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Permanent drainage of the urinary tract by catheters or tubes causes bacteriuria. The potential harmful effects of the indwelling catheter`s bacteriuria are related to: time since the insertion of the catheter; location of the catheter (urethra, bladder, kidney); catheter composition (latex, silicone, etc.); type of ineffective bacteria and specific pathogenic mechanisms; health status of the urinary tract being drained (prior radiation therapy, tumors, etc.); patient`s health status (diabetes, immunodeficiency) and mobility; incidents and manipulations of the catheter, such as obstruction, irrigation, or retrieval. The evaluation of all mentioned factors enables strategies for prevention of septic episodes in relation with indwelling catheters, strategies that can be individualized for greater efficiency. Despite these preventive measures, infections secondary to the indwelling catheter may cause extremely severe septic episodes. Today, the indwelling catheter bacteriuria constitutes the greater source of nosocomial infection and its prevention and treatment a health care action of the highest importance. The study of mechanisms implied in the formation of biofilms, their pathogenic potential and preventive measures have been an attractive field of clinical and experimental research over the last years. The objective of this review is to make a synthesis of the works performed by our group.
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OBJECTIVE: To discuss the possible role of the male factor in early embryo death.METHOD: A detailed bibliographic review has been put together to establish which alterations in spermatozoa can be associated with early embryo death.RESULTS: Before the fusion between plasma membranes of the sperm and the oocyte occurs, both germ cells must undergo a maturation process that allows successful fertilization and embryo development. The study of couples with early embryo loss is usually approached from the side of the woman due to the obvious relationship that exists between the female and the developing embryo. However, it is not illogical to suppose that a genetic or epigenetic alteration of the sperm could have important consequences on these losses due to the necessary contribution of the male gamete not only to embryonic but also to placental development. On the other hand, spermatozoa have certain characteristics such as a highly compact DNA, they undergo apoptosis and the seminal plasma contains antioxidants that protect the structural and functional integrity of the germ cell. These factors assure fertilization and embryo development. Nevertheless, epigenetic alterations of the sperm such as altered chromatin packing, mistakes in imprinting, absence or alteration of the centrosome, telomeric shortening and absence of sperm RNA, could affect functions leading to early embryo loss.CONCLUSIONS: Knowledge concerning sperm intervention previous to embryo development will provide the basis for better understanding and for possible diagnosis and treatment of diverse reproductive alterations in men that could impede embryo development.
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OBJECTIVES: To present the data obtai-ned from surgical specimens and biopsies of residualprostate and prostatic capsule, which in addition to theinformation provided by imaging tests give us the base-line situation of the prostatic surgical bed and residualprostate after transcervical hemostatic adenomectomywith capsule plasty. All this is the first step for the long-term study of its evolution and possible implications inthe genesis of new obstructive or neoplastic pathology.METHODS: 70 consecutive cases of transcervical he-mostatic adenomectomy with the variation of capsule plasty, recently developed, after a previous experienceof 1033 retropubic surgeries.We analyze the histologic findings in surgical speci-mens, biopsies of residual gland and prostate capsule,and confirmed the immediate changes surgery causes,measuring the volumes of residual prostate by ultrasound.As the base for comparisons we analyzed residual pros-tates from prostatectomies or radical cystoprostatectomyspecimens in “young” patientsRESULTS/CONCLUSIONS: We obtained objectivedata about predominant and associated histological le-sions found in adenomectomy specimens. In the sameway, the same data were obtained from biopsies ofperipheral residual prostate together with the volume ofsuch zone, which should establish, if our hypothesis isright, the mid-long-term prognostic criteria for the appro-ach to the so-called post operative reexpansion of theprostatic hollow and the possible establishment of newobstructive pathology
