[Ureteral pseudodiverticulosis. Case report]. / Pseudodiverticulosis uretral. A propósito de un caso.

OBJECTIVES: To report a new case of bilateral ureteral pseudodiverticulosis associated with a transitional cell carcinoma of the bladder. METHODS: 70 year-old male patient under ambulatory study for hematuria. RESULTS: The intravenous urography (IVU) shows images of addition in relation to bilateral ureteral pseudodiverticulosis. Urine cytology and cystoscopy showed the existence of a concomitant tumor. CONCLUSIONS: The diagnosis of ureteral pseudodiverticulosis is incidentally made on an IVU indicated for other reasons. Although it is a benign pathology, it is necessary to follow these patients because of its association with transitional cell carcinoma.

[Fournier's gangrene secondary to urethral catheterization]. / Gangrena de Fournier secundaria a cateterismo uretral.

OBJECTIVES: We report one case of Fournier's gangrene secondary to urethral catheterization. METHODS: We describe the clinical case, in which the initial cause was identified, and perform a short bibliographic review. RESULTS: Although Fournier's gangrene was initially considered as idiopathic in etiology, currently it is possible to identify the entrance site of the infection. In the present case the insertion of a urethral catheter was the starting mechanism, associated with factors such as diabetes and alcoholism which favour its development. The patient was treated by surgical debridement and partial urethrectomy but finally died. CONCLUSIONS: We want to point out that urethral instrumentation should be done by expert hands due to the severity of possible complications. We should insist in the need of precocious treatment with wide spectrum antibiotics, radical debridement and complete urologic evaluation.

[Bladder leiomyoma. A case report and literature review]. / Leiomioma vesical.

OBJECTIVES: To report a new case of bladder leiomyoma. METHODS: A 20 mm tumor of the right lateral wall of the bladder was incidentally found in a pelvic ultrasound study of a 29-year-old female. The cystogram showed the presence of a filling defect in the same side. Cystoscopy showed a right lateral wall tumor with normal mucosal cover. RESULTS: With the working diagnosis of bladder leiomyoma, transurethral resection of the bladder tumor was performed, and pathology confirmed the diagnosis. Postoperatively, the patient developed a calcareous plaque on the resection area which was treated by transurethral resection of the plaque and leiomyoma remainders and subsequence urine acidification. CONCLUSION: Although it is a rare tumor, in certain circumstances it is possible to establish the working preoperative diagnosis with a high index of suspicion. On the other hand, due to the benign character of the process, conservative surgery (transurethral resection in this case) offers excellent results.

[Renal liposarcoma. Report of one case and bibliographic review]. / Liposarcoma renal. Presentación de un caso y revisión de la literatura.

OBJECTIVES: To report a new case of well-differentiated renal liposarcoma, and to describe its clinical features, diagnosis, treatment, and differences with other mesenchymal tumors of the retroperitoneum. METHODS: We perform a clinical review of renal mesenchymal tumors, especially liposarcomas. We report one case of well-differentiated renal liposarcoma in a 52-year-old female, and review current lines of treatment and follow-up. RESULTS/CONCLUSIONS: The well-differentiated renal liposarcoma is a very unfrequent mesenchymal tumor, for which it is necessary to know exactly its origin in the renal parenchyma. The treatment of choice is complete tumor exeresis; close follow-up should be exercised because even though it does not metastasize, local recurrences appear in 30% of the cases.

[Seminal vesicle cyst and ipsilateral renal agenesis]. / Quiste de vesícula seminal y agenesia renal ipsilateral.

OBJECTIVES: To report one case of seminal vesicle cyst with renal agenesis. To describe its clinical, radiological and therapeutic characteristics. METHODS/RESULTS: 42-year-old male presenting with irritative voiding symptoms. Digital rectal examination revealed a soft irregular mass over the prostate. Diagnostic imaging tests showed an enlargement of the left seminal vesicle and ipsilateral renal agenesis. Surgery was carried out with excision of the seminal vesicle cyst by an extravesical and extraperitoneal approach. Two years later the patient remains asymptomatic. CONCLUSIONS: Cystic pathology of the seminal vesicle is rare. Diagnosis is based on clinical symptoms, digital rectal examination and imaging studies. Surgery is necessary for symptomatic cases.

