Radical cystectomy, hysterectomy with double adnexectomy and bilateral nephroureterectomy with transvaginal extraction.

OBJECTIVES: The onset of synchronous urothelial carcinoma in the upper or lower urinary tract is uncommon. Even more uncommon is the onset the bilateral form. The aim of this article is to describe the surgical technique of complete laparoscopic exeresis of the urinary apparatus and to add several variants of the technique that improve the patient's hemodynamics during surgery. MATERIAL AND METHODS: We present the technique of cystectomy with bilateral nephroureterectomy, hysterectomy with double adnexectomy and bilateral ilio-obturator lymphadenectomy by laparoscopy and transvaginal extraction of specimens from a 58-year-old patient with multiple prior vesical resections of high-grade urothelial carcinoma. The patient currently presents bladder recurrence and bilateral ureteropelvic tumor. The technique consists first of the hysterectomy and double adnexectomy along with the lymphadenectomy and cystectomy, maintaining the urethrovesical, ureterovesical and uterovaginal junctions. After changing the patient's position, both nephroureterectomies were performed. Lastly, we completed the resection of the previously mentioned segments to extract the specimens transvaginally. RESULTS: The histological result was high-grade urothelial carcinoma that affected the bladder and both ureteropelvic junctions, along with endometrial carcinoma. After reviewing the literature, we found less than 10 cases in which complete exeresis of the urinary apparatus was performed and none with the technical description presented in this article. In most cases described in the literature, surgery was performed at 2 separate times and without preserving renal function until the end of the complete exeresis. CONCLUSION: This technique helps maintain diuresis for a longer time during surgery and thereby facilitates the work of the anesthesiologist and improves the patient's circulatory dynamics. Additionally, the technique prevents any type of handling of the urinary tract, thereby avoiding the passage of tumor cells to the peritoneal cavity, given that the specimens are extracted whole through the vagina.

Carcinoma de células renales bilateral sincrónico. Presentación de un caso / Bilateral synchronic renal cell carcinoma. Report of a case

La nefrectomía radical es considerada el tratamiento de elección para el carcinoma renal. Los buenos resultados obtenidos en los últimos años con la resección parcial, hacen considerar a la cirugía conservadora como el mejor tratamiento en los casos de tumores renales bilaterales bien seleccionados. Así mismo se evita la diálisis en estos casos minimizando el riesgo subsiguiente de déficit inmunológico y mayor posibilidad de enfermedad metastásica. Sin embargo actualmente en lo que se refiere a la cirugía electiva conservadora parece existir controversia en cuanto a las indicaciones y la técnica quirúrgica a realizar (resección parcial versus enucleación). Presentamos un caso de carcinoma renal bilateral sincrónico en el que se optó por cirugía radical en el riñón izquierdo que presentaba gran tumoración con focos múltiples corticales confirmados mediante PAAF, y cirugía conservadora en el riñón derecho con enucleación de masa bien delimitada en polo inferior renal, así mismo confirmada mediante PAAF. Durante cinco años el paciente mantuvo función renal normal con buena calidad de vida, presentando en ese momento y en uno de los controles radiológicos, recidiva tumoral en el único riñón que obligó a cirugía radical e inclusión del paciente en programa de diálisis (AU)

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[Bilateral synchronous renal cell carcinoma. Report of a case]. / Carcinoma de células renales bilateral sincrónico. Presentación de un caso.

The radical nephrectomy is considered to be the optional treatment for renal carcinoma. In the last years, the good results with partial resection shows conservadora surgery the most suitable treatment for well-localized bilateral renal tumours. In this cases dialysis is avoided, and the subsequent risk of immunological deficit and the higher possibility of metastasic illness are minimized. Nowadays, however, there seems to be some controversy over conservative surgery, concerning applications and technique of surgery to practice (partial resection vs. enucleation). We have a case of bilateral synchronic renal cell carcinoma where radical surgery on the left kidney was put into practice, as it presented a great tumour with multiples points corticals confirmed by PAAF and conservative surgery on the right kidney with enucleation of localized mass in the lower renal. The patient held normal renal function with a good quality of life for five years, finding out then, in one of the radiological tests, carcinoma relapse in the only kidney, that forced to radical surgery and to his inclusion in dialysis programme.

[Endoscopic anterior commissurotomy (EAC) versus TUR as the treatment for the neck obstruction syndrome. Our experience. The results]. / La comisurotomía anterior endoscópica (CAE) versus RTU como tratamiento del síndrome obstructivo cervical. Experiencia. Resultados.

