Search

Introduction: Approximately 70-85% of transitional bladder cell carcinomas are non-muscle-invasive. After an initial surgery, around 60-90% will have a recurrence, being the highest risk period the first two years. Urothelium instability could be the main reason for recurrence in mid grade tumours, reason why a single dose of a chemotherapy after transurethral resection of the bladder (TURB) might be insufficient. That is why a deferred therapy in occasions associated with maintenance is recommended., Patients and Methods: A prospective, controlled and randomized study was performed. We included non-muscle-invasive mid risk bladder tumours. All patients had initially a TURB performed and were randomized to receive a single dose of mitomycin C (MMC), in the immediate postoperative period., Results: A total of 105 patients were included. Mean follow-up was 22, 70 +/- 8, 15 months. MMC was administered to 53 patients. Of these 66, 0% had no recurrence and 34.0% had a non-muscle-invasive recurrence. Of the 52 patients in the non MMC group, 53.8% had no recurrence and 44.2% had a non-muscle-invasive recurrence and only 1 patient had a muscle-invasive progression. We did not find significantly differences in time to recurrence in mid risk tumours when using immediate postoperative single dose of MMC or deferred therapy. There was only one case of myelosuppression., Discussion: In mid risk non-muscle-invasive tumors, some studies suggest that early intravesical instillation of chemotherapy reduces the risk of recurrence after TURB. We could not show significantly differences when comparing postoperatorive MMC versus traditional deferred instillations.

Objective: We report one case of ovarian metastasis secondary to a renal clear cell carcinoma., Methods/results: 52 year-old consulting for metrorrhagia with the initial diagnosis of primary ovarian carcinoma. Tumor dissemination work up tests reported a renal mass suggestive of ovarian metastasis. Surgery included hysterectomy, double annexectomy, and radical nephrectomy. Final diagnosis was renal clear cell carcinoma with ovarian metastasis., Conclusions: Metastases to the ovary pose a diagnostic problem in their interpretation, especially when they show a similar histology to the primary ovarian tumor. Due to therapeutic and prognostic implications, it is very important to differentiate if it is a primary ovarian tumor or a metastasis from a renal carcinoma.

Objective: To report a new case of renal metastasis from an squamous cell carcinoma of the lung., Methods: A 60 year old male presented to the outpatient office with an ultrasound finding of renal mass., Results: Imaging test studies showed a heterogeneous mass in the upper pole of the left kidney, involving the pelvis and trapping the renal artery., Conclusions: Clinically recognised or symptomatic metastases to the kidney from pulmonary cancer have been a rare occurrence. Nevertheless, prognosis associated with lung carcinoma metastatic to the kidney is very poor, since the likelihood of a truly solitary metastasis is remote.

Objectives: To probe the use of Zoledromic acid in the control of the pain due to bone methastasis of a prostate cancer., Material and Method: We included in our study 37 consecutive patients diagnosed of prostate cancer who developed bone methastasis during 2005 and 2006 to whom we gave a 4 mg dose of Zoledromic acid during a mean time of 10.24 months., Results: We observed a complete control of the pain in 8 of the 20 patients, and partially in 6 of those patients. We did not evaluate any adverse reaction due to this treatment., Conclusions: We still yet to know whether the administration of this treatment in the early stages of the prostate cancer could prevent or retard the appearance of bone methastasis.

Objectives: To evaluate the prognostic significance of the 2002 TNM tumor classification for renal cell carcinoma, as well as other factors intervening in its survival., Methods: Retrospective chart review of 316 renal carcinomas operated between 1970 and 2003. Twenty-five prognostic variables were analyzed., Results: The histological type was renal cell carcinoma in 90.5% of the patients. Most tumors were T1b or T2, with a Fuhrman nuclear grade I or II. Mean tumor size was 7.17 +/- 3.4 cm. Most cases had a solitary tumor. 8.2% of the patients had lymph node involvement at the time of diagnosis, and 8.6% metastases. The most frequent clinical presentations were hematuria and/or pain. Mean follow-up was 57.8 months. 24.1% of the cases had recurrence, more than 50% of them during the first year. Advanced tumors (T3, T4) had the tendency to have a nuclear grade III-IV, bigger size, necrosis, vascular involvement, lymph node involvement, and metastases. At the end of follow-up, most patients were alive and disease free. The number of months free of disease, the presence of metastatic lymph nodes, the treatment of the first recurrence and the presence of anemia were independent factors for cancer specific mortality., Conclusions: The modification of the current classification of renal tumors pT3 and pT4 would help to a better decision-making in the therapy of tumors with vascular, perirenal fat or adrenal involvement. Anemia and treatment of the first recurrence are important factors for cancer specific survival.

