[Local anesthesia significantly improves the tolerance of prostate biopsy]. / La anestesia local mejora significativamente la tolerancia de la biopsia prostática.

UNLABELLED: Transrectal biopsy is one of the most frequent procedures in urological practice. Generally, transrectal biopsies have been practiced without anesthesia, because of a supposed good tolerance. Nevertheless, it is not infrequent to find patients with a high level of pain and adverse effects attributable to such procedure. OBJECTIVES: In the present article the effect of transrectal local anesthesia in order to significantly diminish the perception of pain by the patient is evaluated. METHODS: A total of 131 consecutive patients undergoing transrectal prostate biopsy are included in the study. After randomization, 76 patients were biopsiated with anesthesia and 55 represent the control group. Cases and control groups do not differ in age or prostate volume. Anesthesia consisted on a periprostatic nerve blockage with injection of 5 cc of 1% mepivacaine solution in the angle between prostate and seminal vesicles bilaterally. A visual analogical scale for pain was used; it was given to the patient at the end of the procedure. RESULTS: Mean pain value was 2.41 with a median of 2.0 in the group with anesthesia, and 4.02 with a median of 4 in the control group. A Student's t test comparing the means showed a statistically significant difference of 1.61 (p < 0.0001). Pain in the scale was 66% greater in the control group. CONCLUSION: The use of anesthesia in the performance of transrectal biopsies significantly diminishes the perception of pain by patients. This effect, along with the tendency to increase the number of biopsies, will result in short time in a more generalized use of local anesthesia.

La anestesia local mejora significativamente la tolerancia de la biopsia prostática / Local anesthesia significantly improves the tolerance of prostate biopsy

La biopsia transrectal es uno de los procedimientos mas frecuentes en la práctica urológica. Usualmente las biopsias transrectales se han practicado sin administrarse anestesia, ante la consideración de una buena tolerancia. Sin embargo no es infrecuente encontrarnos ante pacientes con un nivel del dolor alto e incluso efectos adversos atribuibles al mismo. OBJETIVO: Se evalúa en el presente trabajo si la anestesia local transrectal puede disminuir significativamente la percepción del dolor por el paciente. MÉTODOS: Se incluyen en el siguiente estudio 131 pacientes consecutivos y sometidos a biopsia transrectal. Efectuándose la randomización 76 pacientes fueron biopsiados con anestesia y 55 representan el grupo control. Casos y controles no difieren en edad ni volumen prostático. La anestesia se efectuó administrándose 10 cc del anestésico mepivacaína al 1%, 5 cc en cada lado en el ángulo entre la próstata y las vesículas seminales. Se empleó una escala analógica y visual del dolor que se suministró al paciente una vez acabado el procedimiento. RESULTADOS: En el grupo de pacientes anestesiados la media de valoración del dolor fue de 2,41 con una mediana de 2 y en el grupo control se obtuvo una media de 4,02 con una mediana de 4. Se realizó test de comparación de medias (t de Student), obteniéndose entre los grupos una diferencia estadísticamente significativa de 1,61 (< 0,0001). Porcentualmente encontramos una diferencia en la escala del dolor de un 66 % más en el grupo control. CONCLUSIÓN: La utilización de anestesia en la realización de las biopsias transrectales disminuye significativamente la percepción del dolor por los pacientes. Este efecto junto a la tendencia en incrementar el número de biopsias, generalizará en poco tiempo el empleo de la anestesia local

Transrectal biopsy is one of the most frequent procedures in urological practice. Generally, transrectal biopsies have been practiced without anesthesia, because of a supposed good tolerance. Nevertheless, it is not infrequent to find patients with a high level of pain and adverse effects attributable to such procedure. OBJECTIVES: In the present article the effect of transrectal local anesthesia in order to significantly diminish the perception of pain by the patient is evaluated. METHODS: A total of 131 consecutive patients undergoing transrectal prostate biopsy are included in the study. After randomization, 76 patients were biopsiated with anesthesia and 55 represent the control group. Cases and control groups do not differ in age or prostate volume. Anesthesia consisted on a periprostatic nerve blockage with injection of 5 cc of 1% mepivacaine solution in the angle between prostate and seminal vesicles bilaterally. A visual analogical scale for pain was used; it was given to the patient at the end of the procedure. RESULTS: Mean pain value was 2.41 with a median of 2.0 in the group with anesthesia, and 4.02 with a median of 4 in the control group. A Student´s t test comparing the means showed a statistically significant difference of 1.61 (p<0.0001). Pain in the scale was 66% greater in the control group. CONCLUSION: The use of anesthesia in the performance of transrectal biopsies significantly diminishes the perception of pain by patients. This effect, along with the tendency to increase the number of biopsies, will result in short time in a more generalized use of local anesthesia

