Cistectomía radical abierta versus laparoscópica: comparación de resultados perioperatorios y oncológicos a mediano plazo / Open vs Laparoscopic Radical Cystectomy: Comparison of perioperative and Mid-term oncological outcomes

OBJETIVO: Comparar los resultados perioperatorios y oncológicos a mediano plazo entre Cistectomía Radical Abierta (CRA) versus Cistectomía Radical Laparoscópica (CRL). MÉTODOS: Se realizó una cohorte retrospectiva, en la cual se incluyeron 182 pacientes sometidos de forma consecutiva a Cistectomía radical (CR) como tratamiento de Cáncer Vesical Músculo-Invasor entre el 2000 y el 2010 en un solo centro. La serie se dividió en dos grupos: CRA (n = 83) y CRL (n = 99). Todas las CR fueron realizadas por el mismo cirujano. Las complicaciones perioperatorias fueron registradas según la clasificación Clavien-Dindo. Se evaluó sobrevida libre de recurrencia, sobrevida cáncer-específica y asociación entre la técnica quirúrgica y recurrencia de enfermedad ajustando co-variables. RESULTADOS: Las características clínicas y patológicas fueron similares entre los dos grupos. Se observaron diferencias significativas en pérdida sanguínea estimada, tiempo operatorio y estadía hospitalaria entre los grupos (p < 0,05). Se presentaron 27 (32,5%) complicaciones Clavien I-II en el grupo abierto y 11 (11,1%) en el grupo laparoscópico. Cuatro complicaciones Clavien ≥ III (4,8%) se presentaron en el grupo CRA versus 7 (7%) en el grupo CRL (ns). La mediana de seguimiento para pacientes sin recurrencia fue de 23 meses (12-48). Un total de 60 pacientes (72,3%) presentaron recurrencia de algún tipo en el grupo de CRA y 59 pacientes (59,6%) en el de CRL. La incidencia acumulada de mortalidad cáncer-específica, estratificada por abordaje quirúrgico, fue similar entre ambos grupos (p.0,9). CONCLUSIONES: En base a nuestra experiencia, la CRL mostró ventajas en sangrado intraoperatorio y estadía hospitalaria, sin encontrar diferencias en complicaciones mayores entre ambos grupos. El control oncológico a mediano plazo en relación a recurrencia como a sobrevida cáncer-especifica no presenta diferencias significativas entre la CRL y CRA en el manejo del cáncer vesical músculo-invasor

OBJECTIVE: To compare peri-operative and mid-term oncological outcomes between Open radical cystectomy (ORC) and Laparoscopic radical cystectomy (LRC). METHODS: A retrospective cohort was assembled, in which 182 patients had been subjected consecutively to Radical Cystectomy (RC) for treatment of muscle-invasive bladder cancer (MIBC) between 2000 and 2010 in a single center. Two cohorts were included: ORC (n = 83) and LRC (n = 99). All the RCs were performed by the same surgeon. Perioperatory complications were registered according to Clavien-Dindo classification. We evaluated recurrence-free survival, cancer-specific survival and association between the surgical technique performed and disease recurrence, with co-variable adjustment. RESULTS: Clinical and pathologic characteristics were similar for both groups. Significant differences were observed between the two groups, regarding blood loss, operative time and hospitalization days (p < 0.04). The ORC group displayed 27 (32.5%) Clavien I-II cases, vs. 11 (11.1%) in the LRC group. Four Clavien≥III (4.8%) complications were reported in the ORC, vs. 7 (7%) in the LRC group (NS). Mean follow-up time for patients without recurrence was 23 months (12-48). A total of 60 patients (72.3%) showed recurrence in the ORC group, compared to 59 (59.6%) in the LRC group. Cumulative cancer-specific mortality index, stratified by surgical technique, was similar between both groups (p.-0.9) CONCLUSIONS: Based on our experience, LRC showed advantages in intraoperative bleeding and length of hospital stay with no difference in major complications between both groups. Mid-term oncological control, regarding local recurrence and cancer-specific survival, showed no significant difference between LRC and ORC in the management of MIBC

[Open vs Laparoscopic Radical Cystectomy: Comparison of perioperative and Mid-term oncological outcomes.] / Cistectomía radical abierta versus laparoscópica: comparación de resultados perioperatorios y oncológicos a mediano plazo.

