ABSTRACT
Cada vez son más frecuentes en nuestras consultas los pacientes diagnosticados de HBP en los que al indicar la intervención quirúrgica, se plantean limitaciones por la toma de medicación concomitante, edad, morbilidad asociada o condiciones psicosociales. La RTU de próstata, aun siendo el patrón quirúrgico de referencia, en este grupo de pacientes ancianos y de alto riesgo, no está exenta de complicaciones como la posibilidad de reabsorción, sangrado e incluso transfusión en un porcentaje de casos. La fotovaporización prostática mediante láser puede ser una alternativa válida en este subgrupo de pacientes. Revisamos nuestra experiencia en este procedimiento, así como lo publicado al respecto y describimos recomendaciones técnicas que consideramos útiles para evitar en lo posible complicaciones durante la cirugía o en el postoperatorio inmediato (AU)
It is more and more common to have patients in our clinics with the diagnosis of BPH and indication for surgery who present limitations due to their medications, age, associated morbidity or psychosocial conditions. Transurethral resection of the prostate, though it is the surgical standard of reference, is not free from complications such as reabsorption syndrome, bleeding, or even blood transfusion in a percentage of cases. Laser PVP may be a valid alternative in this subgroup of patients. We review our experience with this procedure, as well as the published articles on this topic, and describe technical recommendations we consider useful to avoid complications when possible during surgery or the immediate postoperative period (AU)
Subject(s)
Humans , Male , Lasers/therapeutic use , Laser Therapy/methods , Laser Therapy/trends , Morbidity , Urinary Retention/surgery , Urinary Retention , Cystoscopy/methods , Endoscopy/methods , Psychosocial Impact , Neovascularization, Physiologic/physiology , Angiogenesis Inhibitors/therapeutic use , Length of Stay/economicsABSTRACT
It is more and more common to have patients in our clinics with the diagnosis of BPH and indication for surgery who present limitations due to their medications, age, associated morbidity or psychosocial conditions. Transurethral resection of the prostate, though it is the surgical standard of reference, is not free from complications such as reabsorption syndrome, bleeding, or even blood transfusion in a percentage of cases. Laser PVP may be a valid alternative in this subgroup of patients. We review our experience with this procedure, as well as the published articles on this topic, and describe technical recommendations we consider useful to avoid complications when possible during surgery or the immediate postoperative period.
Subject(s)
Laser Therapy/methods , Prostatic Hyperplasia/surgery , Equipment Design , Humans , Laser Therapy/instrumentation , Male , Risk FactorsABSTRACT
OBJECTIVE: To evaluate the results obtained in the correction of the curved penis by means of Nesbit's technique during the four first years of integration of our Service in the Major Ambulatory Surgery Unit (CMA) of our Hospital. PATIENTS AND METHOD: From January of 2000 to April of 2004 we intervened in ambulatory regime 21 patient suffering from curved penis (12 congenital and 9 with Peyronie's disease) by means of Nesbit's technique. The surgical-anesthetic performed procedure is described and also the criteria of inclusion and discharge are evaluated, as well as the results obtained and the degree of satisfaction by means of the elaboration of a questionnaire. RESULTS: None of the patients needed entrance for intrasurgery nor postsurgery complications. Thus, we obtained a null incidence of complications with the exception of the inevitable shortening of the penis, clearly independent from the regime of out-patient's process. The degree of satisfaction with the received treatment has been superior to 95%. CONCLUSIONS: The practical totality of the susceptible patients for surgical correction of penile curvature are candidates to be included in a CMA program, improving obviously the relation cost-efficacy, not diminishing for that reason the welfare quality nor the degree of patient's satisfaction.
