[Polyorchidism]. / Poliorquidismo.

OBJECTIVE: To report one case of supernumerary testicle, a rare entity with around 100 cases published. METHODS: 44-year-old male patient consulting for incidental discovering of a right scrotal mass. The diagnosis of polyorchidism was suspected after physical examination, ultrasound, and CT scan, and confirmed subsequently on surgical exploration and biopsy. Due to the absence of pathology and complete normal seminal lines decision was taken to not perform orchiectomy of the supernumerary testicle. RESULTS: There are classifications for proper evaluation of polyorchidism, which state the relation between site of the testicle in relation to scrotum, existence or absence of independent epididymis and vasa deferentia for both testicles. CONCLUSIONS: Although remotely, there is a possibility of malignant degeneration of these testicles, so that surgical exploration and excision of the supernumerary testicles when their biopsy is doubtful in terms of dysplasia or if they present carcinoma in situ or they are a source of pain.

Pliorquidismo / Polyorchidism

OBJETIVO: Presentamos un caso de teste supernumerario, rara entidad, de la que hay recogidos y fundamentados unos 100 casos.MÉTODOS: Se trata de un varón de 44 años, que consultó por descubrimiento casual de masa escrotal derecha. A la exploración física, ecográfica y tomográfica ya se sospechó el diagnóstico de poliorquidia, refrendándose posteriormente mediante exploración quirúrgica y biopsia. Dada la ausencia de patología y la completa normalidad de la línea seminal se optó por no actuar, no extirpando el teste supernumerario.RESULTADOS: Existen clasificaciones para una correcta evaluación de la poliorquidia, que relacionan la localización respecto a escroto, y la existencia o no de epidídimo y deferentes independientes para las dos gónadas.CONCLUSIONES: Aunque remota, existe la posibilidad de degeneración maligna en estos testes, por lo que se impone la exploración quirúrgica y la extirpación de los testes supernumerarios cuando la biopsia arroje dudas, en cuanto a displasia o presencia de carcinoma in situ, o cuando sean origen de dolor(AU)

OBJECTIVE: To report one case of supernumerary testicle, a rare entity with around 100 cases published.METHODS: 44-year-old male patient consulting for incidental discovering of a right scrotal mass. The diagnosis of polyorchidism was suspected after physical examination, ultrasound, and CT scan, and confirmed subsequently on surgical exploration and biopsy.Due to the absence of pathology and complete normal seminal lines decision was taken to not perform orchiectomy of the supernumerary testicle.RESULTS: There are classifications for proper evaluation of polyorchidism, which state the relation between site of the testicle in relation to scrotum, existence or absence of independent epididymis and vasa deferentia for both testicles.CONCLUSIONS: Although remotely, there is a possibility of malignant degeneration of these testicles, so that surgical exploration and excision of the supernumerary testicles when their biopsy is doubtful in terms of dysplasia or if they present carcinoma in situ or they are a source of pain(AU)

[Neurological metastases secondary to germ cell testicular tumor]. / Metástasis neurológicas secundarias a tumor testicular germinal.

OBJECTIVE: Neurological metastases secondary to urological tumors account for 12% overall. The ones derived from germ cells testicular tumors are exceptional in the age of cisplatin. METHODS: We report one case of mixed germ cell tumor in a 49-year-old male patient treated with systemic chemotherapy during 18 months before presenting with severe central and peripheral neurological symptoms leading to death due to massive cerebral hemorrhage. RESULTS: We describe three types of presentation of cerebral metastases in patients with testicular cancer. Type I present synchronically with the primary tumor. Type 2 are diagnosed after a period of remission after conventional cytostatic treatment. Type 3 metastases are diagnosed during the course of the disease and its treatment. CONCLUSIONS: Except unique metastases classified in groups 1 and 2, which are susceptible of surgery or radiosurgery, in which in response may be expected; the rest of lesions secondary to germ cell tumors have an ominous prognosis and outcomes, with short survivals.

[Adenomatoid tumor of the epididymis. Report of five cases]. / Tumor adenomatoide epididimario. Aportación de 5 casos.

OBJECTIVE: Adenomatoid tumor of the epididymis is unfrequent, benign, with no malignant outcomes described. METHODS: We report five cases, with patient's ages varying from 31 to 76 years, and tumor sizes from 6 to 30 mm. All patients underwent surgery with excision of the mass, some of them after several months of growing. In one of the cases the evolution reached six years. RESULTS: None of the cases presented recurrence or bad outcome after surgery. Pathology confirmed the benign adenomatoid character in all cases. CONCLUSIONS: Despite the clinical, ultrasound and physical examination findings suggest the localization in the epididymis and its benign character, surgical exploration is mandatory with surgical excision of the paratesticular mass.

