[Double-barreled wet colostomy: analysis of a urinary diversion]. / Colostomía húmeda en doble barra: análisis de una derivación.

We analyse our experience in performing the wet colostomy, also called urocolostomy and present seven cases treated at our hospital in which this was used. We present: a) three women, one underwent an urocolostomy as a result of a myelomeningocele with urinary and fecal incontinence, another because of a pelvic malignancy, and the third after developing a post radiotherapy cysto-proctitis; b) four men, one underwent this surgical procedure as a result of a traumatic paraplegia with multiple urinary fistulae and neurogenic bladder, the other three were secondary to pelvic malignancies (two bladder and one sigmoid malignacies). The outcome was fine in all cases with no pyelonephritis or metabolic imbalances; in all cases it represented a good option for these patients.

Colostomía húmeda en doble barra: análisis de una derivación / Double barred wet colostomy: analysis

En este artículo revisamos y analizamos nuestra experiencia en la realización de la colostomía húmeda o urocolostomía presentando siete casos. Se trata de: tres mujeres a una de las cuales se le practicó una urocolostomía por un mielomeningocele con incontinencia total de heces y vejiga neurógena, a otra por una neoplasia ginecológica tras exenteración pélvica, y a la tercera debido a una cistoproctitis rádica tras radiación por neoplasia ginecológica. Cuatro hombres de los cuales en uno se realizó urocolostomía por una paraplejia con múltiples fístulas urinarias y vejiga neurógena y tres tras exenteraciones pélvicas por neoplasias (en dos casos vesicales y en otro caso de sigma con infiltración vesical). Los resultados fueron buenos durante el seguimiento de todos los casos no habiéndose reportado casos de alteraciones metabólicas ni pielonefritis. En todos los casos representó una buena opción terapéutica para estos pacientes. (AU)

[Renal carcinoma with tumor thrombus in the vena cava and auricle. Experience and review]. / Carcinoma renal con trombo tumoral en vena cava-aurícula. Experiencia y revisión.

OBJECTIVES: To report on our experience in the treatment of renal cell carcinoma with vena caval or right atrial extension, with special reference to the level of involvement and the surgical technique indicated for each case. METHODS: From early 1975 to April, 1997, 212 patients underwent surgery for renal cell carcinoma. Of these, 15 patients (11 male, 4 female), aged 27 to 73 years, had a tumor thrombus extending to the inferior vena cava. The tumor was located in the right kidney in 11 patients and in the left kidney in 4 patients. The tumor thrombus was infrahepatic in 10 cases, it extended beyond the suprahepatic veins in 3 cases, and 2 cases showed right atrial extension. The 10 patients with infrahepatic caval thrombus underwent radical nephrectomy with cavotomy and thrombus removal. In the remaining 5 patients with suprahepatic or atrial extension, thrombus removal was performed via cardiopulmonary by-pass with hypothermic circulatory arrest, with the assistance of a team of cardiac surgeons. RESULTS: Pathological staging showed 2 T3cNoMo, 1 T3bNoMo and 2 T3bN1Mo in the patients who underwent cardiopulmonary bypass. There were 5 T3bNoMo, 2 T3bN2Mo, 1 T3bN2M1, 1 T4NoMo and 1 T4N1M1 in the group of patients with infrahepatic thrombus. There were two postoperative deaths. The overall survival rate was poor. Six patients are alive at 3-26 months' follow-up and 9 have died from disease progression. Patients with lymph node involvement or metastasis at the time of diagnosis had a worse survival rate. CONCLUSIONS: Surgical treatment of renal cancer with vena caval extension is specially difficult depending on the level of involvement, which must therefore be determined with precision. MRI is an effective and noninvasive technique. Tumors with thrombus below the suprahepatic veins can be managed by the direct approach with cavotomy. The use of cardiopulmonary bypass is advocated for tumors with suprahepatic caval or atrial extension. Tumors with caval-atrial extension have a negative influence on survival.

Endoscopic treatment of vesicoureteral reflux following transurethral resection of a vesical carcinoma by Teflon injection.

We have treated 33 patients who presented with reflux in 40 ureters following transurethral resection (TUR) for bladder cancer. One or two injections of Teflon were made under the submucosal intramural ureter. Among the 32 ureters that could be correctly evaluated, we observed that vesicoureteral reflux disappeared in 18 (56.3%), and decreased the grade of reflux in 5 (15.6%). There were no modifications in the 9 remaining ureteral units (28.1%). Control urogram and/or sonogram scan were performed in all cases and demonstrating the absence of obstructive uropathy.

[Persistent Mullerian duct syndrome]. / Síndrome del conducto persistente de Müller.

We report on a 14-year-old boy who was admitted to the emergency department for acute retention of urine. At age 1 year, he had been submitted to surgery for left cryptorchidism and left-sided herniation, associated with hypospadias of the glans penis. Radiologic and endoscopic work up revealed a large retrovesical cavity with septation in its upper portion communicating with the prostatic urethra. These structures were removed and pathologic examination disclosed remnants of Müllerian ducts. This uncommon disease entity whose etiopathogenesis is ascribed to a deficient activity of the Müllerian inhibiting factor (MIF) classically presents in phenotypically male subjects with unilateral cryptorchidism, contralateral herniation, and persistent Müllerian remnants. The literature is reviewed, highlighting the diagnostic and therapeutic aspects of this syndrome.