Second brazilian consensus on the treatment of advanced prostate cancer - a SBOC-SBU-SBRT panel review.

Prostate cancer is the second most common cancer and the fi fth leading cause of cancer deaths. In Brazil, it is likewise the second most common cancer among men, second only to non-melanoma skin cancers. The aim of this consensus is to align different opinions and interpretations of the medical literature in a practical and patient-oriented approach. The fi rst Brazilian Consensus on the Treatment of Advanced Prostate Cancer was published in 2017, with the goal of reducing the heterogeneity of therapeutic conduct in Brazilian patients with metastatic prostate cancer. We acknowledge that in Brazil the incorporation of different technologies is a big challenge, especially in the Sistema Único de Saúde (SUS), which allows for the disparity in the options available to patients treated in different institutions. In order to update the recommendations and to make them objective and easily accessible, once more a panel of specialists was formed in order to discuss and elaborate a new Brazilian Consensus on Advanced Prostate Cancer. This Consensus was written through a joint initiative of the Brazilian Society of Clinical Oncology (SBOC) and the Brazilian Society of Urology (SBU) to support the clinical decisions of physicians and other health professionals involved in the care of patients with prostate cancer.

Laparoscopic resection of prescral and obturator fossa schwannoma.

INTRODUCTION: Pelvic Schwannoma is an extremely rare event. Laparoscopic approach for radical resection on pelvic region already has been described in the literature. However, with better image quality provided by optic in the laparoscopy we can assure an improvement in this kind of approach for tumor resection. OBJECTIVE: Our goal is to describe and evaluate the results of one laparoscopic resection of presacral and obturator fossa tumor. MATERIALS AND METHODS: We present a case of a 60-year-old man with progressive congestion in the right inferior member and CT scan revealing a mass with miscellaneous content located behind of the right iliac vessels and right obturator nerve. Exploratory transperitoneal laparoscopy was indicated. During laparoscopy it was possible to see the mass between the spermatic cord and external iliac artery. We made the identification and preservation of iliac vessels and obturator nerve. Resection of the tumor was performed carefully, allowing the safe removal of the specimen with complete preservation of the iliac vessels and obturator nerve. RESULTS: Mean operative time of 150 minutes. No perioperative complications occurred. Two days of hospital stay. Posterior histopathological exam confirmed that the mass was a Schwannoma. CONCLUSION: The maximization of the image in the laparoscopic surgery offers dexterity and capacity of dissection required for complex mass dissection on pelvic region.

Prostate cancer in Brazil and Latin America: epidemiology and screening.

INTRODUCTION: Prostate cancer is one of the tumors with higher incidence and mortality among men in the World. Epidemiological data are influenced by life expectancy of population, available diagnostic methods, correct collection of data and quality of health services. Screening of the disease is not standardized around the World. Up till now there is no consensus about the risks versus benefits of early detection. There are still missing data about this pathology in Latin America. OBJECTIVE: to revise current epidemiologic situation and early diagnosis policies of prostate cancer in Brazil and Latin America. MATERIALS AND METHODS: Medline, Cochrane Library and SciELO databases were reviewed on the subject of epidemiology and screening of prostate cancer. Screening research was performed in websites on national public health organizations and Latin America. Screening recommendations were obtained from those governmental organizations and from Latin American urological societies and compared to the most prominent regulatory agencies and societies of specialists and generalists from around the World. RESULTS: Brazil and Latin America have a special position in relation to incidence and mortality of prostate cancer. In Brazil, it occupies the first position regarding incidence of cancer in men and the second cause of mortality. Central America has the highest rate of mortality of the continent with lower incidence/mortality ratios. Screening recommendations are very distinct, mainly among regulatory organs and urological societies. CONCLUSION: prostate cancer epidemiology is an important health public topic. Data collection related to incidence and mortality is still precarious, especially in less developed countries. It is necessary to follow-up long term screening studies results in order to conclude its benefits.

Argus T® versus Advance® Sling for postprostatectomy urinary incontinence: A randomized clinical trial.

