Clinical application of the UroLift® prostatic urethral lift in Spain: consensus on the treatment of lower urinary tract symptoms associated with urinary flow obstruction and secondary to benign prostatic hyperplasia (BPH).

Benign prostatic hyperplasia (BPH) is an increasingly common pathology in the adult male. BPH increases after the age of 40-45 years, and its management consumes an enormous amount of resources. The UroLift® System is an approved technology designed to treat lower urinary tract symptoms (LUTS) secondary to BPH and is used to perform the prostatic urethral lift (PUL) procedure. Various urology specialists in Spain with experience in PUL have prepared this consensus document. Endorsed by the Spanish Urology Association, its information is based on the most recent findings. The main objective of this document is to disseminate the consensus recommendations among all professionals treating patients with LUTS/BPH. Both primary care physicians and urologists can assess and offer PUL as an effective, minimally invasive treatment.

Punto G: enfoque anatómico y seguridad del paciente / G-spot: anatomical approach and patient safety

Se investiga la región uretro-vaginal (pared posterior de la uretra ­ pared anterior de la vagina), en el área que corresponde a la descripción del "punto G", con el fin de colaborar a la discusión respecto de si existe una estructura morfológica que lo identifique. Se destaca una mayor y ocasional distribución venosa en esta zona, que puede explicar el fenómeno fisiológico descrito por Gräfenberg. Para los ginecólogos, urólogos y sexólogos, el conocimiento de la anatomía funcional de esa región tiene importancia para tratar las disfunciones orgásmicas además de la incontinencia urinaria. Esta situación controvertida influye en el marco actual de la seguridad del paciente

The urethro-vaginal region (posterior wall of the urethra ­ anterior wall of the vagina) is investigated, in the area that corresponds to the description of the "G-spot", in order to contribute to the discussion regarding whether there is a morphological structure that identifies it. A greater and occasional venous distribution in this area stands out, which may explain the physiological phenomenon described by Gräfenberg. For gynecologists, urologists and sexologists, knowledge of the functional anatomy of that region is important to treat orgasmic dysfunctions in addition to urinary incontinence. This controversial situation influences the current framework of patient safety

Inguinal lymph node metastases from prostate cancer: clinical, pathology, and multimodality imaging considerations / Metástases de linfonodos inguinais de câncer de próstata: considerações clínicas, patológicas e de imagem multimodalidade

Abstract Objective: To investigate clinical, pathology, and imaging findings associated with inguinal lymph node (LN) metastases in patients with prostate cancer (PCa). Materials and Methods: This was a retrospective single-center study of patients with PCa who underwent imaging and inguinal LN biopsy between 2000 and 2023. We assessed the following aspects on multimodality imaging: inguinal LN morphology; extrainguinal lymphadenopathy; the extent of primary and recurrent tumors; and non-nodal metastases. Imaging, clinical, and pathology features were compared between patients with and without metastatic inguinal LNs. Results: We evaluated 79 patients, of whom 38 (48.1%) had pathology-proven inguinal LN metastasis. Certain imaging aspects— short-axis diameter, prostate-specific membrane antigen uptake on positron-emission tomography, membranous urethra involvement by the tumor, extra-inguinal lymphadenopathy, and distant metastases—were associated with pathology-proven inguinal LN metastases (p < 0.01 for all). Associations with long-axis diameter, fatty hilum, laterality, and uptake of other tracers on positronemission tomography were not significant (p = 0.09-1.00). The patients with metastatic inguinal LNs had higher prostate-specific antigen levels and more commonly had castration-resistant PCa (p < 0.01), whereas age, histological grade, and treatment type were not significant factors (p = 0.07-0.37). None of the patients had inguinal LN metastasis in the absence of locally advanced disease with membranous urethra involvement or distant metastasis. Conclusion: Several imaging, clinical, and pathology features are associated with inguinal LN metastases in patients with PCa. Isolated metastasis to inguinal LNs is extremely rare and unlikely to occur in the absence of high-risk imaging, clinical, or pathology features.

Resumo Objetivo: Investigar achados clinicopatológicos e de imagem associados a metástases linfonodais inguinais em pacientes com câncer de próstata (CaP). Materiais e Métodos: Estudo retrospectivo de uma única instituição de pacientes com CaP submetidos a exames de imagem e biópsia inguinal de linfonodos em 2000-2023. A imagem multimodalidade foi avaliada para morfologia inguinal do linfonodo, linfadenopatia fora da região inguinal, extensão do CaP primário/recorrente e sítios metastáticos não nodais. Características de imagem e clinicopatológicas foram comparadas entre pacientes com e sem linfonodos inguinais metastáticos pela patologia. Resultados: Entre 79 pacientes estudados, 38 (48,1%) apresentaram metástase inguinal de linfonodo comprovada patologicamente. Certos achados de imagem - diâmetro do eixo curto, captação do antígeno de membrana prostático específico na tomografia por emissão de pósitrons, envolvimento da uretra membranosa pelo tumor, linfadenopatia fora da região inguinal e metástases a distância - foram associados com metástases inguinais no linfonodo pela patologia (p < 0,01). Diâmetro de eixo longo, hilo gorduroso, lateralidade, captação em outros traçadores de tomografia por emissão de pósitrons não foram significativos (p = 0,09-1,00). Clinicopatologicamente, os pacientes com linfonodos inguinais metastáticos apresentaram maior antígeno prostático específico e foram mais resistentes à castração (p < 0,01); idade, grau histológico e tipo de tratamento não foram estatisticamente significantes (p = 0,07-0,37). Nenhum paciente apresentou metástase inguinal isolada no linfonodo na ausência de doença localmente avançada com envolvimento da uretra membranosa ou metástase a distância. Conclusão: Várias características de imagem e clinicopatológicas foram associadas a metástases em LNs inguinais em pacientes com CaP. A metástase isolada para os LNs inguinais é extremamente rara e é improvável que ocorra na ausência de características de imagem e clinicopatológicas de alto risco.

