OBJECTIVES: Female urethral divertilumis a rare disease; its diagnosis has increased with theuse of new diagnostic technologies. It must be suspectedin women consulting for chronic irritative symptomswithout response to conventional treatments.Transvaginal surgical excision is the most acceptedtherapeutic option. We reviewed their clinical presentations,diagnostic findings, and therapeutic options and reportour experience.METHODS/RESULTS: We retrospectively reviewed ourcase series, finding 4 patients with the diagnosis offemale urethral diverticulum; we performed a bibliographicreview.CONCLUSIONS: Urethral diverticulum is a rare clinicalentity which has to be included in the differential diagnosisof women with chronic lower urinary tract symptoms.Clinical presentation may vary from asymptomatic torich voiding symptoms. The most frequently useddiagnostic method is voiding cystourethrogram; othertechniques such as transvaginal ultrasound or MRI arevery useful for complicated cases. Surgical treatment bytransvaginal diverticulectomy with closure in severallayers is the most frequent approach. Postoperativecomplications are rare.
OBJECTIVES: The article focuses on themultilocular cystic renal carcinoma, the most frequent ofthe renal cystic carcinomas. The importance of performing aseparate analysis of these cystic tumors comes from theirbetter prognosis some authors have suggested.Moreover, they are frequently difficult to differentiatefrom multilocular benign cysts and other benign lesionsby radiological studies, cytology or even during surgery.Pathologic study is essential for a definitive diagnosis ofthe lesion. METHODS AND RESULTS: We reviewed 14 cases ofmultilocular cystic renal carcinoma obtained from theseries of 191 renal cell carcinomas diagnosed in ourhospital in the period 1995-2002. Inclusion criteriawere existence of a multicystic complex mass, in whichclear cells partially or completely covered the cysticwalls and accumulate within the septa.CONCLUSIONS: The lack of well-documented casesof multilocular cystic renal carcinoma with metastasessupports the fact that they are tumors with a very goodprognosis. In conclusion, data from both literature andour series support that multilocular cystic renal carcinomashould be considered a low-grade neoplasia, and itstreatment should be conservative.
OBJETIVE: To evaluate the efficacy ofradiotherapy to the prostatic bed in patients withbiochemical recurrence prostate cancer after radicalprostatectomy.METHODS: We analyse the outcomes of 292 patientswho underwent radical prostatectomy for localizedprostate cancer T1-T2 between January 1992 and June2003, with an average folow-up of 36 months (range 6 months to 12 years). We detected biochemical recurrence(PSA> 0.20 ng/ml) in 75(26%) patients. 75 patientswith biochemical recurrence, 9 (12 %) were diagnosedof local recurrence by the following criteria: a) First PSAobtained 6 weeks after radicalprostatectomy < 0.20 ng/ml. b) Time to biochemicalrecurrence > 6 months. c) Prostate specific antigen doublingtime> 6 months. d) Prostate specific antigen velocityafter radical prostatectomy < 0.75 ng/ml/year. e)Prostate specific antigen level after radical prostatectomy< 2.5 ng/ml. The 9 patients diagnosed of local recurrencereceived an average dose of 56.42 Gy to the prostatebed.RESULTS: Of all 9 patients with local recurrence,8(88.8%) have complete response with a mean followupof 30 months (12-36 months). The time between theradiotherapy and the response, in patients with completeresponse, was lower than 3 months in 7 patients and12 months in 1 patient. Significant adverse effectsassociated to radiotherapy were not observed.CONCLUSIONS: Salvage radiotherapy may be beneficialin selected patients with local recurrence. The characteristicsof prostate specific antigen elevation are useful indistinguishing men with local recurrence from those withdistant metastases.
