Hiperplasia prostática gigante. Adenocarcinoma. Reporte de un caso / Giant prostatic hyperplasia. Adenocarcinoma. Case report

RESUMEN Se presenta el caso de una hiperplasia prostática gigante, combinada con un adenocarcinoma que se presentó como una tumoración abdominal. El paciente presentaba una tumoración palpable en hipogastrio y un síndrome obstructivo urinario bajo. Se intervino quirúrgicamente y se realizó adenomectomía combinada, transvesical y retropúbica. La biopsia informó pequeño adenocarcinoma prostático acinar Gleason 3-4 puntos, en el contexto de una hiperplasia prostática. El paciente evolucionó satisfactoriamente y se sigue en consulta. La tumoración extraída tenía 736 g y constituye la de mayor peso reportada en Cuba y la quinta a nivel mundial (AU).

ABSTRACT We describe the case of a giant prostatic hyperplasia, combined with an adenocarcinoma presented as an abdominal tumor. The patient had a palpable tumor in the hypogastrium and a low urinary obstructive syndrome. He was operated and a combined, transvesicular and retropubic adenomectomy was performed. The biopsy informed a little 3-4 points-Gleason, acinar, prostatic adenocarcinoma, in the context of a prostatic hyperplasia. The patient evolved satisfactorily and was followed up in consultation. The removed tumor was 736 g, and is the heaviest one reported in Cuba and the fifth worldwide (AU).

Casos clínicos: hidrocolpos secundario a reflujo vesicovaginal / Hydrocolpos caused by vesicovaginal reflux

The presence of fluid in the vaginal cavity, hydrocolpos, is uncommon to see during a pelvic ultrasound. The causes can be obstructives or not, like de vesicovaginal reflux (VVR). Objective: Report a case and the differential diagnosis of a hydrocolps in a teenage girl during a pelvic ultrasound. Case: A 13 yo girl, obese, Tanner III of pubertal development in a study for primary amenorrhea. The ultrasound shows a vaginal collection that disappeared after voiding. Non obstructive cause was confirmed with MRI. Conclusions: The pelvic ultrasound evaluation of a hydocolpos must be done with full bladder follow by a postvoid study to rule out a hydrocolpos ocurring without anatomical obstruction, which the VVR it is the most probable cause...(AU)

Introducción: La distensión de la vagina por acumulación de líquido en su interior, hidrocolpos, es un hallazgo infrecuente durante la realización de una ultrasonografía ginecológica pelviana (USG). Puede deberse a causas obstructivas y no obstructivas, dentro de las cuales se encuentra el reflujo vesico vaginal (RVV).Objetivo: Reportar el hallazgo e interpretación de un hidrocolpos en una adolescente durante la realización de USG ginecológica pelviana. Caso Clínico: En el estudio por amenorrea primaria y dolor pelviano de una adolescente obesa de 13 años, estadio Tanner III se pesquisa en el USG pelviano un hidrocolpos. Se repite evaluación post miccional, desapareciendo la colección. Mediante RNM se descarta malformación genital obstructiva. Conclusión: La evaluación ultrasonográfica de un hidrocolpos, debe realizarse con vejiga llena y luego vacía para descartar una causa no obstructiva en cuyo caso la etiología más probable es el RVV...

Non-invasive Parameters Predicting Bladder Outlet Obstruction in Korean Men with Lower Urinary Tract Symptoms

The goal of this study was to evaluate the clinical and urodynamic features in Korean men with lower urinary tract symptoms (LUTS) and to determine non-invasive parameters for predicting bladder outlet obstruction (BOO). Four hundred twenty nine Korean men with LUTS over 50 yr of age underwent clinical evaluations for LUTS including urodynamic study. The patients were divided into two groups according to the presence of BOO. These two groups were compared with regard to age, the results of the uroflowmetry, serum prostate-specific antigen (PSA) level, prostate volume, International Prostate Symptom Score (I-PSS), and the results of the urodynamic study. Patients with BOO had a lower maximal flow rate (Q(max)), lower voided volume, higher serum PSA level and larger prostate volume (P<0.05). BOO group had a significantly higher rate of involuntary detrusor contraction and poor compliance compared to the patients without BOO (P<0.05). The multivariate analysis showed that Q(max) and poor compliance were significant factors for predicting BOO. Our results show that Q(max) plays a significant role in predicting BOO in Korean men with LUTS. In addition, BOO is significantly associated with detrusor dysfunction, therefore, secondary bladder dysfunction must be emphasized in the management of male patients with LUTS.

Vesicoureteral reflux: current concepts and management implications.

