[Effectiveness and treatment satisfaction in patients with erectile dysfunction in Spain: EDOS study]. / Efectividad y satisfacción con el tratamiento en pacientes con disfunción eréctil en España: estudio EDOS.

INTRODUCTION: Erectile dysfunction (ED) is a worldwide health problem with an ever increasing prevalence, affecting the quality of life of many patients. OBJECTIVE: The aim of this study was to describe treatment effectiveness and patient satisfaction with ED treatment in the Spanish cohort of the EDOS study. MATERIAL AND METHODS: This observational, pan-European study, assessed treatment effectiveness and patient satisfaction with ED treatment under routine clinical settings, using standard questionnaires. Men > or =18 years about to initiate or change ED treatment were enrolled. Patients were assessed at baseline, 3 and 6 months. RESULTS: A total of 1,029 patients were analyzed (12.8% of the total European sample). In general, the Spanish population characteristics are consistent with the overall population. At baseline 56.6% of patients received tadalafilo, 16.6% sildenafilo, 19.6% vardenafilo, and 7.2% received other treatments. At 3 months, a higher proportion of patients on tadalafil reported improved erections (GAQ 1: 96.5% tadalafil, 85.7% sildenafil and 87.2% vardenafil), satisfaction with treatment (EDITS: 84.2% tadalafil, 75.0% sildenafil and 76.0% vardenafil), and sexual self confidence (SF-PAIRS: 2.73 tadalafil, 2.39 sildenafil and 2.55 vardenafil), in comparison with sildenafil and vardenafil. At 6 months, differences between treatments were not significant. The mean+/-SD time elapsed from drug intake to sexual intercourse was higher for patients on tadalafil (18.6+/-26.4 h) compared to sildenafil (3.6+/-7.5) and vardenafil (8.6+/-19.4). CONCLUSION: The longer duration of action for tadalafil, and thus, the longer period of time between dosing and sexual intercourse may contribute to enhance sexual spontaneity, patient satisfaction with the treatment and greater self-confidence.

Efectividad y satisfacción con el tratamiento en pacientes con disfunción eréctil en España: Estudio EDOS / Effectiveness and treatment satisfaction in patients with erectile dysfunction in Spain: EDOS study

Introducción: La disfunción eréctil (DE) es un problema de salud mundial con una prevalencia creciente que afecta la calidad de vida de muchos pacientes. Objetivo: Analizar la efectividad y satisfacción con el tratamiento en la cohorte española de pacientes con DE incluidos en el estudio observacional de disfunción eréctil. Material y método: Estudio observacional, paneuropeo, que analizó la efectividad y satisfacción de los tratamientos para la DE en la práctica clínica habitual, utilizando cuestionarios estándares. Participaron varones ≥18 años que iniciaron o cambiaron su tratamiento para la DE. Los pacientes fueron evaluados en la visita basal, a los 3 y 6 meses. Resultados: Se analizaron 1.029 pacientes (12,8% de la muestra europea total). En general, las características de la población española son consistentes con las de la población global. En la visita basal 56,6% recibió tadalafilo, 16,6% sildenafilo, 19,6% vardenafilo y 7,2% otros tratamientos. A los 3 meses, una mayor proporción de pacientes con tadalafilo experimentó mejorías en la erección (cuestionario de evaluación global 1: 96,5% tadalafilo, 85,7% sildenafilo, 87,2% vardenafilo), se observó una mayor satisfacción con el tratamiento (inventario de satisfacción con el tratamiento para la DE: 84,2% tadalafilo, 75,0% sildenafilo y 76,0% vardenafilo) y mayor autoconfianza (escalas psicológicas y de relaciones interpersonales: 2,73 tadalafilo, 2,39 sildenafilo y 2,55 vardenafilo). A los 6 meses, las diferencias entre tratamientos no resultaron significativas. El tiempo medio±desviación estándar entre la toma del fármaco y la relación sexual fue mayor en los pacientes con tadalafilo (18,6±26,4h) vs. sildenafilo (3,6±7,5) y vardenafilo (8,6±19,4). Conclusiones: La mayor duración del efecto de tadalafilo y en consecuencia el mayor tiempo medio entre la toma y la relación sexual podría contribuir a aumentar la espontaneidad en las relaciones sexuales, la satisfacción con el tratamiento y mayor autoconfianza (AU)

