OBJECTIVE: To determine the association,if any, between the human spermatic membrane integritytest and normal or altered membrane ABH glycosphingolipidsexpression.METHODS: Semen samples from 50 patients whoconsulted at the infertility services of the Provincial delCentenario and Eva Peron de Granadero Belgorriateaching hospitals in Rosario (Argentina) were collectedand analyzed in accordance with WHO guidelines. Thepercentage of dead sperm was analyzed by the eosin testwhile the percentage of swollen sperm was analyzed by thehypoosmotic test. They were classified according to theirABH expression, either diminished or absent (group 1) ornormal (group 2), by applying the hemagglutinationinhibition and specific antibody consumption technique.For the statistical analysis the two groups were comparedwith both spermatic viability tests using the non parametricMann-Whitney technique for independent samples, sincethe assumptions for the application of the parametric test(test t) were not fulfilled.RESULTS: A significant difference was found in thepercentage of dead sperm (eosin test) of both groups(p<0,001). However, there was no significant differencein the percentage of swollen sperm (hypoosmotic test) ofthe two groups.CONCLUSIONS: Our results and the data published inthe literature indicate a relationship between a reducedABH expression and spermatozoid membrane integrity,especially at the level of the head, which leads us toconsider that ABH glycosphingolipids are mainly locatedin this segment of the human spermatozoon involved in thespermatozoon-ovum interactions.
OBJECTIVE: To analyze the presenting features, diagnosis and management of uncommon cystic lesions located at the midline of the prostate. METHODS: From 1990 to 1999, 8 patients with medial prostatic cyst were treated in our hospital. Vesicorenal ultrasound evaluation was the first procedure that was performed and was diagnostic in most of the cases. Only those patients that underwent surgery required admission to hospital. RESULTS: The most common presenting features were irritative and obstructive voiding syndromes. Treatment achieved cure or clinical improvement. CONCLUSIONS: Vesicorenal ultrasound assessment is the first procedure that should be considered in the diagnosis of this disease. Before ascribing the symptoms to a prostate cyst, other urological conditions with more prognostic relevance should be excluded. Treatment should be instituted only in the symptomatic patients and should be individualized according to the characteristics of each case.
Summary.- OBJECTIVE: To evaluate the cystoscopic findings during initial follow-up, the anatomopathological correlation of tumor endoscopic features and the results of standard control multiple biopsy performed 6 months after TUR in patients with G3T1 transitional carcinoma treated with BCG. METHODS: 114 patients with G3T1 bladder tumor (52% asssociated with Cis) were treated with 81 mg Connaught BCG intravesical instillations weekly for 6 consecutive weeks. Follow-up was performed with cystoscopy and cytology at 3 months, and cystoscopy and standard multiple biopsy at 6 months. The endoscopic findings were described as normal bladder, macroscopically tumorous lesion or erythematous lesion. RESULTS: During the first 6 months of follow-up superficial recurrence was found in 16% and 5% showed progression to muscle invasion. Tumor recurrence or progression was found in 61% and 39% at 3 and 6 months, respectively. Most of the macroscopically tumorous lesions resulted in a tumor at 3 and 6 months in 56% and 64%, respectively, and the remaining lesions were mainly inflammatory granulomas produced by BCG therapy. Twenty biopsies of erythematous areas detected only one case of Cis (5%) and 98 standard multiple biopsies of endoscopically normal mucosa detected 10 cases of Cis (overall, 3 at 3 months and 7 at 6 months); all cases were preceded by initial Cis except in one case. CONCLUSIONS: Cystoscopy performed at 3 months is very useful since it detected 61% of the superficial recurrences and 66% of the cases with progression to muscle invasion during the first 6 months. Routine biopsy of erythematous areas detected during cystoscopy is of little value since a large number of these biopsies are unnecessary in view of its diagnostic yield (5%). Since 90% of the Cis detected during the first 6 months of follow-up were patients with Cis in the initial tumor, it would be appropriate to perform standard multiple biopsy for control only in this subgroup of patients if the sensitivity of cytology is low in high grade tumors or Cis.
OBJECTIVE: To analyze the diagnosticmethods utilized in prostate cancer and the preoperativeinformation on the extent of the tumor, and compare theseresults with those obtained from anatomopathologicalanalyses of the radical prostatectomy specimen.METHODS: Data on the radical prostatectomiesperformed during the study period were obtained from theAdmissions and Clinical Records services and wereanalyzed using the SPSS statistical analysis software forWindows.RESULTS: From 1991 to 1998, 109 radicalprostatectomies were performed. Evaluation by transrectalUS was carried out in 89 patients (81.6%) and detected atumor (unilateral or bilateral) in 77, for a sensitivity of86% (CI 78.8-93.2). A CT study was performed in 94patients and was positive in 25, for a sensitivity of 26.5%(CI 17.6-35.4). The sensitivity for transrectal US and CTwere 4.17% and 3.33% for capsular involvement, 5.88%and 5.26% for seminal vesicle involvement, and 0% and0% for node involvement, respectively.CONCLUSIONS: Transrectal ultrasound is a reliablediagnostic imaging method, although it has a low sensitivitywhen used to determine the extent of the tumor. In ourseries, the radiological methods showed a low sensitivitywhen they were utilized to determine the extent of theprostate cancer. Routine preoperative assessment by CTcan be obviated in prostate cancer.
