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Objectives: To describe the incidence of germ cell testicular tumors in our Center, their characteristics and therapy results., Methods: Retrospective study of 66 cases of germ cell testicular tumors diagnosed in the Health Area of Badajoz between 1993 and 2005., Results: Mean age of the time of diagnosis was 32 years (range 16-80 years), presenting a younger age patients with non seminomatous germ cell tumors (NSGCT) (mean age 30 years). 86.5% of the patients did not have risk factors associated with the diagnosis of germ cell testicular tumor. Testicular mass was the most frequent symptom, and a higher proportion of tumors were located in the left testicle (51.5%). Non seminomatous germ cell tumors were the most frequent histological type (64.8%). Stage I (72%) was the most frequent stage in the group of seminomatous tumors, in comparison with 68.5% of non seminomatous tumors. Stages II-III appeared in 34.4% of the NSGCT and 28% of seminomatous, having worse prognosis. 92% of the patients received adjuvant treatment with chemotherapy and/or radiotherapy, and curative surgery was the only treatment in the remainder 8%. Residual mass surgery was undertaken in five patients (stages IIa, IIc and IIIa). Eight of the 66 cases were lost for follow-up. Fifty-three of the 58 patients with follow-up are disease-free, 18 of them with more than five years of follow-up., Conclusions: An increased incidence of germ cell testicular tumors have been verified over last years, mainly NSGCT Nevertheless, the diagnosis of advanced stages of the disease has diminished in favour of initial stages, which have a better prognosis for the patient. Oncologycal treatment protocols have high cure rates, although a long-term follow-up is needed due to the natural history of these tumors.

Objective: To report a case of urinary ascites secondary to an urinoma produced by a pielic and proximal ureter fistula after kidney transplantation in a 21 year old male patient., Methods: Diagnosis was established by biochemical analysis of the perirenal fluid collection and ascitic fluid, and conservative management of the urinary tract by percutaneous nephrostomy was undertaken., Results: Surgical repair of the fistulae solved the case., Conclusions: Urinary ascites is an unusual complication after kidney transplantation. Urinary tract fistula is the etiology in most of the cases although it can be idiopathic. In the case of urinary tract fistulae, conservative management can solve the case and surgical repair is the option when conservative treatment fails.

Nonvenereal sclerosing lymphangitis of the penis is a rare condition that preferably affects men aged between 20 and 40 years, and it is appeared like a hard cord or a nodular lesion in the sulcus coronarius penis. It is believed that it has origin in lymph vessels of the penis. Usually it is resolved in a self-limited way, so the initial treatment is conservative. We report two cases, and some etiopathogenic, diagnosis and therapeutic aspects are discussed.

Primary adenocarcinoma of ring cells's bladder is a neoplasm very uncommon and aggressive. Its clinic aspects and diagnosis don't differ too much from the rest of the bladder's neoplasm. It's important the differentiation from a possible primary extravesical origin. Radical surgery is the only treatment with sensitive answer, and the prognosis in awful. We report a case.

We report two cases of a very uncommon pathology as is the rupture of the corpus cavernosum of the penis, undergoing early surgical management with good results. We also review the diagnostic, clinical and etiological aspects, and the most appropriate treatment.

Presentation of three cases of bladder leiomyoma in women. All cases were characterized for the unspecific clinical presentation and a difficult pre-operative diagnosis, where ultrasound, cystoscopies, CAT and PAAF were used as complementary methods. The certainty diagnosis was only obtained after the histological study of the surgical piece. Treatment was in all three cases surgical, and the pathoanatomical diagnosis was bladder leiomyoma.

Description of a case report of a male patient with a long standing pressure hydrocele that underwent spontaneous rupture while doing farm work although there was no previous trauma. The clinical signs were minimal scrotal discomfort, disappearance of turgescence and late ecchymosis and localized edema in penis and scrotum.

Objective: To report an uncommon case of bilateral synchronous mixed testicular germ cell tumor., Methods: A young male had consulted at our urological services for a unilateral enlarged testis. A testicular tumor was suspected; scrotal US was performed, testicular tumor markers were determined and complementary studies to determine tumor extension were performed., Results: The US findings suggested a chronic inflammatory condition with bilateral diffuse infiltration, tuberculosis was discarded and bilateral testicular tumor was suspected, which was confirmed by bilateral intraoperative biopsy. A bilateral radical orchidectomy was performed. Adjuvant chemotherapy with cisplatin, VP-16 and bleomycin was administered after bilateral radical orchidectomy due to the attending risk factors for tumor recurrence. The patient is disease-free one year postoperatively., Conclusions: Bilateral synchronous testicular germ cell tumors are rare. Scrotal US is a simple, noninvasive and efficient diagnostic imaging method; however, it does not provide pathognomonic images that could indicate the histological nature of the tumor.