Introduction: Erectile dysfunction (ED) is a worldwide health problem with an ever increasing prevalence, affecting the quality of life of many patients. Objective: The aim of this study was to describe treatment effectiveness and patient satisfaction with ED treatment in the Spanish cohort of the EDOS study. Material and methods: This observational, pan-European study, assessed treatment effectiveness and patient satisfaction with ED treatment under routine clinical settings, using standard questionnaires. Men ≥18 years about to initiate or change ED treatment were enrolled. Patients were assessed at baseline, 3 and 6 months. Results: A total of 1,029 patients were analyzed (12.8% of the total European sample). In general, the Spanish population characteristics are consistent with the overall population. At baseline 56.6% of patients received tadalafilo, 16.6% sildenafilo, 19.6% vardenafilo, and 7.2% received other treatments. At 3 months, a higher proportion of patients on tadalafil reported improved erections (GAQ 1: 96.5% tadalafil, 85.7% sildenafil and 87.2% vardenafil), satisfaction with treatment (EDITS: 84.2% tadalafil, 75.0% sildenafil and 76.0% vardenafil), and sexual self confidence (SF-PAIRS: 2.73 tadalafil, 2.39 sildenafil and 2.55 vardenafil), in comparison with sildenafil and vardenafil. At 6 months, differences between treatments were not significant. The mean±SD time elapsed from drug intake to sexual intercourse was higher for patients on tadalafil (18.6±26.4 h) compared to sildenafil (3.6±7.5) and vardenafil (8.6±19.4). Conclusion: The longer duration of action for tadalafil, and thus, the longer period of time between dosing and sexual intercourse may contribute to enhance sexual spontaneity, patient satisfaction with the treatment and greater self-confidence (AU)

[Development and psychometric validation of a new screening questionnaire for erectile dysfunction (SQUED questionnaire)]. / Desarrollo y validación psicométrica de un nuevo cuestionario de screening para la disfunción eréctil (cuestionario SQUED).

BACKGROUND: It is necessary to have simple tools to screen erectile dysfunction (ED) in an easy, reliable and valid manner. The objective of this study was to develop and validate a short diagnostic questionnaire for erectile dysfunction [SQUED), easy to use in the primary care setting. SUBJECTS AND METHOD: The development of SQUED included: concepts identification, item generation and evaluation of contents and face validity through interviews with subjects to assess comprehension and idiomatic adequacy. The psychometric validation was conducted in an epidemiologic, observational, comparative and multicenter study. Participants should complete the questionnaire in primary care setting and send to the specialist to confirm the diagnosis by an in depth interview and the application of IIEF questionnaire. Internal consistency, test-retest reliability and sensitivity and specificity of SQUED was evaluated. RESULTS: Out of 405 subjects enrolled, 316 (208 ED and 108 non-ED) were evaluable. The SQUED questionnaire showed a high internal consistency (Cronbach's alpha = 0.92) and a good test-retest reliability (Kappa index = 0.77). Furthermore, the questionnaire showed a good diagnostic capacity with high values of sensitivity and specificity, 0.87 and 0.78, respectively, in relation to the diagnosis made by urologists. The cutting point was established at a score of 12. DISCUSSION: The SQUED questionnaire is a simple, easy to use and reliable instrument. It can become a useful tool, and the shortest validated, for primary care physicians to easily screen for ED patients. Its simplicity should facilitate an easy cultural adaptation and validation into other languages.

