[Supernumerary spleen simulating a renal tumor. Case report]. / Bazo supernumerario simulando un tumor renal: a propósito de un caso.

OBJECTIVE: Report one case of ectopic spleen simulating a renal tumor. We performed a review of etiopathogenesis, diagnosis and treatment. METHODS: We present the case of a 54-year-old splenectomized female patient with the incidental diagnosis on ultrasound of a left kidney upper pole mass simulating a renal tumor. RESULTS: After the performance of CT scan, and with the suspicion of renal neoplasia, the patient underwent tumorectomy with the pathologic diagnosis of the specimen compatible with supernumerary spleen. CONCLUSIONS: We emphasize the importance of including pseudo masses of splenic origin in the differential diagnosis of left renal, adrenal and retroperitoneal tumors. We emphasize the importance of CT scan as the imaging test of choice, and gammagraphy as a complementary test. We point out conservative attitude as the most suitable in cases of asymptomatic pseudomass of splenic origin.

Bazo supernumerario simulando un tumor renal: a propósito de un caso / Supernumerary spleen simulating a renal tumor. Case report

Objetivo: Presentar un caso de bazo ectópico simulando un tumor renal. Hacemos una revisión de la etiopatogenia, diagnóstico y del tratamiento. Método: Presentamos a una paciente de 54 años esplenectomizada que se le detecta incidentalmente mediante una ecografía una masa en polo superior del riñón izquierdo simulando un tumor renal. Resultados: Tras la realización de un TAC, y bajo la sospecha de neoplasia renal, se le practicó tumorectomía de la lesión observándose en el diagnóstico histológico posterior pieza compatible con bazo supernumerario. Conclusiones: Resaltamos la importancia de incluir las pseudomasas de origen esplénico dentro del diagnóstico diferencial de los tumores renales, suprarrenales y retroperitoneales izquierdos. Destacamos la importancia del TAC como técnica de elección y de la gammagrafía como estudio complementario. Apuntamos la actitud conservadora como la más idónea en los casos de pseudomasa de origen esplénico asintomática tumor (AU)

Objective: Report one case of ectopic spleen simulating a renal tumor. We performed a review of etiopathogenesis, diagnosis and treatment. Methods: We present the case of a 54-year-old splenectomized female patient with the incidental diagnosis on ultrasound of a left kidney upper pole mass simulating a renal tumor. Results: After the performance of CT scan, and with the suspicion of renal neoplasia, the patient underwent tumorectomy with the pathologic diagnosis of the specimen compatible with supernumerary spleen. Conclusions: We emphasize the importance of including pseudo masses of splenic origin in the differential diagnosis of left renal, adrenal and retroperitoneal tumors. We emphasize the importance of CT scan as the imaging test of choice, and gammagraphy as a complementary test. We point out conservative attitude as the most suitable in cases of asymptomatic pseudomass of splenic origin (AU)

[Idiopathic scrotal edema: report of two cases]. / Edema del escroto agudo idiopático: presentación de dos casos.

OBJECTIVE: To report two cases of acute idiopathic scrotal edema. METHODS: We describe the cases of two 12-year-old male patients presenting at the emergency department of our hospital with pain, edema and erythema in one hemiscrotum without history of trauma. RESULTS: On physical examination both patients showed red hemiscrotum skin and increase of the size with normal testicles and epididymis. With the diagnosis of acute scrotum testicular ultrasound were performed and showed heterogeneous edema of the scrotal skin with increased in Doppler flows and normal testicles. CONCLUSIONS: Acute idiopathic scrotal edema is a self-limited pathology which basically affects children before puberty and should be included in the differential diagnosis of acute scrotum to avoid aggressive interventions.

Edema del escroto agudo idiopático: presentación de dos casos / Idiopathic scrotal edema: report of two cases

OBJETIVO: Presentar dos casos de edema de escroto agudo idiopático. MÉTODOS: Describimos los casos de dos varones de 12 años que acudieron al Servicio de Urgencias de nuestro hospital presentando dolor, edema y eritema en un hemiescroto sin recordar antecedente traumático previo. RESULTADOS: A la exploración de ambos pacientes se puede observar los hemiescrotos enrojecidos y aumentados de tamaño pero con testes y epidídimos normales. Con el diagnóstico de escroto agudo se les efectuaron unas ecografías en las que se pudo ver un edema heterogéneo en piel escrotal con flujo Doppler aumentado y testes ecográficamente normales. CONCLUSIONES: El edema de escroto agudo idiopático es una patología autolimitada que afecta básicamente a niños prepúberes que debe ser incluida en el diagnostico diferencial del escroto agudo para evitar intervenciones más agresivas innecesarias

