[Extrinsic ureteral obstruction secondary to appendiceal mucocele]. / Obstrucción ureteral extrínseca secundaria a mucocele apendicular.

OBJECTIVE: To report a case of extrinsic ureteral obstruction arising from mucocele of the appendix and review the clinical, diagnostic and therapeutic aspects of this appendiceal pathology of interest in urology. METHODS: A 71-year-old female patient that had previously undergone radical gynecological surgery and postoperative radiotherapy presented with right lumbar pain. Patient evaluation by ultrasound, IVP and CT showed a pelvic mass causing right extrinsic ureteral obstruction. Release and reinsertion of the right ureter and appendectomy were performed. RESULTS: The anatomopathological study showed an appendiceal mucinous cystadenoma. The patient is asymptomatic after surgery. CONCLUSIONS: Appendiceal mucocele is a dilatation of the vermiform appendix due to collection of mucoid material that is frequently produced by a cystadenoma. The presenting feature is usually that of acute appendicitis. The definitive diagnosis is based on the anatomopathological findings. Treatment is by appendectomy for the benign tumors and by right hemicolectomy in a second stage procedure for malignant tumors. This appendiceal pathology should be taken into account in the differential diagnosis of right extrinsic ureteral obstruction.

[Syringocele of the Cowper's gland]. / Siringocele de la glándula de Cowper.

OBJECTIVE: To report an additional case of syringocele of Cowper's glands and briefly review its etiopathogenesis, diagnosis and treatment. METHODS/RESULTS: A 26-year-old male consulted for a recent voiding syndrome and chronic postvoid dribbling. A voiding cystourethrogram demonstrated a syringocele, which was confirmed during endoscopic treatment. CONCLUSIONS: Syringocele or cystic dilatation of Cowper's gland duct usually has a congenital etiology. There are four morphological types: simple, perforated, imperforate and ruptured. Diagnosis is made by voiding cystourethrography and confirmed by endoscopy. Transperineal ultrasound was also utilized for the diagnosis. Treatment is by endoscopic incision.

[High-flow priapism in the pediatric age: review]. / Priapismo de alto flujo en edad pediátrica: revisión.

OBJECTIVE: To review the literature on high flow priapism in children and analyze the etiology, pathophysiological mechanism, diagnostic tests, treatment and complications. METHODS: The literature is reviewed and an additional case of posttraumatic arterial priapism in an 11 year-old boy treated at our hospital is presented. RESULTS: 24 cases of high flow priapism in children were found; 18 had a history of genitoperineal trauma, 5 had sickle cell anemia and one child had Fabry's disease. Diagnosis was based on patient history, intracavernous blood gases and echo doppler findings. Fourteen patients with posttraumatic priapism, one patient with sickle cell anemia and the child with Fabry's disease were treated by pudendal arteriography with embolization. The immediate results and erectile function were good. CONCLUSIONS: Genitoperineal trauma is the most common cause of arterial priapism in children. High flow must be considered in children with sickle cell disease and priapism that do not respond to conventional treatment. Pudendal arteriography with embolization is the treatment of choice. Erectile function is recovered after treatment.

[Colonic perforation in percutaneous surgery of the kidney. Report of two cases]. / Perforación colónica en la cirugía renal percutánea. Presentación de dos casos.

We show our experience about iatrogenic damage of colon secondarily to percutaneous surgery of the kidney. One of them treated by means of open surgery, the other by conservative procedures. Making discussion on risk factors, as well as the diagnostic therapeutical aspects.

[Nephrogenic adenoma: study of 9 cases, including one of the urethra in a 14-year-old male]. / Adenoma nefrogénico: estudio de nueve casos, incluyendo uno de uretra en un varón de 14 años.

OBJECTIVES: To review our series of nephrogenic adenoma and compare our results with those reported in the literature. METHOD: The records of our Department of Pathology were reviewed to determine the cases of nephrogenic adenoma diagnosed at our center. The clinical features, diagnostic aspects, pathological findings, treatment and outcome are presented. RESULTS/CONCLUSIONS: Nephrogenic adenoma is a rare lesion, probably arising from nephrogenic metaplasia caused by injury to the urothelial mucosa. The site of presentation is frequently the bladder, followed by the urethra. The diagnosis is based on the histopathological findings, which can be occasionally equivocal. The cases described in the present series were benign. To date there is no established therapeutic approach. We performed TUR in two patients, antibiotic therapy was administered in one patient and 4 patients were managed conservatively. Two of our patients had no control evaluation following biopsy of the lesion. In 2 of the 4 patients that were managed conservatively, the lesion remitted spontaneously.

