Bladder endometriosis: report of 7 new cases and review of the literature.

OBJECTIVE: To describe our experience with bladder endometriosis at the Department of Urology of Complejo Hospitalario Universitario de Santiago de Compostela. METHODS: We performed a retrospective analysis of the cases of bladder endometriosis diagnosed during the last 11 years in our hospital, from January 2000 to December 2011. RESULTS: A total of 7 women, with a mean age of 32-year-old have been diagnosed by biopsy of bladder endometriosis. The most common symptoms were dysuria, suprapubic pain, urinary urgency and hematuria. All patients have undergone surgery (5 transurethral resection, 2 partial cystectomy), 6 of them were also treated with post-operative LHRH analogues. CONCLUSIONS: Endometriosis is a common disease in young women, but the involvement of the urinary tract is unusual. There are multiple therapeutic options; despite this there exists a high probability of recurrence.

Endometriosis vesical: aportación de 7 nuevos casos y revisión de la literatura / Bladder endometriosis: report of 7 new cases and review of the literature

OBJETIVO: Describir nuestra experiencia en el Departamento de Urología del Complejo Hospitalario Universitario de Santiago de Compostela en endometriosis vesical. MÉTODOS: Se realiza un análisis retrospectivo de los casos de endometriosis de vejiga diagnosticados durante los últimos 11 años en nuestro hospital, desde enero de 2000 a diciembre de 2011. RESULTADOS: Un total de 7 mujeres, con un promedio de 32 años de edad, ha sido diagnosticadas por biopsia de endometriosis vesical. Los síntomas más frecuentes han sido disuria, dolor suprapúbico, urgencia urinaria y hematuria. Todas ellas han sido tratadas con cirugía (5 con resección transuretral, 2 con cistectomía parcial), en 6 de ellas se asociaron análogos de LHRH en el post-operatorio. CONCLUSIONES: La endometriosis es una enfermedad común en mujeres jóvenes, pero la afectación de las vías urinarias es inhabitual. Existen múltiples posibilidades terapéuticas, pero a pesar de ello es alta la probabilidad de recurrencia

OBJECTIVE: To describe our experience with bladder endometriosis at the Department of Urology of Complejo Hospitalario Universitario de Santiago de Compostela. METHODS: We performed a retrospective analysis of the cases of bladder endometriosis diagnosed during the last 11 years in our hospital, from January 2000 to December 2011. RESULTS: A total of 7 women, with a mean age of 32-year-old have been diagnosed by biopsy of bladder endometriosis. The most common symptoms were dysuria, suprapubic pain, urinary urgency and hematuria. All patients have undergone surgery (5 transurethral resection, 2 partial cystectomy), 6 of them were also treated with post-operative LHRH analogues. CONCLUSIONS: Endometriosis is a common disease in young women, but the involvement of the urinary tract is unusual. There are multiple therapeutic options; despite this there exists a high probability of recurrence

[Emphysematous cystitis: case report]. / Cistitis enfisematosa:a propósito de un caso.

OBJECTIVE: To report one case of emphysematous cystitis and to review its diagnosis and treatment in the related literature. METHOD: We report the case of a type II diabetic 91-year-old woman with jaundice, hematuria, vomits, abdominal pain and poor glycemia control. Diagnosis was obtained by plain abdominal X-ray and ultrasonography, and confirmed by CT. E.coli was isolated in urinary culture. RESULTS: Antibiotic intravenous therapy with piperacillin-tazo-bactam, urinary bladder catheterization and strict glycemia control. The patient was discharged from hospital on day 5, with 14 additional days of orally administered amoxicillin-clavulanic and bladder catheterization. Complete clinical, radiologic and microbiologic resolution was achieved. CONCLUSIONS: Emphysematous cystitis is a rare entity, most common in diabetic women, which results from infection of the urinary bladder with gas-producing pathogens, mainly E.coli. Clinical presentation is variable. Emphysematous cystitis can be diagnosed radiologically, mainly with CT scan. The management consists of broad-spectrum antibiotics, strict glycemic control and bladder drainage. Emphysematous cystitis usually has a benign course, but complications may arise in up to 10-20% of cases, requiring surgical treatment.

Cistitis enfisematosa. A propósito de un caso / Emphysematous cystitis: Case report

Resumen.- OBJETIVO: Presentar un caso de cistitis enfisematosa y revisar aspectos diagnósticos y terapéuticos en la literatura relacionada.MÉTODO: Presentamos el caso de una mujer de 91 años, diabética tipo II, con ictericia, hematuria, vómitos, dolor abdominal y mal control glucémico. El diagnóstico inicial fue mediante radiografía simple de abdomen y ecografía abdominal, luego confirmado con TC. Urocultivo positivo para Escherichia coli.RESULTADOS: Tratamiento antibiótico intravenoso con piperacilina-tazobactam, sondaje vesical y control estricto de las glucemias. Alta hospitalaria a los 5 días con sonda urinaria y tratamiento antibiótico vía oral durante 14 días con amoxicilina-clavulánico. Completa resolución clínica, radiológica y microbiológica del cuadro.CONCLUSIONES: La cistitis enfisematosa es una entidad poco frecuente, típica de mujeres diabéticas, producida por microorganismos productores de gas, principalmente E.coli. Su presentación clínica es variable. El diagnóstico generalmente se realiza por métodos de imagen, fundamentalmente TC. El tratamiento consiste en drenaje vesical, estricto control glucémico y antibioterapia de amplio espectro. El pronóstico suele ser favorable, salvo en un 10-20% de los casos, en los que se requiere intervención quirúrgica(AU)

