Rapture of renal angiomyolipoma during pregnancy: a case report

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Spinal versus General Anaesthesia in Postoperative Pain Management during Transurethral Procedures

We compared the analgesic efficacy of spinal and general anaesthesia following transurethral procedures. 97 and 47 patients underwent transurethral bladder tumour resection (TUR-B) and transurethral prostatectomy (TUR-P), respectively. Postoperative pain was recorded using an 11-point visual analogue scale (VAS). VAS score was greatest at discharge from recovery room for general anaesthesia (P = 0.027). The pattern changed significantly at 8 h and 12 h for general anaesthesia's efficacy (P = 0.017 and P = 0.007, resp.). A higher VAS score was observed in pT2 patients. Patients with resected tumour volume >10 cm3 exhibited a VAS score >3 at 8 h and 24 h (P = 0.050, P = 0.036, resp.). Multifocality of bladder tumours induced more pain overall. It seems that spinal anaesthesia is more effective during the first 2 postoperative hours, while general prevails at later stages and at larger traumatic surfaces. Finally, we incidentally found that tumour stage plays a significant role in postoperative pain, a point that requires further verification

Laparoscopic pyeloplasty for ureteropelvic junction obstruction of the lower moiety in a completely duplicated collecting system: a case report

<p>Abstract</p> <p>Introduction</p> <p>There are only a few reports on laparoscopic pyeloplasty in kidney abnormalities and only one case for laparoscopic pyeloplasty in a duplicated system. Increasing experience in laparoscopic techniques allows proper treatment of such anomalies. However, its feasibility in difficult cases with altered kidney anatomy such as that of duplicated renal pelvis still needs to be addressed.</p> <p>Case presentation</p> <p>We present a case of a 22-year-old white Caucasian female patient with ureteropelvic junction obstruction of the lower ureter of a completely duplicated system that was managed with laparoscopic pyeloplasty. Crossing vessels were identified and transposed. The procedure was carried out successfully and the patient's symptoms subsided. Follow-up studies demonstrated complete resolution of the obstruction.</p> <p>Conclusion</p> <p>Since laparoscopic pyeloplasty is still an evolving procedure, its feasibility in complex cases of kidney anatomic abnormalities is herein further justified.</p

The expression of HIF-1a factor in detrusor muscle of patients with prostate hyperplasia

Bladder outlet obstruction is the most common cause of lower urinary tract symptoms in males over the age of 50. Prostate enlargement, stricture disease or neurogenic dysfunctions are found as the most common entities. Bladder modificates its structure which finally leads to organ hypertrophy in order to compensate the increased resistance to flow. A lot of studies in experimental animals have extensively investigated the metabolic and ultrastructure modification that occur in this process. It is known that in partial outlet obstruction significant hypoxia ensues because of the high resistance to flow, and to the consequent high intravesical pressures generated. In humans however these modifications have not been explored thoroughly since BOO is a chronic and long standing disease. The aim of the present study was to explore the presence of hypoxia and its distribution in the bladder wall. From September 2004 to October 2006 60 patients scheduled for BPH surgery were recruited in the study group, and another 10 subjects, with no evidence of bladder outlet obstruction, served as control group. For each subject detrusor together with bladder mucosa was retrieved and stained for hypoxia inducible factor-1a (HIF-1a) (marker of tissue hypoxia). Expression of HIF-1a was found mainly in stromal cells. The mean (SD) number of cells positive to HIF-1a in the study group was 93.3(49) while in the control group only few rare cells were found to be positive and showed weak intensity of staining. The positive cells were located between muscle bundles and submucosa, while detrusor muscle and urothelium showed no immunoreactivity. Strong immunoreactivity was more evident in BOO < 10 years declining thereafter, and in patients who presented urinary retention. In a subgroup analysis between patients receiving al-blockers and not, there was no deference detected in the HIF-la positivity. There is evidence that obstructed human bladder is hypoxic, urothelium and detrusor seems to be more resistant to hypoxic stress while stromal cells perceive low oxygen tension. Medication with al-blockers does not seem to alter this condition.Το υποκυστικό κώλυμα αποτελεί την πιο συχνή αιτία συμπτωμάτων του κατώτερου ουροποιητικού σε άνδρες άνω των 50 ετών. Υπερπλασία προστάτου, στενώματα ουρήθρας και νευρογενής δυσλειτουργία της κύστης αποτελούν τις κύριες οντότητες. Η ουροδόχος κύστη τροποποιεί την μορφολογία της, τελικώς καταλήγοντας σε υπερτροφία του οργάνου με σκοπό να αντιρροπήσει την αυξημένη αντίσταση στην ροή των ούρων. Οι μεταβολικές και δομικές μεταβολές που παρατηρούνται σε αυτήν την διαδικασία έχουν μελετηθεί σε πολλές εργασίες χρησιμοποιώντας πειραματόζωα. Είναι γνωστό ότι επί παρουσίας μερικού υποκυστικού κωλύματος παρατηρείται σημαντική υποξία εξαιτίας της υψηλής αντίστασης στην ροή των ούρων, και την επακόλουθη υψηλή ενδοκυστική πίεση που αναπτύσσεται. Οι μεταβολές όμως αυτές δεν έχουν μελετηθεί εκτενώς σε ανθρώπους επειδή το υποκυστικό κώλυμα είναι μια μακροχρόνια κατάσταση. Ο σκοπός της μελέτης αυτής είναι η διερεύνηση της υποξίας και της κατανομής αυτής στην ουροδόχο κύστη. Από το Σεπτέμβριο του 2004 έως τον Οκτώβριο του 2006, 60 ασθενείς που προγραμματίστηκαν για χειρουργική αντιμετώπιση της καλοήθους υπερπλασίας του προστάτη συμπεριλήφθηκαν στην ομάδα μελέτης και άλλα 10 άτομα, χωρίς ένδειξη παρουσίας υποκυστικού κωλύματος χρησιμοποιήθηκαν ως ομάδα ελέγχου. Για κάθε ασθενή βιοψίες του εξωστήρα και του κυστικού βλεννογόνου διερευνήθηκαν για την παρουσία του επαγώμενου από την υποξία παράγοντα (HIF 1-a) (δείκτης ιστικής υποξίας). Η έκφραση του HIF 1-a, βρέθηκε κυρίως στα στρωματικά κύτταρα. Ο μέσος αριθμός των κυττάρων θετικών στο HIF 1-a στην ομάδα μελέτης ήταν 93.3 (49) ενώ στην ομάδα ελέγχου μόνο λίγα κύτταρα βρέθηκαν θετικά και με ένταση χρώσης ασθενή. Τα θετικά κύτταρα βρισκόταν μεταξύ των μυϊκών ινών και του υποβλεννογόνου ενώ ο εξωστήρας και το ουροθήλιο ήταν αρνητικοί στην ανοσοαντίδραση. Ισχυρή ανοσοαντίδραση ήταν περισσότερο εμφανής στα άτομα με υποκυστικό κώλυμα < 10 ετών που μειώνονταν στη συνέχεια και σε ασθενείς που παρουσίαζαν επίσχεση ούρων Υπάρχουν ενδείξεις οτι επί παρουσίας υποκυστικού κωλύματος η ουροδόχος κύστη παρουσιάζει υποξία, με το ουροθήλιο και το κυστικό τρίγωνο να εμφανίζουν περισσότερη ανθεκτικότητα στο υποξικό στρες ενώ στα στρωματικά κύτταρα η τάση του οξυγόνου είναι χαμηλότερη. Η φαρμακευτική αγωγή με α-1 ανταγωνιστές δεν φαίνεται να επηρεάζει την κατάσταση

