Outcomes of laparoscopic adrenalectomy Conventional technique versus laparo-endoscopic single-site surgery. / Resultados de la suprarrenalectomía laparoscópica: técnica convencional vs puerto único laparoscópico.

OBJECTIVE: Perform a comparative analysis of the outcomes of conventional laparoscopic adrenalectomy (LC) and the newly introduced laparo-endoscopic single-site surgery (LESS) over ten years. MATERIAL AND METHOD: We retrospectively reviewed the experience of a single surgeon from our medical centre with laparoscopic adrenalectomy, either through LC or LESS, with 75 patients between August 2005 and June 2015. Here we describe: age, sex, size, lateralization, preoperative diagnosis, total operating time, intraoperative bleeding, conversion to open surgery, mean hospital stay, intra- and postoperative complications and histopathology report. We used Fischer's and the Chi-squared tests to compare categorical data and Student's T-test for a comparison of the means with a normal distribution. Statistical significance was determined when p<0.05. RESULTS: LC was performed in 51 patients, and LESS in 24 patients. No statistical significance was found for total operating time (LC: 103.9±13.21min vs. LESS: 101.46±13.65min; p=0.07), estimated bleeding (LC: 258.82±136.92cc vs. LESS: 131,25±36,74cc; p=0.46), intraoperative complications (5 cases in LC, none in LESS; p=0.47), nor for postoperative complications (two in LC vs. one in LESS; p=0.69), as catalogued according to the modified Clavien classification system. We detected a statistical significance difference in the comparisons of the mean hospital stay, which was reduced in LESS (LC: 3.55±0.69 days vs. LESS: 2.21±0.31 days; p=0.01). CONCLUSIONS: Adrenalectomy with LC is the approach of choice for surgical treatment of adrenal pathologies. The LESS technique is safe, improves the cosmetic results, and does not increase mortality if performed by experienced teams.

[An analysis of our experience in cryopreservation of semen from cancer patients]. / Análisis de nuestra experiencia en la criopreservación del semen en pacientes oncológicos.

OBJECTIVE: To analyze the characteristics of patients with oncological problems who were users of the sperm bank, as well as use of cryopreserved semen. MATERIALS AND METHODS: A retrospective analysis was made of all cryopreserved semen samples from males diagnosed with cancer from April 1992 to October 2007 at the province of Las Palmas. RESULTS: One hundred and one male patients with cancer were referred to the sperm bank before cancer therapy. Eighty percent of them were contacted by telephone. Mean freezing age was 25 years. Forty-one percent of patients had testicular tumors. Thirty-three percent had no prior biological children. Only one patient had known fertility problems before treatment. Sixty-seven percent of patients were warned by the healthcare team about the possibility of infertility at the time of cancer diagnosis. Only 1% of samples were not adequate for cryopreservation. The frozen sample was used by 4% of the patients. When patients were asked about future use of semen, 63% of them wanted to continue with semen cryopreservation, as compared to 17% who had no interest in having offspring in the future. CONCLUSION: The number of fertile patients who cryopreserve semen is extremely low. It is very important that the healthcare team warns patients of potential infertility after treatment. A high proportion of patients have valid samples for cryopreservation, but semen is used by a low number of patients. A high proportion of patients want to maintain their semen frozen.

[Renal artery aneurysm. Laparoscopic nephrectomy, ex-vivo reconstruction and autotrasplantation]. / Aneurisma de arteria renal. Nefrectomía laparoscópica, reconstrucción en banco y autotrasplante.

We report a case of severe hypertensive patient with poor response regardless 5 drugs, that is diagnosed with right renal artery aneurysm, during the study of his HTN. Conservative surgery was performed by extracting laparoscopic kidney graft,ex-vivo pedicle reconstruction, followed by transplant in right iliac fossa utilizing the ilioinguinal incision used for the extraction, without need for two incisions. We perform a brief discussion of surgery indications of surgery in these patients.

[Clinical-pathology relationship in bladder cancer]. / Relación clinico-patólogica en cáncer vesical.

OBJECTIVES: Analyze the role of the Computerized Axial Tomography (TAC) like image study of pre-surgery stadification, in the subjected patients to radical cystectomy, for the treatment of muscle infiltrate bladder cancer. METHODS: Retrospective study of cohorts on 63 subjected patients to radical cystectomy for bladder cancer, in oneself service, between january of 1995 and december of 2.005. The capacity of the TAC was determined for the stadification bladder (pT), node (pN) and the results were compared, with the obtained ones in the pathological anatomy after the radical cystectomy, acording to TNM clasification. The possible impact of this image technique was evaluated in the change of surgical attitude in these patients. RESULTS: The estimate of bladder affectation with TAC was correct in 28.6%, sub-estadificate in 50.8%, and up-estadificate in 20.6%. The TAC for the bladder possesses a lower sensibility the more outpost it is this affectation. It specificity is higher the more advanced locally is the cancer, oscillating among 44% in the pT2 and 94% in the pT4. Regarding the estadification node, it is correct in 73.5% of all cases, although this percentage depends almost exclusively on the patients with negative node (N -). These data offer us a sensibility of 28%, specificity of 55%, positive predictive value of 68% and negative predictive of 67%. SUMMARY: The impact of the TAC in the clinical estadification of the infiltrate bladder cancer is relatively low. The biggest benefit is obtained in patient with suspicion of advanced illness. Its limitation to this group would suppose a significant reduction of costs, with low risk of an inappropriate surgical handling.

