RESUMO
BACKGROUND: Ureterocele is a cystic dilation of the distal ureteral segment. The incidence in women ranges from 1/5,000 to 1/12,000. In adults, they are poorly diagnosed and are asymptomatic. Prolapse through the urethra is uncommon, and involves acute urine retention and a reducible vulvar tumour. CLINICAL CASE: Woman of 24 years old, two previous caesarean and two abortions. She had incomplete bladder emptying, intermittent voiding, bladder straining and tenesmus, three months before admission. After the voiding effort she presented with acute urine retention with sudden onset of tumour in the vulva. The tumour was manually reduced under regional anaesthesia. A cystoscopy was performed, finding an ischaemic de-roofing of the anterior wall of the ureterocele, causing vesicoureteral reflux grade IV. Surgical correction was performed with Cohen re-implantation and insertion of a double-J catheter. The catheter was removed 30 days later, with a successful post-operative course. DISCUSSION: Its aetiology is unclear, and most are diagnosed by ultrasound in the prenatal period. The clinical presentation is variable, from urinary tract infection to prolapse. Despite its size, it may cause complications such as ischaemic de-roofing, which if diagnosed soon may be resolved successfully, as with this patient. CONCLUSION: The results and treatment may be favourable when no renal impact or concomitant anatomical changes are present, as is the case of this patient.
Assuntos
Prolapso de Órgão Pélvico/complicações , Ureterocele/complicações , Retenção Urinária/etiologia , Doença Aguda , Cistoscopia , Feminino , Humanos , Prolapso de Órgão Pélvico/diagnóstico por imagem , Prolapso de Órgão Pélvico/cirurgia , Reimplante , Ureter/cirurgia , Ureterocele/diagnóstico por imagem , Ureterocele/cirurgia , Cateterismo Urinário , Refluxo Vesicoureteral/etiologia , Adulto JovemRESUMO
Se presentan los casos de 21 pacientes de carcinoma vesical y tres de carcinoma de pelvis renal bajo control de la Consulta Externa del Servicio de Urología, Hospital de Especialidades, Centro Médico de Puebla, IMSS. Se encontró carcinoma vesical superficial en 15 (71.4%) de los pacientes; de éstos siete (46.6%) se trataron mediante resección transuretral a la que se añadió quimioterapia intravesical, y uno (6.6%) mediante radioterapia radical. La enfermedad resultó invasora en seis (28.5%). De los 21 pacientes, 16 (76.2%) se encontraban vivos sin datos de actividad tumoral en el momento de terminar la redacción de este informe; otros más (4.7%) lo estaba pero con actividad tumoral, tres habían fallecido a causa del padecimiento, y el deceso del último se debió a una causa ajena al mismo. Dos de los pacientes que padecían carcinoma de la pelvis renal se sometieron a nefroureterectomía con resección de un segmento vesical, y el otro a operación conservadora de la pelvis renal. Los tres se encontraban libres de actividad tumoral en el momento de terminarse de redactar este informe. La finalidad de este artículo es valorar los aspectos aplicados e informar las experiencias obtenidas con el tratamiento de los carcinomas de estos tipos.