Corrección de curvatura peneana utilizando la técnica de "Plicatura de 16 puntos" / Corrrection of penile curvature using the 16-Dot plication technique

En 1965 Nesbit describió por primera vez la corrección quirúrgica de la curvatura de pene siendo posteriormente modificadapor múltiples autores. Presentamos dos pacientes con incurvación peneana corregida mediante la técnica de "plicatura de 16 puntos" (AU)

In 1965 Nesbit first described the surgical correction of penile curvature that was later modified by many authors. We present two patients with penile curvature corrected using the 16-dot plication technique (AU)

[Bladder carcinoma with osteoclast-type giant cells. A case with a rare presentation. Review of the literature]. / Carcinoma con células gigantes tipo osteoclasto de vejiga. Un caso de rara presentación. Revisión de la literatura.

We report a case of neoplasm of the urinary bladder with pseudosarcomatous stromal differentiation. Heterologous carcinosarcomas are extremely rare malignant neoplasms (seventy-eight cases have been previously described). This is a case of carcinoma containing numerous osteoclast type giant cells that stained for vinmentin and acid phosphatase and were negative for cytokeratin and lysozyme.

Carcinoma con células gigantes tipo osteoclasto de vejiga. Un caso de rara presentación. Revisión de la literatura / Giant osteoclast type cell carcinoma of the urinary bladder. A case with unusual presentation. Review of the literature

Presentamos un caso de tumor vesical con diferenciación pseudosarcomatosa del estroma.Son extremadamente raros (sólo se había descrito 78 casos en el mundo hasta el año 2001).También son llamados carcinosarcomas heterólogos, dentro de los cuales se encuentran los llamados carcinosarcomas con células gigantes tipo osteoclasto, que se caracterizan por ser positivos para vimentina y fosfatasa ácida y negativos para marcadores epiteliales (citoqueratinas de bajo peso y lisozima) (AU)

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[Hemorrhagic cystitis caused by BK and JC polyomavirus in patients treated with bone marrow transplantation: clinical features and urologic management]. / Cistitis hemorrágica por poliomavirus BK y JC en pacientes sometidos a transplante de médula ósea: aspectos clínicos y manejo urológico.

INTRODUCTION: Differential diagnosis of hematuria after bone marrow transplantation (B.M.T.) may include polyomavirus (BK and JC)-associated haemorrhagic cystitis. Many reports have implied BK virus as the major pathogen in the development of hemorrhagic cystitis after BMT. BK viruria is also associated with ureteric stenosis in renal allografts recipients. Viral urinary tract infections are uncommon in healthy individuals, but we can find them frequently in patients under immunosuppressive conditions. MATERIAL AND METHODS: Retrospective study of 123 consecutive B.M.T. recipients in the period from 1995 to 2000, evaluating those with polyomavirus-associated hemorrhagic cystitis. We present patient's characteristics, primary disease, clinical features, diagnosis aspects and treatment of these "hidden hosts of urinary tract". RESULTS: 7 patients (5.7% of B.M.T.) developed BK or JC virus-associated hemorrhagic cystitis; 3 men and 4 women; median patient age was 29 years (range 14 to 45 years). Bacterial, mycobacterial and parasitic urine cultivates had negative results in all of them. The clinical course was characterized by a late onset of haemorrhagic cystitis (days +30 to +132 after BMT). All 7 patients developed macroscopic haematuria (duration 3 to 30 days). In 6 cases Graft Versus Host Disease (G.V.H.D.) criteria were found. Ultrasonographic studies revealed diffuse thickening of bladder wall in 5 patients. Hematuria was managed by hyperhydratation, blood transfusions, transurethral catheter and evacuation of blood clots, continuous bladder irrigation, urine alkalinization and antiviral therapy. No other more aggressive measures were required to stop the bleeding. Only 1 case of transient elevated creatinine. CONCLUSIONS: Polyomavirus-associated haemorrhagic cystitis must be considered in differential diagnosis of hematuria in bone marrow transplantation recipients. Urological management, according with the severity and duration of hematuria, is frequently required.

