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Objective: To present two cases of infrequent renal masses, trying to achieve the diagnosis before surgery., Methods: We describe a case referred from the Department of Hematology in which bilateral perirrenal masses were described in the CT scan; after biopsy they where classified as extramedullary hematopoietic tissue. The other case was a patient presenting to the emergency room with dyspnea. CT Scan showed lungs with multiple cysts, chylothorax and a cystic-solid mass in the left perirenal space. In the lung biopsy they reported lung lymphangiomatosis, so we didn't perform renal biopsy., Results: Most renal masses are renal carcinomas (856%). The less common diagnosis are sarcomas, lymphomas, upper urinary tract transitional cell carcinomas, metastases of other primary tumors, the Erdheim-Chester disease, the Castleman disease and benign tumors. All these diseases might show similar images in the CT scan and MRI, being the biopsy and histological study necessary for the diagnosis, Conclusions: Perirenal extramedullary hematopoiesis and perirenal lymphangioma are rare diseases that need a pathologic study for their diagnosis.

Ultrasonography has demonstrated to be a precise test with high sensitivity and specificity. The urologist is the most capable professional to obtain the maximum effectiveness of this technique, so that the availability of ultrasound machines in urology departments rationalizes and limits the demand of ultrasound tests, diminishes significantly the indication of radiological tests and the number of cystoscopies, being an indispensable element in high-resolution office consultations. We report the statistics of the use of ultrasound in our department, with the disappearance of the demand of ultrasound tests from the urology outpatient clinic to the radiology department. The use rate is high, reflecting the functional criteria for use of the ultrasound equipment. In the economic analysis we found there is an almost complete absence of controlled clinical trials comparing the cost effectiveness of imaging tests in urology. There are not cost studies comparing ultrasounds performed by the urologist with those performed by radiologists.

Objectives: To determine the clinical utility of free/total PSA ratio and PSA density in the early diagnosis of prostate cancer (patients with serum PSA between 4 and 10 ng/ml) and to determine the differences, if any, in the free/total PSA ratio in patients with cancer and those with benign prostatic hyperplasia (BPH)., Methods: A prospective and descriptive study was conducted on 61 patients with low grade obstructive symptoms and total serum PSA between 4 and 10 ng/ml (group 1), and 42 patients who underwent prostate surgery and had an anatomopathologically confirmed diagnosis of BPH (group 2). Free and total PSA were determined, as well as prostate volume by transrectal US, in all cases. Prostate biopsy was performed in all patients with a total PSA value between 4-10 ng/ml. The sensitivity, specificity, positive and negative prognostic values of free/total PSA ratio and PSA density were analyzed., Results: The mean age of the patients in group 1 was 67.7 years and 68.3 years in group 2. The mean prostate volume by US was 55.2 and 47.1, respectively (n.s.). The mean total PSA was 6.39 ng/ml for group 1 and 5.73 ng/ml for group 2 (n.s.). No significant difference was found between the mean free PSA values of both groups. However, the free/total PSA ratio and PSA density were significantly different (p < 0.000). In group 1 (total PSA 4-10 ng/ml), prostate biopsy was positive in 32.8% of the patients. In this group of patients, there were no significant differences in the parameters analyzed. Application of different cutoffs for both tests showed a higher clinical utility for the 0.24-0.30 range., Conclusions: At similar mean prostate volume and mean total PSA, significant differences were found in the free/total PSA ratio and PSA density of patients submitted to surgery for BPH and those with a total PSA value of 4-10 ng/ml. However, these results were not observed when patients with PSA of 4-10 ng/ml were analyzed for presence or absence of evidence of malignancy in the prostate biopsy.

Case report of an embryonary paratesticular rhabdomyosarcoma. The paper includes a literature review and discusses the current diagnostic, prognostic and therapeutic criteria analyzing in detail the current role of retroperitoneal lymphadenectomy and the value of adjuvant radiotherapy or chemotherapy.