OBJECTIVE: To compare peri-operative and mid-term oncological outcomes between Open radical cystectomy (ORC) and Laparoscopic radical cystectomy (LRC). METHODS: A retrospective cohort was assembled, in which 182 patients had been subjected consecutively to Radical Cystectomy (RC) for treatment of muscle-invasive bladder cancer (MIBC) between 2000 and 2010 in a single center. Two cohorts were included: ORC (n=83) and LRC (n=99). All the RCs were performed by the same surgeon. Perioperatory complications were registered according to Clavien-Dindo classification. We evaluated recurrence-free survival, cancer-specific survival and association between the surgical technique performed and disease recurrence, with co-variable adjustment. RESULTS: Clinical and pathologic characteristics were similar for both groups. Significant differences were observed between the two groups, regarding blood loss, operative time and hospitalization days (p<0.04). The ORC group displayed 27 (32.5%) Clavien I-II cases, vs. 11 (11.1%) in the LRC group. Four Clavien≥III (4.8%) complications were reported in the ORC, vs. 7 (7%) in the LRC group (NS). Mean follow-up time for patients without recurrence was 23 months (12-48). A total of 60 patients (72.3%) showed recurrence in the ORC group, compared to 59 (59.6%) in the LRC group. Cumulative cancer-specific mortality index, stratified by surgical technique, was similar between both groups (p.-0.9). CONCLUSIONS: Based on our experience, LRC showed advantages in intraoperative bleeding and length of hospital stay with no difference in major complications between both groups. Mid-term oncological control, regarding local recurrence and cancer-specific survival, showed no significant difference between LRC and ORC in the management of MIBC.

OBJETIVO: Comparar los resultados perioperatorios y oncológicos a mediano plazo entre Cistectomía Radical Abierta (CRA) versus Cistectomía Radical Laparoscópica (CRL).MÉTODOS: Se realizó una cohorte retrospectiva, en la cual se incluyeron 182 pacientes sometidos de forma consecutiva a Cistectomía radical (CR) como tratamiento de Cáncer Vesical Músculo-Invasor entre el 2000 y el 2010 en un solo centro. La serie se dividió en dos grupos: CRA (n=83) y CRL (n=99). Todas las CR fueron realizadas por el mismo cirujano. Las complicaciones perioperatorias fueron registradas según la clasificación Clavien-Dindo. Se evaluó sobrevida libre de recurrencia, sobrevida cáncer-específica y asociación entre la técnica quirúrgica y recurrencia de enfermedad ajustando co-variables. RESULTADOS: Las características clínicas y patológicas fueron similares entre los dos grupos. Se observaron diferencias significativas en pérdida sanguínea estimada, tiempo operatorio y estadía hospitalaria entre los grupos (p<0,05). Se presentaron 27 (32,5%) complicaciones Clavien I-II en el grupo abierto y 11 (11,1%) en el grupo laparoscópico. Cuatro complicaciones Clavien ≥III (4,8%) se presentaron en el grupo CRA versus 7 (7%) en el grupo CRL (ns). La mediana de seguimiento para pacientes sin recurrencia fue de 23 meses (12-48). Un total de 60 pacientes (72,3%) presentaron recurrencia de algún tipo en el grupo de CRA y 59 pacientes (59,6%) en el de CRL. La incidencia acumulada de mortalidad cáncer-específica, estratificada por abordaje quirúrgico, fue similar entre ambos grupos (p.0,9). CONCLUSIONES: En base a nuestra experiencia, la CRL mostró ventajas en sangrado intraoperatorio y estadía hospitalaria, sin encontrar diferencias en complicaciones mayores entre ambos grupos. El control oncológico a mediano plazo en relación a recurrencia como a sobrevida cáncer-especifica no presenta diferencias significativas entre la CRL y CRA en el manejo del cáncer vesical músculo-invasor.

Corrigendum to "Modified urethrovesical anastomosis during robot-assisted simple prostatectomy: Technique and results" [Prostate Int 4 (2016) 61-64].

[This corrects the article DOI: 10.1016/j.prnil.2016.04.001.].

American Confederation of Urology (CAU) experience in minimally invasive partial nephrectomy.

