OBJECTIVES: The presentation of the cultof phallus in ancient Greece and the artistic appearanceof the phenomenon on vase figures and statues, asindicative of the significant role of the male genitalia inall fertility ceremonies.METHODS: The examination of a great number ofpenile representations from the ancient Greek potteryand sculpture and the review of the ancient theater plays(satiric dramas and comedies).RESULTS: Phallus in artistic representation is connectedeither with gods of fertility, such as the goat-footed andhorned Pan or the ugly dwarf Priapus or the semi-animalnailed figures Satyrs, devotees of the god Dionysusaccompanying him in all ritual orgiastic celebrations.Phallus also symbolizes good luck, health and sexuality:people bear or wear artificial phalli exactly like theactors as part of their costume or carry huge penisesduring the festive ritual processions. On the contrary, theOlympic gods or the ordinary mortals are not imagedithyphallic; the ideal type of male beauty epitomized inclassical sculpture, normally depicts genitals of averageor less than average size. It is noteworthy that many ofthese images belong to athletes during or immediatelyafter hard exercise with the penis shrunk. The normalsize genitalia may have been simply a convention todistinguish normal people from the gods of sexualityand fertility, protectors of the reproductive process ofNature.CONCLUSIONS: The representation of the over-sizedand erected genitalia on vase figures or statues of ancientGreek art is related to fertility gods such as Priapus, Panand Satyrs and there is strong evidence that imaginationand legend were replacing the scientific achievementsin the field of erectile function for many centuries
Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are often associated, and they both reduce the quality of life of those who suffer from these conditions.OBJECTIVES: Primarily, to determine the relationship of LUTS/BPH as an independent risk factor for suffering ED and, secondarily, the relationship of LUTS/BPH and ED according to the severity of the symptoms.METHODS: A descriptive, analytic, multicentre study was carried out in 580 patients consulting for prostatic control or LUTS. 305 patients, who met the inclusion/exclusion criteria, were included in the analysis. Erectile dysfunction and LUTS were assessed by IIEF5 and IPSS. The presence, predictors and degree of severity of ED were examined according to patients’ age and comorbidities. Qualitative and continuous variables were considered for the statistical analysis and simple and multiple regression analyses were applied. A value of p < 0.05 was considered statistically significant.RESULTS : Mean age was 62 years (IQR 56-67). ED prevalence in patients with LUTS/BPH was 83.6%. Patients with ED were older, showed a higher prevalence of hypertension and higher IPSS scores (p < 0.05). Multivariate analysis for ED predictors showed that age, diabetes and IPSS score were significantly associated with ED (p < 0.05).CONCLUSIONS. According to our results, there is a high prevalence of ED in patients with LUTS/BPH, which are also independent risk factors for suffering ED. The presence of ED was more prevalent in moderate LUTS/BPH than in the severe LUTS/BPH. The importance of assessing the sexual health of men consulting for LUTS/BPH is emphasized.
OBJECTIVES: To analyze the characte-ristics, etiology and treatment of a series of patients with spontaneous retroperitoneal hemorrhage from renal causes.METHODS: We retrospectively reviewed patients diagnosed of spontaneous retroperitoneal hemorrhage between 2006 and 2011. All patients consulted for back pain and the diagnosis was made by computed tomography (CT) and / or magnetic resonance (MR). All patients were treated surgically.RESULTS: The series includes 8 patients. Six cases had renal mass and associated hematoma and 2 presented only perirenal hematoma. Six patients underwent total nephrectomy, one underwent partial nephrectomy, and one just drainage of the hematoma.The pathological study showed 4 cases of renal angiomyolipoma (one associated with multiple small renal carcinomas), 2 cases of renal carcinoma and 1 case of hemorrhagic renal infarction.CONCLUSION: Renal masses are the main cause of Wunderlich syndrome and CT is the diagnostic procedure of choice. Surgical treatment is preferred in patients with renal mass diagnosed and cases of hemodynamic compromise.
OBJECTIVES: Minimally invasive techniques for the surgical treatment of prostate cancer have aimed to achieve the same functional and oncological outcomes of open surgery with a significant decrease in postoperative morbidity and a subsequent decreasing hospital stay. These improvements are important in the current economic context. Our aim was to evaluate the feasibility and safety of hospital discharge 24 h after laparoscopic radical prostatectomy (LRP).METHODS : A total of 266 consecutive patients with clinical diagnosis of localized prostate cancer consecutively treated with extraperitoneal LRP between May 2007 and December 2010 were analyzed. There were no exclusion criteria for the surgical procedure. Patients were discharged in less than 24 h only in the case of absence of medical complications, with drainage of less than 50 mL allowing its removal before discharge, normal oral feeding tolerance, no significant hematuria by bladder catheter and good functional recovery of the patient. All surgery-related complications that occurred within 90 days after surgery were recorded and were classified according to the modified Clavien scale.RESULTS : A total of 266 patients who underwent LRP were studied with a median follow-up of 34 months. 80 (30.1%) patients were discharged from the hospital in less than 24h. 89 (33.4%) patients were discharged within 48 h and 97 (36.5 %) after 48h.The mean hospital stay of the entire case series was 2.9 days (SD 3.08). The mean hospital stay of patients who were discharged after 48h was 5,5 days (SD 3.94).Thirty-one patients (10.7%) experienced post-surgical complications. 25 (9.3%) of them were classified as Clavien I or II, and 6 (2.2%) Clavien III or IV.A total of 9 (3.3%) patients were readmitted. Of the group of patients who were discharged within 24h only one was readmitted due to hematuria.CONCLUSIONS: Extraperitoneal LRP is the standard treatment for localized prostate cancer in our institution. This treatment reliably and safely allows a hospital stay shorter than 24 h in a significant percentage of our patients.
