The Effect of Anticholinergics for Prevention of Storage Symptoms After Prostate Photovaporization.

PURPOSE: To evaluate the efficacy of oral anticholinergics as a preventive strategy of storage symptoms and urinary incontinence associated with the early postoperative period after Greenlight laser photovaporization of the prostate (PVP). To analyze potential variables related to the onset of these symptoms. MATERIALS AND METHODS: Retrospective study of 105 patients who underwent PVP using a 180-W Greenlight laser (XPS). Patients were divided into two groups, depending on whether they were or weren´t prescribed anticholinergics when discharged (oral solifenacin 5 mg for 1 month after surgery). Differences between both groups were analyzed according to IPSS, ICIQ-SF and OABq-SF scores at 1 and 6 months. The potentially predictive variables of the symptomatology after undergoing PVP that we analyzed included age, prostate volume, PSA, IPSS, ICIQ-SF, OABq-SF, Qmax, previous use of a permanent urinary catheter, energy used, and laser application time. RESULTS: 58 patients in the group with anticholinergics and 47 in the group without anticholinergics were compared. No significant differences were observed between both groups in IPSS (p = .521), ICIQ-SF (p = .720) or OABq-SF (p = .851) at 1 and 6 months after surgery. Regardless of the use of anticholinergics, there was a significant score improvement between the first and second checkup in all the questionnaires: there was a significant decrease in the mean IPSS (p < .001) and the mean score of the eighth IPSS question on patient's quality of life (p = .026), ICIQ- SF (p = .010) and OAB-q related to symptoms (p = .001) as well as a significant increase in the mean OAB-q score regarding quality of life (p = .005). None of the variables analyzed showed a significant relation to the storage-symptom rate, rate of incontinence, or ICIQ-SF and OABq-SF scores. CONCLUSIONS: The use of solifenacin 5 mg after Greenlight laser PVP is not an effective preventive treatment for storage and incontinence symptoms associated with this procedure, which seem to self-limit over time.

[The role of therapies in the treatment of small renal masses]. / Papel de las terapias diana en el tratamiento de las masas renales pequeñas.

OBJECTIVES: To analize the current role of target therapies in the treatment of small renal masses. METHODS: We performed a bibliographic review on the effect of target therapies on primary renal tumor, including our initial experience with two cases of small renal tumor in single kidneys treated with sunitinib. RESULTS: There is very limited experience with target therapies, being possible to use them, as the reviewed literature shows, to increase safety in nephron sparing surgery or tissue ablation technique, or as the treatment for small renal tumors in patients with single kidney in whom nephron sparing surgery is not feasible. Of our two cases with small renal tumors in patients with single kidney, the first case has had complete response to sunitinib after 21 months of follow up, and the second has had tumor stabilization after 33 months of follow up, shifting from sunitinib to pazopanib due to intolerance. CONCLUSIONS: The indication of target therapies in the treatment of metastatic renal cancer could be expanded. These therapies could be useful in localized small renal cancer and, although experience with this indication is limited, results are promising.

Papel de las terapias diana en el tratamiento de las masas renales pequeñas / The role of target therapies in the treatment of small renal masses

OBJETIVO: Analizar el papel actual de las terapias diana en el tratamiento de las masas renales pequeñas. MÉTODOS: Realizamos una revisión bibliográfica del efecto de las terapias diana sobre el tumor renal primario, aportando nuestra experiencia inicial de dos casos de pacientes monorrenos con tumor renal pequeño tratados con sunitinib. RESULTADO: Existe muy poca experiencia con terapias diana, pudiendo utilizarse, según la literatura revisada, para aumentar la seguridad de una cirugía conservadora de nefronas o la de una técnica ablativa, o como tratamiento de tumores renales en pacientes monorrenos en los que no se pueda realizar una cirugía conservadora de nefronas. De nuestros dos casos aportados con tumor renal pequeño en pacientes monorrenos, en el primer caso se ha producido una respuesta completa con sunitinib tras 21 meses de seguimiento, y en el segundo se ha producido una estabilización tumoral tras 33 meses de seguimiento, cambiando sunitinib por pazopanib por intolerancia. CONCLUSIONES: La indicación de las terapias diana en el tratamiento del cáncer renal metastásico podría ampliarse, pudiendo ser útiles estas terapias en el cáncer renal pequeño localizado, y aunque la experiencia con esta indicación es limitada, los resultados son prometedores(AU)

