Abstract
Since the introduction of minimal invasive surgery in the 90s, many international urologic centres have developed retroperitoneoscopy as access way for treatment of multiple urologic pathologies. The aim of this work is to analyze our initial experience in retroperitoneoscopy. Materials and methods: Retrospective analysis of the first 100 cases of retroperitoneoscopy by counsulting the clinical records. These operations were classified according to their technical difficulty and operative risk. Operative complications were stratified into five grades using the modified Clavien classification system (CCS). The first 100 retroperitoneoscopic procedures of our hospital were performed from January 2008 to July 2013 in 51 men and 49 women with a mean age of 52 years old (18‐84 years old). They were comprised of 22 renal cyst marsupialization, 36 Simple Nephrectomies, 4 Radical Nephrectomies, 2 Nephroureterectomies, 14 dismembered pyeloplasties, 1 lumbar ureterolithotomy and 21 Parcial Nephrectomies. Using the classification of surgical complexity European Scoring System for Laparoscopic Operations in Urology modified by Rassweiler in 2006, we classified 22 procedures as simple, 57 procedures as difficult and 21 procedures as very difficult. The mean operation time was 158 minutes (range: 67‐280 minutes). The mean operation time was 96, 157, and 220 minutes in simple, difficult and very difficult procedures, repectively. The open conversion rate was 3%. A total of 12 patients had postoperative complications: CCS Grade I in 4, CCS Grade II in 6 and CCS Grade IIIb in 2 patients. Discussion/Conclusions: The retroperitoneoscopy has proven to be a safe and a versatile access for a minimally invasive treatment of many urologic pathologies.Abstract
Since the introduction of minimal invasive surgery in the 90s, many international urologic centres have developed retroperitoneoscopy as access way for treatment of multiple [...]
Abstract
Renal cell tumors comprise both benign – oncocytoma – and malignant – clear cell renal cell carcinoma, papillary renal cell carcinoma, and chromophobe renal cell carcinoma – entities. Since the differential diagnosis among renal cell tumors is sometimes difficult on clinical, imaging and pathological grounds, and prognosis is quite dissimilar, epigenetic-based diagnostic biomarkers, specially promoter methylation, might be useful for accurate diagnosis and therapeutic planning. EpiTect Methyl II PCR Array was used to screen methylation status of 22 genes, involved in epithelial to mesenchymal transition. Quantitative real-time methylation specific polymerase chain reaction was performed for candidate gene validation, and methylation levels of renal cell tumors subtypes and normal kidney were determined and compared. MST1R promoter methylation level was significantly higher in clear cell renal cell carcinoma (median: 5367) compared to other renal cell tumors (median: papillary renal cell carcinoma – 1084, chromophobe renal cell carcinoma – 1023, oncocytoma – 1337) and normal kidney (median: 1125), allowing for accurate discrimination from other renal cell tumors with high sensitivity (>96.7%) and specificity (86.7%). Quantitative MST1R promoter methylation may be useful as biomarker for accurate diagnosis of clear cell renal cell carcinoma in problematic cases.Abstract
Renal cell tumors comprise both benign – oncocytoma – and malignant – clear cell renal cell carcinoma, papillary renal cell carcinoma, and chromophobe renal cell carcinoma [...]
Abstract
The adenomatoid tumor is a rare benign neoplasm of mesothelial origin, possible to occur in the genital tract in both sexes. It is commonly paratesticular, mainly in the epididymis. Surgical treatment consists of tumor resection and preservation of the testis whenever possible. We describe a case of a 40 years old man presenting scrotal discomfort, palpable lower pole mass of the right testicle and normal tumor markers. The patient underwent local excision of nodule with right testis preservation, as the neoplasm was unrelated with the albuginea. Subsequent pathology study (with histology and immunohistochemical markers) diagnosed a paratesticular adenomatoid tumor.Abstract
The adenomatoid tumor is a rare benign neoplasm of mesothelial origin, possible to occur in the genital tract in both sexes. It is commonly paratesticular, mainly in the epididymis. [...]
Abstract
The use of intravesical Bacillus Calmette-Guérin is a valid option in the treatment of non-muscle invasive bladder tumors, making it the main subject of a lot of publications. The aim of the present study is to review and consolidate the data available about this subject. A review of the data available was made on PubMed with the keywords: “intravesical BCG” and “non-muscle invasive bladder cancer”. Original and review articles written in English or Portuguese were selected. We present the discussion alongside the results for structural purposes. Scientific evidence strongly advises in favor of BCG use on intermediate and high risk tumors, due to its impact on the recurrence and possibly on the progression rates. It is important to be watchful for possible local and systemic side effects, that when detected call for a rightful therapeutically decision alongside the recommended schemes. The use of intravesical BCG with therapeutically purposes has strong evidence on the non-muscle invasive bladder tumors. More studies are needed in order to better understand the best administration scheme and its mechanism of action.Abstract
The use of intravesical Bacillus Calmette-Guérin is a valid option in the treatment of non-muscle invasive bladder tumors, making it the main subject of a lot of publications. [...]
Abstract
Spinal cord injury in males is frequently associated with infertility, due to ejaculatory dysfunction and/or semen properties alterations. Penile vibratory stimulation can be used as a semen collecting method. The aim of this work is to disclose the use of this method in spinal cord injured male patients, evaluate its possible complications and clarify if the ejaculated semen is prone to fertilization. Vibratory stimulation was used in three spinal cord injured patients to collect semen and, after that procedure, the evaluation of sperm parameters was performed. Vibratory stimulation was efficient in all the subjects, in the majority of the sessions. The ejaculates present normal sperm concentration, but variable sperm progressive motility and morphology, when comparing with the standard criteria. Penile vibratory stimulation is an efficient procedure to induce ejaculation in spinal cord injured patients. Despite the considerable variability between the subjects, the ejaculates met the required quality to allow fertilization trough assisted reproductive technologies.Abstract
Spinal cord injury in males is frequently associated with infertility, due to ejaculatory dysfunction and/or semen properties alterations. Penile vibratory stimulation can [...]
Abstract
Androgen deprivation therapy (ADT) is the standard therapy for advanced prostate cancer. However, it encompasses several adverse effects, with impact on patient’s quality of life and, eventually, on overall survival. This article will review the most important side-effects associated with androgen deprivation therapy and the methods for minimizing their impact.Abstract
Androgen deprivation therapy (ADT) is the standard therapy for advanced prostate cancer. However, it encompasses several adverse effects, with impact on patient’s quality [...]
Abstract
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). The authors conducted a review of the current indications for performing testicular sparing surgery as well as functional and oncological results of it. 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. 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. 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.Abstract
Malignant germ cell tumors represent the majority of testicular masses, according to current knowledge, radical orchiectomy remains the standard of care in the management [...]