[Sertoli cell malignant tumor]. / Tumor de células de Sertoli maligno.

OBJECTIVE: We report a new case of Sertoli cell testicular tumor with malignant characteristics. METHODS: 77 year-old male patient, suffering a general wasting syndrome presenting with a left solid testicular mass with the diagnosis of malignant Sertoli cell tumor after orchyectomy, without local, regional or distant dissemination, and a benign outcome after 18 months of follow-up. RESULTS: Sertoli cell tumor or androblastoma is classified as non-germ cell tumor derived from the stroma of the sexual cords. There are three types depending on its cellular composition: calcified big cell, sclerotic cell, and the most frequent of all, the classic type. CONCLUSIONS: Being the Sertoli cell testicular tumor rare, its malignant type is even rarer, accounting for not more than 10% of all. Despite the pathological characteristics related to malignancy, its posterior behaviour is unpredictable and not much known, the some than follow-up and treatment, because it is not sensible to cytostatic drugs. The existence of metastases continues to be the only valid parameter with prognostic value.

Metástasis neurológicas secundarias a tumor testicular germinal / Neurological metastases secondary to germ cell testicular tumor

Objetivo: Las metástasis neurológicas secundarias a tumores urológicos suponen un 12% del total. Las derivadas de los tumores germinales testiculares en la época del cisplatino son excepcionales. Métodos: Presentamos un caso de tumor germinal mixto en un varón de 49 años tratado mediante quimioterapia sistémica desde 18 meses antes que presentó severa clínica neurológica central y periférica, que le condujo a la muerte por hemorragia cerebral masiva. Resultados: Se describen 3 tipos de presentación de las metástasis cerebrales en pacientes con cáncer testicular. El tipo 1 en el que se presentan sincrónicamente al tumor primario. El tipo 2 en el que se diagnostican tras un período de remisión luego del tratamiento citostático convencional. En el tipo 3 las metástasis se diagnostican durante el curso de la enfermedad y durante su tratamiento. Conclusiones: Salvo en caso de metástasis únicas encuadradas en el grupo 1 y 2 susceptibles de cirugía o radiocirugía, en el que cabe esperar respuesta, en el resto de lesiones secundarias a tumores germinales la evolución y el pronóstico son ominosos, con supervivencias escasas (AU)

Objective: Neurological metastases secondary to urological tumors account for 12% overall. The ones derived from germ cells testicular tumors are exceptional in the age of cisplatin. Methods: We report one case of mixed germ cell tumor in a 49-year-old male patient treated with systemic chemotherapy during 18 months before presenting with severe central and peripheral neurological symptoms leading to death due to massive cerebral hemorrhage. Results: We describe three types of presentation of cerebral metastases in patients with testicular cancer. Type 1 present synchronically with the primary tumor. Type 2 are diagnosed after a period of remission after conventional cytostatic treatment. Type 3 metastases are diagnosed during the course of the disease and its treatment. Conclusions: Except unique metastases classified in groups I and 2, which are susceptible of surgery or radiosurgery, in which in response may be expected; the rest of lesions secondary to germ cell tumors have an ominous prognosis and outcomes, with short survivals (AU)

Tumor adenomatoide epididimario. Aportación de 5 casos / Adenomatoid tumor of the epididimys. Report of five cases

Objetivo: El tumor adenomatoide de epidídimo es infrecuente, de carácter benigno, no habiéndose descrito evoluciones malignas. Método: Presentamos 5 casos, con edades variopintas entre los 31 y los 76 años, y también con tamaños diversos entre los 6 y los 30 mm. Todos fueron intervenidos realizándose exéresis de la masa, tras varios meses de crecimiento. En un caso la evolución era de 6 años. Resultado: Ninguno presentó ni recidiva ni evolución tórpida tras la cirugía. La histología confirmó el carácter adenomatoide benigno en todos ellos. Conclusiones: A pesar de que los hallazgos clínicos, ecográficos y exploratorios sugieren la localización epididimaria y la benignidad, es mandatoria la exploración y extirpación quirúrgica de toda masa sólida paratesticular (AU)

