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OBJECTIVES: We find that Urology at the end of the 20th century was a consolidated speciality as a result of years of evolution and development, and the studies and works of authors whose contributions are considered today the basements of our speciality. So we think that Urology should be understood with its historical references, because, as Aristotle said “...thinks are better understood when one has got to clearly see how they were formed...”Numerous specialists contributed to this; among them we can cite Prof. Rafael Alcala Santaella, the object of this bibliographic and scientific works compilationpaper.METHODS: We reviewed all his scientific works.Original articles have been obtained from MedicinaIbera, Revista Española de Cirugía y Urología, and Cirugía, Urología y Ginecología. His most important urologic work is Clinic Urology (1942), divided in 3 volumes. For his biography we used the biographic and bibliographic historical source of Spanish urology over the 20th-century and direct family members interviews.RESULTS: He analyzed topics as important as voiding disorders and the study of urine pyuria. He gave special importance to the study of prostatic pathology, its diagnosis by means of cystourethrography, and the modification of surgical techniques, as well as the results of urinary diversions performed in his department.CONCLUSIONS: Due to his extensive scientific andtechnical contributions he is one of the most outstanding figures of Valencia`s Urology over the first half of the 20th century, together with Rafael Molla Rodrigo and Nicasio Benlloch Giner.
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OBJECTIVES: To perform an epidemiological pathologic and therapeutic study of asymptomaticbacteriuria (AB) in a population of outpatient women.METHODS: Transversal study for detection of AB in1718 outpatient women14-year-old or older. Allpatients complied with the inclusion/exclusion criteriafor the study. Two groups of patients, with AB (n = 113)and controls without AB (n = 200), underwent: 1) urineanalysis: urine sediment, biochemical analysis, andculture; 2) blood tests: hemoglobin, red blood cellcount, urea, creatinine, sedimentation rate velocity, Creactive protein, immunoglobulins (Ig A, Ig M, andIgG), HLA-A 3, blood group and Rh. The therapeuticmanagement for AB was analyzed. Comparativestatistical analyses of data were performed. RESULTS: AB prevalence was 6.34%. The mostfrequently isolated germ was E.Coli (77.87%).Diabetes mellitus was detected in 27.43% of patientswith AB and 7.01% without AB (27.43% vs. 7.01%);coronary arterial disease and other heart disorders(9.73% vs. 4%,p = 0.0206); general cardiovasculardisorders excluding hypertension (46.9% vs. 31%,p =0.0025). Urine analysis showed leukocyturia in81.41% of the patients with AB and 17.5% without AB(p = 0.0002); positive nitrites (77.87% vs. 0%, p<0.001); urine sediment showed bacteriuria in 86.72%of patients with AB and 0% of non-AB patients (p<0.0001), leukocytes (93.80% vs. 6%,p<0.0001),and pyuria (19.46% vs. 2.5%). Low water intake(50.44% vs. 9.5%,p<0.0001) was the most significanturinary tract infection hygienic-dietetic predisposingfactor. Higher levels of IgA (15% vs. 2%,p = 0.004).Positive HLA-A 3 (5% vs. 0%,p = 0.039), Rh negative(16.66% vs. 13.33%), and increased C reactive protein(15% vs. then%). Renal abnormalities detected byradiological tests (10.29% vs. 1.47%,p = 0.014).AB disappeared after treatment with cefuroxime, ceftibuten,trimetropin/sulfametoxazole and amoxicillin in 100% ofthe patients receiving treatment. Topical vaginal estrogentherapy was effective in 38.09% of the patients.CONCLUSIONS: The prevalence of AB increases withage. The most frequent germ is Escherichia coli. Astatistically significant greater number of coronary arterydisease, other heart diseases, and cardiovascular disorderswere found among patients with AB in comparison withnon-AB controls. Immunoglobulins levels disturbances,and HLA-A3 positivity suggest an immune systemicimbalance in certain patients with recurrent AB. Othertherapeutic alternatives such as vaginal topical estrogens,fruit juices intake, vaccinations, etc. should be pursuedin addition to antimicrobial therapy.
