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OBJECTIVES: Adrenal masses havedifferent presentations, from an incidentally diagnosedmass to a blooming Cushingës syndrome, this stimulatedour interest to evaluate and describe our case series overthe last 10 years, besides to perform a bibliographicupdate.METHODS: Retrospective and descriptive study of 22patients suffering from adrenal masses, evaluating theirclinical and radiological characteristics, functionaldisturbances, and histological diagnosis, emphasizing thefirst suspicion or finding suggesting adrenal disease.RESULTS: Men were more often affected than womenin this series, 12 men vs. 10 women. Mean age was 51.2years (33-71). Regarding side, 10 cases were right, 8 leftand 2 presented bilateral disease, one of them bilateraladenoma and the other asynchronous renal carcinoma metastasis. Theinverted ìYî morphology usually observedon CT scan was lost in 14 patients. Size varied between thefollowing ranges: 2-4 cm - 9 cases, 4-6 cm - 12 cases, andone case of a gigantic cyst within the left hemi-abdomen.CONCLUSIONS: Results in our series are similar tothose in the literature, adrenal masses are uncommon anddespite their low incidence they have different clinical anda histological forms of presentation. 27% of them wereincidental, which represents a significant percentage incomparison with other series. Adequate clinical andfunctional studies as well as their radiologicalcharacteristics will set the indication for adrenalectomyor follow-up. Most cases < 4 cm (7/9) were renal carcinoma metastasis or pheochromocytoma. Incidentallydiagnosed cases have increased with the development ofnew imaging technologies as well as with more frequentuse of them. The functional study of adrenal masses hassuffered little change. Surgical treatment of thesepathologies is suffering important changes with the adventof laparoscopic urologic surgery.
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OBJECTIVES: To analyze our results interms of continence and complications of treatment ofurinary incontinence with TVT during the 4 first years.METHODS: 72 patients underwent surgery for urinaryincontinence between 1999 and 2002. Chart review wasperformed for medical history, physical examination,urodynamic tests, surgical procedure, intraoperative andpostoperative complications, objective and subjectiveresults.RESULTS: 62 patients were diagnosed of genuinestress urinary incontinence and 10 patients of mixedurinary incontinence. 14 patients had grade 3 cystocele,12 ofthem underwent associated colporrhaphy.Operationswere performed under local anaesthesia in 1 patient,spinal anaesthesia in 41 and general anaesthesia in 30.Mean operation time was 32 minutes, 66 minutes whencolporrhaphy was associated, and previous surgery didnot increase the surgical difficulty. 6 patients (8.3%)suffered bladder perforation which was identified duringcystoscopy, but only required reposition ofthetape withoutaffecting patientsí outcomes; 1 patient had a pelvic hematoma that evolved without sequel; 16 patients (22.22%)had urinary retention which spontaneously resolvedbetween 2 and 60 days, except one case that requiredsection of the mesh. 8 patients (11.11%) developed de novobladder instability; there were 2 cases of late meshperforation into urethra or bladder, which were solved byendoscopic mesh section; 3 patients had voiding discomfortand 1 chronic perineum pain. 70 patients (97.3%) achievedcontinence under stress; nevertheless only 57 patients(79.17%) were satisfied with their outcomes. Main causesfor dissatisfaction were failure, de novo instability,persistence of urgency in cases of mixed incontinence, andvoiding discomfort.Previous surgery and performance of associatedprocedures did not influence outcomes, although theywere associated with longer operation times and higherincidence of urinary retention. Patients with Valsalvaísleak point pressure <60 H2O cm had slightly worseoutcomes (63.5% satisfaction).CONCLUSIONS: TVT is an easy to learn and easy toperform technique, with few complications and goodresults.
