Chromophobe renal cell carcinoma (eosinophilic variant) in bilateral pelvic kidneys: a false-negative diuretic renogram due to bladder overlap
Introduction: Distinguishing renal oncocytoma from eosinophilic variant chromophobe renal cell carcinoma (ChRCC) is challenging in clinical practice, particularly when anatomical variants such as bilateral pelvic kidneys are present, as they may cause artifacts or misinterpretation on diuretic renography. Case presentation: A 52-year-old woman with bilateral ectopic pelvic kidneys presented with a solid mass in the right pelvic kidney. CT angiography revealed a complex vascular pedicle with an accessory renal artery. Preoperative 99mTc-DTPA diuretic renography showed a split renal function of 75% for the right tumor-bearing pelvic kidney and 25% for the left pelvic kidney, without evidence of obstruction. Laparoscopic right radical nephrectomy was performed. Initial histopathology suggested oncocytoma; however, the immunohistochemical profile (CK7+, CD10+, RCC+) supported reclassification as eosinophilic variant ChRCC. One month after surgery, an initial postoperative renogram reported "no visualization" of the left kidney. As the patient was asymptomatic with serum creatinine of 1.5 mg/dL, imaging was reviewed and confirmed a retrovesical pelvic kidney overlapping the bladder in the standard projection. A second renogram in oblique projection with pelvic-centered field showed 72.8% split function, Tmax of 2.0 min and T½ of 13.8 min, without obstruction. eGFR by CKD-EPI 2021 was ~46 mL/min, consistent with CKD stage G3a. Conclusion: This case highlights (1) the crucial role of immunohistochemistry in differentiating eosinophilic ChRCC from oncocytoma; (2) the importance of recognizing bilateral pelvic kidneys to avoid false-negative interpretation of diuretic renography; and (3) the need to adapt renographic technique (oblique projection, pelvic-centered acquisition or SPECT/CT) for accurate functional assessment of a solitary pelvic kidney.
Copyright (c) 2026 Sociedad Dominicana de Urología
Not all scrotal masses are testicular tumors: incidental paratesticular liposarcoma after orchiectomy. A rare case report
Introduction: Paratesticular tumors are uncommon. Treatment is surgical, with local excision recommended for benign masses and radical orchiectomy for malignant tumors. Clinical case: A 65-year-old male presented with a progressive, painless enlargement of the left hemiscrotum over six months. Physical examination revealed a firm scrotal mass. Imaging studies showed a heterogeneous expansile lesion in the left hemiscrotum. A left radical orchiectomy with high ligation of the spermatic cord was performed, and pathological examination reported a well-differentiated paratesticular liposarcoma. Conclusion: Paratesticular liposarcoma is a rare neoplasm that can mimic other scrotal masses. The definitive diagnosis is histopathological, and the treatment of choice is radical surgical resection. Its recognition is essential in the differential diagnosis of scrotal masses.
Severe congenital ventral penile curvature (chordee): staged surgical correction. A case report
Introduction: Congenital ventral penile curvature is an uncommon developmental anomaly, with an estimated prevalence of 4–10% among congenital penile malformations, associated with ventral fibrous tissue or structural alterations of the tunica albuginea (chordee), leading to functional and psychosocial impairment. Case presentation: A 19-year-old male presented with penile deformity since birth. Physical examination revealed a ventral penile curvature of approximately 90° during erection, located at the mid-distal shaft, with orthotopic urethral meatus and hypoplasia of the corpus spongiosum. A three-stage surgical reconstruction was performed. Surgical correction was achieved through a staged reconstructive approach using oral mucosal grafting, with satisfactory correction of the curvature and no significant complications during follow-up. Conclusions: Staged reconstruction represents an effective alternative for severe congenital ventral penile curvature with urethral involvement, allowing favorable functional and aesthetic outcomes.
Relationship between male age and the degree of sperm DNA fragmentation in patients attending an assisted reproduction clinic
Objective: To evaluate the relationship between male age and the degree of sperm DNA fragmentation (SDF) in patients attending an assisted reproduction clinic. Methods: 273 seminal samples were analysed and classified into three age groups: <35 years, 35–41 years, and >41 years. The DNA fragmentation index (%DFI) was determined, and correlation tests (Spearman and Pearson), linear regression, and between-group comparison (Kruskal–Wallis) were applied. Results: a positive and significant correlation was observed between age and %DFI (Spearman p = 0.136, p = 0.0245; Pearson r = 0.210, p = 0.00046). For each additional year of age, the %DFI increased by 0.61 percentage points. The >41 years group had the highest mean fragmentation (24.3%). Conclusion: advanced male age is significantly associated with increased sperm DNA fragmentation. This finding highlights the importance of including fragmentation analysis in the diagnostic evaluation of male fertility.
