Da Vinci vs. Hugo RAS for robot-assisted radical prostatectomy: a prospective comparative single-center study.

PURPOSE: To evaluate Hugo RAS against the Da Vinci system for Robot-Assisted Radical Prostatectomy (RARP) in prostate cancer treatment. METHODS: We compared outcomes of 150 patients with prostate cancer undergoing RARP with either Hugo or Da Vinci systems. Our analysis included operative, postoperative, pathological, and functional outcomes. RESULTS: Both groups had 75 patients. Baseline characteristics and tumor features were similar. Intraoperatively, Da Vinci had a shorter docking time (10.45 vs. 18.62 min, p = 0.02), but total operative times were comparable (145.34 vs 138.95, p = 0.85). Hugo outperformed in neck dissection and lymphadenectomy times (22 vs 13.67 min, p = 0.027 and 37.82 vs 45.77 min, p = 0.025). Postoperative metrics like stay duration, catheter time, and complications showed no significant difference. Functional results, using IPSS and IIEF5, were similar between systems. Six Da Vinci patients (8%) and nine Hugo patients (12%) experienced social incontinence (p = 0.072). Pathological outcomes like T stage, Gleason Score, and nodes removed were alike. However, Hugo had more positive surgical margins (20% vs. 10.67%, p = 0.034). CONCLUSIONS: RARP outcomes using Hugo RAS were similar to the Da Vinci system in our study. More research and extended follow-up are required to ascertain long-term oncological and functional results.

The Failing Kidney Transplant Allograft. Transplant Nephrectomy: Current State-of-the-Art.

PURPOSE OF REVIEW: This review provides a critical literature overview of the risks and benefits of transplantectomy in patients with a failed allograft. Additionally, it offers a summary of related problems, primarily alloantibody sensitization in the event of nephrectomy and immunosuppression weaning. RECENT FINDINGS: Transplant nephrectomy has high morbidity and mortality rates. The morbidity of transplant nephrectomy (4.3 to 82%) is mostly due to hemorrhage or infection. Mortality rates range from 1.2 to 39%, and most are due to sepsis. Transvascular graft embolization has been described as a less invasive alternative technique for the management of symptomatic graft rejection, with minimal complications compared with transplantectomy. The number of patients with a failed allograft returning to dialysis is increasing. The role of allograft nephrectomy in the management of asymptomatic transplant failure is still controversial and up today continues to depend on the usual clinical practice of each institution. The less invasive transvascular embolization could have applicability in asymptomatic patients with the obvious lower morbidity and mortality rate.

Da Vinci and Hugo RAS Platforms for robot-assisted partial nephrectomy: a preliminary prospective comparative analysis of the outcomes.

BACKGROUND: Robot-assisted partial nephrectomy (RAPN) has emerged as the preferred approach for T1 renal-cell-carcinoma. As new robotic platforms like Hugo RAS emerge, we seek to understand their potential in achieving similar RAPN outcomes as the established Da Vinci system. METHODS: A prospective single-center comparative study was conducted, and 50 patients selected for RAPN were enrolled (25 Da Vinci Xi; 25 Hugo RAS). The choice of robotic system was based solely on hospital logistics criteria. Surgeries were performed by expert surgeons. Demographic data, tumor characteristics, operative details and postoperative outcomes were collected. SPSS version 22.0 was used for statistical analyses. RESULTS: The average age of patients was 62.52±9.47 years, with no significant differences in median age, sex, and nephrometry scores between groups. Da Vinci group showed a significantly shorter docking time (12.56 vs. 20.08 min; P<0.01), while other intraoperative measures like console time and warm ischemia time were similar. The Hugo RAS group had a shorter renorraphy time (14.33 vs. 18.84 min; P=0.024). Postoperative outcomes and surgical margin positivity showed no significant differences. Each group had one patient (4%) who developed major surgical complications (Clavien IIIa). Trifecta rates were comparable between both groups (Da Vinci 88% vs. Hugo RAS 84%; P=0.93). CONCLUSIONS: Initial findings suggest similar perioperative outcomes for RAPN when using Hugo RAS compared to the Da Vinci system. Further research with long-term follow-up is necessary to evaluate oncological and functional outcomes.

Genital self-mutilation. Case report and bibliographic review.

