OBJECTIVES: Urology, having been part ofgeneral surgery for centuries, was completely consolidatedas a medical speciality in the middle of the XX Centuryas the result of years of evolution and development, andall the studies and works of certain authors that represent today the mainstays of our speciality. Valencia in themiddle of the 20th century saw the birth of new hospitalsincluding the “Ciudad Sanitaria La Fe”. AlfredoTramoyeres Cases was the first chairman of theDepartment of Urology. This article reviews his longand fertile professional life.METHODS: We have reviewed all his scientific works.The articles have been obtained from MedicinaEspañola, Revista Española de Cirugía Traumatológicay Ortopedia, and Archivos Españoles de Urología. Hismost important urological work is his doctoral thesis withthe title “Sigmoid-procto-ureterostomy: personal modification”published in Valencia in 1976. For his biography weused the” Biographic and bibliographic history of theSpanish Urology over the XX century” and interviewswith family members.RESULTS: We emphasize his thorough description of thevarious types of urinary diversion. He covers the topicsof bladder diverticula and bladder neck disorders, inwhich he supports surgical treatment. Finally, he sets outthe rupture of the posterior urethra and various treatmentsfor prostate cancer at that time.CONCLUSIONS: Alfredo Tramoyeres Cases contributedto the definitive consolidation of our speciality in thearea of Valencia during the second half of the XXcentury, through his long professional life, with hisinteresting scientific contributions.
Cryosurgery is an emerging technology consisting on controlled freezing of tissues. Good results, maintained in the long-term, have been referred in the treatment of prostate adenocarcinoma. A role as possible substitute of partial nephrectomy in the treatment of renal adenocarcinomas smaller than 4-5 cm is under research. There is no discussion that freezing destroys cellular machinery and triggers several events the final result of which is cell death by necrosis and apoptosis. The decrease of temperature makes extracellular liquid crystallize and creates a hyperosmotic environment, which induces water to go out of the cell producing intracellular dehydration. Intracellular ice is created with fast freezing speeds being attributed the most destructive effect on biological tissues with irreparable damage. In blood vessels, it directly induces endothelial cell death and mechanical lesions of the endothelium; the consequence is the formation of thrombi that obstruct the lumen of the vessel. In the post-thawing phase there is an increase in free radicals formation and neutrophil activity, which induces cellular membrane lipids peroxidation and new endothelium lesions. Tissue destruction is determined by: minimal temperature achieved, freezing speeds, freezing phase duration, number of freezing-thawing cycles provided, and distance to the freezing focus. As we move away from the freezing focus cells are affected in different ways, and there are several mechanisms proposed to explain the lethal action induced by temperatures higher than - 40 ºC. In our series pathologic findings were: necrosis, hemorrhagic areas either developed or not, fibrosis, hyalinization and increases in the relative number of hematic capillaries, microscopic calcifications, basal cells hyperplasia, and transitional or squamous metaplasia. Residual cancer is localized in the areas less affected by freezing. It should be emphasize the scarce morbimortality associated with the procedure. It does not require ICU admission or blood transfusions, no cerebral vascular accidents (CVA) or heart events have been described, and mortality is null, so that it is feasible in high surgical risk patients and without age limit.
