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Attractivity of robotic high intensity focused ultrasound (HIFU) is based largely on the non-invasive, extremely precise nature of this high-tech robotic therapy as well as its clean, radiation free, surgical, but nevertheless, bloodless character. Today, in urological oncology, HIFU is used clinically as a therapeutic tool for the treatment of prostate cancer. Experimentally it is investigated for therapeutic use in kidney and breast cancer. Transrectal treatment of localized prostate cancer with HIFU has been under investigation since the 1990s and it is meanwhile an actively used therapy for the disease in many urological departments worldwide. Since 2000 HIFU is mostly used in combination with transurethral resection of the prostate in order to reduce prostate gland size, to facilitate effective tissue destruction and to avoid side effects. Palliative and salvage indications as well as focal therapy of prostate cancer are under investigation to extend the spectrum of HIFU indications for non invasive prostate cancer therapy.
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OBJECTIVES: Hyperbaric oxygen therapy (HBO) has been successfully used in several disorders derived from tissue hypoxia, due to the extra oxygen supply to the tissues it enables.In this manuscript we performed a systematic review including all the existing data published until 2010 about HBO in urologic disorders.METHODS: We performed a Medline search using the terms “hyperbaric oxygen”, “radical cystitis”, “interstitial cystitis”, “hemorrhagic cystitis”, “urological/pelvic fistula” and “Fournier´s gangrene”. The search was restricted to human clinical trials published in any language.RESULTS: We found 56 papers: 1 randomized controlled trial, 7 reviews and 48 case reports; only one of them was a prospective study. A total of 695 patients were included. Just one study used tissue oxygen measurement to define hypoxia. The number of hyperbaric oxygen therapy sessions ranged from 4 to 44 (mean 19.2 sessions/patient).CONCLUSIONS: The level of evidence from most reviewed papers is low because most of them are case series. Nevertheless, results of most of those studies regarding patient management are good or very good. So it seems that HBO can be very useful in urological diseases related to tissue hypoxia.
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OBJECTIVES: To report the clinical charac-teristics of recto-urethral fistula (RUF) after radical prosta-tectomy (RP) as well as our experience managing them.METHODS: We present our experience in the treatment of RUF based on their clinical characteristics and the pre-sence of associated complexity factors. After medical history and physical examination, the diagnostic work up was completed in all cases with urethrograms, cystoscopy and barium enema. From January 2000 to July 2010 we treated 12 patients with RUF. Mean age was 64 years (range 56-74 years). The etiology was open sur-gery in two cases and laparoscopic surgery in ten. Clinical presentation varied from 4 to 60 days after surgery.RESULTS: In our experience, endoscopic and radiolo-gical findings were well correlated. Two fistulae were small -less than 5 mm- on the urethral side of the anasto-mosis allowing spontaneous closure after conservative treatment. Ten patients had larger fistulas on the bladder side of the anastomosis and/or were associated with com-plexity factors that required a posterior trans-sphincteric York-Mason approach for resolution, with good reco-very of urinary and fecal continence.CONCLUSION: The RUF is a significant compli-cation after RP and it is difficult to solve. We propose early recons-tructive surgery in large or complex RUF. The posterior trans-sphincteric York-Mason approach has allowed the repair in all cases
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OBJECTIVE: To evaluate the predictive factors for relapse in clinically localized squamous cell car-cinoma of the penis undergoing surgical treatment.METHODS: Forty-nine patients were diagnosed with cancer of the penis in our Service between 1999 and 2009. In the present study we excluded 18 subjects: 9 due to the presence of palpable adenopathies, 6 due to histological characteristics other than squamous cell carcinoma, two lost to follow-up, and one due to death at the time of diagnosis.Diagnosis was based on physical examination and biopsy findings. The primary lesion was treated by circumcision, partial surgery or total penectomy. Disease relapse was defined by lymph node or metastatic involvement after three months from surgery.Univariate and multivariate analysis were carried out using the chi-squared test and logistic regression to identify the factors involved in tumor relapse.RESULTS: Thirty-one patients were included in the study. Mean follow-up was 36 months (median 29). The histopathological study yielded the following profile: 55% pT1 cases, 32% pT2 cases and 13% pT3 tumors. Regarding histological grade, the distribution was G1: 29%, G2: 32%, G3: 39%. Recurrence and mortality rates were 38.7% and 35.5%, respectively.In the univariate analysis, location of the lesion (p=0.004), type of surgery (p=0.008), tumor stage (p=0.003) and cellular grade (p﹤0.001) were significantly correlated to disease relapse.In the multivariate analysis, only cellular grade proved statistically significant (p=0.01).CONCLUSION: In our series, only histological grade could be regarded as an independent predictor of tumor relapse.
