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The distance from the genitals to the anus, anogenital distance, reflects androgen concentration during prenatal development in mammals. The use of anogenital distance in human studies is still very limited and the quality and consistency of measurements is an important methodological issue. The aim of this study was to assess the feasibility and reproducibility of adult male anogenital distance measurements by two different methods. All men were attending an outpatient clinic at a university hospital and underwent an andrological examination and completed a brief questionnaire. Two variants of anogenital distance [from the anus to the posterior base of the scrotum (AGDAS ) and to the cephalad insertion of the penis (AGDAP )] by two methods (lithotomy or frog-legged position) were assessed in 70 men. Within and between coefficient of variations, intra-class correlation coefficients, two-way repeated-measures analysis of variance, and scatter and Bland-Altman plots were calculated. The two methods produced similar values for AGDAP but different estimates for AGDAS . Nonetheless, the overall agreement (ICC ≥ 0.80) was acceptable for both measures. Therefore, both methods are internally consistent and adequate for epidemiological studies, and may be used depending on the available medical resources, clinical setting, and populations., (© 2016 American Society of Andrology and European Academy of Andrology.)

Objective: To report a rare case of penile paraffinoma caused by the subcutaneous or intra-urethral injection of foreign substances containing long-chain saturated hydrocarbons. These were injected in order to increase the penis size which generated a chronic granulomatous inflammatory reaction. This is a rare practice in the western world., Methods: We present the case of a 32-year-old Bulgarian male who presented with a two-year history of elastic, slightly painful penis swelling after subcutaneous liquid paraffin injection. The proposed treatment was excision of the affected tissue and penile reconstruction in a two-stage procedure., Results: The operative procedure was successful and the patient had good aesthetic and functional results. Paraffin and other materials injected into the penis can produce many complications. Foreign body granuloma, skin necrosis, penile deformity, chronic and unhealed ulcer, painful erection, and the inability to achieve a satisfactory sexual relationship are some of the resulting complications. Intralesional or systemic steroids have been used in primary sclerosing lipogranuloma resulting in the disappearance of the granuloma, but in our opinion the treatment of choice should be radical excision, and, if necessary, secondary reconstruction of the penis., Conclusion: The injection of foreign substances to enhance penis size is currently an unjustifiable practice. However, it is still carried out, especially in Eastern Europe and Asia. In most cases surgical treatment is needed to treat the complications and the best modality seems to be radical excision together with follow-up.

Epidemiology supports the important role of nutrition in prostate cancer (PCa) prevention. Pomegranate juice (PJ) exerts protective effects against PCa, mainly attributed to PJ ellagitannins (ETs). Our aim was to assess whether ETs or their metabolites ellagic acid and urolithins reach the human prostate upon consumption of ET-rich foods and to evaluate the effect on the expression of three proliferation biomarkers. Sixty-three patients with BPH or PCa were divided into controls and consumers of walnuts (35 g walnuts/day) or pomegranate (200 mL PJ/day) for 3 days before surgery. Independently of the ETs source, the main metabolite detected was urolithin A glucuronide, (3,8-dihydroxy-6H-dibenzo[b,d]pyran-6-one glucuronide) (up to 2 ng/g) together with the traces of urolithin B glucuronide, (3-hydroxy-6H-dibenzo[b,d]pyran-6-one glucuronide) and dimethyl ellagic acid. The small number of prostates containing metabolites was likely caused by clearance of the compounds during the fasting. This was corroborated in a parallel rat study and thus the presence of higher quantities of metabolites at earlier time points cannot be discarded. No apparent changes in the expression of CDKN1A, MKi-67 or c-Myc were found after consumption of the walnuts or PJ. Our results suggest that urolithin glucuronides and dimethyl ellagic acid may be the molecules responsible for the beneficial effects of PJ against PCa.

Objectives: Multilocular cystic nephroma is a rare benign entity grouped among the cystic non genetic diseases, which usually presents with a clinical picture and radiological features indistinguishable from malignant neoplasias, making impossible to rule out malignancy preoperatively., Methods: We report two cases of multilocular cystic nephroma which were treated with different surgical attitudes despite their clinical and radiological similarities, because on the second case intraoperative pathologic study of the specimen was performed., Results: The diagnosis of multilocular cystic nephroma was confirmed in both cases, with the difference that radical nephrectomy was performed in the first case whereas the intraoperative study of the tumor in the second allowed to perform tumorectomy with renal parenchyma preservation., Conclusions: We consider that in the presence of a multiloculated renal mass of complex appearance and benign clinical behavior, the intraoperative study of the tumor will avoid performance of radical surgery.

