OBJECTIVE: To report our experience with clinical presentation, appearance, diagnosis and treatment of Xanthogranulomaous pyelonephritis (XP).METHODS: Multicenter, observational, descriptive and retrosprospective study carried out during six years.RESULTS: We studied 10 patients, 8 women and 2 males, with an average age of 50 years. All cases presented with lumbar and abdominal pain, loss of weight, conjuntival pallor, renal lithiasis and chronic evolution. Fever and palpable abdominal mass, were present in 80% of cases and 60% presented history of urinarytract infection. Initial diagnosis, in most cases, waspyonephrosis. Two cases (20 %) were associated with cancer and other 2 (20%) with Psoriasis. Mortality was of 10%.Laboratory hallmark were anemia, high SGV rate and leukocytosis. Urinary sediment showed pyuria. Urine culture was positive in the 50% of the patients. On the other hand urine cultures obtained from nephrostomy tube were always positive. The onset was unilateral and diffuse in all cases without predominance in the location. Direct abdominal x-ray showed lithiasis, ultrasound showed increased renal size, with a pattern of hydronephrosis and/or intraparenchymatous abscesses. CT scan was useful to demonstrate disease extension.CONCLUSIONS: Xanthogranulomatous pyelonephritis (XP) is a chronic and unusual inflammatory-infectious disease with acute episodes involving renal parenchyma. Most cases appear in medium aged women. Histopathologic study offers the accurate diagnosis. Antibiotic therapy avoids septic complications. Total or partial nephrectomy is the definitive treatment. We propose nephrostomy because it facilitates the microbiological diagnosis and surgery (nephrectomy)
OBJECTIVES: To define the usefulness of adjuvant chemotherapy in patients with pT2, pN0, pT3-4, pN0 and pN+ disease.METHODS: Retrospective analysis of 397 patients with transitional bladder cancer who underwent radical cys-tectomy between 1986 and 2005. Adjuvant chemo-therapy was administered to 40.2% of patients. Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin and cisplatin) were given.RESULTS: In patients with pT3, pN0 (p=0.04) and/or N+ stages (p=0.001), adjuvant chemotherapy signifi-cantly improved cancer-specific survival, which did not occur in pT2N0 (p=0.9) and pT4, pN0 (p=0.6) pa-tients. In the univariate analysis, adjuvant chemotherapy was significantly associated with a lower cancer-speci-fic survival rate (RR 1.452 95% CI: 1.028- 2.057 p= 0.03), while the multivariate analysis showed a trend (RR: 0.651 95% CI 0.398-1.065, p=0.08) towards a decrease in cancer-specific mortality.CONCLUSIONS: Although adjuvant chemotherapy was not shown to improve survival in patients with pT0-2, pN0 and pT4, pN0 disease, it did increase survival in those with extravesical disease, pathological state T3, pN0 and/or pN+. Considering its tendency to im-prove cancer-specific survival, adjuvant chemotherapy may be considered as a “protective factor” (RR=0.651, p=0.08).
OBJECTIVES: To report our personal experience in the reusability of the iliac fossa for renal transplantation (RT) when there are not more favorable options.METHODS: Of a total of 645 kidney transplantations, which include 52 living-donor transplantations, and three combined kidney-pancreas ones, we have selected seven, in six patients, in whom the same iliac fossa of a previous RT was reused.RESULTS: The cases reported were preceded by renal grafts placed on lumbariliac position, as Gil Vernet described at 1964, varying the classic situation. Transplantectomies were always performed using the extracapsular technique. We do think that those two circumstances have facilitated the second location of the graft.
