An acute lymphoblastic leukemia cell-based preclinical assay revealed functional differences between commercial brands of L-asparaginase administered in Colombia.

BACKGROUND: L-asparaginase (L-ASNase) is an essential component of chemotherapy strategies due to its differential action between normal and leukemic cells. Recently, concerns about the efficiency of commercial formulations administered in developing countries have been reported, and available methods have limitations for directly determining the quality of the formulation of the medications. PROCEDURE: We developed a cell-based protocol to analyze the activity of different L-ASNase formulations used in Colombia to induce apoptosis of the NALM-6 cell line after 24, 48, and 72 hours, using flow cytometry. Then we compared results and determined the statistically significant differences. RESULTS: Three statistically different groups, ranging from full to no activity against leukemic cells, using 0.05, 0.5, and 5.0 IU/ml concentrations, were identified. Group 1 (asparaginase codified [ASA]2-4) exhibited very low to no activity against B-cell acute lymphoblastic leukemia (B-ALL) cells. Group 2 (ASA6) exhibited intermediate-level activity, and group 3 (ASA1 and ASA5) exhibited high activity. CONCLUSIONS: Differences found between the therapeutic formulations of L-ASNase distributed in Colombia raise concerns about the quality of the treatment administered to patients in low- and middle-income countries. Therefore, we recommend a preclinical evaluation of formulations of L-ASNase in order to prevent therapeutical impacts on the outcome of ALL patients.

Incorporation of Molecular Reorientation into Modeling Surface Pressure-Area Isotherms of Langmuir Monolayers.

Langmuir monolayers can be assembled from molecules that change from a low-energy orientation occupying a large cross-sectional area to a high-energy orientation of small cross-sectional area as the lateral pressure grows. Examples include cyclosporin A, amphotericin B, nystatin, certain alpha-helical peptides, cholesterol oxydation products, dumbbell-shaped amphiphiles, organic-inorganic nanoparticles and hybrid molecular films. The transition between the two orientations leads to a shoulder in the surface pressure-area isotherm. We propose a theoretical model that describes the shoulder and can be used to extract the energy cost per molecule for the reorientation. Our two-state model is based on a lattice-sublattice approximation that hosts the two orientations and a corresponding free energy expression which we minimize with respect to the orientational distribution. Inter-molecular interactions other than steric repulsion are ignored. We provide an analysis of the model, including an analytic solution for one specific lateral pressure near a point of inflection in the surface pressure-area isotherm, and an approximate solution for the entire range of the lateral pressures. We also use our model to estimate energy costs associated with orientational transitions from previously reported experimental surface pressure-area isotherms.

cT1a Renal Masses Less Than 2 versus 2 cm or Greater Managed by Robotic Partial Nephrectomy: A Propensity Score Matched Comparison of Perioperative Outcomes.

PURPOSE: We performed a single center evaluation to compare perioperative, pathological and functional outcomes of robotic partial nephrectomy of T1a renal masses less than vs greater than 2 cm. MATERIALS AND METHODS: Propensity score 1:1 matching of queried patients was performed using the institutional robotic partial nephrectomy database from January 2007 to January 2017. Matching was done by patient age, gender, race, body mass index, the Charlson comorbidity index, smoking status, diabetes, hypertension, hyperlipidemia, ASA® (American Society of Anesthesiologists®) score, estimated glomerular filtration rate, chronic kidney disease stage and R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar line and abutting main renal artery or vein) score. We analyzed the records of 524 patients, including 262 with a renal mass less than 2 cm vs 262 with a renal mass 2 cm or greater. Perioperative, pathological and functional outcomes were evaluated. RESULTS: Smaller renal masses (less than 2 cm) were associated with significantly lower operative time, blood loss, ischemia time (mean ± SD 14.3 ± 9.58 vs 21.5 ± 9.51 minutes, p <0.001) and intraoperative transfusions (0% vs 2.7%, p = 0.015). Moreover, we found superior early renal functional outcomes as assessed by the estimated glomerular filtration rate on postoperative day 1 (mean 83.1 ± 21.3 vs 76.6 ± 22.0 mg/ml/1.73 m, p = 0.001), greater parenchymal preservation (mean 89.9% ± 9.45% vs 83.6% ± 8.20%, p <0.001) and a trend toward a lower rate of postoperative complications (13.5% vs 19.5%, p = 0.080). A higher incidence of malignancy was found in larger tumors (85.9% vs 74.8%, p = 0.002) but no difference was recorded in positive surgical margins. CONCLUSIONS: Robotic partial nephrectomy tends to be a low morbidity treatment modality for renal masses less than 2 cm. Although active surveillance is a common option for such tumors, robotic partial nephrectomy remains an alternative in select patients.

