How many procedures are needed to achieve learning curve of Millin simple laparoscopic prostatectomy?

BACKGROUND: Aim of our study was to evaluate learning curve of the Millin simple prostatectomy analyzing three expert laparoscopic surgeons. METHODS: Learning curve of 3 expert laparoscopic surgeons with excellent radical prostatectomy training was evaluated. Surgeon 1 had more than 20 years of experience, while other surgeons had 10 years of experience. The first 45 procedures of the surgeons were considered for analysis. The cumulative sum (CUSUM) technique, one of the methods developed to monitor the performance and quality of the industrial sector, was adopted to analyze learning curves. The variables included to evaluate learning curve of the surgeons were: operative time (OT), hospitalization (HO) and complication rate. RESULTS: Overall 135 patients were included in the analysis. Median age was 68 (64/74), median prostate volume was 83 (75/97), median Qmax 9 mL/s (6/11) and median IPSS=20 (18/22). Complications included: 9/135 (7%) transfusion, 4/135 (3%) Urinary retention, 3/135 (2%) fever, 1/35 (<1%) reintervention and 1/135 (<1%) conversion. Surgeon 1 presented a lower median operative time when compared to surgeon 2 and 3. No significant differences were recorded in terms of hospitalization, blood loss and transfusion rate as well as postoperative outcomes. According to the CUSUM analysis the number of procedures needed to achieve a plateau in surgical time is 10/15 procedures. CONCLUSIONS: According to our results 15 procedures are needed to reach a plateau in surgical time for trained laparoscopic surgeons.

[Scrotum-perineal granular cell tumor in pediatric age: A case report.] / Tumor de células granulares escroto-perineal en edad pediátrica: a propósito de un caso.

OBJECTIVE: Report a case of a scrotum-perinea lGranular Cell Tumor (GCT) in pediatric age. METHODS: To report a case. RESULTS: A 12 years old men with a multiple GCT history, located in both extremities, abdomen and scrotum perineal region. Surgical excision of all lesions and a genetic studyare performed to rule out Noonan syndrome. CONCLUSION: GCT or Abrikossoff tumor is a tumor witha very low incidence, especially in pediatric age. The most frequent form of presentation a solitary nodule and the most common behavior is in the form of a benign tumor. Immunohistochemistryis crucial for its diagnosis, the main characteristicis positivity for the S100 protein. Although scrotal location is very rare, it must be considered in the differential diagnosis of scrotal mass. Surgical excision is the treatment of choice.

OBJETIVO: Exposición de un caso de Tumor de Células Granulares (TCG) escroto-perineal en edad pediátrica.MÉTODOS: Presentación de un caso clínico. RESULTADOS: Se trata de un paciente de 12 años de edad con historia de TCG múltiples, localizados en ambas extremidades, abdomen y región escroto-perineal. Se realiza exéresis quirúrgica de todas las lesiones y se lleva a cabo estudio genético para descartar síndrome de Noonan.CONCLUSIÓN: El TCG o Tumor de Abrikossoff es un tumor con una incidencia muy baja, sobre todo en edad pediátrica. La forma de presentación más frecuente es la de nódulo solitario y el comportamiento más habitual es como tumor benigno. La inmunohistoquímica resulta crucial para su diagnóstico, siendo lo más característico su positividad para la proteína S-100. Aunque la localización escrotal es muy poco frecuente, hay que considerarla en el diagnóstico diferencial de masa escrotal. La exéresis quirúrgica es el tratamiento de elección.

