Seguimiento telefónico de pacientes con malformaciones del tracto genitourinario en sus primeros dos años de vidas / Telephonic follow-up of patients with genitourinary malformations in their first two years of life

Las malformaciones del tracto genitourinario (MTG) son una causa importante de morbilidad en la población pediátrica pudiendo llevar a los pacientes a falla renal severa o incluso a la muerte y dejando como posible discapacidad impotencia e infertilidad en el adulto. Es de vital importancia hacer un seguimiento a estos pacientes para determinar las complicaciones, pronóstico y posibles discapacidades secundarias a estas patologías congénitas. Por esta razón se realizó una encuesta telefónica de seguimiento a 40 pacientes con diagnóstico de MTG en la ciudad de Bogotá. Después de analizar múltiples variables se encontró que en nuestro medio, la mortalidad directamente relacionada con el defecto urogenital fue baja comparada con otros estudios y se relacionó directamente con malformaciones mayores. El 22 por cien de los pacientes que sobrevive requiere al menos una cirugía en los primeros dos años de vida, con buenos resultados. También se encontró que los pacientes son valorados en su mayoría de forma interdisciplinaria por más de un especialista. Para complementar estos resultados es necesario un sistema de seguimiento más exhaustivo que busque evaluar estos pacientes a más largo plazo para evaluar discapacidad en la adolescencia y edad adulta

Síndromes genéticos con manifestaciones oncológicas del tracto genitourinario / Genetic syndromes with oncologic manifestations at the genitourinary tract

La mayoría de los casos de manifestaciones malignas en el tracto genitourinario en la edad pediátrica son esporádicos siendo la neoplasia más frecuente, el tumor de Wilms'. De todos modos una minoría de los casos tienen una asociación a síndromes genéticos causados por la mutación de uno o más genes. Es por esto, la importancia de conocer las diferentes asociaciones y sus manifestaciones clínicas con el fin de identificar oportunamente las diferentes patologías para así tratarlas adecuadamente

Urogenital involvement in the Klippel-Trenaunay-Weber syndrome: treatment options and results

OBJECTIVE: Klippel-Trenaunay-Weber syndrome (KTWS) is a congenital condition characterized by vascular malformations of the capillary, venous and lymphatic systems associated to soft tissue and bone hypertrophy in the affected areas. This syndrome may involve bladder, kidney, urethra, ureter and genitals. We report the treatment of 7 KTWS patients with urogenital involvement. MATERIALS AND METHODS: From 1995 to 2005, 7 patients with KTWS were evaluated and the charts of these patients were reviewed. RESULTS: PatientsÆ median age was 19-years (range 4 to 46-years) and only 1 was female. The clinical presentation included genital deformities in 3 cases, hematuria in 2 and urethrorragia in 2, one of which associated with cryptorchidism and phimosis. Three patients had an association of pelvic and genital malformations, including 2 patients with hematuria due to vesical lesions and 1 patient with left ureterohydronephrosis due to a pelvic mass. Two patients had urethral lesions. Treatment included endoscopic laser coagulation for 1 patient with recurrent hematuria and 1 patient with urethrorrhagia, pelvic radiotherapy for 1 patient with hematuria and circumcision in 2 patients with genital deformities. One patient required placement of a double-J catheter to relieve obstruction. Hematuria and urethrorragia were safely and effectively controlled with laser applications. Circumcision was also effective. The patient treated with radiotherapy developed a contracted bladder and required a continent urinary diversion. CONCLUSIONS: Urogenital involvement in patients with KTWS is not rare and must be suspected in the presence of hematuria or significant cutaneous deformity of the external genitalia. Surgical treatment may be warranted in selected cases.

Effect and safety of 17 beta-estradiol vaginal tablet in postmenopausal women with urogenital symptoms.

OBJECTIVE: To evaluate the effects of a 17 beta-estradiol vaginal tablet on urogenital symptoms, vaginal pH, vaginal cytology, endometrial thickness, and plasma estradiol level in postmenopausal women with urogenital symptoms. METHOD: Twenty-seven postmenopausal women with urogenital symptoms received 25 microg of a 17 beta-estradiol tablet intravaginally daily for the first 2 weeks, followed by 10 weeks of twice a week dosage. The results of urogenital symptoms, vaginal pH, vaginal cytology, endometrial thickness, and plasma estradiol level were analysed. RESULTS: The urogenital symptoms improved significantly in all women. The mean vaginal pH was significantly decreased. The vaginal cytology showed estrogenic effect on the karyopyknotic index and the maturation value. There was no significant difference in endometrial thickness and level of plasma estradiol before and after treatment. There was one case of vaginal bleeding from endometrial proliferation. CONCLUSION: Local vaginal treatment of 17 beta-estradiol (25 microg) had a positive effect on the urogenital symptoms, vaginal pH, and vaginal cytology. No elevation of plasma estradiol level was detected after treatment.

