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El leiomioma renal es un tumor mesenquimatoso benigno poco frecuente que, no obstante, se debe tener en cuenta ante el diagnóstico de una masa renal. Esta neoplasia puede originarse en cualquier órgano del aparato genitourinario que contenga músculo liso, siendo la cápsula renal la localización más frecuente. Dado el comportamiento benigno de la lesión, es subsidiario de la realización de una cirugía renal conservadora. No obstante, ante la dificultad para distinguirlo del adenocarcinoma, no será infrecuente que el diagnóstico se produzca tras el análisis histológico de una pieza de nefrectomía radical.

In spite of the development of non-invasive strategies, surgical treatment of the prostate (TURP) and, mostly transurethral resection, is the most effective choice for patients suffering from benign prostatic hyperplasia who do not respond properly to pharmacological treatment. Absorption of hypotonic fluids used during TURP may cause hemodynamic and central nervous system disturbances. These symptoms, both taken separately or as a whole, are best known as “Transurethral prostatic resection syndrome” or “TURP syndrome”. The original description of this syndrome dates from half a century ago; however, a number of items regarding its physiopathology and treatment remain unclear. We present a review of this pathological entity, compiling diagnostic and therapeutical approaches.

Resumen Objetivo Analizar la serie de pacientes sometidos entre los anos 1990 y 1999 a sustitucion de su protesis de pene debido a la aparicion de algun tipo de complicacion. Material y metodos 85 pacientes fueron sometidos a implante, siendo utilizados 13 modelos diferentes de protesis. En 15 de estos pacientes (17,64%) esta tuvo que ser sustituida una vez o mas. La edad media en el momento de la sustitucion fue de 51,5 anos. El acceso quirurgico mas frecuente fue el infrapubico. Resultados Se realizaron en total 32 intervenciones de sustitucion protesica. Las causas principales fueron: fallo mecanico (13 casos, 40,62%); infeccion (10 casos, 31,25%); y perforacion de cuerpos cavernosos (cinco casos, 15,62%). No se observo incremento progresivo en la incidencia de complicaciones en relacion con el numero ordinal de la protesis implantada. Mejores resultados globales: Mentor Mark II y AMS 700 Ultrex Plus. Actualmente solo ocho (53,33%) de los 15 pacientes reimplantados hacen uso normal de su protesis. Conclusiones Los pacientes sometidos a sustitucion de su protesis de pene son fuente potencial de complicaciones posteriores. Su conocimiento y correcto manejo es importante, de cara a una mejora progresiva en los resultados finales, (sobre todo si estos -como en uestro caso- no son aptos para el conformismo).

Resumen Objetivo Analizar la serie de pacientes sometidos en nuestro Centro a linfadenectomia inguinal por carcinoma escamoso de pene, entre los anos 1984 y 1999. Material y metodos La linfadenectomia fue realizada en 19 pacientes, con una media de edad de 61 anos. El tipo de intervencion mas frecuente fue la ilioinguinal bilateral (42,1 %). Solo cuatro pacientes fueron sometidos simultaneamente a penectomia y linfadenectomia. Presentamos los resultados clinicos y anatomopatologicos, segun la clasificacion TNM de 1997. Resultados Las adenopatias inguinales palpables persistieron tras antibioterapia en siete de 12 pacientes. La correlacion global de nuestra serie entre estadio N y pN fue de 68,42 %. Presentamos asimismo los resultados anatomopatologicos segun categorias pT y pN. Las complicaciones postoperatorias se presentaron en 13 casos (68,42 %), (siendo el linfedema la mas frecuente). Se obtuvo una supervivencia global a uno y cinco anos de 90 y 80 % en pacientes con dos o menos ganglios pN(+); frente al 11,11 y 0 % cuando mas de dos estuvieron presentes. Conclusiones La importancia del control de los ganglios linfaticos metastaticos en el carcinoma escamoso de pene, situa a la linfadenectomia inguinal como herramienta esencial en los casos apropiados. Su incidencia de complicaciones hace necesario, no obstante, un progresivo consenso en cuanto a sus indicaciones.

To report a case of solitary metachronous contralateral metastasis of a renal carcinoma that had been previously resected.A 63-year-old male that had previously undergone a right radical nephrectomy due to renal carcinoma is presented. The patient's left breast was found to be slightly larger at the control evaluation 24-months postoperatively. Analytical and hormonal studies showed no significant findings except for a serum creatinine value of 1.75 mg/dl. However, a CT scan showed a left adrenal nodule of 3 cm. After 6 months of watchful waiting, the nodule had increased to 4.3 cm. A CT-guided fine needle punction aspiration biopsy demonstrated a malignant lesion and a left adrenalectomy was performed.Histopathological analysis of the surgical specimen showed adrenal metastasis of clear cell renal carcinoma. At 21 months' follow-up after adrenalectomy, there is no evidence of recurrence of the metastasis.This type of lesion is uncommon. We emphasize the importance of the analytical and hormonal studies, as well as CT and FNPA, in the diagnosis of this adrenal pathology. Like other authors, we advocate performing adrenalectomy in these cases.

