OBJECTIVE: To determine the secretorexpression in patients with bladder cancer, adenoma ofthe prostate and normal subjects.METHODS: The secretor character was determined insaliva of normal subjects (n = 40), patients with bladdercancer (n=61) and adenoma of the prostate (n=44) by thetechnique of hemoagglutination inhibition.RESULTS: 80% of the normal subjects were found to besecretors, which is in agreement with the data reported inthe literature. Only 23 (37.71%) of the patients withbladder cancer were secretors and 24 (54.54%) of thepatients with prostate adenoma expressed the secretorgene.CONCLUSIONS: The expression of soluble antigensdecreased in patients with bladder cancer or prostateadenoma in comparison to the normal subjects. Deletionof ABH antigens in the membrane of tumor cells has beenreported in other studies. This lack of expression resultsfrom a genetic alteration in the clones involved in tumorpathology. The decrease in soluble antigens in the patientgroups analyzed might be due to the same mechanism ofgenetic alteration that could involve non tumor tissues.Most of the cancers in humans originate in epithelial cellsand the changes in blood group antigens constitute animportant aspect in tumor immunology.
OBJECTIVE: To review the literature onartifical urinary sphincters, to describe their function,technique of implantation, indications, results andcomplications, and to analyze the possible utility of theprosthesis in the treatment of stress incontinence.METHODS: Medline (Index Medicus Online) andEmbase (Excerpta Medica Online) were accessed to reviewthe literature on artificial urinary sphincters publishedfrom 1974 (when the first artificial urinary sphincter was described by Foley) to October 1999. Of 322 articlesidentified, only those that described the patient selectioncriteria, type of prosthesis utilized, results andcomplications, and mean follow-up were considered.Articles describing historical aspects and new prototypeswere also reviewed. Papers by the authors of the presentarticle were excluded to avoid the bias of author preference.The bias of the language barrier, which occurs whenarticles published in Spanish, English and French arereviewed, was minimum.RESULTS: The AMS-800 is the only model availabletoday. The results achieved are excellent if the indicationis correct and perioperative management is careful andexact. The ideal candidate is one with genuine stressurinary incontinence and normal bladder function,although hyper or hyporeflexia is not an absolutecontraindication if corrected before, during or afterinsertion of the prosthesis. The surgical technique isrelatively simple and the only difficulty consists in thechoice of the appropriate cuff and reservoir. Thecomplications include urethral atrophy, erosion, infectionand bladder instability, and are less frequent in womenwith strress urinary incontinence type III and in menincontinent after prostate surgery, and more frequent inpatients with incontinence following pelvic trauma,incontinence due to congenital malformation and thosewith a neurogenic bladder. The mechanical failures of theprosthesis have diminished with its improved design. Newhydraulic and non-hydraulic prototypes have been designedto reduce the complications, but the results are as yetunavailable.CONCLUSIONS: Today, patients with stress urinaryincontinence have more possibilities to recover continence.If incontinence persists after all the available medical andsurgical options have been attempted, one possibility stillremains: the artificial urinary sphincter.
OBJECTIVE: To analyze the impact ofprostatic symptoms and to identify the factors associatedwith the problems caused by these symptoms.METHODS: A descriptive, transverse study wasconducted on 133 patients. The problems arising fromprostatism were analyzed by means of a self-administeredquestionnaire, using the Symptomatic Prostatic Index(SPI), which was compared with the International ProstateSymptom Score (I-PSS), uroflowmetry, morbidity,medication required and sociodemographic variables.The reliability and consistency of the SPI scale were analyzed and the variables associated with a greaterimpact of prostatism were determined by linear regressionanalysis.RESULTS: Patient mean age was 68.8 years. Meanscores were 20.1 and 4.75 for the I-PSS and IQL item,respectively. Mean and maximum urinary flow were belowthe 50th percentile in 95.2%. A high correlation was foundbetween the items of the SPI questionnaire and betweenthe items and the total score. The SPI scale showed a highdiscriminating power (δ = 0.95) and internal consistency(α = 0.82), and factorial analysis showed only one factoraccounted for the 49.05% total variance. The SPIquestionnaire score was 15.5 and involved the irritativesymptoms, basically nocturia, proportionally more thanthe obstructive symptoms (p<0.0001). A direct correlationwas found between the higher SPI score and the severityof the prostatic symptoms (p<0.0001) and, consequently,a worse quality of life (p<0.0001). Younger patientstolerated the symptoms poorly (p = 0.002). Linearregression analysis confirmed that tolerance was worse inthe younger patients with more severe symptoms and noother disease (r2 = 0.43, p<0.0001).CONCLUSIONS: The impact of prostatism increasesaccording to its severity, particularly for the irritativesymptoms, basically nocturia. Psychological factors mayprobably affect the variability of patient tolerance,indicating that the decision for treatment of BPH might bebased on the problems it may cause and the impact on thequality of life more than on the severity of the symptoms.
