OBJECTIVES: To show the beginning of the General Hospital of Madrid, its localization, economical problems and medical protagonists, mainly the first medical director: Dr. Perez de Herrera. Also, to show its scientific and health-care contributions to the people of Madrid and other cities, coming in the search for training or health-care.METHODS: We reviewed writings and books from well-known doctors, experts on history of medicine, anddocuments about the old and new Madrid and itsmonuments.RESULTS AND CONCLUSIONS: The history of this hospital, medical school and temple, is engaged with the history of Madrid’s provincial Charity.Economical difficulties were great to subside. At the end of the 19th century one of the eldest urology departments in Spain was consolidated.
OBJECTIVES: To confirm the results of previous studies demonstrating the morphology of the levator ani muscle in the living subject is different to that described in classic anatomical works; to evaluate the anatomical-morphological differences of the pelvic floor between nulliparous and multiparous women in order to analyze the influence of pregnancy and delivery.METHODS: Comparative study of the morphological variations of the iliococcigeous fascicle of the levator ani muscle between two groups of females using T2 MRI: the first group included 11 nulliparous women and the second group 9 multiparous women. The curvature radium of the fascicles was calculated in the frontal projections. The differences in height were also calculated. The anterior limit of the iliococcygeal muscle dome was determined in the sagittal plane. The software Image Tool 3.0 was employed for the measurements. The Kolmogorov-Smirnov test was employed to analyze the distribution of the study populations; mean value comparisons between groups were performed by the Student`s t test. Finally, the various morphological measurements were compared in relation to various parameters: parity, side, body mass index (BMI), sports practice, menstrual cycle phase, and presence or absence of episiotomy. Data obtained were analyzed using the Fisher’s exact test, with a statistical significance of p>0.05.RESULTS: Morphological measurements: We observed that the concavity of the iliococcygeal fascicle dome is larger in nulliparous women (p = 0.03 for the right side and p = 0.04 for the left). Moreover, these women have the domes significantly more anterior (p>0.001 for both sides). Comparisons between other variables: an association between nulliparous status and the presence of a higher and more anterior left dome, and multiparous status and a higher and more anterior right dome were (p = 0.02).CONCLUSIONS: The hypothesis of the pelvic floor morphology being a double dome with inferior-posterior concavity in the living asymptomatic female is confirmed. We also demonstrate the existence of anatomicalmorphological differences in the iliococcygeal muscle of the levator ani between nulliparous and multiparous females, which seems to confirm a relationship with pregnancy and/or delivery.
OBJECTIVES: To report a series of patients with bladder inverted papilloma, pointing out the clinical features, presentations, treatment options and outcomes. We also perform a bibliography review oriented to the diagnostic criteria, treatment options and prognosis of the inverted papilloma. METHODS: We reviewed the medical charts of all patients with the diagnosis of bladder inverted papilloma treated by our group between July 1996 and June 2003. RESULTS: 16 cases of inverted papilloma of the bladder were diagnosed in ten males and six females, with a mean age of 53.1 yr. (range 31-72). The most frequent reason for consultation was voiding urgency (43.7%), followed by hematuria (37.5%). In 14/16 patients the lesion was localized in the bladder trigone. Transurethral resection of the lesion was performed in all patients. Two cases (12.5%) presented associated transitional cell carcinoma. CONCLUSIONS: The inverted papilloma is a rare pathologic entity. Despite the absence of agreement about its aggressiveness or innocuousness we consider its potential malignancy should be taken into consideration after the evidence of recurrences and its association with transitional cell carcinoma.
