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OBJECTIVES: For the celebration of the first Century of Dr. Antonio Puigvert Gorro`s birth we want to know his contribution to and relationship with Archivos Españoles de Urología.METHODS: We review all articles published by Dr. Puigvert, and additionally all articles with reference to his person and his work; we also review his written works and biography.RESULTS: He was one of the founders of the journal and always maintained a great cooperation until the ‘70s; he published important works in it, which are analyzed. We also emphasize his contribution to Urology in addition to his dedication to the history of the speciality.CONCLUSIONS: Dr. Puigvert is one of the most distinguished figures in the Spanish Urology, with an immense working capacity and written works. In his works published in Archivos he presents the results of his observations and his studies, as well as part of his innovations, ideas, and discoveries, that he later left in his urology books.
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OBJECTIVES: To evaluate the safety and efficacy of the TOT surgical technique in the treatment of female stress urinary incontinence (SUI). METHODS: Prospective study of 49 patients undergoing TOT at the Gynecology Unit of the Obstetrics and Gynecology Department in Barros Luco-Trudeau Hospital between November 2003 and January 2005. The mesh used was polypropylene, macropore, monofilament (Prolene). Median age was 52 years. The observational phase was completed in November 2005. RESULTS: Median operative time was 15 minutes. Thirty- two cases (65%) under went a second gynecologic surgery. One patient had an intraoperative bladder lesion. In the immediate postoperative period there was one case of lower urinary tract infection and another acute pyelonephritis. At the end of the observation phase 47 (96%) patients were cured, 1 (2%) improved, and 1 (2%) had a failure. The failure appeared after a trauma three months after surgery. CONCLUSIONS: The TOT is an effective technique for the correction of SUI. It is easier than TVT. Although rare, it is not free of complications.
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OBJECTIVES: To evaluate the mostrelevant epidemiological and survival data of the renal cell carcinoma (RCC) in a 90.000 citizens geographic area, as well as its association with risk factors such as tobacco or diuretic drugs use.METHODS: All patients with the pathologic diagnosis of renal cell carcinoma between January 1st 1987 and January 31st 2004 were included in the study. Adjusted incidence rates (standardized) per 100.000 inhabitants year, annual percentage increase, and epidemic index in the health-care area VIII in Ciudad Real (90.000inhabitants) were calculated. For the population adjustment we used the data Published by the National Institute of Statistics. We evaluated the differences in mortality between males/females, as well as in relation to tobacco consumption, using the chi-square test or the Fisher exact test, and the overall survival by a Coxregression model.RESULTS: Thirty-eight RCC were diagnosed, with a maximum incidence of 7.21 cases per 100.000 inhabitants year. There was an annual percentage increase of 2.06% over the whole period. There were no statistically significant differences in gender-associated mortality (p = 0.1), tumor stage (p = 0.063), tobacco consumption (p = 0.13), diuretic drugs consumption (p = 0.69), or both (p = 0.5). Mortality was significantly higher during the first 5 years after surgery.CONCLUSIONS: The incidence of RCC is progressively increasing, and it is predictable that this trend will be maintained in the next years. Overall mortality (any cause) associated with RCC is higher in the first five years after diagnosis.
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OBJECTIVES: To perform an update on the bibliography about the influence of dietetic factors on bladder cancer.METHODS: Bibliography search in various databases (PubMed, Ovid) on each one of the dietetic agents that can influence on the incidence of bladder tumors.RESULTS/CONCLUSIONS: There is a growing number of evidences that a great number of substances present in our usual diet have an influence on bladder cancer.
