First Case Described in the Medical Literature: Male Urethral Sarcoidosis. Description of a Case and Review of the Literature.

OBJECTIVE: Although the sarcoidosis is a multisystemic disease that theoretically can affect almost any organ, the presence of sarcoidosis in the male urethra has not been described in the medical literature. We present the first male case of urethral sarcoidosis. METHOD: A 46 years old male undergoing follow up due to lower urinary tract symptoms was diagnosed of endobronchial sarcoidosis during the preoperative study for internal urethrotomy. After surgery, he presented clinical improvement for one year. Given the worsening, a new internal urethrotomy was tried. As it was impossible due to complexity they took a biopsy of the urethra. The pathology report described non-caseating granulomas compatible with sarcoidosis. After that, medical and endoscopic management of the urethral sarcoidosis was attempted. As it didn't achieve an adequate control, the patient was derivate to the "complex urethral unit" of the Cruces University Hospital. Once it was valuated, it was decided to start immunotherapy and subsequently an urethroplasty with a double oral mucosa graft was performed. OUTCOMES: During the postoperative period, a urethral catheter was maintained for two weeks. It was removed after no urinary leakage was observed in de cystourethrography. After that the patient remains with good evolution until today. CONCLUSIONS: Urethral affectation by sarcoidosis is a therapeutic challenge itself. For a better symptom control and to reduce the recurrences, a dual approach using systemic treatment in combination with local surgical treatment seems necessary.

[Surgical treatment of urethral stenosis. Results of 100 urethroplasties]. / Tratamiento quirúrgico de la estenosis uretral. Resutado de 100 uretroplastias.

BACKGROUND: We report our results after 100 urethroplasties for the treatment of urethral stricture both at the bulbar and penile urethra, using different techniques. METHODS: 100 patients with the diagnosis of anterior urethral stricture, that were submitted for urethroplasty in the period 1997-2007. Of them, 57 treated by end to end urethroplasty. 4 patients underwent augmented free graft anastomotic urethroplasty. Buccal mucosa free graft was used in 16 patients and penile skin onlay flap in 23. RESULTS: We have obtained 84% good results overall. In patients undergoing end to end urethroplasty we obtained 91.2% success rate. We had 75 % of good results with the free graft anastomosis. In the cases in which we used buccal mucosa patch we obtained 90% success in bulbar urethra and 67 % in penile urethra. When we used onlay flaps good results were 70.6% in penile urethra and 66,7% in bulbar urethra. CONCLUSIONS: Open surgery is the best form of treatment for urethral strictures. The anastomotic urethroplasty is the technique that, applied in bulbar urethra, enables better results. For strictures over two centimeters we have other procedures of choice in penile urethra, pediculated skin flaps, except in cases with Lichen Esclerosus, in which the use of buccal mucosa as a graft is preferable, and in the bulbar urethra in which augmented onlay graft urethroplasty or free grafts, mainly buccal mucosa, are preferred. In long and complex strictures, the option that we must contemplate is two-stage surgery. Any type of urethroplasty can fail, and this risk increases as the time passes.

Tratamiento quirúrgico de la estenosis uretral. Resutado de 100 uretroplastias / Surgical treatment of urethral stenosis. Results of 100 urethroplasties

OBJETIVO: Presentar nuestros resultados tras realizar 100 uretroplastias como tratamiento de estenosis uretral tanto a nivel peneano como bulbar, utilizando distintas técnicas.MÉTODOS: 100 pacientes diagnosticados de estenosis uretral, que fueron sometidos a uretroplastia en el período 1997-2007. De ellos, 57 tratados mediante anastómosis término terminal. 4 pacientes en los que se utilizó una técnica de anastómosis ampliada con un injerto libre. En 16 pacientes se realizó un injerto libre de mucosa bucal y en 23 la técnica usada fue el colgajo pediculado.RESULTADOS: En conjunto hemos obtenido un 84% de buenos resultados en la totalidad de los pacientes. En aquellos a los que realizamos una anástomosis término terminal obtuvimos un 91,2% de buenos resultados. De cuatro pacientes con técnica combinada de anastómosis con injerto libre, tuvimos un 75% de buenos resultados. En los casos en que utilizamos mucosa bucal en forma de parche obtuvimos un 90% en uretra bulbar y un 67% en uretra peneana. Cuando se utilizaron colgajos pediculados los buenos resultados fueron del 70,6% en uretra peneana y del 66,7% en uretra bulbar.CONCLUSIONES: La cirugía abierta es la mejor forma de tratamiento de la estenosis de uretra. La uretroplastia término terminal es la técnica que, aplicada en uretra bulbar, permite obtener mejores resultados. Para estenosis mayores de dos centímetros disponemos de otros procedimientos, siendo de elección, en uretra peneana, los colgajos pediculados, salvo que exista Liquen Escleroatrófico, en que la preferencia seran los injertos libres extragenitales y en uretra bulbar los injertos libres, preferentemente con mucosa bucal. En estenosis largas y complejas la opción que debemos contemplar es la cirugía en dos tiempos. Cualquier tipo de uretroplastia puede recidivar, y ese riesgo aumenta conforme pasa el tiempo(AU)

