Síndrome de Klipper-Trenaunay-Weber con compromiso vesical y uterino tratado por vía endoscópica y endovascular / Klippel-Trenaunay-Weber syndrome with vesical and uterine involvement treated by endoscopic and endovascular routes

El síndrome de Klippel-Trenaunay-Weber (SKTW) es una rara malformación venosa que, en general afecta a los miembros inferiores y, más raramente, a los superiores. Se caracteriza por formaciones angiomatosas cutáneas, várices e hipertrofia del miembro afectado. El compromiso genitourinario es sumamente infrecuente. Se presenta el caso de una paciente de 14 años. Ingresó por hematuria macroscópica de 48 h de evolución y metrorragia con grave compromiso hemodinámico. Se encontraba en estudio por presentar un hemangioma en el miembro inferior izquierdo que se extendía hasta la región pelviana. La uretrocistofibroscopía demostró la presencia de múltiples lesiones angiomatosas diseminadas en forma amplia en la vejiga, algunas de ellas con sangrado activo. La angioresonancia mostró una voluminosa formación hipervascularizada en contacto con la pared vesical a la cual desplazaba y fístulas arteriovenosas a nivel pelviano y en el miembro inferior izquierdo confirmando el diagnóstico etiológico. Se realizó una embolización arterial selectiva de los territorios ilíacos interno y externo e inmediatamente después una endocoagulación láser de los focos angiomatosos sangrantes. La hematuria remitió completamente en las 24 h posteriores al procedimiento. La metrorragia asociada al SKTW fue controlada mediante la utilización de análogos LHRH y progestágenos.

Klippel-Trenaunay-Weber syndrome (KTWS) is a rare venous malformation that generally affects the lower limbs and, more infrequently, the upper limbs. It is characterized by cutaneous angiomatous formations, varicose veins and hypertrophy of the affected limb. The involvement of the genitourinary tract is extremely infrequent. We expose the case of a 14 years old female patient who was admitted for macroscopic hematuria of 48 hours of evolution and metrorrhagia with severe hemodynamic decompensation. The patient was under study for presenting a hemangioma in the lower left limb that extended to the pelvic region. Urethrocystofibroscopy showed the presence of multiple wide-spread angiomatous lesions in the bladder, some of them with active bleeding. The angio-resonance showed a voluminous hypervascular formation in contact with the bladder wall showing several arteriovenous fistulas at the pelvic level and in the left lower limb confirming the etiological diagnosis. A selective arterial embolization of the internal and external iliac territories was performed and then, a laser endocoagulation of the bleeding angiomatous foci was carried out. The hematuria completely stopped within 24 hours later of the procedure. The metrorrhagia associated with KTWS was controlled by the use of LHRH analogs and progestogens.

Point electro-cauterization versus holmium laser cauterization in the treatment of post-ejaculation hematuria / 中华男科学杂志

Objective@#To investigate the advantages and disadvantages of point electro-cauterization (PEC) and holmium laser cauterization (HLC) in the treatment of post-ejaculation hematuria.@*METHODS@#From January 2015 to December 2018, 73 patients with post-ejaculation hematuria, aged 24－63 (36.8 ± 4.2) years, underwent PEC (n = 35) or HLC (n = 38) after failure to respond to 3 months of conservative treatment. We compared the hospital days, total hospitalization expenses, maximum urinary flow rate (Qmax), average urinary flow rate (Qavg), Hamilton Anxiety Rating Scale (HAMA) score, postoperative duration of hematuria, and recurrence rate at 3 and 6 months after surgery.@*RESULTS@#All the patients experienced first ejaculation but no post-ejaculation hematuria at 1 month after operation. The recurrence rates were lower in the PEC than in the HLC group at 3 months (5.71% vs 2.63%, P > 0.05) and 6 months postoperatively (8.57% vs 5.26%, P > 0.05). Compared with the baseline, the Qmax was decreased from (18.56 ± 2.53) ml/s to (13.68 ± 3.31) ml/s (P < 0.05) and the Qavg from (14.35 ± 2.26) ml/s to (9.69±1.84) ml/s in the PEC group at 1 month after surgery (P < 0.01), but neither showed any statistically significant difference in the HLC group. Mild to moderate anxiety was prevalent in the patients preoperatively, particularly in those without job or regular income and those with a long disease course or frequent onset, the severity of which was not correlated with age, education or marital status. The HAMA score was decreased from18.65 ± 4.33 before to 12.35 ± 3.63 after surgery in the PEC group (P < 0.01), and from 16.88 ± 2.11 to 6.87 ± 4.36 in the HLC group (P < 0.01). The mean hospital stay was significantly longer in the former than in the latter group (［5.2 + 1.3］ vs ［3.4 ± 0.5］ d, P < 0.01), while the total cost markedly lower (［6.35 ± 1.20］ vs ［12.72 ± 2.15］ thousand RMB ¥, P < 0.05).@*CONCLUSIONS@#Both PEC and HLC are safe and effective for the treatment of post-ejaculation hematuria, with no significant difference in the recurrence rate at 3 and 6 months after operation, but their long-term effect needs further follow-up studies. PEC may increase the risk of negative outcomes of the postoperative urinary flow rate, while HLC has the advantages of better relieving the patient's anxiety, sooner discharge from hospital and earlier recovery from postoperative hematuria, though with a higher total cost than the former.

