OBJECTIVES: To make an update onGregorio Marañon's work "Biological essay about HenryIV and his time" (Madrid 1930), reviewing the clinicaldiagnosis made by the famous spanish doctor-historianmore than 70 years ago on the last Monarch of theCastilian Trastamara, because we consider that diseasessuffered by Henry IV were urologic mainly.METHODS: We reviewed 10 chronicles, 5 contemporarymanuscripts, and 25 works about the figure of Henry IVpublished up to year 2000. For comparisons betweenworks we evaluated not only the chronicles and works usedby Marañon, but also the more recent ones of medicalcharacter, which have resulted in a significant increase inthe amount of data about the figure of the Monarch.Additionally, following our current knowledge we tried toadapt the clinical diagnosis from Marañon — eunucoiddysplasia with acromegalic reaction — to currentnomenclature in order to define the kind of endocrinopathythe Monarch suffered.RESULTS: Following a review of contemporarychronicles and recent bibliography about Henry IV, theMonarch was a singular urologic patient. He sufferedchronic renal lithiasis, impotence, a presumptive penileanomaly, and almost surely infertility, although all hisuro-andrological diseases were part of the endocrinopathythe Monarch suffered, probably a hypophyseal tumor.Included in the work there are descriptions of hisphysiognomy and psychopathological characters of hispersonality from the chronicles, commenting on all clinicalsymptoms the Monarch suffered according to hisbiographers and present day doctors and historians.
OBJECTIVES: To review a group oftesticular lesions either clearly benign or that may simulatemalignant neoplasia on testicular ultrasound. To describethose clinical and ultrasound findings allowing to makethe right differential diagnosis, and proper clinicalmanagement.METHODS: We collect a numerous series of cases seenin the Urological Radiology Unit at the University Hospital“Marques de Valdecilla”, Santander (Spain), andevaluated by means of a Logiq 500 GE ultrasound. Forthis study we used linear multifrequency probes (6 - 11mHz).RESULTS: A series of patients with benign testicularlesions are presented. The most characteristic ultrasoundfindings in the grey scale, color-Doppler and Angio-Doppler are reviewed. CONCLUSION: Ultrasound is the diagnostic tests ofchoice in the study of scrotal pathology. This techniqueallows easy differentiation of lesions within the testiclesfrom extra testicular ones. Such a simple difference is ofvital value because it is demonstrated that most intratesticular masses are malignant, whereas extra testicularlesions are generally benign. However, experience hasdemonstrated us that orchyectomies resulting in a benignhistological process were the few, although significant.We describe various benign testicular lesions withcharacteristic ultrasound features. These features inassociation with patient’s clinical picture and negativetumor markers allow surgery avoidance in a given patient.Then, it is a question of knowing and identifying theselesions, and differentiating them from malignant neoplasialesions with the purpose of avoiding unnecessarysurgical interventions.
OBJECTIVE: To study the prognostic value of p53, bcl-2 and c-erbB-2 immunoexpression in predicting tumor relapses in low-grade papillary bladder neoplasms. METHODS: In all patients a complete transurethral resection of the lesion was performed. All the material was formalin-fixed and paraffin-embedded. At the immunohistochemical level, the following monoclonal antibodies were utilized: p53 (clone DO7), bcl-2 (clone 124) and c-erbB-2 (clone CB11). In order to predict tumor relapses during follow-up, a study of specificity, sensitivity and predictive positive value (PVP) and negative was designed. In univariate statistical studies, the following tests were utilized: Chi-square, Kaplan-Meier estimates and Cox logistic regression. RESULTS: Mean follow-up was 76.6 months (38 to 168). In recurrence prediction, p53 expression showed a high specificity (99%) as well as a high PPV (96%). Regarding bcl-2 and c-erbB-2 immunoexpression, both specificity (65% and 72%) and PPV (61% and 72%) were also high, although these percentages were lower than those obtained for p53 expression . The combined analysis of p53 and bcl-2 indicated that bcl-2 immunoexpression in non-basal cells of the urothelium could be independent of p53, although the number of cases showing this particular expression pattern is not high enough to perform an accurate statistical analysis. Otherwise, histologic grade demonstrated higher sensitivity (64%) and lower specificity (40%) than the immunohistochemical markers. In univariate studies, p53 showed an intense statistical correlation with relapse-free interval (RFI) and prediction of tumor recurrences during follow-up (p<0.001), whereas the expression of bcl-2 (p=0.065) was nearly correlated with RFI (p=0.065). In contrast, expression of c-erbB-2 did not show statistical correlation (p=0.112). CONCLUSIONS: In our study, individual and combined analysis of p53 and bcl-2 immunoexpression have demonstrated to be useful in predicting tumor recurrences and RFI in low-grade bladder lesions.
