Cirugía retroperitoneal asistida por robot por puerto único: un abordaje factible / Single-port robot-assisted retroperitoneal surgery: A feasible approach

Introducción: La cirugía mediante una única incisión ha sido un concepto perseguido en el campo de la mínima invasión para el tratamiento de diferentes afecciones. Este concepto, sumado a un abordaje retroperitoneal, puede suponer una disminución de la agresión al paciente a diferentes niveles. Describimos los primeros casos de cirugía retroperitoneal asistida por robot mediante puerto único de nuestro entorno. Material y métodos Presentamos 2 casos de pacientes con masas suprarrenales derechas con un tamaño superior a 4cm. El primer caso se trataba de una mujer de 55 años con diagnóstico incidental de angiomiolipoma, y el segundo, de un varón de 62 años con adenoma suprarrenal no funcionante. Ambos casos se operaron a través de una única incisión subcostal de 4cm mediante el sistema Da Vinci Xi®, anulando el brazo 4 sin realizar reasignaciones de lateralidad en consola. Resultados Los tiempos de consola para las cirugías fueron de 75 y 150min, con tiempos de acceso y acoplamiento robótico inferiores a 30min. El sangrado fue inferior a 100cc en ambas cirugías, sin necesidad de realizar incisiones accesorias o dejar tubo de drenaje. Las piezas quirúrgicas fueron extraídas por la misma incisión sin necesidad de ampliación. En ningún caso fue necesaria analgesia intravenosa postoperatoria (EVA 0) y la estancia fue inferior a 24h en ambos pacientes, sin reportarse ninguna complicación. Conclusiones La cirugía retroperitoneal asistida por robot mediante puerto único es un abordaje factible a través del sistema Da Vinci Xi® (AU)

Introduction: The concept of surgery through a single incision has been pursued in the field of minimal invasion for the treatment of different pathologies. This, added to a retroperitoneal approach, implies less aggression for the patient at different levels. We describe the first cases of single-port robot-assisted retroperitoneal surgery (SP-RARS) in our country using the Da Vinci Xi® system. Material and methods We present 2 cases of patients with right adrenal masses larger than 4cm. The first case was a 55-year-old woman with an incidental diagnosis of angiomyolipoma, and the second case was a 62-year-old man with a non-functioning adrenal adenoma. Both cases were operated through a single 4cm subcostal incision using the Da Vinci Xi® system, annulling arm 4 without reallocating laterality on the surgeon's console. Results Console times for surgeries were 75 and 150min, with access and docking times below 30min. Bleeding was less than 100cc in both surgeries with no need of accesory trocars, make new incisions or leave a drainage tube. The surgical specimens were removed through the same initial incision without the need for enlargement. Postoperative intravenous analgesia was not necessary in any case (VAS 0) and hospital stay was less than 24h in both patients, without reporting any complications. Conclusions SP-RARS is a feasible approach using the Da Vinci Xi® system (AU)

Single-port robot-assisted retroperitoneal surgery: A feasible approach.

INTRODUCTION: The concept of surgery through a single incision has been pursued in the field of minimal invasion for the treatment of different pathologies. This, added to a retroperitoneal approach, implies less aggression for the patient at different levels. We describe the first cases of single-port robot-assisted retroperitoneal surgery (SP-RARS) in our country using the da Vinci Xi® system. MATERIAL AND METHODS: We present two cases of patients with right adrenal masses larger than 4 cm. The first case was a 55-year-old woman with an incidental diagnosis of angiomyolipoma, and the second case was a 62-year-old man with a non-functioning adrenal adenoma. Both cases were operated through a single 4-cm subcostal incision using the da Vinci Xi® system, annulling arm 4 without reallocating laterality on the surgeon's console. RESULTS: Both surgeries were performed with console times of 75 and 150 min, respectively, with access and docking times below 30 min. Bleeding was less than 100 cc in both surgeries without the need to make accessory incisions or leave a drainage tube. The surgical specimens were removed through the same initial incision without the need for enlargement. Postoperative intravenous analgesia was not necessary in any case (VAS 0) and hospital stay was less than 24 h in both patients without reporting any complications. CONCLUSIONS: SP-RARS is a feasible approach using the da Vinci Xi® system.

Suprarrenalectomía retroperitoneoscópica por puerto único: experiencia inicial y estandarización de la técnica / Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique

