Bladder injury during trans-obturator tape surgery in a patient with previous colposuspension: is there a connection?

OBJECTIVE: Bladder injuries are quite rare and complex complications of transobturator tapes in the treatment of female stress urinary incontinence, with very few published cases. The authors present a case report and discuss possible injury mechanisms and the role of cystoscopy in this setting. METHODS: A 51 year-old female with past surgical history of Burch colposuspension underwent an uneventful transobturator tape surgery. After 15 days, she complained of dysuria and frequency. Cystoscopy revealed the tape protruding within the bladder. RESULTS: Reoperation was performed with the sub-urethral segment of the tape removed by vaginal approach and the vesical one excised endoscopically. Presently, the patient is asymptomatic. CONCLUSIONS: In patients with previous incontinence surgical treatments, cystoscopy at the time of surgery should be considered to exclude and treat eventual injuries, in order to avoid future complications.

Calyceal fistula: a problematic, but treatable, complication of renal transplantation.

OBJECTIVE: Calyceal fistula is a rare complication of renal transplantation that may lead to graft loss. This article reports a case of functional recuperation of a graft that seemed condemned to failure. METHODS: 31 year old male patient, submitted to living donor renal transplant, in which was necessary to ligate a superior polar artery found during donor nephrectomy, due to its short length. This resulted in development of a calyceal fistula, unsolved with conservative treatment by percutaneous drainage. A new surgical intervention revealed a large upper pole area of necrotic tissue, corresponding to the obliterated artery irrigation zone. RESULTS: Debridement and calyceal suture were performed and a posterior pyelography confirmed fistula closure. Presently, he is asymptomatic, with stabilized graft function. CONCLUSION: Calyceal fistulas are complications of difficult resolution. However, the present case demonstrates that with an appropriate treatment it is possible to save a graft with no apparent solution at the first place.

Lesión vesical en procedimiento con banda transobturatriz con colposuspensión previa: ¿existe alguna conexión? / Bladder injury during trans-obturator tape surgery in a patient with previous colposuspension: is there a connection?

OBJETIVO: La lesión vesical es una complicación bastante compleja y rara de la banda transobturatriz en el tratamiento de la incontinencia urinaria de esfuerzo femenina, con muy pocos casos publicados en la literatura. Los autores presentan un caso y discuten el posible mecanismo de la lesión y el papel de la cistoscopia en este contexto. MÉTODO: Paciente de 51 años, previamente tratada por colposuspensión de Burch, que fue sometida a colocación de banda transobturatriz sin complicaciones. Quince días después desarrolló disuria y polaquiuria. La cistoscopia mostró la banda colocada a nivel intravesical. RESULTADO: Fue realizada re-intervención con la parte suburetral de la banda retirada por abordaje vaginal y la parte vesical restante seccionada con una pinza por vía endoscópica. Actualmente está asintomática. CONCLUSIÓN: En pacientes con tratamientos quirúrgicos previos de incontinencia, la cistoscopia peroperatoria debe ser considerada para excluir y tratar lesiones del tracto urinario inferior, para evitar futuras complicaciones(AU)

OBJECTIVE: Bladder injuries are quite rare and complex complications of transobturator tapes in the treatment of female stress urinary incontinence, with very few published cases. The authors present a case report and discuss possible injury mechanisms and the role of cystoscopy in this setting. METHODS: A 51 year-old female with past surgical history of Burch colposuspension underwent an uneventful transobturator tape surgery. After 15 days, she complained of dysuria and frequency. Cystoscopy revealed the tape protruding within the bladder. RESULTS: Reoperation was performed with the sub-urethral segment of the tape removed by vaginal approach and the vesical one excised endoscopically. Presently, the patient is asymptomatic. CONCLUSIONS: In patients with previous incontinence surgical treatments, cystoscopy at the time of surgery should be considered to exclude and treat eventual injuries, in order to avoid future complications(AU)

Fístula calicial: una complicación problemática pero tratable del transplante renal / Calyceal fistula: a problematic, but treatable, complication of renal transplantation

