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OBJECTIVE: Thirty cases ofadrenalectomy are presented. The diagnostic andtherapeutic aspects of adrenal disease are reviewed.METHODS: Over the last 6 years, 30 adrenalectomieswere performed in 28 patients (20 females and 8 males)aged 16 - 83 years (mean age 51 years). The lesion wasincidentally discovered in 18.5%, 33.3% presented abdominalor lumbar pain, 18.5% had Cushing’s syndrome,18.5% presented headache and hypertension, and 7.4%virilization.Diagnostic evaluation included laboratory studies,ultrasound and CT assessment. Scintigraphic localizationwith MIBG, MRI or arteriography was performed inspecific cases. The flank approach was utilized in 53% ofthe cases.RESULTS: The postoperative period ranged from 7-23days (mean 11). Postoperative complications (38.4%)following adrenalectomy were splenectomy, hemorrhage,hypertensive episodes, vascular complications, woundinfection and pneumonia. Fifty percent of the masses were pheochromocytomas, 10% carcinomas and 5% adenomas.The rest were two neural crest derived tumors, one calcifiedcyst, one myelolipoma and one metastatic renal carcinoma.CONCLUSION: The diagnostic and therapeutic aspectsof adrenal disease are reviewed.
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OBJECTIVE: To review the treatmentstrategies for adrenal melanoma and to emphasize the roleof curative surgical resection and adjuvant treatment inselected patients with melanoma metastatic to the adrenalgland versus chemotherapy alone in the treatment ofpatients with advanced malignant melanoma.METHODS: A case of adrenal gland metastasis of acutaneous melanoma (Clark IV, Breslow 5mm.) treated byexcision one year before that was referred to the UrologyDepartment for Wünderlich syndrome is presented.RESULTS: The analyzed series of programmedadrenalectomy for adrenal metastases from melanomadescribe survivals of 26 (3), 36 (9), 59 (3) and 72 (5)months. In our case the patient died at home one monthlater due to stroke, although concomitant brain metastasisis suspected. Autopsy was not performed.CONCLUSIONS: In the differential diagnosis of anincidentaloma, metastatic disease is likely in a patient with a history of malignant disease. The frequency ofmalignant melanoma among metastatic adrenal diseasevaries between 1% and 8.6%; the majority areasymptomatic and incidental findings. We believe that inselected patients with advanced malignant melanoma,with no major coexisting morbidity factors who haveisolated melanoma metastatic to the adrenal gland or withlimited extra-adrenal sites of disease, curative surgicalresection and adjuvant treatment may improve theirsurvival. It must be emphasized that all patients should befollowed after surgical resection of the primary tumorbecause it will facilitate staging of the disease and avoidemergency situations of ruptured friable metastases thatmake complete resection difficult.
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OBJECTIVE: To describe the clinical andhistological findings of the unusual involvement of theurinary bladder by multiple inverted papillomas oftransitional cells.METHODS/RESULTS: A 53-year-old male presentedwith obstructive symptoms and gross hematuria lasting forone year. Ultrasound examination of the urinary bladderdemonstrated two polypoid masses. Transurethral resectionwas performed and histopathological examination ofspecimens showed a subepithelial, non-atypical cellproliferation arranged in a trabecular pattern. DNAploidyshowed diploid population and ki-67 determinationrevealed a low proliferation index.CONCLUSIONS: Multiple inverted papillomas of theurinary bladder are very rare. Histological examination isessential for the definitive diagnosis. Determination ofDNA-ploidy and proliferative index may be useful forappropriate management of this disease.
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OBJECTIVE: To study vesicosphinctericdysfunction in 108 patients with multiple sclerosis.METHODS: We reviewed the clinical records of 108patients with multiple sclerosis and analyzed those withvoiding symptoms ascribable to multiple sclerosis. Thesepatients underwent complete urodynamic assessment andcomplementary tests according to their symptoms. TheBlaivas classification was used for the clinical classificationof multiple sclerosis.RESULTS: 64 of the 108 patients presented voidingsymptoms ascribable to multiple sclerosis (59.2%). Theclinical features presented as episodes in 75% and wereprogressive in 25% of the cases. In 6 % of the patients, thevoiding symptoms were the first symptoms of multiplesclerosis. Urodynamic assessment showed detrusorhyperreflexia in 73% of the patients, hyporeflexia in 14%,and 13% showed normal urodynamics. All complicationswere infective; no patient showed upper urinary tractcomplications.CONCLUSIONS: Vesicosphincteric dysfunction inmultiple sclerosis is frequent. Most of the patients presentbladder hyperreflexia. The urological complications areusually infective. Involvement of the upper urinary tract israre.
