RESUMO
A case of large retrovesical tumor in a 50 year-old man is reported here. The diagnosis of schistosomial spermatocyst was made by histopathology. The authors underline the difficulty of the topographic diagnosis in large retrovesical masses.
Assuntos
Neoplasias Retroperitoneais/diagnóstico por imagem , Esquistossomose Urinária , Espermatocele/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Esquistossomose Urinária/cirurgia , Espermatocele/diagnóstico por imagem , Espermatocele/cirurgia , Cálculos Ureterais/complicações , Cálculos da Bexiga Urinária/complicaçõesRESUMO
The authors report 30 cases of uretero-vaginal fistulae collected in the department of Urology at Charles Nicolle's Hospital in Tunis. The majority of patients are multipare between 28 and 47 years old. The main causes remain gynecological and obstetrical procedures. The main motive of consultation was leaking of urine from the vagina; unfortunately the attendance to our clinic was late. IVP was performed in all cases; in 22 cases it showed a dilatation of the ureter, pelvis and calyces, on one side; in 3 cases it showed a non functional kidney and in 5 cases it was normal. Retrograde uretero-pyelography was performed for seven patients, twice in case of non functional kidney and five times after a normal IVP. In all cases it showed extravasation of contrast medium at the level of the fistula and the proximal portion of the ureter was not opacified. Treatment was by: reimplantation of the ureter in the bladder in 21 cases; end to end ureteric anastomosis in 5 cases; nephrectomy in 3 cases; in one case the fistulae healed by drainage. Control IVP was performed after a while and showed: success of the procedure in 15 cases; no change in 4 cases; an affected kidney in one case. Unfortunately diagnosis is never made at the time of surgery and this underlines the absolute necessity to check the ureter if there is any doubt about its integrity. In case of post operative complications it is important to request an IVP as soon as possible. In large fistulae reimplantation of the ureter by the Leadbetter-Politano technique, with fixation of the bladder to the psoas muscle, gave the best result in our hands. Postoperative follow up is necessary to detect any stenosis or reflux.
Assuntos
Fístula/etiologia , Doenças Ureterais/etiologia , Doenças Uterinas/etiologia , Fístula Vaginal/etiologia , Adulto , Feminino , Fístula/cirurgia , Doenças dos Genitais Femininos/cirurgia , Humanos , Complicações Intraoperatórias , Pessoa de Meia-Idade , Tunísia , Doenças Ureterais/cirurgia , Doenças Uterinas/cirurgia , Fístula Vaginal/cirurgiaRESUMO
A hypogastric mass compressing the bladder in an adult, in a zone endemic for hydatid disease, should raise to suspicion of a retrovesical cyst, especially as the cyst sometimes opens into the bladder resulting in haematuria and hydatiduria. Intravenous urography and ultrasonography facilitate the topographical diagnosis. Treatment is surgical: transperitoneal cystectomy and pericystic resection as extensive as possible with exploration of the abdomen looking for other sites (liver, mesentery, omentum). This treatment was successful in the two cases reported here. In conclusion, a stable cure can be obtained by adopting a well defined therapeutic approach to these rare lesions.
Assuntos
Equinococose/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Adulto , Equinococose/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
The authors report 5 new cases of malakoplakia: 2 with kidney, 1 with prostatic and 2 with testicular involvement. The symptoms are not clinically specific, but pseudo-tumor forms are predominant. Four cases were treated by removal of the organ. Owing to a better understanding of its etiopathogenic mechanism, this disease can be treated by long-term antibiotic, cholinergic agonists and vitamin C therapy.
Assuntos
Nefropatias/diagnóstico , Malacoplasia/diagnóstico , Doenças Prostáticas/diagnóstico , Doenças Testiculares/diagnóstico , Idoso , Criança , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The authors report the case of an ectopic pheochromocytoma without any clinical symptoms or laboratory signs which simulated a renal tumor during clinical and complementary investigations. The diagnosis was established by histology. The ectopic pheochromocytoma and the diagnostic problems of silent tumors are discussed.
Assuntos
Neoplasias das Glândulas Suprarrenais/patologia , Coristoma/patologia , Neoplasias Renais/patologia , Feocromocitoma/patologia , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Coristoma/diagnóstico por imagem , Humanos , Neoplasias Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Feocromocitoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia , UrografiaRESUMO
Calcified necrotising cystitis is an urological curiosity, the authors report two cases. With subsidence of the acute process, regeneration and fibrosis take place, with contracture of the bladder and reduction of its capacity. Augmentation ileocystoplasty was performed with success in one case. The clinical and therapeutic aspects of this rare disease are discussed.
Assuntos
Calcinose/diagnóstico , Cistite/diagnóstico , Adulto , Calcinose/patologia , Calcinose/cirurgia , Cistite/patologia , Cistite/cirurgia , Feminino , Humanos , Necrose , UrografiaRESUMO
In a series of 13 adults with calculi in ureteroceles, 10 cases underwent endoscopic meatotomy associated with endoscopic lithotripsy. In 2 bulky ureteroceles with calculi, the authors performed excision of the ureterocele and reimplantation of the ureter. In one case, the authors successfully performed extracorporeal lithotripsy. The authors obtained good results in all cases. Endoscopic meatotomy with lithotripsy is a very useful procedure for treatment of small or medium sized ureteroceles with calculi in adults.