Desarrollo y validación psicométrica de un nuevo cuestionario de screening para la disfunción eréctil (Cuestionario SQUED) / Development and psychometric validation of a new screening questionnaire for erectile dysfunction (squed questionnaire)

Introducción. Es necesario contar con herramientas sencillas que permitan detectar de forma válida y fiable la presencia de disfunción eréctil (DE). El objetivo de este estudio fue desarrollar y validar un cuestionario de cribado de la DE que fuera útil para usar en atención primaria (AP). Material y Métodos. El desarrollo del cuestionario SQUED (Short Questionnaire for Erectile Dysfunction) incluyó la identificación de conceptos y generación de ítems, evaluación del contenido y la validez aparente a partir de entrevistas con sujetos para valorar la compresión y adecuación del lenguaje. Para la validación psicométrica se realizó un estudio epidemiológico, observacional, comparativo y multicéntrico. Los participantes completaron el cuestionario en el ámbito de la AP y fueron derivados al especialista para la confirmación diagnóstica mediante entrevista clínica y la administración del International Index of Erectile Function (IIEF). Se evaluó la consistencia interna, la fiabilidad del test-retest y la sensibilidad y la especificidad del SQUED. Resultados. Participaron 405 sujetos, de los cuales 316 (208 con DE y 108 sin DE) fueron evaluables. El cuestionario SQUED mostró una alta consistencia interna (alfa de Cronbach = 0,92) y una buena fiabilidad test-retest (índice Kappa= 0,77). Además, el cuestionario mostró una alta capacidad diagnóstica con valores de sensibilidad y especificidad, 0,87 y 0,78, respectivamente, respecto al diagnóstico del urólogo. El punto de corte se estableció en una puntuación de 12. Discusión. El cuestionario SQUED es un instrumento sencillo, fácil de usar y fiable. Constituye una herramienta útil, y la más corta validada, para que los médicos de AP puedan identificar fácilmente pacientes con DE. Su sencillez debería hacer fácil el proceso de adaptación cultural y validación en otros idiomas

Background. It is necessary to have simple tools to screen erectile dysfunction (ED) in an easy, reliable and valid manner. The objective of this study was to develop and validate a short diagnostic questionnaire for erectile dysfunction (SQUED), easy to use in the primary care setting. Subjects and method. The development of SQUED included: concepts identification, item generation and evaluation of contents and face validity through interviews with subjects to assess comprehension and idiomatic adequacy. The psychometric validation was conducted in an epidemiologic, observational, comparative and multicenter study. Participants should complete the questionnaire in primary care setting and send to the specialist to confirm the diagnosis by an in depth interview and the application of IIEF questionnaire. Internal consistency, test-retest reliability and sensitivity and specificity of SQUED was evaluated. Results. Out of 405 subjects enrolled, 316 (208 ED and 108 non-ED) were evaluable. The SQUED questionnaire showed a high internal consistency (Cronbach’s alpha = 0.92) and a good test-retest reliability (Kappa index = 0.77). Furthermore, the questionnaire showed a good diagnostic capacity with high values of sensitivity and specificity, 0.87 and 0.78, respectively, in relation to the diagnosis made by urologists. The cutting point was established at a score of 12. Discussion. The SQUED questionnaire is a simple, easy to use and reliable instrument. It can become a useful tool, and the shortest validated, for primary care physicians to easily screen for ED patients. Its simplicity should facilitate an easy cultural adaptation and validation into other languages

[Laparoscopic ureterolithotomy of an iliac ureteral stone forgotten for more than eight years]. / Ureterolitotomia laparoscópica de un cálculo de uréter iliaco olvidado durante más de ocho años.

INTRODUCTION: Laparoscopic ureterolithotomy recently rises as a new option in the treatment of ureteral calculi, particularly those of the greatest size, hardness or impactation. We describe such an indication to resolve a case of forgotten for more than eight years and severely obstructive ureteral stone. PATIENT AND METHOD: A 64 years-old male received extracorporeal shock wave lithotripsy for a right distal ureteral stone and, simultaneously, a left impacted iliac ureteral calculi was discovered, at the confluence of an incomplete duplication of the ureter, for which treatment was recommended, but deferred by the patient. Eight years after, the same stone caused a massive dilatation with poor function of the upper pole moiety and slightly preserved function of the lower pole moiety of the left kidney. Two intents of retrograde ureteroscopy failed because of impossibility to reach the stone. Transperitoneal laparoscopic ureterolithotomy was performed in lateral decubitus position, with double J in place and three 10 mm ports. After identification of the dilated ureter, an V-shape ureterothomy was made and the stone mobilized and extracted. The ureter was stented and the ureterothomy closed with intracorporeal suture. The patient had a postoperative stage of four days and a mild functional recovery. DISCUSSION: If the usual treatment options (extracorporeal lithotripsy and ureteroscopy with intracorporeal lithotripsy) failed, then laparoscopic ureterolithotomy is less invasive than open ureterolithotomy. However, the indications of laparoscopic ureterolithotomy are restricted because substantial laparoscopic experience is needed to cope with possible technical difficulties.

