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OBJECTIVES: We report a retrospective review of the case series of Fournier’s gangrene treated in our department from November 1996 to October 2004. METHODS/RESULTS: We studied nine male patients with ages between 21 and 85 years (mean 55 years). 66% of the patients had associated risk factors, and the underlying cause was identified in 56% of the cases. Mean hospital stay was 21 days and two of the patients died from the disease. CONCLUSIONS: Fournier’s gangrene is an infection with a very fast evolution, producing necrotizing fascitis of the external genitalia and perineum. It has a high mortality rate, mainly if diagnosis and treatment are deferred. This last includes wide spectrum antibiotic coverage, surgical treatment with debridement and drainage, and, in many cases, a second surgical intervention for reconstructive plasties.
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OBJECTIVES: To analyze the importance of the starting time for pelvic floor physiotherapy in patients with post radical prostatectomy urinary incontinence.METHODS: Between May 2003 and February 2004 18 patients with the diagnosis of post radical prostatectomy urinary incontinence underwent physiotherapy of the pelvic floor. Each patient received 12 sessions using kinesitherapy and electric stimulation on a weekly basis. Patients were divided into two groups: Group 1 included eight patients that started therapy within the first six months after surgery; Group 2 included 10 patients starting therapy after the sixth post operative month. All patients were evaluated by the pad test and number of incontinence pads per day.RESULTS: Evaluating pad tests before and after treatment, six patients in group 1 had a reduction of the amount of urine leak in comparison to seven patients in group 2. The statistical analysis showed significant differences before and after treatment for both groups (group 1: p = 0.028; group 2: p = 0.018). The evaluation of the number of pads showed: Group 1: all eight patients using pads had a reduction in the number of pads. Group 2: 5 of the eight patients using pads had a reduction and the other three continued using the same number. Statistical analysis comparing the number of pads per day before and after treatment showed a significant difference in group1 (p = 0.004). There was no statistically significant difference in the number of pads per day before andafter physiotherapy in group 2, although half of thepatients showed a diminishment in the number of pads required after treatment.CONCLUSIONS: Results demonstrate that early indication of physiotherapy for the treatment of post radicalprostatectomy urinary incontinence is better than delayed treatment. New works may be developed in the future to confirm our results.
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OBJECTIVES: We report two exceptional cases of metachronous adrenal metastasis of renal cell carcinomas and perform a bibliographic review. After the evaluation of various features such as frequency, etiopathogenesis, diagnosis and follow-up of these patients we conclude that these metastases are rare, and they usually appear late in the evolution of patients with low stage renal cell carcinoma.RESULTS/CONCLUSIONS: Once reviewed the treatment and checked the absence of guidelines for the therapeutic management of these patients we propose surgery for the adrenal metastasis as well as adjuvant treatment with immunotherapy.
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OBJECTIVES: The squamous cell carcinoma of the bladder is a rare tumor in our environment, representing between 1.6-6.7% of all bladder neoplasias. It is more common to find foci of squamous differentiation associated with a transitional cell carcinoma.METHODS: We retrospectively review all squamous cell carcinomas diagnosed and treated in our hospital between 1994 and 2004. We analyze their biological behaviour and the treatment applied.RESULTS: We found 11 cases of squamous cell carcinoma of the bladder, which pathologically were pure squamous cell carcinomas in eight patients and mixed in another three. Mean patient age was 70.9 years ranging from 49 to 88 years, six of them were males and five females. All of them presented locally advanced tumor stages at the time of diagnosis (≥T2). Although the treatment of choice is radical cystectomy, it could only be applied in three patients; it was associated with adjuvant chemotherapy in one patient. The rest of the patients were treated by transurethral resection of the tumor, with adjuvant radiotherapy in two cases and bilateral cutaneous ureterostomy in one due to the advanced stage. Mean survival was 20 months ranging from 1 to 91 months. Only two patients are alive, both after radical surgery.CONCLUSIONS: The squamous cell carcinoma, in both its forms, pure and mixed, is an aggressive tumor. The late diagnosis of these tumors and their biological behaviour entail a bad prognosis. Only early diagnosis and radical treatment may improve prognosis.
