Prostate cancer is currently one of the main causes of urological practice workload. Patients withnegative prostate biopsies may pose serious problems to the urologist in the decision making process for followup due to the lack of definitive data in the follow-up algorithm. MRI spectroscopy seems to open a diagnosticwindow evaluating prostatic metabolic changes. The performance of perineal prostatic biopsy with stabilizer and template enables selective biopsy of the suspect voxels following the spectroscopic study, simulating the Rubick’s cube.
OBJECTIVES: The final phenotype ofpatients. with cystinuria depends on the absence ormolecular defect, more o less acute, of the transport of cystine and dibasic aminoacids, and, also on environmental factors. The objective of this work is to study the effect of the modulation of some environmental factors (urinary pH, intake of liquids, pharmacological treatment and, specially, diet) on the final phenotype of the patient with cystinuria.METHODS: We study 45 patients with cystinuria (25 men and 20 women), 42 relatives (15 men and 27 women) and 90 unrelated controls. Anthropometric, clinical (personal and familiar history of urinary infections, colics and calculi expulsion), biochemical (microscopyanalysis of urine and urinary aminoacids cuantification) and life style (diet and medical treatment) variables were obtained. Statistical analysis was performed using tests to compare means and frequencies and, also, logistic regression and multivariate analysis.RESULTS: Of the 45 patients with cystinuria, only 20% showed cystine cristalls in urine, the rest of the phenotypical manifestations of cystinuria were found with the same prevalence as in relatives and in the control group. 50% of the patients did not undergo any therapeutic intervention; of these, only 50% were effective. In patients with cystinuria, the presence of cystine cristalls was associated with a diet rich in meats and poor in milk products (p< 0.05). Meat consumption also tend toassociate with a higher risk of urinary infections, meanwhile the stone expulsion showed a negativetendance with a diet rich in phytate. The elevateconsumption of oranges and mandarins was the variable of the diet which was more associated with urinaryaminoacids concentrations, specially with lower levels of lysine and arginine (p< 0,05).CONCLUSIONS: Some components of the diet, in addition to standard treatment, modulate the phenotypical manifestations of cystinuria.
The global heating of the atmosphere, as well as the increase of the exposition to sunlight, will be associated with a decrease of the mortality from prostate cancer, due to an increase of the plasmatic levels of vitamin D.OBJECTIVES: To evaluate if climatological factors(temperature, rainfall, and number of sunlight hours per year) may influence the mortality associated with prostatecancer over a five-year period.METHODS: In this ecology type study we will evaluatethe trends of prostate tumors associated mortality in the period between January 1st 1998 and December 31st 2002, in the geographic area of Spain (17 Autonomic communities-CA-and 2 Autonomic cities- Ceuta and Melilla-, 43 million inhabitants). Demographic and mortality data were obtained from the National Institute of Statistics(INE) and climatological data about temperature andrainfall were obtained from the National Institute ofMeteorology (INM). The provinces were classified using the climatic index of Martonne (defined as the quotient between annual rainfall and mean annual temperature plus 10). Areas with a quotient below 5 ml/m2/o C are considered extremely arid zones; between 5 and 15 ml/m2/o C are considered arid zones, between 15 and 20 ml/m2/o C semiarid zones; between 20 and 30 ml/m2/o C subhumid zones; between 30 and 60 ml/m2/o C humid zones; and over 60 ml/m2/o C superhumid zones. We compared mortality rates between different climatic areas using the Jonckheere-Terpstra test for six independent samples following the index ofMartonne. All calculations were performed using the SPSS v13.0 for Windows software. A logistic regressionmodel was performed to identify climate factors associatedwith prostate cancer mortality. A likeliness of the null hypotheses inferior to 0.05 was considered significant. RESULTS: Prostate cancer mortality presented statistically significant differences, being higher in provinces with higher Martonne index (p < 0.001) and lower in areas with a greater number of sunlight hours per year (p = 0.041). The adjusted mortality rate associated withextreme aridity regions and was 21.51 cases/100.000 males year, whereas in humid zones it was 35.87 cases /100.000 males years.CONCLUSIONS: Mortality associated with prostate cancer is significantly superior in regions with lessexposition to the sunlight. The climate change may lead to a modification of the main epidemiologic patterns, and it may be associated with a modification of cancermortality rates. Nevertheless, these results should be taken with caution and should be confirmed byprospective studies.
