Role of the 4Kscore test as a predictor of reclassification in prostate cancer active surveillance.

BACKGROUND: Management of active surveillance (AS) in low-risk prostate cancer (PCa) patients could be improved with new biomarkers, such as the 4Kscore test. We analyze its ability to predict tumor reclassification by upgrading at the confirmatory biopsy at 6 months. METHODS: Observational, prospective, blinded, and non-randomized study, within the Spanish National Registry on AS (AEU/PIEM/2014/0001; NCT02865330) with 181 patients included after initial Bx and inclusion criteria: PSA ≤10 ng/mL, cT1c-T2a, Grade group 1, ≤2 cores, and ≤5 mm/50% length core involved. Central pathological review of initial and confirmatory Bx was performed on all biopsy specimens. Plasma was collected 6 months after initial Bx and just before confirmatory Bx to determine 4Kscore result. In order to predict reclassification defined as Grade group ≥2, we analyzed 4Kscore, percent free to total (%f/t) PSA ratio, prostate volume, PSA density, family history, body mass index, initial Bx, total cores, initial Bx positive cores, initial Bx % of positive cores, initial Bx maximum cancer core length and initial Bx cancer % involvement. Wilcoxon rank-sum test, non-parametric trend test or Fisher's exact test, as appropriate established differences between groups of reclassification. RESULTS: A total of 137 patients met inclusion criteria. Eighteen patients (13.1%) were reclassified at confirmatory Bx. The %f/t PSA ratio and 4Kscore showed differences between the groups of reclassification (Yes/No). Using 7.5% as cutoff for the 4Kscore, we found a sensitivity of 89% and a specificity of 29%, with no reclassifications to Grade group 3 for patients with 4Kscore below 7.5% and 2 (6%) missed Grade group 2 reclassified patients. Using this threshold value there is a biopsy reduction of 27%. Additionally, 4Kscore was also associated with changes in tumor volume. CONCLUSIONS: Our preliminary findings suggest that the 4Kscore may be a useful tool in the decision-making process to perform a confirmatory Bx in active surveillance management.

[Renal carcinoma metastatic to the peritoneum. Case report]. / Carcinoma renal metastásico a peritoneo. A propósito de un caso.

OBJECTIVE: We describe the case of a young male presenting with non-specific abdominal symptoms on follow-up after radical nephrectomy for renal carcinoma leading to the finding of local recurrence and peritoneal metastases. A second exploratory laparotomy was carried out for tumor reduction, but it was followed by fast peritoneal recurrence. Despite the treatment with alpha interferon, three months later he developed multiple hepatic metastases. CONCLUSIONS: Peritoneal involvement by renal cell carcinoma is rare and implies a bad prognosis.

Carcinoma renal metastásico a peritoneo. A propósito de un caso / Renal carcinoma metastatic to the peritoneum. Case report

OBJETIVO: Aportar un caso de carcinoma renal que presentó implantes peritoneales en su evolución. MÉTODO/RESULTADOS: Describimos el caso de un varón joven que en el seguimiento de su patología neoplásica tras nefrectomía radical presenta sintomatología abdominal inespecífica que conduce al descubrimiento de implantes peritoneales y recidiva local. Se realizó una segunda cirugía exploradora y de citorreductora, con recidiva peritoneal rápida. A los tres meses y a pesar del tratamiento que siguió con Interferón-α, el paciente presento metástasis hepáticas múltiples. CONCLUSIONES: La afectación peritoneal por carcinoma de células renales es un hecho infrecuente y que confiere un mal pronóstico

OBJECTIVE: We describe the case of a young male presenting with non-specific abdominal symptoms on follow-up after radical nephrectomy for renal carcinoma leading to the finding of local recurrence and peritoneal metastases. A second exploratory laparotomy was carried out for tumor reduction, but it was followed by fast peritoneal recurrence. Despite the treatment with alpha interferon, three months later he developed multiple hepatic metastases. CONCLUSIONS: Peritoneal involvement by renal cell carcinoma is rare and implies a bad prognosis

[Right transperitoneal laparoscopic nephroureterectomy]. / Nefroureterectomía derecha laparoscópica vía transperitoneal.

