[Spontaneous extraperitoneal bladder perforation in an elderly patient with genitalia prolapse]. / Rotura vesical espontánea en paciente senil con prolapso genital.

There are many etiologic reasons which explain the bladder perforation. Bladder injuries happen most commonly in poli-traumatisms (traffic accident), blunt trauma, penetrating injury and iatrogenic injury (surgery, laparoscopic...). However, there is not always a vigorous, direct, extern and blunt agent causing the rupture. In the case reported the extraperitoneal bladder rupture started after a smooth perineal injury caused when the patient seated down. The patient already suffered from a cystocele III/IV plus uterine prolapse for a long time ago.

Rotura vesical espontánea en paciente senil con prolapso genital / Spontaneous extraperitoneal bladder perforation in an elderly patient with genitalia prolapse

Son múltiples y diversas las causas etiológicas de la rotura vesical. Los politraumatismos (accidentes de tráfico), el traumatismo directo abdominal, cerrado o abierto, y las lesiones y atrogénicas (cirugía abierta, endocirugía, cateterismo uretral) figuran entre las más frecuentes; sin embargo, la rotura vesical no siempre exige para su producción un enérgico, violento, directo y evidente agente externo que la provoque. En el caso que a continuación se comunica, la rotura vesical extraperitoneal tuvo su origen en un leve traumatismo perineal ocasionado al sentarse la paciente , la cual presentaba y padecía desde mucho tiempo atrás un cistocele grado III/IV acompañado de prolapso uterino (AU)

There are many etiologic reasons which explain the bladder perforation. Bladder injuries happen most commonly in poli-traumatisms (traffic accident), blunt trauma, penetrating injury and iatrogenic injury (surgery, laparoscopic…). However, there is not always a vigorous, direct, extern and blunt agent causing the rupture. In the case reported the extraperitoneal bladder rupture started after a smooth perineal injury caused when the patient seated down. The patient already suffered from a cystocele III/IV plus uterine prolapsed for a long time ago (AU)

[The persistence of the müllerian duct]. / Persistencia del conducto Mülleriano.

OBJECTIVE: To report two rare cases of persistent müllerian duct syndrome. METHODS/RESULTS: Two patients with normal chromosome studies (46, XY) are presented. The radiological evaluation showed structures compatible with those of the müllerian duct. These structures were completely excised with excellent results. The histological findings confirmed the clinical diagnosis. CONCLUSIONS: Persistent müllerian duct syndrome is a rare form of male pseudohermaphroditism that presents difficulties in making the differential diagnosis from other conditions with a different etiopathogenesis and that are not completely defined.

[Ureteral iatrogenic disease of obstetric-gynecologic origin]. / Yatrogenia ureteral de origen obstetro-ginecológico.

OBJECTIVE: To review our experience in the diagnosis and management of ureteral injuries secondary to obstetric and gynecologic procedures. METHODS: During the last 25 years, 42 patients were treated at our center for iatrogenic ureteral injuries (45 renal units) associated with obstetric and gynecologic procedures, principally hysterectomy via the abdominal approach (29 cases). The injury was diagnosed in the immediate postoperative period in 21 of the 42 cases. Surgical management was frequently by ureteroneocystostomy. Patient follow-up ranged from 3 months to 11 years. RESULTS: Good results were obtained in 83.3% of the cases. CONCLUSIONS: Ureteral injuries detected intraoperatively should be immediately repaired. For those diagnosed postoperatively, management by retrograde or antegrade catheterization and/or US or CT-guided percutaneous nephrostomy should be attempted before performing surgery.

[Sarcomatoid renal carcinoma]. / Carcinoma renal sarcomatoide.

OBJECTIVE: To analyze the pathological and clinical features of a variant of renal carcinoma: sarcomatoid renal carcinoma. METHODS: Of 316 patients diagnosed as having a renal tumor from 1975 to 1995, 11 (3.5%) with a pathological diagnosis of sarcomatoid renal carcinoma were analyzed. The clinical history, biological data and diagnostic imaging findings of these patients were reviewed. All patients had undergone surgical exploration. RESULTS: All the tumors showed a double cellular population, with a fusiform component. Histological analysis showed a high grade and stage tumor. Ten patients died from the disease, the mean survival rate was 9 months (range 2-48) following diagnosis. CONCLUSIONS: Sarcomatoid carcinoma of the kidney is uncommon and can be occasionally difficult to distinguish from sarcoma. It has a worse prognosis than other variants of renal carcinoma.

[Urothelial tumors of the upper urinary tract: epidemiologic study, diagnostic assessment, and treatment]. / Tumores uroteliales del tracto urinario superior: estudio epidemiológico, evaluación diagnóstica y terapéutica.

