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OBJECTIVES: To perform a comprehensive,up-to-date review of the treatment of all cases ofbladder endometriosis published in Spanish languagejournals in our country, including those published innon-urological scientific journals.METHODS: We identified 28 cases of bladderendometriosis published in the Spanish literature. Thetreatment performed in each case has been studied, aswell as the treatment of relapses and follow-up afterdefinitive treatment. Age and history of caesareansection were registered.RESULTS: Mean patient age was 35 years, with amedian of 34 years and limits of 27 and 48. The historyof caesarean section is present in 11 cases (39%).Several therapeutic regiments have been followed.Watchful waiting was only undertaken in one case dueto the absence of urinary symptoms. Three patientsreceived medical therapy initially. Only one of themhad a favourable response. The other two underwent partial cystectomy and transurethral resection (TUR)respectively due to negative response. Transurethralresection was the most frequently used therapeuticmodality; it was performed in 19 patients in addition tothe aforementioned case. Bladder endometriosis recurredin 7 cases after TUR. Four of these cases underwent partialcystectomy, one of them laparoscopic, and three asecond transurethral resection. Partial cystectomy was the initial therapeutic option in 5 cases. 4 of them wereopen and 1 laparoscopic. No recurrences have beendescribed after partial cystectomy, including thoseperformed for TUR failures. Mean follow-up was 37months and median follow-up 12 months, being thelimits 3 and 192 months.CONCLUSIONS: To date most published cases ofbladder endometriosis appear in urologic journals. Themost common therapeutic modality is transurethral resection,carried out in 20 cases (71%). However, it is necessaryto inform the patient about the chances of treatmentfailure after TUR, around 35% after this review. Finally,the reported cases treated by laparoscopic partialcystectomy have been published by gynaecologists.
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OBJECTIVES: Professor Rafael MollaRodrigo is considered by some the author who contributedwith his scientific work and solid technique to consolidateUrology as a speciality in Valencia. Such importance isalso perceived in a national level, as demonstrated bythe fact that he belonged to the first board of theSpanish Association of Urology and contributed to its foundation in the two-year period 1910-1911, from hisposition of head of the department of Surgical Therapyand Operations at the Central University.Genitourinary tuberculosis is one of the most outstandingchapters of his extensive works.METHODS: We reviewed all his works, selecting alloriginal articles about genitourinary tuberculosis.Original articles have been obtained from the journalsRevista de Higiene y Tuberculosis, La MedicinaValenciana, Revista Valenciana de Ciencias Médicas yPolicínica, and from his two most important books,Clinical Lessons In Urology and Clinical Lessons inUrology and Genitourinary Surgery.RESULTS: Throughout his work he analyzes features ofrelevance about this disease, such as diagnosis, aboutwhich he emphasizes the clinical and bacteriologicaldifficulties, and treatment, which was only feasible byprecocious nephrectomy.CONCLUSIONS: He dedicates a great part of hiswork to the study of this pathology and defends aprecocious diagnosis in order to perform the onlytreatment that had demonstrated efficacy. He also exposesthe symptoms and variety of clinical presentations, as wellas diagnosis through separate kidney catheterization withthe aim to determine unilateral involvement.
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OBJECTIVES: To determine the diagnosticusefulness of data provided by clinical history for thediagnosis of lower urinary tract obstruction in patientswith acute urinary retention.METHODS: We performed a transversal study in aseries of 70 patients (19 women and 51 men) with amean age of 61.5 years (typical deviation 20.7 years),who underwent urodynamic study due to acute urinaryretention.Past medical history was recorded in all patients.Physical exam was also carried out, evaluating prostatesize in males, presence of genital prolapse in females,and neurourological examination. Urodynamic testsconsisted on flowmetry, pressure/flow studies withsimultaneous perineal electromyography, and voidingcystourethrogram or videocystogram. Student’s t meancomparison and chi-square tests were used for thestatistical analysis.RESULTS: The only clinical data that showed a statisticallysignificant relationship with obstruction of the lowerurinary tract were: age, sex, prostate size, and existenceof infrasacral neurological lesion (absence of bulbocavernousreflex). Age >74 years showed a sensitivity of 71% forlower urinary tract obstruction and a specificity of 60%.Male sex showed a sensitivity of 88% and specificity of36%. Prostate size ³’3d grade II sensitivity was 58%and specificity 82%; and absence of infrasacral lesiona sensitivity of 77% and specificity of 48%.CONCLUSIONS: Provided that a negative result in atest with high sensitivity makes the likelihood of diseaselow, in women the presence of infrasacral neurogenicdysfunction or age ²’3d74 years diminish the probabilityof obstruction in patients with acute urinary retention.On the other side, if a negative result of a test with highspecificity increases the probability of having the disease,a prostate size ³’3d grade II and age> 74 yearsfavour the likelihood of having urinary tract obstructionfor a patient with acute urinary retention.
