[Correlation between symptoms and survival in patients with renal cell carcinoma]. / Correlación de los síntomas de los pacientes con cáncer de células renales con la supervivencia.

OBJECTIVES: To evaluate the correlation between type of presentation in patients with renal cell carcinoma and survival. METHODS: Longitudinal retrospective study of 42 patients with clinical and histological diagnosis of renal cell carcinoma (RCC) between July 2002 and September 2007 at University Hospital Manuel Fajardo. The following variables were studied: Sex, age, clinical presentation: 1) asymptomatic: 2) symptomatic: 3) paraneoplastic syndrome; tumor stage (TNM 1997) and survival. RESULTS: There is a predominance of men over women, the age of greater incidence was between the fifth a and seventh decades. The tumors were classified as: asymptomatic 7%, 3/42; symptomatic 67%, 28/42, with flank pain 31%, 13/42; with hematuria 24%, 10/42, and tumor 10%, 4/42, the classic triad of hematuria, flank pain and mass was 2.3%, 1/42 of the patients and paraneoplastic syndrome 24%, 11/42. The patients with non-metastatic disease were 57%, 24/42 and 43%, 18/42 presented metastases. Five-year survival for patients with RCC by TNM stage was T1, 100% ( 12/12) , T2, 97% (11/12) , T3, 36% (4/11) , T4, 0% (0/7) . The survival of localized and metastatic RCC was 95%, 23/24 and 22%, 4/18 cases respectively and all stage was 64% (27/42). CONCLUSIONS: The asymptomatic RCCs were smaller; pain, hematuria, and mass were the most common manifestations in symptomatic RCC. The prognosis is dismal in patients with RCC showing paraneoplastic syndromes.

[Survival of patients with advanced renal carcinoma treated with interferon]. / Sobrevida de los pacientes con carcinoma renal avanzado tratados con interferón.

OBJECTIVES: To determine survival of patients with metastatic renal carcinoma treated with interferon. METHODS: Retrospective longitudinal study with 18 patients with the diagnosis of metastatic renal carcinoma treated in the University Hospital Manuel Fajardo between July 2002 and September 2007 with radical surgery and alpha 2b recombinant interferon, either adjuvant or as monotherapy. RESULTS: 74% (14/18) of the patients were males, 26% (5/18) females. 72% (13/18) underwent radical surgery plus interferon, and 28% (5/18) received interferon monotherapy. Complete response was observed in 22% (4/18); 78% (14/18) had progression. One, 2, 4 and 5-year survivals were 50%, 33%, 28%, and 22%, respectively. CONCLUSIONS: No significant response was found. There was not tumor regression in any case using interferon. Survival was better in cases undergoing radical nephrectomy plus interferon than cases treated with interferon monotherapy.

Correlación de los síntomas de los pacientes con cáncer de células renales con la supervivencia / Correlation between symptoms and survival in patients with renal cell carcinoma

OBJETIVO: Analizar la correlación existente entre los síntomas de los pacientes con Carcinoma de Células Renales y la supervivencia.MÉTODO: Se realizó un estudio retrospectivo longitudinal de 42 pacientes con diagnóstico clínico e histológico de carcinoma de células renales tratados durante el período comprendido entre julio del 2002 a septiembre 2007 en el hospital Universitario Manuel Fajardo. Se analizaron las variables de: sexo, edad, forma de presentación de la enfermedad (asintomática, sintomática y síndrome paraneoplásico), estadio tumoral de la clasificación de TNM y sobrevida.RESULTADOS: El hallazgo asintomático se presentó en el 7%, 3/42 de los casos y se manifestaron por síntomas el 67%, 28/42, el dolor en el 31%, 13/42, la hematuria en el 24%, 10/42, el tumor en el 10%, 4/42, la tríada clásica (dolor, tumor y hematuria) en el 2.3%, 1/42 de los pacientes. El resto de los enfermos el 24%, 11/42 acudieron por síndrome paraneoplásico. El 57%, 24/42 al momento del diagnóstico no tenían metástasis y el 43%, 18/42 con enfermedad metastásica. La supervivencia para los estadios no metastásicos fue del 95%, 23/42 y para el metastásico del 22%, 4/18.CONCLUSIONES: El diagnóstico de carcinoma de células renales asintomático fue muy pobre, la presentación más frecuente fue el dolor, la hematuria y la masa palpable y representa la mayoría de las veces enfermedad avanzada. Los pacientes con síndrome paraneoplásicos tienen grave pronóstico con una baja supervivencia(AU)

