Carcinoma primario de próstata con diferenciación en célula en anillo de sello con respuesta a abiraterona / Primary signet ring cell carcinoma of the prostate with response to abiraterone

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Reimplante ureteral directo con catéter ureteral. Imagen endoscópica / Ureteral reimplantation with ureteral stent. Endoscopic image

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Anastomic urethroplasty in bulbar urethral stricture. 13 years experience in a department of urology. / Uretroplastia anastomótica en el manejo de estenosis de uretra bulbar. Experiencia de 13 años en un Servicio de Urología.

UNLABELLED: Urethral stenosis is a common disease in the clinical practice of urology, with a major impact on the quality of life of patients. The anastomotic urethroplasty is a technique with very precise indications usually membranous or bulbar urethra stenosis with a length of 3 cm or up to 7 cm when it is secondary to urethral disruptions (no stenosis) after pelvic trauma. OBJECTIVE: We review anastomotic urethroplasty performed in our department between 2002 and 2015. METHODS: A retrospective, descriptive and inferential analysis on 107 patients out of 482 treated with Anastomotic urethroplasty by urethral strictures at the Urology Department of the Hospital "Virgen de la Victoria" (Malaga) from January 2002 to September 2015, establishing effectiveness and safety of the technique, as well as factors that might influence the results. The main diagnostic method was retrograde urethrography and voiding cystourethrography in 100% of patients undergoing surgery, using voiding uroflowmetry for subsequent monitoring. The definition of success was a postoperative flowmetry with Qmax>15 ml/s, and in case of lower flow, we perform a cystoscopy to verify recurrence of stenosis or exclude other pathology. RESULTS: The median age was 42 years, with a mean follow up of 59 months. The length of stenosis valued by retrograde urethrography and voiding cystourethrography was in 91.6% of cases of >1 cm and <2 cm. The most common etiology was idiopathic in 72.9%, followed by iatrogenic with 15.9%. Regarding the location, it was observed that the area most often affected was the bulbar urethra with 82.2%, with the membranous urethra in second place. In 77.6% of patients anastomotic urethroplasty was the initial treatment, followed in frequency by direct vision internal urethrotomy 9.3%. In the case of comorbidities associated with treatment with anastomotic urethroplasty it was observed that only Diabetes Mellitus had a tendency to statistical significance, with p=0.092, not demonstrating such significance in the case of hypertension or when the subject presented Diabetes Mellitus together with hypertension. Finally, the intervention was successful in 102 cases (95.3%), with only 5 cases (4.7%) where it failed, 4 of them treated with a new Anastomotic urethroplasty, with resolution of the stricture. CONCLUSIONS: Anastomotic urethroplasty is the treatment of choice for short bulbar urethral stricture, with high success rate and low complication rate, as well as low recurrence of these.

Uretroplastia anastomótica en el manejo de estenosis de uretra bulbar. Experiencia de 13 años en un Servicio de Urología / Anastomic urethroplasty in bulbar urethral stricture. 13 years experience in a department of urology