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OBJECTIVES: To analyze the impact of season and weather parameters on serum PSA values in men without prostate cancer.METHODS: Retrospective study including medical recordsfrom the Spanish arm of the European Randomized Studyof Screening for Prostate Cancer (ERSPC). Exclusion criteria: prostate cancer diagnosis, PSA >= 10 ng/ml, or PSA >= 3 ng/ml and/or digital rectal examinationabnormalities unless a negative prostate biopsy was provided.Univariate relationships between PSA value, season and several weather parameters were assessed. A multivariatelogistic regression model was used to identify independentpredictors of a PSA value >=3 ng/ml.RESULTS: A total of 2,147 men entered into the study. Median age and PSA level were 57 years and 0.9 ng/ml respectively. A non-significant trend to higher PSA levels was observed during autumn and winter. Multivariate logistic regression analysis identified only maximum temperature (p< 0.001), minimum temperature (p=0.001) and age (p< 0.001) as independent predictorsof a PSA value >= 3 ng/ml. Mean age-adjusted PSA levels at maximum temperatures of < =15ºC, 16-20ºC, 21-25ºC and >=26ºC were 1.25, 1.20, 1.17 and 1.09 ng/ml respectively. CONCLUSIONS: PSA levels are slightly higher during cold weather conditions. Because of the small magnitudeof this PSA increment we do not recommend to change biopsy indication based solely on climatic parameters.
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OBJECTIVES: To report our experience on the diagnosis and treatment of this rare type of infravesicalfunctional obstruction.METHODS: Over the last ten years we diagnosed and treated 32 males with this entity. We evaluate previous treatments and time to diagnosis. Clinical , radiological, endoscopic, and urodynamic features are evaluated, as well as results obtained with the administration of alpha-adrenergic blockers and endoscopic transurethral incision of the bladder neck.RESULTS: Patient age ranged from 26 to 48 years (Mean 38.2). All patients presented significant long-lasting lower urinary tract symptoms, having received various non-specific treatments. Uroflowmetry showed a peak of mean flow of 9.8+- 3.2 cc/s, being the voiding detrusor pressure 98+- 25 cm H2O, with significant post void residual volume in 21 patients (188+- 62 cc). Medical treatment with alpha-adrenergic blockers only achieved significant subjective improvement in four patients. Twentyone patients underwent unilateral endoscopic bladder neck incision, obtaining objective and subjectiveimprovements all of them.CONCLUSIONS: Endoscopic bladder neck incision is the treatment of choice of this dysfunction, being imperativeto inform the patient of the risk of retrograde ejaculation as a postoperative sequel, since this entity appears in young males, for whom fertility may be a priority.
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OBJECTIVES: To demonstrate the efficacy of ambulatory ureteroscopy under sedation-analgesia as diagnostic and/or therapeutic procedure for the upper urinary tract diseases, neoplasias, stenosis, stones.METHODS: We analyze the results of a series of diagnostic and/or therapeutic procedures in 1243 patients divided into five groups: 1. Work up for filling defects with positive cytology and hematuria, 36 cases. 2. Treatment of urinary stones, 1135 cases. 3. Treatment and follow-up of upper urinary tract tumors, 19 cases. 4. Foreign body extraction, 27 cases. 5. Dilation/section of ureteral stenosis, 26 cases. We perform the procedure under local anesthesia (urethral xylocaine gel), sedation with midazolam and analgesia withremifentanil perfusion (0.08-0.20 mcg kg/minute); the operation is subdivided into three steps: access to the ureter, progression/ureteral examination, and diagnostic and/or therapeutic actions.RESULTS: Fifteen percent of the patients presented pain or intolerance at the start or during the procedure, and they progress to general anesthesia. 10% of the cases have a hospital admission longer than six hours. Ureteroscopy was effective as a diagnostic procedure in 30/36 cases. Ureteroscopy was indicated as elective treatment in 833 cases of ureteral stones (54 lumbar; 248 iliac; 531 pelvic), achieving good results in 93% of the patients; it was indicated for failures or complications of extracorporeal shockwave lithotripsy in 302 cases (73 lumbar; 83 iliac; 146 pelvic), with good results in 98% of the patients. Ureteroscopy was used to treat conservatively low-grade ureteral tumors of the pelvic ureter in 12 cases, or as palliative therapy (7 cases). From the 26 cases of ureteral stenosis, 8 underwent ureterotomy and 18balloon dilation, leaving a ureteral catheter for 4-6 weeks, obtaining good results in 21 cases.CONCLUSIONS: Ureteroscopy is an effective technique in 94% of the cases, and it can be performed as an outpatient procedure for diagnosis or treatment of urinary stones and ureteral stenosis.