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OBJECTIVES: To evaluate the usefulness of Ki-67 expression in preoperative diagnostic biopsies to predict prostate cancer biochemical relapse of after radical prostatectomy. METHODS: We analyze the expression of Ki-67 in ultrasound guided biopsies of 103 patients who under- went radical prostatectomy. Mean follow-up was 3.4 years (1.3-8.8 yr.). We correlated biochemical progression with traditional prognostic factors such as PSA (> 10/≤ 10), Gleason (≥ 7/< 7),pT classification (pT3/pT 0-2), and the immunohistochemical prognostic factor Ki-67 (> 3%/≤ 3%). RESULTS: 71/103 (69%) patients did not have progression and 32 (31%) had biochemical progression. Mean preoperative PSA was 10.7 ng/ml in patients without progression and 20.90 ng/ml in patients with biochemical progression (p = 0.0001). Mean Gleason score was 6.03 in patients without progression and 6.75 in patients with biochemical progression (p = 0.0001). Ki-67 expression was 3.95% in patients without progression in comparison to 5.05% of patients with biochemical progression. 12/67 (17.9%) of pT 0-2 tumors and 20/36 (55 .6%) pT3 tumors progressed (p = 0.0001). Multivariate analysis indicates that there is not relationship between Ki 67 (> 3% ≤ 3%) in preoperative biopsy specimens and prostate cancer biochemical progression after radical prostatectomy (p = 0.204). CONCLUSIONS: The immuno histochemical prognostic factor Ki 67 (> 3%/≤ 3%) in preoperative biopsies is less effective than classic factors, PSA (> 10/≤ 10), Gleason score (≥ 7/< 7) and pT classification (pT3/pT 0-2), to predict prostate cancer biochemical progression after radical prostatectomy.
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OBJECTIVES: To analyze the evolution ofprostate cancer (PCa) in our community health area overthe last years, in terms of incidence, clinical-epidemiological characteristics, and cancer-specific mortality.METHODS: Retrospective analysis of the medicalrecords of patients with PCa in our hospital over the1991-2003 period. We calculated the annual incidencerates for our community health area as well as its trendover the period of study. Changes of several clinicalepidemiological parameters over time were studied.The evolution of PCa mortality was also analyzed.RESULTS: 730 patients with PCa were evaluated.Median age and PSA at diagnosis were 69 years and11.4 ng/ml, respectively. 60.5% tumors were detectedin a localized clinical stage, and 18.6% were metastasic.30.4% of PCa in the study (the most numerous group)had a Gleason score between 5 and 6. A constantincrease of PCa incidence was observed with anannual percentage increase of 5.5% (p < 0.001).Standardized incidence rate for the year 2003 Spanishpopulation pyramid was 100 .9 cases/100.000males. A significant trend to a greater proportion ofPCa cases diagnosed by uncontrolled screening wasobserved, being the cases currently detected aftersymptoms only a small proportion (p < 0.001).Decreases in the age at diagnosis (p< 0.001), PSAlevel (p < 0.001), proportion of advanced clinicalstages (p< 0.001), as well as proportion of cancerswith well-differentiated Gleason score (2-4) (p < 0.001)were also detected. PCa mortality adjusted by thepopulation pyramid was 8.7 deaths/100.000 malesin the year 2003.CONCLUSIONS: We found an increase in theincidence of prostate cancer in our community healtharea over the last years, parallel to an increase in theproportion of cases detected by screening in asymptomaticpopulation. Because of that, tumors currently detectedtend to appear in younger ages, with lower PSA levels,and localized clinical stages.
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OBJECTIVES: Bladder leiomyoma is an uncommon mesenchymal benign tumor. It is generally asymptomatic and incidentally detected. METHODS: We report a new case managed with transurethral resection without evidence of relapse. A bibliographic search was performed to evaluate the diagnostic techniques, clinical features and treatment options of this rare disease. CONCLUSIONS: Bladder leiomyoma is a benign mesenchymal tumor originating from smooth muscle. Biopsy and histological study are required for definitive diagnosis. Surgery is the treatment of choice, and it has an excellent prognosis if resection is complete.
