Hidatidosis paravesical. Presentación de un caso clínico / Bladder hidatidosis. Presentation of a clinical case

La hidatidosis primaria pélvica o paravesical es una forma excepcional de presentación de la enfermedad, mucho más común en pulmón, hígado y riñón. La clínica suele corresponder a trastornos irritativos miccionales. El diagnóstico de imagen es por ecografía, TAC y RNM. La serología es complementaria. El tratamiento médico es con albendazol pero la solución definitiva del quiste hidatídico paravesical es la cirugía. Se presenta un caso clínico de quiste hidatídico paravesical tratado con cirugía abierta, con una breve revisión de la literatura (AU)

Primary pelvic or paravesical hydatid disease is an exceptional presentation of the disease, more common in lung, liver and kidney. The symptoms are typically for irritative micturition disorders. The image diagnosis is by ultrasound, CT and MRI. The serology is complementary. Albendazole is pharmacological treatment but the final solution for the paravesical hydatid cyst is surgery. We present a case of paravesical hydatid cyst treated with open surgery, with a brief review of the literatura (AU)

Divertículo vesical adquirido. Caso clínico / Acquired bladder diverticulum. A clinical case

El divertículo vesical (DV) puede ser congénito o adquirido. Consiste en una herniación de la mucosa vesical. Los adquiridos se deben a un mecanismo de hiperpresión endovesical generalmente en pacientes con obstrucción infravesical secundaria a hiperplasia benigna de próstata (HBP), patología del cuello vesical o uretral. Cuando los DV son sintomáticos o producen complicaciones se debe plantear tratamiento quirúrgico. En los últimos años la diverticulectomía laparoscópica ha presentado muy buenos resultados aunque la cirugía abierta está indicada en algunos casos más complejos. En DV adquiridos de tamaño pequeño y mediano está indicado el tratamiento transuretral. Se presenta un caso clínico y una revisión de diferentes aspectos diagnósticos y quirúrgicos del DV (AU)

The bladder diverticulum (DV) can be congenital or acquired. It consists of a herniation of the bladder mucosa. The acquired is due to a mechanism of intravesical hyperpressure usually in patients with bladder outlet obstruction secondary to BPH, cervical or urethral pathology. When DV are symptomatic or produce complications surgical treatment should be considered. In recent years laparoscopic diverticulectomy has shown very good results although open surgery is indicated in some more complex cases. In small and medium acquired DV transurethral treatment is indicated. One clinical case and a review of various diagnostic and surgical aspects of DV are presented (AU)

Gangrena de Fournier. Caso clínico y revisión de literatura / No disponible

La gangrena de Fournier es una condición grave que se presenta mayormente en varones a raíz de lesiones infecciosas perineales y en pacientes con factores de riesgo predisponentes. Los gérmenes implicados son bacilos gram negativos, cocos gram positivos y anaerobios, comensales de la zona perineal. El diagnóstico es clínico, encontrando desde lesiones eritematosas hasta necrosis junto con crepitación, y se confirma con pruebas de imagen, principalmente TC que es la prueba de referencia y nos muestra la extensión de la lesión. El pronóstico de supervivencia se calcula con el índice de severidad de la gangrena de Fournier que incluye parámetros analíticos y funcionales. El manejo consiste en tratamiento médico con antibióticos y desbridamiento quirúrgico urgente de las lesiones necróticas. Luego de la fase aguda se puede realizar cirugía reconstructiva de las zonas desbridadas con posterior rehabilitación para recuperación de la función. Entre otras opciones terapéuticas encontramos el cierre asistido por vacío, la aplicación de miel y la oxigenoterapia hiperbárica (AU)

Fournier's gangrene is a serious condition that occurs mostly in males following perineal infectious lesions and in patients with predisposing risk factors. Germs involved are gramnegative bacilli, positive cocci and anaerobes, located on perineum. The diagnosis is clinical, from erythematous lesions to necrosis with crepitus. Diagnosis is confirmed mainly with CT and shows the extent of the injury. The prognosis for survival is calculated using the Severity Index Fournier's gangrene which includes analytical and functional parameters. Management is medical treatment with antibiotics that requires emergency surgical debridement of necrotic lesions. After the acute phase can be performed reconstructive surgery of debrided areas with subsequent rehabilitation for functional recovery. Other therapeutic options are the vacuum-assisted closure, application of honey and hyperbaric oxygen therapy (AU)

Celdopatía prostática incrustante: a propósito de un caso / Encrusted prostatitis: a report of a case

