OBJECTIVES: To report our personal experience in a rare urethral pathology in relation with iatrogenic sequelae from surgical treatment of lower urinary tract pathologies.METHODS: We analyze the causes, type of presentation, and surgical treatment of seven cases of urethral diverticula, which account for 2.18% of the urethral procedures performed in our department, this latter representing 2.3% of a total of 11.845 surgical procedures in a period of 25 years. RESULTS/CONCLUSIONS: Male urethra diverticula go unnoticed because their initial symptoms are very similar to other lower urinary tract entities. But there is a defi-nitive sign once the case is advanced: the appearance of a “lump” in the ventral side of the anterior urethra, the compression of which empties urinary content, sometimes fetid; or also the feeling of having a bag with stones if they host lithiasis. Surgical reconstructive treatment is very important to guarantee the absence of an obstacle distal to the cavity as well as to achieve a consistent ventral floor for the urethra to avoid recurrence, and that, as we will see, maybe obtained by various procedures. The attention to the original disease which indirectly had been the cause of the problem completes the therapeutic scheme for each case
OBJECTIVES: To determine predisposingfactors in perinephric abscesses and to find events as-sociated with unfavourable outcome.METHODS: We carried out a clinical, descriptive, re-trospective and cross-sectional study, including 23 pa-tients diagnosed of perinephric abscess admitted to ourhospital.RESULTS: In patients with perinephric abscess, cli-nicalcharts included diabetes mellitus in 65.2%, history of ne-phrolithiasis in 43.47% and history of urological surgeryin 17.38%.On hospital admission, haemoglobin greater than 10.5g/dL and white blood cell count lower than 15 x 10 3 /μL were associated with nephrectomy, and platelet countlower than 140 x 10 3 / μL with septic shock. Generalmortality was 8.69%, and 78.3% if patient required ne-phrectomy. Patients who died had fever, anaemia, whiteblood cell count greater than 16 x 10 3 / μL, plateletcount lower than 130 x 10 3 / μL, and hyponatremia of125 mEq/L or lower at hospital admittance, and all ofthem had septic shock and required nephrectomy.CONCLUSIONS: In our series, a higher percentage ofpatients had diabetes mellitus and/or nephrolithiasis.Haemoglobin level and white blood cells count wereassociated with loss of the renal unit, thrombocytope-nia was associated with septic shock and hyponatremiawith mortality
OBJECTIVES: From the beginning of TUR in 1931 the reseccionists thought of resecting prostate cancer. Execution however failed for deﬁcient instruments and techniques. The ﬁrst transurethral resection for pros-tate cancer: TURPC - was performed at our institution in 1957 by Hans J. Reuter. Low pressure irrigation enabled safe transurethral resection of the prostate including the capsule. Thus we started in 1985 a prospective study to verify TURPC as a radical procedure.METHOD: TURPC requires continuous low pressure irrigation with irrigating reservoir ﬁxed at the operating table. The liquid level within is to maintain less than 20cm. water above the pubic region in lithotomy posi-tion. Continuous ﬂow is maintained by suprapubic trocar and a resectoscope with 28Fr. sheath. An autoregula-ted electro-surgical unit is indispensable. It automatically adjusts the high-frequency current to suit the cut tissue’s electrical resistance for precise cutting. Videomonitoring is mandatory. The prostate is resected completely with its capsule into periprostatic fat together with the semi-nal vesicles. The specimen is retrieved in fractions to guarantee correct histopathological staging. If indicated laparoscopic staging lymphadenectomy is performed. A secondary session for control of positive margins follows after 12 weeks.RESULTS: From 1985 – 2004 1017 patients with a mean age of 68.9 years and with clinically localized prostate cancer were resected by 5 surgeons with cura-tive intention. The cancer stage distribution was in %: T1: 12, T2: 43, T3: 41, T4: 4. - G1: 8, G2: 72, G3: 20. Mortality 1 out of 1017. Bladder neck incision 8.9%. Incontinence grade 3: none. Postoperative survi-val over 10 years was 82% in T1, 87% in T2, 81% in T3 and 34% in T4 patients. Biochemical recurrence as of the rise of three consecutive PSA-values was within 5 years 15 % in T1, 19 % in T2, 27 % in T3.CONCLUSIONS: Considering our results we conclude that prostate cancer can be resected transurethrally as radical as with open surgery. The outcome as to survi-val and PSA-recurrence is comparable, the incontinen-ce rate is less then with open surgery. It is mandatory to have low pressure irrigation with suprapubic trocar, 28Fr. sheath and an autoregulated electrosurgical unit, video monito-ring and a well experienced reseccionist.
