Anastomic urethroplasty in bulbar urethral stricture. 13 years experience in a department of urology. / Uretroplastia anastomótica en el manejo de estenosis de uretra bulbar. Experiencia de 13 años en un Servicio de Urología.

UNLABELLED: Urethral stenosis is a common disease in the clinical practice of urology, with a major impact on the quality of life of patients. The anastomotic urethroplasty is a technique with very precise indications usually membranous or bulbar urethra stenosis with a length of 3 cm or up to 7 cm when it is secondary to urethral disruptions (no stenosis) after pelvic trauma. OBJECTIVE: We review anastomotic urethroplasty performed in our department between 2002 and 2015. METHODS: A retrospective, descriptive and inferential analysis on 107 patients out of 482 treated with Anastomotic urethroplasty by urethral strictures at the Urology Department of the Hospital "Virgen de la Victoria" (Malaga) from January 2002 to September 2015, establishing effectiveness and safety of the technique, as well as factors that might influence the results. The main diagnostic method was retrograde urethrography and voiding cystourethrography in 100% of patients undergoing surgery, using voiding uroflowmetry for subsequent monitoring. The definition of success was a postoperative flowmetry with Qmax>15 ml/s, and in case of lower flow, we perform a cystoscopy to verify recurrence of stenosis or exclude other pathology. RESULTS: The median age was 42 years, with a mean follow up of 59 months. The length of stenosis valued by retrograde urethrography and voiding cystourethrography was in 91.6% of cases of >1 cm and <2 cm. The most common etiology was idiopathic in 72.9%, followed by iatrogenic with 15.9%. Regarding the location, it was observed that the area most often affected was the bulbar urethra with 82.2%, with the membranous urethra in second place. In 77.6% of patients anastomotic urethroplasty was the initial treatment, followed in frequency by direct vision internal urethrotomy 9.3%. In the case of comorbidities associated with treatment with anastomotic urethroplasty it was observed that only Diabetes Mellitus had a tendency to statistical significance, with p=0.092, not demonstrating such significance in the case of hypertension or when the subject presented Diabetes Mellitus together with hypertension. Finally, the intervention was successful in 102 cases (95.3%), with only 5 cases (4.7%) where it failed, 4 of them treated with a new Anastomotic urethroplasty, with resolution of the stricture. CONCLUSIONS: Anastomotic urethroplasty is the treatment of choice for short bulbar urethral stricture, with high success rate and low complication rate, as well as low recurrence of these.

Uretroplastia anastomótica en el manejo de estenosis de uretra bulbar. Experiencia de 13 años en un Servicio de Urología / Anastomic urethroplasty in bulbar urethral stricture. 13 years experience in a department of urology

La estenosis de uretra es una patología frecuente en la práctica clínica diaria de las consultas de Urología, con un impacto importante en la calidad de vida de los pacientes. La Uretroplastia anastomótica es una técnica con indicaciones muy precisas en estenosis generalmente de uretra bulbar o membranosa con una longitud de hasta 3 cm o de hasta 7 cm cuando se trata de disrupciones uretrales (no estenosis) tras traumatismos pelvianos. OBJETIVO: Realizamos una revisión de las Uretroplastias anastomóticas llevadas a cabo en nuestro servicio entre 2002 y 2015. MÉTODO: Análisis retrospectivo, descriptivo e inferencial sobre 107 pacientes de un total de 482 estenosis uretrales tratadas mediante Uretroplastia anastomótica en el Servicio de Urología del Hospital 'Virgen de la Victoria' de Málaga desde enero de 2002 a septiembre de 2015, estableciendo eficacia y seguridad de dicha técnica, así como factores que pudiesen influir en los resultados. El método diagnóstico principal fue la uretrografía retrograda y miccional en el 100% de los pacientes sometidos a tratamiento quirúrgico, recurriendo a la flujometría miccional para el seguimiento posterior. La definición de éxito fue una flujometría postoperatoria con un Qmax >15 ml/s, y en caso de flujos inferiores se realizaron uretrografías o uretroscopias para verificar la recidiva de la estenosis o descartar otra patología. RESULTADOS: La mediana de edad fue de 42 años, con un seguimiento medio de 59 meses. La longitud de la estenosis valorada mediante uretrografía miccional y retrógrada fue en un 91.6% de los casos de >1 cm y <2cm. La etiología más frecuente fue la Idiopática con un 72.9%, seguida por la Iatrógena con un 15.9%. Respecto a la localización se objetivó como la zona más frecuentemente afecta fue la uretra bulbar con un 82.2%, continuándole la uretra membranosa. En un 77.6% de los pacientes la Uretroplastia anastomótica fue el tratamiento inicial, continuando en frecuencia la Uretrotomía Interna con un 9.3%. En el caso de las comorbilidades asociadas al tratamiento con la Uretroplastia anastomótica se objetivó como únicamente la Diabetes Mellitus presenta una tendencia a la significación estadística, con una p = 0.092, no demostrándose dicha significación ni en el caso de la Hipertensión arterial ni cuando el sujeto presentaba Diabetes Mellitus conjuntamente con Hipertensión. Por último, la intervención resultó un éxito en 102 casos (95.3%), con sólo 5 casos (4.7%) en los que fracasó, siendo tratados 4 de ellos con una nueva Uretroplastia anastomótica con resolución de la estenosis. CONCLUSIONS: La Uretroplastia anastomótica es el tratamiento de elección en las estenosis cortas de uretra bulbar por su alto porcentaje de éxitos y baja tasa de complicaciones, así como en las recidivas de éstas

