Fibrous pseudotumor affecting the tunica vaginalis, epididymis and seminal duct.

OBJECTIVE: To report one case of advanced fibrous pseudotumour. METHODS: A 34-year-old patient presented with a painless lump on the right side of the scrotum. Examination revealed a hard tissue thickening attached to the tail and body of the right epididymis. The results of the ultrasound study were not clear and multiple differential diagnosis were considered. The lesion was surgically removed by partial right epididymectomy and resection of the affected tunica vaginalis and ductus deferens for anatomopathological study. RESULTS: The histopathological study revealed an evolved fibrous pseudotumour with bone metaplasia. CONCLUSION: Fibrous pseudotumour is a benign paratesticular lesion that grows slowly and painlessly. It is usually diagnosed by chance or in associated processes such as hydrocele. Differential diagnosis with malignant tumors avoids unnecessary radical treatment.

Pseudotumor fibroso que afecta a la túnica vaginal, el epidídimo y la vía seminal / Fibrous pseudotumor affecting the tunica vaginalis, epididymis and seminal duct

OBJETIVO: Presentamos un caso evolucionado de Pseudotumor fibroso. MÉTODOS: Varón de 34 años que consulta por bultoma escrotal derecho indoloro presentando a la exploración un engrosamiento de consistencia indurada fusionado a la cola y el cuerpo de epidídimo derecho. El estudio ecográfico no fue aclaratorio planteando múltiples diagnósticos diferenciales. Se realizó exéresis de la lesión precisando una epididimectomía parcial derecha y resección de la túnica vaginal y el conducto deferente afectados para su estudio anatomopatológico. RESULTADOS: El estudio histopatológico de la pieza quirúrgica correspondía a un pseudotumor fibroso evolucionado, con metaplasia ósea. CONCLUSIÓN: El pseudotumor fibroso es una lesión paratesticular benigna, de crecimiento lento e indoloro. El diagnóstico suele ser por hallazgo casual o por procesos asociados como el hidrocele. El diagnóstico diferencial con los tumores malignos evita tratamientos radicales innecesarios (AU)

OBJECTIVE: To report one case of advanced fibrous pseudotumour. METHODS: A 34-year-old patient presented with a painless lump on the right side of the scrotum. Examination revealed a hard tissue thickening attached to the tail and body of the right epididymis. The results of the ultrasound study were not clear and multiple differential diagnosis were considered. The lesion was surgically removed by partial right epididymectomy and resection of the affected tunica vaginalis and ductus deferens for anatomopathological study. RESULTS: The histopathological study revealed an evolved fibrous pseudotumour with bone metaplasia. CONCLUSION: Fibrous pseudotumour is a benign paratesticular lesion that grows slowly and painlessly. It is usually diagnosed by chance or in associated processes such as hydrocele. Differential diagnosis with malignant tumors avoids unnecessary radical treatment (AU)

Penile metastasis from primary bladder tumour.

OBJECTIVE: We present a case of cutaneous metastasis caused by a bladder tumor. METHODS: 68 year old male, diagnosed with an ISUP high grade urothelial carcinoma, affecting the whole bladder wall, including the perivesicular fat and macroscopic metastasis in the left ilio-obturator chain (T3N2MO), who presents painless induration on the dorsal surface of the glans penis with non-exudative ulcerated areas, evolving over several months. Given the negative serology result, the lesion was biopsied for anatomopathological study. RESULTS: The histopathological study of the lesion corresponded to a cutaneous metastasis from high grade urothelial carcinoma. CONCLUSION: Approximately 370 cases of penile metastasis have been described and the primary tumor is located in the bladder in 30-35% of them. Presentation of these lesions is very heterogeneous and requires anatomopathological study of the lesion for definitive diagnosis.

