OBJECTIVE: To quantify the morphologic protection of PGE1 on renal glomerulus following normothermic acute renal ischemia. METHODS: This experimental study was carried out in 48 adult male Wistar rats. A simple right nephrectomy was performed in all rats. The rats were divided into two groups: one group was perfused with PGE1 and the other group with saline solution immediately after acute renal ischemia, which was produced by non-traumatic vascular clamping. The ischemia times were 15 and 60 minutes. The recovery period ranged from 24 hours to 7 days. After this period the animals were anesthetized and sacrificed. Histological and morphometric analyses of the right kidneys of the control group and the left kidneys of the study group were performed. RESULTS: The mortality was 31% (18.5% for the group perfused with PGE1 and 11.4% for the group perfused with saline solution). Kidneys of rats perfused with saline solution weighed more than the kidneys of rats perfused with PGE1 (1.771±0.455 and 1.55±0.34, respectively). Acute tubular necrosis was observed after 60 minutes' ischemia and was more evident in the saline than in the PGE1 group. The morphometric study showed no significant differences between the control (normal) and the PGE1 group for glomerular diameter (p ≤ 0.101), sphericity factor (p ≤ 0.239), glomerular perimeter (p ≤ 0.092) and glomerular volume (p ≤ 0.059). However, significant differences were found between the control and the saline perfusion group for area (p ≤ 0.000), diameter (p ≤ 0.000), perimeter (p ≤ 0.000) and volume (p ≤ 0.000). CONCLUSIONS: Kidney weight after ischemia increased more in the saline than in the PGE1-treated group since the edema in the renal parenchyma is attenuated by the anti-inflammatory and cytoprotective effects of PGE1. The morphometric study showed that in comparison to saline, PGE1 exerts a cytoprotective effect, although it is not considerable.
OBJECTIVE: To describe the utility ofendoscopic management of stress urinary incontinencewith Stamey's needle.METHODS: 50 multiparas (2-8 deliveries; mean 4)aged 26-72 years (mean 42) consulted for stress urinaryincontinence. All patients were evaluated by the Valsalvamaneuver, cough and perineal ultrasound and wereclassified as mild (8 cases), moderate (26 cases) andsevere (16 cases). Thirty-eight patients had cystocele.Bladder neck suspension with Stamey's needle wasperformed in all patients. A cystostomy and not aurethrovesical catheter, was left indwelling in all patients.RESULTS: Multiparity and management at childbirthwere the most common factors associated with stressurinary incontinence. Perineal ultrasound was found to beuseful in the evaluation of the incontinent patient and thesurgical procedure. The endoscopic procedure permitsphysiologic correction of stress urinary incontinence andcystocele.CONCLUSIONS: Endoscopic surgery with Stamey'sneedle reduces the operating time, length of hospital stay,recovery time and surgery-related pain. Patientmanagement is facilitated by cystostomy.
- OBJECTIVE: PCNA and Ki-67 expressionare used as markers of cellular proliferation and differentstudies have investigated their value as prognosticindicators for renal adenocarcinoma. The aim of thisstudy was to determine PCNA and Ki-67 expression inlocally confined renal adenocarcinoma, their relationshipwith other histopathological variables and prognosticsignificance.METHODS: 58 cases of renal adenocarcinoma stagespT1-T3a N0 M0 (TNM 1997), treated by curative radicalor partial nephrectomy were reviewed. The clinical andhistopathological variables were analyzed. PCNA and Ki67 expression in tissue embedded in paraffin were studiedby immunohistochemical techniques.RESULTS: The mean percentage of nuclei that stainedfor PCNA was 7.03% (range 0-50%). Analysis of thecorrelation between PCNA and histopathological variables (size, grade and stage), showed a statisticallysignificant correlation of PCNA only for the nuclear grade(p = 0.009). The mean percentage of nuclei that stained forKi-67 expression was 2.96% (range 0-30%) and arelationship was found for size ( p < 0.001), nuclear grade(p < 0.001) and stage (p < 0.001). The incidental clinicalpresentation, tumor size, stage, nuclear grade, PCNA andKi-67 expression showed a relationship with survival.However, only perirenal fat infiltration, tumor size, nuclear grade and PCNA expression were found to beindependent factors by multivariate analysis.CONCLUSIONS: PCNA expression correlated withnuclear grade, while Ki-67 demonstrated a significantcorrelation with tumor size, grade and stage. Survivalanalysis showed a relationship of both markers withprognosis. However, only PCNA was found to be anindependent factor by multivariate analysis.