[Outcomes of early endoscopic realignment of post-traumatic posterior urethral ruptures]. / Résultats du réalignement endoscopique précoce des ruptures de l'urètre postérieur post-traumatique.

INTRODUCTION: Post-traumatic rupture of the posterior urethra is a serious injury that can compromise the micturition and erectile prognosis of the often-young patient. The management of this lesion is still controversial, leaving the choice between early endoscopic realignment or suprapubic catheterization with deferred urethroplasty. The objective of this study was to report our clinical experience and outcomes with early endoscopic realignment (EER) for patients with pelvic fracture urethral injury. PATIENTS AND METHODS: We underwent a retrospective review of patients with pelvic fracture associated urethral injury who underwent EER from 2010 to 2020. Preoperative, perioperative, and postoperative outcome data were collected. Complications for the surgical procedure were analyzed, as well as postoperative stenosis, urinary incontinence and erectile dysfunction. The primary endpoint was success, defined as satisfying micturition with no urethral stricture at the time of last follow-up. RESULTS: Early endoscopic realignment was performed in 26 patients managed for complete post-traumatic posterior urethral rupture. The median age was 26 (16-39) years. The most common mechanism of urethral injury was road traffic accidents in 69.23% of cases. The most common urethral injury was grade 4 in 23 patients (88.46%). The median time to endoscopic realignment was 8 days (3-18). The median time to postoperative bladder catheterization was 22 (10-32) days. The median follow-up time was 34 (18-54) months. Ten patients developed urethral stricture during follow-up: 7 (26.92%) were treated with one or two internal cold blade urethrotomies, 3 required urethroplasty. There were no urethroplasty failures after a first endoscopic realignment. Two patients reported severe stress urinary incontinence. The median IIEF-5 score at the date of last news was 23 (17-25). CONCLUSION: Early endoscopic realignment allows some patients to avoid a heavier surgical treatment, and doesn't compromise the realization of a later urethroplasty.

Hematuria macroscópica como signo inicial del cáncer primario de uretra. Reporte de caso / Macroscopic hematuria as an initial sign of primary urethral cancer. Case report

Fundamento: El cáncer primario de uretra se define como el tumor cuya primera lesión se localiza en la uretra; es infrecuente, el mismo representa menos del 1 % de los tumores malignos y el 5 % de los tumores malignos del sistema urinario. La extensión de este proceso a la glándula prostática genera sintomatología urinaria obstructiva e irritativa y cuadros agudos como la hematuria macroscópica. Objetivo: Presentar el caso de un paciente con cáncer primario de uretra en su variedad urotelial con hematuria macroscópica como forma clínica de presentación. Presentación del caso: Caso clínico de un paciente masculino de 75 años de edad, con hematuria macroscópica como forma clínica de presentación de cáncer primario de uretra en su variedad urotelial, el cual se diagnosticó anatomopatológicamente durante el estudio de la hematuria. Conclusiones: El caso que se presenta permite alertar a la comunidad científica que en pacientes que presentan hematuria macroscópica, sin manifestaciones urológicas obstructivas ni irritativas, también debe tenerse en cuenta el diagnóstico de cáncer uretral primario, aunque sea un signo infrecuente como forma clínica de presentación de esa enfermedad.

Background: Primary urethral cancer is defined as a tumor whose first lesion is located in the urethra; is very uncommon, represents less than 1% of malignant tumors and 5% of malignant tumors of the urinary system. The extension of this process to the prostate gland creates obstructive and irritative urinary symptoms and acute conditions such as macroscopic hematuria. Objective: To present the case of a patient with primary urethral carcinoma in its urothelial variety with macroscopic hematuria as clinical presentation. Case presentation: Clinical case of a 75-year-old male patient, with macroscopic hematuria as a clinical presentation of primary cancer of the urethra in its urothelial variety, diagnosed anatomopathologically during the hematuria study. Conclusions: The case presented alerts the scientific community that the diagnosis of primary urethral cancer should be considered in patients with macroscopic hematuria in the absence of obstructive or irritative urologic manifestations, although it is a rare sign as clinical presentation of this disease.

Buccal mucosa graft urethroplasty for bulbar urethral stricture: Outcomes andpredictive factors affecting success.

INTRODUCTION AND OBJECTIVE: The bulbar urethra is the location where urethral stricture is most commonly observed. The most successful method for long and recurrent urethral stenosis is graft urethroplasty. The most successful graft source is buccal mucosa, with advantages like easy adaptation to the corporeal bed, thick epithelium, thin lamina propria with rich vascular structure and easy ability to obtain the graft. In this study we aimed to retrospectively assess the outcomes and predictive factors affecting surgical success of our buccal mucosal graft urethroplasty surgery performed for bulbar urethra stenosis with moderate length. MATERIAL AND METHOD: In this study, we monitored 51 patients with mean 4.4 cm bulbar urethral stricture length for mean 17 months follow-up. From operative and postoperative data, stenosis length, operation duration, Qmax, International Prostate Symptom Score, International Index of Erectile Function-Erectile Function and OF, success rates in total and in subgroups (age, according to DVIU, etiology, BMI and DM), follow-up duration, complications, re-stricture time and number were assessed. RESULTS: The total success of the operations was 86.3%. In 17 months, the re-stricture rate was 13.7%. Oral and urethral complications were all minor. The complications with longest duration (6 months) were ejaculation, erection problems and urethral fistula. Mean time to re-stricture was 11 months. All re-stricture patients were relieved by one DVIU session each. CONCLUSION: For bulbar urethral stricture longer than 2 cm and with recurrence, the dorsal buccal mucosa graft replacement is a very successful method with low complication rates.

