RESUMO
Extra-adrenal myelolipomas are rare bening tumours that are componed of mature fat cells and myeloid elements. These lesions are usually asyntomatic and often found incidentally on radiographic studies. We report a case of extra-adrenal perirenal myelolipoma.
Assuntos
Neoplasias das Glândulas Suprarrenais , Mielolipoma , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/etiologia , Neoplasias das Glândulas Suprarrenais/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Mielolipoma/diagnóstico , Mielolipoma/etiologia , Mielolipoma/terapiaRESUMO
OBJECTIVE: We present the first cases of our robotic radical prostatectomy with Da Vinci (RRPdaV) that corresponds to the learning curve (LC) of the surgeon that has initiated with this technique. METHODS: We reviewed the first 20 patients that underwent RRPdaV, performed by an expert surgeon, without previous laparoscopic training, but with a wide experience in retropubic and perineal prostatectomy (HV). We analyzed: Surgical time, blood loss, conversion rate, intra and postoperative complications, hospital stay and days of bladder catheterization. Also: rates and location of surgical margins, as well as functional outcomes with an average follow up of 10 months. RESULTS: Mean operating time was 140 minutes (100-211) and blood loss 180 mL (80-360), and none required a blood transfusion. There were no intraoperative complications and neither any conversion to open surgery. The only postoperative outstanding fact was mean hospital stay were 3,35 days. (3-5). We had 6 cases of positive surgical margins (30%). The most frequent location was postero-lateral. Eighteen out of 20 patients (90%) were early totally continent, 2 (10%) required the use of one pad during the first six months due slight stress incontinence that stopped spontaneously. From 20 cases, two of them (10%) had preoperative erectile dysfunction; 12 out of the remaining 18 (66.6%) preserved potency at review and 6 (33.4%) had postoperative erectile dysfunction. CONCLUSIONS: It has been demonstrated that robotic surgery for radical prostatectomy is clearly an advantage technique (easy maneuver although it is a minimally invasive technique, comfortable and ergonomic position for the surgeon, 3D visualization and short learning curve). The RRPDAv learning curve is significantly shorter if the surgeon has a wide previous surgical experience in open and/or laparoscopic surgery.
Assuntos
Adenocarcinoma/cirurgia , Laparoscopia/métodos , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Robótica/instrumentação , Adenocarcinoma/complicações , Adenocarcinoma/patologia , Idoso , Perda Sanguínea Cirúrgica , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Humanos , Aprendizagem , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias/epidemiologia , Prostatectomia/instrumentação , Neoplasias da Próstata/complicações , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologiaRESUMO
Loop diuretics are quite often used in medical practice. In spite of a wide security, there are several adverse events that should be known, in order to be early recognised as soon as they appear. Ototoxicity associated to furosemide is infrequent and reversible. However, permanent deafness associated with furosemide administration has been previously reported.
Assuntos
Diuréticos/efeitos adversos , Otopatias/induzido quimicamente , Furosemida/efeitos adversos , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To describe the filling and voiding urinary dynamics of enterocystoplasty and continent urinary diversion. METHODS: The different behaviour of the tubularized and detubularized intestinal segments and the different sphincteric lesions related with various surgical techniques are described. The possible causes of incontinence are discussed and the literature briefly reviewed. RESULTS/CONCLUSIONS: We underscore the importance of detubularizing the intestinal segment and preserving the sphincteric system as far as possible. Furthermore, voiding using abdominal pressure may cause post void residual urine, dilatation of the neobladder and renal changes. If warranted, self-catheterization should be performed.
Assuntos
Doenças da Bexiga Urinária/fisiopatologia , Doenças da Bexiga Urinária/cirurgia , Coletores de Urina , Urodinâmica , Humanos , Intestinos/transplanteRESUMO
OBJECTIVES: To determine the usefulness of preoperative hormone therapy in patients with organ-confined prostatic carcinoma undergoing radical prostatectomy. METHODS: 7 patients with localized prostatic carcinoma are presented. All patients were submitted to radical prostatectomy; 4 had been randomly selected for preoperative hormone therapy. RESULTS: Histological examination showed no nodal involvement in all cases. The tumor could not be identified (Po) in two of the four patients who received hormone therapy. The other two patients were staged down; the Gleason score remained unchanged in one and increased in the other. The patients who did not receive preoperative hormone therapy showed concordant clinical and pathological stages, except one in whom infiltration of the prostatic capsule was observed. No difference was found concerning the facility in performing surgery between the treated and untreated patients. CONCLUSIONS: Hormonal deprivation eliminated the tumor burden in two cases that might have been completely hormone sensitive, with no correlation in the pretreatment histological grade. Clinical downstaging is achieved by this treatment modality. However, further studies in larger series comparing the percentages of downstaging, histological downgrading, absence of tumor cells in the surgical specimen and impact on survivorship are warranted.
