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OBJECTIVES: To perform a chronologicalsearch about symptoms of bladder outlet obstruction ofprostatic origin and some of its treatments.METHODS/RESULTS: Over the years we have beencollecting data about the topic from books and journals;we present them in such a way that they can beconsulted chronologically.From more than 100 references we have selected the60 most relevant to our judgment.CONCLUSIONS: Many ideas about the syndrome andthe way to solve it have arisen, which vary from onetime to another. For most urologists, the main operativecomplication has always been bleeding, leading to thedevelopment of a great number of techniques to avoidit. Infection, the other great complication, prompted thatinitially surgical maneuvers were performed very fastlyand with the small incisions. In addition, big drainageswere necessary.
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OBJECTIVES: To evaluate the impact ofthe lower urinary tract symptoms (LUTS) included in theIPSS on the quality of life and to determine therelationship between quality of life or total IPSS scoreand treatment.METHODS: Retrospective review of the IPSS questionnairein 125 male patients who had consulted for LUTSbetween January 2001 and December 2003. Resultswere included in an Access database. Statistical analyses were done with the SPSS 11.0 software.RESULTS: 17% of the patients showed severe symptomsin accordance to the IPSS score. In the quality of lifeevaluation grouped into two categories, 88% referredgood or indifferent quality of life. In the evaluation ofthe association between IPSS individual questions andquality of life there was a significant association for allquestions. Patients reporting worse quality of life had a6 times higher risk of receiving treatment. With a meanfollow-up of two years, 91% of patients who were noton treatment continued without it.CONCLUSIONS: The most severe symptoms are, theworse the quality of life. The independent parametersthat most influenced decision to start treatment werequality of life and total IPSS. Frequency, weak streamand hesitation may explain quality of life on eachpatient.
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OBJECTIVES: We report the case of afemale patient with adrenal carcinoma who had undergonesurgery and presented with local-regional and distantrecurrences, emphasizing the importance of theaggressive surgical treatment to achieve long-term survivalwhich is unexpected sometimes. Currently, it representsthe gold standard and all cases should be reported tostimulate other groups to work in this line.METHODS/RESULTS: We report the case of a 29-year-old female patient who consulted for left flank pain,being diagnosed of an adrenal tumor by radiologicaltests; she underwent surgical excision of a left adrenalcarcinoma (stage II). Later on she presented with localregional recurrences (2 times) and distant metastases(liver) undergoing excision in three procedures. Currently, the patient is alive and free of disease 7 yearsafter diagnosis.CONCLUSIONS: Adrenal cancer recurrences havebeen considered lethal in the short-term. Nevertheless,an aggressive surgical approach of local recurrencesand metastasic disease may significantly prolongpatient’s survival and, sometimes, leave the patient diseasefree several years after the diagnosis of the primarytumor.
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OBJECTIVES: To analyze the surgical aspects and complications from retransplantation into the iliac fossa for third and fourth kidney transplants. METHODS: Retrospective study of the 34 third and 5 fourth transplants performed in our department. We analyze patient’s characteristics, surgical aspects and complications, and graft outcomes. RESULTS: Mean patient age was 41.6 years. 67% of the first and second transplants had been lost to vascular problems (19%) or chronic rejection (48%). Average time from last transplant in the retransplanted iliac fossa was 9 years (3 days-17 years). There were not significant differences between the groups of first and second transplant and third and fourth in cold ischemia time, number of mismatches, and number of days on hemo- dialysis after transplantation; there were significant differences in receptor age, number of transfusions, maximum and current antibodies and donor age, all of which were higher in third and fourth transplants. The graft was basically implanted in the right iliac fossa (71%) through a lumbar-iliac iterative incision; vascular anastomosis were equally made to the common and external iliac vessels; ureteral reimplant was performed following an extravesical technique; simultaneous transplant nephrectomy of the previous graft was performed in 33% of the cases. 59% of the cases had immediate diuresis and 49% did not require dialysis within the first 7 postransplant days. Surgical complications were mainly vascular: 4 cases of hemorrhage, 3 venous thrombosis and 2 arterial thrombosis. There were also 4 cases of lymphocele, 1 perirenal hematoma, and 1 enterocutaneous fistula with an abscess of the surgical bed. There were no urologic complications in the series. Globally, there was 1 death (2.5%) secondary to hemorrhage and another 6 grafts (15%) were lost to complications, 5 vascular thrombosis and 1 after surgical bed abscess.1, 3, 5, and ten-year actuarial graft survival were 65%,52%, 40% and 28% respectively. CONCLUSIONS: Retransplantation into the iliac fossa for third and fourth transplants is associated with a small increase in the number of surgical complications, mainly vascular complications.
