Editorial
Knowledge map
Save
Article
Knowledge map
Save
OBJECTIVES: Retrospective analysis of a series of patients with stress urinary incontinence that underwent surgery in our department, by means of the TVT and TOT techniques. We evaluate post operative continence, considering “cured” the patient with complete continence and “failure” any type of involuntary stress urine leak, independently of its severity, registering the time of its appearance. For this purpose we used the Kaplan-Meier analysis comparing both techniques with the Breslow test. Additionally, postoperative complications were evaluated.RESULTS: 128 patients who underwent surgery by TVT (69 patients, 53.9%) and TOT (59 patients, 46.1%). Mean age was 54.4 years for TVT (95% CI 52.0-56.8) and 59 years for TOT (95% CI 55.9-62.1). Mean follow-up time was 18.7 months for TVT (95% CI 15.6-21.9) and 7.4 months for TOT (95% CI 5.8-8.9). Overall continence rate was 86.7%, 88.4% for TVT and 84.7% for TOT. The probability of being continent six months after surgery was 89.1% for TVT and 78.2% for TOT (no significant differences, p = 0.31), with almost all failures within the first six months after surgery. TVT was more frecuently associated with urgency symptoms (33.3%,p = 0.001) and urge incontinence (18.8%,p = 0.16), urinary retention (11.6%,p = 0.38), and prevesical hematoma requiring mesh retrieval. Greater post operative pain was observed with TOT (20.3%, p= 0.005).CONCLUSIONS: Our results evidence a similar efficacy with both techniques, with the failures appearing over the first months after surgery. Complications of the voiding urgency type are significantly more frequent with TVT.
Article
Knowledge map
Save
OBJECTIVES: Vesicoureteral reflux (VUR) may have medical management, which implies prophylactic antibiotic therapy, control with serial urine cultures and imaging tests, such as annual voiding cystourethrogram (VCUG) or direct isotopic cystogram (DIC); or it may be surgical, when medical treatment fails, due to recurrent UTI or renal damage. We analyze the chronological age of the patient at which VUR resolve spontaneously, so that we know when we should have a more precise control with VCUG, avoiding a traumatic test and irradiation, but also avoiding to give prophylactic antibiotic without real need. We aim to associate age of resolution with VUR grade and side, and patient’s gender.METHODS: Retrospective study of patients with VUR under control at the Hospital Clínico of the Catholic University of Chile between 1996 and 2004. Inclusion criteria: patients with the diagnosis of VUR grades I, II, and III obtained by VCUG, and spontaneous resolution of VUR on control VCUG or DIC, with no urological surgery, without bladder dysfunction or other urinary tract disorders. 156 patients were included.RESULTS: 73.5% are females, with a mean age at the time of resolution of 52.7+- 36 months. 74.3% of the patients had unilateral VUR. There were not statistically significant differences in the age of resolution between unilateral or bilateral VUR, or between different grades. There is a statistically significant difference in the age of resolution comparing gender (p < 0.0001), resolving between 12 and 17 months before in males.CONCLUSIONS: VUR improves earlier in males than females, without differences between unilateral-bilateral, or VUR grade I, II and III. The control VCUG or DIC should be indicated in relation to the most probable chronological age of resolution, generally around 4 years of age, and not once a year, so avoiding irradiation and trauma, with a special consideration to the child gender.
Article
Knowledge map
Save
OBJECTIVES: The uneven relationship between length and diameter of the intramural ureter is essential for the development of vesicoureteral reflux (VUR). Surgical treatment should reconstruct that relationship. Several surgical techniques have been described to achieve this objective. After more than 30 years of experience, in our hands the Lich-Gregoir extra vesicoureteral reimplantation technique shows excellent results. We describe the technique step-by-step, emphasizing the modifications introduced, also in its laparoscopic version.METHODS: The Lich-Gregoir extravesical ureteral reimplantation technique is completely described, reinforcing those technical details allowing the achievement of better results. We comment on the technical variations in the laparoscopic version. We also perform a retrospective review of the clinical records and imaging tests in patients who underwent vesicoureteral reimplantation in the period between 1974-2006 in the Hospital de Niños Dr Exequiel Gonzalez Cortés. Inclusion criteria: patients with primary VUR in which Lich-Gregoir extravesical ureteral reimplantation technique was performed. Secondary de VUR was excluded. We registered age, gender, radiological grade, bilateralism, surgical time, and development of complications such as persistent reflux, contralateral reflux, postoperative urinary tract infection, urinary retention, postoperative obstruction, reoperation, the degree of renal insufficiency, and long-term followup.RESULTS: Over the 33 years of the study period there were 267 patients with primary VUR who required surgery. 379 ureters were reimplanted in an extravesical fashion, 112 (42%) corresponded to bilateral VUR. Mean age at the time of surgery was 4 years (from three months to 16 years); 156 patients (58%) were girls and 111 boys (42%). All patients presented primary VUR, and 63% of them were high grade (grades IV-V). All ureters were reimplanted without modelling in a mean surgical time of 62 minutes for the open technique. After a mean follow-up of two years (2 months-5.5 yr.) 7% of the patients have presented complications. Our reoperation rate is 1.3%. There was not any postoperative urinary retention. Our success rate for VUR resolution with this technique is 98.5%.CONCLUSIONS: Based on the results the the authors think that extravesical ureteral reimplantation following the Lich-Gregoir technique is safe, simple, technically reproducible, efficient, and with a low morbidity to resolve primary unilateral and bilateral primary VUR.
