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The true pathophysiologic nature of Peyronie’s disease continues to evolve. This pathology often results in a penile plaque(s), penile deformity, curvature, pain, and erectile dysfunction. Clinically, there are two distinct phases, acute and chronic. The focus of this review will center on the management of the acute phase of Peyronie’s disease. While little data exists demonstrating disease resolution, disease stabilization is an important clinical goal for patients as this often allows acceptable sexual function. Thus, medical management during the acute phase of Peyronie’s disease is aimed at limiting and stabilizing the degree of penile fibrosis, decreasing penile curvature, and reducing penile pain. In this manuscript we explain different therapies; oral, topical, intralesional injection and others like extracorporeal shockwave (ESWT), radiation and penile traction for acute phase of Peyronie’s disease.Although no consensus exists for the treatment of acute phase Peyronie’s disease, a majority of patients can achieve stabilization and in some cases regression of their disease with proper medical therapy. The goals of therapy should be discussed extensively with each patient, noting that erectile function will be likely despite some degree of curvature
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OBJECTIVES: In this paper we describethe history of lithiasis and the development of its treat-ment. We discuss the steps that led to the birth of endos-copic surgery and extracorporeal shockwave lithotripsy.METHODS: We reviewed books and writings of Historyof Urology and Endourology.RESULTS/CONCLUSIONS: To know a little of the his-tory and treatment of lithiasis, the contributions of Spa-nish urologists, as well as the instruments that made itpossible
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OBJECTIVES: International TNM StagingSystem for renal cell carcinoma (RCC) classifies as T3bwhen “tumor grossly extends into the renal vein or its seg-mental branches, or vena cava below the diaphragm”.The finding of microscopic invasion of the vein wall isnot taken into account for TNM staging. We analyse itsprognostic significance in localized and locally advan-ced RCC METHODS: From January 1989 to July 2002, 257RCC were surgically excised. Excluding Von Hippel-Lindau patients and stage IV (TNM 2002), 241 caseswere studied in retrospect, with a median follow up of50.96 months. Histopathological data from the renalvein were available in 216 specimens. There was renalvein wall invasion in 22. We compare the outcomes inthis group vs. the group without microscopic involvementof the renal vein wall (n: 194).RESULTS: Mean age for the group with renal vein inva-sion (RVI) was 65.02 years. Mean tumour size in thesame group was 9 cm, larger than in control group(p>0,001). Thrombus was found in 72.7% vs. 6.2%in the control group. Clear cell carcinoma (77.3%) wasthe predominant histological subtype. Nuclear grade 2according to Fuhrman’s Classification System accountsfor 42.9% of the cases. Metastatic progression risk (HR:4,86) and death risk (HR: 6,49) are significantly higherin RVI group. When renal vein thrombosis is found, pro-gression and death risks are still higher (HR: 7.22 and8.38, respectively).CONCLUSIONS: Microscopic invasion of the renalvein wall is a dependent prognostic factor for disea-se progression and death for RCC. Macroscopic renalvein involvement is an independent prognostic factor.When both factors are found together, disease outcomeis worse
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OBJECTIVES: To estimate the percentageof patients with Overactive Bladder (OB) attending uro-logy or gynaecology outpatient clinics who show asso-ciated diseases which complicate their clinical state andquality of life.METHODS. This is an epidemiologic, cross-sectionaland multi-centre real world trial. 1,659 patients with OBwere studied in urology or gynaecology outpatient cli-nics. Demographic data, anthropometric data, presence of chronic diseases (hypertension, diabetes, cerebrovas-cular disease, ischemic cardiopathy, chronic obstructivepulmonary disease, cognitive damaged, cataract, move-ment disability and constipation), presence of associateddiseases (falls, lower urinary tract infections, genital skininfections, depression, sexual dysfunction and sleep di-sorders), presence of urinary incontinence symptoms andimpact on quality of life according to ICIQ-UI SF score.RESULTS. Mean age (S.D) of studied sample was 59.2(12.9) years and 73.6% were female. Most patientslived in urban settings (67.3%), had primary studiesor less (56.8%) and had active work or at home work(66.2%). Most frequent diseases associated to OB weregenital skin infections, lower urinary tract infections andsleep disorders. Sexual dysfunction was more frequent inmales than in females; lower urinary tract infections, ge-nital skin infections and depression were more frequentin females than in males. Patients with these diseasesshowed higher ICIQ-UI SF scores than patients withoutthem, indicating higher impact.CONCLUSIONS. Presence of associated diseases inpatients with OB is frequent in males and females and itis associated to higher impact in patients’ life. It seemsrelevant to pay attention in detecting them through themedical history of patients consulting about OB or urina-ry incontinence symptoms
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OBJECTIVES: This retrospective study compared semen parameters from fertile men of two South American cities (Medellín–Colombia and Petrópolis–Brazil) to investigate their differences in some semen parameters.METHODS: We evaluated semen volume using a graduated tube, total progressive motility (a + b) using light microscopy (40X) and sperm concentration using a Neubauer Counting Chamber. RESULTS: We observed that fertile men from Medellín presented a significantly lower volume (p<0.0001), whereas individuals from Petrópolis presented a signi-ficantly lower percentage of total progressive motility (p<0.0001). On the other hand, no difference was found in sperm concentration (p>0.05). CONCLUSIONS: In conclusion, this study showed differences in semen parameters between fertile men of these South American populations. We think that these differences could be attributed to the geographical variations, like those observed in other countries. However, new studies are required to investigate this phenomenon and their causes.
