OBJECTIVES: Extracorporeal shock wave lithotripsy is a minimally invasive therapeutic option for the treatment of renal-ureteral lithiasis. The aim of this study was to analyze the results and complications of shock wave extracorporeal lithotripsy treatment with the Dornier Gemini® Generator EMSE 220f-XXP device in patients with renal and ureteral lithiasis.MATERIAL AND METHODS: Retrospective study includ-ing 377 patients with renal or ureteral lithiasis with in-dication for treatment with extracorporeal shock wave lithotripsy. The following variables were analyzed, age, sex, body mass index, lithiasis size, lithiasis location, presence of urinary diversion, number of lithotripsy ses-sions, number of shock waves, fluoroscopy time, wave energy, applied focal energy coefficient, efficiency co-efficient, lithiasic fragmentation, lithiasic clearance, re-sidual lithiasis, presence of lithiasis and complications. The results were analyzed with SPSS 17.0 considering statistical significance p≤0.05.RESULTS: Of the 377 patients, 213 were men and 164 women, with a mean age of 51.28 ± 12.77 years. The mean size of the stones in maximum diameter was 11.77 ± 6.13 mm. Lithiasis fragmentation occurred in 81.9% of cases, with a percentage of residual lithiasis after the first session of 58.7% and a total or partial ex-pulsion rate of lithiasis fragments of 68.3%, with global success at the end of sessions of lithotripsy of 69.8%. The overall Efficiency Ratio was 0.42, higher in upper calyx 0.51 and lower in medium calyx 0.35, with sig-nificant differences (p<0.05). The only differences were found in relation to the success of lithotripsy treatment (75% versus 64.6%, p=0.02), according to lithiasis size (≤10 mm maximum diameter in comparison to >10 mm). In patients with a DJ catheter there is a higher percent-age of residual lithiasis (p=0.006).CONCLUSIONS: Treatment with extracorporeal lith-otripsy in small lithiasis and in well-selected patients obtains good results with a low rate of complications regardless of sex and body mass index.
OBJECTIVE: Following first-line treatment progression in metastatic renal carcinoma, different op-tions for second-line treatment are available, with ax-itinib being one of them. The objective of this article is to evaluate the results of Axitinib in a real practice setting.METHODS: From December 2011 to October 2016, we treated 19 patients with CCRM with Axitinib, 3 pa-tients in third line and 16 patients in second line after progression on Sunitinib or Pazopanib. We performed a retrospective study of the last 16 patients, analyzing the effectiveness and safety of the drug. RESULTS: The median progression-free survival (PFS) was 9 months and the median overall survival with 8 dead patients was 59 months. Overall, toxicity by Axitinib was very common, diarrhea 87.5%, asthenia 75%, dyspho-nia 56.25%, hypertension 37.5% and anorexia 37.5%,although most are grade 1-2 toxicities controlled with hygiene-diet measures and treatment recommendations.CONCLUSIONS: Axitinib is a drug that has been shown to increase PFS after 1st line progression, with a tolerable toxic profile. With the approval of nivolumab and cabozantinib, the place of Axitinib in sequential therapy is yet to be defined.
OBJECTIVES: 1.- To know the risk of de-tectable Prostate Cancer (PC) and significant PC by applying a Risk Calculator to patients who underwent a prostate biopsy (PB) and to analyze if there are significant differences between the risk of patients who had positive versus negative biopsies.2.- To compare the risk of those patients with positive results who were detected in the first biopsies vs re-bi-opsies.3.- To compare our results with those obtained if we had applied the cut points established in the CP risk calculator.METHODS: Through a retrospective descriptive an-alytical study, we studied 496 prostate biopsies (PB) performed during 3 years (2014-2016), applying the SWOP risk calculator, analyzing if there are significant differences between those patients who had a positive vs negative result and those submitted to re-biopsies.RESULTS: The mean risk of detectable PC by the cal-culator for positive PB was 34.98% versus 24.71% of negative PB; in relation to the risk of significant PC, for positive PB it was 19.13% versus 8.8% of the negative PB, with significant differences (p <0.001) in both com-parisons. When patients were grouped by first biopsies vs re-biopsies, we observed that patients with the first positive biopsy had an estimated risk by the calculator of 44% compared to 31% of the first negative prostate biopsies, this difference being statistically significant.CONCLUSIONS: The application of a prostate cancer risk calculator in candidates for first biopsy allows op-timization of the test, although it loses effectiveness in patients with previous negative PB.
