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Background: In horses, an increase in the volume of penis and foreskin can be caused by trauma. The resultant edema interferes with the retraction of the penis and cause paraphimosis. Surgical intervention through penectomy is indicated in cases wherein an alternative treatment is not feasible. Partial penectomy can prolong the life and reproductive function of many stallions. The present study aims to report on the methodological, functional, and economic feasibility of a successful case of the use of Williams technique for partial penectomy performed in the field in a horse with paraphimosis, preserving urinary, productive, and reproductive functions. Case: A 10-year-old horse weighing 500 kg had clinical signs of paraphimosis due to the formation of granulomatous tissue following trauma to the glans region. A surgical intervention, namely a partial penectomy was decided to be performed to prevent injury from priapism. Due to the limited resources provided by the owner and the impossibility of moving the animal to a surgical center in a veterinary hospital, the procedure was performed in the field, with prior sanitization and preparation of the environment used to perform surgery. The horse was tranquilized with intravenous xylazine hydrochloride and acepromazine, with subsequent induction of anesthesia with ready-to-use (RTU) guaifenesin bolus and maintenance of anesthesia with an intravenous association of RTU guaifenesin, xylazine hydrochloride, and ketamine. The distal third of the penis was amputated using the recommended Williams technique. Although the complications like dehiscence and emergence of granulation tissue occurred after surgery, these were controlled in the daily follow-up of the animal and post-surgical treatment. Discussion: Paraphimosis predisposed the horse to abrasions and edema of the exposed portion of the penis. However, there was no urine retention, which suggested that the urethral ostium and the urethra had no lesions. Because the granulomatous lesions were located in the distal third of the penis and the extent of penile exposure was small, the partial penectomy technique proved effective in solving the permanent exposure of the penis. The anesthetic protocol used was inexpensive, easy to execute, and effective, and no anesthetic complications occurred, proving this protocol to be efficient for the anesthetic induction of animals in the field. In addition to being reliable and widespread, the Williams technique was recommended to prevent possible urethral stenosis and the development of contact dermatitis by urine. This technique makes a rapid recovery of the animal possible, with improvement of its physiological parameters, and due to ease of being able to be done in the field, it is also inexpensive. The edema and the granulation tissue that occurred after surgery were controlled with medication. In general, post-penectomy animals are not used for reproduction. This makes the present report an important contribution, because in cases in which the lesions present a distal disposition and the penile exposure is small, stallions have a chance of maintaining reproductive function after surgery, even with a long period of evolution before surgical treatment. This was demonstrated in the present case, as the animal in this case later impregnated a mare, with the pregnancy confirmed by ultrasound examination. Partial penectomy is a resolution technique for cases of traumatic paraphimosis, in which exuberant granulation tissue is formed in the distal third of the penis, with a long period of evolution. The surgery can be done in the field, with a low surgical cost to the owner, and a good productive and reproductive prognosis for the animal.