Article
Knowledge map
Save
OBJECTIVES: The objective of this monograph is to familiarize the reader with dynamic hydrodistention classification of the ureter and Hydrodistention Implantation Technique (HIT) methodology for the endoscopic correction of vesicoureteral reflux (VUR). The indications, current success rates, complications, and potential future applications of these methods are reviewed.METHODS: Hydrodistention (HD) of the ureteral orifice and distal ureter permits visualization of the intraureteral submucosal injection site and assessment of the degree of ureteral coaptation. We have designated 4 levels of HD. H0 denotes absence of ureteral dilation, H1 indicates dilation of the ureteral orifice only. H2 allows visualization of the intramural ureter, and H3 allows visualization of the extramural ureter. The Double HIT method is a systematic technique that utilizes HD to both classify the ureter and gauge the degree of ureteral coaptation secondary to bulking during endoscopic injection. The needle is inserted at the mid ureteral tunnel at the 6 o’clock position. The first injection coapts the detrusor tunnel (until H1 or H0 is achieved), while a second implant within the most distal intramural tunnel leads to complete coaptation of the ureteral orifice (H0).RESULTS: HD grade correlated significantly with VUR grade. Normal ureters rarely hydrodistended. While non-refluxing contralateral ureters demonstrated low HD grades, all contralateral ureters that subsequently developed VUR showed H2 or H3. The HIT method has not only been employed for primary VUR (90% cure), but also for repeat endoscopic injections (90%), VUR associated with paraureteral diverticula (81%), complex cases such as post-reimplantation (88%), neurogenic bladders (78%), duplication anomalies (80%), and in adults (88%). Furthermore, injection of contralateral VURnegative but hydrodistending ureters may be treated to prevent new contralateral VUR. While decreasing success was seen with increasing VUR grade with the STING method, superior success rates have been realized with the HIT method. CONCLUSIONS: The dynamic hydrodistention classification reflects the competency of the ureterovesical junction. The HIT and Double HIT methods achieve superior cure rates and are likely to become the method of choice for the treatment of primary as well as complex cases of VUR
Article
Knowledge map
Save
OBJECTIVES: The objective is to know the prevalence of renal hematoma after lithotripsy in our unit, as well as the incidence of symptomatic and/or progressive hematomas, their clinical behavior and management, and also the factors potentially influencing those features.METHODS: A prospective study in wich we analyzed various parameters from the database on 314 patients undergoing SWL on 324 renal units. SPSS 15.0l was employed for statistical analysis under supervision of biostatistics experts. The diagnosis of hematoma was obtained with clinical data (history and physical examination), blood analysis, and ultrasound, this latter with the complement of CT scan in isolated cases. All patients underwent follow-up by means of phone contacts over a period between 7-19 months after lithotripsy.RESULTS: The prevalence of hematoma was 13% but only 6.2% were symptomatic. Accumulated incidence of hematoma with progressive evolution was 2.16%, and blood transfusion requirement due to hematoma was 0.92% of all lithotripsies, which represents 7.14% or them.Factors statistically associated with the incidence of hematoma were: number of shock waves (over 2300), total energy (above 150J), number of KV (above 17.5), preoperative microhematuria, perioperative hypertension, cystine lithiasis, hydrocalyx, caliceal localizations (mainly lower calyces), the association of coronary artery disease with hypertension, or hepatic diseases, chronic hepatopathy, elevation of transaminases, usual intake of anti platelet aggregation drugs and nonsteroidal anti-inflammatory drugs (mainly with prior lowweight heparin treatment for hematoma progression), and a combination of the previous with preoperative hypertension (for symptomatic hematoma), as well as the presence of multiple stones treated in the same session, with different degrees of association for the various subgroups of hematomas.We observed differences in clinical behavior depending on the type of hematoma (subcapsular and perirenal) and 12% of the patients with hematoma remained symptomatic between 2 and six months later.CONCLUSIONS: Renal hematoma after shock wave lithotripsy is more frequent than what is believed. Hematoma’s size and evolution depend on multiple factors some of them with a greater weight (hepatopathy, perioperative blood pressure behavior, usual intake of anti-aggregation drugs with need of perioperative low weight heparin) which a greater risk when three or more factors concurred. Subcapsular and perirenal hematomas have a different clinical behavior. Initial ultrasound hematoma diameters equal ≥4 cm were more prone to progression.The risk of symptomatic clinical presentation or progression was evident within the first five days after shockwave lithotripsy even when asymptomatic or clinically/radiologically stable over the first 24 hours, therefore, careful follow-up and physical resting is counselled over the first week in patients with high risk, and relative physical resting during at least five days in all patients undergoing treatment. Lumbar pain may persist up to six months in some patients with renal clinically significant hematoma after shockwave lithotripsy.
