[Laparoscopic ureterolithotomy of an iliac ureteral stone forgotten for more than eight years]. / Ureterolitotomia laparoscópica de un cálculo de uréter iliaco olvidado durante más de ocho años.

INTRODUCTION: Laparoscopic ureterolithotomy recently rises as a new option in the treatment of ureteral calculi, particularly those of the greatest size, hardness or impactation. We describe such an indication to resolve a case of forgotten for more than eight years and severely obstructive ureteral stone. PATIENT AND METHOD: A 64 years-old male received extracorporeal shock wave lithotripsy for a right distal ureteral stone and, simultaneously, a left impacted iliac ureteral calculi was discovered, at the confluence of an incomplete duplication of the ureter, for which treatment was recommended, but deferred by the patient. Eight years after, the same stone caused a massive dilatation with poor function of the upper pole moiety and slightly preserved function of the lower pole moiety of the left kidney. Two intents of retrograde ureteroscopy failed because of impossibility to reach the stone. Transperitoneal laparoscopic ureterolithotomy was performed in lateral decubitus position, with double J in place and three 10 mm ports. After identification of the dilated ureter, an V-shape ureterothomy was made and the stone mobilized and extracted. The ureter was stented and the ureterothomy closed with intracorporeal suture. The patient had a postoperative stage of four days and a mild functional recovery. DISCUSSION: If the usual treatment options (extracorporeal lithotripsy and ureteroscopy with intracorporeal lithotripsy) failed, then laparoscopic ureterolithotomy is less invasive than open ureterolithotomy. However, the indications of laparoscopic ureterolithotomy are restricted because substantial laparoscopic experience is needed to cope with possible technical difficulties.

[Spermatic cord mass as a manifestation of systemic vasculitis: a case report and review of the literature]. / Masa en el cordón espermático como primera manifestación de una vasculitis sistémica: presentacion de un caso y revisión de la literatura.

We report a case of necrotizing granulomatous vasculitis in the spermatic cord in a 35-year-old man with an antecedent of brain stroke 3 years before. The clinical manifestation was as a painless left scrotal mass. The diagnosis was established by histological examination of the spermatic cord. We discuss the physical findings, radiological features and pathological findings, reviewing the literature for previous similar cases.

[Primary non-Hodgkin large B-cell lymphoma of bladder. Report of a case]. / Linfoma no hodgkin B de célula grande primario de vejiga. Presentación de un caso.

INTRODUCTION: primary genitourinary lymphomas are uncommon. Among them, bladder lymphomas are extremely unusual tumors, with clinico-radiological features similar to urothelial carcinomas of bladder. Histopathological, immunohistochemical and molecular studies are compulsory for the diagnosis. We report a case of this tumor. CLINICAL CASE: An 80-year-old woman was admitted to our hospital with hematuria. Abdominal ultrasound and cystoscopy revealed an infiltrating bladder tumor involving the right lateral wall. After transuretral biopsy, a diagnosis of non-Hodgkin large B-cell lymphoma was made. Neither clinical symptoms nor radiological findings showed disseminated disease, indicating that the tumor was localized in the bladder. After chemotherapy, the patient is disease-free after 9 months follow-up. COMMENT: if a bladder tumor with uncommon histopathological features is found, lymphoma should be excluded, because chemotherapy avoids cystectomy.

[Diffuse xanthogranulomatous pyelonephritis with a renocolic fistula neglected for more than two years]. / Pielonefritis xantogranulomatosa difusa con fistula renocólica inadvertida durante más de dos años.

INTRODUCTION: Although reno-colic fistula is a well-known complication of the diffuse form of xanthogranulomatous pyelonephritis, the features of the case here presented are unusual because of the paucity of symptoms and long lasting evolution of the disease before it was diagnosed. CLINICAL CASE: A 75 year-old woman was seen at the emergency room complaining of fever and malaise. Physical and laboratory examination showed anemia and a left abdominal mass, and on X-ray and abdominal CT, a gross stone and huge left renal and extrarenal xanthogranulomatous pyelonephritis with renocolic fistula were disclosed. A review of her clinical record showed an X-ray performed two years before by the attending family clinician, with identical gross calculi and gas into the kidney. Nephrectomy, caudal pancreatectomy and partial colectomy were accomplished with good results. COMMENT: This case of poor-symptomatic xanthogranulomatous pyelonephritis that destroyed the kidney and induced a renocolic fistula, is unusual because it was neglected for more than two years due to unawareness of the clinical and radiological picture.

