Characterization of the deposition of collagen fibers and lithogenic potential in bladder of rats submitted to a sugar cane biopolymer graft.

OBJECTIVES: Suture materials are widely used in urology. The interaction of these materials with the extracellular matrix in the inflammatory process can be estimated by stereology of collagen fibers and the present study was designed to determine the behavior of the bladder tissue of rats to grafts of the biopolymer of sugar cane (BPCA), and the inflammation and intravesical stone formation compared to the polyglactin 910. MATERIALS AND METHODS: 42 Wistar rats were divided in four groups: Group I (n = 10) rats submitted to bladder implantation of ~4-0 BPCA suture graft and euthanized at 4 weeks; Group II (n = 10) rats submitted to bladder implantation of 4-0 polyglactin 910 suture graft and euthanized at 4 weeks; Group III (n = 12) rats submitted to bladder implantation of ~4-0 BPCA suture graft and euthanized at 8 weeks; Group IV (n = 10) rats submitted to bladder implantation of 4-0 polyglactin 910 suture graft and euthanized at 8 weeks. Bladders collected at necropsy were analyzed for their weight and the presence of grafts and calculi. Sections were prepared for stereological analysis of collagen fibers. RESULTS: The bladder weight was higher in group I, particularly in the presence of bladder stones. The presence of the graft was observed in 100 % (group I), 80 % (group II), 91.6 % (group III) and 30 % (group IV); polyglactin 910 showed an absorption of 70 % in this period. The stereological analysis showed a higher volume density of collagen fibers in group I versus other groups (p < 0.001). CONCLUSION: The BPCA was a material with good integration into the bladder of rats; its absorption was slower than that of the polyglactin 910. The presence of urinary stones was lower in bladders with implantation of BPCA, particularly after 8 weeks. There was a greater initial inflammatory response to BPCA graft that was directly related to the increase in bladder weight and the presence of urinary stones, but that equalized the results of polyglactin 910 after 8 weeks.

Characterization of the deposition of collagen fibers and Lithogenic potential in bladder of rats submitted to a sugar cane biopolymer graft

OBJECTIVES: Suture materials are widely used in urology. The interaction of these materials with the extracellular matrix in the inflammatory process can be estimated by stereology of collagen fibers and the present study was designed to determine the behavior of the bladder tissue of rats to grafts of the biopolymer of sugar cane (BPCA), and the inflammation and intravesical stone formation compared to the polyglactin 910. MATERIALS AND METHODS: 42 Wistar rats were divided in four groups: Group I (n = 10) rats submitted to bladder implantation of ~4-0 BPCA suture graft and euthanized at 4 weeks; Group II (n = 10) rats submitted to bladder implantation of 4-0 polyglactin 910 suture graft and euthanized at 4 weeks; Group III (n = 12) rats submitted to bladder implantation of ~4-0 BPCA suture graft and euthanized at 8 weeks; Group IV (n = 10) rats submitted to bladder implantation of 4-0 polyglactin 910 suture graft and euthanized at 8 weeks. Bladders collected at necropsy were analyzed for their weight and the presence of grafts and calculi. Sections were prepared for stereological analysis of collagen fibers. RESULTS: The bladder weight was higher in group I, particularly in the presence of bladder stones. The presence of the graft was observed in 100% (group I), 80% (group II), 91.6% (group III) and 30% (group IV); polyglactin 910 showed an absorption of 70% in this period. The stereological analysis showed a higher volume density of collagen fibers in group I versus other groups (p < 0.001). CONCLUSION: The BPCA was a material with good integration into the bladder of rats; its absorption was slower than that of the polyglactin 910. The presence of urinary stones was lower in bladders with implantation of BPCA, particularly after 8 weeks. There was a greater initial inflammatory response to BPCA graft that was directly related to the increase in bladder weight and the presence of urinary stones, but that equalized the results of polyglactin 910 after 8 weeks.

Dispositivo intrauterino intravesical en expulsión en embarazo de tercer trimestre: reporte de un caso / Intravesical migration of intrauterine device in a pregnant woman

Se estima que en el mundo cerca de 160 millones de mujeres son usuarias de dispositivos intrauterinos (DIU), siendo Chile uno de los países con más alta tasa, con cerca del 70 por ciento de las usuarias en el sistema público. Sin embargo, su uso no está exento de complicaciones. Presentamos un caso infrecuente de DIU intravesical en expulsión en gestante de 28 semanas.