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OBJECTIVES: To review the pathology offemale urethra diverticulum and our own experience.METHODS: We review 10 cases of female urethraldiverticula studied in or Department of Urology. Medicalhistory, symptoms, location, number, size, associatedlesions, and treatment performed were reviewed.RESULTS: The performance of vaginal palpation,voiding cystourethrogram, intravenous urography, andtransvaginal ultrasound are useful for the diagnosis.Thesurgical techniqueperformedhasbeentransvaginal,with and good results in a 80% (8/10) of the cases.CONCLUSIONS: It is a pathology that should be takeninto consideration in front of recurrent urinary tractinfections and relapsing irritative lower urinary tractsymptoms. Treatment requires surgery, being thetransvaginal approach the one that gives the best results
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OBJECTIVES: Primary objective: toinvestigate the usefulness of cuff flowmetry for the diagnosis of lower urinary tract obstruction in males.Secondary objectives: 1)To investigate the relationshipbetween isovolumetric pressure (Piso) and bladdercontractility. 2) To investigate the relationship betweenthe type of flow curves obtained by this method and thetype of lower urinary tract obstruction, and previoushistory of prostate surgery.METHODS: We perform a cohort study in a series of 93consecutive males (mean age 54.1 yr.) referred withfunctional lower urinary tract symptoms. They wereinterviewed about history of prostatic surgery, and theyunderwent isovolumetric pressure measurements (Piso),and corresponding flow (Qiso) by means of cuff flowmetry.From these parameters we calculated the Riso parameter,defined as Piso/(Qiso)2. A conventional pressure/flow studywas performed afterwards, with computer calculation ofurethral resistance parameters ófootpoint and PURRcurvatureó, and the bladder contractility parameter Wmax.RESULTS: The diagnostic efficiency curve for the Risoparameter showed that the ideal cutpoint corresponded toa value of 1.29 cm H2O/(ml/sec)2. For this value thesensitivity for the diagnosis of lower urinary tractobstruction was lower than 78% and specificity was 73%.We elaborated a nomogram for the relationship betweenPiso and Qiso using a logistic regression model. Thisnomogram was divided in three areas (obstructive,equivocal, and not obstructive). If patients within theequivocal area (9.7% of the sample) were excluded, thenthe nomogram had a sensitivity of 84% and a specificity of73% for the diagnosis of obstruction.We observed a significant association between flowcurves with an absent initial peak morphology andobstruction of the constrictive type. No relationship wasdemonstrated between history of prostate surgery and typeof curve.CONCLUSIONS: Cuff flowmetry has an acceptablesensitivity and specificityforthe diagnosis oflower urinarytract obstruction. However, our study did not demonstrateits usefulness for the determination of the detrusorcontractile capacity. Piso and Qiso parameters would beurethral resistance parameters.
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OBJECTIVES: To evaluate lower urinarytract functional symptoms in a series of patients withataxia and to determine by urodynamic studies the kind ofbladder-urethra neurological dysfunction in each case.We posed the question if the clinical picture could beenough to establish the diagnosis and therapeuticmanagement of these patients with hereditary ataxia, oron the contrary it would be necessary to perform urodynamicstudies in all cases.METHODS: Due to the low incidence of hereditaryataxias and patients' mobility it was necessary to recruitpatients from various hospitals. The urodynamic studyprotocol employed in this study included 1) Evaluation ofurinary symptoms; 2) Neurological physical examination;3) Flowmetry with post void residual; 4) Cystomanometry;and 5) Perineal electromyography. We analyzed therelationship between urinary symptoms and urodynamicdiagnosis, considering variables such as age, gender, typeof ataxia, and time of evolution of the disease.RESULTS: The series includes 34 patients with ataxiaand urinary symptoms,14 cases of Friedreich's ataxia(FA) (41.2%) and other 20 cases of other various forms ofataxia we name non-Friedreich's (NF) (58.8%).Mean agewas 37.2 years in FA and 50 years in NF (p < 0.05). Meantime of disease evolution was 20.5 yr. for FA, and 14.9 yr.for NF ataxia (p < 0.1). A mixed urinary syndrome waspredominant in 53% of the patients, and 41.1% presentedpure irritative symptoms in relation to voiding urgency(85.2%). The most frequent urodynamic diagnosis wasdetrusor hyperreflexia (61.7%) (37.5% with dyssynergia),followed by areflexia (or hyporeflexia) (23.5%), and normal studies (14.7%). Detrusor hyperreflexia presentedwith irritative urinary symptoms in 85.7% of the patients,and areflexia or hyporeflexia presented with obstructivesymptoms in 75% of the cases.CONCLUSION: Although there is a good clinicalurodynamic correlation in cases of ataxia, we consider itis necessary to perform a complete urodynamic study inmales with hereditary ataxia in order to rule out bladderoutlet obstruction due to BPH. On the other hand, due tothe fact that progression of the lesions can modify theclinical picture of the patient (including urinary tractsymptoms), we consider essential to re-evaluate ataxicpatients periodically to adapt their treatment to theurodynamic diagnosis.
