Uréter ectópico como causa de pionefrosis e incontinencia urinaria / Ectopic ureter as cause of pyonephrosis and incontinence urinary

El ureter ectópico se presenta aproximadamente en 1 de cada 2000 recién nacidos. En un 85% de los casos va asociado a una duplicidad pieloureteral. Las manifestaciones clínicas de esta entidad incluyen la incontinencia y las infecciones del tracto urinario. Frecuentemente el uréter ectópico se asocia a un polo superior displásico y poco funcionante. En estos casos, el tratamiento de elección es la nefrectomía polar superior. Se presenta un caso de una mujer de 23 años con dolor tipo cólico en fosa renal izquierda, fiebre y escapes urinarios. La ecografía, la urografía y la pielografía anterograda mostraron bifidez ureteral derecha, duplicidad ureteral izquierda e hidronefrosis del pielón superior izquierdo con desembocadura ectópica del mismo en la uretra. Una vez hecho el diagnóstico, se realizó una nefrectomía polar superior izquierda y ureterectomía parcial (AU)

Ectopic ureter accounts with an incidence of 1 in 2000 newborns. When present, ectopic ureter can be associated with duplex kidneys in an 85 % of the cases. Clinical manifestations of this malformation include incontinence and urinary tract infections. Ectopic ureter frequently occurs in association with a dysplastic upper pole renal moiety. When a poorly functioning upper pole segment is present, a standard surgical treatment is upper pole heminephrectomy. A 23-years old woman presented with left renal colic pain, fever and urinary leak. Ultrasound, intravenous pyelogram and antegrade pyelogram revealed a partial duplex right kidney and a complete duplex left kidney with hydronephrosis and ectopic insertion into the urethra of the left upper pole moiety. Following diagnosisupper pole heminephrectomy and partial ureterectomy was performed (AU)

[Primary renal lymphoma]. / Linfoma renal primario.

OBJECTIVE: To describe a case of primary renal lymphoma. MATERIAL AND METHODS: We presents a patient with a right renal mass which histological analysis revealed a non-Hodgkin Lymphoma. RESULTS: A 78-year-old male patient with right flank pain mass was referred to our Service. He was diagnosed of renal mass by imaging studies. Inmunohistochemical investigations revealed a B-cell-type lymphoma. He received combination chemotherapy with CHOP. CONCLUSIONS: Primary renal lymphoma is a rare disease whose existence has been questioned, because the kidney does not normally contain lymphoid tissue. Its clinical presentation is like any other renal tumor and its definitive diagnosis is by histology. Elective treatment is chemotherapy (CHOP).

Linfoma renal primario / Primary renal lymphoma

OBJETIVO: Presentar un caso de linfoma renal primario. MATERIAL Y MÉTODOS: Estudiamos el caso clínico de un paciente en el que se descubrió una masa renal, con el diagnóstico anatomopatológico de linfoma renal primario. RESULTADOS: Se trata de un paciente de 78 años de edad que acudió a nuestra consulta por dolor en fosa renal derecha. Al realizar varias pruebas complementarias se llegó al diagnóstico de masa renal derecha, cuyo estudio anatomopatológico tras punción-biopsia reveló un linfoma difuso de células B, siendo tratado con ciclos de quimioterapia sistémica según la pauta CHOP. CONCLUSIONES: El linfoma renal primario es una entidad rara y cuestionada por muchos autores. En la práctica clínica se presenta de modo similar al resto de tumores renales, por lo que su diagnóstico debe ser histológico. El tratamiento de elección es la quimioterapia sistémica con la combinación CHOP (AU)

[Endoscopic treatment of ureteral lithiasis. Our experience with 360 retrograde uretero-renal endoscopies in the last ten years]. / Tratamiento endoscópico de la litiasis ureteral. Nuestra experiencia en 360 ureterorrenoscopias retrógradas en los últimos 10 años.

Presentation of results and complications obtained in 360 procedures of transuretral ureterorenoscopy (URS) in ureteral lithiasis performed in our unit from january 1990 to august 2000 in 354 patients: 55% female and 45% male. A rigid ureteroscopy Storz 10.5 Ch. was used and intracorporeal lithotripsy was necessary in 17.31% of cases. URS indications were always treatment of ureteral lithiasis, pelvic ureter localization in most cases (70.33%) being 93.05% the percentage of overall success and with a significant decrease when the calculus was located in the upper third of the ureter. Serious complications were only 3.05% of cases and endoscopic surgery was necessary in three cases of ureteral stenosis. In our experience, URS is our technique of choice for treatment of lower and medium third of the ureter where the percentage of success we have obtained were 98.99% and 95.83% respectively.

[Hypercalcemia, leukemoid reaction, and thrombocytosis as paraneoplastic presentation of transitional cell carcinoma of the kidney]. / Hipercalcemia, reacción leucemoide y trombocitosis como presentación paraneoplásica del carcinoma renal de células transicionales.