OBJECTIVES: To analize the current role of target therapies in the treatment of small renal masses. METHODS: We performed a bibliographic review on the effect of target therapies on primary renal tumor, including our initial experience with two cases of small renal tumor in single kidneys treated with sunitinib. RESULTS: There is very limited experience with target therapies, being possible to use them, as the reviewed literature shows, to increase safety in nephron sparing surgery or tissue ablation technique, or as the treatment for small renal tumors in patients with single kidney in whom nephron sparing surgery is not feasible. Of our two cases with small renal tumors in patients with single kidney, the first case has had complete response to sunitinib after 21 months of follow up, and the second has had tumor stabilization after 33 months of follow up, shifting from sunitinib to pazopanib due to intolerance. CONCLUSIONS: The indication of target therapies in the treatment of metastatic renal cancer could be expanded. These therapies could be useful in localized small renal cancer and, although experience with this indication is limited, results are promising(AU)

Primary renal lymphoma: report of three new cases and literature review.

OBJECTIVES: We report the cases of three patients with primary renal lymphoma. Diagnosis and subsequent treatment are discussed. METHODS: The literature on the origin, epidemiology, clinical presentation, diagnosis, treatment and prognosis of primary renal lymphoma was reviewed. RESULTS: The first patient was diagnosed after radical nephrectomy and subsequently was given six cycles of CVP (cyclophosphamide, vincristine, prednisone). The diagnosis of the second patient was established by renal biopsy, and the patient received six cycles of CHOP (cyclophosphamide, adriamycin, vincristine and predisone). The last patient had a lymphoma, secondary to immunosuppression, in a transplanted kidney. In this case transplant nephrectomy sufficed to cure the patient's lymphoma. All patients had B-cell non-Hodgkin lymphoma (an extrarenal origin was ruled out by bone marrow biopsy), and were disease-free 15 months, 7 months, and 6.5 years after diagnosis, respectively. CONCLUSIONS: Primary renal lymphoma is rare. Diagnosis is established by renal biopsy, although it often presents as a mass simulating renal cell cancer and diagnosis is obtained after radical nephrectomy. Treatment consists of chemotherapy (CHOP). associated with rituximab.

Linfoma renal primario: Aportación de tres nuevos casos y Revisión de la literatura / Primary renal lymphoma: Report of three new cases and literature review

OBJETIVOS: Se presentan tres casos clínicos de pacientes con linfoma renal primario, su diagnóstico y posterior tratamiento.MÉTODOS: Se realiza una revisión bibliográfica del origen, epidemiología, características clínicas, diagnóstico, tratamiento y pronóstico de esta enfermedad.RESULTADOS: En nuestro primer caso la paciente es diagnosticada tras una nefrectomía radical y tratada posteriormente con seis ciclos de CVP (ciclofosfamida, vincristina, prednisona). En el segundo paciente el diagnóstico se llevó a cabo mediante biopsia renal, administrándose seis ciclos de CHOP (ciclofosfamida, adriamicina, vincristina y prednisona). El último caso se trata de un linfoma secundario a la inmunosupresión en un riñón trasplantado en la que la realización de una trasplantectomía fue suficiente. Todos los casos fueron linfomas no-Hodgkin de células B descartándose el origen extrarrenal con biopsia de médula ósea, estando libres de enfermedad tras 15, 7 meses y 6.5 años del diagnóstico respectivamente.CONCLUSIONES: El linfoma renal primario es muy raro. El diagnóstico se realiza mediante biopsia renal aunque con frecuencia se presenta como una masa simulando un cáncer renal y es diagnosticado tras nefrectomía radical. El tratamiento consiste en quimioterapia (CHOP) asociada a rituximab(AU)

