OBJECTIVE: The creation of the first chair of Urology in Spain and, consequently, the official recognition of the specialty in the urinary tract as a subject in the university curriculum was not an easy task for the urologists early in the last century. The curriculum of 1886 and 1902 included some medical specialties in the licentiate (ORL, Ophthalmology, Dermatology and Venereal Disease, and Neuropathy) as complementary and subsequently compulsory subjects, but not Urology. Perhaps this was due to the laco of representative or influential urologists that could exert pressure on the ministers of Public Education at that time. Although the Spanish Society of Urology was founded in 1911 and some urologists like Rafael Mollá and Rodrigo and Leonardo de la Peña Díaz, professors of the Central University, exerted pressure on the university faculty, Royal Academy of Medicine and the Ministry of Public Education, Urology was not included in the curriculum until 1920, although, in my view, its category was again devaluated since it was only an optional subject in the licentiate or doctorate. Apart from the procedures and processes, convoking the chair required political and administrative maneuvers that are shown in a broad review of newspaper articles and documents of that period. The controversial result of the competition based on merits that some considered should have been competition for a position according to the convocation, is no discredit to Leonardo de la Peña Díaz (1875-1957), the first professor of Urology in the history of Spanish Medicine. An unbiased historical and discerning evaluation clearly shows that his merits, accomplishments, tenacity and competence in teaching made him the most appropriate for the position. His merits were finally recognized not only by the board but also by his opponents.
OBJECTIVE: To review the literature ontextiloma or surgical sponges left during renal surgerybecause of the important medical-legal implications of thiscomplication.METHOD: Three cases of textiloma in patientsundergoing renal surgery are presented. Two of them hadundergone surgery at other hospitals 26 and 4 yearsearlier. The third patient had undergone transplantation atour hospital and was reoperated 4 months later for apurulent cutaneous fistula caused by the textiloma.RESULTS / CONCLUSIONS: A review of the literaturesince 1950 showed few reports of textiloma. The riskfactors according to the type of surgery performed andcurrent controls in the operating room to avoid thiscomplication that can occasionally be severe, are presentedin detail. The forms of presentation, diagnostic methodsand difficulties encountered due to the long period of timethe foreign body has been left indwelling, are analyzed. Toour knowledge, 8 cases of textilomas have been reported inpatients undergoing renal surgery.
OBJECTIVE: Asymptomatic micro-hematuria continues to be a problem. It has a prevalence of 16% and numerous conditions can present this clinical manifestation.METHODS: A prospective study was carried out on all patients that consulted at the urological services during 2000 for asymptomatic hematuria. Patients presenting with irritative symptoms, urethral secretion, perineal or suprapubic pain, urinary tract infections, renal lithiasis or history of trauma were not included in the study.RESULTS: None of the patients presented tumors. Two patients presented renal lithiasis, 5 simple renal cysts, 8 hypercalciuria and 3 hyperuricosuria. None of the 11 patients with hypercalciuria or hyperuricosuria had a history of lithiasis.CONCLUSIONS: Although the size of the study is small, the incidence of tumors in patients with asymptomatic microhematuria appears to be far from the 12.5% incidence reported by some authors and might probably be closer to the 0.5% incidence reported by others. Furthermore, the significant pathology (renal lithiasis), which requires treatment, is also infrequent.
OBJECTIVE: To analyze the probabilitiesof total PSA, digital rectal examination (DRE) and PSAdensity in prostate cancer diagnosed by ultrasound-guidedsextant prostate biopsy.METHODS: The clinical records of 170 patients withelevated PSA levels and/or symptomatic BPH that hadbeen referred to the outpatient services of the urologydepartment were reviewed. Ultrasound-guided sextantprostate biopsy was performed in all patients. Serum PSAand PSA density were determined before biopsy. Age andDRE findings were also analyzed.RESULTS/CONCLUSIONS: Statistical analysis showeda significant difference (p < 0.00001) for DRE, PSA andPSA density in relation to the prostate biopsy. Concerningthe magnitude of the effect of DRE adjusted for age, PSAand PSA density determined by logistic regression analysis,a significance was found for DRE (odds ratio: 9.7) andPSA density > 0.5 (odds ratio: 11.3).DRE showed a sensitivity of 59%, a specificity of 89%and a positive predictive value of 88%.
