OBJECTIVES: Rupture of the corporacavernosum is an uncommon pathology requiringimmediatetreatment.Weperformedabibliographic search,andanalyzed different diagnosticandtherapeutic methods.METHODS/RESULTS: Two cases of traumatic ruptureof the corpus cavernosum are described. The clinicalfeatures, penile ultrasound findingsandimmediate surgicaltreatment are discussed.CONCLUSIONS: Penile fracture is an uncommonpathology. Generally, history and physical examinationare enough to establish the diagnosis. Penile ultrasoundcan help in case of doubt. Most urologists deem immediatesurgery the standard therapy.
OBJECTIVES: To determine the mostfrequent causes of ureteral injury, and the way to correctsevere damage of the ureter.METHODS: We reviewed the medical records of 25patients who suffered ureteral injuries during abdominalor pelvic surgery in a five-year period; endoscopic injurieswere excluded.RESULTS: The most common presentation includedpain, urinary incontinence and fever. Hysterectomy wasthe most frequent operation causing ureteral injuries. Thediagnosis was made by intravenous urography andultrasound. Ureteral reimplantation using a Boari’s flap,without other complications, was the preferred treatmentdue to ureteral damage. Right side and distal third of theureter where the most frequently affected sites.CONCLUSIONS: In cases of iatrogenic injuries of thedistal third of the ureter with severe lesions, ureteralreimplantation with a Boari’s flap may be the option.
OBJECTIVES: Cryosurgery is defined as in situ freezing of tissues. Criosurgery in the treatment of prostate cancer aims to: 1- Eliminate all the glandular tissues and completely destroy the adenocarcinoma, 2- With a minimum number of complications. a) Preserving neighbour structures: bladder neck, striated sphincter, and rectum. b) Preserving urethral mucosa to reduce the elimination of sloughing tissues. METHODS: We describe the technique of prostatic cryosurgery including all innovations introduced during the last ten years. The map with the number and situation of the 6-8 crioprobes should be done in such a way that the iceball created around each of them overlaps the contiguous ones. Probe-mapping and icing strategy together get the prostate included in a unique, solid mass, in which temperature descents homogeneously and spreads out of its limits, so that intraprostatic and extraprostatic temperatures (sensors at the apex, Denonvilliers fascia and both neurovascular bundles) are below -40oC. RESULTS: The standardized technique is based on: Substitution of liquid nitrogen by argon. Use of 6 to 8 cryoprobes. The probes are properly inserted into the perineum percutaneously under transrectal ultrasound guidance. Ice ball evolution control by biplane transrectal ultrasound. Separation of the two layers of Denonvilliers‘ fascia by injection of saline solution. Real-time measurement of temperature descent. Minimal temperature lower than -40 °C. Commercial ureteral heating system. Double cycle of freezing-unfreezing. Administration of hormonal therapy during time enough to avoid the gland size to exceed 45-50 cc. CONCLUSIONS: We describe the most advanced technique for prostatic freezing, highlighting the basic requirements to achieve the objectives pursued. It has improved oncologic results, in relation to PSA and percentage of negative biopsies, and has dramatically reduced complications.
OBJECTIVES:Toevaluatetheeffectiveness of extracorporeal shock wave lithotripsy (ESWL) treatment of bladder stones using a retrospective study.METHODS: Between February 1991 and June 2002, 45 patients with bladder stones were treated (41 males and 4 females). Age ranged from 23 to 87 years. 63% had previous renal-ureteral lithiasis and 29% had undergone upper urinary tract ESWL. We used the Storz Modulith SL 10/SL 20. Treatments were performed using intravenous analgesia on an outpatient basis.RESULTS: 83 sessions of ESWL were performed on 53 stones. Complete fragmentation and elimination was achieved in 55% of the patients after a single session, 26.7% of the patients after 2 sessions, 6.7% after 3 sessions, 8.8% four, and 2.2% five. Mean number of shock waves was 3196.3 with an average 7-8 Kv.8.5% had stone recurrence due to residual lithiasis, whereas 79% achieved total elimination. 13% required endoscopic procedures to evacuate stone fragments impacted in urethra. 6.6% required transurethral prostatic resection after ESWL.CONCLUSIONS: ESWL therapy is an effective option for the treatment of patients with bladder stones, non invasive, with low morbidity, without need for anesthesia, and outpatient. The effectiveness is high (79% of the patients stone free) and even higher when treating smaller stones.