PURPOSE: To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014. METHODS: Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95 % confidence intervals, Kaplan-Meier curves, multivariate logistic and Cox regression analyses. Clavien-Dindo classification was used. RESULTS: We evaluated 1501 laparoscopic (98 %) or robotic (2 %) PNs. Median age: 58 years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20 min and 200 cc. 81 % of the lesions were malignant, with clear cell histology being 65 % of the total. Median maximum tumor diameter is 2.7 cm, positive margin is 8.2 %, and median hospitalization is 3 days. One or more postoperative complication was recorded in 19.8 % of the patients: Clavien 1: 5.6 %; Clavien 2: 8.4 %; Clavien 3A: 1.5 %; Clavien 3B: 3.2 %; Clavien 4A: 1 %; Clavien 4B: 0.1 %; Clavien 5: 0 %. Bleeding was the main cause of a reoperation (5.5 %), conversion to radical nephrectomy (3 %) or open partial nephrectomy (6 %). Transfusion rate is 10 %. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95 % CI 1.02-1.2; p = 0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37 years. The 5-year progression or kidney cancer mortality-free rate was 94 % (95 % CI 90, 97). Positive margins (HR 4.98; 95 % CI 1.3-19; p = 0.02) and females (HR 5.6; 95 % CI 1.7-19; p = 0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter. CONCLUSION: Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.

First Report: Robot-Assisted Total Pelvic Exenteration for Locally Advanced Prostate Cancer.

Pelvic exenteration is used in the treatment of several pelvic cancers, including those of the rectum, uterus, and bladder. We report the first case of robotic pelvic exenteration for the treatment of symptomatic prostate cancer involving the rectum and bladder. A six-port transperitoneal robotic approach was used. Bilateral extended lymphadenectomy up to the inferior mesenteric artery was performed. The rectum and bladder were removed en bloc, and a double-barrel anastomosis was then performed with both ureters being connected to the lower opening of the colostomy. Operative time was 249 minutes, and estimated blood loss was 600 mL. No intraoperative or postoperative complications were recorded. Biopsy of the rectum and bladder showed prostatic adenocarcinoma with a Gleason score of 9 (5+4), and 1 of 17 nodes was positive for cancer. Postoperative prostate-specific antigen level was 1.24 ng/mL. The patient is already 19 months after surgery with optimal quality of life. Thus pelvic exenteration is a feasible alternative for highly symptomatic prostate cancer involving adjacent pelvic organs.

[Testosterone replacement therapy and prostate cancer: the downfall of a paradigm?]. / Terapia de reemplazo con testosterona y cáncer de próstata: ¿la caída de un paradigma?

For six decades, it has been a part of the conventional medical wisdom that higher levels of testosterone increase the risk of prostate cancer. This belief is mostly derived from the well-documented regression of prostate cancer after surgical or pharmacological castration. However, there is an absence of scientific data supporting the concept that higher testosterone levels are associated with an increased risk of prostate cancer. Moreover, men with hypogonadism have substantial rates of prostate cancer in prostatic biopsies, suggesting that low testosterone has no protective effect against the development of prostate cancer. Moreover, prostate cancer rate is higher in elderly patients when hormonal levels are low. These results argue against an increased risk of prostate cancer with testosterone replacement therapy.

Por casi seis décadas ha sido parte de la cultura médica en general, que los niveles altos de testosterona incrementan el riesgo de padecer o agravar un cáncer de próstata. Esta creencia se ha derivado fundamentalmente de la bien documentada regresión del cáncer de próstata luego de la castración médica o quirúrgica. Sin embargo, no existe evidencia científica que apoye la idea de que niveles altos de testosterona están asociados con un incremento del riesgo de cáncer de próstata. Más aún, los hombres con hipogonadismo tienen una tasa substancialmente alta de cáncer de próstata detectado por biopsia, lo que sugiere que los niveles bajos de testosterona no tienen un efecto protector en el desarrollo de cáncer de próstata y, además, la tasa de cáncer de próstata es más alta en los pacientes de edades avanzadas cuando sus niveles hormonales son más bajos. Estos argumentos tienden a demostrar que no existiría un incremento del riesgo de padecer un cáncer de próstata asociado a la terapia de reemplazo con testosterona.

Chylous ascites and high-output chylous fistula after extended pelvic lymph node dissection for urological cancer: a rare postoperative complication.

OBJECTIVES: Chylous ascites and high-output chylous fistula are rare complications following abdominal or pelvic surgery. We report a series of five cases that occurred after pelvic lymph node dissection for urological cancer, in addition to their clinical presentation, diagnosis, and treatment. METHODS: The series comprises five patients; four men in whom robotic radical prostatectomy and extended pelvic lymphadenectomy were performed, and one woman with an infiltrating bladder cancer that underwent robotic anterior pelvic exenteration and extended pelvic lymphadenectomy. The first four patients developed chylous ascites, and the female patient a high-output chylous fistula. RESULTS: In all cases, diagnosis of chylous ascites or chylous fistula was confirmed, and they were handled in varied ways, from observation to medical treatment, paracentesis, and surgery, according to their clinical presentation and evolution. We describe a simple treatment algorithm. CONCLUSION: This rare surgical complication requires a grade of suspicion and a defined treatment according to the probability of the medical compromise. Prevention is an important element. This series, according to our knowledge, is the first description in patients undergoing robotic extended pelvic lymphadenectomy.

