Diagnóstico del cáncer de próstata mediante biopsia ampliada de 24 cilindros / Prostate cancer diagnosis using 24 cores extended biopsy

Objetivo: Determinar el rendimiento diagnóstico de la biopsia prostática (BP) ampliada en el cáncer de próstata (CP) y las variables que influyen en su positividad. Material y métodos: Pacientes (n=147) sometidos a BP de 24 cilindros, en el Hospital Arquitecto Marcide, Ferrol, La Coruña, entre diciembre 2002-septiembre 2004. Los criterios de inclusión fueron: pacientes ≤70 años con una o más BP negativas o ≤75 años con dos o más BP negativas. Se realizó análisis univariado mediante testΧ2 en variables cualitativas y test t-Student y U de Mann-Whitney, en variables cuantitativas y análisis de regresión logística para determinar variables relacionadas con la positividad de BP ampliada. Resultados: 60 pacientes (40,82%) presentaron CP. Entre los pacientes con BP negativa y positiva, se observaron diferencias significativas en volumen prostático, relación PSA libre/total en la primera BP, relación PSA libre/total en la BP ampliada, PSA-densidad en la BP ampliada y existencia de prostatitis crónica en BP previas. En el análisis multivariado se comprobó que la densidad de PSA y la existencia de prostatitis crónica en BP previas, predecían de forma independiente la positividad de la BP ampliada. Conclusiones: La BP ampliada permite detectar CP en el 40,82% de los pacientes con BP previamente negativas. El incremento de la densidad de PSA se asocia una mayor probabilidad de CP, mientras que la existencia de prostatitis crónica en las BP previas reduce significativamente la probabilidad de CP, en la BP ampliada (AU)

Objective: To determine the diagnostic performance of extended prostatic biopsy (PB) in prostate cancer (PC) and variables affecting positivity. Materials and Methods: Patients (n=147) underwent 24 cylinder PB at the Arquitecto Marcide Hospital, Ferrol, La Coruña, between December 2002-September 2004. Inclusion criteria were the following: patients aged ≤70 with one or more negative PB or aged ≤75 with two or more negative PB. An univariate analysis was carried out using the Χ2 test for the qualitative variables and the t-Student and U Mann-Whitney tests in the case of the quantitative variables, plus a logistical regression analysis in order to identify those variables related to the extended PB positivity. Results: 60 patients (40.82%) were identified as having PC. Significant differences were observed in prostatic volume, free/total PSA ratio in the initial PB, free/total PSA ratio in the extended PB, PSA-density in the extended PB as well as the existence of chronic prostatitis in previous PB. During the multivariate analysis it was found that the PSA-density and the presence of chronic prostatitis in previous PB independently predicted the positivity of the extended PB. Conclusions: Extended PB allows for the detection of PC in 40.82% of patients with previous negative PB. The increase in PSA density is associated with a greater probability of PC, whilst the existence of chronic prostatitis in prior PB significantly reduces the probability of PC in the extended PB (AU)

[Partial substitution of the ureter using a short segment of the ileum following the Monti procedure]. / Sustitución parcial del uréter por un segmento de ileon tratado según el procedimiento de Monti.

The partial substitution of the ureter using a pediculated segment of the ileum is a technique used to re-establish ureteral transit and preserve the renal unit, following the resection of extensive ureteral lesions. Standard surgical procedure for an ileoureteroplasty consists of isolating an ileal duct of equal or greater length than the ureteral defect and interposing it in the urinary tract in an isoperistaltic direction. Monti described a surgical technique that allows for the creation of catheterizable stomas in continent urinary diversions, using the Mitrofanoff principle. These passageways were created from one or several 2.5 cm long ileal sections by means of their detubulization and transverse retubulization. The clinical case study presented here corresponds to a 57 year-old male with a history of ureteral lithiasis, with a 9 cm stenosis of the sacroiliac ureter. He was treated surgically by means of a resection of the stenotic ureter and the interposition of a duct made up of 2.5 ileal sections, treated in accordance with the Monti procedure. Since this operation, the patient's metabolic state has been completely normal. Morphological and functional results have also proved totally satisfactory, as the use of image techniques have shown.