[Conservative treatment of a seminal vesicle abscess. Report of one case]. / Tratamiento conservador del absceso de vesícula seminal. Aportación de un caso.

OBJECTIVE: To describe the clinical conditions, the radiological findings and the management of a case of seminal vesicle abscess. METHODS: A 47-year old man presented with irritative voiding symptoms, fever, diminished ejaculated volume, hematuria and testicular pain. Diagnosis was made with digital rectal examination, ultrasound and CT. RESULTS: The patient was managed with antibiotic therapy alone for 4 weeks. Clinical and radiological resolution was achieved. CONCLUSIONS: Seminal vesicle abscess is a rare condition. Diagnosis is based on clinical data and radiological findings. Conservative treatment could be effective in selected cases.

[Renal cell carcinoma with late lung and ocular metastases]. / Carcinoma de células renales con metástasis pulmonar y ocular tardías.

OBJECTIVES: We report one case of ocular and lung metastases seven years after radical nephrectomy for renal cell carcinoma. METHODS: The case of a 45-year-old male patient who underwent radical nephrectomy for a localized renal cell carcinoma (T2N0M0) in 1995 was found in a review of malignant renal neoplastic pathology. RESULTS: Seven years later he presented with a lung metastasis requiring neumonectomy, and an ocular metastasis requiring enucleation. He is currently receiving systemic treatment with interferon and interleukin. CONCLUSIONS: Clinical presentation and evolution of metastasic renal carcinoma is very variable, a difference with other neoplasias. Ocular localization is exceptional and may appear long time after primary tumor; clinically, it may be asymptomatic or present with sudden sight loss. MRI, CT scan and retinal examination are the diagnostic methods employed, and treatment may be surgery, brachytherapy or radiotherapy depending on location and size of the lesion.

[Bladder perforation as a complication of uterine curettage after spontaneous abortion]. / Perforación vesical como complicación de legrado uterino por aborto espontáneo.

OBJECTIVE: To present a case of bladder and uterine perforation following curettage for first-trimester abortion. METHODS: A 30 years-old female, pregnant of 19 week of gestation had undergone a therapeutic abortion for fetal death. Following the procedure, she presented hematuria and vaginal bleeding. A vesico-uterine perforation was achieved. An exploratory laparatomy was performed with repair of the bladder and the uterus. RESULTS: There were no surgical complications. Eleven days after the laparatomy a cistography demonstrated closure of the perforation. The patient did well postoperatively. Two years later the patient was pregnant. A caesarean procedure with tubaric ligation was performed without complications. CONCLUSIONS: Bladder perforation following uterine curettage is rare. Surgical management is necessary with bladder and uterus repair.

[Necrosis of the penis in a diabetic patient: presentation of a case]. / Necrosis de pene en paciente diabético, presentación de un caso.

OBJECTIVES: To present a short review of the diagnosis, clinical features, and treatment of male genitalia necrosis under the format of a case report. METHODS: We review the case of a diabetic patient without good blood sugar control who suffered from various diabetic complications diagnosed and treated at our hospital of a penile necrosis. We perform a bibliographic review about male genitalia necrosis regarding its etiology, diagnosis and treatment. RESULTS: Male genitalia necrosis is a rare disease but it is associated with high morbidity and mortality. The present case was diagnosed at the emergency room at our Hospital. Conservative treatment with antibiotic therapy and corticosteroid ointments was undertaken successfully. CONCLUSIONS: To perform an etiologic evaluation of the necrosis (dry or infectious) is important to select the right treatment. The high mortality of these diseases requires a precise and early diagnosis, since this influences the good or bad evolution of the disease.

[Ovarian vein syndrome. Report of 2 cases]. / Síndrome de la vena ovárica. Presentación de 2 casos.