Abstract
The impact of using ASA (acetylsalicylic acid), metformin and statins on the prostate cancer may be significant, but is not clear and findings from previous studies are inconsistent. This study aims to evaluate the relationship between the use of ASA, metformin and statins and the pathological characteristics and risk of biochemical recurrence (BCR) of prostate cancer. A total of 311 patients submitted to radical prostatectomy (RP) at Hospital de Braga between January 2010 and June 2014 were analyzed. Data were obtained from clinical records and the crude and adjusted association between the use of a specific drug and prostate specific antigen (PSA), pathological stage, Gleason score, positive surgical margin and risk of biochemical recurrence were calculated. Overall, 26 (8.4%) of the patients used ASA, 35 (11.3%) metformin and 112 (36%) statins. The ASA users had a lower PSA compared with the non users (5.9 vs. 8.9 ng/m, p = 0.008). Its use was an independent predictor of positive surgical margin (OR = 3.77, IC 95%: 1.45‐9.78). The use of metformin was associated with advanced pathological stages, more precisely pT3b (20% vs. 7.7%, p = 0.048). No other differences were detected between ASA, metformin and statins users. The use of ASA, metformin and statins has no beneficial effect on prostatic cancer patients. On the opposite, an association between the use of metformin and advanced pathological stages was observed. These results should be validated in other larger samples and longer follow‐up. The association between the use of ASA and lower PSA was already detected in other studies, whose mechanism should be clarified in futureAbstract
The impact of using ASA (acetylsalicylic acid), metformin and statins on the prostate cancer may be significant, but is not clear and findings from previous studies are inconsistent. [...]
Abstract
Due to considerable morbidity and mortality rates, radiation‐induced hemorrhagic cystitis is an important complication of pelvic irradiation. The available conservative treatment techniques show limited results. Hyperbaric oxygen has shown to be effective in the treatment of radiation‐induced lesions, including radiation cystitis. Our aim was to analyze the effectiveness and safety of hyperbaric oxygen therapy for refractory radiation‐induced hemorrhagic cystitis. Clinical records of 176 patients with refractory radiation‐induced hemorrhagic cystitis treated at our centre were retrospectively analyzed. The evolution of macroscopic hematuria was the main therapeutic outcome analyzed. 23, 9% of patients showed other radiation‐induced soft tissue lesions. After an average of 37 sessions of hyperbaric oxygen, 89, 8% of patients showed resolution of hematuria. Adverse events were reported in 1, 7% of patients. Hyperbaric oxygen was a safe and effective therapy for radiation‐induced hemorrhagic cystitis. Concomitant radiation‐induced soft tissue lesions were relatively frequent, which makes hyperbaric oxygen an excellent choice as first line treatment in those patients.Abstract
Due to considerable morbidity and mortality rates, radiation‐induced hemorrhagic cystitis is an important complication of pelvic irradiation. The available conservative [...]
Abstract
Although exceedingly rare in developed countries nowadays, we still come across some devastating sequels of genitourinary tuberculosis, requiring careful medical evaluation and expertise on surgical reconstruction. A 58‐year‐old man, previously submitted to a right nephrectomy, developed a life‐threatening episode of urosepsis, leading to the need of a percutaneous nephrostomy due to a long stricture of the terminal ureter of the remaining left kidney. The patient had also developed very severe urinary frequency related to an extremely crippled bladder, with a capacity under 20 mL. After medical treatment of the tuberculosis, an augmentation cystoplasty was performed but in a patient‐tailored way, using an ileal neobladder constructed following the Studer technique that was anastomosed to the remaining bladder tissue with implantation of the healthy segment of the shortened ureter on the afferent limb of the reservoir. The normalisation of bladder capacity (over 250 mL), with preserved filling sensation allowed an excellent patient adaptation. The combination of a severely decreased bladder capacity with a stenosis of the terminal ureter of a single kidney led to a need of a great capacity reservoir as well as a reimplantation of a shortened ureter. The use of an orthotopic ileal neobladder as a large ileocystoplasty patch was the solution adopted.Abstract
Although exceedingly rare in developed countries nowadays, we still come across some devastating sequels of genitourinary tuberculosis, requiring careful medical evaluation [...]
Abstract
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. 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 WHOs 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. 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). 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.Abstract
Infertility is a clinical disorder affecting approximately 15% of reproductive-aged couples worldwide. Recently, the influence of oxidative stress (OS) in decreased semen [...]
Abstract
To describe the initial experience of CHVNG/E in microsurgical vasovasostomy. The two‐layer technique was applied under microscope magnification in every patient by the same surgeon. 8 bilateral vasovasostomies were performed for vasectomy reversal between 2008 and 2014 at our unit. All the patients were available for follow‐up, with a mean follow‐up time of 6 months. Mean patient age was 38.8 ± 8.7 years and the interval between vasectomy and recanalization of 6 ± 1.5 years. Overall spermatozoid patency rate was 100%, with mobile spermatozoa in the ejaculate of all patients (median 12 x 106 /mL, interquartile interval [7 x 106 /mL‐21 x 106 /mL]). Four of the 8 patients fathered after the procedure. Our results were comparable to the ones described in the literature, confirming the performance of a good surgical technique. Microsurgical vasovasostomy constitutes a very safe method of vasectomy reversal, enabling couples to obtain pregnancies without additional medical treatment. To our knowledge, this is the first group of patients treated by this method in Portugal.Abstract
To describe the initial experience of CHVNG/E in microsurgical vasovasostomy. The two‐layer technique was applied under microscope magnification in every patient by the [...]
Abstract
The ureterointestinal stenosis is a relatively frequent complication after urinary diversions. The laparoscopic approach is rarely used but stay a therapeutic option. Show the surgical technique, step by step, of the laparoscopic ureteral/ureterointestinal estenosis correction. A vídeo of a distal ureteral stenosis laparoscopic correction, on a patient that undergone laparoscopic radical cystectomy with orthotopic neobladder confection, was presented. It was possible the laparoscopic correction of a distal right ureter estenosis with good results and no complications. The laparoscopic approach proved effective for treating ureter/ureterointestinal anastomosis stenosis and should be taken as a good option of treatment.Abstract
The ureterointestinal stenosis is a relatively frequent complication after urinary diversions. The laparoscopic approach is rarely used but stay a therapeutic option. Show [...]
Abstract
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. 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. 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.Abstract
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 [...]
