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OBJECTIVES: To report the case-series of Leydig cell tumors diagnosed at our center, and to perform a bibliographic review on the topic. METHODS: Retrospective review of the clinical records of all patients with the diagnosis of Leydig cell tumor in our center over the last 12 years. We evaluated the clinical, diagnostic and therapeutic features, as well as outcomes. RESULTS: Four patients were diagnosed and treated in our department over this period. Mean patient age of the time of diagnosis was 51 years. Each of our cases have a different presentation. The two patients who underwent sperm analysis had azoospermia. None of the cases showed anomalous hormonal studies. Seventy-five percent of the cases showed ultrasound signs compatible with testicular neoplasia. In all of them surgical treatment was undertaken (inguinal orchyectomy); one of the patients underwent chemotherapy due to metastasis, having a good response. Mean follow-up is 76 months. CONCLUSIONS: It is a rare testicular tumor. Inguinal orchyectomy is the treatment of choice. Its good outcome is remarkable.
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OBJECTIVES: To perform a retrospective evaluation of surgical complications and morbidity in patients undergoing radical retropubic prostatectomy (RRP) as elective treatment for organ-confined prostate cancer in our center with previous transurethral resection of the prostate (TURP).METHODS: Between 1980-2004 we performed 59 radical prostatectomies in patients with previous TURP. We analyze the morbidity and mortality of the RRP, its functional outcomes, and the accordance between clinicaland pathological stage. RESULTS: Mean time between TURP and RRP was 16 months. Mean patient age at the time of diagnosis was 63 years. Clinical stage: 16 T1a,18T1b,20T1c, 3T2a,2T2b. Average surgical time was 180 minutes. Intraoperative events: technical difficulties in the dissectionof the gland 57%, bladder neck preservation 27%, neurovascular bundles preservation 3.39%, ureter ligation 1.69%, rectal laceration 1.69, urethrorrhagia 1.69%, urinary leak 5%, and blood transfusions 11.8%. Postoperative complications: urinary tract infection 10.17%, wound infection 10.17%, pelvic hematoma 5.08%, deep vein thrombosis 1.69%, and one sudden death of unknown cause one month after surgery . Pathologic report: 49pT2b, 8 pT3 and 2pT4. Late complications: erectile dysfunction 85.7%, vesicourethral anastomosis stenosis 10.3%, and complete urinary incontinence 3%.CONCLUSIONS: Radical retropubic prostatectomy in patients with previous TURP is technically more difficult and has comparable outcomes to RRP patients without previous TURP.
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OBJECTIVES: To characterize theneurourological features of the vesicourethral dysfunction of patients with cogenital myelomeningocele when they reach the adult age.METHODS: We report the results of the neurourological physical examination and video urodynamic tests of 52 adult patients born with myelomeningocele, with ages ranging from 18 to 14 years (mean age 20.7) controlled over the last 14 years in the Urodynamics Unit of theHospital Gregorio Marañon in Madrid. The neurological level of the lesion was evaluated in all of them. Following these results we established the diagnosis of the lesion of the three constitutive elements of the vesicourethralinnervation (sympathetic, parasympathetic, and pudendal) in order to classify the lower urinary tract neurogenic dysfunction of the patients based on lesion level and type of damaged innervation.RESULTS: The alteration of the perineal sensitivity anddiminishment of the anal sphincter tone, in addition to absence of anal voluntary controlled and bulbocavernosus reflex, where the most frequent findings in the neurourological physical examination. Detrusor behaviour was predominantly areflexic (88.4%), in association with diminished bladder compliance in half of the cases. The sphincter was not competent during the filling phase in 51.9% of the cases, competent in 42.3%, and normal in the remainder 5.7%. During the voiding phase we confirmed the absence of sphincter relaxation in 82.6% of thecases. There was a predominance of the lower level of lesion in all three sympathetic, parasympathetic andpudendal nerves. In almost all patients (96.7%) there was lesion in at least two of the three types of innervation. The most frequent neurogenic dysfunction of the lower urinary tract was the multiple inferior motor neuron pure lesion (65.3%), also finding pure superior motor neuron (3.8%), mixed multiple (9.6%), and pure single lesions (1.9%). Three patients presented a normal vesicourethral function. CONCLUSIONS: We demonstrated the multiplicity of lower urinary tract neurogenic dysfunction in adult patients with congenital myelomeningocele, its occasionalabsence, the lack of correlation with the neurological level of the lesion, and the predominance of the multiple inferior motor neuron pure type of lesion.