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OBJECTIVES: To identify the mostfrequent urinary tract symptoms of acute appendicitis.To determine the findings in urine analysis. To establishstatistically the relationships between age, sex, durationof abdominal pain, appendix position and the evolutionstage with the findings on clinical history and urineanalysis. METHODS: We studied 500 consecutive patientsundergoing surgery for acute appendicitis registering alldata specified in the objectives . The chi-square test wasused to establish statistical relationships .RESULTS: One third of the patients showed some urinarysymptoms; right flank pain and dysuria were the mostfrequent symptoms. Urinary sediment showed pyuria >10 cells per high-power field in 1/7 patients, and morethan 3 red blood cells per high-power field in 1/6.1/7 patients presented proteinuria; and 1/77 presentedcasts. Urinary symptoms, proteinuria, and urinary castsappeared more frequently in patients older than 59years; pyuria in the group between 15-19 years; andmicrohematuria in females. Pelvic and retrocecal appendixpositions were associated with a higher incidence ofvoiding symptoms. Duration of abdominal pain andevolution stage did not have any statistical relationshipwith either symptoms or urine analysis findings.CONCLUSIONS: Urinary tract symptoms are frequentin acute appendicitis; their presence should not excludethe diagnosis of this disease. Urine analysis is not usefulto rule out the existence of acute appendicitis.
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OBJECTIVES: Prostatic brachytherapy bypermanent implant of I 125 or Pd103 is a therapeuticoption in the treatment of organ confined prostate cancer.We analyze preliminary results and complications afterfive years in the group of patients who received I 125low dose rate brachytherapy as the only intention-to-cure treatment and evaluate the differences with thestandard treatment (surgery).METHODS: From a case series of more than 400patients treated with brachytherapy as radical intention-to-cure monotherapy for organ-confined prostate cancerwe excluded patients with less than 12 months offollow-up for statistical analysis; the study group includes275 patients enrolled between april 1999 andDecember 2003. Mean follow-up is 31 months (12-68). Biochemical failure was defined in accordance tothe ASTRO criteria. Statistical survival analysis wascarried out with the SPSS statistical software using theKaplan Meyer method. Urinary and gastrointestinalcomplications were evaluated in accordance to theRTOG criteria.RESULTS: Mean age was 68 years (range 49-83years). 93% of the patients presented a clinical stage≤ ’3dT2a and 7% T2b, with 60 8% of the cases havinga PSA ≤ ’3d 10 ng/ ml. Gleason score was ≤ ’3d 6 in94% of the cases. 9% of the cases had a prostate volume> 50 cc. Overall 5 year survival was 96%, with a 97%disease-free survival and a 99% biochemical failure-freesurvival. Figure 3 and tables II-VI summarize thecomplications in various series including this.CONCLUSIONS: Multiple published series seem toshow similar results on biochemical control of the diseasewhen comparing surgery and low dose rate brachytherapyin organ-confined disease. In comparison to surgery,brachytherapy has the advantage of having a lowerpercentage of immediate postoperative complications,lower incontinence rate, and a higher number ofpatients preserving erectile function
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OBJECTIVES: To determine the efficacyof endoscopical injections for the treatment of stressurinary incontinence (SUI), evaluating its low invasivenessand positive impact on quality of life.METHODS/RESULTS: Between 1997-2003 30 proceduresof periurethral injection of various substances for urinaryincontinence were performed at our department inwomen between 47-80 years. All patients wereevaluated before surgery, clinically and urodynamically,in accordance to international standardized parameters(filling pressure/flow studies, maximum urethral closurepressure, LPP-leak point pressure). The kind of materialemployed for injection, surgical technique and satisfactiondegree were also evaluated.RESULTS: The indication for surgery was SUI in 17cases (56.6%), and mixed urinary incontinence in 13cases (43.3%). 16 cases (53.3%) had history ofprevious surgery for SUI. Regarding urodynamicparameters,19 patients (63.3%) have a maximum urethralclosure pressure below 25 H2O cm, and 22 patients(73.3%) had a leak point pressure below 60 H2O cm.Collagen was employed in six cases (20%) andmacroplastic in 24 (80%) (14 of them with the MISsystem). 22 patients had three injection sites (73.3%).Mean follow-up was 38 months. Continence outcomeswere evaluated in relation to complete continence (12cases, 40%), mild incontinence and patient satisfaction(11 cases, 36.6%), and severe incontinence (7 cases,23.3%).CONCLUSIONS: 1-To achieve acceptable results it ismandatory to do the best possible indication (Mc Guiretype III SUI). 2.-There is an excellent relationship betweenminimal invasiveness and good results.
