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C González Enguita

Publications and source records attributed to C González Enguita.

At least 19 recordsLinked to original sources
PubMed2006

[Synchronous bilateral urothelial carcinoma of the upper urinary tract].

OBJECTIVE: Report a case of a synchronous bilateral urothelial carcinoma of the upper urinary tract without bladder affectation. METHODS: We describe the diagnosis and treatment of a case of a bilateral upper urothelial carcinoma. CONCLUSIONS: Synchronous bilateral urithelial carcinoma of the upper urinary tract without bladder affectation in an unusual occurance (1-5% of urothelial tumors) and radical surgery continues to be the treatment of choice, although it is possible to take a less aggressive approuch with selected groups of patient, in which we can achiese a survival rate similar to that which we obtain with radical surgery.

Aged↗
PubMed2003

[Acute and immediate urination syndrome after transurethral resection: a case of incrustating cystopathy].

The authors present a case of acute and prompt symptomatic irritative urinary cystitis after transurethral resection (TR) of bladder cancer. The clinical presentation, like a irritative syndrome, was with a positive urine cultive to Enterococci and Staphylococcus. The physical examination, under general anesthesia (EBA), eliminated the urethral injury or the meatus trauma, so the urethral stenosis. The bladder view, in scaring processing yet, was congestive, bledding and edematous; an extensive white calcification was covering all the mucose surface bladder. The presumptive diagnosis was incrusted cystophatie (cystitis) and a transurethral resection (TR), along total bladder mucosa, was made so the result of pathological examination was sure. Intravenous and oral antimicrobial agent (Amoxicillin-Clavunan), in different ways, was instaured like a treatment, to achieve a negative urinary cultive, to eradicate the bacterial agents. We made a revision of the most important aspects in the clinical presentation, laboratory diagnosis and therapy, in this cystophatie that is not frequent, where the ureolitic bacterial agents have the responsibility, main Corynebacterium urealiticum, and where the recent urologic surgery or instrumentation, is narrowly related with the development of this cystophatie.

Acute Disease↗
PubMed2003

[Categorization of adrenergic alpha 1 receptors in detrusor of patients with obstructive BPH. Initial study on experimental animal model].

INTRODUCTION: The action of alpha 1-adrenergic receptor antagonists in ameliorating irritation and obstruction in patients with bladder outlet obstruction (due to Benign Prostatic Hyperplasia-BPH) has been demonstrated. Although it is well known that alpha 1-a receptors are responsible for prostate smooth muscle relaxation, the mechanism by which irritative bladder symptoms are improved is unknown. Different alpha 1 receptor subtypes may be involved. The objective of this study is to investigate the changes in the alpha-adrenergic receptor populations in the obstructed detrusor, and to determine which subtype is proportionally increased in this situation (bladder outlet obstruction). MATERIAL AND METHODS: This was an in vivo study in an experimental model: male NZ (New Zealand) rabbits. The bladder neck of one group of rabbits was obstructed surgically using the technique proposed by Levin et al. Subsequent to bladder catherization with a 8Fr catheter, the bladder neck was exposed by means of a low medial abdominal incision. The bladder neck was tied with a 2/0 silk thread below the ureteral orifices. The catheter was taken out at the end of the intervention. The rabbits were sacrificed after 4 weeks using intracardiac pentothal and cystectomy was performed. A control group that did not undergo bladder obstruction were also sacrificed at this time, for the comparative study. Part of the detrusor was used for a pathological study and the rest for a physio-pharmacological study in which the organ was placed in a bath of adrenoceptor agonists (phenylephrine and noradrenaline) and antagonists WB101, AH11101A and BMY7378 (antagonists of the alpha 1a, b, d, respectively). RESULTS: The findings of the pathological study show that the bladder wall was thicker in the rabbits that underwent bladder obstruction. The physio-pharmacological studies demonstrate that the detrusor response to the selective alpha-1 adrenergic agonist was greater in the rabbits that underwent bladder obstruction, however detrusor contractility was decreased (KPSS). With bladder obstruction the alpha 1d receptors were increased. DISCUSSION AND CONCLUSIONS: Receptor-binding studies (Malloy et al) aim to differentiate the alpha-adrenoreceptor populations. These studies identify and quantitate the different receptor subtypes in tissue without taking into account their activity. The isometric and physio-pharmacological tests evaluate active receptors, i.e. those that respond to agonist and antagonist stimuli. This enables detrusor activity to be evaluated accurately. The results obtained in this investigational study support the hypothesis that there is a high statistically significant increase in the alpha 1 adrenergic receptors in the obstructed detrusor. Furthermore, in agreement with previous molecular studies, during prostate obstruction alpha 1d is the predominate sub-population in the bladder. These findings may have patho-physiological, clinical and pharmacological implications. If this hypothesis which has been demonstrated in an experimental model, is also demonstrated in studies in humans, pharmacological development should not only be focussed on selective alpha 1a receptor antagonists (prostate) but also on those of alpha 1d, for relieving symptoms in patients with bladder outlet obstruction (BPH and prostatism).