Achieving tumour control when suspecting sinus fat involvement during robot-assisted partial nephrectomy: step-by-step.

OBJECTIVES: To report a single expert robotic surgeon's step-by-step surgical technique for achieving local cancer control during robot-assisted PN (RAPN) for T3 tumours. PATIENTS AND METHODS: Since January 2010 to December 2016, the institutional RAPN database was queried for patients who underwent transperitoneal RAPN performed by a single surgeon for tumours ≤4 mm from the collecting system at preoperative computed tomography (three points on the 'N [Nearness]' R.E.N.A.L. nephrometry-score item) that were pT3a involving sinus fat at final pathology. Baseline characteristics, perioperative and oncological outcomes (particularly positive surgical margins, PSMs), were identified. RESULTS: Of 1497 masses that underwent RAPN, 512 scored 3 points on the 'N' item of the R.E.N.A.L. nephrometry score assessment. In all, 24 patients had pT3a tumours involving sinus fat at final pathology and represented the analysed cohort. RAPN were performed according to the here described technique. No PSMs were reported. Trifecta achievement was 54.2%. Within a median follow-up of 30 months, two and one patients had recurrence or metastasis, respectively. Two patients died unrelated to renal cancer. Retrospective analysis and limited follow-up represent study limitations. CONCLUSION: In a selected cohort of patients with renal tumours near the sinus fat at baseline R.E.N.A.L. nephrometry score assessment and confirmed pT3a at final pathology, the described RAPN technique was able to achieve optimal local cancer control.

An exploratory study investigating the impact of the bladder tumor microbiome on Bacillus Calmette Guerin (BCG) response in non-muscle invasive bladder cancer.

PURPOSE: Intravesical Bacillus Calmette-Guerin (BCG) is standard of care for intermediate- and high-risk non-muscle invasive bladder cancer (NMIBC). The effect of the bladder microbiome on response to BCG is unclear. We sought to characterize the microbiome of bladder tumors in BCG-responders and non-responders and identify potential mechanisms that drive treatment response. MATERIALS AND METHODS: Patients with archival pre-treatment biopsy samples (2012-2018) were identified retrospectively. Prospectively, urine and fresh tumor samples were collected from individuals with high-risk NMIBC (2020-2023). BCG response was defined as tumor-free 2 years from induction therapy. Extracted DNA was sequenced for 16S rRNA and shotgun metagenomics. Primary outcomes were species richness (α-diversity) and microbial composition (ß-diversity). Paired t-tests were performed for α-diversity (Observed species/Margalef). Statistical analysis for ß-diversity (weighted and unweighted UniFrac distances, weighted Bray-Curtis dissimilarity) were conducted through Permanova, with 999 permutations. RESULTS: Microbial species richness (P < 0.001) and composition (P = 0.001) differed between BCG responders and non-responders. Lactobacillus spp. were significantly enriched in BCG-responders. Shotgun metagenomics identified possible mechanistic pathways such as assimilatory sulfate reduction. CONCLUSION: A compositional difference exists in the tumor microbiome of BCG responders and non-responders with Lactobacillus having increased abundance in BCG responders.