OBJECTIVE: To determine the efficacy of urinary BTA-TRAK as a marker in monitoring superficial transitional cell carcinoma of the bladder and to compare urine cytology with urinary sediment testing.METHODS: 700 consecutive determinations using BTA-TRAK to monitor unselected patients that had undergone surgery for transitional cell carcinoma of the bladder were analyzed. Cystoscopy, urinary sediment and urine cytology were performed during follow-up. Urography was performed yearly or when tumor of the upper urinary tract was suspected. (positive cytology or hematuria with no bladder tumor). Cystoscopy was performed a few days after determination of BTA-TRAK and voiding urine cytology and urinary sediment analyses (considered positive when microhematuria was observed) were both requested.RESULTS: Of the 700 determinations, 95 (13.6%) were urothelial carcinomas (93 bladder, 2 upper urinary tract) that had been discovered during patient monitoring. Of the 93 bladder tumors, 39 were Ta (37 TaG1 and 2 TaG2), 29 T1 (4 T1G1, 20 T1G2 and 5 T1G3), 5 Tis and 20 muscle-infiltrating tumors (progression from T2-4 during monitoring).The sensitivity of urine cytology to detect urothelial tumor was 41.1% and the specificity was 97.3%. The urine cytologies were negative in 48.4% and inflammatory in 9.5% of the tumors. The sensitivity was 19% in low grade turmors. The sensitivity of urinary sedimentation testing to detect urothelial tumor (microhematuria) was 40% and the specificity was 96.7%. When associated with pyuria, it was considered to be a urinary infection or urothelial inflammatory condition, which was observed in 10.6% of the cases.Considering the proposed normal reference value for BTA-TRAK (≤ 14 U/ml), we have found a sensitivity of 62.1% and a specificity of 68.4%. A logistic regression model was developed, including BTA-TRAK, urinary sedimentation and cytology, to identify the independent variables that are useful for tumor detection during follow-up of superficial carcinoma of the bladder in this series. The combination of three variables showed an odds ratio of 18.5 (8.9-38.5) for urinary cytology, 11.8 (5.9-23.5) for urinary sedimentation and an odds ratio for BTA-TRAK that did not fall within the equation.CONCLUSIONS: Although overall the sensitivity of BTA-TRAK is higher than that of urine cytology and urinary sedimentation testing, it provides no additional information than that obtained from the combination of urine cytology and urinary sedimentation testing in the detection of tumor recurrence during monitoring for su-perficial bladder cancer.
OBJECTIVE: To analyze the indicationsand outcome of cystectomy for superficial bladder cancersince the introduction of BCG therapy.METHODS: From June 1990 to December 1996, 384patients underwent cystectomy for transitional cell bladdertumor. A retrospective study was carried out on 43 cases(11.1%) that underwent cystectomy for Tis, Ta, T1 tumors.The characteristics of patients with superficial bladdercancer, correlation between the clinical stage (determinedafter TUR) and pathological findings (cystectomyspecimen) and outcome were analyzed.RESULTS: 36 patients were male and 7 were female;mean age 63 years (range 39-79). Mean follow-up was 48months (8-120). Twenty-nine patients received BCGtherapy prior to surgery. No response to BCG was themain indication for cystectomy. By clinical stage, 79%were high grade, 65% T1 and 65% CIS. A correlationbetween the clinical stage and the pathological findingswas found in 32.5%, overstaging in 28% and understagingin 39.5%. The increase in stage after analysis of thesurgical specimen in 13 patients (30%) was due toprogression of the superficial bladder tumor to infiltratingor metastatic tumor. Urinary tract tumor was found duringfollow-up in 8 patients (18.6%). Eleven patients died ofbladder cancer, 3 of other causes and 29 (67%) are free ofdisease. Seven of the 13 patients (53%) that were clinicallyunderstaged and had infiltrating tumor or metastasis died.CONCLUSIONS: No response to BCG therapy was themain indication for cystectomy. Before startingconservative treatment for high risk superficial bladdercancer, the possibility of endoscopic understaging shouldbe taken into account. Patients undergoing cystectomy forsuperficial bladder cancer have a high risk of developingurinary tract tumor.