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OBJECTIVE: To describe a case of priapism following testosterone administration.METHODS/RESULTS: A 14-year-old boy treated with testosterone for delayed puberty presented with priapism after the administration of a single depot dose of 100 mg testosterone. Punction-aspiration of the corpora caverno-sa was required to resolve the priapism.CONCLUSION: Administration of testosterone for delayed male puberty is safe but may occasionally cause priapism.
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OBJECTIVE: To present an uncommonassociation of renal carcinoma with an undiagnosedipsilateral pheochromocytoma that caused severecardiovascular disorders during surgical treatment of therenal carcinoma, and emphasize the need for carefulassessment of these adrenal nodules before resectionalthough they may appear to be clinically irrelevant.METHODS: A 61-year-old male with mild arterialhypertension controlled with drug therapy for 40 yearswas diagnosed as having a right renal hypernephroma anda probable adrenal adenoma by IVP, abdominal ultrasound,CT, bone scintiscan and renal arteriography. Preoperativevalues were within the normal limits.The patient developed severe hypertensionintraoperatively, which was controlled by administrationof lidocaine, nitroglycerine, sodium nitroprusside andlabetalol. Surgery was interrupted and completed whenthe patient was stable.RESULTS: The pathological analysis showed clear cellrenal adenocarcinoma and pheochromocytoma.Postoperative evaluation showed dopamine, adrenaline,noradrenaline and vanilmandelic acid were normal. A131MIBG scan was normal.CONCLUSION: Although an adrenal mass may appearto be clinically irrelevant, a careful study should beperformed to discard a functioning tumor and to avoid theserious complications that might arise during surgery.
Case Report
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OBJECTIVE: To present a rare site of schwannomaand review the literature.METHODS/RESULTS: A case of a young male patient whoconsulted for removal of a penile lipoma is presented. The small,regular, well-circumscribed tumor localized under Buck’s fascia onthe dorsal penile aspect was excised. The anatomopathologicalanalysis showed a schwannoma.CONCLUSION: A review of the literature showed schwannomaof the penis to be very uncommon. For this reason, we were promptedto report this case.
Case Report
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OBJECTIVE: To describe an additional case ofparatesticular solitary fibrous tumor.METHODS/RESULTS: A 67-year-old man presented aparatesticular mass lasting for one year. Histological examinationshowed a well-circumscribed lesion comprised of spindle cellsproliferation without atypia, arranged in a fascicular pattern,intimately intertwining with thick collagen fibers. Tumor cells werestrongly positive for vimentine and CD-34. Diagnostic criteria,clinical features and treatment of this condition are discussed.CONCLUSION: Solitary fibrous tumors are spindle cell neoplasmoriginally described in the pleura, but may occur in many differentsites. Intrascrotal solitary fibrous tumors are uncommon and fewcases have been reported.
Case Report
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OBJECTIVE: To present a case of extramedullary plasmacytoma localized in the kidney. The clinical features, diagnostic tests, treatment and outcome are discussed. METHODS/RESULTS: A 59-year-old patient presented with a right renal mass and renal failure. The complementary tests showed a lambda monoclonal band in blood and urine, and a left renal biopsy showed changes compatible with myeloma. The definitive diagnosis of plasmacytoma was based on the findings of open renal biopsy since fine needle punction findings were compatible with a carcinoma. The patient received polychemotherapy, but died one year after the diagnosis due to a rapidly progressing plasmatic cell dyscrasia. CONCLUSION: Renal plasmacytoma is rare and should be suspected when paraprotein is detected in blood and urine, and when the patient has a history of plasmatic cell dyscrasia. There is no widely-established treatment. Surgery, radiotherapy or chemotherapy, alone or in combination, can be utilized.
Case Report
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OBJECTIVE: To report a case of infected urachalcyst, with special reference to the difficulty in making the diagnosisdue to the low incidence of this condition.METHODS/RESULTS: The embryologic origin of the urachus,its anomalies, clinical features, diagnosis and treatment are discussed.CONCLUSION: A high index of suspicion is necessary to diagnosethis condition with unspecific clinical features. Ultrasound and CTare useful in making the diagnosis. Radical surgery continues to bethe first therapeutic procedure.
