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Objectives: Testosterone deficit syndrome (TDS)is a clinical and biochemical entity characterized by low testosterone levels and androgenic deprivation clinic, which can cause a decrease in the quality of life. However, today there are doubts about its diagnosis and therapeutic management., Methods: Bibliographic review using the MedLine database and detailed presentation of one clinical case., Results: Testosterone deficit syndrome is associated with metabolic syndrome (visceral obesity, arterial hypertension, diabetes mellitus and dyslipemia). Currently, the performance of TDS screening in all males over the age of 45 years is under discussion. We propose a diagnostic-therapeutic algorithm for the management of TDS and erectile dysfunction., Conclusions: The treatment of erectile dysfunction associated with late start hypogonadism follows the same steps tha other generic cases of erectile dysfunction.

Objectives: To detect and enumerate circulating prostatic tumor cells (CTC) in the peripheral blood of patients with prostate cancer (PC) and study the relationship between CTCs and clinical-pathological parameters., Methods: Prospective three-arm study: 26 patients (p) with localised PC (LPC); 24 P with metastatic PC (MPC) and 30 healthy volunteer controls. A single 7.5 ml sample of peripheral blood was retrieved; CTCs were isolated using an immunomagnetic method based on the CellSearch system (Veridex). CTCs were identified as nucleated cells negative for CD45 (leukocytes) and positive for cytokeratins. (8, 18 y 19) The relationship between CTC numbers and PSA levels, Gleason score and TNM classification was studied., Results: Only 10% of the healthy controls had 1 CTC/7.5 mL, none of the patients with localised PC had more than 3 CTCs (88% < or = 2 CTCs), and patients with MPC had significantly higher CTC levels [m: 29 (1-178)] compared with the other two groups (P: 0.000). A positive correlation was demonstrated between the CTC count and PSA levels, tumor size, and presence or absence of enlarged lymph nodes. Gleason score was the only parameter that did not show any correlation with CTC levels, and although the number of CTCs was higher in patients with visceral metastases [m: 297 (0-416)] compared with bone metastases patients [m: 68 (9.5-168)] , these differences were not significant., Conclusions: Immunomagnetic analysis permits CTCs to be enumerated in peripheral blood and could be a possible way to correctly stage and make a reasonable prognosis of metastatic disease.

Objective: To present a case of infantile myofibromatosis of visceral location and a review of the literature., Method/results: We report the case of an 11-year-old Caucasian girl hospitalized for abdominal tumorous mass, weight loss and lack of appetite. Physical examination showed: cutaneous-mucous paleness and a painless, palpable tumorous mass of 8-10cm in the right abdominal flank, of firm consistency with defined edges and extending past the midline. Blood test showed hemoglobin 90 mg/l and erythrocyte sedimentation rate of 130 mm/hour. Chest x-ray and bone study were normal, while abdominal x-ray showed intratumorous calcification, intravenous urographyc showed light displace downwards and outwards of the right kidney. Ultrasound showed a solid echogenic mass with a diameter of 11cm in the right abdominal flank, above and extending towards the lower portion of the right kidney. Surgical treatment for possible neuroblastoma was initiated, during which various tumorous growths were observed in the mesocolon, the largest measuring 7cm, which were removed. Macroscopic examination showed whitish well-defined tumorous growths of firm consistency with focal calcifications. Microscopic examination showed a proliferation of fibroblastic type cells, with some areas having smooth muscle cell characteristics. Diagnosis was myofibromatosis., Conclusions: Infantile myofibromatosis is the most common fibrous disorder of infancy and childhood, more commonly found between birth and two years of age, may also appear later in life. Etiology is unclear, but certain studies report estrogen involvement in its pathogenesis. Clinical symptoms depend on the location and extension of the lesion and age at presentation. Spontaneous relapse may occur. Prognosis is good in the absence of visceral damage, although generalized congenital myofibromatosis with visceral damage is associated with high mortality especially in the first months of life, due to its destructive capacity, obstruction of vital organs, growth inhibition or infection. Urologic concerns include possible infiltration of genito-urinary organs (kidney, corpus spongiosum) and its association with urologic abnormalities. Ultrastructural and immunohistochemical studies show that the tumor is composed of myofibroblasts, with estrogen receptors, displaying vimentin and smooth muscle actin immunoreactivity. Strict follow up is recommended in patients with congenital myofibromatosis to avoid or detect possible complications that may be life-threatening (Bone survey abdominal-pelvic ultrasound, echocardiogram, chest-abdominal CT and biopsy). The treatment of choice is surgical removal, with extensive excision to avoid possible relapse.

