Obstrucción uretral en gatos / Urethral obstruction in cats / Obstrução uretral em gatos

A obstrução uretral é um quadro clínico emergencial, comumente observado em felinos, que pode resultar em sério comprometimento à sua saúde, como lesões renais agudas. Essa afecção pode ter causas mecânica, anatômica ou funcional, e apresentar como principais sintomas a estrangúria, periúria e lambedura excessiva da genitália. O diagnóstico é realizado com base no histórico, exame físico e de imagem, como ultrassonografia e radiografia, sendo a identificação da etiologia de suma importância para instituir o tratamento e diminuir os quadros de recidiva. Ao diagnosticar a doença, o início do tratamento deve ser imediato e intensivo, em virtude do risco de evoluir rapidamente para o óbito. Neste sentido, busca-se corrigir os distúrbios hidroeletrolíticos, fornecer analgesia e realizar a desobstrução uretral, havendo uma variação neste último procedimento, de modo que, a escolha do método mais indicado pode variar de acordo com cada caso. Com base na complexidade em seu estabelecimento, diagnóstico e tratamento, foi objetivado com esse artigo de revisão reunir informações atuais e relevantes, relacionadas ao quadro de obstrução uretral em gatos, procurando enfatizar aspectos clínico, cirúrgico e etiológico da doença, assim como, orientar médicos veterinários no tratamento e prevenção da mesma.(AU)

Urethral obstruction is an emergency clinical condition, commonly observed in cats, that can result in serious commitment of their health, such as acute kidney damage. This condition can have mechanical, anatomical or functional causes, presenting as main symptoms stanguria, periuria and excessive licking of genitals. The diagnosis is based on the history, physical and image exams, such as ultrasound and radiography, being the identification of etiology of great importance to institute the treatment and reduce recurrence. After diagnosing the disease, initiation of treatment needs to be immediate and intensive, because of the risk of evolving quickly to death. In this regard, its necessary to correct hydroelectric disturbances, provide analgesia and perform a urethral clearance, however there is a variation in this last procedure, so the choice of the most suitable method may vary according to each case. Based on the complexity of its establishment, diagnosis and treatment, this review aimed to gather current and relevant information related to urethral obstruction in cats, intending to emphasize clinical and etiological symptoms of the disease, as well as to guide veterinarians in its treatment and prevention.(AU)

La obstrucción uretral es una condición clínica de emergencia, comúnmente vista en gatos, que puede resultar en un deterioro grave de su salud, como daño renal agudo. Esta condición puede tener causas mecánicas, anatómicas o funcionales, y presentar extrañeza, periuria y lamido excesivo de los genitales como síntomas principales. El diagnóstico se realiza con base en la historia, examen físico y de imagen, como ecografía y radiografía, y la identificación de la etiología es de suma importancia para instituir el tratamiento y reducir la recurrencia. Al diagnosticar la enfermedad, el inicio del tratamiento debe ser inmediato e intensivo, debido al riesgo de evolucionar rápidamente a la muerte. En este sentido, buscamos corregir las alteraciones hidroelectrolíticas, aportar analgesia y realizar el aclaramiento uretral, con una variación en este último procedimiento, por lo que la elección del método más adecuado puede variar según cada caso. A partir de la complejidad de su establecimiento, diagnóstico y tratamiento, este artículo de revisión tuvo como objetivo recopilar información actual y relevante relacionada con la condición de obstrucción uretral en gatos, buscando enfatizar los aspectos clínicos, quirúrgicos y etiológicos de la enfermedad, así como orientar a los médicos veterinarios en su tratamiento y prevención.(AU)

Obstrucción uretral en gatos / Urethral obstruction in cats / Obstrução uretral em gatos

