RESUMO
OBJECTIVE: To present our experience in both uni-and bilateral priapism, highlighting good results obtained with supraselective embolisation. MATERIAL AND METHODS: We present 5 cases of high-flow priapism secondary to perineal trauma, with a mean age of 31 years (24-43 years). The mean time to presentation from the moment of the trauma was 18, 6 days (1-60 days). Diagnosis was confirmed through gasometry of the corpora cavernosa, penile Doppler ultrasound (2 cases) and selective arteriography of the pudendal artery. In all cases treatment was by supralective embolisation with gelatin sponge. In the two bilateral cases, embolisation was performed in the same act. RESULTS: In the short-term was a recovery of flaccidity and in the long-term (3-4 months) a recovery of erection with no fibrotic sequelae of the corpora cavernosa. CONCLUSIONS: Embolisation of the lacerated artery, in a single procedure in cases of bilateral lacerations, provides excellent results.
Assuntos
Pênis/irrigação sanguínea , Períneo/lesões , Priapismo/terapia , Fístula Vascular/etiologia , Adulto , Velocidade do Fluxo Sanguíneo , Embolização Terapêutica , Humanos , Masculino , Priapismo/fisiopatologia , Estudos Retrospectivos , Fístula Vascular/fisiopatologiaRESUMO
We report the case of a young man with a recurrent idiopathic priapism, successfully treated with methoxamine intracarvenosal self-injections. The patient was instructed in intracorporeal self-injection of this pure alpha-1 adrenergic agonist, which provided complete detumescence. The patient became asymptomatic after one month of domiciliary treatment. We conclude that intracavernosal self-administered methoxamine can be a useful treatment of recurrent idiopathic priapism.
Assuntos
Agonistas alfa-Adrenérgicos/administração & dosagem , Metoxamina/administração & dosagem , Priapismo/tratamento farmacológico , Adulto , Humanos , Injeções Intralesionais , Masculino , Priapismo/fisiopatologia , Recidiva , Fluxo Sanguíneo Regional , AutoadministraçãoRESUMO
We present the case of a renal pseudotumor corresponding to a esteatonecrotic granuloma, secondary to an enolic acute pancreatitis a few months ago. The main caractheristics, diagnosis and terapeuthics of the renal pseudotumors are discussed with the case report of a 60 year old man who presents a renal mass founded incidentally at a control computed tomography.
Assuntos
Granuloma de Células Plasmáticas/etiologia , Nefropatias/etiologia , Pancreatite Necrosante Aguda/complicações , Granuloma de Células Plasmáticas/diagnóstico por imagem , Granuloma de Células Plasmáticas/cirurgia , Humanos , Nefropatias/diagnóstico por imagem , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/diagnóstico por imagem , Pancreatite Necrosante Aguda/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
Urethral duplicity is a rare congenital malformation. We report a case of one 25 years old male suffering recurrent urinary infections. The diagnostic of uncompleted urethral duplicity was performed by retrograde urethrography and micturating cystourethrogram. The accessory channel was excised by a perineal approach. Clinical results were satisfactory, remaining an asintomatic patient two years after surgery, with normal mictional behavior.
Assuntos
Uretra/anormalidades , Doenças Uretrais/diagnóstico por imagem , Adulto , Técnicas de Diagnóstico Urológico , Humanos , Masculino , Radiografia , Resultado do Tratamento , Uretra/diagnóstico por imagem , Uretra/cirurgia , Doenças Uretrais/cirurgia , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
Presentation of a new alternative to the traditional percutaneous vesical approach using a laparoscopic trocar. This approach fulfils two purposes: the first one, to reduce the cost of vesical drainage (recyclable material); the second and more interesting one, to avoid draining surgical procedures and uretral lesions during mechanical vesical lithotripsy by using a direct percutaneous access. The difference between this method and the previous ones is not the access route but the materials used.