[Verrucous carcinoma of the penis arising from a lichen planus. A true preneoplastic lesion?]. / Carcinoma verrucoso de pene desarrollado sobre un liquen plano. Una auténtica lesión preneoplásica?

INTRODUCTION: Up to 30% of squamous cell carcinomas of the penis arise from a lichen sclerosus, but very few reports in which lichen planus was the preexisting lesion have been published. We report a male with verrucous carcinoma of penis that developed in an area of lichen planus. CLINICAL CASE: A 53-year-old male presented with an exophytic tumor on the glans penis that had been present for about 6 months. The lesion developed in a previously biopsied area of lichen planus hypertrophicus. After excision, histological diagnosis was verrucous carcinoma. COMMENT: The development of any subtype of squamous cell carcinoma of penis in a lichen planus can be coincidental, or a neoplastic transformation of lichen planus can take place.

Ureterolitotomia laparoscópica de un cálculo de uréter iliaco olvidado durante más de ocho años / Laparoscopic ureterolithotomy of an iliac ureteral stone forgotten for more than eight years

Introducción: La ureterolitotomía laparoscópica ha surgido recientemente como una nueva opción de tratamiento de los cálculos ureterales de tamaño, dureza o impactación particularmente grandes. Mostramos una indicación de ureterolitotomia laparoscópica para resolver un caso de litiasis olvidada y gravemente obstructiva. Paciente y técnica: Un varón de 64 años fue tratado mediante litotricia extracorpórea de un cálculo de uréter distal derecho, y se le encontró simultáneamente un cálculo impactado en uréter iliaco izquierdo, en la confluencia de una duplicidad ureteral incompleta, cuyo tratamiento prefirió posponer. Ocho años después, el mismo cálculo causaba una masiva dilatación, con mala función del pielón superior y función conservada en el pielón inferior de ese riñón. En dos intentos de ureteroscopia retrógrada resultó imposible alcanzar el cálculo. Se realizó ureterolitotomía laparoscópica transperitoneal, con un catéter doble J en posición y con tres accesos de 10 mm. Se identificó el uréter muy dilatado y mediante una ureterotomía en V, se movilizó y extrajo el cálculo. Se dejó intubado el uréter y se cerró la ureterotomía con puntos intracorpóreos. La estancia postoperatoria fue muy corta y la recuperación funcional se consideró satisfactoria. Discusión: Si las opciones de tratamiento habitual (litotricia extracorpórea y ureteroscopia con litotricia intracorpórea) han fracasado, la ureterolitotomía laparoscópica es una opción menos invasiva que la ureterolitotomía abierta. Sus indicaciones son muy restringidas, pues las posibles dificultades de la técnica exigen una considerable experiencia laparoscópica

Introduction: Laparoscopic ureterolithotomy recently rises as a new option in the treatment of ureteral calculi, particularly those of the greatest size, hardness or impactation. We describe such an indication to resolve a case of forgotten for more than eight years and severely obstructive ureteral stone. Patient and method: A 64 years-old male received extracorporeal shock wave lithotripsy for a right distal ureteral stone and, simultaneously, a left impacted iliac ureteral calculi was discovered, at the confluence of an incomplete duplication of the ureter, for which treatment was recommended, but deferred by the patient. Eight years after, the same stone caused a massive dilatation with poor function of the upper pole moiety and slightly preserved function of the lower pole moiety of the left kidney. Two intents of retrograde ureteroscopy failed because of impossibility to reach the stone. Transperitoneal laparoscopic ureterolithotomy was performed in lateral decubitus position, with double J in place and three 10 mm ports. After identification of the dilated ureter, an V-shape ureterothomy was made and the stone mobilized and extracted. The ureter was stented and the ureterothomy closed with intracorporeal suture. The patient had a postoperative stage of four days and a mild functional recovery. Discussion: If the usual treatment options (extracorporeal lithotripsy and ureteroscopy with intracorporeal lithotripsy) failed, then laparoscopic ureterolithotomy is less invasive than open ureterolithotomy. However, the indications of laparoscopic ureterolithotomy are restricted because substantial laparoscopic experience is needed to cope with possible technical difficulties