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.

Objective: To analyze the influence of personal and histopathological factors as prognostic variables in the evolution of upper urothelial tumors submitted to radical surgery., Methods: Multifactorial retrospective study of a series of 61 patients submitted to radical surgery for upper urinary tract transitional cell tumors. Patient habits and histopathological factors are analyzed. The statistical significance of the different factors was analyzed using the Pearson chi-square test for the qualitative variables, with analysis of the residuals and Kaplan-Meier survival curves and statistical validation with the Mantel Cox test. The level of significance was p < 0.05., Results: A statistically significant correlation was found for tumor-related death and pathological stage, positive lymphadenectomy and positive lymphadenopathy on the CT (p < 0.05). The presence or absence of a history of smoking was not available for all patients and was therefore not evaluable. The most frequent reason for consultation was hematuria (39%). Tumor growth was mostly of the papillary type (79%), localization was mostly in the renal pelvis (30%) and the most frequent procedure was nephroureterectomy without endoscopic detachment (60%)., Conclusions: The pathological stage and a positive lymphadenectomy or the presence of positive lymphadenopathies on the CT were found to be prognostic factors in urothelial tumors of the upper urinary tract.

A histopathological and immunohistochemical study of a case of nephrogenic adenoma of the bladder associated to glandular cystitis is presented with a very similar immunostaining to adenomatoid tumors in other organs and probably of a mesothelial origin. Its pathogenesis seems to correspond to a metaplastic change of the bladder's urothelium through anomalous differentiation of the reserve cells faced with different irritating agents. Because of its benign characteristics, we think that treatment can be confined to endoscopic observation and conservative technique.

Objective: To present a case of urothelial tumor inside a simple ureterocele with a coexisting contralateral tumor that caused bilateral obstructive uropathy., Methods: Follow-up evaluation of a 74-year-old male patient with superficial tumor of the urinary bladder diagnosed 4 years earlier, revealed renal failure and bilateral obstructive uropathy. The complementary tests showed a simple left ureterocele containing a lesion suggestive of a tumor and a right ureteral tumor., Results: After biopsy confirmed coexisting urothelial disease at 3 levels (intraureterocele, contralateral ureter and in situ carcinoma of the bladder), the patient was submitted to cystoprostatectomy, nephroureterectomy and en bloc segmental ureterectomy., Conclusions: Multicentric synchronous urothelial tumors warrant a close and long follow-up of the entire urinary tract. Among the possible sites of presentation, few cases of tumors inside a ureterocele have been reported. The case described herein, with this uncommon site of presentation, is an example of panurothelial disease.

Objective: To report a case of urothelial tumor of the bladder in a 17-year-old patient that required emergency surgical treatment due to acute hematuria., Methods: The clinical history, anatomopathological and immunohistochemical findings are described., Results: A 17-year-old patient with no remarkable clinical history, consulted at the emergency services for gross hematuria of sudden onset that caused anemia and was refractory to conservative management. Patient evaluation disclosed a bladder lesion that required immediate resection via the transurethral approach to control bleeding. The pathological analysis demonstrated a grade I, Jewett stage 0, pTaN0M0 transitional cell carcinoma of the bladder., Conclusions: Urothelial tumors of the bladder are uncommon in patients less than 40 years old. The case described herein is uncommon because of the patient's age and the form of presentation of the tumor, which required emergency surgical treatment. Follow-up and subsequent therapy should be based on the pathological characteristics of the tumor rather the age of the patient.

Objective: To describe two cases of symptomatic syringocele diagnosed in adult patients., Methods/results: Two cases of symptomatic syringocele diagnosed in adult patients that both consulted for obstructive voiding syndrome, are described. Diagnosis was made by retrograde urethrography. An incision extending to the outlet of the syringocele was performed in both cases. Good results were achieved and the symptoms remitted., Conclusions: Syringocele is the cystic dilatation of Cowper's gland. It is generally congenital and a majority of the symptomatic cases (urinary infection, obstruction or hematuria) are diagnosed in childhood. The diagnosis is based on the findings of retrograde urethrography and urethroscopy. Treatment is by urethroscopic incision or marsupialization of the syringocele. Some cases may require open surgery via the perineal approach.