Abstract
The prevalence of neurogenic lower urinary tract disfunction (NLUTD) is unknown, but the risk of developing NLUTD associated with spinal cord injury (SCI) is high. Verify the changes of intradetrusor BTX‐A injection on urodynamic parameters and in the QoL of NLUTD patients due to SCI. Retrospective study of 38 patients with SCI submitted to BTX‐A injection in our departments. Urodinamic studies were performed before and 3 to 6 months after treatment. QoL was evaluated by the Qualiveen questionnaire applied to 20 patients. Statistical analysis was performed with correlation tests for paired samples. Mean age was 38 years (Min = 23, Máx = 63), with 63.2% of males. The most frequent level of SCI was thoracic (52.6%). The average period between the SCI and the first treatment was 92 months (15 to 240 months). The patients had a mean of 3 treatments (min = 1, máx = 8), with 3 episodes of side effects ‐ transient and mild hypoasthenia. We collected data of urodynamic studies in 35 patients that showed increase in bladder capacity (p = 0, 24) and compliance (p < 0, 01) as well as a reduction in Pdetmax (p < 0.01). 20 patients answered the Qualiveen questionnaire with a mean result of 1 (possible final score 0‐4) The use of BTX‐A in our NLUTD patients is a treatment option with very good outcomes and important improvements in urodynamic parameters and in patients quality of life.Abstract
The prevalence of neurogenic lower urinary tract disfunction (NLUTD) is unknown, but the risk of developing NLUTD associated with spinal cord injury (SCI) is high. Verify [...]
Abstract
Multiparametric Magnetic Resonance Imaging of the prostate (Mp‐MRI) allows the detection, localization and characterization of suspicious lesions for prostate cancer (PCa). When done prior to the diagnosis it also allows targeting of the biopsy, significantly improving the performance of the standard random prostate biopsy. Our goal is to compare a targeted biopsy technique (cognitive fusion) with the standard double sextant randomized prostate biopsy, and to determine which has better accuracy in the detection of cinically significant prostate cancer. 30 patients aged 61‐67 were selected with a PSA greater than 4 ng/mL (PSA between 5.6 – 19.2) and with suspicious PCa lesions on Mp‐MRI (Pi‐RADS 3‐5). A total of 75 suspicious lesions were detected. All biopsies were performed by the same Urologist (JMP), using trans‐rectal ultrasound guidance and after previous visualization of MRI images. Sampling was targeted to the area considered suspicious on MRI, using a Cognitive Fusion Technique, collecting two samples per area. After that, a double‐sextant standard prostate biopsy was also done in all patients. The variables used for statistical analysis were PCa detection rate and amount of cancer per sample. 22 patients were diagnosed with PCa. In 5 patients, cancer was only detected on targeted cores. Targeted biopsies diagnosed 17% more PCa when compared to random biopsies, and almost doubled the amount of cancer per sample. The overall PCa detection rate was 61% for all samples. 360 fragments were collected from standard randomized prostate biopsy, of which 169 were positive for PCa (47%), with a median Gleason score of 6 (3+3). The average amount of cancer per sample was 25% (5%‐85%). 105 of 150 fragments collected by cognitive fusion targeted biopsies were positive for PCa (70%). The median Gleason score was 7(3+4) with a median amount of cancer per sample of 45% (10%‐90%). Multiparametric prostatic MRI detects areas highly suspicious for PCa, allowing targeted biopsies, which increases diagnostic accuracy and improves the detection of clinically significant PCa.Abstract
Multiparametric Magnetic Resonance Imaging of the prostate (Mp‐MRI) allows the detection, localization and characterization of suspicious lesions for prostate cancer (PCa). [...]
Abstract
To evaluate the relationship between mean apparent diffusion coefficient (ADC) and post-surgical Gleason scores. To determine the diagnostic accuracy of multiparametric magnetic resonance imaging (mp-MRI) on a 1.5 T magnet in distinguishing low, intermediate and high-grade prostate tumors. This is a retrospective institutional-review-board-approved, single-center study including 30 patients (median age, 60 years) who underwent mp-MRI before prostatectomy for prostate cancer. Using histological reports for guidance, the tumors were localized in ADC maps, and mean ADCs were measured and examined for correlation with Gleason scores. 2 patients had 2 measurable foci, so a total of 32 tumors were studied. The diagnostic accuracy of the mean ADC was assessed by using the area under the receiver operating characteristic curve (ROC). In the differentiation of tumors with a Gleason score of 6 from those with a Gleason score of at least 7, mean ADC yielded an AUC of 0.76 (95% confidence interval: 0.59, 0.93). In the differentiation of tumors with Gleason scores of 6 or 7 from those with a Gleason score of at least 8, mean ADC yielded an AUC of 0.94 (95% confidence interval: 0.86, 1.00). Mean ADC values may allow a correct assessment of the patient risk using a 1.5 T magnet without ERC.Abstract
To evaluate the relationship between mean apparent diffusion coefficient (ADC) and post-surgical Gleason scores. To determine the diagnostic accuracy of multiparametric magnetic [...]
Abstract
In the evaluation of prostate cancer, clinical nomograms are commonly used to predict the probability of lymphatic and extra‐nodal spread. Those nomograms may suggest the presence and the extension of this cancer but do not allow a clear distinction between loco‐regional and distant disease. In this study, it was intended to evaluate the usefulness of 18F‐Fluorocoline positron emission tomography/computed tomography (18F‐FCH‐PET/CT) in the workup of patients with the initial diagnosis of prostate cancer and staged by this imaging technique. The medical records of 39 patients with prostate cancer who underwent 18F‐FCH PET/CT for initial staging, between November 2010 and April 2015, were reviewed. Of these, 20 patients were excluded because they had already started hormonotherapy. In the other 19 patients, the performance of 18F‐FCH PET/CT for the detection of lymph node metastasis was evaluated by calculating the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy. Six patients had performed pelvic lymphadenectomy (total of 69 lymph nodes), allowing histological confirmation. When there was no histological confirmation (total of 30 lymph nodes and 3 cases of bone metastasis), the findings of 18F‐FCH PET/CT were correlated with the values of PSA and the information from multiple imaging modalities such as CT, bone scan, magnetic resonance (MRI), 18F‐Sodium Fluoride (18F‐NaF) PET/CT of control. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for lymph node metastasis detection were, respectively, 96.8%, 80.9%, 69.8%, 98.2% and 85.8%. In our sample, this technique also allowed the identification of nodal extra pelvic or bone metastasis in 5 patients (26.3%) with implications in the treatment. It showed uptake suggestive of bone metastasis, corroborated by other diagnostic technics or by the follow‐up, in 3 patients, those with prostate specific antigen (PSA) of 9.5 ± 2.9 ng/mL. 18F‐FCH PET/CT is an entire body and multi organ imaging modality that allows the identification, globally, of the sites of disease in patients with prostate cancer. In this study, 18F‐FCH PET/CT showed good results when used in the initial staging of these patients. It is highlighted the ability to detect distant disease, in particular bone metastasis, even with PSA< 20 ng/mL.Abstract
In the evaluation of prostate cancer, clinical nomograms are commonly used to predict the probability of lymphatic and extra‐nodal spread. Those nomograms may suggest the [...]