Urethral stenosis is a common disease in the clinical practice of urology, with a major impact on the quality of life of patients. The anastomotic urethroplasty is a technique with very precise indications usually membranous or bulbar urethra stenosis with a length of 3 cm or up to 7 cm when it is secondary to urethral disruptions (no stenosis) after pelvic trauma. OBJECTIVE: We review anastomotic urethroplasty performed in our department between 2002 and 2015. METHODS: A retrospective, descriptive and inferential analysis on 107 patients out of 482 treated with Anastomotic urethroplasty by urethral strictures at the Urology Department of the Hospital 'Virgen de la Victoria' (Malaga) from January 2002 to September 2015, establishing effectiveness and safety of the technique, as well as factors that might influence the results. The main diagnostic method was retrograde urethrography and voiding cystourethrography in 100% of patients undergoing surgery, using voiding uroflowmetry for subsequent monitoring. The definition of success was a postoperative flowmetry with Qmax>15 ml/s, and in case of lower flow, we perform a cystoscopy to verify recurrence of stenosis or exclude other pathology. RESULTS: The median age was 42 years, with a mean follow up of 59 months. The length of stenosis valued by retrograde urethrography and voiding cystourethrography was in 91.6% of cases of >1 cm and <2cm. The most common etiology was idiopathic in 72.9%, followed by iatrogenic with 15.9%. Regarding the location, it was observed that the area most often affected was the bulbar urethra with 82.2%, with the membranous urethra in second place. In 77.6% of patients anastomotic urethroplasty was the initial treatment, followed in frequency by direct vision internal urethrotomy 9.3%. In the case of comorbidities associated with treatment with anastomotic urethroplasty it was observed that only Diabetes Mellitus had a tendency to statistical significance, with p = 0.092, not demonstrating such significance in the case of hypertension or when the subject presented Diabetes Mellitus together with hypertension. Finally, the intervention was successful in 102 cases (95.3%), with only 5 cases (4.7%) where it failed, 4 of them treated with a new Anastomotic urethroplasty, with resolution of the stricture. CONCLUSIONS: Anastomotic urethroplasty is the treatment of choice for short bulbar urethral stricture, with high success rate and low complication rate, as well as low recurrence of these

Spontaneous hemoperitoneum secondary to retroperitoneal tumor rupture.

OBJECTIVE: To report a case of GIST type retroperitoneal tumor with spontaneous rupture to the abdominal cavity causing acute abdomen secondary to hemoperitoneum. METHODS/RESULTS: We report the case of an 84 year-old man with history of BPH and chronic atrial fibrillation. He presented to the Emergency Department with diffuse abdominal pain, syncope and accompanying vegetative symptoms. Diagnostic work up showed a 19 cm retroperitoneal mass dependent of the left kidney with active bleeding and secondary hemoperitoneum. Left radical nephrectomy was performed with pathology report of gastrointestinal stromal tumor attached to the renal capsule. CONCLUSIONS: Spontaneous hemoperitoneum is a rare entity and it has various etiologies. It is rarely described in retroperitoneal tumors.

Syringocele in adult patient. Case report.

OBJECTIVE: To describe one case of syringocele in an adult patient. METHODS/RESULTS: We report the case of a 26 year old man who presented frequency, hematuria and fever during one year, mictional cystourethrography showed a syringocele. Treatment consisted in endoscopic surgery, with good results in the follow-up. CONCLUSIONS: The syringocele is a relatively infrequent entity, that is necessary to study in a young patient with voiding symptoms, accompanied or not of haematuria and fever. The diagnosis is based on the cystourethrography, and treatment consisted, usually, in endoscopic surgery.

Siringocele uretral en adulto. A propósito de un caso / Syringocele in adult patient. Case report

OBJETIVO: Presentación de un caso de siringocele en la edad adulta. MÉTODO/RESULTADO: Describimos el caso de un paciente que consultó en nuestro centro por un síndrome irritativo vesical, hematuria y fiebre de un año de evolución, que en el seguimiento se objetiva mediante cistouretrografía miccional un siringocele simple. El tratamiento consistió en una marsupialización endoscópica, presentando buenos resultados en el seguimiento. CONCLUSIONES: El siringocele es una entidad relativamente infrecuente, pero que es necesaria tenerla en cuenta ante un paciente joven con clínica miccional, acompañada o no de hematuria y fiebre. El diagnóstico se basa en la uretrografía, y como modalidad terapéutica más habitual destaca la marsupialización endoscópica(AU)

OBJECTIVE: To describe one case of syringocele in an adult patient. METHODS/RESULTS: We report the case of a 26 year old man who presented frequency, hematuria and fever during one year, mictional cystourethrography showed a syringocele. Treatment consisted in endoscopic surgery, with good results in the follow-up. CONCLUSIONS: The syringocele is a relatively infrequent entity, that is necessary to study in a young patient with voiding symptoms, accompanied or not of haematuria and fever. The diagnosis is based on the cystourethrography, and treatment consisted, usually, in endoscopic surgery(AU)

Retroperitoneal cystic mature teratoma as the presenting clinical scenario of testicular carcinoma.