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OBJECTIVES: Patients with end stage renal disease in dialysis are a population susceptible to suffer various types of cancers, mainly in the kidney and urinary tract. These tissues suffer systemic carcinogenic effects, including all that result from chemical and immunological changes secondary to renal failure, from the treatment they receive and dialysis itself. In the present article we determine the clinical, epidemiological, and pathological characteristics of patients with chronic renal failure in dialysis who presented renal tumors during the evolution of their disease over the last ten years.METHODS: We reviewed the medical charts of patients with chronic renal failure receiving dialysis in our institution who were diagnosed of renal tumors and received surgical treatment over the last 10 years. Patients with incomplete medical charts, HIV infection, and renal adult policystic disease were excluded from the study.RESULTS: 10 tumors were detected in a total of nine patients with a mean age of 45.22 years (range 41-65 years), six males and three females; regarding the mean time from the start of dialysis to de diagnosis of the tumor: 5 appeared the first year, 2 between 2 and 5 years, and 2 more than five years from the start of dialysis. The most frequent cause of chronic renal failure was high blood pressure, in 55.5% of the patients. 90% of the tumors were diagnosed incidentally during a control study, with ultrasound being the main diagnostic test (100%), a finding that was confirmed with MRI and CT scan in 60% and 30% of the patients respectively. The operative findings were: 8 solid masses, 1 mixed mass, and 1 cystic mass. Six patients underwent open surgery and 4 laparoscopic surgery. The most frequent pathologic diagnosis was clear cell carcinoma in 60% of the tumors.CONCLUSIONS: In our study population, we found that performance of periodic ultrasound controls enabled us to achieve early diagnosis and treatment of tumors of the kidney in patients in dialysis. Over the last years laparoscopy has become the treatment of choice for renal tumors, even in patients with chronic renal failure in dialysis.
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OBJECTIVES: The association of cystocele and urodynamic lower urinary tract obstruction is frequent, occasionally not being possible to rule out intrinsic obstruction of bladder neck and urethra. With the aim to confirm the obstructive character of the cystocele we performed at test consisting in manual reduction of the cystocele by the patient herself, to check if by this simple manoeuvre the urodynamic parameters of obstruction disappear or diminish. METHODS: 24 patients consulting for sensation of vaginal bulge, with a mean age of 66 years, participated in the study. The initial diagnosis of lower urinary tract obstruction and cystocele was obtained after video-urodynamic tests. The urodynamic test with self reduction of the cystocele was based on cystomanometry and voiding pressure-flow tests. The parameters of the study included presence, amplitude and bladder capacity during detrusor involuntary contractions in the cystomanometry; in the voiding pressure/flow test the parameters of the study were the URA as a urethra resistance parameter, the type of obstruction with the Chess classification, and Wmax and W80-W20 as parameters of detrusor contractility. RESULTS: A higher frequency of severe (58.3%) than moderate (41.6%) cystocele was demonstrated. No significant relation with age was demonstrated. The URA sig- nificantly diminished (p<0.01) with self reduction: from a median value of 30.5 before to 15.5 H2O cm after reduction. Although it was observed in all grades of cystocele, this reduction was greater in the severe ones. The most frequent type of obstruction was the constrictive (62.5%), over compressive (4.2%), mixed (12.5%) and unobstructed (4.2%). The constrictive obstruction significantly disappeared or diminished after reduction (p < 0.05) to a 45.8% of the cases, the compressive to 0%, the mixed to 4.2% and the nonobstructive to 50%. No significant relationship between these data and grade of cystocele was demonstrated. On the other hand, no significant differences were demonstrated with cystocele self reduction in the other urodynamic parameters (detrusor hyperactivity and contractility, Wmax and W80-W20), neither in their relationship with the grade of cystocele. CONCLUSIONS: This test could be very useful in the diagnosis of lower urinary tract obstruction for its validity and significance, apart from being an easy to perform and reproducible test.