OBJECTIVES: We report our results after 100 urethroplasties for the treatment of urethral stricture both at the bulbar and penile urethra, using different techniques.METHODS: 100 patients with the diagnosis of anterior urethral stricture, that were submitted for urethroplasty in the period 1997-2007. Of them, 57 treated by end to end urethroplasty. 4 patients underwent augmented free graft anastomotic urethroplasty. Buccal mucosa free graft was used in 16 patients and penile skin onlay flap in 23.RESULTS: We have obtained 84% good results overall.In patients undergoing end to end urethroplasty we obtained 91.2% success rate. We had 75 % of good re-sults with the free graft anastomosis. In the cases in which we used buccal mucosa patch we obtained 90% success in bulbar urethra and 67 % in penile urethra. When we used onlay flaps good results were 70.6% in penile urethra and 66,7 % in bulbar urethra.CONCLUSIONS: Open surgery is the best form of treatment for urethral strictures. The anastomotic urethroplasty is the technique that, applied in bulbar urethra, enables better results. For strictures over two centimeters we have other procedures of choice in penile urethra, pediculated skin flaps, except in cases with Lichen Esclerosus, in which the use of buccal mucosa as a graft is preferable, and in the bulbar urethra in which augmented onlay graft urethroplasty or free grafts, mainly buccal mucosa, are preferred. In long and complex strictures, the option that we must contemplate is two-stage surgery. Any type of urethroplasty can fail, and this risk increases as the time passes(AU)

Divertículo uretral tras uretroplastia de sustitución. A propósito de seis casos / Urethral diverticulum after substitution urethroplasty. Report of six cases

OBJETIVO: Mostrar la patogenia, diag- nóstico y posibilidades de tratamiento de los divertículos uretrales que pueden producirse tras realizar una uretroplastia de sustitución. Comentamos los seis casos que hemos recogido en una serie de 34 pacientes y las técnicas que pueden ser útiles para tratar de evitar esta complicación. MÉTODOS: Sobre un total de 34 uretroplastias, 20 con colgajo pediculado y 14 con injerto de mucosa bucal hemos recogido seis casos de formación de un divertículo o saculación uretral. De ellos cinco han sido intervenidos y en un caso optamos por la abstención dado que no presentaba síntomas. RESULTADOS: Cuatro pacientes permanecen asintomáticos en la actualidad tras el tratamiento. Los dos restantes están pendientes de cierre uretral en un segundo tiempo. CONCLUSIONES: La aparición de pseudodivertículos uretrales tras cirugía de sustitución uretral por estenosis no es una complicación infrecuente. Existen técnicas que buscan reforzar la resistencia de ésta zona de la uretra debilitada y que es importante conocer en la práctica de esta cirugía reconstructiva (AU)

OBJECTIVES: To expose the pathogenesis, diagnosis and therapeutic options for urethral diverti- cula appearing after substitution urethroplasty. METHODS: Over a total of 34 urethroplasties, 20 with pediculated flap and 14 with buccal mucosa, we collected six cases of urethral diverticula/sacculation develop- ment. Five of them underwent surgery, and in one case without symptoms we opted for therapeutic abstention. RESULTS: Currently four patients remain asymptomatic after treatment. The other two are waiting for a second- time urethral closure. CONCLUSIONS: The development of urethral pseudo- diverticula secondary to stenosis after urethral substitution surgery is not an infrequent complication. For the practice of reconstructive surgery it is important to know that there are techniques to reinforce the resistance of this weakened area of the urethra (AU)

[Surgical treatment of urethral stenosis: update]. / Cirugía de la estenosis de uretra. Actualización.

OBJECTIVES: To compile the main methods of surgical treatment of penile and bulbar urethral stenosis. METHODS: We review the most updated bibliography, focusing on authors with large experience in the treatment of urethral stenosis, and we use our own experience to contrast or reaffirm some of the techniques. RESULTS/CONCLUSIONS: The base of the treatment of urethral stenosis remains in the stenosis itself (localization, etiology and length) and also in patient's characteristics (age, past medical history). Among the techniques of urethroplasty we have techniques in one step, as the technique of excision and anastomosis, and the use of free grafts or vascularized flaps. The techniques in two steps like Johannson's or perineostomy are very useful in certain cases of complex stenosis. We should keep an eye on the development of new techniques and the use of new materials that will help, once consolidated, to improve results.