[Laparoscopic extraperitoneal suspension of the neck of the bladder in stress incontinence: midterm results]. / Suspensión extraperitoneal laparoscópia del cuello vesical en la incontinencia de esfuerzo: resultados a medio plazo.

OBJECTIVE: There are few reports on the medium- and long-term outcomes of laparoscopic suspension of the bladder neck. METHODS: Our medium-term results in 24 patients with genuine stress urinary incontinence who underwent surgery from March, 1994 to July, 1996 are presented. The patients had a mean follow-up of 18 months. RESULTS: Although the initial results were encouraging, some failures appeared in the medium-term and incontinence recurred in 20%. CONCLUSIONS: The overall outcomes of laparoscopic suspension of the bladder neck did not differ from those achieved with the original technique of Pereyra-Stamey and the mean operating time was longer. The mean length of stay did not decrease and the rate of postoperative complications was similar. All the foregoing reasons have led us to abandon this procedure in the treatment of genuine stress urinary incontinence.

[Bilateral renal angiomyolipoma associated with tuberous sclerosis: conservative surgical treatment]. / Angiomiolipomas renales bilaterales asociados a la esclerosis tuberosa: tratamiento quirúrgico conservador.

OBJECTIVES: To evaluate the efficacy of surgical treatment of angiomyolipoma. METHODS: We present a case of multiple, bilateral renal angiomyolipoma in a patient with tuberous sclerosis, who was treated by conservative surgery. RESULTS: The patient is clinically asymptomatic one year after surgery and both kidneys are functioning correctly as shown by pyelography. CONCLUSIONS: We recommend conservative surgical treatment of symptomatic or developing angiomyolipomas.

[Endopyelotomy: 6 years of experience]. / Endopielotomía: 6 años de experiencia.

From January, 1988 to December, 1993, we have performed 35 percutaneous endopyelotomy procedures; 100 had acquired and 25 had congenital stricture. The UPJ was cut posterolaterally with an electric device in 34 cases. The mean follow up was 45.6 months. There were 6 failures (17.1%) that were resolved with the Anderson-Hynes technique (5 cases) and nephrectomy (1 case). There was 1 intraoperative complication (2.86%), a lesion to the accessory inferior pole artery that required open surgery. However, 80% of the cases were successfully treated by endourological techniques.

[Injection of autologous fatty tissue in the bladder submucosa: experimental study in swine]. / Inyección en la submucosa vesical de tejido graso autólogo: estudio experimental en suidos.

The results achieved by the use of inert materials via endoscopic injection for the treatment of urological pathologies have been disappointing. Furthermore, these materials are costly, carry the risk of migration and may not be tolerated locally. Autologous fatty tissue, however, is not costly and is tolerated better. The authors have conducted an experiment in the pig to evaluate the degree of resorption and persistence of autologous fat injected into the bladder submucosa. The results show that submucosal injection of autologous fat acts like an autograft and persists as mature fatty tissue. The degree of resorption and/or steatonecrosis is directly related to the amount injected; the smaller the amount used the better the results.

[Cystic pyeloureteritis. Our approach]. / Pieloureteritis quística: nuestra actitud.

We report a case of massive cystic pyeloureteritis that had been diagnosed by ureterorenoscopy in a patient with recurrent urinary infection and episodes of nephritic colic. The reports published in the literature indicate there is no specific treatment for this disease whose etiology is unknown. Its pathogenesis has not been well-established and it is difficult to distinguish from other urothelial filling defects. Although it has also been reported that it may progress to malignancy, we believe that the therapeutic approach should be conservative.

[Endoscopic resection of tumor of the renal pelvis]. / Resección endoscópica de tumor de pelvis renal.

We report on a patient who was submitted to percutaneous resection of a solitary, low grade urothelial transitional cell tumor of the renal pelvis. A review of the literature shoned endourologic treatment to be a valid in carefully selected cases. The measures to minimize the risk of tumor spread and the good results obtained are discussed. However, a longer follow up and larger series are necessary in order to draw definitive conclusions.

[Eosinophilic cystitis associated with transitional cell carcinoma: apropos a case]. / Cistitis esosinófila asociada a carcinoma de células transicionales: a propósito de un caso.

