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OBJECTIVE: To briefly describe the lifeand works of D.F.J.B. Trehet, a physician of the city ofRouen (France), who was the first to describe the "osseouspoints" in a renal calculus. Trèhet has not been recognizedor referenced for this original observation in theurological publications.METHODS: Trehet lived in the period of theEnlightenment and endured the upheavals of the FrenchRevolution. Data gleaned from several sources havepermitted and elaborate description of this Frenchphysician from both the social and professionalperspectives.RESULTS: After completing his studies at the HôtelDieu in Rouen, D.F.J.B. Trehet pursued his education atthe School of Health in Paris. He read his doctorate'sthesis at the Paris School of Medicine in 1803 andpublished his observation of a renal calculus "with osseouspoints" in 1812. Other studies by D.F.J.B. Trehet werealso published in Le Journal de Médecine, Chirurgie etPharmacie.CONCLUSIONS: D.F.J.B. Trehet should be recognizedas the first to describe an osseous renal calculus
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OBJECTIVE: To analyze the incidence of high grade prosatic intraepithelial neoplasia (PIN) in the transrectal prostate biopsies of patients from the Urology department. METHODS: From 1995 to 1999, 2018 patients aged 46-92 years (mean 68 ± 10) had a transrectal biopsy. Thirty-six percent had a suspicious DRE and the mean serum PSA was 31.7 ± 152.9 ng/ml. The anatomo- pathological diagnoses were: a) cancer, b) benign pathology, c) high grade PIN and d) glandular atypia. Statistical analysis using the chi square and Mann-Whitney tests was performed to compare the following variables: age, DRE, PSA, PSAf/PSAt ratio and the finding of a suspicious node on ultrasound. RESULTS: The incidence of high grade PIN in this series was 8% and the incidence of prostate cancer was 38.6%, PIN grade 3 was diagnosed in 94 patients and PIN grade 2 in 67, and was associated with glandular atypia in 13 patients. Patients with prostate cancer were older and showed statistically significant higher PSA, percentage of suspicious DRE, sonographically suspicious nodes, and a lower PSAf/PSAt ratio than the other diagnoses (p<0.001). Comparison of patients with high grade PIN and those with benign pathology showed no differences for age, DRE, PSA levels and PSAf/PSAt ratio. However, a significantly lower incidence of sonographically suspicious nodes was found (p< 0.001). CONCLUSIONS: The incidence of high grade PIN was 8%. High grade PIN does not cause sufficient changes in the clinical variables analyzed to suspect this lesion before it is confirmed by the pathological findings.
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OBJECTIVES: For many years we haveused both ileal or colon conduits for urinary diversionduring pelvic exenteration. Continent urinary reservoirshave replaced ileal and colon conduits as a method ofurinary diversion at our institution. The aim of this studywas to review the results and complications associatedwith continent urinary diversion in patients withgynecologic malignancies.METHODS: We reviewed the records of 26 patientswho underwent construction of a continent urinaryreservoir (Miami pouch) from February 1991 to June1994 at the Department of Gynecologic Oncology of theNational Cancer Institute of Mexico (Instituto Nacionalde Cancerología). Twenty-four of these patients hadreceived radiotherapy for gynecologic malignancies.RESULTS: An ileocolonic continent urinary reservoir(Miami pouch) was created in 26 patients, aged 38-81years, as part of a concurrent anterior or total pelvicexenteration for primary or recurrent gynecologicmalignancies (19 pts.), for the relief of a vesicovaginal fistula (3 pts.), hemorrhagic cystitis (2 pts.), or insubstitution of an ileal conduit (2 pts.), with follow-upranging from 2-54 months. Additional proceduresperformed concurrently with the Miami pouch and pelvicexenteration included low rectal anastomosis (11 pts.),pelvic floor reconstruction (8 pts.), and vaginalreconstruction (4 pts.). The complications associated withthe reservoir included incontinence (1 pt.), ureteralstrictures (3 pts.), pouch leakage (1 pt.), difficult selfcatheterization(4 pts.), and urosepsis and pyelonephritis(6 pts.). One patient developed pouch stones. In this series,95.6% of the patients were completely continent. Noobstruction or reflux was noted in 92.3% of the cases.Nonsurgical management strategies used for reservoirrelatedcomplications included percutaneous nephrostomy,intravenous antibiotics, and percutaneous pouchdecompression. Reoperation was required in 5 patients:one patient (early) due to a fistula, another patient requiredreimplantation due to obstruction, one patient with anonfunctioning kidney underwent nephrectomy, and twopatients with stoma stenosis.CONCLUSIONS: The Miami pouch is a low-pressurecontinent form of urinary diversion. The continencemechanism is easy to construct and the procedure cansuccessfully be accomplished at the time of pelvicexenteration in patients with gynecologic malignancies.The rate of major complications of the Miami pouch issmall and the continent urinary diversion can be undertakenwith concurrent low rectal anastomosis or vaginalreconstruction.
