Laparoscopic Abdominopexy: Surgery for Vaginal Prolapse.

OBJECTIVES: We present a new surgery based on the round ligament anatomy that is called laparoscopic abdominopexy, which uses a synthetic mesh without fixation at any pelvic point. The aim of this study is to provide a step-by-step description of the laparoscopic abdominopexy technique and present the first anatomical and functional results of the procedure. METHODS: This prospective cohort study included patients with apical and anterior vaginal prolapse who were subjected to laparoscopic abdominopexy. Before and after surgery, the Pelvic Organ Prolapse Quantification (POP-Q) scale, Overactive Bladder Questionnaire-Short Form (OABq-SF), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) were used to evaluate the vaginal prolapse stage, storage, and sexual symptoms, respectively. The surgical technique is described step by step. RESULTS: Twenty patients were included with follow-up times between 6 and 25 months. The mean surgical time was 78.4 minutes. A statistically significant improvement was observed in the Aa (P ≤ 10-5), Ba (P ≤ 10-5), C (P = 5 × 10-5), D (P = .002) and tvl (P = .02) POP-Q points and in OABq-SF (22.2%; P = .02). Successful surgery was observed in 100% of patients for the apical compartment and 90% of patients for the anterior compartment. CONCLUSION: Laparoscopic abdominopexy is a quick, safe, and reproducible surgical technique with beneficial anatomical and functional results that preserve the pelvic floor anatomy.

[Renal cell carcinoma metastases in rare anatomical locations: pituitary, thyroid and mammary glands. of our experience and report of three cases.] / Metástasis de carcinoma de células renales en localizaciones poco frecuentes: hipófisis, tiroides y mama. Revisión de nuestra experiencia y presentación de tres casos clínicos.

OBJECTIVE: Metastatic Renal Cell Carcinoma(RCC) may develop in different anatomical locationsand after a strict follow up within normal limits. We assessthe importance of close follow up in patients with historyof RCC through 3 clinical cases with unusual locations ofmetastatic RCC. METHODS: We present 3 cases of metastatic involvementof pituitary, thyroid and mammary glands. We retrospectivelyreview our data base on metastatic RCC with 76patients. DISCUSSION: There is not agreement about the time offollow up and image methods requested after surgery ofRCC. The reason is the development of late onset and atypicalplacement metastases. CONCLUSION: Metastatic disease of renal neoplasmscan occur at any time and at any location. It is importantto keep suspicion of metastatic renal disease in patients inthis background, even in those with good progress andregardless of the years that have passed since the initialdiagnosis.

OBJETIVO: El Carcinoma de Células Renales (CCR) metastásico puede presentarse en localizaciones anatómicas muy variables y tras varios años de seguimiento. En éste artículo resaltamos la importancia del seguimiento de pacientes con antecedente de CCR. MATERIAL Y MÉTODOS: A partir de la revisión de 76 casos de CCR metastásico que recibieron tratamiento sistémico, se presentan tres casos clínicos con afectación de glándulas hipófisis, tiroides y mama.DISCUSIÓN: Existe debate acerca del tiempo de seguimientotras una cirugía por CCR y los métodos de imagen de control por la posibilidad de aparición de metástasis tardías y en lugares atípicos.CONCLUSIÓN: Es importante mantener la sospecha de enfermedad renal metastásica en pacientes con antecedente de CCR, incluso en aquellos con buena evolución y sin tener en cuenta el tiempo transcurrido desde el diagnóstico inicial.

[Laparoscopic ureteral reimplantation.] / Reimplante ureteral laparoscópico.

Although the laparoscopic ureteral reimplantation (LUR) has a history of over 20 years, its presence in the literature is relatively sparse, almost always in the form of small case series with low statistical power, which has prevented consistent results. It has proven to be a safe and effective technique, improving the safety profile and perioperative complications compared to open ureteral reimplantation (OUR). The few long-term results suggest a similar success rate between the open and laparoscopic approaches. Although we do not found in the literature a strong evidence of the benefits of anti-reflux reimplantation techniques in adults, most of the published series include these procedures. Ureteral reimplantation is considered the treatment of choice in ureteral injuries below the iliac vessels. This is its main indication now. Intraoperative recognition of the injury and immediate LUR avoid other complications, but most of ureteral injuries are diagnosed in the early postoperative period. Although the classical recommendations advise urinary diversion and delayed treatment, the immediate approach is feasible, and indeed seems to improve results in complications, stay and long-term renal function. In situations of postoperative peritonitis secondary to a ureteral fistula, immediate LUR offers specific advantages, at least theoretically, for the protective effect of pneumoperitoneum in abdominal sepsis.

[Renal angiomyolipoma in a patient with tuberous sclerosis. Case report.] / Angiomiolipoma renal en un paciente con esclerosis tuberosa. Presentación de un caso clínico.

OBJECTIVE: To assess the importance of management and close follow-up of patients with tuberous sclerosis that associate renal angiomyolipomas. METHODS: To report a case. RESULTS: A 55 years old men with tuberous sclerosis diagnosed in childhood and later finding of bilateral giant renal masses in imaging studies, with significant compromise of renal function. The patient did not have a proper follow up and did not receive any treatment. At the moment he has end stage kidney disease. CONCLUSION: Patients that associate renal angiomyolipoma and tuberous sclerosis, have specific characteristics with a higher risk of complications requiring strict follow-up and specific treatment.