OBJECTIVE: To report two cases of acute idiopathic scrotal edema. METHODS: We describe the cases of two 12-year-old male patients presenting at the emergency department of our hospital with pain, edema and erythema in one hemiscrotum without history of trauma. RESULTS: On physical examination both patients showed red hemiscrotum skin and increase of the size with normal testicles and epididymis. With the diagnosis of acute scrotum testicular ultrasound were performed and showed heterogeneous edema of the scrotal skin with increased in Doppler flows and normal testicles. CONCLUSIONS: Acute idiopathic scrotal edema is a self-limited pathology which basically affects children before puberty and should be included in the differential diagnosis of acute scrotum to avoid aggressive interventions

[Bilateral synchronic testicular tumor with germ cell intratubular neoplasia foci: case report]. / Tumor testicular bilateral sincrónico con focos de neoplasia intratubular de células germinales: presentación de un caso.

OBJECTIVE: To report one case of bilateral synchronic testicular tumor with germ cell intratubular neoplasia foci affecting both testicles. METHODS: We describe the case of a 29-year-old male presenting with a painless tumor in the left testicle for a month. With the suspect of testicular tumor scrotal ultrasound, tumor markers and extension study to rule out metastasis were performed. RESULTS: Ultrasound showed a hypertrophic left testicle with a lesion suspect for neoplasia, and incidental diagnosis of a hypoechoic lesion with augmented Doppler flow within the right testicle. Bilateral orchyectomy was performed with the pathologic diagnosis of classic seminoma with germ cell intratubular neoplasia foci in both testicles. Treatment was completed with two cycles of chemotherapy. CONCLUSIONS: Bilateral synchronic testicular tumors are very rare. The most frequent histological type is classic seminoma. The diagnosis and treatment are similar to unilateral testicular tumors except certain cases in which partial excision of the testicle may be considered.

[Results of the surgical treatment of benign prostatic hyperplasia in geriatric patients]. / Resultados del tratamiento quirúrgico de la patología prostática benigna en pacientes geriátricos.

OBJECTIVES: To evaluate the effect of age in morbidity-mortality and outcomes of the surgical treatment of benign prostatic hyperplasia (BPH). METHOD: We performed a retrospective analysis of the medical records of 305 patients over 70 years undergoing surgery for BPH between 1999-2003, grouped in four categories depending on ages 70-80 years and over 80, and type of surgery (transurethral resection or open prostatectomy). The variables evaluated were: American society of anesthesiologists (ASA) operative risk classification, surgical indication, preoperative factors, postoperative outcome and follow-up. Statistical analysis was carried out with the Anova and chi-square tests (p = 0.05). RESULTS: Open prostatectomy was performed in 59.1% of the cases and transurethral resection in the other 40.9%. 98.4% of the patients showed some degree of comorbidity. Indwelling transurethral catheter was the main clinical feature of patients undergoing surgery over 80 years of age; the main characteristic in patients between 70-80 years was the existence of severe symptoms. Urological complications appeared more frequently than general complications (14% vs. 10.1%). The most frequent urological complications were mild, mainly inflammatory-infectious diseases. Urological and general complications were more frequently observed in the open prostatectomy group, with no differences between ages. Patient satisfaction was high in the four groups (84.8%-96.2%). No case of perioperative mortality happened and only one patient died in the immediate post operative period. CONCLUSIONS: We think the differences observed cannot be attributed to chronological age as clinical risk factor. Therefore, these patients could benefit of a definitive surgical treatment which will improve their quality of life.

Tumor testicular bilateral sincrónico con focos de neoplasia intratubular de células germinales: presentación de un caso / Bilateral synchronic testicular tumor with germ cell intratubular neoplasia foci: case report

OBJETIVOS: Presentar un caso de tumor testicular bilateral sincrónico con focos de Neoplasia Intratubular de Células Germinales (NICG) en ambos testículos. METODOS: Describimos el caso de un varón de 29 años que presenta tumoración indolora de un mes de evolución en teste izquierdo. Bajo la sospecha de tumor testicular se le realiza una ecografía escrotal, una determinación de marcadores tumorales y un estudio de extensión tumoral. RESULTADOS: En la ecografía se puede ver un teste izquierdo hipotrófico con lesión sospechosa de neoplasia e, incidentalmente, un testículo derecho con una lesión hipoecoica y aumento de flujo doppler. Se le practicó una orquiectomía bilateral con el diagnóstico de anatomía patológica de seminoma clásico con focos de Neoplasia Intratubular de Células Germinales (NICG) en ambos testículos y se completó el tratamiento con 2 ciclos de quimioterapia. CONCLUSIONES: Los tumores testiculares bilaterales sincrónicos son muy infrecuentes. El tipo histológico más frecuente es el seminoma clásico. El diagnóstico y tratamiento es similar al de los tumores testiculares unilaterales excepto en determinados casos en los que se puede plantear la resección parcial del testículo (AU)

