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OBJECTIVE: To present the results of aone-year retrospective study that analyzed the clinicaland epidemiological aspects of urological emergencies,which is not a negligible percentage of all hospitalemergencies.METHODS: Data on all the urological emergencies ofthe emergency department of our hospital were collectedduring a one-year period by filling out a form that includedsex, age, whether referred or not, disease, etc.RESULTS: There were 1504 urological emergencies;the urologist was required in 458 of these cases (30.45%).There were more men (837) than women (667). Patientages ranged from 1-101 years (mean 53 years); a higherincidence was found for those aged 65 years. By agegroups, there were more patients aged 61-80 years (575patients). Most of the patients came to the hospital on theirown initiative (1114) and 390 had been referred by theirprimary care physician. Renal colic (670 cases) was themost common diagnosis in both males and females, followedby cystitis, which was prevalent in the females (67.35%).Other conditions seen were urinary retention, hematuria,etc.CONCLUSIONS: There was a higher prevalence ofmales that consulted for urological conditions at theemergency department and there was a higher incidencein patients in the 6th and 7th decades of life, which issimilar to the findings reported in other studies. Renalcolic was the main reason for consultation for bothgenders and for all age groups, except those younger than20 who presented more scrotal and penile involvement.Infective conditions involving the lower urinary tract(cystitis) and pyelonephritis were prevalent in the females.The large number of patients that were discharged fromthe emergency department and who consulted on theirown initiative shows their confidence in the emergencyservices and that they could have been attended to at otherhealth centers and did not have to come and unnecessarilystrain the hospital emergency services
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OBJECTIVE: According to the literature,the typical histological findings and simple colloidal ironstaining permit the identification of chromophobe cellrenal carcinoma, a genetically well-established entitiy.Our doubts on whether this tumor type can be recognizedby conventional methods are presented in this study.METHODS: 130 cases of renal carcinoma were treatedfrom 1977 to 1997. Of these, 12 showed characteristicgeneral histological features compatible with chromophobecell renal carcinoma and reticulated and intense, diffuse cytoplasmic positivity on colloidal iron staining. Thesetumors were reviewed for the following: 1) grossappearance, 2) architecture, 3) cytoplasmiccharacteristics, 4) nuclear characteristics, 5) colloidaliron histochemical staining which is considered fundamentaland exclusive, 6) immunohistochemical phenotype.Ultrastructural study of material fixed in paraffin was alsoperformed.RESULTS: One case met all 6 criteria, 3 met 5 of them,6 cases met 4, and 2 cases met 3 of the criteria. Theultrastructural study was not useful in making the diagnosisdue to the poor quality of the material.CONCLUSIONS: If all cases were chromophobe cellrenal carcinoma, then this tumor type can be recognizedand diagnosed by simple techniques in any pathologylaboratory, and its incidence, presence of necrosis,hemorrhage and high nuclear grade would be even greaterthan currently accepted. Furthermore, it would be expectedthat the prognosis, by each grade and stage, would not beso different from that of the conventional renal carcinoma,as some large series have already indicated. On the otherhand, if our cases or some of them were in fact conventionalrenal cell carcinoma that closely resembled chromophobecell renal carcinoma, an exact diagnosis cannot be madewithout a genetic or ultrastructural study (using adequatelyfixed material), and most of the published studies wouldtherefore have to be questioned.
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OBJECTIVE: To present the results of adescriptive analysis of 267 surgically treated renal tumors.METHODS: From January 1986 to October 1999, 267patients (153 males and 114 females) with renal tumorwere treated in our department. All data were introducedinto the Access data base program and analyzed using theSPSS software. Descriptive analysis was performed andlife expectancy was calculated with the Kaplan-Meiersurvival curve. Mean follow-up was 42.72 months.RESULTS: 56.4% were in the right and 43.6% were inthe left kidney. 41.2% of the cases were incidentallydiscovered. In the symptomatic patients, the most commonpresenting feature was hematuria (51.8%). Radicalnephrectomy was performed in 94.2%, partial in 3.1% andtumor resection in 2.7%. The lumbar approach was usedin 75.5% of the cases. In regard to the histology, 88.7%were carcinomas. Clear cell was the most frequent celltype (91.5%). By grade, 55.8% were GI, 32.9% GII and 11.3% were GIII. By stage (according to the 1992 TNMclassification), 64.3% were stage I, 15.4% stage II, 17%stage III and 3.3% stage IV. 80.5% showed no vascularinvolvement. The 5-year overall survival was 71.93%(mean 114 months; median 167 months). Currently , 76%of the patients are alive.CONCLUSIONS: Distribution by sex in our series wasdifferent to that reported in most of the studies. The tumorwas incidentally discovered in a high proportion of thecases. The lumbar access was the most widely usedsurgical approach. The overall survival is similar to thatreported by other groups.