Introducción y objetivo: El abordaje mediante cirugía mínimamente invasiva de la patología de la glándula suprarrenal es el más extendido hoy en día, en donde la retroperitoneoscopia ocupa un lugar a tener muy en cuenta; sin embargo, la evolución de estas técnicas hacia abordajes todavía menos invasivos a través de puerto único es anecdótica.La finalidad de este trabajo es describir nuestra experiencia inicial en cirugía retroperitoneoscópica por puerto único (SPORS) de la glándula suprarrenal centrándonos en los datos perioperatorios y dolor postoperatorio.Material y métodosRecogimos y analizamos los datos demográficos y operatorios de una serie de pacientes tratados mediante suprarrenalectomía mediante SPORS. Todos los procedimientos se realizaron mediante una única incisión subcostal de 3-4cm a través de un puerto multicanal. Se recogen diferentes datos quirúrgicos como tiempo operatorio, sangrado, estancia o presencia de complicaciones. Empleamos la escala visual analógica (EVA) para la valoración del dolor postoperatorio.ResultadosEntre diciembre del 2018 y agosto del 2020, 6 pacientes con diferentes patologías suprarrenales fueron intervenidos en nuestro Departamento de forma consecutiva por el mismo cirujano mediante SPORS. Todas las cirugías se realizaron sin requerir colocación de trocares accesorios o reconversión a cirugía abierta. El tiempo medio de las intervenciones fue de 91,6±16,3 min, con un sangrado <150ml, una estancia media de 35,8±13,3 h y un dolor postoperatorio analizado EVA ≤ 3 (mediana de 0,5). El tamaño medio de las piezas fue de 57,8±18mm. No se reportó ninguna complicación según la escala Clavien-Dindo.

Introduction and objective: The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain.Material and methodsWe collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment.ResultsFrom December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6±16.3minutes, with <150mL bleeding, mean length of stay of 35.8±13.3hours and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8±18mm. No complications were reported according to the Clavien-Dindo scale. (AU)

Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique.

INTRODUCTION AND OBJECTIVE: The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain. MATERIAL AND METHODS: We collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4 cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment. RESULTS: From December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6 ±â€¯16.3 min, with <150 mL bleeding, mean length of stay of 35.8 ±â€¯13.3 h and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8 ±â€¯18 mm. No complications were reported according to the Clavien-Dindo scale. CONCLUSIONS: Even in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.

Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique. / Suprarrenalectomía retroperitoneoscópica por puerto único: experiencia inicial y estandarización de la técnica.

INTRODUCTION AND OBJECTIVE: The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain. MATERIAL AND METHODS: We collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment. RESULTS: From December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6±16.3minutes, with <150mL bleeding, mean length of stay of 35.8±13.3hours and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8±18mm. No complications were reported according to the Clavien-Dindo scale. CONCLUSIONS: Even in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.

[Importance of PSA velocity and PSA density in the prediction of prostate cancer in TURP or open prostatectomy specimen of patients with previous negative prostate biopsy]. / Importancia de la velocidad y la densidad de PSA en la predicción de cáncer de próstata en la pieza de RTU o adenomectomía de pacientes con biopsia prostática previa negativa.

PURPOSE: To determine variables related to the finding of prostate cancer (PC) in patients who underwent surgery following at least one negative prostate biopsy (PB). MATERIALS AND METHODS: A retrospective study of 170 patients who underwent transurethral resection of the prostate (TURP) or open prostatectomy between 1999 and 2007, following one or more negative PB sets. A multivariate logistic regression analysis was carried out in order to determine variables related to the finding of PC. The predictive capacity of PSA, PSA-density and PSA-velocity was assessed by means of ROC curves and the area under the curve (AUC). Sensitivity, specificity and predictive values were determined for several PSA-density and PSA-velocity cut-off points. RESULTS: Open prostatectomy was carried out on 104 patients (61.18%) and TURP on 66 (38.82%). PC was detected in the surgical specimen of 16 patients (9.41%). Variables associated with the finding of PC in the surgical specimen were PSA-density (OR: 1.47; 95% CI: 1.22-6.64; p: 0.007) and PSA-velocity (OR: 2.87; 95% CI: 1.60-5.12: p < 0.001). The AUCs were 0.746, 0.793 and 0.832, for PSA, PSA-density and PSA-velocity, respectively. The most sensitive PSA-density and PSA-velocity cut-off points in detecting PC were 0.15 and 1 ng/ml/year, respectively. Patients without PC showed a median PSA reduction of 9.35 ng/ml (-2.40 - 35.40), following surgery. CONCLUSIONS: PSA-density and PSA-velocity in particular, allow for the prediction of the presence of PC in the TURP or open prostatectomy specimen of patients with previously negative PBs. Diagnostic TURP could prove useful in patients with clinical suspicion of PC, susceptible to curative treatment, with PSA-velocity > 1l ng/ml/year and one or more negative saturation biopsies.