OBJECTIVE: To report one case of bilateral synchronic testicular tumor with germ cell intratubular neoplasia foci affecting both testicles. METHODS: We describe the case of a 29-year-old male presenting with a painless tumor in the left testicle for a month. With the suspect of testicular tumor scrotal ultrasound, tumor markers and extension study to rule out metastasis were performed. RESULTS: Ultrasound showed a hypertrophic left testicle with a lesion suspect for neoplasia, and incidental diagnosis of a hypoechoic lesion with augmented Doppler flow within the right testicle. Bilateral orchyectomy was performed with the pathologic diagnosis of classic seminoma with germ cell intratubular neoplasia foci in both testicles. Treatment was completed with two cycles of chemotherapy. CONCLUSIONS: Bilateral synchronic testicular tumors are very rare. The most frequent histological type is classic seminoma. The diagnosis and treatment are similar to unilateral testicular tumors except certain cases in which partial excision of the testicle may be considered

Resultados del tratamiento quirúrgico de la patología prostática benigna en pacientes geriátricos / Results of the surgical treatment of benign prostatic hyperplasia in geriatric patients

OBJETIVOS: Valorar el efecto de la edad en la morbi-mortalidad y en el resultado del tratamiento quirúrgico de la hiperplasia benigna de próstata. METODOS: Se ha realizado un estudio retrospectivo, 1999-2003, con una muestra de 305 pacientes mayores de 70 años de edad, con diagnóstico histológico de hiperplasia benigna de próstata intervenidos por resección transuretral de próstata o cirugía abierta. Valorando en cuatro grupos de pacientes, entre 70-80 años de edad y mayores de 80 años de edad para ambas técnicas quirúrgicas, las siguientes variables: ASA, indicación quirúrgica, factores relacionados con la cirugía, la evolución postoperatoria y en el seguimiento. Se ha utilizado como estadísticos el test Anova y χ2 con un nivel de confianza del 95%. RESULTADOS: En nuestra serie se llevó a cabo cirugía abierta en el 59.1% de los casos y resección transuretral de próstata en el 40.9%. El 98.4% de los pacientes presentaba algún grado de comorbilidad. La sonda vesical permanente era la principal indicación quirúrgica en pacientes mayores de 80 años de edad, mientras que el prostatismo severo lo era para los pacientes entre 70-80 años de edad. Las complicaciones urológicas son más frecuentes que las complicaciones generales, 14% y 10.1% respectivamente. Las complicaciones urológicas más frecuentes son las menos graves, sobre todo inflamatorio-infecciosas. Además se observa que las complicaciones urológicas y las generales se dan sobre todo en el grupo de cirugía abierta sin encontrar diferencias significativas según el grupo de edad. La satisfacción es elevada en todos los grupos (84.8%-96.2%). No ocurrió ningún éxitus perioperatorio, y sólo un paciente falleció en el postoperatorio inmediato. CONCLUSIONES: Pensamos que las diferencias observadas no deben atribuirse a la edad cronológica per se entendida como factor de riesgo clínico. Por lo tanto, estos pacientes pueden beneficiarse de un tratamiento quirúrgico resolutivo consiguiendo mejorar su calidad de vida (AU)

