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OBJECTIVES: Abdominal compartment syndrome is an unfrequent clinical entity, the course of which has a rapid progression with multiorgan compromise leading to a fatal outcome if appropriate and urgent action is not undertaken.METHODS AND RESULTS: We report the clinical case of a patient who developed the clinical picture after renal trauma. Diagnosis was obtained by CT scan and arteriography, afterwards the patient required ICU admission with intra-abdominal pressure monitoring, and several decompression laparotomies before definitive closure with a reabsorbible mesh.CONCLUSIONS: Urologists should know the existence of this syndrome its appropriate treatment, because we manage patients who are candidates to suffer it. Due to the high mortality rate associated, it is essential to know how to recognize it in order to act fast.
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OBJECTIVES: To analyze the preliminary results in our series of radical retropubic prostatectomies (RRP) in terms of complications; and to evaluate also its efficacy in disease control (cancer progression and survival).METHODS: We reviewed the charts of 139 patients who underwent radical prostatectomy. Preoperative data such as age at the time of diagnosis, serum PSA, presence of suspicious digital rectal examination (DRE), clinical stage, and Gleason’s score on biopsy. Complications noted after RRP were studied. Survival analysis (Kaplan-Meier) was performed to study clinical and biochemical progression in relation to factors such as baseline PSA, pathologic Gleason’s score, pathologic stage, affected surgical margins and capsular penetration. Univariate comparison of factors was performed using the log-rank test. Multivariate analysis (Cox model) was also carried out to identify predictive variables (or risk factors) for progression.RESULTS: 127 patients were available for progression assessment (91.4%). Overall, 19 complications were registered in the immediate postoperative period. 89 patients (91.8%) stated being continent in their last follow-up visit. Complete erectile dysfunction (ED) was noted in 74 patients (76.3%), partial ED in fifteen (15.5%), and 8 (8.2%) reported not they have not problems with their erectile function after surgery. Thirty-four patients (26.8%) presented biochemical progression, being the mean time to progression for the whole series 5.8 years (standard error 0.38). 2 and 5 -year probability to remain free of biochemical progression were 71.2% and 58.8%, respectively. Only preoperative PSA (p = 0.023) and Gleason’s score in the surgical specimen (p = 0.001) were identified as predictive variables for biochemical progression on the univariate analysis (log-rank).CONCLUSIONS: Radical prostatectomy offers acceptable results in terms of tolerability and short and mid-term survival. Preoperative PSA or Gleason’s score in the surgical specimen may help to predict subsequent outcome of the disease.
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OBJECTIVES: To determine the age of onset of urolithiasis in patients with urinary calcium stones and to establish the relationship between age of onset and clinical profile and metabolic risk factors.METHODS: A total of 500 patients with the diagnosis of calcium urinary lithiasis (average age 47.4 years, range 20-75) were asked regarding the age of onset of the disease. Age of onset of urinary stone disease was compared with other factors such as gender, family history of lithiasis, clinical course, unique or recurrent episodes, and metabolic disturbances found in a comprehensive metabolic evaluation, using the chi-square test for categorical variables and analysis of variance (one way-ANOVA) with the Scheffe test for continuous variables.RESULTS: Mean age of onset of urinary stone disease was 38 years (range 4-73 years). This age of onset was lower in patients with low diuresis (31 years), family history of urolithiasis (32 years), hypercalciuria (36 years), recurrent disease (37 years), and hyperuricosuria (37 years). Significant differences were found in patients who had family history of urolithiasis (32 years) vs. those who did not have (40 years) (p<0.01); patients with recurrent disease (37 years) vs. patients with a unique lithiasic episode (43 years) (p<0.001); patients with hypercalciuria (36 years) vs. those who did not have (39 years) (p<0.05); and also patients with low diuresis (31 years) vs. those with higher diuresis (39 years) (p<0.001).CONCLUSIONS: The average age of onset of urolithiasis is significantly earlier in patients with low fluid intake habits, family history of urolithiasis, hypercalciuria and recurrent stone disease.
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OBJECTIVES: Over the last few years we see an increase in the number of patients with vascular disease who need a renal transplant. We discuss their management and different therapeutic options available.METHODS/RESULTS: We report the case of a female patient with history of systemic vascular disease having undergone multiple surgical procedures for it, including aortobifemoral bypass, presenting with end stage renal disease. A kidney transplant into the right iliac fossa was carried out with end to side vascular anastomosis to the iliac vein and arterial vascular prosthesis, respectively. The main difficulty came from the existence of an important fibrosis around the prosthesis, which forced a much more careful dissection of the iliac vein. Immediate postoperative course was uneventful, and the graft shows a normal function two years after surgery.CONCLUSIONS: The coexistence of vascular and renal disease is not a contraindication for kidney transplantation. Larger experience is required, but published data to date do not show significant differences on graft or patient survival.
