OBJECTIVES: To present minimally invasive management of annular ureteric valve that causes upper urinary tract obstructionMETHODS: A case report description: endourological technique and medium-term results with review of the published reports. RESULTS: A 12 year old patient with right flank pain was attended. Ultrasonography shows a right hydroureteronephrosis with conserved parenchyma. Uro MRI (axial plane) showed dilatation until the middle of the right ureter with a filling defect without extrinsic compression. Ureterorenoscopy showed a ureteral valve that was resected by holmium laser. Ureteral stent was maintained for 3 weeks. Twelve months after treatment patient has no clinic and the following ultrasonographies not reveal right ureteronephrosis.CONCLUSIONS: Obstructive ureteral valve resection by endourological treatment using holmium laser Dormier is a safe and effective less invasive method according to shortmedium term results.
OBJECTIVES: Living-donor nephrectomy has significantly expanded the pool of renal transplant donors, allowing for a marked increase in transplantation. Improvements in antirejection medications and refi-nement of donor selection criteria have allowed for extremely favorable rates of graft survival. More recently, laparoscopic donor nephrectomy (LDN) has significantly reduced the morbidity of renal transplantation in the donor population. The University of Miami/Jackson Memorial Hospital Transplant Center performs a large number of living-donor nephrectomies, with increasing use of LDN and here we report our cumulative experience. METHODS: A retrospective review was performed of all live donor nephrectomies performed over the last 10 years, including LDN. Surgical complications, both minor and major, were ascertained. Conversion from LDN to open was similarly noted. Follow up, including creatinine one year post-transplant was recorded in open donor nephrectomy (ODN) and LDN groups. RESULTS: Over 10 years, 413 live donor nephrectomies were performed. Of these, 257 were LDN, and 156 were ODN. In two cases, LDN was converted to ODN. Three patients needed reoperation after donor nephrectomy. There were no perioperative mortalities or deep venous thrombosis. Minor complications, including hernia, fever, and C. difficile diarrhea were very rare, the most common being testicular pain in eight patients. CONCLUSION: Our extensive experience with living donor nephrectomy, with 413 cases spanning ten years, has been very favorable. The risk of major complications was extremely low, with six reported in the series. Minor complications were similarly rare. Living donor nephrectomy is a safe and feasible method of increasing the number of renal transplantation donors with minimal morbidity.
El número de donantes cadáver varía considerablemente entre países, pero parece encontrarse relativamente estabilizado, siendo el aumento de donantes vivos prácticamente el único recurso disponible para poder aumentar el número de trasplantes. La nefrectomía de donante vivo, además de suponer una fuente adicional que ayuda a paliar la escasez de órganos disponibles, aporta varias ventajas al receptor. Por un lado le evita la permanencia en lista de espera, y por otro la función del injerto suele ser inmediata, presentando una mejor evolución a largo plazo, con unas tasas de supervivencia del injerto del 95, 88 y 80% a los 1, 3 y 5 años comparado con el 87, 77 y 65% de los riñones de cadáver.
OBJECTIVES: To investigate epidemiologic, etiopathogenic and clinical factors associated with emergency renal colic (RC). METHODS ANDS RESULTS: We performed a prospective cross-sectional multicenter case-control study of 146 patients treated for RC at emergency departments. Data collected included age, sex, localization/severity of pain, symptoms, personal/family medical history, urine analysis, etiopathogenic factors, chemical composition of the lithiasis, and x-ray studies. Comparative statistical analysis was performed using SPSS 12.2 software. RC was more frequent in men; maximum incidence was between 31-50 years for both sex, with 36.3% in men and 21.23% in women; 60.27% of patients rated pain as severe; 140 RC patients (95.89%) had urologic antecedents vs. 15 (10.27%) controls without RC (p﹤0.001). The most frequent presentation (93.83%) was sudden intense lumbar-abdominal or lumbar pain; 23.28% of RC patients had family history for urinary lithiasis vs. 6.16% controls (p﹤0,001). Most RC patients were seen during summer (36.58%), 82% of RC patients drank ﹤2L of water daily vs. 18.49% in non-RC patients (p﹤0.001). Hematuria was found in 132 (90.41%) patients with RC vs. 17 (11.64%) in those without (p﹤0.001). Lithiasis was observed by KUB x-ray in 42.10% of RC patients vs. 57.89% controls, most frequent calculi composition was calcium oxalate monohydrate and dehydrate (61,2%).CONCLUSIONS: The incidence of urinary lithiasis and RC in our health care area shows a male predominance. The characteristic pain of RC is severe and appears suddenly. It starts in the back (lumbar region), below the ribs, radiating towards the groin and external genitals (testicles in man or major lips in woman) on the same side. Nausea and vomiting are frequent. Family history of urinary lithiasis and low water intake are risk factors that need to be investigated. Occupations associated with a sedentary life style or with a hot, dry workplace show a higher incidence of lithiasis. A hot, dry climate favours the formation of urinary lithiasis and the highest incidence of lithiasis is in the summer, during the months of July and August. The most frequent component of urolithiasis in our study, as well as in other studies, was calcium oxalate monohydrate and dihydrate.
OBJECTIVES: To evaluate the urodynamic changes when a severe cystocele is correct by a vaginal valve to identify occult urinary incontinence. METHOD: Prospective study in 70 women at the Urogynecology and Vaginal Surgery Unit, in Clínica Las Condes. Inclusion Criteria: Symptomatic cystocele degree III or IV. Exclusion criteria: antecedent of incontinence and/o genital prolapse surgery; presence of urinary incontinence symptoms. In all patients the urethra retroresistance pressure was measured by a non-multichannel urodynamic test with and without cystocele reduction by a vaginal Bresky valve. Additionally a cystometry was realized. RESULTS: In all patients the URP was normal when the severe cystocele was not reduced. When the severe cystocele was reduced in 50 (71.4%) women the URP was altered. The cystometry identify asymptomatic overactive detrusor in 8 women. Occult urinary incontinence in the 50 women was: Type I in 1, type II in 27, type III in 1, type II+III in 21.CONCLUSION: When a severe cystocele is reduced by a vaginal valve, urodynamic changes can be detected and women with occult urinary incontinence may be identified. These women may express symptoms of urinary incontinence when a prolapse surgery is realized.
