One-step Endovascular Aortic Aneurysm Repair With CO2 contrast and Robotic Partial Nephrectomy for Renal Cell Carcinoma: Case Report.

INTRODUCTION: Although rare, as the population ages, abdominal aortic aneurysm synchronous to abdominal malignancies, as renal cell carcinoma, is expected to become more prevalent. There are only two case reports of minimally invasive surgeries to treat these synchronous diseases, with endovascular aortic repair and laparoscopic nephrectomy, but they were performed in two stages, with iodinated contrast and without robotic assistance. CASE REPORT: We herein present a case of a 71-year-old patient with chronic kidney disease, a 6.4 cm infra-renal abdominal aortic aneurysm associated and a suspicious 6 cm solid-cystic expansile lesion in the right kidney, successfully treated at one stage with endovascular aortic repair using carbon dioxide as a contrast medium and with robotic right partial nephrectomy, aiming to preserve the renal function as much as possible. The patient's postoperative course was free of complications with hospital discharge on the fifth postoperative day, with a serum creatinine of 0.84 mg/dL. CONCLUSION: single-stage minimally invasive surgical treatment of AAA and RCC can be a safe and feasible approach. Combining a robot-assisted laparoscopic partial nephrectomy with an EVAR using carbon dioxide as a contrast medium was safe and successfully preserved renal function.

Evaluation of the incidence of bladder perforation after transurethral bladder tumor resection in a residency setting.

PURPOSE: To evaluate prospectively the actual bladder perforation incidence during transurethral resection of bladder tumor (TURB) performed by residents and to identify possible predisposing factors to such condition. PATIENTS AND METHODS: Thirty-four patients with bladder tumor were submitted to TURB in our academic institution in April 2006, and were prospectively studied. Procedures were all done by senior residents under an attending direct supervision. All patients had a cystograms performed after the procedure by the injection of 400 mL of saline-diluted contrast solution with low-pressure infusion through the Foley catheter. The cystograms were evaluated blindly by a single radiologist. All patients were examined by cystoscopy and/or CT every 3 months for the first 2 years postoperatively. RESULTS: The cystogram showed contrast leaking compatible with bladder perforation in 17 (50%) cases. None of the perforations were recognized intraoperatively by the surgeon. All perforations were extraperitoneal and managed conservatively. There was no significant correlation between the incidence of bladder perforation and the patient age (p = 0.508), the tumor stage (p = 0.998), the tumor grade (p = 0.833), the number of lesions (p = 0.394), and the tumor size (p = 0.651). The only factor that had impact on the development of bladder perforation was tumor localization at the bottom of the bladder (p = 0.035; OR, 6750; 95% CI, 1.14, 39.8). CONCLUSION: Asymptomatic perforations of the bladder wall occur very frequently after a TURB procedure performed by residents in training and, most of the time, are not noticed by the surgeon. Localization of the tumor at bladder dome was the only factor that negatively influenced perforation rates.

Prostate cryoablation: prospective analysis comparing high- and low-risk prostate cancer outcomes.

AIM: To evaluate percutaneous cryotherapy as a primary treatment option for prostate cancer, comparing different risk groups. PATIENTS AND METHODS: Forty-seven prostate cryoablation procedures were performed on 44 patients. Patients median age was 70.9, and average pretreatment PSA of 13.8 ng/dl. Patients were divided into low-risk (13 patients), high-risk (24 patients) and radiation failure patients (7 patients). The follow-up period ranged from 18 to 60 months (median 41 months). RESULTS: In the low-risk group, we found after 12 and 24 months of follow-up, 92 and 86% of patients free of PSA relapse (PSA <1 ng/ml), respectively. In the high-risk group, the PSA failure was 39 and 52.9%. For the radiation failure group, 86 and 71.4% of patients had PSA below 1 ng/dl. At 48 months of follow-up, 80% of the low-risk patients, 42.8% of the high-risk group and 71.4% of the radiation failure group were free of PSA relapse. The complication rates were low, with 13% of urinary incontinence and no cases of rectal injury. CONCLUSION: Prostate cryoablation is a viable and promising minimally invasive alternative for localized or locally advanced prostate cancer patients.

Leiomyosarcoma of the renal vein

Leiomyosarcoma of the renal vein is a rare tumor of complex diagnosis. We presented a case of renal vein leiomyosarcoma detected in a routine study. The primary treatment was complete surgical removal of the mass. In cases where surgical removal is not possible the prognosis is poor, with high rates of local recurrence and distant spread

Leiomyosarcoma of the renal vein.

Leiomyosarcoma of the renal vein is a rare tumor of complex diagnosis. We presented a case of renal vein leiomyosarcoma detected in a routine study. The primary treatment was complete surgical removal of the mass. In cases where surgical removal is not possible the prognosis is poor, with high rates of local recurrence and distant spread.

Rigid ureteroscopy for diagnosis and treatment of ureteral calculi during pregnancy.

OBJECTIVE: To evaluate ureteroscopy as a treatment option for women presenting ureteral calculi during pregnancy. MATERIALS AND METHODS: Eighteen pregnant patients presenting renal colic and indication of surgical treatment for ureteral calculi were analyzed. Patients were 20 to 34 years old (medium = 28), and the gestation period ranged from 12 to 34 weeks (medium = 18). Lumbar pain was present in 14 patients, and 4 had diffuse abdominal pain. Four patients were febrile in the occasion of the examination. Thirteen patients presented microscopic hematuria, 8 leucocituria, and 4 positive urine culture. The stone was detected by ultrasonography (US) in 12 patients. Magnetic resonance imaging (MRI) was performed in 2 cases, and did not demonstrate calculi. The stone location was: 1 in the superior ureter (pregnancy of 15 weeks), 4 in the medium ureter (pregnancy of 12, 15, 18 and 20 weeks), 12 in the inferior ureter, and 1 was not determined. The surgical indication was difficult pain control, fever, and presence of uterine contractions. RESULTS: Double-J insertion, as single treatment, was possible in 4 patients and it was kept in place for up to 2 weeks after delivery. Among the patients submitted to ureteroscopy, the calculi retrieval was always possible, except in 1 case where the calculus was not located by US, MRI or ureteroscopy. In 2 patients, the ultrasonic lithotriptor was used and in 11 the stone was removed intact with a basket. There were no complications due to the procedure and all pregnancies were carried to full term. CONCLUSION: Rigid ureteroscopy for extraction of ureteral calculi during pregnancy is efficient and safe.