Catálogo de publicaciones - libros

Sexual activity provides great enjoyment and is very important for quality of life, but sometimes can be disastrous for a man. This occurred to our patient who fractured his penis during sexual intercourse when his extremely rigid penis slipped out of the vagina hitting the pubis of his female partner. The result of this accident was penile fracture with concomitant complete urethral rupture.

As with many surgical emergencies, the saying “time is tissue” holds true for priapism. This condition is a true urological emergency and early intervention provides the best chance of functional recovery. It has been described at nearly all ages. Idiopathic low-flow is chemic priapism in the pediatric population is extremely rare.

A 21-year-old African-American male was brought to the emergency room of a suburban community hospital following a motorcycle accident. The patient had sustained severe injuries, including a fracture of the right femur and a pelvic fracture. In the emergency room, a Foley catheter was placed without any evaluation of a possible urologic injury. The patient was taken to the operating room and the fracture of the femur repaired. On the third postoperative day, the Foley was removed but the patient experienced difficulty in voiding, at which time the catheter was reinserted. Another attempt at voiding was attempted 1 day later with similar results. At that point, it was noticed that the patient was septic and had severe perineal and lower abdominal swelling.

I recently treated an unconscious male who had suffered a small-caliber handgun gunshot wound to the pelvis and immediately had gross blood per urethra and inability to void. A retrograde urethrogram was obtained, which showed posterior urethral disruption. Per our protocol, we made a single unsuccessful attempt at gentle placement of a Foley catheter. Also per our usual protocol, the patient was then brought to the operating room for an attempt at endoscopic placement of a Foley catheter, or failing that, a suprapubic tube. During flexible cystoscopy, a large defect in the posterior urethra was seen, a defect that seemed much more than would be seen by a small-caliber bullet wound. While attempting to find the proximal urethra with the scope, a glint of shiny metal was seen (Fig. 21.29.1). Closer examination revealed the broken off tip of a knife! This explained why instead of a small, neat bullet hole in the urethral we found a completely divided urethra, cut in half by a thin knife that left little sign of skin entry.

Everyone knows that extraperitoneal bladder lacerations are usually benign. They most often heal spontaneously with a period of catheter drainage. However, they are not, I have found, always completely benign.

In a 63-year-old male, a cystectomy and continent urinary diversion were performed for muscle-invasive transitional cell carcinoma of the bladder. The postoperative course was uneventful and the patient was discharged from the hospital with a base excess of −0.5 mmol/l. He was instructed to drink at least 2 l of fluid per day and to increase his salt intake. Additionally, he received sodium bicarbonate 3 g orally per day.

A 21-year-old soldier was working out in his company’s gym. While practicing some wrestling techniques, he felt a sharp pain in the left testis. He completed his session and at the end of the session he reported his problem to his company’s paramedic. The latter warned him that he might lose his position on the wrestling team and gave him a non-steroid anti-inflammatory tablet. The pain eased for a few hours and the soldier returned to duty. During the night he awoke with great scrotal discomfort. When he presented to the infirmary, he had a large painful swelling in the left scrotum. The testis could not be palpated. He was transferred to the hospital and a Doppler ultrasound revealed a nonfunctioning left testis. Later the same night, exploration revealed torsion and a small hematoma of the left testis. Orchiectomy was carried out at the same time.

A 27-year-old resident in radiology presented in the urology department complaining of renal colic. He had a family history of renal lithiasis and reported frequent incidents of renal colic and spontaneous hematuria during the last 6 months. Anti-inflammatory medication had occasionally been given to him. He was advised to have an ultrasound examination. The ultrasound findings showed a medium dilatation of the left ureter and renal pelvis, several stones in the left kidney, 0.5−0.8 mm in size, and a 3.5×2.5-cm lesion on the bladder wall. A cystoscopy revealed a TCC close to the left ureteric orifice. The young radiologist had a TUR bladder 2 days later. Histopathologic examination confirmed the presence of a Grade 1, pTa TCC.

A 53-year-old male initially suffering from spinal cord injury was referred from another unit. He had a T8–T9 complete lesion due to a car accident dating from September 1996. Since then he had complete paraplegia. The urological management consisted in the use of an indwelling catheter followed by a condom collector. During rehabilitation, he had adapted well to the wheel chair. However, during progression of his condition he presented several symptomatic urinary tract infections and sacral scars. He was referred to our department 2 years later.

A 62-year-old male patient was diagnosed with prostate cancer after TRUS-guided biopsy prompted by a PSA level of 5.6 ng/ml. Pathological examination revealed adenocarcinoma of the prostate, a Gleason score of 3+3=6, and five out of 12 cores were positive for cancer. A baseline bone scintigraphy was negative for metastatic disease and abdominal ultrasonography revealed normal kidneys and bladder. After discussion of possible treatment options, he decided for radical retropubic prostatectomy, which was performed 6 weeks after the biopsy. The surgery and postoperative period were uneventful and his drain came out on postoperative day 3. Retrograde cystography was performed on day 7 and showed no extravasation and catheter removal was planned. However, after deflation of the Foley catheter balloon, it was not possible to withdraw the catheter. Further tension on the catheter produced significant pain and a small amount of bleeding per urethra. The catheter was then twisted 720° around itself to set it free, with no success. A repeat cystography confirmed the watertight anastomosis and complete deflation of the catheter balloon.