ABSTRACT
OBJECTIVE: To report two cases of acute idiopathic scrotal edema. METHODS: We describe the cases of two 12-year-old male patients presenting at the emergency department of our hospital with pain, edema and erythema in one hemiscrotum without history of trauma. RESULTS: On physical examination both patients showed red hemiscrotum skin and increase of the size with normal testicles and epididymis. With the diagnosis of acute scrotum testicular ultrasound were performed and showed heterogeneous edema of the scrotal skin with increased in Doppler flows and normal testicles. CONCLUSIONS: Acute idiopathic scrotal edema is a self-limited pathology which basically affects children before puberty and should be included in the differential diagnosis of acute scrotum to avoid aggressive interventions.
Subject(s)
Edema , Genital Diseases, Male , Scrotum , Child , Edema/diagnostic imaging , Edema/drug therapy , Genital Diseases, Male/diagnostic imaging , Genital Diseases, Male/drug therapy , Humans , Male , UltrasonographyABSTRACT
OBJETIVO: Presentar dos casos de edema de escroto agudo idiopático. MÉTODOS: Describimos los casos de dos varones de 12 años que acudieron al Servicio de Urgencias de nuestro hospital presentando dolor, edema y eritema en un hemiescroto sin recordar antecedente traumático previo. RESULTADOS: A la exploración de ambos pacientes se puede observar los hemiescrotos enrojecidos y aumentados de tamaño pero con testes y epidídimos normales. Con el diagnóstico de escroto agudo se les efectuaron unas ecografías en las que se pudo ver un edema heterogéneo en piel escrotal con flujo Doppler aumentado y testes ecográficamente normales. CONCLUSIONES: El edema de escroto agudo idiopático es una patología autolimitada que afecta básicamente a niños prepúberes que debe ser incluida en el diagnostico diferencial del escroto agudo para evitar intervenciones más agresivas innecesarias
OBJECTIVE: To report two cases of acute idiopathic scrotal edema. METHODS: We describe the cases of two 12-year-old male patients presenting at the emergency department of our hospital with pain, edema and erythema in one hemiscrotum without history of trauma. RESULTS: On physical examination both patients showed red hemiscrotum skin and increase of the size with normal testicles and epididymis. With the diagnosis of acute scrotum testicular ultrasound were performed and showed heterogeneous edema of the scrotal skin with increased in Doppler flows and normal testicles. CONCLUSIONS: Acute idiopathic scrotal edema is a self-limited pathology which basically affects children before puberty and should be included in the differential diagnosis of acute scrotum to avoid aggressive interventions
Subject(s)
Male , Child , Humans , Scrotum/injuries , Genital Diseases, Male/diagnosis , Diagnosis, Differential , Laser-Doppler FlowmetryABSTRACT
OBJECTIVE: To report one case of bilateral synchronic testicular tumor with germ cell intratubular neoplasia foci affecting both testicles. METHODS: We describe the case of a 29-year-old male presenting with a painless tumor in the left testicle for a month. With the suspect of testicular tumor scrotal ultrasound, tumor markers and extension study to rule out metastasis were performed. RESULTS: Ultrasound showed a hypertrophic left testicle with a lesion suspect for neoplasia, and incidental diagnosis of a hypoechoic lesion with augmented Doppler flow within the right testicle. Bilateral orchyectomy was performed with the pathologic diagnosis of classic seminoma with germ cell intratubular neoplasia foci in both testicles. Treatment was completed with two cycles of chemotherapy. CONCLUSIONS: Bilateral synchronic testicular tumors are very rare. The most frequent histological type is classic seminoma. The diagnosis and treatment are similar to unilateral testicular tumors except certain cases in which partial excision of the testicle may be considered.
