ABSTRACT
INTRODUCTION AND OBJECTIVES: Currently, there are no established criteria regarding treatment for lumbar ureteral stones. The objective of this work is to present our results in the endourological treatment of this pathology, analyzing the variables associated with the use of the flexible ureterorenoscope. MATERIAL AND METHODS: Retrospective review of 103 patients who underwent retrograde URS with semi-rigid or flexible ureterorenoscope. Proximal location: L2-L3. Medial location: L4-L5. Semirigid URS was the initial treatment, with conversion to flexible URS when it was required to complete the procedure. Success was defined as absence of residual fragments (6 weeks). Demographic, surgical, immediate postoperative variables, and those related to the stone, were analyzed. Their correlation with the use of the flexible ureterorenoscope was evaluated. RESULTS: Mean age: 57.2 years (SD 15.6); there were 73 men (70.9%). Stone size: 8â¯mm (range 4-30; IQR 4.5). Proximal location: 58 (56.3%). Previous JJ: 44.7%. Previous nephrostomy: 10.7%. Semirigid URS with conversion to flexible URS: 51 (49.5%). Impacted stones: 28.2%. Intraoperative complications: 2 (1.9%). Postoperative JJ: 84.5%. Immediate postoperative complications: 23 (22.3%) (Clavien-Dindo I-II: 91.3%). Postoperative ureteral stricture: 5.8%. Success: 88.4%. Residual fragments: 12 (11.7%). Spontaneous passage: 6 (50%). Greater performance of flexible URS in proximal ureteral stones (pâ¯=â¯0.001) of more than 11 mm (pâ¯=â¯0.02) in univariate analysis, and in proximal stones [OR 3.5; 1.5-8.1; pâ¯=â¯0.004] in multivariate analysis. CONCLUSIONS: Endourological treatment obtained a high success rate in our sample. Size greater than 11â¯mm and proximal ureteral location in univariate and multivariate analysis, respectively, behaved as predictors of flexible URS.
Subject(s)
Lithotripsy , Ureteral Calculi , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Ureteral Calculi/surgery , Ureteroscopy/adverse effectsABSTRACT
INTRODUCTION AND OBJECTIVES: Currently, there are no established criteria regarding treatment for lumbar ureteral stones. The objective of this work is to present our results in the endourological treatment of this pathology, analyzing the variables associated with the use of the flexible ureterorenoscope. MATERIAL AND METHODS: Retrospective review of 103 patients who underwent retrograde URS with semi-rigid or flexible ureterorenoscope. Proximal location: L2-L3. Medial location: L4-L5. Semirigid URS was the initial treatment, with conversion to flexible URS when it was required to complete the procedure. Success was defined as absence of residual fragments (6 weeks). Demographic, surgical, immediate postoperative variables, and those related to the stone, were analyzed. Their correlation with the use of the flexible ureterorenoscope was evaluated. RESULTS: Mean age: 57.2 years (SD 15.6); there were 73 men (70.9%). Stone size: 8mm (range 4-30; IQR 4.5). Proximal location: 58 (56.3%). Previous JJ: 44.7%. Previous nephrostomy: 10.7%. Semirigid URS with conversion to flexible URS: 51 (49.5%). Impacted stones: 28.2%. Intraoperative complications: 2 (1.9%). Postoperative JJ: 84.5%. Immediate postoperative complications: 23 (22.3%) (Clavien-Dindo I-II: 91.3%). Postoperative ureteral stricture: 5.8%. Success: 88.4%. Residual fragments: 12 (11.7%). Spontaneous passage: 6 (50%). Greater performance of flexible URS in proximal ureteral stones (P=0.001) of more than 11mm (P=0.02) in univariate analysis, and in proximal stones [OR 3.5; 1.5-8.1; P=0.004] in multivariate analysis. CONCLUSIONS: Endourological treatment obtained a high success rate in our sample. Size greater than 11mm and proximal ureteral location in univariate and multivariate analysis, respectively, behaved as predictors of flexible URS.
Subject(s)
Urologic Neoplasms/therapy , Humans , Practice Guidelines as Topic , Societies, Medical , Spain , UrologyABSTRACT
Spermatic Cord Liposarcoma are uncommon soft tissue neoplasm. Association with others tumors is so exceptional. We describe and relation between liposarcoma and prostate cancer in a 66 years old patient who had a left paratesticular tumor with low speed growth and 12 cm of length; nodule in prostate gland was detected. Ecography demostrate an hipoecoic tumor in the spermatic cord; Prostate Specific Antigen (PSA) was 1276 ng./ml. and bone gammagraphy reported metastatic lesions. We made an radical orquiectomy and pathological diagnosis including inmunohistoquimical process was sclerosing dedifferenciated liposarcoma. We discuss clinical and pathologic behaviour of this lesions and diagnosis and treatment options.
