RESUMO
Tuberculosis continues to be a worldwide public health issue, known as "the great pretender" resembling many diseases. Overall 1% of women infected with Mycobacterium species develop genital tuberculosis (GT) which is widespread more commonly during their fertility age, 20-40 years old. GT is the second most common cause of extra pulmonary tuberculosis. One of the clinical manifestations in these patients is Infertility; with a poor prognosis of a successful pregnancy even with a correct diagnosis, medical and/or surgical treatment. Most pregnancies result in ectopic pregnancies or abortions. In low income countries GT may account for 5-20% of infertility cases. It was widely believed that pregnancy represented a period of risk to women infected with tuberculosis; and actually abortion is suggested. We report a case of a 21 year old female patient who came to the General Hospital Dr. Miguel Silva in the city of Morelia, Michoacán with the diagnosis of late puerperium postpartum complicated with retained placental tissue to perform a uterine curettage. The patient had fever and anemia for which we had to perform a laparotomy exploration of the doubt of uterin perforation; the surgical findings were pathognomonic of GT for which we continue to realize Hysterectomy. The macro and microscopically pathologic findings consists in GT, confirming the diagnosis with Ziehl-Neelsen acid stain. GT findings must always be differentiated from ovarian cancer.
Assuntos
Doenças dos Genitais Femininos/microbiologia , Tuberculose Urogenital , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/cirurgia , Humanos , Período Pós-Parto , Gravidez , Nascimento a Termo , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/cirurgia , Adulto JovemRESUMO
AIMS: Clinical and urodynamic evaluation of the late outcome of 25 patients with chronic tuberculous cystitis who underwent bladder augmentation. PATIENTS AND METHODS: Twenty men and five women with median age of 40 years were evaluated. The tubularized ileocecal segment was used in 8 cases, the detubularized sigmoid in 13, and the tubularized sigmoid in 4. Patients underwent a postoperative clinical and urodynamic evaluation. Miccional diurnal frequency of more than 2 hr together with patient satisfaction as assessed by the quality of life question of the ICSmaleSF questionnaire was considered a good result. RESULTS: The average postoperative follow-up was of 11.1 +/- 9.1 (1 to 36) years. A good result was seen in 80% of the patients. Bad results occurred statistically in the cases using tubularized sigmoid and in patients with prostatitis. Patients with good results showed augmented bladders with normal sensation (P = 0.03) and greater capacity (P < 0.01) and compliance (P < 0.01) than did those with bad results. There was no statistically significant difference in the frequency of involuntary contractions (P = 0.27) but in the good result patients, the contractions started with greater bladder filling volume (P = 0.02). CONCLUSIONS: The sigmoid should be detubularized but the ileocecal segment may be used in its original tubularized form to augment the bladder with chronic tuberculous cystitis. Augmented bladder with capacity of more than 250 ml, good compliance, and normal sensation are necessary for diurnal frequency of more than 2 hr. The presence of involuntary contractions does not lead to a decrease in the diurnal frequency.
