Prostatic nephrogenic adenoma. Case report.

OBJECTIVE: We present a case of prostatic urethra nephrogenic adenoma as an incidental finding following transurethral resection of the prostate. METHOD/RESULT: It is an incidental diagnosis of nephrogenic adenoma of prostatic urethra in a 50-year-old male operated for benign prostatic hyperplasia by means of transurethral resection. CONCLUSIONS: Nephrogenic adenoma is an infrequent and benign lesion of the urinary tract, associated with a previous history of trauma or irritation on the urothelium. Predisposing factors include infections, calculi, surgery, trauma and kidney transplantation.

Adenoma nefrogénico de localización prostática. Aportación de un caso / Prostatic nephrogenic adenoma. Case report

OBJETIVO: Presentamos el caso de un adenoma nefrogénico de uretra prostática como hallazgo incidental tras una resección trasuretral de próstata.MÉTODO/RESULTADO: Se trata del diagnóstico incidental de adenoma nefrogénico de uretra prostática en varón de 50 años intervenido de hiperplasia benigna prostática mediante resección trasuretral.CONCLUSIONES: El adenoma nefrogénico es una lesión benigna del tracto urinario, infrecuente, asociado con una historia previa de traumatismo o irritación sobre el urotelio. Los factores predisponentes incluyen las infecciones, cálculos, cirugía, traumatismos y el trasplante renal(AU)

OBJECTIVE: We present a case of prostatic urethra nephrogenic adenoma as an incidental finding following transurethral resection of the prostate.METHOD/RESULT: It is an incidental diagnosis of nephrogenic adenoma of prostatic urethra in a 50-year-old male operated for benign prostatic hyperplasia by means of transurethral resection.CONCLUSIONS: Nephrogenic adenoma is an infrequent and benign lesion of the urinary tract, associated with a previous history of trauma or irritation on the urothelium. Predisposing factors include infections, calculi, surgery, trauma and kidney transplantation(AU)

[Hematuria of papillary or medullar origin: a difficult diagnosis entity]. / Hematuria de origen papilar o medular: entidad de difícil diagnóstico.

OBJECTIVES: Renal haemangiomas of renal papillary or medullar origin are a difficult diagnosis entity, being one of the most frequent processes of chronic episodes of hematuria, secondary to benign disease, mainly in young patients. The objective of this paper is to show the difficulty of this diagnosis and the need to suspect it in cases with clinical history similar to the ones described in these cases. METHODS: We report 4 cases of spontaneous hematuria of renal origin, with clinical presentation as renal colic, from the historical case series of the Fundacion Jimenez Díaz-Capio, the last two from the years 2005-6. We present the diagnostic and therapeutic methodology employed, including angio-CT and flexible ureterorenoscopy (URS) as well as various treatment options. RESULTS: Hematuria was identified as "essential" when any relation with tumor or lithiasic pathologies was ruled out, and of renal origin when the source was clearly pointed. We interpreted it was related to angiomas or microangiomas of papillary or medullar origin. In one case, the vascular malformation was interpreted as an arterial venous fistula (AVF) at that level. Hematuria stopped spontaneously in two cases after exploratory URS. The eldest historical case required surgical expiration of the caliceal structures. CONCLUSION: Years ago, following the professional development of Urology as speciality, conventional surgery was carried out in all these cases, of very difficult diagnosis, with a very small number of cases undergoing a conservative approach based on the examination of renal cavities trying to observe and find the bleeding point. Most cases underwent complete or partial nephrectomy. Currently, the possibility of exploration of all renal cavities with the flexible ureterorenoscope enables a better diagnosis of the lesions and a more conservative treatment. The ultimate diagnosis of renal papillary angioma is the pathologic diagnosis, without pathognomonic data in the imaging tests. This pathology is thought of at the end of the diagnostic workup, and when the papillary area is identified as the source of bleeding. The historical case series, with the pathologic findings from nephrectomy specimens, permits us to point out this entity as papillary angioma, in patients with similar clinical presentation.