Metástasis peneana de un tumor primario vesical / Penile metastasis from primary bladder tumour

OBJETIVO: Presentamos un caso de una metástasis cutánea originada desde un tumor vesical. MÉTODOS: Varón de 68 años diagnosticado de un carcinoma urotelial de alto grado de la ISUP con afectación de toda la pared vesical incluida la grasa perivesical y macrometástasis en la cadena ilio-obturatriz izquierda (T3N2MO) que presenta una induración en la cara dorsal del glande, no dolorosa y con áreas ulceradas no exudativas, de varios meses de evolución. Dado el resultado negativo de la serología, se biopsió la lesión para su estudio anatomopatológico. RESULTADOS: El estudio histopatológico de la lesión correspondía a una metástasis cutánea de carcinoma urotelial de alto grado. CONCLUSIÓN: Existen aproximadamente 370 casos de metástasis peneana descritos y en el 30-35% de los casos el tumor primario se localiza en la vejiga. La presentación de estas lesiones es muy heterogénea precisando para el diagnóstico definitivo el estudio anatomopatológico de la lesión (AU)

OBJECTIVE: We present a case of cutaneous metastasis caused by a bladder tumor. METHODS: 68 year old male, diagnosed with an ISUP high grade urothelial carcinoma, affecting the whole bladder wall, including the perivesicular fat and macroscopic metastasis in the left ilio-obturator chain (T3N2MO), who presents painless induration on the dorsal surface of the glans penis with non-exudative ulcerated areas, evolving over several months. Given the negative serology result, the lesion was biopsied for anatomopathological study. RESULTS: The histopathological study of the lesion corresponded to a cutaneous metastasis from high grade urothelial carcinoma. CONCLUSION: Approximately 370 cases of penile metastasis have been described and the primary tumor is located in the bladder in 30-35% of them. Presentation of these lesions is very heterogeneous and requires anatomopathological study of the lesion for definitive diagnosis (AU)

Embolización de aneurisma calcificado de arteria renal en paciente monorreno / Calcified renal artery aneurism embolization in a solitary kidney

OBJETIVO: Revisar la presentación, diagnóstico y tratamiento de una entidad poco frecuente como los aneurismas de la arteria renal.MÉTODOS: Presentamos el caso de un paciente monorreno con un aneurisma renal calcificado sintomático.RESULTADOS: Los aneurismas de la arteria renal pueden provocar hipertensión, hematuria, dolor en flanco, o ser totalmente asintomáticos. Las causas más frecuentes son laarteriosclerosis y la displasia fibromuscular y el diagnóstico se basa en la tomografía computerizada y en la angiografía. El tratamiento puede ser quirúrgico, endovascular o expectante.CONCLUSIONES: Los aneurismas de la arteria renal son una patología sobre la que, por su baja prevalencia, no existen pautas claras de actuación. El número de casos diagnosticados ha aumentado en las últimas décadas y el tratamiento endovascular se muestra como una buena opción(AU)

OBJECTIVE: To review presentation, diagnosis and treatment of renal artery aneurysms, a very uncommon disease.METHODS: We report the case of a male with a calcified renal artery aneurysm in a solitary kidney.RESULTS: Symptomatic effects may be hypertension, hematuria or flank pain. Arteriosclerosis and medial dysplasia are the most frequent causes and diagnosis is based on CT scan and angiography.CONCLUSIONS: The renal artery aneurysm is a disease with low prevalence and there is no clear protocol for management. The number of cases has increased over the last decades and endovasculrar treatment is a good therapeutic option(AU)

[Posterior nutcracker syndrome: retroaortic renal vein associated with arteriovenous fistula and renal cancinoma. Report of a case and review of literature]. / Síndrome del cascanueces posterior: vena renal retroaórtica asociada a fístula arteriovenosa y carcinoma renal. A propósito de un caso y revisión de la literatura.

Vascular retroperitoneal alterations are little frequent and nevertheless, more diagnosed. We presented a case of association very little frequents in which a vascular congenital malformation is related to the presence of a renal arteriovenous fistula and a left renal carcinoma in a patient who only presented hematuria. These vascular variations must be considered at the moment for planning a surgery with the purpose of making it safer and to avoid complications. The case is discussed and literature is reviewed.

