Complicaciones en cirugía laparoscópica: como lo hago yo, para que usted no lo haga y le vaya bien / Complications in laparoscopic surgery: how I do it, so you won´t and do well

INTRODUCCIÓN: La cirugía laparoscópica urológica no esta exenta de complicaciones. Estas van a depender de la selección del paciente, así como de la experiencia del cirujano. MATERIAL Y MÉTODOS: Se presentan cuatro casos en los que ocurrieron complicaciones durante una cirugía laparoscópica renal. Se discute la complicación y se analizan los factores que la precipitaron, el manejo de esta y sugerencias para evitarla. RESULTADOS: Se presentan dos casos de lesión de pedículo renal durante nefrectomía parcial laparoscópica, 1 lesión de vena renal y una lesión de arteria renal. En ambos fue posible la resolución mediante sutura intracorpórea. Se presenta dos casos de lesión de pedículo durante nefrectomía radical laparoscópica. 1 lesión de arteria renal y una lesión de venal renal. En ambos casos fue necesaria la conversión a cirugía abierta para controlar la complicación. Se presenta un caso de lesión esplénica durante una nefrectomía parcial laparoscópica. La laceración fue controlada mediante compresión y electro coagulación. CONCLUSIONES: Las presencia de complicaciones durante la cirugía laparoscópica urológica es inherente al procedimiento. El uso de equipo e instrumental adecuados son fundamentales para minimizar el riesgo, así como también la selección del paciente es un factor importante. El dominio de la sutura intracorpórea es de suma importancia para solucionar la complicación una vez que esta ya está establecida. linfadenectomía aorto-ilíaca. Se realizó un abordaje transperitoneal con el sistema da Vinci S-HD® y técnica de 6 trócares. Nuestra plantilla de disección ganglionar tiene como límites el pubis hacia distal, la arteria mesentérica inferior hacia proximal, el nervio genito-femoral hacia lateral y la vejiga hacia medial. (AU)

Introduction: Laparoscopic urological surgery is not without complications. These will depend on the patient's selection as well as the surgeon's experience. Material and Methods: Four cases in which complications occurred during laparoscopic renal surgery are presented . The complication is discussed and the causes that produced it are analyzed. Results: Two cases of renal pedicle injury are presented during laparoscopic partial nephrectomy, 1 renal vein and 1 renal artery injuries. In both cases resolution was possible by intracorporeal suture. Two cases of pedicle injury are presented during laparoscopic radical nephrectomy. 1 renal artery injury and renal venal injury. In both cases, conversion to open surgery was necessary to control the complication. A case of splenic injury is presented during a laparoscopic partial nephrectomy. The laceration was controlled by compression and electrocoagulation. Conclusions: The presence of complications during laparoscopic urological surgery is inherent in the procedure. The use of appropriate equipment and instruments are essential to minimize risk, as well as patient selection is an important factor. The domain of intracorporeal suture is of paramount importance to solve the complication once it is already established. (AU)

Nefrectomias parciales y tumorectomias: experiencia durante los ultimos 10 años en servicio de urología Hospital Clínico de Valdivia / Partial nephrectomy and Tumorectomy specimens: experience duringthe last 10 years in the Urology department of the Hospital the Valdivia

INTRODUCCIÓN Y OBJETIVO: El mayor uso de imágenes diagnósticas, ha implicado un aumento en el diagnóstico de lesionestumorales renales de menor tamaño, llevando al desarrollo de técnicas quirúrgicas conservadoras de parenquimarenal. Series internacionales han demostrado que los resultados oncológicos de este tipo de cirugía son similares a la nefrectomía radical. Nuestro objetivo es mostrar la experiencia y resultados oncológicos de la cirugía conservadora deparenquima renal. MATERIALES Y MÉTODOS: Estudio retrospectivo, de las nefrectomías parciales y tumorectomías realizadas entre Enero del año 2002 y Junio del año 2013, en el Hospital Clínico Regional de Valdivia. RESULTADOS: 50 pacientes fueron sometidos a cirugía renal conservadora, con 51 cirugías realizadas. 26 corresponden a sexo masculino y 24 a sexo femenino; promedio de edad de 58,2 años. De las cirugías realizadas veinte correspondieron a nefrectomías parciales, contamaño tumoral promedio de 4,3 cms. (2-7 cms.) y 31 a tumorectomías, con tamaño tumoral promedio de 2,5 cms. (1-6,1cms.). Del total de los tumores resecados, ocho (26%) fueron informados como tumores benignos y 43 (84%) corresponden a adenocarcinomas; 41 (95%) corresponden a la variante células claras y solo dos a variante de células cromofobas. Lasbiopsias rápidas están todas entre 1-2 mm de tejido sano como margen, y todas fueron negativas para tumor. La biopsiadiferida, informo cuatro márgenes positivos para tumor. De estas, tres fueron a re-cirugía cuyas biopsias fueron negativaspara tumor. El tiempo promedio de seguimiento fue de 51,1 meses, con una sobrevida actuarial a los diez años cercana al70% y una sobrevida específica a los diez años cercana al 95%...