OBJECTIVES: The new immunosuppressiveregimens in kidney transplantation have diminished the rate of acute rejection and improved graft survival. However, the use of new agents results in the development of surgical complications. The authors analyze theincidence of such complications accordingly to the type of drug.METHODS: This study included 350 kidney transplantations performed between January 1997 and December 2004. The average age was 54 years. The incidence of diabetes mellitus was 8.5% and the rate of obese recipients (BMI> 30 kg/m2) was 15.4%. The average follow-up rate was 44+/- 5.6 months (5-96). A surgical complication was defined as any complication directly related to the surgical transplant that occurs along the first year after transplantation.RESULTS: The incidence of surgical complications was 34.8% (122/350). The rates of perigraft collections and bleeding posttransplant were significantly higher in the CsA group than in the Tacro one: 12% vs. 3.8% (p=0.005) and 11.5% vs. 3% (p=0.002). The Sirolimus and Everolimus-based immunosuppresive regimens led to a higher incidence of lymphocele (16% vs. 3.7%) (p= 0.012). There were no significant difference in theincidence of surgical complications in recipientsimmunosuppressed with and without MMF, and in diabetic vs. no diabetic patients. Surgical complications werehigher in obese patients (66.5% vs. 33.5%) (p= 0.002).CONCLUSIONS: Recipients receiving Sirolimus/Everolimus demonstrated a significantly higher lymphocele rate. The CsA regimens were associated with bleeding and post transplant pararenal fluid collections. The introduction of MMF did not result in a significant increase in posttransplant surgical complications. The obesity was a risk factor associated with those complications.
OBJETIVO: La disfunción del tracto uri-nario inferior puede repercutir sobre el tracto urinariosuperior con la producción de reflujo vesicoureteral. Elobjetivo de nuestro estudio es valorar qué tipo de alte-raciones del tracto urinario inferior se asocian a reflujovesicoureteral en el adulto.MÉTODOS. Se realizó un estudio transversal (“crosssectional study”) en una muestra de 236 pacientes (149varones y 87 mujeres), de edad media 45, 5 años(desviación típica 19,0 años), remitidos para estudiovideourodinámico por síntomas funcionales del tractourinario inferior. Los pacientes fueron sometidos a unahistoria clínica, exploración neurourológica, cistomano-metría asociada a videocistografía de llenado, estudio presión/ flujo asociado a videocistografía miccionaly electromiografía selectiva del esfínter periuretral. Elanálisis estadístico se realizó mediante el test de la chi-cuadrado.RESULTADOS: Se observó la presencia de reflujo vesi-coureteral en 19 pacientes (8,1 % de la muestra). En15 casos (79%) el reflujo tuvo lugar durante el llenado,en 3 casos (16%) durante la micción, y en 1 caso (5%)en ambas fases. Se comprobó la existencia de una dis-función neurógena vesicouretral en 8 casos (42 %), noexistió disfunción neurógena vesicouretral en 11 casos(58%). El reflujo vesicoureteral se clasificó como pasivoprimario (sin alteración urodinámica que lo justifique)en 1 caso (5%), pasivo con acomodación disminuidaen 4 casos (21%), pasivo evolutivo en 3 casos (16%),activo involuntario en 7 casos (38%), activo asociadoa obstrucción orgánica del TUI en 1 caso (5%), activoasociado a potencia contráctil elevada en 1 caso (5%),y por prensa abdominal en 2 casos (10%). Se compro-bó que las únicas alteraciones urodinámicas asociadasa un aumento significativo de la prevalencia de reflujovesicoureteral fueron: una presión de llenado, a máximacapacidad, superior a 12,5 cm H 2 O (que aumentó laprevalencia de reflujo 7 veces) y la micción con prensaabdominal que aumentó la prevalencia de reflujo 2,8veces.CONCLUSIONES: La mayoría de los pacientes consíntomas funcionales del tracto urinario inferior y reflu-jo vesicoureteral asociado, presentan disfunciones deltracto urinario inferior que podrían justificar su reflujo.Sin embargo, sólo se comprobó un aumento estadísti-camente significativo de la prevalencia de reflujo vesi-coureteral en los pacientes con presión de llenado amáxima capacidad superior a 12,5 cm H 2 O y en aque-llos que realizaban la micción con prensa abdominal
OBJECTIVES: The system enables a non endoscopic, outpatient treatment of the female stressurinary incontinence. The article intends to familiarize the readers with the procedure.METHODS: We describe the technique, graphically, with all steps, and perform a bibliographic review.RESULTS: In accordance to the main clinical studiesreviewed, the periurethral injection of dextranomer/hyaluronic acid copolymer has an efficacy of near 75%, with a simple, reproducible technique with rare adverse events.CONCLUSIONS: The treatment with this type of periurethralinjections may be valid as a minimally invasive treatment of the female stress urinary incontinence, because of its efficacy, tolerability and reproducibility.