Síndrome del cascanueces posterior: Vena renal retroaórtica asociada a fístula arteriovenosa y carcinoma renal. A propósito de un caso y revisión de la literatura / Posterior nutcracker syndrome: retroaortic renal vein associated with arteriovenous fistula and renal cancinoma. Report of a case and review of literature

Las alteraciones vasculares del retroperitoneo son poco frecuentes y sin embargo, cada vez más diagnosticadas. Presentamos un caso de asociación muy poco frecuente en el que se relaciona una malformación congénita vascular con la presencia de una fístula arteriovenosa renal y un carcinoma renal izquierdo en una paciente que sólo presentó hematuria. Estas variaciones vasculares deben ser consideradas en el momento de planificar una cirugía con la finalidad de hacerla más segura y con menos complicaciones. Se discute el caso y se revisa la literatura (AU)

Vascular retroperitoneal alterations are little frequent and nevertheless, more diagnosed. We presented a case of association very little frequents in which a vascular congenital malformation is related to the presence of a renal arteriovenous fistula and a left renal carcinoma in a patient who only presented hematuria. These vascular variations must be considered at the moment for planning a surgery with the purpose of making it safer and to avoid complications. The case is discussed and literature is reviewed (AU)

[Our experience in the treatment of staghorn calculi (1987-2004). Review of our results]. / Nuestra experiencia en el tratamiento de la litiasis coraliforme (1987-2004). revisión de los resultados.

OBJECTIVES: The objective of this work is to analyze the treatment of staghorn calculi at our Department of Urology. We have to know the recent development of endoscopic surgery (percutaneous renal surgery) and external shock wave lithotripsy. METHODS: We reviewed the surgical management of staghorn calculi during the period between 1987 and 2004. RESULTS: Percutaneous renal surgery was performed successfully in 24.1% of the cases. Persisting residual fragments appeared in 75.9% and were treated by ESWL or second endoscopic surgery. CONCLUSIONS: Percutaneous renal surgery may be considered the technique of choice to treat staghorn calculi. Endoscopic surgery has good results and little complications with low morbidity. In other cases the treatment is combined therapy, percutaneous renal surgery and ESWL.

Nuestra experiencia en el tratamiento de la litiasis coraliforme (1987-2004). Revisión de los resultados / Our experience in the treatment of staghorn calculi (1987-2004). Review of our results

Objetivo: Analizar los resultados del tratamiento de la litiasis coraliforme en nuestro servicio atendiendo a los avances tecnológicos que se han producido en los últimos años destacando el papel fundamental que supone el desarrollo de la cirugía endoscópica y de la litotricia extracorpórea por ondas de choque. Métodos: Hemos revisado todos los pacientes tratados de litiasis coraliforme en nuestro servicio entre los años 1987 y 2004. Resultados: Se consiguió la extracción completa con un sólo acto quirúrgico mediante nefrolitotomía percutánea en un 24.1%. En el 75.9% restante se realizó un tratamiento combinado mediante litotricia extracorpórea con ondas de choque o una segunda nefrolitotomía percutánea. Conclusiones: La endourología ha revolucionado el tratamiento de la litiasis coraliforme. Es eficaz sola y en combinación con la LEOC para el manejo de esta patología con un número reducido de complicaciones y una alta tolerabilidad por parte de los pacientes (AU)

Objectives: The objective of this work is to analyze the treatment of staghorn calculi at our Department of Urology. We have to know the recent development of endoscopic surgery (percutaneous renal surgery) and external shock wave lithotripsy. Methods: We reviewed the surgical management of staghorn calculi during the period between 1987 and 2004. Results: Percutaneous renal surgery was performed successfully in 24.1% of the cases. Persisting residual fragments appeared in 75.9% and were treated by ESWL or second endoscopic surgery. Conclusions: Percutaneous renal surgery may be considered the technique of choice to treat staghorn calculi. Endoscopic surgery has good results and little complications with low morbidity. In other cases the treatment is combined therapy, percutaneous renal surgery and ESWL (AU)

[Squamous cell carcinoma in a duplicated renal pelvis after percutaneous nephrolithotomy]. / Carcinoma de células escamosas en pelvis renal bífida, tras nefrolitotomía percutánea.