INTRODUCTION AND OBJECTIVE: The increased use of diagnostic imaging, has involved an increase in the diagnosis ofsmaller tumor lesions, taking the development of conservative surgical techniques of renal parenchyma. Internationalseries have shown that cancer results from this type of surgery are similar to radical nephrectomy. Our goal is to show the experience and oncological results of renal parenchymal sparing surgery. MATERIALS AND METHODS: Retrospective studyof tumorectomies and partial nephrectomies performed between January 2002 and June 2013, at the Regional Hospital ofValdivia. RESULTS: 50 patients underwent renal sparing surgery, with 51 surgeries performed. 26 are male and 24 female,average age of 58.2 years old. Of the surgeries performed, twenty were partial nephrectomy, with average tumor size of4.3 cm. (2-7 cms.) and 31 tumorectomies, with average tumor size of 2.5 cm. (1-6.1 cms.). Of all resected tumors, eight (26%)were reported as benign and 43 (84%) were adenocarcinomas, 41 (95%) were clear cell variant and only two chromophobecell variant. Quick biopsies are all 1-2 mm of healthy tissue margin, and all were negative for tumor. The deferred biopsy,reported four positive tumor margins. Of these, three went to re-surgery, whose biopsies were negative for tumor. The average follow-up time was 51.1 months, with an actuarial survival at ten years about 70% and a specific survival at ten years was approximately 95%...

Prostatectomía simple (adenomectomía) por vía laparoscópica: experiencia en 59 pacientes consecutivos / Laparoscopic Simple Prostatectomy (Adenomectomy): Experience in 59 Consecutive Patients

Objetivo: La adenomectomía laparoscópica es una alternativa mínimamente invasiva a la cirugía abierta en próstatas de gran volumen. Nuestro objetivo es dar a conocer nuestra serie de 59 pacientes tratados mediante adenomectomía laparoscópica con control vascular preciso. Material y métodos: Entre junio de 2003 y junio de 2006 un total de 59 pacientes con una edad promedio de 65,5 años (51 a 82) fueron sometidos a adenomectomía laparoscópica extraperitoneal. Todos los pacientes tenían un historial de síntomas del tracto urinario inferior (STUI) y de hiperplasia benigna de próstata (HPB). La mediana del International Prostate Symptom Score (IPSS) fue de 20 puntos (16-22). La información fue recogida de forma prospectiva en una base de datos. El análisis fue realizado a posteriori. Resultados: Todos los 59 adenomas fueron extirpados en su totalidad por vía laparoscópica sin conversión a cirugía abierta. La mediana de volumen prostático preoperatorio medida por ultrasonidos fue de 108,5 cc (75-150). El tiempo operatorio promedio fue de 123 minutos (90-180). La pérdida de sangre promedio fue 415ml (50-1500) y 4 pacientes (14,8%) requirieron transfusión de sangre. Dos (7,4%) de los pacientes presentaron complicaciones perioperatorias. La mediana de estancia hospitalaria y el tiempo de sonda vesical fueron de 3,5 (2-7) y 4,2 (3-7) días respectivamente. Conclusiones: La prostatectomía laparoscópica simple extraperitoneal es un procedimiento efectivo para el tratamiento de grandes adenomas prostáticos. Parece haber menos morbilidad perioperatoria y en nuestra experiencia esta técnica parece factible y reproducible; sin embargo, su curva de aprendizaje es un tema complicado de abordar (AU)

