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El pasado viernes 18 de junio, celebramos la tradicional “Cena de Archivos” en el precioso Salón Puerta del Sol del Casino de Madrid. La revista Archivos Españoles de Urología entregaba, en esta XXXII Edición de los Premios Pérez Castro, los galardones a los mejores trabajos publicados durante el año 2009.
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OBJECTIVES: The aim of this review is to evaluate the place of transurethral resection of the prostate (TURP) in patients with elevated and/or rising prostate specific antigen (PSA). The role of TURP in these patients s assessed in symptomatic as well as in asymptomatic patients.METHODS: Current literature (1987-2009) was reviewed with regard to this specific population. This research was performed using the Medline online search tools. RESULTS: Initially, possible therapeutic strategies other than TURP could be used in patients with elevated and/or rising PSA values and no sign of proven prostate cancer. Consequently, the value of TURP in patients with elevated and/or rising PSA and no proven prostate cancer is discussed. In this setting, TURP can be executed with or without concomitant prostate biopsies. Furthermore, TURP can be proposed to patients with and without lower urinary tract symptoms.CONCLUSIONS: In this review, we evaluated the role of TURP in patients with elevated and/or rising PSA values and no proven prostate cancer. We believe TURP has a place in this particular population even in patients without lower urinary tract symptoms. This strategy is well founded on solid ground after an extensive review of the available literature. In most cases, a TURP will result in a normalization of PSA as well as a symptomatic benefit. Additionally, this procedure will allow histological evaluation which might show a possible life threatening prostate cancer in some patients.
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OBJECTIVES: The American cranberry proanthocyanidins (PACs) are the main responsible for its efficacy in urinary tract infections. Their mechanism of action is related to inhibition of Escherichia coli to urothelial cells. Cysticlean ® contains an extract of American cranberry which provides 118 mg of PACs per dose. The activity of Cysticlean® tablets on Escherichia Coli adherence to bladder epithelial cells has been studied in vitro. Moreover, the activity of Cistyclean® both in powder for oral suspension and tablets has been compared ex-vivo.METHODS: The rats received both Cysticlean® preparations per orem, and urine from each animal was collected during the following 16 hours and pre-incubated with E. coli. Subsequently, bacteria were incubated with T24 cells. After 1 hour the number of bacteria adhered per cell was calculated. For the in vitro study, E. Coli pre-incubated at various concentrations of the products were incubated with T24 cells and the same process previously referred was carried out.RESULTS: Urine samples from rats taking Cysticlean® powder for oral suspension and tablets (118 mg PACs/animal) showed an important inhibition of E. Coli adherence (83% and 52% respectively). The inferior dose of 59 mg PACs/animal also showed marked inhibition of E. Coli adherence (29% after Cysticlean® tablets intake and 40% for powder). In vitro, Cysticlean® showed inhibition of bacterial adherence in all tested concentrations: 5, 25 and 75 PACs mg/ml, diminishing the number og bacteria adhered to epithelial cells by 25%, 36% and 34% respectively.CONCLUSIONS: Cysticlean® shows a significant inhibition of E. Coli adherence to urothelial cells. Cysticlean® powder for suspensión preparation is more effective tha tablets. Cysticlean® powder for suspensión is well tolerated, and compliance has been observed. Its use is very recommendable in pediatric urinary tract infection prophylaxis. Due to the variety of products with American cranberry extracts in the market, with different proanthocyanidins declared content, it would be interesting to compare their activity using established pharmacological methods.
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OBJECTIVES: We show our experience in the treatment of post-prostatectomy stress urinary incontinence with the male Remeex system (MRS). We also describe the elements of the system, its therapeutic indications, technical implantation and appropriate adjustment. METHODS: From March 2007 to January 2009 five male patients aged 57 to 71 years (mean age 66 years) with post-prostatectomy stress urinary incontinence were operated on to insert a suburethral readjustable sling (Remeex). All patients had severe urinary incontinence with deterioration of their quality of life. The evolution period ran-ged from 2 to 10 years with an average of 3.5 years, requiring from 5 to 8 pads a day. RESULTS: All patients are continent after a mean follow up of 15.4 months (range 6-28 months). Only two of them use one security pad when they perform physical efforts. The Incontinen-ce Impact Questionnaire (7) scores befo-re surgery and 6 months after diminished from 68±7 to 10±3. All patients are very satisfied.CONCLUSIONS: MRS is a valid therapeutic option for post-prostatectomy incontinence, being a reproducible technique, of easy execution, that allows readjustment through a suprapubic incision under local anesthesia as an outpatient procedure. It has a low complication rate with excellent and endured results.