OBJECTIVE: To compare the results of two slings, Argus T® and Advance®, for the treatment of postprostatectomy urinary incontinence (PPUI). MATERIAL AND METHODS: From December 2010 to December 2011, 22 patients with PPUI were randomized as follows: 11 (mean age 62.09(±5.30)) underwent treatment with Advance® and 11 (mean age 62.55(±8.54)) with Argus T®. All patients were evaluated preoperatively with urodynamic testing, quality of life questionnaire (ICIQ-SF), voiding diary and 24-hour pad test. Exclusion criteria were: neurological diseases, severe detrusor overactivity and urethral stenosis. Evaluation was performed at 6, 12 and 18 months after the surgery. After implantation of the Argus T® sling, patients who experienced urine leakage equal to or greater than the initial volume underwent adjustment of the sling tension. Results were statistically analyzed using the Fisher's test, Kolmogorov-Smirnov test, Friedman's non-parametric test or the Mann-Whitney test. RESULTS: Significant improvement of the 24-hour pad test was observed with the Argus T® sling (p=0.038), With regard to the other parameters, there was no significant difference between the two groups. Removal of the Argus T® device due to perineal pain was performed in one patient (9%). Despite non uniform results, both devices were considered useful to improve quality of life (ICIQ-SF): Argus T® (p=0.018) and Advance® (p=0.017). CONCLUSIONS: Better results were observed in the 24h pad test and in levels of satisfactionwith the Argus T® device. Both slings contributed to improve quality of life (ICIQ-SF), with acceptable side effects.

Laparoscopic - assisted transpyelic rigid nephroscopy - simple alternative when flexible ureteroscopy is not available.

INTRODUCTION: In special situations such as malrotated or ectopic kidneys and UPJ stenosis treatment of renal lithiasis can be challenging. In these rare cases laparoscopy can be indicated. OBJECTIVE: Describe the Laparoscopic-assisted rigid nephroscopy performed via transpyelic approach and report the feasibility. PATIENTS AND METHODS: We present two cases of caliceal lithiasis. The first is a patient that ESWL and previous percutaneous lithotripsy have failed, with pelvic kidney where laparoscopic dissection of renal pelvis was carried out followed by nephroscopy utilizing the 30 Fr rigid nephroscope to remove the calculus. Ideal angle between the major axis of renal pelvis and the rigid nephroscope to allow success with this technique was 60-90 grades. In the second case, the kidney had a dilated infundibulum. RESULTS: The operative time was 180 minutes for both procedures. No significant blood loss or perioperative complications occurred. The bladder catheter was removed in the postoperative day 1 and Penrose drain on day 2 when patients were discharged. The convalescence was completed after 3 weeks. Patients were stone free without symptons in one year of follow-up. CONCLUSIONS: Laparoscopic-assisted rigid nephroscopy performed via tranpyelic approach can be done safely with proper patient selection and adherence to standard laparoscopic surgical principles. This approach is an alternative in cases where flexible endoscope is not available and when standard procedure is unlikely to produce a stone-free status.

Retzus-sparing robotic-assisted laparoscopic radical prostatectomy: a step-by-step technique description of this first brazilian experience.

INTRODUCTION: Retzus-sparing robotic-assisted radical prostatectomy(RARP) is a newly approach that preserve the Retzus structures and provide better recovery of continence and erectile function. In Brazil, this approach has not yet been pre¬viously reported. OBJECTIVE: Our goal is to describe Step-by-Step the Retzus-sparing RARP surgical technique and report our first Brazilian experience. METHODS: We present a case of a 60-year-old white man with low risk prostate cancer. Surgical materials were four arms Da Vinci robotic platform system, six transperitoneal portals, two prolene wires and Polymer Clips. This surgical tech¬nique was step-by-step described according to Galfano et al. One additional step was added as a modification of Galfano et al. Primary technique description: The closure of the Denovellier fascia. RESULTS: We have operated one patient with this technique. The operative time was 180minutes, console time was135 min, the blood loss was 150ml, none perioperative or postoperative complications was found, hospital stay of 01 day. The anatomopathological classification revealed a pT2aN0M0 specimen with free surgical margins. The patient achieved continence immediately after bladder stent retrieval. Full erection reported after 30 days of surgery. CONCLUSION: Retzus-sparing RARP approach is feasible and reproducible. However, further comparative studies are neces¬sary to demonstrate potential benefits in continence and sexual outcomes over the standard approaches.

Open suprapubic versus retropubic prostatectomy in the treatment of benign prostatic hyperplasia during resident's learning curve: a randomized controlled trial.