Objective: Laparoscopic adenomectomy 150 is a minimally invasive alternative to open surgery in large prostates. Our aim is to discuss our series of 59 patients treated by means of laparoscopic adenomectomy with precise vascular control. Materials and methods: Between June 2003 and June 2006, a total of 59 patients with a mean age of 65.5years (51 to 82), underwent laparoscopic extraperitoneal adenomectomy. All the patients had a history of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). The mean International Prostate Symptom Score (IPSS) was 20 points (16-22). The information was collected prospectively in a database. The analysis was performed subsequently. Results: All 59 adenomas were completely removed laparoscopically without conversion to open surgery. The mean preoperative prostate volume by ultrasound was 108.5 cc (75-150). The average operating time was 123minutes (90-180). The mean loss of blood was 415ml (50-1500) and 4 patients (14.8%) required a blood transfusion. Two (7.4%) of the patients presented perioperative complications. The mean hospital stay and the bladder catheterization time were 3.5 (2-7) and 4.2 (3-7) days respectively. Conclusions: Laparoscopic extraperitoneal simple prostatectomy is an effective procedure for the treatment of large prostatic adenomas. There seems to be less perioperative morbidity and, in our experience, this technique seems to be feasible and reproducible; however, its learning curve is a complicated matter to deal with (AU)

Cistectomía radical laparoscópica con confección extracorpórea de neovejiga ortotópica ileal en forma de ‘‘Y’’ usando sutura mecánica no reabsorbible (Fontana) / Laparoscopic radical cystectomy with extracorporeal creation of a ‘‘Y’’ shaped orthotopic ileal neobladder using non-reabsorbable mechanical suture (Fontana)

Introducción: se describe la técnica y se presentan los resultados preliminares de la técnica decistectomía radical laparoscópica con confección extracorpórea de neovejiga ortotópica ileal en forma de ‘‘Y’’, usando una sutura mecánica no reabsorbible (Fontana). Material y método: se describe paso a paso la técnica y se presenta una serie de 15 pacientes sometidos a esta cirugía entre noviembre de 2005 y agosto de 2009, con especial énfasis en el tiempo de cirugía, tiempo de derivación urinaria, las complicaciones intraoperatorias y postoperatorias, la continencia diurna y nocturna y la frecuencia miccional postoperatoria. Resultados: la mediana de seguimiento de la serie es de 24 meses (6-32). El tiempo quirúrgico medio fue 280 (rango: 210-345) minutos y el tiempo medio de la derivación urinaria fue 54,5 (rango: 40-75) minutos. No se presentaron complicaciones intraoperatorias y el tiempo promedio de hospitalización fue de 7 días (rango: 5-15). Durante el seguimiento se presentaron 5complicaciones postoperatorias tardías, dos cuadros de infección urinaria con buena respuesta al tratamiento antibiótico y tres estenosis de la anastomosis uretero-neovesical, que se han manejado con una dilatación percutánea con balón con un buen resultado funcional. No se han encontrado litiasis en la neovejiga. Se obtuvo continencia diurna completa en 13 de 14 pacientes (92,9%) y nocturna completa en 6 de 14 (42,9%). Un paciente (6,7%) precisa autosondaje limpio intermitente por no presentar micción espontánea. Conclusiones: la neovejiga ortotópica ileal en forma de ‘‘Y’’ usando una sutura mecánica no reabsorbible es una técnica factible, rápida, segura y que permite resultados funcionales prometedores. Se necesita mayor seguimiento para determinar sus resultados a largo plazo (AU)

