OBJECTIVES: To determine and compare the antioxidant power, cellular damage by lipidic peroxidation, and membrane damage in normal patients and patients with prostate cancer, so determining the antitumoral capacity.METHODS: The study population included 19 patients with elevated total PSA, greater than 4 ng /ml, with a minimum of 10 ultrasound guided transrectal biopsies, and 10 normal subjects as control group. In all cases, medical history, rectal digital examination, PSA determination and routine analyses were performed in addition to spectrophotometric tests to measure the antioxidant power. Membrane damage was measured by detemination of malonyldialdehyde (MDA) and cellular damage by glutathione peroxidase.RESULTS: From a total of 19 cases: 6 (31.5%) presented prostate cancer (4 Gleason 7; 1 Gleason 6 and 1 Gleason 8); 8 presented histological benign prostatic hyperplasia with a component of chronic prostatitis; 3 patients prostatic hyperplasia and glandular atrophy; and 2 cases isolated benign prostatic hyperplasia. All 10 control patients presented values within normal range in all determinations, whereas study patients showed antioxidant power < 1.3 mmol/l in 13 cases; higher than 1.77 mmol/l in 4 and normal values in 2 . MDA was elevated in 15 patients and normal in 4, all of them without histological chronic prostatitis. Four of the patients with prostate cancer presented a diminished antioxidant power below 0.90, with a relationship with glandular architecture, because those with Gleason 8 and 7 did not exceed 0.58 mmol/l. Two patients with prostate cancer with a lower Gleason score presented normal minimal values.CONCLUSIONS: Patients with prostate cancer or reactive processes, such as chronic prostatitis or atrophic prostatitis, present a decreased antioxidant power and an increase of lipidic peroxidation.
OBJECTIVES: Renal haemangiomas of renal papillary or medullar origin are a difficult diagnosis entity, being one of the most frequent processes of chronic episodes of hematuria, secondary to benign disease, mainly in young patients (1). The objective of this paper is to show the difficulty of this diagnosis and the need to suspect it in cases with clinical history similar to the ones described in these cases.METHODS: We report 4 cases of spontaneous hematuria of renal origin, with clinical presentation as renal colic, from the historical case series of the Fundacion Jimenez Díaz - Capio, the last two from the years 2005-6. We present the diagnostic and therapeutic methodology employed, including angio-CT and flexible ureterorenoscopy (URS) as well as various treatment options.RESULTS: Hematuria was identified as “essential” when any relation with tumor or lithiasic pathologies was ruled out, and of renal origin when the source was clearly pointed. We interpreted it was related to angiomas or microangiomas of papillary or medullar origin. In one case, the vascular malformation was interpreted as an arterial venous fistula (AVF) at that level. Hematuria stopped spontaneously in two cases after exploratory URS. The eldest historical case required surgical expiration of the caliceal structures.CONCLUSION: Years ago, following the professional development of Urology as speciality, conventional surgery was carried out in all these cases, of very difficult diagnosis, with a very small number of cases undergoing a conservative approach based on the examination of renal cavities trying to observe and find the bleeding point. Most cases underwent complete or partial nephrectomy. Currently, the possibility of exploration of all renal cavities with the flexible ureterorenoscope enables a better diagnosis of the lesions and a more conservative treatment. The ultimate diagnosis of renal papillary angioma is the pathologic diagnosis, without pathognomonic data in the imaging tests. This pathology is thought of at the end of the diagnostic workup, and when the papillary area is identified as the source of bleeding. The historical case series, with the pathologic findings from nephrectomy specimens, permits us to point out this entity as papillary angioma, in patients with similar clinical presentation.
