OBJECTIVES: To review the literature and present a contemporary image of androgen deprivation for prostate cancer.METHODS: We conducted a PubMed search on intermittent androgen deprivation. Articles obtained on intermittent androgen deprivation (IAD) and the experiences at Institut Montsouris were used for the review. RESULTS: IAD is an approach to hormonal deprivation that holds effective cancer control while preventing the morbidity associated with continuous androgen blockade. IAD nuances have been assessed by urological community teams in order to verify its possible potential benefits. Evidence based approach supports the idea of IAD as a standard of therapy for advanced prostate cancer requiring hormone deprivation. Variation among medical teams’ criteria for the treatment and surveillance await standardization.CONCLUSIONS: Reassessing the gold standard of hormonal blockade in advanced prostate cancer is mandatory. The undeniable evolution of IAD needs to be embraced by the urological community.
We review the printed work of the English anatomist and surgeon William Cheselden, with special attention to the chalcographic engravings which illustrated it, mainly those by Gerard van der Gucht and the miniaturist Jacob Schijnvoet, vindicating the valuable collaboration of illustrators and printers and their essential figurative contribution to explain the texts and make them easier to understand for the reader. These images were as important as the texts and contributed considerable artistic value to the work.Likewise, we present the bitter controversy caused in the English medical-surgical society of the time, most especially in the lithotomist or “urology” community, by the publication of the work entitled “The High Operation for the Stone” by W. Cheselden. The publication coincided chronologically with the second edition of “Lithotomia Douglassiana” by John Douglas, and the scathing criticism hurled against Cheselden, one of the prime examples of which was the publication of the book entitled “Lithotomus Castratus”; in the book, both works were revised meticulously by its author, collated, analysed in detail and compared against each other, publically indicating that Cheselden plagiarised Douglas.
OBJECTIVES: Recent reports place prostate cancer (PCa) as third cause of death in the World among males, in Mexico it is the leading cause of male death. In this study, we studied molecular markers and one genetic marker related in tissues with PCa and benign prostatic hyperplasia(BPH) : The Mn-superoxide dismutase (Mn-SOD) gen and protein , prostate specific antigen (PSA) and 3-nitrotyrosine (3-NT). It was evaluated if various markers of oxidative stress show altered expression in prostate cancer and BPH. to amplify and evaluate the immunoreactivity of the genes of interest (Mn-SOD and 3-NT) and the correlation between PSA and Mn-SOD immunoreactivity in prostate cancer and benign prostatic hyperplasia were standardized.RESULTS. Gene overexpression and Mn-SOD and 3-NT immunoreactivity were greater in prostate cancer with respect to the BPH group. Correlation between levels of PSA and the Mn-SOD immunoreactivity was not observed.CONCLUSIONS. The above results suggest that the parameters evaluated can be used as tumor markers making the determinations in biopsies of patients suspected of prostate cancer.