OBJECTIVES: The prostate cancer screen-ing based on systematic biopsies in patients with elevat-ed PSA values has low sensitivity and low specificity. We assessed the use of multiparametric magnetic reso-nance imaging (mpMRI) as a screening tool for prostate cancer detection.METHODS: We retrospectively analyzed a cohort of patients with suspicious signs of prostate cancer who underwent prostate mpMRI before the biopsy. Patients underwent either targeted biopsy or systematic biopsy, depending on the presence or not of mpMRI lesions. Cancer diagnosis was confirmed from pathologic find-ings in biopsy samples. RESULTS: The final record included 148 patients with a median of 3 previous negative biopsies (IQR 1–5).Can-cer was diagnosed in 21 patients (14%); of them, 18 had highly suspicious mpMRI lesions (53% positive pre-dictive value), 2 had lesions of other suspicion degree, and one had no mpMRI lesions. Cancer diagnosis was ruled out in 111 patients over 114 without highly sus-picious mpMRI lesions (97% negative predictive value). In a multivariate analysis including PSA levels, abnormal DRE, the presence of mpMRI lesions, and the presence of highly suspicious mpMRI lesions, only the presence of highly suspicious mpMRI lesions significantly predicted cancer diagnosis.CONCLUSIONS: The identification of highly suspicious lesions in prostate mpMRI examination has moderate sensitivity and high specificity in the detection of pros-tate cancer in patients with multiple previous negative biopsies. The use of mpMRI should be considered as a screening tool for prostate cancer in routine clinical practice.
OBJECTIVES: Suburethral male slings are an alternative option for mild stress urinary incontinence. Our purpose is to evaluate the long-term functional out-comes, efficacy and worsening continence of male su-burethral slings.MATERIAL AND METHODS: The functional outcomes of realignment/anatomical slings were evaluated with AdVance ®, and the outcomes of compressive slings were evaluated with InVance®. We considered 55 patients fulfilling 5 years of complete follow-up. We in-cluded patients with a 24-hour pad weight test <400 grams. Night-continent patients who also had positive “reposi-tioning tests” were considered for AdVance®, whereas patients without sphincter contraction or previ-ous pelvic radiotherapy were considered for InVance®.RESULTS: Between February 2006 and September 2010, 24 AdVance® and 31 InVance® slings were im-planted. The median follow-up times from sling insertion were 75 months in the AdVance® group (range: 64-97) and 86 months in the InVance® group (range: 61-108). At three months of follow-up, 43 of 55 patients were considered to be cured (pad-free) (78.1%), 79.1% in the AdVance® group and 77.4% in the InVance® group. Postoperatively, 16.6% of patients with AdVance® and 22.5% of patients with InVance® presented “de novo” urgency. At 5 years of follow-up, we observed 10 cases of some deterioration of continence, 3 patients in the AdVance® group and 7 in the InVance® group (15.8% and 29.1% of the initially cured, respectively). To date, there have been no reports of urethral sling erosion. CONCLUSIONS: Male slings are safe and effective. Although we observed an increase in “de novo” urgen-cy, in our experience, slings seemed to maintain their efficacy during long-term follow-up, and the risks of ure-thral erosion are low.
