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OBJECTIVES: To determine the frecuency of complications during the management of bladder trauma and its associated factors in a third level reference Hospital.METHODS: A cross-sectional study of adult patients admitted in a reference Hospital from January 2006 to June 2011 with the diagnosis of bladder trauma. We identified demographic variables, type of trauma (blunt, penetrating), diagnostic method, associated traumatisms, management of bladder traumatism, frequency of complications and mortality. Univariate analysis was performed with frequency tables, measures of central tendency and dispersion. Similarly, bivariate analysis was performed to explore the association between variables. We used chi-square test for categorical variables and Student`s t test to compare quantitative variables.RESULTS: We reviewed 40 medical records, which met the eligibility criteria. The median age was 27 years (range 16-67) and 85% (34 patients) were male. Twenty-nine patients (72.5%) had penetrating injuries, being mainly firearm projectile (96.55%) and 11 patients (27.5%) blunt injuries. Most patients had intraoperative diagnosis (67.5%), while 25%, 5% and 2% were diagnosed by CT-cystography, cystoscopy and voiding cystography respectively. 70% (28 patients) had intraperitoneal bladder injuries. Of the forty patients enrolled, thirty six (90%) underwent surgery, while only four (10%) received conservative management. A total of ten patients (25%) had some type of complication. The most frequent was persistent hematuria (40%), followed by surgical site infection (30%), orchitis (20%), urinary tract infection (10%), urine leakage through the operative site, or to the peritoneal cavity (10%). No mortality was detected. On the bivariate logistic regression model type of trauma, number of injuries, performance of cystostomy, use of perivesical drainage tube, chest trauma and small bowel trauma, no association was found with the presence of complications.CONCLUSIONS: The frequency of complications was 25%. The presence of gross hematuria after 72 hours of trauma was found to be the most common complication. The type of trauma, performance or not performance of cystostomy, perivesical drain, presence of associated lesions in chest or small bowel were not associated with complications
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OBJECTIVES: To analyze the complications and quality of life after cystectomies performed in women with bladder cancer at our hospital.METHODS: Descriptive analysis of demographic data and early/late complications of cystectomies and urinary diversions performed in women at our hospital between 1990-2010. We also assessed quality of life using the Functional Assessment of Cancer Therapy - Bladder Cancer (FACT-BL) questionnaire and a comparison was drawn between groups of clinical variables.RESULTS: Out of 265 cystectomies, 25 (10%) were performed in women. The predominant urinary diversion was ureterosigmoidostomy (60%), followed by cutaneous ureterostomy (16%), orthotopic ileal neobladder Studer pouch (12%), ileal conduit (10%) and permanent nephrostomy (4%). Mean age was 55.75 years. The most commonly occurring early complications were prolonged ileus (20%) and urinary fistula (20%). Late complications included hydronephrosis (32%) and pyelonephritis (32%). The results of quality of life questionnaires were very similar for the different types of urinary diversions, with a mean score of 104.5 out of 156 points.CONCLUSIONS: Radical cystectomy is a high-risk procedure associated with many complications. In women, ureterosigmoidostomy may be a good choice for urinary diversion in selected patients, with a quality of life very similar to those with different urinary diversions
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OBJECTIVES: To determine the oncological and functional results obtained after salvage radical prostatectomy (SRP) in patients with recurrence following radiotherapy (3 consecutive PSA rises after a nadir until the year 2006, then 2 ng/mL above nadir) for prostate cancer (PC), and to analyze the impact of different preand postoperative variables on biochemical recurrencefree survival (BCR-free survival).METHODS: Retrospective analysis of 29 cases treated with SRP, 23 cases of conventional technique and 6 cases assisted by the Da Vinci surgical system between August 2004 and March 2012 at the Hospital Italiano de Buenos Aires. There was an attempt to preserve neurovascular bundles in cT1c patients with low tumor volume, Gleason score 7 or