OBJECTIVE: 30 patients were included over a 5-year period in a protocol divided into two uniform cohorts (age, surgical risk, prostatic volume, etc.). Both groups are compared based on morphological effectiveness, functionality, quality of life parameters, etc. Also a comparison on the efficacy of anterior commissurotomy vs. conventional TUR is carried out. METHOD: After 12 hours, a cohort of 15 patients had a Collins' loop section of the vesical neck anterior aspect, a technique described by Keitzer (1969). RESULTS: Results were optimal and superior to those obtained with TUR. We conclude this technique is effective, and emphasize the validity of the concepts described by Gil Vernet in 1956.

[Usefulness of posterior capsulectomy in the treatment of bladder neck disease]. / Utilidad de la capsulectomía posterior como tratamiento de la enfermedad de cuello vesical.

RATIONALE: Presentation of 12-year experience accrued in the surgical treatment of the acquired bladder neck disease. Based on Riches' experience (1961), posterior capsulotomy, although exceptional in terms of indication, was effective in the treatment of 26 patients with early failure of standard endoscopic techniques. MATERIALS AND METHOD: Over a 12-year period, 945 prostatectomies were entered in a protocol, 305 (32.2%) open surgery and 640 (67.8%) transurethral resections. Incidence of sclerosis was 5.03% (48 patients). Treatment of second group with TUR and/or cervicotomy failed in 26 (45-58%) patients. Posterior capsulotomy was effective in 100% patients. RESULTS: Mean follow-up has been productive, and exceeds 4 years based on clinical, radiologic, endoscopic and urodynamic parameters.

[Eosinophilic cystitis in children. Study of 4 cases]. / Cistitis eosinofílica en el niño. Estudio de 4 casos.

OBJECTIVE: To present our experience in the diagnosis and treatment of 4 children with eosinophilic cystitis. METHODS: 4 children (3 boys and 1 girl) with eosinophilic cystitis are described. The mean follow-up since diagnosis was 30 months, the mean age was 7 years and the main symptom was hematuria. The clinical features, etiology, course of the disease, pathological findings and diagnostic methods are reviewed. The definitive diagnosis was established by the pathological findings. None of the patients had a recurrence. CONCLUSIONS: The diagnosis of eosinophilic cystitis is exclusively based on the histological findings. There are no clinical or complementary pathognomonic signs. Like most authors, we believe that the immune system plays a decisive role in the appearance of this disease.

[A retrospective study of surgery for tumors of the renal parenchyma in adults]. / Estudio retrospectivo sobre la cirugía de los tumores del parénquima renal en el adulto.

OBJECTIVES: To determine the incidence of renal parenchymal tumors in adult patients over the last 30 years, analyze the therapeutic approach and compare radical vs conservative surgery, the surgical principles involved and the survival rates achieved. METHODS/RESULTS: We have reviewed 260 cases of renal parenchymal tumors in adults and the utilization of conservative vs radical surgery over the last 30 years. This tumor type has been significantly influenced by the availability of US for routine evaluation, which has led to changes in the clinical features of this condition and the surgical expectations. CONCLUSIONS: Although the techniques of conservative surgery of the kidney have remained unchanged over the last 50 years, the indications have changed. The incidence of nononcological conditions has decreased while the number of incidentally discovered tumors has increased. The tumor is diagnosed earlier, of smaller size and lower histological grade and stage.

[Vestibular approach in urinary incontinence in women. Original technic. Experience. Results]. / La vía de abordaje vestibular en la incontinencia de orina en la mujer. Técnica original. Experiencia. Resultados.

Presentation of an original technique to treat S.U.I. in women. This technique contains in itself many others, both in terms of the conceptual anatomical base on which it is inspired, and in the possibilities of its surgical application. Lisfranc's approach, supra-meatic and infra-clitoridean, allows to section both the pubo-urethral ligament and Colles fascia thus reaching into the Retzius. It makes possible the use of solid anatomical elements (pelvian fascia, elevator, urethro-vaginal septum, etc...) thus allowing to suspend the pelvian base from fascia ligaments or from the abdominal wall muscles. Sixty patient who had simple S.U.I. received treatment, with a 95% efficacy index based on the evaluation of the urodynamic, bacteriological and clinical studies. We conclude with an evaluation on the validity of the results obtained by emphasizing the high efficacy index, simplicity, low morbidity and short hospital stay.