In the world, about 160 million women are users of intrauterine devices (IUD); Chile is one of the countries with the highest rate, with about 70 percent of users in public system. However, its use may be complications. We present an unusual case of intravesical IUD expulsion in 28 weeks pregnant.

Manejo laparoscópico de dispositivo intrauterino incrustado en pared vesical con litiasis vesical secundaria / Laparoscopic handling of intrauterune device embedded in bladder wall with secondary vesical lithiasis

Se presenta el caso clínico de la migración intravesical de dispositivo intrauterino con litiasis vesical secundaria. El diagnóstico se realizó 20 años después de la inserción del dispositivo, por la aparición de síntomas urinarios bajos a repetición y hematuria. La ultrasonografía y la radiografía de pelvis son herramientas diagnósticas relevantes en la sospecha inicial de esta patología, que debe siempre completarse con tomografía pélvica y cistoscopia.

This is a case report of an intravesical migration of an intrauterine device, with secondary vesical lithiasis. The diagnosis was made 20 years after the insertion of the device, because of the appearance of recurrent low urinary tract symptoms and haematuria. Ultrasonography and pelvic radiography are important diagnostic tools on the initial study of this pathology that must be completed with pelvic tomography and cistoscopy.

[Bladder lithiasis secondary to intrauterine device migration. Case report]. / Litiasis vesical secundaria a migración de dispositivo intrauterino. Reporte de un caso.

OBJECTIVE: To report one clinical case of bladder lithiasis secondary to the migration of an intrauterine device, its symptoms, diagnostic tests employed and treatment. METHODS/RESULTS: 30-year-old female patient who presented lower urinary tract irritative symptoms. One year before she underwent insertion of an intrauterine device (copper T) after endometrial curettage for pregnancy interruption. She received treatment for infection cystitis over two years, with various antibiotic cycles. The persistence of symptoms led her to the urology clinics, and a 5 x 3 cm intravesical lithiasis with a copper T inside was detected by ultrasound and pelvic anterior-posterior x-ray Suprapubic cystolithotomy was performed with a good outcome and disappearance of the symptoms. CONCLUSIONS: The migration of an intrauterine device to the bladder is an unfrequent cause of bladder lithiasis secondary to foreign body. Nevertheless, we must consider this possibility in front of chronic lower urinary tract irritative symptoms in every female using this birth control method.

Colestasis gravidica: a propósito de un caso / Cholestasis gravidarum: a purpose of a case

La Colestasis Gravídica en un síndrome que habitualmente se produce en el tercer trimestre del embarazo y se resuelve en el embarazo. Se caracteriza clínicamente por la presencia de prurito, ictericia o ambos sin otra disfunción hepática importante. En el siguiente trabajo se reporta caso de paciente femenino de 24 años III gestas II para FUR: 12/8/06 quien refiere de 6 días de evolución orinas coluricas, prurito generalizado predominio de manos y tórax, exámenes para clínicos con aumento de un transaminasas, fosfatasas alcalinas, se diagnóstica colestasis gravídica, patología de baja incidencia de 1/300 y 1/2000 embarazos, se considera importante realizar una revisión académica del mismo.

Resultados del retiro precoz de sonda Foley luego de prostatectomía radical retropúbica / Results of early catheter withdrawal after retropubic radical prostatectomy

El tiempo que una sonda Foley se mantiene in situ luego de una prostatectomía radical (PR) ha disminuido progresivamente de acuerdo a la técnica quirúrgica y la experiencia del cirujano. El retiro precoz de la sonda Foley, en la literatura, se describe siempre precedida de la realización de una cistografía. El objetivo del presente trabajo es evaluar los resultados del retiro precoz de sonda Foley luego de PR retropúbica sin realización previa de una cistografía. Material y métodos: Entre marzo de2000 y marzo de 2005 fueron realizadas 197 PR retropúbicas consecutivas por un cirujano. La sonda Foley se retiró entre el 3º y 5º día postoperatorio sin la realización previa de una cistografía. Se evaluó la presentación de retención urinaria, filtración de orina, estenosis de la anastomosis y continencia. Resultados: Cuatro pacientes presentaron retención urinaria (2 por ciento), 3 de ellas inmediatas al retiro de sonda y una a los 3 meses de operado, esta última secundaria a granuloma de la anastomosis. Se pesquisó filtración de orina en dos pacientes (1 por ciento), al 5º y 9º día, que se manejaron satisfactoriamente con reinstalación de la sonda Foley. Dos pacientes (1 por ciento) presentaron litiasis vesical. La continencia urinaria evaluada al tercer mes fue: continencia total 89 por ciento, continencia parcial (un paño) 6,6 por ciento e incontinencia (2 o más paños)4,4 por ciento. No se presentó estenosis de la anastomosis clínicamente significativa. Conclusión: La frecuencia de 4 por ciento de eventos adversos (retención urinaria, filtración de orina y litiasis vesical) nos permite afirmar que el retiro precoz de sonda Foley en la PR retropúbica es seguro.

