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Endoscopic treatment of urothelial tumors of renal pelvis and ureter is gaining acceptance as a conservative treatment modality. Technological advances have increased its applicability. Ureteroscopic and percutaneous tumor ablation have become reasonable treatment options for patients with imperative indications, such as bilateral disease, renal insufficiency or solitary kidney. However, endoscopic tumor ablation is being utilized more frequently for patients with UTTCC even in the setting low grade disease and a normal contralateral kidney, provided long-term close surveillance to detect and treat recurrences is ensured. This paper reviews the current role of endoscopic management of UTTCC.
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OBJECTIVES: The objective of this article is to describe the diagnosis of bladder outlet obstruction in women and the treatment of urethral stricture as a cause thereofMETHOD: A bibliographic review was performed in the Medline (PubMed) data base on articles published on the diagnosis of bladder outlet obstruction in women and the treatment of urethral stricture in the 1989-2009 period.RESULTS: The prevalence of obstruction in women varies between 2.7% and 23% in the literature. The gold standard for diagnosis is the videourodynamic study. 78% of obstructions are functional, and only 6.8% are secondary to urethral stricture. Stricture commonly affects the urethral meatus and the distal third of the urethra, the most frequent cause being yatrogenic, secondary to surgery for incontinence, urethral dilations and traumatic catheterisation. The treatment of urethral stricture will depend on the location and length of the stricture, the length of the healthy proximal urethra, bladder neck integrity and the coexistence of incontinence. The repeat failure of non-invasive techniques and the presence of partial or total urethra defects will be subsidiary to urethral reconstruction techniques by means of flaps or grafts, although the technique of choice is still controversial.CONCLUSION: The diagnosis of bladder outlet obstruction in women is limited by the absence of clearly defined urodynamic parameters. Urethral stricture is an infrequent cause of obstruction, the treatment of which may constitute a therapeutic challenge. Early stricture relapse may constitute grounds for considering early surgical reconstruction. Vaginal flaps are the cornerstone of urethral reconstructions. Extensive vulvar scarring may require the use of grafts.
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OBJECTIVES:Large cell neuroendocrine carcinoma (LCNEC) of the urinary bladder is very rare. We intend to update diagnostic criteria, pathologic and immunohistochemical characteristics, prognosis and treatment options.All published articles related with LCNEC of the urinary bladder have been reviewed and a descriptive study has been done.RESULTS: A total of 17 LCNEC of the bladder has been found. The 50% of all LCNEC of the bladder are mixed histological variant. This variant implies a better prognosis than the pure variant. The 70% of LCNEC of the bladder were ≥T3 at the time of diagnosis and the survival rate was 25%, whereas T2 tumors showed a survival rate of 100%. Radical cystectomy with lymphadenectomy combined with chemotherapy can sometimes reduce local and distant recurrence and improve survival of LCNEC of the bladder.CONCLUSIONS: LCNEC of the bladder is a tumor with high rate of local and distant recurrence, as well as low survival, requiring early diagnosis and aggressive combined treatment.
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OBJECTIVES: To report our experience in a series of bilateral synchronous laparoscopic adrenalectomies detailing technique and results.METHODS: A total of 242 laparoscopic adrenalectomies were performed in an 8 year period at our institution. Twenty four out of these were bilateral. Of the 24 patients, 22 (92%) were bilateral and synchronous. Mean patient age was 41.4 years (range 17 to 72 years) and male to female ratio was 1:2.1.RESULTS: Mean adrenal size was 5.5 cm (range 2 to 11 cm). In order of frequency, pathological finding was: pheochromocytoma, cushing`s disease, metastatic lesions, hyperaldosteronism, congenital adrenal hyperplasia, myelolipoma and adrenal adenoma. Complete adrenalectomy was performed in 36 cases (82%) while in 8 cases (18%) partial adrenalectomy was preferred. Mean operative time was 78.6 minutes (range 25 to 210 min) being 79.5 min and 77 min for right and left adrenalectomies respectively. Mean operative bleeding was 63 ml (range 0 to 500 ml). Only one patient received blood transfusion. Intraoperative complications occurred in only one patient (2%), a small tear in the renal vein that was successfully controlled by intracorporeal suturing. Mean hospital stay was 3.2 days (range 2 to 5 days).CONCLUSION: We believe that laparoscopic synchronous bilateral adrenalectomy is a feasible, safe and reproducible technique that should be considered of choice for the management of benign bilateral adrenal pathology.