Subject(s)
Penile Induration/surgery , Urologic Surgical Procedures, Male/methods , Adolescent , Adult , Ambulatory Surgical Procedures/methods , Humans , Male , Middle Aged , Patient Satisfaction , Penile Erection/physiology , Penis/pathology , Penis/surgery , Postoperative Complications , Suture Techniques , Treatment Outcome , Urologic Surgical Procedures, Male/adverse effectsABSTRACT
Objetivo: Evaluar los resultados obtenidos en la corrección del pene curvo mediante la técnica de Nesbit durante los cuatro primeros años de integración de nuestro Servicio en la Unidad de Cirugía Mayor Ambulatoria (CMA) de nuestro Hospital. Pacientes y método: Desde enero de 2000 hasta abril de 2004 hemos intervenido en régimen ambulatorio a 21 pacientes afectos de pene curvo (12 congénito y 9 con enfermedad de Peyronie) mediante la técnica de Nesbit. Se describe el procedimiento quirúrgico-anestésico realizado y también se evalúan los criterios de inclusión y alta, así como los resultados obtenidos y el grado de satisfacción mediante la elaboración de un cuestionario. Resultados: Ninguno de los pacientes precisó ingreso por complicación intra ni postoperatoria. Así, hemos tenido una nula incidencia de complicaciones a excepción del inevitable acortamiento del pene, claramente independiente del régimen de ambulatorización del proceso. El grado de satisfacción con el tratamiento recibido ha sido superior al 95%. Conclusiones: La práctica totalidad de los pacientes susceptibles de corrección quirúrgica de incurvación peneana son candidatos a ser incluidos en un programa de CMA, mejorando ostensiblemente la relación costo-eficacia, no disminuyendo por ello la calidad asistencial ni el grado de satisfacción de los pacientes (AU)
Objective: To evaluate the results obtained in the correction of the curved penis by means of Nesbits technique during the four first years of integration of our Service in the Major Ambulatory Surgery Unit (CMA) of our Hospital. Patients and method: From January of 2000 to April of 2004 we intervened in ambulatory regime21 patient suffering from curved penis (12 congenital and 9 with Peyronie´s disease) by means of Nesbits technique. The surgical-anesthetic performed procedure is described and also the criteria of inclusion and discharge are evaluated, as well as the results obtained and the degree of satisfaction by means of the elaboration of a questionnaire. Results: None of the patients needed entrance for intrasurgery or postsurgery complications. Thus, we obtained a null incidence of complications with the exception of the inevitable shortening of the penis, clearly independent from the regime of out-patients process. The degree of satisfaction with the received treatment has been superior to 95%. Conclusions: The practical totality of the susceptible patients for surgical correction of penile curvature are candidates to be included in a CMA program, improving obviously the relation cost-efficacy, not diminishing for that reason the welfare quality nor the degree of patientss satisfaction (AU)
Subject(s)
Male , Adult , Humans , Penile Induration/surgery , Urologic Surgical Procedures/methods , Ambulatory Surgical Procedures , Patient Satisfaction , Penile Erection/physiology , Penis/pathology , Penis/surgery , Postoperative Complications , Suture Techniques , Treatment Outcome , Urologic Surgical Procedures/adverse effectsABSTRACT
OBJECTIVE: The impact of the creation of the andrology unit on intracavernous injection therapy for erectile dysfunction is analyzed in the present study. METHODS: The records of patients treated by intracavernosal injection of vasoactive drugs for erectile dysfunction from 1990 to 1997 were reviewed. RESULTS/CONCLUSIONS: Demands for solutions to the problem of erectile dysfunction have significantly increased over the last decades. The efficacy of intracavernosal injection of vasoactive drugs in the treatment of erectile dysfunction has been demonstrated. After the creation of the andrology unit within the urology services, patient acceptance of treatment and compliance increased, and complications have diminished.
Subject(s)
Erectile Dysfunction/drug therapy , Patient Compliance , Urology Department, Hospital , Humans , Injections , Male , Penis , Retrospective StudiesABSTRACT
OBJECTIVE: Extragonadal germ cell tumor is a rare condition. The present study reports an additional case of this uncommon disease. METHODS/RESULTS: A 24-year-old male with retroperitoneal disease and a testicular lesion detected by ultrasonography is described. Histopathological analysis of the orchiectomy specimen disclosed a 'burned out' tumor. The anatomopathological features of this tumor type are discussed. CONCLUSION: Extragonadal germ cell tumor is a rare condition. It derives from the germ cells that exist in the gonad and is located in every anatomical region but the gonad itself. Ultrasonography must be performed if an extragonadal germ cell tumor is suspected.
