Mullerianosis vesical / Mullerianosis of the urinary bladder

La mullerianosis vesical, entidad raramente descrita, fue definida por primera vez en 1996 por Young y Clement como la combinación de al menos 2 tipos de tejido ectópico de origen mulleriano (endometriosis, endocervicosis y endosalpingiosis) en el espesor de la pared vesical. Se ha intentado explicar su origen tanto por un mecanismo de implantación como metaplásico. El carácter cíclico de la sintomatología, que puede aparecer hasta en el 50% de las pacientes, debería hacer sospechar su presencia. Aunque la resección transuretral tiene un valor diagnóstico indudable, el carácter transmural de la lesión aconseja su exéresis completa (cistectomía parcial), como ocurrió en nuestro caso (AU)

Müllerianosis of the urinary bladder, a rare entity, was first defined by Young and Clement in 1996 as the combination of at least two types of ectopic tissue of Müllerian origin (endometriosis, endocervicosis, and endosalpingiosis) in the bladder wall. Theories of implantation or metaplasia have been proposed to explain the origin of this entity. Recurrent or cyclic symptomatology, which is reported in up to 50% of patients, is highly suspicious of müllerianosis of the bladder. Although transurethral resection is useful in diagnosis, complete removal of the lesion (partial cystectomy) is highly advisable, as performed in the patient presented herein (AU)

[Nephron sparing renal surgery as salvage treatment after failure of radiofrequency thermal ablation in a patient with a single kidney and renal adenocarcinoma]. / Cirugía renal conservadora de nefronas como tratamiento de rescate tras fracaso de la termoablación mediante radiofrecuencia en paciente monorreno con adenocarcinoma renal.

OBJECTIVES: To describe the technique of renal radiofrequency (RF) thermal ablation. Case report of a successful nephron-sparing surgery after failure of the RF thermal ablation of a renal adenocarcinoma in a patient with a single kidney. METHODS: A patient presenting with a renal adenocarcinoma in a single left kidney was treated by RF thermal ablation. The failure of the technique was patent on follow-up after demonstration of a central area of necrosis surrounded by a peripheral contrast enhancing area. Nephron sparing surgery was indicated as salvage procedure. RESULTS: Surgical excision of the tumor with a safety margin, without renal pedicle clamping was undertaken. Fat tissue and hemostatic synthetic material were placed in the surgical bed. Pathology report: renal adenocarcinoma with changes secondary to central necrosis. Twenty-four month postoperative follow-up: fatty renal nodule with small fibrous tracts inside in the area of the tumor. No evidence of contrast enhancing areas. Normal renal function (sCr 0.7 mg/dl, urea 24 mg/dl). CONCLUSIONS: Radiofrequency thermal ablation is a relatively new technique. Its oncological efficacy greatly depends on appropriate case selection. One of its main caveats is achieving an area of tissue ablation enough to completely destroy the tumor. When the technique fails, renal surgery (nephron sparing or not) seems to be the most recommended alternative.

Cirugía renal conservadora de nefronas como tratamiento de rescate tras fracaso de la termoablación mediante radiofrecuencia en paciente monorreno con adenocarcinoma renal / Nephron sparing renal surgery as salvage treatment after failure of radiofrequency thermal ablation in a patient with a single kidney and renal adenocarcinoma

OBJETIVO: Descripción de la técnica de la termoablación renal mediante radiofrecuencia (TARF). Presentación de una cirugía renal conservadora de nefronas como tratamiento exitoso de rescate tras fracaso de la TARF de un adenocarcinoma renal en un paciente monorreno quirúrgico. MÉTODOS: Un adenocarcinoma renal izquierdo parcialmente exofítico en un paciente monoreno es tratado mediante TARF. En el seguimiento de la misma se observa fracaso de dicha técnica al comprobar la existencia de una zona central necrótica rodeada de una zona periférica captadora de contraste. Se decide cirugía renal conservadora como técnica de rescate. RESULTADOS: Extirpación quirúrgica del tumor y tejido renal próximo con margen de seguridad, sin clampaje del pediculo renal. Aposición de tejido graso y material hemostático sintético en el lecho quirúrgico Estudio anatomopatológico: adenocarcinoma renal con cambios secundarios a necrosis en su zona central. Seguimiento postcirugía de 18 meses: nódulo graso renal con pequeños tractos fibrosos en su interior en la zona previamente ocupada por el tumor. Sin evidencia de ninguna zona captante de contraste en el TAC. Función renal normal (Crp 0,7 mg/dl, Urea 24 mg/dl). CONCLUSIONES: La TARF es una técnica relativamente nueva. Su eficacia oncológica depende en gran medida de la selección adecuada de los casos a tratar. Uno de sus principales problemas radica en el hecho de conseguir una zona de ablación tisular suficiente como para destruir totalmente el tumor. En caso de fracaso de la técnica, la cirugía renal (conservadora de nefronas o no) parece la alternativa mas recomendada