OBJETIVO: La fístula calicial es una complicación rara del trasplante renal que puede ocasionar la pérdida del injerto. Presentamos un caso de recuperación funcional de un injerto aparentemente condenado al fracaso. MÉTODO: Varón de 31 años, sometido a trasplante renal de donante vivo, en el que fue necesario anular una arteria polar superior hallada durante la extracción del riñón, debido a su escaso calibre. Esto produjo una fistula calicial precoz, sin respuesta al tratamiento conservador con drenaje percutáneo. Una nueva cirugía reveló una granárea de tejido necrótico, correspondiente a la zona de irrigación de la arteria anulada. RESULTADO: Fue realizado el desbridamiento y cierre calicial. Una pielografía posterior confirmó su clausura. Actualmente, el paciente se encuentra asintomático y con injerto funcional estabilizado. CONCLUSIÓN: Las fístulas caliciales son de difícil resolución. Sin embargo, el presente caso nos muestra que con un tratamiento apropiado es posible recuperar un trasplante sin salvación aparente (AU)

OBJECTIVE: Calyceal fistula is a rare complication of renal transplantation that may lead to graft loss. This article reports a case of functional recuperation of a graft that seemed condemned to failure. METHODS: 31 year old male patient, submitted to living donor renal transplant, in which was necessary to ligate a superior polar artery found during donor nephrectomy, due to its short length. This resulted in development of a calyceal fistula, unsolved with conservative treatment by percutaneous drainage. A new surgical intervention revealed a large upper pole area of necrotic tissue, corresponding to the obliterated artery irrigation zone. RESULTS: Debridement and calyceal suture were performed and a posterior pyelography confirmed fistula closure. Presently, he is asymptomatic, with stabilized graft function. CONCLUSION: Calyceal fistulas are complications of difficult resolution. However, the present case demonstrates that with an appropriate treatment it is possible to save a graft with no apparent solution at the first place (AU)

Does 3D Ultrasound Enhance the Diagnosis of Bladder Tumours in Patients with Haematuria?

Purpose. Bladder cancer is a frequent cause of haematuria in elderly patients, and bladder ultrasound (US) is a valuable tool in diagnosing these malignancies. We examined the accuracy of 3D bladder US in diagnosing bladder tumors in patients with haematuria. Patients and Methods. Twenty-one patients observed in the emergency department for haematuria underwent a kidney and bladder US. Patients with normal or uncertain bladder US findings underwent a 3D US and a cystoscopy. Results. In 5 (23.8%) patients, the 3D US detected bladder tumours not seen in 2D US. All these patients were found to have bladder tumours on cystoscopy. Another 5 (23.8%) patients with uncertain findings on 2D US had normal 3D US and cystoscopy. 3D US showed a sensitivity of 83.3% and a specificity of 100% with a positive predicted value and negative predictive values of 100% and 93.8%, respectively. Conclusion. 3D US was more sensitive than 2D US in diagnosing bladder tumours in patients with haematuria.

Surgical treatment of penile duplication.

INTRODUCTION: Penile duplication is a rare anomaly with an incidence of 1 in 5,500,000. It is normally associated with other malformations, such as double bladder, presence of the cloaca, imperforate anus, duplication of the rectosigmoid and vertebral deformities. Presented here is the surgical technique used to resolve a rare case of complete penile duplication in a 5-year-old child, without any other malformation. PATIENT AND METHODS: A male Caucasian patient presented with a rare diagnosis of complete penile duplication, without any associated systemic malformation. At 5 years of age, he was successfully submitted to surgical treatment. The procedure included the following steps: penile dissection up to the point of ischial-pubic insertion; dissection of the hypoplastic urethra; amputation of the less developed penis; termino-lateral urethral anastomosis and phalloplasty. RESULTS: Three years after surgery, penile morphology was normal, with a normal urinary flow according to age. CONCLUSIONS: Treatment should always be individualized. The malformations that are potentially life-threatening should be solved first. Fortunately, this patient had only penile duplication, successfully corrected after surgical treatment.

Emergency management of ureteral stones: Recent advances.

Most ureteral stones can be observed with reasonable expectation of uneventful stone passage. When an active ureteral stone treatment is warranted, the best procedure to choose is dependent on several factors, besides stone size and location, including operators' experience, patients' preference, available equipment and related costs. Placement of double-J stent or nephrostomy tube represents the classical procedures performed in a renal colic due to acute ureteral obstruction when the conservative drug therapy does not resolve the symptoms. These maneuvers are usually followed by ureteroscopy or extracorporeal shockwave lithotripsy, which currently represent the mainstay of treatment for ureteral stones. In this review paper a literature search was performed to identify reports dealing with emergency management of renal colic due to ureteral stones. The main aspects related to this debated issue are analyzed and the advantages and disadvantages of each treatment option are carefully discussed.