OBJECTIVES: To evaluate the correlation between type of presentation in patients with renal cell carcinoma and survival.METHODS: Longitudinal retrospective study of 42 patients with clinical and histological diagnosis of renal cell carcinoma (RCC) between July 2002 and Septem-ber 2007 at University Hospital Manuel Fajardo. The following variables were studied: Sex, age, clinical presentation: 1) asymptomatic: 2) symptomatic: 3) paraneoplastic syndrome; tumor stage (TNM 1997) and survival. RESULTS: There is a predominance of men over women, the age of greater incidence was between the fifth a and seventh decades. The tumors were classified as: asymptomatic 7%, 3/42; symptomatic 67%, 28/42, with flank pain 31%, 13/42; with hematuria 24%, 10/42, and tumor 10%, 4/42, the classic triad of hematuria, flank pain and mass was 2.3%, 1/42 of the patients and paraneoplastic syndrome 24%, 11/42. The patients with non-metastatic disease were 57%, 24/42 and 43%, 18/42 presented metastases. Five-year survival for patients with RCC by TNM stage was T1, 100% (12/12), T2, 97% (11/12), T3, 36% (4/11), T4, 0% (0/7). The survival of localized and metastatic RCC was 95%, 23/24 and 22%, 4/18 cases respectively and all stage was 64% (27/42).CONCLUSIONS: The asymptomatic RCCs were sma-ller; pain, hematuria, and mass were the most common manifestations in symptomatic RCC. The prognosis is dismal in patients with RCC showing paraneoplastic syndromes(AU)

Sobrevida de los pacientes con carcinoma renal avanzado tratados con interferón / Survival of patients with advanced renal carcinoma treated with interferon

OBJETIVO: Determinar la sobrevida de los pacientes con carcinoma renal metastásico tratados con Interferón.MÉTODOS: Estudio retrospectivo longitudinal de 18 pacientes atendidos en el Hospital Universitario Manuel Fajardo entre julio del 2002 a septiembre del 2007, con diagnóstico de carcinoma renal metastásico tratados con cirugía radical e Interferón Alfa 2b recombínante adyuvante a la cirugía o como monoterapia.RESULTADOS: El 74%, 14/18 de los pacientes fueron masculinos, el 26%, 5/18 femeninos. Al 72%, 13/18 se les realizó cirugía radical más Interferón y el 28%, 5/18 se le administró el Interferón como monterapía. Se observó respuesta completa en el 22%, 4/18 y progresión en el 78%, 14/18. La sobrevida fue del 50%, 33%, 28% y 22% a 1, 2, 4 y 5 años respectivamente.CONCLUSIONES: No se encontró respuesta significativa. No hubo regresión de la carga tumoral en ningún caso con el uso del Interferón. La sobrevida fue mejor en los casos que se les realizó nefrectomía radical más Interferón que en los casos tratados con Interferón como monoterapia(AU)

OBJECTIVES: To determine survival of patients with metastatic renal carcinoma treated with interferon.METHODS: Retrospective longitudinal study with 18 patients with the diagnosis of metastatic renal carcinoma treated in the University Hospital Manuel Fajardo between July 2002 and September 2007 with radical surgery and alpha 2b recombinant interferon, either adjuvant or as monotherapy.RESULTS: 74% (14/18) of the patients were males, 26% (5/18) females. 72% (13/18) underwent radical surgery plus interferon, and 28% (5/18) received interferon monotherapy.Complete response was observed in 22% (4/18); 78% (14/18) had progression. One, 2, 4 and 5-year survivals were 50%, 33%, 28%, and 22%, respectively. CONCLUSIONS: No significant response was found. There was not tumor regression in any case using interferon. Survival was better in cases undergoing radical nephrectomy plus interferon than cases treated with interferon monotherapy(AU)

[Adrenal myelolipoma. Case report and bibliographic review]. / Mielolipoma de la glándula suprarrenal. Informe de un caso y revisión de la literatura.