Objective: Adenomatoid tumor of the epididymis is unfrequent, benign, with no malignant outcomes described. Methods: We report five cases, with patient's ages varying from 31 to 76 years, and tumor sizes from 6 to 30 mm. All patients underwent surgery with excision of the mass, some of them after several months of growing. In one of the cases the evolution reached six years. Results: None of the cases presented recurrence or bad outcome after surgery. Pathology confirmed the benign adenomatoid character in all cases. Conclusions: Despite the clinical, ultrasound and physical examination findings suggest the localization in the epididymis and its benign character, surgical exploration is mandatory with surgical excision of the paratesticular mass (AU)

Tumor de células de Sertoli maligno / Sertoli cell malignant tumor

Objetivo: Aportamos a la literatura un nuevo caso de tumor testicular compuesto por células de Sertoli de características histológicas malignas. Métodos: Se trata de un varón de 77 años, afecto de un síndrome general constitucional y una masa sólida testicular izquierda en la que tras la orquiectomía se diagnostica de tumor de células de Sertoli maligno, sin diseminación locorregional ni a distancia, con una benigna evolución tras 18 meses de seguimiento. Resultados: El tumor de células de Sertoli o androblastoma se encuadra en la clasificación de tumores no germinales derivados del estroma de los cordones sexuales. Se reconocen 3 tipos dependiendo de su composición celular: de célula grande calcificada, de célula esclerosada, y la más frecuente de todas, la variante clásica. Conclusiones: Siendo el tumor de células de Sertoli un tumor testicular poco común, la forma maligna lo es menos aún, no más del 10% del total. A pesar de las características patológicas que se relacionan con la malignidad, su comportamiento posterior es imprevisible y poco conocido, al igual que la forma de seguimiento y tratamiento, pues no es sensible a citostáticos. La presencia de metástasis sigue siendo hoy en día el único parámetro válido como valor pronóstico (AU)

Objective: We report a new case of Sertoli cell testicular tumor with malignant characteristics. Methods: 77-year-old male patient, suffering a general wasting syndrome presenting with a left solid testicular mass with the diagnosis of malignant Sertoli cell tumor after orchyectomy, without local, regional or distant dissemination, and a benign outcome after 18 months of follow-up. Results: Sertoli cell tumor or androblastoma is classified as non-germ cell tumor derived from the stroma of the sexual cords. There are three types depending on its cellular composition: calcified big cell, sclerotic cell, and the most frequent of all, the classic type. Conclusions: Being the Sertoli cell testicular tumor rare, its malignant type is even rarer, accounting for not more than 10% of all. Despite the pathological characteristics related to malignancy, its posterior behaviour is unpredictable and not much known, the same than follow-up and treatment, because it is not sensible to cytostatic drugs. The existence of metastases continues to be the only valid parameter with prognostic value (AU)

[Metachronic testicular metastasis secondary to clear cell renal adenocarcinoma]. / Metástasis testicular metacrónica secundaria a adenocarcinoma renal de células claras.

OBJECTIVE: To report one case of unusual testicular metastasis from a renal origin. METHODS: 57 year-old patient with disseminated right renal cancer under treatment who presented bone metastasis and a painful nodule in the upper pole of the right testicle during his follow-up with medical therapy, making surgery necessary. The pathology result was clear cell adenocarcinoma. RESULTS: Six months later the patient continues under oral Sorafenib without evidence of new metastatic implants. CONCLUSIONS: Testicular secondary metastatic tumors account for less than 1% of old testicular tumors. In patients in the fifth and sixth decades, mainly if they are affected by other neoplasias, testicular masses use to be metastatic implants. The most frequent origin is prostate.

[Epithelioid renal angiomyolipoma]. / Angiomiolipoma epitelioide renal.

OBJECTIVE: To issue the existence of a variety of angiomyolipoma, named epithelioid, with different histological and clinic properties. METHODS: We report the case of a 17 year old female, with Bourneville's disease, who was discovered to have a solid renal mass suggestive of carcinoma in a control CT scan, adjacent to other smaller masses identified as angiomyolipomas. RESULTS: After several tumorectomies, the suspicious mass, 4 cm in size, was diagnosed as epithelioid angiomyolipoma, with immunohistochemical confirmation of capacity for HMB45, and negative vimentin and keratin. CONCLUSIONS: Despite the possibility of coexistence of adenocarcinoma and angiomyolipoma, the existence of an epithelioid variety cannot be discarded, mainly in patients with phakomatosis. The indications for surgery are the same than for the rest of renal masses. Nevertheless, follow-up criteria must be stricter due to the possibility of torpid outcome in terms of dissemination of this infrequent variety of angiomyolipoma.

