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OBJECTIVES: Urology, as other medical-surgical specialities, had its consolidation process in the mid 19th century. This phenomenon in the history of medicine occurs around certain authors, which in the case of urology in Valencia was Dr. Raphael Molla Rodrigo, and several key elements such as development of lithotripsy and cystoscopy, as cited by prestigious authors in the second national meeting of history of medicine in Salamanca in 1965. For this process a spreading media is necessary, either regional or national, for posterior bibliometric analysis. METHODS: We performed a retrospective study of urological publications in the area of Valencia to know the main areas of knowledge, main authors and publications. Regarding this latter we point out Cronica medica, Revista Valenciana de Ciencias Médicas, Archivos Españoles de Urología y Policlínica. As authors, Rafael Molla Rodrigo, Victor Molla Fambuena and Rafael Alcalá Santaella stand out. Genitourinary tuberculosis and surgical procedures with their complications are among the most commonly treated topics. RESULTS: Dr. Rafael Molla Rodrigo is the author with the highest number of articles and the one who contributed to the consolidation of the speciality nationwide with his extensive scientific contributions. Genitourinary tuberculosis is extensively treated, and surgical procedures and their complications are in second place. The journal in which we were able to find more articles was Cronica Medica, due to its greater diffusion among general practitioners. CONCLUSIONS: We emphasize Dr. Rafael Molla as the main author, genitourinary tuberculosis as the main topic and the journal Cronica Médica as the most commonly used media.
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OBJECTIVES: To evaluate the results of this surgical treatment of hydrocele over the first four years of integration of the Urology Department in the Major Ambulatory Surgery Unit in our Hospital. METHODS: From January 2000 to July 2004 we have performed 167 hydrocelectomies as ambulatory surgery in 152 patients (15 cases bilateral) with ages ranging from 16-87 years (mean 52.6). All procedures were performed under local anesthesia, using between 10-15ml of 1% lidocaine. The Lord’s vaginalis plication technique was employed in 92% of the cases, leaving resection techniques for the remaining 8%, which presented certain degree of enlargement of the tunica vaginalis. We evaluated inclusion and discharge criteria, results, and degree of satisfaction by means of a questionnaire. RESULTS: Results are equivalent to those of inpatient surgery. Only one patient required admission to the hospital due to a postoperative complication, which was clearly independent of the ambulatory character of the process. Satisfaction with treatment was higher than 95%. CONCLUSIONS: Almost all patients with hydrocele are candidates to ambulatory surgery, significantly improving the cost-efficacy rate, without diminishing the quality of care or patient satisfaction.
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OBJECTIVES: The diagnosis of prostatecancer has changed significantly with the introductionof PSA in the clinical practice. Despite screening isunder controversy the use of PSA has become widespread.The objective of this paper is to know the use of PSA inour health-care area and to analyze perceived risks andbenefits.METHODS: From the informatic archives we analyzePSA determinations performed in our health-care area(290.956 citizens) over 2000 and 2001. We alsoanalyzed prostate biopsies generated and number ofcancers detected.RESULTS: 25.519 PSA determinations were performed.59% came from general practitioners (GP), 34% fromurologists and 7% from the rest of specialists. 39% areperformed to men older than 70 years. PSA was normalin 78.7% of the patients and higher than 4 ng/ml in21.2%. 488 prostatic biopsies were performeddiagnosing 178 cancers (diagnostic yield 36.5%).Depending on the first PSA, diagnosis was started by aGP in 44% of the cases, a urologist in 46%, and theremaining 10% by other specialists. Mean time fromfirst PSA to diagnosis was 5 months, without significantdifferences between GPs and specialities . The use ofPSA by GPs is variable (between 8 .1 and 45.8determinations per 100 men over 50 years), withoutsignificant differences in prostate cancer detection bynumber of PSAs or differences in age. In comparisonwith the period 1982-1993 the incidence of prostatecancer goes from 30.76 to 52.8 new cases/100.000inhabitants/year. There is a greater incidence andincrease of cancer in the rural area (from 33.52 to221.1 new cases/100.000 inhabitants/year).CONCLUSIONS: We confirm the general use of thistest and the trend to screening in the primary health-carelevel, which participates in an important manner in thediagnosis. PSA brings forward the diagnosis of prostatecancer 5 years in our area, and shoots its incidencerates. The high use of such marker in our population ofadvanced age may be considered inadequate.
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OBJECTIVES: To decide the actionpolitics (to perform or not transrectal prostatic biopsy) fora PSA cut point of 4 and 10 ng/ml through theconstruction of a mathematical decision tree.METHODS: We calculate the usefulness of the biopsythrough a subjective score, from 0 to 10, establishedafter a survey of the 20 staff members of the health-carearea, applying an global analysis with creation of totalprofile cards through an orthogonal design.RESULTS: The main usefulness of prostate cancerscreening would be not to perform transrectal prostaticbiopsies when PSA is lower than 4 ng/ml.