Clinical record case of a retroperitoneal seminoma with "burned-out" phenomenon in the testicular primary, in a 38 year old male with no background of interest who consults for a picture of left nephritic colic. The ipsilateral testis study detects a fibrotic area with hyalinosis and hemosiderin deposits, although there are no tumoral debris, compatible with the "burned-out" phenomenon. Management is through surgery plus a chemotherapy protocol. Discussion of the diagnostic algorithm of retroperitoneal tumours and the literature on extragonadal germinal tumours.

Explanation of one case of abscessified brucellar prostatitis in a 44-year old patient. The emphasis is placed on the high incidence of brucellosis in the province of Soria and the rarity of the prostatic location of this condition. Also, a revision is made of the diagnostic methodology and current therapeutical approaches. The crucial role of the endocavitary ultrasound techniques both for diagnosis as well as treatment and case follow-up is highlighted.

Presentation of one case of renal Brucelloma in a 61-year old patient. The emphasis is placed in the pathophysiology of the condition and the extraordinary rarity of its renal location. Also an explanation is proposed for the diagnostic methodology and the dissociation, typical in chronic brucellosis, of the different serologic testing. Finally, the increased incidence experimented by this condition in our environment, which involves the reappearance of clinical pictures today thought eradicated, is pointed out.

A retrospective study of orchiepididymitis, diagnosed and admitted to our Unit over the 1989-94 period was conducted. there were 125 orchiepididymitis, of which 16 (12.8%) had a brucellar etiology, and three had simultaneously become abscessified (18.75%). Considering that our working area is located within an endemic region, and even more, our province has the country's highest incidence rate (112.8/100000 inh.), this prompted us to study the conditions' morbidity in the testicular location, while we make a superficial revision of this disease. Brucellar orchitis is a diagnostic option to be taken into account in endemic regions, and the clinical picture associated to the orchiepididymal process should make us suspect its diagnosis and trigger follow-up of these patients.

Objective: The sonographic anatomy of the urethrovesical anastomosis in patients submitted to radical prostatectomy is described herein., Method: Video sonographic voiding cystourethrography was performed using a 7.5 MHz linear-array transrectal probe., Results: The longitudinal ultrasound scans of the urethrovesical anastomosis during the different phases of micturition are shown., Conclusion: Video sonographic voiding cystourethrography is useful in the evaluation of the urethrovesical anastomosis after radical prostatectomy, at rest and during micturition. It also permits detecting any postoperative complication as hematoma, abscess or early recurrence.

Presentation of a new case of Suprarenal Myelolipoma, its singularity being the urinary clinical presentation. Brief review of the literature, placing special emphasis on the Spanish references.

Presentation of a study, based on a survey conducted among urology patients on the extend of their wish to know the truth of their illness. The results indicate that the majority of patients DO want to know the truth, although such option is mediated by many environmental factors (such as age, sex, place of residence, education level, etc.). Some remarks are made on the lack of literature on the subject and the belief that awareness of this fact may be useful in the currently difficult physician-patient relationship.

Presentation of one case of renal carcinoma which interest lies in the osteoblastic differentiation presented by the sarcomatoid component. The rarity of this tumour type in major series of sarcomatoid renal carcinomas published is emphasized. Also, a description of its most relevant singularities is made.

A 54-year-old male who consulted for an episode of right-sided nephric colic is described. A urological ultrasound scan disclosed grade I hydronephrosis in the upper half of the right kidney and an anechoic tubular image ending in the prostate gland. A subsequent urographic evaluation confirmed the diagnosis of ectopic ureter in prostatic urethra.

Presentation of one case of renoduodenal fistula due to pyonephrosis in an oligophrenic female patient. In view of the patient's characteristics, the clinical picture was highly developed at presentation which resulted in failure of the conservative treatment. We emphasize the diagnostic and therapeutical methodology followed. Also, we include a literature review on this disease.

Evaluation of the diagnostic capacity of lineal ultrasound examination of a male's vesical neck and urethra, known as video cysto-urethro-sonography. The tests has been shown to have high diagnostic accuracy (93.6%), with 93.4% overall sensitivity and 94.4% specificity, in a selected group of men with suspicion disease in the cervico-prostate-urethral area (prevalence, 80.9%). The technique, nevertheless, is not exempt from limitations, including anal or ureteral meatus stenosis, as well as highly obstructive prostate adenoma (where maximal vesical repletion necessary to carry out the examination may decompensate the picture, and lead to retention), or the inhibition of the voiding urge referred by certain individuals when they have to urinate in uncomfortable circumstances.