OBJECTIVE: To determine the value ofhigh grade prostatic intraepithelial neoplasia (with orwithout the influence of certain risk factors) in predictingprostate cancer in subsequent biopsies.METHODS: The study comprised 41 patients from aprostate cancer screening program with high gradeprostatic intraepithelial neoplasia. Subsequent biopsieswere reviewed and the probability of detecting prostatecancer was calculated. We analyzed the influence of age,DRE and transrectal US findings, PSA levels and PSAdensity on the results of the repeat biopsies.RESULTS: The patients were aged 50 to 83 years (mean62.8 ± 1.6 SD, median 61). Only 27 of the 41 patients withhigh grade prostatic intraepithelial neoplasia accepted arepeat biopsy. Of these, prostate cancer was demonstratedin 11 (40.7%; all cases were clinically localized at thetime of diagnosis) and 16 showed no changes (59.3%) onrepeat biopsy. By univariate and multivariate analysis,patient age, DRE and transrectal US findings, PSA levelsand PSA density were not found to be predictors of cancerin the subsequent biopsies.CONCLUSIONS: The finding of high grade prostaticintraepithelial neoplasia in the prostate biopsy carries ahigh probability of detecting cancer in subsequentbiopsies. We therefore advocate performing a repeatbiopsy in these patients.
OBJECTIVE: To determine the telomeraseactivity in urine samples of patients with superficialbladder cancer, its sensitivity and specificity as a tumormarker, and possible implications for prognosis, diagnosis and therapeutic efficacy.METHODS: Urine samples of 50 patients with superficial bladder cancer were analyzed. Telomerase activitywas determined by TRAP (telomeric repeat amplificationprotocol). Standard urinary cytology, urine culture andurinary sediment analysis were performed, as well as apathological analysis of the surgical specimen.RESULTS: 84% of the patients were positive fortelomerase activity and only 52% had a positive cytology.Telomerase activity showed a sensitivity and specificity of73.6% and 92.7%, respectively, versus 53.2% and 81.8%for urinary cytology. The degree of cell differentiationand, to a lesser extent, bladder wall infiltration showeddifferences in comparison with conventional urinarycytology.CONCLUSIONS: Telomerase activity can be determinedin voided urine samples of patients with superficial bladdercancer. It has a higher sensitivity and specificity thanconventional urinary cytology and is a good marker fordiagnosis and follow-up of these patients.
OBJECTIVE: To determine the utility of p185 oncogene in the biological characterization of transitional cell carcinoma and in the prediction of recurrence, and to analyze survival at 5 years mean follow-up. METHODS: A prospective clinical cohort study was conducted on 81 patients. Tissue specimens were obtained between November 1992 and November 1993. The study comprised two groups: nontumoral bladder tissue specimens from 20 patients (group I) and tissue specimens from 61 patients with bladder carcinoma (group II). p185 expression was determined by enzyme immunoanalysis (EIA). A statistical analysis of the results was performed. RESULTS: p185 oncoprotein levels were higher in patients with recurrence (1098.97 HNU/mg protein vs. 924.54 HNU/mg). Although higher levels of p185 were found in the patients that had died vs those who are alive, the differences were not statistically significant for overall survival or stratification by tumor grade or infiltration (p = 0.556; ns). CONCLUSIONS: Determination of p185 oncoprotein was found to be useful in the prediction of tumor recurrence at 5 years mean follow-up.
