Resumo em Inglês:

Ureteropelvic junction (UPJ) obstruction is a well-recognized entity that may present at any time - in fetal life, infancy, childhood, or early or late adulthood. As the most common site of obstruction in the upper urinary tract, the UPJ is an area with which urologists should be well familiar. There has been an improved understanding of the pathophysiology of primary congenital UPJ obstruction that has been reflected in the evolution of surgical options, from open surgical repair to minimally invasive surgery. Although the primary scope of this review is the surgical management of this condition, we will briefly review the pathogenesis, clinical presentation, and diagnosis of UPJ obstruction.

Resumo em Inglês:

OBJECTIVE: Report the authors’ initial experience with hand-assisted laparoscopic nephrectomy technique in renal donors for transplantation. MATERIALS AND METHODS: Twenty-seven donors submitted to hand-assisted laparoscopic nephrectomy were retrospectively analyzed from February 2001 to June 2002. Technical aspects of the donor surgery, results, and complications, are discussed, as well as recipient’s complications and outcomes. RESULTS: Among 27 hand-assisted laparoscopic nephrectomies, left kidney was withdrew in 18 donors (66.6%), and right kidney in 9 (33.3%). The operative time ranged from 55 to 210 minutes (mean 132.7 ± 37.6 min), and the time of hot ischemia ranged from 2 to 11 minutes (mean 4.7 ± 2.5 min), with an estimated mean blood loss during the intraoperative period of 133.3 mL. Conversion to open surgery was necessary for 1 (3.7%) patient due to vascular lesion. In graft evaluation, immediate diuresis was observed in 26 (96.3%) cases, and mean serum creatinine in PO day 7 was 1.5 ± 1.1 mg/dL. Renal vein thrombosis occurred in 1 (3.7%) patient requiring graft removal. Lymphocele was observed in 3 recipients (11.1%), and urinary leakage due to ureteral necrosis in 1 case (3.7%). CONCLUSION: Hand-assisted laparoscopic nephrectomy in living donors is a safe procedure and an effective alternative to open nephrectomy. In this series, the procedure presented low morbidity after surgery providing to the recipient a good morphological and functional quality of the graft.

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PURPOSE: Report and review the literature on ureteral avulsion as a rare complication of ureteroscopy. MATERIALS AND METHODS: We analyzed 3 cases of ureteral avulsion in a series of 4,645 ureteroscopic procedures performed from January 1990 to December 2001. We especially report the different managements for this complication. RESULTS: Due to the different extent of the injury, each patient was treated in a particular way, including a patient managed by means of an endourological approach. CONCLUSIONS: When performing ureteroscopy or using Dormia baskets, one should always bear in mind the possibility of serious complications, including ureteral avulsion or perforation. The use of an extremely careful technique of ureteral insertion, the mandatory placement of a safety guidewire, and a working guidewire, all minimize the risk of untoward events.

Resumo em Inglês:

OBJECTIVE: Establish the efficiency of 6- and 12-punctures transrectal ultrasound-guided needle biopsies in low risk patients for prostate cancer. Six-punctures (sextant) biopsies were compared to 12-punctures biopsies, assessing which is the best strategy to detect this neoplasm. MATERIALS AND METHODS: Among 240 patients submitted to prostate biopsy, 54 with suspected small and organ-localized tumors (prostatic specific antigen < 10 ng/mL and digital exam of the prostate not suggesting cancer) in glands < 50 cm³ were selected, constituting a homogenous sample. These patients were submitted to standard 3-punctures (basal, mid, and apical) sextant biopsy in parasagittal midline of each prostatic lobe, with 3 additional lateral punctures, bilaterally. Each specimen was separately submitted to histological study. RESULTS: Twenty-two (40.7%) patients had prostatic cancer, and 28 presented prostatic hyperplasia, associated or not to inflammatory conditions. High-grade prostatic intraepithelial neoplasia (PIN) was detected in 4 patients. From 22 tumors detected by 12-punctures biopsies, 6-punctures biopsies in the parasagittal midline (sextant) diagnosed 50% of the cases, while isolated lateral punctures diagnosed 90.9% of the malignant neoplasms. Basal lateral punctures responded for 72.7% of the cancer diagnosis, while basal sextant punctures responded only for 9.1% of the cases. CONCLUSION: For low risk prostate cancer, patients’ 12-punctures biopsy was more effective, for sextant biopsy failed to diagnose half of the cases of neoplasm. Three lateral punctures (basal, mid, and apical), with 2 additional punctures in the parasagittal midline (mid and apical) bilaterally are suggested as the best biopsy strategy.