OBJECTIVE: To report one case of emphyse-matous cystitis and to review its diagnosis and treatment in the related literature.METHOD: We report the case of a type II diabetic 91-year-old woman with jaundice, hematuria, vomits, abdominal pain and poor glycemia control. Diagnosis was obtained by plain abdominal X-ray and ultrasonography, and confirmed by CT. E.coli was isolated in urinary culture. RESULTS: Antibiotic intravenous therapy with piperacillin-tazo-bactam, urinary bladder catheterization and strict glycemia control. The patient was discharged from hospital on day 5, with 14 additional days of orally administered amoxicillin-clavulanic and bladder catheterization. Complete clinical, radiologic and microbiologic resolution was achieved.CONCLUSIONS: Emphysematous cystitis is a rare entity, most common in diabetic women, which results from infec-tion of the urinary bladder with gas-producing pathogens, mainly E.coli. Clinical presentation is variable. Emphysema-tous cystitis can be diagnosed radiologically, mainly with CT scan. The management consists of broad-spectrum antibiotics, strict glycemic control and bladder drainage. Emphysema-tous cystitis usually has a benign course, but complications may arise in up to 10-20% of cases, requiring surgical treat-ment(AU)

Orquiepididimitis brucelosa: a propósito de un caso / Brucellar orchyoepididymitis: case report

OBJETIVOS: Presentar un caso de orquiepididimitisaguda unilateral secundaria a brucella y revisar aspectos diagnóstico-terapéuticos en la literatura relacionada. MÉTODO: Presentamos el caso de un varón de 37 añoscon fiebre ondulante, dolor, tumefacción escrotal y afectación osteoarticular. Diagnóstico mediante anamnesis, hemocultivos y serologías específicas para brucella. RESULTADOS: Tratamiento antibiótico con Doxiciclina víaoral (6 semanas) y Estreptomicina intramuscular (3 semanas). Completa resolución clínica del cuadro. CONCLUSIONES: En áreas endémicas de brucella oante la refractariedad al tratamiento antibiótico habitualde una orquiepididimitis debemos realizar una detalladaanamnesis en busca de posibles contactos con ganado oingesta de productos lácteos contaminados. El diagnósticose basa en el aislamiento de brucella spp. en hemocultivos y en la positividad de pruebas serológicas (test rosa de Bengala, test de seroaglutinación estándar, test deCoombs anti-Brucella y test Brucellacapt). Doxiciclina asociadaa Estreptomicina o Rifampicina durante 6 semanasparecen las combinaciones antibióticas de elección.Tratamiento quirúrgico sólo en casos excepcionales

OBJECTIVES: To report one case of unilateral acute orchiepididymitis due to Brucella and to review its diagnosis and treatment in the related literature. METHOD: We report the case of a 37-year-old-male with undulant fever, scrotal pain and swelling and osteoarticular involvement. Diagnosis was obtained by anamnesis, blood cultures and specific serologic tests for Brucella. RESULTS: Antibiotic therapy with orally administered Doxycycline (6 weeks) and im-administered Streptomycin (3 weeks). Complete clinical resolution was achieved. CONCLUSIONS: We must perform an exhaustive anamnesis looking for a history of contact with animals or ingestion of contaminated dairy products in endemic areas of Brucella when facing the case of orchiepididymitis resistant to usual antibiotic therapy. The diagnosis is based on Brucella spp. isolation in blood cultures and on positive serologic tests (Rose Bengal test, standard seroagglutination test, anti-Brucella Coombs test, Brucellacapt test). Doxycycline with Streptomycin or Rifampin for 6 weeks seems to be the most adequate combinations of antibiotics. Surgical treatment only in exceptional cases

Externally readjustable device to regulate sling tension in stress urinary incontinence: preliminary results.

BACKGROUND AND PURPOSE: Slings, especially those called "tension free," have low complication rates and good long-term success rates. However, they still have problems with either an excess or a lack of tension, which produces voiding difficulties or urinary leakage persistence, respectively. The effectiveness of a new adjustable sling for the treatment of stress urinary incontinence (SUI) has been evaluated. PATIENTS AND METHODS: Between November 1999 and May 2002, 113 consecutive patients were operated for SUI by means of a new adjustable sling. The results were analyzed retrospectively. The average follow-up time was 22 months (range 6-36 months). RESULTS: Objective success was achieved in 108 of 113 patients (95.5%), but subjectively, only 90.3% of the patients were completely satisfied with the procedure because of persistent urge incontinence in 6 cases (5.3%). Morbidity was minimal. CONCLUSIONS: This new minimally invasive treatment allows readjustment of sling tension at the immediate or mid-term postoperative period. It is applicable to primary and recurrent SUI and has shown encouraging results.