Dysuria and acute urinary retencion as initial presentation of primary vaginal lymphoma. Case report and bibliographic review.

OBJECTIVE: We report a case of primary vaginal lymphoma. The clinical presentation was an episode of dysuria and acute urinary retention. We performed a bibliographic review. METHODS: Thirty-six year-old patient who consulted in the urology clinic for hesitancy that triggered an episode of acute urinary retention. Physical examination revealed thickening of the vaginal wall. Biopsy was performed and diagnosis of diffuse large B-cell primary vaginal non-Hodgkin's lymphoma was obtained. RESULTS: Primary lymphomas of the female genital tract are rare. The third most frequent location is vagina. The most common manifestation is vaginal bleeding. Urinary symptoms are rarely the first sign. Diagnosis requires a biopsy. The first choice for treatment is Rituximab- CHOP immuno-chemotherapy. CONCLUSIONS: Vaginal lymphoma is a rare disease. Unfrequently, the first clinical manifestations are urinary tract symptoms, and even less acute urinary retention.

[Multilocular cystic nephroma. Report of three new cases]. / Nefroma quístico multilocular. Aportación de 3 nuevos casos.

OBJECTIVE: To analyze the presentation of multilocular cystic nephroma and its diagnostic-therapy scheme. METHODS: We report the three last new cases presenting in our department in a period of three years. RESULTS: Multilocular cystic nephroma is a benign lesion, rare that appears both in adult age, generally asymptomatic, and in children, frequently as a palpable mass. Differential diagnosis with malignant tumours is required. CONCLUSIONS: The great variety of clinical presentations, differential diagnosis and places of origin of the cases is demonstrated, being this a reflection of our daily medical practice, in which we cannot reach definitive diagnosis with imaging tests, being the Bosniak's classification very useful for the setting of indication for surgery, which will give definitive diagnosis of multilocular cystic nephroma or what is more important will rule out malignancy.

Nefroma quístico multilocular aportación de 3 nuevos casos / Multilocular cystic nephroma. Report or three new cases

OBJETIVO: Analizar la forma con la cual se nos presenta el nefroma quístico multilocular y el enfoque diagnóstico- terapéutico que debemos realizar.MÉTODOS: Aportamos los 3 últimos nuevos casos que se nos han presentado en nuestro servicio en un periodo de 3 años.RESULTADO: El nefroma quístico multilocular es una lesión benigna, poco frecuente apareciendo en edad adulta, habitualmente de forma asintomática, y en edad infantil frecuentemente como masa palpable. Requiere realizar diagnostico diferencial con tumoraciones malignas.CONCLUSIONES: Se demuestra la gran variedad de presentaciones clínicas, diagnósticos diferenciales y lugares de procedencia de los casos, siendo esto un reflejo de nuestra practica médica diaria sin poder llegar al diagnostico definitivo mediante pruebas de imagen, siendo muy útil la aplicación de la clasificación de Bosniak para indicar la intervención quirúrgica que nos dará el diagnostico definitivo de nefroma quístico multilocular o lo que es más importante, nos descartará proceso maligno(AU)

OBJECTIVE: To analyze the presentation of multilocular cystic nephroma and its diagnostic-therapy scheme.METHODS: We report the three last new cases presenting in our department in a period of three years.RESULTS: Multilocular cystic nephroma is a benign lesion, rare that appears both in adult age, generally asymptomatic, and in children, frequently as a palpable mass. Differential diagnosis with malignant tumours is required.CONCLUSIONS: The great variety of clinical presentations, differential diagnosis and places of origin of the cases is demonstrated, being this a reflection of our daily medical practice, in which we cannot reach definitive diagnosis with imaging tests, being the Bosniak’s classification very useful for the setting of indication for surgery, which will give definitive diagnosis of multilocular cystic nephroma or what is more important will rule out malignancy(AU)