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OBJECTIVES: Retroperitoneal laparoscopic surgery has been applied in many centers as the first therapeutic option in an ever increasing number of cases. We analyze the complications seen in our 5 years of experience in laparoscopic renal surgery.METHODS: We retrospectively analyze intraoperative and postoperative complications that occurred in the lapa-roscopic renal procedures carried out bet-ween June 2004 and November 2009. We also study several demographic factors that may play a role in the cause of the complications.RESULTS: A total of 404 laparoscopic procedures that meet these characteristics were performed with a total of 98 medical and surgical complications (24.2%). Death rate was 0.6, conversion to open surgery occurred in 8 patients (1.9%) and postoperative surgical revision was required on 4 patients (0.99%). The most common intraoperative complication was bleeding (6.4%) and the most common postoperative complication was dete-rioration of renal function (6.4%). Nephroureterectomy was the procedure with the highest complication rate. CONCLUSIONS: Analysis of the complications of a surgical technique is fundamental and a consensus on the definition of such complications must be reached in order for the study to be as complete and critical as possible.
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OBJECTIVE: We report a rare clinical case of scrotum carcinoma and evaluate its treatment and prognosis.METHODS: We describe the case of a 62 year old man who presented an ulcerated-bleeding lesion on the right side of the scrotum. The diagnostic tests found carcinoma of the scrotum. We performed surgical radical treatment preserving the left scrotum.RESULTS: Histological examination showed lesions of well differentiated squamous cell tumor.CONCLUSIONS: After literature review we conclude that scrotal carcinoma is currently a rare tumor , and even more in cases with industrial exposure to carcinogens. Its incidence has declined greatly and advanced cases requiring radical surgery are rare.
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OBJECTIVE: Metastases to the urinary bladder are rare, representing less than 2% of bladder tumors. We report two cases of bladder involvement by primary gastric adenocarcinoma and perform a bibliographic review of the literature on this subject.METHODS: A search for published data was performed in the PubMed database using the key words “bladder”, “secondary malignant tumors” and “metastatic gastric carcinoma”. We reviewed the two cases of secondary bladder involvement by primary gastric adenocarcinoma managed at our institution.RESULTS: Case 1: 62 year old female presenting with irritative LUTS, hypogastric pain and constitutional symptoms, with bilateral hydronephrosis. After bilateral nephrostomy, bladder wall biopsies revealed poorly differentiated metastatic gastric carcinoma.Case 2: 41 year old male with gastric adenocarcinoma diagnosed by endoscopic biopsy with pancreatic involvement, under neo-adjuvant chemotherapy regimen, with sporadic macroscopic hematuria. Cistoscopy revealed a protuberant bladder mass with biopsies conclusive for secondary bladder involvement by gastric carcinoma.CONCLUSION: Bladder metastasis from primary gastric adenocarcinoma usually means advanced disease with multiple metastatic involvement and peritoneal dissemination. The overall prognosis is very poor.
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OBJECTIVE: To report a rare case of hematuria caused by an arteriovenous fistula which may be a urological emergency.METHODS: We describe the medical history, physical examination, complementary tests performed and their results, as well as the treatment applied in an adolescent with hematuria.RESULTS: Congenital arteriovenous fistula was diagnosed and treated by percutaneous embolization with immediate stop of hematuria.CONCLUSION: Non-traumatic renal arteriovenous fistulae are rare, even more if they present with gross hematuria. We present a case of a life-threatening emergency caused by one of them the treatment of which was possible by embolization, avoiding surgery.
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OBJECTIVE: To remind the existence of pelvic venous congestion syndrome as a diagnostic possibility in women with chronic or relapsing abdominal pain that simulates repetitive renal colic, in which common diagnostic tests do not show any positive finding.METHODS: We present the case of a 36-year-old woman with a picture of unilateral relapsing abdominal pain that, after many visits to the emergency room is sent for study with the diagnosis of renal colic. Ultrasound, intravenous urogram and ureteroscopy did not demonstrate any pathological finding.RESULTS: Contrast enhanced CT scan demonstrated the severe dilatation of the gonadal venous system as unique finding. She was diagnosed of pelvic venous congestion syndrome and sent to the Gynecology Department for specific treatment.CONCLUSIONS: The pelvic venous congestion syndrome is a clinical entity to keep in mind in patients with chronic or relapsing abdominal pain in whom we do not find evidence of urinary lithiasic disease. Generally, patients present an anxiety or depression state that is secondary to the problems caused by chronic pain and the absence of diagnosis, despite of the many diagnostic tests performed. Reaching a diagnosis that allows adequate treatment will also solve this picture. Contrast enhanced CT scan must be the first step for diagnosis, leaving venography for special situations.
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