Objectives: To review the influence of various intravesical treatments on superficial bladder cancer progression., Methods: We retrospectively reviewed 473 superficial bladder neoplasias. Based on diagnosis and transurethral resection of bladder tumor (TUR BT), and depending on pathology, we proposed different treatment and follow-up schemes, with BCG in 139 cases and intravesical chemotherapy, mainly Mytomicin C, in 80., Results: Overall, the use or not of bladder instillations did not show statistically significant differences in time to progression. The use of intravesical therapy and maintenance therapy was an independent risk factor for disease-free time to progression when compared with induction., Conclusions: The use of maintenance intravesical therapy with BCG resulted in a delayed progression of superficial bladder cancer, so that it seems the most effective treatment, mainly in moderate-high risk tumors.

Introduction and Objectives: To report to the literature a new case of primary psoas abscess., Methods: The patient is a 65 years old woman who suffered back and left hip pain for approximately 1 month. A CTA showed a retroperitoneal mass that involved the left Psoas. It was drained 1800 cc of purulent fluid infected by Streptococo pneumoniae., Results: In a CTA made 21 days after drainage, showed a very small residual collection., Conclusions: Primary Psoas Abscess are a very rare entity, with a low rate of mortatility if well treated.

Objective: To report a rare case of a giant epidermoid cyst in an intertesticular localization, analyzing its histological and pathologic features, and to perform a bibliographic review., Methods/results: We report the case of a 49-year-old male consulting for a slowly growing intra-scrotal mass of five years of evolution causing discomfort because of its size. After excision the pathology report showed the presence of a keratoid epidermoid cyst very big in size., Conclusions: Superficial scrotal epidermoid cysts are frequent in clinical practice; that is not the case of the so-called "intra scrotal inclusion cysts". Epidermoid cysts are firm, mobile, slowly growing, generally asymptomatic intra epidermal neoformations. There are descriptions in multiple sites, even the genitalia, nevertheless their size in this location does not usually pass 5 cm.

Objectives: Syphilis is a systemic disease the course of which follows successive clinical stages. Central nervous system and spinal cord involvement on late phases may lead to bladder dysfunction. We report one case of neurosyphilis with associated bladder hyperreflexia., Methods/results: 51-year-old male with the diagnosis of neurosyphilis consulting for voiding disorders with evidence of detrusor hyperactivity of neurogenic etiology on the urodynamic study., Conclusions: The differential diagnosis of neurogenic bladder in patients with psychiatric or neurological symptoms should include neurosyphilis. Etiologic diagnosis is obtained by cerebrospinal fluid examination, and the diagnosis of bladder dysfunction by urodynamic study.

Objectives: To report a rare clinical case of solitary pararenal fibrous tumor, analyzing its pathological characteristics and prognosis by a bibliographic review., Methods/results: We present the case of a 36-year-old male consulting for right flank colic pain, which was diagnosed of a solid mass in the lower pole of the right kidney and underwent right radical nephrectomy. Pathological study of the surgical specimen showed the presence of a solitary pararenal fibrous tumor., Conclusions: Solitary fibrous tumor is a rare neoplasia, being its pararenal localization even rarer. It is a tumor with benign behavior in up to 90% of the cases. The immunohistochemical study is the key to diagnosis.

