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Introduction:Osteoporosis is a chronic, progressive skeletal disease characterized by low bone mineral density and deterioration of bone structure. There are multiple risk factors, both modifiable and non-modifiable. The main complication is fractures, which is why it must be diagnosed early and in a timely manner. Material and methods:Fourteen articles and one book on the diagnosis and treatment of osteoporosis were chosen in order to compare the best plan to follow in these patients in the different bibliographies reviewed. Discussion:The gold standard for diagnosing osteoporosis is the measurement of bone density with the dual energy X-ray absorptiometry device, using the T-score. The use of different biomarkers is useful both for early diagnosis and for monitoring the reaction to treatment, but it is necessary to take into account that the main objective is to prevent the disease and to improve the quality of life of the patients. On the other hand, the main and early treatment consists of physical activity adapted to each patient, diet rich in calcium, magnesium and vitamins that promote bone health, the pharmacological part of the treatment has different areas that depends on the situation of each patient, considering gender such as estrogens and progestogens in postmenopausal women, tolerance to drugs such as Denosumab, and in general, bisphosphonate is used as the first line of treatment due to the increase in bone mineral density that it produces, helping to prevent fractures and improving the quality of life of each patient. Conclusion:Osteoporosis is one of the diseases that can prevent the realization of basic activities, for this disease there are different methods of diagnosis and treatment, the main objective is to detect risk factors and make an early diagnosis to avoid complications that entails, relying on tools such as the FRAX calculator and the use of biomarkers, all this to reach the conclusion of the investigation, to use the different options and tools to provide appropriate treatment, this publication being an update on the options that are available today to treat this condition.

Objective: Ureaplasma urealyticum and Mycoplasma hominis are the most common microorganisms found in the amniotic fluid of patients at risk for preterm delivery. However, culture techniques for gen...

Introduction A short right renal vein remains a challenge for renal transplant surgery, especially in the living donor. Our objective was to report on a new technique to solve this problem. Technical Considerations We describe our experience with the use of cryopreserved iliac artery grafts for right renal vein extension. Two renal grafts from living donors with a short right renal vein were subjected to an extension with a cryopreserved external iliac artery allograft. There were no perioperative or postoperative complications. There were also no changes in ischemia times. The renal implantation was performed easily and conveniently using our standard technique. For the first and second procedures, at 3 and 3.5 years after surgery, respectively, both vascular grafts maintain good patency, and the renal function of both recipients is optimal. Conclusion Tissue-banked cryopreserved cadaveric vessels can be a useful tool in renal transplant surgery. The use of a cryopreserved iliac artery for renal vein extension is a simple and effective new technique that can be added to the pool of surgical solutions for a short renal vein in living-donor kidney transplantation. To our knowledge, this is the first time that the use of such grafts for this purpose has been described.

Resumen Objetivo Valorar la situacion actual en el tratamiento del carcinoma renal con extension a vena cava inferior (VCI): Clasificacion, diagnostico, abordaje quirurgico, terapia adyuvante, factores de pronostico y supervivencia. Materiales y metodos Se revisan 19 casos de carcinomas renales con extension a VCI intervenidos entre enero de 1988 y agosto de 2008. Se valoran la edad, el sexo, lateralidad y funcion renal de los pacientes. Con respecto al tumor se valoran: estadio segun TNM y la clasificacion de Neves-Zincke. Se describe el abordaje quirurgico segun el nivel del trombo. Resultados Con una tasa de mortalidad perioperatoria del 10.5% y una media de seguimiento de 22,65 meses (rango 2- 79), sobreviven 5 pacientes; 11 han fallecido por la enfermedad; uno por otra causa y 2 se han perdido. Los pacientes metastasicos han recibido tratamiento adyuvante con Inmunoterapia o inhibidores de las kinasas. La supervivencia media es de 15,1 meses. Existen diferencias significativas a tres y cinco anos en la supervivencia de los pacientes estadiados como n0m0 vs resto (n+m0, n0m+, n+m+). no hay diferencias en funcion del nivel del trombo. Conclusiones El carcinoma renal con trombo en VCI es un tumor con alta mortalidad. El abordaje quirurgico del mismo es la opcion mas valida y precisa una correcta valoracion prequirurgica y el apoyo de un equipo multidisciplinar preparado y con experiencia. La supervivencia depende de la extension de la enfermedad.

