Stem Cell Therapy for Erectile Dysfunction: A Step towards a Future Treatment.

Background: The improvement of absent or partial response in the medical treatment of erectile dysfunction (ED) has led to the development of minimally invasive new treatment modalities in the field of regenerative medicine. Methods: A literature review on stem cell therapy for the treatment of ED was performed. We searched for the terms "erectile dysfunction" and "stem cell therapy" in PubMed and Clinicaltrials.gov. Literature searching was conducted in English and included articles from 2010 to 2022. Results: New treatment modalities for ED involving stem cell therapy are not only conceived with a curative intent but also aim to avoid unnecessary adverse effects. Several sources of stem cells have been described, each with unique characteristics and potential applications, and different delivery methods have been explored. A limited number of interventional studies over the past recent years have provided evidence of a safety profile in their use and promising results for the treatment of ED, although there are not enough studies to generate an appropriate protocol, dose or cell lineage, or to determine a mechanism of action. Conclusions: Stem cell therapy is a novel treatment for ED with potential future applications. However, most urological societies agree that further research is required to conclusively prove its potential benefit.

Prospective Observational Cohort Study of the Efficacy of Bacterial Immune Prophylaxis in the Prevention of Uncomplicated, Recurrent Urinary Tract Infections.

OBJECTIVE: To investigate the long-term prophylactic effect of a vaccine on lower urinary tract infections (UTI) of bacterial and the impact of the intensity of the symptoms on the quality of life (QoL). METHODS: Adult female could be enrolled in this study if they had acute UTI at the enrolment visit and bacterial microbiological count of ≥103 CFU/mL of Escherichia coli. RESULTS: A total of 21 patients were included. Fifteen days after the administration of a vaccine for 3 months, the number of infections dropped almost to zero. Significant differences were observed in the QoL score (p < 0.05). The safety profile was good. CONCLUSIONS: In patients diagnosed with recurrent UTI and treated for 3 months with the vaccine the number of UTI episodes fell very quickly (15 days), and patients remained free of episodes and improved their QoL significantly for 1 year. These results suggest that bacterial vaccines are a possible effective alternative in the prevention of recurrent UTI.

[Greenlight-XPS laser vaporization, the new standard of treatment in men with myasthenia gravis and benign prostatic obstruction]? / La fotovaporización prostática con laser (PVPL) podría constituir una alternativa eficaz y segura a la resección transurethral (RTUP) en pacientes con miastenia gravis.

UNLABELLED: Patients with Benign Prostatic Obstruction (BPO) and Myasthenia Gravis (MG) treated with Transurethral Resection of the prostate (TURP) show a high incidence of urinary incontinence due to unnoticed damage to muscle fibres of the external sphincter. Photoselective laser vaporization could be an alternative treatment based on the hypothesis that using Laser as energy source in the treatment of BPH prevents sphincter damage because the energy is not transmitted outside the fiber tip. METHODS: We report the case of a man diagnosed of MG and symptomatic BPO treated satisfactorily with photoselective laser vaporization (GreenLight-XPS). RESULTS: Patient did not experienced postoperative secondary incontinence. CONCLUSIONS: Laser photoselective vaporization (GreenLight-XPS) could be the standard treatment for men with MG and BPO, whose prostate volume is less than 60 cc who are candidates for surgical treatment. Despite the extremely low incidence of these cases, further investigations are needed to confirm this affirmation.

La fotovaporización prostática con láser (PVPL) podría constituir una alternativa eficaz y segura a la resección transuretral (RTUP) en pacientes / Greenlight-XPS laser vaporization, the new standard of treatment in men with myasthenia gravis and benign prostatic obstruction?