Rare phylotypes in stone, stool, and urine microbiomes are associated with urinary stone disease.

Introduction: In complex microbial communities, the importance of microbial species at very low abundance levels and their prevalence for overall community structure and function is increasingly being recognized. Clinical microbiome studies on urinary stone disease (USD) have indicated that both the gut and urinary tract microbiota are associated with the onset of the disease and that kidney stones them-selves harbor a complex, yet consistent and viable, microbiome. However, how rare phylotypes contribute to this association remains unclear. Delineating the contribution of rare and common phylotypes to urinary stone disease is important for the development of bacteriotherapies to promote urologic health. Methods: The objectives of the current report were to conduct a metaanalysis of 16S rRNA datasets derived from the kidney stone, stool, and urine samples of participants with or without urinary stone disease. To delineate the impact of rare and common phylotypes, metaanalyses were conducted by first separating rare and common taxa determined by both the frequency and abundance of amplicon sequence variants. Results: Consistent with previous analyses, we found that gut, upper urinary, and lower urinary tract microbiomes were all unique. Rare phylotypes comprised the majority of species observed in all sample types, with kidney stones exhibiting the greatest bias toward rarity, followed by urine and stool. Both rare and common fractions contributed significantly to the differences observed between sample types and health disparity. Furthermore, the rare and common fractions were taxonomically unique across all sample types. A total of 222 and 320 unique rare phylotypes from urine and stool samples were found to be significantly associated with USD. A co-occurrence correlation analysis revealed that rare phylotypes are most important for microbiome structure in stones, followed by urine and stool. Discussion: Collectively, the results indicate that rare phylotypes may be important for the pathophysiology of USD, particularly in the kidney stone matrix, which is inherently a very low microbial biomass niche that can have implications for the diagnosis and treatment of kidney stones. Further studies are needed to investigate the functional significance of rare phylotypes in kidney stone pathogenesis.

Evidence of Homeostatic Regulation in Mycobacterium avium Subspecies paratuberculosis as an Adaptive Response to Copper Stress.

BACKGROUND: Bacteria are capable of responding to various stressors, something which has been essential for their adaptation, evolution, and colonization of a wide range of environments. Of the many stressors affecting bacteria, we can highlight heavy metals, and amongst these, copper stands out for its great antibacterial capacity. Using Mycobacterium tuberculosis (Mtb) as a model, the action of proteins involved in copper homeostasis has been put forward as an explanation for the tolerance or adaptive response of this mycobacteria to the toxic action of copper. Therefore, the aim of this study was to confirm the presence and evaluate the expression of genes involved in copper homeostasis at the transcriptional level after challenging Mycobacterium avium subsp. paratuberculoisis (MAP) with copper ions. METHODOLOGY: Buffer inoculated with MAP was treated with two stressors, the presence of copper homeostasis genes was confirmed by bioinformatics and genomic analysis, and the response of these genes to the stressors was evaluated by gene expression analysis, using qPCR and the comparative ΔΔCt method. RESULTS: Through bioinformatics and genomic analysis, we found that copper homeostasis genes were present in the MAP genome and were overexpressed when treated with copper ions, which was not the case with H2O2 treatment. CONCLUSION: These results suggest that genes in MAP that code for proteins involved in copper homeostasis trigger an adaptive response to copper ions.

Biology, Population Fluctuation, and Foliar Consumption Rate of Durrantia arcanella Busk, 1912 (Lepidoptera: Depressariidae), a Defoliator of Oil Palm in the Colombian Caribbean.