Tumor de células granulares escroto-perineal en edad pediátrica: a propósito de un caso / Pediatric scrotoperineal granular cell tumor: report of a case

Objetivo: Exposición de un caso de Tumorde Células Granulares (TCG) escroto-perineal en edad pediátrica.Métodos: Presentación de un caso clínico.Resultados: Se trata de un paciente de 12 años de edadcon historia de TCG múltiples, localizados en ambas extremidades, abdomen y región escroto-perineal. Se realizaexéresis quirúrgica de todas las lesiones y se lleva a caboestudio genético para descartar síndrome de Noonan.Conclusiones: El TCG o Tumor de Abrikossoff es un tumor con una incidencia muy baja, sobre todo en edad pediátrica. La forma de presentación más frecuente es la denódulo solitario y el comportamiento más habitual es comotumor benigno. La inmunohistoquímica resulta crucial para su diagnóstico, siendo lo más característico su positividadpara la proteína S-100. Aunque la localización escrotal esmuy poco frecuente, hay que considerarla en el diagnóstico diferencial de masa escrotal. La exéresis quirúrgica esel tratamiento de elección.(AU)

Objetive: Report a case of a scrotum-perineal Granular Cell Tumor (GCT) in pediatric age.Methods: To report a case.Results: A 12 years old men with a multiple GCT history,located in both extremities, abdomen and scrotumperinealregion. Surgical excision of all lesions and a genetic studyare performed to rule out Noonan syndrome.Conclusion: GCT or Abrikossoff tumor is a tumor witha very low incidence, especially in pediatric age. The mostfrequent form of presentation a solitary nodule and the mostcommon behavior is in the form of a benign tumor. Immunohistochemistry is crucial for its diagnosis, the main characteristic is positivity for the S100 protein. Although scrotallocation is very rare, it must be considered in the differentialdiagnosis of scrotal mass. Surgical excision is the treatmentof choice.(AU)

Laparoscopic simple prostatectomy: a large single-center prospective cohort study.

BACKROUND: The aim of our study was to analyze outcomes and safety of laparoscopic simple prostatectomy (LSP) in a high-volume center. METHODS: A consecutive series of men with lower urinary tract symptoms and large prostates (>80 cc) prospectively enrolled between November 2015 and December 2017 in one center. All patients underwent laparoscopic simple prostatectomy. Outcomes were evaluated considering the trifecta favorable outcome which was defined as a combination of the following items: 1) no perioperative complications; 2) postoperative IPSS <8; 3) postoperative Qmax >15 mL/s. Complications were evaluated according to the modified Clavien classification system. Univariate and multivariate binary logistic regression was performed to identify predictors of a positive trifecta outcome. RESULTS: Overall 272 patients were enrolled. At three months after surgery median IPSS total score was 4 (IQR: 3-7), median IPSS QoL was 1 (IQR:1-2), median prostate-specific antigen was 0.53 (IQR: 0.33-1.00) ng/ml and median Qmax was 23 (IQR: 17-30) mL/s. All these parameters improved statistically when compared to baseline (P<0.001). The overall complication rate was 21% however most of the complications were low grade complications according to modified Clavien-Dindo classification (grade ≤2). Overall, 68% of the patients presented a positive trifecta outcome. On multivariate analysis only preoperative hemoglobin and hospital stay were confirmed predictors of positive trifecta outcome. CONCLUSIONS: LSP represents a safe and effective procedure in the treatment of large adenomas. Although RCTs are needed before reaching definitive conclusions, LSP is a promising technique for patients with LUTS and large prostates.

Laparoscopic simple prostatectomy vs bipolar plasma enucleation of the prostate in large benign prostatic hyperplasia: a two-center 3-year comparison.

PURPOSE: To compare surgery outcomes and safety of button bipolar enucleation of the prostate vs laparoscopic simple prostatectomy in patients with large prostates (> 80 g) in a two-center cohort study. METHODS: All patients with lower urinary tract symptoms due to benign prostatic enlargement (Prostate volume > 80 cc) undergoing button bipolar enucleation of the prostate (BTUEP) or laparoscopic simple prostatectomy (LSP) in two centers were enrolled. Data on clinical history, physical examination, urinary symptoms, uroflowmetry and prostate volume were collected at 0, 1, 3 6, 12, 24 and 36 months. Early and long-term complications were recorded. RESULTS: Overall, 296 patients were enrolled. Out of them, 167/296 (56%) performed a LSP and 129/296 (44%) performed a BTUEP. In terms of efficacy both procedures showed durable results at three years with a reintervention rate of 8% in the LSP group and of 5% in the BTUEP group. In terms of safety, BTUEP and LSP presented similar safety profiles with a 9% of transfusion rate and no major complications. CONCLUSION: LSP and BTUEP are safe and effective in treating large-volume adenomas with durable results at three years when performed in experienced centers.

