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OBJECTIVES: After the 50th anniversaryof the Hospital Virgen de las Nieves in Granada weperform a historical summary of its Department ofUrology.METHODS/RESULTS: We mention some data relatedto Granada`s urology during the 20th century until1975, when the Department of Urology was created.We highlight the figures of José Martín Vivaldi and JoséMacías Godoy.CONCLUSIONS: The historical summary of theDepartment of Urology, initially directed by theaforementioned Jose Macías and later on by MiguelTallada, collects various events happening over theyears, emphasizing the human side and the achievementsin health care, education and research.
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OBJECTIVES: To evaluate a historicalseries of urethral stenosis retrospectively. To study theurinary, genital and systemic complications. To studyrisk factors for the development of such complicationsand, based on them, identify groups of patients moresusceptible to complications with the aim to establishprophylactic, therapeutic or follow-up actions.METHODS: We studied 175 male patients with urethralstenosis, which constitute the historical series of maleurethral stenosis treated in the Hospital GeneralUniversitario in Alicante from 1977 to 1987 (11years). Statistical treatment: clinical protocol for datacollection. Codification of variables. Descriptive statisticsfor all variables. Percentage description of qualitativevariables. Data processing by the basic SPSS + statisticalsoftware and the Harvard Graphics graphical softwareran in an IBM PS/2 computer. The level of statisticalsignificance for comparisons between variables wasestablished in p< 0.05.RESULTS: 155/175 patients presented complications(88.57%). The number of complications overall was795. Complication sites in order of frequency were:628(78.99%) urinary tract, 111 (13.96%) genitalsystem, 44 (5.53%) systemic and 12 (1.50%) abdominalwall hernias. The most frequent complications were:acute urinary retention 100 patients, bladder obstructiveuropathy 84, urinary tract infection 63, ejaculationdisorders 50, stenosis recurrence 47, and 30 withvarious degrees of renal failure. Most complicationswere reversible after resolution of the stenosis, although3 patients had non reversible deterioration of their renalfunction and 4 unilateral postobstructive renal atrophy.3 patients died as a consequence of such complications(two cases of septicemia and one postoperative pulmonaryembolism.Prophylaxis is the best treatment for these complications,eradicating urinary tract infection if present, and treatingstenosis itself. Nevertheless, the treatment of complications required 132 medical treatments,16 suprapubic bladderpunctions,94 surgical treatments, 5 extracorporealshock wave lithotripsies, 2 mechanical lithotripsies, and1 hemodialysis in a patient with end stage renal disease(single kidney with ureteritis secondary to tuberculosis).Risk factors for the development of complications areamong others: age > 70 years (retired), history ofsexually transmitted diseases, urinary tract infection,previous urethral surgery for recurrent stenosis, and postvoid residual urine.CONCLUSIONS: Complications of urethral stenosisare very frequent in this series. Currently, in comparisonwith past times, these complications can be prevented,since its diagnostic is very simple by ultrasound. Manyof these complications are reversible if obstruction andinfection are corrected. Based on these results we haveidentified several groups of patients with higher risk ofcomplications. Global studies of this issue are necessary,both national and international.
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OBJECTIVES: To show the results of ourfour-year experience since starting urologic proceduresin the Ambulatory Surgery Unit in our hospital. Theprogressively increasing demand of surgery has showedup the limitations of sanitary resources. AmbulatorySurgery arises with the aim to optimize such resources,because it improves surgical procedures and rationalizesthe increasing sanitary expenditures.METHODS: We study the results obtained after operatingon 415 patients, showing inclusion criteria, relationshipbetween surgical procedure and anesthetic drug employed,as well as discharge criteria.RESULTS: Among all patients operated on, 4 (1%) requiredhospital admission, and 12 presented with complications in the immediate postoperative period (3%), all of themminor. Satisfaction with treatment was around 95%.CONCLUSIONS: A great percentage of patients withurologic diseases who need surgery are candidates tobe included in an ambulatory surgery program, withoutcompromise of the quality of care or patient’s satisfaction.
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OBJECTIVES: We analyse the concordance between Gleason scores on prostatebiopsies diagnostic of adenocarcinoma and radical prostatectomy specimens.METHODS: We reviewed the charts of 214 patients who underwent radical prostatectomy between January 1992 and November 2002. We calculated the percentage of correct diagnosis, understaging andoverstaging for individual Gleason and for groups with scores between 2-4, 5-6, 7 and 8-10. We performed the statistical analyses of concordance for the groups using the κ weighted index (< 0.4 low reliability, 0.4-0.75 good reliability; > 0.75 excellent reliability).RESULTS: 41 patients were excluded. The percentages of right diagnosis, understaging and overstaging for the remainder 173 were 32.3%,44% and 23.7% respectively for individual Gleason scores, and 52.6%, 32.4% and 15% respectively for grouped Gleason scores.Statistical analysis resulted in a κ weighted index of 0.52, a result which did not vary after excluding patients treated with neoadjuvant hormonal therapy.CONCLUSIONS: In our series, the statistical correlation obtained for grouped Gleason scores is good.However, understaging is the biggest problem for prostate biopsies diagnostic of adenocarcinoma when compared with definitive pathologic results on the specimen.Besides, and in opposition, more than 50% of ourpatients deemed as less differentiated (Gleason score 7 and 8-10) presented lower grades in the specimen.Both limitations should be taken into consideration when therapeutic options are exposed to our patients.