OBJECTIVES: The result of an epidemiological study and evaluation of diagnosis and treatment of transitional cell tumors of the upper urinary tract are presented. MATERIAL AND METHODS: A retrospective study was conducted on 34 patients with transitional cell tumor of the upper urinary tract. RESULTS: The most common symptom was intermittent hematuria. Smoking was found to be the most important risk factor and 41.7% of the cases previously had a bladder cancer. IVP was the diagnostic technique most commonly utilized (61.7%). Nephroureterectomy was performed in 58.8% of the cases. Six cases had recurrence of the upper urinary tract tumor. There were 9 deaths (26.5%). CONCLUSIONS: The epidemiological data are similar to those of larger series. The tumors appear to develop in the presence of generalized urothelial disease. The low incidence of recurrence in the ipsilateral ureteral meatus indicates that resection of the distal ureter may not be required in patients at high risk.

[Obstructive uropathy as a complication of aortic disease and reconstructive peripheral vascular surgery: report of 4 cases and review of the literature]. / Uropatía obstructiva como complicación de la patología aórtica y de la cirugía reconstructiva vascular periférica: presentación de 4 casos y revisión de la literatura.

OBJECTIVES: Ureteral injury can be a complication of peripheral vascular reconstructive surgery or aneurysm of the abdominal aorta. The present study analyses 4 cases of obstructive uropathy; 3 following peripheral vascular reconstructive surgery and 1 from aneurysm of the abdominal aorta. METHODS: All 4 patients were prospectively evaluated. RESULTS: Both renal units were compromised in all 4 cases. The initial management consisted of internal urinary diversion with a double J catheter. Ureterolysis was performed in one case of unresolved uropathy secondary to prior bypass surgery. One case with uropathy due to infection of the vascular prosthetic graft required graft replacement. CONCLUSIONS: The risk of ureteral injury is likely to be seen more often due to the increasing number of operations on the vascular tree and enhanced survival of patients with aortic aneurysm. Prevention of the foregoing complication includes doing US and/or IVP early postoperatively and in the first 4 months following surgery. Patient management is initially conservative.

[Biologic behavior of human chorionic gonadotropin hormone (HCGH) in transitional cell carcinomas of the bladder]. / Comportamiento biológico de la hormona gonadotropina coriónica humana (HGCH) en los carcinomas vesicales de células transicionales.

Transitional cell carcinoma of the bladder carries a high rate of local recurrence and 15%-30% of the cases progress to advanced stages of the disease. The multiple forms of the tumor make it difficult to find reliable diagnostic elements of tumor evolution and some authors have advocated the use of tumor markers for the diagnosis and follow-up of malignant bladder tumors. This study was conducted to determine the biological behaviour of the HCG beta subunit it transitional cell carcinoma of the bladder. One hundred patients were entered into the study; the control group comprised 30 healthy subjects and the patient group comprised 70 cases of transitional cell carcinoma of the bladder. The results showed the HCG beta subunit increased with the size and degree of tumor infiltration, although the data were not statistically significant. Similarly, analysis of the degree of tumor differentiation/non differentiation provided no statistically significant data.

[Basic concepts in the use of tumor markers in the diagnosis and follow-up of malignant bladder neoplasms]. / Conceptos básicos en la utilización de los marcadores tumorales en el diagnóstico y seguimiento de las neoplasias vesicales malignas.

The absence of reliable diagnostic elements for the evaluation of malignant bladder tumors and the low sensitivity of the conventional diagnostic methods have prompted studies on the biological behaviour of this tumor type. The well known studies of Gold and Freedman and the recent investigations of Bates and Logo have proposed using tumor markers for early diagnosis and follow-up of different types of malignant tumors. However, the "ideal" tumor marker, one that is sufficiently sensitive and specific, has as yet to be discovered. We reviewed the tumor markers widely utilized to diagnose and follow-up malignant bladder tumors, and describe their main features. It must be pointed out that the lack of sensitivity and specificity of these tumor markers have led to the development of a new generation of tumor markers, such as cytogenetic markers, oncogenes, etc. Undoubtedly, this review of the literature will become obsolete with the advent of subsequent generations of tumor markers.

[Conservative treatment of ureteral iatrogenesis of gynecologic origin]. / Manejo conservador de la yatrogenia ureteral de origen ginecológico.

Five patients with iatrogenic ureteral injuries are described herein. Two patients had a vesicoureteric fistula and the remaining three patients had obstructive uropathy secondary to ligation with resorbable material during hysterectomy for a benign uterine condition, which spontaneously resolved with conservative management. Classically, the approach of this type of lesion was interventional and careful patient selection afforded the possibility of definitive resolution. US, CT and modern endourological technology have facilitated temporary diversion via percutaneous nephrostomy (or surgery, if the foregoing is not possible) to protect renal function during the process of recanalization of the injured ureter. Furthermore, it permits radiological control of the course and functional assessment of the excretory tract.