less, and favorable surgical anatomy. The degrees of postoperative incontinence and erectile function were recorded. The overall survival, the disease-specific survival, and the BCR-free survival were assessed. The BCR-free survival was compared among groups in accordance with the pre- and post-operative variables. RESULTS. No complications, injury to nearby organs or blood transfusions were recorded. Of all the patients, 85.7% showed normal continence (no pads used). Eight patients (27.5%) preserved their potency with sildena-fil. There were 6 positive margins for tumor extension, 44.8% of pT3a, and 10.3% pT3b. All patients are alive at present, and 58.6% with at least 1 year of followup have a PSA with recovery criteria (less than 0.02 ng/mL). The biochemical recurrence (BCR) was 41.3%, and the estimated 4-year BCR-free survival was 51.7%. Of the groups analyzed, the presence of a preoperative Gleason score ≥8 and the presence of positive surgical margins (PSMs) significantly influenced the BCR-free survival, both in the univariate as well as the multivariate analysis (p=0.02 and 0.017, respectively). CONCLUSIONS. SRP is a challenging and achievable surgery with an acceptable complication rate, and constitutes a chance to cure patients with biochemical recurrence following prostate radiotherapy. The presence of a preoperative Gleason score ≥8, and the presence of PSMs in the specimen increase the chances of a BCR after four years post-SRP
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OBJECTIVES: To determine the prevalence of urinary incontinence (UI) before pregnancy, in the third trimester and postpartum. To analyze its influence on quality of life and associated potential risk factors and the efficacy of pelvic floor exercises.METHODS: Prospective study in 413 pregnant women. The modified ICIQ-SF incontinence questionnaire was given to the pregnant women at the end of the third quarter. This questionnaire was administered by telephone at 3 and 6 months postpartum. The influence of several risk factors for UI in pregnancy and postpartum were analyzed. Patients with persistent UI at 6 months postpartum were trained to do pelvic floor exercises.RESULTS: Patients with UI before pregnancy were excluded from the study. UI in the third trimester was 31%. Analyzed risk factors did not condition a higher percentage of UI. Prevalence of UI was 11.3% at 3 months postpartum and 6.9% at 6 months. 70% of the incontinent patients already had it during pregnancy and it appeared de novo post-delivery in 30% of the patients. Prevalence of UI after delivery was higher in women with UI in pregnancy and lower in caesarean cases. Most women improved with pelvic floor exercises.CONCLUSIONS: Analysed risk factors did not significantly increase UI in pregnancy. Prevalence of UI after delivery is higher in women with UI in pregnancy and lower in caesarean cases. Postpartum pelvic floor exercises for three months in patients with persistent stress UI at 6 months postpartum clearly improved the degree of continence.
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OBJECTIVES: To evaluate the result of retrograde intrarenal surgery (RIRS) assisted by flexible ureterorenoscopy (FURS) and Holmium laser in the treatment of lithiasis within calyceal diverticula as a minimally invasive therapeutic option.METHODS: We retrospectively evaluated 11 cases of symptomatic lithiasis within calyceal diverticula treated between January 2010 and December 2011. We defined treatment success as absence of residual stones and absence/disappearance of symptomatology over the course of follow-up. We describe the RIRS technique and maneuvers for locating the diverticulum, opening the neck, and fragmenting intradiverticular lithiasis.RESULTS: The most frequently experienced symptom was flank pain (72.7 %). The size of the lithiasis treated ranged from 7-20 mm. The overall success rate of RIRS was approximately 73% (absence of lithiasis and disappearance of symptoms) with an average follow-up of 13.3 months. Three cases were not solved by RIRS (2 due to unsuccessful location of the neck, 1 due to persistence of lithiasis and symptoms). Cases of unsuccessful location were treated with laparoscopic surgery. CONCLUSION: RIRS assisted by FURS and Holmium laser is an effective and minimally invasive procedure for the treatment of lithiasis in the interior of the calyceal diverticulum. This treatment’s efficacy improves upon the results from ESWL [extracorporeal shock wave lithotripsy] and equals that of the percutaneous method, exhibiting a lower rate of complications.