Abstract
Fibroepithelial polyps are extremely rare benign tumors arising from mesodermal tissue in the ureteral wall in children, that can cause ureteropelvic junction obstruction. In this report, we present an 11‐year‐old boy complaining of left intermitent lumbar pain related with ipsilateral hydronephrosis. Surgical exploration revealed several endoluminal polyps located at the ureteropelvic junction, obstructing the lumen of the ureter. Standard treatment consists in resection of the affected ureteral segment followed by open or laparoscopic dismembered pyeloplasty. The prognosis is excellent.Abstract
Fibroepithelial polyps are extremely rare benign tumors arising from mesodermal tissue in the ureteral wall in children, that can cause ureteropelvic junction obstruction. [...]
Abstract
We present the clinical case of a 74-year-old woman with an urachal tumor diagnosed in 2004. The patient underwent a partial cystectomy of the dome with remotion of the urachal remnant and the umbilicus. She had been clinical well until 2011 when she had a kidney metastasis from the urachal tumor. Urachal tumors are very rare, comprising 0.17-0.34% of all bladder cancers. The most common sites of distant metastases are: lung, lymph nodes, bone, intestine, brain, liver, peritoneum, skin and spine. We describe an extremely rare case of a renal metastasis from an urachal cancer, seven years after the initial diagnosis. Usually, patients with localized disease have a good prognosis when treated with surgery. The prognosis gets worse for patients with metastases or local recurrence because a standard chemotherapy regimen does not exist.Abstract
We present the clinical case of a 74-year-old woman with an urachal tumor diagnosed in 2004. The patient underwent a partial cystectomy of the dome with remotion of the urachal [...]
Abstract
Renal oncocytoma account for 3 to 7% of primary renal tumors. It is usually diagnosed incidentally and typically has a benign behavior. No currently used imaging techniques can reliably distinguish it from malignant lesions. Similarly, the microscopic diagnosis of oncocytoma remains a challenge. We present a case of an asymptomatic elderly, hypertensive, diabetic and with moderate chronic renal insufficiency, who underwent radical nephrectomy for a solid exophytic lesion of 4.7 cm in the renal pole, detected accidentally. Pathological examination revealed a renal oncocytoma. In this situation, partial nephrectomy would be the preferred surgical treatment, avoiding the long‐term risk of living with a single kidney. The lack of diagnostic tools that reliably differentiate between benign and malignant lesions makes this an important area of study, in order to reduce the number of surgical interventions and the associated morbidity.Abstract
Renal oncocytoma account for 3 to 7% of primary renal tumors. It is usually diagnosed incidentally and typically has a benign behavior. No currently used imaging techniques [...]
Abstract
Introduction : Imperforate hymen occurs in approximately 1 in 1, 000 females. It can be found incidentally on physical examination, it is treatable and does not cause significant morbidity. If it is not screened for and treated early, patients present at menarche with a history of cyclical pelvic or abdominal pain and symptoms of urinary retention due to hematocolpos. Case presentation : A 12-year-old premenarchal girl presented to the emergency department with cyclical hypogastric abdominal pain and pollakiuria, with 6 months-evolution. Her medical history was unremarkable, she had never been menstruated or sexually active. She took no medications. Examination of the perineum revealed an imperforate hymen protruding from the introitus. A Y incision was made on the imperforate hymen and during hymenectomy 500mL of brown blood (viscous chocolate colored) was drained from the vagina. She was discharged on postoperative day 2. At the follow-up visit (52nd postoperative day), the patient reported her symptoms had resolved. Conclusion : Although rare, imperforate hymen with retrograde menstruation can cause dilatation of the vagina and uterus (i.e., hematocolpometra). It is an important differential diagnosis of abdominal pain in premenarchal girls often associated with urinary symptoms. It is easily diagnosed by physical examination. © 2014 Associação Portuguesa de Urologia. Published by Elsevier España, S.L.U. All rights reserved.Abstract
Introduction : Imperforate hymen occurs in approximately 1 in 1, 000 females. It can be found incidentally on physical examination, it is treatable and does not cause significant [...]
Abstract
Currently, the use of mesh in surgery for pelvic organ prolapse has increased, mainly due to the high anatomic failure rate of native tissues repair. The objectives of this study were to analyze the results obtained in the surgical treatment of anterior and posterior defects with native tissues and assess the success rate. Retrospective study of 418 vaginal surgeries to repair defects in the anterior and posterior compartments using native tissues, performed in the Department of Urogynecology, from January 2008 to December 2012. In our sample, mean age was 64 years, with 90% of patients in menopause. 48.1% of women was hysterectomized, 78.2% were submitted to anterior colporrhaphy and 72.7% to posterior colporrhaphy. The correction of anterior paravaginal defect occurred in 32.5% of the surgeries and the posterior in 25.4%. Enterocele was repaired in 68.1% of cases. The intra‐operative and postoperative complications rate was 5%. Of the 347 patients evaluated in the postoperative period, 91.6% was discharged. Seven were later readmitted (2.2%). 29 women were kept in surveillance, mostly for recurrent prolapse, which worsened after a year of follow‐up. A total of 18 women was re‐operated, 13 for recurrence (3.7%). Therefore, the anatomic success rate was 80%. After adding the asymptomatic cases, in which anatomic cure was not achieve, the rate rose to 94%. The compartment defects correction rate of success, in our department, is in accordance with that described in the literature, with lower rates of complications and re‐interventions.Abstract
Currently, the use of mesh in surgery for pelvic organ prolapse has increased, mainly due to the high anatomic failure rate of native tissues repair. The objectives of this [...]
Abstract
The new Integrated Outpatient Surgery Centre (CICA) of Oporto’s Hospital Centre (CHP), opened in March/2011, developed around a paradigm of innovation and accurate protocols. Analysis of complications and Grade of satisfaction (Grade 1-5) of patients operated by Urology in the first 2 years of CICA, and their correlation through the χ2 test. 550 patients operated between March/2011 and April/2013, predominantly male (96.4%), mean age 43.5 years and anesthetic risk (ASA Average) 1.7. Main pathologies addressed: phimosis (34.0 %), hydrocele (22.7 %), varicocele (10.0%), and isolated short frenulum (6.9%). Mean surgical time 31.71 ± 14.32 min. Rate of early complications (< 28 days) was 4.9% and late complications (≥ 28 days) was 1.3%, with a median time between surgery and complication 8.5 days. 371 patients (67.5 % of the population) answered the telephone interview, presenting Satisfied and Very Satisfied (Grade 4 and 5, respectively) in 94.3% of the cases with surgery and 98.4% with the outpatient conditions and regime. Correlation between the presence of complications (early and late) and Grade of Satisfaction (Grade < 4 Vs. ≥ 4), showed a statistically significant (pAbstract
The new Integrated Outpatient Surgery Centre (CICA) of Oporto’s Hospital Centre (CHP), opened in March/2011, developed around a paradigm of innovation and accurate protocols. [...]
