Background: Clear cell renal cell carcinoma (ccRCC) is the most common malignant renal neoplasm and exhibits heterogeneous biological behavior. Prognosis is influenced by histopathological factors such as nuclear grade, tumor necrosis, and vascular invasion, even in small tumors. The development of robotic platforms such as the Hugo™ RAS system has expanded the role of nephron-sparing surgery. Case presentation: We report a 42-year-old male with an incidentally detected left renal mass measuring approximately 4 cm, with solid-cystic features with a 5p R.E.N.A.L Score. The patient underwent Hugo™ RAS-assisted partial nephrectomy without intraoperative complications. Histopathological evaluation revealed clear cell renal cell carcinoma, WHO/ISUP grade 3, with 30 % tumor necrosis and vascular invasion, confined to the kidney, with negative surgical margins (pT1a). Immunohistochemical analysis showed positivity for CAIX and negativity for CK7, TFE3, and ALK, supporting the diagnosis. Discussion: Despite its early stage, the presence of tumor necrosis, high nuclear grade, and vascular invasion suggests a potentially aggressive biological behavior. This case highlights the importance of integrating histopathological findings with advances in robotic surgery to achieve accurate prognostic stratification and optimize clinical management.
The male prepuce is the skin that covers and protects the glans. This structure has been underestimated, stigmatized and even ablated for non-medical reasons. The main aim of this review is to summarize existing literature on male prepuce neurobiology and secondary to it, to discuss the potential effect of circumcision and the associated axotomy on neuroplasticity and male urogenital physiology. It was found that the prepuce ontogeny and innervation include prenatal and postnatal development. Since its separation from the glans penis is androgen dependent, the physiological phimosis at birth is resolved during childhood and adolescence. In contrast to the glans penis, the prepuce is innervated by a dense network of corpuscular sensory receptors, specialized nerve endings that are essential for the perception of various tactile sensations, including light touch, pressure, vibration, and stretch. Thus, the foreskin is a specialized sensory tissue, with potential roles in sexual perception and modulation of genital reflexes. Its ablation may induce peripheral and central neural reorganization, but little is known about the neuroplasticity associated with genital nerve axotomy. Preclinical research will allow elucidating the mechanisms and their long-term implications, understanding these aspects is essential for interpreting clinical findings.
Introduction: Giant bladder leiomyomas are rare benign tumors that may clinically and radiologically mimic malignant neoplasms. When large or located near the bladder neck, they are traditionally managed through open or laparoscopic approaches due to concerns regarding incomplete resection and significant bleeding. Case presentation: A 41-year-old man presented with a three-year history of intermittent hematuria. Imaging revealed a 61.6 × 54.9 × 43 mm intravesical mass. Endoscopic thulium laser vaporresection was performed, revealing an approximately 8 × 7 × 7 cm pedunculated tumor occupying 90 % of the bladder lumen and attached to the bladder neck by a broad pedicle. Complete resection was achieved without intraoperative or postoperative complications. Histopathological analysis confirmed bladder leiomyoma (actin and desmin positive; CD117 and S100 negative). No recurrence was observed at six-month follow-up. Conclusion: To our knowledge, reports of giant bladder leiomyomas successfully treated endoscopically with thulium laser are scarce. This case suggests that, in carefully selected patients, endoscopic management may expand traditional treatment boundaries and potentially avoid more invasive surgical approaches.
The identity of gender in transgender people calls for integrated, multidisciplinary care. In Mexico, about 316,192 transgender individuals may require specialized medical attention. Gender-affirming treatment brings together hormonal therapy and surgical options, with the urologist serving as a key member of a coordinated team of specialists. Research supports that this approach is safe and effective when provided by a multidisciplinary group and followed over the long term, improving both physical health and overall quality of life for patients.