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OBJECTIVE: To analyze the results oftransurethral incision of the prostate in 205 patients withprostatic obstruction.METHODS: 205 patients comprised the study. Theclinical records and surgical reports were reviewed forpatient age, pre and postoperative symptoms, physicalexamination (principally digital rectal examination),ultrasound findings (prostate weight), endoscopy, type ofsurgery (type of incision), operating time, hospital stayand complications.RESULTS: 37.07% were aged 60-69 years, 59.51%were grade I according to the DRE and ultrasound findings,and prostatic weight. Bilateral incision was performed in65.36%. The operating time was 15 minutes in 79.02% ofthe cases and the length of stay was 3 days in 89.75% ofthe cases. Postoperative hematuria was the most commoncomplication.CONCLUSIONS: Endoscopic transurethral incision ofthe prostate is an alternative minimal invasive surgery inthe treatment of early onset benign hyperplasia of theprostate with small prostates and short urethras.
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OBJECTIVE: To describe a case ofcystinuria treated with tiopronin that produced thenephrotic syndrome.METHODS/RESULTS: A case of nephrotic syndromewith ascites and heart failure in a patient who hadreceived tiopronin for the treatment of cystinuria ispresented. Cystinuria as a rare cause of kidney stones isanalyzed. The clinical features, diagnosis and the sideeffects of treatment with tiopronin are discussed. Thepatient recovered after withdrawal of the drug.CONCLUSIONS: It must be emphasized that patientstreated with tiopronin should be screened for proteinuria.
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OBJECTIVE: To analyze the role oftransrectal ultrasound in the diagnosis of diverticula ofthe female urethra.METHODS/RESULTS: Transrectal ultrasoundassessment was performed with a biplanar 5MHz probeand translabial ultrasound was performed with a 7 MHzlinear or 3.5 MHz sectorial transducer in 9 women suspectedto have urethral diverticula. Cystourethrography was alsoperformed in three patients. Eleven diverticula were foundin these 9 patients.CONCLUSIONS: The incidence of diverticula of thefemale urethra has been reported to range from 0.5-6%.Diagnosis is confirmed by urethroscopy or imagingmethods. Transrectal ultrasound is the method of choice inthe assessment of urethral diverticulum.
Case Report
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OBJECTIVE: To describe a case of primary seminalvesicle abscess that was managed conservatively.METHODS: Antibiotics, according to the urine culture andantibiotic profile, were administered for four weeks. Outpatientfollow-up was carried out with digital rectal examination, urine culture and ultrasound.RESULTS: A favorable clinical response was observed at daythree. The patient was discharged from hospital on day 7. DRE, urineculture and ultrasound findings were normal after 4 weeks.CONCLUSIONS: Primary abscess of the seminal vesicle can besuccessfully treated with antibiotics. Percutaneous drainage of theabscess should be reserved for those cases that do not respond toconservative management with antibiotics.
Case Report
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OBJECTIVE: To report a case of ectopic adrenal inthe epididymis.METHODS: A 17-year-old male consulted for a left varicoceleand complaints referred to the right epididymis a year and a halfafter an episode of acute epididymitis. A nodule was excised from theepididymis.RESULTS: The pathological analysis showed an 0.4 cm nodulecomprised of adrenocortical tissue.CONCLUSIONS: Ectopic adrenal cortical tissue is a benignlesion. Although routine search for this lesion is not indicated, itshould be resected for histological analysis and differential diagnosiswhen it is found during a surgical procedure in this area.
Case Report
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OBJECTIVE: To present a case of crossed fusedrenal ectopia that was incidentally discovered in a patient consultingfor abdominal pain in the emergency department.METHODS: A 46-year-old patient consulted at the emergencydepartment for abdominal pain. Assessment by diagnostic imagingtechniques demonstrated a crossed renal ectopia and associatedbone anomalies.RESULTS/CONCLUSIONS: Crossed renal ectopia is anuncommon congenital anomaly and in most of the cases usuallypresents with fusion of both kidneys. It can also be associated withcongenital anomalies of other organs. No treatment is requiredunless there are other complications or superimposedpathologies
Case Report
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OBJECTIVE: To report a case of extrinsic ureteral obstruction arising from mucocele of the appendix and review the clinical, diagnostic and therapeutic aspects of this appendiceal pathology of interest in urology.METHODS: A 71-year-old female patient that had previously undergone radical gynecological surgery and postoperative radiotherapy presented with right lumbar pain. Patient evaluation by ultrasound, IVP and CT showed a pelvic mass causing right extrinsic ureteral obstruction. Release and reinsertion of the right ureter and appendectomy were performed. RESULTS: The anatomopathological study showed an appendiceal mucinous cystadenoma. The patient is asymptomatic after surgery.CONCLUSIONS: Appendiceal mucocele is a dilatation of the vermiform appendix due to collection of mucoid material that is frequently produced by a cystadenoma. The presenting feature is usually that of acute appendicitis. The definitive diagnosis is based on the anatomopathological findings. Treatment is by appendectomy for the benign tumors and by right hemicolectomy in a second stage procedure for malignant tumors. This appendiceal pathology should be taken into account in the differential diagnosis of right extrinsic ureteral obstruction.
