OBJECTIVES: To evaluate variations on the serum PSA levels during and after administration of intravesical BCG and its relationship with previous transurethral resection of the prostate (TURP).METHODS: PSA serum concentration variations were studied after each instillation, at 1 month and at 3 months in 24 patients with superficial bladder cancer and/or CIS under weekly BCG instillations treatment. Three patients had undergone TURP.RESULTS: A raise in PSA was observed in 87.5% of the cases during BCG instillations, although the increase was only significative in patients who had undergone TURP. PSA values descended at one and three months.CONCLUSIONS: Endovesical BCG administration pro-duces an increase on serum PSA levels. This variation is higher in patients with history of TURP.
OBJECTIVES: To analyse the role of CTscan on preoperative determination of bladder and lymphnode involvement of infiltrative bladder cancer, and itspossible impact on the surgical management of thesepatients.METHODS: Retrospective study including 115 patientswith the diagnosis of infiltrative bladder cancer between 1984 and 1999. The ability of CT-scan for bladder andlymph node staging was evaluated comparing results withthe findings after radical surgery. Potential impact of thisimaging technique on change of surgical attitudes wasevaluated.RESULTS: Perivesical involvement estimation by CTscan was right in 36.5%, underestimated in 49.6% andoverestimated in 14%. The more advanced the perivesicalinvolvement the lower the sensitivity for CT-scan inperivesical staging. The more locally advanced tumourthe higher specificity, oscillating between 44% for pT2and 94% for pT4.In reference to lymph node staging, it was correct in71.3% of the cases, although this percentage dependedalmost exclusively on patients with negative nodes (N-).However, there was a 24.3% understaging rate whichcorresponded to the majority of N+ patients.These data offer a 28% sensitivity, 93% specificity,68% positive predictive value, and 72% negative predictivevalue.Finally, the reliability of bladder staging in patientswith lymph node involvement (N+) (39 patients) wasestablished; it was correctly estimated in as low as 30% ofthe cases with a 70% understaging rate. CT-scan wouldhave modified surgical attitudes in only 6 patients (5%),all of them with advanced tumours.CONCLUSIONS: The impact of CT-scan on infiltrativebladder cancer clinical staging is relatively low. Thehighest benefit is obtained in patients suspect of havingadvanced disease. Limitation to this group would result insignificative cost reductions with low risk for unappropiatesurgical management.
OBJECTIVES: To study the evolution of49 patients with squamous cell carcinoma of the penis.METHODS: 49 patients who underwent surgery forsquamous cell carcinoma of the penis (30 partial penileamputations, 11 total amputations and 7 circumcisions).27 inguinal lymphadenectomies, superficial, profoundand ilio-obturator (2 cases), were performed due topersistent lymph nodes after penile amputation despite ofantibiotic treatment for 4 weeks, or to high grade primarytumour. 13 patients were found to have lymph nodemetastases after treatment, receiving posterior adjuvanttreatment with radiotherapy, chemotherapy or acombination of them.Patients were followed in relation to stage, celldifferentiation degree, and presence or absence of positivelymph nodes and distant metastases.RESULTS: There were 5 Ta stage tumours, 26T1(63.2%), 16 T2 (32.6%), and 2 T3 (4.08%). Regarding cytological degree 81% were GI, 16% G II, and 2% G III.Lymph node metastasis were detected in 13 patients(26,53%) after lymph node dissection.6 patients died from tumour dissemination, 2 of themwere T2G2, one T2G1, and three T1G2; two additionalpatients died from causes different from the tumour, all ofthem being N+ at the time of diagnosis.CONCLUSIONS: Penile squamous cell carcinoma isan aggressive tumour the evolution of which mainlydepends on the local-regional stage at the time of diagnosis and cell differentiation; these factors will conditionlymphadenectomy versus observation.