OBJECTIVES: To quantify anxiety and im-mediate and late pain, efﬁcacy of the common anal-gesic methods, and complications.METHODS: 117 patients were randomized to three groups: 1(39): lubricant gel; 2 (38): intrarectal lidocai-ne gel; 3 (40): anesthetic blockage with 1% lidocaine. Complications and immediate and late pain were co-llected, these latter with a visual analogic scale.RESULTS: 70% of the patients were not much anxious. We did not ﬁnd signiﬁcant differences between the anal-gesia achieved in group 1 (4.37± 2.41) and group2 (4.22± 2.46), but we found with group 3 (1.88± 2.03). Mean pain score the afternoon after biopsy was lower in group 3 (2.08± 2.28) than in groups 1 and 2 (4.06± 2.80 and 2.42± 2.03), without statistical signiﬁcance. The patients did not show a difference in pain during the pass of the transrectal transducer, va-rying between 2.34 for group 3 and 3.38 for group 2. Grouped by sphincter tone we ﬁnd differences (low 2.71± 2.76, medium 3.23± 2.38, high 4.99+- 2.22). Patients feeling very nervous before the test had a pain score of 4.98± 2.57, signiﬁcantly greater than the pain of those not feeling nervous (2.59± 2.21). We did not ﬁnd differences in complications between the three groups.CONCLUSIONS: The use of intrarectal lidocaine gel did not demonstrated being more effective in pain con-trol in our series than the use of lubricant gel, but lido-caine injected into the apex and seminal vesicles was. Sphincter tone and pre-test anxiety are the most determi-nants factors for pain.
OBJECTIVES: Morbidity secondary to in-travesical Bacillus Calmette-Guèrin (BCG) may present both locally and systemically. Most patients suffer a self-limited irritative voiding syndrome. Often, there are not uniﬁed criteria for the management of BCG side effects. After treating more than 500 patients with BCG we de-veloped a practical guideline for the management of its morbidity. We present clearly and schematically the practice gui-deline we follow in our Center when the patient presents symptoms and morbidity secondary to BCG intravesical installations.METHODS: We analyze and describe, following the literature and our own experience, the management of adverse events experienced by patients treated with in-travesical BCG, since the initial implementation of the protocol for its indication in patients with high risk non-muscle invasive bladder tumors and/or CIS.RESULTS: Irritative voiding symptoms are among the most frequent symptoms, generally self-limited; but if they persist (> 48 hours) will have the urologist treat them de-pending on intensity and duration. Macroscopic hema-turia is not unfrequent and diminishes with an expectant approach and water intake. But, it may also be a urina-ry tract infection or residual tumor. A febrile syndrome, if present, is usually self-limited to the ﬁrst 24-48 hours and below 38.5ºC without general status affectation. In cases of persistence and/or sepsis, tuberculostatic treatment and/or corticoids should be started. Other clinical pictures may appear, such as orchyoepididymi-tis, arthritis, etc.CONCLUSIONS: Proper diagnosis and treatment of adverse events after BCG therapy are basic to allow intravesical immunotherapy be properly prescribed and managed by urologists, enabling a proper treatment of patients and avoiding the possibility of more severe complications.
OBJECTIVES: Pubovaginal sling has been the treatment of choice for female SUI over the last two years. Those made with autologous materials have de-monstrated a lower rate of complications. We present our experience using autologous fascia lata.METHODS: Between May 2005 and July 2006 we performed 10 procedures through a suprapubic appro-ach. In eight cases they were ascended to the retropu-bic space using needles, and in 2 cases we employed the vaginal tunneler (Tyco®). In the 8 initial cases both sling branches were anchored to the Cooper`s ligament. In the remainder two cases they were anchored to the fascia of the obliquus externus muscle.RESULTS: Mean age was 57.7 years; mean follow-up time was 14.8 months (6-20). In 6 cases cystocele was simultaneously corrected. Hospital stay was 72 hours. In two cases, section of the autologous sling was required due to excessive correction. Four patients keep using pads; nevertheless, all 10 patients refer no SUI. Post-operative urine culture was positive in four patients, with negative controls. One case presented vaginal candidiasis.CONCLUSIONS: Autologous fascia lata pubovaginal sling is an effective low cost treatment, with a low com-plication rate.
