[Trombosis of the dorsal penis vein (of Mondor's phlebitis). Presentation of a new case]. / Trombosis de la vena dorsal del pene (Flebitis de Mondor). Aportación de un nuevo caso.

OBJECTIVE: We present a new case of trombosis of the superficial dorsal penis vein called Penile Mondor's disease. The characteristics of the disease are reviewed and the most usual diagnostic and therapeutic methods. METHODS: The case of a 41 year old man is reviewed who consulted for pain and induration on the proximal part of the penis. RESULTS: After phisical examination and Eco-doppler was made the diagnosis of Mondor's disease. He receibed treatment with non steroidal antiinflamatories and antibiotics. CONCLUSIONS: The dorsal vein thrombosis is a rare disease with pain an induration of the dorsal part of the penis. The ethiology can be traumatic, neoplasic, excesive sexual activity or abstinence. Is necesary the diferencial diagnosis with esclerosant linphangitis and the most important imaging is the Eco-doppler. The treatment is based in non steroidal antiinflamatories and antibiotics wit infection. The local aplication of heparine can be useful and the surgery with thrombectomy and resection is for persistent cases.

Trombosis de la vena dorsal del pene (Flebitis de Mondor). Aportación de un nuevo caso / Trombosis of the dorsal penis vein (of Mondor´s phlebitis). Presentation of a new case

Objetivo: Presentamos un nuevo caso de trombosis de la vena dorsal superficial del pene o “flebitis de Mondor”. Revisamos las características de la enfermedad y los métodos diagnósticos y terapéuticos actuales. Métodos: Revisamos el caso de un varón de 41 años que consultó por dolor e induración dorsal del pene. Resultados: Después de realizar exploración física y Eco-doppler fue diagnosticado de Trombosis de la vena dorsal superficial o flebitis de Mondor. Recibió tratamiento con antiinflamatorios no esteroideos y antibióticos experimentando mejoría clínica. Conclusiones: La trombosis de la vena dorsal del pene es una rara entidad que cursa con dolor e induración dorsal, la etiología puede ser traumática, neoplásica, por excesiva actividad sexual o prolongada abstinencia. Puede cursar de forma aguda, subaguda o crónica. Es necesario realizar diagnóstico diferencial con la linfangitis esclerosante, el estudio de imagen ideal es el Eco-doppler y el tratamiento se basa en antiinflamatorios y antibióticos en caso de infección. Pueden ser útiles sustancias heparinizantes locales reservándose el manejo quirúrgico con trombectomía o resección de la vena dorsal para casos persistentes

Objective: We present a new case of trombosis of the superficial dorsal penis vein called Penile Mondor´s disease. The characteristics of the disease are reviewed and the most usual diagnostic and therapeutic methods. Methods: The case of a 41 year old man is reviewed who consulted for pain and induration on the proximal part of the penis. Results: After phisical examination and Eco-doppler was made the diagnosis of Mondor´s disease. He receibed treatment with non steroidal antiinflamatories and antibiotics. Conclusions: The dorsal vein thrombosis is a rare disease with pain an induration of the dorsal part of the penis. The ethiology can be traumatic, neoplasic, excesive sexual activity or abstinence. Is necesary the diferencial diagnosis with esclerosant linphangitis and the most important imaging is the Eco-doppler. The treatment is based in non steroidal antiinflamatories and antibiotics wit infection. The local aplication of heparine can be useful and the surgery with thrombectomy and resection is for persistent cases

[Utility of prostate-specific antigen in pleural fluid for the diagnosis of metastatic effusion secondary to prostate cancer]. / Utilidad del antígeno prostático específico en líquido pleural para el diagnóstico del derrame metastático por cáncer de próstata.

Pulmonary or pleural involvement from prostate cancer is an uncommon clinical finding. We report on a patient with prostate cancer and a diagnosis of malignant pleural effusion made by determination of pleural fluid prostate specific antigen.

[Ectopic prostatic tissue in the bladder]. / Tejido prostático ectópico en vejiga urinaria.