Presentamos un caso clínico de celda prostática incrustada de litiasis, a la que denominamos celdopatía incrustante, raramente reportada en la literatura, que comparte características fisiopatológicas con la cistitis alcalina incrustante, descrita desde inicios del siglo XX. Ambas presentan síntomas urinarios irritativos, hematuria, orina alcalina y necrosis tisular por debajo de una capa de calcificación, asociada a bacteria ureolítica, en su mayor parte. El tratamiento de la celditis, cistitis, y pielitis incrustante incluye antibióticos específicos, acidificación urinaria y escisión endoscópica de las lesiones calcificadas (AU)

We report a case of an encrusted prostatic celdopathy fouling or encrusted prostatitis, rarely reported, that accordingly to literature reviwed, seems to share physiopathological features with alkaline encrusted cystitis, described from the early twentieth century. Both cause irritative urinary symptoms, haematuria, alkaline urine and tissue necrosis below a layer of calcification, this associated to ureolytic bacteria, mostly. The treatment of encrusted prostatitis, cystitis, and pyelitis includes specific antibiotics, urinary acidification and endoscopic excision of the calcified lesions (AU)

Fistula uretrorectal post prostatectomia radical: reparación vía perineal con interposición del músculo gracilis. Caso clinico / Post radical prostatectomy fistula: perineal repair with gracilis muscle interposition. Clinical case

Existen diversas técnicas quirúrgicas para la solución de las fístulas uretrorectales debidasa cirugía prostática. La plastia con interposición de músculo gracilis vía perineal es una técnica eficaz. Se presenta un caso clínico de fístula uretrorectal post prostatectomía radical y su resolución por vía perineal con músculo gracilis (AU)

There are several surgical techniques for the solution of uretrorectales fistulas due to prostate surgery. Plasty with gracilis muscle interposition perineal approach is an effective technique. We report a case of fistula uretrorectal post radical prostatectomy and perineal resolution with gracilis muscle (AU)

[Renal retransplantation: risk factors and results]. / Retrasplante renal: factores de riesgo y resultados.

OBJECTIVE: to review our experience in renal retransplantations. MATERIALS AND METHODS: we carried out a retrospective study on 71 patients with retransplantation performed between 1980 and 2005. We studied: the characteristics of the recipient and graft, surgery data, causes of loss of the graft, number of rejects and transplantectomies and, survival of the graft. RESULTS: the most frequent cause of graft loss was chronic rejection. The causes of first graft loss were not associated with a greater loss of the second graft (p>0.05). The percentage of anti-HLA antibodies increased in the second transplant in comparison to the first (17.23±27.91% vs. 1.21±7.43%) (p=0.001), however, it was not correlated with a significant increase in loss of the second graft (p=0.320). There were no significant differences between the complications of the first and second transplants (p>0.05) and they were not associated with graft loss (p>0.05). The patients with a transplantectomy in the first transplant presented a risk 8.5 times higher of undergoing a second one (p=0.0001; OR: 8.54; CI: 95% 0.941 - 77.501). The most frequent cause of transplantectomies in the second transplant was acute rejection. Acute rejection as a cause for transplantectomy in the first transplant proved to be an independent risk factor of transplantectomy of the second transplant (p=0.009). The mean survival of the second graft was 5.08±4.81 years, higher than the first transplant (p=0.133). The survival of the graft at 1.5 and 10 years was 83%, 75% and 52%, respectively. CONCLUSIONS: the survival of the second transplant was not lower than the first, neither was there an increase in the number of complications.

Retrasplante renal: factores de riesgo y resultados / Renal retransplantation: risk factors and results

Objetivo: revisar nuestra experiencia en retrasplantes renales. Material y métodos: se realizó un estudio retrospectivo de 71 pacientes retrasplantados entre 1980 y 2005. Se analizaron: características del receptor e injerto, datos de la intervención, causas de pérdida del injerto, número de rechazos y trasplantectomías y supervivencia del injerto. Resultados: la causa más frecuente de pérdida del injerto fue el rechazo crónico. Las causas de pérdida del primer injerto no se asociaron con una mayor pérdida del segundo (p>0,05). El porcentaje de anticuerpos anti-HLA incrementó en el segundo trasplante respecto del primero (17,23±27,91% vs 1,21±7,43%) (p=0,001), pero no se correlacionó con un aumento significativo de pérdida del segundo injerto (p=0,320). No existieron diferencias significativas entre las complicaciones del primer y segundo trasplante (p>0,05) y no se asociaron con una pérdida del injerto (p>0,05). Los pacientes con una trasplantectomía en el primer trasplante presentaban un riesgo 8,5 veces mayor de sufrir una segunda (p=0,0001; OR: 8,54; IC 95%: 0,941 - 77,501). La causa más frecuente de trasplantectomía en el segundo trasplante fue el rechazo agudo. El rechazo agudo como causa de trasplantectomía en el primer trasplante se mostró como factor de riesgo independiente de trasplantectomía del segundo trasplante (p=0,009). La supervivencia media del segundo injerto fue de 5,08±4,81 años, superior al primer trasplante (p=0,133). La supervivencia del injerto a 1, 5 y 10 años fue del 83, 75 y 52%, respectivamente. Conclusiones: la supervivencia del segundo trasplante no es inferior al primero y tampoco existe incremento en el número de complicaciones (AU)

