[Ureteral obstruction secondary to Rosai-Dorfman disease]. / Obstrucción ureteral secundaria a enfermedad de Rosai-Dorfman.

Ureteral obstruction can be secondary to a lot of reason. We present a uncommon case report of ureteral obstruction to Rosai-Dorfman disease. The form of clinic presentation is described, the diagnostic methods used and the therapeutic management.

[Malignant retroperitoneal schwannoma]. / Schwanoma retroperitoneal maligno.

We present an uncommon case of retroperitoneal malignant schwannoma diagnosed accidentally. The clinical, diagnostic and therapeutic features are discussed.

[Inverted papilloma of the bladder with recurrence in prostatic urethra]. / Papiloma invertido vesical con recidiva en uretra prostática.

Urothelial inverted papilloma is usually a solitary lesion with rare recurrences. Its behaviour is unclear, its potential for recurrence or progression is not well-known. We present a case of inverted papilloma of the bladder with recurrence in prostatic urethra after four years of follow-up. We review etiology, clinical presentation, diagnose, treatment and the present discussion about its malignancy ability.

[Statistical study of outpatient urologic care]. / Estudio estadístico de la asistencia urológica extrahospitalaria.

Attendance generated in an urology outpatients office, reaching up to 6564 visits, was studied for a complete year. Considering only the initial visits handled during that period (1968), we evaluated the following parameters: age, sex, mode of remission, data presented, type of consultation, most common type of urological pathology. No particular period of life has come out as showing greater incidence of urological pathology. Males represented twice as many visits as women. 84.29% patients had been correctly referred to the office. Sixty percent of visits happened without appropriate clinical data to support the case. Emergencies represented 13.31%, but 90% of those actually lacked such condition. Renal-ureteral lithiasis (25.57%) was the most frequently present pathology in our office, followed by benign hypertrophy of the prostate (16.07%). Urinary lower tract infections (15.59%) and inflammatory and/or congenital prepuce pathologies (14.09%) were the second most frequent ones. In this paper, we emphasize the increasing prevalence of male-related sterility visits in the outpatients environment, as well as nephrological.

[Synergistic necrotizing fasciitis of genitalia and perineum. Our experience]. / Fascitis necrosante sinérgica de genitales y periné. Nuestra experiencia.

Presentation of 9 cases of synergistic genitalia and perineum necrosing fascitis treated in our service over the last 5 years. The contents of the disease and its terminology has been reviewed by the light of the existing literature. In our series, patients mean age was 65 years. Three of our 9 patients had diabetes mellitus, and also 3 had liver disease due to alcohol. The initial septic focus was found in 8 cases, and in 4 it was urological, basically urethra's stricture. The most frequently involved germs were aerobe-anaerobe associations. Mortality was 11%.

[Inguinal varicocelectomy with sedoanalgesia. Preliminary experience]. / Varicocelectomia inguinal con sedoanalgesia. Experiencia preliminar.

Presentation of 12 cases of inguinal varicocelectomy under analgesic sedation. Details relative to surgery, type of anaesthesia used, and preliminary results are reviewed. We conclude that this technique is excellent because it allows a monitored surgical procedure well tolerated by the patient, and which it would even allow ambulatory surgery and could an alternative to laparoscopic surgery of the varicocele.

[Calcified retroperitoneal liposarcoma]. / Liposarcoma retroperitoneal calcificado.

Case report of a retroperitoneal liposarcoma pleomorfico with calcification in diagnosed in our hospital. We comment on its clinical characteristics, diagnostic methods and treatment. We likewise comment the possible differential diagnoses.

[Adult polycystic disease in horseshoe kidney]. / Enfermedad poliquística del adulto en riñón en herradura.

A case report of kidney polycystic and horseshoe kidney coincidence in the same patient. They are two congenital associated renal diseases uncommon for urologists. The form of clinic presentation is described, the diagnostic methods used and the therapeutic management.

[Computerization of protocols for tumor follow-up]. / Informatización de los protocolos de seguimiento tumoral.

OBJECTIVE: Evaluation of the effectiveness of the surveillance tumoral by means of computerized protocols. MATERIAL AND METHODOLOGY: We have carried out a retrospective study, taking as example the superficial bladder cancer, where we have compared the execution of the tumoral surveillance of the computerized protocols regarding the conventional ones. RESULTS: It has been demonstrated that the execution percentage and the adjustment to the predetermined terms of the explorations requested by the facultative are superior in the computerized protocols that in the conventional ones. CONCLUSION: The computerization of the tumoral protocols is user-friendly, it improves the execution degree and it saves time, providing bigger effectiveness and scientific rigor.

[Retrovesical schwannosarcoma]. / Schwannosarcoma retrovesical.