[Metastases in the paranasal sinuses secondary to prostatic adenocarcinoma]. / Metástasis en senos paranasales secundaria a adenocarcinoma prostático.

OBJECTIVE: To report a new case of exceptional metastases from a prostatic carcinoma. METHODS: 64-year-old male with nine months history of disseminated prostate cancer, taking hormonal treatment and biphosphonates, who presents with rising PSA, facial dysesthesia and left exophtalmos. MRI recognizes the existence of a solid mass in the right maxillary sinus with involvement of the ipsilateral orbital floor, and another one in the left frontal sinus invading the roof of the ipsilateral orbit and also with orbital extraconal involvement. RESULTS: Once the diagnosis was established hormonal maneuvers were performed and chemotherapy with docetaxel was administered achieving at the start of treatment measurable disease stabilization with biochemical remission of PSA levels, followed posteriorly by progression without changes in the metastatic images. Currently new cytoreductive therapy with docetaxel has been initiated. CONCLUSIONS: 1% of the prostatic tumors involve the head in their evolution. Most frequent metastases are localized in the brain and meninges, being the involvement of paranasal sinuses and ocular orbit extraordinary. The importance of these comes from the extension to the orbit and the eye in vicinity. Second line hormonal maneuvers, local radiotherapy and systemic chemotherapy will be necessary for control, although results are discouraging. In general, prognosis is poor, with short survival.

Metástasis en senos paranasales secundaria a adenocarcinoma prostático / Metastases in the paranasal sinuses secondary to prostatic adenocarcinoma

Objetivo: Presentar un nuevo caso de metástasis excepcional por carcinoma de próstata. Método: Varón de 64 años diagnosticado 9 meses antes de carcinoma prostático diseminado, en tratamiento hormonal además de bifosfonatos, que debuta con elevación de las cifras de PSA, disestesia facial y exoftalmos izquierdo. En RMN se reconoce la existencia de una masa sólida en seno maxilar derecho con afectación del suelo orbitario del mismo lado, y de otra de las mismas características localizada en seno frontal izquierdo con invasión del techo de la órbita homolateral y afectación extraconal orbitaria. Resultados: Una vez establecido el diagnóstico se sometió al paciente a maniobras hormonales y se administró quimioterapia con docetaxel obteniendo una estabilización de la enfermedad mensurable con una remisión bioquímica de los niveles del PSA al principio del tratamiento, para progresar posteriormente, sin observarse cambios en las imágenes metastásicas. En la actualidad se ha iniciado de nuevo terapia citorreductora con docetaxel. Conclusiones: El 1% de los tumores prostáticos afectarán la cabeza en su evolución. Las metástasis más frecuentes se localizan en cerebro y meninges, siendo la afectación de senos paranasales y órbita ocular extraordinaria. La importancia de éstas viene dada por la afectación en vecindad de la órbita y del ojo. Serán precisas para su control las maniobras hormonales de 2ª línea, la radioterapia local y la quimioterapia sistémica, aunque con resultados desalentadores. En general el pronóstico es malo, con sobrevivas cortas (AU)

Objective: To report a new case of exceptional metastases from a prostatic carcinoma. Methods: 64-year-old male with nine months history of disseminated prostate cancer, taking hormonal treatment and biphosphonates, who presents with rising PSA, facial dysesthesia and left exophtalmos. MRI recognizes the existence of a solid mass in the right maxillary sinus with involvement of the ipsilateral orbital floor, and another one in the left frontal sinus invading the roof of the ipsilateral orbit and also with orbital extraconal involvement. Results: Once the diagnosis was established hormonal maneuvers were performed and chemotherapy with docetaxel was administered achieving at the start of treatment measurable disease stabilization with biochemical remission of PSA levels, followed posteriorly by progression without changes in the metastatic images. Currently new cytoreductive therapy with docetaxel has been initiated. Conclusions: 1% of the prostatic tumors involve the head in their evolution. Most frequent metastases are localized in the brain and meninges, being the involvement of paranasal sinuses and ocular orbit extraordinary. The importance of these comes from the extension to the orbit and the eye in vicinity. Second line hormonal maneuvers, local radiotherapy and systemic chemotherapy will be necessary for control, although results are discouraging. In general, prognosis is poor, with short survival (AU)

[Metachronic thyroid metastasis secondary to renal carcinoma. Case report]. / Metástasis tiroidea metacrónica secundaria a carcinoma renal. A propósito de un caso.

