First Case Described in the Medical Literature: Male Urethral Sarcoidosis. Description of a Case and Review of the Literature.

OBJECTIVE: Although the sarcoidosis is a multisystemic disease that theoretically can affect almost any organ, the presence of sarcoidosis in the male urethra has not been described in the medical literature. We present the first male case of urethral sarcoidosis. METHOD: A 46 years old male undergoing follow up due to lower urinary tract symptoms was diagnosed of endobronchial sarcoidosis during the preoperative study for internal urethrotomy. After surgery, he presented clinical improvement for one year. Given the worsening, a new internal urethrotomy was tried. As it was impossible due to complexity they took a biopsy of the urethra. The pathology report described non-caseating granulomas compatible with sarcoidosis. After that, medical and endoscopic management of the urethral sarcoidosis was attempted. As it didn't achieve an adequate control, the patient was derivate to the "complex urethral unit" of the Cruces University Hospital. Once it was valuated, it was decided to start immunotherapy and subsequently an urethroplasty with a double oral mucosa graft was performed. OUTCOMES: During the postoperative period, a urethral catheter was maintained for two weeks. It was removed after no urinary leakage was observed in de cystourethrography. After that the patient remains with good evolution until today. CONCLUSIONS: Urethral affectation by sarcoidosis is a therapeutic challenge itself. For a better symptom control and to reduce the recurrences, a dual approach using systemic treatment in combination with local surgical treatment seems necessary.

[Fungal aneurysm with ileal conduit fistula to external iliac artery: Complication following laparoscopic radical cystoprostatectomy.] / Aneurisma micótico y fístula arteria ilíaca externa-ureteroileostomía Bricker: complicación post cistoprostatectomía radical laparoscópica.

OBJECTIVE: Despite the high frequency of complications after a radical cystoprostatectomy, the presence of a fistula that communicates the external iliac artery and the ureteroileostomy has not been described in the medical literature. We present the diagnosis and medical management of a massive hemorrhage through the Bricker´s ostomy due to an external iliac artery´s mycotic aneurysm  fistulized to the ureteroileostomy. METHOD: A 78 years old patient under went laparoscopic radical cystoprostatectomy with Bricker-type urinary diversion due to muscle-invasive bladder cancer. During the immediate pos toperative period he presented different complications including sepsis caused by a pelvic collection. Due to a massive hemorrhage through Bricker´s ostomy he went to the emergency department where was diagnosed by CT of active bleeding from right external iliac artery to the interior of the ureteroileostomy. We decided to perform exploratory laparotomy showing an aneurysm with fistulous orifice communicating the medial external iliac artery to Bricker ureteroileostomy. A femoro-femoral bypass, ligation of two centimeters of the external iliac artery, closure of the Bricker´s orifice and right cutaneous ureterostomy was needed. RESULTS: After the surgery, the patient required renal replacement therapy and vasoactive drugs. Discharge from the hospital was 11 days after the intervention. CONCLUSIONS: The presence of an uncontrolled arterial fistula implies urgent care in a pathology such as the mycotic aneurysm that already constitutes a challenge. Fast diagnosis and surgical skills are essential to increase patient's survival chances.

OBJETIVO: Pese a la alta frecuencia de complicaciones tras la cistoprostatectomía, no ha sido descrita en la literatura médica una fístula que comunique arteria iliaca externa y ureteroileostomía. Presentamos un caso de hemorragia masiva a través de la ostomía de la ureteroileostomía Bricker debido a un aneurisma micótico de arteriailiaca externa fistulizado a la ureteroileostomía.MÉTODO: Paciente de 78 años intervenido de cistoprostatectomía laparoscópica con derivación Bricker debido aneoplasia vesical infiltrante. Durante el postoperatorio inmediato presentó diferentes complicaciones destacando la sepsis debido a una colección pélvica. Acudió a urgencias  por hemorragia masiva a través de ostomía de Bricker siendo diagnosticado mediante TC de sangrado activo desde arteria iliaca externa a interior de ureteroileostomía. Ante los hallazgos se decidió cirugía abierta urgente donde se apreció aneurisma con orificio fistuloso comunicando cara medial de arteria iliaca externa con asa de Bricker de medio centímetro de diámetro. Fue necesario ligar dos centímetros de arteria iliaca externa, realizar bypass fémoro-femoral, cierre de orificio en asa de Bricker y ureterostomía cutánea derecha. RESULTADO: Durante el postoperatorio requirió terapia renal sustitutiva, drogas vaso activas y cuidados en reanimación tras lo cual presento mejoría clínica y analítica decidiéndose alta 11 días tras la intervención. CONCLUSIONES: La presencia de una fístula arterial no controlada supone actuar de manera urgente ante una patología como el aneurisma micótico que ya de por sí supone un reto. La sospecha clínica, la rapidez del diagnósticoy la habilidad quirúrgica suponen piezas clave para aumentar las posibilidades de supervivencia del paciente.

