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Vesicoureteral reflux is one of the most important pediatric urology topics. The correction of this pathology by means of open and endoscopic surgery has been well established. The laparoscopic approaches are evolved with the aim of combining the minimally invasive nature of endoscopic treatments with the high success rates of open surgeries. The first applications of laparoscopic ureteral reimplantation techniques started in mid 1990s. However, it did not gain wide acceptance as the latter endoscopic trigonoplasties could not. With 2000s, case series of transperitoneal extravesical and pneumovesicoscopic intravesical ureteral reimplantations showed the feasibility. Today, both conventional and robotic assisted laparoscopic approaches are shown to have comparable outcomes with open counterparts in terms of successful resolution of reflux, postoperative comfort and improved cosmesis. The only shortcoming of new techniques seem to be the longer operative period which stands as a barrier against the wide acceptance which probably will take some time to be improved.
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OBJECTIVES: To determine the current status of the training of Urology Resident`s in Laparoscopic surgery, robotics and endourology.METHODS: We performed a survey among Spanish Urology Residents between 2011 and may 2012. We designed a survey that was disseminated through the web page of the Spanish Society of Laparoscopic and Robotic surgery (SECLA) (www.seclaendosurgery.com) to all residents from every Spanish hospital. The survey was divided in four blocks: General data, data of the Training Hospital, data of the surgical procedures (endoscopic, laparoscopic and robotic) and training features. We performed a descriptive study of the results.RESULTS: 36 Urology residents out of a total of 384 answered the survey (9,3%). In reference to endoscopic procedures 25% of the residents had never been involved on a percutaneous nephrostomy (n=36), and did not expect to do it. On the contrary, 77% have performed ureterorrenoscopy as first surgeon (n=36) and 25% have participated in more than 10 procedures. 54.4% of the participants took part as surgeons in percutaneous nephrolithotomies (n=28) and 79% looked forward to do them. Participation of residents in Da Vinci Robot assisted laparoscopic procedures is low. Laparoscopic procedures are very attractive and their participation is reduced as procedure complexity increases.CONCLUSIONS: 41.6% of participants think their training is adequate whereas 58,3% think it is not. 88% think their training could improve through courses and seminars and acquiring a greater degree of responsibility.
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OBJECTIVES: Primary CPCs are those detected in the blood of prostate cancer patients before radical treatment; secondary CPCs are those detected afterwards. Although primary CPCs are frequently found, it has been suggested that only a few will survive and go on to form metastasis. We evaluate the frequency of primary and secondary CPC detection and the association with biochemical failure, relation with clinical-pathological parameters and clinical implications in men treated by radical prostatectomy (RP) for prostate cancer.METHODS: Serial blood samples were taken before surgery and during follow up after RP. Mononuclear cells were obtained by differential gel centrifugation, and CPCs were identified using standard immunocytochemistry using anti-PSA monoclonal antibodies. Age, pathological stage (organ confined, non organ confined), pathological grade, margin status (positive, negative), extracapsular extension, perineural, vascular, and lymphatic infiltration (positive, negative) were compared with the presence/absence of CPCs in patients with and without biochemical failure. Kaplan Meier method was used to compare the unadjusted biochemical failure free survival of patients with and without CPCs. RESULTS: 138 of 423 (32.6%) men undergoing prostate biopsy for an elevated serum PSA were diagnosed of prostate cancer. Of these men 15 (10.9%) were CPC negative. 95 CPC positive men underwent RP. There was no relation between primary CPC detection and clinical-pathological parameters; however, secondary CPCs were associated both with clinical-pathological parameters and biochemical failure.CONCLUSIONS: Primary CPCs are frequently detected in men with prostate cancer, but they are not associated with biochemical failure, so that they may be useful for prostate cancer detection but not for prognosis. The persistence of CPCs after surgery is associated with increased biochemical failure.