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OBJECTIVE: Scrotal lymphedema (SL) is a rare clinical pathology with multiple etiologies. We report a case of idiopathic giant scrotal lymphedema and review the existing medical literature in Medline from the last ten years.METHODS: We report the case of a male patient with a giant scrotal lymphedema (43x 40 cm) of unknown etiology developed over four years.RESULTS: The patient was treated by scrotal excision and reconstruction with skin graft plasty, with a successful result.CONCLUSIONS: Scrotal Lymphedema is a rare entity, especially in industrialized countries. If the lymphedema is severe, surgery is the most appropriate therapeutic option, whatever the cause is. Complete resection up to healthy tissue and surgical reconstruction is the choice. Thin skin grafts are necessary for reconstruction when it affects the entire scrotum.
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OBJECTIVE: To describe the clinical and radiological features, and the role of imaging in diagnosis and extension study of testicular lymphoma (TL).METHODS: Testicular and inguinal color Doppler ultrasound, extension-study Multidetector Computed Tomography (MDCT), and Doppler ultrasound and MDCT in an upper extermity metastasis were performed.RESULTS: Case 1: A 65-year-old man with TL 11 years ago, recurrence in the contralateral testis 5 years later, orbital involvement at 8 years and currently recurrence in the arm with ulnar nerve infiltration. Case 2: A 44-year-old man with TL and metastatic inguinal lymphadenopathy. Case 3: An 85 year-old man with TL, retroperitoneal lymph nodes and obstructive uropathy. Histological subtype: B-cell non-Hodgkin´s lymphoma.CONCLUSIONS: TL typically presents as an aggressive disease with contralateral testicular involvement and spreading to regional lymph nodes and non-contiguous extranodal sites. The main radiological techniques are Doppler ultrasound for the study of the primary disease and MDCT in the evaluation of disease extension. Diagnosis is usually obtained after orchiectomy by histological study, and despite the aggressive treatment modalities (surgery associated with radiotherapy or chemotherapy) prognosis remains poor.
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OBJECTIVE: To report one case of intrapyelic loop of a guide wire during double J catheter insertion.METHODS: We report the case of a 24 year-old female, with the diagnosis obstructive uropathy secondary to pelvic tumor who required double J catheter insertion for urinary diversion. A loop of the guide wire was formed during the procedure which was finally solved without aggressive measures.RESULTS: We report the case of a rare complication appeared during urinary catheter insertion procedure, as well as a review of the current literature.CONCLUSION: The use of guide wires and endourological catheters is not free of complications that may require aggressive measures to be solved.
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OBJECTIVE: To review the unusual localizations of metastasic prostate cancer with the contribution of a clinical case of prostatic adenocarcinoma metastasis in the thyroid cartilage.METHODS: 49-year-old-male admitted with history of 48 hour hematuria associated with lumbar pain radiating to the lower extremities and cervical tumour for 3 months.RESULTS: CT scan of the thorax, abdomen and pelvis was performed showing an insufflating lesion on the left thyroid cartilage lamina suggesting chondrosarcoma, a 4 cm tumour on the posterior side of the bladder, and metastases on L4-S1 vertebral bodies and left iliac bone. Cystoscopy revealed an image on the posterior vesical wall suggesting prostatic infiltration by a tumoral process without evidence of urothelial tumors. PSA was 617 ng/ml. Digital rectal examination: Prostate with augmented consistency. Due to these results an ultrasound-guided transrectal prostatic biopsy was performed with the pathological result of Gleason 8 prostatic adenocarcinoma involving boths lobes.Complete androgen blockade with Bicalutamide and Goserelin was started with good response lowering the PSA level down to 29 ng/ml.Regarding the cervical mass suggestive of thyroid chondrosarcoma a left vertical partial laryngectomy was performed with replacement of the thyroid cartilage by septal cartilage. Pathological study of the piece revealed the presence of prostatic adenocarcinoma.CONCLUSION: Metastatic prostate cancer in the thyroid cartilage is exceptional, there being only five cases described in the literature. This fact, linked to the scant frequency of tumours lying in this cartilage and diagnosis by means of radiological suspicion, makes it very difficult to include metastatic prostate cancer in the routine differential diagnosis of cervical masses.
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Case Report
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