OBJECTIVES: We report the cases of three patients with primary renal lymphoma. Diagnosis and subsequent treatment are discussed.METHODS: The literature on the origin, epidemiology, clinical presentation, diagnosis, treatment and prognosis of primary renal lymphoma was reviewed.RESULTS: The first patient was diagnosed after radical nephrectomy and subsequently was given six cycles of CVP (cyclophosphamide, vincristine, prednisone). The diagnosis of the second patient was established by renal biopsy, and the patient received six cycles of CHOP (cyclophosphamide, adriamycin, vincristine and prednisone). The last patient had a lymphoma, secondary to immunosuppression, in a transplanted kidney. In this case transplant nephrectomy sufficed to cure the patient’s lymphoma. All patients had B-cell non-Hodgkin lymphoma (an extrarenal origin was ruled out by bone marrow biopsy), and were disease-free 15 months, 7 months, and 6.5 years after diagnosis, respectively.CONCLUSIONS: Primary renal lymphoma is rare. Diagnosis is established by renal biopsy, although it often presents as a mass simulating renal cell cancer and diagnosis is obtained after radical nephrectomy. Treatment consists of chemotherapy (CHOP) associated with rituximab(AU)

[Intrathoracic ectopic kidney in an adult: case report and bibliographic review]. / Riñón ectópico intratorácico en un adulto: aportación de un caso y revisión de la literatura.

OBJECTIVE: We report the case of a 61-year-old male with the incidental diagnosis of intrathoracic renal ectopia during the workup study for a possible lung mass. METHODS: We performed a bibliographic review on the incidence, origin, clinical presentation and diagnosis of this type of renal ectopia. RESULTS: Chest x-ray showed a left posterior mediastinum mass. Bronchoscopy was performed showing signs of extrinsic compression with absence of neoplastic cells. CT scan revealed a left intrathoracic ectopic kidney with diaphragmatic hernia. CONCLUSIONS: Intrathoracic renal ectopia is a very unfrequent finding, often asymptomatic, frequently an incidental diagnosis that does not require treatment.

Riñón ectópico intratorácico en un adulto: aportación de un caso y revisión de la literatura / Intrathoracic ectopic kidney in an adult: case report and bibliographic review

Objetivo: Se presenta el caso clínico de un varón de 61 años diagnosticado de manera incidental de ectopia renal intratorácica durante el estudio de posible masa pulmonar. Métodos: Se realiza una revisión bibliográfica de la incidencia, origen, clínica y diagnóstico de este tipo de ectopia renal. Resultados: En la radiografía de tórax se aprecia una masa en mediastino posterior izquierdo. Es practicada una fibrobroncoscopia apreciando signos de compresión extrínseca con ausencia de células neoplásicas. El TAC revela un riñón ectópico intratorácico con hernia diafragmática izquierda. Conclusiones: La ectopia renal intratorácica es un hallazgo muy infrecuente, habitualmente asintomático, diagnosticado con frecuencia de manera incidental y que no suele requerir tratamiento (AU)

Objective: We report the case of a 61-year-old male with the incidental diagnosis of intrathoracic renal ectopia during the workup study for a possible lung mass. Methods: We performed a bibliographic review on the incidence, origin, clinical presentation and diagnosis of this type of renal ectopia. Results: Chest x-ray showed a left posterior mediastinum mass. Bronchoscopy was performed showing signs of extrinsic compression with absence of neoplastic cells. CT scan revealed a left intrathoracic ectopic kidney with diaphragmatic hernia. Conclusions: Intrathoracic renal ectopia is a very unfrequent finding, often asymptomatic, frequently an incidental diagnosis that does not require treatment (AU)

[Low flow priapism. Treatment by sapheno-cavernous shunt]. / Priapismo de bajo flujo. Tratamiento mediante shunt safeno-cavernoso.

