Metástasis vaginal de carcinoma urotelial de vía urinaria superior / Vaginal metastasis of upper urinary tract urothelial carcinoma

Las metástasis vaginales de carcinomas uroteliales han sido descritas en raras ocasiones. Presentamos un caso de carcinoma urotelial de vía urinaria superior, metastatizado en vagina, en una paciente que comenzó con un cuadro de dolor en fosa renal izquierda y hematuria. La paciente fue sometida a nefroureterectomía izquierda y escisión de la lesión vaginal. Este caso revela la variabilidad en el mecanismo de diseminación de los carcinomas uroteliales

Vaginal metastases from urothelial carcinomas have been reported in rare cases. We present a case of vaginal metastasis of upper urinary tract urothelial carcinoma in a patient who presented with pain in the left renal Fossa and haematuria. The patient underwent left nephroureterectomy and excision of the vaginal injury. This case reveals variability in the mechanism of spread of urothelial carcinomas

Extrofia vesical y vejiga rectal / No disponible

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Collateral urethral duplication in an adult.

OBJECTIVE: Congenital anomalies or malformations of the urethra that involve number are extremely rare and only 7 cases of trifurcation of the urethra and under 500 cases of urethral duplication have been described. METHODS: In the case we present, urethral duplication was diagnosed in adulthood, even though glans malformation with 2 urethral orifices was clearly evident and only 1 was functional. RESULTS: The condition is usually diagnosed in childhood due to the presence of 2 urethral meatus or from double stream if both are functional; at other times, the condition is diagnosed from complications that trigger infections or obstruction or if it is associated with more extensive malformations. CONCLUSIONS: Urethral duplication is an extremely rare birth defect, and diagnosis in adulthood is even more uncommon. No single embryologic argument explains all the anatomic variants of urethral duplication. The treatment of the urethral duplication should be individualized according to the type of duplication and the clinical symtoms.

Duplicidad uretral colateral en un adulto / Collateral urethral duplication in an adult

OBJETIVO: Las anomalías o malformaciones congénitas uretrales de número son muy escasas; así, se han descrito solo siete casos de trifurcación uretral 1 y no llega a quinientos de duplicación. METODOS: En el caso que presentamos el diagnóstico se hizo en edad adulta, a pesar de que era muy evidente la malformación del glande con dos orificios uretrales, aunque solo uno de ellos funcional. RESULTADOS: Suele diagnosticarse en la infancia cuando existen dos meatos uretrales, o si son ambas funcionales por efectuar micciones con doble chorro; otras veces se diagnostican por las complicaciones que pueden desencadenar, especialmente infecciosas u obstructivas o por estar asociadas a malformaciones más extensas. CONCLUSIONES: La duplicación uretral es una malformación congénita de muy escasa frecuencia, y su diagnóstico en el adulto todavía más. No existe un argumento embriológico único que explique las diferentes variantes anatómicas de duplicidad uretral. El tratamiento de la duplicidad uretral deberá ser individualizado y dependerá del tipo de duplicidad y de la clínica que provoque (AU)

OBJECTIVE: Congenital anomalies or malformations of the urethra that involve number are extremely rare and only 7 cases of trifurcation of the urethra and under 500 cases of urethral duplication have been described. METHODS: In the case we present, urethral duplication was diagnosed in adulthood, even though glans malformation with 2 urethral orifices was clearly evident and only 1 was functional. RESULTS: The condition is usually diagnosed in childhood due to the presence of 2 urethral meatus or from double stream if both are functional; at other times, the condition is diagnosed from complications that trigger infections or obstruction or if it is associated with more extensive malformations. CONCLUSIONS: Urethral duplication is an extremely rare birth defect, and diagnosis in adulthood is even more uncommon. No single embryologic argument explains all the anatomic variants of urethral duplication. The treatment of the urethral duplication should be individualized according to the type of duplication and the clinical symtoms (AU)

[Pheochromocytoma: more than a decade of experience. Review of the literature]. / Feocromocitoma: más de una década de experiencia. Revisión de la literatura.

