[Soft tissue metastases by micropapillary bladder carcinoma. Metastatic disease]. / Metástasis en partes blandas por un carcinoma micropapilar de vejiga.

Micropapillary transitional cell carcinoma is a rare (incidence of 0.7%) and highly aggressive variant of bladder carcinoma. Morphologically, it is characterized by small tight clusters of neoplastic cell floating in clear spaces resembling lymphatic channels. Its usual presentation is like a high grade and stage carcinoma and most often is associated with a variable component of conventional carcinoma or other variants. The usual sites of bladder cancer metastases are the lymph nodes, lungs, bone and liver. Soft tissues metastases from transitional cell carcinoma of the bladder occur infrequently. We report the cases of a 77-year-old man presenting with an abdominal soft tissue mass a six years after local excision of a micropapillary bladder carcinoma.

[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.

[Verrucous carcinoma of the penis arising from a lichen planus. A true preneoplastic lesion?]. / Carcinoma verrucoso de pene desarrollado sobre un liquen plano. Una auténtica lesión preneoplásica?

INTRODUCTION: Up to 30% of squamous cell carcinomas of the penis arise from a lichen sclerosus, but very few reports in which lichen planus was the preexisting lesion have been published. We report a male with verrucous carcinoma of penis that developed in an area of lichen planus. CLINICAL CASE: A 53-year-old male presented with an exophytic tumor on the glans penis that had been present for about 6 months. The lesion developed in a previously biopsied area of lichen planus hypertrophicus. After excision, histological diagnosis was verrucous carcinoma. COMMENT: The development of any subtype of squamous cell carcinoma of penis in a lichen planus can be coincidental, or a neoplastic transformation of lichen planus can take place.

[Valdivia supine position as the best option for percutaneous surgery of renal calculi in morbidly obese patients]. / La posición supina de Valdivia como mejor opción para la cirugía percutánea de los cálculos renales en el paciente con obesidad mórbida.

INTRODUCTION: Treatment of the morbidly obese patient with symptomatic renal calculi is an interesting urological challenge. Extracorporeal shock wave lithotripsy is frequently not possible for several reasons, and many urological centers match these patients as one of the residual indications for open surgery of kidney lithiasis. MATERIAL AND METHOD: Two patients with body mass index more than 50 k/m2 and symptomatic kidney stones were treated with percutaneous nephrolithotomy in the supine position described by Valdivia (slightly lateralized supine decubitus). Standard instrumentation for percutaneous surgery and the semi-rigid ureteroscopy were used, through an Amplatz sheath proximally transfixed with a polypropylene stitch, so to avoid its lost under the fatty skin. Both patients were rendered stone-free without significant morbidity. DISCUSSION: The advantages of Valdivia position in those patients are clear, both for the commodity of the surgical team, -because time may be spared and help needed to mobilized the patient is less-, as well as for what concerns to the anesthesia, because cardio-respiratory restrictions created by a general anesthesia in prone are greater and more severe in the obese patient. This position seems to be more suitable than other ones recommended for percutaneous nephrolithotomy in the obese patients, such as prone decubitus on a surgical saddle, or lateral decubitus position, that may compromise the radiological control of the operation.

Chromosomal translocation 3;22 in an infertile man.

OBJECTIVE: To present the first case of an infertile male with a normal phenotype and chromosomal translocation 3;22. DESIGN: Case report. SETTING: POVISA Medical Center. PATIENT(S): A 45-year-old man with primary infertility for 13 years and with different partners; the patient has a family history of recurrent miscarriages and low fertility. INTERVENTION(S): Lymphocytic karyotype and electron microscopy. MAIN OUTCOME MEASURE(S): Physical examination and semen analysis. RESULT(S): The semen analysis revealed oligoasthenoteratospermia. The lymphocytic karyotype detected a translocation 3;22, and electron microscopy showed a lack of the central microtubule pair and peripheral doublet. CONCLUSION(S): An association between translocation 3;22 and other abnormalities in infertile males has been reported, but no such association has ever been described in men whose only clinical manifestation is infertility.

[Treatment of pyelocaliceal transitional cell carcinoma with partial nephrectomy]. / Tratamiento del carcinoma de células transicionales pielocalicilar con nefrectomía parcial.

Nephroureterectomy is the choice treatment for tumours of the upper urinary tract. Conservative surgical management is sometimes warranted due to the risk of renal failure or just as palliative treatment. Contribution of two cases of transitional tumours in the pyelocalyceal zone treated with partial nephrectomy, and discussion of the usefulness and indication of conservative surgery for these tumours.

[Urethral substitution with synthetic material]. / Sustitución de la uretra con material sintético.