Carcinoma verrucoso de pene desarrollado sobre un liquen plano. ¿una auténtica lesión preneoplásica? / Verrucous carcinoma of the penis arising from a lichen planus. A true preneoplastic lesion?

Introducción: Hasta un 30% de carcinomas epidermoides de pene se desarrollan sobre un liquen escleroso, mientras que hay muy pocos casos publicados en los que la lesión preexistente sea un liquen plano. Se presenta un carcinoma verrucoso de pene desarrollado sobre un área de liquen plano. Caso clínico: Un varón de 53 años consultó por presentar un tumor exofítico en glande de 6 meses de evolución, que había crecido sobre una lesión biopsiada 2 años antes, y diagnosticada como liquen plano hipertrófico. Tras su extirpación, el diagnóstico histológico fue de carcinoma verrucoso. Comentario: el desarrollo de cualquier variante de carcinoma epidermoide de pene sobre un liquen plano puede ser meramente casual, o por el contrario podría ser una transformación neoplásica del mismo

Introduction: up to 30% of squamous cell carcinomas of the penis arise from a lichen sclerosus, but very few reports in which lichen planus was the preexisting lesion have been published. We report a male with verrucous carcinoma of penis that developed in an area of lichen planus. Clinical case: a 53-year-old male presented with an exophytic tumor on the glans penis that had been present for about 6 months. The lesion developed in a previously biopsied area of lichen planus hypertrophicus. After excision, histological diagnosis was verrucous carcinoma. Comment: the development of any subtype of squamous cell carcinoma of penis in a lichen planus can be coincidental, or a neoplastic transformation of lichen planus can take place

[Psychological impact of erectile dysfunction on self-esteem and self-confidence]. / Repercusiones psicológicas de la disfunción eréctil sobre la autoestima y autoconfianza.

BACKGROUND AND OBJECTIVE: Erectile dysfunction (ED) is caused by a large range of organic, psychological, psychiatric, interpersonal and pharmacological factors. Numerous scientific publications mention the loss of self-esteem as a collateral effect of ED, with a very probable affectation of the subject's self-confidence. The objective of this study was to evaluate the self-esteem and self-confidence of subjects with ED and to compare them with a group of non-ED subjects. SUBJECTS AND METHOD: An epidemiological, cross-sectional, observational, comparative and multicentric study was conducted. General Practitioners selected 405 men older than 18 years in which they suspected ED. All the participants had to complete the self administered form of the Spanish version of the Rosenberg self-esteem scale and the Spanish culturally adapted version of the Johnson and McCoy self-confidence scale. After that, patients were referred to the urologist in order to confirm the ED diagnosis. RESULTS: The statistical analysis of the data showed that the subjects with ED obtained significantly lower scores in the self-confidence and self-esteem scales than the non-ED subjects (p < 0.01). DISCUSSION: The results of this study show the loss of self-confidence and self-esteem that suffer patients with ED.