Objective: to evaluate the clinical and functional outcomes of single-stage urethroplasty using the Kulkarni technique in patients with panurethral stricture disease treated at a national military referral center between 2020 and 2024. Methods: an observational retrospective study was conducted including male patients with panurethral strictures measuring ≥8 cm who underwent urethroplasty with the Kulkarni technique. Demographic data, comorbidities, etiology, uroflowmetry parameters, quality-of-life scores (EQ-VAS, EQ-5D-3L, IIEF-5, MSHQ-EjD, ICIQ-MLUTS, ICIQ-UI SF), and postoperative complications were analyzed. Continuous variables were summarized using medians and interquartile ranges. Paired differences in quality-of-life scores were assessed using the Wilcoxon test. Recurrence-free survival was evaluated with Kaplan–Meier analysis. Results: eighteen patients were included (median age 62 years). The most frequent etiology was iatrogenic injury (61.1 %), followed by lichen sclerosus and trauma (16.7 % each). The preoperative Qmax was 8 mL/s, increasing to 14.4 mL/s at three months and remaining stable at 12 and 24 months. EQ-VAS scores improved from 70 to 95 points at follow-up (p < 0.001). Sexual-function and urinary-symptom scores demonstrated significant improvement across all instruments. Postoperative complications were infrequent and mild, with no reoperations or infections recorded. Median follow-up was 27 months, and no recurrences were identified, yielding a recurrence-free survival of 100 %. Conclusions: single-stage urethroplasty using the Kulkarni technique demonstrated favorable clinical and functional outcomes in patients with panurethral strictures, with sustained symptom improvement, low complication rates, and no recurrences during follow-up. These findings support its use as an effective and safe reconstructive option for extensive anterior urethral disease.
Introducción: la urolitiasis es una patología caracterizada por el desarrollo de cálculos en las vías urinarias que pueden generar complicaciones graves si no es identificada de forma oportuna. Durante la gestación, la urolitiasis puede causar complicaciones materno-fetales, aumentando el riesgo de preeclampsia y mortalidad intrauterina. En México, los estudios epidemiológicos son pocos; comprender la epidemiología y los patrones de la enfermedad durante el embarazo es crucial para la salud pública y clínica. Objetivo: describir las características clínicas y sociodemográficas de las hospitalizaciones por urolitiasis durante el embarazo en México (2020-2024). Métodos: se realizó un estudio observacional descriptivo de corte transversal y retrospectivo. Se utilizaron los datos de egresos hospitalarios de la Secretaría de Salud entre los años 2020 y 2024. Se calcularon tasas de hospitalización y estadística descriptiva. Resultados: se registraron 126 hospitalizaciones por urolitiasis en embarazadas, Yucatán tuvo la tasa más alta (11.69/1000 nacidos vivos). La mayoría de los casos fueron primigestas jóvenes (media 25.49 años), concentrándose el 47.61 % en el segundo trimestre. Se encontraron diferencias en la proporción de mujeres con obesidad entre las mujeres con urolitiasis y la población en edad fértil. Conclusiones: la urolitiasis gestacional es más común en mujeres jóvenes y primigestas. Los hallazgos ofrecen datos inéditos para desarrollar políticas preventivas regionales y mejorar la atención prenatal, enfatizando el diagnóstico y seguimiento oportunos.
Introduction: erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) are common and often coexisting conditions in older men. Objective: to assess the prevalence and association between ED and LUTS in men from southeastern Mexico. Methods: observational study involving 316 men over 40 years of age during a community health campaign. The IPSS and IIEF-5 questionnaires were applied. Descriptive, comparative, and multivariate logistic regression analyses were performed. Results: the prevalence of ED was 66.8 %, with a mean IIEF-5 score of 17.6 ± 5.7. Moderate-to-severe LUTS were present in 46.2 % of participants. Age (OR: 1.03; 95 % CI: 1.00–1.06; p = 0.027) and smoking (OR: 2.26; 95 % CI: 1.21–4.22; p = 0.010) were identified as independent risk factors for ED. A weak but significant positive correlation was observed between LUTS severity and ED (ρ = 0.12; p = 0.047). Conclusion: the high prevalence and correlation between ED and LUTS support the systematic assessment of sexual function in men with LUTS, particularly in high-risk populations with limited access to specialized care.
Introduction and objectives: renal cell carcinoma (RCC) with tumor extension to the inferior vena cava (IVC) presents an oncological surgical challenge. The aim of this study was to analyze perioperative outcomes, overall survival (OS), and associated prognostic factors in patients undergoing surgery at a tertiary center. Methods: retrospective study of 34 patients diagnosed between 2001 and 2024, all of whom underwent radical nephrectomy and thrombectomy. Preoperative evaluation was performed using computed tomography (CT) and magnetic resonance imaging (MRI). Clinical, surgical, and survival variables were analyzed using descriptive methods and univariate and multivariate Cox regression models. Results: the mean age at diagnosis was 61.9 ± 8.7 years. The thrombus was classified as level I (23.5 %), II (35.3 %), III (26.5 %), and IV (14.7 %) according to Neves and Zincke. Surgery was performed with curative intent in 91.2 % of cases and cytoreductive intent in 8.8 %. Cardiopulmonary bypass was required in 20.6 %. In multivariate analysis, the need for cardiopulmonary bypass (HR = 0.24; 95 % CI: 0.09–0.66; p = 0.005) and lymph node involvement (HR = 0.33; 95 % CI: 0.11–0.96; p = 0.042) were identified as factors associated with a worse prognosis. Conclusions: colorectal cancer with thrombus in the inferior vena cava presents a surgical challenge. Lymph node involvement and the need for cardiopulmonary bypass are associated with lower survival. Adequate preoperative evaluation and multidisciplinary management are essential to optimize oncological and surgical outcomes.
