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We present a brief historic reference of who probably was the most famous English urologist-surgeon of the 18th century, and who, following the chronicle writers, holds the record for extraction of a bladder stone (between 24 and 54 seconds). He also was an example of humanism related to the medical profession: he was an extraordinary illustrator of his own books with the help of the “dark chamber”, so frequently used by Renaissance artists, contributed to the design and performance of civil architectonic work, had rela- tionships with the literature world through poetry, and decisively influenced the reformation and separation of barbers and surgeons, which ultimately lead to the creation of the Royal College of Surgeons
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OBJECTIVES: UrolumeTM is a stent type, non magnetic, self expanding urethral endoprosthesis indicated to keep the urethral lumen in cases of infravesical obstruction. It has been approved by the food and drug administration. We present our experience with the use of this prosthesis in cases of obstruction secondary to BPH and urethral stenosis.METHODS: From April 1999 to July 2005 we implanted 18 UrolumeTM endoprosthesis in seventeen male patients; 10 of them had symptoms of BPH and 7 bulbar urethral stenosis. We analyze the results of our series.RESULTS: Mean patient age was 61 years [30-79], being the mean age for patients with bulbar prosthesis significantly lower. Among patients with BPH (58.8%, n = 10), 80% (n = 8) had indwelling catheter (40% with ASA III surgical risk and 60% ASA IV). 4 patients have died with only one of them having indwelling catheter at the time of death. The implantation of the endoprosthesis was performed with xylocaine gel in 4 of these 10 patients (40%). The technique failed in two patients, one of them required indwelling catheter for urinary retention (to the time of his death), and the other one extraction of the prosthesis and prostatic adenomectomy for acute urinary retention. Among patients with urethral stenosis (41.2%, n = 7), we needed to implant a second prosthesis telescoped with the first one in one case (due to distal displacement), and to perform 2 transurethral resections of intraprosthesic hyperplastic tissue in the same patient. Subjectively, the mean value of the Madsen-Iversen score before surgery was 22.5 in comparison to 7.78 after surgery (p<0.005; Wilcoxon test). There were also objectives improvements in mean maximal flow before and after surgery (5.7 to 20.9ml/sec.;p<0.005; Wilcoxon test).CONCLUSIONS: This is a safe and simple technique, which may be performed under local anesthesia as outpatient surgery. It has a low complication rate, significantly improves the flowmetry parameters and symptom questionnaire results. It is a very good option to be taken into consideration in old patients, with chronic urinary retention, and high surgical risk. It may be a valid alternative to surgery in patients with short bulbar urethral stenosis, without previous skin flap urethroplasty and not having spongiofibrosis.
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OBJECTIVES: Data from the participation of our department in the ERSPC study in terms of detec- tion and PSA diagnostic yield, staging, therapeutic ma- nagement and mortality in the context of a multicentric randomized screening study for prostate cancer. METHODS: Patients were recruited between February 1996 and June 1999, randomized in screening and control arms, with several rounds for screening patients with four-year intervals, with PSA analysis and sextant prostate biopsy (t PSA > 4 ng/ml before May 1998, tPSA > 2.99 ng/ml after May 1998). These tests were not done in the control group. All deaths were studied (date and cause) RESULTS: A total of 4278 patients were included, 2416 in the screening arm (56.4%) and 1862 in the control arm (43.5%), with an age between 45 and 70 years (mean age 57.8 years, 95 CI 57.6-58.0). Median follow-up was 8.77 years. 142 prostate cancers were found, 113 in the screening arm (accumulated detection rate 4.7%) and 29 in the control arm (1.6%). Detection rates were 1.7%, 2.2% and 0% in the first, second and third round respectively. Organ confined cancers (T1 and T2) were 102 in the screening arm (90.3% ) and 24 in the control arm ( 82.8% ) , p = 0.254 . Metastatic disease was found in six patients ( 4.2% out of 142 ) , 3 in the screening arm ( 2.7% ) and three in the control arm ( 10.3% ) , p = 0 . 187 . Radical prostatectomy was the most frequently performed treatment: 47 cases in the screening arm (41. 6 %), 10 in the control arm (34. 5 %). 151 patients have died, 82 in the screening arm and 69 in the control arm. Only 3 of this deaths were secondary to prostate cancer, all of them in the screening arm (p = 0.308). CONCLUSIONS: We observed a non significant ten- dency to lower clinical stages in patients undergoing screening. Radical surgery was the treatment of choice in patients with prostate cancer. Even with the current follow-up in the series (close to 9 years), no differences have been observed in terms of prostate cancer mortality between both study arms.
