Spermatic cord torsion: a retrospective analysis

ABSTRACT Objective To evaluate the time interval and possible delay in transportation to referral units for the treatment of testicular torsion. Methods We retrospectively analyzed all cases of spermatic cord torsion surgically treated at a university hospital between January 2018 to December 2021. We evaluated the time intervals, including pain onset until the first presentation (D1), interhospital transference time (D2), pain onset until urological evaluation in a tertiary service (D3), urological evaluation until surgery (D4), and time from pain onset to surgical treatment (D5). We analyzed demographic and surgical data, orchiectomy rates, and time intervals (D1-D5). Torsions presented to the first medical presentation within 6h were considered early for testicular preservation. Results Of the 116 medical records evaluated, 87 had complete data for the time interval analysis (D1 to D5) and were considered the total sample. Thirty-three had D1 ≤6h, 53 had D1 ≤24h (includes patients in the D1 ≤6h subgroup), and 34 had D1 >24h. The median time intervals of the total samples and subgroups D1 ≤6h, D1 ≤24h, and D1 >24h were D1 = 16h 42min, 2h 43min, 4h 14min and 72h, D2 = 4h 41min, 3h 39min, 3h 44min and 9h 59min; D3 = 24h, 6h 40min, 7h and 96h; D4 = 2h 20min, 1h 43min, 1h 52min and 3h 44min; D5 = 24h 42min, 8h 03min, 9h 26min and 99h 10min, respectively. Orchiectomy rates of the total sample, subgroups D1 ≤6h, D1 ≤24h, and D1 >24h were 56.32%, 24.24% (p<0.01), 32.08% (p<0.01), and 91.18% (p<0.01), respectively. Conclusion Late arrival at the emergency department or a long interhospital transference time determined a large number of patients who underwent orchiectomy. Thus, public health measures and preventive strategies can be developed based on the data from this study aiming to reduce this avoidable outcome.

COVID-19: The impact on urolithiasis treatment in Brazil

ABSTRACT Introduction: It has been more than a year since the first case of Covid-19 was diagnosed in Brazil, and its most problematic feature is the oversaturation of the healthcare system capacity. Urolithiasis is a disease that requires timely and appropriate management. The present study aimed to evaluate the impact of the pandemic in hospital admissions for urolithiasis in the Brazilian public healthcare system. Materials and Methods: In this cross-sectional study, hospital admissions were obtained from the Brazilian Public Health Information system. All hospital admissions associated with urolithiasis diagnosis (ICD-10 N20) between March 2017 and February 2021 were analyzed. Results: During the COVID-19 outbreak, there was a significant decrease in hospital admissions (p<0.0001). More than 20.000 patients probably did not have the opportunity to undergo their surgeries. The impact of the COVID-19 outbreak on women's admissions was significantly more intense than for men, reducing from 48.91% to 48.36% of the total (p=0.0281). The extremes of age seemed to be more affected, with patients younger than 20 years and older than 60 years having a significant reduction in access to hospital services (p=0.033). Conclusions: In conclusion, we have noticed a considerable reduction in overall admissions for the treatment of urolithiasis in the Brazilian public healthcare system during the first year of the Covid-19 pandemic. Women and individuals older than 60 years were especially affected. In contrast, we noted a rise in urgent procedures, comparing with the average of the corresponding period of the three previous years. Recovery plans will be needed while returning to activities to handle the impounded surgical volume.

Calcified intrarenal aneurysm simulating urinary lithiasis

ABSTRACT We describe the case of a female patient with calcification in renal topography, initially diagnosed as lithiasis in the left kidney, and later attributed to calcification of intrarenal vascular aneurysm. Next, we discuss the relevance of considering such an entity in the differential diagnoses of intrarenal calcifications before choosing any form of specific interventional treatment.

Giant prostatic hyperplasia: report of a previously asymptomatic man presenting with gross hematuria and hypovolemic shock / Hiperplasia prostática gigante: hematúria macroscópica com choque hipovolêmico em paciente previamente assintomático

Giant prostatic hyperplasia is a rare condition characterized by very high volume benign prostatic enlargement (>500g). Few cases have been reported so far and most of them are associated with severe lower urinary symptoms. We report the first case of asymptomatic giant prostatic hyperplasia in an elderly man who had a 720g prostate adenoma, sudden gross hematuria and hypovolemic shock. The patient was successfully treated with open transvesical prostatectomy and had an uneventful postoperative recovery.