OBJECTIVE: To analyze the prevalenceand risk factors for erectile dysfunction in Bierzo (León,Spain).METHODS: A study was conducted based on a selfadministeredsurvey in males aged 19 to 90 years thatconsulted at the urology and family medicine services of10 health centers in Bierzo (León, Spain). To determinethe existence or absence of erectile dysfunction, the malesexual health questionnaire (SHIM) was included, andthose with a score of 21 or less were considered to havesome degree of erectile dysfunction. Distribution of thequestionnaire began in September 1999 and ended in May2000. Submission of the questionnaires concluded on May31, 2000. Of 935 questionnaires that were received, 830were valid.RESULTS: The overall prevalence of erectiledysfunction in this study was 63.9%, which increased withage and was markedly higher after age 50 years (38.6%for age 41-50 years and 72.6% for age 51-60 years). Theage-adjusted analysis showed the risk factors for erectiledysfunction were depression and arterial hypertension ontreatment with drugs. Diabetes mellitus on treatment with oral glucose lowering agents or insulin, heart disease andhypercholesterolemia were also associated with the moresevere forms.CONCLUSIONS: The prevalence of erectile dysfunctionin patients consulting at the primary care and generalurological services in Bierzo (León, Spain) wasoutstandingly high. The present study showed erectiledysfunction to be an age-dependent disease that causedconcern in slightly more than half of the patients with thiscondition. Apart from age, depression and vascular diseasewere found to be risk factors.
OBJECTIVE: Our experience in themanagement of priapism, its etiology, blood gas changes,treatment and outcome are presented.METHODS: The records of patients that had beentreated at the Urology services of our hospital over the last8 years were reviewed. During this period, patients witherectile dysfunction were treated according to a protocol.RESULTS: There were 9 episodes of priapism in 8patients; all cases were low flow and the patients wereaged 37-71 years. The duration of the prolonged erectionranged from 4 to 72 hours. Of these 9 cases, the etiologywas intracavernosal PGE in 7, after trazodoneadministration in one case, and unknown in one case.Intracavernosal metoxamine was administered in all caseswith excellent results, except one case that required asaphenous-cavernosal shunt and another case that wasinitially treated with adrenalin also with good results.CONCLUSIONS: Since intracavernosal agents havebeen utilized in the treatment of erectile dysfunction,priapism has become a more frequent urologicalemergency. Although a lower incidence has been reportedfor PGE, the dose should be well adjusted to avoid a higherincidence.
OBJECTIVE: To evaluate the results of the vaginal wall sling procedure in the treatment of stress incontinence.METHODS: A retrospective study was conducted to evaluate the clinical outcome of the vaginal wall sling procedure in the treatment of genuine stress incontinence.The study comprised 27 women with a mean follow-up of 15 months postoperatively.RESULTS: Of the 27 patients who underwent this surgical procedure, 12 44% are continent and 9 33% have improved, accounting for 77% overall cure andimprovement rate. Six patients 22% remained incontinent.Mean operating time was 90 minutes and mean length of hospital stay was 8 days.CONCLUSION: In our experience, the vaginal wall sling procedure for genuine stress incontinence did not achieve the good results obtained in other series.
OBJECTIVE: To describe a case of mucinous adenocarcinoma of the prostate. METHODS: A 77-year-old patient presented with urinary complaints. Patient evaluation showed an enlarged prostate and increased PSA levels. RESULTS: A prostate biopsy showed a glandular neoplasm with extensive mucinous differentiation and abundant lacunae of PAS positive mucus (mucinous adenocarcinoma). The patient remains well one year after the diagnosis. CONCLUSIONS: Mucinous adenocarcinoma of the prostate is a rare variant that should be recognized and does not necessarily imply a worse prognosis than other carcinomas of the prostate.
OBJECTIVE: To describe a case of adenocarcinomaof the urinary bladder.METHODS: A 63-year-old patient consulted for gross hematuria.Ultrasound evaluation showed a bladder neoplasm and CTdemonstrated extensive infiltration of adjacent structures.RESULTS: Histological analysis of the TUR specimen confirmeda muscle infiltrating glandular neoplasm (adenocarcinoma) withdiffuse areas of cystitis glandularis. Patient evolution has been poorand he is now in the end stage of the disease.CONCLUSIONS: The morphology is not unlike that of colorectalcarcinoma, which should be distinguished. The association of areasof cystitis glandularis indicates a possible relationship.
