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OBJECTIVE: Cytosolic cathepsin D is arecognized predictor in breast cancer. This study wasconducted to determine its behaviour in benign prostatichyperplasia (BPH) and prostate cancer. The changesaccording to prostate volume, its relation with otherserum markers (PSA, PAP, etc.) in regard to tumor grade,stage and survival were analyzed.METHODS: The study was carried out on 376 patientswith prostatic disease that had been diagnosed from 1991-1996. Determination of cytosolic cathepsin D levels wasperformed on all samples of prostate tissue according tothe CIS BioInternational Immunoradiometric study.RESULTS: Cathepsin D values ranged from 0.2 to 86.5pmol/mg (mean 14.9) in patients with BPH and highervalues were found for prostates with a larger volume (p =0.004). A significant difference was found between patientswith and those without a bladder catheter (p = 0.024);values were higher in the former group of patients.Cathepsin D values ranged from 0.5 to 74 pmol/mg (mean18.13) in patients with prostate cancer. A statisticallysignificant difference was found between the mean values of patients with prostate cancer and those with BPH(p=0.047). In patients with prostate cancer, a significantdifference was also found between patients with and thosewithout a catheter (p = 0.04). No relationship was foundbetween cathepsin D and the other parameters analyzed.CONCLUSIONS: As in most of the literature reviewed,cytosolic cathepsin D was not found to be a predictor inprostate cancer. Furthermore, no correlation was foundbetween cathepsin D and the other markers analyzed. Theforegoing may be due to the small number of tumorsamples and short follow-up.
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OBJECTIVE: To analyze the care process and treatment outcomes from the perspective of patients undergoing prostatectomy. METHODS: A qualitative study based on depth interviews was performed in 12 of 14 patients who had undergone prostatectomy for localized prostate cancer at a regional hospital. An intentional survey was carried out. Patients were informed about the survey through a letter and by telephone and were asked to decide where they wished the interview to be held. All patients were interviewed by one of the authors who was unrelated with the hospital. The interviews were recorded and transcribed with the patients' consent and the assurance of confidentiality. We performed qualitative analysis of the transcriptions, interviewer's notes and patient hospital discharge reports, and validation through discussion of the results after deleting all identity-related data. RESULTS: Transmission of the care process experiences transcends the presumable adequacy to the conventional phases of diagnosis, treatment and outcome. Patient assessment varied according to the functional results achieved, previous symptoms, patient expectations and interpretation of the information provided. Due to this variability, the urologist's approach should be individualized to each patient from the outset, before the definitive diagnosis is made, and should continue long after surgery. In this regard, substantial shortcomings in urologist-patient communication were found. CONCLUSIONS: The approach to the perspectives of patients with localized prostate cancer is a necessary component that has not been sufficiently developed by the urologist during the clinical management of this disease or its subsequent assessment. Apart from the changes in attitude that the foregoing may entail, it is advisable to incorporate quantitative and qualitative measures that support patient assessment of quality of life and its variability, into the daily practice of all the health professionals involved.
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OBJECTIVE: To review the resultsachieved with the Mainz II detubularizedureterosigmoidostomy for urinary diversion in patientsundergoing bladder resection.METHODS: This study was conducted on 12 prospectivepatients undergoing radical cystectomy for urothelialcarcinoma after 1996. All patients met the followingselection criteria: no changes in upper urinary tractfunctions, normal rectosigmoid, no previous radiation tothe area and good anal continence.RESULTS: All patients had a diagnosis of infiltratingurothelial carcinoma of the bladder. Four of these patientsdied from tumor progression. Renal function is preserved at 31.7 months' mean follow-up, although 3 patientsdeveloped moderate metabolic acidosis despite theprophylactic alkalization therapy instituted after surgery.One patient presented recurrent pyelonephritis andstricture of the ureterointestinal anastomosis that requiredsurgical correction. Colonoscopy was unremarkable inall but one patient who showed adenomatous polyp of thecolon, which was removed endoscopically, and no otherlocal changes. Continence was complete from the time theurinary catheters were removed. Voiding occurred every2.9 hours during the day and 2.2 times during the night.CONCLUSIONS: The Mainz II modifiedureterosigmoidostomy clearly reduces the upper urinarytract complications because accomodation of the reservoiris better and the pressure inside the pouch is reduced. Thistechnique of urinary diversion is well-accepted by thepatients because voiding can be achieved comfortably, astoma is not required and body image is preserved. Thedegree of patient satisfaction was high in all cases