[Lymphocele after renal transplantation: case report and bibliographic review]. / Linfocele gigante tras trasplante renal. A propósito de un caso y revisión de la literatura.

OBJECTIVES: To report the case and iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and the treatment of this surgical complication. METHODS: 69 year-old woman status post renal transplantation who presents right lower extremity edema and worsening renal function. A liquid collection was demonstrated by ultrasound and computerized tomography, compatible with lymphocele after biochemical study of the liquid obtained by percutaneous puncture. RESULTS: The patient underwent laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcome. CONCLUSION: Lymphocele is a common pathology after a renal transplantation which needs to be treated depending on its clinical manifestations. There mainly are two therapeutic alternatives depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from very selected cases, laparoscopic approach is currently considered, because of its security and effectiveness, the first choice when a surgical treatment is prescribed.

Linfocele gigante tras trasplante renal. A propósito de un caso y Revisión de la literatura / Giant lymphocele after renal transplantation. Case report and bibliographic review

OBJETIVOS: Comunicar el caso y la iconografía de un linfocele postrasplante renal y revisar la literatura sobre diagnóstico y tratamiento de esta complicación quirúrgicaMÉTODOS: Mujer de 69 años sometida a trasplante renal, que se presenta con edema en miembro inferior derecho y deterioro de función renal. Se demostró con ecografía y TAC una colección líquida, compatible con linfocele tras estudio bioquímico del líquido obtenido por punción percutánea. RESULTADOS: Se somete a la paciente a una marsupialización del linfocele por vía laparoscópica, con buenos resultados quirúrgicos.CONCLUSIONES: El linfocele es una entidad frecuente tras el trasplante renal, precisando tratamiento según las manifestaciones clínicas. Existen fundamentalmente dos alternativas terapéuticas, dependiendo del tamaño: escleroterapia y marsupialización quirúgica. Salvo casos muy seleccionados, el abordaje laparoscópico se considera actualmente, por su seguridad y eficacia, de primera elección cuando se indica tratamiento quirúrgico(AU)

OBJECTIVES: To report the case and iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and the treatment of this surgical complication.METHODS: 69 year-old woman status post renal transplantation who presents right lower extremity edema and worsening renal function. A liquid collection was demonstrated by ultrasound and computerized tomography, compatible with lymphocele after biochemical study of the liquid obtained by percutaneous puncture.RESULTS: The patient underwent laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcome.CONCLUSION: Lymphocele is a common pathology after a renal transplantation which needs to be treated depending on its clinical manifestations. There mainly are two therapeutic alternatives depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from very selected cases, laparoscopic approach is currently considered, because of its security and effectiveness, the first choice when a surgical treatment is prescribed(AU)

[Giant lymphocele after renal transplantation. Case report and bibliographic review]. / Linfocele gigante tras trasplante renal. A propósito de un caso y revisión de la literatura.

OBJECTIVE: To report the case and the iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and treatment of this surgical complication. METHODS: 69 year-old woman who undergone renal transplantation and presented right lower extremity edema and worsening renal function. It was demonstrated by ultrasound and computerized tomography a liquid collection, compatible with lymphocele after biochemical study of the liquid which was obtained by percutaneous puncture. RESULTS: The patient underwent a laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcomes. CONCLUSION: Lymphocele is a common pathology after a renal transplantation, which needs to be treated depending on its clinical manifestations. There are mainly two therapeutic alternatives, depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from highly selected cases, laparoscopic approach is currently considered first choice when a surgical treatment is prescribed due to its security and effectiveness.

