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In April 1979, a 68-year-old woman underwent a hysterectomy for a huge myoma. Anuria ensued immediately, which proved resistant to diuretics and aggressive hydration. Three days later, a urologic consultation was requested by the gynecologists and she was referred to the urological department of La Paz University Hospital in Madrid. The exam revealed an obese patient with severely distended abdomen, signs of ascites, arterial hypertension (190/100 mmHg), moderate acidosis (pH 7.25), blood creatinine 2.80 mg/dl, K 5.5 nmol/l, Na 130 nmol/l, and mild hypocalcemia (7.9mg/dl). Ultrasound revealed a left dilated upper urinary tract and intraperitoneal fluid. An IVU showed bilateral nephrogram in early films, but very poor concentration of the contrast medium in the excretory phase prevented an accurate diagnosis. In delayed films, the entire peritoneal cavity appeared to be filled with contrast, which outlined a distended stomach and some intestinal loops, but hindered the visualization of the urinary tract (Fig. 21.16.1). A section of one of the ureters, with intraperitoneal urine leakage, was suspected, and to confirm the suspicion a bilateral retrograde ureteral catheterization was undertaken.

In the evening of February 26, 1991, a 25-year-old man presented at the emergency unit of La Paz University Hospital of Madrid with swelling and subcutaneous ecchymoses of the penis and scrotum (Fig. 21.17.1). He said that in the heat of sexual intercourse he had hit the mons pubis of his partner with his erect penis, then heard an audible crack and experienced pain and immediate detumescence.

A 64-year-old Jehovah’s Witness with initially no coagulation defect and no anemia suffered from severe hematuria from a bladder tumor, so that a transurethral monopolar electrocoagulation and insertion of an irrigation Foley catheter was performed under general anesthesia. After the procedure, the irrigational solution showed no further bleeding.

Roughly 10 years ago, I was invited to operate in Iran to treat a number of urological problems relating to war wounds during the Iran-Iraq war. On the first day, I was taken on a ward round and the first patient I saw was standing smartly to the side of his bed holding a urine drainage bag on the end of a suprapubic catheter. I was told that he had a prostatorectal fistula as a result of a gunshot wound and was shown an x-ray with a bullet perfectly in place between his rectum and bladder. Contrast studies confirmed that the bullet was in a cavity that communicated with the rectum and the prostate. I was told that everything else was normal. He told me he had feces in his urine and he was very glad that I had come over from England to fix it, as he had had three failed operations over the previous 4 years.

I have encountered vena caval problems on two different occasions during my lifetime. Fortunately, all caval injury cases were successfully managed. In this brief presentation, I will explain how I was able to secure the caval injury without losing the patient.

I have seen two circumstances in my lifetime where a patient with transitional cell cancer (usually well advanced) has presented with significant leukocytosis and fever. The very presence of these two findings would keep your medical consultants from allowing you to intervene surgically in such cases for fear of engendering urosepsis. However, after seeing that both blood and urine cultures are negative, and instituting a raft of antibiotic support, there comes a time when one should respect the fact that leukocytosis and febrile reactions are common in advanced TCC.

In the majority of cases, bleeding during a laparoscopic procedure can be managed conservatively. Initial compression and subsequent suture are the best way to handle the problem. The situation is different when there is substantial bleeding from major vessels, most frequently venous vessels. These are true vascular emergencies, when the surgical team must work as a unit and everything needed has to be readily available.

After visiting several university hospitals in Germany to watch the percutaneous nephrolithotomy (PCNL) procedures, a colleague and I planned to return to Madrid with the desire to start this technique in our university hospital.

We describe a singular experience that I had not seen before nor since. I have not read a similar case report in the urologic literature.

Twenty-five years ago, open discussion of sex in our country (Spain) was taboo; nobody talked about it and there were no office visits for impotence.