Úlcera de presión por prótesis de pene / Pressure ulcer secondary to penile prostheses

No disponible

[Bladder exstrophy adenocarcinoma in an adult woman. Case report]. / Adenocarcinoma sobre extrofia vesical en mujer adulta. A propósito de un caso.

OBJECTIVE: To report a clinical case of bladder exstrophy adenocarcinoma. METHODS: 57-year-old female presenting with a hypogastric mass. The biopsy of the mass revealed bladder adenocarcinoma. We performed radical cystectomy. RESULTS: Pathologic study was compatible with moderately differentiated adenocarcinoma. CONCLUSIONS: After six months of follow-up patient is disease-free.

Adenocarcinoma sobre extrofia vesical en mujer adulta. A propósito de un caso / Bladder exstrophy adenocarcinoma in an adult woman. Case report

OBJETIVOS: Aportamos un caso clínico de adenocarcinoma sobre extrofia vesical. METODOS: Paciente de 57 años de edad, a la exploración física evidenció una tumefacción hipogástrica. Efectuamos biopsia de la masa revelando adenocarcinoma vesical. Realizamos cistectomía radical. RESULTADOS: El estudio anatomo-patológico de la masa fue compatible con un adenocarcinoma moderadamente diferenciado de la vejiga infiltrando muscular. CONCLUSIONES: La paciente a los 6 meses se encuentra libre de tumor (AU)

OBJECTIVE: To report a clinical case of bladder exstrophy adenocarcinoma. METHODS: 57-year-old female presenting with a hypogastric mass. The biopsy of the mass revealed bladder adenocarcinoma. We performed radical cystectomy. RESULTS: Pathologic study was compatible with moderately differentiated adenocarcinoma. CONCLUSIONS: After six months of follow-up patient is disease-free

Emergency ureteroscopic management of ureteral stones: why not?

OBJECTIVES: To describe a single-center experience in the emergency ureteroscopic management of ureteral stones. METHODS: We retrospectively considered the data from 144 patients (mean age 49.6 years, range 23 to 82) who had had obstructive ureteral stones and had undergone emergency ureteroscopy with stone retrieval. Intracorporeal pneumatic lithotripsy was performed when necessary. At the end of the procedure, a ureteral catheter was systematically left in place in 100 patients (69.4%) and removed within 24 hours. In the remaining 44 patients, a double-J stent was preferred and was removed within 30 days, depending on the clinical course. Stone-free status was defined as the complete absence of fragments at 1 month of follow-up. RESULTS: The calculi were more frequently localized in the distal ureter than in the proximal one (90.3% versus 9.7%, respectively). The overall mean stone diameter was 9.1 mm (range 5 to 20). The overall stone-free rate was 92.4%. A greater stone-free rate was obtained in those with stones less than 10 mm (95.8%) than in those with stones larger than 10 mm (89%, P = 0.002). Similarly, a significantly better outcome occurred for those with stones located in the distal ureter (94.6%) than for those with stones in the proximal one (71.4%, P = 0.004). The overall complication rate was 4.2%. The mean hospital stay was 2.5 days (range 1 to 7). CONCLUSIONS: In our experience, emergency ureteroscopy in cases of obstructive ureteral stones proved to be safe and effective. It has the main advantage of offering both immediate relief from pain and stone fragmentation. Additional extensive studies are warranted to corroborate these findings.

[Transperitoneal laparoscopic adrenalectomy: initial experience]. / Adrenalectomía transperitoneal laparoscópica: experiencia inicial.

OBJECTIVES: Since the first published report in 1992, laparoscopic adrenalectomy has been widespread and it is now accepted as the standard treatment option in most of benign diseases of the adrenal gland. Aim of the present study is to describe our initial experience with laparoscopic adrenalectomy. METHODS: Between May 2001 and December 2005, 15 patients were submitted to laparoscopic adrenalectomy for benign diseases of the adrenal gland. We analyzed patients characteristics (sex, age, initial diagnosis), operative and perioperative results (operative time, blood loss, time to first oral intake) and complications. RESULTS: Mean operative time was 143 minutes. Blood loss was minimal. Mean hospital stay was 90 hours. There was no need for open conversion and complication rate was low. CONCLUSIONS: Laparoscopic surgery of the adrenal gland is a safe and effective option which offers quality of life benefits to the patients.