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OBJECTIVES: To evaluate the differences in results and complications between retropubic and ob-turator TVT.METHODS: Descriptive prospective study including 245 patients who underwent retropubic TVT and 90 obtura-tor TVT, after the diagnosis of stress urinary incontinence by means of clinical history, physical examination and urodynamic tests. Continence outcomes and Intraopera-tive/post operative complications were recorded.RESULTS: There were intraoperative complications in 12.65% of the retropubic TVT and 1.11% of the obtura-tor TVT (p = 0.002). Immediate post operative compli-cations appeared in 24.5% of the retropubic TVTs and 12 .2% of the obturator TVTs: severe anemia (0.4 vs. 1.1%), inguinal pain (1.2 vs. 4.4%), hematoma (1.6 vs. 0%), urinary tract infection (12.2 vs. 4.4%), and acute urinary retention (8.9 vs. 2.2%) (p = 0.018). Complica-tions during follow-up: partial exteriorization of the mesh (0.81 vs. 1.11%) and de novo urgency incontinence (9.38 vs. 4.44%) (p = 0.031). Post operative results were similar for both groups: 90.2% vs. 91.1% cured (p = 0.046), improvement in 8.2% vs. 6.7% (p = 0.18) and failure in 1.6% vs. 2.2% (p = 0.57).CONCLUSIONS: The obturator TVT seems to be prefe-rable to retropubic TVT because it offers a lower compli-cations rate without differences in post operative results in the short-term.
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OBJECTIVES: To describe the failure of one case of suburethral tape for the correction of the stress urinary incontinence with the multifilament Sapphi- re VS (vaginal-suprapubic approach) system after 34 months of good outcome. METHODS: Description of the case and its resolution. RESULTS: The patient presented with a descent of the lateral fixation and erosion of the vaginal mucosa with exposure of the mesh and infection. The silicone fixation system, which was loose, was retrieved very easily and a new suburethral mesh with the system TVT-O was inser- ted; the patient recovered continence as before. CONCLUSIONS: Synthetic mesh in the suburethral tape systems for stress urinary incontinence correction should be polypropylene, macropore and monofilament. The- se characteristics enable better bio integration, theoretically reducing the number of complications (vaginal wall erosion, exposition and over infection). In relation with the failure of the silicone fixation system, no other casers have been reported in follow-up studies between 12 and 36 months (mean follow-up 14 and 18 months), so hat studies with long-term follow-up will be able to determine if this is an isolated case or there will be others.
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OBJECTIVES: Despite the fact that transurethral resection of the prostate (TURP) continues being the gold standard for the surgical treatment of benign prostatic hyperplasia (BPH), the good results obtained with the use of new energy sources have led to their use in daily practice.METHODS: Between September 2005 and January 2007, we have treated 63 patients with KTP laser photoselective vaporization of the prostate (PVP) in our service. Preoperatively we asked for IPSS, performed physical exam, digital rectal exam, abdominal , renal, bladder and prostatic ultrasound measuring postvoid residual volume, as well as flowmetry and PSA determination. Patients were revised after 1, 3, 6 and 12 months, undergoing uroflowmetry, IPSS, ultrasound and PSA; a satisfaction survey was also fulfilled at this interviews.RESULTS : Mean age was 67 years (range 58-85) and mean preoperative prostatic volume was 48cc (range 34-67 ), mean preoperative IPSS was 17.7 and mean maximum flow 8.1 mL/s. 12 patients presented post void residual volume larger than 100mL. Most patients presented medium or high anaesthetic risk. Mean operative time was 64 minutes (range 45-95). In most cases we used just one fibre, and mean energy released was 175.000 Joules (range 85.000-24.000). Mean hospital stay was 32.2 hours (range 19-55). In postoperative revisions we could state a significant decrease of IPSS , improvement in maximum flow, and also good or very good satisfaction degree in about 80% of the patients. Only 3 of them presented hematuria that needed to be attended by the urologist, none of them needed transfusion. One patient was admitted for severe urinary infection and eight patients referred irritative low urinary tract symptoms in their first postoperative checkup. CONCLUSIONS: KTP laser PVP is a safe, reproducible technique with optimal short and middle term outcomes, which should be considered as the first choice surgical treatment in elderly patients, patients with chronic anaemic diseases or anticoagulated, and patients with high anaesthesic or surgical risk.