OBJECTIVES: To report the clinicae characteristics and treatment of the ovarian vein syndrome. METHODS: We studied two cases of female patients with obstructive uropathy secondary to ovarian vein syndrome cared for at our department over the last 4 years. RESULTS: Both cases were treated surgically. Postoperative outcomes were satisfactory. CONCLUSIONS: The ovarian vein syndrome is rare. Surgery is the treatment of choice for symptomatic cases.

[Implementation of a clinical pathway for transurethral resection in benign prostatic hyperplasia]. / Implantación de una vía clínica para la resección transuretral por hiperplasia benigna de próstata.

OBJECTIVE: Clinical pathways constitute a powerful tool for reducing the variability that occurs in clinical practice. The results obtained with the use of a clinical pathway for patients undergoing transurethral resection for benign hyperplasia of the prostate (BPH) are presented. METHODS: A prospective study was carried out on a cohort of 80 consecutive patients that had undergone transurethral resection for BPH after the application of a clinical pathway (5 days hospitalization) and compared with the results of a historical cohort of 80 consecutive patients that had been treated before the application of the clinical pathway. The exclusion criteria were diabetes mellitus, anticoagulation therapy with dicoumarin and other pathologies that changed the length of the preoperative stay established in the clinical pathway. For the evaluation of the degree of satisfaction, patients were asked to fill out a questionnaire included in the pathway documents. RESULTS: 73 patients met the inclusion criteria of the clinical pathway. 67 of the 80 patients that underwent surgery before the application of the clinical pathway were valid for comparative analysis. No statistically significant differences were found between both groups for age, prostate volume measured by DRE and US, previous treatment for prostatism, anesthetic risk and weight of the resected specimen. With the application of the pathway, the mean duration of hospital stay was reduced from 6 (SD 1.7; range 4-15) to 4.9 (SD 1.4; range 3-13) days (p < 0.0001) and the duration of urethral catheterization from 4.5 (SD 1.4; range 3-13) to 3.8 (SD 1.3; range 2-11) days (p < 0.01). Statistically significant differences were found before and after the application of the clinical pathway for degree of compliance of the preestablished antimicrobial prophylaxis guidelines during hospitalisation and after discharge, and thromboembolic prophylaxis. The relative risk of complications after discharge was less after the application of the clinical pathway (RR = 0.66), although it was not statistically significant (CI: 0.41-1.05). 63 of the 73 patients included in the clinical pathway submitted the questionnaire without identifying themselves. Duration of hospitalization was considered adequate by 89%, and coincided with the programmed and actual duration according to 82.5%. CONCLUSIONS: The application of a clinical pathway for patients undergoing transurethral resection for BPH has reduced costs by reducing the length of hospital stay and adverse effects. Furthermore, reducing the variability of medical care has improved its quality.

[Intra-scrotal lithiasis. Crystallographic analysis]. / Litiasis intraescrotal. Análisis cristalográfico.

OBJECTIVE: To present two cases of intrascrotal lithiasis associated with hydrocele and the results of the crystallographic study. METHODS: Three intrascrotal calculi in two patients aged 72 and 75 years that underwent surgery for hydrocele were analyzed. Two 2-mm. calculi were incidentally discovered during surgery for a right hydrocele in one patient. An ultrasound scan of the other patient showed a left hydrocele with a free-floating, round, hyperechoic, 6-mm. calculus, with posterior acoustic shadow. None of the patients had a previous history of trauma. The 3 calculi were white and smooth, but turned yellow and rough after removal. Scanning electron microscopy and x-ray dispersion studies were performed. RESULTS: All 3 calculi had a center comprised of hydroxyapatite and white organic matter, and an exterior of yellow organic matter. The mineral portion of the center of the 6-mm. calculus and one of the 2-mm. calculi was composed of 33% phosphorus and 67% calcium, and the other 2-mm. calculus contained 32% phosphorus and 68% calcium by x-ray dispersion analysis. CONCLUSIONS: Intrascrotal lithiasis is rare. In the two cases described herein, we observed abundant organic matter, particularly on the stone surface, and hydroxyapatite, particularly in the center. Among the possible etiologic causes, the deposit of organic matter in the presence of high oversaturation of calcium phosphates and absence of crystallization inhibitors, can initiate calcification and the subsequent collection of organic matter makes the process irreversible.

