ABSTRACT
PURPOSE: The possible etiopathogenic factors, symptoms, diagnostic methods, surgical management and complications of the urethral diverticula are reviewed. MATERIALS AND METHODS: A retrospective study of the clinical charts with urethral diverticula diagnosis during the period 1986-2006 was carried out. RESULTS: In the last 20 years a total of 19 patients have been treated for this pathology: 15 females and 4 males. Five of the females started with a sensation of vaginal mass; the rest were diagnosed of micturitional (irritative) syndrome, urinary incontinence or urinary infection. In the case of males, 3 of them had a palpable tumour in the penis. The most used diagnostic method was retrograde and voiding cystourethrography; urethrography with double-occlusion balloon catheter was used in 5 cases and urethroscopy in 4 patients; other techniques of image diagnosis like magnetic resonance imaging were necessary for the most complex cases. The treatment was the excision of the diverticulum, except for one of the females who rejected the treatment. The evolution in all treated women was successful, according to follow up 2 years after the treatment. In males, two of them had complex recurrent diverticula. CONCLUSIONS: Urethral diverticula are nosologic entities of difficult diagnosis, due to their low prevalence and their unspecific clinic, therefore diagnosis is sometimes incidental. The etiopathogenity is acquired in most cases and its surgical treatment is more challenging in males than in females probably linked to the fact that diverticula appear in urethras with previous surgery, endourologic manipulation or associated injuries.
Subject(s)
Diverticulum/diagnosis , Urethral Diseases/diagnosis , Adult , Aged , Diverticulum/surgery , Female , Humans , Male , Middle Aged , Urethral Diseases/surgeryABSTRACT
Objetivo: Se valoran los posibles factores etiopatogénicos y se describen la clínica, métodos diagnósticos, abordaje quirúrgico, resultados y complicaciones del manejo de los divertículos uretrales. Material y métodos: Se realizó una revisión retrospectiva de las historias clínicas con diagnóstico de divertículo uretral en el periodo 1986-2006. Resultados: Durante estos 20 años se han tratado un total de 19 pacientes con esta patología: 15 mujeres y 4 hombres. Cinco de las mujeres debutaron clínicamente con sensación de masa vaginal; el resto fueron diagnosticadas en el contexto de un síndrome miccional, incontinencia urinaria o infección urinaria. En el caso de los varones, 3 de ellos presentaron una tumoración palpable en el pene. La prueba diagnóstica más utilizada fue la uretrocistografía miccional seriada; la uretrografía con sonda de doble balón se utilizó en 5 ocasiones y la uretroscopia en 4 pacientes. En los casos más complejos se utilizaron otras técnicas de diagnóstico por la imagen, como la resonancia magnética nuclear. El tratamiento fue la extirpación del divertículo en todos los pacientes, excepto en una mujer que rechazó la intervención. La evolución de las pacientes ha sido satisfactoria realizándose controles periódicos hasta dos años después de la intervención. Dos de los casos, en varones, tuvieron recidivas complejas. Conclusiones: Los divertículos uretrales son una entidad nosológica de difícil diagnóstico dada su baja prevalencia y su clínica inespecífica lo que motiva que, en algunas ocasiones, el diagnóstico sea incidental. La etiopatogenia es adquirida en la mayoría de los casos y su tratamiento quirúrgico, con peores resultados en los hombres debido, probablemente, a que los divertículos se producen en uretras con antecedentes de cirugías previas, manipulación endourológica o lesiones asociadas
Purpose: The possible etiopathogenic factors, symptoms, diagnostic methods, surgical management and complications of the urethral diverticula are reviewed. Materials and methods: A retrospective study of the clinical charts with urethral diverticula diagnosis during the period 1986-2006 was carried out. Results: In the last 20 years a total of 19 patients have been treated for this pathology: 15 females and 4 males. Five of the females started with a sensation of vaginal mass; the rest were diagnosed of micturitional (irritative) syndrome, urinary incontinence or urinary infection. In the case of males, 3 of them had a palpable tumour in the penis. The most used diagnostic method was retrograde and voiding cystourethrography; urethrography with double-occlusion balloon catheter was used in 5 cases and urethroscopy in 4 patients; other techniques of image diagnosis like magnetic resonance imaging were necessary for the most complex cases. The treatment was the excision of the diverticulum, except for one of the females who rejected the treatment. The evolution in all treated women was successful, according to follow up 2 years after the treatment. In males, two of them had complex recurrent diverticula. Conclusions: Urethral diverticula are nosologic entities of difficult diagnosis, due to their low prevalence and their unspecific clinic, therefore diagnosis is sometimes incidental. The etiopathogenity is acquired in most cases and its surgical treatment is more challenging in males than in females probably linked to the fact that diverticula appear in urethras with previous surgery, endourologic manipulation or associated injuries
Subject(s)
Male , Female , Middle Aged , Humans , Diverticulum/diagnosis , Diverticulum/surgery , Urethral Diseases/diagnosis , Diagnostic Imaging/methods , Magnetic Resonance Imaging/methods , Gynecologic Surgical Procedures/methods , Surgical Procedures, Operative/methods , Urologic Surgical Procedures/methods , Urinary Incontinence, Stress/complications , Urinary Incontinence, Stress/diagnosis , Urethra/pathology , Diverticulum/complications , Urethral Diseases/surgery , Urethra/surgery , Urethra , Retrospective Studies , Urogenital Surgical Procedures/methodsABSTRACT
