OBJECTIVES: More than 200 articles about treatment of staghorn calculi have been published over the last 15 years; we observe a progressive tendency to the elective indication of a combination of therapeutic methods. Recent development of flexible ureteroscopy and endoscopical holmium-YAG laser lithotripsy has prompted the application of a new method of combined treatment for staghorn calculi: retrograde ureteroscopy and external shock wave lithotripsy.The objective of this work is to analyze indications andresults of various therapeutic methods in relation to staghorn calculi complexity.METHODS and RESULTS: We analyze the results of open surgery, extracorporeal shock wave lithotripsy, percutaneous nephrostomy and retrograde ureteroscopy in the treatment of staghorn calculi Group 1 (soft calculi < 700 mm2 of area and homogeneous pyelocalyceal distribution), Group 2 (calculi < 700 mm2 hard or with predominantly central pyelocalyceal distribution, wide infundibula and calyces with few branches), Group 3 (calculi > 700 mm2with predominantly central or homogeneous distribution, absence of infundibular stenosis or excluded calyces) and Group 4 (great lithiasic mass predominantly homogeneous or peripheral, narrow infundibula or multiple infundibular stenosis and/or lithiasis within excluded calyces).CONCLUSIONS: In Group 1 staghorn calculi ESWL (JJ catheter + ESWL) has good results in 62.5% - 72.5% of the patients after an average of 3.2-3.6 sessions. The combination of contact lithotripsy by retrograde ureteroscopy and ESWL may be a therapeutic alternative.In group 2, percutaneous renal surgery may be considered the technique of choice; persisting residual fragments are treated by ESWL. Group 3 calculi are indication for combined therapy, percutaneous renal surgery and ESWL. ESWL therapy only is not indicated; open surgery through a sinus approach combined with intraoperative pyelocalyceal nephroscopy may be considered an option. Open surgery is recommended for Group 4 calculi —sinus approach is preferred— with mechanical extraction of caliceal fragments and/or pyelocalyceal nephroscopy support.
OBJETIVES: To evaluate the current knowledge about interstitial cystitis pathophysiology and its relationship with rheumatic, autoimmune and chronic inﬂammatory diseases.METHODS: Literature search under "interstitial cystitis pathophysiology" either clinical or experimental trials and reports, in Medline, PubMed, Digital Urology Journal and Doctor's Guide, in addition to our own clinical research experience results.RESULTS: Both human and experimental trials show resemblances between interstitial cystitis and rheumatic, autoimmune, and chronic inﬂammatory diseases on cli-nical presentations, pathophysiology. Some interstitial cystitis patients show the bladder inﬁltrated with speciﬁc mononuclear cells, high incidence of circulating anti-nuclear antibodies, good response to anti-inﬂammatory and/or immunosuppressive therapies. Interstitial cystitis in association with rheumatic, autoimmune and chronic inﬂammatory diseases is very common. Many patients with systemic lupus erythematosus, Sjögren syndrome and ﬁbromyalgia syndrome show antibodies against urothelium and/or muscle cells and/or other connective tissue com-ponents of urinary bladder. Systemic lupus erythematosus and Sjögren syndrome are the autoimmune diseases which bear strongest similarity with interstitial cystitis. Moreover, rheumatoid arthritis, chronic pelvic pain syndrome, irritable bowel syndrome, ﬁbromyalgia, chronic fatigue syndrome, Evan's syndrome and atopic dermatitis share some patho-genic characteristics.CONCLUSIONS: Nowadays, interstitial cystitis patho-physiology is unknown. Based on clinical presentations, epidemiology, pathology and laboratory ﬁndings and treatment response, there is an important correlation among interstitial cystitis and rheumatic, autoimmune and chronic inﬂammatory diseases. These disorders may share some pathophysiologic mechanisms. Rigorous studies of pathophysiology of these group of diseases are needed to conﬁrm consistently this approach for such conditions.
OBJECTIVES: Anemia is a frequent ﬁnding in patients with prostate cancer. Reduction of erythropoiesis caused by androgenic blockade is among its etiologies. Therefore, quality of life of these patients results decreased, being origin of signiﬁcant morbidity and mortality. Recom- binant forms of human erythropoietin have demonstrated their effectiveness improving quality of life of patients with various solid tumors, but speciﬁc studies in prostate cancer are a few. Our objective is to evaluate the efﬁcacy of human recombinant erythropoietin (EPO) correcting anemia and improving the quality of life of patients with prostate cancer. METHODS: Prospective study of patients with prostate cancer under combined androgenic blockade treatment having hemoglobin levels lower than 11g/dl. We analyze clinical characteristics and quality of life prior to EPO dispense. We used the Triple Linear Analogical Scale for patients with cancer (CLAS) to evaluate quality of life. EPO was administered during 12 weeks (10.000 units subcutaneously, three times a week). We study the evolution of different parameters compared to baseline. RESULTS: We included a total of 17 patients. Average age was 75.5 +/- 5.9 yr. Average time of neoplasia evolution was 57.6+/- 13.9 months. Eleven patients presented active disease (PSA > 1 ng/ml). Mean initial haemoglobin level was 10.3+/- 0.4 mg/dl, reaching 12.2+/- 1.0 after treatment (p < 0.001). Patients with active disease and levels of initial haemoglobin smaller than 10.2 g/dl presented worse outcomes. There were not adverse events attributable to EPO. CONCLUSIONS: We consider that the administration of EPO increases signiﬁcantly the levels of haemoglobin and the quality of life of patients with prostate adenocarcinoma, being the response worse in patients with low levels of baseline haemoglobin.
