Obstrucción urinaria / Urinary obstruction

La uropatía obstructiva se integra en la peculiar configuración canalicular del aparato urinario e involucra prácticamente a todos sus órganos. En este trabajo de revisión se analizan la obstrucción del aparato urinario superior y también situaciones del inferior cuando algunas circunstancias evolutivas de la uropatía lo aconsejan. Se exponen con carácter exhaustivo las modalidades de obstrucción y los principios básicos de la fisiopatología con su correspondiente traducción anatómica. Se destacan las características fisiopatológicas que caracterizan las obstrucciones intrauterinas, las presentes en el embarazo y las del varón añoso. Finalmente se analiza con un carácter muy actualizado la contribución diagnóstica de todas las técnicas susceptibles de ser utilizadas ante una uropatía obstructiva enfatizando la trascendencia pronóstica del diagnóstico y tratamiento precoces, así como la esperanza de modernas técnicas en el diagnóstico diferencial de la uropatía obstructiva crónica. (AU)

Quiste mesentérico con repercusión ureteral / Mesenteric cyst with ureteral obstruction

Se presenta un caso de quiste mesentérico con repercusión sobre el uréter izquierdo. El examen físico y la palpación abdominal fue determinante en su diagnóstico que, posteriormente confirmó la TAC en su localización, tamaño y contenido líquido. (AU)

[Nephrectomy of a giant hypernephroma (5,150 g)]. / Nefrectomía de un hipernefroma gigante (5.150 g).

We report a giant renal adenocarcinoma (5150 g weight) excised in a 52 years old male. He presented a severe clinical symptoms: serious haematuria, fever (40 degrees C), left flank pain, abdominal discomfort and weight loss (10 kg). The patient underwent left renal artery embolization because of severe anemia (blood transfusion: 4 uu) but haematuria didn't decrease; that's why radical surgery was advised. Until our knowledge this case is the largest removed kidney adenocarcinoma published in the world literature (Medline 1966-2001).

Nefrectomía de un hipernefroma gigante (5.150 G) / Nephrectomy of a giant renal adenocarcinoma (5.150 g)

Presentamos un adenocarcinoma renal gigante (5150 g) extirpado a un paciente varón de 52 años. Se presentó con una severa clínica: hematurias abundantes, fiebre (40º), lumbalgia izquierda, molestias abdominales y pérdida de peso (10 kg).El paciente fue sometido a embolización de arteria renal debido a anemia por hemorragia (se transfundieron 4uu) pero, al no ceder la hematuria, se indicó la cirugía radical. En la revisión bibliográfica (Medline 1966-2001) no hemos encontrado publicado ningún carcinoma renal extirpado de este peso, por lo que este caso podría tratarse del más voluminoso publicado hasta la fecha (AU)

Envejecimiento, dieta y cáncer de próstata / Ageing, diet and prostate cancer

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[Xanthogranulomatous pyelonephritis associated with pregnancy, in ex-transplant donor with single kidney]. / Pielonefritis Xantogranulomatosa asociada a embarazo, en riñón único de antigua donante para trasplante.

We present the first case, up to our knowledge, of XGP in pregnant woman, in solitary kidney (related living kidney donor). Therapeutic abortion was not resolutive and nephron sparing surgery (espeleostomy) was successfully performed. Fourteen years later the renal function is still normal and 2/3 of renal parenchima are preserved. Literature review is pointed out.

[Urinary obstruction]. / Obstrucción urinaria.

Obstructive uropathy is a result of the particular tubular configuration of the urinary tract and involves virtually all its organs. This review analyses upper urinary tract obstructions as well as a number of lower urinary tract conditions whenever the circumstances of the urological disease progress so advises it. A comprehensive exposition is made of the different types of obstruction, the basic pathophysiological principles and the respective anatomical transposition. The pathophysiological features characterising intrauterine obstructions, obstructions occurring during pregnancy and in the elderly are also highlighted. Finally an updated analysis is made of the diagnostic contribution made by all techniques susceptible to be used when dealing with obstructive uropathies highlighting the prognostic relevance of early diagnosis and treatment. The hope placed in the use of modern techniques to establish a differential diagnosis of chronic obstructive uropathy is also emphasised.

[Mesenteric cyst with ureteral involvement]. / Quiste mesentérico con repercusión ureteral.

We expose a mesenteric cyst with obstruction on the left ureter. Physical abdominal examination was essential in the mass diagnosis. Definitive location, size and liquid structure was confirmed by CT.

[Ureteral complications of retroperitoneal prosthetic vascular surgery]. / Complicaciones ureterales de la cirugía vascular protésica retroperitoneal.

OBJECTIVE: Ureteral obstruction following retroperitoneal vascular by-pass has rarely been reported in the international world literature (only 169 cases). That's why we present three new cases to contribute at best knowledge of this iatrogenic disease. MATERIAL AND METHOD: Our cases were diagnosed by symptoms (number 2 and 3) and incidentally (number 1). The case 3 is exceptional because only 6 cases were previously described. RESULTS: Three different treatments were applied in our cases. The urinary fistula resulted into nephrectomy and the others were treated by endourological and reconstructive methods. We noted that the added comorbidity factors in all these cases make the pronogstic hazardous.

[Urogenital malacoplakia. Report of 4 cases and review of the literature]. / Malacoplaquia urogenital. Presentación de 4 casos y revisión de la literatura.