Neoplasias endocrinas múltiples en un recién nacido / Multiple endocrine neoplasias in a newborn

En este trabajo se presenta el caso de un recién nacido con neoplasia endocrina múltiple, poniéndose énfasis en las diferencias entre los síndromes clásicos y el que ahora se describe. También se comenta la naturaleza de las lesiones proliferativas.

Atualizaçäo: complicaçöes actínicas do sistema genital e urinário / Atualization: actinics complications of genitourinary system

A radioterapia é empregada em várias neoplasias malignas pélvicas. Näo infreqüentemente, verifica-se complicaçöes actínicas em vários órgäos dos sistemas genital e urinário com intensidade variável. Nos casos mais graves, os pacientes mesmo com câncer controlado podem ter comprometidas de maneira significativa sua qualidade de vida e suas funçöes sexuais e reprodutivas. O risco da ocorrência de um segundo tumor primário, radioinduzido, deve ser lembrado. Os autores discutem de maneira individualizada essas complicaçöes, enfatizando aspectos de seu tratamento.

Repair of distal hypospadius: decision making of a technique

The aim of this study is to evaluate alternative techniques in repair of different types of primary hypospadias, with suggested plan for decision making of suitable technique of repair. A retrospective study of 96 cases of primary distal hypospadias [glandular, coronal, distal penile with and without chordee] were performed over a period of three years, with a minimum follow up of six months. Methods of repar included MAGPI [40], extended MAGPI [12], Mathieu [24], modified Mathieu [4], tubularised uretheral plate [9] and preputial tubed island flap [7]. The results revealed that, MAGPI [40 patients] had no major complications in glandular type and 12.5% complication rate in coronal. Extended MAGPI [12 patients] had complication rate of 37.5% in distal penile. Classic Mathieu [24] had 15% complication rate and modified Mathieu [4 patients] 25% major complication in distal penile with chordee. Tubularised uretheral plate [9 patients] had 22.2% complication rate for coronal and distal penile. Preputial island flap [7] had 28.5% complication rate in distal penile with chordee. Total major complication rate was 15.6%. Best results were obtained from proper technique selection for different types of distal hypospadias. Decision making of proper technique depends on meatal location and variety, presence of chordee, gland configuration [flat or conical], uretheral plate [flat or grooved and/or a seat of chordee] and availability of shaft or preputial skin

Developmental anomalies associated with hypospadias.

Hundred and thirty patients with hypospadias were studied between 1983 and 1990, with an aim of analysing the associated anomalies in these patients. Urogenital anomalies were observed in 30% and extra-urogenital anomalies were noted in 16%. Undescended testis was the most frequently seen anomaly, having been noted in 6.9% of 130 cases. Vesico-ureteral reflux was present in 5.4% and inguinal hernia in 3.8%. The incidence of these anomalies increased in proportion to the severity of penile deformity. The present article emphasizes the need for systemic urological and endocrinal examination, especially in severe cases of hypospadias.

Alteraçöes do sistema genital de ovinos deslanados / Genital anatomo-histopathological alterations in sheep rams

Foram examinados anátomo-histopatologicamente os diversossegmentos do sistema genital de 16 ovinos machos adultos, das raças Morada Nova (6), Santa Inês (7) e Somalis (3), procedentes do município de Sobral/CE. Os animais foram sacrificados após exames clínico-andrológicos ao se diagnosticar algum problema reprodutivo. As lesöes foram registradas, apenas, nos testículos, nosepidídimos e na bolsa escrotal, apresentando a seguinte ordem de freqüência: degeneraçäo testicular (37,50//), epididimite näo infecciosa (25,00//) e calcificaçäotesticular, orquite-epididimite, hipoplasia testicular e epididimária ocorrendo em 8,33//cada uma. A lesäo menos freqüente foi o abscesso escrotal devido ao Corynebacterium pseudotuberculosis na frequência de 4,1//. O diagnóstico clínico-andrológico das alteraçöes gonadais é de fundamental importância pois a maioria delas causa subfertilidade ou esterilidade