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OBJECTIVE: To provide an updatedepidemiological description of urinary lithiasis in ahealth area in the Western hemisphere over the pastfour decades.METHODS: 2704 urinary lithiases analysed in ourinstitution between 1980 and 2015 were retrospectivelyreviewed. They were analyzed using polarized lightmicroscopy, and in the case this method had questionableresults we used X-ray diffraction. The variables collectedwere the lithiasis chemical composition (oxalates,phosphates, uric acid, infectious, cystine, mixed, other).Regarding the date of the analysis, the series of caseswas grouped into four periods (1980-1989, 1990-1999, 2000-2009, and 2010-2015), and also by sexand age of the patient.RESULTS: The mean age at diagnosis was 48.32 years(49.37 in men vs 46.53 in women, p=0.005). A malepredominance was found (58.7%). Throughout the fourdecades, the involvement of women has progressivelydiminished compared to men. Of all the lithiases, themost frequent were those composed of oxalates (43.3%),followed by uric acid (16.9%) and infectious types(10.7%). The uric acid and oxalate lithiases were morecommon in men than in women (67.4% vs. 32.6% and59.1% vs. 40.9%, respectively, p< 0.001), while thelithiasis of infectious origin was more frequent in womenthan in men (56.3% vs. 43.7%, p< 0.001). Throughoutthe time period, a trend of increasing oxalic lithiasesand decreasing uric acid and phosphate lithiases wasobserved, as well as an increase of infectious lithiasesover the past five years.CONCLUSIONS: In our setting, urinary lithiases appearmore frequently in males at the end of the fourth decadeof life. The most common lithiases are composed ofoxalates, and their frequency has increased over time,while uric acid and phosphates lithiases have decreased.
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OBJECTIVES: Prostate cancer is considereda tumour with a long natural history. However, its high-risk variants exhibit variable behaviour. We analysethe factors that affect BR and CSS (multivariate, KaplanMeier).METHODS: From 1997 to 2013, 657 patients wereoperated of a high-grade prostate cancer (pT2b 7.2%,pT3a 73%, pT3b 18.3%, pT4 1.5%). Gleason scorewas ≥8 in 23% of cases. Percentage of PSMs was46.1%. Mean follow-up was 113 months (24-192).RESULTS: BR occurred in 36.5%. Patients with Gleasonscore >8, 31.7% had BR, Gleason ≥8 had BR in48% (p>0.05). PSMs recurrence occurred in 48.9%,whereas 26.1% in NSM (p>0.05). If lymphadenectomy,BR occurred in 48.7%, if not 30.9% (p>0,05). Inmultivariate analysis, stage, Gleason≥8 and PSMs wereindependent factors for BR.Treatment of BR was 36.5% radiotherapy, 24.1% HT,and 21.2% both simultaneously. Active surveillance wasperformed in 13.3%. Disease progression (biochemicalor radiological) occurred in 23.5%.CSS was 98.93%, pT4 was the stage with the greatestmortality (10%), followed by pT3b (3.4%), p>0.05.Patients with a Gleason score ≥8 accounted for 71%CSM (p>0,05). PSMs and lymphadenectomy didn´thave repercussions for survival. In multivariate analysis,Gleason≥8 was independent factor for CSM.CONCLUSIONS: Radical prostatectomy plays animportant role in multi-modal approach with goodoncological control at medium follow up. Gleason score≥8 was the factor with the greatest effect on CSM.Lymphadenectomy didn´t affect CSS
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OBJECTIVE: The urodynamic results insuburethral slings (SS), are contradictory. We evaluatea series on patients with stress urinary incontinence(associated or not with bladder hyperactivity) thatunderwent suburethral slings (SS) operations.METHODS: 42 women (age 62±12 years) with urinaryincontinence underwent suburethral slings (86% TOT,12% TVT, 2% others), 36% of them with simultaneouspelvic organ prolapse correction. Medical history anda pre and postsurgery urodynamic studies (according toICS instructions, except when specified) were performed.RESULTS: After surgery, the improvement of urinaryincontinence was lower in patients with previous detrusorhyperactivity (DH) than without DH (60% vs 81 %), andthe bladder capacity (BC) was lower (123±36 ml) inpatients with previous mixed urinary incontinence (MUI)versus no MUI (241±83 ml) (p=0.004). The decreaseof BC was higher with previous MUI (184±92 ml vs123±36 ml) versus no MUI (240±91 ml vs 237±78ml), and the DH was more frequent in previous MUIand DH. There was a significant decrease of maximumflow rate (Qmax) (p=0.000) (although without clinicalmanifestation), and post void residual urine (p=0.007).We demonstrated a significant increase (p=0.001) ofmean urethral resistance (URA): 12±9 cmH2O versus15±12 cmH2O (without reaching obstruction range),and an improvement of detrusor contractility (W80-20):(3±4 W/m2 vs 6±17 W/m2).CONCLUSION: We demonstrated worst results in MUIin patients with urinary incontinence undergoing SS. Theurodynamic study gives a better prognosis reliability inthe treatment of female urinary incontinence with SS.