Sustitución parcial del uréter por un segmento de íleon tratado según el procedimiento de Monti / Partial substitution of the ureter using a short segment of the ileum following the Monti procedure

La sustitución parcial del uréter por un segmento pediculado de íleon es una técnica que se utiliza para restablecer el tránsito ureteral y preservar la unidad renal, tras la resección de lesiones ureterales extensas. La técnica quirúrgica habitual para realizar una íleoureteroplastia consiste en aislar un asa ileal de igual o superior longitud al defecto ureteral, e interponerla en el tracto urinario, en dirección isoperistáltica. Monti describió una técnica quirúrgica que permitía crear estomas cateterizables en derivaciones urinarias continentes, utilizando el principio de Mitrofanoff. Dichos conductos eran confeccionados a partir de uno o varios segmentos ileales de 2,5 cm de longitud, mediante su destubulización y retubulización transversa. El caso clínico que presentamos corresponde a un varón de 57 años con antecedente de litiasis ureteral, que presentaba una estenosis del uréter lumbo-sacro de 9 cm. Se trató quirúrgicamente mediante resección del uréter estenótico, e interposición de un conducto formado por dos segmentos ileales de 2,5 cm, tratados según el procedimiento de Monti. La situación metabólica del paciente has ido absolutamente normal desde la fecha de la intervención. Los resultados morfológicos y funcionales fueron asimismo, plenamente satisfactorios, según se demuestra mediante técnicas de imagen (AU)

The partial substitution of the ureter using a pediculated segment of the ileum is a technique used to re-establish ureteral transit and preserve the renal unit, following the resection of extensive ureteral lesions. Standard surgical procedure for an ileoureteroplasty consists of isolating an ileal duct of equal or greater length than the ureteral defect and interposing it in the urinary tract in an isoperistaltic direction. Monti described a surgical technique that allows for the creation of catheterizable stomas in continent urinary diversions, using the Mitrofanoff principle. These passageways were created from one or several 2.5 cm long ileal sections by means of their detubulization and transverse retubulization. The clinical case study presented here corresponds to a 57 year-old male with a history of ureteral lithiasis, with a 9 cm stenosis of the sacroiliac ureter. He was treated surgically by means of a resection of the stenotic ureter and the interposition of a duct made up of 2.5 ileal sections, treated in accordance with the Monti procedure. Since this operation, the patient’s metabolic state has been completely normal. Morphological and functional results have also proved totally satisfactory, as the use of image techniques have shown (AU)

[Prostate cancer diagnosis using 24 cores extended biopsy]. / Diagnóstico del cáncer de próstata mediante biopsia ampliada de 24 cilindros.

OBJECTIVE: To determine the diagnostic performance of extended prostatic biopsy (PB) in prostate cancer (PC) and variables affecting positivity. MATERIALS AND METHODS: Patients (n = 147) underwent 24 cylinder PB at the Arquitecto Marcide Hospital, Ferrol, La Coruña, between December 2002-September 2004. Inclusion criteria were the following: patients aged < or = 70 with one or more negative PB or aged < or = 75 with two or more negative PB. An univariate analysis was carried out using the chi-squared test for the qualitative variables and the t-Student and U Mann-Whitney tests in the case of the quantitative variables, plus a logistical regression analysis in order to identify those variables related to the extended PB positivity. RESULTS: 60 patients (40.82%) were identified as having PC. Significant differences were observed in prostatic volume, free/total PSA ratio in the initial PB, free/total PSA ratio in the extended PB, PSA-density in the extended PB as well as the existence of chronic prostatitis in previous PB. During the multivariate analysis it was found that the PSA-density and the presence of chronic prostatitis in previous PB independently predicted the positivity of the extended PB. CONCLUSIONS: Extended PB allows for the detection of PC in 40.82% of patients with previous negative PB. The increase in PSA density is associated with a greater probability of PC, whilst the existence of chronic prostatitis in prior PB significantly reduces the probability of PC in the extended PB.

[Iatrogenic rupture of the ureter following extracorporeal shock wave lithotripsy]. / Rotura yatrógena de uréter secundaria a litotricia extracorpórea por ondas de choque.

Extracorporeal shock wave lithotripsy is the treatment of choice in most cases of urinary calculi, with the estimation that open surgery is only necessary in 5% of all cases. In most cases, the complications derived from this technique are slight, transitory and of little clinical importance, with isolated cases of serious urological or extraurological injury. These complications are either caused by the action of the stone itself or its fragments, or by the action of shock waves. We present a case of ureteral rupture following treatment of a ureteral calculus using extracorporeal shock wave lithotripsy which led to a periureteral retroperitoneal abscess that was treated by nephroureterectomy.

