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OBJECTIVES: The use of nanoparticulesfor drug transport is one of the topics with priority interestwithin the field of biomedical research. Our objectiveis to show the initial results of an innovative method tofocalize drug carrier ferro-carbon nanoparticules to solidorgans. We obtained and characterized various types of ferrous magnetic nanoparticules and studied theirbehaviour in vitro and in vivo in laboratory animals withintrarenal magnetic targets laparoscopically implanted.METHODS: Using a plasma arch we obtained ferro-car-bon nanoparticules with the ability to absorb and deliverdoxorubicin, showing an excellent behaviour in in vitrorheological studies. Under general anesthesia andcontrol we inserted a gold covered magnetic microharpoonin the left kidney of New Zealand rabbits. At the sametime we injected intravenously different doses of varioustypes of nanoparticules. The animals were sacrifiedafter pre-established times and pathologic studies of theirkidneys, spleens, livers, lungs and bone marrow werecarried out.RESULTS: After selection of the most adequate nano-particules for our purposes, we ascertained significantdifferences in the distribution of nanoparticules in post-mortem studies, with accumulation in the magnetic targetand surrounding renal parenchyma. Nevertheless, thereticuloendothelial system retains a great amount of theinjected dose.CONCLUSIONS: Although our magnetic focalizationsystem is effective, nanoparticule temporary protectionsystems should be tested to allow us avoid the action ofthe immune system
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OBJECTIVES: Despite its high prevalence and its important impact on patient’s life, overactive bladder is a disorder poorly known and not usuallytackled in daily clinical practice. The aim of this study is to know the main procedures and techniques used by both urologists and general practitioners to diagnose overactive bladder in usual clinical practice in Spain.METHODS: A standardized questionnaire was administered to 748 physicians specialized in urology and to 696 primary care physicians or general practitioners. The questionnaire collected information about the management of patients who attended surgery with urinary symptoms suggesting overactive bladder.RESULTS: A total of 64.8% of urologists argued theyfollowed a standardized protocol in order to diagnose patients suffering from overactive bladder. Concerning primary care physicians, 58.4% of them admitted not referring patients with urinary symptoms suggestingoveractive bladder to specialist. Up to 77.8% of urologists confirmed that referred patients from primary care had no previous exam or diagnosis. Health history, physical examination and urinalysis were the usual diagnosisprocedures in clinical practice conditions for bothspecialities. Other instruments such as the micturitiondiary or the questionnaires to assess symptoms or patients’ quality of life are still little used for the diagnosis and management of overactive bladder.CONCLUSIONS: Although overactive bladder is acondition that causes a high impairment in the quality of life (QoL) and daily activities of those patients suffering from it, it still remains poorly tackled by doctors. Therefore, it is important to define strategies to detect its symptoms in the clinical practice.
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OBJECTIVES: To evaluate the effect of age in morbidity-mortality and outcomes of the surgical treatment of benign prostatic hyperplasia (BPH).METHOD: We performed a retrospective analysis of the medical records of 305 patients over 70 years undergoing surgery for BPH between 1999-2003, grouped in four categories depending on ages 70-80 years and over 80, and type of surgery (transurethral resection or open prostatectomy). The variables evaluated were: American society of anesthesiologists (ASA) operative risk classification, surgical indication, preoperative factors, postoperative outcome and follow-up. Statistical analysis was carried out with the Anova and chi-square tests (p = 0.05).RESULTS: Open prostatectomy was performed in 59.1% of the cases and transurethral resection in the other 40.9%. 98.4% of the patients showed some degree of comorbidity. Indwelling transurethral catheter was the main clinical feature of patients undergoing surgery over 80 years of age; the main characteristic in patients between 70-80 years was the existence of severe symptoms. Urological complications appeared more frequently than general complications (14% vs 10.1%). The most frequent urological complications were mild, mainly inflammatory-infectious diseases. Urological and general complications were more frequently observed in the open prostatectomy group, with no differences between ages. Patient satisfaction was high in the four groups (84.8%-96.2%). No case of perioperativemortality happened and only one patient died in the immediate post operative period.CONCLUSIONS: We think the differences observed cannot be attributed to chronological age as clinical risk factor. Therefore, these patients could benefit of adefinitive surgical treatment which will improve theirquality of life.