OBJECTIVES: Laparoscopic surgeryoffers potential advantages in terms of diminishment ofpostoperative pain, shorter hospital stay, fasterconvalescence, and better cosmetic results. Theseadvantages may increase kidney donation, makingdonation be accepted by more candidates. We reportour first 2 years` experience with laparoscopic donornephrectomy.METHODS: Between March 2002 and February2004 we performed 38 laparoscopic living donornephrectomies for kidney transplantation. The techniqueof choice was the transperitoneal laparoscopic approachwith four trocars, usually three of them from the start ofthe procedure —two 10-12 mm and one 5 mm—, anda 6.5 cm perumbilical midline incision for kidney retrievalat the end of the procedure.RESULTS: Receptor and donor survivals were 100%.Graft survival was 97.6%. There was not any case ofdelayed graft function.Donor: Mean operative time was 161 minutes (115-260). Mean estimated blood loss was 270 ml (100-1200). Three patients required blood transfusions, 2units of packed red blood cells each. Mean hospitalstay was 5.1 days (3-11). Mean warm ischemia timewas 3.2 min. (2-10). Conversion to open surgery wasnecessary in four cases.Receptor: there have been three significant complicationsrequiring surgical repair: one case of low arterial flow,one vesico ureteral leak, and one midurethra stenosis.Initial renal function: mean serum creatinine at onemonth was 147mmol/l, with a trend to improve to 126mmol/l at one year, which is considered optimum. Firstpostoperative day mean serum creatinine was192mmol/l and the nadir was on second postoperativeday with a value of 152mmol/l.CONCLUSIONS: We believe laparoscopic livingdonor nephrectomy is a real alternative to open surgerybecause it offers better recovery to the donor with thesame capacity to preserve renal function in the receptor.
OBJECTIVES: To report our experiencewith laparoscopic pyeloplasty in the treatment ofpyeloureteral junction obstruction.METHODS: Between August 2001 and August 200414 patients with the diagnosis of pyeloureteral junctionobstruction underwent laparoscopic repair. Seven caseshad the obstruction on the left side and the other sevenon the right side. We describe the technique of laparoscopicdismembered Anderson-Hynes type pyeloplasty, performedto 12 patients in our series. The remainder 2 patientsunderwent Foley’s Y-V plasty and the Fenger`s technique.RESULTS: Mean operative time was 199.7 minutes (r:126-290). There were not intraoperative complications.Mean hospital stay was 4.63 days (r: 3-9). One caseof double J catheter obstruction can be cited as latepostoperative complication. Only one of the 14 casessuffered a recurrence of the stenosis after double J catheter retrieval.CONCLUSIONS: Laparoscopic pyeloplasty has become the operation of choice in cases of hydronephrosissecondary to crossing vessel, when there is great pyelicdilation, and for the treatment of failures of previousendopyelotomy.
OBJECTIVE: The aim of this review is to recognize the role of molecules involved in intergamete interactions during the process of fertilization and further understanding of the molecular basis of fertilization in humans for the development of new methods for contraception. METHODS: We carried out a bibliographic review on intergamete interactions. RESULTS: Fertilization is the product of a series of ordered steps that must take place both in the sperm and the oocyte for a correct interaction leading to the development of the new individual; this interaction requires that both cells are in perfect state for recognition to occur; this recognition is dependant on terminal oligosaccharide residues present in zona pellucida and their complementary receptors on sperm plasmatic (primary receptors) and inner acrosomal (secondary receptors) membranes. CONCLUSIONS: Knowledge of these processes will provide a better understanding of the molecular mechanisms n intergamete interaction and could lead to the development of tools for controlling reproduction as well as for helping couples presenting alterations of their.
OBJECTIVES: To evaluate the usefulnessof percutaneous or laparoscopic application of radiofrequencyfor ablation of tumoral tissue in patients withthe diagnosis of solitary renal tumor.METHODS: 3 male patients (one with bilateral renaltumor) underwent 4 radiofrequency ablation treatments(1 laparoscopic, 3 percutaneous) for renal massesbetween 1.5 and 5 cm (average 3.15 cm).Percutaneous approach was gained under ultrasoundcontrol. Energy was applied progressively, followingstandardized tables, requiring between 2 (tumor diameter1.5 cm) and 4 cycles (diameter 5 cm) applied in quadrants. Postoperative control was performed in all cases by IVcontrast helical CT scan.RESULTS: Treatment was completed in all cases. In onecase, laparoscopic tumorectomy was also performed.Radiofrequency cycles oscillated between 30 and 19minutes depending on tumor size. There were notprocedure-derived complications. IV contrast CT scancontrols at 3 and 6 months showed absence of tumor inone case (1.5 cm) and absence of intratumoral contrastuptake in the rest of them.CONCLUSIONS: Radiofrequency ablation of smallrenal tumors, either percutaneous or laparoscopic, is awell-tolerated and minimally invasive procedure.Adequate parameters to consider complete tumor tissuedestruction remain to be determined and validated.