OBJECTIVES: To describe the surgical technique of the right laparoscopic nephroureterectomy. METHODS/RESULTS: With the patient in the lithotomy position we performed an endoscopic section of the ureteral meatus. Once the patient is placed in the lumbotomy position and trocars are placed, the retroperitoneal space is accessed. The gonadal vein, and the ureter medial to it, are identified. We proceed to dissect and clip it. Posteriorly, the Kocher maneuver on the duodenum is performed, identifying the inferior vena cava. We dissect the renal artery and vein placing Hemolock clips on both. Once the vascular control is achieved, we free the upper pole with the help of the Ligasure Atlas instrument. When the kidney is free we continue with the ureter down. CONCLUSIONS: Laparoscopic nephroureterectomy is a feasible technique for groups with experience in laparoscopic surgery.

[Post chemotherapy laparoscopic retroperitoneal lymph node dissection]. / Linfadenectomía retroperitoneal vía laparoscópica postquimioterapia.

OBJECTIVES: To describe the laparoscopic excision of a postchemotherapy retroperitoneal residual mass in a patient with mixed germ cell testicular tumor. METHODS/RESULTS: We report the operative technique of laparoscopic excision of a retroperitoneal mass in a 33 year old patient with mixed germ cell testicular tumor. The patient is placed in a lateral decubitus right lumbotomy position and trocars are introduced into the abdominal cavity. Once the retroperitoneum is approached, and after a Kocher manoeuvre of the duodenum, the interaortocaval mass is identified and excised. The operation is completed with lympadenectomy down to the common iliac artery bifurcation bilaterally. CONCLUSION: The laparoscopic approach is another option for the surgical treatment of residual masses after chemotherapy in testicular tumors. Nevertheless, previous laparoscopic experience is necessary due to its difficulty.

Nefrourectomiía derecha laparoscópica vía transperitoneal / right transperitoneal laparoscopic nephroureterectomy

OBJETIVO: Describir la técnica quirúrgica para la realización de una nefroureterectomía por vía laparoscópica. MÉTODOS/RESULTADOS: Con el paciente en posición de litotomía se realiza desinserción endoscópica del meato ureteral. Una vez colocado el paciente en posición de lumbotomía e introducidos los trócares, se accede al espacio retroperitoneal. Se identifica la vena gonadal y más medial el uréter. Procedemos a su disección y clipado precoz. Posteriormente se realiza la maniobra de Kocher sobre el duodeno, identificándose la vena cava. Disecamos la vena y arteria renal colocando clips Hemolock® en ambas. Con el control vascular realizado, liberamos el polo superior de riñón, ayudándonos de la pinza Atlas de Ligasure®. Una vez liberado todo el riñón, realizamos la misma operación sobre el uréter hasta desinsertarlo completamente. CONCLUSIÓN: La nefroureterectomía por vía laparoscópica es una técnica realizable en grupos con experiencia en cirugía laparoscópica

OBJECTIVES: To describe the surgical technique of the right laparoscopic nephroureterectomy. METHODS/RESULTS: With the patient in the lithotomy position we performed an endoscopic section of the ureteral meatus. Once the patient is placed in the lumbotomy position and trocars are placed, the retroperitoneal space is accessed. The gonadal vein, and the ureter medial to it, are identified. We proceed to dissect and clip it. Posteriorly, the Kocher maneuver on the duodenum is performed, identifying the inferior vena cava. We dissect the renal artery and vein placing Hemolock clips on both. Once the vascular control is achieved, we free the upper pole with the help of the Ligasure Atlas instrument. When the kidney is free we continue with the ureter down. CONCLUSIONS: Laparoscopic nephroureterectomy is a feasible technique for groups with experience in laparoscopic surgery

Linfadenectomía retroperitoneal vía laparoscópica postquimioterapia / Post chemotherapy laparoscopic retroperitoneal lymph node dissection

