OBJECTIVE: To review our experience with surgical management of hydrocele under local anesthesia.METHODS: From January 1991 to March 2001, 76 patients with hydrocele (6 bilateral) were treated in our department. Patients were monitored in the OR (EKG, BP and pulseoxymetry); a peripheral line was inserted. Twenty minutes before the procedure, midazolam (5 mg), meperidine (50 mg) and atropine (0.5 mg) were administered i.m. for sedation. The spermatic cord and the area of the scrotal wall to be incised were injected with 2%mepivacaine (10-20 cc). Dissection and excision of the vaginalis sac was performed.RESULTS: Anesthetic tolerance was very good in 71 patients (93%) and unsatisfactory in 5 (7%). The following complications were observed: scrotal hematoma (4 cases; 5%), infection (3 cases; 4%), bradycardia and hypotension (2 cases; 3%). Only 5 patients (7%) required hospitalization for more than 24 hours.CONCLUSIONS: Surgical management of hydrocele can be performed under local anesthesia, thereby avoiding the morbidity of more aggressive anesthetic techniques. This treatment procedure should be considered in the smaller departments with limited resources.
OBJECTIVE: To report a case of primitiveneuroectodermal tumor (PNET) of the kidney and reviewthe literature and the 25 cases previously reported asPNET.METHODS: A 39-year-old man who consulted fornephric colic is described. Ultrasound evaluation discloseda mass arising from the left kidney. The clinical,radiological and pathologic features, treatment anddifferential diagnosis of small cell tumors are discussed,as well as the important role of immunohistochemicaltechniques (positive staining with O13 or 12E7 antibodies)and cytogenetic analysis [a characteristic chromosomaltranslocation t(11;22) (q24;q12) or variant translocation,such as t(21;22) (q22;q12), may be detected by fluorescencein situ hybridization (FISH) or polymerase chain reactionreversetranscriptase (PCR-RT)].RESULTS: Survival of our patient was 20 months. Onlythree of the 25 previously reported cases had a longersurvival: 60, 48 and 24 months. Mean survival was 10months. 95.24% of the cases were positive for NSE.Immunostaining (CD99) was performed in 16 patients andwas found to be positive in all cases. Cytogenetic andmolecular analyses were performed in 11 cases; PCR-RTwas negative in two, as well as in the case describedherein.CONCLUSIONS: PNET is a highly aggressive neoplasmthat tends to recur locally and to metastasize. Despite thepoor response to standard therapy combining surgicalresection, postoperative irradiation and chemotherapy,the results might change due to current research ongenetic therapy based on creating antisenseoligonucleotides against the EWS-FLI 1 fusion gene.
OBJECTIVE: One of the basiccharacteristics of urothelial carcinoma is its tendency tosynchronous or metachronous multifocality. Thus theneed to explore the entire urinary tract of patients withurothelial neoformations. The aim of this article is to study the tumors of the upper urinary tract that appearsynchronously with infiltrating carcinoma of the bladder.The clinicopathological characteristics and the morbidityand mortality of en bloc surgery of both tumors areanalyzed.METHODS: A retrospective study was carried out on170 radical cystectomies for infiltrating bladder tumorperformed in our department over a 13-year period.Patient history, clinicopathological characteristics,complementary tests, type of surgery performed,postoperative complications and follow-up were analyzed.RESULTS: Tumor of the upper urinary tract appearedin 14 (1 bilateral) of these patients and were synchronousin 10 cases. All patients were male; mean age 63 years.Three were localized in the pelvis, 2 in the proximal ureterand 6 in the distal third. Diagnosis was made by IVP in 6patients and by US and antegrade pyelography in theother 4 patients. Nephroureterectomy and radicalcystectomy were performed en bloc in 8 cases; 6 had aBricker procedure and 2 ileal substitution. Salvage radicalcystectomy + distal ureterectomy were performed inthe other two patients. Two patients submitted to en blocsurgery had postoperative complications; one presentedprolonged ileua and the other required surgery forretroperitoneal hemorrhage. The two patients submittedto palliative surgery died of and sepsis during thepostoperative period. At 33 months’ mean follow-up, 3patients have shown tumor progression. CONCLUSIONS: There is a high proportion ofsynchrous tumor of the upper urinary tract in our series ofpatients with infiltrating carcinoma of the bladderundergoing radical cystectomy, therefore we consider itnecessary to explore the entire urinary system.Surgical removal of both tumors en bloc does notincrease the morbidity and mortality.
