Challenging Clinical Case

Idiosyncratic reaction after injection of polyacrylate – polyalcohol copolymer

 Vol. 44 (x): 2018 February 2.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0446


Cristiano Linck Pazeto 1, Fábio José Nascimento 1, Lucila Heloisa Simardi Santiago 2, Sidney Glina 1
1 Departamento de Urologia, Faculdade de Medicina do ABC (FMABC), Santo André, SP, Brasil; 2 Departamento de Patologia, Faculdade de Medicina do ABC (FMABC), Santo André, SP, Brasil


Context: Polyacrylate-polyalcohol copolymer is a synthetic product, non-biodegrada­ble, with low rate of therapeutic failure and lower incidence of reactions at the site of injection, when compared to biodegradable agents. We report an unprecedent, exube­rant and persistent inflammatory reaction following injection of that substance.

Patient: a 17 years-old patient with vesico-ureteral reflux and complete pyelocaliceal right duplication was submitted to treatment with polyacrylate-polyalcohol copolymer (STING technique). In the seventh day of post-operatory, she presented intense dysuria and hypogastric pain, without laboratory exams alterations; a symptomatic treatment was started. After two months, the symptoms persisted and an ultrasound detected thickening of bladder wall close to the uretero-vesical junction. After that exam, a cys­tostopic biopsy showed epithelial hyperplasia with increased edema of lamina propria, suggesting an adverse reaction to the polymer. After four months, there was complete remission, but the reflux persisted with the same grade.

Hypothesis: This is an unprecedent reaction following injection of this copolymer. The presence of characteristics such as absence of infection, temporal relation between treatment and beginning of symptoms, and detection of epithelial hyperplasia at the local of injection reinforce the hypothesis of association of the substance and adverse reaction. In that...

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Laparoscopic approach to pheochromocytoma in pregnancy: case report

 Vol. 44 (x): 2018 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0540


Felipe de Almeida e Paula 1,2,3, Ravisio Israel dos Santos Junior 1,2,3, Odivaldo Antonio Ferruzzi 2, Rafael Osti de Melo 3, Mariana Takaku 1,2
1 Hospital Regional do Câncer de Presidente Prudente, Presidente Prudente, SP, Brasil; 2 Santa Casa de Misericórdia de Presidente Prudente, Presidente Prudente, SP, Brasil; 3 Faculdade de Medicina de Presidente Prudente, Universidade do Oeste Paulista, Presidente Prudente, SP, Brasil


A 32-year-old 22-week pregnant hypertensive woman with sporadic episodes of headaches, sweating, and facial flushing was diagnosed with pheochromocyto­ma through biochemical and imaging tests. Perioperative management included a multidisciplinary approach, symptom stabilization with ɑ blockade followed by ß blockade, and tumor resection by laparoscopic adrenalectomy at 24 weeks gesta­tion. The diagnosis was confirmed by histopathological examination and immuno­histochemistry tests. The decision for surgical removal of the tumor was based on maternal symptoms, tumor size, gestational age, the possibility of doing a laparos­copy, and the expertise of the surgical team.

Keywords: Pheochromocytoma; Pregnancy; Laparoscopy

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Salvage surgical procedure for artificial sphincter extrusion

Vol. 44 (x): 2018 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0462


Flavio Trigo Rocha 1, Jean Felipe Prodocimo Lesting 1
1 Centro de Incontinência Urinaria, Hospital Sírio Libanês, SP, Brasil


Case Hypothesis: Surgical removal is the standard treatment for artificial sphincter extrusion. However in some specific situations is possible to maintain the prosthesis with good results.

Case report: We report a 60 years old patient presenting sphincter pump extrusion one month after artificial urinary sphincter (AUS) AMS 800™ placement for treating post-radical prostatectomy urinary incontinence (PRPUI). He also had a penile prosthesis implant one year before that was replaced in the same surgery the sphincter was implanted. As patient refused sphincter removal and there were no signals of active infection he was treated by extensive surgical washing with antibiotics and antiseptics.

