Incidence and management of isolated renal injury and polytrauma patients.

OBJECTIVES: The management of renal trauma has undergone important changes in recent years, the current tendency being more conservative than in the past. The present study analyzes our experience over the last 11 years in patients with isolated renal trauma or associated to other lesions. METHODS: Over an 11-year period (January 2001- December 2011 ) we documented a total of 149 renal injuries (47 isolated and 102 associated renal lesions ). An analysis was made of the demographic characteristics of the two groups, as well as of the clinical presentation, diagnostic methods, grade of injury, associated lesions, emergency management, mortality, and length of stay. RESULTS: Closed trauma secondary to fall was the most frequent type of injury in both groups. The grade of injury proved similar in both (80%corresponding to grades 1-3 and 20% to grades 4-5). Conservative management was used in 93% of all isolated renal injuries and in 75.5% of the polytrauma patients with 10% and 5.7% failure rates respectively. Mortality rates were 0% and 7.8%, respectively. CONCLUSIONS: Renal injures are increasingly subjected to conservative management, with treatment generally being somewhat more aggressive in polytrauma patients.

First experience with the ATOMS(®) implant, a new treatment option for male urinary incontinence.

INTRODUCTION: Urinary incontinence (UI) is defined as any complaint of involuntary urine leakage. A description is provided of our experience with the ATOMS(®) (Adjustable Transobturator Male System. Agency for Medical Innovations. A.M.I.) adjustable implant in patients with mild to moderate UI. MATERIAL AND METHODS: A retrospective study was made of the data referring to 13 patients treated with this adjustable system. Demographic and personal data were collected along with information on the etiology, severity, characteristics, duration of UI, complementary tests, surgery times, complications and results obtained. RESULTS: The full continence (no use of pad) recovery rate at the close of the study was 12/13 (92.3%). Three cases required a single filling during the mean 16 months of follow-up (range 4-32; median 14 months). A complication in the form of perineal hematoma was resolved with conservative treatment and a case of urinary retention was resolved by placing a bladder catheter for the duration of one week. Three patients experienced perineal-scrotal dysesthesias that disappeared spontaneously in the first three months. CONCLUSIONS: The described adjustable continence system has been found to be very effective in males with mild to moderate UI. In our experience, the ATOMS(®) implant offers excellent results over the middle term with a very low rate of complications that were easily resolved in all cases.

Laparoscopy in elderly patients.

OBJECTIVES: Aging of the current population is an evident fact, and the surgical treatment of these patients is something we find in our daily practice. In this sense, all doubts that may arise when it comes to carrying out this technique in patients with important comorbidities appear to be cleared, as even patients with prior respiratory or heart disease benefit from the laparoscopic approach. METHODS: An analysis was carried out on a total of 99 patients over 70 years of age who underwent renal laparoscopic surgery, compared, on one hand, to 173 patients under 70 years of age undergoing the same procedure, and on the other, to 95 patients over 70 years of age who underwent open surgery We collected and compared all complications described intraoperatively and in the immediate postoperative period, as well as hospital stay. RESULTS: Patients over 70 years of age have a greater comorbidity compared to patients under 70 (ICH 1.46 vs. 0.89 p<0.05), but there are no statistical differences in terms of intraoperative or postoperative complications, or mean hospital stay. When compared to patients over 70 years of age with a similar comorbidity who underwent classic surgery, (ICH 1.46 vs. 1.45), we found a lower rate of complications (12.2 vs. 28.4% transfusion, 1.4 vs. 4.0% fever, p<0.05) and a shorter hospital stay (4.9 vs. 7.1%p<0.002). CONCLUSION: Patient age does not seem to have a determining effect on complications or on the postoperative period of kidney disease when laparoscopy is used, which is why this method of treatment seems adequate in such cases.

Complications in laparoscopic renal surgery. Five year experience.