Objective: to review our experience in renal retransplantations. Materials and methods: we carried out a retrospective study on 71 patients with retransplantation performed between 1980 and 2005. We studied: the characteristics of the recipient and graft, surgery data, causes of loss of the graft, number of rejects and transplantectomies and, survival of the graft. Results: the most frequent cause of graft loss was chronic rejection. The causes of first graft loss were not associated with a greater loss of the second graft (p>0.05). The percentage of anti-HLA antibodies increased in the second transplant in comparison to the first (17.23±27.91% vs. 1.21±7.43%) (p=0.001), however, it was not correlated with a significant increase in loss of the second graft (p=0.320). There were no significant differences between the complications of the first and second transplants (p>0.05) and they were not associated with graft loss (p>0.05). The patients with a transplantectomy in the first transplant presented a risk 8.5 times higher of undergoing a second one (p=0.0001; OR: 8.54; CI: 95% 0.941 - 77.501). The most frequent cause of transplantectomies in the second transplant was acute rejection. Acute rejection as a cause for transplantectomy in the first transplant proved to be an independent risk factor of transplantectomy of the second transplant (p=0.009). The mean survival of the second graft was 5.08±4.81 years, higher than the first transplant (p=0.133). The survival of the graft at 1.5 and 10 years was 83%, 75% and 52%, respectively. Conclusions: the survival of the second transplant was not lower than the first, neither was there an increase in the number of complications (AU)

Amiloidosis primaria del uréter. A propósito de caso / Primary amyloidosis of the uréter: a clinical case

La amiloidosis se define por la presencia extracelular de depósitos de una proteína fibrilar insoluble (amiloide) en los tejidos. La afectación urológica corresponde con más frecuencia a riñón y vejiga. La afectación ureteral es infrecuente. El tercio distal es el más afectado y suele presentarse como uropatía obstructiva. Presentamos un caso de amiloidosis ureteral primaria tratada medinte nefroureterectomía (AU)

Amyloidosis is defined by the presence of extracelular deposits of insoluble fibrilar protein (amyloid) in tissues. Urological involvement most often corresponds to kidney and bladder. Ureteral involvement is uncommon. The distal third is most affected and usually presents as obstructive uropathy. We present a case of primary ureteral amyloidosis treated by nephroureterectomy (AU)

Endometriosis ureteral: a propósito de un caso / Ureteral endometriosis: a clinical case

Se presenta un caso de hidronefrosis derecha secundaria a endometriosis ureteral unilateral con revisión de la literatura. La endometriosis afecta a las mujeres jóvenes en edad fértil, siendo la vejiga la localización preferente. La afectación ureteral corresponde al 15%, manifestándose como uropatía obstructiva. El diagnóstico se realiza con ecografía, UIV, TAC o RM, pero es la biopsia la forma de obtener un diagnóstico preciso. El tratamiento es quirúrgico. En nuestro caso se realizó ureterectomía segmentaria iliaca con anastomosis ureteral término-terminal, con buena recuperación de la unidad renal. El análisis histopatológico confirmó la presencia de tejido endometrial en la pared ureteral

We present the case of a patient with a right kidney hydronephrosis due to a unilateral ureteric endometriosis, as well as a bibliographic review. Endometriosis presents in fertile-age women, being bladder its main localization. Ureteric implication corresponds to 15% being hydronephrosis its clinical presentation. Diagnosis is made by IVU, CtT-Scan or MRI, but biopsy is the only way of having a precise diagnosis, It demands a surgical approach. An iliac segmentary ureterectomy with a an end to end anastomosis was performed in our patient with a complete recovery of renal function. Pathology confirmed the presence of endometrial tissue in ureteric wall

[Paraurethral cyst of the Littre's gland: an exceptional case]. / Quiste parauretral de la glándula de Littré, un caso excepcional.

