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Testosterone determination in an old men population has demonstrated its about the as general health marker, not only sexual, prompting a greater in to arrest for this analytic determination and the potential relations of testosterone with other markers of cardiovascular health, obesity, hypertension, erectile dysfunction, sarcopenia, metabolic syndrome, ageing, and other conditions. We specifically review the relationship between cardiovascular health, erectile dysfunction, and androgen deficiency, processes easily recognizable, prevented and treated. Current information gives such a prominence to testosterone as a health reference that its determination seems to be inexcusable in the ageing male consult.
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OBJECTIVES: We attempt to unravel the complex condition of the last king of the Hapsburg dynasty in Spain, Charles II, called The Bewitched, in whom a genitourinary disorder was preponderant, preventing him from fulfilling one of the objectives of the monarchial institution, engendering a heir, and causing a series of complications that led to his death. METHODS: We review the works describing the life of the King, with special emphasis on his bloodline, the doubts about his sex at birth, his pathological processes, the repercussion among European Courts, but above all on his marriages and the inability to engender an heir. We also emphasize the thought of 17th century Spanish society which led to the belief that he was bewitched. The nickname he passed into history with.RESULT: It was deduced that he could have presented posterior hypospadias which, together with monorchism and atrophic testicle, led to the belief that he presen-ted an intersexual state with ambiguous genitals. The physical phenotype leans more towards true hermaphro-ditism and above all a XX male, rather than the more often attributed Klinefelter’s syndrome. This is probably also associated with a fragile X syndrome. Very possibly congenital monorenal, death was due to chronic kidney failure caused by glomerulopathy or interstitial nephro-pathy as a consequence of renal lithiasis plus recurrent infections of the urinary tract.CONCLUSIONS: As a result of a reiterated endogamic matrimonial policy, the Hapsburg dynasty died out in Spain in 1700, represented by Charles II, a pluripatho-logical king who can only be freed from speculation by chromosomal and genetic studies of his remains buried in El Escorial monastery.
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OBJECTIVES: The renal parenchyma acute infection, known as acute pyelonephritis (APN), is diagnosed and treated in some Hospital Departments of the H.C.U. Lozano Blesa. We want to know if the process was made in a homogeneous way, fixed to the described quality standards and if we could detect improvement areas.METHODS: Retrospective study in admitted patients with the diagnosis of APN over and 2 year period (11-05/10-07), evaluating some variables referred to epidemiological data, diagnosis, treatment and evolution.RESULTS: We studied 118 patients (80.5% women, mean age 34 years), that supposed 0.39% of patients admitted from the Emergency Department (36% in Urology and the rest in Paediatric, Obstetric, Internal Medicine and others).45% showed risk factors (urinary anomalies, diabetes, pregnancy, immunosuppressant, …), and it is considered complicated APN (CAPN). In children there was a high rate of urinary tract malformations.Diagnosis was clinical in 82.2%. The rest required ima-ging techniques, specially children, using gamma scan. In 82.7 % there was leukocyturia and in 79.9% leukocytosis. A urine culture pre-treatment was made in 76.3%, with a positive rate of 55.5%, detecting negative Gram germs in 94% (E. coli in 82%).Treatment was empiric in all cases, based on cephalosporin, amoxicillin/clavulanic acid and fluoroquinilones. Evolution was favorable in 93.1% (95.1% of NCAPN and 85.7% of CAPN).The mean hospital stay was 6.4 days (5.6 in NCAPN and 7.5 in CAPN).CONCLUSIONS: Acute pyelonephritis management in our hospital is highly satisfactory and similar to the revised medical literature.We could emphasize the low rate of urinary cultures pre-treatment (negative in quite a lot of the cases, due to early beginning of antibiotic treatment) and that mean hospital stay could be reduced in CAPN.We want to congratulate all involved professionals at the hospital for the good practice demonstrated