A obstrução uretral é um quadro clínico emergencial, comumente observado em felinos, que pode resultar em sério comprometimento à sua saúde, como lesões renais agudas. Essa afecção pode ter causas mecânica, anatômica ou funcional, e apresentar como principais sintomas a estrangúria, periúria e lambedura excessiva da genitália. O diagnóstico é realizado com base no histórico, exame físico e de imagem, como ultrassonografia e radiografia, sendo a identificação da etiologia de suma importância para instituir o tratamento e diminuir os quadros de recidiva. Ao diagnosticar a doença, o início do tratamento deve ser imediato e intensivo, em virtude do risco de evoluir rapidamente para o óbito. Neste sentido, busca-se corrigir os distúrbios hidroeletrolíticos, fornecer analgesia e realizar a desobstrução uretral, havendo uma variação neste último procedimento, de modo que, a escolha do método mais indicado pode variar de acordo com cada caso. Com base na complexidade em seu estabelecimento, diagnóstico e tratamento, foi objetivado com esse artigo de revisão reunir informações atuais e relevantes, relacionadas ao quadro de obstrução uretral em gatos, procurando enfatizar aspectos clínico, cirúrgico e etiológico da doença, assim como, orientar médicos veterinários no tratamento e prevenção da mesma.

Urethral obstruction is an emergency clinical condition, commonly observed in cats, that can result in serious commitment of their health, such as acute kidney damage. This condition can have mechanical, anatomical or functional causes, presenting as main symptoms stanguria, periuria and excessive licking of genitals. The diagnosis is based on the history, physical and image exams, such as ultrasound and radiography, being the identification of etiology of great importance to institute the treatment and reduce recurrence. After diagnosing the disease, initiation of treatment needs to be immediate and intensive, because of the risk of evolving quickly to death. In this regard, it’s necessary to correct hydroelectric disturbances, provide analgesia and perform a urethral clearance, however there is a variation in this last procedure, so the choice of the most suitable method may vary according to each case. Based on the complexity of its establishment, diagnosis and treatment, this review aimed to gather current and relevant information related to urethral obstruction in cats, intending to emphasize clinical and etiological symptoms of the disease, as well as to guide veterinarians in its treatment and prevention.

La obstrucción uretral es una condición clínica de emergencia, comúnmente vista en gatos, que puede resultar en un deterioro grave de su salud, como daño renal agudo. Esta condición puede tener causas mecánicas, anatómicas o funcionales, y presentar extrañeza, periuria y lamido excesivo de los genitales como síntomas principales. El diagnóstico se realiza con base en la historia, examen físico y de imagen, como ecografía y radiografía, y la identificación de la etiología es de suma importancia para instituir el tratamiento y reducir la recurrencia. Al diagnosticar la enfermedad, el inicio del tratamiento debe ser inmediato e intensivo, debido al riesgo de evolucionar rápidamente a la muerte. En este sentido, buscamos corregir las alteraciones hidroelectrolíticas, aportar analgesia y realizar el aclaramiento uretral, con una variación en este último procedimiento, por lo que la elección del método más adecuado puede variar según cada caso. A partir de la complejidad de su establecimiento, diagnóstico y tratamiento, este artículo de revisión tuvo como objetivo recopilar información actual y relevante relacionada con la condición de obstrucción uretral en gatos, buscando enfatizar los aspectos clínicos, quirúrgicos y etiológicos de la enfermedad, así como orientar a los médicos veterinarios en su tratamiento y prevención.

Severe anemia in cats with urethral obstruction: 17 cases (2002-2011).

OBJECTIVE: To characterize clinical parameters of cats with severe anemia due to suspected urinary bladder hemorrhage associated with urethral obstruction. DESIGN: Retrospective case-control study. SETTING: University teaching hospital. ANIMALS: Seventeen cats with urethral obstruction and severe anemia (group "UO-A") that required transfusion were identified via medical record database search. Thirty cats with urethral obstruction and mild or no anemia (group "UO") were included as controls. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The median PCV of all cases at presentation was 28% (range, 9%-47%). Seven cats had PCV ≤20% at presentation, and all transfused cats had PCV ≤20% at the time of transfusion. Three cats did not receive a transfusion despite PCV ≤18%. Cats in the UO-A group had a significantly longer duration of clinical signs (P = 0.001), and were more likely to have a history of previous urethral obstruction (P = 0.011), have a heart murmur (P = 0.002), have a gallop rhythm (P = 0.005), and have lower blood pressure (P = 0.007) compared to those in the UO group. Additionally, UO-A cats had significantly lower pH, more negative base excess, higher BUN, and higher creatinine compared to UO cats. Duration of urinary catheterization was significantly (P = 0.016) longer in UO-A cats. All UO cats survived to discharge, whereas 4/17 (23.5%) UO-A cats were euthanized (P = 0.013). CONCLUSIONS: A history of previous urethral obstruction and longer duration of clinical signs may be important risk factors for severe anemia in UO cats. Additionally, UO-A cats appeared to be more severely affected, as evidenced by lower blood pressure, more severe metabolic acidosis, higher BUN and creatinine, and worse outcome.