Objective: To describe a case of Leydig cell tumor of the testis, discuss the criteria for determining its benign or malignant nature and the clinical features according to patient age and the hormone profile., Methods/results: Scrotal US evaluation for an associated pathology incidentally detected a hypoechoic, homogeneous mass with preserved borders. Biological testicular tumor markers were determined and the suspicion of a Leydig cell tumor prompted a hormone study. The diagnosis of Leydig cell tumor was confirmed by intraoperative biopsy and radical orchidectomy was performed., Conclusion: In the case described, the ultrasound findings prompted the etiological diagnosis given the characteristics of the lesion. The definitive diagnosis was based on the pathological findings. Although classified as benign Leydig cell tumor, radical orchidectomy is advocated.

Objectives: An additional case of retrocaval ureter is described, with special reference to the diagnosis and treatment of this uncommon condition., Methods/results: We report a case of retrocaval ureter in a patient who had consulted for urological infection. Patient data and clinical history are presented and discussed., Conclusions: The clinical and pathological significance of retrocval ureter depend on the degree of urinary flow obstruction and the associated complications. CT with iv contrast medium is useful in confirming the diagnosis in most of the cases. When indicated, treatment by surgery and urinary tract maneuvers generally achieve good results.

Castleman's disease is a disorder of the lymph tissue, of undetermined etiology and with preferentially mediastinal location, although other lymphatic and extra-lymphatic locations are also possible. This entry appears under two varieties: the most frequent, hyalovascular type which generally does not have associated systemic symptoms, and the plasmocellular type associated to multisystemic symptoms in up to 50% cases, such as fever, anaemia, hypergammaglobulinemia, etc. Additional examinations beyond those usually available are not enough to establish a certainty diagnosis against other types of tumours, so an histopathological study is required prior to arrive to this definite diagnosis. Surgery is the choice therapy, although sometimes a favourable response to radiotherapy, used as alternating or adjuvant therapy, can be obtained. Corticoid therapy can be an effective option when dealing with systemic symptoms. The paper submits one case of Castleman's disease of the hyalinovascular type with retroperitoneal location which forced us to establish a differential diagnosis with other disorders in that region more frequent in our specialty. Definite clinical diagnosis was not possible surgery was chosen and the entire lesion removed. As certainty diagnosis was therefore histologic and, up to this point, the patient has shown no signs or symptoms of relapsing.

Abdominal-scrotal hydrocele is an uncommon lesion, most specially during childhood. It is an entity, though, that should be included in the differential diagnosis of abdominal masses in children, and also considered as a likely cause of ureterohydronephrosis. Diagnosis is arrived at through ultrasound, CAT and occasional excretory urography. Radical surgical excision using inguinal access is the recommended approach, but sometimes the inguinoabdominal or pure abdominal approaches can be performed. Following surgical ablation the cure is complete, and includes remission of the ureterohydronephrosis when present. This paper reviews the literature, presents one case and discusses both the diagnostic possibilities and therapeutic alternatives.

We report on a patient with congenital renal arteriovenous fistula whose only clinical manifestation was hematuria. The diagnosis was confirmed by arteriography and treatment was by percutaneous embolization. Hematuria resolved immediately after treatment and most of the renal parenchyma was preserved. The patient has moderate arterial hypertension as a sequela, although it is currently controlled by drug therapy.

We report a case of renal cell adenocarcinoma (T2-G3) metastatic to the stomach in a patient who underwent a left radical nephrectomy and presented hematemesis and melena two weeks postoperatively. We were prompted to report this case because metastasis to the stomach is rare and the literature is scant. Despite treatment by radical surgery, the short disease-free period following nephrectomy, the high histological grade (G3) and the aggressive nature of the tumor have resulted in a short survival.

A case of renal adenocarcinoma localized to the isthmus of a horseshoe kidney is described. We underscore the importance of complementary US and/or CT to urography to study the acquired pathologies of the horseshoe kidney because the pyelocaliceal distribution of these kidneys may not facilitate correct identification of certain space occupying lesions. The angiographic study is considered essential for planning surgery for this type of lesion.

