Young male patient with bilateral synchronous testicular germ cell tumour. Considerations for partial orchiectomy

Bilateral synchronous testicular cancer is a rare disease and is usually associated with similar histological findings in each testicle. The standard therapy of bilateral testis cancer is generally considered to be inguinal orchiectomy. We present a case of synchronous bilateral testicular germ cell tumour, with different histology, initially treated with testis-sparing surgery. After pathology review, the margin of the partial orchiectomy was considered affected, and an inguinal orchiectomy was planned. Options for testis-sparing surgery are discussed (AU)

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[Vasectomy: study of 300 interventions. Review of the national literature and of its complications]. / La vasectomía: estudio de 300 intervenciones. Revisión de la literatura nacional y de sus complicaciones.

OBJECTIVES: The aims of this paper are: 1. To study the demand and reasons why of the vasectomy in area 12 of Valencian Community. 2. To analyse the adverse effects of our series and the predictable risk factors. 3. To review the adverse effects in the national series. 4. To review the adverse effects referred to in international publications. PATIENTS AND METHODS: A retrospective study was made of 300 patients who had submitted themselves to a vasectomy between january 1992 and december 2000. All the clinical dossiers were reviewed according to 10 pre-established variables. age, number of offspring, reasons why, pre-vasectomy anticontraceptives; date of operation, type of anaesthesia used, pathologic anatomy, semen analysis after vasectomy, adverse effects and their possible causes (risk factors). The basic statistic study was done using a data base of Microsoft Access and the interpretations of the different variables using a table of Excel. RESULTS: The demand for contraceptive attention (vasectomy) is the 8th cause for external urological consulting and the 4th for urological local ambulatory surgery of our area. 300 operations were done during that period. The average age of the patients was 37.5 years old (ranging from 25 to 51). The number of offspring ranged from 1 to 7, with a promedia of 2.41 children/patient. The reasons why were: voluntary family planning (86%), medical illnesses of the female which contraindicated gestation (9%), genetic reasons (4.33%) and social-sanitary problems (0.66%). Contraceptive methods used by 71.63% are known: The widest-used method being IUD (49.74%) and the preservative (25.88%). 30 patients (10%) had adverse effects, 29 patients having light adverse effects. The most frequent were: 12 orchiepididymitis (4%), 5 spermatic granulomas (1.66%), 3 chronic scrotal pain (1%), 2 scrotal haematoma (0.66%) and 2 bleeding (0.66%). There was one serious complications and of all the cases mentioned above only one needed hospitalization (impetigo-sepsis) and another needed surgery due to a spermatic granuloma. There were no pregnancies or post-vasectomy court cases. 81% of the patients had been declared azoospermic within 45 to 60 days after the vasectomy in one or two consecutive semen analysis. CONCLUSIONS: The vasectomy is a safe and simple way for male sterilization. It's the most widely done urologic operation in Spain. The technique isn't extent of adverse effects (0 to 18%) and its seriousness varies from a simple ecchymosis to Fournier's gangrene, endocarditis or sepsis. A doctor would be considered negligent if he/she didn't inform the patient about the remote possibility of a spontaneous recanalisation of the vas deferens leading to renewed fertility (failure of the vasectomy). It is imperative to give post-vasectomy information where the patient must continue using his habitual anticonceptive method until the azoospermia shown in 2 semen analysis confirm the sterility of the patient so that the urologist has no legal problem.

Escleroterapia del hidrocele y quiste de cordón con polidocanol. Estudio de eficiencia / Sclerotherapy of hydrocele and epididymal cyst with polidocanol: efficiency study

OBJETIVOS: Comprobar la eficiencia (coste/beneficio) de la escleroterapia con polidocanol en nuestro medio para el tratamiento del hidrocele y quiste de cordón. PACIENTES Y MÉTODOS: Estudiamos 86 pacientes con este diagnóstico desde mayo de 1995, hasta abril de 2000. Aplicamos los costes por proceso según los indicadores de gestión precio de nuestro hospital en el año 1999.RESULTADOS: 79 pacientes completaron el protocolo. Hemos curado al 83,87 por ciento de los pacientes con escleroterapia sólo; el 42,3 por ciento en el primer tratamiento. Un 4,5 por ciento de los pacientes tuvo dolor significativo y un 7,4 por ciento alguna complicación. DISCUSIÓN: Fueron necesarios 1,5 tratamientos de media para conseguir la curación, resultando ésta 4,78 veces más barata que mediante cirugía. CONCLUSIÓN: La escleroterapia con polidocanol del hidrocele o quiste de cordón es un tratamiento eficaz, seguro, sencillo, razonablemente confortable y sobre todo, económico (AU)

[Transitional carcinoma of the ureter and ipsilateral synchronous renal cell carcinoma in hydronephrotic atrophic kidney: infrequent association]. / Carcinoma transicional de uréter y carcinoma ipsilateral sincrónico de células renales en riñón atrófico hidronefrótico: asociación infrecuente.