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OBJECTIVES: Currently, there is not agreement about the adequate tension for each patient with female stress urinary incontinence treated with urethral slings. The adjustable tension sling Remeex (external mechanic regulation) allows adjustment to ideal tension trying to avoid or minimize possible reoperations. The objective of these paper is to describe the components of the Remeex system, its indications, and the surgical technique to implant and adjust it.METHODS: Indications: The Remeex system is indicated for female urinary incontinence in cases of urethral hypermobility, fixed urethra, primary sphincteric dysfunction, failure of other incontinence repaired techniques, and urinary incontinence in bladder hyperreflexia. Studyprotocol: The diagnosis is made with appropriate history and physical examination and completed with voiding cystourethrogram and urodynamic study, urinary tractultrasound and, optionally, urethrocystoscopy. Remeex prosthesis characteristics: The system has three elements: polypropylene mesh, pressure tensor, and disconnection tool.TECHNIQUE: 1. Anesthesia: It maybe performed under general or spinal anesthesia. 2. Preparation and patient position. 3. Surgical technique step-by-step: - Abdominal access: 4-6 cm suprapubic incision and development of a supra- aponeurotic space to place the pressure tensor. - Vaginal access: longitudinal incision 1 cm from the urethra meatus, dissection of the vesicovaginal plane, and development of the space to place the polypropylene mesh. - Combined abdominal-vaginal access: bilateral punction with a 20 cm suture-passing needle from the abdomen to the vagina and passage of the mesh from the paraurethral espace threading its sutures in the pressure tensor system, and closure of the incisions. - Cystoscopy. - Tension adjustment and postoperative control.CONCLUSIONS: 1. It is an easy to implant system and a reproducible operation. 2. This technique avoids the morbidity of abdominal operations. 3. It allows the readjustment after surgery through a small suprapubic incision under local anesthesia. 4. Good results have been described in the short and mid-term.
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OBJECTIVES: The retroperitoneoscopic approach enables adequate vision of the renal fossa and retroperitoneal structures. Our objective is to support the performance of renal biopsies through a retroperitoneoscopic approach in those pediatric surgery departments still doing open biopsies.METHODS: We performed 53 renal biopsies through a retroperitoneoscopic approach. Twenty-eight patients were males and 25 females, with ages between 13 months and 19 years (mean age range 4 years). The biopsies were indicated after the following diagnosis:nephrotic syndrome (n = 20), hemolytic-uremic syndrome(n = 3), hematuria (n = 15), idiopathic purpura (n = 2), proteinuria (n = 13). Ten patients were in renal failure. We performed our technique of retroperitoneoscopic approach in all cases.RESULTS: Adequate exposure of the kidney was achievedin all cases, and the biopsy sample gave a pathologic diagnosis after immunohistochemical and morphologic studies. One case was converted to open surgery due to bleeding from the kidney. In 51 cases the estimated blood loss was lower than 20 cc. No drainage was necessary after surgery. Mean hospital stay was 48 hours for the first 20 cases and between 24-36 hours for the remainder.CONCLUSIONS: The Retroperitoneoscopic renal biopsyis an adequate procedure for the pediatric patients and represents a real alternative to open biopsy, and in cases of contraindication for ultrasound guided percutaneous biopsy, because: 1. It offers an excellent exposure of the kidney. 2. It obtains a kidney sample enough for the study. 3. The morbidity associated with the procedure is minimal. 4. Diminishes the hospital stay and shortens the time to return back to normal life.
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OBJECTIVES: To report the first case of bladder diverticulectomy in a female patient.METHODS: 74-year-old female patient with a two-year history of recurrent lower urinary tract infection and the diagnosis of big bladder diverticulum. A laparoscopic bladder diverticulectomy was performed.RESULTS: Operative time was 90 minutes. The patient had a satisfactory outcome with the drainage being retrieved on postoperative day three and discharged home the same day with bladder catheter. The catheter was retrieved on postoperative day 7. Cystography showed a normal bladder without diverticulum.CONCLUSIONS: We considered that laparoscopic surgery of the bladder diverticulum is an alternative, completely comparable to classic surgery, and it should be considered an option in the management of bladder diverticula requiring surgery.
Case Report
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OBJECTIVE: To report one case of penile abscess, with special reference to diagnostic and therapeuticaspects.METHODS: One case of penile abscess is presented in a patient referred for penile swelling.RESULTS: During surgical exploration it showed to be acorpora cavernosum rupture with drainage of a small volumeof purulent fluid.CONCLUSIONS: Penile abscess is uncommon. Highfrequency ultrasonography is a reliable diagnostic imaging method. We were able to incise the affected area of the corpus cavernosum and glans safely, and with appropriate antibiotics this patient was treated successfully
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The thyroid metastasis of renal carcinoma is a very rare entity; in most cases, the diagnosis is obtained after necropsy. We report one clinical case of thyroid metastasis from a renal carcinoma presenting as a cold node seven years after nephrectomy. We perform a biblio-graphic review.
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OBJECTIVE: Certain pathologic entities should be ruled out in the diagnostic work up of hematuria,because they are so rare that if they would not share diagnostictests with more frequent urological diseases they could be missed. The cavernous haemangioma of the bladder is one of them.METHODS: We report the case of a male patient presentingwith rectal bleeding and hematuria with the diagnosis of rectal-vesical cavernous haemangioma. RESULTS: After 8 years of follow-up he did not need surgicaltreatment, only blood transfusions at the time of diagnosis.He has self limited episodes of hematuria not requiring aggressive therapy.CONCLUSIONS: The cavernous haemangioma of the bladder is a rare disease presenting as bleeding bladder excrecent lesions that do not require surgery as first treatmentoption if the bleeding is not life-threatening.
