J. Salvador

Prostatic Abscess: Diagnosis and Treatment

We present a series of 25 men with prostatic abscesses studied during an 11-year interval in whom prostatic fluctuation upon digital rectal examination was the most characteristic sign. Transrectal ultrasound was the most reliable method for diagnosis and transurethral drainage under antibiotic coverage was the ideal treatment for this disease.

Ultrasound-guided needle aspiration in prostatic abscess

OBJECTIVES To review the clinical presentation of prostatic abscess and to assess the usefulness of ultrasound-guided needle aspiration as a treatment option for this condition. METHODS Between October 1984 and November 1997, prostatic abscess was diagnosed in 31 patients. The average age was 60 years (range 29 to 79). Prostate ultrasound was performed using either a hypogastric or transrectal approach. Initial therapy included ultrasound-guided needle aspiration in 24 (77.4%), transurethral resection of prostate (TURP) in 5 (16.1%), or conservative management with antibiotic therapy. During follow-up, ultrasound examinations and urine cultures were performed on an outpatient basis. RESULTS Past medical history most often included previous urinary infection (15 patients, 48%) and bladder outlet obstruction (13 patients, 42%). Sixty-one percent of patients presented with irritative voiding symptoms at the time of diagnosis. Ultrasound-guided needle aspiration resolved 83.3% of cases; 2 patients needed a second procedure. Three patients required TURP for drainage and 2 to remove an obstruction after abscess resolution. CONCLUSIONS A high degree of suspicion is needed to diagnose prostatic abscess clinically. Transrectal ultrasound is necessary for the differential diagnosis. Transrectal ultrasound-guided needle aspiration is a technically simple and effective therapeutic procedure with no morbidity and, in case of failure, may be repeated or a drainage TURP may be undertaken.

Laparoscopic Kidney Transplantation

We present the details of the first laparoscopic transplantation of a kidney from a living, related donor, performed April 16, 2009. Surgical and functional results were acceptable. Surgical time was 240 min (53 min for vascular suture), with blood loss of 300 cm(3) and a hospital stay of 14 d. Serum creatinine at discharge was 73 mmol/l. Laparoscopic kidney transplantation is a complex technique that requires previous experience in vascular and laparoscopic surgery. As with all novel procedures, technical modifications will be required to formalize its use and detailed comparisons will need to be made with standard procedures.

Management of Urethral Recurrence in Patients with Studer Ileal Neobladder

OBJECTIVE The overall risk of urethral recurrence (UR) of transitional cell carcinoma (TCC) in patients with orthotopic neobladder ranges from 2% to 6%. We are presenting herein our experience in order to evaluate and define the management of these patients, since the cases with urethral recurrence in patients with orthotopic neobladder are very scarce. MATERIALS AND METHODS Five hundred and sixteen radical cystectomies due to TCC were performed at our Centre between January 1990 and February 1998. One hundred and thirty-eight of them (26.7%) underwent an orthotopic neobladder procedure with the Studers technique. We are reviewing five cases of UR in patients with orthotopic neobladder, the cystectomy indications and the differences between the clinical and the pathologic stages. We are also assessing its clinical presentation, diagnosis, treatment and evolution. RESULTS Five patients (3.6%) from 50 to 71 years old with Studers orthotopic neobladder presented with UR. All of those neobladders were initially superficial TCC, mostly multifocal, and all had failed the endovesical treatment. Endoscopic treatment was administered in two cases with superficial UR. One patient with urethral CIS received intraurethral BCG instillations. One case because of multiplicity, and another due to the presence of an infiltrating urethral tumour, underwent urethrectomy and neobladder exeresis. In both cases, the intact 15-20cm isoperistaltic proximal ileal limb of the Studer-type orthotopic neobladder was used as an ileal conduit. CONCLUSIONS UR in patients with orthotopic bladder substitution is unusual. A conservative approach is possible when dealing with superficial recurrences. In cases of urethrectomy, the isoperistaltic proximal ileal limb of the Studer neobladder may be used as an ileal conduit.

Trisomy 7 may be a primary change in non-invasive transitional cell carcinoma of the bladder

We describe two cases of transitional cell carcinoma of the bladder associated with trisomy 7. In one of them, trisomy 7 was the only chromosome abnormality observed. In the second case, trisomy 7 was found in 25 (80.6%) of the metaphases; in two of them this was the only anomaly, while in three metaphases trisomy 8 was also present, and in other two trisomy 10 was also observed. Our results suggest that trisomy 7 could be a primary change in TCC, and a review of the literature indicates that when it is present as the sole karyotypic abnormality is may be associated with a non-invasive behavior of the tumor.

Cytogenetic characterization of a familial papillary renal cell carcinoma

We describe the first case of a familial renal cell carcinoma cytogenetically characterized as a papillary renal cell carcinoma. Cytogenetic and molecular studies were performed on primary renal cell carcinomas and normal kidney tissue from two members of the same family. Both patients showed a normal constitutional karyotype. The two tumors analyzed from the first patient showed the numerical chromosome alterations characteristic of papillary renal cell carcinomas. From the four tumors analyzed in the second patient, three of them presented the cytogenetic pattern of papillary renal cell tumors, and the fourth showed only structural chromosome abnormalities with the presence of a del(7)t(7;7) or dup(7) in all metaphases analyzed. Chromosome 3 was cytogenetically unaffected in all tumors from both patients, and restriction fragment length polymorphism analysis performed with probe pEFD145 (3p21.1-p23) did not detect any loss of heterozygosity.

Follow-up of the remaining bladder after supravesical urinary diversion

OBJECTIVES To review our experience in 14 patients who underwent supravesical urinary diversion maintaining their defunctionalized bladder in situ. METHODS A variety of pathological entities indicated surgery, including neurogenic bladder, urinary tuberculosis (with severely contracted bladder), interstitial cystitis, and retroperitoneal fibrosis. RESULTS Global analysis revealed a total of 11 patients (78.5%) who presented complications, the most frequent being mucopurulent and bloody secretions (28.5%), and painful bladder spasms (14.2%), followed by hemorrhage, pyocystis, hypogastric or urethral pain, and sepsis. CONCLUSION Two patients (14.2%) required hospitalization for treatment of complications. The majority of complications were treated successfully with bladder irrigations and antibiotics. One patient required total cystectomy secondary to pyocystis.

BLADDER PERFORATION CAUSED BY FOREIGN BODY MIGRATION

Lower urinary tract symptoms is a well known presentation of the presence of foreign bodies inside the bladder. Most such cases are diagnosed by chance, while investigating unrelated conditions. We present the transvesical endoscopic extraction of a surgical sponge that migrated to the bladder six years after an inguinal hernioplasty.

Prostatic abscess due to Candida with no systemic manifestations.

Prostatic abscess due to fungi is a rare condition. It is generally secondary to systemic disease in immunosuppressed patients. It usually occurs with affection of other organs in a septic patient. Only in exceptional cases does it occur isolatedly. We present the case of a prostatic abscess due to Candida albicans with no systemic manifestations. The diagnosis is helped by transrectal ultrasound, which allows to differentiate this condition from nonabscessed acute prostatitis. The treatment of choice is ultrasound-guided transrectal needle aspiration after antibiotic therapy has been started. As with abscesses of bacterial origin, an ultrasonographic follow-up is required due to the possibility of persistence or recurrence.

Prevesical and inguinal abscess following intravesical BCG instillation.

Many complications have been described, both local and systemic, with intravesical BCG in the treatment and prophylaxis of superficial bladder carcinoma. The case discussed herein is a pelvic and inguinal abscess after BCG instillation for high-grade superficial bladder cancer.