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INTRODUCTION. The description of thefirst laparoscopic nephrectomy made a revolution in themanaging of the benign and malignant renal diseases.Hand-assisted laparoscopy (HAL) was developed withthe aim of offering advantages to both patients andsurgeons. The aim of the present work is to compare, inour experience, the results offered in the radicalnephrectomy by HAL and open surgey, by analysis ofsurgical time, estimated blood loss during surgery andhospital stay.METHODS. Eleven Hand-assisted laparoscopic(HAL) radical nephrectomies and eight open radicalnephrectomies were carried out at our institutionduring the same period (June 2001 to December2002). All patients underwent computed tomographyand were found to have a clinically localised functioningrenal mass in all cases. The size of this renal mass was4-7cm (average 5.5 cm) in the HAL group and 4.5-15cm (average 7.8 cm) in the open group. Patient age,body mass index, and American Society ofAnaesthesiologists` score showed no significantdifference between groups.RESULTS: The average surgical time in the HAL groupwas 156.72 minutes, the average blood loss duringsurgery was of 83.6 ml and the average hospital staywas of 3.09 days. Conversion to open surgery was notnecessary in any patient. Average surgical time in theopen surgery group was 178.25 minutes, the estimatedblood loss during surgery was of 337.75 ml (p < 0.05)and the hospital stay was of 5.37 days (p < 0.05). Thecomparison of the means by two-tailed student`s t testrevealed significant differences in estimated blood lossand hospital stay, favoring HAL, and no significantdifferences in surgical time.CONCLUSIONS. HAL nephrectomy is feasible inalmost all nephrectomies and is a safe, reproducible,and minimally invasive technique to perform extirpablerenal surgery. HAL offer clear advantages over traditionalopen surgery, including deecreased blood loss andhospital stay.
Case Report
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OBJECTIVES: To report the radiologicalfindings of retroperitoneal paragangliomas.METHODS: A patient who presents with colic pain andundergoes intravenous urography and CT scan.RESULTS: KUB x-ray revealed an increase of radiodensity onthe left flank. The urography showed a partially obstructiveurinary lithiasis in the proximal third of the left ureter with amass effect laterally displacing pelvis and ureter.The study was completed with an IV contrast abdominal CTscan which showed a left para-aortic solid mass under thekidney with heterogeneous contrast uptake.CONCLUSIONS: The correlation of symptoms andcatecholamine levels is the best way to guide the etiologicaldiagnosis after CT scan.
Case Report
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OBJECTIVES: To report the case of a patientwith a bilateral synchronic renal tumor who underwent alaparoscopic surgical approach.METHODS: 57-year-old caucasian male with history of endstage renal disease and secondary hypertension, type IIdiabetes Mellitus, proteinuria of 2.83 g/24 hours, chronicsmoker, and allergic to iodinated contrast who underwentright nephrectomy and simultaneous left laparoscopictransperitoneal nephroureterectomy for a bilateral renal tumor.RESULTS: Operative time was 4 hours; NG tube was inserted;estimated blood loss was 200 ml and no transfusions wererequired. Oral intake was re-established after two days. Nointraoperative complications occurred; metabolic acidosisappearing in the intermediate postoperative period wascorrected with intravenous sodium bicarbonate. Hospital staywas 9 days.CONCLUSIONS: Bilateral laparoscopic nephrectomy is aneffective therapeutic option in the management of patientswith bilateral malignant renal diseases, which ensures surgicalradicality, and diminishes morbidity, hospital stay and recovery time.
Case Report
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OBJECTIVES: To review the diagnosis and therapeutic management of scrotal wall smooth muscle tumors by reporting an illustrative case. To emphasize that despite their histological characteristics on presentation, compatible with malignancy, these tumors have a benign behaviour, even when their size is much bigger than the ones found in thereview bibliography.METHODS: 75-year-old male who presented a big, very slowly growing, painless, mobile, hard, not adhered to deep layers, non transilluminating scrotal tumor.RESULTS: Pathology reported a giant bizarre scrotal leiomyoma. CONCLUSIONS: We emphasize the atypical characteristics of this case, which despite its compliance with almost all classical criteria establishing the malignant character of tumor lesions has a benign behaviour. It complies with the criterion that, accordingly to reviewed bibliography, seems to be the most important to determine it: the absence of mitosis. We also insist on the importance of an adequate diagnostic approach which guarantees a proper surgical approach, for which we think ultrasound is essential.
Case Report
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OBJECTIVES: To report one case of urinary stone as a relatively frequent complications of urinary diversion using bowel loops.METHODS: We perform a short bibliographic review using the case report format.RESULTS: Stone formation in Bricker’s type urinary diversion is secondary to various factors such as urinary stasis, bacteriuria, presence of intestinal mucus, metallic sutures, metabolic disturbances, etc.CONCLUSIONS: Periodic control by radiological studies is recommended due to the high frequency of this complication in patients with urinary diversion. Treatment is usually conservative or minimally invasive, being surgery reserved for those cases in which stone extraction is not safe using other methods.
