Ureterocele urothelial carcinoma: managing a rare presentation.

It is very uncommon for urothelial carcinoma to develop in an ureterocele. It is generally discovered in an imaging study or in connection with haematuria. We found very few reports in the literature. Here, we report on the case of a 71-year-old male who initially presented with haematuria and low back pain and who then underwent transurethral resection for an intraureterocele tumour. Pathology confirmed urothelial carcinoma.

Endoscopic inguinal lymphadenectomy in penile cancer: case report and literature review.

OBJECTIVES: The objective was to submit our first experience in endoscopic inguinal lymphadenectomy (EIL), evaluate the feasibility of the procedure and carry out a review of the literature. MATERIAL AND METHODS: A 41-year-old patient was diagnosed with penile cancer with squamous cell carcinoma pT2G1 pathology, with no palpable inguinal lymph nodes. A bilateral inguinal lymphadenectomy was performed with preservation of the saphenous vein, conventional left and endoscopic right procedures. The perioperative data is presented and that obtained is discussed in the literature. RESULTS: The total time was 270 minutes, 180 for endoscopic and 90 for conventional procedures. Blood loss was minimal in both cases. Fifteen lymph nodes were dissected on the endoscopic side, and 17 in the conventional side, the latter with more pain and devitalised skin flap. CONCLUSIONS: EIL for penile cancer is feasible and there is less morbidity with an early recovery. The literature is not conclusive on the indication of EIL.

Testicular plasmacytoma as presentation of multiple myeloma: case report and review of the literature.

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.

Plasmocitoma testicular como presentación inicial de mieloma multiple: presentación de un caso y revisión de la literatura / Testicular plasmacytoma as presentation of multiple myeloma: case report and review of the literature

OBJETIVO: Presentamos el caso de un paciente con diagnóstico de plasmocitoma testicular como presentación inicial de mieloma múltiple y realizamos la revisión de la literatura en relación a lo infrecuente de dicha patología. MÉTODOS: Paciente de sexo masculino de 63 años portador de un tumor testicular, de 3 meses de evolución, de crecimiento progresivo. Una vez evaluado clínicamente y con estudios de ayuda diagnóstica fue sometido a orquiectomía radical. RESULTADO: La anatomía patológica reveló la presencia de células redondas, algunas de aspecto plasmocítico; el estudio inmunohistoquímico concluyó que era Plasmocitoma. Estudios de extensión de enfermedad mostraron lesiones líticas redondeadas diseminadas en los huesos de la bóveda del cráneo. Los estudios de médula ósea, así como la biopsia de hueso demostraron infiltración por neoplasia de células plasmáticas en más del 90%, consistente con el diagnóstico de Mieloma Múltiple. Paciente recibe el tratamiento respectivo, presentando progresión de enfermedad y posteriormente fallece. CONCLUSIONES: El plasmocitoma solitario es una lesión poco frecuente que representa sólo el 6% de todas las neoplasias de células plasmáticas. El compromiso testicular por esta enfermedad constituye un evento inusual, estimado en el 2% de los casos. Aunque éste es generalmente un hallazgo de autopsia, carente de expresión clínica, en raras ocasiones, como en el presente caso, puede constituir la primera manifestación de un mieloma múltiple o excepcionalmente ser la única localización de una neoplasia de células plasmáticas. Hasta la fecha son pocos los reportes publicados en la literatura y éste constituye un aporte más al conocimiento del mismo(AU)

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(AU)

Single-port transvesical enucleation of the prostate: a clinical report of 34 cases.

OBJECTIVE: To present our experience with single-port transvesical enucleation of the prostate (STEP) in 34 patients with large-volume benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: We performed STEP in 34 patients with large volume (>60 g) BPH (mean age 69 years, body mass index 26 kg/m(2), and American Society of Anesthesiology class 2). The mean prostate volume estimated by transrectal ultrasonography was 102.5 mL and the mean baseline prostate-specific antigen level was 6.7 ng/mL. A novel single-port device was inserted percutaneously into the bladder through a 2-3 cm incision in the suprapubic skin crease. After establishing pneumovesicum, the prostate adenoma was enucleated transvesically using standard laparoscopic instruments, and the adenoma was extracted in pieces through the port. Digital assistance expedited enucleation of the apical adenoma in 19 (55%) cases. RESULTS: Transvesical enucleation was completed in all 34 cases; the mean operative duration was 116 min, and the estimated blood loss was 460 mL. There was one death from postoperative bleeding from uncontrolled coagulopathy in a Jehovah's Witness who refused a transfusion of blood and blood products. There were three complications during STEP (one death, one bowel injury and one haemorrhage) and five afterwards (four bleeding, one epididymo-orchitis). Open conversion was necessary in two patients for complications, and extension of the skin incision by 1-2 cm was necessary in two to expedite apical digital enucleation. The mean hospital stay was 3 days and mean analogue pain score at discharge was 2. All 33 patients (excluding the patient who died) were voiding spontaneously at a maximum follow-up of 8 months, with a mean American Urologic Association symptom score of 3, a maximum urinary flow rate of 44 mL/s, and a postvoid residual of 30 mL at the latest follow-up. No patient developed urinary incontinence. CONCLUSIONS: STEP is an effective treatment option for selected patients with large-volume obstructive BPH. Under pneumovesicum using laparoscopic visualization, the entire adenoma can be effectively enucleated and expeditiously extracted through the novel single port. Comparison of the STEP procedure with other open and transurethral techniques will determine its place in the surgical treatment of large-volume BPH.