Use of selective arterial renal embolization in patients with renal masses
Introduction: Selective arterial renal embolization (SARE), as an alternative minimally invasive therapy, is utilized in different pathological conditions. Objective: To describe the results of SARE in renal masses. Material and Method: Descriptive and retrospective study of 36 patients, who underwent 44 SARE, at "Hermanos Ameijeiras" Hospital and the National Center of Minimally Invasive Surgery, 2019-2022. Descriptive statistics was applied. Results: Mean age was 55.3 years, patients with comorbidities (86.11%) prevailed, ECOG 0 (83.33%). The most frequent indications were: palliative in patients with renal carcinoma with contraindication for surgery, or preoperative to diminish intraoperative bleeding (35%, respectively); most were malignant masses (75%), and stage IV patients (51.85%). The embolizing material mostly used was PVA (65.91%). 90.91% of the patients reached total embolization, the expected success was achieved in 88.81% of the patients, it was not associated to indications or tumor size (p>0.05). The post embolization syndrome was the most frequent complication (25%). Conclusions: When utilized, SARE was successful and safe for treating renal masses; usually only one embolization was required. Palliative indication prevailed in cases with RCC, in which surgery was not possible and the total infarction of the mass was achieved in most cases.
Impact of Exogenous Testosterone Therapy on Male Fertility: A Systematic Review of the Evidence
Introduction: Testosterone deficiency is a clinical and biochemical syndrome associated with sexual, metabolic, musculoskeletal, and reproductive alterations. In men of reproductive age, exogenous testosterone administration induces suppression of the hypothalamic–pituitary–gonadal axis through negative feedback, leading to decreased luteinizing hormone (LH) and follicle-stimulating hormone (FSH), reduced intratesticular testosterone levels, and potential impairment of spermatogenesis. Between 2021 and 2026, the literature has provided relevant evidence regarding the clinical effects of testosterone replacement therapy (TRT) and therapeutic alternatives aimed at preserving fertility. Objective: To systematically evaluate the evidence published between January 2021 and February 2026 regarding the clinical benefits of TRT and therapeutic strategies designed to optimize androgen status without compromising reproductive function. Methods: A systematic review was conducted in accordance with PRISMA guidelines. A literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science for the period 2021–2026. Clinical trials, observational studies, systematic reviews, meta-analyses, and international guidelines reporting outcomes related to sexual function, body composition, bone mineral density, mood status, metabolic profile, hormonal parameters, semen parameters, and adverse events were included. Results: In men with biochemically confirmed hypogonadism, TRT is associated with significant improvement in libido, erectile function, lean body mass, bone mineral density, and quality of life. In specific populations, such as Klinefelter syndrome, sickle cell disease, and secondary hypogonadism, clinically relevant benefits have been reported under structured monitoring protocols. Recent evidence does not demonstrate a conclusive increase in prostatic or cardiovascular risk when TRT is appropriately indicated and hematological monitoring is performed. From a reproductive perspective, TRT and the use of anabolic-androgenic steroids are associated with gonadotropin suppression and deterioration of semen parameters; recovery after discontinuation is variable. In men seeking paternity, human chorionic gonadotropin (hCG) alone or combined with FSH, selective estrogen receptor modulators, and, in selected cases, aromatase inhibitors, allow increases in serum testosterone while preserving intratesticular function and improving semen parameters in specific subgroups. Interventions targeting obesity and metabolic comorbidities are associated with partial reversibility of functional hypogonadism and reproductive improvement. Conclusions: Evidence published between 2021 and 2026 supports TRT as an effective treatment for appropriately diagnosed hypogonadism. However, in men of reproductive age, assessment of paternity intentions is essential before initiating androgen therapy. Strategies based on stimulation of the gonadal axis and management of metabolic factors allow optimization of androgen status while preserving the functional integrity of the hypothalamic–pituitary–gonadal axis and spermatogenesis.
Robotic-Assisted Pyelolithotomy for the Management of Complex Kidney Stones: Feasible and Safe Approach
Introduction: Urolithiasis is a common condition in the urological practice. Its surgical management has changed in recent years due to the advent of new technologies1. Given the rise of endourological techniques as a first-line treatment, robotic-assisted pyelolithotomy emerges as a minimally invasive alternative for selected cases of complex renal stone. Case presentation: A 79-year-old male with a known pathological personal history of arterial hypertension and benign prostatic hyperplasia treated with transurethral resection of the bipolar prostate 6 months earlier and a diagnosis of predominantly pyelic partial coralliform lithiasis. A robotic-assisted pyelolithotomy (PAR) was performed using a Da Vinci Xi platform with a transperitoneal approach. Results: The patient had a satisfactory postoperative course. Conclusions: Robotic-assisted pyelolithotomy represents a safe and effective therapeutic option for the management of complex kidney stones, offering advantages in terms of surgical precision, postoperative recovery and functional results1.
