OBJECTIVE: From the clinical perspective, pharmacological research on ureteral dynamics – the contraction-relaxation mechanisms of the ureter –, has been prompted by renal colic. Studies of the events triggered by the calculus have been conducted to identify the pharmacological aspects that permit pain relief, passage of the calculus and protection of the kidney from injury caused by acute obstruction. METHODS: Many and varied studies on ureteral pharmacology, both in vivo and in vitro, have been carried out since the beginning of the 20th century. Numerous studies on the anatomical, neurophysiological and hormonal aspects, and different neuroactive substances have attempted to identify the behavior of the ureter under normal and pathological conditions. Since 1967, the Urology Department of the ‘Jiménez Díaz’ Foundation has investigated the mechanisms of ureteropelvic dynamics utilizing techniques developed at this institution, such as pyelomanometry, pressure / flow to constant pressure studies and antegrade pyelography. RESULTS: The different behavior of the ureter and the stimuli it receives according to the zone analyzed, are known. The classical neurohumoral mechanisms (adrenergic and cholinergic), ureteral pacemaker, effects of urinary pH and infection, action of glucagons, prostaglandins, as well as the new mechanisms of action mediated by substances and non-adrenergic non- cholinergic (NANC) receptors (tachykinins, nitric oxide (NO), vasoactive intestinal peptide (VIP), neuropeptide Y, etc.) have led to new concepts of ureteral contraction- relaxation. CONCLUSIONS: The current therapeutic strategy in renal colic utilizes non-steroidal antiinflammatory drugs (NSAID) and extracorporeal shock wave lithotripsy (ESWL) in situ for analgesia and resolution. Recent insight into ureteral dynamics attempt to promote the development of new drugs for enhanced and more effective management of renal colic.
OBJECTIVE: To review the literature andanalyze the main contributions in molecular markers inrenal adenocarcinoma.METHODS: We reviewed the literature over the last 10years on molecular markers in renal adenocarcinoma(Medline 1991-2001). Outstanding papers published before1991, included in the references of the selected articles,were also reviewed.RESULTS: A large number of biomolecular markershave been studied in renal adenocarcinoma with resultsthat are often contradictory. Some proteins have beenassociated with different histopathological parametersand with tumor prognosis, although their clinicalimportance has yet to be established.CONCLUSIONS: Although the traditional prognosticfactors, such as tumor grade and stage, provide importantinformation on the outcome of renal adenocarcinoma,they are insufficient to predict the clinical behavior of thistumor type with absolute certainty. The foregoing hasprompted the study of a variety of biomolecular markersthat might predict the biological behavior of the tumor andidentify the patients at a higher risk for tumor recurrenceor death from the tumor. Despite the promising resultsobtained with biomolecular markers in renaladenocarcinoma, further studies are warranted to determine the prognostic value of these markers.
OBJECTIVE: To describe the frequency and type of complications after radical cystectomy for cancer of the urinary bladder and their relationship with the different types of urinary diversion techniques utilized. METHODS: We conducted a retrospective study of 166 patients who underwent radical cystectomy in the same department of urology over a period of 12 years. The intraoperative, early, late complications and the need for postoperative treatments are analyzed according to percentages, main trends, scatter and confidence interval. RESULTS: 87.3% of the patients were male. The most common tumor stage was pT3 (37.9%). Transintestinal urinary diversion was performed in 81.1%; the most common being cutaneous ureteroileostomy (44%) and external diversion (64.1%). 16.7% presented hyperchloremic metabolic acidosis. Intraoperative, early and late complications were observed in 53.6%, 47.5%and 71.1% of the survivors for each time period, respectively. 28.3% of the patients required some type of medical treatment in the course of their disease and 30.7%required some type of surgical or percutaneous procedure. The most frequent complications were intraoperative bleeding (50%), respiratory complications early postoperatively (12.6%) and chronic urinary infection as late complication (30.7%).CONCLUSIONS: The high percentage of complications in our series is basically due to the fact that all types of complications, whether directly related or not to the disease and surgical procedure, were included. There was a higher incidence of late complications, the survival time being an important factor that influences the presentation of these complications. Complications are directly related to the type of urinary diversion performed, patient age, tumor stage and previous morbidity. The appearance of complications carries a high percentage of long-term complementary medical treatments or surgical and percutaneous procedures.