OBJECTIVES: To evaluate the effect of age in morbidity-mortality and outcomes of the surgical treatment of benign prostatic hyperplasia (BPH). METHOD: We performed a retrospective analysis of the medical records of 305 patients over 70 years undergoing surgery for BPH between 1999-2003, grouped in four categories depending on ages 70-80 years and over 80, and type of surgery (transurethral resection or open prostatectomy). The variables evaluated were: American society of anesthesiologists (ASA) operative risk classification, surgical indication, preoperative factors, postoperative outcome and follow-up. Statistical analysis was carried out with the Anova and chi-square tests (p = 0.05). RESULTS: Open prostatectomy was performed in 59.1% of the cases and transurethral resection in the other 40.9%. 98.4% of the patients showed some degree of comorbidity. Indwelling transurethral catheter was the main clinical feature of patients undergoing surgery over 80 years of age; the main characteristic in patients between 70-80 years was the existence of severe symptoms. Urological complications appeared more frequently than general complications (14% vs. 10.1%). The most frequent urological complications were mild, mainly inflammatory-infectious diseases. Urological and general complications were more frequently observed in the open prostatectomy group, with no differences between ages. Patient satisfaction was high in the four groups (84.8%-96.2%). No case of perioperative mortality happened and only one patient died in the immediate post operative period. CONCLUSIONS: We think the differences observed cannot be attributed to chronological age as clinical risk factor. Therefore, these patients could benefit of a definitive surgical treatment which will improve their quality of life

[Bladder leiomyosarcoma. Case report]. / Leiomiosarcoma vesical. Aportación de un nuevo caso.

OBJECTIVE: We report a new case of bladder leiomyosarcoma in a young female patient. We review its features and different treatment options. METHODS: The patient underwent neoadyuvant chemotherapy and surgical excision. RESULTS: A partial response was achieved with neoadyuvant chemotherapy and remains still alive 60 moths after radical cystectomy CONCLUSION: Despite the poor prognosis of this disease, multimodal treatment may improve results. Neoadyuvant chemotherapy and subsequent radical excision could be a good combination therapy for these aggressive tumors.

[Fournier's gangrene]. / Gangrena de Fournier.

OBJECTIVES: We report a retrospective review of the case series of Fournier's gangrene treated in our department from November 1996 to October 2004. METHODS/RESULTS: We studied nine male patients with ages between 21 and 85 years (mean 55 years). 66% of the patients had associated risk factors, and the underlying cause was identified in 56% of the cases. Mean hospital stay was 21 days and two of the patients died from the disease. CONCLUSIONS: Fournier's gangrene is an infection with a very fast evolution, producing necrotizing fascitis of the external genitalia and perineum. It has a high mortality rate, mainly if diagnosis and treatment are deferred. This last includes wide spectrum antibiotic coverage, surgical treatment with debridement and drainage, and, in many cases, a second surgical intervention for reconstructive plasties.

Leiomiosarcoma vesical. Aportación de un nuevo caso / Bladder leiomyosarcoma. Case report

OBJETIVO: Presentamos un nuevo caso de leiomiosarcoma vesical en una mujer joven. Revisamos sus características y sus diferentes opciones terapéuticas. MÉTODO: La paciente recibió quimioterapia neoadyuvante y posteriormente cirugía radical. RESULTADOS: Tras la quimioterapia neoadyuvante se consiguió una respuesta parcial, permaneciendo libre de enfermedad 60 meses tras el tratamiento quirúrgico. CONCLUSIÓN: A pesar del mal pronóstico de esta enfermedad, el tratamiento multimodal puede mejorar los resultados. La quimioterapia neoadyuvante y posterior excisión quirúrgica puede ser una buena combinación terapéutica para estos tumores agresivos

OBJECTIVE: We report a new case of bladder leiomyosarcoma in a young female patient. We review its features and different treatment options. METHODS: The patient underwent neoadyuvant chemotherapy and surgical excision. RESULTS: A partial response was achieved with neoadyuvant chemotherapy and remains still alive 60 moths after radical cystectomy. CONCLUSION: Despite the poor prognosis of this disease, multimodal treatment may improve results. Neoadyuvant chemotherapy and subsequent radical excision could be a good combination therapy for these aggressive tumors

Gangrena de Fournier / No disponible

OBJETIVOS: Presentamos una revisión de los casos de gangrena de Fournier tratados en nuestro servicio desde noviembre de 1996 hasta octubre de 2004. MÉTODO/RESULTADOS: Estudiamos nueve pacientes, todos varones, con edad comprendida entre 21 y 85 años (media 55). En el 66% tenían factores de riesgo y en el 56% de los casos se identificó la causa subyacente. Su estancia media fue de 21 días y destacamos que se produjeron dos defunciones. CONCLUSIÓN: La gangrena de Fournier es una infección de muy rápida evolución que cursa con fascitis necrotizante de los genitales externos y el periné. Tiene una alta mortalidad, sobre todo, si se demora su diag- nóstico y tratamiento. Éste se basa en una cobertura antibiótica agresiva de amplio espectro, en un tratamiento quirúrgico con desbridamiento y drenaje, y, en muchos casos, un segundo tiempo quirúrgico para las plastias correctoras (AU)