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OBJECTIVES: To determine the long-term efficacy and complications of contact laser prostatectomy in the treatment of the benign prostatic hyperplasia (BPH).METHODS: 32 patients in a prospective clinical trial of contact laser prostatectomy were followed for 5 years. Patients were assessed by physical examination, International Prostate Symptom Score (IPSS), uroflowmetry, post void residual urine, transrectal ultrasound and PSA.RESULTS: From the initial cohort, three patients had died from concomitant diseases. Three patients (9%) had undergone reoperation (TURP).Seven Patients (22%) received alpha blockers for irritative symptoms. IPSS and maximum flow improved significantly and remained stable at five years. There were not statistically significant differences in prostate volume or PSA level.CONCLUSIONS: Contact laser prostatectomy is a safe and effective treatment for BPH in the long-term. It has minimal morbidity and durable therapeutic effects. Nevertheless, in our experience postoperative irritative voiding symptoms (22%) are the major disadvantage.
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OBJECTIVES: In this article we developthe analysis of stability of the solution (s) of the differentialequation describing detrusor behaviour as a forced andovercushioned tensor.We followed the theories of Lyapunov about stability.Therefore, we used a matricial method which is moredidactical and also analytically more graphic . Solutionsare placed in the Trace-Determinant (T-D) plane. This work represents a previous study to the one aboutdetrusor as a dispersing system. And about which wewould have to perform an analysis, first from the point ofview of the Hamiltonian systems, then from the point ofview of chaos.METHODS/RESULTS: We worked on the equationwhich has been widely described in previous articles in theseries of publications titled “the bases of urodynamics”.In previous articles, we gave results after applyingother methods different from the ones that are usuallyemployed to solve differential equations.We used the matricial method for the analysis ofstability of solutions because of its greater didacticalclarity.CONCLUSIONS: We conclude that we are in an unstablebalance until the moment right before to start voiding.Once voiding is initiated, we are in front of a system witha drain, which at the same time is a fountain. Then we passfrom a Hamiltonian dispersing system to a chaotic one.But this is another question...
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OBJECTIVES: To evaluate the results of the Nesbit technique in patients with congenital penile curvature. METHODS: From January 1990 to July 2002, 19 patients with congenital penile curvature were treated following the Nesbit technique. Mean age was 25.89 (range 19-37), and the most common curvature was ventral (73.68%). RESULTS: Complete correction was achieved in 18 patients (94.73%), and 17 patients reported a high degree of satisfaction (89.47%). CONCLUSIONS: The Nesbit technique is an easy and safe procedure for the correction of congenital penile incurvation.
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OBJECTIVES: This is a descriptive prospective study of semen analysis in 113 men who were candidates for vasectomy as an option for fertility control after a recent event of fertility.METHODS: Each subject provided a semen sample for the analysis of volume, pH, spermatozoid concentration, mobility, and morphology. The results were compared with the reference values established by WHO.RESULTS: Different from what was expected, a great proportion of these fertile subjects, 54.9%, showed at least one altered parameter in comparison to minimal values established by WHO. Generally, median values for the whole group were normal: volume 2.4 ml, spermatozoid concentration measured in Makler and Neubauer chambers 89 and 91 millions/ml, respectively; sperm mobility (A + B) 56%; vitality 78%; and normal morphology 79%.CONCLUSIONS: In this group of fertile subjects we found a high probability to have altered semen parameters, which argues questions the real value and significance of sperm analysis in the diagnosis of a subfertile patient.
Case Report
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OBJECTIVES: To report one case of collecting duct (Bellini) carcinoma and to review the national bibliography. To analyze the clinical, diagnostic, and therapeutic features of this malignant renal tumor.METHODS/RESULTS: A 36-year-old male presenting with monosymptomatic hematuria and clot retention was diagnosed of left renal mass suggestive of renal carcinoma. Radical nephrectomy with interaortocaval lymphadenectomy through an “L” abdominal incision (inverted Makuuchi) and postoperative radiotherapy were carried out. The pathologic report showed a collecting duct (Bellini) carcinoma. The patient died 34 months after surgery, having been treated with two courses of chemotherapy and palliative vertebral radiotherapy.CONCLUSIONS: The collecting duct (Bellini) carcinoma is an unfrequent malignant renal tumor. It does not differ from the clear cell adenocarcinoma either clinically or epidemiologically. However, it presents its own embryological, pathologic, immunohistochemical, and cytogenetic characteristics. Radical nephrectomy is the treatment of choice. Prognosis is ominous because of the aggressive behaviour and diagnosis in advanced stages.