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OBJECTIVES: Artificial urinary sphincter“FlowSecure TM ” is a prosthesis designed for stress uri-nary incontinence that has achieved excellent results.Although implantation is easy, some urologist used toother prosthesis may find difficult the change to this newtechnique. This article shows how easily and quickly thisnew sphincter can be implanted and discuss the diffe-rences with the artificial sphincter AMS-800 TM .METHODS: Following the case of a patient who wasimplanted artificial urinary sphincter “FlowSecure TM ” inour center we describe with pictures the technique ofimplantation and give some advices to make this quickerand easier.RESULTS: Surgical time was 90 minutes. Patient presen-ted uneventful recovery, urethral catheter was removed24 hours after surgery and discharge was done 72hours after surgery. Three months after implantation pa-tient describes complete resolution of his stress urinaryincontinence.CONCLUSIONS: Artificial urinary sphincter “FlowSecu-re TM ” is easy and quick to implant, and as its use isextended we would compare if results are better thanthose of the AMS-800 TM mode
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OBJECTIVES: To evaluate the correlation between type of presentation in patients with renal cell carcinoma and survival.METHODS: Longitudinal retrospective study of 42 patients with clinical and histological diagnosis of renal cell carcinoma (RCC) between July 2002 and September 2007 at University Hospital Manuel Fajardo. The following variables were studied: Sex, age, clinical presentation: 1) asymptomatic: 2) symptomatic: 3) paraneoplastic syndrome; tumor stage (TNM 1997) and survival.RESULTS: There is a predominance of men over women, the age of greater incidence was between the fifth a and seventh decades. The tumors were classi-fied as: asymptomatic 7%, 3/42; symptomatic 67%, 28/42, with flank pain 31%, 13/42; with hematuria 24%, 10/42, and tumor 10%, 4/42, the classic triad of hematuria, flank pain and mass was 2.3%, 1/42 of the patients and paraneoplastic syndrome 24%, 11/42. The patients with non-metastatic disease were 57%, 24/42 and 43%, 18/42 presented metastases. Five-year survival for patients with RCC by TNM stage was T1, 100% (12/12), T2, 97% (11/12), T3, 36% (4/11), T4, 0% (0/7). The survival of localized and metastatic RCC was 95%, 23/24 and 22%, 4/18 cases respectively and all stage was 64% (27/42).CONCLUSIONS: The asymptomatic RCCs were smaller; pain, hematuria, and mass were the most common manifestations in symptomatic RCC. The prognosis is dismal in patients with RCC showing paraneoplastic syndromes
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OBJECTIVES: To analyze the clinical presentation and therapeutic response of renal cell carcinoma (RCC) of the renal graft.METHODS: Analysis of the cases described in our centre and review of current literature.RESULTS: RCC has a higher incidence in transplant patients, affecting the graft in less than 10% of the cases. Detection is usually a casual event during follow-up due to the absence of innervation, although its presentation may be as an acute abdomen in case of breakage of the graft. Conventional treatment consists of transplant nephrectomy, but partial nephrectomy has been performed in recent years with good results. The modification of immunosuppression is a routine measure after treatment.CONCLUSIONS: The incidence of RCC after renal transplants in our series is 0.7%, of which 22% are originated in the graft. The clinical presentation of the primitive RCC of the graft is variable. Partial nephrectomy is technically feasible and oncologically safe in the treatment of RCC of the renal graft.
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OBJECTIVES: To evaluate the ability of non contrast computed tomography (NCCT) to predict stone composition and fragility for treatment with extracorporeal shock wave lithotripsy (ESWL).METHODS: 27 stones of about 10 mm from patients who had undergone different endourological procedures were collected. All patients had been evaluated with NCCT. To perform in vitro ESWL an experimental device was designed. Three thousand pulses were applied with 17.2 Kv intensity using an electromagnetic generator (Lithostar) to all stones. Composition of each fragment was studied with crystallographic study. Results were statistically analyzed with Student Test, Chi2 Test and multivariate study.RESULTS: In vitro ESWL had a success rate of 59.26%. Average stone HU, grouped by composition: cistine 1015 HU, Calcium monohydrate oxalate 1193 HU, uric acid 419 HU, dihydrate calcium oxalate 2122 HU, struvite 1543 HU and basic phosphate magnesium 1517 HU. A statistically significant relationship was found between values which were lower than 500 HU and uric acid composition (p=0.0006), as well as values higher than 2000 HU and composition of dihydrated calcium acid (p=0.0244). In the group of stones with less than 1000 HU (n=11) efficacy was 81.1%, whereas it was 43.75% in the others (p=0.0479). We found a statistically significant relationship between uric acid and effectiveness (p=0.021). There was not statistically significant relationship between size and treatment effectiveness.CONCLUSIONS: The use of NCCT will allow predicting stone composition and fragility.
