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OBJECTIVE: To present an introductionto scientific writing and reading.METHODS/RESULTS: To analyse the most frequentlyused different formats of scientific-technical documentsas reported by UNESCO (1983) including Scientificjournals, books, monographies, presentations tocongresses, technical reports, yearbooks and bulletins.We describe the main characteristics of each one.CONCLUSIONS:To emphasize the importance ofwritten communication, in its different formats, in healthsciences, for health care professionals formation andinformation.
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OBJECTIVE: To define the importance ofthe scientific article as a source of original information.METHODS: To describe the fundamental contents ofthe scientific article and its three different formats: original scientific article, review article and case reports.CONCLUSIONS: The contents and structure of thedifferent documents vary depending on the type of articleconsidered as a result of the goal pursued with itspublication.
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OBJECTIVE: To evaluate the efficacy offinasteride in the treatment of prostatic origin haematuria.METHODS: This is a prospective observational studyin 29 patients with hematuria from a demonstratedprostatic-origin which were treated with finasteride 5 mg/day. 58.6% had underwent previous prostatic surgery.Both previous-to-treatment hematuria and response totreatment were evaluated under the Puchner & Miller´scriteria.RESULTS: Response rate was 86.2% without additionalhaematuria episodes. The remaining patients had mildhaematuria episodes during follow-up. No patient neededsurgery.CONCLUSIONS: Finasteride is effective in thetreatment of prostatic-origin haematuria.
Case Report
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OBJECTIVE: We report three cases of pelvic lipomatosis, and from them we discuss its diagnostic and therapeutic considerations. METHODS/RESULTS: Three patients, 71, 65 and 61 years old respectively, presented with irritative lower urinary tract symptoms. Intravenous pyelogram (IVP) and CT scan were performed as diagnostic procedures. After diagnosis an endoscopic evaluation including biopsies was performed to rule out tumours. All three underwent Bricker-Wallace II type urinary diversion resulting in good control of irritative symptoms. During follow-up one patient presented with an infiltrative bladder tumour. CONCLUSION: Pelvic lipomatosis is a rare disease; although traditionally has been considered benign it can result in urinary tract obstruction with severe phisyopathological consequences. IVU and CT-scan are valuable to confirm the diagnosis. Lower urinary tract symptoms are controlled with urinary diversion without cystectomy but potential malignization of the bladder lesions should make us reconsider treatment.
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OBJECTIVE: A brief revision of the historyof the prostate biopsy is done, and emphasis is made in theimportance of seek deeply in the diagnosic of smalllesions, PIN and atipic prostate hyperplasia.METHODS: A total of 221 patients, are presented.A description of the two groups of patients is made.group I with 148 patients in which the sextant type wasperformed, and the group II, in which our technique of 12cores was done, using separeted bottles for each core. Thecomplete technique used is described and we used the "T"and Rank Sum Test for the statistical analysis of theresults.RESULTS: We found a global 22.9% positive byopsiesin the group I. This grew up as we took out more cores, with25.9% with more than six cores. The global result ingroup II was 37.1% of positive byopsies (p =0.03). Therewere 25 patients with 12 cores, and the rate of positive was34.2%. Tumor in one core was found in eight patients andalso in two to four cores, in the group of ten cores tumorwas found in ten patients. No side effects were reported.DISCUSSION: We review the results, and emphasiswas made in the necessity of have multiple cores byopsiesof the prostate, studing them separate.CONCLUSION: Multi-core biopsy of the prostate is avery useful procedure in the diagnosis of cancer of theprostate with better specificity results, statisticallysignificative, and without side effects.