Subject(s)
Adenocarcinoma/complications , Liposarcoma/complications , Prostatic Neoplasms/complications , Spermatic Cord/pathology , Adenocarcinoma/diagnosis , Adenocarcinoma/therapy , Aged , Genital Neoplasms, Male/complications , Genital Neoplasms, Male/diagnosis , Genital Neoplasms, Male/surgery , Humans , Liposarcoma/diagnosis , Liposarcoma/surgery , Male , Orchiectomy , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/therapy , Spermatic Cord/diagnostic imaging , Spermatic Cord/surgery , Treatment Outcome , UltrasonographyABSTRACT
Los liposarcomas de cordón espermático son tumores de origen mesenquimal de presentación muy poco frecuente. La asociación con otros tumores es aun más excepcional. Se presenta un caso clínico de asociación de esta patología con carcinoma de próstata en un paciente de 66 años que consulta por una masa paratesticular izquierda de lento crecimiento con un tamaño aproximado de 12 cm y un nódulo pétreo en próstata; la Ecografía informa de una masa hipoecoica con áreas de menor ecogenicidad que depende del cordón espermático; el Antígeno Prostático Específico (PSA) es de 1276 ng/ml y en la gammagrafía ósea se observan múltiples lesiones metastásicas. La tumoración es resecada realizando una orquiectomía radical y el resultado de anatomía patológica incluyendo pruebas inmunohistoquímicas concluyen liposarcomades diferenciado variedad esclerosante. Se discuten las características generales y anatomopatológicas de estos tumores, así como el diagnóstico y las opciones de tratamiento (AU)
Spermatic Cord Liposarcoma are uncommon soft tissue neoplasm. Association with others tumors is so exceptional. We describe and relation between liposarcoma and prostate cancer in a 66 years old patient who had a left paratesticular tumor with low speed growth and 12 cm of length; nodule in prostate gland was detected. Ecography demostrate an hipoecoic tumor in the spermatic cord; Prostate Specific Antigen (PSA) was 1276 ng./ml. and bone gammagraphy reported metastatic lesions. We made an radical orquiectomy and pathological diagnosis including inmunohistoquimical process was sclerosing dedifferenciated liposarcoma. We discuss clinical and pathologic behaviour of this lesions and diagnosis and treatment options (AU)
Subject(s)
Male , Aged , Humans , Liposarcoma/complications , Spermatic Cord/pathology , Genital Neoplasms, Male/complications , Prostatic Neoplasms/complications , Liposarcoma/pathology , Genital Neoplasms, Male/pathology , Prostatic Neoplasms/pathologyABSTRACT
La asociación de una dilatación quística de la vesícula seminal con agenesia renal ipsilateral, fue descrita por primera vez por Zinner en 1914, constituyendo una anomalía congénita muy poco frecuente. La presencia añadida de la desembocadura ectópica del uréter en dicha vesícula seminal quística resulta aún más excepcional. En estas circunstancias, la clínica suele presentarse a partir de los 15 años de edad, debido a la distensión de la vesícula por las secreciones seminales, siendo el disconfort perineal y las epididimitis de repetición las formas de presentación más frecuentes. Ante el hallazgo clínico-radiológico de una masa quística pélvica, es obligada la revisión del tracto urinario superior. La resonancia magnética (RM) se muestra como la mejor técnica de imagen para este objetivo, así como para precisar la localización del abocamiento ectópico ureteral en la vesícula seminal. Aportamos un nuevo caso de esta infrecuente malformación congénita en el que únicamente la RM entre todas las pruebas de imagen, permitió un claro diagnóstico preoperatorio y una adecuada planificación quirúrgica
The association of a seminal vesicle cyst with ipsilateral renal agenesis was initially reported in 1914 by Zinner, and it is a very rare congenital anomaly. The association of this anomaly with an ectopic ureter entering the seminal vesicle cyst is even less common. In these cases, clinical symptoms appear in patients 15 years or older due to the distention of the seminal vesicle caused by the secretions of the reproductive tract. Perineal discomfort and recurrent epididymitis are the most often presentations. Urogenital upper tract image studies are mandatory in the management of a cystic pelvic mass and magnetic resonance imaging (MRI) is the best of this radiographic studies, that also reveals the ectopic ureter draining into the seminal vesicle. We report an additional case of this rare congenital anomaly where only MRI provided a correct preoperative diagnosis and a right surgical approach
Subject(s)