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OBJECTIVES: Current treatment of hyper-calciuria is still controversial, not being recommended calcium restriction since it may cause a negative balance with important consequences to bone metabolism. In adults, the use of biphosphonates (sodium alendronate) has shown a good response. Biphosphonates are synthetic analogs of the endogenous pirophosphate. Pirophosphate is the simplest form of phosphate. In 1968, Fleisch demonstrated that inorganic pirophosphate inhibits the precipitation of calcium phosphate. The differences between various biphosphonates are in the safety margin between their inhibitor effect for bone resorption and the inhibitor effect for mineralization; bone resorption inhibition has been their most widely spread application. The objective of this work is to analyze the clinical and biochemical effect of biphosphonates in patients with hypercalciuria, osteopenia and renal lithiasis.METHODS: From 1996 to 2006 we treated 25 cases of recurrent renal lithiasis associated with hypercalciuria and primary or secondary bone mass loss. All cases were treated with sodium alendronate and oral calcium (1000-1200 mg/day). We analyze tolerance and treatment compliance, side effects, biochemical effects on blood and urine, effect on bone mineralization, and the outcome of lithiasic disease before and after treatment.RESULTS: All patients have followed the recommendations for the administration of the drug (sodium alendronate 10 mg/day or 70 mg/week), have had good tolerance without relevant side effects, and no one quit treatment.76% of the cases have had remission of the lithogenesis activity and 24% reduction, and all cases have had an increase of bone mineralization.CONCLUSIONS: In this group of selected patients with recurrent lithiasis and osteopenia the treatment with biphosphonates alone or associated with thiazide diuretics has given good results in renal lithiasis control and bone demineralization. The extension of indications should be analyzed in a multicentric randomized study
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OBJECTIVES: With regard to oncological outcomes and perioperative morbidity, surgical treatment of localized prostate cancer has proved to be an excellent treatment option. At present, there are three different approaches, open, laparoscopic and robotic. Open radical prostatectomy remains the “gold Standard” due to accumulated experience and long follow up of series. But, without a doubt, laparoscopic and robotic groups are contributing with a far from negligible experience. Looking carefully at outcomes we will have to elucidate amongst advantages and disadvantages of each one of them. In this study we have performed a review of the literature trying to compare the three techniques, focusing in available surgical morbidity and oncological outcomes.METHODS: We performed a systematic search in the following data bases: PubMed; EMBASE; Cochrane; SCOPUS; Science Citation Index, from January 1990 to January 2007 for terms: “radical retropubic prostatectomy”; “open radical prostatectomy”; “laparoscopic prostatectomy”; “laparoscopic radical prostatectomy”; ”robotic prostatectomy”; “robotic radical prostatectomy”; “treatment outcome”; “oncologic outcome”; “outcomes morbidity”; “mortality” and “minimally invasive treatment”. We analyzed the most representative series (finished learning curve) in each one of the three approaches regarding perioperative morbidity and oncological outcomes.RESULTS: To be able to perform an objective and truthful comparison of the three techniques, there is an absence in randomized studies in the literature. In this scenario we have analyzed the most representative individual series. With respect to the analyzed perioperative results, it seems to be no clear differences regarding surgical time, intraoperative complications, and catheter and hospital stay days. Otherwise, the endoscopic approach (laparoscopy and robotics) show a more favorable results in respect of blood loss and less postoperatorive analgesic. The short-term oncological outcomes (surgical margins) seem to be comparable amongst the three approaches. We only have long-term data (more than 10 years) on open series biochemical recurrence.CONCLUSIONS: The open surgery has become a reference for all comparisons. The laparoscopic surgery is being replaced (specially in North America) by robotic surgery which is constantly expanding. It is necessary the publication of randomized and prospective studies to be able to objectively compare the three techniques.
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OBJECTIVES: Radical prostatectomy is worldwide accepted as treatment for clinically localized prostate cancer. Its oncological results are excellent, so nowadays the functional outcomes: continence and potency, have become essential factors when evaluating the results. Open radical prostatectomy (ORP) is the gold standard against the new techniques, Laparoscopic (LRP) and robotic (RRP) must be compared. A systematic review of the literature is done to evaluate functional outcomes between the three approaches.METHODS: Systematic review in the databases: PubMed; EMBASE; Cochrane; SCOPUS; Science Citation Index for: “radical retropubic prostatectomy”, “open radical prostatectomy”; “laparoscopic prostatectomy”; “laparoscopic radical prostatectomy”; “robotic prostatectomy”; “robotic radical prostatectomy and functional assessment”; “continence”; “urinary function”; “incontinence”; “erectile function”; ‘sexual function”; “quality of life”; “functional assessment”; “minimally invasive treatment was performed”.RESULTS: The lack of randomized trials for this issue forces us to evaluate the functional results comparing the most important series of each approach, so the value of the results are very limited. Accepting 0 pads per day as continence definition and evaluated 12 months following surgery, the continence rates for each approach ORP, LRP and RRP are respectively: 81% (60-93%); 87% (82-95%) and 91% (84-98%). For erectile function admitting the capability for intercourse as potency definition, with or without the use of oral drugs and evaluated 12 months following surgery; the potency rates for each approach are: 68% (62-75%), 69% (52-78%) y 60% (20-97%).CONCLUSIONS: Due the lack of randomized trials, we have to evaluate the most important contemporaneous series. The lack of homogeneity in evaluating and reporting results is evident in the urological community. With the limitations of the data available it seems to exist no differences between the three groups for functional outcomes. It is mandatory to develop randomized trials and achieve a consensus for the criteria at the time of evaluating the functional outcomes.
