[Management of neurourological patients during the COVID-19 pandemic.] / Manejo del paciente neurourológico durante la pandemia COVID-19.

OBJECTIVES:  To report the recommendations of an expert panel to reorganize Neurourology units and to prioritize examinations and both conservative and surgical treatments during the COVID-19 pandemic. MATERIALS AND METHODS: Non-systematic review of the literature and national experts' opinion summarizing the recommendations in the diagnosis, management, and follow-up of neurourological patients during the COVID-19 pandemic. A modified nominal group technique was used due to extraordinary meeting and mobility restrictions during COVID-19 pandemic. RESULTS: Neurourological patients have special physiological and pathological characteristics that make them more vulnerable to SARS-CoV-2 infection. For prioritization purposes, they encompass in Functional Urology patients and their management is considered non-urgentor delayable with no specific deadline of recovery from normality. However, it is important to identify individual situations jeopardising the upper urinary tract, urinary retention or predisposing to urinary infections/sepsis. A classification is provided prioritizing conservative/outpatient management and the surgical treatment of the events occurring in neurourological patients during the COVID-19 pandemic. CONCLUSIONS: In neurourological patients we can find exceptional clinical situations in which a delayed treatment could develop irreversible changes in the upper urinary tract, advocating a more urgent treatment inspecific scenarios.

OBJETIVOS: Exponer las recomendaciones de un comité de expertos para la reorganización de las unidades de neurourología y la priorización de estudios y tratamientos durante la pandemia COVID-19.MATERIAL Y MÉTODOS: Revisión no sistemática de la literatura científica y opinión de expertos nacionales  para resumir las recomendaciones en el diagnóstico, tratamiento y seguimiento de los pacientes neurourológicos durante la pandemia COVID-19. Se utiliza una técnica de grupo nominal modificada debido a las restricciones extraordinarias de reunión y movilidad durante la pandemia COVID-19. RESULTADOS: Los pacientes neurourológicos poseen características fisiopatológicas especiales que les hace más vulnerables frente a la infección por SARS-CoV-2. Han sido englobados en general en el grupo de la Urología Funcional, relegando su manejo al de las situaciones no urgentes y demorables sin plazo concreto de recuperación de la normalidad. Sin embargo, es importante identificar situaciones específicas en las que exista compromiso funcional del aparato urinario superior, retención urinaria, o desarrollo de infecciones/sepsis urinaria. Se realiza una clasificación según el nivel de prioridad tanto del manejo ambulatorio y conservador como del tratamiento quirúrgico de eventos relacionados con pacientes neurourológicos durante la pandemia COVID-19. CONCLUSIONES: En los pacientes neurourológicos encontramos situaciones clínicas excepcionales en las que un retraso de su tratamiento puede conllevar alteraciones irreversibles en el tracto urinario superior, dada su condición de vejiga de riesgo funcional, por lo que debe individualizarse un manejo más precoz en ciertos escenarios.

Manejo de la hiperplasia benigna de próstata durante la pandemia COVID-19 / Benign prostatic hyperplasia management during COVID-19 pandemia

OBJETIVOS: Exponer las recomendaciones de un comité de expertos para la reorganización de las unidades de neurourología y la priorización de estudios y tratamientos durante la pandemia COVID-19. MATERIAL Y MÉTODOS: Revisión no sistemática de la literatura científica y opinión de expertos nacionales para resumir las recomendaciones en el diagnóstico, tratamiento y seguimiento de los pacientes neurourológicos durante la pandemia COVID-19. Se utiliza una técnica de grupo nominal modificada debido a las restricciones extraordinarias de reunión y movilidad durante la pandemia COVID-19. RESULTADOS: Los pacientes neurourológicos poseen características fisiopatológicas especiales que les hace más vulnerables frente a la infección por SARS-CoV-2. Han sido englobados en general en el grupo de la Urología Funcional, relegando su manejo al de las situaciones no urgentes y demorables sin plazo concreto de recuperación de la normalidad. Sin embargo, es importante identificar situaciones específicas en las que exista compromiso funcional del aparato urinario superior, retención urinaria, o desarrollo de infecciones/sepsis urinaria. Se realiza una clasificación según el nivel de prioridad tanto del manejo ambulatorio y conservador como del tratamiento quirúrgico de eventos relacionados con pacientes neurourológicos durante la pandemia COVID-19. CONCLUSIONES: En los pacientes neurourológicos encontramos situaciones clínicas excepcionales en las que un retraso de su tratamiento puede conllevar alteraciones irreversibles en el tracto urinario superior, dada su condición de vejiga de riesgo funcional, por lo que debe individualizarse un manejo más precoz en ciertos escenarios

