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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.

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We report on a 24-year-old female patient with posttraumatic migration of a bony fragment from the site of the fracture to the bladder. The foreign body was removed from the bladder by endoscopy. The etiopathogenic mechanism, clinical signs, diagnostic method and therapeutic management are discussed.

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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.

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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.

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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.

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We report 10 cases of spontaneous perirenal hematoma that had been treated from 1974 to 1992. Retroperitoneal hemorrhage was secondary to renal disease in 7 cases, perirenal in 2 and extrarenal in 1. The etiology of the condition is analyzed in detail and the diagnostic usefulness of the different radiologic examinations are discussed. Making a preoperative diagnosis permits a more adequate surgical strategy.

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Evaluation of results obtained in 70 hormone-treated patients with disseminated prostate cancer. Thirty-six of them were treated via orchiectomy and 34 received also flutamide. Initial objective response rates were 47% in the monotherapy group versus 58% for those undergoing complete blockade. Decrease of PSA and PAP was also higher in the group given flutamide. Nonetheless, no significant changes were observed with regard to biological and clinical progression or patients survival.

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We report a case of Wunderlich's syndrome secondary to spontaneous rupture of a renal artery aneurysm. Wunderlich's syndrome, also called spontaneous perirenal hematoma, may arise from several causes, the most common being renal tumors, particularly angiomyolipoma and hypernephroma. Spontaneous perirenal hematoma secondary to a ruptured renal artery aneurysm is rare and very few cases have been reported in the literature. We discuss the usefulness of the different noninvasive imaging techniques (US, CT and arteriography), our therapeutic approach and those advocated by others.

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Muscular haematoma of the straight muscles of the abdomen are very rare to observe and, although there is a possibility of the haematoma extending to the retroperitoneum, they very rarely cause oligoanuria by compression of the urinary tract. Presentation of one case of spontaneous haematoma of the straight muscles of the abdomen with urologic damage by ureteral compression inducing oligoanuria and bilateral ureterohydronephrosis.

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This paper examines the behaviour of PSA in 70 patients with metastatic prostate cancer. PSA serum concentration, prior to therapy, was directly related to the tumoral mass and inversely related to the histological degree, which does not constitute a prognostic factor with regard to the disease evolution. Within 3 months of therapy, PSA concentration decreased more noticeably in clinically responding patients, down to less than 10 ng/ml in 93% of them. Also, this level represented a prognostic factor with regard to the free-of-progression interval of the disease.

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Eight patients with prostate adenoma and high surgical risk were given leuprolide in depot. Prostate volume decreased by 44.7% after 3 months of treatment and by 58.9% at six months. Two of the 7 patients were resident vesical catheter carriers, 28% re-started spontaneous miction.

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Congenital or acquired pathology of the lower urinary tract currently does not preclude renal transplantation in patients with end-stage nephropathy. We report two cases of renal transplantation with ureteroileal cutaneous diversion in patients with a nonfunctional lower urinary tract due to bladder fibrosis secondary to urinary tuberculosis. We discuss the possibilities of the urodynamic study in the preoperative evaluation of patients with similar conditions.

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Report on one case of lithiasis in a transplanted kidney treated successfully with extracorporeal shockwave lithotrity. This is considered to be the choice therapeutical method when there are no bone interposition or urinary tract obstruction which may preclude the correct removal of lithiasis fragments.

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Endoscopic trigonocervicoprostatotomy incision has become a minimally aggressive alternative to surgical treatment of early benign prostatic hypertrophy (BPH). The present article analyzes its indications, advantages and disadvantages. We describe the technique utilized and report on the results achieved in 146 patients (mean age 62.7 years, mean follow-up 15.7 months). Clinically, the results were completely satisfactory in 78.1% of the cases, symptomatology improved in 15.7%, and 4.8% warranted a second procedure. The incidence of retrograde ejaculation was observed to be only 20.5%. With regard to the urodynamics, the preoperative mean maximum flow rate of 9 ml/sec. increased to almost 20 ml/sec. postoperatively. The results of urethral evaluation support the hypothesis of Turner-Warwick which ascribes the obstructive symptomatology in these patients to cervical dysfunction.

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The new therapeutic approach combining percutaneous nephrolithotomy (PNL) and extracorporeal shock wave lithotripsy (ESWL) has become widely used instead of conventional surgery. The use of this combined treatment modality has been extended to complex renal calculi. In our view, the need to achieve complete removal of struvite stone fragments to cure infection and prevent subsequent stone formation has led to a change in our therapeutic approach. The present study describes several maneuvers to facilitate PNL and compares two treatment modalities: PNL to reduce stone volume + ESWL (an approach utilized by many) and ESWL + PNL for remaining stone fragments (our therapeutic approach). Our approach (ESWL followed by PNL) has enhanced our results in the treatment of complex renal calculi: 68.4% of the renal units were completely stone-free at the time of discharge from the hospital. Good results were achieved in 89.5%, if we include the renal units with stone fragments that could be spontaneously passed.

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Various surgical procedures have been described for correction of stress urinary incontinence (SUI) which have afforded different results. Modifications to these procedures have been made in an attempt to reduce morbidity and the operating time without detriment to the efficacy of the procedures. Herein we describe two procedures, the modified Cobb-Radge and Raz techniques, and report on the results achieved. In patients with no cystocele that had been submitted to the modified Cobb-Radge technique, we achieved 80.4% good results. In patients with significant cystocele, our modified Cobb-Radge technique and anterior colporrhaphy achieved a success rate of 80%, and we achieved good results in 88.3% of these cases with our modified Raz procedure.

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The irritative micturition syndrome is commonly observed following endoscopic surgery for benign prostatic hyperplasia. This condition almost consistently presents following removal of the bladder catheter and may last from 15 to 45 days. The present study was undertaken to determine the efficacy of treatment with diclofenac sodium. Fifty patients submitted to endoscopic resection for benign prostatic hyperplasia received the agent IM a few hours prior to catheter removal and posteriorly via the rectal route for a total treatment period of 13 days. Good results were achieved in 95.5% of the cases. Mild side effects were observed in 14% of the patients.

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Trigono-cervico-prostatotomy (TCP) incision was performed endoscopically in 102 patients, 99 for benign hypertrophy of the prostate (BHP) less than 35 g., and 3 for bladder neck obstruction. Good results were achieved in 81.4%, symptom relief was achieved in 12.7%, and 5.8% required reoperation. The incidence of retrograde ejaculation was only 20.6%. Patient follow-up was one year. Our findings show the usefulness of ultrasound, urethroscopy and urodynamics in determining the size of the adenoma and in assessing the results achieved by the surgical technique.

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