Xenograft iterposition in female urethral diverticulum surgery.

OBJECTIVE: To describe the use collagen xenograft as adjuvant therapy in the surgical treatment of female urethral diverticulum (FUD) and to perform a bibliographic review. METHODS: We performed a surgical approach to remove the diverticulum and repair the remaining dead space with a porcine collagen mesh to avoid fistulas. Monitoring is done by MRI. RESULTS: After two years of follow up the patient improved considerably, disappearing the previous symptoms. Follow-up MRI showed no abnormality: There was no inflammatory reaction or encapsulation of any kind. CONCLUSIONS: We recognize that the flap or the use of a xenograft are not always necessary, but due to its technical simplicity and effectiveness, it is an important tool for diverticulum surgery. However, more experience is needed to assess the appropriateness of this method.

Comparison of surgical approaches to radical prostatectomy in our series beyond oncological and functional outcomes.

OBJECTIVES: To evaluate the outcomes of robot-assisted radical prostatectomy (RARP) compared to those of open (ORP) and laparoscopic (LRP) surgery. The interest lies fundamentally in the quality-of-life (QoL) evaluation, postoperative recovery, and personal satisfaction of patients with the intervention (PS) beyond oncological and functional outcomes. METHODS: Six hundred eighty-five RPs were performed in our center between 2011-2018 (17,8% ORP, 22,2% LRP and 60% RARP). Patients were prospectively assessed through follow-up until April 2020 and a multiple questionnaire at 12-months post-RP that included ICIQ-SF, SHIM, IPSS, IQL and questions about pain, postoperative recovery and PS. Also baseline and postoperative patient- and treatment-related data were collected, and binomial logistic regressions were performed for the 1 vs.1 comparisons (ORP vs. RARP and LRP vs. RARP). RESULTS: RARP patients have overall fewer comorbidities, less tumor aggressiveness, more operative time requirements and more positive surgical margins than ORP and LRP patients. Nevertheless, RARP outperforms ORP in: hospital stay (days) (OR 0,86; 95% CI: 0,80-0,94), hemoglobin loss (OR 0,38; 95% CI: 0,30-0,47), transfusion rate (OR 0,18; 95% CI: 0,09-0,34), early complications (p = 0,001), IQL (OR 0,82; 95% CI: 0,69-0,98), erectile function (OR 0,41; 95% CI: 0,21-0,79), pain control (OR 0,82; 95% CI: 0,75-0,89), postoperative recovery (p < 0,001) and choice of a different approach (OR 5,55; 95% CI: 3,14-9,80). RARP is superior to LRP in: urinary continence (OR 0,55; 95% CI: 0,37-0,82), IPSS (OR 0,96; 95% CI: 0,93-0,98), IQL (OR 0,76; 95% CI: 0,66-0,88), erectile function (OR 0,52; 95% CI: 0,29-0,93), postoperative recovery (p = 0,02 and 0,004), PS (p = 0,005; 0,002; and 0,03) and choice of a different approach (OR 7,79; 95% CI: 4,63-13,13). CONCLUSIONS: The findings of our study globally endorse a positive effectiveness of RARP over ORP and/or LRP, both on functional issues, postoperative recovery, QoL and PS. Oncologic results should still be improved.

Surgical thromboprophylaxis in daily urologic surgery: Beyond bridge therapy. / La tromboprofilaxis quirúrgica en el día a día de la cirugía urológica: más allá de la terapia puente.

INTRODUCTION: With the advanced laparoscopic and robotic surgery, thromboembolic prophylaxis in urologic procedures has traditionally been based on the experience of other surgical specialties. This paper aims to analyze the current recommendations, through a detailed study of the European clinical guidelines and bibliography, applying the recommendations of thromboprophylaxis to the daily urological practice. OBJECTIVES: To elaborate general recommendations to surgical patients in Urology, avoiding the risk of perioperative thromboembolic events. Optimize medication in chronic patients and accurately classify who are eligible for bridge therapy. MATERIAL AND METHODS: A review of the available literature and the European clinical guidelines was carried out. We analyzed the most recent consensus articles by studying the available bibliography, trials and reviews on which the European guidelines for thromboprophylaxis in urology are based. RESULTS: Thromboembolic prophylaxis should be targeted towards surgeries that require abdominal approaches, prolonged bed rest or oncological pathologies. Bridge therapies with low molecular weight heparins should be limited. Patients undergoing treatment for chronic conditions can benefit from bridge therapies in specific cases. CONCLUSIONS: According to the current guidelines, there might be an overuse of heparins in the daily clinical practice. The development of -direct oral- anticoagulants have shown to reduce the time to reintroduction of medication for chronic conditions as well as a more effective bleeding management.