Introduction: We describe the technique and present the preliminary results of the laparoscopic radical cystectomy technique with the extracorporeal creation of a ‘‘y’’ shaped ileal orthotopicneo bladder using non-absorbable mechanical suture (Fontana). Materials and method: We describe the technique step by step and we present a series of 15 patients that underwent this surgery between November 2005 and August 2009, with special emphasis on the duration of the surgery, urinary diversion time, intraoperative and postoperative complications, daytime and night time continence and the frequency of postoperative micturition. Results: The mean follow-up of the series was 24 months (6-32). The mean duration of surgery was 280 (range 210-345) minutes and the mean urinary diversion time was 54.5 (range 40-75) minutes. There were no intraoperative complications and the average hospitalization time was 7 (range 5-15) days. During the follow-up, there were 5 late postoperative complications, 2cases of urinary infection with good response to antibiotic treatment and 3 uretero-neovesical anastomosis strictures, which were treated with percutaneous balloon dilation, with a good functional result. No lithiasis was found in the neobladder. Complete daytime continence wa sobtained in 13/14 patients (92.9%) and complete night time continence in 6/14 (42.9%). One patient (6.7%) required clean intermittent self-catheterization as the patient did not micturate spontaneously. Conclusions: The creation of a ‘‘Y’’ shaped ileal orthotopic neobladder using non-absorbable mechanical suture is a feasible, fast and safe technique and it provides promising functional results. Further follow-up is required to determine its long-term results (AU)

[Laparoscopic simple prostatectomy (adenomectomy): experience in 59 consecutive patients]. / Prostatectomía simple (adenomectomía) por vía laparoscópica: experiencia en 59 pacientes consecutivos.

OBJECTIVE: Laparoscopic adenomectomy 150 is a minimally invasive alternative to open surgery in large prostates. Our aim is to discuss our series of 59 patients treated by means of laparoscopic adenomectomy with precise vascular control. MATERIALS AND METHODS: Between June 2003 and June 2006, a total of 59 patients with a mean age of 65.5 years (51 to 82), underwent laparoscopic extraperitoneal adenomectomy. All the patients had a history of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). The mean International Prostate Symptom Score (IPSS) was 20 points (16-22). The information was collected prospectively in a database. The analysis was performed subsequently. RESULTS: All 59 adenomas were completely removed laparoscopically without conversion to open surgery. The mean preoperative prostate volume by ultrasound was 108.5 cc (75-150). The average operating time was 123 minutes (90-180). The mean loss of blood was 415 ml (50-1500) and 4 patients (14.8%) required a blood transfusion. Two (7.4%) of the patients presented perioperative complications. The mean hospital stay and the bladder catheterization time were 3.5 (2-7) and 4.2 (3-7) days respectively. CONCLUSIONS: Laparoscopic extraperitoneal simple prostatectomy is an effective procedure for the treatment of large prostatic adenomas. There seems to be less perioperative morbidity and, in our experience, this technique seems to be feasible and reproducible; however, its learning curve is a complicated matter to deal with.

[Laparoscopic radical cystectomy with extracorporeal creation of a "Y" shaped orthotopic ileal neobladder using non-reabsorbable mechanical suture (Fontana)]. / Cistectomía radical laparoscópica con confección extracorpórea de neovejiga ortotópica ileal en forma de ''Y'' usando sutura mecánica no reabsorbible (Fontana).

INTRODUCTION: We describe the technique and present the preliminary results of the laparoscopic radical cystectomy technique with the extracorporeal creation of a "y" shaped ileal orthotopic neobladder using non-absorbable mechanical suture (Fontana). MATERIALS AND METHOD: We describe the technique step by step and we present a series of 15 patients that underwent this surgery between November 2005 and August 2009, with special emphasis on the duration of the surgery, urinary diversion time, intraoperative and postoperative complications, daytime and night time continence and the frequency of postoperative micturition. RESULTS: The mean follow-up of the series was 24 months (6-32). The mean duration of surgery was 280 (range 210-345) minutes and the mean urinary diversion time was 54.5 (range 40-75) minutes. There were no intraoperative complications and the average hospitalization time was 7 (range 5-15) days. During the follow-up, there were 5 late postoperative complications, 2 cases of urinary infection with good response to antibiotic treatment and 3 uretero-neovesical anastomosis strictures, which were treated with percutaneous balloon dilation, with a good functional result. No lithiasis was found in the neobladder. Complete daytime continence was obtained in 13/14 patients (92.9%) and complete night time continence in 6/14 (42.9%). One patient (6.7%) required clean intermittent self-catheterization as the patient did not micturate spontaneously. CONCLUSIONS: The creation of a "Y" shaped ileal orthotopic neobladder using non-absorbable mechanical suture is a feasible, fast and safe technique and it provides promising functional results. Further follow-up is required to determine its long-term results.

