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OBJECTIVES: Bleeding secondary tosevere vesicoprostatic pathology (mainly neoplasic diseaseand radiation cystitis) may be a serious clinicalmanagement problem due to its morbidity and associatedincreased resources demand in the form of admissions,transfusions and other measures. We review a series ofpatients embolized for this purpose, its efficacy, tolerabilityand adverse events.METHODS: We review 8 patients who underwenthypogastric arteries embolization between July 1998 andDecember 2001, analyzing indications, efficacy andduration, tolerability, and consequences. Right femoralartery access was undertaken in all except one case thatneeded bilateral femoral accesses. Embolization wasachieved by means of coils and particles. All procedureswere performed under local anaesthesia.RESULTS: 9 procedures were performed in 8 patients.3 patients presented with hematuria due to radiationcystitis, 3 from prostatic carcinoma, and 2 withurethrorragy from urethral relapses after cystectomy.7/9 embolizations were effective achieving immediatecomplete or almost complete bleeding control; in one casecontrol was partial; another one had limited or no effect.Selective embolization of distal arteries was performed in3 cases; all the remainders underwent direct hypogastrictrunk embolization sparing the superior gluteal artery.Effect lasted between 1 and 31 months. 4 patients died, 3of them without haematuria, 1 because of an intercurrentdisease, and the others from disease progression. 2 patientsunderwent posterior surgery, one due to recurrenthaematuria, and the other, a case of urethral tumour, dueto partial failure; partial cystectomy and urethrectomywere performed respectively. 2 patients neededadministration of morphic derivatives after embolization,all the others were managed with magnesium metamizol.Only one patient referred mild transitory glutealclaudication.CONCLUSIONS: Percutaneous arterial embolizationis an effective instrument to treat patients with haematuriaor urethrorragy and severe lower urinary tract pathologyin whom curative treatments are not applicable due totheir general status, life expectancy, or tumor status.
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OBJECTIVES: Ureteral lesions duringgynaecologic surgery are a serious problem, affectingmorbidity even when they are diagnosed postoperatively.METHODS: 742 gynaecological surgical proceduresperformed between 1994 and 2000 at the Manuel FajardoUniversity Hospital where evaluated. Eight operationswere complicated with ureteral lesions (1.07%); onepatient suffered double lesions, for a total of 9 lesions.RESULTS: 9 ureteral lesions were treated in 8 patients,7 of them were diagnosed in the postoperative period; 5bladder reimplantations with submucosal bladder tunneland 2 ureteral suture repairs (end to end) were performed.Delayed lesions were 2 ureteral-vaginal fistulae treatedwith nephrectomy and ureteroneocystostomy into a Boary´sflap respectively. In both cases diagnosis was establishedby combination of ultrasound, intravenous pyelogram,cystoscopy, and retrograde catheterization. In all sevenpatients urinary tract integrity was demonstratedpostoperatively.CONCLUSIONS: Lower urinary tract integrity may bedamaged during gynaecologic surgery, being bladderureteral reimplantation with submucosal tunnel the mostfrequently used repairing procedure. Operations for benigndiseases had fewer lesions (0.47%) than malignant (4.8%).
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OBJECTIVES: Delays in the diagnosisand treatment of bladder cancer may change survivalrates (6).We present the application of a plan for quality controlin the management of primary bladder cancer, studyingdelays globally, and for individual indicators, as well asthe impact of implemented improvement measures.METHODS: We performed a retrospective chart reviewto detect problems appeared through the whole clinicalmanagement process in a population of patients undergoingsurgery for primary bladder cancer in the Hospital Costadel Sol during 2001. Causes were studied and correctivemeasures established, application of which has beenevaluated during the first semester of 2002. Study indicatorsencompass from delay time for first visit to delay time forradical surgical treatment.RESULTS: Excessive average global delays for radicaltreatment of bladder tumor (208.3 days), and variability inthe time to transurethral resection (one to 73.42 days) andto postoperative revision (54.4 days), were the most significant results. Evaluation of implemented measuresshows a descent in global delays (134.2 days) and time topostoperative revision variability (32.4 days).CONCLUSIONS: Application of quality controlprocedures for clinical management is essential in dailyclinical practice, for systematic, continuous, and rigorousevaluation will allow us to offer patients a product thatsatisfies their personal and social expectations.