In spite of the numerous surgical techniques described, management of urethral stenosis continues to be an unresolved problem. Free graft urethroplasty is indicated in selected cases and several organic and synthetic materials have been described for this use. Our group reviews the synthetic alloplasts used for partial or total replacement of the male urethra. The search for an appropriate alloplast for urethral replacement has been rather frustrating. Complication rates are still too high to allow routine usage. The most encouraging results are those with new absorbable materials which cause minimal inflammatory reactions of a foreign body type. These are readily available and allow urethral replacement using tissues regenerated from removed ends.

[Detubulised ureterosygmoidostomy]. / Ureterosigmoidostomía destubulizada.

There is renewed interest on ureterosymoidostomy due to the application of gut detubulisation principles that provide a low pressure reservoir in continuity with the colon. We contribute our experience with 15 detubulised ureterosymoidostomies, 13 of the Mainz II type and 2 with dual detubulisation. Mean follow-up was 12.6 months. Continence was achieved in all cases immediately. Total continence rate was 92.8% with mean frequency of passing stools/urine of 4.4 times during daytime and 2.5 times at night. Detubulised ureterosymoidostomy is a means for an effective continent internal urinary bypass that provides patients with good quality of life.

[Radical cystectomy with orthotopic urinary diversion in patients older than 70 years of age]. / Cistectomía radical con derivación urinaria ortotópica en pacientes mayores de 70 años.

Some patients with infiltrant vesical cancer can be treated successfully with radical cysto-prostatectomy and urinary by-pass and increasingly more authors publish successful results in series of selected patients over 70- and 80-year old. Between February 1988 and July 1996, 18 radical cystectomies with orthotopic urinary by-pass were performed in the Urology Service, Policlinico Vigo, in patients over 70 (range 70-84 years), with an operative mortality rate of 11%. 8 patients (44%) developed immediate complications and 9 patients (50%) presented distant complications. Overall mortality in our series was 33.3% and survival 66.6% after a mean follow-up of 30.7 months. We believe orthotopic-continent by-pass is a valid alternative with operative mortality and complication rates similar to those of ileal ducts, with the advantage for the patient of avoiding permanent urinary stoma.

[Unilateral renal cystic disease]. / Enfermedad quística renal unilateral localizada.

Unilateral and localized cystic disease of the kidney, is characterized by the substitution of either all or a portion of one of the kidneys, by no encapsulated, multiple simple cysts. We present a case--to our knowledge the first in the Spanish bibliography-, of this rare benign condition that needs to be recognized to be differentiated from more transcendent ones. Contrary to autosomal dominant polycystic kidney disease, it is unilateral, it is not familiar, and it is neither progressive nor associated with renal insufficiency or with cysts in other abdominal organs. Lack of encapsulation allows, in general, to distinguish it from multilocular cystic nephroma and cystic renal carcinoma.

[Laparoscopic pyelolithotomy in a pelvic kidney]. / Pielolitotomía laparoscópica en riñón pelviano.

INTRODUCTION: Pelvic renal ectopia bearing stones is a particularly rare case of complex calculi. Several percutaneous and laparoscopic procedures had been proposed in the last years to treat this challenge problem in a minimally invasive way. CLINICAL CASE: We describe the procedure of laparoscopic pyelolithotomy under general anesthesia, using three port sites, in a male patient with symptomatic stones in a left pelvic kidney with normal function. Two stones were successfully removed, with the help of flexible nephroscopy through a port, and the pyelotomy was closed with intracorporeal suture. COMMENT: Laparoscopic pyelolithotomy of a pelvic kidney is a minimally invasive technique that is not difficult to perform, making laparotomy unnecessary. Laparoscopic technique must be take into account when dealing with the infrequent complex stone patient candidate to an open stone surgery. A review of the Spanish bibliography shows this to be the second reported case of pelvic kidney calculi treated by laparoscopic pyelolithotomy.

[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.

[Chronic irritative urinary syndrome. Diagnostic value of cystoscopy, urinary cytology and biopsy]. / Síndrome irritativo urinario crónico. Valor diagnóstico de la cistoscopia, citología urinaria y biopsia.

Chronic irritative urinary syndrome (CIUS), is a diagnostic concern for urologists from the moment that it becomes chronic and there is no etiologic diagnostic available. The objective of this study is to find out the diagnostic value of Cystoscopy, Urinary cytology and Biopsy of the vesical mucosa. A prospective, descriptive study was conducted in 30 patients who developed CIUS. Cystoscopy showed visible damage in 7 patients (31.8%); urinary cytology, 22 patients with cytologic changes (73.3%); and vesical biopsy, 24 patients with histologic changes (80.0%). The authors conclude that CIUS occurs more frequently in females than in males, the age range with higher incidence are 43 and 45 years. The most common diagnosis are unspecific chronic inflammatory changes followed by metaplasia.

[Stenosis of the membranous bulbar urethra: our experience in termino-terminal urethroplasty]. / Estenosis de la uretra bulbo membranosa: nuestra experiencia en uretroplastia término terminal.