OBJECTIVES: Urethral stenosis is a frequent disease in males. The variable results of its treatment have prompted the surgeon to search for new therapeutic alternatives. We propose to treat it by self expandable endourethral prosthesis. METHODS: Since February 1993 to March 2000 48 patients with urethral stenosis previously treated with en- doscopic urethrotomy have undergone the procedure. RESULTS: All patients completed a minimum of 3 years of follow-up. Patients lost to follow-up for any cause were not included in the ﬁnal study description. All patients had satisfactory micturition at the time of discharge. Mean ﬂow on uroﬂowmetry at three years was higher than 14 ml/s in 87.5% (42/48 patients evaluated). CONCLUSIONS: The use of self expandable endo- urethral prosthesis is a valid alternative in the treatment of recurrent urethral strictures due to its good long-term results and low morbidity. We recommend not using it in cases of traumatic etiology.
OBJECTIVES: To compare the rate of infectious complications using 2 antibiotic schemes in prostatic transurethral resection of the prostate (TUR-P) of patients at low risk, in order to reduce the use of antibiotics in this kind of patients. Secondarily, try to weigh the influence of clinical background, intraoperative complications and postoperative outcome on the development of such complications.METHODS: A comparative, prospective, randomized, open study was designed including 95 patients with sterile urine without indwelling catheter, subjected to TUR-P during one year. Group 1 received cefazolin 1 gr. IV preoperative and every 8 hrs. during the first day (3 doses) followed by ciprofloxacin 250 mg. oral every 12 hrs until the catheter was removed (therapeutic dose). Group 2 received cefazolin 1 gr. IV preoperative and at 8 hrs postoperative (2 doses) followed by nitrofurantoin 100 mg. oral every night until the catheter was removed (prophylactic dose). Five patients were excluded after randomization (5.3%) and all the remainders completed follow up.RESULTS: Ninety patients are analyzed, 45 in each group. Both groups were well matched with regard to clinical background, surgical and postoperative parameters and complications. Fever (axillary temperature equal or over 37.5 °C) was present in 2% of Group 1 and 11% of Group 2 (p = 0.091). Postoperative early or late bacteriuria (colony count > 100,000 CFU/mL) was present in 2% of Group 1 and in 13% of Group 2 (p = 0.049). Postoperative urinary infection (bacteriuria + clinical infection) was present in 2% of Group 1 and in 16% of Group 2 (p = 0.026). A statistical association was found between fever and postoperative urinary infection in all patients (p = 0.029) and between purulent secretion during prostatic tissue cutting and fever in Group 2 ( p = 0.01).CONCLUSION: Patients in Group 1 (cefazolin-cipro-floxacin) presented significant less postoperative urinary infection than those in Group 2 (cefazolin-nitrofurantoin) represented by less postoperative bacteriuria frequency. This was possibly due to different antimicrobial activity and dosage of used drugs. Fever was statistically related to postoperative urinary infection.
OBJECTIVES: We currently see an increase of demand of vasectomy reversion, mainly due to the wish of recovering fertility.METHODS: We review 21 cases of vasovasostomy performed at our department over the last 5 years with the single layer technique under optical magnification, comparing our results with those from bibliography for both vasovasostomy and in vitro fecundation techniques used in patients with obstructive azoospermia, specifically intracytoplasmic spermatozoids injection (ICSI).RESULTS: Success rates obtained for permeability, pregnancy, and births were 80%,33%, and 26.66% respectively.CONCLUSIONS: Our results in terms of pregnancies are equivalent to those obtained by ICSI. These data, together with the disadvantage of greater rates of multiple pregnancies associated with in vitro fecundation techniques, moved us to choose vasovasostomy as the initial option for treatment of male infertility secondary to vasectomy.
OBJECTIVES: We report one case of left adrenal tumor discovered during the study of an inﬁltrating bladder car-cinoma. We discuss the diagnostic and therapeutic implications of the clinical case.METHODS: Surgical procedure was undertaken with radical cystectomy and Bricker’s type urinary diversion, plus adenomectomy by anterior approach.RESULTS: The pathologic report showed a myelolipoma. CONCLUSIONS: Most adrenal tumors are benign, mainly if they are small and non-functioning. The protocol of hormonal study should include potassium and catecholamines. Tumors greater than 6 cm and functioning masses are indications for surgery. For oncological patients, surgical approach of the lesion is indicated if there is not evidence of dissemination.
