Pelvic exenteration for gynecologic malignancies: Postoperative complications and oncologic outcomes. / Exenteración pélvica para neoplasias ginecológicas: Complicaciones postoperatorias y resultados oncológicos.

INTRODUCTION AND OBJECTIVE: To evaluate complications, morbidity and oncologic outcomes of pelvic exenteration as treatment for gynecologic malignancies. MATERIALS AND METHODS: Between 2008 and 2015, a total of 35 patients underwent pelvic exenteration, due to recurrence of gynecological cancer. Surgical outcomes, early and late postoperative complications, and recurrence/survival outcomes were assessed. RESULTS: Mean patient age was 53.8 years. Anterior exenteration was done in 20 patients, while 15 were total exenterations. Ileal conduit was done in 24 patients, while 8 received a neobladder and 3 a cutaneous ureterostomy. Postoperative complications were divided in 2groups, early (<30 days) and late complications (>30 days). A total of 25 patients (71.4%) had one or more early complications; 16 (45.7%) had fever due to a urinary tract infection, pyelonephritis or intra-abdominal collection; 2 (5.7%) developed a vesicovaginal fistula; 4 (11.4%) a rectovaginal fistula; 3 (8.5%) acute kidney failure and one (2.85%) uronephrosis. Regarding to late complications, 8patients (22.8%) had fever. Six (17%) presented with uronephrosis, and 5 (14.2%) with ureteral-pouch stricture. Five patients (14.2%) had acute renal insufficiency, 3 (8,6%) rectovaginal fistula and one (2.85%) urinary fistula. Mean follow up time was 20.3 month (2-60). A total of 22patients (62.8%) were free of disease. Another 13 (37.1%) patients relapsed. Only 4 (11.4%) patients died after pelvic exenteration due to underlying disease. CONCLUSION: Pelvic exenteration has a high rate of complications and morbidity, but can be the last curative opportunity in patients with recurrent or persistent gynecologic malignancies. This procedure should be performed by multidisciplinary, experienced teams in a tertiary medical center.

Reconstrucción nde la uretra posterior postrauma por via perineal / Postraumatic posterior urethra reconstruction through a perineal approach

Introducción y objetivos: La lesión de la uretra posterior postrauma es un complejo problema a resolver en un paciente que, probablemente por meses, ha transitado por el consultorio y quirófano de varios especialistas para resolver las distintas alteraciones generadas por el accidente. Una de las maneras de resolver la estrechez es por via perianal realizando una anastomosis bulboprostática. El objetivo de esta presentación es evaluar los resultados obtenidos con este abordaje. Métodos: Se presenta la evolución de 22 pacientes con lesión de la uretra posterior operados por vía perianal. El rango de seguimiento osciló entre los 12 y 101 meses, con una media de 48,2 meses. Cuarenta por ciento de los pacientes tenían intentos de realinación en agudo. Los pacientes se controlaron el primer año con endoscopia, uretrografía y flujometría. Luego del año, con flujometría y endoscopia en los que la aceptaron. Resultados: La cirigía fue exitosa en 21 pacientes (95,4 por ciento). Ningún paciente necesitó de otro precedimiento, salvo dos (9 por ciento), a quienes realizamos una uretrotomía interna a los 13 y 20 meses del posoperatorio. Se registró un solo fracaso que necesito de una segunda reconstrucción, con buena evolución posterior. Un paciente perdió la función sexual a causa de la cirugía y dos la recuperaron luego de la misma. Conclusión: De acuerdo a nuestra experiencia, el abordaje perineal y la anastomosis bulboprostática es una opción segura y que generalmente no necesita de otro procedimiento complementario. En un mínimo porcentaje, la función sexual puede ser afectada(AU)

Reconstrucción nde la uretra posterior postrauma por via perineal / Postraumatic posterior urethra reconstruction through a perineal approach

Introducción y objetivos: La lesión de la uretra posterior postrauma es un complejo problema a resolver en un paciente que, probablemente por meses, ha transitado por el consultorio y quirófano de varios especialistas para resolver las distintas alteraciones generadas por el accidente. Una de las maneras de resolver la estrechez es por via perianal realizando una anastomosis bulboprostática. El objetivo de esta presentación es evaluar los resultados obtenidos con este abordaje. Métodos: Se presenta la evolución de 22 pacientes con lesión de la uretra posterior operados por vía perianal. El rango de seguimiento osciló entre los 12 y 101 meses, con una media de 48,2 meses. Cuarenta por ciento de los pacientes tenían intentos de realinación en agudo. Los pacientes se controlaron el primer año con endoscopia, uretrografía y flujometría. Luego del año, con flujometría y endoscopia en los que la aceptaron. Resultados: La cirigía fue exitosa en 21 pacientes (95,4 por ciento). Ningún paciente necesitó de otro precedimiento, salvo dos (9 por ciento), a quienes realizamos una uretrotomía interna a los 13 y 20 meses del posoperatorio. Se registró un solo fracaso que necesito de una segunda reconstrucción, con buena evolución posterior. Un paciente perdió la función sexual a causa de la cirugía y dos la recuperaron luego de la misma. Conclusión: De acuerdo a nuestra experiencia, el abordaje perineal y la anastomosis bulboprostática es una opción segura y que generalmente no necesita de otro procedimiento complementario. En un mínimo porcentaje, la función sexual puede ser afectada

[Stenosis in kidney transplantation]. / Estenosis en el transplante renal.

