Uso de la urografía por resonancia magnética en el estudio del aparato urinario frente a la urografía convencional

Conventional urography (IVU) is an essential examination for the assessment of urinary tract but it is not free of complications, such as adverse reactions to contrast agents used (vasovagal and anaphylactic reactions), neurotoxicity, nephrotoxicity, as well as the damage due to the ionizing irradiation applied to the patient. For this reason, alternative imaging techniques such as magnetic resonance (MR) urography or uro-resonance have been developed.

OBJECTIVE

We present a case study assessing the diagnostic accuracy, specificity and sensitivity of uro-resonance and IVU as a morphological and functional examination of the urinary tract: and a quality study of the urographic images obtained with MR versus IVU.

MATERIALS AND METHODS

150 patients have submited to a MR study, 63 of them with an IVU study already performed, acquiring high-intensity signals at T2 corresponding to abdominal and retroperitoneal fluid, initially using furosemide at low doses and, in a final study, administering gadolinium at a rate of 0.1 mg/Kg. The test was indicated in patients with antecedents of adverse reactions to iodine contrast, acute or chronic kidney failure, functional cancellation of the kidneys, pregnant patients and those in paediatric age. The capacity of diagnosis of urinary obstruction and the aetiology of this obstruction of both tests was studied, as well as the quality of the images obtained by the urographic study using MR.

RESULTS

High resolution images were obtained of all the upper urinary tracts using MR, especially in the renal pelvis, without artefacts caused by peristalsis or intestinal fluid interposition. In 83.3% of cases, examinations revealed urological pathology. The diagnostic accuracy of the involvement cause of the urinary tract was 83.3%, with a sensitivity of 89.6%, a specificity of 69.2%. a positive predictive value of 86.6% and a negative predictive value of 75%.

CONCLUSION

MR urography is a high sensitive technique for the study of urinary tract, used as an alternative to conventional urography particularly in cases of the contraindication of ionizing radiation or allergy to the contrast agent, as well as in patients with renal failure, and offers a wider morphological and functional study, with a high image quality, able to displace conventional examinations in the short or medium term.

Obra urológica y biográfica del doctor Felipe Alcalá-Santaella Núñez (1927-1977): Análisis documental histórico

OBJECTIVES

In the middle of the 20th century, Urology in Valencia was fully consolidated as a surgical speciality since Prof. Molla started it about the end of the 19th century; Dr. Felipe Alcala Santaella Nuñez stands out as the chairman of the Department of Urology of the "Hospital Provincial de Valencia", after his father Dr. Rafael Alcalá Santaella. He achieved to form a group of renowned professionals, some of which still are in active practice.

METHODS

We reviewed all his scientific work and the journals it was published in, mainly Archivos Espaioles de Urologia, through the Department of Medical History of the University of Valencia. His biography was reconstructed using the "Biographic and Bibliographic History of Spanish Urology" by Drs. E. Maganto Pavón and M. Pérez Albacete, as well as direct interviews with family members.

DISCUSSION

We emphasize the magnificent approach to the clinical presentations of tuberculosis he does in his doctoral thesis, analyzing its types by location, main features, and most adequate treatment. He also emphasized the importance of relapse in lithiasic patients and recommendations to be follow, as well as the condition of bladder neoplasias.

CONCLUSIONS

We consider Dr. Felipe Alcalá Santaella Nuñez as a wide-experience-professional who mode solid contributions to the regional urology in his times, thanks to his excellent surgical abilities and dedication.

Complicaciones de la prostatectomía radical: evolución y manejo conservador de la incontinencia urinaria

OBJECTIVES

Radical retropubic prostatectomy is the major procedure for curing early stage prostate cancer. In this retrospective study we valued the complications of this surgery and its evolution in time, as well as the efectiveness of the urinary incontinence preservative treatment in the recovery of urinary continence.

MATERIALS AND METHODS

During the period between december of 1998 to january of the 2005 we have treated 168 patients suffering prostatic adenocarcinoma clinically confined to the gland by means of retropubic radical prostatectomy. We removed the vesical catheter the fourteenth day of the postoperative and made a clinical monitoring the first, third and sixth month after the surgery, and thereafter every six months.

RESULTS

Of the 168 patients who underwent clinical surgery, 15% required postoperative blood transfusion in the immediate postoperative. Other complications, with a lower incidence, were the intestinal perforation, surgical wound infection and the haematoma. The most frequent delayed complications we registered were erectile dysfunction, observed in 164 patients (98%), micturition alterations in 32 patients (19%) and intestinal alterations in approximately 11%. Among the micturitional alterations found, the most frequent (64%) was the Urinary Incontinence (UI). However, most of them were of minor importance (34%) and all improved during the first six months after the surgery. We advised patients with minor and moderate UI to perform pelvic floor muscle training, being very useful since they allowed to anticipate the recovery of continence.

