Uncommon renal masses: Perirenal extramedullary hematopoiesis and multiple lymphangiomatosis with a perirenal lymphangioma.

OBJECTIVE: To present two cases of infrequent renal masses, trying to achieve the diagnosis before surgery. METHODS: We describe a case referred from the Department of Hematology in which bilateral perirrenal masses were described in the CT scan; after biopsy they where classified as extramedullary hematopoietic tissue. The other case was a patient presenting to the emergency room with dyspnea. CT Scan showed lungs with multiple cysts, chylothorax and a cystic-solid mass in the left perirenal space. In the lung biopsy they reported lung lymphangiomatosis, so we didn't perform renal biopsy. RESULTS: Most renal masses are renal carcinomas (856%). The less common diagnosis are sarcomas, lymphomas, upper urinary tract transitional cell carcinomas, metastases of other primary tumors, the Erdheim-Chester disease, the Castleman disease and benign tumors. All these diseases might show similar images in the CT scan and MRI, being the biopsy and histological study necessary for the diagnosis CONCLUSIONS: Perirenal extramedullary hematopoiesis and perirenal lymphangioma are rare diseases that need a pathologic study for their diagnosis.

Indication for early cystectomy in nonmuscle-invasive bladder cancer. Literature review. / Indicación de cistectomía precoz en el cáncer vesical no músculo infiltrante. Revisión de la literatura.

CONTEXT: High-risk nonmuscle-invasive bladder cancer is a disease that includes a heterogeneous group of patients, for whom close follow-up is recommended due to the risk of progression to a muscle-invasive tumour. The treatment of choice for these tumours is transurethral resection of the bladder tumour followed by a programme of bacillus Calmette-Guerin instillations. There is a subgroup of patients who have a greater risk of progression and who benefit from early radical treatment. OBJECTIVE: To identify which patient group with nonmuscle-invasive bladder cancer will benefit from early radical treatment. SEARCHING THE EVIDENCE: We performed a literature review to identify the risk factors for progression for these patients and thereby recommend a treatment that improves their survival rate. SYNTHESIS OF THE EVIDENCE: We identified the various prognostic factors associated with tumour progression: the persistence of T1 tumour in re-resection of the bladder tumour, the presence of carcinoma in situ, patients refractory to bacillus Calmette-Guerin treatment, patients older than 70 years, tumours larger than 3cm, the substaging of T1 tumours, the presence of lymphovascular invasion and the presence of a tumour in the prostatic urethra. Similarly, we comment on the advantages of radical versus conservative treatment, considering that the performance of an early cystectomy due to a high-risk noninvasive vesical tumour has a better cancer prognosis than those in which the operation is deferred until the progression. CONCLUSIONS: In this disease, it is important to individualise the patients to provide them personalized treatment. For patients with the previously mentioned characteristics, it is recommended that early cystectomy not be delayed.

[Diagnosis of urethral stenosis and follow-up after Urethroplasty]. / Diagnóstico de las estenosis uretrales y seguimiento después de Uretroplastia.

This article presents a review of the different tests used for the evaluation and follow-up of urethral strictures. Because there is no consensus on how to assess urethral pathology, we reviewed each of the next follow-up tests: questionnaires, uroflowmetry, ultrasound, urethroscopy, urethrogram, CT scan and MRI, outlining their benefits and limitations in the diagnosis and follow-up of urethral stricture. Urethrogram and urethroscopy are the most commonly used tests, as they are those that give us more information on the evaluation of stenosis and for surgery planning. Questionnaires and uroflowmetry play a key role in the follow-up of these patients. Ultrasonography has high sensitivity and specificity for evaluating the spongiofibrosis, however it is not done routinely. The CT/MRI is recommended in the evaluation of pelvic trauma associated with fractures.