Contribution of one case of retrovesical schwannosarcoma in a 23-year-old female patient, with discussion of signs and symptoms, diagnosis and treatment. Retroperitoneal schwannosarcoma is an extremely uncommon tumour. Diagnosis is always histologic and immunohistochemical. This is an extraordinary aggressive tumour, with low response to chemo- and radiotherapy. Surgery is the only curative treatment, and presents a high index of recurrence. Prognosis is sombre. We support the most radical surgical approach possible as the only definite diagnostic possibility, since it provides the best survival indexes and in any case, improves symptomatology of tumours not completely resectable.

[Complications of transurethral resection of the prostate: review of 408 cases]. / Complicaciones de la resección transuretral de la próstata: revisión de 408 casos.

Retrospective study conducted on 408 TUPRs performed in our centre over the time span 1985-1995. Patient's mean age was 68 (51-89) years. In 73% cases regional anaesthetics was used. Mean surgery duration (without anaesthetics) was 41 minutes for prostates under 60 g and 63 minutes for those over 60 g. 40.9% patients had in-dwelling urethral catheter. Early complications were seen in 19.6% patients, of which 9.6% were urinary infections, 4.6% major haematuria requiring transfusion of two or more units of packed blood cells and 12% relevant systemic complications. Overall mortality was 0.5% (2 patients). Late complications affected to 12.7% patients, which in 6.4% were urethral stenosis. Both mean hospital stay and mortality were low. We conclude that TUPR morbidity is not trivial, emphasizing the occurrence of urethral stenosis and urinary infection. In spite of the frequency of these complications, we believe this to be the choice procedure for most patients who require surgical treatment for benign prostate hyperplasia.

[Testicular germinal cell tumors. Authors' case load. Treatment review]. / Tumores testiculares germinales. Nuestra casuística. Revisión del tratamiento.

This article reports our case series of testicle germinal cell tumours, consisting of 14 cases, between 1974-1991. 42.85% (6 cases) were seminomas, 4 (66.6%) in Stage I. There was one case (16.6%) in Stage III and another one in Stage IV. 14.29% (2 cases) were embryonic carcinomas, one in Stage I and one in Stage II. Teratomas represented 14.29% (2 cases), in Stages I and IV respectively. There were 4 cases of mixed tumours (2 cases) in which teratomatous components (3 out of 4) were predominant. 50% were in Stage I and 50% in Stage III. Inguinal orchiectomy was performed in all cases, and three received radiotherapy (seminomas in Stages I (2 cases) and III), with survival ranging from 1 to 7 years. Two cases (seminoma and embryonic carcinoma) received chemotherapy under different regimes depending on the time of diagnosis. One patient has survived 11 years following rescue lymphadenectomy while the other one died 14 months later from pulmonary metastasis. Among the mixed tumours, 50% (2 cases in Stages II and III) died 5 and 11 months afterwards without further treatment due to overall affectation at diagnosis. An abstentionist approach in Stage I (seminomas and non-seminomas), which was "strictly" applied in 5 cases showing disease-free survival ranging from 1 to 5 years, is defended. Follow-up was not feasible in 2 cases (14.2%). Both the diagnostic means and a review of treatment by Stages, reflecting the evolution of chemotherapy and the results obtained, are analyzed. Also the most widely accepted approaches in the management of these tumours.

[Massive inguinal vesical hernia. Report of 3 cases]. / Hernia vesical inguinal masiva. Aportación de tres casos.

Vesical hernia is defines as a vesical shift associated to a direct or indirect inguinal hernia. It accounts for 0.4-3% of all inguinal hernias, but the existence of a massive vesical hernia formation at the inguinoscrotal level is uncommon; a total of 114 cases have been found in the literature. Clinically it should be suspected every time an inguinoscrotal hernia is found in patients over 50 years old with urinary flow obstruction. Diagnosis is usually reached through serial voiding cystouretrography (SVCU). The preferred treatment should be extraperitoneal inguinal herniorrhaphy associated to correction of the obstructive process.

[Urethral diverticulum complicated with giant lithiasis]. / Divertículo uretral complicado por litiasis gigante.

Presentation of one case report of acquired urethral diverticulum in a male with giant urethral lithiasis. Urethral diverticulum are rare entities in males, the condition being more frequent in females. In general, they are acquired in up to 90% cases, the remaining 10% being hereditary Giant urethral lithiasis is also uncommon in our milieu, incidence being higher in Eastern Countries; 4-10% of urethral diverticulum are occupied by lithiasis. Diagnosis is mainly through clinical symptomatology involving the development of a perineal mass or phlegmon; however definite diagnosis is made through CUMS. Management of giant diverticulum in males is by open surgery, preferably a one-step diverticulectomy procedure; in cases such as the reported here, where urethral stenosis or a significant inflammatory involvement of the periurethral tissues is present, a two-step urethroplasty should be preferred.

