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OBJECTIVES: Transrectal ultrasonogra-phy-guided prostate biopsy is still the main technique in prostate cancer diagnosis. In spite of being a relatively well-tolerated exploration, often results in an awkward and painful procedure, especially in those cases in which the number of samples increase.We designed a prospective randomized study that compares biopsies tolerance with the use of intravenous analgesia and intrarectal gel with or without intracapsu-lar prostatic anesthesia.METHODS: We have included an amount of 80 pro-cedures between June 2006 and December 2007. In-travenous analgesia was given to all patients and 12.5 gr. of lidocaine gel (which contains 250 mg of lidocai-ne hydrochloride) was instilled into the rectal vault. All patients underwent methodically 10 cores biopsy after having an intracapsular injection of 8 ml. of 2% lidocai-ne in a randomized group. A questionnaire with three measurements of the visual analogue scale of pain was given immediately after the procedure and another one thirty minutes later, as well as a satisfaction survey.RESULTS: The average age of patients in control group was 68 years (48-73 range) and 69 years (50-75 ran-ge) in treatment group. The average PSA was 7.1 ng/mL (4.8-9.8 range) in the first group and 7.3 ng/mL (4.5-9.7 range) in the second one. Average pain in the visual analogue scale in patients without intracapsular anesthesia was 8.3 (2 – 9) in the first questionnaire and 2 (0 – 4) in the second one, against 4 (0 – 8) and 1.33 (0 – 2) of the group who did receive anesthesia. If we compare both groups, we find statistically significant differences only in immediately measurements (p<0,01), not in the second questionnaire (p=0,2). We didn’t find statistically significant differences as for urethral bleeding, rectorrhagia or infection between both groups.CONCLUSION: We consider the injection of intracap-sular lidocaine a reproductible technique and effective for both improving tolerance and diminishing the pain related to transrectal ultrasound-guided prostate biopsy without increasing morbidity.
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OBJECTIVES: To study the clinical, diag-nostic, and therapeutic features of upper urinary tracttumors.METHODS: We perform a retrospective study of upperurinary tract tumors treated in our Department at ClinicaLa Luz Madrid between 1995 and 2008 RESULTS: We treated 42 tumors in 40 patients. Meanage was 64 years; there were 29 males and 11 fema-les.Macroscopic hematuria was the most frequent clinicalpresentation, in 45% of the cases, and the imagingdiagnostic test most frequently used was intravenous uro-gram (62,5%).There were more tumors on the right side(20 cases) than the left side (18 cases), 2 cases werebilateral. Distal ureter was the most frequent site.27,5%of the patients presented associated bladder tumors.The most frequently used therapy was laser endoscopicresection. 5 patients required a second operation dueto recurrence and 2 more a programmed second pro-cedure due to incomplete resection; 7 cases presentedpostoperative complications. 70% of the tumors weresuperficial. 40% of the cases underwent local chemothe-rapy with weekly bladder instillations of Mitomycin C for8 weeks. Recurrence rate was 20% and mortality 10%.CONCLUSIONS: Upper urinary tract tumors keep be-ing a rare entity appearing in mid-advanced ages. Ra-dical nephroureterectomy with excision of bladder cuffhas been the treatment of choice for years, but in recentyears endoscopic treatment is gaining more importanceand is showing good results in selected cases
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OBJECTIVES: Cancer is a complex pro-cess in which cytokines play an important role. Cytoki-nes are low-molecular weight soluble proteins involved in cellular transmission signals and several disorders. Pro-inflammatory cytokines (IL-1, TNF-α and IL-6) are involved in prostate cancer development. The aim of this study was to relate the expression (analyzed by Western blot and immuno-histochemistry) of several pro-inflammatory cytokines (IL-1, TNF-α and IL-6) with serum levels of prostate-specific antigen (PSA) in normal (no pathological samples) as pathological samples (hyperplasia and cancer), in order to elucidate their possible role in tumor progression. We are also discussing the possible use of these cytokines as a potential therapeutic target.METHODS: This study was carried out in 5 normal, 25 benign prostatic hyperplastic (BPH) and 17 prostate cancer (PC) human prostates. Immunohistochemical and Western blot analysis were performed. Serum levels of PSA were assayed by a PSA DPC immulite assays (Diag-nostics Products Corporation, Los Angeles, CA)RESULTS: In BPH, IL-1α, IL-6 and TNF-α were only ex-pressed in patients with PSA serum levels of 0-4 ng/ml or 4-20 ng/ml, but not in the group >20 ng/ml. In PC these cytokines were only expressed in patients with PSA serum levels >4 ng/ml, although the expression of these cytokines was elevated when PSA levels were >20 ng/ml.CONCLUSIONS: In PC there might be an association between high expression of pro-inflammatory cytokines (IL-1, TNFα and IL-6), elevated serum levels of PSA and cancer progression. A better understanding of the biologic mechanism of this association may improve the finding of new targets for therapy in these patients.