Durrantia arcanella is a recurring pest insect of oil palm in Colombia. Because the biology and ecology of D. arcanella are unknown, it was proposed to determine the life cycle and foliar consumption under laboratory conditions. Furthermore, through sequential sampling for two and a half years, its population fluctuation and natural enemies were determined in Agustín Codazzi and El Copey (Cesar, Colombia). Also, temperature, precipitation, and relative humidity were registered. The life cycle of D. arcanella lasted 48.0 ± 10.1 days, the egg 8.0 ± 0.7 days, larva 24.2 ± 6.2 days, pre-pupa 1.5 ± 0.5 days, pupa 7.1 ± 0.9 days, and adult 7.2 ± 2.0 days. The larvae consumed 8.2 ± 5.3 cm2 of leaflets. Correlations were found between the population fluctuation in D. arcanella and the temperature in El Copey (ρ = -0.45; p < 0.0043), relative humidity in Codazzi (ρ = 0.33; p < 0.034), and with the natural control in both locations ((ρ = 0, 61; p < 0.000044) and (ρ = 0.42; p < 0.006)). These results suggest monitoring the pest populations in the second semester of the year and show the importance of promoting native natural enemies.

Foliar Lesions Induced by Pestalotiopsis arengae in Oil Palm (O × G) in the Colombian Southwest Palm Zone.

In Colombia, plantings with the oil palm hybrid between Elaeis oleifera × Elaeis guineensis, known as O × G hybrid, have increased due to its tolerance to bud rot. Despite this, different degrees of foliar necrosis, chlorosis, and leaf blight have been reported in some cultivars; therefore, this work aimed to diagnose this problem. We visited plantation plots with palms exhibiting the mentioned symptoms and collected 21 samples of affected tissues in different disease states. The affected tissues were examined and seeded in a culture medium. Pathogenicity tests were performed and the isolates were characterized by culture and morphological and molecular features. Curvularia, Colletotrichum, Phoma, and 25 Pestalotiopsis-like fungi were isolated from the foliar lesions. In the pathogenicity tests, the symptoms observed in the field were reproduced with MFTU01-1, MFTU12, and MFTU21 isolates, which were identified at the species level through a sequence analysis of three genes (ITS, TUB2, and TEF1-α) as Pestalotiopsis arengae with an identical level of 99% based on the results of BLAST and phylogenetic tree analyses. The remaining 22 Pestalotiopsis-like non-pathogenic isolates were identified as species of Neopestalotiopsis and Pseudopestalotiopsis. The direct association of P. arengae with the disease was confirmed via molecular detection in affected tissues in 15 of 21 samples collected for this evaluation. This is the first report of P. arengae as the causal agent of foliar lesions in O × G hybrid oil palm in Colombia.

Delineating the Role of the Urinary Metabolome in the Lithogenesis of Calcium-Based Kidney Stones.

OBJECTIVE: To delineate the role of the urinary metabolome in the genesis of urinary stone disease (USD). METHODS: Untargeted metabolomics was utilized in comparative analyses of calcium-based stones (CBS) and spot urine samples from patients with a history of USD with or without urinary stone activity based on radiologic imaging. Stone and urine metabolomes were stratified by composition and radiographic stone-activity, respectively. Additionally, we quantified highly abundant metabolites that were present in either calcium oxalate (CaOx) or calcium phosphate (CaPhos) stones and also significantly enriched in the urine of active stone formers (SF) compared to non-active SF. These data were used to delineate either a direct involvement of urinary metabolites in lithogenesis or the passive uptake of biomolecules within the stone matrix. RESULTS: Urinary metabolomes were distinct based on radiographic stone-activity and the 2 types of CBS. Stratification by radiologic stone activity was driven by the enrichment of 14 metabolites in the urine of active SF that were also highly abundant in both CaOx and CaPhos stones, indicative of a potential involvement of these metabolites in lithogenesis. Using the combination of these 14 metabolites in total, we generated a model that correctly classified patients as either active vs non-active SF in a prospectively recruited cohort with 73% success. CONCLUSION: Collectively, our data suggest specific urinary metabolites directly contribute to the formation of urinary stones and that active SF may excrete higher levels of lithogenic metabolites than non-active patients. Future studies are needed to confirm these findings and establish the causative mechanisms associated with these metabolites.

