[Effect of surgical approach on radical nephrectomy outcomes: Comparative study between open and laparoscopic nephrectomy.] / Influencia de la vía de acceso para la nefrectomía radical en el tratamiento del cáncer renal: estudio comparativo entre cirugía abierta y cirugía laparoscópica.

OBJECTIVE: The aim of this study is to evaluate the influence of laparoscopy in patients with renal cancer treated with radical nephrectomy in terms of surgical time, hospital stay, postoperative complications and survival.MATERIAL AND METHODS: Retrospective study of 570 patients with renal cancer treated with radical nephrectomyin stage ≤pT3a. Differences between groups were analysed using ANOVA test for quantitative variables and Chi squared test for qualitative. In order to evaluate possible risk factors for longer hospital stay and surgical time, multivariate analysis was performed (lineal regression). For complications we performed binary logistic regression. Overall survival (OS), recurrence free survival (RFS) and cancer specific survival (CSS) were estimated using Kaplan Meier and compared using Log Rank test. Univariate and multivariate analysis was performed using Cox regression in order to identify independent risk factors for overall, cancer specific and recurrence mortality. RESULTS: Two cohorts: 361 (63.3%) open radical nephrectomies (ORN) and 209 (36.7%) laparoscopic (LRN). Surgical time was longer in LRN (p=0.001) globally. After the period when the learning curve was over these differences were no longer significant. Hospital stay was shorter in LRN (p=0.0001). cT stage (p=0.005) and surgical access (p=0.001) acted as independent risk factors for longer surgical time. 33,5% (121 patients) of the ORN had some sort of postoperative complication vs. 11% (23 patients) in the LRN group (p=0.0001). These differences were observed in the Clavien-Dindo's grade II group. Independent risk factors for postoperative complications observed were: ASA≥III (OR=1.82, p=0.004) and stage pT3a (OR=2.29,p=0.0001). Laparoscopy acted as a protective factor for complications (OR=0,26, p=0.0001). Surgical access did not influence RFS (HR=0.87, p=0.50), CSS(HR=0.69, p=0.12). CONCLUSIONS: Laparoscopic access to RN in patients with renal cancer in ≤pT3a stage increased surgical time only in the first years, reduced hospital stayand postoperative complications and did not influence RFS, OS or CSS.

OBJETIVO: El objetivo del estudio es evaluarla influencia de la laparoscopia en pacientes concáncer renal tratados con nefrectomía radical (NR) en términos de tiempo quirúrgico, estancia media, complicaciones postoperatorias y supervivencia.MATERIAL Y MÉTODO: Análisis retrospectivo de 570 pacientes con cáncer renal tratados con NR en estadio ≤pT3a comparando cohorte de acceso abierto (NRA) y laparoscópico (NRL). Contraste de variables cualitativas con el test de Chi cuadrado y cuantitativas con ANOVA. Para identificar factores de riesgo (FR) de tiempo quirúrgico y estancia media se utilizó regresión lineal multivariante y para complicaciones la regresión logística binaria. Estimación de la supervivencia libre de recidiva (SLR), global (SG) y cáncer específica (SCE) mediante Kaplan-Meier y test de log-rank para analizar las diferencias. Análisis multivariante mediante regresión de Cox para identificar variables predictoras independientes (VPI) de SLR y SCE. Todos los cálculos se han realizado con el paquete estadístico IBM® SPSS® statisticsv-21. RESULTADOS: Dos cohortes: 361 (63,3%) NRA y 209(36,7%) NRL. El tiempo de cirugía fue mayor en NRL (p=0,001) de forma global siendo las diferencias entre ambas en el periodo tras la curva de aprendizaje no significativas. La estancia media fue menor en NRL(p=0,0001). El estadio cT (p=0,005) y la vía de acceso (p=0,001) se comportaron como VPI de prolongación del tiempo quirúrgico. El 33,5% (121 casos) de las NRA presentaron algún tipo de complicación en el postoperatorio, frente al 11% (23 casos) de las NRL (p=0,0001). Esta diferencia se observó en complicaciones tipo II de Clavien. VPI de complicaciones postoperatorias: ASA≥III (OR=1,82, p=0,004) y el estadio pT3a (OR=2,29, p=0,0001). La laparoscopia se comportó como factor protector de complicaciones (OR=0,26, p=0,0001). La vía de acceso no influyó en la SLR (HR=0,87, p=0,50) ni en la SCE (HR=0,69,p=0,12). CONCLUSIONES: El acceso laparoscópico a la nefrectomía radical en pacientes con cáncer renal en estadio ≤pT3a aumentó el tiempo quirúrgico pero solo en los primeros años, presentó menor estancia y complicacionespostoperatorias y no influyó en la SG,SLR y SCE.

