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OBJECTIVES: With the occasion of the Centenary of Dr. Enrique Perez Castro’s birth, being a relevant figure in our speciality in the second half of the 20th century, we performed a study of the urological environment in which his life was developed and collect the main data about his life and works with the aim of paying tribute to his memory as a great personality in urology.METHODS: We review the books of History of Urology, his writings and the journal Archivos Españoles de Uro-logía during the period of his directorship and as many references related to him as we found.RESULTS/CONCLUSIONS: He had a brilliant acade-mic curriculum; he trained urology in the best centres. He lived in Madrid, his birth place, were his entire pro-fessional career developed, in the Hospital Provincial, where he was the chairman of urology, and the Central University where he was associated professor. He liked to study, and had researcher spirit; his works, which had great quality --he received several prizes--, are clearly ex-posed, with a fine style, always with an extensive biblio-graphy. We emphasize his main merit, the foundation of the journal Archivos Españoles de Urología, a fruit of his personality, his organizing capacity and scientific restlessness, of which he was editor and directed with eagerness and dedication during 36 years and, thanks to his tenacity, he consolidated it as the reference of the Spanish urology.
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OBJECTIVES: When talking about day surgery we have to differentiate between minor and major ambulatory surgery. Ambulatory surgery enables the patient to stay in the hospital not more than a few hours, showing similar safety and efficacy than conventional surgery. The objective of this paper is to evaluate the results of an ambulatory surgery program.METHODS: Descriptive retrospective study of the results of the Ambulatory Surgery in a Urology Department, including 4185 patients in a four-year period, from January 1st 2003 to December 31st 2006.RESULTS: In the study period the global substitution rate was 83.6%. The hospital admission rate was 2.5%, most of which were early admissions. Major complications appeared in 26 patients (0.6%), being major bleeding the predominant one. Most complications were minor or mild, and pain at the site of the surgical wound was the most frequent problem found.CONCLUSIONS: The increase and continuous promotion of ambulatory surgery are more than justified. The high satisfaction among patients undergoing this type of surgery, with a very low number of complications registered, provides us with a valuable tool for health-care expenditure control.
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OBJECTIVES: To compare the cytocentrifugation cellular concentration method for urine cytology with the filtration-adhesion method, mainly evaluating their diagnostic efficacy and their inconveniences.METHODS: Voiding urine samples from 100 patients were processed by cytocentrifugation and filtration-adhesion to detect neoplastic cells.RESULTS: The filtration-adhesion method is superior to cytocentrifugation in the detection of neoplastic cells, without false positive results. The inconveniences are similar in both methods.CONCLUSIONS: The filtration-adhesion method is simple, low-cost, and more sensitive than cytocentrifugation for the detection of malignant cells.
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OBJECTIVES: The goal of this work is to evaluate the usefulness of NMP22 BladderChek in the diagnosis and follow-up of bladder cancer, comparing it with cystoscopy and urine cytology. METHODS: Group 1: 109 asymptomatic patients on follow up for bladder cancer underwent cystosco-py, cytology and NMP22 BladderChek. Group 2: 15 patients with history of hematuria underwent cystoscopy and NMP22 BladderChek. RESULTS: Group 1: 9 patients had tumor relapse. Sensitivity was 25% for NMP22 test, 50% for cito-logy and 100% for cystoscopy. Specificity was 91.1%, 94.1% and 95% respectively. Group 2: 12 pa-tients had bladder cancer. The sensitivity was of 83.3% for NMP22 BladderChek and 100% for cystoscopy. The specificity was of 100% for NMP22 BladderChek and 66.7% for cystoscopy. CONCLUSIONS: The low sensitivity of NMP22 Bladder-Chek invalidates it as alternative method to cys- toscopy in the follow-up of bladder cancer. But it can be recommended for screening in patients without history of bladder cancer but with an increased risk (smokers, patients with dysuria and hematuria).