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OBJECTIVES: To describe the rate of infectious complications using a discontinuous scheme of oral ciprofloxacin in transurethral resection of the prostate (TUR-P). To tr y to weigh the influence of clinical background, operative complications and postoperative outcome on the development of such complications. To compare the results to those obtained with equal methodology using antibiotics in a continual scheme until the catheter removal. METHOD: A prospective open study was designed including 53 consecutive patients with sterile urine and without indwelling catheter subjected to TUR-P. Patients received oral ciprofloxacin 500 mg (4 doses) before going to the surgical room, the night of surgery, next morning of surgery and before catheter removal. Three patients were excluded after incorporation (5,6%) and all the remainders completed follow up. RESULTS: Fifty patients are analyzed. Fever was present in 8 patients (16%). Systemic clinical infection was present in 3 patients (6%). No isolated-ger m postoperative bacteriuria was present. Previous urinar y infection (UTI) was statistically associated to systemic clinical infection (p= 0,007) and to active chronic prostatitis on operative biopsy (p= 0,002). CONCLUSION: Probably previous UTI antecedent made less advisable the discontinuous scheme use in TUR-P, although a greater number of patients is needed to confirm these statement. When these results are compared to those using antibiotics in a continual scheme until catheter removal, a significant higher frequency of fever is seen (p= 0,022).
Case Report
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OBJECTIVE: To report one case of obstructive anuria due to ureteral compression by an external iliac artery aneurysm in a patient with a single kidney.METHODS/RESULTS: We report the case of a 76-year-old male with a single kidney presenting at the emergencydepartment with left lumbar pain and anuria for several days. Hydronephrosis of the solitary left kidney due to an aneurysmatic tumor of the external iliac artery was diagnosedafter performing various tests (ultrasound, arteriography). Emergency percutaneous nephrostomy was performed with subsequent vascular repair of the aneurysm. The outcome was favourable. CONCLUSIONS: Aorto-iliac aneurysm constitutes a rare cause of obstructive anuria. Patients affected are usually males over 50 years of age, smokers, with a history ofdiabetes mellitus, arterial hypertension (AHT), chronicobstructive pulmonary disease (COPD), etc. Diagnosis is based on clinical symptoms, outstandingly lumboabdominalpain, and the finding of a beating abdominal tumor, as well as signs of a renal failure. Useful complementary studies for diagnosis include ultrasound, intravenous urography (IVU), arteriography and computerised axial tomography (CT). Surgical treatment of the aneurysm generally relieves the obstruction.
Case Report
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OBJECTIVE: Ureteral-iliac artery fistula is a rare condition. We perform a bibliographic review and report a case of ureter-iliac artery fistula reviewing its major differential diagnosis.METHODS: This case-study describes a patient with massivehematuria that presented a ureter-iliac artery fistulasecondary to spontaneous rupture of an internal iliac artery aneurysm.RESULTS: 86 -year-old male patient with history of previous surgery for aneurysm and ureteral catheterization.CONCLUSIONS: This difficult diagnosis should be thought of in a patient with massive macroscopic hematuria and previous vascular surgery. The treatment is always surgery.
Case Report
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OBJECTIVE: To report a new case of bladder endometriosis and to perform a bibliographic review. METHODS: We report the case of a 34-year-old female with the diagnosis of bladder endometriosis treated by transurethral resection and subsequent hormonal therapy with good outcome one year after diagnosis. RESULTS: Treatment with analogs was started after TUR, in conjunction with the Gynecology Department, and maintained six months. The patient remained asymptomatic one year after diagnosis, with a negative cystoscopic study. CONCLUSIONS: We emphasize the need of early diagnosis due to the increased morbidity and health-care expenses; also the need of surgical treatment of all urological lesions before any hormonal therapy, mainly ureteral lesions. We finally emphasize that definitive treatment should be performed by the gynecologist.
