Priapismo de bajo flujo convertido en priapismo de alto flujo por fístula arterio-lacunar secundaria a la técnica de Winter / Low-flow priapism developing to high-flow priapism by arterial-lacunar fistula secondary to the winter procedure

El priapismo es una afección patológica que consiste en una erección peneana persistente más allá de la estimulación sexual. Presentamos el caso de un paciente de 80 años, diagnosticado inicialmente, por la historia clínica, valores gasométricos de los cuerpos cavernosos y ultrasonografía doppler color peneana, de priapismo de bajo flujo que durante la realización de la técnica de Winter se produce iatrogénicamente la laceración bilateral de las arterias dorsales, originando una fístula arteriolacunar y en consecuencia un priapismo de alto flujo. Se realizó arteriografía selectiva de la pudenda, al no ser la eco-doppler color concluyente, que puso de manifiesto dicha fístula y permitió la embolización supraselectiva con microcoils...

Priapism is a pathology consisting of prolonged penile erection unrelated to sexual stimulation. We present an 80-year-old patient with relevant clinical history; corpora cavernosa blood gas analysis and penile Doppler ultrasound examination confirmed low-flow priapism. The Winter procedure was performed, which provoked iatrogenic laceration of the dorsal artery, leading to an arterio-lacunar fistula and high-flow priapism. A second Doppler ultrasound was inconclusive, and so a selective angiography was performed to observe the pudendal artery, following which selective embolization with microcoils was carried out...

Complicación derivada del uso de Hem-O-Lok en la prostatectomía radical laparoscópica / Complications arising from the use of Hem-O-Lok in laparoscopic radical prostatectomy

Se presenta una rara complicación pos operatoria, la formación de pseu dodivertículo uretral, que se produce después de una prostatectomía radical laparoscópica con preservación de nervios, procedimiento llevado a cabo con la colocación de Hem-o-lok sobre los pedículos látero-prostáticos, en un paciente con cáncer de próstata clínicamente localizado. Por tanto, estos dispositivos deben utilizarse con precaución en la región de la anastomosis vesicouretral...

We present a rare postoperative complication, pseudodiverticulum urethral formation, occurring after a laparoscopic radical prostatectomy with nerve-sparing procedure carried out with the placement of Hem-o-lok c in the latero-prostatic pedicles, in a patient with clinically localized prostate cancer. As such, these devices should be used with caution in the region of the vesicourethral anastomosis...

[Intradiverticular transitional cell tumor. Report of a case]. / Tumor intradiverticular de células transicionales. A propósito de un caso.

OBJECTIVES: To emphasize the diagnostic difficulty in some cases of intradiverticular transitional cell tumor of the bladder. METHODS/RESULTS: A patient with intradiverticular transitional cell tumor is described. The clinical features and diagnostic aspects are discussed. Despite the use of different diagnostic procedures (X-ray, US, CT, retrograde cystography), diagnosis could only be made after surgery. CONCLUSION: In patients suspected as having intradiverticular transitional cell tumor, the definitive diagnosis can only be made following surgery.

[Kidney trauma with congenital hydronephrosis. Report of a case]. / Traumatismo sobre riñón con hidronefrosis congénita. A propósito de un caso.

We report on a 16-year-old patient with stricture of the pyeloureteric junction (PUJ) that had been incidentally discovered following trauma to the lumbar region. The literature is briefly reviewed.

[Transitional carcinoma of the prostate. Report of a case treated with chemotherapy]. / Carcinoma transicional de próstata. A propósito de un caso tratado con quimioterapia.

A case of transitional cell carcinoma of the prostate is described which had been diagnosed following TUR of the prostate due to cervico-prostatic obstruction. Subsequent cystoscopic and cytological controls, as well as multiple bladder biopsies have discarded a concomitant urothelial tumor. We underscore the rarity of transitional cell tumor of the prostate, its response to chemotherapy and the possibility of suspecting this tumor type when there is massive invasion of the prostate following TUR.

[Giant retroperitoneal liposarcoma]. / Liposarcoma retroperitoneal gigante.

A case of giant retroperitoneal liposarcoma is described. Treatment was by radical surgery, using the anterior approach, with preservation of the renal unit. The diagnostic procedure is briefly discussed and the literature reviewed.

[Spontaneous extravasation of urine at the pyelo-caliceal level. Spontaneous urinomas]. / Extravasación espontánea de orina a nivel pielo-calicial. Urinomas espontáneos.

We present two cases of spontaneous rupture of the excretory tract within the context of reno-ureteral colic due to lithiasis. We comment on the etiopathogenic aspects and underscore the need for emergency evaluation in patients with very severe nephric colic and/or symptoms of peritoneal irritation (ileus, abdominal guarding), and temporary urinary diversion must be performed via nephrostomy as a palliative procedure for the symptoms and to avoid complications.