OBJECTIVE: To report a very uncommon case of penile open wound made by self-mutilation in a 51-year-old man, and to perform a bibliographic review. METHODS: 51-year-old man presenting at the Emergency Department under Police guard after self-cutting his penis while he was urinating, presenting an almost complete circular section that required immediate surgical repair. RESULTS: Early surgical management showed the section of almost the whole penile circumference, from ventral to dorsal, including urethra and both cavernous bodies, respecting only the dorsal vascular penile complex. We performed a primary anastomosis of the damaged structures and careful haemostasis of the penis. CONCLUSIONS: Open traumas to the penis usually require an urgent surgical examination, being mandatory to try a primary reconstruction if the global clinical situation allows it. Cosmetic and functional postoperative results advise this attitude.

Bibliographic review about the usefulness of ultrasound contrast media in the study of renal masses.

OBJECTIVES: The microbubbles enhanced ultrasound contrast is a novel technique that informs us in real time of renal perfusion and microcirculation. METHOD: We reviewed the literature about its use in the study of renal masses in order to show their actual clinical performance in this condition. RESULT: This technique is useful in the differential diagnosis of pseudotumors, characterization and monitoring of small renal masses, the study of complex renal cysts and controlling the progression of renal masses that underwent ablative treatments. Like any diagnostic technique has some limitations on usage;its rapid contrast wash, being operator-dependent, require some experience and need special software to be correctly interpreted. CONCLUSIONS: The microbubbles enhanced ultrasound contrast is a useful and economic technique for the study and differential diagnosis of the renal masses.

Kidney Autotransplantation in the Management of Residual Retroperitoneal Mass in a Germ Cell Tumor.

The main indication for kidney autotransplantation is ureteric disease, although it is also performed to treat renovascular diseases or neoplasms, such as complex intrasinusal kidney tumors or in patients with a solitary kidney. Only a few cases of kidney autotransplantation in the context of resection of complex retroperitoneal masses have been reported in the literature. CASE PRESENTATION: We report the case of a 26-year-old man with history of nonseminomatous germ cell tumor who had undergone a left radical orchiectomy 3 months earlier. Follow-up computed tomography revealed a residual retroperitoneal postchemotherapy mass involving the renal hilum. It was surgically removed via en bloc resection and bench ex vivo nephron-sparing surgery, and subsequently autotransplantation, thereby avoiding the necessity of nephrectomy and the resulting risk of chronic kidney disease. The pathology of the excised specimen demonstrated mixed germ cell tumor, composed of immature teratoma and yolk sac tumor, and confirmed tumor-free margins. CONCLUSIONS: This technique should be taken into account in selected patients as an alternative to radical nephrectomy when a retroperitoneal tumor is unresectable using standard surgical techniques or when a radical nephrectomy is considered, especially in patients with chronic kidney disease or solitary kidney, or in young patients who will potentially need nephrotoxic chemotherapy.

Kidney Autotransplantation and Orthotopic Kidney Transplantation: Two Different Approaches for Complex Cases.

Introduction: Transplantation surgery teams often have to face complex cases. In certain circumstances, such as occlusion of the iliac vessels or prior pelvic surgery, heterotopic kidney transplantation may not be feasible and orthotopic kidney transplantation (OKT) could be a good alternative. Kidney autotransplantation (KAT) has been described as a potential treatment for complex renovascular, ureteral, or neoplastic conditions. There are scarce data regarding the complications and outcomes of these procedures; therefore, we present our experience. Materials and Methods: We retrospectively analysed the medical records of both 21 patients who had received OKT and 19 patients who underwent KAT between 1993 and 2020. We collected demographic features and data regarding surgical technique, complications, and graft outcomes. Kidney graft survival was calculated using Kaplan-Meier survival analysis. Results: Regarding OKT, in 15 (71.43%) cases, it was the first kidney transplantation. The most common indication was the unsuitable iliac region due to vascular abnormalities (57.14%). The early postoperative complication rate was high (66.67%), with 23.81% of Clavien grade 3b complications. During the follow-up period (mean 5.76 -SD 6.15- years), we detected 9 (42.85%) graft losses. At 1 year, the survival rate was 84.9%. Concerning KAT, the most frequent indication was ureteral pathology (52.63%), followed by vascular lesions (42.11%). The overall early complication rate was 42.11%. During the follow-up period (mean of 4.47 years), 4 (15.79%) graft losses were reported. Conclusions: Although OKT and KAT have high complication rates, these techniques can be considered as two valuable approaches for complex cases, in the absence of other therapeutic options.

[Renal allograft transplant vascular complications. Diagnostic and treatment.] / Complicaciones vasculares del trasplante renal. Diagnóstico y tratamiento.