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OBJECTIVE: To report a new case of the rare Leydig cell tumor, and to perform bibliographic review.METHODS: We report the case of a 38-year-old male with the clinical and ultrasound diagnosis of testicular tumor, and normal hormonal and extension studies. He underwentinguinal radical orchyectomy and the pathology report of the specimen showed a Leydig cell tumor. It was staged as T1N0M0, not receiving any further treatment withchemotherapy or radiotherapy. Five years after surgery there is no evidence of disease on follow-up.RESULTS: The patient does not show evidence of recurrenceafter chest x-rays, abdominal-pelvic CT scan, ultrasound of the contralateral testis, and tumor markers.CONCLUSIONS: We recommend a long-term follow-up with contralateral testicle ultrasound, CT scan, chest x-ray, and tumor markers.
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OBJECTIVE: To report a rare case of a giantepidermoid cyst in an intertesticular localization, analyzingits histological and pathologic features, and to perform abibliographic review.METHODS/RESULTS: We report the case of a 49-year-oldmale consulting for a slowly growing intra-scrotal mass offive years of evolution causing discomfort because of itssize. After excision the pathology report showed thepresence of a keratoid epidermoid cyst very big in size.CONCLUSIONS: Superficial scrotal epidermoid cysts arefrequent in clinical practice; that is not the case of theso-called “intra scrotal inclusion cysts”. Epidermoid cystsare firm, mobile, slowly growing, generally asymptomaticintra epidermal neoformations. There are descriptions inmultiple sites, even the genitalia, nevertheless their size inthis location does not usually pass 5 cm
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OBJECTIVE: There is some controversy in the terminology used for transitional cell tumors with mucinous differentiation.METHODS: We report the case of a 50-year-old male with history of recurrent lithiasis whose radological tests discovereda heterogeneous renal pelvis lesion.RESULTS: The histologic study of the lesions determined the diagnosis of transitional cell carcinoma of the renal pelvis with ample mucinous differentiation.CONCLUSIONS: They are rare tumors in such location and the mucinous differentiation does not seem to influence prognosis.
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OBJECTIVES: Male infertility caused by irreparable obstructive azoospermia is widely treated with MESA (Microsurgical Epididymal Sperm Aspiration)or TESE (Testicular Sperm Extraction) or PESA (PercutaneousEpididymal Sperm Aspiration) followed by an Intracytoplasmatic Spermatozoa Injection (ICSI). For eachprocedures are claimed advantages and disadvantages.Aim of this work is to describe our technique (OESA) for sperm retrieval reporting the results.METHODS: From 1998 to 2003 153 sperm retrieval procedures in azoospermic patients were performed. The technique consists in a small (1 cm.) surgical incisionof scrotal wall under local or spinal anaesthesia. After inspecting the intrascrotal component to record the status of the epididymis and of the testicle, epididymal spermaspiration was performed in the most appropriate site with 18 gauge needle. The aspirated spermatozoa were used immediately after aspiration not beingpermitted in our Institute cryopreservation. When no sperms were found TESE was performed.RESULTS: In 78 cases aspiration from epididymis was successful (OESA). In the other patients (75) TESE was performed. Higher count of spermatozoa were retrieved in all cases of OESA. Pregnancy rate was 26,6% for OESA and 6,4% for TESE. No complications occurred.CONCLUSIONS: This technique is very simple and easy allowing to obtain the advantages of microsurgicaltechniques (mainly choice of the most appropriate site of aspiration and immediate haemostasis if needed) with minimal invasivity (avoiding epididymal surgical incision).Moreover if OESA does not allow sperm extraction is possible to perform immediately TESE.