OBJECTIVE: To determine the current state of vesicouterine fistulae in our hospital, the factors associated with their development and the findings obtained from the treatments used. MATERIAL AND METHODS: We carry out a retrospective study on a group of patients suffering from vesicouterine fistulae who were treated in our service for the last 25 years with a 2 year minimum follow-up. RESULTS: 6 cases of vesicouterine fistulae were evaluated. In 83.3% (5/6) of the cases occurred following caesarean section. The average age of the patients was 36.5 years old. In 50% of the cases, urinary incontinence immediately after surgery determined an early diagnosis. In 5 patients deferred abdominal surgical approach was carried out. All of the patients remained asymptomatic during the follow-up years. Two pregnancies were recorded 24 months after repair with a full term delivery. CONCLUSIONS: The vesicouterine fistula, despite being infrequent, is no longer an exceptional diagnosis. Currently, the low segmentarian caesareans constitute the major isolated risk factor for fistula development. We recommend a deferred surgical repair without discarding a conservative approach for those cases of small and early fistula.
Subject(s)
Fistula , Urinary Bladder Fistula , Uterine Diseases , Adult , Female , Fistula/diagnosis , Fistula/etiology , Fistula/surgery , Humans , Middle Aged , Retrospective Studies , Time Factors , Urinary Bladder Fistula/diagnosis , Urinary Bladder Fistula/etiology , Urinary Bladder Fistula/surgery , Uterine Diseases/diagnosis , Uterine Diseases/etiology , Uterine Diseases/surgeryABSTRACT
OBJETIVO: Determinar el estado actual de las fístulas vesicouterinas en nuestro hospital, los factores asociados a su desarrollo y evaluar los resultados de los tratamientos realizados para su resolución. MATERIAL Y MÉTODOS: Realizamos un estudio retrospectivo de las pacientes con fístulas vesicouterinas tratadas en nuestro servicio en los últimos 25 años con un seguimiento mínimo de 2 años. RESULTADOS: Se evaluaron 6 casos de fístulas vesicouterinas. En el 83,3 por ciento (5/6) de los casos la causa principal fue la realización de una cesárea. La edad media de las mujeres fue de 36,5 años. En el 50 por ciento de los casos la incontinencia urinaria inmediata a la intervención quirúrgica condicionó el diagnóstico precoz. En 5 pacientes se realizó una reparación quirúrgica diferida de la fístula vía abdominal. Todas ellas permanecieron asintomáticas durante los años de seguimiento. En 2 pacientes se produjo un embarazo a término a partir de los 24 meses de la intervención. CONCLUSIONES: La fístula vesicouterina, aún siendo infrecuente, ha dejado de ser un diagnóstico excepcional. Las cesáreas segmentarias bajas constituyen actualmente el mayor factor de riesgo aislado relacionado con el desarrollo de estas fístulas. Recomendamos una reparación quirúrgica diferida sin descartar una actitud conservadora en los casos de pequeño tamaño diagnosticados precozmente (AU)
OBJECTIVE: To determine the current state of vesicouterine fistulae in our hospital, the factors associated with their development and the findings obtained from the treatments used. MATERIAL AND METHODS: We carry out a retrospective study on a group of patients suffering from vesicouterine fistulae who were treated in our service for the last 25 years with a 2 year minimum follow-up. RESULTS: 6 cases of vesicouterine fistulae were evaluated. In 83,3% (5/6) of the cases occurred following caesarean section. The average age of the patients was 36,5 years old. In 50% of the cases, urinary incontinence immediately after surgery determined an early diagnosis. In 5 patients deferred abdominal surgical approach was carried out. All of the patients remained asymptomatic during the follow-up years. Two pregnancies were recorded 24 months after repair with a full term delivery. CONCLUSIONS: The vesicouterine fistula, despite being infrequent, is no longer an exceptional diagnosis. Currently, the low segmentarian caesareans constitute the major isolated risk factor for fistula development. We recommend a deferred surgical repair without discarding a conservative approach for those cases of small and early fistula (AU)
Subject(s)
Middle Aged , Adult , Female , Humans , Uterine Diseases , Fistula , Urinary Bladder Fistula , Time Factors , Retrospective StudiesABSTRACT
OBJECTIVES: To asses the impact of augmentation enterocystoplasty on the success of cadaveric renal transplantation in patients with dysfunctional bladders. PATIENTS AND METHODS: Between 1980 and 2001, 3 men and a woman with severe dysfunctional lower urinary tract underwent a total of 4 cadaveric renal transplantations. The etiologies of the bladder dysfunction were bladder contraction secondary to urinary tuberculosis in all cases. In 3 patients were performed an enterocystoplasty with ileocecal segment and one with ileon. RESULTS: The overall allograft survival was 58.7 months. Two patients have functioning grafts 27 and 74 months after transplant, 1 has died due to an intestinal disease and other had chronic rejection after follow-up of 98 months. Technical complications occurred in 3 patients. All patients remain continent without catheterization after the transplantation. CONCLUSIONS: Enterocystoplasty is a safe and effective method of restoring lower urinary tract function in the patient with end stage renal disease and a small non compliant bladder.