Mechanisms of the intestinal and urinary microbiome in kidney stone disease.

Kidney stone disease affects ~10% of the global population and the incidence continues to rise owing to the associated global increase in the incidence of medical conditions associated with kidney stone disease including, for example, those comprising the metabolic syndrome. Considering that the intestinal microbiome has a substantial influence on host metabolism, that evidence has suggested that the intestinal microbiome might have a role in maintaining oxalate homeostasis and kidney stone disease is unsurprising. In addition, the discovery that urine is not sterile but, like other sites of the human body, harbours commensal bacterial species that collectively form a urinary microbiome, is an additional factor that might influence the induction of crystal formation and stone growth directly in the kidney. Collectively, the microbiomes of the host could influence kidney stone disease at multiple levels, including intestinal oxalate absorption and direct crystal formation in the kidneys.

Robotic radical prostatectomy after aborted prostatectomy: still feasible? The experience from a tertiary care center.

To describe the surgical management of patients who had radical prostatectomy previously attempted but aborted due to diverse causes. Patients who underwent an "aborted prostatectomy" were extracted from the institutional prostatectomy database. A description of the tailored robotic approach was reported for each case. Tips and tricks for the accomplishment of robotic prostatectomy after aborted prostatectomy were reported. Six clinical cases were analyzed. Three patients had aborted prostatectomy due to complicated dissection hindered by pelvic mesh and bowel adhesions; one prostatectomy was aborted due to anesthesiology/respiratory matters; one for narrow pelvis; one due to abnormal pelvic vascular anatomy. All patients successfully underwent robotic prostatectomy at our institution. In five patients, standard transperitoneal robotic approach was performed. In one patient, robotic transperineal approach was mandatory. Median operative time was 282 min (86-460). Median estimated blood loss was 325 mL (50-1000). Two patients had positive surgical margins. One patient was found with nodal metastasis at final pathology. Neither perioperative nor postoperative complications were reported. At last follow-up, PSA was undetectable in 5/6 patients. Even after previous aborted prostatectomy, robot-assisted prostatectomy is feasible, with acceptable results. The case-by-case tailoring of the technique is the key for a successful intervention.

Perioperative, oncological and functional outcomes after robotic partial nephrectomy vs. cryoablation in the elderly: A propensity score matched analysis.

OBJECTIVE: To compare perioperative, oncological and functional outcomes of robotic partial nephrectomy (RPN) versus cryoablation in elderly patients (>75 years old), accounting for patient's and tumor's related factors. METHODS: Retrospective institutional review of 312 consecutive elderly patients (> 75 years old) who underwent RPN or cryoablation for renal mass (June 2006-December 2016). Demographic, perioperative, functional, and oncological data were evaluated. Sixty-five patients who underwent RPN were propensity-score matched 1:1 to 65 who underwent cryoablation (matching was based on demographics, renal function, comorbidities and tumor characteristics). Perioperative outcomes were compared. Survival analysis was performed to estimate overall (OS), recurrence-free (RFS) and cancer-specific survival (CSS) by Kaplan-Meier method. A linear mixed effect model (LME) estimated the effect of follow-up on estimated glomerular filtration rate (eGFR). RESULTS: After matching, the variables were well balanced with no differences at baseline between groups. Shorter operative time and lower blood losses favored cryoablation (140 vs. 200 min, P < 0.0001 and 100 vs. 195 ml, P = 0.0002, respectively). Overall complications rate was higher for RPN (31% vs. 9%; P = 0.007), but no difference was found in major (Clavien III-IV) complications (6% vs. 1.5%, P = 0.2). At a median follow-up of 37 (29-44) and 46 (38-53) months for RPN and cryoablation, no significant differences were found in CSS (100% vs. 95%, P = 0.3) and OS (80% vs. 75%, P = 0.2) but RFS was higher for RPN (100% vs. 83%, RPN vs. cryoablation, respectively, P = 0.02). eGFR was comparable between the groups at every time point analyzed. CONCLUSIONS: Although with a higher rate of recurrences, our data confirm cryoablation as a lower morbidity profile treatment option for small renal masses in the elderly population, with cancer-specific survival comparable to surgery.