OBJETIVO: Describir la realización de la exéresis de una masa residual retroperitoneal post-quimioterapia, de un tumor germinal mixto por vía laparoscópica. MÉTODO/RESULTADOS: Presentamos la descripción técnica, por vía laparoscópica, de la exéresis de una masa residual post-quimioterapia de un tumor germinal mixto, en un paciente de 33 años. Se coloca al paciente en posición de lumbotomía derecha y se introducen los trócares. Una vez que se accede al retroperitoneo y realizada la maniobra de Kocher sobre el duodeno identificamos la masa residual interaorto-cava, procediendose a su exéresis. Por último se completa la disección, realizándose una linfadenectomía hasta la bifurcación de las arterias ilíacas primitivas. CONCLUSIÓN: La vía laparoscópica es una alternativa más para el tratamiento quirúrgico de las masas residuales post-quimioterapia en los tumores de testículo. No obstante precisa de experiencia en técnicas laparoscópicas debido a su dificultad

OBJECTIVES: To describe the laparoscopic excision of a postchemotherapy retroperitoneal residual mass in a patient with mixed germ cell testicular tumor. METHODS/RESULTS: We report the operative technique of laparoscopic excision of a retroperitoneal mass in a 33 year old patient with mixed germ cell testicular tumor. The patient is placed in a lateral decubitus right lumbotomy position and trocars are introduced into the abdominal cavity. Once the retroperitoneum is approached, and after a Kocher manoeuvre of the duodenum, the interaortocaval mass is identified and excised. The operation is completed with lympadenectomy down to the common iliac artery bifurcation bilaterally. CONCLUSION: The laparoscopic approach is another option for the surgical treatment of residual masses after chemotherapy in testicular tumors. Nevertheless, previous laparoscopic experience is necessary due to its difficulty

[Impact of the weather on the serum levels of prostatic specific antigen (PSA)]. / Impacto de la climatología sobre el nivel sérico de antígeno especifico prostático (PSA).

OBJECTIVES: To analyze the impact of season and weather parameters on serum PSA values in men without prostate cancer. METHODS: Retrospective study including medical records from the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). EXCLUSION CRITERIA: prostate cancer diagnosis, PSA > = 10 ng/ml, or PSA > = 3 ng/ml and/or digital rectal examination abnormalities unless a negative prostate biopsy was provided. Univariate relationships between PSA value, season and several weather parameters were assessed. A multivariate logistic regression model was used to identify independent predictors of a PSA value > = 3 ng/ml. RESULTS: A total of 2,147 men entered into the study. Median age and PSA level were 57 years and 0.9 ng/ml respectively. A non-significant trend to higher PSA levels was observed during autumn and winter. Multivariate logistic regression analysis identified only maximum temperature (p < 0.001), minimum temperature (p = 0.001) and age (p < 0.001) as independent predictors of a PSA value > = 3 ng/ml. Mean age-adjusted PSA levels at maximum temperatures of < = 15 degrees C, 16-20 degrees C, 21-25 degrees C and > =26 degrees C were 1.25, 1.20, 1.17 and 1.09 ng/ml respectively. CONCLUSIONS: PSA levels are slightly higher during cold weather conditions. Because of the small magnitude of this PSA increment we do not recommend to change biopsy indication based solely on climatic parameters.

[Laparoscopic pyelolithotomy]. / Pielolitotomía laparoscópica.

The application of laparoscopy as a surgical technique in Urology has enabled to expand the therapeutic options for various pathologies. The treatment of urinary lithiasis localized in the renal pelvis is one of them. We report a laparoscopic pyelolithotomy, describing the operation step-by-step, from patient positioning and trochar insertion to drainage tube insertion and closure. The objective of this article is to show the technique, presenting it as an alternative option.