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OBJECTIVES: Hospital Clínico San Carlos in Madrid is the first Spanish public centre using the latest surgical technology: the Da Vinci® robot. First operation was carried out in our department in October 9th 2006. Since then, numerous changes have happened which enabled us to overcome difficulties, to complete the learning curve. METHODS: Between October 9th 2006 and November 30th 2007 we performed 30 radical prostatectomies with the Da Vinci® robot. Mean patient age was 63 years (47-70 years) with an ASA (American society of anesthesia) risk below III in all cases, a Gleason score between 2 and 8 and a PSA≤ 15 (3.5-15). Mean prostatic volume measured by transrectal ultrasound was 36 cc (16-90 cc). RESULTS/CONCLUSIONS: Six trocars and a 15 mm Hg pneumoperitoneum were employed. Mean operative room occupation time was 5.9 hours (4-14 hours). Two cases were converted to open surgery and one to laparoscopy. No major intraoperative complications have happened. In the immediate post-operative period, 2 patients presented plexopathy and arthralgia, 1 infection at the site of one trocar, and 2 haematomas at the site of trocar insertion. Sixteen patients required transfusion (mean 1 red blood cells unit (0-4)). Bladder catheter was retrieved between 5th and 21st post-operative days (mean 11 days). Regarding continence: 10 patients were completely continent or present mild incontinence (0-1 pad) and 5 had moderate incontinence (2-5 pads). Three patients preserve sexual potency, the rest show different grades of dysfunction.
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OBJECTIVES: Simple renal cysts (SRC) are usually asymptomatic and do not require any kind of treatment. Laparoscopy is a reasonable minimally invasive surgical option for symptomatic cysts. Herein, we present the results of the laparoscopic technique for the treatment of symptomatic renal cysts performed in our institution.METHODS: Between November 1992 and May 2006, 41 patients with symptomatic renal cysts were laparoscopically treated. The surgical techniques employed were transperitoneal and retroperitoneal. De-mographic and surgical data was prospectively collec-ted and analysis retrospectively performed.RESULTS: 41 patients were treated for symptomatic renal cysts in a fourteen year period. 23 (56%) women and 18 (44%) men, with a median age of 54 years. (Range 27-74 years.). All patients in the series were symptomatic. Pain was the most frequent symptom. Median cyst size was 10 cm. (range 5-16 cm.). Transperitoneal appro-ach was performed in 24 patients (58%) and retrope-ritoneal in 17 (42%). No differences were verified between these approaches. 16 lesions were located at the left renal unit, 24 in the right renal unit (54%) and one case presented bilateral lesions (3%). Median operative time was 52 min. (range 20-150 min.), me-dian hospital stay was 42 hours (range 12-96 h.). 39 cysts (95.2%) were classified as Bosniak’s type I lesio-ns, 2 lesions (4.8%) were type II based on Bosniak’s description. Final pathology confirmed every lesion as a simple renal cyst. There was only one relapse in the series. The latter was treated percutaneously.CONCLUSIONS: Laparoscopy is a feasible, safe and advantageous surgical therapeutic option for sympto-matic renal cysts.
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OBJECTIVES: Erectile dysfunction (ED) is a disorder with a high prevalence that increases with age. It is estimated that 18.9% of men’s between 25 and 70 years suffer it in Spain. Most cases have a multifactorial origin and it is admitted the influence on its pathogenesis of systemic diseases, different kind of drugs, psychogenic factors, cardiovascular, endocrinological and neurological diseases. Neurologic cause erectile dysfunction may have its origin in the central or peripheral nervous system. Among possible process of neurogenic erectile dysfunction of central origin would be tumors, cerebral vascular accidents, encephalitis, Parkinson disease, multiple sclerosis and other demyelinization diseases, dementias, olivopontocerebellar degeneration and epilepsy. Myelopathies of any etiology may be, depending on their localization and extension, cause of erectile dysfunction. At the peripheral level, disorders of the sensitive tracts constituting the afferent limb of the erection spinal reflex, and the efferent vegetative or somatic tracts mediating arterial vasodilatation, cavernous smooth muscle relaxation or pelvic floor striated muscle contraction. The aim of this work is to review in detail the most relevant causes of neurogenic erectile dysfunction, their etiopathogenic mechanisms and therapeutic approaches currently considered more adequate for each particular case.CONCLUSIONS: The correct diagnostic approach to patients with erectile dysfunction passes through identification, if possible, of the etiopathogenic factors implied. Regarding this, detection and identification of a possible neurogenic risk factor will contribute to a better understanding of the physiopathologic mechanisms, and more adequate diagnostic, prognostic and therapeutic approaches, mainly in those patients refractory to first line therapy.