Vascular complications remain common after renal transplantation, occurring in 3% to 15% of patients. These complications can compromise graft function,with graft loss rates ranging from 12.6 to 66.7%.Vascular abnormalities of the graft, specifically the presence of multiple vessels, represent the most frequently studied risk factor for the development of vascular complications. Other risk factors identified for the development of vascular complications are linked to the characteristics of the recipient, or thromboembolic diseasesharing atherosclerosis and/or hypercoagulant state aspathogenic features.Although the most frequent vascular complication is renal artery stenosis, we will also address the complications according to their early or late on set in order to highlightthe potentially more severe complications that may affectgraft survival during the follow-up period.Early vascular complications include mainly arterial and venous thrombosis and lacerations or disruptions of artery and/or vein, as well as arterio-venous fistulas or intrarenal pseudoaneurysms. In contrast, late-onset complications include stenosis or kinking of the renal artery-and less commonly of the renal vein-, as well as extrinsic compression as a consequence of the presence of perigraft fluid collections. Finally, extrarenal pseudoaneurysm is a potentially severe complication in the late post-transplant period.Finally, this article explores special transplant situations such as complications derived from the paediatric donor in adult recipients, transplantation in the paediatric recipient and emerging techniques like robotic renal transplantation.

Las complicaciones vasculares siguen siendo frecuentes después del trasplante renal, ocurriendo entre el 3% y el 15% de los pacientes. Estas complicaciones pueden comprometer la función del injerto,con unas tasas de pérdida del injerto que varían entreel 12,6 ­ 66,7%.Las anomalías vasculares del injerto, y concretamente la presencia de múltiples vasos, representan el factor de riesgo más frecuente y estudiado para el desarrollo de complicaciones vasculares. Otros factores de riesgo de complicaciones vasculares se han relacionado con las características del receptor, o la enfermedad tromboembólica, compartiendo como características patogénicas la aterosclerosis y/o el estado hipercoagulante. Aunque la complicación vascular más frecuente está constituida por la estenosis de la arteria renal, expondremos las complicaciones en función de su presentación clínica temprana o tardía en un intento de destacar para el lector las complicaciones potencialmente más severas y que en cada momento del tiempo pueden condicionar la supervivencia del injerto.Las complicaciones de presentación preferentemente perioperatoria incluyen fundamentalmente la trombosis arterial y venosa y las laceraciones o disrupciones de arteria y/o vena, así como las fístulas arterio-venosas opseudoaneurismas intrarrenales. Por el contrario, otras complicaciones tienen comúnmente una presentación clínica más tardía. En este grupo incluimos la estenosiso acodamiento de la arteria renal y excepcionalmente de la vena renal, así como la compresión extrínseca de los vasos del injerto como consecuencia de la presencia de colecciones peri-injerto. Finalmente, una complicación severa que puede manifestarse de forma tardía enla evolución del receptor, es el pseudoaneurisma extrarrenal. Finalmente, haremos brevemente referencia a situaciones especiales del trasplante como las complicaciones derivadas del donante pediátrico en receptores adultos,del trasplante en el receptor pediátrico y de técnicas emergentes como el trasplante renal robótico.

The Usefulness of Contrast-Enhanced Ultrasound in the Assessment of Early Kidney Transplant Function and Complications.

OBJECTIVES: The routine diagnostic method for assessment of renal graft dysfunction is Doppler ultrasound. However, contrast-enhanced ultrasound (CEUS) may provide more information about parenchymal flow and vascular status of kidney allografts. The aim of the study was to assess the effectiveness of CEUS in the immediate post-transplant period, focusing on acute vascular complications. A brief review of available literature and a report of our initial experience is made. MATERIAL AND METHODS: 15 kidney transplant (KT) cases with clinical suspicion of acute surgical complication were assessed with CEUS and conventional Doppler ultrasound (US). In addition, bibliographic review was conducted through PubMed, Embase, and ClinicalKey databases. RESULTS: 10% of KT underwent CEUS, useful for detecting vascular complication or cortical necrosis in 4 (26%) and exclude them in 74%. Grafts with acute vascular complications have a delayed contrast-enhancement with peak intensity lower than normal kidneys. Perfusion defects can be clearly observed and the imaging of cortical necrosis is pathognomonic. CONCLUSIONS: CEUS is a useful tool in the characterization of renal graft dysfunction with special interest on acute vascular complications after renal transplant. It is a feasible technique for quantitative analysis of kidney perfusion, which provides information on renal tissue microcirculation and regional parenchymal flow. Exploration could be done by a urologist at the patient's bedside while avoiding iodinated contrast.