We report a new case of simultaneous occurrence of renal cell carcinoma and transitional cell carcinoma into ipsilateral ureter. A review of the literature to date indicates this is the 45 world-wide case and the 8 in the Spanish publications.

Carcinoma transicional de uréter y carcinoma ipsilateral sincrónico de células renales en riñón atrófico hidronefrótico: asociación infrecuente / Transitional cell carcinoma of the ureter and sinchronous ipsilateral renal cell carcinoma in hydronephrotic-atrophic kidney: an infrequent association

Presentamos un nuevo caso de aparición simultánea de adenocarcinoma de células renales y carcinoma urotelial del uréter ipsilateral. La revisión de la literatura indica que éste es el caso 45 mundial y 8 en publicaciones españolas (AU)

[Sclerotherapy of hydrocele and cord cyst with polidocanol. Efficiency study]. / Escleroterapia del hidrocele y quiste de cordón con polidocanol. Estudio de eficiencia.

OBJECTIVES: Checking the efficiency (cost/benefit) of the sclerotherapy with polidocanol in our country for the treatment of hydrocele and epididymal cyst. PATIENT AND METHODS: We studies 86 patients with this diagnosis from may of 1995, until april of 2000. We have applied the costs for process according to the indicators of administration-cost our hospital in the year 1999. OUTPUTS: 79 patient completed the protocol. The overall cure rate was 83.87% with sclerotherapy; 42.3% with first one treatment. Only a 4.5% of the patients had significant pain and a 7.4% others complications. DISCUSSION: There were necessaries 1.5 sclerotherapies of mean for curation, resulting this treatment 4.78 more cheaper than surgery. CONCLUSION: The sclerotherapy with polidocanol of the hydrocele or epididymal cyst are an effective treatment, sure, simple, reasonably comfortable and fundamentally, economical.

[Significance of simple radiography of the abdomen in nephritic colic]. / El valor de la radiología simple de abdomen en el cólico nefrítico.

BASIS: The utility of the abdominal plain film in the emergency department to evaluate urolithiasis is questionable. Between another things, there are influence of the different formation of distinct examinators. METHODS: A retrospective study in 65 patients referrals to urology in 1997 and 1998 by suspicion of renal colic was carried out. The radiography of abdomen took in the emergency room the day of the income is reviewed with a protocol, by a resident of Familiar and Community Medicine and by the urologist, separately and without information of the medical records. RESULTS: We have excluded three patients. At last, we diagnose 49 patients as renal colic with certainty, 6 patients with doubtful diagnosis and 7 patients with distinct diagnosis. The urologist achieved the most adequate reading in 11 cases; in 7 was best the resident, to equal in 31, and in 13 the differences were not important. The resident obtained of radiography a sensitivity of the 67% and a specificity of the 42% and the urologist 71% and 57% respectively. CONCLUSIONS: There are few differences of reading, at least when the resident dispose a protocol of interpretation. Despite to the almost null diagnostic utility of the radiography, supply additional ation, and permit to value the evolution with a few aggressive technique.

El valor de la radiología simple de abdomen en el cólico nefrítico / The value of plain abdominal radiography in renal colic

FUNDAMENTO: La utilidad de la radiografía de abdomen en urgencias para diagnosticar cálculos urinarios es cuestionable. Entre otros motivos, influye la diferente formación de los distintos lectores. MÉTODOS: Estudiamos retrospectivamente 65 pacientes ingresados en 1997 y 1998 por sospecha de cólico nefrítico. La radiografía de abdomen hecha en urgencias el día del ingreso es revisada con un protocolo, por un residente de Medicina Familiar y Comunitaria y por un adjunto de Urología, separadamente y sin información de la historia clínica. RESULTADOS: Tres pacientes se han excluido. Finalmente diagnosticamos 49 pacientes como cólico nefrítico con certeza, 6 pacientes con diagnóstico dudoso y 7 pacientes con diagnóstico distinto. El adjunto hizo mejor lectura en 11 casos; en 7 mejor el residente, igual en 31, y en 13 las diferencias eran intrascendentes. El residente obtuvo de la radiografía una sensibilidad del 67 por ciento y una especificidad del 42 por ciento y el adjunto 71 por ciento y 57 por ciento respectivamente. CONCLUSIONES: Existen mínimas diferencias de lectura, al menos cuando al residente se le proporciona un protocolo de interpretación. Pese a la casi nula utilidad diagnóstica de la radiografía, suministra información adicional, y permite valorar la evolución de forma poco agresiva (AU)