Importancia de la velocidad y la densidad de PSA en la predicción de cáncer de próstata en la pieza de RTU o adenomectomía de pacientes con biopsia prostática previa negativa / Importance of PSA velocity and PSA density in the prediction of prostate cancer in TURP or open prostatectomy specimen of patients with previous negative prostate biopsy

Objetivo: Determinar variables relacionadas con el hallazgo de cáncer de próstata (CaP) en pacientes sometidos a cirugía prostática tras al menos una biopsia prostática (BP) negativa. Material y métodos: Estudio retrospectivo de 170 pacientes sometidos a resección transuretral de próstata (RTUP) o adenomectomía entre 1999 y 2007, después de una o más BPs negativas. Se realizó un análisis multivariado de regresión logística para identificar variables relacionadas con la presencia de CaP. La capacidad predictiva de PSA, PSA densidad y PSA velocidad se determinó mediante curvas ROC y su área bajo la curva (ABC). Se analizó la sensibilidad, especificidad y valores predictivos para diversos puntos de corte de PSA densidad y PSA velocidad. Resultados: Se realizó adenomectomía en 104 pacientes (61,18%) y RTUP en 66 (38,82%). Se detectó CaP en la pieza quirúrgica de 16 pacientes (9,41%). Las variables asociadas al hallazgo de CaP en la pieza quirúrgica fueron PSA densidad (OR:1,47;95% IC:1,22-6,64; p:0,007) y PSA velocidad (OR:2,87;95% IC:1,60-5,12; p<0,001). Las ABC ROC fueron 0,746, 0,793 y 0,832, para PSA, PSA densidad y PSA velocidad, respectivamente. Los puntos de corte de PSA densidad y PSA velocidad con mayor sensibilidad y especificidad en la detección de CaP fueron 0,15 y 1 ng/ml/año, respectivamente. Los pacientes sin CaP mostraron una reducción mediana de PSA de 9,35 ng/ml (-2,40 – 35,40), después de la cirugía. Conclusiones: El PSA densidad y el PSA velocidad en particular, permiten predecir la presencia de CaP en la pieza de RTUP o adenomectomía, de pacientes con BPs previas negativas. La RTUP diagnóstica podría ser recomendada en pacientes con sospecha clínica de CaP, susceptibles de tratamiento curativo, con PSA velocidad >1ng/ml/año y una o más biopsias de saturación previas negativas (AU)

Purpose: To determine variables related to the finding of prostate cancer (PC) in patients who underwent surgery following atleast one negative prostate biopsy (PB).Materials and methods: A retrospective study of 170 patients who underwent transurethral resection of the prostate (TURP)or open prostatectomy between 1999 and 2007, following one or more negative PB sets. A multivariate logistic regression analysis was carried out in order to determine variables related to the finding of PC. The predictive capacity of PSA, PSA-density and PSA-velocity was assessed by means of ROC curves and the area under the curve (AUC). Sensitivity, specificity and predictive values were determined for several PSA-density and PSA-velocity cut-off points. Results: Open prostatectomy was carried out on 104 patients (61.18%) and TURP on 66 (38.82%). PC was detected in the surgical specimen of 16 patients (9.41%). Variables associated with the finding of PC in the surgical specimen were PSA-density(OR:1.47;95% CI:1.22-6.64; p:0.007) and PSA-velocity (OR:2.87;95% CI:1.60-5.12; p<0.001). The AUCs were 0.746, 0.793 and 0.832, for PSA, PSA-density and PSA-velocity, respectively. The most sensitive PSA-density and PSA-velocity cut-off points indetecting PC were 0.15 and 1ng/ml/year, respectively. Patients without PC showed a median PSA reduction of 9.35 ng/ml (-2.40– 35.40), following surgery. Conclusions: PSA-density and PSA-velocity in particular, allow for the prediction of the presence of PC in the TURP or open prostatectomy specimen of patients with previously negative PBs. Diagnostic TURP could prove useful in patients with clinical suspicion of PC, susceptible to curative treatment, with PSA-velocity >1ng/ml/year and one or more negative saturation biopsies (AU)

[Inferior caval agenesis and renal trauma]. / Agenesia de vena cava inferior y traumatismo abdominal cerrado.

We are publishing a case of sixteen years old male, with inferior caval agenesis suffering a fall, and having a serious trauma over the left renal unit. We review the recommendations of intervention in front of high grade renal trauma and we too study the existing knowledge on the literature in order to get a posible higher incidence of this kind of trauma in patients with these anomaly.

Agenesia de vena cava inferior y traumatismo abdominal cerrado / Inferior caval agenesis and renal trauma

Presentamos el caso de un varón de 16 años, con agenesia de vena cava inferior que sufre una caída, resultando de la misma un severo traumatismo de la unidad renal izquierda. Revisamos las recomendaciones de actuación frente a traumatismos de alto grado y, valoramos, si existen en pacientes con esta anomalía, factores que predispongan a aumentar la severidad de las lesiones frente a traumatismos (AU)

We are publishing a case of sixteen years old male, with inferior caval agenesis suffering a fall, and having a serious trauma over the left renal unit. We review the recommendations of intervention in front of high grade renal trauma and we too study the existing knowledge on the literature in order to get a posible higher incidence of this kind of trauma in patients with these anomaly (AU)

Tratamiento quirúrgico de la incontinencia urinaria de esfuerzo mediante cabestrillo suburetral SPARC. Análisis de nuestra experiencia / Stress urinary incontinence surgical treatment with suburethral suprapubic sparc sling