OBJECTIVES: To determine byquestionnairesthelevel of satisfaction of patients diagnosedof urinary lithiasis treated by extracorporeal shock wavelithotripsy (ESWL) in our Renal Stone Centre.METHODS: Atotal of 100 patientswith urinarylithiasiswho underwent ESWL, 54 males and 46 females with anaverage age of 50 years, answered a Lickert typequestionnaire (score 1 to 5) consisting of 6 questions toevaluate the patient satisfaction regarding the treatmentreceived. The relationship between answers to eachquestion and patient's clinical characteristics wereanalyzed applying chi-square and linear regression todetermine the level of significance of these relationships.RESULTS: General satisfaction level was high, with amean score of 4.33 for the six questions. The most valuedquestion was the one referred to assistance received inrelation to the planned medical one. Questions referred totreatment suitability, expected timing, and absence ofcomplexity were also highly valued. The least valuedquestionwasthe one referredto painlevel duringtreatment,which level was kept in a good approval degree with amean score of 3.81 despite the fact that some patients saidthey suffered more pain than expected.CONCLUSIONS: ESWL resulted in a high level ofsatisfaction among patients treated for urinary lithiasis,revealed not only by its suitability, easy planning andperformance, but also by its low level of complexity. Painexperienced by these patients during treatment was welltolerated,so that general use of anesthesia was notrequired.
OBJECTIVES: We report 2 cases of Sertolicell only syndrome and perform a bibliographic review.METHODS: Clinical and pathologic study of 2 malepatients 33 and 37-year-old respectively who presentedwith infertility.RESULTS: Testicular biopsy, the most importantdiagnostic test in the study of infertile men, showedbilateral Sertoli cell only syndrome.CONCLUSIONS: The Sertoli cell only syndrome is anentity in which seminiferous tubules show a total absenceof germ cells with Sertoli cells alone. Etiology is unknownin most cases. Testicular biopsy is performed in theseazoospermic men to rule out tubular obstruction orabnormalities of the spermatogenesis. Assistedreproduction techniques are a therapeutic option, makinggenetic counselling necessary duetothe risk oftransmissionof the genetic defects that cause male infertility.
Peyronie’s disease is a type of acquiredpenile incurvation of unknown origin yet, which generatesfrom the difficulty of symmetric expansion of the corporacavernosum produced by fibrous plaques in the middleline of the albuginea.OBJECTIVES: To define the results of iontophoresisamong the wide spectrum of treatments used for thisdisease.METHODS: 61 patients treated by iontophoresis withorgotein in weekly sessions.RESULTS: Pain improvement 42.6%, incurvationimprovement 6.1%, improvement of both 21.3%.CONCLUSIONS: In patients with Peyronie’s diseaseiontophoresis with orgotein diminishes pain with erections,and, to a lesser extent, penile incurvation.
OBJECTIVES: Intravenous urography(IVU) has been classically considered as an essentialexamination in the great majority of urologic diseases dueto the great amount of information that supplies bothfunctional and morphological, mainly for ureteralabnormalities where other exams do not reach enoughdefinition. Nevertheless, there are cases in which it is notpossible to perform an intravenous urography due toallergy to iodine contrasts or renal failure with impossibilityof contrast excretion.METHODS: We report three cases which represent theexample of the indications of MRI urography as analternative to IVU in cases in which this latter cannot orshould not be performed.RESULTS: MRI urography is completely accepted as adiagnostic technique for urologic diseases asanalternativeto IVU. It has advantages, such as obtaining images inmultiple planes, avoiding the use of ionizing radiation,that there is no evidence of it causing cell damage, that itdoes not require glomerular elimination of any substance so it can be used in patients with renal failure and allergyto iodine contrasts.CONCLUSIONS: The use of MRI urography results inan advantage for patients with renal failure, iodinecontrasts allergy, or greater risk of contrast nephrotoxicityas it is the case of renal transplant patients.
