[Transurethral enucleation prostate with plasmakinetic energy. A new technique of enucleation].

OBJECTIVES: We present a new technique of transurethral prostatic enucleation. METHODS. We use an Olympus resectoscope with two electrodes; one has a button or "mushroom" shape to vaporize and enucleate, and the other one the shape of a conventional "cutting loop electrode"to resect. With the button-shaped electrode, we vaporize transversally at the level of the veru montanum, extending the dissection towards the lateroapical lobes, looking for the capsular plane. Once it is found, we ascend vaporizing up to the 3 and 9 in the clock following the capsular plane. Subsequently, we vaporize longitudinally the anterior commissure and keep going down to join the previously vaporizatized area. Then enucleation is achieved by pushing the adenoma with the button-shaped electrode, from distal to proximal, at the capsular plane level. Before the enucleated lobe falls inside the bladder, we can proceed, with the help of the conventional cutting loop electrode, to its resection, which is very fast and bloodless. If there is middle lobe, enucleation is initiated with it, performing two lateral grooves lengthways down to the veru montanum. RESULTS. We have carried out 45 procedures since October 2011, with excellent functional results. Prostate volumes range between 40-120 gr, with an operating time of 30-90 minutes. Hospital stay was 24-48 h. and the catheter is removed in 4-5 days. Blood transfusions were not needed in any case, and we have not recorded complications within this first year of follow-up. CONCLUSIONS. This technique makes possible the enucleation of the adenoma with a good haemostasis control. It also provides a good visualization of the capsular plane. Vaporization of the prostatic tissue is similar to the use of other energy forces. We don't need to use a "morcellator" to extract the enucleated prostatic tissue. It is an economical and easily reproducible procedure, with a short learning curve.

Enucleación trasnuretral prostática con energia plasmaquinética. Una nueva técnica de enucleación / Transurethral enucleation prostate with plasmakinetic energy. A new technique of enucleation

OBJETIVO: Presentamos una nueva técnica de enucleación transuretral prostática. MÉTODO: Empleamos un resector de Olympus que dispone de dos terminales, uno en forma de botón o “seta” para vaporizar y enuclear y otro en forma de “asa” convencional para resecar. Con el terminal en forma de botón, se vaporiza transversalmente a nivel del veru montanum, prolongando la misma hacia los lóbulos lateroapicales, buscando el plano capsular. Una vez localizado se asciende vaporizando hasta las 3 y 9 horarias por el plano capsular. Posteriormente, en sentido longitudinal se vaporiza la comisura anterior prostática y se va descendiendo hasta encontrarse con las áreas previamente vaporizadas. Después se enuclea empujando el adenoma con el terminal en forma de botón, de distal a proximal a nivel del plano capsular. Antes de que caiga el lóbulo enucleado al interior de la vejiga, se procede a su resección con el asa convencional, siendo esta muy rápida y exangüe. Si existe lóbulo medio, se inicia la enucleación por éste, realizando dos surcos laterales al mismo y en sentido longitudinal hasta unirlo con el veru montanum. RESULTADO: Llevamos realizados 45 procedimientos desde octubre de 2011 con unos excelentes resultados funcionales. Los volúmenes prostáticos oscilan entre 40-120 gr, con un tiempo operatorio de 30-90 minutos. La estancia hospitalaria fue de 24- 48h. y la sonda se retira al 4-5º día. No se ha precisado transfusión sanguínea en ningún caso y durante este primer año de seguimiento no hemos objetivado complicaciones. CONCLUSIONES: Ésta técnica consigue enuclear el adenoma con un buen control de la hemostasia. Buena visualización del plano capsular. La vaporización del tejido prostático es similar a otras fuentes de energía. No es preciso el empleo de un morcelador para la extracción del tejido prostático enucleado. Es un procedimiento económico con una corta curva de aprendizaje y fácilmente reproducible(AU)