OBJECTIVE: To study the prevalence of high grade prostatic intraepithelial neoplasia in a Spanish population and to compare it with the prevalence in Caucasians of other countries and Afroamericans. METHODS: 162 prostates obtained at autopsy from Spanish men aged 20-80 years, were fixed in 10% formalin and slices perpendicular to the posterior margin were made every 3-4 mm along its entire length. All blocks were embedded in paraffin and examined microscopically. Mapping of focality and site of the high grade prostatic intraepithelial neoplasia was done for each case. The Wayne University autopsy study was used for comparison of the prevalence in other countries and races. RESULTS: 146 prostates from men with a mean age of 48.5 years were considered valid for histological analysis. There were 42 high grade prostatic intraepithelial neo- plasia; 20 were focal and 22 multifocal. By age group, the prevalence of high grade prostatic intraepithelial neopla- sia were 7.1%, 14.7%, 28.5%, 33.3%, 45.4% and 51.8% for the 3rd, 4th, 5th, 6th, 7th, and 8th decades. CONCLUSIONS: High grade prostatic intraepithelial neoplasia begins to manifest in the Spanish population after the 3rd decade. It is usually focal and peripheral, and significantly increases with age and becomes multifocal. Its prevalence in the Spanish population is moderately lower than in American Caucasians and significantly lower than in Afroamericans.
OBJECTIVE: To evaluate the utility andneed for percutaneous surgery in the General UrologyDepartment according to its applicability and efficacy.METHODS: 40 percutaneous surgery procedures wereperformed over a period of 11 years (average 3.6procedures/year), which accounts for 0.60% of all surgicalprocedures performed. These were carried out for pyelicstone (10), caliceal stone (12), pyelic stone in horseshoekidney (2), pyelic stone + UPJ stricture (4), UPJ stricture(7), UPJ re-stenosis post-pyeloplasty (1), cystectomy (3),diagnostic percutaneous surgery (1).RESULTS: Good results were achieved in 89.2% of thecases with lithiasis and there were 3 failed attempts(10.7%). Cystectomy achieved a 100% success rate; residual cavity persists in all the cases but there has been norecurrence at 5 years. Endopyelotomy was successful in41.6% of the cases and stricture recurred in 58.3%.Overall, there were 4 complications without majorconsequences, although the procedure could not becompleted in two cases.CONCLUSIONS: Although there is little opportunity toapply the technique, it is currently necessary because itachieves unquestionably good results in specific cases.
OBJECTIVE: Indinavir is a proteaseinhibitor used in the treatment of HIV with a lithogeniccapacity as a urological side effect. The pathogenesis,diagnosis and treatment of indinavir urolithiasis are brieflyreviewed.METHODS: A 37-year-old male, seropositive for HIVon treatment with indinavir, lamiduvine and zidovudine,consulted for colicky left lumbar pain, nausea, vomitingand dark urine for the past three days.RESULTS: Patient evaluation showed a nonfunctioningleft kidney and ureterohydronephrosis of unknown origin.URS showed a yellowish, friable material with a mucinousappearance that occupied the entire lumen of the ureter.Fragmentation was achieved with the lithotriptor probe.Six months later the patient had fully recovered and wasasymptomatic.CONCLUSIONS: The incidence of protease inhibitor-induced urolithiasis is increasing. This condition should bedistinguished from uric acid calculi whose treatment willaggravate the indinavir urolithiasis
OBJECTIVE: Various tumors have been describedin the scrotal area arising from skin and the underlying tissues:nevus, dermoid and epidermoid cysts, epidermoid carcinomas,lipomas, leiomyomas, angiokeratomas, lymphangiomas, granularcell tumors, granuloma, malignant tumors of the peripheral nervetissue, and some ‘pseudotumors’ such as fibromatosis and nodularcalcinosis.We describe for the first time a sweat gland tumor, which is alsoremarkable for its unusually large size.METHODS/RESULTS: A 76-year-old patient consulted for apainful left scrotal tumor that he had noted for some time and that hadslowly and gradually grown. Ultrasound assessment of the GUsystem confirmed the presence of a 4.2 cm left, solid paratesticularmass that was removed under local anesthesia.CONCLUSIONS: Chondroid syringoma is a tumor arising fromthe sweat gland that is usually localized to the head and neck. It hasan excellent prognosis and recurrence has only been described inpatients in whom the tumor had not been completely resected.
OBJECTIVE: To report a case of left adrenocortical neoplasm. METHODS: A case of left adrenocortical neoplasm measuring 16x10x7 cm in a 47-year-old male is presented. After puncture biopsy, a left adrenalectomy through the abdominal approach was performed. RESULTS: Immunohistochemical studies showed reactivity to the anti-Melan-A A103 antibody, suggesting an adrenal origin of the tumor cells. Strong reactivity to the mES-13 mitochondrial antibody, which is characteristic of oncocytes, made ultrastructural studies unnecessary. CONCLUSIONS: In this type of tumor, an increased mitotic activity and necrosis are suggestive of malignancy. Despite the foregoing, most of this type of lesions are clinically benign and nonfunctioning.