Vaginal Gartner cysts: clinical report of four cases and a bibliographic review.

OBJECTIVES: To present a series of four cases of Gartner cysts and their clinical presentation. A bibliographic review was performed. METHODS: The series consisted of 4 women, mean age 39, who complained of a bulge at the anterior vaginal wall, associated with a variety of urinary symptoms. RESULTS: Surgical removal was performed in all cases. The pathological studies confirmed the diagnosis of Gartner cyst. There were no recurrences in the long-term follow-up. CONCLUSION: Vaginal wall cysts are rarely found in common urological practice. Gartner cysts arise as a consequence of the Gartner duct (mesonephric remainder) obstruction and they are located in the anterior or lateral wall of the vagina. They may be associated with renal and ureteral anomalies. Differential diagnosis with other vaginal cysts can only be made by histological studies. The correct treatment is the entire removal through a vaginal approach.

Quiste del conducto de Gartner. Presentación de una serie de cuatro casos y revisión de la literatura / Vaginal Gartner cysts: Clinical report of four cases and a bibliographic review

OBJETIVO: Presentar una serie de 4 casos de quiste de Gartner, mostrando su forma de presentación y realizando una revisión de la literatura. MÉTODO: La serie está constituida por 4 mujeres, con una edad media de 39 años, cuyo motivo de consulta fue la presencia de un aumento de volumen de pared vaginal anterior y diversa sintomatología urinaria. RESULTADOS: Se realizó la extirpación quirúrgica en todos los casos, sin complicaciones. En los cuatro casos se confirmó el diagnostico anátomo-patológico de quiste de Gartner. No hubo recidivas en el largo plazo. CONCLUSIÓN: Los quistes de la pared vaginal constituyen una entidad poco frecuente dentro de la práctica urológica habitual. Los quistes de Gartner se originan como consecuencia de la obstrucción del conducto de Gartner, remanente mesonéfrico, y se localizan en la pared anterior o lateral de la vagina. Puede asociarse a anomalías renales y ureterales. El diagnostico diferencial con otros quistes vaginales solo puede realizarse mediante el estudio histológico, siendo el tratamiento de elección la extirpación por vía vaginal

OBJECTIVES: To present a series of four cases of Gartner cysts and their clinical presentation. A bibliographic review was performed. METHODS: The series consisted of 4 women, mean age 39, who complained of a bulge at the anterior vaginal wall, associated with a variety of urinary symptoms. RESULTS: Surgical removal was performed in all cases. The pathological studies confirmed the diagnosis of Gartner cyst. There were no recurrences in the long-term follow-up. CONCLUSION: Vaginal wall cysts are rarely found in common urological practice. Gartner cysts arise as a consequence of the Gartner duct (mesonephric remainder) obstruction and they are located in the anterior or lateral wall of the vagina. They may be associated with renal and ureteral anomalies. Differential diagnosis with other vaginal cysts can only be made by histological studies. The correct treatment is the entire removal through a vaginal approach

Spontaneous retroperitoneal haemorrhage of renal origin (Wunderlich syndrome): analysis of 8 cases.

OBJECTIVES: To analyze the characteristics, etiology and treatment of a series of patients with spontaneous retroperitoneal hemorrhage from renal causes. METHODS: We retrospectively reviewed patients diagnosed of spontaneous retroperitoneal hemorrhage between 2006 and 2011. All patients consulted for back pain and the diagnosis was made by computed tomography (CT) and /or magnetic resonance (MR). All patients were treated surgically. RESULTS: The series includes 8 patients. Six cases had renal mass and associated hematoma and 2 presented only perirenal hematoma. Six patients underwent total nephrectomy, one underwent partial nephrectomy, and one just drainage of the hematoma.The pathological study showed 4 cases of renal angiomyolipoma (one associated with multiple small renal carcinomas), 2 cases of renal carcinoma and 1 case of hemorrhagic renal infarction. CONCLUSION: Renal masses are the main cause of Wunderlich syndrome and CT is the diagnostic procedure of choice. Surgical treatment is preferred in patients with renal mass diagnosed and cases of hemodynamic compromise.