Repercusiones psicológicas de la disfunción eréctil sobre la autoestima y autoconfianza / Psychological impact of erectile dysfunction on self-esteem and self-continence

Introducción: La disfunción eréctil (DE) está causada por una amplia gama de factores orgánicos, psicológicos, psiquiátricos, interpersonales y farmacológicos. En numerosas publicaciones se menciona la pérdida de autoestima como un efecto colateral de la DE siendo muy probable también una afectación de la autoconfianza del sujeto. El objetivo del siguiente estudio fue evaluar la autoestima y autoconfianza de sujetos con DE y compararla con un grupo de sujetos sin DE. Material y Métodos: Estudio epidemiológico, transversal, observacional, comparativo y multicéntrico. Se seleccionaron 405 sujetos varones mayores de 18 años en los que el médico de Atención Primaria sospechara que pudieran padecer DE. Todos los participantes debían cumplimentar de forma autoaplicada la versión española del cuestionario de autoestima de Rosenberg y la adaptación cultural al español del Cuestionario de autoconfianza de Johnson y McCoy. Después fueron remitidos a un urólogo que confirmaba el diagnóstico de DE (“gold Standard”).Resultados: El análisis estadístico mostró que los sujetos afectados de DE obtenían puntuaciones significativamente inferiores en las escalas de autoconfianza y autoestima que los sujetos sin DE (p< 0.01).Discusión: Los resultados ponen de manifiesto la pérdida de autoconfianza y autoestima que sufren los pacientes afectados de DE (AU)

Background and objective: Erectile dysfunction (ED) is caused by a large range of organic, psychological, psychiatric, interpersonal and pharmacological factors. Numerous scientific publications mention the loss of self-esteem as a collateral effect of ED, with a very probable affectation of the subject´s self-confidence. The objective of this study was to evaluate the self-esteem and self-confidence of subjects with ED and to compare them with a group of non-ED subjects. Subjects and Method: An epidemiological, cross-sectional, observational, comparative and multicentric study was conducted. General Practitioners selected 405 men older than 18 years in which they suspected ED. All the participants had to complete the self administered form of the Spanish version of the Rosenberg self-esteem scale and the Spanish culturally adapted version of the Johnson and McCoy self-confidence scale. After that, patients were referred to the urologist in order to confirm the ED diagnosis. Results: The statistical analysis of the data showed that the subjects with ED obtained significantly lower scores in the self-confidence and self-esteem scales than the non-ED subjects (p< 0.01). Discussion: The results of this study show the loss of self-confidence and self-esteem that suffer patients with ED

[Laparoscopic pyelolithotomy in a pelvic kidney]. / Pielolitotomía laparoscópica en riñón pelviano.

INTRODUCTION: Pelvic renal ectopia bearing stones is a particularly rare case of complex calculi. Several percutaneous and laparoscopic procedures had been proposed in the last years to treat this challenge problem in a minimally invasive way. CLINICAL CASE: We describe the procedure of laparoscopic pyelolithotomy under general anesthesia, using three port sites, in a male patient with symptomatic stones in a left pelvic kidney with normal function. Two stones were successfully removed, with the help of flexible nephroscopy through a port, and the pyelotomy was closed with intracorporeal suture. COMMENT: Laparoscopic pyelolithotomy of a pelvic kidney is a minimally invasive technique that is not difficult to perform, making laparotomy unnecessary. Laparoscopic technique must be take into account when dealing with the infrequent complex stone patient candidate to an open stone surgery. A review of the Spanish bibliography shows this to be the second reported case of pelvic kidney calculi treated by laparoscopic pyelolithotomy.

Pielolitotomía laparoscópica en riñón pelviano / Laparoscopic pyelolithotomy in a pelvic kidney

INTRODUCCIÓN: El riñón pelviano afecto de cálculos es un caso particularmente raro de litiasis compleja. Diversos procedimientos, percutáneos y laparoscópicos, se han propuesto en los últimos años para resolverlo de manera poco invasiva. CASO CLÍNICO: Se muestra el procedimiento de pielolitotomía laparoscópica mediante tres únicos accesos, en un varón con cálculos sintomáticos en un riñón pelviano izquierdo con función normal. Se extrajeron dos cálculos con ayuda del nefroscopio flexible introducido a través de uno de los accesos, y cerrando la pelvis renal con sutura intracorpórea. COMENTARIO: La pielolitotomía laparoscópica de un riñón pelviano es poco invasiva y puede hacerse con facilidad, haciendo innecesaria una laparotomía. La técnica laparoscópica debe tenerse en cuenta en el infrecuente paciente con litiasis compleja en el que se considere una intervención abierta. Este es el segundo caso de riñón pelviano operado mediante laparoscopia, en la bibliografía española

