OBJECTIVE: To give notice of thebiography and urologic contributions of José Rives yMayor MD, "Catedrático" (Professor) of Surgery in theSan Carlos Royal College of Surgery of Madrid, becausehe is considered one of the renovators of surgery in ourcountry, as well as one of the principal introducers ofanatomopathological studies in teaching.METHODS: Among 69 urologic communicationspresented at the San Carlos Royal College LiteraryMeetings of, we selected those from Dr. Rives, author thatpresented the greater number of communications referentto urologic pathology in the period between 1788 and1825, and we transcript two of them for better knowledgeand understanding of Urology during that period. We alsoperform a bibliographic search to obtain as manybiographic data about him as possible.RESULTS: From the exposition of seven of his urologicobservations and eight reviews we appreciate hisknowledge of urological anatomy and pathology, and hisknowledge of classic authors. He was specially expert inperforming urethral dilations with little candles, whichmisuse he prevents against, in scrotal-testicular pathologyand in urinary retention processes, that are includedamong his most significant analyses.CONCLUSIONS: Mr Jose Rives y Mayor was a notablesurgeon, he was outstanding in the San Carlos RoyalCollege of Surgery of Madrid literary meetings where hepresented a great number of observations and reviews, inwhich he maintained a galenic-hipocratic reasoning,besides a great anatomical knowledge, that informs usabout the state of Urology in that period.
OBJECTIVE: We emphasize the goodresults obtained by authors of the United States of NorthAmerica and Europe using prostate braquitherapy in thetreatment of localized prostate cancer.METHODS: We report 50 patients with stage T1c-T2ctreated during the last twenty one months (September2000, June 2001). Two groups were made - according toGleason, PSA, local infiltration and percentaje of tumorvolumen in the Biopsy – in low and high risk patients. Wereport the methodology used in the surgical procedure.RESULTS: We found the nadir of PSA was 0.5-1 inseven patients followed during eighteen months, andfifteen patients followed during twelve months. We had afailure in two patients. A reference is made about twopatients with previously TURP and one with openprostatectomy, with very good post-operative results.Secondary efects are esencially irritative simptoms, wellcontrolled by medical treatment. Four patients had acuteurinary retention, one of them persistent. Normal erectionswere found in thirty five patients, and partial in fifteen,which had a very good respond to Sildenafil. Four caseshad partial incontinence, currently only one persist duringsleep.CONCLUSION: We have had very good results duringthe first twenty one months of treatment of cancer of theprostate with brachytherapy. In our opinion the procedureis a very valid option of treatment for this disease
OBJECTIVE: to evaluate P 53 and c-erb- 2 overexpression as a prognostic factor for progression and survival in patients with renal pelvis and ureter tumors. METHODS: Retrospective review of the medical records and pathology/immunohistochemical reports of 61 patients who underwent surgery for upper urinary tract urothelial tumors. Immunohistochemical studies were performed using the STREPTAVIDIN-BIOTIN-PEROXIDASE techniques with a LASAB kit (DAKO). Pearson ́s Chi square for 2x2 contingence tables and residues analysis were used for non continuous variables, with a confidence level of p<0.05. COX multivariate analysis and survival curves were used for multiple variables association. RESULTS: A higher P 53 overexpression was related with tumour dependant death (p<0.001) These patients have their long term survival compromised. C-erb-2 overexpression is not statistically related to either proliferation or cancer specific death in upper urinary tract urothelial tumors. CONCLUSIONS: In our series P53 overexpression has prognostic value in upper urinary tract urothelial tumors, but c-erb-2 did has not prognostic value.