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OBJECTIVES: The aim of this paper is to analyze the clinical profile of patients with chronic pelvic pain (CPP) to obtain a more accurate and fast clinical diagnosis.METHODS: In this retrospective and descriptive crosssectional study, we recruited 64 patients with CPP (32men and 32 women). Patients had confirmed diagnosis of CPP. History was done including past medical history, prior abdominal and pelvic surgery, practice of risk sports, start and evolution of the pain, and number of physicians visited. We evaluated pain intensity with a VAS scale, neuropathic characteristics of the pain with the DN4 questionnaire, anxiety and depression with the HAD Scale (HADS) and disability with the Oswestry Disability Index (ODI). Pelvic floor evaluation integrated intrapelvic and extrapelvic muscles assessment.RESULTS: Average number of doctors visited was 6.4 for men and10 for women. The VAS for men was 5.43 (± 2.29), for women 6.89 (± 1.89). The DN4 for men was 4.53 (± 2.2), for women 4.44 (± 2.2). The mean anxiety in men was 10.18 (± 4.27) and for women 9 (± 4.6); and mean depression in men was 7.31 (± 4.88) and for women 7.16 (± 4). ODI for men was 26.7% (± 2.2), for women 33.75% (± 2.2).CONCLUSION: We have defined a clinical profile of patients with CPP that can enable a better approach to the reality of these patients with diminished quality of life.
Case Report
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OBJECTIVE: To report two cases of prostatesarcoma and perform a review of the published literature.METHODS / RESULTS: The first case is a 21 year oldpatient who presented acute urine retention and lungmetastases on diagnosis. He was diagnosed by TURP ofrhabdomyosarcoma of the prostate dying 1 month aftersurgery. The second case was a 33 years old male whopresented to the emergency room with anal pain, urinarysymptoms, hematochezia and loss of 20 kg over the past3 months. Abdominal CT scan showed an 11 x 10 x 9cm mass in the lower pelvis that infiltrated the bladder andrectum, being unable to define its origin. CA 19.9, CEAand PSA were normal. The suspected diagnosis was aprostate sarcoma infiltrating rectum and bladder. A pelvicexenteration was performed with a wet colostomy. Thepathologic diagnosis was a high grade sarcoma not clearlyidentified of the prostate. He was treated with adriamycinas adjuvant chemotherapy, having local recurrence, nodalinvolvement and multiple pulmonary metastases after 3months of follow upCONCLUSIONS: Prostate sarcomas are rare tumors. Thismakes difficult to know their natural history. Their rapidprogression and systemic spread, despite multimodaltreatment, gives a mean survival of 24 months. Mainsurvival factors are grade, a complete resection of the tumor and a low local stage. There is a need to find newchemotherapy protocols to increase survival rates as it hasbeen shown in extremities sarcomas
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OBJECTIVE: Haemangiopericytoma is an uncommon perivascular tumor that occurs more frequently in soft tissues and is extremely rare in the kidney.METHODS: We report two cases: The first one is the case of a 57-year-old man with bilateral metastatic renal haemangiopericytoma which appeared 18 years after removal of a meningeal haemangiopericytoma. The second is a 29-year-old woman with a primary kidney haemangiopericytoma that was casually found in a nephrectomy piece.RESULTS: In the first case, radical left nephrectomy and right renal mass radiofrequency ablation were performed. The patient had an uneventful postoperatory recovery. He remained disease-free 22 months after surgery but two new lesions appeared that were treated with radiofrequency ablation. The second case was a casual finding, a small tumor that had been totally resected.CONCLUSIONS: Haemangiopericytoma is a rare tumor with an uncertain clinical behaviour. Long-term follow up is important as local recurrences and metastases can develop years after initial treatment.
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OBJECTIVE: To describe ischemic priapism as an atypical presentation of chronic myeloid leukaemia.METHODS / RESULTS: We discuss two patients diagnosed with chronic myeloid leukaemia presenting an episode of priapism, adequately resolved after applying the treatment protocol established in our center.CONCLUSION: Priapism is defined as a persistent erection that persists despite not having sexual stimulus, without involvement of the spongy tissue of the penis.Its debut appearance as a hematologic dyscrasia is a rare event. It is a urological emergency, requiring early multidisciplinary (Urology and Hematology) management, since the speed in treatment will result in good functional results and the preservation of a good quality of life.