Non-traumatic High-Flow Priapism Following Combination Therapy for Lower Urinary Tract Symptoms: Case Report and Literature Review
Introduction: High-flow priapism is an uncommon urological condition, most frequently associated with blunt perineal trauma. Non-traumatic presentations are rare and may pose a diagnostic challenge. Case Presentation: We report the case of a 65-year-old man who developed painless persistent partial penile erection three days in duration after initiating combination therapy with tamsulosin and tadalafil for lower urinary tract symptoms. Cavernosal blood gas analysis and penile Doppler ultrasonography confirmed the diagnosis of high-flow priapism. Conservative management resulted in complete spontaneous resolution within two weeks. Discussion: High-flow priapism accounts for approximately 5–10% of all cases of priapism. Although trauma remains its principal cause, isolated reports have suggested a possible association with phosphodiesterase type-5 inhibitors. Early recognition allows appropriate diagnosis and prevents unnecessary invasive interventions. Conclusions: Clinical evaluation combined with cavernosal blood gas analysis and penile Doppler ultrasound provides accurate diagnosis. Conservative management remains an appropriate initial strategy in clinically stable patients.
Editorial - Despertar la vocación investigadora: un nuevo horizontepara la urología dominicana
La medicina, en su esencia más pura, es una ciencia en constante movimiento. Cada avance en el diagnóstico, en el refinamiento de una técnica quirúrgica y cada nuevo protocolo terapéutico nacen de una pregunta, de una observación clínica y, finalmente, de la rigurosidad de la publicación científica. En el campo de la urología, una especialidad altamente tecnológica y en rápida evolución, la investigación no es un lujo académico, sino un pilar fundamental de la excelencia clínica. Por ello, contribuir al segundo número de la naciente Revista Científica de la Sociedad Dominicana de Urología no es solo un acto protocolar; es el reconocimiento de un hito histórico para la especialidad en la región. Sin embargo, para valorar este logro en su justa dimensión, debemos mirar con honestidad el panorama actual. La producción científica en urología en la República Dominicana ha permanecido, hasta ahora, por debajo de su enorme potencial. Esta "depresión" en la publicación no es un reflejo de la capacidad intelectual de sus profesionales, sino el resultado de la convergencia de desafíos estructurales y culturales. Para dimensionar este desafío, es útil mirar los números con objetividad, pero también con empatía. Un reciente análisis bibliométrico publicado en Actas Urológicas Españolas1, que evaluó la producción científica en urología en Latinoamérica a través de la base de datos Scopus entre los años 2000 y 2021, registró un total de 9 135 artículos, miles de ellos liderados por grandes potencias regionales: Brasil, México, Argentina. Sin embargo, naciones como la República Dominicana, Cuba y la mayoría de los países de Centroamérica ni siquiera logran desglosarse como entidades individuales en los resultados principales. Quedamos agrupados en la categoría de 'Otros', un grupo que apenas concentra el 7,5 % de la producción de toda la región durante más de dos décadas. Esta invisibilidad estadística en bases de datos internacionales no es un simple detalle metodológico, es el síntoma de una realidad ineludible: la rica experiencia clínica dominicana no está llegando a la literatura científica global. Y es precisamente este vacío el que justifica la urgente necesidad de su propia plataforma de publicación. No escribo esto desde la lejanía de quien juzga, sino desde la trinchera de quien comparte una realidad similar. Soy uróloga e investigadora cubana, y conozco de primera mano esta paradoja: podemos tener una sólida tradición médica y una inmensa riqueza de experiencia clínica, pero enfrentamos barreras comunes que asfixian la publicación especializada. La abrumadora carga asistencial, la falta de tiempo protegido para la investigación, la brecha persistente en la formación continua en metodología de la investigación durante y después de la residencia, la percepción de que publicar es un trámite burocrático o un objetivo reservado únicamente para revistas de alto factor de impacto en el extranjero, las limitaciones de financiamiento y las barreras de acceso a las grandes plataformas de indexación internacional crean un muro invisible. El resultado no es una falta de talento o de hallazgos valiosos, sino una invisibilidad bibliométrica que nos condena a ser solo consumidores de resultados y guías diseñadas partiendo de realidades epidemiológicas y económicas muy distintas a la nuestra. ¿Cómo revertiremos esta situación? El cambio requerirá una transformación cultural que debe comenzar desde las sociedades científicas —como lo están haciendo—, los servicios de urología y las residencias. Necesitamos fomentar la mentoría: que los urólogos con experiencia en investigación guíen a los más jóvenes en el proceso de convertir una duda clínica en una pregunta de investigación, y esta, en un artículo científico. Debemos promover la investigación colaborativa y multicéntrica dentro del país y de la región, uniendo fuerzas para obtener muestras más robustas y resultados más representativos. Asimismo, las instituciones deben comenzar a valorar y premiar la