Pump was repositioned in the opposite side of the scrotum. Patient had good evolution with sphincter activation 50 days later. After 10 months of follow up, patient is socially continent and having regular sexual intercourse. Savage surgery may be an option in select cases of artificial sphincter extrusion.

Promising future implications: Like in some patients with penile prosthesis some patients with artificial sphincter extrusion can be treated without removing the device.

This may be a line of research about conservative treatment of artificial sphincter complications.

Keywords: Urinary Incontinence; Surgical Procedures, Operative; Urinary Sphincter, Artificial

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Spermatozoa retrieval for cryopreservation after death

Vol. 44 (1): 188-191, January – February, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0249


Fernando Lorenzini 1, Eduardo Zanchet 1, Gustavo M. Paul 1, Ricardo T. Beck 1, Mariana S. Lorenzini 1, Elisângela Böhme 1

1 Centro de Reprodução Humana Curitiba, PR, Brasil


Objectives: To describe the retrieval spermatozoa technique for cryopreservation after death, including the proximal part of vas deferens.
Material and Methods: A 28-years old man, with previous history of infertility, who died 12 hours ago, was submitted to spermatozoa retrieval for cryopreservation, with surgical bilateral resection in bloc of the proximal part of vas deferens, testicle and epididymis. At the laboratory, by milking the epididymis and vas deferens, the ex¬tracted fluid was collected; also, three samples of each testicle parenchyma were also harvested.
Results: The fluid from the vas deferens showed spermatozoa, mostly with in situ motility. Testicular fragments also presented spermatozoa, mostly with small tail movements or immobile.
Conclusion: The inclusion of the proximal part of vas deferens during spermatozoa retrieval after death must be performed, since it contains high concentration of sper¬matozoa, and even in the presence of previous infertility, as was with this patient, it is possible to retrieve spermatozoa.

Keywords: Cryopreservation; Spermatozoa; Vas Deferens; Testis

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Prostate cancer recurrence in vas deferens – fusion image guide as an important tool in dignosis

Vol. 44 (1): 192-195, January – February, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0071


Leonardo Guedes Moreira Valle 1, Antônio Rahal Jr. 1, Priscila Mina Falsarella 1, Juliano Ribeiro de Andrade 1, Oren Smaletz 2, Akemi Osawa 3, Rodrigo Gobbo Garcia 1
1 Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, Brasil; 2 Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, Brasil; 3 Departamento de Medicina Nuclear e Radiologia, Hospital Israelita Albert Einstein, São Paulo, Brasil


The biochemical recurrence after local treatment for prostate cancer is an often chal­lenging condition of clinical management. The aim of this report is to demonstrate the importance of the association of various imaging methods in the identification and subsequent accurate percutaneous biopsy in patients with recurrence of prostate cancer, especially in unusual sites.

An 86 years old male with biochemical recurrence, during radiological investigation a PET-MRI was noted the presence of an asymmetry of the vas deferens with PSMA- 68Ga uptaken, suggesting the recurrence. A percutaneous fusion biopsy with PET-MRI and ultrasound was performed using transrectal access using ultrasound confirming infiltrating adenocarcinoma of the wall of the vas deferens, compatible with neoplastic prostate recurrence.

The fusion image technique combines the real-time view of the US to the possibility of higher definition and higher specificity, methods more anatomical detail as tomography and magnetic resonance imaging, simultaneously.

High resolution acquired in PET / MR associated with image fusion allows orienta­tion procedures, even in...

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Inflammatory pseudotumor of kidney: a challenging diagnostic entity

Vol. 44 (1): 196-198, January – February, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0063


Anudeep Mukkamala 1, Robin M. Elliott 2, Nicholas Fulton 3, Vikas Gulani 3, Lee E. Ponsky 1, Riccardo Autorino 1
1 Department of Urology, UH Case Medical Center, Cleveland, Ohio, USA; 2 Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio, USA; 3 Department of Radiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA

No abstract available

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