Case Report
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OBJECTIVES: To report the case of a 37 year-old woman suffering from endometriosis of the urinary tract, that presented with lumbar and pelvic pain associated to cyclic recurrent haematuria.METHODS: Following history, physical examination, abdomino-pelvic ultrasound (USS), CT scan and cystoscopy with biopsies, surgical treatment was indicatedRESULTS: Imaging (USS-CT) revealed a protrusion of the left bladder hemi-trigone with a nodular, irregular thickening and ipsilateral grade II-III/IV uretero-hydronefrosis. Cistoscopy confirmed a swollen and oedematous lesion in left hemi-trigone that seemed extrinsic in origin. With the clinical diagnosis of a possible neoplasia of gynaecological origin, the patient underwent surgical treatment consisting in radical hysterectomy with bilateral oophorectomy, partial cystectomy and left ureteroneocystostomy.CONCLUSIONS: The frequency of endometriosis in the urinary tract is relatively low and therefore, endometriosis presenting with ureteral obstruction (uretero-hydronephrosis) has been rarely reported in the literature and should be part of the differential diagnosis in young women, especially if symptoms are cyclic. The treatment is surgery and the final diagnosis by pathology report
Case Report
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OBJECTIVES: To present a new case of ade-nomatoid tumor of the epididymis, the first report in ourhospital since 1962.METHODS: We report a clinical case with a brief biblio-graphic review about adematoid tumor of the epididymis.The diagnostic and therapeutic implications are discussedfocusing on the role of ultrasound and immunohistochemi-cal studies.RESULTS: A 30-year-old man presented pain and inflam-mation in the left epididymis. Physical examination and ul-trasound study demonstrated a tumor of 5x5x2 cm. It wasremoved and the histopathological study was compatiblewith adenomatoid tumor of the epididymis.CONCLUSION: The adenomatoid tumor of the epididymisis a neoplasm located in the paratesticular region, howeverit can be found infrequently in other sites. Mesothelial originhas been mentioned and inflammation has played somerole in the development of these tumors. Physical exami-nation and testicular ultrasound constituted important toolsin the diagnosis. It can minimally invade adjacent structu-res, though it is benign without metastatic potential. Somereports have mentioned malignant behavior, but it is veryrare. Surgical treatment is the procedure of choice
Case Report
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OBJECTIVES: Transitional cell carcinomas (TCC) of the bladder are usually aggressive and may produce bone metastases that infiltrate the bone marrow. Most of these cases present with bone symptoms and metastases and are detected with imaging tests. It is extremely rare for asymptomatic patients with a normal bone scan to have bone marrow involvement (anaemia and thrombocytopenia) due to tumour infiltration. We aim to examine that state with a case report.METHODS: We present the case of a 41-year old male with infiltrating TCC of the bladder, who presented with isolated, unexplained anaemia and thrombocytopenia after radical cystoprostatectomy. A bone marrow puncture was required, in which metastatic infiltration was revealed. We performed a literature search of similar cases.RESULTS: There are very few cases of TCC with bone marrow infiltration which become apparent only through haematological changes and have normal imaging tests.CONCLUSIONS: Patients with infiltrating carcinoma of the bladder with isolated haematological changes and a negative extension study should be assessed by bone marrow puncture for correct staging and to be able to offer the best treatment.
Case Report
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OBJECTIVES: Retroperitoneal tumors are a rare finding and most masses are of malignant origin. We report laparoscopic management of a low grade retroperitoneal leiomyosarcoma.METHODS: A 56 year old woman with a left 12 cm retro-renal mass underwent transperitoneal laparoscopic exploration. The tumor was clearly visualized on the lateral aspect of the left kidney. Following basic oncologic principles, the mass was carefully dissected off the renal capsule and extracted in a laparoscopic bag through a small incision on the left lower quadrant.RESULTS: Operative time was 135 minutes and estimated surgical bleeding was 200 ml. The patient evolved uneventfully and was discharged home on postoperative day 3. Final pathological analysis revealed that the lesion was a very low grade leiomyosarcoma. At six months follow-up the patient remains disease free and has completely recovered.CONCLUSIONS: Even though open surgery remains the standard treatment for all retroperitoneal tumors, the laparoscopic approach of a retroperitoneal mass is technically feasible and oncologically safe. Further studies will show long term results.
Case Report
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OBJECTIVES: To report the case and iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and the treatment of this surgical complication.METHODS: 69 year-old woman status post renal transplantation who presents right lower extremity edema and worsening renal function. A liquid collection was demonstrated by ultrasound and computerized tomography, compatible with lymphocele after biochemical study of the liquid obtained by percutaneous puncture.RESULTS: The patient underwent laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcome.CONCLUSION: Lymphocele is a common pathology after a renal transplantation which needs to be treated depending on its clinical manifestations. There mainly are two therapeutic alternatives depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from very selected cases, laparoscopic approach is currently considered, because of its security and effectiveness, the first choice when a surgical treatment is prescribed.
Case Report
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OBJECTIVES:To report one case of primary adenocarcinoma of the seminal vesicles.METHODS/ RESULTS: We report the case of a 69-yearold man with obstructive voiding symptoms. Digital rectal examination reveals a marked enlargement of posterior area of the prostate and surrounding tissues. Transrectal needle biopsy shows a primary adenocarcinoma of the seminal vesicles.CONCLUSION: Primary adenocarcinoma of the seminal vesicles is an extremely uncommon neoplasm that is often difficult to diagnose as it has inespecific morphology and can be confused with other primary adenocarcinomas from prostate, bladder or colon.
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