OBJECTIVE: We report the case of the patient with metachronic thyroid metastasis of a renal adenocarcinoma. METHODS: 61-year-old patient with the diagnosis of renal adenocarcinoma treated by radical nephrectomy (stage pT3bpN0M0) and subsequent interleukin-2 for twelve months presenting four years after surgery with a thyroid nodule displacing the trachea laterally, requiring left hemithyroidectomy. RESULTS: Pathology reported a lesion made of clear cytoplasm tumor cells, with marked atypia and anaplastic areas, compatible with clear cell renal adenocarcinoma. CONCLUSIONS: Thyroid metastases are extremely rare, being renal tumors the most frequent origin. They present as painless nodules, cold in gammagram, with normal thyroid hormones. The treatment of choice is surgical excision, with a better prognosis the longer the time between the primary and the appearance of metastasis.

[Nephroblastoma or Wilms tumor. Adult presentation. Report of two cases]. / Nefroblastoma o tumor de Wilms. Presentación en adultos. Estudio de dos casos.

OBJECTIVES: To present to new cases of nephroblastoma or Wilms tumor diagnosed in adult age. METHODS: The first case we report is a 16-year-old female with the diagnosis of stage I nephroblastoma after radical nephrectomy for a right renal mass. She underwent systemic polychemotherapy. The second case is a 33-year-old female with the diagnosis of nephroblastoma after percutaneous biopsy of a right renal mass. Due to the presence of lymph node, hepatic and lung dissemination systemic polychemotherapy (ACTD-VCR-DOX) was given. Right nephrectomy with regional lymph node dissection and hepatic metastasis excision were performed after confirmation of mass reduction. After that, the patient continued receiving systemic polychemotherapy with the same drugs. After resection of a lung nodule which did not disappear, and after confirmation of tumoral presence CB and VP 16 were added. RESULTS: Both patients are disease-free after 58 and 46 months respectively. CONCLUSIONS: This type of tumor typical of childhood is extremely rare in adult age, and despite worse survivals and more aggressiveness are described, they may be treated with the same protocols used in children, following any of the two big co-operative groups: American NWTS or European SIOP.

Metástasis tiroidea matacrónica secundaria a carcinoma renal. A propósito de un caso / Metachronic thyroid metastasis secondary to renal carcinoma. Case report

Objetivo: Presentamos el caso de una paciente con metástasis tiroidea metacrónica de un adenocarcinoma renal. Métodos: Paciente de 61 años, tratada mediante nefrectomía radical y posteriormente con interleukina-2 durante 12 meses por un adenocarcinoma renal, en estadío pT3b pN0 M0, que 4 años después desarrolla un nódulo tiroideo con desplazamiento tráqueal, que obligó a realizar una hemitiroidectomía izquierda. Resultados/Conclusiones: Histopatológicamente se informó como una lesión constituida por células tumorales con citoplasma claro, con acusada atipia y zonas anaplásicas compatible con adenocarcinoma renal de células claras. El estudio de extensión fue negativo. Conclusiones: Las metástasis tiroideas son extraordinariamente raras, siendo su origen renal el más frecuente. Se presentan como un nódulo indoloro, gammagráficamente frío, y niveles de hormonas tiroideas normales. Su tratamiento es la exéresis quirúrgica, con un pronóstico mejor cuanto mayor sea el tiempo trascurrido entre el tumor primario y la aparición de metástasis (AU)

Objective: We report the case of the patient with metachronic thyroid metastasis of a renal adenocarcinoma. Methods: 61-year-old patient with the diagnosis of renal adenocarcinoma treated by radical nephrectomy (stage pT3bpN0M0) and subsequent interleukin-2 for twelve months presenting four years after surgery with a thyroid nodule displacing the trachea laterally, requiring left hemithyroidectomy. Results: Pathology reported a lesion made of clear cytoplasm tumor cells, with marked atypia and anaplastic areas, compatible with clear cell renal adenocarcinoma. Conclusions: Thyroid metastases are extremely rare, being renal tumors the most frequent origin. They present as painless nodules, cold in gammagram, with normal thyroid hormones. The treatment of choice is surgical excision, with a better prognosis the longer the time between the primary and the appearance of metastasis (AU)

