Genital self-mutilation. Case report and bibliographic review.

OBJECTIVE: To report a very uncommon case of penile open wound made by self-mutilation in a 51-year-old man, and to perform a bibliographic review. METHODS: 51-year-old man presenting at the Emergency Department under Police guard after self-cutting his penis while he was urinating, presenting an almost complete circular section that required immediate surgical repair. RESULTS: Early surgical management showed the section of almost the whole penile circumference, from ventral to dorsal, including urethra and both cavernous bodies, respecting only the dorsal vascular penile complex. We performed a primary anastomosis of the damaged structures and careful haemostasis of the penis. CONCLUSIONS: Open traumas to the penis usually require an urgent surgical examination, being mandatory to try a primary reconstruction if the global clinical situation allows it. Cosmetic and functional postoperative results advise this attitude.

Conventional ovarian stimulation vs. delayed single dose corifollitropin alfa ovarian stimulation in oocyte donors: a prospective randomized study. Tail trial.

The present study compares two protocols for ovarian controlled stimulation in terms of number of cumulus-oocyte complexes and metaphase II oocytes. We employed a single injection of 150mcg of corifollitropin alfa after a 7-day oral contraceptive pill-free interval for TAIL group and a conventional administration of corifollitropin alfa after a 5-day OCP-free interval with additional rFSH from 8th of ovarian controlled stimulation. Prospective, randomized, comparative, non-inferiority, opened and controlled trial carried out in 180 oocyte donors 31 were excluded, 81 were randomized to the control group and 68 to the TAIL group. No differences were found in the number of follicles larger than 14 and 17 mm at triggering day. However, a lower number of cumulus-oocyte complexes and metaphase II oocytes were obtained in TAIL group compared to the control group, expressed as median (interquartile range): 10.5 (5.5-19) vs. 14 [11-21] and 9 (4-13) vs. 12 (9-17) respectively. Additionally, the incidence of failed retrieval or metaphase II oocytes = 0 was higher in TAIL group 7(10.3%) vs. 1(1.2%) p = 0.024. The use of a single injection of corifollitropin alfa after a 7-day oral contraceptive pill-free interval in oocyte donors resulted in a lower number of cumulus-oocyte complexes and metaphase II oocytes. No additional rFSH was administered in this group. Clinical Trial Registration: https://www.clinicaltrialsregister.eu/ctr-search/trial/2019-001343-44/results.

Bladder hernia.

OBJECTIVE: To report a new case of bladder hernia. We reviewed the clinical features, diagnosis and treatment of this disease. METHODS: Case report of a patient diagnosed with bladder hernia. RESULTS: We expose the clinical picture and the most common form of diagnosis and the more effective treatment. CONCLUSIONS: Bladder hernia is rare disorder that is diagnosed clinically and whose treatment is surgical, with very good results.

[Cystic displasia of the testis. Review of literature]. / Displasia quística de rete testis: revisión de la literatura.

OBJECTIVE: Review this pathology nowadays. METHODS: We search in Medline/PubMed database for reviews about cystic dysplasia of the testis. We review and discuss the relevant literature about it. RESULTS: Cystic dysplasia of the testis (CDT) is a rare benign disease, associated with upper urinary tract malformations. Its most frequent clinical manifestation is the increase of testicular size; the presence of cysts is demonstrated by ultrasound. No consensus exists in its treatment, it oftenly requires histological confirmation, performing testicle-sparing surgery. CONCLUSION: CDT needs to be taken into account in the differential diagnosis of childhood testicular tumors.

[Pathological assessment of prostate cancer. New problems]. / Valoración patológica del cáncer de próstata. Nuevos problemas.

INTRODUCTION: Currently, the diagnosis and treatment of prostate cancer requires the pathologist to adopt a fresh approach to the interpretation of biopsies in order to provide the data required for the new forms of therapy. DISCUSSION: The new evaluation criteria of the Gleason system are explained, with the redefinition of histological patterns and degree of malignancy, the incorporation of the so-called prognostic groups and the assessment of the tumour mass. CONCLUSIONS: Updating of histopathological information helps to improve patient management, especially in cases of tumour confined to the prostate, given the possibility of local therapy.