Assuntos
Drenagem/instrumentação , Laparoscópios , Desenho de Equipamento , HumanosRESUMO
OBJECTIVE: Evaluate the results of Nesbit's technique in patients with Peyronie's disease. METHODS AND MATERIALS: Between 1990 and 2002, 45 patients were treated using the Nesbit's procedure to correct Peyronie's disease curvature. Mean age was 57.6 (range 41-73). Dorso lateral incurvation was the most common. RESULTS: Total correction of the curvature in 40 patients (88%). High grade of satisfaction in 39 patients (86.66%). CONCLUSION: Nesbit's operation is an easy and effective surgical technique in the peyronie's disease for curvature correction.
Assuntos
Induração Peniana/cirurgia , Adulto , Idoso , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Urológicos/métodosRESUMO
Presentation as a novelty of the application of endoscopic methods in the display of the renal artery (angioscopy). Review of findings seen in the renal artery of a donor corpse with polytraumatism using direct view with a MiniScope-type rigid urethroscopy and the possible future application of this technique.
Assuntos
Angioscopia , Artéria Renal/anatomia & histologia , Cadáver , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Congenital mesoblastic nephroma is a benign renal tumour of uncertain histogenesis and characteristic histology that can be mistaken with Wilms' tumour and other mesenchymal neoplasias. It is nearly always diagnosed in the early months of life, and its presentation in adults and older children is very rare. Its benign behaviour justifies the diagnostic significance mainly to avoid over-treatment. This paper presents one case of mesoblastic nephroma in a 17-year old female which appeared as a large abdominal mass. The therapeutic approach was radical nephrectomy and, after a 2-year follow-up, the patient has been found to be disease free.
Assuntos
Neoplasias Renais , Nefroma Mesoblástico , Adolescente , Feminino , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Nefroma Mesoblástico/diagnóstico , Nefroma Mesoblástico/cirurgiaRESUMO
Increased production of prolactin by the pituitary is a factor to be taken into account as a cause of peneal erectile dysfunction (PED), which varies depending on the series from 1 to 16%. 1,2,7 We contribute in this paper one patient with infertility and erectile dysfunction secondary to a prolactin-producing pituitary tumour, prolactin plasma levels returning to normal after treatment with bromocriptine, which also achieved a remission of the clinical picture.
Assuntos
Adenoma/complicações , Disfunção Erétil/etiologia , Neoplasias Hipofisárias/complicações , Adulto , Humanos , MasculinoRESUMO
INTRODUCTION AND OBJECTIVES: To present our experience with Hydroflex and Dynaflex self-contained inflatable penile prosthesis. MATERIAL AND METHODS: Between october 1988 and december 2000 a total of 63 men underwent implantation of 8 Hydroflex and 55 Dynaflex penile prosthesis. The follow-up period ranged from 12 and 127 months (mean 54.5). RESULTS: A total of 124 cylinders were implanted (in 2 cases only 1 cylinder was implanted). During implantation 3 corpora cavernosun ruptures were present, but implantation was possible in 2. Specific complication rates after implantation were as follow: early infection, 3 patients (4.7%); late infection, 1 patient (1.6%); pain that needed readmission 2 cases (3.2%); mechanical device failure, 7 cylinders in 6 men (mean time 83.5 months). 7 men (11.1%) needed prolonged teaching time to operate the prosthesis. Only 6 men (9.5%) wer dissatisfied with the prosthesis. It was possible to change only 1 cylinder when needed. CONCLUSIONS: Self-contained inflatable prosthesis brings good results on long time use. The mechanical malfunction rate is low and it is possible to change only one cylinder if needed. An important number of patients need intensive and prolonged teaching time to obtain a successful result.
Assuntos
Prótese de Pênis , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de PróteseRESUMO
The introduction of new diagnosis techniques has made the study of the suprarenal gland much more accessible. In particular, ultrasonography, CAT and MRI have contributed to the increased detection of suprarenal masses by chance, and this raises problems when it comes to deciding the attitude to take to the diagnosis of these masses. We present nine suprarenal tumours, most of which appeared in the course of follow-up of patients suffering from carcinoma of the bladder. On detecting a suprarenal mass, we carry out a morphological study with CAT as well as determination of hormonal activity and puncture with cytology of the mass, according to the schema proposed by Copeland. We comment on the most significant clinical aspects and on the criteria of action proposed by various authors.