OBJECTIVES: Horseshoe kidney is themost frequent renal congenital anomaly, with an estimatedgeneral population prevalence of 1/400-500. This entitymay be asymptomatic for the entire lifetime, or producesymptoms from associated complications such as lithiasis,hydronephrosis, or recurrent infections. The incidence oflithiasis varies between 20% and 80% of the patients.The treatment of lithiasis in this entity is controversialdue to problems derived from the anatomy of the kidneyand its drainage when stones are treated with externalshock wave lithotripsy (ESWL).We tried to evaluate the efficacy of ESWL treatment andto establish the ideal conditions in which this techniquemay be considered treatment of choice.METHODS & RESULTS: A total of 25 patients wereevaluated (17 males and 8 females). Patient age rangedfrom 8 to 75 year old. Three patients presented withbilateral lithiasis. 27 renal units were treated, 18 of whichwere left (66.7%) and 7 right. Stone size was measured incm2 of surface. Lithiasis was located at the renal pelvis in13 cases (48.1%), and lower calyx in 7 (25.9%). Fourpatients required JJ stent insertion. Mean number of shockwaves per session was 3480 (range 1000-4000).Two Shock wave generators were used for treatment ,the Dornier lithotripter S and the Dornier MFL-5000, witha range of 10-120 KV for the first one and 14-23 KV for thesecond. Follow up KUB X-rays were performed at 3, 6 and12 months to evaluate fragmentation and eliminationrates. In our series total fragmentation was 85.2%, andpartial fragmentation (fragments > 6 mm) 14.8%.Elimination rates were satisfactory with 37.4% totalelimination, and 48.1% partial elimination (Fragments<6 mm). 14.8% of the patients had no elimination at all.CONCLUSIONS: We consider ESWL the firsttherapeutic option for cases of lithiasis with a mean area4 cm2 or less and pelvic location. In case of great lithiasicareas other therapeutic options should be considered(open surgery or percutaneous nephrolithotomy) either inmonotheraphy or complementary to ESWL.
OBJECTIVES: Erectile dysfunction is one of the sequelae after radical prostatectomy most concerning for the patient, its appearance being influenced by factors such as surgical technique, or patient’s age. Thus, around 40% of the patients younger than 70 years and over 90% of the patients older than 70 present with erectile dysfunction after prostatectomy. We studied the response to sildenafil citrate in patients who underwent non nerve sparing radical prostatectomy.METHODS: Medical records of 100 patients who underwent radical prostatectomy at our department between 1985 and 1998 were retrospectively reviewed and telephone interviews were done to investigate the degree of erectile dysfunction following surgery. All patients were offered to start a two-month therapeutic trial with sildenafil citrate, in dose escalation up to a maximum of 100 mg. Therapeutic response was evaluated by personal interviews.RESULTS: 5 out of 100 patients interviewed showed similar potency than preoperatively. Among 95 patients with erectile dysfunction 63 (66.3%) did not wish treatment for erectile dysfunction. 22 of the remainder 32 patients initiated treatment with sildenafil citrate, whereas 10 preferred trying intracavernous PGE1 injections only.In the intracavernous injections group 5 patients abandoned because of pain with injections and refused any further treatment with oral drugs; 5 patients are satisfied with intracavernous therapy and they do not want to try sildenafil.In the sildenafil group form 22 patients starting treatment 14 (63.6%) are satisfied, with a subjective improvement. Only 5 patients (22%) show an erectile response enough to have sexual intercourse with penetration. 8 (36.5%) abandon treatment because of lack of efficiency.CONCLUSIONS: 5% of the patients who undergo non nerve sparing radical prostatectomy maintain sexual potency without treatment postoperatively. Most patients with postoperative erectile dysfunction (63/95=66.3%) do not want any treatment. From 22 patients initiating treatment with sildenafil 5 can have sexual intercourse with penetration (5/22=22%), all of them with 100 mg doses of sildenafil.