La estenosis de uretra es una patología frecuente en la práctica clínica diaria de las consultas de Urología, con un impacto importante en la calidad de vida de los pacientes. La Uretroplastia anastomótica es una técnica con indicaciones muy precisas en estenosis generalmente de uretra bulbar o membranosa con una longitud de hasta 3 cm o de hasta 7 cm cuando se trata de disrupciones uretrales (no estenosis) tras traumatismos pelvianos. OBJETIVO: Realizamos una revisión de las Uretroplastias anastomóticas llevadas a cabo en nuestro servicio entre 2002 y 2015. MÉTODO: Análisis retrospectivo, descriptivo e inferencial sobre 107 pacientes de un total de 482 estenosis uretrales tratadas mediante Uretroplastia anastomótica en el Servicio de Urología del Hospital 'Virgen de la Victoria' de Málaga desde enero de 2002 a septiembre de 2015, estableciendo eficacia y seguridad de dicha técnica, así como factores que pudiesen influir en los resultados. El método diagnóstico principal fue la uretrografía retrograda y miccional en el 100% de los pacientes sometidos a tratamiento quirúrgico, recurriendo a la flujometría miccional para el seguimiento posterior. La definición de éxito fue una flujometría postoperatoria con un Qmax >15 ml/s, y en caso de flujos inferiores se realizaron uretrografías o uretroscopias para verificar la recidiva de la estenosis o descartar otra patología. RESULTADOS: La mediana de edad fue de 42 años, con un seguimiento medio de 59 meses. La longitud de la estenosis valorada mediante uretrografía miccional y retrógrada fue en un 91.6% de los casos de >1 cm y <2cm. La etiología más frecuente fue la Idiopática con un 72.9%, seguida por la Iatrógena con un 15.9%. Respecto a la localización se objetivó como la zona más frecuentemente afecta fue la uretra bulbar con un 82.2%, continuándole la uretra membranosa. En un 77.6% de los pacientes la Uretroplastia anastomótica fue el tratamiento inicial, continuando en frecuencia la Uretrotomía Interna con un 9.3%. En el caso de las comorbilidades asociadas al tratamiento con la Uretroplastia anastomótica se objetivó como únicamente la Diabetes Mellitus presenta una tendencia a la significación estadística, con una p = 0.092, no demostrándose dicha significación ni en el caso de la Hipertensión arterial ni cuando el sujeto presentaba Diabetes Mellitus conjuntamente con Hipertensión. Por último, la intervención resultó un éxito en 102 casos (95.3%), con sólo 5 casos (4.7%) en los que fracasó, siendo tratados 4 de ellos con una nueva Uretroplastia anastomótica con resolución de la estenosis. CONCLUSIONS: La Uretroplastia anastomótica es el tratamiento de elección en las estenosis cortas de uretra bulbar por su alto porcentaje de éxitos y baja tasa de complicaciones, así como en las recidivas de éstas

Urethral stenosis is a common disease in the clinical practice of urology, with a major impact on the quality of life of patients. The anastomotic urethroplasty is a technique with very precise indications usually membranous or bulbar urethra stenosis with a length of 3 cm or up to 7 cm when it is secondary to urethral disruptions (no stenosis) after pelvic trauma. OBJECTIVE: We review anastomotic urethroplasty performed in our department between 2002 and 2015. METHODS: A retrospective, descriptive and inferential analysis on 107 patients out of 482 treated with Anastomotic urethroplasty by urethral strictures at the Urology Department of the Hospital 'Virgen de la Victoria' (Malaga) from January 2002 to September 2015, establishing effectiveness and safety of the technique, as well as factors that might influence the results. The main diagnostic method was retrograde urethrography and voiding cystourethrography in 100% of patients undergoing surgery, using voiding uroflowmetry for subsequent monitoring. The definition of success was a postoperative flowmetry with Qmax>15 ml/s, and in case of lower flow, we perform a cystoscopy to verify recurrence of stenosis or exclude other pathology. RESULTS: The median age was 42 years, with a mean follow up of 59 months. The length of stenosis valued by retrograde urethrography and voiding cystourethrography was in 91.6% of cases of >1 cm and <2cm. The most common etiology was idiopathic in 72.9%, followed by iatrogenic with 15.9%. Regarding the location, it was observed that the area most often affected was the bulbar urethra with 82.2%, with the membranous urethra in second place. In 77.6% of patients anastomotic urethroplasty was the initial treatment, followed in frequency by direct vision internal urethrotomy 9.3%. In the case of comorbidities associated with treatment with anastomotic urethroplasty it was observed that only Diabetes Mellitus had a tendency to statistical significance, with p = 0.092, not demonstrating such significance in the case of hypertension or when the subject presented Diabetes Mellitus together with hypertension. Finally, the intervention was successful in 102 cases (95.3%), with only 5 cases (4.7%) where it failed, 4 of them treated with a new Anastomotic urethroplasty, with resolution of the stricture. CONCLUSIONS: Anastomotic urethroplasty is the treatment of choice for short bulbar urethral stricture, with high success rate and low complication rate, as well as low recurrence of these