[Fixed drug-induced exanthema of the glans]. / Exantema fijo medicamentoso en glande.

OBJECTIVES: To claim attention on an relatively frequent adverse reaction to drugs affecting genitalia, therefore a reason for consultation to the Urology Department. METHODS: We report a clinical case and a bibliographic review of this disease. RESULTS: Fixed drug eruption is a cutaneous eruption secondary to drug intake that appears every time the drug is taken, always in the same location, being more common in hands and feet. The course of the disease is usually progressive with increasing number of lesions after each dose of drug taken. CONCLUSIONS: Relapsing lesions in the same spot is key for the proper diagnosis of this eruption. To forbid causing drug intake is the treatment of choice, although it may be necessary to administer local or even oral corticosteroids.

[Acute scrotum secondary to testicular tumor]. / Escroto agudo secundario a tumor testicular.

OBJECTIVE: To report a case of testicular tumor, classified as seminoma, with a very uncommon form of presentation since it presented as acute scrotum. METHODS: The clinical features, treatment and outcome of this uncommon condition are presented. RESULTS: A review of the literature showed that this form of presentation is rare although in the present case it is impossible to determine if testicular inflammation was due to tumor necrosis or infection from the associated hydrocele. CONCLUSIONS: Testicular tumor should be considered in all male patients aged 20 to 35 years with acute scrotum.

[Urinary stone in a Bricker's ileal conduit]. / Litiasis en conducto urinario tipo Bricker.

OBJECTIVES: To report one case of urinary stone as a relatively frequent complications of urinary diversion using bowel loops. METHODS: We perform a short bibliographic review using the case report format. RESULTS: Stone formation in Bricker's type urinary diversion is secondary to various factors such as urinary stasis, bacteriuria, presence of intestinal mucus, metallic sutures, metabolic disturbances, etc. CONCLUSIONS: Periodic control by radiological studies is recommended due to the high frequency of this complication in patients with urinary diversion. Treatment is usually conservative or minimally invasive, being surgery reserved for those cases in which stone extraction is not safe using other methods.

Pseudodiverticulosis uretral. A propósito de un caso / Ureteral pseudodiverticulosis. Case report

OBJETIVOS: Comunicar un nuevo caso depseudodiverticulosis ureteral bilateral, asociado a tumorvesical de células transicionales.METODOS: Varón de 70 años de edad, estudiado deforma ambulatoria en consulta de Urología por hematuria.RESULTADOS: En la urografía intravenosa (UIV) aparecenimágenes de adición en relación a pseudodiverticulosisureteral bilateral. La citología y cistoscopia demuestran laexistencia de una tumoración concomitante.CONCLUSIONES: El diagnóstico de la pseudodiverticulosisureteral se hace de forma casual durante la realizaciónde una UIV por otros motivos. Si bien es una patologíabenigna, es necesario el seguimiento de los pacientespor la asociación con tumores de células transicionales

OBJECTIVES: To report a new case of bilateral ureteral pseudodiverticulosis associated with a transitional cell carcinoma of the bladder. METHODS: 70-year-old male patient under ambulatory study for hematuria. RESULTS: The intravenous urography (IVU) shows images of addition in relation to bilateral ureteral pseudodiverticulosis. Urine cytology and cystoscopy showed the existence of a concomitant tumor. CONCLUSIONS: The diagnosis of ureteral pseudodiverticulosis is incidentally made on an IVU indicated for other reasons. Although it is a benign pathology, it is necessary to follow these patients because of its association with transitional cell carcinoma

Gangrena de Fournier secundaria a cateterismo uretral / Fournier´s gangrene secondary to urethral catheterization