Fístula próstato-rectal post resección transuretral de próstata / No disponible

No disponible

Linfocele gigante tras trasplante renal. A propósito de un caso y revisión de la literatura / Giant lymphocele after renal transplantation. Case report and bibliographic review

OBJETIVO: Comunicar el caso y la iconografía de un linfocele postrasplante renal y revisar la literatura sobre diagnóstico y tratamiento de esta complicación quirúrgicaMÉTODOS: Mujer de 69 años sometida a trasplante renal, que se presenta con edema en miembro inferior derecho y deterioro de función renal. Se demostró con ecografía y TAC una colección líquida, compatible con linfocele tras estudio bioquímico del líquido obtenido por punción percutánea.RESULTADOS: Se somete a la paciente a una marsupialización del linfocele por vía laparoscópica, con buenos resultados quirúrgicos.CONCLUSIONES: El linfocele es una entidad frecuente tras el trasplante renal, precisando tratamiento según las manifestaciones clínicas. Existen fundamentalmente dos alternativas terapéuticas, dependiendo del tamaño: escleroterapia y marsupialización quirúgica. Salvo casos muy seleccionados, el abordaje laparoscópico se considera actualmente, por su seguridad y eficacia, de primera elección cuando se indica tratamiento quirúrgico(AU)

OBJECTIVE: To report the case and the iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and treatment of this surgical complication.METHODS: 69 year-old woman who undergone renal trans-plantation and presented right lower extremity edema and worsening renal function. It was demonstrated by ultrasound and computerized tomography a liquid collection, compatible with lymphocele after biochemical study of the liquid which was obtained by percutaneous puncture.RESULTS: The patient underwent a laparoscopic intraperito-neal drainage of the lymphocele, with good surgical outco-mes.CONCLUSION: Lymphocele is a common pathology after a renal transplantation, which needs to be treated depending on its clinical manifestations. There are mainly two therapeu-tic alternatives, depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from highly selected cases, laparoscopic approach is currently considered first choice when a surgical treatment is prescribed due to its security and effectiveness(AU)

[Left renal atrophy and ureteral abouchement in seminal vesicle. Laparoscopic surgical treatment]. / Atrofia renal izquierda y abocamiento ureteral a vesícula seminal. Tratamiento quirúrgico laparoscópico.

Renal atrophy with an ectopic drainage of the ureter is an uncommon malformation. Zinder described in 1914 a cystic dilation of the seminal vesicle in association with an ipsilateral renal agenesis. Usually, these patients present lower urinary tract symptoms with perineal discomfort and fever. The most accurate diagnosis is given by the MRI, while CT and ultrasonography are less precise. We present a case of a patient who goes into hospital because of left lumbar pain and urinary sepsis data, whose CT detects an ectopic drainage of the left uereter in the seminal vesicle. He underwent a successful laparoscopic surgical treatment.

Atrofia renal izquierda y abocamiento ureteral a vesícula seminal. Tratamiento quirúrgico laparoscópico / Left renal atrophy and ureteral abouchement in seminal vesicle. Laparoscopic surgical treatment

La atrofia renal con abocamiento ectópico del uréter es una malformación poco frecuente. Zinder describe en 1914 la asociación de una dilatación quística de la vesícula seminal con agenesia renal ipsilateral. Con mayor frecuencia estos pacientes presentan síntomas del tracto urinario inferior con molestias perineales y fiebre. El diagnostico más certero lo aporta la RMN siendo la ecografía y la TAC menos precisas. Presentamos un caso de un paciente que ingresa por dolor lumbar izquierdo y datos de sepsis de origen urinario que en la TAC se detecta una desembocadura ectópica del uréter izquierdo en vesícula seminal. El tratamiento se realizó con éxito mediante cirugía laparoscópica (AU)

Renal atrophy with an ectopic drainage of the ureter is an uncommon malformation. Zinder described in 1914 a cystic dilation of the seminal vesicle in association with an ipsilateral renal agenesis. Usually, these patients present lower urinary tract symptoms with perineal discomfort and fever. The most accurate diagnosis is given by the MRI, while CT and ultrasonography are less precise. We present a case of a patient who goes into hospital because of left lumbar pain and urinary sepsis data, whose CT detects an ectopic drainage of the left uereter in the seminal vesicle. He underwent a successful laparoscopic surgical treatment (AU)

[Metastasis of a renal cell carcinoma in the corpora cavernosum of the penis. Case report and bibliographic review]. / Metastasis de carcinoma renal en cuerpo cavernoso, a propósito de un caso y revisión de la literatura.

