Torsión testicular: ¿qué sutura utilizar? / Testicular torsion: wich type of suture must be used?

Presentamos un caso de torsión testicular izquierda ocurrida cuatro meses después de un cuadro similar homolateral en el que se realizó detorsión y fijación bilateral de ambos testículos. La orquidopexia previa se realizó con seda 3-0 y fijación transeptal del testículo contralateral. El antecedente de orquidopexia bilateral no debe influir en el diagnóstico diferencial en el escroto agudo. La fijación creemos que debe realizarse con sutura irreabsorbible en tres localizaciones entre el testículo y el músculo dartos, y se debe realizar exploración del hemiescroto contralateral (AU)

[Testicular torsion: which suture should be used?]. / Torsión testicular: qué sutura utilizar?

We report a case of left testicular torsion four months after a similar homolateral case in which we did detorsion and bilateral fixation of both testicles. The antecedent orchiopexy was accomplished using 3-0 silk and transseptal fixation of the contralateral testicle. A history of bilateral orchiopexy should nor interfere with diagnosing torsion in the acute scrotum. We recommend the use of nonabsorbable suture material joining the testis to the dartos muscle in 3 locations and the contralateral hemiscrotum must be explored.

[Artificial sphincter implantation in women with urinary incontinence using a combined abdomino-vaginal approach]. / Implantación del esfínter urinario artificial en la mujer con incontinencia urinaria por vía combinada abdomino vaginal.

OBJECTIVE: The artificial sphincter has been utilized for urinary incontinence due to intrinsic sphincteric insufficiency, with good fixation of the urethra and a maximum urethral closing pressure of 20-30 cms H2O, or after failed attempts at correction using other techniques. This procedure is difficult to perform since the patients have generally undergone several operations and it is necessity to prepare the cleavage between the urethra and vagina. We propose a modified combined vaginal and suprapubic approach of the technique described by Appell and Abbassian in 1988 for enhanced exposure of the urethra and bladder neck and easy access. METHODS: The modified combined abdominovaginal approach has been utilized in 18 females aged 16-62 years since 1995. RESULTS: 16 patients were continent (88%). One patient (5.5%) required removal of the artificial sphincter due to infection. Another patient (5.5%) has mild incontinence and requires 2 pads a day. Four patients (22%) with detrusor instability are receiving anticholinergics. Three patients (16%) with an underlying neurogenic incontinence require intermittent catheterization. Fourteen patients (77.7%) have type III stress urinary incontinence. We performed the Kelly procedure in 10 patients (55.5%), the Marshall-Marcetti-Kranz in 7 (38.8%), Gittes in 3 (16.6%), and 2 patients (11.1%) had a sling procedure. Two techniques were simultaneously performed in some patients. CONCLUSIONS: Although the number of patients in this series is small, the fact that only one case required removal of the artificial spincter due to infection indicates that this is a useful alternative approach that significantly facilitates implantation of the artificial sphincter in these patients.

[Penile fracture involving cavernous bodies and urethra]. / Fractura de pene con afectación de cuerpos cavernosos y uretra.

Reports on fracture of the penis are scarce in the spanish urological literature and in most cases injury appear limited to the corpora cavernosa. In this report a case of rupture of both corpora cavernosa and the urethra during sexual intercourse is presented. Early surgical treatment rendered good results. A literature review on currently recommended diagnostic and treatment practices is presented.

[New report of epididymal adenomatoid tumor. Infrequent pathology]. / Nueva aportación de un tumor adenomatoide de epididimo. Una patología poco frecuente.

Case report of a 42-year old patient with an epididymal adenomatoid tumour found after a three-month history of increased left hemiscrotum and scrotal discomfort. Definite diagnosis was arrived at following surgical exeresis and pathoanatomical study. The etiopatogenesis, clinical presentation and management are all analyzed. Since urological incidence is very low within intrascrotal processes, we believe it is important to understand the condition so that a differential diagnosis from other inflammatory processes can be established; also the convenience of a much more aggressive attitude in scrotal diseases is restated due to the low morbidity of this type of surgery.

[Asymptomatic bladder paraganglioma. Report of a case]. / Paraganglioma vesical asintomático. Aportación de un caso.

Paragangliomas are tumors which arise from collections of neuroepithelial cells (paraganglion system) scattered throughout the body and rarely in the urinary bladder. In this work, we described a case of bladder paraganglioma, not suspected in a 64-year-old male who showed occasional total hematuria as only symptom. Cystoscopically, it was diagnosed as a rounded, not papillary tumor, one centimeter in diameter on account of which it was subjected to TUR. Confirmed the diagnosis, a partial cystectomy and a limited regional lymphadenectomy were subsequently practised. Posterior evolution, after a year, was completely favourable. The main clinicopathologic characteristics of this entity are revised.

[Congenital inward curvature of the penis without hypospadias. Report of 3 new cases]. / Incurvación congénita del pene sin hipospadias. Aportación de tres nuevos casos.

We report on 3 young patients with congenital curvature of the penis without hypospadias (a rare disease entity) who consulted us for erectile deviation causing difficulty or inability to achieve vaginal penetration. No patient referred pain and the deviation was ventral, left lateral and ventral, and left lateral, respectively. These patients underwent surgical correction with the technic described by Nesbit in 1965. Good results were achieved in all patients; correction permitted patients to resume normal sexual activity. The literature is reviewed highlighting the good results afforded by this simple yet effective technic for surgical correction of this condition.