Animals↗
PubMed2001

[Surgery of renoureteral lithiasis. Current indications].

INTRODUCTION: Today, the issue about kidney and ureteral stone and their management is based on ESWL (Extracorporeal Shock Wave Lithotripsy) like singly or as a part of combination therapy. In some cases, endoscopic procedures (URS, PNL) with contact lithotripsy, is the first-line treatment. Retroperitoneoscopic is a therapeutical option in some hospitals. Open stone surgery is now drastically reducing and the endoscopic and extracorporeal methods are increasing, overcoat ESWL in those hospitals who has an own lithotripter. The optimal results of non-invasive procedures, and the ESWL advantages for the patients (outpatient and anesthesia-free treatment, decreased morbidity,...), has caused limited annual indications of open surgery for stone disease even a complete disappearance in many center. MATERIALS AND METHODS: The Stone and Lithotripsy Unit of "Jiménez Díaz" Foundation (FJD) (Madrid), who has an own lithotipter (Modulith SL 20, STORZ) make an evaluation of 54 patients treated with open surgery (1990-2000) in order to reflect on the indications. Nephrectomy for serious paremquimal lithiasic lesions (complicated pyelonefhritis, xantogranulomatosis....) is not included. RESULTS: The open surgery techniques for stone diseases were the classic according to every case: pielolithotomy (simple or extended +/- infundibulolithotomy), anatrophic nephrotomy, ureterolithotomy,.... At the same time it should be resolved those anomalous structures or obstruction associated to the stone disease (congenital hydroneprosis, ureterocele,...). DISCUSSION: Now days are difficult cases of stone diseases to be managed for any methods included open surgery. It's the renal complex stone. Of course, surgery is the best option, the more effectively choice. When endoscopic procedures (URS, NPL) fall and the stone is synthomatic must be operated. When they are serious situation (septic shock, complications derived from the others methods,...). It's necessary an urgent and effectively treatment and it's the open surgery. CONCLUSION: Open surgery is actually indicated for the complex renal stone and the complicated ureteral stone. So, the training on open surgery should be at the same time on the endoscopic, laparoscopic or extracorporeal. Open surgery will be the first-line treatment in some case. Open surgery should be considered in those urgent situation and will be done with skill and precision.

Adult↗
PubMed2001

[Treatment of ureteral lithiasis with shock waves].

