[Atypical sites of metastatic renal carcinoma. Literature review]. / Carcinoma renal metastásico de localización atípica. Revisión de la literatura.

OBJECTIVE: To review in the literature atypical sites of metastatic renal cell carcinoma, its onset, clinical features, diagnosis, treatment and prognosis. METHODS: To review, using Medline database, atypical sites of metastatic renal cell carcinoma in the last five years Spanish literature. RESULTS: There have been published 15 spanish articles about atypical metastatic renal cell carcinoma in the last five years. Most patients were male with a mean age of 62,3 years and methacronous metastases. Imaging and pathological diagnosis. Main sites: ocular, renal graft, larynx, suprarenal, brain, penis, gastric and pancreatic. Surgical treatment if the surgeon is able to remove the lesion. Inmunotherapy and radiotherapy in the rest of cases. CONCLUSIONS: Renal cell carcinoma represents about 3% of all adult malignancy neoplasms. Its metastatic sites, in order of frequency, are lung, bone and liver, whether synchronic or methacronic. Its location, clinical features, onset, evolution and prognosis is very variable. Individualized diagnostic and therapeutic approach, according to prognostic factors. The knowledge of this atypical sites in patients with renal cell carcinoma in the past can lead us to an earlier diagnosis and treatment which could change the evolution of the illness.

[Female urinary stress incontinence: transobsturator technique]. / Cabestrillo suburetral transobturatriz en el tratamiento de la incontinencia urinaria de esfuerzo femenina.

The wide use of retropubic TVT has been associated with various complications. To avoid these, alternative procedures have been developed and continence rates obtained with these new routes have been quite similar to those after classic TVT. In the transobsturator technique (TOT) described by Delorme and colleagues in 2001, the tape is inserted through the obturator foramens from outside to inside and is positioned without tension under the urethra. Another surgical technique allows the passage of a tape from inside to outside. The aim of this paper is to describe a new, simple surgical technique for the treatment of female urinary stress incontinence and to evaluate its feasibility.

Histiocitoma fibroso maligno vesicoprostático / Malignant fibrous histiocytoma of bladder and prostate

Dentro de los sarcomas vesicales del adulto, el histiocitoma fibroso maligno constituye una variedad histológica extremadamente rara. Presentamos un caso con afectación simultánea de vejiga y próstata en un varón de 25 años, que fue tratado favorablemente con cirugía radical y poliquimioterapia. Así mismo, revisamos la bibliografía existente hasta la fecha sobre estas neoplasias (AU)

Hemangiopericitoma retroperitoneal gigante / Giant retroperitoneal hemangiopericytoma

Presentamos un nuevo caso de hemangiopericitoma retroperitoneal con la peculiaridad del gran tamaño de la tumoración. Debido a esto y al llamativo aporte vascular se procedió a una embolización arterial preoperatoria, que facilitó su extirpación completa. Realizamos una revisión bibliográfica reflejando los aspectos clínicos, patológicos y terapéuticos fundamentales de estos tumores (AU)

[Malignant vesico-prostatic fibrous histiocytoma]. / Histiocitoma fibroso maligno vesicoprostático.

Among the adult bladder sarcomas it's extremely rare as an histological variety the malignant fibrous histiocytoma. We present a case of a 25 years old young male with bladder and prostate both affected, successfully treated with radical surgery and poliquimiotherapy. We also reviewed the bibliography about this neoplasias up to now.

[Giant retroperitoneal hemangiopericytoma]. / Hemangiopericitoma retroperitoneal gigante.

We present a new case of retroperitoneal hemangiopericytoma with the special feature of a big size tumour. Due to this feature and also to the hypervascularitation we proceeded a preoperative arterial embolization that made possible its complete removal. We did a bibliographic review showing the fundamental clinic pathologic and therapeutical basic aspects of this tumours.

Torsión testicular: ¿qué sutura utilizar? / Testicular torsion: wich type of suture must be used?

Presentamos un caso de torsión testicular izquierda ocurrida cuatro meses después de un cuadro similar homolateral en el que se realizó detorsión y fijación bilateral de ambos testículos. La orquidopexia previa se realizó con seda 3-0 y fijación transeptal del testículo contralateral. El antecedente de orquidopexia bilateral no debe influir en el diagnóstico diferencial en el escroto agudo. La fijación creemos que debe realizarse con sutura irreabsorbible en tres localizaciones entre el testículo y el músculo dartos, y se debe realizar exploración del hemiescroto contralateral (AU)

The predictive value of inguinal herniography for the diagnosis and treatment of cryptorchidism.