INTRODUCTION: Pelvic renal ectopia bearing stones is a particularly rare case of complex calculi. Several percutaneous and laparoscopic procedures had been proposed in the last years to treat this challenge problem in a minimally invasive way. CLINICAL CASE: We describe the procedure of laparoscopic pyelolithotomy under general anesthesia, using three port sites, in a male patient with symptomatic stones in a left pelvic kidney with normal function. Two stones were successfully removed, with the help of flexible nephroscopy through a port, and the pyelotomy was closed with intracorporeal suture. COMMENT: Laparoscopic pyelolithotomy of a pelvic kidney is a minimally invasive technique that is not difficult to perform, making laparotomy unnecessary. Laparoscopic technique must be take into account when dealing with the infrequent complex stone patient candidate to an open stone surgery. A review of the Spanish bibliography shows this to be the second reported case of pelvic kidney calculi treated by laparoscopic pyelolithotomy

[Hyperplasia of adrenal rests in the testicle: a rare cause of male infertility]. / Hiperplasia de restos adrenales en el testículo: una causa infrecuente de infertilidad masculina.

We report the case of a 37-year-old man with infertility caused by bilateral testicular masses secondary to congenital adrenal hyperplasia (21-hydroxylase deficiency). Testicular biopsy was done and its was initially interpreted as Leydig cell tumor but after clinical information was histologically reclassified as tumor of the adrenogenital syndrome. The differential diagnosis with Leydig cell tumor is discussed and it must be established through the clinical, biochemical, radiological and pathological features.

Hiperplasia de restos adrenales en el testículo: una causa infrecuente de infertilidad masculina / Testicular adrenal rest issue hyperplasia: an unusual cause of male infertility

Presentamos un caso de azoospermia secretora y masas testiculares bilaterales secundarias a hiperplasia adrenal congénita por déficit de 21-hidroxilasa en un varón de 37 años. La biopsia testicular fue informada como tumor de células de Leydig, pero se consideró el diagnóstico después de la información clínica, siendo el diagnóstico final de hiperplasia de restos adrenales en el testículo. Comentamos el diagnóstico diferencial con el tumor de células de Leydig insistiedo en la necesidad de diagnosticar esta lesión con una adecuada correlación clínica, analítica, radiológica e histológica (AU)

We report the case of a 37-year-old man with infertility caused by bilateral testicular masses secondary to congenital adrenal hyperplasia (21-hydroxylase deficiency). Testicular biopsy was done and its was initially interpreted as Leydig cell tumor but after clinical information was histologically reclassified as tumor of the adrenogenital syndrome. The differential diagnosis with Leydig cell tumor is discussed and it must be established through the clinical, biochemical, radiological and pathological features (AU)

[Traumatic unilateral testicular dislocation]. / Dislocación unilateral testicular traumática.

OBJECTIVE: To report a case of traumatic testicular dislocation, an unusual complication of pelvic trauma. METHODS/RESULTS: A case of traumatic testicular dislocation that had been diagnosed two months after the initial injury is presented. CT and color doppler US revealed a viable right testis displaced in the inguinal subcutaneous region. The testis was repositioned in the scrotum and orchidopexy was performed. Follow-up control evaluation at 6 months revealed a normal testis in the right hemiscrotum. CONCLUSIONS: Traumatic testicular dislocation is a rare complication that may be undetected at the time of the initial injury. Surgical reduction and repositioning achieve good results.

[High-flow priapism after perineal trauma]. / Priapismo de alto flujo después de traumatismo perineal.

We report on the case of a 19-year-old man with post-traumatic high-flow priapism that appeared after riding on a mountain bike. Laboratory test (cavernous blood gas measurement) and image studies (color flow Doppler ultrasound and arteriography of the internal pudendal artery) that confirmed the diagnosis are depicted. He was successfully treated with selective percutaneous arterial embolization with autologous blood clot, recovering a normal erectile function.