[Bladder leiomyosarcoma. Report of 2 cases]. / Leiomiosarcoma vesical. Presentación de dos casos.

OBJECTIVES: The difficulties encountered in making the differential diagnosis and the highly malignant nature of leiomyosarcoma of the bladder, an uncommon tumor type, have prompted us to report on these two cases. MATERIAL AND METHODS: Two cases of leiomyosarcoma of the bladder are described: a 64-year-old female that was treated sequentially by TUR and chemotherapy and died of metastatic disease after 14 months, and an 81-year-old male with metastasis at the time of diagnosis. The literature is reviewed and the clinical pathological immunohistochemical features and treatment are discussed. CONCLUSIONS: The differential diagnosis of this tumor type is complex and requires immunohistochemical data. The diagnosis of leiomyosarcoma is confirmed by the expression of myogenic antigens. Historically, patient survival has been poor and management has been based upon information obtained from a relatively small number of cases with diverse treatment regimens. Because the efficacy of chemotherapy and radiotherapy remains unclear, the treatment of choice is by radical cystectomy or partial cystectomy when tumor location and size permit.

[Is urogenital tuberculosis a current disease still?]. / Es todavía la tuberculosis urogenital una enfermedad actual?

In 1991, the epidemiology service of the health department of La Rioja announced that the number of deaths and new cases were higher than the national average (45/100,000 in 1991). Our service detected 16 new cases of urogenital tuberculosis during 1990-1991. The most common clinical symptoms being urgency and frequency. The bacteriological diagnosis using the Lowenstein-Jensen culture medium was positive in 87.50% of the cases. Anomalies were detected in 87.50% of the urographic analyses, the more frequently observed being infundibular involvement. Polychemotherapy consisting of rifampicin, ethambutol and isoniazid was administered for a period of 9 months in all of the cases, which resulted in negative cultures in 100% of the patients. Control evaluation was performed every 3 months, including CBK and serial bacilloscopy, biochemical assays, renal ultrasound, examination of eye grounds (1st trimester), chest X-ray and sputum bacilloscopy. Only endourological methods were utilized, except in one patient with coexisting congenital stricture of the pyeloureteric junction.

[The accidental diagnosis of giant urethral lithiasis of long-term evolution. A clinical case]. / Diagnóstico accidental de litiasis uretral gigante de larga evolución. Caso clínico.

Presentation of one case of giant urethral lithiasis found accidentally. No associated urethral pathology was identified which could justified the bulbar urethra location or the large size. Lithiasis was removed through urethrolithotomy, closing in one operation the urethral wall.

[Perirenal hematoma after ESWL in a patient with stage T1 renal tumor]. / Hematoma perirrenal post ESWL en paciente con tumor renal estadio T1.

We report a case of perirenal hematoma post ESWL in a patient with controlled hypertension and a previously undiagnosed stage T1 kidney neoplasm. The foregoing complication can be partly ascribed to the renal tumor. It must therefore be taken into account that a small kidney mass may be overlooked during urography and consequently an ultrasound study of the kidney should be done before the patient is submitted to X-ray-guided lithotripsy.

Blunt traumatic rupture of the high right ureter, repaired with appendix interposition.

We report the first case of upper lumbar ureteral replacement with the vermiform appendix, in a blunt traumatic ureter rupture with important urinoma. In selected cases, in which the appendix has a required caliber and length, the vermiform appendix is a very good autograft for ureteral substitution. The vermiform appendix must be preserved if possible in the abdominal surgery.

[Complete separation between epididymis and testis associated with cryptorchism. Presentation of a case and review of the literature]. / Desunión completa epidídimo testicular asociada a criptorquidia. Presentación de un caso y revisión de la literatura.

We report a case of complete separation of the epididymis and testis discovered during surgery for cryptorchidism. The epididymis was found in the scrotum and the testis in the inguinal canal. Although this malformation has been reported sporadically, the incidence in patients with cryptorchidism may be higher. These cases support the hypothesis that testicular descent is guided by the tail of the epididymis.

[Diagnostic and therapeutic aspects of vesico-colonic fistulae. Review of our experience]. / Aspectos diagnósticos y terapéuticos de las fístulas colónico vesicales. Revisión de nuestra experiencia.

Analysis of 10 fistulae in 9 patients, all male. The etiology was diverse although there was a predominance of colovesical diverticulitis. Mictional urinary symptomatology was most frequent. In one case symptoms had been first referred 10 months earlier, while the others ranged between 24 hours and 15 days. Cystography was the radiological procedure which diagnosed more cases whereas cystoscopy was the endoscopic procedure which provides more data. Seven fistulae were treated surgically, in 5 instances with curative and 2 with palliative purposes. Three cases were subsidiary to surgery. 44.4% of patients died within one month from diagnosis.

[Normal echographic anatomy of the penis and the perineum]. / Anatomía ecográfica normal del pene y del periné.

Sonourethrography has recently become available for evaluating the urethra. To perform this procedure correctly, precise knowledge of the ultrasound anatomy of the penis and perineum is required. Sixty-one males were studied using the 7.5 Mhz ultrasound transducer. During sonographic evaluation the site where the suspensory ligament of the penis is attached must be identified routinely. The nothc of the compressor nudae muscle in the posterior bulbous urethra can be visualized occasionally. The origin of the membranous urethra and urogenital diaphragm can be identified upon visualizing the entire urethral bulb and the cavernous bulb muscle.

[Obstruction of double-J catheter. Obstruction of urinary drainage in the renal unit with double-J catheter. Two different concepts]. / Obstrucción de catéter doble "J". Obstrucción del drenaje urinario en la unidad renal portadora de catéter doble "J". Dos conceptos diferentes.

We report on three patients with a functioning solitary kidney that required placement of a double-J catheter. All three patients presented with obstruction of urinary drainage within three weeks. In one patient clots were observed inside the catheter. The catheters of the other two patients, however, showed no signs of obstruction. Two patients presented symptoms and signs of reduced volume of diuresis and the other a deteriorated general condition. In patients with a normally functioning contralateral renal unit, deterioration of renal function of the unit with an indwelling double-J catheter may probably go undetected. A compromised urinary drainage of the renal unit with an indwelling double-J catheter is not necessarily associated with obstruction of the catheter lumen. Urinary drainage around an obstructed double-J catheter is not sufficient in all cases.