OBJECTIVE: To describe a case of mucinous adenocarcinoma of the prostate, an uncommon variant of prostatic carcinoma of which few cases have been reported in the literature. This tumor type is briefly reviewed with special reference to the controversial issues that remain unresolved due to the small number of cases. METHODS/RESULTS: A case of mucinous adenocarcinoma of the prostate is presented. An extraprostatic origin had been discarded. The diagnosis was made by DRE, transrectal US and histological confirmation by transrectal biopsy. PSA values were normal. Studies to determine the extent of the lesion showed advanced locoregional dissemination. Surgery was therefore not indicated and hormonal therapy was administered. Patient outcome was poor with no apparent clinical response to hormone blockade. Radiotherapy was attempted. The patient rapidly became worse and died. CONCLUSIONS: Mucinous adenocarcinoma of the prostate is characterized by the presence of significant amounts of extra and intracellular mucin. Its clinical features are not unlike those of classical adenocarcinoma and in general terms, it is considered to carry a worse prognosis and refractory to hormone therapy.
OBJECTIVE: To present an additional case of orthotopic ureterocele in a patient that consulted for hematuria and outlet obstruction, with special reference to the utility of non- invasive color doppler ultrasound in the diagnosis of this condition. METHODS/RESULTS: This condition was suspected on detecting a ureteral jet inside a cystic lesion of the bladder. The diagnosis was confirmed by IVP and cystoscopy. Treatment was by transurethral resection with good functional results. CONCLUSION: Color doppler ultrasound is useful for the diag- nosis of ureteroceles, particularly in patients in whom contrast or ionizing radiation must be avoided.
OBJECTIVE: To report a case of xantho-granulomatous cystitis, a rare disease especially in the western countries (12 of the 16 cases reported were Japanese and Korean). METHODS: A case of xanthogranulomatous cystitis in a 34-year-old female is presented. Patient evaluation included histological, histochemical and immunohistochemical studies. RESULTS/CONCLUSIONS: The lesion was localized to the bladder dome, anatomically related with the urachus. It consisted of collections of histiocytes with lymphoplasmocytic infiltrate. The adhesions observed in the omentum in this case indicate a possible relationship with a previous inflammatory process. Surgery is advocated in most of the cases with good results.
OBJECTIVE: A case of adult mesoblastic nephromais presented. The clinical features, treatment, histological diagnosisand outcome are discussed.METHODS/RESULTS: A 68-year-old patient in whom a renalmass had been detected by ultrasound is described. The patientunderwent radical nephrectomy. The anatomopathological analysisdemonstrated a mesoblastic nephroma. No signs of recurrence havebeen observed at 3 years' follow-up.CONCLUSIONS: Mesoblastic nephroma of adulthood has abenign behavior and recurrence is rare after surgery.
OBJECTIVE: To report a case of malepseudohermaphroditism.METHODS: A 45 day-old infant was referred for ambiguity ofexternal genitalia. The anatomy of the external and internal genitaliaand chromosomal and gonadal sex were analyzed.RESULTS/CONCLUSIONS: Female sex was assigned andlabioscrotal reduction and orchidectomy were performed at age 6months with good adaptation to gender role
OBJECTIVES: Calcium oxalate kidneystones are more common in patients with Crohn's disease(CD). The aims of this study were to verify the prevalenceof the main risk factors for calcium oxalate nephrolithiasisin patients with CD and to evaluate the degree of urinaryrelative supersaturation for calcium oxalate (CaOx),dihydrogen uric acid (DHUA) and monohydrogen calciumphosphate (MHCaP).SUBJECTS AND STUDY PROTOCOL: 42 patientswith CD (22 male and 20 female, aged 15-72 years) and18 controls (8 male and 10 female, aged 26-65) werestudied. Nine patients were evaluated during an activeepisode and 33 in a quiescent phase. All patients hadnormal glomerular filtration rate. All subjects collected a24-hr urine sample and fasting venous blood was drawn.Good compliance of urine collection was assessed by theCockcroft and Gault formula. In urine pH and oxalate(Ox), calcium (Ca), phosphate (P), uric acid (UA), citrate(Cit), magnesium (Mg), sulphate (Sulph), sodium,potassium and chloride concentrations were measuredand their excretions calculated. Urinary RS index wasobtained using the software EQUIL93.RESULTS: A decreased urinary volume (61.9%) wasthe most frequent finding. A decreased excretion of Cit, Mg and Sulph (38.1%, 31.0% and 31.0%, respectively)and increased excretion of P, Ox, UA and Ca (33.3%,23.8%, 16.7% and 14.3%, respectively) were found. Thirtyfour patients (81.0%) showed at least 2 lithogenic riskfactors and only 2 patients showed none. Urine of patientshad a higher urinary CaOx and DHUA relative supersaturation. Patients studied in an active episode showed ahigher urinary CaOx and MHCaP RS than those studiedin the quiescent period.CONCLUSIONS: The majority of patients with CDhave a multifactorial high risk for calcium oxalate and asingle patient usually has several metabolic disturbanceswhich are more evident in an active episode.