The natural orifice translumenal endoscopic Surgery (NOTES) approach has been successfully reported by several surgical teams in different specialties. Urologic teams have recently presented several experimental and clinical experiences with the technique. Our aim is to review the initial experience with NOTES in minimal access urological surgery
OBJECTIVES: Many studies have investi-gated the association between obesity, adipose tissue-derived factors (leptin and adiponectin) and prostatecancer (CaP) but the results are still inconsistent.METHODS: The aim of this study was to carry out acomprehensive review of the existing evidence aboutthe role of leptin and adiponectin in prostate carcinoge-nesis and to provide an overview of it.RESULTS: Recent evidence suggests that leptin may playa rol in prostate cancer progression, while adiponectinmay act as an “anti- prostatic cancer” adipokine.CONCLUSIONS: Obesity may promote the progressionof established prostate cancer and and adipokines mayprovide a molecular mechanism whereby obesity exertsits effects on prostate tumour biology
OBJECTIVES: We report our results after 100 urethroplasties for the treatment of urethral stricture both at the bulbar and penile urethra, using different techniques.METHODS: 100 patients with the diagnosis of anterior urethral stricture, that were submitted for urethroplasty in the period 1997-2007. Of them, 57 treated by end to end urethroplasty. 4 patients underwent augmented free graft anastomotic urethroplasty. Buccal mucosa free graft was used in 16 patients and penile skin onlay flap in 23.RESULTS: We have obtained 84% good results overall.In patients undergoing end to end urethroplasty we obtained 91.2% success rate. We had 75 % of good re-sults with the free graft anastomosis. In the cases in which we used buccal mucosa patch we obtained 90% success in bulbar urethra and 67 % in penile urethra. When we used onlay flaps good results were 70.6% in penile urethra and 66,7 % in bulbar urethra.CONCLUSIONS: Open surgery is the best form of treatment for urethral strictures. The anastomotic urethroplasty is the technique that, applied in bulbar urethra, enables better results. For strictures over two centimeters we have other procedures of choice in penile urethra, pediculated skin flaps, except in cases with Lichen Esclerosus, in which the use of buccal mucosa as a graft is preferable, and in the bulbar urethra in which augmented onlay graft urethroplasty or free grafts, mainly buccal mucosa, are preferred. In long and complex strictures, the option that we must contemplate is two-stage surgery. Any type of urethroplasty can fail, and this risk increases as the time passes.
OBJECTIVES: To compare the clinicaldiagnosis of the urinary incontinence with the results ob-tained by MoniTorr® urodynamic test.METHODS: Prospective study of 590 consecutive pa-tients with symptomatic urinary incontinence, betweenJanuary 2006 and June 2008, at the Urogynecologyand Vaginal Surgery Unit, Obstetrics and GynecologyDepartment, Clínica Las Condes, Santiago, Chile. Me-dian age was 55 years (Range 30-91 years). In all patients the type of urinary incontinence (stress, mixedor urgency) was classified according to symptoms andsigns observed during the first approach. Urodynamictest with a non-multichannel system was performed (retro-re-sistance pressure and cystometry were measured) andincontinence was classified in accordance to the para-meters obtained. The clinical diagnoses were comparedwith the urodynamic test results.RESULTS: In 420 patients with clinical diagnosis of stressurinary incontinence (SUI) urodynamics registered 43(type 0), 4 (I), 181 (II), 2 (III), 118 (II+III), 21 (0+HD),26 (II+HD), 3 (III+HD) and 22 (II+III+HD). In 92 withMixed Urinary incontinence urodynamics registered 17(0), 16 (II), 20 (II+III), 9 (0+HD), 12 (II+HD), 1 (III+HD)and 17 (II+III+HD). In 78 women with urgency inconti-nence, urodynamics registered 32 (normal), 2 (I), 5 (II),5 (II+III), 27 (HD), 3 (II+HD) and 4 (II+III+HD).CONCLUSIONS: The non-multichannel MoniTorr testis an objective method to demonstrate the urinary in-conti-nence diagnosed clinically. The urodynamic test isa complementary examination, very useful in the studyof urinary incontinence. The clinical diagnosis can bedifferent to objective urodynamic diagnosis. The urody-namic study allows planning the solution adapted foreach patient