OBJECTIVES: To evaluate the changes experienced by the amount of PSA in patients diagnosed with BPH undergoing retropubic adenomectomy (with vesico-capsule plasty) in the short and long term, and the relationships between weight and / or prostate volume calculated preoperatively, volumes and histology of the surgical tissue and residual tissue remaining immediate and on the long term.METHODS: A consecutive series of 70 cases of BPH surgery and followed up beyond 5 years with preoperative PSA and transrectal ultrasound, histology of the piece, postoperative transrectal ultrasound, PSA annually until the fifth year and ultrasound. Within this group, residual prostate histology was obtained in 30 patients between 12 and 36 months after adenomectomy.RESULTS: In accordance to our own confirmed studies, the ATH (transcervical hemostatic adenomectomy) removes by enucleation 76% of the entire volume reported by preoperative ultrasound, including capsule. In our cases, PSA has dropped 83% at one year after surgery compared with the preoperative value, and in most cases that have already reached 5 years of follow-up, this percentage remains with little variation. Having being established a strong relationship between PSA and glandular volume, we must evaluate the need for new cut-off values giving more value to the PSA density in relation to the volume of residual prostate, attempting to improve early diagnosis of carcinoma in these particular cases, in which will be useful a new protocol design. CONCLUSIONS: PSA decline, histology of the prostate after adenomectomy and the morphometric changes after surgery and at mid-term, advise a more accurate value of PSA in patients who underwent open surgery, in order to detect a carcinoma in the residual prostate gland
OBJECTIVES: The aim of this study is to describe the surgical technique, and assess the complications and middle-term results of the Contasure Needleless (Neomedic International), a single incision TOT sling for the surgical treatment of stress urinary incontinence. The main concept of this device is that it is not a minisling, it has 138% more surface area. We are analyzing the results of a minimally invasive solution that is a TOT like sling with the same known benefits of a TOT and the advantages of a single incision technique. The surface area to support the urethra of the Needleless is very similar to the surface area of the TOT. (16% less surface area of tissue ingrowths) It is 100% macroporous polypropylene without any additional material.METHODS: 120 patients were evaluated retrospectively. They were all treated of SUI with the Contasure Needleless. Female patients were evaluated under clinical study protocol consisting in cough test, urodynamic and Quality Of Life questionnaire, before and after the procedure. Inclusion criteria: patients with genuine SUI and patients with SUI plus concomitant procedures as prolapse. Exclusion criteria: patients with ISD and or neurogenic incontinence. Anesthesia used: general (30%) or epidural (70%), patients with associated pathology.PROCEDURE: The 114 mm long and tension-free mesh was placed beneath the midurethra. The central part is 12mm wide. The sling can be repositioned during surgery due to the 22mm wide T-Pocket Positioning System located at the 2 edges. These pockets fixed the sling to the surrounding tissue in order to have the proper tissue in growth and anchoring. A 20mm sub urethral incision was made to dissect the paraurethral spaces only up to the ischiopubic ramus. A surgical forceps with the T-pocket folded was inserted into the dissected spaces and penetrates at the contra lateral side, like the standard transobturator technique. The forceps was introduced until the fascia of the Internal Obturator muscle was perforated. Then the forceps is opened to extend the pocket inside the muscle fibers for fixation.RESULTS: 120 patients with a mean age of 55 years (from 36 to 79) and a mean number of deliveries of 3 (0-7). Follow-up period: 24 months. Success rate: 100 patients (84%) Improved rate: 10 patients (8%) Failure rate: 10 (8%) Mean operating time of sling procedure alone: 9 minutes (4-12).Complications: 3 patients had mesh extrusion solved with estrogens and 2 patients required short term catheterization due to voiding difficulties and no patients had inguinal pain. CONCLUSIONS: The results of the study suggest that the Contasure Needleless can be considered a minimally invasive TOT with no-needles and maintaining the same cure rate than our TOT cases at 2 years follow up
OBJECTIVES: The best time to perform a genitoplasty in a Congenital Adrenal Hyperplasia (CAH) girl is an issue that has been discussed extensively. The purpose of this study is to find criteria that may help in the decision.METHODS: Charts of all patients with diagnosis of CAH with 21 Hydroxylase deficit who underwent genitoplasty in our institution were reviewed (Jan 1996-Dec 2006). Demographic data, surgery performed and outcomes were analyzed.RESULTS: In the 10 year-period, 25 patients fit the inclu sion criteria; 22 had complete data. All patients were classified based on Prader’s criteria; Prader 2 (n=3), Pra der 3 (n=13) and Prader 4 (n=6). Mean age at first surgery was 13.5 months (range 2-89m). In Prader 2 patients, a reduction clitoroplasty with a “cut back” vaginoplasty was performed with no complications. All patients in the Prader 3 group underwent a reduction clitoroplasty. A vaginoplasty was done in 9/13; 5/9 at the same surgery session (4 stenotic) and the other 4 in a 2nd stage with good results; vaginoplasty is still pending for the other 4 girls. In the Prader 4 group, a vaginoplas ty pull-through was performed in 4/6 using the poste rior sagital approach; one at the reduction clitoroplasty stage which ended stenotic and need dilatations, and the other 3 in a 2nd surgery with a good outcome. The other 2/6 girls are awaiting a vaginoplasty. 22/22 had acceptable results after a mean follow-up of 63 months (range 12-144).CONCLUSIONS: Congenital Adrenal Hyperplasia (CAH) shows di fferent approaches may be used for different degrees of virilization. For less severe cases (Prader<3) a cut-back may be the surgery of choice for vaginoplasty, while in the more complex cases a flap with pull-through or a posterior sagital procedure could be useful. Based on this series, we recommend performing vaginoplasty in a 2nd stage surgery, avoi ding complications and further procedures such as dilatations.
