Laparoscopic simple prostatectomy vs bipolar plasma enucleation of the prostate in large benign prostatic hyperplasia: a two-center 3-year comparison.

PURPOSE: To compare surgery outcomes and safety of button bipolar enucleation of the prostate vs laparoscopic simple prostatectomy in patients with large prostates (> 80 g) in a two-center cohort study. METHODS: All patients with lower urinary tract symptoms due to benign prostatic enlargement (Prostate volume > 80 cc) undergoing button bipolar enucleation of the prostate (BTUEP) or laparoscopic simple prostatectomy (LSP) in two centers were enrolled. Data on clinical history, physical examination, urinary symptoms, uroflowmetry and prostate volume were collected at 0, 1, 3 6, 12, 24 and 36 months. Early and long-term complications were recorded. RESULTS: Overall, 296 patients were enrolled. Out of them, 167/296 (56%) performed a LSP and 129/296 (44%) performed a BTUEP. In terms of efficacy both procedures showed durable results at three years with a reintervention rate of 8% in the LSP group and of 5% in the BTUEP group. In terms of safety, BTUEP and LSP presented similar safety profiles with a 9% of transfusion rate and no major complications. CONCLUSION: LSP and BTUEP are safe and effective in treating large-volume adenomas with durable results at three years when performed in experienced centers.

How many procedures are needed to achieve learning curve of Millin simple laparoscopic prostatectomy?

BACKGROUND: Aim of our study was to evaluate learning curve of the Millin simple prostatectomy analyzing three expert laparoscopic surgeons. METHODS: Learning curve of 3 expert laparoscopic surgeons with excellent radical prostatectomy training was evaluated. Surgeon 1 had more than 20 years of experience, while other surgeons had 10 years of experience. The first 45 procedures of the surgeons were considered for analysis. The cumulative sum (CUSUM) technique, one of the methods developed to monitor the performance and quality of the industrial sector, was adopted to analyze learning curves. The variables included to evaluate learning curve of the surgeons were: operative time (OT), hospitalization (HO) and complication rate. RESULTS: Overall 135 patients were included in the analysis. Median age was 68 (64/74), median prostate volume was 83 (75/97), median Qmax 9 mL/s (6/11) and median IPSS=20 (18/22). Complications included: 9/135 (7%) transfusion, 4/135 (3%) Urinary retention, 3/135 (2%) fever, 1/35 (<1%) reintervention and 1/135 (<1%) conversion. Surgeon 1 presented a lower median operative time when compared to surgeon 2 and 3. No significant differences were recorded in terms of hospitalization, blood loss and transfusion rate as well as postoperative outcomes. According to the CUSUM analysis the number of procedures needed to achieve a plateau in surgical time is 10/15 procedures. CONCLUSIONS: According to our results 15 procedures are needed to reach a plateau in surgical time for trained laparoscopic surgeons.

[Scrotum-perineal granular cell tumor in pediatric age: A case report.] / Tumor de células granulares escroto-perineal en edad pediátrica: a propósito de un caso.

OBJECTIVE: Report a case of a scrotum-perinea lGranular Cell Tumor (GCT) in pediatric age. METHODS: To report a case. RESULTS: A 12 years old men with a multiple GCT history, located in both extremities, abdomen and scrotum perineal region. Surgical excision of all lesions and a genetic studyare performed to rule out Noonan syndrome. CONCLUSION: GCT or Abrikossoff tumor is a tumor witha very low incidence, especially in pediatric age. The most frequent form of presentation a solitary nodule and the most common behavior is in the form of a benign tumor. Immunohistochemistryis crucial for its diagnosis, the main characteristicis positivity for the S100 protein. Although scrotal location is very rare, it must be considered in the differential diagnosis of scrotal mass. Surgical excision is the treatment of choice.

OBJETIVO: Exposición de un caso de Tumor de Células Granulares (TCG) escroto-perineal en edad pediátrica.MÉTODOS: Presentación de un caso clínico. RESULTADOS: Se trata de un paciente de 12 años de edad con historia de TCG múltiples, localizados en ambas extremidades, abdomen y región escroto-perineal. Se realiza exéresis quirúrgica de todas las lesiones y se lleva a cabo estudio genético para descartar síndrome de Noonan.CONCLUSIÓN: El TCG o Tumor de Abrikossoff es un tumor con una incidencia muy baja, sobre todo en edad pediátrica. La forma de presentación más frecuente es la de nódulo solitario y el comportamiento más habitual es como tumor benigno. La inmunohistoquímica resulta crucial para su diagnóstico, siendo lo más característico su positividad para la proteína S-100. Aunque la localización escrotal es muy poco frecuente, hay que considerarla en el diagnóstico diferencial de masa escrotal. La exéresis quirúrgica es el tratamiento de elección.

Laparoscopic simple prostatectomy: a large single-center prospective cohort study.