[Primary laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ-cell testis tumor]. / Linfadenectomía retroperitoneal laparoscópica primaria para el tumor testicular de células germinales no seminomatoso en estadio clínico I.

INTRODUCTION: this report is intended to retrospectively assess cancer control and morbidity of primary laparoscopic reproperitoneal lymphadenectomy (L-RPLND) in patients with clinical Stage I non seminomatous germ cell tumour (NSGCT). MATERIALS AND METHODS: one hundred and sixty-four patients with clinical Stage I NSGCT underwent primary diagnostic LRPLND between 1993 and 2006. Patients were operated unilaterally limiting the dissection to templates. Kaplan Meier curves were generated estimating time to recurrence. RESULTS: of the 164 patients, 82 (48%) had embryonal components and 35 (20%) lymphovascular invasion in the orchiectomy specimen. The median (IQR) age, operative time, length of hospital stay, blood loss and number of lymph nodes retrieved was 28 years (24-33), 135 minutes. (120- 180), 48 hours (24-48), 50 cc (20-100) and 14 (10-18) nodes, respectively. All patients had negative serum markers preoperatively. Presence of lymph node metastasis was identified in 32 (19.5%) patients. Follow-up was available in 15 of these. Fourteen received adjuvant chemotherapy and 2 of them had recurrence at 3 and 64 months. Absence of lymph node metastasis was diagnosed in 132 (80.5%) patients. Follow-up was available in 80 of these. Among them 7 recurred (5 retroperitoneum, 2 lung), one of them 33 months after L-RPLND. Median follow-up for patients without recurrence was 14 months (IQR:4-35). The cumulative 3-year recurrence free rate was 82% (95%CI: 64-91). Seventeen (10%) of 164 patients had intra or perioperative complications. CONCLUSIONS: this is the largest series of L-RPLND performed in a single institution. Both morbidity and oncologic safety of this technique needs to be prospectively evaluated in randomized trials.

Linfadenectomía retroperitoneal laparoscópica primaria para el tumor testicular de células germinales no seminomatoso en estadio clínico I / Primary laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ-cell testis tumor

Introducción: el propósito de este informe es evaluar retrospectivamente el seguimiento de cáncer y la mortalidad en linfadenectomía retroperitoneal laparoscópica (LRL) primaria en pacientes con tumor de células germinales no seminomatoso (TCGNS) es estadio clínico I. Materiales y métodos: ciento sesenta y cuatro pacientes con TCGNS en estadio clínico I se sometieron a LRL diagnóstica primaria entre 1993 y 2006. Los pacientes fueron operados unilateralmente limitando la disección a áreas. Se generaron curvas Kaplan Meier estimando el período de recurrencia. Resultados: de los 164 pacientes 82 (48%) tenían componentes embrionarios y 35 (20%) invasión linfovascular en la muestra de orquiectomía. La edad media (RI), tiempo operatorio, estancia en el hospital, pérdida de sangre y número de ganglios linfáticos recuperados fueron 28 años (24-33), 135 minutos (120-180), 48 horas (24-48), 50 cc (20-100) y 14 (10-18) ganglios linfáticos, respectivamente. Todos los pacientes tenían marcador sérico negativo antes de la intervención. La presencia de metástasis en ganglios linfáticos se identificó en 32 (19,5%) pacientes. Se hizo un seguimiento en 15 de ellos. Catorce recibieron quimioterapia adyuvante y dos de ellos sufrieron recurrencia a los 3 y 64 meses. La ausencia de metástasis en ganglios linfáticos se diagnosticó en 132 (80,5%) pacientes. Se hizo un seguimiento en 80 de ellos. Entre ellos 7 sufrieron recurrencia (5 retroperitoneo, 2 pulmonar), uno de ellos a los 33 meses de la LRL. El seguimiento medio de los pacientes sin recurrencia fue de 14 meses (RI: 4-35). La tasa acumulada de supervivencia libre de enfermedad a los tres años fue del 82% (IC 95%: 64-91). Diecisiete de 164 (10%) padecieron complicaciones intra o perioperatorias. Conclusiones: ésta es la serie más larga de LRL llevada a cabo en una única institución. Tanto la mortalidad como la seguridad oncológica de esta técnica deben ser evaluadas prospectivamente en ensayos aleatorios (AU)

