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OBJECTIVES: To study the efficacy and safety of totally tubeless percutaneous nephrolithotomy (PNL) using absorbable gelatin sponge as an adjunct.METHODS: From January 2004 to March 2009, 45 patients underwent totally tubeless PNL (no internal draArchinage either with double J stent or ureteric catheter). Inclusion criteria were no significant bleeding from the nephrostomy tract or injury to the pelvicalyceal system (PCS), single nephrostomy tract, infra-costal puncture and complete clearance on fluoroscopy. Median stone size was 3cm (longest diameter recorded). The PNL tract was plugged with absorbable gelatin sponge at the end of the procedure. Drop in hematocrit, hospital stay, pain score by visual analogue scale, urinary leak and perirenal collection by ultrasonography were documented in all the patients.RESULTS: Median age was 32 years (range 18-57 yrs). Median size of the stone (largest dimension was taken into consideration) was 3cm (1.8 to 4cm). All patients had complete stone clearance on postoperative X-ray KUB. Drop in mean haematocrit value recorded was 2.4% and none of the patients required blood transfusion. Median pain score was 3. Median value for oral and intravenous Diclofenac sodium was 200mg (150 mg-300mg). Perinephric collection was recorded in 3 patients who were managed conservatively. Median hospital stay was 3 days (2-5 days).CONCLUSION: Totally tubeless PNL using absorbable gelatin sponge as sealant of percutaneous nephrostomy tract appears to be safe and effective in select group of patients.
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OBJECTIVES: To analize the influence that maximal androgen blockade (MAB) exerts on quality of life in patients from the health area of Zamora diagnosed of prostate adenocarcinoma between 2000-2005.METHODS: Basal, 12-month, 24-month and 36-month application of the health-related quality of life measurement instrument EORTC QLQ-PR25 to the population sample (n= 111), as well as a control sample (n= 100). We performed a comparative study of the outcomes between groups; between various time measurements in MAB patients; and inter-categories/ intervals of some variables in patients with hormonal deprivation therapy (third year of follow-up).RESULTS: Cognitive and symptomatic fields were affected in patients with MAB at some specific time points. No field showed a significant constant worsening through the period of study for hormonally deprivated patients. A recovery is seen in the sociofamiliar field.Less academic level in MAB patients represents a distinguishing factor leading to worse outcomes in the health-related quality of life parameters analyzed here.CONCLUSIONS: There is a negative initial repercussion of MAB on quality of life, although tinged according to the different fields studied.
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OBJECTIVES: We report the cases of three patients with primary renal lymphoma. Diagnosis and subsequent treatment are discussed.METHODS: The literature on the origin, epidemiology, clinical presentation, diagnosis, treatment and prognosis of primary renal lymphoma was reviewed.RESULTS: The first patient was diagnosed after radical nephrectomy and subsequently was given six cycles of CVP (cyclophosphamide, vincristine, prednisone). The diagnosis of the second patient was established by renal biopsy, and the patient received six cycles of CHOP (cyclophosphamide, adriamycin, vincristine and prednisone). The last patient had a lymphoma, secondary to immunosuppression, in a transplanted kidney. In this case transplant nephrectomy sufficed to cure the patient’s lymphoma. All patients had B-cell non-Hodgkin lymphoma (an extrarenal origin was ruled out by bone marrow biopsy), and were disease-free 15 months, 7 months, and 6.5 years after diagnosis, respectively.CONCLUSIONS: Primary renal lymphoma is rare. Diagnosis is established by renal biopsy, although it often presents as a mass simulating renal cell cancer and diagnosis is obtained after radical nephrectomy. Treatment consists of chemotherapy (CHOP) associated with rituximab.
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OBJECTIVES: 1). To evaluate the satisfaction and clinical outcome in patients with penile prosthesis implant as a treatment to Severe Biogenic Erectile Dysfunction. 2). To identify the most frequent complications associated with the surgical intervention. 3). To compare the behaviour of sexual satisfaction in partners and patients with penile prosthesis implant before and after the application of the treatment.METHODS: A descriptive, (longitudinal) study with quantitative and qualitative methodology was done, where 25 men with penile prosthesis implants, performed at Faustino Perez Hospital, were evaluated. RESULTS: The complications presented in the procedures were perforation of the tunica albuginea, postoperatory pain, thin penis and the expulsion of one or two cylinders, this latter case in a patient who presented periprosthetic sepsis.CONCLUSIONS: The penile prosthetic implant constitutes an option of effective treatment which achieves an 88 % of sexual satisfaction in patients.Both partners and patients treated with penile prosthetic implantation referred increase in erotism, satisfactory sexual activity, improvement of self-esteem, quality of communication with their partner, better labour results, interpersonal and social relationships and strengthening of couple’s bonds
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OBJECTIVES: Extracorporeal shock wave lithotripsy (ESWL) is one of the most commonly used procedures for removal of renal calculi from the upper urinary tract, but complete expulsion of the fragments generated is not always achieved. This can lead to new lithiasic episodes, and it is considered that 10-26% of fragmented calculi can undergo regrowth. This in vitro study investigated the influence of fragment and urinary composition on post-ESWL growth of fragments, with the aims of establishing the effect and importance of these parameters, and identifying effective prophylactic measures.METHODS: Fragments collected from patients immediately following expulsion after ESWL treatment were selected for regrowth experiments. The particles included 24 calcium oxalate monohydrate (COM) fragments, 48 calcium oxalate dihydrate (COD), 24 hydroxyapatite (HAP), and 16 uric acid.RESULTS: In all treatments, calculi fragments showed a considerable capacity to induce growth of calcium oxalate and calcium phosphate. Under normocalciuria conditions, new COM crystals formed; both COM and COD crystals developed under hypercalciuria conditions at a urinary pH < 6.0; and in hypercalciuric conditions and urinary pH > 6.0 both HAP and brushite (BRU) crystals were formed. The highest growth rates were observed for COD calculi fragments under hypercalciuria conditions and at a urinary pH of 6.5, followed by growth on COM and HAP fragments under the same conditions; growth rates under other conditions tested were similar but 10-fold lower. With regard to the role of crystallization inhibitors, phytate exhibited inhibitory effects under all assay conditions. However, citrate had little effect, even at the highest concentration tested (1,000 mg/L).CONCLUSIONS: This study demonstrates the importance of avoiding heterogeneous nucleant retention (pre-existing solid microparticles) in renal cavities, as these can act as very efficient inducers of the formation of new calculi, the composition of which is mainly dependant on the urine composition.