Routine Screening Examinations in Attendance of Cats With Obstructive Lower Urinary Tract Disease.

This study evaluates the clinical findings obtained in routine screening examinations in cats with obstructive feline lower urinary tract disease at the time of service. Twenty-six cats with urethral obstruction were assessed by physical examination, blood pressure, electrocardiogram, and laboratory tests. Cats with signs of obstruction less than 36 hours before the service were in a state of alert, with body temperature and heart rate higher compared with cats in lethargy and stupor, obstructed up to 36 hours. The results revealed that 30.76% of the cats were hypertensive (>140mmHg). Arrhythmias were found in 15.38% of the cats with potassium >8.5mEqL. Creatinine, phosphorus, magnesium, potassium, and lactate concentrations were higher in cats obstructed more than 36 hours. All these data claim that a protocol of examinations should be established for obstructed cats, principally to stabilize the cat before the anesthesia for unobstruction.

Cystoscopic placement of transurethral stent in a fetus with urethral stenosis.

We report the case of a fetus with severe megabladder, displaying the 'keyhole' sign on ultrasound imaging, that underwent cystoscopy at 22 weeks' gestation. There was a familial history of mild urethral atresia. Fetal cystoscopy revealed congenital urethral atresia. A guide wire was advanced through the fetal urethra and a transurethral vesicoamniotic stent was placed successfully. The fetus was delivered at 36 weeks' gestation and postnatal cystoscopy confirmed the absence of posterior urethral valves or urethral atresia. The infant was 5 years old with normal renal function at the time of writing. We conclude that fetal cystoscopic placement of a transurethral stent for congenital urethral stenosis is feasible.

Antegrade pressure measurement of urinary tract in children with persistent hydronephrosis.

INTRODUCTION: Dilation of urinary tract occurs without the presence of obstruction. Diagnostic methods that depend on renal function may elicit mistaken diagnosis. Whitaker (1973) proposed the evaluation of urinary tract pressure submitted to constant flow. Other investigators proposed perfusion of renal pelvis under controlled pressure, making the method more physiological and reproducible. The objective of the present study was to evaluate the results of the anterograde pressure measurement (APM) of the urinary tract of children with persistent hydronephrosis after surgery suspected to present persistent obstruction. MATERIALS AND METHODS: Along 12 years, 26 renal units with persistent hydronephrosis after surgery (12 PUJ and 14 VUJ) were submitted to evaluation of the renal tract pressure in order to decide the form of treatment. Previous radionuclide scans with DTPA, intravenous pyelographies and ultrasounds were considered undetermined in relation to obstruction in 10 occasions and obstructive in 16. APM was performed under radioscopy through renal pelvis puncture or previous stoma. Saline with methylene blue + iodine contrast was infused under constant pressure of 40 cm H2O to fill the urinary system. The ureteral opening pressure was measured following the opening of the system and stabilization of the water column. RESULTS: Among the 10 cases with undetermined previous diagnosis, APM was considered non-obstructive in two and those were treated clinically and eight were considered obstructive and were submitted to surgery. Among the 16 cases previously classified as obstructive, nine confirmed obstruction and were submitted to surgery. Seven cases were considered non-obstructive, and were treated clinically, with stable DMSA and hydronephrosis. CONCLUSIONS: APM avoided unnecessary surgery in one third of the cases and was important to treatment decision in 100 %. We believe that this simple test is an excellent diagnostic tool when selectively applied mainly in the presence of functional deficit.

