OBJECTIVES: The work ”Tratado nuevamenteimpreso de todas las enfermedades de los riñones,vejiga y carnosidades de la verga y orina“ from FranciscoDiaz is the first Urology treaty and the main urologic textfrom the spanish renaissance. The idea that prompted ourwork was to collect the Romance language from a textabout urology dated at the end of the XVI century. Itsinterest consists, on the one hand in the lack of similarstudies, and on the other in the novelty resulting from thefact that the author decided to write in Romance languageat a moment in which scientific treaties were written inLatin.METHODS: We performed a meticulous reading of thetreaty on a facsimile edition of the original of the same titleedited in Madrid in 1588. We extract 1.288 medical termsthat we consulted in three modern dictionaries to analyzethe lexicon used by Diaz in its composition. We analyze thewords from the point of view of their make up andethimology; we review the meaning of the medical termsin relation to their current use——meaning conservation orloss——, and also the date of appearance of those terms inthe spanish language, to know how many of them appearedin the work of Diaz for the first time, and to know theconservation or loss of the meaning that Diaz gave themcurrently.RESULTS: We extract 1.288 medical terms, 195 ofthem have been conserved with the same meaning fromtheir origin to date; on the contrary, 35.5% are not foundin either of the three dictionaries, so that they are medicalterms used by Francisco Diaz for the first time and thatwere erased by time. 543 medical terms were contributionsfrom Diaz in their first written appearance.CONCLUSIONS: The author performs a magnificentstudy in which he analyzes and explains his experience, hisknowledge, and his deductions on everything referred tourinary tract diseases, with great expertise, offering at thesame time an extraordinary living document of his time. Itis also an extensive source of medical and generalknowledge, provided from the great culture, maturity, andclassic education of the author. It is a pleasant-to-readand easy-to-understand work thanks to its exquisitecomposition and perfect use of the the Romance language,well defined syntax, rich vocabulary, and abundance ofpractical examples.
OBJECTIVES: We report 5 new cases ofprimary psoas abscess in this review.We describe the various pathogen agents involved inthe development of this disease, as well as theetiopathogenesis, which is explained by several theories,being the most commonly accepted hematogenousdissemination from a septic focus.In the same way, we refer the most interesting clinicaldata and the value of current diagnostic tests, amongwhich are abdominal x-ray (KUB), ultrasound, isotopescan, and CT scan, being this latter the ideal diagnostictest for these processes.METHODS: Retrospective study from 1985 to 2000,including a total of 5 patients with an average age of 48.2years.RESULTS: 4 of these 5 patients were males, and two ofthem had documented history of addiction to parenteral drugs and chronic alcoholism respectively. All patientspresented with lumbar pain, four of them with fever, 2functional impotence and 1 mass effect. Four of them hadincreased white blood cells count; ultrasound wasdiagnostic in one case only, and CT scan in all 5. Bloodcultures were positiveinthree cases, being StaphylococcusAureus the germ isolated from the pus in four cases. Thefour patientstreated had a positive outcome without recurrence todate.CONCLUSIONS: The reappearance of primaryabscesses in young population with history of alcoholismor addiction to parenteral drugs. CT scan is the diagnostictests of choice. Percutaneous drainage has good resultsand is less aggressive therapeutic option for this disease.
OBJECTIVES: To evaluate the similaritybetween Gleason grade on prostate biopsies and theirfinal result after radical prostatectomy.METHODS: We retrospectively review the medicalrecords of 129 patients who underwent radicalprostatectomy. Mean PSA value was 10.7 ng/ml. Therelationships between pathological reports of biopsiesand radical prostatectomy specimens, and other variablessuch as PSA were established.RESULTS: Globally, 72 cases (55.8%) were in the samerisk group by grade on biopsy and surgical specimen.Biopsy result was understaged in 48 cases (37.2%) andoverstaged in 9 cases (7%). We found biopsy understagingin 42 cases (60%) in the low grade group, 6 cases (10.9%)in the intermediate grade group, and 50% in the highgrade group, although in this latter the number of caseswas very low.CONCLUSIONS: Overall biopsy understaging was37.2%, being much more evident in low grade tumors(60%).It seems that understaging was greater when PSA>10ng/ml, although differences were not significant.