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Background: Paraphimosis is characterized by persistent penile exposure, due to the inability to retract the penis into the prepuce. This persistent exposure of a non-erect penis might result from traumas, infections, neoplasia, anatomic or neurological alterations, or even occur in its idiopathic form. Surgical treatment is indicated when it is not possible to keep the penis covered by the foreskin by trying it manually. The surgical techniques described are efficient in small exposures, however, when these are over 1.5 cm, surgical success might become a challenge. The objective of this study is to report a modified surgical approach to solve a 5 cm recurrent paraphimosis in a dog. Case: A 1-year-old male unneutered mixed-breed dog, weighing 26 kg, was presented for examination with a history persistent paraphimosis background for around 2 months without apparent cause. The animal's tutor reported that it had been submitted to 2 unsuccessful surgical procedures. When the reproductive system was examined, the animal showed a flaccid penis with 5 cm exposure outside the foreskin. A conservative treatment was used, which was also unsuccessful. The next step was a surgical procedure that used the combination of techniques, namely, phallopexy, preputial advancement and reconstruction preputial opening with suture along with orchiectomy. After 10 days, dehiscence of the ostium stitches occurred, which required debridement and new suture. However, it was not efficient and recurrence of the paraphimosis was observed. After 1 month, a new surgery was performed by adapting the phallopexy technique, which was carried out bilaterally and associated to the reconstruction preputial opening with captonated suture, which presented a successful outcome. After 8 months as of the last procedure, the patient is healthy and has no signs of paraphimosis recurrence. Discussion: No consensus has been achieved regarding the paraphimosis treatment, and the resolution of such disorder remains a challenge. For this reason, some parameters should be considered to minimize failure when choosing the surgical technique and, consequently, the recurrence of such condition. Tissue viability, morphological alterations, time of exposure, previous surgeries, and the length of the penis exposure are some of the criteria that must be taken into consideration when choosing the surgical technique. In this case, the first choice was the association of techniques that included preputial advancement, phallopexy and suture preputial opening due to the fact that the exposure was over 1.5 cm and for the existence of a preputial ostium defect, which justified its suture. Despite these associations, paraphimosis recurrence was observed and some of the probable causes include the inadequate position of the penis inside the foreskin flap during the phallopexy and lack of preputial integrity in its ventral aspect. The preputial advancement performed was not sufficient to prevent the exposure or reduce it in the recurrence of the condition, showing that the shortening of preputial muscles and the skin tension might loosen up with time. The second surgery employed bilateral phallopexy without penis exposure to guarantee its correct position, more caudal within the foreskin at the moment of the fixation. The ostium captonated suture also had a relevant role in the tension distribution up to the full tissue healing. New surgical approaches might be needed to achieve success in the paraphimosis treatment. In this report, the length of the penis exposure and the ostium defect were complicating factors. However, the association of the modified surgical techniques resulted in a successful resolution of the condition.

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Background: Papillomas are cutaneous neoplasms, also known as warts. They are usually benign and are caused by apapillomavirus. The development of papillomas in certain locations on the body may cause irreparable consequences.Paraphimosis is a urological emergency characterized by the inability of the penis to retract or the impossibility of retentioninside the foreskin, causing local circulatory disorders and severe pain. However, the association between genital papillomas and the development of paraphimosis in horses has not been previously documented. The objective here is to describethe clinical and histopathological aspects of a case of penile papilloma associated with persistent paraphimosis in a horse.Case: A 15-year-old mixed-breed, 350 kg, horse presented nodular and crusted lesions, similar to warts, on the penis andforeskin, which progressed over at least 6 months. An incisional biopsy of one of the nodular lesions of the horses peniswas performed. Tissue fragments were collected, packed in 10% buffered formaldehyde, and sent for histopathologicalevaluation to the Animal Pathology Laboratory of the University Veterinary Hospital of the Federal University of CampinaGrande (UFCG), Campus de Patos, Paraíba. The biopsy resulted in a histopathological diagnosis of papilloma, and thehorse was reevaluated. Due to the severity of the clinical case, it was referred to the HVU/UFCG Large Animal Medicaland Surgical Clinic for surgical removal of the penis. The penectomy product was sent to the Animal Pathology Laboratory. Macroscopically, the penis fragment measured 18.0×10.5×6.0 cm in size, had an irregular surface, and presented withnumerous multilobulated, reddish nodules on a sessile base, which were exophytic with projections having the appearanceof a “cauliflower.” The nodules extended from the foreskin and compromised from...(AU)

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Background: Papillomas are cutaneous neoplasms, also known as warts. They are usually benign and are caused by apapillomavirus. The development of papillomas in certain locations on the body may cause irreparable consequences.Paraphimosis is a urological emergency characterized by the inability of the penis to retract or the impossibility of retentioninside the foreskin, causing local circulatory disorders and severe pain. However, the association between genital papillomas and the development of paraphimosis in horses has not been previously documented. The objective here is to describethe clinical and histopathological aspects of a case of penile papilloma associated with persistent paraphimosis in a horse.Case: A 15-year-old mixed-breed, 350 kg, horse presented nodular and crusted lesions, similar to warts, on the penis andforeskin, which progressed over at least 6 months. An incisional biopsy of one of the nodular lesions of the horse’s peniswas performed. Tissue fragments were collected, packed in 10% buffered formaldehyde, and sent for histopathologicalevaluation to the Animal Pathology Laboratory of the University Veterinary Hospital of the Federal University of CampinaGrande (UFCG), Campus de Patos, Paraíba. The biopsy resulted in a histopathological diagnosis of papilloma, and thehorse was reevaluated. Due to the severity of the clinical case, it was referred to the HVU/UFCG Large Animal Medicaland Surgical Clinic for surgical removal of the penis. The penectomy product was sent to the Animal Pathology Laboratory. Macroscopically, the penis fragment measured 18.0×10.5×6.0 cm in size, had an irregular surface, and presented withnumerous multilobulated, reddish nodules on a sessile base, which were exophytic with projections having the appearanceof a “cauliflower.” The nodules extended from the foreskin and compromised from...