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OBJECTIVES: Cushing’s syndrome is arare disease. Most patients have a hypophyseal tumorand the treatment is neurosurgical. A small percentageof patients require bilateral adrenalectomy. This paperreports the cases of two patients undergoing bilateral si-multaneous laparoscopic surgery with excellent results.METHODS: Under general anesthesia, with the patientin the lumbotomy position right adrenalectomy was per-formed first. 15 mm Hg Pneumoperitoneum was startedwith the Verres needle in the ipsilateral upper quadrant;four trocars were placed, two 10 mm and two 5 mm.In both cases the adrenal vein was divided between me-tallic clips. Once dissection was completed the glandwas placed in a plastic bag and extracted through one of the trocar incisions. For the left side the position ofthe patient was changed, and the same procedure wasperformed using three trocars, two 10 mm and one 5mm. No drainage was employed in either patient.RESULTS: The procedures were successfully performedwithout conversion. Surgical time was 150 minutes forthe first patient and 210 for the second. Mean estima-ted blood loss was 125 ml. Mean hospital stay was2.5 days. Both patients had a clinical reversion andthey are managed with oral corticoid supplements.CONCLUSIONS: The results show that laparoscopicaccess to the adrenal gland is the approach of choicewith very satisfactory outcomes for both patients and me-dical team
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OBJECTIVES: The characteristics of the patients may favour the appearance of complications. Taking into account the high morbimortality of the process, we believe that is convenient knowing main features of acute peritonitis in postoperatory in our surgical area.METHODS: We have retrospectively studied the radical cystectomies having postoperative peritonitis. Variables considered can be classified in four main categories: patient physiology, operation, peritonitis and morbimortality.RESULTS: During considered time, 9 of 80 cystectomies showed complications related with peritonitis (11,25%). Except one patient, 44-year-old, all others where 50-year-old or older males. 5 surgeries were curative and 4 palliative. 5 of the peritonitis appeared during first week. Initial mechanism was dehiscence, necrosis or hypertension (6.2 and 1 respectivelly). In 6 patients, origin was ureteroileal anastomosis, 2 intestinal anastomosis and 1 cutaneous ureterostomy. 3 of 9 patients died due to peritonitis.CONCLUSIONS: The incidence of intra-abdominal complications during the immediate post operative period of radical cystectomy is high and, often, difficult to diagnose. In patients subjected to this surgery as a palliative method, possibility of showing complications is higher. To correct this medical profile, early intervention is fundamental, determining patient prognosis.
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OBJECTIVE: We report one case of unilateral epididymo-orchitis secondary to Brucella and perform a bi- bliographic review. METHODS: We report the case of a 51-year-old male with fever, predominantly in the evening hours, over one month associated with a subacute inflammatory process on the right testicle and osteoarticular pain on the left ribs. RESULTS: Treatment was performed with rifampicin 600 mg/day for 45 days and doxicilin 100 mg/12 hours for 45 days. CONCLUSIONS: The brucellar etiology should be taken into consideration in front of an epididymo- orchitis with tor- pid outcome, mainly in areas of endemic Brucella and pa- tients that have had contact with cattle or non controlled milk derivatives. We emphasize that contact could have been several months before the appearance of clinical epididymo-orchitis.
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OBJECTIVE: To report one case of bilharziasis treated at our centre and to briefly comment the literature in the current context of increase of parasitical diseases in Europe, imported from the Third World by immigrants and tourists.METHODS: We report the case of a male patient from a Central African country referred to our department due to penile pain with painful voiding and ejaculation for several months, without other clinical symptoms. We performed a bibliographic search in the PubMed and Up-to-date databases with the following search terms: schistosomiasis, bilharziasis, hematuria, bladder infection, parasitosis, combined by boolean operators.RESULTS: After cystoscopy and pathologic study of the biological material the final diagnosis was chronic bilharziasis. The patient remains asymptomatic 14 months after treatment with praziquantel.CONCLUSIONS: Bilharziasis or schistosomiasis is a rare parasite disease, potentially severe which can severely compromise the urinary tract. In developed countries the cases are mainly imported from sub-saharian countries and other areas of North Africa, South Africa, Asia and Middle East.The cause is a parasite, Schistosoma haematobium, from the family of trematodes, genus helmints.In the active phasee the diagnosis is facilitated by the presence of Schistosomal eggs in urine. In latent or non active phase it is necessary the performance of cystoscopy and analysis of the biological material to reach the diagnosis.
