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OBJECTIVES: To analyze the trends in theprevalence of the languages used in Medline, since itscreation up to the present time, for the overall indexedarticles in this database and those specifically related tothe field of Urology. The results are extrapolated todetermine the trend over the next 15 years.METHODS: The Pubmed page on Internet(http:www.nlm.nih.gov/pubs/factsheets/nlm.html) and theMedline database (OldMedline 1960-1965 and currentMedline 1966-1999) were accessed to determine the totalnumber of indexed articles and the distribution by year,language and country. The same method was applied forarticles specifically pertaining to the field of Urology.RESULTS: Overall, English accounts for 75% of thenearly 10 million articles indexed in Medline since its creation. The prevalence of the English language hasgrown steadily since 1966 when it already accounted for53% of these indexed articles up to 89% in 1999, for ayearly increase of 1%. Similar results were found for thearticles specifically pertaining to the field of Urology. Thenumber of the indexed articles in the English language hasgrown to almost 400% since 1966, whereas those writtenin other languages have dropped by 40%. In some countrieslike Holland, Germany or Japan, most of the articles arepublished in English.CONCLUSIONS: If the current trend continues, all thearticles indexed in the Medline database will compriseonly those written in the English language by 2014.
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OBJECTIVE: The correlation betweenleukocytospermia and genital infections remainscontroversial. Similarly, it is inaccurate to consider theincrease of round cells (RC) in semen as leukocytospermia.The purpose of this study was to determine the possible association between round cells, leukocystospermia andbacterial infections in infertile patients.METHODS: 410 semen samples were analyzed todetermine sperm concentration, motility, morphology andround cells according to standard WHO citeria. Immaturegerm cells were differentiated by the Papanicolau stain,while the Nahoum-Cardozo method was used forpolymorphonuclear leukocytes (PMN). Bacteriologicalstudies in semen first urine sprout and urethral secretionwere performed. Gram-Nicolle stain was utilized for thedirect examination. Cultures were made in enriched bloodColumbia agar and Thayer Martin agar was used forcommon germs. For mycoplasma identification, both A7Sheppard solid and liquid media were used. Presence ofChlamydia trachomatis in urethral secretion wasinvestigated by direct immunofluorescence.RESULTS: 79% (324) of the samples were dispermic,9.02% presented more than 106 RC/ml. Of these, only29.7% (11) presented leukocytospermia. Spearman'sranked correlation, used to measure association betweenRC/field and PMN leukocytes/ml, showed a value of0.2705 with an associated probability of 0.1046, indicatinga non-significant association between variables.Bacteriological studies performed in 32 samples showed13 were positive, but only 4 (30.7%) presentedleukocytospermia. Of the 19 samples with negativebacteriology, 15.78% were leukocytospermic. There wasno statistically significant correlation between increasedRC and the presence of germs (χ2: 0.14965, p<0.05) orbetween PMN and germs (χ2: 1.01390, p<0.05).CONCLUSIONS: These data suggest the convenienceof performing bacteriological studies in semen in spite ofthe presence of RC in the direct examination.
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OBJECTIVE: The results obtained in 9female patients who underwent bladder substitution aftera modified anterior pelvic exenteration are presented.METHODS: From 1994 to 1999, 9 women underwentbladder substitution after a modified anterior pelvicexenteration that preserved the two distal thirds of theurethra, the pubourethral ligaments and endopelvic fasciaand limited laterovaginal dissection to preserve theinnervation of the striated sphincter for continence.RESULTS: The bladder capacity was 332.9 ± 35.6 mland urinary flow was 17.7 ± 2.9 ml/sec. Seven patients arecompletely continent and two patients have stressincontinence grade II. None of the patients had difficultywith bladder emptying. Fistula (one case) and diarrhea(one case) were the most important complications.CONCLUSIONS: Our approach is based on a betterunderstanding of the anatomical mechanisms of femalecontinence and the viability of the remaining urethra fromthe oncologic perspective. This technique achieves a highlevel of patient satisfaction and quality of life
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OBJECTIVE: To analyze our results in thetreatment of calculi in renoureteral malformations withextracorporeal shock wave lithotripsy (ESWL) alone andthe efficacy of ESWL and adjuvant methods in the resolutionof calculi in different types of renoureteral malformations.METHODS: The study comprised 141 cases ofrenoureteral malformations with urinary calculi; 68 wererenal, 69 ureteral and 4 in the Bricker urinary diversion.All patients had been diagnosed by IVP and treated byESWL. These patients were compared with a controlgroup of 125 patients with calculi and a normal renoureteralsystem that were treated similarly.RESULTS: The malformations accounted for 2.61% ofthe 5,400 patients that had been treated in our unit from1990-1998. The mean number of sessions for the patientswith malformations was 1.5 versus 1.2 for the controlgroup. The results of treatment were significantly lowerfor the group of patients with renal malformations than forthe control group (54% vs. 87.2%, respectively). Similarresults were obtained for the group of patients withureteral malformations and the control group (87% vs.75%).CONCLUSIONS: ESWL can be the first treatmentoption for calculi in patients with renal malformations,although they should be individually evaluated for status of the excretory system, urinary flow dynamics and size ofthe calculus in order to select the best treatment option. Inpatients with ureteral malformations, the same criteriautilized for those with a normal excretory system should beapplied.