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OBJECTIVES: To review the influence ofvarious intravesical treatments on superficial bladdercancer progression.METHODS: We retrospectively reviewed 473 superficialbladder neoplasias. Based on diagnosis and transurethralresection of bladder tumor (TUR BT), and depending onpathology, we proposed different treatment and follow-up schemes, with BCG in 139 cases and intravesicalchemotherapy, mainly Mytomicin C, in 80.RESULTS: Overall, the use or not of bladder instillationsdid not show statistically significant differences in time toprogression. The use of intravesical therapy andmaintenance therapy was an independent risk factor fordisease-free time to progression when compared withinduction.CONCLUSIONS: The use of maintenance intravesicaltherapy with BCG resulted in a delayed progressionof superficial bladder cancer, so that it seems the mosteffective treatment, mainly in moderate-high risk tumors
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OBJECTIVES: To review the influence of various intravesical treatments on superficial bladder cancer recurrence.METHODS: We retrospectively reviewed 473 superficial bladder neoplasias. Based on diagnosis and transurethral resection of bladder tumor (TUR BT), and depending on pathology, we proposed different adjuvant treatment and follow-up schemes.RESULTS: The following factors were independent risk factors for a longer recurrence-free time: intravesicalinstillations, high dose BCG, and maintenance therapy in comparison to induction.CONCLUSIONS: The use of intravesical instillations independently increases the time to recurrence. It was demonstrated that recurrence was significantly later when high dose BCG and maintenance therapy were employed.
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Transobturator systems for anterior vaginal wall prolapse repair exemplify the current trend in pelvic floor surgery. They may be considered an approach and also a mesh fixation system, in opposition to free mesh cystocele repair where they work by the creation of fibrotic tissue after mesh implant (biological orsynthetic).OBJECTIVES: To describe the elements of the Avaultaanterior system, its indications and the surgical techniqueto implant it and adequately adjust it.METHODS: The operation has five steps: 1) midline vaginal incision and mucosal dissection, 2) Obturator foramen identification, design and performance of 2superior mini incisions in both the genitofemoral folds, and another two 3 cm below and 1-2 cm lateral to them, 3) Needle introduction and passage through the upper portion of the obturator foramen, parallel to the ischiopubicramus, and once past needle charging with the arm of the implant, 4) Needle introduction and passage from the inferior incisions vertically through the inferior portion of the obturator foramen, directing the needle with bimanualcontrol to the theoretical localization of the uterine cervix,with connection and charging of the inferior arm of the mesh. 5) Tension free adjustment of the mesh and closure of the incisions.CONCLUSIONS: 1. It is a reproducible technique that adequately corrects the anterior vaginal compartment defects. 2. The design and technology of Avaulta aims to correct the anterior compartment defects, based on the principles of ideal mesh.
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OBJECTIVES: Sacral neuromodulation is a new treatment option in patients with urge incontinence, urgency-frequency and urinary retention refractory to the pharmacological therapy. The electrophysiological monitoring provides direct and immediate feedback about the function of nerves. We evaluated the utility of the electrophysiological monitoring to assert the correct position of the lead at the third sacral root (S3).METHOD: We registered the sacral-vesicourethral and sacral plantar evoked potentials in two patients (a 55 years old man and a 37 years old woman) during the implant of a sacral neuromodulator (Interstim®, Medtronic, MN USA).RESULTS: We registered vesico-urethral and sacroplantar potentials in response to sacral stimulation. We found vesical evoked potentials after the stimulation of S3 and S4 and plantar responses after the stimulation of S2 and S3. The vesico-urethral evoked potentials had a latency of 25.10 mseg in our first case and 28.52 mseg in the second. The sacroplantar evoked potentials had a latency of 20.80 mseg and 22.46 mseg respectively. We observed the evoked potential register during the surgery prior to the visual motor and sensory responses with a lower intensity of stimulation (average 3.5 mAmp). The only sacral root in which we could find both responses was in S3.CONCLUSION: The electrophysiological monitoring was helpful in identifying the right position of the lead at the correct sacral root. It avoided the necessity of high stimulation intensity during the procedure.
