Herniation of renal pelvis and ureteropelvic junction resulting from superior lumbar triangle hernia.

A 79-year-old female admitted as a result of respiratory insufficiency due to pneumonia presented with a painful swelling in the left lumbar region and acute ureteral colic pain. The diagnosis of Grynfeltt's bilateral hernia was made by means of CT, which revealed herniation in the left side of the renal pelvis and proximal ureter.

[Surgical treatment of renal adenocarcinoma with venous thrombus]. / Tratamiento quirúrgico del adenocarcinoma renal con trombo venoso.

OBJECTIVES: To analyze therapeutic management and survival of renal adenocarcinoma with tumor venous extension treated by surgery in our experience. METHODS: We retrospectively evaluate a series of 29 cases of renal adenocarcinoma with venous thrombus who underwent radical nephrectomy and thrombectomy from January 1986 to November 2003. Mean age was 63.4 11.9 (29-79) years. 23 patients were males (79%) and 6 (21%) females. 17 (59%) patients had the tumor in the right kidney and 12 (42%) in the left kidney. Tumor thrombus level was: Level I (renal vein-inferior vena cava) 13 (45%), Level II (infrahepatic vena cava) 9 (31%), Level III (retrohepatic vena cava/suprahepatic) 3 (10%), and Level IV (auricula) 4 (14%). 92% of the cases presented perirenal fat involvement. Survival analysis was performed including 24 cases of the 29. We analyzed overall and cancer-specific survival, as well as possible influence of tumor thrombus level, fat involvement, and tumor grade as prognostic factors. RESULTS: Mean tumor size was 8.15 +/- 2.25 cm (5-13). Surgical approach was purely abdominal in 23 cases (79%) and thoraco-phreno-laparotomy in 6 (21%). Hepatic mobilization maneuvers and hepatic pedicle clamping were performed in 5 (17%) patients. Venous clamping was: renal-cava 13 cases (44%), triple clamping I1 (37%) (9 infrahepatic and 2 suprahepatic), and supradiaphragmatic-auricula 5 (17%). Conventional extracorporeal circulation (CEC) with moderate hypothermia (26-28 degrees C) was employed in 4 cases and CEC with heart arrest (4 min) in one. Mean follow-up was 52 months. At the time of review 9 patients were alive, 11 had died from tumor and 4 had died from other causes. Mean overall survival was 71 +/- 12 months and cancer specific survival 86 +/- 14 months. Neither renal fat involvement (p=0.6) nor tumor thrombus level (p = 0.9) were prognostic factors for survival in the univariant analysis, but tumor grade was (p = 0.03). CONCLUSIONS: Patients with venous tumor extension without lymph node involvement or metastasis should be treated by radical surgery with complete excision of the tumor thrombus. Tumor grade was a prognostic factor for survival, but venous involvement level and presence of perirenal fat involvement were not.

Tratamiento quirúrgico del adenocarcinoma renal con trombo venoso / Surgical treatment of renal adenocarcinoma with venous thrombus

OBJETIVO: Analizar nuestra experienciaen el manejo terapéutico y la supervivencia de lospacientes con adenocarcinoma renal con extensiónvenosa tumoral tratados con cirugía.MÉTODOS: Evaluamos retrospectivamente una serie de29 casos de adenocarcinoma renal con trombo venosoque fueron tratados mediante nefrectomía radical ytrombectomía desde Enero de 1986 a Noviembre de2003. La media de edad de nuestra serie fue de 63,411.9 (29-79) años, 23 casos fueron varones (79%) y6 (21%) mujeres. El tumor se localizó en el riñón derechoen 17 (59%) pacientes y en 12 (42%) en el izquierdo.El nivel de trombo tumoral fue: Nivel I (Vena renalcava)13 (45%), Nivel II (Cava Infrahepática)9(31%),Nivel III (Cava Retrohepática/Suprahepática) 3 (10%),Nivel IV (Aurícula) 4 (14%) El 92% de los casos presentabaafectación de la grasa perirrenal. El cálculo dela supervivencia se realizó sobre 24 casos del total de29. Analizamos la supervivencia global y cáncer-específicaasí como la posible influencia del nivel de trombo tumoral, la afectación de grasa y el grado tumoralcomo posibles factores pronósticos.RESULTADOS: El tamaño medio tumoral fue de 8.15 ±2.25 (5-13) cm. La vía de abordaje utilizada fue abdominalpura en 23 casos (79%) y toraco-abdominal en6 (21%). Realizamos maniobras de movilización hepáticay clampaje del pedículo hepático en 5(17%)pacientes. La forma de clampaje venoso realizado fue:Reno-cavo 13(44%), Triple clamplaje 11(37%) (9 infrahepáticoy 2 suprahepático), y Supradiafragmático-Aurícula 5(17%). En 4 casos se utilizó circulación extracorpóreaconvencional (CEC) con hipotermia moderada(26-28º C) y en un caso se uso CEC con ParadaCardiaca (4 min). El seguimiento medio de la serie fuede 52 meses. En el momento de la revisión: 9 pacientesestaban vivos, 11 muertos por tumor y 4 muertospor otras causas. La media de supervivencia global fuede 71±12 meses y cáncer-específica de 86±14meses. En el análisis univariante ni la invasión de lagrasa renal (p=0,6), ni el nivel del trombo venoso(p=0,9) fueron factores pronósticos de supervivencia, sien cambio el grado tumoral (p=0,03).CONCLUSIONES: Los pacientes con extensión tumoralvenosa sin afectación ganglionar o metastásica debende ser tratados con cirugía radical y extracción completadel trombo tumoral. El grado tumoral fue un factorpronóstico en la supervivencia, no así el nivel de afectaciónvenosa y la existencia de invasión de la grasaperirrenal