OBJECTIVES: The accidental puncture of the renal cavities and the performance of anterograde pyelogram by Goodwin in 1955 gave way to the beginning of modern endourology. The possibility to insert thick caliber catheters in the excretory system through the renal parenchyma had led to the current state of percutaneous surgery techniques in the treatment of urinary lithiasis.Percutaneous nephrolithotomy (PNL) in the supine position makes possible, nowadays, to treat a high number of patients with outstanding results and a fast recovery.METHODS: We describe the technique used for the surgical treatment of renal lithiasis in supine position and the established indications.RESULTS: From 2004 to 2007 we treated 150 patients using the PNL technique in supine position. We show a brief analysis of the results obtained while applying these techniques and evaluated the trans and post operative complications, post operative stay, evolution and kind of technique used for the extraction of the gravel.CONCLUSIONS: The good results achieved during the application of the supine position gives credit to its use for the treatment of renal lithiasis.
OBJECTIVES:We present our initial experience with transumbilical surgery in a simple nephrectomy performed with a flexible cystoscope and standard laparoscopic instruments.METHODS: A 15 year-old child, with severe left renal parenchyma atrophy, secondary to recurrent urinary tract infection (UTI) complicated with left pyelonephritis. Decision for simple nephrectomy was taken and we planned to perform a single port laparoscopic nephrectomy. In the lumbotomy position, two 5mm ports were insertend through a 3 cm umbilical incision. One trocar permitted the progression of the flexible cystoscope (Olympus®) and the other the entrance of the PKS Plasma Trissector®. The latter was then changed for a 10mm port to allow the entrance of the Weck clips. A Maryland grasper for countertraction was placed without port in the left-upper quadrant and progressed directly into de peritoneal cavity under direct vision.RESULTS: The standard laparoscopic steps were duplicated uneventfully. Mean operative time was 90 minutes and mean blood loss was 200 mL. Hospital stay was 18 hours. No transfusion was needed. CONCLUSION: Single port urologic surgery will expand in the future. There is lack of commercial availability of the ideal hardware needed for the procedures. Versatility of urologic instruments allow for its use in different settings
OBJECTIVES: To present the double action a urologist has to consider in front of a Renal cell carcinoma (RCC); on one hand, when the normality of the contralateral kidney is stated and, on the other hand when, forced by the existence of the tumor in a solitary kidney, it is mandatory to perform a surgical technique to preserve renal function.METHOD: The case of a 43 year-old patient, diabetic who in 1982 underwent left radical nephrectomy for RCC diagnosed during a diagnostic work up for hypertension (HTA). Ten years later an upper pole renal tumor is found in the remaining kidney. Nephron-sparing surgery with in situ hypothermia was performed.RESULTS: The patient died 18 years after the first surgery and 8 years after the second. Death was due to diabetic decompensation, haemorrhage from a gastric ulcer and “retroperitoneal mass probably pancreatic” that was not characterized.CONCLUSIONS: The PSA decline, the histology of the prostate during the adenomectomy and the morphometric changes after surgery and at mid-term, advise a more accurate value of PSA in patients who underwent open surgery, in order to detect a carcinoma in the residual prostate gland.
OBJECTIVE: To report a case of laparoscopic radical cystectomy and pelvic lymphadenectomy with vagi-nal extraction of the surgical specimen in an elderly patient with muscle invasive bladder tumor.METHOD: A 78 year old patient with history of hematuria was diagnosed of muscle invasive bladder cancer. Lapa-roscopic radical cystectomy and pelvic lymphadenectomy with vaginal extraction of the surgical specimen was performed without incident.RESULTS: Operative time was 240 minutes, surgical blee-ding was 200 ml and hospital stay 8 days. The patient evolved uneventfully and remains disease free after 9 months of follow-up.CONCLUSION: Laparoscopic radical cystectomy provides adequate oncologic results with decreased morbidity, making this surgery an attractive alternative for the management of patients in a delicate condition.