Antegrade pressure measurement of urinary tract in children with persistent hydronephrosis

INTRODUCTION: Dilation of urinary tract occurs without the presence of obstruction. Diagnostic methods that depend on renal function may elicit mistaken diagnosis. Whitaker (1973) proposed the evaluation of urinary tract pressure submitted to constant flow. Other investigators proposed perfusion of renal pelvis under controlled pressure, making the method more physiological and reproducible. The objective of the present study was to evaluate the results of the anterograde pressure measurement (APM) of the urinary tract of children with persistent hydronephrosis after surgery suspected to present persistent obstruction. MATERIALS AND METHODS: Along 12 years, 26 renal units with persistent hydronephrosis after surgery (12 PUJ and 14 VUJ) were submitted to evaluation of the renal tract pressure in order to decide the form of treatment. Previous radionuclide scans with DTPA, intravenous pyelographies and ultrasounds were considered undetermined in relation to obstruction in 10 occasions and obstructive in 16. APM was performed under radioscopy through renal pelvis puncture or previous stoma. Saline with methylene blue + iodine contrast was infused under constant pressure of 40 cm H2O to fill the urinary system. The ureteral opening pressure was measured following the opening of the system and stabilization of the water column. RESULTS: Among the 10 cases with undetermined previous diagnosis, APM was considered non-obstructive in two and those were treated clinically and eight were considered obstructive and were submitted to surgery. Among the 16 cases previously classified as obstructive, nine confirmed obstruction and were submitted to surgery. Seven cases were considered non-obstructive, and were treated clinically, with stable DMSA and hydronephrosis. CONCLUSIONS: APM avoided unnecessary surgery in one third of the cases and was important to treatment decision in 100%. We believe that this simple test is an excellent diagnostic tool when selectively applied mainly in the presence of functional deficit.

Aspectos clínicos e epidemiológicos de gatos com doença do trato urinário inferior felina atendidos no Hospital Veterinário na Universidade Federal de Campina Grande / Clinical and epidemiological aspects of cats with lower urinary tract cat disease attended at the Veterinary Hospital of the Federal University of Campina Grande

Objetivou-se com esta pesquisa analisar descritivamente dados referentes às principais alterações clínicase à epidemiologia dos gatos com DTUIF no Hospital Veterinário no período de 2007 a 2009.Foram estudados 55 animais com sintomas de hematúria, polaciúria, disúria, estrangúria, iscúria, distensãovesical e obstrução uretral. Avaliou-se sexo, idade, dieta e urinálise (densidade, pH, proteína,glicose e sedimento). A incidência da DTUIF foi de 4,6%, sendo 23,6% no mês de maio. Na avaliaçãodo sedimento observou-se cristalúria em 46,5% de animais obstruídos e 41,6% não obstruídos, altaincidência de hematúria em ambas uropatias, proteinúria em 95,3% dos animais obstruídos e pHalcalino. A bacteriúria teve alta incidência em 46,5% dos gatos obstruídos e 50% dos não obstruídos,assim como a piúria. A faixa etária entre 1 e 5 anos de idade correspondeu 76% dos doentes. Houveuma taxa de 18% de recidivas. Concluiu-se que a DTUIF na região estudada acomete mais machosna forma obstrutiva e que a cristalúria não é encontrada apenas em animais obstruídos, sendo a dietaseca o possível fator predisponente e os processos infl amatórios e crônicos são comuns. Os procedimentosde desobstrução requerem assepsia evitando infecção do trato urinário e agravamento daenfermidade(AU)

