Avoiding and managing vascular injury during robotic-assisted radical prostatectomy.

There has been an increase in the number of urologic procedures performed robotically assisted; this is the case for radical prostatectomy. Currently, in the USA, 67% of prostatectomies are performed robotically assisted. With this increase in robotic urologic surgery it is clear that there are more surgeons in their learning curve, where most of the complications occur. Among the complications that can occur are vascular injuries. These can occur in the initial stages of surgery, such as in accessing the abdominal cavity, as well as in the intraoperative or postoperative setting. We present the most common vascular injuries in robot-assisted radical prostatectomy, as well as their management and prevention. We believe that it is of vital importance to be able to recognize these injuries so that they can be prevented.

Laparoscopic treatment of genitourinary fistulae.

We present the laparoscopic management of genitourinary fistulae, mainly five types of fistulae, vesicovaginal, ureterovaginal, vesicouterine, rectourethral and rectovesical fistula. Vesicovaginal fistula (VVF) is mostly secondary to urogynecologic procedures in developed countries, abdominal hysterectomy being the main cause of this condition; they represent 84.9% of the genitourinary fistulae (1).Management has been described for this type of fistula, where low success rate (7-12%) has been reported. Ureterovaginal fistulas may occur following pelvic surgery, particularly gynecological procedures, or as a result of vaginal foreign bodies or stone fragments after shock wave lithotripsy, patients typically present with global and persistent urine leakage through the vagina, this causes patient discomfort, distress, and typically protection is used to stay dry, the initial management is often conservative but typically fails. Vesicouterine fistula is a rare condition that only occurs in 1 to 4% of genitourinary fistulas, the primary cause is low segment cesareansection, and clinically presents in three different forms, which will be described. Treatment of this type of fistulae has been conservative,with hormone therapy and surgery, depending on the presenting symptoms. Recto-urinary (rectovesical and rectourethral) fistulae (RUF) are uncommon and can be difficult to manage clinically. Although they may develop in patients with inflammatory bowel disease and perirectal abscesses, rectourethral fistula frequently result as an iatrogenic complication of extirpative or ablative prostate procedures. Rectovesical fistula usually develops following radical prostatectomy, and occurs along the vesicourethral anastomotic line or along the suture line of a posterior "racquet-handle" closure of the bladder. Conservative management consisting of urinary diversion, broad-spectrum antibiotics and parenteral nutrition is often initially attempted but these measures often fail. Timing of repair is often individualized mainly according to the etiology, delay of diagnosis, size of fistula, the first or subsequent repairs, and the general condition of the patient. Different surgical techniques for the management of RUF have been reported. Encouraged by our experience in minimally invasive surgery we present the laparoscopic approach.

Tratamiento laparoscópico de fístulas genitourinarias / Laparoscopic treatment of genitourinary fistulae

Presentamos el manejo laparoscópico de fístulas genitourinarias, principalmente cinco tipos de fístulas, vesico-vaginal, uretero-vaginal, vesico-uterina, recto uretral y recto vesical. La fístula vesico-vaginal (FVV) es secundaria principalmente a procedimientos de uroginecología en los países desarrollados, siendo la principal causa de esta enfermedad la histerectomía abdominal, que representa un 84,9% de las fístulas genitourinarias (1). Se ha publicado el bajo índice (7-12%) de éxito en el manejo de este tipo de fístula. Las fístulas uretero-vaginales pueden presentarse después de cirugía pélvica, especialmente procedimientos ginecológicos, o como resultado de cuerpos extraños en la vagina o fragmentos litiásicos residuales después de la litotricia. Estos pacientes presentan típicamente pérdidas globales y persistentes de orina a través de la vagina, esto provoca molestias y angustia al paciente, el tratamiento inicial es conservador, pero a menudo insuficiente. La fístula vesico-uterina es una enfermedad rara que sólo ocurre entre el 1 al 4% de las fístulas genitourinarias, la causa principal es la cesárea del segmento bajo. Se presenta clínicamente de tres formas diferentes, que se describirán. El tratamiento de este tipo de fístulas ha sido conservador, con la terapia hormonal y cirugía, dependiendo de los síntomas presentes. Las fístulas recto urinarias (recto vesical y recto uretral) (FRU) son poco comunes y pueden ser difíciles de manejar clínicamente. A pesar de que se pueden desarrollar en pacientes con enfermedad inflamatoria intestinal y abscesos peri rectales, las fístulas recto uretrales se producen con frecuencia como una complicación iatrogénica de procedimientos de próstata. La fístula recto vesical generalmente se desarrolla después de prostatectomía radical, y se produce a lo largo de la línea anastomótica vesico-uretral o a lo largo de la línea de sutura de un cierre posterior (raqueta posterior) de la vejiga (...) (AU)