OBJECTIVES: To report one case of an opportunistic bladder infection by fungus of the Mucorales order.METHODS: An old patient with permanent bladder catheter due to cerebral vascular accident presented with hematuria associated with change in his general health status, and a bladder mass on ultrasound. Cystoscopy and cold biopsy were performed.RESULTS: Pathology reported bladder mucormycosis.CONCLUSIONS: Mucormycosis is an opportunistic infection by fungus of the Mucorales order, which disseminate hematogenously from an entrance. Diagnosis is usually histological, seeing characteristic hyphae and ischemic or hemorrhagic necrosis. Bladder involvement is very uncommon. Treatment is based on the combination of debridement of the necrotic areas and intravenous antifungal drugs (amphotericin B)
OBJECTIVE: To describe our experience using theMitrofanoff procedure in adult patients after a complete urethralresection.METHODS AND RESULTS: We describe 2 clinical cases, bothwith neoplasic lesions in the urethra. Once completed the urethralresection, we made a continent urinary diversion using the Mitro-fanoff procedure with the cecal apendix, apllying a few technicalvariations.CONCLUSIONS: The Mitrofanoff procedure is a simple technique,aplicable to both pediatric and adult patients and it should be cosidereda good urinary diversion after complete urethral resection
OBJECTIVES: To report the case of a 28-year-old female patient carrying a lithiasis of soft appearance located within a calyceal diverticulum in the right kidney which presented clinically during pregnancy, and to comment on therapeutic management, as well as the outcome one year after conservative treatment.METHODS AND RESULTS: 28-year-old female patient with history of renal colic during pregnancy, who presents at our clinics in the postpartum period with a recurrent abdominal and lumbar pain. Kidney-ureter-bladder (KUB) x-ray and intravenous urography (IVP) detected a lithiasis of soft appearance within a calyceal diverticulum in the right kidney. Treatment was conservative with potassium citrate/citric acid and follow-up controls with urine culture (every 3 months) and ultrasounds (every 8 months). Currently she is asymptomatic but the lithiasis persists on KUB and urine culture is positive (Escherichia coli) and receives treatment with cefuroxime 250 mg every 12 hours for 6 days and nitrofurantoin 100 mg every night for three months.CONCLUSIONS: Most urinary stones located within calyceal diverticula have an asymptomatic course, treatment not being necessary. The most frequent clinical presentations of these stones are flank pain, urinary infection demonstrated by positive urine culture, and incidental finding. IVU is an effective method for diagnosis. ESWL is not an effective treatment for them, being percutaneous techniques the most suitable for a single-surgical procedure resolution of both lithiasis and pyelocalyceal diverticulum.
OBJECTIVES: To report one case of uterine per- foration and migration into the urinary bladder of an intrauterine contraceptive device. METHODS/RESULTS: 42-year-old female patient who presents with lower urinary tract irritative syndrome in association to recurrent urinary tract infection. Ultrasound revealed a part of an intrauterine device inside the bladder, device which was inserted years before and was supposed to have come out spontaneously. Urethrocystoscopy with extraction of the intravesical segment and hysteroscopy with extraction of the intrauterine segment were carried out. CONCLUSIONS: The postoperative period was satisfactory and patient is currently asymptomatic. Radiological or ultrasound controls should be performed in the follow-up of patients with intrauterine contraceptive devices. The inability to locate an intrauterine contra- ceptive device in a patient who did not realize it coming out should be considered an uterine perforation until proved otherwise.
OBJECTIVES: To report one case of Sertoli cell testicular tumor of the large cell calcifying type, a rare presentation, and to perform a medical literature review on the topic.METHODS: Our case report is based on the patient’s medical history and images of the diagnostic tests and pathology. We perform a bibliographic review of the available literature in MEDLINE.RESULTS: The case is reported with the diagnostic tests and pathology report. We present a comprehensive review of the medical literature on the topic.CONCLUSIONS: The large cell calcifying Sertoli cell tumor is a rare testicular tumor of benign behaviour. Due to its benign behaviour, treatment of this kind of tumor should be conservative with resection of the lesion, preserving the testicle.
OBJECTIVES: To report one case of metachronous recurrence of idiopathic high flow priapism.METHODS: We describe the case of a 28-year-old male patient who presents with penile partial tumescence which started 10 hours before and history of a similar episode seven years before.Physical examination confirmed the clinical picture, with mild local discomfort on palpation. Blood tests were normal. Cavernous blood gases were compatible with arterial blood 02 saturation levels.The patient had a satisfactory progressive response to oral administration of diazepam. No pathologic findings were seen at the time of arteriography.RESULTS: Complete resolution of the episode. Erectile function was satisfactorily preserved. There was no relapse after one year of follow-up.CONCLUSIONS: We remark the validity of a deferred therapeutic attitude in front of pictures of high flow priapism, as well as the possibility of resolution with conservative measures. We emphasize the peculiarities of this case, mainly its idiopathic character and the metachronous recurrence.