RESUMEN
OBJECTIVE: Our aim was to assess our results in the management of renal trauma patients. PATIENTS AND METHODS: A retrospective review of medical charts from 1989 to 1997 was carried out. RESULTS: Twenty-seven cases involving 27 kidneys were treated during the study period, with 16 grade II injuries, 8 grade II and 3 grade III. Ultrasound was the most used diagnostic tool, followed by computerized tomography (CT) and intravenous pyelography (IVP). Falls and traffic accidents were the main etiologic agents (48 and 41%, respectively). Eight out of 11 patients with grade II/III injuries received surgical treatment. Three cases required early surgery immediately after arrival and 5 cases had planned surgery. After a mean follow-up period of 16 months, renal function has remained above 40% in all patients, excluding 3 cases treated with partial nephrectomy. CONCLUSIONS: A conservative attitude is of choice in children with renal trauma. CT is the main diagnostic tool except in patients suspected of isolated grade I injury. Ultrasound followed by IVP is a valid choice for these cases and especially helpful for preschool patients which require general anesthesia for CT exploration.
Asunto(s)
Riñón/lesiones , Accidentes por Caídas , Accidentes de Tránsito , Adolescente , Algoritmos , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Puntaje de Gravedad del Traumatismo , Riñón/cirugía , Masculino , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Urografía , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/etiología , Heridas y Lesiones/cirugíaRESUMEN
We present a case of transitional cell tumor of the urinary bladder in an 8-year-old boy and discuss certain aspects of the epidemiology, aetiology, prognosis, treatment and follow-up. We review the published cases in the literature since 1992, and compare them with the classic series.
Asunto(s)
Carcinoma de Células Transicionales/diagnóstico , Neoplasias de la Vejiga Urinaria/diagnóstico , Carcinoma de Células Transicionales/cirugía , Niño , Estudios de Seguimiento , Humanos , Masculino , Pronóstico , Radiografía , Ultrasonografía , Vejiga Urinaria/diagnóstico por imagen , Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
We report a case of a 3-month-old boy with a megaprepuce presented since birth. Certain aspects of the aetiology, denomination, diagnosis and treatment are discussed. We compare our case with the three unique cases published in the literature.
Asunto(s)
Pene/anomalías , Fimosis/congénito , Circuncisión Masculina , Diagnóstico Diferencial , Humanos , Lactante , Masculino , Pene/cirugía , Fimosis/cirugíaRESUMEN
OBJECTIVE: To discuss the current aspects and the impact of innovations on the clinical, diagnostic and therapeutic aspects of vesicoureteral reflux (VUR). METHODS: The literature on Medline over the last five years are reviewed and the urodynamic findings in our series of children with VUR are analyzed. RESULTS: Fetal VUR and those diagnosed in children with a family history are currently considered to be the most interesting study groups from the clinical perspective. Renal scintiscanning, isotope-labelled cystography and urodynamic evaluation are well-established diagnostic methods that permit selecting the most appropriate treatment for patients with this anomaly. In our experience, 50.8% of the 128 patients in whom a urodynamic study was performed, showed changes in lower urinary tract function. Innovations in open surgery have been scanty and endoscopic treatment is increasingly utilized, although the search continues for the ideal biological material. CONCLUSIONS: The new diagnostic methods utilized in the evaluation of children with VUR will permit a better understanding of the natural history of this anomaly lead to changes in the protocols that are currently used.
Asunto(s)
Reflujo Vesicoureteral/diagnóstico , Biomarcadores/análisis , Niño , Femenino , Enfermedades Fetales/diagnóstico , Humanos , Masculino , Urodinámica , Reflujo Vesicoureteral/etiología , Reflujo Vesicoureteral/fisiopatología , Reflujo Vesicoureteral/terapiaRESUMEN
RATIONALE: The purpose of our work is to know the prevalence of allergies to latex in patients with myelomeningocele (MMC) and to evaluate any potential factors influencing its development. METHODS: The study included 100 children with mean age 7.5 +/- 4.8 years, diagnosed with MMC by skin tests and total and latex-specific IgE determination. The results were compared to those obtained in three "control" groups: atopic patients, patients undergoing their first operation and multi-operated patients. The relationship between the different variables analyzed was assessed using univariant and multivariant statistical studies. RESULTS: 29 were sensitized (15 symptomatic and 14 asymptomatic) and 8 doubtful. Results showed statistically significant (p < 0.05) differences for atopic and first operation groups and non significant differences for the multi-operation group. The multivariant study selected the followed as the most relevant variables: number of surgical interventions, total IgE levels in z units, ventricle-peritoneal by-pass carriers and atopy background. Also in the multivariant study, the following showed statistically significant results: age, Cums' number, inclusion in intermittent catheterism program and total IgE levels. Neither sex or familial background of atopy showed statistical significance. CONCLUSIONS: Allergy to latex in MMC patients is related to multiple antigen contacts, the numerous manipulations and operations undertaken throughout the patient's life plus a personal propensity to allergies. It is essential that this group should adopt certain standards to minimize contact with the antigen and undergo an allergological study so as to detect those who are sensitized, which in nearly half our series has not yet exhibited symptomatology in contact with latex utensils. All diagnostic and therapeutical procedures should be conducted in latex-free environments.
