[Risk of tumor seeding after nephroureterectomy combined with endoscopic resection of the ureteral meatus]. / Riesgo de implantación tumoral tras la nefroureterectomía combinada con resección endoscópica del meato ureteral.

OBJECTIVE: To describe a case of tumor implantation at the site of resection in the ureteral orifice, following nephroureterectomy combined with resection of the bladder cuff of. METHODS/RESULTS: A patient with high grade and stage carcinoma of the renal pelvis and no previous bladder tumor presented with a perivesical mass 6 months following nephroureterectomy. She had a high grade transitional cell carcinoma that infiltrated all of the bladder wall, vagina and parametrium in the region of the meatus that had been resected endoscopically. CONCLUSIONS: The present case indicates there may be histological or technique-related factors that facilitate tumor cell implantation in the deep perivesical region after this procedure is performed. It is necessary to identify these factors before this procedure is used widely.

[Epidermoid carcinoma of the penis. Review of 30 cases]. / Carcinoma epidermoide de pene. Revisión de 30 casos.

OBJECTIVE: To review our series of epidermoid carcinoma of the penis. METHODS: 30 cases of epidermoid carcinoma of the penis are reviewed. The clinical features, tumor stage, grade, treatment and outcome are analyzed. RESULTS: The time to diagnosis ranged from one month to 10 years, mean 10.3 months (1 to 36); therefore the mean diameter of the tumors was significantly greater (1.9 cm) at the time of diagnosis than at the beginning of the lesion. Eighteen patients had tumor superinfection. Twenty-four patients (80%) had low grade carcinoma; 6 had verrucous carcinoma, 6 (16.7%) intermediate and one (3.3%) high grade. Total penectomy with perineal meatus was performed in 5 cases, 23 had a partial penectomy with 2 cm margin and circumcision was done in two cases. Patients with positive lymph nodes at exploration after antibiotic treatment (13 cases) were submitted to lymphadenectomy, which was associated with chemotherapy in 4 patients. The surgical complications were mainly lymphorrhea and edema and infection of the surgical incision after lymphadenectomy. Complications at the site of penile resection were unusual. Only 6 patients have more than 5 years' follow-up (7-14), with only 1 local recurrence. The remaining patients have a mean follow-up of 22 +/- 16 months (6-60). Of these, only one patient had died from penile cancer (previously pT2pN0M0). This patient had lymph node and distant metastases 6 months following penectomy due to invasive local recurrence (pT3pN2pM1). Lymph node recurrence has been detected in three other patients. CONCLUSION: Inguinal lymphadenectomy is clearly of therapeutic value in cancer of the penis and performing it early in infiltrating tumors is likely to improve the outcome in these patients.

[Bilateral isolated infiltration in the epididymis and sperm cord as first sign of chronic lymphatic leukemia]. / Infiltración aislada bilateral de epidídimo y cordón espermático como primer signo de leucemia linfática crónica.

OBJECTIVE: Involvement of extralymphatic tissue in chronic lymphocytic leukemia (CLL) is uncommon and that of the epididymis and spermatic cord is rare. This paper describes an unusual case with metastasis to both epididymis and the spermatic cord as the first sign of reactivation of CLL. METHODS/RESULTS: A patient with CLL is described. The first sign of disease progression was the involvement of both epididymis and the spermatic cord. The literature on tumors of the epididymis and spermatic cord and CLL is briefly reviewed. CONCLUSION: Metastatic tumors of the epididymis and spermatic cord are rare. The importance of the pathological findings in making the diagnosis is underscored.

[Renal adenocarcinoma in young patients]. / Adenocarcinoma renal en pacientes jóvenes.

OBJECTIVE: To discover potential differences in known prognostic factors of renal adenocarcinoma in patients under 40 years of age. PATIENTS AND METHODS: A series of 246 patients with renal adenocarcinoma included 17 patients 40 years. Both groups were analyzed for sex, tumour size, histological characteristics and stage, examining the relative proportions within each group and looking for an association between those sets of data and age. RESULTS: No statistically significant associations were found, although it should be noted that in some cases data is incomplete. A larger proportion of low stages at least locally and a greater proportion of granule cell tumours was found in patients 40 years-old compared to those over 40. CONCLUSIONS: Existence of differences in the biological and histological characteristics of renal adenocarcinomas that develop at a younger age is not unlikely. The analysis of each factor and the survival rates in larger series should elucidate these questions, which will also be of interest to improve our understanding of the histogenesis of this type of tumours.

[Squamous cell carcinoma of the prostate. Presentation of a case and review of the literature]. / Carcinoma de próstata de células escamosas. Presentación de un caso y revision de la literatura.

Presentation of one case report of squamous cells prostate carcinoma. This type of prostate tumour accounts for 0.5-1% of all prostate neoplasias and presents clinical and evolutive aspects that are different from those of prostate adenocarcinoma with a poor response to any therapy and a very poor prognosis relative to adenocarcinoma. A literature review is included.

