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Testicular torsion in adult, is an uncommonly etiology, but we should make differencial diagnosis in every person over thirty years old, with acute scrotum. The wrong diagnosis raises the incidence orchiectomy in adults for vascular etiology. We report a male of 74 years old with acute scrotum and review of the literature.

Objective: To determinate the efficacy in the treatment of ureteral estenoses after renal transplantation with metallic self-expandable stent., Materials and Methods: From october of 1995 to april of 2002, 8 ureteral obstruction post renal transplantation have treated by means of implants of a metallic self-expandable stent (6 men and 2 women). The average time of pursuit was of 30 months (rank 2-53 months). In this work the severity and location of the estenosis are analysed, the method of implant of the stent, the permeability of the same one, the levels of creatinine pre and postimplant and the complications derived from the same one., Results: The treatment was effective in the 100% of the patients (8/8), with an average reduction of the creatinine of 36% (rank 13.6%-59.6%). The complications were minimum and the hospital stay was short., Conclusions: In the patients with: chronic deterioration of the graft with short functional expectation, patient with high surgical risk and reestenosis after ureteral reimplantation by previous ureteral estenosis, the use of a metallic self-expandable stent, constitutes technique of election given its efficacy and low associate morbidity.

Malacoplakia is an unusual chronical granulomatous disorder. In the urinary tract is more frequent in female, in 75 percent of cases involve the bladder. Pelvis extension of this disease is infrequent, and even less frequent is the involvement of pelvic and retroperitoneal lymph nodes. We present the second case in the literature of bladder malacoplakia with extravesical and pelvic node involvement.

Objective: To report a new case of low grade endometrial stroma sarcoma late relapse involving bladder wall and ureter., Methods: We report the case of a 64 year old female with history of Wertheim-Meigs hysterectomy 30 years before for uterine sarcomatous tumour, who presented with intermittent macroscopic haematuria episodes associated with mild elevation of serum creatinine. Image diagnostic tests--mainly CT-scan--evidenced a right pelvic mass involving the bladder wall and the homolateral distal ureter. Different lines of palliative treatment--chemotherapy and radiotherapy--were started., Results: Histologic and immunohistochemical studies of samples obtained by transvaginal ultrasound guided biopsies were consistent with low grade endometrial stroma sarcoma. Results from palliative treatment were discouraging., Conclusions: This type of neoplasms are rare, although relapses may appear after extremely long silent periods. They have potential to compromise urological structures. Although there are publications reporting good results, the role of different palliative therapeutic alternatives is not well established yet, and responses in cases like ours are minimal or none.

Objective: To report a case of priapism secondary to leukemia, with special reference to the initial treatment in the emergency services., Methods: A 53-year-old male with chronic myeloid leukemia presented with prolonged involuntary painful erection of 12 hours' duration. The physical examination and particularly the cavernosal blood gas study, indicated low flow priapism. Punction-lavage of the corpora cavernosa was performed. Because complete response was not achieved with this procedure, adjuvant intracavernous methoxamine was administered., Results: Complete detumescence was achieved after the third dose of methoxamine. There was no recurrence and erectile function was preserved., Conclusions: We underscore the utility of combined cavernous lavage + adjuvant alpha-1 adrenergic agonist as initial therapy in priapism with this special etiology.

Objectives: To describe the effectiveness of sacral root neuromodulation in ameliorating symptoms of refractory voiding disfunction in our center., Material and Methods: During the period from december 1998 throught december 2001, 31 Percutaneous Nerve Evaluation (PNE) was performed to 20 patients with refractory voiding dysfunction; a sacral nerve stimulation device was implanted in 10 patients (8 female, 2 male). The median age was 49 years. Refractory voiding dysfunction included: mixed disorders (30%), idiopathic nonobstructive chronic urinary retention (20%), urgency/frequency (20%), faecal and urinary incontinence with absence of sphincter defect (20%) and frequency (10%)., Results: The 2 patients with frequency/urgency decreased their symptoms more than 50%, bladders were emptied without post-void residual urine in 2 patients with urinary retention, faecal and urinary incontinence in 2 patients and mixed disorders in other 3, reduced their symptoms more than 90% without residual urine. The frequency improved more than 50% in 1 patient., Conclusions: Sacral Root Neuromodulation is a successful treatment in some cases of idiopathic chronic micturition dysfunction which don't respond to pharmacotheraphy or bladder retraining. The effects of neuromodulation are long-lasting and associated morbidity is low.

