Hematomas renales tras Litotricia Extracorpórea por Ondas de Choque (LEOCH) / Renal hematomas after extracorporeal shock-wave lithotripsy (ESWL)

Introducción: La introducción de la fragmentación por ondas de choque en el campo de la litiasis urinaria es una de las mayores aportaciones terapéuticas en la historia de la urología. Es el método de elección para el tratamiento de la mayoría de los cálculos de ubicación renal y ureteral, ya que es un método poco invasivo y con bajo número de complicaciones; pero su aplicación no está totalmente exenta de efectos adversos. Produce traumatismo o lesión más o menos importante en los órganos que atraviesan las ondas de choque, incluido el riñón, donde pueden producir desde una pequeña contusión a hematomas renales con diferente resolución y tratamiento. Material y métodos: Realizamos una revisión de 4.815 litotricias que se han realizado en nuestro servicio, exponiendo siete casos en los que se diagnosticó hematomas renales subcapsulares o perirrenales, con su evolución, manejo y tratamiento. Resultados: Después de las complicaciones urológicas (dolor, obstrucción e infección), las colecciones hemáticas renales y perirrenales ocupan el primer lugar en orden de frecuencia en cuanto a efectos adversos de las ondas de choque, relacionándose fundamentalmente con la potencia de energía aplicada y con el incremento de edad del paciente. Conclusiones: Entre los años 1992-2007 se realizaron 4.815 litotricias con un total de 7 casos de hematomas graves, que representan menos del 1%. El manejo suele ser conservador si bien en ocasiones es necesario el drenaje quirúrgico o incluso la nefrectomía (AU)

Introduction: The use of fragmentation due to shock- waves as a treatment of urinary stone was one of the most important therapeutics findings in the history of urology. It´s the first election treatment for most of the calculus at renal and urethral location due to the fact that it is a low invasive treatment and it has a few number of complications, but this method also has a few negative side effects, it can caused a more or less important traumatic lesion at the organs which crosses the shock- waves, including the kidney where it can caused a small contusion or renal hematoma with different resolution and treatment. Material and method: We reviewed 4815 extracorporeal shock-wave lithotripsy that we performed in our department in which we found six cases with subcapsular and perirrenal hematoma which we followed up and treated. Results: After the urological complications (pain, obstruction and infection) the renal and perirrenal hematic collections are the most frequent adverse effects of shock- waves used in lithotripsy, these are related to the power of energy used and patient age. Conclusions: Between the years 1992-2007 we performed 4.815 extracorporeal shock-wave lithotripsy finding seven cases of severe hematoma, less then 1%.Treatment of these complications is usually not aggressive though sometimes it is necessary to perform surgical drainage and even nephrectomy (AU)

[Current status of the diagnosis and treatment of Leydig cell testicular tumor. Report of two cases]. / Estado actual del diagnóstico y tratamiento del tumor testicular de células de Leydig. Aportación de dos casos.

OBJECTIVES: To review the current diagnosis and treatment of Leydig cell testicular tumors, with special attention to conservative treatment. METHODS: We report two cases of Leydig cell tumor in young adults, diagnosed two years after the appearance of bilateral gynecomastia as first clinical symptom. RESULTS: One year and eight months after orchyectomy, respectively, clinical symptoms completely disappear in the first case and significantly improved in the second. CONCLUSIONS: Around 10% of the cases, and only in adult patients, these tumors may be malignant, being radical orchyectomy the treatment of choice, although conservative surgery may be performed. Independently of the operation, follow-up must be prolonged.

Estado actual del diagnóstico y tratamiento del tumor testicular de células de Leydig. Aportación de dos casos / Current status of the diagnosis and treatment of Leydig cell testicular tumor. Report of two cases

Objetivo: Revisar el diagnóstico y tratamiento actual de los tumores testiculares de células de Leydig, poniendo especial atención en el tratamiento conservador. Métodos: Presentamos dos casos de tumor de células de Leydig en adultos jóvenes, diagnosticados dos años después de aparecer ginecomastia bilateral como primera manifestación clínica. Resultados: al año y ocho meses respectivamente de efectuarse la orquiectomía, las manifestaciones clínicas desaparecieron totalmente en el primer caso y mejoraron ostensiblemente en el segundo. Conclusiones: Alrededor del 10% y sólo en adultos, estos tumores pueden ser malignos, siendo el tratamiento de elección la orquiectomía radical, aunque es posible la realización de cirugía conservadora. El seguimiento de estos pacientes, independientemente de la cirugía practicada, debe ser prolongado (AU)

Objectives: To review the current diagnosis and treatment of Leydig cell testicular tumors, with special attention to conservative treatment. Methods: We report two cases of Leydig cell tumor in young adults, diagnosed two years after the appearance of bilateral gynecomastia as first clinical symptom. Results: One year and eight months after orchyectomy, respectively, clinical symptoms completely disappear in the first case and significantly improved in the second. Conclusions: Around 10% of the cases, and only in adult patients, these tumors may be malignant, being radical orchyectomy the treatment of choice, although conservative surgery may be performed. Independently of the operation, follow-up must be prolonged (AU)

Isolated testicular polyarteritis nodosa.

Isolated polyarteritis nodosa is a rare condition that may be triggered by local exposure to certain agents capable of provoking local immunostimulation without a systemic immune reaction. Isolated polyarteritis nodosa in the testes presents similar histologic characteristics as those of systemic inflammation, although infarcted areas in the testis are more common in generalized polyarteritis nodosa. Definitive diagnosis requires histologic study. We present the case of a 26-year-old patient with isolated testicular polyarteritis nodosa whose symptoms consisted predominantly of intense testicular pain and slight enlargement of both testes.

Update on the diagnosis and treatment of bladder endometriosis.

Bladder endometriosis is rare, although the bladder is the urinary tract structure most often affected by this condition. The common clinical manifestations of bladder endometriosis include menouria and urethral and pelvic pain syndrome occurring cyclically. Imaging methods are not conclusive for the definitive diagnosis. Cystoscopy is the most useful diagnostic test with confirmation by histologic study. Treatment must be individualized according to the patient's age, desire for future pregnancies, the severity of the symptoms, the site affected, and whether other organs are involved. Two types of treatment are currently used as follows: medical-hormonal and surgical.