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OBJECTIVE: To study the phenomenon ofbiomineralization in an experimental model oflithogenesis by percutaneous renal punction without mueslaparotomyand no antibiotics.METHODS/RESULTS: The study comprised 4 Brown-Norway rats. Nanobacteria inoculum (X, 2X and 4X) wasadministered to three rats and the remaining one was usedas control. The analytical and radiological findingsshowing the development of obstructive pyelocaliceallithiasis in the kidneys of rats no. 2 and 3 are presented.CONCLUSIONS: Translumbar percutaneous renalpuncture has permitted performing laparotoy withoutantibiotic coverage, which was the main difficulty of theexperimental model of lithogenesis. Nanobacteria werecultured successfully, but not without difficulty, andformation of calculi in the rat pyelocaliceal system wasachieved. This experimental model will provide furtherinsight into lithogenesis and will allow us to find theanswers to some of the many questions concerning thiscondition that remain.
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OBJECTIVES: The present study was conducted to determine the efficacy of NMP-22 as a diagnostic test for recurrence of bladder tumors and to compare its efficacy with urine cytology. METHODS: 30 patients (25 male, 5 female), aged 41 - 87 years (mean 73.4), with bladder tumor were evaluated by cytology, cystoscopy and determination of NMP-22 at 3 and 6 months post-TUR of the bladder. A positive test was defined as NMP-22 greater than 10 U/ml. RESULTS: 80.7% were T1, 15.3% T2-T3, 76.8% were grade I and II, and 23.2% were grade III. NMP-22 showed a sensitivity of 69%, a specificity of 64%, a positive predictive value of 52% and a negative predictive value of 78%, using tumor recurrence at 3 and 6 months as the unit of analysis, for a recurrence rate of 36%. Cytology showed a sensitivity of 44%, a specificity of 92%, a positive predictive value of 77% and a negative predictive value of 74%. When both tests were used, we obtained a sensitivity of 87.5%, a specificity of 64.2%, a positive predictive value of 58.3% and a negative predictive value of 90%.In grade I tumors, determination of NMP-22 had a sensitivity of 100%, a specificity of 77.7%, a positive predictive value of 60% and a negative predictive value of 69%. CONCLUSIONS: NMP-22 showed an acceptable sensitivity but a low positive predictive value, therefore control cystoscopic evaluation cannot be avoided. The sensitivity and negative predictive values increased when NMP-22 and cytology are used in combination. We found NMP-22 to be a very useful marker for recurrence of low grade tumors.
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OBJECTIVE: The pathogens responsible for urinary infection originate from the digestive tract prior passage through the genital region. Samples were obtained from this region in an attempt to identify women with these pathogens. We have analyzed the most frequently colonized areas of the genital region in order to develop a method for obtaining samples. Risk factors were evaluated by determining the relationship of the samples with factors implicated in the pathogenesis of recurrent infection.METHODS: Samples were obtained from 146 women of all ages that consulted for recurrent urinary tract infection. The samples from the genital region (perimeatal vulva, vagina, urethral and intraurethral meatus) and urine obtained through a catheter were cultured.RESULTS: The overall incidence of positive samples was 41%; 23% of the patients showed urinary infection (urine obtained by catheterization) at the time the samples were taken. The vaginal samples were the most frequently colonized and the intraurethral samples were the most sensitive when compared with the urinary samples. The sensitivity, specificity, positive and negative predictive values of these two samples were the same as those of the other samples together. In regard to colonization, a difference was found only between menopausal and premenopausal women, and in proportion to the duration of the history of infection.CONCLUSIONS: The study shows that it is unnecessary to obtain various samples; vaginal and intraurethral smears are sufficient. Menopausal women who referred two symptomatic episodes a year were found to be at a higher risk for vaginal infection, and in proportion to the number of years they have had recurrent infection.