OBJECTIVE: To determine the significanceof gray scale ultrasound as a tool for diagnosis, follow-upand treatment of urological complications of renaltransplantation based on the experience of our institution.METHODS: A retrospective, longitudinal andobservational study was carried out. We reviewed thepatients’ perioperative ultrasound scans and their respective urological complications from January 1, 1982 toJanuary 1, 2000. The patients were consecutively takenfrom the kidney transplant registry of the Urology andNephrology and Transplant Departments.We describe the ultrasound findings of normalfunctioning grafts as well as those with urologicalcomplications, such as fluid collections (lymphocele, hematoma, urinoma and abscess), uronephrosis and itspossible causes, and symptomatic vesicourethral reflux.RESULTS / CONCLUSIONS: Diagnostic andtherapeutic algorithms in kidney transplant patients havebeen changed since the advent of ultrasound in ourcountry in 1981. Rapid diagnosis and better therapeuticoptions have been the hallmarks of ultrasound. Addedadvantages are: it is low-cost, non-invasive, not timeconsuming. It can be performed regardless of kidneyfunction, can be repeated as many times as required,subsequent scans can be compared. It can be carried outin special care units. The superficial location of the graftmakes it highly sensitive. Its disadvantages are lowspecificity to identify either the nature of the fluid collectionsor the precise site of urinary tract obstruction, apart fromdepending on the skill of the operator. Specialists shouldbe familiar with the surgical anatomy of the kidney graftand its variations in order to utilize completely its diagnosticand therapeutic potentials.
OBJECTIVE: To present the results achievedby rigid transurethral ureteroscopy for the management ofureteral calculi over a period of 10 years.METHODS: From January 1991 to November 2000,735 rigid transurethral ureteroscopy procedures for ureteralcalculi were performed in our Lithotripsy Unit. The rigidureteroscopes utilized ranged from 9.5-11.5 F. There wasa higher prevalence of male patients (63%). The mean agewas 49.9 years. Calculi were more frequently localized inthe pelvic ureter (74.2%). The mean maximum diameter ofthe calculi was 9.6 mm and caused moderate to severeuropathy in 78.6% of the cases and functional impairmentin 3.7% of the cases. After performing ureteroscopy, adouble-J catheter was left indwelling in 65.8% of thepatients. The patients were discharged from hospital usually12-18 h after the endoscopic procedure.RESULTS: Of the 735 ureteroscopies performed,satisfactory results were achieved in 676 cases (92%);stone resolution was not achieved in 59 cases. For completeresolution of the calculi, mechanical or electrokineticfragmentation was used in a high proportion of patients(56.3%). Removal of the stone or stone fragments wasmainly by forceps (79.7%); the Dormia basket was used in18.2% of the cases. The complications occurred during orimmediately after the procedure and were minor (10.7%),although there were 3 patients with major complications (2ureteral eversion and one case of ureteral avulsion).CONCLUSIONS: In our view, rigid transurethralureteroscopy is a useful, safe and efficient technique in thetreatment of calculi in the pelvic ureter, and in selectedcases of calculi in the sacral or lumbar level, after failedESWL. Rigid transurethral ureteroscopy achieves excellentresolution and the complications are scanty.
