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Modern imaging capabilities has created a renal tumor stage and size migration with approximately 70% of patients today detected incidentally with a median tumor size of 4cm or less. In addition, our current understanding indicates that renal cortical tumors are a family of neoplasms with distinct histopathological and cytogenetic features and variable metastatic potential. The conventional clear cell tumor has a malignant potential and accounts for only 54% of the total renal cortical tumors but 90% of those that metastasize. Radical nephrectomy, whether performed by open or minimally invasive surgical technique, plays an important role in the management of massive renal tumors that have replaced the normal renal parenchyma, invade the the renal vein, and have associated regional lymphadenopathy or metastatic disease. Partial nephrectomy has emerged as the treatment of choice for patients with smaller tumors. This operation can be performed through a “miniflank” surgical incision without rib resection. Complications related to partial nephrectomy, including bleeding, urinary fistula and infection occur in less than 10% of cases. Radical nephrectomy should not be performed for the treatment of small renal tumors since it is associated with the causation or worsening of preexisting CKD which can cause an increased likelihood of cardiovascular morbidity and mortality. Despite a wealth of evidence supporting the more restricted indications for RN, strong evidence exists that it remains over utilized in the United States. Widespread education and training in kidney preserving surgical strategies is essential going forward.
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OBJECTIVES: Sickle cell disease is one of the most common hereditary diseases, and migration trends and cross breeding have increased its incidence in Europe. While much has been published about the disease, there are few reviews in the literature dealing with its manifestations in the genitourinary system.METHODS: We conducted a comprehensive review, using as our main instrument the PubMed online database, on recent advances in knowledge of the pathophysiology and urological, nephrological, and andrological manifestations of the disease.RESULTS: Manifestations include sickle cell nephropathy, enuresis, nocturia, hematuria, priapism, renal medullary carcinoma, and infarctions and necrosis in various organs of the genitourinary system. CONCLUSIONS: The characteristics of this important disease and the multisystemic spectrum it covers make knowledge of its genitourinary manifestations necessary.
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OBJECTIVES: To establish the rate of infectious complications derived from the use of transrectal ultrasound-guided prostate biopsy (TRUS), identify its microbiological profile and related risk factors.METHODS: We designed a prospective non-randomized study in which we enrolled 220 patients undergoing TRUS biopsy at our centre between April and September 2008. The inclusion criteria were: suspicious digital rectal exa-mination, PSA >10 ng/ml, and free/total ratio of PSA is assessed in patients with PSA 4-10 ng/ml. The exclu-sion criteria were: having an indwelling urinary catheter, the administration of antibiotic treatment in the week before the needle biopsy, manipulation of the urinary tract in the month prior to the needle biopsy, allergy to quinolones and risk of endocarditis, failure to comply with the anti-biotic prophylaxis regimen and loss to follow-up.We analyzed the relationship between diabetes, immunodepression, previous UTI or prostatitis and positive pre-biopsy urine culture with the appearance of fever, dysuria or bacteriuria following needle biopsy.RESULTS: Mean age was 69.5 years (+/-7.9), mean total PSA 12.7ng/ml (+/-28.7), mean prostate volume 50.6 cc (+/-29.6) and mean number of cores obtained by needle biopsy 13.5 (+/-1.7). 25% of the patients had dysuria following needle biopsy, 3.2% fever and 4.5% bacteriuria. E.coli was the pathogen most frequently found in pre- and post-biopsy urine cultures.No statistically significant relationship was found between the appearance of dysuria and fever and being diabetic, having immunosuppression, previous UTI or prostatitis, prostate volume and number of cores obtained in the biopsy.Only the existence of a positive pre-biopsy urine culture and biopsy with more than 14 cores proved to have a statistically significant association with the existence of bacteriuria following biopsy, p=0.007 and p= 0.018, respectively. CONCLUSIONS: Our rate of infectious complications was similar to that described in other series. The existence of a positive pre-biopsy urine cul-ture and obtaining more than 14 cores per biopsy was related, with statistical significance, to the existence of bacteriuria following the biopsy. E.coli was the most fre-quently isolated pathogen.
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OBJECTIVES: We present our series of residual retroperitoneal mass surgery after chemotherapy. We evaluate possible preoperative parameters that can predict the retroperitoneal mass histology. Survival and relapse rates were also evaluated. METHODS: We reviewed sixty resections of residual retroperitoneal masses of testicular tumours after chemotherapy performed at our department between 1995 and 2007. We evaluate the relationship between histology of the retroperitoneal mass and possible risk factors, such as outcomes after chemotherapy, which was evaluated as changes in the size of the re-troperitoneal mass, and negativization of serum tumor markers. We also evaluate histology and size of the primary testicular cancer.RESULTS: The histology of retroperitoneal mass was necrosis or fibrosis in 25 (42%) cases, teratoma in 29 (48%) and viable tumor in 6 (10%). The size of the retroperitoneal mass decreased after the chemotherapy in 62% cases; moreover negative serum tumor markers were found in 87%. Elevated values of human chorionic gonadotropin were associated with viable cells in the retroperitoneal mass (p=0.014) and, the presence of teratoma in the primary tumor may be associated with teratoma in the retroperitoneal mass histology (p=0.002). However, no other preoperative factors that predict the residual mass histology were found. Repeated resections of retroperitoneal masses were required in four patients and 9 patients died during follow-up.CONCLUSIONS: We cannot determine preoperative parameters that accurately predict the histology of retroperitoneal masses. Therefore, resection of residual retroperitoneal masses after chemotherapy in non-seminomatous germ cell tumours must be performed.