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OBJECTIVE: To determine the efficacy,tolerance and quality-of-life effects of trospium chloridein women with overactive bladder.METHODS: An open, prospective multicenter trial wasconducted on 75 women with urinary incontinence fromoveractive bladder (ICS criteria, urodynamic evaluation).Trospium chloride was administered at a dose of 20 mgtwice daily for 8 weeks. Neurourological examination andcystometry were performed at the start of the trial. Qualityof life was evaluated by analogue visual scales (facesscale) and EUROQOL (health status scale). At the 4thweek, urodynamic, clinical, quality-of-life and toleranceevaluations were performed. Clinical and tolerance dataand quality of life index were assessed at the 8th week.RESULTS: 8 of the 75 patients did not complete thestudy. Thus, analysis of the therapeutic efficacy wasperformed in 67 patients, while description and toleranceanalyses were performed for the overall group of patients.Urodynamic parameters significantly improved at 4 weeks:maximum bladder capacity (232.09 ml pre-treatment vs315.83 ml post-treatment) and first desire to void (100.9ml pre-treatment vs 156.7 ml post-treatment). Incontinenceclinical items also improved. All quality-of-life indixessignificantly increased at the 4 and 8 weeks controlevaluation. Excellent or very good tolerance was observedin 89.5% of the patients.CONCLUSIONS: The results of the study corroboratethe efficacy and tolerance of trospium chloride in themanagement of overactive bladder in women. Improvementin patient quality of life was also observed.
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OBJECTIVE: To describe the mathematicalrepresentation of a common phenomenon: the urinaryflow curve.METHODS: The statistical adjustment for minimumsquares was the method employed in the study.RESULTS: A mathematical expression was obtainedwith a goodness of fit for each flow curve and anacceptable margin of error.CONCLUSIONS: The model which considers the flowcurve as a parabola is not useful since this is an expressionof a statistical phenomenon that varies from case to case.We utilized the minimum squares fit to obtain aregression curve that provides the nearest possiblerepresentation of urinary flow. Furthermore, we considerthe flow curve to be the result of forces that develop in thedetrusor, which produces the complex phenomenon ofvoiding. This study is the first step toward the developmentof a mathematical representation of the urinary flowmechanics.
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OBJECTIVE: To review our series of hypospadias. The incidence of the different types of hypospadias and the complication rates according to the different surgical techniques and materials utilized are analyzed.METHODS: We reviewed our series of 130 patients with hypospadias who underwent surgical correction at the Department of Pediatric Urology from 1993-1998.RESULTS: The patients presented the following types of hypospadias: glandular (13 cases), balano-preputial (56), distal penile (42), mid-penile (9), proximal penile (2) and penoscrotal hypospadias (8). The surgical techniques utilized were the Mickulitz meatotomy procedure (6 ca-ses), MAGPI (24), Mathieu (77), Crawford (5), onlay (7), Duckett (3), Retik (4), Duplay (1), Denis-Brown (2) and penoscrotal transposition (1). The complications commonly observed were fistula (20 cases), hematoma (4), stricture of urethral meatus (4), infection (3), megaurethra (3), skin necrosis (1).CONCLUSIONS: Surgical repair of this developmental anomaly is performed when the patient is approximately 18 months old. In our series 15% of the patients developed fistula, which is similar to the complication rate reported in the literature. However, since we started using monofilament resorbable material, the incidence of fistula has dropped from 20% to approximately 5%. Although other factors are involved, the lower incidence of fistula formation may be largely due to a reduced tissue reaction to foreign body.
