Acta Urológica Portuguesa最新文献

Introduction

The pancreas is a rare metastization site for renal cell carcinoma (RCC); this paper reports a rare presentation of metastatic RCC, of obstructive jaundice secondary to a solitary synchronous pancreatic metastasis; the authors review the existing literature on pancreatic metastization of RCC in what concerns etiopathogenesis, clinics and therapeutic options.

Clinical case

A 53-year-old man was referenced to consultation for complains of weakness, dyspepsia, back pain, choluria, weight loss and jaundice; image exams revealed a single lesion on the head of the pancreas and a tumour in the left kidney; after elective pancreaticoduodenectomy and radical nephrectomy, histology revealed a RCC, and a metastatic lesion with endoluminal growth in Wirsung duct; the follow-up was uneventful with no evidence of recurrence at 6 months.

Discussion

Pancreatic metastization of RCC tend to occur many years after nephrectomy; computerize tomography imaging is the method of choice for its characterization; the R0 resection provide the longest disease-free survival possible; any patient with solitary metastatic RCC in the pancreas should be a candidate for complete surgical excision if technically feasible, for palliation and prognostic reasons.

Objectives

To identify the predictive factors associated with bladder recurrence of UTUC in patients undergoing radical nephroureterectomy and determine the overall survival of these individuals.

Materials and methods

Retrospective analysis of 64 patients with UTUC subjected to radical nephroureterectomy between 2003 and 2013 in Department of Urology–Hospital S. João, Porto, Portugal. The following variables were analysed: age, gender, tumour characteristics (stage, grade, location, lymphovascular invasion, multifocality), previous malignant neoplasia of the bladder, surgical approach of the distal ureter and adjuvant (systemic) chemotherapy.

Results

The median age was 71.0 years (percentile25‐percentile75: 64.5‐75.5) and 65.6% were male. The median follow‐up was 33.8 months (P25‐P75: 15.0‐64.6). T3 and T4 stages [Hazard ratio (HR) = 1.35 (95%confidence interval: 0.47‐3.94)], the location in the ureter [HR = 1.47 (95%CI: 0.53‐4.06)], multifocality [HR = 2.86 (95%CI: 0.89‐9.12)] and adjuvant chemotherapy [HR = 3.84 (95%CI: 0.90‐16.45)] were associated with worse overall survival, although not statistically significant. Previous malignant neoplasia of the bladder [HR = 2.03 (95%CI: 0.66‐6.26)], lymphovascular invasion [HR = 1.40 (95%CI: 0.49‐4.05)] and high‐grade tumours [HR = 1.43 (95%CI: 0.33‐6.29)] showed higher bladder recurrence, although not statistically significant. A tendency to a lower risk of bladder recurrence was observed among patients receiving adjuvant chemotherapy [HR = 0.78 (95%CI: 0.22‐2.72)].

Conclusions

The previous history of malignant neoplasia of the bladder was the strongest predictor of bladder recurrence and individuals with worse prognostic markers tend to have a lower risk of bladder recurrence, due to supposed competing risks between death and recurrence.

The intracorporeal suture is considered one of the most difficult and challenging procedures of the urologic laparoscopic surgery. The suture of the renal parenchyma during partial nephrectomy and the vesico‐urethral anastomosis in radical prostatectomy are critical and time consuming steps requiring a long learning curve. In an attempt to optimize these procedures, it was created on March 2009 a unidirectional self‐retaining bearded suture to maintain the tension in the suture lines even avoiding the need to run knots.

After a brief experience using a barbed suture during the laparoscopic partial nephrectomy with a subjective feeling of having made the procedure simpler, faster and more effective, we decided to conduct a systematic literature review on the use of of the usual polyglactin vs. a barbed suture to ascertain the real benefit its use.

Comparing to the usual polyglactin suture, the use of a barbed one appears to simplify the nephrorrhaphy technique during laparoscopic partial nephrectomy significantly reducing the warm ischemia time and possibly the perioperative complications. Its use in the laparoscopic radical prostatectomy allows performing the vesico‐urethral anastomosis safely and significantly faster with similar postoperative complication rates. There may be an overall cost reduction using this suture, although stronger global analyses are still needed.

Objective

To study Escherichia coli pathogenicity in urinary tract infections and their relationship with the host. Association of bacteriuria by E. coli with defined pathogenicity criteria or host specific conditions, in women aged up to 59 years.