Fistula between external iliac artery and ileal conduit after radical cystectomy: a life-threatening complication.

OBJECTIVE: To present a rare complication of an iliac artery to ileal conduit fistula after radical cystectomy. METHODS: A 74 year-old man with muscle invasive bladder cancer was submitted for robotic radical cystectomy with intracorporeal ileal conduit. Twenty-four days after surgery he was readmitted due to an active bleeding from the ileal conduit. RESULTS: CT-Scan showed an arterial fistula between the external iliac artery and the ileal conduit. The emergency procedure done was an artery ligation, bilateral cutaneous ureterostomy and extra-anatomic femoro-femoral bypass. CONCLUSIONS: A fistula from the external iliac artery to the ileal conduit is a rare and serious complication in the Bricker type urinary diversion, with only 7 cases reported in the international literature.

Hemorragia retroperitoneal espontánea de origen renal (síndrome de Wunderlich): análisis de 8 casos / Spontaneous retroperitoneal haemorrhage of renal origin (Wunderlich syndrome): Analysis of 8 cases

OBJETIVO: Analizar las características, etiología y tratamiento en una serie de pacientes con hemorragia retroperitoneal espontánea de causa renal. MÉTODOS: Revisamos retrospectivamente los pacientes diagnosticados de hemorragia retroperitoneal espontanea entre 2006 y 2011. Todos los pacientes consultaron por dolor lumbar y el diagnóstico se realizó mediante Tomografía computada (TC) y/ o Resonancia magnética (RM). Todos los pacientes fueron tratados quirúrgicamente. RESULTADOS: La serie está compuesta por 8 pacientes. Seis casos presentaron masa renal y hematoma asociado y en 2 solo se apreció un hematoma perirenal. Seis pacientes fueron tratados mediante nefrectomía total, uno mediante nefrectomía parcial y otro solo con drenaje del hematoma. El estudio anátomo-patológico demostró 4 casos de Angiomiolipoma renal (uno asociado a múltiples carcinomas renales pequeños), 2 casos de Carcinoma renal y 1 caso de infarto renal hemorrágico. CONCLUSIÓN: Las masas renales constituyen la principal causa de síndrome de Wünderlich y la TC es la técnica diagnostica de elección. El tratamiento quirúrgico es de elección en pacientes con masa renal diagnosticada y en casos de compromiso hemodinámico (AU)

OBJECTIVES: To analyze the characteristics, etiology and treatment of a series of patients with spontaneous retroperitoneal hemorrhage from renal causes. METHODS: We retrospectively reviewed patients diagnosed of spontaneous retroperitoneal hemorrhage between 2006 and 2011. All patients consulted for back pain and the diagnosis was made by computed tomography (CT) and / or magnetic resonance (MR). All patients were treated surgically. RESULTS: The series includes 8 patients. Six cases had renal mass and associated hematoma and 2 presented only perirenal hematoma. Six patients underwent total nephrectomy, one underwent partial nephrectomy, and one just drainage of the hematoma. The pathological study showed 4 cases of renal angiomyolipoma (one associated with multiple small renal carcinomas), 2 cases of renal carcinoma and 1 case of hemorrhagic renal infarction. CONCLUSION: Renal masses are the main cause of Wunderlich syndrome and CT is the diagnostic procedure of choice. Surgical treatment is preferred in patients with renal mass diagnosed and cases of hemodynamic compromise (AU)

Fístula desde arteria ilíaca a conducto ileal tras cistectomía radical: una grave e infrecuente complicación con riesgo vital / Fistula between external iliac artery and ileal conduit after radical cystectomy: a life-threatening complication

OBJETIVO: Presentar un caso de fístula desde arteria ilíaca a conducto ileal, una infrecuente complicación después de cistectomía radical y derivación urinaria con conducto ileal. MÉTODOS: Paciente de 74 años, portador de un cáncer vesical infiltrante, a quien se le realiza una cistectomía radical con derivación urinaria con conducto ileal robótica totalmente intracorpórea. Reingresa 24 días después de la cirugía por sangrado brusco y activo desde el conducto ileal. RESULTADOS: Se realiza Angio-TAC que confirma el diagnóstico de una fístula entre la arteria ilíaca externa y el conducto ileal, por lo cual es operado de urgencia realizando una ligadura arterial, ureterostomía cutánea bilateral y by-pass femoro-femoral extraanatómico. CONCLUSIONES: La fístula arterial hasta el conducto ileal es una rara y grave complicación de la derivación urinaria tipo conducto ileal, con sólo 7 casos comunicados en la literatura (AU)

