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OBJECTIVES: To report the principles of penile re-sculpturing of different deformities caused by M. Peyronie: restoration of penile length, girth and shape with or without penile prosthesis implantation. METHODS: In the period between February 2007 and March 2009, we performed grafting surgery for M. Peyronie in 98 patients aged between 24 and 72 years (mean 52 years). Penile deformities were diferent: dorsal curvature in 54 (55%), lateral in 7 (7%), ventral in 11 (11%), and combined curvature in 21 (21%); associated corporal narrowing was present in 24 patients (24%). Four (4%) patients presented isolated penile shortening without other deformity. Isolated diffuse corporal narrowing without shortening was found in two (2%) patients. Severity of curvature ranges from 60 to 90 degrees, mean 72. Thirty one (31%) patients had associated ED. Surgical options for severe Peyronie’s disease were: single grafting in 26 pts (26%), complex grafting including circular tunical incision in 36 pts (36%), and in patients with ED the same procedures combined with penile prosthesis implantation (37 pts, 38%). Surgical correction was based on measurement of the tunical defect and precise calculation of graft size and shape. Penile straightening and lengthening was achieved by equalizing of shortened penile side/s with the longest one (convex) and grafting. Penile width is reestablished with additional longitudinal incision/s and grafting; graft width is determined by measurement of difference in circumference between normal and narrowed part of the corpora. We used Intexen LP (AMS) as a grafting material in all cases. RESULTS: The mean follow-up was 15 months (6-25). Mean penile length gain without prosthesis was 2.8cm (1.5-4.2) and with prosthesis 3.2cm (2-4.5cm). Insuficient straightening was in 5 patients (>15 degree) where Neuro Vascular Bundle (NVB) was limiting factor. Twenty four patients reported hypoesthesia and reduced orgasmic sensitivity that recovered spontaneously after 3-6 months. De-novo ED occurred in 6 pts and progression of disease in 6 patients. Infection occurred only in one patient with penile prosthesis implantation. Overall patients’ satisfaction was 95%. CONCLUSIONS: Complete tunical reconstruction in IPP can be performed as a safe procedure by transversal, longitudinal and circular grafting with or without simultaneous penile prosthesis implantation. Maximum penile length, girth and shape restoration can be achieved using geometrical calculation, regardless of type of deformity.
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OBJECTIVES: Various protein kinases are known to be activated in cancer cells and drive tumor growth and progression. In metastatic renal cell carcinoma tyrosine-kinase inhibitors (TKIs) have achieved significant progression-free and overall survival improvements. For bladder and prostate cancers TKIs may also be considered as a promising treatment option. Our aim was to report the most relevant published articles to support the interest of the use of TKIs in the treatment of bladder and prostate cancer.METHOD: PubMed database and bibliographies of retrieved articles were reviewed. The key words used were tyrosine-kinase inhibitor, protein-kinase inhibitor, hormone refractory prostate cancer, muscle invasive bladder cancer. The most relevant publications from basic science and clinical randomized controlled studies were summarized and analyzed. RESULTS: Regarding bladder cancer, TKI treatment is one of the most studied therapeutic strategies in the field of targeted therapy. Indeed, it has been suggested that targeting TK alone and/or in association with cytotoxic chemotherapy may represent a promising option for treating locally advanced and/or metastatic bladder cancer. Concerning hormone refractory prostate cancer (HRPC), collected data are still confusing. Basic science studies found an interesting expression of EGF and VEGF receptors on cancer cells supporting the idea that TKIs could be efficient in HRPC. Nonetheless most of published clinical phase II studies found a weak effect on symptoms and quality of life without any decrease in PSA levels or overall survival.CONCLUSION: TKIs have not yet achieved in bladder and prostate cancers similar efficacy to what has been obtained in metastatic renal cell carcinoma. Further studies are needed to establish the place of such an approach in non renal tumors.
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OBJECTIVES: Our goal is to analyze the degree of concordance between the Gleason score (GS) obtained in prostate biopsies and the one after radical prostatectomy. The intention is to know whether 12-core biopsy, ins-tead of 6 (sextant biopsy), improves, or not, this correla-tion. METHODS: A Cohort/prevalence study was conducted on 128 patients who underwent prostate biopsy and subsequent radical prostatectomy. Patients showing biop-sy Gleason values greater or equal to 6 were selected as candidates for radical prostatectomy.RESULTS: Mean age of the group of 128 patients was 62.9 years, with a mean PSA value of 8.53ng/ml. There was concordance between biopsy Gleason score and that obtained after radical prostatectomy in 63.28% of cases, while discordance was found in 36.72% of cases. There were not significant statistical differences after comparing results obtained between Gleason score concordance after 6 or 12-core biopsies and that obtained after radical prostatectomy.CONCLUSIONS: We have noticed a low correlation between Gleason score after biopsy when it was compared with that obtained after radical prostatectomy, while these results are similar to those found in the literature. We did not find better results regarding Gleason score correlation after biopsies performed with 12 cores instead of 6.