Complicaciones vasculares del trasplante renal. Diagnóstico y tratamiento / Vascular complications of kidney transplantation. Diagnosis and treatment

Existen diferentes técnicas quirúrgicaspara la reconstrucción del tracto urinario en el trasplanterenal. Sin embargo es frecuente la aparición de complicaciones urinarias en el postoperatorio, siendo el uréterla localización frecuente de las mismas. Esto implicaun alto gasto sanitario, aumentando la morbimortalidaddel paciente y pudiendo llegar a desencadenar la pérdida del injerto. Por ello es importante la prevención, elcorrecto diagnóstico y su tratamiento.El objetivo de esta revisión es describir las técnicas quirúrgicas más usadas en el trasplante renal para la ureteroneocistostomía. Analizar las ventajas y desventajas decada una de ellas y comparar sus complicaciones. Porotro lado se resume la literatura reciente sobre las cuatrocomplicaciones urinarias más frecuentes en el postoperatorio del trasplante. Se exponen las posibles causas ytratamiento de la fuga urinaria, la obstrucción ureteral,la hematuria y el reflujo ureterovesical.(AU)

There are different surgical techniques forreconstruction of the urinary tract in kidney transplant.However, urinary complications are frequent in the postoperative period, being the ureter the frequent locationof these complications. This results in high health carecosts, increasing patient morbimortality and sometimesgraft loss. For this reason, prevention, correct diagnosisand treatment are important.The aim of this review is to describe the surgical techniques most commonly used in kidney transplant forureteroneocystostomy. To analyze the advantages anddisadvantages of each of them and to compare theircomplications. On the other hand, we summarize therecent literature on the four most frequent urinary complications in the postoperative period after transplantation.The possible causes and treatment of urine leak, uretericobstruction, hematuria and vesicoureteral reflux are presented.(AU)

Empleo de catéteres y stents ureterales en el transplante renal / The use of ureteral stents and catheters in renal transplantation

OBJETIVO: Las complicaciones urológicos mayores, fístulas y estenosis, afectan principalmente a la anastomosis vesico-ureteral y se presentan en el periodo temprano post-trasplante (TR). El empleo sistemático de catéteres ureterales continúa siendo controvertido con muchos grupos utilizándolos sólo de forma selectiva en función de la existencia de factores de riesgo pretrasplante o intraoperatorios. MÉTODOS: Se llevó a cabo una revisión de la literatura mediante la búsqueda automatizada en las bases de datos bibliográficas Medline como fuente bibliográfica principal y en Clinical Key. La estrategia de búsqueda incluyó los siguientes términos: 'stent' AND 'kidney transplantation'. RESULTADOS: La revisión de la literatura puso de manifiesto el efecto protector del empleo de catéteres ureterales en la ureteroneocistostomía del TR tanto para el desarrollo de fístulas (RR 0,29, 0,12 a 0,74, p=0,009) como de estenosis (RR 0,27, 0,09 a 0,81, p=0,02). El empleo de catéteres en pacientes inmunodeprimidos se asoció a un incremento significativo en la incidencia de ITUs post-TR (RR 1,49 IC 95% 1,04 a 2,15, p=0,03) que fue prevenida por la profilaxis antibiótica dirigida a la neumonía por pneumocistis carinii con cotrimoxazol. Las tasas de permeabilidad de los stent metálicos autoexpandibles y los by-pass extra-anatómicos en el tratamiento de la estenosis ureteral post-TR en pacientes de alto riesgo quirúrgico o tras el fracaso previo de la cirugía, con un número limitado de pacientes incluidos, ha variado entre el 50% y el 100%. CONCLUSIONES: El empleo de un catéter ureteral en la ureteroneocistostomía extravesical disminuye la incidencia de complicaciones anastomóticas. El tratamiento de elección de la estenosis ureteral post-TR es el tratamiento quirúrgico. El uso de stents metálicos y by-pass extraanatómicos debe limitarse al tratamiento de estenosis ureterales complejas en las que ha fallado el tratamiento primario, pacientes con elevado riesgo quirúrgico o disfunción crónica del injerto

OBJECTIVE: Mayor urological complications, fistulae and stenosis, mainly affect the vesicoureteral anastomosis and present in the early post-transplant period. The systematic use of ureteral catheters keeps selecbeing controversial with many groups using them only selectively depending on the existence of pretransplant or intraoperative risk factors. METHODS: We performed a bibliographic review through automatized search in the Medline bibliographic database, as the main bibliographic source, and also in Clinical Key. The search strategy included the following terms: 'stent' AND 'kidney transplantation'. RESULTS: The bibliographic search revealed the protective effect of the use of ureteral catheters in the transplant ureteroneocystostomy for both development of fistulae (RR 0.29, 0.12 to 0.74, p = 0.009) and stenosis (RR 0.27, 0.09 to 0.81, p = 0.02). The use of catheters in immunosuppressed patients was associated with significant increase of the incidence of post-transplant urinary tract infections (RR 1.49 IC 95% 1.04 to 2.15, p = 0.03) that was prevented by antibiotic prophylaxis with cotrimoxazole directed against pneumocistis carinii. The rates of permeability of self-expandable metallic stents and extra-anatomic bypasses in the treatment of ureteral stenosis after renal transplantation in high surgical risk patients or after the failure of previous surgery, has varied from 50% to 100%, with a limited number of patients included. CONCLUSIONS: The use of ureteral catheters in the extravesical ureteroneocystostomy reduces the incidence of anastomotic complications. Surgery is the treatment of choice of post-transplant ureteral stenosis. The use of metallic stents and extra-anatomic bypasses should be limited to complex ureteral stenosis when primary therapy has failed, in high surgical risk patients or chronic graft dysfunction

