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OBJECTIVES:OnDecember1905Darling, resident histopathologist on the Panama Channel area, observed a parasite in the large mononuclear cells of different organs. Negroni in 1914 described the first Argentinean case. Lung, oral, nasal, and laryngeal involvement are common. On the other hand, genital involvement is uncommon. The objective of this war is to communicate the case of a patient with genital histoplasmosis. METHODS/RESULTS:A 60-year-old Argentinian male started two years before with penile lesions and pruritus. Two partial penile resections had been performed in 1999, but pathology reports were not available. The lesions evolved towards ulceration and bleeding. Surgical toilette was carried out. A partial penectomy and glanuloplasty with an original technique were performed. Pathology revealed intracelular and extracelular spherical microorganisms. Morphologically it was histoplasma capsulatum.The histoplasmosis is an endemic mycosis. The infection takes place when inhaling the microconidiae of the fungus filamentous phase. Only a small number of people develop thediseaseafterinfection.Diagnosisismadebydiscovering of 2-3 micron yeasts with Giemsa stain.CONCLUSIONS: If a patient from the histoplasmosis endemic area has a granular lesion, a mycotic disease should be considered.
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OBJECTIVES: To report one clinical caseof obstructive uropathy secondaryto bladder pseudotumor.METHODS: We report the case of a 74-year-old malewith obstructive acute renal failure of unknown etiology.RESULTS: After resolution of the acute renal failure bypercutaneous nephrostomy, action was undertaken tocontrol possible etiologic causes, resolving the bilateralureter entrapment and bladder inflammatory process.CONCLUSIONS: Glandular cystitis is a nosologicalentity which in its severe forms behaves clinically andradiologically as a bladder pseudotumor, so that shouldbe considered as a part of the differential diagnosis withbladder tumors. Final diagnosis comes from pathology.For treatment, it is basic to eliminate any predisposingfactor, either infectious, or irritative, or obstructive; if noaction is carried out on these factors other therapeuticmeasures as the aforementioned are not effective. Strictfollow-up should be undertaken (every six months) becauseof the high incidence of bladder adenocarcinoma.
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OBJECTIVES: Testicular microlithiasis is an infrequent urologic diagnosis of non well-known etiology; it has been observed in patients with infertility, testicular atrophy, chromosomopathies, etc., and it had been considered as a benign non progressive disease for a long time. Recent reports have shown its occasional association with malignant tumors. We look for evidences about the significance of testicular microlithiasis and its relationship with gonadal pathologies. METHODS: We perform an electronic bibliographic search in both The Cochrane library and MEDLINE. We performed a manual search in the AUA Update Series, Current Opinion Urology, and bibliographic citations from selected studies. We report one case of bilateral testicular microlithiasis studied at our center which is illustrative. Most published articles are case reports with bibliographic review. RESULTS: The real incidence is unknown, although depending on the series varies from 0.04% in autopsies to 18.1% in testicular ultrasound series. It is more frequent in chryptorchidism, infertility, varicocele, testicular torsion, brain and sympathetic nervous system calcifications, pseudohermaphroditism, Downís syndrome, Klinefelter and Carney, cystic fibrosis, germ cell tumors and carcinoma in situ. There are series which report testicular tumor up to 46% of patients with testicular microlithiasis. It has been described tumor development during follow-up of testicular microlithiasis between 15 months and 11 years, so that it is believed to be a predisposing factor, a possible indirect indicator of premalignant disease, or a tumor marker. It has been also described in normal testicles. CONCLUSIONS: The presence of testicular microlithiasis and its association to both benign diseases and malignant tumors makes a careful evaluation and follow-up necessary, mainly in patients with chryptorchidism, infertility, testicular atrophy, and contralateral testicular tumor; it is recommended testicu- lar ultrasound each semester/year, physical examination, and testicular markers determination; to proceed with testicular biopsy is reasonable in patients of high risk (focal unilateral microlithiasis without mass, or the aforementioned chryptorchidism, infertility, testicular atrophy, and testicular tumor).
