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Clinical stage I testicular nonseminomatous germ cell tumours (NSGCT) are highly curable. Following orchidectomy a risk-adapted approach using active surveillance (AS), nerve sparing retroperitoneal lymph node dissection (nsRPLND) and primary chemotherapy is recommended by the current guidelines.CS I is defined negative or declining tumour markers to their half-life following orchidectomy and negative imaging studies of the chest, abdomen and retroperitoneum. Low risk CS I NSGCT are defined by the absence of vascular invasion, low percentage of embryonal carcinoma (ECA) and low proliferating Ki-67 index. High risk CS I NSGCT are defined by the presence of VI, high percentage of ECA and a high Ki-67 index. According to the current guidelines, active surveillance, primary chemotherapy and nerve sparing RPLND represent 3 treatment options with the same high cure rate of about 100% but significantly different long-term complications. As demonstrated, active surveillance can be performed in low risk and in high risk NSGCT with an anticipated relapse rate of about 15% and 50%. The majority of patients will relapse with good and intermediate prognosis tumours which have to be treated with 3 to 4 cycles chemotherapy. About 25% to 30% of these patients will have to undergo postchemotherapy RPLND for residual masses. Primary chemotherapy with 1 -2 cycles PEB is a therapeutic option for high risk clinical stage I NSGCT associated with a recurrence rate of only 2-3% and a minimal acute and long-term toxicity rate. Nerve sparing RPLND, if performed properly, will cure about 85% of all high risk patients with clinical stage I NSGCT without the need for chemotherapy.Although armchair calculations of the odds of cure and toxicity associated with the various treatment options can be performed, recommendations about the most optimal therapy in clinical stage I NSGCT remain controversial. There seems to be a consensus that active surveillance is the treatment strategy of choice for CS I low risk patients. However, there is no clear cut recommendation in high risk patients. Each treatment has its own advantages and disadvantages which have to be discussed thoroughly with the patient. If, however, the positive results of 1 cycle of PEB can be validated, it will become the standard cytotoxic approach for clinical stage I NSGCT.
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OBJECTIVE: To assess the incidence,characteristics and outcome of upper urinary tract tumors(UUTTs) that developed in patients who underwentradical cystectomy for urothelial carcinoma.METHODS: We performed an analysis of original andreview articles that were related to post-cystectomyUUTTs. The articles were published from 1984 through2011 and were identified by searching the Pub Meddatabase.RESULTS: The incidence of post-cystectomy UUTTranges from 2-6% and is stable over time. The primaryrisk factors include a tumor in the distal ureter in thecystectomy specimen and signs of multifocal disease (e.g., multiplicity, a history of non-muscle-invasive bladdertumor, diffuse carcinoma in situ and the presence of atumor in the prostatic urethra).The median time between cystectomy and UUTTexceeded three years in 70% of the reviewed cases.Even with regular radiological follow-up visits, over50% of cases were diagnosed after clinical onset,and over 70% were in an advanced stage. Currently,a multidetector computed tomography urography is thestandard technique for studying the upper urinary tract.In patients with urinary diversion, the maximum yield ofcytology can be obtained when this technique is usedto confirm a clinical or radiological suspicion of UUTT.Nephroureterectomy is the treatment of choice for thesetumors. The high prevalence of high-grade and stageUUTT results in endourological treatment being restrictedto only selected cases. Despite surgery, fewer than 30%of post-cystectomy UUTT patients experience prolongedsurvival.CONCLUSIONS: Post-cystectomy UUTT is rare andusually has a late onset. A distal ureteral tumor and thepresence of multifocal disease are its primary risk factors.Most cases of post-cystectomy UUTT are diagnosedclinically and in advanced stages
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OBJECTIVES: Neuroendocrine tumors(NET) are cancers found in the bronchopulmonary tract,where they were first described in 1926. The tumorsare associated with poor prognosis due to their highmetastatic potency even after radical treatments asso-ciated with other neo- or adjuvant therapies. NET of theurinary bladder is a rare tumor and accounts for 0.5%of bladder tumors.METHODS: The study was designed as an observatio-nal, descriptive and retrospective study of 13 patientsdiagnosed, treated, and followed for NET of the urinarybladder at the Hospital and University Complex of Alba-cete, Albacete, Spain between 1995 and 2010.RESULTS: The sample was composed of 11 men and2 women. Mean patient age at the time of diagnosiswas 71 (range, 57-88; SD, 6.98) years. T4 (6 patients)was the most common T tumor stage, followed by T2(5 patients) and T3 (2 patients). In the case of N tumorstage, the most common was N2. In the remaining 3patients, the degree of lymph node involvement couldnot be assessed. Six presented distant metastasis at thetime of diagnosis. Eleven patients presented small-cellNET on histology. Seven underwent radical surgery(radical cystectomy). All other patients were treated bydeep transurethral resection of bladder tumor, except for1 patient treated by partial cystectomy. Adjuvant chemo-therapy (usually an association of carboplatin/cisplatinand etoposide) was administered to 4 patients. Of these4 patients, 2 were also treated by pelvic radiotherapy.Two patients survived more than 5 years following diag-nosis. In fact, at the time the study data was collectedonly 4 patients had survived and 2 presented tumor re-currence. Of the 9 deaths, 8 occurred within 6 monthsof diagnosis and 1 at 24 months. All of them were theresult of the disease itself.CONCLUSIONS: Neuroendocrine tumor of the urinarybladder is a rare, aggressive tumor with high metasta-ticpotential that should be considered in the differen-tialdiagnosis of urinary bladder neoplasms. Despite vario-us multimodality treatments have been used prognosis
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OBJECTIVES: To evaluate the efficacy, complications and outcomes of sphincterotomy with bladder neck incision in patients with voiding dysfunction (VD).METHODS: We evaluated our prospectively established urologic urodynamic database and identified the records of 30 male patients with VD that underwent sphincterotomy between Octuber 1993 and December 2008. The IPSS and urodynamics were analyzed before and after surgery, we recorded the outcomes and complications. Numerical data were analyzed with Student`s t and Wilcoxon tests (p﹤0.05). ANOVA was used for the follow up.RESULTS: Thirty patients underwent sphincterotomy with a mean age of 41 years (range 18-63 years). Statistical differences (p﹤ 0.05) were found for: maximum flow rate (17.61 ± 7.7 vs 23.5 ± 12.19 ml/s), detrusor pressure (73.53 ± 21.51 vs 47.4 ± 16.24 cmH20), maximum cystometric capacity (462.74 ± 224.2 vs 382.2 ± 167.48 ml), functional urethral length (64.3 ± 22.6 vs 42.2 ± 18.4 mm), Maximum urethral pressure (120.1 ± 46.8 vs 59.23 ± 22.67 cmH20), total urethral closure area (3315 ± 1269.7 vs 1189 ± 49.23 cmH20*mm) and postvoid residual volume (161.3 ± 177.9 vs 57 ± 100.8 ml). The IPSS improved and was stable at 60 months (p ﹤ 0.02). No significant as-sociation was found to develop incontinence after the procedure. CONCLUSION: Sphincterotomy for male patients with dysfunctional voiding improves voiding dynamics with a low rate of complications and minimum risk of incontinency.
