Article
Knowledge map
Save
OBJECTIVE: To review the subject of malacoplakia and analyze the incidence of urinary and genital, and extraurinary localizations. METHODS: We reviewed the literature on urinary and extraurinary malacoplakia. Our series of 4 cases are presented (two renal, one prostatic with uncommon clinical presentation and one of the urinary bladder). RESULTS: This study confirms that there is an increasing proportion of extravesical involvement in malacoplakia of the urinary tract and extraurinary localization involving practically all the organs and organ systems. CONCLUSIONS: 614 cases of malacoplakia have been reported; of these, 60.4% were urinary and 39.5% extraurinary (including retroperitoneal localization). Renal involvement, if we include the bilateral forms and those occurring in the transplanted kidneys, is equal in number to the cases localized to the bladder. Although malacoplakia is a “benign” condition, the prognosis of the bilateral forms involving the upper urinary tract and those occurring in the transplanted kidney appears to be poor, with a mortality rate of 20%-50%. Furthermore, this review clearly shows the need for follow-up in these patients since “recurrences” have been reported at different levels of the urinary tree up to 10 years after the initial diagnosis.
Article
Knowledge map
Save
OBJECTIVE: To analyze the results of thefirst two years of application of the clinical pathway fortransurethral resection (TUR) of bladder tumors at La PazUniversity Hospital.METHODS: We developed a clinical pathway of 4hospital stays (5 days) for TUR of the bladder thatincluded the following: matrix-verification, treatmentsprescribed, verification of changes, patient informationsheet and patient satisfaction questionnaire. Theinformation for the evaluation of the results were obtainedfrom the pathway records and data on the activities of theUrology services. To assess the results for efficiency in theuse of resources, the mean duration of hospital stay ofpatients in the pathway were compared with that of acontrol group comprised of 50 randomly selected patientssubmitted to TUR of the bladder in 1997.RESULTS: From June 1998 to May 2000, 481 of the494 (97.4%) treated patients entered the clinical pathway.CONCLUSIONS: In our experience, the clinicalpathway for the urinary bladder is a useful instrument fordeveloping the clinical management of this condition. Itreduces the unwanted changes in patient care and hospitalstay, carries a low incidence of complications andreadmissions, and achieves a high degree of patientsatisfaction.
Article
Knowledge map
Save
OBJECTIVE: To analyze the impact ofsurgery for bladder cancer on the patient’s quality of life.METHODS: The SF-36 questionnaire was utilized toassess the quality of life of 53 cystectomized patients.Sociodemographic data, associated and surgery-relatedmorbidity, type of urinary diversion, anatomopathologicalstage and current oncological status were analyzed.RESULTS: Patient mean age was 64.3 years. Therewere 46 males (86.8%), 33 (62.3%) had no schooling, 32(68.1%) were social class IV and 35 (66.0%) had chronicassociated conditions. External urinary diversion hadbeen performed in 28 (52.8%) and bladder substitution in21 (39.6%) patients. The early complication rate was37.7% (n = 20) and the late complication rate was 86.8%(n = 46). Tumor stage was ≤ pT2 in 28 cases (52.8%). Agecorrelated inversely with Physical Performance (r = -0.324;p = 0.018). Patients with chronic conditions had a lowerscore for Physical Performance, Vitality and SFI. Patientswith tumor stage ≤ pT2 scored higher for Physical Performance(p = 0.034), Vitality (p = 0.046), Mental Health (p= 0.036), Emotional Role (p<0.05) and MSI (p<0.05).Those with postoperative complications had a worse scorefor Physical Performance (p = 0.031), Vitality (p = 0.027),Emotional Role (p = 0.014), Mental Health (p = 0.012)and MSI (p = 0.015). The SF-36 showed no differencesbetween the types of urinary diversion except that patientsthat had undergone orthotopic bladder substitution had ahigher score for Physical Performance (p = 0.014) andFSI (p = 0.045).CONCLUSIONS: Although the quality of life ofcystectomized patients is worse than that of the generalpopulation, it is better in younger patients without chronicassociated conditions, no postoperative complications,lower tumor stage and those submitted to orthotopicbladder substitution.