[Penile tunica albuginea plication for the treatment of penile curvature secondary Peyronie's disease]. / Plicatura de la albugínea como tratamiento de la incurvación de pene causada por la enfermedad de Peyronie.

OBJECTIVE: To evaluate, in a retrospective analysis, our long-term results of patients undergoing the Essed plication procedure for the correction of penile curvature due to Peyronie's disease. METHODS: Between January 1998 and June 2003, 83 patients with acquired penile deviation were treated with the Essed technique in our hospital. We analyse the following data: age, main complaint, type of deviation, erection before and after the surgery, physical exploration, ecographic data, complications and results. RESULTS: Mean follow-up was 36 months. Main complaint was penile curvature in 96.3% of patients. The most frequent types of deviation were dorsal (55.4%) and left lateral (48.1%). Erection before surgery was sufficient for sexual intercourse in 74.7%. Physical exploration revealed a plaque in 79.5% of the patients. 93% of the cases reported complete penile curvature correction or residual deviation < 10 degrees. 65.1% of the patients were satisfied or very satisfied with the result of the operation and 64% were able to perform sexual intercourse. CONCLUSIONS: The Essed plication is a simple and minimally invasive method for correcting acquired penile deviation. Although functional results seem to be satisfactory, in our experience the degree of satisfaction with the outcome is not as good, among the patients, as it could be expected.

Plicatura de la albugínea como tratamiento de la incurvación de pene causada por la enfermedad de Peyronie / Penile tunica albuginea plication for the treatment of penile curvature secondary Peyronie´s disease

OBJETIVO: Evaluar nuestros resultados enel tratamiento de la incurvación peneana causada porla enfermedad de Peyronie mediante la plicatura albugíneadescrita por Essed.MÉTODOS:Revisión retrospectiva de los 83 pacientestratados quirúrgicamente de incurvación peneanaadquirida en nuestro centro mediante la técnica de plicaturaentre enero de 1998 y junio de 2003, analizandolas siguientes variables: edad, motivo de consulta,antecedentes personales, exploración física,datos ecográficos, tipo de incurvación, erección pre ypostcirugía, complicaciones y resultados de la técnicaquirúrgica.RESULTADOS:El seguimiento medio fue de 36 meses.El motivo de consulta principal fue la desviación peneanaen erección (96,3%). El tipo de incurvación másfrecuente fue dorsal (55,4%) y lateral izquierda(48,1%). La erección previa a la cirugía era suficientepara mantener una relación sexual en el 74,7% de lospacientes. La exploración física reveló la existencia deplaca en el 79,5% de los casos. En cuanto a los resultadosde la cirugía, el 93% refieren una correccióncompleta de la incurvación o una desviación residualmenor de 10º. El 65,1% manifestaron encontrarse satisfechoso muy satisfechos con la operación, mientrasque el 64% eran capaces de llevar a cabo una relaciónsexual.CONCLUSIONES: La plicatura de Essed es un procedimientosencillo y mínimamente invasivo para corregirla desviación adquirida de pene. En nuestra experiencia,aunque los resultados funcionales parecen ser buenos,el grado de satisfacción entre los pacientes tras lacirugía no es tan alto como cabría esperar