OBJECTIVES: To evaluate the prognostic significance of the 2002 TNM tumor classification for renal cell carcinoma, as well as other factors intervening in its survival.METHODS: Retrospective chart review of 316 renalcarcinomas operated between 1970 and 2003. Twenty-five prognostic variables were analyzed.RESULTS: The histological type was renal cell carcinoma in 90.5% of the patients. Most tumors were T1b or T2, with a Fuhrman nuclear grade I or II. Mean tumor size was 7.17 ± 3.4 cm. Most cases had a solitary tumor. 8.2% of the patients had lymph node involvement at the time of diagnosis, and 8.6% metastases. The most frequent clinical presentations were hematuria and/or pain. Mean follow-up was 57.8 months. 24.1% of the cases had recurrence, more than 50% of them during the first year. Advanced tumors (T3, T4) had the tendency to have a nuclear grade III-IV, bigger size, necrosis,vascular involvement, lymph node involvement, andmetastases. At the end of follow-up, most patients were alive and disease free. The number of months free ofdisease, the presence of metastatic lymph nodes, the treatment of the first recurrence and the presence of anemiawere independent factors for cancer specific mortality.CONCLUSIONS: The modification of the currentclassification of renal tumors pT3 and pT4 would help to a better decision-making in the therapy of tumors with vascular, perirenal fat or adrenal involvement. Anemia and treatment of the first recurrence are important factors for cancer specific survival.
OBJECTIVES: Analysis of all pediatric donoren bloc transplants to adult receptors performed in our department.METHODS: Retrospective analysis of 73 en bloc kidneytransplants and 497 adult transplants performed in our centre from 1990 to 2004. Mean follow-up was 50.23 months (10.18-89.05 months). All patients receivedthe same immunosuppression, although it evolved with time.RESULTS: There were significant differences in terms of nonfunctioning kidneys and delayed graft function, more frequent in pediatric en bloc and adult transplants, respectively. Pediatric kidneys provided better renal function and less proteinuria. Patient and graft survivals were similar in both groups. One and five-year graftsurvivals were 83.56% and 81.47% for pediatric donorkidneys, and 91.50% and 86.99% for adult donorkidneys. Vascular complications were the most frequent cause of graft loss for the en bloc transplants.CONCLUSIONS: Pediatric donor en bloc transplants have an excellent survival and function in the middle and long-term. Vascular complications are the main cause of pediatric donor graft loss. The adoption of a pediatric donor en bloc transplant program increases the transplantactivity.
OBJECTIVES: To know the preferences of patients with stress urinary incontinence (UI), may facilitate the decision making process of resources allocation and it also may help the choice of more suitable treatment.METHODS: Cross-sectional study of 150 women who consulted at a UI-specialized unit and with diagnostic of stress urinary incontinence. All patients underwent the diagnostic protocol of the urogynaecological unit. A personal interview was carried out including detailed information of three different treatments (Pelvic Floor Muscle Exercises-PFME, pharmacologic treatment and surgery) and the “Preferences Questionnaire” designed with the method of paired comparisons. A ranking scale was constructed with the alternatives and the distance between them was assessed aplying the “law of comparative judgements”.RESULTS: Patients preferred treatment with PFME to the other two options in the whole sample and in two age groups: equal or under 46 years and between 56 and 62 years. Patients between 47 and 55 years seem to prefer pharmacologic treatment. The group of patients aged 63 or over preferred surgery. According to severity degree, it seems that PFME treatment is preferred in all degree groups, being the pharmacologic treatment the second choice in moderate and severe degree groups.CONCLUSIONS: Women with stress UI and who haven´t received previous treatment preferred the PFME treatment followed by pharmacologic treatment and surgery.
OBJECTIVES: To perform a long-term evaluation of 15 patients with unilateral essential hematuria, with the aim of determining the causes of bleeding and the response to endoscopic treatment. To design a diagnostic-therapeutic algorithm for patients with unilateral essential hematuria.METHODS: We retrospectively review the clinical data of 15 patients with unilateral essential hematuria evaluated by rigid ureterorenoscopy (15 cases), flexible ureteropyelocalycoscopy (15 cases) and percutaneous nephroscopy(3 cases). In 4 patients electric fulguration of the pyelocalicial lesions was carried out.RESULTS: 14 of the 15 patients were successfully treated endoscopically. Only one patient presented recurrence of the hematuria. Mean follow-up time was 64 months (4-168 months). No patient suffered any relevant complication secondary to the endoscopic treatment.CONCLUSIONS: The cause of bleeding in patients with unilateral essential hematuria is determined only in a few, but endoscopic treatment is successful in a high percentage of cases. We consider that upper urinary tract endoscopy, mainly flexible ureteropyelocalycoscopy, has strongly impacted the diagnosis and treatment of essential unilateral hematuria. We present a new diagnostic-therapeutic algorithm, based on the usefulness of flexible instrumentation.