Nefroblastoma o tumor de Wilms. Presentación en adultos. Estudio de dos casos / Nephroblastoma or Wilms tumor. Adult presentation. Report of two cases

Objetivo: Presentar dos nuevos casos de nefroblastoma o tumor de Wilms diagnosticados en la edad adulta. Métodos: El 1º caso que presentamos corresponde a una mujer de 16 años, a la que tras la nefrectomía radical por masa sólida dcha se diagnostica de nefroblastoma, en estadío I, sometiéndola posteriormente a poliquimioterapia sistémica. El 2º caso corresponde también a una mujer de 33 años diagnosticada mediante biopsia percutánea de masa renal sólida de nefroblastoma derecho. A consecuencia de la diseminación ganglionar, hepática y pulmonar que presentaba, se le ofreció poliquimioterapia sistémica (ACTD-VCR-DOX), tras lo cual, y habiendo evidenciado reducción de la masa se sometió a nefrectomía derecha, linfadenectomía regional y metastasectomía hepática. Posteriormente se continuó con poliquimioterapia sistémica con los mismos productos. Tras tener que resecar un nódulo pulmonar que no desapareció, y habiendo constatando presencia tumoral se añadió CB y VP16. Resultados: Ambas pacientes se encuentran, tras 58 y 46 meses respectivamente, libres de enfermedad. Conclusiones: En la edad adulta, este tipo de tumor propio de la infancia, es extremadamente raro, y aunque estén descritas peores supervivencias y mayor agresividad, puede y debe tratarse con iguales protocolos que los empleados en la infancia, siguiendo a cualquiera de los dos grandes grupos cooperativos existentes, el NWTS americano y el SIOP europeo (AU)

Objectives: To present to new cases of nephroblastoma or Wilms tumor diagnosed in adult age. Methods: The first case we report is a 16-year-old female with the diagnosis of stage I nephroblastoma after radical nephrectomy for a right renal mass. She underwent systemic polychemotherapy. The second case is a 33-year-old female with the diagnosis of nephroblastoma after percutaneous biopsy of a right renal mass. Due to the presence of lymph node, hepatic and lung dissemination systemic polychemotherapy (ACTD-VCR-DOX) was given. Right nephrectomy with regional lymph node dissection and hepatic metastasis excision were performed after confirmation of mass reduction. After that, the patient continued receiving systemic polychemotherapy with the same drugs. After resection of a lung nodule which did not disappear, and after confirmation of tumoral presence CB and VP 16 were added. Results: Both patients are disease-free after 58 and 46 months respectively. Conclusions: This type of tumor typical of childhood is extremely rare in adult age, and despite worse survivals and more aggressiveness are described, they may be treated with the same protocols used in children, following any of the two big co-operative groups: American NWTS or European SIOP (AU)

[Penile fracture with associated urethral rupture]. / Fractura de pene con rotura asociada de uretra.

OBJECTIVE: We report two cases of penile fracture; one case with associated rupture of the corpus spongiosum and complete urethral section, and the other presenting a second cavernous fracture three years after a first episode. METHODS: The first patient, 32-years-old, suffered the fracture of the right corpus cavernosum during intercourse three years after a first fracture requiring surgical repair. This time he also underwent surgery immediately to find and repair the lesion, with good functional outcome. The second patient, 29-years-old, suffered a transverse fracture at the bases of both corpora cavernosa associated with complete section of the urethra. He underwent emergency surgery to repair all lesions with good esthetic and functional results. RESULTS: Traumatic lesions of the penis with fracture of the corpora cavernosa are rare and the association with urethral rupture is exceptional, as well as it is the possibility of second fracture years ofter a first episode. CONCLUSIONS: Penile fracture is a rare reason for consultation in the emergency setting, which should be repaired immediately with evacuation of the hematoma, closure of the albuginea's lesion and repair of the urethral lesions when they appear. Results are better, avoiding mid and long-term complications.