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OBJECTIVE: To determine the relation ofthe classical prognostic factors (tumor stage, grade, sizeand location) to the recurrence rate, disease free intervaland overall survival in patients with superficial bladdercancer.METHODS: The study was carried out on 144 patientswith superficial transitional cell carcinoma of the bladder(pTa, pT1) over a period of three years. Age, sex, historyof exposure to aniline, smoking, histological type, tumor grade, size, stage, localization (single vs multiple) andtype of complementary treatment were analyzed. Tumorswere staged according to the TNM classification (1997version) and cell grade was determined according to theBroders classification.RESULTS: Mean age was 70 years ± 12.55 (range 22-100); 124 (86%) were males and 20 (14%) were females.All tumors were superficial transitional cell carcinoma;93% were papillary and the remaining 7% were solidtumors. There were 52 recurrences (36%); of these, only13 (25%) showed tumor progression: 4 became infiltrating(31%), one (8%) advanced in superficial tumor stage and8 (61%) advanced in grade. Mean follow-up was 31months (range 3-61). Overall and disease free survival at5 years were 88.42% and 45%, respectively. No differenceswere found for disease free survival according to thedifferent prognostic factors analyzed. Tumor gradecorrelated with stage and size. Thus, grade III tumors arelikely to be stage pT1 and greater than 3 cm. in size.CONCLUSIONS: The histological grade is the mostimportant prognostic factor in bladder cancer progression.However, while grade I and III tumors show a rathersimilar behavior, the moderately differentiated tumorscomprise a heterogeneous group with a very disparatebehavior. Tumor grade was found to correlate with stageand size.
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OBJECTIVE: To analyze the urodynamicbehavior of the intestinal neobladders in our series.METHODS: The study comprised 20 patients with adetubularized intestinal neobladder. The ileal segmentwas utilized in 15 (13 Melchior, 1 Camey and 1 Padovana), the ileocecal segment in 4 (3 Mainz, 1 Le Bag) anddetubularized sigmoid in one patient. A urodynamic studywas performed in all patients to determine neobladdercapacity, presence of peristaltic waves, filling and voidingpressures, peak and mean urinary flow and postvoidresidual urine. The patients were also asked aboutcontinence, if a collecting device was required and theoverall degree of satisfaction.RESULTS: Mean neobladder capacity was 508 ml.,mean reservoir accomodation was 38 ml/cm H20 and66.7% presented significant peristaltic contractions.Maximum filling pressure was 27 cm H20. All patientsshowed peaks in the flowmetry due to the abdominalpressure, with a mean maximum peak flow of 16.6 ml/sec.Mean postvoid residual urine was 43.6 ml. Eighty percentof the patients were continent during the day, 55% werecontinent during the night and 25% were completelycontinent. All patients used abdominal pressure for voidingand generally in the sitting position. The overall degree ofsatisfaction was moderate to high in all but two patients;one required self catheterization and the other had frequentinterruptions during work due to leaks during the day, butrefused to use a collecting device.CONCLUSIONS: If renal function is preserved and thecriteria for radical oncologic treatment are observed,substitution of the compromised bladder should beattempted with a reservoir as physiological as possible.The ideal continent urinary diversion must meet thefollowing prerequisites: adequate capacity, low pressureinside the reservoir, absence of pressure waves, continenceand absence of postvoid residual urine. The mean capacityof the intestinal neobladders in this study, as well as themaximum pressure inside the reservoirs were found to beadequate. However, many patients presented peristalticcontractions with urinary leaks in some cases, and thepercentage of patients with residual urine also appears tobe high. Most of these patients do not require the use ofpads during the day, while almost all of the patientsrequire some type of collecting device at night forincontinence. Nevertheless, the patients in this series weregenerally satisfied with their neobladder.
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OBJECTIVE: To review our experience inhypospadias surgery in order to determine the mostappropriate technique for each particular case.METHODS: 109 uretroplasty procedures forhypospadias repair in 102 patients that were performed bythe same surgeon from 1992-1998 were analyzed. Eightyfivepatients were treated for the first time and 17 hadpreviously undergone surgery. The patients were childrenaged 2 - 12 years and 4 adults. There were 28 balanic, 45subcoronal, 10 distal penile, 12 mid penile and 7penoscrotal hypospadias. Twenty-two cases had anassociated ventral penile curvature.The Magpi technique was utilized for the balanichypospadias, the Mathieu for the subcoronal and distalpenile hypospadias without curvature, the Ducketttechnique was utilized for the middle penile third andsome penoscrotal hypospadias, and the two-stageprocedure with extragenital free skin graft in some of thecases with penoscrotal hypospadias.RESULTS: The overall complcation rate was 6.4%.Good results were achieved in all patients treated with theMagpi technique. Two patients treated with the Mathieutechnique developed fistula that was corrected in a secondprocedure, and one patient developed a stricture at 6years, which required another reconstruction procedure.Three patients treated with the Duckett technique developedfistula that required another repair procedure. There wasone case of stricture along the entire length of the graft inthe patients treated with the two-stage procedure andextragenital free skin graft, and satisfactory results wereachieved in the remaining patients.CONCLUSIONS: As in any other urethroplastyprocedure, hypospadias repair requires a correct choiceof technique for each particular case. Success depends ongood tissue vascularization, which a surgeon withexperience in these techniques can achieve better than onethat is less experienced. It is therefore advisable not tooverdiversify.
