Revista mexicana de urologia最新文献

Introduction

In patients with an indwelling urinary catheter presenting with candiduria and risk factors that favor its spread, the sudden onset of ocular symptoms with a decrease in visual acuity should lead us to suspect this organism as a causal agent.

Clinical case

A 56-year-old Caucasian man with risk factors for Candida colonization and spread began to have floaters, photopsia, and decreased visual acuity ten days after the insertion of a double-J stent.

Conclusions

Antifungal therapy should be considered in patients that have undergone a urologic procedure and that present with candiduria and associated risk factors, in order to prevent the spread of infections and their subsequent complications.

Undescended testis is an entity that should be identified from birth. Even when associated with other malformations, it requires a specialized and multidisciplinary approach. Its association with hypogonadotropic hypogonadism is unusual, with a broad spectrum of presentations according to the testicular dysfunction that presents and the consequences of the lack of testosterone action. Diagnostic laparoscopy with laparoscopic orchidopexy is the minimally invasive treatment of choice. We present herein the case of a patient with hypogonadotropic hypogonadism with bilateral undescended testis treated with laparoscopic orchidopexy.

Conservative therapies, such as active surveillance, can be appropriate treatment for low-risk prostate cancer. The aim of this study was to analyze the frequency of Gleason score (GS) upgrading in patients with a low-grade GS. We reviewed our prospectively maintained database of patients with prostate cancer that underwent radical prostatectomy within the time frame of 2004–2015. Potential predictors of upgrading in patients with GS 3 + 3 were studied. Of the 342 patients in our database, 125 had GS 3 + 3. Biopsy GS and surgical GS were identical in 71 (56.8%) patients with GS 3 + 3, whereas 54 (43.2%) patients had an upgrade. The GS was upgraded to 7 in 70% of those patients and to ≥8 in 30%. We found a statistically significant correlation between postoperative upgrade and the preoperative prostate-specific antigen density (PSAD) value (p < 0.001), prostate volume (p = 0.004), and patient age ≥70 years (p = 0.011). We estimated an optimal PSAD cutoff point of 0.17 ng/ml² through ROC analysis, with an AUC of 0.675 (p = 0.001). It is our opinion that every hospital center offering active surveillance should carry out a continuous review of upgrading and related risk factors.

Introduction

Penile injury is not a frequent finding, perhaps due to anatomic, cultural, and psychologic aspects. Penile lesions can include penile fracture, amputation, penetrating injuries, and soft tissue burns or lacerations, and they are considered surgical emergencies. Not all cases are reported and treatment tends to be delayed because of embarrassment on the part of the patient and the association with intercourse. The most common penile injury is penile fracture. Only 34% of cases are due to violence or trauma; the remaining ones are secondary to sexual activities. There is a lower frequency of injuries to the scrotum and testes.

Aim

The aim of our work was to present four cases of penile injury: penile fracture, penile hematoma, penile skin laceration, and penile necrosis.

Cases

We analyzed the causes, predisposing factors, clinical presentation, treatment, and complications. In all the cases, the patients had adequate response with no complications and benefited from the immediate surgical exploration and repair.

Discussion

Our cases showed sexual activity to be the most common cause of penile injury. It should be underlined that rapid medical intervention is necessary for full resolution of the lesion.

Introduction

Obesity has been shown to adversely affect surgical results and so it is considered a relative contraindication for laparoscopy. Increased experience has done away with many obstacles to laparoscopic renal surgery.

Aim

To describe and compare the surgical results of laparoscopic nephrectomies in obese and non-obese patients.

Materials and methods

Seventy-five patients underwent laparoscopic nephrectomy within the time frame of 2011-2015 that was performed by 2 urologists trained in laparoscopic surgery. The cases were divided into obese and non-obese patients. The Student's t test was used to evaluate the variables in the two groups and complications were assessed using the chi-square test.

Results

Twenty-seven patients had normal weight (36%) and 48 had overweight or obesity (64%). In means, hospital stay in days was 3, intraoperative blood loss was 227 ml, and surgery duration was 167 min. Eleven patients had some type of complication (14.7%). Patient age was the only statistically significant variable (P<.008).