OBJECTIVES: Retroperitoneal laparoscopic surgery has been applied in many centers as the first therapeutic option in an ever increasing number of cases. We analyze the complications seen in our 5 years of experience in laparoscopic renal surgery. METHODS: We retrospectively analyze intraoperative and postoperative complications that occurred in the laparoscopic renal procedures carried out between June 2004 and November 2009. We also study several demographic factors that may play a role in the cause of the complications. RESULTS: A total of 404 laparoscopic procedures that meet these characteristics were performed with a total of 98 medical and surgical complications (24.2%). Death rate was 0.6, conversion to open surgery occurred in 8 patients (1.9%) and postoperative surgical revision was required on 4 patients (0.99%). The most common intraoperative complication was bleeding (6.4%) and the most common postoperative complication was deterioration of renal function (6.4%). Nephroureterectomy was the procedure with the highest complication rate. CONCLUSIONS: Analysis of the complications of a surgical technique is fundamental and a consensus on the definition of such complications must be reached in order for the study to be as complete and critical as possible.

Open and laparoscopic nephroureterectomy for urothelial tumors of the upper urinary tract: initial experience.

OBJECTIVE: Advances in urological laparoscopy have increased the oncological safety of this approach for managing upper urinary tract tumours, although the open surgical route remains the method of choice. This article describes our experience of the laparoscopic approach over the past four years compared to open surgery. MATERIALS AND METHODS: Between 1995 and 2009 a total of 95 nephroureterectomies were carried out to remove tumours: 70 by open surgery and 25 by laparoscopy. Lumbotomy with endoscopic detachment of the ureter was the most common approach in open surgery, while transperitoneal access was used for laparoscopy in all cases, with laparoscopic bladder cuff resection in most patients (56%). RESULTS: The mean procedure time for open nephroureterectomies was 205 min (130-300), with a mean blood loss of 525 ml (100-1,800) involving 17 (24.2%) transfusions. The mean hospital stay was 8.4 days (3-30). The mean procedure time for the laparoscopic nephroureterectomies was 189 min (120-270), with a mean blood loss of 130 ml (100-400) and 4 (16%) transfusions. The mean hospital stay was 4.5 (2-28) days. CONCLUSIONS: The patients who underwent the laparoscopic procedure had a lower transfusion rate and shorter hospital stay. Oncological control was similar for both approaches, although laparoscopy requires greater monitoring and a larger caseload.

Human recombinant erythropoietin does not promote cancer growth in presence of functional receptors expressed in cancer cells.

Human recombinant erythropoietin (hrEPO) therapy might be associated with tumor progression and death. This effect has been suggested to be secondary to rhEPO binding to its receptor (EPOR) expressed on cancer cells. However, there are several concerns about EPOR functionality when expressed on cancer cells. In this paper we have provided evidence that EPOR expressed in cancer cells could be implicated in proliferation events because a transfection of EPOR siRNA to EPOR-expressing bladder cancer cells resulted in a marked reduction in cell growth. However, these cell lines do not grow in the presence of hrEPO. Furthermore, bladder cancer patients that expressed EPOR in tumor samples had a reduced survival in absence of rhEPO treatment. Therefore, EPOR is implicated in bladder cancer growth but this effect appears to be independent from rhEPO supplementation. Reports which suggest that rhEPO promotes cancer growth due to the expression of EPOR in cancer cells must be observed with caution since in the presence of functional EPOR rhEPO does not promote growth.

[Laparoscopic nephroureterectomy: new position for the management of distal ureter]. / Nefroureterectomía laparoscópica: nueva posición para el manejo ureteral.

OBJECTIVES: The main challenge of laparoscopic nephroureterectomy is the management of distal ureter, which also will have an important repercussion in the oncological outcome of many cases. We present our experience in such aspect, considering that we performed the last five laparoscopic nephroureterectomies in forced Trendelemburg position, resulting in a more comfortable and safe management of the distal ureter. METHODS: Between August and December 2006 we performed five purely laparoscopic nephroureterectomies with bladder cuff positioning the patient in forced Trendelemburg, a position similar to that of laparoscopic radical cystectomy or prostatectomy. RESULTS: Mean surgical time was 182 minutes (170-210). Mean blood loss was 100 cc and no patient required transfusion. Mean hospital stay was four days. CONCLUSIONS: We believe this position is a good alternative for the management of the distal ureter during the laparoscopic approach. The technique is very similar to open surgery, which continues being the gold standard today.