Although urine cytology plays an important role in the diagnosis of lower urinary tract neoplasias, it should be complemented with other diagnostic tests for the diagnosis of upper urinary tract tumors.METHODS: We present one case of synchronic transitional cell carcinoma of the ureter and bladder papilary neoplasia and carcinoma in situ.RESULTS: The persistent positivity of urine cytology in patients treated for lower urinary tract lesions without evidence of lesion in that level should raise the suspicion of upper urinary tract lesions.CONCLUSIONS: Ureteral carcinoma is an aggressive neoplasia and early diagnosis may be beneficial and also have repercussions in the ipsilateral kidney function.
OBJECTIVES: To present our experience in the treatment of meatal stenosis secondary to balanitis xerotica obliterans with the dorsal meatoplasty technique.METHODS: We have performed dorsal meatoplasty in 15 patients suffering stenosis of the penile meatus secondary to balanitis xerotica obliterans. All cases were performed under local anesthesia, using an inverted V incision plasty following the original of technique from Malone.RESULTS: All patients showed an improvement in uroflowmetry as well as an excellent aesthetic result, with low incidence of scattered urinary stream; there was a high satisfaction index evaluated by a questionnaire.CONCLUSIONS: Dorsal meatoplasty with inverted V incision is an easy-to-perform technique, which may be done under local anesthesia, avoids the development of post-operative hypospadias, and achieves excellent aesthetic and functional results with a low recurrence rate;therefore, we consider it should be included in the list of frequently performed procedures of the urologist.
OBJECTIVES: To expose the pathogenesis, diagnosis and therapeutic options for urethral diverticula appearing after substitution urethroplasty.METHODS: Over a total of 34 urethroplasties, 20 with pediculated flap and 14 with buccal mucosa, we collected six cases of urethral diverticula/sacculation development. Five of them underwent surgery, and in one case without symptoms we opted for therapeutic abstention.RESULTS: Currently four patients remain asymptomatic after treatment. The other two are waiting for a second-time urethral closure.CONCLUSIONS: The development of urethral pseudodiverticula secondary to stenosis after urethral substitution surgery is not an infrequent complication. For the practice of reconstructive surgery it is important to know that there are techniques to reinforce the resistance of this weakened area of the urethra.
OBJECTIVES: To analyze the survival rate in a series of patients with the diagnosis of renal cell carcinoma over a 19 year period based on prognostic factors usually employed in clinical practice.METHODS: Retrospective study of 259 consecutive patients with the diagnosis of renal cell carcinoma undergoing surgery in our department between 1988 and 2006. From clinical, pathological, and follow-up data we performed a survival study comparing the impact of usual prognostic factors: stage, tumor size, nuclear grade, etc.RESULTS: 264 surgical procedures were performed in 259 patients, with a mean age of 61.91 yr. The most frequent way of diagnosis was incidental finding (52.12% of the cases); radical nephrectomy was performed in 72.97% of the cases in comparison with 26.25% partial nephrectomies. Clear cell carcinoma was the most frequent histological diagnosis (69.88%). Patients with clear cell carcinoma, symptomatic tumors, bigger size, and greater Fuhrman nuclear grade presented worse survivals, mainly in tumors with stage >pT3a.The presence of involved lymph nodes or distant metastases is associated with a much lower cancer-specific survival. Global five-year cancer-specific survival was over 80%.CONCLUSIONS: The classical prognostic factors used to predict survival in renal cancer are still useful, mainly pathological stage pT. We observed a better survival in comparison with older series, but this kind of tumors continue generating important morbidity-mortality.