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OBJECTIVES: The aim of this study wasto assess the prevalence of the urinary symptomssuggestive of overactive bladder (OAB) in Spain basedon the International Continence Society (ICS) 2002consensus criteria as urinary urgency, with or withouturge incontinence, usually with frequency and nocturia.METHODS: 1,669 real telephone interviews wereconducted to adults aged ≥ 40 years. The sample sizeestimation was made according to the prevalencefor OAB described in the Milsom paper stratified byage and gender due to the high variability observedbetween ranges. Appearance and prevalence ofmain OAB symptoms, medical diagnostic and therapydue to these symptoms data were collected.RESULTS: the sample population was 1669 aged ≥ 40years, 50,6% women and 49,4% men. Theoverall prevalence of symptoms suggestive of OABaccording to the OAB definition from ICS report 2002was 21,5%, significantly higher in women (25,6%) thanmen (17,4%)(p<0,05). Adjusting these data to SpanishNational Census of year 2000, the prevalence was19.9%, being higher as well in women (23.6%) thanmen (15.4%). Urge urinary incontinence and stress urinaryincontinence were superior in women (16,7% vs 10,4%and 33,1% vs 7,9% respectively)(p<0,01). Urinaryfrequency > 8 voids/day was referred by 9,8% ofwomen and 7,9% of men interviewed. 62% of menand 52,4% of women reported they get up at night tovoid. A total of 52,1% of patients with urinary symptomssuggestive of overactive bladder reported they hadconsulted a doctor anytime before the interview due tourinary disorders and 16,7% was currently receivingtreatment for some of these symptoms.CONCLUSIONS: Prevalence of urinary symptomssuggestive of Overactive Bladder is high in this study, inaccordance with data from international studies.Urinary urgency, symptom which defines the pathology,is more prevalent in Spanish women than men. Furtherstudies are needed to better assess OAB impact in theSpanish general population.
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OBJECTIVES: To demonstrate the usefulnessof antegrade endoscopical examination in the evaluationof the upper urinary tract pathology in patients withorthotopic neobladder.METHODS/RESULTS: We present the technique ofpercutaneous antegrade ureteroscopy and the indicationsfor treatment of the upper urinary tract urothelial tumor(radical or conservative) depending on multiplepyelo-calyceal biopsies and tumor lesions.CONCLUSIONS: Endoscopical evaluation of the upperurinary tract in patients with orthotopic neobladderoffers safer information than urine analysis, urine cytology,and the various radiological tests. The difficulty forretrograde examination is on the identification of theureteral neomeatus, so that in case of failure, antegradepercutaneous approach allows complete ureteral andpyelocalyceal examination and biopsies thanks to thedevelopment of flexible endoscopes. The information supplied by these endoscopical examinations of upperurinary tract urothelial tumors (grade, stage, multifocality)allows the choice of radical or conservative (opensurgery or endoscopical) treatment.
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OBJECTIVES: To describe the techniqueof the minimal access percutaneous nephrolithectomy,miniperc, and to analyze the results obtained with thistreatment in adult patients.METHODS: We performed 42 minipercs betweenaugust 2002 and December 2003. Mean patient agewas 48 years (19-62). The procedure was undertakenusing a 14Fr Amplatz sheath. Stone size varied from1.5-3.5 cm in longest diameter (1.5-7 cm2).Lithofragmentation was performed by pneumaticlithotripsy.RESULTS: Average procedure time was 75.2 min.(range from 60 to 120). All patients were dischargedwithin 24 hours. Only three patients (7.1%) have ahematocrit descent over 2 points. No nephrostomy tube was left for the postoperative time. 95.2% of thepatients were stone free 1 month after surgery.CONCLUSIONS: Our results make us consider theminimal access percutaneous nephrolithectomy(Miniperc) a minimal option for the elimination of renalstones, with low morbidity, diminishment of the hospitalstays, very low analgesic demand, and no transfusionrequirements.
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OBJECTIVES: The endorectal MRspectroscopic imaging is a new imaging test whichallows more accurate and reliable localization andstaging of prostate cancer than simple endorectal MRI.The combination of spectroscopic MR and MRI hasrecently achieved technical improvements that increasedreliability in the detection of prostate cancer. Our groupis now working in the detection of prostate cancer withthe spectroscopic MR, in co-operation with the Agencyfor the Evaluation of Technology for Medical Research(Agencia de Evaluación de Tecnología para laInvestigación Médica-AATRM); although we are waitingfor definitive results, we can advance that this techniquemay be used as a good alternative for localization ofprostate cancer in patients with previous negative biopsiesin whom the suspicion of prostate cancer persists.METHODS: We present a series of 5 patients undercontrol for permanent elevation of PSA with previousnegative biopsies. We were performing ultrasound guidedsextant biopsies every 6 months, after blood test forPSA. Endorectal MRI and spectroscopic MRI wereperformed to try to localize the prostate cancer sodiminishing the number of biopsies.RESULTS: All patients in the series had a low intensitylesion within the normal low intensity of the centralgland, with an obvious spectroscopic metabolicabnormality suggesting the existence of prostate cancer,as it was then demonstrated by biopsy.CONCLUSIONS: The endorectal MR spectroscopicimaging is a non invasive method which offers theability to detect prostate cancer within the central glandwith a higher reliability in selected patients. The centralgland is an area in which prostate cancer is lesscommonly localized, but it often shows the same signalintensity than hyperplastic tissue, so that it is difficult tobe detected by purely morphological methods.Endorectal MR spectroscopic imaging allows evaluatingthe metabolic disturbances in the whole gland, increasingthe reliability of detection of prostate cancer both in thecentral and peripherical glands.