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OBJECTIVES: To assess the complications of polypropylene mesh in the treatment of female pelvic floor disorders.METHODS: Retrospective study of patients with pel-vic floor pathology (SUI, cystocele, rectocele, enteroce-le) undergoing pelvic floor intervention with surgical meshes from March 2002 to October 2009.We evaluated complications, effectiveness of the technique and distribution of the impact of the results. For statistical analysis SPSS software was used and the curve of impact was estimated by Cox model.RESULTS: We analyzed 363 patients. Of these 363 patients, 290 (79.9%) suffered from Stress Urinary Incontinence, 37 (10.2%) cystocele, 33 (9.4%) SUI and cystocele, 1 (0.3%) SUI and enterocele, 1 (0.3%) cys-tocele and enterocele and 1 (0.3%) cystocele, enteroce-le and rectocele. The interventions done were: 34 (9.4%) anterior and middle compartment meshes, 1 (0.3%) middle and posterior compartment meshes, 1 (0.3%) TOT and middle and posterior com-partment mesh, 36 (9.9%) TVT and 3 (0.8%) TVT and anterior and middle compartment mesh. The median fo-llow-up was 36 (3-90) months. 50 patients (13.8%) presented complications: 21 (42%) had lower urinary tract irritative symptoms, 10 (20%) externalization of the mesh, 3 (6%) necrotizing fascitis, 3 (6%) obturator fossa, thigh root or vaginal abscess, 5 (10%) chronic pelvic pain, thigh pain or dyspareunia, 2 (4%) bruising and bleeding, 3 (6%) urinary tract infections, 1 (2%) mesh entering bladder and 2 (4%) obstructive symptoms. The procedures were effective in 350 (96.4%) patients. The impact of complications was manifested in the first 10 months after surgery. CONCLUSIONS: Polypropylene meshes are very effective in the treatment of female pelvic floor disorders. Approximately 10% of the patients had complications that resolved spontaneously or with medical treatment in most cases. One third of the complications are subsidiaries of surgery, by removing the mesh totaly or partialy, without affecting the intervention results.
Case Report
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OBJECTIVE: To review presentation, diagnosis and treatment of renal artery aneurysms, a very uncommon disease. METHODS: We report the case of a male with a calcified renal artery aneurysm in a solitary kidney. RESULTS: Symptomatic effects may be hypertension, hematuria or flank pain. Arteriosclerosis and medial dysplasia are the most frequent causes and diagnosis is based on CT scan and angiography. CONCLUSIONS: The renal artery aneurysm is a disease with low prevalence and there is no clear protocol for management. The number of cases has increased over the last decades and endovasculrar treatment is a good therapeutic option.
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OBJECTIVE: We try to show the relevance of this rare pathology and to set its importance in the differential diagnosis of prostate masses.METHODS: We report a case and perform a search in the MEDLINE database of the series described up to the date.RESULTS: Prostatic leiomyoma is a extremely rare anatomopathological finding, though the appearance of a glandular hyperplasia with small areas of leiomyomatous growth is more common. Up to date there are just a hundred cases described. They are benign mesenchymal tumors without evidence of disease recurrence after surgery.When they present symptomatology, they emulate benign hyperplasia with urinary tract infections. Although it has benign nature, surgical intervention is indicated when severe clinical symptoms appear.CONCLUSIONS: The recognition of this benign entity and the distinction from other neoplasias has important therapeutic and prognostic implications. Imaging techniques and pathological analysis are crucial for this reason. When an unusual prostatic mass is detected, the leiomyoma must be included in the differential diagnosis.
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OBJECTIVE: To report two new cases of Ewing`s sarcoma/ primitive neuroectodermal tumor of the kidney, one of them with tumor thrombus in cava.METHOD: Characterization of two new cases and literature review by PubMed search.RESULTS: We report the cases of two men diagnosed with primary renal Ewing`s sarcoma, who have been treated with nephrectomy and adjuvant chemotherapy, being in complete remission to date.CONCLUSION: Ewing`s sarcoma / primitive neuroectodermal tumor of the kidney is a rare condition that mainly affects young adults. The natural history of these tumors is the evolution towards metastatic disease and death. Treatment is multimodal, combining surgery and chemotherapy. The role of radiotherapy is not well established.
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OBJECTIVE: To report a case seen at the Urology Department and comment on the literature.METHODS: We present the case of 46 year-old male who presented left flank pain. Intravenous pyelography was performed. The study showed evidence of contrast extravasation at the level of the left renal pelvis and a 7 mm stone located on the left ureterovesical junction. A literature search was performed using Promedicum, Pub Med and Ovid. The search words were: rupture, renal pelvis, lithiasis and spontaneous combined by boolean operators.RESULTS: The management was successful using endourology procedures and a double pigtail catheter for a two week period. CONCLUSIONS: Spontaneous rupture of the renal pelvis (SRRP) is an infrequent pathological event. Most of the cases are related to obstructive uropathy, infection and diagnostic procedures. Intravenous pyelography is a useful tool although intravenous contrast CT scan has higher sensibility. The treatment depends on patient state but most cases can be managed with minimally invasive procedures and double pigtail catheter placement.
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Case Report
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