publicación no como un mérito accesorio, sino como un componente intrínseco de la promoción y el desarrollo profesional. Es precisamente en este contexto donde la Revista Científica de la Sociedad Dominicana de Urología emerge no solo como una publicación, sino como una herramienta estratégica de transformación. Contar con una revista local ofrece oportunidades invaluables, como pudiera ser: la visualización de la realidad epidemiológica caribeña, pues la urología en la República Dominicana enfrenta retos específicos (desde los patrones de litiasis renal hasta las particularidades del cáncer de próstata en la población afrodescendiente) que las revistas internacionales no siempre priorizan. Esta revista será el custodio de esa data vital. Ofrecerá un campo de entrenamiento seguro porque antes de aspirar a publicar en The Journal of Urology o European Urology, los autores necesitan un espacio para aprender a responder a revisores, a estructurar sus argumentos y a pulir su metodología. Esta revista será ese "gimnasio" intelectual donde se forjarán los futuros grandes autores dominicanos. Así como, la creación de comunidad, es decir, la revista unirá a los dispersos, fomentará el diálogo entre urólogos de diferentes hospitales, regiones y niveles de experiencia, tejiendo una red de conocimiento que fortalecerá a toda la especialidad en el país. Los primeros números de la revista serán mucho más que un conjunto de artículos: serán semillas. Son la prueba tangible de que, a pesar de las dificultades, hay un grupo de profesionales comprometidos con dejar de ser solo consumidores de conocimiento generado en otras latitudes, para convertirse en generadores de conocimiento propio. Como investigadora y colega, extiendo mi más sincera felicitación al cuerpo editorial y en particular a la Dra. Katia García por concretar este sueño, a los revisores y a los autores de estos primeros números, que se han atrevido a correr el riesgo. Invito a todos los urólogos dominicanos a perder el miedo a la página en blanco, a compartir sus hallazgos, sus casos clínicos inusuales y sus resultados. La urología del futuro en la República Dominicana se escribe hoy, y esta revista es el papel en el que comenzaremos a hacerlo. Y me incluyo, porque como colega cubana, extiendo mi mano y mi apoyo incondicional al cuerpo editorial y a cada urólogo dominicano que se anime a escribir. Que estos primeros números sean los primeros ladrillos de un puente que una a la urología del Caribe y Centroamérica, demostrando que, aunque los recursos sean limitados, nuestra voluntad de generar conocimiento propio es ilimitada. Agradezco la oportunidad brindada por el Dr. Wilton Cabrera Cruz, presidente de la Sociedad Dominicana de Urología, al invitarme a escribir este editorial.
Estimados colegas y lectores: En nuestro compromiso ineludible con la excelencia médica y la salud del pueblo dominicano, presentamos esta nueva edición de la Revista Científica de la Sociedad Dominicana de Urología (SDU). La especialidad ha transitado por un camino de transformación acelerada; sin embargo, la prevalencia de patologías urológicas en nuestro medio exige una respuesta que no solo sea tecnológicamente avanzada, sino también humana y accesible. En este número, se refleja la madurez científica de nuestra comunidad a través de artículos que abarcan desde la oncología hasta la cirugía reconstructiva y la andrología. Se destacan temas cruciales como el carcinoma renal cromófobo y el liposarcoma paratesticular incidental, así como la aplicación de tecnología de punta en la pielolitotomía asistida por robot. Asimismo, se abordan dilemas contemporáneos en salud reproductiva y masculina, tales como la fragmentación del ADN espermático, la relación entre terapia con testosterona y fertilidad, el tratamiento del priapismo y la curvatura peneana ventral congénita. Estos temas no son solo títulos académicos; son el reflejo de los desafíos diarios en nuestros quirófanos y consultas. Como Sociedad, nos reafirmamos en la necesidad de mantener la actualización continua como pilar fundamental de la práctica cotidiana. Exhorto a cada miembro de nuestra comunidad científica a ver esta revista no solo como un medio de lectura, sino como una plataforma de diálogo. Invitamos a todos a divulgar sus investigaciones y casos clínicos, pues la colaboración es el motor que afianza la profesionalidad de los urólogos y otras especialistas afines y, por ende, el bienestar de los pacientes. Agradecemos profundamente a los autores, revisores y al equipo editorial por su rigor y dedicación. Sigamos construyendo, juntos, el futuro de la urología en la República Dominicana. Atentamente, Wilton Cabrera Presidente Sociedad Dominicana de Urología
Renal tumors in horseshoe kidneys: planning tips and laparoscopic approach