Assuntos
Adenocarcinoma/cirurgia , Antagonistas de Androgênios/uso terapêutico , Flutamida/uso terapêutico , Hormônio Liberador de Gonadotropina/análogos & derivados , Prostatectomia , Neoplasias da Próstata/cirurgia , Idoso , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Indução de RemissãoRESUMO
Twenty four patient with neurogenic bladder undergoing vesical enlargement were pre-operatively evaluated to determine the need to perform also an anti-incontinence technique. None of them had such a technique performed, so as to control whether our prediction was correct. Each patient had one or more video-urodynamic studies performed to evaluate adjustment and the likely vesical hyperreflexia, critical incontinence pressure, and the presence of leaks with cough and cervicourethral morphology at different filling times. Critical incontinence pressure and presence of contrast leaks with cough, the latter demanded with moderate intravesical pressures, have been the parameters which better predicted the likely incontinence, with reliability over 90%. With regard to myelodysplastic bladders, the study shows the relevance of the detrusor as a cause of incontinence and sustains the practice of implementing only the cervical cuff without the remaining components when the artificial sphincter is chosen as the anti-incontinence technique, when the likely cause, whether sphincter or detrusor, is unclear at the time of considering vesical enlargement.
Assuntos
Complicações Pós-Operatórias/prevenção & controle , Bexiga Urinaria Neurogênica/cirurgia , Incontinência Urinária/prevenção & controle , Adolescente , Adulto , Criança , Humanos , Valor Preditivo dos Testes , Cuidados Pré-OperatóriosRESUMO
Report of a case of renal and urinary tract leishmaniasis in a 61-year old male patient. The ureteral lesion responded favourably to treatment, unlike the renal one which required conservative surgery. Review of the literature stressing the fact that no other case has been found of kidney and urinary tract involvement. It is concluded that in the future, at least in those areas with a high prevalence of leishmaniasis, this condition should be taken into account as differential diagnosis when facing a toxic picture with renal involvement of the calyceal ecstasies type.
Assuntos
Leishmaniose Visceral/diagnóstico , Infecções Urinárias/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: Conservative management of iatrogenic urethro-rectal fistula is discussed and the literature briefly reviewed. METHODS/RESULTS: The patient's only symptom was rectal voiding, which he considered was not enough to justify an operation. At one-year follow up, patient condition remains unchanged. CONCLUSION: Patients with urethro-rectal fistula and a competent bladder neck, whose only symptom is rectal voiding, can be managed conservatively if the patient refuses an operation.
Assuntos
Doença Iatrogênica , Fístula Retal/etiologia , Doenças Uretrais/etiologia , Fístula Urinária/etiologia , Idoso , Humanos , Masculino , Fístula Retal/diagnóstico , Fístula Retal/cirurgia , Recusa do Paciente ao Tratamento , Doenças Uretrais/diagnóstico , Doenças Uretrais/cirurgia , Fístula Urinária/diagnóstico , Fístula Urinária/cirurgiaRESUMO
Clinical and urodynamic evaluation of a series of 35 patients aged between 49 and 85 years. Clinical symptoms presented post-miocapsulotomy reduction both in obstructive and irritative signs and symptoms in 97.2% and 91.6% cases, respectively. Likewise, a decrease in peak flow and peak flow percentile was shown in 80.5% and 80% of cases, respectively. Vesical instability was seen in 90.9% and 55.5% of cases in pre- and post-operative studies respectively. An statistically significant post-operative drop (p < 0.05) in the detrusor's peak pressure during miction, (76.6 vs. 56 cm H2O), was confirmed. From our results it may be concluded that MC is a useful surgical technique in the treatment of prostatic obstruction, with the advantage versus other techniques that very frequently it preserves the proximal urinary continence mechanism and the sexual sphincter.
