[Primary localized amyloidosis of glans penis. A new case and review of the literature]. / Amiloidosis primaria localizada en glande peneano. Caso clínico y revisión de la literatura.

Primary localized amyloidosis urinary tract is rare. Localized amyloidosid only glands is a very rare entity. The clinical impression may resemble neoplastic disease but the diagnosis is confirmed by histochemical study. Biopsy of the lesion revealed dermal deposits of amorphous eosinophilic material. A case of patient with primary amyldosis of glands penis is reported. The literature is reviewed and the diagnostic and therapeutic options are discussed. This is the seventh reported case of localized amyloidosis of the glands penis.

[Buck's fascia rupture in blunt penile injury]. / Rotura de la fascia de buck en traumatismo peneano cerrado.

Contribution of one case report of closed penial traumatism, in upright penis during intercourse which, apart from affectation of the albuginea of the cavernous bodies, resulted in fracture of Buck's fascia and was treated in a conservative manner. When the fascia is compromised, the picture presents specific clinical characteristics.

[Spontaneous extraperitoneal bladder perforation caused by bladder carcinoma]. / Perforación vesical extraperitoneal espontánea por carcinoma vesical.

We show a case of spontaneous extraperitoneal vesical perforation due to presence of a bladder cancer with urotelial origin.

[Results of ambulatory major surgery in urology, within an integrated unit]. / Realización de cirugía mayor ambulatoria en urología, dentro de una unidad integrada.

OBJECTIVE: To contribute our experience in the performance of ambulatory major surgery, through the creation of an integrated unit. Such units take advantage of existing resources both in terms of space and materials, as well as personnel, without the need to open separate ambulatory major surgery units that would involve greater resources expenditure. MATERIAL AND METHODS: 48 patients undergoing ambulatory major urology surgery were analyzed. The patients were admitted the same morning of the procedure and then, after leaving the operating theatre, they were moved to the reanimation room and later to the urology ward, where they were evaluated by the urologist on duty and discharged. A few days later the patients returned to the outpatient's clinic for re-evaluation. RESULTS: 48 patients underwent surgery, 44 male and 4 female. Mean age of patients was 34 (3-86) years. The procedures most frequently performed were: hydrocelectomy, vaginal peritoneum duct closure, orchiopexy, ureterorenoscopy due to ureteral lithiasis, internal urethrotomy, varicocelectomy, vesical tumor resection and circumcision in children. Only in two cases, hospital stay was longer than 12 hours and there was only one re-admission. CONCLUSIONS: Ambulatory major surgery integrated units may allow to perform this type of surgery in small units, with little resources and with a volume of patients not sufficient to create an independent unit.

[Relapse in brucella orchiepididymitis]. / Recidiva en orquiepididimitis brucelosa.

This paper describes a case of systemic brucellosis accompanied by brucellar orchitis that resolved favourably. There was however a relapse at the testicular level inappropriately treated that triggered a new episode of systemic brucellosis.

[Atypical stromal hyperplasia of the prostate (stromal proliferation of uncertain malignant potential)]. / Hiperplasia estromal atípica de próstata (proliferación estromal de potencial maligno incierto).

OBJECTIVE: To describe a case of atypical stromal hyperplasia of the prostate. METHODS: A 62-year-old patient presented with prostatic syndrome. Physical examination disclosed an indurated prostate and PSA determination showed increased levels. A prostate biopsy was performed. RESULTS: The histological analysis showed atypical stromal proliferation with elongated nuclei and immunohistochemical expression for vimentine, smooth muscle actin and CD34 with glandular hyperplasia. The diagnosis was that of atypical stromal hyperplasia of the prostate (prostatic stromal proliferation of uncertain malignant potential). CONCLUSIONS: A careful histological study is necessary to make the correct diagnosis of prostatic stromal proliferation of uncertain malignant potential. CD34 expression is a characteristic finding. As its name indicates, its evolution is uncertain.

[Partial nephrectomy in partially differentiated cystic nephroblastoma]. / Nefrectomía parcial en nefroblastoma quístico parcialmente diferenciado.

OBJECTIVE: To report on a case of cystic partially differentiated nephroblastoma in an adult female patient that was treated by partial nephrectomy. METHODS/RESULTS: A 21-year-old female patient with multicystic lesions was submitted to partial nephrectomy involving the lower pole of the right kidney. The presence of embryonal blastema in the septae that separated the cysts was diagnostic of cystic partially differentiated nephroblastoma. CONCLUSIONS: Cystic partially differentiated nephroblastoma can be considered to be a well differentiated variant of nephroblastoma (Wilms' tumor). Due to its benign nature, treatment is by conservative renal surgery, if technically possible.