To assess current management of renal cell carcinoma (RCC) extending into the inferior vena cava (IVC): staging, diagnosis, surgical approach, adjuvant therapy, prognostic factors and survival rate.Nineteen cases of RCC extending into the IVC undergoing surgical resection from January 1988 to August 2008 were reviewed. TNM staging and Neves-Zincke grading of the tumor were also assessed. Surgical approach depended on thrombus level.With a perioperative mortality rate of 10.5% and a mean follow-up of 22.65 months (range 2-79), 5 patients are still alive, while 11 patients died from the disease, 1 from an unrelated cause, and 2 were lost to follow-up. Patients with metastatic disease received adjuvant treatment with immunotherapy or kinase inhibitors. Mean survival was 15.1 months. Significant differences were found in 3- and 5-year survival rates in patients staged as N0M0 as compared to all other stages (N+M0, N0M+, N+M+). No differences were found depending on thrombus level.RCC with thrombus in the IVC is a tumor with a high mortality rate. Surgery continues to be the best option, and requires adequate preoperative evaluation and the support of an experienced and well trained multidisciplinary team. Survival depends on disease extension.

We report the case of a 61-year-old male with the incidental diagnosis of intrathoracic renal ectopia during the workup study for a possible lung mass.We performed a bibliographic review on the incidence, origin, clinical presentation and diagnosis of this type of renal ectopia.Chest x-ray showed a left posterior mediastinum mass. Bronchoscopy was performed showing signs of extrinsic compression with absence of neoplastic cells. CT scan revealed a left intrathoracic ectopic kidney with diaphragmatic hernia.Intrathoracic renal ectopia is a very unfrequent finding, often asymptomatic, frequently an incidental diagnosis that does not require treatment.

Objetivo: Se presenta el caso clínico de un varón de 61 años diagnosticado de manera incidental de ectopia renal intratorácica durante el estudio de posible masa pulmonar. Métodos: Se realiza una revisión bibliográfica de la incidencia, origen, clínica y diagnóstico de este tipo de ectopia renal. Resultados: En la radiografía de tórax se aprecia una masa en mediastino posterior izquierdo. Es practicada una fibrobroncoscopia apreciando signos de compresión extrínseca con ausencia de células neoplásicas. El TAC revela un riñón ectópico intratorácico con hernia diafragmática izquierda. Conclusiones: La ectopia renal intratorácica es un hallazgo muy infrecuente, habitualmente asintomático, diagnosticado con frecuencia de manera incidental y que no suele requerir tratamiento.

We report the clinical case of a 21-year-old male presenting with a 36 hour history of low flow priapism, its diagnosis and treatment.We performed a bibliography review on the etiology, physiopathology, diagnosis and treatment options.The patient underwent unsuccessful punction-aspiration of intracavernous blood with phenylephrine injection and cavernous irrigation with saline solution. A covernous-spongiosum shunt was performed subsequently, firstly using the Winter technique and followed by the AlGorab technique with a final positive response.The performance of a sapheno-cavernous shunt is an effective treatment for the low flow priapism resistant to usual medical-surgical treatment.

To report a rare case of testicular metastasis secondary to an infiltrative transitional cell carcinoma years after radical surgery.71-year-old male patient with history of infiltrative bladder tumor, status post radical cystoprostatectomy with urethrectomy. Seven years after surgery he presents with pain and swelling in the right testicle. Inguinal orchyectomy was carried out with the pathologic diagnosis of testicular metastasis of a high-grade transitional cell carcinoma. We perform a bibliographic review.The patient is disease-free twelve months after orchyectomy.Apart from leukemia and lymphoma, testicular metastases are extremely rare. The existence of testicular metastases means a metastatic dissemination to other organs, therefore chemotherapy could improve prognosis.

Objetivo: Se presenta el caso clínico de un varón de 21 años con priapismo de bajo flujo de 36 horas de evolución, su diagnóstico y su posterior tratamiento. Métodos: Se realiza una revisión bibliográfica de la etiología, fisiopatología, diagnóstico y diferentes tratamientos posibles. Resultados: El paciente es sometido a la punción-aspiración de sangre intracavernosa con inyección de fenilefrina y lavados con suero fisiológico sin éxito. Posteriormente se realiza una derivación cavernoesponjosa, primero según la técnica de Winter seguida de la de Al Ghorab, respondiendo finalmente a la realización de un shunt safeno-cavernoso. Conclusiones: La realización de un shunt safeno-cavernoso es un tratamiento eficaz para la resolución de un priapismo de bajo flujo rebelde al tratamiento médico-quirúrgico habitual.

