A 69-year-old man presented to the emergency department in May 2011 with penile edema of 4 days duration and incomplete erection of more than 24 hours, blood hemoglobin level of 8.2 mg/dl.
His personal history included in 2001 a bladder carcinoma of urothelial tissue T2b, G3 diagnosed by bladder TURP and treated by 6 cycles of chemotherapy consisting of taxol 245 mg, cisplatin half 1.456 mg and radiotherapy.
Successive years have recurrences of superficial bladder tumors that are electrocoagulated.
In 2008 he presented PSA elevation of 5 ng/ml performing prostate biopsy reported as prostate adenocarcinoma 3+3, Gleason 6.
It was treated by interstitial brachytherapy with Iodo 125 seeds in 2009.
At the end of 2010, the patient reported pre-voiding discomfort and a prostatic urethra lesion was observed by cystoscopy.
TUR-biopsy was performed and the patient was informed as having bladder adenocarcinoma.
The lesion was treated by resection and 6 cycles of chemotherapy consisting of 3300 mg gemcitabine (1 mg/m2), cisplatin 94 mg/m2) completed in March 2011.
In April 2012 review, the patient continued with PSA levels of up to 0.6 ng/ml; cystoscopy showed a urethral inflammatory bowel disease/CT and positron emission tomography (PET) decreased.
Several hypermetabolic images were observed, suggestive of disease in the right and left lateral wall of the bladder, seminal vesicle in situ and penile urethra deposition encompassing a left ganglion affectation.
Chemotherapy treatment was recommended that she did not receive it.
After reviewing her clinical history in the emergency department, admission was decided.
Symptomatic treatment, blood transfusion, abdominal computed tomography (CAT) for re-staging and second-line chemotherapy treatment with vinflunin bitartrato 500 mg (280 mg/m2) were performed.
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The edema and erection disappeared and was discharged five days after admission.
The patient died 2 months later.