OBJECTIVES: We present a new technique of transurethral prostatic enucleation. METHODS. We use an Olympus resectoscope with two electrodes; one has a button or “mushroom” shape to vaporize and enucleate, and the other one the shape of a conventional “cutting loop electrode” to resect With the button-shaped electrode, we vaporize transversally at the level of the veru montanum, extending the dissection towards the lateroapical lobes, looking for the capsular plane. Once it is found, we ascend vaporizing up to the 3 and 9 in the clock following the capsular plane. Subsequently, we vaporize longitudinally the anterior commissure and keep going down to join the previously vaporizatized area. Then enucleation is achieved by pushing the adenoma with the button-shaped electrode, from distal to proximal, at the capsular plane level. Before the enucleated lobe falls inside the bladder, we can proceed, with the help of the conventional cutting loop electrode, to its resection, which is very fast and bloodless. If there is middle lobe, enucleation is initiated with it, performing two lateral grooves lengthways down to the veru montanum. RESULTS. We have carried out 45 procedures since October 2011, with excellent functional results. Prostate volumes range between 40-120 gr, with an operating time of 30-90 minutes. Hospital stay was 24-48 h. and the catheter is removed in 4-5 days. Blood transfusions were not needed in any case, and we have not recorded complications within this first year of follow-up. CONCLUSIONS. This technique makes possible the enucleation of the adenoma with a good haemostasis control. It also provides a good visualization of the capsular plane. Vaporization of the prostatic tissue is similar to the use of other energy forces. We don´t need to use a “morcellator” to extract the enucleated prostatic tissue. It is an economical and easily reproducible procedure, with a short learning curve(AU)

Fístula arteriovenosa renal congénita / Arteriovenous renal congenital fístula

Presentamos el caso de una mujer joven que acudió a urgencias con un cuadro de hematuria macroscópica anemizante. A su vez confirmamos que ante la sospecha de encontrarnos ante una fístula arteriovenosa, la arteriografía es la prueba diagnóstica de elección y la embolización selectiva, la mejor opción terapéutica (AU)

We present the case of a young woman who went to the Emergency Departent with macroscopic and anaemic haematuria. We also confirm that, when faced with the possibility of finding an arteriovenous fistula, arteriography is the best choice for diagnosis, and the best option for treatment is selective embolization (AU)

[Testicular germ cell tumours: descriptive study of 13 years of experience in the health care area of Badajoz]. / Estudio descriptivo de los tumores testiculares germinales: 13 años de experiencia en el area de salud de Badajoz.

OBJECTIVES: To describe the incidence of germ cell testicular tumors in our Center, their characteristics and therapy results. METHODS: Retrospective study of 66 cases of germ cell testicular tumors diagnosed in the Health Area of Badajoz between 1993 and 2005. RESULTS: Mean age of the time of diagnosis was 32 years (range 16-80 years), presenting a younger age patients with non seminomatous germ cell tumors (NSGCT) (mean age 30 years). 86.5% of the patients did not have risk factors associated with the diagnosis of germ cell testicular tumor. Testicular mass was the most frequent symptom, and a higher proportion of tumors were located in the left testicle (51.5%). Non seminomatous germ cell tumors were the most frequent histological type (64.8%). Stage I (72%) was the most frequent stage in the group of seminomatous tumors, in comparison with 68.5% of non seminomatous tumors. Stages II-III appeared in 34.4% of the NSGCT and 28% of seminomatous, having worse prognosis. 92% of the patients received adjuvant treatment with chemotherapy and/or radiotherapy, and curative surgery was the only treatment in the remainder 8%. Residual mass surgery was undertaken in five patients (stages IIa, IIc and IIIa). Eight of the 66 cases were lost for follow-up. Fifty-three of the 58 patients with follow-up are disease-free, 18 of them with more than five years of follow-up. CONCLUSIONS: An increased incidence of germ cell testicular tumors have been verified over last years, mainly NSGCT Nevertheless, the diagnosis of advanced stages of the disease has diminished in favour of initial stages, which have a better prognosis for the patient. Oncologycal treatment protocols have high cure rates, although a long-term follow-up is needed due to the natural history of these tumors.

[Non venereal sclerosing lymphangitis of the penis. Case report]. / Linfangitis esclerosante no venerea del pene. Presentacion de caso clinico.

OBJECTIVE: We report a clinical case with a diagnosis of nonvenereal sclerosing lymphangitis of the penis and revision of the literature existing on this pathology. CLINICAL CASE: We describe the case of a 28 years old man who has presented for 10 days an induration of cartilaginous consistence next to the sulcus coronarius penis and symptomatic during the erections, compatible with the diagnosis of sclerosing lymphangitis. RESULTS: Sexual abstinence was recommended and we kept an expectating attitude so ceasing the process after 4 weeks. CONCLUSIONS: Nonveneral sclerosing lymphangitis of the penis is a process of unknown etiology, related to an increase of sexual activity, which is during the erection and it has a self-limited character, so the initial treatment is conservative.

