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OBJECTIVES: Hydronephrosis is common during pregnancy, affecting 90% of pregnant women. It is usually asymptomatic, but a small percentage of patients show clinical symptoms requiring treatment. We want to report our experience in the diagnosis and treatment of symptomatic obstructive uropathy in pregnant women.METHODS: We retrospectively evaluate the resultsobtained in 162 pregnant women suffering symptomatic hydronephrosis who received care at our department over the last 12 years.RESULTS: Conservative treatment was effective in most patients, 39 patients required more aggressive therapy. Thirty-five patients underwent insertion of a double Jcatheter, 2 patients percutaneous nephrostomy, and another 2 ureteroscopy and extraction of ureteral lithiasis.CONCLUSIONS: The most frequent etiology of symptomatic hydronephrosis during pregnancy is external compression by the gravid uterus, followed by ureteral lithiasis. We consider conservative treatment as the treatment of choice, leaving ureteral double J catheter insertion or percutaneousnephrostomy for the refractory cases. Ureteroscopy is a new diagnostic and therapeutic option when other less aggressive measures fail.
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OBJECTIVES: We report our experienced with TVT combined with other gynecological procedures, and the complications appeared intraoperative and during the immediate postoperative period.METHODS: Between October 2001 and March 2004 76 patients underwent TVT procedures following the classic technique in the Urogynecology and Vaginal Surgery Unit of Las Condes Clinic. Median age was 53 years old. Urodynamic tests had demonstrated genuine stress urinary incontinence (SUI) (49 cases), intrinsic sphincter deficiency (ISD) (5 cases), and mixed urinary incontinence (MUI) (22 cases). In 61 cases (80.3%) TVT was associated with another gynecological surgery.RESULTS: 82 gynecological operations were associated to TVT. Twenty one patients underwent 2 procedures (34%) and 40 patients one (66%). Laparoscopic surgery 25 cases (41%). Vaginoplasty was the most frequent procedure in 49 cases (80%), laparoscopic hysterectomy 17 (28%), vaginal hysterectomy 5 (8%), laparoscopically assisted vaginal hysterectomy 5 (8%), laparoscopic tubal ligation 3 (5%), Gargiulo operation 1 (2%), annexectomy 1 (2%), and trachelectomy 1 (2%). Intraoperative complications appeared in 4 patients (6.6%). 3 cases of bladder perforation (5%), and 1 case of parietal peritoneum perforation (1.6%). No surgical intervention was necessary to solve complications. Two cases of transitory acute urinary retention appeared in the immediate post-operative period.CONCLUSIONS: Our clinical experience demonstrates that the combination of TVT with other gynecological operations in the same procedure is effective and safe. It enables a more comprehensive solution of patient’s problems in the same procedure without increasing morbidity.
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OBJECTIVES: The growing interest on increasing the number of biopsy samples during ultrasound guided prostatic biopsies moved us to evaluate the tolerability and complications of the extensive biopsy with/without blockage of neurovascular bundles. METHODS: A group of 222 patients underwent prostatic biopsy with the aim to obtain 10 cores on each. After evaluation of the first 50 cases performed without anesthesia, decision was taken to proceed with neurovascular blockage with 2% lidocaine, comparatively evaluating both groups for results on tolerability, complications and global adverse events. RESULTS: The aimed number of cores could not be completed in 16% of the patients without anesthesia in comparison with 2.33% with anesthesia (p < 0.002); the biopsy was qualified as painful or very painful by 10.9% and 1.9% respectively (p < 0. 0002). The results of the visual analogical scale for pain were 2.46 ± 1.67 and 4.5 ± 2.11 for the anesthesia / without anesthesia groups respectively, with mild-moderate vagal reactions in 28% of these latter in comparison with 7.7% in patients receiving lidocaine. Rectal bleeding was the most worrying complication, being moderate-severe in 4.7% of the patients, with 2% hospital admission. CONCLUSIONS: The increase in the number of ultrasound guided prostatic biopsy samples may be associated with a higher frequency of complications, mainly bleeding, and requires the application of local anesthesia due to worse tolerance. Neurovascular bundle blockage with lidocaine is very effective to diminish biopsy associated pain.