OBJETIVOS: Los pacientes con miastenia gravis (MG) diagnosticados de sintomatología del tracto urinario inferior (STUI) secundaria a hiperplasia benigna de próstata (HBP), presentan una elevada incidencia de incontinencia urinaria al ser sometidos a resección transuretral de próstata (RTUp), secundaria a la lesión inadvertida de las fibras musculares del esfínter externo. La fotovaporización prostática con Láser podría ser una alternativa de tratamiento, ya que podría evitar el daño inadvertido del esfínter debido a que la energía no se transmite más allá de la punta de la fibra. MÉTODOS: Presentamos el caso de un varón con antecedente de MG y HBP sintomática tratado de forma satisfactoria mediante fotovaporiazación selectiva con Láser verde (GreenLight-XPS). RESULTADOS: El paciente no presentó incontinencia urinaria tras la cirugía. CONCLUSIONES: La fotovaporización prostática con Láser verde (GreenLight-XPS) podría ser el tratamiento estándar de aquellos varones con MG y HBP candidatos a tratamiento quirúrgico, con volumen prostático menor de 60 cc. A pesar de la baja incidencia de estos pacientes, futuros casos son necesarios para corroborar esta afirmación

Patients with Benign Prostatic Obstruction (BPO) and Myasthenia Gravis (MG) treated with Transurethral Resection of the prostate (TURP) show a high incidence of urinary incontinence due to unnoticed damage to muscle fibres of the external sphincter. Photoselective laser vaporization could be an alternative treatment based on the hypothesis that using Laser as energy source in the treatment of BPH prevents sphincter damage because the energy is not transmitted outside the fiber tip. METHODS: We report the case of a man diagnosed of MG and symptomatic BPO treated satisfactorily with photoselective laser vaporization (GreenLight-XPS). Results Patient did not experienced postoperative secondary incontinence. CONCLUSION: Laser photoselective vaporization (GreenLight-XPS) could be the standard treatment for men with MG and BPO, whose prostate volume is less than 60 cc who are candidates for surgical treatment. Despite the extremely low incidence of these cases, further investigations are needed to confirm this affirmation

Prostatic nephrogenic adenoma. Case report.

OBJECTIVE: We present a case of prostatic urethra nephrogenic adenoma as an incidental finding following transurethral resection of the prostate. METHOD/RESULT: It is an incidental diagnosis of nephrogenic adenoma of prostatic urethra in a 50-year-old male operated for benign prostatic hyperplasia by means of transurethral resection. CONCLUSIONS: Nephrogenic adenoma is an infrequent and benign lesion of the urinary tract, associated with a previous history of trauma or irritation on the urothelium. Predisposing factors include infections, calculi, surgery, trauma and kidney transplantation.

Adenoma nefrogénico de localización prostática. Aportación de un caso / Prostatic nephrogenic adenoma. Case report

OBJETIVO: Presentamos el caso de un adenoma nefrogénico de uretra prostática como hallazgo incidental tras una resección trasuretral de próstata.MÉTODO/RESULTADO: Se trata del diagnóstico incidental de adenoma nefrogénico de uretra prostática en varón de 50 años intervenido de hiperplasia benigna prostática mediante resección trasuretral.CONCLUSIONES: El adenoma nefrogénico es una lesión benigna del tracto urinario, infrecuente, asociado con una historia previa de traumatismo o irritación sobre el urotelio. Los factores predisponentes incluyen las infecciones, cálculos, cirugía, traumatismos y el trasplante renal(AU)

OBJECTIVE: We present a case of prostatic urethra nephrogenic adenoma as an incidental finding following transurethral resection of the prostate.METHOD/RESULT: It is an incidental diagnosis of nephrogenic adenoma of prostatic urethra in a 50-year-old male operated for benign prostatic hyperplasia by means of transurethral resection.CONCLUSIONS: Nephrogenic adenoma is an infrequent and benign lesion of the urinary tract, associated with a previous history of trauma or irritation on the urothelium. Predisposing factors include infections, calculi, surgery, trauma and kidney transplantation(AU)

Prostatic abscess: diagnosis and treatment of an infrequent urological entity.

OBJECTIVE: To report two cases of prostatic abscess of difficult management and review the literature on diagnosis and management of this entity. METHODS /RESULTS: We describe two patients with prostatic abscess. The first one, a 73-year-old diabetic male, was treated using a more passive approach with percutaneous transrectal drainage; after a slow response, the patient passed away due to sepsis. The second case was a 59-year-old male who experienced a negative clinical response to antibiotic treatment. While under antibiotic ambulatory care the patient was treated with a transurethral resection of the prostate, which yielded a successful outcome. CONCLUSION: Prostatic abscess is a rare entity that affects individuals experiencing weakness and can be a serious condition. Measures taken to arrive at a resolution must be rapid and appropriate.