OBJECTIVE: To describe 5 cases of renallymphoma.METHODS / RESULTS: A retrospective study wasconducted on 5 cases of renal lymphoma that had beendiagnosed at our institution in 1999. Of these 5 cases, onewas considered to be primary renal lymphoma. Thecharacteristics, treatment and outcome are discussed.CONCLUSIONS: Secondary kidney involvement fromsystemic lymphoma is common, but primary renallymphoma is a rare and controversial entity.
OBJECTIVE: To present our experiencewith renal collecting duct carcinoma and review theliterature.METHODS: We reviewed our experience with collectingduct carcinoma of the kidney. We found 6 cases out of 176nephrectomies (3.4%), which accounts for one of thelargest series reported in the literature. The radiological,histological and immunohistochemical findings areanalyzed. RESULTS: The histological and immunohistochemicalfindings showed a specificity for high molecular weightcytokeratins and Ulex europeaeus but the imaging findingswere not distinct from those of other renal tumors.According to the anatomopathological findings, we have classified the patients into three groups with three distinctcourses. All patients underwent radical nephrectomy andone patient received adjuvant therapy.CONCLUSIONS: We have identified a subgroup of lowgrade collecting duct carcinoma of the kidney with aparticularly favorable behavior in two patients of ourseries. At 56 and 41 months’ follow-up, both patientsremain disease-free. As reported in the literature, patientswith high grade and stage collecting duct carcinoma of thekidney have a poor outcome. They develop severecomplications and die less than one year after the diagnosis, despite adjuvant immunotherapy.
OBJECTIVE: To determine the degree ofassociation of detrusor-periurethral dyssynergia anddetrusor-bladder neck dyssynergia and if the voidingperiurethral electromyographic (EMG) activity is also avalid method for diagnosing detrusor-bladder neckdyssynergia.METHODS: A clinical, videourodynamic and selectiveperiurethral EMG study was performed in 24 patients(mean age 33 years) with spinal cord injury andhyperreflexia of the bladder.RESULTS: The prevalence of bladder neck dyssynergiawas 12.5% (3 cases) in this series. All patients withdyssynergic bladder neck also showed intermittent or sustained periurethral sphincter EMG activity. However,15 patients showed increased intermittent or sustainedvoiding periurethral EMG activity that was not associatedwith detrusor-bladder neck dyssynergia.Utilizing the videourodynamic demonstration ofdetrusor-bladder neck dyssynergia as reference, selectiveperiurethral EMG showed a sensitivity of 100% and aspecificity of 29% for the diagnosis of detrusor-bladderneck dyssynergia. CONCLUSIONS: The finding of bladder neckdyssynergia indicates the existence of detrusor-periurethraldyssynergia. However, not all cases of detrusorperiurethral sphincter dyssynergia is associated withbladder neck dyssynergia; therefore a videourodynamicstudy should be performed to rule out bladder neckdyssynergia in those patients with detrusor-periurethralsphincter dyssyngergia. This is important in making thedifferential diagnosis and also has significant therapeuticrepercussions.