[Update of the Gleason system and other prognostic pathological data in prostate cancer: Tumor load.] / Actualización del sistema Gleason y de otros datos patológicos pronósticos en el cáncer prostático: carga tumoral.

Desde que D. F. Gleason creara su sistema en 1966 (1 ) y que él mismo modificó en 1974 (2), su método ha sido universalmente aceptado y recomendado por la OMS (3)como factor pronóstico del carcinoma prostático (CaP). Pero, la generalización de la prueba del PSA a partir de 1979 (4), del desarrollo de la TRUS (5) y de la "biopty-gun" para la toma de biopsias en sextantes en los años 80 (6), y sus posteriores modificaciones, son hechos que han cambiado paulatinamente la postura ante el CaP y, con la experiencia adquirida, algunas de las reglas iniciales de Gleason han evolucionado. Aunque se publicaron varios estudios que proponían cambios en el sistema (7), solo los de la ISUP de 2005 (8), han tenido trascendencia real. En ellos se reconsideran algunos de los criterios para identificar aquellos tumores con un patrón histolgico de alto grado (patrón 4 o 5), redefiniendo estos patrones del sistema Gleason.

Evaluation of HIV prevention and counseling practices of obstetrician/gynecologists in Bogota, Colombia: impact on women's knowledge and risk practices.

The present community-based study in Bogotá, Colombia, investigated risk assessment and preventive counseling practices of obstetrician/gynecologists (ob/gyn n = 34) and their impact on women's (n = 230) knowledge and risk behaviors. The data indicate that physician education has a significant and positive impact on women's knowledge and behavior. After controlling for sociodemographic variables, women instructed by their ob/gyn were 11 times more likely to correctly identify preventive measures (p = 0.0001) and high-risk sexual practices for the HIV /sexually transmitted diseases (STDs) transmission (4x; p = 0.05) and were less likely to engage in high-risk sexual practices (OR = 2; p = 0.05). Few ob/gyns (17%), however, assess risk behaviors and provide risk reduction counseling, and only 6% frequently encouraged HIV testing. These findings highlight the potential public health impact of ob/gyn physicians and underscore the need to increase their involvement in halting the HIV/STD epidemic in Colombia.

[Diagnosis and follow-up of benign prostatic hyperplasia by ultrasound]. / Diagnóstico y seguimiento de la hipertrofia prostática benigna mediante ecografía.

OBJECTIVES: The aim of the study is to analyze the utility of ultrasound in the evaluation and treatment selection of patients with benign prostatic hyperplasia (BPH). METHODS: A total of 5000 patients older than 50 years and with prostatic symptoms were evaluated with abdominal ultrasound and in selected cases with transrectal ultrasound. RESULTS: The first ultrasonographic sign of BPH is the increase of anteroposterior and longitudinal diameters. Prostatic volume is measured with a safety of 80%, post-void volume and indirect signs of bladder obstruction are also determined by ultrasound. Upper urinary tract pathological conditions can be also detected. CONCLUSIONS: Ultrasound associated with PSA and urinary flow are adequate to evaluate and select treatment in patients with BPH.

[Ultrasonography for the study of small renal masses]. / Estudio ultrasonográfico de las masas renales de pequeño tamaño.

OBJECTIVES: To perform an update on the usefulness of ultrasound in the study of small size renal tumors and its current possibilities. METHODS: We review the results of ultrasound in this pathology with the addition of the most recent technological advances such as a harmonic digital converters and power color Doppler. We analyze its contribution to the differential diagnosis of the cystic pathology, to the definition of solid masses, to the detection and characterization of small size masses, and to the definition of the vascular patterns of various tumors. RESULTS: Ultrasonography offers a diagnostic safety of 98% in cystic masses, being able to detect them from 0.5 cm diameter in favourable conditions. The differential diagnosis of multiloculated masses, multivesicular hydatid cyst, multiloculated cystic nephroma, and multiloculated cystic carcinoma still poses great difficulty, the same way it happens with other radiological tests. For solid masses, the greater image resolution has lead to a progressive increase in the incidental detection of tumors and the percentage of patients candidates to conservative surgery due to the decrease in size. It is easy to differentiate between adenocarcinoma and angiomyolipoma, up to 85% of the cases, but the rest of the tumors do not have specific characteristics. For small size masses, smaller than 3 cm, ultrasound sensitivity is clearly inferior to CT scan. Power color Doppler helps to confirm the existence of solid masses and helps a better differential diagnosis with pseudo tumors. CONCLUSIONS: The modern ultrasound techniques provide a high cost-effectiveness both in detection and definition of the nature of small size renal masses.