OBJECTIVES: Irritative bladder symptomsare common in females. Besides, micturition disorders areoccasionally associated. Sensory urgency is one of thesyndromes that include the symptoms. This entity is a urodynamic condition defined by the presence of pain orurgency during the filling phase without associatedinvoluntary detrusor contractions. Although it is welldefined urodynamically, the corresponding nosologicalentity is unknown. The objective of this study is to check ifit has any relationship with the capability of the abdominalpress to participate during micturition.METHODS: We perform a transversal study comparinga group of 25 females (mean age 50.2 yr.) with thediagnosis of sensory urgency and a group of 48 patientspaired by age. Urodynamic data from both groups werereviewed, and the existence of significant differences wasdetermined for flowmetry, bladder capacity (cystometry),and participation of the abdominal press during voiding(voiding flow-detrusor pressure test).RESULTS: Patients with sensory urgency showedsignificantly lower maximum and mean flow rates thancontrols. Bladder capacity was similar in both groups, butbladder capacity at first desire to void was significantlylower in the sensory urgency group. No significantdifferences were observed between the groups onparticipation of the abdominal press. However, if thecomparison was performed between the subgroup ofpatientswith sensory urgencywho also referred suprapubicpain during filling and controls, then there was asignificantly higher participation of the abdominal pressduring voiding in this group.CONCLUSIONS: Data from this study are compatiblewith the hypothesis that sensory urgency is associated withbladder contractile capacity alterations. This associationwould be more evident in the group of patients in whichsensory urgency is accompanied by hypogastric painduring filling, which could constitute a subgroup withhigher progression risk.
OBJECTIVES: To know the factorsassociated to a successful result in the treatment of kidneytransplant lithiasisbyextracorporealshockwavelithotripsy(ESWL).METHODS: From 850 kidney transplants performed atour center, we analyze 15 patients who developed urinarystones. Successful result by ESWL was the dependentvariable, and size, location, and multiplicity of the stoneswere independent variables. Associations between variableswere studied by the chi-square test (categoricalvariables) and the U-Mann Whitney test (continuous variables).RESULTS: Incidence was 1.76%. ESWL effectivenesswas 87%; it was greater in solitary stones than in multiplestones (p = 0.001). No significant differences were foundfor stone size, although largest stones had a high risk forinsertion of a nephrostomy tube (p = 0.013). Finally,ESWL was more effective for stones located at the ureteralanastomosis, although this difference was found notsignificant.CONCLUSIONS The treatment of kidney transplantlithiasis by ESWL has an effectiveness of 87%. The bestresult was found for solitary stones located at the ureteralanastomosis.
OBJECTIVES: To evaluate the efficacy and safety of sildenafil in the treatment of erectile dysfunction in hypertensive patients taking antihypertensive drugs, and to investigate factors associated to treatment failure.METHODS: Observational prospective study comparing two groups of patients suffering from erectile dysfunction with or without hypertension. Patients were evaluated by anamnesis, physical examination, blood tests, and the International Index of Erectile Function (IIEF). Blood pressure was measured before and after treatment with an automatic digital oscillometric device.RESULTS: Erections improved in 88.2% and 91.7% of the patients with an without hypertension respectively. On the initial visit 55.2% of all patients had severe dysfunction, which was reduced after sildenafil treatment to 4.7%. Diastolic arterial blood pressure, evaluated in random measures, was slightly reduced after starting treatment with Viagra.No significant adverse events were registered.CONCLUSIONS: Oral treatment with sildenafil in patients with erectile dysfunction and hypertension is effective, well-tolerated and does not produce pharmacologic interactions with antihypertensive drugs.