[Early biochemical failure after radical prostatectomy for prostate cancer. Impact factors?]. / Recidiva bioquímica precoz tras prostatectomía radical retropúbica por cáncer de próstata. Factores implicados. Influye el tiempo de espera entre biopsia y cirugía?

UNLABELLED: Does delay from biopsy to surgery have any influence? OBJECTIVES: To determine wether WT may impact on the EBF (before one year) alter RRP in our series, and to study other factors that may impact on this issue. MATERIAL AND METHODS: We study 310 RRP. Inclusion criteria are: one year follow up, no hormonal manipulation neither previous radiotherapy. Patients are divide in two groups attending WT. Group A < 90 days (n: 148), Group B > 90 days (n: 162). We study EBF (2 or more PSA determinations >= 0.2 ng/ml), and the impact of previous PSA, biopsy Gleason, Gleason of the specimen (G), pT stage (pT), and WT. T of Student or W of Wilcoxon are used to determine the homogeneity of the two groups. Chi Square of Pearson to compare the two group's EBF and pT attending to WT and EBF attending to pT. U of Mann Whitney is used to study EBF attending to G. Multivariate logistic regresion (LR) is used to study the impact of the variables on EBF. RESULTS: There are no differences between the two groups in age (p<0.129), PSA (p<0.479), biopsy's Gleason (p<0.913). There are no differences in EBF nor in pT attending to WT. Significant statystical differences are founded in EBF attending to pT and G. T3 tumors have more chance of recurrence than T2. EBF is more frecuent as G increases. In logistic regresion of the global serie, independent variables for progression are: Previous PSA and pT. Nor biopsy's Gleason nor specimen's Gleason, nor WT, impact on the EBF. CONCLUSIONS: Biopsy Gleason and WT do not impact on EBF. WT do not impact on pT. In our serie differences on EBF are lead by previous PSA and pT. Also Gleason of the especimen seems to impact on EBF, but in lower proportion, with no significance in multivariate analysis.

[Bladder neoplasm after nephroureterectomy for upper urinary tract tumor. Does distal ureter surgery influx on the evolution?]. / Neoplasia vesical tras nefroureterectomía por tumores de urotelio superior. La cirugía del uréter distal influye en la evolución?

OBJECTIVE: To compare evolution in patients with urothelial upper tract tumor (UUTT) in whom we performed the classic open approach to the distal ureter with those in whom whe performed the endoscopic approach. We study the bladder recurrences in each group and the factors which may influx on the evolution. MATERIAL AND METHODS: Retrospective review of nephroureterectomies in our department in the last 20 years. Group A (n:24): double incision (lumbar and pelvic incision), Group B (n:29): endoscopical approach of the distal ureter and classic lumbar incision. A descriptive study is first performed in which we review: sex, and patients age, background transuretral resection of bladder tumor (TURBT), UUTT side, and UUTT location (calices, pelvis or urether). Pathological stage and tumor grade are also exposed. Secondly, a review of the bladder recurrences in each group is performed. In order to find differences between de groups we used the Fisher's Exact test. RESULTS: We observed that in terms of bladder recurrence there is a statistically significant difference between the two groups favoring Group B (p < 0.036), which means that there are less bladder recidives when perform endoscopic approach of distal ureter. Noneless due to the groups inhomogeneity in tumor stage, grade, and location, this differences seem to be associated to these sigues, more than to the approach to the ureter as an independant variable. In that concerning to the eventual relationship between bladder recidive and background of previous TURBT, we have not found any differences between the two groups but there are statystically significant difference in the global series. The small number of recurrences (13) does not allow us to establish a well based conclusion on this issue, but it seems that the background of previous TURBT is an important factor that may influx in posterior bladder recurrences. CONCLUSIONS: In our results, endoscopic approach of distal ureter in nephroureterectomy for UUTT does seems to positively influx in the posterior chance of bladder recurrences. But the studied sample is small and the two groups have not been aleatorized because of ethical reasons. May the low number of cases affect the test's statistical potency. It seems that previous TURBT may conditionate these recurrences, as we show in global serie. It should be necessary a prospective and statistically analised multicenter trial to understand if distal ureter approach influx on the evolution of these tumors.

[Enterocystoplasty in the treatment of interstitial cystitis]. / La enterocistoplastia en el tratamiento de la cistitis intersticial.