Presentation of a new case of cyst of the seminal vesicle in one patient with ipsilateral renal agenesis, stressing the frequency of this association. The cyst become evident following confirmation of renal agenesis, and presented an unusual communication to the bladder due to previous surgery (transurethral resection). This diagnosis was only suspected in the computerized tomography and cystoscopy and later confirmed by deferentovesiculography. The relevance of exploring any possible dysplasia of the seminal tract in the presence of renal agenesis is stressed. From an embryological point of view, the close relationship during development of both urinary and reproductive systems appear to explain the coexistence of these two anomalies. The primary symptoms of the condition, including the unspecific ones, as in the present cases, are discussed. Differential diagnosis from other deep pelvic cysts is referred. Following a literature review and based in our personal experience, already published, our views on the different embryological, clinical, diagnostic and therapeutic considerations are established.

We report on a 44-year-old patient with Leydig cell tumor of the testis that had been incidentally detected following orchidectomy for a tumor. The clinical, hormonal and histological criteria currently used to distinguish the malignant from the benign form of this tumor and the different therapeutical alternatives are discussed.

Non-venereal sclerosing lymphangitis of the penis is a rare condition that affects the distal lymphatics of this organ. It has been reported to be frequently associated with trauma to this area and, although it has a minimum inflammatory component, its etiology is unknown. A serpinginous nodular lesion in the sulcus coronarius penis may be observed by the patient. Because it is generally self-limiting, treatment is initially conservative and surgical excision is performed only if symptomatic lesions persist. The present study reports an additional case. The literature is reviewed and the possible etiopathogenic mechanisms and therapeutic alternatives are discussed.

Renal arteriovenous fistulae (AVF) conform a pathology the urologist is not used to see. The basic purpose of this paper is to collect and update the current knowledge of this renal-vascular disorder, quite frequently forgotten when establishing the likely causes of haematuria. The paper describes the etiology of renal AVF and their generation mechanisms, as well as clinical presentations they can have. A most appropriate diagnostic method is still selective renal arteriography, which usually evidences the anomaly through indirect arteriographic signs. However, when the lesion is small it can be difficult to detect it. Finally, a discussion of therapeutical possibilities, both conservative and radical, and a case recently treated in out unit are presented.

A new case of ureter ectopic abouchement in seminal vesicle with cystic dysplasia is presented in one asymptomatic male attending the clinic on an infertility consultation. Suspected diagnosis was based on right kidney absence observed on abdominal echography, associated to severe oligoastenozoospermia seminograms and decrease in ejaculation volume. The computerized axial tomography revealed changes of the ipsilateral seminal vesicle. Diagnosis was confirmed by deferentovesicullography. Malformation embryological and anatomical aspects, as well as accompanying ipsilateral kidney dysplasia are commented. A review of both national and international literature is made supporting the unusual character of the clinical case presented.

Serum prolactin (PRL) levels were measured in 147 males. All patients had no known tumor, endocrine disorder, or symptoms or signs of hyperprolactinemia. All patients denied taking any medication or agents that could alter PRL levels. Semen analyses revealed 34 patients were normospermic, 69 were oligospermic, 26 were azoospermic, and 18 were purely astenzoospermic. PRL levels for the patient groups were not statistically significantly different. PRL values were higher than the normal ranges in 12.2% of the overall study population. A lower incidence (6.19%) was observed for hyperprolactinemia in the normospermics. These findings are comparable to those described elsewhere. Serum testosterone did not drop significantly in the hyperprolactinemics. Similarly, the FSH and LH values did not change significantly. The possible role of PRL in male infertility and the effect of hyperprolactinemia of varying degrees and etiology on sperm count and motility are discussed.

Massive polyuria existing in congenital nephrogenic diabetes insipidus can cause a more or less severe dilatation of the urinary tract in absence of obstruction. Clinical and diagnostic aspects of this pathology are presented relating then with other types of diabetes insipidus. One case of bilateral severe dilatation with evolution towards renal atrophia is presented. Mechanical obstruction was discarded. The disease was refractory to urinary concentration tests and therapy to reduce urine volume. The possible etiopathological mechanisms of functional obstruction and surgical alternatives directed to preserve the kidney function are explained and discussed. The current literature is reviewed but the cases reported are few due to the low incidence of urological affectation. Presence of kidney atrophia is exceptional.