OBJECTIVES: A clinical evaluation of theuse of a 980 nm diode laser in the treatment of bladderoutlet obstruction secondary to benign prostatic hyper-plasia (BPH), focused on perioperatory morbidity andresults in a short-term follow-up.METHODS: Fifteen patients were included in the study.All of them were evaluated by IPSS and Quality of Life(QoL) questionnaires, digital rectal examination, PSA, ul-trasound scan and uroflowmetry. Prostate vaporizationwas performed with a laser of diode at 980 nm (Inter-medic; Barcelona, Spain) using a 600 microns side-firefiber. In the follow-up any event was recorded, as wellas the IPSS and QoL scores and Qmax.RESULTS: Mean age of the patients was 66.7 years(45-75). The range of prostate volume was 20-76 cc (me-dian 41.3 cc). Mean delivered energy was 161,012kJ (78,3-243). No patient showed either a significanthematic loss or fluid absorption syndrome. A 22F ure-thral three-way catheter was inserted and removed bet-ween 12-40 hours in the postoperatory period. After amean follow-up of 5,5 months (2-9) the average IPSSand QOL questionnaires scores changed, respectively,from 22,4 (19-26) and from 3 (2 -4) to an average of6,8 (1 – 13) (p>0,01) and 1,4 (0 – 3), respectively, atthe end of follow-up (p >0,01). Qmax increased from6,4 ml/s (5-11,9) baseline to 19,7 ml/s (13,9-24 (p>0,01). No patient showed urinary incontinence. Re-treatment was not nee-ded though three patients neededa short-time catheterization (24 hours) after developingacute urinary retention in the first 48h hours.CONCLUSIONS: Our preliminary results suggest thatprostate vaporization using 980 nm diode laser withoutput power up to 120 W, is effective and associatedto minimal morbidity
OBJECTIVE: We report a rare case of horseshoe kidney trauma.METHODS: 67 years old man with a horseshoe kidney, which presented a fracture of the isthmus after falling.RESULTS: The diagnosis was made by IV contrast CT scan. He underwent exploratory laparotomy due to hemodynamic instability and radiologic findings on the CT scan.CONCLUSIONS: The rupture of a horseshoe kidney is a rare injury. CT scan is the test of choice to classify the degree of injury. Depending on the patient’s hemodynamic stability and the findings on the CT scan the options are conservative orimmediate sur-gical treatment
OBJECTIVE: To present a case of giant suprarenal carcinoma assisted by the Urology Service of the “Camilo Cienfuegos Gorriarán” General University Hospital of Sancti Spíritus, Cuba.METHODS: 32 - year - old male patient who attended the emergency urology consultation, presenting left flank pain and a thirty - pound loss of weight in a three - month period. The radiological studies showed a great tumoral mass with displacement and infiltration of neighbor structures. Pathological study confirmed the diagnosis of suprarenal carcinoma.RESULTS: The treatment applied was surgical excision surgery via thoracico-abdominal approach. The postoperative evolution was satisfactory. Several parameters of bad prognosis such as weight and elevated size, necrosis, pattern of diffuse growth and capsular invasion were present. Death took place 6 months after intervention due to the progression of the illness. CONCLUSIONS: The big dimensions of the tumor determined a wide excision surgery which didn’t stop the progression of the disease and the death of the patient 6 months after being operated
OBJECTIVE: To report the cases of adenoma-toid tumors seen at Hospital Universitario La Paz in the last 15 years.METHODS: A clinical, pathological, and surgical study was conducted of males with testicular or paratesticular tumors with a histological report of adenomatoid tumor.RESULTS: Among the nine cases studied, seven had parates-ticular and two intratesticular adenomatoid tumors. Treatment of choice was mass removal for epididymal tumors and or-chidectomy for intratesticular tumors.CONCLUSIONS: Adenomatoid tumors are uncommon be-nign neoplasms of a possible mesothelial origin. Because of their benign nature, the treatment of choice is local excision (conservative surgery), but orchidectomy was performed in two cases due to tumor location.