[Priapism following paraneoplastic leukemoid reaction in a patient with bladder cancer]. / Priapismo secundario a reacción leucemoide paraneoplásica en paciente con cáncer de vejiga.

Priapism associated with solid tumours is usually produced by penile metastasis or direct tumour infiltration of the corpora cavernosa. Neoplasias are responsible for between 3-8% of all cases of priapism, and in 80% of cases the primary tumour has a genito-urinary origin. Leukemoid reaction is an haematological disorder characterised by a leukocytosis of over 50000/microl, which develops reactively with different pathological processes such as severe inflammation, disseminated infections, intoxications and tumours. The pathophysiologic mechanism that explains priapism following leukemoid reaction is an intravascular obstruction due to blood hyperviscosity, leading to a blood stasis in the cavernosa veins, and impeding the drainage of the corpora cavernosa. We present a case of priapism in a patient with locally advanced bladder cancer, which was probably the result of blood hyperviscosity produced by a paraneoplastic leukemoid reaction.

Rotura yatrógena de uréter secundaria a litotricia extracorpórea por ondas de choque / Iatrogenic rupture of the ureter following extracorporeal shock wave lithotripsy

La litotricia extracorpórea por ondas de choque es el tratamiento de elección de la mayoría de los cálculos urinarios, estimándose que sólo en el 5% de los casos es necesario recurrir a técnicas de cirugía abierta. Las complicaciones derivadas de esta técnica son, en la mayoría de los casos, leves, transitorias y con escasa repercusión clínica, observándose sólo en casos aislados lesiones urológicas o extraurológicas de gravedad. Dichas complicaciones se producen bien por la propia acción del cálculo o sus fragmentos, o bien por la acción de las ondas de choque. Presentamos un caso de rotura ureteral secundaria al tratamiento de un cálculo ureteral mediante litotricia extracorpórea por ondas de choque, que derivó en un absceso retroperitoneal periureteral, y fue tratado mediante nefroureterectomía

Extracorporeal shock wave lithotripsy is the treatment of choice in most cases of urinary calculi, with the estimation that open surgery is only necessary in 5% of all cases. In most cases, the complications derived from this technique are slight, transitory and of little clinical importance, with isolated cases of serious urological or extraurological injury. These complications are either caused by the action of the stone itself or its fragments, or by the action of shock waves. We present a case of ureteral rupture following treatment of a ureteral calculus using extracorporeal shock wave lithotripsy which led to a periureteral retroperitoneal abscess that was treated by nephroureterectomy

Priapismo secundario a reacción leucemoide paraneoplásica en paciente con cáncer de vejiga / Priapism following paraneoplastic leukemoid reaction in a patient with bladder cancer

El priapismo asociado a tumores sólidos suele producirse por metástasis peneanas o por infiltración tumoral directa de los cuerpos cavernosos. Las neoplasias son responsables del 3-8% de los casos de priapismo, y en el 80% de los casos el tumor primario es de origen génito-urinario.La reacción leucemoide es un trastorno hematológico caracterizado por una leucocitosis superiora 50000/microl, que se desarrolla de forma reactiva ante diversos procesos patológicos como inflamaciones severas, infecciones diseminadas, intoxicaciones y tumores. El mecanismo fisiopatológico que explica el priapismo secundario a reacción leucemoide es una obstrucción intravascular por hiperviscosidad sanguínea, que origina una estasis sanguínea en las venas cavernosas, impidiendo el drenaje de los cuerpos cavernosos. Presentamos un caso de priapismo en un paciente con un cáncer de vejiga localmente avanzado, que se desencadenó por la hiperviscosidad sanguínea producida por una reacción leucemoide paraneoplásica

Priapism associated with solid tumours is usually produced by penile metastasis or direct tumour infiltration of the corpora cavernosa. Neoplasias are responsible for between 3-8% of all cases of priapism,and in 80% of cases the primary tumour has a genito-urinary origin. Leukemoid reaction is an haematological disorder characterised by a leukocytosis of over 50000/microl, which develops reactively with different pathological processes such as severe inflammation, disseminated infections, intoxications and tumours.The pathophysiologic mechanism that explains priapism following leukemoid reaction is an intravascular obstruction due to blood hyperviscosity, leading to a blood stasis in the cavernosa veins, and impeding the drainage of the corpora cavernosa. We present a case of priapism in a patient with locally advanced bladder cancer, which was probably the result of blood hyperviscosity produced by a paraneoplastic leukemoid reaction

[Giant retroperitoneal cystic mass: appendiceal mucocele]. / Masa quística retroperitoneal gigante: mucocele apendicular.