OBJECTIVE: To evaluate supratrigonal cystectomy and enterocystoplasty in patients with interstitial cystitis. METHODS: We reviewed four women with interstitial cystitis with infructuos conservative treatment and performed supratrigonal cystectomy and enterocystoplasty. All the patients fulfilled the NHI criteria with increased voiding frequency by night (mean 7.3 times). In 3 cases urodynamic study was available. We used is the four patients ileon as segment for the enterocystoplasty. RESULTS: Mean postoperative follow up was 60 months. In all cases the suprapubic pain disappeared and night voiding frequency reduced (mean 2.2 times). We don't have mayor complications. One patient needs self catheterism 3 years after surgery. CONCLUSION: In patients with interstitial cystitis to be operated supratrigonal cystectomy and enterocystoplasty is the most effective method.

[Endoscopic resolution of complications caused by urethrovesical suspension]. / Resolución endoscópica de complicaciones en suspensión uretrovesical.

We presented a total of ten women which referred a varied syntomatology secondary to a bladder foreign body due to the suture employed in the stress incontinence surgery in which urethrovesical suspension techniques were performed. In these patients, to six a Marshall-Marchetti-Krantz technique was practised, to three modified Burch procedure and to the left a suspension according to Raz method. It is described the varied clinic they presented, the necessity of endoscopic study to confirm and the results after solving the 90% of these cases using endoscopic techniques. It is concluded that is not mandatory the employment of non absorbable suture to perform the suspension techniques and in the opposite of the usual tendency of the authors recurring to open surgery, this complication can be solved endoscopically and in ambulatory regime in the most of these cases.

[Bladder leiomyosarcoma in a young man with a transplant. Report of a case]. / Leiomiosarcoma vesical en joven trasplantado. Aportación de un caso.

Contribution of one case of a 24-year-old patient, with a renal graft, who was diagnosed with vesical leyomiosarcoma. Radical cystectomy with ureterosygmoidostomy was performed. The rarity of vesical sarcoma, both in normal population or among those undergoing transplantation, as well as the greater tendency of transplanted patients to suffer malignant neoplasia, are emphasised.

[Bladder paraganglioma. Report of a case and review of the Spanish literature]. / Paraganglioma vesical. Presentación de un caso y revisión de la literatura española.

Paragangliomas are rare tumours of the bladder accounting for 0.06% of all vesical tumours. This paper reports one case of vesical paraganglioma in a young female patient that has the singularity of being associated to melanin pigmentation. A review is made of cases treated in Spain, adding some comments on the signs and symptoms presented, as well as the diagnostic and therapeutical methods used in this unusual condition.

[Ureteroscopy with pseudoanalgesia in the treatment of ureteral lithiasis]. / La ureteroscopia con sedoanalgesia en el tratamiento de la litiasis ureteral.

Presentation of the results obtained in 35 patients with ureteral lithiasis treated over a two-year interval by means of ureteroscopy with pseudoanalgesia at the Hospital Insular, with a 89% success rate. We conclude that in selected cases, the use of peg ureteroscopy or pneumatic lithotrite is a valid therapeutical option since it is well-tolerated and has the benefit of a short or null hospitalization.

[Wunderlich's syndrome as the first manifestation of a renal angiomyolipoma]. / Síndrome de Wunderlich como primera manifestación de un angiomiolipoma renal.

OBJECTIVES: We present a case of renal angiomyolipoma presenting as Wunderlich syndrome. METHODS: The clinical and radiological features of the spontaneous perirenal hematoma are analyzed. RESULTS: Because it is a benign tumor, treatment of renal angiomyolipoma is by conservative surgery; however, this is not always possible. CONCLUSIONS: In patients with renal angiomyolipoma, treatment by nephrectomy or conservative surgery will depend on the hemodynamic status of the patient.

[Urinary bilharziasis. Comments on 10 cases]. / Bilharziosis urinaria. Comentarios sobre 10 casos.

Urinary bilharziasis is a parasitic disease caused by Schistosome haematobium which is prevalent in several African and Middle East countries. The closeness of the Canary Islands to the African continent and a greater population mobility have allowed us to diagnose and treat ten patients, all of them natural of this region. This paper outlines the case-reports, and reviews this parasitic disease which seriously affects the urinary tract and which must be specifically contemplated both in emigrants and occasional visitors from endemic regions.

[Renal adenocarcinoma with multicystic pattern]. / Adenocarcinoma renal con patrón multiquístico.

One growth pattern of renal carcinomas is the multicystic of multilocular cysts one, of which few cases have been published but which according to Hartman represent 15% of total cases. This variant of the renal tumour arouses great diagnostic and therapeutical uncertainties with multicystic kidney, biopsy after surgery being the test which provides true diagnosis. Presentation of two clinical cases and review of this condition.

[Transurethral resection of ureteral tumor]. / Resección transuretral de tumor ureteral.

A patient with a tumor in the right pelvic ureter is described herein. Following diagnosis by ureteroscopy, the patient underwent TUR utilizing a ureteroresectoscope. No short- or long-term complications were observed. The scant number of cases in the literature and the advantages afforded by this technique (noninvasive, short duration of hospital stay, etc.) prompted us to report this case.