Subject(s)
Kidney Transplantation , Urinary Diversion , Adult , Cecum/surgery , Female , Graft Survival , Humans , Ileum/surgery , Kidney Failure, Chronic/complications , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Transplantation, Homologous , Treatment Outcome , Urinary Incontinence/complications , Urinary Incontinence/surgeryABSTRACT
OBJETIVOS: Evaluar la evolución y resultados del trasplante renal de donante cadáver en pacientes con ampliaciones vesicales realizadas por alteración del tracto urinario inferior (TUI). PACIENTES Y MÉTODOS: Entre 1980 y 2001 hemos realizado 4 trasplantes renales en pacientes con fibrosis vesical restrictiva secundaria a tuberculosis (3 hombres y 1 mujer). Previamente se realizó ampliación vesical intestinal: 3 ileocecocistoplastias y 1 ileocistoplastia. RESULTADOS: Tras 27 y 74 meses desde el trasplante renal 2 pacientes conservan buena función renal. Un paciente perdió el injerto por rechazo crónico a los 98 meses y el restante falleció a los 36 meses por sepsis de origen intestinal, conservando el injerto funcionante. Tres casos tuvieron complicaciones post-quirúrgicas que precisaron de tratamiento instrumental. Ningún paciente presentó incontinencia urinaria. CONCLUSIONES: La enterocistoplastia es un procedimiento seguro y eficaz para pacientes con alteración del TUI y que precisan de trasplante renal (AU)
OBJECTIVES: To asses the impact of augmentation enterocystoplasty on the success of cadaveric renal transplantation in patients with dysfunctional bladders. PATIENTS AND METHODS: Between 1980 and 2001, 3 men and a woman with severe dysfunctional lower urinary tract underwent a total of 4 cadaveric renal transplantations. The etiologies of the bladder dysfunction were bladder contraction secondary to urinary tuberculosis in all cases. In 3 patients were performed an enterocystoplasty with ileocecal segment and one with ileon. RESULTS: The overall allograft survival was 58.7 months. Two patients have functioning grafts 27 and 74 months after transplant, 1 has died due to an intestinal disease and other had crohnic rejection after follow-up of 98 months. Technical complications occurred in 3 patients. All patients remain continent without catheterization after the transplantation. CONCLUSIONS: Enterocystoplasty is a safe and effective method of restoring lower urinary tract function in the patient with end stage renal disease and a small non compliant bladder (AU)
Subject(s)
Middle Aged , Adult , Male , Female , Humans , Urinary Diversion , Kidney Transplantation , Transplantation, Homologous , Urinary Incontinence , Treatment Outcome , Postoperative Complications , Retrospective Studies , Cecum , Renal Insufficiency, Chronic , Graft Survival , IleumABSTRACT
Cystadenoma of the seminal vesicles is a extremely rare pathology. To our knowledge only eight cases have been reported in the literature. We report a new case of this benign tumor, bilaterally located and incidentally found at surgery. Literature is reviewed and clinical, diagnostic and therapeutic aspects of these are discussed.