The objective of this research was to examine descriptive data on the main clinical and epidemiologyof cats with DTUIF Veterinary Hospital in the period 2007 to 2009. We studied 55 animals withsymptoms of hematuria, frequency, dysuria, strangury, iscúria, distended bladder and urethral obstruction.We evaluated sex, age, diet and urinalysis (density, pH, protein, glucose and sediment). Theincidence of DTUIF was 4.6% and 23.6% in the month of May. In the assessment of sediment therewas no signifi cant difference of crystalluria in 46.5% of obstructed animals and 41.6% not blocked,high incidence of hematuria in both uropathy, proteinuria in 95.3% of obstructed animals and alkaline pH. The bacteriuria was highly prevalent in 46.5% of cats and blocked 50% of non-blocked, and the pyuria.The age group between 1 and 5 years of age accounted 76% of patients. There was a 18% rate of recurrence. It wasconcluded that the DTUIF in the region studied affects more males in the obstructive form and crystalluria is notfound only in animals obstructed, and the dry diet possible predisposing factor and inflammatory processes arecommon and chronic. The clearance procedures require aseptic preventing urinary tract infection and worseningof the disease(AU)

Aspectos clínicos e epidemiológicos de gatos com doença do trato urinário inferior felina atendidos no Hospital Veterinário na Universidade Federal de Campina Grande / Clinical and epidemiological aspects of cats with lower urinary tract cat disease attended at the Veterinary Hospital of the Federal University of Campina Grande

Objetivou-se com esta pesquisa analisar descritivamente dados referentes às principais alterações clínicase à epidemiologia dos gatos com DTUIF no Hospital Veterinário no período de 2007 a 2009.Foram estudados 55 animais com sintomas de hematúria, polaciúria, disúria, estrangúria, iscúria, distensãovesical e obstrução uretral. Avaliou-se sexo, idade, dieta e urinálise (densidade, pH, proteína,glicose e sedimento). A incidência da DTUIF foi de 4,6%, sendo 23,6% no mês de maio. Na avaliaçãodo sedimento observou-se cristalúria em 46,5% de animais obstruídos e 41,6% não obstruídos, altaincidência de hematúria em ambas uropatias, proteinúria em 95,3% dos animais obstruídos e pHalcalino. A bacteriúria teve alta incidência em 46,5% dos gatos obstruídos e 50% dos não obstruídos,assim como a piúria. A faixa etária entre 1 e 5 anos de idade correspondeu 76% dos doentes. Houveuma taxa de 18% de recidivas. Concluiu-se que a DTUIF na região estudada acomete mais machosna forma obstrutiva e que a cristalúria não é encontrada apenas em animais obstruídos, sendo a dietaseca o possível fator predisponente e os processos infl amatórios e crônicos são comuns. Os procedimentosde desobstrução requerem assepsia evitando infecção do trato urinário e agravamento daenfermidade

The objective of this research was to examine descriptive data on the main clinical and epidemiologyof cats with DTUIF Veterinary Hospital in the period 2007 to 2009. We studied 55 animals withsymptoms of hematuria, frequency, dysuria, strangury, iscúria, distended bladder and urethral obstruction.We evaluated sex, age, diet and urinalysis (density, pH, protein, glucose and sediment). Theincidence of DTUIF was 4.6% and 23.6% in the month of May. In the assessment of sediment therewas no signifi cant difference of crystalluria in 46.5% of obstructed animals and 41.6% not blocked,high incidence of hematuria in both uropathy, proteinuria in 95.3% of obstructed animals and alkaline pH. The bacteriuria was highly prevalent in 46.5% of cats and blocked 50% of non-blocked, and the pyuria.The age group between 1 and 5 years of age accounted 76% of patients. There was a 18% rate of recurrence. It wasconcluded that the DTUIF in the region studied affects more males in the obstructive form and crystalluria is notfound only in animals obstructed, and the dry diet possible predisposing factor and inflammatory processes arecommon and chronic. The clearance procedures require aseptic preventing urinary tract infection and worseningof the disease

Fetal cystoscopy for severe lower urinary tract obstruction--initial experience of a single center.