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OBJECTIVES: To report a new case ofinfiltrative small cell bladder cancer.METHODS: We describe the case of a 60-year-old malepatient who consulted for monosymptomatic hematuria over afew weeks. Cystoscopy showed a neoplasia in the anteriorwall of the bladder. Pathological analysis of the TUR chipswas compatible with infiltrative small cell tumor. After anegative staging study radical cystectomy plus adjuvantchemotherapy were indicated.RESULTS: Pathological study of the surgical specimen confirmedthe diagnosis with involvement of the surrounding fat. There isno evidence of neoplasic involvement after 24 months follow up.CONCLUSIONS: We point out the validity of a radicalsurgical approach for this tumor, also emphasizing the importanceof adjuvant chemotherapy .We concur with other authors in the need of multicentricstudies to outline the most effective surgical option, due to thelimited number of cases of this entity.
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OBJECTIVES: To report the case of a 23-yearoldpatient with ambiguous external genitalia, gynecomastiaand cyclic hematuria who demanded proper investigationsand actions to be considered male.METHODS: A set of tests were performed: history and physicalexamination, blood tests, hormonal determinations, nuclearchromatin, cariotype, renal and pelvic ultrasound, voidingcystourethrogram (VCUG), laparoscopy, exploratory laparotomy,left hystero-salpingo-oophorectomy, right orchydopexy, testicularbiopsy and fibrous cord section.RESULTS: History and physical examination showed a longslim individual with male fat distribution, female pubic hairdistribution, Tanner`s grade 4 gynecomastia with scarce breasthair, absence of scrotal gonads, and urogenital sinus. Bloodtests were normal. Hormonal tests were normal. There wereno anomalies in the renal ultrasound and a small uterus wasfound in the pelvic ultrasound. The chromatin test was positiveand cariotype showed a 46/XX cell line.The VCUG only contrasted a normal posterior urethra.Laparotomy discovered a small uterus with two fallopiantubes: the left one was dilated with a polycystic ovary, and theright one was hypoplastic with testicle, vas deferens, andepididymis near it. Right orchydopexy was carried out afterbiopsy and section of the fibrous cord. Androgen therapy,subcutaneous mastectomy, and urethroplasty were performedpostoperatively with satisfactory results.CONCLUSIONS: Severe cases of genital anomalies may besolved after a good psychological evaluation and propersurgical repair.
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OBJECTIVES: To report one case of precociouspuberty in a 6-year-old boy with bilateral cryptorchidism.METHODS: History and physical examination, blood tests,nuclear chromatin and cariotype, bone age, pneumopelvis,hormonal tests, laparotomy and hysterectomy wereperformed.RESULTS: The absence of testicles within the scrotum wasproved, chromatin was positive and cariotype was normalfemale 46/XX. Bone age was accelerated. The pneumopelvisshowed a uterine shadow and two gonadal shadows in bothsides. Urinary 17-ketosteroids and pregnanetriol were elevated.Due to the male sex identification, it was decided to reinforcethe generic role before starting hormone treatment.Hysterectomy and substitutive steroid treatment wereundertaken.CONCLUSIONS: Genital ambiguity should be consideredwhen evaluating a boy without palpable gonads.
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OBJECTIVES: Leiomyosarcoma is a rarehistological subtype of renal sarcomas, accounting forapproximately 50-60% of the reported cases.Spontaneous rupture of renal tumor is an uncommonevent and the most frequent cause is angiomyolipoma.We report a case of spontaneous rupture of leiomyosarcomain a 45-year-old woman, presenting with severeleft flank pain and perirenal hemorrhage.METHODS: A 45-year-old caucasian white womanwas transferred to our department from emergencyroom of a different Hospital for acute left flank paininterpreted as a renal colic not responsive to medicaltherapy.On clinical examination patient was haemodynamicallystable but with rapid decrease in hemoglobin, pale,without haematuria with a persistent left flank andhypochondrium pain as in acute abdomen. CT scan ofabdomen showed a retroperitoneal haematoma aroundthe left kidney, and a large heterogeneous mass.RESULTS: Laparotomy was urgently performed. Therewas large retroperitoneal hematoma extending from leftkidney to pelvic space. At the upper pole of the kidneya bleeding tumor was found. Radical nephrectomy wasperformed. The histological diagnosis was of low-gradeleiomyosarcoma from renal angiomyolipoma.CONCLUSIONS: We attract attention both on kidneycancer (at our knowledge only 3 cases described inliterature) and on the need of imaging in the clinicalapproach of renal colic. We strongly believe that thepatients presenting at emergency for renal colic must bescanned by ultrasounds or TC.