[Tubulovillous adenocarcinoma of the renal pelvis. Case report]. / Adenocarcinoma túbulovelloso de la pelvis renal. A propósito de un caso.

OBJECTIVE: To present a case of tubulovillous renal pelvis adenocarcinoma. METHODS/RESULTS: An 81 year-old patient presented at Emergency Department with sepsis. CT scan showed a staghorn calculus with signs suggestive of pyonefrosis. A nephrectomy was performed and pathological exam revealed tubulovillous renal pelvis adenocarcinoma. CONCLUSIONS: Renal pelvis adenocarcinoma is a rare disease. It is usually accompanied by chronic urinary infections, on inflammatory state and staghorn calculi. The best therapeutic option is nephrectomy and the prognosis is poor.

[Penile abscess. Case report]. / Absceso del pene. A propósito de un caso.

OBJECTIVE: To report one case of penile abscess, with special reference to diagnostic and therapeutic aspects. METHODS: One case of penile abscess is presented in a patient referred for penile swelling. RESULTS: During surgical exploration it showed to be a corpora cavernosum rupture with drainage of a small volume of purulent fluid. CONCLUSIONS: Penile abscess is uncommon. High frequency ultrasonography is a reliable diagnostic imaging method. We were able to incise the affected area of the corpus cavernosum and glans safely, and with appropriate antibiotics this patient was treated successfully.

Adrenalectomía transperitoneal laparoscópica: experiencia inicial / Transperitoneal laparoscopic adrenalectomy: initial experience

OBJETIVOS: La primera publicación sobre la realización de una adrenalectomía por vía laparoscópica fue presentada en 1992. Desde entonces esta técnica ha sufrido una evolución, siendo actualmente aceptada como el tratamiento estándar de la mayoría de la patología benigna de la glándula adrenal. Con este artículo tratamos de mostrar nuestra experiencia inicial de adrenalectomías laparoscópicas. MÉTODOS: Entre mayo de 2001 a diciembre de 2005 fueron incluidas 15 adrenalectomías por vía laparoscópica en pacientes que presentaban patología de la glándula adrenal benigna. Realizamos un análisis de la edad, sexo, patología, tamaño de la lesión, tiempo quirúrgico, pérdidas hemáticas, complicaciones e inicio de la primera ingestión oral. RESULTADOS: El tiempo quirúrgico fue de 143 minutos, las pérdidas hemáticas mínimas y la estancia hospitalaria de 90 horas. No se tuvo que reconvertir ninguna intervención y mínimas complicaciones intra y postoperatorias. CONCLUSIONES: La cirugía laparoscópica de la glándula adrenal es una opción segura, eficaz y con gran repercusión en la calidad de vida del paciente

OBJECTIVES: Since the first published report in 1992, laparoscopic adrenalectomy has been widespread and it is now accepted as the standard treatment option in most of benign diseases of the adrenal gland. Aim of the present study is to describe our initial experience with laparoscopic adrenalectomy. METHODS: Between May 2001 and December 2005, 15 patients were submitted to laparoscopic adrenalectomy for benign diseases of the adrenal gland. We analyzed patients characteristics (sex, age, initial diagnosis), operative and perioperative results (operative time, blood loss, time to first oral intake) and complications. RESULTS: Mean operative time was 143 minutes. Blood loss was minimal. Mean hospital stay was 90 hours. There was no need for open conversion and complication rate was low. CONCLUSIONS: Laparoscopic surgery of the adrenal gland is a safe and effective option which offers quality of life benefits to the patients

Adenocarcinoma tubulovelloso de la pelvis renal. A propósito de un caso / Tubulovillous adenocarcinoma of the renal pelvis. Case report

OBJETIVO: Presentar un caso de adenocarcinoma túbulovelloso de la pelvis renal. MÉTODO/RESULTADOS: Paciente de 81 años de edad, se presenta en el servicio de urgencias con un cuadro infeccioso grave, en la TAC presencia de cálculo coraliforme de la pelvis renal con signos sugestivos de pionefrosis. Se procede a la nefrectomía revelando en el estudio histológico adenocarcinoma túbulovelloso de la pelvis renal. CONCLUSIONES: El adenocarcinoma de la pelvis renal es una neoplasia infrecuente. Se relaciona con infecciones crónicas, inflamación y con la presencia de cálculos coraliformes de la pelvis renal. La opción terapeútica más adecuada es la nefrectomía. El adenocarcinoma túbulovelloso de la pelvis renal tiene un pronóstico sombrío