OBJECTIVES: Classically, it was understood detrusor contractility was affected in bladder areflexia but not in hyperreflexia. We aim to demonstrate that there is some detrusor contractility affectation in bladder hyperreflexias, although it may seem paradoxical at first sight.METHODS: Neuro-urologic study was performed in a series of 68 consecutive patients with bladder hyperreflexia (neurogenic detrusor hyperactivity), referred to the unit of functional urology for urodynamic evaluation. All patients underwent clinical history, post void residual determination, cystomanometry, voiding pressure-flow test, videourodynamics and selective EMG of the periurethral sphincter. Detrusor contractile potency was measured with W 80-20. Terminology follows the ICS standard. Data processing was performed using the statistical software SPSS 12.0.RESULTS: This series includes 14 males (58.8%) and 28 females (41.2%), of all ages (adults more frequent). 88.2% of the cases had acquired neurological diseases (trauma 30.9%; medical 33.8%; degenerative 35.3%), and 11.8% congenital neurological diseases (myelodysplasia). Most frequent type of neurological lesion was detrusor-sphincter dyssynergia: 59 cases (79.4%); 22 patients (32.4%) had undergone previous treatment of their vesicourethral dysfunction. The amplitude of detrusor involuntary contractions was wider in detrusor-bladder neck dyssynergia. Detrusor isotonic contractility (W 80-20) was significantly affected, mainly in neurological lesions of traumatic nature and less in degenerative lesions (p = 0.01).CONCLUSIONS: We demonstrated that bladder contractility is affected in bladder hyperreflexias (neurogenic detrusor hyperactivity), more important in traumatic lesions without relationship with the type of neurological associated lesion, which could be related to a bladder structural change, or with a change in the central neurological tracts (without requirement of presence of dyssynergia).
OBJECTIVES: To present our surgical experience in laparoscopic adrenalectomy after 70 procedures, comparing our results with the published series and analyzing the learning curve.METHODS: Between June 1997 and December 2007 we performed 87 adrenalectomies (70 transperitoneal laparoscopy, 1 retroperitoneoscopy and 16 open surgery); 60% were female. Mean age was 54 years 15-80); 35 were left adrenalectomies, 33 right and one bilateral. Mean mass size was 3,7 cm (1-10). All patients were assessed regarding the following varia-bles: preoperative diagnosis, histopathology, operative time, blood loss, complications, conversion to open sur-gery and hospital stay. We compared the results of the first 40 surgical procedures (Group 1) and the last 30 (Group 2). We also compared our re-sults with published series. Mean time follow-up was 12 months (2-60).RESULTS: The most frequent preoperative diagnoses were: active suprarenal mass (50%), incidentaloma (20%), pheochromocytoma (20%). Histopathology confirmed 60% adenomas, 14% pheochromocytomas and 11% cortical nodular hyperplasia. Mean ope-rative time was 161 minutes (60-300). Average blood loss (hematocrit) was 5.2 (1-10). Conversion and complication rate were 8.5 and 7%, respectively. Mean hospital stay was 4 days (2-30). In group 2, only reduction on mean operative time (120 min) and hospital stay (3 days) was statistically significant. CONCLUSIONS: Transperitoneal laparoscopic adrenalectomy is a feasible and safe procedure in urological groups with previous laparoscopic experien-ce. Our results are similar to the published series and confirm the efficacy, safety and reproducibility of this technique.