[Extracorporeal circulation and hypothermy surgery in tumors with vena cava extension: 20 years experience at the University Clinic of Navarra]. / Cirugía con circulación extracorpórea e hipotermia en tumores con extensión a vena cava: 20 años de experiencia de la clínica Universitaria de Navarra.

OBJECTIVE: We present our 20 years experience treating patients with vena cava extension in whom an extracorporeal circulation, hypothermia, cardio circulatory arrest (ECC-H-CCA) in order to perform, together with a tumoral resection, a thrombus resection. MATERIAL AND METHODS: From 1985 to 2005 a total of 28 retroperitoneal tumor were treated: 25 renal cancers, a Wilms tumor, a paratesticular rabdomiosarcoma, and a pheocromocitoma. All of them had an extension by means of thrombus above the suprahepatics veins. All of them were treated by means of ECC-H-CCA for thrombus extraction. A descriptive study of the serie is performed as well as a Kaplan Meyer survival study. RESULTS: Surgical complications were present within 10 patients (35%), with a surgical mortality of two patients (7%): one intra-operatively because a massive embolism of the lungs and the other because of a lung embolism on the 4th post-operative day. Global actuarial survival was 29.1+/-10% at three years and 17.5+/-8% at five years. Analyzing only who do not have metastatic lesions, nor lymph nodes at diagnosis their three year survival was 50.9+/-16.3% and 32.2+/-16% at five years. Mean while those who have any metastatic lesion at diagnosis their three and five years survival was 20.8+/-12% and 10.4+/-9% respectively. CONCLUSIONS: The employ of surgical techniques with ECC-H-CCA with in oncological pathology associated with vena cava thrombus is justified and its employment does not worsen the survival; it is indicated because its results, allowing a complete tumoral resection in a safe and reproducible fashion.

[Gleason score 8-10 prostatic adenocarcinoma: prognostic influence in the biochemical progression free survival]. / Adenocarcinoma de próstata gleason clínico 8-10: influencia pronóstica en la supervivencia libre de progresión bioquímica.

OBJECTIVE: Hereby, we analyze the characteristics of the clinical Gleason 8-10 group of patients with in our series diagnosed of Prostate Cancer and treated by means of radical prostatectomy, and we try to ascertain which are the influence factors within this group upon progression and progression free survival. MATERIAL AND METHODS: From the global series of 781 patients with T1-T2 prostate cancer treated by means of radical prostatectomy between 1990 and 2004, we study 108 with a Gleason score on the biopsy of 8-10. Median PSA was 12 ng/ml and 50% were T2. Variables related to biochemical progression and progression free survival have been studied, comparing the group of Gleason 8-10 with the rest and analyzing, within the Gleason 8-10 group which are the related variables with progression and progression free survival, trying to find a predictive model. Contingency tables and logistic regression have been employed. For the survival analysis, Kaplan Meyer curves, log-rank and Cox models. RESULTS: Actual State: 62.7% (490/781) are alive and free of biochemical progression, 24.8% (194/781) are alive with biochemical progression, 2.9% (23/781) are dead by cancer and 1.9% (15/781) are dead by other cause and 7.6% (59/781) are lost. Biochemical progression study of the whole series (781 patients) Clinical Gleason score 8-10 is a influence factor on the univariate study (OR2,61 IC 95%: 1.7-4). In the progression free survival study (PFS) of the whole series (781 patients) the PFS in Clinical Gleason 8-10 at 3 and 5 years is 56 +/- 5% y 35 +/- 7%, significantly worse than the rest of the group (p < 0.0001). In the multivariate study of the influence factors on the PFS includes Clinical Gleason Score 8-10 as an independent prognostic factor (OR: 2.6 IC 95%: 1.6-4.12) p = 0.003, together with the clinical stage (OR: 1.,81 IC 95%: 1.18-2.78) p < 0.006, the PSA (OR: 1.03 IC 95%: 1.025-1.046) p < 0.0001 and the side of tumor on the biopsy (OR: 1.5 IC 95%: 1.01-2.24) p = 0.045. In the clinical Gleason score 8-10 group the influent factors on the PFS are. PSA (OR: 1.02 IC 95%: 1.003-1.04) and pathological stage (OR: 3.84 IC 95%: 1.77-8.27). Patients with a pT2 have a significantly better survival than those pT3 at 3 and 5 years (80 +/- 6%; 54 +/- 13% y 40 +/- 7%; 27 +/- 7%) (p < 0.0001). The best cut point for the PSA is 11 ng/ml. Patients with a PSA < 11 ng/ml have a 3 and 5 years survival better than those with >11 ng/ml PSA (74 +/- 7%, 30 +/- 22% y 40 +/- 7%, 26 +/- 7%) (p < 0.0001). CONCLUSIONS: Clinical Gleason Score 8-10 is a negative independent prognostic factor on the progression free survival, but its prognosis is better if they present a PSA prior surgery lower than 11 ng/ml and the pathological stage is a pT2.

