ABSTRACT
La endometriosis se define como la presencia de tejido endometrial funcionante localizado de manera ectópica fuera de la cavidad uterina. La afectación del aparato urinario es poco frecuente evidenciándose únicamente en el 5% de las pacientes con endometriosis. Presentamos el caso de una paciente de 44 años monorrena izquierda, que ingresa en el servicio de urología por hidronefrosis y dolor en fosa renal de un mes de evolución. Se realiza estudio de uropatía obstructiva izquierda evidenciándose efecto masa en uréter distal izquierdo. Dados los hallazgos y los antecedentes de la paciente (monorrena izquierda) se decide realizar ureterectomía y vejiga psoica, con toma de biopsia intraoperatoria. El estudio histopatológico de la pieza reveló el diagnóstico de endometriosis ureteral. La paciente en la actualidad se encuentra asintomática y con función renal normal (AU)
Endometriosis is defined as the presence of ectopic endometrial tissue outside the normal confines of the uterine cavity. Urinary tract involvement is uncommon, its incidence being about 5%. We report the case of a 44 year-old patient with a single left kidney admitted to the urology department of our hospital diagnosed with left-sided hydronephrosis. She also complained of pain in the left renal fossa for more than a month. A study of left obstructive uropathy was performed, revealing a mass effect in the left distal ureter. Given the findings and the patient's history (a single left kidney), we decided to perform ureterectomy and to fix the bladder to the psoas, as well as to perform an intraoperative biopsy. The histopathological report of the surgical specimen confirmed the previous diagnosis of ureteral endometriosis. The patient is currently asymptomatic and has normal renal function (AU)
Subject(s)
Humans , Female , Adult , Endometriosis/complications , Endometriosis/diagnosis , Biopsy/methods , Danazol/therapeutic use , Endometriosis/physiopathology , Endometriosis/surgery , Pyonephrosis/complications , Urography/instrumentation , Urography/methods , Creatinine/analysis , Magnetic Resonance ImagingABSTRACT
OBJECTIVES: To report our experience with laparoscopic pyeloplasty in the treatment of pyeloureteral junction obstruction. METHODS: Between August 2001 and August 2004 14 patients with the diagnosis of pyeloureteral junction obstruction underwent laparoscopic repair. Seven cases had the obstruction on the left side and the other seven on the right side. We describe the technique of laparoscopic dismembered Anderson-Hynes type pyeloplasty, performed to 12 patients in our series. The remainder 2 patients underwent Foley's Y-V plasty and the Fenger's technique. RESULTS: Mean operative time was 199.7 minutes (r: 126-290). There were not intraoperative complications. Mean hospital stay was 4.63 days (r: 3-9). One case of double J catheter obstruction can be cited as late postoperative complication. Only one of the 14 cases suffered a recurrence of the stenosis after double J catheter retrieval. CONCLUSIONS: Laparoscopic pyeloplasty has become the operation of choice in cases of hydronephrosis secondary to crossing vessel, when there is great pyelic dilation, and for the treatment of failures of previous endopyelotomy.
Subject(s)
Kidney Pelvis/surgery , Laparoscopy , Ureteral Obstruction/surgery , Adolescent , Adult , Child , Female , Humans , Male , Middle AgedABSTRACT
OBJECTIVES: To report our experience with a series of 10 patients undergoing radical cystectomy with bladder substitution. We were supported by a better knowledge of the female continence anatomical mechanisms and the demonstration of the oncological viability of the urethral remnant. METHODS: From 1994 to 2002 10 women underwent radical cystectomy with bladder substitution by means of a modified anterior pelvic exanteration; technical modifications to achieve continence preservation are based on: preservation of the distal 2/3 of urethra, pubourethral ligaments and endopelvic fascia, and limitation of lateral vaginal dissection to avoid damage to the striated sphincter innervation. To avoid the neocystocele effect the vagina is fixed to the uterosacral ligaments and to the sacral promontory. RESULTS: Bladder capacity is 332.9 +/- 35.6 ml with a flow of 17.7 ml/sec. Complete continence wax achieved in 8 patients, the remainder 2 present grade II urinary stress incontinence. All of them empty their neobladder satisfactorily; only one patient needed a bladder re-education program. One bladder fistula and diarrhoea in one patient are the complications to be highlighted. CONCLUSIONS: The results obtained with orthotopic neobladder in females, achieving a high satisfaction level and quality of life, stimulate us to continue with this technique.
Subject(s)
Cystectomy , Urinary Bladder Neoplasms/surgery , Aged , Cystectomy/methods , Female , Follow-Up Studies , Humans , Middle Aged , Urologic Surgical Procedures/methodsABSTRACT
OBJETIVO: Presentamos los resultados obtenidos en nuestra serie de nueve mujeres intervenidas de cistectomía con plastia de sustitución. Nos basamos en un mejor conocimiento de los mecanismos anatómicos de la continencia femenina y la demostración de la viabilidad del remanente uretral desde el punto de vista oncológico. MÉTODOS: Desde 1994 a 1999 nueve mujeres han sido operadas de cistectomía radical con plastia de sustitución, mediante una exenteración pelviana anterior. Las modificaciones de la técnica quirúrgica se basan en: conservar los dos tercios distales de la uretra, conservar los ligamentos pubouretrales, preservar la fascia endopélvica y limitar la disección látero vaginal, para guardar así la inervación del esfínter estriado, consiguiendo conservar la continencia. RESULTADOS: La capacidad vesical es de 332,9 ñ 35,6 ml con una flujometría de 17,7 ñ 2,9 ml/ seg. Se ha conseguido continencia total en 7 mujeres, las dos restantes presentan una incontinencia de esfuerzo grado II. Ninguna de ellas presenta problemas de vaciado vesical. Entre las complicaciones destaca una fístula vesical, y diarrea en una paciente. CONCLUSIONES: Los resultados obtenidos en la mujer nos animan a seguir con esta técnica, ya que se consigue un alto nivel de satisfacción y calidad de vida (AU)