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OBJECTIVES: To report the incidence andmanagement of incidental renal cell carcinoma (RCC).METHODS: We performed a retrospective longitudinaland panel study for our case series between January1990 and December 2003. Thirty cases of RCC wereanalyzed, 6 of which were incidental.RESULTS: 4 patients were males (66.6%) and 2 females(33.3%); age ranged between 28 and 72 years.Reason for consultation was related with gastrointestinalsymptoms. Ultrasound and CT scan are the most usefulstudies. Clinical stage was 4 T1(66.6%), 2 T2(33.3%). 4 radical nephrectomies and 2 conservativesurgeries (partial nephrectomy and tumorectomy) wereperformed. A dose of 3 million units of alpha 2brecombinant interferon (IFN alpha 2b r) was givenIntramuscularly two times a week over 6 months.Follow-up ranged between 120 and 60 months andnone of the patients had evidence of tumor activity.CONCLUSIONS: The incidence of incidental RCC inour hospital is 20%. Clinical stage was always lowand survival is directly related to stage. Conservativesurgery showed similar survival than radical surgery.
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OBJECTIVES: To review the role ofcerebellum on the lower urinary tract dynamics.METHODS: Anatomic-functional methodology includingstructural, functional and neurotransmitters study.RESULTS: We describe the complex connections of thecerebellum and its influence on the lower urinary tractfunction.CONCLUSIONS: It is surprising the functionalrelationship between cerebellum and lower urinarytract, playing a inhibitory modulating role during thefilling phase and facilitating the voiding phase.
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OBJECTIVES: There is not enoughevidence about efficacy in the treatment of stress urinaryincontinence (SUI) after radical prostatectomy (RP). Theobjective of this paper is to describe our experiencewith the injection of pyrolytic carbon microspheres(Durasphere ®) in the treatment of SUI after RP.METHODS: Between January and October 2003 8patients with the diagnosis of SUI after RP underwenttreatment. Analyzed variables included age, time from RP to treatment, number of incontinence pads per day,operative report, subjective and objective response totreatment, and clinical-surgical outcomes.RESULTS: Mean age was 63.2 years (50-71). Mediantime from radical prostatectomy to injection was 25months (14-134). No patient suffered urinary incontinencebefore radical prostatectomy. Median number ofincontinence pads required before treatment withDurasphere ® injection was 2 per day (1-6). MeanDurasphere ® volume injected was 23.8 ml (15-30ml). No patient achieved subjective or objective cureafter treatment. After a median follow-up of 5 months(9.9-12.5) 5 patients (62.5%) chose to undergo asecond more invasive treatment to solve their incontinence.CONCLUSIONS: The use of Durasphere ® as apermanent injectable agent did not result effective in thetreatment of mild to moderate SUI after RP in ourpatients.
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OBJECTIVES: To review the outcomes ofthe ureteroenteric strictures treated by endourologicaltechniques in our department, and to compare ourlong-term results with other reported series with similarfollow-up and number of patients.METHODS: We retrospectively reviewed 27 ureteroentericstrictures treated from March 1994 to June 2003, witha mean follow-up of 30.2 months (1 day-53 months).13 cases underwent ballon dilation + permanentdouble J catheter(3 of them antegrade)8 patients underwent endoscopical incision + double Jcatheter (5 of them with Acucise®) RESULTS: 12/21(57,14%) renal units improvedand/or remained stable. We emphasize the absenceof peroperative complications except 1 case that had avery poor oncological prognosis and died of septicemia1 day after balloon dilation.CONCLUSIONS: Endourological treatment ofureteroenteric strictures has demonstrated to providegood fuctional results on the short and midterm inpatients that open surgery, although being the treatmentof choice, would be too aggressive due to their disease,age, morbid conditions,…
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OBJETIVE: To evaluate, in a retrospectiveanalysis, our long term results of patients undergoing theEssed plication procedure for the correction of penilecurvature due to Peyronie´s disease.METHODS: Between January 1998 and June 2003,83 patients with acquired penile deviation were treatedwith the Essed technique in our hospital. We analyse thefollowing data: age, main complaint, type of deviation,erection before and after the surgery, physical exploration,ecographic data, complications and results.RESULTS: Mean follow-up was 36 months. Maincomplaint was penile curvature in 96.3% of patients.The most frequent types of deviation were dorsal(55.4%) and left lateral (48.1%). Erection beforesurgery was sufficient for sexual intercourse in 74.7%.Physical exploration revealed a plaque in 79.5% of thepatients. 93% of the cases reported complete penilecurvature correction or residual deviation<10º. 65.1%of the patients were satisfied or very satisfied with theresult of the operation and 64% were able to performsexual intercourse.CONCLUSIONS: The Essed plication is a simple andminimally invasive method for correcting acquired peniledeviation. Although functional results seem to besatisfactory, in our experience the degree of satisfactionwith the outcome is not as good, among the patients,as it could be expected.