of patients’ characteristics and the pathology they consult for. This is the first study that estimates the waiting time in the emergency room and the factors that are independently related with hospital admission. METHODS: Descriptive and retrospective study of 2.741 patients who were admitted to the Emergency Department with genitourinary symptoms in 2011. Clin-ical and epidemiological features were reviewed. A multivariable study was performed to identify the factors related with the final resolution of patients, recurrence in emergency attendance, and waiting time in the emer-gency room. RESULTS: Most of the patients were male (60.3%), being diagnosed with hematuria, acute urinary retention and genital pathology. Females complained more frequently for pyelonephritis, urinary tract infection and low-back pain. Male were hospitalized in greater proportion. Age, diagnosis of infection/sepsis or low-back pain, and yellow or orange MTS level were independent features for hospital admission. Also, in the univariate and multivariate study, age > 60 years (311 vs 220 min.), UTI/sepsis related diagnoses (300 vs 250 min.), and hospital admission as final resolution (440 vs 240 min.) had a significant influence in the waiting time in the Emergency Department.CONCLUSIONS: Age over 60 years, hospital admis-sion as final resolution and infection/sepsis diagnosis were independent features for further waiting time in the Emergency Department. Persistent pain and symptoms of infection/sepsis behaved as independent features for hospital admission.
Vesico-vaginal fistula (VVF) is a patholo-gy with serious social repercussions; its resolution can be achieved through multiple surgical, abdominal or vaginal techniques, the choice of which will generally depend on the characteristics of the fistula and the expe-rience of the surgeon.OBJETIVE: We describe our experience with vaginal approach to treat VVF using different flap interpositions. METHODS: A retrospective review of the charts of VVF patients attended at University Hospital of Caracas(UHC) during the 2009 - 2016 period was undertaken. The follow up period ranged from 3 months to 7 years, with an average of 2 years and 6 months. RESULTS: Of a total of 22 cases of VVF, most had a single orifice, retrotrigonal position, with an average di-ameter of 9.5 mm. A peritoneal flap was used in 77.27 % of the cases, Martius flap in 13.63 %, and omen-tum and vaginal mucosa each in 4.54 % of the cases. Success rate was 90.91%. Failure occurred in 2 cases (9.09%), due to relapse of the pathology. Morbidity rate was 13.64%, mainly due to urinary tract infections. CONCLUSION: The vaginal technique for the treatment of VVF is safe and effective with low recurrence rate and complications.
OBJECTIVES: Micropercutaneous nephro-lithotomy (microperc) is a new minimal-invasive tech-nique.We aimed to investigate whether preoperative hydronephrosis has an impact on the stone-free rate of microperc.METHODS: In this study, 66 consecutive patients were included and divided into 2 groups:patients without preoperative hydronephrosis (group-1) and patients with preoperative hydronephrosis (group-2).Both groups were compared for age, gender, body mass index (BMI), stone burden, stone location, fluoroscopy and operati-ve time, blood loss, stone-free rate and perioperative and postoperative complication rates.Parameters were analyzed using univariate and multivariate analyses for the stone-free rate.RESULTS: The mean age, gender, BMI, stone location, and blood loss were similar in both groups (p>0.05). Stone burden in group-2 was greater than group-1 (p=0.011).In addition, mean fluoroscopy time in group-1 was found to be significantly lower (p<0.05). However, operative time was comparable among the groups (p=0.169).Lastly, group-2 had a higher rate of perioperative and postoperative complication rates and lower success rate (p=0.023, p=0.027 and p=0.001, respectively).The success was significantly affected by hydronephrosis, stone burden and location (p<0.05). Logistic regression analysis revealed that unsuccessful outcome was significantly associated only with the pre-sence of hydronephrosis (OR 0.225, p=0.033).CONCLUSION: This study seems to suggest that pre-sence of hydronephrosis is a major factor on the stone free rate of microperc procedures
OBJECTIVES: To evaluate long-term outcomes of patients subjected to corporoplasty, plaque incision and excision, and autologous dermal grafting, with at least 15 years of follow-up.METHODS: The charts of consecutive patients with a penile curvature and a minimum of 15 years follow up were retrospectively reviewed. The patients underwent corporoplasty and penile straightening with autologous dermal grafting, harvested at the level of the anterior-superior iliac spine. At the time of the follow-up, a postoperative IIEF – 5 questionnaire was administered by telephonic interview, and patients were also asked to complete an 8 items self-evaluation questionnaire. After signing informed consent, the patients were invited to undergo dynamic and basal penile sonography, as well as injection of 10 mcg of PGE1 for dynamic evaluation of the graft.RESULTS: A total of 16 patients were identified. Penile shortening of up to 1.5 cm was reported in about 40% of cases and residual bending was reported by 4 of 16 patients. However, there was no impairment in penetration. On physical examination of the suture site, a small indurated nodule was palpable in two patients. Data regarding the dynamic sonography is available for the 5 patients who accepted to undergo the test. No sign of a fibrotic reaction or calcification was detected in the static phase. After injection of 10 mcg PGE-1, in comparison to the basal measurement, the dermal grafts showed compliant length adaptation.CONCLUSIONS: Dermal graft substitution surgery for Peyronie’s disease allows to obtain good functional results with durable satisfaction of the patients on long term follow up.