Tomografía computarizada con reconstrucción 3D para el diagnóstico de lesiones traumáticas de uretra / Three-dimensional computed tomography reconstruction for the diagnosis of traumatic urethral injuries

RESUMEN La uretrografía retrógrada es la técnica de referencia (gold standard) utilizada clásicamente para hacer diagnóstico de lesiones de uretra. En este contexto se presenta un caso en el que se realizó tomografía computarizada con reconstrucción 3D con contraste intravenoso y endouretral, pudiendo reconstruir la uretra en toda su extensión en forma tridimensional. De esta manera se arribó al diagnóstico de certeza de la lesión de uretra. Como ventaja del método se menciona la posibilidad de diagnosticar ‒ con un solo estudio por imágenes‒ lesiones de todo el tracto urinario, órganos sólidos, huecos y lesión del anillo pélvico asociados al traumatismo, con una alta sensibilidad y especificidad sin necesidad de requerir otros estudios complementarios.

ABSTRACT Retrograde urethrography is the gold standard method for the diagnosis of urethral injuries. In this setting, we report the use of computed tomography with intravenous injection and urethral administration of contrast medium and 3D reconstruction of the entire urethra. The definitive diagnosis of urethral injury was made. The advantage of this method is the possibility of making the diagnosis of traumatic injuries of the entire urinary tract, solid organs, hollow viscera and of the pelvic ring within a single imaging test, with high sensitivity and specificity, with no need to perform other complementary tests.

Ressecção endoscópica de extensa lesão condilomatosa uretral ­ relato de caso e revisão da literatura / Endoscopic resection of extensive urethal condilomatic injury - case report and literature review

Introdução: O Condiloma uretral é uma infecção sexualmente transmissível comum associada ao vírus do papiloma humano. O acometimento na uretra é raro, principalmente quando trata-se de um paciente HIV positivo com carga viral indetectável. Objetivo: Tem como objetivo discutir sobre o acometimento uretral do papiloma vírus e as possíveis formas de tratamento, assim como revisar a literatura. Relato de caso: O paciente em questão apresentou suspeita de carcinoma de células de transição, sendo encaminhado para tratamento, porém afastado essa suspeita e fechando diagnóstico para lesão condilomatosa uretral, sendo realizado tratamento por ressecção endoscópica das lesões com energia monopolar. Discussão: O acometimento uretral ocorre em até 5% dos casos, e o mesmo apresenta alta probabilidade de malignização. Não existem diretrizes específicas sobre o manejo do condiloma intra-uretral, pois trata-se de uma patologia rara. O objetivo dos tratamentos é remover as verrugas e induzir períodos livre de lesões, sendo que o conservador com crioterapia e o ácido tricloroacético nem sempre são aplicáveis à uretra devido ao difícil acesso. A ressecção endoscópica das lesões tem se mostrado mais eficaz. Conclusão: Urologistas e patologistas devem estar cientes dessa rara possibilidade, a fim de evitar erros de diagnóstico acerca dessa entidade predominantemente benigna. Desta forma apresentamos um caso de ressecção endoscópica de extensa lesão condilomatosa em uretra peniana de uma paciente masculino hemofílico e HIV positivo. [au]

Introduction: Urethral condyloma is a common sexually transmitted infection associated with the human papillomavirus (HPV). Affection in the urethra is rare, especially when dealing with an HIV positive patient with an undetectable viral load. Objective: It aims to discuss the urethral involvement of the papillomavirus and the possible forms of treatment, as well as to review the literature. Case report: The patient in question presented suspicion of transitional cell carcinoma, being referred for treatment, but this suspicion was removed and the diagnosis of urethral condylomatous lesion was closed, with treatment by endoscopic resection of the lesions with monopolar energy. Discussion: Urethral involvement occurs in up to 5% of cases, and it has a high probability of malignancy. There are no specific guidelines on the management of intra-urethral condyloma, as it is a rare condition. The goal of treatments is to remove warts and induce injury-free periods, the conservative with cryotherapy and trichloroacetic acid not always being applicable to the urethra due to difficult access. Endoscopic resection of the lesions has been shown to be more effective. Conclusion: urologists and pathologists should be aware of this rare possibility, in order to avoid diagnostic errors about this predominantly benign entity. Thus, we present a case of endoscopic resection of an extensive condylomatous lesion in the penile urethra of a male patient with hemophilia and HIV positive. [au]

Complicaciones y re intervenciones de las cintas transobturadoras y retropúbicas en el Hospital Militar Central, Bogotá 2015-2020 / Complications and re-interventions of transobturator and retropubic tapes at Hospital Militar Central, Bogotá 2015-2020

la incontinencia urinaria (IU), se define por la Sociedad Internacional de Continencia, como la perdida involuntaria de orina, una condición potencialmente tratable con disminución de la calidad de vida de las mujeres en diferentes aspectos, entre ellos la salud sexual con su pareja y su bienestar social. Se han descrito que solo el 44,9 % de las mujeres consultan, teniendo mayores tasas de depresión y ansiedad. El objetivo de esta investigación fue determinar la aparición de complicaciones intraoperatorias y posoperatorias con la realización de cintas transobturadora y retropúbica en el Hospital Militar Central en Bogotá durante el periodo 2015 al 2020. Se realizó un estudio observacional, descriptivo, retrospectivo de corte longitudinal, en el Hospital Militar Central en Bogotá; se incluyeron todas las pacientes con diagnósticos de incontinencia urinaria, tanto de esfuerzo, como de urgencias y/o mixtas, intervenidas con cintas medios uretrales libres de tensión por vía retropúbica o transobturadora. Las complicaciones posteriores al procedimiento quirúrgico la más prevalente fue el dolor con un 96,8 %, seguida de infección urinaria o expulsión de la banda con un 8,6 %; entre otras complicaciones menos frecuentes como hematomas, dispareunia y abscesos. La mayoría de las pacientes obtuvieron una adecuada respuesta clínica en el postoperatorio, el 77 % no requirió ningún manejo adicional. Las cintas mediouretrales, proporcionan un buen resultado con una baja incidencia de complicaciones quirúrgicas y recidiva, con mejoría de la calidad de vida de la paciente frente a su patología de incontinencia urinaria.