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OBJECTIVES:Weevaluated the efficiencyof extracorporeal shock wave lithotripsy(ESWL) in thetreatment of pediatric urolithiasis, analyzing results andcomplications in our series.METHODS / RESULTS: 20 patients (16 males and 4females) with ages from 2 to 17 years were evaluated.Twelve patients presented left side lithiasis (60%). The sizeof the stone was measured in cm2 areas. 6 cases (30%)presented with lower calyx stones and 5 cases (25.9%) withstones in the pelvic ureter. 2 patients required JJ catheterinsertion. Mean number of shock waves per session was2,650 (range: 1,000-3,800). The Dornier Lithotripter Sand Dornier MFL-5000 lithotripsy machines were used inthe range of 10-120 Kv and 14-23Kv respectively. Followupevaluation was performed at one week and threemonths from treatment, including abdomen x-ray to obtainfragmentation and elimination percentages. In our seriestotal fragmentation was achieved in 100% of the cases,without any patient with partial fragmentation (fragments> 5 mm). Elimination percentages were satisfactory, witha 65% total elimination and 30% partial elimination(residual fragments<5 mm) within one week. One patienthad no elimination at all.CONCLUSIONS: After the results obtained in ourseries, we consider external shock wave lithotripsy thefirst treatment option in cases of pediatric urolithiasis.
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OBJECTIVES: Obesity is considered asignificant risk factor for diseases such as hypertension,diabetes, coronary artery disease, and metabolic diseases,increasing considerably the risk for surgery. We havetreated with ESWL a significant number of patients withthe aim of avoiding operations which could be long andhave associated complications due to the patient'scondition.METHODS: From April 2000 to May 2002 we treated150 obese patients with kidney and/or ureteral stonesusing a Nova Ultima lithotripter. 94% of the patients weretreated with a neuroleptoanalgesic drug, and 6% of thecases required narcotic-neuroleptoanalgesia. 85% of thecaseswere admittedfor 24 hours, and 15%were outpatient.94 males and 56 females who weighted more than 90 kg(91-141 kg) and more than 80 kg (80-127 kg) respectivelywere treated.Mean age was 41 years (range 20-72). 134 stones werelocated in the kidney, 27 in the pelvis and 16 in theureter(25 patients presented bilateral lithiasis and 2 oneureteral stone and one homolateral kidney stone).Mean stone size was 12 mm. Stone track down was easyin 64% of the cases and difficult in 36%, mainly ureteraland pelvic stones. All patients received 3,000 shock wavesat 21-22 KV and high energy with an average time persession of 35 minutes. Ultrasound tracking was preferredin 80% of the patients.RESULTS: Results at three months were: 72% stonefree, 9% < 4 mm, 14% > = 4 mm, and 5% failures.Best results were obtained in pelvic and lumbar ureterstones (88%).Mean retreatmentwas 1.6,with one additionalsession in 34 patients, two sessions in 8, and three sessionsin 5.CONCLUSIONS: In the treatment of urolithiasis inobese patients, lithotriptor machine characteristics andoperator experience are very important. The knowledgeand the application of stone tracking systems allow theurologist to obtain a higher percentage of stone freepatients. These techniques are important in these patientsbecause positioning is key to obtain a good result.The indication of ESWL in obese patients is a goodchoice but selection criteria should be respected. Thepercentage of stone free patients at three months has beensatisfactory and complications are similar to thosepublished by other authors.