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Background: Penile necrosis is a rare condition that may present in patients with diabetes mellitus or chronic kidney disease (CKD). The recommended treatment is controversial. We report a case of penile necrosis in a diabetic patient caused by episode of paraphimosis associated with uremic arteriopathy treated with partial amputation. Clinical Case: A 53-year-old male with a background of arterial hypertension, diabetes mellitus and CKD in hemodialysis. The patient presented with paraphimosis and glans necrosis. An emergency circumcision was carried out. A doppler ultrasound found fluid collection in the left corpus cavernosum, parietal vascular calcifications and vascular insufficiency in the corpus cavernosum that suggested necrosis. A partial amputation of the penis was carried out. After three years of follow-up, the outcome has remained favorable. Conclusions: Penile necrosis is a rare but serious complication of terminal CKD. In these patients, systemic calciphylaxis is usually observed. The main take-away lesson is that a multidisciplinary approach is necessary.

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Objective To evaluate post-operative complications of circumcision requiring surgical reintervention. Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016. Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients' age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found. Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients' age did not influence in complications.

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A parafimose, uma das diferentes afecções que podem atingir o sistema reprodutor masculino, é uma condição caracteriza da pela incapacidade do pênis em se retrair corretamente, que atinge cães machos de diferentes raças e idades. A gravidade é variável, podendo acarretar desde problemas reprodutivos a óbito. O objetivo do presente relato é descrever um caso de parafimose em um paciente canino sem raça definida, de quatro anos de idade, atendido no Hospital Veterinário da Universidade de Franca (UNIFRAN -SP), que respondeu favoravelmente ao tratamento conservativo instituído.

Paraphimosis, one of the different conditions that can reach the male reproductive system, is a condition characterized by the inability of the penis to retract properly affecting male dogs of different races and ages. The severity is variable, and can lead from reproductive problems to deaths. The aim of this report is to describe a case of paraphimosis in a canine patient, four years, treated at the Veterinary Hospital of the University of Franca (UNIFRAN -SP), who responded favorably to the conservative treatment instituted.

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A parafimose, uma das diferentes afecções que podem atingir o sistema reprodutor masculino, é uma condição caracteriza da pela incapacidade do pênis em se retrair corretamente, que atinge cães machos de diferentes raças e idades. A gravidade é variável, podendo acarretar desde problemas reprodutivos a óbito. O objetivo do presente relato é descrever um caso de parafimose em um paciente canino sem raça definida, de quatro anos de idade, atendido no Hospital Veterinário da Universidade de Franca (UNIFRAN -SP), que respondeu favoravelmente ao tratamento conservativo instituído.(AU)

Paraphimosis, one of the different conditions that can reach the male reproductive system, is a condition characterized by the inability of the penis to retract properly affecting male dogs of different races and ages. The severity is variable, and can lead from reproductive problems to deaths. The aim of this report is to describe a case of paraphimosis in a canine patient, four years, treated at the Veterinary Hospital of the University of Franca (UNIFRAN -SP), who responded favorably to the conservative treatment instituted.(AU)

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ABSTRACT Objective To evaluate post-operative complications of circumcision requiring surgical reintervention. Methods Retrospective analysis of medical records of patients submitted to circumcision from May 1st, 2015 to May 31st, 2016. Results A total of 2,441 circumcisions were performed; in that, 1,940 using Plastibell and 501 by the classic technique. Complications requiring surgical reintervention were found in 3.27% of patients. When separated by surgical technique, 3.4% of circumcisions using Plastibell device required reoperation, as compared to 3% of conventional technique (p=0.79). Preputial stenosis was most frequently found in classic circumcision, with statistical significance (p<0.001). Bleeding was more frequent when using Plastibell device, but the difference was not statistically different (p=0.37). Patients' age was also evaluated to investigate if this variable influenced on the postoperative outcome, but no significant difference was found. Conclusion There was no statistically significant difference when comparing complications between the different techniques performed at this hospital. Preputial stenosis was most frequently found in the classic circumcision, while bleeding was more prevalent when using Plastibell device. Patients' age did not influence in complications.