OBJECTIVE: To report the experience with fetal cystoscopy and laser fulguration of posterior urethral values (PUV) for severe lower urinary tract obstruction (LUTO). METHODS: Between July 2006 and December 2008, fetal cystoscopy was offered to 23 patients whose fetuses presented with severe LUTO, favorable urinary analysis and gestational age <26 weeks. Fetal urinary biochemistry was evaluated before and after cystoscopy. All infants were followed 6-12 months after birth. Abnormal renal function was defined when serum creatinine higher than 50 micromol/L (2 Standard Deviation) or the necessity of dialysis or renal transplantation. Autopsy was always performed whenever fetal or neonatal deaths occurred. RESULTS: Eleven patients decided to undergo fetal therapy and 12 elected to continue with expectant observation. There was no difference between both groups in gestation age at diagnosis and referral examinations. Urethral atresia was diagnosed in 4/11 (36.4%) fetuses by fetal cystoscopy. At 26 weeks, fetuses that were managed expectantly presented with worse urinary biochemistry results (p < 0.05). Survival rates and percentage of infants with normal renal function were significantly higher in the cystoscopic group than in the expectant group (p < 0.05). CONCLUSIONS: Percutaneous fetal cystoscopy is feasible using a thinner special cannula for prenatal diagnosis and therapy of LUTO. Prenatal laser ablation of the PUV under cystoscopy may prevent renal function deterioration improving postnatal outcome.

Válvula da uretra posterior associada a urinoma perinefrético e ascite urinária / Posterior urethral valve associated to perinephric urinoma and urinary ascitis

A válvula de uretra posterior é a principal causa de obstrução do fluxo urinário na infância. Relatamos um caso de válvula de uretra posterior diagnosticada por uretrocistografia e ultra-sonografia, cuja função renal foi poupada devido a incomuns mecanismos redutores das pressões endovesicais.Seu diagnóstico e tratamento precoces foram decisivos no prognóstico do paciente.

The posterior urethral valve is the main cause of urinal flow obstructionin childhood. Here we report a case of a posterior urethral valve diagnosed by urethrocystography and ultrasonography,whose renal function was saved due to unusual reducing mechanisms of endovesical pressures. The diagnosis and early treatment were decisive in the prognosis of the patient.

Catheter-induced urethral trauma in cats with urethral obstruction.

Fifteen cats were evaluated with urethral obstruction. Penile trauma by catheterization was the major indication for perineal urethrostomy. Ten cats had developed a urethral stricture and five had rupture of the urethra following medical management. All cats had abnormalities in penis and/or prepuce and/or scrotal sacs including hyperemia or swelling. Perineal urethrostomy was performed in all cases and they were evaluated for 6 months after surgery. Few complications were noted. Urinary tract infection was the most frequent complication observed. The clients considered their cats to have a good quality of life following surgery.

Ectopic ureterocele prolapse in a small infant

Objetivo: descrever e discutir um caso de obstrução uretral por ureterocele prolapsada em um bebê do sexo masculino. Relato de caso: uma criança de 4 meses, com infecção urinária persistente, apresentava retenção urinária, déficit de crescimento e dificuldade miccional há dois meses. A ultrassonografia (US)fetal, no terceiro trimestre de gestação, havia sugerido duplicação reno-ureteral, megaureter, hidronefrose, atrofia do pólo renal superior e uma grande ureterocele à direira / Objective: to describe and discuss a case of urethral obstruction by a prolapsed ureterocele in a male baby. Case report: a 4-months-old male presented a persistent urinary tract infection, urinary retention, failure to thrive and strained to void for two months. A fetal ultrasonography in the third gestational trimester suggested right renoureteral duplication with associated megaureter, hydronephrosis, parenchymal atrophy and a huge ureterocele...

Discordant lower urinary tract obstruction in early twin gestations: management and outcome.