OBJECTIVE: Priapism is defined as prolonged and persistent erection of the penis without sexual stimulation. Etiologies of this condition are numerous. Recent advances in the understanding of erectile physiology have improved the prompt diagnosis and treatment of priapism. Treatment of priapism varies from a conservative medical to a drastic surgical approach. Normally, priapism is effectively treated with intracavernous vasoconstrictive agents or surgical shunting. Recent findings indicate methylene blue (MB), a guanylate cyclase inhibitor, to be a potential inhibitor of endothelial-mediated cavernous relaxation. This prompted us to assess the feasibility, the use and the effectiveness of MB in the treatment of priapism. METHODS: 25 patients were treated for priapism. Etiologies were: 22 drug-mediated (PGE1 or papaverine/ phentolamine mixture) after corpus cavernosum injection therapy (CCIT), 1 leukemia-induced and 2 idiopathic high-flow priapism. Patient ages ranged from 13 to 72 years. The average duration of priapism was 5 hours and 22 minutes after CCIT. MB was administered after blood aspiration of the corpora cavernosa. 5 ml of MB was injected intracavernously (i.c.) and left for 5 min. MB was then aspirated and the penis compressed for an additional 5 min. RESULTS: All patients with CCIT-induced priapism were cured with MB alone. The 3 patients who did not respond to MB underwent i.c. phenylephrine administration and finally, if necessary, embolization of the pudendal artery. Etiology and duration of priapism were the strongest predictors for success with intracavernously administered MB. The primary side effects were a transient burning sensation and blue discoloration of the penis on injection of MB. The initial baseline erectile status was restored in all patients cured by MB. CONCLUSIONS: These results confirm that MB is a safe and highly effective treatment agent for short-term pharmacologically-induced priapism. Furthermore, MB demonstrates distinct advantages over a-adrenergic agents for intracavernous use, such as lower costs, absence of systemic or local toxic side effects and shorter treatment time leading to faster detumescence. For this reason, MB is a suitable and safe substance for alternative routine intracavernous therapy in males with pharmacologically-induced priapism.
OBJECTIVE: To report an uncommon case ofFournier's gangrene caused by a perforated retrocecal acuteappendicitis that compromised the scrotum and testis.METHODS: Herein we describe a patient that was admitted forabdominal pain localized to the right lower flank and generalizedvirulent sepsis.RESULTS: Resection of the right inguinal cord and testis wasperformed. The outcome was poor and the patient died of mutiorganfailure.CONCLUSIONS: Fournier's gangrene basically arises fromanorectal and urological pathologies, although occasionally it mayarise from an intraabdominal source, which should be ruled outespecially when the abdominal examination shows interestingfindings.
OBJECTIVE: To report an additional case of paratesticular leiomyosarcoma. METHODS: Herein we describe a 68-year-old male patient that presented with a growing, indolent, right inguinoscrotal lesion that he had noted several weeks earlier. Physical examination showed a mass involving the distal right spermatic cord and was confirmed by ultrasound and CT. Analyses were normal. Radical orchidectomy with high ligation of the right spermatic cord was performed. RESULTS: Histopathological and immunohistochemical studies demonstrated a well-differentiated paratesticular leiomyosarcoma. Local recurrence was observed at 3 ½ years' follow-up. Complete excision of the tumorous tissue was performed with no other adjuvant therapy. Six months thereafter, there is no evidence of local recurrence or distant metastasis. CONCLUSIONS: This tumor type is uncommon. Like other authors, we believe that orchifuniculectomy is the treatment of choice. Furthermore, adjuvant radio or chemotherapy does not significantly influence survival in these patients.
OBJECTIVE: To report an uncommon case ofneuroblastoma in adolescence.METHODS: A case of neuroblastoma in adolescence is presented.The etiological and pathogenetic factors, clinical and laboratoryfindings, behavior and treatments are discussed.RESULTS/CONCLUSIONS: Neuroblastoma and related tumors,ganglioneuroblastoma and ganglioneuroma are derived from primordial neural crest cells that migrate in the embrionary period andpopulate the primordial sympathetic ganglia and adrenal medulla.Neuroblastoma, the least differentiated, resembles the fetal adrenalmedulla.The peak age at the time of presentation is about 18 months andonly sporadic cases occur during adolescence, as the case describedherein, or adult life.