OBJECTIVES: We report one case of adrenal myelolipoma in a female patient presenting with right lumbar pain over six months. METHODS: Diagnostic work included ultrasound, intravenous urography (IVU) and CT scan. RESULTS: The patient underwent right adenomectomy with the working diagnosis of adrenal myelolipoma. We describe the pathology report. CONCLUSIONS: Myelolipoma may present hematopoietic, fat and bone components. It continues being an incidental finding. Ultrasound and CT scan are effective diagnostic tests. Asymptomatic small tumors, smaller than 4 cm, may be monitored with watchful waiting. Symptomatic tumors greater than 4 cm should be extirpated because of the risk of spontaneous rupture with retroperitoneal bleeding. Bilateral adrenalectomy for big tumors implies medical replacement with hydrocortisone.

Mielolipoma de la glándula suprarrenal. Informe de un caso y revisión de la literatura / Adrenal myelolipoma. Case report and bibliographic review

OBJETIVO: Se describe un caso de mielolipomade la glándula suprarrenal en una paciente que presentó dolor lumbar derecho de 6 meses de evolución.MÉTODO: El estudio de la paciente incluyó Ecografía, Urograma Descendente y Tomografía Axial Computarizada(TAC).RESULTADOS: Con el diagnóstico de mielolipoma de la glándula suprarrenal se realizó adrenalectomía derecha, se describe el informe histopatológico.CONCLUSIONES: El mielolipoma puede presentar componenteshematopoyéticos, grasos y óseos. Su hallazgo continua siendo incidental. La Ecografía y la TAC son eficacesen el diagnóstico. Los tumores pequeños menores de 4 cms asintomático pueden monitorizarse expectantemente. Tumores con síntomas mayores de 4 cms deben ser removidospor el riesgo de rupturas espontáneas con hemorragia retroperitoneal. La adrenalectomía bilateral por grandes tumores implica sustitución con hidrocortisona

OBJECTIVES: We report one case of adrenal myelolipoma in a female patient presenting with right lumbar pain over six months.METHODS: Diagnostic work included ultrasound, intravenous urography (IVU) and CT scan.RESULTS: The patient underwent right adenomectomy with the working diagnosis of adrenal myelolipoma. We describe the pathology report.CONCLUSIONS: Myelolipoma may present hematopoietic, fat and bone components. It continues being an incidental finding. Ultrasound and CT scan are effective diagnostic tests. Asymptomatic small tumors, smaller than 4 cm, may be monitored with watchful waiting. Symptomatic tumors greater than 4 cm should be extirpated because of the risk of spontaneous rupture with retroperitoneal bleeding. Bilateral adrenalectomy for big tumors implies medical replacement with hydrocortisone

[Incidental renal cell carcinoma]. / Carcinoma de células renales incidental.

OBJECTIVES: To report the incidence and management of incidental renal cell carcinoma (RCC). METHODS: We performed a retrospective longitudinal and panel study for our case series between January 1990 and December 2003. Thirty cases of RCC were analyzed, 6 of which were incidental. RESULTS: 4 patients were males (66.6%) and 2 females (33.3%); age ranged between 28 and 72 years. Reason for consultation was related with gastrointestinal symptoms. Ultrasound and CT scan are the most useful studies. Clinical stage was 4 T1 (66.6%), 2 T2 (33.3%). 4 radical nephrectomies and 2 conservative surgeries (partial nephrectomy and tumorectomy) were performed. A dose of 3 million units of alpha 2b recombinant interferon (IFN alpha 2b r) was given Intramuscularly two times a week over 6 months. Follow-up ranged between 120 and 60 months and none of the patients had evidence of tumor activity. CONCLUSIONS: The incidence of incidental RCC in our hospital is 20%. Clinical stage was always low and survival is directly related to stage. Conservative surgery showed similar survival than radical surgery.

[Cryptorchidism and cancer]. / Testiculos no descendidos y cancer.