RESUMO Objetivo Avaliar as complicações pós-operatórias de postectomia que necessitaram de reintervenção cirúrgica. Métodos Estudo retrospectivo com análise de prontuários de pacientes submetidos à postectomia entre 1o de maio de 2015 a 31 de Maio de 2016. Resultados Foram realizadas 2.441 postectomias no período, sendo 501 utilizando a técnica clássica e 1.940 utilizando o dispositivo Plastibell. Apresentaram complicações que necessitaram reintervenção cirúrgica 3,27% dos pacientes. Quando separados por técnica operatória, 3,4% das postectomias com Plastibell foram reoperadas, comparando com 3% das postectomias convencionais (p=0,79). A estenose de prepúcio foi mais frequentemente encontrada na técnica clássica, com significância estatística (p<0,001). Sangramento foi mais frequente nos casos com uso do Plastibell, porém sem diferença significativa (p=0,37). A idade dos pacientes também foi avaliada para investigar se esta variável influenciou na taxa de complicações pós-operatórias, porém não houve diferença significativa. Conclusão Não houve diferença estatisticamente significativa quando comparadas as complicações entre as diferentes técnicas cirúrgicas utilizadas neste serviço. A estenose de prepúcio foi mais frequentemente encontrada nos pacientes operados pela técnica convencional enquanto demonstrou-se tendência a maior sangramento com uso do Plastibell. A idade dos pacientes não influenciou na presença de complicações.

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As particularidades morfológicas e anatômicas de touros podem predispor à ocorrência de enfermidades acometendo a genitália externa, dentre as quais a acropostite é considerada a de maior importância. O estudo relata um caso de acropostite em que o animal, além dos sinais clínicos normais da enfermidade, apresentou exposição peniana permanente, característico de parafimose. Informações sobre a epidemiologia, fatores de risco, diagnóstico e tratamento foram apresentados. Fragmentos das áreas lesionadas foram colhidos e encaminhados para exame histopatológico. Verificou-se hiperplasia pseudocarcinomatosa acentuada da camada espinhosa associada a crostas serocelulares superficiais. A técnica cirúrgica mostrou-se eficiente e passível de ser realizada a campo.

The morphological and anatomical characteristics of bulls may predispose to the occurrence of diseases affecting the external genitalia, among which acropostite is considered the most important. The study reports a case of acropostite where the animal, beyond the normal clinical signs of the disease, presented permanent penile exposure, characteristic of paraphimosis. Information on the epidemiology, risk factors, diagnosis and treatment were presented. Fragments of injured areas were collected and sent for histopathological examination. It was verified pronounced pseudocarcinomatous hyperplasia on superficial spinous layer with serocelulares crusts. The surgical technique was efficient and able to be carried out in the field.

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As particularidades morfológicas e anatômicas de touros podem predispor à ocorrência de enfermidades acometendo a genitália externa, dentre as quais a acropostite é considerada a de maior importância. O estudo relata um caso de acropostite em que o animal, além dos sinais clínicos normais da enfermidade, apresentou exposição peniana permanente, característico de parafimose. Informações sobre a epidemiologia, fatores de risco, diagnóstico e tratamento foram apresentados. Fragmentos das áreas lesionadas foram colhidos e encaminhados para exame histopatológico. Verificou-se hiperplasia pseudocarcinomatosa acentuada da camada espinhosa associada a crostas serocelulares superficiais. A técnica cirúrgica mostrou-se eficiente e passível de ser realizada a campo. (AU)

The morphological and anatomical characteristics of bulls may predispose to the occurrence of diseases affecting the external genitalia, among which acropostite is considered the most important. The study reports a case of acropostite where the animal, beyond the normal clinical signs of the disease, presented permanent penile exposure, characteristic of paraphimosis. Information on the epidemiology, risk factors, diagnosis and treatment were presented. Fragments of injured areas were collected and sent for histopathological examination. It was verified pronounced pseudocarcinomatous hyperplasia on superficial spinous layer with serocelulares crusts. The surgical technique was efficient and able to be carried out in the field. (AU)