OBJETIVE: To evaluate, in a retrospective analysis, our long term results of patients undergoing the Essed plication procedure for the correction of penile curvature due to Peyronie´s disease. METHODS: Between January 1998 and June 2003, 83 patients with acquired penile deviation were treated with the Essed technique in our hospital. We analyse the following data: age, main complaint, type of deviation, erection before and after the surgery, physical exploration, ecographic data, complications and results. RESULTS: Mean follow-up was 36 months. Main complaint was penile curvature in 96.3% of patients. The most frequent types of deviation were dorsal (55.4%) and left lateral (48.1%). Erection before surgery was sufficient for sexual intercourse in 74.7%. Physical exploration revealed a plaque in 79.5% of the patients. 93% of the cases reported complete penile curvature correction or residual deviation < 10º. 65.1% of the patients were satisfied or very satisfied with the result of the operation and 64% were able to perform sexual intercourse. CONCLUSIONS: The Essed plication is a simple and minimally invasive method for correcting acquired penile deviation. Although functional results seem to be satisfactory, in our experience the degree of satisfaction with the outcome is not as good, among the patients, as it could be expected

[The effect of seminal leukocytes on semen quality in subfertile males with and without varicocele]. / Efectos de la leucocitospermia sobre la calidad seminal en varones subfértiles con y sin varicocele.

OBJECTIVES: To compare the concentration of leukocytes and round cells in semen samples of subfertile males (SM), men with varicocele (VM), and fertile males (FM) to establish a possible relationship between leukocyte concentration, semen parameters (pH, concentration, mobility, spermatic morphology) and lipidic peroxidation of the spermatozoid. METHODS: We evaluated 298 semen samples from: 42 fertile males, 170 subfertile males, and 86 men with varicocele. Sperm tests were performed following WHO criteria. All samples with leukocyte counts higher than 1 million/ml were submitted for oxidative stress study (malonyldialdehyde in seminal plasma). RESULTS: Leukocyte concentration was higher in subfertile males and men with varicocele (2.5 +/- 2.1 x 10(6)/ml and 2.3 +/- 2.1 x 10(6)/ml) than in fertile males (1.1 +/- 0.1 x 10(6)/ml) (p 0.0001). In the same way concentration of round cells was higher in the SM group (6.5 +/- 0.3 x 10(6)/ml) and VM group (6.1 +/- 0.4 x 10(6)/ml) than in FM (4.5 +/- 0.4 x 10(6)/ml) (p 0.05). Spermatozoid concentration was lower in SM (42.1 +/- 2.4 x 10(6)/ml) and VM (9.9 +/- 3.5 x 10(6)/ml) than in FM (82.4 +/- 5.7 x 10(6)/ml) (p 0.0001). The percentage of spermatozoa with type "a" mobility was lower in the SM (14.1 +/- 0.9) and VM (19.9 +/- 1.4) groups than in the FM group (50.0 +/- 1.3) (p 0.0001). In the same way, "a + b" mobility was lower in the SF group (26.7 +/- 1.4) and VM group (34.1 +/- 1.9) than in the FM group (50.0 +/- 1.3) (p 0.0001). The SM group showed a lower percentage of normal forms (43.3 +/- 1.5) than the VM (50.0 +/- 1.6) and FM (60.6 +/- 1.3) groups (p 0.0001). When grouping by concentration of peroxidase positive cells, there were not statistical differences in the spermatic variables in SM, with the exception of progeny cells. Type "a" mobility in the VM group was lower in the peroxidase positive group than in the peroxidase negative group (p 0.005); "a + b" mobility was also lower in the peroxidase positive men than in peroxidase negative (p 0.01); in the progeny cells they were higher in the peroxidase positive males (4.2 +/- 0.4 x 10(6)/ml) than in peroxidase negative males (3.0 +/- 0.3 x 10(6)/ml). Malonyldialdehyde concentrations were significantly higher in seminal plasma of subfertile and varicocele males than in fertile males (p 0.006, and p 0.03). CONCLUSIONS: Increased number of semen lymphocytes is more frequent in subfertile and varicocele males than in fertile males. The increase of semen leukocytes is associated with deterioration of seminal parameters. Oxidative stress has a negative influence on seminal parameters in subfertile males of unknown etiology.

[The treatment of varicocele in the infertile male I: results on semen quality]. / Tratamiento del varicocele en el varón infértil I: resultados sobre la calidad seminal.