PURPOSE: We evaluated the role of a patent processus vaginalis for cryptorchidism as well as inguinal herniography as a predictor of the efficacy of human chorionic gonadotropin (HCG) treatment. MATERIALS AND METHODS: We studied 244 boys with unilateral and 66 with bilateral cryptorchidism. All patients underwent inguinal herniography and received HCG. Nonresponders to treatment subsequently underwent orchiopexy, when processus vaginalis status, testicular position and epididymal characteristics were assessed. RESULTS: HCG was effective for 139 of 281 testes (49.5%) with an obliterated and 0 of 95 with a patent processus vaginalis on herniography. We further evaluated herniography in accordance with orchiopexy findings of persistent unilateral and bilateral cryptorchidism in 206 boys (237 testes) after HCG. Herniography findings of processus vaginalis morphology revealed a close correlation with that reported by the surgeon after orchiopexy (p<0.000005). The incidence of a patent processus vaginalis increased as testicular position became more caudal. The processus vaginalis was obliterated in all cases of anorchia. The incidence of more severe epididymal anomalies decreased as the testicular position became more caudal. Epididymal abnormalities were more common when the processus vaginalis was patent. CONCLUSIONS: Pretreatment herniography assessment of processus vaginalis morphology is of prognostic value for predicting the efficacy of hormone treatment, the presence or absence of testes when they are nonpalpable and future fertility.

[Testicular torsion: which suture should be used?]. / Torsión testicular: qué sutura utilizar?

We report a case of left testicular torsion four months after a similar homolateral case in which we did detorsion and bilateral fixation of both testicles. The antecedent orchiopexy was accomplished using 3-0 silk and transseptal fixation of the contralateral testicle. A history of bilateral orchiopexy should nor interfere with diagnosing torsion in the acute scrotum. We recommend the use of nonabsorbable suture material joining the testis to the dartos muscle in 3 locations and the contralateral hemiscrotum must be explored.

[Artificial sphincter implantation in women with urinary incontinence using a combined abdomino-vaginal approach]. / Implantación del esfínter urinario artificial en la mujer con incontinencia urinaria por vía combinada abdomino vaginal.

OBJECTIVE: The artificial sphincter has been utilized for urinary incontinence due to intrinsic sphincteric insufficiency, with good fixation of the urethra and a maximum urethral closing pressure of 20-30 cms H2O, or after failed attempts at correction using other techniques. This procedure is difficult to perform since the patients have generally undergone several operations and it is necessity to prepare the cleavage between the urethra and vagina. We propose a modified combined vaginal and suprapubic approach of the technique described by Appell and Abbassian in 1988 for enhanced exposure of the urethra and bladder neck and easy access. METHODS: The modified combined abdominovaginal approach has been utilized in 18 females aged 16-62 years since 1995. RESULTS: 16 patients were continent (88%). One patient (5.5%) required removal of the artificial sphincter due to infection. Another patient (5.5%) has mild incontinence and requires 2 pads a day. Four patients (22%) with detrusor instability are receiving anticholinergics. Three patients (16%) with an underlying neurogenic incontinence require intermittent catheterization. Fourteen patients (77.7%) have type III stress urinary incontinence. We performed the Kelly procedure in 10 patients (55.5%), the Marshall-Marcetti-Kranz in 7 (38.8%), Gittes in 3 (16.6%), and 2 patients (11.1%) had a sling procedure. Two techniques were simultaneously performed in some patients. CONCLUSIONS: Although the number of patients in this series is small, the fact that only one case required removal of the artificial spincter due to infection indicates that this is a useful alternative approach that significantly facilitates implantation of the artificial sphincter in these patients.

[Penile fracture involving cavernous bodies and urethra]. / Fractura de pene con afectación de cuerpos cavernosos y uretra.

Reports on fracture of the penis are scarce in the spanish urological literature and in most cases injury appear limited to the corpora cavernosa. In this report a case of rupture of both corpora cavernosa and the urethra during sexual intercourse is presented. Early surgical treatment rendered good results. A literature review on currently recommended diagnostic and treatment practices is presented.

[New report of epididymal adenomatoid tumor. Infrequent pathology]. / Nueva aportación de un tumor adenomatoide de epididimo. Una patología poco frecuente.

Case report of a 42-year old patient with an epididymal adenomatoid tumour found after a three-month history of increased left hemiscrotum and scrotal discomfort. Definite diagnosis was arrived at following surgical exeresis and pathoanatomical study. The etiopatogenesis, clinical presentation and management are all analyzed. Since urological incidence is very low within intrascrotal processes, we believe it is important to understand the condition so that a differential diagnosis from other inflammatory processes can be established; also the convenience of a much more aggressive attitude in scrotal diseases is restated due to the low morbidity of this type of surgery.

[A fibroepithelial polyp of the ureter. A report of 2 new cases]. / Pólipo fibroepitelial del ureter. Aportación de dos nuevos casos.

Primal neoplasias of the ureter are very rare and account for less than 1% of all genitourinary tumours. Only 20% of them are benign, and the fibroepithelial lineage is the more frequent. We contribute two cases of fibroepithelial polyps of the ureter; a brief comment on the etiology of these lesions, the routine diagnosis procedures and current therapeutical options is presented. Due to breakthroughs in radiologic and endoscopic techniques for the upper urinary tract, a more precise pre-operative diagnosis of these lesions has been achieved as well as a more conservative therapy which avoids incorrect and unnecessary nephroureterectomies, so frequent in past times, considering the benign nature of this unusual pathology.