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OBJECTIVES: To present one case ofparatesticular leiomyosarcoma, a rare tumor which hasbeen reported in 5 cases only in our country. To reviewthe management of this type of tumor.METHODS: A 73-year-old male presenting with a 4 cmmass adjacent to the right testicle underwent excision ofthe mass, spermatic cord and testicle through an inguinalapproach.RESULTS: The tumor was classified as a grade 3leiomyosarcoma, with positive immunohistochemicalstaining for desmin and smooth muscle actin. After thispathology report we did not consider adjuvant oncologicaltreatment. Tumor relapse has not appeared so far.CONCLUSIONS: Radical surgery is the only feasibleand successful treatment for paratesticular sarcomas,with the exception of rabdomyosarcoma, because theyare radio and chemoresistant. The inguinal approachis the ideal and obligatory one, including excision ofthe spermatic cord and adjacent testicle. Long-termperiodic follow-up visits are mandatory because relapsesmay occur even long time after diagnosis. In case ofrelapse, surgery is again the only tool we have tocontrol this type of tumor. Currently radiotherapy isrecommended in cases of local recurrence after surgery.5 -year survival rates are around 75%, and 10 -year50%.
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OBJETIVE: Our purpose was to study, insemen samples of infertile patients, the relationshipbetween the Modified Sperm Stress Test (MOST) and thepresence of antisperm antibodies (ASA), macrophagesconcentration and the Hypoosmotic Swelling Test(HOST).METHODS: Semen samples from 42 men undergoingevaluation for infertility were examined according toWHO criteria. Twenty-five of them, whitout clumpingnon hyperviscosity, were selected. The MOST test wasapplied according to the author’s original technique.ASA were determined with a direct mixed agglutinationtest, TAC II, developed and validate by our group.Macrophage concentration was evaluated with NeutralRed stain, and functional integrity of the sperm membranewith the Hypoosmotic Swelling Test using an hypoosmoticsolution of 150 mOm/mlcomposed of equal parts of fructose and sodium citrate.RESULTS: The Chi square test was applied to theobservational data obtaining the following results:There was a statistically significant association betweenthe presence of ASA and altered MOST (p<0.001). Inall samples with ASA, abnormal MOST values wereobtained (MOST<0.39). Besides, there is a statistically significant association existsbetween the increased concentration of macrophagesand abnormal MOST (p<0.01); and altered HOSTwas positively correlated with abnormal MOST(p<0.02). CONCLUSION: Results clearly demonstrate the highpredictive power of MOST like a test of sperm resistanceto the forced lipoperoxidation, offering conditions tobecome a good predictor of sperm performance.Understanding the sperm resistance to the ROS and theirharmfull effects on the sperm functions, a proportion ofinfertile men can be succesfully treated.
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OBJECTIVES: Ureteroscopy with endoscopical stone fragmentation is effective in the treatment of ureteral lithiasis. We report our experience, as well as our methods.METHODS: 1803 cases of ureteral stones were treated as outpatient. 44% were located in the lumbar ureter,11%in the iliac ureter, and 45% in the pelvic ureter. Average size was 0.87 (0.4-2.2) cm. A 7 Fr Wolf rigid ureteroscope and a lithoclast type pneumatic lithotripter were employed. Lithotripsy was performed to an extent that small fragments might be spontaneously passed. RESULTS: 98% of the stones were solved. 16% required additional ESWL. 16% of the patients required theinsertion of a double J stent. 12% of the patients required more than one session. Complications appeared in 8%of the patients.CONCLUSIONS:-Good results: 98% success rate.- It can be performed as outpatient.-The support of an ESWL unit is basic.
Case Report
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OBJECTIVES: We report one case of ocularand Iung metastases seven years after radical nephrectomy forrenal cell carcinoma.METHODS: The case of a 45-year-old male patient whounderwent radical nephrectomy for a localized renal cellcarcinoma (T2N0M0) in 1995 was found in a review ofmalignant renal neoplastic pathology.RESULTS: Seven years later he presented with a lung metastasisrequiring neumonectomy, and an ocular metastasis requiringenucleation. He is currently receiving systemic treatment withinterferon and interleukin.CONCLUSIONS: Clinical presentation and evolution ofmetastasic renal carcinoma is very variable, a difference withother neoplasias. Ocular localization is exceptional and mayappear long time after primary tumor; clinically, it may beasymptomatic or present with sudden sight loss. MRI, CT scanand retinal examination are the diagnostic methods employed,and treatment may be surgery, brachytherapy or radiotherapydepending on location and size of the lesion.