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OBJECTIVES: to evaluate the reliabilityof bladder transitional cell carcinoma (TCC) staging,comparing findings on computerized tomography (CT)with pathologic results after radical cystectomy.METHODS: We retrospectively review 115 consecutivepatients with bladder TCC undergoing radical cystectomy.Preoperative CT findings were compared with pathologyresults obtained after cystectomy and lymphadenectomy.RESULTS: We found that as a whole CT showed atendency to local overstaging of 27.8% for tumoursinfiltrating bladder wall only, and understaging of 36.5%. Regarding lymph nodes involvement, CT overstaged4.6%of patients and understaged 23.8%. CT was capableto detect only 7.15% pN positive cases. CT was unable todetect the only patient with intra-abdominal metastaticinvolvement.CONCLUSIONS: Abdomino-pelvic CT has reallimitations to detect extra vesical extension and lymphnode metastasis in patients with bladder TCC.
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OBJECTIVE: To describe a new procedurefor surgical correction of primary hypospadias withchordee.METHODS: The design of the urethral plate divide it intwo flaps. Chordee must be resected in order to straightenthe penis. Ventral side of neourethra is made with preputialskin or Mathieu procedure. This method has been used in10 pediatric patients diagnosed of primary hypospadiaswith chordee.RESULTS: Medium follow-up was 6 months. Only 2patients developed urethro-cutaneous fistulae and requireda new surgical procedure. No reports of meatal stenosis,urethral dilatation or residual curvature were made. 8patients have excellent cosmetic results and 2 cases wereclassified as aceptable.CONCLUSIONS: This procedure is a new surgicalmethod for correction of primary hypospadias with chordee.
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OBJECTIVES: to evaluate the impact ofreceptor's advanced age on kidney transplant outcomes.METHODS: We reviewed all transplants performedbetween January 1990 and December 1999. Among 570patients receiving grafts, 115 patients were 60 years orolder at the time of transplantation. We compared thisgroup with receptors younger than 60 years. We studiedpossible prognostic variables and compared patient andgraft outcomes.RESULTS: Mean age 63.81 (typical deviation (TD):2.96). Mean follow-up time for elderly receptors was 41.6months (TD: 26.58). 55.7% patients were males (p: 0.4).The most frequent cause for end stage renal disease wasunknown etiology in group 1 and glomerular in theyounger group (p: 0.01). 42% patients older than 60 yearspresented initial graft dysfunction, in comparison to 28.1%among younger than 60 (p: 0.006). Three-year graftsurvival was 90.42% for receptors 60 years old or older compared to 88.72% for group 2, without significantdifferences (p: 0.5). The most frequent graft loss etiologywas patient death. (67.7%). (p= 0.005). Patient survivalwas 81.01% in group 1 and 95.25% in group 2, beingdifferences significant (p <0.001).CONCLUSIONS: Renal grafts in receptors over theage of 60 years show a greater incidence of delayed graftfunction, although it doesn't seem to influence final graftsurvival. The most frequent cause for graft loss is receptor'sdeath. Receptor's age does not represent a contraindicationfor transplant.