Between May 1989 and August 1996, the Urology Service, Polyclinic of Vigo, performed 24 termino-terminal urethroplasties in patients with bulbar or membranous urethral stenosis, measuring 1 to 2.5 cm long. The most frequent etiologies were iatrogenic (9/24) and traumatic rupture (7/24). After a mean follow-up of 5.4 years (1 year minimum) the success rate was 80% (19/24) and 20% (5/24) for restenosis, which were resolved through a single procedure of endoscopic internal urethrotomy in 3 of the 5 cases.

[Acute urologic symptoms associated with uterine myoma]. / Sintomatología urológica aguda asociada al mioma uterino.

While prevalence of uterine leiomyoma is high, its presentation affecting the urinary tract is uncommon. We contribute the cases of two adult women with symptoms of nephritic colic and urinary retention. Etiology was acute obstruction of the urinary tract due to previously asymptomatic urine myomas. Management in both patients was surgery, using hysterectomy to resolve the urinary obstruction. A brief review of the literature is included.

[Bilateral adrenal metastasis as first clinical manifestation of pulmonary carcinoma: report of a case and review of the literature]. / Metástasis adrenal bilateral como primera manifestación clínica de un carcinoma pulmonar: presentación de un caso y revisión de la literatura.

Bilateral adrenal metastases are rare, and the first manifestation from non-small cell lung cancer is also exceptional. We report a case of bilateral adrenal metastases from a poorly differentiated lung adenocarcinoma in a 50 year-old-man. The treatment was local excision of tumor and the diagnosis was histological. We comment the clinical presentation, diagnosis, treatment and evolution of this case, with special attention to the histopathological analysis of this lesion and literature review.

[Expression of CDX2 in urinary bladder and urethra lesions]. / Expresión de CDX2 en lesiones de vejiga urinaria y uretra.

BACKGROUND: CDX1 and CDX2 are transcription factors involved in the development and maintenance of the intestinal epithelial cell. Expression of CDX2 has been reported in normal and metaplastic intestinal epithelium, and in those adenocarcinomas with that cellular origin. We have analyzed the expression of this marker in reactive and tumoral lesions arising in urinary bladder, urethra and urachus. METHOD: CDX2 was investigated through immunohistochemistry on paraffin-embedded tissue, using the labelled streptavidin-biotin method (LSAB2, Dako) with a monoclonal antibody (CDX2-88, BioGenex). RESULTS: Expression of CDX2 was observed in intestinal-type cistitis glandularis, intestinal metaplasia of urinary bladder, bladder adenocarcinoma, mucinous urothelial-type carcinoma of prostatic urethra and urachal mucinous carcinoma. CDX2 was not detected in normal urothelium and prostatic glandular epithelium, Von Brunn nests, typical-type cistitis glandularis, glandular adenosis and transitional carcinoma. CONCLUSIONS: Lesions, both benign and malignant, with enteric-cell morphological features show positivity for CDX2. Expression of this marker is not organ-specific but is just related to a cellular phenotype. Reactivity for CDX2 in an adenocarcinoma can be consistent with an origin in urinary tract or urachus.

[Low grade collecting duct carcinoma of the kidney. Presentation of one case and literature revision]. / Carcinoma renal de los conductos colectores de bajo grado. Presentación de un caso y revisión de la literatura.

Collecting duct renal cell carcinoma is an uncommon variant of renal carcinoma. Typically its behaviour is more aggressive than other forms of renal carcinoma and usually it is diagnosed at advanced stages. A 57-year-old man visited our hospital by right lumbar pain. Abdominal CT showed a enhanced mass on the right kidney. A right partial nephrectomy was done. Histological examination of the surgical specimen showed a low grade collecting duct carcinoma of the kidney. This is a new entity, with unknown behaviour but seems to be less aggressive than classical collecting duct carcinoma of the kidney. The clinical, radiological, pathological and immunohistochemical characteristics of this tumor are reported, and the literature is reviewed.

[Diffuse involvement and rapid progression of high-grade transitional carcinoma in a kidney transplant recipient]. / Afectación difusa y progresión rápida de un carcinoma transicional de alto grado en un paciente trasplantado renal.

In renal transplant patients, an increased risk of cancer has been seen, higher than in the general population, and the more frequent genitourinary neoplasms are the kidney and bladder ones. Moreover, in those patients the pattern of tumor growth is very rapid, with early tendency to local and systemic dissemination. The case here presented, a patient with kidney transplant 3 years before, with high grade, superficial transitional cell carcinoma involving the whole bladder, the pelvis and the ureter of the right native kidney, shown this fast progression. Four months after radical cystectomy plus bilateral nephroureterectomy, the disease progressed to intraperitoneal and hepatic metastases.

[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.