Bladder catheter duration after retropubic radical prostatectomy (RRP) has become shorter according to surgical technique and surgeon’s experience. Early catheter withdrawal has been described with a previous cystography. Our aim is to evaluate results of early catheter withdrawal after RRP without cystographic evaluation. Methods: Between March 2000 and March 2005 197 consecutive RRP were performed by a single surgeon. Foley catheter was withdrawn between 3rd and 5th day postoperatory without previous cystographic evaluation. Urinary retention, urine leakage, anastomotic stenosis and postoperatory continence were reviewed for the study. Results: Four patients (2 percent) presented urinary retention, 3 of them immediately after catheter withdrawal and the other 3 months postoperatory. Urine leakage was verified in 2 (1percent) patients between 5th and 9th day postoperatory. Catheter was reinstalled in these patients. Two patients (1 percent) presented bladder lithiasis. Urinary continence assessed at 3 months postoperatory was 89 percent; 6,6 percent and 4,4 percent for total continence, partial continence (1 pad) and incontinence (2 or more pads. There was no clinically significant anastomoses stenosis in the series. Conclusion: Early catheter withdrawal without previous cystographic evaluation is safe and feasible. It is associated with a 4 percent occurrence of adverse events.

Fístula colovesical secundaria a la migración de una endoprótesis biliar: reporte de un caso / Colovesical fistula secondary to the migration of a biliary stent: case report

Introducción: la colocación endoscópica de stents para descomprimir una obstrucción biliar es un tratamiento comúnmente utilizado para enfermedades malignas de la vía biliar y para estenosis benignas de la misma. Se han descrito complicaciones inusitadas derivadas de la colocación de endoprótesis biliares, incluyendo la migración. Se presenta un caso clínico con el objetivo de compartir con la comunidad científica una rara complicación y la única publicada, secundaria a la migración de un stent biliar. Caso clínico: mujer de 47 años de edad, con estenosis de ámpula de Vater benigna, a quien se le colocó endoprótesis biliar, con la cual mejoró clínicamente. Posterior a la colocación del stent se le realizó colecistectomía abierta con exploración de vías biliares. Al año y medio posterior a la colocación del stent, la paciente presentó dolor vago en abdomen bajo y disuria; se le practicaron estudios de imagen donde se observó un extremo del stent biliar en colon sigmoides y otro en vejiga. Se realizó intervención quirúrgica encontrando fístula colovesical, la cual se resolvió en un solo tiempo quirúrgico. La paciente fue egresada con resultados satisfactorios.

BACKGROUND: The endoscopic placement of endoprostheses to decompress biliary obstruction is a commonly used treatment for malignant biliary diseases and is also used in the treatment of benign biliary strictures. Unusual complications of endoprosthesis placement have been described and include the migration of the stent. We present a case to share with the scientific community, an unusual complication secondary to the migration of a biliary stent that has not previously been reported to our knowledge. CASE REPORT: We present the case of a 47-year-old female with a diagnosis of benign papillary stenosis. The patient received a biliary endoprosthesis with clinical improvement. Later she underwent open cholecystectomy and common duct exploration. At consultation 18 months later, the patient presents with indistinct lower abdominal pain and dysuria. We performed imaging studies where the biliary stent was observed, partly in the sigmoid colon and partly in the bladder. The patient underwent surgery where a colovesical fistula was found and treated during the same surgical event. The patient was discharged succesfully.

[Colovesical fistula secondary to the migration of a biliary stent. Case report]. / Fístula colovesical secundaria a la migración de una endoprótesis biliar. Reporte de un caso.