Perioperative Outcomes and Complications after Robotic Radical Cystectomy With Intracorporeal or Extracorporeal Ileal Conduit Urinary Diversion: Head-to-head Comparison From a Single-Institutional Prospective Study.

OBJECTIVE: To compare perioperative and oncological outcomes of intracorporeal (ICUD) vs extracorporeal urinary diversion (ECUD) after robot-assisted radical cystectomy (RARC). METHODS: From January 2014 to December 2017, data of consecutive patients who underwent RARC performed by 2 institutional surgeons were prospectively collected in a dedicated database (IRB: 251647). Patients were divided in 2 groups according to the operating surgeon, one performing ECUD, the other ICUD. Groups were compared in perioperative outcomes and Clavien complications (during admission, within 30- and 90-days postoperatively). Univariable and multivariable analyses tested the impact of variables of interest on the occurrence of complications at the different time points. Kaplan-Meier method was used to estimate recurrence and metastasis-free survivals. RESULTS: Sixty to 66 patients underwent RARC with ileal conduit ICUD and ECUD, respectively. ICUD patients were younger (69 vs 73 years old, P = .009). No differences were found in other baseline characteristics and final pathology. Regarding perioperative outcomes, shorter operative time favored ECUD (7 vs 6 hours, P = .0004). Specifically, no differences were found in postoperative complications while admitted, either overall (ICUD: 16 [26.7%] vs ECUD: 23 [34.8%] patients, P = .3) or major (ICUD: 10 [16.7%] vs ECUD: 14 [21.2%], P = .6); same was for reassessment within 30- and 90-days postoperatively. At multivariable analysis, Charlson's Comorbidity Index ≥3 and blood losses >600 mL predicted complications during the admission (P = .02). Male gender, higher body mass index, and ureteral involvement predicted 30-days complications (P = .04). No differences in oncological outcomes. CONCLUSION: At head-to-head comparison of 2 expert surgeons, ICUD and ECUD for ileal conduit had comparable perioperative outcomes.

Cold ischemia technique during robotic partial nephrectomy: a propensity score-matched comparison with open approach.

BACKGROUND: Open ice slush for renal cooling during partial nephrectomy (PN) has been reproduced during robotic PN (RPN). The aim of this study was to compare the perioperative and functional outcomes between RPN and open PN (OPN) using a cold ischemia technique. METHODS: Consecutive patients undergoing PN using cold ischemia technique were extracted from our prospectively-maintained database (2007-2016). RPN and OPN patients were 1:2 propensity-score (PS) matched via a greedy algorithm. The balance of the baseline variables was checked for the matched cohorts. Perioperative and functional outcomes were compared. RESULTS: Fifty-one RPN and 334 OPN using cold ischemia were extracted. After PS adjustments, 51 RPN vs. 102 OPN with no significant differences in baseline features were compared. Regarding perioperative outcomes, blood loss (100 mL [IQR 50; 200] vs. 260 mL [IQR 200; 350], <0.001), postoperative complications rate (10 patients (19.6%) vs. 38 patients (37.3%), P=0.027) and hospital stay (3 days [IQR 2; 4] vs. 5 days [IQR 4; 6], P<0.001) favored RPN. Renal functional outcomes were comparable at repeated measures analysis. CONCLUSIONS: In our experience, cold ischemia technique can be effectively reproduced during RPN, with a potential advantage in terms of blood loss, complications rate and hospital stay over the traditional OPN procedure.

Off-clamp vs on-clamp robotic partial nephrectomy: Perioperative, functional and oncological outcomes from a propensity-score matching between two high-volume centers.