Subject(s)
Neoplasms, Multiple Primary/pathology , Seminoma/pathology , Testicular Neoplasms/pathology , Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Atrophy , Carboplatin/administration & dosage , Combined Modality Therapy , Humans , Male , Neoplasms, Multiple Primary/drug therapy , Neoplasms, Multiple Primary/surgery , Orchiectomy , Remission Induction , Seminoma/drug therapy , Seminoma/surgery , Testicular Neoplasms/drug therapy , Testicular Neoplasms/surgery , Testis/pathologyABSTRACT
OBJETIVOS: Presentar un caso de tumor testicular bilateral sincrónico con focos de Neoplasia Intratubular de Células Germinales (NICG) en ambos testículos. METODOS: Describimos el caso de un varón de 29 años que presenta tumoración indolora de un mes de evolución en teste izquierdo. Bajo la sospecha de tumor testicular se le realiza una ecografía escrotal, una determinación de marcadores tumorales y un estudio de extensión tumoral. RESULTADOS: En la ecografía se puede ver un teste izquierdo hipotrófico con lesión sospechosa de neoplasia e, incidentalmente, un testículo derecho con una lesión hipoecoica y aumento de flujo doppler. Se le practicó una orquiectomía bilateral con el diagnóstico de anatomía patológica de seminoma clásico con focos de Neoplasia Intratubular de Células Germinales (NICG) en ambos testículos y se completó el tratamiento con 2 ciclos de quimioterapia. CONCLUSIONES: Los tumores testiculares bilaterales sincrónicos son muy infrecuentes. El tipo histológico más frecuente es el seminoma clásico. El diagnóstico y tratamiento es similar al de los tumores testiculares unilaterales excepto en determinados casos en los que se puede plantear la resección parcial del testículo (AU)
OBJECTIVE: To report one case of bilateral synchronic testicular tumor with germ cell intratubular neoplasia foci affecting both testicles. METHODS: We describe the case of a 29-year-old male presenting with a painless tumor in the left testicle for a month. With the suspect of testicular tumor scrotal ultrasound, tumor markers and extension study to rule out metastasis were performed. RESULTS: Ultrasound showed a hypertrophic left testicle with a lesion suspect for neoplasia, and incidental diagnosis of a hypoechoic lesion with augmented Doppler flow within the right testicle. Bilateral orchyectomy was performed with the pathologic diagnosis of classic seminoma with germ cell intratubular neoplasia foci in both testicles. Treatment was completed with two cycles of chemotherapy. CONCLUSIONS: Bilateral synchronic testicular tumors are very rare. The most frequent histological type is classic seminoma. The diagnosis and treatment are similar to unilateral testicular tumors except certain cases in which partial excision of the testicle may be considered
Subject(s)
Male , Adult , Humans , Seminoma/pathology , Neoplasms, Multiple Primary/pathology , Testicular Neoplasms/pathology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Atrophy , Carboplatin/administration & dosage , Combined Modality Therapy , Orchiectomy , Remission Induction , Seminoma/drug therapy , Seminoma/surgery , Testis/pathology , Neoplasms, Multiple Primary/drug therapy , Neoplasms, Multiple Primary/surgery , Testicular Neoplasms/drug therapy , Testicular Neoplasms/surgeryABSTRACT
OBJECTIVES: We report a retrospective review of the case series of Fournier's gangrene treated in our department from November 1996 to October 2004. METHODS/RESULTS: We studied nine male patients with ages between 21 and 85 years (mean 55 years). 66% of the patients had associated risk factors, and the underlying cause was identified in 56% of the cases. Mean hospital stay was 21 days and two of the patients died from the disease. CONCLUSIONS: Fournier's gangrene is an infection with a very fast evolution, producing necrotizing fascitis of the external genitalia and perineum. It has a high mortality rate, mainly if diagnosis and treatment are deferred. This last includes wide spectrum antibiotic coverage, surgical treatment with debridement and drainage, and, in many cases, a second surgical intervention for reconstructive plasties.