We report the case of a 58-year-old man with ectopic prostatic tissue at the bladder trigone. The diagnosis was by chance during study and treatment of benign prostatic hyperplasia. The appearance was pseudocystic. It occupied completely the bladder trigone. On histology, the lesion was formed by prostatic type-glands, which were positive for the presence of prostatic specific antigen by using inmunoperoxidase technique. It was partially covered by normal urothelium. Ten months later, no trace of recurrence has been evidenced.

Tejido prostático ectópico en vejiga urinaria / Ectopic prostatic tissue in urinary bladder

Se presenta un caso de tejido prostático ectópico localizado en trígono vesical, en un paciente de 58 años. El hallazgo fue casual durante el estudio y tratamiento de un paciente con hipertrofia benigna de próstata. Se manifestó como lesiones seudoquísticas que ocupaban la totalidad del trígono vesical. El tejido de recubrimiento, obtenido por resección transuretral, estaba formado por focos de revestimiento urotelial y glándulas de aspecto prostático que presentaron positividad en el estudio inmunohistoquímico frente a PSA. No existe evidencia de recurrencia a los diez meses del diagnóstico (AU)

No disponible

[Prevalence and risk factors for erectile dysfunction in the Region of Bierzo]. / Prevalencia y factores de riesgo de disfunción eréctil en la Comarca del Bierzo.

OBJECTIVE: To analyze the prevalence and risk factors for erectile dysfunction in Bierzo (León, Spain). METHODS: A study was conducted based on a self-administered survey in males aged 19 to 90 years that consulted at the urology and family medicine services of 10 health centers in Bierzo (León, Spain). To determine the existence or absence of erectile dysfunction, the male sexual health questionnaire (SHIM) was included, and those with a score of 21 or less were considered to have some degree of erectile dysfunction. Distribution of the questionnaire began in September 1999 and ended in May 2000. Submission of the questionnaires concluded on May 31, 2000. Of 935 questionnaire that were received, 830 were valid. RESULTS: The overall prevalence of erectile dysfunction in this study was 63.9%, which increased with age and was markedly higher after age 50 years (38.6% for age 41-50 years and 72.6% for age 51-60 years). The age-adjusted analysis showed the risk factors for erectile dysfunction were depression and arterial hypertension on treatment with drugs. Diabetes mellitus on treatment with oral glucose lowering agents or insulin, heart disease and hypercholesterolemia were also associated with the more severe forms. CONCLUSIONS: The prevalence of erectile dysfunction in patients consulting at the primary care and general urological services in Bierzo (León, Spain) was outstandingly high. The present study showed erectile dysfunction to be an age-dependent disease that caused concern in slightly more than half of the patients with this condition. Apart from age, depression and vascular disease were found to be risk factors.

[Reabsorption syndrome. Report of a case]. / Síndrome de reabsorción. Presentación de un caso.

OBJECTIVE: To report a case of TURP syndrome and emphasize the importance of early diagnosis. METHODS: A case of reabsorption syndrome in a patient that underwent transurethral resection under spinal anesthesia is presented. RESULTS: Reabsorption syndrome (TURP syndrome) is manifested by neurological and hemodynamic changes resulting from absorption of irrigating fluid used during transurethral resection of the prostate. This complication presented in a patient undergoing elective surgery and with no additional risk factors. CONCLUSIONS: Since it is impossible to prevent this complication of TUR, spinal anesthesia should be utilized whenever possible because it permits early detection before important complications develop.

[Scrotal leiomyoma]. / Leiomioma de escroto.

A case of a 32-year-old patient with a diagnosis of leiomyoma of the scrotum was studied. Histologic analyses did not yield evidence of malignancy. Full excision of tumor was achieved and the postoperative period was uneventful.