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OBJECTIVES: The renal graft rupture (RGR) was first described in 1968; it is a severe situation,generally appearing in the immediate post-operative period.OBJECTIVES: To retrospectively analyze the incidence of renal graft rupture in the population of patients who underwent kidney transplant in the Renal TransplantDepartment of the Angerich Hospital.METHODS: 492 kidney transplants were performed from 1-1-1992 to 7-31-2005. 422 (85.7%) cadaver donor transplants and 70 (14.3%) live related donor transplants.RESULTS: 11 renal ruptures were observed, with a clinicalpicture characterized by sudden pain in the graft area, hypotension, and hematocrit descent. CT scan confirmedthe diagnosis. Seven patients underwent transplantnephrectomy (one of them 24 hours after surgical repair), another two were surgically repaired successfully, and for the other two patients a conservative management with watchful waiting also resulted in graft preservation. All cases where cadaver donor drafts.CONCLUSIONS: 1) The renal graft rupture is a rare (2.8% in our series) severe complication characterized by hemodynamic instability, with no diagnostic doubts about its presentation in most cases. We use ultrasound as the diagnostic test. 2) In our series we were able to preserve 40% of the kidneys with low morbidity. 3) This complication appeared in cadaver donor kidneys in all cases (11/386; 2.8%)
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OBJECTIVE: To review our experience in the endoscopic treatment of vesicoureteral reflux (VUR) in children with the subureteral injection of calcium hydroxy-apatite (Coaptite®).METHODS: The serie includes thirteen children whose age ranged between 6 and 13 years. The Coaptite ® implant was injected subureterally to 20 ureteral units (UU) affected by VUR grades I-IV. VUR was unilateral in six patients (46%), bilateral in seven (54%). There were 7 primary cases and 6 secondary to bladder dysfunction and duplex systems.RESULTS: Mean follow-up was 19 months (6-28 months). VUR was cured in 75% of cases after a single injection. A second injection resolved 2 out of 4 treated UU (50%) rendering a global success rate of 85%. This cure ratewas achieved for 13 and 7 procedures treating primary and secondary VUR, respectively. 77% of patients reported no adverse events with only 23% of them complaining of transient mild lumbar and hypogastric discomfort limited to the first postoperative day. In 2 children postoperative urinary infection was detected.CONCLUSIONS: Endoscopic subureteral injection with Coaptite® is a simple technique well tolerated in children. In 85% of primary and secondary cases cure was achieved with minimal morbidity.
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OBJECTIVES: The aim of this investigation was to evaluate the acrosome reaction by fluorescence microscopy and the flow citometry in a group of men with unknown fertility.METHODS: Each individual gave a semen sample for the analysis of the calcium ionophore-induced acrosomereaction after the capacitation process, using lectin Pisumsativum aglutinina (fluorescence microscopy) and antibodyanti-CD46 (flow citometry).RESULTS: Five of out six individuals increased the numberof the sperm with calcium ionophore-induced acrosome reaction versus the percentage of spontaneous acrosome reaction, using fluorescence microscopy (7.4 +/- 2.4 vs 22.5 +/- 10.1) and flow citometry (8.5 +/- 2.8 vs 25.4 +/- 6.0); On the other hand, the other individual the values of the acrosomal reaction with calciumionophore A23187 were similar to those of the spontaneousreaction. CONCLUSIONS: Both techniques are useful to evaluate the in vitro capacity of the spermatozoa to undergo acrosomalreaction, after the capacitation, without fusion between the sperm and the egg, but the flow citometry is more objective and allow the detection of a higher cell numbersof cells. On the other hand, although the individual that did not respond to the stimulus with calcium ionophore has unknown fertility, the obtained results allow to proposethat the evaluation of the acrosomal reaction could be a useful tool in the study of the men who consult for infertility.
