Manuel Cerqueira

Gangrena de Fournier: de urgencia urológica hasta el departamento de cirugía plástica

Resumen La gangrena de Fournier (GF) es una enfermedad infecciosa rara y potencialmente fatal, caracterizada por fascitis necrotica del perine y la pared abdominal junto con el escroto y el pene en los varones y la vulva en las mujeres. La perdida de piel puede ser muy incapacitante y de dificil resolucion. El tratamiento de esta entidad debe ser agresivo. Se han usado varias tecnicas para reconstruir la perdida de tejidos: injertos cutaneos, transposicion de los testiculos y del cordon para una bolsa subcutanea en el muslo, colgajo pediculado musculocutaneo, fasciocutaneo o varios otros tipos de colgajo pediculados miocutaneos. El pediculo cutaneo superomedial del muslo es un pediculo arterial probable y demostro ser un metodo eficaz en la reconstruccion de grandes defectos escrotales.

Fournier's gangrene: from urological emergency to plastic surgery

Fourniers gangrene (FG) is a rare and potentially fatal infectious disease characterised by necrotic fasciitis of the perineum and abdominal wall in addition to the scrotum and penis in men and the vulva in women. Skin loss can be very damaging and difficult to repair. This condition must be treated aggressively. Several techniques are used to reconstruct lost tissue: skin grafts, transposition of the testicles and spermatic cords to a subcutaneous pocket in the upper thigh, scrotal musculocutaneous flaps, fasciocutaneous flaps and several other types of pediculated myocutaneous flaps are all employed. The supero-medial thigh skin flap is a likely arterial flap and has been shown to be an effective method for reconstructing large scrotal defects.

Sling bulbouretral. Experiencia del servicio

Objectives The authors present the clinic results obtained with the bulbourethral sling application with pubic bone anchorage (Invance®) in patients with stress urinary incontinence.

Siringocele imperforado de las glándulas de cowper. tratamiento por vía laparoscópica

Resumen Siringocele imperforado de las glandulas de cowper. tratamiento por via laparoscopica Objetivo Los autores presentan el caso clinico de un siringocele imperforado, diagnosticado en un adulto y tratado por cirugia laparoscopica. Material y metodos Paciente de 44 anos que acude al Servicio de Urgencia por retencion urinaria aguda y antecedente de leves sintomas obstructivos del aparato urinario inferior. Presenta al toque rectal tumefaccion de la pared rectal izquierda. El enfermo fue sometido a uretrocistoscopia, ecografia y uretrografia retrograda. El diagnostico se obtuvo con Tomografia Computerizada y Resonancia Magnetica Nuclear. Resultados La marsupializacion del siringocele por via laparoscopica permitio la resolucion del cuadro clinico con buena evolucion post-operatoria. El paciente tuvo alta hospitalaria a las 48 horas sin necesidad de sonda vesical. Tras seis meses de seguimiento se encuentra asintomatico. Conclusiones El siringocele es una deformidad rara que habitualmente no provoca sintomas. Puede ser de etiologia congenita o adquirida, clasificandose en tres tipos morfologicos: simple, imperforado, perforado o roto. El tratamiento mas frecuentemente utilizado es la marsupializacion por via endoscopica dejando una abertura amplia de la cavidad para la uretra. Algunos autores recomiendan su escision por cirugia abierta, especialmente cuando forma absceso. El abordaje laparoscopico constituye una alternativa minimamente invasiva con buenos resultados. En los casos asintomaticos diagnosticados incidentalmente se debe optar por una actitud expectante.

Tumor fibroso solitario. Dos casos adicionales con implicaciones urológicas

Resumen El termino tumor fibroso solitario designa una entidad patologica bien definida. Inicialmente descrito como tumor pleural, el aparecimiento de estas neoformaciones en otras localizaciones ha comenzado a ser descrito con mayor frecuencia. Actualmente se acepta la posibilidad de que estas neoplasias se puedan desarrollar virtualmente en todos los departamentos anatomicos. La rareza de esta patologia no ha permitido hasta el momento esclarecer su histogenesis, asi como otros aspectos relacionados con el comportamiento clinico, aspectos de tratamiento y de definicion de pronostico. El diagnostico diferencial es importante, particularmente cuando la localizacion es extratoracica, para evitar confundirlo con neoplasias mesenquimatosas notablemente mas agresivas. Los autores presentan dos casos adicionales de este tipo de neoplasia. En el primer caso la neoplasia se localizaba en la pelvis y fue responsable por uropatia obstructiva, descubierta accidentalmente en el transcurso de un traumatismo renal. El segundo caso es referente a un tumor de este tipo histologico localizado a nivel del cordon espermatico. A proposito de los mismos se realiza una revision del tema, teniendo como base la literatura disponible.