Introduction: Horseshoe kidney (HK) is a rare congenital renal anomaly characterized by the fusion of both kidneys along the midline. This article reviews diagnostic strategies and current therapeutic options for renal tumors in HK, highlighting anatomical particularities and advances in surgical management. Materials and Methods: Three male patients (aged 51, 65, and 72 years), all diagnosed with horseshoe kidney and localized renal tumor, were included. In all three cases, computed tomography with 3D reconstruction was performed for anatomical assessment and surgical planning. Laparoscopic partial nephrectomy with selective arterial clamping was carried out, recording surgical times, blood loss, warm ischemia time, and postoperative course. All cases were managed at a single center, the Hospital Alemán in Buenos Aires Results: Tumor sizes ranged from 4 to 7.4 cm (RENAL Score between 4 and 9). Surgical time varied between 180 and 250 minutes, and warm ischemia time between 42 and 50 minutes. Intraoperative blood loss ranged from 300 to 600 ml. Negative margins were achieved in all cases. Two patients had no complications or recurrence during follow-up. One patient (pT1b, G2) developed recurrence at 13 months. Conclusion: The laparoscopic approach has gained prominence in recent years due to its advantages of less invasiveness and faster recovery, achieving greater nephron preservation in complex cases determined by anatomical alterations. However, the choice of surgical approach should be individualized, considering the anatomical characteristics of the horseshoe kidney and the clinical conditions of the patient.
Copyright (c) 2025 Sociedad Dominicana de Urología
A case report: differences between balloons in recurrent urethral stricture. Literature review
Introduction: Recurrent urethral stricture remains a therapeutic challenge due to high restenosis rates after internal urethrotomy. Conventional high-pres- sure balloons provide transient mechanical dilation, whereas paclitaxel-coated balloons combine mecha- nical expansion with an antiproliferative effect that limits fibrosis and recurrence. This case highlights the comparative outcomes of both modalities. Case presentation: A 32-year-old male with prior urethrotomy and a 0.6 cm bulbar stricture underwent cold-knife urethrotomy followed by paclitaxel-coated balloon dilation (10×60 mm). At 12 weeks, he showed marked improvement in urinary flow (Qmax 29 mL/s vs. 7 mL/s pre-op;+314%), reduced IPSS (35 to 6), and lower post-void residual (43% to 12%). Discussion: Conventional balloons achieve immediate relief but show recurrence rates exceeding 40–60% at one year. Paclitaxel-coated devices demonstrated superior outcomes in ROBUST I–III trials, with 70–75% anatomic success, >60% IPSS reduction, and significantly fewer reinterventions. Unlike conventional dilation, drug- coated balloons modulate wound healing by inhibiting fibroblast proliferation, resulting in prolonged urethral patency with comparable safety. Conclusions: Paclitaxel-coated balloons represent a therapeutic advancement over standard dilation, provi- ding mechanical and pharmacological benefits that translate into improved long-term outcomes. Despite higher cost and limited availability, their incorporation into reconstructive urology algorithms appears justified, pending further multicenter confirmation.
Laparoscopic Racical Cystectomy + Orthotopic Neobladder
Introduction: Bladder cancer is the 7th most common cancer in men and the 10th in both genders, represen- ting 3.3% of all tumors most frequently seen over the age of 50. Tobacco is the most important risk factor for this pathology, presenting itself as the main factor in 50% of cases, increasing according to the intensity with which it is consumed and the duration of use, even being associated with passive smokers. Case: Female patient with no known morbid or pathological history with recurrence of bladder tumor on more than four occasions in two years without response to conservative therapy with TUR, BCG and mitomycin. Histopathological reports show high-grade papillary urothelial tumor. Recurrence of multiple tumors larger than 3 cm. Conclusion: In patients with bladder cancer, laparoscopic cystectomy with neobladder does not affect the prognosis of the cancer, facilitating almost normal urination and thus improving the quality of life and selfimage of patients.
Malignant adrenocortical oncocytoma: Diagnostic insights from an incidental finding. A case report
Introduction: Malignant adrenocortical oncocytoma is an extremely rare neoplasm, accounting for less than 1% of primary adrenal gland tumors. Its diagnosis requires detailed histopathological evaluation using the Lin-Weiss-Bisceglia criteria and the Helsinki score, which determine the tumor’s biological behavior and prognosis. Case Presentation: A 44-year-old male with no relevant medical history presented with an incidentally discovered right adrenal mass. Hormonal and metabolic studies were normal. After two years of follow-up, the lesion increased in size to 7.5 × 6 cm, and a right lapa- roscopic suprarenalectomy was performed without complications. Results: Histological analysis revealed an oncocytic proliferation with focal necrosis and more than 25 mitoses per 10 high-power fields, fulfilling Lin-Weiss-Bisceglia major criteria and achieving a Helsinki score of 8, confirming malignancy. Discussion: The combined application of the Lin-Weiss-Bisceglia and Helsinki systems improves diagnostic and prognostic accuracy in rare adrenocortical tumors. This case highlights the importance of an updated histological evaluation and long-term radiological follow-up in lesions initially considered benign. Conclusions: This case emphasizes the clinical and diagnostic significance of malignant adrenocortical oncocytoma as a rare but potentially aggressive entity. Early detection, accurate histologic classification, and the use of modern prognostic systems are essential to optimize surgical management and improve long-term outcomes.