[Testicular ultrasonography]. / Ecografía testicular.

OBJECTIVES: To review the contribution of ultrasound to the differential diagnosis of scrotal pathology, both testicular and adnexal. METHODS: We performed a bibliographic review on the topic, adding the experience of our Unit over the years; we classified the pathology in testicular and extratesticular, separating liquid and solid lesions, and a miscellaneous group of unclassifiable cases. RESULTS: Currently, ultrasonography with high frequency equipment allows not only to differentiate between intra and extratesticular lesions, but also to identify specific lesions, the manage of which may include follow-up without need of unavoidable surgery. CONCLUSIONS: Ultrasonography is a painless simple test that may be repeated without inconvenience so that it is the first test to be indicated for any problem of the scrotal content.

[Immunosuppression and surgical complications after renal transplantation]. / Inmunosupresión y complicaciones quirúrgicas post-trasplante renal.

OBJECTIVES: The new immunosuppressive regimens in kidney transplantation have diminished the rate of acute rejection and improved graft survival. However, the use of new agents results in the development of surgical complications. The authors analyze the incidence of such complications accordingly to the type of drug. METHODS: This study included 350 kidney transplantations performed between January 1997 and December 2004. The average age was 54 years. The incidence of diabetes mellitus was 8.5% and the rate of obese recipients (BMI >30 kg/m2) was 15.4%. The average follow-up rate was 44 +/- 5.6 months (5-96). A surgical complication was defined as any complication directly related to the surgical transplant that occurs along the first year after transplantation. RESULTS: The incidence of surgical complications was 34.8% (122/350). The rates of perigraft collections and bleeding posttransplant were significantly higher in the CsA group than in the Tacro one: 12% vs. 3.8% (p = 0.005) and 11.5% vs. 3% (p = 0.002). The Sirolimus and Everolimus-based immunosuppresive regimens led to a higher incidence of lymphocele (16% vs. 3.7%) (p = 0.012). There were no significant difference in the incidence of surgical complications in recipients immunosuppressed with and without MMF, and in diabetic vs. no diabetic patients. Surgical complications were higher in obese patients (66.5% vs. 33.5%) (p = 0.002). CONCLUSIONS: Recipients receiving Sirolimus/Everolimus demonstrated a significantly higher lymphocele rate. The CsA regimens were associated with bleeding and post transplant pararenal fluid collections. The introduction of MMF did not result in a significant increase in posttransplant surgical complications. The obesity was a risk factor associated with those complications.

[Upper urinary tract urothelial tumor. Antegrade percutaneous management]. / Tumor de urotelio de vía superior. Manejo endoscópico anterógrado.

OBJECTIVES: Upper urinary tract tumors account for 2-4% of urinary tract tumors and 5% of urothelial tumors. The pyelocalyceal system (75%) and distal third of the ureter are the most frequent locolizations. Various series confirm a relatively benign course of low grade and stage tumors, with survivals around 80-66% for pyelic and ureteral tumors respectively. Tumor grade and stage are the most important factors for patient outcome, more than type of treatment undertaken (classic radical nephroureterectomy vs. conservative surgery). With the development of endoscopic techniques and the use of new equipment, both ureteroscopy and nephroscopy have gained a relevant role in the study and treatment of upper urinary tract tumors in selected groups of patients. METHODS/RESULTS: We describe data from the literature about the nature of urothelial tumors, diagnostic methods, and indications of conservative management. We performed a retrospective chart review of patients undergoing endoscopical procedures (ureteroscopy and nephroscopy) to rule out upper urinary tract urothelial tumors at the Hospital Ramon y Cajal in Madrid between January 1996 andJune 2003. We do a comparative analysis between our results and those referred in the literature and a previous study in our department published in 1996. CONCLUSIONS: Both ureteroscopy and nephroscopy are effective and safe procedures in the diagnosis and treatment of suspicious-looking lesions of the urinary tract, with a low complication rate. Main indications are small, papillary, and low grade tumors, confined within the mucosa, with negative urinary cytolo,gy, in patients with associated comorbidity, solitary kidney or bilateral tumors.

