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OBJECTIVES: The objectives of this study were: To analyze the causes of urological consultation of the child with CP, to analyze the role of nursing in the urological care of children with CP referred to Urology, and to know the relationship between the child’s urinary tract infection and CP and its degree of independence. METHOD: Retrospective analytical observational study based on the review of the clinical records of patients diagnosed with cerebral palsy. Forty-seven patients selected by simple randomization in an age range of 2 to 16 years were included in the study in an outpatient clinic for CP patients located in a town in northern Mexico.RESULTS: The causes of urological consultation of the child with CP, referred by nursing were: urinary infection, phimosis, retractable testicle, cryptorchidism, hypogonadism, overactive bladder, and hypospadias.The relationship between the urinary infection of the child with CP and its degree of independence was established with the level of urinary sphincter control.CONCLUSIONS: The nursing staff is a key and decisive factor in the diagnosis, early reference for treatment and monitoring of the evolution of urinary disordersin children with CP.It is not indicated to start a toilet training program in children with CP, without having previously ruled out a urinary tract infection.
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Prostate cancer (PCa) is one of the most frequent neoplasms in the masculine sex, which has multiple etiological factors, inflammation is one of them. OBJECTIVE: To determine the role of different inflammatory markers in the diagnosis of PCa in first prostatic biopsies. METHODS: This is a prospective study evaluating neutrophil/lymphocyte (NLR), neutrophil/monocyte (NMR) and platelet/lymphocyte (PLR) ratios of 78 patients with suspected PCa due to PSA alteration and/or abnormal digital rectal examination, and its correlation with twelve-cylinder biopsy result.RESULTS: The NLR, NMR and PLR were all higher in the group diagnosed with PCa compared to the group with benign prostatic hyperplasia (p>0.05). CONCLUSIONS: Inflammatory markers can be predictive factors in the diagnosis of PCa, although more studies are needed for their routine use.
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OBJECTIVE: Primary Mucin-producing Urothelial-type Adenocarcinoma of Prostate is extremely infrequent. The presence of signet ring cells is exceptional, more atypical in its mucinous variant. Anatomopathological and immunohistochemical study play a key role.METHODS: Bibliographic review and case report of a 66-year-old man with Ca 19.9 and CEA elevation, and normal PSA levels, associated with lower urinary tract symptoms (mucosuria, hesitancy and hematuria). He was diagnosed with mucin-producing urothelial-type adenocarcinoma of the prostate with signet ring. cells by transrectal prostate biopsy after multiparametic MRI.RESULTS: We found 23 cases described in our review. No case diagnosed following an elevation of Ca 19.9 was found in the literature. In our case, after diagnosis, he was treated with retropubic radical prostatectomy and bilateral ilio-obturator lymph node dissection, with subsequent normalization of tumor markers; however, he presented secondary pulmonary involvement and pelvic tumor progression despite chemotherapy treatment.CONCLUSIONS: The elevation of associated tumor markers (Ca 19.9, CEA) is extraordinary. There is no treatment algorithm, however surgery (radical prostatectomy) with or without adjuvant chemotherapy treatment represents an alternative in its therapeutic management.
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OBJECTIVES: To evaluate the complications and 30-day mortality rates following open radical nephrectomy and laparoscopic radical nephrectomy using the Clavien-Dindo classification system in a low-volume hospital.METHODS: We conducted a retrospective analysis of 263 patients who underwent open or laparoscopic radical nephrectomy (1996-2016) in our local district general hospital. Postoperative complications and 30-day mortalities were evaluated using the Clavien-Dindo classification. The predictors of postoperative complications were assessed using multivariate logistic regression analysis.RESULTS: We found that, compared to open radical nephrectomy, laparoscopic resulted in a significantly longer operative time (112.6±41 vs 199.3±61 minutes, p<0.01) and a shorter hospital stay (8.5±2.4 vs 5.7±3 days, p<0.001). The most common complications were bleeding or hematoma (4.9%) and problems associated with the wound (4.5%). There were no significant differences between the ORN and LRN groups in terms of complications based on the Clavien-Dindo classification. On multivariate analysis, a longer operative time (Odds Ratio, 1.009; 95% confidence interval, 1.002-1.015; p=0.010) and higher body mass index (Odds Ratio, 0.898; 95% confidence interval, 0.822-0.981; p=0.017) were found to be significant predictors of complications after nephrectomy.CONCLUSIONS: Our study demonstrated that complication and 30-day mortality rates were low. There was a greater number of low-grade complications, and there were no significant differences in these rates between open and laparoscopic radical nephrectomy. A longer operative time and a higher BMI were predictors of possible complications. We provide additional evidence to support the feasibility of performing open or laparoscopic radical nephrectomy in low-volume hospitals.
