RESUMEN
PURPOSE: Orthotopic neobladders have become the standard of care after radical cystectomy in select women with bladder cancer. We report early and late complications in 192 patients. Although medical complications were important, they were not the focus of this study. MATERIALS AND METHODS: Between January 1995 and December 2003, 192 women with a mean age of 50.6 years received an orthotopic neobladder after radical cystectomy for bladder cancer. Standard radical cystectomy was done. Ileal reservoirs were used, mostly in the form of an ileal W-neobladder. We evaluated the patients for functional outcome, early and late complications, and treatment for these complications. RESULTS: Two patients (1%) died of pulmonary embolism 1 to 2 weeks after cystectomy. Followup was 6 to 125 months (mean 54). Early complications included hemorrhage requiring reexploration in 1 case, postoperative blood transfusion in 1, wound infection in 8, prolonged ileus in 5, deep vein thrombosis in 5, pouch-vaginal fistula in 6, prolonged urinary leakage in 3, pouch-cutaneous fistula in 1 and early ureteral obstruction in 1. Of the 177 patients eligible for functional evaluation 62 experienced a total of 75 late complications, including stone disease in 18, ureteroileal stricture in 19, reflux in 22, intestinal obstruction in 2, incisional hernia in 2 and chronic pyelonephritis in 12. Early and late complications were treated accordingly with good outcomes. CONCLUSIONS: Early and late complications develop in a significant number of patients. Most early complications may be treated conservatively, while late complications are mostly treated with endourological and/or open surgery. Close lifelong surveillance of patients is mandatory to detect and properly treat these complications.
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Cistectomía/efectos adversos , Neoplasias de la Vejiga Urinaria/cirugía , Reservorios Urinarios Continentes/efectos adversos , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Factores de TiempoRESUMEN
OBJECTIVE: Gynecological and obstetric surgeries are not uncommon causes of iatrogenic injury of the urinary tract. Herein, we retrospectively report our experience with these injuries over the last 18 years. MATERIAL AND METHODS: Between 1985 and 2003, 120 females (mean age 34.2+/-13.7 years) were included in this study. The types of injury were as follows: vesicovaginal fistula, n=90; ureterovaginal fistula, n=14, ureteric ligation, n=13, vesicouterine fistula, n=2; and ureterouterine fistula, n=1. Definitive repair of such injuries was performed in all cases, including 10 cases of recurrent vesicovaginal fistulae which were treated by means of augmentation cystoplasty or urinary diversion. All patients were evaluated regarding the time and type of surgical intervention and early and late postoperative complications, including failure of primary repair. RESULTS: Of the 80 cases of vesicovaginal fistulae treated with definitive repair, 12 (13.3%) showed recurrence of the fistula. Early ureteric deligation and early or delayed ureteroneocystostomy or ureteric replacement were successful in all cases with ureteric injury. There was no loss of kidney function following the trauma or its repair. CONCLUSIONS: It is mandatory for gynecologists and obstetricians to pay careful attention to the anatomy of the urinary tract in order to avoid its iatrogenic injury. Endourologic means were successful in enabling first aid management of some of these injuries. Early exploration is indicated in cases of ureteric obstruction that present early after trauma. Augmentation cystoplasty, urinary diversion or ileal replacement are indicated in only a few cases.
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Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Procedimientos Quirúrgicos Obstétricos/efectos adversos , Sistema Urinario/lesiones , Fístula Vesicovaginal/etiología , Adulto , Femenino , Humanos , Enfermedad Iatrogénica , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Fístula Urinaria/etiología , Fístula Urinaria/cirugía , Sistema Urinario/cirugía , Fístula Vaginal/etiología , Fístula Vaginal/cirugía , Fístula Vesicovaginal/cirugíaRESUMEN
PURPOSE: We differentiated renal cell carcinoma subtypes using multislice computerized tomography (CT). MATERIALS AND METHODS: We reviewed the CT images of 87 patients with renal cell carcinoma. Three subtypes of renal cell carcinoma were noted, including clear cell in 37 cases, papillary in 26 and chromophobe in 24. Biphasic CT (unenhanced, corticomedullary and excretory phases) was done in all patients. We compared patient age and sex, tumor size, enhancement degree and pattern (homogeneous, heterogeneous and predominantly peripheral), the presence or absence of calcification or cystic degeneration (necrotic or hemorrhagic areas within the tumor) and tumor spreading patterns, including perinephric change, venous invasion and lymphadenopathy, in the 3 subtypes. RESULTS: The degree of enhancement was significantly different among the 3 subtypes in the corticomedullary and excretory phases (p <0.001). Cystic degeneration was more evident in the clear cell subtype than in the other subtypes regardless of tumor size (p <0.001). A hypervascular pattern (higher tumor enhancement after contrast material injection due to higher vascularity) was noted in 48.6% of clear cell subtype in comparison to 15.4% of papillary and 4.2% of chromophobe subtypes (p <0.001). The chromophobe subtype showed homogeneous enhancement in 75% of cases in comparison to 45% and 65% of clear cell and papillary subtypes (p >0.05). Calcification was evident in 21.6%, 23.1% and 25% of clear cell, papillary and chromophobe subtypes, respectively (p >0.05). CONCLUSIONS: To differentiate the subtypes of renal cell carcinoma the degree of enhancement is the most valuable parameter. The presence or absence of cystic degeneration, vascularity and enhancement patterns can serve supplemental role in differentiating renal cell carcinoma subtypes.