OBJECTIVE: To review the subject of malacoplakia and analyze the incidence of urinary and genital, and extra-urinary localizations. METHODS: We reviewed the literature on urinary and extra-urinary malacoplakia. Our series of 4 cases are presented (two renal, one prostatic with uncommon clinical presentation and one of the urinary bladder). RESULTS: This study confirms that there is an increasing proportion of extravesical involvement in malacoplakia of the urinary tract and extra-urinary localization involving practically all the organs and organ systems. CONCLUSIONS: 614 cases of malacoplakia have been reported; of these, 60.4% were urinary and 39.5% extra-urinary (including retroperitoneal localization). Renal involvement, if we include the bilateral forms and those occurring in the transplanted kidneys, is equal in number to the cases localized to the bladder. Although malacoplakia is a "benign" condition, the prognosis of the bilateral forms involving the upper urinary tract and those occurring in the transplanted kidney appears to be poor, with a mortality rate of 20%-50%. Furthermore, this review clearly shows the need for follow-up in these patients since "recurrences" have been reported at different levels of the urinary tree up to 10 years after the initial diagnosis.

[Extraperitoneal anterior approach to renal vessels in radical surgery of renal cancer]. / Acceso anterior extraperitoneal a los vasos renales en la cirugía radical del cancer renal.

The authors present a modification of Droller approach to the renal vessels prior to any Kidney manipulation, even in fat patients. The anatomical situation of the hilium elements is on the basis of their rationale. The ascending ureter dissection allows the blunt advance of the middle finger by the posterior way until the arterial beat. Then pushing up the artery, its identification, by the anterior way, is facilitated. With an initial series of 7 cases the results show no ileus complication and shorter hospital stay. This extraperitoneal approach enables to keep oncologic surgical rules in selected cases of renal cell carcinoma.

[Reutilization of a transplanted kidney by a 2nd receptor]. / Reutilización de un riñón trasplantado por un 2o receptor.

Contribution of what we believe to be the first case of successful reutilization of the same renal graft by a second receptor after functioning for some time in other patient. Transplantectomy was performed 8 days after initial RT, subsequent to the recipient suffering a fatal AVC. The purpose of this paper is to underline the sequence and technical methodology of this procedure which may become a resource to be taken into account in similar cases.

[An analysis of the anomalies, pathologies and iatrogenic diseases in the kidney graft: an evaluation of bench surgery]. / Análisis de las anomalías, patologías y yatrogenias del injerto renal: valoración de la cirugía de banco.

OBJECTIVES: This study analyzes the anomalies, pathologies and iatrogenic lesions of renal grafts, their impact on graft viability and the possibilities of repair. METHODS: From 1980 to 1983, 315 kidneys were available for transplantation; 50 were from living donors and 265 from cadavers. Of the 265 cadaver grafts, our staff harvested 173 and 92 came from other centers. Of these, 113 (42.6%) presented anomalies, pathologies or iatrogenic lesions requiring surgical repair. RESULTS: 13 kidneys were not suitable for transplantation due to pathologies. Sixty-one grafts presenting anomalies and pathologies, and 38 with iatrogenic lesions were repaired by bench surgery. CONCLUSIONS: Although there was a high incidence of anomalies, pathologies or iatrogenic lesions (42.6%), repair by bench surgery permitted transplantation of these grafts and only 6 (3.01%) allografts required subsequent removal, which is a low incidence considering that a higher percentage of kidneys are lost due to family refusal (19%) or as a result of legal problems.

[Is the inverted position of the kidney graft a cause of disease after transplantation?]. / Es la posición invertida del injerto renal causa de patología tras el trasplante?

The authors explain their experience in a series of 317 consecutive RTs that resulted in renal inversion during transplantation surgery. The likely vascular complications as well as those of the excretory tract are correlated with the above situation of heterotopic graft. No differences have been noted due to placement with regard to necrosis of the ureter; stenosis of the passage, whether distally or at the pyelo-ureteral junction, have occurred in inverted kidneys but at a really low rate (1.7%) in both cases. There has been, however, a higher incidence of arterial thrombosis when the kidney is not inverted. A conclusion can be drawn that it is preeminent to place the kidney with a good vascular arrangement and that, once this is achieved, the tendency is to leave the posterior pelvis which allows to shorten the ureter.

[Systematic extracapsular transplantectomy of non-functioning renal graft]. / Trasplantectomía extracapsular sistemática del injerto renal no funcionante.

Exposition of the experience in our Renal Transplantation Unit with regard to a major problem such as transplantectomy, a technique which our group performs in an entirely extracapsular way. Over a total of 317 renal transplantations, 85 were transplantectomies (26.85%) where secondary renal failure was due to immunological causes in 80% of cases, vascular disease 7.05%, infectious-excretory tract diseases 7.05%, "de novo" renal disease 3.53%, and haemorrhagic picture 2.35%. It should be highlighted from this series the orthotopically placed graft transplantectomy (-- orthotopic transplants and 3 transplantectomies), the simplicity of which is in opposition to the greater difficulty of those positioned in the iliac fossa. Overall results from 18 Spanish Centres are shown in the publication, which contains data from 7,226 renal transplants and 1,112 transplantectomies. An evaluation is made on the mortality rate of our series which was 4.7%, morbidity 10.5% and intra-operative failures which occurred in only three patients.

[Urinary tract involvement as the first clinical manifestation of adenocarcinoma of the colon]. / Afectación de la vía urinaria como primera manifestación clínica de un adenocarcinoma de colon.

A patient with a previous history of left renal colic and no evidence of passing calculi was admitted to hospital for exacerbation of the urinary condition. The IVP and US evaluation revealed a ureteral stop which appeared to be extrinsic on retrograde uretero-pyelography. Surgery disclosed a large urinoma in the lumbar fossa. The compromised ureteral segment was removed and the pathological analysis of the surgical specimen revealed infiltration from adenocarcinoma. A primary tumor was sought early postoperatively due to irregular constipation referred by the patient. Finally, adenocarcinoma of the sigmoid colon was found. Only 8 similar cases of urinoma from extravasation due to ureteral obstruction secondary to a tumor have been reported in the literature up to 1982.