OBJECTIVES: Peyronie's disease is aplastic penile induration which represents a well-knownproblem affecting men in their middle age, who sufferpenile incurvation during erections, pain and poorconsistency at the site of incurvation. There is nosatisfactory treatment for this disease. A patient withPeyronie's disease who received propoleum treatment fora giardiasis infection referred spontaneous improvementofthispenileincurvationastreatmentcycleswererepeated.So, we decided to treat a group of patients with thispathologic entity with propoleum to evaluate its efficacy.METHODS: Initially, 25 patients were studied,only 13completedthestudy6monthslater.Variables:age,penile incurvation, presence or not of pain with erections,detection and measurement (cm) of the fibrous plaque onphysical examination and ultrasound, and description ofits radiologic characteristics.Propoleum powder (300 mg) was administered for 6months.RESULTS: Patient age was predominantly between 51and 60 years. Upward deviation was the most frequentpresentation;itdisappearedin2patientsinthe“Improved”group. Most patients had no pain. 3 patients out of 13 hadno plaque on examination at the end of treatment .Regarding incurvation 10 patients improved, 2 improvedslightly, and only one improved somewhat during the firstthree months but thenafter remained the same. Penile x-ray was not useful as a diagnostic test; penile ultrasoundwas greatly useful.CONCLUSIONS: Penile incurvation improved in 77%of the patients. Fibrous plaques were reduced more than0.5 cm on ultrasound (average 0.64 cm)
OBJECTIVES: To determine the optimaldose for propoleum caps in Peyronie's disease.METHODS: We evaluated two groups of 17 patientseach, analyzing pain and plaque size on physical andultrasound examination, before and aftertreatment. GroupA patients received caps with 300 mg of propoleum powderdaily for six months , and Group B 900 mg.RESULTS: Predominant ages were between 41 and 70years. More than half the patients in group A had pain;more than half the patients in group B did not have pain;considering both groups there were more patients withoutpain. Physical reduction of the plaque: Group A: 0.6 cm,Group B: 0.8 cm. Ultrasound reduction of the plaque:Group A: 1.3 cm, Group B: 0.8 cm. In the higher dosegroup (B) clinical and ultrasound improvement startedearlier. 79.4% of the treated patients evaluated preferredimprovement or slight improvement, being this resultstatistically significant.CONCLUSIONS: Pain is not always an accompanyingsymptom in Peyronie's disease. Both doses administeredreduced the size of the plaque, but the higher one has anearlier improvement. We may consider propoleumadministered in this way another treatment option for thisdisease, with good results and low cost.
OBJECTIVES: Todescribeacaseoforgan-confinedprostatecancer in a patient with hemophilia who wastreated withradical prostatectomy.METHODS: We report the medical history emphasizing thehaematologic, anesthetic and surgical management.RESULTS: Wedemonstratethat a successful retropubic radicalprostatectomy may beundertaken in a hemophilic patient, withoutmajor morbidity, after performing an adequate evaluation andtaking pertinent measures.CONCLUSIONS: Retropubic radical prostatectomy is atherapeutic option which can be undertaken in the treatment ofhemophilicpatientswithorganconfinedprostatecancer,successfullyandwithlowmorbidity.Therefore,thistherapeuticoptionshouldbeconsidered among thoseto beoffered to thesepatients
To report the clinicae characteristicsand treatment of the ovarian vein syndrome.METHODS: We studied two cases of female patients withobstructive uropathy secondary to ovarian vein syndrome cared forat our department over the last 4 years. RESULTS: Both cases were treated surgically. Postoperativeoutcomes were satisfactory.CONCLUSIONS: The ovarian vein syndrome is rare. Surgery isthe treatment of choice for symptomatic cases.
OBJECTIVES: We report the first case of prostaticfoamy gland carcinoma in the Spanish literature.METHODS: Case of a 69-year-old male who consulted for PSAelevation up to 101ng/ml. Transrectal ultrasound showed aheterogeneous gland with a hipoechogenic area in the right lobe andpossible capsular disruption. Six ultrasound guided needle biopsieswere performed. The samples from the right lobe were reported asGleason 6 foamy cell prostatic adenocarcinoma.RESULTS: Prostatic foamy cell carcinoma is a rare tumor, andso are its bibliographic references. Its cells lack of prominentnucleus and nucleoli. They show a plentiful and xanthomatouscytoplasm, with abundant intracytoplasmic pink secretionscharacteristically . It may be mistaken with low gradeadenocarcinomas, and it is essential to differentiate it from the clearcell prostatic adenocarcinoma, prostatic adenosis, and even frombenign prostatic hyperplasia. It usually has an intermediate grade,with a Gleason score greater than 4.