Objective: We present a new case of trombosis of the superficial dorsal penis vein called Penile Mondor's disease. The characteristics of the disease are reviewed and the most usual diagnostic and therapeutic methods., Methods: The case of a 41 year old man is reviewed who consulted for pain and induration on the proximal part of the penis., Results: After phisical examination and Eco-doppler was made the diagnosis of Mondor's disease. He receibed treatment with non steroidal antiinflamatories and antibiotics., Conclusions: The dorsal vein thrombosis is a rare disease with pain an induration of the dorsal part of the penis. The ethiology can be traumatic, neoplasic, excesive sexual activity or abstinence. Is necesary the diferencial diagnosis with esclerosant linphangitis and the most important imaging is the Eco-doppler. The treatment is based in non steroidal antiinflamatories and antibiotics wit infection. The local aplication of heparine can be useful and the surgery with thrombectomy and resection is for persistent cases.

Objectives: To determine the efficacy of endoscopical injections for the treatment of stress urinary incontinence (SUI), evaluating its low invasiveness and positive impact on quality of life., Methods/results: Belween 1997--2003 30 procedures of periurethral injection of various substances for urinary incontinence were performed at our department in women between 47-80 years. All patients were evaluated before surgery, clinically and urodynamically, in accordance to international standardized parameters (filling pressure/flow studies, maximum urethral closure pressure, LPP-leak point pressure). The kind of material employed for injection, surgical technique and satisfaction degree were also evaluated., Results: The indication for surgery was SUI in 17 cases (56.6%), and mixed urinary incontinence in 73 cases (43.3%). 16 cases (53.3%) had history of previous surgery for SUI. Regarding urodynamic parameters, 19 patients (63.3%) have a maximum urethral closure pressure below 25 H2O cm, and 22 patients (73.3%) had a leak point pressure below 60 H2O cm. Collagen was employed in six cases (20%) and macroplastic in 24 (80%) (14 of them with the MIS system). 22 patients had three injection sites (73.3%). Mean follow-up was 38 months. Continence outcomes were evaluated in relation to complete continence (12 cases, 40%), mild incontinence and patient satisfaction (11 cases, 36.6%), and severe incontinence (7 cases, 23.3%)., Conclusions: 1-To achieve acceptable results it is mandatory to do the best possible indication (Mc Guire type III SUI). 2.-There is an excellent relationship between minimal invasiveness and good results.

Objectives: We report the case of a patient who had underwent surgery for a clear cell renal carcinoma 2 years before presenting with metastasic extension to bladder on follow-up., Methods: Radiological finding of a bladder mass during follow-up after nephrectomy., Results: TURBT was carried out with the pathologic report of clear cell carcinoma, compatible with a primary renal origin., Conclusions: Bladder is a very rare place for metastasis from kidney tumors. Prognosis will depend on the time of appearance of such metastases.

Introduction and Objectives: The aim of this study was to review the current situation of penile prosthesis in the treatment of erectile dysfunction and to analyze the indications, degree of acceptability and complications in our experience., Material and Methods: From 1984 to 2003, 48 implants were inserted in men suffering from impotence due to different etiologies. The mean age was 55 years. Vascular disease, Diabetes and pelvic surgery were the most common pathologies recorded. The type of prothesis inserted were malleable inactive in 7 cases (14.58%), Jonas6, Acu-form1. Inflable active with 3 components in 19 cases (39.58%), AMS 700 plus17, Alpha2. Inflable active integrated in 5 cases (10.41%) Hydroflex4, Dynaflex1. Inflable active with 2 components in 17 cases (35.4%), Ambicor2, Mark II15., Results: Infection of the prosthesis was observed in 6.25% of the cases. This infectious complication required removal of the prosthesis. 4.16% of the cases complained of mechanical failure that required change of the prosthesis. 80% of the patients were satisfied with the results., Conclusions: Penile prostheses continue to be an effective and valid therapeutic alternative in impotent. Although the complication rate is low, adequate information must be provided to the patient.

