[Sarcomatoid renal carcinoma]. / Carcinoma renal sarcomatoide.

OBJECTIVE: Sarcomatoid carcinoma of the kidney is a unique, uncommon variety of parenchymatous tumors and is considered to have a worse prognosis by stage than the other histological types. Our experience is reviewed and compared with the larger series reported in the literature. METHODS: Of 101 cases of renal carcinoma submitted to surgery at our department from January, 1990 to December, 1996, there were 4 cases of sarcomatoid carcinoma of the kidney. We compared our cases with the larger series (91 cases in total) reported in the literature for incidence, age, distribution according to sex, tumor size, location, form of presentation, stage and survival. RESULTS: Sarcomatoid renal carcinoma accounts for 1% to 6% of parenchymatous tumors of the kidney according to the different series. The mean age at presentation was 48 years (range 27-61) in our series; there was no prevalence according to sex or location; the renal capsule was not compromised in 3 out of the 4 cases; only one case showed regional lymph node involvement and no case showed distant metastasis at the time of diagnosis. Although these tumors are diagnosed in the advanced stages, two of our cases were incidentally discovered in the early stages (one died 13 months thereafter and the other is alive at 42 months). Patients that are alive and disease-free can only be found in the patient group with stage I or II tumor. All patients with tumor stage III and IV have died. This histological type has a worse prognosis. Most of the series report a mean survival of 5 months. CONCLUSIONS: Sarcomatoid renal carcinoma accounts for 1%-6% of all renal carcinomas. It can present at any age and has a very poor prognosis, with a mean survival of 6 months.

[Albuginea plication in the treatment of penile curvature]. / Plicatura de la albugínea como tratamiento para la incurvación de pene.

Presentation of the results obtained by our team in the treatment of 22 cases of penial incurvation (11 congenital and 11 secondary to Peyronie's Disease) using the albuginea plication technique. Evaluation of post-operative results taking into account both subjective (extent of satisfaction, comfort during the post-operative etc.) and objective (post-operative complications, degree of correction, reincurvation or failure etc.) factors was done by a follow-up programme through the out-patients practices using a Questionnaire-Survey system. Presentation of results obtained and detailed discussion of each case. The conclusions were as follows: Albuginea plication is a safe technique that achieves total penis redressment, with no post-operative complications. The extent of satisfaction and success obtained exceed 85%, and can be increased by improving the pre-operative selection and providing correct and precise information on what can be resolved with this technique.

[Non-instrumental traumatism of the urethra: our experience]. / Traumatismos no instrumentales de la uretra: nuestra experiencia.

OBJECTIVES: To report our experience in the diagnosis and treatment of this type of urologic trauma. The results are analyzed in order to determine the best therapeutic approach and the literature reviewed. METHODS: The series comprised 9 males; 6 had rupture of the posterior urethra and 3 had anterior urethral trauma. Four cases underwent suprapubic drainage and delayed definitive treatment; early realignment of the urethra was performed in 3 cases, and the only patient with a penetrating injury immediately underwent a repair procedure. Urethral urethrotomy sufficed in one patient with partial rupture of the anterior urethra. Delayed treatment consisted of end-to-end anastomosis; one patient required pubic partial resection. RESULTS: Good results were achieved by end-to-end anastomosis; 3 patients have been discharged and one required internal urethrotomy. Two of these patients have remained impotent. The patients submitted to early realignment of the urethra are managed well with regular dilatation and internal urethrotomy in some cases. CONCLUSIONS: We found suprapubic drainage and delayed repair superior to early realignment in those cases with posterior urethral injury. In our view, delayed end-to-end anastomosis, with or without pubic resection can be performed in virtually all cases. We advocate immediate repair of penetrating injuries to the anterior urethra.

[Intestinal obstruction caused by transitional carcinoma]. / La obstrucción intestinal por carcinoma transicional.

OBJECTIVES: To draw attention to the possibility that distant intestinal metastasis can arise from transitional urothelial carcinoma located in the bladder. METHODS: Two female patients developed distant metastasis during treatment of the tumor by transurethral resection of the bladder. RESULTS: Following complicated transurethral resection with perforation of the peritoneal cavity, the patients developed intestinal obstruction from metastatic transitional cell carcinoma. CONCLUSIONS: Direct or distant seeding of tumor cells on previously undamaged peritoneal serosa produced with the resectoscope may not be exceedingly unlikely.