Introducción: La incontinencia urinaria de esfuerzo (IUE) presenta una gran morbilidad y una elevada incidencia. Existen múltiples técnicas quirúrgicas descritas para el tratamiento de la misma, con diversos resultados. Los cabestrillos suburetrales se han establecido en los últimos años como un método simple y poco invasivo para el tratamiento de la incontinencia urinaria de esfuerzo. Material y Método: Analizamos retrospectivamente nuestra serie de 86 pacientes diagnosticadas de IUE, intervenidas, entre Octubre de 2001 y Diciembre de 2005, mediante un cabestrillo suburetral suprapúbico (SPARC(C)). Resultados: La media de edad es de 58,7 años (39-80). La estancia media hospitalaria es de 2,43 días (1-8) y la duración media de sonda de 1,52 días (1-10). En el 14,5% de los casos, se realizó cirugía asociada, siendo la más frecuente, la colpoperineoplastia anterior (10,7 %). Las complicaciones son poco frecuentes; perforación vesical (5,8%), RAO antes del alta (7%), ITU (15,3%), RAO crónica (3,5%). En el 3,5% de las mujeres, se realizó lisis del cabestrillo, por retención crónica. El seguimiento medio es de 10,14 meses, encontrándose un 71,4% de continencia total. Un 26,2% de las pacientes presentaron síntomas de hiperactividad de novo, con problemas de incontinencia en el 54,5% de estas. (p<0,002; OR 5.0 (IC 95% 1,75-14,28). Conclusiones: El SPARC© es un método sencillo, con un tiempo hospitalario corto y una rápida reincorporación a la vida social. Los resultados pueden ser valorados rápidamente y con una tasa elevada de éxito. La aparición de urgencia de novo es elevada y empeora los resultados funcionales. Es necesario un mayor seguimiento para valorar resultados funcionales a largo plazo

Introduction: Stress urinary incontinence (SUI) has a high incidence and important morbidity. Multiple surgical techniques have been described to treat it, with despair results. Suburethral slings have become, in recent years, a simpler and less invasive method to treat SUI surgically. Material and method: The purpose of this paper is to review, retrospectively, 86 patients treated at our institution, from 10/01 to 12/05 of SUI, with a suprapubic suburethral sling (SPARC). Results: Medium (range) age is 58.7 (39-80), hospital stay was 2.43 d (1-8) and catheter was removed 1.52 d (1-10). 14.5% of patients underwent other vaginal surgeries at same time, most frequently anterior colpoperineoplasty (10.7%). Complications are not very frequent; bladder perforation (5.8%), acute urinary retention (7%), chronic urinary retention (3.5%) and UTI (15.3%). Sling release was performed in 3.5% of women with chronic urinary retention. Total continence was found in 71.4% of patients with 10.1 months medium follow up (1-32). De novo urge symptoms were found in 26.2% of women, with urge incontinence in 54.5% of them. (p < 0,002; OR 5.0 (IC 95% 1.75-14.28). Conclusions: Suprapubic suburethral SPARC sling is a simple method, with few complications and fast social recovery. Outcome can be measured soon, with a high continence rate. De novo urge symptoms are high and they worsen functional results. It is necessary longer follow-up to evaluate long term outcomes

[Radical prostatectomy with minilaparotomy "minilap" for patients with prostate cancer]. / Técnica de minilaparotomía "minilap" en pacientes sometidos a prostatectomía radical por cáncer de próstata.

INTRODUCTION: prostate cancer is the most frequent tumor in males. The use of PSA contributes to diagnose tumors with low stage. Radical Prostatectomy (R.P.) is the gold standard to treat this tumor; however such is not exempt of risks. Different technical modifications like minimal incisions minilaparotomy "minilap" had contributed to improve results. We review our experience with Minilap on patients underwent a RP. MATERIAL AND METHODS: Between April 1997 and September 2005 carry out 110 RP with Minilap technique. All cases were performed with minimal incision 7-8 cm of length. We use and specific retractor developed in our hospital. Median age at time of surgery was 65 (47-79). Clinical stage in 39 (35.4%) were T1c, 64 (58.3%) T2 and 7 (6.3%) T3. Sixty eight percent were Gleason score < or =6, 34(30.9%) 7 and 1 (0.9%) Gleason 8. RESULTS: In 86 cases (38.5%) pathological stage were pT2, 21 (19%) pT3, 1 (0.9%) pT4 and 2 (1.8%) pT0. Nine patients (8%) had postoperative complications. No re-interventions were necessary and 101 (90%) were discharge without per operatives complications. Mean length of stay was 4 days and 97 (88.8%) of patients were discharge with only five days length of stay. Urinary continence rate with a year like minimal follow up is 92.3% and 40% preserve sexual activity. CONCLUSIONS: Minimal invasive techniques like minilap can be done in regular form with good results and without long learning curve.

