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OBJECTIVES: The practice of Urology inour country has a long tradition, as demonstrated byseveral treaties of surgery from the Renaissance; it wasthe end of the XIX century when the scientific basis of thespeciality were established separate from Surgery, assome authors demonstrated, with the notorious contributionof Prof. Rafael Mollá Rodrigo. Dr. Nicasio BenllochGiner (1888-1957) did the same at the beginning ofthe XX century when he came back from the professionalschool of George Marion, contributing to the consolidationof this speciality.METHODS: We reconstructed his biography andanalyzed all his bibliography, both in regional andnational journals.RESULTS: According to Nicasio Benlloch, renal lithiasisand its treatment were under controversy. Renal lithiasismight demand three indications: nephrectomy,pyelolithectomy and nephrolithectomy. In his chapter onintravenous pyelography he describes its absolute andrelative indications. In his work about urinary catheterizationand endoscopy he describes in detail the exploratorycatheterization of urethra, bladder, and ureters, as wellas the catheterization for evacuation and dilatation, andthe most frequently used instruments. Finally, he talksabout the benefits of endoscopic resection for bladderneck diseases and describes a resectoscope.CONCLUSIONS: Dr.Nicasio Benlloch contributes withhis works to the consolidation of Urology as a specialityin Valencia, mainly in the field of lithiasis, a topic inwhich his works were fundamental.
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OBJECTIVES: The practice of Urology inour country has a long tradition, as demonstrated byseveral treaties of surgery from the Renaissance; it wasthe end of the XIX century when the scientific basis of thespeciality were established separate from Surgery, assome authors demonstrated, with the notorious contributionof Prof. Rafael Mollá Rodrigo. Dr. Nicasio BenllochGiner (1888-1957) did the same at the beginning ofthe XX century when he came back from the professionalschool of George Marion, contributing to the consolidationof this speciality.METHODS: We reconstructed his biography andanalyzed all his bibliography, both in regional andnational journals.RESULTS: According to Nicasio Benlloch, renal lithiasisand its treatment were under controversy. Renal lithiasismight demand three indications: nephrectomy,pyelolithectomy and nephrolithectomy. In his chapter onintravenous pyelography he describes its absolute andrelative indications. In his work about urinary catheterizationand endoscopy he describes in detail the exploratorycatheterization of urethra, bladder, and ureters, as wellas the catheterization for evacuation and dilatation, andthe most frequently used instruments. Finally, he talksabout the benefits of endoscopic resection for bladderneck diseases and describes a resectoscope.CONCLUSIONS: Dr.Nicasio Benlloch contributes withhis works to the consolidation of Urology as a specialityin Valencia, mainly in the field of lithiasis, a topic inwhich his works were fundamental
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OBJECTIVES: Xanthogranulomatouspyelonephritis is an atypical chronic infection whichsimulates a malignant renal neoplasia, definitive diagnosis of which is obtained by pathologic study after surgical removal. In this paper we analyze our experienceand compare it to that reported on the literature.METHODS: We performed a retrospective study ofcases of xanthogranulomatous pyelonephritis diagnosed in the period from January 1945 to December 2000 atthe Institute of Neoplastic Diseases, analyzing clinical,radiological, and surgical features documented in themedical records.RESULTS: There were11 cases, 82% of them werefemales. The presence of signs and symptoms such aspain and abdominal mass appeared in 73%,accompanied by hematuria and fever. Most radiologicaltests showed destruction of the renal parenchyma withabnormalities in the collecting system and obstruction bylithiasis. 91% of the cases had positive urine cultures,being Escherichia coli, Proteus Mirabilis and Klebsiellathe most frequent germs. Simple nephrectomy was thesurgical treatment, and complications were minimal.CONCLUSIONS: Xanthogranulomatous pyelonephritisshould be considered in the differential diagnosis ofrenal cancer because of its clinical features
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OBJECTIVES: To establish the incidenceof complications secondary to performance of transrectalprostatic biopsy, and to establish the hypotheticalrelationship between the rate of fever and the type ofantibiotic prophylaxis employed.METHODS: All patients undergoing transrectal prostaticbiopsy between January 1992 and December 2003were included in this prospective nonrandomized study.Patients were given a self-administered questionnaire toobtain data about complications related to biopsy thatincluded the following variables: fever, hematuria, rectalbleeding, hemospermia, voiding difficulties, acuteurinary retention, need to visit primary care physician oran emergency department, hospital admissions andneed of medication. The incidence of observedcomplications was calculated and the relationshipbetween post-biopsy fever and type of antibioticprophylaxis employed (oral ciprofloxacin vs. intramusculartobramycin) was studied by means of the chi-squaretest, using the SPSS 11.5 for Windows; a p ﹤ 0.05was considered significant.RESULTS: Overall, 705 questionnaires were received;603 (85.5%) were considered valid for processing.Almost three quarters (73.9%) of the patients undergoingbiopsy presented some complications, being hematuriathe most frequent (53% of the cases).40 patients presented fever (6.64%). Among 360patients treated with oral ciprofloxacin for three days 16developed fever (4.4%), in comparison to 24 patientsout of 243 treated with intramuscular tobramycin(9.87%) (p = 0.009).CONCLUSIONS: Ultrasound guided transrectal prostaticbiopsy is associated with frequent complications,although most of them are mild. The most frequentcomplication is hematuria; fever is the most severe.To prevent post-biopsy fever, antibiotic prophylaxis withciprofloxacin for three days is more effective than singledose intramuscular tobramycin. However, prospectiverandomize studies are required to confirm it.