OBJECTIVE: To compare PSA density(PSAD) results based on prostate volume measurementsobtained by either transrectal or abdominal ultrasound(US) in the diagnosis of prostate cancer.METHODS: We prospectively selected 420 consecutivesubjects whom at the time of a transrectal US (TRUS)guided biopsy or an abdominal US had the other USevaluation done within the previous 6 months and who didnot undergo hormonal, surgical o radiotherapeutic therapy.For both abdominal and transrectal US PSAD (PSA/volume) were obtained from this data and compared, withvolumes calculated using the formula: V=antero-posterior diameter2 x transverse diameter/2.RESULTS: 140 patients had prostate cancer (33.8%).Using Student´s t test mean differences were 0.27cm foranteroposterior diameter, 0.39 cm for transverse diameter,3.36 cc for volume and 0.014 for PSAD, being thedifferences significative in all cases (p﹤0.001).When ROCcurves were calculated for TRUS PSAD and abdominalPSAD areas obtained were 0.66 and 0.67 respectively.For a PSAD cut off point of 0.15, in patients with PSAvalues between 4-10 ng/ml Sensitivity was 0.77 for TRUSand 0.75 for abdominal US, and specificity was 0.40 and0.49 respectively.CONCLUSIONS: Although statistically significativedifferences were found in all measurements between TRUSand abdominal US, most probably due to the high numberof patients, these differences have little clinical relevanceas the other results show. In our experience PSADcalculation by abdominal US has the same utility than bytransrectal US and avoids its mayor inconvenience whichis to perform TRUS.
OBJECTIVE: To evaluate prepucedevelopment and retractibility in a group of boys. To pointout the value of circumcision and prepucial forced dilationduring childhood.METHODS: Prepuce development and retractibilitywere evaluated in 400 boys ages between 0-16 year old.RESULTS: In boys under 1 year prepuce retractibility(assessed only in children who did not undergo forceddilation previously) was type I (non retractile) in 71.5%whereas type V (completely retractile) was only 5.5%. Inadolescent boys type I prepuce was observed in 1 boy only,1.6%, whereas type V was observed in 82.3%. Furthermore,it was observed that at the time of examination for thestudy 106 boys who had undergone forced dilation at anearlier age had balano-prepucial adhesions again , whichdemonstrates that prepuce adheres again to glans penis inmany boys after a forced dilation is performed.Only 11 boys were considered in need forcircumpcision, three of them for prepucial orifice stenosis,which prevented normal micturition, causing a prepucialsac, one case due to a constrictive ring below the prepucialedge that would have prevented ulterior retractibility,two cases with repetitive balanopostitis, and five casessecondary to xerosal balanitis, accounting for 2.7% of allexamined boys.CONCLUSIONS: Incomplete separation betweenprepuce and glans penis is normal and common amongnew-borns, progressing until adolescence to spontaneousseparation, at which time it is complete in the majority ofboys. Accordingly to the criteria we have sustained foryears and present study´s findings, circumcision has fewindications during childhood, as well as forced prepucialdilation.
OBJECTIVE: Genitalia trauma arerelatively frequent pediatric emergencies. There is a widespectrum of lesions that can be produced. The purpose ofthis study is to descriptively analyse our experience withpediatric urologic trauma over the last five years.METHODS: We review 152 cases of male children ages1 to 15 years old who presented with external genitaliatrauma at our hospital's paediatric emergency room andrequired urologic evaluation or treatment. All cases wereevaluated for type of lesion, mechanism of traumaproduction, complementary diagnostic tests performedand treatment: conservative or surgery.RESULTS: 33.5% of lesions were prepucial or penile,and the remainder 66.5% were to the scrotum or itscontent. In 60 cases (61,2% of scrotal trauma) a scrotalultrasound was performed. Treatment was conservative in73.1% cases, and in the remainder 41 boys primary sutureor surgical exploration were performed in cases of hematoma,parenhcymal rupture, important penile-scrotal tears,and in one case of suprapubic cellulitis secondary to a prepucial wound. A deferred orchyectomy was necessaryin one case only: a case with hematocele in which aninitial surgical examination was not performed.CONCLUSIONS: External genitalia trauma duringchildhood are usually mild and the majority of cases do notrequest surgical treatment. When in doubt aboutparenchymal involvement or existence of hematocelesurgical exploration must be performed trying to preservetesticular integrity.
OBJECTIVE: Literature review about arterial priapism cases secondary to bilateral postraumatic arterial-lacunar fistula, with special attention to therapeutic management by bilateral supraselective embolization. METHODS: Bibliographic search using MEDLINE. A new case of high flow priapism secondary to bilateral postraumatic arterial-lacunar fistula is reported. RESULTS: There are a total of ten cases of arterial priapism secondary to bilateral postraumatic arterial- lacunar fistula. Only one patient was treated by embolization in two steps with reabsorbable material; non reabsorbable material was used for embolization in three patients; in four cases embolization was performed as a single procedure and the remainder two cases resolved spontaneously. Erectile function was recovered independently of the therapeutic option performed. CONCLUSIONS: Embolization in two steps with reabsorbable material has been postulated as the treatment for arterial priapism secondary to bilateral postraumatic arterial-lacunar fistula or in cases of high flow status and drepanocytosis which do not resolve with other therapeutic measures. Nevertheless, if supraselective embolization is performed, it could not be mandatory to follow this therapeutic criteria, as it is suggested by erectile function results obtained.