OBJECTIVE: To assess prospectively theimpact of extracorporeal circulation on erectile functionand the probable prognosis of future erectile function inpatients undergoing myocardial revascularization surgery.METHODS: 30 patients who met the following criteriawere analyzed: a) age less than 80 years, b) electivesurgery, c) use of extracorporeal circulation and d) stablepartner. Pre-operative erectile function was determinedand other cardiovascular risk factors by means of awritten questionnaire. The patients were classified intothree groups according to the preoperative erectilefunction: good (group A), fair (group B) and poor (groupC). All patients underwent myocardial revascularizationsurgery.RESULTS: 3 patients (27.2%) of group A reported poorerections after surgery, while 8 (72.7%) reported nochanges in erectile function. Four patients (44.4%) ofgroup B reported poor erection postoperatively, another4 (44.4%) reported no significant changes in erectilefunction and 1 (11.1%) reported improvement in erectilefunction. One patient (10%) of group C reported improvederectile function, while the remaining patients reported nochanges. To determine the influence of extracorporealcirculation and clamping time on erectile function asindependent variables, the patients were classified intogroup I (patients of groups A and B that preserved orimproved erectile function postoperatively) and group II(patients of groups A and B that reported poor erectilefunction postoperatively). The mean extracorporealcirculation time was 99 mins for group I and 116 mins forgroup II (p = 0.7102). The mean clamping time for groupI was 56.84 mins and 69.57 mins for group II (p = 0.5375).No statistically significant differences were found(Wilcoxon test).CONCLUSIONS: A) Patients with good erectile functionundergoing myocardial revascularization surgery withextracorporeal circulation have a high probability ofpreserving the quality of erectile function postoperatively.B) Patients with erectile dysfunction are not likely toimprove after myocardial revascularization surgery . C)Extracorporeal circulation and clamping times do notappear to influence the postoperative results. These weresignificantly shorter in patients that preserved or improvederectile function than in those that reported poor erectilefunction postoperatively and may be due to lessintraoperative complexity. D) The preoperative erectilefunction was found to be the most important predictivefactor of outcome. E) Further studies on larger series ofpatients are warranted to corroborate the foregoingfindings.
OBJECTIVE: To evaluate the efficacy ofprostaglandin E1 in the treatment of erectile dysfunctionin patients with spinal cord or head injury.METHODS: The study comprised 41 patients; 5 headand 36 spinal cord injury. Of these 36 patients, 20 had alesion in the dorsal and 26 in the lumbosacral spine; 11were complete and 25 incomplete. Mean age was 38.5years. Therapy was started at a minimum dose of 5 mg upto maximum of 20 mg in each patient. All patients weretaught the correct use of intracavernous self injection ofprostaglandin E1. The analyses, ECG and penile echoDoppler evaluations of all patients showed no significantfindings that contraindicated treatment. The overall response and the response according to the site of lesion,type of lesion and age were evaluated.RESULTS: The overall response rate was 78.8%.Erection was not achieved in 9 patients even with the 20mg maximum dose.The response rate was 100% in the group of patientswith head injury. In the spinal cord injured patients, theresponse rate was 83.3% in patients < 30 years and 57.2%in patients > 30 years old. The 2 mg dose was effective in1 patient, the 10 mg in 17 and the 20 mg dose in 14 patients.A positive response was achieved in 55.5% of the patientswith complete and 72.7% of the patients with incompletespinal lesions. No complications of intracavernous injectionof prostaglandin were found. Prostaglandin self injectiontherapy achieved satisfactory results in all patients.CONCLUSIONS: Prostaglandin injection is veryeffective in the treatment of erectile dysfunction in patientswith spinal cord or head injury. A higher percentage ofefficacy was found in the younger patients, in those withincomplete lesions and those with head injury. The doserequired is usually lower than in the non neurologicalpatients.
OBJECTIVE: To report a case of transitional cell carcinoma of the bladder metastatic to the right knee and review the literature. METHODS / RESULTS: A 65-year-old patient who had refused to undergo surgery for a T2 N0 M0 bladder tumor in 1995 was admitted for poor general condition and a mass in the right knee. Biopsy confirmed bony metastasis of a carcinoma compatible with primary urothelial tumor of the bladder. CONCLUSIONS: Bony metastasis of transitional cell carcinoma of the bladder is relatively frequent and mainly to the spine. Distal bony lesions are rare and usually appear in the advanced stages of the disease.
OBJECTIVE: To report a case of testicular tumor,classified as seminoma, with a very uncommon form of presentationsince it presented as acute scrotum.METHODS: The clinical features, treatment and outcome of thisuncommon condition are presented.RESULTS: A review of the literature showed that this form ofpresentation is rare although in the present case it is impossible todetermine if testicular inflammation was due to tumor necrosis orinfection from the associated hydrocele.CONCLUSIONS: Testicular tumor should be considered in allmale patients aged 20 to 35 years with acute scrotum.
OBJECTIVE: To present our experience withmesothelial cysts with excretory system involvement.METHODS: 3 cases of mesothelial cyst are presented; two ofthem caused obstructive uropathy.RESULTS: Cases 1 and 2 were treated by surgery, while case 3was managed conservatively. All cases are currently asymptomatic.CONCLUSIONS: Mesothelial cysts are an uncommon cause ofobstructive uropathy. Treatment is by surgery for the symptomaticcases and conservative management is a valid alternative for theasymptomatic cases.
