Guía práctica para el manejo y tratamiento ante la cistitis radical / Practical treatment approach of radiation induced cystitis

Objetivo: Establecer una pauta de actuación y un algoritmo terapéutico ante la aparición de hematuria en pacientes con antecedentes de radioterapia pélvica, revisando para ello las diferentes opciones de tratamiento reflejadas en la literatura médica. Material y métodos: A través de PubMed se realiza una revisión bibliográfica de artículos relacionados con la cistitis rádica, incluyendo términos de búsqueda referidos a las diferentes opciones de tratamiento: ácido hialurónico endovesical; estrógenos conjugados, pentosan polisulfato, ácido aminocaproico oral, factor VIIa recombinante, cámara hiperbárica, embolización, aluminio endovesical, balón Helmstein y formolización. Se limita la búsqueda a publicaciones en castellano e inglés y se excluyen aquellas referidas a la experimentación animal. Resultados: Se expone cada una de las opciones citadas, haciendo referencia al mecanismo de acción, pauta y dosis de administración, efectos secundarios y prevención de los mismos si es posible así como eficacia del tratamiento. Tras conseguir estabilizar hemodinamicamente al paciente y descartar la presencia de lesiones neoformativas vesicales y/o hematurias originadas en tramo urinario superior, se debe iniciar un tratamiento escalonado. Conclusiones: El conocer diferentes opciones de tratamiento y sus pautas de administración permitirá al urólogo obtener una mayor tasa de éxitos en el difícil manejo de esta patología (AU)

Objective: Establish a pattern of behavior and treatment algorithm at the onset of hematuria in patients with a previous history of pelvic radiation, checking for this different treatment options reflected in the literature. Material and methods: Through performing a PubMed literature review of articles related to IC lies, searching items includes the different treatment options: intravesical hyaluronic acid, conjugated estrogens, pentosan polysulfate, oral aminocaproic acid, recombinant factor VIIa, hyperbaric chamber, embolization, aluminum intravesical, Helmstein ball and formalin. Limits the search to english or spanish publications and excluding those related to animal experimentation. Results: Every option is exposed, referring to the physiopathology, dosage regimen and administration, side effects and treatment efficacy. Conclusions: Once patient hemodynamic stabilization is achieved, and after rule out bladder tumors injuries and /or haemathuria originating from the upper urinary tract, treatment should start rolling. To know different treatment options and patterns of administration will allow the urologist to obtain a higher rate of success in the difficult management of this condition (AU)

[Practical treatment approach of radiation induced cystitis]. / Guía práctica para el manejo y tratamiento ante la cistitis radical.

OBJECTIVE: Establish a pattern of behavior and treatment algorithm at the onset of hematuria in patients with a previous history of pelvic radiation, checking for this different treatment options reflected in the literature. MATERIAL AND METHODS: Through performing a PubMed literature review of articles related to IC lies, searching items includes the different treatment options: intravesical hyaluronic acid, conjugated estrogens, pentosan polysulfate, oral aminocaproic acid, recombinant factor VIIa, hyperbaric chamber, embolization, aluminum intravesical, Helmstein ball and formalin. Limits the search to english or spanish publications and excluding those related to animal experimentation. RESULTS: Every option is exposed, referring to the physiopathology, dosage regimen and administration, side effects and treatment efficacy. CONCLUSIONS: Once patient hemodynamic stabilization is achieved, and after rule out bladder tumors injuries and /or haemathuria originating from the upper urinary tract, treatment should start rolling. To know different treatment options and patterns of administration will allow the urologist to obtain a higher rate of success in the difficult management of this condition.

[Arteriovenous fistula of the renal stump after nephrectomy]. / Fistula arteriovenosa renal secundaria a la ligadura en bloque del pedículo renal.

An arteriovenous fistula of the renal pedicle is a rare complication after nephrectomy. Most of cases we identify it time along after surgery. We present a case of an arteriovenous fistula of the right renal pedicle after nephrectomy done for pyonephrosis 40 years before. We comment the clinical features, treatment and evolution of the patient. We also review the actual literature.