[Surgical treatment of penile lymphedema associated with hidradenitis suppurativa]. / Tratamiento quirúrgico de linfedema peneano secundario a hidrosadenitis supurativa.

Penoscrotal lymphedema is a rare disease in the developed countries, although it is relatively frequent in tropical countries. The most common cause is filariasis, although in our practice usually is associate to neoplasic and inflammatory processes, surgery, radiotherapy, hidroelectrolitic disbalances and idiopathic. We present a 22 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa. After unsuccessful medical treatment, was performed a total excision of the penile skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. Even medical management of penoscrotal lymphedema is not effective for most patients, surgery is a safe and effective procedure that gives excellent functional and cosmetic results.

[A Spanish multicenter trial of TVT for female urinary incontinence]. / TVT para la incontinencia urinaria femenina: estudio multicéntrico español.

OBJECTIVE: The purpose of this study was to evaluate results and complications of TVT in a large series from different hospital centers in Spain. METHOD: We retrospectively studied the results of TVT placement from 6 centers with 272 consecutive patients (median follow-up was 636 days). All types of stress urinary incontinence with a surgical indication were included and no previous conditions were established regarding the indication. No protocol was used for either the intervention or postoperative support measures. Data collection was protocolized and carried out using a common questionnaire that was completed by an urologist at each center from 3 to 6 months after the intervention and then annually. All patients who underwent intervention were asked about their satisfaction with the outcome. Multivariate studies were made to identify the factors that influenced the recovery of continence and the occurrence of complications. RESULTS: 92.1% of patients were continent and 2.4% have not shown any improvement. 91.6% of the patients claimed to be satisfied whereas only 2.7% were dissatisfied. After four years only 2.8% of patients showed mild incontinence with time and 0.4% had moderate incontinence. Only previous surgery for incontinence was found to be significantly unfavorable factor for achieving postoperative continence. CONCLUSION: We have reproduced a scenario closer to daily clinical reality than the results of series from a single institution or analyses using stricter selection criteria. This multicenter study verifies the viability and reproducibility of TVT with minimal complications in centers where patients are not selected and where not all urologists are specialized in urinary incontinence.

[Evaluation and prognostic of cystic renal tumors]. / Valoración y pronóstico de los tumores renales quísticos.

OBJECTIVE: To evaluate the clinical and pathological characteristics of cystic renal tumors in our center. MATERIAL AND METHODS: A retrospective review of 239 nephrectomies is performed comparing the clinical and pathological variables of cystic tumors with those of solid renal tumors. Survival outcomes are analyzed in both groups. RESULTS: Our experience shows that cystic renal tumors behave like solid renal tumors, with no differences in survival shown. The variables studied show statistically significant differences in histological grade and number of tumors, with cystic tumors having a lower histological grade and being more often multiple in number. CONCLUSIONS: The behavior of cystic renal tumors is no different than that of solid renal tumors.

[Infiltrating bladder carcinoma: influence of complementary treatment on local control and survival]. / Carcinoma vesical infiltrante: influencia del tratamiento complementario en el control local y en la supervivencia.