The International Continence Society defines urinary incontinence (UI) as the involuntary loss of urine, a potentially treatable condition with a decrease in the quality of life of women in different aspects, including sexual health with their partner and their social well-being. It has been described that only 44.9% of women consult, having higher rates of depression and anxiety. The objective of this research was to determine the occurrence of intraoperative and postoperative complications with the performance of transobturator and retropubic taping at the Central Military Hospital in Bogota during the period 2015 to 2020. An observational, descriptive, retrospective, retrospective. All patients with diagnoses of urinary incontinence, both stress, emergency, and/or mixed, operated with tension-free mid-urethral tapes by retropubic or transobturator route were included. The most prevalent complications after the surgical procedure were pain (96.8 %), followed by urinary tract infection or expulsion of the band (8.6 %), among other less frequent complications such as hematomas, dyspareunia, and abscesses. Most patients obtained an adequate clinical response in the postoperative period, 77 % did not require additional management. Mediourethral tapes provide a good result with a low incidence of surgical complications and recurrence, improving the patient's quality of life concerning her urinary incontinence pathology.

a incontinência urinária (IU) é definida pela Sociedade Internacional de Continência como a perda involuntária de urina, uma condição potencialmente tratável com uma diminuição na qualidade de vida das mulheres em diferentes aspectos, incluindo a saúde sexual com seu parceiro e seu bem-estar social. Foi relatado que apenas 44,9% das mulheres consultam, apresentando taxas mais altas de depressão e ansiedade. O objetivo desta pesquisa foi determinar a ocorrência de complicações intraoperatórias e pós-operatórias com fita transobturatória e retropúbica no Hospital Militar Central de Bogotá, Colômbia, durante o período de 2015 a 2020. Foi realizado um estudo observacional, descritivo, retrospectivo de corte longitudinal no Hospital Militar Central de Bogotá, incluindo todos os pacientes diagnosticados com incontinência urinária, tanto de esforço, de emergência e/ou mista, operados com slings mediouretrais sem tensão via retropúbica ou transobturatória. As complicações mais prevalentes após o procedimento cirúrgico foram dor (96,8%), seguida de infecção do trato urinário ou expulsão da faixa (8,6%), entre outras complicações menos frequentes, como hematomas, dispareunia e abscessos. A maioria dos pacientes teve uma resposta clínica adequada no pós-operatório e 77% não precisaram de nenhum tratamento adicional. Os slings mediouretrais proporcionam um bom resultado com baixa incidência de complicações cirúrgicas e recorrência, com melhora na qualidade de vida da paciente com relação à sua patologia de incontinência urinária.

Urethral leiomyoma: combined vaginal and abdominal approach - a case report / Mioma uretral: abordagem combinada vaginal e abdominal - um relato de caso

Abstract Introduction: leiomyomas are benign mesenchymal tumors of smooth muscle origin that can develop in various locations. Urethral leiomyomas are rare, with approximately only 120 cases reported in the literature. These tumors often occur in the third and fourth decades of life but are rare in menopausal patients. In general, treatment involves surgery, only three recurrence reports in the literature. Description: a case report on a 56-year-old woman; the patient had type II diabetes mellitus and chronic high blood pressure, was overweight (body mass index, 27.1 kg/m2), and a smoker. Besides this, the patient presented symptoms of urinary obstruction and had a large urethral leiomyoma. The tumor was completely removed with no associated urethral lesions using a complex, combined abdominalvaginal surgical approach. Discussion: the management and treatment on urethral leiomyomas is challenging and have not been established yet due to the rarity of these tumors.

Resumo Introdução: os leiomiomas são tumores mesenquimais benignos de origem muscular lisa, podendo manifestar-se em diversas localizações. Os leiomiomas uretrais são raros, tendo apenas aproximadamente 120 casos relatados na literatura. São mais comuns na terceira e quarta décadas de vida, sendo raros em pacientes menopausadas. Em geral, são tratados cirurgicamente, com apenas três relatos de recidivas na literatura. Descrição: relato de caso de uma paciente do sexo feminino, 56 anos, portadora de diabetes mellitus do tipo II, hipertensão arterial crônica, sobrepeso (IMC 27,1Kg/m2) e tabagismo. Além disso, com quadro de sintomas obstrutivos urinários e portadora de um grande leiomioma uretral, este que foi completamente removido, através de uma desafiadora abordagem cirúrgica combinada (abdominal e vaginal), sem lesões uretrais associadas. Discussão: os leiomiomas uretrais são tumores raros e seu manejo é desafiador e ainda não foi estabelecido.

Uretroplastia término terminal y reconstrucción cavernosa temprana en ruptura bilateral de origen traumático / End-to-End Urethroplasty and Early Cavernous Reconstruction in Bilateral Rupture of Traumatic Origin / Uretroplastia término-terminal e reconstrução cavernosa precoce em rotura bilateral de origem traumática

