Manejo conservador urológico de una paciente con esclerosis tuberosa compleja (Bourneville) / Urological conservative management of a patient with Tuberous Sclerosis Complex (Bourneville Disease)

OBJETIVO: Ofrecer datos clínicos e imageneológicos de una enferma con esclerosis tuberosa compleja seguida durante 22 años por urología. Revisar las implicaciones urológicas en esta enfermedad.MÉTODOS: La paciente realizó tratamiento médico conservador urológico, basado en la clínica y los complementarios (ultrasonido, urograma descendente, TAC, humorales). El seguimiento fue realizado en consulta externa por el grupo de Uroncología. En algunas ocasiones fue ingresada para estudio debido a factores geográficos distantes.RESULTADOS: Esta paciente con angiomiolipoma y esclerosis tuberosa ha tenido larga evolución basada en evaluaciones repetidas para mantener o no el tratamiento conservador. El ultrasonido y la TAC fueron dos estudios básicos para mantener conducta no quirúrgica, así como una buena evaluación clínica.CONCLUSIONES: Las manifestaciones renales son frecuentes y serias. El seguimiento deberá basarse en un monitoreo cuidadoso ya que las lesiones renales son la segunda causa de muerte después de las lesiones del sistema nervioso. Este reporte de larga evolución en una paciente con esclerosis tuberosa acompañada de angiomiolipoma bilateral demuestra que algunos pueden ser seguidos con exámenes clínicos repetidos hasta definir el momento en que debemos cambiar de conducta(AU)

OBJECTIVE: To report the clinical and radiological data of a 23-year-woman with bilateral angiomyolipoma and Tuberous Sclerosis with conservative treatment.METHODS: The patient underwent conservative urological management, based on clinical and complementary tests` data (ultrasonography, CT scanning, excretory urogram, and laboratory). Monitoring was carried out in external consultation by the uroncology group. In some occasions she was hospitalized due to distant geographical factors.RESULTS: This patient provides long-term outcome of AML with Tuberous Sclerosis followed by repeated evaluation to define the conservative management or not. Ultrasonound and CT scan were two basic studies to maintain conservative treatment, as well as a good clinical evaluation.CONCLUSIONS: Renal lesions associated with tuberous sclerosis are frequent and serious. Monitoring should be based on a careful monitoring since the renal lesions are the second death cause after the lesions of the nervous system. This case report provides long-term outcome of AML with tuberous sclerosis, that can be followed expectantly with repeated evaluations to define the clinical significance(AU)

[Laparoscopic varicocelectomy in the adult patient]. / Varicocelectomía laparoscópica en el adulto.

OBJECTIVES: We performed a study including 120 patients with the diagnosis of varicocele (testicular Doppler ultrasound), from June 2004 to July 2006, analyzing the following variables: surgical time, hospital stay, postoperative analgesic requirements, complications and return to social-working activities. RESULTS: 120 patients between 18 and 42 years of age underwent surgery. Mean surgical time was 25.07 minutes. A minority of the patients were discharged the following day (difficulties with transportation), the rest were treated as outpatient. Almost no postoperative analgesic drugs were employed, only three patients required pain treatment. Only three minor complications appeared during or after surgery. All patients had a fast recovery back to their social-working activities (between 15 and 21 days). CONCLUSIONS: We consider laparoscopic ligation of spermatic veins may be considered an effective method for the treatment of patients with varicocele. It is the treatment of choice for bilateral varicocele, obese patients, after the failure of conventional techniques, in patients with history of inguinal surgery, and when simultaneous laparoscopic treatment of other pathologies is necessary. We also emphasize the importance it plays as training in the learning curve for the development of this technique.

Varicocelectomía laparoscópica en el adulto / Laparoscopic varicocelectomy in the adult patient

Objetivo: Conocer nuestros resultados con esta novedosa técnica en la Provincia. Método: Se realiza un estudio en 120 pacientes con el diagnostico positivo (doppler testicular) de varicocele. Desde junio del año 2004 a julio del 2006, analizando las siguientes variables: Tiempo quirúrgico, estancia hospitalaria, uso de analgésicos post operatorios, complicaciones e incorporación a las actividades sociolaborales. Resultados: Se intervienen 120 pacientes entre 18 y 42 años de edad. El tiempo quirúrgico promedio fue 25.07 minutos. La minoría de los pacientes egresaron al día siguiente (dificultad con el transporte), el resto se trataron de forma ambulatoria. No se utilizó prácticamente analgésicos post operatorios, sólo 3 pacientes requirieron tratamiento del dolor. Se presentaron sólo 3 complicaciones menores durante o después de la cirugía. Todos los pacientes tuvieron una rápida incorporación a las actividades sociolaborales (entre 15 y 21). Conclusiones: Consideramos que la ligadura laparascópica de las venas espermáticas puede considerarse como método eficaz en el tratamiento de pacientes con diagnóstico de varicocele. De elección en el varicocele bilateral, en pacientes obesos, después del fracaso de las técnicas convencionales, con antecedentes de cirugía inguinal y en la necesidad de tratamiento laparoscópico simultáneo de otras patologías. Sin olvidar la importancia que juega como entrenamiento en la curva de aprendizaje para el desarrollo de esta técnica (AU)

Objectives: We performed a study including 120 patients with the diagnosis of varicocele (testicular Doppler ultrasound), from June 2004 to July 2006, analyzing the following variables: surgical time, hospital stay, postoperative analgesic requirements, complications and return to social-working activities. Results: 120 patients between 18 and 42 years of age underwent surgery. Mean surgical time was 25.07 minutes. A minority of the patients were discharged the following day (difficulties with transportation), the rest were treated as outpatient. Almost no postoperative analgesic drugs were employed, only three patients required pain treatment. Only three minor complications appeared during or after surgery. All patients had a fast recovery back to their social-working activities (between 15 and 21 days). Conclusions: We consider laparoscopic ligation of spermatic veins may be considered an effective method for the treatment of patients with varicocele. It is the treatment of choice for bilateral varicocele, obese patients, after the failure of conventional techniques, in patients with history of inguinal surgery, and when simultaneous laparoscopic treatment of other pathologies is necessary. We also emphasize the importance it plays as training in the learning curve for the development of this technique (AU)

[Locally advanced renal cancer]. / Cancer renal localmente avanzado.

