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OBJECTIVES: Five or six perforations of the abdominal wall increase the possibilities of organ injury, infection, or hernia. Laparoscopy originally offe-red great advantages and significant progress. Multi-ple abdominal ports are now considered superfluous, excessively traumatic and, today, hardly merit the term ‘minimally-invasive-surgery’. All that led us to design a device to help surgeons meet new standards that can have several uses.METHODS: The instrument is a 4 cm diameter, 5 cm long cannula. The superior extremity or lid has five 5 mm sealed openings, one for the telescope and four for ins-truments. Below the lid and its notched retaining screw is the tap to insufflate the operating field. The peripheral flange limits insertion depth and seals the skin wound. Lids with more or less openings are available. The de-vice has been proven first in a simulator, and then five pigs between 20 and 30 kg have been operated. In the first two cases the cannula was introduced through the umbilicus and a cystostomy with suture was carried out. In the other three cases nephrectomy was performed inserting the cannula through the flank.RESULT: The experimental series has allowed us to get adapted to the cannula; we have verified that dia-meter and length of the device are optimal, and vision is excellent. Also the device is hermetic, since there is no loss of gas and the instruments are not trap-ped inside, what has allowed us to work and to suture without special difficulty.DISCUSION: A single port through the abdomen or even transvaginally represent a real challenge to laparoscopy because in the 21st century to make 5 or 6 perforations in the abdominal wall appear untenable. Finally, with this system there are enormous possibilities for robotiza-tion with only one arm that includes the telescope and instruments, that sooner that we might imagine is going to revolutionize surgical practice.
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OBJECTIVES: With the occasion of the centenary of the birth of Dr. Enrique Pérez Castro, founder, first director and editor of the journal Archivos Espa-ñoles de Urología, at this time when the issue No. 61 comes out, we performed a historic study of the evolution of the journal throughout the 36 years it was ruled by him, between April 1944 and December 1980.METHODS/RESULTS: Complete review of the 158 issues, together with three extraordinary issues, included in the 31 volumes edited in the period Dr. Perez Castro directed it.CONCLUSIONS: The journal, senior journal in Spanish Urology, developed its main objective of being the communication and knowledge exchange media, with the exposition of scientific works, among the members of the Spanish urological community who admitted it with interest and complete acceptation. The work and devotion of Dr. Pérez Castro as director conferred the journal a great quality and achieved to join it to the Spanish Association of Urology, which demonstrated its category and reinforced its diffusion, acceptation and continuity. It is by itself an exceptional document and splendid historic synopsis of our urology over the second half of the 20th century.
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OBJECTIVES: Over the last years nume-rous semiquantitative PSA tests have appeared , based on serum or plasma immunochromatography. We pre-sent our experience using the SD BIOLINE PSA test, whi-ch is performed with plasma or serum for fast qualitative determination of PSA; the cutpoint is 3 ng/ml.METHODS: We analized 54 patients who were ad-mitted in our hospital ward. Two blood samples were obtained from every patient, one for cuantitative PSA determination at the hospital laboratory and the other one for qualitative determination with the SD BIOLINE PSA test, and the results were compared.. Two urologists independently interpreted the test without knowing the PSA values from the lab. To calculate the effect of test reading time, readings were performed at 15, 20 and 25 minutes. Results were classified in a classic contin-gency table, which enabled us to calculate sensitivity and specificity of the test, as well as positive and nega-tive predictive values.RESULTS: Mean age was 71.1 years (range 43-96 yr). From 54 patients in the study 26 (48.14%) had a PSA > 3 ng/ml (Mean 18.5 ng/ml, range 3.9-66.9 ng/ml) and 28(51.86%) PSA < 3 ng/mL (mean 0.8 ng/mL, range 0-2.9 ng/mL), in the conventional test. Results for each interval and observer were: 15 min: Observer 1: Sensitivity (S) 76,92%, specificity (E) 100%, positive predictive value (PPV) 100% , negative predictive va-lue (NPV) 82.35%; Observer 2: S 76.92%, E 100% , PPV 100%, NPV 82.35%. 20 minutes: Observer 1: S 100%, E 93.33%, PPV 92.30%, NPV 100%; Observer 2: S 100%, E 93.33%, PPV 92.30% ,NPV 100%. 25 minutes: Observer 1: S 100% , E 85.71%, PPV 86.66%, NPV 100%; Observer 2: S 92.30%, E 92.85%, PPV 92.30%, NPV 92.85%. CONCLUSIONS: The SD Bioline PSA test complies with the characteristics required to be used as a test for pros-tate cancer detection, it is simple, fast, cheap, not much invasive, and has a good efficacy.