OBJECTIVES: To demonstrate the presence of neoplasic degeneration within non descended testicles and the effect that late orchydopexy could have in the increased incidence. METHODS: We review the medical records of 22 patients with the diagnosis of malignant testicular tumor cared for at the Department of Urology of the Hospital CQ D Comandante M. Fajardo between 1982 and 2004, looking for history of cryptorchidism, age at the time of orchydopexy (if carried out), histological diagnosis and stage, and post operative outcome. We include one case which did not belong to this series because it was not reported previously. RESULTS: Four patients with history of cryptorchidism were found, the youngest was 12 years old and the time of orchydopexy and the oldest 57. All cases of testicles outside the scrotum at the time of diagnosis were seminomas. The only case with successful orchydopexy presented teratocarcinoma and died before two years from orchiectomy. All cases of seminoma received radiotherapy and are disease-free with negative tumor markers. CONCLUSIONS: Cryptorchid testicles operated after the age of two years only provide hormonal supply adequate for development of secondary sexual features but not fertility, so that in unilateral cases late orchydopexy would only help to detect neoplasic degeneration before the appearance of pain or symptoms from metastases. If there are not important psychological or cosmetic reasons orchiectomy should be the first therapeutic option for adult's cryptorchidism.

Carcinoma de células renales incidental / Incidental renal cell carcinoma

OBJETIVO: Presentar la incidencia y elmanejo del Cáncer de Células Renales (CCR) incidental.MÉTODO: Se realizó un estudio retrospectivo longitudinaly de panel en el hospital Universitario ManuelFajardo de Enero de 1990 a Diciembre del 2003.Universo de trabajo. Se analizaron 30 casos con diagnósticode CCR y de estos 6 fueron incidentales.RESULTADOS: Por lo que se refiere al sexo, 4 fueronhombres (66.6%) y 2 mujeres (33.3%), el rango deedad de 28 a 72 años. La causa de consulta médicaestuvo relacionada con síntomas gastrointestinales. ElUltrasonido (U/S) y la Tomografía Axial Computarizada(TAC) son los estudios de mayor utilidad. El estadio clínicofue T1, 4 (66.6%) y T2, 2 (33.3%) de los pacientes.Se realizaron 4 cirugías radicales y 2 conservadoras(nefrectomía parcial y enucleación). Se administróInterferón alfa 2 b recombinante (IFN alfa 2b r) a unadosis de 3 Millones de Unidades (MU) 2 veces a lasemana durante 6 meses por vía IM. El seguimiento delos pacientes fue entre 120 y 60 meses, ninguno delos pacientes tenía evidencia de actividad tumoral.CONCLUSIONES: La incidencia en nuestro hospital esde 20%. El estadio clínico fue siempre bajo y la sobrevidaesta directamente relacionada con el estadio. Lacirugía conservadora presentó una sobrevida similar ala cirugía radical

OBJECTIVES: To report the incidence and management of incidental renal cell carcinoma (RCC). METHODS: We performed a retrospective longitudinal and panel study for our case series between January 1990 and December 2003. Thirty cases of RCC were analyzed, 6 of which were incidental. RESULTS: 4 patients were males (66.6%) and 2 females (33.3%); age ranged between 28 and 72 years. Reason for consultation was related with gastrointestinal symptoms. Ultrasound and CT scan are the most useful studies. Clinical stage was 4 T1(66.6%), 2 T2 (33.3%). 4 radical nephrectomies and 2 conservative surgeries (partial nephrectomy and tumorectomy) were performed. A dose of 3 million units of alpha 2b recombinant interferon (IFN alpha 2b r) was given Intramuscularly two times a week over 6 months. Follow-up ranged between 120 and 60 months and none of the patients had evidence of tumor activity. CONCLUSIONS: The incidence of incidental RCC in our hospital is 20%. Clinical stage was always low and survival is directly related to stage. Conservative surgery showed similar survival than radical surgery

