[Clinical cases about secondary sterility caused by obstructive azoospermia with surgical repair possibilities]. / Casos clínicos de esterilidad secundaria por azoospermia obstructiva subsidiaria de reparación quirúrgica.

Secondary sterility in male patients is due to sperm alterations in a high proportion of cases. But, obstructive azoospermia set up a very important cause of sterility, because a surgical repair is possible. Some of the factors cause obstructive azoospermia are the herniorrhaphy intervention, including secondary inflammatory reaction, and epididymal lesion or epididymitis. Currently, both cases are important due to high frequency of these aetiologies. Besides we should identified obstructive cause to provide a surgical repair.

Casos clínicos de esterilidad secundaria por azoospermia obstructiva subsidiaria de reparación quirúrgica / Clinical cases about secondary sterility caused by obstructive azoospermia with surgical repair possibilities

La esterilidad secundaria masculina es debida en una elevada proporción de casos a alteraciones en el esperma. Por otro lado, la azoospermia obstructiva constituye una causa importante de esterilidad, al ser subsidiaria de reparación quirúrgica. Entre los factores que intervienen en la azoospermia obstructiva encontramos la cirugía tras herniorrafia, en donde cabe destacar los procesos inflamatorios subsiguientes, y la lesión epididimaria o epididimitis previa. La importancia de los casos presentados radica actualmente, en la elevada frecuencia de dichas etiologías y en la identificación de causas obstructivas, dado que son potencialmente resolubles (AU)

Secondary sterility in male patients is due to sperm alterations in a high proportion of cases. But, obstructive azoospermia set up a very important cause of sterility, because a surgical repair is possible. Some of the factors cause obstructive azoospermia are the herniorrhaphy intervention, including secondary inflammatory reaction, and epididymal lesion or epididymitis. Currently, both cases are important due to high frequency of these aetiologies. Besides we should identified obstructive cause to provide a surgical repair (AU)

[Acute and immediate urination syndrome after transurethral resection: a case of incrustating cystopathy]. / Síndrome miccional agudo e inmediato post-RTU: un caso de cistopatía incrustante.

The authors present a case of acute and prompt symptomatic irritative urinary cystitis after transurethral resection (TR) of bladder cancer. The clinical presentation, like a irritative syndrome, was with a positive urine cultive to Enterococci and Staphylococcus. The physical examination, under general anesthesia (EBA), eliminated the urethral injury or the meatus trauma, so the urethral stenosis. The bladder view, in scaring processing yet, was congestive, bledding and edematous; an extensive white calcification was covering all the mucose surface bladder. The presumptive diagnosis was incrusted cystophatie (cystitis) and a transurethral resection (TR), along total bladder mucosa, was made so the result of pathological examination was sure. Intravenous and oral antimicrobial agent (Amoxicillin-Clavunan), in different ways, was instaured like a treatment, to achieve a negative urinary cultive, to eradicate the bacterial agents. We made a revision of the most important aspects in the clinical presentation, laboratory diagnosis and therapy, in this cystophatie that is not frequent, where the ureolitic bacterial agents have the responsibility, main Corynebacterium urealiticum, and where the recent urologic surgery or instrumentation, is narrowly related with the development of this cystophatie.

Síndrome miccional agudo e inmediato post-RTU: un caso de cistopatíaincrustante / Acute and prompt urination sindrom after transurethral resection (TR): a case of incrustant cystophatie

Presentamos un caso de sintomatología miccional aguda e inmediata después de RTU de neoplasia vesical. El cuadro miccional, de carácter irritativo, cursó con cultivo de orina positivo a Enterococo y Staphylococo. La exploración vesical bajo anestesia (EBA) descartó la afección uretral (estenosis). Todavía sin cicatrizar, se observó una mucosa vesical edematosa, congestiva y sangrante, cubierta por una extensa calcificación blanquecina. Con la impresión diagnóstica de cistopatía incrustante se realizó RTU de toda la mucosa vesical afecta (legrado). La anatomía patológica confirmó el diagnóstico. Se instauró tratamiento antibiótico (Amoxi-Clavulánico), en diferentes pautas, hasta que el cultivo de orina se negativizó. Se realiza revisión de los aspectos clínicos, diagnósticos y terapéuticos de esta cistopatía, no muy frecuente, donde las bacterias ureolíticas son los microorganismos responsables, fundamentalmente Corynebacterium ureolíticum, y donde la instrumentación endourológica está íntimamente relacionada con el desarrollo de la cistopatía (AU)

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[Bellini's duct carcinoma]. / Carcinoma de los conductos de Bellini.