OBJECTIVE:We report acase of a primary urothelialcarcinoma of the bulbomembranous urethra, with special emphasison histopathological and immunohistochemical findings.METHODS/RESULTS: A 63-year-old man presented urethralobstruction symptoms. A radical phalectomy was performed and a4.5 x 4 cm bulbomembranous urethral tumor was observed.Histopathological analysis disclosed an urothelial carcinoma, thatshowed positive immunostaining for cytokeratin AE1/AE3,cytokeratin 7, carcinoembrionic antigen and epithelial membraneantigen. The patient recived radiotherapy and adjuvant chemotherapyand is currently free of disease.CONCLUSION: Posterior male urothelial carcinoma of theurethra is a rare neoplasm that usually is mistaken clinically for abenign lesion. The diagnostic is generally made in advanced stageswith a poor therapeutical response.
- OBJECTIVES: Fournier's gangrene is a synergisticinfective necrotizing fascitis, which involves perianal, perineal andgenital regions, with rapid evolution and severe prognosis. Weperform a literature review and report a recent case.METHODS: We report the case of a male parient who presentedwith scrotal pain and history of excretion of a chicken bone in a bowelmovement.RESULTS: Despite aggressive surgery and wide spectrumantibiotic, the prognosis severe and the mortality is high.CONCLUSIONS: Rapid and accurate diagnosis remains the keyto achieving a successful outcome. Early, wide and repeateddebridement procedures reduce the mortality.
OBJECTIVES: To report one case of flank painirradiated to lower extremities, progressive paresthesias andfunctional difficulty leading to functional impotence of the lowerlimbs, and difficult voiding.METHODS: Neurologic physical examination showed abolishedosteotendinous reflexes, indifferent plantar, L1 hypoesthesia, L3anesthesia, and lower limbs hypotony. Multiple complementaryexams were performed to get the final diagnosis of hemorrhagicnecrotizing myelitis by MRI, after differential diagnosis withcavernous haemangioma.We performed a bibliographic search in Pub-Med (MEDLINE)using the terms "bladder, neurogenic (MESH) and myelitis (MESH)".Most publications correspond to case reports and prospective studiesof cases of acute myelitis of different etiologies (arteriovenousmalformations, multiple sclerosis, neoplasia, sarcoidosis, HIVinfection, spinal cord compression,...) reviewing the diagnostic andtherapeutic procedures. RESULTS: Neurologic examination, imaging studies andanalytical determinations in cerebrospinal fluid (CSF) and bloodwere conclusive to confirm the level of the lesion and the mostprobable etiology in both the present case and those provided by theliterature. Urodynamic study showed a neurologic bladder both at4 and 24 months, being this the main sequel in our patient.The clinical repercussion derived from the level of the lesionimproved in relation to walking and muscular balance, but thevoiding condition persisted with bladder hyperreflexia anddyssynergia.CONCLUSIONS: The clinical picture alerts about spinalinvolvement. Radiological tests, supported by analysis, allow toidentify the level of the lesion, and in many cases the cause. Bladderdysfunction is common in acute myelopathies, and urodynamicstudies help to label the picture and manage it.
OBJECTIVES: To report an exceptional case ofmulticystic mesothelioma of the testicular tunica vaginalis.METHODS: A 72-year-old male was referred for study of ascrotal mass. Physical examination, blood tests, and ultrasoundwere performed prior to surgical excision and pathologic study of thelesion.RESULTS: The ultrasound study showed a multilobar cysticlesion near the spermatic cord. Pathology reported multiple 3-4 mmcystic formations, with rudimentary papillae covered by ahyperchromatic epithelium and vimentin (+), CD 34 (+)immunophenotype.CONCLUSIONS: Multicystic mesothelioma is a rare form ofmesothelioma, easy to recognize but infrequent. This tumor generallyaffects the peritoneal surface of the pelvis and abdomen; althoughother less frequent locations have been described testicular locationis exceptional. We report the case of a patient presenting with amulticystic mesothelioma of the testicular tunica vaginalis andreview the diagnosis, pathology and treatment options for this typeof tumor.