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OBJECTIVES: To perform an update insuch an infrequent pathology and to report our ownexperience.METHODS: We report two new cases and review thenational and international literature.RESULTS: We report two cases of ipsilateralmetanephric adenoma and clear cell carcinoma. The firstcase, metachronous, was detected after 15 months offollow-up in a patient who underwent partial nephrectomydue to clear cell carcinoma. The second one, synchronic,was incidentally discovered in the surgical specimen.CONCLUSIONS:Metanephricadenomais as infrequentneoplasia; its diagnosis is histological, being difficult tosuspect by complementary diagnostic tests, so that mostcases undergo surgical treatment in spite of its benigncharacter.
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OBJECTIVES:Toreviewtheepidemiology,classification, prognosis, and therapeutic options ofadrenal cortical carcinoma, mainly those of functionaltumors.METHODS AND RESULTS: 52-year-old malepresenting with wasting syndrome and a big left adrenaltumor, as well as a possible inferior vena cava thrombus.Thetumorwascataloguedasnonfunctionalafterfunctionalstudies. Surgical intervention was carried out includingadrenal tumor excision, splenectomy, and cavotomy withthrombectomy of a tumoral thrombus coming from the leftadrenal and renal veins. Infrarenal iliocaval thrombosisappeared during the postoperative period, requiringintensive anticoagulant therapy and ICU admission forcontrol. Pathological diagnosis confirmed the existenceof a high grade malignant adrenal cortical carcinoma.Patient died two months after surgery due to diseaseprogression.CONCLUSIONS: Radiological tests are fundamentalin the diagnosis of adrenal masses. In the case of bigtumoral masses, it is important to rule out the existence ofpossible tumor thrombi in the adrenal vein territory,including the inferior vena cava.Theclampingoftheinferiorvenacavademandstostartanticoagulant treatment in the therapeutic range early.Surgery is the only treatment that has demonstrated anincrease in survival
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OBJECTIVES: To evaluate the influenceof receptor's age on the outcomes of kidney transplantswith organs from donors below the age of three years and/or weighting less than 15 Kg.METHODS: We retrospectively studied the renaltransplants with organs from donors below the age of threeyears and/or weighting less than 15 Kg performed at theHospital Clínico San Carlos between 1991 and 1999.Receptors were divided into two groups depending on theage at the time of transplantation; group I includedpatients younger than 50 years and group II patients olderthan 50.RESULTS:Westudy49kidney transplants with pediatricdonors (8.6%); 22 of them were included in group I and 27in group II. There were no deathsamongreceptors youngerthan 50 years. Five-year survival for group II was 75.99%.Five-year graft survival what's 81.82% for group I, and88.89% for group II (p 0.45).CONCLUSIONS: Receptor's age does not seem toinfluence graft survival when this kind of organs are used;we consider that the lower incidence of acute rejection inpatients older than 50 years may explain the excellentresponse.
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OBJECTIVE: Up to 50% of patients withbladder dysfunctions undergoing sacral neuromodulationtreatment are non-responders. The most commontreatmentmethod today is the implantable neuromodulation systemdescribed by Tanagho and Schmidt; which allows unilateral sacral nerve stimulation. Our aim was to increase thenumber of responders andtoimprovethe general efficiencyof chronic sacral neuromodulation; therefore we havedevelopedthe bilateral electrodeimplantation byminimallyinvasive laminectomy.METHODS: PNE-tests were carried out to assess whichpatients were likely to be good responders. Thirty patients(16 with detrusor instability, 14 with hypocontractiledetrusors) were subjected to minimally invasivelaminectomy and received implants of bilateral electrodes.RESULTS: In those patients with a hyopcontractiledetrusor, the level of residual urine of initially 350 ml wasreduced to 58 ml, and the maximum detrusor pressureduring micturition increased from initially 12 cMH2O to34 cmH2O. In the other patient group with detrusorinstability, the average number of incontinence incidencescould be reduced from initially 7.2 to 1 per day, while thebladder capacity rose from 198 ml to 348 ml. Themodulation effect did not show any signs of deterioratingin any of the patients. The follow-up period was 28 monthson average.CONCLUSIONS: Clinical experience has shown thatoptimal neuromodulation in patients with bladderdysfunction can be achieved bythis new approachinvolvingbilateral electrode implantation. Moreover, thelaminectomy implantation method guarantees a minimumof invasive trauma and enables optimal placement andfixation of the electrode
