RESUMO
A 59-year-old man with a 6-year history of erectile dysfunction presented to the andrology outpatient clinic. Multimodality assessment with ultrasound, MRI venography and fluoroscopic venography demonstrated an aberrant emissary vein arising from the corporal bodies causing venogenic erectile dysfunction. Selective coil embolisation of the collateral vein resulted in an almost immediate and sustained improvement in his erections.
Assuntos
Embolização Terapêutica , Disfunção Erétil/cirurgia , Impotência Vasculogênica/cirurgia , Pênis/irrigação sanguínea , Procedimentos Cirúrgicos Urológicos Masculinos , Veias/anormalidades , Embolização Terapêutica/métodos , Disfunção Erétil/diagnóstico por imagem , Disfunção Erétil/etiologia , Humanos , Impotência Vasculogênica/complicações , Impotência Vasculogênica/diagnóstico por imagem , Ligadura , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Satisfação do Paciente , Pênis/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Veias/diagnóstico por imagem , Veias/cirurgiaRESUMO
A 47-year-old man attended the emergency department following trauma during sexual intercourse after which he developed penile swelling and haematuria several hours later. A penile fracture was suspected but given the slightly atypical history, ultrasound was performed to look for a fracture. Given the history of haematuria, both a standard Doppler ultrasound and a microbubble-enhanced retrograde ultrasound urethrogram were performed. The Doppler confirmed the suspected diagnosis of penile fracture, and microbubble urethrogram demonstrated a urethral injury. This facilitated prompt surgical treatment and helped guide the surgical approach. Retrograde microbubble enhanced ultrasound urethrogram is a novel technique that can be used in conjunction with standard ultrasound to confirm the presence of a concurrent urethral rupture in penile fracture.
Assuntos
Coito , Hematoma/diagnóstico , Pênis/lesões , Uretra/lesões , Diagnóstico Diferencial , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Masculino , Microbolhas , Pessoa de Meia-Idade , Ruptura/diagnóstico , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , Ultrassonografia , Procedimentos Cirúrgicos Urológicos MasculinosRESUMO
The authors present a case of an 87-year-old gentleman who presented with general deterioration, increased confusion, recurrent falls and unsteadiness. He was treated for a urinary tract infection but was found to deteriorate rapidly, developing bilateral nystagmus, marked pastpointing, dysarthria and central ataxia. He had a complex medical history including epilepsy controlled with long-term phenytoin. Phenytoin is 90% protein bound and displaced by bilirubin. At the time of deterioration his total phenytoin concentration was within the limits of the laboratory's recommended therapeutic range. The biochemistry report also denoted the patient was hypoalbuminaemic and hyperbilirubinaemic. His symptoms completely resolved with phenytoin dose reduction. The combination of low albumin and high bilirubin may cause an increase in the free phenytoin concentration, resulting in toxicity, despite the measured total phenytoin concentration being within the therapeutic interval.