Priapism induced by use of tamsulosin: A case report and review of the literature.

Numerous medications have been associated to the development of priapism as an adverse reaction, the most common are intracavernosal vasoactive agents, antipsychotics and antidepressants. Alpha blockers, in particular tamsulosin which is widely used in different urological conditions, has been associated to priapism in only few case reports. We present the case of a healthy 45-year-old man who medicated himself with two doses of 0.4 mg of tamsulosin due to a renal colic with spontaneous passage of a 3 mm stone. Eight hours after the second tamsulosin dose the patient developed a persistent painful erection not associated to sexual stimulation that lasted for 6 hours. He was admitted to the emergency room, and after history taking and physical evaluation the diagnosis of ischemic priapism was made. The patient denied consumption of any other medication or drug during the last month, blood tests in particular hemogram were normal and no recent history of pelvic trauma was reported. To achieve detumescence, five boluses of 200 mcg of phenylephrine were injected directly in the corpora cavernosa, no further procedures were needed. In the follow-up the patient had no new priapism episodes and he reported no problems with erections in sexual intercourse. Tamsulosin is one of most indicated medications in urological general practice; though priapism has been rarely associated to its consumption the risk of this side effect exists, suggesting that patients should be counselled about it.

Cirugía Robótica en cáncer de vejiga músculo-invasor, una interrogante aún sin resolver / Robotic Surgery In Muscle-Invasive Bladder Cancer, An Unresolved Interrogant

INTRODUCCIÓN: La cirugía robótica es una técnica en aumento tanto en Chile como en el mundo. Una de las áreas de la medicina que ha sido pionera en la introducción de esta nueva técnica es Urología, dónde ha crecido el interés en torno a la utilización de la cirugía robótica en cáncer de vejiga músculo invasor(CVMI). El objetivo de esta revisión es examinar la bibliografía disponible sobre el tema. MÉTODOS: Se realizó una búsqueda no sistemática de la literatura utilizando la base de datos de Pubmed y MGH Treadwell library. En estas se utilizaron las palabras claves "Bladder cancer", Muscle-invasive bladder cancer", "Blader cancer epidemiology" , "Radical cistectomy" "Robot-assisted radical cistectomy", ¨Robotic surgery urology¨. Se aplicaron límites de publicaciones dentro de los últimos 10 años. DISCUSIÓN: El cáncer vesical es una enfermedad de alta prevalencia, aproximadamente el 25 % de ellos se presentan con CVMI al momento del diagnóstico. El tratamiento de estándar actualmente para CVMI la cistectomía radical con linfadenectomía pélvica extendida, derivación urinaria y quimioterapia neoadyuvante en ciertos casos. Buscando dar solución a las complicaciones de esta cirugía, surge el interés por utilizar la cirugía robótica en el tratamiento de CVMI a través de la cistectomía radical asistida por robot(CRAR). Actualmente se han publicado estudios con resultados que indican disminución de la morbilidad perioperatoria y menor estadía hospitalaria, manteniendo la eficacia oncológica de este procedimiento versus la cistectomía radical abierta(CRA). Otros estudios no han encontrado diferencias significativas entre las dos técnicas en cuanto a complicaciones. CONCLUSIÓN: Aún existe insuficiente experiencia y evidencia del uso de esta en cáncer de vejiga músculo-invasor pero los resultados actuales tienden a resultados no inferiores y positivos en cuanto a la CRAR versus la CRA.AU

METHODS: We performed a non-systematic literature search using the Pubmed and MGH Treadwell library database. Key words "Bladder cancer", Muscle-invasive bladder cancer", "Bladder cancer epidemiology" , "Radical cystectomy" "Robot-assisted radical cystectomy", ¨Robotic surgery urology¨. were used. Limits of publications were applied within the last 10 years. DISCUSSION: Bladder cancer is a highly prevalent disease. Approximately 25% of patients present with MIBC at the time of diagnosis. The standard treatment currently for CVMI is radical cystectomy with extended pelvic lymphadenectomy, urinary diversion and neoadjuvant chemotherapy in certain cases. In order to solve the complications of this surgery, there is an interest in the use of robotic surgery in the treatment of MIBC through robot assisted radical cystectomy (RARC). Studies with results indicating decreased perioperative morbidity and shorter hospital stay have been published, maintaining the oncological efficacy of this procedure versus open radical cystectomy (ORC). Other studies have found no significant difference between the two techniques in terms of complications. CONCLUSION: There is still insufficient experience and evidence of its use in m