OBJECTIVE: To present a rare complication of an iliac artery to ileal conduit fistula after radical cystectomy. METHODS: A 74 year-old man with muscle invasive bladder cancer was submitted for robotic radical cystectomy with intracorporeal ileal conduit. Twenty-four days after surgery he was readmitted due to an active bleeding from the ileal conduit. RESULTS: CT-Scan showed an arterial fistula between the external iliac artery and the ileal conduit. The emergency procedure done was an artery ligation, bilateral cutaneous ureterostomy and extra-anatomic femoro-femoral bypass. CONCLUSIONS: A fistula from the external iliac artery to the ileal conduit is a rare and serious complication in the Bricker type urinary diversion, with only 7 cases reported in the international literature (AU)

[Renal cell carcinoma of the collecting ducts of bellini with retroperitoneal recurrence by another histological subtype Of renal tumor]. / Carcinoma renal de los conductos colectores de bellini con recidiva retroperitoneal por otro tipo histológico de tumor renal.

OBJECTIVE: Collecting Duct Carcinoma or Bellini Carcinoma (CDC) is a rare aggressive histological subtype. We present a case of CDC with retroperitoneal recurrence by another histological subtype of renal tumor and review of the literature. METHODS: A 59-year-old man with no relevant clinical history presented gross hematuria. At the time of diagnosis, a computed tomography ( CT) showed a tumor mass occupying the left renal pelvis. Left Laparoscopic radical nephroureterectomy was performed with endoscopic intramural ipsilateral ureter disinsertion. RESULTS: The pathological diagnosis was CDC with negative surgical margins. A CT scan control was performed 10 months later, showed a left retroperitoneal tumor compatible with a local recurrence. We performed a left subcostal laparotomy with complete resection of the mass. Histological diagnosis was large cell carcinoma with components of granular cells and clear cell. CONCLUSIONS: The CDC is a rare subtype of renal cell carcinoma (RCC) and has an aggressive behavior that is associated with poor prognosis. Surgical resection remains the treatment of choice. We present the first reported case of CDC with retroperitoneal recurrence by another histological subtype of renal tumor.

Carcinoma renal de los conductos colectores de Bellini con recidiva retroperitoneal por otro tipo histológico de tumor renal / Renal cell carcinoma of the collecting ducts of Bellini with retroperitoneal recurrence by another histological subtype of renal tumor

OBJETIVO: El Carcinoma Renal de los Conductos Colectores (CRCC) o Carcinoma de Bellini esun subtipo histológico raro y agresivo. Presentamos un caso de CRCC con recidiva retroperitoneal por otro subtipo histológico de tumor renal y revisión de la literatura. MÉTODOS: Paciente masculino de 59 años, sin antecedentes médicos de importancia, quien consultó por presentar hematuria macroscópica. Se realizó Tomografía Computada de abdomen (TAC) la cual mostró una masa tumoral que ocupa la pelvis renal izquierda. Se practicó nefroureterectomía radical izquierda laparoscópica con desinserción endoscópica de uréter intramural ipsilateral. RESULTADOS: El diagnóstico anatomopatológico fue CRCC con márgenes quirúrgicos negativos. Se realizó una TAC control 10 meses después, la cual reveló una masa tumoral retroperitoneal izquierda, compatible con una recidiva local. Se realizó una laparotomía subcostal izquierda con resección completa de la masa. El diagnóstico histológico fue un carcinoma renal de células grandes con componentes de células granulares y células claras. CONCLUSIONES: El CRCC es una forma poco frecuente de todos los carcinomas renales y presenta un comportamiento agresivo que se asocia a mal pronóstico. La resección quirúrgica sigue siendo el tratamiento de elección. Presentamos el primer caso descrito de CRCC con recidiva retroperitoneal por otro subtipo histológico de tumor renal (AU)

OBJECTIVE: Collecting Duct Carcinoma or Bellini Carcinoma (CDC) is a rare aggressive histological subtype. We present a case of CDC with retroperitoneal recurrence by another histological subtype of renal tumor and review of the literature. METHODS: A 59-year-old man with no relevant clinical history presented gross hematuria. At the time of diagnosis, a computed tomography (CT) showed a tumor mass occupying the left renal pelvis. Left Laparoscopic radical nephroureterectomy was performed with endoscopic intramural ipsilateral ureter disinsertion. RESULTS: The pathological diagnosis was CDC with negative surgical margins. A CT scan control was performed 10 months later, showed a left retroperitoneal tumor compatible with a local recurrence. We performed a left subcostal laparotomy with complete resection of the mass. Histological diagnosis was large cell carcinoma with components of granular cells and clear cell. CONCLUSIONS: The CDC is a rare subtype of renal cell carcinoma (RCC) and has an aggressive behavior that is associated with poor prognosis. Surgical resection remains the treatment of choice. We present the first reported case of CDC with retroperitoneal recurrence by another histological subtype of renal tumor (AU)

Basaloid carcinoma of the prostate: an extremely rare tumor.

