Article
Knowledge map
Save
In 1960 Hodson and Edwards published their landmark paper about the association between chronic pyelonefritis and vesicoureteric reflux (VUR). Since then, the approach for VUR became more important (1).In the last 30 years there have been multiple publications on vesicoureteric reflux (VUR) and discussions at Pediatric Urology meetings with the purpose to give answers to the questions what the best treatment is for VUR, at what age the treatment is advocated, does it prevent for febrile urinary tract infections (UTI’s) and does it stop of decreases the risk for reflux nefropathy and renal scars. Well known are the International Reflux Study (1981) with a European and an American arm in which the researchers compared medical approaches with surgical approaches to reflux, and the Birmingham Reflux study (1987) which was a prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux in children with five years observation (2).In 2009 the group from John Hopkins (Baltimore, USA) published their interim results from a randomized placebo-controlled study of children with VUR (the RIVUR Study) (3). The most recent randomized controlled trial (RCT) is the Swedish Reflux Trial published in the Journal of Urology 2010, July. This was set up as a RCT to compare 3 treatment alternatives, including antibiotic prophylaxis, endoscopic therapy and surveillance as the control group, in regard to recurrent febrile UTIs, renal damage and VUR status after 2 years (4).Since these new data are available, we want to give an update in this specific and interesting field in Pediatric Urology
Article
Knowledge map
Save
OBJECTIVES: To assess the incidence of genitourinary infections associated with transrectal ultrasound-guided prostate biopsy (TRUS-BX) using endorectal povidone-iodine gel as a bactericidal agent.METHODS: We prospectively studied a total of 530 patients who were given 30g of 10% povidone-iodine intrarectally before TRUS-BX. Each patient received antibiotic prophylaxis with ciprofloxacin, starteing the previous day (1g/day x 3 days), as well as cleansing enemas.RESULTS: One patient (0.20%) presented with an E. coli acute bacterial epididymitis after biopsy. CONCLUSIONS: In our study, the intarrectal use of 10% povidone-iodine gel in TRUS-BX is associated with a much lower rate of infectious complications compared to those described in recent literature
Article
Knowledge map
Save
OBJECTIVES: Testicular cancer represents about 1% of malignant tumors in men. Of these tumors 95% are germ cell tumors (GCTs), which have a maximum incidence between the second and third decades of life. Our objective was to carry out a retrospective analysis of testicular tumor cases that had been diagnosed in our Health Area between the years 2000 and 2010. METHODS: We performed a retrospective descriptive study between the years 2000 and 2010 analyzing 43 patients treated for testicular cancer, including in the analysis tumor incidence, the patient’s age, clinic attended, patient’s time until appointment, presence of tumor markers, patient’s time before treatment, use of testicular prostheses, histological type and their typical characteristics, oncological treatment, tumor progression and mortality rate. RESULTS: We found an incidence of 4-5 cases/100,000 population/year in our Health Area. Two-thirds of the cases were detected in Stage I, and 100% of these cases showed complete remission. Among those with higher stage tumors, two out of three patients were cured after chemotherapy. For the remaining one-third, rescue treatments managed to achieve a remission rate of 66%. Mortality was low and was linked to lymphoma or metastatic dissemination. CONCLUSION: The trend towards early diagnosis with detection during the initial cancer stages, together with current chemotherapy protocols, enables a high cure rate for testicular cancer. Mortality in our series was associated with primary or secondary lymphomas
Article
Knowledge map
Save
OBJECTIVES: The aim of this study was to investigate the prevalence of Sexual and Pelvic Floor Dysfunctions associated with familial type 1 Portuguese amyloid polyneuropathy (FAP). We studied women with FAP in three stages of the disease: asymptomatic women (n=12, women in the early stage of the disease (n=8) and 3 women in the most progressive stage of the disease. We hypothesize that women with FAP suffer from pelvic floor hypotonicity, which may hinder orgasmic function and as such, lead to deteriorated sexual function.METHODS: Twenty-three women with FAP were studied. Clinical examinations were performed using the following scales: Clinical Evaluation Scale (CES), Visual Analog Scale of Quality of Life (VAS), Female Sexual Function Index (FSFI) and Pelvic Floor Manometry (PFM).RESULTS: Of the women, 5 (21.7%) had a score of <26 on the FSFI, suggesting sexual dysfunction, 3 of which had FAP at the most progressive stage. None of the asymptomatic women had low FSFI scores. The manometrical rates (PFM) of tonus and strength of the pelvic floor showed significant differences between groups. CONCLUSION: Female sexual dysfunction (FSD) may occur in the initial stages of the disease but is more prevalent in women in the advanced stages of the disease. There is an increasing incidence of FSD as FAP disease progresses, namely in terms of HSDD and orgasmic sensation. In the asymptomatic group, the females revealed PFM alterations without stress urinary incontinence, which is regarded to be a discrete deterioration of pelvic floor muscle function