Abstract
Bladder cancer is responsible for 90-95% of urotelial carcinoma. Prostate Cancer is the most prevalent visceral tumor for males and one of the main oncological death causes. The presence of both tumours in the same individual is considered common. Radical cystoprostatectomy with lymphadenectomy and urinary diversion is the gold standard treatment for muscle-invasive bladder cancer. Incidental prostate cancer is described as being present in about 37.9% of cystoprostatectomy patients. To demonstrate the presence of incidental prostate cancer in cystoprostatectomy patients at our department. Clinical data concerning 72 men, from 2008 to 2013, at our institution were retrospectively reviewed. There was incidental prostate cancer in 19.4% of patients, being more frequent in patients older than 70 years of age. Lesions detected were small and circumscribed to the prostate. Four patients (5.6%) had clinically significant prostate cancer: one with a Gleason 7 (3 + 4), pT3b, one with a Gleason 7 (3 + 4), pT2c, one with a Gleason 7 (3 + 4), pT2a, and finally one with a Gleason 6 (3 + 3), with a positive surgical (urethral) margin. The most common histological pattern was Gleason 6 (3 + 3) (78.6%). pT2b predominated in 7 patients (9, 7%). There were equally 4.17% of patients with a pT2a and pT2c (3 patients each). Tumoral volume was inferior to 0.5 cc in 78.6% (11 patients) and superior/ equal to 0.5 cc in 22.4% (3 patients). There was only one patient with a biochemical relapse after 7 months of follow-up, initiating hormonal therapy at that time. Incidental prostate cancer rate was close to the one reported in the literature, being very variable, depending on the definition, the type of histopathological analysis, as the particular methodology of the study. Significative incidental prostate cancer was rare, requiring a closer follow-up with direct implications on the patient’s outcome. Standard pre-operatory evaluation is insufficient to determine precisely which tumours are eligible to this category. Adjuvant treatment for these tumours following cystoprostatectomy has been the same as if it were a prostate cancer following radical prostatectomy surgery. A common carcinogenesis pathway has been proposed and is currently being investigated. Prostate sparing cystectomy may occur in very selected individuals with a known oncological risk for disease progression with questionable functional benefits.Abstract
Bladder cancer is responsible for 90-95% of urotelial carcinoma. Prostate Cancer is the most prevalent visceral tumor for males and one of the main oncological death causes. [...]
Abstract
''Objectives'' : To evaluate the exposure of Portuguese Urology residents (IP) to urological laparoscopy and to its training methods, comparing with the remaining Urology residents in Europe (IE). ''Materials and methods'' : A survey consisting of 23 questions concerning laparoscopic training, which was published online as well as distributed on paper, during the Annual European. Association of Urology Congress in 2012. Data was analysed with descriptive statistics, student t, Mann-Whitney and χ2 tests. ''Results'' : We obtained 219 valid responses, 53 (24.2%) of which from IP. Conventional laparoscopy is equally available for both groups (78.8% of IP vs 72.0% of IE, p = NS). IP have greater access to single port laparoscopy (22.6% vs 8.4%, p < 0.05), but lesser exposure to robot-assisted laparoscopy (0% vs 21.9%, p < 0.01) in their training departments. Performance of conventional laparoscopy as first surgeons was reported by 32.7% of IP and 24.8% of IE (p = NS). The most commonly performed procedure was total nephrectomy (38.4% of IP and 28.8% of IE, p = NS). The majority in both groups considered their laparoscopic experience at the moment of the survey to be “Poor” or worse (81.9% of IP e 75.5% of IE, p = NS). However, IP had greater expectations than IE of improvement during residency (p = 0.01). No previous attendance to laparoscopic courses or fellowships was seen in 35.7% of IP and 41.7% of IE (p = NS). However, IP attended more national courses than IE. “Pelvitrainer” is the most commonly available laboratory training method, (30.2% of IP and 33.3% of IE, p = NS), but 41.9% of IP and 42.4% IE do not have access to any laparoscopic training device. Most residents (84.1% of IP and 74.4% of IE, p = NS) rate their motivation to perform laparoscopy in the future as “High” or “Very High”, and plan performing a post-residency fellowship in this field. ''Conclusions'' : The access to conventional laparoscopy is similar between IP and IE, and both take an active part in this technique. A significant proportion has some experience as laparoscopic surgeons. Despite the relative scarcity of training devices in both groups, IP attend more national courses in laparoscopy, and experience a better sense of evolution during residency than IE. © 2014 Associação Portuguesa de Urologia. Published by Elsevier España, S.L.U. All rights reserved.Abstract
''Objectives'' : To evaluate the exposure of Portuguese Urology residents (IP) to urological laparoscopy and to its training methods, comparing with the remaining Urology [...]
Abstract
To quantify the effect of statins’ use on Prostate Specific Antigen (PSA) levels in patients referred to prostate biopsy and to determinate if the exposure to statins must be considered to improve the prostate cancer diagnostic accuracy of PSA. We selected 551 subjects with PSAAbstract
To quantify the effect of statins’ use on Prostate Specific Antigen (PSA) levels in patients referred to prostate biopsy and to determinate if the exposure to statins must [...]
Abstract
Retroperitoneal schwannomas are rare, usually benign tumours that originate in the peripheral neural sheath. Preoperative diagnosis is often impossible. Few cases of laparoscopic removal of retroperitoneal schwannoma have been reported to date. We aim to report a case of retroperitoneal schwannoma using laparoscopic surgical technique. A 61‐year‐old man was found incidentally a solid retroperitoneal tumour by ultrasound. Abdominal computed tomography and magnetic ressonance imaging revealed a well‐defined, heterogeneous tumour, 3 cm in diameter, in pararrenal space close to psoas major. A transperitoneal laparoscopic resection was performed. Operative time was 65 minutes. The patient had an uneventful perioperative course. Histopathological exam revealed a benign schwannoma. No recurrence was detected after 2 years of follow‐up. Preoperative establishment of diagnosis is difficult in case of retroperitoneal schwannomas even with imagiologic or biopsy studies. Complete resection is the diagnosis and treatment of choice. Laparoscopic treatment is minimal invasive, safe and feasible for retroperitoneal schwannomas mainly because these lesions are well limited and hypovascular, allowing a careful dissection from adjacent structures through an improved visualization.Abstract
Retroperitoneal schwannomas are rare, usually benign tumours that originate in the peripheral neural sheath. Preoperative diagnosis is often impossible. Few cases of laparoscopic [...]
