Extrofia vesical y vejiga rectal / No disponible

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Collateral urethral duplication in an adult.

OBJECTIVE: Congenital anomalies or malformations of the urethra that involve number are extremely rare and only 7 cases of trifurcation of the urethra and under 500 cases of urethral duplication have been described. METHODS: In the case we present, urethral duplication was diagnosed in adulthood, even though glans malformation with 2 urethral orifices was clearly evident and only 1 was functional. RESULTS: The condition is usually diagnosed in childhood due to the presence of 2 urethral meatus or from double stream if both are functional; at other times, the condition is diagnosed from complications that trigger infections or obstruction or if it is associated with more extensive malformations. CONCLUSIONS: Urethral duplication is an extremely rare birth defect, and diagnosis in adulthood is even more uncommon. No single embryologic argument explains all the anatomic variants of urethral duplication. The treatment of the urethral duplication should be individualized according to the type of duplication and the clinical symtoms.

Penile foreign bodies.

OBJECTIVE: To describe 8 cases of penile foreign bodies. METHODS/RESULTS: We provide an essentially visual overview of various objects or foreign bodies affecting the penis. CONCLUSIONS: The presence of penile foreign bodies is rarely due to an accident. These objects are placed for a wide variety of reasons, but primarily for erotic or self-arousal purposes. The consequences of penile foreign bodies can be mild or very severe, resulting in penile amputation.

[Femoral neuropathy in urological surgery]. / Neuropatía femoral en cirugía urológica.

We present four cases of femoral neuropathy due to urological surgery, first case happened after right lumbotomy twenty years ago and the other three cases in the last four years after iliac incision. We review lesion production mecanism, evolution, treatment and prevention of this rare neurological complication. We do a literature review about this pathology related with urological activity.

[Hemoperitoneum and death due to hepatoesplenic metastasis rupture in a testicular tumor]. / Hemoperitoneo y muerte por rotura de metástasis hepatoesplénicas de tumor testicular.

We present a case of a mix germinal testicular tumor, in III-C (AJCC-UICC) stage, at a terminal phase due to massive methastasis rupture at hepatic and splenic methastasis locations.

[Entero-neobladder ileal fistula: two cases report]. / Fístula entero-neovejiga ileal: a propósito de dos casos.

Fistulas between the orthotopic reservoir and the gastrointestinal tract have low incidence (1.5-2%). Simptomatology is variable, but it's frecuent to find fecaluria. Among 90 new intestinal bladders we show two fistule of new bladder to ileo, with nest postoperatory diagnosis, using retrograde cystografy; one was resolved with next postoperative treatment and the other with open surgery.

[Urachal pathology: an overview review and report of three clinical cases]. / Patología del uraco: revisión de conjunto y presentación de tres casos.

With the use of these two clinical cases (cyst and urachal adenocarcinoma) we did an overview of the urachal pathology. The urachus cyst is usually asyntomathic, it's detected randomly when we do other diagnostic tests or when we have any complications. The urachal adenocarcinoma is a rare pathology, it usually exhibit hematuria and we need to follow the same diagnostic tools as we use in vesical tumors (cystoscopy and transurethral vesical resection). Adenocarcinoma of the dome of the bladder is the main differential diagnosis. Partial cystectomy is the first choice treatment. Quimiotheraphy and radiotheraphy offer poor results.

[Problem-based learning in urology training. The Faculty of Medicine of the Universidad de Castilla-La Mancha model]. / El aprendizaje basado en problemas en la enseñanza de la urologia. Modelo de la Facultad de Medicina de la Universidad de Castilla-La Mancha.

Ongoing changes in the social, economic, technological and scientific realms have generated new needs and led various organizations to suggest that educational institutions should reorient their educational strategies toward developing effective professionals with the skills to meet these needs. These "modern" strategies include problem-based learning, in which the student seeks and selects information, analyzes the data obtained, integrates both prior and newly acquired knowledge, and, finally, offers diagnostic and therapeutic options to resolve the problem posed, as would occur in professional practice. With this approach, prior skills and practical experience form the foundation of learning. Problem-based learning incorporates some aspects of cognitive psychology, a model that mainly centers on the nature of the knowledge structures found in active memory, the processes involved in information storage and retrieval and the various factors that activate these processes. At the Faculty of Medicine of the Universidad de Castilla-La Mancha, urology is part of a core subject (Medical and Surgical Pathology II) taught in the fifth year of coursework together with nephrology. Each course includes approximately 75 students, divided into five groups. The rotation lasts six weeks, with students spending a mean of two hours a day on theory (nephrology and/or urology) and the remaining time on rotations in the various activities: three weeks in nephrology and three weeks in urology. Upon completion of the rotation, the students write a combined theoretical examination with 100 multiple-choice questions (50 on urology) and take a practical skills examination. At the end of the course, another practical test consisting of an objective, structured clinical examination is taken, in which standard patients are used and the professor directly assesses the level of skills acquired with a "real" case.