Case Report
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OBJECTIVES: To show standard CT findingsand their diagnostic usefulness in female patients sufferingfrom Fournier’s gangrene.METHOD/RESULT: A woman who had undergone a previo-us lateral internal sphincterotomy presented to the emergencydepartment with severe pain in the hypogastrium and pe-rianal region; physical examination revealed an induration inthe left buttock. CT images showed an abscessed collectionin the rectovaginal space and gas in the levator ani muscle,left ischiorectal fossa and the root of the left thigh.CONCLUSIONS: CT scan is considered an excellent diag-nostic tool in the management of patients with Fournier’sgangrene, as it shows both the origin of the infection andits extent
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OBJECTIVE: Renal infarction is rare and hasvariable clinical presentations causing diagnostic difficulties.Although most renal infarctions are caused by an obviousthromboembolic factor some are only explained by heredita-ry or acquired thrombophilia. The authors present a case ofsegmental renal infarction associated with factor V Leiden.METHODS/ RESULTS: A 48-year-old man presented withright flank pain that was unresponsive to analgesia for re-nal colic. CT scan was performed revealing a partial renalinfarction. The etiologic study was only positive to factor VLeiden. In spite of the diagnosis and treatment it resulted inatrophy of the affected renal area.CONCLUSIONS: Renal infarction can be a presentation ofthrombophilia that should be searched in the absence of anobvious embolic factor. Renal CT scan is the best way to arapid diagnosis and treatment
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We report the case of a 65-year-old man who presented with a right testicular mass and synchronous involvement of skin and Waldeyer’s ring. These facts led us to the working diagnosis of malignant primary testicular lymphoma.MATERIAL/RESULTS: We present the case with comments and make a bibliographic review of the disease.CONCLUSIONS: Primary testicular lymphoma is an uncommon testicular tumour that accounts for not more that 9% of all testicular tumours in the series with higher incidence. Testicular lymphomas are also rare among haematopoietic tumours, accounting for just 1% of all lymphomas, but due to their highly malignant histopathology they may become highly aggressive tumours. Patient age at presentation is over 60 years which makes it the most frequent tumour for this age group. 70% of recently diagnosed patients show Ann Arbor stages I and II. Tumours in advanced-stage have a predilection for spreading to extranodal sites such as central nervous system, skin, Waldeyer’s ring and lungs.
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OBJECTIVE: We present a case of primary renal epithelioid angiomyolipoma, its association with tuberous sclerosis and review the literature.METHODS: We present the case of a 12 year-old male with past medical history of tuberous sclerosis, characterized by developmental delay, tonic and clonic seizures, and cutaneous abnormalities. He presented with macroscopic hematuria and abdominal pain. CT scan of the abdomen showed the presence of a left renal tumor. He underwent left radical nephrectomy. Pathologic study of the specimen showed primary renal epithelioid angiomyolipoma, corroborated by immunohistochemistry staining. Review of the literature was performed for this rare variant and its malignant potential.RESULTS: The presence of this epithelial variant is rare and must be taken into account because of its malignant potential and, thus, with different prognosis and follow up, compared to classical angiomyolipoma.CONCLUSIONS: Renal angiomyolipoma is an uncommon benign tumor, representing a challenge for clinical and pathological diagnosis. Despite the big size they can reach, as well as bilaterality, multiplicity of lesions and/or lymphatic regional involvement, its malignant potential has not been established. Nevertheless, the epithelioid variant has been described recently, a rare entity with aggressive behavior, difficult histological characterization and poor prognosis.
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OBJECTIVES: To report the second case of solitary neurofibroma arising from the tunica albuginea in the literature and to show its imaging findings.METHODS/RESULTS: We present a case of neurofibroma arising from the tunica albuginea in an adult patient not affected by neurofibromatosis. We describe the ultrasonographic and magnetic resonance imaging (MRI) features and the histopathological characteristics along with a brief bibliographic review.CONCLUSION: MRI may be useful to characterize paratesticular lesions. Neurofibroma should be included in the differential diagnosis when MRI depicts a well-circunscribed tumour with high-signal intensity on T2 and marked enhancement after gadolinium administration.
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OBJECTIVE: To describe 8 cases of penile foreign bodies.METHODS/RESULTS: We provide an essentially visual overview of various objects or foreign bodies affecting the penis.CONCLUSIONS: The presence of penile foreign bodies is rarely due to an accident. These objects are placed for a wide variety of reasons, but primarily for erotic or self-arousal purposes. The consequences of penile foreign bodies can be mild or very severe, resulting in penile amputation.
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Case Report
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