Appendiceal mucocele is a term used to describe the dilatation of the vermiform appendix produced by an intraluminal accumulation of mucus. Four pathological processes have been described that may lead to an appendiceal mucocele: obturation of cecoappendiceal communication, mucosal hyperplasia, mucinous cystadenoma and mucinous cystoadenocarcinoma. The most frequent is mucinous cystadenoma, seen in 50% of appendiceal mucoceles. 6% of patients with appendiceal mucocele develop peritoneal pseudomixoma, possibly through dissemination of the epithelial cells into the abdominal cavity. Preoperative diagnosis of the lesion is particularly important in order to deal with it carefully during surgery. CT scan is the most precise radiological exploration, although there are no pathognomonic signs of mucocele. Typical CT finding of a mucocele is a well-defined cystic mass that compresses the cecum without any peripheral inflammatory reaction, and with low levels of attenuation that vary between water and soft tissue density. We present a case of an appendiceal mucocele caused by a mucinous cystadenoma clinically presented as a giant retroperitoneal mass. Diagnosis was postoperatively made, after pathological study of the surgical sample.

Masa quística retroperitoneal gigante: mucocele apendicular / Giant retroperitoneal cystic mass: Appendiceal mucocele

Mucocele apendicular es un término que define la dilatación del apéndice vermiforme producida por acumulación intraluminal de moco. Son cuatro los procesos patológicos descritos que pueden ocasionar un mucocele apendicular: obturación de la comunicación cecoapendicular, hiperplasia mucosa, cistoadenoma mucinoso y cistoadenocarcinoma mucinoso. De todos ellos, el cistoadenoma mucinoso es el más frecuente, observándose en el 50% de los mucoceles apendiculares. El 6% de los pacientes con mucocele apendicular desarrollan pseudomixoma peritoneal, posiblemente por diseminación de células epiteliales al interior de la cavidad abdominal. Es de gran importancia el diagnóstico preoperatorio de la lesión, para manipularla cuidadosamente durante el acto quirúrgico. El TAC es la exploración radiológica más precisa, aunque no existen signos patognomónicos de mucocele. En el TAC el mucocele se presenta como una masa quística bien delimitada, que comprime el ciego, sin reacción inflamatoria periférica, y con bajos niveles de atenuación, que oscilan entre densidad agua y tejido blando. Presentamos un caso de mucocele apendicular ocasionado por un cistoadenoma mucinoso, que se presentó clínicamente como masa retroperitoneal gigante. El diagnóstico fue efectuado post-operatoriamente, tras el estudio anatomopatológico de la pieza quirúrgica (AU)

Appendiceal mucocele is a term used to describe the dilatation of the vermiform appendix produced by an intraluminal accumulation of mucus. Four pathological processes have been described that may lead to an appendiceal mucocele: obturation of cecoappendiceal communication, mucosal hyperplasia, mucinous cystadenoma and mucinous cystoadenocarcinoma. The most frequent is mucinous cystadenoma, seen in 50% of appendiceal mucoceles. 6% of patients with appendiceal mucocele develop peritoneal pseudomixoma, possibly through disseminationof the epithelial cells into the abdominal cavity. Preoperative diagnosis of the lesion is particularly important in order to deal with it carefully during surgery. CT scan is the most precise radiological exploration, although there are no pathognomonic signs of mucocele. Typical CT finding of a mucocele is a well-defined cystic mass that compresses the cecum without any peripheral inflammatory reaction, and with low levels of attenuation that vary between water and soft tissue density. We present a case of an appendiceal mucocele caused by a mucinous cystadenoma clinically presented as a giant retroperitoneal mass. Diagnosis was postoperatively made, after pathological study of the surgical sample (AU)

Anuria obstructiva secundaria a prolapso uterino / Obstructive anuria secondary to uterine prolapse