Male , Adult , Humans , Dilatation, Pathologic/complications , Dilatation, Pathologic/diagnosis , Seminal Vesicles/cytology , Seminal Vesicles/surgery , Magnetic Resonance Imaging/methods , Cysts/diagnosis , Cysts/surgery , Ureteral Neoplasms/diagnosis , Gallbladder/pathology , Gallbladder/surgery , Blister/pathology , Blister , Seminal Vesicles/anatomy & histology , Seminal Vesicles/ultrastructure , Seminal Vesicles , Pyelonephritis, Xanthogranulomatous/complications , Pyelonephritis, Xanthogranulomatous/diagnosis , Pyelonephritis, Xanthogranulomatous/surgeryABSTRACT
The association of a seminal vesicle cyst with ipsilateral renal agenesis was initially reported in 1914 by Zinner, and it is a very rare congenital anomaly. The association of this anomaly with an ectopic ureter entering the seminal vesicle cyst is even less common. In these cases, clinical symptoms appear in patients 15 years or older due to the distention of the seminal vesicle caused by the secretions of the reproductive tract. Perineal discomfort and recurrent epididymitis are the most often presentations. Urogenital upper tract image studies are mandatory in the management of a cystic pelvic mass and magnetic resonance imaging (MRI) is the best of this radiographic studies, that also reveals the ectopic ureter draining into the seminal vesicle. We report an additional case of this rare congenital anomaly where only MRI provided a correct preoperative diagnosis and a right surgical approach.
Subject(s)
Abnormalities, Multiple/diagnosis , Kidney/abnormalities , Seminal Vesicles/abnormalities , Ureter/abnormalities , Adult , Dilatation, Pathologic , Humans , Magnetic Resonance Imaging , Male , Seminal Vesicles/pathologyABSTRACT
We report a case of atypical renal angiomyolipoma (AML) because of its clinic presentation like colic renal pain, its uncommon intrasinusal location, its low fatty content, and especially because of the diagnostic doubt with a renal artery aneurysm that could not be resolved before the surgery in spite of making Doppler ultrasound, renal one sided arteriography, computed tomography (CT) and magnetic resonance imaging (MRI). We gave up doing a percutaneous needle biopsy because of the location, the association with hematoma and the possibility of a vascular origin. It has been said that diagnostic images, mainly ultrasound and CT, have a high capacity to get a renal AML diagnosis before the surgery. However when there is an atypical characteristics association like we have talked about, dismissing other pathologies is necessary. We believe AML must be considered one of these because of its difficult differential diagnosis.
Subject(s)
Aneurysm/diagnosis , Angiomyolipoma/diagnosis , Kidney Neoplasms/diagnosis , Renal Artery , Adult , Angiomyolipoma/diagnostic imaging , Angiomyolipoma/surgery , Diagnosis, Differential , Female , Humans , Kidney Neoplasms/diagnostic imaging , Kidney Neoplasms/surgery , Magnetic Resonance Imaging , Nephrectomy , Radiography , Renal Artery/diagnostic imaging , UltrasonographyABSTRACT
Presentamos un caso clínico de angiomiolipoma (AML) renal atípico por su forma de presentación como cólico renal, por su localización infrecuente a nivel intrasinusal, por la escasez de su componente graso, pero sobre todo por la confusión diagnóstica con un aneurisma de la arteria renal que no pudo ser aclarada prequirúrgicamente a pesar de la realización de ecografía-doppler, arteriografía renal selectiva, tomografía computerizada (TC) y resonancia magnética (R.N.). Renunciamos a la realización de biopsia percutánea dada la localización, la asociación de hematoma y la posibilidad de un origen vascular.Se ha descrito la alta capacidad de las pruebas de imagen, fundamentalmente de la ecografía y la TC, para el diagnóstico prequirúrgico del A.M.L. renal. Sin embargo, cuando se presenta una asociación de características atípicas como las que se han comentado es necesario descartar otras entidades patológicas. Creemos que entre éstas debe tenerse en cuenta la dificultad de diferenciación con un aneurisma de la arteria renal. (AU)
Subject(s)
Adult , Female , Humans , Renal Artery , Angiomyolipoma , Nephrectomy , Diagnosis, Differential , Aneurysm , Magnetic Resonance Imaging , Kidney NeoplasmsABSTRACT
A 48-year-old male with a leiomyosarcoma of the prostate is presented. The clinical presenting features were those of rapidly evolving prostatism and rectal symptoms (rectal bleeding, sense of rectal fullness and perineal pain). Arising from the smooth muscle cells of the prostate gland, this is a rare neoplasm that account for less than 0.1% of prostate malignancies, with a poor prognosis. It is often difficult to determine a definite origin, being necessary the differential diagnosis with pseudosarcoma, inflammatory fibrosarcoma, prostate abscess and other rare tumors. There is no established protocol of treatment. Combined modality therapy including radical surgery, radiation therapy and chemotherapy seems to be the best, although prognosis remains poor.