Subject(s)
Fournier Gangrene/therapy , Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
OBJETIVOS: Presentamos una revisión de los casos de gangrena de Fournier tratados en nuestro servicio desde noviembre de 1996 hasta octubre de 2004. MÉTODO/RESULTADOS: Estudiamos nueve pacientes, todos varones, con edad comprendida entre 21 y 85 años (media 55). En el 66% tenían factores de riesgo y en el 56% de los casos se identificó la causa subyacente. Su estancia media fue de 21 días y destacamos que se produjeron dos defunciones. CONCLUSIÓN: La gangrena de Fournier es una infección de muy rápida evolución que cursa con fascitis necrotizante de los genitales externos y el periné. Tiene una alta mortalidad, sobre todo, si se demora su diag- nóstico y tratamiento. Éste se basa en una cobertura antibiótica agresiva de amplio espectro, en un tratamiento quirúrgico con desbridamiento y drenaje, y, en muchos casos, un segundo tiempo quirúrgico para las plastias correctoras (AU)
OBJECTIVES: We report a retrospective review of the case series of Fourniers gangrene treated in our department from November 1996 to October 2004. METHODS/RESULTS: We studied nine male patients with ages between 21 and 85 years (mean 55 years). 66% of the patients had associated risk factors, and the underlying cause was identified in 56% of the cases. Mean hospital stay was 21 days and two of the patients died from the disease. CONCLUSIONS: Fourniers gangrene is an infection with a very fast evolution, producing necrotizing fascitis of the external genitalia and perineum. It has a high mortality rate, mainly if diagnosis and treatment are deferred. This last includes wide spectrum antibiotic coverage, surgical treatment with debridement and drainage, and, in many cases, a second surgical intervention for reconstructive plasties (AU)
Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Aged, 80 and over , Fournier Gangrene/therapy , Retrospective StudiesABSTRACT
OBJECTIVES: To report the case-series of Leydig cell tumors diagnosed at our center, and to perform a bibliographic review on the topic. METHODS: Retrospective review of the clinical records of all patients with the diagnosis of Leydig cell tumor in our center over the last 12 years. We evaluated the clinical, diagnostic and therapeutic features, as well as outcomes. RESULTS: Four patients were diagnosed and treated in our department over this period. Mean patient age of the time of diagnosis was 51 years. Each of our cases have a different presentation. The two patients who underwent sperm analysis had azoospermia. None of the cases showed anomalous hormonal studies. Seventy-five percent of the cases showed ultrasound signs compatible with testicular neoplasia. In all of them surgical treatment was undertaken (inguinal orchyectomy); one of the patients underwent chemotherapy due to metastasis, having a good response. Mean follow-up is 76 months. CONCLUSIONS: It is a rare testicular tumor. Inguinal orchyectomy is the treatment of choice. Its good outcome is remarkable.
Subject(s)
Leydig Cell Tumor , Testicular Neoplasms , Adult , Aged, 80 and over , Humans , Leydig Cell Tumor/diagnosis , Leydig Cell Tumor/surgery , Male , Middle Aged , Retrospective Studies , Testicular Neoplasms/diagnosis , Testicular Neoplasms/surgeryABSTRACT
OBJETIVO: Aportar los casos de tumores de células de Leydig diagnosticados en nuestro Centro, revisando la literatura del tema. MÉTODOS: Estudio retrospectivo de las historias clínicas de los pacientes diagnosticados de tumor de células de Leydig en nuestro Centro en los 12 últimos años. Se valoran los aspectos clínicos, diagnósticos y terapéuticos, así como su evolución. RESULTADOS: Cuatro pacientes fueron diagnosticados y tratados en nuestro Servicio durante este periodo. La edad media de los pacientes en el momento del diagnóstico fue de 51 años. Cada uno de nuestros casos debutó con una manifestación diferente. Los dos casos en los que se realizó espermiograma presentaban azoospermia total. Ningún caso mostró alteraciones en el estudio hormonal. El 75 % presentaba signos ecográficos compatibles con neoplasia testicular. En todos ellos se llevó a cabo tratamiento quirúrgico (orquiectomía vía inguinal), siendo necesario en uno de los pacientes llevar a cabo tratamiento con poliquimioterapia por metástasis, con buena respuesta a la misma. La media de seguimiento ha sido de 76 meses. CONCLUSIONES: Se trata de un tumor testicular poco frecuente. La orquiectomía inguinal es el tratamiento de elección. Destaca su buena evolución
OBJECTIVES: To report the case-series of Leydig cell tumors diagnosed at our center, and to perform a bibliographic review on the topic. METHODS: Retrospective review of the clinical records of all patients with the diagnosis of Leydig cell tumor in our center over the last 12 years. We evaluated the clinical, diagnostic and therapeutic features, as well as outcomes. RESULTS: Four patients were diagnosed and treated in our department over this period. Mean patient age of the time of diagnosis was 51 years. Each of our cases have a different presentation. The two patients who underwent sperm analysis had azoospermia. None of the cases showed anomalous hormonal studies. Seventy-five percent of the cases showed ultrasound signs compatible with testicular neoplasia. In all of them surgical treatment was undertaken (inguinal orchyectomy); one of the patients underwent chemotherapy due to metastasis, having a good response. Mean follow-up is 76 months. CONCLUSIONS: It is a rare testicular tumor. Inguinal orchyectomy is the treatment of choice. Its good outcome is remarkable
Subject(s)
Male , Adult , Aged , Middle Aged , Humans , Leydig Cell Tumor/diagnosis , Leydig Cell Tumor/surgery , Testicular Neoplasms/diagnosis , Testicular Neoplasms/surgery , Retrospective StudiesABSTRACT
OBJECTIVES: We report one case of solitary fibrous tumor of the tunica vaginalis, a benign paratesticular lesion. METHODS: Surgical exploration with intraoperative biopsy and excision of the lesion was undertaken, leaving the testicle and epididymis undamaged. RESULTS: Intraoperative biopsy revealed the presence of fibrous tissue without malignant cellularity. Pathological diagnosis on the surgical specimen was solitary fibrous tumor of the tunica vaginalis. The patient remains asymptomatic and disease-free one year after treatment. CONCLUSIONS: Almost all testicular masses are malignant, but in order to avoid a non-indicated orchyectomy, one should be cautious with the finding of a paratesticular lesion of probable benign nature on ultrasound or during surgery.