OBJECTIVE: To describe the clinical case of a patient presenting a squamous cell carcinoma in a duplicated renal pelvis, after percutaneous nephrolithotomy. METHODS/RESULTS: 60-year-old male patient who was diagnosed of a squamous cell carcinoma of the renal pelvis in the pathological study of a lower pole nephrectomy after percutaneous nephrolithotomy for staghorn calculi in the left lower pole renal moiety. The patient suffered a bladder recurrence one year and a half later. A radical cystoprostatectomy was performed, but the patient died in a few months due to metastasis. CONCLUSIONS: Squamous cell carcinoma of the renal pelvis is a rare tumor with poor prognosis, associated with stone disease and chronic infection. Taking biopsies from suspicious lesions during percutaneous nephrolithotomy may help early diagnosis and improve survival.

[Tumors of the upper urinary tract. Our experience]. / Tumores del tracto urinario superior. Nuestra experiencia.

OBJECTIVES: To study the clinical presentation, diagnosis, treatment, and evolution of upper urinary tract tumours. METHODS: We carried out a retrospective study on the upper urinary tract tumours treated in our centre, HCU Valladolid, between 1994 and 2007. RESULTS: 65 tumours were diagnosed, although only 59 were valid for the study. Mean patient age was 68 years (interval between 46 and 88 years). 47 were men and 12 women. The most common symptom on presentation was hematuria (79.9%). Urography was the most frequently used diagnostic technique (96.6%) and nephroureterectomy with transurethral resection of the intramural ureter was the most common surgical treatment performed, carried out in 28 cases. 9 patients underwent percutaneous treatment with only one recurrence, and 2 patients received ureteroscopic treatment. 50.9% of the lesions were classified as superficial tumours. The 5 and 10-year survival rates were 55 and 47%. CONCLUSIONS: Upper urinary tract tumours are an unusual disease characteristic of medium-advanced ages. Nowadays nephroureterectomy by open surgery or laparoscopy is the standard treatment. Conservative endoscopic procedures have more and more importance and present excellent results in highly selected cases.

[The use of NMP22 Bladder-Chek for the diagnosis and follow-up bladder cancer]. / Empleo del NMP22 Bladder-Chek en el diagnóstico y seguimiento del cáncer de vejiga.

OBJECTIVES: The goal of this work is to evaluate the usefulness of NMP22 BladderChek in the diagnosis and follow-up of bladder cancer, comparing it with cystoscopy and urine cytology. METHODS: Group 1: 109 asymptomatic patients on follow up for bladder cancer underwent cystoscopy, cytology and NMP22 BladderChek. Group 2:15 patients with history of hematuria underwent cystoscopy and NMP22 BladderChek. RESULTS: Group 1: 9 patients had tumor relapse. Sensitivity was 25% for NMP22 test, 50% for citology and 100% for cystoscopy Specificity was 91.1%, 94.1% and 95% respectively. Group 2: 12 patients had bladder cancer. The sensitivity was of 83.3% for NMP22 BladderChek and 100% for cystoscopy. The specificity was of 100% for NMP22 BladderChek and 66.7% for cystoscopy. CONCLUSIONS: The low sensitivity of NMP22 Bladder-Chek invalidates it as alternative method to cystoscopy in the follow-up of bladder cancer. But it can be recommended for screening in patients without history of bladder cancer but with an increased risk (smokers, patients with dysuria and hematuria).

Carcinoma de células escamosas en pelvis renal bífida tras nefrolitotomía percutánea / Squamous cell carcinoma in a duplicated renal pelvis after percutaneous nephrolithotomy

Objetivo: Describir un caso clínico de un paciente que presenta un carcinoma de células escamosas en una pelvis renal bífida, tras la realización de una nefrolitotomía percutánea. Métodos/Resultados: Paciente varón de 68 años de edad, diagnósticado de carcinoma escamoso de pelvis renal, tras el estudio histológico de una nefrectomía polar inferior posterior a una nefrolitotomía percutánea por una litiasis coraliforme en hemirriñón izquierdo. El paciente sufrió una recidiva vesical un año y medio más tarde, se practicó una cistoprostratectomía radical, pero el fallecimiento se dio a los pocos meses ante la presencia de metástasis. Conclusiones: El carcinoma de células escamosas de pelvis renal, es un tumor raro y de mal pronóstico, generalmente asociado con enfermedad litiásica e infección crónica. La realización de biopsias de zonas sospechosas durante la nefrolitotomía percutánea puede ayudar al diagnóstico precoz del tumor, con la consiguiente mejoría de la supervivencia (AU)