Impacto de la climatología sobre el nivel sérico de antígeno específico prostático (PSA) / Impact of the weather on the serum levels of prostatic specific antigen (PSA)

OBJETIVO: Analizar el impacto de la estación climática y de ciertos parámetros meteorológicos sobre el nivel de PSA sérico en varones sin cáncer de próstata. MÉTODOS: Estudio retrospectivo que incluye registros de la rama Española del European Randomized Study of Screening for Prostate Cancer (ERSPC). Los criterios de exclusión fueron el diagnóstico de cáncer de próstata, presentar PSA >= 10 ng/ml, o bien PSA >= 3 ng/ml y/o anomalías en el tacto rectal a menos que se disponga de una biopsia prostática negativa para malignidad. Se investigó la relación univariante entre nivel de PSA y estación climática, así como varios parámetros meteorológicos. Se empleó un modelo multivariante de regresión logística para identificar predictores independientes de la obtención de un nivel de PSA >=3 ng/ml. RESULTADOS: Un total de 2.147 varones fueron incluidos en el estudio. Las medianas de edad y PSA fueron 57 años y 0,9 ng/ml respectivamente. Se observó una tendencia no significativa hacia niveles de PSA más elevados durante las estaciones de otoño e invierno. El modelo multivariante de regresión logística identificó únicamente las temperaturas máxima (p= 3 ng/ml. Los niveles medios de PSA ajustado a la edad en los rangos de temperatura máxima =26ºC fueron 1,25, 1,20, 1,17 y 1,09 ng/ml respectivamente. CONCLUSIONES: Los niveles de PSA sérico son ligeramente más elevados durante condiciones de frío climático. Debido a la pequeña magnitud de esta elevación, no recomendamos cambiar la indicación de biopsia prostática basándonos únicamente en factores climáticos

OBJECTIVES: To analyze the impact of season and weather parameters on serum PSA values in men without prostate cancer. METHODS: Retrospective study including medical records from the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). Exclusion criteria: prostate cancer diagnosis, PSA >= 10 ng/ml, or PSA >= 3 ng/ml and/or digital rectal examination abnormalities unless a negative prostate biopsy was provided. Univariate relationships between PSA value, season and several weather parameters were assessed. A multivariate logistic regression model was used to identify independent predictors of a PSA value >=3 ng/ml. RESULTS: A total of 2,147 men entered into the study. Median age and PSA level were 57 years and 0.9 ng/ml respectively. A non-significant trend to higher PSA levels was observed during autumn and winter. Multivariate logistic regression analysis identified only maximum temperature (p= 3 ng/ml. Mean age-adjusted PSA levels at maximum temperatures of =26ºC were 1.25, 1.20, 1.17 and 1.09 ng/ml respectively. CONCLUSIONS: PSA levels are slightly higher during cold weather conditions. Because of the small magnitude of this PSA increment we do not recommend to change biopsy indication based solely on climatic parameters

[Cystic ectasia of the rete testis]. / Ectasia quística de la rete testis.

OBJECTIVES: The cystic ectasia of the rete testis is a benign entity with a typical ultrasound appearance as a collection of small hypoechoic structures in the confluence of the mediastinum testis. The clinical importance of these entity remains on doing an adequate differential diagnosis with testicular neoplasias with a cystic component. METHODS: We retrospectively reviewed the database of the Ultrasound Unit in the Department of Urology looking for patients with a diagnosis of cystic ectasia of the rete testis over a six-year period. RESULTS: Three cases of cystic ectasia of the rete testis were diagnosed over the six-year period, in all the indication for ultrasound was testicular pain. Mean patient age was 62 years. No patient developed testicular tumor on follow-up. CONCLUSIONS: The knowledge of the ultrasound characteristics found in the cystic ectasia of the rete testis helps to make a proper diagnosis of this benign entity without the need of indication of testicular biopsy.

[Testicular microlithiasis]. / Microlitiasis testicular.

OBJECTIVES: Testicular microlithiasis, characterized by the existence of microscopic calcifications within the seminiferous tubules, is rare, generally an incidental finding during a scrotal ultrasound. METHODS: We report the case of a 45-year-old male without risk factors for the development of a germ cell testicular tumor with the diagnosis of bilateral testicular microlithiasis. RESULTS: The patient was followed yearly with testicular ultrasound, without evidence of germ cell tumor over a four-year follow-up period. CONCLUSIONS: Although the clinical significance of testicular microlithiasis is under debate due to the various controversies found in the literature about its association or not with testicular tumors, as well as the various protocols for initial management and adequate intervals for follow-up, it seems reasonable to perform an ultrasound yearly independently of the existence or not of associated risk factors.