OBJECTIVES: To evaluate the effect of interventionist treatment of varicocele, either open surgery or endovascular radiological occlusion, on seminal parameters, and to identify which factors are associated with their normalization. METHODS: Between 1975 and 2000, 631 patients with the diagnosis of idiopathic varicocele were evaluated in our hospital; 238 of them were part of an infertile couple. Among them, finally, 183 underwent studies; they complied with the following criteria: 1) Infertility for more than one year; 2) seminal parameters below normality following WHO criteria (1992); 3) absence of other pathologies or diseases which could explain male infertility; and 4) absence of evident causes of male infertility. 131 patients were treated by radiological occlusion and 26 by conventional surgery. The remaining 26 patients did not undergo the treatment indicated. Two parameters were evaluated on follow-up: 1) achievement of pregnancy (these results will be analyzed in a next article), and 2) normalization of seminal parameters. RESULTS: 48% and 39% of the patients respectively achieved normalization of the number of spermatozoids per ml (=20 million spermatozoids per ml) and spermatic morbidity (=50%). The association between normalization of seminal parameters and age, clinical grade, or type of treatment was not demonstrated. Only baseline degree of severity in the alteration of seminal parameters showed statistically significant differences in the evaluation of semen quality after treatment of varicocele (p = 0.001 and p = 0.002). CONCLUSIONS: The degree of previous seminal alteration--oligospermia and asthenospermia--was the factor with greatest prognostic value in relation with normalization of seminal parameters.

[The treatment of varicocele in the infertile male II: results on fertility]. / Tratamiento del varicocele en el varón infértil II: resultados sobre la fertilidad.

OBJECTIVES: To analyze the efficacy of varicocele treatment, either surgical or endovoscular radiological occlusion, on pregnancy rates of infertile couples in which the male had clinically. patent left varicocele, and to identify which factors are associated with the probability of obtaining pregnancy in such cases. METHODS: This study is part of a more ample one described in previous article: "The treatment of varicocele in the infertile male I: Results on semen quality". Overall, 183 couples were included. 157 males received treatment (131 radiological occlusion and 26 open surgery), the remaining 26 did not received the treatment indicated. Couples underwent periodic follow-up during the first year, evaluating two parameters: 1) normalization of semen analysis parameters, and 2) pregnancy during the following 12 months after indication of treatment. RESULTS: Overall, 41 couples (22.4%) achieved pregnancy during first year, 35/157 (22%) in the group of treated patients, and 6/26 (23%) in the non treatment group. In the treatment group, surgical ligature achieved higher pregnancy rates than radiological occlusion (35% vs. 20%), but the difference was not statistically significant (p = 0.255). No association was demonstrated between male age, female age, varicocele clinical grade, degree of semen quality abnormalities, or duration of infertility and pregnancy rates. The FSH value was significantly lower (p 0.0006) in patients who achieved pregnancy. CONCLUSIONS: The degree of semen quality abnormality, which so closely correlated to normalization of seminal parameters, locked of prognostic significance in terms of achievement of pregnancy. The FSH value was the only factor with certain prognostic value, although it did not reach significance in logistic regression analysis.

[Testicular epidermoid cyst: report of a new case and bibliographic review]. / Quiste epidermoide testicular: a propósito de un nuevo caso y revisión de la literatura.

OBJECTIVES: The epidermoid cyst of the testis is a rare benign tumor. It accounts for approximately 1% of all testicular tumors. Generally, the testis has a palpable, painless mass with tumor markers (AFP, BHCG, and LDH) within normal ranges. Pathology reveals a cavity consisting of squamous epithelial cells containing keratin and non-nucleated keratic flakes in the absence of atypia or elements of teratoma. METHODS/RESULTS: We report the case of a young man who was diagnosed of epidermoid cyst after orchiectomy. CONCLUSIONS: Tumor enucleation would be a proper treatment when ultrasound studies suggest this diagnosis. However, we often perform orchiectomy due to a low rate of suspicion, non conclusive ultrasound studies, or due to the high percentage of malignant testicular tumors in this age range.