Fístula arteriovenosa renal secundaria a la ligadura en bloque del pedículo renal / Arteriovenous fistula of the renal stump after nephrectomy

La fístula o aneurisma arteriovenoso del pedículo renal después de la nefrectomía es una complicación poco frecuente. La mayoría de las veces se diagnostica muchos años después de la cirugía. Presentamos un caso de fístula arteriovenosa del pedículo renal derecho después de una nefrectomía realizada, por pionefrosis litiásica derecha, 40 años antes. Comentamos el cuadro clínico inicial, el tratamiento y la evolución del paciente. Se revisa la literatura actual

An arteriovenous fistula of the renal pedicle is a rare complication after nephrectomy. Most of cases we identify it time along after surgery. We present a case of an arteriovenous fistula of the right renal pedicle after nephrectomy done for pyonephrosis 40 years before. We comment the clinical features, treatment and evolution of the patient. We also review the actual literature

[The therapeutic management of the rupture of a kidney graft]. / Actitud terapéutica ante la rotura del injerto renal.

From a consecutive series of 106 renal transplants, we present our experience on spontaneous renal allograft rupture. This complication appeared in 6 patients, which accounts for 5.6% of the overall group: four patients (66.6%) had acute rejection, two (33.3%) developed thrombosis of the renal vein (one of which coincided with rejection), and rupture was attributed to trauma in one patient (16.6%). Rupture was diagnosed within the first two weeks after transplant in five patients and on day 27 in one patient. The therapeutic approach was determined according to the cause of the rupture. In our view, nephrectomy is warranted in those cases with venous thrombosis and in acute rejection correction of hypovolemia and adequate immunosuppression are essential. Drainage of perirenal hematoma is the first step when conservative surgical treatment is required. We use three-dimensional renal corsetage with polyglycolic acid mesh (PAM) for hemostasis and to prevent expansion and fragmentation of the parenchyma. PAM is easy to handle and covers the kidney completely and uniformly. Two nephrectomies were carried out and in both cases thrombosis of the renal vein was diagnosed. PAM was placed in two cases: one with rejection and the other with trauma. The remaining two patients were managed conservatively due to the good response of rejection to immunosuppressor therapy and the patients response to medical treatment. There were no deaths and complications were observed in only one patient (16.6%). All patients with preserved transplant (66.6%) had a good course and renal function was preserved.

[Clinical and diagnostic aspects of infective nephrobronchial fistulae]. / Aspectos clínicos y diagnósticos de las fístulas nefrobronquiales infecciosas.

After reviewing all of our hospital admittances, this paper presents two cases of nephrobronchial fistula (NBF) occurring in two patients, one with renal abscess-like granulomatous pathology and one with xantogranulomatous pyelonephritis (XGP). After commenting on these cases and including iconography, among which a fistulography, very rare in this type of cases, should be emphasized, the coincidence of the three microorganisms (and the presence of Morganella morganii) in lung cultures, and kidney in one case, is recorded. The paper remarks on the hidden clinical development, modes of presentations and the time of diagnosis which was pre-operative. Also clinical, diagnostic and behaviour of the NBFs and etiological diseases is reviewed.

[Ambulatory diagnosis of prostatic growth. Analysis of the basic methods to determine its benign or malignant nature]. / Diagnóstico ambulatorio de los crecimientos prostáticos. Análisis de los métodos básicos para determinar la benignidad y la malignidad.

Correlation between different diagnostic procedures rectal touch (RT), intravenous urography (IU), ultrasonography (USG), acid phosphatases and prostatic fraction (AFPF) and the histology of benign and malign growths is analyzed, as well as the relationship between different combinations of these procedures and histology, addressing sensitivity, specificity and negative and positive predictive values; according to our experience RT and USG obtain the best results.