OBJECTIVES: To report the recommendations of an expert panel to reorganize Neurourology units and to prioritize examinations and both conservative and surgical treatments during the COVID-19 pandemic. MATERIALS AND METHODS: Non-systematic review of the literature and national experts' opinion summarizing the recommendations in the diagnosis, management, and follow-up of neurourological patients during the COVID-19 pandemic. A modified nominal group technique was used due to extraordinary meeting and mobility restrictions during COVID-19 pandemic. RESULTS: Neurourological patients have special physiological and pathological characteristics that make them more vulnerable to SARS-CoV-2 infection. For prioritization purposes, they encompass in Functional Urology patients and their management is considered non-urgent or delayable with no specific deadline of recovery from normality. However, it is important to identify individual situations jeopardising the upper urinary tract, urinary retention or predisposing to urinary infections/sepsis. A classification is provided prioritizing conservative/outpatient management and the surgical treatment of the events occurring in neurourological patients during the COVID-19 pandemic. CONCLUSIONS: In neurourological patients we can find exceptional clinical situations in which a delayed treatment could develop irreversible changes in the upper urinary tract, advocating a more urgent treatment in specific scenarios

Manejo del paciente neurourológico durante la pandemia COVID-19 / Management of neurourological patients during the COVID-19 pandemic

OBJETIVOS: Exponer las recomendaciones de un comité de expertos para la reorganización de las unidades de neurourología y la priorización de estudios y tratamientos durante la pandemia COVID-19. MATERIAL Y MÉTODOS: Revisión no sistemática de la literatura científica y opinión de expertos nacionales para resumir las recomendaciones en el diagnóstico, tratamiento y seguimiento de los pacientes neurourológicos durante la pandemia COVID-19. Se utiliza una técnica de grupo nominal modificada debido a las restricciones extraordinarias de reunión y movilidad durante la pandemia COVID-19. RESULTADOS: Los pacientes neurourológicos poseen características fisiopatológicas especiales que les hace más vulnerables frente a la infección por SARS-CoV-2. Han sido englobados en general en el grupo de la Urología Funcional, relegando su manejo al de las situaciones no urgentes y demorables sin plazo concreto de recuperación de la normalidad. Sin embargo, es importante identificar situaciones específicas en las que exista compromiso funcional del aparato urinario superior, retención urinaria, o desarrollo de infecciones/sepsis urinaria. Se realiza una clasificación según el nivel de prioridad tanto del manejo ambulatorio y conservador como del tratamiento quirúrgico de eventos relacionados con pacientes neurourológicos durante la pandemia COVID-19. CONCLUSIONES: En los pacientes neurourológicos encontramos situaciones clínicas excepcionales en las que un retraso de su tratamiento puede conllevar alteraciones irreversibles en el tracto urinario superior, dada su condición de vejiga de riesgo funcional, por lo que debe individualizarse un manejo más precoz en ciertos escenarios

OBJECTIVES: To report the recommendations of an expert panel to reorganize Neurourology units and to prioritize examinations and both conservative and surgical treatments during the COVID-19 pandemic. MATERIALS AND METHODS: Non-systematic review of the literature and national experts' opinion summarizing ther ecommendations in the diagnosis, management, and follow-up of neurourological patients during the COVID-19 pandemic. A modified nominal group technique was used due to extraordinary meeting and mobility restrictions during COVID-19 pandemic. RESULTS: Neurourological patients have special physiological and pathological characteristics that make them more vulnerable to SARS-CoV-2 infection. For prioritization purposes, they encompass in Functional Urology patients and their management is considered non-urgent or delayable with no specific deadline of recovery from normality. However, it is important to identify individual situations jeopardising the upper urinary tract, urinary retention or predisposing to urinary infections/sepsis. A classification is provided prioritizing conservative/outpatient management and the surgical treatment of the events occurring in neurourological patients during the COVID-19 pandemic. CONCLUSIONS: In neurourological patients we can find exceptional clinical situations in which a delayed treatment could develop irreversible changes in the upper urinary tract, advocating a more urgent treatment in specific scenarios

Mullerianosis vesical / Mullerianosis of the urinary bladder

La mullerianosis vesical, entidad raramente descrita, fue definida por primera vez en 1996 por Young y Clement como la combinación de al menos 2 tipos de tejido ectópico de origen mulleriano (endometriosis, endocervicosis y endosalpingiosis) en el espesor de la pared vesical. Se ha intentado explicar su origen tanto por un mecanismo de implantación como metaplásico. El carácter cíclico de la sintomatología, que puede aparecer hasta en el 50% de las pacientes, debería hacer sospechar su presencia. Aunque la resección transuretral tiene un valor diagnóstico indudable, el carácter transmural de la lesión aconseja su exéresis completa (cistectomía parcial), como ocurrió en nuestro caso (AU)

