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OBJECTIVES: A new concept forendoscopy is presented in the form of a ureteroscopeand cystoscope that efficiently adapts to the needsand situation of the surgical scenario, both in patient’shealth benefit and better results, and also physician`swellbeing.METHODS: The concept of the instrument, in the neutralposition, gives response to the urinary tract anatomy insupine decubitus: horizontally- form side to side. Theinstrument has a handle with a rotor to control the distalactive flexible segment of the shaft. It has a unique new shaft with at least three different elastic properties witha proximal firm first segment, followed by a secondpassive flexible and a third distal active flexible segment.Two pending US patents and another patent endorse theinvention.RESULTS: A perceptive instrument from first contact hasbeen developed. The horizontal response reduces rotationrequirements, X-ray needs down to 30 seconds at themost, and operating time to a third. It may be introducedand maneuvered with one hand only, avoiding the needfor an assistant and it has the advantage that it may beused sitting.CONCLUSIONS: Current operating room scenariogenerates a demanding situation, affecting evensurgeon`s own general health. The Campos Instrument hasexclusive features for operating room ergonomic fusion,making procedures more dynamic. It simultaneouslyprocures patient and physician’s health. Allows apredictable navigation and provides the stability of afirm endoscope with the diagnostic and therapeuticcapabilities of the flexible
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OBJECTIVES: Hemorrhagic cystitis (HC) presenting with gross hematuria, bladder pain and urinary frequency develops in 13-38% of patients following bone marrow transplantation (BMT). The objective of the study was to study the characteristics of patients suffering hemorrhagic cystitis after hematopoietic stem cell transplantation in our center. METHODS: We conducted a retrospective chart review of all patients who underwent BMT at our institution between January 1996 and August 2012. We recorded the age, sex, diagnosis, conditioning regimen, interval between BMT and development of symptoms of cystitis and treatment instituted.RESULTS: Five hundred patients underwent BMT in the period of time studied. 52 of them developed hemorrhagic cystitis. The mean age of the affected patients was 39 years; there were 34 males and 18 females. The diagnoses include AML (n=11), ALL (n=8), CML (n=6), MDS (n=11), CLL (n=5), NHL (n=1), HD (n=5), MM (n=2), Medular aplasia (n=3). HC appeared 59.48 days after BMT. There were no differences between sexes. Mortality among the 52 patients was 51.14 % but HC was not the cause of death in any patient. Polyomaviruses were detected in the urine of 78.94 % of survivors.CONCLUSIONS: Polyomavirus infection with BK and JC types is usually acquired in infancy and the virus remains latent in renal tissue. Immunosuppression facilitates reactivation of the renal infection and replication of the virus responsible for the clinical manifestations of HC. The differential diagnoses include other urinary infections, lithiasis, thrombocytopenia and adverse effects of pharmacological agents. The urologist plays a limited role in the management of this disease.
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OBJECTIVES: The management of renal trauma has undergone important changes in recent years, the current tendency being more conservative than in the past. The present study analyzes our experience over the last 11 years in patients with isolated renal trauma or associated to other lesions.METHODS: Over an 11-year period (January 2001 - December 2011) we documented a total of 149 renal injuries (47 isolated and 102 associated renal lesions). An analysis was made of the demographic characteristics of the two groups, as well as of the clinical presentation, diagnostic methods, grade of injury, associated lesions, emergency management, mortality, and length of stay.RESULTS: Closed trauma secondary to fall was the most frequent type of injury in both groups. The grade of injury proved similar in both (80% corresponding to grades 1-3 and 20% to grades 4-5). Conservative management was used in 93% of all isolated renal injuries and in 75.5% of the polytrauma patients with 10% and 5.7% failure rates respectively. Mortality rates were 0% and 7.8%, respectively.CONCLUSIONS: Renal injures are increasingly subjected to conservative management, with treatment generally being somewhat more aggressive in polytrauma patients.
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OBJECTIVES:To present a series of four cases of Gartner cysts and their clinical presentation. A bibliographic review was performed.METHODS: The series consisted of 4 women, mean age 39, who complained of a bulge at the anterior vaginal wall, associated with a variety of urinary symptoms.RESULTS: Surgical removal was performed in all cases. The pathological studies confirmed the diagnosis of Gartner cyst. There were no recurrences in the long-term follow-up.CONCLUSION: Vaginal wall cysts are rarely found in common urological practice. Gartner cysts arise as a consequence of the Gartner duct (mesonephric remainder) obstruction and they are located in the anterior or lateral wall of the vagina. They may be associated with renal and ureteral anomalies. Differential diagnosis with other vaginal cysts can only be made by histological studies. The correct treatment is the entire removal through a vaginal approach.
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OBJECTIVES: To evaluate and compare the functional results of an established technique, laparoscopic radical prostatectomy (LRP), and the initial learning curve of robot assisted laparoscopic radical prostatectomy (RALRP).METHODS: This is a transversal case-control hybrid studio including all patients undergoing RALRP (39) and similar number of patients undergoing LRP (37) from November 2009 to June 2011. We used a transversal phone interrogatory to evaluate functional outcome.RESULTS: The groups were comparable for IMC, age, serum PSA, prostatic ultrasound volume, biopsy Gleason, following time and clinical stage. For operative variables, there was no difference in estimated blood loss, hospital stay, days of drainage, time to catheter removal, transfusion rate and surgical margins. Median operative time was 216 min for RALRP, and 153 min for LRP (p< 0,001). There were no differences in erectile function or continence at 12 months. Mean time to continence was 5.7 weeks in RALRP and 8.9 week in LRP (p< 0,001). There was no difference in time to normal erectile function.CONCLUSIONS: Even in the beginning of RALRP we did obtain results comparable to LRP.