Resumo em Inglês:

OBJECTIVES: Present and discuss the pathogenesis, diagnostic methods and treatment of the prostatic abscess. MATERIALS AND METHODS: We have retrospectively studied the medical records of 9 patients diagnosed and treated for prostatic abscess, between March 1998 and December 2000, assessing age, context, associated diseases, and diagnostic and therapeutic methods. We have compared the data found with those described in literature, based on Medline data. RESULTS: Mean age was 52.6 years. Three patients had previous diabetes mellitus diagnosis, and one was infected by HIV virus. Transrectal ultrasound of the prostate confirmed the diagnosis of prostatic abscess in all 7 cases in which it was performed. All cases received antibiotic treatment, and 77.8% needed concomitant surgical treatment. Two cases of microabscess were treated only with antibiotics. Four patients were submitted to perineal catheter drainage, 2 were submitted to transurethral resection of the prostate (TURP), and one patient required both procedures. Mean hospitalization time was 11.2 days, and most frequent bacterial agent was S. aureus. All patients were discharged from the hospital, and there was no death in this series. CONCLUSIONS: Prostatic abscess should be treated with broad-spectrum antibiotics and surgical drainage (perineal puncture or TURP). Microabscess may heal without surgery.

Resumo em Inglês:

OBJECTIVE: The aim of this work is to report the diagnostic and therapeutic options for 55 patients with clinical diagnosis of penile fracture. MATERIALS AND METHODS: The patients were retrospectively assessed between 1982 and 2002. The primary diagnostic evaluation method for 55 patients (56 fractures) was clinical history and physical exam. Ten (17.8%) cases required complementary exams. Ultrasound (US) was performed in 2 cases, and magnetic resonance imaging (MRI) in 1 case. Retrograde urethrocystogram was performed in suspicious urethral injury, which happened for 7 patients. RESULTS: Of 56 assessed cases, 49 (89.5%) were submitted to surgical exploration, and only 7 were conservatively conducted. Surgical treatment was performed in 48 patients (49 fractures), in these cases, 47 (95.9%) presented tunica albuginea disruption and solely 2 (4.1%) evidenced lesion of dorsal vein. Ultrasonography confirmed disruption of tunica albuginea in 1 (50%) case, and in the other it was not possible to determinate the origin of the lesion, and the patient was submitted to surgical exploration, which confirmed the condition. MRI was used only in 1 case, confirming the lesion. Among 7 patients submitted to conservative management, until now, 3 (42.8%) required surgical intervention to correct penile chordee. CONCLUSIONS: Penile fracture is an entity of eminently clinical diagnosis, which management should be surgical and immediate, avoiding thus complications related to erectile dysfunction. When suspecting an associated urethral injury, Urethrocystogram is recommended. In cases where there is diagnostic uncertainty, ultrasound and/or MRI may be used to reveal the condition.

Resumo em Inglês:

Wilms’ tumor is an uncommon neoplasm in adults. We report the clinical manifestations, complementary explorations, treatment, and results from 3 males aged 16, 21, and 22 years. Computed tomography commonly suggests the diagnosis. Despite its aggressive treatment, such as radical surgery, chemo- and radiotherapy, the prognosis is worse than in children.

Resumo em Inglês:

Leiomyosarcoma of the renal vein is a rare tumor of complex diagnosis. We presented a case of renal vein leiomyosarcoma detected in a routine study. The primary treatment was complete surgical removal of the mass. In cases where surgical removal is not possible the prognosis is poor, with high rates of local recurrence and distant spread.