Introduction: this report is intended to retrospectively assess cancer control and morbidity of primary laparoscopic reproperitoneal lymphadenectomy (L-RPLND) in patients with clinical Stage I non seminomatous germ cell tumour (NSGCT). Materials and methods: one hundred and sixty-four patients with clinical Stage I NSGCT underwent primary diagnostic LRPLND between 1993 and 2006. Patients were operated unilaterally limiting the dissection to templates. Kaplan Meier curves were generated estimating time to recurrence. Results: of the 164 patients, 82 (48%) had embryonal components and 35 (20%) lymphovascular invasion in the orchiectomy specimen. The median (IQR) age, operative time, length of hospital stay, blood loss and number of lymph nodes retrieved was 28 years (24-33), 135 minutes. (120- 180), 48 hours (24-48), 50 cc (20-100) and 14 (10-18) nodes, respectively. All patients had negative serum markers preoperatively. Presence of lymph node metastasis was identified in 32 (19.5%) patients. Follow-up was available in 15 of these. Fourteen received adjuvant chemotherapy and 2 of them had recurrence at 3 and 64 months. Absence of lymph node metastasis was diagnosed in 132 (80.5%) patients. Follow-up was available in 80 of these. Among them 7 recurred (5 retroperitoneum, 2 lung), one of them 33 months after L-RPLND. Median follow-up for patients without recurrence was 14 months (IQR:4-35). The cumulative 3-year recurrence free rate was 82% (95%CI: 64-91). Seventeen (10%) of 164 patients had intra or perioperative complications. Conclusions: this is the largest series of L-RPLND performed in a single institution. Both morbidity and oncologic safety of this technique needs to be prospectively evaluated in randomized trials (AU)

[Eosinophilic cystitis: review and two case reports]. / Cistitis eosinofílica: revisión y reporte de dos casos.

Eosinophilic cystitis is a low frequency disease, with less than 200 reported cases in the world. It is characterized by a bladder wall inflammation, mainly by eosinophils, with fibrosis and muscle necrosis areas. Its origin seems to be immunological, although the triggers are not well known. Several predispose factor have been described such as allergic diseases, bladder injuries, drugs, infections, etc. It affects patient of all ages, mainly adults. It presents with frecuency, haematuria and suprapubic pain. Other less frequent symptoms are disuria, urinary retention, nicturia, and enuresis. The laboratory study (urinalysis, urinalysis and haemogram) and radiology (ultrasound, intravenous pyelography, computed tomography and nuclear magnetic resonance) are non specific. The lesions observed in the cystoscopy could emulate other diseases, that why the proper diagnostic is the histological analysis. The management could be observation o antihistaminic, anti-inflammatory and corticoid treatment. In refractory cases, surgery is an alternative. In this work, two male adult cases are reported with their symptoms, studies and management.

Cistitis eosinofílica: Revisión y reporte de dos casos / Eosinophilic cystitis: Review and two cases report

La cistitis eosinofílica es una enfermedad de baja frecuencia, con menos de 200 casos reportados en el mundo. Se caracteriza por la inflamación de toda la pared vesical, predominantemente por eosinófilos, con fibrosis y áreas de necrosis muscular. Su origen parece ser inmunológico aunque los desencadenantes no se conocen bien. Se han descrito varios factores predisponentes como enfermedades alérgicas, trauma vesical, fármacos, infecciones, etc. Afecta a pacientes de todas las edades, preferentemente adultos. Se presenta con polaquiuria, hematuria y dolor suprapúbico. Otros de menor frecuencia son disuria, retención urinaria, nicturia y enuresis. El estudio de laboratorio (sedimento de orina, urocultivo, hemograma)y radiológico (ecotomografía, pielografía de eliminación, tomografía computada y resonancia nuclear magnética) son inespecíficos. En la cistoscopía se observan lesiones que pueden simular otras enfermedades, por lo que el diagnóstico definitivo es histológico. El manejo puede ser expectante o con antihistamínicos, antiinflamatorios y corticoides. En los casos refractarios al tratamiento médico la cirugía puede ser una alternativa. Reportamos dos casos de pacientes hombres, adultos, con su cuadro de presentación, estudio y manejo (AU)