Introducción. La fractura de pene es una emergencia urológica rara, se desconoce la incidencia real dado el subregistro causado por la reducida consulta de los pacientes, resultado del embarazoso contexto. En Estados Unidos alcanza un 38% donde la etiología de índole sexual predomina. En Colombia hay escasos reportes publicados. El diagnóstico de esta entidad es netamente clínico. El objetivo de este trabajo es reportar una evolución satisfactoria en términos de función miccional y eréctil en un paciente sometido a reconstrucción cavernosa y uretral temprana en rotura bilateral de origen traumático mediante una técnica quirúrgica poco convencional, de acuerdo con lo hallado en la literatura. Presentación del caso. Paciente masculino de 30 años, previamente sano, quien consultó al servicio de urgencias por uretrorragia, edema y dolor peneano secundario a trauma contuso del mismo durante relación sexual. El reporte ecográfico mostró disrupción en túnica albugínea del cuerpo esponjoso, hematoma y aparente transección uretral; se realizó exploración quirúrgica 6 horas después, con evidencia de fractura de cuerpos cavernosos, laceración del 40% de la circunferencia, transección completa de la uretra y cuerpo esponjoso. Se realizó rafia de cuerpos cavernosos y uretroplastia término terminal de uretra bulbar, con evolución clínica satisfactoria. Discusión. La reconstrucción quirúrgica en menos de 24 horas en fractura de pene disminuye significativamente la estancia hospitalaria y complicaciones precoces; asimismo, desciende el riesgo de disfunción eréctil, erecciones dolorosas y problemas miccionales. No hay publicaciones que comparen resultados a largo plazo entre los dos abordajes quirúrgicos. Conclusiones. La fractura de pene es una patología poco frecuente con diagnóstico clínico, la cual debe manejarse de manera temprana por cualquier urólogo y, en caso de ser posible, con experiencia reconstructiva y excelentes resultados en la función sexual y miccional.

Introduction. Penile fracture is a rare urological emergency, the real incidence is unknown given the underreporting caused by the reduced consultation of patients, resulting from the embarrassing context. In the United States it reaches 38%, where sexual etiology predominates. In Colombia there are few published reports. The diagnosis of this entity is purely clinical. The aim of this work is to report a satisfactory evolution in terms of voiding and erectile function in a patient who underwent early cavernous and urethral reconstruction in bilateral rupture of traumatic origin by means of an unconventional surgical technique, in accordance with what has been found in the literature. Case Presentation. A 30-year-old male patient, previously healthy, consulted the emergency department for urethrorrhagia, edema and penile pain secondary to blunt trauma to the penis during sexual intercourse. The ultrasound report showed disruption in the tunica albuginea of the corpus spongiosum, hematoma and apparent urethral transection; surgical exploration was performed 6 hours later, with evidence of fracture of the corpora cavernosa, laceration of 40% of the circumference, complete transection of the urethra and corpus spongiosum. Sutures to the corpora cavernosa and end-to-end urethroplasty of the bulbar urethra were performed, with satisfactory clinical evolution. Discussion. Surgical reconstruction in less than 24 hours in penile fractures significantly reduces hospital stay and early complications; it also reduces the risk of erectile dysfunction, painful erections and voiding problems. There are no publications comparing long-term results between the two surgical approaches. Conclusions. Penile fracture is a rare pathology with clinical diagnosis, which should be managed early by any urologist and, if possible, with reconstructive experience and excellent results in sexual and voiding function.

Introdução. A fratura peniana é uma emergência urológica rara, a real incidência é desconhecida dada a subnotificação causada pela reduzida consulta de pacientes, resultado do contexto constrangedor. Nos Estados Unidos chega a 38% onde predomina a etiologia de natureza sexual. Na Colômbia há poucos relatórios publicados. O diagnóstico desta entidade é puramente clínico. O objetivo deste trabalho é relatar uma evolução satisfatória da função miccional e erétil em um paciente submetido à reconstrução cavernosa e uretral precoce em ruptura bilateral de origem traumática por meio de técnica cirúrgica não convencional, de acordo com o que foi encontrado na literatura. Apresentação do caso. Paciente do sexo masculino, 30 anos, previamente saudável, procurou o pronto-socorro por uretrorragia, edema e dor peniana secundária a trauma contuso durante a relação sexual. O relatório do ultrassom mostrou ruptura na túnica albugínea do corpo esponjoso, hematoma e transecção uretral aparente; a exploração cirúrgica foi realizada 6 horas depois, com evidência de fratura dos corpos cavernosos, laceração de 40% da circunferência, transecção completa da uretra e corpo esponjoso. Foram realizadas ráfia dos corpos cavernosos e uretroplastia término-terminal da uretra bulbar, com evolução clínica satisfatória. Discussão. A reconstrução cirúrgica em menos de 24 horas nas fraturas penianas reduz significativamente o tempo de internação e as complicações precoces. Da mesma forma, diminui o risco de disfunção erétil, ereções dolorosas e problemas de micção. Não há publicações comparando os resultados a longo prazo entre as duas abordagens cirúrgicas. Conclusões. A fratura peniana é uma patologia rara com diagnóstico clínico, que deve ser tratada precocemente por qualquer urologista e, se possível, com experiência reconstrutiva e excelentes resultados na função sexual e miccional.

Consequences of penile fracture: Complications and long-term functional outcomes.

INTRODUCTION: Penile fracture (PF) is a urological emergency with low incidence, and evidence of its long-term outcomes is scarce. This study focuses on postoperative complications and long-term functional outcomes in patients with PF and surgical repair at our center. MATERIALS AND METHOD: Clinical records of patients undergoing urgent surgery for PF at a third level hospital between 2006 and 2020 were retrospectively reviewed. Functional outcomes were assessed with voluntary telephone interviews from June 2020 to February 2021. Lower urinary tract symptoms were screened by IPSS questionnaire, sexual function by EHS and IIEF-5 and morphological alterations by direct questions to patients. RESULTS: A total of 41 patients underwent surgery for PF. Eleven of them also had urethral injury (higher incidence if there was bilateral corpora cavernosa injury, 19.4% vs. 80%, p < 0.05). Only 1 patient presented a Clavien-Dindo type 3a complication due to wound dehiscence, 4 (13%) type 2 and 9 (29%) type 1. Twenty-four patients underwent long-term follow-up, of whom 20 (83.3%) presented normal sexual function. Twelve patients (50%) had a palpable nodule at the fracture site, 8 (33.3%) had new onset penile curvature and 1 patient with previous urethral injury presented urethral stricture. CONCLUSION: In cases of penile fracture, there is a higher incidence of urethral injury if both corpora cavernosa are affected. Long-term functional sequelae after surgical repair of a PF are rare.