Asunto(s)
Dermatitis por Contacto/epidemiología , Dermatitis por Contacto/etiología , Meningomielocele/complicaciones , Goma/efectos adversos , Adolescente , Niño , Preescolar , Dermatitis por Contacto/complicaciones , Femenino , Humanos , Incidencia , Masculino , Análisis Multivariante , PrevalenciaRESUMEN
OBJECTIVES: Urodigestive fistulas are secondary complications of inflammatory, traumatic or neoplastic disease and can occasionally be difficult to diagnose, although the typical symptoms of pneumaturia and fecaluria should make the urologist and surgeon suspect the presence of a fistula, determine its etiology and location. The present study reviews our experience in the diagnosis and treatment of this pathology. METHODS: We reviewed the records of 76 patients with urodigestive fistula that had been diagnosed and treated over a period of 23 years. The form of presentation, usefulness of the diagnostic techniques and treatment options were analyzed. RESULTS: The location was vesicointestinal in 52 cases, rectourethral in 19, renointestinal in 4 and urethrointestinal in 1.
Asunto(s)
Fístula Intestinal/diagnóstico , Enfermedades Renales/diagnóstico , Fístula Rectal/diagnóstico , Enfermedades Ureterales/diagnóstico , Enfermedades Uretrales/diagnóstico , Fístula de la Vejiga Urinaria/diagnóstico , Fístula Urinaria/diagnóstico , Anciano , Femenino , Humanos , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Enfermedades Renales/etiología , Enfermedades Renales/cirugía , Masculino , Persona de Mediana Edad , Fístula Rectal/etiología , Fístula Rectal/cirugía , Enfermedades Ureterales/etiología , Enfermedades Ureterales/cirugía , Enfermedades Uretrales/etiología , Enfermedades Uretrales/cirugía , Fístula de la Vejiga Urinaria/etiología , Fístula de la Vejiga Urinaria/cirugía , Fístula Urinaria/etiología , Fístula Urinaria/cirugíaRESUMEN
OBJECTIVES: This study briefly reviews the histological types, clinical features, diagnostic and therapeutic aspects of urethral hemangioma, an uncommon benign vascular tumor. METHODS/RESULTS: A case of urethral hemangioma in a male patient with a long history of hematuria is described. CONCLUSIONS: Urethroscystoscopy is the most useful diagnostic technique in urethral hemangioma. Treatment is by transurethral resection, radical surgery, radiotherapy or selective arterial embolization depending on tumor location, number, size and patient condition. This tumor type frequently recurs.
Asunto(s)
Hemangioma , Neoplasias Uretrales , Hemangioma/diagnóstico , Hemangioma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Uretrales/diagnóstico , Neoplasias Uretrales/cirugíaRESUMEN
Presentation of a review of 10 paediatric patients with tumour of the testis vitelline sack, to report our experience in the management of this pathology. Mean age was 20 months (14-32), and the interval of the study was from 1970 to 1994. After orchiectomy, 7 children were included in stage I, 1 in stage II, and 2 in stage III. Four underwent Retroperitoneal Lymphadenectomy. All patients in stage I are currently free of disease, with a mean follow-up of 132 months, regardless the type of treatment employed (vigilance in 2 cases, chemotherapy in 2, and chemotherapy plus Retroperitoneal Lymphadenectomy in 3). On the contrary, the 3 children with extratesticular disease died 15, 18 and 15 months after orchiectomy. In conclusion, we believe that patients included in stage I should undergo only a strict vigilance, based on the excellent prognosis of this group and the lack of differences between the survival time obtained with the various therapeutical approaches followed. On the other hand, patients with stage II or stage III disease should receive from the beginning chemotherapy, thus saving the Retroperitoneal Lymphadenectomy for the residual disease.
Asunto(s)
Neoplasias Testiculares/terapia , Preescolar , Estudios de Seguimiento , Humanos , Lactante , Masculino , Estadificación de Neoplasias , Estudios Retrospectivos , Neoplasias Testiculares/patologíaRESUMEN
Contribution of 14 patients with Unilateral Total Multicystic Renal Dysplasia treated with conservative criteria, with particular emphasis in the absence of clinical complications, as well as the natural tendency to involution of the affected organs. Five dysplastic kidneys disappeared in the ultrasound, 4 decreased in size, 3 remained the same and 2 have been removed. Review of the literature and discussion of all the reasons why nephrectomy was traditionally indicated, explaining the reasons why we support an expecting attitude.
