OBJECTIVES: We present a new technique of transurethral prostatic enucleation.METHODS. We use an Olympus resectoscope with two electrodes; one has a button or “mushroom” shape to vaporize and enucleate, and the other one the shape of a conventional “cutting loop electrode” to resect.With the button-shaped electrode, we vaporize transversally at the level of the veru montanum, extending the dissection towards the lateroapical lobes, looking for the capsular plane. Once it is found, we ascend vaporizing up to the 3 and 9 in the clock following the capsular plane. Subsequently, we vaporize longitudinally the anterior commissure and keep going down to join the previously vaporizatized area. Then enucleation is achieved by pushing the adenoma with the button-shaped electrode, from distal to proximal, at the capsular plane level. Before the enucleated lobe falls inside the bladder, we can proceed, with the help of the conventional cutting loop electrode, to its resection, which is very fast and bloodless. If there is middle lobe, enucleation is initiated with it, performing two lateral grooves lengthways down to the veru montanum.RESULTS. We have carried out 45 procedures since October 2011, with excellent functional results. Prostate volumes range between 40-120 gr, with an operating time of 30-90 minutes. Hospital stay was 24-48 h. and the catheter is removed in 4-5 days. Blood transfusions were not needed in any case, and we have not recorded complications within this first year of follow-up.CONCLUSIONS. This technique makes possible the enucleation of the adenoma with a good haemostasis control. It also provides a good visualization of the capsular plane. Vaporization of the prostatic tissue is similar to the use of other energy forces. We don´t need to use a “morcellator” to extract the enucleated prostatic tissue. It is an economical and easily reproducible procedure, with a short learning curve.
OBJECTIVES: Chronic pelvic pain syndrome (CPPS) is a poorly understood and ill-treated condition. It is accompanied by the shortening and increase in tone of the pelvic floor muscles and is closely related to myofascial pain syndrome (MPS). This study aims to evaluate the utility of an anal stretching device (ASD) for improving the pain manifestations of chronic prostatitis (CP) and CPPS.METHODS: Thirty-one men (38.6 years ± 8.2) were consecutively recruited with an average monitoring period of 14.4 months (± 8.2). The treatment duration was between six months and three years. A clinical history was compiled along with a physical examination and neurophysiological tests. To evaluate pain, the Visual Analogue Scale (VAS) was used before and after treatment; at the final visit, the Clinical Global Impression of Improvement scale (CGI-I) was administered. The ASD is a device that is commercially available in different diameters and lengths.RESULT: Patients were diagnosed with MPS using neurophysiological tests. Significant differences were found before and after the treatment when evaluating the intensity of the pain using the VAS (6.1±2.1 vs. 1.9±1.3; p < .001). The CGI-I showed a total of 21 patients (70%) whose symptoms were improved or very much improved. Only one patient was worse after the treatment.CONCLUSIONS: ASD appears to be a safe and useful tool to treat the pain manifestations of CPPS without notable side effects.
OBJECTIVES: To apply the diagnostic criteria of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the criteria of the European Society for Study of Interstitial Cystitis (ESSIC) in our population with Bladder Pain Syndrome /interstitial cystitis (BPS/IC).METHODS: A cohort of 36 patients with the endoscopic clinical diagnosis of BPS/IC were evaluated retrospectively in the Hospital de Clinicas José de San Martin and Urology Center CDU over a period of 5 year. Cystoscopy with diagnostic and therapeutic hydrodistention was applied a to all patients.The NIDDK criteria were applied to the patients with endoscopic clinical diagnosis of BPS/IC. The new criteria proposed by the ESSIC were contrasted and results were compared.RESULTS: Of a total of 36 patients treated, 33 were women and 3 were men with ages between 30 and 75 years, 100% presented pain or urgency. Glomerulation or Hunner lesions appeared in 30 patients (83%). 35 patients (97%) had urinary frequency >8/day, and 22 patients (61%) had bladder capacity <350cc. Only 22 patients (61%) completed the strict diagnostic criteria of the NIDDK. On the other hand, using the new criteria proposed by the ESSIC for the diagnosis of BPS/IC 35 patients (97%) were included in this pathology, with normal cystoscopy in 6 patients (17%) and 14 patients (39%) with bladder capacity >350cc.CONCLUSION: The widest diagnostic criteria of the ESSIC allow the inclusion of more patients in the certainty diagnosis of BPS/IC than the NIDDK criteria, facilitating the diagnosis of this strange urological disease.
OBJECTIVES: To propose relaparoscopy as a feasible diagnostic tool and an efficient treatment in early abdominal complications after urologic laparoscopic procedures in selected patients that require surgical intervention. METHODS: Between January 2008 and April 2011, a total of 246 laparoscopic urologic procedures were performed at our institution. There were 81 radical nephrectomies (33%), 46 radical prostatectomies (19%), 31 pyeloplasties (13%), 28 partial nephrectomies (11%), 6 radical cystectomies (2%) and 54 miscellaneous (22%). Mean age was 53 years (range 15 to 84 years). Male / female ratio was 2.4:1. Patient’s ASA score was 1, 2, 3 and 4 in 48%, 44%, 7.5% and 0.5% respectively. Mean postoperative stay was 2.7 days (range 1 to 8 days). RESULTS: A total of 4 patients (1.6%) developed severe abdominal complications that required surgical intervention. All cases were reoperated laparoscopically. Mean operative time was 57 minutes (range 40 to 80 minutes), and mean hospital stay was 3.7 days (range 3 to 5 days). All patients evolved uneventfully and did not require further treatment. CONCLUSION: Surgical complications secondary to laparoscopic urologic procedures can be safely reoperated by means of laparoscopy especially in hemodinamically stable patients.