Important interaction between urethral taste bud-like structures and Onuf's nucleus following spinal subarachnoid hemorrhage: A hypothesis for the mechanism of dysorgasmia.

BACKGROUND: We previously postulated that orgasmic sensation may occur through recently discovered genital taste bud-like structures. The interaction between the pudendal nerve and Onuf's nucleus may be important for developing orgasmic information. The study aims to investigate whether ischemic damage to Onuf's nucleus-pudendal network following spinal subarachnoid hemorrhage (SAH) causes taste bud degeneration or not. METHODS: The study was conducted on 22 fertile male rabbits who were divided into three groups: control (GI; n=5), SHAM (GII; n=5) and study (GIII; n=12). Isotonic solution, .7cm3, for the SHAM, and .7cm3 homologous blood was injected into spinal subarachnoid spaces at S2 level of the study group. Two weeks later, Onuf's nucleus, pudendal ganglia and the taste bud-like structures of the penile urethra were examined histopathologically. Degenerated neuron densities of Onuf's nucleus, pudendal ganglia and atrophic taste bud-like structures were estimated per mm3 and the results analyzed statistically. RESULTS: The mean degenerated neuron densities of taste bud-like structures, Onuf's nucleus and pudendal ganglia were estimated as 2±1/mm3, 5±1/mm3, 6±2/mm3 in GI; 12±4/mm3, 35±9/mm3, 188±31/mm3, in GII and 41±8/mm3, 215±37/mm3, 1321±78/mm3, in GIII. Spinal SAH induced neurodegeneration in Onuf's nucleus, pudendal ganglia and taste bud atrophy was significantly different between GI/GII (p<.005); GII/GIII (p<.0005) and GI/GIII (p<.0001). CONCLUSION: Ischemic neuronal degenerations of Onuf's nucleus and pudendal ganglia following spinal SAH lead to genital taste bud-like structure atrophy. This mechanism may be responsible for sexual anhedonia and sterility in cases with spinal cord injury, which has not been documented so far. More studies are needed.

Manejo quirúrgico de prolapso uretral en pediatría: Reporte de caso / Surgical management of urethral prolapse in pediatrics: A case report

Introducción. El prolapso uretral es una entidad poco común, con una incidencia estimada de 1 en 3000 mujeres. Se presenta cuando la mucosa uretral sobresale espontáneamente más allá del meato uretral. Es una patología poco diagnosticada dada su baja frecuencia y de allí la importancia de conocer sobre su presentación, diagnóstico y tratamiento. El objetivo de este artículo fue presentar el caso de una paciente de 10 años con diagnóstico de prolapso uretral y su manejo quirúrgico. Caso clínico. Paciente femenina de 10 años, que consultó por cuadro clínico de 1 año de evolución consistente en dolor en región urogenital, que se irradiaba a hipogastrio, asociado a pujo y disuria, a quien se le diagnosticó prolapso uretral y se realizó corrección quirúrgica de mucosa uretral prolapsada mediante técnica de Kelly-Burnham modificada. Conclusión. El prolapso uretral es una entidad que con frecuencia es diagnosticada erróneamente pues su diagnóstico es eminentemente clínico. Si bien se ha descrito el tratamiento médico en primera instancia, éste tiene una alta tasa de recurrencia, por lo que en estos casos se prefiere la resección quirúrgica del tejido prolapsado.

Introduction. Urethral prolapse is a rare entity, with an estimated incidence of 1 in 3,000 women. It occurs when the urethral mucosa spontaneously protrudes beyond the urethral meatus. It is a poorly diagnosed pathology given its low frequency and hence the importance of knowing about its presentation, diagnosis and treatment. The objective of this article was to present the case of a 10-year-old patient with a diagnosis of urethral prolapse and its surgical management. Clinical case. A 10-year-old female patient, who consulted for a 1-year clinical picture consisting of pain in the urogenital region, radiating to the hypogastrium, associated with pushing and dysuria, who was diagnosed with urethral prolapse and a surgical correction of the urethral mucosa was performed prolapsed by modified Kelly-Burnham technique. Conclusion. Urethral prolapse is an entity that is frequently misdiagnosed because its diagnosis is eminently clinical. Although medical treatment has been described in the first instance, it has a high recurrence rate, so surgical resection of the prolapsed tissue is preferred in these cases.

Leiomioma parauretral: manifestación clínica inusual, primer reporte de caso en literatura colombiana / Parauretral leiomioma: unusual clinical manifestation, first case report in colombian literatura

RESUMEN El leiomioma parauretral es una neoplasia benigna con pocos casos descritos en la literatura. El leiomioma abarca el 5% de los casos de las masas parauretrales, ocupando el cuarto lugar como una de las causas menos frecuentes, después del divertículo parauretral. Se presenta el caso de una paciente de 43 años con antecedente de infección urinaria a repetición, con una masa de 8 cm en pared vaginal anterior de cuatro años de evolución. La cistoscopia fue normal y la ecografía mostró una lesión sólida parauretral. Se realizó resección por colpotomía sin complicaciones, con resultado de patología de leiomioma. Control postquirúrgico y uroflujometría normal. Dentro de las posibilidades diagnósticas ante una masa parauretral, el leiomioma debe considerarse. La sintomatología es variable, siendo los síntomas urinarios los más frecuentes. La ecografía y la resonancia son herramientas fundamentales y el manejo se basa en la resección quirúrgica, generalmente vía vaginal. MÉD.UIS.2021;34(2): 77-82.