Subject(s)
Cystadenoma/pathology , Genital Neoplasms, Male/pathology , Seminal Vesicles , Humans , Male , Middle AgedABSTRACT
Between 1980 and 1991, 504 transplantations were performed in our hospital. All patients received pre-surgical therapy with antibiotics. The total incidence of surgical wound infection was 15 cases (3%). After reviewing all parameters that could have been involved in the development of these infections, it become apparent that diabetes mellitus, more than one transplant in the same patient, development of haematoma in the wound and presence of urinary fistulae were statistically significant (p < 0.05). On the other hand, the use of the different immunosuppressive regimes (azathioprin and cyclosporin) and acute tubular necrosis showed no statistical significance (p > 0.05); also, no relationship was found between infection and acute graft rejection.
Subject(s)
Kidney Transplantation/adverse effects , Surgical Wound Infection/epidemiology , Adolescent , Adult , Child , Female , Humans , Incidence , Male , Middle Aged , Surgical Wound Infection/etiologyABSTRACT
Primary adenocarcinoma of the bladder is a rare tumor type. Histologically it can be mucinous, signet ring cell or clear cell. When diagnosed, it is in the advanced stages and carries a poor prognosis because of its aggressive nature. We report on 9 cases with primary adenocarcinoma of the bladder (2 signet ring cell and 7 mucinous tumors). Those with the advanced stage had a mean survival of 13 months. Of the remaining 4, one survived up to 6 years. This patient had a medium stage tumor and had undergone radical treatment.
Subject(s)
Adenocarcinoma, Mucinous/diagnosis , Urinary Bladder Neoplasms/diagnosis , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle AgedABSTRACT
The study of impotentia coeundi requires separating the organic from the psychogenic cause. Arteriogenic impotence falls within the first group and has been assessed with the papaverine test, simple Doppler and arteriography. Currently, more sophisticated techniques such as the pulsed Doppler permit noninvasive assessment of the blood supply to the penile arteries. Intracavernous injection of vasoactive substances such as papaverine cause vascular changes. Evaluation of these changes permits making the diagnosis of arterial insufficiency without recurring to more invasive diagnostic techniques such as arteriography. Currently, this invasive technique is only justified in revascularization surgery but not for diagnosis. The availability of color Doppler facilitates arterial evaluation even further.
Subject(s)
Erectile Dysfunction/diagnostic imaging , Papaverine/therapeutic use , Adult , Erectile Dysfunction/drug therapy , Humans , Injections , Male , Papaverine/administration & dosage , Penis/blood supply , Ultrasonography/methodsABSTRACT
We report on two cases of renal liposarcoma. The clinical features of this tumor type are described and diagnostic and therapeutic considerations are put forward. The usefulness of CT in the diagnosis of this disease entity is underscored. This permits us to evaluate the response to treatment and furthermore, it permits early detection of recurrence.
Subject(s)
Kidney Neoplasms/diagnostic imaging , Liposarcoma/diagnostic imaging , Female , Humans , Kidney Neoplasms/pathology , Kidney Neoplasms/surgery , Liposarcoma/pathology , Liposarcoma/surgery , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Despite the cases reported in the literature, anterior urethral valves continue to be an uncommon condition. The foregoing has to be considered when evaluating children with urinary obstruction or recurrent infections. A case of anterior urethral valves associated with segmental saccular dilatation of the urethra is described and the diagnostic methods are highlighted.
Subject(s)
Urethra/abnormalities , Adolescent , Cystoscopy , Dilatation, Pathologic/diagnostic imaging , Humans , Male , Radiography , Urethra/diagnostic imagingABSTRACT
We present 12 cases with spontaneous healing of ureterovaginal (11 cases) and ureterouterine (1 case) fistulas. In every case disappearance of the fistula with normal renal function and restoration of the excretory tract was obtained. IVP and retrograde pyelographs were performed in every case. Spontaneous healing is feasible under the following conditions: continuity of the ureteral lumen and normality of the infralesional ureter. Spontaneous healing is independent of the number of affected ureters, age, gynecological pathology, gynecological intervention, latency period, urographical findings, duration of incontinence, and urinary infection.
Subject(s)
Fistula , Ureteral Diseases , Uterine Diseases , Vaginal Fistula , Adult , Cesarean Section , Female , Humans , Hysterectomy , Middle Aged , Postoperative Complications , Remission, SpontaneousABSTRACT
Signet ring cell adenocarcinoma of the bladder is rare. Only 16 cases are recorded in the literature, although two meet the requirements for being considered of urachal origin. We present the third case of signet cell adenocarcinoma of urachal origin.
Subject(s)
Adenocarcinoma, Mucinous/pathology , Urinary Bladder Neoplasms/pathology , Urinary Bladder/pathology , Adult , Humans , Urachus/pathologyABSTRACT
We report a rare case of spontaneous healing of a left uretero- and vesicovaginal fistula observed simultaneously in a patient. We have not found reports of similar cases in the reviewed literature. We also suggest the pathogenic mechanisms responsible for total healing.