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OBJECTIVES: The Nesbit technique is the reference technique for the surgical correction of the penile incurvation of Peyronie’s disease. We report our experience at the Centro Urológico San Ignacio.METHODS: 68 patients with stable penile incurvation who requested surgical correction. Correction of the curvature is defined as ≥ 80% rectification of the pathologic angle. Mean patient age was 44 years (31-77). 53% of the patients presented difficulties for penetration, 20% partner`s discomfort on intercourse, and 27% requested surgery for aesthetic reasons. Penile deviation was dorsal in 42% of the patients, to the left in 46% and to the right in 12%. The curvature angle was less than 30 ° in 28%, between 30º-45 ° in 36%, between 45 °-60 ° in 37% and> 60 ° in 7%.RESULTS: Mean follow-up of the series was 36 months. 20% of the patients had a penile shortening longer than 1.5 cm. 85% of the patients are satisfied with the results.The most frequent complaint was penile shortening.Correction was achieved in 92% of the patients. Four patients were reoperated: two of them for significantphimosis three months after surgery, and the other two for curvature recurrence.CONCLUSIONS: The Nesbit technique is a simpletechnique, with a low complication rate, and good results both in curvature correction and patient satisfaction.
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OBJECTIVES: To describe the laparoscopicexcision of a postchemotherapy retroperitoneal residual mass in a patient with mixed germ cell testicular tumor.METHODS/RESULTS: We report the operative techniqueof laparoscopic excision of a retroperitoneal mass in a 33 year old patient with mixed germ cell testicular tumor. The patient is placed in a lateral decubitus right lumbotomy position and trocars are introduced into the abdominal cavity. Once the retroperitoneum isapproached, and after a Kocher manoeuvre of theduodenum, the interaortocaval mass is identified andexcised. The operation is completed with lympadenectomydown to the common iliac artery bifurcation bilaterally.CONCLUSION: The laparoscopic approach is another option for the surgical treatment of residual masses after chemotherapy in testicular tumors. Nevertheless, previouslaparoscopic experience is necessary due to its difficulty.
Case Report
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OBJECTIVE: Given the low frequency oftesticular teratoma in relation to the rest of germ cell testiculartumors and the various treatment options for advancedstages, we report one case of advanced testicular matureteratoma with retroperitoneal adenopathy in whichorchyectomy was performed after retroperitoneal lymphadenectomy, with the same pathology found in the primary tumor.METHODS: We do an update on the treatment for these stages with the possibility of beginning with chemotherapy leaving lymphadenectomy for residual masses, or the contrary,being most cases treated in a mixed way.CONCLUSIONS: Without clear evidence for guidelines in these tumors, it is recommended to individualize the treatmentfor each patient, accordingly to tumor characteristics,probability of relapse and follow-up.
Case Report
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OBJECTIVE: We report a new case of renal metastasis of a lung carcinoma.METHODS: 59-year-old male presenting to the outpatient clinic with a clinical picture compatible with renal colic and hematuria.RESULTS: Ultrasound showed a solid-cystic tumor in the lower pole of the kidney without hydronephrosis. Abdominal-pelvic CT scan reported retroperitoneal adenopathies > 1 cm in the area of the aorta-cava and a 5 cm heterogeneous mass.CONCLUSIONS: Renal metastatic lesions of patients with lung cancer present more frequently due to the higher accuracy of radiological tests and have, as well as the primary tumors, very poor survival rates.
Case Report
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OBJECTIVE: We describe a rare case, the metastasis of a renal clear cell carcinoma in the corpora cavernosum of the penis.METHODS: 53-year-old patient presenting with a painful, hard tumor in the penis three months after right radical nephrectomy with cavotomy and thrombus excision.RESULTS/ CONCLUSIONS: Imaging tests and biopsy led to the diagnosis of metastasis of a renal carcinoma in the corpus cavernosum, which was confirmed on the pathologic study of the specimen after penectomy. The appearance of renal carcinoma metastases in the penis is generally associated with advanced tumor stage, therefore associated with bad prognosis as in the reported case.