Abstract
Introduction : The artificial urinary sphincter (AUS) is the gold standard for surgical treatment of male stress urinary incontinence. Objective : Evaluate the results of the artificial urinary sphincter placement of AMS 800 in the Department of Urology of São João Hospital Center in a 6-year period (January 2007/December 2012). Material and methods : 30 male patients with urinary incontinence (UI) underwent placement of AUS AMS 800 through penoscrotal approach, with an average age of 69 years. 25 patients had severe incontinence and 5 moderate. With regard to etiology, UI secondary to radical prostatectomy (RP) in 26 patients, mixed incontinence (detrusor overactivity and PR) in 1 patient, prostatectomy for BPH in 1 patient, neurogenic UI in 2. 9 patients have a prior history of unsuccessful sling Invance, 14 a prior history of external pelvic radiotherapy and 8 a prior history of internal urethrotomy for stricture of vesico-urethral anastomosis. The mean postoperative follow-up was 22.1 months. Mean pads/day before surgery: 5.73. Results : 20 patients (67%) are fully continent (no protection), 5 patients (17%) partially improved or continents (1-2 pads per day or reduction of > 50% of the number of pads), 5 patients (17%) without improvement (≥ 3 pads/day). Adding cured and improved patients, we obtain an overall success rate of approximately 84%. The variation of pads/day before and after surgery (respectively 5.7 and 0.8) is statistically significant (p < 0.05 - Wilcoxon test). Prior history of urethral sling, adjuvant pelvic radiotherapy and anastomotic VU stricture previously treated by urethrotomy do not compromise the continence rates. Regarding complications, mechanical failure occurred in one case (3%), infection in 3 (10%) and urethral erosion also in 3 (10%). The rate of re-operation (revision or removal of the AUS) was 23%. Conclusions : The AUS is an effective treatment for moderate to severe male stress urinary incontinence. Our success rates and complications are consistent with the literature. It has relevant success rate in peculiar groups: patients with sling, RT and anastomotic VU stricture previously treated by urethrotomy. The main limitations remain: the need for the patient to have satisfactory cognitive function and manual dexterity to handle the sphincter, present a non-negligible rate of re-intervention due to mechanical and non-mechanical complications. © 2014 Associação Portuguesa de Urologia. Published by Elsevier España, S.L.U. All rights reserved.Abstract
Introduction : The artificial urinary sphincter (AUS) is the gold standard for surgical treatment of male stress urinary incontinence. Objective : Evaluate the results of [...]
Abstract
The 2014 European Association of Urology (EAU) guidelines on Penile cancer recommend dynamic sentinel node biopsy (DSNB) as a standard staging method for intermediate and high risk squamous cell carcinoma of the penis (SCCp), (≥ T1G2), c N0. The aim of this work is to evaluate the false negative rate and morbidity of our DSNB series. Since 2005 to 2014, 23 patients with SCCp and a patient with melanoma of the distal urethra, cN0, underwent DSNB in the urology department of Porto Portuguese Oncology Institute ‐ IPOPFG, EPE, Portugal. Bilateral inguinal ultrasound scan and fine needle aspiration cytology (FNAC) of suspicious inguinal nodes were not performed before DSNB. Lymphoscintigraphy starts in the morning of surgery with peri‐tumoral injection of albumin nanocoloid labeled with 99m Tc. Peri‐operatively, patent blue is injected into the dermis in peri‐tumoral location. The sentinel node is identified during surgery with the aid of lymphoscintigraphy images, a portable probe which detects gamma rays and identification of the blue dye in lymph nodes and vessels. The false negative rate was calculated per patient. The complication rate was calculated per groin within 30 days of DSNB. In 23 patients with SCCp, lymphoscintigraphy was bilateral in 7 patients. Biopsy was bilateral in 11 patients, with a mean number of lymph nodes excised per patient of 2, negative for metastasis in 20 patients. After median follow‐up of 45.5 months, we had a false negative. The false negative rate [1 false negative / (3 true positive + 1 false negative)] was 25%. The complication rate of BDGS per groin was 5.8%, with 2 minor linfoceles (Clavien I). Inguinal ultrasound and FNAC of suspicious lymph nodes before DSNB, although operator‐dependent, seems very important to decrease our false negative rate. The referral of patients with SCCp for DSNB can increase the number of patients undergoing this nodal staging method in Portugal. The DSNB morbidity is minimal.Abstract
The 2014 European Association of Urology (EAU) guidelines on Penile cancer recommend dynamic sentinel node biopsy (DSNB) as a standard staging method for intermediate and [...]
Abstract
In the PSA era, the incidence of localized prostate cancer has been increasing. This reality requires new therapeutic strategies, in order to give an answer to patients, in whom active surveillance may be indicate but desire more interventionist strategy with minimal side effects and without compromising cancer control. In these cases, focal therapies that include irreversible electroporation may be effective alternative strategies. The irreversible electroporation is an emergent approach on focal treatment of localized PCa. The nonthermal mechanism that preserves the tissue architecture without damaging tissue structures, such as vessels and nerves within the target region, is the main advantage comparatively to other techniques used in focal treatment. The number of clinical studies is reduced and the results still immature.Abstract
In the PSA era, the incidence of localized prostate cancer has been increasing. This reality requires new therapeutic strategies, in order to give an answer to patients, in [...]
Abstract
Introduction : Patients with cystinuria require multiple and varied treatments due to disease persistence and recurrence. In this study we analyzed therapeutic modalities and outcomes in the treatment of cystine calculi at a single academic center over the last 7 years. Materials and methods : We retrospectively analyzed patients undergoing invasive treatment of cystine calculi at our institution in the period between January 2006 and March 2013. Medical and surgical interventions and patient outcomes regarding stone-free status and renal function were considered. Results : A total of 7 cystinuric patients were invasively treated in our institution over the period of 7 years from January 2006 to March 2013. Of these 4 were male and 3 female with an average age at last follow-up of 39 years (range 19-59). Treatment modalities included medical therapy with high fluid intake, sodium restriction and urine alkalinization (all 7 patients), captopril (6 patients), and penicillamine (1 patient). These patients underwent a total of 156 procedures, with an average of 22.3 procedures per patient. All patients underwent extracorporeal shockwave lithotripsy (SWL), with a mean of 20 sessions per patient, range 8-35). Other treatment modalities included ureterorenoscopy and intracorporeal lithotripsy, (9 procedures in 4 patients, mean = 2, range 1-4), percutaneous nephrolithotomy (PCNL), (3 procedures in 3 patients), pyelolithotomy (2 procedures in 2 patients, one laparoscopic and one open) and one open nephrectomy (sepsis due to an atrophic kidney at presentation). Three patients have been stone free for the last 12 months, all have undergone PCNL or pyelolithotomy. Three patients have had serial renal scintigraphy, all maintained global and differential renal function over a period of 6 years (2 patients) and 2 years (1 patient) despite continued invasive procedures. Conclusions : In our series, more invasive procedures (PCNL or pyelolithotmy) were required for debulking disease burden or achieving a stone-free status. Medical therapy and repeated minimally invasive procedures, especially SWL, were required for preventing recurrence and treating residual stones. Despite the frequent use of procedures with potential deleterious effect for the kidney, in our series renal function was not affected either by the disease or its aggressive treatment over a period of several years. © 2014 Associação Portuguesa de Urologia. Published by Elsevier España, S.L.U. All rights reserved.Abstract
Introduction : Patients with cystinuria require multiple and varied treatments due to disease persistence and recurrence. In this study we analyzed therapeutic modalities [...]
