[Reiter syndrome: atypical complication of treatment with BCG]. / Síndrome de Reiter: una complicación atípica del tratamiento con BCG.

OBJECTIVE: To report a case of Reiter's syndrome, an uncommon complication after intravesical BCG therapy. The etiology, clinical features, diagnostic difficulties and treatment of this condition are discussed. METHODS/RESULTS: A 56-year-old patient with superficial bladder carcinoma developed conjunctivitis, urethritis and arthritis of the right knee and wrist after the fourth BCG instillation. Other pathologies were ruled out by the clinical and laboratory findings (synovial fluid, cultures, HLA B-27, RF, ANA). A progressive clinical improvement was observed when BCG instillation was discontinued and treatment with indomethacin was started. CONCLUSION: Reiter's syndrome is an infrequent complication that is not related with the BCG strain utilized. Early diagnosis of this condition improves response to therapy.

[Fracture of the penis: value of echo-Doppler-color]. / Fractura de pene: valor del eco-doppler-color.

OBJECTIVE: A case of traumatic rupture of the corpora cavernosa evaluated by color Doppler ultrasonography is presented. METHODS: A 43-year-old male consulted for a large penile hematoma that had presented 16 hours earlier during sexual intercourse. The patient was evaluated by Doppler ultrasound using a 5 Mhz linear probe. The vascular integrity of the penis was demonstrated by color Doppler ultrasonography of the cavernous arteries and penile veins. RESULTS: Disruption at the base of the right corpus cavernosum associated with a small hematoma appeared as adjacent hypoechoic images. The color Doppler ultrasonic evaluation demonstrated the integrity of the arteries and cavernous veins and no pulsation of the hematoma, indicating conservative management. Four months after the trauma, no changes in erectile function or penile deviation have been observed. CONCLUSIONS: Color Doppler ultrasound is a useful diagnostic imaging technique in the assessment and follow-up of penile trauma.

[Sphincter reeducation in non-coordinated urination syndrome]. / Reeducación esfinteriana en el síndrome de micción no coordinada.

OBJECTIVE: The bladder re-education programs were initially associated with treatment of women with vesical instability. However, little has been published on the efficiency of the re-education techniques in the uncoordinated voiding syndrome of the Hinman syndrome. This study evaluated the urodynamic results of sphincter re-education in the treatment of the uncoordinated voiding syndrome. METHODS: Our series comprised 50 consecutive patients with uncoordinated voiding syndrome. The mean age was 11.9 years; 82% were females and 18% males. All patients underwent a complete urodynamic study with external perineal electromyography and videocystography. The sphincter re-education protocol was comprised of a manual pre-voiding training phase, an electromyographic pre-voiding training phase and a voiding training phase. Upon completing the re-education process, a new urodynamic study was performed and during the follow-up period, uroflowmetry studies were carried out with external perineal electromyography at 3, 6 and 12 months. Based on the response of the detrusor during voiding, we have classified the uncoordinated voiding syndrome into three types: type A, in which voiding is achieved through voluntary contraction of the detrusor; and type C, in which voiding is achieved through abdominal pressure. RESULTS: The clinical results obtained by sphincter re-education at one-year follow-up were: 42% cured, 22% improved, 2% relapsed and 14% showed no response. The remaining 20% were excluded from the treatment protocol. CONCLUSIONS: It is likely that the three types of the uncoordinated voiding syndrome are merely different physiopathological stages of the same vesico-urethral dysfunction. We consider sphincter re-education to be the treatment of choice for this type of patients.

[Continuing neurologic assessment in myelodysplasia]. / Evaluación neurourológica continuada en la mielodisplasia.

OBJECTIVES: Myelodysplasia produces a neurological lesion with unpredictable urodynamic sequelae. The present study describes our experience in 18 patients with myelodysplasia and vesicourethral dysfunction. METHODS: The study comprised 18 patients (11 males and 7 females) with myelodysplasia and vesicourethral dysfunction. Patient median age was 15.7 years (range 7 months-57 years) and the mean follow-up was 20 months (range 7-47 months). After physical and neurological examination, all patients underwent a complete urodynamic evaluation, including selective electromyography of the periurethral sphincter and videocystography. The urodynamic studies were repeated regularly during follow-up. RESULTS: 14 patients (67.7%) showed a lower motor neuron vesicourethral dysfunction; 2 (11.1%) had upper motor neuron lesion and 2 (11.1%) mixed motor neuron lesion. During the study period, no alterations were observed in the urodynamic pattern of patients with upper or mixed motor neuron lesions, but 9 patients (64.2%) with lower motor neuron lesions showed changes in the urodynamic pattern compared with the first evaluation, with alterations in bladder compliance being the most frequent. CONCLUSIONS: Alterations in bladder compliance may arise from neurogenic and nonneurogenic factors. Our findings indicate the need for close urodynamic surveillance of patients with myelodysplasia and vesicourethral dysfunction.

[Obstructive uropathy as a complication of aortic disease and reconstructive peripheral vascular surgery: report of 4 cases and review of the literature]. / Uropatía obstructiva como complicación de la patología aórtica y de la cirugía reconstructiva vascular periférica: presentación de 4 casos y revisión de la literatura.

OBJECTIVES: Ureteral injury can be a complication of peripheral vascular reconstructive surgery or aneurysm of the abdominal aorta. The present study analyses 4 cases of obstructive uropathy; 3 following peripheral vascular reconstructive surgery and 1 from aneurysm of the abdominal aorta. METHODS: All 4 patients were prospectively evaluated. RESULTS: Both renal units were compromised in all 4 cases. The initial management consisted of internal urinary diversion with a double J catheter. Ureterolysis was performed in one case of unresolved uropathy secondary to prior bypass surgery. One case with uropathy due to infection of the vascular prosthetic graft required graft replacement. CONCLUSIONS: The risk of ureteral injury is likely to be seen more often due to the increasing number of operations on the vascular tree and enhanced survival of patients with aortic aneurysm. Prevention of the foregoing complication includes doing US and/or IVP early postoperatively and in the first 4 months following surgery. Patient management is initially conservative.