Computed tomography scan in supine and prone positions: an alternative method to detect intramural gas in emphysematous cystitis and to evaluate efficacy after adjuvant continuous intravesical irrigation treatment.

OBJECTIVE: To evaluate the efficacy of continuous intravesical irrigation with saline plus amikacin as adjuvant therapy and to evaluate the computed tomography (CT) scan in supine and prone positions (CystoCT scan) as an alternative diagnostic and evaluation method of intramural gas in emphysematous cystitis (EC) before and after treatment. METHODS: Consecutive patients with a diagnosis of EC who were hospitalized between March 2006 and January 2011 were investigated. The diagnosis was made by CystoCT scan. Treatment consisted of intravenous antibiotics, control of concomitant diseases, and placement of a 3-way urinary catheter for continuous irrigation of 500 mg of amikacin diluted in 1 l of saline given on days 0, 3, and 7. Treatment was considered successful when there was an absence of gas in the bladder wall, the urine culture was negative, there was clinical improvement, and there was an absence of toxicity. RESULTS: Eleven patients were hospitalized with a diagnosis of EC during the study period. Four were excluded from the study, 2 due to the lack of confirmation of the diagnosis with the CystoCT scan. Treatment was successful in all patients; for 6 (86%) this was achieved in 3 days and for 1 (14%) in 7 days. No toxicity was reported. CONCLUSIONS: Continuous intravesical irrigation with saline plus amikacin as adjuvant treatment of EC is an inexpensive, effective, and safe tool that might help conventional treatment and provide a rapid recovery. The CystoCT scan is an alternative method to diagnose and evaluate intramural gas in EC patients. These findings should be challenged in a randomized, multi-centre, placebo-controlled clinical trial.

[Extracorporeal tumorectomy and autotransplantation in a patient with a single kidney and a multicentric clear cell carcinoma]. / Enucleación extracorpórea y autotransplante en paciente con riñón único con cáncer renal multicéntrico de células claras.

OBJECTIVE: To demonstrate that "bench surgery" and autotransplantation are still alternatives in the treatment of complex renal cancer cases. METHODS: 58 y/o female with history of radical nephrectomy due to renal cancer who asked for medical attention because of back pain. Renal masses were found during her evaluation and she was referred to our service. RESULTS: Lumbar incision was the preferred approach. After removal, the kidney was irrigated with EuroCollins solution and bench surgery was performed. Cold ischemia time was 63 minutes. The kidney was transplanted into the right pelvic region. Diuresis was immediately achieved after vascular anastomosis. Lich-Gregoir ureteral implant was carried out. During the first 48 hrs no complication was reported, urine output was about 80 cc/hour. She eventually developed renal failure and after 6 sessions of hemodialysis recovered to void in the previous volume range. She had a urinary leak that was resolved with CFT-guided percutaneus drainage. Twelve months after the procedure, she has no complaints; serum creatinine is 1.6 mg/dl and CT scan shows no evidence of recurrences. CONCLUSIONS: Bench surgery is still a therapeutic alternative for the treatment of complex renal cancer cases in order to avoid dialysis.

[Continous bladder irrigation with amikacin as adjuvant treatment for emphysematous cystitis]. / Irrigación intravesical continua con amikacina como tratamiento adyuvante en la cistitis enfisematosa.

OBJECTIVE: To demonstrate that continuos intravesical irrigation with amikacin is an effective adyuvant treatment in Emphisematous Cistitis therapy. METHODS: A 3 way transurethral Foley catheter was placed and a continuous intravesical irrigation was initiated with amikacin 500 mg in 1L of normal saline (500 micrograms per ml) within 6 hours 4 times a day and three consecutive days. RESULTS: After 3 days of treatment the patient showed significant clinical response. A new CT scan showed the absence of gas in the bladder wall compared to the previews CT and negative urine culture was obtained. CONCLUSIONS: We established that treatment using adjuvant continuous intravesical irrigation with amikacin can reduce hospital stay and accelerate the patient's healing process, as well as an earlier negativisation of urine cultures. A comparative prospective study is needed to evaluate if in fact this treatment variant produces a real benefit compared to conventional therapy.