An unusual retroperitoneal cystic tumor.

This report describes a case of textiloma (term given to an inflammatory swelling caused by a retained textile foreign body) in a 60-year-old patient who had undergone surgery for a perforated gastroduodenal ulcer 17 years earlier. On examination the presence of a large mass was detected on the left hypochondria. A CT scan confirmed a cystic tumor with images suggesting detritus or necrosis in its lower part, as well as calcifications. Transperitoneal midline laparotomy was performed with extension by thoracophrenolaparotomy. Splenectomy was necessary. Macroscopic examination showed a spherical mass. After opening the tumor, retained surgical gauze was found. The histopathological diagnosis was granulomatosis reaction to a foreign body.

[Rupture of the corpora cavernosa: its therapeutic assessment and management]. / Rotura de cuerpos cavernosos: evaluación y manejo terapéutico.

INTRODUCTION: The traumatic rupture of cavernous bodies is an uncommon condition that always takes place with an erected penis, the most frequent etiology being an untimely vaginal intercourse, due to the greater vulnerability of the penis in such situation, resulting from contained trauma by direct external forces. The distinctive presenting signs are a "snap", immediate detumescence, pain, deformity, bruise and deviation contralateral to the lesion. The bruises will be limited to the penis in the presence of Buck's fascia integrity. This paper contributes one case of rupture of right cavernous body, explaining its typical etiology, signs and symptoms, and examination of the patients who underwent emergency surgery. MATERIAL AND METHODS: 27-year-old patient who turns up into the emergency service with penile haematoma and local pain, reporting an earlier snap and detumescence. The examination reveals a hose-type haematoma with a "wringer" mark. The ultrasound shows haematoma, albuginea interruption and Buck's fascia integrity. The patient undergoes emergency surgery that involves whole penis denudation, haematoma evacuation and suture of impaired cavernous body. No incidence is reported during the post-operative. The patient is now asymptomatic and holds successful erections. DISCUSSION: The differential diagnosis should be done versus rupture of the penis dorsal vein, which causes identical signs and symptoms. NMR is considered as the best imaging test, although is still quite unaffordable. Standard ultrasounds do not rule out the diagnosis. Under suspicion of associated urethral damage, retrograde urethrography is warranted. Cavernosonography has very specific indications and should be avoided whenever possible. Choice treatment will be emergency revision and surgical repair. Suture of involved cavernous body must be done with loose stitches of absorbable material. Antibiotic prophylaxis is indicated in cases of concomitant urethral involvement.

[Retroperitoneal cystic mesothelioma and lymphangioma]. / Mesotelioma y linfangioma quísticos retroperitoneales.

Retroperitoneal cysts are uncommon entities of difficult diagnosis because of their insidious symptomatology. Urinary apparatus involvement is quite often the mode of presentation and the reason for calling on the urologist. The origin of many of these retroperitoneal cysts remains practically unknown. Surgery with exeresis is the choice management method. Follow-up is necessary for cystic mesothelioma because of the highly frequent relapses. The outlook of hormonal conservative therapy for relapses appears as a future alternative to treatment.

[Suprarenal surgical pathology. Experience of 10 years and review of the literature]. / Patología quirúrgica suprarrenal. Experiencia de diez años y revisión de la literatura.

OBJECTIVES: Our experience with 34 patients who underwent surgery of the adrenal gland over the last 10 years is presented. The most important clinical and pathological aspects are analyzed, particularly from the perspective of surgery, and the literature on the different pathologies observed in our series is reviewed. METHODS: A retrospective study was conducted to analyze the clinical features, analytical and hormonal data, imaging technique findings, types of anesthesia, surgical approaches, intra and postoperative morbidity and mortality, course of the disease, and pathological diagnosis. RESULTS: 53% were female. Mean age was 48.8 years. Left-sided involvement was more prevalent (70.7%). The most common pathology was adrenal adenoma (21 pts), followed by metastasis (4), cysts-pseudocysts (4), primary carcinoma (2), pheochromocytoma (1), etc. Hyperaldosteronism (16 pts) was the most common hormonal disorder; 2 patients had Cushing's syndrome, 2 virilizing syndrome, 1 pheochromocytoma, and 13 patients had a nonfunctioning tumor (3 were incidentalomas). The mean size and weight were 5.6 cm and 21.1 gm, respectively. Adenomas were the smallest tumors and those that weighed the least (mean 2.5 cm; 11.5 gm). Primary carcinomas were the largest tumors (mean 18 cm; 52 gm). US and CT were diagnostic in 56% and 100% of the cases and indicated the size of the mass correctly in 75% and 77%, respectively. Special anesthetic was required in 31%; nitroprusside, phenoxybenzamine, labetolol, corticosteroids and spironolactone were administered according to the hormone disorder. Lumbotomy via the 11th or 12th rib was the most common approach (58.7%), followed by the subcostal and transpleuro-diaphragmatic approach (14.7%, 11.7%, respectively), etc. The mean operating time was 162.2 min; adenoma of the adrenal gland required the shortest operating time (133.06 min), while carcinoma of the adrenal gland required the longest (405 min). Some type of intraoperative event arising from the hormonal disorder was observed in 44.2% of the patients. At 45.1 months mean follow-up, 70.5% of the patients were asymptomatic, arterial hypertension persisted in 11.7% and there were 5 deaths (all cases had a malignant tumor). CONCLUSIONS: The incidence of adrenal gland disease in our series is not unlike that reported in the literature. CT and complementary US are the diagnostic imaging techniques of choice. CT, moreover, has demonstrated a higher specificity. The surgical approach utilized was based on the pathological condition for which surgery had been indicated. The posterolateral and transpleurodiaphragmatic approaches were utilized for small tumors and no remarkable events were observed during the procedure. The anterior and combined approaches were utilized for large or bilateral tumors or obese patients. Our morbidity rate is not unlike that reported in the literature and basically depends on the chronic disease of the patient, type of hormonal disorder and size or malignant nature of the tumor.