OBJECTIVES: To present our series oflaparoscopic radical prostatectomy, comparing to thepublished results up to date.METHODS: From november 2001 to november 2002,we have practised 27 laparoscopic radical prostatectomieswithout lymphadenectomy. We have used the Montsouristechnique with some modifications. All cases started bylaparoscopy are included in the report.RESULTS: Laparoscopic approach was indicated in 27patients; 17 cases were completed and 10 converted toopen surgery. Among the last 17 consecutive cases onlytwo were converted. Mean operative time was 296 minutes(190-480 minutes, MAY: SD 60). Global morbidity was18.5%, without severe complications, reoperations ormortality. Transfusion rate was 11%. There was not anyincontinent patient and three patients developed ananastomosic stenosis. 57% of previously potent patientshave erections with a follow-up over six months. Positivesurgical margins incidence is 33% overall and 17.6% inlaparoscopic cases. Only one of the patients with a followupabove six months has a biological (PSA) recurrence(7%).CONCLUSIONS: Laparoscopic radical prostatectomyis feasible, reproducible and within reach of interestedurologists. It may substitute, once sufficient experience isadquired, conventional surgery.
OBJECTIVES: To report a new case of renal colicin a patient with crossed renal ectopia and L-shaped kidney, and toperform a bibliographic review.METHODS AND RESULTS: A 33-year-old male patient consultedfor abdominal right pain.Ultrasound and CT showed a L-Shaped Kidney with left renal andureteral stones.These stones produced obstructive left collecting system. Thispatient was managed with left pyelolithotomy and ureterolithotomy.The transabdominal approach was recommended to resolve thisstones.CONCLUSIONS: The crossed renal ectopia with fusion is a rarecondition. The abnormal kidney position and the anomalous kidneysupplay may impede drainage from the collecting system, creating apredisposition to urinary tract infection and calculus formation. Thecolic in this patient sometimes is misdiagnosed how abdominaldisease.The usual method of detection was excretory urography but nowultrasonography and CT have showed more cases. The indicationsfor open surgery in treathament the stones, are generally failure ofextracorporeal shock wave lithotripsy , this is common in these casesfor the anatomic abnormality, and the transabdominal approach isrecomended to resolve its complications in this kidneys.
OBJECTIVE: To report two cases of papillarycystadenoma of the epididymis.METHODS: Clinical and pathological study of 2 male patients48 and 26-year-old respectively, presenting with a solid , painfulmass in the head of the epididymis. The nodules were removed.RESULTS: Pathological analysis showed two papillarycystadenomas of the epididymis.CONCLUSIONS: Papillary cystadenoma of the epididymis is anepithelial tumor of unclear origin. It is associated with von Hippel-Lindau disease and infertility. They are uncommon and benign.
OBJETIVE: To assess diagnosis and treatment ofuracal cysts.METHODS : We reviewed the medical records and radiologicalstudies of four patients who were treated for a urachal anomaly: twourachal cysts and two urachal absceses. Diagnostic evaluationincluded, ultrasound, computerized tomography and magneticresonance.RESULTS: Treatment of urachal absceses involved drainage andsecondary excision. The urachal cyst does not require surgicalintervention.CONCLUSIONS: Ultrasound is an excellent diagnostic tool forpatients with urachal cysts. Infected cysts may present with pain,tenderness and erythema in the infraumbilical region. Extraperitonealexcisión is the treatment of choice, although large infected cysts mayrequire an initial drainage procedure.