[Acute scrotum without technology]. / El escroto agudo sin tecnología.

The highly developed diagnostic technologies of our time applied to acute scrotum is not readily available in many of our hospitals. With the purpose of evaluating our results in the diagnosis and treatment of this nosologic entity, and to compare them with those reported by other hospitals where modern technologies are being used, our group revised all patients referring this condition who were given emergency treatment by the urologist on call during the first 100 months of our unit. An analysis is made of the etiology, patient's age, disease location, time of evolution, diagnosis, treatment received and final outcome. The epidemiological data obtained is similar to other series published, except for the hydatid torsion, which was more frequent than previously reported. In cord's torsion, a similar background should be considered a poor prognostic factor. In summary, the left testicle is more exposed to the various acute scrotal diseases. Surgery is an attractive option for hydatid torsion. Finally, an earlier intervention in the event of suspicious cord torsion remains the most important factor in the prognosis. Our results, using no state-of-the-art diagnostic technologies, are similar to other series and we see no trend towards unnecessary surgical examination.

[Acute scrotal hematoma in Schoenlein-Henoch purpura. Infrequent urologic manifestation]. / Hematoma escrotal agudo en la púrpura de Schönlein-Henoch. Manifestación urológica infrecuente.

Schönlein-Henoch purple is a systemic vasculitis due to hypersensitivity. It is typical of childhood and more unusual in adults. The etiology is unknown. It is identified by the presence of skin purpura, joint involvement, abdominal colic pain and quite often renal involvement (nephropathy). Urological manifestations are uncommon and include: haematuria, scrotal swelling, cord haematoma, signs and symptoms mimicking cord or hydatid torsion, testicular pain due to intratesticular segmented infarction, painful ecchymotic induration of the scrotum, or testicular necrosis. Contribution of one case of Schönlein-Henoch purpura developed in adulthood with scrotal-perineal haematoma associated to skin purpura and abdominal colic pain in a 75-year old patient.

[A new solution to the retained Foley catheter]. / Nueva solución frente al catéter Foley retenido.

OBJECTIVE: To describe a new, effective and simple method to remove Foley catheters retained in the bladder. METHODS: After stretching the ureter, it is held close to the meatus with Kocher clamps. The catheter is cut transversely and disobstructed. The liquid utilized to inflate the balloon is removed and the catheter withdrawn. RESULTS: The method is easy, fast, indolent, low-cost, non traumatic, does not impede subsequent maneuvers and effective. CONCLUSION: This method is suitable after eliminating the valve mechanism and before recurring to balloon puncture or invasive methods.

[Epididymal adenomatoid tumor. Review of the national literature and report of a case]. / Tumor adenomatoide de epidídimo. Revisión de la literatura nacional y aportación de un caso.

Benign epididymal epithelial tumours are very uncommon. Their frequency rating is as follows: adenomatoid tumour, leiomyoma and papilliferous cystoadenoma. This paper contributes a new case of epididymal adenomatoid tumour in a 29-year old male who presented with testicular pain. Diagnosis was achieved through physical examination and echography. A simple tumourectomy was performed. As a result of this case, a review was made of the Spanish literature.

[Inguinoscrotal bladder hernia. Report of a case]. / Hernia vesical inguinoescrotal. A propósito de un caso.

Presentation of one case of scrotal vesical hernia in a 66-year old patient who presented with scrotal mass, micturition difficulty and two-phase micturition that improved when pressure was exerted on the scrotum. Diagnosis was established by physical examination and CUMS. The patient underwent surgery during which a direct inguinal hernia due to paraperitoneal vesical sliding was found. Right herniorrhaphy was performed with Shouldice's technique. Postoperative radiological monitoring showed normal vesical morphology. The pathogeny, classification and treatment, as well as the differential diagnosis uncommonly reported by the authors consulted, are commented.