Renal cell carcinoma with bilateral synchronous adrenal gland metastases: a case report

INTRODUCTION: Renal cell carcinoma is characterized by its potential of metastasizing widely and to unusual sites, with the metastases occasionally preceding clinical recognition of the primary tumor. Synchronous bilateral adrenal metastases from renal cell carcinoma, without other metastases, are rare and, to our knowledge, only 17 cases have been published in the literature to date. In general, patients with synchronous bilateral adrenal metastases from renal cell carcinoma have a poor prognosis. CASE PRESENTATION: We report a case of right-sided renal cell carcinoma with simultaneous bilateral adrenal metastases in a 58-year-old woman. The primary tumor was localized in the upper and mid pole of the kidney. The diagnosis was established preoperatively by abdominal ultrasound and computed tomography. Surgical treatment consisted of a right radical nephrectomy and bilateral adrenalectomy. Postoperative cortisone acetate replacement was instituted. The pathological findings of the right renal tumor showed clear cell carcinoma and both adrenal tumors showed the same pathology as the right renal tumor. There was no evidence of recurrence after 6 months of follow-up. CONCLUSION: Patients with bilateral synchronous adrenal metastases should be considered to have disseminated metastatic disease. However, good performance status, the presence of paraneoplastic syndrome and the alleviation of refractory pain are important reasons make an urologist to consider radical nephrectomy in renal cell carcinoma patient with metastases

Hydronephrosis Promotes Expression of Hypoxia-Inducible Factor 1 alpha

Background: Obstructive uropathy is argued to involve an ischemia-type tissue injury. Further, hypoxia-inducible factor 1 alpha (HIF-1 alpha) constitutes a nuclear transcription factor normally upregulated under hypoxic conditions. We hypothesized that HIF-1 alpha is expressed in the hydronephrotic renal pelvis, as a result of tissue hypoxia. Patients and Methods: Renal pelvis tissue specimens were obtained from 2 patient groups. Group 1 (controls, n = 10) consisted of patients who underwent nephrectomy due to nonobstructive renal malignancy. Group 2 (n = 18) consisted of patients who underwent open procedures due to intractable hydronephrosis, not amenable to conservative measures. HIF-1 alpha detection was conducted via immunohistochemical techniques, while histological alterations in both groups were also recorded. Results: Smooth muscle hypertrophy and urothelial hyperplasia were major findings in group 2. HIF-1 alpha-positive cells (fibroblasts and occasionally macrophages), mainly localized in the stroma, were also found to a greater extent in group 2 (p = 0.0066). Conclusion: We conclude that HIF-1 alpha is mainly expressed in stroma fibroblasts of the hydronephrotic renal pelvis, implying the presence of significant tissue hypoxia at the dilated upper urinary tract. Copyright (C) 2009 S. Karger AG, Base