OBJECTIVES: Standardized prostate-spe-cific antigen (PSA) levels are based upon the generalpopulation levels and, although a higher incidence ofprostate cancer in patients on hemodialysis (HD) has notbeen demonstrated, some studies point at the possibilityof observing higher PSA levels in this type of patientsthan in males with preserved renal function.The objective of the present study is to compare PSAlevels in males on hemodialysis with those of the popula-tion with normal renal function.METHODS: Comparative, transversal study of the varia-bles age, total PSA, free PSA and PSA index in 190 pa-tients with chronic renal disease on hemodialysis treat-ment (group 1) and 237 subjects without renal disease(group 2). We carried out a descriptive analysis anda comparative study of the above mentioned variablesusing the SPSS software.RESULTS: Median age of patients on HD was 55 incases (47-61) and 59 in controls (54-63.5). Mean totalPSA was 1.49ng/mL [1.24-1.73] in cases and 1.62ng/mL [1.29-1.95] in controls; mean free PSA was1.40ng/mL [0.89-1.91] in group 1 and 2.31ng/mL[-0.83- 5.45] in group 2; mean PSA index was 27.67%[19.91-35.63] in cases and 14.82% [12.79-16.85]in controls. The comparative study showed differencesbetween the two groups in free PSA (p ≤ 0.007), PSAindex (p ≤ 0.000) and total PSA (p ≤ 0.000) in patientsunder 50 after an age-specific analysis.CONCLUSIONS: Total PSA is higher in patients on HDwithin the subgroup of patients under 50 with statistica-lly significant but not clinically relevant difference. PSAindex is remarkably higher in the group of patients onHD. These data could have clinical implications as faras indications for biopsy is concerned
OBJECTIVES: Renal ischemia, depending on its duration, results in organ function loss to a greater or lesser extent, due to the depletion of the energy cells need for their vital functions. The method of supplying an external energy source that may act as a precursor of ATP, such as inosine, has proved to be protective from a functional point of view. In this work, we aim to reveal the histological ultrastructural bases that underlie this protective effect. METHODS: We studied two groups of rats subjecting the kidneys to different durations of warm ischemia, and compared the histological findings at various parts of the nephron after perfusion with saline or inosine. These findings were compared, in turn, with the normal morphology of a third control group.RESULTS: The histological findings were: 1 ) No signifi-cant lesions after 60 and 120 min of warm ischemia in animals perfused with inosine; and 2) Glomerular and tubular injury after 60 min of warm ischemia in animals perfused with saline.CONCLUSIONS: The saline-perfused animals showed very significant injury at the glomerular and tubular levels after 60 and 120 min of warm ischemia. These lesions were not seen in animals perfused with inosine. The similarity of the morphological findings between the inosine-infused group and the control group suggests that inosine has a protective effect on the morphology of the rat nephron under conditions of warm ischemia for periods shorter than 120 min.
OBJECTIVES: To assess the usefulness of multiparametric magnetic resonance imaging (MRI) in the staging of patients with localized prostate cancer (PC) and high risk of extracapsular disease (ECD).METHODS: Retrospective study including 30 patients with localized PC and high risk of ECD. Pathologist and radiologist established an ECD suspicion according to the evaluation of the prostatic biopsy specimens and the multiparametric MRI analysis, respectively. Radical prostatectomy (RP) specimen analysis was used as a definitive confirmatory reference. Kappa (k) test was used to assess the degree of consistency between the initial suspicion provided by both specialists and the reference RP specimen.RESULTS: When the prostatic gland was analyzed as a single unit, the pathological evaluation of the biopsy specimens did not correctly detect the risk of ECD in 46.6% of the patients (14/30; 10 FN; k=-0.035, 95%CI [- 0.29-0.36]), while multiparametric MRI did not do in 36% of the cases (11/30, 9 FP; k=0.27, 95%CI [- 0.03-0.61]). Whereas, if each side of the prostate (i.e. right and left) was considered as an independent observation, the pathologist wrongly predicted the risk of ECD in 35% of the cases (21/60; 18 FN; k=0.19, 95%CI [- 0.03-0.40]), while the radiologist erred only in 18.3% of the cases (11/60; 7 FN and 4 FP; k=0, 61, 95%CI [0.40-0.81]).CONCLUSIONS: Data from our experience suggest an added value of multiparametric MRI in the clinical staging of localized PC in cases of high risk of ECD. Multiparametric MRI may be used as a helpful tool in the surgical planning and the decision-making process regarding the management of this entity.
OBJECTIVE: To present a rare complication of an iliac artery to ileal conduit fistula after radical cystectomy.METHODS: A 74 year-old man with muscle invasive bladder cancer was submitted for robotic radical cystectomy with intracorporeal ileal conduit. Twenty-four days after surgery he was readmitted due to an active bleeding from the ileal conduit.RESULTS: CT-Scan showed an arterial fistula between the external iliac artery and the ileal conduit. The emergency procedure done was an artery ligation, bilateral cutaneous ureterostomy and extra-anatomic femoro-femoral bypass.CONCLUSIONS: A fistula from the external iliac artery to the ileal conduit is a rare and serious complication in the Bricker type urinary diversion, with only 7 cases reported in the international literature