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OBJECTIVES: Our objective is to verify the diagnostic usefulness of ultrasound measurement of the thickness of the bladder wall, and the correlation with clinical/ urodynamic findings in patients with symptomatic BPH.METHODS: We performed a prospective cross-sectional study (cross-sectional study “) in a series of 74 males (age χ= 72.4 S = 7.1 (56-84 years) with symptomatic BPH. Patients completed the IPSS and determined the plasma level of PSAt (ng / ml). Before performing the urodynamic study, was determined by transabdominal ultrasonography (3.5 MHz transducer): prostate volume (cc) by the ellipsoid formula, and bladder wall thickness (mm) measured on theanterior bladder wall. Statistical analysis was performed using ANOVA, the Pearson correlation, and ROC curve.RESULTS: It was a significant correlation of the sonographic thickness of the bladder wall with the IPSS (p = 0001, r = 0.38) (parameter in turn highly correlated with prostate volume and PSA (p = 0.01, r = 0.62)), as well as the detrusor hyperactivity (p = 0.03, r = 0.21), cut off ROC curve: 3.85 mm. Instead, it was not shown a significant correlation between the sonographic thickness of the bladder wall and the urodynamic diagnosis of obstruction (Abrams and number Griffths p = 0223, r = 0.14) or the detrusor contractile power, measured in power at peak flow (Pw) (p = 0642 r =- 0.55), nor with age (p = 0303, r = 0.12). Neither correlation was observed with other non-invasive urodynamic measures (the maximum urinary flow flowmetry (p = 0318, r = 0.12) and percentage postmicturition residual (p = 0696, r = 0.05)).CONCLUSIONS: The ultrasound measurement of bladder wall thickness, although it has not proved useful ness in our series in the diagnosis of the voiding phase (lower urinary tract obstruction and detrusor contractility impairment), on the contrary it can be introduced as a diagnostic technique for non-invasive studies in the alterations of the filling phase, in the form of detrusor hyperactivity in also patients with symptomatic BPH, and present a significant correlation with prostate growth.
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OBJECTIVES: To prospectively assess if urinary tract infection (UTI) after extracorporeal shock wave lithothripsy (ESWL) enhances immediate renal damage in patients with renal stones.METHODS: Levels of lactic dehydrogenase (LDH), creatine phosphokinase (CPK), and β2 microglobulin were measured in the urine of 171 patients, before and after ESWL for treatment of up to 3cm renal stones. Standard investigation included urine sample before and after treatment. Patients were divided in two groups in accordance to presence of positive bacterial urine sample after ESWL. Changes in biomarker values pre- and postESWL were assessed via X2 test for both groups and compared between the two groups for post-treatment values.RESULTS: Despite pre-treatment antibiotic therapy, 21.6% of the patients presented with UTI after ESWL. In the group with clear post-treatment urine samples there was a 5.8, 2.2, and 0.7 fold increase of CPK, LDH, and β2 microglobulin levels after ESWL, respectively (p< 0.001), indicating some degree of immediate renal damage. In patients with UTI, the levels of the enzymes elevated by 80, 15, and 2.2 fold after ESWL, respectively, which represents a significantly increased elevation comparing with the sterile urine group (p< 0.001). CONCLUSIONS: ESWL results in transient immediate renal damage, which is exaggerated in patients with persistent or treatment prompted UTI. Long-term importance of this finding must be determined.