Two new cases of uncommon Bellini's duct carcinoma are described. The existing literature is reviewed, discussing the clinical manifestations, diagnosis, treatment and embryological aspects, which differentiate from clear cell carcinoma.

[Giant cyst of the seminal vesicle associated with ipsilateral renal agenesis]. / Quiste gigante de vesícula seminal asociado con agenesia renal ipsilateral.

Cyst of the seminal vesicles represent a rare but illustrative type of embryologic malformation whose etiology is associated with an abnormal development of the mesonephric or Wolffian duct. Frequently these malformations are associated with an abnormal development of the ipsilateral upper urinary tract. The initial evaluation of the majority of cases is performed with abdominal or transrectal ultrasound. Considering the possible need of other diagnostic procedures to confirm the diagnosis, ultrasonography is safe in the majority of cases. The treatment of these urologic malformations should be restricted to symptomatic cases and usually consists of vesiculectomy, with of without, removal of the displastic or histoplastic kidney. We present a case of a right mesonephric duct malformation with a giant seminal vesicle associated with ipsilateral kidney agenesis and severe oligozoospermia, that presented with sporadic episodes of hemospermia and urinary complaints.

Carcinoma de los conductos de Bellini / Bellini's duct carcinoma

Se describen dos nuevos casos del carcinoma de conductos de Bellini, neoplasia renal muy poco frecuente, y se revisa la literatura existente. Comentamos los aspectos clínicos, diagnósticos, terapéuticos y embriológicos que lo diferencian del carcinoma de células claras (AU)

Quiste gigante de vesícula seminal asociado con agenesia renal ipsilateral / Giant cyst of the seminal vesicle associated to ipsilateral renal agenesis

Los quistes de las vesículas seminales representan un raro pero ilustrativo tipo de malformación embriológica, su etiología se relaciona con un mal desarrollo del conducto mesonéfrico o wolffiano. A menudo, se combinan con anormalidades del tracto urinario superior ipsilateral. En la mayoría de los casos, la evaluación inicial se realiza con la ecografía abdominal o transrectal. Aunque otros procedimientos diagnósticos pueden ser necesarios para confirmar el diagnóstico, el ultrasonido es bastante seguro en la mayoría de los casos. El tratamiento de tales malformaciones estará restringido a los casos sintomáticos y usualmente consiste en vesiculectomía con o sin extirpación del riñón displásico o hipoplásico.Presentamos un caso de malformación de conducto mesonéfrico derecho compuesta de quiste gigante de vesícula seminal asociado con agenesia renal ipsilateral y oligozoospermia severa, que debutó con episodios de hemospermia esporádicos y clínica miccional. (AU)

[Renal colic and lithiasis in HIV(+)-patients treated with protease inhibitors]. / Cólico renal y litiasis en pacientes HIV (+) tratados con inhibidores de proteasas.

INTRODUCTION: Protease inhibitors, mainly Indinavir, are widely used drugs for the treatment of patients infected by the human immunodeficiency virus (HIV) and are related to renal colic and urinary obstruction. These conditions are the result of urine excretion of these drugs which favours the formation of small calculi (crystalluria and lithiasis). MATERIAL AND METHODS: Five PI treated HIV(+) patients; four males, one female, have recently been seen for renal colic at the Lithiasis Unit, Fundación Jiménez Díaz (FJD). All five patients had renal colic, one bilateral and one renal obstruction and fever. Small lithiasic concretions of null or minor radiological calcium density were identified by urinary X-ray and UIV. The patients had haematuria, crystalluria and urinary pH 5.0-6.0. Treatment was symptomatic, pharmacologic, emergency in situ extracorporeal shock-wave lithotrity (ESWL), or ureteral catheterisation, as appropriate. RESULTS: Patients had been treated with these antiviral agents for several months. They all required urologic care: pharmacologic, ureteral catheterisation, or ESWL, with good results. No stones were obtained for mineralogic analysis, but crystalluria was identified as being due to Indinavir and calcium oxalate. CONCLUSIONS: Renal excretion and urinary elimination of PIs (or their metabolites) results in asymptomatic crystalluria in HIV(+) patients treated with this class of drugs. Other cases present genuine calcium oxalate calculi with sings of renal colic and urinary obstruction requiring urologic care.