Assuntos
Colo Sigmoide/cirurgia , Cistite/cirurgia , Íleo/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Tuberculose Urogenital/cirurgia , Bexiga Urinária/cirurgia , Adolescente , Adulto , Criança , Doença Crônica , Cistite/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Rim/fisiologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Radiografia , Resultado do Tratamento , Tuberculose Urogenital/diagnóstico por imagem , Bexiga Urinária/microbiologia , Bexiga Urinária/fisiologia , UrodinâmicaRESUMO
Se analiza la TBC génitourinaria en la ciudad de Arica desde 1991 al año 2002. Se encuentran 43 casos, con predominio sexo femenino, etnia Aymará. El diagnóstico fue sospechado por las molestias urinarias y hematuria. La pielografía endovenosa fue de utilidad en la sospecha. El examen directo y cultivo permitieron iniciar el tratamiento con buena tolerancia y un sólo abandono. Fueron sometidos a cirugía, el 25,6 porciento de los enfermos. Se comenta los resultados, comparándolos con estudio efectuado en el sur deChile.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Pessoa de Meia-Idade , Chile/epidemiologia , Tuberculose Urogenital/epidemiologia , Indígenas Sul-Americanos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Estudos Retrospectivos , Tuberculose Urogenital/cirurgia , Tuberculose Urogenital/etnologia , Tuberculose Urogenital , UrografiaRESUMO
OBJECTIVES: To assess the surgical and long-term results of renal transplantation in 25 patients with bladder dysfunction and augmentation cystoplasty. METHODS: We retrospectively reviewed the evolution and surgical outcome of 25 renal transplants in 24 recipients with augmentation cystoplasty. The mean patient age at transplantation was 27.6 years. The etiology of bladder dysfunction was neurogenic bladder with detrusor hyperreflexia (11 patients), tuberculosis (5 patients), vesicoureteral reflux (4 patients), posterior urethral valves (3 patients), and interstitial cystitis (1 patient). Seventeen transplants were from living donors. Augmentation cystoplasty was performed before transplantation in 21 patients. The bowel segments used in the augmentation cystoplasty included ileum in 16, ileocecal segments in 2, and sigmoid in 5 patients. The donor ureter was anastomosed to the native bladder in 16 patients, to the bowel segment in 6, and to the native ureter in 3. RESULTS: Twenty kidneys (80%) were functioning at a mean follow-up of 53.2 months (range 6 to 118). The mean serum creatinine was 1.56 mg/dL (range 0.7 to 2.6). Three patients died of unrelated causes and 1 of adenocarcinoma that originated at the vesicointestinal anastomosis. The actuarial graft survival at 1, 2, and 5 years was 96%, 92%, and 78%, respectively. Complications included symptomatic urinary infection, ureteral stenosis, and lymphocele. CONCLUSIONS: Augmentation cystoplasty is a safe and effective method to restore function in noncompliant bladders. Renal transplantation can be performed safely after augmentation cystoplasty.
Assuntos
Transplante de Rim , Doenças da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Adolescente , Adulto , Criança , Complacência (Medida de Distensibilidade) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose Urogenital/cirurgia , Bexiga Urinária/fisiopatologia , Doenças da Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/cirurgia , Refluxo Vesicoureteral/cirurgiaRESUMO
Se estudian 62 casos con tuberculosis genitourinaria tratados entre 1989 y 1996. Corresponden a 41 hombres y 21 mujeres con un promedio de edad de 42,6 años. El 58,1 por ciento habita en localidad rural y un 37,1 por ciento tiene ascendencia mapuche. El 32,3 por ciento tiene antecedentes de tuberculosis anterior o concomitante. La latencia entre inicio de síntomas y diagnóstico fue de 13,1 meses, debutando el cuadro principalmente con hematuria macróscopica (45,2 por ciento), irritación vesical (44,9 por ciento) y dolor y/o aumento de volumen escrotal. La confirmación diagnóstica fue realizada en un 83,9 por ciento mediante cultivo y/o biopsia. Urocultivo de Koch fue positivo en un 69,4 por ciento. En el 90 por ciento la ecotomografía renal y un 74 por ciento la pielografía endovenosa resultaron alteradas, siendo el órgano más afectado el riñón. Fueron intervenidos quirúrgicamente 21 pacientes (33,9 por ciento). En 11 casos la evolución fue hacia una insuficiencia renal crónica. Todos recibieron tratamiento médico con esquema abreviado de 7 meses
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Tuberculose Urogenital/diagnóstico , Hematúria , Hidronefrose/etiologia , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Tuberculose Urogenital/complicações , Tuberculose Urogenital/tratamento farmacológico , Tuberculose Urogenital/cirurgia , Procedimentos Cirúrgicos Urogenitais , UrografiaRESUMO
We have had occasion to treat 8 patients suffering from tuberculous microbladder on whom we carried out augmentation plasty with a segment of ileum according to Ring-plasty technique in 6 cases, and with U-morphology in the other two, all displayed as the main symptom increase in mictional frequency. Six patients were subjected to prior tuberculostatic treatment. Mictional frequency improved in all patients. We observed morphological improvement in seven patients and functional improvement in four, there was one death, in a patients who had only been having prior tubculostatic treatment for one month. Daytime continence was achieved in al cases and there was nocturnal incontinence in five patients. U or ring ileocystoplasties are simple fast techniques displaying good capacity with low pressures and residua of less than 80 cc. No vesicourethral reflux was observed when we carried out the reimplantation.