Case Report
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OBJECTIVES: To study and to review the squamouscell carcinoma of the prostate (SCCP).METHODS: We report one case of squamous cell carcinoma ofthe prostate.RESULTS: A 78-year-old patient was diagnosed of having asquamous cell carcinoma of the prostate. Clinically, the patientpresented with severe irritative lower urinary tract symptoms.Treatment was performed by local radiotherapy and response waspoor, as it usually happens in this type of tumors. Patient survivedseven months after diagnosis. We present the clinical case and abibliographic review.CONCLUSIONS: SCCP is a rare, difficult to diagnose and poorin prognosis tumor with very few therapeutic options.
Case Report
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OBJECTIVES: Papillary renal cell carcinoma is amalignant neoplasia which represents 5-10% of all renal cellcarcinomas.We perform a bibliographic review, and detail the clinical,diagnostic and therapeutic aspects of the case, as well as itspostoperative outcome.METHODS: 55-year-old patient who was admitted in the urologydepartment from the emergency room. On physical examination wedetected a mass in the left flank and left upper abdominal quadrant,painful on flank percussion, and gross hematuria also. It was apatient who debuted with left lumbar-abdominal pain and hematuriawith clots after a physical effort. Blood tests, ultrasound, x-rays andsurgical treatment were performed.RESULTS and CONCLUSIONS: On evaluation of the ultrasoundand x-ray films it was concluded that it was a significant renal tumor.Left radical nephrectomy was performed and pathology reportedpapillary renal cell carcinoma. Postoperative outcome wassatisfactory after three months
Case Report
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OBJECTIVES: To report one new case ofendometriosis in a patient with history of caesarean section.METHODS: It is the case of a female patient presenting withvoiding symptoms and hematuria,with a bladdertumor on ultrasound.RESULTS: After TUR of a retro trigonal tumor pathology reportshowed bladder endometriosis. Treatment was completed withhormone therapy, being the patient relapse free at one year followup.CONCLUSIONS: History of caesarean section is one of thepossible etiologies of bladder endometriosis.
Case Report
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OBJECTIVES: To remind that despite its lowincidence, leukemic relapse in the testicles worsens the prognosis ofthis haematopoietic neoplasia.METHODS/RESULTS: We report the case of a 20-year-old malesuffering from acute lymphoblastic leukemia in complete remissionafter induction and maintenance treatment, who suffered a leukemicrelapse in both testicles. Diagnosis was made by ultrasound andconfirmed after bilateral testicular biopsies. The patient died due tofungal infection after new treatment with systemic chemotherapyand bone marrow transplantation.CONCLUSIONS: It is necessary to suspect the existence ofleukemic cells within the testicles in patients with this disease, mainlyacute lymphoblastic leukemia, who present with acute testicularsymptoms. Testicular biopsy confirms the diagnosis. Treatment issystemic,withtesticularradiationtoeradicatetheleukemicreservoir.Despite the achievement of local disease control, this situationworsens the prognosis.
Case Report
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OBJECTIVES: Mesonephric adenocarcinoma is arare clinical entity, predominantly appearing in women, involved ingreat controversy about its histogenesis. Reported cases to date werenot diagnosed in their initial stages and they were treated by radicalsurgery with poor results.METHODS: We report the case of a 71-year-old male withprevious diagnosis of nephrogenic adenoma two years before.RESULTS: After the diagnosis of mesonephric adenocarcinomawas established, patient underwent radical surgery despite its poorprognosis.CONCLUSIONS: Differential diagnosis between these tumorsshould be made with primary or metastatic adenocarcinoma andnephrogenic adenoma.We highlight the ongoing controversy in the literature in relationto malignant evolution of the nephrogenic adenoma as etiology of therare mesonephric adenocarcinoma. In this case, previous finding ofa nephrogenic adenoma would support that theory.
