[Female paraurethral cysts. Experience of 4 cases]. / Quistes parauretrales femeninos. Experiencia de 4 casos.

Parauthreal cysts are an uncommon pathology. We present 4 cases diagnosed and treated in our hospital during the last 10 years.

Quistes parauretrales femeninos. Experiencia de 4 casos / Female paraurethral cysts. Experience of 4 cases

Los quistes parauretrales son una patología poco frecuente. Presentamos 4 casos que fueron diagnosticados y tratados en nuestro hospital durante los últimos 10 años

Parauthreal cysts are an uncommon pathology. We present 4 cases diagnosed and treated in our hospital during the last 10 years

[Long course metastasis in renal adenocarcinoma. Adrenal gland involvement]. / Enfermedad mestastásica de larga evolución en el adenocarcinoma renal. Afectación suprarrenal.

OBJECTIVES: To report two cases of metachronic adrenal metastasis (one contralateral and the other bilateral) from renal cell carcinoma with long survival. METHODS: Two patients with clear cell renal carcinoma that developed metastasis to the adrenals are described. Each patient had undergone three operations for solitary metastasis during the 8-years follow-up. The indications for the surgical management of solitary metastasis, morbidity, prognosis and recent investigational treatment possibilities reported in the literature are analyzed. RESULTS: Resection of the renal cell carcinoma achieved a survival of more than 8 years with a good quality of life and no significant surgical complications. The outcome, however, is poor. CONCLUSIONS: Although there was no lymph node involvement and the tumor was localized to the renal parenchyma, one patient developed solitary lung metastasis and contralateral adrenal metastasis 4 and 8 years after the initial diagnosis, respectively. In the other case, contralateral adrenal metastasis appeared three years later. The possibility of long-term metastasis to the adrenal gland should be taken into account due to renal vein involvement. Preservation of the adrenal gland at the initial surgery (lower pole tumor) led to adrenal metastasis 8 years after the initial diagnosis. The prognosis is poor in both cases and the situation is discouraging for the urologist.

[Disjunction patterns: the morphological and ultrastructural bases of bladder instability in the male]. / Patrones de disyunción: bases morfológicas y ultraestructurales de la inestabilidad vesical del varón.

OBJECTIVE: To apply the new protocols and recent contributions on detrusor ultrastructural morphology in order to standardize criteria and evaluate our findings relative to the ultrastructural morphology, the presence of a dysfunction pattern, changes in nerve supply and formation of a chained cellular syncytium in hyperactive detrusor bladder instability in the male. METHODS: We studied 480 ultrastructural preparations of detrusor muscle from 32 male patients with bladder outlet obstruction with and without urodynamically demonstrated bladder hyperactivity. Bladder biopsies were obtained from the anterior aspect of the bladder and prepared according to the standard procedures for ultrastructural study. Semiquantitative nerve supply ultrastructural patterns, syncytial composition, and complete and incomplete disjunction were analyzed. RESULTS: Lower urinary tract obstruction was demonstrated in all patients; 6 of these patients had involuntary phasic detrusor contractions during filling. No significant decrease in nerve supply was found in isolated obstruction or in bladder hyperactivity. No axonal degeneration was observed in any of the patients and the myelin sheath structure was normal. Nerve effector endings were also normal. Four patients with hyperactive detrusor showed complete and two incomplete disjunction pattern. Incomplete disjunction pattern was also demonstrated in two patients with isolated obstruction. CONCLUSIONS: The change in the properties of the detrusor muscle in the unstable bladder is due to a complete reduction in excitatory nerve relation to smooth muscle. Having established the concept of common final myogenic pathway that explains involuntary detrusor contraction, complete dysfunction ultrastructural patterns have been defined with univocal relation to hyperactive detrusor. These patterns indicate the existence of a syncytium of chained muscle cells with changes in the excitation threshold that are absent in the normal stable detrusor. Two ultrastructural components sustain this hypothesis: 1) the major loss observed in intermediate cellular unions that are thought to mediate in the mechanical coupling of cellular contraction and 2) the presence in all the microscopic fields of abutments in the narrow cellular unions like gap-junctions, which mediate the electrical coupling. In the present study we have found this pattern in 4 out of 6 patients with hyperactive detrusor, and congruent with other studies, the incomplete disjunction pattern could be the prelude of bladder hyperactivity.

[Treatment of pelvis fungus ball with ureteral catheterization, fluconazole, and urine alkalinization]. / Tratamiento del fungus ball piélico con cateterismo ureteral, fluconazol y alcalinización de la orina.

Fungal concretions known as "fungus ball" may be the cause of ureteral obstruction, normally presenting as pain in the renal cavity. This paper presents one case treated with ureteral catheterism, fluconazol and urine alkalinization.

[Valsalva minimal leak point pressure: a useful approximation to type III female urinary incontinence]. / Presión mínima de escape con Valsalva: una útil aproximación a la incontinencia urinaria femenina tipo III.