We analyzed 82 patients with transitional bladder cancer stages (T2-T4) M0. According to treatment, 3 different groups were considered: Group 1: 25 patients treated with TUR and radical cystectomy. Group 2: 33 patients also received external beam radiotherapy (45-60 Gy/5 weeks) prior cystectomy. Group 3: 24 patients were also treated with intraoperative radiotherapy (15 Gy) and 3 courses of neoadjuvant chemotherapy. Our results suggest that local control rate increases significantly with the intensity of treatment (Group 3: 62% patients were PT0). Similar results were achieved in multivariate analysis. Univariate analysis of survival shows ganglionar status, vascular embolism and treatment intensity as covariates associated. Multivariate analysis demonstrate that renal function and type of complementary treatment were the covariates associated with survival. Taking both groups 2 and 3, survival was related to pathologic stage, vascular embolism and renal function. In conclusion, the significant influence of complementary treatment on the local control and survival suggest strongly their systematic utilization in infiltrating bladder cancer.

[Clinico-pathologic correlation in patients undergoing surgical staging and radical prostatectomy for prostatic cancer]. / Correlación clínicopatológica en los pacientes sometidos a estadiaje quirúrgico y prostatectomía radical por cáncer de próstata.

Presentation of our experience on the clinico-pathological staging of clinically localized prostate cancer (PCa) in 38 patients undergoing staging lymphadenectomy, 34 of which were treated with radical prostatectomy. From total number of patients, 37% were correctly staged, 60% were under-staged and only 3% were over-staged. A total of 11 patients (29%) presented nodular metastasis at the time of lymphadenectomy. Out of the 34 patients undergoing radical prostatectomy, 10 (29%) had microscopical invasion of prostatic capsule and seminal vesicles infiltration. The likelihood of nodes affectation in patients with prostatic capsule invasion and seminal vesicles infiltration was 60% and 70%, respectively. Mean PSA was significantly higher in patients with advanced disease as compared to those with disease localized in the prostatic gland. Also, mean PSA was significantly higher in patients with prostatic capsule invasion and seminal vesicles infiltration. The analysis by logistic regression identified pre-operative PSA as the only variable significantly correlated to the patient's final pathological stage.

[Usefulness of PET in the diagnosis and response to treatment of extragonadal germinal tumor with atypical presentation]. / Utilidad del PET en el diagnóstico y respuesta al tratamiento en un tumor germinal extragonadal de presentación atípica.

Primary tumors of extragonadal origin are rare, with fewer than 1000 cases described in the literature. Although the exact incidence of EGTs is unknown, clinical data suggest that roughly 3% to 5% of all germ cell tumors. We expose a case report of EGT with unusually clinic presentation. We present our diagnostic and therapeutic experience in this injuries.

[Effect of complementary treatment (radiotherapy, chemotherapy) on the survival of patients with T3 tumors of the bladder treated with radical surgery]. / Influencia del tratamiento complementario (radioterapia, quimioterapia) en la supervivencia de los tumores de vejiga T3 sometidos a cirugía radical.

We present the results obtained from the study of 65 patients with vesical carcinoma stage T3 treated with radical surgery with or without supplementary radiotherapy, with or without supplementary chemotherapy. The multivaried study of survival (Cox's model) shows that it depends significantly on the surgical complications and on the pathological state at the time of the cystectomy. Univaried analysis indicates that patients with descent from post-radiotherapy stage and those subjected to IOR (intraoperative radiotherapy) have a significantly better survival than the rest and suggests that radiotherapy improves overall survival. Influence of supplementary treatment (radiotherapy, chemotherapy) in the survival of T3 bladder tumours subjected to radical surgery.

[Pelvic lipomatosis: a new case]. / Lipomatosis pélvica: un nuevo caso.

We present a fresh case of Pelvic Lipomatosis in a non obese young male. We comment on the suggestive radiological findings as well as on the therapeutic options. Although considered traditionally as a benign entity, it may cause serious physiopathological alterations in neighbouring organs.

[Tumor thrombosis in inferior vena cava: diagnostic imaging and therapeutic approximation]. / Trombosis tumoral en vena cava inferior (TTVCI): diagnóstico por imagen y aproximación terapéutica.