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OBJECTIVES: Vasectomy is a surgicalmethod of male contraception. Azoospermia is offered as result of the technique and this is not always attained, resulting in legal matters. The purpose of this study is to know the number of semen samples needed to dischargea patient after intervention. To identify sperm count on semen analysis at time of discharge.METHODS: Retrospective study of men who underwent vasectomy in a 15-month period with a 2 year follow up. Consecutive semen analyses up to 5 samples were measured at 2 to 3 months interval in all men who had persistence of spermatozoa.RESULTS: 618 men were intervened, 106 did not bring semen to the laboratory (17 %), 2 (0.39%) presented motile sperm and were considered a failure of thetechnique and excluded. 510 men completed controls. 316 (61.9%) were azoospermic in the first sperm analysis,74 (14, 5%) in the second, 27 (5, 2%) in the third, 6 (1, 2%) in the fourth and one (0, 2%) in the fifth analysis. The remaining 86 men (16.8%) had persistence of immotile sperm in the ejaculate and were less than 100,000/ml. No pregnancy was reported during 2 years follow up or after.CONCLUSIONS: Five or more semen analysis can be made after the surgery. Persistence of immotile sperm in the ejaculate is frequent and may exist for a long period afterwards. Immotile sperm count of 100.000/ml or less should be accepted as result of the procedure. The patient should be informed about the fact that persistent immotile sperm can be found in his semen. In the informedconsent azoospermia should not be a concern as it is frequent to find immotile sperm in the ejaculate and this is an acceptable issue. As with other contraceptivemethods, vasectomy should be offered as a safe method although clearly stating that the possibilities of failure do exist.
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OBJECTIVES: We report a series ofpatients with stage I non seminomatous testicular cancerin whom laparoscopic retroperitoneal lymphadenectomywas carried out.METHODS: Between March 1993 and January 2004100 and patients with the diagnosis of stage I nonseminomatous testicular cancer underwent laparoscopicretroperitoneal lymphadenectomy (LRPL). All operationswere performed by the same surgeon (O.A.C). Clinical data were collected prospectively in a database.Patients’ demographic data, operative time, estimatedblood loss, hospital stay, operative and post operativecomplications, convention rate and follow-up were allanalyzed.RESULTS: 111 LRPL were performed in 111 patients witha mean age of 29.3 years (range 15-44 years). 61procedures were right-LRPL and 50 left-LRPL. Meanoperative time was 138 minutes (range 60-300 minutes).Intraoperative complications appeared in 10 cases (9%),9 vascular complications (8.1%) and 1 duodenal lesion(0.9%). Conversion to open surgery was necessary inthree patients (2.7%). Mean hospital stay was 43.3hours (range 24-120). 5 patients (4.5%) had tumorrecurrence, with a mean follow-up of 30 months (range24-94 months). Recurrences were localized in theretroperitoneum, mediastinum and lungs. Recurrencetime varied between four and 64 months.CONCLUSIONS: LRPL offers oncological results equivalentto open surgery, with the advantage of being minimallyinvasive and its consequent decrease in morbidity. Thelaparoscopic retroperitoneal lymphadenectomy is agood option for the management of patients with stage1 testicular cance
Case Report
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Case Report
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OBJECTIVE: To report a case with Goldenhar syndrome with posterior urethral valves.METHODS: Goldenhar syndrome (oculoauriculovertebral dysplasia) is a condition featuring the following triad of anomalies: ocular abnormalities (epibulbar dermoids,coloboma), otic anomalies (low set ears, auricular appendage) and/or vertebral anomalies. Multiple malformations,including congenital heart, brain and renal disease.RESULTS: Posterior urethral valves should be treated with primary valve ablation.CONCLUSIONS: It is necessary to perform a carefulevaluations of general malformations, especially renalmalformations.