OBJECTIVE: It has been reported that anatomic female urinary incontinence with complex sphincteric malposition can coexist with intrinsic damage of the sphincter itself. In this study we analyzed the utility of measuring minimum abdominal pressure at standardized bladder capacities that causes urinary incontinence in order to quantify intrinsic sphincteric damage in female urinary incontinence. METHODS: The study comprised 50 women with urinary incontinence aged 36-78 years (mean 59.4), ICS standardized complete urodynamic study was performed. Minimum leak point pressure with Valsalva maneuver in decumbent and standing positions was determined during the filling phase of cystomanometry and it was defined as a measure of the abdominal pressure expressed as total baldder pressure without involuntary detrusor activity and exercised at standardized bladder capacities that originates objective urinary incontinence. Minimum leak point pressure for each bladder capacity was evaluated. Leak point pressures below 60 cm H2O indicate intrinsic sphincteric damage; pressures between 60 and 90 cm H2O indicate intrinsic damage and malposition or urethral hypermobility may coexist, and leak pressures over 90 cm H2O are related to complex sphincteric malposition. RESULTS: 5 women showed severe sphincteric deficiency (type III) and urinary incontinence was demonstrated with 50 ml bladder capacity and 30 cm H2O of abdominal pressure without detrusor activity. Thirty-five women (70%) had type II urinary incontinence. Of these, 10 (28.5%) showed intrinsic sphincteric damage in addition to malpositioning of the sphincteric complex at leak point pressures between 60 and 90 cm H2O. The rest of the women showed Blaivas' type 0 and I urinary incontinence. CONCLUSIONS: Valsalva minimum leak point pressure is a reproducible, reliable, useful and easily measured parameter in diagnosing female stress urinary incontinence. It allows approximation of the abdominal pressure to the level at which urinary leakage is produced during the filling phase of cystomanometry and gives us an idea of the extent of the intrinsic sphincteric damage, if any. Not only is sphincter damage demonstrated in type III urinary incontinence, but that it may also coexist to a varying degree with complex sphincteric malposition.

[Transitional cell tumor of the bladder in children: report of a case]. / Tumor de células transicionales de vejiga en edad pediátrica: a propósito de un caso.

Transitional cell tumours of the bladder in children are exceptionally rare. This paper presents a new case in an 11-year old patient. The benignity of these tumours during the paediatric age can be verified due to the low infiltration incidence; some authors, however, describe cases of relapses which are commented upon. The careful follow-up that has to be done in this type of patients is underlined.

[Diagnostic and therapeutic criteria of inverted papilloma]. / Criterios diagnósticos y terapéuticos del papiloma invertido.

Seven cases of inverted papilloma (IP), two located at the UUT level and five in the bladder, one associated to transitional cells carcinoma. Treatment was conservative for the whole series, and neither co-adjunctive therapy or chemoprophylaxis was applied, except for the last case; after an average follow-up of 19.8 months they all show complete remission. A discussion of urinary tract IP is suggested, studying the epidemiology, histology, pathogeny, clinical characteristics and diagnostic methods, of which endourological investigations are the most effective for a reliable diagnosis, since they allow direct visualization and biopsy sampling. Regarding the therapeutic options, the paper highlights the need for conservative surgery due to its benign biological behaviour. A strict control of the patients is necessary due to likelihood of recurrence and malignant transformation.

[Hydrocele as the first manifestation of paratesticular rhabdomyosarcoma]. / Hidrocele como primera manifestación de rabdomiosarcoma paratesticular.

We report a case of paratesticular rhabdomyosarcoma that presented as a hydrocele. Because it was initially considered idiopathic, diagnosis of the underlying disease could not be made at the outset. The literature is reviewed, highlighting its diagnosis and treatment. It is concluded that all hydroceles warrant a careful analysis, particularly in young patients. These should not be initially classified as idiopathic as it might preclude adequate examination of important structures and the underlying condition may remain undetected.

[An infrequent etiologic agent of vesicointestinal fistula]. / Infrecuente agente etiológico de las fístulas vesicointestinales.

We present a case of colovesical fistula originated by a foreign body (chicken bone) in a patient without prior intestinal pathology, which emigrates spontaneously to the bladder. We comment on its diagnosis and the therapy carried out.

[Symptomatic adrenal myelolipoma: apropos of 2 cases. Review of the literature]. / Mielolipoma adrenal sintomático: a propósito de dos casos. Revisión de conjunto.

We present two symptomatic cases of adrenal myelolipoma with good evolution 24 and 14 months after surgery. We discuss the clinical characteristics of these tumours and diagnostic methods, of which CAT seems to be the most effective. In therapy we single out the need for surgery in those that are of large size and without accompanying symptomatology owing to the risk of spontaneous hemorrhaging or subsequent to traumatism, as well as in those displaying clinical symptoms. In small asymptomatic ones, discovered incidentally, we will carry out periodic observation with controls by CAT and/or echography.