OBJECTIVES: To evaluate the effect ofcircumcision on sexual satisfaction perception in maleswith stable sexual partners.METHODS: Twenty two heterosexual male adults, sexua-lly active with a stable partner, scheduled for circumci-sion for medical (MR) or esthetic reasons (ER) at our clinicbetween June 2005 and June 2006 were included inthis study. Men with severe erectile dysfunction (ED) wereexcluded from the study. These men were surveyed toassess erectile function, penile sensitivity, esthetical pe-nis’ appearance, sexual activity and overall satisfactionbefore the procedure and 12 weeks after. Categoricalscores were evaluated with Chi square.RESULTS: Surgical indications were: Phimosis 50%, ba-lanitis 18.2%, condyloma 13.6% and esthetics 13.6%.After the procedure 82% of patients referred an upgradeon the quality of their sexual intercourse, 4.5% referred itdiminished and 13.5% referred no change at all. 95.5%of the patients felt better with the appearance of theirpenis. Almost all areas of sexual satisfaction weren’t sta-tistical significant except for the improvement in erectilefunction (p 0.0007) and perception of sexual events (p0.04). This improvement on erectile function was repor-ted as shifts from mild to normal on International Indexof Erectile Function 5 scores. Premature ejaculation wasobserved in 31.8%(7) before the procedure and diminis-hed to 13.6%(3).CONCLUSION: Because of our statistic limitations andmix indications for circumcision in the study, we cannotconclude that circumcision might bring certain benefit onsexual satisfaction by itself but certainly does not bringdeleterious effects and, when dissatisfaction is associatedwith local problems, some benefit could be expected
OBJECTIVES: The experience of a renowned Latin American laparoscopic center is reported and the differences with the open technique are thoroughly discussed. METHODS: During a 7 year period a total of 85 laparoscopic cystectomies were performed, in 92% urinary diversion was performed extracorporeally. This accounted for: 14 anterior exenterations, 50 radical cystoprostatectomies, 7 radical cystectomies and 14 simple cystectomies. Male to female ratio was 3:1. Mean patient age was 63 years (range 29 to 83). Mean Body Mass Index (BMI) was 28 kg/m2 (range 20 to 47). Operative data and long term results are analyzed.RESULTS: All 85 procedures were completed laparoscopically without the need for conversion to open surgery. Orthotopic neobladder, Santiago pouch, Studer, Fontana and Le Bag were performed in 42, 13, 16, 12 and 1 case respectively. Ileal conduit, Indiana pouch and Mainz II were employed in 24, 10 and 9 cases respectively. All Mainz II were performed intracorporeally. Mean operative time and blood loss were 279 minutes (range 180 to 375) and 436 ml (range 50 to 1.500) respectively. A total of 8 patients (11%) presented perioperative complications: 5 vascular lesions, 2 eviscerations and 2 septicemias. Delayed complications were observed in 7 cases (9%); 3 urinary sepsis, 1 ureteral stenosis, 2 spontaneous ruptures and 1 mesenteric ischemia. Mean hospital stay was 8.8 days (range de 4 to 28). There was no operative mortality. Mean follow-up was 18 months (range 2 to 68 months). Ten patients (13%) presented disease progression and death. CONCLUSIONS: Laparoscopic radical cystectomy is associated with diminished operative bleeding, time to oral intake and hospital stay. Though this is a reproducible technique it demands a very long learning curve
OBJECTIVES: Case report of a mature cystic teratoma (dermoid cyst), pseudopilomatrixoma like variant.METHOD: 53-year old patient with a left testicular mass, diagnosed as mature cystic teratoma of the testis (dermoid cyst), the pilomatrixoma-like variant, after radical orchiectomy. Tumoral markers were negative and no extension was observed. The patient is disease-free after 6 months follow-up.RESULTS: Testicular teratoma is a tumour composed of cells derived from the three embryonic layers (ectoderm, endoderm and mesoderm). They can appear at any age, but they are much more prevalent in childhood. They appear at any age, but are much more common in childhood, where they comprise up to 30% of all tumours. They are much less prevalent in adults, representing only 7% of all testicular germ cell tumoursCONCLUSIONS: Prepubertal cases are invariably benign in nature, regardless of their histology. However, cases which appear after puberty are potentially malignant, even if histologically pure. Mature cystic teratoma (dermoid cyst) is the only exception to this rule, as no malignant degeneration of these types of tumours has been published.