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METHODS: From November 1992 toNovember 1993, a prospective study was conducted on 20controls and 61 patients with bladder carcinoma. EGFRexpression was determined by radioimmunoassay and thecorrelation of the results of histological analysis and theclinical course was analyzed. The follow-up period wasfrom November 1992 to July 1998. The association betweenqualitative variables and the x2 or Fisher exact test wascompared using the hypothesis of the proportional ordinaltrend for the ordinal variables, and the quantitativevariables were analyzed using Student’s t test and/orvariance analysis (ANOVA). Survival was analyzed by theKaplan-Meier method and comparison was performedusing the Breslow exact test. The Cox proportional hazardsregression model was utilized. The SPSS software forWindows 7.0 was used for the analysis.RESULTS: The EGFR values were higher for patientswith bladder carcinoma than in controls (14.48 vs 2.54fmol/mg of protein). EGFR values were higher in patientswith superficial bladder tumor than in those with infiltratingtumors (27.03 fmol/mg vs. 10.05 fmol/mg of protein; p =0.000). Poorly differentiated tumors showed higher valuesof EGFR (6.73, 14.48 and 17.07 fmol/mg of protein forgrades I, II and III, respectively; p <0.05). The EGFRvalues were higher in patients that died from cancerduring follow-up (64.8) than in those who died from othercauses (47.5) and those who are alive and on follow-up(42). An increase in EGFR values did not carry a risk ofdeath from cancer (p = 0.1269; ns). Analysis of the gradeof tumor differentiation showed that for the more aggressivetumor grade, a positive EGFR was a sign of reducedsurvival. Survival in patients with superficial andinfiltrating tumor did not appear to change significantlyaccording to the EGFR value. EGFR determination wasnot useful in predicting recurrence and increased EGFRvalues did not correlate with a higher risk of recurrence.CONCLUSIONS: 1) The normal pattern of EGFRcould not be established. 2) EGFR was not useful inidentifying subgroups at risk of death. 3) Knowledge aboutthese proteins synthesized by oncogenes offers newpossibilities in the treatment of cancer.
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OBJECTIVES: To determine the clinicalutility of free / total PSA ratio and PSA density in the earlydiagnosis of prostate cancer (patients with serum PSAbetween 4 and 10 ng/ml) and to determine the diffferences,if any, in the free / total PSA ratio in patients with cancerand those with benign prostatic hyperplasia (BPH).METHODS: A prospective and descriptive study wasconducted on 61 patients with low grade obstructivesymptoms and total serum PSA between 4 and 10 ng/ml(group 1), and 42 patients who underwent prostate surgeryand had an anatomopathologically confirmed diagnosisof BPH (group 2).Free and total PSA were determined, as well as prostatevolume by transrectal US, in all cases. Prostate biopsywas performed in all patients with a total PSA valuebetween 4-10 ng/ml. The sensitivity, specificity, positiveand negative prognostic values of free / total PSA ratioand PSA density were analyzed.RESULTS: The mean age of the patients in group 1 was67.7 years and 68.3 years in group 2. The mean prostatevolume by US was 55.2 and 47.1, respectively (n.s.). Themean total PSA was 6.39 ng/ml for group 1 and 5.73ng/ml for group 2 (n.s.). No significant difference wasfound between the mean free PSA values of both groups.However, the free / total PSA ratio and PSA density weresignificantly different (p< 0.000). In group 1 (total PSA 4-10 ng/ml), prostate biopsy was positive in 32.8% of thepatients. In this group of patients, there were no significantdifferences in the parameters analyzed.Application of different cutoffs for both tests showed ahigher clinical utility for the 0.24-0.30 range.CONCLUSIONS: At similar mean prostate volume andmean total PSA, significant differences were found in thefree / total PSA ratio and PSA density of patients submittedto surgery for BPH and those with a total PSA value of 4-10 ng/ml. However, these results were not observed whenpatients with PSA of 4-10 ng/ml were analyzed for presenceor absence of evidence of malignancy in the prostatebiopsy.
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OBJECTIVES: To analyze the incidence oflithiasis and stone composition in our setting. The trend iscompared with the results of the majority of studies onurinary calculi reported in the literature based on thenumber and composition of stones.METHODS: The study comprised patients referred tothe Urolithiasis Unit of our hospital over the last 21 years.Stone composition was analyzed by infra-red spectroscopy.The study period was divided into 4 time intervals: 1977-1979, 1977-1980, 1977-1987 and 1977-1998 in order todetermine the trends of the incidence of lithiasis in oursetting.RESULTS: A total of 5516 patients were reviewed; ofthese, 766 had recurrence. The distribution was 385, 995,3378 and 5516, respectively. Calcium oxalate calculishowed an incidence of 61.3%, calcium phosphate 18.5%,uric acid 11.2%, infectious calculi (ammonium urate andammonium magnesium phosphate) 6.6%, and finally theincidence of cisteine calculi was 0.77%. Concerning thedistribution according to sex, 62% of the males hadcalcium oxalate stones, 68% uric acid, 42.5% phosphateand 45% infectious lithiasis. The trends for uric acid,infectious, oxalate and phosphate calculi changed overtime.CONCLUSIONS: There is a clear trend of calculiprevalence in the male, particularly oxalate and uric acidcalculi. There is a trend for cisteine calculi to remain thesame, calcium phosphate and oxalate calculi to increase,and uric and infectious calculi to decrease. The changesobserved may be due to dietary changes and improvementin the quality of life.