Introduction: 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., Material and Methods: 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"., Results: 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., Conclusions: 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.

Objective: One of the basic characteristics of urothelial carcinoma is its tendency to synchronous or metachronous multifocality. Thus the need to explore the entire urinary tract of patients with urothelial neoformations. The aim of this article is to study the tumors of the upper urinary tract that appear synchronously with infiltrating carcinoma of the bladder. The clinicopathological characteristics and the morbidity and mortality of en bloc surgery of both tumors are analyzed., Methods: A retrospective study was carried out on 170 radical cystectomies for infiltrating bladder tumor performed in our department over a 13-year period. Patient history, clinicopathological characteristics, complementary tests, type of surgery performed, postoperative complications and follow-up were analyzed., Results: Tumor of the upper urinary tract appeared in 14 (1 bilateral) of these patients and were synchronous in 10 cases. All patients were male; mean age 63 years. Three were localized in the pelvis, 2 in the proximal ureter and 6 in the distal third. Diagnosis was made by IVP in 6 patients and by US and antegrade pyelography in the other 4 patients. Nephroureterectomy and radical cystectomy were performed en bloc in 8 cases; 6 had a Bricker procedure and 2 ileal substitution. Salvage radical cystectomy + distal ureterectomy were performed in the other two patients. Two patients submitted to en bloc surgery had postoperative complications; one presented prolonged ileua and the other required surgery for retroperitoneal hemorrhage. The two patients submitted to palliative surgery died of and sepsis during the postoperative period. At 33 months' mean follow-up, 3 patients have shown tumor progression., Conclusions: There is a high proportion of synchronous tumor of the upper urinary tract in our series of patients with infiltrating carcinoma of the bladder undergoing radical cystectomy, therefore we consider it necessary to explore the entire urinary system. Surgical removal of both tumors en bloc does not increase the morbidity and mortality.

Objective: To present an additional case of mucinous adenocarcinoma of the prostate gland. The histochemical and immunohistochemical findings demonstrating its prostatic origin are presented and the literature is reviewed., Methods/results: A 53-year-old male with no previous symptoms or signs presented for a prostatic examination. DRE was normal and PSA was 35 ng/ml. A prostate biopsy demonstrated adenocarcinoma of the prostate with a Gleason score of 3 + 3. Complementary studies were negative. The patient was submitted to radical prostatectomy. Anatomopathological analysis of the surgical specimen demonstrated a prostatic mucinous adenocarcinoma. At one-year follow-up, the patient is alive and disease-free and PSA values have returned to normal., Conclusions: Mucinous adenocarcinoma of the prostate is a rare anatomopathological variant whose natural history and prognosis are not well-known. This tumor type generally does not respond to any treatment and is hormone-resistant.

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.

Objective: Four additional cases of malignant priapism or priapism secondary to penile metastasis from urogenital tumors are presented and the literature is reviewed., Methods: Chest and abdominal radiological evaluation, cavernosal and abdominal US, abdominal and pelvic CT and MRI, and cavernosal biopsy were performed for the localization and staging of the primary tumor., Results: Conservative palliative management achieved a survival of only a few months in three of the patients with tumor dissemination to adjacent vital organs. Radical surgery was performed in one patient with tumor localized to the genital area. Currently, this patient has no clinical symptoms, although the follow-up is only 4 months., Conclusions: Malignant priapism is rare and usually secondary to GU tumors. The prognosis is poor since it generally indicates the presence of multiorgan metastasis. However, the prognosis is better for single metastasis, which is an indication for radical surgery.

Objective: To present three illustrative cases of pyeloureteritis cystica and review the literature., Methods: Three illustrative cases diagnosed at our department are described. Patient history, clinical features, diagnostic procedures and treatment are analyzed and the literature is reviewed., Results: Our patients had no specific symptoms. All three patients had urinary tract infection with pyeloureteral involvement, which was bilateral in two cases. One of these patients had a long-indwelling catheter., Conclusions: Pyeloureteritis cystica is a benign and uncommon condition whose etiology is not well-known. It is generally associated with chronic infection and inflammation, and may be difficult to distinguish from other filling defects of the urinary tract. Due to its benign nature, treatment must always be conservative and close follow-up is recommended.