OBJECTIVES: This article aims to analyse the use of solifenacin in the treatment of overactive bladder in order to show its efficacy and safety within the framework of the scientific evidence.METHODS: The available scientific literature was reviewed, including most of the relevant clinical trials performed with solifenacin. RESULTS: All the studies analysed show significant improvements in patients treated with solifenacin versus placebo and tolterodine. Efficacy parameters were assessed in objective and subjective terms, with particular emphasis placed on quality of life. Urgency improves in 60% of patients (40% report no urgency), 58% of patients get continence and 69% perceive an improvement in bladder condition. On completion of treatment, 80% are satisfied with the results and 79% are willing to continue with the treatment in the long term.CONCLUSIONS: Solifenacin is efficacious in the treatment of overactive bladder. The possibility of finding the most effective and tolerable dose with the best response in terms of quality of life constitutes an important difference with regard to other antimuscarinics. The increase to 10 mg gets additional improvements in terms of efficacy, without a significant increase in adverse effects. The side effects perceived were mild or moderate in most cases, and did not lead to more withdrawals compared to placebo. Most patients were satisfied with the treatment and are willing to stay on it in the long term.
OBJECTIVES: Concomitantly with the actual trend towards later fathering, more detailed studies are necessary to establish the relationship between male age and seminal features.The objective of the present paper was to evaluate the relationship of men age with semen quality and with the seminal levels of epididymal and accessory gland markers.METHODS: The study was conducted as a retrospective study of 9168 cases obtained from the Andrology and Reproduction Laboratory in Cordoba, Argentina for 10 years (1995-2004) (men ages 20 to 77). An important number of factors such as abstinence time, toxic habits, work conditions and drugs consumption has been statistically considered. The parameters measured were: seminal volume, sperm concentration, total sperm count, sperm motility, morphology and viability. Seminal levels of alpha-glucosidase, fructose and citric acid were also evaluated.RESULTS: We detected a significant decrease in seminal volume, sperm count, motility, viability and normal morphology, and a reduction in alpha-glucosidase and fructose levels in relation to age.CONCLUSIONS: Since semen quality is a tool for fertility prognosis estimation, the weight of evidence indicates that men may become progressively less fertile as they get older. Couples who decide to delay childbearing should be warned about this matter.
OBJECTIVES: To study the effectiveness and reliability of a new minimally invasive technique for the treatment of the terminal ureter in nephroureterectomy due to transitional cell carcinoma, both in open and laparoscopic procedures.METHODS: Observational retrospective study of 14 patients that underwent intravesical sealing and endoscopic excision of terminal ureter, before ureterectomy (11 laparoscopic, 3 open), due to an upper urinary tract tumor, between July 2003 and November 2007. This procedure was performed on 11 males and 3 females, average age 59.5 years, (range: 35-70). The tumor settled on the renal pelvis in 12 cases and on the proximal ureter in 2. Stage was Ta – T1 in 10 patients, T2 in 3, and T3 in 1. Tumor grade was G3 in 9 cases and G2 in 5.Excision was carried out with a Collins knife. In order to avoid contact between the urine and retroperitoneal space, the meatus was quickly sealed with a clip introduced by means of a transvesical trocar.RESULTS: Total surgical time of nephroureterectomy was 231.15 minutes (range 200-340). Global complication rate for the procedure was 28.4%, but the rate for the cases associated with this technique (meatus sealing and disinsertion) was 14.2%.All patients were discharged after removing bladder catheter. Mean hospital stay was 10.14 days (range: 6-22).After an average follow-up of 25.3 months (range: 12-64), no retroperitoneal recurrence has been reported. One of the patients had bladder recurrence and another one developed metastasis to the suprarenal gland that was treated satisfactorily. CONCLUSIONS: Quick sealing of distal ureter by transvesical application of a clip before its endoscopic excision in nephrourecterectomy is a sound technique from an oncological point of view, with an acceptable complication rate that avoids a second open time to manage distal ureter.
OBJECTIVES: We review the literature about secondary testicular tumors.METHODS: We present the case of a patient with a metastatic mucus-secreting testicular tumor who presented in the emergency room with symptoms of acute scrotum 10 months after surgery for a mixed tumor of the cecum. This type of tumor is rare, and the treatment of choice is orchiectomy; nevertheless, the prognosis of such metastasis remains poor.RESULTS: Because mucinous tumors can present late dissemination, long-term follow-up with assessment of the most common sites of metastasis is necessary. Our patient died 21 months after the initial diagnosis.CONCLUSIONS: Testicular metastases and mucus-secreting intestinal tumor metastases are rare. These tumors occur in patients older than 60 years of age and young men. As in the case of primary tumors, the treatment is orchiectomy.
OBJECTIVES: To show our experience with 4 cases of cysts of the Skene´s gland and a review of the published literature.METHODS/RESULTS: Diagnosis and treatment of 4 cases of Skene´s gland cyst.CONCLUSIONS: Skene´s gland cyst is a lesion that rarely is treated by Urologists, because it doesn’t usually have clinical repercussion, but when it´s derived to us we have to make a complete study of the urinary tract to exclude complications or different serious lesions. Surgery is the treatment of choice, making a complete excision of the lesion and repair of urethral injuries. All cases evolved well without recurrence or fistulous complications.