Pielotitotomía laparoscópica / Laparoscopic pyelolithotomy

La aplicación de la laparoscopia como técnica quirúrgica en Urología ha permitido ampliar el abanico de opciones terapéuticas para diferentes patologías.Esto incluye también el tratamiento de la litiasis localizada en pelvis renal.Presentamos una Pielolitotomía laparoscópica como técnicaquirúrgica, describiendo paso a paso todo el procesodesde la colocación del paciente e introducción de trócares, hasta la colocación del drenaje y cierre.El objetivo del trabajo es mostrar la realización de dichatécnica y presentarla como alternativa a otras ya existentes

The application of laparoscopy as a ;;surgical technique in Urology has enabled to expand the therapeutic options for various pathologies. The ;;treatment of urinary lithiasis localized in the renal pelvis is one of them. ;;We report a laparoscopic pyelolithotomy, describing the operation step-by-step, from patient positioning and trochar insertion to drainage tube insertion and closure. ;;The objective of this article is to show the technique, presenting it as an alternative option

Ectasia quística de la rete testis / Cystic ectasia of the rete testis

OBJETIVO: La ectasia quística de la rete testis es una entidad benigna y típicamente en la ecografíaaparece como una colección de pequeñas estructurasanecoicas en la confluencia del mediastinum testis. La importancia clínica de esta entidad radica en hacer un adecuado diagnóstico diferencial con la neoplasiatesticular con componente quísticoMÉTODO: De forma retrospectiva, se revisa en la base de datos de la Unidad de Ecografía del Servicio de Urología el número de pacientes diagnosticados de ectasiaquística de la rete testis durante un periodo de 6 años.RESULTADOS: Durante los 6 años revisados se han diagnosticado 3 casos de ectasia quística de la rete testis y la ecografía fue realizada por dolor testicular. La edad media de los pacientes fue de 62 años. Ningún paciente ha desarrollado durante el tiempo de seguimientoun tumor testicularCONCLUSIONES: El conocimiento de las característicasecográficas encontradas en la ectasia quística de la rete testis permite hacer un adecuado diagnóstico de esta entidad benigna sin necesidad de recurrir a la biopsia testicular

OBJECTIVES: The cystic ectasia of the rete testis is a benign entity with a typical ultrasoundappearance as a collection of small hypoechoic structures in the confluence of the mediastinum testis. The clinical importance of these entity remains on doing an adequate differential diagnosis with testicular neoplasias with a cystic component.METHODS: We retrospectively reviewed the database of the Ultrasound Unit in the Department of Urology looking for patients with a diagnosis of cystic ectasia of the rete testis over a six-year period.RESULTS: Three cases of cystic ectasia of the rete testis were diagnosed over the six-year period, in all theindication for ultrasound was testicular pain. Mean patient age was 62 years. No patient developed testicular tumor on follow-up.CONCLUSIONS: The knowledge of the ultrasoundcharacteristics found in the cystic ectasia of the rete testis helps to make a proper diagnosis of this benign entity without the need of indication of testicular biopsy

Microlitiasis testicular / Testicular microlithiasis

OBJETIVO: La microlitiasis testicular (MT), que se caracteriza por la existencia de microcalcificacionesdentro de los túbulos seminíferos, es poco frecuente y generalmente constituye un hallazgo incidental durante la realización de la ecografía escrotal.MÉTODO: Presentamos un caso de un varón de 45 años de edad, sin factores de riesgo para el desarrollo de un tumor testicular de células germinales, diagnosticado de una microlitiasis testicular bilateral.RESULTADOS: El paciente ha sido sometido a control evolutivoanual con ecografía testicular, sin desarrollar un tumorgerminal durante un seguimiento de 4 años.CONCLUSIONES: Aunque el significado clínico de la MT está en debate debido a las diferentes controversias halladasen la literatura sobre su asociación o no con el tumor testicular, así como los diferentes protocolos de manejo inicial y de los intervalos adecuados para su vigilancia y seguimiento, parece razonable realizar un control ecográficoanual, independientemente de la existencia o no de factores de riesgo asociados