OBJECTIVE: This study presents the first Spanish case of a spontaneous knot in the catheter of a suprapubic cystostomy and review the national and international literature. METHODS: The case of an 87-year-old patient who was diagnosed with adenocarcinoma of the prostate is presented. A suprapubic vesical puncture for urinary retention was urgently performed in this patient because of the impossibility of urethral catheterisation. A spontaneous knot in the catheter was detected upon removal; the tightened knot could be removed by gentle and sustained traction without surgery.RESULTS: Knotting or calcification of the catheter was suspected when the catheter remained anchored in the bladder during a removal attempt 5 days after initial catheterisation. Plain pelvis x-ray was taken, but no calcification or knots were observed because the catheter was radiolucent. An ultrasound would have offered more information, but it was not requested. Gentle and sustained traction of the catheter reduced the knot size and allowed catheter removal without complications. Worldwide cases and national publications were reviewed. CONCLUSION: The formation of spontaneous or manipulation-induced knots in urinary cystostomy catheters is an extremely rare complication. The presented case is the first Spanish case of catheter knotting; it is only the 17th reported case worldwide.
OBJECTIVE: To report a case of adeno-carcinoma arising in an augmented bladder 41 years after the procedure.METHODS: After troublesome evaluation and fistula closure with urinary diversion by percutaneous nephrostomy, the patient underwent palliative chemotherapy and radio-therapy.RESULT: He died 5 months after the onset of the fistula.CONCLUSIONS: Development of adenocarcinoma in augmentation enterocystoplasties implies a mortality of about 30%. Early detection requires a high index of suspicion. Surveillance of augmented bladders, by annual cystoscopy and urine cytology, is therefore recommended.
OBJECTIVE: To report a new case with elevation of Ca 125 and hydronephrotic kidney without neoplastic disease, having special reference to clinical aspects.METHOD: The clinical history, anatomopathological and immunohistochemical findings are described. We performed a bibliographic review. We report the case of a 27 year-old female with the diagnosis of giant hydronephrosis and Ca125 elevation (313 u/ml hydronephrotic kidney urine and 112.3 u/ml serum).RESULT: She underwent a radical nephrectomy and Ca125 levels decreased. After 9 years the patient did not have any neoplastic disease and Ca125 levels are normal.CONCLUSIONS: The Ca125 rise with hydronephrotic kidney may be usual although there are not enough studies. We think that in patients with hydronephrotic kidney and malignant neoplasm the Ca125 antigen can lose sensitivity for the early diagnosis, staging and follow up of the malignant diseases.
OBJECTIVE:Malacoplakia is a rare chronic granulomatous disorder that mostly affects the urogenital system. This article describes a case of uncommon location of this disease at the level of the seminal vesicles and the clinical, imaging and histological particularities of this medical entity.METHOD: We report the case of a 69 year-old male consulting for constitutional syndrome that presented a pelvic tumor on the image studies, possibly arising in the seminal vesicles.RESULTS: The diagnosis was made after performing transrectal ultrasound and seminal vesicles biopsy by the pathognomonic histological findings of Michaelis Gutmann bodies. The presence of E. Coli in urine culture in our patient justified the use of a long-term antibiotic therapy such as quinolones with very good results.CONCLUSION: Malacoplakia of the seminal vesicles is an extremely rare condition, sometimes with non-specific clinical presentation. Its diagnosis is histological and it has good response to prolonged antibiotic therapy with a benign outcome
OBJECTIVE: We present the case of a patient with testicular plasmacytoma as initial presentation of multiple myeloma, and we carry out a literature review of this uncommon pathology.METHODS: 63 year-old male who consulted for a testicular mass for three months. After clinical and diagnostic studies he underwent radical orchiectomy.RESULTS: Pathologic study of the specimen revealed the presence of round cells, some with plasmocytic aspect. Immunohistochemical studies gave the final diagnosis of plasmacytoma. Studies on disease extension showed rounded lytic lesions spread over the vault of the skull bones. Bone marrow studies, as well as bone biopsy showed infiltration by plasma cell neoplasia in more than 90%, consistent with the diagnosis of multiple myeloma.The patient received treatment, developing disease progression and subsequently died from the disease.CONCLUSIONS: Solitary plasmacytoma represents only 6% of all plasma cell neoplasms. Testicular presentation is an unusual event, representing 2% of cases. Although this is usually an autopsy finding, it may constitute the first manifestation of multiple myeloma or exceptionally be the unique location of a plasma cell neoplasm. To date there are few reports published in the literature. This case constitutes a contribution for the knowledge of testicular plasmacytoma.