Case Report
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OBJECTIVE: The presence of signet ring cells within a transitional cell carcinoma is a factor of poor prognosis.METHODS: We report the case of a 69-year-old male patient with the diagnosis of high grade transitional cell carcinoma with signet ring cell pattern, the presence of which could have been foreseen in serial cytological tests performed after the clinical debut.RESULTS: To achieve such a diagnosis, it is necessary to rule out the possibility of metastasis or infiltration of a neoplasia from other organ.CONCLUSION: Both the presence of an in situ neoplasia or the coexistence of infiltrative transitional cell tumor can help to determine primary origin of these neoplasias.
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OBJECTIVE:To report one case of microlithiasisdiagnosed by Uro-CT scan (with multidetector CT scan).METHODS: We describe the case of a middle age male patient with symptoms of renal colic and hydronephrosis without and objective cause detected on IVU who underwentCT scan.RESULTS: The Uro-CT scan showed a 2 mm microlithiasis in the most distal portion of the left ureter with edema of the adjacent area causing obstruction.CONCLUSIONS: The Uro-CT scan is an useful imaging technique for the diagnosis of microlithiasis, which can be missed by other imaging tests.
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OBJECTIVE: We report two cases with thepathologic diagnosis of cystic adenoid carcinoma of theprostate, an extremely rare tumor.METHODS: We evaluate two patients with different age,clinical presentation, diagnosis, treatment and outcome.RESULTS: The ages were 41 and 59, the symptoms perinealpain and lower urinary tract symptoms, on digital rectalexamination a round hard tumor mass and normal exam,respectively. PSA and prostatic acid phosphatase werenormal; Transrectal ultrasound may be normal or find ahypoechoic node. The first patient underwent radicalprostatectomy and adjuvant immunotherapy; six years aftersurgery he developed lung metastasis and died. The secondpatient underwent radical cystoprostatectomy with orthotopicurinary diversion with good outcome after two years offollow-up.CONCLUSIONS: The clinical presentation is non specific,with the diagnosis generally obtained by transurethralresection or transrectal biopsy after the suspicion of anabnormal digital rectal examination or ultrasound. The tumoris immunoreactive to p53 and citokeratins 7 and 34 BetaE12, and the treatment of choice is radical cystoprosta-tectomy because it is a potentially aggressive neoplasia;adjuvant treatment may be added
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OBJECTIVE: An uncommon association of renal cell carcinoma in a pelvic kidney is described, the literature is reviewed.METHODS: A case of renal cell carcinoma in a pelvic kidney is presented, and the literature briefly reviewed, with special reference to six cases reported.RESULTS: Renal cell carcinoma in a pelvic kidney isuncommon, the paucity of previous reports of this associationis surprising. Besides renal cell carcinoma is the most commonmalignant renal tumour in the adult and renal ectopy is relatively common more cases of this association would be expected.CONCLUSIONS: Renal cell carcinoma is the most commonmalignant renal tumour in the adult and renal ectopy isrelatively common, the actual incidence among autopsy series is 1 in 900, it has been an uncommon association, with only six cases reported. The surgical approach toectopic kidneys merits caution because of the uncertainvascular anatomy, and vascular studies may be indicated to avoid complications, the present case is important becauseit represent the most common urological cancers at ourinstitution with an unusual presentation.
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OBJECTIVE: Serotonin and norepinephrine systems are involved in the neural control of lower urinary tract function. The aim of this study was to compare the response on striated anal sphincter electromyographic (SAS-EMG) activity and cystometric parameters, when duloxetine and clomipramine were intravenously administrated.METHODS: The effects of intravenous 1 and 2 mg./Kg. duloxetine or clomipramine on lower urinary tract function were studied in a total of 32 male and 32 female rabbits, under nonirritative conditions (intravesical infusion of saline) and in a model of bladder irritation (i.e., transvesical infusion of 0.5% acetic acid). A transurethral double-lumen catheter in male rabbits, and a subcutaneous cystostomy in female rabbits, were used for liquid infusion and recording of intravesical pressure during a cystometrogram. Simultaneously, SAS-EMG was recorded through electromyography electrodes placed in the perianal striated muscle.RESULTS: Cystometric parameters: Under irritative conditions, 2 mg./Kg. clomipramine in male rabbits and 1 or 2 mg./Kg. in female rabbits, depending on the dose, increased bladder capacity (BC), contraction duration (CD) and intercontraction interval (ICI), and decreased baseline pressure (BP). In male and female rabbits, duloxetine dose-dependently increased BC, CD and ICI. Under nonirritative conditions, clomipramine at 2 mg./Kg. and duloxetine dose-dependently solely increased BC in female rabbits. Electromyographic activity: A marked effect on SAS-EMG activity of duloxetine under irritative conditions was revealed in male and female rabbits. Under these conditions, clomipramine increased SAS-EMG activity only in female rabbits. Under nonirritative conditions, 2 mg./Kg. duloxetine increased SASEMG activity only in female rabbits. CONCLUSIONS: The stronger effects on the SAS-EMG activity were produced by duloxetine in female rabbits under irritated bladder conditions. Clomipramine, under irritative conditions, had a relaxing effect on intravesical pressure, which is not the case with duloxetine.