PURPOSE: This study compared the suprapubic (SP) versus retropubic (RP) prostatectomy for the treatment of large prostates and evaluated perioperative surgical morbidity and improvement of urinary symptoms. MATERIALS AND METHODS: In this single centre, prospective, randomised study, 65 consecutive patients with LUTS and surgical indication with prostate volume greater than 75g underwent open prostatectomy to compare the RP (32 patients) versus SP (33 patients) technique. RESULTS: The SP group exhibited a higher incidence of complications (p=0.002). Regarding voiding pattern analysis (IPSS and flowmetry), both were significantly effective compared to pre-treatment baseline. The RP group parameters were significantly better, with higher peak urinary flow (SP: 16.77 versus RP: 23.03mL/s, p=0.008) and a trend of lower IPSS score (SP: 6.67 versus RP 4.14, p=0.06). In a subgroup evaluation of patients with prostate volumes larger than 100g, blood loss was lower in those undergoing SP prostatectomy (p=0.003). Patients with prostates smaller than 100g in the SP group exhibited a higher incidence of low grade late complications (p=0.004). CONCLUSIONS: The SP technique was related to a higher incidence of minor complications in the late postoperative period. High volume prostates were associated with increased bleeding when the RP technique was utilized. The RP prostatectomy was associated with higher peak urinary flow and a trend of a lower IPSS Score.

Cardiovascular events associated with androgen deprivation therapy in patients with prostate cancer: a systematic review and meta-analysis.

CONTEXT: A recently published meta-analysis of randomized clinical trials (RCT) showed that androgen deprivation therapy (ADT) did not significantly increase cardiovascular mortality in prostate cancer patients. However, cardiovascular morbidity, which can impact quality of life, was not evaluated. OBJECTIVE: To evaluate the risk of cardiovascular morbidity associated with ADT in patients with prostate cancer. METHODS: We conducted a literature search from January 1960 to June 2012. RCT and large cohort studies that evaluated first-line endocrine therapy and ADT longer than 6 months were screened for inclusion. RESULTS: In total, 126,898 patients were included in four cohort studies, and 10,760 patients were included in nine RCTs. Analysis of the RCTs showed no differences in the development of acute myocardial infarction (AMI) (OR 1.23; 95 % CI 0.92-1.64; I (2): 0 %) among the patients receiving ADT or not. The analysis of randomized studies that reported other nonfatal cardiovascular events demonstrated a significant increase in such events in the group receiving ADT (OR 1.55; 95 % CI 1.09-2.20; I (2): 0 %). When the large cohort studies were included in the analysis, an increased risk of AMI among men with ADT was found (OR 2.01, 95 % CI 1.90-2.13; I (2): 91,3 %). CONCLUSION: The use of ADT in prostate cancer patients corresponded with a significant increase in cardiovascular morbidity associated with AMI and with nonfatal events. Therefore, ADT is linked to a significant negative impact on quality of life. Periodic cardiovascular evaluation is required for these patients.

Penile cancer: organ-sparing surgery.

PURPOSE OF REVIEW: Penile cancer is a devastating disease, usually diagnosed late, that requires wide excisions, which causes alterations in self-esteem and body image, affecting sexual and urinary functions, which compromise quality of life. Recently, an increasing interest in penile-sparing surgeries (PSSs) has emerged, aiming to spare patients from these complications. RECENT FINDINGS: Several options of PSS have been popularized for selected cases (Ta-1, Tis and some T2), such as wide local excision, circumcision, partial penectomy, total or partial glansectomies with or without glans-resurfacing procedures, as well as new glans reconstructions using spatulated urethral advances or free skin grafts. These options, in general, achieve good local control, with adequate functional results and satisfactory cosmetic appearance. The local recurrences, however, are slightly higher than amputations. Contemporary techniques such as laser or cryotherapy can be performed in selected cases. SUMMARY: PSS must be indicated only for superficial penile cancer cases, such as Tis and Ta-1, and for selected invasive lesions (small distal pT2 tumors). Candidates for PSS should be adherent to follow-up requirements, allowing early detection of local recurrences. Prompt and effective salvage procedures are mandatory in these situations.

Transanal Minimally Invasive Surgery (TAMIS) to Treat Vesicorectal Fistula: A New Approach.