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OBJECTIVE: To review the clinicalfeatures in our series of patients of germ-cell testicularcancer.METHODS: The charts of 73 patients with diagnosis ofgerm-cell testicular tumours were reviewed. Age, historyof cryptorchydism, time to diagnosis, main symptoms, andserum markers values (alphaphetoprotein and beta- HCG)were analysed. All cases underwent orchiectomy andextension study with abdominal CT-scan and either chestX-ray or Thoracic CT-scan. We follow the AJCC-UICC1997 stage classification. Histological cell line, size , andclinical stage at presentation (local, regional anddistance)have been analysed also.RESULTS: Among 73 germ-cell testicular tumours 34were seminomas (46.6%) and 39 were non-seminomatous(54.4%). Clinically, 58.9% of the patients had localisedstage I tumours. On presentation 85.7% seminomas werestage I compared to 35.9% non-seminomatous tumours.The remaining tumours were diagnosed in advancedphases (stages II and III). Inguinal orchiectomy wasperformed in all patients except 5 in whom tumours wereincidentally diagnosed (atrophic testis orchiectomy,hydrocelectomy, trauma) and needed a second operationincluding ipsilateral scrotal excision.When size, cell line and primary tumour T categorywere reviewed we found that 32.3% seminomas and 20.5%non seminomas were smaller than 4 cm. 50% seminomasand 49.7% non seminomas were pT1; 41.2% seminomasand 28.2 non seminomas were pT2; finally 8.8% seminomaswere pT3 compared to 23.1% non seminomas. Vascularinfiltration, also evaluated in this chapter, was present in38.2% seminomas compared to 38.5% non seminomas.Elements of embryonal carcinoma were found in 37 nonseminomatous tumours, either isolated (14) or associatedwith other components. Teratoma appeared in 18 nonseminomatous tumours, 16 of them associated to embryonalcarcinoma alone or together with other components.Elements of choriocarcinoma and endodermal sinus wereevident in 5 and 4 cases respectively, always associatedwith other elements.CONCLUSIONS: Seminomas clinical presentationsubstantially differs from that of non seminomatous testicular tumours in age, clinical features, stage andhistological aggressiveness.
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OBJECTIVE: To review the treatment of testicular germ-cell cancer in our series. METHODS: 73 cases with the diagnosis of germ-cell testicular tumours were reviewed. All cases underwent orchiectomy and extension study with abdominal CT-scan and either chest X-ray or Thoracic CT-scan. We reviewed the treatment options employed in our series, analysing different currently recognised risk factors. RESULTS: 34 out of 73 testicular germ-cell tumours were seminomas (46.6%) and 39 non seminomas (54.4%). Clinically 58.9% of the patients had localised, stage I tumours. 85.7% seminomas were stage I at presentation compared to 35.9% (14) non seminomatous tumours. The remainder tumours presented in advanced phases (stages II &III). Inguinal orchiectomy was performed in all cases except 5 patients in whom tumours were incidentally diagnosed (atrophic testis orchiectomy, hydrocelectomy, trauma) and underwent ipsilateral scrotal excision in a second time. Limphadenectomy was initially performed in 3 patients with non seminomatous tumours. Radiotherapy was used in 23 cases of seminoma (67.6%), although this percentage has been progressively reduced in recent years. 30 patients received chemotherapy after orchiectomy: 3 metastatic seminomas (stage II) (8.8% of seminomas treated with chemotherapy) and 27 non seminomatous tumours (69.2 %of them). All metastatic tumours are among the last (25) (Stages II &III) and 2 stage I non seminomatous tumours. All seminomas achieved complete response without later relapse after a median follow-up of 50 months (12- 145 months). Median follow-up for non seminomatous tumours was 57 months (1-288 months). 13 non seminomas had relapses (33.3%). Relapses appeared in the retroperitoneum in 11 cases (84.6%), 2 of them concurrent with pulmonary relapse; 1 patient had liver relapse, one lung and another in bone. Median time to relapse was 4 months (2-102). 8 patients died and 2 were lost for follow-up. CONCLUSIONS: Testicular germ-cell cancer needs a well established multidisciplinary approach, in which the role of the urologist is fundamental. Orchiectomy is the primary treatment and allows determination of the dissemination risk. Radiotherapy is very effective for localised seminomas with poor prognostic factors, and for non seminomas 2 cycles of chemotherapy seem to be an effective approach, as well as of little toxicity. We must know and apply optimised programs for observation of these tumours (stage I), and also use follow-up protocols after chemotherapy or radiotherapy. Some cases need complex surgery for residual masses resection or post chemotherapy salvage surgery in disseminated tumours (Stages II &III). Sterility treatment protocols are applied to preserve fertility.