Subject(s)
Leiomyosarcoma/diagnosis , Prostatic Neoplasms/diagnosis , Humans , Male , Middle AgedABSTRACT
OBJECTIVE: To present a cae of giant renal angiomyolipoma that required surgical treatment owing to its size and concomitant intratumoral hemorrhage. METHODS: The characteristics of the case are presented and discussed. RESULTS/CONCLUSIONS: Giant renal angiomyolipoma is one of the most frequent causes of Wünderlich syndrome and is diagnosed by ultrasound and CT. The decision to operate is based on the size of the lesion and/or symptomatology, as in the case described herein, which required a simple nephrectomy.
Subject(s)
Angiomyolipoma/pathology , Kidney Neoplasms/pathology , Angiomyolipoma/surgery , Female , Humans , Kidney Neoplasms/surgery , Middle AgedABSTRACT
OBJECTIVE: A case of intestinal obstruction following transurethral resection (TUR) of a locally advanced transitional cell carcinoma of the bladder is presented. METHODS/RESULTS: The unique features of the present case are described. Laparotomy was performed and peritoneal carcinomatosis was found. Renal function became impaired and the abdominal condition persisted. The patient died five days postoperatively. CONCLUSIONS: Intestinal obstruction following TUR of transitional cell carcinoma of the bladder is an uncommon complication that is mainly due to peritoneal seeding following iatrogenic perforation of the tumor or the bladder wall during resection. Still, TUR is undeniably useful in the diagnosis, staging and treatment of bladder neoplasm.
Subject(s)
Carcinoma, Transitional Cell/surgery , Intestinal Obstruction/etiology , Neoplasms, Multiple Primary/complications , Peritoneal Neoplasms/complications , Postoperative Complications/etiology , Urinary Bladder Neoplasms/surgery , Humans , Male , Middle AgedABSTRACT
We report a exceptional case of renal cell carcinoma whose first manifestation was bone metastases located in the sternum. Three years after radical nephrectomy solitary contralateral adrenal metastasis appeared. Exeresis bone metastasis, radical nephrectomy and adrenalectomy were performed. The patient is alive with no evidence of disease with hormonal substitute treatment 5 years and 2 months after esternal metastasis exeresis and 1 year and 3 months after right adrenalectomy.
Subject(s)
Adrenal Gland Neoplasms/secondary , Bone Neoplasms/secondary , Carcinoma, Renal Cell/secondary , Kidney Neoplasms/pathology , Sternum , Adrenal Gland Neoplasms/diagnosis , Bone Neoplasms/diagnosis , Carcinoma, Renal Cell/diagnosis , Humans , Kidney Neoplasms/diagnosis , Male , Middle AgedABSTRACT
OBJECTIVES: The aims of the present study were to assess the results achieved by the newly designed ACUCISE cutting probe in the treatment of the PUJ syndrome, to describe its advantages and disadvantages and to determine the possibility of its replacing other previously utilized techniques. METHODS: The ACUCISE cutting probe was utilized in 10 patients with pyeloureteral stricture. After the stent had been left indwelling for two months, it was removed and the patients had regular control evaluations two months thereafter. RESULTS: The results have been optimal to date, with complete resolution of the pyeloureteral stricture in 100% of the cases. No significant complications have been observed. Some of the control images are presented. CONCLUSIONS: In our view, the availability of the ACUCISE cutting probe represents a major contribution to minimally invasive surgery in the treatment of the PUJ syndrome. Its advantages far surpass its disadvantages, some of which can be overcome by the skill acquired from more experience. Its only major drawback is that it cannot be used in children under thirteen because of its caliber. When positioned correctly, the ACUCISE cutting probe achieves a clean, precise and an even cut of the same diameter and extent. It is a useful alternative to the other techniques utilized in the treatment of PUJ stricture.