Técnica de minilaparotomía “Minilap” en pacientes sometidos a prostatectomía radical por cáncer de próstata / Radical prostatectomy with minilaparotomy “Minilap” for patients with prostate cancer

Introducción: El cáncer de próstata es en la actualidad el tumor mas frecuente en el varón. Muchos de estos tumores con la utilización del PSA y diagnóstico precoz se detectan en fases localizadas. La prostatectomía radical (PR.) sigue siendo el método de tratamiento más usado, si bien dicha cirugía no está exenta de riesgos Los refinamientos técnicos y en la técnica como las incisiones mínimas minilaparotomía (Minilap), han contribuido a mejorar los resultados. Presentamos nuestra experiencia con la técnica de Minilap en pacientes sometidos a PR.. Material y métodos: En el período comprendido entre abril de 1997 y septiembre de 2005 realizamos 110 PR. según técnica de Minilap. En todos los casos se utilizaron incisiones de 7-8 cms. Para la realización de esta técnica utilizamos un separador multivalvas desarrollado en el propio Hospital. La edad media era de 65 años (47- 79) por estadios, 39 (35,4%) eran T1c, 64 (58,3%) cT2 y 7 (6,3%), cT3. En 68,2% el Gleason era ≤6, 34 (30,9%), 7 y 1 (0,9%), 8. Resultados: El estadio patológico fue pT2 86(38,1%), pT3 en 21 (19%), pT4 1(0,9%) y 2(1,8%) pT0. En 9 (8%) casos se presentaron complicaciones postoperatorias. Ninguno precisó reintervenciones y 101(90%) no presentaron complicaciones perioperatorias. La mediana de estancia postoperatoria fue de 4 días y 97 pacientes (88,8%) fueron dados de alta en los 5 primeros días. Al año un 92.3% presentan continencia urinaria completa o fugas mínimas y un 40% vida sexual activa. Conclusiones: Técnicas mínimamente invasivas para la cirugía de cáncer de próstata como la Minilap pueden realizarse de forma habitual con buenos resultados y sin necesidad de una curva de aprendizaje prolongada

Introduction: prostate cancer is the most frequent tumor in males. The use of PSA contributes to diagnose tumors with low stage. Radical Prostatectomy (R.P.) is the gold standard to treat this tumor; however such is not exempt of risks. Different technical modifications like minimal incisions minilaparotomy 'minilap' had contributed to improve results. We review our experience with Minilap on patients underwent a RP. Material and Methods: Between April 1997 and September 2005 carry out 110 RP with Minilap technique. All cases were performed with minimal incision 7-8 cm of length. We use and specific retractor developed in our hospital. Median age at time of surgery was 65 (47-79). Clinical stage in 39 (35.4%) were T1c, 64(58.3%) T2 and 7(6.3%) T3. Sixty eight percent were Gleason score ≤6, 34(30.9%) 7 and 1(0.9%) Gleason 8. Results: In 86 cases (38.5%) pathological stage were pT2 , 21(19%) pT3, 1(0.9%) pT4 and 2 (1.8%) pT0. Nine patients (8 % ) had postoperative complications. No re-interventions were necessary and 101(90%) were discharge without per operatives complications. Mean length of stay was 4 days and 97(88.8%) of patients were discharge with only five days length of stay. Urinary continence rate with a year like minimal follow up is 92.3% and 40% preserve sexual activity. Conclusions: Minimal invasive techniques like minilap can be done in regular form with good results and without long learning curve

[Stress urinary incontinence surgical treatment with suburethral suprapubic SPARC sling]. / Tratamiento quirúrgico de la incontinencia urinaria de esfuerzo mediante cabestrillo suburetral SPARC. Análisis de nuestra experiencia.

INTRODUCTION: Stress urinary incontinence (SUI) has a high incidence and important morbidity. Multiple surgical techniques have been described to treat it, with despair results. Suburethral slings have become, in recent years, a simpler and less invasive method to treat SUI surgically. MATERIAL AND METHOD: The purpose of this paper is to review, retrospectively, 86 patients treated at our institution, from 10/01 to 12/05 of SUI, with a suprapubic suburethral sling (SPARC). RESULTS: Medium (range) age is 58.7 (39-80), hospital stay was 2.43 d (1-8) and catheter was removed 1.52 d (1-10). 14.5% of patients underwent other vaginal surgeries at same time, most frequently anterior colpoperineoplasty (10.7%). Complications are not very frequent; bladder perforation (5.8%), acute urinary retention (7%), chronic urinary retention (3.5%) and UTI (15.3%). Sling release was performed in 3.5% of women with chronic urinary retention. Total continence was found in 71.4% of patients with 10.1 months medium follow up (1-32). De novo urge symptoms were found in 26.2% of women, with urge incontinence in 54.5% of them. (p < 0.002; OR 5.0 (IC 95% 1.75-14.28). CONCLUSIONS: Suprapubic suburethral SPARC sling is a simple method, with few complications and fast social recovery. Outcome can be measured soon, with a high continence rate. De novo urge symptoms are high and they worsen functional results. It is necessary longer follow-up to evaluate long term outcomes.

[External beam radiotherapy on locally advanced prostate carcinoma following iliac staging lymphadenectomy]. / La radioterapia en el cáncer de próstata localmente avanzado tras estadiaje ganglionar con linfadenectomía.