OBJECTIVE: After the age of 60, 20-35% of men present with androgen deficiency. Clinical symptoms of hypogonadism in older men are often more difficult to interpret than in younger men. Knowledge of physiological actions of testosterone and its metabolites are important prerequisites for diagnosis, drug selection and surveillance of therapy. Another question is whether any type of interventions, such as hormone replacement therapy, may play a role in improving the quality of life as proven in post-menopausal women. METHODS: To understand testosterone supplemen- tation in the aging male, this review will discuss the following important topics: physiology of male hormonal balance, changes in reproductive organs in elderly men, endocrine evaluation of the male, pharmacological effects of testosterone on target organs, available preparations for testosterone and testosterone supplementation. RESULTS: Testosterone deficiency may induce organic symptoms such as loss of muscular strengh, decreased libido and loss of bone density and have psychological consequences such as fatigue or depression. Controlled clinical trials show that therapy with natural testosterone results in clinical improvements in elderly men that cover and rogenic effects. CONCLUSIONS: With the current status of knowledge short acting, low dose testosterone preparations seem to be best tailored for substitution of older hypogonadal men. Only intensive research in the future can satisfy these requirements.
OBJECTIVE: To achieve an effective, safeand fast hemostasis. To translate it into a great diminutionof operating time, avoiding multiple ligatures that aretime consuming and being merely a mechanical, repetitiveact do not add any element of quality to surgery in generaland to urologic pelvic procedures in particular.METHODS: A new hemostatic system has beenexperimented in pelvic urologic open surgery, specificallyin radical cystectomy (RC) (with orthotopic substitutionor urinary diversion) and radical prostatectomy (RP). Itachieves vascular sealing by means of tissue collagenprecipitation when applied in previously dissected vascularpedicles during radical cystectomy and neuro-vascularbundles during radical prostatectomy.RESULTS: It has been noted a complete efficacy in thecoagulation of all vascular pedicles as well as a significantdecrease in operating time (around 25%) because the useof ligatures is completely avoided. It has also been noteda great decrease in blood loss, with reductions in transfusionneeds down to 50% of the cases.CONCLUSIONS: The new hemostatic system by tissuecollagen coagulation allows a fast, effective and safe hemostasis in complex urological pelvic surgery, whichtranslates into operative time savings and minimal bloodloss.
OBJECTIVE AND METHODS: We report two new cases of this rare and aggressive tumour; one case appeared in the earliest age reported in the literature (case #2). We also review etiological, diagnostic and therapeutic features. RESULTS: Despite aggressive surgery and adjuvant chemotherapy it has a very poor prognosis, with disease progression within 6 months in both cases. CONCLUSIONS: Sarcomatoid renal cell carcinoma is an infrequent entity, extremely aggressive and requires radical surgery at the time of diagnosis due to its advanced stage, although results are poor. It can also appear in young people with the same aggresiveness than in adult age.
OBJECTIVE: we report a case of fibromatousperiorchitis, a rare entity that may have differential diagnosisproblems with other lesions.METHODS: Our patient underwent a surgical procedure withresection of the tunica vaginalis testis after intraoperative histologicalevaluation.RESULTS: Findings observed in both intraoperative biopsy andspecimen histopathological study were key for diagnosis.CONCLUSIONS: Although macroscopic appearance of the lesioncan be of great value, fibromatous periorchitis diagnosis is based onthe histologic features, being important to avoid erroneous therapeuticdecisions.
OBJECTIVE: Idiopathic spontaneous bladderrupture is a low incidence clinical entity. We perform a literaturereview and report a recidivant case, with special attention to itsphysiopathology mainly if associated with alcohol abuse.METHODS: We report the case of a patient with recidivantspontaneous bladder rupture associated with alcohol abuse. Thepresentation of this case is uncommon.RESULTS: 53 year old male with history of chronic alcohol abusewho presented with abdominal pain and renal failure.CONCLUSIONS: Spontaneous bladder rupture is the cause ofacute abdomen and acute renal failure. Idiopathic rupture associatedwith substance abuse has proper clinical characteristics that makeit to be considered a different entity than other causes of spontaneousbladder rupture.