OBJECTIVES: This cystic hamartoma of therenal pelvis is a very unfrequent benign tumor. We report onecase emphasizing its histology and performed a bibliographicreview.METHODS: Mid age female patient with the incidental diagnosis of a renal mass taking up the pelvis.RESULTS: A radical nephrectomy was performed with thepathologic report of cystic hamartoma of the renal pelvis.CONCLUSIONS: It is a cystic renal tumor with well-definedhistologic and immunohistochemical criteria, and it probablydoes not involve any danger for the patient’s live.
OBJECTIVES: We report the case of apatient who had underwent surgery for a clear cell renalcarcinoma 2 years before presenting with metastasicextension to bladder on follow-up.METHODS: Radiological finding of a bladder mass duringfollow-up after nephrectomy.RESULTS: TURBT was carried out with the pathologic report ofclear cell carcinoma, compatible with a primary renal origin.CONCLUSIONS: Bladder is a very rare place for metastasisfrom kidney tumors. Prognosis will depend on the time ofappearance of such metastases
OBJECTIVES: OBJECTIVES: We report onecase of Metacronous transitional cell carcinoma (TCC) of theprostatic urethra in a patient with history of left nephroureterectomy 22 years before for urothelial neoplasia of the upperurinary tract.METHODS: We describe the case of a 56-year-old malepatient who presents with oligosymptomatic hematuria forseveral months. Cystourethroscopy showed irregular hyperemic lesions in the prostatic urethraa, cold biopsy of which showed urothelial atypia. Pathology report of fragments of a posterior transurethral resection (TUR) was compatible with highgrade superficial transitional cell neoplasia. Instillation of Bacillus Calmette-Guerin (BCG) was indicated. ReevaluationTUR was performed. RESULTS: Pathologic report of new samples showed TCC infiltrating the prostatic stroma. The extension study showed ilioobturator adenopathies. Chemotherapy did not achieve significant results. Radical surgery was rejected. CONCLUSIONS: We emphasize the notable metachronouscharacter of the transitional cell carcinoma of the prostaticurethra with respect to the upper urinary tract TCC. We alsopoint out the metastasic capacity of these neoplasias, as wellas the bad prognosis of those cases in which chemotherapyis not effective.
OBJECTIVES: To report one case of urethralangioleiomyoma because of the rare site, and to review itsmain characteristics.METHODS: We report one case of male urethra angioleiomyomapresenting with obstructive symptoms.RESULTS: We performed excision and end to end anastomosisof a small bulbar urethra stenosis. Pathology reportedangioleiomyoma.CONCLUSIONS: Angioleiomyoma is a benign tumor arisingfrom smooth muscle within blood vessel walls. It is extremelyrare in the urethra. It is more common in females. Recurrenceand metastasis are exceptional. It shows scarce or moderatecellularity with predominance of fusiform cells. They mayexpress smooth muscle vimentin, desmin, and actin. The besttherapeutic option is resection.
OBJECTIVES: To report a new case ofadenoid cystic carcinoma of the prostate.METHODS: We evaluated clinical presentation, diagnosis,treatment and evolution of a 68-year-old patient with anadenoid cystic carcinoma of the prostate.RESULTS: The patient did not receive any of the treatmentssuggested by our department, having a favourable outcomefor 28 months; after this period he presented abdominalmetastases which where surgically excised. Adjuvantradiotherapy was indicated.CONCLUSIONS: The adenoid cystic carcinoma is a raretumor. The treatment of choice of these patients is radicalprostatectomy and close follow-up.