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OBJECTIVES: To demonstrate theimportance of BCG as adjuvant treatment for superficialbladder tumors. To suggest the best dosage and treatmentscheme for patients with this severe disease. Toemphasize treatment-associated toxicity in our studywith endovesical BCG.To evaluate relapse and progression rates of superficialbladder tumors. To describe histological grade andtumor location in our sample. To offer an economic andsocial benefit to both patient and our Country,improving the quality of life of our patients.METHODS: We performed a descriptive research in aseries of cases, both retrospectively and prospectively,and a review of published advances in BCG adjuvanttreatment for superficial bladder tumors. Between 1996and 2000, 90 ambulatory patients were selected at the“Hospital Docente Clinico Quirurgico 10 de Octubre”to receive endovesical treatment with BCG in two differentprograms of treatment, 6 and 12 months long respectively,using statistical methods such as the homogeneicity test,chi-square test and the test for independence in selectedtables and graphics.45 controls were randomly selected from a group ofpatients to whom BCG was not administered between1992 and 1996; their clinical records were retrospectivelyanalyzed selecting the same variables of the 90 casessample, being their results presented in tables andgraphics RESULTS: We evaluate and review a technologyapplied to patients with superficial bladder tumors. Theywere treated with Bacillus Calmette Guerin (BCG) afterendoscopic resection (TUR) of bladder tumors and weobserve that long-term treatment over 12 months is betterthan short-term over 6 months, improving quality of livewith longer survivals. Using low doses of 50 mg/ ml ofa nationally produced BCG, economic savings wereobtained for both patient and Country with fast patient’sreturn to work, achieving the introduction andmaintenance of the treatment in Cuba with relevantresults during the “special period”. Comparisons betweenboth treatment groups and control group showedgreater benefits with the first two.CONCLUSIONS: In patients with superficial bladdertumors stage I, the use of low dose (50 mg/ ml) BacillusCalmette Guerin is an effective treatment with minimalside effects (cystitis). Most tumors were located in thebladder trigone; histological grade 1 was predominant.Long-term treatment for 12 months was more effectivethan the short-term one, offering a social and economicbenefit to patient and to our Country, by delaying orpreventing tumor recurrences and progression, so thatwe recommend this modality of treatment should be partof the therapeutic armamentarium of the urologist in hisfight against this severe health problem
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OBJECTIVES: To evaluate the functional results and incidence of complications in a series of pediatric renal transplants using grafts from pediatric donors under 3 years of age.METHODS: We review a serious of 19 renal transplants consecutively performed in pediatric receptors with donors under the age of 3 years. We analyze immediate function, medical and surgical complications, and long and mid-term graft and patient survivals.RESULTS: We observed initial graft dysfunction in 9 patients (47.4%). Six patients had vascular complications (31.5%). More vascular complications appeared in kidneys preserved with EC solution (35.3%) in comparison with UW solution (23.5%) (p < 0.05). 1,5,10, and 12 year actuarial graft survivals were 57.8%, 41.4%, 35.5% and 35.5%, respectively. Based on preservation solution, 1,5, and 10 year actuarial graft survivals for EC were 44%,33% and 16%, respectively; resultsimproved with UW solution up to 60%,50%, and 50%respectively (p < 0.001).CONCLUSIONS: Kidneys from donors under the age of the 3 years in pediatric receptors suffer a high incidence of vascular complications offering a low graft survival on the long-term, being these facts more evident when simpler preservation solutions are employed.