OBJECTIVE: To present our results with ESWL in situ in the treatment of ureteral lithiasis. Distal ureter calculi can be managed by ESWL or URS. For complex ureteral calculi associated with ureteral malformations, failed ESWL or complications other procedures are utilized (URS) and open surgery has its indications. METHODS: From October 1990 to December 2000 the Lithiasis-Lithotripsy Unit of the FJD has performed 2,500 ESWL in situ for ureteral calculi without endoscopic or percutaneous procedures (double-J or PN). The calculus was located in the lumbar ureter in 45%, sacro-iliac in 11% and renal pelvis in 44%. 67% were males and 33% females (mean age 48 and 42 years, respectively). Stone size was 5-20 mm in 88% of the cases; 1.5% had bilateral involvement, 1.7% multiple and 1.5% had a solitary kidney. 15% had renal colic when the procedure was performed. IVP was performed during ESWL for ureteral uric acid stones. RESULTS: The overall success rate was 95%; 97% for stones in the lumbar ureter and 89% for stones in the distal ureter. Repeat-ESWL rate was 1.10. Renal colic resolved during ESWL, although stone fragmentation was partial. Hematuria is common post-ESWL and irritative voiding symptoms on passage of stone fragments. Post-ESWL colic was observed in 20% of the cases but were managed without difficulty with medication. There were 3 cases of severe complications (0.12%), colon perforation, severe renal hematoma and peritonitis. Septic obstruction was found in 1.5% that required catheterization or nephrostomy. Radiologic and asymptomatic Steinstrasse was observed in 10% of the cases. CONCLUSIONS: ESWL in situ is the treatment of choice in ureteral lithiasis and has been demonstrated by many groups. The size and degree of stone impaction have a negative influence on the results. Resistance to fragmentation, which is basically determined by stone chemical composition, influence the results. Monohydrate calcium oxalate stones have been found to be the most resistant. Previous insertion of a catheter (double-J or nephrostomy) does not enhance the results. It appears to be useful during an episode of renal colic. Distal ureteral calculi can be treated by ESWL and URS. If a lithotriptor is available, ESWL without endoscopic procedures is the first choice.

Adolescent↗
PubMed2001

[Radiotransparent lithiasis. Diagnosis and treatment].

OBJECTIVE: To analyze current clinical, diagnostic and therapeutic aspects of uric acid lithiasis. The role of helical CT in its diagnosis, ESWL and alkalinization in its treatment, and metabolic and crystalographic analyses are discussed. METHODS: The incidence of uric acid calculi is estimated to be from 5% to 7% in the Lithiasis-Lithotripsy Unit of the Jiménez Díaz Foundation. The diagnostic and therapeutic possibilities of helical CT and ESWL are illustrated in a case of complex bilateral renal uric acid staghorn stone. RESULTS: Ultrasound and endoscopic uroradiology are fundamental in the diagnosis of radiotransparent obstructive bilateral renal stone. Ureteral catheterization was warranted due to the anuresis that resulted from bilateral obstructive renal failure. Stone dissolution combined with ESWL achieved rapid resolution of the large calculi. CONCLUSIONS: Helical CT without contrast enhancement should be performed along with the conventional urological diagnostic tests for ureteral lithiasis, especially in patients with renal colic. Although urinary alkalinization is the conventional treatment for uric acid stones, ESWL permits faster resolution in large, obstructive or ureteral stones in patients with renal colic. Complete assessment of patients with uric acid calculi includes metabolic and crystalographic analyses.

Aged↗
PubMed2000

[Renal colic and lithiasis in HIV(+)-patients treated with protease inhibitors].

INTRODUCTION: Protease inhibitors, mainly Indinavir, are widely used drugs for the treatment of patients infected by the human immunodeficiency virus (HIV) and are related to renal colic and urinary obstruction. These conditions are the result of urine excretion of these drugs which favours the formation of small calculi (crystalluria and lithiasis). MATERIAL AND METHODS: Five PI treated HIV(+) patients; four males, one female, have recently been seen for renal colic at the Lithiasis Unit, Fundación Jiménez Díaz (FJD). All five patients had renal colic, one bilateral and one renal obstruction and fever. Small lithiasic concretions of null or minor radiological calcium density were identified by urinary X-ray and UIV. The patients had haematuria, crystalluria and urinary pH 5.0-6.0. Treatment was symptomatic, pharmacologic, emergency in situ extracorporeal shock-wave lithotrity (ESWL), or ureteral catheterisation, as appropriate. RESULTS: Patients had been treated with these antiviral agents for several months. They all required urologic care: pharmacologic, ureteral catheterisation, or ESWL, with good results. No stones were obtained for mineralogic analysis, but crystalluria was identified as being due to Indinavir and calcium oxalate. CONCLUSIONS: Renal excretion and urinary elimination of PIs (or their metabolites) results in asymptomatic crystalluria in HIV(+) patients treated with this class of drugs. Other cases present genuine calcium oxalate calculi with sings of renal colic and urinary obstruction requiring urologic care.

