OBJECTIVE: This study was conducted to analyze ABH antigenic expression in urinary sediment of patients with benign prostatic hyperplasia (BPH) before and after deobstructive surgery. METHODS/RESULTS: The agglutination inhibition technique was utilized to determine the ABH antigenic expression in urinary sediments of 30 healthy subjects and 34 patients with BPH. The presence of neoplastic cells was also determined in urinary sediments of the patients by Papanicolaou’s stain. These studies were performed before and 12 months after surgery. Membrane antigen expression was found in 100% of the healthy subjects and in only 50% of the patients with BPH before surgery. Only 25 patients returned for control evaluation after surgery. Of these, 17 were positive and of the remaining 8 patients who were negative preoperatively, only one continued to be negative. Urine cytology demonstrated progression to malignancy in this patient. CONCLUSIONS: Determination of ABH antigenic expression appears to be able to identify premalignant conditions and could be a useful complementary diagnostic method to cytology.
OBJECTIVE: Since its discovery as amarker for prostate cancer, there have been many attemptsto enhance the diagnostic efficacy of the prostate specificantigen (PSA). Among these are the studies that analyzethe behavior of different forms of serum PSA bound todifferent antiproteases, such as α-1-antichymotrypsin,which forms the complexed PSA (PSA-c). This studyanalyzed the utility of PSA-c to enhance specificity withoutaltering sensitivity in comparison to total PSA (PSA-t).METHODS: From September 1998 to March 1999,blood samples were obtained from 96 patients that hadundergone a prostate biopsy due to a suspicion of prostatecancer. PSA-c, PSA-t (Technicon Immuno1 system, Bayer)and PSA-c/PSA-t ratio were analyzed in these patients.RESULTS: ROC curves were plotted and the optimalcutoffs were found for which the specificity was higher forPSA-c (44.6% [CI 95%, 32-57]) versus PSA-t (35.4% [CI95%, 25-49]) and the PSA-c/PSA-t ratio (38.5% [CI 95%,27-51]) while maintaining a similar sensitivity index(90%). PSA-c showed similar results for other values ofsensitivity.CONCLUSIONS: PSA-c was found to improvespecificity in comparison to PSA-t and PSA-c/PSA-t ratio.PSA-c determination could avoid unnecessary biopsieswithout altering sensivity; i.e., the same number of prostatecancers will be detected
OBJECTIVE: To analyze thecharacteristics of the random biopsies of normal-appearingmucosa taken during TUR of superficial bladder tumorsand to correlate them with the outcome and characteristicsof the superficial tumor.METHODS: Multiple random biopsy specimens fromnormal-appearing areas of 300 TUR procedures forprimary or recurrent superficial urothelial carcinomawere analyzed. Preoperative cytologies were obtained inmost of the patients and tumor number, localization, size,stage and grade according to the WHO classification weredetermined. In patients with multiple tumors, the stage,size and grade of the worst tumor were utilized.Patients who showed a risk of recurrence during follow-up received intravesical therapy postTUR of the bladder.The site and characteristics of recurrence were analyzedand compared with the random biopsy findings.RESULTS: In 38 superficial tumors (12.7%), significanthistological changes were found in the random biopsies ofnormal-appearing mucosa taken during resection. Asignificant difference was found between patients withand without positive random biopsies only for tumorstage. Statistically significant differences were foundwhen comparing the primary and recurrent tumors, due tothe greater number of high and moderate grade tumors inthe primaries.There were significant differences in regard to thepositive preoperative cytologies between the patients withnegative and those with positive random biopsies. Nostatistical correlation was found between the localizationof the superficial tumor and a positive biopsy or between the latter and the site of tumor recurrence.There were 126 recurrences (42%); mean time torecurrence was 13.5 months (median 9.5 months). Nosignificant difference was found (log-rank) for time torecurrence in patients with positive or negative randombiopsies, but significant differences were found when weanalyzed the number of superficial tumors and the use ofintravesical therapy, but not for the type of therapy.CONCLUSIONS: Multiple random biopsies permit abetter categorization of the tumor and complete staging.The outcome and the decision to administer intravesicaltherapy following TUR of the bladder are influenced bythe foregoing. The practical results of random biopsies,however, are scanty, since the prognostic significance ofthe histological changes found in these biopsies is notworse than that of the superficial tumor resected. Thereare, however, a few cases with a higher risk of recurrenceand/or progression than the superficial tumor. Preoperativecytology is useful in the selection of these patients.Furthermore, since the proportion of high grade tumors ishigher in primary tumors, performing multiple biopsies ismandatory in these cases if previous urine cytology is notavailable.