Asunto(s)
Riñón/anomalías , Enfermedades Renales Poliquísticas/terapia , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Enfermedades Renales Poliquísticas/diagnósticoRESUMEN
Between 1970 and 1993, five children with paratesticular rhabdomyosarcoma (PR) and age ranging from 3 to 10 years were treated by our group. Following radical orchidectomy and clinical staging, 4 were rates as Group I-IRS (completely resected local disease) and 1 in Group IV-IRS (distant metastasis). All patients in Group I underwent intensive chemotherapy with vincristine, actynomicin D and cyclophosphamide (VAC) for 18 months, while no case of retroperitoneal lymphadenectomy was performed. Currently, all patients are disease free with a mean follow-up of 8 years and 5 months. The single patient included in Group IV received radiotherapy (800 rads in abdominal field) and chemotherapy with VAC + prednisone (PDR), and retroperitoneal lymphadenectomy of residual masses was performed. The patient developed liver metastasis and died 20 months later. The purpose of this paper is to convey the reader our experience in the treatment of PR in children, making a special reference to the excellent prognosis when the disease is limited to the scrotum and recommending in such cases the use of intensive chemotherapy with VAC after performing radical orchidectomy.
Asunto(s)
Neoplasias de los Genitales Masculinos/cirugía , Escisión del Ganglio Linfático , Rabdomiosarcoma/cirugía , Escroto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Niño , Preescolar , Terapia Combinada , Ciclofosfamida/administración & dosificación , Dactinomicina/administración & dosificación , Estudios de Seguimiento , Neoplasias de los Genitales Masculinos/terapia , Humanos , Escisión del Ganglio Linfático/métodos , Masculino , Espacio Retroperitoneal , Rabdomiosarcoma/terapia , Vincristina/administración & dosificaciónRESUMEN
Atraumatic spontaneous vesical fracture is an uncommon occurrence. Here we present the case of a female patient with spontaneous vesical fracture secondary to urinary tract tuberculosis. A review of current literature showed another published case similar to ours. A brief comment is made on presentation signs and symptoms and picture evolution, as well as a discussion on the predisposing factors of spontaneous vesical fracture and its treatment.
Asunto(s)
Tuberculosis Urogenital/complicaciones , Enfermedades de la Vejiga Urinaria/microbiología , Femenino , Humanos , Persona de Mediana Edad , Rotura EspontáneaRESUMEN
Presentation of one case of a patient with vesical sarcoma with sustained high white blood cells and platelets plasma levels over the course of the disease. In the absence of fever and with a persistently negative blood culture, the situation was rated as a leukaemoid reaction and thrombocytosis of para-renoplastic nature. A brief comment on the features and evolution of this para-neoplastic syndrome and the outcome of the patient with vesical sarcoma is included.
Asunto(s)
Reacción Leucemoide/etiología , Sarcoma/complicaciones , Trombocitosis/etiología , Neoplasias de la Vejiga Urinaria/complicaciones , Anciano , Humanos , MasculinoRESUMEN
Exposition of one case of vesico-ileal fistula with atypical presentation and infrequent etiology, secondary to transitional cell vesical carcinoma. The incident is exploited to review the etiology of acquired enterovesical fistulae.
Asunto(s)
Carcinoma de Células Transicionales/complicaciones , Enfermedades del Íleon/etiología , Fístula Intestinal/etiología , Fístula de la Vejiga Urinaria/etiología , Neoplasias de la Vejiga Urinaria/complicaciones , Carcinoma de Células Transicionales/patología , Carcinoma de Células Transicionales/cirugía , Resultado Fatal , Humanos , Enfermedades del Íleon/diagnóstico , Enfermedades del Íleon/cirugía , Fístula Intestinal/diagnóstico , Fístula Intestinal/cirugía , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Reoperación , Fístula de la Vejiga Urinaria/diagnóstico , Fístula de la Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
PSA concentrations were measured in 421 women. In a first group comprising 309 subjects, the assay was carried out with kits containing polyclonal antibodies (PPSA). In the second group with 112 women, the assays used kits containing polyclonal antibodies (PPSA) and kits containing monoclonal antibodies (MPSA), and results obtained with both assays were compared. In the first group PSA levels higher than 0.4 ng/ml were detected in 47.9%. In the second group concentrations higher than 0.4 ng/ml were detected in 52.7% when using PPSA versus 16.7% when using MPSA. The rate of PSA detectable levels in healthy women, with benignant and malignant conditions was 36.7, 42.1 and 84.4% for PPSA, and 16.7, 14.0 and 21.9 for MPSA. This study shows that it is possible to detect PSA levels in women, and that this is more frequent when using a polyclonal antibodies assay.