CONCLUSIONS

Radical prostatectomy continues to be the most effective treatment for the non spared prostate cancer, in spite of the associated morbidity. The IU is the main factor for the high standard of living these patients. Despite the number of patients with UI being so high, most cases are moderate and minor and may improve with pelvic floor muscle training. Hence, this is a significant tool to tackle this illness, whether in connection with the use of absorbent, the pharmacologic therapy or the use of penile collectors.

[Adrenal gland myelolipoma: review of the bibliography regarding a case]

OBJECTIVE

To describe an additional case of this rare disease entity, with special reference to its diagnosis and treatment, and to briefly review the literature.

METHODS

We report on an 82-year-old male with adrenal myelolipoma that had been incidentally discovered during evaluation for another condition. A left adrenalectomy was performed due to the large size of the tumor and in order to determine its benign or malignant nature.

RESULTS

The histopathological findings disclosed an andrenal myelolipoma.

CONCLUSIONS

Adrenal myelolipoma is an uncommon tumor type. CT is the most effective diagnostic method. Surgery is advocated in symptomatic cases and in asymptomatic cases with a large tumor mass.

[Burned out testicular tumor]

OBJECTIVE

Extragonadal germ cell tumor is a rare condition. The present study reports an additional case of this uncommon disease.

METHODS/RESULTS

A 24-year-old male with retroperitoneal disease and a testicular lesion detected by ultrasonography is described. Histopathological analysis of the orchiectomy specimen disclosed a 'burned out' tumor. The anatomopathological features of this tumor type are discussed.

CONCLUSION

Extragonadal germ cell tumor is a rare condition. It derives from the germ cells that exist in the gonad and is located in every anatomical region but the gonad itself. Ultrasonography must be performed if an extragonadal germ cell tumor is suspected.

[Urologic impact of Crohn disease]

Presentation of two cases of Crohn's disease seen in our Service in which the urological symptoms were of special relevance. One patient presented clinically with a picture of anaemic gross haematuria. The other one, was a patient already diagnosed with Crohn's disease who developed an enterovesical fistula in spite of receiving medical treatment. Both cases were resolved surgically. The clinical aspects, natural history and treatment of this uncommon form of urinary tract involvement are discussed.

[Pheochromocytoma: a review of our own cases]

Presentation of 6 cases of pheochromocytoma, diagnosed and treated in our Unit over the last 5 years. Five were adrenal pheochromocytomas and 1 an abdominal paraganglioma in a 42 year-old woman. Distribution by gender was 4 male and 2 female, and mean age at presentation was 45.2 years ranging from 35 to 55 years. Clinically, all patients were hypertensive. Two of the 5 cases with adrenal location presented with catecholaminic crisis with BP > 240/140 mmHg. The paraganglioma was diagnosed while studying a case of sustained HBP in a 42 year-old female referred from another unit. With regard to diagnosis, the sensitivity of urinary tests was 100%, and gammagraphy with meta-iodine-benzyl-guanidine (MIBG) was particularly useful in the extra-adrenal location case. In all our patients, computerized tomography (CT) was the choice procedure to locate the tumour. Treatment was surgical in all cases, access being transperitoneal in 3 cases, thoracoabdominal in 2 and classic lumbotomy in 1. All our patients received prior treatment with alpha-blocking agents, and intraoperative complications were 1 arrythmic crisis, 1 hypotensive picture and 1 hypertensive crisis, all of which resolved successfully. Currently, 5 patients remain disease free. Mild HBP controlled with low dose captopril still persists in one patient.

[A glandular-type inverted papilloma of the bladder: apropos a case with an evident chronic irritative factor]

OBJECTIVES

Inverted papilloma of the bladder is a rare condition that presents in the middle-aged. Its histological features and prognosis are unique and its diagnosis is always by anatomopathology. To date, its histogenesis has not been elucidated. The present study reports an additional case of this uncommon disease entity, which is even more so due to its glandular anatomopathological morphology.

METHODS

A case of inverted papilloma of the bladder in a 52-year-old man with a permanent bladder catheter is described. The tumor was located in the posterosuperior bladder wall and had been successfully resected.

RESULTS

The histological diagnosis was that of glandular inverted papilloma of the bladder. The patient is asymptomatic at two years follow up.

CONCLUSIONS

In our view, inverted papilloma of the bladder results from a previous metaplasia in which the chronic irritative factor plays an important role.

[Endoscopic electrofulguration of intraurethral condylomata acuminata]

Cluster condyloma is currently one of the sexually transmitted diseases of higher incidence. The most common sites for condyloma in males are the balanopreputial sulcus, frenulum and the glans' mucosa. Associated to penis condyloma there can be urethral lesions in 5% of patients which in 80% of cases develop less than 3 cm from the meatus. This paper presents a series of 14 cases of cluster intraurethral condyloma managed by transurethral electrofulguration. The technique consists in the introduction of a coagulation probe through the urethrotome and the application of electrofulguration to the condyloma base. Results have been satisfactory although relapse has occurred in 2 cases (14%), and in one of them the procedure had to be repeated up to 3 times. There has been no complications such as stenosis in the loop resections. The authors conclude that due to the difficulties in the medical management of these lesions, the use of invasive techniques, of which transurethral electrofulguration of the condyloma base with endoscopic urethrotome is the choice because of its simplicity and effectiveness, is justified.