OBJECTIVE: To report on a female patientwith metachronous bilateral Wilms’ tumor with a longsurvival.METHODS: An 11-year-old girl underwent totalnephrectomy when she was 4 years old for Wilms’ tumorof the right kidney. She received cobalt therapy andchemotherapy, and the evolution was good for three years,at which time a control US scan detected a tumor in the leftkidney that was diagnosed as Wilms’ tumor. She underwenta partial nephrectomy at the Hospital Pediátrico deCentro Habana (Cuba) and received chemotherapy.RESULTS/CONCLUSION: A recent US scan and adescending pyelogram showed completely normal findingsand growth of the remaining renal parenchyma. Thepatient is alive and well 7 years and 8 months later.
OBJECTIVE: A case of lobar nephronia ina child is presented.METHODS: Herein we describe a case of acute lobarnephronia in a 10-year-old boy. The clinical, diagnosticand therapeutic aspects are discussed.RESULTS/CONCLUSIONS: Acute lobar nephronia oracute focal bacterial nephritis is an uncommon form ofpyelonephritis that can affect both adults and children,although few cases have been reported in children. Imagingtechniques are necessary for diagnosis and to distinguishit from other conditions, such as abscess or renal massesthat require a different treatment. Ultrasound is the imagingtechnique of choice in the diagnosis and follow-up of lobarnephronia.
OBJECTIVE: To report our experience inthe treatment of recurrent urethral stricture in the malewith the Memotherm® heat-expansible stent.METHODS: From December 1995 to March 1999, theMemotherm® heat-expansible stent was utilized in 4patients with urethral stricture that had undergoneurethrotomy procedures, periodic urethral dilatation andin those cases with post-traumatic stricture, open surgeryfor urethroplasty and urethral reattachment. All patientshad multiple recurrences of the urethral stricture that wasnot amenable to the treatments utilized, therefore theintraurethral stent was inserted.RESULTS: All patients had a good postoperative course with unhampered voiding and ample stream. The patientswere followed in the outpatient setting by a 6-monthlyassessment of micturition and a yearly endoscopic controlevaluation to detect hypertrophic growth of the urethralmucosa and/or intraluminal calcification. All the stentswere completely enveloped in the urethral wall 12 monthsafter insertion. The only side effects observed was limitedpostvoid leaking during the first few months followinginsertion of the prosthesis and one case of transienthemospermia.CONCLUSIONS: The Memotherm® intraurethral heatexpansiblestent is a valid treatment option for selectedcases of recurrent urethral stricture. Although thisapproach can be utilized before performing urethroplasty,which is often a complicated technique with uncertainresults, currently it is a valid treatment option in case offailure.
OBJECTIVE: To report a case of extraadrenalpheochromocytoma with special reference to the diagnostic andtherapeutic aspects.METHODS: A case of extraadrenal pheochromocytoma in a 20-year-old female with severe hypertension is presented. The clinicaland biochemical aspects are reviewed with special reference to thediagnostic imaging methods.RESULTS: Plasma noradrenaline and urinary normetanephrinelevels were elevated. CT and MRI showed a well-defined mass, 6 cmin diameter, adjacent to the left kidney, abdominal aorta and psoasmuscle. Angiography demonstrated a high vascularization in thearea of the tumor. MIBG scintigraphy revealed a well-defined mass,but no other distant lesions. Surgical treatment was performed withpreoperative alpha and beta adrenergic blockade. Currently thepatient has a normal blood pressure and catecholamine levels, withno evidence of lesions on the MIBG scintiscan.CONCLUSIONS: Plasma catecholamine and urinarynormetanephrine levels levels confirmed the presumptive diagnosisof pheochromocytoma. MIBG is the technique of choice for thelocalization of the mass and suspected metastases. CT, MRI andangiography demonstrated the anatomic relationships of the tumor.The best results are achieved with complete resection and preoperativeadrenergic blockade.