Resumen.- OBJETIVO: Presentar un caso raro de metas-tasis testicular secundaria a carcinoma urotelial infiltrante anos despues de practicada cirugia radical.METODOS: Exposicion del caso clinico: paciente de 71 anos sometido a cistoprostatectomia radical con uretrecto-mia por tumor vesical infiltrante. A los siete anos debuta con dolor y aumento del tamano testicular derecho. Se le practico orquiectomia por via inguinal siendo diagnostica-do de metastasis testicular de carcinoma vesical de alto grado. y revision de la literatura publicada al respecto.Palabras clave: Tumor vesical infiltrante. Metastasis testicular. Tratamiento quirurgico.Summary.- OBJECTIVE: To report a rare case of testicular metastasis secondary to an infiltrative transitional cellcarcinoma years after radical surgery.METHODS: Case Report: 71-year-old male patient with history of infiltrative bladder tumor, status post radicalcystoprostatectomy with urethrectomy. Seven years after surgery he presents with pain and swelling in the righttesticle. Inguinal orchyectomy was carried out with thepathologic diagnosis of testicular metastasis of a high-grade transitional cell carcinoma. We perform a bibliographic review.RESULTS: The patient is disease-free twelve months after orchyectomy.CONCLUSIONS: Apart from leukemia and lymphoma,testicular metastases are extremely rare. The existence of testicular metastases means a metastatic dissemination to other organs, therefore chemotherapy could improveprognosis.

We evaluate the indication and results in the treatment of complex urethral stenosis by the Barbagli's technique.We retrospectively review 8 patients undergoing dorsal onlay urethroplasty with foreskin mucosa free graft. We analyze their preoperative characteristics. Mean stenosis length was 6.25 cm and the site was bulbar urethra in seven cases and penile in one. Mean preoperative flow was 8.78 ml/sec. We describe the technique and present our results.There are 87.5% of goods results (cure of the stenosis) with 22 months of mean follow-up. Only one patient required a second operation (end to end anastomosis) with good outcome.The dorsal onlay urethroplasty with foreskin mucosa free graft is an effective technique in long and complex urethral stenosis, and we consider it the technique of first choice in view of our results.

We report two exceptional cases of metachronous adrenal metastasis of renal cell carcinomas and perform a bibliographic review. After the evaluation of various features such as frequency, etiopathogenesis, diagnosis and follow-up of these patients we conclude that these metastases are rare, and they usually appear late in the evolution of patients with low stage renal cell carcinoma.Once reviewed the treatment and checked the absence of guidelines for the therapeutic management of these patients we propose surgery for the adrenal metastasis as well as adjuvant treatment with immunotherapy.

Objetivo: Valoramos la indicación y nuestros resultados en el tratamiento de la estenosis de uretra compleja mediante la Técnica de Barbagli. Métodos: Realizamos una revisión retrospectiva de 8 pacientes a los que se indica la uretroplastia dorsal con injerto de mucosa libre prepucial. Analizamos las características preoperatorias de los pacientes. La longitud media de la estenosis fue de 6,25 cm, la localización bulbar en 7 casos y peneana en uno. El flujo medio obtenido en la flujometría preoperatoria fue de 8,78 ml/seg. Describimos la técnica y presentamos los resultados obtenidos con la misma. Resultados: Con un tiempo medio de seguimiento de 22 meses tenemos un 87,5% de buenos resultados, entendiendo estos como la resolución definitiva de la estenosis. Sólo 1 paciente ha precisado un nuevo tratamiento quirúrgico (anastomosis término terminal), con buen resultado evolutivo. Conclusiones: Concluimos que la uretroplastia dorsal con injerto libre de mucosa prepucial es una técnica efectiva en estenosis de uretra larga y compleja y que por los resultados obtenidos, la consideramos técnica de primera elección en este tipo de estenosis uretrales.