OBJECTIVE: We report the clinical case of a 21-year-old male presenting with a 36 hour history of low flow priapism, its diagnosis and treatment. METHODS: We performed a bibliography review on the etiology, physiopathology, diagnosis and treatment options. RESULTS: The patient underwent unsuccessful punction-aspiration of intracavernous blood with phenylephrine injection and cavernous irrigation with saline solution. A covernous-spongiosum shunt was performed subsequently, firstly using the Winter technique and followed by the AlGorab technique with a final positive response. CONCLUSIONS: The performance of a sapheno-cavernous shunt is an effective treatment for the low flow priapism resistant to usual medical-surgical treatment.

[Metachronic testicular tumor secondary to invasive bladder carcinoma]. / Tumor testicular metacronico secundario a carcinoma vesical infiltrante.

OBJECTIVE: To report a rare case of testicular metastasis secondary to an infiltrative transitional cell carcinoma years after radical surgery. CASE REPORT: 71-year-old male patient with history of infiltrative bladder tumor, status post radical cystoprostatectomy with urethrectomy. Seven years after surgery he presents with pain and swelling in the right testicle. Inguinal orchyectomy was carried out with the pathologic diagnosis of testicular metastasis of a high-grade transitional cell carcinoma. We perform a bibliographic review. RESULTS: The patient is disease-free twelve months after orchyectomy. CONCLUSIONS: Apart from leukemia and lymphoma, testicular metastases are extremely rare. The existence of testicular metastases means a metastatic dissemination to other organs, therefore chemotherapy could improve prognosis.

Priapismo de bajo flujo. Tratamiento mediante shunt safeno-cavernoso / Low flow priapism. Treatment by sapheno-cavernous shunt

Objetivo: Se presenta el caso clínico de un varón de 21 años con priapismo de bajo flujo de 36 horas de evolución, su diagnóstico y su posterior tratamiento. Métodos: Se realiza una revisión bibliográfica de la etiología, fisiopatología, diagnóstico y diferentes tratamientos posibles. Resultados: El paciente es sometido a la punción-aspiración de sangre intracavernosa con inyección de fenilefrina y lavados con suero fisiológico sin éxito. Posteriormente se realiza una derivación cavernoesponjosa, primero según la técnica de Winter seguida de la de Al Ghorab, respondiendo finalmente a la realización de un shunt safeno-cavernoso. Conclusiones: La realización de un shunt safeno-cavernoso es un tratamiento eficaz para la resolución de un priapismo de bajo flujo rebelde al tratamiento médico-quirúrgico habitual (AU)

Objective: We report the clinical case of a 21-year-old male presenting with a 36 hour history of low flow priapism, its diagnosis and treatment. Methods: We performed a bibliography review on the etiology, physiopathology, diagnosis and treatment options. Results: The patient underwent unsuccessful punction-aspiration of intracavernous blood with phenylephrine injection and cavernous irrigation with saline solution. A cavernous-spongiosum shunt was performed subsequently, firstly using the Winter technique and followed by the AlGorab technique with a final positive response. Conclusions: The performance of a sapheno-cavernous shunt is an effective treatment for the low flow priapism resistant to usual medical-surgical treatment (AU)

Tumor testicular metacrónico secundario a carcinoma vesical infiltrante / Metachronic testicular tumor secondary to invasive bladder carcinoma

OBJETIVOS: Presentar un caso raro de metástasis testicular secundaria a carcinoma urotelial infiltrante años después de practicada cirugía radical. METODOS: Exposición del caso clínico: paciente de 71 años sometido a cistoprostatectomía radical con uretrectomía por tumor vesical infiltrante. A los siete años debuta con dolor y aumento del tamaño testicular derecho. Se le practicó orquiectomía por vía inguinal siendo diagnosticado de metástasis testicular de carcinoma vesical de alto grado. y revisión de la literatura publicada al respecto. RESULTADOS: Supervivencia libre de enfermedad a los 12 meses de la orquiectomía. CONCLUSIONES: El tumor testicular metastático excluyendo leucemias y linfomas es extremadamente raro. La presencia de metástasis testiculares supone una diseminación metastásica a otros niveles y por ello la Quimioterapia podría mejorar el pronóstico (AU)