[Infertility and varicocele through history]. / La infertilidad y el varicocele a través de la historia.

OBJECTIVES: To perform a historical review of varicocele and male infertility with the aim to find descriptions that first related them. In parallel, we review the evolution of treatment for varicocele up to date. METHODS/RESULTS: We refer to multiple authors and their treaties on Medicine, from first to 20th Century, in which descriptions of these pathologies are found, focusing on descriptions of the surgical technique for treatment of varicocele and their application in Spain. CONCLUSIONS: Varicocele was already described in treaties from the first century having bee of n its treatment predominantly surgical from the first description to our days. Not identified as a cause of infertility until late, by the end of the 19th century, it is the main indication for treatment nowadays. The surgical technique has suffered many modifications over time, both in the approach as in the "radicality" of a vascular ligature applied.

[Acute renal failure as the beginning of glandular cystitis. Review of the bibliography]. / Fracaso renal agudo como debut de la cistitis glandular. Revisión de la bibliografía.

OBJECTIVES: To report one clinical case of obstructive uropathy secondary to bladder pseudotumor. METHODS: We report the case of a 74-year-old male with obstructive acute renal failure of unknown etiology. RESULTS: After resolution of the acute renal failure by percutaneous nephrostomy, action was undertaken to control possible etiologic causes, resolving the bilateral ureter entrapment and bladder inflammatory process. CONCLUSIONS: Glandular cystitis is a nosological entity which in its severe forms behaves clinically and radiologically as a bladder pseudotumor, so that should be considered as a part of the differential diagnosis with bladder tumors. Final diagnosis comes from pathology. For treatment, it is basic to eliminate any predisposing factor, either infectious, or irritative, or obstructive; if no action is carried out on these factors other therapeutic measures as the aforementioned are not effective. Strict follow-up should be undertaken (every six months) because of the high incidence of bladder adenocarcinoma.

[AMS-800 artificial sphincter. Our experience in the last 20 years]. / Esfinter artificial AMS-800. Nuestra experiencia en los últimos 20 años.

OBJECTIVE: To present a series of 63 patients with urinary incontinence due to sphincteric incompetence who underwent the implantation of an AMS-800 artificial sphincter. METHODS: From 1984 to December 2002 a total of 69 patients received this prosthesis, 63 of which were available for review. The cause of incontinence was sphincter incompetence in all cases, said secondary to prostate surgery, neurogenic bladder, post-traumatic urethral lesion, and epispadias. 52 of them were placed in the bulbar urethra, and 11 in the bladder neck. The cuff diameters varied from 4 to 10 cm and reservoir pressures from 51-60 to 71-18 H2O cm. RESULTS: The complications that appeared, ordered by frequency, were: malfunction, infection and rejection or exteriorization, fistula, and unappropriate size. The total number of reoperations was 39 in 28 patients. Functional results were successful in 48 cases and failure in 15. CONCLUSIONS: The use of an AMS-800 prosthesis for the treatment of urinary incontinence due to sphincteric incompetence is effective but not without complications. The most frequent indication was following prostate surgery, being this group the one that obtains the best results. Patients with incontinence of neurogenic origin have the highest complication rate, and the worst results in relation to vascularization and tissue trophism abnormalities. In female patients we prefer other techniques that have similar results, are technically easier and more economic.

The role of imaging techniques in renal transplantation.