Robotic extended pyelolithotomy for complete staghorn calculus.

Staghorn stones represent a therapeutic challenge to urologists. We present our experience with laparoscopic extended pyelolithotomy for treatment of staghorn and complex renal calculi in highly selected cases. This approach provides the principles of open surgery with the advantages of minimally invasive surgery. We describe our experience with robot-assisted extended pyelolithotomy for complex coralliform calculi. Since January 2007, robotic extended pyelolithotomy has been performed by transperitoneal approach in two patients with complete coralliform lithiasis (calculi average size 8 cm). One patient had history of percutaneous nephrolithotomy. Demographic and operative data were collected. All procedures were technically successful without need for open conversion. Mean estimated blood loss was 175 ml (range 50-300 ml), and mean operative time was 150 min (range 120-150 min). A perinephric drain was employed in one patient with duration of 5 days. Postoperative imaging confirmed complete stone clearance. Robotic extended pyelolithotomy is a feasible and reproducible procedure for removal of complete and partial staghorn calculi in selected patients with complex nephrolithiasis. This approach might limit the role of open surgery for these calculi, but further publications with more cases are necessary to further define its utility.

Cáncer de próstata en Latinoamérica / Prostate cancer in Latin America

La detección temprana del cáncer de próstata en Latinoamérica es muy baja, ya que los pacientes por lo general llegan con enfermedad avanzada; esporádicamente se realizan campañas de cribado del cáncer de próstata que nos permiten detectar esta enfermedad en estadios tempranos. Las tasas de incidencia y mortalidad varían de país en país; probablemente hay un subregistro en nuestra región, al no contar con registros que muestren la incidencia general por país, sino por ciudades (AU)

There is a very low rate of early prostate cancer detection in Latin America, since patients usually are diagnosed when the disease is in advanced stages. Sporadic prostate cancer screening campaigns do exist which allow us to diagnose this disease in earlier stages. Incidence and mortality rates differ widely from country to country, and they are probably under reported in our region since registers may be city-based instead of country-based (AU)

Epithelioid angiomyolipoma: a rare variant of renal angiomyolipoma.

OBJECTIVE: We present a case of primary renal epithelioid angiomyolipoma, its association with tuberous sclerosis and review the literature. METHODS: We present the case of a 12 year-old male with past medical history of tuberous sclerosis, characterized by developmental delay, tonic and clonic seizures, and cutaneous abnormalities. He presented with macroscopic hematuria and abdominal pain. CT scan of the abdomen showed the presence of a left renal tumor. He underwent left radical nephrectomy. Pathologic study of the specimen showed primary renal epithelioid angiomyolipoma, corroborated by immunohistochemistry staining. Review of the literature was performed for this rare variant and its malignant potential. RESULTS: The presence of this epithelial variant is rare and must be taken into account because of its malignant potential and, thus, with different prognosis and follow up, compared to classical angiomyolipoma. CONCLUSIONS: Renal angiomyolipoma is an uncommon benign tumor, representing a challenge for clinical and pathological diagnosis. Despite the big size they can reach, as well as bilaterality, multiplicity of lesions and/or lymphatic regional involvement, its malignant potential has not been established. Nevertheless, the epithelioid variant has been described recently, a rare entity with aggressive behavior, difficult histological characterization and poor prognosis.

Angiomiolipoma epiteloide: una variante del angiomiolipoma renal / Epithelioid angiomyolipoma: a rare variant of renal angiomyolipoma

