PMC3517837_01
Perineal wound.
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fig1
The wound presented pus and haematic discharge and exposed spermatic cord and testis (Figure 1).
(a) Abdomen CT scan: left ureteral stone. (b) Abdomen CT scan: left hydronephrosis.
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fig2
Patient's urologic history had started two months earlier, when during oncological followup for metastatic prostate cancer, a CT scan showed a 15 mm left ureteral stone causing hydronephrosis (Figures 2(a) and 2(b)).
Abdomen CT scan: left urinoma, left ureteral stone, and left double J stent.
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fig3
Abdominal CT-scan showed (Figure 3) in the distal part of left ureter a 13 mm stone with a well-positioned double J stent and a 12 cm urinoma anterior to iliopsoas muscle as for ureteral leakage according to increased attenuation of urinoma in delayed imaging.
Voiding cystourethrogram.
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fig4
Abdominal CT scan: absence of the urinoma.
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fig5
A second CT scan was performed 10 days after nephrostomy and drain insertion showing complete absence of the urinoma (Figure 5).
Gracilis muscle.
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fig6
A longitudinal incision was made along the medial side of the thigh, making it possible to identify the gracilis muscle (Figure 6) and to mobilize it according to the McCraw technique.
Gracilis flap tunneled.
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fig7
To reach the perineal area, the muscle flap was tunneled (Figure 7) and fixed into position with 3-0 Polyglactin suture without tension.