OBJECTIVES: The epidemiological characteristics of brain-dead donors have changed with time without a significant increase in the rate of explants performed. The objective of this article is to evaluate if the epidemiological characteristics (sex, age, and death cause) have changed with time, and To evaluate if the rate of effective explants is adjusted to a quality standard.METHODS: All patients who became renal donors (one or two renal units) between January 1st 1995 and December 31st 2005 in a level II hospital with intensive care unit but without neurosurgery, which is not a reference center for severe polytrauma patients, within a health-care area of the Autonomic Community of Madrid (Mostoles, 200.000 inhabitants), were included in this retrospective study. Cause of death, age, HBV and HCV serologies, as well as multiorgan donation (liver, pancreas, bowel, heart, lungs, and tissues). Additionally, the differences between two consecutive periods of time will be analyzed: 1995-1999 and 2000-2005. SPSS v 13.0 software (Chicano, Illinois, USA) was used for the statistical analysis; the T test for independent samples was applied, considering an alpha error inferior to 0.05 for significance. A minimum of 0.2% of the total number of hospital deaths was considered as quality indicator for the adjustment of donation rate.RESULTS: Over the whole study period there were 4314 deaths in the hospital. Forty-six renal harvestings were performed with a mean donor age of 58.1 yr. (mean standard error (SE)14.25) . In the first study period (1995-1999) there were 20 donations with a donor mean age of 52.8 yr. (SE 12.13), and there were 26 donations in the second period (2000-2005) with a mean age of 62.23 yr. (SE 14.49) . Nevertheless, there were no statistically significant differences between both groups (p = 2.273). A total of eight patients were HBV positive (17.4%) and four (8.7%) HCV positive. In 80.4% of the patients the cause of brain death was brain hemorrhage (37 patients),15.2% hypoxic encephalopathy (7 patients), one patient died due to fat embolism after motor vehicle accident, and another one from thrombotic purpura. There were no differences in death cause between both periods (p> 2.05). Hepatic extraction was performed in 74% of the patients, heart and lung in 6.5%, pancreas in 4.3%, and tissues in 50%. Donation rate was 1.05%.CONCLUSIONS: 1. There is a trend to higher brain-dead-donor age, although it is not statistically significant, probably due to sample size. 2. The rate of brain-dead donor detection is over quality standards. Nevertheless, training programs to detect these patients and improve results should be established at the hospital level.
OBJECTIVES: To check the urodynamic data in patients with recurrent urinary tract infection in order to demonstrate a cause justifying them.METHODS: We performed a transverse comparative study in a series of 114 women, with a mean age of 51.9 yr. (typical deviation: 23.5 yr.), divided into groups of 57 women each: group I with recurrent urinary tract infection (UTI) and group II without recurrent urinary tract infection (no UTI). Patients underwent history , physical examination, and video-urodynamic study. All data were collected in an Access database and subsequently imported to the SPSS statistical analysis software. Fisher’s exact test, Pearson’s chi-square, and Student’s t-test were applied. ROC curve was calculated. A logistic regression multivalue model was elaborated.RESULTS: significant differences were only found in the values of maximum voiding flow (lower in the UTI group), post void residual volume (greater in the UTI group), and pressure of the involuntary detrusor contraction (lower in the UTI group). Nevertheless, post void residual was the only independent variable, becoming the other two dependent variables. The ideal cut point between post void residual and urinary tract infection was 48.5 ml. The determination coefficient for the model was 0.13. No significant relationships were found between urinary tract infection and, among others, presence and degree of cystocele, detrusor hyperactivity, and stress urinary incontinence.CONCLUSIONS: Postvoid residual would explain 13% of the recurrent urinary tract infection in women. The remainder would be secondary to other factors not included in the model.
OBJECTIVES: To describe the rate of infectious complications using discontinuous oral ciprofloxacin in transurethral resection of the prostate. To weigh up the influence of clinical background, surgical complications and postoperative outcome on the development of such complications. To compare the results to those obtained will equal methodology using antibiotics until catheter removal. METHODS: A prospective open study was designed including 105 consecutive patients with sterile urine and without indwelling catheter subjected to transurethral resection of the prostate. Patients received oral ciprofloxacin 500 mg (4 doses) on call to the surgical room, the night of the surgery, next morning of surgery and before catheter removal.RESULTS: One hundred patients are analyzed. Fever was present in 10% patients (axillary temperature equal or over 37.5 °C). Systemic clinical infection was present in 3% patients (axillary temperature over 38 °C and Creactive protein over 40 mg/l). No isolated postoperative bacteriuria was present (colony count > 105 CFU/ml). Active chronic prostatitis was statistically asociated to fever (p= 0,018) and to systemic clinical infection (p= 0,016). Previous urinary tract infection antecedent was statistically associated to active chronic prostatitis on histopathology (p= 0,049). CONCLUSIONS: This study shows some clinical evidence supporting that previous urinary tract infection antecedent is a risk factor of infectious complications after transurethral resection of the prostate and that prostate bearing microorganisms may be responsible for some of them in this kind of patients. An antibiotic dose before catheter removal seem to reduce postoperative bacteriuria.
OBJECTIVE: To report a new case of renal metastasis from an squamous cell carcinoma of the lung.METHODS: A 60 year old male presented to the outpatient office with an ultrasound finding of renal mass.RESULTS: Imaging test studies showed a heterogeneous mass in the upper pole of the left kidney, involving the pelvis and trapping the renal artery. CONCLUSIONS: Clinically recognised or symptomatic metastases to the kidney from pulmonary cancer have been a rare occurrence. Nevertheless, prognosis associated with lung carcinoma metastatic to the kidney is very poor, since the likelihood of a truly solitary metastasis is remote.