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OBJECTIVES: Although not very frequent,erectile dysfunction (ED) in patients younger than 40years represents a disease to be kept in mind in oursanitary area. We propose a study of the various riskfactors identified in this population group.METHODS: We studied a total of 736 patients withdiagnosis of ED following our protocol, using as inclusioncriteria being between 19 and 40 years of age. In thisgroup, we have studied the incidence of various riskfactors associated with the disease both globally anddividing the group into age subgroups also.RESULTS: Overall, we have diagnosed 64 patientswith ED under the age of 40 years (8.7%). 25 of thesepatients were classified as psychogenic origin dysfunctions(39%), 26 organic (40.7%), and 13 of mixed origin(20.3%).Age subgroups analysis shows: between 19 and 25years: 7 psychogenic, 2 mixed, and 5 organic; between 26and 30: 1 psychogenic, 2 mixed, and 3 organic; between31 and 35: 7 psychogenic, 3 mixed, and 8 organic;between 36 and 40: 11 psychogenic, 6 mixed, and 9organic.We identified as risk factors, in order of prevalence:psychogenic (47%), diabetes (14.6%), cardiovascular(9.7%), toxic-alcohol, tobacco, and drugs- (12.1%),neurogenic (4.8%), and others (7.3%).CONCLUSIONS: ED under the age of 40 years causesa growing demand of medical care day by day, mainly dueto the increasing prevalence of its etiologic factors. Asother publications have shown psychogenic factors arethe most frequently associated with the disease in youngerpatients globally, although when dividing by age groupswe found different results than other publications in termsof association with various risk factors
Case Report
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OBJECTIVES: To report three cases of uterinemyoma as cause of pelvic calcification and to establish differentialdiagnosis with bladder stones.METHODS/RESULTS: Three asymptomatic female patients,ages between 54 years (one patient) and more than 70 years (twopatients), were fortuitously found to have calcified uterine myomasby radiological studies made for suspicion of other pathologies.CONCLUSIONS: Discovering of calcified uterine myomas is notfrequent. Diagnosis is made by radiological studies in postmenopausalfemale patients. The significance from the urological point of view isto do differential diagnosis with bladder stones
Case Report
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OBJECTIVES: Transitional cell carcinoma is themost frequent primary malignant neoplasia obstructive ureteralpathology. Nevertheless, obstructive primary ureteralleiomyosarcoma (stromal tumour) is an unusual disease, diagnosedby histopathological examination of nephroureterectomy surgicalspecimens.METHODS/RESULTS: We report a case of ureteral obstructiveuropathy in a 38-year-old woman, with non functional left kidney.Intravenous and retrograde pyelography revealed pyelocalycealand ureteral dilatation and a large polypoid intraluminal lobulatedmass in the pelvic ureter. Pathologic and immunohistochemicaltechniques showed a nonepithelial, stromal malignant tumour withappearance of smooth muscle cell differentiation: leiomyosarcoma.CONCLUSIONS: Primary leiomyosarcoma is an unusual ureteralobstructive etiology and should be considered in this condition.Correct preoperative diagnosis is rarely made and this tumour isdiagnosed by pathologycal examination. Abdomino-pelviccomputerized tomography scan and ultrasound should be performedbefore diagnosing a lesion with these features as a primitive ureteraltumour .
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OBJECTIVE: To report a case of bifid left ureterwith a blind-ending branch in a 35 year-old female patient whocomplained of poorly defined abdominal pain.METHODS: Clinical features, radiologic findings, differentialdiagnosis and therapeutic approach are discussed and the literaturereviewed.RESULTS: Bifid ureter with a blind branch is not an uncommonanomaly as generally believed. There are at least a hundred andseventy-five cases reported in the literature reviewed.CONCLUSIONS: Diagnosis is most commonly made byintravenous urography (IVU) with oblique views showing the blindendingsegment filled by retrograde uretero-ureteral reflux. Howeverblind segment does not always fill on excretory urography andretrograde pyelography is required for diagnosis (an ectopic kidneyat the distal end of the blind-ending branch should be easily seen onCT scan or ultrasonography)A voiding cystourethrography (VCUG) may be needed todemonstrate an ureteral branch with coexistent vesicoureteral reflux.Treatment is initially conservative although complications orsevere symptons require surgical excision of the blind branchtogether with antireflux reimplantation of the normal ureter whenvesicoureteral reflux is present.