Case Report
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OBJECTIVE: To present a case of massiveinguinoscrotal hernia associated with low detrusor contractility.METHODS/RESULTS: A 70-year-old male patient with a historyof diabetes and a previous diagnosis of low contractile bladderpresented with urinary retention. Acute renal failure secondary toureteral obstruction and inguinal bladder herniation was diagnosed.The direct bilateral hernia was repaired. Postoperative urodynamicevaluation showed an acontractile bladder. Intermittentcatheterization was started, with satisfactory functional result andimprovement of renal function.CONCLUSIONS: Massive bladder hernia can present as acuterenal failure without lower urinary tract obstruction. The underlyingimpaired detrusor contractility can be diagnosed by urodynamicevaluation. Surgical treatment, with self-catheterization if required,achieves good results with preservation of renal function.
Case Report
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OBJECTIVE: To present a case of Cushing’s syndrome due to massive adrenocortical macronodular hyperplasia that gave the gland the appearance of a pseudotumor.METHODS: In a review of the surgical pathology of the adrenal gland recently performed in our hospital, 82 adrenalectomy specimens obtained from 1978-1998 were found. Of these 82 surgical specimens, 44 (53.6%) were cortical pathologies and 10 of these (12.1%) were hyperplasia. There was only one with massive adrenocortical macronodular hyperplasia. A 53-year-old male, chronic alcoholic with cushingoid obesity and hypercortisolism is described.RESULTS: Ultrasound and CT assessment showed enlarged, asymmetrical adrenal glands and macronodules. The analytical and MRI study of the sella turcica showed primary adrenal hypercortisolism. Adrenalectomy of the dominant gland (the left adrenal whose activity was demonstrated on the 131Iodine scintiscan) was performed. The postoperative cortisol levels returned to normal and remain normal up to the present time, 18 months after surgery. The surgical specimen weighed 104 gms and was completely macronodular.CONCLUSIONS: Massive adrenocortical macronodular hyperplasia is a rare cause of pituitary-independent autonomous primary adrenal hypercortisolism. It is always bilateral. Adrenal weight is significantly increased (total weight of both adrenals 60-180 gms) and present yellow or golden, non-encapsulated nodules of a few millimeters to up to 4 cms, comprised of cells with scanty activity, therefore massive enlargement of the glands is necessary to produce Cushing’s syndrome. The clinical, biochemical and surgical aspects can cause confusion and can be suggestive of an adrenocortical neoplasm. Treatment is by adrenalectomy.
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OBJECTIVE: To report 5 cases of cystic nephromaand review the clinical, diagnostic and therapeutic aspects.METHODS: From 1974 to 1988, 5 cases of cystic nephroma werediagnosed at our hospital. Patient evaluation included IVP and renalUS, and occasionally ascending urography, fine needle aspirationbiopsy and CT. The cyst was removed through a lumbar incision in4 patients and nephrectomy in one patient.RESULTS: The patients were followed by yearly ultrasound/urography for 1 to 15 years. No evidence of local recurrence ormetastatic disease has been found.CONCLUSIONS: Cystic nephroma is an uncommon, benignkidney disease whose etiology is unknown. Although new imagingtechniques are available, surgical excision and histologic analysis ofthe tumor are the only effective methods to distinguish benign frommalignant cystic lesions of the kidney. Because it is a benign lesion,surgery must be conservative. Complete excision of the cyst isadvocated. We found a well-encapsulated, noninfiltrating lesion thatpermitted surgical excision without difficuly in most of our cases.Herniation of some cysts into the urinary tract is a characteristicradiological sign.
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OBJECTIVE: In a prospective study it wasour intention to evaluate the reliability and the predictivevalue of expiratory ethanol for the early detection of theoccurrence of TURP syndrome and emphasize the role ofthe serum levels of glycine in clinical manifestation.METHODS: We studied 30 patients scheduled forelective traditional transuretral resection of the prostateperformed with subarachnoid anesthesia. Serum sodiumand glycine concentrations, serum osmolality and end expiratory ethanol levels were monitored at scheduledintervals. Continuous heart rate and blood pressuremonitoring was performed during the perioperative periodin the operativing room and, later, in the recovery room.Occurrence of cardiocirculatory, respiratory andneurologic symptoms were recorded. Statistics includedBonferroni's t-test and Fisher's exact test. A decision level plot for end-expiratory ethanol level was performed forthe choice of predictivity criterion.RESULTS: In our population we identified three groupsof patients: Group I (15 patients) in which no symptom wasrecorded; Group II (6 patients) in which non-specificanesthesia-related symptoms occurred; Group III (9patients) in which TURP syndrome of various degree ofseverity was observed. In this group of patients changes inserum sodium and glycine concentrations, serum osmolalityand end–expiratory ethanol levels were significantlydifferent compared with the other two groups. In regard toend-exipratory ethanol levels, we identified a cut-off pointat 0.05 mg/ml. In Group III two patients developed transientblindness. These patients had the highest serum glycineconcentrations (<4000 µmol/ml). Mortality was nil.CONCLUSIONS: Our data show the reliability andaccuracy of end-expiratory ethanol levels as a predictivetest of the occurrence of TURP syndrome. Further, weemphasize the role of serum glycine concentration in theoccurrence of neurologic symptoms related to thetransurethral resection of the prostate