Objective: To describe the clinical case of a patient presenting a squamous cell carcinoma in a duplicated renal pelvis, after percutaneous nephrolithotomy. Methods/Results: 60-year-old male patient who was diagnosed of a squamous cell carcinoma of the renal pelvis in the pathological study of a lower pole nephrectomy after percutaneous nephrolithotomy for staghorn calculi in the left lower pole renal moiety. The patient suffered a bladder recurrence one year and a half later. A radical cystoprostatectomy was performed, but the patient died in a few months due to metastasis. Conclusions: Squamous cell carcinoma of the renal pelvis is a rare tumor with poor prognosis, associated with stone disease and chronic infection. Taking biopsies from suspicious lesions during percutaneous nephrolithotomy may help early diagnosis and improve survival (AU)

Metástasis cutánea solitaria de carcinoma vesical / Solitary skin metastasis from a bladder carcinoma

Las metástasis cutáneas del carcinoma urotelial de vejiga son muy raras, se relacionan con estadios avanzados de la enfermedad y tiene un pronóstico desfavorable con baja tasa de supervivencia. Se presenta un caso de metástasis cutánea posterior a manipulación urológica en un paciente con un carcinoma vesical infiltrante metastático a otros órganos y con desfavorable respuesta al tratamiento. Se discute el caso y se revisa la literatura (AU)

Cutaneous metastases from urothelial carcinomas of the bladder are very rare. They are related to advanced stages of the disease and have poor prognosis with low survival rates. We report one case of cutaneous metastasis appearing after urological manipulation in a patient with bladder muscle invasive carcinoma, with other metastatic sites and poor response to treatment. The case is discussed and literature is reviewed (AU)

[Solitary skin metastasis from a bladder carcinoma]. / Metástasis cutánea solitaria de carcinoma vesical.

Cutaneous metastases from urothelial carcinomas of the bladder are very rare. They are related to advanced stages of the disease and have poor prognosis with low survival rates. We report one case of cutaneous metastasis appearing after urological manipulation in a patient with bladder muscle invasive carcinoma, with other metastatic sites and poor response to treatment. The case is discussed and literature is reviewed.

[Renal hydatidosis]. / Hidatidosis renal.

OBJECTIVE: Our purpose is to report a case of renal hydatidosis and its treatment. METHODS: The characteristics of the case are presented and discussed. RESULTS AND CONCLUSIONS: The hydotic disease is a parasitic infestation caused by the larvae from echinococcosis granulosus. The kidney ranks third among all visceral localitations, compromising only 2% to 4% of all cases. Most of patients are asymptomatic for years and the correct preoperative diagnosis is difficult.

Hidatidosis renal / Renal hydatidosis

OBJETIVO: Nuestro objetivo es comunicar un nuevo caso de hidatidosis renal y su tratamiento. MÉTODOS: Realizamos una presentación y comentarios de las características del caso clínico. RESULTADOS/CONCLUSIONES: La hidatidosis es una parasitosis causada por la larva del echinococcus granulosus. De todas las localizaciones viscerales, el riñón ocupa el tercer lugar, encontrándose afectado tan sólo en un 2% a 4% de los casos. La mayoría de los pacientes permanecen asintomáticos durante años, siendo difícil establecer un correcto diagnóstico preoperatorio

OBJECTIVE: Our purpose is to report a case of renal hydatidosis and its treatment. METHODS: The characteristics of the case are presented and discussed. RESULTS AND CONCLUSIONS: The hydatic disease is a parasitic infestation caused by the larvae from echinococcosis granulosus. The kidney ranks third among all visceral localitations, compromising only 2% to 4% of all cases. Most of patients are asymptomatic for years and the correct preoperative diagnosis is difficult

[Pelvic recurrence after radical cystectomy for bladder cancer]. / Recidiva pelviana despues de cistectomia radical por cancer vesical.