OBJECTIVE: To report a rare case of testicular metastasis secondary to an infiltrative transitional cell carcinoma years after radical surgery. METHODS: Case Report: 71-year-old male patient with history of infiltrative bladder tumor, status post radical cystoprostatectomy with urethrectomy. Seven years after surgery he presents with pain and swelling in the right testicle. Inguinal orchyectomy was carried out with the pathologic diagnosis of testicular metastasis of a high-grade transitional cell carcinoma. We perform a bibliographic review. RESULTS: The patient is disease-free twelve months after orchyectomy. CONCLUSIONS: Apart from leukemia and lymphoma, testicular metastases are extremely rare. The existence of testicular metastases means a metastatic dissemination to other organs, therefore chemotherapy could improve prognosis

[Dorsal onlay urethroplasty with foreskin mucosa free graft (Barbagli's technique): preliminary results of our case series]. / Uretroplastia dorsal con injerto libre de mucosa prepucial (técnica de Barbagli): resultados preliminares de nuestra serie.

OBJECTIVES: We evaluate the indication and results in the treatment of complex urethral stenosis by the Barbagli's technique. METHODS: We retrospectively review 8 patients undergoing dorsal onlay urethroplasty with foreskin mucosa free graft. We analyze their preoperative characteristics. Mean stenosis length was 6.25 cm and the site was bulbar urethra in seven cases and penile in one. Mean preoperative flow was 8.78 ml/sec. We describe the technique and present our results. RESULTS: There are 87.5% of goods results (cure of the stenosis) with 22 months of mean follow-up. Only one patient required a second operation (end to end anastomosis) with good outcome. CONCLUSIONS: The dorsal onlay urethroplasty with foreskin mucosa free graft is an effective technique in long and complex urethral stenosis, and we consider it the technique of first choice in view of our results.

Uretroplastia dorsal con injerto libre de mucosa prepucial (Técnica de Barbagli): resultados preliminares de nuestra serie) / Dorsal onlay urethroplasty with foreskin mucosa free graft (Barbagli´s technique): preliminary results of our case series

OBJETIVO: Valoramos la indicación y nuestros resultados en el tratamiento de la estenosis de uretra compleja mediante la Técnica de Barbagli.MÉTODO: Realizamos una revisión retrospectiva de 8 pacientes a los que se indica la uretroplastia dorsal con injerto de mucosa libre prepucial. Analizamos las característicaspreoperatorias de los pacientes. La longitud media de la estenosis fue de 6,25 cm, la localización bulbar en 7 casos y peneana en uno. El flujo medio obtenido en la flujometría preoperatoria fue de 8,78 ml/seg. Describimos la técnica y presentamos los resultadosobtenidos con la misma. RESULTADOS: Con un tiempo medio de seguimiento de 22 meses tenemos un 87,5% de buenos resultados, entendiendo estos como la resolución definitiva de la estenosis. Sólo 1 paciente ha precisado un nuevo tratamientoquirúrgico (anastomosis término terminal), con buen resultado evolutivo.CONCLUSIONES: Concluimos que la uretroplastia dorsalcon injerto libre de mucosa prepucial es una técnica efectiva en estenosis de uretra larga y compleja y que por los resultados obtenidos, la consideramos técnica de primera elección en este tipo de estenosis uretrales

OBJECTIVES: We evaluate the indication and results in the treatment of complex urethral stenosis by the Barbagli`s technique.METHODS: We retrospectively review 8 patients undergoingdorsal onlay urethroplasty with foreskin mucosa free graft. We analyze their preoperative characteristics. Mean stenosis length was 6.25 cm and the site was bulbar urethra in seven cases and penile in one. Mean preoperative flow was 8.78 ml/sec. We describe the technique and present our results.RESULTS: There are 87.5% of goods results (cure of the stenosis) with 22 months of mean follow-up. Only one patient required a second operation (end to endanastomosis) with good outcome.CONCLUSIONS: The dorsal onlay urethroplasty with foreskin mucosa free graft is an effective technique in long and complex urethral stenosis, and we consider it the technique of first choice in view of our results

[Malacoplakia within a female urethral diverticulum]. / Malacoplaquia en divertículo uretral femenino.