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OBJECTIVE: To evaluate the efficacy of percutaneous nephropexy in symptomatic renal ptosis. METHODS: From August 1997 to September 1999, 6 women aged 28 - 49 years (mean 34.3) with symptomatic renal ptosis underwent percutaneous nephropexy. All patients were evaluated preoperatively by IVP and diuretic renogram in the standing and lying positions. Patient follow-up ranged from 14 - 34 months (mean 21). RESULTS: Mean operating time was 30 minutes and mean length of hospital stay was 24 hours. Treatment was successful in 5 patients; lumbar pain disappeared and the kidney was fixed in a higher position. CONCLUSIONS: Percutaneous nephropexy can be an alternative to conventional and laparoscopic nephropexy.
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OBJECTIVE: To analyze the utility ofchemolysis and the double-J ureteral catheter in patientswith uric acid calculi.METHODS: The study comprised 30 patients (28 menand 2 women) treated with chemolysis for uric acid calculiand who consulted for renal colic. The indication forplacement of a double-J ureteral stent were pain, moderateto-severe hydronephrosis, fever and urinary tract infection.The calculi were ≤ 10mm in size and were located in therenal pelvis (3), upper ureter (5), middle ureter (2) andlower ureter (23).RESULTS: The uric acid calculi were dissolved withintravenous and oral combination chemolysis. The double-J catheter was useful in the cases with urinary tractobstruction, fever or urinary tract infection.CONCLUSIONS: Medical treatment is useful in themanagement of uric acid calculi. The double-J catheter isbeneficial in patients with urinary tract obstruction.
Case Report
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OBJECTIVE: To describe an additional case of simple syringocele of Cowper's glands and review the literature. METHODS: An additional case of simple syringocele of Cowper's glands is presented and the literature over the last 10 years is reviewed. RESULTS/CONCLUSIONS: The treatment most commonly utilized is marsupialization to the urethra by endoscopy. The foregoing was performed in our patient with satisfactory results.
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OBJECTIVE: To report a case of low grade papillarytransitional cell carcinoma of the left renal pelvis in a young, heavysmoker of marihuana who denied cocaine use, alcohol intake andother habits.METHODS / RESULTS: Intravenous pyelogram demonstrated afilling defect in the left renal pelvis and calyces. Biopsy revealed aurothelial carcinoma. The pathological analysis demonstrated diffuselow-grade non-invasive (Ta) papillary transitional cell carcinomaof the renal pelvis and calyces. Nephroureterectomy was performed.CONCLUSIONS: This case indicates a cause-effect relationshipbetween heavy and long-term marihuana smoking and transitionalcell cancer. However, further cases from the literature or observationsin larger populations are warranted.
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OBJECTIVE: To report two additional cases ofSchönlein-Henoch purpura that developed acute scrotum.METHODS: Two patients with Schönlein-Henoch purpura thatdeveloped acute scrotum in the course of the disease are presented.The literature is briefly reviewed and discussed.RESULTS / CONCLUSIONS: Schönlein-Henoch purpura is asystemic vasculitis with involvement of the genital area in 15% of thecases and must be distinguished from testicular torsion. The clinicalfeatures, the findings at physical examination and scrotal ultrasoundevaluation should suffice to make the correct diagnosis and avoidsurgery. However, if the findings are inconclusive, techniques usingisotopes and/or echo-Doppler can be utilized. If these are notavailable, exploratory scrototomy should not be delayed. Excellentresponse is achieved with steroid therapy.
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OBJECTIVE: To describe an additional case of retroperitoneal schwannoma.METHODS: A case of retroperitoneal neoplasm in a 29-year-old woman is presented. The clinical and therapeutic aspects are discussed.RESULTS: The anatomopathological study showed a benign schwannoma.CONCLUSIONS: Retroperitoneal schwannoma is an uncommon lesion that is difficult to diagnose preoperatively. Treatment is by surgical resection.