Leiomioma de escroto / Leiomyoma of the scrotum

Se presenta un caso de leiomioma escrotal en un paciente de 32 años que consultó por masa escrotal. El estudio histológico no demostró signos de malignidad. El tumor fue extirpado por completo, con evolución posterior favorable (AU)

Tratamiento de las fístulas vesicovaginales no complicadas posthisterectomía / Management of uncomplicated vesicovaginal fistulas after hysterectomy

Objetivo: Aportamos nuestra experiencia en el tratamiento de las fístulas vesicovaginales no complicadas.Material y métodos: Analizamos retrospectivamente a 7 pacientes con fístulas vesicovaginales no complicadas tras histerectomía tratadas en nuestro centro entre 1995 y 2000. La forma más común de presentación fue la incontinencia urinaria constante. Tres casos se acompañaron de hematuria macroscópica en el postoperatorio inmediato.Resultados: Tras fracaso del tratamiento conservador, se realizó reparación transvesical en todos los casos, con un porcentaje de éxito del 100 por ciento y una mediana de seguimiento de 21 meses (límites, 5-35 meses).Conclusiones: Se debe sospechar la existencia de una fístula vesicovaginal tras cirugía ginecológica ante la presencia de hematuria macroscópica, débito importante de líquido de aspecto urinoso por drenaje vaginal o incontinencia urinaria constante postoperatorios. El diagnóstico y tratamiento temprano evita el estrés prolongado de la paciente sin comprometer los resultados. (AU)

[Renal infarct in the adult: apropos of a case]. / Infarto renal en el adulto: a propósito de un caso.

OBJECTIVE: To report a case of renal infarction in a patient on anticoagulant therapy for aortic and tricuspid valvulopathy, with special reference to the diagnostic difficulty. METHODS: The most common causes of this condition, its forms of presentation, diagnostic methods, and therapeutic approaches are discussed. RESULTS/CONCLUSIONS: Renal infarction should be suspected in the presence of abdominal pain of sudden onset that is refractory to treatment with analgesics, especially in patients with a history of embolism, recent surgery or trauma. It is frequent to find increased levels of SGOT, SGPT, LDH, alkaline phosphatase and micro or gross hematuria and proteinuria. Arteriography or isotopic renogram is utilized to confirm the diagnosis, although IVP or CT is useful if the foregoing are not available. Early treatment is important for achieving recovery of the compromised renal parenchyma. In recent years, surgery has been displaced by the good results obtained with intraarterial infusion of fibrinolytics.

[Penile primary melanoma; report of a case]. / Melanoma primario de pene; a propósito de un caso.

OBJECTIVE: An uncommon variant of penile tumor associated with chronic lymphoid leukemia is presented. METHODS/RESULTS: A case of primary melanoma of the penis associated with chronic lymphoid leukemia is presented. Diagnosis was based on the anatomopathological findings. Lymph node involvement could not be determined due to the associated leukemia. Conservative management was instituted due to the patient's age. CONCLUSIONS: Primary melanoma of the penis is a very aggressive and uncommon tumor. To our knowledge, less than 140 cases have been reported. Hyperpigmented lesions must be biopsied to rule out melanoma.

[Transvesical repair of non-complicated vesicovaginal fistula]. / Reparación transvesical de fístulas vesicovaginales no complicadas.

OBJECTIVE: The management of vesicovaginal fistula still remains controversial in regard to the timing of repair and type of approach. We review the relevant literature and describe our experience with the transvesical management of uncomplicated vesicovaginal fistulas after gynecological surgery. MATERIAL AND METHODS: We reviewed retrospectively 6 consecutive women who presented with uncomplicated vesicovaginal fistula, repaired at our institution between 1995 and 1998. Four cases underwent early repair after a trial of conservative management. One case underwent intraoperative repair and another case after 19 months because of delayed diagnosis. Postoperative follow up ranges from 4 to 35 months. RESULTS: All patients were cure. The fistula tract was excised totally in all patients. There were no postoperative complications. CONCLUSIONS: Early repair of uncomplicated vesicovaginal fistulas after gynecological surgery offers reliable success, according with literature records and our own experience. On the other hand, transvesical repair offers an easy operative approach, with a high successful rate.

[Extra-adrenal pheochromocytoma. Report of a case]. / Feocromocitoma extraadrenal. Descripción de un caso.