Cólico renal y litiasis en pacientes HIV (+) tratados con inhibidores de proteasas / Renal colic and lithiasis in HIV (+) patients treated with protease inhibitors

INTRODUCCIÓN: Los Inhibidores de Proteasas, fundamentalmente Indinavir, drogas de gran uso actual en el tratamiento de pacientes afectos por el virus de la Inmunodeficiencia Adquirida (HIV), se relacionan con episodios de cólico renal y obstrucción urinaria. Se produce como consecuencia de la eliminación por la orina de estos medicamentos, y/o favorecer la formación de pequeños cálculos (cristaluria y litiasis). MATERIAL Y MÉTODOS: En la Unidad de Litiasis de la Fundación "Jiménez Díaz" (FJD), se ha atendido recientemente por cólico renal a cinco pacientes HIV(+) que seguían tratamiento con Inhibidores de Proteasas. Fueron cuatro varones y una mujer. Los cinco sufrieron cólico renal, bilateral en un caso, y otro obstrucción renal y fiebre. La radiografía simple de aparato urinario y la UIV identificó pequeñas concreciones litiásicas de nula o escasa densidad cálcica radiológica. Presentaron hematuria, cristaluria y un pH urinario 5,0-6,0. El tratamiento aplicado fue sintomático, farmacológico, litotricia extracorpórea (LEOC) "in situ" inmediata de urgencia, o cateterismo ureteral, según el caso. RESULTADOS: Los pacientes llevaban meses en tratamiento con estos agentes antivirales. Todos precisaron atención urológica: farmacológica, cateterismo ureteral o LEOC, consiguiendo resultados satisfactorios. No fue posible obtener cálculos para su análisis minerealógico, pero si se identificó cristaluria Indinavir y oxalato cálcico. CONCLUSIONES: La excreción renal y la eliminación urinaria de los Inhibidores de Proteasas (o sus metabolitos) pro-duce cristaluria asintomática en pacientes HIV(+) tratados con estos fármacos. En otros casos tienen auténticos cálculos oxalocálcicos que se manifiestan por cólico renal y obstrucción urinaria precisando asistencia urológica inmediata. (AU)

[Bone abnormalities. Muscular dystrophy and lithiasis: lithogenic factors and therapeutic difficulties]. / Deformidades esqueléticas. Distrofia muscular y litiasis: factores litogénicos y dificultades terapéuticas.

UNLABELLED: Duchenne's muscular dystrophy with kypho-scoliosis, progressive muscle weakness and abnormal fatigue of the muscles results in an immobilisation syndrome with increased bone resorption and hypercalciuria. The accompanying chest deformity alters the respiratory capacity, causing pulmonary insufficiency, acidosis and acid urine. Dorso-lumbar kypho-scoliosis, occasionally very serious, alters the status of the upper urinary tract affecting urine transportation (stasis). Thus, hypercalciuria, urinary acidosis, stasis and infection will determine the formation of urinary lithiasis that can take place in these patients. MATERIAL AND METHODS: 15 patients with a variety of myopathies (Duchenne's disease, Myasthenia gravis,...) or serious skeletal deformities with metabolic renal lithiasis (pyelic or calyceal) were seen by our group. Other patients presented post-traumatic (paraplegia, hemiplegia,...) or poliomyelitic skeletal sequels or Pott's disease, with septic lithiasis. After evaluating all likely approaches including ESWL, the latter was chosen being the least aggressive. Conventional surgery, either percutaneous or endoscopic, foretells technical problems in terms of lithiasis approach. Both the case introducing the subject, Duchenne's muscular dystrophy, with bilateral renal lithiasis and the others are a reflection of complexity of finding the righ approach for these patients, including ESWL. RESULTS: Scoliosis was not a technical obstacle, since patients could be placed in lateral/oblique position to situate the stone in the right spot for lithotrity. Debris removal was easy, with no obstructive complications, in spite of the significant immobilisation of these patients. CONCLUSION: Immobilisation syndrome, acidosis, stasis and infection could jointly determine the lithogenesis mechanism in patients with muscle diseases or serious skeletal deformities and with renal lithiasis. ESWL has an opportunity in serious cases, where other techniques including surgery have major difficulties.