OBJECTIVE: To report one case of paraurethral cyst in the male, located in the subglandular penile urethra, an extremely rare pathology. METHODS/RESULTS: 46-years-old male patient with the diagnosis of Littre's gland paraurethral cyst. Diagnosis and subsequent treatment. CONCLUSIONS: Paraurethral cysts of non traumatic origin are very rare, only two cases are described in the literature, one cyst located at the penoscrotal angle dependent from the corpus spongiosum without connection to the urethra, and another case of inflammation of the periurethral Littre's glands simulating a tumor.

Quiste parauretral de la glándula de Llitré, un caso excepcional / Paraurethral cyst of the Littre´s gland: an exceptional case

OBJETIVO: Describir un caso clínico de un quiste parauretral en un varón, a nivel de uretra peneana subglandar, patología extremadamente infrecuente. MÉTODO/RESULTADO: Paciente varón de 46 años de edad diagnosticado de un quiste parauretral de la glándula de littré, su diagnóstico y posterior tratamiento. CONCLUSIÓN: Los quistes parauretrales de origen no traumático son muy raros, sólo se han descrito dos casos en la literatura, un quiste localizado en ángulo penoescrotal dependiendo de cuerpo esponjoso sin conexión con la uretra y otro caso de inflamación de las glándulas periuretrales de Littré simulando un tumor

OBJECTIVE: To report one case of paraurethral cyst in the male, located in the subglandular penile urethra, an extremely rare pathology. METHODS/RESULTS: 46-years-old male patient with the diagnosis of Littre`s gland paraurethral cyst. Diagnosis and subsequent treatment. CONCLUSIONS: Paraurethral cysts of non traumatic origin are very rare, only two cases are described in the literature, one cyst located at the penoscrotal angle dependent from the corpus spongiosum without connection to the urethra, and another case of inflammation of the periurethral Littre`s glands simulating a tumor

[Living donor nephrectomy for kidney transplantation. Experience in the first two years]. / Nefrectomía laparoscópica de donante vivo para trasplante renal. Los dos primeros años de experiencia.

OBJECTIVES: Laparoscopic surgery offers potential advantages in terms of diminishment of postoperative pain, shorter hospital stay, faster convalescence, and better cosmetic results. These advantages may increase kidney donation, making donation be accepted by more candidates. We report our first 2 years' experience with laparoscopic donor nephrectomy METHODS: Between March 2002 and February 2004 we performed 38 laparoscopic living donor nephrectomies for kidney transplantation. The technique of choice was the transperitoneal laparoscopic approach with four trocars, usually three of them from the start of the procedure--two 10-12 mm and one 5 mm--, and a 6.5 cm perumbilical midline incision for kidney retrieval at the end of the procedure. RESULTS: Receptor and donor survivals were 100%. Graft survival was 97.6%. There was not any case of delayed graft function. Donor: Mean operative time was 161 minutes (115-260). Mean estimated blood loss was 270 ml (100-1200). Three patients required blood transfusions, 2 units of packed red blood cells each. Mean hospital stay was 5.1 days (3-11). Mean warm ischemia time was 3.2 min. (2-10). Conversion to open surgery was necessary in four cases. Receptor: there have been three significant complications requiring surgical repair: one case of low arterial flow, one vesico ureteral leak, and one midurethra stenosis. Initial renal function: mean serum creatinine at one month was 147mmol/l, with a trend to improve to 126 mmol/l at one year, which is considered optimum. First postoperative day mean serum creatinine was 192mmol/l and the nadir was on second postoperative day with a value of 152mmol/l. CONCLUSIONS: We believe laparoscopic living donor nephrectomy is a real alternative to open surgery because it offers better recovery to the donor with the same capacity to preserve renal function in the receptor.

