Müllerianosis of the urinary bladder: report of three new cases.

OBJECTIVE: We report three new cases of müllerianosis of the urinary bladder. METHODS: We present three cases of women in the third decade of life, two of them presenting hematuria and pelvic pain, and the third was referred to perform a recto-vaginal endometriosis surgical procedure. Diagnosis was made by ultrasound and cystoscopy in the first and second case, and by CT scan in the endometriosis case. RESULTS: Müllerianosis of the urinary bladder is described as the presence of müllerian remnants (endometrial, endosalpinx and endocervix) in the bladder wall. Diagnosis is made as a result of a pathologic study of the resected lesions. Although a relapse of the disease is infrequent, it can happen, and close monitoring of the patients must be performed. CONCLUSIONS: Müllerianosis of the bladder is a rare condition and differential diagnosis must be done with benign and malignant bladder lesions because it can affect the muscularis propia. It mostly presents as lower urinary tract symptoms and hematuria that can be cyclic. Transurethral resection is the treatment of choice in superficial and focal lesions. In the case of infiltration of the bladder muscle, and depending on the extension of the disease, partial cystectomy may be necessary.

Müllerianosis vesical: presentación de tres nuevos casos / Müllerianosis of the Urinary Bladder: Report of Three New Cases

OBJETIVO: Presentación de 3 nuevos casos de müllerianosis vesical. MÉTODO: Se presentan tres casos de mujeres en la tercera década de la vida, dos de ellas consultan por hematuria y dolor pélvico, la tercera es remitida para cirugía electiva por endometriosis rectovaginal. Las dos primeras se diagnostican mediante ecografía y cistoscopia de lesiones polipoides vesicales y la tercera se realiza el diagnóstico de endometriosis mediante TAC. RESULTADO: La müllerianosis vesical consiste en la presencia de restos müllerianos (endometrio, endosálpinx y endocérvix) en la pared vesical. Se diagnostica por estudio anatomopatológico y por tanto precisa resección de la lesión. Pese a la infrecuencia de las recidivas, éstas pueden ocurrir, por lo que debe realizarse seguimiento de las pacientes. CONCLUSIONES: La müllerianosis es una entidad poco común y debe incluirse en el diagnóstico diferencial de lesiones benignas y malignas de la vejiga tanto superficiales como infiltrantes ya que puede infiltrar en ocasiones la muscular propia. Se presenta principalmente con síntomas irritativos del tracto urinario inferior y hematuria que puede ser cíclica. El tratamiento debe ser quirúrgico mediante resección transuretral en los casos superficiales y focales. Si hay infiltración de la capa muscular y/o afectación extensa puede requerir una cistectomía parcial

OBJECTIVE: We report three new cases of müllerianosis of the urinary bladder. METHODS: We present three cases of women in the third decade of life, two of them presenting hematuria and pelvic pain, and the third was referred to perform a recto-vaginal endometriosis surgical procedure. Diagnosis was made by ultrasound and cystoscopy in the first and second case, and by CT scan in the endometriosis case. RESULTS: Müllerianosis of the urinary bladder is described as the presence of müllerian remnants (endometrial, endosalpinx and endocervix) in the bladder wall. Diagnosis is made as a result of a pathologic study of the resected lesions. Although a relapse of the disease is infrequent, it can happen, and close monitoring of the patients must be performed. CONCLUSIONS: Müllerianosis of the bladder is a rare condition and differential diagnosis must be done with benign and malignant bladder lesions because it can affect the muscularis propia. It mostly presents as lower urinary tract symptoms and hematuria that can be cyclic. Transurethral resection is the treatment of choice in superficial and focal lesions. In the case of infiltration of the bladder muscle, and depending on the extension of the disease, partial cystectomy may be necessary

[Abdominal compartment syndrome in an urological patient]. / Sindrome compartimental abdominal en un paciente urológico.