OBJECTIVE: To make the difference between two uncommon entities, small cell prostate carcinoma and prostatic metastasis of small cell lung cancer. METHODS/RESULTS: We describe a case of single extrapulmonar metastasis in the prostate from small lung carcinoma. CONCLUSION: Clinical and radiographic findings and in-munohistochemistry allow differential diagnosis.
OBJECTIVE: We describe a new case of incidental renal papillary carcinoma. We perform a bibliographic review.METHODS: The papillary renal cell carcinoma is a variant of renal carcinoma. They classify in two subtypes that have relation with their prognosis. We presented one case of renal papillary carcinoma in a male of 76 years, play-acting as severe hydronephrosis.RESULTS/DISCUSSION: We describe the findings and final pathological result associated with a synchronic metastasis in the ipsilateral ureter.
The primary carcinoid tumor of the kidney is a tumor of unusual presentation, 40 cases have been reported in the literature. We describe the presentation of a patient with a primary carcinoid tumor of the kidney.OBJETIVES: To report a new case of renal carcinoid tumor, a rare tumor sometimes presenting without uri-nary tract symptoms, but rather associated with disorders of other or-gans that mask the clinical picture.METHODS: To report the case of an 80 year-old patient, ad-mitted to the Department of Gastroenterology with anaemia associated with diarrhea for one week. After blood, feces and image tests a solid mass was detected in the left renal parenquima; she was referred to our service and radical nephrectomy was performed. After 8 months of follow up her outcome is satisfactory.RESULTS: Renal carcinoid is an infrequent entity, included among neuroendocrine tumors, described 100 years ago by Lubart, derived from Kuchitsky’s cells, they produce po-lipeptidic hormones and biogenic amines; being more fre-quent in the gastrointestinal tract (62-67 %) and respiratory tract(22-27 %). Generally, these tumors have a favorable outcome when they are diagnosed in time.CONCLUSIONS: Primary renal carcinoid is an infrequent entity among endocrine tumors. We must in-dicate this case`s presentation was with anemia, diarrhea and positive occult blood in feces.
OBJECTIVES: To report a new case of bladder mullerianosis.METHOD: We present the case of a 30 year old female patient with history of miscarriage, who refers voiding dis-turbances with menstruations. Vaginal ultrasound showed an exophytic bladder lesion, which was confirmed by cistoscopy. Endoscopic resection was indicated.RESULTS: The pathological study of tissues obtained showed mixed glandular structures with predominant tubaric-like type, in association with endometrial- and endocervical-like elements. No evidence of endoscopic relapse after one year of follow-up.CONCLUSIONS: We contribute with a new case of bladder mullerianosis. We emphasize the scarcity of its pu-blished reports. We support the option of an endoscopic surgery for these patients.
OBJECTIVES: The need and timing of perioperative heparin prophylaxis is matter of debate. The aim of our work is to review the incidence of venous thromboembolism (VTE) after radical retro pubic prostatectomy (RRP) in patients undergoing preoperative blood donation, compressive stockings, haemodilution, surgical prevention of lymphocoele and postoperative low molecular weight heparin therapy as prophylaxis for thrombotic events.METHODS: This is a retrospective analysis considering a series of 500 RRP performed between1999 and 2006 by the same Surgeon (MG) at the Urological Unit, Desio Hospital, Milan, Italy.All the patients were enrolled in an auto transfusion program and were subjected to autologous blood donation. Low molecular weight heparin (0.4 ml of Calcic Nadroparin 3800 UI s.c. daily) was administrated within 24 hours following surgery until the 11th post-operative. Age, PSA, basal, preoperative and postoperative haemoglobin values were assessed in each patient. The incidence of venous thromboembolism was calculated taking into consideration occurrences of both pulmonary embolism and deep venous thrombosis.RESULTS: In this retrospective analysis we did not observe any major event including intra- or peri-operative deaths. There was one occurrence of pulmonary microembolism and one sural phlebitis that were treated with prolonged heparin and dicumarol therapy. Two significant haemorrhagic events occurred in the postoperative period requiring surgical revision. CONCLUSIONS: These data suggest that low weight heparin prophylaxis starting within 24 hours following radical prostatectomy, associated with preoperative blood donation, intra-operative haemodilution, compression stockings, surgical care to avoid lymphocoele and early mobilization is effective in preventing venous thromboembolism.