Objectives: To report a new case of well-differentiated renal liposarcoma, and to describe its clinical features, diagnosis, treatment, and differences with other mesenchymal tumors of the retroperitoneum., Methods: We perform a clinical review of renal mesenchymal tumors, especially liposarcomas. We report one case of well-differentiated renal liposarcoma in a 52-year-old female, and review current lines of treatment and follow-up., Results/conclusions: The well-differentiated renal liposarcoma is a very unfrequent mesenchymal tumor, for which it is necessary to know exactly its origin in the renal parenchyma. The treatment of choice is complete tumor exeresis; close follow-up should be exercised because even though it does not metastasize, local recurrences appear in 30% of the cases.

Objectives: We report one case of ocular and lung metastases seven years after radical nephrectomy for renal cell carcinoma., Methods: The case of a 45-year-old male patient who underwent radical nephrectomy for a localized renal cell carcinoma (T2N0M0) in 1995 was found in a review of malignant renal neoplastic pathology., Results: Seven years later he presented with a lung metastasis requiring neumonectomy, and an ocular metastasis requiring enucleation. He is currently receiving systemic treatment with interferon and interleukin., Conclusions: Clinical presentation and evolution of metastasic renal carcinoma is very variable, a difference with other neoplasias. Ocular localization is exceptional and may appear long time after primary tumor; clinically, it may be asymptomatic or present with sudden sight loss. MRI, CT scan and retinal examination are the diagnostic methods employed, and treatment may be surgery, brachytherapy or radiotherapy depending on location and size of the lesion.

Reports on primary renal lymphoma are scarce in the urological literature, the most part of them are secondary on a lymphomatous infiltration of the kidneys. We report the case of a 77 year old man with an incidental mass on the kidney. After radiological studies (CT), we practise nephrectomy with a pathological result of a non-Hodgking B primary lymphoma. The patient present a IgM monoclonal gammapathy who need complementary treatment with chemotherapy. A literature review on currently recommended diagnostic and treatment practices in presented.

Objectives: We report 2 cases of Sertoli cell only syndrome and perform a bibliographic review., Methods: Clinical and pathologic study of 2 male patients 33 and 37-year-old respectively who presented with infertility., Results: Testicular biopsy, the most important diagnostic test in the study of infertile men, showed bilateral Sertoli cell only syndrome., Conclusions: The Sertoli cell only syndrome is an entity in which seminiferous tubules show a total absence of germ cells with Sertoli cells alone. Etiology is unknown in most cases. Testicular biopsy is performed in these azoospermic men to rule out tubular obstruction or abnormalities of the spermatogenesis. Assisted reproduction techniques are a therapeutic option, making genetic counselling necessary due to the risk of transmission of the genetic defects that cause male infertility.

Objectives: To report one new case of endometriosis in a patient with history of caesarean section., Methods: It is the case of a female patient presenting with voiding symptoms and hematuria, with a bladder tumor on ultrasound., Results: After TUR of a retro trigonal tumor pathology report showed bladder endometriosis. Treatment was completed with hormone therapy, being the patient relapse free at one year follow-up., Conclusions: History of caesarean section is one of the possible etiologies of bladder endometriosis.

Objectives: To report the case of a giant bladder diverticulum clinically presenting with symptoms of inferior vena cava compression., Methods: Patient under study because of inferior limbs edema who underwent ultrasound that found a giant bladder diverticulum., Results: Diverticulectomy plus adenomectomy were performed., Conclusions: Acquired giant bladder diverticula are very rare; they should be treated surgically to avoid possible complications.

Objectives: To evaluate the similarity between Gleason grade on prostate biopsies and their final result after radical prostatectomy., Methods: We retrospectively review the medical records of 129 patients who underwent radical prostatectomy. Mean PSA value was 10.7 ng/ml. The relationships between pathological reports of biopsies and radical prostatectomy specimens, and other variables such as PSA were established., Results: Globally, 72 cases (55.8%) were in the same risk group by grade on biopsy and surgical specimen. Biopsy result was understaged in 48 cases (37.2%) and overstaged in 9 cases (7%). We found biopsy understaging in 42 cases (60%) in the low grade group, 6 cases (10.9%) in the intermediate grade group, and 50% in the high grade group, although in this latter the number of cases was very low., Conclusions: Overall biopsy understaging was 37.2%, being much more evident in low grade tumors (60%). It seems that understaging was greater when PSA > 10 ng/ml, although differences were not significant.