Case Report
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OBJECTIVE: To describe a case of polyorchidism,a rare anomaly of the genital tract, with special reference to the useof non-invasive imaging with color Doppler ultrasound for itsdiagnosis.METHODS/RESULTS: The patient presented with anasymptomatic mass in the left hemiscrotum. Color Doppler assessmentrevealed a supernumerary testis with the same ultrasound andperfusion patterns as the normal testes.CONCLUSION: Doppler ultrasound permits assessment of theechogenicity, perfusion and viability of the supernumerary testis,and to rule out associated anomalies. Surgical exploration to confirmthe diagnosis is unnecessary.
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OBJECTIVE: To describe an additional case of scrotal liposarcoma and its treatment, which was distinct from conventional treatment. METHODS: The literature on paratesticular masses is reviewed with special reference to the liposarcomas. An additional case of liposarcoma is described which was treated by tumor excision without involvement of the testis. The diagnosis, classification and treatment of this condition are discussed. RESULTS: Liposarcoma is a very uncommon tumor and its diagnosis is based on the anatomopathological findings. Treatment is by orchidectomy with high ligation of the spermatic cord. However, the case described herein was treated only by resection of the tumor. Radiotherapy may be indicated in some cases. Chemotherapy does not appear to be useful in this type of tumor. CONCLUSION: In some cases of scrotal liposarcoma, the tumor can be resected without performing orchidectomy.
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OBJETIVE: To report 13-year biochemicaldisease-free survival results on 769 consecutive prostatecancer patients treated with brachytherapy alone.MATERIAL AND METHODS: Seven hundred sixtynine patients with stage T1 - T3, low to high Gleason gradeprostate cancer underwent transperineal prostate implantswith Iodine-125 (I-125) or Palladium-103 (Pd-103) as thesole treatment between January 1, 1987 and January 1,1997. Median age was 69 years (range 43-92) and medianfollow-up was 71 months (range 18-156). Study cohortcharacteristics are summarized in Tables I and II andFigures 4 - 6.The patients were divided into two risk groups (low andhigh risk for extra-prostatic disease) based mainly onclinical stage and Gleason score. Group 1 consisted of 542patients, who were considered at low risk and were treatedwith I-125. Group 2 comprised 227 patients, who wereconsidered higher risk and were treated with Pd-103.No patient underwent pathological staging and nonereceived androgen ablative therapy. Treatment failurewas based on our modification of the American Society forTherapeutic Radiology and Oncology's (ASTRO)recommended failure criteria, defined as 3 consecutiveserum Prostate Specific Antigen (PSA) rises (1). A criticalcomponent in our modification is that the value of the thirdPSA rise be above 0.5 ng/mL.RESULTS: One hundred thirty-seven patients were lostto follow-up*. Thirteen patients expired of non-cancercauses within 18 months of the implant. This left 619patients for evaluation, 441 in Group 1 and 178 in Group2. The biochemical disease-free survival rates of the 619patients at 3, 5, 10, and 13 years were 85%, 80%, 77%, and77%, respectively (Fig. 1). The biochemical disease-freesurvival rates of the 441 "lower risk" I-125 treated patientsat 3, 5, 10, and 13 years were 84%, 79%, 76%, and 76%,respectively (Fig. 2). The biochemical disease-free survivalrates of the 178 "higher risk" Pd-103 treated patients at 3,5, 10, and 13 years were 87%, 82%, 80%, and 80%,respectively (Fig. 3).CONCLUSION: The excellent long-term resultspresented here, as well as the many advantages of prostatebrachytherapy over other common treatments, demonstratethat brachytherapy is an effective treatment for clinicalorgan-confined prostate cancer in the long term.* About 50% of this patient cohort resided in other statesand foreign countries.
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OBJECTIVES: We present our preliminaryexperience in the management of inflammatory anteriorurethral strictures with a dorsally/dorsolaterally placedpenile/preputial vascularized flap and discuss the distinctadvantages of this procedure over a traditional ventrallyplaced flap.METHODS: Twelve patients (age, 20-66 years; meanage, 40.5 years) with recurrent inflammatory strictures ofthe penile and/or bulbar urethra (penile, 2; bulbar, 5 andbulbopenile, 5) were treated with dorsally/dorsolaterallyplaced penile/preputial (penile skin, 5; prepuce, 7)vascularized flap substitution urethroplasty. Prior tosurgery, 7 patients had suprapubic cystostomy for acuteurinary retention and 5 had a mean peak flow rate of 6.2ml/sec. Inferior pubectomy was performed as an adjunctin two patients to facilitate proximal placement of the flap.Follow-up (5 to 24 months; mean, 15.5) includeduroflowmetry and retrograde urethrograms at 6,12 and 18months, and thereafter as required.