[Bilateral hydronephrosis with papillary polypoid cystitis]. / Hidronefrosis bilateral en cistitis papilarpolipoide.

OBJECTIVE: A case of papillary polypoid cystitis with bilateral hydronephrosis and an intravesical mass is presented. METHODS/RESULTS: A routine ultrasound evaluation performed in a 64-year-old diabetic female revealed an intravesical mass and bilateral hydronephrosis. There was extensive bladder involvement and the ureteral orifices could not be visualized during endoscopy. Transurethral resection of the lesion was performed. The histological examination showed papillary polypoid cystitis. The urinary cultures were positive, antibiotic therapy was instituted and the hydronephrosis, disappeared. CONCLUSIONS: Papillary polypoid cystitis, although a benign and superficial lesion, can be diffuse, involve both ureteral orifices and cause hydronephrosis.

[Surgical treatment of kidney pelvis spontaneous rupture]. / Tratamiento quirúrgico en rotura espontánea de pelvis renal.

OBJECTIVE: To describe a case of spontaneous rupture of the renal pelvis that required treatment by open surgery due to its size. METHODS/RESULTS: We describe a case of spontaneous rupture of considerable size in the renal pelvis arising from a calculus in the pelvic ureter. A significant urinary extravasation was produced which became infected. Percutaneous drainage was performed. Repair of the reptured renal pelvis and stone removal were achieved by open surgery. CONCLUSIONS: Open surgery may occasionally be required to repair a spontaneous rupture of the renal pelvis due to the size of the lesion, the importance of the urinary extravasation or other related factors that warrant this approach.

[Rupture of kidney pelvis in retroperitoneal fibrosis]. / Rotura de pelvis renal en fibrosis retroperitoneal.

OBJECTIVE: To present a case of rupture of the renal pelvis in a patient with idiopathic retroperitoneal fibrosis and no previous dilatation of the left excretory system. METHODS/RESULTS: A patient with retroperitoneal fibrosis underwent surgery for ureterolysis and intraperitonealization of the right ureter. The control IVP was unremarkable. One week later, however, rupture of the left renal pelvis was observed, which was resolved by placement of a ureteral catheter. CONCLUSIONS: In the case described, rupture of the renal pelvis without previous obstruction could be due to ureteral akinesia associated with the retroperitoneal fibrosis.

[The bilateral ureteral metastasis of a medullary carcinoma of the thyroid]. / Metástasis ureteral bilateral de carcinoma medular de tiroides.

OBJECTIVE: To describe a case of bilateral hydronephrosis arising from a medullary thyroid carcinoma that had metastasized to both ureters. METHODS/RESULTS: A case of bilateral hydronephrosis in an asthmatic 54-year-old female patient who consulted for recurrent bilateral nephric colic is described. The patient presented with severe impairment of renal function. Patient evaluation with imaging techniques could not identify the cause of the hydronephrosis. Bilateral ureteral catheterization improved renal function. The patient died from an episode of bronchospasm. Autopsy revealed a medullary carcinoma of the thyroid that had metastasized to several organs, including both ureters, causing hydronephrosis. CONCLUSIONS: In a patient presenting with bilateral hydronephrosis without a diagnosis of a primary tumor, it is difficult to suspect an underlying metastasis to the ureter. The imaging techniques are unable to detect small metastatic lesions.

[Is there a place for radical prostatectomy without lymphadenectomy?]. / Hay un lugar para la prostatectomía radical sin linfadenectomía?

OBJECTIVES: Herein we present the procedure we have followed to determine N+ low-risk factors which allow us to identify those patients with prostate cancer in whom radical perineal prostatectomy (RPP) can be performed without a previous staging lymphadenectomy, thereby maintaining the oncological principles but with less morbidity. METHODS: In a series of 88 patients who underwent RPP, we identified an N+ low-risk factor group; i.e., patients with clinically localized tumor of the prostate gland, a Gleason score of < or = 7 and PSA < or = 10 ng/ml. The foregoing criteria were based on the findings reported by Stamey and the status of the lymph nodes of our own series of radical prostatectomies. RESULTS: In 71 of the 88 patients with a follow up of more than one year, RPP was performed after laparoscopic pelvic lymphadenectomy. Of these 71 patients, 17 (19.3%) presented the above-mentioned low-risk characteristics and were all pN-. Since then, the subsequent patients who met this low-risk criteria (n = 17; 19.3% of the total) were submitted to RPP alone without previous staging lymphadenectomy. The rate of positive margins in this group was 17.6%, all cases maintaining PSA within feminization levels after a mean follow-up of 21.7 months. Considering the overall series, 38.6% of the patients could have avoided lymphadenectomy according to our criteria. CONCLUSIONS: We have found RPP without previous staging lymphadenectomy to be a valid therapeutic option for patients with clinically localized prostate cancer, preoperative PSA < or = 10 ng/ml and a Gleason score of < or = 7. According to our data, this group accounts for approximately 40% of the patients in whom radical prostatectomy had been recommended.