Analysis of major methodological aspects of real time ultrasound examination of a male's vesical neck and urethra, known as video cysto-urethro-sonography (VCUS). Consideration must be given, when studying the posterior urethra, to the need of suitable vesical repletion, as well as to the existence of two likely limitations for conducting the test, such as: major anal stenosis, which would prevent introduction of the transrectal transducer; and inhibition of the voiding urge referred by some patients when they have to urinate in uncomfortable circumstances. As for the study of the anterior urethra, the most interesting technical items are: avoidance of air bubbles entering with the physiologic serum, which could artefact the examination; nonexertion of excessive compression on the urethra with the transducer, which may lead to false stenosis; and understanding that a major meatus stenosis may preclude test completion due to impossibility of introduction of Foley's catheter, necessary to obtain backward urethral distension with physiologic serum.

Presentation of one study on the incidence of fibrino-necrotic ulcers in patients undergoing endovesical chemoprophylaxis with mitomycin C. A description is made of these lesions evaluating their likely relationship to infectious processes. The paper concludes stating the need of endoscopic monitoring and the absence of proven prognostic factors.

We report an uncommon case of ureteral ectopia opening to the contralateral vulva in a 20-year-old patient with a long history of night and day urinary incontinence. Since the ectopic ureter drained the superior pelvis of the right kidney, pyelo-pyelic anatomosis was performed and the defunctionalized ureter was abandoned. A completely satisfactory result was achieved. We briefly discuss this rare pathology and describe the simple, yet effective treatment.

Contribution of one case of spontaneous vesical fracture in a patient with no urinary pathological background. Presentation of this picture is highly uncommon. In this case, a major alcoholic intake stands out as the unleashing factor which provoked vesical overdistension with an intraperitoneal posterior fracture. A review is made of the various etio-pathogenic mechanisms which can originate this pathology, as well as the diagnostic and therapeutic methodology.

Renal vein thrombosis is a rare pathology whose diagnosis entails difficulty. A case of renal vein and inferior vena cava thrombosis is described herein. We briefly discuss its association with the nephrotic syndrome, the diagnostic methods and therapeutic approaches.

The appraisal of the prostate weight with transrectal ultrasound scanning is simplified with the use of a simple mathematical formula of an ovoid volume. Such a method does not prolong the examination time but provides an acceptable reliability, and therefore it can be used as a substitute to planimetry, more subject to the observer's error and more time consuming for the physician, even when part of the examination can be made by replaying the video.

The presence of melanin in the prostatic gland's stroma is a histopathological finding of extreme rarity. It receives the name of blue nevus as a result of its similitude to the skin's blue nevus. The paper describes the finding of melanin stores in the fibromuscular stroma of a patient's prostate and reviews the theories on its source.

The use of the new cytostatics for prophylactic therapy of superficial bladder tumor recurrence has been associated with fibrino-necrotic ulcers and eosinophilic cystitis. We underscore the problems in making the differential diagnosis which sometimes present with true tumor necrosis. We describe the characteristic features of both pathological conditions which permit these to be recognized before endoscopic maneuvers are performed. Their presenting features and course are analyzed.

A series of 13 patients with primary gastric lymphoma treated between 1981 and 1990 are presented. Primary gastric lymphoma made up 4.8% of all gastric tumors treated during this period of time. Histologically, there were 3 lymphoplasmocytoid and 3 centroblastic forms (according to Kiel's classification) followed by 2 lymphocytic and 2 centrocytic-centroblastic. According to Mushoff's classification. 4 patients belonged to stage I E, 3 to II E1, 3 to II E2, 2 to III E, and one patient to stage IV E. In all cases gastrectomy was performed (9 subtotal and 4 total) although 3 out the former were palliative (23%). The operative morbidity was 30.7% and the mortality 7.7%. Seven patients received additional treatment with chemotherapy. Survival after 2 years was 70%.