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OBJECTIVES: To evaluate comparativelythe results of treatment with interferon, laser and their as-sociation in a group of patients with Peyronie’s disease.METHODS: We performed an experimental study toevaluate the main results of the treatment of Peyronie’sdisease with interferon and laser, at Hospital ProvincialUniversitario “Saturnino Lora Torres” and Hospital Gene-ral Universitario “Dr. Juan Bruno Zayas Alfonso” in thecity of Santiago de Cuba from January 2003 to July2005. Ninety-six patients were included, divided intothree treatment groups: interferon, laser and interferonplus laser. After initial evaluation, treatment was startedand continued for 28 weeks, with reevaluation six and12 months after the end of treatment RESULTS: Final results with combined interferon and la-ser were: symptoms improvement 84.7%, decrease ofthe size of the fibrous plaque 90.6% and decrease ofpenile curvature 87.5%.CONCLUSIONS: The combination of both therapies re-sulted to be more effective than each of them separately,so the recommendation is to incorporate it as anothertherapeutic alternative in Peyronie’s disease
Case Report
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OBJECTIVE: We report two cases of collec-ting duct carcinoma that were diagnosed in our hospital in a six-month period.METHODS/RESULTS: The first case was a 75-years-old wo-man showing in CT scan a mass in the left kidney which infiltrated perinephric fat. The second case was a 72-years-old that showed in a CT scan a right renal pelvis lesion, involving inferior vena cava and renal vein. After surgical resection by radical nephrectomy in both cases, we confirmed the histolo-gical diagnosis of collecting duct carcinoma.CONCLUSIONS: Collecting duct carcinoma is a rare va-riant of renal cell carcinoma which originates from the epi-thelium of the collecting tubule. It is characterized by both its aggressiveness and peculiar histological and inmu-nohistochemical diagnosis, that separates it from the rest of renal tumors.
Case Report
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OBJECTIVE: To report one case of proximal mi-gration of ureteral stent. To perform a bibliographic review about other cases and management to avoid this complication.METHODS/RESULTS: 48-year-old woman who presents right obstructive uropathy after gyneco-logic surgery . After the introduction of the right ureteral stent we observed a proximal stent migration. We put on a right nephrostomy tube and antergra-de ureteral stentCONCLUSIONS: The right stent length and proper lo-cation of the distal tip are important factors to avoid this complication.
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OBJECTIVE: To present the association between Seminoma and Kartagener´s Syndrome(KS), and its relation with infertility.METHODS: We report one case of Seminoma in a patient with Kartagener´s Syndrome, focussing on the possible relation between both pathologies and fertility. Bibliographic references are discussed.RESULTS: Orchyectomy was performed on a patient with Kartagener´s Syndrome and testicular tumour. The pathology result was Seminoma. Azoospermia was obtained twice in the post operative espermiogram, not being easy to establish the implication of each pathology ( KS or Seminoma) in infertility.CONCLUSIONS: A patient with KS and Seminoma plus azoospermia is reported, with a great outcome from the oncological point of view. Bibliographic references are described. The association between KS and Seminoma is exceptional in the literature.