[Renal cystic mass: the diagnostic dilemma]. / Masa quística renal: el dilema diagnóstico.

OBJECTIVE: To determine the best diagnostic approach and management of cystic renal mass. METHODS: Four cases are described and the literature reviewed. RESULTS: Of the 4 cases of cystic renal mass, 2 had a previous history of renal trauma. Puncture and aspiration of the cystic content were performed in three cases; cytology was positive for malignancy in one, which was confirmed by the histologic analysis. Two cases underwent nephrectomy although one of the post-traumatic cases had a preoperative diagnosis of pararenal pseudocyst. The literature review showed a significant controversy exists concerning the diagnostic approach and treatment. CONCLUSIONS: We advocate an approach free from tenets, where all the appropriately chosen diagnostic tools may be valid. If doubts persist after diagnostic evaluation, nephrectomy should be performed.

[Inverted Y ureteral duplication]. / Duplicación ureteral en Y invertida.

We report a case of inverted Y duplication of the ureter, incidentally found in a man consulting for hematuria. The diagnostic and therapeutic aspects are briefly discussed.

[Prostate-bladder rhabdomyosarcoma: therapeutic approaches]. / Rabdomiosarcoma prostatovesical: actitudes terapéuticas.

We describe the unusual case of a young male who presented lower urinary tract obstruction secondary to a bladder-prostate embryonal rhabdomyosarcoma. Initially he was treated with multiagent chemotherapy and radiotherapy in an attempt to preserve bladder function, but eventually radical cystoprostatectomy was warranted to control tumor growth. The objectives of chemotherapy and radiotherapy, partial and/or radical surgery and the main prognostic factors are briefly discussed.

[The urologist in ambulatory care]. / El urólogo en el ambulatorio.

Although it is widely extended, outpatient urological practice is rarely referred to in the scientific publications. Our experience in the outpatient center is presented. The characteristics of the outpatient, the facilities of the area where we practice and the unique doctor-patient relationship are described. A proposal is made to provide a wide range of diagnostic and therapeutic urological services at the outpatient centers.

[Digestive hemorrhage in renal cell carcinoma]. / Hemorragia digestiva en el carcinoma de células renales.

We report a rare case of a young male patient with a single duodenal metastasis from a renal cell tumor nine years after nephrectomy that presented as upper GI tract hemorrhage. The clinical and pathological aspects of this uncommon intestinal metastasis are briefly discussed.

[Bladder inverted papilloma. Report of a new case]. / Papiloma invertido vesical. A propósito de un nuevo caso.

Herein we describe an additional case of inverted papilloma of the bladder that had been incidentally discovered. Cystoscopy was required to make the diagnosis, which was confirmed anatomo-pathologically. The clinical and histological features of this disease entity are briefly discussed.

[Von Hippel Lindau disease in urologic patients]. / La enfermedad de von Hippel Lindau en pacientes urológicos.

A case of von Hippel Lindau disease in a young female is described. Currently, surgery is unwarranted, since these patients only present cystic disease. However, subsequent control evaluations may indicate surgery since these cysts can easily progress to a carcinoma. The literature is briefly reviewed, with special reference to the therapeutic aspects of current day patient management.

[The psoas bladder-hitch. An illustrative case]. / Vejiga psoica. Caso ilustrativo.

The psoas bladder hitch is an invaluable surgical procedure in the treatment of lesions of the lower ureteral third and transplantation with short ureters. We briefly review this procedure and describe an illustrative case of ureteroneocystostomy of the right lumbar ureter.

[When should bone scanning be carried out in prostatic cancer?]. / Cuándo realizar rastreo óseo en el cáncer de próstata?