[Adipose retroperitoneal tumors. Apropos a giant myxoid liposarcoma]. / Tumores adiposos retroperitoneales. A propósito de un liposarcoma mixoide gigante.

Liposarcomas are the most frequent retroperitoneal tumours, second only to lymphomas. We present a new case of giant retroperitoneal liposarcoma treated in our hospital. A discussion is presented on the most peculiar aspects of this tumour, such us: multicentricity, tendency to local relapse, and need to post-operative (adjuvant) radiotherapy. A review of all nationwide cases over the last few years is included.

[Retroperitoneal fibrosis due to ergotamine. Apropos a case]. / Fibrosis retroperitoneal por ergotamina. A propósito de un caso.

OBJECTIVES: This paper reviews retroperitoneal fibrosis secondary to ergotamine and evaluated the current tools in its diagnosis. METHODS/RESULTS: A well documented case of a young patient with retroperitoneal fibrosis resulting from chronic use of ergotic agents is presented. The fibrous plaque remitted after withdrawal of the causal agent. CONCLUSIONS: The importance of contrast-enhanced CT in the diagnosis of retroperitoneal fibrosis is widely accepted. The usefulness of this technique in determining the extent of the lesion and for subsequent follow up is underscored.

[Conservative approach in total multicystic renal dysplasia. Our experience]. / La actitud conservadora en la displasia renal multiquistica total. Nuestra experiencia.

Contribution of 14 patients with Unilateral Total Multicystic Renal Dysplasia treated with conservative criteria, with particular emphasis in the absence of clinical complications, as well as the natural tendency to involution of the affected organs. Five dysplastic kidneys disappeared in the ultrasound, 4 decreased in size, 3 remained the same and 2 have been removed. Review of the literature and discussion of all the reasons why nephrectomy was traditionally indicated, explaining the reasons why we support an expecting attitude.

[Urologic emergencies: our difficult experience with care services]. / Urgencias urológicas: nuestra experiencia problemática de una labor asistencial.

Urological emergencies, except those occurring in children, seen in a General Hospital were studied for one year. The retrospective study, both descriptive and comparative, conducted has allowed to know that there had been 3,244 emergencies (4.2% of total cases) though the urologist acted only in 1,410 (43.4%). A predominance of males (76.10%) in their sixth and seventh decade (33% of total) was seen. Presentation increased slightly (2%) above average during the summer months. 80.9% came to the Emergency Ward of their own accord and 70% were discharged soon after assistance. Nephritic colic (19.08%), haematuria (14.04%) and U.T.I. (13.83%) were the most common causes for presentation. A total of 284 patients (20.14%) required hospitalization. 96.6% were given medical and/or instrumental treatment, versus 3.4% (49) who underwent surgery basically due to testicular disease (34.69%), sepsis (24.50%), traumatic injury of male genitalia (20.3%), etc. The most frequent conditions were analyzed by age, sex, and seasonal distribution. Also, an analysis was made on the concept of "Urological Emergency" to evaluate incidence and types in our environment.

[Torsion and seminoma in a cryptorchid testis]. / Torsión y seminoma en testículo criptorquídico.

Presentation of one case of seminoma on cryptorchid testicle which presented with torsion of spermatic cord clinically mimicking an inguinal incarcerated hernia. Despite the infrequency of the picture, the high association rate of neoplastic disease in cryptorchid testis which become twisted and force the adoption of oncological criteria for their treatment is highlighted.

[Leydig cell tumor associated with gynecomastia]. / Tumor de células de Leydig acompañado de ginecomastia.

Presentation of one case of testicular Leydig's cells tumour in a young adult who presented with gynaecomastia. The clinical and diagnostic aspects of this entity in which, in the absence of confirmed metastasis, we lack the criteria to sustain a definite prognostic judgement are commented. Finally, the different therapeutic attitudes revealed in the literature are assembled.

[Mixed "organoid" tumor or the testis: general considerations. Report of a case]. / Tumor "organoide" mixto de testículo: consideraciones generales. A propósito de un caso.

Presentation of one case of mixed testicular tumour in a 31-year-old male patient. Since this is the association in the same organ of an "organoid" teratoma plus a seminoma, the histological diversity, frequency, as well as the analysis of the controversies and criteria for its therapeutical approach are all discussed. Also, several histological theories on the genesis of mixed testicular tumours are explained. Prognosis and evolution after treatment of the present case is included.