Challenging Clinical Case

Laparoscopic management of paraganglioma in a pregnant woman: a case report

Vol. 44 (5): 1032-1035, September – October, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0698


Mohammad Hadi Radfar 1, Behnam Shakiba 1, Amir Afyouni 1, Hassan Hoshyar 1
1 Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Introduction: Paraganglioma is an extremely rare catecholamine-producing tumor during pregnancy. Paraganglioma carries high risks of fetal and maternal mortality during pregnancy. We report a pregnant woman with paraganglioma in the second trimester.

Case Description: A 24-year-old pregnant woman presented with severe hypertension in the 17th week of gestation. Hormonal examination and Magnetic Resonance Imaging (MRI) confirmed the diagnosis of extra adrenal pheochromocytoma (paraganglioma). She underwent laparoscopic tumor excision successfully.

Conclusions: A high index of suspicion is needed to diagnose paraganglioma in a pregnant patient with hypertension. Laparoscopic tumor removal for paraganglioma seems to be a feasible and safe procedure during pregnancy.

Keywords: Laparoscopy; Paraganglioma; Pregnant Women

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Neovagina construction and continent cutaneous urinary reservoir using a previous orthotopic ileal neobladder

Vol. 44 (5): 1036-1041, September – October, 2018

doi: 10.1590/S1677-5538.IBJU.2018.0005


Cinthia Alcántara-Quispe 1, Roberto Dias Machado 1, Wesley Justino Magnabosco 1, Alexandre Cesar Santos 1, Eliney Ferreira Faria 1
1 Departamento de Urologia, Hospital do Câncer de Barretos, Barretos, SP, Brasil


Standard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoid¬ing complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome.
This article reports a different surgical approach: a patient who underwent a cutane¬ous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula.
In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neoblad¬der fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.

Keywords: Urinary Bladder Neoplasms; Cystectomy; Urinary Reservoirs, Continentx

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Accidental cystectomy during laparoscopic excision of prostatic utricle cyst – a rare complication

Vol. 44 (4): 826-830, July – August, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0284


Vikash Kumar  1, Chirag Punatar 1, Kunal Jadhav  1, Sharad Sagade 1
1 Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India


Prostatic utricle cyst is a rare congenital anomaly. Symptomatic cysts require treat­ment. Surgical excision is the treatment of choice, but is challenging due to close prox­imity to vas deferens, ejaculatory ducts, bladder, prostate, rectum and pelvic nerves. Complications include rectal injury, ureteral injury, impotence, infertility and faecal incontinence. We here report a rare complication in which bladder was accidentally re­moved during laparoscopic excision of prostatic utricle cyst. To best of our knowledge such a complication has never been reported previously. We also describe the possible cause of this accident and suggest ways to prevent this disastrous complication.


Keywords: Cystectomy; Intraoperative Complications; Prostate

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Idiosyncratic reaction after injection of polyacrylate – polyalcohol copolymer

Vol. 44 (4): 831-834, July – August, 2018

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 (3): 629-633, May – June, 2018

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 (3): 634-638, May – June, 2018

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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