Objectives: To study the evolution of 49 patients with squamous cell carcinoma of the penis., Methods: 49 patients who underwent surgery for squamous cell carcinoma of the penis (30 partial penile amputations, 11 total amputations and 7 circumcisions). 27 inguinal lymphadenectomies, superficial, profound and ilio-obturator (2 cases), were performed due to persistent lymph nodes after penile amputation despite of antibiotic treatment for 4 weeks, or to high grade primary tumour. 13 patients were found to have lymph node metastases after treatment, receiving posterior adjuvant treatment with radiotherapy, chemotherapy or a combination of them. Patients were followed in relation to stage, cell differentiation degree, and presence or absence of positive lymph nodes and distant metastases., Results: There were 5 Ta stage tumours, 26 T1(63.2%), 16 T2 (32.6%), and 2 T3 (4.08%). Regarding cytological degree 81% were GI, 16% G II, and 2% G III. Lymph node metastasis were detected in 13 patients (26.53%) after lymph node dissection. 6 patients died from tumour dissemination, 2 of them were T2G2, one T2G1, and three T1G2; two additional patients died from causes different from the tumour, all of them being N+ at the time of diagnosis., Conclusions: Penile squamous cell carcinoma is an aggressive tumour the evolution of which mainly depends on the local-regional stage at the time of diagnosis and cell differentiation; these factors will condition lymphadenectomy versus observation.

We report report a case of a man with azoospermia who was studied because of infertility. Between the causes of azoospermia and severe oligospermia, in male patients with infertility evaluations, small deletions in regions of the Y chromosome must be considered, as in our case. Regions for spermatogenesis in the Yq chromosome can be evidenced using PCR analysis. Men with azoospermia are at high risk to have small deletions in that regions. Yq chromosome deletions could be transmitted when ICSI (intracytoplasmic sperm injection) is applied. Thereafter, study of microdeletions would be included in severe infertile men.

Objective: To determine the efficacy of urinary BTA-TRAK as a marker in monitoring superficial transitional cell carcinoma of the bladder and to compare urine cytology with urinary sediment testing., Methods: 700 consecutive determinations using BTA-TRAK to monitor unselected patients that had undergone surgery for transitional cell carcinoma of the bladder were analyzed. Cystoscopy, urinary sediment and urine cytology were performed during follow-up. Urography was performed yearly or when tumor of the upper urinary tract was suspected. (positive cytology or hematuria with no bladder tumor). Cystoscopy was performed a few days after determination of BTA-TRAK and voiding urine cytology and urinary sediment analyses (considered positive when microhematuria was observed) were both requested., Results: Of the 700 determinations, 95 (13.6%) were urothelial carcinomas (93 bladder, 2 upper urinary tract) that had been discovered during patient monitoring. Of the 93 bladder tumors, 39 were Ta (37 TaG1 and 2 TaG2), 29 T1 (4 T1G1, 20 T1G2 and 5 T1G3), 5 Tis and 20 muscle-infiltrating tumors (progression from T2-4 during monitoring). The sensitivity of urine cytology to detect urothelial tumor was 41.1% and the specificity was 97.3%. The urine cytologies were negative in 48.4% and inflammatory in 9.5% of the tumors. The sensitivity was 19% in low grade tumors. The sensitivity of urinary sedimentation testing to detect urothelial tumor (microhematuria) was 40% and the specificity was 96.7%. When associated with pyuria, it was considered to be a urinary infection or urothelial inflammatory condition, which was observed in 10.6% of the cases. Considering the proposed normal reference value for BTA-TRAK (< or = 14 U/ml), we have found a sensitivity of 62.1% and a specificity of 68.4%. A logistic regression model was developed, including BTA-TRAK, urinary sedimentation and cytology, to identify the independent variables that are useful for tumor detection during follow-up of superficial carcinoma of the bladder in this series. The combination of three variables showed an odds ratio of 18.5 (8.9-38.5) for urinary cytology, 11.8 (5.9-23.5) for urinary sedimentation and an odds ratio for BTA-TRAK that did not fall within the equation., Conclusions: Although overall the sensitivity of BTA-TRAK is higher than that of urine cytology and urinary sedimentation testing, it provides no additional information than that obtained from the combination of urine cytology and urinary sedimentation testing in the detection of tumor recurrence during monitoring for superficial bladder cancer.