OBJECTIVES: Testicular microlithiasis,characterized by the existence of microscopic calcifications within the seminiferous tubules, is rare, generally anincidental finding during a scrotal ultrasound.METHODS: We report the case of a 45-year-old male without risk factors for the development of a germ celltesticular tumor with the diagnosis of bilateral testicularmicrolithiasis.RESULTS: The patient was followed yearly with testicular ultrasound, without evidence of germ cell tumor over a four-year follow-up period.CONCLUSIONS: Although the clinical significance oftesticular microlithiasis is under debate due to the various controversies found in the literature about its association or not with testicular tumors, as well as the various protocols for initial management and adequate intervals for follow-up, it seems reasonable to perform an ultrasound yearly independently of the existence or not of associated risk factors

Prostatectomía radical laparoscópica transperitoneal / Transperitoneal laparoscopic radical prostatectomy

Las técnicas quirúrgicas laparoscópicas cada vez están más extendidas dentro de la práctica urológica y es preciso realizar un entrenamiento exhaustivopara llegar a un nivel óptimo de habilidad para realizarlas. Presentamos la técnica quirúrgica paso a paso de la prostatectomía radical laparoscópica transperitoneal

Laparoscopic surgical techniques are ;;reaching widespread diffusion in the urological ;;community but intensive training is necessary to achieve an optimal level of skill to perform them. We report the transperitoneal laparoscopic radical prostatectomy surgical technique step-by-step

Hematospermia y quiste del conducto mülleriano / Hemospermia and mullerian duct cyst

OBJETIVO: presentación de un caso de quistede utrículo tratado endoscópicamente.MÉTODO: describimos el caso de un varón de mediana edad que consulta por hematospermia monosintomática de larga evolución. Al tacto rectal presentaba una próstata adenomatosa no sospechosa. Se practicó ecografía transrectalque revela quiste de utrículo complicado.RESULTADOS: Se realizó marsupialización endoscópica del quiste, consiguiendo remisión total de la hematospermia.CONCLUSIONES: Se debe realizar ecografía transrectal a todos los pacientes que consultan por hematospermia de larga evolución, indicando la marsupialización endoscópicadel quiste del conducto mülleriano en aquellos pacientessintomáticos y con quistes complejos observados en la exploración ecográfica, obteniendo un importante porcentaje de cura o mejoría en este grupo de pacientes sin inducir ningún efecto colateral secundario

OBJECTIVES: To report one case of utriculum cyst treated endoscopically. ;;METHODS: We describe the case of a mid-age male patient consulting for long-term monosymptomatic hemospermia. Rectal digital examination revealed a non suspicious ;;adenomatous prostate. Transrectal ultrasound showed a complicated utriculum cyst. ;;RESULTS: Endoscopical marsupialization of the cyst was performed with complete remission of hemospermia. ;;CONCLUSIONS: Transrectal ultrasound should be performed in all patients presenting with long-term hemospermia. ;;Endoscopical marsupialization of the mullerian duct cyst is indicated in symptomatic patients or those with complex cysts on ultrasound, offering a high cure/improvement rate in this group of patients without secondary effects

Rabdomiosarcoma de cordon espermático en el adulto / Spermatic cord rabdomyosarcoma in an adult

OBJETIVOS: Presentar un caso de rabdomiosarcomade cordón espermático en el adulto.MÉTODO: Describimos el caso de un varón de 36 añosque presenta una masa inguinoescrotal izquierda muydolorosa.RESULTADO: Se realizó orquiectomía radical izquierda yexéresis de la masa. El estudio anatomopatológico evidencióun rabdomiosarcoma de cordón espermático.Posteriormente el paciente recibió varios ciclos de quimioterapiasistémica.CONCLUSIÓN: El rabdomiosarcoma de cordón es untumor poco frecuente que deriva del mesodermo indiferenciado.Aparece raramente después de la segundadécada. Es muy frecuente la recidiva locorregional tras lacirugía. Se disponen de tratamientos adyuvantes cuya indicacióny empleo no ha podido prootocolizarse debido ala incidencia anecdótica de este tumor en el adulto