Eosinophilic cystitis is a low frequency disease, with less than 200 reported cases in the world. It is characterized by a bladder wall inflammation, mainly by eosinophils, with fibrosis and muscle necrosis areas. Its origin seems to be immunological, although the triggers are not well known. Several predispose factor have been described such as allergic diseases, bladder injuries, drugs, infections, etc. It affects patient of all ages, mainly adults. It presents with frecuency, haematuria and suprapubic pain. Other less frequent symptoms are disuria, urinary retention, nicturia, and enuresis. The laboratory study(urinalysis, urinalysis and haemogram) and radiology (ultrasound, intravenous pyelography, computed tomography and nuclear magnetic resonance) are non specific. The lesions observed in the cystoscopy could emulate other diseases, that why the proper diagnostic is the histological analysis. The management could be observation o antihistaminic, anti-inflammatory and corticoid treatment. In refractory cases, surgery is an alternative. In this work, two male adult cases are reported with their symptoms, studies and management (AU)

[Intrauterine device migration to the bladder: four case reports]. / Migración de dispositivo intrauterino a vejiga: aportación de cuatro casos.

The intrauterine device has been commonly used in our population for many years as contraceptive method. One of the complications is the device migration out of the uterus. One of the most uncommon fait of this migration is the bladder, with few reports on the literature. In this work, four cases are reported with their clinical presentation, study and treatment.

Migración de dispositivo intrauterino a vejiga: aportación de cuatro casos / Intrauterine device migration to the bladder: four cases report

El dispositivo intrauterino (DIU) ha sido utilizado en nuestro medio durante muchos años como método anticonceptivo. Una de las complicaciones es la migración fuera del útero, siendo la localización vesical inusual, con escasos casos en la literatura. Presentamos cuatro casos de migración del DIU a la vejiga. Se describe cuadro clínico, estudio y tratamiento (AU)

The intrauterine device has been commonly used in our population for many years as contraceptive method. One of the complications is the device migration out of the uterus. One of the most uncommon fait of this migrationis the bladder, with few reports on the literature. In this work, four cases are reported with their clinical presentation, study and treatment (AU)

Tratamiento laparoscopico de quistes simples sintomáticos / Laparoscopic treatment of symptomatic renal cysts

Objetivo: Los Quistes Renales Simples (QRS) son, en general, asintomáticos y no requieren tratamiento. Para los QRS que ameritan terapéutica quirúrgica, la vía laparoscópica ofrece una opción mínimamente invasiva. El objetivo del presente trabajo es mostrarlos resultados obtenidos con esta técnica quirúrgica en nuestra institución. Métodos: Se analizaron en forma retrospectiva 41 casos de pacientes con QRS sintomáticos que fueron tratados mediante marsupialización laparoscópica; todas realizadas por el mismo equipo quirúrgico entre noviembre de 1992 y mayo de 2006. Las vías de abordaje utilizadas fueron la endoscópica transperitoneal y retroperitoneal. Se registraron datos demográficos y perioperatorios de forma prospectiva en una base de datos. Resultados: En el período comprendido entre noviembre de 1992 y mayo de 2006, 41 pacientes fueron operados con el diagnóstico de QRS. La serie estaba formada por 23 (56%) mujeres y 18 (44%) hombres con una edad promedio de 54 años (rango: 27-74 años). Todos los pacientes tratados presentaban síntomas, siendo el más frecuente dolor. El tamaño promedio de las lesiones fue de 10 cm. (rango: 5-16 cm.). Se realizó abordaje transperitoneal en 24 pacientes (58%) y retroperitoneal en 17 (42%). Dieciséis quistes se localizaron en el riñón izquierdo (39%), 24 en el derecho (54%) y un caso era bilateral (3%). El tiempo operatorio promedio fue de 52 min. (rango: 20-150 min.), la estadía hospitalaria fue de 42 horas (rango: 12-96 h.). Treinta y nueve de las lesiones (95.2%) correspondieron al tipo Bosniak I y 2 (4.8%) al tipo Bosniak II. La patología final confirmó QRS en todas las lesiones. Se presentó una única recidiva que fue resuelta con tratamiento percutáneo. Conclusión: La marsupialización laparoscópica es una excelente opción quirúrgica para el tratamiento de los QRS sintomáticos, siendo este tratamiento realizable y seguro (AU)

