of bladder tumor. METHODS/RESULTS: The patient described herein had consulted at the emergency services for perineal abscess. He had previously undergone transurethral resection of a bladder tumor and had received prophylactic intravesical BCG instillation thereafter. A culture of the exudate led to the diagnosis of tuberculosis, with no microbiological relation to BCG therapy. During the course of the disease, the patient developed a urethrocutaneous fistula which resolved after specific medical treatment. CONCLUSIONS: In a patient with clinical features of tuberculosis and a recent history of exposure to BCG, it does not necessarily follow that this bacillus is the cause of the tuberculosis. Furthermore, not all tuberculous fistulas progress to chronicity or require surgical treatment.

[Tuberculous prostatic abscess in acquired immunodeficiency syndrome]. / Absceso prostático tuberculoso en síndrome de inmunodeficiencia adquirida.

OBJECTIVE: To review the diagnostic and therapeutic aspects of prostatic abscess in the acquired immunodeficiency syndrome. METHODS/RESULTS: Herein we report on a patient with AIDS and prostatic abscess due to tuberculosis. The clinical features and a less invasive therapeutic approach are described. CONCLUSION: Appropriate treatment must be based on cultures, as patients with AIDS are increasingly frequently affected by uncommon organisms originating prostatic abscess. Treatment is by drainage, although spontaneous urethral drainage has been described, as in the present case. Percutaneous ultrasound-guided drainage appears to be a less invasive and effective procedure.

[Adenomatoid tumor of the epididymis. Report of a new case]. / Tumor adenomatoide de epididimo aportación de un nuevo caso.

OBJECTIVES: To report on an additional case of adenomatoid tumor of the right epididymis, a rare benign intrascrotal mass. METHODS/RESULTS: A 41-year-old man consulted for severe scrotal pain. Physical examination disclosed a mass in the right epididymis which was confirmed by scrotal ultrasound. A right orchidectomy was performed. Histological analysis of the surgical specimen disclosed a benign adenomatoid tumor of the epididymis. CONCLUSIONS: Although most scrotal solid masses are malignant tumors, those arising in the epididymis are frequently benign; therefore a conservative approach is recommended.

[Bilateral obstructive uropathy secondary to encrusted cystitis. Report of a case]. / Uropatía obstructiva bilateral secundaria a cistopatía incrustante. A propósito de un caso.

OBJECTIVES: Bilateral urinary obstruction is usually secondary to tumors or bilateral lithiasis. A rare case of encrusted cystitis causing bilateral hydronephrosis is described. METHODS/RESULTS: A 70-year-old woman presented with severe dysuria and vesical tenesmus. She had previously undergone pelvic surgery and received radiotherapy for a gynecological tumor. She was diagnosed as having encrusted cystitis. Treatment with urinary acidification and antibiotics achieved complete radiological and functional recovery. CONCLUSIONS: Some cases of urinary obstruction can be managed conservatively. An accurate diagnosis is necessary to avoid surgery in these cases.

[Splenic abscess secondary to xanthogranulomatous pyelonephritis]. / Absceso esplénico secundario a pielonefritis xantogranulomatosa.

OBJECTIVE: We report another case of splenic abscess after nephrectomy, a condition which must be considered in the differential diagnosis of post-operative fever. METHODS/RESULTS: A 20-year-old man presented with lumbar pain and fever. A diagnosis of xanthogranulomatous pyelonephritis was made and he was treated by subcapsular nephrectomy. Thirty days later the patient presented with a lumbar fistula from a splenic abscess and was treated by splenectomy. CONCLUSIONS: Fistulas and abscesses are more common after nephrectomy for xanthogranulomatous pyelonephritis. In our view, the subcapsular approach is an additional risk factor for the foregoing complications.

[Potential of ultrasonography in urologic diagnostic algorithms]. / Posibilidades de la ecografía en los algoritmos diagnósticos urológicos.

OBJECTIVES: The present study analyzed the place of ultrasound in the urological diagnostic protocols. Currently, most of the patients undergo some type of ultrasonographic evaluation at the outset or at some time during follow up. Our experience concerning the results, limitations and errors of this imaging technique are presented. METHODS: We reviewed the indications for US in different pathologies and its use together with other diagnostic techniques. Simple, cost-efficient algorithms are described. RESULTS: Its excellent performance permits making a correct diagnosis in many patients and remarkably simplifies evaluation in others. Its accuracy obviates the need for other explorations in certain pathologies. CONCLUSIONS: Ultrasound must be included in the urological armamentarium and should be considered as an extension of physical examination. Its accuracy and efficacy have been demonstrated. Furthermore, it is simple and easy to use, low-cost, and remarkably simplifies our diagnostic algorithms.

[Metastasizing adenocarcinoma of the colon in a patient with ceco-cystoplasty]. / Adenocarcinoma de colon metastásico en paciente portador de cecocistoplastia de ampliación.

Augmentation and substitution erocystoplastias are currently widely accepted techniques for the treatment of several benign and malignant diseases. Appearance of neoplasia on the various gut segments used after a latency period ranging from 5 to 25 years following initial surgery has been described. The paper presents one case of metastatic colon adenocarcinoma initially located in the region of ureteral reimplantation, in a patient with augmentation cecocystoplastia performed as a result of vesical retraction secondary to genitourinary tuberculosis. Appearance of this type of neoplasia in an increasing population, quite often young, compels the urologist to keep a tight watch. Endoscopic monitoring of the new bladder is the most effective diagnostic procedure. A once-a-year endoscopy after an interval as yet not definitely established, but which could be around 10 years after initial enterocystoplastia, seems advisable at least in cases at higher risk.