An additional case of eosinophilic cystitis coexisting with transitional cell carcinoma of the bladder is presented. The patient was treated with antihistamine but posteriorly presented with an infiltrating tumor that warranted a cystectomy procedure and ureteroileostomy. The patient is currently symptom-free.

[Percutaneous U-loop nephrostomy: our experience]. / Nefrostomía percutánea en raqueta: nuestra experiencia.

Thirteen U-loop nephrostomy procedures performed percutaneously in 9 patients are described. Thirty-three percent of these patients had a bilateral, one-stage procedure. This procedure can be performed under local anesthesia and, on average, requires 45 minutes. It is simple, yet it provides many other advantages; i.e., enhanced urinary drainage, easy to change and excellent patient tolerance. For all the foregoing reasons, we consider this procedure to be a valid alternative to open surgery.

[Inverted papilloma of the ureter]. / Papiloma invertido de uréter.

We report a case of inverted urothelial papilloma localized to the ureter in a patient with solitary kidney. Treatment was by segmental resection and end-to-end anastomosis. In spite of the benign nature of this tumor type and because treatment is conservative, patients should be closely followed owing to the possibility of recurrence and because progression to malignancy has been reported in the literature.

[Monoclonal gammopathy and osteolytic lesions as the initial manifestation of a metastatic hypernephroma]. / Gammapatía monoclonal y lesiones osteolíticas como primera manifestación de un hipernefroma metastásico.

We report on a patient with metastatic renal adenocarcinoma that had been detected following evaluation for monoclonal gammopathy associated with osteolytic lesions. When the foregoing associated conditions present, we must discard the presence of a myeloma. No objective data relating gammopathy with tumor behaviour are currently available.

[Bilateral adrenal masses during clinical staging of renal carcinoma]. / Masas adrenales bilaterales durante el estadiaje clínico del carcinoma renal.

We report a case of renal adenocarcinoma with bilateral adrenal masses at the time of diagnosis. Owing to the methods currently used for clinical staging, this association is no longer infrequently observed. Experience has demonstrated the value of the diagnostic techniques in this condition. The use of some of these techniques will depend on the findings during clinical staging of the tumor. Well-selected cases with metastasis to the adrenal gland can benefit from surgery.

[Duplication of the inferior vena cava associated with renal carcinoma]. / Duplicidad de vena cava inferior asociada a carcinoma renal.

Although uncommon, vascular anomalies of the inferior vena cava can have important consequences in urological oncologic surgery. A case of duplicated vena cava associated with clear cell renal adenocarcinoma is described. This type of tumor of the genitourinary system had been detected intraoperatively.

[Treatment of urinary stress incontinence using paraurethral injection of autologous fat]. / Tratamiento de la incontinencia urinaria de esfuerzo mediante la inyección parauretral de grasa autóloga.

The authors present the late results (greater than 1 year) in the treatment of urinary incontinence in 15 women with stress urinary incontinence and 5 men with post-adenomectomy incontinence using endoscopic injection of autologous fat tissue obtained by microliposuction. Good results were achieved in 23% of the cases with stress urinary incontinence and in 0% of those with post-adenomectomy incontinence. Although the results are disappointing, they are not very different from those obtained with teflon injection. Furthermore, the technique is simple, has no complications and it costs very little to obtain the autologous graft material. A historical review of free fat grafting and injection of liposuction fatty tissue is performed and the hypotheses that have been put forward recently relative to the fate of the fat graft are discussed.

[Acquired hydrocele in the adult: sclerotherapy]. / Hidrocele adquirido del adulto: escleroterapia.

We report our experience in the treatment of hydrocele using sclerosant therapy in 50 patients with adult acquired hydrocele (AAH) or cord cyst (CC). The sclerosing agent utilized in all of the patients was quinacrine dihydrochloride (quinacrine) at a dose of 13.3 mg 50 cc aspirated volume. The results were assessed clinically, ultrasonographically and thermographically. The presence of multilocular cysts or incomplete aspiration of the liquid was the most frequent cause of failure. The results show a success rate of 85%; however, 18% required more than one treatment.

[Bladder bilharziasis: report of a case]. / Bilharziosis vesical: a propósito de un caso.

Herein we describe a case of vesical bilharziasis in a Spanish patient who became infected during a trip to an endemic area. The characteristic features of the disease and particularly its relationship to squamous type bladder tumors are discussed with a special focus on treatment with Praziquantel.