Case Report
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OBJETIVES: To focus on the need of includingtuberculosis among differential diagnoses of any epidymo-testicularmass, especially if its evolution is torpidMETHODS/RESULTS: A 73-year-old man who presented withscrotum abscess underwent surgical drainage and antibiotictreatment, but suppuration relapsed through cutaneous fistulae. Aepipidymectomy was then performed, which demonstratedtuberculous granulomas. Torax Rx showed a cystic apical pulmonarywound which was treated with 3 antituberculostatics for 12 months.Sputum culture was positive for Micobacterium BovisCONCLUSIONS: Aspirative punction under sonographic control is a valuable technique to avoid mutilating surgeries and topermit an almost always effective treatment, before the appearanceof permanent lesions which lead to sterility.
Case Report
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OBJECTIVES: To report a new case ofneuroendocrine renal cell carcinoma.METHODS: We report the case of a 76-year-old woman withneuroendocrine renal cell carcinoma who underwent radicalnephrectomy without any further adjuvant treatment. We performeda bibliographic review about this rare renal neoplasia of which thereare less than 20 published case reports.RESULTS: Patient is asymptomatic four years after surgery,although she has local recurrence.CONCLUSIONS: Small cell renal cell carcinoma is a very rareneoplasia, affecting people over the age of 60 years, large in size, andmetastatic at diagnosis. It has bad prognosis, with short survivaltimes. The most adequate treatment has not been determined due tothe scarcity of published cases; the combination of surgery andchemotherapy is the most frequently used.
Case Report
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OBJECTIVES: To present two cases of extrinsicureteral obstruction secondary to gynaecological inflammatorydiseases, and to perform a bibliographic review.METHODS: We present two cases of obstructive uropathy withuretero-hydronephrosis secondary to tubo-ovarian abscessesdiagnosed at our department. Clinical features at presentation,diagnostic tests, and preoperative management are reported.RESULTS: We report the clinical resolution of each case andperform a review about this pathology.CONCLUSIONS: Extrinsic ureteral obstruction is a frequentproblem in urology. Inflammatory gynaecologic disease should beincluded among possible causes at the time of differential diagnosis.A methodical diagnosis process allows defining the exact location ofthe obstruction, diagnostic possibilities, and most adequate treatmentplan for each case. Although association of gynaecological pathologyand urinary tract obstruction is well known, there are not manybibliographic references in the national and international literature.
Case Report
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OBJECTIVES: To report a case of high flow priapismand to review its diagnostic methodology and treatment options.METHODS: A 25-year-old patient consulted with prolongederection after penile trauma. Colour Doppler ultrasound andangiogram were performed to confirm diagnosis. Cavernous arteryselective embolization with reabsorbable material was performed.RESULTS: The case was resolved, and erectile function recovered.CONCLUSIONS: Colour Doppler ultrasound allows to diagnosehigh flow priapism. Angiography, in addition to diagnosisconfirmation, allows performing selective cavernous arteryembolization, which is currently the treatment of choice because itresolves the clinical picture preserving erectile function.
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OBJECTIVE: To report a case of small cellcarcinoma of the bladder. To analyse Literature dataconcerning disease stage, treatment and prognosis ofsmall cell carcinoma of the bladder.METHODS/RESULTS: We report a case of small cellcarcinoma of the bladder with hepatic and skeletalmetastases who underwent radical cystectomy and systemicchemotherapy. The patient died 9 months after surgerybecause of chemotherapy complications and in diseaseprogression.The Authors reviewed and analysed Literature dataconcerning 139 cases of bladder small cell carcinomawith available follow-up.CONCLUSIONS: The extreme variability of treatmentoptions, the small number of cases and stratification by stages make it very difficult to deduce therapeuticrecommendations. The management that seems to give abetter survival is the combination of radical cystectomy(or radiotherapy) and chemotherapy.