Cirugía de la estenosis de uretra. Actualización / Surgical treatment of urethral stenosis: update

Objetivo: Llevar a cabo una recopilación de los principales métodos de tratamiento quirúrgico de la estenosis de uretra peneana y bulbar. Métodos: Revisamos la bibliografía más actualizada, centrándonos en autores con gran experiencia en el tratamiento de la estenosis uretral, y utilizamos nuestra experiencia para contrastar o reafirmar alguna de las técnicas. Resultados/Conclusiones: La base del tratamiento de la estenosis uretral radica en la propia estenosis, es decir, localización, etiología y longitud, así como en las características del paciente (edad, historia clínica). Entre las uretroplastias disponemos de técnicas en un tiempo, como la excisión y anastomosis, y el uso de injertos libres o colgajos pediculados. Las técnicas en dos tiempos como la de Johanson o la perineostomía son de gran utilidad en determinados casos de estenosis complejas. Debemos permanecer atentos al desarrollo de nuevas técnicas y al empleo de nuevos materiales que ayudaran, una vez consolidados a obtener mejores resultados (AU

Objectives: To compile the main methods of surgical treatment of penile and bulbar urethral stenosis. Methods: We review the most updated bibliography, focusing on authors with large experience in the treatment of urethral stenosis, and we use our own experience to contrast or reaffirm some of the techniques. Results/Conclusions: The base of the treatment of urethral stenosis remains in the stenosis itself (localization, etiology and length) and also in patient’s characteristics (age, past medical history). Among the techniques of urethroplasty we have techniques in one step, as the technique of excision and anastomosis, and the use of free grafts or vascularized flaps. The techniques in two steps like Johannson's or perineostomy are very useful in certain cases of complex stenosis. We should keep an eye on the development of new techniques and the use of new materials that will help, once consolidated, to improve results (AU)

[Urethral diverticulum after substitution urethroplasty. Report of six cases]. / Divertículo uretral tras uretroplastia de sustitución. A propósito de seis casos.

OBJECTIVES: To expose the pathogenesis, diagnosis and therapeutic options for urethral diverticula appearing after substitution urethroplasty. METHODS: Over a total of 34 urethroplasties, 20 with pediculated flap and 14 with buccal mucosa, we collected six cases of urethral diverticula/sacculation development. Five of them underwent surgery, and in one case without symptoms we opted for therapeutic abstention. RESULTS: Currently four patients remain asymptomatic after treatment. The other two are waiting for a second-time urethral closure. CONCLUSIONS: The development of urethral pseudo-diverticula secondary to stenosis after urethral substitution surgery is not an infrequent complication. For the practice of reconstructive surgery it is important to know that there are techniques to reinforce the resistance of this weakened area of the urethra.

[Urachal cyst. Current status]. / Quiste de uraco. Estado actual.

OBJECTIVES: We report one case of urachus diverticulum. It is very rare in adults so that the level of diagnostic suspicion is low. METHODS: 50-year-old male without history of urologic diseases who presented with recurrent urinary tract infections over a two-year period. There were not findings on physical examination. Abdominal ultrasound showed a 3 x 2 cm cystic image with internal echoes on the bladder dome. CT scan confirmed the cystic lesion which thickened the bladder wall at the dome. The patient underwent surgery for the excision of a suspected urachal cyst. RESULTS AND CONCLUSIONS: In order of frequency, the 4 types of urachal congenital abnormalities are: permeable urachus (50%), urachal cyst (30%), urachal sinus (15%), and urachal diverticulum (5%). The indication of surgery comes from the possibility of infection and malignant transformation; the cyst should be excised with a bladder dome cuff due to the risk of existence of urachal remnants at that level and their potential to degenerate to adenocarcinoma.

Quiste de uraco. Estado actual / Urachal cyst. Current status

OBJETIVO: Presentamos un caso de patología uracal, concretamente un quiste. En el adulto es muy poco frecuente presentando por lo tanto un bajo índice de sospecha diagnóstica. MÉTODO: Varón de 50 años sin antecedentes urológicos de interés que consulta por infecciones urinarias recidivantes de unos 2 años de evolución. Exploración física anodina. Ecográficamente se demostró una imagen quística de 3 x 2 cm con ecos internos localizada en cúpula vesical. La TAC confirma la lesión quística que engrosa la pared vesical a nivel de la cúpula. Con sospecha de quiste uracal se procedió a su exéresis. RESULTADOS Y CONCLUSIONES: Los 4 tipos de anormalidades congénitas del uraco son por orden de frecuencia: uraco permeable (50 por ciento), quiste de uraco (30 por ciento), seno uracal (15 por ciento) y divertículo uracal (5 por ciento). La indicación de intervención quirúrgica viene dada por la posibilidad de infección y transformación maligna, debiendo resecarse el quiste acompañado de un rodete de cúpula vesical por el riesgo de existencia de restos uracales a ese nivel y su potencial degenerativo a adenocarcinoma (AU)

Lipomatosis pelviana: aportación de un nuevo caso a la literatura / Pelvic lipomatosis: a case report

OBJETIVO: Presentar un nuevo caso de lipomatosis pelviana, una rara patología con la que puede encontrarse el especialista en urología. MÉTODO/RESULTADOS: Paciente varon de 66 años de edad que consulta por sindrome miccional irritativo y fiebre, es diagnosticado mediante U.I.V. y T.A.C. de lipomatosis pelviana. Permanece en control a través del servicio de consultas externas sin haber presentado complicaciones hasta el momento. CONCLUSIÓN: La lipomatosis pelviana es una enfermedad con una variada expresión clínica y radiológica que precisa un seguimiento para la prevención y tratamiento de sus posibles complicaciones (AU)

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