OBJECTIVES: We present 18 patients with pheochromocytoma in the past 12 years. MATERIAL AND METHODS: It is a retrospective observational study evaluating the clinical, biochemical and pathological most important. RESULTS: The mean age was 53.5 years with male predominance and monitoring of five years, being the most frequent incidental findings (29%). Four patients had a familial syndrome hereditary. The tumors were equally distributed with a bilateral case. For the clinical study was made and plasma catecholamines and metanephrines in urine for 24h and subjected to control blood pressure before surgery and beta blockers. Until the introduction of laparoscopic surgery in our department in 2003, the treatment of choice was open surgery. Transabdominal subcostal access was more frequent (47%) and average duration of 207 min. No patients showed metachronous tumors and two patients developed distant metastases to death in short time. CONCLUSIONS: Pheochromocytoma in a threatening disease by cardiovascular disease, which needs to perform an analytical and functional. Surgical treatment, by open or laparoscopic surgery, depending on the characteristics of the tumor and the patient, is satisfactory and comparable results.

Feocromocitoma: más de una década de experiencia. Revisión de la literatura / Pheochromocytoma: More than a decade of experience. Review of the literature

Objetivos: Presentamos 18 pacientes diagnosticados de feocromocitoma en los últimos 12 años. Material y métodos: Es un estudio retrospectivo observacional valorando los aspectos clínicos, analíticos y patológicos más importantes. Resultados: La edad media fue de 53,5 años con predominio masculino y un seguimiento de 5 años; siendo la consulta más frecuente el hallazgo incidental (29%). Cuatro pacientes padecían un síndrome familiar hereditario. Los tumores se distribuyeron por igual con un caso bilateral. Para el estudio clínico se solicitaron catecolaminas y metanefrinas plasmáticas y en orina de 24h, siendo sometidos a control de la tensión arterial antes de la cirugía con alfabloqueantes y betabloqueantes. Hasta la introducción de la cirugía laparoscópica en nuestro servicio en el 2003, el tratamiento de elección era la cirugía abierta. El acceso transabdominal subcostal fue el más utilizado (47%) y la duración media de 207min.Ninguno presentó tumores metacrónicos y dos pacientes desarrollaron metástasis a distancia con fallecimiento en corto espacio de tiempo. Conclusiones: El feocromocitoma en una enfermedad amenazante por su morbilidad cardiovascular, que precisa realizar un estudio analítico y funcional. El tratamiento quirúrgico, por vía abierta o laparoscópica, dependiendo de las características del tumor y del paciente, tiene resultados satisfactorios y comparables (AU)

Objectives: We present 18 patients with pheochromocytoma in the past 12 years. Material and methods: It is a retrospective observational study evaluating the clinical, biochemical and pathological most important. Results: The mean age was 53.5 years with male predominance and monitoring of five years, being the most frequent incidental findings (29%). Four patients had a familial syndrome hereditary. The tumors were equally distributed with a bilateral case. For the clinical study was made and plasma catecholamines and metanephrines in urine for 24h and subjected to control blood pressure before surgery and beta blockers. Until the introduction of laparoscopic surgery in our department in 2003, the treatment of choice was open surgery. Transabdominal subcostal access was more frequent (47%) and average duration of 207min.No patients showed metachronous tumors and two patients developed distant metastases to death in short time. Conclusions: Pheochromocytoma in a threatening disease by cardiovascular disease, which needs to perform an analytical and functional. Surgical treatment, by open or laparoscopic surgery, depending on the characteristics of the tumor and the patient, is satisfactory and comparable results (AU)

Cistoscopia en la bilharziasis vesical / Cistoscopy in bladder bilharziasis

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Penile foreign bodies.

OBJECTIVE: To describe 8 cases of penile foreign bodies. METHODS/RESULTS: We provide an essentially visual overview of various objects or foreign bodies affecting the penis. CONCLUSIONS: The presence of penile foreign bodies is rarely due to an accident. These objects are placed for a wide variety of reasons, but primarily for erotic or self-arousal purposes. The consequences of penile foreign bodies can be mild or very severe, resulting in penile amputation.

[Saturation biopsy in prostate cancer diagnosis]. / Biopsia por saturación en el diagnóstico de cáncer de próstata.