Cistitis hemorrágica por poliomavirus BK y JC en pacientes sometidos a trasplante de medula osea: aspectos clínicos y manejo urológico / Polyomavirus BK and JC associated haemorrhagic cystitis in patients under bone marrow transplantation clinical features and urological management

INTRODUCCION: Dentro del diagnóstico diferencial de la hematuria en pacientes receptores de un trasplante de médula ósea (T.M.O.) debemos considerar la cistitis hemorrágica por poliomavirus BK y JC. Algunos han implicado al virus BK como el principal agente en su desarrollo. La viruria por BK también se ha asociado a estenosis ureteral en pacientes sometidos a trasplante renal. Las infecciones urinarias virales, excepcionales cuando existe indemnidad del sistema inmune, pueden aparecer con frecuencia en situaciones de inmunocompromiso.MATERIAL Y MÉTODOS: Estudio retrospectivo de 123 pacientes consecutivos sometidos a trasplante de médula ósea (1995-2000). analizando los casos en que se presentó cistitis hemorrágica con aislamiento de poliomavirus BK y JC en orina. Se estudian: características poblacionales, enfermedad de base, manifestaciones clínicas y radiológicas, métodos diagnósticos y medidas terapéuticas. Realizamos una revisión de los principales aspectos de estos "desconocidos huéspedes del aparato urinario".RESULTADOS: Se presentó cistitis hemorrágica asociada a poliomavirus en 7 casos (5,7 por ciento de los TMO), 6 por BK y 1 por JC. Corresponden <: a 3 varones y 4 mujeres, con una edad media de 29 años (14-45). Todos los pacientes con urocultivos bacteriológicos, micóticos y parasitológicos negativos. Presentación clínica como hematuria macroscópica en todos los casos (aparición entre los días +30 y+132 post-trasplante), cuya duración osciló entre 3 y 30 días. En 6 casos existían criterios de Enfermedad de Injerto Contra Huésped. Eeográficamente, en 5 pacientes se evidenció un engrosamiento difuso de la pared vesical. En todos se instauró tratamiento mediante hiperhidratación, sondaje vesical y extracción de coágulos, lavado endovesical continuo, alcalinización urinaria y antivirales sistémicos. No fueron necesarias actuaciones " más agresivas. Como complicación, un caso de insuficiencia renal leve, reversible.COMENTARIOS: La cistitis hemorrágica por poliomavirus es una entidad que considerar en pacientes que han recibido un T.M. O., debiendo realizar diagnóstico diferencial ante toda hematuria que se presente en estos casos. Es necesario un adecuado manejo urológico de la hematuria, que puede llegar a comprometer la vida del paciente. (AU)

[Primary vaginal lithiasis associated with urethrovaginal fistula. Report of a case and review of the literature]. / Litiasis vaginal primaria asociada a fístula uretrovaginal. Presentación de un caso y revisión de la literatura.

Vaginal stones are rare. We can classify them as primary or secondary, depending on the presence or the absencse of a foreign body nidus. Various cases can led to stone formation. Most of them developed in women with a vesicovaginal or urethrovaginal fistula, as well as in patients with congenital anomalies of the genitourinary tract, previous pelvic radiotherapy, neuropathic bladder and other different causes of vaginal outlet obstruction. Secondary vaginal stones, formed around foreign bodies, are not so frequent. Radiological examination and urethro-vaginoscopy make easy the right diagnosis. Sometimes the stone may be fragmented by lithotripsy before the extraction. The associated etiology should be treated concomitantly in order to prevent recurrence. We report a case of primary vaginal stone associated with an urethrovaginal fistula in a 25 years old women and a review of the related literature.