Resumo em Inglês:

INTRODUCTION: The main objective of this article is to describe ureterolysis and ovarian vein resection laparoscopic technique. SURGICAL TECHNIQUE: With the patient in a 45o flank position, 3 trocars are used, 1 of 12 mm in the umbilicus for the optic passage, and 2 of 5 and 10 mm inserted in right hypochondrium and iliac fossa, respectively, for the forceps and stapler passage. The ureter and ovarian vein are identified after the mobilization of the colon. Both structures are dissected, with one ovarian vein segment is resected between metallic clips. COMMENTS: the ureteral approach by transperitoneal laparoscopy and colon mobilization facilitates its dissection, identify its relation to other structures, as well as making possible the concomitant treatment of gynecological diseases. For the ovarian syndrome treatment, ureterolysis and ovarian vein resection are performed, using only 3 trocars. Owing to its simplicity, low morbidity, and good results obtained, this procedure represents a good option for the surgical management of this syndrome.

Resumo em Inglês:

We describe a modification of the cadaveric prolapse repair and sling - CaPS technique that uses the sling surgery principles to correct grade IV cystocele. In this modification, the central and paravaginal defects reconstitution are performed using cadaveric fascia lata fixed over rectus abdominis muscle, eliminating the need of pubic fixation by screws, as proposed by the original technique. The modification described, besides presenting the benefits of CaPS, i.e., not using impaired tissues to reconstruct vesical support, and lower risks of perineal hypercorrection, also reduces the probability of complications of bone fixation.

Resumo em Inglês:

Spina bifida and myelodysplasia are associated with neurogenic abnormalities of the bladder and bowel function. All children with myelodysplasia require an evaluation of their urinary tract with ultrasound and urodynamics to confirm normal bladder and kidney function. Patients with anatomical and functional abnormalities require treatment, the mainstay being intermittent catheterization and anticholinergic medication. The treatment goals for patients with a neurogenic bladder are the preservation of the upper urinary tract, bladder and bowel continence, independence, autonomy, and facilitation of self-esteem. A minority of children will not respond to conservative therapy and will ultimately require surgical intervention. This review will discuss the surgical options for bladder augmentation, bladder neck reconstruction and closure, as well as the methods for the creation of continent catheterizable stomas. The timing, indications, and description for each procedure will be addressed. Finally, the antegrade continence enema procedure will be described for the management of refractory fecal incontinence.

Resumo em Inglês:

OBJECTIVE: Propose a new experimental model of bladder instability in rabbits after partial bladder obstruction. MATERIALS AND METHODS: Thirty North Folk male rabbits, weighting 1,700 to 2,820 g (mean: 2,162 g) were studied. The animals were distributed in 2 experimental groups, formed by 15 rabbits each: Group 1 - clinical control. In this group there was no surgical intervention; Group 2 - bladder outlet obstruction. In this group, after anesthetizing the animal, urethral cannulation with Foley catheter 10F was performed and then an adjustable plastic bracelet was passed around the bladder neck. It was then adjusted in order to not constrict the urethra. The following parameters were studied in M1 - pre-operative period; M2 - 4 weeks post-operatively moments: 1)- urine culture; 2)- cystometric study; 3)- serum creatinine and BUN. RESULTS: Bladder weight was 2.5 times larger in the group with obstruction than in the control group. Cystometric evaluation showed a significant increase in maximal vesical volume in the final moment at Group G2. However, there was no statistically significant difference among the groups studied. There was no statistically significant difference between maximal detrusor pressure and vesical compliance in the different moments or in the studied groups. There was an absence of uninhibited detrusor contractions in all the animals in group 1, and involuntary contractions were detected in 93% of group 2 animals. There was no significant variation in BUN and serum creatinine either among the groups or in the same group. CONCLUSIONS: We observed in the group with obstruction a bladder weight 2.5 higher than normal bladders. We detected involuntary contractions in 93% of the animals in group 2, establishing this experimental model as appropriate to secondary bladder instability and partial bladder outlet obstruction.