Absceso prostático. Diagnóstico y tratamiento de un proceso urológico poco frecuente en la actualidad / Prostatic abscess: diagnosis and treatmente of an infrequent urological entity

OBJETIVO: Presentar dos casos clínicos de absceso prostático de difícil manejo y revisar el diagnóstico y tratamiento de esta entidad.MÉTODOS/RESULTADOS: Descripción de dos pacientes con absceso prostático. El primer caso es un varón diabético de 73 años a quien se le instaura un manejo conservador con drenaje percutáneo transrectal y quien tras una evolución tórpida fallece de una sepsis urológica. El segundo caso es un varón de 59 años con mala evolución clínica tras tratamiento antibiótico ambulatorio realizándose una resección transuretral de próstata con resultado satisfactorio.CONCLUSIÓN: El absceso prostático es una entidad rara. Afecta principalmente a personas debilitadas lo que le confiere un carácter grave. Las medidas encaminadas a su resolución deben ser rápidas y oportunas(AU)

OBJECTIVE: To report two cases of prostatic abscess of difficult management and review the literature on diagnosis and management of this entity.METHODS /RESULTS: We describe two patients with prostatic abscess. The first one, a 73-year-old diabetic male, was treated using a more passive approach with percutaneous transrectal drainage; after a slow response, the patient passed away due to sepsis. The second case was a 59-year-old male who experienced a negative clinical response to antibiotic treatment. While under antibiotic ambulatory care the patient was treated with a transurethral resection of the prostate, which yielded a successful outcome.CONCLUSION: Prostatic abscess is a rare entity that affects individuals experiencing weakness and can be a serious condition. Measures taken to arrive at a resolution must be rapid and appropriate(AU)

Adrenal myelolipoma. Contribution of a case and bibliographic review.

OBJECTIVE: We report the case of adrenal gland myelolipoma. METHODS/RESULTS: The patient was a 29 year old who is diagnosed with an adrenal adenoma during an endocrinology review. He underwent laparoscopic adrenalectomy. The pathological study confirmed the diagnosis of adrenal myelolipoma. CONCLUSIONS: The myelolipoma is a rare tumor composed of hematopoietic elements in different maturation stages and without histological changes, combined with mature adipose tissue in varying proportions. Most of them are incidental findings during radiologic complementary tests. Treatment should be tailored to each particular case. Surgery is indicated when the mass exceeds the size 4-6 cm or when it is a functioning mass.

Mielolipoma suprarrenal. Aportación de un caso y revisión de la literatura / Adrenal myelolipoma. Contribution of a case and bibliographic review

OBJETIVO: Presentamos el caso de un mielolipoma de localización adrenal.MÉTODO/RESULTADO: Presentamos una paciente de 29 años que es diagnosticada de un adenoma suprarrenal de 6 cm durante una revisión endocrinológica. Se le practica una suprarrenalectomía laparoscópica. El estudio patológico confirma el diagnóstico de mielolipoma suprarrenal.CONCLUSIONES: El mielolipoma es un tumor infrecuente constituido por elementos hematopoyéticos en diferentes estadios madurativos y sin alteraciones histológicas, combinados con tejido adiposo maduro en proporciones variables. La mayoría son hallazgos incidentales durante exploraciones radiológicas complementarias.La cirugía de la masa está indicada cuando la lesión sea mayor de 6 cm, funcionante y/o sintomática (AU)

OBJECTIVE: We report the case of a myelolipoma of the adrenal glands.METHOD/RESULTS: The patient is a 29 year old who is diagnosed with an adrenal adenoma during a review in endocrinology. He underwent laparoscopic adrenalectomy. The pathological study confirmed the diagnosis of adrenal myelolipoma.CONCLUSIONS: The myelolipoma is a rare tumor composed of hematopoietic elements in different maturation stages and without histological changes, combined with mature adipose tissue in varying proportions. Most are incidental findings during radiologic complementary. Treatment should be tailored to each particular case. Surgery is indicated when the mass exceeds the size 4-6 cm or when it is functioning (AU)

Síndrome metabólico y disfunción eréctil / Metabolic síndrome and erectile dysfunction