OBJECTIVE: To report a case of extraadrenal pheochromocytoma with special reference to the diagnostic and therapeutic aspects. METHODS: A case of extraadrenal pheochromocytoma in a 20-year-old female with severe hypertension is presented. The clinical and biochemical aspects are reviewed with special reference to the diagnostic imaging methods. RESULTS: Plasma noradrenaline and urinary normetanephrine levels were elevated. CT and MRI showed a well-defined mass, 6 cm in diameter, adjacent to the left kidney, abdominal aorta and psoas muscle. Angiography demonstrated a high vascularization in the area of the tumor. MIBG scintigraphy revealed a well-defined mass, but no other distant lesions. Surgical treatment was performed with preoperative alpha and beta adrenergic blockade. Currently the patient has a normal blood pressure and catecholamine levels, with no evidence of lesions on the MIBG scintiscan. CONCLUSIONS: Plasma catecholamine and urinary normetanephrine levels levels confirmed the presumptive diagnosis of pheochromocytoma. MIBG is the technique of choice for the localization of the mass and suspected metastases. CT, MRI and angiography demonstrated the anatomic relationships of the tumor. The best results are achieved with complete resection and preoperative adrenergic blockade.

Reparación transvesical de fístulas vesicovaginales no complicadas / Transvesical repair of uncomplicated vesicovaginal fistulas

OBJETIVO: El manejo de las fístulas vesicovaginales es objeto de controversia. Principios fundamentales como la vía de abordaje o el momento adecuado para la reparación quirúrgica varían ampliamente según los distintos autores. Realizamos una revisión de la literatura y aportamos nuestra experiencia en el abordaje transvesical para la reparación de las fístulas vesicovaginales no complicadas de causa ginecológica. MATERIAL Y MÉTODOS: Analizamos retrospectivamente una serie de 6 pacientes con fístulas vesicovaginales no complicadas sometidas a reparación quirúrgica en nuestro centro entre 1995 y 1998. En cuatro casos se realizó corrección quirúrgica precoz, tras un intento de cierre espontáneo con medidas conservadoras. En un caso la reparación se realizó intraoperatoriamente. En otro caso la reparación se realizó a los 19 meses por retraso en el diagnóstico. El seguimiento medio fue de 21 meses (límites: 4-35 meses). RESULTADOS: El tratamiento definitivo de la fístula fue quirúrgico en todos los casos, con un porcentaje de éxitos en un solo tiempo del 100 por ciento. El trayecto fistuloso fue escindido totalmente en todos los casos. No hubo complicaciones postoperatorias. CONCLUSIONES: La reparación precoz de las fístulas vesicovaginales no complicadas de causa ginecológica ofrece buenos resultados de acuerdo con los datos aportados por la literatura y nuestra propia experiencia. Por otra parte, el abordaje abdominal proporciona un acceso fácil y cómodo para la corrección de la fístula, con un alto porcentaje de éxitos (AU)

[Lipoma of spermatic cord; report of a case]. / Lipoma de cordón espermático; presentación de un caso.

OBJECTIVE: To report an additional case of lipoma of the spermatic cord, an uncommon, silent tumor. METHODS: A case of lipoma of the spermatic cord is described. The patient had presented with an enlarged scrotum with no symptoms. The literature on lipoma of the spermatic cord is briefly reviewed, with special reference to its diagnosis, forms of presentation and treatment. RESULTS: US evaluation demonstrated a mass adhered to the epididymis. An epididymal tumor was suspected and surgical exploration by the inguinal approach was performed. CONCLUSIONS: Lipoma is the most common tumor of the spermatic cord. Its etiology is unknown. It frequently appears in the fourth and fifth decades of life and usually involves the left hemiscrotum. It is silent and is detected by enlargement of the scrotum. The diagnosis is histological supported by US, which offers a reliability of 80%-100%. Treatment is by surgery in all cases.