OBJECTIVE: To report a case of urothelial tumor ofthe bladder in a 17-year-old patient that required emergency surgicaltreatment due to acute hematuria.METHODS: The clinical history, anatomopathological andimmunohistochemical findings are described.RESULTS: A 17-year-old patient with no remarkable clinicalhistory, consulted at the emergency services for gross hematuria ofsudden onset that caused anemia and was refractory to conservativemanagement. Patient evaluation disclosed a bladder lesion thatrequired immediate resection via the transurethral approach tocontrol bleeding. The pathological analysis demonstrated a grade I,Jewett stage 0, pTaN0M0 transitional cell carcinoma of the bladder.CONCLUSIONS: Urothelial tumors of the bladder are uncommonin patients less than 40 years old. The case described herein isuncommon because of the patient's age and the form of presentationof the tumor, which required emergency surgical treatment. Followupand subsequent therapy should be based on the pathologicalcharacteristics of the tumor rather the age of the patient.
OBJECTIVE: To report a case of priapism secondary to leukemia, with special reference to the initial treatment in the emergency services.METHODS: A 53-year-old male with chronic myeloid leukemia presented with prolonged involuntary painful erection of 12 hours' duration. The physical examination and particularly the cavernosal blood gas study, indicated low flow priapism. Punction-lavage of the corpora cavernosa was performed. Because complete response was not achieved with this procedure, adjuvant intracavernous methoxamine was administered.RESULTS: Complete detumescence was achieved after the third dose of methoxamine. There was no recurrence and erectile function was preserved.CONCLUSIONS: We underscore the utility of combined cavernous lavage + adjuvant α-1 adrenergic agonist as initial therapy in priapism with this special etiology.
OBJECTIVE: To describe two cases of symptomatic syringocele diagnosed in adult patients.METHODS / RESULTS: Two cases of symptomatic syringocele diagnosed in adult patients that both consulted for obstructive voiding syndrome, are described. Diagnosis was made by retrograde urethrography. An incision extending to the outlet of the syringocele was performed in both cases. Good results were achieved and the symptoms remitted.CONCLUSIONS: Syringocele is the cystic dilatation of Cowper's gland. It is generally congenital and a majority of the symptomatic cases (urinary infection, obstruction or hematuria) are diagnosed in childhood.The diagnosis is based on the findings of retrograde urethrography and urethroscopy. Treatment is by urethroscopic incision or marsupialization of the syringocele. Some cases may require open surgery via the perineal approach.
OBJECTIVE: To report two cases of epidermoidcyst of the testis, with special reference to the diagnostic andtherapeutic aspects, and to review the literature.METHODS: Two cases of epidermoid cyst of the testis arepresented: one patient consulted for testicular swelling and the otherfor supraclavicular lymphadenopathy.RESULTS: In both cases the pathological diagnosis was testicularepidermoid cyst.CONCLUSIONS: Testicular epidermoid cysts are uncommon.High frequency ultrasonography is a reliable diagnostic imagingmethod. Treatment by tumor enucleation with preservation of thetestis is advocated, when possible
OBJECTIVE: The authors present theirexperience in the management of a rare complicationobserved during long-term use of a ureteral catheter. Thecalcification along the entire surface of the catheterfollowed by incrustation can make its removal by means ofcystoscopy difficult, thus becoming a great challenge tothe urologist.METHODS: The authors describe their experience inthe management of this complication through the analysisof two illustrative cases.RESULTS: After failing to remove the catheter usingextracorporeal lithotripsy, ureterolithotripsy wasperformed and the calcified ureteral catheter wassuccessfully removed in both cases.CONCLUSION: Ureterolithotripsy proved to be aneffective and safe method in the management of calcifieddouble-J catheter.