OBJECTIVE: To present the resultsachieved with the artificial urinary sphincter in thetreatment of 44 patients with severe urinary incontinence.METHODS: From April 1990 to December 1998, anartificial urinary sphincter was implanted in 44 patientswith severe urinary incontinence, aged 21 to 82 years(mean 56). These patients were categorized into thefollowing groups:Group A comprised 24 males, aged 37 to 82 years(mean 66), who had undergone previous prostaticprocedures. Four of them had undergone radical retropubicprostatectomy. The remaining 20 had undergone a total of34 de-obstructive procedures (mean 1.7 procedures /patient; range 1 - 3); 28 were endoscopic procedures and6 open prostatectomy. One of them had a previousileocystoplasty due to severely low compliance. Ten werecompletely incontinent and were using a condom catheter(7), penile clamp (2) or permanent indwelling Foleycatheter (1). The rest used a mean of 3.7 pads per day.Group B comprised 11 males with a complex urologichistory: 9 had neurogenic dysfunction, 1 had bladderexstrophy and 1 had a previous cystectomy and Studerneobladder. Eight were using a condom catheter. The cuffwas placed in the bulbar urethra in 8 (4 - 4.5 cm) and inthe bladder neck in 4 (9 - 10 cm). Group C comprised 9women with type III stress incontinence after failed previousinterventions (range 1- 4, mean 2.7). All of these patientsrequired at least 3 pads per day (mean 4.5). The cuff wasplaced in the bladder neck with diameters ranging from 5to 10 cm.RESULTS: The mean follow-up was 28.5 months (range8 - 96). One patient died two years after implantation ofthe artificial sphincter which was never activated.In group A, 83% are socially continent and 17 do notrequire pads. Three of the 20 patients with the artificialsphincter have undergone a total of 4 surgical revisions.In group B, the social continence rate was 63% with a 36%revision rate. Four patients required a complete change ofthe system. In group C, The continence rate with revisionwas 66%. One patient underwent two successive successfulrevisions and 3 required removal of the device, accountingfor a failure rate of 33%.Definitive removal of the artificial sphincter wasrequired in 3 females and 5 males. Aside from one malewho refused a new implant, the rest were consideredunsuitable for a new device. Six patients underwent atleast one reoperation to change one or more parts of thesystem. Continence was recovered in 66% after the revision.CONCLUSIONS: The artificial urinary sphincterachieves a good continence rate in patients with severeincontinence, although careful patient follow-up isrequired.
OBJECTIVE: To present our experiencewith renal angiomyolipoma.METHODS: The series comprised 27 patients (26female, 1 male) with renal angiomyolipoma. Twenty-three(85%) had unilateral renal involvement and of the 4remaining patients (15%) with bilateral involvement,three (10%) had tuberous sclerosis.RESULTS: Due to the complications, three patientswith bilateral and one patient with unilateral renalinvolvement required surgery. Mean patient follow-upwas 38 months.CONCLUSIONS: Surgery is warranted in patients withtumors of more than 4 cm, symptomatic or associated withtuberous sclerosis. Regular control evaluation is indicatedfor tumors less than 4 cm.
OBJECTIVE: To analyze the results achieved with transplantation of children kidneys to adult recipients.METHODS: The results achieved with transplantation of children cadaver kidneys (<15 years) from 1989 to 1994 over a follow-up period of at least 36 months were reviewed. Patients (n = 43) were stratified into group A (13 grafts from donors <6 years), group B (30 grafts from donors >6 years) and group C (control group), which comprised 73 patients who received grafts from donors of an ideal age during the same time period. All three groups were similar for variables considered to influence the results of transplantation, except for the higher incidence of hypotension in group B.RESULTS: The number of episodes of rejection was three-fold higher in group A than in the control group (p = 0.019). A higher incidence of surgical complications, principally vascular complications (arterial thrombosis, renal rotation), was found in group A versus the control group (p = 0.039). When the grafts transplanted en bloc from donors under 12 months were excluded from the analysis, the incidence of vascular or urological surgical complications in group A was not found to be higher than that of the control group. No difference was found for mean length of stay, renal function (creatininemia), graft or patient survival for the three groups.CONCLUSIONS: Grafts from donors more than 6 years old showed a similar behavior as those from donors of an ideal age. Furthermore, single kidneys from donors aged more than 12 months can be transplanted with excellent results. It is necessary to have a larger series to confirm and explain the high incidence of acute rejection in grafts from donors less than 6 years old.
OBJECTIVE: To present our experiencewith helical CT for vascular assessment prior to renaltransplantation.METHODS: In our hospital, all candidates to renaltransplantation are referred to the Urology TransplantUnit for previous assessment. For the past 3 years, patientswith multiple arterial calcifications (non linear) havebeen evaluated by helical CT with three-dimensionalreconstruction of the calcification densities, which providesan accurate representation of the lesion.RESULTS/CONCLUSIONS: Pretransplant evaluationhas been fundamental for individualized planning of therenal transplant surgery. The use of helical CT is extendingin our field and it has also been utilized in graft donorassessment. In our experience, the extent and thickness ofarterial wall calcifications are accurately depicted byhelical CT. These findings could have an importantsignificance when making pre and perioperative decisionsin renal transplantation.