[Spermatic cord torsion in the Comarca del Bierzo. Clinico-epidemiological analysis of the 5-year period 1994-1998]. / Torsiones de cordón testicular en la Comarca del Bierzo. Análisis clínicoepidemiológico del quinquenio 1994-1998.

OBJECTIVE: To review the cases of torsion of the spermatic cord diagnosed at the emergency and urology services of our hospital over the last 5 years and analyze the clinical and epidemiological features. METHODS: The cases of torsion of the spermatic cord diagnosed at our hospital from 1994-1998 were reviewed. Age, reason for consultation, time from onset of symptoms to consultation, location of the torsion, final diagnosis, treatment, and other data were analyzed. RESULTS: There were 20 cases of torsion of the spermatic cord in patients aged 1 to 25 years, with the highest incidence at age 14 years. The left testis was more frequently compromised. Six patients had a history of testicular pain and/or inflammation. The mean time from presentation of symptoms to consultation was 13.5 hours (range 1 hour to 7 days). The diagnosis was torsion of the spermatic cord in 14 cases and hydatid torsion in 6. Treatment was fundamentally by surgery (orchidopexy), except in three cases that spontaneously resolved or were detorsioned by manipulation. Two patients underwent excision of the compromised testis. CONCLUSIONS: Torsion of the spermatic cord is a urological emergency due to the high risk of complications that may even require orchidectomy. The epidemiological findings for our area are similar to those reported in other series.

[Bladder endometriosis]. / Endometriosis vesical.

OBJECTIVE: To describe an additional case of endometriosis of the bladder and to review the diagnostic and therapeutic aspects. METHODS/RESULTS: A case of endometriosis of the bladder in a 30-year-old female with a long history of dysuria, pollakiuria and suprapubic pain during menstruation is described. The endoscopic findings indicated endometriosis of the bladder. Gn-Rh analogues and anovulatories were administered, but were poorly tolerated. Resection of the bladder endometrioma was performed. The patient is asymptomatic at two years' follow-up. CONCLUSION: Transurethral resection of the endometriotic plaque may be a valid therapeutic option in selected cases of endometriosis of the bladder.

[Multilocational cystic nephroma. Review of a case with reference to echographically observed changes]. / Nefroma quístico multilocular. Aportación de un caso con referencia a los cambios ecográficos observados.

OBJECTIVE: To describe an additional case of multilocular cystic nephroma, with special reference to the sonographic features of a renal cystic lesion. METHODS: The clinical and radiological features of a kidney tumor in a 61-year-old female patient were retrospectively analyzed. RESULTS: The preoperative diagnosis was that of a complex multicystic renal mass suggestive of a renal carcinoma. Radical nephrectomy was performed; histopathological analysis of the surgical specimen disclosed a multilocular cystic nephroma. An ultrasound scan 18 months earlier had demonstrated a simple renal cyst in the same site. CONCLUSIONS: Multilocular cystic nephroma is a tumor that is difficult to diagnose preoperatively. Making an accurate differential diagnosis is of interest, since it will permit conservative treatment. The case described herein supports the hypothesis with regard to the pathogenesis of this lesion, since it had previously showed sonographic features of a simple renal cyst.

[Hemangioma of the spermatic cord. Presentation of a case with review of the literature]. / Hemangioma de cordón espemático. Aportación de un caso y revisión de la literatura.

OBJECTIVE: To describe a rare variety of spermatic cord tumor, with special reference to the differential diagnosis. The literature is briefly reviewed. METHODS: The clinical and pathological features of a tumor located in the right inguino-scrotal region of a 27-year-old male patient are described. RESULTS: The preoperative evaluation disclosed an irregular mass in the right hemiscrotum that was unconnected to the testis. The patient underwent orchidectomy and resection of the tumor. Pathological analysis of the surgical specimen revealed a hemangioma of the spermatic cord. CONCLUSIONS: Hemangioma of the spermatic cord is a very uncommon tumor, it is a slow growing, indolent, benign scrotal lesion that must be distinguished from other paratesticular masses or tumors with similar clinical features. Ultrasound and other diagnostic imaging techniques are not useful in making the preoperative differential diagnosis.