Histological changes due to intravesical instillation of mitomycin C.

OBJECTIVE: Transurethral resection (TUR) is highly effective in the local control of superficial bladder cancer. However, the recurrence rate can reach 80% of the cases. Adjuvant intravesical chemotherapy may decrease significantly tumor recurrence. We describe a bladder adverse reaction to mitomycin C as adjuvant therapy for non-invasive bladder cancer METHODS: Three patients with diagnosis of pTa G1 urothelial carcinoma were treated by TUR plus an instillation of 40 mg. of mitomicin C. A month later, the patients were attended for dysuria and hematuria. Cystoscopy and bladder biopsy were performed in all cases. RESULTS: Multiple sessile lesions suspicious of tumor recurrence were found on cystoscopy. The histopathological diagnosis disclosed the existence of severe atypia of the urothelium and stromal changes similar to those observed after radiotherapy CONCLUSIONS: Adjuvant intravesical chemotherapy with mitomycin C may cause local reactions with macroscopic patterns similar to tumoral recurrences.

[Laparoscopic simple nephrectomy with transvaginal notes assistance and the use of standard laparoscopic instruments]. / Nefrectomía laparoscópica simple con asistencia de notes transvaginal y uso de instrumentos laparoscópicos estándar.

INTRODUCTION: Natural orifice transluminal endoscopic surgery (NOTES) is an emerging technique, which allows to performed surgical procedures avoiding any surgical scars. However there are some problems due to the lack of equipment available for these procedures. The aim of these study is to present our initial experience with the transvaginal nephrectomy NOTES using standard laparoscopic instruments. MATERIAL AND METHODS: Two female patients 23 and 29 years old, both of them with diagnosis of recurrent urinary tract infection and renal atrophy. A transvaginal simple nephrectomy was performed using a transvaginal Access for the camera port and two abdominal work ports of 10 and 3 mm. RESULTS: Total operation room time was 120 min in the first case and 40 min. in the second with an average blood loss of 200 cc. There were no perioperative complications, and both patients was discharged 36 hours after the surgery CONCLUSION: Laparoscopic nephrectomy with transvaginal NOTES assistance is technically feasible with the use of standard laparoscopic instruments. Special Access trocars and instruments development for this procedure will allow to perform a pure technique without the use of abdominal incisions.

[Transumbilical laparoscopic simple nephrectomy using a flexible cystoscope and standard laparoscopic instruments]. / Nefrectomía simple laparocópica transumbilical con el uso de cistoscopio flexible e instrumentos laparsocópicos estándar.

OBJECTIVES: We present our initial experience with transumbilical surgery in a simple nephrectomy performed with a flexible cystoscope and standard laparoscopic instruments. METHODS: A 15 year-old child, with severe left renal parenchyma atrophy, secondary to recurrent urinary tract infection (UTI) complicated with left pyelonephritis. Decision for simple nephrectomy was taken and we planned to perform a single port laparoscopic nephrectomy. In the lumbotomy position, two 5mm ports were insertend through a 3 cm umbilical incision. One trocar permitted the progression of the flexible cystoscope (Olympus) and the other the entrance of the PKS Plasma Trissector. The latter was then changed for a 10mm port to allow the entrance of the Weck clips. A Maryland grasper for countertraction was placed without port in the lef-upper quadrant and progressed directly into de peritoneal cavity under direct vision. RESULTS: The standard laparoscopic steps were duplicated uneventfully. Mean operative time was 90 minutes and mean blood loss was 200 mL. Hospital stay was 18 hours. No transfusion was needed. CONCLUSION: Single port urologic surgery will expand in the future. There is lack of commercial availability of the ideal hardware needed for the procedures. Versatility of urologic instruments allow for its use in different settings.

[Urologic Notes: where are we and where we are going]. / Cirugía endoscópica transluminal por orificios naturales en Urologia: Dónde estamos y hacia dónde vamos.

BACKGROUND: The natural orifice translumenal endoscopic Surgery (NOTES) approach has been successfully reported by several surgical teams in different specialties. Urologic teams have recently presented several experimental and clinical experiences with the technique. Our aim is to review the initial experience with NOTES in minimal access urological surgery.

[Robotically assisted urologic endoscopic surgery]. / Cirugía endoscópica urológica asistida por robot.

OBJECTIVES: Comprehensive evaluation of surgical procedures remains the cornerstone of quality control. Robotic surgery has become a popular surgical option in urology. We review the English medical literature on urological robot-assisted endoscopic surgery (URAES) in order to assess the trends of medical publications regarding this subject. METHODS: All Studies addressing URAES were included. Information for this review was obtained by Pub Med searches from 2003 to 2008. Keywords used in our search included: "robotic urologic surgery", "robotic assisted urological surgery". Only articles published in English were included in this review. RESULTS: We identified 383 studies. 366 articles corresponded to clinical series of different topics regarding robotics in urology; 13 articles presented comparisons of robotic surgery versus either pure laparoscopic or open surgery in urological procedures such as radical cistectomy (1), radical prostatectomy (10) and pyeloplasty (2). Four studies corresponded to randomized control trials, addressing robotic telerounding (2), kidney percutaneous access (1) and camera holding devices for endoscopic surgery (1). CONCLUSIONS: URAES is an emerging surgical option for urological operations like radical prostatectomy, pyeloplasty and radical cystectomy. There is lack of high-level evidence information to support the idea of robotic surgery as the upcoming surgical gold standard in urology. Surgical evolution will favour the potential benefits of robotic technology, but there is need for design and performance of prospective randomized trials in robotic urologic surgery in order to consolidate the application of this novel technology.