OBJECTIVE: The incidence of simple renal cysts is very high, especially in elderly people. However, malignant transformation of a simple renal cyst is exception-al. Likewise, the treatment to be carried out, in these rare cases, is controversial, with respect to opting for radical renal surgery.METHODS: We present the case of a patient with a solid nodule in a large cyst. Complete removal of the cyst was performed by transperitoneal laparoscopic technique. The histopathological study of the surgical piece revealed the existence of a cyst with clear renal cell carcinoma with nucleolar grade 2. The clinical evolution has been satisfac-tory, performing a minimally invasive surgery (laparoscopic cyst excision).DISCUSSION: Although it is considered that surgical treat-ment of choice is radical surgery in these cases, we believe that nephron sparing surgery may represent a therapeutic option, taking into account the young age of our patient. A histogenetic hypothesis is discussed to explain the appear-ance of a clear cell tumor in a simple renal cyst.CONCLUSION: The development of a renal cell carcino-ma in simple renal cysts is a very infrequent pathology.Laparoscopic total cystectomy is a minimally invasive thera-peutic option for the treatment of renal cell carcinoma orig-inating in a simple renal cyst, although it is of an important size. We establish the hypothesis of migration of the cells of the renal collecting tubes into the cyst wall to explain the malignant transformation of the renal simple cyst.
OBJECTIVE: This paper describes our initial experience with laparoscopic ureteroneocystostomy in two patients with distal ureter lesions following gynaecological surgery (hysterectomy). Furthermore, we review the evi-dence on the incidence, prevention, and management of urinary tract injuries that occur during laparoscopic gynae-cological surgery.METHOD: Two patients with iatrogenic lower ureteral in-juries during hysterectomy leading to ureterovaginal fistula underwent laparoscopic ureteroneocystostomy with a pso-as hitch. RESULTS: The procedures were successfully performed without any conversion. No intraoperative or postopera-tive complications were noted. Our minimally invasive approach has yielded successful results, similar to those achieved through open surgical repair. CONCLUSION: Laparoscopic ureteroneocystostomy with a psoas hitch for ureterovaginal fistula secondary to hys-terectomy is a safe and feasible option for patients with gynecologic distal ureteral injury, with excellent results and low morbidity.
OBJECTIVE: Persistent Müllerian Duct Syndrome (PMDS), one of the causes of male pseudohermaphroditism, is a rare syndrome characterized by the presence of internal female genitalia (uterus, fallopian, tubes, cervix and upper vagina) in otherwise phenotypically and normally virilized men. METHODS: We present the 4th documented case of uterine malignancy in a 45-year-old man with PMDS presenting with lower abdominal protuberance and hematuria. RESULTS: Although testicular malignancies are common in undescended testis associated with PMDS, very few cases of müllerian duct malignancies have been reported. CONCLUSIONS: Persistent mullerian duct syndrome can be associated with aggressive non-testicular malignancies, especially uterine cancer, in normally virilized males.