[Iatrogenic splenectomy in surgery of renal tumors]. / Esplenectomía iatrógena en cirugía del tumor renal.

A description of our experience with iatrogenic spleen lesions requiring splenectomy caused during surgery for a renal tumour. Out of a total 83 nephrectomies due to renal tumour performed in our Centre between 1988 and 1996, 46 were left and 4 of them (8.7%) involve splenectomy. Clinical, surgical, pathoanatomical and follow-up data of these 4 cases is analyzed. Anatomical relationship of the spleen with kidney and colon, as well as factors to consider during surgery to avoid splenic lesions are discussed.

[Adenocarcinoma in ileocystoplasty]. / Adenocarcinoma en ileocistoplastia.

Case report of an adenocarcinoma in ileocystoplasty in a 54-year old female that at the age of 24 had undergone right nephrectomy and partial cystectomy surgery followed by vesical extension with ileon due to urinary tuberculosis. Discussion on the rare incidence of this condition, its diagnostic features, the need for long-term follow-up and the relevance of a broad resection of the affected intestinal portion.

[Malignant endometriosis]. / Endometriosis maligna.

Presentation of two case reports of severe and multiple urinary tract involvement by endometriosis due to the low frequency of this disorder. Although this is a benign condition, the term "malignant" endometriosis has been used because of the significant consequences it may have for the urinary tract, since it may compromise both excretory systems with a likely vital risk.

[Primary bladder amyloidosis]. / Amiloidosis vesical primaria.

Primary amyloidosis of the bladder is a rare disease entity manifested as extracellular deposits of a fibril protein in an amyloid substance form. Clinical presentation resembles a bladder tumor, as hematuria is the most common clinical manifestation. Single organ affectation is most frequent in the bladder, however, we have found less than 100 cases. We present the case of a woman with primary amyloidosis of the urinary bladder with symtoms of hematuria. Endoscopic examination suggested a bladder tumor.

[Retroperitoneal paraganglioma. Differential diagnosis with hypernephroma]. / Paraganglioma retroperitoneal. Diagnóstico diferencial con hipernefroma.

Paraganglioma are tumours that show embryological origin from the neural crest, and which derive from the paraganglia. They can be found in any location throughout the aorta and/or in association to the sympathetic chain. They can be either functioning or non-functioning based on hormone production. The authors present here a non-functioning retroperitoneal paraganglioma as an incidental finding in a 72-year old female patient. Pre-operative diagnosis was cystic hypernephroma, for which radical nephrectomy was performed. The extra-renal origin of the tumour was found subsequently on examining the piece. A discussion is included on the diagnosis, treatment, prognosis as well as a review of the literature.

[Traumatic unilateral testicular dislocation]. / Dislocación unilateral testicular traumática.

OBJECTIVE: To report a case of traumatic testicular dislocation, an unusual complication of pelvic trauma. METHODS/RESULTS: A case of traumatic testicular dislocation that had been diagnosed two months after the initial injury is presented. CT and color doppler US revealed a viable right testis displaced in the inguinal subcutaneous region. The testis was repositioned in the scrotum and orchidopexy was performed. Follow-up control evaluation at 6 months revealed a normal testis in the right hemiscrotum. CONCLUSIONS: Traumatic testicular dislocation is a rare complication that may be undetected at the time of the initial injury. Surgical reduction and repositioning achieve good results.

Ureterolitotomia laparoscópica de un cálculo de uréter iliaco olvidado durante más de ocho años / Laparoscopic ureterolithotomy of an iliac ureteral stone forgotten for more than eight years