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OBJECTIVE: Enterocutaneous fistula is a rare complication after percutaneous nephrolithotomy. Some situations are risk factors for it to occur, such as horseshoe kidney, retrorenal colon and chronic colonic dilation by several factors, among them late postoperative time after yeyunoileal bypass in morbid obesity treatment.METHODS: 35-year-old female patient with a 2.5 cm calculus in the right renal pelvis. Late postoperative time after bariatric surgery using duodenal switch technique, and 55 kg lost till present. She undergone percutaneous nephrolithotomy (PCNL) with two punctures, one in the lower calyx, lost during dilation, and other in the upper calyx through which surgery was successfully carried out. During immediate postoperative time it enteric secretions were observed through the lower chalice puncture. Once the intraperitoneal lesion was removed, decision for conservative treatment was taken with fistula drainage, broad-spectrum antibiotic therapy, fasting and total parenteral nutrition. The fistula debt ceased in the 8th postoperative (PO) day, when drain and nephrostomy tube were withdrawn and patient was discharged from the hospital on 10th PO day. On ambulatory follow up the patient is in good conditions.RESULTS: One case of enterocutaneous fistula after PNL presented in a patient in late postoperative time after yeyunoileal bypass. She was successfully treated by conservative therapy. Several authors point to chronic colonic distention and to great loss of retroperitoneal fat as causes for the increase of inadvertent colonic punctures in percutaneous renal access.CONCLUSIONS: The risk of complications with entero-cutaneous fistula is significantly higher during the post-operatory in patients of bariatric surgery than in others.
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OBJECTIVE: We report a primary renal Synovial Sarcoma (SS) case and analyze its features.METHOD: A 15 year old male presented with left abdominal mass and weight loss. CT scan images showed a 13 cm mass located in the lower pole of the left kidney. Renal biopsy recognized an undifferentiated neoplasm, the immunohistochemistry suggesting the probability of neuroectodermic primitive tumor versus SS. Chemotherapy and radical nephrectomy were carried out. Pathological study showed a big multilobulated necrotic tumor 22x13x12.5 cm. Histopathological study demonstrated a neoplasm composed by immature cells. Currently, patient has survived 1,8 years.A structured bibliographical search was performed in the Medline, Imbiomed and Scielo databases.RESULTS: The final immunohistochemistry studies gave the diagnosis of poorly differentiated renal SS small cell variety.CONCLUSION: The renal SS is extremely infrequent, with less than 40 cases reported, of which this case reports the earlier age. These tumors, when located in the kidney, represent a great diagnostic challenge that requires adequate clinical, radiological, surgical, and pathological correlation for appropriate diagnosis and treatment.
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OBJECTIVE: To describe two cases of urothelial tumors in inguinoscrotal bladder hernias and comment on the low incidence of this condition.METHODS: Two patients were diagnosed and treated by partial cystectomy and hernia repair.RESULTS: The clinical outcome of both patients was good at two and three years, respectively, and neither patient experienced hernia or tumor recurrence.CONCLUSIONS: Inguinal bladder hernias are relatively common. However, few reports of tumor in the herniated bladder have been published. Treatment consists of tumor removal, hernia repair and treatment of any associated urethroprostatic condition.
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OBJECTIVE: We present the case of a big retroperitoneal tumor that received the pathologic diagnosis of malignant fibrous histiocytoma. We also review the diagnostic and therapeutic features of this disease in the current literature.METHODS: We present the case of a 75-year-old male who was admitted to the Gastrointestinal Disease Department with asthenia of several months of evolution and gastrointestinal problems. Abdominopelvic CT scan revealed a big mass of 20 x 22 x 12 cm, which seems to depend from the left kidney, together with an 8 cm diameter abdominal aortic aneurysm.RESULTS: The patient underwent surgery and left radical nephrectomy together with radical resection of the retroperitoneal mass were performed. Pathology reportes malignant fibrous histiocytoma of the storiform-pleomorphic type, with hyaline degeneration foci (stadium pT2B).CONCLUSIONS: Sarcomas are rare neoplasias. They can adopt several different morphologic patterns, as well as many differentiation degrees. The surgical treatment is still the only therapy with healing possibilities. Adjuvant treatments through radiotherapy and/or chemotherapy are brought into question.
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