RESUMEN
Pregnancy may be associated with urological complications but gross hematuria is rare. Mechanical obstruction of venous return with pregnancy-associated smooth muscle dilatation and vasodilatation causes venous congestion, predisposing to varicose veins. We present a case of bladder submucosal venous hemorrhage secondary to such varices and describe mechanisms underlying cystovarix formation.
Asunto(s)
Hematuria/etiología , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Vejiga Urinaria/irrigación sanguínea , Retención Urinaria/etiología , Várices/complicaciones , Adulto , Cistoscopía , Femenino , Humanos , Membrana Mucosa , Embarazo , Várices/diagnósticoRESUMEN
BACKGROUND: Radical cystectomy is universally accepted as the definitive treatment for muscle invasive bladder cancer and preventing stage progression in high-risk groups. There are few recent reviews outside of major international centres. We compared our institution's results with published literature. METHODS: Records of 50 consecutive patients treated with radical cystectomy for biopsy-proven bladder carcinoma between 1995 and 2005 were reviewed. RESULTS: The mean age was 70 years and 76% were male. Median follow up was 38 months (1-111 months). Twenty-three patients (46%) had known history of superficial transitional cell carcinoma and 12 patients (24%) had undergone previously intravesical therapy. Transitional cell carcinomas accounted for 94% of cases and most (76%) were poorly differentiated. Twenty-four (48%) had disease at pT3 stage or higher. Regional lymph nodes were involved in 35%. Twenty-three patients (46%) developed recurrence and over half (12 patients) recurred within 12 months. Both lymph node involvement and recurrence were associated with higher pT stage (P < 0.001). All patients with recurrent disease were dead within a year (median 103 days). Median hospital stay was 19 days and there was one postoperative death (2%). Five-year disease-free and overall survival were 42 and 34% respectively. CONCLUSION: Survival following curative resection for primary bladder malignancy is at best modest. Our overall proportion of higher stage disease contributed to earlier recurrence and lower survival rates. Our postoperative morbidity and mortality rates as well as length of stay are acceptable compared with major international units.
Asunto(s)
Cistectomía/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Complicaciones Posoperatorias , Pronóstico , Reoperación , Tasa de Supervivencia , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
PURPOSE: To our knowledge this study represents the first analysis monitoring the efficacy of cyproterone acetate (CPA) monotherapy for achieving castrate testosterone levels prior to administering a luteinizing hormone-releasing analogue (LHRHA) for treating prostate cancer in the prostate specific antigen (PSA) era. MATERIALS AND METHODS: Patients with untreated locally advanced or metastatic prostate cancer were recruited prospectively. Treatment involved a 28-day course of oral cyproterone acetate and LHRHA depot injection on day 14. Patients had serum PSA, luteinizing hormone and testosterone monitored at intervals during a 56-day period. RESULTS: A total of 15 patients with a mean age of 74 years completed the study. Near castrate serum testosterone was achieved on day 7 (mean +/- 95% CI 83.38 +/- 17.87 ng/dl). There was a significant testosterone increase after LHRHA administration on day 14 compared with the level of 160.23 +/- 36.60 ng/dl on day 16 (p <0.01). Serum luteinizing hormone mirrored testosterone, increasing from a mean of 4.93 +/- 0.61 to 15.4 +/- 6.12 nmol/l after LHRHA administration (p <0.01). Mean serum PSA demonstrated a decrease from 199.25 +/- 6.12 microg/l at day 0 to 43.77 +/- 33.08 microg/l by day 56. There was no increase in serum PSA after LHRHA administration. CONCLUSIONS: Two weeks of priming with CPA does not eliminate the surge in serum testosterone (testosterone flare) upon LHRHA administration but the testosterone increase does not exceed pretreatment levels. Furthermore, 2 weeks of CPA may not offer a benefit over 1 week in lowering serum testosterone. Finally, there is no increase in serum PSA when LHRHA is administered after priming with CPA.
Asunto(s)
Antagonistas de Andrógenos/uso terapéutico , Antineoplásicos Hormonales/uso terapéutico , Acetato de Ciproterona/uso terapéutico , Leuprolida/uso terapéutico , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/tratamiento farmacológico , Testosterona/antagonistas & inhibidores , Testosterona/sangre , Anciano , Anciano de 80 o más Años , Castración , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
PURPOSE: To demonstrate the safety and efficacy of percutaneous drainage of the peritoneal cavity using an 8F pigtail catheter placed under ultrasound guidance in cases of intraperitoneal perforation of the bladder as a result of transurethral resection of a bladder tumor (TURBT). PATIENTS AND METHODS: Three patients undergoing TURBT had inadvertent but significant intraperitoneal perforations of the bladder. All patients developed signs and symptoms of peritonism despite large catheters draining the bladder. An 8F pigtail catheter (Boston Scientific, Watertown, MD, USA) was inserted percutaneously under ultrasound guidance with local anesthetic infiltration. RESULTS: All three patients made a good recovery without needing a laparotomy. Cystograms a week later confirmed an intact bladder. Clinical review revealed no sequelae as a result of the perforation or its treatment. CONCLUSION: Percutaneous drainage of the abdomen in patients with intraperitoneal perforation of the bladder during TURBT is a safe alternative to laparotomy.