Quiste epidermoide testicular: a propósito de un nuevo caso y revisión de la literatura / Testicular epidermoid cyst: report of a new case and bibliographic review

OBJETIVO: El quiste epidermoide testícular es un tumor raro de naturaleza benigna. Este supone aproximadamente el 1 por ciento de todos los tumores testiculares.Habitualmente el testículo presenta una masa palpable e indolora con marcadores tumorales AFP, BHCG y LDH dentro de parámetros normales. Los hallazgos patológicos revelan una cavidad quistica formada por células epiteliales escamosas conteniendo queratina y escamas corneas anucleadas en ausencia de atipia o elementos teratomatosos(1). MÉTODO/ RESULTADO: resentamos un caso de un varón joven que fue diagnosticado de quiste epidermoide testicular después de orquiectomía. CONCLUSIONES: La enucleación del tumor podría ser un tratamiento correcto cuando los hallazgos ecográficos sugieran esta posibilidad. Sin embargo, con frecuencia realizamos orquiectomía debido a un bajo índice de sospecha, estudios ecográficos no concluyentes o debido al alto índice de tumores testiculares malignos a estas edades (AU)

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[Neuroendocrine renal carcinoma. Presentation of a case]. / Carcinoma renal neuroendocrino. Presentación de un caso.

OBJECTIVES: To report a new case of neuroendocrine renal cell carcinoma. METHODS: We report the case of a 76-year-old woman with neuroendocrine renal cell carcinoma who underwent radical nephrectomy without any further adjuvant treatment. We performed a bibliographic review about this rare renal neoplasia of which there are less than 20 published case reports. RESULTS: Patient is asymptomatic four years after surgery, although she has local recurrence. CONCLUSIONS: Small cell renal cell carcinoma is a very rare neoplasia, affecting people over the age of 60 years, large in size, and metastatic at diagnosis. It has bad prognosis, with short survival times. The most adequate treatment has not been determined due to the scarcity of published cases; the combination of surgery and chemotherapy is the most frequently used.

[Renal colic in a patient with crossed renal ectopia]. / Crisis reno-ureteral en paciente con ectopia renal cruzada.

OBJECTIVES: To report a new case of renal colic in a patient with crossed renal ectopia and L-shaped kidney, and to perform a bibliographic review. METHODS AND RESULTS: A 33-year-old male patient consulted for abdominal right pain. Ultrasound and CT showed a L-Shaped Kidney with left renal and ureteral stones. These stones produced obstructive left collecting system. This patient was managed with left pyelolithotomy and ureterolithotomy. The transabdominal approach was recommended to resolve this stones. CONCLUSIONS: The crossed renal ectopia with fusion is a rare condition. The abnormal kidney position and the anomalous kidney supply may impede drainage from the collecting system, creating a predisposition to urinary tract infection and calculus formation. The colic in this patient sometimes is misdiagnosed how abdominal disease. The usual method of detection was excretory urography but now ultrasonography and CT have showed more cases. The indications for open surgery in treatment the stones, are generally failure of extracorporeal shock wave lithotripsy, this is common in these cases for the anatomic abnormality, and the transabdominal approach is recommended to resolve its complications in this kidneys.

[Bladder hemangioma after radiotherapy]. / Hemangioma vesical postradioterapia.

OBJECTIVES: Bladder hemangiomas are exceptional benign tumours representing 0.6% bladder tumours. Most times they present as solitary, unique lesions; radiological signs are very similar to urothelial neoplasias making differential diagnosis or at least diagnostic suspicions very difficult due to its low incidence. We perform a bibliographic review and comment on its clinical and pathological characteristics, as well as on diagnostic methods and latest modifications in therapy. METHODS: We present a case of bladder haemangioma secondary to pelvic radiotherapy, being this presentation unique among approximately 100 cases described in the literature. RESULTS: From cystoscopy we suspected the lesion could be an endothelial neoplasia based on its vascular appearance. We performed transurethral resection and electrocoagulation of the lesion because it was small and unique. Pathology report confirmed it was a bladder hemangioma secondary to radiotherapy, being this an exceptional presentation. There has been no relapse up to date. CONCLUSION: We think that resection and electrocoagulation of unique, solitary bladder hemangiomas is a therapeutic option to be taken into consideration in the management of this kind of benign tumours.

Retroperitoneal abscesses--analysis of a series of 66 cases.