Assuntos
Endoscopia , Cálculos Ureterais/complicações , Ureterocele/complicações , Ureterocele/cirurgia , Adulto , Idoso , Endoscopia/métodos , Feminino , Humanos , Litotripsia , Masculino , Pessoa de Meia-Idade , Sucção , Cálculos Ureterais/terapia , Ureterocele/patologiaRESUMO
The authors report a series of nine reno-ureteral obstructive uric acid calculi initially treated by percutaneous nephrostomy. After attempting stone dissolution by in situ alkalinization, they discuss the place of such a method among the various treatments for uric acid stones.
Assuntos
Bicarbonatos/uso terapêutico , Nefrostomia Percutânea/métodos , Sódio/uso terapêutico , Ácido Úrico/química , Cálculos Urinários/terapia , Idoso , Bicarbonatos/administração & dosagem , Humanos , Concentração de Íons de Hidrogênio , Pessoa de Meia-Idade , Nefrostomia Percutânea/normas , Radiografia , Sódio/administração & dosagem , Bicarbonato de Sódio , Irrigação Terapêutica , Resultado do Tratamento , Urinálise , Cálculos Urinários/química , Cálculos Urinários/diagnóstico por imagemRESUMO
Five "silent" adrenal tumors were reported. 3 of them were very large. Excision of tumor was enlarged to adjacent organs in 3 cases. On palpation a mass was felt in three cases, and in two cases the mass was accidentally discovered by ultrasound. Operation was performed with the diagnosis of adrenal mass in four cases. Microscopic examination revealed the tumor to be pheochromocytoma in 3 cases and adrenal cortex mass in two cases. Malignancy is confirmed from metastasis. Treatment was only surgical. Since no reliable preoperative investigations are yet available to assess the nature of adrenal masses, their surgical excision is indicated for microscopic examination.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Feocromocitoma/diagnóstico , Neoplasias do Córtex Suprarrenal/diagnóstico , Neoplasias do Córtex Suprarrenal/diagnóstico por imagem , Neoplasias do Córtex Suprarrenal/cirurgia , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/cirurgia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
The authors report different techniques for surgical reconstruction of the sequelae of penile, scrotal and perineal gangrene. The repair of skin defects and the reconstruction of the scrotum requested several interventions. Where the scrotal skin loss was limited to a 1/2 of scrotum, the testis could be covered by mobilising the surrounding rim. When the disease was confined to the penis or inguinal region, skin cover has been provided by free grafts. More elaborate techniques of skin cover were necessary when the disease was extended to the whole scrotum: a fasciocutaneous flap from the thigh was used for reconstruction of the scrotum. The scrotal myocutaneous flap was used to cover skin and anterior urethral loss of tissue.
Assuntos
Gangrena/cirurgia , Pênis/cirurgia , Períneo/cirurgia , Escroto/cirurgia , Cirurgia Plástica , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/irrigação sanguínea , Períneo/irrigação sanguínea , Escroto/irrigação sanguínea , Retalhos CirúrgicosRESUMO
The authors report two cases of congenital ureteral valves of the upper third of the ureter complicated by renal stone in two children and diagnosed by I.V.P. The two patients underwent a resection of the pathological segment and a pelvic-ureteral anastomosis successfully. The review of the literature data regarding ureteral valves allowed to emphasize the uncommon of the bilateral form complicated by renal stone and the better preoperative diagnosis by ureteroscopy and antegrade pyelogram.
Assuntos
Ureter/anormalidades , Criança , Pré-Escolar , Humanos , Masculino , Ureter/patologia , Cálculos Ureterais/patologia , Obstrução Ureteral/patologiaAssuntos
Transplante de Rim , Análise Atuarial , Morte Encefálica , Cadáver , Humanos , Imunossupressores/uso terapêutico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/cirurgia , Falência Renal Crônica/terapia , Transplante de Rim/mortalidade , Transplante de Rim/fisiologia , Diálise Renal , Análise de Sobrevida , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Tunísia/epidemiologiaAssuntos
Neoplasias Renais/diagnóstico , Leiomiossarcoma/diagnóstico , Neoplasias Retroperitoneais/diagnóstico , Diagnóstico Diferencial , Humanos , Neoplasias Renais/diagnóstico por imagem , Leiomiossarcoma/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Neoplasias Retroperitoneais/diagnóstico por imagemAssuntos
Aneurisma/complicações , Hipertensão Renovascular/etiologia , Obstrução da Artéria Renal/complicações , Adulto , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Feminino , Humanos , Nefrectomia , Radiografia , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/cirurgiaAssuntos
Estreitamento Uretral/cirurgia , Endoscopia , Seguimentos , Humanos , Masculino , Radiografia , Uretra/diagnóstico por imagem , Uretra/cirurgia , MicçãoRESUMO
The authors report 5 cases of prostato-rectal fistulae. Two men were treated by a posterior approach and two by an abdominal approach because of associated lesions. They review all of the techniques of approaching the prostato-rectal fistulas. The transsphincteric approach provides excellent exposure and reliable closure of prostato-rectal fistulas: the concern for possible anal incontinence is unfounded. Additional security can be obtained by performing a colostomy beforehand.