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Updated critical review of chronic prostatitis as a nosologic, anatomic-clinical entity of supposed microbiological or inflammatory origin. Scientific reasoning about the role of amicrobial inflammation in both caudal and cranial prostate, after new progresses, to reconsider the convenience of maintaining the current classification of chronic prostatitis, mainly in the section referred to “histological prostatitis”. Analysis of scientific evidences relating prostatitis and “pelvic pain”, the dominant syndrome in many patients and basement of the current terminological proposal: prostatitis-pelvic pain. The role of inflammation in the genesis of BPH and prostate cancer. Justification and convenience of a new term in logic consensus on prostatitis.
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OBJECTIVES: Our aim is not only to measure the satisfaction of both sex patients with urinary incontinence but also to analyse the influence of urgency incontinence in our patient’s sexuality as well as their treatment fulfilment.METHODS: This is a quasi-experimental naturalistic, longitudinal, open and not controlled study made during 24 weeks with before-after analysis on 60 urgent or mixed urinary incontinence patients treated with physic therapy and tolterodine. We have used the Spanish version of the questionnaire about overactive bladder (OAB-q), the Spanish version of the King’s Health Questionnaire (KHQ) and the Golombok Rust Inventory of Sexual Satisfaction (G.R.I.S.S.) about sexual satisfaction. We have born in mind treatment fulfilment.RESULTS: The 56,25% (18) of the valid calendars showed “normal” mictional values at the end of the study (p<0,001). Each item of the OAB-q has improved after the treatment of the 26,55% (p<0,001). The health status has also improved in the KHQ (p<0,001), but it hasn’t happened the same in the G.R.I.S.S. Finally, an improvement in several items of the treatment fulfilment can be contrasted.CONCLUSIONS: The results of this study corroborate the efficiency of pelvic floor rehabilitation combined with pharmacological therapy in urinary incontinence treatment. These results are very hope-giving because the incontinence problem affects negatively to the patients’ perception of their own health status, so solving this problem their health status will be improved
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OBJECTIVES: To compile the main methods of surgical treatment of penile and bulbar urethral stenosis.METHODS: We review the most updated bibliography, focusing on authors with large experience in the treatment of urethral stenosis, and we use our own experience to contrast or reaffirm some of the techniques.RESULTS/CONCLUSIONS: The base of the treatment of urethral stenosis remains in the stenosis itself (localization, etiology and length) and also in patient’s characteristics (age, past medical history). Among the techniques of urethroplasty we have techniques in one step, as the technique of excision and anastomosis, and the use of free grafts or vascularized flaps. The techniques in two steps like Johannson`s or perineostomy are very useful in certain cases of complex stenosis. We should keep an eye on the development of new techniques and the use of new materials that will help, once consolidated, to improve results.
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OBJECTIVES: Recently it has been reported in the EORTC (European Organisation for Research and Treatment of Cancer) trial 22911 and the SWOG (Southwest Oncology Group) 8794, the evidence that radiotherapy (RT) is an effective treatment after the prostatectomy in patients with high risk of biochemical failure. We analyze predictor factors of biochemical relapse and the potential benefits induced by rescue treatment are the main purposes of our study. METHODS: From 1993 to 2003, 597 prostatectomy were followed at Hospital Universitario Gregorio Marañón de Madrid, identifying 166 patients (p) (28%) of biochemical failure (defined as PSA ≥0’5 ng/ml, including post-surgical persistent values). 42 p received RT (78% due to delayed PSA relapse). The median total dose was 66 Gy [60-74].RESULTS: Clinical variables: Median age: 68 years [49-80], median PSA at diagnosis: 29,8 ng/ml [2,6-475]; presurgical Gleason ≥7: 65%. Histological variables: Prostatectomy induces stage migration to superior T (pT3-T4: 95%) and Gleason categories (≥7: 81%). 83% of relapsed p had positive margins and 90% had pT3-pT4. Outcome variables: median time to biochemical recurrence was 22,2 months. Median time interval between biochemical failure and RT was 10,5 months. Overall survival (5 years) was 86±6%. Freedom-frombiochemical failure at 5 years was 76±4%. RT had poor survival in p with PSA >2 ng/ml preRT (p=0,03), post-prostatectomy persistant disease (p=0,05) and Gleason score ≥7 (p=0,01). No increased grade 3-4 uro-rectal toxicity was observed. CONCLUSIONS: RT after prostatectomy improves freedom-from-biochemical failure in p with PSA values below 2 ng/ml. In our experience, Gleason score ≥7 is a negative predictor of response. There is no severe toxicity in our series. Improvement of the staging presurgery, the role of the adjuvant androgen deprivation and selection of patients for adjuvant RT focus current studies on treatment after prostatectomy.