To perform a historical introduction anda review of the mathematical model, emphasizing thatour mathematical model may be the solution to the viscoelasticmodel.It is evident that the same experiment has been repeatedover half a century, with similar results in all cases.We also show one of the projects we are working on:the electro-vesicogram for the evaluation of the fillingphase, and Doppler uroflowmetry for the study of thevoiding phase.METHODS: We have chosen and studied in depth theresults Dr. Virseda presents in his thesis of one of theexperiments performed in relation to the viscoelasticmodel. After applying analytical methods we reach adifferential equation we suppose defines detrusor behaviour,as it has been explained by the viscoelasticmodel.The solution of this equation by means of the Laplace’stransform enables to obtain the values of the incognitasset by urodynamics. Besides, we analyzed the behaviourof solutions´ stability using a matricial method followingthe Lyapunov theory. The former may solve theincognitas for the voiding phase. We used urethralDoppler with simultaneous uroflowmetry to obtain thedata equations demanded; this is what we named“Doppler uroflowmetry”. The filling phase was studiedby superficial electromiography. We named it “electrovesicogram”.We attach images for both doppler waveand electrovesicogram. They both are the projects weare working on.RESULTS: Currently we can only explain the methodologywe are following. Indeed, this article is the first ofa series in which we aim to explain the methodologywe are following in detail: Doppler wave capture;mounting process photogram by photogram, and vectorizationand cleaning of the wave, either Doppler orflow waves; treatment in autocad to obtain the vector;and management of the vector with the matalab software,which gives us the results we are looking for.CONCLUSIONS: It is intuitive to deduct the usefulnessof these methods as not invasive techniques in the urodynamicdiagnosis. We have our illusions in these projectswhich open a window to the future.
OBJECTIVES: To review the evidencecurrently available to establish the pathogenic connectionbetween erectile dysfunction (ED) and cardiovasculardisease (CVD), and the effects this scientific progresshas introduced in the classical impotence urology clinic.METHODS: We reviewed the most recent publicationsabout this disease (2000-2004) and the concept ofendothelial dysfunction by appropriate MEDLINEsearches, with specific selection of reviews and clinicalpractice guidelines.RESULTS: The fact that ED and CVD share risk factors isconfirmed; the pathogenic unity of both processeshaving endothelial dysfunction as the underlying problem;anticipation of ED over CVD in time of presentation;notable increase of research about this issue over thelast two years; the change of scenario in the impotenceurology clinics due to these findings.CONCLUSIONS: The number of cases in which ED isnot an organ disease but an early symptom of endothelialdysfunction forces changes in the extent and depth ofthe diagnostic, prognostic and follow-up strategies in the urology impotence clinics of extraordinary importancefrom both the individual and health-care politics point ofview.
OBJECTIVES: Since Helal and Jackmandeveloped the mini-percutaneous (“mini-perc”) percutaneous nephrolithotomy (PCNL) for the treatment ofpediatric renal lithiasis various authors have used istechnique in adults with the aim to preserve renalparenchyma and diminish morbidity associated with thestandard PCNL.METHODS: We describe the surgical technique of“mini-perc” PCNL in the treatment of renal lithiasis.RESULTS: We review various case series from the literatureof “mini perc” PCNL for the treatment of adult renallithiasis, its current indications, percentages of stone freepatients, and associated problems, mainly the requiredinstruments.CONCLUSIONS: Morbidity associated with “mini-perc” PCNL seems to be lower than with the standard PCNL,but the use a smaller calibre tract with the only aim topreserve renal parenchyma does not offer advantages.It is a complementary technique to the standard PCNL;however, the diameter of the percutaneous access is notwell defined yet and depends on the calibre of theinstruments used.
OBJECTIVES: To report one case ofmalignant recurrence of a cutaneous horn of the glanspenis.METHODS: We report the case of a 66-year-old malepatient presenting with penile discomfort over severalmonths. Physical examination showed a corneal lesionin the glans-penis, the biopsy of which was reported ashyperkeratosis on top of pseudoepiteliomatous hyperplasia.Partial penectomy of the glans penis was performedafter recurrence three months later.RESULTS: Pathological study of the specimen identifieda microinvasive squamous cell carcinoma in the base ofthe lesion. The patient is disease-free after two years offollow-up.CONCLUSIONS: We emphasize the capacity thepenile cutaneous horn has to become malignant. Wealso point out the need for observation of these lesionsafter excision.