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Carcinoma de Células Renales/diagnóstico por imagen , Neoplasias Renales/diagnóstico por imagen , Adulto , Anciano , Carcinoma de Células Renales/patología , Diferenciación Celular , Femenino , Humanos , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Curva ROC , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To evaluate gadolinium-enhanced dynamic magnetic resonance imaging (MRI) as the sole method for the anatomical and functional assessment of potential live-kidney donors. SUBJECTS AND METHODS: The study included 50 consecutive kidney donors; in addition to routine donor evaluation, the kidney was imaged with Gd-enhanced dynamic MRI, which was also used for selectively determining the glomerular filtration rate (GFR) of each kidney. All donors had a m99Tc-mercaptoacetyltriglycine (MAG3) renal scan as the reference standard to measure GFR. The anatomical results of MRI were compared with the findings at donor nephrectomy, and the GFR estimated from MRI compared with that from MAG3 scintigraphy. RESULTS: MR angiography had 100% sensitivity, 94% specificity and 96% overall accuracy for detecting the number of renal arteries, and 100% sensitivity, 98% specificity and 98% overall accuracy for the number of renal veins. There was a close correlation (r = 0.54, P < 0.01) between the GFR of each kidney estimated by MRI or MAG3. For the right and left kidneys the mean isotope clearance was not significantly different from that of mean MRI clearance. MR urography allowed visualization of the urinary tract and the detection of any abnormality. CONCLUSION: Gd-enhanced dynamic MRI can provide accurate information about the anatomy of the urinary tract and vasculature of the kidney, and can be used to accurately estimate the selective GFR of each kidney. Therefore, we recommend MRI as a single imaging diagnostic method for assessing potential live kidney donors.
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Tasa de Filtración Glomerular/fisiología , Trasplante de Riñón/métodos , Riñón , Donadores Vivos , Imagen por Resonancia Magnética/métodos , Adulto , Femenino , Gadolinio , Humanos , Riñón/anatomía & histología , Riñón/irrigación sanguínea , Riñón/fisiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiofármacos , Tecnecio Tc 99m MertiatidaRESUMEN
OBJECTIVE: To study the value of an acellular matrix graft of the tunica albuginea for reconstruction of the penis in cases of severe Peyronie's disease. MATERIAL AND METHODS: In nine mongrel dogs, an acellular matrix graft of the tunica albuginea was used to cover a 30 x 10 mm2 tunical defect. Equal numbers of animals were sacrificed at 1, 3 and 6 months after surgery. Before death, an erection was induced by means of papaverine injection and cavernosography was performed. After death the penis was prepared for histopathological study. RESULTS: All animals survived the surgery and none developed haematoma, wound infections or dehiscence. All dogs developed a straight, rigid erection. Cavernosography showed patent corpora cavernosa in all animals. The papaverine injection and cavernosographic results did not change over time. Inspection of the graft site and measurement of its length and width showed healing with no contracture. Histologically, the regenerated matrix appeared thicker than the neighbouring tunica albuginea in the 1-month group; otherwise the appearance was normal. Gradual orientation of the fibrocytes, capillaries and collagen fibres was demonstrated at 1 month and was complete at 3 and 6 months. Comparison between an implanted tunica at 6 months and a control tunica from a normal dog showed no significant histological difference. CONCLUSION: A homologous acellular matrix graft of the tunica albuginea may be an alternative treatment for severe cases of Peyronie's disease.
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Tejido Elástico/trasplante , Induración Peniana/cirugía , Pene/cirugía , Procedimientos de Cirugía Plástica/métodos , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Animales , Modelos Animales de Enfermedad , Perros , Tejido Elástico/citología , Estudios de Seguimiento , Masculino , Induración Peniana/diagnóstico por imagen , Induración Peniana/patología , Pene/diagnóstico por imagen , Pene/patología , Radiografía , Resultado del TratamientoRESUMEN
PURPOSE: We studied changes in the renal resistive index (RI) of the remaining kidney after live donor nephrectomy. MATERIALS AND METHODS: The study included 24 healthy live kidney donors (14 males and 10 females) with a mean age of 42 years. After donor evaluation Doppler ultrasound was done of the 2 kidneys the day before nephrectomy with RI measurement of each kidney. After nephrectomy the RI of the remaining kidney was measured on days 2, 4, 6, 8 and 10, and then at weeks 2, 3, 6 and 12. Mean RI of the remaining kidney before nephrectomy was compared to values at different time points after nephrectomy. Changes in the RI of the remaining kidney were screened at the followup time points. RESULTS: There was no difference between the mean RIs of the right and left kidneys before nephrectomy (0.67 +/- 0.04 and 0.67 +/- 0.04, respectively). The RI of the remaining kidney increased from 0.67 +/- 0.04 before nephrectomy to 0.71 +/- 0.06 on day 2 after nephrectomy, which was significantly different (p <0.0001). The mean RI increase of the remaining kidney on day 2 was 0.05 +/- 0.03. The RI of the remaining kidney remained almost stable on days 4, 6, 8, and 10, and also at week 2. Comparison between the mean RI at weeks 2 (0.72 +/- 0.05) and 3 (0.73 +/- 0.05) showed a further increase of significant value (p <0.0001). The mean RI remained stable at weeks 6 (0.73 +/- 0.05) and at 12 (0.73 +/- 0.05). CONCLUSIONS: The RI of the remaining kidney significantly increases after nephrectomy of the contralateral kidney. Therefore, an RI value of 0.7 is not suitable to diagnose a pathological condition in a solitary kidney in adults.