Long term controlled studies in children with vesicoureteral reflux (VUR) largely conducted in developed societies, challenge the validity of established management principles.The backflow of urine into the upper tracts is not a disease by itself, but part of a clinical spectrum which is heterogeneous and has low risk and high risk categories. Management, medical, endoscopic or surgical have to take into consideration the risk to the child not only from the reflux but also from renal dysplasia and voiding dysfunction which are important risk factors for end stage renal disease (ESRD) and perpetuation of VUR respectively. Social factors, parental choices and access to medical treatment are also important in choosing therapy.

Variables predictive of voiding disfunction following aponeurotic sling surgery: multivariate analysis

INTRODUCTION: Aponeurotic sling surgeries can evolve with obstruction or voiding dysfunction in 5 to 20 percent of patients. There are few studies on factors that could possibly predispose to voiding difficulties or urinary retention. The objective of this work is to identify these potential clinical or urodynamic factors. MATERIALS AND METHODS: Records from 130 patients who underwent aponeurotic sling surgeries were reviewed. All patients underwent a throughout urodynamic study during pre-operative investigation. The variables studied were age above 65 years, previous pelvic surgeries, concomitant surgeries, post-voiding residue higher than 100 mL, vesical obstruction (according to Blaivas-Groutz nomogram) and urinary flow under 12 mL/s. Post-voiding residue was assessed on the seventh post-operative day through vesical catheterization. Recovering of spontaneous voiding after 7 post-operative days or with a residue higher than 100 mL, was regarded as voiding dysfunction. Univariate analysis was performed with qui-square test and Fisher's exact test, and multivariate analysis was performed by logistic regression with alpha = 5 percent. RESULTS: Age in the studied group ranged from 41 to 83 years (mean 56.7 years), with 69 (53 percent) patients having urethral hypermobility and 61 (47 percent) having intrinsic urethral lesion. Normal voiding occurred in 97 (75.6 percent) women with 7 post-operative days. The only significant variable in the univariate (p = 0.014) and multivariate (p = 0.017) analysis was post-voiding residue higher than 100 mL. CONCLUSION: Pre-operative presence of a post-voiding residual urine higher than 100 mL was the only variable predictive of voiding dysfunction.

The use and rationale of selective alpha blockade in children with non-neurogenic neurogenic bladder dysfunction

INTRODUCTION: We present here a long-term observation of 2 children with a rare syndrome with a non-neurogenic neurogenic bladder dysfunction (Hinman's syndrome), and we investigated the safety and efficacy of long-term use of terazosine in association with prophylactic antibiotics, timed voiding and a bowel regimen. MATERIALS AND METHODS: Two children, 7 years-old (22 kg) and 11 years-old (36 kg) presented in 1997 to our pediatric urology clinic with symptoms of urgency, frequency, urge incontinence and nocturnal enuresis. Both children were placed in a regimen of terazosine (starting with 0.5 mg increasing until 2 mg). RESULTS: There were no significant side effects throughout the entire treatment. The first 7-year old boy however developed some dizziness when the dose of terazosine was increased to 2 mg (after 4 weeks of administrating 1 mg), and this disappeared immediately when the dosage was reduced back to 1 mg daily. The urgency symptoms improved in both boys after 3 weeks of 1 mg terazosine. The secondary enuresis in the 11 year-old boy resolved after 2 months of 2 mg terazosine. CONCLUSION: It is possible to say that the alpha-blocker medication, terazosine can be administered safely to children with a non-neurogenic bladder dysfunction, also known as the Hinman's syndrome. These results have shown that dysfunctional voiding, postvoiding residual and upper tract involvement can disappear over time when long term terazosine is given in combination with timed voiding, prophylactic antibiotic therapy and treatment of the associated constipation. Our observations also suggest a permanent effect after discontinuing the medication.

Analysis on pathogenesis of 50 cases of bladder proliferative lesions / 华中科技大学学报（医学）（英德文版）

In order to study the pathogenesis, clinical and pathological characteristics of proliferative lesions of the bladder, 50 cases of proliferative lesions of the bladder from 150 patients with complaints of frequency, urgency, hematuria and dysuria were subjected to cystoscopic biopsy of the suspicious foci in the bladder. In combination with the symptoms, urine and urodynamics, the relationship of proliferative lesions of the bladder to the inflammation and obstruction of the lower urinary tract was analyzed. Of the 50 cases of proliferative bladder lesions, 44 cases (88%) had lower urinary tract infection and 29 (58%) lower urinary tract obstruction. The patients with lower urinary tract obstruction were all complicated with infection. Three cases were associated with transitional cell carcinoma. Malignant cells were detected in 1 case by urinary cytologic examination. Proliferative lesions of the bladder, especially those without other obvious mucosa changes under cystoscopy, are common histological variants of urothelium in the patients with chronic inflammation and obstruction of the lower urinary tract. Chronic inflammation and obstruction of the lower urinary tract might be the causes for proliferative lesions of the bladder. It is suggested that different treatments should be applied according to the scope and histological type of the proliferative lesions.