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OBJECTIVES: To establish an adequate follow-up protocol based on time to azoospermia achievement after vasectomy. Also, to review the rate of complications in our setting.METHODS: Retrospective analysis of 391 men who underwent vasectomy. Follow-up was performed by means of semen analysis 6 months after surgery, and then every 3 months until azoospermia was achieved. Data of visits to the emergency unit at our centre were obtained within the first 30 postoperative days.RESULTS: During follow-up 567 semen analysis were performed. From 391 vasectomy interventions, 275 had at least one semen sample available and valid for processing. After the first 6 months from surgery, 41.1% men still presented nonmotile rare sperm in semen analysis, 9.7% after 9 months, and 4.7% after 12 months. If semen analysis was postponed from 6 to 9 months after surgery, a total yearly saving of 6,153.23 Euro would be observed in our setting, but with the drawback of delaying the diagnosis of azoospermia in nearly 60% of men. Overall complication rate was 3.1% (only one man required hospital admittance and re-intervention). No statistical difference was observed in operative time with regard to the presence or absence of urological complications.CONCLUSIONS: The percentage of men not achieving azoospermia 6 months after surgery is notorious. Vasectomy practice in our setting seems to be reliable and safe, with a limited rate of complications.
Case Report
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OBJECTIVE: We report a rare case of advanced testicular cancer that describes the natural progression of testicular cancer without medical treatment. This study also describes the effectiveness of chemotherapy, which was the approach used for treatment.METHODS: 37 year old male with history of mental retardation, presented to the emergency room with an ulcer on his right scrotum that had been present for a few months. He was diagnosed of pT4 embryonal carcinoma by biopsy. CT scan showed multiple lung nodes. He was treated with five cycles of Bleomycin/Etoposide/Cisplatin with complete response after treatment.RESULTS: Testicular tumors are the most frequent solid tumors in males between the ages of 20 and 39 years old. Testicular tumors represent 1% of all neoplasias diagnosed in males and 0.1% of all male deaths due to cancer. Several studies have reported the current real incidence rate of testicular tumors has increased to 3%, which accounts for the diagnosis of 450 new cases of testicular cancer a year in Spain. CONCLUSIONS: The cure rate for patients with intermediate risk non-seminoma is around 70% following a conventional treatment approach of four cycles of BEP. The present case is noteworthy because, in our experience, testicular tumors are diagnosed at an early stage without extensively affecting the skin or simulating another type of epithelial tumor. As a result, the present study describes the natural progression of testicular cancer.
Case Report
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OBJECTIVE: We present a case of leiomyoma of the renal capsule in a 49 year-old woman that was detected incidentally during an abdominal study for gastroesophageal reflux. We discuss the clinical, radiological and pathological diagnosis of renal leiomyoma as well as its treatment alternatives.METHODS: Ultrasonography, CT and MRI were performed. A conventional pathological analysis including immunohistochemistry was performed after radical nephrectomy.RESULTS: Ultrasonography detected a solid hypoechoic mass poorly vascularized in the upper pole of the right kidney. CT and MRI detected a well-delimited mass showing soft tissue density without extension to the neighbor structures and without lymphadenopathies. Radical nephrectomy was performed. Microscopically, the mass was made of a low-grade fusocellular proliferation with cells staining with antibodies against smooth muscle markers. The mass was in continuity with the renal capsule and compressed slightly the renal parenchyma without damaging it.CONCLUSIONS: Renal leiomyomas are unfrequent benign tumors that should be suspected in young and middle aged women showing asymptomatic, well delimited and hypoechoic renal tumors with soft tissue density in CT scans. When vascular structures are not involved by the tumor, a conservative surgical intervention could be the first therapeutic option. Microscopically, renal leiomyomas are low-grade fusocellular tumors showing a smooth muscle immunohistochemical profile.
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OBJECTIVE: Renal malformations are rare entities and rarely have clinical consequences. Crossed renal ectopia has an incidence of 1/2.000 autopsies. The association with aortic aneurysm is even more exceptional. METHODS: We present our case and perform a bibliographic review.RESULTS: To date and in our knowledge , seven cases of crossed renal ectopia associated with aortic aneurysm were described on the literature. This malformation makes the treatment of the aneurysm more complex. The possibility of renal function decrease caused by injuries to the renal arteries during the surgical procedure is always present. Because of this risk of injury of the kidney during surgery preoperative evaluation of the vascularization must include image technologies as the MRI, CT-angiography or conventional arteriography. During the aortic intervention vascular conservation must be performed and it is necessary to minimize the time of renal ischemia.CONCLUSIONS: The association of crossed renal ectopia and aortic aneurysm is a rare event. The surgical intervention of the aorta does not have to necessarily originate a loss of renal function. Anyway the worsening of the renal clearance must be foreseen.
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OBJECTIVE: To describe the case of a patient with paratesticular hemangiopericytoma and to perform a bibliographic review. METHODS: We describe the case of a patient with paratesticular hemangiopericytoma. We conducted an exhaustive literature review in different databases to support the case discussion. RESULTS: We present the case of a 64 year old male with a progressively growing mass in the right scrotum that underwent complete resection of the mass. The result of the pathology report was hemangiopericytoma / solitary fibrous tumor and we present the treatment.CONCLUSIONS: We present a rare case of paratesticular hemangiopericytoma. Most of these have a benign outcome, but one must take into account the criteria of malignancy to make decisions regarding their management.
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