Cirugía mínimamente invasiva en urología pediátrica dentro de un servicio de urología general / Minimally invasive surgery in pediatric patients within a general urology department

Objetivo: Los avances en cirugía minimamente invasiva en urología en los últimos años han permitido la paulatina y constante introducción de la endourología y laparoscopia en pacientes pediátricos. Realizamos una revisión de nuestra experiencia, como hospital general, de la cirugía minimamente invasiva realizada en los últimos 10 años en pacientes pediátricos. Métodos: Se analizan retrospectivamente las intervenciones en el ámbito de la endourología y laparoscopia realizadas durante el periodo entre 1997 y 2007 en niños de hasta 16 años, recogiendo datos sobre la edad y sexo de los pacientes, tipo de patologías, técnicas empleadas, anestesia realizada e incidencias perioperatorias. Resultados: Se realizaron 72 intervenciones quirúrgicas en pacientes con un rango de edad entre 28 días y 16 años y una media de 6,8 años. El 56% son varones y el 44% niñas. 28 intervenciones por Reflujo Vesico Renal (RVRj (38,8º%), 17 intervenciones por patología litiásica (23,6%) de las cuales 4 fueron cistolitotricias, 9 uretero-rrenolitotricia, 1 nefrolitectomía percutánea (NLP) pura y 3 mixtas. 9 intervenciones sobre ureteroceles (12,5%), 7 por obstrucciones uretrales (9,7%), 3 criptorquidias diagnósticas laparoscópicas (4,1 %), 2 intervenciones mediante laparoscopia por patología quistita (2,7%) y otras 2 laparoscopias para realización de biopsia renal (2,7%) y un síndrome de la unión pieloureteral intervenido mediante laparoscopia. Un caso de nefrostomía percutánea en decúbito supino de urgencia tras pieloplastia abierta con posterior intervención mediante resección percutáneo de granuloma. Un caso de inyección de toxina botulínica en detrusor. Conclusiones: La consolidación en nuestro servicio de la endourología, y mas recientemente la laparoscopia infantil, contribuyendo a mejorar la calidad asistencial en el paciente pediátrico lográndose gracias a un conocimiento previo en técnicas endourológicas generales y de unos medios técnicos y humanos adecuados (AU)

Objectives: The advances of minimally invasive surgery in urology over the last years have enabled a progressive and constant implementation of endourology and laparoscopy in pediatric patients. We perform a review of our experience, as a general hospital, with minimally invasive surgery performed in pediatric patients over the last ten years. Methods: We retrospectively analyzed the endourological and laparoscopic operations performed between 1997 and 2007 in children up to the age of 16 years, collecting data about patient's age and gender, type of disease, techniques, anesthesia, and perioperative events. Results: seventy-two surgical operations were performed in patients with an age range between 28 days and 16 years, with a mean age of 6.8 years. 56% of the patients were boys and 44% girls. Indications for surgery was vesicoureteral reflux (VUR) in 28 cases (38.8%); lithiasis 17 cases (23.6%) which were distributed in 4 cystolithotripsies, 9 ureterorenoscopy with lithotripsy, one pure percutaneous nephrolithotomy and three mixed; ureterocele 9 cases (12.5%); urethral obstruction 7 cases (9.7%); 3 diagnostic laparoscopies for cryptorchidism (4.1%), 2 laparoscopic procedures for cystic pathology (2.7%), another 2 laparoscopic renal biopsies (2.7%), and one laparoscopic repair of a ureteropyelic junction syndrome; 1 case of emergency percutaneous nephrostomy in the supine position after open pyeloplasty with subsequent reoperation with percutaneous resection of a granuloma; and 1 case of botulin toxin injection into the detrusor muscle. Conclusions: The consolidation of pediatric endourology in our department, and more recently laparoscopy, has contributed to improve the quality of care in pediatric patients; it has been achieved thanks to our previous know-how in general endourological techniques and the existence of adequate technical and human resources (AU)