Case Report
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OBJECTIVES: To report the finding of a raretesticular anomaly.METHODS: We performed physical examination, blood tests,surgical exploration, and testicular biopsy.RESULTS: Patient had penile phymosis. Left scrotum had a normaltesticle inside. Right scrotum was empty and hypoplastic.There was and ovoid formation near the root of the penis, similarto a testicle. Blood tests were normal. Orchydopexy wascarried out following the technique by Bevan. Testicularbiopsy was normal.CONCLUSIONS: Ectopic testicles usually keep the power offertilization so that their treatment should not be as prematureas in the case of cryptorchidism.
Case Report
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OBJECTIVES: To report a new case of bilateralsynchronic testicular tumors, and to perform a bibliographicreview on the topic, emphasizing the ultrasound characteristicsand oddity of these presentation, which accounts forless than 1% of germ cell testicular tumors.METHODS/RESULTS: 29-year-old patient consulting becauseof an increase of the testicular size over one year. Physicalexamination and ultrasound revealed a synchronic neoplasticinvolvement of the testicles, suggesting the radiological diagnosisof bilateral “seminomatous tumor”, with “non seminomatous”foci in one of them. Histologically, tumors were in accordancewith ultrasound working diagnosis (seminomas, showingone of them anaplastic foci).CONCLUSIONS: Synchronic testicular involvement by neoplasiasis an unfrequent fact, scarcely reported in the literature,being most cases germ cell tumors, mainly seminomas,and shows a good correlation between ultrasound and histologicdiagnosis.
Case Report
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OBJECTIVE: To present a case of bladder anduterine perforation following curettage for first-trimesterabortion.METHODS: A 30 years-old female, pregnant of 19 week ofgestation had undergone a therapeutic abortion for fetaldeath. Following the procedure, she presented hematuria andvaginal bleeding. A vesico-uterine perforation was achieved.An exploratory laparatomy was performed with repair of thebladder and the uterus.RESULTS: There were no surgical complications. Eleven daysafter the laparatomy a cistography demonstrated closure ofthe perforation. The patient did well postoperatively. Twoyears later the patient was pregnant. A caesarean procedurewith tubaric ligation was performed without complications.CONCLUSIONS: Bladder perforation following uterine curettageis rare. Surgical management is necessary with bladder anduterus repair.
Case Report
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OBJECTIVES: To describe the clinical andradiological (color doppler ultrasound, CT scan andarteriography) features of a case of renal arteriovenousmalformation type mixed fistula with pseudoaneurysm in afemale patient after extracorporeal shock wave lithotripsy.METHODS/RESULTS: We report one case of secondaryvascular malformation in a 54-year-old female patient whounderwent extracorporeal shockwave lithotripsy, presenting asrecurrent hematuria. Ultrasound detected a “cystic” formationnewly appeared after lithotripsy, being the diagnostic madeby a color doppler study which showed a mixed high speedarteriovenous turbulent flow. The lesion showed intenseintravenous contrast uptake on CT scan. Diagnosis wasconfirmed by arteriography.CONCLUSIONS: External shock wave lithotripsy is, as wellas interventional procedures, a known cause of renal vascularcomplications, so that doppler color studies may be diagnosticin patients with suggestive clinical features, focusing speciallyon those lesions or morphological abnormalities newlyappeared when compared to pre-treatment studies.
Case Report
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OBJECTIVES: To report one case of colovesicalfistula after the diagnosis of unresponsive urinary tractinfection.METHODS: The 76-year-old patient underwent a diagnosticwork up including cystography, cystoscopy and bariumenema.RESULTS: Cystography revealed an image of the sigmoidcolon, and cystoscopy showed a granuloma at the bladderdome. A fistula was identified underneath. A colovesical fistulawas diagnosed and several intestinal germs grew on urinecultures. Partial cystectomy and end to end anastomosis of thesigmoid colon were carried out. Pathology report showed awell-differentiated adenocarcinoma which invaded down tothe bladder mucosa.CONCLUSIONS: Inflammatory diseases are the main theetiology of colovesical fistula, followed by neoplasias. Wereviewed around 170 cases reported in our country. It isimportant to identify the fistula by means of the gastro-intestinalseries and the study of the lower urinary tract when treatingpatients with urinary tract infection difficult to control. We suggestthe best radical therapy is surgery in a single procedure.
Case Report
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OBJECTIVES: Carcinoma with basaloidfeatures, known as basaloid carcinoma of prostate, isan extremely rare tumor. We report the clinical, histological and immunohistochemical findings in a case ofprostatic basaloid carcinoma. METHODS/RESULTS: A 68-year old man consultedwith a two-year history of increasing urinary outflowobstruction that developed into acute urinary retention.A routine suprapubic prostatectomy was carried out,following which normal voiding was achieved.Microscopically, the neoplasm showed differenthistological aspects; some areas were typical of basalcell hyperplasia, intermixed with other in which therewas evidence of basaloid carcinoma.Immunohistochemical staining of the basaloid carcinomarevealed cytokeratin 34βE12 immunoreactivity withoutexpression of prostatic specific antigen and prostaticacid phosphatase. CONCLUSION: This case is a very unusual basaloidcarcinoma and may indicate that there is a spectrum inprostate basal cell proliferation.