PURPOSE: Vesicorectal fistula is one of the most devastating postoperative complications after radical prostatectomy. Definitive treatment is difficult due to morbidity and recurrence. Despite many options, there is not an unanimous accepted approach. This article aimed to report a new minimally invasive approach as an option to reconstructive surgery. MATERIALS AND METHODS: We report on Transanal Minimally Invasive Surgery (TAMIS) with miniLap devices for instrumentation in a 65 year old patient presenting with vesicorectal fistula after radical prostatectomy. We used Alexis® device for transanal access and 3, 5 and 11 mm triangulated ports for the procedure. The surgical steps were as follows: cystoscopy and implant of guide wire through fistula; patient at jack-knife position; transanal access; Identification of the fistula; dissection; vesical wall closure; injection of fibrin glue in defect; rectal wall closure. RESULTS: The operative time was 240 minutes, with 120 minutes for reconstruction. No perioperative complications or conversion were observed. Hospital stay was two days and catheters were removed at four weeks. No recurrence was observed. CONCLUSIONS: This approach has low morbidity and is feasible. The main difficulties consisted in maintaining luminal dilation, instrumental manipulation and suturing.

Comparison beetwen open and laparoscopic radical cistectomy in a Latin American reference center: perioperative and oncological results.

OBJECTIVES: To evaluate the differences of peri-operatory and oncological outcomes between Laparoscopic Radical Cystectomy and Open Radical Cystectomy in our center. MATERIALS AND METHODS: Overall, 50 patients were included in this non randomized match-pair analysis: 25 patients who had undergone Laparoscopic Radical Cystectomy for invasive bladder cancer (Group-1) and 25 patients with similar characteristics who had undergone Open Radical Cystectomy (Group-2). The patients were operated from January 2005 to December 2012 in a single Institution. RESULTS: Mean operative time for groups 1 and 2 were 350 and 280 minutes (p=0.03) respectively. Mean blood loss was 330 mL for group 1 and 580 mL for group 2 (p=0.04). Intraoperative transfusion rate was 0% and 36% for groups 1 and 2 respectively (p=0.005). Perioperative complication rate was similar between groups. Mean time to oral intake was 2 days for group 1 and 3 days for group 2 (p=0.08). Median hospital stay was 7 days for group 1 and 13 for group 2 (p=0.04). There were no differences in positive surgical margins and overall survival, between groups. CONCLUSIONS: In a reference center with pelvic laparoscopic expertise, Laparoscopic Radical Cystectomy may be considered a safe procedure with similar complication rate of Open Radical Cystectomy. Laparoscopic Radical Cystectomy is more time consuming, with reduced bleeding and transfusion rate. Hospital stay seems to be shorter. Oncologically no difference was observed in our mid-term follow-up.

Intermittent versus continuous androgen deprivation for locally advanced, recurrent or metastatic prostate cancer: a systematic review and meta-analysis.

BACKGROUND: Prostate cancer is the most common cancer in older men in the United States (USA) and Western Europe. Androgen deprivation (AD) constitutes, in most cases, the first-line of treatment for these cases. The negative impact of CAD in quality of life, secondary to the adverse events of sustained hormone deprivation, plus the costs of this therapy, motivated the intermittent treatment approach. The objective of this study is to to perform a systematic review and meta-analysis of all randomized controlled trials that compared the efficacy and adverse events profile of intermittent versus continuous androgen deprivation for locally advanced, recurrent or metastatic hormone-sensitive prostate cancer. METHODS: Several databases were searched, including MEDLINE, EMBASE, LILACS, and CENTRAL. The endpoints were overall survival (OS), cancer-specific survival (CSS), time to progression (TTP) and adverse events. We performed a meta-analysis (MA) of the published data. The results were expressed as Hazard Ratio (HR) or Risk Ratio (RR), with their corresponding 95% Confidence Intervals (CI 95%). RESULTS: The final analysis included 13 trials comprising 6,419 patients with hormone-sensitive prostate cancer. TTP was similar in patients who received intermittent androgen deprivation (IAD) or continuous androgen deprivation (CAD) (fixed effect: HR = 1.04; CI 95% = 0.96 to 1.14; p = 0.3). OS and CSS were also similar in patients treated with IAD or CAD (OS: fixed effect: HR = 1.02; CI 95% = 0.95 to 1.09; p = 0.56 and CSS: fixed effect: HR = 1.06; CI 95% = 0.96 to 1.18; p = 0.26). CONCLUSION: Overall survival was similar between IAD and CAD in patients with locally advanced, recurrent or metastatic hormone-sensitive prostate cancer. Data on CSS are weak and the benefits of IAD on this outcome remain uncertain. Impact in QoL was similar for both groups, however, sexual activity scores were higher and the incidence of hot flushes was lower in patients treated with IAD.

Laparoscopic treatment of vesicovaginal fistula.