OBJECTIVE: This work is reported toencourage experienced urologists to take advantage of alaparoscopic nephrectomy technique that has evolvedinto a remarkably inexpensive, uncomplicated routineprocedure almost comparable with the gallbladderoperations of general surgery.METHODS: The patient is placed in the lumbotomyposition. The unsleeved, uncuffed hand is introducedthrough a mini-McBurney incision in the iliac fossa. Thefirst 12 mm trocar is introduced just above the posteriorpart of the iliac crest. The second is placed anteriorly some10 to 12 cm from the first. The kidney is released byextraperitoneal manual dissection. The artery is clippedand sectioned and then, without dissecting the vein, therest of the pedicle is sectioned en bloc with the endostapler.However, if the artery is not found, then the whole pedicleis sectioned en bloc. Lastly, the ureter is sectioned. Thekidney is then introduced into a simple plastic bag (openurine bag) and digitally fragmented for easy removalthrough the incision.RESULTS / CONCLUSIONS: The oblique McBurneyincision is also useful in the event reconversion to an openlumbotomy is necessary. As we described in 1994, manual manipulation significantly simplifies the procedure.Operators soon gain confidence when they appreciate inpractice the surprising versatility of the technique. Becausemost of the procedure is done under visual control,operator precision soon increases and successive operationtimes shorten considerably. Operation costs are lowerbecause an expensive inflatable cuff or sleeve isunnecessary, only two trocars are required and a standardurine bag serves to receive the kidney. We are sure thatonce urologists experienced in conventional surgery trythe procedure, they will wonder why they did not adopt itearlier.
OBJECTIVE: To analyze the resultsobtained with antegrade endopyelotomy and comparethem with those reported in the literature.METHODS: 16 patients with ureteropelvic junction(UPJ) obstruction treated by antegrade endopyelotomywere evaluated.RESULTS: In our series the success rate was 81.3%.Avulsion of the UPJ was observed in one patient andrequired conversion into an Anderson-Hynes pyeloplasty.Two cases of re-stenosis were diagnosed within the firstthree months.CONCLUSIONS: Long-term follow-up shows thatantegrade endopyelotomy can be indicated as the treatmentof choice for primary and secondary UPJ strictures.
OBJECTIVE: To report a case of two synchronousprimary adenocarcinomas involving two different organ systems. METHODS/RESULTS: The urological assessment of a patientwith hematuria disclosed an intravesicular polypoid mass and aright renal mass that were treated by surgery.CONCLUSIONS: The histopathological findings demonstrateda clear cell adenocarcinoma of the kidney and another primaryadenocarcinoma of the gallbladder. The patient has a prolongedsurvival.
OBJECTIVE: Seminal vesicle cysts are rare diseasesand frequently cause no symptoms. An acquired giant seminalvesicle cyst in a 73-year-old man is presented. Bladder outlet obstruction was the main complaint, mimicking that arising from theprostate.METHODS: Ultrasonography and computed tomographyrevealed a well-defined, homogeneous, retrovesical cystic mass.Urinary tract was normal.RESULTS: A CT-guided drainage of the cystic mass was performedand urinary symptoms disappeared. The cystic mass recurred at 6months’ follow-up. Treatment was by surgery, which confirmed theseminal vesicle origin of the cyst.CONCLUSIONS: Acquired seminal vesicle cysts may causebladder outlet obstruction.
OBJECTIVE: To present a case of urothelial tumorinside a simple ureterocele with a coexisting contralateral tumorthat caused bilateral obstructive uropathy.METHODS: Follow-up evaluation of a 74-year-old male patientwith superficial tumor of the urinary bladder diagnosed 4 yearsearlier, revealed renal failure and bilateral obstructive uropathy.The complementary tests showed a simple left ureterocele containinga lesion suggestive of a tumor and a right ureteral tumor.RESULTS: After biopsy confirmed coexisting urothelial diseaseat 3 levels (intraureterocele, contralateral ureter and in situ carcinoma of the bladder), the patient was submitted to cystoprostatectomy,nephroureterectomy and en bloc segmental ureterectomy. CONCLUSIONS: Multicentric synchronous urothelial tumorswarrant a close and long follow-up of the entire urinary tract. Amongthe possible sites of presentation, few cases of tumors inside aureterocele have been reported. The case described herein, with thisuncommon site of presentation, is an example of panurothelialdisease.