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OBJECTIVE: To describe two cases of adrenal pseudocyst that presented as acute abdomen and shock.METHODS: Two cases of adrenal pseudocyst are presented: one patient was a 69-year-old woman who presented with shock and pain in the left hypochondrium and the other was a 23-year-old woman who complained of dizziness and pain in the left hypochondrium.RESULTS: US and CT evaluation showed a heterogeneous cystic mass. Blood analysis showed low hematocrit and hemoglobin levels. Surgical resection of the retroperitoneal cystic mass was performed. The pathological analysis disclosed an adrenal pseudocyst.CONCLUSIONS: Adrenal pseudocyst is an uncommon lesion that infrequently causes symptoms and rarely presents as acute abdomen. Ultrasound and CT are the most useful diagnostic imaging methods. Treatment is by surgery if the lesion is large and symptomatic, if it cannot be clearly distinguished from a tumor, and if massive hemorrhage occurs.
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OBJECTIVE: A case of idiopathic retroperitonealfibrosis in a 34-year-old man with anemia and elevated erythrocytesedimentation rate is presented.METHODS/RESULTS: Ultrasound, CT and MRI evaluation andpathological study were performed. These diagnostic imagingtechniques demonstrated an infiltrating mass in the upper portion ofthe abdomen which was resected. Histological and immunohistochemical studies of the surgical specimen demonstratedsclerosing retroperitonitis.CONCLUSIONS: Idiopathic retroperitoneal fibrosis (Ormond’sdisease) is a rare disease entity whose etiology is obscure and ischaracterized by retroperitoneal fibrosis with inflammatory infiltratescomposed of plasma cells, lymphocytes and eosinophils. This case isof interest due to its atypical location, and because the patient wasyoung with no remarkable clinical history and only mild anemia andan elevated erythrocyte sedimentation rate.
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OBJECTIVE: To report a rare case of renoureteralcolic in a patient with a solitary left kidney, due to fibrosis around therenal pelvis and ureter from metastatic lobular carcinoma of thebreast.METHODS / RESULTS: A 45-year-old patient consulted at theemergency services for pain in the left renal fossa that irradiated tothe genital organs. Patient evaluation showed lid edema and oliguria.An abdominal ultrasound scan demonstrated left hydronephrosis.The cause of the obstruction could not be determined by imagingtechniques. Exploratory lumbotomy was performed and the pelvisand ureter were released from the fibrotic covering. The histologicalanalysis showed infiltration of the ureteral adventitia arising fromlobular breast carcinoma. CONCLUSIONS: Retroperitoneal metastases that cause ureteralobstruction usually occur two years following diagnosis of theprimary tumor. This is one of the few cases of ureteral obstructionfrom metastatic lobular carcinoma of the breast reported in theliterature. Unlike the other cases, however, our patient showed acomplicated genitourinary malformation.
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OBJECTIVES: Benign enlargement of theprostate comprises both hypertrophy and in particularhyperplasia of prostatic stromal and glandularcompartments. Alpha adrenergic blockade has been shownto be effective in the management of BPH. Recentinvestigations have shown that this effect may in part bedue to apoptosis.METHODS: A total of 29 patients who were symptomaticdue to BPH were enrolled into this prospective placebocontrolled, double-blind randomized study and underwentprostatectomy at the end of the 4th week. Clinical efficacywas evaluated by a set of detailed investigations. Surgicalspecimens were analyzed by immunohistochemistry andtissue components of stroma, smooth muscle and glandular epithelium were calculated by a software on a computerafter representative areas were scanned and captured ashigh resolution images. Apoptosis in each tissue specimenwas analyzed by Terminal Deoxynucleotidyl TransferaseEnd Labelling (TUNEL) method utilizing Biotin-16-dUTP.RESULTS: Both groups were similar in terms of baselineevaluation in all aspects. There was a steady decline inpatients’ urinary complaints as evidenced by International Prostate Symptom Score System (IPSS) in the doxazosingroup compared to placebo. Uroflowmetric investigationson patients revealed that maximum flow rates in the activedrug group increased throughout the study. Mean PSAlevels decreased by 14% at the end of the study in thedoxazosin group, while it increased by 11% in the placebogroup. Average stroma to epithelial ratio in the doxazosingroup was 2:1 in comparison to a value of 1:1 in theplacebo group. The rate of apoptosis was 2.2% and 3.2%for the epithelial and stromal compartments, respectively,in the doxazosin group, and 1.2% and 2.7% for theplacebo arm.CONCLUSIONS: These data suggest apoptosis as thepossible underlying molecular mechanism partlyresponsible for the clinical efficacy and morphologicalchanges induced by doxazosin treatment in BPH.[This project is funded by a grant (DAZ-NY-94-013)from Pfizer International Inc.]