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OBJECTIVE: To review our experience with cadaveric kidney transplantation with ex situ reconstruction of damaged renal artery. METHODS: To obtain a minimum follow-up of 5 years, 20 cases treated from January 1989 to December 1994 were retrospectively reviewed. The control group comprised 73 patients that had received an "ideal" graft during the same period. Both groups were similar for all the variables that could influence graft outcome. RESULTS: Both groups showed similar results for incidence of NTA, rejection episodes, creatinine values, surgical complications or reoperations. However, a strong trend (25% of the cases) to develop renal artery stenosis was found (p= 0.052). These latter cases were diagnosed by the onset of arterial hypertension that was difficult to control and were treated conservatively by percutaneous angioplasty with good functional results in 100% of the cases, although 80% required more than one session. This complication, however, did not lead to graft failure. CONCLUSIONS: Renal grafts with arteries damaged during procurement or as a result of pathological changes, such as arteriorclerosis or aneurysm, are useful after bench reconstruction before transplantation. However, the greater trend to develop symptomatic arterial stenosis that has been observed makes it convenient to look for this complication routinely during follow-up. If diagnosed and treated early, it does not influence the graft outcome. The therapeutic approach is first by percutaneous transluminal angioplasty and if it fails, then by open surgery.
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OBJECTIVE: To analyze the utility oflaparoscopic evaluation in the diagnosis of the nonpalpabletestis versus conventional imaging techniques based onour experience with 51 cases and data reported in theliterature.METHODS/RESULTS: Testicular tumors were foundin both intra-abdominal testes in one patient, as well as 7cases of evanescent testis and 39 testicular rests in theinguinal canal. Four other intra-abdominal testes showedno changes.CONCLUSIONS: The possibility of an existing intraabdominaltestis and its possible progression to malignancywarrant exploration of the nonpalpable testis bylaparoscopy, a very simple and effective procedure.
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OBJECTIVES: Laparoscopic surgery hasnot been extended enough among the urologists due to theinaccessibility of the retroperitoneal organs andconsequently to the steep learning curve that is required.In this article we describe our experience in laparoscopicsurgery assisted by the surgeon’s hand introduced in theoperating field. This is a technique that we have beenusing since 1994 and that has not been generally accepteduntil very recently.METHODS: Difficult nephrectomies andnephroureterectomies are considered to be the mainindications for this technique. The approach to eachkidney is described.RESULTS: The operating time is dramatically reduced.The surgeon’s hand introduced intra-abdominally allowsfor a better control in difficult situations. The economiccost is lower. The use of analgesics and the recovery timein the postoperative period is similar to that of conventionallaparoscopy.CONCLUSIONS: The optimal indication for thisprocedure are cases that require a very large and mutilatingincision. The learning curve is significantly easier and itis an invaluable technique in cases considered until nowto be unsuitable for an endoscopic procedure.