Müllerianosis of the urinary bladder, a rare entity, was first defined by Young and Clement in 1996 as the combination of at least two types of ectopic tissue of Müllerian origin (endometriosis, endocervicosis, and endosalpingiosis) in the bladder wall. Theories of implantation or metaplasia have been proposed to explain the origin of this entity. Recurrent or cyclic symptomatology, which is reported in up to 50% of patients, is highly suspicious of müllerianosis of the bladder. Although transurethral resection is useful in diagnosis, complete removal of the lesion (partial cystectomy) is highly advisable, as performed in the patient presented herein (AU)

Síndrome OHVIRA (hemivagina obstruida y anomalía renal ipsilateral) asociado a útero didelfo / Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) associated to uterus didelphys

La asociación de útero didelfo, hemivagina obstruida y aplasia renal ipsilateral es una entidad rara, diagnosticada habitualmente después de la menarquia, que cursa con dismenorrea y dolor pélvico cíclico secundario a hematocolpos. Aunque la ecografía es de elección para la valoración inicial, la resonancia magnética es la técnica que permite clasificar la anomalía. El reconocimiento temprano facilita la exéresis quirúrgica del septo vaginal obstructivo, con alivio rápido de los síntomas y prevención de complicaciones. Dado que la agenesia renal o la displasia multiquística son un diagnóstico prenatal o neonatal frecuentes, sería recomendable buscar una anomalía mulleriana asociada en estos casos (AU)

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis is a rare entity that usually presents after menarche with dysmenorrhea and cyclic pelvic pain due to hemihematocolpos. Although ultrasound scanning allows correct diagnosis, magnetic resonance imaging plays a decisive role in characterizing the malformation. Early diagnosis is important so that prompt excision of the vaginal septum can relive pain and prevent further complications. The possibility of an obstructed Müllerian system should be investigated whenever a multicystic dysplastic kidney or the absence of a kidney is diagnosed in a fetus or neonate (AU)

[Segmentary testicular infarction]. / Infarto segmentario de testículo.

OBJECTIVE: A new case of segmental testicular infarction is reported. METHODS: A 52-year-old man presented to the emergency department with severe pain in the left testicle over a few days period. Physical examination revealed a tender induration in the upper pole of the left testicle. Beta-human chorionic gonadotropin and alpha-fetoprotein were normal. Sonography demonstrated a poorly-defined, hypoechoic, 13 mm lesion. On power Doppler sonography, the hypoechoic area appeared completely avascular in contrast to the rest of the testicle. RESULTS: Since testicular tumor was the initial diagnosis, the patient underwent a left radical orchiectomy. Pathological study revealed a focal testicular infarction, without signs of malignancy or vasculitis. CONCLUSIONS: Segmental testicular infarction is usually diagnosed after radical orchiectomy, performed when testicular tumor is suspected. On certain occasions Doppler ultrasound and magnetic resonance imaging findings suggested a segmental testicular infarction. However, if tumor cannot be entirely excluded, exploratory surgery is necessary.

Endometriosis detrusoriana / Bladder detrusor endometriosis

Se presenta un caso de endometriosis detrusoriana en una paciente de 32 años con antecedente de cesárea que consultó por síndrome miccional de larga evolución. Se indagó sobre la posible recurrencia del cuadro y su relación con el ciclo menstrual, lo que permitió orientar inmediatamente el diagnóstico y aplicar de forma temprana el tratamiento adecuado, evitando así un sufrimiento prolongado e innecesario a la paciente. Ante el antecedente de cesárea y síndrome miccional recurrente se debe descartar endometriosis detrusoriana, sobre todo si en la ecografía o en la tomografía computarizada se evidencia un engrosamiento de la pared vesical en contacto con el útero (AU)

A 32-year-old woman with a history of cesarean section presented with longstanding urinary symptoms. The patient was asked about possible symptom recurrence and its relation with her menstrual cycle, leading us to suspect a diagnosis of bladder detrusor endometriosis. Early diagnosis avoided prolonged and unnecessary patient distress. Bladder detrusor endometriosis should be suspected in patients with a history of cesarean section and recurrent urinary symptoms, especially if ultrasound or computed tomography reveals a thickened bladder wall in contact with the anterior uterine wall (AU)