[Endoscopic removal of the ureter prior to nephroureterectomy. Preliminary analysis]. / Desinserción endoscópica del uréter previa a nefroureterectomía. Análisis premilinar.

AIM OF THE STUDY: To describe a simplified technique for nephroureterectomy based on a prior endoscopic disconnection of the ureter or transurethral circumcision of the ureteral orifice. PATIENTS AND METHODS: From November 1993 to December 1997 we treated 16 patients diagnosed with cancer of the renal pelvis of proximal ureter, using this technique. Mean age was 68.8, 15 males and 1 female. RESULTS: There was no operative or postoperative complications. Mean follow up was 17 months and the mean hospital stay was 7.2 days. CONCLUSIONS: We believe that this is an easy technique to learn, that significantly cut down the operating time, reduce postoperative complications and it is adequate for upper tract urothelial cancer treatment.

[Hematoma of the iliac psoas secondary to anticoagulant treatment. Urological implications]. / Hematoma del psoas ilíaco secundario a tratamiento anticoagulante. Implicaciones urológicas.

We describe the urological manifestations arising from hematoma of the left iliac psoas that developed in the course of anticoagulant therapy in a 54-year-old patient with a mitral prosthesis. The onset of the clinical picture was acute and mimicked left reno-ureteral colic. Ultrasound and CT were decisive in making the diagnosis, revealing a left retroperitoneal mass in the anterolateral aspect of the left psoas muscle. Intravenous urography evidenced the urological repercussions of the disease process consisting of medialization of the left ureter, ureterohydronephrosis, and anterior and lateral displacement of the kidney. Although this condition is considered by most to be a surgical emergency, we opted for conservative treatment because the patient had no hemodynamic instability, severe obstructive uropathy or signs or crural paralysis. The literature on the urological repercussions of psoas hematomas due to anticoagulant therapy is briefly reviewed.

45,X/46,XY gonadal dysgenesis in an infertile adult male.

A 33-year-old male was referred for infertility. Examination revealed bilateral scrotal gonads of soft consistency and small size. Semen analysis showed azoospermia. Elevated serum follicle-stimulating hormone levels and normal testosterone values were found. Surgical exploration and histopathology diagnosed dysgenetic testes with complete epididymis, and remnants of Fallopian tubes attached to the albuginea, with normal vas deferens and seminal vesicles showed on deferentovesiculography. Karyotype was 45,X/46,XY del(Y)(q11) with only 15% of 46XY cells in gonadal tissue. The clinical spectrum of 45,X/46,XY mosaicism and significance of this chromosomic anomaly is discussed.

[Bladder tumors in patients under 40 yr of age. Our experience and review of the literature]. / Tumores vesicales en pacientes menores de cuarenta años. Nuestra experiencia y revisión de la literatura.

During a period spanning 11 years, 392 patients diagnosed as having tumor of the bladder were treated at our department. Of these, 9 were patients under age 40. We compared the anatomopathological features and course of the disease. The foregoing condition was suspected on the basis of the urographic findings. We emphasize the need to perform endoscopic inspection and urinary cytology before discarding the presence of a bladder tumor. The anatomopathologic conditions of anaplasia and infiltration are frequently more favourable in this younger patient group, indicating a better prognosis. However, the natural history of tumors with histopathologically similar features is not influenced by age.

[Calcified bladder lesions secondary to the instillation of mitomycin C]. / Lesiones vesicales calcificadas secundarias a instilación de mitomicina C.

We report on 10 cases of bladder wall calcification after mitomycin C instillation. The cystoscopic and microscopic features of these lesions are described. In our view, these lesions can be ascribed to the use of mitomycin C instillation therapy immediately after TUR. Because they are asymptomatic and occasionally present features of tumor recurrence, biopsy is advocated to determine the true nature of these lesions.

[The complete testicular feminization syndrome: apropos 2 new cases]. / Síndrome de feminización testicular completo: a propósito de dos nuevos casos.

Two additional cases of complete testicular feminization syndrome or Morris syndrome are described. The patients had consulted for primary amenorrhea. Patient work up revealed a female phenotype, hormone profile and 46,XY karyotype. They were submitted to abdominal surgical exploration and orchidectomy of the cryptorchid male gonads. The potential etiologic factors, pathogenesis, incidence and clinical features of this syndrome are discussed. Furthermore, the surgical treatment and outcome are described, highlighting the incidence of gonadal malignancy if these are not removed early.