OBJETIVO: Presentar un caso de angiomiolipoma (AML) variante epitelioide, primario renal, su asociación con Esclerosis Tuberosa (ET) y revisión de la literatura.MÉTODOS: Presentamos el caso de un paciente varón de 12 años con antecedente de retardo en el desarrollo psicomotor, crisis epilépticas tónico clónicas y estigmas cutáneos, todo esto compatible con ET. Debuta con hematuria macroscópica y dolor abdominal, encontrándose en la tomografía tumor que compromete dos tercios superiores del riñón izquierdo. Fue sometido a nefrectomía radical izquierda. La anatomía patológica, corroborada con estudios de inmunohistoquímica informó la presencia de AML, variante epiteliode.Se reviso la bibliográfica existente sobre esta variante poco común y su comportamiento maligno.RESULTADOS: La presencia de la variante epitelial es poco frecuente pero debe tenerse en cuenta por su comportamiento maligno y por lo tanto diferente pronóstico y seguimiento comparado al AML clásico.CONCLUSIONES: El AML renal es un tumor benigno, poco común, que representa un reto para el diagnóstico clínico e histopatológico. A pesar del gran tamaño que puede alcanzar, la bilateralidad, la multiplicidad de las lesiones y/o el compromiso linfático regional, no se ha demostrado su potencial maligno. Sin embargo, en los últimos años se ha descrito la variante epitelioide, entidad rara de comportamiento agresivo, difícil caracterización histológica y pobre pronóstico(AU)

OBJECTIVE: We present a case of primary renal epithelioid angiomyolipoma, its association with tuberous sclerosis and review the literature.METHODS: We present the case of a 12 year-old male with past medical history of tuberous sclerosis, characterized by developmental delay, tonic and clonic seizures, and cutaneous abnormalities. He presented with macroscopic hematuria and abdominal pain. CT scan of the abdomen showed the presence of a left renal tumor. He underwent left radical nephrectomy. Pathologic study of the specimen showed primary renal epithelioid angiomyolipoma, corroborated by immunohistochemistry staining. Review of the literature was performed for this rare variant and its malignant potential.RESULTS: The presence of this epithelial variant is rare and must be taken into account because of its malignant potential and, thus, with different prognosis and follow up, compared to classical angiomyolipoma.CONCLUSIONS: Renal angiomyolipoma is an uncommon benign tumor, representing a challenge for clinical and pathological diagnosis. Despite the big size they can reach, as well as bilaterality, multiplicity of lesions and/or lymphatic regional involvement, its malignant potential has not been established. Nevertheless, the epithelioid variant has been described recently, a rare entity with aggressive behavior, difficult histological characterization and poor prognosis(AU)

[Laparo-endoscopic single site (LESS)]. / Laparo-endoscopia por acceso único: experiencia inicial.

OBJECTIVE: We present our initial experience in laparo-endoscopic single site (LESS) surgery, through multichannel port, articulated instruments and standard instruments adapted others adapted for the procedures. MATERIALS AND METHODS: Between February and October 2008, 28 LESS surgical procedures with multi-port were performed (Transumbilical simple prostatectomy (PSTU) and transvesical (PSTV), simple nephrectomy (NS), Enterocystoplasty augmentation (ECA) and simple hysterectomy (HS)). The clinical data were collected prospectively and analyzed retrospectively. Was used access device Multichannel (R-Port). The procedures were performed for a single surgeon (RS). The surgical technique was the same route used by conventional laparoscopic. RESULTS: Twenty-eight surgeries were performed: PSTU (01), PSTV (20), NS (01), ECA (01), HS (05). The incision was performed umbilical or infraumbilical. Only one case (nephrectomy) needed it placement of an additional trocar. The average age by procedure was PSTU and PSTV, 67- and 68-year-old (57-89 y) respectively; NS 12 year-old; RCT 20-year-old; HS 46.4-year-old (41 - 54 y). The operative time was: PSTU 120 minutes, PSTV 91 minutes (45-210 min); NS 120 minutes: RCT 300 minutes; HS 112 minutes(90-160 min). The operative bleeding was PSTU and PSTV 200 cc. and 337 cc (50-1500 cc) respectively; NS 100 cc; EAC 100 cc; HS 118 cc (100-160 cc). The complication was haematury in two cases of PSTV, both patients required exploration postoperative endoscopic with satisfactory evolution. CONCLUSIONS: LESS is a feasible and reproducible surgical option in uro-gynecologic surgical treatment. Further studies, experience and follow-up will provide an objective assessment of the technique.

Laparo-endoscopia por acceso único: experiencia inicial / Laparo-endoscopic single site (LESS)