Objectives: The present study was conducted to determine the efficacy of NMP-22 as a diagnostic test for recurrence of bladder tumors and to compare its efficacy with urine cytology., Methods: 30 patients (25 male, 5 female), aged 41-87 years (mean 73.4), with bladder tumor were evaluated by cytology, cystoscopy and determination of NMP-22 at 3 and 6 months post-TUR of the bladder. A positive test was defined as NMP-22 greater than 10 U/ml., Results: 80.7% were T1, 15.3% T2-T3, 76.8% were grade I and II, and 23.2% were grade III. NMP-22 showed a sensitivity of 69%, a specificity of 64%, a positive predictive value of 52% and a negative predictive value of 78%, using tumor recurrence at 3 and 6 months as the unit of analysis, for a recurrence rate of 36%. Cytology showed a sensitivity of 44%, a specificity of 92%, a positive predictive value of 77% and a negative predictive value of 74%. When both tests were used, we obtained a sensitivity of 87.5%, a specificity of 64.2%, a positive predictive value of 58.3% and a negative predictive value of 90%. In grade I tumors, determination of NMP-22 had a sensitivity of 100%, a specificity of 77.7%, a positive predictive value of 60% and a negative predictive value of 69%., Conclusions: NMP-22 showed an acceptable sensitivity but a low positive predictive value, therefore control cystoscopic evaluation cannot be avoided. The sensitivity and negative predictive values increased when NMP-22 and cytology are used in combination. We found NMP-22 to be a very useful marker for recurrence of low grade tumors.

Objective: To analyze the efficacy of the BTA Trak test as a diagnostic marker for bladder cancer, determine its correlation with tumor grade and stage, compare its sensitivity with urinary cytology and its utility in urological conditions other than bladder cancer., Methods: 77 patients comprised the study; 33 with bladder cancer and 44 without. A urine sample was obtained from all patients for the BTA Trak test and another three samples for urinary cytology from each of the 33 patients with bladder cancer. Of the 44 patients without bladder cancer, 36 had conditions involving the urinary tract and 8 presented conditions without urothelial involvement. The BTA Trak test was repeated three months after treatment in 11 of the patients with bladder cancer and three months after the first test in 13 patients without bladder cancer., Results: Using BTA Trak threshold values of 14 U/ml as first reference and 50 U/ml as the value indicating clinical warning, these were found to be higher in 24 of 33 patients with bladder tumor (sensitivity 72.7%). By tumor stage, BTA Trak was positive in 12 of 21 pT1 (sensitivity 57%) and in 11 of 11 pT2 (sensitivity 100%). Concerning tumor grade, values were higher than threshold in 13 of 22 GI-II (sensitivity 59.9%) and 10 of 10 GIII (sensitivity 100%). Urinary cytology was positive in only 8 cases (sensitivity 24.4%). In the patients without bladder cancer, values are higher than threshold in 3 of 8 patients with urological conditions without urinary tract involvement and 14 of 36 with a probable urothelial involvement without tumor, accounting for an overall sensitivity of BTA Trak of 61.4%. The BTA Trak test three months after treatment showed lower value in 7 of 8 patients with bladder tumor and pretreatment values higher than threshold., Conclusions: The BTA Trak test is a simple quantitative method with a high sensitivity for the diagnosis of bladder tumors, especially those in the advanced stages and grades. It is superior to cytology, although it has a lower specificity, particularly in conditions with urinary tract involvement.