The most common etiologies of hypercalcemia are hyperparathyroidism or malignancy, most often of the lung, breast or hematological system, but rarely occur in transitional cell carcinoma. The appearance of this metabolic disorder and other paraneoplastic signs like leukemoid reaction or thrombocytosis is a potential marker for malignant behaviour and poor prognosis in advanced tumours. Simultaneous presentation of that three paraneoplastic signs have only been described in two patients with wellknown bladder carcinoma. Most paraneoplastic syndromes appear only during the late stages of malignancy when the diagnosis has long been established, but sometimes may be an early sign of the malignancy. We describe a case of a previously unknown infiltrating transitional cell carcinoma of the kidney without bony metastasis, that presented itself with hypercalcemia, hyperleukocytosis resembling a leukemoid reaction and thrombocytosis. We think recognizing the paraneoplastic syndrome is very important because it is an alarm sign of malignancy.

[Prostatic leiomyosarcoma. Report of a case a review of the literature]. / Leiomiosarcoma de próstata. Aportación de un caso y revisión de la literatura.

A 48-year-old male with a leiomyosarcoma of the prostate is presented. The clinical presenting features were those of rapidly evolving prostatism and rectal symptoms (rectal bleeding, sense of rectal fullness and perineal pain). Arising from the smooth muscle cells of the prostate gland, this is a rare neoplasm that account for less than 0.1% of prostate malignancies, with a poor prognosis. It is often difficult to determine a definite origin, being necessary the differential diagnosis with pseudosarcoma, inflammatory fibrosarcoma, prostate abscess and other rare tumors. There is no established protocol of treatment. Combined modality therapy including radical surgery, radiation therapy and chemotherapy seems to be the best, although prognosis remains poor.

Leiomiosarcoma de próstata. Aportación de un caso y revisión de la literatura / Prostate leimiosarcoma. Contribution of a new case and revision of the literature

Presentamos el caso de un paciente de 48 años con un leiomiosarcoma de próstata. Los síntomas iniciales fueron prostatismo de rápida evolución e intensos síntomas rectales (rectorragias, tenesmo rectal, estreñimiento y dolor perineal). El leiomiosarcoma de próstata es una neoplasia poco frecuente (supone menos del 0,1-0,2 por ciento de los tumores prostáticos), con mal pronóstico, que se origina en las células del músculo liso de la glándula prostática. Frecuentemente es difícil determinar su origen rectal o prostático, y debe establecerse el diagnóstico diferencial con el absceso prostático, el pseudosarcoma, el fibrosarcoma inflamatorio y otras neoplasias poco frecuentes de próstata y vesículas seminales. No existe un protocolo terapéutico establecido, aunque la mayoría de los autores proponen una terapia combinada con cirugía radical, quimioterapia y radioterapia. Aún así no se ha conseguido un aumento significativo de la supervivencia, que parece depender más del momento del diagnóstico que de la modalidad terapéutica empleada (AU)

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Hipercalcemia, reacción leucemoide y trombocitosis como presentación paraneoplásica del carcinoma renal de células transicionales / Hypercalcemia, leukaemoid reaction and thrombocytosis as a paraneoplastic presentation of transitional cell carcinoma of kidney

Las causas más comunes de hipercalcemia son el hiperparatiroidismo y las neoplasias malignas con más frecuencia de pulmón, mama o del sistema hematológico, pero raramente ocurren en el carcinoma de células transicionales. La aparición de este desorden metabólico y de otros signos paraneoplásicos como la reacción leucemoide o la trombocitosis, es un marcador potencial de comportamiento maligno y mal pronóstico en tumores avanzados. La presentación simultánea de estos tres signos paraneoplásicos sólo ha sido descrita en dos pacientes con carcinoma vesical, en ambos previamente conocido. La mayoría de los síndromes paraneoplásicos aparecen sólo durante las etapas tardías del tumor maligno cuando el diagnóstico ha sido bien establecido, pero en algunos casos pueden ser un signo precoz de malignidad. Describimos un caso no conocido previamente de carcinoma infiltrante de células transicionales de riñón con estudio negativo para metástasis óseas, que se presentó con hipercalcemia, hiperleucocitosis simulando una reacción leucemoide y trombocitosis. Pensamos que es importante el reconocimiento del síndrome paraneoplásico como señal de alarma de malignidad (AU)

[Granulomatous orchitis]. / Orquitis granulomatosa.

Granulomatous orchitis is an inflammatory change of the testis. This is a rare lesion of unknown etiology. Usually are unilateral. The clinical appearance varies, and it is difficult to differentiate from testicular cancer. The diagnosis usually being made on histological examination after orchiectomy. Our paper report one case of granulomatous orchitis in a 27 year old patient. A review of the literature is made on the diagnosis and pathogenesis.

Orquitis granulomatosa / Granulomatous orchitis

La orquitis granulomatosa es un proceso inflamatorio en el testículo. Es una lesión rara de etiología desconocida. Habitualmente es unilateral. La forma de presentación clínica es variable y es difícil diferenciar del cáncer de testículo. El diagnóstico habitualmente se realiza mediante estudio histológico después de orquiectomía. Presentamos un caso de orquitis granulomatosa en un varón de 27 años y revisamos la literatura en lo referente al diagnóstico y al tratamiento. (AU)

[Giant renal angiomyolipoma]. / Angiomiolipoma renal gigante.