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OBJECTIVES: Laparoscopic prostatectomyis the treatment of choice for localized prostate cancer.The learning curve for unexperienced teams is dauntinglysteep because it is associated with high incidence ofcomplications and such long operation times that theprocedure becomes almost unacceptable. Therefore,we needed to seek an alternative for this operation thathas been almost unmodified since first description in1998.METHODS: The patient is placed in lithotomy positionand draped with an urological apron similar to the oneused for transurethral resection. A beniqué sound isintroduced up to the bladder and a 12 mm incision ismade in the perineum, through which we slowly introducethe index finger touching the posterior aspect of theprostate. We advance the finger further longitudinallyand laterally separating the rectum all the way to thebladder neck and prostatic pedicles on each side.Having freed the prostate, generally the most hazardousmanoeuvre, we can then carry out a conventionallaparoscopic prostatectomy, safely and quickly becausethe most difficult step, rectum dissection, has beencarried out.RESULTS: Digital separation of the prostate through aperineal incision facilitates the operation a lot and shortensoperation times significantly, allowing us to avoid theuse of one or two trocars. At this time, we can not presentstatistical analysis because our limited experience, butthere are significant advantages making the procedureeasier and operation time shorter. Furthermore, thetechnique may also be used for laparoscopic cystectomy.CONCLUSIONS: laparoscopic prostatectomy isconsidered a very difficult procedure, with an unacceptablehigh incidence of complications, being rectum perforationthe most feared. Therefore, laparoscopic prostatectomyassisted by digital manipulation through a small perinealincision appears to be a most welcome developmentwith benefits similar to those brought ten years ago byintroduction of hand assisted laparoscopy.
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OBJECTIVES/METHODS: To review theincidence of male infertility secondary to intake of anabolicproducts and our experience and outcomes with treatment.There is a variety of such substances (testosterone,nandrolone, stanozolol, etc.) in their intake may beunique or combinations, both orally or parenterally.Comparisons between patients and case series aredifficult because of the hiding of this practice andvarious consumption practices and doses employed.RESULTS/CONCLUSIONS: Most of the patients recovernormal spermatogenesis does by stopping intake ofanabolic substances. The period of time until recoveryis 6.35 months. Patients not recovering after six monthswere given tamoxifen 20 mg/24-hour, if having a normalor inhibited hypothalamus-hypophysis axis. Duration ofabuse, doses, and anarchical consumption maderesponseto treatment with antiestrogen drugs or gonadotropinsunpredictable in patients not responding to conservativetreatment.
Case Report
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- OBJECTIVES: To report another rare case ofskin metastasis from a renal adenocarcinoma, analyzingthe prognostic significance, response to therapy, andclinical presentation after a bibliographic review. METHODS/RESULTS: We report the case of a 65-year-oldmale with a cutaneous metastasis in the root of his inferiorleft extremity one year after right nephrectomy for a clearcell adenocarcinoma.CONCLUSIONS: Skin metastases usually present as solitarycutaneous lesions of variable macroscopic features andrapid growing; the diagnosis is made by histologicalanalysis, being excision the treatment of choice wheneverpossible. Prognosis is better for solitary lesions appearingasynchronously with the primary tumor, and among themthe longer the time after diagnosis of initial lesion theyappear the better the prognosis.