[Eosinophilic cystitis and glandular-cystic cystitis as pseudotumor lesions]. / Cistitis eosinofílica y cistitis glánduloquística como lesiones seudotumorales.

OBJECTIVES: To report on two different types of cystitis presenting as pseudotumor. The differential diagnosis between the foregoing lesions and true tumors can only be established by biopsy. METHODS: We report two cases of cystitis (eosinophilic cystitis and glandular-cystic cystitis) with clinical, radiological and endoscopic features of a bladder tumor. The diagnosis, etiopathological aspects, clinical course and treatment of both types of cystitis are reviewed. RESULTS/CONCLUSIONS: Hematuria is the most frequent and most important symptom of these uncommon lesions. They present as space occupying lesions in more than 50% of the cases and have no specific diagnostic features. The diagnosis can only be made by pathological examination following TUR-biopsy.

[Survival of patients with upper urothelial tumor]. / Estudio de supervivencia en pacientes con tumor de urotelio superior.

OBJECTIVE: A descriptive analysis of 35 patients with transitional cell carcinoma of the upper urinary tract is presented. The actuarial survival was analyzed to determine which circumstances associated with superficial bladder cancer had a prognostic significance. METHODS: The records of 35 patients with upper urothelial tumor diagnosed from 1987 to 1993 were retrospectively analyzed. A descriptive statistical analysis was performed on all the variables. Correlation was determined by Pearson's Xi2 test, Yates' and Fisher's exact test. McNemar's test was used to determine which diagnostic method had the highest yield. The actuarial survival data were analyzed with the Kaplan-Meier and Mantel-Haenzel test. RESULTS: Patient mean age was 67.74 yrs, mean follow up was 26.83 months, 40% were ureteral tumors, 25.7% were pelvic tumors, 60.6% were superficial tumors and 62.6% were GI and GII, 48.5% were associated with bladder tumors and no correlation was found between the grade and stage of bladder relapses and the upper urinary tract tumors. Intravenous urography demonstrated function was abolished in 45.5%. Cytology gave the highest diagnostic yield (84.6%). Nephroureterectomy with perimeatal cystectomy was the surgical technique most frequently used (57.1%). To date, 71.4% of the patients have survived. Significantly women demonstrated the most undifferentiated cellular grade (p < 0.001), although no prognostic value was found for sex. 95% of the patients with non-infiltrating tumor stages and 95% of the patients with GI-GII tumors survived, whereas 61.5% of the patients with infiltrating tumors and 58.3% of those with GIII tumors did not survive (p < 0.002). Evidently, the grade of cellular differentiation and the stage of infiltration were interrelated (p < 0.002). Analysis of the actuarial survival data showed that the probability of survival after 24 months (mean follow up) was 67.07% and the probability of reaching 74 months (maximum follow up) was 60.04%. CONCLUSIONS: After a comparative analysis of the survival with the Mantel-Haenzel test, it was found that the grade of cellular differentiation (p < 0.001) and stage of infiltration (p < 0.01) had significant differences in the survival curves.

[Keratinizing squamous metaplasia (cholesteatoma) of the upper urinary tract]. / Metaplasia escamosa queratinizante (colesteatoma) del tracto urinario superior.

Presentation of four cases of keratinizing squamous metaplasia (KSM), two of the renal pelvis, one pyelocaliceal and one ureteral. Nephrouretetectomy was performed in all cases. All our patients showed good evolution. A review of the literature is made discussing all the etiological, diagnostic and therapeutical aspects of the condition. Its benign evolution is highlighted as well as the current need, once a better knowledge of the condition's natural history is available, of using a conservative approach.