[Pacinian neurofibroma of the vulva]. / Neurofibroma pacciniano de la vulva.

OBJECTIVE: To report on a rare case of Pacinian neurofibroma of the vulva. METHODS: A 27-year-old patient who presented with a vulvar tumor is described. Patient evaluation showed no other remarkable findings. RESULTS: The nodule was resected without difficulty. The histopathological analysis-demonstrated Pacinian neurofibroma with abundant concentric laminar structures. The immunohistochemical (CD34+), ultrastructural and histological analyses showed perineural cells. No signs of neurofibromatosis were found. CONCLUSIONS: Pacinian neurofibroma may present in the vulva and could probably arise from the so-called perineural fibroblasts.

[Mucinous adenocarcinoma of the prostate]. / Adenocarcinoma mucinoso de próstata.

OBJECTIVE: To describe a case of mucinous adenocarcinoma of the prostate. METHODS: A 77-year-old patient presented with urinary complaints. Patient evaluation showed an enlarged prostate and increased PSA levels. RESULTS: A prostate biopsy showed a glandular neoplasm with extensive mucinous differentiation and abundant lacunae of PAS positive mucus (mucinous adenocarcinoma). The patient remains well one year after the diagnosis. CONCLUSIONS: Mucinous adenocarcinoma of the prostate is a rare variant that should be recognized and does not necessarily imply a worse prognosis than other carcinomas of the prostate.

[Bladder adenocarcinoma with glandular cystitis areas]. / Adenocarcinoma vesical con áreas de cistitis glandular.

OBJECTIVE: To describe a case of adenocarcinoma of the urinary bladder. METHODS: A 63-year-old patient consulted for gross hematuria. Ultrasound evaluation showed a bladder neoplasm and CT demonstrated extensive infiltration of adjacent structures. RESULTS: Histological analysis of the TUR specimen confirmed a muscle infiltrating glandular neoplasm (adenocarcinoma) with diffuse areas of cystitis glandularis. Patient evolution has been poor and he is now in the end stage of the disease. CONCLUSIONS: The morphology is not unlike that of colorectal carcinoma, which should be distinguished. The association of areas of cystitis glandularis indicates a possible relationship.

[Differential diagnosis of intrascrotal calcification: lithiasis attached to hydrocele wall]. / Diagnóstico diferencial de calcificación intraescrotal: litiasis adherida a pared de hidrocele.

OBJECTIVE: To report a case of scrotal calculus in a hydrocele, attached to the parietal portion of the tunica vaginalis, complicating the differential diagnosis. METHODS: A 54-year-old patient with a clinical diagnosis of hydrocele is described. Ultrasound confirmed the diagnosis and demonstrated a calcified structure in the hydrocele fluid, attached to the parietal portion of the tunica vaginalis. A calculus of 1.7 cm diameter was found during the surgical procedure. CONCLUSION: The presence of calculus in a hydrocele does not change the prognosis or treatment of this condition, although some doubts may arise during sonographic assessment if it is attached to the parietal portion of the tunica vaginalis.

[Non-specific granulomatous epididymitis]. / Epididimitis granulomatosa inespecífica.

OBJECTIVE: A case of granulomatous epididymitis is presented. METHODS: A 23-year-old patient consulted for nonspecific pain in the left supratesticular region. Physical examination showed a hard, indolent, enlarged epididymis. An ultrasound scan revealed normal testes with small bilateral hydrocele and left epididymal enlargement with calcifications. Resection was performed via the inguinal approach. RESULTS: The histopathological analysis demonstrated intense granulomatous reaction with multinucleated giant cells and foci of spermatozoal remnants. Staining for fungi and acid-fast bacilli were negative. CONCLUSION: The condition was diagnosed as nonspecific granulomatous epididymitis.