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OBJECTIVES: We want to show our experiencewith paraurethral balloon implantation in thetreatment of male urinary incontinence.METHODS: We retrospectively reviewed our series fromMarch 2003 to March 2007, including 69 male patientswith urinary incontinence, most of them after radicalprostatectomy.RESULTS: 6 patients did not have their first follow-up visitafter surgery. Mean follow-up was 22 months (3-48).57.14% of the patients (36/63 do not need pads, and12.69% use one safety pad (8/63); therefore 69.83%(44/63) of the patients are dry or use one safety pad.If we stratify patients by incontinence severity, 81.25%of the patients with mild incontinence and 59.25% withmoderate incontinence are dry. Nevertheless, only 35% of the patients with severe incontinence are dry (no protection).CONCLUSIONS: In our experience, we believe that paraurethral balloon implantation could be the first therapeutic option for mild and moderate male urinary incontinence.
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OBJECTIVES: This work tries to analyze the urodynamic studies performed in patients over the age of 65 years in the Department 19 of HCAV with the aim of reviewing our activity in this population segment between January 2001 and September 2006, and to perform a clinical-urodynamic correlation which will help to find a diagnosis avoiding the need to repeat urodynamic tests.METHODS: We perform a descriptive transversal study with retrospective analysis of data from patients older than 65 years who underwent urodynamic tests. Total population in this age range in our health-care department (HCD) (HCD 19) is 35.260 inhabitants (12% of total population)(Valencia health care agency. Healthcare Management HCD 19. Alicante General University Hospital. May 2005). In this population 41% are males (14.620 people) and 59% females (20.637 people)RESULTS: Among males, the most frequent urodynamic finding is infravesical obstruction in almost half of the cases (48%), followed by bladder hyperactivity in 19%, and idiopathic bladder hyperactivity and urgency incontinence with 10%, respectively. No reproducibility of the symptoms reaches 9% of the cases. On the other hand, in females the most frequent finding is mixed urinary incontinence in 25% of the cases, followed by bladder hyperactivity 17%, urgency incontinence 14% and stress urinary incontinence 13%. No reproducibility of the symptoms reached 11%. In the opposite extreme are intravesical obstruction and sphincter/detrusor dyssynergia without any case.CONCLUSIONS: We find that people between 70 and 75 years old are the population group undergoing a greater number of urodynamic tests in our area. The most frequent urodynamic tests performed at our department was pressure/flow study with evaluation of post void residual. Urethra profile was reserved for recurrent stress urinary incontinence after surgery. Obstructive symptoms in males and mixed urinary incontinence in females were the most frequent causes for the indication of urodynamic tests. Our symptom no-reproduceability rates were below 10% of the cases.
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OBJECTIVES: To report the series of our Urology Department in the treatment of urinary stone disease with extracorporeal lithotripsy as well as the effec- tiveness of the Dornier lithotripter MFL-5000. METHODS: 6.602 patients were treated by extracorpo- real lithotripsy during 12 years with a total of 17.120 sessions. We examined the treatment outcome of 4.402 patients with a solitary stone, accordingly to stone size and localization. RESULTS: There were no major complications and only 43 patients experienced “calle litiásica”. We treated 4.402 stones. For all stones, independently of size and localization, 2615 (59.4%) were treated in one session, 801 (18.2%) required two sessions, 379 (8.6%) 3 sessions, 213 (4.8%) 4 sessions and 373 (8.4%) 5 or more sessions. CONCLUSION: The Dornier MFL-5000 lithotripter succe- ssfully treated urinary stone disease in patients of all age groups with a retreatment rate and number of sessions per stone similar to other studies, without analgesia or anesthetic procedures, except in the younger age group.