Objective: to compare treatment recommendations from multidisciplinary teams (MDTs) and artificial intelligence (AI) in high- and very high-risk prostate cancer (PCa) with positive surgical margins (PSM) after radical prostatectomy (RP). Design, methodology or approach: we conducted a retrospective proof-of-concept study at a tertiary referral center. Among 700 men who underwent RP between 2010–2024, 76 had PSM, and 14 had documented preoperative MDT discussions. Five patients fulfilled inclusion criteria: high-/very high-risk PCa (per NCCN), confirmed PSM, and both pre- and postoperative MDT evaluations. Clinical and pathological data were entered into ChatGPT-4.0 (OpenAI), primed with NCCN, AUA, and EAU guidelines. The AI was queried in a zero-shot manner for treatment recommendations, and concordance was evaluated using Cohen’s kappa (κ). Results: five patients were included in the final analysis. AI recommendations aligned with MDT decisions in 2 of 5 cases (40 %) both preoperatively and postoperatively. Agreement was minimal for initial therapy (κ = 0.00) and slight for postoperative management (κ = 0.12). Limitations or implications: this pilot study is limited by its small sample size and retrospective design, restricting generalizability. Originality or value: this is the first study to directly compare AI-driven and MDT recommendations in high-risk PCa with PSM in Mexico. Findings or conclusions: AI generated rapid, guideline-based recommendations, but showed limited concordance with MDT decisions in this pilot cohort. AI may support efficiency and guideline adherence as an adjunctive tool; however, this study did not evaluate whether either recommendation strategy leads to superior clinical outcomes.
Background: overactive Bladder Syndrome (OAB) is defined by the International Continence Society as urgency, frequency, and nocturia, with or without urge urinary incontinence (UUI), in the absence of urinary tract infection. In Mexico, a prevalence of OAB has been reported at 19 %. These urinary symptoms can lead to affective disorders; in the United States, the prevalence of anxiety and depression in patients with OAB is 16.9 %. Objective: to determine the prevalence of anxiety and depression and their relationship with overactive bladder. Material and methods: prolective, cross-sectional, analytical study in a tertiary care center. From August 1 to September 30, 2024. Consecutive sampling. 95 adult female patients with OAB were included. Validated Spanish questionnaires were used: the International Consultation on Incontinence Questionnaire for Overactive Bladder (ICIQ-OAB) and the Depression, Anxiety, and Stress Scale-21 (DASS-21). The Excel 2016 database. Association with Fischer´s exact, and SPSS v25® were used. Results: the 70-79 age group presented symptoms in 31.6 %. The most common OAB symptoms were urgency and UUI, with 50.5 % and 47.4 % reporting “sometimes.” Of the total patients, 10.5 % presented depression and 17.9 % anxiety. No significant association was found between OAB symptoms and affective disorders. Conclusions: depression and anxiety are prevalent in women with OAB. Studies with larger samples and control groups are needed to corroborate the associations between OAB symptoms and affective disorders.
Case description: we present the case of a 20-year-old transgender female patient who after completion of multidisciplinary protocol for gender-affirming surgery went through robotic-assisted peritoneal flap vaginoplasty using the Davydov technique. Relevance: gender-affirming surgery has increased its prevalence and a wide variety of procedures have been described with their own advantages and specific complications. The Davydov vaginoplasty provides a minor degree of possible complications because it lacks the use of bowel segments or grafts, with the advantages of reconstruct the neovaginal cavity with a peritoneal flap. Clinical implications: this is the first report of robotic-assisted peritoneal flap vaginoplasty using this technique in Mexico; with a detailed description of the surgical steps and outcomes of our patient. Showing the benefits and feasibility of the procedure adding the proper advantages of the robotic platform. Conclusions: this technique involves a minimally invasive approach for gender-affirming surgery that offers the advantage of not using grafts or bowel segments with excellent functional and aesthetic outcomes. Prospective studies are needed to validate the role of this technique compared to other techniques for vaginoplasty.