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OBJECTIVES: To compare three different surgical approaches for the performance of varicocelec- tomy in the pediatric population, analyzing their effecti- veness and secondary complications. METHODS: Over an eight year period 90 varicocelec- tomies were performed in 89 children with a mean age of 12 years (range 8-16). Patients were divided into three groups, in 21 cases laparoscopic approach was performed (Group 1), in 55 the Palomo’s retroperitoneal approach (Group 2) and inguinal approach in 14 cases (Group 3). Preoperative demographic characteristics, and intraoperative data, follow-up and complications were analyzed. RESULTS: Age, indication and follow-up time were simi- lar in all three groups. Average surgical time were 36 minutes,34 minutes and 30 minutes respectively. Recurrences appeared in one (4%), 5 (9%) and 0 patients respectively. Postoperative hydrocele requiring surgical treatment appeared in 2 (9%), 4 (7%) and 0 respective- ly, with an incidence of hydrocele of 2 cases (9%), 5 (9%) and 1 (7%) which resolved during follow-up. One patient presented bleeding at the site of trocar insertion which was solved intraoperatively, and another patient in the laparoscopy group had a wound infection. CONCLUSIONS: Comparisons between the three groups reveal that there were not significant differences, although the results were somewhat better in the inguinal approach group. Any technique has adequate results, with a total recurrence rate in our series of 6%, and 6% of hydroceles. The development of methods that will make possible to diminish hydrocele, such as lymphatic preservation, will give better general results.
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OBJECTIVES: The advances of minimally invasive surgery in urology over the last years have enabled a progressive and constant implementation of endourology and laparoscopy in pediatric patients. We perform a review of our experience, as a general hospital, with minimally invasive surgery performed in pediatric patients over the last ten years.METHODS: We retrospectively analyzed the endourological and laparoscopic operations performed between 1997 and 2007 in children up to the age of 16 years, collecting data about patient’s age and gender, type of disease, techniques, anesthesia, and perioperative events.RESULTS: seventy-two surgical operations were performed in patients with an age range between 28 days and 16 years, with a mean age of 6.8 years. 56% of the patients were boys and 44% girls. Indications for surgery was vesicoureteral reflux (VUR) in 28 cases (38.8%); lithiasis 17 cases (23.6%) which were distributed in 4 cystolithotripsies, 9 ureterorenoscopy with lithotripsy, one pure percutaneous nephrolithotomy and three mixed; ureterocele 9 cases (12.5%); urethral obstruction 7 cases (9.7%); 3 diagnostic laparoscopies for cryptorchidism (4.1%), 2 laparoscopic procedures for cystic pathology (2.7%), another 2 laparoscopic renal biopsies (2.7%), and one laparoscopic repair of a ureteropyelic junction syndrome; 1 case of emergency percutaneous nephrostomy in the supine position after open pyeloplasty with subsequent reoperation with percutaneous resection of a granuloma; and 1 case of botulin toxin injection into the detrusor muscle.CONCLUSIONS: The consolidation of pediatric endourology in our department, and more recently laparoscopy, has contributed to improve the quality of care in pediatric patients; it has been achieved thanks to our previous know-how in general endourological techniques and the existence of adequate technical and human resources.
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OBJECTIVES: To demonstrate the increase of preputial retractability with age. To point out the small usefulness of circumcision and preputial forced dilation during childhood.METHODS: The development of the prepuce and its retractability were evaluated in 1200 boys between 0 and 16 years. The prepuce was classified as type I to V depending on its lower or higher retractability in all cases having been dilated previously or not. RESULTS: Prepuce retractability in boys under one year was type I (not retractile) in 63.4%, whereas it was type V (completely retractile) in only 3.7%. The contrary was observed in adolescents (11 to 16 years), in which type I was 0.9% and type V was observed in 80.9%. It was also observed that 309 boys (43.1%) among the 717 with previous prepuce forced dilation, had types I to IV prepuces, so, they had acquired new balanopreputial adherences by the time of examination for our study. Seventeen boys (0.4%) required circumcision. No children suffered upper urinary tract infections.CONCLUSIONS: All boys are born with the prepuce covering the glans penis, keeping adherences between both structures, which disappear with age, being the detachment complete at the time of puberty in most boys. So, we consider circumcision or forced dilation of the prepuce unnecessary in most boys.