INTRODUCTION AND OBJECTIVES: Locally advanced prostate cancer supposes a high risk condition of post-treatment progression due to the limit situation that represents. Our purpose was to analyze prognoses factors in function of progression probability after using a treatment with external source radiotherapy on patients with this kind of tumors. MATERIAL AND METHODS: We retrospectively reviewed a set of 128 patients submitted to pelvic staging limphadenectomy prior to accomplish an external radiotherapeutic treatment. We employed the Kaplan-Meier curves to study the probability of progression, logarithmic ranks test were used for detection of possible statistically significant differences and proportional risks Cox model was employed to study possible risk factors of progression (employing astro criteria). RESULTS: 5 years freedom probability from progression was of 49,93%; in spite of appreciating important differences in the groups stratified by the predictive variables used (total PSA, gleason of pathological biopsy, clinical stage and % of cores affection on biopsy), none of them reached statistical meaning, being the level of total PSA the closest to it. CONCLUSIONS: The external radiotherapeuthic treatment represents a valid alternative in the treatment of locally advanced prostate cancer, with a tolerable index of secondaries. It must be used combined with hormonotherapy. It seems that the use of higher radiation doses, in a safer way thanks to 3D conformed radiotherapy, allows to improve the results. The most powerful clinical predictor of evolution must be the total PSA.

Papel actual del antígeno prostático específico y otros marcadores en el diagnóstico del cáncer de próstata / Current role of PSA and other markers in the diagnosis of prostate cancer

OBJETIVOS: Valorar el papel actual del PSA como método de diagnóstico en el cáncer de próstatay analizar los avances con nuevos marcadores relacionadoscon dicho tumor.MÉTODOS: Revisamos en la literatura el valor del PSA como marcador para definir la presencia de cáncer de próstata, así como sus fórmulas moleculares. Las factores relacionados con sus modificaciones, modelos predictivoso las diferentes discrepancias en la utilidad sobre el nivel de corte para definir riesgo o como marcador en si mismo. Analizamos los posibles nuevos marcadores o líneas más interesantes de trabajo en el desarrollo de nuevos test. Utilizamos como vía de trabajo fundamental para la búsqueda bibliografica el Medline.RESULTADOS: Los datos disponibles confirman que el PSA mantiene un nivel alto de sensibilidad aunque la especificidad es baja especialmente en rango de PSA≤10 ngr/ml, se puede ver aumentada con sus diferentesisoformas moleculares, ratios o modelos predictivos.Si bien es verdad que a pesar de dichos estudios persiste la dificultad para aumentar la especificidad y por lo tanto obviar biopsias. En la actualidad se disponede nuevos marcadores, algunos comercializados y otros en vía de desarrollo como las nuevas isoformas o con biología molecular, que parecen mejorar la especificidaddel PSA.CONCLUSIONES: El PSA sigue siendo el marcador patrón para el diagnóstico del cáncer de próstata. Es importante mejorar la especificidad para lo que necesitamosnuevos modelos predictivos o nuevas isoformas que puedan ayudarnos a seleccionar mejor los pacientescandidatos a biopsia. Existen en este momento diferenteslíneas de investigación prometedoras con nuevos marcadores, si bien aún no existe sustituto ideal para el PSA que sigue siendo el patron estándar

OBJECTIVES: To evaluate the current role of PSA as a diagnostic method for prostate cancer, as well as to analyze possible new markers.METHODS: We perform a bibliographic review for PSA, and its molecular forms, as a marker to define the presence of prostate cancer. We review the factorsrelated to PSA modifications, predictive models, or the current controversies about the usefulness of its cutpoint to define the risk of prostate cancer or the marker itself. We analyze possible new markers and the most interesting work lines in the development of new markers. We used MEDLINE for the bibliographic search.RESULTS: Available data confirm that PSA has a high sensitivity; although specificity is low, mainly in the ≤ 10ng/ml range, it may be increased with the use of variousmolecular isoforms, ratios or predictive models.Nevertheless, it is true that despite such studies it isdifficult to increase specificity, so biopsies are reduced. Currently we have new markers, some of them already marketed, others in development, which seem to improve the specificity of PSA (isoforms, use of molecular biology).CONCLUSIONS: PSA is still the standard marker for the diagnosis of prostate cancer. It is important to improve the specificity; therefore we need new predictive models or new isoforms that help us to do a better selection of candidates for biopsy. There are various promising research lines with new markers, but there is not ideal substitute for PSA yet

La radioterapia en el cáncer de próstata localmente avanzado tras estadiaje ganglionar con linfadenectomía / External beam radiotherapy on locally advanced prostate carcinoma following iliac staging lymphadenectomy