Infarto segmentario de testículo / Segmentary testicular infarction

OBJETIVO: Se presenta un nuevo caso de infarto segmentario de testiculo.METODOS: Paciente de 52 anos que solicito valoracion por dolor en hemiescroto izquierdo de varios dias de evolucion. En la exploracion fisica presentaba una induracion palpable, dolorosa al tacto, en el polo superior del testiculo izquierdo. Los marcadores tumorales (ƒÀ-hCG y ƒ¿-fetoproteina) fueron normales. En el estudio ultrasonografico se aprecio una lesion nodular hipoecogenica intratesticular izquierda de 13 mm de diametro, de bordes ligeramente irregulares, que no mostraba flujo en el analisis con Doppler color.RESULTADO: Con el diagnostico de tumoracion testicular izquierda se realizo orquiectomia por via inguinal. Al corte dicha induracion se correspondia con un nodulo bien delimitado. El estudio histopatologico mostro que la lesion correspondia a un infarto testicular segmentario, sin evidencia de malignidad ni signos de vasculitis.CONCLUSIONES: La forma mas habitual de diagnostico del infarto segmentario de testiculo se produce durante el estudio histopatologico de las piezas de orquiectomia radical realizadas por sospecha de tumor.La ultrasonografia con Doppler y la resonancia magnetica nuclear tienen alta fiabilidad diagnostica, si bien puede resultar dificil descartar categoricamente un tumor de testiculo. En estos casos se puede recurrir a la exploracion con biopsia que confirme la lesion isquemica no tumoral(AU)

OBJECTIVE: A new case of segmental testicu-lar infarction is reported.METHODS: A 52-year-old man presented to the emergency department with severe pain in the left testicle over a few days period. Physical examination revealed a tender indura-tion in the upper pole of the left testicle. ƒÀ-human chorionic gonadotropin and ƒ¿-fetoprotein were normal. Sonography demonstrated a poorly-defined, hypoechoic, 13 mm lesion. On power Doppler sonography, the hypoechoic area appeared completely avascular in contrast to the rest of the testicle.RESULTS: Since testicular tumor was the initial diagnosis, the patient underwent a left radical orchiectomy. Pathological study revealed a focal testicular infarction, without signs of malignancy or vasculitis.CONCLUSIONS: Segmental testicular infarction is usually diagnosed after radical orchiectomy, performed when testi-cular tumor is suspected.On certain occasions Doppler ultrasound and magnetic resonance imaging findings suggested a segmental testicular infarction. However, if tumor cannot be entirely excluded, exploratory surgery is necessary(AU)

[Evolution of Escherichia coli antibiotic resistances in urine samples from the community]. / Evolución de la resistencia a antibióticos de Escherichia coli en muestras de orina procedentes de la comunidad.

OBJECTIVES: The objectives of this work are two: first, to evaluate the resistance of Escherichia coli to several antibiotics and their trends over a six-year period in strands isolated in urine samples from patients receiving health-care in general practitioner offices in our environment; and second, to evaluate if empirical treatment regimens commonly accepted in our country would be applicable in our environment depending on the results of this study. METHODS: We analyzed the urine cultures positive for Escherichia coli obtained from samples collected at the 10 primary health care centers of the health-care area of El Bierzo and Laciana (Leon, Spain) between the years 2002 and 2007. In vitro resistances of these germs to several common use antibiotics were determined: fosfomycin, nitrofurantoin, tobramycin, cefuroxime, cefixime, amoxicillin-clavulanic acid, cotrimoxazole, ciprofloxacin, norfloxacin, and ampicillin. The existence of statistically significant (p < 0.05) differences in sensitivity comparing the years 2002 and 2007, including all antimicrobials except cefixime, was analyzed by the chi-square test. For cefixime we compared the results between 2002 and 2005. RESULTS: An increase of the resistance of Escherichia coli isolated in urine to all antimicrobials under study has occurred, except for nitrofurantoin, being the differences statistically significant in most cases. Nevertheless, resistances to fosfomycin and nitrofurantoin have remained below 6% throughout the study period. Resistances to tobramycin and cefuroxime were slightly over 10% and cefixime below 3.4%, although in the last one we only have data until 2005. Resistances to amoxicillin-clavulanic acid, initially low, have progressively increase reaching 20.6% in 2007. The same has happened for cotrimoxazole, ciprofloxacin, norfloxacin and ampicillin, passing 32% in 2007 in the first three cases and 62% in the last one. CONCLUSIONS: Variations in bacterial resistance patterns for Escherichia coli obliges to have an updated knowledge of them to adapt general empirical treatment uses to each specific health-care area.

Evolución de la resistencia a antibióticos de Escherichia Coli en muestras de orina procedentes de la Comunidad / Evolution of Escherichia coli antibiotic resistances in urine samples from the community