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OBJECTIVE: To compare the subjectiveand objective penile rigidity in the same group of patientswith erectile dysfunction after intracavernous injection ofdifferent vasoactive drugs.METHODS: 91 impotent males were randomly assignedto three groups of intracavernous injection: A: 20μg PGE1, B: 30 mg papaverine hydrochloride + 1 mg phentolamine(bimix), and C: 10 μg PGE1 + 15 mg papaverinehydrochloride + 0.5 mg phentolamine (trimix). Eachpatient was scheduled to receive the three modalities ofintracavernous injection randomly with an interval of 7-10 days between injections. Penile rigidity equal to ormore than 60% was considered positive. Subjective andobjective penile rigidity were evaluated with callipers bythe same observer.RESULTS: 82 patients completed the study and 9dropped out after prolonged erection with one of the ICImodalities. Rigidity after treatment with C (66±15%) wassignificantly superior to that of B (59± 15%, p = 0.0001)and A (60±13%, p = 0.0115). No differences were observedbetween A and B (p = 0.4644). Analysis of only the positiveresponse showed significant differences between A and C,but not between C and B (p = 0.3323). Differences werenot found between the response to PGE1 (A) and bimix (B)(p = 0.1275). The order of application of the drug had noeffect on response (p = 0.026).CONCLUSIONS: A higher percentage of positiveresponse in patients with erectile dysfunction was achievedwith the trimix modality. Choice of more potent ICIregimens can improve the diagnostic and/or therapeuticefficacy in males that do not respond to PGE1 alone.
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- OBJECTIVE: The aims of this study wereto analyze the cavernosal tissue metabolic status of patientswith vascular and psychogenic impotence and attempt toestablish metabolic differences between these types oferectile dysfunction.METHODS: 103 patients were classified according tothe type of erectile dysfunction into group A (vascular)and group B (psychogenic). Diagnosis was based onclinical history, physical examination, intracavernosalinjection test, penile echo-doppler assessment,cavernosography-cavernosometry and nocturnal peniletest. Cavernosal and peripheral venous blood sampleswere obtained from each patient and the lipoperoxide(LPO) levels and total antioxidant status (TAS) were determined. SPSS V9.0 was used for the statistical analysis.RESULTS: The mean age was 62 years (range 32-73).Cavernosal blood lipoperoxide levels were statisticallyhigher (p <0.05) in patients with vascular impotence(2.45µmol/L) than in those with psychogenic impotence(1.47 µmol/L). Cavernosal blood total antioxidant statuswas statistically higher (p <0.05) in patients withpsychogenic (1.40 mmol/L) than those with vascularimpotence (1.10 mmol/L). The lipoperoxide levels andtotal antioxidant status for peripheral blood were 1.68µmol/L vs 1.60 µmol/L and 1.29 mmol/L vs 1.35 mmol/L,respectively, with no statistically significant differencesbetween both groups.CONCLUSIONS: Cavernosal blood lipoperoxide levelsand total antioxidant status can be an indicator ofcavernosal tissue metabolic status and function.
Case Report
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OBJECTIVE: To describe a case of cutaneous hornof the penis and review its clinical and histological features.METHODS: The clinical and histological features of cutaneoushorn of the penis are described.RESULTS/CONCLUSIONS: Cutaneous horn of the penis is anuncommon lesion that is diagnosed without difficulty. Treatment isby surgery with sufficient margins due to its possible association withmalignant lesions.
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OBJECTIVE: To report an uncommon case of testicular microlithiasis that was incidentally discovered.METHODS/RESULTS: A case of bilateral testicular microlithiasis in an 8-year-old boy that presented with a left scrotal cystic mass is described. Testicular microlithiasis was discovered on ultrasound evaluation.CONCLUSIONS: Bilateral testicular microlithiasis is a rare condition that requires control follow-up of tumor markers and by ultrasound since this condition has been associated with tumors.
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OBJECTIVE: To report a case of Wilms' tumor in anadult patient.METHODS: The records of an adult patient with renal tumor isreviewed.RESULTS: A 23-year-old male consulted for hematuria. Physicalexamination and patient assessment by ultrasound and CT showeda solid tumor in the right kidney. The patient was submitted to radicalsurgery. Pathological analysis demonstrated a biphasicnephroblastoma (Wilms’ tumor) with infiltration of renal hilar fat(stage II). After surgery, adjuvant chemotherapy with vincristineactinomycinD was administered for 60 weeks.CONCLUSIONS: Although rare in adults, Wilms' tumor shouldbe included in the differential diagnosis of all renal tumors. Treatmentis usually by surgery and chemotherapy with or without radiotherapy,depending on tumor stage.