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OBJECTIVES: Laparoscopic pyeloplasty (LP) is the treatment of choice for ureteropelvic junction obstruction (UPJO). We present the 3-trocars LP technique with several considerations and practical advices. METHODS: Several maneuvers to optimize exposure and simplifying the implementation of the operation were showed. A total of thirteen patients with UPJO and criteria for surgical treatment were included, and were operated using the 3 trocars LP technique. Demographic data, perioperative and follow-up were collected retrospectively. RESULTS: Mean operative time was 132 minutes. No conversion to open surgery was registered and additional trocar insertion was not required. Neither perioperative complications nor postoperative complications were reported. Three patients needed ureteral stenting preoperatively for pain. Five patients required flexible nephroscopy with CO2 for extraction of calyceal stones. The pain was controlled in all cases. CONCLUSIONS: The LP is a feasible and safe technique for the surgical correction of UPJO, and maneuvers presented in this study simplify the procedure and may be applied in other laparoscopic procedures.
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OBJECTIVE: Prostatitis affects 10-14%of men of all ages and ethnicities. More than 50% ofthe men experience episodes of prostatitis at one timeof their lives. Patients with CP typically have longlastinggenitourinary/pelvic pain and obstructiveand/or irritative voiding symptoms. Sexual dysfunctionand psychological symptoms are frequently added tothese symptoms. We also investigated the relationshipbetween sexual functions, and lower urinary systemsymptoms, and asymptomatic histological prostatitisdetected on transrectal ultrasound-guided (TRUS) biopsyperformed with the indication of high PSA levels.METHODS: Sixty cases compliant with the study criteriaamong patients who underwent prostate biopsiesbetween September 2014 and June 2015 with the of higher PSA levels were included in thestudy. All patients were requested to complete IIEF-5 andIPSS forms one day previously. Based on histologicalanalysis of biopsy materials, the patients were allocatedinto groups of BPH (simple BPH without histologicalprostatitis) (n:30) and histological chronic prostatitis(combination of BPH and histological prostatitis) (n:30).RESULTS: Mean age of the cases was 65.73±5.01(range, 56-75 yrs) years. PSA levels ranged between4-15ng/ml. A statistically significant intergroupdifference was not found regarding mean age, BMIs,PSA levels, incidence rates of hypertension and coronaryartery disease (p>0.05). Prostate volumes of the HCPgroup were higher than those of the BPH group , withstatistically significant differences (p:0.001; p<0.01).Questionnaire forms of the patients included in the studywere statistically evaluated, and mean IPSS score of theHCP group was found to be higher when comparedwith that of the BPH group, with statistically significantdifferences. (p:0.016; p<0.05). However mean IIEFscore of the BPH group was higher than that of the HCPgroup, with statistically significant differences (p:0.039;p<0.05).DISCUSSION: These findings suggested the presence ofa correlation between chronic inflammation and lowerurinary tract symptoms (LUTS). In addition, statisticallysignificant lower IIEF values in patients with histologicalchronic prostatitis relative to those without suggestednegative effects of even asymptomatic inflammation onsexual functions and mechanism of erection.
Case Report
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OBJECTIVE: We report two cases of patients with a previous diagnosis of hematologic tumor who present with testicular recurrence, and we carry out a review of the literature regarding the infrequency of this pathology.METHODS: We present a retrospective review of the medical records of two patients diagnosed with hematologic malignancies (acute myelogenous leukemia and multiple myeloma) with occurrence of relapse in the testicle. We reviewed the management and outcome after treatment with bilateral orchiectomy.RESULTS: Case 1: The patient was diagnosed with acute myeloid leukemia and treated with an allogeneic transplant. Two years later, the patient reported an increase in testicular size. The complementary studies lead us to suspect a testicular recurrence that was confirmed after orchiectomy. Currently, the patient awaits the start of a chemotherapy treatment prior to a new allogeneic transplant.Case 2: Patient with the diagnosis of multiple myeloma who started a polychemotherapy treatment without response and underwent allogeneic transplant. After five months with complete remission, there were signs of systemic recurrence, and a study for a new transplant was carried out. During the study, potential testicular recurrence was observed. After a batch of complementary tests, bilateral orchiectomy was performed and the diagnosis was confirmed. Currently, the patient is undergoing an allogeneic transplant protocol after radiotherapy and chemotherapy treatment.CONCLUSIONS: Currently the mortality rate in cases of relapse of hematologic malignancy in the testicle has declined despite the sharp rise in its incidence. This is because of, as in our case, early diagnosis and the combined use of chemotherapy, radiotherapy and surgery. This has been achieved through an interdisciplinary collaboration of urologists, hematologists, oncologists and radiotherapists
Case Report
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OBJECTIVE: To report a clear cell renal cellcarcinoma recipient of a metastasizing ductal carcinoma ofthe breast: A tumor-to-tumor metastasis.METHODS: A 71 year-old woman with a past history ofbreast carcinoma, diagnosed 12 years before, underwenta nephrectomy for an incidental kidney mass found in aroutine imaging examination.RESULTS: Histological examination revealed foci of ductalcarcinoma of the breast in an otherwise typical clear cellrenal cell carcinoma of the kidney. Immunohistochemicalexamination confirmed a metastasis of an infiltrating breastcarcinoma to a clear cell renal cell carcinoma (positive toGATA3, hormonal receptors and mamoglobin) in a clearcell renal cell carcinoma (positive to PAX8, CD10 andvimentin).CONCLUSIONS: Awareness of this phenomenon shouldalways be kept in mind by urologist in patients with aknown history of a previous malignancy and by pathologistswhen finding a renal tumor with an unusual or dimorphicmorphology. Immunohistochemistry plays an important roleto establish the exact diagnosis.