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OBJECTIVE: Urinary tract obstruction is one of the most prevalent diseases in urology. The handling of it includes conservative (analgesia and fluid therapy) and invasive (urinary diversion) measures. Ureteral stent is the method currently employed for urinary tract diversion. Complications of urinary tract stents maintenance have already been studied and are well known. We report a case of ureteral stent migrated to the bladder, calcified and embedded and we review the existing literature.METHODS: A 28 year-old man with the diagnosis of ureteral stent coiled in bladder and calcified. The patient was successfully operated of suprapubic cystolithotomy.We conducted a Medline search using the terms “ureteral stent “+” embedded stent, “” bladder ureteral stent, “incrusted bladder stent” and “ureteral stent complicactions”.RESULTS: He is currently free of disease. We found a total of 45 articles that responded to the search criteria, from which we select the highest citation index.CONCLUSIONS: The use of ureteral stents for urinary diversion of the upper urinary tract is safe and well tolerated but not without complications, that is why we have to raise awareness among patients of the need to undergo periodic inspections and instruct them to possible symptoms and / or signs that may indicate changes in position and / or state of the stent.
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OBJECTIVE: To describe the use collagen xenograft as adjuvant therapy in the surgical treatment of female urethral diverticulum (FUD) and to perform a bibliographic review.METHODS: We performed a surgical approach to remove the diverticulum and repair the remaining dead space with a porcine collagen mesh to avoid fistulas. Monitoring is done by MRI.RESULTS: After two years of follow up the patient improved considerably, disappearing the previous symptoms. Followup MRI showed no abnormality: There was no inflammatory reaction or encapsulation of any kind.CONCLUSIONS: We recognize that the flap or the use of a xenograft are not always necessary, but due to its technical simplicity and effectiveness, it is an important tool for diverticulum surgery. However, more experience is needed to assess the appropriateness of this method.
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OBJECTIVE: To describe the case of a patient with gross hematuria. The pathological study revealed a subepithelial hematoma of the renal pelvis (AntopolGoldman lesion).METHODS/RESULTS: An 86 year-old woman presented with gross hematuria through the right ureteral orifice. A filling defect is visualized in the right renal pelvis on CT and right nephroureterectomy was carried out after the diagnosis of suspicious upper urinary tract tumor. The pathological study revealed the presence of a subepithelial hematoma without evidence of malignancy.CONCLUSION: Antopol-Goldman lesion is a benign condition that one must have in mind in the work up of patients with hematuria and filling defects in the urinary tract who present a predisposing factor for pyelic hematoma.
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OBJECTIVE: To describe clinical featuresand ultrasound findings of three cases of a little-known andrelatively infrequent entity in daily clinical activity, whichis often unnoticed and under-reported: penile Mondor’sdisease or superficial penile veins thrombophlebitis.METHODS: We are reporting the cases of three patientsaged 33, 25 and 39 years who were referred to ourdepartment, the first case with suspicion of inguinal hernia,the second one to rule out testicular pathology because ofpubic and perineal discomfort, and the third one for painful induration of the dorsal region of the penis. The three patientsunderwent Doppler-ultrasound examination (Toshiba®,using a 13-18MHz linear transducer) to establish definitivediagnosis, and had a favorable evolution with conservativemanagement.RESULTS: Ultrasound examination revealed: Case 1.Penile superficial dorsal vein and lateral superficial veinsthrombosis. Case 2. Thrombosis of the right branch of thesuperficial dorsal vein and its perineal distal connections.Case 3. Penile superficial dorsal vein thrombosis.Definitive diagnosis of the three cases was Mondor’sdisease.CONCLUSIONS: Mondor’s disease is an often under-reported entity in daily clinical activity. Doppler-ultrasoundfindings (echogenic material within veins, lack of anyresponse after compression by the transducer and absenceof color flow) confirm de diagnosis. This disease has afavorable evolution and functional prognosis. Knowledgeof Mondor’s disease by echographists is basic to avoidfalse-negative results in radiologic examination
