OBJECTIVE: To determine the relationship of the immunohistochemical expression of p53 and EGF-r (epidermal growth factor receptor) and the recurrence rate and disease-free interval in superficial bladder cancer. METHODS: 144 patients with superficial transitional cell carcinoma of the bladder were studied over a period of three years. Direct dilution anti-EGF-r monoclonal antibody (Biogenex, San Ramon, CA 94583, USA) was utilized for EGF-r determination. Anti-p53 mouse monoclonal antibody (DO7, Novocastra, Newcastle, 24 Claremont Place, UK) at a concentration of 1:100 was utilized for protein p53 determination and was considered negative if less than 10% of the tumor cells were stained and positive if 10% to 100% of the cells stained. EGF-r was determined only as either positive or negative regardless of percent of expression. RESULTS: 55 patients (38%) showed EGF-r and 14 (9.7%) showed p53 expression. The disease free survival was 54.08 months in the patients that showed EGF-r expression vs 30 months for those that did not, the difference being statistically significant (p = 0.027). However, no differences were found in this regard for p53 expression. Tumors that expressed EGF-r recurred in the same site as that of the primary tumor. By contrast, those that did not express EGF-r recurred in another or in multiple sites. CONCLUSIONS: The risk of recurrence is lower in bladder tumors that express EGF-r than those that do not, and when they recur, this generally occurs in the same site as the primary tumor . However , determination of p53 expression was not useful in determining the risk of recurrence or progression of superficial bladder tumors.
OBJECTIVE: Inverted papilloma of theurothelium accounts for 2.2% of urothelial neoplasms. Itsoncologic significance is unclear; its potential forrecurrence and/or progression is not well-known. Ourexperience from 1976 to 1999 is reviewed.METHODS: From 1976 to 1999, 31 patients withurothelial inverted papilloma of the lower urinary tracthave been treated in our service: 17 presented previousand/or synchronous association with urothelial carcinoma (group I) and 14 had primary inverted papilloma(group II). The recurrence and progression rates for eachgroup were determined and compared. The overallrecurrence and progression rates were also determined.Two patients (one from each group) were lost to follow-up.The remaining 29 patients had a mean follow-up of 51.3months (range 3-125).RESULTS: 12 patients (41.4%) showed recurrence inthe form of bladder carcinoma; 10 from group I (10/16;62.3%) and 2 from group II (2/13; 15.4%) (p<0.05). Meantime to recurrence was 17.9 months (range 3-58). Diseasefree interval was higher in group II (p<0.05). Progressionto infiltrating tumor was observed in three patients; allthree had associated superficial bladder carcinoma (groupI). The mean time to progression was 30.7 months (range18-38). No statistically significant differences were foundin the percentage of progression between both groups.CONCLUSIONS: Inverted papilloma of the lowerurinary tract showed a high incidence of association withurothelial carcinoma and a high recurrence rate, even inprimary tumors. Therefore it should be considered a tumorof low grade malignancy that should be followed regularly.
OBJECTIVE: To determine the efficacy of ESWL treatment in children and the need for auxiliary urological procedures. In a retrospective analysis we investigated the number of auxiliary procedures and the stone-free rate in children after ESWL treatment. METHODS: 28 girls and 21 boys with a total of 56 stones were treated from January 1990 to January 1999. ESWL was carried out on either the Lithostar Plus or the Modulith SL20/SLX. Auxiliary procedures were subdivided into curative (ureterorenoscopy, percutaneous nephrolitholapaxy) and adjuvant (urethral stent, nephrostomy). RESULTS: 34.7% of the children were stone-free after the first ESWL treatment; 40.8% of the children were discharged with residual stone particles ready for spontaneous passage; 24.5% underwent re-ESWL treatment. Auxiliary urological procedures were required in 28.6% of the cases (adjuvant 18.3%, curative 10.3%). CONCLUSIONS: Extracorporeal shock wave lithotripsy is also a highly effective method of treatment for urolithiasis in children. However, curative or adjuvant auxiliary urological measures are required. In order to achieve high success rates, it is advisable to perform this method of treatment in centers with broad experience in ESWL and endourological procedures in children.
OBJECTIVE: To analyze the sexual activityof patients before and after surgery for BPH and todetermine the factors influencing sexual activity afterprostatectomy.METHODS: The sexual activity of 189 patients wereevaluated before and 6 months after surgery for BPH.Sociodemographic variables, severity of prostaticsymptoms (IPSS), quality of life (SF-36) and surgeryrelated data were also analyzed.RESULTS: Before surgery, 59% of the patients had sexual activity; 70.9% of patients<chronic pathologies, 45.5% had no sexual activity andcomplained of vascular and CNS problems (50% in bothcases). A higher proportion of patients with IPSS ≥20showed changes in sexual activity (42.3%). The SF-36quality of life scores for General Health (p = 0.0018),Physical Performance (p < 0.01) and Vitality (p = 0.007)were higher in patients who preserved sexual activity.After surgery, 5.6% of previously active patients reportedno sexual activity and 66.2% of those who had no sexualactivity prior to surgery recovered sexual potency.Maintenance or recovery of sexual activity after surgerywas associated with a better quality of life prior to surgery,basically in the SF-36 Health Survey for Vitality (p <0.0001), Social Function (p = 0.006), General Health (p= 0.009) and Mental Summary Index (p = 0.005), animprovement in the IPSS score (p = 0.02) and the absenceof postoperative complications (p = 0.016).CONCLUSION: Sexual activity in patients with BPH ishigher in the younger patients with no associatedpathologies, milder prostatic symptoms and better qualityof life. A high percentage of patients with no sexualactivity prior to surgery reported recovery of sexualpotency after surgery. Sexual activity after surgery isassociated with a better quality of life before surgery,basically in the mental aspects, improvement of prostatesymptoms and the absence of postoperative complications.