Laparoscopic Living Donor Nephrectomy for Kidney Transplantation during the period January 2017–January 2025 at the General Hospital of the Plaza de la Salud, Distrito Nacional, Dominican Republic
Introduction: Kidney transplantation is the treatment of choice for end-stage renal disease, improving quality of life and reducing costs compared to chronic dialysis. Given the increasing demand for organs and the limitations of cadaveric transplantation, laparoscopic living donor nephrectomy has emerged as a safe and effective alternative. Methods: A retrospective descriptive study was con- ducted of living donors who underwent laparoscopic nephrectomy during the period January 2017–January 2025 at the General Hospital of the Plaza de la Salud. Demographic variables, surgical findings, intra- and postoperative complications, as well as the evolution of renal function in these patients were evaluated. Results: A total of 167 donors were included, of whom 66.47% were women. The predominant age group was 50–59 years (26.95%). Most nephrectomies were performed on the left side (84.43%). Of the donors, 79.64% presented no anatomical anomalies, while 7.78% presented a polar artery in the extracted kidney. The majority of these patients (98.20%) did not present intraoperative complications. Postoperative complications were mostly mild (Clavien-Dindo I: 28.74%). Postoperative creatinine remained between 1–2 mg/dL in 68.86% of cases, with increases >2 mg/dL in only 2.99%, mainly in patients over 50 years of age (p=0.021). Blood pressure >120/80 mmHg was observed in 19.8% of cases, also associated with age >50 years (p=0.007). Hospital stay was 1–2 days in 79.64% of cases. Conclusions: Laparoscopic living donor nephrectomy at the General Hospital of the Plaza de la Salud is a safe and effective technique, with a low incidence of complications and adequate preservation of renal function in donors. The identification of risk factors related to advanced age reinforces the need for long-term follow-up. These results support the expansion of the program and the creation of systematic registries to optimize clinical decision-making.
Penile metastasis from prostate cancer: systemic management vs. focal radiotherapy. The clinical (and Twitter) dilemma
Introduction: Penile metastasis from prostate cancer is an extremely rare finding (estimated incidence < 0.3 %). Diagnosis usually occurs in advanced stages; however, PSMA-PET imaging has enabled the early detection of atypical and asymptomatic recurrences. Case report: A 60-year-old man, diagnosed in 2013 with prostate adenocarcinoma, initially treated with external beam radiotherapy. During follow-up, he developed biochemical recurrence with a PSA of 1.04 ng/mL. In 2023, an 18F-PSMA PET/CT revealed a 1.1 cm nodular lesion at the right penile base (SUVmax 3.47), consistent with early metastasis. Exclusive systemic therapy with leuprolide acetate and enzalutamide was initiated, achieving a sustained PSA decrease to 0.12 ng/mL and complete resolution of pathological uptake on PET-PSMA in 2024. Conclusion: This case highlights the role of PSMA-PET in the early detection of atypical metastases and demons- trates that exclusive systemic therapy can achieve complete metabolic response in selected patients with oligometastatic, low-volume disease.
Unusual Cystic Mass Involving the Urethral Meatus and Glans: Case report of a rare condition in a young patient
Introduction: Cystic lesions of the glans are rare and may mimic neoplastic or infectious processes, making diagnosis challenging. Objective: To report a case of benign cystic lesion of the glans extending into the urethral meatus, emphasizing the role of surgical excision. Materials and Methods: A 25-year-old male presented with an 18-month history of a painless, progressive glans mass. Examination revealed a 1-cm cystic lesion partially obstructing the urethral meatus. Urethrocystography was normal, and STI panel (PCR) was negative. Complete excision was performed. Results: Histopathology confirmed a dermoid cyst. Postoperative course was favorable, with preserved urethral anatomy and function. At 12 months, the patient remained asymptomatic and without recurrence. Conclusions: Dermoid cysts of the glans are uncommon. Surgical excision ensures definitive diagnosis, effective treatment, and favorable outcomes.