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OBJECTIVES: In endoscopic subcutaneous surgical procedures, new to Urology, the subcutaneous tissues are insufflated with carbon dioxide through a trocar to create working space without a surgical incision. Although this technique now predominates in surgery of the face, neck and breast, from the literature it appears that it has not yet been adopted for surgery in the region of the inguinal canal or in the scrotum. We describe these approaches.METHODS: To carry out the inguinal canal approach we introduced three 5mm trocars and dissected the external oblique fascia until we identified the superficial inguinal ring and gained access to the scrotum. The scrotal approach is directly into the scrotum. To date, we have only used the scrotal approach to treat hydroceles. We carefully detached the tunica vaginalis from the scrotal wall and kept the tunica intact before puncturing it to empty the fluid contents. The tunica was then resected and withdrawn through a trocar.RESULTS: We have removed three cysts and one solid tumor of the spermatic cord with the inguinal approach.With the scrotal approach we have treated six hydroceles. Our experience with these two small series allows us to confidently state that the procedure offers no particular technical difficulty; that operating times are short and that post-operative pain is very probably less than usual.CONCLUSIONS: Although endoscopic subcutaneous surgery in Urology is in its infancy, our results until now have been excellent and permit us to conclude that in the future there will be more indications for this type of surgery.
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OBJECTIVES: The main challenge of laparoscopicnephroureterectomy is the management ofdistal ureter, which also will have an important repercussionin the oncological outcome of many cases. Wepresent our experience in such aspect, considering thatwe performed the last five laparoscopic nephroureterectomiesin forced Trendelemburg position, resulting in amore comfortable and safe management of the distalureter.METHODS: Between August and December 2006 weperformed five purely laparoscopic nephroureterectomieswith bladder cuff positioning the patient in forcedTrendelemburg, a position similar to that of laparoscopicradical cystectomy or prostatectomy.RESULTS: Mean surgical time was 182 minutes (170-210). Mean blood loss was 100 cc and no patient requiredtransfusion. Mean hospital stay was four days.CONCLUSIONS: We believe this position is a goodalternative for the management of the distal ureter duringthe laparoscopic approach. The technique is verysimilar to open surgery, which continues being the goldstandard today.
Case Report
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BJECTIVE: Inverted papilloma is a rare po-lypoid lesion of the urothelium, known as a different entity since 1963. Not many more than 100 cases have been published. Although its malignant potential is still unknown, several scientific publications have noted it.METHODS: We report to cases of inverted papilloma and perform a detailed bibliographic review.RESULTS: Both patients were diagnosed by the Pathology Department and entered periodic follow-up visits, being free of recurrence at 24 and 18 months respectively.CONCLUSIONS: The possibility that inverted papilloma is a lesion with malignant potential should be considered in every case, and we suggest that patients with this diagnosis should enter a follow-up protocol like any bladder neoplasia.
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OBJECTIVE: Primary mesothelial tumors of the bladder are rare entities, being leiomyoma the most frequent of them. It may grow without any clinical symptoms or with very unspecific ones.METHODS: We report two cases of bladder leiomyoma in 2 patients, and performed a bibliographic review.RESULTS: They were treated by transurethral resection, with an excellent outcome, without incidences over five years of follow-up.CONCLUSIONS: Surgical treatment continues to be the best solution; it is easy to perform and has a very limited number of complications. Prognosis is good in any case and progression is anecdotic.
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OBJECTIVES: Penile and scrotal lymphedema produces a monstrous deformity with psychological impact and occasionally extreme mental anguish. The penis is buried in the scrotal tissue, deformed, thickened, edematous, and curved. The scrotum changes to a great, very thick, hard skin mass, sometimes cracked, exudative, and fetid. Erection and sexual intercourse are very difficult or impossible, and the scrotal enlargement interferes with walking. To report a new case of male external genitalia lymphedema.METHODS/RESULTS: We present a technical variation of the surgical treatment of penile-scrotal primary lymphedema in a 32-year-old patient suffering this disease for several years, which had underwent several medical and surgical treatments, such as lymphangioplasty and penile root fasciotomy. Observation consisted in the performance of two incisions in w-plasty, one at the root of the penis, the other one in the preserved preputial mucosa, and excision of all the lymphedematous tissue with reconstruction using the preputial mucosa and a small area of non infiltrated skin at the root of the penis. In the scrotum, two butterfly-wing shape skin flaps were performed; the testicles and the spermatic cord were isolated to ease the operation, minimize the surgical time and avoid complications; the lymphedematous tissue was resected with a great fragment of scrotum; finally reconstruction was performed from the adjacent healthy skin.CONCLUSIONS: With this technique it was not necessary to perform a free or vascularized skin graft. The patient recovered his penile functional capacity, improved aesthetically.and his anguish disappear.