OBJECT: Evaluate the incidence of ureterovesical stenosis in the renal transplant and its outcomes in the evolution of the allograft. MATERIAL AND METHOD: Seventy three renal transplants were made between August 1988 and December 1995 in Italian Hospital in Buenos Aires. The mean follow up period was 35 months. The incidence of ureterovesical stenosis and its outcomes in the renal allograft were evaluated. Seven cases of ureterovesical stenosis were found. Clinic diagnosis was made in all cases (decreased filtration, diuresis rythm diminished, pain over the implant) confirmed with ecography that showed hydronefrosis and pielography percutaneous anterograde to check the cause of obstruction. Time elapsed between transplant and diagnosis of stenosis varied from 2 to 23 months. Inicial treatment was percutaneous derivation and then in all cases where renal function was recovered ureterovesical reimplant was made out, but ureterotomy in one of them. RESULTS: Incidence of ureterovesical stenosis was 9.58% (seven patients). Two of the patients keep an adequate renal function, one has altered renal function, the forth lost the implant due to pyelonephritis, and the other three lost the implant due to cronic rejection between 6 and 18 months after diagnosis and treatment of stenosis. CONCLUSIONS: Ureterovesical stenosis is an important cause for lost of renal allograft. Imaging is outstanding for diagnosis. Definitive treatment can be made by open reconstructive operation or endoscopy.

[Liposarcoma of the renal sinus]. / Liposarcoma del seno renal.

The authors describe a case of liposarcoma of the renal sinus, a relatively uncommon tumor site. We briefly review its pathogenesis and underscore the importance of the preoperative differential diagnosis, particularly from other tumor masses that are often difficult to distinguish.

[Low-dose BCG in the therapy of superficial neoplasms of the bladder]. / BCG a baja dosis en la terapia de las neoplasias superficiales vesicales.

The preliminary results of a randomized ongoing study performed in order to evaluate the efficacy and the relative toxicity of a low dose (75 mg). BCG regimen in the treatment of superficial bladder cancer were considered. Ninety-eight patients (58 patients for prophylaxis of the recurrences of Ta-T1 papillary tumors; 40 patients for therapy of carcinoma in situ) received a 6-weeks course of 75 mg. BCG Pasteur vaccine. An additional course was given to non-responders. A maintenance therapy was administered in complete responders monthly for the first year and quarterly for the second. The prophylaxis group (TUR + BCG) was randomized vs TUR alone (40 patients = control group). Complete response in evaluated patients of the prophylaxis, control and therapy groups achieved 86%, 17% and 78%, respectively, after 18 months; 5%, 20% and 9% of patients, respectively, experienced tumor progression. As regards the toxicity, irritative disturbances (27%) and fever (16%) appeared significantly decreased in comparison with those reported in the literature. No major complications were experienced. In conclusion, the low dose (75 mg.) Pasteur BCG regimen used in our trial was effective as a prophylaxis against recurrent superficial papillary tumors and as a treatment of carcinoma in situ, with a significant decrease in toxicity.

[Neurogenic bladder caused by meningomyelocele in childhood: urodynamic pattern and treatment regimens]. / Vejiga neurógena por mielomeningocele en la infancia: patrón urodinámico y pautas de tratamiento.

The authors reviewed the records of 160 patients with neurogenic bladder secondary to myelomeningocele (MMC) treated at the Urology Department of the University of Padua during 1977-1988. All patients had been evaluated by excretory urography, urethrocystography and videocystomannometry (VCM). Urodynamic studies are fundamental in determining vesicosphincteric dysfunction and patients who are at high risk for early renal lesions. For this reason, the authors recommend urodynamic evaluation from the first year of the infant's life in order to institute treatment early. The therapeutic approach should aim at a) preserving renal function, b) achieving a socially acceptable degree of urinary continence, and c) protecting sexual function.

[Mitomycin C in the topical treatment of superficial neoplasms of the bladder]. / La mitomicina C en el tratamiento tópico de las neoplasias vesicales superficiales.

From January 1982 to October 1987, 100 patients with multifocal superficial bladder cancer received intravesical MMC at the Institute of Urology, University of Padova. Seventy-three patients had papillary multifocal superficial bladder carcinoma (stages Ta-T1): treatment was divided into therapeutic (18 cases), and prophylactic (55 cases). 27 patients had carcinoma in situ. 39 patients affected by neoplasia relapsed to previous intravesical ADM treatment. All patients received 40 mg. intravesical MMC weekly for 8 consecutive weeks, repeating the cycle in cases of relapse. Complete response rates at 12 months was 53%, 50 to 67% for each group, respectively. Recurrence rate was lower compared to that before treatment; progression rate was also lower compared to a group who received only endoscopic treatment. In patients who relapsed with ADM treatment, the percentage of complete response was 69%. We underscore the efficacy of MMC in lowering relapse and progression in multifocal superficial bladder cancer, which represents the best indication for this kind of treatment.

[Ureteral perfusion test in the urodynamic evaluation of the upper urinary tract: critical review and case study]. / El test de perfusión ureteral en la valoración urodinámica de las vías urinarias superiores: revisión crítica y casuística.

The authors report on their clinical experience with the use of Whitaker test in 38 patients (27 men, 5 women; age 3 months-66 years). Clinical applications of ureteral pressure-flow test are extensively reviewed. A standardized method with simultaneous recording of bladder pressure and combined video-pressure-flow study are basic points to be considered in order to obtain more objective data.