OBJECTIVE: To report the case of a patient with the diagnosis of locally advanced renal carcinoma. METHODS: We present in the case in a clear and well illustrated way (pictures). We report the case of a female patient with a very big renal carcinoma, with local extension, who underwent nephrectomy through a lumbar approach and received chemotherapy and immunotherapy. RESULTS: Despite radical surgery, chemotherapy and immunotherapy the tumor had rapid evolution locally and systemically, as a demonstration of its high aggressiveness. CONCLUSIONS: Renal carcinoma is considered the tumor with a high tendency to have metastases. The prognosis depends on size, stage and grade, determining factors for patient survival. Although there are new therapeutic options (immunologic), surgery continues being the main therapeutic tool. Continuous regular follow-up enable us detection and timely treatment of any event (local or systemic recurrence).

Cáncer renal localmente avanzado / Locally advanced renal cancer

Objetivo: Presentar un paciente con el diagnóstico de carcinoma renal con enfermedad localmente avanzada. Métodos: Se presenta de forma clara e ilustrativa. El enorme tamaño del tumor en su crecimiento local en paciente femenina operada hace quince meses con el diagnóstico de cáncer renal, realizándole nefrectomía por vía lumbar y tratada con quimioterapia e inmunoterapia. Resultados: A pesar de realizar la cirugía radical, utilizar la quimioterapia y la inmunoterapia. Su seguimiento demostró la alta agresividad del tumor y su rápida evolución local y sistémica. Conclusiones: El carcinoma renal es un tumor considerado muy metastizante. Su pronóstico depende de su tamaño, estadio y grado, factores que determinan la supervivencia del paciente. A pesar de las nuevas opciones de tratamiento utilizadas (inmunológico). La cirugía sigue siendo la principal arma terapéutica. Su seguimiento continuado y regular nos permite detectar y tratar a tiempo cualquier eventualidad que pueda aparecer (recidiva local ó sistémica) (AU)

Objective: To report the case of a patient with the diagnosis of locally advanced renal carcinoma. Methods: We present in the case in a clear and well illustrated way (pictures). We report the case of a female patient with a very big renal carcinoma, with local extension, who underwent nephrectomy through a lumbar approach and received chemotherapy and immunotherapy. Results: Despite radical surgery, chemotherapy and immunotherapy the tumor had rapid evolution locally and systemically, as a demonstration of its high aggressiveness. Conclusions: Renal carcinoma is considered the tumor with a high tendency to have metastases. The prognosis depends on size, stage and grade, determining factors for patient survival. Although there are new therapeutic options (immunologic), surgery continues being the main therapeutic tool. Continuous regular follow-up enable us detection and timely treatment of any event (local or systemic recurrence) (AU)

[Bechet's disease. Case report]. / Enfermedad de Behcet. Presentación de un caso.

OBJECTIVE: To report one case of a rare disease. METHODS: 39-year-old male patient presenting with the suspicion of sexually transmitted disease. We show several pictures of a clinical case diagnosed and treated in our hospital. We performed a bibliographic review on the disease and present its etiology, diagnosis and treatment. RESULTS: We concluded it was Bechet's disease because of the past medical history, clinical presentation, and diagnostic tests (positive pathergy test). CONCLUSIONS: Although it is a rare disease, we should always think of the diagnosis of Bechet's disease in a patient with genital ulcers non responsive to treatment.

Litiasis vesical rara / Unusual bladder stones

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Enfermedad de Behcet. Presentación de un caso / Bechet's disease. Case report

OBJETIVOS: Aportar un nuevo caso de una enfermedad poco frecuente. METODOS: Se presenta paciente masculino de 39 años de edad, con sospecha de enfermedad de trasmisión sexual. Mostrando varias fotos de un caso clínico, diagnosticado y tratado en nuestro hospital. Revisamos la literatura que existe sobre esta enfermedad, con mención de su etiología, diagnóstico y tratamiento. RESULTADOS: Por los antecedentes, cuadro clínico, y complementarios (Prueba de Patergia Positiva), llegamos a la conclusión de que se trataba de la Enfermedad de Behcet. CONCLUSIONES: Pensamos que aunque es una enfermad rara, ante un paciente con lesiones ulcerosas genitales rebeldes a tratamientos, debemos siempre pensar en la posibilidad del diagnóstico de la enfermedad de Behcet (AU)

OBJECTIVE: To report one case of a rare disease. METHODS: 39-year-old male patient presenting with the suspicion of sexually transmitted disease. We show several pictures of a clinical case diagnosed and treated in our hospital. We performed a bibliographic review on the disease and present its etiology, diagnosis and treatment. RESULTS: We concluded it was Bechet's disease because of the past medical history, clinical presentation, and diagnostic tests (positive pathergy test). CONCLUSIONS: Although it is a rare disease, we should always think of the diagnosis of Bechet's disease in a patient with genital ulcers non responsive to treatment