Review of our experience in the diagnosis and treatment of 44 patients with inferior vena cava tumoral thrombosis (IVCTT), associated or not to other neoplastic processes: 34 hypernephroma, 2 cava leiomyosarcoma, 1 paratesticular rhabdomyosarcoma and 1 biphasic synovial sarcoma. Twenty-five patients with hypernephroma and tumor thrombi in the ipsilateral renal vein only were excluded from the analysis since this fact did not change the usual therapeutic approach. In the 19 remaining patients, concomitantly to the primary tumour exeresis a thrombectomy was performed, using cavotomy with proximal and distal clamping in 11 patients and cardiopulmonary by-pass, deep hypothermia and cardiocirculatory arrest in 8 patients. The paper analyzes the radiological investigations performed in order to reach a IVCTT diagnosis, and reviews the related literature.

[Kidney pelvis tumor in ectopic kidney. Report of a case]. / Tumor de pelvis renal en riñón ectópico. A propósito de un caso.

A case of urothelial carcinoma in pelvic ectopic kidney is described. The low incidence of both pathologies and their rare association justifies the description.

[Infiltrating bladder carcinoma with metastatic lymph node involvement: radical treatment and survival]. / Carcinoma vesical infiltrante con afectación ganglionar metastásica: tratamiento radical y supervivencia.

Presentation of the results obtained from the study of 64 patients with T2-4 stage vesical carcinoma, treated with radical cystectomy, local lymphadenectomy, with and without complementary radiotherapy, with and without neoadjuvant chemotherapy. The univariate study of 19/64 patients with microscopic nodular disease revealed a significant relationship with the pathological stage but not with the clinical stage. The multivariate study demonstrated that the most relevant prognostic factors are a decrease in tumoral stage (P) and the presence of vascular and/or lymphatic involvement in the TUR-biopsy. The analysis of survival confirms the poor prognosis of patients with metastatic nodular involvement, in spite of the association of pelvic radiotherapy or neoadjuvant chemotherapy to the treatment.

[Stage Ta/T2 bladder tumors: prognostic and clinical course factors]. / Tumores vesicales estadío Ta/T2: factores pronóstico y progresión.

One hundred and twenty-three patients with a Ta/T2 stage vesical tumour were studied in order to identify the histological aspects associated to a tumoral behaviour particularly aggressive. The multivariate study demonstrates that those patients with a infiltrating tumour (T1-T2) or diffused urothelial dysplasia, have specially high possibilities to progress with regard to the degree of cell anaplasia (p less than 0.05); very close follow-up is needed in those patients. Likewise, patients presenting disseminated dysplastic lesions and with a history of previous urothelial tumours, progress to a new tumour stage with a significantly higher frequency (p less than 0.01); in those cases, radical surgery is the choice treatment.

[Superficial tumors of the bladder: prognostic value of the free of disease period]. / Tumores vesicales superficiales: valor pronóstico del periodo libre de enfermedad.

We study retrospectively 123 cases of patients suffering from Ta/T1/T2 vesical tumour so as to evaluate the Disease Free Period as a predictive factor of relapse potential, capability of progression and survival. This parameter has no influence over the variables that define the progression of the tumour, but it has a close correlation with relapse potential; Annual Relapse Rate (p less than 0.001) and Mean Interval between Relapses (p less than 0.0001). We were not able to show any relationship between Disease-Free Period and Survival, however it defines those tumours which relapse due to tumoural persistence. These tumours progress in stage in 80% of cases and 75% of these do so with deep tumours.

[Paratesticular rhabdomyosarcoma with intracaval neoplastic involvement: presentation of a case and review of the literature]. / Rabdomiosarcoma paratesticular con afectación tumoral intracava: presentación de un caso y revisión de la literatura.

One case of paratesticular embryonal rhabdomyosarcoma (RMS), affected during its evolution by a tumoral thrombus in the inferior vena cava. This unusual association forced the use of a cardiopulmonary by-pass, profound hypothermia and circulatory arrest, in order to carry out complete exeresis of the damage. Also, revision of the literature emphasizing that today's therapeutical approach for RMS should essentially be multidisciplinary.

[Uretero-iliac fistula: presentation of a case and review of the literature]. / Fístula uretero-ilíaca: presentación de un caso y revisión de la literatura.

We report a case of right common iliac artery fistula to the left ureter in a patient affected by an invasive bladder tumour treated with radical surgery, radiotherapy and neo-adjuvant chemotherapy. At the time of manifestation, our patient had indwelling catheters and presented an urinary tract infection. Diagnosis was established during autopsy. We feel that the cause of this complication is multifactorial.