INTRODUCTION: Aim of the study was to compare perioperative, functional and oncological outcomes after off-clamp vs on-clamp robotic partial nephrectomy (RPN). MATERIALS AND METHODS: Patients who underwent off-clamp or on-clamp (warm ischemia) RPN were extracted from 2 institutional prospectively-maintained databases. 123 patients who underwent off-clamp RPN at one institution were excluded, so that each institution contributed with unselected patients (institution 1:on-clamp RPN vs institution 2:off-clamp). 2:1 propensity-score matching (age, sex, smoking, diabetes, hypertension, ASA score, solitary kidney, preoperative eGFR, tumor size and R.E.N.A.L.score). Perioperative outcomes were compared. A linear mixed model was fitted to eGFR as the outcome regressed on fixed effects for 1) management of clamping (on-clamp/off-clamp), 2) time (at baseline, at discharge, at 12 and 24 months postoperatively), and 3) clamp/time interaction. Survival events were compared between groups. RESULTS: 1983 patients were pooled. After matching, 400 on-clamp vs 200 off-clamp patients were analyzed. No significant differences were found in key perioperative outcomes. The effect of on-clamp on eGFR changed over time. At discharge, groups had similar drop in eGFR. The difference between groups was greatest at 12-months postoperatively, with on-clamp patients showing a deficit of 5 ml/min. At 24-months follow-up, this gap shrunk to 2 ml/min. There were no significant differences in overall survival (p = 0.1), recurrence (χ2 = 0.008, p = 0.9), or metastasis free survival (χ2 = 0.962 p = 0.3). Only one cancer-specific death occurred in off-clamp group. CONCLUSION: We confirm no significant differences in the perioperative and oncological outcomes between off-clamp and on-clamp RPN. Avoided ischemia benefits renal function within 1-year follow-up after surgery. At longer follow-up, difference with on-clamp is softened.

Surgical Hints for Robot-Assisted Transvesical Simple Prostatectomy.

OBJECTIVES: To report a step-by-step technique for robot-assisted transvesical simple prostatectomy (RASP) focusing on surgical hints to facilitate the procedure. METHODS: From January 2014 to April 2018 the institutional database was queried for consecutive patients undergoing RASP performed by a single-surgeon. Procedures were performed according to standardized steps as reported in the accompanying video. Ports were placed in a 'W' configuration. Surgery started with the bladder detachment, then the endopelvic fascia was exposed. The bladder neck was incised in a longitudinal fashion. Exposure of the adenoma was aided by using Keith needles. The bladder mucosa was incised and the dissection of the adenoma was performed till complete adenomectomy. Hemostasis of the enucleation bed was performed with electrocauterization. A 2-0 Polysorb suture was used for accomplishing the trigonization. Bladder closure was performed in double layer. A Foley catheter was inserted, then a water-tightness test was performed. Specimen was retrieved via the incision for the optical port. RESULTS: Twenty-eight patients were performed, according to the described technique. Median prostate volume was 180 cm3. Median blood losses were 200 mL. No intraoperative complications were recorded. Four patients had minor complications (14%). Median catheterization time was 8 days. Regarding functional outcomes, patients had significant improvement of Qmax, postvoided residual volume, and international prostate symptom score at postoperative control (P < .001). CONCLUSION: RASP is feasible, safe and effective, and represents a viable approach to large adenomas. Prospective comparison with alternative minimally-invasive endoscopic techniques is warranted.

Cold Versus Warm Ischemia Robot-Assisted Partial Nephrectomy: Comparison of Functional Outcomes in Propensity-Score Matched "At Risk" Patients.