OBJECTIVES: Malacoplakia is a chronicgranulomatous disease which can involve differentareas of the body, being the genital renal system themost frequent site. We describe a case of unilateralrenal malacoplakia.METHODS/RESULTS: We report the case of a femalepatient with the clinical working diagnosis of renal cellcarcinoma that required drainage of a homolateral abscesswhich cultured positive for E.Coli. Nephrectomy wasperformed. Pathologic study showed the presence ofMichaelis-Gutmann bodies, patognomonic of malacoplakia.
OBJECTIVES: To report the case of a breastmetastasis as initial presentation of renal carcinoma.METHODS: 72-year-old male patient who consulted fora painful right breast tumor. We describe clinical history,complementary tests, biopsy and treatment.RESULTS: Pathologic study confirmed a metastasis of arenal clear cell carcinoma. A CT scan confirmed theexistence of bilateral renal tumors.CONCLUSIONS: Breast metastases are exceptional asinitial presentation of a renal carcinoma. We performeda bibliographic review on the topic.
OBJECTIVES: To report one case ofadverse reaction to tamsulosin.METHODS: We describe the case of an 80-year-oldpatient who was started on alpha blocker treatmentafter acute urinary retention with the aim to perform avoiding test .RESULTS: The patient presented self-limited episodes ofdisorientation in time and space and abnormal behaviourin coincidence with the first three administrations of thedrug. Treatment was stopped.RESULTS: We report one case of an adverse reaction totamsulosin not previously described. We make a referenceto the drug vigilance mechanisms. We point out theimportance of coordination between health-care levels.
OBJETIVE: Leiomyosarcoma of the prostate isan uncommon neoplasm with a poor prognosis. We reviewthe three cases of leiomyosarcoma of the prostate observed inour hospital in the last twenty years and studied their clinicalfollow-up,METHODS: We have found trhee cases and we have studiedtheir clinical follow-up, immunohistochemical profile and ultrastructuralfeatures.Results: In all cases tumor cells were positive for vimentin andalso for either desmin or actin. Two cases were consideredgrade III sarcomas, with an aggressive course even with treatment,they died 5 and 24 months later, respectively. Thethird case, was considered grade II and is still alive, 60months after diagnosis, without evidence of disease.CONCLUSIONS: Leiomyosarcoma of the prostate is anuncommon neoplasm that accounts for less than 0.1% of prostatetumors. We found no prognostic factors for predicting prolongedsurvival although complete resection and low mitoticactivity may be predictive.
OBJECTIVES: We report a new case ofsquamous metaplasia because of its interest and subtledifferential diagnosis with other bladder pathologies.METHODS: We report the case of a male patient withhistory of previous neoplasia with an exophytic lesion ofthe bladder wall discovered on follow-up. Pathologicaldiagnosis after TUR was bladder squamous metaplasia.RESULTS: Follow-up is performed by ultrasound, cystoscopy,and urine cytology in adherence to clinical guidelinesdue to the possibility of transformation into squamouscell carcinoma.CONCLUSIONS: Urothelium is able to develop nonneoplastic transformations such as squamous metaplasia.The importance of such transformations depends onproper diagnosis and follow-up due to their ability totransform into a neoplastic process.
OBJETIVE: We describe the clinical,histological and immunohistochemical studies in a caseof extramammary Paget´s disease localized in thescrotum with lymph node inguinal metastasis.METHODS/RESULTS: A 80-year old man consultedwith a one-year history of a pruritic erythematous skinrash of the scrotum. Physical examination showeddemarcated erythematous lesion involving the scrotumand right inguinal adenopathy. Final histologicalexamination revealed extramammary Paget´s diseasewith inguinal metastasis.CONCLUSION: Extramammary Paget´s disease of thescrotum is a rare disease. This pathological conditionmay spread to dermal region and the regional lymphnodes. Although genitourinary cancer may accompanyscrotal extramammary Paget´s disease, an extensivesearch for cancer may be unnecessary.