Case Report
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OBJECTIVE: To report an interesting case of a rare complication of cystourethropexy, as well as its precisediagnosis and results after treatment.METHODS: We reviewed the medical records of thepatients as well as their operative report and she underwent outpatient follow-up for the following six months. Wedescriptively report the findings.RESULTS: It is the case of a female patient presenting a foreign body rejection of a suburethral tension free vaginal tape (TVT). She complained of severe pain in the immediate postoperative period, which led to retrieval of the tape in spite of a good continence result.CONCLUSIONS: Foreign body rejection is a rare complicationof vaginal tapes; it is rarely taken into account but it should be present in any exclusion diagnosis because the possibilityof tape retrieval is not always associated with recurrence of the incontinence.
Case Report
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OBJECTIVE: To report one case of VURD syndrome (posterior urethral valves, vesicoureteral reflux, and renal dysplasia) in an adult. METHODS: 32-year-old male patient with recurrent urinary tract infections and the diagnosis of VURD syndrome after imaging tests and cystoscopy. RESULTS: One year after valve resection the patient keeps renal function and adequate voiding without needing dialysis. CONCLUSIONS: The VURD syndrome is a congenital disease, frequently with poor prognosis in the first years of life. Etiology is not clear. A cause-effect relationship between dysplasia and obstruction-reflux has been proposed; alternatively, the “theory of the bud” suggests vesicoureteral reflux and renal dysplasia are the result of an anomaly of the ureteral bud and not necessarily of obstruction and/or VURD per se.
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OBJECTIVE: To report a case of prostatelymphoma and a brief review of the literature.METHODS/RESULTS: A 70 year-old mele patient wasreferred to the Urology departament with a clinical picture of prostatism, with acute urinary retention (AUR). Surgery with retropubic prostatectomy was performed, and pathology revealed a primary prostate lymphoma. The patient was referred to the departament of Oncology where he received polychemotherapy and radiotherapy. The patient is currently followed by regular visits to Urology outpatients service.The case study is followed by a brief bibliographic review, where we analyse clinical menifestations of this entity,complementary studies useful for diagnosis (laboratory test, trasrectal prostate biopsy, transuretral resection, ultrasound and computerised axial tomography), treatment options (surgery, polychemotherapy, radiotherapy) as well as survival in these patients.CONCLUSIONS: Of the cases reviewed, mean age at diagnosis was 57 years. Clinical debut was with prostate symptoms, with or without AUR and sometimes manifestations of renal failure due to obstructive uropathy, as well as general symptoms (astenia, anorexia, weight loss). PSA valuesremain unaltered in prostate lymphoma patients. Histologic diagnosis may be made by transrectal prostate biopsy, although transurethral resection (TUR) may be necessary for confirmation. Ultrasound and CT scan are of great utility for diagnosis of both local and distant tumors. From a therapeuticpoint of view, surgery for the obstruction of the lower urinary tract (TURP or retropubic prostatectomy) may be necessary, as well as the cyclophosphamide based polychemotherapy with corticosteroids and other cytostatic agents, andradiotherapy; intratecal chemotherapy has also been used adjuvant bone marrow transplantation.
Case Report
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OBJECTIVE: Lymphangiomas are lesions usually presenting during childhood and are located mainly in the head and neck region; less than 5% are intraabdominal. Lymphangiomatosis is the term used for multifocal or diffuse lymphangiomas.METHODS AND RESULTS: We report the case of a mesenteric lymphangiomatosis presenting as an acute abdomen in a 19-year-old man, review the literature and discuss the clinical management of these patients.CONCLUSIONS: Prognosis and treatment of these lesions depends of its site of origin and extension, being complete surgical excision the optimal treatment.
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OBJECTIVES: The aim of this study was to evaluate the importance of a) urethral and/or vaginal infections caused by common germs or Mycoplasmas, Chlamydia, Candida; b) age of patients; c) pelvic floor disorders in the development of irritative urinary symptoms in women.METHODS: 77 consecutive abacteriuric symptomatic female patients were compared with 55 asymptomatic women. A detailed micturition history and a genitourinary physical examination were performed. Urine samples as well as vaginal and urethral swabs were taken for cultures.RESULTS: No statistical difference was found between the two groups regarding both urethral and/or vaginal infections and pelvic floor disorders. Whereas a signifi-cant statistical difference was found in the age of the patients. In the symptomatic group the women were older than in the asymptomatic group.