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-OBJECTIVE: To determine with the highestlevel of evidence the efficacy of pelvic floor rehabilitationin the treatment of stress urinary incontinence in women.METHODS: A systematic search was performed in theMEDLINE electronic database with the purpose to findrandomised and controlled clinical trials evaluating theefficacy of pelvic floor rehabilitation in the treatment ofstress urinary incontinence. A quantitative metanalysiswas performed then by the Logit method combining theresults from these studies to obtain an Odds ratio (OR)with its confidence interval. Moreover, it was determinedthe heterogeneity of the studies included in metanalysis bycalculus of the Cochrane Q component.RESULTS: 8 randomised controlled clinical trialsmatched the inclusion criteria. Global OR resulting fromthe combination of these studies was 7.03 (Confidenceinterval 4.99-9.89). Nevertheless, the heterogeneity of thestudies was significant, secondary among other circumstances to the fact that these studies did not establishthe difference between improvement and cure clearly.CONCLUSIONS: The heterogeneity of the studies doesnot allow to state after metanalysis (maximum level ofscientific evidence) that pelvic floor rehabilitation iseffective in the treatment of woman’s stress urinaryincontinence. Nevertheless two randomised controlledstudies were found confirming that rehabilitation cureswoman’s stress urinary incontinence, from which there isgood scientific evidence in favour of this treatment.
Case Report
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OBJECTIVE: To emphasise a case of splenic hematomasecondary to ESWL.METHODS: We report the case of a 69 year old patient with thediagnosis of left kidney stone who underwent ESWL. The treatmentwas performed with an electric lithotripter after pre-treatmentantibiotic prophylaxis; 2000 shock waves of 18 Kv were given to thepatient.RESULTS: Patient presented abdominal pain and hematocritdescent after lithotripsy. The diagnosis of splenic hematoma wasestablished after abdominal ultrasound and CT-scan and the patientwas treated conservatively. He required a posterior emergencysplenectomy secondary to infection of the hematoma, with the resultof death secondary to septic shock.CONCLUSION: Splenic lesion is an exceptional complicationafter ESWL. There are no studies about the effect of shock waves onthe spleen, having been reported only four cases. It is believed thatextreme care should be taken in cases with splenic pathology:leukaemia, lymphoma, etc.
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OBJECTIVE: To report a new case of low grade endometrial stroma sarcoma late relapse involving bladder wall and ureter.METHODS: We report the case of a 64 year old female with history of Wertheim-Meigs hysterectomy 30 years before for uterine sarcomatous tumour, who presented with intermittent macroscopic haematuria episodes associated with mild elevation of serum creatinine. Image diagnostic tests — mainly CT-scan— evidenced a right pelvic mass involving the bladder wall and the homolateral distal ureter. Different lines of palliative treatment - chemotherapy and radiotherapy- were started.RESULTS: Histologic and immunohistochemical studies of samples obtained by transvaginal ultrasound guided biopsies were consistent with low grade endometrial stroma sarcoma.Results from palliative treatment were discouraging. CONCLUSIONS: This type of neoplasms are rare, although relapses may appear after extremely long silent periods. They have potential to compromise urological structures. Although there are publications reporting good results, the role of different palliative therapeutic alternatives is not well established yet, and responses in cases like ours are minimal or none.
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OBJECTIVE: Renal arterial-venous fistula is a lowincidence clinical entity generally secondary to processes invasiveto such organ. We report a new case with a bibliographic review, andevaluate the diagnostic and therapeutic approach.METHODS/RESULTS: We report the case of a patient whosuffered a left flank knife wound and developed an arterial-venousfistula presenting with hematuria that was solved by selectiveembolization.CONCLUSIONS: Arterial-venous fistula is a low incidence entity,usually secondary to renal trauma (open or blunt) and invasiveprocesses. Renal Doppler-Ultrasound is the initial diagnosticprocedure when its diagnosis is strongly suspected and thenangiography is both confirmatory and therapeutic.