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OBJECTIVES: Partial cystectomy is a recognized bladder sparing surgical technique. Patient selection is essential in order to optimize long term results. We present our initial experience with laparoscopic partial cystectomy performed in a selected group of patients that includes both benign and malignant lesions. METHODS: Nine patients were surgically treated with laparoscopic partial cystectomy between July 2002 and September 2006 in our institution. Partial cystectomy was indicated for the treatment of a foreign body, endometriosis, urachal adenocarcinoma, trancisional cell carcinoma, acquired lesions of urachus and extravesical tumor. Analyzed surgical variables were operative time, conversion rate, blood loss, hospital stay and catheterization period. RESULTS: Nine patients with bladder lesions were laparoscopically operated for partial cystectomy. Transperitoneal technique was employed and no conversion to open surgery was performed. Median operative time was 77.77 min (range 30-120 min.). No patient received any transfusion. No intraoperative lesions were verified. Median hospital stay was 4.22 days (range 3- 5 d.), median catheterization period was 7 days (range 5-10d.). CONCLUSIONS: Laparoscopic partial cystectomy is a doable surgical procedure. It is a useful technique for both benign and malignant bladder disease. In TCC and urachal carcinoma oncological safety prevails. Patient selection is essential for this procedure.
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OBJECTIVE: We describe a most unusual urological emergency: a firearm wound in which the blunt-nosed hand-gun bullet was lodged in the prostate. A bibliographic search of the literature revealed no similar case. METHODS: The patient was admitted presenting a gunshot wound with the entrance hole on the right buttock. There was no exit wound. An X-ray revealed the bullet behind the pubic symphysis. We introduced a suprapubic catheter and then carried out a laparotomy making a discharge colostomy. Urethrogram revealed a pathway of contrast to the rectum. Several days later, we reached the bladder with an urethrotome and introduced an 18 Fr catheter. Under radiological control we made an open approach to the retropubic space, palpated the bullet within the prostate and then removed it.DISCUSSION/CONCLUSIONS: The velocity of a rifle or hand-gun bullet is the main determinant of the severity of this type of injury. As there was no exit wound, we knew that the entrance velocity was low, therefore tissue damage would probably be small. In these cases, a preparatory suprapubic cystostomy is essential to be able to carry out a urethral reconstruction later . Radiological control during the procedure proved extremely useful to precisely locate the bullet. Our conservative approach of simply leaving in place the catheter helped us later to avoid a difficult repair of a recto-urethral fistula.
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OBJECTIVE: We report a case of non-traumatic adrenal hemorrhage in a man with antiplatelet treatment.METHODS: The patient was admitted to the Critical Care Unit because of a non-controlled hypertensive crisis. Pheochromocytoma was analytically excluded. The patient underwent a delayed adrenalectomy.RESULTS: Pathologic study of the specimen showed a wide hemorrhagic necrosis.CONCLUSIONS: Association of high blood pressure and adrenal hemorrhage is not pathognomonic of pheochromocytoma.
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OBJECTIVE: Metanephric adenoma is an unfrequent renal neoplasm, usually asymptomatic. Differential diagnosis with other renal tumors has to be performed. METHODS/RESULTS: We report the case of a 67 years old woman with a metanephric adenoma.CONCLUSIONS: Metanephric tumors comprise a pathologic spectrum of lesions. At one end of the pathologic spectrum are the metanephric adenomas. These tumors usually behave in a benign fashion. It is important to differentiate metanephric adenoma from clinically aggressive renal tumors
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OBJECTIVE: We present the clinical case of an intrauterine testicular torsion. METHODS/RESULTS: Three days old boy complaining of testicular pain and scrotum enlargement with the diagnosis of intrauterine testicular torsion. Left testicular extirpation and right fixation were performed. CONCLUSIONS: We analyze cases reported, clinical diagnosis and therapeutic options. Testicular torsion can be misdiagnosed with other pathologies like tumors, testicular infarctions, hydrocele, etc. We should always consider it a surgical emergency. The future fertility of the patient can be compromised.