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OBJECTIVE: To report a rare process and to stimulate clinicians and pathologists to have this possibility present in their diagnoses.METHODS: We report the case of an adult male with pain and swelling in the left inguinal region and increased volume of the homolateral testicle.CONCLUSION: It is appropriate to bear in mind the possibility of testicular metastasis of a primary unknown tumor in adult males since metastatic affectation can constitute the first manifestation of the disease
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OBJECTIVE: We describe one case of recurrent lithiasis associated with anatomical alteration of the renal pelvis related to previous surgery.METHODS/RESULTS: The patient presented a urinary tract infection episode, complicated with pyonephrosis and septicemia. In the intravenous urography, infectious radiopaque pyelocaliceal multiple and complex lithiasis can be seen, as well as kidney hydronephrosis grade III-IV. Important pyelic sclerosis secondary to previous surgery on the renal unit was seen. Nephrectomy was performed with lower pole nephrolithotomy and reconstruction of the upper urinary tract through ureterocalicostomy. Two and a half years after surgery, control urogram shows absence of urolithiasis and a slight delay of renal function.CONCLUSIONS: Ureterocalicostomy is indicated in cases of ureteropelvic junction obstruction associated with intrarenal pelvis caused by alterations of fusion, rotation or location of kidney. It is also indicated in cases of severe peripyelic fibrosis secondary to previous pyeloplasty failure or renal surgery. In our case, in addition to the infectious component of lithiasis, an anatomical alteration, probably secondary to previous surgery, caused the chronification of lithiasis. Facing such suspicion a surgical management was undertaken to eliminate the lithiasis and get a correct derivation of the working area of the kidney, in order to prevent further recurrences.
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OBJECTIVE: We report the event of an atypical presentation of primary bladder lymphoma, treated in our hospital, and review the literature of such tumors, representing 0,2% of bladder tumors, being macroscopic hematuria with clots the most frequent reason for patient consultation.METHODS: We report the case of an 83 years old man who went to the emergency room because of oligoanuria of 48 hours of evolution. He was diagnosed of bladder tumor.RESULTS: The pathology turned out to be a primary bladder lymphoma cell B.CONCLUSIONS: Primary bladder lymphoma is a rare entity that presents a similar behaviour to other bladder tumors, having a good response to treatment with chemotherapy
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OBJECTIVE: We present a rare localizationfor a foreing body in the urinary system, and review thebibliography to know about it existence, frequency and lo-calization.METHODS: We present the case of a 49 year old womanwho referreds she had introduced a metallic objet in hergenital area.RESULTS: After the necessary tests, we could see a metalliccylinder. It was 8 cm long and was localized inside theright pelvic ureter.CONCLUSIONS: The presence of strange bodies in theurinary system is a rare urological emergency. Treatment isthe key element of the extraction of the least bloody waypossible
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OBJECTIVE: A new case of segmental testicu-lar infarction is reported.METHODS: A 52-year-old man presented to the emergency department with severe pain in the left testicle over a few days period. Physical examination revealed a tender indura-tion in the upper pole of the left testicle. β-human chorionic gonadotropin and α-fetoprotein were normal. Sonography demonstrated a poorly-defined, hypoechoic, 13 mm lesion. On power Doppler sonography, the hypoechoic area appeared completely avascular in contrast to the rest of the testicle.RESULTS: Since testicular tumor was the initial diagnosis, the patient underwent a left radical orchiectomy. Pathological study revealed a focal testicular infarction, without signs of malignancy or vasculitis.CONCLUSIONS: Segmental testicular infarction is usually diagnosed after radical orchiectomy, performed when testi-cular tumor is suspected.On certain occasions Doppler ultrasound and magnetic resonance imaging findings suggested a segmental testicular infarction. However, if tumor cannot be entirely excluded, exploratory surgery is necessary.
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OBJECTIVE: We report a rare case of malignant priapism secondary to transitional cell carcinoma.METHODS: The patient with bladder cancer (pT4G3) presented with painful penile erection. Corpora cavernosa biopsy was done.RESULTS: The pathologic diagnosis was penile metastasis of transitional cell carcinoma.CONCLUSIONS: Priapism secondary to penile metastasis of transitional cell carcinoma is rare and indicates advanced disease with a poor prognosis.
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OBJECTIVE: To study and review spermatic cord sarcomas, including symptoms, diagnosis, and treatment.METHODS/RESULTS: We review the Spanish and international literature and report 4 new cases: 2 patients with well-differentiated spermatic cord liposarcomas (1 treated by simple tumorectomy), 1 patient with liposarcomatous degeneration of a previously excised atypical lipoma, and 1 patient operated for a malignant retroperitoneal fibrous histiocytoma with subsequent local recurrence in the paratesticular region. CONCLUSIONS: Spermatic cord sarcomas are rare entities that usually appear as painless paratesticular mass. They are diagnosed by imaging studies (ultrasound, computed tomography, magnetic resonance) and confirmed by histological examination. Spermatic cord sarcomas are treated surgically; the efficacy of adjuvant treatments such as chemotherapy or radiation therapy is still under debate
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