Leiomyoma of the seminal vesicles: laparoscopic excision.

Leiomyoma of the seminal vesicles is an extremely rare type of benign tumor of the genitourinary system and can cause lower urinary tract symptoms. Despite their low incidence, these tumors can be identified with transrectal ultrasound of the seminal vesicles during prostate examination. The removal of these tumors is facilitated by a laparoscopic approach.

Long-term outcomes after robotic sacrocolpopexy in pelvic organ prolapse: prospective analysis.

OBJECTIVE: To evaluate the feasibility and long-term outcomes of our initial series of robot-assisted laparoscopic sacrocolpopexy. METHODS: We conducted a prospective analysis of our series of robotic sacrocolpopexy. INCLUSION CRITERIA: patients with grades III and IV cystocele and or other symptomatic pelvic organ prolapse. We performed a transperitoneal four-trocar technique with the Da Vinci robotic system using two polypropylene meshes for fixation to the sacral promontory. The primary outcome was recurrence; secondary outcomes included operating room time, blood loss, conversion to open surgery, complications and length of stay. RESULTS: 31 consecutive procedures were included. Mean patient age was 65.2 (50-81) years. Mean operating room time was 186 (150-230) min. We converted 1 case to laparoscopy (3.2%). There were two major complications (1 acute myocardial infarction and 1 reoperation for excess tension with syncopes), two minor complications (1 wound infection and 1 ileus) and no recurrences at a mean follow-up of 24.5 (16-33) months. CONCLUSIONS: Robotic sacrocolpopexy could possibly improve with experience after overcoming the learning curve. There is no doubt it is a reproducible technique, but its safety and efficacy still need to be proven. Our initial series demonstrated good outcomes and no recurrences at 24.5 months of follow-up.

Bladder diverticulum robotic surgery: systematic review of case reports.

INTRODUCTION: We report one case of robot-assisted transperitoneal bladder diverticulectomy and perform a systematic review of published experience. PATIENT AND METHODS: Our patient was a 64-year-old male with a history of lower urinary tract symptoms secondary to benign prostatic enlargement for 6 years with recurrent urinary tract infection. Ultrasound and voiding cystourethrogram showed a 7-cm diverticulum in the posterior bladder wall. After bibliographic search in PubMed/Medline, 17 articles on laparoscopic diverticulectomy and 8 on robotic diverticulectomy were selected. RESULTS: Transperitoneal robot-assisted diverticulectomy was performed with the Da Vinci 4-arm system (Intuitive Surgical Inc., Sunnyvale, Calif., USA) without perioperative complications. Operative time was 80 min and blood loss less than 100 ml. Transurethral prostatic resection combined with Greenlight laser vaporization was performed in a second step. CONCLUSIONS: Robot-assisted bladder diverticulectomy is safe, effective, reproducible and minimally invasive. Cost is higher than for laparoscopic surgery and access to this technology is limited.

[Cirugía guiada por la imagen y otros avances en la ayuda al diagnóstico y tratamiento quirúrgico urológico.] / Cirugía guiada por la imagen y otros avances en la ayuda al diagnóstico y tratamiento quirúrgico urológico.

 La evolución de la cirugía va ligada inexorablemente al avance de la tecnología,en un ciclo acelerado que ha transformado completamente el escenario de la cirugía urológica.Poco tiene que ver la realidad actual con la cirugía que los urólogos del siglo XXaprendimos de nuestros maestros...

 La evolución de la cirugía va ligada inexorablemente al avance de la tecnología,en un ciclo acelerado que ha transformado completamente el escenario de la cirugía urológica.Poco tiene que ver la realidad actual con la cirugía que los urólogos del siglo XXaprendimos de nuestros maestros...

[On line learning in urologic surgery. The value of the 2.0 Web tools.] / Formación on line en cirugía urológica. Valor de las herramientas de la Web 2.0.

The field of Surgery is under the pressure of accelerated change where technological cycles get shorter and shorter, sometimes transformational. Learning and training have gotten a key role because learning curves for new techniques directly affect patient's safety and learning cycles are slower. The traditional learning model within the urology department is overwhelmed. We need new training and learning methods. The aim of this article is to perform a critical analysis of the current status of learning in urological surgery and the challenges we face, evaluating how new information and communication technologies can help us to facilitate the learning process. We also present our initial experience with on line education on upper urinary tract laparoscopic and robotic surgery using the 2.0 Web tools.

[Outpatient female stress urinary incontinence surgery: budget impact study]. / Cirugia de la incontinencia urinaria femenina en regimen de cirugia mayor ambulatoria: estudio de impacto presupuestario.

OBJECTIVES: The surgical procedures for the insertion of tension free vaginal tapes in the treatment of female stress urinary incontinence (SUI) are simple and can be done as outpatient operations. The aim of this study was to perform a budget study comparing TVT in an outpatient basis with transobturator tape (TOT) with hospital admission. METHODS: Retrospective analysis of the medical records of 23 patients undergoing surgery for SUI between October 2004 and October 2005. 13 patients were treated by TVT in an outpatient basis (group 1, Department of Urology), 10 patients were treated by TOT with hospital admission (Group 2, Department of Gynaecology). Cost analysis was carried out by the construction of a Marcov model, incorporating the time sequence of the treatment, including adverse events and results. Variables considered for the analysis: number of visits, preoperative tests, operative time, tape cost, hospital stay, unpredicted visits in the first postoperative month at the outpatient clinics or emergency room, and hospital readmissions. Statistical analysis was performed with the G-Stat software. Student's t test was used to compare quantitative variables. RESULTS: 11/13 patients (84.6%) in group 1 completed the day-surgery protocol. Mean surgical time was 61.7 min. (SD 16.2; 35-100) and 61.6 min. (SD 8.3; 50-73) for groups I and 2 respectively. Two cases in group 1 had perioperative complications (15.4%); no patient in group 2 had perioperative complications. Mean hospital stay was 1.3 days for group 1 (SD 0.85; 1-4) and 2.9 days for group 2 (SD 0.31; 2-3). Three patients in group 1 (23%) and 2 in group 2 (20%) presented postoperative complications. Mean cost per process was 4740 EUR for group 1 and 7099 EUR for group 2. CONCLUSIONS: SUI correction by tension free tapes as day surgery is a valid option which saves a substantial amount of resources.