OBJECTIVES: We report the first case of bilateralrenal solitary fibrous tumor diagnosed in a patient suffering fromtuberous sclerosis.METHODS: From the bibliographic review , only 15 cases ofsolitary fibrous tumor have been described in the kidney. We did notfind any case of simultaneous bilateral involvement. We did not findany case described in a patient with tuberous sclerosis either, as thepresent case, being a 51-year-old female with presenting with a bigabdominal mass arising from the left kidney (25 cm) and another 2cm mass in the right kidney.CONCLUSIONS: We emphasize the extreme rarity of this tumorin the kidney. It has benign characteristics and behavior, and goodprognosis, but requires surgical treatment to obtain a properhistopathologic diagnosis, based on immuno-histochemical studies.
OBJECTIVES: To report one case of prostaticabscess which required emergency surgical treatment because of itsaggressive evolution.METHODS: We describe the case of a 61-year-old male patientwho was diagnosed of prostatic abscess in the emergency room, andinitially underwent conservative treatment with antibiotics andurinary diversion. Due to clinical impairment to septicemia andupper urinary tract involvement we decided to perform a surgicalperineal drainage, .RESULTS: The septic clinical picture resolved immediately, buthe presented a prostatic-perineal fistula in the intermediatepostoperativeperiodwhichresolvedwithprolongedurinarydiversionby cystotomy catheter.HIV serologies were performed considering the aggressivenessof picture; they were positive.CONCLUSIONS: We emphasize this case because of the greataggressiveness that presented, possibly due to factors such asdiabetes and immunosuppression (HIV). Provided the great varietyof presentations of this disease, a high degree of suspicion must beexercised for its diagnosis, and once the diagnosis is got immediatetreatmentisrecommended.Wereviewetiopathogenicfactors,clinicalfindings, diagnosis and therapeutic options.
OBJECTIVES: To report the case of a giant bladderdiverticulum clinically presenting with symptoms of inferior venacava compression.METHODS: Patient under study because of inferior limbs edemawho underwent ultrasound that found a giant bladder diverticulum.RESULTS:Diverticulectomy plus adenomectomywere performed.CONCLUSIONS: Acquired giant bladder diverticula are veryrare;they should betreated surgicallyto avoid possiblecomplications.
Summary.- OBJECTIVES: To report the case of a 64-year-oldmale patient who was diagnosed of complete genital transposition.METHODS: Physical examination, blood tests, and radiologictests (ultrasound, intravenous urography) were performed.RESULTS: Physical examination findings were limited to thegenital area. There was a complete genital transposition withnormal testicles, epididymis, and spermatic cord. Both blood andradiologic tests were normal. Patient did not refer any symptoms ofdysuria, and he had normal sexual intercourse, so that he refused theproposed surgical treatment.CONCLUSIONS: Genital transposition is a rare malformation,it is not life-threatening in most cases, but some cases have multiplecoexistent malformations, some of them incompatible with life,partially justifying the scarcity of reports
OBJECTIVES: Cervical lymph node enlargement (LAP) due to metastatic spread is an uncommon manifestation of prostatic adenocarcinoma. In case of non-regional lymphatic spread, left supraclavicular region was found to be the most common site (1,2,3) whereas right sided metastatic lymph node involvement has been extremely uncommon. METHODS: We here in describe a case of a 75 year-old man who had an enlarged cervical lymph node for a year which subsequently proved to be involved by metastatic adenocarcinoma of the prostate. CONCLUSIONS: Although, prostate cancer rarely metastasize to the cervical lymph node chain it should always be considered in the differential diagnosis of metastatic lymph node enlargement in the cervical area of elderly men.