OBJECTIVE: We describe a rare case, the metastasis of a renal clear cell carcinoma in the corpora cavernosum of the penis. METHODS: 53-year-old patient presenting with a painful, hard tumor in the penis three months after right radical nephrectomy with cavotomy and thrombus excision. RESULTS/CONCLUSIONS: Imaging tests and biopsy led to the diagnosis of metastasis of a renal carcinoma in the corpus cavernosum, which was confirmed on the pathologic study of the specimen after penectomy. The appearance of renal carcinoma metastases in the penis is generally associated with advanced tumor stage, therefore associated with bad prognosis as in the reported case.

Metástasis de carcinoma renal en cuerpo cavernoso. A propósito de un caso y revisión de la literatura / Metastasis of a renal cell carcinoma in the corpora cavernosum of the penis. Case report and bibliographic review

OBJETIVO: Describimos un caso infrecuente, la metástasis en cuerpo cavernoso de un carcinoma renal de células claras. MÉTODOS: Se trata de un paciente de 53 años, que a los tres meses tras realizarle nefrectomía radical derecha con cavotomía y exéresis de trombo, presenta una tumoración localizada en pene, indurada y dolorosa. RESULTADOS/CONCLUSIONES: Con pruebas de imagen y biopsia, se llegó al diagnóstico de metástasis de carcinoma renal en cuerpo cavernoso que se confirmó con la anatomía patológica de la pieza tras penectomía. La aparición de metástasis de carcinoma renal en pene está generalmente asociada a un estadio avanzado del tumor y por lo tanto, con mal pronóstico, como el caso relatado

OBJECTIVE: We describe a rare case, the metastasis of a renal clear cell carcinoma in the corpora cavernosum of the penis. METHODS: 53-year-old patient presenting with a painful, hard tumor in the penis three months after right radical nephrectomy with cavotomy and thrombus excision. RESULTS/ CONCLUSIONS: Imaging tests and biopsy led to the diagnosis of metastasis of a renal carcinoma in the corpus cavernosum, which was confirmed on the pathologic study of the specimen after penectomy. The appearance of renal carcinoma metastases in the penis is generally associated with advanced tumor stage, therefore associated with bad prognosis as in the reported case

[Prevalence of incidental prostatic adenocarcinoma after suprapubic adenomectomy with or without previous prostatic biopsy]. / Prevalencia de adenocarcinoma prostático incidental tras adenomectomía suprapúbica con o sin biopsia prostática previa.

OBJECTIVES: To establish the prevalence of incidental prostate cancer after transrectal ultrasound guided prostatic biopsy and subsequent suprapubic prostatic adenomectomy and to compare it with a similar group of patients who did not underwent biopsy before surgery. To evaluate treatment, outcomes, and disease progression in patients with incidental prostate cancer. METHODS: Retrospective study of 549 suprapubic adenomectomy performed between 1996-2001 (6 yr.), comparing the group of patients with biopsies before surgery vs. the group of patients without biopsies. RESULTS: 291 (53%) patients did not undergo biopsy before adenomectomy. 258 (47%) underwent biopsies. 25 incidental prostate cancers were detected, 19 (76%) in the group of no biopsy and 6 (24%) in the biopsy group. 88% pT1a and 12%pT1b. Mean Gleason score 4.5 (3-7). 84% of the patients did not receive treatment (21) ("wait and see"); 8% (2) androgen blockade; 8% (2) finasteride (2). Three patients (12%) in the group of no biopsy had disease progression. Mean follow-up was 48.1 months (22-96). No case of cancer-specific mortality was detected. CONCLUSIONS: Global prevalence of incidental prostate cancer in our series of patients undergoing suprapubic prostatic adenomectomy was 4.55%. Prevalence was higher in the group of patients without previous biopsy (3.46%) than in the biopsy group (1.09%). Tumor progression was 12% and cancer specific survival 100% after a mean follow-up of 48.1 months (22-92). Previous prostatic biopsy in patients with suspicions digital rectal examination or elevated PSA diminishes the prevalence of incidental prostate cancer. Watchful waiting may be a valid option in some cases.