La prevalencia de uropatía obstructiva asociada al prolapso uterino varía según las series entre un 4 per cent y un 80 per cent, probablemente debido a la diferente severidad de los prolapsos considerados. El desarrollo de insuficiencia renal o anuria es una complicación poco frecuente. Se han postulado diversas teorías etiopatogénicas sobre la uropatía obstructiva producida por el prolapso: compresión ureteral por los vasos uterinos, angulación uretral extrema, compresión ureteral sobre la musculatura elevadora del ano y elongación y estrechamiento del uréter distal. La exploración radiológica princeps en el estudio del tracto urinario de estas pacientes es la urografía intravenosa en bipedestación. El tratamiento de urgencia de la anuria obstructiva secundaria a prolapso uterino consiste en la reducción manual del prolapso. La cirugía se considera como el tratamiento definitivo de elección, aunque en pacientes con elevado riesgo anestésico-quirúrgico, la colocación de un pesario de forma permanente puede ofrecer un resultado satisfactorio. Presentamos un caso de anuria obstructiva secundaria a prolapso uterino, que resolvió satisfactoriamente mediante la colocación de un pesario (AU)

[Primary bladder osteosarcoma treated with hemicystectomy]. / Osteosarcoma vesical primario tratado mediante hemicistectomía.

Primary osteosarcoma of the bladder is an extremely rare type of tumour, and less than 30 adequately documented cases have been registered. From a clinical and radiological point of view, it is impossible to distinguish from other types of bladder tumours, since despite the fact that calcification of the bladder wall is common in osteosarcoma, other bladder diseases exist which may also present calcification. Prior to primary bladder osteosarcoma diagnosis, it is vital to first rule out the existence of an skeletal origin. Differential diagnosis must be carried out essentially with other bone-forming tumours, such as carcinosarcoma and transitional cell carcinoma with bone metaplasia. Prognosis for bladder osteosarcoma is extremely pessimistic, as the majority of patients do not survive beyond 6 months, regardless of the treatment carried out. We present a case of bladder osteosarcoma treated by right hemi-cystectomy, which remains disease free after a follow-up period of one year.

[Subepithelial hematoma of kidney pelvis and ureter: Antopol-Goldman lesion]. / Hematoma subepitelial de pelvis renal y uréter: lesión de Antopol-Goldman.

The subepithelial hematoma of the renal pelvis and ureter was described by Antopol and Goldman in 1948. Hematuria and filling defect in the renal pelvis are the most consistently recurring clinical and radiological findings. Only 21 cases were found in the literature on the subject and all of them were treated surgically, usually with partial or total nephrectomy. Here we present a case of Antopol-Goldman lesion which was treated conservatively.

[Duplication of the male urethra]. / Duplicidad de uretra masculina.

Duplication of the male urethra is an uncommon congenital malformation. The majority of cases are diagnosed during infancy, and are detected by observing two urethral meatus, or by the appearance of some form of complication, normally of an obstructive nature. Micturitional cystourethrography is an essential test, both in confirming diagnosis of this pathology, and in determining the type of urethral duplication. Excretory urography is also recommended due to its association with other possible urological and extra-urological congenital disorders. Treatment is based on the patient's clinical symptoms, with a waiting period considered advisable for asymptomatic cases. Here we present a case of incomplete urethral duplication, diagnosed from a bladder outlet obstruction, secondary to stenosis of the urethra, which was treated with an endoscopic urethrotomy and distal septotomy, obtaining excellent clinical results.

Osteosarcoma vesical primario tratado mediante hemicistectomía / Primary vesical osteosarcoma treated with hemicystectomy

El osteosarcoma primario de vejiga es un tumor de extraordinaria rareza, con menos de 30 casos adecuadamente documentados. Desde el punto de vista clínico y radiológico es indistinguible de otros tipos de tumor vesical, ya que aunque las calcificaciones de la pared vesical son frecuentes en el osteosarcoma, existen otras patologías vesicales que también pueden presentar calcificaciones. Para realizar el diagnóstico de osteosarcoma vesical primario es imprescindible descartar la existencia de afectación esquelética. El diagnóstico diferencial debe realizarse fundamentalmente con otros tumores formadores de hueso, como el carcinosarcoma y el carcinoma de células transicionales con metaplasia ósea. El pronóstico del osteosarcoma vesical es ominoso, ya que la mayoría de los pacientes fallecen antes de los 6 meses, independientemente del tratamiento efectuado.Presentamos un caso de osteosarcoma vesical tratado mediante hemicistectomía derecha, que permanece libre de enfermedad tras un año de seguimiento. (AU)

Hematoma subepitelial de pelvis renal y uréter: lesion de Antopol-Goldman / Subepithelial hematoma of the renal pelvis and uretra: Antopol-oldman lesion