Case Report
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OBJECTIVES: To report a new case of spindle cell angiosarcoma of the adrenal gland.METHODS: We reviewed 22 cases previously published of this rare entity, analyzing at the same time both clinical and pathologic findings of this unfrequent sarcoma of urological localization. The epithelioid variety is the most common, which makes our spindle cell type case rarer, if possible.RESULTS: 59-year-old male without significant previous medical history presenting at the emergency department with sudden onset of pain in the left hemithorax after several months of discomfort in the area. Diagnostic imaging tests showed a heterogeneous mass dependent of the left kidney. After performing radical nephrectomy and adrenalectomy, pathologic and immunohistochemical studies offered the diagnosis.CONCLUSIONS: Despite the rarity of these tumors it should be taken into consideration in the differential diagnosis of every adrenal tumor. Complete surgical excision is the treatment of choice, adding systemic chemotherapy as adjuvant therapy; radiotherapy is reserved as a second line after excision of recurrences if there are.
Case Report
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OBJECTIVES: To report a new case of an intrauterine device causing bladder lithiasis, because of its rarity as a complication of the intrauterine device contraceptive method.METHODS/RESULTS: 27-year-old female patient admitted in the urology department of the “Hospital Medico-quirurgico 10 de Octubre” who having an intrauterine device was pregnant, underwent a caesarean section, and a new intrauterine device implant, and a few months later presented with lower urinary tract infectious syndrome, being diagnosed of double bladder lithiasis secondary to intrauterine device migration, for which cystolithotomy was performed.CONCLUSIONS: We performed a short review of the bladder foreign bodies reported in the literature, and present this case which is very unfrequent because of the finding of 2 stones in the bladder and an intrauterine device inside one of them. The intrauterine device was detected after crushing one of the calculi, 2 cm in size. It seems that first intrauterine device had migrated through the uterine wall into the bladder, creating a calcareous concretion around.
Case Report
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OBJECTIVES: We report one case of malakoplakia within a female urethral diverticulum. METHODS: 33-year-old patient who consulted for an asymptomatic vaginal tumor. Physical examination, blood and urine analysis and microbiology tests, as well as urethrocystoscopy and intravenous pyelogram were performed. With the diagnosis of urethral diverticulum we undertook surgical excision through a vaginal approach. RESULTS: Pathology revealed the typical characteristics of malakoplakia within the diverticular lumen. CONCLUSIONS: Malakoplakia is an unfrequent inflammatory disease which involves the urinary tract in most cases. Urethra location is exceptional.
Case Report
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OBJECTIVES: We report one case of seminal vesicle cyst with ectopic drainage of the left ureter. We performed a bibliographic review of this pathology.METHODS: 23-year-old patient who presented several episodes of acute epididymitis. Complementary study showed a retroprostatic cystic structure on transrectal ultrasound. Surgical treatment with resection of the cystic structure was proposed.RESULTS: The clinical picture which caused the process was solved and the patient keeps his fertility.CONCLUSIONS: This is a rather unfrequent pathology that urologists should know. We bring up the need of performing complementary studies in pathologies that in spite of seeming banal do not progress satisfactorily.
Case Report
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OBJECTIVES: To report one case of seminal vesicle cyst with renal agenesis. To describe its clinical, radiological and therapeutic characteristics.METHODS/RESULTS: 42-year-old male presenting with irritative voiding symptoms. Digital rectal examination revealed a soft irregular mass over the prostate. Diagnostic imaging tests showed an enlargement of the left seminal vesicle and ipsilateral renal agenesis. Surgery was carried out with excision of the seminal vesicle cyst by an extravesical and extraperitoneal approach. Two years later the patient remains asymptomatic.CONCLUSIONS: Cystic pathology of the seminal vesicle is rare. Diagnosis is based on clinical symptoms, digital rectal examination and imaging studies. Surgery is necessary for symptomatic cases.
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OBJECTIVES: To report one case of a large retro- peritoneal malignant fibrohistiocytoma. METHODS/RESULTS: 40-year-old female with the diagnosis of a large right retroperitoneal mass after a study for right flank pain and weight loss over several months. Surgery was performed with excision of a large tumor; the pathologic diagnosis was malignant fibrohistiocytoma. CONCLUSIONS: Primary retroperitoneal tumors are rare neoplasias, usually diagnosed in advanced stages. The malignant fibrohistiocytoma is an unfrequent entity with difficulty histological diagnosis and poor prognosis. To date, the only valid option is surgery, because adjuvant treatments do not offer clear advantages today.
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OBJECTIVES: Collecting duct carcinoma (Bellini) of the kidney is a rare histological type of renal cell carcinoma (1%) with distinctive clinical and histopathological features. It is associated with aggresive behavior and a poor prognosis.METHODS AND RESULTS: We describe the clinical and immunohistochemical features of a new case of collecting duct carcinoma and discuss the radiological findings and therapeutic aspects.CONCLUSIONS: Collecting duct carcinoma is associated with aggresive behavior and a poor prognosis. The imaging features (US and CT) suggest the diagnosis. The immunohistochemical characteristics of the distal tubular epithelium aid the differential diagnosis between renal tumours. Percutaneous biopsy with a Tru-cut needle can be useful for pathological diagnosis. Management is currently restricted to radical nephrectomy, and chemotherapy or immunotherapy may offer only limited benefits