Trigonocervicotomy is a barely invasive technique for the treatment of infravesical obstruction, first introduced in the 60's by Turner-Warkic and Orandi. To achieve good results with this procedure, the selection criteria must take into account a series of parameters such as age, sexual activity, PSA, prostate weight (below 30 grams) and others. In addition to its low morbidity, a larger percentage of patients preserve ejaculation than with the use of other techniques, also the neck sclerosis rate being lower as seen in all our series and expertise. The efficacy of this technique was studied on 100 patients.

Presentation of eight cases of urinary candidiasis in patients who underwent radical cystectomy and were managed using by-pass of the urinary tract, oral antifungal therapy and solutions in the way of intermittent instillation through nephrostomy catheters.

Analysis of the infiltrant tumours of the bladder diagnosed in our service between 1986-1996 both inclusive, with associated tumour of the upper tract during its evolution. From a total of 262 infiltrant transitional tumours of the bladder and 52 transitional tumours of the upper urinary tract, 8 patients were found to have both types of tumours in association, which accounted for 3.05% of all infiltrant vesical tumours. Mean age of our patients, all male, was 65. The pathological anatomy of the upper tract tumours was: 4 pT1 and 4 pT3. 75% presented relapsing tumours of the bladder, 50% had a background of bladder Cys, 87.5% were multifocal vesical tumours and 100% were larger than 3 cm. In addition, 62% cases were ipsilateral to the tumours of the upper urinary tract. It can therefore be concluded that for tumours of the bladder, multifocality, relapse, presence of vesical Cys and tumour size, are all concurring features when association of these two types of tumours occurs.

Objective: To analyze the association of congenital bilateral agenesis of the vas deferens and cystic fibrosis., Methods: Three azoospermic patients with surgically confirmed congenital agenesis of the vas deferens in whom a molecular genetics study had been performed to discard the more common mutations of cystic fibrosis are described and the literature reviewed., Results: All patients showed azoospermia. The molecular genetics study showed one of the patients to be a heterozygotic carrier of G542X and no other mutations like the remaining patients., Conclusions: 15% of patients with azoospermia have chromosomal anomalies. Recently, it has been reported that 50%-65% of patients with congenital bilateral agenesis of the vas deferens have mutations for the CFTR gene, with more than 400 reported. Patients with bilateral agenesis and their partners should be screened for cystic fibrosis prior to any in vitro fertilization techniques.

Objective: To review the literature on priapism following intracavernous injection of PGE1, its management and the physiopathological mechanisms involved., Methods/results: The literature on PGE1-induced priapism available on Medline is reviewed and two cases treated at our hospital are described. The diagnostic and therapeutic algorithms are presented. The relationship between drug use and priapism is difficult to establish since patients with the same history who received the same dose of Alprostatil did not develop priapism., Conclusions: Although infrequent, treatment must be instituted urgently since there is generally low flow.

Presentation of one patient with a highly infrequent association of transitional cells carcinoma and renal cells adenocarcinoma synchronically developed in the same renal unit. There has been very few cases diagnosed up to now, and only around 25 have been described in the literature. There is a clear predominance of males versus females, with haematuria being the most frequent sign present in 90% cases. Elective complementary examination is CT and the choice treatment can be either nephroureterectomy or extended nephrectomy based on early suspicion of transitional cells carcinoma or renal cells adenocarcinoma.

A series of 60 cases of tumours of the Upper Urinary Tract (UUT) diagnosed in our centre between 1987-1996 and affecting 57 patients is presented. Patient's mean age was 63.7 years, males being clearly predominant, 4:1, there was no predominant laterality and the preferential location was the renal pelvis. Fifty-two (52) out of all tumours were transitional, 1 was a fibroepithelial polyp and 2 were metastasis from prostate and colon cancers. Pathoanatomy of the remaining cases is not known since no surgery was performed, although the cytologic diagnosis has identified them as transitional tumours. Our series shows a significant association to other transitional tumours as demonstrated by the existence of 2 cases with a background of UUT tumours and other 31 cases associated to transitional tumour of the bladder. Haematuria was the predominant sign (54%) and UIV the leading examination technique. Nephroureterectomy was the most commonly used therapeutical approach. UUT appear to be highly predominant in our environment, with a clear male predominance and preferential location in the renal pelvis. Haematuria continues to be the most frequent presentation sign and UIV the exploratory technique offering better performance in the diagnosis. Also a high association was found to other types of transitional tumours, the diagnosis and follow up of which allowed us to diagnose a large number of tumours of the upper tract.