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OBJECTIVE: To explore the possibility of choriocarcinoma syndrome developing as a potentially fatal complication in patients with this pathology.METHOD: Choriocarcinoma syndrome consists of hemorrhagic manifestations of metastases in advanced germ cell cancer containing large elements of choriocarcinoma. It should be suspected in patients with high tumor mass, multiple metastases and elevated tumor markers characteristic of germ cell tumors. It usually occurs before and during the onset of systemic treatment with chemotherapy. Failure to diagnose it can lead to fatal consequences and may require aggressive diagnostic and therapeutic measures such as surgery. It can also be prevented by developing a good therapeutic strategy that includes an interdisciplinary team, raising the possibility of deferring testicular surgery and beginning chemotherapy beforehand.RESULTS: We report two cases of men with the diagnosis of choriocarcinoma syndrome on liver metastases. We provide ultrasound and CT images of the two cases of hemorrhage on liver metastases and radiological characteristics peculiar to each case that have never been published before.CONCLUSIONS: There should be a high index of suspicion of life-threatening complications in patients with germ cell tumors with a choriocarcinoma component, including the development of life-threatening choriocarcinoma syndrome.
Case Report
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OBJECTIVE: Collecting duct carcinoma ofthe kidney is a rare and aggressive subtype of renal cellcarcinoma with low cancer-specific survival. We reviewedour series of collecting duct tumours retrospectively.METHODS/RESULTS: We performed a retrospectiveanalysis of the collecting duct carcinomas of the kidneytreated in our unit between January 2007 and December2012. The variables analysed were: age, gender, reasonfor consultation, side affected, ASA score according toanaesthetic risk, surgical treatment, tumour size, Fuhrmangrade, lymphovascular invasion, TNM staging (2009classification), adjuvant treatment and survival time. Fourcollecting duct carcinomas were identified. Mean patientage was 61 years. Constitutional syndrome and lowerback pain were the most frequent reasons for consultation(75%), followed by hematuria. The surgical treatment waslaparoscopic radical nephrectomy in 100% of the cases,with lymphadenectomy in 2 patients due to lymph nodedisease detected on imaging studies. The 4 patients wereinitially treated with temsirolimus as adjuvant therapy withno response. Two patients were given second-line treatmentwith sunitinib without any response. All 4 patients died fromtheir disease with a mean survival of 9.5 months (range:4-15 months).CONCLUSIONS: Collecting duct carcinoma of the kidneyis a rare and aggressive renal parenchymal tumour. Long-term survival rate is low, because the only potentiallycurative treatment seems to be surgery if it is performed inpatients with localised tumours
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OBJECTIVE: Primary cancer of female urethra is rare and represents about 0.02% of all neoplasias found in women and the majority of them are squamous cell carcinomas. Diagnosis is difficult due to the fact that the disease has usually reached advanced stage. We report our experience with two patients with urethral adenocarcinoma.METHODS: We describe clinical-pathological findings and treatment carried out in two patients with urethral adenocarcinoma. We review the literature focusing on the origin of these tumors and available treatment options.RESULTS: After diagnosis, radical surgery was performed in both patients. Despite this, one patient died of local progression. The other patient is still alive and free of recurrence.CONCLUSIONS: Adenocarcinoma of the female urethra is a rare tumor of difficult diagnosis. Surgery is the only curative treatment. Chemotherapy (CT) and radiotherapy (RT) must be used in patients in whom surgery is not possible, although there is no consensus on the best therapeutic approach. Prognosis tends to be poor due to delay in diagnosis.
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OBJECTIVE: To report 5 cases of adenomatoid tumor of the epididymis that have been diagnosed in the last 11 years at our hospital. We performed a bibliographic review with discussion of diagnosis, differential diagnosis and treatment of this rare type of lesion.METHOD: We have performed a retrospective analysis of epididymal adenomatoid tumors diagnosed during the last 11 years in our hospital, from January 2001 to June 2012.RESULTS: The average age of the series was 44 years. The predominant reason for consultation was long duration painless scrotal mass, with palpable nodule, usually dependent of the epididymis. 60% of the patients have been studied with abdominal ultrasound, which showed a nodular paratesticular lesion, with an echogenicity compatible with solid tissue. Tumor markers associated with testicular tumors (alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (b-HCG) and lactate dehydrogenase (LDH)) were analyzed in 60% of the cases, being normal in all patients. 3 lumpectomies, 1 epididymectomy and 1 radical orchiectomy have been performed.CONCLUSIONS : The discovery of a solid epididymal mass is uncommon in clinical practice. Physical examination and imaging tests should confirm the paratesticular origin of the lesion, being then trans---scrotal epididymectomy the treatment of choice. If diagnosis is uncertain, inguinal approach and intraoperative biopsy are mandatory.