Assuntos
Adenoma/diagnóstico , Neoplasias das Glândulas Suprarrenais/diagnóstico , Carcinoma/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias das Glândulas Suprarrenais/urina , Idoso , Carcinoma/secundário , Seguimentos , Humanos , Neoplasias Renais , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ultrassonografia , Neoplasias da Bexiga UrináriaRESUMO
Evaluation on the incidence of Acute Renal Failure (ARF) from a total of 41 corpse renal graft receptors, 20 of which received perfusion with mannitol solution at 400 mOsm/kg (Group 1) and 21 the same mannitol solution plus allopurinol (Group 2). No significant differences were present between both groups when they were analyzed for ARF incidence (15% vs 23.8%); overall incidence was 19.5%. 24-hour initial diuresis was shown to be an excellent predictor for long-term graft functionality. We can conclude that the addition of mannitol to the perfusion solution contributes decisively to reduce post-transplantation ARF, while addition of allopurinol does not have further beneficial effects.
Assuntos
Injúria Renal Aguda/prevenção & controle , Alopurinol/administração & dosagem , Transplante de Rim , Manitol/administração & dosagem , Cadáver , Avaliação de Medicamentos , Quimioterapia Combinada , Rejeição de Enxerto/efeitos dos fármacos , HumanosRESUMO
Analysis of the indications for transplantectomy and its complications over a 12-year period. Over a total of 159 failure grafts, we performed 53 transplantectomies (33.3%). The percentage of complications was 16.9%. Three patients died (5.6%) during the more or less immediate post-operative period. In our experience, consistent and prolonged maintenance of immunosuppression should avoid the need for transplantectomy in a high percentage of grafts. Only 15 transplantectomies were made on 104 failure grafts after 6 months (14.4%). Our short but successful experience with embolization of 2 rejected grafts confirms the validity of this conservative alternative versus conventional surgical transplantectomy in selected cases.
Assuntos
Transplante de Rim , Nefrectomia , Complicações Pós-Operatórias/cirurgia , Humanos , Reoperação , Falha de TratamentoRESUMO
Between 1974 and 1988, 35 testicle germinal tumours, 16 seminomas and 19 non seminomas, were studied. Mean age in seminoma cases was 34 years and 26 in non seminoma cases; the former were mainly presented as located stages at the time of diagnosis (75%) while the latter were, on the contrary, mostly stages II and III. Following orchiectomy, all histologically pure seminomas received radiotherapy with the exception of two cases. All of them are presently free from the disease with an average follow-up of 2.8 years (range 0.5-5 Yr.) Radiotherapy continues to be proposed as first choice therapeutic action for siminomas in located stages, although we do not disagree with other more conservative possibilities. In the non seminoma group, all three patients diagnosed in stage I were clinically controlled without supplementary therapy, two of them having a recurrence during the first year of follow-up, but currently free of the disease after chemotherapy and surgery of residual masses. Of the three non seminoma patients in stage II, with negative post-orchiectomy markers, two underwent lymphadenectomy and the other one only chemotherapy. In the remaining group of non seminoma patients, and always after an orchiectomy, chemotherapy was performed as first choice therapy, although rescue lymphadenectomy was required in eight cases. Chemotherapy schemes with cisplatin have relegated to a second level any other therapy for the non seminoma patients. The excellent response and reduction of side effects allow the adoption of more conservative attitudes. This paper explains our retrospective study and, following a wide review of exiting literature, discussed any conflictive prognostic and therapeutic items.