Case Report
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OBJECTIVE: To describe the clinical presentation, preoperative diagnostic possibilities, and treatment of cystic nephroma. METHODS: We describe a case of cystic nephroma in an adult male and show that, both in our patient and in the literature, a definitive diagnosis can only be obtained postoperatively, even when there is a reasonable clinical suspicion.CONCLUSIONS: Cystic nephroma is rare, and some authors consider it a questionable entity. However, it should be distinguished from renal cystic neoplasms, which can resemble the condition.
Case Report
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OBJECTIVE: Amyloidosis is a disease characterised by deposition of eosinophilic hyaline material in different tissues. Urinary bladder involvement is uncommon with less than 200 cases of the primary form published in the literature. We present a new case of primary AA type amyloidosis of the urinary bladder (typical of secondary forms).METHODS: A 66-year-old male was seen in the outpatient urology consultation with several-weeks history intermittent haematuria with decreased voiding urinary calibre. In addition, he had intense nocturia, 10-12 times per night, and occasional urgency. Physical examination of the abdomen and genitals was unremarkable. Urine sediment and blood tests were normal. Urine cytology studies were requested and revealed urothelial cells with no atypical cells and a moderate quantity of neutrophils and erythrocytes. Cystoscopy was performed and revealed yellowish erythematous lesions at the level of the vesicoureteric junction and the fundus. The lesions were biopsied. Pathology studies revealed urothelial mucosa with marked chronic inflammation and accumulations of amyloidappearing hyaline material in the area of the vessels with green birefringence on polarised light. TUR of the bladder was later performed with the goal of completely resecting the lesion. The result of the pathology studies confirmed the biopsy findings and immunohistochemistry studies revealed AA type amyloid (typical of secondary forms).RESULTS: Two years after the intervention, the patient remains asymptomatic with normal endoscopic follow-up studies.CONCLUSIONS: Primary AA type amyloidosis of the bladder is a very uncommon pathology with few cases reported in the international urology literature. Nevertheless, we must keep it in mind in the differential diagnosis when faced with a patient with haematuria and/or persistent urinary symptoms.
Case Report
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OBJECTIVE: Congenital anomalies or malformations of the urethra that involve number are extremely rare and only 7 cases of trifurcation of the urethra and under 500 cases of urethral duplication have been described.METHODS: In the case we present, urethral duplication was diagnosed in adulthood, even though glans malformation with 2 urethral orifices was clearly evident and only 1 was functional.RESULTS: The condition is usually diagnosed in childhood due to the presence of 2 urethral meatus or from double stream if both are functional; at other times, the condition is diagnosed from complications that trigger infections or obstruction or if it is associated with more extensive malformations. CONCLUSIONS: Urethral duplication is an extremely rare birth defect, and diagnosis in adulthood is even more uncommon. No single embryologic argument explains all the anatomic variants of urethral duplication. The treatment of the urethral duplication should be individualized according to the type of duplication and the clinical symtoms.
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OBJECTIVE: We report the case of a 54 year old man with an intraabdominal germinal tumor originated from an ectopic testis, and its treatment.METHODS: The tumor was diagnosed with percutaneous biopsy and treated with three cycles of BEP (bleomycin, etoposide, platinum), showing an important decrease of its size. Treatment was completed with the excision of the remnant mass and regional lymphadenectomy.CONCLUSIONS: Abdominal masses in patients with a testicle outside the scrotum can be germ cell tumors and should be considered during the diagnosis.
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OBJECTIVE: To report a clinical case of penile metastasis of a rectal adenocarcinoma.METHODS: We report the case of a 78-year-old male with a clinical history of rectum adenocarcinoma. The management included an anterior rectum-resection and postoperative combination of neoadjuvant chemo and radiotherapy. Eight months after the operation, a painful solitary nodular lesion on the glans penis was diagnosed. We performed a needle biopsy (Tru-cut).RESULTS: Histological examination confirmed metastasis of the rectal tumour. We performed partial penectomy.CONCLUSIONS: The incidence of penile metastasis is extremely low. In a large number of cases the primary tumour is localized in the genito-urinary tract, less likley they originate from other organs. The treatment, depending to each case, is mostly palliative due to the poor prognosis of disease.