OBJECTIVE: Solitary fibrous tumours (SFTs) are rare neoplasias that were first reported in pleura, but can occur in different sites. Inguinal location is extremely rare. METHODS/RESULTS: We report one case of a 74 year old man with a right inguinoscrotal mass with 50 years of evolution. After surgical extirpation, solitary fibrous tumour was diagno-sed. CONCLUSIONS: The vast majority of solitary fibrous tumours (SFTs) have a benign course. Only a few cases have aggressive behaviour, with local recurrence and metastasis. Treatment is surgical, but we must do a long-term follow up in all cases.
OBJECTIVE: Sarcomas arising from the urinary tract are rare, representing less than 2% of all urologic tumors. The paratesticular region is one of the most unfrequent locations. Leiomyosarcoma, rhabdomyo-sarcoma, liposarcoma, malignant fibrohistiocytoma, etc. and the combination of two or more histological types has exceptionally been reported . We describe the case of a patient with a mixed paratesticular sarcoma and perform a bi-bliographic review.METHODS: The patient underwent right radical orchyectomy and the surgical specimen was sent to pathologic study.RESULTS: There are no previous case reports in the literature of paratesticular mixed tumor with liposarcoma and rhabdomyosarcoma.CONCLUSIONS: Sarcomas of the spermatic cord are rare neoplasias and should be considered on the differen-tial diagnosis of scrotal masses. The treatment of choice is surgical and adjuvant treatment must be individualized depending on tumor aggressiveness.
OBJECTIVE: Carcinosarcoma is a neoplasia with malignant epithelial and mesenchymal differentiation. Carcinosarcoma of the urinary tract is a rare neoplasm. It is an extremely rare entity in the ureter.METHODS/RESULTS: We report one case of carcinosarco-ma arising from the ureter in a 69-year-old male patient who underwent total ureterectomy.CONCLUSION: Carcinosarcomais a malignant neoplasia associated with poor prognosis, probably resulting from the advanced stage at diagnosis.
Cutaneous metastases from urothelial car-cinomas of the bladder are very rare. They are related to advanced stages of the disease and have poor prognosis with low survival rates. We report one case of cutaneous metastasis appearing after urological manipulation in a patient with bladder muscle invasive carcinoma, with other metastatic sites and poor response to treatment. The case is discussed and literature is reviewed.
OBJECTIVE: To demonstrate that continuos intravesical irrigation with amikacin is an efective adyuvant treatment in Emphisematous Cistitis therapy. METHODS: A 3 way transurethral Foley catheter was placed and a continuous intravesical irrigation was initiated with amikacin 500mg in 1L of normal saline (500 mi- crograms per ml) within 6 hours 4 times a day and three consecutive days. RESULTS: After 3 days of treatment the patient showed sig- niﬁcant clinical response. A new CT scan showed the absence of gas in the bladder wall compared to the previews CT and negative urine culture was obtained. CONCLUSIONS: We established that treatment using adjuvant continuous intravesical irrigation with amikacin can reduce hospital stay and accelerate the patient’s healing process, as well as an earlier negativisation of urine cultures. A comparative prospective study is needed to evaluate if in fact this treatment variant produces a real beneﬁt com- pared to conventional therapy.
OBJECTIVE: Thirty percent of patients with localized prostate cancer undergoing radical prostatectomy experience biochemical recurrence with rising serum prostate-specific antigen (PSA). More than 50% of these develop distant metastases.METHODS: Presence of PSA mRNA in pathologically normal pelvic lymph nodes from 154 patients undergoing radical prostatectomy was investigated with non-quantitative PSA reverse transcriptase polymerase chain reaction (RT-PCR). In 135 of these patients preoperative serum PSA RT-PCR was also assessed. RT-PCR positivity was correlated with biochemical recurrence and compared with other clinical risk factors.RESULTS: At a median follow-up of 58 months the biochemical failure-free survival of patients with positive versus negative lymph node RT-PCR was 68.4% and 76.7% respectively (p=0.2). Biochemical failure-free survival was not influenced by the serum PSA RT-PCR result either (72.3% versus 72.6%). Surgical margin status, preoperative serum PSA, pT category and Gleason score were independent prognostic risk factors for biochemical recurrence with a hazard ratio of 5.48, 2.56, 2.56 and 2.13 respectively.CONCLUSIONS: At 5 year follow-up after radical prostatectomy, both serum and lymph node RT-PCR are not correlated with biochemical failure-free survival. Established clinical risk factors have a much stronger impact on biochemical recurrence.