Female urethral carcinoma: evidences to origin from Skene's glands.

PURPOSE: Urethral carcinoma is among the rarest neoplasias of the genitourinary tract and its origin is unclear. Prostate-specific antigen (PSA) is considered an evidence of origin from Skene's glands. We considered the origin from these glands in PSA negative cases. MATERIAL AND METHODS: We studied 3 patients with urethral carcinoma surgically treated. The surgical specimens were examined including cytochemical and immunohistochemical stains. The possible origin of the tumors was based on a comparative study of normal Skene's glands from autopsies and noninvolved glands in periurethral tumors. RESULTS: The gross findings and the microscopic examination of 2 adenocarcinomas, including the cytochemical and immunohistochemical studies, favor an origin from Skene's glands. CONCLUSIONS: The origin from Skene's glands may be established in PSA negative cases. The establishment of this origin in a higher number of urethral carcinomas may have an impact on diagnostic and treatment strategies in the future.

Impact of treadmill gait training with neuromuscular electrical stimulation on the urodynamic profile of patients with high cervical spinal cord injury / Impacto da marcha com estimulação elétrica neuromuscular no perfil urodinâmico em pacientes com lesão raquimedular cervical alta

Objective: To evaluate the impact of gait training with neuromuscular electrical stimulation on urodynamic parameters of patients with neurogenic bladder. Methods: Eight male quadriplegic patients with complete cervical injury level ranging from C4 to C7 comprised the study population. They underwent treadmill gait training with neuromuscular electrical stimulation for six months, only after having their quadriceps and tibialis anterior muscles stimulated for five months in order to support at least 50% of their body weight (pre-gait training). Urodynamic testing was performed before the treadmill gait training and six months after. Results: The mean time after cervical lesion was 74.63 months. The urodynamic parameters before and after neuromuscular training by electrical stimulation did not show significant difference. Conclusion: This study demonstrated that neuromuscular training with electrical stimulation can benefit the urinary tract. This promising minimally invasive requires further and more complete studies to confirm a possible benefit to the low urinary tract.

Objetivo: Avaliar o impacto do treinamento neuromuscular, por estimulação elétrica da marcha, nos parâmetros urodinâmicos de pacientes com bexiga neurogênica. Métodos: A população do estudo compreendeu oito pacientes quadriplégicos do sexo masculino com lesão cervical completa nos níveis C4 a C7. Eles foram submetidos a um treinamento neuromuscular por estimulação elétrica da marcha por seis meses, somente após estimulação dos músculos quadríceps e tibial anterior, por cinco meses, de modo a poder suportar 50% de seu peso corporal (pré-treinamento). Testes urodinâmicos foram feitos antes do treinamento e seis meses depois. Resultados: O tempo médio após a lesão cervical foi de 74,63 meses. Os parâmetros urodinâmicos antes e depois do treinamento neuromuscular por estimulação elétrica da marcha não mostraram diferença significante. Conclusão: Este estudo mostrou que o treinamento neuromuscular com estimulação elétrica pode ser benéfico para o trato urinário. Esse campo, promissor e minimamente invasivo, requer outros estudos mais completos para confirmar um possível benefício no trato urinário inferior.

Impact of treadmill gait training with neuromuscular electrical stimulation on the urodynamic profile of patients with high cervical spinal cord injury.

OBJECTIVE: To evaluate the impact of gait training with neuromuscular electrical stimulation on urodynamic parameters of patients with neurogenic bladder. METHODS: Eight male quadriplegic patients with complete cervical injury level ranging from C4 to C7 comprised the study population. They underwent treadmill gait training with neuromuscular electrical stimulation for six months, only after having their quadriceps and tibialis anterior muscles stimulated for five months in order to support at least 50% of their body weight (pre-gait training). Urodynamic testing was performed before the treadmill gait training and six months after. RESULTS: The mean time after cervical lesion was 74.63 months. The urodynamic parameters before and after neuromuscular training by electrical stimulation did not show significant difference. CONCLUSION: This study demonstrated that neuromuscular training with electrical stimulation can benefit the urinary tract. This promising minimally invasive field requires further and more complete studies to confirm a possible benefit to the low urinary tract.

Triple therapy in refractory detrusor overactivity: a preliminary study.

PURPOSE: To evaluate in a prospective study the impact of the "three-drug therapy" (antimuscarinic, alpha-blocker and tricyclic antidepressants) on the treatment of refractory detrusor overactivity (DO). METHODS: Data from 27 consented patients with refractory DO were available for study. They were asked to complete a daily urinary chart and underwent urodynamic evaluation (UD) before and 60 days after treatment. Response to treatment was considered the presence of one or less involuntary detrusor contractions (IDC) on post-treatment UD. Statistical analysis was performed with Fisher and Mann-Whitney tests, besides Spearman's correlation. P values <0.05 were considered significant. RESULTS: The mean follow-up was 15 months. The comparison of the daily urinary chart before and after treatment showed significant increase on bladder capacity and decreases on urgency, urge-incontinence and frequency. Objective data from UD showed that the mean maximum bladder capacity (MBC) ranged from 200 to 300 mL (P < 0.001) with treatment. The same trend was observed with the other UD variables. When compared to baseline, the questionnaire OAB-v8 showed significant improvement (P < 0.01). Main side effects comprised dry mouth and constipation (40%), with average scores of 5.16 and 3.08, respectively (visual scale from 0 to 10). CONCLUSIONS: Triple therapy may be an effective, easily employed and well-tolerated option to refractory DO treatment. More studies are necessary to achieve more consistent data on the matter.