The determination and quantification of grey levels in the echography scale, designated by some authors Echodensitometry, is viewed as a new method for diagnosis using ultrasound techniques. This paper advances the results from a study conducted with an echographer equipped with an echographic density measuring device. This model analyzes the number of pixels in the image showing the most frequent level of grey. Normal and pathological parenchymatous urological organs (kidney, prostate and testicle) have been examined. Normal organs show a gaussian distribution of grey with a predominant level of typical grey for each of them. When affected by an acute inflammatory process the organs maintain their gaussian distribution but the predominant grey is lower (darker) due to the edema and the hyperaemia. When the inflammatory process becomes chronic, distribution, although somewhat irregular, is still gaussian but with higher predominance of grey (lighter) probably due to the fibrosis. The tumoral cases of our study also showed a gaussian curve even more irregular and with levels of variable grey. When specific areas of the tumour are analyzed the findings are very distinct depending on whether the areas are hypo or hyperechoic. Hyperechoic areas produce highly irregular maps. Research should be directed to provide more complex, although easy to perform systems of analysis which can correlate adequately with the histological study. It would be desirable that the equipment would be standardized to allow analysis of 'in vitro' images. If and when these objectives can be accomplished we would be able to venture into an echography histological diagnosis, something nowadays yet impossible.

The incidence and features of malignant primary multiple (MPM) neoplasias found in clinical urological patients have been analyzed so as to determine the actual magnitude of the problem and to obtain a better knowledge of this disease. For this reason, case histories of patients with MPMN, where at least one of the involved neoplasia was urological, were retrospectively studied. The study included a 9-year follow-up period and followed the Warren and Gates inclusion criteria. The number of MPMN patients was 23, representing an incidence of 6.1% among patients with urological neoplasias. Mean age at the time of discovery of the second tumour was 77.1 years. In the 15 patients with metachronic tumours, the time interval between the first and second tumours ranged between 1 to 25 years (average 5.4 years). The most frequently observed tumour association was bladder transitional carcinoma and prostate adenocarcinoma. The cause of death was always the second neoplasia.

Herein we describe a new technique for urethral exploration which replaces conventional radiological urethrography to a large extent. Retrograde sonourethrography is capable of providing data different from those of radiology, eliminates most of the inconveniences of the radiologic techniques and provides images of the entire trajectory of the urethra. Because this procedure can be repeated as often as necessary, it is the diagnostic procedure of choice in urethral stricture, a persistent and recurrent pathological condition. The results of a study conducted in 30 patients with different urethral pathologies are presented.

One of the major challenges of using prostate transrectal ultrasound scanning as a procedure to diagnose through images is the theoretical possibility of reaching an early diagnosis of prostate cancer. This paper compiles the author's experience in this field. Based on 142 established diagnosis of prostate cancer since 1984, the conclusion being reached is that prostate cancer has no pathognomonic signs, and therefore it is impossible to make an early diagnosis just by using the images obtained with transrectal ultrasound scanning. This procedure could be used, however, to select patients with scan abnormalities (Alarm signs) who should have a biopsy performed. The support of ultrasound-led transperineal biopsy of the prostate is currently indispensable to achieve an early diagnosis. This paper suggests that a biopsy should be done at the appearance of just one alarm sign, although this may involve a large number of cancer negative biopsies. The almost null incidence of complications from transperineal biopsies enhances this reasoning.

The paraneoplastic syndromes in patients with malignant urological tumors are reviewed herein. Some general aspects of these syndromes are briefly described and discussed. Similarly, the different urological tumors in which paraneoplastic syndromes have been observed are briefly reviewed. These are very common in renal cancer and cancer of the prostate, uncommon in bladder cancer and rare in testicular cancer.

We present a case of "Measles Appendicitis" treated recently in our unit. We point out the lack of bibliographic references on this pathology, despite its relatively high rate of incidence. The possible coexistence of appendicitis and measles; along with the possibility of a bacterial superinfection of the obliterated appendix due to submucous lymphoid hyperplasia, in our opinion, justifies an initial surgical approach in patients with measles who suffer from bouts of diagnostically uncertain pain in the lower right abdomen.