OBJECTIVE: To report a case of focalized stage IIxanthogranulomatous pyelonephritis and the diagnostic difficultiesencountered.METHODS: A 63-year-old female consulted at the emergencyservices for fever during the last two months and right lumbar pain.Urinary cultures were negative. A CT scan showed a poorly-definedheterogeneous mass in the lower pole of the right kidney. Fine needlepunction-aspiration biopsy was compatible with renal cell carcinoma.The patient underwent radical nephrectomy.RESULTS: The histopathologcial study showed focalized stage IIxanthogranulomatous pyelonephritis but no evidence of neoplasia.CONCLUSIONS: Xanthogranulomatous pyelonephritis canmimick the clinical, cytological and imaging features of renalneoplasia.
OBJECTIVE: To report a case of leiomyoma of thebladder in a patient with unspecific urinary symptoms and discussthe utility of the diagnostic imaging techniques.METHODS / RESULTS: A 39-year-old man who consulted forunspecific urinary symptoms is described. Patient evaluation withultrasound, CT and MRI showed a mass in the posterior aspect of theurinary bladder.CONCLUSIONS: Leiomyoma of the bladder is an uncommonbenign tumor that is asymptomatic in most of the cases and isfrequently discovered incidentally during assessment for otherconditions. The case described herein presented with unspecificurinary symptoms. Patient evaluation with different diagnosticimaging techniques was required for correct diagnosis and treatment.
OBJECTIVE: To describe an additional case of desmoid tumor of the penis. The incidence, etiopathogenesis, symptoms, diagnosis and treatment of this condition are discussed. METHODS: A 70-year-old male consulted at the emergency services for pain and urinary symptoms. Physical examination showed no regional lymphadenopathy. Patient assessment by ultrasound and CT disclosed a penile lesion. Treatment was by wide local excision. RESULTS: Control evaluation at 3, 6 and 12 months showed normal findings and the patient remains asymptomatic. CONCLUSIONS: Wide local excision is advocated as the treatment of choice for desmoid tumor of the penis.
OBJECTIVE: To report a rare case of plasma cellgranuloma of the renal pelvis. To our knowledge, only five caseshave been reported in the literature.METHODS: Clinicopathological description of a case of plasmacell granuloma of the renal pelvis with light chainimmunohistochemical study.RESULTS: A young male patient with a radiologically benignmass in the right renal pelvis extending into the upper calices thatcaused hematuria is described. The diagnosis was suggested duringthe intraoperative study of the mass that was suggested by pyelotomy(conservative surgery). Immunohistochemical study confirmed theinitial diagnosis.CONCLUSIONS: Although this condition is rare, plasma cellgranuloma, an inflammatory pseudotumor, can occur in the urinarytract and should be considered in the differential diagnosis of masslesions. Histopathological diagnosis requires a complete study of theentire tumor and the use of immunohistochemical techniques todiscard plasmacytic non-Hodgkin lymphoma or neoplastic plasmacell proliferation.
OBJECTIVE: To investigate the influenceof tamsulosin treatment on the severity of lower urinarytract symptoms (LUTS) and the impact on quality of life(QoL), including daily life activities and mental wellbeing, in real life practice in Spain.METHODS: 2740 LUTS patients aged 45-75 years whovisited a urologist office in Spain received tamsulosin 0.4mg o.d.. At baseline, after 3 months and after 6 months oftreatment a questionnaire was completed by the urologistand the patient. The urologist estimated some aspects ofthe patient's QoL related to his LUTS. The InternationalProstate Symptom Score (I-PSS) was used to assess theseverity of LUTS, while the BPH-Specific Interferencewith Activities (BSIA) and the Total Mental Health Rate assessed the impact on daily life activities andpsychological well being respectively.RESULTS: After 3 months of treatment tamsulosinsignificantly improved the mean total I-PSS compared tobaseline. After 6 months, the mean total I-PSS was reducedby 11.0 points from a baseline score of 20.3 (>50%reduction). Tamsulosin also significantly improved themean total BSIA score and the mean Total Mental HealthRate. These observations were confirmed by the urologists'assessment of the patient's condition: an increase of morethan 50% of patients with no or mild voiding and fillingLUTS and an increase of 45% of patients with no or onlya small interference of their LUTS with daily life activities.The withdrawal rate due to adverse reactions was 2.4%.CONCLUSION: This study shows that tamsulosinimproves LUTS and their impact on the patient's QoL anddaily life activities, in the opinion of both the patients andthe urologists.