[Transurethral thermotherapy with microwaves in patients with benign prostatic hypertrophy and urinary retention: comparative study between high energy (25) and standard energy (2.0)]. / Termoterapia transuretral con microondas en pacientes con hipertrofia benigna prostática y retención urinaria: estudio comparativo entre alta energía (25) y energía standard (2.0).

OBJECTIVES: During a 36-month period, 63 patients with benign prostatic hypertrophy (BPH) who presented urinary retention, were treated on an outpatient basis by transurethral microwave thermotherapy (TUMT) with the Prostatron device using analgosedation. METHODS: Treatment consisted of a single one hour session with Prostasoft 2.0 for the first group of 11 patients. The second group of 19 patients received 2 hours Prostasoft 2.0. The third group comprised of 33 patients were treated with higher energy TUMT (Prostasoft 2.5/1 h 30 min). The number of sessions (144) depended on prostate length: L < 45 mm: one session (Prostanec catheter); L < 55 mm: two sessions (additional black catheter session); L < 65 mm: three sessions (additional white catheter session). RESULTS: In the first group of patients, 54% were catheter-free after one year (5 TURP); 84% (3 TURP) in the second group; 96% (1 TURP) in the third group. The morbidity was similar for all groups. CONCLUSIONS: Only high energy TUMT (Prostasoft 2.5/1 h 30 min) appears to be a minimally reasonable alternative to surgery in elderly patients with urinary retention secondary to prostatism and concomitant diseases. Longer followup is warranted to determine if the beneficial effects will persist.

[Transurethral thermotherapy with microwaves in symptomatic prostatic benign hypertrophy: comparison between the high-energy (2.5) protocol and the standard protocol (2.0)]. / Termoterapia transuretral con microondas en la hipertrofia benigna prostática sintomática: comparación entre el protocolo de alta energía (2.5) y el protocolo standard (2.0).

OBJECTIVES: The efficacy of three therapeutic protocols of transurethral microwave thermotherapy (TUMT), was compared in a study comprised of 355 patients that had been treated for benign prostatic hypertrophy (BPH) between March, 1992 and March, 1995. METHODS: TUMT were performed with the Prostatron device with intravenous analgosedation and on an outpatient basis. In the first group (Protocol A), 122 patients received a standard treatment (Prostasoft 2.0/hour); the second group of 81 patients were included into Protocol B (Prostasoft 2.0/2 hours); 152 patients were treated with higher-energy in Protocol C (Prostasoft 2.5/1 hour). The number of sessions (635) performed were based on prostatic length: L < 45 mm - one session (Prostanec catheter); L < 55 mm - two sessions (additional black catheter session); L < 65 mm - three session (additional white catheter session). RESULTS: All groups improved significantly for subjective symptoms (symptom score) and objective parameters (peak flow, residual urine). Comparison of the results between the three groups at 6 and 12 months showed a significantly better clinical outcome in protocol C >> B > A: Morbidity was higher in group C than in group B than in group A. CONCLUSION: Our results indicate that transurethral microwave thermotherapy is a safe and effective procedure which improves objective and subjective parameters. Better outcomes were obtained with long session times (2H) and overall higher energy (2.5) input, which may be explained by the creation by cavities within the prostate, but at the cost of increased morbidity. However, TUMT can still be delivered as an anesthesia-free and outpatient non-surgical alternative treatment for BPH.

[Transurethral prostatic thermotherapy with microwaves (prostatron system) in bladder obstruction secondary to benign prostatic hypertrophy]. / Termoterapia prostática transuretral con microndas (sistema prostatron) en la obstrucción vesical secundaria a hipertrofia benigna prostática.

Since April, 1992, 178 patients with symptomatic benign prostatic hyperplasia were treated by TUMT (363 treatments). Before entering the study, all patients had a Madsen symptom score of > 8, peak flow rate of < 15 ml/s, or average flow rate of < 10 ml/s, and post voiding residual urine of < 300 ml/s. The prostatic length was classified into group I < 50 mm (101 patients) and group II < 50 mm (77 patients). TUMT with the Prostatron device (Technomed) was performed in one, two or three session(s) of one or two hour(s) with analgosedation and on an outpatient basis. After treatment all patients were catheterized for 1-3 weeks; the morbidity rate was very low. Three and six months after treatment, the Madsen symptom score, peak flow rate, average flow rate and postvoiding residual urine improved to a high statistical significance in both groups. TUMT for benign prostatic outflow obstruction proved to be an effective treatment throughout the study period, with minimum morbidity. It must be emphasized that the degree of prostatic enlargement or the severity of the symptoms does not indicate clinical success or failure. However, the degree of bladder outflow obstruction and the quality of treatment achieved are very important: a) In patients with severe obstruction, TURP or open surgery continues to be the treatment that affords rapid relief of their symptoms. b) The clinical response to TUMT is dose-dependent; i.e., higher thermal dose, longer session (2 h) and the use of different catheters enhance the therapeutic efficacy.

[Extracorporeal shockwave lithotripsy in patients with a single kidney]. / Litotricia extracorpórea mediante ondas de choque en pacientes monorrenos.

Seventy-eight patients with calculi in solitary kidney were submitted to treatment with shock waves. The epidemiologic data presented herein include stone volume, localization, and type (29 caliceal, 10 pyelic, and 5 multiple calculi; 13 pseudostaghorn, 11 staghorn, and 10 ureteral calculi). Patient evaluation 3 months after treatment revealed overall good results were achieved: 46 renal units were stone-free and 20 had small stone fragments that could be spontaneously passed. Thirteen patients had persistent residual lithiasis. Different types of complementary endoscopic treatments had been utilized in 65% of the cases. With regard to complications, there were 5 cases with obstructive anuria and 4 with fever. The foregoing results show that ESWL is a safe and effective method of treatment of lithiasis in patients with solitary kidney. It is currently the procedure of choice for this patient group.

Spontaneous healing of ureterogenital fistulas: selection criteria.

We present 12 cases with spontaneous healing of ureterovaginal (11 cases) and ureterouterine (1 case) fistulas. In every case disappearance of the fistula with normal renal function and restoration of the excretory tract was obtained. IVP and retrograde pyelographs were performed in every case. Spontaneous healing is feasible under the following conditions: continuity of the ureteral lumen and normality of the infralesional ureter. Spontaneous healing is independent of the number of affected ureters, age, gynecological pathology, gynecological intervention, latency period, urographical findings, duration of incontinence, and urinary infection.

Signet ring cell adenocarcinoma of the urachus.

Signet ring cell adenocarcinoma of the bladder is rare. Only 16 cases are recorded in the literature, although two meet the requirements for being considered of urachal origin. We present the third case of signet cell adenocarcinoma of urachal origin.

Spontaneous healing of uretero-vesico-vaginal fistulas.

We report a rare case of spontaneous healing of a left uretero- and vesicovaginal fistula observed simultaneously in a patient. We have not found reports of similar cases in the reviewed literature. We also suggest the pathogenic mechanisms responsible for total healing.