OBJECTIVES: To report one case of ;;spermatic cord rabdomyosarcoma in an adult patient. ;;METHODS: We report the case of a 36-year-old male ;;presenting with a painful left inguinal scrotal mass. ;;RESULTS: Left radical orchiectomy was performed with ;;excision of the mass. Pathology showed a spermatic ;;cord rabdomyosarcoma. The patient received several ;;cycles of systemic chemotherapy. ;;CONCLUSIONS: Spermatic cord rabdomyosarcoma is ;;a rare tumor derived from the undifferentiated mesoderm. ;;It rarely appears after the second decade of life. Localregional ;;recurrence after surgery is very frequent. There ;;are adjuvant treatments, the indication and use of which ;;couldn’t be included in proper protocols due to the low ;;incidence of this tumour in adults

Diagnóstico ecográfico del varicocele intratesticular / Ultrasound diagnosis of intratesticular varicocele

OBJETIVO: El varicocele es una entidad relativamentefrecuente; en la gran mayoría de los casos estadilatación venosa solo afecta a la porción extratesticular,pero en un 2% de los casos existe afectación intratesticular.Presentamos un caso de varicocele intratesticularizquierdo.MÉTODOS/RESULTADOS: Presentamos el caso de unpaciente varón de 25 años remitido para estudio pordolor testicular izquierdo y que en su estudio se identificócomo único hallazgo un varicocele intratesticular izquierdo.CONCLUSIONES: El varicocele intratesticular es una entidadpoco frecuente que puede asociarse a dolor testicular,masa escrotal e infertilidad o bien ser asintomática. Esdiagnosticada mediante ecografía Doppler y si es sintomáticapuede ser manejada mediante ligadura de la venaespermática

OBJECTIVES: Varicocele is a relatively frequent entity; in most cases venous dilation only involves the extratesticular portion, but 2% of the cases present intratesticular dilation. We report one case of left intratesticular varicocele. METHODS/RESULTS: We report the case of a 25-yearold male patient referred for study of left testicular pain, whose work up only found left intratesticular varicocele. CONCLUSIONS: Intratesticular varicocele is an infrequent entity which can be associated with testicular pain, scrotal mass and infertility or may be asymptomatic. The diagnosis is established by Doppler ultrasound; if symptomatic, it may be treated by spermatic vein ligation

[Stone Cone: a device that prevents ureteral stone migration during intracorporeal lithotripsy]. / Stone Cone: un dispositivo que previene la migración de litiasis ureteral durante la litotricia intracorpórea.

OBJECTIVES: Proximal migration of stone fragments during ureteroscopic lithotripsy is a common problem influenced by pressure of irrigation solution, type of energy for lithotripsy, site and degree of fixation of the stone to the ureteral wall, and degree of proximal ureteral dilation. The Stone Cone (Boston Scientific & Spencer) is a device that helps to prevent proximal migration of fragments and favours a safe extraction during ureteroscopic lithotripsy. TECHNIQUE: The Stone Cone is an helical device made of stainless steel and nitinol alloy, which consists of an internal guide wire and a sheath-like radiopaque catheter with a 3 Fr. calibre. Once the cone is placed above the stone it is maintained in that position during lithotripsy to avoid fragment migration. The external catheter is used to coil and unroll the cone, and allows access to place the cone above the stone. METHODS: We describe two cases of urinary calculi in the left lumbar ureter treated by ureteroscopy and intracorporeal lithotripsy with holmium YAG laser using the Stone Cone to avoid migration of fragments. RESULTS: One month after surgery no lithiasic fragments were observed in the imaging tests. CONCLUSIONS: The Stone Cone decreases the need to perform repeated ureteral instrumentations, and is also a safer and simpler method for the extraction of stone fragments. The use of Stone Cone seems to have more advantages than Dormia's basket during ureteroscopic lithotripsy in terms of lower incidence of residual fragments and reoperation rate.