INTRODUCTION: Vesicovaginal fistula is a rare disease with great impact for the patients. Laparoscopic repair can be an interesting option in selected cases with goods results but few experience is reported. OBJECTIVES: Detailed demonstration of our laparoscopic vesicovaginal fistula repair technique. Initial results for ten patients are provided Methods: We treated all cases by the same technique. The surgical steps were: Patient positioning in Lloyd-Davis; Cystoscopy and implant of guide wire on fistula and ureteral catheters (that was removed after procedure); Transperitoneal access and 4 or 5 ports in V or W shape; Opening the bladder wall; Dissection between bladder and vagina for tension free repair; Fistula resection; Vagina repair with Vicryl 3-0; Bladder repair with Vicryl 3-0; Peritoneum/omentum interposition; Positioning 20 Fr urethral catheter. RESULTS: Mean age was 50 years. Mean number of fistulas was 1,2. The most common etiology was gynecologic surgery (7). Mean operative time was 2,5 (1,8-3,2) hours. Mean blood loss was 150 (100-200)mL. Complication rate was 10% (one case of urinary infection treated conservatively). Mean hospital stay was 1,2 (1-2) days. Mean return to normal and activities was 20 (15-30) days. For nine patients mean sexual intercourse time was 3 (1-6) months. Success rate after 1 year was 90% (one case of recurrence in patient with previous radiotherapy). Mean follow-up was 36 (12-60) months. CONCLUSIONS: Laparoscopic repair is feasible, reproducible and present all advantages of minimally invasive surgical procedure. Long term results are similar to conventional open approaches.

Laparoscopic ureteroneocystostomy for ureteral injuries after hysterectomy.

OBJECTIVES: To examine the feasibility of early laparoscopic ureteroneocystostomy for ureteral obstruction due to hysterectomy injury. METHODS: We retrospectively reviewed a 10-y experience from 2 institutions in patients who underwent early (<30 d) or late (>30 d) laparoscopic ureteroneocystostomy for ureteral injury after hysterectomy. Evaluation of the surgery included the cause of the stricture and intraoperative and postoperative outcomes. RESULTS: A total of 9 patients with distal ureteral injury after hysterectomy were identified. All injuries were identified and treated as early as 21 d after hysterectomy. Seven of 9 patients underwent open hysterectomy, and the remaining patients had vaginal and laparoscopic radical hysterectomy. All ureteroneocystostomy cases were managed laparoscopically without conversion to open surgery and without any intraoperative complications. The Lich-Gregoir reimplantation technique was applied in all patients, and 2 patients required a psoas hitch. The mean operative time was 206.6 min (range, 120-280 min), the mean estimated blood loss was 122.2 cc (range, 25-350 cc), and the mean admission time was 3.3 d (range, 1-7 d). Cystography showed no urine leak when the ureteral stent was removed at 4 to 6 wk after the procedure. Ureteroneocystostomy patency was followed up with cystography at 6 mo and at least 10 y after ureteroneocystostomy. CONCLUSION: Early laparoscopic ureteral reimplantation may offer an alternative surgical approach to open surgery for the management of distal ureteral injuries, with favorable cosmetic results and recovery time from ureteral obstruction due to hysterectomy injury.

Laparoendoscopic single-site nephroureterectomy for morbid obese patients.

Since the first laparoendoscopic single-site (LESS) surgery report in urology in 2007 (1) (Rane A e Cadeddu JA), the few reports of LESS extraperitoneal access in the literature were mainly described for less complex cases. The aim of this video is to demonstrate the feasibility of LESS extraperitoneal access in a morbid obese patient presenting a malignant tumor in the renal pelvis. The patient is positioned in 90-degree lateral decubitus. An incision is made below the abdominal skin crease on the left side of the patient and the anterior rectus fascia is vertically incised with manual dissection of the extra/retroperitoneal space. We use an Alexis® retractor to retract the skin maximizing the incision orifice. Three trocars (12, 10 and 5 mm) are inserted through a sigle-port. The pedicle was controlled "en bloc" with a vascular stapler and the bladder cuff treated by the conventional open approach through the same incision. Operative time was 126 minutes with minimal blood loss. The pathology reported high grade papillary urothelial carcinoma in the pelvis (pT3N0M0) and in the ureter (pTa). LESS extraperitoneal nephroureterectomy is feasible and safe, even in more complex cases. It is a good alternative for morbid obese patients and for patients with synchronous distal ureteral tumors for whom an open approach to the bladder cuff is proposed to avoid incisions in two compartments of the abdominal wall.