Estudio descriptivo de los tumores testiculares germinales: 13 años de experiencia en el área de salud de Badajoz / Testicular germ cell tumours: descriptive study of 13 years of experience in the health care area of Badajoz

Objetivo: Descripción de la incidencia, las características tumorales y los resultados de la terapéutica aplicada en los tumores germinales testiculares diagnosticados en nuestro Centro. Método: Estudio retrospectivo de los 66 casos de tumores germinales diagnosticados en el Área de Salud de Badajoz en el período comprendido entre 1993 y 2005. Resultados: La edad media del diagnóstico de los tumores germinales de testículo (TGT) fue de 32 años (rango 16-80 años), presentando una edad más precoz los pacientes con tumores no seminomatosos (TGNS), media de 30 años. En un 86.5% de los paciente no se encontraron factores de riesgo relacionados con el diagnóstico de TGT. El hallazgo de una masa escrotal fue el síntoma mas frecuente y el tumor se localizó en mayor proporción en el testículo izquierdo (51.5%). Los tumores germinales no seminomatosos fueron la histopatología más común (64.8%). En el grupo de los tumores seminomatosos (TGTS), el estadio I (72%) fué el más diagnosticado frente al 68.5% de los no seminomatosos. Los estadios II-III se dieron en el 34.4% de los TGNS y 28% de los seminomas, conllevando peor pronóstico. El 92% de los pacientes recibió tratamiento adyuvante con quimioterapia y/o radioterapia, y se realizó cirugía curativa como único tratamiento en el 8% restante de los pacientes. Se practicó cirugía de masas residuales en 5 pacientes (estadios IIb, IIc y IIIa). Ocho de los 66 casos se han perdido en el seguimiento. De los 58 pacientes restantes, donde fue posible el control de la evolución, 53 pacientes están libre de enfermedad,18 de ellos con más de 5 años de seguimiento. Conclusiones: En los últimos años se verifica un aumento de la incidencia de TGT, sobre todo a expensa de los TGNS. Sin embargo, ha disminuido el diagnóstico en fase avanzada de la enfermedad en favor de estadios iniciales que confieren un mejor pronóstico para el paciente. Los protocolos de tratamiento oncológicos utilizados proporcionan una alta tasa de curabilidad, aunque debido a la historia natural de tumor, es necesario un seguimiento a largo plazo (AU)

Objectives: To describe the incidence of germ cell testicular tumors in our Center, their characteristics and therapy results. Methods: Retrospective study of 66 cases of germ cell testicular tumors diagnosed in the Health Area of Badajoz between 1993 and 2005. Results: Mean age of the time of diagnosis was 32 years (range 16-80 years), presenting a younger age patients with non seminomatous germ cell tumors (NSGCT) (mean age 30 years). 86.5% of the patients did not have risk factors associated with the diagnosis of germ cell testicular tumor. Testicular mass was the most frequent symptom, and a higher proportion of tumors were located in the left testicle (51.5%). Non seminomatous germ cell tumors were the most frequent histological type (64.8%). Stage I (72%) was the most frequent stage in the group of seminomatous tumors, in comparison with 68.5% of non seminomatous tumors. Stages II-III appeared in 34.4% of the NSGCT and 28% of seminomatous, having worse prognosis. 92% of the patients received adjuvant treatment with chemotherapy and/or radiotherapy, and curative surgery was the only treatment in the remainder 8%. Residual mass surgery was undertaken in five patients (stages IIa, IIc and IIIa). Eight of the 66 cases were lost for follow-up. Fifty-three of the 58 patients with follow-up are disease-free, 18 of them with more than five years of follow-up. Conclusions: An increased incidence of germ cell testicular tumors have been verified over last years, mainly NSGCT. Nevertheless, the diagnosis of advanced stages of the disease has diminished in favour of initial stages, which have a better prognosis for the patient. Oncologycal treatment protocols have high cure rates, although a long-term follow-up is needed due to the natural history of these tumors (AU)

[Follicular cystitis. Case report and bibliographic review]. / Cistitis folicular. Aportación de un caso y revisión de la uteratura.