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OBJECTIVE: To present a case of granular celltumor with an uncommon localization.METHODS: A 38-year-old patient presented with a painlessnodule 10mm in diameter on the scrotum that he had noted two yearsearlier.RESULTS: The tumor was surgically excised. Pathologicalanalysis demonstrated a granular cell tumor that was stronglypositive for protein S-100 and negative for cytokeratin AE1-AE3 andCEA.CONCLUSIONS: Granular cell tumors are very frequent in thehead and neck, but rare in the genitourinary region and areasymptomatic. Histological diagnosis is simple but should beconfirmed by protein S-100 staining, which is positive in all cases.Treatment is by simple excision of the lesion. Tumor recurrence andmetastasis have been reported, therefore follow-up is necessary
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Case Report
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OBJECTIVE: To report a case of TURP syndromeand emphasize the importance of early diagnosis.METHODS: A case of reabsorption syndrome in a patient thatunderwent transurethral resection under spinal anesthesia ispresented.RESULTS: Reabsorption syndrome (TURP syndrome) ismanifested by neurological and hemodynamic changes resultingfrom absorption of irrigating fluid used during transurethral resectionof the prostate. This complication presented in a patient undergoingelective surgery and with no additional risk factors.CONCLUSIONS: Since it is impossible to prevent thiscomplication of TUR, spinal anesthesia should be utilized wheneverpossible because it permits early detection before importantcomplications develop.
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OBJECTIVE: To report an additional case ofsyringocele of Cowper's glands and briefly review itsetiopathogenesis, diagnosis and treatment.METHODS/RESULTS: A 26-year-old male consulted for a recentvoiding syndrome and chronic postvoid dribbling. A voidingcystourethrogram demonstrated a syringocele, which was confirmedduring endoscopic treatment.CONCLUSIONS: Syringocele or cystic dilatation of Cowper'sgland duct usually has a congenital etiology. There are fourmorphological types: simple, perforated, imperforate and ruptured.Diagnosis is made by voiding cystourethrography and confirmed byendoscopy. Transperineal ultrasound was also utilized for the diagnosis. Treatment is by endoscopic incision.
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OBJECTIVE: To examine the changes inserum prostatic acid phosphatase (PAP) and two differentmolecular forms of serum prostate-specific antigen (PSA)in men treated with finasteride for benign prostatichyperplasia (BPH).METHODS: Eighty-five patients on finasteride therapy(5 mg/day) for symptomatic BPH comprised the studygroup (mean age 67 years, range 61-86). Blood sampleswere taken before and after 6 and 12 months of treatmentto determine PAP, total PSA (tPSA) and free PSA (fPSA).These prostatic markers were measured using the AxSYMPSA assay ®, AxSYM free PSA assay ® and IMx PAPassay ® systems (Abbott Laboratories Diagnostics, SouthPasadena, CA, USA).RESULTS: Although the mean total and free PSA levelsdecreased significantly, the mean f/t PSA ratio increasedonly slightly. The free PSA index (f/t PSA) remainedunchanged (over or under the 0.20 cut off point) during treatment in 95.3% of the patients. Serum PAP showed nosignificant variation.CONCLUSIONS: Serum PSA decreased to half after 6to 12 months of treatment; the rule "PSA x 2" is confirmedto be a valid reference for the interpretation of posttreatmentvalues. Serum PAP and f/t PSA ratios (0.20 cutoff point) remained practically unchanged and are thereforevalid tumor markers, without any modification, infinasteride-treated patients. This differential effect onserum PAP and PSA strongly suggests that expression ofthese proteins is regulated by androgens through differenttargets. We recommend the use of tPSA multiplied by 2 andf/tPSA without modification to discriminate between benignand malignant conditions in men treated with finasteride.