Quiste epidermoide testicular: una rara entidad clínica / Testicular epidermoid cyst: a rare entity

OBJETIVO: El quiste epidermoide testicular es una rara entidad clínica, representando un 1% de las neoplasias testiculares. Método y resultados: Presentamos dos pacientes de 18 y 19 años de edad respectivamente con una lesion indolora a nivel de testículo. Se realiza una ecografía testicular donde se evidencia un nódulo hipoecogénico en ambos casos. Con la sospecha de tumor testicular se realiza una orquiectomía inguinal con colocación de una prótesis testicular en mismo acto. El resultado anatomopatológico fue de quiste epidermoide testicular en los dos casos. CONCLUSIÓN: Los quistes epidermoides testiculares son una rara entidad clínica benigna, que en caso de ser sospechada en función a los marcadores testiculares y la ecografía o la RMN, debe intentarse una cirugía conservadora

OBJECTIVE: Testicular epidermoid cyst is a rare clinical entity that accounts for 1% of testicular neoplasias. METHODS AND RESULTS: We report two cases of testicular epidermoid cysts in a 18 and 19 year old males with a painless testicular lesion. Testicular US was carried out showing a hypoechoic nodule in both cases. With the suspicion of testicular neoplasm inguinal orchiectomy was carried out with placement of testicular prostheses in the same act. The pathology report was testicular epidermoid cyst in both cases. CONCLUSIONS: Testicular epidermoid cysts are an uncommon benign entity. When there is a suspicion of this diagnosis, based on tumor markers and ultrasound or MRI images, testicular parenchyma-sparing surgery must be attempted

Carcinoma de células transicionales localizado en fosa navicular / Urothelial transitional cell carcinoma located in fossa navicularis

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Syringocele in adult patient. Case report.

OBJECTIVE: To describe one case of syringocele in an adult patient. METHODS/RESULTS: We report the case of a 26 year old man who presented frequency, hematuria and fever during one year, mictional cystourethrography showed a syringocele. Treatment consisted in endoscopic surgery, with good results in the follow-up. CONCLUSIONS: The syringocele is a relatively infrequent entity, that is necessary to study in a young patient with voiding symptoms, accompanied or not of haematuria and fever. The diagnosis is based on the cystourethrography, and treatment consisted, usually, in endoscopic surgery.

Siringocele uretral en adulto. A propósito de un caso / Syringocele in adult patient. Case report

OBJETIVO: Presentación de un caso de siringocele en la edad adulta. MÉTODO/RESULTADO: Describimos el caso de un paciente que consultó en nuestro centro por un síndrome irritativo vesical, hematuria y fiebre de un año de evolución, que en el seguimiento se objetiva mediante cistouretrografía miccional un siringocele simple. El tratamiento consistió en una marsupialización endoscópica, presentando buenos resultados en el seguimiento. CONCLUSIONES: El siringocele es una entidad relativamente infrecuente, pero que es necesaria tenerla en cuenta ante un paciente joven con clínica miccional, acompañada o no de hematuria y fiebre. El diagnóstico se basa en la uretrografía, y como modalidad terapéutica más habitual destaca la marsupialización endoscópica(AU)

OBJECTIVE: To describe one case of syringocele in an adult patient. METHODS/RESULTS: We report the case of a 26 year old man who presented frequency, hematuria and fever during one year, mictional cystourethrography showed a syringocele. Treatment consisted in endoscopic surgery, with good results in the follow-up. CONCLUSIONS: The syringocele is a relatively infrequent entity, that is necessary to study in a young patient with voiding symptoms, accompanied or not of haematuria and fever. The diagnosis is based on the cystourethrography, and treatment consisted, usually, in endoscopic surgery(AU)