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OBJECTIVES: To perform a bibliographic review of the main features of cryotherapy as a therapeuticoption in the managemente of prostate cancer and to report our initial experience.METHODS: We employed the Endocare Fast-Trac system(Medipro) with 2,4 mm needles implanted in a single maneouvre without rack or transrectal US transducersupport. Two cycles of freezing -thawing were employed,with apex backward movement when necessary. Freezing cycle duration was between 7-10 minutes or more. The Onik maneouvre – injection of saline into the Denonvillier’s space-diminishes the risk of rectal injury and fistula allowing reaching posterior limits of the icaballbeyond the prostatic capsule.RESULTS: We treated 20 patients. Follow-up wasbetween 30-36 months. 58% of the patients had unilateralprostate cancer, 42% bilateral. In accordance to the classic definition 9 patients were classified as low risk of extraprostatic disease, 6 medium risk and 5 high risk; using number of positive cores as the criterion for risk 5, 6 and 9 were low, medium and high risk respectively. Per protocol prostate biopsies were performed in 18 patients 6, 12 and 24 months after treatment. Twopatients underwent a second treatment due to persistenceof cancer cells in the 6-month biopsy (11%).3-month PSA nadirs after a total of 21 cryo treatments administered were < 0,2 ng/cc in 15 cases (78,9%), < 0,5 ng/cc in 17 (89,4%) and ≤ 1.0ng/cc in 18 (94,7%); it was over 1 ng/cc in only 5,6% . 30 month PSA for the same cutoff values was 27.8%, 50.0%, 66.6% and 33.3%, respectively.Prostate cancer cells were detected in the 12-month biopsies of 5.5% cases. All 24-month biopsies were negative. COMPLICATIONS: We observed scrotal edema, hematoma, perineal pain and constipation which lasted 2-3 weeks. 1 patient suffered injury of the mucosa at the prostatic urethra, which did not result in rectal fistula and was treatedwith bladder catheter for 3 months. 4 patients had erectiledysfunction before treatment. All others presented erectiledysfunction after treatment; 3 of them (20%) recovered rigidity enough to have intercourse over the 30 month period.No urethral sloughing or acute urinary retention appearedand all patients are continent.CONCLUSIONS: Prostatic cryosurgery is an effective, minimally invasive procedure for the treatment of prostatecancer with very low surgical risk, low morbidity and almost null mortality.
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OBJECTIVES: We report a review of all patients with testicular tumors undergoing surgery in our Hospital over a 13 year period. There were 151 cases, 50 of them were reported as non germ cell tumors (33%).METHODS/RESULTS: 42% of them were haematopoietic tumors, lymphomas and leukemias. 30% of them were non neoplastic tumors, including vascular tumors and granulomatous orchitis. 12% were identified as Leydig or Sertoli cell tumors. 10% were metastases.CONCLUSIONS: Non germ cell tumors were morefrequent in adults (78%) than in children (22%). Among children, 82% of the neoplasias were leukemic infiltration of the testicle.Non germ cell tumors do not imply a better prognosis.