OBJECTIVES: To review the current diagnosis and treatment of Leydig cell testicular tumors, with special attention to conservative treatment.METHODS: We report two cases of Leydig cell tumor in young adults, diagnosed two years after the appearance of bilateral gynecomastia as first clinical symptom.RESULTS: One year and eight months after orchyectomy, respectively, clinical symptoms completely disappear in the first case and significantly improved in the second.CONCLUSIONS: Around 10% of the cases, and only in adult patients, these tumors may be malignant, being radical orchyectomy the treatment of choice, although conservative surgery may be performed. Independently of the operation, follow-up must be prolonged.
OBJECTIVES: Therapy with protease inhi-bitors is commonly used in patients infected by human inmunodeﬁcency virus (HIV). 20% of the administered dose is excreted by the kidney, and when alkaline urine is present , indinavir may crystallize forming stones and patients may experience renal colic due to this fact.METHODS: Between January 1998 and June 2005, 26 patients receiving antiretroviral treatment with pro-tease inhibitors received care at our hospital because of renal colic or ﬂank pain. All of them underwent phy-sical examination, echography and urography as well as blood and urine analysis. Patients were treated am-bulatory excepting those in whom oral analgesics were insufﬁcient to control the pain.RESULTS: All patients had been treated with indinavir for longer than 12 months. They represented 4% of all patients treated with the recommended dose of Crivixan ®. Most of them presented ﬂank pain, associated in most cases to microhaematuria. Five of them required hospitalization because of persistent pain in spite of en-dovenous analgesia. Imaging tests (echography and urography) showed functional delay of the kidney ( 2 cases), ureteral stasis (4 cases) and little lithiasic con-cretions of mild radiologic density (5 cases). Urinalysis revealed suggestive christaluria and alkaline pH. All pa-tients required hidratation and analgesic treatment. In 3 patients indinavir dose was reduced, it was retired in another one, and 100mg of rito-navir were added in another one. Unsuccesfuly ureteral cateterization was tried in one patient. All of them presen-ted symptomatic improvement.CONCLUSIONS: We ought to know the capability of indinavir to form urolithiasis in HIV patients treated with protease inhibitors, although its use is decreasing along time. Prevalence of urolithiasis in these patients seems to be higher as length of treatment becomes longer.Me-tabolic alterations in urine have been proved in these patients, contributing to a higher incidence of lithiasis than in general population.
OBJECTIVES: To analyze the modifications induced by laparoscopic and open nephrectomies in living donor transplantation on cytokines, to evaluate operative trauma of different surgical techniques and the influence on ischemia/reperfusion syndrome and renal function.METHODS: Thirty pigs underwent left nephrectomy, 15 by laparoscopy and 15 by open approach in an experimental autotransplantation model.RESULTS: Serum level of IL-2, IL-6, IL-10 and tumor necrosis factor (TNF) were lower during laparoscopic than open nephrectomy: 6,8±0,6 vs 13,9±1,1 pg/ml for IL-2, 46,2±2,3 vs 84,4±2,5 pg/ml for IL-6, 26,1±2,4 vs 92,8 ± 12,6 pg/ml for IL-10, and 17,6 ± 2,1 vs 38,5±4,8 pg/ml for TNF. There was no association between renal blood flow (RBF) and cytokines levels during nephrectomy: IL-2 (p= 0,498), IL-6 (p=0,117), IL-10 (p=0,081) y TNF (p=0,644). However, there was correlation between IL-10 and the decrease of RBF after transplantation: (R2 0,48; p= 0,02). Initial serum creatinine levels were correlated with RBF and IL-2 levels during nephrectomy (R=0,831, R2= 0,691, p= 0,025), and postransplantation RBF (R= 0,784, R2= 0,614, p< 0,0001). Seventh day creatinine levels were correlated with postransplantation RBF (R= 0,537, R2= 0,289, p= 0,002) and IL-2 levels during nephrectomy (R=0,685, R2= 0,469, p= 0,015). CONCLUSIONS: Cytokine levels were higher during the open approach than laparoscopic procedure. High levels of RBF during nephrectomy and transplantation improve early graft function while low levels of RBF and high levels ol IL-2 during nephrectomy induce delayed graft function.