Objetivo: Los objetivos de este trabajo son dos: primero, evaluar la resistencia a varios antibióticos y las tendencias de la misma en un periodo de seis años en cepas de Escherichia coli aisladas en muestras de orina de pacientes atendidos en Atención Primaria en nuestro medio y, segundo, valorar si las pautas de tratamiento empírico comúnmente aceptadas en nuestro país serían aplicables en nuestro entorno en función de los resultados del estudio. Métodos: Se analizaron los urocultivos positivos para Escherichia coli obtenidos de muestras enviadas desde los diez centros de Atención Primaria del Área Sanitaria de El Bierzo y Laciana (León) entre los años 2002 y 2007. Se determinó la resistencia in vitro de este germen a diversos antibióticos de uso frecuente: fosfomicina, nitrofurantoína, tobramicina, cefuroxima, cefixima, amoxicilina-clavulánico, cotrimoxazol, ciprofloxacino, norfloxacino y ampicilina. Se analizó mediante Chi cuadrado la existencia de diferencias estadísticamente significativas (p < 0,05) de sensibilidad, comparando los años 2002 y 2007 para todos los antimicrobianos excepto para cefixima. En este último caso se compararon los resultados obtenidos en 2002 y 2005. Resultados: Se ha producido un aumento de la resistencia de los aislamientos urinarios de Escherichia coli a todos los antimicrobianos estudiados, menos para la nitrofurantoína, que fue estadísticamente significativo en la mayoría de los casos. Aún así, la resistencia frente a fosfomicina y nitrofurantoína se ha mantenido por debajo del 6% a lo largo del periodo de estudio. Para tobramicina y cefuroxima apenas ha superado el 10% y para cefixima se encuentra por debajo del 3,4%, aunque en este último caso sólo se dispone de datos hasta 2005 en nuestro estudio. La resistencia frente a amoxicilina-clavulánico, inicialmente baja, ha ido aumentando progresivamente hasta alcanzar el 20,6% en 2007. Lo mismo ocurre para cotrimoxazol, ciprofloxacino, norfloxacino y ampicilina, hasta superar el 32% en 2007 en el caso de los tres primeros y el 62% en el último. Conclusiones: La variación en los patrones de resistencia bacteriana de Escherichia coli obliga a disponer de un conocimiento actualizado de los mismos para adaptar las pautas generales de tratamiento empírico a cada área de salud concreta (AU)

Objectives: The objectives of this work are two: first, to evaluate the resistance of Escherichia coli to several antibiotics and their trends over a six-year period in strands isolated in urine samples from patients receiving health-care in general practitioner offices in our environment; and second, to evaluate if empirical treatment regimens commonly accepted in our country would be applicable in our environment depending on the results of this study. Methods: We analyzed the urine cultures positive for Escherichia coli obtained from samples collected at the 10 primary health care centers of the health-care area of El Bierzo and Laciana (Leon, Spain) between the years 2002 and 2007. In vitro resistances of these germs to several common use antibiotics were determined: fosfomycin, nitrofurantoin, tobramycin, cefuroxime, cefixime, amoxicillin-clavulanic acid, cotrimoxazole, ciprofloxacin, norfloxacin, and ampicillin. The existence of statistically significant (p < 0.05j differences in sensitivity, comparing the years 2002 and 2007, including all antimicrobials except cefixime, was analyzed by the chi-square test. For cefixime we compared the results between 2002 and 2005. Results: An increase of the resistance of Escherichia coli isolated in urine to all antimicrobials under study has occurred, except for nitrofurantoin, being the differences statistically significant in most cases. Nevertheless, resistances to fosfomycin and nitrofurantoin have remained below 6% throughout the study period. Resistances to tobramycin and cefuroxime were slightly over 10% and cefixime below 3.4%, although in the last one we only have data until 2005. Resistances to amoxicillin-clavulanic acid, initially low, have progressively increase reaching 20.6% in 2007. The same has happened for cotrimoxazole, ciprofloxacin, norfloxacin and ampicillin, passing 32% in 2007 in the first three cases and 62% in the last one. Conclusions: Variations in bacterial resistance patterns for Escherichia coli obliges to have an updated knowledge of them to adapt general empirical treatment uses to each specific health-care area (AU)

Multiple pilomatricoma in the context of previous seminoma: discussion on the possible relationship.

Multiple pilomatricomas are rare. In the literature, they have been associated with many conditions, although the most common association is with myotonic dystrophy. We present a new association not previously described in the literature, observed in a 28-year-old male with three pilomatricomas, who had been diagnosed with seminoma 15 months before the current diagnosis of multiple pilomatricomas. Concerning the current association, as well as many of those described in the literature, we also discuss whether they might be more than mere coincidences, maybe explained by some molecular alterations.