We present the laparoscopic management of genitourinary fistulae, mainly five types of fistulae, vesicovaginal, ureterovaginal, vesicouterine, rectourethral and rectovesical fistula. Vesicovaginal fistula (VVF) is mostly secondary to urogynecologic procedures in developed countries, abdominal hysterectomy being the main cause of this condition; they represent 84.9% of the genitourinary fistulae (1).Management has been described for this type of fistula, where low success rate (7-12%) has been reported. Ureterovaginal fistulas may occur following pelvic surgery, particularly gynecological procedures, or as a result of vaginal foreign bodies or stone fragments after shock wave lithotripsy, patients typically present with global and persistent urine leakage through the vagina, this causes patient discomfort, distress, and typically protection is used to stay dry, the initial management is often conservative but typically fails. Vesicouterine fistula is a rare condition that only occurs in 1 to 4% of genitourinary fistulas, the primary cause is low segment cesareansection, and clinically presents in three different forms, which will be described. Treatment of this type of fistulae has been conservative,with hormone therapy and surgery, depending on the presenting symptoms. Recto-urinary (rectovesical and rectourethral) fistulae (RUF) are uncommon and can be difficult to manage clinically. Although they may develop in patients with inflammatory bowel disease and perirectal abscesses, rectourethral fistula frequently result as an iatrogenic complication of extirpative or ablative prostate procedures. Rectovesical fistula usually develops following radical prostatectomy, and occurs along the vesicourethral anastomotic line or along the suture line of a posterior "racquet-handle" closure of the bladder (...) (AU)

Prospective study of prostate cancer's detection rate at our hospital in Northeast Mexican patients with PSA values between 2.6 y 4 ng/ml.

UNLABELLED: SUMMAR OBJECTIVES: To find the detection rate of prostate cancer (PCa) in our population with PSA values between 2.6 and 4 ng/ml. METHODS: We included 33 consecutive patients with a median age of 66 years, that had a Transrectal Ultrasound (TRUS) guided biopsy with PSA between 2.6-4 ng/ml. Patients were divided into 2 groups. Group 1: patients with normal Digital Rectal Examination (DRE) and Group 2: Patients with DRE with asymmetry not definitive of PCa. EXCLUSION CRITERIA: known history of PCa, intraepithelial neoplasia or Positive DRE. Statistical analysis/ Chi square, t-student and Fischer exact test. RESULTS: Twenty eight percent of the patients had positive biopsy for PCa. Fifty six percent were Gleason 6 and 44% Gleason 7. Group 1 had 59%(20) and Group 2 41% (13) in. In Group 1 16% had positive biopsy for PCa vs 46% in group 2 (p 0.04) RR 3.07. CONCLUSIONS: There are traces that the detection rate in our population could be lower in comparison with what has been reported in the literature. DRE is crucial in the initial evaluation; asymmetry could increase 3 fold the risk of having PCa.

Estudio prospectivo sobre la tasa de detección de cáncer de próstata en nuestro hospital en pacientes del Noroeste de México con antígeno prostático específico entre 2, 6 y 4 ng/ml / Prospective study of prostate cancer’s detection rate at our hospital in Northeast Mexican patients with PSA values between 2.6 y 4 ng/ml

OBJETIVO: Encontrar la tasa de detección de Cáncer Prostático (CaP) en nuestra población con Antígeno Prostático Específico (APE) entre 2.6 y 4 ng/ml.MÉTODOS: Se incluyeron 33 pacientes consecutivos, mediana 66 años. se les realizó biopsia transrectal guiada por ultrasonido (BTR-US) con APE entre 2.6 y 4 ng/ml. Se dividieron en 2 grupos. Grupo 1: pacientes con tacto rectal (TR) normal. Grupo 2: pacientes con ligero aumento en la consistencia de la próstata. Criterios de exclusión: CaP, neoplasia intraepitelial o TR evidente de CaP. Análisis estadístico: t de student, Fischer y X2.RESULTADOS: El 28.3% (9) fue positiva para CaP. El 56% (5) presentó CaP Gleason 6 (3+3) y el 44% (4) Gleason 7 (3+4). El 59% (20) se incluyeron en el Grupo 1 y 41% en el Grupo 2. En el grupo 1 16%(3) presentaron CaP vs 46% (6) del grupo 2 (p 0.04), RR=3.07.CONCLUSIÓN: Hay indicios de que la tasa de detección del CaP en la población de estudio pueda ser menor a lo reportado en la literatura. El TR es importante en la evaluación inicial, pequeñas anormalidades incrementan 3 veces el riesgo de CaP(AU)

OBJECTIVES: To find the detection rate of prostate cancer (PCa) in our population with PSA values between 2.6 and 4 ng/ml.METHODS: We included 33 consecutive patients with a median age of 66 years, that had a Transrectal Ultrasound (TRUS) guided biopsy with PSA between 2.6-4 ng/ml. Patients were divided into 2 groups. Group 1: patients with normal Digital Rectal Examination (DRE) and Group 2: Patients with DRE with asymmetry not definitive of PCa. Exclusion criteria: known history of PCa, intraepithelial neoplasia or Positive DRE. Statistical analysis: Chi square, t-student and Fischer exact test.RESULTS: Twenty eight percent of the patients (9) had positive biopsy for PCa. Fifty six percent (5) were Gleason 6 and 44% (4) Gleason 7 (3+4). Group 1 had 59% (20) and Group 2 41% in. In Group 1 16% (3) had positive biopsy for PCa vs 46% (6) in group 2 (p 0.04) RR 3.07.CONCLUSIONS: There are traces that the detection rate in our population could be lower in comparison with what has been reported in the literature. DRE is crucial in the initial evaluation; asymmetry could increase 3 fold the risk of having PCa(AU)