Tetículos no descendidos y cáncer / Cryptorchidism and cancer

OBJETIVO: Comunicar un caso de uropatíaobstructiva que evolucionó a anulación funcional renalpor lesión pseudotumoral en uréter iliaco.METODOS: Varón de 66 años en estudio por HBP, presentaepisodio autolimitado de hematuria monosintomática.RESULTADOS: En estudio ecográfico se detecta ureteropielocaliectasiagrado II RD; U.I.V. demuestra anulaciónfuncional RD.Citología de orina compatible con carcinomade células transicionales de bajo grado. Se realizanefrostomía percutánea que confirma la pérdida funcionalirreversible. La pielografía descendente muestra defectode replección a nivel de uréter iliaco derecho. El pacientees intervenido quirúrgicamente practicándosele nefroureterectomíaradical con cistectomía perimeática, con buenaevolución postoperatoria. El dictamen histopatológico dela pieza es de pielonefritis crónica y lesión inflamatoriaparietal ureteral que oblitera la luz con infiltrado inflamatorio,erosión de urotelio y presencia de actinomices.CONCLUSIONES: La actinomicosis es una infección bacterianacrónica cuyo patógeno más común es A.israelii.Se encuentra como comensal en la cavidad oral y tubodigestivo y la. afectación clínica más frecuente es laregión cervicofacial (60% casos) La infección del tractourinario es excepcional y en la evolución del paciente alargo plazo no se ha constatado ningún otro foco

OBJECTIVES: To report one case of pseudotumoral lesion of the iliac ureter with obstructive uropathy leading to loss of function of the renal unit. METHODS: 66-year-old male being studied for BPH who presents with a self-limited monosymptomatic hematuria. RESULTS: Renal ultrasound detected grade II pyelocaliectasis of the right kidney. IVU showed absence of function of the right kidney. Urine cytology was consistent with low-grade transitional cell carcinoma. Percutaneous nephrostomy was performed confirming irreversible function loss. Antegrade pyelography showed a filling defect in the right iliac ureter. Radical nephroureterectomy with bladder cuff was carried out with good results. Pathology reported chronic pyelonephritis and parietal inflammatory lesion of the ureter obliterating the lumen with inflammatory infiltrates, urothelial erosion and presence of actinomyces. CONCLUSIONS: Actinomycosis is a chronic bacterial infection, with A. israeli being the most common pathogen. It is part of the normal flora of the oral cavity and GI tract, and cervical-facial region is the most frequent clinical involvement (60% of the cases). Urinary tract infection is exceptional. No other focus was found in the long-term follow-up

[The role of CT scan in the diagnosis of renal cell carcinoma]. / Valor de la tac en el diagnóstico del cáncer de células renales.

OBJECTIVES: To establish the role of CT scan as a reliable and effective method in the diagnosis of renal cell carcinoma (RCC) and to report the experience with this radiological test at the Manuel Fajardo Hospital. METHODS: 29 patients with the diagnosis of RCC who underwent CT scan during the period between January 1992 and December 2002 were evaluated. All patients were preoperatively classified as stages I to IV by CT scan. Tumor stage was confirmed by surgical findings and pathology report, and matched with preoperative CT scan evaluation in all cases. RESULTS: 29 patients with the diagnosis of RCC were treated, 65.5% were males and 34.5% females between 48 and 73 years of age. In 100% of the tumors were confirmed by ultrasound (US) and CT scan, and their limits were well defined. CT scan detected regional lymph nodes in 3.4% of the patients, distant lung metastases in two patients (6.8%) and bone metastases in one (3.4%). Preoperative study showed a tumor limited within the kidney in 72.3% of the patients, not exceeding Gerota's fascia in 17.2%, and extending outside Gerota's fascia in 10.3%. All patients underwent radical nephrectomy through an anterior approach and CT scan precision was confirmed, being quite similar to that of the surgical procedure. CONCLUSIONS: CT scan with or without contrast is the most precise method of diagnostic confirmation and staging currently available, achieving 100 percent of the diagnosis in comparison with other diagnostic modalities.

[Adrenal gland cyst. Report of one case and review of the literature]. / Quiste de la glándula suprarrenal. Informe de un caso y revisión de la literatura.

