[Vesical endometriosis after cesarean section: diagnostico-therapeutic aspects]. / Endometriosis vesical tras cesárea: aspectos diagnóstico-terapéuticos.

Endometriosis is a benign condition with an aggressive behaviour defined by the presence of ectopic endometrial tissue, outside the uterus. It occurs in 15-20% women with child bearing potential. Most commonly it affects organs such as the ovaries, uterine ligaments, fallopian tubes, rectum and the cervico-vaginal region. Involvement of the urinary tract, however, is rare. It can be seen in just about 1% cases, vesical location being the most frequent of these presentations (84% cases). We describe one case of vesical endometriosis that developed after a cesarean section. The intra-operative findings confirmed the existence of infiltration of the detrusor muscle and the vesical mucosa by endometrial tissue from the area of the uterine incision. A discussion of the different diagnostic and therapeutic options is also included.

[Clinical course of superficial transitional carcinoma of the bladder without poor prognostic factors]. / Evolución clínica de los carcinomas transicionales superficiales de vejiga sin factores pronóstico desfavorables.

OBJECTIVES: Surface carcinoma of the bladder shows a high incidence of tumour recurrence that require frequent examinations associated to potential morbidity. This paper analyses our series of patients with vesical tumours with no known unfavourable clinical prognostic factors, aiming to detect low risk groups where it may be feasible to change the usual follow-up criteria. MATERIAL AND METHODS: Between 1983 and 1996, 503 patients with vesical cancer, 388 of which 388 were primarily surface tumours, were monitored. The study analyzed 24 patients with surface transitional carcinoma with no unfavourable prognostic factor, i.e. Ta tumours, grade 1, single, under 1 cm, negative urine cytology and multiple negative vesical biopsies. This group was then compared to a control group comprising all other patients with surface tumours in our series (364 patients), and the prognostic factors were assessed based on the disease-free interval, progression-free interval, and overall and tumour-specific survival. Also the recurrence-free interval from the first endoscopic control at 3 months after transurethral resection, were studied according to Parmar's criteria. RESULTS: With a mean follow-up of 53 months, 37% patients in the study group have relapsed versus 41% in the control group (n = 0.9), after 2 years on average. Actuarial curves in the control group reveal statistical significance for higher degree tumours recurrence. No grade progression has occurred in the study group versus 9% in the control group. No patient evolved to T2 versus 5% in the control group; also in this group, 5% patients died because of their tumour versus none in the study group. The 24 patients in the study belong to group 1 in Parmar's low risk, while the remainder of patients in the control group ranked according to these criteria have demonstrated an unfavourable statistical significance (p < 0.01) in patients with early relapse. CONCLUSIONS: Good results obtained in the evolution of patients with surface tumours with no unfavourable prognostic factors are due to the strict monitoring they undergo in order to detect early relapses. However, 37% of recurrences in this group does not allow to modify the usual follow-up schedule. In our experience, Parmar's criteria does not contribute any benefit over classical criteria to evaluate prognostic factors in surface vesical cancer.

[Meconial hydrocele]. / Hidrocele meconial.

Presentation of one case of meconial hydrocele, a very infrequent disease that should be taken into account in all newborns presenting intrascrotal mass. Ultrasonography performed to a 29 year-old female during the 36th week of pregnancy, demonstrated in the fetus the presence of an enlarged right hemiscrotum with homogenous material inside, which was diagnosed as an intrascrotal haematoma due to a likely intrauterine spermatic cord torsion. After eutocic delivery, within one month from birth the newborn developed signs and symptoms which were compatible with acute scrotum and the emergency surgical exploration showed meconial hydrocele secondary to patency of peritoneal-vaginal duct with associated inguinal hernia. The causes, forms of presentation, differential diagnoses and therapeutical options of meconial peritonitis, a rare condition with favourable evolution in most cases, are analyzed showing that, under certain circumstances, treatment is controversial.

[Bladder pseudosarcoma in pediatrics: clinico-pathological features and treatment]. / Pseudosarcoma vesical en pediatría: aspectos clínico-patológicos y tratamiento.

OBJECTIVES: To review the most common clinical signs and symptoms of inflammatory pseudotumor of the bladder in children and to distinguish this benign lesion from malignant neoplasms such as rhabdomyosarcoma and leiomyosarcoma. METHODS: Two cases os pseudosarcomatous tumor of the bladder in children are described. In the first patient, the tumor had appeared spontaneously in a 9-year-old boy. The second had developed in a 6-year-old girl and was considered to be reactive to prior surgery. The literature is reviewed and data from 16 cases of inflammatory pseudotumor of the bladder in patients under 16 years of age are also presented. RESULTS: The mean age at presentation was 8 years. The male-to-female ratio was 3:1. Hematuria (56%), dysuria (37%) and abdominal pain with a palpable mass (18%) were the most commonly described clinical manifestations. Tumor size ranged from 3 to 10 cm and they were frequently located in the lateral walls and base of the bladder. Histological analysis showed an inflammatory pseudosarcomatous reaction. Immunohistochemical analysis showed moderate staining for vimentin, mild staining for focal muscle actin and negative for keratin and S-100 protein. Patients were treated by local resection (7 pts), partial cystectomy (5 pts), radical cystectomy (2 pts) and pelvic exenteration (2 pts). The mean follow-up was 34 months. All patients that had been followed (14/16) were reported to be free of disease with no evidence of recurrences or metastases. CONCLUSIONS: Inflammatory pseudotumor of the bladder is an unusual benign tumor that is very rare in children. Long-term follow-up confirms the benign nature of the lesion and conservative management is therefore advocated. However, given its histological similarity to malignant tumors, a close follow-up is recommended.

[Flubiprofen vs dipyrone combined with hyoscine: the analgesic efficacy in renal colic]. / Flubiprofeno vs dipirona asociada a hioscina: eficacia analgésica en el cólico nefrítico.

OBJECTIVE: We compared the efficacy of flurbiprofen (NSAID) versus dipirone + hyoscine N-butylbromide in the treatment of nephric colic. METHODS: The study comprised 135 patients, aged 18 to 75 yrs, with intense nephric colic. The patients were observed 60 min after a single IM dose of 150 mg flurbiprofen (n = 67) or 2 gm dipirone + 20 mg hyoscine N-butylbromide. RESULTS: Both treatment modalities were well-tolerated and afforded significant pain relief. Flurbiprofen, however, was faster-acting and superior to dipirone + hyoscine in the overall evaluation of good and excellent therapeutic response rates. CONCLUSION: The results of the study show that IM flurbiprofen is a useful alternative to dipirone + hyoscine N-butylbromide in the treatment of nephric colic.