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OBJECTIVE: Polypoid cystitis and intestinal metaplasia are well-known lesions of the bladder.METHODS: We report the case of one patient with both lesions identified synchronically in the bladder.RESULTS: Although these lesions are not neoplastic, there are evidences supporting a possible degeneration of the metaplastic epithelium to adenocarcinoma.CONCLUSIONS: The diagnosis of both lesions is histological and there are not clinical tests or image studies that could enable identification of the real nature of these lesions.
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OBJECTIVE: Rhabdomyomas are benign tu- mors of the skeletal muscle and extracardiac rhabdomyomas are very rare. METHODS/RESULTS: We report one case of spermatic cord rhabdomyoma in a 28-year-old male. CONCLUSIONS: Genital rhabdomyomas are rare benign tumors. Rhabdomyomas should be considered in the clini- copathological differential diagnosis of tumors of the male genital tract.
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OBJECTIVE: We report the case of the patient with metachronic thyroid metastasis of a renal adenocarci- noma. METHODS: 61-year-old patient with the diagnosis of renal adenocarcinoma treated by radical nephrectomy (stage pT3bpN0M0) and subsequent interleukin-2 for twelve mon- ths presenting four years after surgery with a thyroid nodule displacing the trachea laterally, requiring left hemithyroidec- tomy. RESULTS: Pathology reported a lesion made of clear cyto- plasm tumor cells, with marked atypia and anaplastic areas, compatible with clear cell renal adenocarcinoma. CONCLUSIONS: Thyroid metastases are extremely rare, being renal tumors the most frequent origin. They present as painless nodules, cold in gammagram, with normal thyroid hormones. The treatment of choice is surgical excision, with a better prognosis the longer the time between the primary and the appearance of metastasis.
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OBJECTIVE: Tumors of the epididymis are rare. They are ususally benign and adenomatoid tumors are the most frequent. Report of two cases of this kind of tumor of the epididymis.METHODS/RESULTS: We report two cases of adenomatoid tumor of the epididymis diagnosed at our hospital during last year. Two males, 35 and 54 years old respectively asked for urology consultation about a palpable scrotal mass. They didn´t have any other symptoms. Imaging techniques revealed a solid epididymal mass. Epidydimectomy was performed. Pathological diagnosis was adenomatoid tumor.CONCLUSIONS: The majority of epipidydimal tumors follow a benign course. In the finding of an epididymal mass, after palpation and imaging tests, organ sparing surgery (epididymectomy) is recommended. We will avoid unnecessary orchiectomies.
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OBJECTIVE: Report of one case of desmoid tumor in a patient who had been treated of a testicular semi-noma 26 months before, with excision of a retroperitoneal mass and chemotherapy. On follow-up he presented with a mesenteric abdominal mass which was clinically labeleled as a recurrence of the seminoma.RESULTS: Histologically it was reported as a mesenteric desmoid tumor. Differential diagnosis with gastrointestinal stromal tumor was performed with immunohistochemical stu-dies.CONCLUSIONS: Desmoid tumor is rare. There are few cases reported in patients with history of previous testicular tumor. It should be included in the differential diagnosis of testicular tumor recurrences.
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OBJETIVE: Primary extragonadal germ cell tumors are rare and their histogenetic origin is not clear. We describe two cases presenting as primary retroperitoneal germ cell tumors without clinical evidence of testicular tumor.METHODS: A 21 and 18 years-old patients presented retroperitoneal choriocarcinoma and yolk sac tumor, respectively. In both cases, testicular palpation was not suspicious for testicular cancer. Testicular ultrasound founded alterations in right testes.RESULTS: A right orchitectomy were performed and the final diagnostics were mature teraroma associated with intratubular malignant germ cell.CONCLUSION: Adult mature teratoma is infrequent and the retroperitoneal germ cell tumors should be considered to be metastases of a viable or burned–out testicular cancer.