OBJECTIVES: To report one case of adrenal gland cyst in a patient presenting with lower urinary tract symptoms. The diagnosis and therapeutic aspects are discussed. METHODS: Diagnostic studies included ultrasound, KUB x-ray, CT scan and fine needle aspiration. RESULTS: Conservative treatment was chosen after the diagnosis of uncomplicated adrenal gland cyst with oligosymptomatic obstructive uropathy. CONCLUSIONS: The reliability of diagnostic tests (radiological and cytological) for adrenal cysts leave surgical treatment for symptomatic tumors and complicated cases; an incidental finding does not justify surgery.

Valor de la TAC en el diagnóstico del cáncer de células renales / The role of CT scan in the diagnosis of renal cell carcinoma

OBJETIVO. Establecer el papel de la Tomografía Axial Computarizada (TAC) como método fiable y eficaz en el diagnóstico del Cáncer de Células Renales (CCR) y reportar la experiencia con este estudio imagenológico en el Hospital Universitario Manuel Fajardo. MÉTODO: Se evaluaron 29 enfermos con el diagnóstico de CCR que se les realizó TAC en el período de Enero de 1992 a Diciembre del 2002. Todos los pacientes fueron clasificados en el preoperatorio con los resultados de la TAC en estadios del I al IV. Con los hallazgos en el acto operatorio y el informe microscópico obtuvimos la etapa tumoral que coincidió en todos los casos con la evaluación preoperatorio de la TAC. RESULTADOS. Fueron tratados 29 enfermos con diagnóstico de CCR, el 65.5 por ciento del sexo masculino y el 34.5 por ciento femenino entre 48 y 73 años de edad. En el 100 por ciento de los casos el Ultrasonido (U/S) y la TAC confirmaron la imagen tumoral y sus bordes bien definidos. En el 3.4 por ciento de los pacientes por la TAC se detectó nódulos linfáticos regionales y metástasis a distancia en dos pacientes (6.8 por ciento) en pulmón y el 3.4 por ciento en hueso: En el estudio preoperatorio en el 72.3 por ciento de los pacientes el tumor se encontraba limitado al riñón, el 17.2 por ciento no rebasaba la fascia de Gerota y en el 10.3 por ciento la lesión tumoral se extendía fuera de la fascia de Gerota. A todos los pacientes se les realizó nefrectomía radical por vía anterior y se confirmó la precisión de la TAC que fue muy similar a la conseguida con el acto quirúrgico. CONCLUSIONES: La TAC con y sin contraste es el método de confirmación diagnóstica y de estadificación más precisos que disponemos actualmente, alcanzando el 100 por ciento del diagnóstico comparado con otras modalidades terapéuticas (AU)

Quiste de la glándula suprarrenal. Informe de un caso y revisión de la literatura / Adrenal gland cyst. Report of one case and bibliographic review

OBJETIVOS. Se describe una caso de quiste de la glándula suprarrenal en un paciente que presentó síntomas obstructivos urinario bajo. Se comenta el diagnóstico y lo aspectos terapéutico. MÉTODO. El estudio del paciente incluyó ecografía, tracto urinario simple, tomografía axial computarizada (TAC) y punción aspiración con aguja fina. RESULTADOS. Con el diagnóstico de quiste de la glándula suprarrenal no complicado y uropatia obstructiva poco sintomática se decidió tratamiento conservador. CONCLUSIONES. La fiabilidad de los medios diagnósticos (imagenológicos y citológicos) en el quiste de la glándula suprarrenal hacen que el tratamiento quirúrgico se reserve para los tumores sintomáticos y en aquellos considerados como complicados, un hallazgo casual no justifica la cirugía (AU)

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[Renal fibrosarcoma. Report of a case]. / Fibrosarcoma renal. Presentación de un caso.

OBJECTIVES: To describe one case of renal fibrosarcoma in a patient who presented with left flank pain, fever and palpable mass. We review clinical data, diagnosis, therapeutic aspects and prognostic factors for this type of tumor. METHODS: The study of the patient included intravenous urography, ultrasound, and CT scan. Left radical nephrectomy was performed. RESULTS: The patient remained asymptomatic for 14 months, but then presented with a tumor in the frontal-parietal area, dying ten months later due to generalized metastasis. CONCLUSIONS: Fibrosarcoma is an rare malignant tumor arising from renal mesenchyma with poor prognosis. In radiological tests renal sarcomas show malignant tumor characteristics, but without a specific histology they cannot be differentiated from a renal cell carcinoma.