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OBJECTIVE: Mesoblastic nephroma is a rare renal neoplasia mainly diagnosed in the first three months of life; there is an adult type with pathologic similarities but it has its own features.METHODS: We report the case of a 71-year-old female patient with the diagnosis of adult mesoblastic nephroma, the clinical outcome of which was ominous.RESULTS: The presence of epithelial elements with tubular conformation surrounded by a spindle cell component is greatly useful to perform the differential diagnosis between this entity and others of greater clinical significance.CONCLUSIONS: Although scarce, there are cases in the bibliography similar to ours, with an aggressive behaviour that maybe require a more aggressive treatment, and not the conservative one traditionally used for these tumors.
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OBJECTIVE: To determine the diagnosticusefulness of MRI in the diagnosis of Leydig cell testiculartumor.METHODS/RESULTS: Male patient consulting for infertility.Testicular ultrasound and MRI were performed. Testicular MRIshowed a hypointense lesion in T2 powered sequences withintense, homogeneous enhance after contrast administration.CONCLUSIONS: MRI is considered an excellent diagnostictest for the management of patients with testicular diseasesof difficult diagnosis on ultrasound, contributing to definethe lesion, a Leydig cell testicular tumor in this case
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OBJECTIVE: To report one case of chronic follicular cystitis and to perform a bibliographic review on this pathology.CASE REPORT: We report a case of a 70-year-old woman with an irritative voiding syndrome over an eight-monthperiod, with several previous episodes of urinary tractinfection treated by her family doctor. Bullous lesions were found in the bladder mucosa on cystoscopy. Histological tests showed lymphoid follicles at the level of the bladder mucosa, leading to the diagnosis of follicular cystitis.RESULTS: Medical treatment was carried out withciprofloxacin, vitamin A, and prednisone, which led to symptom remission.CONCLUSIONS: Follicular cystitis is an entity that belongs to the group of chronic cystopathies; it is a non-specific chronic inflammatory disease characterized by the presence of large number of plasmatic cells and lymphocytes inlymphoid follicles within the bladder mucosa and submucosa; pathologic study is necessary for the final diagnosis of this entity
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OBJECTIVE: To report a rare case of testicular metastasis secondary to an infiltrative transitional cellcarcinoma years after radical surgery.METHODS: Case Report: 71-year-old male patient with history of infiltrative bladder tumor, status post radicalcystoprostatectomy with urethrectomy. Seven years after surgery he presents with pain and swelling in the righttesticle. Inguinal orchyectomy was carried out with thepathologic diagnosis of testicular metastasis of a high-grade transitional cell carcinoma. We perform a bibliographic review.RESULTS: The patient is disease-free twelve months after orchyectomy.CONCLUSIONS: Apart from leukemia and lymphoma,testicular metastases are extremely rare. The existence of testicular metastases means a metastatic dissemination to other organs, therefore chemotherapy could improveprognosis.
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OBJECTIVE: Complications of transurethral resection of the prostate (TURP) related to hypotonicity and hypervolemia were well described in the literature. However acute renal failure, kown to be a clinical presentation of some TURP syndromes was less discussed.METHODS. We report a case of oliguric acute renal failure as a major complication after TURP, with a discussion of a possible mechanism for the disorder.RESULTS. The mechanism by which renal failure developed in our patient is not entirely clear, but most likely is due to hemolysis. Other factors such as hemodynamic alterations, hypotension and rabdomyolisis are also suspected based on analysed data.CONCLUSION. We believe that a detailed evaluation before and after TURP will allow to reduce the incidence of this abnormality and to prevent its occurrence.
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OBJETIVE: To report a rare case of secondary testicular plasmocytoma in the context of a testicular mass.METHOD: We introduced a patient with plasmocytoma and a testicular infiltration of his systemic affection.RESULT: An inguinal orquiectomy was performed to treat the testicular infiltration and no recurrence of the process was seen after 6 months of follow up.CONCLUSIONS: Plasmacytoma is a plasma cell tumor that involves bone marrow or extramedullary sites. Testicular infiltration by plasma cells such as plasmacytoma happens in only 2 % of cases of all plasma cell neoplasm