OBJECTIVE: To report one case of chronic follicular cystitis and to perform a bibliographic review on this pathology. CASE REPORT: We report a case of a 70-year-old woman with an irritative voiding syndrome over an eight-month period, with several previous episodes of urinary tract infection treated by her family doctor. Bullous lesions were found in the bladder mucosa on cystoscopy. Histological tests showed lymphoid follicles at the level of the bladder mucosa, leading to the diagnosis of follicular cystitis. RESULTS: Medical treatment was carried out with ciprofloxacin, vitamin A, and prednisone, which led to symptom remission. CONCLUSIONS: Follicular cystitis is an entity that belongs to the group of chronic cystopathies; it is a non-specific chronic inflammatory disease characterized by the presence of large number of plasmatic cells and lymphocytes in lymphoid follicles within the bladder mucosa and submucosa; pathologic study is necessary for the final diagnosis of this entity.

Linfangitis esclerosante no venerea del pene. Presentacion de caso clinico / Non venereal sclerosing lymphangitis of the penis. Case report

Objetivo: Aportar un caso clínico con diagnóstico de linfangitis esclerosante de pene y revisión de la literatura existente sobre esta patología. Método: Describimos el caso de un varón de 28 años, que presentaba desde hacía 10 días induración próxima a nivel del surco balanoprepucial de consistencia cartilaginosa y sintomático durante las erecciones, compatible con diagnóstico de linfangitis esclerosante. Resultados: Se recomendó abstinencia sexual y se mantuvo una actitud expectante, remitiendo el proceso a las 4 semanas. Conclusiones: La linfangitis esclerosante no venérea de pene es un proceso de etiología desconocida, al cual se relaciona con aumento de la actividad sexual y que se presenta como un cordón subcutáneo indurado que causa molestias o dolor durante la erección y que suele ser de carácter autorresolutivo, por lo que no suele ser necesario el tratamiento con fármacos (AU)

Objective: We report a clinical case with a diagnosis of nonvenereal sclerosing lymphangitis of the penis and revision of the literature existing on this pathology. Clinical case: We describe the case of a 28 years old man who has presented for 10 days an induration of cartilaginous consistence next to the sulcus coronarius penis and symptomatic during the erections, compatible with the diagnosis of sclerosing lymphangitis. Results: Sexual abstinence was recommended and we kept an expectating attitude so ceasing the process after 4 weeks. Conclusions: Nonveneral sclerosing lymphangitis of the penis is a process of unknown etiology, related to an increase of sexual activity, wich is during the erection and it has a self-limited character, so the initial treatment is conservative (AU)

Cistitis folicular. Aportación de un caso y revisión de la literatura / Follicular cystitis. Case report and bibliographic review

OBJETIVOS: Aportar un caso clínico con diagnóstico de cistitis crónica folicular y revisión de la literatura existente sobre esta patología. METODOS: Describimos el caso de una mujer de 70 años con síndrome miccional irritativo de 8 meses de evolución, con varios episodios previos de infección urinaria tratados por su médico de cabecera y en cuyo estudio se descubrió lesiones bullosas vesicales durante la cistoscopia; el estudio histológico demostró folículos linfoides a nivel de la mucosa vesical, permitiendo el diagnóstico de cistitis folicular. RESULTADOS: Se inicio tratamiento médico con ciprofloxacino, vitamina A y prednisona remitiendo la sintomatología. CONCLUSIONES: La cistitis folicular es una entidad que pertenece al grupo de las cistopatías crónicas, al tratarse de un proceso inflamatorio inespecífico crónico que se caracteriza por presentar a nivel de mucosa y submucosa células plasmáticas y linfocitos constituyendo folículos linfoides, siendo imprescindible el estudio histológico para diagnosticar esta patología (AU)

OBJECTIVE: To report one case of chronic follicular cystitis and to perform a bibliographic review on this pathology. CASE REPORT: We report a case of a 70-year-old woman with an irritative voiding syndrome over an eight-month period, with several previous episodes of urinary tract infection treated by her family doctor. Bullous lesions were found in the bladder mucosa on cystoscopy. Histological tests showed lymphoid follicles at the level of the bladder mucosa, leading to the diagnosis of follicular cystitis. RESULTS: Medical treatment was carried out with ciprofloxacin, vitamin A, and prednisone, which led to symptom remission. CONCLUSIONS: Follicular cystitis is an entity that belongs to the group of chronic cystopathies; it is a non-specific chronic inflammatory disease characterized by the presence of large number of plasmatic cells and lymphocytes in lymphoid follicles within the bladder mucosa and submucosa; pathologic study is necessary for the final diagnosis of this entity