Abstract
Erectile dysfunction (ED) is one of the most common complications of diabetes, being oxidative stress an important feature of diabetic ED. Deleterious events induced by oxidative stress lead to crucial cellular and tissue alterations targeted by oxidative lesions. However, the noxious effects of oxidative stress mechanisms in penile tissue with the progression of diabetes, remains unclear. We intended to evaluate systemic and penile oxidative stress in an early and late stage of diabetes. Male Wistar rats were divided in groups: 2 and 8‐weeks of streptozotocin‐induced type 1 diabetes, and age‐matched controls. Systemic oxidative stress was evaluated in urine by hydrogen peroxide (H2 O2 ) quantification and in plasma by reduced/oxidized glutathione (GSH/GSSG) ratio. Penile oxidative status was assessed by H2 O2 production and by the evaluation of protein nitration through the detection of 3‐nitrotyrosine (3‐NT). 3‐NT was quantified by Western blotting analysis and immunohistochemistry allowed to identify its cavernosal cellular location. Systemic evaluation revealed a significant increase in urinary H2 O2 levels in both diabetic groups. A significant decrease of circulating GSH/GSSG ratio was observed in animals with late stage diabetes. In cavernosal tissue, H2 O2 production was significantly increased at 8‐weeks diabetes. Regarding 3‐NT cavernosal formation, data revealed a significant increment in advanced diabetes and a predominant location in cavernosal smooth muscle cells. We observed that systemic and cavernosal noxious effects induced by oxidative stress are predominant in advanced diabetes. Increased penile protein oxidative modifications in late‐staged diabetes may be responsible for structural/functional deregulations in cellular/molecular systems, contributing to the development of diabeticassociated ED.Abstract
Erectile dysfunction (ED) is one of the most common complications of diabetes, being oxidative stress an important feature of diabetic ED. Deleterious events induced by oxidative [...]
Abstract
Urethral diverticula affect from 0.6 to 4.7% of women, are a frequent cause of persistent urinary symptoms and can present with complications such as lithiasis and malignization. Today, underdiagnosis and diagnostic and therapeutic delay of female urethral diverticula are still common. The aim of this article is to analyse the state of art regarding ethiology, diagnosis and therapeutics of this disease. Bibliographic revision of articles published until January/2014 after search of the database Medline for the keywords: “female urethral diverticula”, “female urethral diverticulum”, “urethral diverticula”, “urethral diverticulum” and “female urethra”, and of bibliographic references of the articles obtained. Most female urethral diverticula are secondary to infection of the periurethral and urethral glands. Despite the classically described triad of dysuria, dyspareunia and post‐void dribbling, the clinical manifestations are diverse and unspecific. Over a third are palpable on gynaecologic examination. Imaging exams, namely magnetic resonance and ultrasound, have high diagnostic capability and contribute to surgical planning. Depending on location, conformation and associated symptoms, urethral diverticula can be managed conservatively or, more frequently, surgically. Clinical evaluation is still essential for the diagnosis of female urethral diverticula. Currently, magnetic resonance is considered to be the best modality to diagnose the diverticula and to exclude pre‐ and post‐operative complications. Less invasive techniques have been described but transvaginal urethral diverticulectomy yields the highest symptomatic cure rates. Awareness of the medical community is the most powerful weapon to reduce the underdiagnosis and diagnostic delay associated with female urethral diverticula.Abstract
Urethral diverticula affect from 0.6 to 4.7% of women, are a frequent cause of persistent urinary symptoms and can present with complications such as lithiasis and malignization. [...]
Abstract
As the prevalence of urolithiasis is growing and there has been an increase in technologies and minimally invasive techniques in all areas of surgery, it would be expected that the total number of publications about this disease should increase. We hypothesized if there is also an evident trend towards the increase of urolithiasis related publications in urology journals. We evaluated the publications in five prestigious urology journals over the last decade, in order to perform a bibliometric analysis of every article published related to urinary lithiasis. An electronic search was performed using PubMed and all issues of British Journal of Urology International® (BJU Int), European Urology® (Eur Urol), Journal of Endourology® (J Endourol), Journal of Urology® (J Urol) and Urology® (Urology) were consulted from 2001 to 2010. All articles related to renal and ureteral lithiasis were collected, recorded and analyzed. A total of 30, 847 articles were published in these five prestigious journals. The J Urol was the journal with the most number of articles published per year with an average of 1146 papers. J Endourol was the publication with less publicated articles in this decade, with an average of 231 papers per year. There was a total of 1425 urolithiasis related papers in all journals. The J Endourol was the journal with the greatest number of urolithiasis related articles published in the period of analysis, with a total of 545 articles. The ratio of urolithiasis related articles and the total articles published per year in each journal was analyzed. The J Endourol was the publication with the greatest ratio. Eur Urol was the journal with less publications in urolithiasis, with ratios ranging from 0 in the year of 2010 and 5.3% in the year of 2003, with a decrease in the last years. All the other journals maintained a stable ratio of publications. Urolithiasis as a great subject to urologists practice would be expected to be an important source of original research studies in the more active urology journals. However, our study showed that, during the last decade, there was a steady number of urolithiasis related articles published in several journals.Abstract
As the prevalence of urolithiasis is growing and there has been an increase in technologies and minimally invasive techniques in all areas of surgery, it would be expected [...]
Abstract
To present our clinical and surgical experience of radical cystectomy in bladder cancer, evaluate postoperative complications and overall survival. We performed a retrospective analysis of all patients undergoing radical cystectomy for bladder cancer between 2006 and 2010. Pathological characteristics were described based on 2009 TNM classification. We evaluated postoperative complications in the first 30 days after surgery according to the Clavien-Dindo classification and determined overall survival. We analyzed the data from 195 patients with a mean age of 67.8 years (28-87 years). 82.6% were male. The median follow-up was 2.5 years. Urothelial cancer was diagnosed in 93.8% cases. The majority of patients had extravesical disease with pathologic T3 stage in 28.7% and T4 in 22.1%. 32.8% of patients who underwent lymphadenectomy had positive lymph nodes. The most frequent urinary diversion was the ileal conduit, performed in 79% of cases, followed by neobladder in 10.3%. Postoperative complications were reported in 40.5% of patients, 28.2% were grade I/II and 12.3% were grade III-V, with a mortality rate of 3.6%. The overall survival at 3 years was 54% and at 5 years was 48%. The cases with disease localized to the bladder (≤ pT2N0) showed a 3-year survival of 89%. The presence of extravesical disease (≥ pT3) and lymph nodes metastasis confirmed to be poor prognostic factors, with a 3-year overall survival of 46% and 22%, respectively. This series results show that radical cystectomy is a complex surgery but with reasonable early postoperative morbidity and mortality. Surgery should be performed in the early stages of disease in order to offer the best survival outcomes.Abstract
To present our clinical and surgical experience of radical cystectomy in bladder cancer, evaluate postoperative complications and overall survival. We performed a retrospective [...]