BACKGROUND: The endoscopic placement of endoprostheses to decompress biliary obstruction is a commonly used treatment for malignant biliary diseases and is also used in the treatment of benign biliary strictures. Unusual complications of endoprosthesis placement have been described and include the migration of the stent. We present a case to share with the scientific community, an unusual complication secondary to the migration of a biliary stent that has not previously been reported to our knowledge. CASE REPORT: We present the case of a 47-year-old female with a diagnosis of benign papillary stenosis. The patient received a biliary endoprosthesis with clinical improvement. Later she underwent open cholecystectomy and common duct exploration. At consultation 18 months later, the patient presents with indistinct lower abdominal pain and dysuria. We performed imaging studies where the biliary stent was observed, partly in the sigmoid colon and partly in the bladder. The patient underwent surgery where a colovesical fistula was found and treated during the same surgical event. The patient was discharged succesfully.

Intravesical calculus secondary to ethanol gel injection into the prostate.

A 78-year-old man with coagulopathy and lower urinary tract symptoms secondary to benign prostatic hyperplasia underwent transurethral prostate ethanol gel injection. Six months after the injection, the patient presented with irritative symptoms and hematuria. Ultrasonography revealed a 5-cm intravesical calculus. Cystolitholapaxy was unsuccessful, and the patient underwent cystolithotomy with retrieval of a large, soft, round, brownish mass. Histologic examination of the mass demonstrated prostatic hyperplastic glandular stroma with extensive coagulate necrosis and peripheral calcification. To our knowledge, this is the first report of a calculus formed by prostatic tissue slosh after ethanol injection.

[Double bladder lithiasis from an intrauterine device. Report one case]. / Litiasis doble vesical como consecuencia de dispositivo intrauterino (DIU). Reporte de un caso.

OBJECTIVES: To report a new case of an intrauterine device causing bladder lithiasis, because of its rarity as a complication of the intrauterine device contraceptive method. METHODS/RESULTS: 27-year-old female patient admitted in the urology department of the "Hospital Medico-quirurgico 10 de Octubre" who having an intrauterine device was pregnant, underwent a caesarean section, and a new intrauterine device implant, and a few months later presented with lower urinary tract infectious syndrome, being diagnosed of double bladder lithiasis secondary to intrauterine device migration, for which cystolithotomy was performed. CONCLUSIONS: We performed a short review of the bladder foreign bodies reported in the literature, and present this case which is very infrequent because of the finding of 2 stones in the bladder and an intrauterine device inside one of them. The intrauterine device was detected after crushing one of the calculi, 2 cm in size. It seems that first intrauterine device had migrated through the uterine wall into the bladder, creating a calcareous concretion around.

Migration of intrauterine contraceptive device as cause of bladder stone / Migraçäo de dispositivo contraceptivo intra-uterino como causa de cálculo de bexiga

Uma mulher multípara de 34 anos que possuía um dispositivo intra-uterino contraceptivo (DIUC) T de cobre inserido há oito anos apresentou sintomas de irritaçäo urinária. Diagnosticou-se a migraçäo do DIUC da cavidade uterina para a bexiga, com formaçäo de um cálculo. O dispositivo intra-uterino calcificado foi removido por laparotomia.

Factores de riesgo nutricionales en la litiasis vesicular: análisis epidemiológico / Nutritional risk factors for gallstones: epidemiological analysis

This article reviews the role of nutrition in the incidence of gallstones. The epidemiological situation of gallbladder disease has wide worldwide geographical variations, being Pima Indians and the Chileans the most affected populations. The main nutritional risk factor is obesity. Other risk are serum cholesterol and triglyceride levels, unbalanced and excessive caloric intake, fasting periods of more than eight hours, hypocaloric diets of less than 700 Kcal/day, specially in obese subjects and parenteral nutrition lasting more than two weeks. The main conclusion of this revision is that nutritional behaviors of the population must be improved through public health programs, to reduce the incidence of obesity and related nutritional imbalances

Patología biliar en ancianos / Biliary disease in ancient

Se analizaron 101 pacientes con patología biliar mayores de 60 años de edad, admitidos al Servicio de Cirugía IV del Hospital "Miguel Pérez Carreño", en el lapso comprendido entre enero de 1993 y septiembre de 1996. La edad promedio fue de 68,33 años y predominó el sexo femenino. Se constata la presencia de un gran número de enfermedades concomitantes en ese grupo etáreo. Llama la atención el predominio de patología biliar litiásica complicada (más del 50 por ciento) y la mayor incidencia de patología neoplásica, así como el porcentaje de intervenciones de emergencia. También se registra un mayor número de complicaciones posoperatorias, mayor mortalidad y estancia hospitalaria más prolongada

Behavior of chromed catgut and polyglecaprone 25 sutures in the urinary bladder of rats, with special reference to stone formation