BACKROUND: The aim of our study was to analyze outcomes and safety of laparoscopic simple prostatectomy (LSP) in a high-volume center. METHODS: A consecutive series of men with lower urinary tract symptoms and large prostates (>80 cc) prospectively enrolled between November 2015 and December 2017 in one center. All patients underwent laparoscopic simple prostatectomy. Outcomes were evaluated considering the trifecta favorable outcome which was defined as a combination of the following items: 1) no perioperative complications; 2) postoperative IPSS <8; 3) postoperative Qmax >15 mL/s. Complications were evaluated according to the modified Clavien classification system. Univariate and multivariate binary logistic regression was performed to identify predictors of a positive trifecta outcome. RESULTS: Overall 272 patients were enrolled. At three months after surgery median IPSS total score was 4 (IQR: 3-7), median IPSS QoL was 1 (IQR:1-2), median prostate-specific antigen was 0.53 (IQR: 0.33-1.00) ng/ml and median Qmax was 23 (IQR: 17-30) mL/s. All these parameters improved statistically when compared to baseline (P<0.001). The overall complication rate was 21% however most of the complications were low grade complications according to modified Clavien-Dindo classification (grade ≤2). Overall, 68% of the patients presented a positive trifecta outcome. On multivariate analysis only preoperative hemoglobin and hospital stay were confirmed predictors of positive trifecta outcome. CONCLUSIONS: LSP represents a safe and effective procedure in the treatment of large adenomas. Although RCTs are needed before reaching definitive conclusions, LSP is a promising technique for patients with LUTS and large prostates.

[Inguinal ureteral hernia: a clinical case]. / Hernia ureteral inguinal: caso clínico.

SUMMARY OBJECTIVES: To describe a clinical case of ureteral inguinal hernia and to comment briefly about the topic. METHODS: 80 year-old patient with, hypertension, left inguinal hernia surgery, right hemicolectomy for colon adenocarcinoma and cholecystectomy. Intravenous urogram casually found that the right ureter was leaving the abdominal cavity though the right inguinal duct and then returned to the abdomen. RESULTS: CT scan confirmed the diagnosis. Due to the advanced age of the patient, comorbidities and the absence of symptoms, conservative treatment was decided. CONCLUSIONS: Ureteral hernias through the inguinal duct are uncommon. There are 2 types: paraperitoneal and extraperitoneal. The most common is the paraperitoneal (80%) which is accompanied by hernia sac and can appear with other abdominal organs. The extraperitoneal often accompanied by retroperitoneal fat. Both types of hernias are usually indirect. Treatment is usually herniorrhaphy.

[Lymphocele after renal transplantation: case report and bibliographic review]. / Linfocele gigante tras trasplante renal. A propósito de un caso y revisión de la literatura.

OBJECTIVES: To report the case and iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and the treatment of this surgical complication. METHODS: 69 year-old woman status post renal transplantation who presents right lower extremity edema and worsening renal function. A liquid collection was demonstrated by ultrasound and computerized tomography, compatible with lymphocele after biochemical study of the liquid obtained by percutaneous puncture. RESULTS: The patient underwent laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcome. CONCLUSION: Lymphocele is a common pathology after a renal transplantation which needs to be treated depending on its clinical manifestations. There mainly are two therapeutic alternatives depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from very selected cases, laparoscopic approach is currently considered, because of its security and effectiveness, the first choice when a surgical treatment is prescribed.

[Giant lymphocele after renal transplantation. Case report and bibliographic review]. / Linfocele gigante tras trasplante renal. A propósito de un caso y revisión de la literatura.

OBJECTIVE: To report the case and the iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and treatment of this surgical complication. METHODS: 69 year-old woman who undergone renal transplantation and presented right lower extremity edema and worsening renal function. It was demonstrated by ultrasound and computerized tomography a liquid collection, compatible with lymphocele after biochemical study of the liquid which was obtained by percutaneous puncture. RESULTS: The patient underwent a laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcomes. CONCLUSION: Lymphocele is a common pathology after a renal transplantation, which needs to be treated depending on its clinical manifestations. There are mainly two therapeutic alternatives, depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from highly selected cases, laparoscopic approach is currently considered first choice when a surgical treatment is prescribed due to its security and effectiveness.

Hemorragia suprarrenal espontánea unilateral / Spontaneous unilateral adrenal hemorrhage

Hombre de 73 años que acude al servicio de urgencias por dolor abdominal. Al examen físico se palpa masa que ocupa hipocondrio derecho. Angio TAC muestra masa abdominal de 12 cm dependiente de glándula suprarrenal derecha. Analítica de orina muestra elevación de metanefrinas y normetanefrinas. La gamagrafía fue compatible con feocromocitoma. Se realiza extirpación quirúrgica de masa y la anatomía patológica describe hemorragia suprarrenal sin malignidad.

A 73 year old man, came to the emergency department referring abdominal pain. A palpable mass occupying right upper quadrant on physical examination was identified. CT angiography showed a 12 cm abdominal mass dependent of the right adrenal. Urinalysis showed elevation of metanephrines and normetanephrines. Gamagraphy scan was compatible with pheochromocytoma. Surgical resection of the mass was performed and pathology described an adrenal hemorrhage without malignancy.