OBJECTIVE: To describe a case of right retroiliac ectopic ureter opening into the seminal vesicle, an uncommon congenital malformation. METHODS/RESULTS: This anomaly was diagnosed in a 24-year-old male with recurrent acute right epididymitis based on the clinical, ultrasound and CT findings. Cystoscopy and IVP provided no additional information. Surgical exploration showed right renal agenesis and a retroiliac ectopic ureter opening into a dilated right seminal vesicle. These structures were resected. Patient evolution was satisfactory with no recurrence of the infective episodes. CONCLUSIONS: Diagnosis of this anomaly is based on clinical suspicion and the findings of the diagnostic imaging techniques. Surgical exploration, which is only required in symptomatic patients, will establish the correct diagnosis and treatment.
OBJECTIVE: To report an uncommon associationof prostate and lung cancer.METHODS: The characteristics of both tumors, their associationwith tumors in other sites and the time of presentation are analyzed.RESULTS: Both tumors were in the advanced stages. Metastaticcarcinoma of the prostate was discarded due to the form ofpresentation.CONCLUSIONS: Although the association of prostate and lungcancer is uncommon, the possibility of synchronous tumors shouldbe considered in patients with urinary and pulmonary symptomssuggestive of neoplasm. It is important to determine if the lesion is ametastasis, since the prognosis depends on the second tumor.
OBJECTIVE: To report a case of acute lobar nephronia, an unusual form of localized renal infection, and review the literature with special reference to the clinical features, ultrasound and CT findings that distinguish this condition from other renal masses (abscess, infected cyst and renal carcinoma). METHODS/RESULTS: A female patient presented at the emergency services with symptoms and signs compatible with pyelonephritis. An admission abdominal ultrasound scan demonstrated a solid mass in the left inferior renal pole. CT showed a renal mass with peripheral enhancement after infusion of contrast and central striation. Blood and urine analyses were compatible with renal infection. Acute lobar nephronia was suspected and antibiotic treatment was administered. Control ultrasound and CT examinations performed one month after instituting antibiotic treatment showed the mass had disappeared. CONCLUSIONS: Acute lobar nephronia should be considered in all patients with a renal mass detected during an episode of urinary infection. Correlation of the clinical and radiological findings, and resolution of the mass with appropriate antibiotic therapy will confirm the diagnosis.
OBJECTIVE: To report a case of genital gunshotinjuries and review the literature.METHODS: A case of low velocity multiple gunshot penileinjuries is described. Surgical exploration was performed, gunshotremoved and the albuginea repaired. A broad spectrum antibioticwas administered prophylactically for infection.RESULTS: Good cosmetic and functional results, includingsexual potency and voiding, were achieved.CONCLUSIONS: Surgical exploration is mandatory in genitalgunshot injuries. The best approach to the albuginea is by a crownincision and denudation of the penile skin, which permits surgicalrepair with excellent cosmetic results.
OBJECTIVE: To present a case of giant calculus ofthe bladder.METHODS / RESULTS: Herein we describe a case of a giantcalculus of the bladder in a 72-year-old patient with almost twentyyears’ evolution without urological control and with symptoms ofprostatic disease. Surgery disclosed a giant calculus of 12 x 9 cmweighing approximately 1 kg adhered to the bladder mucosa.CONCLUSIONS: Although the number of cases have dropped inour setting due to the technological advancements and availabilityof health services, giant calculus of the bladder is not an insignificantor rarely diagnosed condition.
OBJECTIVE: To report a case of adrenalmyelolipoma in a female patient with a history of arterial hypertensionand increased plasma aldosterone levels.METHODS: Evaluation by CT and ultrasound, andanatomopathological analysis were performed.RESULTS: The CT and ultrasound scans showed a fat-containingadrenal mass. The patient underwent surgery. Histological analysisof the surgical specimen demonstrated a myelolipoma, a benigntumor composed in varying proportions of adipose and hematopoietictissue.CONCLUSIONS: A diagnosis of adrenal myelolipoma must beconsidered when a fat-containing adrenal mass is demonstrated byultrasound, CT or MRI.
OBJECTIVE: To report two cases of verrucouscarcinoma of the penis, a rare tumor with a characteristic course andspecific treatment that accounts for approximately 1% of tumors inthe male.METHODS: Two patients, aged 86 and 51 years, with verrucouscarcinoma of the penis are described. Treatment was by partialpenectomy and resection of the glans penis, respectively. Theanatomopathological characteristics and prognostic aspects arereviewed.RESULTS/CONCLUSIONS: Verrucous carcinoma of the penisusually presents as an exophytic lesion in the glans penis or prepuceand should be distinguished from epidermoid carcinoma whichcarries a worse prognosis and requires a different therapeuticapproach. The differential diagnosis is based on the biopsy findings.Verrucous carcinoma of the penis carries a good prognosis and canbe managed by conservative surgery (partial penectomy).