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OBJECTIVES: To report one case of rightparatesticular rabdomyosarcoma in a 21-year-oldyoung adult.METHODS: After treatment with right radical orchiectomythrough an inguinal incision it was classified as clinicalgroup I A following the IRS-III (localized diseasecompletely excised) and received adjuvant treatmentwith Vincristine and actinomicin D.RESULTS/CONCLUSIONS: The patient is disease free18 months after surgery. We emphasize the importanceof adjuvant treatment in the posterior evolution of thetumoral disease.
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OBJECTIVES: We report one case ofretroperitoneal schwannoma with unfrequent histologicalcharacteristics evaluating its clinical significance andtherapeutic options.METHODS: We report the case of a benign retroperitonealschwannoma as an incidental MRI finding in a 70-yearoldfemale patient with symptoms of lumbosciatic painfor 6 months. We perform a bibliographic review.RESULTS: After surgical excision the diagnosis wasretroperitoneal old schwannoma. No additionaltreatment was given. There is no evidence of recurrenceon follow-up. The histological changes apparent in thecases of old schwannoma have been interpreted asdegenerative, indicating a long evolution, which hasmotivated its denomination as old. Some cases havebeen diagnosed as malignant.CONCLUSIONS: The old schwannoma is a rarevariety of the benign common schwannoma.Microscopically its shows areas of hypocellular tissueand pleomorphic nuclei suggestive of malignancy. Therapeutic management is similar to other benignretroperitoneal processes, surgical excision and follow-up.
Case Report
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OBJECTIVES: We report one case ofFournier`s gangrene secondary to urethral catheterization.METHODS: We describe the clinical case, in which theinitial cause was identified, and perform a shortbibliographic review.RESULTS: Although Fournier`s gangrene was initiallyconsidered as idiopathic in etiology, currently it ispossible to identify the entrance site of the infection. Inthe present case the insertion of a urethral catheter wasthe starting mechanism, associated with factors such asdiabetes and alcoholism which favour its development.The patient was treated by surgical debridement andpartial urethrectomy but finally died.CONCLUSIONS: We want to point out that urethralinstrumentation should be done by expert hands due tothe severity of possible complications. We should insistin the need of precocious treatment with wide spectrumantibiotics, radical debridement and complete urologicevaluation.
Case Report
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OBJECTIVES: To report two cases ofbladder and prostate oat cell tumors with bad outcome,in accordance to the bibliographic review.METHODS: The case in the bladder was associatedwith squamous differentiation and adenocarcinoma.Radical treatment followed by adjuvant chemotherapydid not stop the fatal outcome which ended 13 monthslater in acute septicemia having developed multiplemetastases. The case in the prostate presented asoliguria-anuria and bilateral hydronephrosis whichrequired the placement of a nephrostomy tube in anemergency basis. Once diagnosis was achieved theexternal urinary diversion was converted to internal toimprove patient’s comfort. There was no response tosystemic chemotherapy and the patient died 4 monthsafter diagnosis.CONCLUSIONS: These cases add to the rare presenceof this pathology in the bibliography. In our country,15cases have been confirmed in the bladder and 5 in theprostate; around the world, 150 and 59 respectively.Although there is a certain tendency to think that radicaltreatment and chemotherapy is the least bad of theoptions, some consequences of conservative attitudesoffer similar results, mainly when preserving the bladder.
Case Report
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OBJECTIVES: To report one case of renalcell carcinoma and contralateral metacronousoncocytoma, and to perform a bibliographic review onthe topic.METHODS: 52-year-old male patient with history ofright radical nephrectomy for renal cell carcinoma. Onhis ten-year follow-up multiple lesions appeared in theleft kidney. Partial nephrectomy was performed.Pathological study showed three oncocytomas.CONCLUSIONS: The presence of metacronous lesionsin the contralateral kidney of a patient with history ofrenal cell carcinoma is rare. The presence of the samehistological type of tumor should always be suspectedand the management should follow this suspicion.Contralateral metacronous oncocytoma is a rarepathology which has not been reported in the literatureso far.