Hematuria de origen papilar o medular: entidad de díficil diagnóstico / Hematuria of papillary or medullar origin: a difficult diagnosis entity

Objetivo: Los hemangiomas renales de origen papilar o medular renal, es una entidad de difícil diagnóstico, siendo una de las causas más frecuentes de episodios crónicos de hematuria, por patología benigna, fundamentalmente en pacientes jóvenes (1). El objetivo de esta presentación es mostrar la dificultad de este diagnóstico y la necesidad de sospecharlo en cuadros con historia similar a la que expresan estos casos. Métodos: Se presentan 4 casos de hematuria espontánea de origen renal, con expresión clínica de dolor cólico, de la serie histórica del Servicio de Urología de la Fundación Jiménez Díaz-Capio, los dos últimos del año 2005-6. Se presenta la metodología diagnóstica y terapéutica realizada, incluidos los estudios de angioTAC y la URS (ureterorenoscopia flexible), asi como diversas opciones de tratamiento. Resultado: La hematuria se identificó como “esencial” al descartar la relación responsable con patología tumoral o litiásica, y de origen renal al señalar claramente su origen. Se interpretó relacionada con angiomas o microangiomas de origen papilar o medular. En un caso la malformación vascular fue interpretada como FAV (fístula arteriovenosa) a ese nivel. Tras la URS exploradora, la hematuria cedió espontáneamente en dos casos. El caso histórico más antiguo requirió la exploración quirúrgica de las estructuras calicilares. Conclusión: Hace años y siguiendo el desarrollo profesional de la Especialidad de Urología, todos estos casos, de gran dificultad diagnóstica, eran sometidos a cirugía convencional, en muy pocas ocasiones con actitud conservadora, basada ésta en la exploración de las cavidades renales, intentando observar y encontrar el lugar del sangrado activo. La mayoría de los casos eran sometidos finalmente a Nefrectomía total o parcial. La posibilidad actual, de poder explorar las cavidades renales en su totalidad con el ureterorenoscopio flexible, permite un mejor diagnóstico de las lesiones y un tratamiento más conservador. El diagnóstico último de angioma renal papilar es anatomo-patológico, sin existir datos patogneumónicos de diagnóstico por la imagen Se piensa en esta patología, al final del proceso diagnóstico, y al identificar la zona papilar como origen del sangrado. La serie histórica de casos clinicos, con los hallazgos anatomo-patológicos de las nefrectomías realizadas, permite señalar la entidad, como angioma papilar, en pacientes con clínica similar (AU)

Objectives: Renal haemangiomas of renal papillary or medullar origin are a difficult diagnosis entity, being one of the most frequent processes of chronic episodes of hematuria, secondary to benign disease, mainly in young patients (1). The objective of this paper is to show the difficulty of this diagnosis and the need to suspect it in cases with clinical history similar to the ones described in these cases. Methods: We report 4 cases of spontaneous hematuria of renal origin, with clinical presentation as renal colic, from the historical case series of the Fundacion Jimenez Díaz - Capio, the last two from the years 2005-6. We present the diagnostic and therapeutic methodology employed, including angio-CT and flexible ureterorenoscopy (URS) as well as various treatment options. Results: Hematuria was identified as “essential” when any relation with tumor or lithiasic pathologies was ruled out, and of renal origin when the source was clearly pointed. We interpreted it was related to angiomas or microangiomas of papillary or medullar origin. In one case, the vascular malformation was interpreted as an arterial venous fistula (AVF) at that level. Hematuria stopped spontaneously in two cases after exploratory URS. The eldest historical case required surgical expiration of the caliceal structures. Conclusion: Years ago, following the professional development of Urology as speciality, conventional surgery was carried out in all these cases, of very difficult diagnosis, with a very small number of cases undergoing a conservative approach based on the examination of renal cavities trying to observe and find the bleeding point. Most cases underwent complete or partial nephrectomy. Currently, the possibility of exploration of all renal cavities with the flexible ureterorenoscope enables a better diagnosis of the lesions and a more conservative treatment. The ultimate diagnosis of renal papillary angioma is the pathologic diagnosis, without pathognomonic data in the imaging tests. This pathology is thought of at the end of the diagnostic workup, and when the papillary area is identified as the source of bleeding. The historical case series, with the pathologic findings from nephrectomy specimens, permits us to point out this entity as papillary angioma, in patients with similar clinical presentation (AU)

[Infections of the urinary tract caused by permanent catheterization. Natural history, infective mechanisms and prevention strategies. An overall review based on our clinical experience and research]. / Infecciones del aparato urinario motivadas por la sonda permanente. Historia natural, mecanismos infectivos y estrategias de prevención. Una revisión de conjunto basada en nuestra experiencia clínica e investigaciones.

