[Metastatic adenocarcinoma of the prostate with atypical presentation].
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Biomedical subjects
Publications and source records attributed to A Silmi.
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The penis carcinoma is a neoplasia representing 0.7% of all male neoplasias, with an annual incidence between 1 and 2 cases per 100,000 inhabitants/year. The present study compiles the authors' experience in treating 22 patients presenting this neoplasia in the period between 1977-90. The procedures carried out included local resection, partial amputation, radical penectomy with lymphadenectomy plus radiotherapy, and palliative surgery plus radiotherapy all based on staging made following TNM grading. Therapy complications, follow-up, and survival results are explained. There were 5 occasions of spinocellular carcinoma co-existing with other neoplasias: 1 colon adenocarcinoma, 1 prostate carcinoma, 1 cleaved small cell centrocytic diffuse lymphoma, and 2 skin epithelioma in other sites, and relevant literature was reviewed. A background of psoriasis treated with psoralens plus UV was present in 4 cases, and caution was advised towards genital protection in patients undergoing UV radiations whether for therapeutic, recreational or cosmetic reasons.
The incidence of PGX in our setting is low (0.67%). Middle-aged women comprise most of our cases. This disease process is usually unilateral; 53.2% of the present series had right-sided renal involvement. Over the past 17 years, 135 cases of histopathologically-documented XGP have been recorded at our hospital. Sixty-three cases were studied retrospectively. Patient history, symptoms and signs, and data gleaned from physical examination are presented. Similarly, patient outstanding pathogenetic features are described. Preoperative diagnosis of XGP is difficult. The availability of high resolution imaging techniques has enhanced diagnostic accuracy. Urinary cytology permits preoperative diagnosis with an accuracy rate of 80%. The postoperative prognosis is excellent.
Twenty-four patients with post-prostatectomy urinary incontinence were submitted to clinical and urodynamic evaluation. The clinical evaluation analyzed urinary symptoms and included rectal examination of the prostate lodge, neurourologic examination (perineal sensitivity, anal tone, bulbocavernous reflex, voluntary control of anal sphincter). The urodynamic study consisted of flowmetry, cystomanometry, detrusor pressure/micturition flow test and videocystography. An unstable bladder was demonstrated in 62.5% of the cases. Bladder dysfunction was recognized in 75% of the cases. Involvement of the striated periurethral sphincter was demonstrated in no patient. The clinical data did not provide orientation. No relation was observed between the urodynamic data, type of surgery, and amount of prostate removed. The urodynamic data appear to have a prognostic significance.
We report on 23 consecutive patients with urinary retention following prostatectomy for benign prostatic hypertrophy. The patients were clinically and urodynamically evaluated. Urodynamic work-up included flowmetry, cystomanometry, detrusor pressure-micturition flow test, and videocystography. The involvement of detrusor contractility in urinary retention was observed in 60.87% of the cases and was ascribable to lower urinary tract obstruction in 39.19%. These data permitted instituting correct treatment.
A case of a giant fibrous polyp of the pyelocaliceal system producing hydronephrosis is described. The presentation of the findings in this case as well as brief review of the literature are included.
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A case is reported, the 33rd to be published in the literature, of malignant retroperitoneal xanthogranuloma. The tumor involved 2 cm of the right ureter at the junction between the middle and upper thirds. The middle third of the ureter was removed and ureteral continuity established by end to end ureteral anastomosis. The patient died fourteen months later probably from metastases, though the presence of these was not confirmed.
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A surgical technique is described for the treatment of genuine urinary exercise incontinence (U.E.I.) in the female, consisting in the performance of simplified retropubic colpouretrocerico- pexia which allows to obtain a 89.2% urinary incontinence recovery rate and 97% cystocele reduction (n=40 cases).
Fourteen male and female patients aged 8 to 21 (mean 12.57 years) underwent clinical and urodynamic evaluation. These patients had different lower urinary tract symptoms, and flow changes and increased perineal muscle activity during voiding were demonstrated urodynamically. The urodynamic work up consisted of flowmetry, cystomanometry, detrusor pressure-flow test, videocystourethrography and electromyography of the periurethral sphincter. The urinary symptoms were nocturnal enuresis in 6 cases (42.85%), urinary infection in 6 (42.85%), difficulty in voiding in 4 (28.57%), urgency incontinence in 4 (28.57%), voiding urgency in 2 (14.28%) and diurnal urgency and frequency in 1 case (7.18%). The following 3 voiding bladder behaviour patterns were observed; 1) involuntary micturition from bladder instability (7 cases, 50%), 2) micturition from voluntary bladder contraction (2 cases, 14.28%) and 3) absence of bladder contractile activity with voiding achieved using the abdominal muscles (5 cases, 35.71%). Decompensated voiding was observed in 21% of the overall group. Of these, 75% belonged to the group that used the abdominal muscles to void. Dilatation of the proximal or prostatic urethra was frequently accompanied by bladder instability (57%). The urodynamic data may be useful in determining the outcome of treatment.
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