OBJECTIVE: To present a cae of giant renal angiomyolipoma that required surgical treatment owing to its size and concomitant intratumoral hemorrhage. METHODS: The characteristics of the case are presented and discussed. RESULTS/CONCLUSIONS: Giant renal angiomyolipoma is one of the most frequent causes of Wünderlich syndrome and is diagnosed by ultrasound and CT. The decision to operate is based on the size of the lesion and/or symptomatology, as in the case described herein, which required a simple nephrectomy.

[Intestinal obstruction secondary to peritoneal carcinomatosis after iatrogenic perforation during TUR for transitional cell carcinoma of the bladder]. / Obstrucción intestinal secundaria a carcinomatosis peritoneal tras perforación yatrogénica durante RTU de carcinoma de células transicionales de vejiga.

OBJECTIVE: A case of intestinal obstruction following transurethral resection (TUR) of a locally advanced transitional cell carcinoma of the bladder is presented. METHODS/RESULTS: The unique features of the present case are described. Laparotomy was performed and peritoneal carcinomatosis was found. Renal function became impaired and the abdominal condition persisted. The patient died five days postoperatively. CONCLUSIONS: Intestinal obstruction following TUR of transitional cell carcinoma of the bladder is an uncommon complication that is mainly due to peritoneal seeding following iatrogenic perforation of the tumor or the bladder wall during resection. Still, TUR is undeniably useful in the diagnosis, staging and treatment of bladder neoplasm.

[Endoscopic pyelotomy with the "ACUCISE" probe]. / Pielotomía endoscópica por sonda "ACUCISE".

OBJECTIVES: The aims of the present study were to assess the results achieved by the newly designed ACUCISE cutting probe in the treatment of the PUJ syndrome, to describe its advantages and disadvantages and to determine the possibility of its replacing other previously utilized techniques. METHODS: The ACUCISE cutting probe was utilized in 10 patients with pyeloureteral stricture. After the stent had been left indwelling for two months, it was removed and the patients had regular control evaluations two months thereafter. RESULTS: The results have been optimal to date, with complete resolution of the pyeloureteral stricture in 100% of the cases. No significant complications have been observed. Some of the control images are presented. CONCLUSIONS: In our view, the availability of the ACUCISE cutting probe represents a major contribution to minimally invasive surgery in the treatment of the PUJ syndrome. Its advantages far surpass its disadvantages, some of which can be overcome by the skill acquired from more experience. Its only major drawback is that it cannot be used in children under thirteen because of its caliber. When positioned correctly, the ACUCISE cutting probe achieves a clean, precise and an even cut of the same diameter and extent. It is a useful alternative to the other techniques utilized in the treatment of PUJ stricture.

[Pyeloureteral stenosis: its treatment by endopyelotomy]. / Estenosis pieloureteral: tratamiento mediante endopielotomía.

Percutaneous endopyelotomy is becoming widely accepted in the treatment of primary or secondary stenosis of the ureteropelvic junction because it achieves excellent results and is less invasive. Herein we describe our experience with this technique, which we perform with the electric knife and large caliber ureteral stents. Seventeen endopyelotomy procedures were performed in 16 patients with a minimum follow-up of one year. This technique successfully resolved the stenosis in 14 cases. We consider it to be the procedure of choice due to the excellent results and the low complication rate.

[Our experience with the 1st 100 cases of transurethral incision of the prostate performed for benign prostatic hypertrophy]. / Nuestra experiencia en los 100 primeros casos de incisión transuretral de la próstata, realizados en la hiperplasia benigna prostática .

Transurethral incision of the prostate (TUIP) or prostatotomy is a recently developed surgical technique whose favourable results have been reported elsewhere to range from 88% to 92%. It has a precise indication in small prostates and short urethras, and in well-selected cases its results are superior to that achieved by transurethral resection (TUR). Moreover, alterations of sexual function (impotence, retrograde ejaculation, etc.) are less and it affords the following advantages: the surgical technique is easy to perform, postoperative hospital stay is minimal, and patient comfort is enhanced. We have reviewed the first 100 prostatotomy procedures performed at the Urology Department of our hospital. Patient follow-up was 1 1/2 years. Good results were achieved in 65 (95.5%) of 68 patients with prostates less than 20 gms. In 20 patients with prostates between 20-30 gms., we achieved a success rate of 85% (3 poor results). The results were poor in 4 of 12 patients (60% success) with prostates more than 30 gms. The early complications were minimal and no late complications were observed. Thus, we believe this is a valid technique when performed in the appropriate cases.

[Urothelial carcinoma of the ureter excised using percutaneous nephrostomy]. / Carcinoma urotelial ureteral resecado por nefrostomía percutánea.

We report on a case of ureteral carcinoma submitted to resection by percutaneous nephrostomy. After considering the different therapeutic alternatives, we believe that the approach described herein is very interesting in well-selected cases since it is a highly conservative surgical procedure that permits followup and reoperations relatively easily.