OBJECTIVES: After the description and standardization of the technique of ureteroscopy in 1979, several methods to obtain a nontraumatic, simple, efficient and fast ureteral acce-ss have been developed. The hydraulic expansion of the ureter was possible in 1986, with the development of ureteromat. We evalua-te the effectiveness of hydraulic ureteral expansion (Ureteromat) for ureteral access and the later endos-copic procedures.METHOD: The last 100 ureteroscopy carried out from February to October 2006 were evaluated. We used a semi-rigid 9.8 Fr. ureteroscope and hydraulic expansion (Ureteromat) was performed in the same way in all procedures since 1986.RESULTS: Of the total of cases, 92 were indicated for lithiasic pathology, 7 were exploratory and 1 for ureteral stricture. In 94 patients the procedure was carried out with hydraulic expansion alone, in 2 cases we used a balloon catheter , in 3 patients expansion of the mea-tus was done with forceps and 1 procedure was not possible due to an ureteral stop.CONCLUSION: The Ureteromat pump guarantees an excellent hydraulic expansion of the ureteral meatus and the passage of the intramural ureter. The visibility is very good at any moment of the procedure, making ureteroscopy a simple, effective, non traumatic and fast method.
OBJECTIVE: To report one case of myofibroblastic bladder tumor.METHODS/RESULTS: We report the case of a 30-year-old woman with recurrent urinary tract infections and incidental finding of a bladder mass after abdominal ultrasound. After TUR, inflammatory myofibroblastic tumor of the bladder was diagnosed.CONCLUSION: Myofibroblastic tumor (also known as infla-mmatory pseudotumor or pseudosarcoma) is a benign tumor with mesenchymal origin. Bladder location is very uncom-mon. It must not be misdiagnosed as a malignant neoplasm. Optimal treatment when arising in the bladder is TUR, with excellent long-term prognosis.
OBJECTIVE: To report a new case of penile testicular ectopia.METHODS: We present the case of a three-year old boy who was diagnosed of penile testicular ectopia and underwent surgery.RESULTS: Physical examination revealed an ovoid tumor in the center of the dorsal side of the penile root, together with empty left scrotum. Inguinal incision revealed the exit of the spermatic cord from the left superficial inguinal ring, which was directed to a testicle in a subdermal position in the root of the penis. Funiculolysis and orchyopexy were performed.CONCLUSIONS: The case here reported corresponds to a penile testicular ectopia of central localizations, with normal inguinal course of the spermatic cord.
OBJECTIVE: The collecting duct carcinoma (Bellini’s carcinoma) is an unfrequent lesion; its macro and microscopic charac-teristics can help diagnosis.65-year-old Colombian woman presenting left-flank and hypochondrio stub-type episodic pain asso-ciated with hematuria, nausea and weight loss.RESULTS: The diagnosis was of collecting duct carcinoma.CONCLUSIONS: The clinical characteristics, macrocospic features, histology and immunohistochemistry are analyzed; we also perform a bibliography review.
OBJECTIVE: Usual complications of retropubic adenomectomy are well-known. Despite their low incidence, urologists face them relatively often in their daily practice due to the frequent performance of this technique, and they usually have satisfactory outcomes. We want to attract attention to the presence of a thigh abscess as an exceptional complication of adenomectomy. It is such an oddity that may pose very important diagnostic problems, with negative implications due to treatment delay. The knowledge of it may be decisive at the time of diagnosis and enable a fast decision-making process.METHODS/RESULTS: We present the case of a great thigh abscess as a complication of adenomectomy. We performed a detailed description of its presentation and avatars occurred until diagnosis and treatment, fortunately successful. We collect the pathogenic mechanisms of dissemination and comment on bibliography.CONCLUSIONS: The presence of a thigh abscess as a late complication of adenomectomy is an exceptional entity requiring a rapid diagnosis to an enable successful treatment, because it is a severe complication.