Conclusions

Our study suggests that laparoscopic nephrectomy has the same surgical results in obese and non-obese patients. The minimally invasive approach is a safe and feasible technique in the obese population.

Introduction

In recent years, total androgen blockade therapy for advanced prostate cancer has been a reasonable option to castration due to the discovery and development of new pharmacologic agents. In this study, our aim was to evaluate the efficacy of the combined treatment of nilutamide plus buserelin and to describe the occurrence of adverse events associated with this treatment.

Material and methods

A descriptive, prospective study was conducted. Patients with advanced prostate cancer receiving nilutamide plus buserelin were evaluated at 3, 6, and 9 months. The primary endpoint was the reduction of serum levels of prostate-specific antigen (PSA).

Results

One hundred and four patients were included in the study, but only 67 patients had complete information and thus were evaluated in the efficacy analysis: 65 (97.0%) achieved a 50% reduction in PSA level, compared with the baseline value, and 2 patients achieved a decrease <10 ng/ml. The combination therapy was well tolerated, given that only 7 patients (6.7%) presented with mild adverse events that did not require treatment suspension or other specific maneuvers.

Conclusions

Treatment with nilutamide plus buserelin appears to be safe and effective in controlling tumor activity in advanced prostate cancer patients.

Introduction

Adrenal cysts are usually benign, unilateral, and nonfunctioning. They have a 0.06-0.18% incidence, are more frequent in women, and they mainly present between the fifth and sixth decades of life. The malignization rate is under 7%.

Clinical case

A 66-year-old man sought medical attention for discomfort in the left flank and hypogastrium associated with slight weight loss. An abdominopelvic computed axial tomography study revealed a tumor with extraluminal, exophytic growth located between the gastric fundus and the pancreas and measuring about 4.6 cm in diameter. Due to the suspicion of a gastric gastrointestinal stromal tumor, laparoscopic surgical treatment was decided upon. After the retroperitoneal dissection of the mass, its dependence on the left adrenal gland was observed. It was enucleated up to the dissection of its implantation base. The histopathology study confirmed that the retroperitoneal tumor was an endothelial cyst of the adrenal gland.

Conclusions

In our case, the intervention was more complex than expected, given that it involved a detailed dissection of the cyst at the aorta and the splenic artery. The result was favorable, despite the fact that initially the lesion was not thought to be an adrenal one.

Lower urinary tract symptoms (LUTS) are very frequent in men, especially in those above 65 years of age. Benign prostatic hyperplasia (BPH) is the pathology most associated with LUTS in men and is a frequent cause of altered quality of life. Monotherapy with alpha blockers is the treatment of choice in patients with moderate-to-severe LUTS secondary to BPH.

Silodosin is currently the most uroselective alpha blocker acting on the α1A receptors. Its uroselectivity has been confirmed in different in vitro, as well as in vivo, studies. The present study analyzed the main benefits of silodosin in phase iii clinical trials (standard approach) and in «real life» (analyzing the «Silodosin in Real-life Evaluation (SiRE)» phase iv trial) to validate the registrational trials and confirm the positive risk-benefit profile of silodosin in an environment that can more closely reflect clinical practice.

Introduction

Papillary renal cell carcinoma is the second most frequent type of kidney cancer, representing 13 to 15% of lesions. Its greatest incidence is between the third and eighth decades of life and there is a 2 to 1 predominance in males. There are 2 morphologic types of papillary renal cell carcinoma and type 2 has the worse prognosis. Presentation is sporadic and unilateral in the majority of cases.

Clinical case

A 42-year-old man had no history of chronic degenerative disease and was a chronic smoker. He presented with gross hematuria of 20-day progression and severe anemia associated with general malaise. An abdominal computed axial tomography scan showed a 10 × 12 cm heterogeneous mass at the interpolar and lower pole region of the right kidney, retroperitoneal adenopathies, and a subdiaphragmatic vena cava thrombus. Right radical nephrectomy and thrombectomy of the inferior vena cava were performed. The histopathology study reported type 2 papillary renal cell carcinoma extending into the perirenal fat and adrenal gland and an inferior vena caval tumor thrombus.

Conclusions

Even though our patient had a poor short-term survival prognosis given the advanced clinical stage of his disease, palliative surgical management was indicated due to the persistent hematuria resulting in anemia.