OBJECTIVES: To test the concordancebetween clinical and neurophysiologic data of the varioustypes of erectile dysfunction, and to describe a diagnosticalgorithm based on corpus cavernosum electromyography(cc-EMG).METHODS: 32 patients with a mean age of 50.6 years(typical deviation 13.2 years) referred with the diagnosisof erectile dysfunction underwent medical history,neuroandrologic physical exam, neurophysiologic studies period, threshold and latency of pudendal nervesomatosensory potentials, as well as genital sympatheticevoked potentials-SSR-), and corpus cavernosumelectromyography(cc-EMG) both in basal conditions andafter administration of 20 micrograms of E-1 prostaglandin(PGE-1).RESULTS: 1- A significative relationship was shownbetween clinical data of arterial or corpus cavernosumintrinsic origin erectile dysfunction and patients withvascular or structural lesion on cc-EMG data. 2- Asignificative relationship was shown between patientswithout previous pathologic history and patients withnormal or anxiety cc-EMG. 3- No significative relationshipwas shown between patients with neurologic lesion andpatients with autonomic lesion on cc-EMG. 4- Nosignificative relationship was found between patients withperipheric neurologic lesion and patients with inferiorautonomic lesion on cc-EMG. 5- A significative relationshipwas shown between patients with suprasacral neurologiclesion and patients with superior autonomical lesion oncc-EMG.CONCLUSIONS: Isolated application of pudendal nerveneurophysiologic techniques for the diagnosis of erectiledysfunction is not enough. Autonomic innervation studiesshould be included, with a cc-EMG dichotomic qualitativeinterpretation.
OBJECTIVES: To demonstrate the viability of a neobladder created after radiotherapy, anterior pelvic exanteration and previous ileal conduit.METHODS: We report the case of a female patient who underwent anterior pelvic exanteration, radiotherapy and ileal conduit as treatment for uterine cervix cancer. A transverse colon neobladder was performed and anastomosed to the urethral stump. It was also constructed an independent self-catheterizable conduct connected to the abdominal wall, with an adjacent segment of transverse colon using the Monti's technique. This was an alternative route for catheterization in the case of problems with the urethral anastomo-sis.RESULTS: Patient achieved complete continence but requires intermittent catheterization to empty her neobladder. Upper urinary tract has remained stable. The patient presented with urethral stenosis that required periodic dilations. The catheterizable conduit presented incontinence and obstruction problems due to granuloma formation and had to be removed.CONCLUSIONS: Undiversion with creation of a neobladder and urethral anastomosis is viable in female patients after radiotherapy. Urethral stenosis was an important complication.
OBJECTIVE: To describe two cases of sarcomatoid renal carcinoma, one of them is alive after five years from surgery.METHODS: Both patients had undergone radical nephrectomy, without complementary treatment.RESULTS: One patient is alive after five years; the second patient presented acute renal failure and died after five days from surgery.CONCLUSIONS: Sarcomatoid renal carcinoma is a uncommon variety of renal cell carcinoma, with highly malignant behavior. The median survival is six months, but exceptional cases with larger survival ( five years) have been reported in the literature.
OBJECTIVES: To report the case of a newborn witha supernumerary penis. To make this extremely rare pathologicalentity known, although the newborn was not operated due to religiousbeliefs, so that histological evaluation was not performed.METHODS: We report the case of a newborn that was found tohave a perianal malformation at the time of birth. On call, theurologist diagnosed all the characteristics of a supernumerary peniswith a blind urethral meatus and empty scrotum after physicalexamination.RESULTS/ CONCLUSION: With the diagnosis of supernumerarypenis on physical examination proper tests, like blood tests, X-raysand sexual chromosomes were performed, but surgery was notallowed by his parents and the patient was discharge from thehospital.