OBJECTIVE: To report our experience with the management of twin pregnancies discordant for lower urinary tract obstruction. METHODS: Cases of twin pregnancies discordant for lower urinary tract obstruction were identified from our fetal medicine database. Information on ultrasonographic findings, antenatal course, pregnancy complications, and perinatal outcome was obtained by reviewing medical records or contacting the referring obstetricians. RESULTS: Five twin pregnancies discordant for lower urinary tract obstruction were diagnosed between 11 and 15 weeks of gestation. There were 3 dichorionic and 2 monochorionic pregnancies (1 diamniotic and 1 monoamniotic). The dichorionic pregnancies were managed conservatively, resulting in a pregnancy loss of both twins in 1 case, a single fetal death at 29 weeks in 1 case, and an early neonatal death due to lung hypoplasia of the affected twin in 1 case. On the other hand, both monochorionic twin pregnancies were managed with serial vesicocenteses. In both cases, the prenatal course was complicated, 1 by premature rupture of the membranes and the other by cord entanglement, requiring delivery at 29 and 31 weeks, respectively. Among the 4 continuing pregnancies with complete perinatal outcome, none of the affected twins survived, and the structurally normal twins were delivered between 29 and 36 weeks and discharged from the hospital in good condition. CONCLUSION: Twin pregnancies discordant for lower urinary tract obstruction are at high risk of perinatal death and premature delivery. Prenatal intervention seems not to be associated with an improved perinatal outcome of the affected twin, but it may be beneficial in selected cases to attain viability of the unaffected twin.

Compresión y obstrucción uretral y tracción vesical por mioma del cuerpo uterino / Vesical and uretral obstruction by uterine fibroma

La miomatosis uterina es la patología uterina más frecuente como responsable de la histerectomía abdominal total, cuando produce sangrado, crecimiento rápido y/o dolor. La obstrucción uretral, elongación vesical y tracción uretral al grado uretelopieloectasis, es asombrosamente rara. Presentamos el caso de una paciente nuligrávida de 44 años vista de carácter emergente por dolor en hipogastrio, urgencia urinaria y oliguria de 6 horas de duración. Al examen se detecta útero aumentado como de 16 semanas de gestación duro, impactado en fosa pélvica. La ultrasonografía confirma mioma. El pielograma revela ureteropieloectasia. Creatinina 3.6 mgs. Previa miomectomía abdominal total y salpingo-oforectomí bilateral...(AU)

Compresión y obstrucción uretral y tracción vesical por mioma del cuerpo uterino / Vesical and uretral obstruction by uterine fibroma

La miomatosis uterina es la patología uterina más frecuente como responsable de la histerectomía abdominal total, cuando produce sangrado, crecimiento rápido y/o dolor. La obstrucción uretral, elongación vesical y tracción uretral al grado uretelopieloectasis, es asombrosamente rara. Presentamos el caso de una paciente nuligrávida de 44 años vista de carácter emergente por dolor en hipogastrio, urgencia urinaria y oliguria de 6 horas de duración. Al examen se detecta útero aumentado como de 16 semanas de gestación duro, impactado en fosa pélvica. La ultrasonografía confirma mioma. El pielograma revela ureteropieloectasia. Creatinina 3.6 mgs. Previa miomectomía abdominal total y salpingo-oforectomí bilateral...

Prenatal intervention for urinary obstruction and myelomeningocele

Widespread use of ultrasonography has resulted in an increase in the recognition of fetal hydronephrosis. The enthusiasm that accompanied early interventions has been tempered by the experience and results obtained over the past 2 decades. The goal has remained the same: to identify patients with serious prenatal obstruction and to identify those which may benefit from intervention. Myelomeningocele remains a devastating congenital anomaly. Fetal and experimental studies suggested that patients with myelomeningocele could benefit from prenatal intervention. Advances in technology and perinatal management have made intervention for more complex malformations such as myelomeningocele possible. This article will review current knowledge and will detail rational management for the management of prenatal hydronephrosis. The current state of antenatal myelomeningocele repair and the urologic implications will be described as well.

Prenatal intervention for urinary obstruction and myelomeningocele.

Widespread use of ultrasonography has resulted in an increase in the recognition of fetal hydronephrosis. The enthusiasm that accompanied early interventions has been tempered by the experience and results obtained over the past 2 decades. The goal has remained the same: to identify patients with serious prenatal obstruction and to identify those which may benefit from intervention. Myelomeningocele remains a devastating congenital anomaly. Fetal and experimental studies suggested that patients with myelomeningocele could benefit from prenatal intervention. Advances in technology and perinatal management have made intervention for more complex malformations such as myelomeningocele possible. This article will review current knowledge and will detail rational management for the management of prenatal hydronephrosis. The current state of antenatal myelomeningocele repair and the urologic implications will be described as well.

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.