Adenocarcinoma of the prostate is the tumour most frequently involved in bone metastasis. With the come back of curative-intended radical surgery to treat this tumour, the diagnostic methodology that tries to rule out or check the existence of dissemination in order to eliminate those surgical procedures which are entirely unnecessary recuperates special relevance. The most simple and effective method to discover the metastasis is through a bone scan. Prostate specific antigen levels have a great predictive value for metastasis, although there are some tumours that for obscure reasons do not express this antigen. Therefore, practice of a routine bone scan is currently considered mandatory in order to diagnose the tumour, most specially when radical prostatectomy is being considered. In patients with disseminated tumours who are receiving medical therapy, the routine practice of periodic bone scanning is not indicated, unless an specific type of therapeutical approach is intended on those metastasis that are resistant to therapy. Subjects undergoing radical prostatectomy are controlled with prostate antigen evaluations. When these levels increase or when clinical symptoms of suspected bone affectation appear, the procedure followed in order to verify the existence of metastasis is bone scanning.

[Testicular metastasis of renal adenocarcinoma. Report of a case]. / Metástasis testicular de adenocarcinoma renal. Presentación de un caso.

Metastatic tumors of the testis are extremely rare, if we exclude leukemias and lymphomas. The present article reports a case of renal adenocarcinoma metastatic to the testis that presented with paraneoplastic syndrome, hematuria and a palpable testicular mass. The literature on metastatic tumors of the testis is briefly reviewed.

[Retroaortic renal vein. Report of a case]. / Vena renal retroaórtica. Presentación de un caso.

The retroaortic renal vein is a malformation characterized by the presence of a vessel that drains the left renal blood up to the inferior vena cava crossing behind the aortic artery. Unfamiliarity with this condition may lead to an incorrect diagnosis of adenopathy in patients with testicular and/or renal neoplasia and increases the number of complications of surgery of the left renal pedicle. Herein we describe a 71-year-old male with a retroaortic renal vein that had been detected during radical surgery for a left renal tumor.

[Spontaneous retroperitoneal hemorrhage]. / Hemorragia retroperitoneal espontánea.

We report three cases of spontaneous retroperitoneal hemorrhage; two patients had a ruptured angiomyolipoma and one had a Wünderlich's syndrome. They had presented with the so called Lenk's triad. The definitive diagnosis was made on the CT findings and treatment was by nephrectomy (cases 1 and 2) and simple evacuation of the hematoma (case 3). The clinical, diagnostic and therapeutic aspects are briefly discussed.

[Lipoma of the spermatic cord. Report of a case]. / Lipoma de cordón espermático. A propósito de un caso.

Thirty per cent of spermatic cord tumors are malignant and the remaining 70% are benign, lipoma being the most common benign lesion. Although it is the most common tumor of the spermatic cord, its clinical presentation is rare. It is an extratesticular intrascrotal mass that grows relatively rapidly, with no other clinical symptoms or signs. The clinical diagnosis is confirmed by US, CT and, occasionally, by exploratory scototomy. Treatment is by surgical excision.

[Cytology positive for malignant cells in hydrocele secondary to testicular seminoma]. / Citología positiva a células malignas en hidrocele secundario a seminona testicular.

Finding tumor cells in the fluid of hydrocele secondary to testicular tumor is rare and may be due to the fact that hydrocele fluid cytology has not been studied systematically. The presence of malignant cells in the hydrocele fluid may be ascribed to two mechanisms: retrograde lymphatic flow from the infiltrated retroperitoneal lymph nodes or from tumor directly invading the tunica albuginea and vaginalis testis, with cells passing into the cavity of the vaginalis. Only two cases of hydrocele secondary to testicular seminoma with vaginalis fluid cytology positive for malignant seminomatous cells have been previously reported in the literature. To our knowledge, the case reported herein is the third. These three cases are briefly discussed.

[Fraley's syndrome: a case report]. / Síndrome de Fraley: presentación de un caso.

A case of Fraley's syndrome is described. Intermittent nephralgia was the presenting symptom. The diagnosis was made on the radiologic finding of obstruction of the infundibulum arising from vascular compression. The diagnostic and therapeutic aspects of this uncommon cause of obstruction of the infundibulum are discussed.

[Multifocal renal adenocarcinoma. Considerations regarding a case]. / Multifocalidad en el adenocarcinoma renal. Consideraciones a propósito de una observación.

There is scant reference to the clinicopathological feature of multifocality in renal adenocarcinoma. Inadvertently disregarding this feature may result in local recurrence in those patients in whom partial nephrectomy is contemplated.