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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 evaluate P 53 and c-erb-2 overexpression as a prognostic factor for progression and survival in patients with renal pelvis and ureter tumors., Methods: Retrospective review of the medical records and pathology/immunohistochemical reports of 61 patients who underwent surgery for upper urinary tract urothelial tumors. Immunohistochemical studies were performed using the STREPTAVIDIN-BIOTIN-PEROXIDASE techniques with a LASAB kit (DAKO). Pearson's Chi square for 2 x 2 contingency tables and residues analysis were used for non continuous variables, with a confidence level of p < 0.05. COX multivariate analysis and survival curves were used for multiple variables association., Results: A higher P 53 overexpression was related with tumour dependent death (p < 0.001). These patients have their long term survival compromised. C-erb-2 overexpression is not statistically related to either proliferation or cancer specific death in upper urinary tract urothelial tumors., Conclusions: In our series P53 overexpression has prognostic value in upper urinary tract urothelial tumors, but c-erb-2 did has not prognostic value.

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.

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.

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.

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.

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

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.

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.

Objective: To analyze our experience in the management of complications of ureteroenteric reimplantation in patients undergoing urinary diversion by endourological techniques or open surgery, in order to identify a useful algorithm that takes the oncologic prognosis into account, as well as the probability of success., Methods: A retrospective study was conducted on 136 patients who had undergone urinary diversion from 1987-1998. Of these, 126 had transitional cell carcinoma, two had infiltrating carcinoma, two had a benign condition and 6 had undergone urinary diversion for patient comfort without cystectomy. The following techniques were utilized: cutaneous ureteroileostomy or Bricker technique (104 patients), Mainz neobladder (10 patients), ileal neobladder (15 patients), colonic conduit (5 patients) and cutaneous ureter (2 patients)., Results: Overall, 56 patients (41%) had some type of alteration at the ureteroenteric reimplantation site, but only 36 (26%) required intervention. The reimplantation techniques utilized were: the Bricker direct ureteroileostomy (26 patients), Le Duc (6 patients), Leadbetter (3 patients), and the direct cutaneous technique (1 patient). Patient mean age was 67 years (range 53-80). There were 35 males and one female. Seven patients required immediate reimplantation due to a persistent urinary fistula and 29 had late obstruction (more than 3 months), accounting for 21.3% of the cases undergoing urinary diversion. The antegrade endourological approach was utilized in 24 patients (5 nephrostomy alone and 19 stent or balloon dilatation). Dilatation was performed palliatively in 6 cases with extensive tumor spread. Permanent success was achieved in 5 cases (38%) and in spite of the initial success, there were 4 reobstructions. Open surgery was performed in 24 patients (66% of the complicated reimplantations); 5 of these patients had another pathology that warranted laparotomy, 7 required reimplantation early due to a fistula and two patients with a nonfunctioning kidney underwent nephrectomy. Ureteral replacement using the ileum was performed in 4 patients and direct reimplantation to the primary loop was performed in 6 patients. Good surgical results were consistently achieved., Conclusions: The complication rate of ureteral reimplantation is high in patients undergoing urinary diversion. Endourology has an important role in these cases, particularly in patients with a poor prognosis. Surgery achieves the best results. Although they may entail difficulty, complex cases such as extensive ureteral necrosis can be managed successfully.

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.