OBJECTIVE: Penile incarceration is an infrequentclinical reality. Diagnosis is evident in most cases, and the challengesare to find the best way to retrieve the constrictive ring and repair thedamage. Nevertheless, this event being curious has motivated us toreport it.METHODS AND RESULTS: We report the case of a 48 year oldpatient victim of a "joke" resulting in a 13 day penile incarcerationproduced by 7 double metallic rings, 24 mm in internal diameter and4 mm wide, which required section and extraction of the rings as wellas wide tissue debridement and posterior plastic reconstructionusing partial thickness cutaneous grafts. We review diagnostic antherapeutic features from the literature.CONCLUSIONS: Penile incarceration should be considered anemergency, so that the earlier the constrictive object is retrieved thelower the risk for complications secondary to penile devascularization,urinary retention and urethral damage.We emphasise the need to perform retrograde urethrography andsuprapubic cistostomy if urethral lesion is suspected, a cutaneousvascular evaluation with doppler ultrasound or fluorescein test andthe opportunity of cutaneous grafts to solve tissue lesion.
OBJECTIVE: We update the diagnostic criteria forrenal cystic masses, emphasising in the clinical entity known ashyperdense renal cyst.METHODS: We report the case of a male parient who presentedwith an atypical left renal cyst. Radiological examinations (US andCT) were performed. A description of renal cyst classification ismade. We review the diagnostic criteria for hyperdense renal cystusing the iconography from this case and also its therapeuticapproach.RESULTS: An image compatible with left simple renal cyst wasfound on ultrasound. A CT scan study showed an homogeneous masswith a high attenuation value, non vascular in nature, which complieswith all diagnostic criteria for hyperdense renal cyst.CONCLUSIONS: Hyperdense renal cyst is a simple cyst whichhas suffered bleeding or infection. Diagnosis is made by CT scan andit does not require treatment.
OBJECTIVE: We report a new case of benignretroperitoneal schwannoma arising from the adrenal gland.METHODS: 53 year old male with history of moderate benignprostatic hyperplasia under alpha blocker theraphy who referredright flank discomfort for two months prior to last visit, without anyother symptoms; radiologic examination with Ultrasound and CTscan and preoperative endocrine study were suggestive of nonfunctioning adrenal tumour which was surgically extirpated.RESULTS: Anatomopathological report showed a benignyuxtaadrenal schwannoma.CONCLUSIONS: It is an uncommon retroperitoneal tumour.The presence of cystic changes within a retroperitoneal tumour isrelatively frequent in schwannomas and may suggest its diagnosis.The case we report did not have cystic structures.
OBJECTIVE: Increasingly nephronsparingpartial nephrectomy has became widely acceptedas a preferred treatment option for the select patient whenthe adenocarcinoma involves a solitary kidney or poorlyfunctioning contralateral kidney, and in patients withsynchronous bilateral tumors. While open partialnephrectomy is currently the standard nephron sparingprocedure for treatment of renal tumors, laparoscopicpartial nephrectomy has emerged as a potential alternativerecently.METHODS: This review seeks a critical assessment ofthe current status of laparoscopic partial nephrectomy,worldwide results and a brief description of energy basedin-situ tumor ablation systems.We have duplicated laparoscopicaly, the open surgicaltechniques. While choice of laparoscopic approach dependsupon the surgeon's personal preference, the precise locationof the tumor on the kidney is the main factor determiningour either retroperitoneal or transperitoneal approach.Hilar clamping reliably achieves a bloodless field,decreases renal turgor and allows surgical precisionduring tumor excision and control of larger vessels, whichrepresents a real, practical and significant advantage.Precise suture repair currently remains the optimaland most reliable method for sealing a collecting systementry during the course of a laparoscopic partialnephrectomy. With increasing experience, laparoscopicpartial nephrectomy can be safely applied to renal tumorsthat extend deeply, even upto the renal sinus.CONCLUSIONS: As more data emerges and thetechnical success rates of laparoscopic partial nephrectomyimprove this minimally invasive technique will gain awider role in the treatment of select renal cell carcinomas.