Revista mexicana de urologia最新文献

Recent interest in the coadministration of approved pharmaceutical agents has resulted in a wealth of emerging data on the safety and efficacy of dual pharmacological treatment for lower urinary tract symptoms (LUTS). Much evidence supports the coadministration of α-blockers with 5-alpha-reductase inhibitors (5-ARIs) in patients at risk for clinical progression. The use of phosphodiesterase-5 inhibitors (PDE5Is) in combination with 5-ARIs has also demonstrated a good safety and efficacy profile, providing early symptomatic relief and reduction of sexual side effects associated with 5-ARI use, although longer-term studies are needed. Studies investigating the combination of PDE5Is with α-blockers have shown additive effects on each of the individual agents with respect to the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF), which holds promise for patients who have shown a poor response to monotherapy. The coadministration of α-blockers and antimuscarinic agents provides an alternative for treatment of storage symptoms in patients who have failed to respond to monotherapy. This review aims to summarize and comment on available evidence regarding the safety and efficacy of combination treatment for LUTS.

Introduction

Testicular tumors make up close to 1% of malignant tumors in men and 6% of the patients present with the disease between the ages of 20 and 35 years. Choriocarcinoma is a highly metastatic malignant tumor derived from undifferentiated trophoblasts. Ocular involvement in testicular tumors is extremely rare and occurs in 0.2% of cases.

Materials and methods

A 23-year-old man's disease symptoms began with intense headache associated with visual disturbances in the left eye and vertigo. He was referred to the Urology Department due to an enlarged left testis with a hardened consistency. Choriocarcinoma of the testis with metastases to the choroid, lung, and central nervous system was reported. After a cycle of chemotherapy, the patient presented with rapid deterioration of his vital functions and died in the intensive care unit. The pathology report stated metastatic testicular choriocarcinoma.

Discussion

Eighteen cases have been reported worldwide and the majority had very poor outcome. Prognosis in these cases was poor until the introduction of cisplatin-based chemotherapy in 1970. Choriocarcinoma is an aggressive variant of testicular carcinoma and has a high metastatic potential. Despite its hematogenous spread, it rarely metastasizes to the choroid.

Conclusions

Choriocarcinoma is an aggressive strain of testicular carcinoma with rapid hematogenous dissemination. Metastasis to the choroid is rare. Despite the combination of radiotherapy and chemotherapy, our patient's state of health deteriorated rapidly.

Background

The detection of renal cell carcinoma has increased due to the wider availability of tomography. However, mortality figures have remained stable.

Aim

Our aim was to observe the progression of a group of patients with complex renal cysts or solid renal tumors that were closely monitored through imaging studies.

Material and methods

Nineteen kidney tumors were retrospectively included from patients that did not wish to undergo surgical treatment or whose comorbidities were contraindications for it. Each lesion was characterized and compared through initial and final CT-urography during follow-up.

Results

Sixty-eight percent of the lesions were catalogued as solid masses and 31% as complex cysts. Median surveillance was 33 months (range 6-88) and the mean growth rate was 0.2 cm/year. There was only one case of clinical stage progression.

Discussion

Strict surveillance of complex cystic and solid renal masses is a valid option in the initial management of some patients with small renal masses, mainly when comorbidities or age are contraindications for surgical treatment, due to their slow growth and low risk for progression. Nevertheless, more information at the national level is needed to have a higher level of evidence.

A 67-year-old asymptomatic man had a slightly elevated prostate-specific antigen level 30 months after undergoing radical retropubic prostatectomy due to T1c adenocarcinoma of the prostate, with a Gleason score of 5. Physical examination only revealed a subcutaneous, infraumbilical, painless nodule of 3 cm coinciding with the incisional area of the abovementioned intervention. Computed axial tomography scan with contrast medium confirmed that finding, as well as the absence of suspicious adenopathies and other tumor foci. Local biopsy was performed, confirming the diagnosis of prostate cancer recurrence and the mass was completely excised.

Even when dealing with a tumor of slow growth and low Gleason score, the possibility of tumor cell seeding during surgery cannot be ignored. Therefore the basic principles of oncologic surgery must be strictly followed to optimally reduce this possibility.

Background

Even though laparoscopic nephrectomy is considered the gold standard in renal surgery in the adult, its role in the pediatric population is still a subject of debate. Laparoscopic nephrectomy has been shown to be a safe and effective procedure, compared with the open approach.

Aim

To present a case series of pediatric patients with different renal pathologies treated through transperitoneal laparoscopic nephrectomy.

Material and methods

Twenty-two pediatric patients that underwent transperitoneal laparoscopic nephrectomy were included in the study. All of the cases underwent the 3-port transperitoneal laparoscopic approach.

Results

All the kidneys were satisfactorily removed and the mean surgery duration was 142 min. There were no complications requiring conversion to open surgery in 21 of the 22 cases. Oral diet and ambulation were begun the same day of the surgery for all patients. Twenty of the 21 patients that did not require conversion were released on the second postoperative day.

Conclusions

We report herein on the transperitoneal laparoscopic approach for nephrectomy with the 3-port technique. It can be performed in the pediatric population with the same results and safety as other laparoscopic procedures and is an excellent alternative to traditional open surgery. This procedure should be considered for reducing surgical risk.

Background

Urethral stricture is a urologic disease that has significant morbidity. Direct visual internal urethrotomy is used for the majority of cases in the United States, but end-to-end urethroplasty is the most successful technique. The choice of primary management is controversial. Direct visual internal urethrotomy is widely accepted in the majority of Mexican hospital centers. However, it is reported to have lower long-term success rates. Urethroplasty is indicated for long, densely fibrotic strictures. Diagnosis is based on radiologic studies (nuclear magnetic resonance or ultrasound, with contrast medium). Scales (Urethral Stricture Score) describing stricture complexity are employed to choose surgical treatment.

Aims

To communicate the results of primary treatment for urethral stricture in patients at the Hospital General Dr. Manuel Gea González that underwent end-to-end urethroplasty.

Materials and Methods

A descriptive study was conducted that reviewed the case records of 210 patients with urethral stricture, selecting the 58 cases that underwent end-to-end urethroplasty as primary treatment within the time frame of January 1, 2007 and December 31, 2013.

Results

The median age of the patients was 46.4 years. Stricture etiology: traumatic 23%, iatrogenic 58%, idiopathic 17%, and infectious 2%. The most frequent stricture location was at the bulbar level (87.9%) (51), mean length was 2.12 cm, 3 cases presented with double-site stricture, 11% (19) of the cases had urinary retention, and the mean urethral stricture score was 5.8. There were 10 recurrences, 9 re-interventions (urinary tract infection), and one augmented urethroplasty. Preoperative Qmax was 5.7-10 ml/sec and postoperative Qmax was 13-16 ml/sec. Cure was achieved in 82.7% of the cases.

Conclusions

Urethroplasty success rates worldwide are reported at 84-97%. Results are related to stricture complexity and surgical experience. There is still no consensus on success parameters. Urethroplasty presents less recurrence compared with direct visual internal urethrotomy, promoting long-term quality of life.

Paragangliomas of the urinary bladder are catecholamine-secreting tumors derived from chromaffin cells of the sympathetic nervous system. The most common symptoms are hematuria and paroxysmal hypertension. We describe herein a 67-year-old man that had bladder paraganglioma with hematuria and no associated symptomatology. The tumor was resected with no hemodynamic complications.