OBJECTIVE: To demonstrate that “bench surgery” and autotransplantation are still alternatives in the treatment of complex renal cancer cases. METHODS: 58 y/o female with history of radical nephrectomy due to renal cancer who asked for medical attention because of back pain. Renal masses were found during her evaluation and she was referred to our service.RESULTADOS: Lumbar incision was the preferred approach. After removal, the kidney was irrigated with EuroCollins solution and bench surgery was performed. Cold ischemia time was 63 minutes. The kidney was transplanted into the right pelvic region. Diuresis was immediately achieved after vascular anastomosis. Lich-Gregoir ureteral implant was carried out. During the first 48 hrs no complication was reported, urine output was about 80 cc/hour. She eventually developed renal failure and after 6 sessions of hemodialysis recovered to void in the previous volume range. She had a urinary leak that was resolved with CT-guided percutaneus drainage. Twelve months after the procedure, she has no complaints; serum creatinine is 1.6 mg/dl and CT scan shows no evidence of recurrences.CONCLUSIONES: Bench surgery is still a therapeutic alternative for the treatment of complex renal cancer cases in order to avoid dialysis.
OBJECTIVES: We present one case of urino-ma after gynecologic surgery and the surgical repair.METHODS: 46-year-old woman referred for urologic consul-tation for ﬂank pain after hysterectomy.RESULTS: CT scan showed the existence of an urinoma with the ureter included in the radiological lesion.CONCLUSION: Early treatment after diagnosis with end-to-end anastomosis solved the problem.
OBJECTIVES: The existence of non seminomatous mixed germ cell tumors of the testis is a frequent event in urologic oncology. Nevertheless, the presence of both compo-nents, seminomatous and non seminomatous, in a germ cell tumor is unusual.METHODS: We present a case of pure classic seminoma of the testis with a lymph node metastasis of pure embryonal carcinoma, with confirmatory immuohistochemical study and clinical outcome of the patient.RESULTS: A 34 year old man presented with 3 cm supraclavicu-lar tumor. CT scan also revealed multiple metastases in lymph nodes, liver, kidney and left adrenal gland.Tumor markers were negative and the biopsy performed discovered a lymph node metastasis of embryonal carcinoma of probable testicular origin. Ultrasound revealed a 6 mm hypoechoic nodule in the right testis. Orchyectomy was performed and pathologic analysis demonstrated a tu-mor, 1 cm of diameter, histopathologically compatible with classical seminoma with pagetoid extension to rete testis. Albuginea and spermatic cord did not present neo-plastic involvement. Currently the patient is being treated with chemotherapy.CONCLUSION: The interest of the case is to remark an unusual aggressive clinical presentation as well as to perform a bibliographic review with emphasis in the theories regarding heterogeneous differentiation and spontaneous regression of germ cell tumors of the testis
OBJECTIVE: We report the case of a 61-year-old male with the incidental diagnosis of intrathoracic renal ectopia during the workup study for a possible lung mass.METHODS: We performed a bibliographic review on the incidence, origin, clinical presentation and diagnosis of this type of renal ectopia.RESULTS: Chest x-ray showed a left posterior mediastinum mass. Bronchoscopy was performed showing signs of extrinsic compression with absence of neoplastic cells. CT scan revealed a left intrathoracic ectopic kidney with diaphragmatic hernia.CONCLUSIONS: Intrathoracic renal ectopia is a very unfrequent finding, often asymptomatic, frequently an incidental diagnosis that does not require treatment.
OBJECTIVE: To describe the clinical case of a patient presenting a squamous cell carcinoma in a duplica-ted renal pelvis, after percutaneous nephrolithotomy.METHODS/RESULTS: 60-year-old male patient who was diagnosed of a squamous cell carcinoma of the renal pelvis in the pathological study of a lower pole nephrectomy after percutaneous nephrolithotomy for staghorn calculi in the left lower pole renal moiety. The patient suffered a bladder recu-rrence one year and a half later. A radical cystoprostatectomy was performed, but the patient died in a few months due to metastasis.CONCLUSIONS: Squamous cell carcinoma of the renal pelvis is a rare tumor with poor prognosis, associated with stone disease and chronic infection. Taking biopsies from suspicio-us lesions during percutaneous nephrolithotomy may help early diagnosis and improve survival.
