ABSTRACT
La prevalencia de uropatía obstructiva asociada al prolapso uterino varía según las series entre un 4 per cent y un 80 per cent, probablemente debido a la diferente severidad de los prolapsos considerados. El desarrollo de insuficiencia renal o anuria es una complicación poco frecuente. Se han postulado diversas teorías etiopatogénicas sobre la uropatía obstructiva producida por el prolapso: compresión ureteral por los vasos uterinos, angulación uretral extrema, compresión ureteral sobre la musculatura elevadora del ano y elongación y estrechamiento del uréter distal. La exploración radiológica princeps en el estudio del tracto urinario de estas pacientes es la urografía intravenosa en bipedestación. El tratamiento de urgencia de la anuria obstructiva secundaria a prolapso uterino consiste en la reducción manual del prolapso. La cirugía se considera como el tratamiento definitivo de elección, aunque en pacientes con elevado riesgo anestésico-quirúrgico, la colocación de un pesario de forma permanente puede ofrecer un resultado satisfactorio. Presentamos un caso de anuria obstructiva secundaria a prolapso uterino, que resolvió satisfactoriamente mediante la colocación de un pesario (AU)
Subject(s)
Aged, 80 and over , Aged , Female , Humans , Urethral Obstruction , Uterine Prolapse , AnuriaABSTRACT
El riñón en herradura es una malformación congénita que predispone al desarrollo de infecciones urinarias altas, por la ectasia piélica inherente a la malrotación de las unidades renales.La nefritis bacteriana aguda es un estadio evolutivo de la infección renal aguda situado entre la pielonefritis aguda y el absceso renal. El diagnóstico diferencial entre estas entidades sólo es posible mediante el apoyo de alguna técnica de imagen, ya que desde el punto de vista clínico son indistinguibles. El TAC con contraste es la técnica de mayor sensibilidad y especificidad en el diagnóstico de nefritis bacteriana aguda, y se considera la prueba de elección. Los hallazgos característicos del TAC son áreas corticales redondeadas o cuneiformes que adquieren una apariencia estriada tras la administración de contraste. El tratamiento está basado en antibioterapia de amplio espectro, que debe mantenerse durante un período de 3-6 semanas.Presentamos un caso de nefritis bacteriana aguda difusa, en un paciente pediátrico con riñón en herradura, que se resolvió satisfactoriamente con tratamiento antibiótico prolongado (AU)
Subject(s)
Adolescent , Male , Humans , Nephritis , Acute Disease , Kidney , Escherichia coli InfectionsABSTRACT
Horseshoe kidney is a congenital malformation which predisposes the patient to severe urinary tract infections, due to pelvic ectasia which is inherent in the malrotation of the renal units. Acute bacterial nephritis is an evolutionary stage of the acute renal infection situated between acute pyelonephritis and renal abscess. It is only possible to carry out a differential diagnosis of these two bodies through the application of some imaging technique, as it is impossible to differentiate them from a clinical point of view. A CT contrast scan is the most sensitive and specific means of diagnosing acute bacterial nephritis, and is considered to be the most appropriate test method. The CT scan usually reveals circular or wedge-shaped cortical areas which become striated after contrast administration. Treatment is based on broad-spectrum antibiotherapy, which must be continued for a period of 3 to 6 weeks. We present a case of diffuse acute bacterial nephritis, occurring in a paediatric patient with a horseshoe kidney, which was successfully treated by means of a prolonged course of antibiotics.
Subject(s)
Escherichia coli Infections/complications , Kidney/abnormalities , Nephritis/complications , Acute Disease , Adolescent , Escherichia coli Infections/drug therapy , Humans , Male , Nephritis/drug therapy , Nephritis/microbiologyABSTRACT
The prevalence of obstructive uropathy linked to uterine prolapse ranges between 4% and 80%, depending on the series, probably due to the varying degree of severity of the prolapses under consideration. Renal failure or anuria is an unusual complication. Several etiopathogenic theories regarding obstructive uropathy secondary to prolapse have been put forward: ureteral compression by the uterine vessels, severe urethral angulation, ureteral compression against levator ani muscles and the elongation and narrowing of the distal ureter. The major radiological exploration used in studying the urinary tract of these patients is intravenous urography in bipedestation. Emergency treatment for obstructive anuria resulting from a uterine prolapse consists of manually replacement of the prolapse. Surgery is considered to be the definitive ideal treatment, although in the case of surgical or anaesthetic high risk patients, inserting a permanent pessary may constitute a satisfactory solution. We present a case of obstructive anuria resulting from uterine prolapse, which was successfully treated with the insertion of a ring pessary.
Subject(s)
Anuria/etiology , Uterine Prolapse/complications , Aged , Aged, 80 and over , Female , Humans , Urethral Obstruction/etiologyABSTRACT
Inflammatory pseudotumor is a reactive benign lesion which can be very difficult to distinguish from some malignant bladder tumors like sarcomas or sarcomatoid carcinoma. The aim of this study was to present a new case of inflammatory pseudotumor and to review the present diagnostic and therapeutic criteria for this lesion. A 72-year-old female was admitted to the emergency room due to important hematuria. Transurethral resection of a bladder tumor located in the left lateral wall was performed. Pathologic studies were suggestive of inflammatory pseudotumor, but a mixoid leiomyosarcoma couldn t be completely discarded and a partial cystectomy with ipsilateral lymphadenectomy were carried out. Immunohistochemical studies were positive for vimentin, desmin, smooth muscle actin and cytoqueratins while epithelial membrane antigen and S-100 protein were negative. The patient is disease free after a year follow-up. When diagnosis is certain, complete transurethral resection is the treatment of choice. However, if there is no total pathologic confirmation, if it is a very wide lesion or if it is recurring after endoscopic resection, a partial cystectomy is suggested.