A Novel Approach for the Treatment of Radiation-Induced Hemorrhagic Cystitis with the GreenLight™ XPS Laser

The treatment of pelvic malignancies with radiotherapy can develop severe sequelae, especially radiation-induced hemorrhagic cystitis. It is a progressive disease that can lead to the need for blood transfusion, hospitalizations, and surgical interventions. This tends to affect the quality of life of these patients, and management can at times be difficult. We have evaluated the GreenLight Xcelerated Performance System (XPS) with TruCoag, although primarily used for management of benign prostatic hypertrophy (BPH), for the treatment of radiation-induced hemorrhagic cystitis.

A novel endoscopic treatment for renal arteriopelvic fistula post-percutaneous nephrolithotomy (PCNL)

Main findings We describe the use of a novel endoscopic approach in the management of unremitting gross hematuria following post-percutaneous nephrolithotomy (PCNL) in a 65-years-old male. This approach proved successful and cost-effective in managing haemorrhage post-PCNL when renal angiography failed to localize the source of bleeding. Case hypothesis The recommended treatment modality for renal calculi ≥ 2cm is PCNL. It is essential that clinicians are aware of the various complications that can arise from PCNL, including arteriovenous fistula, which is typically managed with renal angio-embolization. The development of a renal arteriopelvic fistula (APF) is an extremely rare complication, and accounts of haemorrhage from renal APF and its treatment have not been well-described in the literature. We successfully hypothesized that the ureteroscopic localization, fulguration, and closure with a fibrin sealant at the site of the arterial bleed results in optimal treatment for this clinical presentation. We report this case in detail. Promising Future Implications The successful and cost-effective endoscopic approach described here for treatment of post-PCNL renal APF and unremitting gross hematuria ought to be considered as an adjunct to renal angiography and embolization when the source of bleeding cannot be accurately identified using traditional imaging modalities. .

Ureteroscopia flexible: experiencia inicial / Flexible ureteroscopy: experience in 13 patients

Background: Flexible ureteroscopy is an increasingly used diagnostic and therapeutic tool for the upper urinary tract. Aim: To report our experience with flexible ureteroscopy. Material and Methods: Analysis of 13 procedures performed to seven males and 6 women aged 30 to 72 years. Results: The indications for flexible ureteroscopy were urinary lithiasis in six patients, a filling defect found in a CAT scan in five, proximal displacement of a double J catheter in one patient and unilateral hematuria in one patient. Lithiasis was managed with extracorporeal lithotripsy using a Holmium laser. Biopsies were obtained from the sites with filling defects; the catheter was extracted using a Dormia basket. In the patient with hematuria, a hemangioma was found and managed with laser excision. No complications were registered. Conclusions: Flexible ureteroscopy is safe and effective.

Introducción: El gran desarrollo tecnológico de los últimos años ha permitido un impresionante avance en la endourologia. Debido a esto, la ureteroscopia flexible ha ganado cada vez más espacio, tanto como método diagnóstico y terapéutico, en la patología de la vía urinaria alta. Presentamos nuestra experiencia inicial en ureteroscopia flexible. Material y Métodos: Entre marzo y noviembre de 2009 realizamos 13 ureteroscopias flexibles, analizándose en todos los casos las variables demográficas y perioperatorias. Se describe además la técnica quirúrgica. Resultados: Realizamos un total de 13 ureteroscopias flexibles en 7 hombres y 6 mujeres, con una edad promedio de 55 años. Respecto a la indicación del procedimiento, en 6 casos esta fue producto de un cuadro de litiasis urinaria, en 5 casos debido a un defecto de llene en la tomografía axial computada (TC), en 1 paciente debido al desplazamiento proximal de un catéter Doble-J y en 1 paciente producto de una hematuria unilateral. El manejo de las litiasis se realizó mediante litotricia intracorpórea con láser Holmium. En los defectos de llene, se realizaron biopsias del sitio del defecto. El catéter Doble-J fue extraído con Dormia. Finalmente, en el paciente con hematuria se evidenció la presencia de un hemangioma, el que fue manejado con láser. No se registraron complicaciones. Discusión: El desarrollo de los ureteroscopios flexibles ha permitido ampliar el uso de la ureteroscopia tanto en lo diagnóstico como en lo terapéutico. Las complicaciones son cada vez menos frecuentes, convirtiéndolo en un procedimiento seguro y eficaz para el manejo de la patología de la vía urinaria alta.

Trauma renal: diagnóstico e tratamento / Kidney trauma: diagnosis and treatment

Baseado em extensa revisäo da literatura, apresentam-se conceitos atuais sobre a orientaçäo diagnóstica e a conduta terapêutica do traumatismo renal. Descrevem-se as interpretaçöes das alteraçöes clínicas e dos achados laboratoriais e dos métodos de imagem. Enfatizam-se por fim os critérios das indicaçöes terapêuticas expectante e cirúrgica