OBJECTIVES: The usual laparoscopic hand assisted nephrectomy procedure requires either two or three trocars and a small incision to extract the organ. Our experience reveals that surgical invasion is significantly less when we use only one trocar and a retroperitoneal approach.METHODS: We start with a small low oblique incision close to the pubis and insert a trocar over the iliac crest. When the kidney is free we grasp the undissected vascular pedicle between thumb and middle finger and without moving the inserted hand, we remove the telescope and introduce the stapler. The index finger is used blind to check that the stapler is correctly positioned before triggering. Finally, we divide the ureter in the same way. We have carried out 74 nephrectomies with this procedure.RESULTS: The mean operative time was 67.12 minutes. A retroperitoneal haematoma occurred in one patient and was drained by the same approach without further incident. One patient had an intestinal occlusion that in the reoperation was found to be caused by a loop of intestine trapped in a peritoneal tear: the postoperative was satisfactory. We lost one patient: an 89-year-old lady with a pyonephrosis and a retroperitoneal abscess. The operation was uneventful, but the patient died after five days; possibly because of septic shock. The other patients had no significant complications.CONCLUSIONS: The use of only one trocar markedly reduced operative invasion. The blind division en-bloc of the pedicle saves valuable time and does not offer any additional risk. The possibility of an arterio-venous fistula is remote because the stapler leaves the artery close to the vein, but separated from it. Cost is minimal because the surgeon only needs one trocar and a stapler. Consequently, we believe that this procedure with only one trocar could also be safely adopted for living donor nephrectomy.
OBJECTIVE: To report one case of idiopathic granulomatous orchitis, an extremely rare disease, in a 76-year-old patient.METHODS/RESULTS: The pathology department received a testicle with the clinical/radiological diagnosis of testicular tumor. The pathologic study showed absence of neoplasias and presence of morphological findings compatible with idiopathic granulomatous orchitis.CONCLUSIONS: The idiopathic granulomatous orchitis is an entity of unknown etiology, clinically or ultrasonographically not distinguishable from testicular neoplasias, the diagnosis of which is made after orchiectomy.
OBJECTIVE: Primary penile leiomyosarcoma is a rare entity. Since 1930 only 30 cases have beenreported in the bibliography. We wanted to add a new case to the international literature, in addition to a review of all available publications on the topic from 1957. A 54-year-old patient presented with a lobulated 8x4x3 cmlesion in the balanopreputial groove over two years; he was treated initially with partial penectomy and subsequently with total penectomy. We analyze the evolution, progression and adjuvant treatments of this rare pathology.METHODS/RESULTS: We report one case with its clinical presentation, diagnostic tests performed for staging, treatment and follow-up.CONCLUSIONS: The first case of penile leiomyosarcoma was described by Levi in 1930. In 1957 Ashley and Edwards reported the first case in the British literature and in 1963 Pack reported the first in the American literature. MacKenzie et al. were the first to recognize two types of leiomyosarcoma: superficial and deep. The first develop from smooth muscle cells from the superficial dermal layers of the glans penis or distal third of the penis, they aregenerally asymptomatic and less malignant, rarely invading deeper structures and without involvement of the urethra on physical exam. The best prognostic predictors are type of tumor at presentation (superficial vs. deep) and treatment choice, being total penectomy more effective for failures of local resections than for primary treatment of deep tumors.
OBJECTIVE: We report two cases of penile fracture; one case with associated rupture of the corpus spongiosum and complete urethral section, and the other presenting a second cavernous fracture three years after a ﬁrst episode.METHODS: The ﬁrst patient, 32 years old, suffered the fracture of the right corpus cavernosum during intercourse three years after a ﬁrst fracture requiring surgical repair. This time he also underwent surgery immediately to ﬁnd and repair the lesion, with good functional outcome. The second patient,29 years old, suffered a transverse fracture at the bases of both corpora cavernosa associated with complete section of the urethra. He underwent emergency surgery to repair all lesions with good esthetic and functional results.RESULTS: Traumatic lesions of the penis with fracture of the corpora cavernosa are rare and the association with urethral rupture is exceptional, as well as it is the possibility of second fracture years after a ﬁrst episode.CONCLUSIONS: Penile fracture is a rare reason for consultation in the emergency setting, which should be repaired immediately with evacuation of the hematoma, closure of the albuginea’s lesion and repair of the urethral lesions when they appear. Results are better, avoiding mid and long-term complications.