[Polycystic renal dysplasia. Casual diagnosis in adult age]. / Displasia renal multiquística. Diagnóstico casual en la edad adulta.

OBJECTIVE: Multicystic renal dysplasia is the most frequent type of cystic renal disease and also one of the most common causes of abdominal mass in childhood. Herein we describe a case of multicystic renal dysplasia that was incidentally discovered in an asymptomatic adult patient. METHODS/RESULTS: A kidney abnormality was incidentally detected during physical examination in a young woman who had consulted for unspecific digestive symptoms. The findings of the imaging techniques, which were fundamental in making the diagnosis, are presented. The most important congenital and cystic renal abnormalities and their differential diagnosis are reviewed. CONCLUSIONS: The main features of multicystic renal dysplasia and its differential diagnosis are underscored.

[Mucinous adenocarcinoma of the prostate. Report of 3 cases and review of the literature]. / Adenocarcinoma mucinoso de próstata. Presentación de tres casos y revisión de la literatura.

OBJECTIVES: To describe 3 cases of mucinous adenocarcinoma, an uncommon variant of prostatic adenocarcinoma, and review the literature. METHODS: 3 cases of mucinous adenocarcinoma of the prostate are described. The histological and immunohistochemical features, diagnostic and therapeutic aspects of this variant of prostatic adenocarcinoma are presented and the literature briefly reviewed. RESULTS/CONCLUSIONS: This variant of prostatic adenocarcinoma is characterized by the presence of extra and intracellular mucus formation. It is generally seen in the advanced stages and responds poorly to any form of therapy.

[Disk kidney. Report of a case]. / Riñón en disco. Presentación de un caso.

Crossed fused renal ectopia (CFRE) is a rare anomaly, the incidence of which is estimated in one case per 700-1,000 births. We present here one case of Disk Kidney, an uncommon variant of CFRE, diagnosed in a female adult patient. Fused renal congenital anomalies are reviewed and the etiologies and presentation forms commented.

[Retrospective study of the treatment of 329 patients with prostatism syndrome and review of the literature]. / Análisis retrospectivo del tratamiento de 329 pacientes con síndrome de prostatismo y revisión de la bibliografía.

OBJECTIVES: New drugs for the treatment of prostatism have been developed in recent years; only surgery, however, has been demonstrated to achieve cure. Each modality of drug therapy may afford symptomatic relief in those patients in whom surgery is not indicated and a symptom-based stepwise indication could be established. METHODS: 329 patients with prostatism were treated by surgery, administration of finasteride, alphablockers or plant extracts, according to the recommendations of the WHO. Patient evaluation included abdominal US. PSA determination and uroflowmetry. Patients with urodynamic or other derangements were excluded from the study. RESULTS: Patients with a worse quality of life and important obstructive symptoms underwent surgery. Patients with important obstructive symptoms and no complications requiring surgery (infection, urinary retention, etc.) received finasteride, which proved to be effective in these patients, although 16.6% required another type of treatment and two presented impotence. Patients treated with plant extracts had moderate prostatism; 17% of these patients required another type of treatment. Patients treated with alphablockers presented symptoms that were similar to those treated with plant extracts, but they had a more important irritative component; 24% of these patients withdrew from the study due to the side effects or inefficacy of their treatment regimen. CONCLUSIONS: Further studies and a longer follow-up are warranted to determine whether these new drugs can replace or effectively delay (avoiding the appearance of complications) surgery. We believe that the indications for each treatment should be established according to the different stages of prostatism. Moreover, further insight into the pathogenesis of BPH, appropriate diagnostic methods and patient selection are essential to the development of new therapeutical modalities and to achieving enhanced results.

[Malignant bilateral pheochromocytoma and von Recklinghausen disease]. / Feocromocitoma bilateral maligno y enfermedad de Von Recklinghausen.

OBJECTIVES: To review the main features of malignant pheochromocytoma and its relationship to von Recklinghausen's neurofibromatosis. METHODS/RESULTS: We report on a case of malignant bilateral pheochromocytoma with hepatic and pulmonary metastasis, associated with von Recklinghausen's neurofibromatosis. Surgery achieved good results and the patient is well seven years postoperatively. CONCLUSIONS: Approximately 10% of the pheochromocytomas are malignant and treatment is principally by surgery. (131) metaiodobenzylguanidine may be useful in cases with metastasis, residual tumor or local relapse.

[Review of 408 cases of prostatism syndrome. Have the new classifications improved its practical management?]. / Revisión de 408 casos de síndrome de prostatismo. Han mejorado las nuevas clasificaciones su manejo práctico?