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OBJECTIVE: To report two cases of acute idiopathic scrotal edema.METHODS: We describe the cases of two 12-year-old male patients presenting at the emergency department of our hospital with pain, edema and erythema in one hemiscrotum without history of trauma.RESULTS: On physical examination both patients showed red hemiscrotum skin and increase of the size with normal testicles and epididymis. With the diagnosis of acute scrotum testicular ultrasound were performed and showed heterogeneous edema of the scrotal skin with increased in Doppler flows and normal testicles.CONCLUSIONS: Acute idiopathic scrotal edema is a selflimited pathology which basically affects children before puberty and should be included in the differential diagnosis of acute scrotum to avoid aggressive interventions.
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OBJECTIVE: Renal oncocytosis is a rare pathology. We report the first case published of a patient with this disease undergoing combined pancreas-kidney transplantation.METHODS: We report the case of one patient with end stage chronic renal failure receiving hemodialysis with the incidental diagnosis of two renal oncocytomas and microscopic oncocytomatosis in a routine revision while awaiting for renal transplantation. Right radical nephrectomy was performed with the pathologic diagnosis of renal oncocytomas. The patient underwent combined kidney-pancreas transplantation nine months later.RESULTS: The postoperative course was uneventful. After three years of follow-up the patient has not shown recurrence and the graft has normal function.CONCLUSIONS: The presence of the antecedent of end stage renal disease under treatment with hemodialysis in patients with renal oncocytomatosis is striking, but the causative relationship is not established. The treatment for renal oncocytosis and pathologic characteristics present will condition when will be possible the performance of a kidney transplant in these patients, and will also condition prognosis. Long-term follow-up is recommendable due to the possibility of metachronic or bilateral involvement, and the association between renal oncocytomatosis and renal cell carcinoma in up to 32% of the cases.
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OBJECTIVE: Renal autosomal recessive policystic disease is responsible for a great number of deaths among affected individuals (mainly prenatal and neonatal forms).METHODS: We report the necropsy studies of two successive newborns from the same mother with such disease.RESULTS: We analyze the macroscopic and microscopic characteristics of this cystic disease.CONCLUSIONS: Those children that make it through the breast-feeding period will surely suffer from the associated liver pathology.
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OBJECTIVE: We report the case of a penile tumor presenting with lung and lymph node metastasis, with fatal evolution after the absence of response to surgery and adjuvant treatment.METHODS: Male patient presenting with a penile mass appearing progressively, with metastases.RESULTS: Partial penectomy and adjuvant chemotherapy were performed, with the appearance of a rapidly growing local recurrence which led to death of the patient in a few months. The tumor was a penile sarcoma with osteosarcomatous differentiation.CONCLUSIONS: Penile sarcoma is an unfrequent tumor that has a very aggressive behavior, requiring early diagnosis and aggressive management. It has tendency to local recurrence, and when it presents with distant metastases is lethal within a few months.
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OBJECTIVE: Lymphangiomatosis is a benign disease of difficult diagnosis. The bilateral form is very rare, being in some cases an incidental finding. METHODS: We report the case of a female patient with the incidental radiological diagnosis of bilateral lymphan- giomatosis, who did not present symptoms in relation to the disease. RESULTS: After a meticulous study with ultrasound, abdominal CT scan and the MRI the diagnosis was asymptomatic bilateral lymphangiomatosis and expectant management was decided with good outcome. CONCLUSIONS: Most cases reported have been treated by nephrectomy for diagnosis, but in our case it was possible to do precise diagnosis adding the experience of the radiologist and the urologist and she had a good outcome with conservative management.
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OBJECTIVE: The aim of the present study was to evaluate in 111 ejaculates from fertile men membrane integrity of spermatozoa before selection and sperm motility, and sperm concentration and chromatin integrity before and after selection of motile spermatozoa. METHODS: We evaluated the membrane integrity (using hypoosmotic swelling test and Eosin-Y) before separation and chromatin integrity (using acridine orange), concentration and motility before and after separation by migration sedimentation technique. All individuals had pregnant wives or had procreated a baby during the last year. RESULTS: The data of sperm membrane integrity by the eosin-Y and hypoosmotic swelling tests did not show significant statistical differences and the correlation between them was low. The percentage of motile sperm (grades a + b) increased from 57% to 87% (p < 0.001), the concentration decreased from 89 to 31 x 106 sperm/mL (p < 0.001) and chromatin integrity increased signi-ficantly (p < 0.0001) after separation of semen. CONCLUSIONS: The great variation in the values obtained in the functional test in fertile males requires a re-evaluation of the use of these tests in clinical practice of infertility