Assuntos
Hiperplasia Prostática/cirurgia , Idoso , Idoso de 80 Anos ou mais , Endoscopia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Cuidados Pré-Operatórios , Hiperplasia Prostática/complicações , Hiperplasia Prostática/fisiopatologia , Radiografia , Fatores de Tempo , Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/etiologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/cirurgia , UrodinâmicaRESUMO
Transitional cell carcinoma of the bladder carries a high rate of local recurrence and 15%-30% of the cases progress to advanced stages of the disease. The multiple forms of the tumor make it difficult to find reliable diagnostic elements of tumor evolution and some authors have advocated the use of tumor markers for the diagnosis and follow-up of malignant bladder tumors. This study was conducted to determine the biological behaviour of the HCG beta subunit it transitional cell carcinoma of the bladder. One hundred patients were entered into the study; the control group comprised 30 healthy subjects and the patient group comprised 70 cases of transitional cell carcinoma of the bladder. The results showed the HCG beta subunit increased with the size and degree of tumor infiltration, although the data were not statistically significant. Similarly, analysis of the degree of tumor differentiation/non differentiation provided no statistically significant data.
Assuntos
Biomarcadores Tumorais/sangue , Carcinoma de Células de Transição/sangue , Gonadotropina Coriônica/sangue , Fragmentos de Peptídeos/sangue , Neoplasias da Bexiga Urinária/sangue , Gonadotropina Coriônica Humana Subunidade beta , HumanosRESUMO
The absence of reliable diagnostic elements for the evaluation of malignant bladder tumors and the low sensitivity of the conventional diagnostic methods have prompted studies on the biological behaviour of this tumor type. The well known studies of Gold and Freedman and the recent investigations of Bates and Logo have proposed using tumor markers for early diagnosis and follow-up of different types of malignant tumors. However, the "ideal" tumor marker, one that is sufficiently sensitive and specific, has as yet to be discovered. We reviewed the tumor markers widely utilized to diagnose and follow-up malignant bladder tumors, and describe their main features. It must be pointed out that the lack of sensitivity and specificity of these tumor markers have led to the development of a new generation of tumor markers, such as cytogenetic markers, oncogenes, etc. Undoubtedly, this review of the literature will become obsolete with the advent of subsequent generations of tumor markers.
Assuntos
Biomarcadores Tumorais/análise , Neoplasias da Bexiga Urinária/diagnóstico , Biomarcadores Tumorais/classificação , Seguimentos , HumanosRESUMO
Five patients with iatrogenic ureteral injuries are described herein. Two patients had a vesicoureteric fistula and the remaining three patients had obstructive uropathy secondary to ligation with resorbable material during hysterectomy for a benign uterine condition, which spontaneously resolved with conservative management. Classically, the approach of this type of lesion was interventional and careful patient selection afforded the possibility of definitive resolution. US, CT and modern endourological technology have facilitated temporary diversion via percutaneous nephrostomy (or surgery, if the foregoing is not possible) to protect renal function during the process of recanalization of the injured ureter. Furthermore, it permits radiological control of the course and functional assessment of the excretory tract.
Assuntos
Histerectomia/efeitos adversos , Doenças Ureterais/terapia , Obstrução Ureteral/terapia , Fístula Urinária/terapia , Fístula Vaginal/terapia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Radiografia , Doenças Ureterais/diagnóstico por imagem , Doenças Ureterais/etiologia , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia , Fístula Urinária/diagnóstico por imagem , Fístula Urinária/etiologia , Fístula Vaginal/diagnóstico por imagem , Fístula Vaginal/etiologiaRESUMO
We report our experience of 5 consecutive cases of acute spinal cord compression from epidural metastasis of genitourinary tumors seen over a period of 14 months. Three patients developed paraplegia and the remaining two patients developed paraparesis of the lower extremities. Four patients underwent emergency decompression laminectomy and the remaining patient received spot radiotherapy to the metastatic vertebral lesion. The degree of neurologic deterioration and its rapid progression to the more severe forms have significantly influenced patient quality of life and survival. The literature is reviewed highlighting the epidemiological, physiopathological, clinical, diagnostic and therapeutic aspects of this condition.