Objective: To compare the usefulness and accuracy of the BTA test versus urinary cytology., Methods: The BTA test was performed in 45 patients distributed into three groups: group I comprised patients with hematuria of unknown origin; group II had a diagnosis of bladder cancer; and group III comprised patients who had undergone TUR for a bladder tumor and were undergoing endoscopic control evaluation. The sensitivity and specificity of each diagnostic method were determined for each group of patients., Results: The BTA test showed a higher sensitivity than urinary cytology in all groups, the difference being significant for groups II and III. Its specificity, however, was lower than that of cytology in groups I and III, and similar in group II., Conclusion: The BTA test is a simple and useful method for the diagnosis and follow-up of bladder cancer. It has a higher sensitivity than urinary cytology, although its specificity is lower due to the higher number of false positives observed in patients with inflammatory bladder conditions. Randomized studies are warranted to determine if the accuracy of urinary cytology can be enhanced with the combined use of the BTA test which has been demonstrated to have a higher specificity.

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.

Objectives: The possible solutions to a case of ureteral duplication complicated by obstruction of one of the collecting systems are reviewed., Methods/results: We report an uncommon case of ureteropelvic junction obstruction in the lower system of an incomplete duplication of the collecting systems that was resolved by pyeloureterostomy., Conclusions: Anastomosis of the lower renal pelvis to the upper ureter may provide a simple solution for the functional recovery of an important renal segment.

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.

Objectives: We report on a patient with an increase in testicular size that had been initially diagnosed as neoplasm., Methods: The ultrasound and histological findings, the atypical clinical features and possible causes are analyzed., Results: Segmental infarction with diffuse testicular atrophy., Conclusion: Infarction of testis may atypically present as a testicular mass that may lead us to suspect a testicular neoplasm since the age of presentation of both types of lesions are similar.

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.

Objectives: We evaluated the form of presentation, clinical features and analytical values and their relationship with survival in renal cell carcinoma patients and analyzed the efficiency of different diagnostic and staging procedures., Methods: We reviewed the form of presentation, clinical features, staging procedures and analytical values of 229 consecutive renal cell carcinomas diagnosed at our hospital between 1975 and 1991., Results: Malaise and weight loss or symptoms different from those of the classical triad (hematuria, pain and a flank mass) are factors of poor prognosis and lower survival. The time of presentation of symptoms does not influence prognosis. Computerized tomography was found to be the best imaging technique, with a low sensitivity and a high specificity in our experience. We have found a correlation between hypercalcemia and lower survival, but not for the more advanced tumoral stage. There was a correlation between the levels of hemoglobin and alkaline phosphatase and survival: patients with hemoglobin levels less than 14 g/dl or alkaline phosphatase levels greater than 85 U/l had a lower survival rate and a more advanced tumoral stage., Conclusions: Computerized tomography was found to be the best imaging technique. Symptoms different from those of the classical triad, malaise and weight loss, hypercalcemia, low levels of hemoglobin or high levels of alkaline phosphatase are factors of poor prognosis.

Herein we describe a case of penile incarceration due to a nut at the base of the penis which was resolved by cutting the metallic object. The literature on penile strangulation describes different foreign bodies and methods of management of constrictive penile band injury.

Ureteral iatrogenic lesions occur with variable frequency in the different types of surgery, mainly in uncomplicated abdominal hysterectomy. This paper contributes 29 patients (2 male and 27 female) with several types of lesions, secondary to gynaecological, intestinal and vascular surgery. The series produced 16 cases of clamping, 6 ureterovaginal fistulae, 6 ureteral sections (5 total and 1 partial) and 1 ureterouterine fistula. The terminal ureter was the most frequently damaged. The diagnostic and therapeutical methods used in this type of lesions are analyzed.

We report an additional case of ectopic ureter opening into the seminal vesicle in a patient who had consulted for nephric colic from calculus in dysplastic kidney and urinary tract infection. The clinical features, the diagnostic and therapeutic aspects of this rare malformation are briefly reviewed.

Review of two new cases of fracture of the cavernous body, one treated with early surgery and the other one conservatively. In both cases, the patients preserved good erections after one year.