Adult↗
PubMed2000

[Bladder hyporeflexia caused by vinca alkaloids].

Presentation of one case of hyporreflexic bladder like a first step of neurotoxicity due to Vinca alkaloids. These drugs produces peripheral neuropathies as usual, but in some rare occasions they may affect to the autonomic nervous system with its effects in the bladder producing hyporreflexic. This disease reverts spontaneously after suppressing drugs.

Adolescent↗
PubMed2000

[Efficient, immediate or emergency ESWL: an attractive strategic alternative to be considered in the treatment of renal colic!].

INTRODUCTION: Renal colic due to acute ureteral obstruction caused by lithiasic impact results in severe rise of intracavitary pressure. Traditional drug therapy (painkillers, anti-inflammatories, spasmolytics) is symptomatic and provisional, and pain can reappear when obstruction is maintained. A pathoetiological approach would be the ultimate therapy vs the symptomatic one. MATERIAL AND METHODS: From the beginning, the approach used at the Lithiasis-Lithotrity Unit at the FJD, once the ureteral stone is accurately identified during a renal colic, is that of immediate or emergency "in situ" SWEL together with the usual drug therapy. 15% of 2100 cases of ureteral lithiasis treated (1991-1999) were renal colic. RESULTS: Renal colic can be resolved in all cases (100%) even when fragmentation may be partial and/or require a second deferred SWEL on remnants of the first lithiasis. When obstruction has been resolved, pain does not reappear as it happens with the effects of analgesics. DISCUSSION: Placement of a ureteral catheter or nephrostomy for analgesia in order to perform deferred SWEL of the ureteral stone origin of the acute ureteral obstruction and the renal colic, do not improve SWEL results. There are physical reasons to support the practice of immediate or emergency "in situ" SWEL during a renal colic. Fragmentation of the obstructive stone together with the resulting ureteral oedema allow urine passage. Intracavitary pressure and pain disappear when the obstruction is withdrawn. CONCLUSIONS: Immediate, "in situ" or emergency SWEL in cases of obstructive ureteral stones during a renal colic, is an attractive strategic alternative for drug therapy that should be considered mainly in institutions with means to perform the procedure.

Colic↗
PubMed1999

[ESWL-resistant lithiasis].

INTRODUCTION: To the extent in which the "lithotripter" improves technically. SWEL experts provide different explanations to the failures of this technique. It will depend on the type of "lithotripter" as well as the calculus and its features (size, number, location, composition, obstruction, impact, absence of expansion chamber, presence of ureteral catheter, ...). Not all facts in SWEL have a clear explanation today. Physically, the "cavitation" phenomena (shock, rebound, negative pressure, explosion, heat, ...) explain almost anything that takes place during SWEL. Certainly, the type of lithotripter has some influence, but the calculus fragility, determined by the chemical composition and the crystalline architecture, could be more determinant. MATERIAL AND METHOD: From a total series of 6,500 SWEL procedures performed in the Lithiasis-Lithotrity Unit at the "Jiménez Díaz" Foundation (JD) (January 1991-July 1998), 20 cases considered as failures after multiple SWELs were analyzed. Also the actual diagnostic tests (X-rays, helicoid CAT, densitometry, ...) were studied to establish a pre-SWEL chemical recognition of the calculi that may determine the behaviour of each case prior to treatment. RESULTS: After multiple SWELs (average 5 sessions) negative results were obtained in 65% cases. These cases were resolved with surgery (38%), ureterorenoscopy and ultrasound lithotrity (23%) or watchful wait in absence of signs and symptoms (39%). 57% were calcium phosphate calculi, 29% calcium oxalate monohydrate (COM) and 14% hypercalciuria calculi. CONCLUSIONS: SWEL resistant cases, either unresolved or undergoing multiple SWELs, demonstrate the existence of calculi that cannot be broken by SWEL, although no coincident or similar reasons can be established in all cases. Calcium phosphate dihydrate (brushite) and calcium oxalate monohydrate (COM) together with cystine are the most difficult to destroy with current shockwaves. Helicoid CAT could recognise chemically each case prior to SWEL, since it basically differentiates the most frequent ones, uric acid, struvite and calcium oxalate.