Uterocaliorrafia: tratamiento de la estenosis del ostium recidivada / No disponible

La ureterocaliorrafia es un tratamiento alternativo para la resolución de la estenosis del ostium recidivada. Presentamos el caso de un paciente afecto de estenosis del ostium recidivada tras pieloplastia dilatación percutánea con balón, que se solucionó mediante ureterocaliorrafia. Realizamos revisión bibliográfica sobre el tema (AU)

The ureterocalicostomy is an alternative treatment for the recurrence of ureteropelvic junction obstruction. We present one patient case affected of ureteropelvic juntion obstruction recurrence after pyeloplasty and percutaneous dilatation. This was solved with a ureterocalicostomy. Under review of the literature (AU)

Fibrosis retroperitoneal. Presentación de un caso clínico / Retroperitoneal fibrosis. A clinical case

Se presenta el caso clínico de un paciente con ureterohidronefrosis izquierda secundaria a fibrosis retroperitoneal, manejado inicialmente con sonda de nefrostomia que posteriormente se cambió por catéter doble J. El tratamiento médico fue con corticoides, que se disminuyeron progresivamente hasta ser suspendidos. A los 10 meses de tratamiento, se comprobó mediante tomografía axial computadorizada (TAC) la resolución de la placa fibrosa retroper itoneal. Ante estos hallazgos, ; el catéter doble J fue retirado endoscópicamente.Se discuten las :causas, el diagnóstico por imagen y los distintos tratamientos médicos y quirúrgicos de esta enfermedad poco frecuente y de etiología incierta (AU)

Ureteropieloplastia e riñón en herradura / Ureteropieloplasty of the horseshoe kidney

Este artículo presenta el caso de una paciente de 35 años con estenosis de ostium y riñón en herradura (AU)

Traumatismo ureteral en fractura pelviana / Uretral injury in pelvis fracture

Presentación a través de un caso clínico, de los métodos quirúrgicos de tratamiento con referencia a las variaciones por causas anatómicas (AU)

[Spurious renal tumor: acute lobar nephronia]. / Tumor renal espúreo: nefronía lobar aguda (NLA).

OBJECTIVE: To report a case of acute lobar nephronia, an unusual form of localized renal infection, and review the literature with special reference to the clinical features, ultrasound and CT findings that distinguish this condition from other renal masses (abscess, infected cyst and renal carcinoma). METHODS/RESULTS: A female patient presented at the emergency services with symptoms and signs compatible with pyelonephritis. An admission abdominal ultrasound scan demonstrated a solid mass in the left inferior renal pole. CT showed a renal mass with peripheral enhancement after infusion of contrast and central striation. Blood and urine analyses were compatible with renal infection. Acute lobar nephronia was suspected and antibiotic treatment was administered. Control ultrasound and CT examinations performed one month after instituting antibiotic treatment showed the mass had disappeared. CONCLUSIONS: Acute lobar nephronia should be considered in all patients with a renal mass detected during an episode of urinary infection. Correlation of the clinical and radiological findings, and resolution of the mass with appropriate antibiotic therapy will confirm the diagnosis.

Hasson's laparoscopic trocar in percutaneous bladder stone lithotripsy.

Bladder calculi are a common problem traditionally treated with open cystolithotomy or transurethral cystolithalopaxy. Percutaneous cystolithotomy via an Amplatz sheath is a recent approach that keeps urethral instrumentation to a minimum. We describe a percutaneous approach to bladder stones using a Hasson's trocar. With this approach, one or more watertight approaches to the bladder can be created, allowing any kind of endoscopic surgical material to be introduced, thus opening new possibilities in the design of percutaneous bladder surgery techniques.

Clear cell adenocarcinoma in a female urethral diverticulum.

The incidence of a neoplasm within the female urethral diverticulum is rare. Clear cell adenocarcinoma, which is the most common neoplasm, arises from the metaplasia of surface transitional epithelium and the paraurethral ducts. These tumors are usually diagnosed at a late stage, which worsens their prognosis. The treatment of choice is surgery.

[Treatment of prostate benign hyperplasia (BPH) with visually controlled laser, assessment at 2 years, and anatomopathologic findings]. / Tratamiento de la hiperplasia benigna de próstata (HBP) con láser de control visual, evaluación a dos años y hallazgos anatomopatológicos.

The endoscopically-guided lateral discharge laser (VLAP) has been considered an alternative in the management of benign prostate hyperplasia (BPH). The purpose of this paper is to describe the technique, results obtained in 20 treated patients, and pathoanatomical findings in those later treated with prostate transurethral resection. Four patients were carriers of an indwelling catheter, while IPSS/QL mean values in the other 16 patients were 23/4. Mean maximum flow was 7.01 mL/s. Assessment after one and two years shows a fall of mean IPSS/QL to 5/1 and mean maximum flow to 15.2 mL/s and 21 mL/s, respectively, but the difference is not significant. This paper also describes the morbidity affecting 65% patients, which is comparable to the retreatment rate (15%) obtained in other series published. The results are similar to those described in the literature although, in our view, the high rate of complications undermines this choice as an alternative in BPH management.