OBJECTIVE: To discuss the clinical presentation,complementary evaluation procedures and treatment of ileovesicalfístula, an uncommon complication of Crohn’s disease.METHODS/RESULTS: After the clinical presentation,complementary evaluation procedures were performed to confirmthe diagnosis in all cases. Treatment was based on the patient’sgeneral condition; surgery was performed in two cases and one casewas carefully followed.CONCLUSIONS: Ileovesical fístula is an uncommon complicationof Crohn’s disease. Occasionally, the urological symptoms mayprecede the digestive symptoms, therefore this condition should besuspected particularly if the complementary evaluation proceduresare not very sensitive. Surgery is the treatment of choice.
OBJECTIVE: To review the pathogenesis, clinicalfeatures and treatment of a rarely observed site of presentation ofhydatid cyst.METHODS/RESULTS: A case of an isolated retroperitonealhydatid cyst is presented. Diagnosis was based on the immunodiagnostic test and radiological examination. Treatmentwas by surgery.CONCLUSIONS: Isolated retroperitoneal hydatic cyst is rare.The abdominal mass is the most frequent sign, and less frequently,concomitant compressive syndrome. Diagnosis is based on thebiological examinations, percutaneous puncture and radiologicalfindings. Treatment is by surgery. Azoles are useful for intraoperativeruptured cysts and to reduce the risk of recurrence.
OBJECTIVE: A case of a nonfunctioning ectopicadrenal tissue tumor in the epipidymis is described.METHODS/RESULTS: A case of a nonfunctioning ectopic adrenaltissue tumor in the epipidymis is presented. A left testicular mass hadbeen incidentally detected in this patient.CONCLUSIONS: Tumors of this type localized in thejuxtafuniculogonadal region are usually benign. However, resection and histological analysis are always indicated in order to detectmetastasis or confirm the histiological type is normal.
OBJECTIVE: To describe a case of epithelial cellparatesticular carcinoma of the epididymis and briefly review theliterature on this tumor type.METHODS/RESULTS: A 69-year-old male consulted for atesticular mass and intrascrotal pain, together with irritative bladdersymptoms. The patient underwent orchidectomy, but consulted againshortly thereafter for persistent irritative bladder symptoms. A TURbiopsy of the bladder wall demonstrated undifferentiated carcinomaarising from the epididymis. The patient did not respond tochemotherapy. He developed systemic metastasis and died 4 monthsafter the diagnosis.CONCLUSIONS: Carcinoma of the epididymis is a rare malignantparatesticular tumor arising from the epithelial cells with a very poorprognosis. Its clinical features are unspecific and this tumor typeshould be taken into account when making differential diagnosisfrom intrascrotal masses arsing from other causes. Due to the rarityof this disease, it has not been possible to identify treatments thatmight achieve better results.
OBJECTIVE: An uncommon case of Fournier’sgangrene following vasectomy is described.METHODS/RESULTS: A 35-year-old male with no remarkableprevious history, who underwent vasectomy in another hospital,developed a clinical picture compatible with Fournier’s gangrene7-8 days later. The patient required wide, aggressive surgicaldebridement on several occasions with broad spectrum antibioticcoverage. After a long stay at the hospital, the patient was finallydischarged and referred to another hospital for plastic surgery.CONCLUSIONS: Fournier’s gangrene is a polymicrobial infectionof the perineoscrotal region that manifests as a rapidly progressivenecrotizing fasciitis. Most of the cases have a predisposing and/ortriggering factor. Fournier’s gangrene following vasectomy isuncommon. The morbidity and mortality in this severe complicationdepend on early diagnosis and aggressive surgical management.
OBJECTIVE: To describe a case oftraumatic rupture of renal angiomyolipoma (AML).METHODS: The images and clinical data of the presentcase are presented.RESULTS: A rare case with exuberant clinicalpresentation of a perirenal hematoma resulting fromtraumatic rupture of renal AML is presented with a briefreview of the role of ultrasound (US) and body-CT in thediagnosis of this pathology and its complications.CONCLUSIONS: Whenever there is a collectiondetected by US in the various anatomic renal spaces, in apatient with flank pain and low hemoglobin shortly afterabdominal trauma, it is advisable to perform abdominalCT and search for a hematoma. Small amounts of fat,detected by US and body-CT, may lead to the diagnosis ofan underlying AML that can rupture, even in the caseminor forces are applied to the kidney.