[Surgical treatment of hypospadias. Our experience and follow up in 1993-1998]. / Tratamiento quirúrgico del hipospadias. Nuestra experiencia y seguimiento durante el período 1993-1998.

OBJECTIVE: To review our series of hypospadias. The incidence of the different types of hypospadias and the complication rates according to the different surgical techniques and materials utilized are analyzed. METHODS: We reviewed our series of 130 patients with hypospadias who underwent surgical correction at the Department of Pediatric Urology from 1993-1998. RESULTS: The patients presented the following types of hypospadias: glandular (13 cases), balano-preputial (56), distal penile (42), mid-penile (9), proximal penile (2) and penoscrotal hypospadias (8). The surgical techniques utilized were the Mickulitz meatotomy procedure (6 cases), MAGPI (24), Mathieu (77), Crawford (5), onlay (7), Duckett (3), Retik (4), Duplay (1), Denis-Brown (2) and penoscrotal transposition (1). The complications commonly observed were fistula (20 cases), hematoma (4), stricture of urethral meatus (4), infection (3), megaurethra (3), skin necrosis (1). CONCLUSIONS: Surgical repair of this developmental anomaly is performed when the patient is approximately 18 months old. In our series 15% of the patients developed fistula, which is similar to the complication rate reported in the literature. However, since we started using monofilament resorbable material, the incidence of fistula has dropped from 20% to approximately 5%. Although other factors are involved, the lower incidence of fistula formation may be largely due to a reduced tissue reaction to foreign body.

[Skin metastasis from transitional cell carcinoma of the bladder]. / Metástasis cutáneas de carcinoma de células transicionales de vejiga.

OBJECTIVE: To report an additional case of skin metastasis from transitional cell carcinoma of the bladder. The clinical features, distribution, differential diagnosis, treatment and survival are reviewed. METHODS: A 73-year-old patient with stage pT2 pN0 pMx carcinoma of the bladder is described. The imaging studies indicated tumor recurrence, but the patient refused reevaluation by endoscopy one year ago. RESULTS: An erythematous, nodular, indurated lesion extending from the hypogastrium to the proximal region of both lower limbs was found. The biopsy findings were compatible with metastatic spread from a carcinoma. CONCLUSION: Although skin metastasis from bladder carcinoma is rare, the number of cases reported is increasing. Skin metastasis is generally limited to the advanced stages of the disease and is an indication of poor prognosis.

[Renal carcinoma and von Hippel-Lindau disease]. / Carcinoma renal y enfermedad de Von Hippel Lindau.

Von Hippel Lindau disease is a highly uncommon autosomic dominant condition characterised by the presence of cerebellar hemangioblastomas, retina angioma, pancreas, kidney and epididymal cysts, and renal cells carcinoma. This article describes the case report of a male patient with Von Hippel Lindau disease which presented as a jaundice secondary to biliary obstruction due to pancreatic cystic mass. After urological examination, bilateral cystic lesions and right renal solid lesion were detected requiring surgical treatment. A review is made of the diagnostic and therapeutic aspects, highlighting the significance of early diagnosis and treatment.

[Skin metastasis as first manifestation of prostatic adenocarcinoma]. / Metástasis cutáneas como primera manifestación de un adenocarcinoma prostático.

Incidence of prostate disease has seen a sudden boost over the last few years as a result of an increase in male life expectancy. Prostate carcinoma is the third most common cause of cancer mortality in Spain. Post-mortem studies reveal that this is the most prevalent neoplasia in the elderly. 30% of all males over 50 years could host malignant cells in their prostate, although only 20% of these neoplasias have clinical manifestations. Prostate carcinoma expansion occurs by local spreading, as well as lymph and blood dissemination. Local spreading to the urethra, bladder neck, trigonous and seminal vesicles is frequent. Lymph dissemination to obturating, hypogastric, iliac, presacral and paraaortic nodes is a major path for metastasis. Bone metastasis with increased acid phosphatase is the most illustrative sign of prostate adenocarcinoma expansion. Visceral metastasis occur more frequently in lungs, liver and renal glands. There is a 0.3% likelihood of skin metastasis from prostate adenocarcinoma. Considering the rareness of skin metastasis from prostate adenocarcinoma, the case reported in the present paper, first evidence of a prostate carcinoma, is even more exceptional.

[Advanced tubercular disease of urogenital tract]. / Enfermedad tuberculosa avanzada del tracto urogenital.

OBJECTIVE: The genitourinary tract is one of the most common sites of extrapulmonary tuberculosis (30%-33%), followed by the lymphatic tissue, skeletal system and gut. Due to the diagnostic methods and therapeutic modalities currently available, it is infrequent to find advanced tuberculosis with extensive genitourinary involvement. METHODS/RESULTS: Herein we describe a patient with advanced genitourinary tuberculosis characterized by loss of right renal unit, left hydronephrosis due to ureterovesical junction stricture, contracted bladder, prostatic caseation and urethral stricture. Right nephrectomy and bladder substitution ileocystoplasty were performed. The clinical features, diagnostic and therapeutic aspects are discussed and the literature briefly reviewed. CONCLUSION: Extensive genitourinary tuberculosis is uncommon. The importance of early diagnosis and treatment is emphasized in order to avoid the irreversible sequelae.