AIMS: To analyze the results obtained after doing saturation prostate biopsy to a series of patients with high level of PSA. SUBJECTS, MATERIAL AND METHOD: Among 2006 and 2007 saturation biopsies have been realized in our Service to 32 patients with high PSA, previous biopsies without diagnosis of prostate cancer and high suspicion of malignant disease. RESULTS: The mean age was 65.81 years, with an average of previous biopsies of 2.41 (range: 1 to 5). Mean of PSA was 15.45 ng/dl (range: 5.63 to 35.47 ng/ml). The mean number of cores obtained in the saturation biopsies was of 20.78 (range: 16-26). 13 were diagnosed prostate adenocarcinomas (40.63%), of which 10 had previous diagnosis of PIN or atipia. 8 patients underwent radical prostatectomy, 3 cases were treated with radiotherapy, 1 case was treated with hormonetherapy and the remaining one is kept in watchful waiting. Concordance of Gleason grade was in 6 of 8 patients treated surgically. CONCLUSIONS: Saturation biopsy is an effective method for the diagnosis of prostate cancer after several negative biopsies and a strong clinical suspicion of malignant pathology. Saturation biopsy is not a first choice procedure for the diagnosis of prostate cancer.

Biopsia por saturación en el diagnóstico de cáncer de próstata / Saturation biopsy in prostate cancer diagnosis

Objetivos: Analizar los resultados obtenidos tras la realización de biopsia de próstata por saturación a una serie de pacientes con PSA elevado. Sujetos, material y método: Durante los años 2006 y 2007 se han realizado en nuestro Servicio biopsias por saturación a 32 pacientes con PSA elevado, biopsias previas sin diagnóstico de cáncer de próstata y alta sospecha de padecerlo. Resultados: La edad media de los pacientes fue de 65,81 años, con una media de biopsias previas de2,41 (rango: 1 a 5). La media de PSA por el que se indicó la biopsia fue de 15,45 ng/dl (rango: 5,63 a 35,47ng/ml). El número medio de cilindros obtenidos en las biopsias por saturación fue de 20,78 (rango: 16-26).Se diagnosticaron 13 adenocarcinomas de próstata (40,63%), de los cuales 10 tuvieron diagnóstico previo de PIN o atipia. Se realizó prostatectomía radical a 8 pacientes (5 retropúbicas y 3 laparoscópicas), 3 casos fueron sometidos a radioterapia, 1 caso fue tratado con hormonoterapia y el restante se mantiene en seguimiento. Hubo concordancia del estadio de Gleason en 6 de los 8 pacientes intervenidos quirúrgicamente. Conclusiones: La biopsia por saturación es un método eficaz para el diagnóstico de adenocarcinoma de próstata cuando tras varias biopsias convencionales negativas persiste una fuerte sospecha clínica de patología maligna. No debe consistir en un procedimiento de primera elección para el diagnóstico del cáncer de próstata (AU)

Aims: To analyze the results obtained after doing saturation prostate biopsy to a series of patients with high level of PSA. Subjects, material and method: Among 2006 and 2007 saturation biopsies have been realized in our Service to 32 patients with high PSA, previous biopsies without diagnosis of prostate cancer and high suspicion of malignant disease. Results: The mean age was 65.81 years, with an average of previous biopsies of 2.41 (range: 1 to 5). Mean of PSA was 15.45 ng/dl (range: 5.63 to 35.47 ng/ml). The mean number of cores obtained in the saturation biopsies was of 20.78 (range: 16-26). 13 were diagnosed prostate adenocarcinomas (40.63 %), of which 10 had previous diagnosis of PIN or atipia. 8 patients underwent radical prostatectomy, 3 cases were treated with radiotherapy, 1 case was treated with hormonetherapy and the remaining one is kept in watchful waiting. Concordance of Gleason grade was in 6 of 8 patients treated surgically. Conclusions: Saturation biopsy is an effective method for the diagnosis of prostate cancer after several negative biopsies and a strong clinical suspicion of malignant pathology. Saturation biopsy is not a first choice procedure for the diagnosis of prostate cancer (AU)

Hidronefrosis masiva / Massive hydronephrosis

No disponible