[Hematuria due to polypoid cystitis. Its differential diagnosis from bladder carcinoma]

Polypoid cystitis is not uncommon in patients with a permanent urethral catheter. In some cases difficulties are encountered when making the differential or anatomopathological diagnosis from transitional cell carcinoma of the bladder. We report a case of polypoid cystitis mimicking bladder carcinoma in a patient with a permanent urethral catheter.

[Endoscopic trigono-cervico-prostatotomy: our experience]

Presentation of our experience in treating the disease of the vesical neck through longitudinal endoscopic transurethral incisions in 24 patients following the Orandi procedure. Of the 24 patients seen in our service, 21 showed a clear clinical and urodynamic improvement. Complications were 2 cases of epididimorchitis and 1 iatrogenic stenosis of the anterior urethra. There were no major haemorrhages, urinary incontinence, or retrograde ejaculation except for an obvious decrease of ejaculate volume in 2 cases.

[Supernumerary kidney with ectopic ureteral opening to the vagina associated with horseshoe kidney]

Contribution of one case of supernumerary kidney with ureter ectopically opened to vagina associated to horseshoe kidney. Supernumerary kidneys are extremely unusual entities, there being only about 70 cases described in the international literature. This is the first case where it is found associated to horseshoe kidney.

[Nephrogenic adenoma of the bladder]

Presentation of one case of vesical nephrogenic adenoma diagnosed as an accidental histological finding following TUR of vesical tumour. This case if considered of interest due to the rarity of the lesion (some 300 cases reported) and the limited number of quotations in the Spanish literature.

[Primary carcinoma of the male urethra: review of the literature and presentation of a new case]

A primary carcinoma of the male urethra is described. The etiology, diagnosis, clinical features and treatment of this uncommon tumor are discussed. Because this tumor frequently presents as a benign urethral process, biopsies should be performed in urethral conditions with a torpid clinical course.

[Association of giant condyloma acuminatum of the penis with intraurethral simple condylomata. Apropos of a case]

We report on an HIV-positive male patient with a giant condyloma acuminatum at the base of penis coexisting with simple intraurethral condylomas and no crown lesions. The association of both processes indicate the likelihood of a common viral etiology. The presentation of this florid picture in a terminal patient with AIDS indicates that urologists are likely to find an increased incidence of this condition in the forthcoming years.

[Hypernephroma at the isthmus of a horseshoe kidney]

Presentation of a case of neoplasia associated to horseshoe kidney (HK). There is a tendency to suffer neoplasia in HK, hypernephroma being the most commonly seen, followed by renal pelvis tumours and Wilms' tumour with a frequency up to 8 times higher than in normal kidneys. This observation suggests that it should be compulsory to carry out cytogenetic studies in order to detect the 11p13 deletion as a possible marker in all children with HK.

[Renal oncocytoma. Presentation of a case]

One case of renal oncocytoma whose diagnosis was established after radical nephrectomy is presented here. The histological heterogeneity of this tumour indicates that the safest treatment is still the radical nephrectomy, at which time diagnosis is most often established. Our case has a special interest as it presented two hepatic lesions suggestive of metastasis.

[Transitional cell carcinoma of the urethra in a male]

We present a case of primitive urethral carcinoma in a male. The diagnosis was established with physical exploration when we observed papillomatous formations in the fossa navicularis upon everting the meatus. The interest of this case lies in the rare nature of primitive urethral tumours, in its localization at anterior urethra level, and in its transitional histological strain, as transitional ones are usually located at prostatic and not anterior urethra level as in this case that we submit.

[Ureteroiliac fistula as a complication of ureterorenoscopy]

Although complications post-URS are scant and can usually be resolved by conservative methods, these however, may be potentially severe as in the present case in whom a ureteroiliac fistula was observed during a URS procedure that had been performed to dilate a post-URS stenosis. Previously, extravasation had also occurred. The post-URS complications are briefly described and discussed.

[Calicial diverticulum]

The authors present a series of five cases of calicial diverticuli with important radiological diameters, an entity which is not frequently described in literature. They analyse the symptoms which, because they do not posses characteristics of their own, correspond instead to the clinical picture of their complications. The radiological study is the basis of the diagnosis, when the diverticular cavity is refilled late, when the contrast of the same is drained slowly and when there is a communication with the pelvis or calix, hence the importance of the late plates. The treatment which should be expectant in asymptomatic cases and which leads us to opt for a cystectomy with excision of the epithelial bed and closure of the communication where surgery is indicated.