Case Report
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OBJECTIVE: We report one case of renal angiomyolipoma with three characteristics: renal sinus ori-gin, inferior vena cava tumor thrombus reaching the right atrium and Budd-Chiari syndrome.METHODS: The characteristics of the case are presented and discussed.RESULTS/CONCLUSIONS: Renal angiomyolipoma is a be-nign mesenchymal tumor. It is an uncommon tumor (2-6.4% of all kidney tumors), with a female predominance. Angio-myolipoma most often originate from the renal parenchyma but they can rarely originate from the renal sinus. They can involve the renal vein, the inferior vena cava and even the right atrium as a tumor thrombus. Angiomyolipoma common-ly present as an incidental finding on radiographic studies, but the clinical presentation varies from flank pain to fatal pulmonary tumor embolism. The Budd-Chiari syndrome is an extremely rare presentation. Because of the risk of potentially fatal cardiopulmonary embolism and death, surgical treatment (radical nephrectomy plus tumor thrombectomy) of these le-sions is indicated even when they are asymptomatic.
Case Report
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OBJECTIVE: To report the spontaneous rupture of a renal cyst into the adjacent pyelocalyceal collec-ting system.METHODS: We present the case of a 47 year old woman with a 17 centimeter simple renal cyst (Bosniak I) as well as ipsilateral nephrolithiasis. The patient had a febrile urinary tract infec-tion with flank pain. A subsequent CT scan revealed that this cyst spontaneously ruptured into the renal pelvis.RESULTS: Follow up evaluations showed the former cyst has decreased in size and contain thick and nodular calci-fications. At present it is a Bosniak IIF cyst.CONCLUSION: Simple renal cysts can spontaneously rupture and drain into the adjacent renal collecting system
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OBJECTIVE: To report a brucellar orchie-pididymitis case and to review the diagnosis and treatment of this pathology.METHOD: We present the case of a 62 year old man presenting with fever, testicular pain and constitutional syndrome. The diagnosis was made after ultrasound, blood cultures and anamnesis.RESULTS: The treatment was Doxiciclin six weeks and teicoplanin, the second one was replaced with ciprofloxacin.CONCLUSION: It is important to make a correct anamnesis to the patient with orchiepididymitis to identify any risk factor for brucellosis. The diagnosis is confirmed with blood cultures. The oral antibiotics are enough to cure patients.
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OBJECTIVE: To report one case of discontinuous splenogonadal fusion, an rarely referred entity, with clinical interest, without important repercussions in most cases.METHODS: 23-year-old male with the diagnosis of right paratesticular mass, with negative markers for germ cell tumors. On ultrasound the mass was homogeneous and isoechoic in comparison with the adjacent testicular parenchyma. On surgical exploration, the mass was excised, with the pathologic result of splenogonadal fusion, with normal splenic tissue.RESULTS: Being maybe more frequent in pediatric surgery and urology practices, splenogonadal fusion presents two differentiated forms: continuous with a fibrous or nodular cord from the spleen to the gonad, retroperitoneal or intraperitoneal; and discontinuous in which there is no topographic communication between spleen and ectopic splenic tissue adjacent to the testicle.CONCLUSIONS: Although they are exceptional, splenic remainders fused to the testicle, epididymis or vas deferens may present the differential diagnosis with testicular and paratesticular masses.
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OBJECTIVE: The aim of this study was to investigate the role of biomagnetic activity measurements in detecting prostate malignancies, in differentiating cancerous from benign prostate lesions and in generally improving our understanding of prostate cancer biology.METHODS: Magnetic recordings were obtained from 47 patients with palpable prostate lesions. Twenty-four had prostate carcinoma and 23 benign prostatic hyperplasia (BPH).RESULTS: The magnetic field recorded in the 2-7Hz frequency range was of high amplitude in most (95%) malignant lesions 248±82 Ft/ √Hz) and of low amplitudein most (95%) benign ones (166±31 Ft/ √Hz). These findings displayed significant difference (p=0.0021).CONCLUSIONS: Prostate cancer emits higher biomagnetic activity than BPH. This finding confirms the higher angiogenic activity of prostate cancer. The use of this method is safe and seems promising.