Case Report
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OBJECTIVES: To report a new case of bilateral ureteral pseudodiverticulosis associated with a transitionalcell carcinoma of the bladder. METHODS: 70-year-old male patient under ambulatorystudy for hematuria. RESULTS: The intravenous urography (IVU) shows images ofaddition in relation to bilateral ureteral pseudodiverticulosis.Urine cytology and cystoscopy showed the existence of aconcomitant tumor. CONCLUSIONS: The diagnosis of ureteral pseudodiverticulosisis incidentally made on an IVU indicated for other reasons. Although it is a benign pathology, it is necessary to followthese patients because of its association with transitionalcell carcinoma.
Case Report
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OBJECTIVES: Non tractable hematuria hasa varied etiology. It may be a complication difficult totreat. We report the case treated in our hospital by selectivearterial embolization.METHODS: We report the case of an 86-year-old patientwho underwent radiotherapy for transitional cell carcinoma.Later on, she presented with hematuria, not responding tousual therapeutic management. Urinary diversion did notsolve the problem either. We decided to proceed withselective arterial embolization of the hypogastric arteriesusing polyvinylalcohol microspheres and metallic coils.RESULTS: Hematuria disappeared after embolization,without the recurrence after nine months of follow-up.Immediate outcome was characterized by a post-embolizationsyndrome which was treated with antipyretics, antibioticand morphine derivatives.It diminished progressively and disappeared in 48 hours.CONCLUSIONS: Arterial selective embolization is a usefultherapeutic resource for the management of non tractablehematuria, mainly in cancer patients, which present adeteriorated general status.
Case Report
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OBJECTIVES: To report our experience withone case of penile silicone granuloma, that has clinicalinterest for its unfrequent presentation.METHODS/RESULTS: We report the case of a patient withsexual dysfunction secondary to subcutaneous injection ofliquid silicone in the penis resulting in a penile granulomaand migration of the particles to the penile root and midlinescrotal raphe. We proceeded to the surgical excision ofthe granuloma and migrated particles, repairing the peniledefect with scrotal skin.CONCLUSIONS: Subcutaneous injection of liquid siliconeis a practice that does not have any justification becauseof its devastating effects and requires major perations forthe elimination of the injected material.
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OBJECTIVES: We report a new case ofsimultaneous renal cell adenocarcinoma and ipsilateralmultifocal transitional cell carcinoma.METHODS: 73-year-old man with initial diagnosis oftransitional cell carcinoma of the urinary tract whosepathological report showed a asynchronous renal cellcarcinoma.RESULTS: We present microphotographs of both tumorsafter radical surgery.CONCLUSIONS: The presentation of both tumors in thesame kidney is unusual, although there are around 47cases in the bibliography worldwide, 8 of them inSpanish. Presentation of both tumors altogether does notworsen prognosis.
Case Report
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OBJECTIVES: To report one case of hypertension in association with congenital unilateral stenosis ofthe ureteropelvic junction (UPJ).METHODS: We describe the case of a 19-year-old malepatient without urologic symptoms who was incidentallydiagnosed of high blood pressure. Radiological tests showedright hydronephrosis suggestive UPJ stenosis. The insertionof a percutaneous nephrostomy allowed discontinuation ofantihypertensive treatment. Dismembered pyeloplasty wasindicated.RESULTS: Functional results were satisfactory. Bloodpressure normalization without medical treatment wasachieved.CONCLUSIONS: We emphasize the physiopathogenicconnection between unilateral ureteral obstructivepathology, as the case, described and other entities notstrictly urological, such as high blood pressure. We concurwith other authors in the validity of conservativereconstructive surgery for these cases.
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OBJECTIVES: Urothelial carcinoma ofthe bladder occurs rarely in the first 2 decades of life.We report a case of a 12 year-old child that presentedwith a Ta grade II/III urothelial carcinoma of the bladder.METHODS: We describe its clinical presentation anddiagnostic procedures as well as treatment and followup.Finally, we review the literature to analyze the etiology,treatment, and surveillance of urothelial carcinoma inthe pediatric population.RESULTS: Since 1950, there are less than 100 casesof urothelial carcinoma reported in patients less than 30years, and even less in children and adolescents. Mostof the small series describe these tumors as beingcharacteristically superficial and low grade (I-II). This child presented with silent macroscopic hematuria andan MRI revealed a solid and papillary mass measuring2.7 cm. A cystoscopy and resection of the tumorconfirmed the diagnosis. A re-resection at two monthsconfirmed no residual tumor in the bladder.CONCLUSIONS: There is no established criteria for theetiology, treatment, and surveillance of urothelialcarcinoma in the pediatric population. Children withgross hematuria as the presenting complaint shouldundergo a complete evaluation to rule out the presenceof urothelial carcinoma.