Materials and methods

Overall 228 Escherichia coli strains were studied. These were isolated from urine of women with age ≤ 59 provided by various Portuguese laboratories in the community. The study of the virulence genes fimH, papC, ecpA, usp, hlyA and cnf1, pathogenicity islands (PAI) I_CFT073 and PAI II_CFT073, and phylogenetic group determination was performed by PCR.

Results

The most frequently isolated genes were ecpA, followed by fimH and the most prevalent phylogenetic groups were pathogenics B2 and D, both in cITU and ncITU.

Both commensal and pathogenic isolates showed presence of fimH, papC and ecpA genes with functions in adhesion and colonization, while usp, hlyA and cnf1 usually associated with invasive strains and PAI I_CTF073 and PAI II_CFT073 were found predominantly in pathogenic group strains.

Conclusion

Studied virulence factors were not restricted to pathogenic strains, both in ncITU and cITU. The host risk factors which propitiate cystitis such as pregnancy, recurrence and diabetes, are associated with bacterial pathogenicity.

The Ewing's family of tumours comprises a spectrum of malignancies of primitive neuroectodermal cells: embryonic cells that migrate from the neural crest. 1Primary kidney Ewing's sarcoma is a rare neoplastic disease representing less than 1% of renal tumors and is characterized by highly aggressive biological behavior.

We reported a case of an asymptomatic, 53 year old man with an incidental lesion in the right kidney found in a routine renal ultrasound. Computed tomography showed a solid nodule with 67 x 65 mm, occupying the lower pole of the right kidney with renal vein, inferior vena cava and right auricular invasion. The patient underwent a right radical nephrectomy and Inferior vena cava and atrial tumor thrombectomy with cardiopulmonary bypass and deep hypothermic circulatory arrest. Pathologic characteristics and immunohistochemical analysis confirmed the diagnosis of Ewing's Sarcoma. Surgery and early post‐operative were free of complications. The patient underwent chemotherapy and died 21 months after the surgery of relapse of the disease.

Introduction

Thrombosis or thrombophlebitis of the superficial dorsal vein of the penis (TSDVP) is an uncommon condition which may be associated with important psychological distress, both to the patient as well as his relatives. It was first described by Mondor in 1939 as thrombosis of the superficial thoracic veins, and years later, Helm and Hodge described it as an isolated penile vein thrombosis.

Case report

A 64 year‐old man going through chemotherapy in our Hospital due to a stage IV bladder tumour was assessed for possible orchiepididymitis. After a thorough physical examination we found a dorsal cord‐like structure on the penis, without associated pain or swelling. We reviewed the physiopathology of the condition and its treatment.

Discussion

Penile Mondor's disease is a rare yet benign clinical entity with a fairly simple diagnosis. Patients feel the superficial vein of the penis like a hard rope and may complain of pain and local swelling. The appropriate treatment should be as conservative as possible, leaving the surgical option as a last resource.

Conclusion

TSDVP is a rare condition, nevertheless Urologists should know its main features in order to achieve correct diagnosis and treatment. We think Doppler ultrasonography is an important diagnostic tool, especially if in doubt. Sexual activity should be restricted and anti ‐ inflammatory and anti ‐ coagulant drugs prescribed. The surgical resection of the thrombosed vain may be an option in refractory cases.

Laparoendoscopic single site surgery (LESS) has been accompanied by the development of a new generation of purpose-built optics and instruments. Despite all these, suturing still represents a challenge in LESS. The authors describe a technique of urachal cyst excision by LESS, with extramucosal partial cystectomy and cystorrhaphy performed with the SILS™ Stitch instrument. The technique is safe and feasible, offering the advantages of reducing the number of abdominal incisions to one that can be hidden in the umbilicus, with less post-operative pain and improved cosmesis. The extramucosal technique shortens the period of postoperative catheterization and hospitalization.

Introduction

Nephrogenic adenoma of the urinary bladder (NAB) is a rare and benign urothelial tumor. The existing literature is scarce regarding its etiology, clinical symptoms and therapeutic options. This paper presents the first reported case of a patient with HIV‐1 infection to whom an NAB was diagnosed.