OBJETIVOS: Mediante el formato de casoclínico presentamos un caso de Gangrena de Fourniersecundario a cateterismo uretral.MÉTODOS: Realizamos una descripción del caso clínicoque nos ocupa, en el que se ha identificado la causa inicial,así como una breve revisión bibliográfica de estapatología.RESULTADO: Aunque la gangrena de Fournier se considerabainicialmente como de etiología idiopática, en laactualidad es posible identificar en la mayoría de loscasos la puerta de entrada de la infección. En nuestrocaso la colocación de un catéter uretral fue el mecanismode inicio de la infección, asociado a dos factores como ladiabetes y el alcoholismo que favorecen el desarrollo dela misma. Se trató mediante desbridamiento quirúrgico yse realizó uretrectomía parcial. El paciente fue finalmenteexitus.CONCLUSIONES: Se debe llamar la atención sobre lanecesidad de que la manipulación uretral sea realizadapor manos expertas dada la gravedad de las posiblescomplicaciones.Hay que insistir en la necesidad de un tratamiento precozcon una cobertura de antibióticos de amplio espectro, undesbridamiento radical y una revisión urológica completa

OBJECTIVES: We report one case ofFournier`s gangrene secondary to urethral catheterization.METHODS: We describe the clinical case, in which theinitial cause was identified, and perform a shortbibliographic review.RESULTS: Although Fournier`s gangrene was initiallyconsidered as idiopathic in etiology, currently it ispossible to identify the entrance site of the infection. Inthe present case the insertion of a urethral catheter wasthe starting mechanism, associated with factors such asdiabetes and alcoholism which favour its development.The patient was treated by surgical debridement andpartial urethrectomy but finally died.CONCLUSIONS: We want to point out that urethralinstrumentation should be done by expert hands due tothe severity of possible complications. We should insistin the need of precocious treatment with wide spectrumantibiotics, radical debridement and complete urologicevaluation

Leiomioma vesical / Bladder leiomyoma. A case report and literature review

OBJETIVO: Aportar un nuevo caso de leiomiomavesical a la literatura española.MÉTODO: Hallazgo casual en un estudio ecográfico pélvicode una tumoración de 20 mm en la cara lateral derechade la vejiga de una mujer de 29 años. El cistogramade la urografía intravenosa mostró la presencia de undefecto de repleción en esa misma localización. Se realizócistoscopia con el hallazgo de una tumoración en lacara lateral derecha de la vejiga, con recubrimiento mucosode aspecto normal.RESULTADO: Con el diagnóstico de sospecha de leiomiomavesical se realizó resección transuretral de la tumoración,con confirmación anatomopatológica de dicho diagnóstico.En el postoperatorio desarrolló una placa calcáreasobre el área de resección previa, que se tratómediante resección transuretral de ésta y de restos leiomiomatososy acidificación urinaria posterior.CONCLUSIÓN: Aunque se trata de un tumor raro, endeterminadas circunstancias es posible establecer el diagnósticoprequirúrgico con un alto índice de sospecha. Porotra parte, dada la benignidad del proceso, la cirugíaconservadora, en esta caso la resección transuretral, ofreceexcelentes resultados

OBJECTIVES: To report a new case of ;;bladder leiomyoma. ;;METHODS: A 20 mm tumor of the right lateral wall of ;;the bladder was incidentally found in a pelvic ultrasound ;;study of a 29-year-old female. The cystogram showed ;;the presence of a filling defect in the same side. ;;Cystoscopy showed a right lateral wall tumor with normal ;;mucosal cover. ;;RESULTS: With the working diagnosis of bladder leiomyoma, ;;transurethral resection of the bladder tumor was performed, ;;and pathology confirmed the diagnosis. ;;Postoperatively, the patient developed a calcareous plaque ;;on the resection area which was treated by transurethral ;;resection of the plaque and leiomyoma remainders and ;;subsequence urine acidification. ;;CONCLUSION: Although it is a rare tumor, in certain ;;circumstances it is possible to establish the working ;;preoperative diagnosis with a high index of suspicion. ;;On the other hand, due to the benign character of the ;;process, conservative surgery (transurethral resection in ;;this case) offers excellent results