OBJECTIVE: The basaloid carcinoma of the prostate (BC) is a rare malignant neoplasm arising from the basal cells of prostatic ducts and acini. We report a case and review the literature. METHODS: A 76-year-old man presented with symptoms of lower obstructive uropathy, the IPSS score was 29 and prostate specific antigen (PSA)of 0,924 ng /ml. Transurethral resection of prostate (TURP) was performed in September 2008, histopathological diagnosis was BC. In February 2009 laparoscopic radical prostatectomy was performed. RESULTS: Histopathological examination revealed a BC with adenoid cystic growth pattern, perineural infiltration and focal involvement of the left seminal vesicle. Immunohistochemically, the cells were negative for PSA, stained and were strongly positive for specific monoclonal antibodies anti-cytokeratin 34ßE12, p63 and BCL-2. The patient has 23 months of follow-up, with complete continence and no evidence of tumor recurrence. CONCLUSIONS: The BC is an extremely rare subtype of malignant tumors of the prostate, where immunohistochemistry plays a fundamental role in diagnosis.

Carcinoma basaloide de la próstata: un tumor extremadamente raro / Basaloid carcinoma of the prostate: an extremely rare tumor

OBJETIVO: El carcinoma basaloide de la próstata (CB) es una neoplasia maligna poco frecuente derivada de las células basales de los conductos prostáticos y acinos. Presentamos un caso clínico y hacemos una revisión de la literatura. MÉTODOS: Paciente de sexo masculino, de 76 años de edad quien consulta por síntomas de uropatía obstructiva baja con score IPSS de 29 y antígeno prostático (APE) de 0.924 ng/ml. Se practica resección transuretral de próstata (RTUP) en Septiembre de 2008 cuya histopatología concluyó CB. En febrero de 2009 se realiza prostatectomía radical laparoscópica. RESULTADOS: El estudio anatomopatológico revela un CB, con patrón de crecimiento adenoideo quístico, infiltración perineural y extensión extraprostática con compromiso focal de vesícula seminal izquierda y márgenes quirúrgicos negativos. En el estudio inmunohistoquímico las células son negativas para Antígeno prostático específico (APE), siendo fuertemente positivas a anticuerpos monoclonales específicos anti-citoqueratina 34βE12, p63 y BCL-2. El paciente lleva 23 meses de seguimiento, con continencia completa y sin evidencias de recurrencia tumoral. CONCLUSIONES: El CB es un subtipo extremadamente raro de los tumores malignos de la próstata, donde la inmunohistoquímica juega un papel fundamental en su diagnóstico (AU)

OBJECTIVE: The basaloid carcinoma of the prostate (BC) is a rare malignant neoplasm arising from the basal cells of prostatic ducts and acini. We report a case and review the literature. METHODS: A 76-year-old man presented with symptoms of lower obstructive uropathy, the IPSS score was 29 and prostate specific antigen (PSA) of 0,924 ng / ml. Transurethral resection of prostate (TURP) was performed in September 2008, histopathological diagnosis was BC. In February 2009 laparoscopic radical prostatectomy was performed. RESULTS: Histopathological examination revealed a BC with adenoid cystic growth pattern, perineural infiltration and focal involvement of the left seminal vesicle. Immunohistochemically, the cells were negative for PSA, stained and were strongly positive for specific monoclonal antibodies anti-cytokeratin 34βE12, p63 and BCL-2. The patient has 23 months of follow-up, with complete continence and no evidence of tumor recurrence. CONCLUSIONS: The BC is an extremely rare subtype of malignant tumors of the prostate, where immunohistochemistry plays a fundamental role in diagnosis (AU)

Renal cancer from laparoscopic to robotic: How to proceed.