Primary squamous cell carcinoma of the kidney: a case report
Introduction: Primary renal squamous cell carcinoma (RSCC) is a rare entity. It represents less than 1% of all kidney tumors. Frequently, it is related to chronic inflammatory processes of the renal urothelium, which condition a secondary metaplasia, with renal lithiasis being one of the most important risk factors. Its symptomatology is vague and not very specific, the diagnosis late, and with it, a reserved prognosis. Clinical case: We report the case of a 59-year-old male patient, history of repeated urinary tract infec- tions, not renal lithiasis, who reports diffuse pain of moderate intensity in the left lumbar region, associated with macroscopic hematuria, fever and involuntary weight loss. Imaging studies revealed large left renal mass and heterogeneity. Open left radical nephrectomy is performed, with a histopathological report that confirms the diagnosis. Conclusion: Primary squamous cell carcinoma of the kidney presents with nonspecific clinical manifestations and inconclusive imaging findings that delay the initiation of treatment. It should be suspected in patients with a long-standing history of kidney stones or any inflammatory condition associated with a complex renal mass. Diagnosis is histopathological. Nephrectomy is the primary therapeutic option in the early stages of the disease.
Radical nephroureterectomy with laparoscopic vesicalRoux-en-Y in high-grade urothelial carcinoma of distal ureter.Case presentation and literature review
Introduction: Upper urinary tract urothelial carcinoma (UTUC) is an uncommon but potentially aggressive entity, whose standard treatment is radical nephroureterectomy with excision of the vesical cuff. The laparoscopic approach has gained prominence due to its benefits associated with minimal invasion. Clinical case: We present a 75-year-old male patient with a history of hypertension, diabetes, and chronic smoking, who came in with persistent left renal colic and gross hematuria. Imaging studies revealed an obstructive mass in the distal left ureter with severe hydronephrosis. The endoscopic biopsy was compatible with high-grade papillary urothelial neoplasm. Complete clinical staging was performed (T1N0M0) and a two-stage laparoscopic radical nephroureterectomy was carried out, including complete resection of the bladder cuff. The procedure lasted 105 minutes, with minimal blood loss and no complications. Conclusion: Laparoscopic radical nephroureterectomy with excision of the vesical cuff is a safe, reproducible, and effective option in the management of localized UTUC, as long as the surgical oncological principles are respected.
Analysis of renal calculi by infrared spectrometry: experience at the advanced urology Unit URONET in the Dominican Republic
Introduction: Urolithiasis is a common condition with an increasing incidence in Latin America. Infrared spectrometry (IR) is considered the reference method for renal stone characterization, enabling precise identifi- cation of their chemical composition. Objective: To determine the chemical composition of kidney stones using infrared spectrometry in surgically treated patients in the Dominican Republic. Methods: A descriptive, retrospective study was conducted between January 2023 and June 2024, including 23 patients (14 females, 9 males; mean age 49.5 years). Stones collected during surgery were analyzed by Fourier-transform infrared spectrometry (FTIR). Results: Calcium oxalate monohydrate was the most frequent component (69.6%), followed by struvite (39.1%), carbonate apatite (30.4%), and cystine (17.4%). A female predominance was observed (60.9%). Conclusion: IR spectrometry confirmed a high prevalence of calcium oxalate stones and a considerable proportion of infectious stones (struvite) in the Dominican population. These findings underscore the importance of compositional analysis for the prevention and personalized management of urolithiasis.
“En block” treatment of the vascular pedicle in laparoscopic nephrectomy
Introduction: Nephrectomy is one of the most stressful procedures for urological surgeons due to the need for adequate release of the renal pedicle, making this step particularly important. Objective: To describe this working group’s experience using en bloc ligation of the renal vascular pedicle during laparoscopic nephrectomy. Methods: A cross-sectional study was conducted on 25 patients treated at the “Francisco Moscoso Puello” Teaching Hospital and the Center for Advanced Medicine and Telemedicine (CEDIMAT). These patients underwent nephrectomy via a transperitoneal laparoscopic approach, and the vascular pedicle was treated en bloc using a linear vascular stapler. The laparoscopic nephrectomy was performed by the same surgeon in each case. Results: The mean age was 55.6 years; 80% patients were between 31 and 60 years old. Females predominated (76%), and loss of renal function due to urinary stones was the most frequent cause of nephrectomy (72%). There was no need for conversion to open surgery, and no complications occurred. The average hospital stay was two days. No arteriovenous fistulas were clinically observed postoperatively. Conclusions: The use of a linear vascular stapler by this working group in laparoscopic nephrectomy for loss of renal function, for en bloc control of the vascular pedicle, was possible without the need for conversion to open surgery and complications.