Clinical case description: We present the case of a 41-year-old female patient whose condition began prior to admission with weight loss, accompanied by diaphoresis and nighttime fever. Later, she developed pain in the left renal fossa with a torpid evolution and signs of low output. She was subsequently evaluated for hospital evaluation, where resuscitation maneuvers were initiated and complementary studies were performed. These findings revealed the presence of imaging in the renal unit suggestive of a tumor, as well as a collection in the ipsilateral perinephric space suggestive of a hematoma. A surgical approach was decided upon. The histopathological report revealed clear cell renal cell carcinoma.Relevance: Although CRC is the second most common cause of WS, it is only observed in 0.3 % to 1.4 % of patients with this condition. However, due to the incidence of CRC, it is the most common malignant neoplasm. Clinical implications: Mortality associated with Wunderlich syndrome is primarily related to the rapid expansion of the hematoma and the potential for complications such as hypovolemic shock, renal failure, and internal bleeding.Conclusions: WS represents a urological emergency with a broad etiology that requires a rapid diagnostic approach for timely intervention due to the fatal consequences of delayed treatment.
Background: cystoscopy is one of the procedures frequently used in urogynecological consultation, the main disadvantage is the risk of a urinary tract infection (UTI). This research aimed to determine the effectiveness of the use of the prophylactic antibiotic in the prevention of UTIs in patients undergoing cystoscopy. Methods: a prospective, longitudinal, comparative and analytical quasi-experimental study was carried out at the Hospital Civil de Guadalajara Fray Antonio Alcalde, in Guadalajara, Mexico. Patients over 18 years of age who underwent cystoscopy were included and assigned to 3 groups (Group 1: Ciprofloxacin 500 mg PO DU, Group 2: Nitrofurantoin 100 mg PO DU and Group 3: No treatment). A week later, the patients were evaluated with a urine culture. Results: the study included 186 patients undergoing cystoscopy, of whom 63 were administered ciprofloxacin, 62 nitrofurantoin, and 61 were not treated. The average age was 56 years. A significant difference (p = .013) was observed in the reduction of UTIs with nitrofurantoin (RR = .13, 95 % CI .02 to .97) compared to group 2. A difference (p = 0.13) was also observed in the percentage with positive urine culture among patients in the nitrofurantoin 7 group (12.3 %) and no treatment 19 (33 %); (RR = .37, 95 % CI: .17 to .81). Conclusions: the study confirms a significant difference in the prevention of UTIs with the use of nitrofurantoin, which is why this drug is considered useful in post-cystoscopy antimicrobial prophylaxis in the population of the west of the country.
Primary renal neuroendocrine tumors are exceedingly rare neoplasms, with fewer than 100 cases reported in the literature. We report the case of a 45-year-old male with an eight-month history of intermittent gross hematuria. Imaging revealed a large Bosniak 3 renal cyst with inconclusive solid components. Laparoscopic radical nephrectomy was performed uneventfully. Histopathological analysis confirmed a well-differentiated neuroendocrine tumor, grade II, with a Ki-67 index of 15 % and mitotic count of 1/2 mm². The patient remains under active surveillance with no recurrence. This case emphasizes the diagnostic challenges and the role of a multidisciplinary approach in the management of rare renal tumors.
Case description: A 55-year-old man with a history of urinary catheterization due to benign prostatic hyperplasia presented with a corpus cavernosum abscess. The diagnosis was confirmed by FDG-PET/CT. Streptococcus anginosus and Parvimonas micra were isolated in blood cultures. Initial abdominopelvic CT did not clearly define the abscess, but PET/CT revealed intense radiotracer uptake (SUVmax 32.6) throughout the penis, which guided both surgical drainage and targeted antibiotic therapy. Clinical implications: Cavernosal abscesses can present as fever of unknown origin without obvious findings on conventional imaging techniques such as ultrasound or CT. In such cases, advanced imaging methods like PET/CT may be required to localize the infectious focus. The clinical-radiological discordance observed in this case highlights the value of PET/CT in diagnosing deep or atypical infections. Relevance: PET/CT can serve as a key diagnostic tool for identifying infectious foci within the corpus cavernosum that may not be visible with other imaging modalities. Conclusions: Although corpus cavernosum abscess is rare, it should be considered in patients presenting with perineal pain, persistent fever, and a history of urological interventions such as urinary catheterization. This case demonstrates the diagnostic challenges that can arise when conventional imaging fails to identify the source of infection. In this context, FDG-PET/CT proved fundamental for localizing the abscess and guiding appropriate management. The case underscores the importance of advanced imaging and a multidisciplinary approach in the diagnosis and treatment of complex infections.