Extending boundaries in minimally invasive procedures with simultaneous bilateral video endoscopic inguinal lymphadenectomy (veil) for penile cancer: initial Denver health medical center and ABC school of medicine experience and surgical considerations.

PURPOSE: To report the surgical technique, procedural outcomes, and feasibility of simultaneous bilateral Video Endoscopic Inguinal Lymphadenectomy (VEIL) in the management of patients with indication for inguinal lymphadenectomy. SURGICAL TECHNIQUE: VEIL was applied in all patients using the oncological landmarks (the adductor longus muscle medially, the sartorius muscle laterally and the inguinal ligament superiorly). A 1.5 cm incision was made 2 cm distally to the lower vertex of the femoral triangle. A second incision was made 2 cm proximally and 6 cm medially. Two 10 mm Hasson trocars were inserted in these incisions and the working space was insufflated with CO2 at 5-15 mmHg. The final trocar was placed 2 cm proximally and 6 cm laterally from the first port. RESULTS: A total of 5 VEIL procedures in 3 patients were performed. Two patients underwent simultaneous bilateral VEIL while another underwent simultaneous bilateral surgery with VEIL on the right and open lymphadenectomy on the left side due to an enlarged node. All laparoscopic procedures were successfully performed without conversion and maintained the oncological templates. One lymphocele occurred in the patient who underwent the open procedure. None of the patients presented with skin necrosis after the procedure. Mean number of nodes retrieved was 6 from each side and 2 patients presented with positive inguinal nodes. After one year of follow-up no recurrences were observed. CONCLUSION: Simultaneous lymphadenectomy procedures are feasible. Improvement in operative and anesthesia time could decrease the morbidity associated with inguinal lymphadenectomy while maintaining the oncological principles.

Alternative techniques to reduce warm ischemia time in laparoscopic partial nephrectomy.

PURPOSE: Demonstrate two alternatives that permit a warm ischemia time reduction during laparoscopic partial nephrectomy. MATERIALS AND METHODS: In this video, two cases of intermediate complexity renal tumors according to the RENAL nephrometry renal scoring system illustrating the techniques and our preliminary experience: a 65 year old man with a 4 cm right, posterior renal tumor. This patient underwent an early unclamping and parenchymal suturing using a greek bar continuous suture with hem-o-lock clips attached to the respective extremities of the suture; The second patient is a 49 year old man with a 3 cm renal tumor. The technique utilized was no clamping resection following the ABC Medical School technique: dissection of renal hilum for eventual clamping if necessary, a frontal 360 degrees visualization of tumor limits, pneumoperitoneum pressure elevated to 25mmHg during tumor resection, spiral excavation of normal parenchyma around the tumor and resection with negative margins. RESULTS: We previously performed 15 cases utilizing the early unclamping technique. The mean clamp time was 15 minutes with a mean blood loss of 285 mL. Only 1 patient had focal positive surgical margins, without recurrence demonstrated at 30 months. Fifteen partial nephrectomies were previously performed with on demand clamping. In 3 cases, clamping was necessary with a mean ischemia time of 11 minutes. The mean blood loss was 390 mL and 2 cases required a perioperative blood transfusion. One case presented with a positive focal margin without recurrence demonstrated at 24 months of follow-up. Renal function was preserved in all cases regardless of the technique applied. CONCLUSION: Warm ischemia time can be reduced and kidney function can be preserved during laparoscopic nephrectomy if either early unclamping or on demand clamping are selectively applied.

Long-term experience on laparoscopic incontinent urinary diversion unrelated to cystectomy in radiated or recurrent pelvic malignancies.

BACKGROUND: There are few reports describing series of cases about development on laparoscopic urinary diversions no related to cystectomy. The aim of this paper is to show the experience of our reference institutions for treatment of pelvic malignancies when laparoscopic techniques were applied to perform only urinary diversion without cystectomy or pelvic exenteration. MATERIALS AND METHODS: We included retrospectively 12 cases of cutaneous ureterostomy and 21 cases with a reservoir (16 ileal conduits, 2 colonic conduits and 3 wet colostomies) treated in our institute from 2004 to 2010. It was evaluated operative time, blood loss, intraoperative complications, conversion rate, length of large incision, post operative complications, analgesic consumption, time to food intake, hospital stay, time to recovery to normal activities. Mean time to follow-up was 3(2-7) years. RESULTS: All procedures were completed without conversions. In the cutaneous ureterostomy group the mean surgical time.