[Urological surgery in the octogenarian: excessive preconceptions?]. / Cirugía urológica en el octogenario: demasiados prejuicios?

We reviewed the records of 277 patients aged 80 or older that had been considered for surgery during the period 1980-1990. We analyzed the surgical risk (Goldman and ASA score), patient history, type of surgery and the post-operative course (Karnofsky index) in order to identify the risk factors and to permit objective and practical selection of patients amenable to surgical treatment. Overall, regardless of sex, the benign (35%) and malignant (18%) diseases of the prostate and bladder neoplasms (30%) accounted for more than 80% of the surgical procedures. The early postoperative complications were shown to be influenced by the type of surgery (emergency surgery), the approach (open surgery), the presence of preoperative urinary tract infections and the ASA score. Regardless of the cure rate, the analysis of the postoperative course and data gleaned from telephone interviews indicate that 61.5% of the patients probably had a very good or good quality of life at 6 months. In the non-operated group 1 out of 10 procedures that had been anticipated was not performed and many had a malignant disease. Although there were more patients with fair/poor quality of life in the patient group that did not undergo surgery than in the operated group (42.8% versus 28.5%, respectively), patient general condition at 6 months was very good or good in 50% of the patients that were followed or interviewed. The use of the preoperative evaluation methods and our clinical experience can eliminate subjective evaluation and permit developing safe and precise surgical programs.

[THe clinical aspects of benign prostatic hypertrophy: the times are changing]. / Aspectos clínicos de la hiperplasia benigna de la próstata: los tiempos cambian.

To determine if the incidence of benign prostatic hypertrophy (BPH) had increased in the general population and to reevaluate the therapeutic approaches, we reviewed and compared the clinical records, surgical procedures and therapeutic results achieved in 198 patients that had undergone surgery in 1980 (52 patients) and 1990 (146 patients). We observed that the number of BPH procedures had increased in 1990. These, however, had been performed earlier in the course of the disease, in younger patients with more severe, but better controlled pathologies.

[Spinal cord compression by epidural metastases of urologic tumors]. / Síndrome de compresión medular por metástasis epidurales de tumores urológicos.

We report our experience of 5 consecutive cases of acute spinal cord compression from epidural metastasis of genitourinary tumors seen over a period of 14 months. Three patients developed paraplegia and the remaining two patients developed paraparesis of the lower extremities. Four patients underwent emergency decompression laminectomy and the remaining patient received spot radiotherapy to the metastatic vertebral lesion. The degree of neurologic deterioration and its rapid progression to the more severe forms have significantly influenced patient quality of life and survival. The literature is reviewed highlighting the epidemiological, physiopathological, clinical, diagnostic and therapeutic aspects of this condition.

[Penile metastases. Report of 3 new cases and review of the national literature]. / Metástasis peneanas. Aportación de tres nuevos casos y revisión de la literatura nacional.

Penile metastasis from primary tumors at other sites are extremely rare. To our knowledge, Alonso Gorrea reported the first case in the Spanish literature in 1980. Since then, 20 cases have been reported. Three additional cases of penile metastasis from tumors at other sites are described herein. The pathogenesis, symptoms, prognosis and treatment of this tumor type are discussed.

[Leiomyoma of the lower urinary tract]. / Leiomiomas de tracto urinario inferior.

Tumors of mesothelial origin account for 1-5% of all vesical neoplasms. Leiomyomas, although rare, are the most frequently encountered. Three patients diagnosed as having leiomyoma are presented. Two had leiomyoma of the bladder and one had leiomyoma of the distal urethra. The etiopathogenesis, diagnosis and treatment of this tumor type are discussed.

[Priapism secondary to phenothiazines]. / Priapismo secundario a fenotiazinas.

We report two cases of priapism in patients previously treated with neuroleptic agents. None of these patients had a previous history of urological or hematological disorders. These two patients warranted emergency treatment by punction-aspiration of the corpora cavernosa and posterior cavernospongiosa shunt. The foregoing approach achieved penile detumescence in both cases. Excellent results were achieved relative to erectile function in one patient. Although the mechanism responsible for phenothiazine-induce priapism has as yet not been elucidated, it has been suggested that this might be due to adrenergic block which directly inhibits the sympathetic impulse of detumescence.

[Bladder endometriosis: review and presentation of 2 new cases]. / Endometriosis vesical: revisión y presentación de dos neuvos casos.

Two cases of vesical endometritis in two women aged 48 and a 46 years respectively are presented. Both cases were detected incidentally during a gynecological and vesical ultrasound study and the diagnosis was confirmed by cystoscopy and transurethral resection and histopathological exam. An exhaustive literature review is also presented and we insist on the rare presentation and the relatively specific clinical symptoms. A special note is made on the cystoscopic findings and on the different treatment techniques, including the latest approach with LH-RH analogues and/or transurethral photocoagulation with laser rays.