OBJECTIVES: To analyze therapeutic management and survival of renal adenocarcinoma with tumor venous extension treated by surgery in our experience. METHODS: We retrospectively evaluate a series of 29 cases of renal adenocarcinoma with venous thrombus who underwent radical nephrectomy and thrombectomy from January 1986 to November 2003. Mean age was 63.4 11.9 (29-79) years. 23 patients were males (79%) and 6 (21%) females. 17 (59%) patients had the tumor in the right kidney and 12 (42%) in the left kidney. Tumor thrombus level was: Level I (renal vein-inferior vena cava) 13 (45%), Level II (infrahepatic vena cava) 9 (31%), Level III (retrohepatic vena cava/suprahepatic) 3 (10%), and Level IV (auricula) 4 (14%). 92% of the cases presented perirenal fat involvement. Survival analysis was performed including 24 cases of the 29. We analyzed overall and cancer-specific survival, as well as possible influence of tumor thrombus level, fat involvement, and tumor grade as prognostic factors. RESULTS: Mean tumor size was 8.15 ± 2.25 cm (5- 13). Surgical approach was purely abdominal in 23 cases (79%) and thoraco-phreno-laparotomy in 6 (21%). Hepatic mobilization maneuvers and hepatic pedicle clamping were performed in 5 (17%) patients. Venous clamping was: renal-cava 13 cases (44%), triple clamping 11 (37%) (9 infrahepatic and 2 suprahepatic), and supradiaphragmatic-auricula 5 (17%). Conventional extracorporeal circulation (CEC) with moderate hypothermia (26-28º C) was employed in 4 cases and CEC with heart arrest (4 min) in one. Mean follow-up was 52 months. At the time of review 9 patients were alive,11 had died from tumor and 4 had died from other causes. Mean overall survival was 71 ± 12 months and cancer specific survival 86 ± 14 months. Neither renal fat involvement (p=0,6) nor tumor thrombus level (p = 0.9) were prognostic factors for survival in the univariant analysis, but tumor grade was (p = 0.03). CONCLUSIONS: Patients with venous tumor extension without lymph node involvement or metastasis should be treated by radical surgery with complete excision of the tumor thrombus. Tumor grade was a prognostic factor for survival, but venous involvement level and presence of perirenal fat involvement were not

Radiological assessment of penile prosthesis: the role of magnetic resonance imaging.

Penile implants offer a dependable way of restoring erections in virtually all motivated patients. The satisfaction rate among both patients and partners using these devices is high. Advances in technology have reduced the infection rate and increased the mechanical reliability of these products. However, too often, urologists do not present this option with the same authority as other treatments. The reason is fear of complications and lack of expertise in managing them. Although they are not very frequent, complications may be catastrophic. The most significant postoperative complication associated with the implant surgery is infection of the device, which is quite frequent, but some other important complications are distal and proximal perforation of the albuginea, SST deformity, "S-shaped" deformity of the penis, erosion of a component, and mechanical malfunction of the device. The best way to manage complications is to prevent them, but we do not have many diagnostic tools available. Diagnosis is based on clinical history and physical examination, but imaging techniques are also needed to explore the prosthesis "in situ" to plan the surgical approach if it is needed. In this article we review the different imaging techniques used for the diagnosis of complications of prosthetic surgery of the penis, including conventional radiology, use of sonography, the role of CT scan and the magnetic resonance imaging (MRI) of the penile prosthesis. We conclude that MRI is the most valuable method for the diagnosis of penile prosthesis complications. It is not an ionizing radiation imaging method and has the unique feature among imaging techniques of demonstrating penile anatomy in three orthogonal planes. It is superior to any other imaging method in the definition of soft tissue contrast.