Article
Knowledge map
Save
OBJECTIVE: To investigate the occurrenceof antisperm antibodies (ASAs) and their correlation tosemen parameters in varicocele patients.METHODS: Semen samples from 137 patients withunilateral palpable clinical varicocele aged 15-35 yearswho consulted at the Infertility and Urology services of theProvincial del Centenario and Eva Peron teachinghospitals in Rosario (Argentina) were collected andanalyzed according to the WHO standardized protocolsand ASAs were tested with TAC II. Statistical analyseswere performed using log linear models.RESULTS: Motility was impaired in 67.2% (p > 0.001)and morphology in 97.1%. Sperm concentration decreasedin 19.7%, although it was not statistically different fromthat of the normal population. Of the infertile populationwith varicocele, 46.7% had positive ASAs with TAC II.CONCLUSIONS: We found a statistically significantcorrelation only between motility and sperm count (p >0.01). Our study indicates that the severe dysspermiaobserved may be caused by autoimmune processes thattrigger cellular and humoral mechanisms.
Article
Knowledge map
Save
OBJECTIVE: Rupture of the corpuscavernosum is an uncommon condition that requiresimmediate treatment in the emergency services. Thediagnostic methods and therapeutic approaches arediscussed and the literature reviewed.METHODS: Two cases of rupture of the corpuscavernosum diagnosed 8 years and 3 months earlier arepresented. One was treated conservatively and the otherwas submitted to early surgical management. Imagesshowing the technique utilized for cavernosal repair inone of the patients and the satisfactory clinical course ofboth patients are presented.RESULTS/CONCLUSIONS: Rupture of the corpuscavernosum is an uncommon urological emergency in oursetting. Patient history and examination are diagnostic inmost of the cases. Early surgical management is advocated.
Case Report
Knowledge map
Save
OBJECTIVE/ METHODS: To present an additionalcase of leiomyosarcoma of the inferior vena cava and review theliterature, with special reference to the etiology, diagnosis andtreatment of this rare tumor. RESULTS: The patient was submitted to radical surgery andshort course radiotherapy. Twelve months thereafter, the patient isasymptomatic and disease-free.CONCLUSIONS: Leiomyosarcoma of the inferior vena cava is arare and aggressive tumor. Treatment is by aggressive and radicalsurgery.
Case Report
Knowledge map
Save
OBJECTIVE: To present a case of solitary pelvickidney with congenital absence of the vagina.METHODS: A patient with solitary pelvic kidney and vaginalaplasia is described. Patient evaluation included hematological,hormonal, cytogenetic, laparoscopic and imaging studies.RESULTS: Blood, hormone and cytogenetic studies were normal. Laparoscopy showed absence of the uterus and both tubes and ovaries, which was confirmed by pneumopyelography. IVP showedabsence of renal shadows and a solitary pelvic kidney.CONCLUSIONS: Congenital absence of the vagina should besuspected in a patient with a pelvic solitary kidney consulting forprimary amenorrhea.
Case Report
Knowledge map
Save
OBJECTIVE: To report a rare case of coexisting renal oncocytoma and pheochromocytoma. To our knowledge, only one such case has been reported in the literature. METHODS: The findings of the imaging studies of this rare case and the unsuspected anatomopathological findings are presented. RESULTS/CONCLUSIONS: Despite its very low frequency, coexisting renal ocnocytoma and pheochromocytoma should be taken into account in patients with synchronous renal and adrenal masses. Unfortunately, there are no radiological patterns that allow us to suspect this rare condition.
