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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.

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.