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OBJECTIVES: To determine the therapeuticusefulness and side effects of a new disposableintraurethral device (Uriabsorber ®) for female stressurinary incontinence.METHODS: A prospective study was performed in acohort of 48 women (mean age 42.7 yr.) consultingbecause of urinary incontinence with coughing. Lack ofmanual ability or difficulty to understand, pregnancy,puerperium, vaginitis, urinary tract infection and currentadministration of active treatment for urinary incontinencewere all exclusion criteria. Patients were instructedabout the use of the device. Two visits were performed:one after two weeks and the other at the end of themonth. Clinical results were collected and urine analysiswas performed. A multivariate statistical analysis wasperformed to determine what variables influenced thefinal result.RESULTS: Treatment withdrawal rate was 42% after onemonth, being most withdrawals before 14 days (19cases, 40%). The causes of withdrawal were localdiscomfort (11 cases, 23%) and difficult insertion (3cases, 6%). There were only five cases (10%) of urinarytract infection, and two cases (4%) of macroscopichematuria. The presence of cystocele was associatedwith higher frequency of complications (80%). 79% ofthe patients completing the month of treatment hadpositive results (50% resolution of incontinence and 29%improvement). Multivariate statistical analysis showedthat variables independently influencing the resultswere: incontinence intensity (the lower the intensity, thebetter the results), presence of urinary tract symptoms(the lower the intensity of the symptoms, the better theresults), and absence of past history of pathology.CONCLUSIONS: The intraurethral disposable devicesignificantly reduces the rate of urinary tract infections.Tolerance depends on the ability and motivation of thepatients. It is indicated in the control of non intense urinaryincontinence in motivated patients, without evidentcystocele.
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OBJECTIVES: To analyze the distributionby symptoms, signs, and urodynamic diagnosis ofwomen with urinary incontinence referred for study and treatment to the urogynecologic unit of a third levelhospital.METHODS: Descriptive epidemiological study of 1713consecutive women with symptoms of urinary incontinencereferred for study and treatment to the urogynecologicunit between January 1998 and December 2002.Urogynecologic history, physical examination andurodynamic study were performed to all patients.Patients with genital prolapse greater than grade II wereexcluded. We analyzed the general characteristics ofthis group of patients, the distribution by main urinarysymptoms, and the urodynamic diagnosis.RESULTS: Among 1732 patients complying with inclusioncriteria, 1386 (80%) referred symptoms of urine losswith effort, 977 (56.4%) urgency incontinence, and795 (45.9%) presented the association of both. 1175patients (67.8%) presented symptoms of urine losseswith effort associated to other symptoms suggestive ofmixed UI (frequency, urgency, nicturia, or urgency UI).Urodynamic diagnosis of stress urinary incontinencewas obtained in 782 patients (45.2%); detrusor hyperactivitywas found in 290 (16.7%); mixed urinary incontinence413 (23.8%); 142 patients (8.2%) were grouped underthe concept of other diagnosis and 105 (6.1%) had anormal study.CONCLUSIONS: Stress urinary incontinence is themost frequently referred symptom in patients withsymptoms of incontinence without symptomatic genitalprolapse. In most cases it is associated to other urinarysymptoms suggestive of mixed UI. The urodynamicdiagnosis of stress urinary incontinence is the mostfrequent in this kind of patients.
Case Report
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OBJECTIVES: The epidermoid cyst of the testis is a rare benign tumor. It accounts for approximately 1% of all testicular tumors. Generally, the testis has a palpable, painless mass with tumor markers (AFP,BHCG, and LDH) within normal ranges. Pathology reveals a cavity consisting of squamous epithelial cells containing keratin and non-nucleated keratic flakes in the absence of atypia or elements of teratoma (1). METHODS/RESULTS: We report the case of a young man who was diagnosed of epidermoid cyst after orchiectomy. CONCLUSIONS: Tumor enucleation would be a proper treatment when ultrasound studies suggest this diagnosis.However, we often perform orchiectomy due to a low rate of suspicion, non conclusive ultrasound studies, or due to the high percentage of malignant testicular tumors in this agerange.