Objectives: Simple renal cysts (SRC) are usually asymptomatic and do not require any kind of treatment. Laparoscopy is a reasonable minimally invasive surgical option for symptomatic cysts. Herein, we present the results of the laparoscopic technique for the treatment of symptomatic renal cysts performed in our institution. Methods: Between November 1992 and May 2006, 41 patients with symptomatic renal cysts were laparoscopically treated. The surgical techniques employed were transperitoneal and retroperitoneal. Demographic and surgical data was prospectively collected and analysis retrospectively performed. Results: 41 patients were treated for symptomatic renal cysts in a fourteen year period. 23 (56%) women and 18 (44%) men, with a median age of 54 years. (Range 27-74 years.). All patients in the series were symptomatic. Pain was the most frequent symptom. Median cyst size was 10 cm. (range 5-16 cm.). Transperitoneal approach was performed in 24 patients (58%) and retroperitoneal in 17 (42%). No differences were verified between these approaches. 16 lesions were located at the left renal unit, 24 in the right renal unit (54%) and one case presented bilateral lesions (3%). Median operative time was 52 min. (range 20-150 min.), median hospital stay was 42 hours (range 12-96 h.). 39 cysts (95.2%) were classified as Bosniak’s type I lesions, 2 lesions (4.8%) were type II based on Bosniak’s description. Final pathology confirmed every lesion as a simple renal cyst. There was only one relapse in the series. The latter was treated percutaneously. Conclusions: Laparoscopy is a feasible, safe and advantageous surgical therapeutic option for symptomaticrenal cysts (AU)

[Microdoses of BCG vaccine for prophylaxis in bladder cancer stage T1]. / Microdosis de vacuna BCG como profilaxis en cáncer vesical etapa T1.

A prophylaxis with a minidose of BCG Vaccine (1 mgr.) is performed in vesical instillation during one year, to 108 patients bearing bladder cancer in the stage T1. In the first month the instillations are once a week, each fifteen days the second and third month and then, once a month for one year. An 19.4% of recurrences is obtained with an general average observation time of 37.3 months as well as an important increase of muster populations of T lymphocytes and a positive test of dinitroclorobenzene. As complications we have obtained an inguinal BCG adenitis and in a few cases disury and frequency for two or three days. We conclude that the doses of the BCG vaccine used during the period of one year, is satisfactory in the reduction of recurrences and without important complications.

Adenocarcinoma renal: experiencia clínica y tratamiento / Renal adenocarcinoma: clinical experience and treatment

Revisamos 118 adenocarcinomas renales operados en un período de 20 años, con un seguimiento entre 1 y 20 años. La edad, sexo, sitio anatómico, diámetro tumoral y tiempo sintomático no influyeron en la sobrevida. Esta fue mejor a menor estadio tumoral, existiendo dfiferencias significativas en la sobrevida a 10 años, entre el estadio IIIa (58 por ciento) y IIIb (0 por ciento). Similares diferencias mostró el grado de Skinner (56,3 por ciento el grado bajo y 24,5 por ciento el grado alto) y el grado de Broders (54,5 por ciento el grado bajo y 13,7 por ciento el grado alto), corvirtiéndose ambos en exelentes factores pronósticos. No hubo diferencias estadísticas en la sobrevida según tipo histológico y arquitectura tumoral. El principal tratamiento fue la nefrectomía radical (70 por ciento), no encontándose diferencias según vía de abordaje

Caso clínico: adenocarcinoma mesonefroide de la uretra femenina / Clinic case: mesonephroide adenocarcinoma of the female urethra

Se presenta un caso de adenocarcinoma mesonefroide de la uretra en un paciente de 63 años, tratada con exanteración pelviana anterior logrando una sobrevida de tres años. Se destaca la rareza de este tumor y se revisa la literatura