Enucleación extracorpórea y autotransplante en paciente con riñón único con cáncer renal multicéntrico de células claras / Extracorporeal tumorectomy and autotransplantation in a patient with a single kidney and a multicentric clear cell carcinoma

Objetivo: Demostrar que la cirugía de banco y el autotransplante continúan siendo alternativas vigentes para el tratamiento de casos complejos de cáncer renal. Métodos: Femenina de 58 años con diagnóstico de cáncer de células renales tratado con nefrectomía radical derecha 13 años antes. Acude al servicio de medicina del dolor tras presentar como único síntoma lumbalgia. En los estudios de imagen para la evaluación de la lumbalgia se realiza el hallazgo de tumoraciones en riñón izquierdo por lo que es referida a nuestro servicio. Resultados: Se realiza abordaje con lumbotomía. Se extrae pieza quirúrgica y se realiza perfusión con solución de EuroCollins y se realiza cirugía de banco. El tiempo isquemia fría antes de la anastomosis vascular fue de 63 min. Se colocó riñón en región pélvica derecha. Hubo diuresis inmediatamente posterior a anastomosis vascular. Se realizó reimplante ureteral tipo Lich-Gregoir. Cursa sus primeras 48 horas postoperatorias sin complicaciones y con diuresis en promedio de 80cc por hr. Presenta insuficiencia renal aguda, posterior a 6 sesiones de hemodiálisis diuresis normal. Presentó fuga urinaria en anastomosis ureteral que produjo urinoma que se resolvió con drenaje percutáneo guiado por TAC. Doce meses después de la cirugía la paciente esta asintomática, creatinina sérica 1.6 mg/dl depuración de creatinina de 60 ml/min, estudios de control con riñón libre de neoplasia. Conclusiones: La cirugía de banco continúa siendo una opción terapéutica para casos complejos de cáncer renal para evitar que los pacientes sean sometidos a diálisis en espera de transplante renal (AU)

Objective: To demonstrate that “bench surgery” and autotransplantation are still alternatives in the treatment of complex renal cancer cases. Methods: 58 y/o female with history of radical nephrectomy due to renal cancer who asked for medical attention because of back pain. Renal masses were found during her evaluation and she was referred to our service. Resultados: Lumbar incision was the preferred approach. After removal, the kidney was irrigated with EuroCollins solution and bench surgery was performed. Cold ischemia time was 63 minutes. The kidney was transplanted into the right pelvic region. Diuresis was immediately achieved after vascular anastomosis. Lich-Gregoir ureteral implant was carried out. During the first 48 hrs no complication was reported, urine output was about 80 cc/hour. She eventually developed renal failure and after 6 sessions of hemodialysis recovered to void in the previous volume range. She had a urinary leak that was resolved with CT-guided percutaneus drainage. Twelve months after the procedure, she has no complaints; serum creatinine is 1.6 mg/dl and CT scan shows no evidence of recurrences. Conclusiones: Bench surgery is still a therapeutic alternative for the treatment of complex renal cancer cases in order to avoid dialysis (AU)

Irrigación intravesical continua con amikacina como tratamiento adyuvante en la cistitis enfisematosa / Continuous bladder irrigation with amikacin as adjuvant treatment for emphysematous cystitis

OBJETIVO: Demostrar que la irrigación intravesical continua con amikacina es un tratamiento adyuvante eficaz en la terapia para la cistitis enfisematosa. MÉTODOS: Se colocó en paciente con diagnóstico de cistitis enfisematosa una sonda transuretral de 3 vías y se inicio irrigación vesical continua con Amikacina 500mg en 1L de solución fisiológica al 0.9% (500 microgramos por ml) cada 6 horas por 3 días consecutivos. RESULTADOS: Después de 3 días de tratamiento la paciente evolucionó satisfactoriamente. Se tomo nuevo TAC con contraste intravenoso e intravesical y se evidenció ausencia de gas en la pared vesical así también se obtuvo urocultivo negativo. CONCLUSIONES: El tratamiento adyuvante con amikacina con irrigación intravesical continua podría disminuir la estancia hospitalaria y mejorar rápidamente las condiciones generales del paciente así como negativizar los cultivos en un periodo menor de tiempo. Se necesita un estudio prospectivo y comparativo para valorar si esta modalidad aquí planteada produce un beneficio real comparado con la terapia convencional (AU)

OBJECTIVE: To demonstrate that continuos intravesical irrigation with amikacin is an efective adyuvant treatment in Emphisematous Cistitis therapy. METHODS: A 3 way transurethral Foley catheter was placed and a continuous intravesical irrigation was initiated with amikacin 500mg in 1L of normal saline (500 micrograms per ml) within 6 hours 4 times a day and three consecutive days. RESULTS: After 3 days of treatment the patient showed significant clinical response. A new CT scan showed the absence of gas in the bladder wall compared to the previews CT and negative urine culture was obtained. CONCLUSIONS: We established that treatment using adjuvant continuous intravesical irrigation with amikacin can reduce hospital stay and accelerate the patient’s healing process, as well as an earlier negativisation of urine cultures. A comparative prospective study is needed to evaluate if in fact this treatment variant produces a real benefit compared to conventional therapy (AU)