OBJECTIVES: We report one case of malakoplakia within a female urethral diverticulum. METHODS: 33-year-old patient who consulted for an asymptomatic vaginal tumor. Physical examination, blood and urine analysis and microbiology tests, as well as urethrocystoscopy and intravenous pyelogram were performed. With the diagnosis of urethral diverticulum we undertook surgical excision through a vaginal approach. RESULTS: Pathology revealed the typical characteristics of malakoplakia within the diverticular lumen. CONCLUSIONS: Malakoplakia is an infrequent inflammatory disease which involves the urinary tract in most cases. Urethra location is exceptional.

Mesotelioma multiquístico de túnica vaginal testicular / Multicystic mesothelioma of the testicular tunica vaginalis

OBJETIVO: Aportamos un caso excepcional de mesotelioma multiquístico de túnica vaginal testicular. MÉTODO: Varón de 72 años remitido para estudio de masa escrotal. Se realiza examen físico, analítico y ecográfico previo a la extirpación quirúrgica y estudio anatomopatológico de la lesión. RESULTADO: En el estudio ecográfico se apreció una lesión quística multilobulada junto a cordón espermático. Los hallazgos anatomopatológico fueron múltiples formaciones quísticas de 3-4 mm,con papilas rudimentarias revestidas por epitelio hipercromático e inmunofenotipo vimentina (+), CD34 (+). CONCLUSIÓN: El mesotelioma multiquístico es una forma rara de mesotelioma, bien reconocido pero infrecuente. Este tumor afecta normalmente a la superficie peritoneal de la pelvis y del abdomen, aunque se han descrito otras localizaciones menos frecuentes, la localización testicular es excepcional. Presentamos el caso de un paciente afecto de un mesotelioma multiquístico de túnica vaginal testicular y revisamos el diagnóstico, la histopatología y las opciones de tratamiento de este tipo de tumor (AU)

[Left adrenal carcinoma with caval thrombosis]. / Carcinoma suprarrenal izquierdo con trombo en cava.

OBJECTIVES: To review the epidemiology, classification, prognosis, and therapeutic options of adrenal cortical carcinoma, mainly those of functional tumors. METHODS AND RESULTS: 52-year-old male presenting with wasting syndrome and a big left adrenal tumor, as well as a possible inferior vena cava thrombus. The tumor was catalogued as non functional after functional studies. Surgical intervention was carried out including adrenal tumor excision, splenectomy, and cavotomy with thrombectomy of a tumoral thrombus coming from the left adrenal and renal veins. Infrarenal iliocaval thrombosis appeared during the postoperative period, requiring intensive anticoagulant therapy and ICU admission for control. Pathological diagnosis confirmed the existence of a high grade malignant adrenal cortical carcinoma. Patient died two months after surgery due to disease progression. CONCLUSIONS: Radiological tests are fundamental in the diagnosis of adrenal masses. In the case of big tumoral masses, it is important to rule out the existence of possible tumor thrombi in the adrenal vein territory, including the inferior vena cava.

[Testicular microlithiasis and testicular cancer]. / Microlitiasis testicular y cáncer de testículo.

OBJECTIVE: To check the possible relationship between testicular microlithiasis and testicular carcinoma in a patient in the one which previously we discovered a sonographic image of this condition. The etiopathogenesis, incidence and attitude are discussed. METHODS: A 23-year-old male with a psychomotor retardation secondary to a chromosomopathy presented with orchitis. Scrotal ultrasound discovered testicular microlithiasis, described as many hyperechoic images. Thirteen months later a testicular cancer was found in a new ultrasound. Radical orchiectomy was performed. Currently the patient is under intense follow-up. RESULTS: The histopathological study showed mature teratoma and intratubular germ cell neoplasm. CONCLUSIONS: The testicular microlithiasis has been related with benign and malignant testicular pathology. However, this presence it is not sufficiently clarified and the urologist's attitude to a patient with testicular microlithiasis but asymptomatic is not enough studied.