Introducción: La ureterolitotomía laparoscópica ha surgido recientemente como una nueva opción de tratamiento de los cálculos ureterales de tamaño, dureza o impactación particularmente grandes. Mostramos una indicación de ureterolitotomia laparoscópica para resolver un caso de litiasis olvidada y gravemente obstructiva. Paciente y técnica: Un varón de 64 años fue tratado mediante litotricia extracorpórea de un cálculo de uréter distal derecho, y se le encontró simultáneamente un cálculo impactado en uréter iliaco izquierdo, en la confluencia de una duplicidad ureteral incompleta, cuyo tratamiento prefirió posponer. Ocho años después, el mismo cálculo causaba una masiva dilatación, con mala función del pielón superior y función conservada en el pielón inferior de ese riñón. En dos intentos de ureteroscopia retrógrada resultó imposible alcanzar el cálculo. Se realizó ureterolitotomía laparoscópica transperitoneal, con un catéter doble J en posición y con tres accesos de 10 mm. Se identificó el uréter muy dilatado y mediante una ureterotomía en V, se movilizó y extrajo el cálculo. Se dejó intubado el uréter y se cerró la ureterotomía con puntos intracorpóreos. La estancia postoperatoria fue muy corta y la recuperación funcional se consideró satisfactoria. Discusión: Si las opciones de tratamiento habitual (litotricia extracorpórea y ureteroscopia con litotricia intracorpórea) han fracasado, la ureterolitotomía laparoscópica es una opción menos invasiva que la ureterolitotomía abierta. Sus indicaciones son muy restringidas, pues las posibles dificultades de la técnica exigen una considerable experiencia laparoscópica

Introduction: Laparoscopic ureterolithotomy recently rises as a new option in the treatment of ureteral calculi, particularly those of the greatest size, hardness or impactation. We describe such an indication to resolve a case of forgotten for more than eight years and severely obstructive ureteral stone. Patient and method: A 64 years-old male received extracorporeal shock wave lithotripsy for a right distal ureteral stone and, simultaneously, a left impacted iliac ureteral calculi was discovered, at the confluence of an incomplete duplication of the ureter, for which treatment was recommended, but deferred by the patient. Eight years after, the same stone caused a massive dilatation with poor function of the upper pole moiety and slightly preserved function of the lower pole moiety of the left kidney. Two intents of retrograde ureteroscopy failed because of impossibility to reach the stone. Transperitoneal laparoscopic ureterolithotomy was performed in lateral decubitus position, with double J in place and three 10 mm ports. After identification of the dilated ureter, an V-shape ureterothomy was made and the stone mobilized and extracted. The ureter was stented and the ureterothomy closed with intracorporeal suture. The patient had a postoperative stage of four days and a mild functional recovery. Discussion: If the usual treatment options (extracorporeal lithotripsy and ureteroscopy with intracorporeal lithotripsy) failed, then laparoscopic ureterolithotomy is less invasive than open ureterolithotomy. However, the indications of laparoscopic ureterolithotomy are restricted because substantial laparoscopic experience is needed to cope with possible technical difficulties

Masa en el cordón espermático como primera manifestación de una vasculitis sistémica: Presentacion de un caso y revisión de la literatura / Spermatic cord mass as a manifestation of systemmic vasculitis: a case report and review of the literature

Describimos una vasculitis granulomatosa necrotizante del cordón espermático en un varón de 35 años que presentó tres años antes un accidente cerebrovascular agudo (ACVA) de etiología no filiada. La forma de presentación clínica fue una masa no dolorosa en región testicular izquierda. El diagnóstico fue realizado en biopsia del cordón espermático. Se comentan las características clínicas, radiológicas e histológicas de este caso y se revisa la literatura (AU)

We report a case of necrotizing granulomatous vasculitis in the spermatic cord in a 35-year-oldman with an antecedent of brain stroke 3 years before. The clinical manifestation was as a painless left scrotal mass. The diagnosis was established by histological examination of the spermatic cord. We discuss the physical findings, radiological features and pathological findings, reviewing the literature for previous similar cases (AU)

Linfoma No Hodgkin B de célula grande primario de vejiga. Presentación de un caso / Primary Non Hodgkin large B-cell lymphoma of bladder. Report of a case

Introducción: Los linfomas primarios del tracto genitourinario son raros. Dentro de ellos, los de vejiga son extremadamente infrecuentes, con características clínico-radiológicas indistinguibles de las de los carcinomas uroteliales, por lo que para su diagnóstico es necesario estudio histopatológico, inmunohistoquímico y molecular. Presentamos un caso de este tipo de tumor. Caso clínico: una mujer de 80 años consultó en nuestro hospital por hematuria. La ecografía abdomina ly la cistoscopia mostraron una tumoración vesical infiltrante en pared lateral derecha. Tras biopsia por resección transuretral, se diagnosticó como linfoma no Hodgkin B de célula grande, que fue considerado primario de vejiga al no existir signos clínicos ni radiológicos de afectación en otras topografías. La paciente recibió quimioterapia y está actualmente libre de enfermedad tras 9 meses de seguimiento. Comentario: ante una tumoración vesical de características histopatológicas poco habituales, la posibilidad de un linfoma debe ser tenida en cuenta, ya que el tratamiento quimioterápico permite conservar la vejiga (AU)