Aneurisma micótico y fístula arteria ilíaca externa-ureteroileostomía Bricker: complicación post cistoprostatectomía radical laparoscópica / Fungal aneurysm with ileal conduit fistula to external iliac artery: Complication following laparoscopic radical cystoprostatectomy

OBJETIVO: Pese a la alta frecuencia de complicaciones tras la cistoprostatectomía, no ha sido descrita en la literatura médica una fístula que comunique arteria iliaca externa y ureteroileostomía. Presentamos un caso de hemorragia masiva a través de la ostomía de la ureteroileostomía Bricker debido a un aneurisma micótico de arteriailiaca externa fistulizado a la ureteroileostomía. MÉTODO: Paciente de 78 años intervenido de cistoprostatectomía laparoscópica con derivación Bricker debido aneoplasia vesical infiltrante. Durante el postoperatorio inmediato presentó diferentes complicaciones destacando la sepsis debido a una colección pélvica. Acudió a urgencias por hemorragia masiva a través de ostomía de Bricker siendo diagnosticado mediante TC de sangrado activo desde arteria iliaca externa a interior de ureteroileostomía. Ante los hallazgos se decidió cirugía abierta urgente donde se apreció aneurisma con orificio fistuloso comunicando cara medial de arteria iliaca externa con asa de Bricker de medio centímetro de diámetro. Fue necesario ligar dos centímetros de arteria iliaca externa, realizar bypass fémoro-femoral, cierre de orificio en asa de Bricker y ureterostomía cutánea derecha. RESULTADO: Durante el postoperatorio requirió terapia renal sustitutiva, drogas vaso activas y cuidados en reanimación tras lo cual presento mejoría clínica y analítica decidiéndose alta 11 días tras la intervención. CONCLUSIONES: La presencia de una fístula arterial no controlada supone actuar de manera urgente ante una patología como el aneurisma micótico que ya de por sí supone un reto. La sospecha clínica, la rapidez del diagnósticoy la habilidad quirúrgica suponen piezas clave para aumentar las posibilidades de supervivencia del paciente

OBJECTIVE: Despite the high frequency of complications after a radical cystoprostatectomy, the presence of a fistula that communicates the external iliac artery and the ureteroileostomy has not been described in the medical literature. We present the diagnosis and medical management of a massive hemorrhage through the Bricker 's ostomy due to an external iliac artery's mycotic aneurysm fistulized to the ureteroileostomy. METHOD: A 78 years old patient underwent laparoscopic radical cystoprostatectomy with Bricker-type urinary diversión due to muscle-invasive bladder cancer. During the immediate postoperative period he presented different complications including sepsis caused by a pelvic collection. Due to a massive hemorrhage through Bricker's ostomy he went to the emergency department where was diagnosed by CT of active bleeding from right external iliac artery to the interior of the ureteroileostomy. We decided to perform exploratory laparotomy showing an aneurysm with fistulous orifice communicating the medial external iliac artery to Bricker ureteroileostomy. A femoro-femoral bypass, ligation of two centimeters of the external iliac artery, closure of the Bricker's orifice and right cutaneous ureterostomy was needed. RESULTS: After the surgery, the patient required renal replacement therapy and vasoactive drugs. Discharge from the hospital was 11 days after the intervention. CONCLUSIONS: The presence of an uncontrolled arterial fistula implies urgent care in a pathology such as the mycotic aneurysm that already constitutes a challenge. Fast diagnosis and surgical skills are essential to increase patient's survival chances