Leiomioma vesical / Bladder leiomyoma. A case report and literature review

OBJETIVO: Aportar un nuevo caso de leiomiomavesical a la literatura española.MÉTODO: Hallazgo casual en un estudio ecográfico pélvicode una tumoración de 20 mm en la cara lateral derechade la vejiga de una mujer de 29 años. El cistogramade la urografía intravenosa mostró la presencia de undefecto de repleción en esa misma localización. Se realizócistoscopia con el hallazgo de una tumoración en lacara lateral derecha de la vejiga, con recubrimiento mucosode aspecto normal.RESULTADO: Con el diagnóstico de sospecha de leiomiomavesical se realizó resección transuretral de la tumoración,con confirmación anatomopatológica de dicho diagnóstico.En el postoperatorio desarrolló una placa calcáreasobre el área de resección previa, que se tratómediante resección transuretral de ésta y de restos leiomiomatososy acidificación urinaria posterior.CONCLUSIÓN: Aunque se trata de un tumor raro, endeterminadas circunstancias es posible establecer el diagnósticoprequirúrgico con un alto índice de sospecha. Porotra parte, dada la benignidad del proceso, la cirugíaconservadora, en esta caso la resección transuretral, ofreceexcelentes resultados

OBJECTIVES: To report a new case of ;;bladder leiomyoma. ;;METHODS: A 20 mm tumor of the right lateral wall of ;;the bladder was incidentally found in a pelvic ultrasound ;;study of a 29-year-old female. The cystogram showed ;;the presence of a filling defect in the same side. ;;Cystoscopy showed a right lateral wall tumor with normal ;;mucosal cover. ;;RESULTS: With the working diagnosis of bladder leiomyoma, ;;transurethral resection of the bladder tumor was performed, ;;and pathology confirmed the diagnosis. ;;Postoperatively, the patient developed a calcareous plaque ;;on the resection area which was treated by transurethral ;;resection of the plaque and leiomyoma remainders and ;;subsequence urine acidification. ;;CONCLUSION: Although it is a rare tumor, in certain ;;circumstances it is possible to establish the working ;;preoperative diagnosis with a high index of suspicion. ;;On the other hand, due to the benign character of the ;;process, conservative surgery (transurethral resection in ;;this case) offers excellent results

[Ureteral pseudodiverticulosis. Case report]. / Pseudodiverticulosis uretral. A propósito de un caso.

OBJECTIVES: To report a new case of bilateral ureteral pseudodiverticulosis associated with a transitional cell carcinoma of the bladder. METHODS: 70 year-old male patient under ambulatory study for hematuria. RESULTS: The intravenous urography (IVU) shows images of addition in relation to bilateral ureteral pseudodiverticulosis. Urine cytology and cystoscopy showed the existence of a concomitant tumor. CONCLUSIONS: The diagnosis of ureteral pseudodiverticulosis is incidentally made on an IVU indicated for other reasons. Although it is a benign pathology, it is necessary to follow these patients because of its association with transitional cell carcinoma.

Pseudodiverticulosis uretral. A propósito de un caso / Ureteral pseudodiverticulosis. Case report

OBJETIVOS: Comunicar un nuevo caso depseudodiverticulosis ureteral bilateral, asociado a tumorvesical de células transicionales.METODOS: Varón de 70 años de edad, estudiado deforma ambulatoria en consulta de Urología por hematuria.RESULTADOS: En la urografía intravenosa (UIV) aparecenimágenes de adición en relación a pseudodiverticulosisureteral bilateral. La citología y cistoscopia demuestran laexistencia de una tumoración concomitante.CONCLUSIONES: El diagnóstico de la pseudodiverticulosisureteral se hace de forma casual durante la realizaciónde una UIV por otros motivos. Si bien es una patologíabenigna, es necesario el seguimiento de los pacientespor la asociación con tumores de células transicionales

OBJECTIVES: To report a new case of bilateral ureteral pseudodiverticulosis associated with a transitional cell carcinoma of the bladder. METHODS: 70-year-old male patient under ambulatory study for hematuria. RESULTS: The intravenous urography (IVU) shows images of addition in relation to bilateral ureteral pseudodiverticulosis. Urine cytology and cystoscopy showed the existence of a concomitant tumor. CONCLUSIONS: The diagnosis of ureteral pseudodiverticulosis is incidentally made on an IVU indicated for other reasons. Although it is a benign pathology, it is necessary to follow these patients because of its association with transitional cell carcinoma

[The treatment of bladder endometriosis. Spanish literature review]. / Tratamiento de la endometriosis vesical. Revisión de la literatura española.

OBJECTIVES: To perform a comprehensive, up-to-date review of the treatment of all cases of bladder endometriosis published in Spanish language journals in our country, including those published in non-urological scientific journals. METHODS: We identified 28 cases of bladder endometriosis published in the Spanish literature. The treatment performed in each case has been studied, as well as the treatment of relapses and follow-up after definitive treatment. Age and history of caesarean section were registered. RESULTS: Mean patient age was 35 years, with a median of 34 years and limits of 27 and 48. The history of caesarean section is present in 11 cases (39%). Several therapeutic regiments have been followed. Watchful waiting was only undertaken in one case due to the absence of urinary symptoms. Three patients received medical therapy initially. Only one of them had a favourable response. The other two underwent partial cystectomy and transurethral resection (TUR) respectively due to negative response. Transurethral resection was the most frequently used therapeutic modality; it was performed in 19 patients in addition to the aforementioned case. Bladder endometriosis recurred in 7 cases after TUR. Four of these cases underwent partial cystectomy, one of them laparoscopic, and three a second transurethral resection. Partial cystectomy was the initial therapeutic option in 5 cases. 4 of them were open and 1 laparoscopic. No recurrences have been described after partial cystectomy, including those performed for TUR failures. Mean follow-up was 37 months and median follow-up 12 months, being the limits 3 and 192 months. CONCLUSIONS: To date most published cases of bladder endometriosis appear in urologic journals. The most common therapeutic modality is transurethral resection, carried out in 20 cases (71%). However, it is necessary to inform the patient about the chances of treatment failure after TUR, around 35% after this review. Finally, the reported cases treated by laparoscopic partial cystectomy have been published by gynaecologists.