Subject(s)
Germinoma , Neoplasms, Multiple Primary , Retroperitoneal Neoplasms , Testicular Neoplasms , Adult , Germinoma/diagnosis , Humans , Male , Neoplasms, Multiple Primary/diagnosis , Retroperitoneal Neoplasms/diagnosis , Testicular Neoplasms/diagnosisABSTRACT
Presentation of two cases of Crohn's disease seen in our Service in which the urological symptoms were of special relevance. One patient presented clinically with a picture of anaemic gross haematuria. The other one, was a patient already diagnosed with Crohn's disease who developed an enterovesical fistula in spite of receiving medical treatment. Both cases were resolved surgically. The clinical aspects, natural history and treatment of this uncommon form of urinary tract involvement are discussed.
Subject(s)
Crohn Disease/complications , Hematuria/etiology , Ileal Diseases/etiology , Intestinal Fistula/etiology , Urinary Bladder Fistula/etiology , Adult , Humans , MaleABSTRACT
Presentation of 6 cases of pheochromocytoma, diagnosed and treated in our Unit over the last 5 years. Five were adrenal pheochromocytomas and 1 an abdominal paraganglioma in a 42 year-old woman. Distribution by gender was 4 male and 2 female, and mean age at presentation was 45.2 years ranging from 35 to 55 years. Clinically, all patients were hypertensive. Two of the 5 cases with adrenal location presented with catecholaminic crisis with BP > 240/140 mmHg. The paraganglioma was diagnosed while studying a case of sustained HBP in a 42 year-old female referred from another unit. With regard to diagnosis, the sensitivity of urinary tests was 100%, and gammagraphy with meta-iodine-benzyl-guanidine (MIBG) was particularly useful in the extra-adrenal location case. In all our patients, computerized tomography (CT) was the choice procedure to locate the tumour. Treatment was surgical in all cases, access being transperitoneal in 3 cases, thoracoabdominal in 2 and classic lumbotomy in 1. All our patients received prior treatment with alpha-blocking agents, and intraoperative complications were 1 arrythmic crisis, 1 hypotensive picture and 1 hypertensive crisis, all of which resolved successfully. Currently, 5 patients remain disease free. Mild HBP controlled with low dose captopril still persists in one patient.
Subject(s)
Adrenal Gland Neoplasms/diagnosis , Pheochromocytoma/diagnosis , Adrenal Gland Neoplasms/metabolism , Adrenal Gland Neoplasms/surgery , Adrenal Glands/diagnostic imaging , Adrenal Glands/pathology , Adrenalectomy , Adult , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Pheochromocytoma/metabolism , Pheochromocytoma/surgery , Preoperative Care , Retrospective Studies , Tomography, X-Ray Computed , UltrasonographyABSTRACT
OBJECTIVES: Inverted papilloma of the bladder is a rare condition that presents in the middle-aged. Its histological features and prognosis are unique and its diagnosis is always by anatomopathology. To date, its histogenesis has not been elucidated. The present study reports an additional case of this uncommon disease entity, which is even more so due to its glandular anatomopathological morphology. METHODS: A case of inverted papilloma of the bladder in a 52-year-old man with a permanent bladder catheter is described. The tumor was located in the posterosuperior bladder wall and had been successfully resected. RESULTS: The histological diagnosis was that of glandular inverted papilloma of the bladder. The patient is asymptomatic at two years follow up. CONCLUSIONS: In our view, inverted papilloma of the bladder results from a previous metaplasia in which the chronic irritative factor plays an important role.
Subject(s)
Papilloma, Inverted/diagnosis , Urinary Bladder Neoplasms/diagnosis , Humans , Male , Middle Aged , Papilloma, Inverted/pathology , Papilloma, Inverted/surgery , Urinary Bladder/pathology , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/surgeryABSTRACT
Cluster condyloma is currently one of the sexually transmitted diseases of higher incidence. The most common sites for condyloma in males are the balanopreputial sulcus, frenulum and the glans' mucosa. Associated to penis condyloma there can be urethral lesions in 5% of patients which in 80% of cases develop less than 3 cm from the meatus. This paper presents a series of 14 cases of cluster intraurethral condyloma managed by transurethral electrofulguration. The technique consists in the introduction of a coagulation probe through the urethrotome and the application of electrofulguration to the condyloma base. Results have been satisfactory although relapse has occurred in 2 cases (14%), and in one of them the procedure had to be repeated up to 3 times. There has been no complications such as stenosis in the loop resections. The authors conclude that due to the difficulties in the medical management of these lesions, the use of invasive techniques, of which transurethral electrofulguration of the condyloma base with endoscopic urethrotome is the choice because of its simplicity and effectiveness, is justified.