To the variety of symptoms known as prostatism, ultrasound, flowmetry, PSA and other complementary testing has been added over the last few years in an attempt to define it better. Also, several score tables such IPSS have been used to grade more objectively each symptom. It remains to be seen, however, whether all this is really useful to define a specific treatment in the clinical practice. To this end, we intend to analyze our own series taking advantage of a table of symptoms routinely used for years, together with the patient's own perception of his quality of life, checking which factors have more influence on the latter. We believe that the use of different overall scores in the usual practice is not effective, although they could be added to the patient's evaluation since they seem a good tool to establish comparisons between different communities.

[Leydig cell tumor in the adult]. / Tumor de células de Leydig del adulto.

Presentation of 3 cases of Leydig's cells tumour in the adult seen in our hospital over the last 10 years. They account for 3% of all testicular tumours, 20 to 25% of them appearing during the pre-puberty period. Although an isolated testicular nodule is the most frequent symptom, gynaecomastia can be found in about 30% of adult patients, as it happened in 2 of our patients. Even though no malignant case has been described in children, up to 10% of cases in adults have metastasis, this being the only demonstration of malignant behaviour in these tumours, so radical orchiectomy is the choice therapy. Certain histological and hormonal parameters may be suggestive of the aggressive behaviour of this neoplasia which, however, we have not found in our series of all whom presented a good evolution after surgery. The most common diagnostic and therapeutic approaches, based on the different characteristic of the tumour, are reviewed.

[Epididymal leiomyoma. Report of 2 cases]. / Leiomioma de epidídimo. Presentación de dos casos.

At present, the paratesticular tumors are not frequent, but when they appear, the most common location is on spermatic cord and epididymis. Within the epididymal tumors the most frequent (75%) are benign tumors, been the second one the leiomyoma after the adenomatoid tumor. We want to show two clinical cases about epididymal leiomyoma in patients who had different ages. We achieve the definitive diagnostic after the tumor removed by histological analysis. We also checked the medical literature.

[Long-term results of endoscopic urethrotomy]. / Resultados a largo plazo de la uretrotomía endoscópica.

OBJECTIVES: To analyze the long-term results of treatment of urethral strictures by internal endoscopic urethrotomy, a simple, easily reproducible procedure that carries a low morbidity and requires a short period of convalescence. MATERIAL AND METHODS: We report our experience of 78 cases submitted to urethrotomy as primary treatment. The results at 19.7 months mean follow-up (range 6 months--5 years) are presented. A maximum of three Sachse procedures were performed if stricture recurred. RESULTS: The complications were rare. Although the results were poor in only 21% of the patients 6 months postoperatively, 46% had recurrent strictures. Moreover, nearly 50% of these strictures recurred after a second or third urethrotomy. CONCLUSIONS: The nature of the stricture, determined by spongiofibrosis, is the main prognostic factor. Internal urethrotomy is indicated in urethral strictures without exorbitant spongiofibrosis, otherwise stricture will recur after internal urethrotomy and other treatment modalities will be required.

[Our experience with renal adenocarcinoma (III): results of surgical treatment, other treatments. Survival analysis]. / Nuestra experiencia en adenocarcinomas renales (III): Resultados del tratamiento quirúrgico, otros tratamientos. Análisis de la supervivencia.

OBJECTIVES: Evaluation of survival and results of treatment of renal cell carcinoma. METHODS: We reviewed the records of 229 consecutive cases of renal cell carcinoma diagnosed at our hospital. In 178 surgical treatment was done to achieve cure and in 6 patients it was palliative. RESULTS: No statistical differences in survival were found according to the surgical approach, or extensive vs hilar lymphadenectomy, or in the presence or absence of venous involvement. There were statistical differences in survival depending on the tumor stage and an inverse correlation between survival and tumor size. Sixty-nine cases received complementary treatments. Radiotherapy, alpha 2b interferon and vinblastine, resection of metastasis, or gestagen therapy failed to improve survival. No improvement in survival was achieved with palliative embolization, but it ameliorated local symptoms. The mean survival in patients with metastasis and without treatment was 5.5 months and there was no statistical difference in survival relative to the number of site of metastasis, or the number of affected viscera. The mean survival in patients that were not operated and had no metastasis was greater: 23.5 months. CONCLUSIONS: Surgery, regardless of the surgical approach or type of lymphadenectomy, is the only treatment that improves survival in renal cell carcinoma. Patients with metastasis receiving no treatment have a worse prognosis.

[Renal leiomyoma. Report of a new case]. / Leiomioma renal. Aportación de un nuevo caso.

Though renal leiomyoma is an unusual tumour, symptomatic tumours are even more uncommon. They often raise problems with differential diagnosis from malignant tumours which not even the most advanced imaging techniques manage to elucidate. On the other hand, their sarcomatous degeneration has been described. Considering these premises, doubts arise on their therapeutical approach, on which we here present our own views.