[Fournier's gangrene secondary to urethral catheterization]. / Gangrena de Fournier secundaria a cateterismo uretral.

OBJECTIVES: We report one case of Fournier's gangrene secondary to urethral catheterization. METHODS: We describe the clinical case, in which the initial cause was identified, and perform a short bibliographic review. RESULTS: Although Fournier's gangrene was initially considered as idiopathic in etiology, currently it is possible to identify the entrance site of the infection. In the present case the insertion of a urethral catheter was the starting mechanism, associated with factors such as diabetes and alcoholism which favour its development. The patient was treated by surgical debridement and partial urethrectomy but finally died. CONCLUSIONS: We want to point out that urethral instrumentation should be done by expert hands due to the severity of possible complications. We should insist in the need of precocious treatment with wide spectrum antibiotics, radical debridement and complete urologic evaluation.

Tratamiento de la endometriosis vesical. Revisión de la literatura española / The treatment of bladder endometriosis. Spanish literature review

OBJETIVO: Análisis actualizado y de conjuntodel tratamiento de todos los casos de endometriosisvesical publicados en revistas en lengua españolaen nuestro país, incluyendo aquéllos aparecidos enrevistas científicas fuera del ámbito urológico.MÉTODOS: Se han localizado 28 casos de endometriosisvesical publicados en la literatura científica enlengua española en nuestro país. Se ha estudiado eltipo de tratamiento aplicado en cada caso, así comoel de la recidiva y el seguimiento después del tratamientodefinitivo, además de la edad y el antecedentede cesárea.RESULTADOS: Las pacientes analizadas presentaronuna edad media de 35 años, con mediana de 34años y límites entre 27 y 48 años. El antecedente decesárea aparece en 11 casos (39%). Se han seguidovarios regímenes terapéuticos. Sólo en un caso se decidióvigilancia por ausencia de clínica urinaria. En trescasos se utilizó inicialmente la terapia médica. Deéstos, sólo uno respondió favorablemente. Los otros dosse siguieron o bien de cistectomía parcial, o bien deresección transuretral, por mala respuesta. La modalidadterapéutica inicial más utilizada fue la reseccióntransuretral, realizada en 19 pacientes, además delcaso citado previamente. La endometriosis vesical recidivóen siete casos tratados por esta vía. De éstos, cuatrofueron sometidos a cistectomía parcial, una de ellaspor vía laparoscópica, y tres a nueva resección transuretral.Se realizó cistectomía parcial como modalidadterapéutica inicial en cinco casos. De éstas, cuatro serealizaron por vía abierta y una laparoscópica. No sehan descrito recidivas tras las cistectomías parciales,incluyendo aquéllas realizadas para el tratamiento delos casos en los que fracasó la resección transuretral. Lamedia de seguimiento ha sido de 37 meses y medianade 12 meses, con límites entre 3 y 192 meses.CONCLUSIONES: Hasta el momento actual la mayoríade los casos publicados de endometriosis vesicalcorresponden a revistas urológicas. La modalidad terapéuticamás común ha sido la resección transuretral,que se utilizó con este fin en 20 casos (71%). No obstante,es necesario informar a la paciente de la probabilidadde fracaso del tratamiento, del 35% según larevisión de este conjunto de casos, con la reseccióntransuretral. Finalmente, los casos tratados mediante cistectomíaparcial laparoscópica en nuestro país hansido publicados por ginecólogos