OBJECTIVE: To present a case of tubulovillous renal pelvis adenocarcinoma. METHODS/RESULTS: An 81 year-old patient presented at Emergency Departament with sepsis. CT scan showed a staghorn calculus with signs suggestive of pyonefrosis. A nephrectomy was performed and pathological exam revealed tubulovillous renal pelvis adenocarcinoma. CONCLUSIONS: Renal pelvis adenocarcinoma is a rare disease. It is usually accompanied by chronic urinary infections, an inflammatory state and staghorn calculi. The best therapeutic option is nephrectomy and the prognosis is poor

Absceso del pene. A propósito de un caso / No disponible

OBJETIVO: Este trabajo pretende aportar un caso clínico más a la literatura de esta infrecuente entidad haciendo hincapié en aspectos del diagnóstico y del tratamiento. MÉTODO: Se presenta un paciente que consulta por tumefacción peniana resultando ser un absceso de pene. RESULTADO: Al efectuar el acto quirúrgico constatamos una fractura del cuerpo cavernoso con pequeña salida de pus por el orificio de la fractura. CONCLUSIONES: El absceso de pene es de aparición clínica poco frecuente. La ultrasonografia de alta frecuencia nos permite identificarlo. En cuanto al tratamiento abogamos por el drenaje y la cobertura con antibióticos de amplio espectro de acción (AU)

OBJECTIVE: To report one case of penile abscess, with special reference to diagnostic and therapeutic aspects. METHODS: One case of penile abscess is presented in a patient referred for penile swelling. RESULTS: During surgical exploration it showed to be a corpora cavernosum rupture with drainage of a small volume of purulent fluid. CONCLUSIONS: Penile abscess is uncommon. High frequency ultrasonography is a reliable diagnostic imaging method. We were able to incise the affected area of the corpus cavernosum and glans safely, and with appropriate antibiotics this patient was treated successfully (AU)

[Hematuria after ureteral-iliac aneurysm rupture]. / Hematuria por rotura de aneurisma ilíaco-ureteral.

OBJECTIVE: Ureteral-iliac artery fistula is a rare condition. We perform a bibliographic review and report a case of ureter-iliac artery fistula reviewing its major differential diagnosis. METHODS: This case-study describes a patient with massive hematuria that presented a ureter-iliac artery fistula secondary to spontaneous rupture of an internal iliac artery aneurysm. RESULTS: 86 -year-old male patient with history of previous surgery for aneurysm and ureteral catheterization. CONCLUSIONS: This difficult diagnosis should be thought of in a patient with massive macroscopic hematuria and previous vascular surgery. The treatment is always surgery.

Hematuria por rotura de aneurisma ilíaco-ureteral / Hematuria after ureteral-iliac aneurysm rupture

OBJETIVO: La fístula entre uréter y arteria iliaca es una patología poco frecuente. Revisamos la literatura y aportamos un caso clínico que puede plantear problemas de diagnóstico diferencial con otras entidades patológicas. MÉTODOS: Presentamos un caso de hematuria masiva por fístula arterio-ureteral debida a la rotura espontánea de aneurisma de la arteria iliaca interna. RESULTADOS: El cuadro debutó con hematuria masiva en un varón de 86 años de edad con antecedentes de cirugía aneurismática y cateterismo ureteral retrógrado. CONCLUSIÓN: El diagnóstico es difícil y se debe sospechar en paciente que inician un cuadro de hematuria macroscópica masiva y que tengan antecedentes de cirugía vascular. La única posibilidad terapéutica es quirúrgica

OBJECTIVE: Ureteral-iliac artery fistula is a rare condition. We perform a bibliographic review and report a case of ureter-iliac artery fistula reviewing its major differential diagnosis. METHODS: This case-study describes a patient with massive hematuria that presented a ureter-iliac artery fistula secondary to spontaneous rupture of an internal iliac artery aneurysm. RESULTS: 86 -year-old male patient with history of previous surgery for aneurysm and ureteral catheterization. CONCLUSIONS: This difficult diagnosis should be thought of in a patient with massive macroscopic hematuria and previous vascular surgery. The treatment is always surgery