Case Report
Knowledge map
Save
OBJECTIVE: The inability to remove a bladder catheter due to impossible balloon removal is a situation with controversial management; there are no action guidelines and it is limited to individual experience in most cases. In this article, we review the techniques described for removing a urethral catheter and we share our experience with one case.METHODS: A 70-year-old male with permanent bladder catheter was referred to the emergency department due to an inability to deflate the self-retaining balloon during routine change in his health centre.RESULTS: After unsuccessfully trying to puncture the balloon through the inflation channel previously cut above the valve, we punctured it via the suprapubic route under ultrasound guidance with a biopsy needle. Using this technique, we managed to rupture the balloon without free fragments, enabling the catheter to be changed without incident.CONCLUSIONS: There are various techniques for approaching this situation, the knowledge of which enables the urologist to resolve the problem by adapting to patient’s characteristics and available resources. Suprapubic puncture of the self-retaining balloon is an easily reproducible technique with minimal complications and a lower rate of free fragments
Article
Knowledge map
Save
OBJECTIVE: To report a new case of giantretroperitoneal mass with silent beginning.METHODS: We present the case of a 36 year old manwith a giant retroperitoneal liposarcoma 35 x 15 cm insize. The only symptom was a one month history of minimalabdominal pain CONCLUSION: Liposarcoma is the most frequentretroperitoneal mass. In most of the cases clinical symptomsare silent, being this the reason why diagnosis is late andthe size is large. The best image options are CT scan orMRI but final diagnosis is based on pathology results. Itstreatment is surgery and relapse is very usual
Case Report
Knowledge map
Save
OBJECTIVE: A retained postoperative drain tube, trapped by one or more of the sutures of the abdominal wall closure, is a rare complication of frustrating consequences and potential legal repercussions. There are few reports of techniques for minimally invasive removal of an anchored postoperative drain tube, which not infrequently has been treated by reopening the wound. METHOD/RESULT: A 75 years-old man with a left T2-T3N0M0 renal carcinoma was treated with transperitoneal laparoscopic nephrectomy and a Jackson-Pratt drain was left in place. Drain removal the day after revealed impossible, as if being caught with fascial suture. With the patient under sedation, we introduced a Sachse urethrotome parallel to the drain, and the abdominal fascia was identified, then the polyglycolic stitch anchoring it to the wall could be severed, freeing the drain. CONCLUSIONS: Percutaneous extraction with the Sachse urethrotome of an anchored postoperative drain, should be the first option, before trying a forced traction or using more complex options. This technique is for the first time published in the Spanish bibliography, and we think this possibility should be disclosed to abdominal surgeons
Case Report
Knowledge map
Save
OBJECTIVE: Literature review of adenocarcinoma of the urachus in connection with two cases recently diagnosed and treated in our center.METHODS/RESULTS: We report 2 cases of urachus Adenocarcinoma treated in our institution, both underwent extended partial cystectomy including excision of the urachus up to the umbilicus.CONCLUSION: Urachal adenocarcinoma is an exceptional tumor, of poor prognosis, the treatment of which is surgical (partial cystectomy), and the main predictors of disease-free survival are the degree of tumor differentiation and the free margins of the surgical specimen
Case Report
Knowledge map
Save
OBJECTIVE: To describe one case of syringocele in an adult patient.METHODS/RESULTS:We report the case of a 26 year old man who presented frequency, hematuria and fever during one year, mictional cystourethrography showed a syringocele. Treatment consisted in endoscopic surgery, with good results in the follow-up.CONCLUSIONS: The syringocele is a relatively infrequent entity, that is necessary to study in a young patient with voiding symptoms, accompanied or not of haematuria and fever. The diagnosis is based on the cystourethrography, and treatment consisted, usually, in endoscopic surgery