OBJECTIVES: To determine the effectivenessof the 80 watt KTP-laser method for the vaporization and ablation of the symptomatic BPH. Also the results when combining the KTP-laser with the RTU-P and theirrepercussion on the haemoglobin are analysed. METHOD: 230 patients with symptomatic BPH were treated between August 2004 and July 2006 with the KTP-Laser or combined with RTU-P. The additionalResection was carried out in those patients with great adenomas or having a big middle lobe. The ablative effect was controlled at the end of the operation with TRUS (transrectal ultrasound). RESULTS: 230 patients were treated in 2 groups. The group 1 (n: 50) just by laser treatment and small adenomas,the haemoglobin was reduced a 3.2% and nobodyrequired a transfusion. Group 2 (n: 180) with combined treatment of KTP-laser and TUR-P in great adenomas, the haemoglobin was reduced in average 13.7% after the intervention; 2 patients (1.1%) needed a transfusion. CONCLUSION: Our study shows the advantages of combining both, the advantages to combine both surgicalprocedures to mainly obtain a better result in theablation of the prostate adenoma in prostates of great size.
OBJECTIVES: We describe a series of surgicalmanoeuvres to perform a completely laparoscopicnephroureterectomy.METHODS/RESULTS: We set the patient in the lateral position. The trocars are placed in a rhombus shape, with an accessory trocar for liver retraction on the right side. Once the parietal peritoneum is open the ureter and gonadal vein are localized. We clip and section the gonadal vein. The renal pedicle is localized anddissected. We divide separately the renal artery and vein. We complete the dissection of the kidney. We start the caudal dissection of the ureter from the iliac vessels level down to the pelvis. We clip the ureter. Due to the trocar deployment we reach a point in which ureteral dissection becomes difficult. Then we perform 3 manoeuvres: 1) We change the camera from the lower trocar to the right side one. 2) We move the monitor to the feet of the patient. 3) The surgeon moves to the other side of the patient to work with the superior and inferior trocars. We introduce a retractor through the remaining trocar. With these changes the ureter is in line with the camera and we may have a good access to the pelvis, making the distal dissection of the ureter easier. The dissection ends when the classic image of tent of the vesicoureteral junction is seen. The bladder patch is resected and the bladder is sutured closed with acontinuous suture. The specimen is bagged and extractedopening the orifice of the iliac fossa trocar.CONCLUSIONS: With this technique, a completelylaparoscopic nephroureterectomy may be performedfollowing the oncological principles of open surgery.
OBJECTIVE: To demonstrate that strangulation of the prepuce needs immediate specialist care.METHODS: Presentation of a 8-years-old boy case with an entrapped foreskin in his pant’s zipper.RESULTS: After multiple attempts to remove the zipper under sedation, the case was referred to our service. The patient was surgically treated and his evolution was good.CONCLUSIONS: Immediate care, individualization of each case, as well as the experience of the treatingphysician will dictate the approach to follow in eachpatient. Medical personnel in adult as well as pediatric emergency departments must be aware that it is a problem that requires immediate care and avoid doing empirical and/or heroic treatments.
OBJECTIVE: Lymphangiomas are rareadrenal lesions, most of them asymptomatic.METHODS: We report one case of adrenal lymphangioma in a 41-year-old female patient with elevated serumcatecholamine levels.RESULTS: Lymphangiomas are multicystic lesions covered by endothelium and with serous content, the differential diagnosis of which is mainly established with hemangioma and adenomatoid tumor.CONCLUSIONS: Surgical treatment is indicated in biglesions and symptomatic cases, which are left asymptomatic after surgery.
OBJECTIVE: To show the characteristicfindings of testicular ultrasound and MR imaging in patients with congenital adrenal hyperplasia and testicular adrenal remnants.METHODS/RESULTS: Male patient with congenital adrenal hyperplasia presenting with azoospermia. Testicular ultrasound showed heteroecogenic nodular lesions in bothtesticles. In view of the past medical history of the patient suspect of adrenal tissue remnants was raised. Testicular MRI findings supported the diagnosis. Regression of the intratesticular masses after glucocorticosteroid treatment confirmed the disease.CONCLUSIONS: The presence of a testicular mass in a patient with congenital adrenal hyperplasia may pose a diagnostic dilemma in relation to perform or not testicular biopsy or orchyectomy to identify it. The combination of imaging diagnostic tests such as testicular ultrasound and MRI, the medical history of congenital adrenal hyperplasia and the regression of the lesions after administration of glucocorticosteroids allow to identify this pathologic entity without performance of other invasive procedures.