OBJECTIVE: To analyze our experience with the management of retroperitoneal abscesses. PATIENTS AND METHODS: A retrospective study was made of 66 patients with retroperitoneal abscesses treated at our hospital from January 1975 to July 2001 for the purpose of analyzing the diagnosis and treatment of these rare infections. In each case, we analyzed patient characteristics, abscess location and origin, predisposing factors, clinical presentation, microbiology, radiographic findings, treatment, and outcome. RESULTS: In our series, the most frequent type of abscess was perinephric (45.4%), and the most frequent origin was the kidney (72.7%), generally renal lithiasis or previous urological surgery. Gram-negative bacilli were the microorganisms most often involved as causal agents of abscesses. CT had the best diagnostic performance (95%). Percutaneous drainage resolved the abscess in 86.3% of the patients in which it was used, compared with 87.5% for traditional surgical drainage. In 4 cases, the only treatment was administration of antibiotics. In all these cases the abscesses were smaller than 3 cm and patients were in good general condition. The mortality rate was excellent (1.5%), probably due to the low rate of comorbidity in our patients. CONCLUSIONS: Gram-negative bacilli were the most frequent microorganisms in our retroperitoneal abscesses. CT was the imaging technique that produced the most reliable and rapid diagnosis. Radiographically-guided percutaneous drainage was a safe and effective therapeutic alternative when used as definitive treatment or preoperatively.

[Encrusted pyelitis in patients with urinary diversion]. / Pielitis incrustante en pacientes con derivación urinaria.

OBJECTIVE: This is a case of Encrusted Pyelitis (EP) caused by Corynebacterium urealyticum (CU) in a patient who had undergone a cystectomy and Bricker type urinary diversion 28 months beforehand. METHODS/RESULTS: After the immediate post-operative period no urinary catheterisation or any other urological procedure was performed on the patient. Before surgery, the patient presented non functional of the right kidney, secondary to a lithiasic obstructive uropathy. Clinical symptoms were deteriorated renal function, anuria, haematuria, pyrexia and left lumbar pain. It was suspected that the patient had this pathology and this was fundamental in diagnosis. Helicoid CT was the principal method used to show calcification plaques on the wall of the left renal pelvis, and selective culture of CU confirmed the diagnosis. Early commencement of treatment with vancomycin at an initial dosage of 500 mg/12 hours, and subsequent adjustment of dosage according to blood drug levels, achieved negative urine culture within a fortnight. Oral acidification was effected using acetohidroxamic acid 125 mg/12 hours, and it was continued until CT confirmed the disappearance or considerable reduction of the pyelic calcification plaques. CONCLUSION: The presence of EP in patients with urinary diversion is a matter worthy of consideration, even in patients who have not undergone recent urological procedures. Awareness of risk factors and early commencement of effective treatment may improve the prognosis of these patients.

Crisis reno-ureteral en paciente con ectopia renal cruzada / Renal colic in a patient with crossed renal ectopia