Case Report
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OBJECTIVES: To report one case of adrenal incidentaloma and to review the sensitivity and specificity of urine methanephrines in the diagnosis of pheochromocytoma. METHODS: We report the case of a patient with high blood pressure and a left adrenal incidentaloma. Surgical excision of the mass was indicated after elevated urine methanephrine. RESULTS: Pathologic study of the nodule established the diagnosis of cortical adenoma. CONCLUSIONS: The elevation of urine normethanephrine is a non-specific parameter for the diagnosis of pheochromocytoma.
Case Report
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OBJECTIVES: To report a new case of well-differentiated renal liposarcoma, and to describe its clinical features, diagnosis, treatment, and differences with other mesenchymal tumors of the retroperitoneum.METHODS: We perform a clinical review of renal mesenchymal tumors, especially liposarcomas. We report one case of well-differentiated renal liposarcoma in a 52-year-old female, and review current lines oftreatment and follow-up.RESULTS/CONCLUSIONS: The well-differentiated renal liposarcoma is a very unfrequent mesenchymal tumor, for which it is necessary to know exactly its origin in the renal parenchyma.The treatment of choice is complete tumor exeresis; closefollow-up should be exercised because even though it does not metastasize, local recurrences appear in 30% of thecases.
Case Report
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OBJECTIVES: We report a case of urethral foreign bodies in a patient with posttraumatic psychiatric disorders.METHODS: The patient presents with clinical signs of scrotal abscess. Many foreign bodies were removed from the bulbar urethra; one urinary stone formed around one of them required lithotripsy.RESULTS: Treatment included removal of the foreign bodies, abscess drainage, and administration of wide spectrum antibiotics.CONCLUSIONS: Urethral foreign bodies are exceptional, and may present with many symptoms making diagnosis difficult. We noted symptoms and diagnosis in our case, and additionally the therapeutic options proposed in the literature.
Case Report
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OBJECTIVES: Villous adenoma is a benignneoplasia, the appearance of which in the urinary tract isextraordinarily unfrequent. We report a new case recentlyexperienced in our department.METHODS: We report the case with its past urologic history,clinical picture, diagnostic tests, and treatment.RESULTS: Pathologic report confirmed the diagnosis of bladdervillous adenoma, being transurethral resection the only treatmentapplied to leave the patient disease-free.CONCLUSIONS: Prognosis of this kind of neoplasia, whichis unfrequent, is excellent; being endoscopic resection curative,with no local or distant progression, except in cases associatedwith adenocarcinoma foci, in which local recurrence ordistant metastasis are possible, and a more aggressivetreatment might be indicated.
Case Report
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OBJECTIVES: To report a new case of penileincarceration by a metallic object.METHODS: 28-year-old male presenting to the emergencyroom with a ring at the medial part of the penis that he wasunable to remove. The ring was placed 16 hours before.Such incarcerating object was causing important oedema, asmall plate of necrosis, and hypoesthesia of the glans penis.RESULTS: After many unsuccessful attempts the penis wasfinally released using a strong cutting tool. The wound wascleaned with removal of devitalized tissue and sutured.Twenty-four hours later the penis looked almost normal,although patient complained of slight hypoesthesia at theglans penis.CONCLUSIONS: Incarceration of the penis by a metallicobject is an unusual clinical situation causing a vascularemergency and an incredible therapeutic challenge to removethe constructive object.
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OBJECTIVES: To report one case of anexceptional benign prostatic pathology and its differentialdiagnosis with malignant tumors.METHODS: 67-year-old male who suffers an acute urinaryretention requiring bladder catheterization and subsequentnegative catheter removal tests. Digital rectal examinationshowed a small prostate, adenomatous, without nodules. PSAwas 1.01 ng/ml. The patient underwent transurethral resectionof the prostate because of the persistence of urinary retention.RESULTS: Pathologic study reported a hypercellular stroma,with a perivascularly distributed inflammatory infiltrate andmyxoid stromal background with slightly atypical fusiformcells. Immunohistochemical studies showed positive stainingof fusiform cells for vimentin and histiocytes in the lesion forCD68, and negative staining for cytokeratin. The final diagnosiswas prostatic inflammatory pseudotumor.CONCLUSIONS: In spite of being an unfrequent presentationit is important to take this benign lesion under considerationto avoid unnecessary aggressive radical complementarytreatments.