Subject(s)
Neoplasms, Fibrous Tissue , Testicular Neoplasms , Adult , Humans , Male , Neoplasms, Fibrous Tissue/pathology , Neoplasms, Fibrous Tissue/surgery , Testicular Neoplasms/pathology , Testicular Neoplasms/surgeryABSTRACT
OBJECTIVES: To report one case of pseudotumoral lesion of the iliac ureter with obstructive uropathy leading to loss of function of the renal unit. METHODS: 66-year-old male being studied for BPH who presents with a self-limited monosymptomatic hematuria. RESULTS: Renal ultrasound detected grade II pyelocaliectasis of the right kidney. IVU showed absence of function of the right kidney. Urine cytology was consistent with low-grade transitional cell carcinoma. Percutaneous nephrostomy was performed confirming irreversible function loss. Antegrade pyelography showed a filling defect in the right iliac ureter. Radical nephroureterectomy with bladder cuff was carried out with good results. Pathology reported chronic pyelonephritis and parietal inflammatory lesion of the ureter obliterating the lumen with inflammatory infiltrates, urothelial erosion and presence of actinomyces. CONCLUSIONS: Actinomycosis is a chronic bacterial infection, with A. israeli being the most common pathogen. It is part of the normal flora of the oral cavity and GI tract, and cervical-facial region is the most frequent clinical involvement (60% of the cases). Urinary tract infection is exceptional. No other focus was found in the long-term follow-up.
Subject(s)
Actinomycosis , Ureteral Diseases , Urinary Tract Infections , Actinomycosis/diagnosis , Actinomycosis/therapy , Aged , Humans , Male , Ureteral Diseases/diagnosis , Ureteral Diseases/therapy , Urinary Tract Infections/diagnosis , Urinary Tract Infections/therapyABSTRACT
OBJECTIVES: To report one case of uterine perforation and migration into the urinary bladder of an intrauterine contraceptive device. METHODS/RESULTS: 42-year-old female patient who presents with lower urinary tract irritative syndrome in association to recurrent urinary tract infection. Ultrasound revealed apart of an intrauterine device inside the bladder, device which was inserted years before and was supposed to have come out spontaneously. Urethrocystoscopy with extraction of the intravesical segment and hysteroscopy with extraction of the intrauterine segment were carried out. CONCLUSIONS: The postoperative period was satisfactory and patient is currently asymptomatic. Radiological or ultrasound controls should be performed in the follow-up of patients with intrauterine contraceptive devices. The inability to locate an intrauterine contraceptive device in a patient who did not realize it coming out should be considered an uterine perforation until proved otherwise.