[Urethral stricture in women]. / Estenosis uretral en la mujer.

UNLABELLED: To perform a bibliographic review on female urethra stenosis, following the criteria for evidence based medicine. METHODS: We performed a PubMed Search with the following keywords; "female urethral stricture ","women urethral stricture","female urethral reconstruction "and " female urethral stricture treatment ",without time limits, both in English and Spanish languages. RESULTS: Female urethra stenosis is a rare pathology, in which the working diagnosis is essential, as much as detailed physical examination, urodynamic study and radiological tests. We found in the literature a total of 73 cases treated with dilation with or without maintenance self catheterization, 120 cases treated with meatotomy, 65 cases treated by flap urethroplasty (46 with vaginal flap, 17 with vestibular flap and 12 with labia minora graft and 28 with oral mucosa grafts). There are not comparative studies between the various techniques, making it difficult to set up a therapeutic algorithm. CONCLUSIONS: The surgical treatment with flaps/grafts has the highest success rate; whereas less invasive procedures such as urethrotomy/meatotomy/dilations/self-catheterization should be reserved for short female urethra stenosis or women with high comorbidity.

Urachal adenocarcinoma. Case report and bibliographic review.

OBJECTIVE: Literature review of adenocarcinoma of the urachus in connection with two cases recently diagnosed and treated in our center. METHODS/RESULTS: We report 2 cases of urachus Adenocarcinoma treated in our institution, both underwent extended partial cystectomy including excision of the urachus up to the umbilicus. CONCLUSION: Urachal adenocarcinoma is an exceptional tumor, of poor prognosis, the treatment of which is surgical (partial cystectomy), and the main predictors of disease-free survival are the degree of tumor differentiation and the free margins of the surgical specimen.

[Paratesticular liposarcoma. Clinical and pathological study of three cases and review of the literature]. / Liposarcomas paratesticulares. Estudio clinicopatológico de tres casos y revisión de la literatura.

OBJECTIVES: Paratesticular liposarcomas are rare; most published cases are single cases. We report the clinical, histological and immunohistochemical characteristics of three cases of paratesticular liposarcomas. METHODS: We performed clinical, histological and immunohistochemical studies with expression of ki 67 and p 53 markers in three cases of tumors of the spermatic cord. RESULTS: Patient age ranged from 36 to 67 years, with a mean of 54 years. All tumors were big, multinodular and predominant histological type was well-differentiated (2/3), being one case undifferentiated (1/3). All cases were treated by surgical excision; one of them had a relapse five years later (33%) as a low-grade undifferentiated liposarcoma. None of the patients have developed metastases after a long follow-up (10, 7, and 5 yr.). CONCLUSIONS: Paratesticular liposarcomas have favourable prognostic markers (histological type, low proliferation index Ki 67 and p 53). The evaluation of this masses should be based on imaging tests, but a biopsy is necessary to determine their nature both in the case of primary tumors and recurrences. Surgical treatment should include complete excision with free margins to avoid recurrences.

[Results of the use of donors under 3 years of age for pediatric renal transplantation]. / Resultados de la utilización de donantes de edad inferior a 3 años en trasplante renal pediátrico.