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OBJECTIVES: Upper urinary tract transitional cell carcinoma (UUT-TCC) is a rare disease. Open nephroure-terectomy remains the gold standard for surgical treat-ment. We aim to evaluate the standing of novel surgical treatment in UUT-TCC. METHODS: Extensive review of available literature on UUT-TCC, with emphasis in surgical treatment. English me-dical literature available in PubMed, Ovid, EMBASE y Science Direct was employed for the study.RESULTADOS: Laparoscopic nephroureterectomy, ureteroscopy and percutaneous treatment are the available surgical options that based on adequate patient selection offer acceptable cancer control. CONCLUSIONES: Indications for the treatment of UTTCC are expanding and this allows clinicians to tailor treatment while preserving oncological results.
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OBJECTIVES: To review the effectiveness and security of the TVT-Secur system in the surgical treatment of stress urinary incontinence (SUI). METHODS: Prospective analysis of 110 patients undergoing SUI surgical treatment in the Urogynecology and Vaginal Surgery Unit of Clínica Las Condes, between January 2007 and May 2008. The patients must have stress urinary incontinence over one year or more. They must not have history of a previous surgery for urinary incontinence or prolapse. They must not have mixed urinary incontinence or urge incontinence, only SUI demonstrated by clinical symptoms and non-multichannel urodynamic study.RESULTS: Mean surgical time was 8 minutes (6 to 16 minutes). The observational period was between 2 months (4 cases) and 19 months, mean 8 months. During the intraoperative time 2 cases of bladder perforation were registered. In the immediate postoperative time 2 cases of obstruction were observed. In 97 (88,2%) of the 110 patients some concomitant gynecological surgery was performed. In 105 (95,5%) of the 110 cases cure of the SUI was registered. In 4 (3,6%) cases improvement was observed and 1 (0,9%) case was a failure. In 2 (1,8%) patients de novo urge incontinence was registered.CONCLUSIONS: The TVT-Secur system corresponds to a third generation tape effective and safe in the surgical treatment of stress urinary incontinence. This technique has potential advantages when compared with the preceding operations. Only the long time follow-up and incorporation of new patients will allow to determine the permanence of these good results in the time.