OBJECTIVES: To compare functional outcomes of warm ischemia RPN (wRPN) to cold ischemia RPN (cRPN) in "at risk" patients. MATERIALS AND METHODS: Retrospective review of institutional database queried for all patients who underwent cRPN/wRPN (January 2007-December 2016). For the study purpose, patients with solitary kidney and/or history of partial nephrectomy and/or multiple tumors and/or preoperative estimated Glomerular Filtration Rate (eGFR) <60 mL/minute were extracted. To reduce inherent biases, groups were matched on key variables related to renal function through a greedy matching algorithm with no replacement. Renal functional outcomes were evaluated by eGFR drops at 1-3 days and at 1, 3, 6, and 12 months postoperatively. A linear mixed effects model was used to assess eGFR at each follow-up who received either cRPN or wRPN. Follow-up was treated as a factor variable to account for nonlinear time trends. Contrast analysis was used to compare cRPN vs wRPN groups at each follow-up, using Sidak-Holm p-value adjustments for multiple comparisons. RESULTS: Out of 19 cRPN patients and 279 wRPN patients, 14 cRPN patients were finally matched 1:1 with no replacement to 14 wRPN. There was no significant difference in preoperative eGFR for matched patients undergoing cRPN vs wRPN. Since the first postoperative day, cRPN patients had higher eGFR. The difference was statistically significant since the third month postoperatively (mean difference = 18.201, 95% confidence interval [CI]: 1.930-34.472) and remained at both the sixth month (mean difference = 18.839, 95% CI: 2.568-35.109) and the 12th month (mean difference = 21.277, 95% CI: 5.006-37.547) follow-up. CONCLUSIONS: Accounting for unmodifiable and modifiable factors, in a cohort of highly selected patients "at risk" for postoperative significant decline in renal function after RPN, renal functional outcomes appear to be superior with cold ischemia technique.

Clasificación de cesárea según el sistema de Robson en una IPS privada de Cali, 2017 / Cesarean section classification according to Robson's system in a private HSPI in Cali, 2017

RESUMEN Objetivo: Caracterizar las cesáreas según el sistema de clasificación de Robson en una IPS privada de alta complejidad, en el periodo comprendido entre el 1 de enero y el 31 de diciembre de 2017. Métodos: Estudio descriptivo, retrospectivo y de corte transversal realizado en una IPS privada de la ciudad de Cali. Se incluyó en el estudio gestantes ingresadas para atención del parto en el 2017. Se construyó una base de datos en Microsoft Excel 2010, con las variables definidas en la clasificación de Robson y se calculó la tasa de cesáreas, el tamaño relativo de cada grupo y la contribución relativa de cada grupo a la tasa general de cesáreas, así como se analizó las causas de las cesáreas. Se presentan los resultados en tablas. Resultados : La tasa de cesáreas general fue del 35,4 %. Los grupos de mayor contribución al porcentaje total de cesáreas fueron los grupos 2, 1 y 10, con 20,4%, 3,9 % y 3,3 %, respectivamente. El antecedente de cesárea previa fue la causa principal. Conclusiones. Utilizando la clasificación de Robson se logra concluir que es posible reducir la tasa de cesáreas en un 14 % interviniendo el antecedente de cesárea previa.

ABSTRACT Objective : To characterize cesarean sections according to the Robson classification system in a private high complexity HPSI, in the period between January 1 December 31, 2017. Methods : Descriptive, retrospective, cross-sectional study conducted in a private HPSI in the city of Cali. The study included pregnant women admitted for delivery care in 2017. A database was constructed in Microsoft Excel 2010, with the variables defined in Robson's classification. The rate of cesarean sections, the relative size of each group and the relative contribution of each group to the overall rate of cesarean sections were calculated, as well as the causes of cesarean sections were analyzed. The results are presented in tables. Results : The overall cesarean section rate was 35.4 %. The groups with the highest contribution to the total percentage of cesarean sections were groups 2, 1 and 10 with 20.4 %, 3.9 % and 3.3 %, respectively. History of previous cesarean section was the main cause. Conclusions: Using Robson's classification, it can be concluded that it is possible to reduce the rate of cesarean section rate by 14 % by intervening in the history of previous cesarean section.