Litiasis vaginal primaria asociada a fístula uretrovaginal. Presentación de un caso y revisión de la literatura / Primary vaginal stones associated to a urethrovaginal fistula. A case presentation and bibliography review

Las litiasis vaginales son poco frecuentes. Se clasifican en primarias o secundarias, en función de la existencia o no de un cuerpo extraño que haya actuado como matriz para la formación del cálculo. Además, varias condiciones pueden contribuir a su desarrollo. La mayoría de los casos están asociados a fístulas vésico-vaginales o uretrovaginales, apareciendo también en casos de malformaciones congénitas genitourinarias, vejigas neurógenas, radioterapia pélvica u otras etiologías que condicionen obstrucción a nivel vulvovaginal. Las debidas a la presencia de un cuerpo extraño son menos frecuentes. Los exámenes radiológicos y la uretrovaginoscopia permiten establecer el diagnóstico. Para su extracción puede ser necesaria la litofragmentación previa. Es necesario corregir al mismo tiempo la etiología subyacente para prevenir las recurrencias. Presentamos un caso de litiasis vaginal asociada a fístula uretrovaginal en una joven de 25 años, y realizamos una revisión de los aspectos más importantes existentes en la literatura (AU)

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[Juvenile gangrenous vasculitis of the scrotum. Report of a new case and review of the literature]. / Vasculitis gangrenosa juvenil del escroto. Aportación de un nuevo caso y revisión de la literatura.

Juvenile gangrenous vasculitis of the scrotum is a peculiar form of scrotal gangrene of undetermined etiology, with clinical and pathological features of its own, described in 1973 by Piñol et al. We report a new case, considering this entity as part of the differential diagnosis of scrotal gangrene, and a review of relative literature.

Vasculitis gangrenosa juvenil del escroto. Aportación de un nuevo caso y revisión de la literatura / Juvenile gangrenous vasculitis of the scrotum. Contribution with a new case and a revision of the literature

La vasculitis juvenil del escroto es una forma peculiar de gangrena escrotal de etiología desconocida y características clínicas y patológicas propias, descrita en 1973 por Piñol y colaboradores. Presentamos un nuevo caso de esta entidad, dentro del diagnóstico diferencial de las gangrenas escrotales y revisamos la literatura existente al respecto (AU)

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[Prostatic mucinous adenocarcinoma. Report of a new case and review of the literature]. / Adenocarcinoma mucinoso de próstata. Presentación de un nuevo caso y revisión de la literatura.

OBJECTIVE: To present an additional case of mucinous adenocarcinoma of the prostate gland. The histochemical and immunohistochemical findings demonstrating its prostatic origin are presented and the literature is reviewed. METHODS/RESULTS: A 53-year-old male with no previous symptoms or signs presented for a prostatic examination. DRE was normal and PSA was 35 ng/ml. A prostate biopsy demonstrated adenocarcinoma of the prostate with a Gleason score of 3 + 3. Complementary studies were negative. The patient was submitted to radical prostatectomy. Anatomopathological analysis of the surgical specimen demonstrated a prostatic mucinous adenocarcinoma. At one-year follow-up, the patient is alive and disease-free and PSA values have returned to normal. CONCLUSIONS: Mucinous adenocarcinoma of the prostate is a rare anatomopathological variant whose natural history and prognosis are not well-known. This tumor type generally does not respond to any treatment and is hormone-resistant.

[Synchronous tumor of the upper urinary tract with bladder cancer. Opportunity for nephroureterectomy and block-cystectomy]. / Tumor sincrónico de vías altas con cáncer vesical. Oportunidad de nefroureterectomía y cistectomía en bloque.

OBJECTIVE: One of the basic characteristics of urothelial carcinoma is its tendency to synchronous or metachronous multifocality. Thus the need to explore the entire urinary tract of patients with urothelial neoformations. The aim of this article is to study the tumors of the upper urinary tract that appear synchronously with infiltrating carcinoma of the bladder. The clinicopathological characteristics and the morbidity and mortality of en bloc surgery of both tumors are analyzed. METHODS: A retrospective study was carried out on 170 radical cystectomies for infiltrating bladder tumor performed in our department over a 13-year period. Patient history, clinicopathological characteristics, complementary tests, type of surgery performed, postoperative complications and follow-up were analyzed. RESULTS: Tumor of the upper urinary tract appeared in 14 (1 bilateral) of these patients and were synchronous in 10 cases. All patients were male; mean age 63 years. Three were localized in the pelvis, 2 in the proximal ureter and 6 in the distal third. Diagnosis was made by IVP in 6 patients and by US and antegrade pyelography in the other 4 patients. Nephroureterectomy and radical cystectomy were performed en bloc in 8 cases; 6 had a Bricker procedure and 2 ileal substitution. Salvage radical cystectomy + distal ureterectomy were performed in the other two patients. Two patients submitted to en bloc surgery had postoperative complications; one presented prolonged ileua and the other required surgery for retroperitoneal hemorrhage. The two patients submitted to palliative surgery died of and sepsis during the postoperative period. At 33 months' mean follow-up, 3 patients have shown tumor progression. CONCLUSIONS: There is a high proportion of synchronous tumor of the upper urinary tract in our series of patients with infiltrating carcinoma of the bladder undergoing radical cystectomy, therefore we consider it necessary to explore the entire urinary system. Surgical removal of both tumors en bloc does not increase the morbidity and mortality.