OBJETIVO: Puesta al día de un síndrome que en los pasados años ha ido incrementando las patologías coincidentes en el mismo, tales como obesidad, hipertensión, hipercolesterolemia, diabetes tipo II, con la reciente adición de la disfunción erectil y la androgenodeficienciaMÉTODO: Revisión global de la literatura tomando como referencia las últimas aportaciones y muy especialmente las debidas al profesor M. Serrano Ríos, de Madrid, y su grupoRESULTADOS: El síndrome metabólico parece actualmente consolidado como terminó universalmente aceptado, a pesar de su complejo itinerario semántico y nosologico. La inclusión de la disfunción erectil y la androgenodeficiencia le da más solidez patogénica y aproxima más al terreno profesional de la endocrinología a dos procesos prioritariamente urológicos. El urólogo recibe a su vez una nueva perspectiva de procesos que son inexcusablemente propios y a los que ha de atender con mayor amplitud exploratoria, analítica y terapéuticaCONCLUSIÓNES: El síndrome metabólico puede ser reconocido en la consulta urológica con más frecuencia de lo sospechado. El urólogo queda obligado, en este proceso típicamente médico, a ejercer con más dedicación y amplitud el compromiso médico de su especialidad médico quirúrgica(AU)

OBJECTIVES: To update a syndrome that has increased the number of pathologies included such as obesity, hypertension, hypercholesterolemia, type II diabetes mellitus, and the recent addition of erectile dysfunction and androgen deficiencyMETHODS: Global review of bibliography taking the last articles as a reference and mainly those from Prof. M. Serrano Rios and his group in Madrid.RESULTS: Metabolic syndrome seems to be consolidated as a universally accepted term, despite its complex semantic and gnoseologic itinerary. The inclusion of erectile dysfunction and androgen deficiency gives more pathogenic solidity and makes the professional field of endocrinology closer to two mainly urological processes.The urologist has a new perspective of processes that are of his own, that he has to take care of in a comprehensive manner, with physical examination, blood tests and therapy. CONCLUSIONS: Metabolic syndrome may be more frequently than suspected recognized in the urologist office. Urologists are compelled, in this typically medical process, to exercise with more dedication and fullness the medical compromise of our medical-surgical specialty(AU)

[Hematuria of papillary or medullar origin: a difficult diagnosis entity]. / Hematuria de origen papilar o medular: entidad de difícil diagnóstico.

OBJECTIVES: Renal haemangiomas of renal papillary or medullar origin are a difficult diagnosis entity, being one of the most frequent processes of chronic episodes of hematuria, secondary to benign disease, mainly in young patients. The objective of this paper is to show the difficulty of this diagnosis and the need to suspect it in cases with clinical history similar to the ones described in these cases. METHODS: We report 4 cases of spontaneous hematuria of renal origin, with clinical presentation as renal colic, from the historical case series of the Fundacion Jimenez Díaz-Capio, the last two from the years 2005-6. We present the diagnostic and therapeutic methodology employed, including angio-CT and flexible ureterorenoscopy (URS) as well as various treatment options. RESULTS: Hematuria was identified as "essential" when any relation with tumor or lithiasic pathologies was ruled out, and of renal origin when the source was clearly pointed. We interpreted it was related to angiomas or microangiomas of papillary or medullar origin. In one case, the vascular malformation was interpreted as an arterial venous fistula (AVF) at that level. Hematuria stopped spontaneously in two cases after exploratory URS. The eldest historical case required surgical expiration of the caliceal structures. CONCLUSION: Years ago, following the professional development of Urology as speciality, conventional surgery was carried out in all these cases, of very difficult diagnosis, with a very small number of cases undergoing a conservative approach based on the examination of renal cavities trying to observe and find the bleeding point. Most cases underwent complete or partial nephrectomy. Currently, the possibility of exploration of all renal cavities with the flexible ureterorenoscope enables a better diagnosis of the lesions and a more conservative treatment. The ultimate diagnosis of renal papillary angioma is the pathologic diagnosis, without pathognomonic data in the imaging tests. This pathology is thought of at the end of the diagnostic workup, and when the papillary area is identified as the source of bleeding. The historical case series, with the pathologic findings from nephrectomy specimens, permits us to point out this entity as papillary angioma, in patients with similar clinical presentation.