Objetivos/Métodos: Presentamos dos casos excepcionales de metástasis suprarrenales metacrónicas de carcinoma de células renales y revisamos la literatura existente. Valorados distintos aspectos como la frecuencia, etiopatogenia, diagnóstico y seguimiento de estos pacientes concluimos que estas metástasis son poco frecuentes y suelen presentarse tardías en su evolución en pacientes con CCR con bajo estadios anatomo-patológicos. Resultados/Conclusiones: Revisado el tratamiento y constatando que no hay directrices en cuanto al manejo terapéutico de estos pacientes con metástasis proponemos la cirugía de la metástasis suprarrenal así como el tratamiento adyuvante con inmunoterapia.

We report one case of malakoplakia within a female urethral diverticulum.33-year-old patient who consulted for an asymptomatic vaginal tumor. Physical examination, blood and urine analysis and microbiology tests, as well as urethrocystoscopy and intravenous pyelogram were performed. With the diagnosis of urethral diverticulum we undertook surgical excision through a vaginal approach.Pathology revealed the typical characteristics of malakoplakia within the diverticular lumen.Malakoplakia is an infrequent inflammatory disease which involves the urinary tract in most cases. Urethra location is exceptional.

To report an exceptional case of multicystic mesothelioma of the testicular tunica vaginalis.A 72-year-old male was referred for study of a scrotal mass. Physical examination, blood tests, and ultrasound were performed prior to surgical excision and pathologic study of the lesion.The ultrasound study showed a multilobar cystic lesion near the spermatic cord. Pathology reported multiple 3-4 mm cystic formations, with rudimentary papillae covered by a hyperchromatic epithelium and vimentin (+), CD 34 (+) immunophenotype.Multicystic mesothelioma is a rare form of mesothelioma, easy to recognize but infrequent. This tumor generally affects the peritoneal surface of the pelvis and abdomen; although other less frequent locations have been described testicular location is exceptional. We report the case of a patient presenting with a multicystic mesothelioma of the testicular tunica vaginalis and review the diagnosis, pathology and treatment options for this type of tumor.

To check the possible relationship between testicular microlithiasis and testicular carcinoma in a patient in the one which previously we discovered a sonographic image of this condition. The etiopathogenesis, incidence and attitude are discussed.A 23-year-old male with a psychomotor retardation secondary to a chromosomopathy presented with orchitis. Scrotal ultrasound discovered testicular microlithiasis, described as many hyperechoic images. Thirteen months later a testicular cancer was found in a new ultrasound. Radical orchiectomy was performed. Currently the patient is under intense follow-up.The histopathological study showed mature teratoma and intratubular germ cell neoplasm.The testicular microlithiasis has been related with benign and malignant testicular pathology. However, this presence it is not sufficiently clarified and the urologist's attitude to a patient with testicular microlithiasis but asymptomatic is not enough studied.

To report a case of acute prostatitis as the first symptom of brucellosis.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.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.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.

To review the epidemiology, classification, prognosis, and therapeutic options of adrenal cortical carcinoma, mainly those of functional tumors.52-year-old male presenting with wasting syndrome and a big left adrenal tumor, as well as a possible inferior vena cava thrombus. The tumor was catalogued as non functional after functional studies. Surgical intervention was carried out including adrenal tumor excision, splenectomy, and cavotomy with thrombectomy of a tumoral thrombus coming from the left adrenal and renal veins. Infrarenal iliocaval thrombosis appeared during the postoperative period, requiring intensive anticoagulant therapy and ICU admission for control. Pathological diagnosis confirmed the existence of a high grade malignant adrenal cortical carcinoma. Patient died two months after surgery due to disease progression.Radiological tests are fundamental in the diagnosis of adrenal masses. In the case of big tumoral masses, it is important to rule out the existence of possible tumor thrombi in the adrenal vein territory, including the inferior vena cava.

To evaluate different methods for clinical evaluation of female urinary incontinence.A through bibliographic review has been carried out with special attention to the diagnostic tests of greater importance currently. Additionally we present the various female incontinence classifications.There is a growing interest in the use of questionnaires for subjective evaluation of symptoms. Among the objective tests for evaluation and quantification of the urine leaks the frequency/volume charts and the diaper test are very useful. Video-urodynamics and the late contributions from ultrasonography must be highlighted in the field of imaging tests. From the Urodynamics point of view, abdominal leak point pressure plays an interesting role in the diagnosis of female's urinary incontinence.After proper clinical evaluation, reasonable use of diagnostic tests and urologists experience will allow to set an exact diagnosis to offer the right treatment to the patients.