Automutilación genital. Presentación de un caso clínico y revisión de la literatura / Genital self-mutilation. Case report and bibliographic review

OBJETIVO: Presentar un caso clínico muy poco frecuente de herida abierta del pene producida por automutilación, así como revisar la literatura principal existente sobre este tipo de traumatismo infrecuente.MÉTODO: Varón de 51 años de edad que acude al Servicio de Urgencias custodiado por el Cuerpo Nacional de Policía tras haberse autoinfringido un corte en el pene mientras orinaba, que le causó una sección circunferencial del pene casi completa, y que requirió revisión quirúrgica urgente. RESULTADO: La intervención quirúrgica puso de manifiesto la sección de prácticamente toda la circunferencia peneana, de ventral a dorsal, incluyendo uretra y ambos cuerpos cavernosos y respetando tan sólo el complejo vascular dorsal del pene. En dicho acto se procedió a la anastomosis primaria de las estructuras seccionadas y a la hemostasia cuidadosa de los vasos sangrantes.CONCLUSIONES: Las heridas abiertas del pene requieren generalmente revisión quirúrgica urgente, debiendo intentarse la reconstrucción primaria si la situación clínica lo permite, dados los buenos resultados estéticos y funcionales logrados tras la cirugía (AU)

OBJECTIVE: To report a very uncommon case of penile auto-mutilation in a 51-year-old man, self-made with a biting object.METHODS: 51-year-old man presenting at the Emergency Department guarded by the Police after auto-cutting his penile while he was urinating, causing him an almost complete circular section that required immediate surgical management.RESULTS: early surgical management showed the section of almost the whole penile circumference, from ventral to dorsal, including the urethra and both cavernous bodies, respecting only dorsal vascular penile complex. We performed a primary anastomosis of damaged structures and carefully haemostasis of the penis.CONCLUSIONS: open traumas to the penis usually require an urgent surgical examination, being mandatory to try a primary reconstruction if global clinical situation allows it. Cosmetic and functional postoperative results advise this attitude (AU)

Revisión bibliográfica sobre la utilidad de los contrastes ecográficos en el estudio de las masas renales / Bibliographic review about the usefulness of ultrasound contrast media in the study of renal masses

OBJETIVO: La ecografía realzada con contraste de microburbujas es una técnica novedosa que nos informa en tiempo real de la perfusión renal y su microcirculación. MÉTODOS: Hemos revisado la literatura sobre su uso en el estudio de las masas renales con el fin de mostrar su rentabilidad clínica real en esta patología. RESULTADOS: Esta técnica resulta útil en el diagnóstico diferencial de pseudotumores, en la caracterización y seguimiento de masas renales de pequeño tamaño, en el estudio de quistes renales complejos y en el control evolutivo de masas renales sometidas a tratamientos ablativos. CONCLUSIONES: Como toda técnica diagnóstica, no está exenta de limitaciones de uso, siendo sus principales inconvenientes la rapidez del lavado del contraste, el ser operador-dependiente, requerir de cierta experiencia y la necesidad de un software especial para su correcta interpretación(AU)

OBJECTIVES: The microbubbles enhanced ultrasound contrast is a novel technique that informs us in real time of renal perfusion and microcirculation. METHOD: We reviewed the literature about its use in the study of renal masses in order to show their actual clinical performance in this condition. RESULT: This technique is useful in the differential diagnosis of pseudotumors, characterization and monitoring of small renal masses, the study of complex renal cysts and controlling the progression of renal masses that underwent ablative treatments. Like any diagnostic technique has some limitations on usage; its rapid contrast wash, being operator-dependent, require some experience and need special software to be correctly interpreted. CONCLUSSIONS: The microbubbles enhanced ultrasound contrast is a useful and economic technique for the study and differential diagnosis of the renal masses(AU)