OBJECTIVE: To describe a case of retroperitoneal mature teratoma presenting as metastasis of a testicular mixed germ cell tumor in a thirty year old man who had lumbar and abdominal pain and mass sensation in the left hemiabdomen. METHODS: Abdominal ultrasound and thoracic-abdominal-pelvic CT multidetector scan were performed, and then after a Doppler ultrasound study of the testicles. Surgical treatment was performed: orchiectomy and retroperitoneal lesion resection. RESULTS: Imaging studies showed a big cystic lesion in the left retroperitoneal space, 13 × 12 × 11 cm, well defined, with thin septa, displacing the kidney; and a solid-cystic 4 cm left testicular tumor, with multiple septa, solid poles and arterial flows with low resistances. Thoracic extension study did not show any finding. The histopathologic results of the orchiectomy and retroperitoneal resection pieces were, respectively, testicular mixed germ cell tumor (seminoma, with intratubular seminoma foci and teratoma) and mature cystic teratoma. CONCLUSIONS: Germ cell tumors derive from multipotencial cells with a large capacity of differentiation, and the nodal paraaortic chains are a natural way of dissemination of these neoplasms. Because of that, in the presence of a retroperitoneal lesion in a young patient we have to rule out testicular tumor metastasis. The retroperitoneal mature cystic teratoma must be considered as a lesion with malignant potential.

Teratoma quístico maduro retroperitoneal como primera manifestación de carcinoma testicular. Estudio radiológico / Retroperitoneal cystic mature teratoma as the presenting clinical scenario of testicular carcinoma. Radiological study

OBJETIVO: Describir un caso de teratoma maduro retroperitoneal como metástasis de un tumor mixto de células germinales testicular en un paciente de 30 años que debutó con dolor lumbar, abdominal y sensación de masa en hemiabdomen izquierdo.MÉTODOS: Se realizó ecografía abdominal, TC multidetector tóraco-abdomino-pélvico, y ante los hallazgos apreciados ecografía-doppler testicular. Se practicó orquiectomía y resección de la lesión retroperitoneal. RESULTADOS: En las pruebas de imagen se apreció a nivel retroperitoneal izquierdo una gran lesión quística de 13x12x11 cm de diámetro, bien delimitada, con finos septos, que desplazaba el riñón; y una masa testicular de 4 cm, sólido-quística, multiseptada, con polos sólidos y flujos vasculares arteriales de baja resistencia. El estudio de extensión torácico no mostró hallazgos. Los resultados anatomopatológicos de las piezas de orquiectomía y de la lesión retroperitoneal fueron respectivamente: tumor mixto de células germinales (seminoma, con focos de seminoma intratubular y teratoma), y teratoma quístico maduro.CONCLUSIONES: Debido a que los tumores de células germinales derivan de células multipotenciales con gran capacidad de diferenciación y que las cadenas ganglionares paraaórticas constituyen una vía de diseminación natural de estas neoplasias, la presencia de una lesión retroperitoneal en un paciente joven, aún sin signos radiológicos de malignidad (en nuestro caso quística) obliga a descartar metástasis de tumor testicular. El teratoma maduro retroperitoneal postpuberal debe considerarse una lesión con potencial maligno(AU)

OBJECTIVE: To describe a case of retroperitoneal mature teratoma presenting as metastasis of a testicular mixed germ cell tumor in a thirty year old man who had lumbar and abdominal pain and mass sensation in the left hemiabdomen.METHODS: Abdominal ultrasound and thoracic-abdominal-pelvic CT multidetector scan were performed, and then after a Doppler ultrasound study of the testicles. Surgical treatment was performed: orchiectomy and retroperitoneal lesion resection.RESULTS: Imaging studies showed a big cystic lesion in the left retroperitoneal space, 13 x 12 x 11 cm, well defined, with thin septa, displacing the kidney; and a solid-cystic 4 cm left testicular tumor, with multiple septa, solid poles and arterial flows with low resistances. Thoracic extension study did not show any finding. The histopathologic results of the orchiectomy and retroperitoneal resection pieces were, respectively, testicular mixed germ cell tumor (seminoma, with intratubular seminoma foci and teratoma) and mature cystic teratoma.CONCLUSIONS: Germ cell tumors derive from multipotencial cells with a large capacity of differentiation, and the nodal paraaortic chains are a natural way of dissemination of these neoplasms. Because of that, in the presence of a retroperitoneal lesion in a young patient we have to rule out testicular tumor metastasis. The retroperitoneal mature cystic teratoma must be considered as a lesion with malignant potential(AU)