Case Report

We report a case of a female patient of 49 years old, seropositive for HIV‐1, with pollakiuria, mictional urgency, feeling of incomplete bladder emptying and intermittent macroscopic hematuria. The patient was submitted to TURB of a suspected intravesical lesion. Histopathological examination of the resected material was consistent with an NAB. The patient is in follow‐up, having completed one year with no sign of lesion recurrence.

Discussion

NAB is a metaplastic lesion of the urothelial tissue. Its etiology is not fully understood. NAB is associated with chronic inflammatory processes or to a state of immunosuppression. Its diagnosis is histological, characterized by the presence of tubular structures similar to renal tubules. This work is particularly relevant because it is the first described case of NAB in a patient immunodepressed by HIV‐1 infection.

Objectives

Infertility is a clinical disorder affecting approximately 15% of reproductive-aged couples worldwide. Recently, the influence of oxidative stress (OS) in decreased semen quality has been discussed. OS corresponds to an imbalance between oxidants and antioxidants defenses, present in the organism. High levels of reactive oxygen species (ROS) damage biomolecules present in sperm cells and may lead to the loss of membrane integrity, DNA fragmentation or even to death by apoptosis. This study aimed to evaluate the correlation between human semen clinic parameters and parameters that assessed the presence of OS.

Material and methods

A total of 32 semen samples, obtained from a randomized group of donors, were included in this study. Basic semen parameters were analyzed according to the WHO's guidelines. The total antioxidant capacity of sperm cells was measured as well as the expression of certain antioxidant proteins, namely superoxide dismutase (SOD) and glutathione peroxidase 4 (GPx4), by colorimetric techniques and immunoblotting, respectively. The effect of ROS in spermatozoa protein oxidation was analyzed by determining the presence of 3-nitrotyrosine and carbonyl groups, by slot blot. Lipid peroxidation was evaluated, by performing the thiobarbituric acid reactive substances (TBARS) assay with colorimetric tests.

Results

The results indicated that SOD was negatively correlated with viscosity (p = 0.035), volume (p = 0.004) and carbonyl groups presence (p = 0.005). This protein also showed a positive correlation with the presence of tail defects in sperm cells (p = 0.044). In turn, GPx4 showed a negative correlation with the presence of non-progressive motile spermatozoa (p = 0.012). TBARS assay revealed a negative correlation with the concentration of sperm cells (p = 0.000) and the total number of spermatozoa (p = 0.026), but, in turn, this assay showed a positive correlation with the volume of semen (p = 0.038).

Conclusion

It was concluded that the seminal quality is affected by the oxidative balance in sperm cells. The obtained results suggest that lipid peroxidation leads to a reduction in sperm concentration; antioxidant proteins protect the spermatozoa against protein oxidation and contribute to an increased sperm motility and normal semen viscosity. Thus, evaluation of oxidative parameters may be a useful tool for male infertility diagnosis and follow-up of antioxidant treatments.

Introduction

Malignant germ cell tumors represent the majority of testicular masses; according to current knowledge, radical orchiectomy remains the standard of care in the management of this type of cancer. However, testis‐sparing surgery (TSS) can be an alternative to radical surgery in selected cases, particularly in patients with small testicular masses (STM).

Objective

The authors conducted a review of the current indications for performing testicular sparing surgery as well as functional and oncological results of it.

Material and methods

We conducted a literature search in Medline database (PubMed) using the keywords: “testis sparing surgery”, “partial orchiectomy”, ‘testis tumor’, ‘small testicular mass/tumor’. The search was limited to article in English language, published from 2010 to the current date.

Results

randomized controlled trials/studies with high level of evidence that compare TSS with radical orchiectomy were not found. Indications for TSS are still controversial, particularly in patients with normal contralateral testis. The organ sparing surgery seems a viable therapeutic option for patients with small non‐palpable testicular mass (with < 20 mm major axis), bilateral tumors or single testicle. The frozen section examination plays a decisive role in the technique, since it allows the distinction between malignant and benign neoplasms, as well as assessing the status of surgical margins. The medium and long follow‐up results of the analyzed retrospective studies revealed no significant risk of local and/or distant relapses.

Conclusion

Regarding the testis, the organ‐sparing surgery can be adopted safely in the treatment of selected cases. Prospective multicentric and high level of evidence studies are needed in order for TSS become a real alternative to radical surgery, as well to evaluate the oncological safety and real functional benefits of preserving the testis.