Case Report
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OBJECTIVE: To report a case of squamous cellcarcinoma of the bladder, an uncommon tumor type, that presentedwith wide calcified areas. The literature on calcified bladder tumorsis reviewed with special reference to the diagnostic aspects.METHODS/RESULTS: The plain film, US and CT findings arepresented. All the diagnostic imaging techniques demonstratedcalcifications on the tumor surface and the characteristic curvilinearshape of this lesion.CONCLUSIONS: Calcified bladder carcinoma is rare and occursin only 0.5% of the cases evaluated by conventional radiology. Allcalcifications probably arising in the bladder detected on conventionalradiological evaluation should be studied further with other imagingtechniques. If its etiology is unclear, cystoscopy with biopsy and/ora microbiological study should be performed.
Case Report
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OBJECTIVE: A case of spontaneous perirenal hematoma in pelvic kidney in an HIV(+) patient is described.METHODS: The literature on the etiology of spontaneousperirenal hematoma in pelvic kidney is reviewed, with specialreference to the three cases reported in HIV(+) patients.RESULTS/CONCLUSION: The patient presented none of thefeatures described in the literature. The "watchful waiting" approachwas adopted and the outcome was favourable.
Case Report
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OBJECTIVE: To report a case of renal cell carcinoma associated with renal angiomyolipoma and renal cortical adenomaand discuss the possibility of a hereditary etiology.METHODS: A 64-year-old patient with a tumor in the rightkidney underwent right renal nephrectomy. The pathological findingsrevealed a clear cell renal carcinoma, two cortical angiomyolipomaand a renal cortical adenoma. The literature on these three coincidentrenal tumors is reviewed.RESULTS: The association of these three renal tumors is rareand is usually seen in patients with tuberous sclerosis.CONCLUSIONS: Renal angiomyolipoma is a benign tumorfrequently associated with Bourneville’s disease or tuberous sclerosis,a disorder of autosomal dominant transmission. Familial evidenceof renal cell carcinoma has been previously reported, as in vonHippel-Lindau disease. It has been suggested that heredity may playan important role in the association of renal cell carcinoma andother renal tumors.
Case Report
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OBJECTIVE: To report an additional case ofleiomyoma of the bladder and review the literature.METHODS: A case of leiomyoma of the bladder is presented. Itsetiopathogenesis is described and the literature briefly reviewed,with special reference to the differential diagnosis.RESULTS/CONCLUSIONS: Leiomyoma of the bladder is anuncommon benign tumor that must be distinguished from otherlesions. Treatment is by surgery, which generally achieves goodresults.
Case Report
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OBJECTIVE: To describe an additional case of a large retroperitoneal liposarcoma.METHODS/RESULTS: A case of a large retroperitoneal liposarcoma in a young male is presented. Treatment was by surgery. The clinical and pathological features, diagnosis, course and treatment of this lesion are discussed.CONCLUSIONS: Retroperitoneal tumors constitute a heterogeneous group of uncommon neoplasms of unknown etiology. Liposarcoma is the most frequent lesion in this group. It is usually asymptomatic and is often identified by the presence of a large abdominal mass. It is considered to be a peculiar lesion because of its biological and morphological features and course.
Case Report
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OBJECTIVE: To present a case of tubular renal adenocarcinoma associated with transitional cell carcinoma of the bladder.METHODS/RESULTS: A case of tubular renal adenocarcinoma associated with transitional cell carcinoma of the bladder in a 42-year-old patient is described. Patient evaluation included intravenous urography, nephrotomograms, renal and bladder ultrasound evaluation and cystoscopic examination with biopsy. The patient underwent nephroureterectomy and partial cystectomy with subsequent radiotherapy and intravesical chemotherapy. At two-years follow-up, there is no evidence of disease progression.CONCLUSIONS: The appearance of various early-stage urological tumors in the same patient. is uncommon. Although a review of the literature showed that these cases were considered a medical curiosity, it should be taken into account that there is an increasing number of new cases.
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OBJECTIVE: To evaluate the efficacy oftamoxifen in the treatment of idiopathic retroperitonealfibrosis in one patient and to review the results reportedin the literature.METHODS: A 68-year-old man with idiopathicretroperitoneal fibrosis and obstructive acute renal failurewas admitted to our department. Bilateral ureteral stentswere placed and tamoxifen 20 mg daily p.o. was started.RESULTS: The ureteral stents were removed five monthsafter tamoxifen therapy. IVP demonstrated normalappearance of the ureters nine months after medicaltreatment. An MRI scan showed an important decrease ofthe fibrotic periaortic mass at 12 months and then westopped tamoxifen.CONCLUSIONS: Actually tamoxifen represents anattractive and safe choice of medical treatment forretroperitonea fibrosis, particularly in the acute stages.Neverthless, the duration of treatment, the effectivenessand the persistence of the results are still uncertainbecause few cases have been reported in the literature.
