Mejora de las variaciones en la ecografía vesical Evaluación del volumen de orina residual posmiccional en obstrucción moderada de la salida de la vejiga / Improving Variations in Bladder Ultrasound Assessment of Post-Void Residual Urine Volume in Moderate Bladder Outlet Obstruction

Objectives: This study aimed to assess the accuracy of post-void residual (PVR) urine volume measurements in patients with moderate bladder outlet obstruction. Materials and Methods: This prospective observational study was conducted between January and December 2019. The inclusion criteria were male patients with symptoms of moderate bladder outlet obstruction. On the other hand, patients with a history of diabetes, symptoms of urinary tract infection, and positive urine for pyuria, as well as patients using medications, such as diuretics, alpha-blockers, and anticholinergic drugs, were excluded. The patients were asked to drink 1000 mL of water one to two hours before the initial ultrasound scan. Pre-void bladder capacity was measured, followed by a post-void ultrasound for residual urine volume measurement at three intervals: immediately after voiding, 15-20 minutes after the first void, and one week later with an empty bladder. Assessment of per-void capacity was carried out, based on the patient's subjective sensation of bladder fullness (a strong desire to void). Results: A total of 78 male patients, with the mean age of 60 years, were included in this study (27 cases in group I; 37 cases in group II; and 14 cases in group III). The mean PVR volume was 92 mL in the first measurement, 62 mL in the second measurement, and 60 mL in the third measurement. Significant differences were found between the first and second PVR measurements and between the first and third PVR measurements (P<0.05). However, no significant difference was found between the second and third PVR measurements (P=0.107). On the other hand, significant differences were found between groups I and II and between groups I and III (P<0.05) in the three PVR measurements. Nevertheless, there was no significant difference between groups II and III in the three PVR measurements (P=0.204, 0.56, and 0.487 for the first, second, and third PVR measurements, respectively). Conclusion: A bladder ultrasound must be performed and interpreted carefully to avoid further unnecessary medications, investigations, or procedures. We recommend a second PVR measurement in patients with bladder outlet obstruction. Also, it is suggested to conduct similar studies in different conditions to confirm our findings.

Pyeloduodenal Fistula Successfully Treated By Endoscopic Ligation without Surgical Nephrectomy: Case Report

A 74-yr-old woman presented with fever and abdominal discomfort. She was in a septic condition caused by urinary tract infection. Her computed tomogram of the abdomen revealed features of hydronephrosis with ureteral stones in both kidneys. During percutaneous nephrostomies, right pyeloduodenal fistula (PDF) was diagnosed. Elective surgery was originally planned but the patient was in a poor condition to undergo surgery. Instead, 2 times endoscopic clipping and ligation by endoloop were applied with parenteral antibiotics for the fistula lesion. On admission day 30, she was discharged from the hospital after confirmation of no more contrast leakage on fistulography. We reviewed the literature and discuss the etiologies, clinical presentations, diagnosis, and treatment of PDF.

Variables predictive of voiding disfunction following aponeurotic sling surgery: multivariate analysis

INTRODUCTION: Aponeurotic sling surgeries can evolve with obstruction or voiding dysfunction in 5 to 20 percent of patients. There are few studies on factors that could possibly predispose to voiding difficulties or urinary retention. The objective of this work is to identify these potential clinical or urodynamic factors. MATERIALS AND METHODS: Records from 130 patients who underwent aponeurotic sling surgeries were reviewed. All patients underwent a throughout urodynamic study during pre-operative investigation. The variables studied were age above 65 years, previous pelvic surgeries, concomitant surgeries, post-voiding residue higher than 100 mL, vesical obstruction (according to Blaivas-Groutz nomogram) and urinary flow under 12 mL/s. Post-voiding residue was assessed on the seventh post-operative day through vesical catheterization. Recovering of spontaneous voiding after 7 post-operative days or with a residue higher than 100 mL, was regarded as voiding dysfunction. Univariate analysis was performed with qui-square test and Fisher's exact test, and multivariate analysis was performed by logistic regression with alpha = 5 percent. RESULTS: Age in the studied group ranged from 41 to 83 years (mean 56.7 years), with 69 (53 percent) patients having urethral hypermobility and 61 (47 percent) having intrinsic urethral lesion. Normal voiding occurred in 97 (75.6 percent) women with 7 post-operative days. The only significant variable in the univariate (p = 0.014) and multivariate (p = 0.017) analysis was post-voiding residue higher than 100 mL. CONCLUSION: Pre-operative presence of a post-voiding residual urine higher than 100 mL was the only variable predictive of voiding dysfunction.