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OBJECTIVES: Spermatic count and number of mobile forms are two very important parameters for the measurement of spermatic quality by means of sperm analysis. Numerous factors such as obesity, smoking, environment contamination, stress, or age act modifying the sperm fecundation capacity, therefore they interfere in the numbers of this two variables.METHODS: We aim to study the influence of age on semen quality. We studied 156 patients. They were divided into three groups: 20-30 years; 31-40 years; and 40-50 years. A Mackler`s camera and a Nikon microscope were used for evaluation.RESULTS: Nonparametric statistical study was performed establishing the relationship between sperm count and mobility and age. Age-count: X2: 8.239 (p = 0.016). Non mobile spermatozoids-age: X2 = 6.871 (p = 0.032). Mobile spermatozoids-age: X2 = 7.378 (p = 0.025). CONCLUSIONS: The age of the patient is intimately related to a decrease of the number of spermatozoids, with the decrease of the number of mobile forms and the increase of the non mobile.
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OBJECTIVES: To evaluate the relevance of size and location of penile condylomatous lesions as prognostic factors to Imiquimod 5% cream treatment res-ponse in uncircumcised men. METHODS: Twenty-two patients with condylomatous lesions in the glans, prepuce and penile shaft were included in this study. Size was no exclusion criteria. Patients with lesions on scrotal, suprapubic, inguinal or perineal area were excluded from this study. Treatment with Imiquimod 5% cream 3 times per week was given and follow up was at the first and second week and afterwards every second week. Response was classified as complete when all lesions disappeared, partial when lesions diminished in more than 50% of its original size and absence of response if no change was seen or if they di-minished less than 50% of its original size. RESULTS: Six patients were excluded from the study be-cause they did not come for follow up. Mean age was 33 years (24-51). Seventy five (12) percent of the pa-tients had a complete response, 18.7% (3) did not have response and 6.3% (1) had partial response. A comple-te response was observed in 75% (9) of patients with lesions on glans and prepuce. The same response rate was observed in patients with penile shaft lesions. There was complete response in patients with lesions as big as 7cm and as small as 0.3 cm. Response was observed between the first and fourth week. Non responders were classified after 12 weeks of treatment and alternative treatment was advocated. CONCLUSIONS: Site and size of penile lesions of condyloma acuminata had no relevance as prognostic factors for treatment response of Imiquimod 5% cream. If Imiquimod was the treatment selected, alternative thera-peutic approaches should be advised if no response is seen after the fourth week of treatment.
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OBJECTIVES: With the popularisation oflaparoscopic radical prostatectomy, the above techni-que has once again taken on an important role in thework of urology departments. Our extensive experiencein laparoscopy means that we are performing increasin-gly more interventions using this approach. In the contextof minimally invasive surgical procedures, this is proba-bly bringing clearer benefits to retroperitoneal surgerythan to prostatic surgery. In this article, we describe ourseries over nearly 4 years.METHODS: The period analysed covers June 2004 toMarch 2008, during which time 288 retroperitonealoperations were performed (184 nephrectomies, 113other procedures). In the majority of cases, the route ofapproach was transperitoneal.RESULTS: The mean hospital stay was 3.6 days for thenephrectomies and 3 days for the other procedures. Thetransfusion rate for the nephrectomies was 5% and there was a conversion rate of in 2%. In the other types ofsurgery, the transfusion rate was 6% and there were noconversions.CONCLUSIONS: The expansion of laparoscopy in Uro-logy has to be accompanied good patient selection andthe progressive acquiring of experience on the part ofthe surgeon. Certain interventions should only be tackledin cases where there is extensive experience
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OBJECTIVE: Vascular invasion in the form of tumour thrombus appears in a significant percentage of renal neoplasias. The importance of cephalic extension of the thrombus in prognosis is currently under discussion, but surgical treatment is mandatory in the absence of distant metastasis.METHODS: We report the case of a 56-year-old male patient with a filter in the inferior vena cava, who underwent surgery in our department through a thoracoabdominal approach with extracorporeal circulation, deep hypothermia (below 18ºC) and cerebral retrograde perfusion.RESULTS: Although in the past it was believed tumour thrombus worsened prognosis in these patients, currently we know that surgical treatment, in selected cases, gives good results in terms of survival and disease-free time.CONCLUSIONS: We think the implementation of venous filters may increase the complexity of surgery.
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OBJECTIVE: Throughout the history, many devices have been used for breaking urinary tract stones. StoneBreakerTM (LMA Urology, Gland, Switzerland) is a se-cond generation of intracorporeal lithotripter, pneumatic and portable, which adds several new advantages, like effecti-veness in stone fragmentation and easy handling, very useful during percutaneous lithotripsy. METHODS/RESULTS: We report the case of a 40 year-old male pa-tient, with a left kidney pyelic lithiasis, who was treated by percutaneous lithotripsy, under general anaesthesia, with StoneBreakerTM (LMA Urology, Gland, Switzerland) as li-thotripter. CONCLUSIONS: StoneBreakerTM (LMA Urology, Gland, Switzerland) is a lithotripter usable with rigid and semirigid ureteroscopes, much more powerful than its predecessors. It is able to decrease the number of shocks necessary for stone fragmentation, without bigger tissue reaction. It also has a more comfortable design due to the absence of connections, and its power by replaceable carbon dioxi-de cartridges.