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OBJECTIVE: To describe a 46,XX male with ahidden mosaicism.METHOD: Clinical, hormonal and genetic findings are presented.RESULTS: The patient was a normal phenotypic male with abilateral testicular volume of 10 ml. Hypergonadotropichypogonadism (elevated serum concentrations of FSH and LH, andnormal serum concentration of testosterone) without gynecomastiawas found. Final karyotype was a 46,XX/47,XX+mar mosaic, with3% of studied cells containing an abnormal SRY positive Ychromosome.CONCLUSION: XX males karyotype must include a great numberof metaphases in order to ascertain a definitive genetic diagnosis.
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OBJECTIVE: To report the case of an adrenalpheochromocytoma presenting as a retroperitoneal haemorrhage.METHODS: 53 year old patient without previous medical historywho presents with a spontaneous retroperitoneal haemorrhage.RESULTS: CT-scan was performed showing a retroperitoneal collection. The patient underwent emergency adrenalectomy with afinal histopathologic diagnosis of pheochromocytoma.CONCLUSION: Pheochromocytomas can occasionally presentas Wünderlich´s syndrome, needing radical surgery as treatment forits resolution.
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OBJECTIVE: We report the case of a 33 year oldfemale presenting with an upper pole renal mass suggestive of renalcell carcinoma which in the pathological specimen resulted to be aretained surgical gauze.METHODS/RESULTS: The case of a female patient with historyof previous nephrolithotomy 5 years before who presented with flankpain. CT-scan and ultrasound were suggestive of malignant renalmass.CONCLUSIONS: A retained surgical gauzed should always besuspected in all patient with an abdominal mass and with history ofprevious surgery close to the area of the lesion without caring thetime lapsed between surgery and the discovery.
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OBJECTIVE: We report a case of prostatic utriclecyst complicated with giant lithiasis.METHOD/RESULTS: A 42 year old man with history of surgeryfor bilateral cryptorchidism and hipospadias in his infancy, presentedwith initial and terminal hematuria and a digital rectal examinationshowing a rocky, smooth enlargement of the anterior rectal wall.Prostatic specific antigen was normal. Transrectal and transabdominal ultrasound showed a large retrovesical calcification andintravenous pyelogram showed normality of the upper urinary tract.The patient underwent a complete resection through a suprapubicextraperitoneal approach without complications. Histopathologyrevealed a 10 cm long prostatic utricle cyst complicated withlithiasis.CONCLUSIONS: The prostatic utricle cysts are rare in clinicalpractice and associate with anomalies of testicular descent andhipospadias. They have a difficult diferential diagnosis and indicationfor treatment depends on presenting symptoms, size andcomplications.
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OBJECTIVE: To study the incidence,clinical presentation and pathological prognostic factorsaffecting disease outcome of RCC in young adults lessthan 40 years old.METHODS: The charts o medical records of 400patients treated surgically for RCC between January 1984and December 1999 were reviewed. 29 (7.25%) patientswere under 40. We used ANOVA regression and Chisquare (Fisher exact test) to assess the prognostic value ofthe quantitative and qualitative variables, respectively.Estimation of the survival distributions were calculatedaccording to Kaplan-Meier method and compared withLog rank test. Multivariate analysis of the entire populationutilizing Cox models was performed.RESULTS: The most common histological cell type wasclear cell carcinoma, found in 20 (69%) patients. At amedian follow-up of 80 months, 20 (69%) patients weredisease free and 9 (31%) died of the disease. Incidentaldiscovery (p=0.05), tumor stage (p=0.043), grade(p=0.011), lymphatic invasion (p<0.0001) metastasis(p=0.003), adrenal invasion (p=0.024), and renal veininvasion (p<0.0001) were associated with prognosis(Kaplan-Meier). When comparing patients less than 40years vs. older than 40 years, we found significantdifferences in histology type (clear cell carcinoma 69% vs.91%; p=0.0001), and tumor stage at presentation (pT2=34.5% vs. 17.3%; p=0.04) (pT3= 20.7% vs. 42%; p=0.03).Disease free survival was not significantly different betweenthe two groups (69% vs. 65.7%; Log rank test p=0.4).CONCLUSION: Although rare, RCC in young adultsseems to follow a course similar to the disease seen inolder patients. Among the prognostic factors studiedincidental discovery, pathological stage of the tumor andgrade, were associated with survival. Stage at presentationwas different between the two populations however survivalwas not affected by age.