OBJECTIVE: Four additional cases ofmalignant priapism or priapism secondary to penilemetastasis from urogenital tumors are presented and theliterature is reviewed.METHODS: Chest and abdominal radiologicalevaluation, cavernosal and abdominal US, abdominaland pelvic CT and MRI, and cavernosal biopsy wereperformed for the localization and staging of the primarytumor.RESULTS: Conservative palliative managementachieved a survival of only a few months in three of thepatients with tumor dissemination to adjacent vital organs.Radical surgery was performed in one patient with tumorlocalized to the genital area. Currently, this patient has noclinical symptoms, although the follow-up is only 4 months.CONCLUSIONS: Malignant priapism is rare andusually secondary to GU tumors. The prognosis is poorsince it generally indicates the presence of multiorganmetastasis. However, the prognosis is better for singlemetastasis, which is an indication for radical surgery.
OBJECTIVE: The sonographic findingsand associated etiological conditions in 19 patients withtubular ectasia of the rete testis are described.METHODS: 19 patients with tubular ectasia of the retetestis diagnosed by ultrasound over a two-year period arepresented. Twenty-seven testes showed ectasia. The meanage at the time of diagnosis was 59 years. US evaluationwas performed with the 7-8 MHz multifrequency linearprobe (Acuson 128, Mountain View, CA, USA). The patientswere evaluated in the supine position and the scrotalcontent was examined in the sagittal and transverseplanes. A color and pulsed Doppler study were performedin all the cases.RESULTS: 8 patients showed bilateral involvement, 7had left and 4 right tubular ectasia. Other frequentlyassociated findings were spermatocele (8 cases), cord cyst(6 cases) and varicocele (5 cases). Four patients hadundergone scrotal surgery and one had a previous historyof epididymitis.CONCLUSIONS: Tubular ectasia of the rete testis is anuncommon, benign condition that is usually associatedwith epididymal obstruction following trauma or infectionin most of the cases. Diagnosis of tubular ectasia by US,in a correct clinical context, obviates the need to perform a biopsy and orchidectomy for its diagnosis in a vastmajority of the cases
OBJECTIVE: To report a case of cystitis glandularis,a proliferative disorder of the bladder mucosa whose incidence isestimated to be approximately 1%.METHODS/RESULTS: A case of diffuse cystitis glandularis in amale patient is presented. Intravesical steroid therapy achievedsymptomatic resolution, although the proliferative mucosal lesionspersist.CONCLUSION: There is currently no non ablative treatmentthat has been demonstrated to be effective in diffuse cystitisglandularis.
OBJECTIVE: To report a case of cystic dilatation ofthe prostatic utricle.METHODS: A case of cystic dilatation of the prostatic utricleassociated with right renal agenesis in a 26-year-old patient whoconsulted for recurrent orchiepididymitis and a history ofhemospermia is presented.RESULTS: Physical examination showed a hypogastric tumormimicking a vesical globus that was palpable on digital rectalexamination. Ultrasonography and urethrocystoscopy were decisivein the diagnosis of this anomaly. The utricle was removed by thetransperitoneal approach. Gross examination showed opening ofboth deferent ducts and right ureter (blind-ending) into the utricle.CONCLUSION: The pathological characteristics of this anomalypermitted its identification as cystic dilatation of the prostaticutricle, a condition that should be taken into account in the differentialdiagnosis of pelvic tumors in the male.
OBJECTIVE: To describe an uncommon case of iatrogenic bladder lithiasis in a female patient who underwentcolposuspension according to the Burch technique. METHODS/RESULTS: A female patient who had undergone colposuspension for urinary stress incontinence presented with irritative bladder symptoms and dyspareunia two years later. Patientevaluation revealed stone formation on the nonresorbable suture. Stone removal was achieved endoscopically using local anesthesia and without compromising continence.CONCLUSION: Removal of the calculus that had formed on the suture was achieved by endoscopy without compromising continence.
OBJECTIVE: To report a case of ureteralendometriosis, an uncommon disease in the urological practice that is diagnosed late and may cause irreversible damage to the upperurinary tract.METHODS/RESULTS: A case of unilateral ureteral endometriosisis presented. After attempting hormonal therapy and endourologicalmanagement, the patient eventually underwent aggressive surgicaltreatment.CONCLUSIONS: The diagnosis of ureteral endometriosis shouldbe considered in women presenting with noncalculous renalobstruction, particularly premenopausal women of low parity orthose who have had previous pelvic surgery. Only a high index ofsuspicion and the radiological supports may help to reduce thenumber of alarming nephrectomies associated to this condition.
OBJECTIVE: To describe a case of rupture of the deep dorsal vein of the penis during sexual intercourse. METHODS: A 21-year-old patient consulted at the emergency services for acute penis after vigorous sexual intercourse, with clinical features suggestive of rupture of the corpora cavernosa. RESULTS: Surgery demonstrated complete rupture of the deep dorsal vein of the penis, which was repaired. Examination showed no injury to the corpora cavernosa. CONCLUSIONS: Early surgical management is advocated in acute penis, since it will permit us to make the correct diagnosis and treat the underlying cause to avoid future sequelae. Rupture of the deep dorsal vein of the penis is another condition that should be considered in the differential diagnosis of acute penis. Its clinical features are similar to those of cavernosal rupture. Ultrasound and cavernosography are not diagnostic.
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.
OBJECTIVES: Although there arenumerous case reports of spontaneous rupture of thecollecting system, especially including the calyceal fornixor the renal pelvis, spontaneous rupture of the ureter is arare condition.METHODS: Herein, we present a case of a patient whosuffered symptoms of acute abdomen due to rupture of theproximal ureter. Extensive assessment revealed noetiological factor as to the extravasation.RESULTS/CONCLUSIONS: The condition wasmanaged conservatively by insertion of a double-J catheter.The double-J ureteral stent was removed on the firstpostoperative month under local anesthesia uneventfully.One year after the spontaneous ureteral extravasation, thepatient remained without clinical problems. The diagnosis,pathogenesis and complications of this unusualcondition are reviewed.