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OBJECTIVES: To describe the bladder management in spinal cord injury and to verify if the increase in the age of the patient who is suffering a spinal cord injury in recent years is conditioning a change in its treatment.METHODS: We performed a retrospective review of all acute traumatic spinal cord injured patients in Canary.Islands between 2001-2015. Data were collected from the hospital records of a regional referral Spinal Cord Unit.RESULTS: The sample included 250 patients. Patients’ mean age was observed to increase from 38 to 47 years during the study (p<0.05). Clean Intermittent Catheterization (CIC) was the most used bladder emptying method (42.4%), followed by normal voiding (NV) (26.4%) and permanent derivation (PD) (23.6%). There was a decrease in CIC use (48.1% to 40.3%) and an increase in PD use (13.5% to 32.5%) (p<0.05). Cervical injuries were associated with NV (35.8%), while thoracic and lumbar injuries were associated with IC (67% and 41.7% respectively). Patients discharged to a health care residence were associated with IC (81.8%) (p<0.05).CONCLUSIONS: CIC is currently the most frequently used bladder emptying method in spinal cord injured patients in our population. The mean age of new spinal cord injury patients is progressively increasing and it promotes the use of indwelling catheter with an increased risk of urologic complications.
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OBJECTIVES: To investigate the efficacy of tadalafil 5mg in patients with lower urinary tract symptoms who failed alpha blocker treatment.PATIENTS AND MEHODS: Twenty-three patients were included. Patient consent was obtained after explaining the efficacy of tadalafil 5mg in lower urinary tract symptoms. Before initiating tadalafil 5mg treatment, prostate cancer and urinary tract infection in the patients were eliminated. IPSS, IIEF-5 and Qmax values were assessed before and one month after tadalafil 5mg treatment. Difference between two assessments was evaluated by the Wilcoxon method. RESULTS: After 1 month of Tadalafil 5mg treatment, IPSS decreased and IIEF-5 and Qmax increased. The difference between two assessments were statistically significant.CONCLUSION: Tadalafil 5mg once daily in the treatment of BPH/LUTS is found to be successful in patients who failed previous alpha blocker treatment.
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Prostate Cancer (PC) is the most common malignancy in men, and a diagnosis can only be confirmed following a prostate biopsy (PB). 10-12 cores ultrasound-guided PB is currently the state of the art in the primary diagnosis of PC, presenting clear advantages in terms of detection rate of clinically significant PC, pathology concordance, and both positive and negative predictive value, when compared with the former classical sextant biopsy. Persistent clinical suspicion of PC despite previous negative PB is a challenging topic, with several serum and urinary markers, as well as imaging techniques, aiming to help in the optimal management of these patients. Currently, the most accepted and used methods in clinical practice to reduce the number of unnecessary PBs in this subset of patients are Prostate Cancer Antigen 3 (PCA3) and multiparametric MRI (mpMRI). These methods have shown to improve the diagnostic accuracy of prostatic rebiopsy, but there still aren’t clear guidelines defining the optimal strategy in this setting. New biomarkers have been proposed in recent years with the aim of increasing specificity and distinguishing aggressive from non-aggressive PC, highlighting the emerging role of the Prostate Health Index (PHI) and the Four Kallikrein (4k) score. The aim of this review is to demonstrate the evolution to the actual standard 10-12 core ultrasound-guided PB, the indications and controversies concerning repeated PB and to explore the data regarding the potential role of the leading methods affecting the decision to rebiopse – PCA3 and mpMRI -, as well as new PC biomarkers used in the clinical practice (PHI and 4K score).
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OBJECTIVE: To compare c-kit-positive interstitial Cajal-like cells (ICC) and Caveolin-1 protein levels as a pacemaker and signaling molecules, on ureteropelvic junction (UPJ) specimens, between two groups of pediatric patients with and without ureteropelvic junction obstruction (UPJO).METHODS: We evaluated the UPJ specimens of 45 pediatric patients operated between 2005- 2012 retrospectively. Group 1 included 37 patients who underwent dismembered pyeloplasty due to UPJO. Eight patients underwent nephrectomy by the other reasons (renal tumor, trauma etc) and had normal UPJ were accepted as Group 2. The specimens were examined immunohistochemically with CD117 and Caveolin-1 antibody. According to the total number of ICC; 0-5 cells were accepted as a few (1), 610 cells as moderate (2), and >10 as many (3). According to the staining intensity of Caveolin-1 at muscle tissue, a subjective evaluation was performed as; mild staining (1), moderate staining (2) and strong staining (3).RESULTS: The mean value of ICC distribution was calculated 1.37 ± 0.54 in Group 1 and 2.13 ± 0.64 in Group 2 (p=0.003), and the median value of ICC distribution was found 1 [1-3] in Group 1 and 2 [1-3] in Group 2 (p=0.008). Median values for the intensity of staining with Caveolin-1 were found 2 [1-3] in the Group 1, and 2.5 [2-3] in the Group 2 (p=0.025).CONCLUSIONS: A decrease in ICC and Caveolin-1 levels support that there may be a relationship between ICC and Caveolin-1 for UPJO associated with signal transduction and peristalsis in urinary system.