OBJECTIVE: High-grade lymphoepithelioma-like urothelial carcinoma is a rare neoplasia in the bladder, and its relationship with Epstein-Barr virus has not been demonstrated. METHODS: We report the case of an old male presenting with recurrent hematuria diagnosed of this tumor. RESULTS: These are neoplasias with a great lymphocyte component, sometimes predominant, which may lead to histological confusion with inflammatory processes like chronic cystitis or even lymphomas. CONCLUSIONS: Despite their infiltrative character and high cytological and architectural grade their prognosis is better than urothelial carcinomas of the same grade and stage, but this only applies for pure forms and those with predominant lymphoepithelioma-like pattern.
OBJECTIVE: To report the case of a patient with long-term giant genital lymphedema as a consequence of partial penectomy with bilateral inguinal lymphadenectomy 26 years before.METHODS: 58-year-old male patient consulting for genital volume increase (penis and scrotum). Diagnostic tests were performed and surgery was indicated.RESULTS: Complete bilateral scrotal excision includingtesticles and complete amputation of the penile remnant were carried out. Urethra was anastomosed to skin in the root of the scrotum. Post-operative outcome was satisfactory.CONCLUSIONS: Genital lymphedema is a diseaseassociated with severe aesthetic and psychological disorders. The present case demonstrates that these patients may be rehabilitated.
OBJECTIVE: To report a clinical case of bladder exstrophy adenocarcinoma.METHODS: 57-year-old female presenting with a hypogastricmass. The biopsy of the mass revealed bladder adenocarcinoma. We performed radical cystectomy.RESULTS: Pathologic study was compatible with moderatelydifferentiated adenocarcinoma.CONCLUSIONS: After six months of follow-up patient is disease-free.
OBJECTIVE: To report one case of progressive bilateral ureteral stenosis without demonstrable etiologic cause.METHODS: We diagnosed and treated a 73-year-old female patient who developed progressive bilateral distal ureteral stenosis without a demonstrable cause.RESULTS: Surgery was carried out and the pathologic study showed a bilateral ureteral stenosis secondary to fibrosis and chronic unspecific inflammation.CONCLUSIONS: Idiopathic ureteral stenosis is a rare clinical picture, more if progressive and bilateral.
OBJECTIVE: To report one case of bilateral synchronic testicular tumor with germ cell intratubularneoplasia foci affecting both testicles.METHODS: We describe the case of a 29-year-old male presenting with a painless tumor in the left testicle for a month. With the suspect of testicular tumor scrotal ultrasound, tumor markers and extension study to rule out metastasis were performed.RESULTS: Ultrasound showed a hypertrophic left testicle with a lesion suspect for neoplasia, and incidental diagnosis of a hypoechoic lesion with augmented Doppler flow within the right testicle. Bilateral orchyectomy was performed with the pathologic diagnosis of classic seminoma with germ cell intratubular neoplasia foci in both testicles. Treatment was completed with two cycles of chemotherapy.CONCLUSIONS: Bilateral synchronic testicular tumors are very rare. The most frequent histological type is classicseminoma. The diagnosis and treatment are similar tounilateral testicular tumors except certain cases in which partial excision of the testicle may be considered.
OBJETIVE: To evaluate the results of laparoscopic adrenalectomy for adrenal myelolipoma in a single center.METHODS: Between November 1999 and February 2006, 226 laparoscopic adrenalectomies were performed at our institution. 19 specimens corresponded with adrenal myelolipomas (8%). Mean patient age was 53.8 years (range 35 to 75) with male-to-female ratio 2:1. Clinical data was prospectively collected. Patient characteristics, lesion size evaluated by CT scan or MRI, surgical technique, operative time, operative blood loss, complications, conversion to open surgery and hospital stay were reviewed. RESULTS: Nineteen adrenal myelolipomas were laparoscopically treated in eighteen patients. 16 lesions were located on the right adrenal gland (84%). Mean surgical time was 84.7 minutes (range 45 to 150). Average bleeding was 25.8 ml (range 0 to 300). Only one patient required a blood transfusion. There were no intraoperative complications or conversions to open surgery. Average hospital stay was 2.1 days (range 1 to 4); no complications were registered during the immediate postoperative period. Pathology reports confirmed all specimens as myelolipomas. Mean maximum tumor diameter was 8.6 cm (range 4.5 to 14). CONCLUSIONS: Adrenal myelolipoma is an infrequent, benign entity which can occasionally become symptomatic due to spontaneous hemorrhage. Typical radiographic presentation permits conservative management in asymptomatic small masses. In cases where surgical treatment is advocated, laparoscopic surgery is a safe and feasible technique with reasonable operating time as well as limited blood loss, hospital stay and convalescence.