Angiomixoma agresivo penoescrotal

Resumen Angiomixoma agresivo designa una neoplasia mesenquimatosa extremadamente rara. Afecta casi exclusivamente estructuras genitales, pelvicas o perineales de pacientes de sexo femenino, siendo muy raros los casos que envuelven el sexo masculino. Se trata de neoformaciones bien caracterizadas desde el punto de vista histologico y de comportamiento benigno. Los autores presentan un caso clinico de un tumor de este tipo en un adulto joven de sexo masculino con envolvimiento penoescrotal de grandes dimensiones implicando exeresis y reconstruccion compleja, con recurso a colgajos e injertos cutaneos. Es igualmente realizada una revision bibliografica exhaustiva sobre el tema englobando aspectos etiopatogenicos, clinicos, de imagen, anatomo-patologicos y de diagnostico diferencial, asi como terapeuticos y de pronostico.

Adenocarcinoma mucinoso primário de pélvis renal: caso adicional

Mucinous adenocarcinoma of the renal pelvis may be classified as among the rarest neoplasms of the genitourinary tract. Until the present moment just a few dozen cases have been reported previously. Despite the known association with chronic inflammatory conditions of the upper urinary tract, the exact pathogenesis remains unknown. The authors report an adicional clinical case with particular aspects in what concerns differential diagnosis. A review of the available literature concerning clinical, imagiologic, therapeutic and prognostic aspects is also presented.Mucinous adenocarcinoma of the renal pelvis may be classified as among the rarest neoplasms of the genitourinary tract. Until the present moment just a few dozen cases have been reported previously. Despite the known association with chronic inflamatory conditions of the upper urinary tract, the exact pathogenesis remains unknown. The authors report an adicional clinical case with particular aspects in what concerns diferencial diagnosis. A review of the available literature concerning clinical, imagiologic, therapeutic and prognostic aspects is also presented.

Isquemia renal aguda - causa rara de lumbalgia

ACUTE RENAL ISCHEMIA - UNUSUAL CAUSE OF LUMBAR PAIN Acute renal artery occlusion is rarely found in daily clinical practice. Its rarity and inespecific clinical presentation are responsible for late diagnosis or diagnostic errors, with symptoms frequently being erroneously attributed to other more common entities. There is no consensus in what concerns therapeutic options. Multiple treatment modalities are described in the available literature. Some defend anticoagulant therapy and support measures only while others recommend other more invasive alternatives reaching even open surgery. The authors present two additional case reports of acute embolic renal ischemia. A thorough literature review is also presented comprehending etiological, clinic, diagnostic and therapeutic aspects.

Lipossarcoma do Cordão Espermático

Introduction: Spermatic cord liposarcomas are rare diseases, with only a few reported studies published. In this study we present 2 clinical cases of spermatic cord liposarcoma. Case Report: Case 1: A 76-years-old man was evaluated for a painless left inguinal mass. Imaging studies demonstrated a solid mass, of 38 x 31 cm, located in the left inguinal region. Case 2: A 55-years-old men, evaluated for a painless left scrotal mass, with imaging studies demonstrating a solid lesion of 28 x 27 mm near the left testicle. Both patients underwent left radical orchiectomy, with wide local excision. Histological examination revealed liposarcoma in both situations and the patients performed adjuvant radiotherapy. The patients remain free of disease during follow-up, of eight years in case 1 and four years in the case 2. Conclusion: The recommended treatment of spermatic cord liposarcomas is radical orchiectomy with wide local excision. Adjuvant radiotherapy can reduce de incidence of local recurrence. Considering the recurrence probability, a long follow- up period is recommended for these patients.

Hyperbaric oxygen for long-term complications of radiation cystitis

Introduction Bladder complications may be seen in up to 12% of patients treated with pelvic irradiation. To report the long-term efficacy of hyperbaric oxygen therapy (HBOT) on radiation-induced cystitis. Methods We followed 70 patients diagnosed with radiation cystitis submitted to HBOT in our institution from 2007 to 2013. All patients answered a questionnaire documenting symptom severity pre-HBOT and at the end of the follow-up period using the Late Effects of Normal Tissues – Subjective, Objective, Management, Analytical (LENT-SOMA) scale. Our treatment protocol consisted of multiple sessions (median of 40) of 100% oxygen delivery in a multiplace hyperbaric chamber at 2·4 atm for 80 minutes. Results With a median follow-up of 55·5 (4–85) months, the success rate after the follow-up period in terms of haematuria resolution or improvement was 91·4%. The mean score of each subjective variable of LENT-SOMA scale (dysuria, frequency, haematuria, incontinence) were significantly lower after the follow-up period ( p p =0·14). The sum of all subjective scores of LENT-SOMA scale was also significantly lower after the follow-up period ( p Conclusions Our results highlight the safety and long-term benefits of HBOT on haemorrhagic radiation cystitis and other distressful bladder symptoms.