Objective: To analyze the incidence of non-urothelial neoplasms in patients with infiltrating bladder tumor submitted to radical surgery., Methods: A retrospective study was conducted in patients who underwent radical cystoprostatectomy for an infiltrating bladder tumor from 1987-1996. The pathological and follow-up data were analyzed., Results: Of 120 patients submitted to radical cystoprostatectomy for an infiltrating bladder tumor, 23 (19%) had an associated non-urothelial neoplasm: 14 (61%) were metachronous and 9 (39%) were synchronous. Two patients had two secondary tumors (9%)., Conclusion: We have found a high incidence of non-urothelial tumor in patients with infiltrating bladder tumor. By order of frequency, these were prostate cancer, gastrointestinal cancer, pulmonary cancer, etc. Studies have ascribed the association of prostate and bladder cancer to the deletion of suppressor genes.

The infection caused by the Human Immunodeficiency Virus (HIV), a retrovirus, leads to a progressive decline and to the suppression of cell-mediated immunity favouring the development of opportunistic diseases and potentially fatal neoplasias which are practically innocuous in individuals with an intact immunologic system. The number of AIDS cases recorded in Spain until March 1997 was 45,132, with a revised mortality rate of 58%. Cases in Murcia total 713 up to October 1997, of which 217 patients are being monitored in the AIDS Unit in our centre, 414 individuals have died in the region. It is well know that about one third of patients with diagnosed AIDS or who are HIV carriers will develop some type of genitourinary lesion, either as a result of a renal disorder, concurrent or not with HIV, or any other condition directly related to the infection. This is a report on our Service's experience in the treatment of HIV patients with genitourinary symptoms that, in a total of 15 cases, required our intervention. Emphasis is placed on the incidence of nephrolithiasis secondary to therapy with protease inhibitors over the last few months following introduction of this new therapeutic tool, prostatitis due to salmonella, and inlaid cystitis among others.

Vesical inverted papilloma (IP) is a transitional disease most commonly found in the bladder, representing a small percentage within the group of vesical neoformations. Although of benign behaviour, some authors advise that a relatively strict monitoring should be used considering its high rate of proliferative activity. It mainly affects males in their fifth to seventh decade, and it presents as any other transitional tumour. In about one fourth of the cases a transitional carcinoma becomes associated throughout its evolution, thus supporting the theory of periodic monitoring.

Objective: To report an uncommon case of familial Mediterranean fever with urological manifestations., Methods/results: A case of recurrent hydrocele in a patient with familial Mediterranean fever is described., Conclusions: Although familial Mediterranean fever is characterized by an acute febrile stage and involvement of the serosa, it may manifest as recurrent hydrocele due to involvement of the urological serosa, as in the case described herein.

Utriculocele is the engrossment of the prostate utricle with occlusion and/or cystic formation, sometimes including the ejaculatory conducts. We report three patients diagnosed with utriculocele with different presentation forms: hypospermia, haematuria and mictional syndrome, and the treatment used. Theories on their formation, clinical presentation forms described in the literature, diagnostic means, most frequent associations, and different therapeutic alternatives are all discussed as well as a revision of the reported cases.

Eosinophilic cystitis (EC) is a clinical-pathological entity characterised by the transmural infiltration of the bladder. It shows as an irritative mictional syndrome, though the most common sign is haematuria. Endoscopically it appears as an intravesical mass and is usually mistaken for a transitional tumour of the bladder. There has been many etiologies involved but not one single factor has been identified as responsible for the condition. Medical approach is the most appropriate initial treatment, but since the condition is so often mistaken with vesical tumoration, the first therapeutical attitude in most cases is Transurethral Resection (TUR) which, though more aggressive, is therapeutic, haemostatic and provides material for the pathoanatomical diagnosis.

Objective: To describe a case of rupture of the corpora cavernosa demonstrated by intracavernosal PGE1., Methods/results: Herein we describe a patient with fracture of the penis in whom the degree of injury could not be determined by questioning and clinical inspection. The artificial erection test with intracavernosal PGE1 was utilized to evaluate the ruptured corpora cavernosa., Conclusion: Intracavernous PGE1 is useful in the diagnosis of rupture of the corpora cavernosa and has minimum side effects.