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OBJECTIVES: Upper urinary tract videourodynamic studies were first described in the second half of the 20th century (years 60-70). The antegrade pyelogram with constant pressure and controlled flow received the name of its author, “Vela Navarrete test” (1982) (4), who currently refers to it as video-urodynamicstudy of the upper urinary tract. It is the simultaneous study of pressure, flow, and dynamic x-ray of the upper urinary tract and it keeps same indications than theoriginal design, in spite of the appearance of new dynamicand static imaging techniques (ultrasound, CT scan, MRI, radioisotope studies). The continued practice of video urodynamic study of the upper urinary tract in the FJD prompted an update of the procedure reviewing its current indications.METHODS: Patient is positioned in the prone decubitus on an x-ray table with video. After punctioning renal cavities with fine needle, video urodynamic tests areperformed: pyelomanometry, basal pyelic pressure (basicurodynamics study), pressure changes after induceddiuresis, and pressure-flow studies. 10-20 ml of urine are obtained for biochemical tests (creatinine, electrolytes, osmolarity,...), which give information about the functionalviability of the renal unit, cytology or microbiological tests. Finally, the study concludes with an antegrade pyelogram, a fluoroscopic study of the radiologicalanatomy which provides morphologic and dynamic data of the upper urinary tract (3). In the Urodynamics Unit of the FJD, urologists perform 30-40 studies per year. We analyzed retrospectively all studies performed over the last five years (1999-2005) for various pathological entities of kidney dilation. (Table I).RESULTS: Structural and dynamic data obtained by the studies offered conclusive information in most of them facilitating the decision for surgery or observation (Table II).CONCLUSIONS: The interpretation of the upper urinary tract video-urodynamic study is based on radiological and dynamic findings. Flow-controlled pyelogram enablesdetermining the existence of obstruction, dilation volume,and ureteral peristaltic behaviour. Constant pressure enables quantification of obstruction. The videourodynamic study of the upper urinary tract is easy to perform, well tolerated and may be repeated as many times as required, mainly if nephrostomy tube is placed for more prolonged evaluations. It offers excellentanatomical, dynamic, and etiological information about the upper urinary tract, and furthermore conclusive, with minimal risk.
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OBJECTIVES: From August 1997 to December 2004 we performed 47 vasovasostomies for vasectomy reversal in the same number of patients. Only 42 patients are available for follow-up, with a mean follow-up of at least six months. Mean age is 40.7 years for the patients and 30.8 for the couples.METHODS: The two-layer technique was applied under microscope magnification in the first 22 patients; single layer technique was performed in the others.RESULTS: Overall spermatozoid patency rate was 71.42%, and pregnancy rate was 32.45%. Surgical technique did not have influence on results.CONCLUSIONS: Better prognosis is expected in young men; the longer the interval between vasectomy and reversal, the lower the patency rate. Regarding pregnancy rate, it is not influenced by delay of reversal.
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OBJECTIVES: To investigate sperm quality before and after swim up in infertile patients, and tocompare it with a fertile men population.METHODS: Semen samples from 55 patients consulting at the infertility services of the Hospitals “Centenario” in Rosario and “Eva Perón” in Gro Baigorria were collected and analyzed accordingly with the WHO guidelines. 30 sperm samples with a volume higher than 1.0 ml, and spermatozoid concentration higher than 5.000.000/ml, not presenting hyperviscosity were selected. Outcome variables including progressive mobility (PM), morphology (M), chromatin condensation (CC) and chromatin integrity (CI), were compared in fresh semen samples, between patients without previous treatment (G2) and after swim up (G3) and 15 fertile men (G1). Sperm morphology was evaluated by brilliant green hematoxyllin stain;progressive mobility with a subjective method accordingly to WHO (1999); chromatin condensation with aniline blue test; and chromatin integrity with acridine orange as fluorocrom. Swim up technique was based on Berger et al. (1985) with mHTF, heatingthe samples in a Falcon tube in a 45º angle in a 37ºC gas heater for one hour (5% C02 atmosphere). Following incubation 0.5 ml of the overlay containing sperm cells that swam up from the pellet were removed to process the recoveredspermatozoids.Student’s t test was applied to compare PM, M, CC, and CI between the four groups. A significant difference was found between G1 vs G3 and G2 vs G3 (p<0.001). No significant differences were found between G1 and G3 (p>0.1). It showed that PM, M, CC and CI parameters in the recovered spermatozoids after swim up were similar to fertile population.CONCLUSIONS: Our results indicate that through the swim up procedure gametes with fertile ability similar to normal fertile population can be recovered to be applied in low complexity in vitro fertilization techniques such as intrauterine insemination, where the natural selection is still viable.
