2. Médico Assistente Doutor, Chefe do Grupo de Pronto Socorro -HC-FMUSP. 3. Médico Assistente Doutor, HC-FMUSP. 4. Médico Residente em Urologia, HC-FMUSP. 5. Médico Preceptor de Urologia, HC-FMUSP. Cury J, Mesquita JLB de, Pontes J, Oliveira LCN de, Cordeiro M, Coelho RF. Trauma urológico. Rev Med (São Paulo). 2008 jul.-set.;87(3):184-94. RESUMO:Os traumas geniturinários representam 10% de todos os traumas em nosso serviço de emergência (HC-FMUSP). O rim é, em geral, o órgão mais freqüentemente envolvido, sendo os traumas de ureter e bexiga mais raros e associados a traumas de alta energia e a outras lesões severas concomitantes. As lesões de ureter são causadas em sua maioria por traumas penetrantes ou por lesões cirúrgicas iatrogênicas. As lesões de uretra, por sua vez, são quase sempre associadas a fraturas do anel pélvico, estando associadas a lesões vesicais em 10 a 17% dos casos. Um princípio primordial a ser aplicado no diagnóstico do trauma urológico é suspeitar-se da lesão pela avaliação do seu mecanismo e das forças envolvidas no traumatismo, pois os sinais envolvidos são inespecífi cos, principalmente em vítimas de trauma fechado. O conhecimento da etiologia, fi siopatologia, diagnóstico e tratamento das principais lesões traumáticas do trato urinário é fundamental para a abordagem adequada do paciente politraumatizado no serviço de emergência. A interação do urologista com o cirurgião do trauma desde os momentos iniciais do atendimento permite guiar as decisões terapêuticas de maneira integrada e congruente. Neste artigo discutiremos os aspectos centrais do diagnóstico e do tratamento das principais lesões do trato geniturinário (TGU). DESCRITORES:Traumatismo múltiplo/complicações. Trato urinário/lesões. Trato urinário/cirurgia. Bexiga urinária. Ferimentos e lesões. Uretra/lesões. 184 Seção Aprendendo 185 Cury J, Mesquita JLB de, Pontes J, Oliveira LCN de, Cordeiro M, Coelho RF. Trauma urológico.
A 23-year-old male with a history of bone marrow transplant for acute myeloid leukemia. He presented a large mass in the right inguinal region 5 years ago. Upon physical examination, right-sided cryptorchidism was observed. The tumor markers alpha-fetoprotein and beta-HCG were within normalcy range and lactate dehydrogenase was raised. Computed tomography of the abdomen and pelvis revealed right testicular mass in contiguity with the inguinal canal to the ipsilateral retroperitoneum, associated with right hydronephrosis. Due to the risk of germ-cell tumor in undescended testicle, the patient underwent radical right orchiectomy. The pathological examination showed recurrence of acute myeloid leukemia in the testis. He was referred to oncology for adjuvant therapy. Our literature review found no similar cases described.
The present 67-year-old male had clinically localized prostate cancer and needed a perineal radical prostatectomy.He also needed prosthesis implantation for severe erectile dysfunction. We describe a new perineal access for implantation of a malleable penile prosthesis during the prostatectomy surgery that does not require a second incision. The prostatectomy technique was not altered. Prosthesis implantation began after removal of the prostate and before performing the vesicourethral anastomosis. The procedure is described. Dilatation of the cavernous bodies and prosthesis implantation were performed without technical problems. Transoperative bleeding was similar to that observed for prosthesis implantation through a penile access. No shortening of the urethral stump was observed and vesicourethral anastomosis was performed without difficulty. Surgical time was 40 minutes. Use of the same access for the 2 procedures is easy and has low morbidity. This approach should be considered by other surgeons for patients with prostate cancer and severe erectile dysfunction.
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