Our aim is to review the utility of the different imaging techniques in the field of renal transplantation (RT). A total of 500 potential RT recipients have been evaluated and were included in the waiting list. From 1978 to 2003, a total of 900 RT recipients were clinically followed-up and different imaging techniques assessed. The main indications for the different techniques were: (1) MR angiography to establish the vascular anatomy of the living donor with 95% accuracy for the detection of multiple renal vessels. (2) Abdominal ultrasound of the donor in order to detect lithiasis, incidental renal tumors or anatomic anomalies. (3) Vascular evaluation of the recipients was essential considering the aging character of this population. X-ray film of the abdomen was a routine technique. Doppler ultrasound (DOP-US) of the iliac vessels and an angiographic study (DSA, CT, MR) of the iliac and splenic arteries were indicated only in selected cases. (4) DOP-US was useful in the diagnosis of graft dysfunction after RT. It allowed the exclusion of thrombosis and urinary obstruction, and was useful to distinguish between acute tubular necrosis, cyclosporine nephrotoxicity and acute rejection (AR). (5) Finally, ultrasound was used as a percutaneous approach to pyelocaliceal systems of grafts affected by ureteral stenosis or fistula and for draining fluid collections after RT (lymphocele, abscess, hematoma or urinoma).

[Pathologic classification of upper urinary tract tumors]. / Clasificación anatomopatológica de los tumores del urotelio superior.

OBJECTIVES: To do an update on the upper urinary tract tumors classification systems. METHODS/RESULTS: Bibliography review of the various classification systems appeared over the last years, comparing them and reviewing their associated problems. CONCLUSIONS: Current systematization advocated by WHO and ISUP are the most adequate for patient stratification. However, there are problems for coupling tumors with characteristics in the limit between some of their categories, so that we consider it will be convenient to review them.

[Urinary cytology in the diagnosis of upper urinary tract urothelial tumor]. / Citología de orina en el diagnóstico del tumor urotelial del tracto urinario superior.

OBJECTIVES: To review the current usefulness of urinary cytology in the diagnosis of upper urinary tract urothelial tumor in relation to conservative endoscopic treatment. METHODS: Bibliographic review of the published articles about urinary cytology of the upper urinary tract urothelial tumor and evaluation of the diagnostic efficacy obtained in various series. Review of the cytological diagnostic criteria for urothelial tumors. RESULTS: From 1960 to 2003, 26 series collecting results of the cytological diagnosis of urothelial tumors of the ureter and renal pelvis have been published. Results have been variable with a diagnostic accuracy between 23 and 100%. Such an ample variation depends on sampling techniques, preparation techniques, type of tumor, and the urologists and pathologist's experience. The collection of the sample by direct endoscopical visualization significantly proves the diagnostic efficacy of cytology for upper urinary tract urothelial tumors. CONCLUSIONS: Urine cytology selectively obtained from the upper urinary tract with endoscopical techniques is a reliable method in the diagnosis of renal pelvis and ureter neoplasias. Urine cytology has a sensitivity close to 90% and specificity between 98-100% for carcinoma in situ and high-grade urothelial neoplasias, so that it can contribute in the therapeutic decision making process in a very effective manner. Despite its low sensitivity, it may be useful in the diagnosis of low grade urothelial neoplasias when samples are selectively obtained by catheterization, and it has not been excelled by any of the biomarkers molecular tests yet.

[Upper urinary tract tumors pathology (ureter, pelvis and renal calyces)]. / Anatomía patológica de los tumores del tracto urinario alto (ureter, pelvis y cálices renales).

OBJECTIVES: To show the pathologic characteristics of upper urinary tract tumors with special emphasis on the peculiarities due to anatomical site and secondary to endoscopic treatment. METHODS: Bibliographic review and presentation of our ten-year experience at the "Hospital Ramon y Cajal" Pathology Department in Madrid studying 203 urothelial tumors of the ureter, renal pelvis and calyces. RESULTS: More than 95% of the upper urinary tract tumors in adults have their origin in the urothelium, and most of them are either malignant or potentially malignant. Their biological behaviour is similar to bladder tumors, although they have some peculiarities due to their anatomical localization. Tumors at the renal calyces may be more aggressive due to their particular way of intrarenal dissemination. CONCLUSIONS: Anatomical localization and proper pathological study are the determinant factors to establish prognosis and possible adjuvant treatment for upper urinary tract tumors after endoscopic resection.