OBJECTIVE: This is a case of Encrusted Pyelitis (EP) caused by Corynebacterium urealyticum (CU) in a patient who had undergone a cystectomy and Bricker type urinary diversion 28 months beforehand.METHODS/RESULTS: After the immediate post-operative period no urinary catheterisation or any other urological procedure was performed on the patient. Before surgery, the patient presented non functional of the right kidney, secondary to a lithiasic obstructive uropathy. Clinical symptoms were deteriorated renal function, anuria, haematuria, pyrexia and left lumbar pain. It was suspected that the patient had this pathology and this was fundamental in diagnosis. Helicoid CT was the principal method used to show calcification plaques on the wall of the left renal pelvis, and selective culture of CU confirmed the diagnosis. Early commencement of treatment with vancomycin at an initial dosage of 500mg/12 hours, and subsequent adjustment of dosage according to blood drug levels, achieved negative urine culture within a fortnight. Oral acidification was effected using acetohidroxamic acid 125mg/12 hours, and it was continued until CT confirmed the disappearance or considerable reduction of the pyelic calcification plaques.CONCLUSION: The presence of EP in patients with urinary diversion is a matter worthy of consideration, even in patients who have not undergone recent urological procedures. Awareness of risk factors and early commencement of effective treatment may improve the prognosis of these patients.
OBJECTIVES: To claim attention on an relativelyfrequent adverse reaction to drugs affecting genitalia, therefore areason for consultation to the Urology Department.METHODS: We report a clinical case and a bibliographic reviewof this disease.RESULTS: Fixed drug eruption is a cutaneous eruption secondaryto drug intake that appears every time the drug is taken, always in thesame location, being more common in hands and feet. The course ofthe disease is usually progressive with increasing number of lesionsafter each dose of drug taken.CONCLUSIONS: Relapsing lesions in the same spot is key for theproper diagnosis of this eruption. To forbid causing drug intake is thetreatment of choice, although it may be necessary to administer localor even oral corticosteroids.
OBJECTIVES:We report a new case of severe renaltrauma with significant active bleeding and urinary tract lesion in ahemodinamically stable patient, emphasizing the option ofconservative treatment with selective embolization of the bleedingsegmentary renal arteries, and stenting of the urinary tract withretrograde insertion of a JJ stent; thus avoiding emergency surgeryassociated with a high risk of nephrectomy. We review the indicationsof this therapeutic option.METHODS: Embolization of bleeding segmentary renal arteriesand retrograde insertion of a JJ stent in a 24 year old patientpresenting with severe renal trauma after motorbike motor vehicularaccident. Patient remained hemodynamically stable during thewhole diagnostic and therapeutic process. Good clinical outcomeafter 72 hours of ICU control and 18 days of admission in theUrology ward.RESULTS: After selective embolization bleeding stoppedimmediately; significative hematoma resorption and urinary fluidcollection disappearance was seen during a 3 week hospital admission.There were not either immediate or deferred complications, beingboth renal function and blood pressure normal after 18 monthsfollow up.CONCLUSION: Embolization of the bleeding segmentary renalarteries after severe renal trauma in hemodinamically stable patientsis a therapeutic option that allows avoiding emergency surgery,which is associated with high risk for nephrectomy. Urinary tractstenting is enough for a good outcome of the pyelocalicilar system.
OBJECTIVES: Anterior urethropexy,introduced by Lapides, is a retropubic suspensionprocedure in which the anterior urethral wall is securedto the posterior surface of the symphysis pubis by fullthickness trans-urethral sutures. Little information existsin the literature about its effectiveness and morbidity as asurgical treatment option for female stress incontinence.In this study, the outcome of this technique in the treatmentof anatomic genuine stress urinary incontinence has beenevaluated.METHODS: Thirty women with urodynamically-provenanatomic stress urinary incontinence underwent anteriorurethropexy and 27 of them were followed up for aminimum of 12 months with a mean period of 28.9 months.RESULTS: A complete dry rate of 52% and a significantimprovement of 11% were achieved at the mean follow upperiod. No postoperative retention or other significant complication was observed in the study group. De novourge incontinence was noted in 2 patients and managed byanticholinergic treatment.CONCLUSION: Anterior urethropexy is found to be asafe retropubic suspension technique with a considerablylow morbidity but revealed a relatively lower success ratecompared to other open bladder neck suspension techniques.