[Mixed urogenital schistosomiasis]. / Esquistosomiasis genitourinaria mixta.

Urinary schistosomiasis is a parasitosis caused by Schistosoma Haematobium which affect in a diffuse manner all the genitourinary tract. Presentation of 5 patients (4 male, 1 female) with mixed Bilharziosis that was detected after the study of a young male that came to the clinic with a complaint of haematuria and who underwent transurethral resection under the suspicion of a vesical urothelial neoformation. Sch. Hameatobium eggs were detected in the urine and Sch. Mansoni in the semen of all 4 male. All of them evolved favourably with Praziquantel. Considering the rarity of schistosomiasis in our environment and its increased incidence in endemic areas, this process should be included in the algorithm of differential diagnosis in young patients reporting dysuric syndromes associated to haematuria; the relevance of an epidemiological anamnesis so as to institute early treatment and avoid the consequences of chronic infection is pointed out.

[Ureteral obstruction secondary to inflammatory iliac aneurysm]. / Obstrucción ureteral secundaria a aneurisma ilíaco inflamatorio.

Inflammatory iliac aneurysms are uncommon and account for 1-2% of total abdominal aneurysms. These aneurysms are more susceptible to present urological symptoms and are difficult to diagnose because of their uncommon incidence and location in the deep pelvis which makes them little accessible to physical examination. This case report presents one patient with right obstructive uropathy secondary to extrinsic ureteral trapping due to inflammatory iliac aneurysm which evolved favourably after ureterolysis, endoaneurysmectomy and interposition of aortoiliac graft. A brief review of diagnostic and therapeutic aspects in the literature is included. The relevance of a high degree of suspicion to diagnose this entity in patients with otherwise explainable vesical irritative symptoms, haematuria or renal failure is highlighted.

[Primary prostatic infiltration by Burkitt's lymphoma]. / Infiltración prostática primaria por linfoma de Burkitt.

OBJECTIVE: Genitourinary tract involvement arising from non-Hodgkin lymphoma occurs in 10% of patients; prostatic infiltration is uncommon and accounts for less than 0.1%. The uncommon clinical onset of this infrequent condition prompted us to report on the present case. METHODS/RESULTS: A 41-year-old male patient with lower urinary tract outflow obstruction arising from prostatic enlargement secondary to non-Hodgkin lymphoma (Burkitt's lymphoma) is described. Treatment with chemotherapy achieved good results. The clinical features, diagnostic and therapeutic aspects are discussed and the literature briefly reviewed. CONCLUSION: The present case emphasizes the need to include non-Hodgkin lymphoma in the differential diagnosis of lower urinary tract outflow obstructive symptoms in young men with prostatic enlargement.

[Usefulness of magnetic resonance angiography in the diagnosis of polar vessel in stenosis of the pyeloureteral junction]. / Utilidad de la angioresonancia magnética en el diagnóstico del vaso polar en la estenosis de la unión pieloureteral.

OBJECTIVES: To present the results of a prospective study that had been conducted to determine the accuracy of magnetic resonance angiography (MRA) in the detection of accessory or polar vessels associated with ureteropelvic junction (UPJ) stricture, in order to utilize the most appropriate surgical procedure in the management of this condition. METHODS: From October, 1994 to September, 1996, 30 MRA procedures were done in 12 males and 18 females, aged 14 to 73 years (mean 38.12), with symptomatic UPJ obstruction. When the MRA was positive for polar vessels, the patients underwent open dismembered pyeloplasty; surgical correlation and a true positive result could be established. Percutaneous endopyelotomy was offered when the MRA was negative. The findings at open surgery and an unremarkable clinical course and radiological findings at one year follow-up established a true negative result. RESULTS: Accessory or polar vessels (11 arteries; 4 veins) were found in 11 patients (36.4%). MRA had a sensitivity of 92.3% (15/16) for detection of accessory vessels. Fourteen patients underwent open surgery (11 dismembered pyeloplasties; 3 nephrectomies) and the MRA findings were confirmed in each case (8 positive; 6 negative). Surgery disclosed an accessory vein that had not been detected on MRA in only one patient. This patient also had a polar artery that had been observed on MRA and demonstrated at surgery; thus, the sensitivity of MRA for detection of UPJ stenosis with polar vessel is 100% (11/11). Each vessel described on MRA was confirmed at surgery; there were therefore no false positives and the specificity was 100%. CONCLUSIONS: Although this is a preliminary study with a short follow-up and with some limitations, the results indicate that MRA is a simple, non-invasive technique with a high sensitivity and specificity for detection of polar vessels associated with UPJ stenosis, and appears to be a useful preoperative diagnostic procedure due to the surgical implications.