OBJECTIVES: We report the case of a male patient who had undergone radical cystectomy and orthotopic neobladder for bladder cancer presenting with local recurrence eight months later. METHODS: Diagnostic tests included CT scan and ultrasound guided transrectal biopsy RESULTS: With the diagnosis of local recurrence he underwent chemotherapy and radiotherapy CONCLUSIONS: The pelvic recurrence of transitional cell carcinoma after radical cystectomy is rare and prognosis is poor. It is frequently associated with advanced tumor stage. It should be treated by a multidisciplinary approach.

Recidiva pelviana después de cistectomía radical por cáncer vesical / Pelvic recurrence after radical cystectomy for bladder cancer

OBJETIVO: Presentamos un caso de unvarón sometido a cistectomía radical con neovejiga ortotópicapor cáncer vesical, con recurrencia local desarrolladoa los 8 meses.MÉTODO: Los estudios diagnósticos incluyen TAC y biopsiatransrectal ecodirigida.RESULTADO: Con el diagnóstico de recurrencia local, fuetratado con quimioterapia y radioterapia.CONCLUSIONES: La recurrencia pélvica por carcinomatransicional después de cistectomía radical, es infrecuentey con pobre pronóstico. Está frecuentemente asociado conestadio tumoral avanzado. Debe ser tratado con abordajemultidisciplinario

OBJECTIVES: We report the case of a male ;;patient who had undergone radical cystectomy and ;;orthotopic neobladder for bladder cancer presenting with ;;local recurrence eight months later. ;;METHODS: Diagnostic tests included CT scan and ;;ultrasound guided transrectal biopsy. ;;RESULTS: With the diagnosis of local recurrence he ;;underwent chemotherapy and radiotherapy. ;;CONCLUSIONS: The pelvic recurrence of transitional cell ;;carcinoma after radical cystectomy is rare and prognosis is ;;poor. It is frequently associated with advanced tumor ;;stage. It should be treated by a multidisciplinary approach

[Clinico-urodynamic correlation in the hereditary ataxias]. / Correlación clínico-urodinámica en las ataxias hereditarias.

OBJECTIVES: To evaluate lower urinary tract functional symptoms in a series of patients with ataxia and to determine by urodynamic studies the kind of bladder-urethra neurological dysfunction in each case. We posed the question if the clinical picture could be enough to establish the diagnosis and therapeutic management of these patients with hereditary ataxia, or on the contrary it would be necessary to perform urodynamic studies in all cases. METHODS: Due to the low incidence of hereditary ataxias and patients' mobility it was necessary to recruit patients from various hospitals. The urodynamic study protocol employed in this study included 1) Evaluation of urinary symptoms; 2) Neurological physical examination; 3) Flowmetry with post void residual; 4) Cystomanometry; and 5) Perineal electromyography. We analyzed the relationship between urinary symptoms and urodynamic diagnosis, considering variables such as age, gender, type of ataxia, and time of evolution of the disease. RESULTS: The series includes 34 patients with ataxia and urinary symptoms, 14 cases of Friedreich's ataxia (FA) (41.2%) and other 20 cases of other various forms of ataxia we name non-Friedreich's (NF) (58.8%). Mean age was 37.2 years in FA and 50 years in NF (p < 0.05). Mean time of disease evolution was 20.5 yr. for FA, and 14.9 yr. for NF ataxia (p < 0.1). A mixed urinary syndrome was predominant in 53% of the patients, and 41.1% presented pure irritative symptoms in relation to voiding urgency (85.2%). The most frequent urodynamic diagnosis was detrusor hyperreflexia (61.7%) (37.5% with dyssynergia), followed by areflexia (or hyporeflexia) (23.5%), and normal studies (14.7%). Detrusor hyperreflexia presented with irritative urinary symptoms in 85.7% of the patients, and areflexia or hyporeflexia presented with obstructive symptoms in 75% of the cases. CONCLUSION: Although there is a good clinical-urodynamic correlation in cases of ataxia, we consider it is necessary to perform a complete urodynamic study in males with hereditary ataxia in order to rule out bladder outlet obstruction due to BPH. On the other hand, due to the fact that progression of the lesions can modify the clinical picture of the patient (including urinary tract symptoms), we consider essential to re-evaluate ataxic patients periodically to adapt their treatment to the urodynamic diagnosis.