The benefits laparoscopic surgery brings to the table are well established in the literature. In our environment however, still most of the reconstructive/oncologic procedures are performed as open surgery. This can be explained by the multiple challenges this technique involves, as well as a demanding learning curve. Technology has provided means to improve precision and usefulness of laparoscopy, as well as broaden its use amongst the medical community by shortening its learning curve. Renal tumors have been managed by laparoscopic approach for the past 20 years. During this time, many studies appeared in the literature comparing this procedure with open surgery. In the vast majority, laparoscopic surgery has the upper hand in regards of perioperative events. A number of series are available regarding the feasibility of robotic radical nephrectomy, however there is no literature available that demonstrates better outcome of robotic radical nephrectomy compared to standard laparoscopy. Laparoscopic partial nephrectomy is technically difficult, which has prevented its massive spread through the urologist community, even amongst trained laparoscopists. Current reports are starting to favor robotic partial nephrectomy over standard laparoscopy regarding perioperative outcomes, with similar oncologic results. More studies have to be performed in order to elucidate the importance of NOTES and LESS in the treatment on localized renal cancer, but the use of the robot will lower their learning curve and probably make them attractive in the short term. Even though this technology has brought laparoscopy closer to a greater number of surgeons, physicians should become familiar and proficient in conventional laparoscopic procedures before embarking into robotics.

De la laparoscopia a la robótica en cáncer renal: ¿Cómo proceder? / Renal cancer from laparoscopic to robotic: how to proceed

Los beneficios de la cirugía laparoscópica están bien establecidos en la literatura. Sin embargo, en nuestro entorno, todavía la mayor parte de los procedimientos reconstructivos/oncológicos se realiza como cirugía abierta. Esto se puede explicar por los múltiples desafíos que esta técnica conlleva, así como una curva de aprendizaje exigente. La tecnología ha proporcionado los medios para mejorar la precisión y utilidad de la laparoscopia, así como para ampliar su uso entre la comunidad médica, acortando su curva de aprendizaje. Los tumores renales han sido manejados por laparoscopia durante los últimos 20 años. En este tiempo, muchos estudios han aparecido en la literatura comparando este procedimiento con la cirugía abierta. En la gran mayoría, la cirugía laparoscópica es superior en lo que respecta a los eventos peri-operatorios. Varias series están disponibles con respecto a la viabilidad de la nefrectomía radical robótica, sin embargo no hay literatura disponible que demuestre un mejor resultado de la nefrectomía radical robótica en comparación con la laparoscopia estándar. La nefrectomía parcial laparoscópica es una técnica difícil, lo que ha impedido su difusión masiva en la comunidad urológica, incluso entre laparoscopistas entrenados. Los reportes actuales comienzan a favorecer a la nefrectomía parcial robótica por sobre la laparoscopia estándar en lo que respecta a los resultados peri-operatorios, con similares resultados oncológicos. Se necesitan más estudios con el fin de identificar la importancia de NOTES/LESS en el tratamiento del cáncer renal localizado, sin embargo el uso del robot disminuirá su curva de aprendizaje y probablemente las hará atractivas en el corto plazo. A pesar de que esta tecnología ha acercado la laparoscopia a un mayor número de cirujanos, los médicos deben estar familiarizados con procedimientos laparoscópicos convencionales, antes de embarcarse en la cirugía robótica(AU)

The benefits laparoscopic surgery brings to the table are well established in the literature. In our environment however, still most of the reconstructive/oncologic procedures are performed as open surgery. This can be explained by the multiple challenges this technique involves, as well as a demanding learning curve. Technology has provided means to improve precision and usefulness of laparoscopy, as well as broaden its use amongst the medical community by shortening its learning curve. Renal tumors have been managed by laparoscopic approach for the past 20 years. During this time, many studies appeared in the literature comparing this procedure with open surgery. In the vast majority, laparoscopic surgery has the upper hand in regards of perioperative events. A number of series are available regarding the feasibility of robotic radical nephrectomy, however there is no literature available that demonstrates better outcome of robotic radical nephrectomy compared to standard laparoscopy. Laparoscopic partial nephrectomy is technically difficult, which has prevented its massive spread through the urologist community, even amongst trained laparoscopists. Current reports are starting to favor robotic partial nephrectomy over standard laparoscopy regarding perioperative outcomes, with similar oncologic results. More studies have to be performed in order to elucidate the importance of NOTES and LESS in the treatment on localized renal cancer, but the use of the robot will lower their learning curve and probably make them attractive in the short term. Even though this technology has brought laparoscopy closer to a greater number of surgeons, physicians should become familiar and proficient in conventional laparoscopic procedures before embarking into robotics(AU)