Case Report
Knowledge map
Save
OBJECTIVE: To present an additional case ofmucinous adenocarcinoma of the prostate gland. The histochemicaland immunohistochemical findings demonstrating its prostatic originare presented and the literature is reviewed.METHODS/RESULTS: A 53-year-old male with no previoussymptoms or signs presented for a prostatic examination. DRE wasnormal and PSA was 35 ng/ml. A prostate biopsy demonstratedadenocarcinoma of the prostate with a Gleason score of 3+3.Complementary studies were negative. The patient was submitted toradical prostatectomy. Anatomopathological analysis of the surgicalspecimen demonstrated a prostatic mucinous adenocarcinoma. Atone-year follow-up, the patient is alive and disease-free and PSAvalues have returned to normal.CONCLUSIONS: Mucinous adenocarcinoma of the prostate is arare anatomopathological variant whose natural history andprognosis are not well-known. This tumor type generally does notrespond to any treatment and is hormone-resistant.
Case Report
Knowledge map
Save
OBJECTIVE: A case of epididymal leiomyoma ispresented. This lesion is uncommon and sometimes misdiagnosed.The literature is briefly reviewed.METHODS/RESULTS: A 29-year-old patient presented with atumor in the tail of the right epididymis that was initially diagnosedas scrotal hematoma or complex cyst in the tail of the epididymis.RESULTS/CONCLUSIONS: Ultrasound has an important rolein distinguishing testicular from epididymal tumors. However, if thediagnosis is unclear, surgical resection and subsequentanatomopathological analysis must be performed.
Case Report
Knowledge map
Save
OBJECTIVE: To report a case of solitarymetachronous contralateral metastasis of a renal carcinoma thathad been previously resected.METHODS: A 63-year-old male that had previously undergonea right radical nephrectomy due to renal carcinoma is presented.The patient’s left breast was found to be slightly larger at the controlevaluation 24-months postoperatively. Analytical and hormonalstudies showed no significant findings except for a serum creatininevalue of 1.75 mg/dl. However, a CT scan showed a left adrenalnodule of 3 cm. After 6 months of watchful waiting, the nodule hadincreased to 4.3 cm. A CT-guided fine needle punction aspirationbiopsy demonstrated a malignant lesion and a left adrenalectomywas performed.RESULTS: Histopathological analysis of the surgical specimenshowed adrenal metastasis of clear cell renal carcinoma. At 21months' follow-up after adrenalectomy, there is no evidence ofrecurrence of the metastasis.CONCLUSIONS: This type of lesion is uncommon. We emphasizethe importance of the analytical and hormonal studies, as well as CTand FNPA, in the diagnosis of this adrenal pathology. Like otherauthors, we advocate performing adrenalectomy in these cases.
Case Report
Knowledge map
Save
OBJECTIVE: To report a case of malignantmelanoma of the penis, a rare malignant neoplasm whose aggressivebehaviour carries a poor prognosis.METHODS: A 58-year-old male consulted for a pigmentedelevated lesion in the balanopreputial sulcus. The biopsy was positivefor melanoma. Complementary studies did not demonstratedisseminated disease.RESULTS: Partial resection of the penis and bilateral inguinallymphadenectomy were performed. Histological analysis showedtwo positive nodes in the same lymphatic chain. Interferon wasadministered for 6 months. The patient remains disease-free at 35months’ follow-up.CONCLUSIONS: Although surgery is the treatment of choice,adjuvant therapy (chemotherapy and immunotherapy) should beconsidered in those patients without localized disease.
Article
Knowledge map
Save
OBJECTIVE: The possible occurrence of venous thrombosis in tumor-bearing patients had already been reported by Trousseau in the past century. The blood clotting alterations in cancer-bearing patients can cause Deep Venous Thrombosis (DVT), especially in those patients with disseminated metastases. Anti-tumor chemotherapy can increase the risk of thrombosis. Herein we report our past experience on a sample of patients who underwent pelvic surgery to treat infiltrating bladder tumors. METHODS: We have retrospectively analyzed the records of patients with infiltrating bladder tumors who underwent salvage radical cystectomy. RESULTS: We observed the highest incidence of DVT (33.3%; 3 out of 9)in those patients with a higher risk due to anesthesia and an absolute need for extensive surgery. One of our patients died of pulmonary embolism. CONCLUSION: The diagnosis of DVT and Pulmonary Embolism is not always easy to achieve and all possible tests must be performed whenever possible (e.g. clinical examination, hematological test, etc.).