OBJECTIVES: To evaluate the functional results and incidence of complications in a series of pediatric renal transplants using grafts from pediatric donors under 3 years of age. METHODS: We review a serious of 19 renal transplants consecutively performed in pediatric receptors with donors under the age of 3 years. We analyze immediate function, medical and surgical complications, and long and mid-term graft and patient survivals. RESULTS: We observed initial graft dysfunction in 9 patients (47.4%). Six patients had vascular complications (31.5%). More vascular complications appeared in kidneys preserved with EC solution (35.3%) in comparison with UW solution (23.5%) (p < 0.05). 1, 5, 10, and 12 year actuarial graft survivals were 57.8%, 41.4%, 35.5% and 35.5%, respectively. Based on preservation solution, 1, 5, and 10 year actuarial graft survivals for EC were 44%, 33% and 16%, respectively; results improved with UW solution up to 60%, 50%, and 50% respectively (p < 0.001). CONCLUSIONS: Kidneys from donors under the age of the 3 years in pediatric receptors suffer a high incidence of vascular complications offering a low graft survival on the long-term, being these facts more evident when simpler preservation solutions are employed.

[Treatment of urinary stress incontinence using a laparoscopic technique]. / Tratamiento de la incontinencia urinaria de esfuerzo mediante técnica laparoscópica.

OBJECTIVES: To evaluate our own experience with laparoscopic bladder neck suspension. The laparoscopic procedure is performed by anchoring a mesh from the vagina to the ligament, thus creating tension. This technique has several characteristics that make it very attractive: it is easy to learn, operating times are short and it is a commonly indicated procedure. METHODS: We present a series of 72 women with history of urinary stress incontinence to whom a laparoscopic bladder neck suspension was indicated. RESULTS: The procedure was completed in 69 patients, with a mean operative time of 40 minutes. Mean hospital stay was 1.6 days (Range 1 to 5 days). Continence rate was 82% after a median follow up of 31 months. 12 patients recurred after the operation, 7 of them recurred in the first 2 months and 5 had previous surgical history; this makes us think whether the technique was not adequately performed or the indication for treatment was not suitable. CONCLUSIONS: We believe that, although it is necessary a longer follow-up, laparoscopic bladder neck suspension can be considered a good alternative in the treatment of urinary stress incontinence.

[Laparoscopic technique in the treatment of stress urinary incontinence]. / La técnica laparoscópica en el tratamiento de la incontinencia urinaria de esfuerzo.

OBJECTIVES: To evaluate the usefulness of laparoscopy as a corrective technique for urinary stress incontinence in our experience. METHODS: We review 72 cases of urinary stress incontinence who were treated by laparoscopic bladder neck suspension between April 1996 and December 2001. RESULTS: Average operative time was less than 40 minutes and mean hospital stay was 1.6 days. The continence rate was 82% after a mean follow up of 32 months. From the 12 patients with incontinence recurrence, 7 had the urinary incontinence recurrence within 2 months from surgery. CONCLUSIONS: The results of laparoscopic correction in urinary stress incontinence seem to be satisfactory in the midterm, although it is necessary to have at least 5 years of follow up to be able to compare it with consolidated techniques considered the gold standard in the treatment of this disease.

[Female stress urinary incontinence. Surgical repair with pubovaginal sling techniques]. / Incontinencia urinaria de esfuerzo femenina. Corrección quirúrgica con técnicas de cabestrillo pubovaginal.

OBJECTIVES: To review the treatment of female stress urinary incontinence by new systems of tension-free urethral sling TVT type (Tension free vaginal tape) or IVS (intravaginal slingplasty), and the bone anchoring trasvaginal sling procedure Infast. METHODS: We describe the surgical techniques of the various procedures and perform a bibliographic review on the topic. RESULTS/CONCLUSIONS: The pubovaginal sling has become the gold standard in the treatment of female stress urinary incontinence, mainly if there is sphincter intrinsic dysfunction. The concept of tension free medium urethra support has been the most important contribution, that questions the classification of incontinence in types I, II and III, because the pubocervical tension free sling can correct all three. Tension free urethral sling techniques have demonstrated to be effective, minimally invasive with a low complication rate, easily reproducible, and with good continence results in the mid-term.