Asunto(s)
Inmunoensayo/métodos , Antígeno Prostático Específico/sangre , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Patients on anticoagulant therapy may develop urologic complications, the most common being hematuria. Other less common but more severe complications are spontaneous hemorrhage arising from urological structures, as spontaneous perirenal hematoma, or from extra-urological structures, such as the iliac psoas muscle or the anterior rectus abdominis muscle. We report on four patients on anticoagulant therapy for different reasons, with no previous history of trauma, who suddenly developed spontaneous bleeding with urologic consequences: spontaneous perirenal hematoma (2), hematoma of the iliac muscle (1) and the anterior rectus abdominis muscle (1). The diagnostic strategy, the usefulness of the different imaging techniques and our approach to these complications are discussed.
Asunto(s)
Anticoagulantes/efectos adversos , Enfermedades Urológicas/inducido químicamente , Anciano , Femenino , Hematoma/inducido químicamente , Hematoma/diagnóstico , Hemorragia/inducido químicamente , Hemorragia/diagnóstico , Humanos , Enfermedades Renales/inducido químicamente , Enfermedades Renales/diagnóstico , Masculino , Persona de Mediana Edad , Músculos Psoas , Recto del Abdomen , Espacio Retroperitoneal , Enfermedades Urológicas/diagnósticoRESUMEN
Contribution of one case of Spontaneous Perirenal Haematoma (SPH) secondary to hydronephrosis accompanied by lithiasis in pelvic kidney. SPH can result from multiple causes, the most frequent ones being renal tumours, most particularly angiomyolipoma and hypernephroma. Hydronephrosis is an uncommon cause of SPH, and very few cases are described in the literature. The present paper addresses the diagnostic usefulness of the various radiological tests as well as the therapeutical approach to be followed.
Asunto(s)
Hematoma/etiología , Hidronefrosis/complicaciones , Riñón/anomalías , Adulto , Hematoma/diagnóstico por imagen , Humanos , Hidronefrosis/diagnóstico por imagen , Riñón/diagnóstico por imagen , Masculino , RadiografíaRESUMEN
Ureteral endometriosis is an uncommon process. It should be suspected, however, in patients with known pelvian disease presenting urological sings and symptoms. It is important to establish early diagnosis which does not delay a conservative therapeutical approach, so as to avoid the progressive decline of renal function and, eventually, nephrectomy. Contribution of one case of extraluminar ureteral endometriosis fitting this hypothesis and review of the most appropriate etiology, sings and symptoms, diagnosis and therapeutical approach.
Asunto(s)
Endometriosis , Neoplasias Ureterales , Adulto , Endometriosis/diagnóstico , Endometriosis/terapia , Femenino , Humanos , Neoplasias Ureterales/diagnóstico , Neoplasias Ureterales/terapiaRESUMEN
Analysis of the evolution of 78 patients with hormonally-treated non-metastatic prostate cancer. During an average follow-up of 62.3 months, local clinical and metastatic progression in 14.1% and 7.7% cases, respectively, was observed. Overall, PSA detected progression of disease in 94.1% cases, with an anticipation which range between 4 and 52 months. Evidence of bone metastatic progression was confirmed in 2.1% of the 286 scintigraphies performed. Following analysis of results, by accepting their indication from a PSA level higher than 100 ng/ml, 97.9% would have been avoided, achieving a 100% sensitivity and 94.1% diagnostic efficacy.
Asunto(s)
Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Anciano , Anciano de 80 o más Años , Antagonistas de Andrógenos/uso terapéutico , Terapia Combinada , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Orquiectomía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/terapia , Cintigrafía/estadística & datos numéricos , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
Acute appendicitis, particularly pelvic, may cause a suppurative process that spontaneously drains to the bladder and an appendicovesical fistula may result. The pelvic appendix and the bladder may occasionally become fused in an inflammatory and necrotic focus, directly creating a fistula. A case of vesicointestinal fistula secondary to appendiceal pelvic peritonitis is described and the cases reported in the literature are reviewed.
Asunto(s)
Apendicitis/complicaciones , Apéndice , Fístula Intestinal/etiología , Fístula Urinaria/etiología , Enfermedad Aguda , Adulto , Enfermedades del Ciego/etiología , Femenino , HumanosRESUMEN
The evolution of non-metastatic prostate cancer treated with hormonal therapy does not appear to be affected by the performance of a transurethral resection (TUR) as a measure to expedite the common urinary tract. Of 82 patients followed for an interval ranging from 6 months to 15 years, 3 of 45 patients (6.7%) undergoing RUT experienced metastatic dissemination, while the same happened in 2 of 37 (5.4%) patients who did not undergo RUT, p being NS. The group of patients requiring RUT, however, experienced higher local progression rates, 22.2% vs 5.4%, a situation not ascribable to the RUT procedure but to the fact that such surgery was selectively indicated in neoplasias with larger tumoral mass.