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OBJECTIVES: The aim of this study is to investigate the role of the inguinal hernia over the development of varicocele, in cases with accompanying inguinal hernia.METHODS: The continuous variables were calculated from mean and standard deviation, and intermittent variables were calculated over percentage and frequency. Normality testing was performed on continuous variables using the Kolmogorov–Smirnov test. Univariate analyses were performed using the unpaired Mann–Whitney U test and Chi-squared test was used for proportions. Kendall’s tau-b correlation coefficient was used for correlition coefficient. Logistic regression modeling were used to identify the impact of inguinal hernias on selected cases. The data were analyzed with SPSS™ for Windows 22 (SPSS,Chicago, IL).RESULTS: Twelve cases (23.1%) in the inguinal hernia group also had varicocele, which was relatively high, whereas 12 cases with inguinal hernia in the varicocele group corresponded to only were 4.02% (12/52 (23.1%) vs 12/298 (4.02%) ). On the other hand, as a result of the binary logistic regression, we found statistically significant difference in the probability of being diagnosed varicocele among the patients with inguinal hernia as 1.94 times.CONCLUSIONS: We think that in addition to the direct compression of some of the inguinal hernias on testicular veins, the potential for a combination of common enzymatic and biochemical disorders in some of the cases involving these two disorders may be play role.
Case Report
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OBJECTIVE: Hemangiopericytoma is a tumor of vascular origin. It is very rare in the prostate. They are generally aggressive tumors. Currently, the treatment of choice is radical surgery. In the literature, there are less than 50 cases described, and neoadjuvant treatment has not been reported in any article. This treatment presents positive responses in another type of sarcomas. Our goal is to report two cases of malignant hemangiopericytoma. The first case was treated with radical surgery and the second case was treated with neoadjuvant chemotherapy before surgery.METHODS: The first case is a 40 year old male. Obstructive urinary symptoms were his first symptoms. A prostate mass with tumor characteristics was seen on ultrasound. After transrectal biopsy, he was diagnosed with hemangiopericitoma. Because the tumor size, neoadjuvant chemotherapeutic prior to radical surgery was decided. The second case is a 77 year old male with an incidental diagnosis of renal mass. After radical nephrectomy, he was diagnosed with hemangiopericitoma. He did not receive adjuvant chemotherapy. RESULTS: In the first case, after neoadjuvant therapy, tumor size was reduced significantly. A pelvic exenteration with radical cystoprostatectomy and rectal resection and Bricker type urinary diversion and colostomy were carried out. In the second case controls after radical nephrectomy were correct and he did not need any treatment. CONCLUSIONS: In urinary tumors, the prostate hemangiopericytoma is a rare entity. Currently, neoadjuvant chemotherapy is not established as treatment for these tumors. For other sarcomas neoadyuvant treatment has good response. In our case, a good result was obtained with neoadjuvant chemotheraphy before surgery. However, a greater number of cases are necessary to establish the use of neoadjuvant chemotherapy in urinary hemangiopericytomas.
Case Report
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We describe the first clinical case in the reviewed literature of a patient with a complicated renal cyst by fistula of an appendicular neoplasm with acute appendicitis, as well as the management performed and the therapeutic options in similar cases.
Case Report
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OBJECTIVE: Estramustine is an stable estradiol and nitrogenated mustard conjugatewith antymicotic properties. Currently, with the appearance of chemotherapy and new molecules, estramustin acetate is not a drug of choice for castration resistant prostate cancer.METHODS: We describe two patients with castration resistant prostate cancer under treatment with estramustine acetate and complete biochemical response and stable disease. We review the literature to elucidate if the drug should be stopped and changed for the new molecules that have demonstrated survival increase. RESULTS: To our knowledge, there are not data in the literature to either solve the questions posed or shed light regarding cumulative toxicity due to prolongued use of estramustine acetate. CONCLUSIONS: We recognize that these clinical cases do not translate that estramustine acetate is a first line treatment for patients with CRPC. Nevertheless, they translate the heterogeneity of CRPC. It would be interesting to investigate the combination of new agents with estramustine acetate as well as the search of biomarkers that enable selection of candidates who could respond to estramustine acetate.