A hiperplasia prostática gigante é uma condição rara caracterizada por aumento benigno prostático significativo, com volume maior que 500g. Existem poucos casos relatados e, em sua maioria deles está associada a sintomas graves do trato urinário inferior. Relatamos aqui o primeiro caso de hiperplasia prostática benigna assintomática em paciente idoso com próstata de 720g, hematúria macroscópica de início súbito e choque hipovolêmico. O paciente foi submetido com sucesso à prostatectomia suprapúbica, sem intercorrências no intra e pós-operatório.

Steinstrasse predictive factors and outcomes after extracorporeal shockwave lithotripsy

PURPOSE: Urinary stone disease is a common medical problem. Extracorporeal shockwave lithotripsy (SWL) has been applied with high success and low complication rates. Steinstrasse (SS) is a possible complication after SWL. The aim of the present study was to prospectively evaluate the factors and outcomes associated with SS after SWL. MATERIALS AND METHODS: We have prospectively evaluated 265 SWL sessions (2005-2009). Two lithotriptors were used randomly: Siemens Lithostar and Dornier Compact S. All patients had imaging exams after 30 and 90 days or according to symptoms. RESULTS: SS was observed in 14 (5.3 percent) out of 265 SWL procedures (n = 175 patients, 51.5 percent women/48.5 percent men, mean ± SD age = 46.3 ± 15.5 years). SS was more common after SWL for pelviureteral calculi rather than caliceal stones (p = 0.036). There was a trend toward more occurrences of SS after SWL for larger stone area (> 200 mm², p = 0.072). Preoperative ureteral stent didn't prevent SS. SWL machine, intensity, number of pulses and frequency were not associated with SS formation. Post-SWL pain, fever and gravel elimination were factors associated with SS (p = 0.021; p = 0.011; p = 0.078). When SS occurred, treatment modalities included Medical Expulsive Therapy (MET), ureteroscopy and SWL. CONCLUSIONS: Steinstrasse is an uncommon event after SWL and seems to occur more frequently with larger pelviureteral stones. Impaction of stones is more frequent in the middle ureter. All patients should be followed after SWL, but SS should be specially suspected if there is macroscopic gravel elimination, flank pain and/or fever. When SS occurs, treatment should be promptly introduced, including medical expulsive therapy, surgical approach or SWL in selected cases. Further prospective studies are awaited to evaluated preventive measures for SS occurrence.

Robotic assisted radical prostatectomy: a different treatment for prostate cancer? / Prostatectomia radical robô-assistida: um tratamento diferente para câncer de próstata?

Considering the Health Care System in Brazil, a developing country, and public healthcare policies, robotic surgery is a reality to very few citizens. Therefore, robotic assisted radical prostatectomy is far removed from the daily practice of the vast majority of Brazilian urologists. Scientific evidence of the superiority of robotic assisted radical prostatectomy does not presently justify public investments for widespread development of robotic centers. Maybe over time and with reductions in costs, robotic technology will become a more established practice, as observed in other countries, and more feasible for the Brazilian urological community.

Levando em conta o Sistema de Saúde do Brasil, um país em desenvolvimento, e as políticas de saúde pública, a cirurgia robótica é uma realidade disponível a poucos cidadãos. Assim, a prostatectomia radical robô-assistida está longe da prática diária da grande maioria dos urologistas brasileiros. As evidências científicas da superioridade da prostatectomia radical assistida por robôs não justificam, no momento, os investimentos públicos para o desenvolvimento disseminado de centros de robótica. Talvez mais tarde e com redução nos custos, a tecnologia da robótica torne-se uma prática mais estabelecida, como já observado em outros países, e fique, assim, mais viável para a comunidade urológica do Brasil.

Experiência da Faculdade de Medicina do ABC em nefrolitotripsia percutânea / Experience of the Faculdade de Medicina do ABC in percutaneous nephrolithotripsy

Objetivos: Demonstrar a experiência e os resultados em nefrolitotripsia percutânea na Faculdade de Medicina do ABC. Pacientes e métodos: Entre janeiro de 2002 e janeiro de 2005, foram revisados os prontuários de 69 pacientes foram submetidos a NLPC. Resultados: A massa calcárea média foi de 850 mm2. Todos os pacientes foram tratados através de apenas uma punção renal e somente em 1 caso foi necessária transfusão peri-operatória. A taxa de sucesso após o procedimento inicial foi de 70%, sendo 39% livre de cálculo. Após tratamentos complementares a taxa de sucesso final foi de 85,5%. Conclusão: Os nossos resultados iniciais em NLPC foram um pouco inferiores aos publicados em outras séries. Tal diferença pode ser justificada pela curva de aprendizado inicial neste procedimento, envolvimento de residentes em treinamento, pelo maior volume dos cálculos em relação aos trabalhos da literatura, por ter sido realizada apenas uma punção e não disponibilidade de material flexível para exploração completa da via excretora.