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OBJECTIVES: To evaluate hypoxia-inducible factor 1 subunit α (HIF-1α) expression during the performance of extracorporeal shock wave lithotripsy (ESWL) and to investigate the effects of pentoxyphylline on HIF-1α expression.METHODS: One hundred New Zealand Albino rabbit were used in the study divided in 5 groups. There were 20 rabbits in each group. The groups were divided in two parts: early (7 days) and late period (14 days) according to follow up duration. Immunohistochemical analyses were performed using nuclear staining to show HIF-1α expression in rabbit renal tissue sample.RESULTS: HIF-1α expression was higher in rabbits undergoing ESWL (group 4). In the hyperoxaluria group taking pentoxyphylline before ESWL (group 5), HIF-1α expression was lower in both early and late period subgroups (p < 0.05)CONCLUSION: In this study we evaluated HIF-1α expression and showed that ESWL may cause renal cell injury. Our results suggest that pentoxyphylline, as a circulatory regulator agent, may prevent renal cell injury induced by ESWL.
Case Report
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OBJECTIVES: We describe a case of hyaline vascular type Castleman’s disease with unifocal presentation as retroperitoneal mass. We describe the pathological and radiological findings and present a bibliographic review.METHODS: Castleman’s disease is a rare benign disease of unknown etiology characterized by a lymphoproliferative disorder. Two clinical types have been described: localized and multicentric. Isolated retroperitoneal involvement is uncommon.RESULTS: 39-year-old female who complained of back pain. Abdominal CT scan identified a 5 cm retroperitoneal interaortocaval mass. Complete laparoscopic excision was performed. Pathological study showed localized angiofollicular hyperplasia (hyaline vascular type Castleman’s disease).CONCLUSIONS: The presentation of Castleman’s disease as isolated retroperitonealmass is quite rare and should be distinguished from other retroperitoneal lesions of malignant character. The treatment of choice is surgery, providing a definitive and curative diagnosis. Operative biopsy may be useful.
Case Report
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OBJECTIVE: Tuberculosis of the penis is an extremely rare disease with few cases reported in the literature.CLINICAL CASE: We present the case of a 64 year-old man with a whitish papular-ampullary eruption in the glans penis. After antibiotic/antimycotic therapy and several topical ointments for 3 months without response he was referred to our Department. Biopsy of the ulceration edge was performed and pathology result showed a chronic granulomatous inflammatory necrotizing lesion with granulomatous vasculitis lesions, without tumor infiltration.Systemic examination to rule out other tuberculosis foci was negative. With de suspicion of primary tuberculosis of the glans penis, anti tuberculosis therapy with Isoniazid and Piridoxine was started.RESULTS: Within a period of five months the ulceration healed significantly. Currently, the patient is still asymptomatic without glans penis lesions.CONCLUSIONS: Primary glans penis tuberculosis is a rare disease, but we must consider it (both primary and secondary forms) to try to avoid diagnostic delays that may cause prejudice for the patient. This condition promptly responds to anti tuberculosis therapy as evidenced by our case and many other reports.
Case Report
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OBJECTIVE: We review the literature aboutbleeding complications of percutaneous nephrolithotomy(PCNL) and the application of the modified Clavien systemclassification.METHODS: We present a 38 year old man who underwentleft PCNL with acute severe hematuria during the immediatepostoperatory time. We review the literature and analyzethe usefulness of the modified Clavien system to gradeperioperative complications.RESULTS: Conservative management was insufficient so wehad to perform arteriography and superselective embolizationto solve the acute arterial bleeding. According to Clavien´sclassification, our case would be included within the grade3a group complications.CONCLUSIONS: The complications following a PCNL arenot uncommon. However most of them are not severe. Themodified Clavien system, used for classifying complicationsafter performing PCNL, can be useful for reporting results inan objective and replicable way
Case Report
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OBJECTIVE: To report a case of GIST typeretroperitoneal tumor with spontaneous rupture to theabdominal cavity causing acute abdomen secondary tohemoperitoneum.METHODS/RESULTS: We report the case of an 84 year-old man with history of BPH and chronic atrial fibrillation.He presented to the Emergency Department with diffuseabdominal pain, syncope and accompanying vegetativesymptoms. Diagnostic work up showed a 19 cmretroperitoneal mass dependent of the left kidney withactive bleeding and secondary hemoperitoneum. Leftradical nephrectomy was performed with pathology reportof gastrointestinal stromal tumor attached to the renalcapsule.CONCLUSIONS: Spontaneous hemoperitoneum is a rareentity and it has various etiologies. It is rarely described inretroperitoneal tumors
Case Report
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OBJECTIVE: Xanthogranulomatous Pyelonephritis(XP) is a renal chronic inflammatory disease infrequentduring childhood produced by the association of long-termurinary tract obstruction with chronic infection. We reportthe cases of two children diagnosed of XP.METHODS: One of them consulted for cloudy urine.Hypergammaglobulinemia with the presence of ahomogeneous band in the gamma fraction of theproteinogram stood out among laboratory findings. Theother case was diagnosed while performing a urologicultrasound in the follow up of kidney stone disease. In thelatter, the renal inflammation was adhered to the perirenalcapsule, colonic splenic flexure and descending colon.Both presented mild proteinuria and hematuria. None ofthem showed clinical sings of affectation of the generalstatus and their renal function laboratory data as well as theinfection markers were normal.RESULTS: All the alterations disappeared after performing anephrectomy of the affected kidney.CONCLUSIONS: We present two cases of XP in a groupof age rarely affected by this disease that also showedan uncommon presentation for their age. A high rate ofsuspicion must be held to diagnose and correctly treatthis disease because the grade of renal and extra renaldamage is closely related with the extension and durationof the disease