OBJECTIVE: Report one case of ectopic spleen simulating a renal tumor. We performed a review of etiopathogenesis, diagnosis and treatment.METHODS: We present the case of a 54-year-old splenectomized female patient with the incidental diagnosis on ultrasound of a left kidney upper pole mass simulating a renal tumor.RESULTS: After the performance of CT scan, and with the suspicion of renal neoplasia, the patient underwent tumorectomy with the pathologic diagnosis of the specimen compatible with supernumerary spleen.CONCLUSIONS: We emphasize the importance of including pseudo masses of splenic origin in the differential diagnosis of left renal, adrenal and retroperitoneal tumors. We emphasize the importance of CT scan as the imaging test of choice, and gammagraphy as a complementary test. We point out conservative attitude as the most suitable in cases of asymptomatic pseudomass of splenic origin.
OBJECTIVE: To show that a one-stage transperi-neal procedure may be effective in the treatment of urethral stones secondary to urethral strictures.METHODS: We present the case of a 36 y/o paraplegic male with neurogenic bladder, history of intermittent catheterization, and urethral strictures treated with internal urethrotomies several times. Imaging tests showed the presence of giant urethral and bladder stones with a concomitant bulbar urethra stricture. A one-stage transperineal approach was indicated.RESULTS: Postoperative follow up was satisfactory. The patient was discharged from the hospital one day after the surgery. At 12 months there were no signs of urethral obstruction and he continued with intermittent catheterizations uneventfully.CONCLUSION: One stage procedure was indicated because previous endourological treatments were unsuccessful. To our knowledge there is no published case of urethral stones the size we report to or its treatment with lithotripsy and litholapaxy in a one-stage transperineal approach.
OBJECTIVE: To report a new case of metastatic renal carcinoma with atypical localization. Skin metastatic involvement by urological tumors is a rare clinical entity. It is usually associated with internal organ involvement, so that this finding makes prognosis poor.We review the most frequent metastatic sites, their prognostic implications and treatment.METHODS: We present the case of a 60-year-old male patient with the diagnosis of inferior maxillary skin metastasis 18 months after radical nephrectomy for clear cell adenocarcinoma.RESULTS: The patient was treated with oral Sorafenib within a phase II clinical trial. Two years after diagnosis the patient is alive and a disease-free.CONCLUSIONS: The wide variability of localizations and forms of presentation of metastatic renal carcinoma obliges to be alert during follow-up. New antiangiogenic drugs are an efficient therapeutic option.
OBJECTIVE: Leiomyoma is a benign lesion which represents 0,04-0,5% of bladder tumors. It is more common in females and its peak incidence is between 4th and 5th decades. Surgery is the treatment of choice and adequate results have been previously reported.METHODS: 38 years old male patient who consulted for chronic pelvic pain syndrome. CT scan showed a 2cm diameter exophitic lesion at the anterior left lateral bladder wall, which protruded into the perivesical fat. We performed a laparoscopic partial cistectomy locating the tumor and resecting it with simultaneous cystoscopic control, obtaining negative margins. The operaResumentive time was 70 minutes with an intraoperative blood loss of 50 ml. Postoperative period was uneventful. Final pathology reported: Bladder wall leiomyoma, without mitosis or atypia. Immunohistochemistry was positive for Actine and Vimentine stablishing diagnosis. Cd 117 (c-kit) was negative and ruled out a Gastrointestinal Stromal Tumor.CONCLUSIONS: Leiomyoma is bladder’s most common benign non epithelial tumor. It represents 35-46% of these lesions with a 2:5 male/female ratio. It origins from the smooth muscle bundles and at the urinary tract the most common localizations are kidney and bladder. Clinical presentation depends on tumor size and localization. Ultrasound is the most useful diagnostic tool and the pathological diagnosis is mandatory. Surgery is the treatment of choice and technique depends on tumor size and localization. The laparoscopic approach seems to be an effective alternative in this group of tumors. Prognosis is good and recurrence is rare.
OBJECTIVE: To report a case of a Seg-mental testicular infarction (STI) simulating a testicular tumour and to discuss the importance of the excisional frozen biopsy.METHODS: We present the case of a patient with STI mimicking a testicular tumour.RESULTS: The patient was treated with partial orchiec-tomy after excisional frozen biopsy.CONCLUSIONS: The excisional frozen biopsy in testi-cular masses is a diagnostic maneuver to be considered in order to perform a testis-sparing surgery.