El hematoma subepitelial de la pelvis renal y del uréter fue descrito por Antopol y Goldman en 1948. La existencia de hematuria y un defecto de repleción de la pelvis renal son los hallazgos clínicos y radiológicos observados de forma constante. Se han comunicado 21 casos hasta la fecha describiendo esta lesión, y en todos ellos se realizó tratamiento quirúrgico, habitualmente mediante nefrectomía parcial o total. Presentamos un caso de lesión de AntopolGoldman tratado de forma conservadora (AU)

Duplicidad de uretra masculina / Male urethra duplicity

La duplicidad de la uretra masculina es una malformación congénita de presentación infrecuente. La mayoría de los casos se diagnostican durante la infancia, por la observación de dos meatos uretrales, o bien por el desarrollo de alguna complicación, habitualmente obstructiva. La cistouretrografia miccional es una prueba imprescindible, tanto para confirmar el diagnóstico de esta patología, como para determinar el tipo de duplicidad uretral. Se recomienda asimismo la realización de urografía intravenosa, por la posible asociación con otras anomalías congénitas urológicas y extraurológicas. El tratamiento se realiza en función de las manifestaciones clínicas del paciente, recomendándose una actitud expectante en los casos asintomáticos.Presentamos un caso de duplicidad uretral incompleta, diagnosticado por un cuadro miccional obstructivo, secundario a una estenosis de uretra, que fue tratado mediante uretrotomía endoscópica y septotomía distal, con la consecución de un excelente resultado clínico (AU)

[Acute diffuse bacterial nephritis in horse shoe kidney]. / Nefritis bacteriana aguda difusa en riñón en herradura.

Horseshoe kidney is a congenital malformation which predisposes the patient to severe urinary tract infections, due to pelvic ectasia which is inherent in the malrotation of the renal units. Acute bacterial nephritis is an evolutionary stage of the acute renal infection situated between acute pyelonephritis and renal abscess. It is only possible to carry out a differential diagnosis of these two bodies through the application of some imaging technique, as it is impossible to differentiate them from a clinical point of view. A CT contrast scan is the most sensitive and specific means of diagnosing acute bacterial nephritis, and is considered to be the most appropriate test method. The CT scan usually reveals circular or wedge-shaped cortical areas which become striated after contrast administration. Treatment is based on broad-spectrum antibiotherapy, which must be continued for a period of 3 to 6 weeks. We present a case of diffuse acute bacterial nephritis, occurring in a paediatric patient with a horseshoe kidney, which was successfully treated by means of a prolonged course of antibiotics.

[Obstructive anuria secondary to uterine prolapse]. / Anuria obstructiva secundaria a prolapso uterino.

The prevalence of obstructive uropathy linked to uterine prolapse ranges between 4% and 80%, depending on the series, probably due to the varying degree of severity of the prolapses under consideration. Renal failure or anuria is an unusual complication. Several etiopathogenic theories regarding obstructive uropathy secondary to prolapse have been put forward: ureteral compression by the uterine vessels, severe urethral angulation, ureteral compression against levator ani muscles and the elongation and narrowing of the distal ureter. The major radiological exploration used in studying the urinary tract of these patients is intravenous urography in bipedestation. Emergency treatment for obstructive anuria resulting from a uterine prolapse consists of manually replacement of the prolapse. Surgery is considered to be the definitive ideal treatment, although in the case of surgical or anaesthetic high risk patients, inserting a permanent pessary may constitute a satisfactory solution. We present a case of obstructive anuria resulting from uterine prolapse, which was successfully treated with the insertion of a ring pessary.

Fractura de pene. Aportación de un caso / Penile fracture. Fracture of a case

La fractura de pene es una entidad clínica de presentación infrecuente, que en la mayoría de los casos se produce por un traumatismo durante el coito. Afecta a uno o ambos cuerpos cavernosos, y se acompaña de lesión uretral en un 10-38 por ciento de las ocasiones. El diagnóstico es fundamentalmente clínico, aunque si existe sospecha de lesión uretral, se recomienda la práctica de uretrocistografía. En la actualidad la mayoría de los autores realizan tratamiento quirúrgico precoz para evitar la aparición de secuelas sexuales y urológicas, que tienen lugar en el 10-53 por ciento de los pacientes tratados de forma conservadora. Presentamos un caso de fractura de pene que fue tratado mediante cirugía precoz, obteniendo buenos resultados estéticos y funcionales (AU)

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