Archivos españoles de urología
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To review the treatment of testicular germ-cell cancer in our series. ⋯ Testicular germ-cell cancer needs a well established multidisciplinary approach, in which the role of the urologist is fundamental. Orchiectomy is the primary treatment and allows determination of the dissemination risk. Radiotherapy is very effective for localised seminomas with poor prognostic factors, and for non seminomas 2 cycles of chemotherapy seem to be an effective approach, as well as of little toxicity. We must know and apply optimised programs for observation of these tumours (stage I), and also use follow-up protocols after chemotherapy or radiotherapy. Some cases need complex surgery for residual masses resection or post chemotherapy salvage surgery in disseminated tumours (Stages II & III). Sterility treatment protocols are applied to preserve fertility.
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To report the case of an adrenal pheochromocytoma presenting as a retroperitoneal haemorrhage. ⋯ Pheochromocytomas can occasionally present as Wünderlich's syndrome, needing radical surgery as treatment for its resolution.
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To present a case of fulminant sepsis caused by Clostridium perfringens of urological origin. ⋯ Sepsis is a possible complication of infection from Clostridium perfringens. It is more frequent in immune-depressed patients and carries a high mortality despite medical and surgical treatment. Although it is not the most frequent, the genitourinary tract is a known portal of entry that should not be forgotten as in the case described herein.
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To report a case of acute lobar nephronia, an unusual form of localized renal infection, and review the literature with special reference to the clinical features, ultrasound and CT findings that distinguish this condition from other renal masses (abscess, infected cyst and renal carcinoma). ⋯ Acute lobar nephronia should be considered in all patients with a renal mass detected during an episode of urinary infection. Correlation of the clinical and radiological findings, and resolution of the mass with appropriate antibiotic therapy will confirm the diagnosis.
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To review the pathophysiology, diagnostic methods and treatments of priapism, with special reference to alternative treatment options. ⋯ Complete detumescence and recovery of normal arterial blood flow can be achieved in a majority of the cases by systematic and standardized management. Sedatives, alpha-adrenergic agents or oral ketamine hydrochlorate can be utilized. However, due to the importance of the time factor, intracavernosal therapy should be the priority for persistent erection, using alpha-adrenergic agonists or other alternatives, such as methylene blue, which do not have the well-recognized risks of the conventional agents. The etiology of the priapism should be clearly established by metabolic and hemodynamic studies, since treatment will be based on the underlying disorder. In veno-occlusive low flow priapism, surgical shunting should be performed if aspiration of intracavernosal blood and other treatments are not successful. Arterial embolization and surgical ligation should be performed for high flow persistent priapism.