Background: currently, the state of robotic surgery in Mexico has shown significant growth in both nationwide availability and the number of certified surgeons. Today, more platforms are available, including the addition of Versius and Hugo™ RAS. Clinical case: a 64-year-old male with no significant chronic-degenerative history presented with elevated total prostate-specific antigen (PSA) of 30.20 ng/ml. A transrectal biopsy showed Gleason 6 (3+3). An 18F-PSMA PET-CT showed uptake at the base of the left lobe with SUVmax of 6.3 and in the peripheral zone of the right side at the mid-third with SUVmax of 7.8. There was no evidence of regional lymph node involvement or metastatic disease. A radical prostatectomy assisted by Hugo™ RAS was performed. Relevance & Discussion: we present a case of high-grade localized prostate cancer treated with a radical prostatectomy using a modified Retzius-sparing technique with the Hugo™ RAS robotic platform. This is a case report and technique description. Conclusion: it is feasible to perform minimally invasive techniques using the new robotic platform now available in Mexico for robot-assisted procedures, with comparable outcomes.
Introduction: the Hugo TM RAS (Robotic-Assisted Surgery) system, developed by Medtronic, has emerged as an alternative for robotic surgery, particularly in radical prostatectomy. This review aims to analyze the current evidence about his docking to the patient. Methods: a review of the literature was conducted using PubMed, Scopus, and Web of Science, including studies published up to August 2025. Priority was given to prospective, comparative studies and systematic reviews reporting outcomes of HugoTM RAS-assisted robotic radical prostatectomy. Results: nineteen studies were included. Hugo RAS demonstrated comparable results to the Da Vinci system in terms of operative time, blood loss, functional recovery, and positive surgical margins. Some differences were noted in docking time and the learning curve. Conclusion: HugoTM RAS represents a promising robotic platform for radical prostatectomy in México. We propose schema of docking. Current evidence suggests comparable performance to the established standard, with potential advantages in cost and modularity.
Renal cell carcinoma (RCC) is a significant health burden that is associated with morbidity and mortality. Factors exacerbating the challenges of this condition include late diagnosis, intrinsic resistance to chemotherapy, and the cellular heterogeneity of tumors. In addition, the role of immunity in this condition was suggested by the successful use of immunotherapy in advanced RCC, which requires an understanding of the underlying immunopathological mechanisms involved in the progression of the disease. Moreover, the functional status of infiltrated immune cells and histological tumor subtypes could be used as predictive tools for selecting individualized treatments. This review summarizes the available information on the role of immunity in clinical outcomes and response to treatment in patients diagnosed with RCC.
Introduction: Urolithiasis has a prevalence of 5 to 13 % worldwide, depending on the continent and region. Mexico, particularly the Yucatán Peninsula region, has the highest prevalence, affecting approximately 10 % of the population. Clinical case: A 41-year-old male patient with a 20-year history of neurogenic bladder, treated with transurethral foley catheter changes every 14 days at a health center without follow-up by the urology service, presented with symptoms after being struck by a vehicle. As part of the diagnostic protocol, a non-contrast abdominal and pelvic CT scan was performed, revealing a giant bladder stone. He was scheduled for elective open cystolithotomy surgery, which revealed a stone measuring 21 cm in length x 16 cm in width and weighing 2.460 kg. Conclusions: Urolithiasis is a prevalent pathology in Mexico, especially in the southeastern region of our country. Treatment is based on the size of the stone. In this clinical case, due to the size and characteristics of this case, open cystolithotomy is the treatment of choice.
Clinical case description: an 8-year-old male patient with severe genital trauma with exposure and loss of skin on the scrotum, penis, and lower abdomen, leaving the testes uncovered. At the secondary level of care, the testes were hidden in the inguinal region, and a thin skin graft was placed on the shaft of the penis without cellular tissue, which caused distal penile lymphedema. Our management consisted of an initial orchidopexy, followed by the placement of an abdominal skin expander to obtain skin with adequate lymphatic drainage. Finally, a pedicled full-thickness skin flap was created to cover the penis, achieving a functional and aesthetic result. Relevance: external genital trauma in children is a rare condition, accounting for 0.6 % of cases. Clinical implications: this case demonstrated that a stepwise reconstructive approach with a skin expander and pedicled full-thickness skin flap restored genital function and aesthetics in a complex pediatric genital trauma. Conclusions: initial orchidopexy and the use of a skin expander and a pedicled full-thickness skin flap allowed adequate restoration of lymphatic drainage, obtaining functional and aesthetic results.
