Rotura de ureter em trauma fechado de abdome / Ureter rupture from blunt abdominal trauma

Introduction: We present a case of a 49-year-old man, who suffered an abdominal contusion in a automotive accident and developed a cystic painless right hemiabdominal mass few weeks later. Case Report: The patient was submitted to intravenous pyelography, abdominal CT scan, echography, and retrograde ureteropyelography. His preoperative diagnosis was blunt rupture of the right ureter 6 cm below the ureteropelvic junction with a consequent urinary retroperitoneal collection. Percutaneous puncture of the cystic collection confirmed the diagnosis of urine collection. An open end-to-end ureteral anastomosis was performed tow months after the trauma. The patient's evolution was uneventful and a late intravenous pyelography confirmed the success of the operation

Multiple biopsies in bladder urothelial carcinomas: correlation of atypical lesions with histological grade, clinical staging and number of tumors

Twenty-eight cases of transitional cell carcinomas, (19 papillary cell carcinomas, 9 nonpapillary invasive carcinomas) with concomitant mucosal biopses are reported. Multiple biopses were obtained cystoscopically at diagnosis (during ressection or biopsy of the main tumor) or afterwards, during post-operative evaluation. Fifteen patients (53.6%) wre positive for dysplasia, carcinoma "in situ" or micro-invasive carcinoma in the biopsies. These lesions were correlated with the primary neoplasm in regard to: 1) histological grade. Atypical lesions were more frequent the higher the grade (0.01 < p < 0.05); 2) clinical staging. The possibility of finding atypical lesions was higher in cases with more advanced staging (0.01 < < 0.05) and 3) presence of one or more tumors visible cystoscopically. The results were not statistically significant (0.10 < p < 0.50) but there was a trend toward a highr incidence of atypical lesions among patients with more than one tumor at cystoscopy. Performance of multiple mucosal biopsies is the only means of diagnosing for atypical lesions of the bladder because, due to their plane configuration, they are not detected cystoscopically. The presence of these lesions is very important because they influence the prognosis and the therapeutic measures

Tratamento da hematúria encoercível com alúmen / Alun treatment for incoercible hematuria

A hematúria incoercível de origem vesical é um problema de difícil resoluçäo terapêutica e de etiologia variada. Os recursos terapêuticos disponíveis säo numerosos e já se mostraram eficazes em determinadas situaçöes, embora freqüentemente se associem a aumento da morbi-mortalidade, particularmente quando o tratamento cirúrgico é empregado. A alternativa terapêutica mais recente para a resoluçäo da hematúria vesical baseia-se na irrigaçäo intravesical contínua com soluçäo de alúmen (sulfato de alumínio). Estudou-se 13 pacientes portadores de hemorragia vesical maciça, de várias etiologias, utilizando-se como tratamento a soluçäo de alúmen a 1%. Em 76,9% dos paciente houve controle do sangramenteo em intervalo de tempo que variou de 1 a 7 dias. Verificou-se que o uso do alúmen intravesical oferece maiores vantagens sobre os outros procedimentos no controle da hemorragia vesical incoercível. O método mostrou-se eficaz, de baixo custo, com poucos efeitos colaterais, näo requerendo qualquer tipo de manipulaçäo mais agressiva. Este novo e promissor recurso terapêutico poderá transformar-se no método de eleiçäo para o tratamento desta grave enfermidade

Estudo crítico de 120 casos de biopsia transretal de próstata / Critical study of 120 cases of transrectal biopsies of the prostate

Foram realizados biopsias transretais de próstata em 120 pacientes com toque suspeito de carcinoma, utilizando-se agulha de Franklin-Silvermann modificada e sob anestesia local. Os resultados obtidos foram: 47,5% de adenocarcinoma; 28,3% de hiperplasia benigna; 10,8% prostatile crônica; 9,2% sem alteraçöes histológicas e 4,2% inconclusivas. Em cinco pacientes houve necessidade de repetiçäo do procedimento, para a confirmaçäo diagnóstica. Conclui-se que a biopsia é de grande valia para o diagnóstico do carcinoma de próstata e ressaltam a alta possibilidade de erro do toque retal, mesmo nos casos sugestivos de caráter neoplásico