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La parafimosis es una urgencia urol¢gica producida por la inflamación y edema del prepucio, que impide el recubrimiento del glande tras su retracción forzada y que produce una construcción o estrangulamiento del glande por un anillo del prepucio que se ha retraído, con riesgo de necrosis del glande, que puede ocasionar su pérdida. Es relativamente frecuente en adultos con sondaje urinario y en niños tras sus primeras manipulaciones peneanas. Los cambios inflamatorios progresan en la parte retenida bajo presión (glande) y no cesarán hasta su reducción manual o quirúrgica. La maniobra de reversión es un método rápido que se puede realizar en el servicio de emergencia y que debe ser conocido por los médicos generales para así brindarle alivio al paciente y prevenir complicaciones peneanas si se realiza a tiempo.

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Introducción: la parafimosis es frecuente en los servicios de urgencia. Su reducción precoz resulta fácil, pero si los niños asisten tardíamente, puede constituir un problema. Debido a los intentos de reducción infructuosos y dolorosos, estos pacientes sufren gran carga de tensión emocional. Objetivos: describir y mostrar la aplicación de un método práctico de reducción manual sin dolor, en pacientes con parafimosis de largo tiempo de evolución. Métodos: se realizó un estudio longitudinal, prospectivo y descriptivo, de los pacientes tratados (n= 25), con diagnóstico de parafimosis de largo tiempo de evolución (+ 12 horas), en el periodo comprendido entre enero de 2009 y junio de 2011. Se les aplicó un método fundamentado en el bloqueo anestésico anular subcutáneo en la base del pene, derivada de la inervación pudenda. Se seleccionaron variables como edad, causa externa desencadenante, tratamiento conservador inicial, tiempo de demora en asistir para la reducción, y complicaciones. Se procesó la información en frecuencias absolutas y porcentajes, dando como resultado pruebas de significación para su análisis estadístico. Resultados: la manipulación brusca del prepucio por la propia madre, condicionó esta complicación en el 68 porciento de los menores de 5 años. Tratamientos conservadores, motivaron una demora para su reducción significativa, en el 80 porciento de los casos. Conclusiones: este método es bien aceptado por el paciente, le brinda una solución sin dolor, y es de fácil aplicación en los servicios de urgencias. Se evitan procederes más cruentos como la fimotomía

Introduction: the paraphimosis is frequent in emergence services. Its early reduction is easy, but if children come late it may to be a serious problem. Due to the unsuccessful and painful attempts of reduction, these patients suffer a significant charge of emotional tension. Objectives: to describe and to show the implementation of a practical method of painless manual reduction in patients with a prolonged paraphimosis. Methods: a descriptive, prospective and longitudinal study was conducted in patients treated (25), diagnosed with paraphimosis of long term course (+ 12 hr) from January, 2009 to June, 2011. A method based in the subcutaneous annular anesthetic block was applied in the penis base derived of the pudendal innervation. The following variables were selected: age, triggering external cause, initial conservative treatment, to until reduction and complications. Information was processed in absolute frequency and percentages where the results were significant tests for its statistic analysis. Results: the sudden manipulation of prepuce by mother leads to this complication in the 68 percent of children aged under 5. The conservative treatments caused a significant delay for its reduction in the 80 percent of cases. Conclusions: this method is well accepted by patient giving him a painless solution and it is of easy application in emergence services. Procedures more painful like the phimotomy are avoided

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Las urgencias en pediatría siempre han constituido un problema frecuente y, muchas veces, difícil de resolver, ya sea por la poca historia aportada por los padres -lo que es propio de la preocupación y ansiedad de la situación-, como también por la falta de información en relación a algunas maniobras simples que pueden ser realizadas por cualquier médico. Las lesiones genitourinarias suelen desestimarse en una evaluación de urgencia, a pesar de la trascendencia que éstas pudieran tener a futuro, por lo que suelen pesquisarse en una evaluación secundaria, o luego de la aparición de complicaciones. El presente artículo tiene como objetivo dar a conocer los conceptos que componen el manejo de urgencias genitourinarias en cirugía pediátrica, haciendo énfasis en aquellas que ocurren con mayor frecuencia y que implican un riesgo de complicaciones deletéreas, así como también en las que, por simplicidad de maniobras, pueden ser realizadas en cualquier servicio de atención de urgencia. Los temas expuestos son: torsión testicular, torsión de hidátide testicular, parafimosis, lesiones del tracto urinario y atrapamiento de prepucio en cremallera del pantalón.