Case Report
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OBJECTIVES: Atypical lymphatic spread ofgerm cell tumors to inguinal lymph nodes has been reportedmostly related to prior surgical involvement of the inguinos-crotal region, as in orchiopexy.METHODS: A patient with cryptorchidism and failed orchio-pexy in his childhood was diagnosed with a testicular neo-plasm. Inguinal orchiectomy was performed.RESULTS: Pathological analysis showed classical seminomaspreading into a subcutaneous adjacent lymph node. Furthermetastatic disease was not found. Patient was treated withadjuvant chemotherapy.CONCLUSIONS: We emphasize the need for accurate sta-ging and a multidisciplinary approach when dealing withonco-urological patients presenting with atypical disease
Case Report
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OBJECTIVE: To report one case of emphyse-matous cystitis and to review its diagnosis and treatment in the related literature.METHOD: We report the case of a type II diabetic 91-year-old woman with jaundice, hematuria, vomits, abdominal pain and poor glycemia control. Diagnosis was obtained by plain abdominal X-ray and ultrasonography, and confirmed by CT. E.coli was isolated in urinary culture.RESULTS: Antibiotic intravenous therapy with piperacillin-tazo-bactam, urinary bladder catheterization and strict glycemia control. The patient was discharged from hospital on day 5, with 14 additional days of orally administered amoxicillin-clavulanic and bladder catheterization. Complete clinical, radiologic and microbiologic resolution was achieved.CONCLUSIONS: Emphysematous cystitis is a rare entity, most common in diabetic women, which results from infec-tion of the urinary bladder with gas-producing pathogens, mainly E.coli. Clinical presentation is variable. Emphysema-tous cystitis can be diagnosed radiologically, mainly with CT scan. The management consists of broad-spectrum antibiotics, strict glycemic control and bladder drainage. Emphysematous cystitis usually has a benign course, but complications may arise in up to 10-20% of cases, requiring surgical treatment.
Case Report
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OBJECTIVE: To report a case of splenosis and to review its diagnosis and treatment in the related literature.METHOD: We report the case of an asymptomatic 49-year-old man with splenectomy performed when he was 22. Lumbo-sacral MRI showed a left perirenal mass probably with renal origin.RESULTS: CT scan ruled out the renal origin. Due to previous splenectomy, splenosis was suspected. 99mTc-labeled heat-damaged erythrocytes scan confirmed the diagnosis. No treatment was applied.CONCLUSIONS: Clinicians should be aware that unknown origin masses, mainly in the peritoneal cavity, with a history of previous splenic trauma or splenectomy, might represent splenosis. A non-invasive diagnosis can be achieved with 99mTc-sulphur colloid scan, 99mTc-labeled heat-damaged erythrocytes or ferrumoxide-enhanced MRI, thus avoiding unnecessary surgical explorations.
Case Report
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OBJECTIVE: To report the case and the iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and treatment of this surgical complication.METHODS: 69 year-old woman who undergone renal transplantation and presented right lower extremity edema and worsening renal function. It was demonstrated by ultrasound and computerized tomography a liquid collection, compatible with lymphocele after biochemical study of the liquid which was obtained by percutaneous puncture.RESULTS: The patient underwent a laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcomes.CONCLUSION: Lymphocele is a common pathology after a renal transplantation, which needs to be treated depending on its clinical manifestations. There are mainly two therapeutic alternatives, depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from highly selected cases, laparoscopic approach is currently considered first choice when a surgical treatment is prescribed due to its security and effectiveness.
Case Report
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OBJECTIVE: We propose a modification to urethroplasty for stricture due to lichen sclerosus (balanitis xe-rotica obliterans).METHODS: We combine two-stage bucal mucosa graft and onlay ventral island flap.RESULTADOS/CONCLUSIONES: This technique offers enlargement of the graft with the island flap and removal of the pa-thological skin
Case Report
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OBJECTIVE: To describe an unusual case ofemphysematous pyelonephritis, a disease with high morbidi-ty and mortality.METHODS: We present the case of a 62-year old diabe-tic female with history of kidney stones, who consulted forfever, left lower-back pain and impairment of the generalcondition. Abdominopelvic computed tomography revealeda perinephric collection of air reaching the abdominal wall.RESULTS: After initial medical management with antibioticsand general supportive measures, we performed an openincision and drainage. A week later, signs of sepsis reap-peared and the left kidney was excised. The patient diedtwo weeks later of septic shock.CONCLUSIONS: This disease must be suspected in dia-betic females with renal lithiasis and pyelonephritis not res-ponding to treatment, and impaired general condition. Earlydiagnosis (computed tomography is the gold-standard) andsupportive measures are essential for initial management.Surgery can be open (drainage, initial or deferred nephrec-tomy), percutaneous (nephrostomy) or endoscopic (double-Jstent). Conservative management is a choice in bilateral ormild cases. Mortality rate is high and worsens with delayedtherapy
Case Report
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Case Report
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