Subject(s)
Foreign-Body Migration/etiology , Intrauterine Devices/adverse effects , Urinary Bladder/pathology , Uterine Perforation/etiology , Adult , Cystoscopy/methods , Female , Foreign-Body Migration/diagnostic imaging , Foreign-Body Migration/surgery , Humans , Radiography, Abdominal , Time Factors , Treatment Outcome , Ultrasonography , Urinary Bladder/diagnostic imaging , Uterine Perforation/diagnostic imagingABSTRACT
OBJECTIVES: We report a new case of severe renal trauma with significant active bleeding and urinary tract lesion in a hemodynamically stable patient, emphasizing the option of conservative treatment with selective embolization of the bleeding segmentary renal arteries, and stenting of the urinary tract with retrograde insertion of a JJ stent; thus avoiding emergency surgery associated with a high risk of nephrectomy. We review the indications of this therapeutic option. METHODS: Embolization of bleeding segmentary renal arteries and retrograde insertion of a JJ stent in a 24 year old patient presenting with severe renal trauma after motorbike motor vehicular accident. Patient remained hemodynamically stable during the whole diagnostic and therapeutic process. Good clinical outcome after 72 hours of ICU control and 18 days of admission in the Urology ward. RESULTS: After selective embolization bleeding stopped immediately; significative hematoma resorption and urinary fluid collection disappearance was seen during a 3 week hospital admission. There were not either immediate or deferred complications, being both renal function and blood pressure normal after 18 months follow up. CONCLUSION: Embolization of the bleeding segmentary renal arteries after severe renal trauma in hemodynamically stable patients is a therapeutic option that allows avoiding emergency surgery, which is associated with high risk for nephrectomy. Urinary tract stenting is enough for a good outcome of the pyelocalicilar system.
Subject(s)
Embolization, Therapeutic/methods , Kidney/injuries , Adult , Humans , Injury Severity Score , Male , Renal ArteryABSTRACT
OBJETIVOS: Aportamos un nuevo caso de traumatismo renal severo con importante sangrado activo y lesión de la vía excretora en paciente hemodinámicamente estable, resaltando la posibilidad de tratamiento conservador con la embolización selectiva de las arterias segmentarias renales sangrantes y tutorización de la vía excretora con catéter doble J retrógradamente, evitando la cirugía urgente con alto riesgo de nefrectomía. Revisamos las indicaciones de esta alternativa terapéutica. METODO: Embolización selectiva de las arterias segmentarias renales sangrantes y colocación de doble J vía retrógrada, tras Las lesiones en general aparecen después de algunas horas de haber ingerido el fármaco causal y se resuelven espontáneamente en el curso de varias semanas. Las reincidencias tendrán lugar exactamente en los mismos sitios si el paciente vuelve a ingerir el mismo fármaco. Este tipo de reincidencia en los mismos sitios por lo general es el rasgo clínico que orienta hacia el diagnóstico correcto (3).El tratamiento consiste en averiguar el tipo de fármaco que origina la reacción medicamentosa y evitarlo. En manifestaciones graves o más generalizadas en el resto del tegumento cutáneo es aconsejable la utilización de corticoides tópicos y por vía general (1). traumatismo renal severo en paciente varón de 24 años de edad por accidente de motocicleta. El paciente permaneció hemodinámicamente estable durante todo el proceso diagnóstico y terapéutico. Control en UCI durante 72 h. y en sala de Urología durante 18 d. con buena evolución clínica. RESULTADOS: Cese inmediato del sangrado activo tras embolización selectiva, importante reabsorción del hematoma perirrenal y desaparición del urinoma durante las 3 semanas de estancia hospitalaria. No hubo complicaciones inmediatas ni diferidas, siendo la función renal y la tensión arterial normales tras un año y medio de seguimiento. CONCLUSION: La embolización selectiva de las arterias renales sangrantes tras un traumatismo renal severo, en pacientes hemodinámicamente estables, es una alternativa terapéutica que puede evitar la cirugía urgente con alto riesgo de nefrectomía. La tutorización de la vía urinaria es suficiente para la buena evolución de las lesiones del sistema pielocalicial (AU)
Subject(s)
Adult , Male , Humans , Injury Severity Score , Renal Artery , Kidney , Embolization, TherapeuticABSTRACT
OBJETIVOS: aportación de un caso de ectopia renal cruzada con fusión descubierta de forma casual en urgencias por dolor abdominal. MÉTODO: se presenta un caso de un paciente de 46 años que acude a urgencias por dolor abdominal y que en los estudios de imagen realizados se descubre la existencia de una extopia renal cruzada. En este caso se descubren también anomalías óseas asociadas. RESULTADOS: la ectopia renal cruzada es una anomalía congénita poco frecuente y en la mayoría de lso casos suele presentarse con fusión de ambos riñones. Puede asociarse a anomalías congénitas de otros órganos. CONCLUSIÓN: la abstención terapéutica suele ser la norma, a no ser que existan complicaciones o patología sobreañadida (AU)
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