OBJECTIVE: We report one case of metastaticdissemination of a rectal adenocarcinoma to the prepuce.METHODS: 61-year-old patient with the diagnosis of rectaladenocarcinoma treated 18 months before by surgery andchemotherapy. He presents with a painful enlargement ofthe penis associated with outgrowing erythematous lesionsin the skin of the prepuce that bled on touch and did notallow the vision of the meatus and the glans penis. Physicalexamination showed the presence of hypogastric, penileand scrotal lymphedema. Circumcision was performed.RESULTS: The pathologic study reported a moderatelydifferentiated intestinal type adenocarcinoma with highmitotic index infiltrating the squamous cell flat epithelium ofthe prepuce.CONCLUSIONS: Although extremely rare, tumor implantsin the prepuce secondary to extra urologic tumors areexceptional. Surgical excision confirms the origin and mayavoid bleeding and discomfort, and also may help withcatheterization, which is many times necessary in the finalstages
OBJECTIVE: Our purpose is to report a case of renal hydatidosis and its treatment.METHODS: The characteristics of the case are presented and discussed.RESULTS AND CONCLUSIONS: The hydatic disease is a parasitic infestation caused by the larvae from echinococcosis granulosus. The kidney ranks third among all viscerallocalitations, compromising only 2% to 4% of all cases. Most of patients are asymptomatic for years and the correct preoperative diagnosis is difficult.
OBJECTIVE: To report one case of synchronicprostate cancer and bilateral renal tumors, radiologically suggestive of renal cell carcinoma.METHODS: We present the case of a 63-year-old diabetic male, heavy smoker, who presents at the outpatient office complaining of right upper quadrant abdominal pain and mild obstructive voiding symptoms. Abdominal examination was negative and digital rectal examination revealed a rock hard irregular prostate.RESULTS: The prostatic biopsy showed a moderatelydifferentiated prostate adenocarcinoma. Abdominal ultrasoundshowed the existence of a 6 cm heterogeneous complex tumor at the lower pole and middle portion of the rightkidney, and another at the upper pole-middle left kidney. CT scan confirmed the tumors, which enhanced with contrast. Chest x-ray and bone scan were negative for metastases. Two fine-needle aspiration biopsies of the right kidney tumor were unsuccessful and patient refused to undergo further diagnostic procedures. Treatment for the prostate cancer with LHRH analogues and antiandrogenic drugs was started. The three-month follow-up CT scan showed no variation.CONCLUSIONS: Despite the absence of a histological diagnosis due to refusal of the patient, CT scan images are typical of bilateral renal cell carcinoma, supporting the idea that in the presence of a genitourinary neoplasia we should suspect and rule out a synchronic second tumor of the same apparatus.
OBJECTIVE: To report the case of an epididymaland spermatic cord metastasis of a colon adenocarcinoma.METHODS/RESULTS: We present the case of a 67 years old man, who presents several months after subtotal left colectomy for a left colon adenocarcinoma (pT3 NoMo), with a symptomatic right palpable testicular tumour. Right orchiectomy was done, demonstrating colon adenocarcinomametastasis.CONCLUSIONS: Epididymal and spermatic cord metastasesare very infrequent and they usually are found incidentally after prostate cancer orchyectomy.
OBJECTIVE: The aim of this case report is to add to the literature a new case of renal actinomycosis,but with a form of presentation that has never beenreported: renal tumor with retroperitoneal bleeding.METHODS/RESULTS: We present the case of a 27 yearold woman, with a 5-month history of general syndrome and right flank pain. Radiological findings showed a right renal tumor with suspicious of retroperitoneal bleeding. Right radical nephrectomy was performed and thepathological examination of the specimen foundactinomyces colonies. The patient received 8 weeks of Penicillin after surgery and had none sequelae.CONCLUSIONS: Renal actinomycosis is an uncommon chronic infection caused by a gram-positive anaerobic actinomyces bacteria, usually actinomyces israelii, not easily diagnosed because of non-specific clinical andradiological findings. Early diagnosis of renal actinomycosisis important to avoid surgery since actinomyces respond well to high doses of Penicillin.