Subject(s)
Condylomata Acuminata/surgery , Electrocoagulation , Urethral Diseases/surgery , Electrocoagulation/instrumentation , Electrocoagulation/methods , Endoscopy , Equipment Design , Humans , MaleABSTRACT
Polypoid cystitis is not uncommon in patients with a permanent urethral catheter. In some cases difficulties are encountered when making the differential or anatomopathological diagnosis from transitional cell carcinoma of the bladder. We report a case of polypoid cystitis mimicking bladder carcinoma in a patient with a permanent urethral catheter.
Subject(s)
Carcinoma, Transitional Cell/diagnosis , Cystitis/complications , Hematuria/etiology , Polyps/complications , Urinary Bladder Neoplasms/complications , Cystitis/diagnosis , Cystitis/surgery , Diagnosis, Differential , Hematuria/diagnosis , Hematuria/surgery , Humans , Male , Middle Aged , Polyps/diagnosis , Polyps/surgery , Urinary Bladder/pathology , Urinary Bladder/surgery , Urinary Bladder Neoplasms/diagnosis , Urinary Bladder Neoplasms/surgeryABSTRACT
Presentation of our experience in treating the disease of the vesical neck through longitudinal endoscopic transurethral incisions in 24 patients following the Orandi procedure. Of the 24 patients seen in our service, 21 showed a clear clinical and urodynamic improvement. Complications were 2 cases of epididimorchitis and 1 iatrogenic stenosis of the anterior urethra. There were no major haemorrhages, urinary incontinence, or retrograde ejaculation except for an obvious decrease of ejaculate volume in 2 cases.
Subject(s)
Cystoscopy , Urethral Obstruction/surgery , Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Surgical Procedures, Operative/methods , Urethra/surgery , Urinary Bladder/surgeryABSTRACT
Cyclophosphamide has been used since 1958 in the treatment of various malignant tumours and certain systemic diseases, toxicity to the urothelium, frequently causing haemorrhagic cystitis and less often urothelial carcinomas, being one of its most notorious side effects--some 60 urothelial carcinoma cases have been published following therapy with cyclophosphamide since 1971. The present paper is a contribution of two new cases and its raises the need of paying special attention to urinary manifestations as well as narrowing the cooperation between the physicians which prescribe cyclophosphamide and the urologist, in order to make an appropriate follow-up and management of the patient.
Subject(s)
Carcinoma, Transitional Cell/chemically induced , Cyclophosphamide/adverse effects , Urinary Bladder Neoplasms/chemically induced , Humans , Male , Middle AgedABSTRACT
Contribution of one case of supernumerary kidney with ureter ectopically opened to vagina associated to horseshoe kidney. Supernumerary kidneys are extremely unusual entities, there being only about 70 cases described in the international literature. This is the first case where it is found associated to horseshoe kidney.
Subject(s)
Abnormalities, Multiple , Kidney/abnormalities , Ureter/abnormalities , Vagina/abnormalities , Abnormalities, Multiple/diagnosis , Abnormalities, Multiple/surgery , Adult , Female , HumansABSTRACT
Presentation of one case of vesical nephrogenic adenoma diagnosed as an accidental histological finding following TUR of vesical tumour. This case if considered of interest due to the rarity of the lesion (some 300 cases reported) and the limited number of quotations in the Spanish literature.
Subject(s)
Adenoma/pathology , Urinary Bladder Neoplasms/pathology , Humans , Male , Middle AgedABSTRACT
A primary carcinoma of the male urethra is described. The etiology, diagnosis, clinical features and treatment of this uncommon tumor are discussed. Because this tumor frequently presents as a benign urethral process, biopsies should be performed in urethral conditions with a torpid clinical course.
Subject(s)
Carcinoma, Squamous Cell , Urethral Neoplasms , Aged , Carcinoma, Squamous Cell/diagnosis , Humans , Male , Urethral Neoplasms/diagnosisABSTRACT
We report on an HIV-positive male patient with a giant condyloma acuminatum at the base of penis coexisting with simple intraurethral condylomas and no crown lesions. The association of both processes indicate the likelihood of a common viral etiology. The presentation of this florid picture in a terminal patient with AIDS indicates that urologists are likely to find an increased incidence of this condition in the forthcoming years.