Assuntos
Disgerminoma/terapia , Neoplasias Testiculares/terapia , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Perda Sanguínea Cirúrgica , Terapia Combinada , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Retrospective review of 126 urinary by-passes performed in our service over the last 15 years where efficacy and complications arisen from the ureteroileal by-passes, ureterosigmoidostomy and skin ureterostomy are analyzed. Patients were found to be pre-operatively homogeneous with no statistically significant differences with regard to age, renal function or previous radiotherapy, except in the case of ureterostomies which are always initiated from a poorer renal function and general condition. It was concluded that there was no difference between the various Bricker types according to the anastomosis, which allows joint a comparison with other groups. After three months, Bricker's showed better radiologic evolution than Goodwin's (p less than 0.08) and a statistically lower number of complication (p less than 0.05) therefore establishing they should be the choice procedure versus any other type of by-pass. Literature review with regard to results and conditions of container reservoirs and vesical substitutions, evaluating their contraindications within the neoplastic scope and/or psychosocial range, as well as comparing the reflux, stenosis and infection rates with our series, make the ureteroileal by-pass a technique entirely legitimate at present.
Assuntos
Derivação Urinária/métodos , Adolescente , Adulto , Idoso , Criança , Colo Sigmoide/cirurgia , Contraindicações , Estudos de Avaliação como Assunto , Feminino , Humanos , Íleo/cirurgia , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Ureterostomia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos , Derivação Urinária/psicologiaRESUMO
Presentation of a case of prostatic utriculus cyst which due to its size and the patient's history suggested a differential diagnosis with a urethral or vesical diverticulum. Awareness of frequent association to urethral malformations and azoospermia would be very useful when choosing a treatment strategy in such cases.
Assuntos
Cistos , Oligospermia/etiologia , Doenças Prostáticas , Adulto , Calcinose/etiologia , Cistos/complicações , Cistos/diagnóstico , Cistos/embriologia , Diagnóstico Diferencial , Divertículo/diagnóstico , Humanos , Hipospadia/complicações , Masculino , Ductos Paramesonéfricos/embriologia , Doenças Prostáticas/complicações , Doenças Prostáticas/diagnóstico , Doenças Prostáticas/embriologiaRESUMO
The arterial pseudoaneurysms are an infrequent complication or renal transplantation. Depending on her localization, are divided in intra and extrarenal. The first are relacionated with the practice of percutaneous needly biopsy. The seconds are associated with defects of vascular anastomose or infection onsurgical area (with relative precocious presentation). Presentation of case of a iliac pseudoaneurysm in non-functional kidney allograft embolizated ten years before. This pathology, for this clinic gravity, requires urgent surgical treatment.
Assuntos
Falso Aneurisma/etiologia , Artéria Ilíaca , Transplante de Rim/efeitos adversos , Adulto , Embolização Terapêutica , Humanos , Masculino , Fatores de TempoRESUMO
A case is described of a urethral foreign body of long evolution, introduced for masturbatory purposes and which had its clinical origins as a periurethral abscess. We comment on the diagnostic steps and the therapeutic attitude followed.
Assuntos
Corpos Estranhos/diagnóstico por imagem , Uretra , Abscesso/etiologia , Corpos Estranhos/complicações , Humanos , Masculino , Masturbação , Pessoa de Meia-Idade , Radiografia , Doenças Uretrais/etiologiaRESUMO
The etiology of retroperitoneal masses that can compress the bladder or the ureters and can result in urinary sings and symptoms is highly varied and may include both benign and malignant entities. This paper contributes one patient that presented with relapsing retrovesical mass with cystic features. The diagnosis from the pathoanatomical study was intestinal duplication.
Assuntos
Colo/anormalidades , Neoplasias Retroperitoneais/diagnóstico , Adulto , Colo/patologia , Colo/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Recidiva , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Bexiga UrináriaRESUMO
Primary actinomycosis of the bladder is an infrequent presentation of this condition. The main concern is obtaining a differential diagnosis from tumours of the bladder and the subsequent impact this has on the therapeutic choices. Contribution of one case report of a male patient with actinomycosis of the bladder, with remarks on relevant diagnostic (including differential diagnosis) and therapeutic data.