OBJECTIVE: To describe clinical and pathologicalfindings of a new case of juvenile gangrenous vasculitis of thescrotum, a peculiar and unusual (only 7 cases, approximately, havebeen previously reported) type of scrotal gangrene described byPiñol in 1973.METHODS: A 24 year-old male presented at the emergencyroom with a right scrotal necrotising cutaneous lesion and fever.Physical examination, complete blood count, biochemical test,roentgenographic abdominal and toracic findings, microbiologicaltest and biopsy were performed.RESULTS: Clinical aspects (symptoms and sings) and results ofcomplete blood count (leukocytosis), normal ultrasound explorationand biochemical and roentgenographic abdominotoracic findings,microbiological test (negative) and biopsy (necrotising vasculitis)are compatible with juvenile gangrenous vasculitis of the scrotumCONCLUSIONS: Juvenile gangrenous vasculitis of the scrotumis a rare entity which should be diagnosed by strict clinicopathologicaldiagnostic criteria because treatment and prognosis are distintc ofother numerous ulcerative scrotal diseases.
OBJECTIVES: To report a case of prevesical hematoma without previous trauma in a patient under anticoagulanttreatment.METHODS: A 70-year-old female admitted with a transitoryischemic cerebrovascular accident was given sodium heparin. Fourdays later she presented with abdominal distention and hypogastricdiscomfort. Abdominal ultrasound showed a big prevesical hematoma.RESULTS: CT scan confirmed the presence of a big hematoma.The hematoma was drained five days later after an optimal coagulationprofile. Patient was discharged with normal ultrasound after anuneventful postoperative course.CONCLUSIONS: Spontaneous bleeding in patients withcoagulation abnormalities is a well-known event, although there arefew bibliographic references about primary prevesical bloodcollections. We opted for deferred drainage of the hematoma toavoid perivesical fibrosis.
OBJECTIVES: Bladder hemangiomas areexceptional benign tumours representing 0.6% bladder tumours.Most times they present as solitary, unique lesions; radiologicalsigns are very similar to urothelial neoplasias making differentialdiagnosis or at least diagnostic suspicions very difficult due to its lowincidence. We perform a bibliographic review and comment on itsclinical and pathological characteristics, as well as on diagnosticmethods and latest modifications in therapy.METHODS: We present a case of bladder haemangiomasecondary to pelvic radiotherapy, being this presentation uniqueamong approximately 100 cases described in the literature.RESULTS: From cystoscopy we suspected the lesion could be anendothelial neoplasia based on its vascular appearance. Weperformed transurethral resection and electrocoagulation of thelesion because it was small and unique. Pathology report confirmedit was a bladder hemangioma secondary to radiotherapy, being thisan exceptional presentation. There has been no relapse up to date.CONCLUSION: We think that resection and electrocoagulationof unique, solitary bladder hemangiomas is a therapeutic option tobe taken into consideration in the management of this kind of benigntumours.
OBJECTIVES: To review two cases of extra adrenal pheochromocytoma.METHODS: We present two cases: a 75-year-old patient with history of high blood pressure and intravesical tumor compatible with urinary bladder paraganglioma, and a 59-year-old patient with a retroperitoneal tumor arising from para-aortic ganglia.RESULTS: Diagnosis was made by CT scan and transurethral resection in the first case, all posterior extension studies were negative; in the second case retroperitoneal exeresis surgery was performed after CT scan.CONCLUSIONS: Extra adrenal pheochromocytomas are catecholamine producing tumours, which determines their clinical features; treatment should be surgical. A bibliographic review about this disease is performed.
OBJECTIVE: To present recent data dealing with the two major post-radical prostatectomy complications incontinence and sexual dysfunction, and investigate if they affect the quality of life of the patients.METHODS: We evaluated recent data available on Medline, from different series examining the incidence, pathophysiology, evaluation and treatment of incontinence and impotence after radical prostatectomy. We also evaluated the effect upon quality of life of these complications.RESULTS: Many experienced surgeons observe low incidence rates of incontinence and sexual dysfunction after radical prostatectomy and it seems that meticulous surgical technique might prevent these devastating complications. However there are many papers in the literature, which show a great variety of results with incontinence ranging from to 0.3 to 65.6% and potency rates from 11.6 to 86% among treated patients. Depending on the individual's opinion incontinence is a minor problem and does not have a great impact upon their quality of life. Impotence affects more frequently these men and seems to be the most disturbing complication after radical prostatectomy affecting the quality of life.CONCLUSIONS : Today avoidance of major complications after radical prostatectomy depends mostly upon high quality surgical technique. Post-radical prostatectomy incontinence does not seem to be a frequent event and when it occurs it does not dramatically affect patients' quality of life. Impotence although most annoying for the majority of the treated patients can be effectively managed by various methods when the neurovascular bundles are preserved.