Introducción y objetivos: El cáncer de próstata localmente avanzado supone una condición de alto riesgo de progresión bioquímica post-tratamiento debido a la situación límite que representa. Nos planteamos analizar los factores pronósticos clínicos en función de la probabilidad de progresión tras emplear un tratamiento con fuente radioterapeútica externa en pacientes con este tipo de tumores. Material y métodos: Revisamos retrospectivamente una serie de 128 pacientes sometidos a linfadenectomía pélvica de estadiaje como método de estadiaje previo a la realización de el tratamiento radioterápico. Empleamos las curvas de Kaplan-Meier para estudiar la probabilidad de progresión, el test de rangos logarítmicos para la demostración de posibles diferencias estadísticamente significativas y el modelo de riesgos proporcionales de Cox para estudiar los posibles factores pronósticos implicados. Resultados: La probabilidad de no progresión a 5 años ha sido del 49,93%; a pesar de apreciar diferencias importantes en los grupos estratificados por las variables predictivas empleadas (PSA total, gleason de biopsia, estadio patológico y % de cilindros afectos en biopsia), ninguna de ellas alcanzó significación estadística, siendo el nivel de PSA t el más próximo a la misma. Conclusiones: La radioterapia externa representa una alternativa válida en el tratamiento del cáncer de próstata localmente avanzado con un tolerable índice de secundarismos. Debe emplearse en tratamiento combinado junto a la hormonoterapia. Parece que el empleo de unas dosis más altas de radiación, posible de manera segura gracias a la radioterapia conformada 3D, permiten alcanzar una mayor eficacia. Es probable que el indicador clínico con mayores implicaciones pronósticas sea el nivel de PSA total

Introduction and objectives: Locally advanced prostate cancer supposes a high risk condition of post-treatment progression due to the limit situation that represents. Our purpose was to analyze prognoses factors in function of progression probability after using a treatment with external source radiotherapy on patients with this kind of tumors. Material and methods: We retrospectively reviewed a set of 128 patients submitted to pelvic staging limphadenectomy prior to accomplish an external radiotherapeutic treatment. We employed the Kaplan-Meier curves to study the probability of progression, logarithmic ranks test were used for detection of possible statistically significant differences and proportional risks Cox model was employed to study possible risk factors of progression (employing astro criteria). Results: 5 years freedom probability from progression was of 49,93%; in spite of appreciating important differences in the groups stratified by the predictive variables used (total PSA, gleason of pathological biopsy, clinical stage and % of cores affection on biopsy), none of them reached statistical meaning, being the level of total PSA the closest to it. Conclusions: The external radiotherapeuthic treatment represents a valid alternative in the treatment of locally advanced prostate cancer, with a tolerable index of secondaries. It must be used combined with hormonotherapy. It seems that the use of higher radiation doses, in a safer way thanks to 3D conformed radiotherapy, allows to improve the results. The most powerful clinical predictor of evolution must be the total PSA

[Renal angiomyolipomatosis and pulmonary lymphangiomyomatosis. Its relationship with Bourneville syndrome]. / Angiolipomatosis renal y linfangioleiomiomatosis, su relación con la enfermedad de Bourneville.

INTRODUCTION: Renal angiomyolipomas are not very frequent in urologic activities. Pulmonary lymphangioleiomyomatosis is a rare disease that occurs mainly in women of reproductive age. Tuberous sclerosis shows lesions to different organs, including these both entities. MATERIAL AND METHOD: We retrospectively analyze patients treated in our center. Three most representatives cases are reported. An indexed literature review is done, in order to establish a clinical protocol to manage these kinds of patients. RESULTS: [corrected] Between 1990 and 2004, eight patients have been attended with an angiomyolipoma renal diagnostic. Five women (62%) and three men (38%). Medium age is 52,3y (29-69). In 3 of them (all women), it was also done a diagnostic of pulmonary lymphangioleiomyomatosis. CONCLUSIONS: Bourneville syndrome is not very frequent. Associated angiomyolipomas usually are multiple, bilateral, with tender to grow and require more interventions. Previous diagnostic let us prevent future complications with vigilance, selective arterial embolization and nephron-spare surgery. Tumour size and the presence of symptoms are more decisive to decide best therapy alternative. Young patients with pulmonary lymphangioleiomyomatosis should be advise against pregnancy and the use of preparations containing estrogens.

Angiolipomatosis renal y linfangioleiomiomatosis, su relación con la enfermedad de Bourneville / Renal angiomyolipomatosis and pulmonary lymphangiomyomatosis. It´s relationship with bourneville syndrome