OBJECTIVES: To report one case of severe lowerhematuria 48 hours after urinary diversion by percutaneousnephrostomy for obstructive uropathy.METHODS: The clinical picture, its severity, and previousprocedure probably causing it made the study by arteriographyessential to identify the existence of an arteriovenous fistula afterstabilization of the acute anaemia; it was confirmed and selectiveembolization was undertaken with an optimal result.We performed a bibliographic search on Pub-Med (MEDLINE)using the terms "percutaneous nephrostomy", "complications", and"arteriovenous fistula". Most published papers are case reports andseries of nephrostomies analyzing their complications and themanagement of them.RESULTS: Complications attributable to percutaneousnephrostomy are very rare varying from pneumothorax/hydrothorax,infection, perforation and injuries to neighbour organs, allergicreactions to contrasts, urinomas, to pictures of mild to severehematuria due to vessel laceration and arteriovenous fistula, eitherhigh or through bladder,.In the case we report as well as in those from the literature, initialtreatment of hematuria was watchful waiting; only severity orpersistence for more than 3-4 days should make to suspect theexistence of arteriovenous fistula, and then arteriography ismandatory to obtain confirmation and if possible treat it by selectiveembolization; there are various materials to do it.Clinical repercussion was severe but thanks to radiologicalinterventional techniques the case was solved with preservation ofthe renal unit.CONCLUSIONS:Complicationsafterpercutaneousnephrostomyare very rare, and the clinical picture alerts about the possibility ofsome of them. Radiological tests allow to identify the great majorityof them and to perform an effective treatment.
-OBJECTIVES: To describethemost relevantfeaturesof matrix lithiasis, an infrequent type of lithiasis seldom reportedsince the generalization of extracorporeal shock wave lithotripsy.METHODS: We report a clinical case and analyze the mostimportant bibliography found by MEDLINE search (1950-1999).We will focus on the physiopathology and etiology of these stones tounderstand its development and the clinical presentation showed bythese patients.RESULTS: Matrix lithiasis is a very rare entity, described almostone century ago. It is mainly composed of lithiasis matrix, and thepercentage of mineral content is really low in comparison with usualstones. Persistent urinary tract infection is another constant in thesepatients, which to some extent conditions the modification of theusual urinary components, creating a series of the disturbanceswithinthe urinarytractthatfavourthe aggregation ofthe componentsof the lithiasis matrix up to the formation of a stone, without need ofaggregation of mineralized crystals.CONCLUSIONS: A high degree of suspicion is necessary for thediagnosis of matrix lithiasis, because it does not show the usualclinical picture of a renal stone. Exhaustive lavage of calicealcavities and elimination of bacteriuria are essential elements fortreatment, in order to avoid recurrence of the disease.
OBJECTIVES: To report a case of unila-teral ureteral obstruction associated with giant retroperitoneal urinoma which was treated successfully by percutaneous drainage.METHODS: A 19G ultrasound guided needle was introduced into the mass and after dilatation procedure, a 14 Fr nephrostomy catheter was placed and 5.5 of liquid were drained.RESULTS: Drainage from the nephrostomy catheter stopped 24 hours later. Patient was discharged with the nephrostomy tube. One week later, on control tomography, absenceofleftrenalsuprahilarposteromedialfocalcortical contour was seen.CONCLUSIONS: A minor cortical or forniceal rupture with no urinary extravasation on radiographic examination is thought to be the cause of this urinoma. Percutaneous drainage may be considered as an alternative treatment option to surgical intervention in the treatment of urinomas, especially when there is no persistent ureteral obstruction or communication between the collecting system and the urinoma.