Queridos colegas y lectores: La historia de la Urología en la República Dominicana reconoce numerosos nombres ilustres como los de Francisco Henríquez y Carvajal, Pedro de Marchena y Arturo Grullón, en los albores del siglo xx. Asimismo, considera al doctor Abel González Massenet como pionero en la práctica de la Urología dominicana. Otros afamados urólogos, como los doctores Franz Miniño Marion-Landais y Manuel Morillo Pichardo, consolidaron los cimientos sobre los que se erige nuestra especialidad. La Sociedad Dominicana de Urología (SDU) fue fundada el 17 de julio de 1957 por un grupo visionario de urólogos, entre ellos el Dr. Francisco González Cruz (1957-1958), su primer presidente. Durante más de seis décadas, la SDU ha contado con 27 presidentes, tres de los cuales han tenido el honor de servir en dos gestiones, consolidando una tradición de liderazgo, ética y compromiso con el progreso de la Urología nacional. Durante el último año hemos tenido el privilegio de ocupar la presidencia de esta honorable institución. En el marco de esta gestión, una de nuestras principales misiones ha sido elevar el nivel científico y promover la actualización constante de nuestra membresía. Se desarrollaron Simposios de Cirugía en Vivo en cada una de las filiales, abordando temas como salud sexual y reproductiva, laparoscopia y enucleación prostática, urodinamia y urología funcional, así como actividades de impacto social, con orientación comunitaria y toma de muestras de PSA para la detección temprana del cáncer de próstata. En igual sentido, se impulsó la formación práctica mediante pelvitrainers en laparoscopía prostática y renal, como fortalecimiento de las destrezas quirúrgicas de nuestros urólogos. Estas iniciativas motivaron a colegas jóvenes a gestionar rotaciones internacionales, ampliando las posibilidades de incorporar estas técnicas a la práctica nacional. En el ámbito académico, se gestionó el patrocinio de 33 urólogos para participar en el ‘Curso de Uroncología’ impartido por la Sociedad Argentina de Urología, fortaleciendo de esta manera la capacitación en esta área del conocimiento. De igual modo, la alianza con la ONG “Sanar una Nación” permitió la toma de 10 000 muestras de PSA en todo el país, facilitando biopsias prostáticas sin copago para los pacientes que calificaron, en una jornada de prevención sin precedentes en favor de la salud masculina dominicana. Durante nuestro próximo Congreso Nacional, se celebrará por primera vez el “ Bowl de Residentes”, donde cinco escuelas de Urología nacionales competirán en un ambiente académico dinámico, promoviendo el estudio, la sana competencia y la excelencia entre los urólogos en formación. Además, se formalizó una alianza institucional con el Instituto Tecnológico de Santo Domingo, INTEC, que avala todas las actividades académicas de la Sociedad. Este respaldo otorga valor universitario y reconocimiento académico a cada curso, simposio y jornada desarrollada, fortaleciendo la recertificación del urólogo dominicano y reafirmando nuestro compromiso con la educación médica continua y la excelencia profesional. Como fruto de esta madurez institucional, y colofón de esta gestión, surge el proyecto de crear una revista científica como espacio de difusión, intercambio académico y crecimiento profesional. Una plataforma destinada a visibilizar el trabajo de los investigadores y residentes nacionales, y a proyectar el conocimiento urológico dominicano al mundo. En esta primera edición, abordamos áreas de gran relevancia clínica y quirúrgica que reflejan la diversidad y el avance de la práctica urológica nacional. Los temas comprenden desde el manejo oncológico —con aportes sobre cáncer de vejiga y tumores renales de presentación infrecuente— hasta la urología reconstructiva y mínimamente invasiva, destacando experiencias en cistectomía radical con neovejiga ortotópica por vía laparoscópica, cirugía robótica en litiasis renal compleja y el tratamiento en bloque del pedículo vascular en nefrectomía laparoscópica. También se incluyen reportes de casos singulares que enriquecen el acervo científico, reafirmando la calidad y la capacidad investigativa de los urólogos dominicanos Con gran entusiasmo y profundo sentido de compromiso, presento ante ustedes la primera edición de la Revista Científica de la Sociedad Dominicana de Urología, SDU. Este proyecto marca un nuevo hito histórico para nuestra institución, que eleva un peldaño más su nivel académico. Este no es el final del camino, sino el inicio de un recorrido que hoy emprendemos con este primer número. Un trayecto que demandará tiempo, preparación, recursos y esfuerzos conjuntos para convertir esta revista en un referente de la Urología regional. Agradezco a cada miembro de la Sociedad, a los revisores, autores y colaboradores que han hecho posible este logro. Avancemos fortaleciendo la ciencia, la docencia y el compromiso social que caracterizan a esta Sociedad. “La historia de la urología dominicana se escribe con trabajo, ciencia y compromiso. Hoy abrimos un capítulo que honra nuestro legado y proyecta con fuerza el futuro que estamos construyendo”.