Assuntos
Adenocarcinoma/secundário , Carcinoma de Células de Transição/secundário , Neoplasias Epidurais/secundário , Neoplasias Renais/patologia , Neoplasias da Próstata/patologia , Compressão da Medula Espinal/etiologia , Neoplasias da Bexiga Urinária/patologia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Idoso , Carcinoma de Células de Transição/diagnóstico , Neoplasias Epidurais/complicações , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/diagnóstico , Paraplegia/etiologia , Neoplasias da Próstata/diagnóstico , Compressão da Medula Espinal/epidemiologia , Compressão da Medula Espinal/cirurgia , Neoplasias da Bexiga Urinária/diagnóstico , Bexiga Urinaria Neurogênica/etiologiaRESUMO
Spontaneous renal subcapsular hematoma in patients undergoing hemodialysis is a very uncommon condition that is attributed to acquired cystic disease of the kidneys and other causes. We report on a patient undergoing hemodialysis due to chronic renal failure who developed right spontaneous perirenal subcapsular hematoma ascribable to no underlying pathology. Treatment was by nephrectomy.
Assuntos
Hematoma , Doenças Renais Císticas/complicações , Nefropatias , Diálise Renal/efeitos adversos , Idoso , Dicumarol/efeitos adversos , Dicumarol/uso terapêutico , Feminino , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Nefropatias/etiologia , Nefropatias/cirurgia , Doenças Renais Císticas/etiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , NefrectomiaRESUMO
In 106 male human cadavers the incidence of benign prostatic hyperplasia was found to be 63%. The present review confirmed age to be a determinant factor of the first order in the development of adenoma of the prostate. A delay in the presentation of BPH was observed in the cirrhotic alcoholic. Surprisingly, prostatic hyperplasia was not observed in those who had died from genitourinary, gastric or malignant hematologic diseases. No evidence of BPH was observed in 68.4% of patients who had died of cancer.
Assuntos
Hiperplasia Prostática/etiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Di-Hidrotestosterona/metabolismo , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Hiperplasia Prostática/epidemiologia , Hiperplasia Prostática/patologia , Estudos RetrospectivosRESUMO
We report two cases of priapism in patients previously treated with neuroleptic agents. None of these patients had a previous history of urological or hematological disorders. These two patients warranted emergency treatment by punction-aspiration of the corpora cavernosa and posterior cavernospongiosa shunt. The foregoing approach achieved penile detumescence in both cases. Excellent results were achieved relative to erectile function in one patient. Although the mechanism responsible for phenothiazine-induce priapism has as yet not been elucidated, it has been suggested that this might be due to adrenergic block which directly inhibits the sympathetic impulse of detumescence.
Assuntos
Preparações de Ação Retardada/efeitos adversos , Flufenazina/análogos & derivados , Priapismo/induzido quimicamente , Tioridazina/efeitos adversos , Adulto , Drenagem , Flufenazina/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Priapismo/cirurgia , RecidivaRESUMO
The clinical features and management of genuine hereditary hydronephrosis (GHH) in 4 members of the same family are presented. Genealogical studies provide evidence of a dominant autosomal inheritance with complete penetrance. All affected members of the family had inherited the same HLA haplotype through the male line. This finding, added to those from previous association studies with histocompatibility typing (in 3 families), lends support to the localization of the GHH gene/s in the 6p human chromosome. Based on our findings from the present familial study and on a review of the literature, we suggest that all first-degree relatives of children or adults with genuine hydronephrosis should be screened by ultrasound. Such a prospective screening, including fetal echography, will lead to earlier diagnosis and treatment of asymptomatic cases and, moreover, will identify GHH cases for possible genetic counseling with regard to the empiric recurrence risk.
Assuntos
Genes Dominantes , Antígenos HLA/genética , Hidronefrose/genética , Adulto , Criança , Haplótipos/genética , Humanos , Hidronefrose/diagnóstico por imagem , Rim/diagnóstico por imagem , Escore Lod , Masculino , Pessoa de Meia-Idade , Linhagem , UltrassonografiaRESUMO
Twenty-six male and female patients with urinary incontinence due to vesical instability underwent intravaginal/intra-rectal electrostimulation therapy. Positive clinical results were achieved in 65.3% of the cases. During subsequent urodynamic study, 80% of these cases showed absence of vesical instability. Based on these results, intravaginal/intra-rectal electrostimulation would constitute an option for the treatment of urinary incontinence due to vesical instability.