OBJECTIVES: To describe a patient withdedifferentiated liposarcoma of the spermatic cord and toperform a bibliographic review.METHODS: We describe the case of a patient with dedi-fferentiated liposarcoma of the spermatic cord, and con-ducted an extensive search of literature in different databa-ses that support the discussion of the case.RESULTS: A 65 years old male presented a right scrotalmass with progressive growth, and underwent excision ofthe mass (measured 34 x 22 x 17 cm and weighed 5786grams). Pathology reported dedifferentiated liposarcoma ofthe spermatic cord. This patient draws attention to the re-occurrence of papillary thyroid cancer.CONCLUSIONS: Paratesticular tumors are rare entities,derived from mesenchymal tissue. Most of them are be-nign, but up to 30% could be of sarcomatoid type. Theirtreatment is based on the extraction of the mass along withradical orchiectomy, but being a very rare disease is notclear whether the benefit of adjuvant chemotherapy andradiotherapy in these patients is beneficial
OBJECTIVES: To describe a clinical case of ureteral inguinal hernia and to comment briefly about the topic. METHODS: 80 year-old patient with, hypertension, left inguinal hernia sugery, right hemicolectomy for colon adenocarcinoma and cholecystectomy. Intravenous urogram casually found that the right ureter was leaving the abdominal cavity though the right inguinal duct and then returned to the abdomen. RESULTS: CT scan confirmed the diagnosis. Due to the advanced age of the patient, comorbidities and the absence of symptoms, conservative treatment was decided. CONCLUSIONS: Ureteral hernias through the inguinal duct are uncommon. There are 2 types: paraperitoneal and extraperitoneal. The most common is the paraperitoneal (80%) which is accompanied by hernia sac and can appear with other abdominal organs. The extraperitoneal often accompanied by retroperitoneal fat. Both types of hernias are usually indirect. Treatment is usually herniorrhaphy
OBJECTIVES: To report a case of eosinophilccystopathy associated to infiltrative transitional-cell carcinoma of the bladder in an adult.METHODS: We describe the case of a 79-year-old woman who complains of meso- and hipogastric pain sinceseveral months before, and to whom a parietal thickeningof the bladder was detected by means of abdominal CTscan during the diagnostic work up for a digestive diseaseindicated by the Internal Medicine Service. Cistoscopy con-firmed that finding, together with areas of greater endoluminal protrusion. Cold biopsy showed an inflammatory infiltrate with eosinophilic component. Transurethral resectionwas indicated.RESULTS: The pathological assessment was compatible withhigh-grade infiltrative transitional carcinoma of the bladder.The patient developed multiple lung metastases and diedfive months after surgery.CONCLUSIONS: Reports describing the coincidence ofboth entities are infrequent. We emphasize the importanceof a correct filiation of apparently “pseudotumoral” endo-luminal lesions