OBJECTIVES: To describe the technique of renal radiofrequency (RF) thermal ablation. Case report of a successful nephron-sparing surgery after failure of the RF thermal ablation of a renal adenocarcinoma in a patient with a single kidney. METHODS: A patient presenting with a renal adenocarcinoma in a single left kidney was treated by RF thermal ablation. The failure of the technique was patent on follow-up after demonstration of a central area of necrosis surrounded by a peripheral contrast enhancing area. Nephron sparing surgery was indicated as salvage procedure. RESULTS: Surgical excision of the tumor with a safety margin, without renal pedicle clamping was undertaken. Fat tissue and hemostatic synthetic material were placed in the surgical bed. Pathology report: renal adenocarcinoma with changes secondary to central necrosis. Twenty-four month postoperative follow-up: fatty renal nodule with small fibrous tracts inside in the area of the tumor. No evidence of contrast enhancing areas. Normal renal function (sCr 0.7 mg/dl, urea 24 mg/dl). CONCLUSIONS: Radiofrequency thermal ablation is a relatively new technique. Its oncological efficacy greatly depends on appropriate case selection. One of its main caveats is achieving an area of tissue ablation enough to completely destroy the tumor. When the technique fails, renal surgery (nephron sparing or not) seems to be the most recommended alternative

[Urologic damage of the primary antiphospholipid syndrome]. / Manifestaciones urológicas del síndrome antifosfolípido primario. Vejiga neurógena.

OBJECTIVES: To perform a review and update of the antiphospholipid syndrome summarizing its urological presentations. METHODS: A complete bibliographic search was performed through PubMed MEDLINE and articles were reviewed with special attention to those bibliographic references about urological presentations. We document the unique and unpublished case of a patient with neurogenic bladder secondary to antiphospholipid syndrome. RESULTS/CONCLUSIONS: The antiphospholipid syndrome is an acquired autoimmune systemic disease generating a permanent hypercoagulability status with recurrent multiorgan thrombotic events due to circulating antiphospholipid antibodies. It may be secondary to a heterogeneous group of diseases (mainly lupus) and drugs, or primary if it appears isolated without any demonstrable systemic disease or concomitant medication. It is mainly characterized by venous or arterial recurrent thrombosis, recurrent abortion, thrombocytopenia, and circulating antiphospholipid auto-antibodies. Treatment with anticoagulants and correction of the hypercoagulable status contributing factors, arterial or venous thrombosis, and vascular risk aim to avoid new thrombosis episodes. Genitourynary system may be affected in any of its parts, generally by arterial or venous thrombosis. Kidney is the most frequently affected organ, in addition to transplanted kidney grafts, adrenal glands, bladder and testicles. There is a relationship between antiphospholipid syndrome and infertility. For the first time, we describe bladder involvement presenting as hyperreflexic neurogenic bladder with detrusor-sphincter dyssynergia after spontaneous spinal cord thrombosis in an asymptomatic adolescent with primary antiphospholipid syndrome which was unknown before.

[Ureteroplasty using the appendix: apropos of a case]. / Ureteroplastia con apéndice: a propósito de un caso.

OBJECTIVE: To report a case of ureteroplasty using the vermiform appendix. METHODS: Herein we describe a patient who underwent partial resection of the ureter due to a neoplasm. The ureteral defect was repaired using the vermiform appendix. The surgical technique and the results achieved are presented and the literature is briefly reviewed. RESULTS/CONCLUSIONS: The few cases reported in the literature and the case described herein show the utility of the vermiform appendix for ureteral substitution in specific cases where this procedure is indicated.

Ureteroplastia con apéndice: a propósito de un caso / Uteroplasty with vermiform appendix: A case report

Objetivo: Comunicar un caso de uso de apéndice para reparar un defecto ureteral. Dado el escaso número de referencias en la literatura nos parece interesante aportar una más para recordar este procedimiento.Métodos: Se presenta un caso clínico en el cual por proceso neoplásico es necesario resecar parcialmente uréter, y su posterior reconstrucción. Se expone la técnica quirúrgica y la evolución.Resultados/conclusiones: Haciendo una breve revisión de la literatura y demostrando como ejemplo nuestra propia experiencia nos parece que el apéndice vermiforme es un buen sustituto ureteral en casos determinados y bajo ciertas indicaciones clínicas (AU)

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