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Introduction: The crisis in the SARSCoV-2 coronavirus causing COVID-19 is putting health systems around the world to the test. In a great effort to standardize the management and treatment guidelines, the different health authorities and scientific associations have tried to issue recommendations on how to act in this new and complex scenario. OBJECTIVE: To synthesize the existing evidence and recommendations about urological emergency surgery during the COVID-19 pandemic situation. Furthermore, we propose a general action protocol for these patients., Material and Methods: The document is based ont he scarce evidence on SARS / Cov-2 and the experience of the authors in the management of COVID-19 in their institutions, including specialists from Andalusia, Cantabria, Madrid and the Basque Country. A web and PubMed search was performed using the keywords "SARS-CoV-2", "COVID19",  "COVID Urology", "COVID19 surgery" and "emergency care". A narrative review of the literature was carried out until April 30, 2020, including only articles and documents written in Spanish and English. After the nominal group technique modified due to the extraordinary restrictions, a first draft was made to unify criteria. Finally, a definitive version was made, agreed by all the authors on May 12, 2020., Results: General principles of action are set out, as well as specific recommendations for the most frequent urgent urological procedures., Conclusions: Given the exceptional nature of the situation, there is a lack of evidence regarding the optimal management of the patient with urgent urological pathology. The information is changing, as the epidemiological knowledge of the disease advances. The establishment of multidisciplinary surgical committees that develop and implement action protocols appropriate to the different resources and particular situations of each center is recommended. Likewise, these committees must individually assess each possible urological surgical emergency situation and ensure compliance with protective measures for the patient and other healthcare personnel.

Objective: To report one case of supernumerary testicle, a rare entity with around 100 cases published., Methods: 44-year-old male patient consulting for incidental discovering of a right scrotal mass. The diagnosis of polyorchidism was suspected after physical examination, ultrasound, and CT scan, and confirmed subsequently on surgical exploration and biopsy. Due to the absence of pathology and complete normal seminal lines decision was taken to not perform orchiectomy of the supernumerary testicle., Results: There are classifications for proper evaluation of polyorchidism, which state the relation between site of the testicle in relation to scrotum, existence or absence of independent epididymis and vasa deferentia for both testicles., Conclusions: Although remotely, there is a possibility of malignant degeneration of these testicles, so that surgical exploration and excision of the supernumerary testicles when their biopsy is doubtful in terms of dysplasia or if they present carcinoma in situ or they are a source of pain.

Objective: Neurological metastases secondary to urological tumors account for 12% overall. The ones derived from germ cells testicular tumors are exceptional in the age of cisplatin., Methods: We report one case of mixed germ cell tumor in a 49-year-old male patient treated with systemic chemotherapy during 18 months before presenting with severe central and peripheral neurological symptoms leading to death due to massive cerebral hemorrhage., Results: We describe three types of presentation of cerebral metastases in patients with testicular cancer. Type I present synchronically with the primary tumor. Type 2 are diagnosed after a period of remission after conventional cytostatic treatment. Type 3 metastases are diagnosed during the course of the disease and its treatment., Conclusions: Except unique metastases classified in groups 1 and 2, which are susceptible of surgery or radiosurgery, in which in response may be expected; the rest of lesions secondary to germ cell tumors have an ominous prognosis and outcomes, with short survivals.

Objective: To issue the existence of a variety of angiomyolipoma, named epithelioid, with different histological and clinic properties., Methods: We report the case of a 17 year old female, with Bourneville's disease, who was discovered to have a solid renal mass suggestive of carcinoma in a control CT scan, adjacent to other smaller masses identified as angiomyolipomas., Results: After several tumorectomies, the suspicious mass, 4 cm in size, was diagnosed as epithelioid angiomyolipoma, with immunohistochemical confirmation of capacity for HMB45, and negative vimentin and keratin., Conclusions: Despite the possibility of coexistence of adenocarcinoma and angiomyolipoma, the existence of an epithelioid variety cannot be discarded, mainly in patients with phakomatosis. The indications for surgery are the same than for the rest of renal masses. Nevertheless, follow-up criteria must be stricter due to the possibility of torpid outcome in terms of dissemination of this infrequent variety of angiomyolipoma.

Objective: To report one case of unusual testicular metastasis from a renal origin., Methods: 57 year-old patient with disseminated right renal cancer under treatment who presented bone metastasis and a painful nodule in the upper pole of the right testicle during his follow-up with medical therapy, making surgery necessary. The pathology result was clear cell adenocarcinoma., Results: Six months later the patient continues under oral Sorafenib without evidence of new metastatic implants., Conclusions: Testicular secondary metastatic tumors account for less than 1% of old testicular tumors. In patients in the fifth and sixth decades, mainly if they are affected by other neoplasias, testicular masses use to be metastatic implants. The most frequent origin is prostate.

Objective: To report a new case of exceptional metastases from a prostatic carcinoma., Methods: 64-year-old male with nine months history of disseminated prostate cancer, taking hormonal treatment and biphosphonates, who presents with rising PSA, facial dysesthesia and left exophtalmos. MRI recognizes the existence of a solid mass in the right maxillary sinus with involvement of the ipsilateral orbital floor, and another one in the left frontal sinus invading the roof of the ipsilateral orbit and also with orbital extraconal involvement., Results: Once the diagnosis was established hormonal maneuvers were performed and chemotherapy with docetaxel was administered achieving at the start of treatment measurable disease stabilization with biochemical remission of PSA levels, followed posteriorly by progression without changes in the metastatic images. Currently new cytoreductive therapy with docetaxel has been initiated., Conclusions: 1% of the prostatic tumors involve the head in their evolution. Most frequent metastases are localized in the brain and meninges, being the involvement of paranasal sinuses and ocular orbit extraordinary. The importance of these comes from the extension to the orbit and the eye in vicinity. Second line hormonal maneuvers, local radiotherapy and systemic chemotherapy will be necessary for control, although results are discouraging. In general, prognosis is poor, with short survival.

Objective: We report the case of the patient with metachronic thyroid metastasis of a renal adenocarcinoma., Methods: 61-year-old patient with the diagnosis of renal adenocarcinoma treated by radical nephrectomy (stage pT3bpN0M0) and subsequent interleukin-2 for twelve months presenting four years after surgery with a thyroid nodule displacing the trachea laterally, requiring left hemithyroidectomy., Results: Pathology reported a lesion made of clear cytoplasm tumor cells, with marked atypia and anaplastic areas, compatible with clear cell renal adenocarcinoma., Conclusions: Thyroid metastases are extremely rare, being renal tumors the most frequent origin. They present as painless nodules, cold in gammagram, with normal thyroid hormones. The treatment of choice is surgical excision, with a better prognosis the longer the time between the primary and the appearance of metastasis.