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OBJECTIVES: We present the calculationof two parameters of practical interest for the urologists,which help to understand bladder phenomena. They arethe real (total) power developed during micturition, andthe spectral power of the flow curve, considered this as afinite time discrete signal.METHODS: We use Doppler ultrasound to calculatethe propelling power of the urine towards the exterior. Thecalculation of the spectral power is included among theauxiliary calculus methods employed for the calculationof the contractile power in those cases in which the flowcurve has several humps; we could only calculate the realpower in one of them because the Doppler only measuredthe speed in one curl.RESULTS: We report one case with several curls in theflow curve, in which we could only test speed in one of the curls.The calculation of the spectral power allows us tocompare curls and to calculate the total power just byaddition.CONCLUSIONS: These two power measures are theexpression of the same phenomenon, but they are different,showing one the micturition process from the flow curveand the other one from bladder contraction.We believe it is interesting to know them as a usefulwork tool.In the same way, the usefulness of Doppler ultrasoundto obtain the values of urine speed through the urethra isdemonstrated, a necessary data for the calculation of thebladder contractile power
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OBJECTIVES: To review the main imagesthat can be observed by ultrasound, trying to highlightwhat decision to take after their finding: exploratorysurgery, orchyectomy, or follow-up.METHODS: We performed a bibliographic reviewabout the topic and incorporated our personal experiencewith scrotal ultrasound. Given that there is an extensivevariety of anomalies that can be observed we divide themin liquid and solid lesions, and these in intra orextratesticular, plus a group of lesions that do not qualifyin the previous groups.RESULTS: The development of high frequenciestransducers (8-10 Mhz) and a greater experience todayallows to diagnose not only testicular tumors but also anumber of benign clinical entities, with enough specificityin some of them as to avoid surgery.CONCLUSIONS: Ultrasound is a simple test, painless,and can be repeated without trouble, so that it is the firsttest that should be ordered when managing any intrascrotal problem.
Case Report
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OBJECTIVE: To check the possible relationshipbetween testicular microlithiasis and testicular carcinoma in apatient in the one which previously we discovered a sonographicimage of this condition. The ethiopatogeny, incidence and attitudeare discussed.METHODS: A 23-year-old male with a psychomotor retardationsecondary to a chromosomopathy presented with orchitis. Scrotalultrasound discovered testicular microlithiasis, described as manyhyperechoic images. Thirteen months later a testicular cancer wasfound in a new ultrasound. Radical orchyectomy was performed.Currently the patient is under intense follow-up.RESULTS: The histopathological study showed mature teratomaand intratubular germ cell neoplasm.CONCLUSIONS: The testicular microlithiasis has been relationwith benign and malicious testicular pathology. However, thispresence it is not sufficiently clarified and the urologistís attitudebefore of a patient with testicular microlithiasis but asymptomatic isnot enough studied.
Case Report
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OBJECTIVES: To report complications that are very rare in patients undergoing radical cystectomy and Bricker´s ileal conduit. In accordance to the literature and our own experience, to remark the importance of a proper preoperative preparation (nutritional, preanesthetic evaluation...), and adequate postoperative controls to avoid this kind of problems.METHODS: We report three cases which are demonstrative of these complications, their main characteristics, as well as their diagnosis, treatment, and outcomes.RESULTS: All three cases were complicated by fistulae, with different outcomes. The diagnostic measures undertook on each one are reviewed in detail. Although it is well shown in the literature that most of these fistulae appear in patients with intestinal inflammatory/infectious diseases, this was not our experience.CONCLUSIONS: After a bibliographic review and study of our cases, we insist in the importance of a good nutritional evaluation before surgery, and that radical cystectomy with Bricker´s type urinary diversion, although consolidated as treatment for infiltrative bladder cancer, is not exempt of inmmediate postoperative complications or even deferred, as in our case.