A glomerulopatia da imunoglobulina a na síndrome de anormalidades urinárias / The IGA glomerulopathy in the syndrome of urinary abnormalities

Foram analisadas 32 biópsias renais realizadas no Serviço de Nefrologia do HU-U.F.J.F. A glomerulopatia da imunoglobulina A (GlgA) foi a doença glomerular mais freqüente (25%), manifestando-se principalmente como síndrome de anormalidades urinárias (SAU) assintomática. Demonstrou-se ainda que os indivíduos com GlgA apresentaram tempo conhecido de doença até a realização da biópsia renal significativamente maior (p<0,05), traduzindo uma demora na elucidação da doença renal. Por outro lado, a depuração da creatinina plasmática nos casos de GlgA foi significativamente maior (p<0,05) do que aquela de outras doenças glomerulares. Observou-se que nos sete casos de GlgA com SAU, a esclerose focal e segmentar foi a glomerulopatia presente em quatro casos. A GlgA é uma doença glomerular freqüente em nosso meio, manifestando-se principalmente como síndrome de anormalidades urinárias assintomáticas. Estratégias clínicas e terapêuticas deverão ser traçadas com o objetivo de retardar a progressão da GlgA para insuficiência renal crônica.

The authors assessed 32 renal biopsies done at our Unit, and found that Immunoglobulin A (IgA) glomerulopathy was the most frequent glomerulonephritis, particularly among patients who presented with abnormal urinary syndrome. It was observed that the time course between clinical presentation and renal biopsy was longer time to confirm the diagnosis of the disease. On ther hand, creatinine clearance was higher in patients with IgA gomerulopathy (p<0,05) when compared to other histological patterns. The IgA glomerulopathy is frequent in our region, and its clinical prescritation is mainly as abnormal urinary syndrome. Clinical and therapeutic strategies should be used aiming to delay the progression of IgA nephroparhy to end stage renal failure.

Fístulas genitourinarias en el Instituto Nacional de Perinatología / Urogenital fistulae at Instituto Nacional de Perinatología

Se evaluaron las características clínicas de las pacientes con diagnóstico de fístula genitourinaria. Se realizó un estudio retrospectivo en la Clínica de Urología Ginecológica de Instituto Nacional de Perinatología, en un período comprendido de marzo 1992 a junio de 1995, se encontraron 21 pacientes evaluadas con diagnóstico de fístula urogenital, en las cuales se analizó la etiología, la localización, la vía de abordaje quirúrgico, la frecuencia de infección de vías urinarias y la resolución. La etiología fue ginecológica en 51.1 por ciento de los casos y obstétrica en 48.5 por ciento, la localización fue: vesicovaginales 14 (66.6 por ciento), ureterovaginales 5 (23.5 por ciento), uretrovaginales 2(9.5 por ciento). La resolución por vía abdominal fue de ocho pacientes, por vía vaginal en 9 y con manejo conservador, dos. El porcentaje de resolución fue de 8.9 por ciento. La infección de vías urinarias bajas a su ingreso fue para la de causa obstétrica de 47.6 por ciento y las de causa ginecológica de 52.2 por ciento. Se observa un incremento en la presentación de fístulas urogenitales de causa obstétrica, lo cual puede esta influido por el hecho de que la mayoría de las pacientes en el Instituto son de tipo obstétrico

Bexiga de choque / Bladder injury

O tratamento urológico dos pacientes vítimas de traumatismo raquimedular nem sempre é bem conduzido. Esquece-se que as complicaçöes urinárias säo as de maior morbidade nesse grupo de doentes. O presente artigo salienta a importância da abordagem urológica precoce, apresentando as diretrizes básicas apra o atendimento urológico desses pacientes ainda na fase aguda, de choque medular

Lipotimia noturna durante a micçäo: síncope miccional / Nocturne lipothymia during miction: mictional syncope

A lipotimia noturna durante a micçäo, chamada síndrome miccional, é uma entidade pouco conhecida, mas muito mais comum do que a literatura faz crer. Säo descritos 3 casos desta síncope, todos ocorrendo em homens relativamente jovens, gozando de boa saúde e causando traumatismos cranianos e torácicos de alguma importância. A investigaçäo neurológica e cardiológica em 2 deles nada revelou de anormal e os episódios näo recorreram num período de observaçäo de até 2 anos. A síncope miccional parece ser causada por hipotensäo provocada pela manobra de Valsalva, associada a alteraçöes da resistência vascular periférica, que ocorrem quando o indivíduo assume posiçäo ereta, após decúbito prolongado. Um reflexo vasovagal por súbito esvaziamento vesical também poderia se associar