OBJECTIVE: To analyze our series andreview the prognostic factors in the treatment of epidermoidcarcinoma of the penis.METHODS: Age, time to consultation, circumcision,form of presentation, local treatment, tumor stage andgrade, lymph node involvement and outcome were analyzedin 27 cases of carcinoma of the penis diagnosed at ourhospital from 1981 to 1999.RESULTS: The incidence rate was 1.8 cases/100,000men/year. No patient had been circumcised, except one who was circumcised in the adult age. The median time toconsultation was 24 months (interquartile range: 60-7.75). The median follow-up was 37 months (interquartilerange: 84-12). All patients with pT1GI-II and pT2G-IIprimary tumor (n = 21; 78% of the series) and with nolymphadenopathy were disease-free at 6 months’ minimumfollow-up [17 of the 21 patients (81%) had more than 32months’ follow-up]. Only one patient with pT1-GII tumor,but with a vertical growth pattern, had positive inguinallymph nodes (pN2). The remaining patients with lymphnode involvement showed infiltration of the erectile tissueand moderately or poorly differentiated tumors. Only twoprophylactic lymphadenectomy procedures wereperformed (pN0). Regardless of treatment, 5 of the 6patients with lymph node involvement died within oneyear after diagnosis.CONCLUSIONS: Given the demonstrated relationshipbetween carcinoma of the penis and hygiene, and phimosiswhich makes hygiene difficult, circumcision should beperformed in childhood. Furthermore, circumcision atthis age has been demonstrated to have a prophylacticvalue that disappears in the adult age.
OBJECTIVE: To analyze our series ofpatients with renal lithiasis who underwent partialnephrectomy from 1980-1999.METHODS: 28 patients who underwent partialnephrectomy were analyzed (22 females; mean age 48.09years, and 6 males; mean age 60 years). Surgery forlithiasis had been previously performed in 5 renal units.Nine patients had previously undergone ESWL (more than3 sessions), all of whom subsequently developed multipleresidual calculi. Twelve patients had a microbiologicallyconfirmed positive urine culture. The renal lithiasisamenable to treatment by partial nephrectomy wasfrequently localized in the lower calyces (17 cases).RESULTS: Histopathological analysis of thenephrectomy specimen showed a prevalence of signs ofchronic parenchymal atrophy (25 cases). Three casesshowed segmental renal dysplasia (those in whom asuperior heminephrectomy was performed for duplexexcretory system). Fifty percent of the stone fragmentsanalyzed showed calcium phosphocarbonate. Eightpatients had postoperative complications; the mostimportant were two cases of renal cutaneous fistula andone subphrenic abscess.At 91/2 years' mean follow-up, renal function is normalin 25 patients. Lithiasis developed in the contralateralunit in 6 cases and in the same renal unit in one case.CONCLUSIONS: Partial nephrectomy continues to bea therapeutic option for lithiasis. Its indication depends onthe morphological and functional characteristics of thecompromised renal unit, especially in those cases in whomrenal preservation can be obviated due to its scantysignificance.
OBJECTIVE: To analyze the resultsachieved with vacuum devices in the treatment of erectiledysfunction.METHODS: A telephone survey was conducted on 150patients undergoing treatment with a vacuum device. Ofthese, 89 responded; 79 of which were considered valid forthe study. The duration and frequency of use, side effectsand degree of patient and partner satisfaction wereanalyzed. Mean follow-up was 59.5 months.RESULTS: There were 14 dropouts early in the courseof treatment. The remaining 65 patients used the device fora mean duration of 34.6 months, 3.7 times monthly. 63.3%of the patients achieved erection in more than half of theattempts. The most frequent side effects were pain (27patients) and ecchymosis (7 patients). Forty-eight patientsdiscontinued treatment at 10.8 months’ mean follow-up.The most common causes for discontinuing treatmentwere lack of efficacy, refusal of the partner and pain. CONCLUSIONS: Treatment of erectile dysfunctionwith the vacuum constriction device should be utilized asan alternative to intracavernosal drug-induced erectiontherapy when oral therapy fails or is contraindicated. Amale with a stable partner and impotence arising fromvenous leakage or mild cavernous artery insufficiency isthe ideal candidate.
OBJECTIVE: To report a case of locallyinvasive angiomyofibroblastoma of the scrotum. To ourknowledge, this is the first case of invasive scrotalangiomyofibroblastoma reported in the literature.METHODS: A case of invasive angiomyofibroblastomaof the scrotum is presented. The literature is reviewed withspecial reference to the etiopathogenesis, clinical features,diagnosis and treatment of this rare soft tissue tumor. RESULTS/CONCLUSIONS: The case described hereinshows that angiomyofibroblastoma can be invasive.