OBJECTIVES: Abdominal compartment syndrome is an infrequent clinical entity, the course of which has a rapid progression with multiorgan compromise leading to a fatal outcome if appropriate and urgent action is not undertaken. METHODS AND RESULTS: We report the clinical case of a patient who developed the clinical picture after renal trauma. Diagnosis was obtained by CT scan and arteriography, afterwards the patient required ICU admission with intra-abdominal pressure monitoring, and several decompression laparotomies before definitive closure with a reabsorbable mesh. CONCLUSIONS: Urologists should know the existence of this syndrome its appropriate treatment, because we manage patients who are candidates to suffer it. Due to the high mortality rate associated, it is essential to know how to recognize it in order to act fast.

[Renal transplant in a patient with aortobifemoral bypass]. / Trasplante renal en paciente con bypass aortobifemoral.

OBJECTIVES: Over the last few years we see an increase in the number of patients with vascular disease who need a renal transplant. We discuss their management and different therapeutic options available. METHODS/RESULTS: We report the case of a female patient with history of systemic vascular disease having undergone multiple surgical procedures for it, including aortobifemoral bypass, presenting with end stage renal disease. A kidney transplant into the right iliac fossa was carried out with end to side vascular anastomosis to the iliac vein and arterial vascular prosthesis, respectively. The main difficulty came from the existence of an important fibrosis around the prosthesis, which forced a much more careful dissection of the iliac vein. Immediate postoperative course was uneventful, and the graft shows a normal function two years after surgery. CONCLUSIONS: The coexistence of vascular and renal disease is not a contraindication for kidney transplantation. Larger experience is required, but published data to date do not show significant differences on graft or patient survival.

[Effect of recipient age on transplants performed using organs from donors in asystole]. / Influencia de la edad del receptor en el trasplante realizado con órganos procedentes de donantes en asistolia.

OBJECTIVES: To evaluate the influence of receptor's age on the outcomes of kidney transplants with organs from non heart beating donors. METHODS: Observational study of the historic cohort of 570 kidney transplants performed at the Hospital Clínico San Carlos between 1991 and 1999. Receptor's were divided into two age groups, group 1 younger than 50 years, and group 2 older than 50 years. All organs where harvested from non heart beating donors. RESULTS: We studied 110 kidney transplants coming from non heart beating donors; 52 belonged to group 1, and 57 to group 2. Three-year patient survival for receptor's younger than 50 years was 100%. The probability of three-year survival for receptor's older than 50 years was 79.39% (p 0.07). Graft survival was 88.46%, 86.54%, and 86.54% at 12, 24, and 36 months respectively for receptor's younger than 50 years. When receptors were older than 50 years the probability of functioning graft in the same periods of time was 89.20%, 89.20%, and 86.32% respectively. CONCLUSIONS: Receptor's age doesn't seem to influence graft survival when kidneys from non heart beating donors are used.

Influencia de la edad del receptor en el trasplante realizado con órganos procedentesde donantes en asistolia / Influence of receptor´s age on the outcome of kidney transplants with organs from non heart beating donors

OBJETIVO: Examinar la influencia que pueda ejercer la edad del receptor en la evolución de los trasplantes renales realizados con órganos procedentes de donantes en parada cardiaca irreversible. MÉTODO: Estudio observacional de cohorte histórica de los 570 trasplantes realizados en el Hospital Clínico San Carlos entre los años 1991 a 1999. Los receptores se dividieron según su edad en dos grupos, el primero por debajo de 50 años y un segundo, por encima de dicha edad. Todos los órganos procedían de donantes en asistolia. RESULTADOS: Se estudian 110 trasplantes renales realizados con donantes en asistolia, de ellos 52 pertenecían al grupo I y 57 al grupo II. La supervivencia del paciente en los receptores menores de 50 años fue del 100 por ciento a los 36 meses. En los receptores mayores de 50 años la probabilidad de supervivencia a los 36 meses se sitúa en el 79,39 por ciento (p 0,07). La supervivencia del injerto se situó cuando los receptores eran menores de 50 años en el 88,46 por ciento, 86,54 por ciento y 86,54 por ciento a los 12, 24 y 36 meses respectivamente. Cuando el receptor era mayor de 50 años la probabilidaddeinjertofuncionantefuedel89,20 por ciento,89,20 por ciento y 86,32 por ciento en los mismos periodos. CONCLUSIONES: La edad del receptor no parece influir en la supervivencia del injerto cuando se utilizan órganos procedentes de donantes asistolia (AU)