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OBJECTIVES: To report one case of utriculum cyst treated endoscopically.METHODS: We describe the case of a mid-age male patientconsulting for long-term monosymptomatic hemospermia.Rectal digital examination revealed a non suspiciousadenomatous prostate. Transrectal ultrasound showed a complicated utriculum cyst.RESULTS: Endoscopical marsupialization of the cyst was performed with complete remission of hemospermia.CONCLUSIONS: Transrectal ultrasound should be performedin all patients presenting with long-term hemospermia.Endoscopical marsupialization of the mullerian duct cyst is indicated in symptomatic patients or those with complex cysts on ultrasound, offering a high cure/improvement rate in this group of patients without secondary effects.
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OBJECTIVES: We report the first two cases of HTLV-1 infection after a renal transplant appearing in our country and their outcomes. METHODS: We describe the cases of two transplant patients who developed subacute myelopathy, known as Tropical Spastic Paraparesis, secondary to HTLV-I infection and review their evolution. RESULTS: Both cases show a great disability today, being one of them dependent for his daily life. CONCLUSIONS: We believe that HTLV-I detection is necessary in all donors by indirect (ELISA) or direct (PCR) techniques due to its symptomless evolution in the transplant patient on the one hand, and the growing immigrant population in our country which associates an increase in the number of asymptomatic carriers of the virus.
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OBJETIVE: To inform a case and the handling of the vesical giant lithiasis in the boy.RESULTS: Presentation of a case of a 5 year-old boy had urinary infections, and who was diagnosed giant vesical lithiasis, was made the cistolithotomy.CONCLUSIONS: The giant vesical lithiasis is not very common, and it is usually associated with nutrition factors.
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OBJETIVE: Evaluate the treatment of the meatus urethral lithiasis.METHODS/RESULTS: A case of a 52 year-old male patient is reported with a big stone in the urethral meatus. Male patient that consults for Micturitional Syndrome, disury and difficulty when urinating, in whom felt induration of the glans and observed a water-pipe where the patient urinated. The Diagnoses was made by the observation and the palpation of the glans. It was extracted by meatoplasthy with good results.CONCLUSIONS: The treatment of the meatus urethral big lithiasis that causes obstruction is the meatoplasthy.
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OBJECTIVES: To report a new case of bladder leiomyoma.METHODS: We describe the case of a 56-year-old female patient presenting with renal colic who was diagnosed of a bladder filling defect after work up with intravenous urography, ultrasound and urine cytology. Complete transurethralresection of the lesion was performed.RESULTS: Pathology reported bladder leiomyoma.CONCLUSIONS: Every pathological possibility should be considered in the differential diagnosis and treatment of a filling defect. Bladder leiomyoma is usually an incidental diagnosis on the pathologic report after resection of a bladder tumor.
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OBJECTIVES: To report one case of renal trauma in a patient with horseshoe kidney treated conservatively by superselective embolization. METHODS: We report the case of a 19 year old male presenting at the emergency room with macroscopic hematuria and severe abdominal pain after a motor vehicular accident. RESULTS: IV contrast CT scan showed a horseshoe kidney with a fracture in the area between the lower pole of the left kidney and the isthmus, with active bleeding and a big retroperitoneal hematoma extended to pelvis. Retarded exams showed contrast extravasation compatible with significant urinoma. Renal arteriography was performed, showing a double renal pedicle on each kidney and a common caudal lumbar-renal trunk giving accessory branches to both kidneys’ lower poles and contrast extra- vasation compatible with active bleeding. The lumbar-renal trunk was selectively catheterized reaching the left kidney and isthmus branches which were embolized. Retrograde catheterization of the urinary tract with a straight ureteral catheter was performed to facilitate drainage of the urinoma. This catheter was subsequently removed after control CT scan showing complete resolution of the urinoma and no bleeding. Control CT scan three months after embolization demonstrated complete resolution of the hematoma. No late complications appeared. Renal function and blood pressure have been completely normal after 12 months of follow-up. CONCLUSIONS: Horseshoe kidney is a rare congenital malformation. This clinical case demonstrates that conservative treatment is a still the gold standard treatment for renal trauma, even in kidneys with congenital anomalies.