Introducción: Los angiomiolipomas renales son poco frecuentes en la actividad urológica. La linfangioleiomiomatosis es una rara enfermedad pulmonar que afecta mayoritariamente a mujeres en edad reproductiva. La Esclerosis Tuberosa afecta a diversos órganos, incluyéndose entre sus presentaciones, estas dos entidades. Material y método: Se revisan de forma retrospectiva los pacientes atendidos en nuestro centro, haciendo referencia a tres casos representativos de la enfermedad. Se expone su manejo clínico y Resultados: Asimismo se realiza una revisión de la literatura indexada, que nos permita establecer un protocolo de actuación. Resultados: Entre 1990 y 2004, han sido atendidos 8 pacientes con angiomiolipoma renal. 5 mujeres (62%) y 3 hombres (38%). La media de edad es de 52,3 años (29-69). En 3 pacientes (todas mujeres) se diagnosticó también linfangioleiomiomatosis. Conclusiones: La enfermedad de Bourneville es poco frecuente. Los angiomiolipomas que se asocian, suelen ser múltiples, bilaterales, tendentes al crecimiento y requieren más intervenciones. El diagnóstico precoz permite prevenir futuras complicaciones mediante vigilancia, embolización arterial selectiva o cirugía conservadora. Es importante el tamaño y la presencia de síntomas para decidir la mejor terapia. Las pacientes jóvenes con linfangioleiomiomatosis pulmonar deben ser advertidas del uso de preparados estrogénicos y evitar embarazos

Introduction: Renal angiomyolipomas are not very frequent in urologic activities. Pulmonary lymphangioleiomyomatosis is a rare disease that occurs mainly in women of reproductive age. Tuberous sclerosis shows lesions to different organs, including these both entities. Material and method: We retrospectively analyze patients treated in our center. Three most representatives cases are reported. An indexed literature review is done, in order to establish a clinical protocol to manage these kinds of patients. Resultados: Between 1990 and 2004, eight patients have been attended with an angiomyolipoma renal diagnostic. Five women (62%) and three men (38%). Medium age is 52,3 y (29-69). In 3 of them (all women), it was also done a diagnostic of pulmonary lymphangioleiomyomatosis. Conclusions: Bourneville syndrome is not very frequent. Associated angiomyolipomas usually are multiple, bilateral, with tender to grow and require more interventions. Previous diagnostic let us prevent future complications with vigilance, selective arterial embolization and nephron-spare surgery. Tumour size and the presence of symptoms are more decisive to decide best therapy alternative. Young patients with pulmonary lymphangioleiomyomatosis should be advise against pregnancy and the use of preparations containing estrogens

[Current role of PSA and other markers in the diagnosis of prostate cancer]. / Papel actual del antígeno prostático específico y otros marcadores en el diagnóstico del cáncer de próstata.

OBJECTIVES: To evaluate the current role of PSA as a diagnostic method for prostate cancer, as well as to analyze possible new markers. METHODS: We perform a bibliographic review for PSA, and its molecular forms, as a marker to define the presence of prostate cancer. We review the factors related to PSA modifications, predictive models, or the current controversies about the usefulness of its cutpoint to define the risk of prostate cancer or the marker itself. We analyze possible new markers and the most interesting work lines in the development of new markers. We used MEDLINE for the bibliographic search. RESULTS: Available data confirm that PSA has a high sensitivity; although specificity is low, mainly in the < 10 ng/ml range, it may be increased with the use of various molecular isoforms, ratios or predictive models. Nevertheless, it is true that despite such studies it is difficult to increase specificity, so biopsies are reduced. Currently we have new markers, some of them already marketed, others in development, which seem to improve the specificity of PSA (isoforms, use of molecular biology). CONCLUSIONS: PSA is still the standard marker for the diagnosis of prostate cancer. It is important to improve the specificity; therefore we need new predictive models or new isoforms that help us to do a better selection of candidates for biopsy. There are various promising research lines with new markers, but there is not ideal substitute for PSA yet.

[Role of nephrectomy in metastatic renal cell carcinoma. Experience of the Department of Urology Juan Canalejo Hospital]. / Papel de la nefrectomía en el adenocarcinoma renal metastático: experiencia del Servicio de Urología del Hospital Juan Canalejo.

OBJECTIVES: We expose our experience in nephrectomy in metastatic renal cell carcinoma, and also show complications, evolution and survival of these patients. MATERIAL AND METHODS: We performe a retrospective review of renal cell carcinoma treated at our service in the period between January 1st 1991 and December 31st 2002. We only studied those which presented in a metastatic pattern (31), and divide these in two groups: the ones which were nephrectomized and those which were not. We try to showw the differences between the two groups in order of status performance (E.C.O.G.), associated morbidity and median survival. In the first group we also study complications of surgery and treatment that patients underwent. RESULTS: we performed nephrectomy in 19 cases, all of them E.C.O.G. 0-1. Median postoperative stay was 12 days, and complication rate was 11.5%. Of these patients, 45% underwent some type of systemic treatment, and median survival was 31 months. We didn't performed nephrectomy in 12 patients, of which 9 were E.C.O.G. 2-3. Associated co-morbidity was higher in this group. Only in three patients any treatment was offered always with palliative reason. Median survival was 3.8 months. CONCLUSIONS: In those patients with good performance status this approach does not represent more morbility nor mortality than in non-metastatic patients, and that is a cornerstone in their management. We also make a literature review in which we see the last pathways in the management of these patients, and that show the needing for a combined approach both quirurgical and inmunotherapical. We have review with special interest the studie's conclusions of SWOG and EORTC groups.