To analyse the importance of complete pelvic floor defects correction at the time of female stress urinary incontinence treatment.We review the basic principles in the treatment of genital prolapse. It is required to treat the anterior, central and posterior compartments. We describe the various anterior vaginal prolapse correction techniques and their basics depending on the association or not of urinary incontinence. The techniques for central compartment and posterior wall (rectocele) correction are also analysed. The recurrent vaginal dome prolapse and closure procedures are mentioned.We confront a multidisciplinary pathology in which urologists, gynaecologists, proctologists and pelvic floor physiotherapists can coexist and work together. Due to the variety of problems to be solved, it is necessary to standardise both the terminology and treatment, either surgical or not.

To record the findings from pelvic floor examination in an understandable way that permits the indication of a proper treatment.We review classic classifications, as well as genital prolapse stages and degrees. We also record the POPQ examination system which is the established standard nowadays.Based on different classifications we intend to set up a systematic examination starting at the anterior segment, following with central and posterior compartments without forgetting pelvic floor descent, anal sphincter and pelvic floor muscles evaluation.The evaluation of pelvic floor defects is complex, complicating the pathologic diagnosis in order to determine the proper treatment. The various attempts to standardise classifications find problems. Nevertheless, a detailed history, a systematic examination and multidisciplinary cooperation will be able to correct this dysfunction.

Interstitial cystitis is a nosological entity of which many etiological, diagnostic and therapeutic features were unknown until recently, so that we had the objective to review new knowledge acquired during the last decade to offer an update in the disease.A bibliographic review on interstitial cystitis is performed with special interest in national and international authors who have experience and large case series.Among the multiple etiopathogenical theories proposed in the past, the hypothesis to be highlighted, that is gaining strength, is the altered bladder urothelium permeability or hemato-urinary barrier alteration, with the aggression of toxic substances contained in urine in high concentrations like potassium. Epidemiologically, some authors think the disease is present in the population in a higher frequency than it is diagnosed, and it may be found in many women with the misdiagnosis of recurrent urinary tract infections. Regarding diagnosis, a new test is proposed to help clinical diagnosis: the potassium test, which consists in the endovesical instillation of this ion at high concentrations reproducing the symptoms. Finally, in the medical treatment it is demonstrated the efficacy of drug associations over monotheraphy (heparinoids, antihistaminic and antidepressant drugs), looking for the correction of the physiopathological abnormalities caused by the disease. Psicologic support and continuous information to the patient about the disease continue to be one of the mainstays of this multimodal therapy. New options like neural stimulation have appeared, although its results are not conclusive so that further studies must be done.New knowledge about interstitial cystitis allow us to better understand the chain of events happening in it. An early clinical diagnosis, now reinforced with a positive potassium test, is key to start medical treatment (drug combination) targeted to stop the pathogenic process, because it is more effective in the early phases of the disease. For that purpose, the Urologist must have this disease in mind.

We report three cases of pelvic lipomatosis, and from them we discuss its diagnostic and therapeutic considerations.Three patients, 71, 65 and 61 years old respectively, presented with irritative lower urinary tract symptoms. Intravenous pyelogram (IVP) and CT scan were performed as diagnostic procedures. After diagnosis an endoscopic evaluation including biopsies was performed to rule out tumours. All three underwent Bricker-Wallace II type urinary diversion resulting in good control of irritative symptoms. During follow-up one patient presented with an infiltrative bladder tumour.Pelvic lipomatosis is a rare disease; although traditionally has been considered benign it can result in urinary tract obstruction with severe physiopathological consequences. IVU and CT-scan are valuable to confirm the diagnosis. Lower urinary tract symptoms are controlled with urinary diversion without cystectomy but potential malignization of the bladder lesions should make us reconsider treatment.

Chagas disease is an important endemic disease in Latinamerica. The transmitions mechanism of Trypanosoma cruzi, etiologic agent of Chagas disease are multiples, this comunication is refering to congenital infection or transplacental infection. The aim of the present report was to describe the finding of trypomastigote in citochemical study of amniotic fluid from pregnant women with 32 weeks of gestation. Clinical findings of trypomastigote in amniotic fluid, shows the importance of microscopics tools in order to detect and diagnose de Chagas disease in pregnant patients. Diagnosis of Chagas disease by citochemical study is an unreported and unexploited technique, easy to perform in an ordinary laboratory, allowing the possibility to explore events of early detection in the newborn.