OBJECTIVES: To perform a comprehensive, up-to-date review of the treatment of all cases of bladder endometriosis published in Spanish language journals in our country, including those published in non-urological scientific journals. METHODS: We identified 28 cases of bladder endometriosis published in the Spanish literature. The treatment performed in each case has been studied, as well as the treatment of relapses and follow-up after definitive treatment. Age and history of caesarean section were registered. RESULTS: Mean patient age was 35 years, with a median of 34 years and limits of 27 and 48. The history of caesarean section is present in 11 cases (39%). Several therapeutic regiments have been followed. Watchful waiting was only undertaken in one case due to the absence of urinary symptoms. Three patients received medical therapy initially. Only one of them had a favourable response. The other two underwent partial cystectomy and transurethral resection (TUR) respectively due to negative response. Transurethral resection was the most frequently used therapeutic modality; it was performed in 19 patients in addition to the aforementioned case. Bladder endometriosis recurred in 7 cases after TUR. Four of these cases underwent partial cystectomy, one of them laparoscopic, and three a second transurethral resection. Partial cystectomy was the initial therapeutic option in 5 cases. 4 of them were open and 1 laparoscopic. No recurrences have been described after partial cystectomy, including those performed for TUR failures. Mean follow-up was 37 months and median follow-up 12 months, being the limits 3 and 192 months. CONCLUSIONS: To date most published cases of bladder endometriosis appear in urologic journals. The most common therapeutic modality is transurethral resection, carried out in 20 cases (71%). However, it is necessary to inform the patient about the chances of treatment failure after TUR, around 35% after this review. Finally, the reported cases treated by laparoscopic partial cystectomy have been published by gynaecologists

Gangrena de Fournier secundaria a cateterismo uretral / Fournier´s gangrene secondary to urethral catheterization

OBJETIVOS: Mediante el formato de casoclínico presentamos un caso de Gangrena de Fourniersecundario a cateterismo uretral.MÉTODOS: Realizamos una descripción del caso clínicoque nos ocupa, en el que se ha identificado la causa inicial,así como una breve revisión bibliográfica de estapatología.RESULTADO: Aunque la gangrena de Fournier se considerabainicialmente como de etiología idiopática, en laactualidad es posible identificar en la mayoría de loscasos la puerta de entrada de la infección. En nuestrocaso la colocación de un catéter uretral fue el mecanismode inicio de la infección, asociado a dos factores como ladiabetes y el alcoholismo que favorecen el desarrollo dela misma. Se trató mediante desbridamiento quirúrgico yse realizó uretrectomía parcial. El paciente fue finalmenteexitus.CONCLUSIONES: Se debe llamar la atención sobre lanecesidad de que la manipulación uretral sea realizadapor manos expertas dada la gravedad de las posiblescomplicaciones.Hay que insistir en la necesidad de un tratamiento precozcon una cobertura de antibióticos de amplio espectro, undesbridamiento radical y una revisión urológica completa

OBJECTIVES: We report one case ofFournier`s gangrene secondary to urethral catheterization.METHODS: We describe the clinical case, in which theinitial cause was identified, and perform a shortbibliographic review.RESULTS: Although Fournier`s gangrene was initiallyconsidered as idiopathic in etiology, currently it ispossible to identify the entrance site of the infection. Inthe present case the insertion of a urethral catheter wasthe starting mechanism, associated with factors such asdiabetes and alcoholism which favour its development.The patient was treated by surgical debridement andpartial urethrectomy but finally died.CONCLUSIONS: We want to point out that urethralinstrumentation should be done by expert hands due tothe severity of possible complications. We should insistin the need of precocious treatment with wide spectrumantibiotics, radical debridement and complete urologicevaluation

[Bladder leiomyoma. A case report and literature review]. / Leiomioma vesical.

OBJECTIVES: To report a new case of bladder leiomyoma. METHODS: A 20 mm tumor of the right lateral wall of the bladder was incidentally found in a pelvic ultrasound study of a 29-year-old female. The cystogram showed the presence of a filling defect in the same side. Cystoscopy showed a right lateral wall tumor with normal mucosal cover. RESULTS: With the working diagnosis of bladder leiomyoma, transurethral resection of the bladder tumor was performed, and pathology confirmed the diagnosis. Postoperatively, the patient developed a calcareous plaque on the resection area which was treated by transurethral resection of the plaque and leiomyoma remainders and subsequence urine acidification. CONCLUSION: Although it is a rare tumor, in certain circumstances it is possible to establish the working preoperative diagnosis with a high index of suspicion. On the other hand, due to the benign character of the process, conservative surgery (transurethral resection in this case) offers excellent results.

[Urinary stone in a Bricker's ileal conduit]. / Litiasis en conducto urinario tipo Bricker.

OBJECTIVES: To report one case of urinary stone as a relatively frequent complications of urinary diversion using bowel loops. METHODS: We perform a short bibliographic review using the case report format. RESULTS: Stone formation in Bricker's type urinary diversion is secondary to various factors such as urinary stasis, bacteriuria, presence of intestinal mucus, metallic sutures, metabolic disturbances, etc. CONCLUSIONS: Periodic control by radiological studies is recommended due to the high frequency of this complication in patients with urinary diversion. Treatment is usually conservative or minimally invasive, being surgery reserved for those cases in which stone extraction is not safe using other methods.