Actas urologicas españolas
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Three factors in extracorporeal shock-wave lithotripsy (ESWL) result in pain: shock wave pressure, size of focal area and pressure distribution at entry in the skin. Our Lithotripsy Unit has performed 21,000 outpatient treatments (Dornier HM-4 Lithotripter) with no sedation or anaesthetics. Pain requiring treatment discontinuation resulted in 10% instances. Anxiety-associated pain increases the perceived intensity of pain and influences the emotional response to pain. ⋯ SWEL is a painful therapy (95% of sample had mild-to-moderate pain); pain perception is increased by status of anxiety (45% of pain variance) more than by the trait of anxiety (26.3%); therefore, usage of sedation-analgesia in patients with high anxiety status would improve the lithotripter efficacy ratio.
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The fracture of the penis is an uncommon injury that is defined as a rupture of the tunica albuginea of the corpus cavernosum. We present our experience in 9 cases admitted to our department between 1989 and 1998. Most of the cases were caused by traumatism during sexual intercourse. Clinical presentation and physical examination were enough to make the diagnosis. The treatment was surgery in all cases, with evacuation of the hematoma and reconstruction of the rupture with absorbable suture. The result about penile function and curvature was excellent in all cases. There was no cases of penile incurvation nor erectil disfunction. ⋯ In our experience, surgical management of the penile fracture has good results, with no erectil disfunction, nor penile incurvation.
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Review Case Reports
[Rupture of the corpora cavernosa: its therapeutic assessment and management].
The traumatic rupture of cavernous bodies is an uncommon condition that always takes place with an erected penis, the most frequent etiology being an untimely vaginal intercourse, due to the greater vulnerability of the penis in such situation, resulting from contained trauma by direct external forces. The distinctive presenting signs are a "snap", immediate detumescence, pain, deformity, bruise and deviation contralateral to the lesion. The bruises will be limited to the penis in the presence of Buck's fascia integrity. This paper contributes one case of rupture of right cavernous body, explaining its typical etiology, signs and symptoms, and examination of the patients who underwent emergency surgery. ⋯ The differential diagnosis should be done versus rupture of the penis dorsal vein, which causes identical signs and symptoms. NMR is considered as the best imaging test, although is still quite unaffordable. Standard ultrasounds do not rule out the diagnosis. Under suspicion of associated urethral damage, retrograde urethrography is warranted. Cavernosonography has very specific indications and should be avoided whenever possible. Choice treatment will be emergency revision and surgical repair. Suture of involved cavernous body must be done with loose stitches of absorbable material. Antibiotic prophylaxis is indicated in cases of concomitant urethral involvement.
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Review Case Reports
[Giant calcifications of a double-J ureteral catheter].
We present a case of recurring gigantic calcifications of both extreme of a double-J ureteral catheter, with long permanency of the same. We expose the technical maneuvers that were specified for the managing of so important complication. We emphasize the renal functional conservation found in spite of the magnitude of the calcifications. We check the national literature in this regard of this complication and we expose the etiological mechanisms, prophylactic recommendations and therapeutic managing of this complication to the extended use of ureteral catheters.
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Pelvic trauma is associated in a high rate of patients with posterior urethral injuries. Blood at the urethral meatus or the inability to void are suspicious of urethral damage, but their absence do not exclude it. The attempt to pass a urethral catheter can worse a previous injury. ⋯ There was 60 urethral injuries among 565 pelvic trauma (10.61%); 15 (25%) grade I were associated with trauma of the posterior ring of the pelvis; 17 (28.3%) grade II were associated in 12 cases with fractures of the anterior ring and in 5 cases with severe fractures of the posterior ring; 28 (46.66%) grade III were associated in 26 cases with fractures of the anterior ring and 2 fracture-luxation of the posterior one. Against the suggest of avoiding the attempt of passing a urethral catheter, nearly all patients had suffered and attempt before the urologist were asked for. The deferred combined urethrography was the best method of urethral evaluation.