Introduction: primary genitourinary lymphomas are uncommon. Among them, bladder lymphomas are extremely unusual tumors, with clinico-radiological features similar to urothelial carcinomas of bladder. Histopathological, immunohistochemical and molecular studies are compulsory for the diagnosis. We report a case of this tumor. Clinical case: An 80-year-old woman was admitted to our hospital with hematuria. Abdominal ultrasound and cystoscopy revealed an infiltrating bladder tumor involving the right lateral wall. After transuretral biopsy, a diagnosis of non-Hodgkin large B-cell lymphoma was made. Neither clinical symptoms nor radiological findings showed disseminated disease, indicating that the tumor was localized in the bladder. After chemotherapy, the patient is disease-free after 9 months follow-up. Comment: if a bladder tumor with uncommon histopathological features is found, lymphoma should be excluded, because chemotherapy avoids cystectomy (AU)

Pielonefritis xantogranulomatosa difusa con fístula renocólica inadvertida durante más de dos años / Diffuse xanthogranulomatous pyelonephritis with a renocolic fistula neglected for more than two years

INTRODUCCIÓN: Aunque la fístula renocólica es una complicación conocida de la forma difusa de la piel o nefritis xantogranulomatosa, describimos un caso inusual, por la pobreza de los síntomas y la larga evolución de la enfermedad antes de ser diagnosticada. CASO CLÍNICO: Una mujer de 75 años fue vista en el Servicio de Urgencias con fiebre y malestar general. El examen y las pruebas de laboratorio mostraron una masa en el hemiabdomen izquierdo y anemia, y en la radiografía de abdomen y la tomografía computarizada se encontró un cálculo grande así como una gruesa pielonefritis xantogranulomatosa con fístula renocólica. Una revisión de su historial médico mostró una radiografía de abdomen realizada más de dos años antes por su médico de familia, con el mismo cálculo y gas en la cavidad renal. Se le realizó nefrectomía, pancreatectomía caudal y colectomía parcial con buenos resultados. COMENTARIO: La pielonefritis xantogranulomatosa es una forma infrecuente de infección crónica del riñón y de los espacios retroperitoneales. Este caso poco sintomático que destruyó el riñón e indujo una fístula renocólica, es inusual porque pasó inadvertido durante años a pesar de una manifestación clínica y radiológica bastante típica

INTRODUCTION: Although reno-colic fistula is a well-known complication of the diffuse form of xanthogranulomatous pyelonephritis, the features of the case here presented are unusual because of thepaucity of symptoms and long lasting evolution of the disease before it was diagnosed. CLINICAL CASE: A 75 year-old woman was seen at the emergency room complaining of fever and malaise. Physical and laboratory examination showed anemia and a left abdominal mass, and on X-ray and abdominal CT, a gross stone and huge left renal and extrarenal xanthogranulomatous pyelonephritis with renocolicfistula were disclosed. A review of her clinical record showed an X-ray performed two years before bythe attending family clinician, with identical gross calculi and gas into the kidney. Nephrectomy, caudal pancreatectomy and partial colectomy were accomplished with good results. COMMENT: This case of poor-symptomatic xanthogranulomatous pyelonephritis that destroyed the kidneyand induced a renocolic fistula, is unusual because it was neglected for more than two years due to unawareness of the clinical and radiological picture

Amiloidosis vesical primaria / Primary amyloidosis of the bladder

La amiloidosis primaria de la vejiga es una patología rara que se manifiesta con depósitos extracelulares de una proteína fibrilar en forma de substancia amiloide. La clínica de presentación asemeja a un cáncer vesical, debido a que la hematuria es la manifestación clínica más común. La afectación más frecuente en órgano único es la vesical, a pesar de esto, hemos encontrado publicados menos de 100 casos. Presentamos el caso de una mujer con amiloidosis vesical primaria cuyo síntoma fue la hematuria y el examen endoscópico hacía sospechar un tumor vesical (AU)