OBJECTIVE: To present a case of ureterocolonic fistula secondary to acute sigmoid diverticulitis in a nonfunctioning ureter due to a previous nephrectomy. METHODS/RESULTS: A 68-year-old patient that had undergone nephrectomy due to xanthogranulomatous pyelonephritis two years earlier, consulted for long-standing non-specific abdominal pain. Radiological evaluation showed a pneumogram pattern in the ureteral stump associated to a pelvic mass. The patient underwent surgery for a suspected uretero-intestinal fistula. The intraoperative findings and anatomopathological study demonstrated a uretero-sigmoid fistula due to diverticular disease of colon. CONCLUSIONS: Uretero-intestinal fistulas present unimportant clinical features. Radiological assessment and a clinical suspicion are important to diagnosis.
OBJECTIVE: To describe an additional case of anuncommon variant of Sertoli cell testicular tumor.METHODS/RESULTS: A 34-year-old male infected with thehuman immunodeficiency virus presented with a right testiculartumor he had noted one year earlier. A right inguinal orchidectomywas performed. Histological examination demonstrated sclerosingSertoli cell tumor.CONCLUSIONS: Sertoli cell tumor is a rare variant of testiculartumor from sexual cords. Although it is uncommon, histologicalvariants have been described: classical Sertoli cell tumor, largecalcifying cells and the sclerosing variant.The case of sclerosing Sertoli cell tumor described herein is avariant of which 11 cases have been reported in the world literature.The fact that our patient is HIV-positive makes this case even rarer.
OBJECTIVE: To report a case of renal splenosis in a patient that had previously undergone splenectomy due to traumatic rupture. METHODS/RESULTS: A 42-year-old patient consulted for pancreatitis. A CT scan disclosed a mass behind the tail of pancreas. MRI assessment with gadolinium enhancement showed a left renal mass which was surgically resected. Histopathological analysis of the surgical specimen demonstrated splenic tissue. CONCLUSIONS: Splenosis should be considered in splenectomized patients with lesions compatible with tumors and should be distinguished from hyperplasia of accessory spleens.
OBJECTIVE: To describe the clinical and histological findings of a case of renal cell carcinoma metastatic to the testes, an uncommon site of metastasis of this tumor type that can cause difficulty in making the differential diagnosis and consequently, in the staging and treatment of the disease.METHODS/RESULTS: A 65-year-old patient diagnosed of renal cell carcinoma presented a paratesticular mass. Histopathological examination of the orchidectomy specimen showed proliferation of clear cells arranged in a diffuse pattern, with intimate intertwining with vascular structures. Tumor cells were strongly positive for vimentin, CAM5.2 and EMA.CONCLUSIONS: Although renal cell carcinoma rarely metastasizes to the testes, it should be considered in the differential diagnosis of testicular masses. Histological examination is essential to diagnosis and correct management.
OBJECTIVE: To describe and discuss primarymalignant lymphoreticular proliferative tumors of the bladder.METHODS: A case of a 70-year-old woman with hematuria,dysuria, malaise and 5-kg weight loss is presented.RESULTS: Pelvic ultrasound examination showed an 8x7x8 cmsolid and cystic mass adjacent to the bladder and uterus. Cystoscopicbiopsy disclosed a low grade B cell non-Hodgkin lymphoma.Disappearance of the mass was achieved with 6 cycles ofchemotherapy and radiotherapy. Four years thereafter the patientremains free of disease.CONCLUSIONS: Primary malignant lymphoma of the bladder isuncommon. The anatomopathological study is essential to differentialdiagnosis from other diseases. The response to chemotherapy andradiotherapy are excellent and permits bladder preservation.
OBJECTIVE: To evaluate the effectiveness and tolerability of intravesical epirubicin treatment to prevent recurrence and progression of superficial bladder tumor after TURMETHODS: 44 patients with superficial bladder tu-mor, 28 primary and 16 recurrent cases were given 50 mg intravesical epirubicin once a week for 8 weeks after TUR. Recurrent cases had not been treated by any intravesical agent before. Follow-up was done by cystoscopy, urine cytology and random biopsies.RESULTS: Local recurrence after treatment was found in 14.28% and 18.75%, and recurrence in another area was found in 21.42% and 31.25% of the primary and recurrent tumor groups respectively. Total recurrence in both groups was 40.91%. No systemic toxicity was observed and local side effects were treated symptomatically.CONCLUSION: Intravesical epirubicin after TUR for superficial bladder tumors especially for the primary ones, is a reliable method that provides effective prophylaxis with tolerable side effects.