La colección de escritos médicos griegos que se nos ha transmitido con la denominación general de Corpus Hippocraticum, se dedica a una amplia temática que incluye consideraciones generales sobre la profesión y ética médica, y estudios de fisiología, patología, dietética, y ginecología. La medicina debe a la escuela hipocrática dos contribuciones: la figura del médico y la creación de un método. El método se apoya en la experiencia, se basa en la observación estricta y esto lo acerca a la práctica actual de la anatomía patológica. "Los Aforismos" constituyen el tratado más conocido del Corpus Hippocraticum. En opinión de los autores el primer aforismo señala con especial precisión la actividad del patólogo. "La vida es breve" se dedica a Bichat, de corta vida, creador del concepto de tejido y de la Patología Tisular. "La ciencia extensa" incluye un comentario de la amplitud de conocimientos básicos, clínicos y técnicos necesarios para la práctica de la anatomía patológica. "La ocasión fugaz" alude a las indicaciones y contraindicaciones actuales de la biopsia intraoperatoria. "La experiencia insegura" se refiere a los errores patológicos y la oportunidad de corregirlos. "El juicio difícil" incluye comentarios de la variabilidad inter e intraobservador, reproducibilidad, aplicación de criterios de expertos y clasificaciones de consenso de los cuadros patológicos. La anatomía patológica requiere un proceso constante de refinamiento de los criterios diagnósticos. Esto lleva a los autores a la conclusión de que la morfología patológica aún no se ha completado. El Corpus Hippocraticum señala el origen de la medicina racional. OBJETIVOS: Presentar un nuevo caso de crisis reno-ureteral (CRU) en paciente con ectopia renal cruzada con fusión en L y revisión de la literatura. MÉTODO Y RESULTADOS: Un paciente varón de 33 años acudió a nuestro servicio por presentar dolor en fosa ilíaca derecha. Es diagnosticado mediante ecografía y T.A.C. de ectopia renal cruzada con fusión en L más uropatía obstructiva litiásica izquierda. El paciente fue sometido a pielolitectomía más ureterolitectomía izquierda con abordaje transperitoneal. CONCLUSIÓN: La ectopia renal cruzada con fusión es una patología infrecuente. La anormal posición y aporte vascular del riñón puede impedir el drenaje del sistema colector induciendo una fuerte predisposición a las infecciones del tracto urinario y a la formación de cálculos. La CRU simula en estos pacientes un cuadro de abdomen agudo. El método habitual de detección de esta patología fue la urografía intravenosa pero actualmente el uso de la ecografía y la T.A.C han mostrado más casos. Las indicaciones para la cirugía abierta en el tratamiento de las litiasis, son generalmente las derivadas del fallo de la L.E.O.C.; esto es algo común en este tipo de casos como consecuencia de las anomalías anatómicas que presentan este tipo de pacientes, siendo el abordaje transabdominal el recomendado para resolver esta complicación en estos riñones (AU)

Hemangioma vesical postradioterapia / Bladder hemangioma after radiotherapy

OBJETIVOS: Los hemangiomas vesicales son tumores benignos excepcionales que representan el 0,6 por ciento de los tumores de vejiga. La mayoría de las veces se presentan como lesiones solitarias y únicas y con hallazgos en las pruebas de imagen muy similares a los encontrados en las neoplasias uroteliales, por lo que hacen muy difícil su diagnóstico diferencial, o por lo menos su sospecha ante su baja incidencia. Se revisa la literatura y comentan sus características clínicas y patológicas, así como los métodos diagnósticos y las últimas modificaciones a su tratamiento. METODOS: Presentamos un caso de hemangioma vesical secundario a radioterapia pélvica, siendo esta forma de presentación única en los aproximadamente cien casos descritos en la literatura. RESULTADOS: Según los hallazgos aportados por la cistoscopia, sospechamos que la lesión podría tratarse de una neoplasia endotelial en base a su aspecto vascular, por lo que al tratarse de una lesión única y pequeña realizamos resección y electrocoagulación de la misma. El informe anatomopatológico nos confirmó que se trataba de un hemangioma vesical secundario a radioterapia, siendo esta forma de presentación excepcional. No ha presentado nueva recidiva hasta la fecha. CONCLUSIONES: Creemos que la resección y electrocoagulación de las lesiones solitarias y únicas de los hemangiomas vesicales, es una alternativa muy a tener en cuenta en el tratamiento de este tipo de tumores benignos (AU)

Carcinoma renal neuroendocrino. Presentación de un caso / Neuroendocrine renal cell carcinoma. Report of a case

OBJETIVOS: Aportar un nuevo caso a la literatura científica de carcinoma renal neuroendocrino. MÉTODOS: Presentamos un caso de carcinoma renal neuroendocrino en una mujer de 76 años en la que se realizó nefrectomía radical, sin posterior tratamiento adyuvante. Realizamos una revisión de la literatura publicada acerca de esta infrecuente neoplasia renal de la que existen menos de una veintena de casos en la bibliografía. RESULTADO: Tras cuatro años después de la cirugía la paciente se encuentra asintomática, aunque presenta recidiva local. CONCLUSIONES: el carcinoma renal de células pequeñas se trata de una neoplasia muy infrecuente, que afecta a personas por encima de 60 años, de gran tamaño y con metástasis a diagnóstico. Tiene mal pronóstico con escasa supervivencia y donde el tratamiento más adecuado no se ha podido determinar por la escasez de casos publicados, siendo el más utilizado la combinación de cirugía y quimioterapia (AU)