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OBJECTIVE: To determine if menopauseincreases the risk of developing bladder hyperactivity orstress urinary incontinence.METHODS: A case control study was conducted on111 women, 57 with bladder hyperactivity and 54 controlswithout hyperactivity, and 55 cases with stress urinaryincontinence and 55 controls without stress urinaryincontinence. The results were analyzed by multivariantlogistic regression for the influence of age.RESULTS: A relationship was found between age andmenopause and the risk of developing stress urinaryincontinence. No relationship was found between bladderhyperactivity and age or menopause. Age was found to bea negative factor of menopause in regard to the risk ofdeveloping stress urinary incontinence.CONCLUSIONS: The risk of developing stress urinaryincontinence in menopausal women decreases with ageand disappears after age 52.
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OBJECTIVES: Our results in the treatmentof distal ureteral calculus with pulsed dye lasertripsy(Pulsolith) and the EKL-Compact (Olympus) electrokineticlithotriptor are analyzed.METHODS: The time interval compared was 12 months for both cases; lasertripsy was utilized in 57 andelectrokinetic energy in 61 cases. All patients underwentIVP or radiological and/or US evaluation of the urinarytree to determine the size and location of the calculus, anda complete routine presurgical assessment. Epiduralanesthesia was administered in all patients, as well asprophylactic antibiotics. The approach and endoscopictechnique using the 7.9-9.8 FR ureteroscopes (Olympus),stone removal with long forceps and ureteral dilatationwith the Uromat hydraulic pump are described. All but 9patients had a 5 FR catherter indwelling for 24 hours toavoid the postureteroscopy colic pain caused byperilithiasic ureteral edema.RESULTS: Our success rate was 93% for both modalitiesof stone fragmentation. Fragmentation with ultrasoundwas required in 4 cases of failed lasertripsy and 3 cases offailed lithotripsy with electrokinetic energy.There were 7 cases with mucosal laceration fromureteroscope insertion and punctate mechanicalperforation of the ureteral mucosa produced by the laserfiber. There were no complications with the use of EKL-Cexcept for small areas of petechiae.CONCLUSION: Analysis of our results for bothtreatment modalities, as well as their advantages anddisadvantages, showed stone fragmentation with the EKL-C to be the treatment of choice. We have utilized thissystem in our unit since December 1994 because of itsefficacy. Furthermore, it is easy to use, to transport insideand outside the hospital, easy to assemble and low-cost
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OBJECTIVES: It has been widelydemonstrated that there is an increased level of spermautoantibodies (SAA) in infertile than in normal fertilemen, suggesting this could be a cause of infertility. Thisstudy was designed to correlate the direct agglutinationmethods of TAC II (a kit developed and validated by ourstaff) and the MAR-Screen (Fertility Technologies, NatickM.A., Bioscreen Inc.).METHODS: 645 semen samples from patients whoconsulted for infertility at the Infertility and Urologyservices of the Provincial del Centenario and Eva Perónde Granadero Baigorria teaching hospitals in Rosario(Argentina) and 30 fertile controls were analyzed.RESULTS: Statistical analysis showed a sensitivity of87%, a specificity of 100%, a positive predictive value of100% and a negative predictive value of 98% for TAC II.CONCLUSIONS: We recommend the use of TAC II. Ithas similar methodological characteristics as the MAR-Screen method and offers some advantages, such as thepossibility to perform analysis on frozen sperm samplesand oligospermic patients, since it is not necessary for thespermatozoa to be moving. Furthermore, the test has a higher immunological specificity because spermatozoaare washed
Case Report
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OBJECTIVE: Four additional cases of nephrogenic adenoma are described.METHODS: The clinical records of patients with nephrogenic adenoma that had been diagnosed at our hospital from 1994 to 1999 were reviewed.RESULTS: The most frequent localization was the urinary bladder and it was more prevalent in middle-aged men. This condition usually presented as a histological finding in the course of follow-up or treatment of other bladder conditions by TUR or cystectomy. Biopsy is fundamental for diagnosis.CONCLUSIONS: Nephrogenic adenoma is a rare benign metaplastic lesion of the urinary tract that appears to result from chronic irritative stimulus to the urothelium. The treatment of choice is by transurethral resection. Although no case of progression to malignancy have been detected, long-term follow-up by endoscopy and ultrasound is advocated due to its predispositon to recurrence.
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OBJECTIVE: To report a case of scrotal calculus in a hydrocele, attached to the parietal portion of the tunica vaginalis, complicating the differential diagnosis.METHODS: A 54-year-old patient with a clinical diagnosis of hydrocele is described. Ultrasound confirmed the diagnosis and demonstrated a calcified structure in the hydrocele fluid, attached to the parietal portion of the tunica vaginalis. A calculus of 1.7 cm diameter was found during the surgical procedure.CONCLUSION: The presence of calculus in a hydrocele does not change the prognosis or treatment of this condition, although some doubts may arise during sonographic assessment if it is attached to the parietal portion of the tunica vaginalis.