ABSTRACT Introduction: Paraurethral leiomyoma is a rare benign neoplasm, with few cases described in the literature. Most of the data on prevalence are based on case series, the leiomyoma covers 5% of the paraurethral masses, occupying the fourth place as one of the less frequent causes, after parurethral diverticulum. Case: 43 years old patient with antecedents of recurring urinary infections and a previous 8 cm mass on the vaginal walls with 4 years of clinical evolution course. Cystoscopy was normal and ultrasound with a solid paraurethral injury. Colpotomy resection was performed without complications, resulting in leiomyoma pathology. Post-surgical control and normal uroflowmetry. Discussion and conclusion: leiomyomas should be considered as a possible diagnosis in case of a periurethral mass presence. Symptomatology is variable. The urinary symptoms are the most frequent as in this case. Ultrasonography and resonance are essential tools treatment are based on surgical resection which is usually vaginally. MÉD.UIS.2021;34(2): 77-82

[Predictors of complex urethral surgery in anterior urethral stricture disease.] / Predictores de cirugía uretral compleja en estenosis de la uretra anterior.

OBJECTIVE: To determine the clinical-surgical factors associated with Complex Urethral Surgery (CUC) in anterior urethral stenosis. MATERIAL AND METHOD: This is a cross-sectional study with retrospective data recording, including all male patients who under went anterior urethroplasty between 2011 and 2018. CUC included two or more grafts urethroplasty, excisional augmented anastomotic urethroplasty, combined flaps and grafts urethroplasty and stages surgery. The data were collected from the electronic medical record, recording the demographic data, background of previous treatments as well as the characteristics of the stenosis (etiology, anatomical location, length, number of strictures, among others). A univariate and multivariate analysis were conducted using the chi-squared test and logistic regression to identify the variables related to CUC. RESULTS: The data of 665 patients met the inclusion criteria were analyzed. The mean age was 56.1 years, 27.5% were smokers, 32.5% had received some previous treatment, and dilatations were the most common procedure. The most prevalent etiology was iatrogenic, followed by idiopathic in a 61.1 and 20.3% respectively. Bulbar urethral stricture were the most common location (56.2%) while the mean length of the stenosis was 4.8 cm. After univariate and multivariate analysis, previous dilations (HR 2.6), multifocality (2.51), lengthof stenosis (>4 cm) (HR 1.49) and the hypospadias etiology (HR 11.9) were independent predictors for CUC (p<0.05)CONCLUSIONS: Hypospadias was the only etiology factor that predicts the need for CUC. Regarding radiological findings, extensive and multifocal stenosis, were predictors of complex surgery. History of previous dilations were also predictors of CUC.

OBJETIVO: Determinar los factores predictores asociados a Cirugía Uretral Compleja (CUC) en los casos de estenosis de la uretra anterior.MATERIAL Y MÉTODO: Estudio transversal con registro de datos retrospectivo, incluye a todos los pacientes masculinos a quienes se les practicó una plastía de la uretra anterior entre 2011 y 2018. Como CUC se consideró a la Uretroplastia con dos o más injertos, la anastomosis término terminal ampliada, la uretroplastia combinada y la cirugía por estadíos. Los datos se recabaron de la historia clínica electrónica consignándose aquellos demográficos, antecedente de tratamientos previos, así como las características de la estenosis (etiología, ubicación anatómica, longitud, número de estenosis entre otras). Se realizó un análisis univariado y multivariado para identificar variables predictoras de CUC. RESULTADOS: Se analizaron los datos de 665 pacientes con criterios de inclusión válidos. La media de edad fue de 56,1 años, 27,5% eran fumadores crónicos, 32,5% habían recibido algún tratamiento previo, siendo las dilataciones el procedimiento más común (17,6%), la etiología más prevalente fue la iatrógena seguida por la idiopática en un 61,1 y un 20,3% respectivamente, la ubicación más común fue la uretra bulbar en 56,2% mientras que la media de longitud de la estenosis fue de 4,8 cm. En el análisis univariado y multivariable el antecedente de dilataciones (HR 2,6), la multifocalidad (HR 2,51), la longitud de la estenosis (>4 cm) (HR 1,49) y la etiología hipospadias (HR 11,9) resultaron ser factores predictores independientes para CUC (p<0,05). CONCLUSIONES: La hipospadia fue dentro de las etiologías analizadas la única que predice la necesidad de CUC. En lo que respecta a antecedentes y hallazgos radiológicos, las dilataciones y las estenosis extensas y multifocales respectivamente fueron predictores de CUC.

[Pediatric foreign body. A two case report.] / Cuerpo extraño uretral en la infancia. A propósito de 2 casos.

INTRODUCTION: Urethral insertion of foreign bodies is an infrequent emergency, being it exceptionally rare in prepubertal children. Both clinical presentation and the introduced elements are varied. Although sexualabuse and mental disorders must always be considered, these events are mainly related to the children's own  body self-discovery without any sexual connotation. Endourologic approach is the treatment of choice while the need for conventional surgery is unusual. OBJECTIVE: To review clinical and therapeutic aspects of the insertion of urethral foreign bodies in early childhood, and to report two new clinical cases. MATERIALS AND METHODS: A 7-year-old boy and a 5-year-old boy, brought to emergency for referring the insertion of a metallic foreign body in the urethra. Both were oligosymptomatic, and the diagnosis was confirmed by radiology. They were treated with an endourological approach without any complications. CONCLUSION: The introduction of foreign bodies in the urinary tract is an unusual problem in prepubertal children. Theirs approach must be individualized, not only limited to the removal of the foreign body but also to the exclusion of child abuse and psychiatric disorders.