OBJECTIVES: We report a retrospective review of the case series of Fournier’s gangrene treated in our department from November 1996 to October 2004. METHODS/RESULTS: We studied nine male patients with ages between 21 and 85 years (mean 55 years). 66% of the patients had associated risk factors, and the underlying cause was identified in 56% of the cases. Mean hospital stay was 21 days and two of the patients died from the disease. CONCLUSIONS: Fournier’s gangrene is an infection with a very fast evolution, producing necrotizing fascitis of the external genitalia and perineum. It has a high mortality rate, mainly if diagnosis and treatment are deferred. This last includes wide spectrum antibiotic coverage, surgical treatment with debridement and drainage, and, in many cases, a second surgical intervention for reconstructive plasties (AU)

[Solitary fibrous tumor of the tunica vaginalis testis]. / Tumor fibroso solitario de la túnica vaginal.

OBJECTIVES: We report one case of solitary fibrous tumor of the tunica vaginalis, a benign paratesticular lesion. METHODS: Surgical exploration with intraoperative biopsy and excision of the lesion was undertaken, leaving the testicle and epididymis undamaged. RESULTS: Intraoperative biopsy revealed the presence of fibrous tissue without malignant cellularity. Pathological diagnosis on the surgical specimen was solitary fibrous tumor of the tunica vaginalis. The patient remains asymptomatic and disease-free one year after treatment. CONCLUSIONS: Almost all testicular masses are malignant, but in order to avoid a non-indicated orchyectomy, one should be cautious with the finding of a paratesticular lesion of probable benign nature on ultrasound or during surgery.

[Migration of an intrauterine contraceptive device into the urinary bladder: report of one case]. / Migracion intravesical de un dispositivo intrauterino: presentacion de un caso.

OBJECTIVES: To report one case of uterine perforation and migration into the urinary bladder of an intrauterine contraceptive device. METHODS/RESULTS: 42-year-old female patient who presents with lower urinary tract irritative syndrome in association to recurrent urinary tract infection. Ultrasound revealed apart of an intrauterine device inside the bladder, device which was inserted years before and was supposed to have come out spontaneously. Urethrocystoscopy with extraction of the intravesical segment and hysteroscopy with extraction of the intrauterine segment were carried out. CONCLUSIONS: The postoperative period was satisfactory and patient is currently asymptomatic. Radiological or ultrasound controls should be performed in the follow-up of patients with intrauterine contraceptive devices. The inability to locate an intrauterine contraceptive device in a patient who did not realize it coming out should be considered an uterine perforation until proved otherwise.

Migracion intravesical de un dispositivo intrauterino: Presentacion de un caso / Migration of an intrauterine contraceptive device into the urinary bladder: Report of one case

OBJETIVO: Se describe un caso de perforación uterina y migración vesical de un dispositivo intrauterino (DIU.) METODOS/ RESULTADOS: Paciente de 42 años que consulta por síndrome irritativo del tracto urinario inferior en relación con infección urinaria recidivante. En estudio ecográfico se detecta porciónde DIU endovesical insertado años antes y del que se suponía había sido expulsado espontáneamente. Se procedió bajo anestesia a uretrocistoscopia y extracción del segmento endovesical del DIU y por histeroscopia a extracción del segmento intrauterino. CONCLUSIONES: El postoperatorio se desarrolló de manera satisfactoria y actualmente la paciente está asintomática.. Debería realizarse un control radiológico o ecográfico en el seguimiento de pacientes con DIU. El no localizar un dispositivo intrauterino en una paciente que no se ha dado cuenta de su expulsión nos orienta al diagnóstico de perforación uterina mientras no se demuestre lo contrario (AU)

No disponible

Ectopia renal cruzada con fusión: presentación de un caso / Crossed fused renal ectopia: a case report

OBJETIVOS: aportación de un caso de ectopia renal cruzada con fusión descubierta de forma casual en urgencias por dolor abdominal. MÉTODO: se presenta un caso de un paciente de 46 años que acude a urgencias por dolor abdominal y que en los estudios de imagen realizados se descubre la existencia de una extopia renal cruzada. En este caso se descubren también anomalías óseas asociadas. RESULTADOS: la ectopia renal cruzada es una anomalía congénita poco frecuente y en la mayoría de lso casos suele presentarse con fusión de ambos riñones. Puede asociarse a anomalías congénitas de otros órganos. CONCLUSIÓN: la abstención terapéutica suele ser la norma, a no ser que existan complicaciones o patología sobreañadida (AU)

No disponible