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Tipo de estudio: investigación prospectiva descriptiva. Objetivos: conocer la incidencia, características, factores predisponentes y complicaciones pos-operatorias de esta patología en el hospital base de este estudio. Metodología: se realizó en el hospital “Provincial General Docente Riobamba” entre enero 1999 – diciembre 2002, encontrando 15 casos de balanitis xerótica obliterante. Resultados: tenemos una incidencia de 24,1% entre todas las circuncisiones realizadas, la disuria fue el síntoma principal en el 66,7%, la rinitis alérgica fue la patología común en 10 casos. Todos nuestros casos fueron corroborados con estudio histopatológico de la muestra prepucial. En el 93% el tiempo máximo de hospitalización fue de 2 días y la hemorragia post-operatoria, en un 6%, fue la complicación encontrada. Conclusiones: entidad poco conocida en nuestro medio, pero más frecuente de lo que se pensaba; se caracteriza por estrechez prepucial fibrótica y acartonada de coloración blanco nacarada que se presenta en la edad escolar; la alergia fue frecuente en estos niños.

Study design: Prospective descriptive research. Objectives: To know the incidence, characteristics, risk factors and postoperative complications of this pathology in our hospital. Methods: this study was performed in the Riobamba General Teaching Hospital between January1999 – December 2002, finding 15 cases of Balanitis Xerotica Obliterans. Results: we have an incidence of 24.1% among the total amount of performed circumcisions, dysuria was the major symptom in 66.7%, allergic rhinitis became the most common pathology in 10 cases. All our cases were corroborated with a histopathological study of the prepucial sample. In 93%, the longest hospitalization time was 2 days, and in 6% postoperative hemorrhage was the most encountered complication. Conclusions: little known entity but more frequent than expected. It´s featured by fibrotic and wizened prepucial narrowness, pearly white colored that presents in scholar aged patients, history of allergy was frequent in these children.

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La fimosis fisiológica es un problema temporal que se presenta en todos los recién nacidos, es la “sinequia congénita balanoprepuncial. Esta anormalidad transitoria desaparece en un 90% a los 3 años de edad, esta unión balanoprepuncial es laxa, por lo que su liberación es fácil, si no se ha realizado en forma espontánea, sólo es necesario realizar balanosis o sinequiotomía, nunca circuncisión. La intervención quirúrgica con resección del prepucio sólo esta indicado cuando existe fimosis complicada o balanopostitis recurrente. En el presente trabajo exponemos la experiencia de los autores y la revisión bibliográfica sobre el tema.

The physiological fimosis is a temporal problem that appears in all new born, is the “congenital balanopreputial synequia”. This transitory disability disappear in a 90% at the age of 3years, the balanopreputial union is lax, reason why his release is easy, if not been realized in a spontaneous form, only is necessary to do a balanosis or synequioctomy, never a circumcision. The surgical intervention with resection of foreskin is indicated only when there is a complicated phymosis or recurrent balanoposthitis. The present work explains the author’s experiences and bibliographical revision about the topic.

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Paraphimosis usually develops when a tight foreskin is retracted over the glans penis for a prolonged period. Many esoteric aetiologies have been implicated in the development of paraphimosis including piercing the foreskin, Plasmodium falciparum infection, application of celadine juice to the foreskin, chancroid, pessaries and the implantation of pearls. We report the first two cases of paraphimosis developing during wining, an erotic dance native to Trinidad & Tobago.

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El pediatra que atiende niños en servicio de urgencia recibe pacientes politraumatizados, en los cuales es relevante descartar una lesión de riñon o de vías urinarias, las que pueden ser silenciosas en sus manifestaciones clínicas y en general requieren resolución quirúrgica de urgencia. A continuación se describen los problemas urológicos que constituyen una emergencia y la forma correcta de estudio y tratamiento

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