[Detubularized ureterosigmoidostomy Mainz II: a diversion with a future?]. / Ureterosigmoidostomía destubulizada Mainz II: una derivación con futuro?

OBJECTIVE: To review the results achieved with the Mainz II detubularized ureterosigmoidostomy for urinary diversion in patients undergoing bladder resection. METHODS: This study was conducted on 12 prospective patients undergoing radical cystectomy for urothelial carcinoma after 1996. All patients met the following selection criteria: no changes in upper urinary tract functions, normal rectosigmoid, no previous radiation to the area and good anal continence. RESULTS: All patients had a diagnosis of infiltrating urothelial carcinoma of the bladder. Four of these patients died from tumor progression. Renal function is preserved at 31.7 months' mean follow-up, although 3 patients developed moderate metabolic acidosis despite the prophylactic alkalization therapy instituted after surgery. One patient presented recurrent pyelonephritis and stricture of the ureterointestinal anastomosis that required surgical correction. Colonoscopy was unremarkable in all but one patient who showed adenomatous polyp of the colon, which was removed endoscopically, and no other local changes. Continence was complete from the time the urinary catheters were removed. Voiding occurred every 2.9 hours during the day and 2.2 times during the night. CONCLUSIONS: The Mainz II modified ureterosigmoidostomy clearly reduces the upper urinary tract complications because accommodation of the reservoir is better and the pressure inside the pouch is reduced. This technique of urinary diversion is well-accepted by the patients because voiding can be achieved comfortably, a stoma is not required and body image is preserved. The degree of patient satisfaction was high in all cases.

[Infrequent association: massive inguinoscrotal bladder hernia, multiple scrotal lithiasis, and bilateral obstructive uropathy]. / Una asociación poco frecuente: hernia vesical inguinoescrotal masiva, litiasis escrotal múltiple y uropatía obstructiva bilateral.

Vesical hernias occur in a significant number of patients with inguinal hernia, though massive inguinoscrotal vesical hernias are uncommon. This paper presents a case report of a male patient where massive inguinoscrotal vesical hernia, and scrotum-located multiple vesical lithiasis was associated to a large amount of lithiasic mass and bilateral ureterohydronephrosis. We consider this association of urinary conditions extremely rare, since to our knowledge bilateral ureterohydronephrosis has only been formerly documented in one case.

[Bladder endometriosis. Diagnostic and therapeutic approximation]. / Endometriosis vesical. Aproximación diagnóstica y terapéutica.

Endometriosis is defined by the presence of functionally active endometria in ectopic position; so when its clinical behaviour adopts the characteristics of tumoration, endometrioma is accepted as an alternative name. Location of this pathology in the urinary apparatus is uncommon in terms of incidence, since the bladder is a selected site. This condition implies a high morbidity rate because it requires a high level of suspicion in order to be diagnosed. It is acknowledged that no image study (CAT, Echography, MNR, etc.) is pathognomonic for endometriosis and it is necessary to perform endoscopy and biopsy to achieve a correct diagnosis. The paper includes the strategy to follow, both with regard to diagnosis and the current therapeutic approaches.