Abstract
Over the past few years, the increasing use of cross‐sectional imaging, including ultrasound and computed tomography imaging, resulted in an increase incidental diagnosis of renal tumors, especially small renal masses (< 4 cm). The knowledge that 30% of these masses may be benign, including oncocytomas led to the investigation for more effective methods of diagnosis in order to avoid overtreatment situations. The authors decided to analyse and compare contrast enhancement patterns of oncocytomas and clear‐cell renal cell carcinoma (ccRCC) to predict histology. Between 2004‐2015 we retrospectively identified 32 patients with either histological confirmation of renal oncocytoma (N = 16) or ccRCC (N = 16) who underwent percutaneous biopsy, total or partial nephrectomy. The relative attenuation of solid renal lesions and normal renal cortex was determined in the unenhanced and nephrographic phase. Statistical comparison was carried out by Mann‐Withney test. The oncocytomas and cc‐RCC average size was 3.7 cm [1.8 to 14] and 3.5 cm [1.9 to 8.4], respectively. The average attenuation in the unenhanced phase was 33 HU and 32 HU, respectively. In nephrographic phase, the average contrast enhancement was 47.5 and 47.4 H, respectively. In nephrographic phase, the attenuation difference between the oncocytomas and normal renal cortex was 43.5 HU and the attenuation difference between the cc‐RCC and normal renal cortex was 59.7 HU. These results were statistically significant (p < 0.05). In the nephrographic phase, URO‐CT reveals that oncocytomas have greater isodensity to the normal renal cortex compared to cc‐RCC. This finding can help us to determine which lesions we should biopsy or not.Abstract
Over the past few years, the increasing use of cross‐sectional imaging, including ultrasound and computed tomography imaging, resulted in an increase incidental diagnosis [...]
Abstract
Until the late 1980s, it was considered that any testicular mass, if suspicious, should be removed totally by radical orchiectomy, however, a marked increase in incidental testicular mass diagnosis, the high accuracy of diagnosis obtained from frozen section examinations, and evidence showing the potential advantages of testis‐sparing surgery, threw into question the need to sacrifice the entire testis even when a normal contralateral testis was present. We present a 23‐year‐old patient who was asymptomatic at diagnosis of a non‐palpable testicular mass with a size of approximately 7.5 mm and negative for tumor markers. He underwent a Testis‐sparing surgery guided by ultrasound with frozen section examination, however, with the suspicious of Germ cell tumor, it was decided to complete the orchiectomy. The final histological results were Leydig cell tumor. Given the high likelihood of non‐palpable and small testicular lesions being benign (80%), the negative impact of radical orchiectomy on spermatogenesis, cosmetic aspects, and endocrine function, impossible to ignore, Testis‐sparing surgery is a procedure that although it is not a standard procedure must be employed as the first approach in selected cases and specialized reference centers.Abstract
Until the late 1980s, it was considered that any testicular mass, if suspicious, should be removed totally by radical orchiectomy, however, a marked increase in incidental [...]
Abstract
Urothelial bladder carcinoma (UBC), the most frequent type (90%) of bladder cancer and the second most common malignancy of the urogenital region, is a relatively well understood type of cancer, with numerous studies concerning pathogenetic pathways, natural history and bladder tumor biology being reported. Despite this, it continues to remain a challenge in the oncology field, mostly due to its relapsing and progressive nature, and to the heterogeneity in the response to cisplatin-containing regimens. Although the formulae based on clinical staging and histopathological parameters are classically used as diagnostic and prognostic tools, they have proven insufficient to characterize the individual biological features and clinical behaviour of the tumours. Understanding the pathobiology of the disease can add important information to these classical criteria, and contribute to accurately predict outcome and individualize therapy for UBC patients. In this line of investigation, we found that tumour angiogenesis and lymphangiogenesis, the process of invasion and metastasis and the energy metabolism reprogramming/tumour microenvironment encompass several potential biomarkers that seem to infl bladder cancer aggressiveness and chemoresistance. We particularly highlight the roles of lymphovascular invasion, and of RKIP, CD147 and MCT1 immunoexpressions, as relevant prognostic and/or predictive biomarkers, and as promising areas of therapeutic intervention, eliciting for the development of additional studies that can validate and further explore these biomarkers.Abstract
Urothelial bladder carcinoma (UBC), the most frequent type (90%) of bladder cancer and the second most common malignancy of the urogenital region, is a relatively well understood [...]
Abstract
Laparoscopic radical prostatectomy has become an accepted alternative to open surgery. Our goal is to compare the oncological outcome of both approaches. The prospective study was initiated in September 2012, during 10 months. The high risk tumors were excluded from the study, only low and intermediate risk were included. We evaluated the following parameters: age, PSA, biopsy Gleason score, operative time, blood units, surgical margins, complications, Gleason score and TNM stage of the surgical specimen. Within 10 months, 45 patients underwent radical prostatectomy. 24 underwent laparoscopic approach and 21 the open approach. In the laparoscopic group, 70.8% (17) presented negative margins, 25% (6) positive margins and 4.17% (1) not suitable for classification. In the open approach 66.7% (14) presented negative margins, 28.6% (6) presented positive margins and 4.76% (1) not suitable for classification. It was used a Chi-Square Test considering positive and negative margins. No statistically differences were found (p value = 0.79). We evaluated the distribution of the different tumor stages T2a, T2b, T2c, T3a and T3b (TNM) in both groups. No difference was found in the distribution of the tumor stages in both groups. We have used a chi-square test (p value = 0.23). There is no association between the margins and the surgical approaches, and no association between the tumor stages and the two surgical approaches. We can conclude that the laparoscopic approach can be an alternative in low and intermediate risk cancers, even in low volume centres. © 2014 Associação Portuguesa de Urologia. Published by Elsevier España, S.L.U. All rights reserved.Abstract
Laparoscopic radical prostatectomy has become an accepted alternative to open surgery. Our goal is to compare the oncological outcome of both approaches. The prospective study [...]
Urology & Nephrology