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OBJECTIVE: To report a case of retroperitonealbronchogenic cyst, an anomaly during the development of theprimitive anterior intestine from which the bronchi and lungs aredeveloped.METHODS/RESULTS: A 38-year-old male presented with leftlumbar pain. Patient evaluation disclosed a left adrenal polycysticmass which was removed by surgery. Pathological analysis of thesurgical specimen demonstrated a bronchogenic cyst. This case iscompared with some of the few cases reported in the literature.CONCLUSIONS: Retroperitoneal bronchogenic cyst is a cause ofretroperitoneal tumors in the splenic or hepato-renal region. Althoughit is uncommon, it should be taken into account when making thedifferential diagnosis.
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OBJECTIVE: An uncommon variant of penile tumorassociated with chronic lymphoid leukemia is presented.METHODS/RESULTS: A case of primary melanoma of the penisassociated with chronic lymphoid leukemia is presented. Diagnosiswas based on the anatomopathological findings. Lymph nodeinvolvement could not be determined due to the associated leukemia.Conservative management was instituted due to the patient’s age.CONCLUSIONS: Primary melanoma of the penis is a veryaggressive and uncommon tumor. To our knowledge, less than 140cases have been reported. Hyperpigmented lesions must be biopsiedto rule out melanoma.
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OBJECTIVES: To report two cases of metachronicadrenal metastasis (one contralateral and the other bilateral) fromrenal cell carcinoma with long survival.METHODS: Two patients with clear cell renal carcinoma thatdeveloped metastasis to the adrenals are described. Each patient hadundergone three operations for solitary metastasis during the 8-years follow-up. The indications for the surgical management ofsolitary metastasis, morbidity, prognosis and recent investigationaltreatment possibilities reported in the literature are analyzed.RESULTS: Resection of the renal cell carcinoma achieved asurvival of more than 8 years with a good quality of life and nosignificant surgical complications. The outcome, however, is poor.CONCLUSIONS: Although there was no lymph node involvementand the tumor was localized to the renal parenchyma, one patientdeveloped solitary lung metastasis and contralateral adrenalmetastasis 4 and 8 years after the initial diagnosis, respectively. Inthe other case, contralateral adrenal metastasis appeared threeyears later. The possibility of long-term metastasis to the adrenalgland should be taken into account due to renal vein involvement.Preservation of the adrenal gland at the initial surgery (lower poletumor) led to adrenal metastasis 8 years after the initial diagnosis.The prognosis is poor in both cases and the situation is discouragingfor the urologist.
Case Report
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OBJECTIVE: A case of granulomatous epididymitisis presented.METHODS: A 23-year-old patient consulted for nonspecific painin the left supratesticular region. Physical examination showed a hard, indolent, enlarged epididymis. An ultrasound scan revealednormal testes with small bilateral hydrocele and left epididymalenlargement with calcifications. Resection was performed via theinguinal approach.RESULTS: The histopathological analysis demonstrated intensegranulomatous reaction with multinucleated giant cells and foci ofspermatozoal remnants. Staining for fungi and acid-fast bacilli werenegative.CONCLUSION: The condition was diagnosed as nonspecificgranulomatous epididymitis.
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OBJECTIVE: To report a case of multiple urethralcalculi, an uncommon urological condition in our setting. Theclinical, radiological and therapeutic aspects are discussed and theliterature is briefly reviewed.METHODS/RESULTS: A 77-year-old male consulted at theemergency services of our hospital for dysuria, pollakiuria anddifficulty in voiding. The patient also referred and indurated area inthe penile ventral aspect. Radiological examination disclosed threecalculi in the penile urethra with were successfully removed bymeatotomty and urethrolithotomy. The patient is currentlyasymptomatic.CONCLUSIONS: Urethral calculus is uncommon in developedcountries. "Milking" is not advocated due to the high incidence ofurethral injury. Treatment is by simple urethrolithotomy incombination with other techniques (urethroplasty, diverticulectomy,etc.), if required.
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OBJECTIVE: To establish the utility of endoscopic sclerotherapy using 1% ethoxysclerol for the control of intractable hematuria following post-irradiation telangiectatic cystitis (PTC). METHODS: Our experience of treating 4 patients (one female and three male) with massive exsanguinating hematuria resulting from PTC, using a combined intralesional and perilesional injection of 1% ethoxysclerol, is presented. Observation on the distribution, grading of telangiectasis and pattern of bleeding are made. RESULTS: A dramatic and lasting cessation of the hematuria in all the 4 patients was achieved during the follow-up period varying from 1 month to 4 years. CONCLUSION: Endoscopic injection sclerotherapy is a simple, highly effective, less invasive new technique in the management of massive and intractable hematuria due to radiation-induced telangiectasia of the urinary bladder.