OBJECTIVE: Primary prostatic tuberculosis is a very rare form of presentation of the tuberculous infec-tion, which is generally caused by the M. tuberculosis, and which has shown an increase in incidence and prevalence, due to an increase of immunocompromised patients and the pandemic of the Syndrome of Acquired Immune Deficiency (AIDS).We describe a case of primary prostatic tuberculosis attended at the Hospital Universitario de Santander, Colombia, and to perform a discussion about this topic.METHODS/RESULTS: 65 year old man who consulted with symptoms of frequency, dysuria and hesitancy, and 10 Kg weight loss in the last 6 months, without pulmonary symptoms and negative ELISA test for HIV. On physical examination there was evidenceof the presence of a high volume, irregular and hard prostatic gland. That is why a prostatic Doppler ecography was performed showing a prostatic volume of 39 cm3, without sign of malignity. Biopsy of the prostatic gland showed multiple granulomas and the ZN staining was positive for mycobacteria. With these findings the diagnosis of primary prostatic tuberculosis was established, and treatment was carried out and now the patient is asymptomatic with no evidence of active tuberculosis.CONCLUSIONS: Primary prostatic tuberculosis without his-tory or evidence of commitment of the immune system is a very rare condition, nevertheless, it is particularly important to know it due to the progressive increase of its presentation and the possibility of a curative treatment to affected patients.
OBJECTIVE: We present the case of a patientwith urogenital and osteoarticular tuberculosis.METHODS: Patient with end stage renal disease on hemod-yalisis in study for fever of unknown origin. Multiple diagnos-tic tests were performed.RESULTS: Medical treatment for tuberculosis was given withimpro-vement of the symptoms.CONCLUSION: The early urogram study can be crucial inthe diagnosis of urogenital tuberculosis in initial stages, thusavoiding the progressive deterioration of kidney function
OBJECTIVE: We review the presen-tation, diagnosis and treatment of Mondor’s disease of the penis, with the contribution of a new clinical case.METHODS: A 43-year-old male reported to the emergency room with preputial inflammation and edema associated to swelling of the dorsal region of the penis for the previous three weeks.RESULTS: Doppler ultrasound revealed thrombosis of the superficial dorsal vein of the penis, associated to candidiasic balanitis. Treatment was provided in the form of nonsteroidal antiinflammatory drugs and antibiotic and antifungal agents. The symptoms disappeared after 7 days of treatment, followed by the development of punctate phimosis that required circumcision. CONCLUSIONS: Mondor’s syndrome is an infrequent condition usually caused by trauma, though it is important to consider the possibility of associated coagulation problems, infections and neoplastic processes. Doppler ultrasound is the technique of choice for confirming the diagnosis and resolution of the condition.Treatment is based on nonsteroidal antiinflammatory medication, antibiotherapy and sexual abstinence. The use of anticoagulation is controversial, but may prove useful in patients with coagulation disorders.
OBJECTIVE: We report a new case of bladder leiomyosarcoma in an old patient.METHODS: We present the case of a 75-year-old man with bladder leiomyosarcoma treated by partial surgery followed by adjuvant treatment.RESULTS: Partial surgery of the primary tumor followed by concomitant chemo-radiotherapy was the approach for this patient. Nowadays, patient is free of tumor and living without any problems.CONCLUSIONS: Bladder leiomyosarcoma is an uncom-mon tumor (only about 1% of all bladder cancers) treated ba-sically with radical surgery. Nowadays, partial surgery is a usual approach in other tumors and there is a trend toward less aggressive surgery with preservation of function (such as head and neck cancer, bladder cancer).
OBJECTIVE: We report a clinical case of renal carcinoma in horseshoe kidney and some anatomical particularities during surgery.METHODS: We describe the case of a 54 year old man who presented pain and prostatism. A renal tumor in horseshoe kidney was found in the diagnostic tests.RESULTS: We performed surgical treatment saving the left kidney.CONCLUSIONS: Horseshoe kidney is the most frequent fusion abnormality of the kidney. Renal carcinoma in this type of renal fusion is similar to those with normal anatomy. Anatomical particularities should be taken into account during surgery.