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OBJECTIVE:To report two cases of late metas-tases of clear cell renal cell carcinoma.METHODS: Two patients, a male and a female with history of nephrectomy 17 and 16 years before for renal cell carci-nomas, presented new tumours in the thyroid and pancreas, which were excised.RESULTS: Pathology reported that both lesions were clear cell tumours and immunohistochemically they were consistent with metastases from clear renal cell carcinomas.CONCLUSIONS: 1º) Previous history of any type of car-cinoma should suggest the possibility of metastases when facing a thyroid or pancreatic nodule. 2) All-life follow-up should be made, nephrectomy (resection) for a renal cell carcinoma. 3) In the presence of a clear cell tumour of the thyroid or pan-creatic glands, the differential diagnosis must always include metastatic renal cell carcinoma. 4) The treatment of choice is surgical resection.
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OBJECTIVE: To report one case of bilateralsynchronic germ cell testicular tumour of different histology.METHODS/RESULTS: 37-year-old patient with left testiculartumor under study was found to have a contralateral synchro-nic testicular tumor on ultrasound. Bilateral inguinal orchiec-tomy was performed and pathology reported the presenceof bilateral testicular tumours of different histological type.CONCLUSIONS: Around 75% of the cases of bilateral tes-ticular tumours are metachronic, with only 10% presentingdifferent histology. Histological type often correlates with theultrasound findings, and the treatment of choice in patientswith this type of oncological pathology is bilateral inguinalorchiectomy
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OBJECTIVE: We describe and document the first case of PEcoma published in Spain following the Pub-Med database. We review the bibliography about these tumors.METHODS/RESULTS: 39-year-old female patient with a 9 cm pelvic tumor discovered in a routine gynecologic review. CT scan showed multiple periaortic adenopathies extending up to the left renal vein. The diagnosis of PEcoma was obtained by needle biopsy. Tumor excision including left annex and aortoiliac lymphadenectomy were performed. Pathology confirmed the diagnosis after immunohistochemi-cal study with smooth muscle actin and HMB-45. No ad-juvant treatment was given. After one year of follow-up the patient does not show signs of recurrence of the CT scan. A PubMed search was performed finding 73 references about this kind of tumor the conclusions of which are exposed in this article.CONCLUSIONS: Perivascular epithelioid cell tumor, PEco-ma, is a very low incidence mesenchymal neoplasia with uncertain malignancy. Very rare tumors such as epithelioid angiomyolipoma, lymphangioleiomyomatosis, lymphangiomyoma, myelomelanocytic tumor of the falciform ligament, “sugar” clear cell lung tumor and its extrapulmonary variant are all descriptions of what is now a unique tumoral entity named PEcoma. It has not been described yet the normal tissue cell giving origin to this tumor. It affects mainly middle age women, and may appear in any anatomical site. Treat-ment is surgical, although the role of lymphadenectomy and adjuvant treatment is unknown.
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OBJECTIVE: To evaluate the reasons why patients reject digital rectal examination (DRE) when screening for prostate cancer.METHODS: Four hundred and fifty men were prospectively evaluated in a prostate cancer educational program consisting of lectures, PSA testing, and DRE. Patients rejecting DRE were compared with those accepting DRE in regard to epidemic, social and cultural variables.RESULTS: DRE was rejected by 8.2% of patients. Refusal rate was not different when patients were stratified by age, prostate cancer family history, school level, family income, and PSA level. Patients with a prior history of DRE had a lower rejection rate than those undergoing DRE for the first time (4.4% vs. 10.4%, p = 0.038). Patients with mild or no lower urinary tract symptoms rejected DRE more frequently than those with moderate or severe symptoms (9.6% vs. 1.4%, p = 0.018). Misconceptions about prostate cancer screening were present in 84.4% of those rejecting DRE vs. 46.9% of controls (p = 0.002); 43.7% expected severe discomfort in the group that rejected DRE vs. 28.1% in the control group (p = 0.090); fear of finding a cancer during DRE was present in 34.4% of patients that refused DRE vs. 46.9% of controls (p = 0.121); and 53.1% of patients rejecting DRE responded it was a source of shame vs. 15.6% of patients in the control group (p = 0.019).CONCLUSIONS: The main reasons patients reject DRE when attending prostate cancer screening are the lack of lower urinary tract symptoms, misconceptions about prostate cancer screening and shame, especially when undergoing screening for the first time.