Objective: To report an additional case of paratesticular leiomyosarcoma., Methods: Herein we describe a 68-year-old male patient that presented with a growing, indolent, right inguinoscrotal lesion that he had noted several weeks earlier. Physical examination showed a mass involving the distal right spermatic cord and was confirmed by ultrasound and CT. Analyses were normal. Radical orchidectomy with high ligation of the right spermatic cord was performed., Results: Histopathological and immunohistochemical studies demonstrated a well-differentiated paratesticular leiomyosarcoma. Local recurrence was observed at 3 1/2 years' follow-up. Complete excision of the tumorous tissue was performed with no other adjuvant therapy. Six months thereafter, there is no evidence of local recurrence or distant metastasis., Conclusions: This tumor type is uncommon. Like other authors, we believe that orchifuniculectomy is the treatment of choice. Furthermore, adjuvant radio or chemotherapy does not significantly influence survival in these patients.

Objective: To describe a case of endometriosis of the urinary bladder in a patient with a previous history of cesarean section. Its possible relationship is discussed., Methods: A 31-year-old female that had undergone cesarean section 8 years earlier is described. She had been referred by the gynecologist for further evaluation of a hyperechogenic area of about 2.5 cm in the posterior bladder wall. The patient had mild pollakiuria. Physical examination and analytical studies were normal except for microhematuria. CT suggested a possible uterine origin of the lesion. Endoscopic examination showed a lesion with a bullous appearance. Exploration and TUR with electrocoagulation of the bed were performed under anesthesia. Three small recurrences 0.5 cm in size were observed at 18 months' follow-up. TUR was repeated and the patient received complementary hormone therapy for 6 months., Results: Histopathological analyses of both TUR specimens demonstrated bladder endometriosis. At control evaluation 12 months after the second TUR, the patient is asymptomatic and the analytical and cystoscopic evaluation showed no significant findings., Conclusions: There may be a possible relationship between some cases of endometriosis and previous cesarean section. Diagnosis is confirmed by histological analysis of tissue obtained by endoscopy. TUR and complementary hormone therapy is an alternative treatment option. The need for subsequent control follow-up is emphasized.

Objective: To report an additional case of liposarcoma of the spermatic cord., Methods: A 69-year-old male presented with an indolent left inguinal mass that he had noted one month earlier and had gradually increased in size. Two irregular mobile nodular left inguinal lesions were detected on physical examination. Analytical tests were normal. An ultrasound showed three nodular lesions in the left spermatic cord. CT attenuation values indicated predominantly fat tissue in the lesion. The patient underwent a radical left orchidectomy and funiculectomy., Results: The histopathological analysis of the surgical specimen showed a well-differentiated liposarcoma of the spermatic cord., Conclusions: Liposarcoma of the spermatic cord is uncommon. Some imaging techniques are useful in making the diagnosis. Like other authors, we believe that orchifuniculectomy is the treatment of choice in these patients.

Objective: To report a case of solitary metachronous contralateral metastasis of a renal carcinoma that had been previously resected., Methods: A 63-year-old male that had previously undergone a right radical nephrectomy due to renal carcinoma is presented. The patient's left breast was found to be slightly larger at the control evaluation 24-months postoperatively. Analytical and hormonal studies showed no significant findings except for a serum creatinine value of 1.75 mg/dl. However, a CT scan showed a left adrenal nodule of 3 cm. After 6 months of watchful waiting, the nodule had increased to 4.3 cm. A CT-guided fine needle punction aspiration biopsy demonstrated a malignant lesion and a left adrenalectomy was performed., Results: Histopathological analysis of the surgical specimen showed adrenal metastasis of clear cell renal carcinoma. At 21 months' follow-up after adrenalectomy, there is no evidence of recurrence of the metastasis., Conclusions: This type of lesion is uncommon. We emphasize the importance of the analytical and hormonal studies, as well as CT and FNPA, in the diagnosis of this adrenal pathology. Like other authors, we advocate performing adrenalectomy in these cases.

Objective: To analyze the series of patients who underwent replacement of their penile prosthesis between years 1990 to 1999, due to any kind of complication., Material and Methods: 85 patients underwent implantation, 13 different prosthesis models being utilized. It was replaced (once or more) in 15 of these patients (17.64%). The mean age at the moment of the replacement was 51.5 years. The most frequent surgical approach was the infrapubic one., Results: A total of 32 prosthesis-replacement interventions were carried out. The main causes were: mechanical failure (13 cases, 40.62%); infection (10 cases, 31.25%); and corpus cavernosum perforation (five cases, 15.62%). Progressive increase of complications incidence with regard to the ordinal number of the implanted prosthesis was not observed. Best overall results: Mentor Mark II and AMS 700 Ultrex Plus. At present day, only eight (53.33%) out of 15 reimplanted patients use their prosthesis with normality., Conclusions: Those patients who undergo replacement of their penile prosthesis are potential sources for later complications. Their knowledge and proper handling is important in order to a progressive improvement of the final results, (above all if--such as our case--these ones are not suitable for conformity).