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OBJECTIVES: To report a case of acute prostatitis as the first symptom of brucellosis. METHODS: 43-year-old patient who presented with a clinical picture of acute prostatitis and a febrile syndrome for seven days. Physical exam, blood and urine analysis and microbiological tests, and specific serologic studies were performed. RESULTS: Microbiological diagnosis was negative for bacteria, but Bengala pink (+), antibrucella serum agglutination (+) 1/320, and anti-Brucella Coombs test (+) 1/5120. Specific treatment was started with doxycyclin 100 mg b.i.d for 45 days and streptomycin 1 gr o.d for 15 days, with a positive outcome. CONCLUSIONS: The genitourinary tract is the second most frequent localization, being the testicle the most frequently affected organ, although it can also be localized in other areas of the urinary tract.
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OBJECTIVES: We report a new case of intra-scrotal inclusion epidermoid cyst. METHODS: We describe the case of a 47-year-old male patient who referred an increase in size of the right hemiscrotum lasting seven months. Physical examination evidenced an intra scrotal mass of elastic consistency, which was confirmed by ultrasound. Testicular tumour markers were negative. Trans-scrotal excision of the lesion was performed. RESULTS: Pathology was compatible with inclusion epidermoidcyst. The patient remains asymptomatic on follow-up visits, without evidence of lesion relapse. CONCLUSIONS: We highlight the importance of establishing a nomenclature consensus for scrotal cystic lesions. We agree with other authors in the indication of simple excision of the lesion as a treatment with intention-to-cure. However, the limited number of cases makes the long in time follow-up of these patients recommendable.
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OBJECTIVES: To report a rare case of left renal cellcarcinoma causing simultaneous acute left varicocele. We alsoperformed a bibliographic review.METHODS: We present the case of a male adults who wasdiagnosed as having a left varicocele during a medical exam at hisworkcenterandreferredtotheurologyclinic.Onphysicalexaminationa left flank and hypochondrium mass was found. We analyze thediagnostic tests performed and possible therapies.RESULTS: With the diagnosis of left hypernephroma the patientunderwent surgery.Abig lower pole and medial portion kidney tumordisplacing neighbor structures was found, and left radicalnephrectomy was performed.CONCLUSIONS: Although it was easy to diagnose ahypernephroma with the diagnostic tests performed, the clinicalpresentation is not frequent, neither is the sudden onset of leftvaricocele. Currently, after 8 year’s of follow-up, the patient hasnormal blood-ultrasound tests.
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OBJECTIVES: We present a case of adult polycystickidney disease, also known as autosomal dominant polycystic kidney,complicated by infection of the cysts and the formation of gas withinthem.METHODS/RESULTS: A 59 year old patient diagnosed of adultpolycystic kidney disease with chronic renal failure on treatmentwith haemodialysis, who presented sepsis secondary to infection ofthe renal cysts. The CT scan demonstrated the presence of gas withinthe cysts and the microbiology revealed E. coli in one of them. Urgentnephrectomy was performed. A histological specimen of the excisedorgan is also presented.CONCLUSIONS: Infection of one or more cystsin adult polycystickidney disease is a rare and serious complication which may requireimmediate nephrectomy, particularly if gas appears within the cysts.
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Reconstruction of the penile urethra is achallenging exercise, and for many surgeons anungratifying experience. The past three decades have seenus move from predominantly 2-staged surgery, throughforeskin grafts, and then single stage flap reconstructions,and now in the 3rd millenium, for some situations 2-stagerepair has again become the favoured option. Satisfyingshort-term solutions have sometimes resulted in poorlong-term outcomes when reviewed 10 years later. Clearlythere are still problems to be resolved, hence the need forcontinuing evolution in our surgical management.Lessons have been learned from the treatment of LichenSclerosus, from strictures following hypospadias repair,and strictures associated with severe spongiofibrosis.Management of these problems has traditionally been associated with not only a high incidence of restrictureand fistula formation, but also with poor cosmetic results,something that men today find increasingly difficult toaccept.Several considerations are fundamental to achievingthe best functional and aesthetic results. These include thepresence or absence of Lichen Sclerosus, the extent ofurethral disease and its grade (i.e. mucosal disease or withaccompanying spongiofibrosis); furthermore the use ofnon-genital grafts for urethral reconstruction when thelocal penile tissues are deficient or unhealthy.In arriving at our present strategy, a collaborativeapproach that integrates established urological practicewith the different perspectives of a plastic surgeon (A.B.)has proved constructive and beneficial.