Summary.- OBJECTIVE: To present a case of fulminant sepsiscaused by Clostridium perfringens of urological origin.METHODS: An 81-year-old diabetic female (the only factor ofimmunodepression) presented complicated renal colic two dayslater with fulminant and fatal sepsis caused by Clostridium perfringenswith signs of disseminated intravascular coagulation.RESULTS: The patient died one hour after the presentation ofdisseminated intravascular coagulation despite attempts to resuscitatethe patient in the emergency department. Due to the fulminant courseof the condition, it was not possible to demonstrate the presence ofmassive intravascular hemolysis characteristic of these conditions.Blood cultures obtained immediately after the patient died werepositive for Clostridium perfringens.CONCLUSIONS: Sepsis is a possible complication of infectionfrom Clostridium perfringens. It is more frequent in immunedepressedpatients and carries a high mortality despite medical and surgicaltreatment. Although it is not the most frequent, the genitourinarytract is a known portal of entry that should not be forgotten as in thecase described herein.
OBJECTIVE: To report a case of necrosis of the glans penis caused by necrotizing granulomatous arteritis, an uncommon form of presentation of this vasculitis that basically affects the upper and lower respiratory tracts and glomerulus. Furthermore, it produces ocular inflammatory lesions and in 50% of the cases skin lesions. The mean age at presentation is around 40 years and affects both males and females in the same proportion.METHODS: A 68-year-old male consulted for pain and change in the color of the penis he had noted two months earlier, and gradually increasing difficulty in voiding. Patient examination revealed a hard necrotic lesion in the distal two thirds of the penis with secondary stenosis of the meatus. We review the literature on the different forms of presentation of this condition and the differential diagnosis of ischemic penile lesions.RESULTS / CONCLUSIONS: In patients with an ischemic lesion of the glans penis, we must consider among other causes iatrogenic lesions, use of constricting devices, gangrenous pyoderma and diseases of small vessels. According to the literature, penile involvement due to necrotizing granulomatous arteritis is uncommon.
OBJECTIVE: A case of small cell neuroendocrine carcinoma of the urinary bladder is described. Treatment was by transurethral resection of the bladder tumor in two steps and adjuvant chemotherapy with cisplatin (CDDP) plus etoposide (VP- 16) and radiotherapy. To date, 152 cases have been reported. The literature on this type of lesion is reviewed. METHODS / RESULTS: A 54-year-old male was referred to our Service with a complaint of gross hematuria. The radiologic examination showed a lesion on the right aspect of the bladder, close to the bladder neck. Urethroscopy revealed a non-papillary broad- based tumor involving the right lateral wall. TUR of the bladder tumor was performed and an initial diagnosis of small cell neuroendocrine carcinoma was made. Complementary studies showed no widespread disease. The patient refused major open surgery and accepted treatment planning at the preoperative diag-0 M0 as described above. The patient remains disease-free 28 months after the operation. We also report our experience in a patient free of disease diagnosed at stage pT3BN0M0 and 84 months’ follow-up, treated with partial cystectomy and adjuvant M-VAC chemotherapy. CONCLUSIONS: Small cell neuroendocrine carcinoma is an uncommon, usually aggressive neoplasia of the bladder. Patients that are treated have a median survival of 13 months. Cisplatin- based chemotherapy appears to be the only factor associated with a better survival. Relationship between clinical stage and survival has not been demonstrated, which suggests that micrometastatic disease is usually present at presentation in clinically localized tumors and systemic metastases are the major cause of mortality. We believe that partial cystectomy with adjuvant chemotherapy is a valid procedure in favorable cases that allows preservation of the bladder and a high quality of life.
OBJECTIVE: To present a case of preputialneurilemoma.METHODS: A 23-year-old man presented with a small, nodular,preputial mass that he had noted three years earlier.RESULTS: The tumor was excised under local anesthesia withoutcomplications. Currently, no evidence of tumor recurrence has beenobserved.CONCLUSIONS: Preputial nuerilemoma is rare. Diagnosis isbased on the findings of the pathological study.
OBJECTIVES: Herein we report anadditional case of a seminal vesicle cyst with ipsilateralrenal agenesis and ectopic ureter in an asymptomaticindividual with a normal examination.METHODS: We review the literature on retrovesicalmass regarding the embryology, evaluation, managementand treatment.RESULTS/CONCLUSIONS: Seminal vesicle cysts withipsilateral renal agenesis and ectopic ureter may appearas an incidental mass by transrectal ultrasound.