[Metastasis priapism. Report of 4 new cases and review of the literature]. / Priapismo metastásico. Presentación de cuatro nuevos casos y revisión de la literatura.

OBJECTIVE: Four additional cases of malignant priapism or priapism secondary to penile metastasis from urogenital tumors are presented and the literature is reviewed. METHODS: Chest and abdominal radiological evaluation, cavernosal and abdominal US, abdominal and pelvic CT and MRI, and cavernosal biopsy were performed for the localization and staging of the primary tumor. RESULTS: Conservative palliative management achieved a survival of only a few months in three of the patients with tumor dissemination to adjacent vital organs. Radical surgery was performed in one patient with tumor localized to the genital area. Currently, this patient has no clinical symptoms, although the follow-up is only 4 months. CONCLUSIONS: Malignant priapism is rare and usually secondary to GU tumors. The prognosis is poor since it generally indicates the presence of multiorgan metastasis. However, the prognosis is better for single metastasis, which is an indication for radical surgery.

[Cystic pyeloureteritis and infection. Presentation forms and review of the literature]. / Pieloureteritis quística e infección. Formas de presentación y revisión de la literatura.

OBJECTIVE: To present three illustrative cases of pyeloureteritis cystica and review the literature. METHODS: Three illustrative cases diagnosed at our department are described. Patient history, clinical features, diagnostic procedures and treatment are analyzed and the literature is reviewed. RESULTS: Our patients had no specific symptoms. All three patients had urinary tract infection with pyeloureteral involvement, which was bilateral in two cases. One of these patients had a long-indwelling catheter. CONCLUSIONS: Pyeloureteritis cystica is a benign and uncommon condition whose etiology is not well-known. It is generally associated with chronic infection and inflammation, and may be difficult to distinguish from other filling defects of the urinary tract. Due to its benign nature, treatment must always be conservative and close follow-up is recommended.

[Trigonocervicoprostatomy. Indications and results from 100 case reports]. / La trigonocervicoprostatotomía. Indicaciones y resultados de 100 casos.

Trigonocervicotomy is a barely invasive technique for the treatment of infravesical obstruction, first introduced in the 60's by Turner-Warkic and Orandi. To achieve good results with this procedure, the selection criteria must take into account a series of parameters such as age, sexual activity, PSA, prostate weight (below 30 grams) and others. In addition to its low morbidity, a larger percentage of patients preserve ejaculation than with the use of other techniques, also the neck sclerosis rate being lower as seen in all our series and expertise. The efficacy of this technique was studied on 100 patients.

[The management of urinary candidiasis in cystectomized patients]. / Manejo de la candidiasis urinaria en pacientes cistectomizados.

Presentation of eight cases of urinary candidiasis in patients who underwent radical cystectomy and were managed using by-pass of the urinary tract, oral antifungal therapy and solutions in the way of intermittent instillation through nephrostomy catheters.

[Tumors of the upper urinary tract]. / Tumores de tracto urinario superior.