Article
Knowledge map
Save
OBJECTIVES: This paper aims to evaluate the clinical and diagnostic usefulness of uro MRI, to show the study technique and to establish correlations of some of its results with conventional intravenous urography (IVU). Frequency and prevalence by age and gender of pathologies were evaluated.METHODS: We studied a total of 58 patients, 31 females and 27 males, with an age range between 22-92 years. All patients underwent uro MRI between April 2003 and January 2005. We perform a double-blind study with those patients undergoing conventional IVU before uro MRI.RESULTS: The total number of patients evaluated was 58, 35 of which present more than 1 concurrent pathology. 17.2% (n = 10) of the studies were normal, five males and five females, with an age range between 22 and 83 years, and a mean age of 46.1 years.IVU was diagnostic for 100% and 83.3% of A and B observers respectively; uro MRI was diagnostic for 50% and 0% respectively. Ureteral lithiasis showed a result of 50% and 100% for IVU; uro MRI had a 75% for both observers. In cases of double pyelocalyceal system both methods have a 100% accordance between both observers. In bladder cancer, uro MRI was diagnostic in 100% and IVU in 0% for both observers.CONCLUSIONS: The most frequent concurrent pathology was cystic renal disease, and the second was urolithiasis with urinary tract dilation. Uro MRI was superior to see bladder and pyeloureteral pathologies, but in cases of renal lithiasis and urinary tract calcifications IVU is the test of choice yet (1).
Case Report
Knowledge map
Save
OBJECTIVE:Recently, intraoperative floppy-iris syndrome (IFIS) has been related to tamsulosin treatment. This review evaluates the epidemiological evidence of the association of tamsulosin with IFIS and the necessity of a prior ophthalmolo-gic examination in this group of patients.METHOD: Systematic review of the literature.RESULTS: Since 2005, when the syndrome was described, some studies have confirmed this association. Tamsulosin is the most clearly involved drug. No prospective studies have been published, but some authors consider that the syndro-me affects, at least, half of the patients receiving this drug. No medical treatment has demonstrated its usefulness in the prevention of this syndrome.CONCLUSION: Considering the high prevalence of this syndrome, all the patients who are going to start this treat-ment should receive previous ophthalmologic examination, to evaluate the convenience of performing early cataract sur-gery in order to avoid intraoperative complications.
Case Report
Knowledge map
Save
OBJECTIVE: We report a case of strangulated urethral prolapse.METHOD/RESULTS: A 62 year old female patient presents to the emergency department with complaints of a bleeding vaginal mass, pain referred to the vaginal introitus and dysu-ria. After being diagnosed with a strangulated urethral pro-lapse, surgical excision of the prolapsed urethra was performed. Pathologically, vascular proliferation of the angioma-tous type with thrombosis and focal recanalization(Masson) and inclusion of rare muscular fibers were recognized. Her postoperative course was uneventful, without any recurrence or abnormal micturition.CONCLUSION: For the treatment of strangulated urethral prolapse, surgical excision has been widely applied with successful results.
Case Report
Knowledge map
Save
OBJECTIVE: Nowadays, there is the high prevalence of sexual intercourse including oral sex, which implies some peculiarities in the infections, balanitis and cellulitis they may produce.METHODS: We report two new cases of penile cellulitis treated in the urology department in our hospital.DISCUSSION: We review the indications of prophylaxis, and the medical and surgical treatment both referred in the literature and carried out in our patients.CONCLUSIONS: When dealing with balanitis and penile cellulitis, the history should include explicit references to the practice of oral sex. Early medical or surgical treatment has a favourable influence on the evolution of the lesions.