Duvertículo vesical congénito: Informe de cuatro casos y revisión de la literatura / Congenital bladder diverticulum: Report of four cases and review

RESUMEN. Se reportan los primeros cuatro casos de Drivertículo vesical Congénito diagnosticado y operados en el Hinstituto Hondureño de Seguridad social, (IHSS) Unidad Materno Infantil), en Tegucigalpa. Todos los pacientes fueron varones, con afección del ureter derecho en tres de ellos y un caso bilateral. El motivo de consulta en todos los pacientes fue infección recurrente en las vías urinarias. Los estudios uroradiológicos demostraron la presencia de divertículo vesical congénito con hidroureteronefrosis obstructiva ipsilateral. Todos los pacientes fueron operados realizandoles una diverticuiectomia intravesical más reimplantación uretral ipsilateral tipo Cohen. Su evolución postoperatoria, tanto clinica como radiológica, ha sido exelente.

Fibrose retroperitoneal: relato de dois casos e revisäo da literatura / Retroperitoneal fibrosis: relate of two cases and literature review

A fibrose retroperitoneal é uma doença rara, geralmente vista em pacientes com idade entre os 40 e 70 anose é secundária a um processo inflamatório crônico do retroperitôneo quepode comprimir os ureteres. A etiologia é desconhecida na maioria dos casos, ainda que vários fatores, como medicaçöes, doenças malignas einflamatórias, possamestar envolvidos. O diagnóstico de fibrose retroperitoneal deve ser considerado em pacientes com dor abdominal ou lombar e lesäo no retroperitôneo. Os sinais e sintomas säorelacionados com comprometimento de estruturas retroperitoneais como veia cava, aorta e ureteres. Quando ambos ureteres säo comprometidos, a insuficiência renal do tipo obstrutivo pode se desenvolver. Várias opçöes medicamentosas têm sido utilizadas nessas situaçöes. Apresentam-se neste trabalho dois casos de fibrose retroperitoneal: um deles idiopático e o outro, provavelmente, secundário a processo inflamatório crönico. Ambos foram submetidos a procedimentos cirúrgicos convencionais com a liberaçäo cirúrgica dos ureteres ou nefrostomia"au"

Inserción percutánea de cateter de derivación vésico-amniótica en fetos con obstrucción urinaria baja / Percutaneous insertion of catheter of vesico-amniotic bypass in fetus with low urinary obstruction

Se presentan 7 casos de fetos con obstrucción urinaria baja a quienes se insertó un catéter de derivación de confección artesanal a diversas edades del embarazo, considerándose el procedimiento exitoso, en 3 de ellos

Sequência da obstruçäo precoce da uretra: um caso de consanguinidade / Urethral premature obstruction sequence: a case of consanguinity

A sequencia de obstruçäo precoce da uretra ou Síndrome de Prune-belly é uma anomalia rara e complexa que afeta órgäos genito-urinários e a parede abdominal. A etiologia é controversa. Relata-se caso de uma recém-nascida em uma família consanguínea. O propósito faleceu pouco tempo após o nascimento

Fenótipo "prune-belly": apresentaçäo de três casos / Syndrome versus phenotype \"prune-belly\": presentation of three cases

A síndrome de prune-belly ocorre geralmente no sexo masculino e consiste em ausência ou hipoplasia dos músculos abdominais em acentuada dilataçäo da bexiga e ureteres, em criptorquidia e ausência de próstata. Neste trabalho säo apresentados três casos de nati/neomortos com acentuada atrofia da musculatura abdominal secundária e prolongada distensäo do abdome. Nos dois casos do sexo masculino havia uropatia obstrutiva (válvula de uretra posterior) com grande distensäo da bexiga associada a doença policística renal tipo II de Potter ao lado de ausência de próstata. No terceiro caso, do sexo feminino, a atrofia da parede abdominal foi secundária à volumosa ascite näo-imune. Em todos, havia hipoplasia pulmonar e de órgäos abdominais. Considerando os seus achados e dados de outros trabalhos, os autores consideram que a síndrome é secundária à acentuada e precoce distensäo abdominal, qualquer que seja a sua causa, constituindo em verdade uma seqüência e näo uma síndrome