A series of 60 cases of tumours of the Upper Urinary Tract (UUT) diagnosed in our centre between 1987-1996 and affecting 57 patients is presented. Patient's mean age was 63.7 years, males being clearly predominant, 4:1, there was no predominant laterality and the preferential location was the renal pelvis. Fifty-two (52) out of all tumours were transitional, 1 was a fibroepithelial polyp and 2 were metastasis from prostate and colon cancers. Pathoanatomy of the remaining cases is not known since no surgery was performed, although the cytologic diagnosis has identified them as transitional tumours. Our series shows a significant association to other transitional tumours as demonstrated by the existence of 2 cases with a background of UUT tumours and other 31 cases associated to transitional tumour of the bladder. Haematuria was the predominant sign (54%) and UIV the leading examination technique. Nephroureterectomy was the most commonly used therapeutical approach. UUT appear to be highly predominant in our environment, with a clear male predominance and preferential location in the renal pelvis. Haematuria continues to be the most frequent presentation sign and UIV the exploratory technique offering better performance in the diagnosis. Also a high association was found to other types of transitional tumours, the diagnosis and follow up of which allowed us to diagnose a large number of tumours of the upper tract.

[Transitional cell carcinoma and renal cell adenocarcinoma: unusual case of association in the same kidney]. / Carcinoma de células transicionales y adenocarcinoma de células renales: caso inusual de asociación en el mismo riñón.

Presentation of one patient with a highly infrequent association of transitional cells carcinoma and renal cells adenocarcinoma synchronically developed in the same renal unit. There has been very few cases diagnosed up to now, and only around 25 have been described in the literature. There is a clear predominance of males versus females, with haematuria being the most frequent sign present in 90% cases. Elective complementary examination is CT and the choice treatment can be either nephroureterectomy or extended nephrectomy based on early suspicion of transitional cells carcinoma or renal cells adenocarcinoma.

[Congenital bilateral agenesis of the vas deferens associated with cystic fibrosis. A molecular genetic study]. / Agenesia congénita bilateral de vasos deferentes asociada a fibrosis quística. Estudio genético molecular.

OBJECTIVE: To analyze the association of congenital bilateral agenesis of the vas deferens and cystic fibrosis. METHODS: Three azoospermic patients with surgically confirmed congenital agenesis of the vas deferens in whom a molecular genetics study had been performed to discard the more common mutations of cystic fibrosis are described and the literature reviewed. RESULTS: All patients showed azoospermia. The molecular genetics study showed one of the patients to be a heterozygotic carrier of G542X and no other mutations like the remaining patients. CONCLUSIONS: 15% of patients with azoospermia have chromosomal anomalies. Recently, it has been reported that 50%-65% of patients with congenital bilateral agenesis of the vas deferens have mutations for the CFTR gene, with more than 400 reported. Patients with bilateral agenesis and their partners should be screened for cystic fibrosis prior to any in vitro fertilization techniques.

[Management of priapism induced by PGE1]. / Manejo del priapismo inducido por PGE1.

OBJECTIVE: To review the literature on priapism following intracavernous injection of PGE1, its management and the physiopathological mechanisms involved. METHODS/RESULTS: The literature on PGE1-induced priapism available on Medline is reviewed and two cases treated at our hospital are described. The diagnostic and therapeutic algorithms are presented. The relationship between drug use and priapism is difficult to establish since patients with the same history who received the same dose of Alprostatil did not develop priapism. CONCLUSIONS: Although infrequent, treatment must be instituted urgently since there is generally low flow.

[AIDS and HIV infections in urologic practice]. / SIDA e infecciones por VIH en la práctica urológica.

The infection caused by the Human Immunodeficiency Virus (HIV), a retrovirus, leads to a progressive decline and to the suppression of cell-mediated immunity favouring the development of opportunistic diseases and potentially fatal neoplasias which are practically innocuous in individuals with an intact immunologic system. The number of AIDS cases recorded in Spain until March 1997 was 45,132, with a revised mortality rate of 58%. Cases in Murcia total 713 up to October 1997, of which 217 patients are being monitored in the AIDS Unit in our centre, 414 individuals have died in the region. It is well know that about one third of patients with diagnosed AIDS or who are HIV carriers will develop some type of genitourinary lesion, either as a result of a renal disorder, concurrent or not with HIV, or any other condition directly related to the infection. This is a report on our Service's experience in the treatment of HIV patients with genitourinary symptoms that, in a total of 15 cases, required our intervention. Emphasis is placed on the incidence of nephrolithiasis secondary to therapy with protease inhibitors over the last few months following introduction of this new therapeutic tool, prostatitis due to salmonella, and inlaid cystitis among others.