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Resumen Introduccion Dentro del diagnostico diferencial de la hematuria en pacientes receptores de un trasplante de medula osea (T.M.O.) debemos considerar la cistitis hemorragica por poliomavirus BK y JC. Algunos han implicado al virus BK como el principal agente en su desarrollo. La viruria por BK tambien 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 inmunocom-promiso. Material y metodos Estudio retrospectivo de 123 pacientes consecutivos sometidos a trasplante de medula osea (1995-2000), analizando los casos en que se presento cistitis hemorragica con aislamiento de poliomavirus BK y JC en orina. Se estudian: caracteristicas poblacionales, enfermedad de base, manifestaciones clinicas y radiologicas, metodos diagnosticos y medidas terapeuticas. Realizamos una revision de los principales aspectos de estos “desconocidos huespedes del aparato urinario”. Resultados Se presento cistitis hemorragica asociada a poliomavirus en 7 casos (5,7% de los TMO), 6 por BK y 1 por JC. Corresponden a 3 varones y 4 mujeres, con una edad media de 29 anos (14-45). Todos los pacientes con urocultivos bacteriologicos, micoticos y parasitologicos negativos. Presentacion clinica como hematuria macroscopica en todos los casos (aparicion entre los dias +30 y +132 post-trasplante), cuya duracion oscilo entre 3 y 30 dias. En 6 casos existian criterios de Enfermedad de Injerto Contra Huesped. Ecograficamente, en 5 pacientes se evidencio un engrosamiento difuso de la pared vesical. En todos se instauro tratamiento mediante hiperhidratacion, sondaje vesical y extraccion de coagulos, lavado endovesical continuo, alcalinizacion urinaria y antivirales sistemicos. No fueron necesarias actuaciones mas agresivas. Como complicacion, un caso de insuficiencia renal leve, reversible. Comentarios La cistitis hemorragica por poliomavirus es una entidad que considerar en pacientes que han recibido un T.M.O., debiendo realizar diagnostico diferencial ante toda hematuria que se presente en estos casos. Es necesario un adecuado manejo urologico de la hematuria, que puede llegar a comprometer la vida del paciente.

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.

The extramedular hematopoyesis is the result of the bown marrow sever chronical hipofunction, being the genitourinary afection very unusual. We are presenting a singular case by its own clinicopathology consecuences and exceptional incidence in context of a upper tract urothelial tumor.

Resumen Los tumores renales neuroendocrinos son de presentacion extremadamente rara. Presentamos un caso clinico y revisamos la literatura sobre esta patologia

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.

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.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".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.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.

The extramodular hematopoiesis is the result of the bone marrow sever chronical hypofunction, being the genitourinary affection very unusual. We are presenting a singular case by its own clinicopathology consequences and exceptional incidence in context of a upper tract urothelial tumor.

The neuroendocrine renal tumors are of extremely strange presentation. We present a review of the literature published on this pathology.

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.

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.