Fractura de pene con rotura asociada de uretra / Penile fracture with associated urethral rupture

OBJETIVO: Presentamos dos casos de fractura de pene, 1 con fractura asociada de cuerpo esponjoso y sección completa de uretra y otro que sufrió la segunda fractura cavernosa 3 años después de la primera. MÉTODOS: El primer paciente, de 32 años, sufrió la fractura del cuerpo cavernoso derecho durante el coito, 3 años después de haber sufrido una primera fractura de la que fue intervenido de urgencia. En este caso también fue intervenido de inmediato evidenciando la lesión y reparándola, con buenos resultados funcionales. El segundo paciente, de 29 años, sufrió la fractura transversal de ambos cuerpos cavernosos a nivel basal asociándose la sección completa de la uretra en una misma línea de fractura. Intervenido de urgencia se solucionaron todas las lesiones, con buenos resultados estéticos y funcionales. RESULTADOS: Dentro de la rareza que supone la lesión peneana traumática con fractura cavernosa, la asociación de lesión uretral supone una excepción, así como la posibilidad de sufrir una segunda fractura años después de la primera. CONCLUSIONES: La fractura peneana supone una rara urgencia que debe ser reparada de forma inmediata evacuando el hematoma, suturando la lesión albugínea y solucionando la lesión uretral en los raros casos en que se asocie. Los resultados serán mejores, evitándose complicaciones a medio y largo plazo

OBJECTIVE: We report two cases of penile fracture; one case with associated rupture of the corpus spongiosum and complete urethral section, and the other presenting a second cavernous fracture three years after a first episode. METHODS: The first patient, 32 years old, suffered the fracture of the right corpus cavernosum during intercourse three years after a first fracture requiring surgical repair. This time he also underwent surgery immediately to find and repair the lesion, with good functional outcome. The second patient,29 years old, suffered a transverse fracture at the bases of both corpora cavernosa associated with complete section of the urethra. He underwent emergency surgery to repair all lesions with good esthetic and functional results. RESULTS: Traumatic lesions of the penis with fracture of the corpora cavernosa are rare and the association with urethral rupture is exceptional, as well as it is the possibility of second fracture years after a first episode. CONCLUSIONS: Penile fracture is a rare reason for consultation in the emergency setting, which should be repaired immediately with evacuation of the hematoma, closure of the albuginea’s lesion and repair of the urethral lesions when they appear. Results are better, avoiding mid and long-term complications

Infección por HTLV post-trasplante renal / HTLV infection after renal transplant

OBJECTIVOS: Presentamos los 2 primeros casos de infección por HTLV-I tras trasplante renal ocurridosen nuestro país y su evolución (1998).MÉTODOS: Se describen los casos de 2 pacientes trasplantadosque han desarrollado una mielopatía subaguda, la Paraparesia Espástica Tropical, secundaria a infección por HTLV-I y se revisa su evolución.RESULTADOS: En ambos casos, en el momento actual, presentan gran incapacidad, siendo, en concreto un paciente,dependiente para la vida diaria.CONCLUSIONES: Creemos necesaria la detección de HTLV-I, en todos los donantes, mediante técnicas indirectas(enzimoinmunoensayo, ELISA) o directas (PCR) dada la evolución tórpida de la infección en el paciente trasplantadopor un lado y por otro, por la creciente población inmigrante en nuestro país que conlleva un aumento de portadores asintomáticos del virus

OBJECTIVES: We report the first two cases of HTLV-1 infection after a renal transplant appearing in our country and their outcomes. ;;METHODS: We describe the cases of two transplant patients who developed subacute myelopathy, known as Tropical Spastic Paraparesis, secondary to HTLV-I infection and ;;review their evolution. ;;RESULTS: Both cases show a great disability today, being one of them dependent for his daily life. ;;CONCLUSIONS: We believe that HTLV-I detection is ;;necessary in all donors by indirect (ELISA) or direct (PCR) techniques due to its symptomless evolution in the transplant patient on the one hand, and the growing immigrant ;;population in our country which associates an increase in the number of asymptomatic carriers of the virus

[HTLV infection after renal transplant]. / Infección por HTLV post-trasplante renal.

OBJECTIVES: We report the first two cases of HTLV-1 infection after a renal transplant appearing in our country and their outcomes. METHODS: We describe the cases of two transplant patients who developed subacute myelopathy, known as Tropical Spastic Paraparesis, secondary to HTLV-1 infection and review their evolution. RESULTS: Both cases show a great disability today, being one of them dependent for his daily life. CONCLUSIONS: We believe that HTLV-1 detection is necessary in all donors by indirect (ELISA) or direct (PCR) techniques due to its symptomless evolution in the transplant patient on the one hand, and the growing immigrant population in our country which associates an increase in the number of asymptomatic carriers of the virus.