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Pielitis incrustante en pacientes con derivación urinaria / Encrusted pyelitis in patients with urinary diversion

OBJETIVO: Presentamos un caso de pielitis incrustante (PI) ocasionada por Corynebacterium urealyticum (CU) sobre paciente cistectomizado hace 28 meses y al que se le realizó una derivación urinaria tipo Bricker. MÉTODO/RESULTADOS: Desde el postoperatorio inmediato, no había sido sometido a cateterismo urinario ni a ninguna otra manipulación urológica. El sujeto presentaba con anterioridad a la cirugía, anulación funcional del riñón derecho secundario a uropatía obstructiva litiásica. El deterioro de la función renal, anuria, hematuria, fiebre y dolor lumbar izquierdo fue la clínica de presentación. La sospecha de esta entidad fue primordial para su diagnóstico. La TC helicoidal fue el método principal para mostrar las placas de calcificación en la pared de la pelvis renal izquierda, siendo el cultivo selectivo para CU el método diagnóstico de confirmación. La instauración precoz de tratamiento con vancomicina a una dosis inicial de 500 mg/ 12 horas y ajustando posteriormente su dosificación según los niveles de fármaco en sangre, logró una negativización del urocultivo en 15 días. Se llevó a cabo acidificación oral con ácido acetohidroxámico a dosis de 125 mg/ 12 horas, y se mantuvo su administración hasta la constatación mediante TC de la desaparición o reducción considerable de las placas de calcificación piélicas. CONCLUSIÓN: La existencia de PI en pacientes portadores de derivaciones urinarias es un hecho a tener en cuenta, incluso en aquellos pacientes que no han sufrido manipulaciones urológicas recientes. El conocimiento de los factores de riesgo y la instauración precoz de un tratamiento eficaz puede mejorar el pronóstico de estos sujetos (AU)

[[Primary psoas abscess. Presentation of 3 cases]. / Absceso primario de psoas. Presentación de 3 casos.

OBJECTIVE: To present 3 cases of primary abscess of the psoas muscle. The clinical features, diagnostic tests, treatment and outcome are discussed. METHODS/RESULTS: Three patients that presented with fever and pain referred to the renal and/or iliac fossa are described. Physical examination showed psoas involvement in only one patient. Among the complementary tests performed, ultrasound demonstrated the abscess in one of the cases; the definitive diagnosis was made by contrast-enhanced CT. One of the cases was treated only with antibiotics while the other two cases were treated with CT-guided percutaneous drainage and appropriate antibiotic therapy. CONCLUSIONS: Psoas abscess is an uncommon pathology whose presenting features are usually unspecific. CT with contrast enhancement is considered to be the technique of choice for the diagnosis and to corroborate the resolution of the condition. Recently, the use of CT or US-guided percutaneous drainage has replaced surgery as the initial therapeutic approach for this condition.

[Biomolecular markers in renal adenocarcinoma]. / Marcadores biomoleculares en el adenocarcinoma renal.

OBJECTIVE: To review the literature and analyze the main contributions in molecular markers in renal adenocarcinoma. METHODS: We reviewed the literature over the last 10 years on molecular markers in renal adenocarcinoma (Medline 1991-2001). Outstanding papers published before 1991, included in the references of the selected articles, were also reviewed. RESULTS: A large number of biomolecular markers have been studied in renal adenocarcinoma with results that are often contradictory. Some proteins have been associated with different histopathological parameters and with tumor prognosis, although their clinical importance has yet to be established. CONCLUSIONS: Although the traditional prognostic factors, such as tumor grade and stage, provide important information on the outcome of renal adenocarcinoma, they are insufficient to predict the clinical behavior of this tumor type with absolute certainty. The foregoing has prompted the study of a variety of biomolecular markers that might predict the biological behavior of the tumor and identify the patients at a higher risk for tumor recurrence or death from the tumor. Despite the promising results obtained with biomolecular markers in renal adenocarcinoma, further studies are warranted to determine the prognostic value of these markers.