Flutamide is a non-steroidal anti-androgen used in the treatment of prostate cancer, usually in combination with LHRH-analogs. Incidence of hepatotoxicity associated to Flutamide in the literature is very low and does not exceed 0.18%. Between February 1989 and December 1994, the FDA was reported 20 cases of patients who had died and 26 who had been hospitalized due to hepatotoxicity secondary to Flutamide. We contribute two cases of patients diagnosed with prostate adenocarcinoma following treatment with flutamide and LHRH-analogs who presented liver failure; one with signs and symptoms of acute hepatitis that recovered after discontinuation of the drug, and a second one who developed micronodular cirrhosis and later died of icteroascitic decompensation and hepatorenal syndrome. Including a review of the literature, the paper comments on the likely biological mechanisms for liver toxicity caused by Flutamide. The authors conclude that clinical and laboratory monitoring of patients who either will receive or are receiving treatment with Flutamide is necessary, and withdrawal of drug imperative as soon as certain symptoms of hepatic dysfunction become apparent.

PSA is currently the best marker in the diagnosis and staging of prostate cancer, although it has a low specificity when trying to distinguish between BPH and prostate cancer. Between January 1994 and December 1995, 243 BPHs were diagnosed after prostate TUR and retropubic adenomectomy. A selection of 131 cases were analyzed based on PSA higher than 4 and normal rectal examination pre-surgery. After surgery PSA was determined again with a time interval from the earlier one ranging between 103-211 days, noting that in about 70% cases PSA levels were normalized and 64% of these also presented focused acute prostatitis, chronic prostatitis, prostate infarction, lithiasis or areas of abscess formation. In spite of a significant number of patients with high PSA levels, this elevation should be interpreted cautiously considering the large percentage of cases where posterior pathological anatomy is a sign of BPH. We believe that among the conditions that could justify such abnormal PSA elevations are those described of areas of chronic or acute prostatitis, prostate infarctions, areas of abscess formation and presence of intraprostate lithiasis.

One of the anomalies affecting the ureter is the blind bifid cranial ureter, which is truly an uncommon alteration. Clinical signs and symptoms are very ambiguous, and sometimes the condition is diagnosed accidentally while conducting an urographic examination. The aim of this paper is simply to contribute a new case to the existing literature.

Presentation of one case of relapsed urethral stenosis in a penoscrotal location where after several failed therapeutical approaches, the final decision was to place a Wallstent endoluminal prothesis. The patient underwent several endoscopic internal urethrotomies and urethroplasty in two occasions, developing complications: urethral calculi, hair follicles requiring cauterization, repeat infections and relapse urethral stenosis, which finally lead to the decision of fixing a intraluminal stent even if in an unusual location (penoscrotal). The result, 40 months after implantation, is both subjectively and objectively better, with a good mictional calibre and satisfactory erection which allows the patient to have sexual intercourse. The Wallstent prothesis can be the ultimate alternative in those cases of "ill-treated" urethra where other techniques fail.

Case report of a giant retroperitoneal liposarcoma which presented with a picture of acute abdomen resulting from a massive tumoral haemorrhage. Diagnosis was achieved by ECO and CT, and was confirmed by Pathological Anatomy. Treatment was surgical, performing tumour removal plus polar nephrectomy of the affected side. The patient evolution was favourable. The standard methods of diagnosis and prognostic factors are commented.

Objectives: To describe our experience with urethral stents in the treatment of recurrent strictures., Methods: From March 1991 to July 1992, 17 Wallstent and 1 Strecker self-expandable stents were implanted. Patient follow-up ranged from 11 to 40 months. The results were analyzed on the basis of the clinical, urodynamic, radiological and cystoscopic findings., Results: Of the 18 patients in whom a urethral stent had been implanted, 2 (11.1%) required removal of the stent, 1 patient was lost to follow-up, 2 had died during follow-up from causes unrelated with the procedure. At 40 months follow-up, late complications were observed in 8 patients (47%): intraprosthetic excrescence, erectile disorders, pollakiuria, lithiasis, episodes of RAO, or incontinence., Conclusions: In our view, the implanted urethral stent is a valid alternative when other techniques are not feasible or have failed (dilatation, internal urethrotomy, urethroplasty...), but we should not forget the long-term complications.

The Ovarian Vein Syndrome has been the subject of controversy ever since first described as such by Clark in 1964. This is an uncommon entity within urologic sings and symptoms which appears as a recurrent nephritic colic coinciding with menstruation or during the immediately preceding days. The authors review a clinical case from our Urology Service, including some considerations on the case.