INTRODUCCIÓN: La inserción uretral de cuerpos extraños es una urgencia poco frecuente, siendo excepcional en niños prepuberales. La presentación clínica y los elementos utilizados son muy variables. En los preadolescentes el incidente está relacionado al autoconocimiento corporal sin una connotación sexual, aunque siempre debe contemplarse la posibilidad de abuso infantil y alteraciones mentales. El tratamiento de elección es el endourológico, siendo inusual la necesidad de una cirugía convencional.OBJETIVO: Realizar una revisión clínica y terapéutica de la inserción de cuerpos extraños uretrales en la primera infancia, con el reporte de dos nuevos casos clínicos.MATERIAL Y MÉTODO: Niño de 7 y otro de 5 años, traídos a la consulta por referir la inserción de un cuerpo extraño metálico en la uretra. Ambos fueron oligosintomáticos, y el diagnóstico fue confirmado por radiología. Se trataron por vía endourológica sin complicaciones.CONCLUSIÓN: La introducción de cuerpos extraños en el tracto urinario es un problema infrecuente en niños prepuberales. Su abordaje debe ser individualizado, no sólo limitado a la extracción del cuerpo extraño sino también a la exclusión de abuso infantil y trastornos psiquiátricos.

Gross Anatomy of Urethra and Penis in Uncastrated and Castrated Buck of Black Bengal Goat

SUMMARY: Urethral process, sigmoid flexure, urethra at the pelvic arch and neck of urinary bladder in goats are very much prone to form obstructive urolithiasis. The present study was carried out to establish baseline work on the normal measurement of the urethral passage and different segments of penis of uncastrated and castrated Black Bengal (BB) goat which will be supportive for obstructive urolithiasis management. Different segment of penis along with urethra of 25 uncastrated and 25 castrated male Black Bengal goats were collected from different slaughter house of Chattogram City Corporation. The length and diameter of male urethra and different segment of penis in uncastrated buck were significantly higher (p<.001) than castrated buck. The length of the pelvic urethra was 5.88 ± 0.111 cm and 4.58 ± 0.15 cm in uncastrated and castrated buck respectively. The length of the neck of urinary bladder; root, body, sigmoid flexure, glans penis and urethral process of the penis in uncastrated and castrated buck were 0.688 ± 0.156 cm and 0.38 ± 0.048 cm, 5.02 ± 0.09 cm and 4.24±0.10 cm, 23.48 ± 0.37 cm and 22.74 ± 0.43 cm, 9.2 ± 0.107 cm and 8.18 ± 0.29 cm, 1.92 ± 0.032 cm and 1.44 ± 0.10 cm, 2.32 ± 0.029 cm and 1.78 ± 0.07 cm respectively. The diameter of the neck of urinary bladder, root, body, sigmoid flexure, glans penis and urethral process of the penis in uncastrated and castrated buck were 1.94 ± 0.041 cm and 1.44 ± 0.05 cm, 3.7 ± 0.049 cm and 3.3 ± 0.144 cm, 2.63 ± 0.066 cm and 1.86 ± 0.08 cm, 2.77 ± 0.90 cm and 2.18 ± 0.07 cm , 1.81 ± 0.034 cm and 1.4 ± 0.06 cm, 0.66 ± 0.014 cm and 0.56 ± 0.05 cm respectively. Finally, total lengths of penis in uncastrated and castrated buck were 30.42±0.459 cm and 28.42±0.553 cm respectively. The length and diameter of the neck of the urinary bladder, root, sigmoid flexure, urethral process of the penis are clinically more important for obstructive urolithiasis.

RESUMEN: El proceso uretral, el ángulo sigmoideo, la uretra en el arco pélvico y el cuello de la vejiga urinaria en las cabras son muy propensos a formar urolitiasis obstructiva. El presente estudio se llevó a cabo para establecer un trabajo de referencia sobre la medición normal del pasaje uretral y diferentes segmentos de pene de cabra de Bengala Negra (BB) no castrada y castrada, que serán de apoyo para el manejo de la urolitiasis obstructiva. Se recolectaron diferentes segmentos de pene junto con la uretra de 25 machos de cabras de Bengala negras sin castrar y 25 castrados de diferentes mataderos de Chattogram City Corporation. La longitud y el diámetro de la uretra y los diferentes segmentos del pene en el macho no castrado fueron significativamente más altos (p <0,001) que en el macho castrado. La longitud de la uretra pélvica fue de 5,88 ± 0,111 cm y 4,58 ± 0,15 cm en animales sin castrar y castrados, respectivamente. La longitud del cuello de la vejiga urinaria; raíz, cuerpo, flexión sigmoidea, glande del pene y proceso uretral del pene en el macho sin castrar y castrado fueron 0,688 ± 0,156 cm y 0,38 ± 0,048 cm, 5,02 ± 0,09 cm y 4,24 ± 0,10 cm, 23,48 ± 0,37 cm y 22,74 ± 0,43 cm , 9,2 ± 0,107 cm y 8,18 ± 0,29 cm, 1,92 ± 0,032 cm y 1,44 ± 0,10 cm, 2,32 ± 0,029 cm y 1,78 ± 0,07 cm, respectivamente. El diámetro del cuello de la vejiga urinaria, la raíz, el cuerpo, el ángulo sigmoide, el glande del pene y el proceso uretral del pene en el macho no castrado y castrado fueron 1,94 ± 0,041 cm y 1,44 ± 0,05 cm, 3,7 ± 0,049 cm y 3,3 ± 0,144 cm. 2,63 ± 0,066 cm y 1,86 ± 0,08 cm, 2,77 ± 0,90 cm y 2,18 ± 0,07 cm, 1,81 ± 0,034 cm y 1,4 ± 0,06 cm, 0,66 ± 0,014 cm y 0,56 ± 0,05 cm respectivamente. Finalmente, las longitudes totales de pene en machos castrados y no castrados fueron de 30,42 ± 0,459 cm y 28,42 ± 0,553 cm respectivamente. La longitud y el diámetro del cuello de la vejiga urinaria, la raíz, el ángulo sigmoideo y el proceso uretral del pene son clínicamente más importantes para la urolitiasis obstructiva.