Systemic lupus erythematosus with obstructive uropathy: Case report and review

We report a case of patient with documented SLE who displayed dysuria, gastrointestinal (GI) symptoms and renal insufficiency associated with the unusual occurrence of bilateral hydroureteronephrosis due to urterovesical junction stricture (obstructive uropathy). Pathologic investigations disclosed chronic interstitial cystitis (IC) with evidence of focal immune complex deposition in the blood vessel walls of the bladder. The GI symptoms and dysuria regressed with initial therapy for SLE with steroids. However, the persistent obstructive uropathy (OU) and renal insufficiency required bilateral nephrostomy followed by steroids plus intravenous pulse injection of cyclophosphamide. The obstructive uropathy was relieved even after removing the nephrostomy tube and renal function remained stable. Including this case, nineteen SLE patients associated with clinical and radiographic findings of OU were found in the world literature and reviewed to find any consistent pattern of clinical features. Most of the patients with OU in SLE were female (mean age, 31.7 yr) and orientals (63%), and had interstitial cystitis (89%) as a common underlying cause with concomitant involvement of the GI tract (89%) and WHO class IV or V advanced glomerulonephritis (67%). Despite the remarkable response (68%) to steroids in majority of OU patients associated with SLE, certain patients still required surgical correction (32%) and some even died (32%). OU, potentially reversible, was not an exception in patients with SLE, which might be overshadowed by other major organ involvement of SLE.

Female urethral diverticulum with stones

Female diverticulum is an uncommon problem in the practice of a urologist. Here we report a case of female diverticulum with stones. The most important physical sign was palpation of the sac with the stones on vaginal examination. Micturating cystourethrography was the most useful investigation. Asymptomatic urethral diverticulum may not require surgical correction. However, we suggest that a diverticulum with the stones should be treated with surgical excision to prevent it undergoing malignant change. The aetiology of the candition is not known but in this case histology was suggestive of congenital origin

Extravasación de orina espontánea por cálculo ureteral obstructivo: informe de dos casos y revisión de la literatura / Spontaneous urine tissular leak caused by ureteral calculus: report of two cases and literature review

Se presentan dos casos de extravasación espontánea de orina por rotura de la vía, secundaria a obstrucción ureteral distal por cálculo. El diagnóstico se estableció con urografía intravenosa, ultrasonografía y tomografía axil computadorizada. En ambos enfermos, la extracción del cálculo resolvió la extravasación. Se revisan etiopatogenia, cuadro clínico y diagnóstico diferencial. Está indicado el tratamiento de su etiología y la recuperación morfofuncional completa suele ser regla.

Válvulas de uretra posterior en niños / Posterior urethra valves in children

Se han revisado 8 casos con diagnósticos de Válvulas de Uretra Posterior registrados en los Archivos del Instituto Nacional de Salud del Niño, entre los años de 1977 y 1985. Los resultados mostraron una incidencia de la enfermedad de 1 caso por cada 114.7 admisiones urológicas, en una frecuencia de 1 caso por año. El grupo etáreo más comprometido fue el pre-escolar en el 37 por ciento. El cuadro clínico demostró esfuerzo miccional en el 100 por ciento de los casos, seguido de retención urinaria total en el 87 por ciento, y manifestaciones generales en el 75 por ciento. El diagnóstico clínico fue conformado mediante cistouretografía miccional en el 87 por ciento. Se pudo evidenciar asimismo Reflujo Vésico-ureteral en el 25 por ciento Hidronefrosis bilateral en el 75 por ciento y Ureterectasia moderada en el 62 por ciento. El laboratorio clínico mostró bacteriuria en el 100 por ciento. El tratamiento paleativo consistió en Cistostomía suprapúbica en el 25 por ciento, Vesicostomía cutánea en el 25 por ciento y Nefrostomía bilateral en el 12 por ciento. En los casos con tratamiento definitivo se realizó Electrofulguración en el 37 por ciento y Cirugía abierta de la Válvula en el 12 por ciento. Los resultados mostraron una evolución favorable en el 37 por ciento, Hidronefrosis e Infección urinaria en el 37 por ciento y fallecimientos en el 24 por ciento

Infecçäo das vias urinárias associada a uropatias obstrutivas na infância / Urinary tract infections associated with obstructive uropathies in childhoood

Estudos clínicos, laboratoriais e radiológicos foram realizados com o objetivo de avaliar a incidência de uropatias obstrutivas em 85 crianças portadoras de infecçäo das vias urinárias, acompanhadas por período de 2 anos. Foram detectados 49 casos de uropatias obstrutivas, em faixas etárias que variam de 0 a 10 anos, com predomínio em lactentes do sexo feminino. A uropatia mais encontrada foi o refluxo vésico-ureteral. Os dados clínicos de maior importância foram anorexia e polaciúria, sendo a E. coli o germe presente na maioria dos casos. Avaliaram-se, ainda, o tratamento clínico e/ou cirúrgico utilizado, bem como a evoluçäo de todos os casos