OBJECTIVE: To report a case of granuloma due to a retained surgical sponge that mimicked a pseudotumor in a patient with autosomal dominant polycystic kidney disease. The appearance of retained surgical sponges on diagnostic imaging is reviewed. METHODS: Patient evaluation included renal ultrasound, magnetic resonance imaging (MRI) and arteriography. RESULTS: MRI provides characteristic features that permit preoperative diagnosis. CONCLUSIONS: In the presence of a mass or abscess in patients who have previously undergone surgery, a retained surgical sponge should be included in the differential diagnosis. MRI permits preoperative diagnosis.
OBJECTIVE: To report two cases of bilharziasis andreview the literature with special reference to treatment according tothe stages of the disease.METHODS/RESULTS: Two patients that had previously visitedendemic areas consulted for hematuria and renal colic, respectively.One patient was in the acute stage of the disease. Diagnosis was madeon the demonstration of eggs of the schistosome in urine. Goodresponse was achieved by medical treatment. The other patient wasin the chronic stage. No eggs were demonstrated in urine anddiagnosis was based on the anatomopathological findings. Thispatient required reconstructive surgery.CONCLUSIONS: Although bilharziasis is uncommon in our setting,its incidence is rising due to increasing migration and travel. Thedisease has different clinical manifestations depending on its stageand therefore different diagnosis and treatment. Recognizing thedisease in the early stage prevents progression to the chronic stageand the morbidity and mortality of the late stage of the disease, aswell as more aggressive treatment.
OBJECTIVE: To describe an additional case of metastatic bladder tumor from gastric signet-ring cell adenocarcinoma. METHODS/RESULTS: Local recurrence was demonstrated by gastrointestinal endoscopy and biopsy in a 52-year-old female who underwent total gastrectomy for signet-ring cell gastric adenocarcinoma two years earlier. A CT scan showed bilateral hydronephrosis and diffuse thickening of the bladder wall. Bladder biopsy demonstrated signet-ring cell adenocarcinoma. Palliative treatment with ureteral catheterization was instituted. CONCLUSIONS: Signet-ring cell adenocarcinoma of the bladder is usually a primary tumor. Metastatic signet-ring cell adenocarcinoma to the urinary bladder is uncommon.
OBJECTIVE: To report an uncommon case of basalcell carcinoma of the penis.METHODS: A case of basal cell carcinoma of the penis ispresented. This has been the only case of this tumor type detected inour setting. The literature is briefly reviewed.RESULTS/CONCLUSIONS: Basal cell carcinoma of the penis israre. To date only 20 cases have been reported in the literature. Toour knowledge, no case of distant metastasis has been documented.Diagnosis by gross examination may be difficult due to the broadpolymorphism of this lesion and must be confirmed by histologicalanalysis.
OBJECTIVE: To report an additional case of lipomaof the spermatic cord, an uncommon, silent tumor.METHODS: A case of lipoma of the spermatic cord is described.The patient had presented with an enlarged scrotum with no symptomsThe literature on lipoma of the spermatic cord is briefly reviewed,with special reference to its diagnosis, forms of presentation andtreatment.RESULTS: US evaluation demonstrated a mass adhered to theepididymis. An epididymal tumor was suspected and surgicalexploration by the inguinal approach was performed.CONCLUSIONS: Lipoma is the most common tumor of thespermatic cord. Its etiology is unknown. It frequently appears in thefourth and fifth decades of life and usually involves the lefthemiscrotum. It is silent and is detected by enlargement of thescrotum. The diagnosis is histological supported by US, which offersa reliability of 80%-100%. Treatment is by surgery in all cases.
OBJECTIVE: A case of nonfunctional renalparaganglioma associated with appendicular mucocele andmetachronic carotid paraganglioma is presented.METHODS/RESULTS: A 68-year-old patient consulted for abdominalpain. Patient evaluation with US, CT and opague enemashowed an elongated mass that compromised the cecum and a solidmass in the right kidney. The patient underwent appendectomy andradical right nephrectomy. The anatomopathological findings showedan appendicular mucocele and renal paraganglioma. The postoperativehormone analyses were normal. A carotid paragangliomawas removed 8 months later.CONCLUSIONS: Renal tumors arising from neural crest cells areuncommon. To our knowledge, this is the third case of nonfunctionalrenal paraganglioma reported in the literature. The associatedappendicular mucocele was an incidental finding.