Case Report
Knowledge map
Save
OBJECTIVE: To report one case of postoperative lateral femoral neuropathy presenting after a retropubic radical prostatectomy. We review the topic.METHODS: We describe the case of a 72-year-old patient undergoing radical prostatectomy. Combined anesthesia, general and spinal, was given. A self-retaining automatic retractor (Omnitract ™) was employed. In the immediate postoperative period the patient presented bilateral femoral neuropathy, with difficulties for knees extension and hips flexion, diminished patellar reflex, and absence of sensitivity in the anterior area of the thighs. MRI was performed to rule out spinal pathology.RESULTS: The symptoms improved a lot within a week, completely recovering after two months.CONCLUSIONS: Femoral neuropathy is a rare complication after pelvic surgery. In our case we believe it was secondary to nerve compression by the ret
Case Report
Knowledge map
Save
OBJECTIVE: Benign testicular proliferative processes are known by the name of pseudotumors, because currently they are not considered real neoplasias. The paratesticular fibrous pseudotumor (PFP) is a rare entity, the definition and etiopathogenesis of which is under great confusion. It is a process that misleads the clinical because they simulate neoplasias. This paper aims to help a better knowledge of this non-tumoral process and to avoid diagnostic confusions.METHODS/RESULTS: We review our series of PFP (three cases), which can be considered significant due to its oddity. We analyze the clinical picture, its behavior, imaging diagnostic tests, operative findings and outcomes.CONCLUSIONS: PFP is a rare entity which may misleads the clinical because it may be diagnosed as a neoplasia and lead to aggressive treatment (orchiectomy) which in case of a proper diagnosis could be avoided. The analysis of our series of three cases, with their contribution, and a literature review may help the clinical practice of urologists by recognizing this disease.
Case Report
Knowledge map
Save
OBJECTIVE: Penile fracture is a rare lesion that occurs almost exclusively during erection. This lesion may be associated with rupture of the urethra in 20-30% of the cases. We describe a case that has been treated at our institution and review the literature. METHODS: A 42 years old patient suffered fracture of penis, with urethral section, during sexual intercourse. The patient underwent surgical exploration, the lesions of the cor-poral bodies and urethra were identified. Both lesions were repaired. RESULTS: patient’s recovery was satisfactory without compli-cations or esthetical or functional sequelae.CONCLUSIONS: Penile fracture with urethral section is an exceptional disease, the most frequent cause of which in oc-cident is violent sexual activity. For diagnosis it is necessary in most cases a correct anamnesis and physical examina-tion. Early surgical approach and closure of the albuginea´s lesion and repair of the urethral lesion is the best way of treatment.
Case Report
Knowledge map
Save
OBJECTIVE: Neurological metastases secon- dary to urological tumors account for 12% overall. The ones derived from germ cells testicular tumors are exceptional in the age of cisplatin. METHODS: We report one case of mixed germ cell tumor in a 49-year-old male patient treated with systemic chemothe- rapy during 18 months before presenting with severe central and peripheral neurological symptoms leading to death due to massive cerebral hemorrhage. RESULTS: We describe three types of presentation of cerebral metastases in patients with testicular cancer. Type 1 present synchronically with the primary tumor. Type 2 are diagnosed after a period of remission after conventional cytostatic treat- ment. Type 3 metastases are diagnosed during the course of the disease and its treatment. CONCLUSIONS: Except unique metastases classified in groups 1 and 2, which are susceptible of surgery or ra- diosurgery, in which in response may be expected; the rest of lesions secondary to germ cell tumors have an ominous prognosis and outcomes, with short survivals.
Case Report
Knowledge map
Save
Case Report
Knowledge map
Save
Article
Knowledge map
Save
OBJECTIVE: The EORTC Quality of Life Group has developed a questionnaire for evaluating Quality of Life in international clinical trials: EORTC QLQ-C30, which is widely used in many countries. The purpose of this study was to assess the psychometric properties of the third version of this questionnaire, EORTC QLQ-C30 (version 3.0), when applied to Spanish prostate cancer patients.METHODS: A sample of 137 prostate cancer patients prospectively filled in the questionnaire three times: on the first and last day of the treatment, and in the follow-up period. Psychometric evaluation of the structure, reliability and validity was made.RESULTS: Multitrait scaling analysis showed that most item-scale correlation coefficients met the standards of convergent and discriminant validity. Few exceptions appeared mainly in CF. Most scales had low to moderate inter-correlations. Cronbach’s coefficients of the scales were above 0.7, except for the CF and NV values. Group comparison analyses showed better QL in patients with higher Performance Status. Changes in functioning and symptom areas appeared throughout the different measurements, which were in line with the treatment process.CONCLUSIONS: The EORTC QLQ-C30 (version 3.0) appeared as a reliable and valid instrument when applied to a sample of Spanish prostrate cancer patients. The results are in line with previous studies.
