Likelihood of retrograde double-J stenting according to ureteral obstructing pathology

OBJECTIVES: To evaluate the likelihood of retrograde double-J stenting in urgent ureteral drainage according to obstructing pathology. MATERIALS AND METHODS: From July 2002 to January 2003, 43 consecutive patients with ureteral obstruction who needed urgent decompression were evaluated at our institution, where we performed a total of 47 procedures. Emergency was defined as ureteral obstruction associated with infection, obstructive acute renal failure, or refractory pain. Ureteral obstruction was defined as intrinsic and extrinsic based on etiology and evaluated by ultrasound. Patients submitted to previous double-J stenting were excluded. Failures in retrograde ureteral stenting were treated with percutaneous nephrostomy. Results were analyzed with Fisher's exact test and regression analysis. RESULTS: Failure in retrograde ureteral stenting occurred in 9 percent (2/22) and 52 percent (13/25) of the attempts in patients with intrinsic and extrinsic obstruction respectively (p < 0.001). Failures in stenting extrinsic obstructions occurred due to lack of identification of the ureteral meatus in 77 percent and impossibility of catheter progression in 23 percent (p < 0.05). All attempts of retrograde catheter insertion failed in obstructions caused by prostate or bladder pathologies (6/6). Inability to identify the ureteral meatus was the cause of all failures. CONCLUSION: Retrograde double-J stenting has a low probability of success in extrinsic ureteral obstruction caused by prostate or bladder disease. Such cases might be best managed with percutaneous nephrostomy.

Tumores de células germinativas extratesticulares / Extragonadal germ cell tumours

Estes tumores constituem neoplasias raras e de origem controversa. Entre as teorias que tentam justificar o seu aparecimento destacam-se a do desenvolvimento a partir de restos de células germinativas e a de metástases de microtumores testiculares. Na propedêutica destas lesöes é de grande importância a ultra-sonografia escrotal visando excluir foco tumoral primário, e a quimioterapia sistêmica constitui a principal medida terapêutica com altos índices de remissäo. Neste estudo foram revistos quatro casos sendo três seminomas que tiveram evoluçäo satisfatória e um misto que näo respondeu ao tratamento, falecendo após cinco meses