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OBJECTIVES: We report a case of a huge bladder hernia conditioning the migration of almost all the bladder into the scrotum.METHODS AND RESULTS: 65-year-old male being studied for BPH who presents a scrotal tumor, which turned out to be a huge inguinal bladder hernia in scrotum, paraperitoneal, accompanied by an inguinal hernia. The treatment consisted in bladder resection and repair of the inguinal hernia with a marlex mesh. Later on, a TURP was done. At a six month control, the patient was non-asymptomatic.CONSLUSIONS: Bladder hernia is an uncommon pathology, and in most of the cases it is an incidental finding during the repair of an inguinal hernia. It can be intraperitoneal, extraperitoneal or paraperitoneal. The diagnosis is clinical, but comfirmation can be done by retrograde cystoghraphy, ultrasonography or CT. The treatment is surgical, repairing the herniation or adding the resection of the bladder herniation.
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OBJECTIVES: The diversity of experimental results obtained in the study of the effect of citrus juice on urinary lithogenicity moved us to study the effect of these substances in vitro and in-vivo. The in-vitro study is based on the turbidimetric method on calcium oxalate crystallization. In vivo, we studied the effect of lemon juice consumption on urinary chemistry and we tested it on calcium oxalate crystallization in natural urine.METHODS: The formation of crystals is induced by the addition of the oxalate and calcium solution.Optical density (OD) is measured in a closed system at physiological conditions. The effects of the various juices of lemon, was evaluated by the addition of 50 ml of juice. A male volunteer with no history of kidney stone participated in this study, by lemon juice ingestion. The pH, concentration of oxalate, calcium and citrate were determined before and after ingestion and urine was freshly analyzed by microscopy.RESULTS AND CONCLUSIONS: In synthetic urine, the inhibition rate of calcium oxalate crystallization increases gradually with the lemon juice concentration. In natural urine, we noted that the kinetics of crystallization of calcium oxalate, before and after ingestion of lemon juice, are comparable. In vivo, after ingestion, a small increase in mean urinary pH (from 6.7 ± 0.1 to 6.9 ± 0.1) was noted. Indeed, oxalate calcium means and citrate excretion increased during this period with 33. 41%, 6. 85 % and 3. 53% respectively. This increase in the oxalate excretion is probably explained by the conversion of the exogenous ascorbic acid contained in the lemon juice. These results show that the lemon juice presents an important inhibitory effect in vitro. The ingestion of the lemon juice seems to dissipate a effect of great quantity of citrates which in turn increases the excretion of oxalates. The presence of these two elements simultaneously: citrate and oxalate compensate for their opposite effect.
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OBJECTIVE: To report a case of local recurrence 16 years after radical nephrectomy; to analyse literature data concerning, treatment and prognosis. METHODS/RESULTS: We report a case of local recurence associated with caval trombosis who was underwent an en–bloc resection of vena cava along with pericaval lesion and caval replacement with PTFE prosthesis. The Authors reviewed and analysed literature data.CONCLUSIONS: Local recurrence after radical nephrectomy is rare as it is reported only in 2-4% of patients. This condition is even rarer beyond 10 years especially if associated with caval trombosis.A case of isolated local recurrence of renal cell carcinoma with caval involvement 16 years after radical nephrectomy is described herein. To the best of our knowledge, this is the first case reported in literature. This case highlights the opportunity of a periodic checkup of patients submitted to radical nephrectomy, even many years after surgery.
