An 80-year-old man with a history of TURP 3 years ago presented with pollakiuria, hypogastric pain and fever of 48 hours of evolution a month after surgery for an incarcerated right inguinal hernia.
When asked, she reported progressive worsening of her voiding jet in recent months.
Physical examination revealed bladder balloon, minimal serous secretion of inguinal wound and painful induration of the penile base.
A cystostomy tube was placed because of the impossibility of urethral catheterization and laboratory tests showed leukocytosis with deviation to the left and urine sediment positive to gram-negative bacilli, was admitted for intravenous antibiotic treatment.
After clinical and analytical improvement, an abdominal ultrasound showed subtricial seroma at the right inguinal level and cystostomy tube cystography where an extravasation in the proximal penile urethra was observed.
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After treating febrile UTI with positive urine culture for multisensitive C. trachomatis, the patient was discharged.
At the follow-up visit, the patient reported significant perineal pain that had been treated with conservative treatment and pathological moderated the anatomo-pathological report of the surgery service where she had undergone surgery for inguinal hernia, reporting that the resected material.
At that time, it was suggested as a possible urethral squamous cell carcinoma with inguinal adenopathy and an extension study was performed.
Pelvic MRI showed a collection of 3 cm between the urethra and corpus cavernosum as well as right inguinal lymphadenopathy.
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Toco-abdominal CT showed a single subpleural lesion in the upper lobe of the right lung suggestive of metastasis, without the presence of lymph nodes.
The patient was admitted due to poor perineal pain control and the appearance of several cutaneous nodular lesions in the pubis and right thigh.
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Biopsy of one of these lesions was positive for squamous cell carcinoma.
The patient underwent 6 cycles of polychemotherapy with cisplatin + 5-fluorouracil (CDDP 137 mg-5FU 6839 mg) with good tolerance and good initial clinical response with improvement of asthenia,
One month after the end of chemotherapy, the disease progressed early, with the appearance of a greater number of skin lesions.
Perineal radiotherapy was then performed, resulting in a better control of pain and a poor response of the lethaloids.
Currently, the patient is under palliative care treatment with antibiotics and is followed up by a palliative care team at home 9 months after the diagnosis of squamous cell carcinoma.