Permanent drainage of the urinary tract by catheters or tubes causes bacteriuria. The potential harmful effects of the indwelling catheter's bacteriuria are related to: time since the insertion of the catheter; location of the catheter (urethra, bladder, kidney); catheter composition (latex, silicone, etc.); type of ineffective bacteria and specific pathogenic mechanisms; health status of the urinary tract being drained (prior radiation therapy, tumors, etc.); patient's health status (diabetes, immunodeficiency) and mobility; incidents and manipulations of the catheter, such as obstruction, irrigation, or retrieval. The evaluation of all mentioned factors enables strategies for prevention of septic episodes in relation with indwelling catheters, strategies that can be individualized for greater efficiency. Despite these preventive measures, infections secondary to the indwelling catheter may cause extremely severe septic episodes. Today, the indwelling catheter bacteriuria constitutes the greater source of nosocomial infection and its prevention and treatment a health care action of the highest importance. The study of mechanisms implied in the formation of biofilms, their pathogenic potential and preventive measures have been an attractive field of clinical and experimental research over the last years. The objective of this review is to make a synthesis of the works performed by our group.

Infecciones del aparato urinario motivadas por la sonda permanente. Historia Natural, mecanismos infectivos y estrategias de prevención. Una revisión de conjunto basada en nuestra experiencia clínica e investigaciones / No disponible

El drenaje permanente, externo, del aparato urinario, mediante sondas y tubos, causa bacteriuria. Los potenciales efectos nocivos de la bacteriuria de la sonda permanente están relacionados con; tiempo de permanencia de la sonda; localización del catéter o sonda (uretra, vejiga, riñón); material que compone el catéter (látex, silicona, etc.); tipo de bacteria infectante y sus mecanismos patogénicos específicos; estado de salud del aparato urinario drenado (radiaciones previas, tumores, etc.); estado de salud del paciente portador de la sonda (diabetes, inmunodeficiencia) y motilidad del mismo; incidentes y manipulaciones de la sonda, tales como, obstrucciones, lavados o retirada de la misma. La valoración de todos los factores enumerados permite estrategias de prevención de los episodios sépticos relacionados con la sonda permanente, estrategias que pueden ser individualizadas para una mayor eficiencia. A pesar de estas medidas preventivas la infección motivada por la sonda permanente puede ocasionar episodios sépticos de extremada gravedad. La bacteriuria de la sonda permanente constituye hoy en día la mayor fuente de infección nosocomial y su prevención y tratamiento, una acción sanitaria de máxima importancia. El estudio de los mecanismos implicados en la formación de biofilms, su potencial patogénico y las estrategias preventivas han supuesto un atractivo campo de investigación clínica y experimental en los últimos años. Una síntesis de los trabajos realizados por nuestro grupo es el motivo de está revisión

Permanent drainage of the urinary tract by catheters or tubes causes bacteriuria. The potential harmful effects of the indwelling catheter`s bacteriuria are related to: time since the insertion of the catheter; location of the catheter (urethra, bladder, kidney); catheter composition (latex, silicone, etc.); type of ineffective bacteria and specific pathogenic mechanisms; health status of the urinary tract being drained (prior radiation therapy, tumors, etc.); patient`s health status (diabetes, immunodeficiency) and mobility; incidents and manipulations of the catheter, such as obstruction, irrigation, or retrieval. The evaluation of all mentioned factors enables strategies for prevention of septic episodes in relation with indwelling catheters, strategies that can be individualized for greater efficiency. Despite these preventive measures, infections secondary to the indwelling catheter may cause extremely severe septic episodes. Today, the indwelling catheter bacteriuria constitutes the greater source of nosocomial infection and its prevention and treatment a health care action of the highest importance. The study of mechanisms implied in the formation of biofilms, their pathogenic potential and preventive measures have been an attractive field of clinical and experimental research over the last years. The objective of this review is to make a synthesis of the works performed by our group