OBJECTIVE: A case of ductal carcinoma of the prostatic utricle is described, previously known as endometrial carcinoma, and literature is reviewed.METHODS: 75 years old patient who consults for lower urinary tract obstructive symptoms, with a PSA of 8.1 ng/ml., without more symptoms. Digital rectal examination and ultrasound showed a small and stony prostate. Deobstructive transurethral resection of the prostate was performed and the biopsy revealed ductal carcinoma of the utricle.RESULTS: Nine years after diagnosis signs of dissemination are not present.CONCLUSIONS: As incidental finding in the biopsy, ductal carcinoma of the utricle is a rare tumor, the incidence of which among all prostatic carcinomas has been cited as 0.2 – 0.8%. We report a review about this topic for improving its knowledge. Symptoms, pathological findings and treatment of this carcinoma have been reviewed
OBJECTIVE: To report one clinical case of bladder lithiasis secondary to the migration of an intraute-rine device, its symptoms, diagnostic tests employed and treatment.METHODS/RESULTS: 30 year old female patient who presented lower urinary tract irritative symptoms. One year before she underwent insertion of an intrauterine device (copper T) after endometrial curettage for pregnancy inte-rruption. She received treatment for infection cystitis over two years, with various antibiotic cycles. The persistence of symptoms led her to the urology clinics, and a 5x 3 cm intravesical lithiasis with a copper T inside was detected by ultrasound and pelvic anterior-posterior x-ray. Suprapubic cystolithotomy was performed with a good outcome and disappearance of the symptoms.CONCLUSIONS: The migration of an intrauterine device to the bladder is an unfrequent cause of bladder lithiasis se-condary to foreign body. Nevertheless, we must consider this possibility in front of chronic lower urinary tract irritative symptoms in every female using this birth control method.
OBJECTIVE: Testicular epidermoid cysts are rare and can be clinically misleading with other testicular neoplasms. We describe a case of epidermal cyst of the testis, with the aim to contribute to the clinicopathological knowledge of this entity. METHODS: A 24-year-old caucasian man presented with a self-detected right testicular mass. Ultrasound features were consistent with solid tumor. He underwent an inguinal radical orchyectomy. RESULTS: An intraparenchymal cyst measuring 1,4 cm was observed, covered by epidermal epithelium with no other skin components. Adnexal testicular pulp was normal.CONCLUSIONS: When a preoperative diagnosis is made, a conservative treatment is recommendable, including frozen sections analysis of the cyst and adjacent testicular parenchy-ma to rule out a coexistent intratubular germ cell neoplasia.
OBJECTIVE: We report the case of a young patient without known cardiovascular risk factors, complaining of lumbar colic pain due to renal infarction.METHODS: Differential diagnosis of lumbar colic pain must include some rare events. We performed a review of the current knowledge on the topic.RESULTS/CONCLUSION: The increasing difficulty in the diagnosis of these pathology lies on its clinical suspect, which can be clear when having cardiovascular risk factors. Its diagnosis, on a rare scenario, needs leucocytosis and LDH rising as suspicious indicators. Computed tomography, MRI, radionuclids and arteriography may confirm diagnosis. Treatment is based on thrombolytic therapy, anticoagulants and antiagregants.
OBJECTIVE: Phyllodes tumor of the prostate is a rare neoplasm. We report the clinical, histopatho-logical, and immunohistochemical features of a low grade phyllodes tumor of the prostate with lung metastases. METHODS: A 68-year-old man presented acute urinary obstruction. Suprapubic prostatectomy was performed, and one month later he developed acute urinary obstruction, shortness of breath and cough. RESULTS: Microscopically, the prostatic tumor showed elongated ducts and cellular stroma. Lung biopsy was composed of stromal cells with enlarged, hyperchromatic nuclei. CONCLUSION: This case represents a typical low grade prostatic phyllodes tumor to lung. Grading of these neoplasm is not always of value to predict patient prognosis.