Litíase ureteral gigante: relato de caso / Giant ureteral stone: case report

A cirurgia convencional para o tratamento dos cálculos urináriosestá hoje restrita a algumas situações especiais, ou quando há falha do tratamento minimamente invasivo. A litíase ureteral gigante é uma entidade patológica rara. O tratamento clássico é aureterolitotomia com ampla incisão do ureter. Relatamos um caso de um paciente de 16 anos do sexo masculino que apresentou um cálculo ureteral de 11 cm, submetido a cirurgia aberta, onde a fratura do cálculo e uma incisão de 2 cm no ponto médio do cálculopermitiram uma menor agressão ao ureter para retirada do cálculo.Não houve complicações e o paciente recebeu alta no 4º dia pósoperatório.Especulamos que a técnica utilizada pode ser perfeitamente reprodutível por laparoscopia, tornando o procedimento ainda menos invasivo.

Análise crítica das opções de tratamento para cálculo ureteral proximal / Critical analysis of treatment options for proximal ureteral calculus

A litíase ureteral é uma afecção freqüente e que pode acarretar doloroso quadro de cólica renal. Quando existe necessidade de intervenção, várias opções podem ser cogitadas. O surgimento de técnicas endourológicas e procedimentos minimamente invasivostornaram-se as principais vias de tratamento e reduziram drasticamente a indicação de ureterolitotomia convencional. O último “guideline” publicado em 1997, baseado em metanálise da literatura, sugere a litotripsia extracorpórea como a primeira opção de tratamento para a maioria dos cálculos ureterais. Após aelaboração dessas diretrizes, surgiram séries demonstrando excelentes resultados com a utilização de aparelhos endourológicos mais finos, fontes de energia a laser e ureterolitotomialaparoscópica. Essas publicações suportam e credenciam essas técnicas como opções de tratamento para cálculos ureterais e provavelmente serão cogitadas em um próximo “guideline” mais atualizado. Particularmente em relação à litíase ureteral proximal, os resultados da litotripsia extracorpórea e das técnicasendourológicas são inferiores em comparação aos outros segmentos do ureter, principalmente se esses cálculos apresentarem dimensões acima de 10 mm. As novas abordagens e publicações demonstraram resultados superiores aos publicados no “guideline” de 1997, o que pode alterar as diretrizes para tratamento dos cálculos ureterais proximais. Esta revisão visa avaliar os resultados das alternativas atuais para abordagem da litíase ureteral proximal e sugerir algoritmo de tratamento.

Duodenal damage complicating percutaneous access to kidney

CONTEXT: Since the first percutaneous nephrostomy performed by Goodwin in 1954, technical advances in accessing the kidneys via percutaneous puncture have increased the use of this procedure and thus the complications too. Among these complications, digestive tract damage is not common. DESIGN: Case report. CASE REPORT: We report a duodenal lesion that was corrected using surgical exploration and we touch on the therapeutic options, which may be conservative or interventionist. We chose conservative treatment, which has been approached in diverse manners in the literature

Retenção urinária aguda por extenso hematoma pélvico após herniorrafia inguinal / Acute urinary retention caused by an extensive pelvic hematoma after inguinal herniorraphy

The authors report a rare case of a patient with urinary retention following an inguinal herniorraphy, due to extrinsic compression of the bladder by an extensive pelvic hematoma, diagnosed by cystourethrogram and pelvic computadorized tomography. A medical treatment was provided by vesical catheterization for seven days. After this period of time, the hematoma had disappeared and the patient recovered to spontaneous miction

Hiperplasia benigna de próstata e neoplasia vesical: ressecar simultaneamente ou não? / Prostatic adenoma and bladder tumor: simultaneous ressection or not?

A ocorrência simultânea de hiperplasia prostática benigna e neoplasia vesical não é um evento raro. A neoplasia vesical pode ser um achado intra-operatório durante a ressecção trans-uretral de próstata. Ressecar concomitantemente evitaria do paciente ser submetido a novo procedimento cirúrgico-anestésico, diminuiria os gastos hospitalares e eliminaria a urina residual, que tem papel na fisiopatologia dos tumores vesicais e suas recidivas. Os contrários a esta conduta, sustentam sua opinião no risco de implante tumoral em uretra prostática. O objetivo desta revisão de literatura é tentar elucidar se a ressecção simultânea é recomendável ou não

Síndrome da alça aferente secundária à recorrência de câncer gástrico operado / Afferent loop syndrome secondary to the recurrence of an operated gastric cancer

Os autores relatam um caso de paciente portador de Síndrome de alça aferente, submetido a uma gastrectomia subtotal radical a Billroth II por adenocarcinoma gástrico dois anos antes, e realizam breve revisao de literatura.