In order to determine and compare the behavior of chromed catgut and polyglecaprone 25 sutures, 49 female rats anesthetized with ether were submitted to laparotomy, cystotomy and cystorrhaphy with separate stitches using catgut for group C and polyglecaprone 25 for group E. When the bladders were observed 3, 7, 15, 30 and 50 days after suture application, stone formation was observed in 6 group C animals (p = 0.0058), with two stones (one per stitch) in 3 of them. No stones were detected in group E bladders. Microscopy revealed a similar course for the healing process and crystals were observed only in group C (p = 0.0159). We conclude that: 1) the tissue behavior of chromed catgut and polyglecaprone 25 sutures is similar, 2) catgut suture produce lithiasis in 46.15 per cent of the bladders sutured with it up to 50 days after surgery (p = 0.0058), and 3) polyglecaprone 25 sutures do not produce lithiasis up to 50 days after surgery.

[Bladder lithiasis formed from an IUD. A rare case]. / Litiasis vesical formada a partir de un DIU (dispositivo intrauterino). Un caso raro.

OBJECTIVE: To describe an uncommon case of bladder calculus arising from an intrauterine device (IUD). METHODS/RESULTS: A female patient with an IUD for the past 10 years consulted for frequent episodes of cystitis. Patient evaluation demonstrated a bladder calculus that warranted surgery. Treatment was by cystolithotomy, which disclosed a 6 cm calculus attached to the IUD. CONCLUSION: Bladder calculus arising from an IUD is rare. The case described herein was successfully managed by cystolithotomy.

[Endoscopic treatment of vesico-ureteral reflux in the neurogenic bladder. Presentation of 2 cases and review of the literature]. / Tratamiento endoscópico del reflujo vésico-ureteral en la vejiga neurogénica. Presentación de dos casos y revisión bibliográfica.

OBJECTIVE: To describe two cases of vesicoureteric reflux associated with neurogenic bladder treated by endoscopic subureteric injection of collagen. METHOD: A 22 Fr cystoscope was introduced with the patient in the lithotomy position. The meatus was identified, a 6 Fr needle was introduced beneath the meatus and collagen was injected until the terminal ureter had been raised with the meatus at the top. RESULTS: One year later the first patient consulted for recurrent urosepsis and severe incontinence between catheterizations. Patient assessment disclosed multiple bladder lithiasis and bilateral vesicoureteric reflux grade III-IV. Endoscopic electrohydraulic lithotripsy was performed, the urine sterilized and collagen injected under the ureter on both sides without result. The procedure was repeated later and reflux disappeared completely. The control ultrasound was satisfactory, urosepsis was controlled and incontinence had improved. Recovery of the upper urinary tract was observed six months later. The second patient consulted one year later for frequent urosepsis, urge incontinence and increasing residual urine. Patient evaluation disclosed vesicoureteric reflux grade III on the right side and signs suggestive of external sphincter hypertony, external sphincter disease and bladder trabeculation. Subureteric injection of collagen combined with endoscopic external sphincterotomy reduced the reflux from grade III to grade I. Collagen injection was repeated and reflux disappeared. The control ultrasound was satisfactory, urine sterile and urinary continence was acceptable. Recovery of the upper urinary tract was observed six months later. CONCLUSION: Subureteric injection of collagen was effective in both cases. It permitted precise evaluation of bladder function and did not interfere with bladder reeducation. Bladder emptying and urinary continence improved, urinary infection was better controlled and it facilitated upper urinary tract recovery. The procedure is fast and can be performed on an outpatient basis. It is safe, repeatable and does not interfere with subsequent therapeutic modalities. No differences between teflon and collagen have been found in the literature.

[Uterine perforation and localization of an IUD in the bladder associated with bladder calculosis. Report of a case and review of the literature]. / Perforación uterina y localización vesical de un dispositivo intrauterino y cistolitiasis. Comunicación de un caso y revisión de la literatura.

A case is reported of the presence of an intrauterine device into the bladder due to uterine perforation with calculus formation in a 39 year old woman, with two pregnancies after its installation. The patient was seen for complaints of pelvic pain, pollakiuria, dysuria and tenesmus, without uterine sintomatology. The case was studied in July of 1993 in the General Hospital "Vicente Guerrero" of Acapulco. To our knowledge only 19 previous cases have been reported in the literature of migration of an intrauterine device into the bladder with calculus formation. The literature is reviewed and we discuss the clinico-radiological findings.