Objetivo: Presentar nuestra experiencia inicial en LESS Surgery (Laparo-Endoscopic Single Site Surgery/Cirugía laparoendoscópica por acceso único), mediante uso de dispositivo multicanal, instrumentos estándar, articulables y otros adaptados para la consecución de los procedimientos. Materiales y métodos: Entre febrero y septiembre del 2008 se realizaron 28 procedimientos quirúrgicos LESS con puerto multicanal: prostatectomía simple transumbilical (PSTU) y transvesical (PSTV), nefrectomía simple (NS), enterocistoplastia de aumento (ECA) e histerectomía simple (HS). Los datos clínicos fueron recopilados de manera prospectiva y analizados retrospectivamente. Se utilizó dispositivo de acceso multicanal (R-Port). Los procedimientos fueron realizados en un centro por un solo cirujano (RS). La técnica quirúrgica empleada correspondió a la misma utilizada por vía laparoscópica convencional. Resultados: Se realizaron 28 intervenciones quirúrgicas: PSTU (01), PSTV(20), NS(01), ECA(01), HS(05). La incisión de acceso fue realizada a nivel umbilical o infraumbilical. Solo un caso (nefrectomía) ameritó uso de trocar adicional de 2 mm. La edad media en años por procedimiento fue: PSTU, 67; PSTV, 68 (57–89); NS, 12; ECA, 20; HS, 46.4 (41–54). El tiempo quirúrgico medio en minutos fue: PSTU, 120; PSTV, 91 (45–210); NS, 120; ECA, 300; HS, 112 (90–160). El sangrado operatorio fue: PSTU, 200cc; PSTV, 337 cc (50-1500); NS, 100cc; EAC, 100cc; HS, 118cc. (100–160). La complicación observada fue hematuria profusa en dos casos de PSTV, ambos pacientes requirieron exploración postoperatoria con evolución satisfactoria. Conclusiones: LESS es una alternativa factible y reproducible en patología uroginecológica de resolución quirúrgica. Mayores estudios, experiencias y seguimiento permitirán la evaluación objetiva de esta técnica (AU)

Objetive: We present our initial experience in laparo-endoscopic single site (LESS) surgery, through multichannel port, articulated instruments and standard instruments adapted others adapted for the procedures. Materials and methods: Between February and October 2008, 28 LESS surgical procedures with multi-port were performed (Transumbilical simple prostatectomy (PSTU) and transvesical (PSTV), simple nephrectomy (NS), Enterocystoplasty augmentation (ECA) and simple hysterectomy (HS)). The clinical data were collected prospectively and analyzed retrospectively. Was used access device Multichannel (R-Port). The procedures were performed for a single surgeon (RS). The surgical technique was the same route used by conventional laparoscopic. Results: Twenty-eight surgeries were performed: PSTU (01), PSTV (20), NS (01), ECA (01), HS (05). The incision was performed umbilical or infraumbilical. Only one case (nephrectomy) needed it placement of an additional trocar. The average age by procedure was PSTU and PSTV, 67 and 68 year-old (57-89 y) respectively; NS 12 year-old; RCT 20 year-old; HS 46.4year-old (41 – 54 y). The operative time was: PSTU 120 minutes, PSTV 91 minutes (45-210 min); NS 120 minutes; RCT 300minutes; HS 112 minutes (90-160 min). The operative bleeding was PSTU and PSTV 200 cc. and 337 cc (50-1500 cc) respectively; NS 100cc; EAC 100 cc; HS 118 cc (100-160 cc). The complication was haematury in two cases of PSTV, both patients required exploration postoperative endoscopic with satisfactory evolution. Conclusions: LESS is a feasible and reproducible surgical option in uro-gynecologic surgical treatment. Further studies, experience and follow-up will provide an objective assessment of the technique (AU)

Prostate cancer in Latin America.

There is a very low rate of early prostate cancer detection in Latin America, since patients usually are diagnosed when the disease is in advanced stages. Sporadic prostate cancer screening campaigns do exist which allow us to diagnose this disease in earlier stages. Incidence and mortality rates differ widely from country to country, and they are probable underreported in our region since registers may be city-based instead of country-based.

Single-port transvesical simple prostatectomy: initial clinical report.

INTRODUCTION: To present the initial report of single-port transvesical enucleation of the prostate in 3 patients with large-volume benign prostatic hyperplasia. METHODS: Single-port transvesical enucleation of the prostate was performed in 3 patients with large-volume (187, 93, and 92 g) benign prostatic hyperplasia. A novel single-port device (r-Port) was introduced percutaneously into the bladder through a 2.5-cm incision under cystoscopic guidance. After establishing pneumovesicum, the adenoma was enucleated in its entirety transvesically under laparoscopic visualization using standard and articulating laparoscopic instrumentation. The adenoma was extracted through the solitary skin and bladder incision after bivalving the prostate lobes within the bladder. RESULTS: Single-port transvesical enucleation of the prostate was technically feasible in all 3 cases. The operative time was 6, 1.5, and 2.5 hours, and the blood loss was 900, 250, and 350 mL. In patient 1, who had previously undergone open suprapubic surgery, a bowel injury occurred during r-Port insertion; the injury was recognized and repaired intraoperatively without sequelae. The urethral Foley catheter was removed on day 4, and all patients were voiding spontaneously with a minimal postvoid residual volume and full continence. CONCLUSIONS: Transvesical single-port laparoscopic simple prostatectomy is technically feasible. Additional experience at our and other institutions is necessary to determine its role in the surgical management of large-volume symptomatic benign prostatic hyperplasia.