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OBJECTIVE: Leiomyosarcoma of the inferior vena cava is a rare tumor, clinically silent which often remains undiagnosed for much longer. Imaging methods allow us to detect these entities. We report a single case and perform a bibliographic review.METHODS: 58-year-old woman with a 6 cm adrenal mass, which during surgery was found to be a tumor from the wall of the vena cava.We performed complete removal of the mass. Radiotherapy of the surgical area was applied within three months following surgery.RESULTS: Two years later, there is no evidence of disease recurrence.CONCLUSION: This is a rare entity, with low prevalence. Complete surgical excision is the gold standard for treatment. Local recurrence is a common finding during follow up.
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OBJECTIVE: We report this clinical case not only for the laparoscopic approach of a pheochromocytoma but also because of its particular aggressiveness and oddity of its clinical presentation.METHODS: 44 years old male presenting with oppressive chest pain with accompanying vegetative symptoms, who was diagnosed of right adrenal pheochromocytoma.RESULTS: After the diagnosis of pheochromocytoma was established and double adrenergic blockage implemented, transperitoneal laparoscopic surgery was performed. Pathological analysis of the surgical specimen confirmed the clinical diagnosis of pheochromocytoma. Patient was discharged home two days after surgery without any complication.CONCLUSIONS: The laparoscopic approach of adrenal pheochromocytoma is possible and safe in centres with laparoscopic experience, obtaining the same results than open surgery, offering advantages for the patient such as less pain, smaller incisions, and early ambulation, which results in a shorter hospital stay.
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OBJECTIVE: We report a case of seminal vesicle cyst with ipsilateral renal agenesis associated wit abnormalities of the abdominal great vessels, not described previously in the bibliography.METHODS: 33 year-old-male with history of abdominal pain and fever. This case was evaluated by ultrasound, IV urography, CT scan and MRI.RESULTS/CONCLUSIONS. Congenital cystic disease of the seminal vesicle is an uncommon disorder. It is associated with genitourinary anomalies, often renal agenesis, and even anomalies of the lower spine. However, anomalies of the abdominal great vessels have not been described previously. CT scan provided excellent demonstration of associated anomalies.
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OBJECTIVE: To report a new case of exceptio-nal metastases from a prostatic carcinoma.METHODS: 64-year-old male with nine months history ofdisseminated prostate cancer, taking hormonal treatment andbiphosphonates, who presents with rising PSA, facial dyses-thesia and left exophtalmos. MRI recognizes the existenceof a solid mass in the right maxillary sinus with involvement ofthe ipsilateral orbital floor, and another one in the left frontalsinus invading the roof of the ipsilateral orbit and also withorbital extraconal involvement.RESULTS: Once the diagnosis was established hormonal ma-neuvers were performed and chemotherapy with docetaxelwas administered achieving at the start of treatment measura-ble disease stabilization with biochemical remission of PSAlevels, followed posteriorly by progression without changesin the metastatic images. Currently new cytoreductive thera-py with docetaxel has been initiated.CONCLUSIONS: 1% of the prostatic tumors involve thehead in their evolution. Most frequent metastases are loca-lized in the brain and meninges, being the involvement ofparanasal sinuses and ocular orbit extraordinary. The im-portance of these comes from the extension to the orbit andthe eye in vicinity. Second line hormonal maneuvers, localradiotherapy and systemic chemotherapy will be necessaryfor control, although results are discouraging. In general,prognosis is poor, with short survival
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OBJECTIVE: The management of the distal ureter and bladder cuff is an important issue related to laparoscopic nephroureterectomy, because of the fear that local and bladder recurrences could be induced by an inadequate manipulation of the specimen. We present a case of muscle invasive bladder tumor that appeared 18 months after laparoscopic radical nephroureterectomy. METHODS/RESULTS: A 42 year-old woman with multifocal grade 3 pT3, right kidney urothelial carcinoma, treated by laparoscopic radical nephroureterectomy with early clipping of the distal ureter, transurethral detachment of the intramural ureter, and no bladder closure, presented with an invasive bladder recurrence after 18 months of follow-up. CONCLUSSIONS: There is no a definitive answer to the question of what is the best and safest way of treating the intramural ureter to prevent local and bladder recurrences. However, early clip occlusion of the ureter to avoid downstream cell seeding during kidney manipulation, and an open approach to the distal ureter in case of concomitant distal ureter or bladder tumor is recommended.