Case Report
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OBJECTIVES: To report the first case ofspontaneous regression of renal vein and inferior venacava thrombus in a patient with renal clear cell carcinoma.METHODS/RESULTS: We describe the case of a womanwith the diagnosis of renal mass with venous thrombus ofthe renal vein and inferior vena cava. Extension studiesbefore radical nephrectomy showed regression of thethrombus which was confirmed during nephrectomy.CONCLUSIONS: Spontaneous regression of clear cellrenal carcinoma metastases is estimated below 1% of thecases. This is the first case report of regression of a tumoralthrombus of the renal vein and inferior vena cava.
Case Report
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OBJECTIVE: To report one case of primary bladder amyloidosis. METHODS: We studied a male patient with asymptomatic hematuria by means of transurethral resection. RESULTS: Pathologic features were consistent with amyloidosis of the bladder wall. We cannot prove either sites of amyloid deposits or an etiology for this disease. CONCLUSIONS: Local idiopathic bladder amyloidosis is a very rare disease and the most common presenting symptom is painless hematuria. It may be difficult to differentiate between this disease and a urothelial bladder neoplasia.
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OBJECTIVES: To report a rare case of renallymphangioma in a 30-year-old female consulting with leftflank pain.METHODS: We perform a bibliographic review and presentthe clinical, radiological and pathologic features.RESULTS: The patient underwent surgical treatment: radicalnephrectomy. Final pathology report showed a renallymphangioma.CONCLUSIONS: Renal lymphangioma is a mesenchymaltumor of benign behavior which poses several diagnosticdifficulties, both radiologically and histologically. Thistumor may be confused with other renal tumors, includingclear cell renal carcinoma.
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OBJECTIVES: We report the case of a malepatient who had undergone radical cystectomy andorthotopic neobladder for bladder cancer presenting withlocal recurrence eight months later.METHODS: Diagnostic tests included CT scan andultrasound guided transrectal biopsy.RESULTS: With the diagnosis of local recurrence heunderwent chemotherapy and radiotherapy.CONCLUSIONS: The pelvic recurrence of transitional cellcarcinoma after radical cystectomy is rare and prognosis ispoor. It is frequently associated with advanced tumorstage. It should be treated by a multidisciplinary approach.
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OBJECTIVES: In this study, we investigatedthe association of positive biopsy core percent (PBCP),as well as other preoperative factors, with prostatecancer outcomes in a cohort of consecutive patientswith clinically localized prostate cancer who underwentRRP. METHODS: Data from 203 patients who underwentRRP from March 1993 to May 2004 for clinicallyorgan confined prostate cancer was analysed. Thecorrelation of preoperative serum prostate specificantigen (PSA) level, biopsy Gleason score, total numberof positive biopsies and PBCP with the extent of disease atfinal pathology and biochemical progression wereanalyzed.RESULTS: The mean PBCP was 29.8±21.1 (median25). Histopathological examination of the RRP specimensrevealed ECE in 66 (32.5 %), SVI in 43 (21.2 %), LNI in 8 (4 %), and positive SM in 59 (29.1 %). Overall,only 9% of patients (18 of 203) had biochemicalprogression at a median postoperative follow-up of 22months. Univariate analysis revealed serum PSA,biopsy Gleason Score, the number of positive cores andPBCP as predictive factors for extra-prostatic disease inRRP specimens. However, multivariate analysis revealedthat biopsy Gleason score and serum PSA were thestrongest independent predictive factors for extra-prostaticdisease while percent positive biopsy cores carriedsignificance in the prediction of ECE and SM positivity.The number of positive cores was not a predictor ofnon-organ confined disease. Preoperative serum PSAwas the only prognostic factor for determination ofbiochemical failure.CONCLUSION: Gleason score is the most importantand independent predictive factor for extra-prostaticdisease. The percentage of cores positive for cancerhas significance only in the prediction of ECE and SMpositivity. Further studies are needed before routine useof PBCP as one of the important preoperative prognosticfactors.