Objective: We present nephron sparing renal surgery as a therapeutic option for the conservative treatment of renal cancer by reporting one case of de novo renal cell carcinoma (RCC) presenting in a functioning renal graft., Methods/results: We describe one case of de novo RCC presenting in a functioning renal graft 51 months after transplantation. Tumorectomy was carried out with a margin of normal parenchyma and the base was free of tumor. Definitive pathologic study showed type I papillary renal cell carcinoma, Fuhrman grade 2, pathological stage I with free margins. There were not post operative complications and immunosuppression therapy was not modified. After almost three years of follow-up there is no evidence of tumor recurrence and an adequate renal function., Conclusions: Renal graft RCC is rare. Conservative surgery in selected patients may be a safe and effective technique when the tumor appears in a functioning graft, because it offers good oncological control and preserves renal function, avoiding transplant nephrectomy and the need of haemodialysis.

Objectives: Analysis of all pediatric donor en bloc transplants to adult receptors performed in our department., Methods: Retrospective analysis of 73 en bloc kidney transplants and 497 adult transplants performed in our centre from 1990 to 2004. Mean follow-up was 50.23 months (10.18-89.05 months). All patients received the same immunosuppression, although it evolved with time., Results: There were significant differences in terms of nonfunctioning kidneys and delayed graft function, more frequent in pediatric en bloc and adult transplants, respectively. Pediatric kidneys provided better renal function and less proteinuria. Patient and graft survivals were similar in both groups. One and five-year graft survivals were 83.56% and 8 1.47% for pediatric donor kidneys, and 91.50% and 86.99% for adult donor kidneys. Vascular complications were the most frequent cause of graft loss for the en bloc transplants., Conclusions: Pediatric donor en bloc transplants have an excellent survival and function in the middle and long-term. Vascular complications are the main cause of pediatric donor graft loss. The adoption of a pediatric donor en bloc transplant program increases the transplant activity.

Objectives: To evaluate the impact of receptor's advanced age on kidney transplant outcomes., Methods: We reviewed all transplants performed between January 1990 and December 1999. Among 570 patients receiving grafts, 115 patients were 60 years or older at the time of transplantation. We compared this group with receptors younger than 60 years. We studied possible prognostic variables and compared patient and graft outcomes., Results: Mean age 63.81 (typical deviation (TD): 2.96). Mean follow-up time for elderly receptors was 41.6 months (TD: 26.58). 55.7% patients were males (p: 0.4). The most frequent cause for end stage renal disease was unknown etiology in group 1 and glomerular in the younger group (p: 0.01). 42% patients older than 60 years presented initial graft dysfunction, in comparison to 28.1% among younger than 60 (p: 0.006). Three-year graft survival was 90.42% for receptors 60 years old or older compared to 88.72% for group 2, without significant differences (p: 0.5). The most frequent graft loss etiology was patient death. (67.7%). (p = 0.005). Patient survival was 81.01% in group 1 and 95.25% in group 2, being differences significant (p < 0.001)., Conclusions: Renal grafts in receptors over the age of 60 years show a greater incidence of delayed graft function, although it doesn't seem to influence final graft survival. The most frequent cause for graft loss is receptor's death. Receptor's age does not represent a contraindication for transplant.

Objective: To present a rare case of well-differentiated mucus-producing adenocarcinoma of the renal pelvis., Methods: Patient history, the results of the complementary tests after surgery, treatment and anatomopathological findings are presented., Results/conclusions: Well-differentiated mucus-producing adenocarcinoma of the renal pelvis is rare and is often associated with lithiasis, a long history of obstruction and inflammation. Nests of tumor cells surrounded by abundant mucus is a characteristic histological finding in this tumor type.

Objective: To report a case of renal parenchymal neurilemoma and review the literature., Methods/results: A 44-year-old male patient presented with total hematuria. Patient evaluation by IVP, renal US and CT revealed a right renal mass. Radical nephrectomy was decided. The anatomopathòlogical analysis showed a renal parenchymal neurilemoma., Conclusions: Renal parenchymal neurilemoma is a rare benign tumor. The diagnosis is based on the clinical symptoms and the IVP, renal US and CT findings and confirmed by the anatomopathological findings. Surgical resection achieves cure and there is usually no recurrence.

Objectives: A case of renal angiomyolipoma in a boy is described. The rarity of this condition prompted us to report on the present case. The problems encountered in making the differential diagnosis are discussed., Methods/results: The clinical history of the patient with renal angiomyolipoma is presented., Conclusions: Renal angiomyolipoma is extremely rare in children.

We report on a 52-year-old patient who presented with a right-sided tumor mass of the spermatic cord. We describe the operative and biopsy procedures and present our conclusions.