To analyze the series of patients who underwent replacement of their penile prosthesis between years 1990 to 1999, due to any kind of complication.85 patients underwent implantation, 13 different prosthesis models being utilized. It was replaced (once or more) in 15 of these patients (17.64%). The mean age at the moment of the replacement was 51.5 years. The most frequent surgical approach was the infrapubic one.A total of 32 prosthesis-replacement interventions were carried out. The main causes were: mechanical failure (13 cases, 40.62%); infection (10 cases, 31.25%); and corpus cavernosum perforation (five cases, 15.62%). Progressive increase of complications incidence with regard to the ordinal number of the implanted prosthesis was not observed. Best overall results: Mentor Mark II and AMS 700 Ultrex Plus. At present day, only eight (53.33%) out of 15 reimplanted patients use their prosthesis with normality.Those patients who undergo replacement of their penile prosthesis are potential sources for later complications. Their knowledge and proper handling is important in order to a progressive improvement of the final results, (above all if--such as our case--these ones are not suitable for conformity).

To analyze the series of patients who underwent inguinal lymphadenectomy in our Center due to squamous penile carcinoma, between years 1984 to 1999.Lymphadenectomy was carried out in 19 patients, with a mean age of 61 years. Bilateral ilioinguinal (42.1%) was the most frequent type of intervention. Only four patients underwent penectomy and lymphadenectomy simultaneously. We present the clinical and pathological results, according to the 1997 TNM classification.Palpable inguinal nodes after antibiotherapy remained in seven out of 12 patients. The overall correlation between N and pN stages in our series was 68.42%. Pathological results according to pT and pN stages are also presented. Postoperative complications were present in 13 cases (68.42%), (lymphedema being the most frequent one). In those patients with two or less pN(+) nodes, an overall one-year and five-year survival of 90 and 80% were obtained; compared to 11.11 and 0% when there were more than two.The importance about control of metastatic lymph nodes in squamous carcinoma of the penis, places inguinal lymphadenectomy as an essential tool, in those suitable cases. However, its incidence of complications makes a progressive agreement about its indications be necessary.

The UroLume stent has been utilized in the management of symptomatic benign prostatic hyperplasia (BPH), particularly in patients at high surgical risk. Our results are analyzed and the literature reviewed.From June, 1994 to November, 1996, 19 patients at high surgical risk (ASA III/IV) with symptomatic BPH were treated at our center; 17 (89.4%) had an indwelling catheter. The UroLume stent was inserted under local anesthesia and intravenous sedation.Stent placement as monotherapy was found to be clinically effective in 15 patients (78.9%) with a mean follow-up of 8.2 +/- 5.7 months (range 1-18). The mean symptom score (Madsen-Iversen) was 6.1 +/- 1.2. Patients with no further manipulations had a mean maximum flow rate of 8.8 +/- 3.8 ml/s. Two patients (10.5%) required stent removal due to retrograde displacement in one case and perineal discomfort and irritative voiding symptoms in the other. In two other patients (10.5%), remnant tissue had to be resected in order to void spontaneously. Seventeen patients (89.4%) were satisfied with the results. No case of urosepsis or incrustations were documented. A microbiological analysis disclosed urinary tract infection in one patient.The UroLume stent is clinically effective in the treatment of symptomatic BPH in patients unfit for prostatic surgery. It carries a low incidence of major complications and procedure-related morbidity.

To analyze the prevalence of neoplasms in renal transplant patients and the relative risk for each tumor type according to the immunosuppression regimen.609 renal transplants were reviewed. The risk index was determined by the ratio of the cases observed and predicted.Tumor prevalence was 4.9% (30/609); 6.3% (25/393) were males and 2.3% (5/216) were females. The most common tumors were cutaneous tumors other than melanoma, accounting for 2.4% (15/609), followed by Kaposi's sarcoma, pulmonary epidermoid carcinoma and genitourinary tumors (0.5%) and non-Hodgkin lymphoma (0.3%). Tumor prevalence was 6.8% for the group treated with azathioprine-prednisone and 3.9% for the cyclosporine A-prednisone-treated group. The estimated relative risk of having a neoplasm was 10-fold higher for the males and 4.2-fold higher for the females vs the general population. The mortality rate was 36.6%; specifically tumor-related in 82%. The mortality rate for those with solid tumors was 77.7%. The long-term survival rate for the group that developed a tumor was significantly lower than that of the general population, 75% vs 53%, respectively (p0.05).In this series no significant differences were observed relative to tumor prevalence or type according to the immunosuppression regimen. A recipient of a renal graft has a higher risk of developing a tumor. Cutaneous tumors were the most frequent. The long-term survival is lower for recipients of renal grafts who develop a tumor.