[Retroperitoneal abscess. Report of 2 cases]. / Abscesos retroperitoneales. A propósito de dos casos.

Two cases of retroperitoneal abscess that had recently been treated in our service are described. The primary infection was localized to the psoas muscle in one patient with a previous injury to the right lumbar region. The other case was secondary to an ascending urinary infection. Staph aureus were isolated in the first case and E. Coli in the second. The different clinical course and treatment of each case are described.

[Nonpenetrating trauma of the penis. Rupture of corpus cavernosum albuginea]. / Traumatismos no penetrantes de pene. Ruptura albugínea de cuerpos cavernosos.

We report a case of penile trauma that had been treated early by surgery. The value of ultrasound in diagnosing rupture of the corpus cavernosum albuginea is highlighted. The good functional and cosmetic results afforded by early surgical treatment is underscored.

[Rhabdomyosarcoma of the epididymis]. / Rabdomiosarcoma de epidídimo.

A 5-year-old boy with intrascrotal rhabdomyosarcoma arising from the epididymis is described. The patient was submitted to radical orchidectomy via the inguinal approach and high ligation of the spermatic cord. The anatomopathological examination revealed germ cell rhabdomyosarcoma of the epididymis with no testicular or spermatic cord involvement, which corresponded to stage I of the IRS classification (Intergroup Rhabdomyosarcoma Study). Its clinical and histological features and treatment are discussed.

[Erythrocytosis and renal adenocarcinoma]. / Eritrocitosis y adenocarcinoma renal.

Contribution of one left renal adenocarcinoma in a 54-year old women, where the initial data was the finding of erythrocytosis discovered during routine laboratory tests performed by her gynaecologist. Review of the diagnostic and therapeutic procedures followed in this case, establishing a differentiation between erythrocytosis and polyglobulia. Normalization of the hemogram following extended nephrectomy is emphasized. This case history is considered to be of interest due to its presentation pattern. Finally, we believe that faced to an erythrocytosis of unknown etiology, a renal tumoral disease, more specifically a renal adenocarcinoma, should be suspected.

[Colloid carcinoma of the prostate]. / Carcinoma coloide de próstata.

We report a case of colloid carcinoma of the prostate, a rare tumor type whose diagnosis is exclusively based on the anatomopathological findings. The case described herein is a primary prostatic tumor. Patient work up revealed no tumor localized to other organs. The total acid phosphatase and prostate acid phosphatase levels were elevated. Subsequent analyses revealed metastases.

[Vesico-uterine fistula]. / Fístula vésico-uterina.

We report a case of uterovesical fistula that had been diagnosed by cystoscopy, vaginoscopy and ultrasonography. Fistulorrhaphy via the transperitoneal transvesical approach resolved the passage of urine to the vagina. The decision to perform a conservative or more aggressive approach is determined by the site of the fistula.

[Review of 36 trigono-cervico-prostatectomies, carried out for prostatic pathology]. / Revisión de 36 trigono-cérvico-prostatotomías, practicadas por patología prostática.

Review of 36 trigone-cervix-prostatectomies, performed in our services. Studies made before and after the procedure. Indications for trigone-cervix-prostatectomies. Complications and results obtained. Trigone-cervix-prostatectomies as an alternative to prostate transurethral resection, in a highly selected group of patients, because of its simplicity and better results.

[Prostatic abscess--new diagnostic and therapeutic guidelines]. / Abscesos prostáticos--nuevas pautas diagnósticas y terapéuticas.

Five prostatic abscesses treated in our Unit over the last three years (1988, 89, 90) are presented. Both the mode of presentation and symptoms as well as the course of treatment followed (three percutaneous drainage through the perineum, lead by ultrasound scanning, one endoscopic abscess incision with Collins' knife and one resolved with antibiotics subsequently needing TUR of the prostatic adenoma) are reviewed. The change of attitude in the treatment of prostatic abscesses (Ultrasound-lead percutaneous drainage) and the major usefulness of ultrasound scanning for diagnosis, treatment and subsequent follow-up are emphasized.

[Diagnostic guidelines in female ureteral diverticulum]. / Pauta diagnóstica en divertículos uretrales femeninos.

A case of diverticulum of the female urethra is presented which was successfully treated surgically. The diagnostic methods used are described, highlighting the usefulness of ultrasound in making the topographic diagnosis. Furthermore, because it is a non-invasive imaging technique, it can be used in screening the cases. Performing positive pressure urethrography is advocated. If the catheter for this purpose is unavailable, a substitute can be easily assembled.