Adult↗
PubMed1998

[Lithiasis of the distal ureter: ESWL or URS].

UNLABELLED: A nephritic colic is the clinical picture that evidences the presence of ureteral stones, the natural evolution being their spontaneous passing. Stones in the distal ureter are self-eliminated in about 71-80% cases. The adoption of a "watchful wait" involves an uncertain occupational and medical evolution since, although in some cases the stones will pass with no problems, in other instances they can result in severe, life threatening situations for the patient's health (intractable pain, anuria or sepsis). When a decision is made to treat the condition, there are two choices available: "in situ" SWEL (extracorporeal lithotrity), or URS (ureterorenoscopy), long-standing conflicting techniques each with its own advantages and disadvantages, which should now be considered complementary. SWEL's major disadvantage is the number of repetitions required and the long wait, sometimes even months, until the last fragment is passed. The greater strength of URS is that it can be resolutive in just one episode (95% cases), thus avoiding the obstruction problems that can arise after SWEL. In the Lithiasis-Lithotrity Unit of FJD, SWEL is the first therapeutical option for the treatment of stones in the distal ureter. SWEL and URS are equally likely to be performed although SWEL is the initial choice for efficiency reasons that are explained. We achieve 93.6% positive results with a 1.82% re-SWEL rate (retreatment), 0.60 coefficient of efficiency (EQ) and 0.69 modified coefficient of efficiency (EQM) (Chart). No serious complications were recorded. Morbidity is variable with little clinical significance. CONCLUSION: Distal ureter lithiasis can be treated with either URS and SWEL, both considered "different and complementary". The choice in each particular case and within each hospital will depend on availability of means to perform one or the other, equipment's efficiency, skill of the urologist, patient's preference and cost of each treatment.

Adolescent↗
PubMed1996

[Strategy changes in the treatment of ureteral lithiasis and nephritic colic].

Since lithotripters were first introduced to the clinical practice in 1980, extracorporeal shock wave lithotrite (ESWL) has been universally recognized as the first choice to resolve urinary tract lithiasis, ureteral calculi being the most susceptible lithiasic site for controversy. The urologist approach to the lithiasic patient has changed mainly as compared to that of ureteral calculi. These profound changes translate an undeniable advance of the extracorporeal procedures versus those of endourology, basically based on ESWL low morbidity. In those cases when lithiasis is found in a situation of nephritic colic, there is a real therapeutical chance with ESWL, thus leading to drug therapy losing its major role. We present 768 patients with ureteral lithiasis (1991-1994), 20-25% of which were examined for a nephritic colic. Once the colic situation is overcome in all instances, 35% will require a new lithotrite for complete lithiasic resolution. Overall, our rate of successful ureteral lithiasis resolution is 97% (30% need repeated session).

Adolescent↗
PubMed1993

[Ambulatory ureteral lithotripsy with "Modulith SL-20"].