Prevalencia de adenocarcinoma prostático incidental tras adenomectomía suprapúbica con o sin biopsia prostátic previa / Prevalence of incidental prostatic adenocarcinoma after suprapubic adenomectomy with or without previous prostatic biopsy

OBJETIVO: Determinar la prevalencia de cáncer de próstata incidental tras biopsia prostática transrectal ecodirigida y posterior adenomectomía prostáticasuprapúbica, y compararlo con la prevalencia de un grupo similar de pacientes que no fueron biopsiados previamente a la cirugía. Evaluar el tratamiento, la evolucióny las progresiones de la enfermedad tumoral en los pacientes con cáncer de próstata incidental.MÉTODOS: Estudio retrospectivo de 549 adenomectomíassuprapúbicas realizadas entre 1996-2001 (6 años), comparando el grupo de pacientes biopsiados previamente a la adenomectomía con el grupo no biopsiado.RESULTADOS: 291 (53%) pacientes no fueron biopsiadospreviamente a la adenomectomía. 258 (47%) fueronbiopsiados. 25 cánceres de próstata incidentales detectados, 19 (76%) en el grupo de los no biopsiados y 6 (24%) en el de los biopsiados. 88% pT1a y 12% pT1b. Gleason medio 4,5 (3-7). No fueron tratados el 84% de los pacientes (21) (“esperar y ver”); bloqueo hormonal 8% (2); finasteride 8% (2). Progresaron 3 pacientes (12%), todos del grupo de los no tratados. Media de seguimiento de 48,1 meses (22-96). No se detectó ningún caso de mortalidad cáncer de próstata específico.CONCLUSIONES: La prevalencia global de cáncer de próstata incidental en nuestra serie en pacientes a los que se les realizo adenomectomía prostática suprapúbicafue del 4,55%. La prevalencia fue mayor en el grupo de pacientes no biopsiados previamente a la adenomectomía (3,46%) que en el grupo de los biopsiados(1,09%). La progresión tumoral fue del 12% y la supervivencia cáncer de próstata específica del 100% tras una media de seguimiento de 48,1 meses (22-92). La biopsia prostática previa a la adenomectomía en pacientescon tacto rectal sospechoso o PSA elevado disminuyela prevalencia de cáncer prostático incidental. El seguimiento expectante activo puede ser una actitud valida en determinados casos

OBJECTIVES: To establish the prevalence of incidental prostate cancer after transrectal ultrasound guided prostatic biopsy and subsequent suprapubic prostatic adenomectomy and to compare it with a similar group of patients who did not underwent biopsy before surgery. To evaluate treatment, outcomes, and disease progression in patients with incidental prostate cancer. METHODS: Retrospective study of 549 suprapubicadenomectomy performed between 1996-2001 (6 yr.), comparing the group of patients with biopsies before surgery vs. the group of patients without biopsies.RESULTS: 291 (53%) patients did not undergo biopsy before adenomectomy. 258 (47%) underwent biopsies. 25 incidental prostate cancers were detected, 19 (76%) in the group of no biopsy and 6 (24%) in the biopsy group. 88% pT1a and 12%pT1b. Mean Gleason score 4.5 (3-7). 84% of the patients did not receive treatment (21) (“wait and see”); 8% (2) androgen blockade; 8% (2) finasteride (2). Three patients (12%) in the group of no biopsy had disease progression. Mean follow-up was 48.1 months (22-96). No case of cancer-specific mortality was detected.CONCLUSIONS: Global prevalence of incidental prostate cancer in our series of patients undergoing suprapubic prostatic adenomectomy was 4.55%. Prevalence was higher in the group of patients without previous biopsy (3.46%) than in the biopsy group (1.09%). Tumorprogression was 12% and cancer specific survival 100% after a mean follow-up of 48.1 months (22-92).Previous prostatic biopsy in patients with suspicionsdigital rectal examination or elevated PSA diminishes the prevalence of incidental prostate cancer. Watchful waiting may be a valid option in some cases