Hematuria de origen papilar o medular: entidad de díficil diagnóstico / Hematuria of papillary or medullar origin: a difficult diagnosis entity

Objetivo: Los hemangiomas renales de origen papilar o medular renal, es una entidad de difícil diagnóstico, siendo una de las causas más frecuentes de episodios crónicos de hematuria, por patología benigna, fundamentalmente en pacientes jóvenes (1). El objetivo de esta presentación es mostrar la dificultad de este diagnóstico y la necesidad de sospecharlo en cuadros con historia similar a la que expresan estos casos. Métodos: Se presentan 4 casos de hematuria espontánea de origen renal, con expresión clínica de dolor cólico, de la serie histórica del Servicio de Urología de la Fundación Jiménez Díaz-Capio, los dos últimos del año 2005-6. Se presenta la metodología diagnóstica y terapéutica realizada, incluidos los estudios de angioTAC y la URS (ureterorenoscopia flexible), asi como diversas opciones de tratamiento. Resultado: La hematuria se identificó como “esencial” al descartar la relación responsable con patología tumoral o litiásica, y de origen renal al señalar claramente su origen. Se interpretó relacionada con angiomas o microangiomas de origen papilar o medular. En un caso la malformación vascular fue interpretada como FAV (fístula arteriovenosa) a ese nivel. Tras la URS exploradora, la hematuria cedió espontáneamente en dos casos. El caso histórico más antiguo requirió la exploración quirúrgica de las estructuras calicilares. Conclusión: Hace años y siguiendo el desarrollo profesional de la Especialidad de Urología, todos estos casos, de gran dificultad diagnóstica, eran sometidos a cirugía convencional, en muy pocas ocasiones con actitud conservadora, basada ésta en la exploración de las cavidades renales, intentando observar y encontrar el lugar del sangrado activo. La mayoría de los casos eran sometidos finalmente a Nefrectomía total o parcial. La posibilidad actual, de poder explorar las cavidades renales en su totalidad con el ureterorenoscopio flexible, permite un mejor diagnóstico de las lesiones y un tratamiento más conservador. El diagnóstico último de angioma renal papilar es anatomo-patológico, sin existir datos patogneumónicos de diagnóstico por la imagen Se piensa en esta patología, al final del proceso diagnóstico, y al identificar la zona papilar como origen del sangrado. La serie histórica de casos clinicos, con los hallazgos anatomo-patológicos de las nefrectomías realizadas, permite señalar la entidad, como angioma papilar, en pacientes con clínica similar (AU)

Objectives: Renal haemangiomas of renal papillary or medullar origin are a difficult diagnosis entity, being one of the most frequent processes of chronic episodes of hematuria, secondary to benign disease, mainly in young patients (1). The objective of this paper is to show the difficulty of this diagnosis and the need to suspect it in cases with clinical history similar to the ones described in these cases. Methods: We report 4 cases of spontaneous hematuria of renal origin, with clinical presentation as renal colic, from the historical case series of the Fundacion Jimenez Díaz - Capio, the last two from the years 2005-6. We present the diagnostic and therapeutic methodology employed, including angio-CT and flexible ureterorenoscopy (URS) as well as various treatment options. Results: Hematuria was identified as “essential” when any relation with tumor or lithiasic pathologies was ruled out, and of renal origin when the source was clearly pointed. We interpreted it was related to angiomas or microangiomas of papillary or medullar origin. In one case, the vascular malformation was interpreted as an arterial venous fistula (AVF) at that level. Hematuria stopped spontaneously in two cases after exploratory URS. The eldest historical case required surgical expiration of the caliceal structures. Conclusion: Years ago, following the professional development of Urology as speciality, conventional surgery was carried out in all these cases, of very difficult diagnosis, with a very small number of cases undergoing a conservative approach based on the examination of renal cavities trying to observe and find the bleeding point. Most cases underwent complete or partial nephrectomy. Currently, the possibility of exploration of all renal cavities with the flexible ureterorenoscope enables a better diagnosis of the lesions and a more conservative treatment. The ultimate diagnosis of renal papillary angioma is the pathologic diagnosis, without pathognomonic data in the imaging tests. This pathology is thought of at the end of the diagnostic workup, and when the papillary area is identified as the source of bleeding. The historical case series, with the pathologic findings from nephrectomy specimens, permits us to point out this entity as papillary angioma, in patients with similar clinical presentation (AU)