[Acute prostatitis as the 1st symptom of brucellosis]. / Prostatitis aguda como primer síntoma de brucelosis.

OBJECTIVES: To report a case of acute prostatitis as the first symptom of brucellosis. METHODS: 43-year-old patient who presented with a clinical picture of acute prostatitis and a febrile syndrome for seven days. Physical exam, blood and urine analysis and microbiological tests, and specific serologic studies were performed. RESULTS: Microbiological diagnosis was negative for bacteria, but Bengala pink (+), antibrucella serum agglutination (+) 1/320, and anti-Brucella Coombs test (+) 1/5120. Specific treatment was started with doxycyclin 100 mg b.i.d for 45 days and streptomycin 1 gr o.d for 15 days, with a positive outcome. CONCLUSIONS: The genitourinary tract is the second most frequent localization, being the testicle the most frequently affected organ, although it can also be localized in other areas of the urinary tract.

Prostatitis aguda como primer síntoma deBrucelosis / Acute prostatitis as the first symptom of brucellosis

OBJETIVO: Aportamos un caso clínico de prostatitis aguda como primer síntoma de brucelosis. MÉTODO: Paciente de 43 años que presentó cuadro clínico de prostatitis aguda acompañado de síndrome febril de una semana de evolución. Se realiza examen físico, analítico y microbiológico de sangre y orina, y estudio serológico específico. RESULTADO: El diagnóstico bacteriológico fue negativo, pero presentó rosa de Bengala (+), seroaglutinación anti-brucella (+) 1/ 320 y Coombs anti-brucella (+) 1/5120. Se instauró tratamiento específico con doxiciclina 100 mg cada 12 horas durante 45 días y estreptomicina 1 gr cada 24 horas durante 15 días, con resultado satisfactorio. CONCLUSIÓN: El aparato genitourinario es el segundo en frecuencia, siendo el testículo el órgano más afectado, aunque también puede localizarse en otros tramos del tracto urinario (AU)

Microlitiasis testicular y cáncer de testículo / Testicular microlithiasis and testicular cancer

OBJETIVOS: Revisar la posible relación entre el carcinoma testicular y la microlitiasis testicular, presentando el caso clínico de un paciente con hallazgo casual de imagen ecográfica compatible con esta entidad, y que tras un intervalo de tiempo desarrolló una neoplasia testicular. Se comentan la etiopatogenia, incidencia y actitud a tomar ante la presencia de microlitiasis testicular. MÉTODOS: Varón de 23 años, afecto de retraso psicomotor por cromosomopatía, que consulta por orquiepididimitis. En estudio ecográfico de urgencias, aparte de describir imagen compatible con esta, se aprecian múltiples focos hiperecogénicos en ambos testículos, imagen que define la microlitiasis testicular. En ecografía de seguimiento trece meses mas tarde, con persistencia de dichos focos hiperecoicos, se descubre imagen hipoecogénica compatible con proceso tumoral testicular. Ante dicho hallazgo se decide realizar orquiectomía radical. El paciente se encuentra en programa de seguimiento en estrecha vigilancia clínica. RESULTADOS: En el estudio histopatológico se informa la presencia de teratoma maduro asociado a neoplasia intratubular de células germinales. CONCLUSIONES: Se ha intentado relacionar la presencia de microlitiasis testicular con una amplia variedad de procesos testiculares, tanto benignos como malignos. Sin embargo, el significado real de dicha presencia esta aun por establecer, así como la actitud del urólogo ante su hallazgo casual en un testículo, que por otro lado no presente otras alteraciones significativas (AU)