[Surgical management of retroperitoneal metastatic testicular tumor with inferior vena caval thrombus using cardiopulmonary bypass, arrested circulation, and profound hypothermia: a case report]. / Tratamiento quirúrgico de un tumor testicular retroperitoneal metastásico con trombo en la vena cava inferior mediante derivación cardiopulmonar, paro circulatorio e hipotermia profunda: un caso clínico.

Testicular tumors represent the most common type of solid neoplasia in men aged between 18 and 35 years. Its cure rate is approximately 90% 1,2. In some cases, tumoral vascular invasion can occur and demands surgical resection to stop disease progression and prevent thromboembolic events. That is the only valuable therapeutic choice although it is a high risk procedure. We present a case report of a patient who underwent successful chemotherapy and surgery for a right-sided testicular tumor associated with an inferior vena cava tumor thrombus extending from the renal vein to the right atrium and extensive retroperitoneal lymph node disease.

Tratamiento quirúrgico de un tumor testicular retroperitoneal metastásico con trombo en la vena cava inferior mediante derivación cardiopulmonar, paro circulatorio e hipotermia profunda: un caso clínico / Surgical management of retroperitoneal metastatic testicular tumor with inferior vena caval thrombus using cardiopulmonary bypass, arrested circulation, and profound hypothermia: a case report

Los tumores testiculares son el tipo más frecuente de neoplasia sólida en los varones de 18 a 35 años de edad. Su tasa de curación aproximada es del 90% 1,2. En algunos casos puede producirse invasión vascular del tumor, que exigirá resección quirúrgica para detener la progresión de la enfermedad y prevenir episodios tromboembólicos. La cirugía es la única opción terapéutica válida, aunque el procedimiento entraña un riesgo elevado. Presentamos el caso clínico de un paciente sometido con éxito a quimioterapia y cirugía por un tumor del testículo derecho asociado con un trombo tumoral en la vena cava inferior que se extendía desde la vena renal a la aurícula derecha y linfadenopatía retroperitoneal extensa (AU)

Testicular tumors represent the most common type of solid neoplasia in men aged between 18 and 35 years. Its cure rate is approximately 90% 1,2. In some cases, tumoral vascular invasion can occur and demands surgical ressection to stop disease progression and prevent thromboembolic events. That is the only valuable therapeutic choice although it is a high risk procedure. We present a case report of a patient who underwent successful chemotherapy and surgery for a right-sided testicular tumor associated with an inferior vena cava tumor thrombus extending from the renal vein to the right atrium and extensive retroperitoneal lymph node disease (AU)

Extra-anatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis: report of five patients.

OBJECTIVES: Squamous cell carcinoma (SCC) of the penis with inguinal lymph node involvement aggravates prognosis and can cause femoral artery bleeding, hemorrhagic shock and even death. The objective of this study is to describe the use of extra-anatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis. CASUISTIC AND METHOD: Five patients with SCC and inguinal lymphatic metastasis involving the femoral vessels, who underwent extra-anatomical arterial bypass through obturator foramen between 1999 and 2007, were reviewed. The surgical technique and the postoperative outcome were described. RESULTS: After extra-anatomical transobturator bypass, all patients presented distal pulses. The mean time of surgery was 6 h. In four patients, a knitted Dacron tube was used; and in one, the contralateral devalvulated greater saphenous vein was used. Concomitantly, two patients underwent mass resection and one patient underwent node dissection 2 weeks after bypass. Two patients chose not to undergo inguinal resection, opting for palliative chemotherapy after the vascular procedure. The average follow-up period was 12 months and four patients have died-three due to pulmonary metastasis, and one due to acute myocardial infarct. No prosthetic complication was identified and no patient presented femoral bleeding. CONCLUSIONS: The use of the transobturator bypass can benefit patients presenting with penile SCC and inguinal lymph nodes metastasis involving the femoral vessels, allowing resection of extensive tumor lesions, as well as avoidance of local complications.

Umbilical grafting in treatment of recurrent stomal stenosis.

OBJECTIVES: The continent catheterizable conduit was first described by Mitrofanoff and is a good option for treating patients with urinary incontinence of different etiologies and those unable to perform transurethral self-catheterization. Stomal stenosis is the most common minor complication involved in this procedure and often is not an easily dealt with problem. Stenosis has a tendency to recur, and the surgical approach becomes progressively more difficult because of local fibrosis and retraction. We present our initial experience with a new surgical technique involving umbilical grafting for the treatment of stomal and urethral meatal stenosis. METHODS: Four female patients who presented with either recurrent stomal or urethral meatal stenosis underwent a new surgical approach with umbilical grafting for treatment. We present the results of this new technique. RESULTS: The initial clinical results of this innovative technique, at a median of 4 months of follow-up, showed that all 4 patients remained continent and mostly satisfied with their voiding pattern. CONCLUSIONS: The results of our study have shown that umbilical grafting is a viable option for the treatment of recurrent stomal and urethral stenosis.