Analysis of our experience in 'in situ' ambulatory shockwave extracorporeal lithofragmentation of ureteral stones in 104 patients seen in the Lithotrity Unit, Urology Service, Fundación "Jiménez Díaz". Using Modulith SL 20, a third generation lithotripter, 'in situ' disintegration was achieved in 82.69% of cases, 51.92% of which were fragmented in a single lithotrity session. As a first choice, no ureteral handling was used in any of the patients prior to lithotrity. In 9.62% of patients it was necessary to place a 'double J' by-pass catheter, due to the disease presenting with a septic picture. The patient's position was either dorsal or ventral decubitus depending on the lithiatic site, while location and focusing of the stones was done radiologically. All patients were treated ambulatory without hospitalization. Only 18% was given oral or i.v. anaesthesia. Fursemide 40 mg was administered to all patients shortly before starting the session. Each patient received an average of 3,200 shockwaves per session (14-18 Kv, average 16 Kv). Haematuria was the single and modest side effect that happened during the 24 hours following lithofragmentation in 30% of patients, while 20% reported slight discomfort at the time of eliminating the gritted stones. We conclude stating that 'in situ' shockwave extracorporeal lithotrity of ureteral stones with Modulith SL 20 allows for elective disintegration of ureteral stones in whatever location they are found, due to the patient's easy positioning. The simple location and focusing of ureteral stones has allowed us to treat and solve some cases of ureteral lithiasis at the precise moment of the nephritic colic painful emergency, thus speeding up and facilitating the resolution of the condition. Our results and our strategy imply a new change of direction in the management of these lithiasis, as opposed to the well established and historical doctrines in existence regarding stones with ureteral location.

Adult↗
PubMed1992

[Value of CAT staging in renal adenocarcinoma. Correlation with anatomo-pathologic findings].

On a total of 128 renal adenocarcinomas diagnosed in our Unit between January 1975 and August 1990, the data provided by CATs carried out in 85 of them was compared with that from surgical and anatomo-pathological findings. The precision in both the diagnosis and the tumour staging was determined, evaluating the involvement of perirenal, nodular, venous and neighbouring structures fat. The diagnosis of renal adenocarcinoma was made correctly in 96% cases. With regard to staging, maximal precision was achieved in the involvement of adjacent structures and vena cava, followed by the renal vein, perirenal fat and lymphatic nodes, in this order. We conclude that CAT provides a high diagnostic reliability, permitting with a single study the determination of the most defining parameters of renal cancer staging.

Adenocarcinoma↗
PubMed1992

[Non-radical treatment and bladder conservation in infiltrating tumor of the bladder].

The fate of some infiltrant tumours of the bladder locally advanced (pT2-3NxM0) which were radically resected, with or without association to other treatments, has been similar to those in which initial radical treated was used. To carry out simultaneously a radical RTU as a local action plus systemic chemotherapy (M-VAC), for microscopic metastasis, clinically undetected, seems to us the most effective combination. In our Urology Unit, the evolution (September 88-January 91) of 9 patients presenting this tumour and preservation of the bladder is being followed-up. The primary tumour was treated with radical RTU in 7 cases and partial cystectomy in 2. There are 5 tP2, 1 pT2 + "in situ" carcinoma (Ca) and 3 pT3, 4 G1, 4 G2 and 1 G3. All tumours were single, small (2-4 cm), with varied location and nearly all with medium to low differentiation. Later all patients underwent systemic chemotherapy with M-VAC (3 cycles). Following RTU and QMT every three months, the likely local and systemic progression of the disease has been evaluated through cystoscopy and multiple biopsies including from the prostatic urethra, RTU of anterior scar, two-hand palpation, urinary cytology, blood testing, CAT, abdominal ECO, chest X-ray and laparoscopic lymphadenectomy (coinciding with its development within the Unit) in the last case. Average follow-up (at the time of the review) has been 15.77 months (6-28 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Transitional Cell↗
PubMed1992

[Metastasis in maxillary sinus as presentation form of adenocarcinoma of the prostate].

Presentation of one case of prostate adenocarcinoma its initial clinical manifestation being the appearance of facial tumour secondary to metastatic affectation of left maxillar sinus. After stressing its rarity, the relevance of immunohistochemical studies for the specific prostatic antigen and acid phosphatase in determining the unconnected origin of metastatic lesions is addressed.

Adenocarcinoma↗