Fibrosarcoma renal. Presentación de un caso / Renal fibrosarcoma. Report of one case

OBJETIVOS: Se describe un caso de fibrosarcoma del riñón en una paciente que presentó dolor lumbar izquierdo, fiebre y masa palpable. Se revisan los datos clínicos, el diagnóstico, los aspectos terapéuticos y los factores pronósticos de este tipo de tumor. METODO: El estudio de la paciente incluyo urograma descendente, ultrasonido y tomografía axial computarizada (TAC). Se le realizó nefrectomía radical izquierda. RESULTADOS: La enferma estuvo asintomático durante 14 meses que presentó tumoración frontoparietal, falleciendo 10 meses después con un cuadro de metástasis generalizadas. CONCLUSIONES: El fibrosarcoma es un tumor maligno del mesénquima renal, poco frecuente y de pobre pronóstico. En los estudios imagenológicos los sarcomas renales muestran características de tumor maligno, pero sin una histología especifica no puede diferenciarse del carcinoma renal (AU)

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[Ureteral lesions in gynecologic surgery]. / Lesiones ureterales en cirugía ginecológica.

OBJECTIVES: Ureteral lesions during gynaecologic surgery are a serious problem, affecting morbidity even when they are diagnosed postoperatively. METHODS: 742 gynaecological surgical procedures performed between 1994 and 2000 at the Manuel Fajardo University Hospital where evaluated. Eight operations were complicated with ureteral lesions (1.07%); one patient suffered double lesions, for a total of 9 lesions. RESULTS: 9 ureteral lesions were treated in 8 patients, 7 of them were diagnosed in the postoperative period; 5 bladder reimplantations with submucosal bladder tunnel and 2 ureteral suture repairs (end to end) were performed. Delayed lesions were 2 ureteral-vaginal fistulae treated with nephrectomy and ureteroneocystostomy into a Boary's flap respectively. In both cases diagnosis was established by combination of ultrasound, intravenous pyelogram, cystoscopy, and retrograde catheterization. In all seven patients urinary tract integrity was demonstrated postoperatively. CONCLUSIONS: Lower urinary tract integrity may be damaged during gynaecologic surgery, being bladder ureteral reimplantation with submucosal tunnel the most frequently used repairing procedure. Operations for benign diseases had fewer lesions (0.47%) than malignant (4.8%).

Lesiones ureterales en cirugía ginecológica / Ureteral lesions in gynaecologic surgery

OBJETIVO: Las lesiones del ureter en cirugía ginecológica son un grave problema que afectan la morbilidad aun diagnosticándose en el transoperatorio. MÉTODO: Se evalúan 742 intervenciones quirúrgicas ginecológicas realizadas en el Hospital Universitario Manuel Fajardo entre 1994 y el 2000. De ellas en 8 operaciones se produjeron lesiones del ureter (1,07 por ciento); en una paciente la lesión fue doble, para un total de 9 lesiones. RESULTADOS: Fueron tratadas 9 lesiones del ureter en 8 enfermas, de ellas 7 fueron diagnosticadas en el transoperatorio, con 5 reimplantaciones en vejiga con túnel submucoso vesical y 2 suturas de ureter (terminoterminal). Las dos lesiones tardías fueron fístulas ureterovaginales tratadas con nefrectomía y ureteroneocistostomía con flap de Boari respectivamente. En ambos casos el diagnóstico de la lesión se estableció con la combinación de ecografía, urograma descendente, cistoscopia y cateterismo retrógrado. En el post operatorio se demostró en las 7 enfermas la integridad de vía excretora. CONCLUSIÓN: La integridad del tractus urinario inferior puede ser lesionada en la cirugía ginecológica, siendo la intervención quirúrgica reparadora más utilizada la reimplantación del ureter en vejiga, con túnel mucoso vesical. En las afecciones benignas hubo menos lesiones (0,47 por ciento) que en las malignas (4,8 por ciento) (AU)