Espermatocele calcificado en paciente con malformación congénita y litiasis renal

OBJETIVOS Paciente varon de 82 anos acudio a consulta por dolor en flanco izquierdo. Los examenes fisico general y abdominal fueron negativos. A nivel inguinoescrotal derecho se constataba la presencia de una voluminosa masa paratesticular, que no transiluminaba, de consistencia dura y firme por encima del testiculo, sin dolor al tacto

Use of cinacalcet in nephrolithiasis associated with normocalcemic or hypercalcemic primary hyperparathyroidism: Results of a prospective randomized pilot study

OBJECTIVES: To evaluate, by means of a prospective randomized study, the efficacy of cinacalcet in the forms of nephrolithiasis associated with primary hyperparathyroidism in both the hypercalcemic and normocalcemic variant. MATERIALS AND METHODS: Ten patients suffering from active nephrolithiasis associated with primary hyperparathyroidism (4 hypercalcemics and 6 normocalcemics), equally divided between males and females, were randomly but not blindly addressed to treatment with potassium citrate and allopurinol, or to the same therapeutic regimen in combination with cinacalcet. The dosage of cinacalcet was optimized for each patient in order to obtain a reduction of parathyroid hormone (PTH) within normal limits while enabling the maintenance of adequate calcemic values. All study participants were given the same diet based on a reduction in sodium intake, oxalate-rich foods and animal protein with standardized intake of calcium and an increase in hydration. After a follow up period of 10 months , cinacalcet was associated to standard therapy and diet in patients who were not taken it, conversely cinacalcet was withdrawn in the remaining patients who remained on standard therapeutic regimen and diet. Follow up was continued for a second period of observation of the same duration of the first. RESULTS: At the end of the period of treatment with cinacalcet, for both variants of hyperparathyroidism, a statistically significant reduction in the overall number and in the diameter of renal stones was found. CONCLUSIONS: This prospective randomized study shows the effectiveness of cinacalcet used in combination with a diet with normalized calcium intake, in reducing the number and size of urinary stones in hypercalemic and normocalcemic forms of primary hyperparathyroidism

Triorchidism: genetic and imaging evaluation in an adult male

We report the results of imaging and cytogenetic studies in a case of tri- orchidism in a 54 years old male without any associated anomaly. A scrotal ultrasonography revealed the presence of two testes within the left hemiscrotum with complete septa- tion and echotexture and vascular flow pattern similar to the vascular flow of the normal right testis. There was no focal abnormal echogenicity suggesting malignancy. Scrotal MRI confirmed two soft-tissue structures in the left hemiscrotum with normal signal intensity at T1w and T2w images. Both testes had a tunica albuginea with low-signal intensity. Cytogenetic analysis resulted in normal male karyotype 46XY. Array-CGH analysis detected the presence of two interstitial rearrangements: a ~120 Kb deletion of chro- mosome 1 and a ~140 Kb deletion of chromosome 16. Currently there are little details on the functions of both genes

Realtime elastosonography of the penis in patients with Peyronie's disease

Objective: To evaluate the performance of real time elastosonography (RTE) in the iden- tification of different types of penile lesions in patients with Peyronie’s disease. Materials and methods: Seventy four consecutive patients with complaints of Peyronie’s disease underwent B-Mode ultrasonography (US) and RTE of the penis in the same sit- ting. In each patient all sequences of elastosonography and B-Mode US were recorded and compared to evaluate the diagnostic performance of the new imaging technique. Results: B-Mode US detected penile plaques in 64 patients (86.41%) and elastosonography con- firmed these data. In the remaining 10 patients elastosonography documented, in five of them, areas of reducing elasticity suggesting the presence of initial fibrosis. Cohen’s K was used to eval- uate the discordances between B-Mode US and Elastosonography scan. A p value 30°, and the penile plaque evalua- tions were completely concordant. Conclusions: RTE is a simple, non invasive, rapid complementary imaging technique that may improve the accuracy of B-Mode US in detecting penile lesions in patients with Peyronie’s disease

Renal extracapsular hypoechoic rim and kidney cortical thickness

Objectives: A renal extracapsular hypoechoic rim was previously recognized and interpreted as a typical sonographic finding of renal failure. Subsequently it was hypothesized that the hypoechoic rim could be produced by a state of sodium retention and oedema caused by nephropathy but not necessarily associated with renal failure. In order to get this cleared we performed a retrospective analysis of 80 renal ultrasound examinations, carried out at our center, in 41 of which it was found a renal extracapsular hypoechoic rim. Materials and methods: For each patient we recorded the glomerular filtration rate, the diameters in the longitudinal axis, the resistive indexes and the cortical thickness of each kidney, the possible presence and thickness of the hypoechoic rim and yet the possible coexistence of diabetes mellitus, proteinuria and clinical signs of fluid overload as peripheral oedema, distended jugular veins, ascites, increased caliber and reduced respiratory excursion of the vena cava. Results: The F value calculated to assess the weight/influence on the hypoechoic rim of each of the variables showed as all variables, except the sex, significantly weighed on the hypoechoic rim although the greatest weight was reached by a glomerular filtration rate < 60 ml/min/1.73 m2 and a renal cortical thickness between 7 and 12 mm. The hypoechoic rim was found only when cortical thickness was between 7 and 12 mm while it was absent if the cortical thickness was less than 7 or greater than 12 mm. We also found numerous cases of sidedness of the hypoechoic rim. Conclusions: It is our opinion that in case of unilateral finding of an hypoechoic rim, the association between the hypoechoic rim and the cortical thinning is consistent and therefore more accurate than the correlation between the presence of the hypoechoic rim and the reduction of the glomerular filtration rate

Impact of body mass index on clinical outcomes in robotic radical prostatectomy

Obesity can make any surgical procedure more challenging and increase the risks of morbidity. The introduction of robot-assisted laparoscopic radical prostatectomy (RALP) can help overcome some of these technical difficulties. RALP in obese patients is feasible procedure with acceptable perioperative outcomes and complications. RALP is an effective approach to prostatectomy in obese patients as perioperative and functional outcomes are almost identical across BMI. This supports the continued utilization of RALP in obese and overweight me