Flexible ureterorenoscopy (URS): technique and results.

OBJECTIVES: This paper has two main objectives: First, to expose the URS technique used in our Department because there are important differences with respect to others centres published, explaining same aspect that can benefit to the better development of the technique. Second, we present the results of a series of 100 cases. Flexible ureterorenoscopy (Flex URS) has been little used to date, mainly because of the technical difficulties created by the deficient quality of the instruments used, such as ureteroscopes offering scant visibility, poor illumination, a small working channel, deficient quality of the forceps and baskets, etc. METHODS: We present our recent series of flexible URS for the treatment of renal lithiasis. We performes a retrospective analysis of this treatment corresponding to the period between January 2007 and March 2010. In this period we have treated 100 patients. The medium size of the stone treated is 1.5cm (0.5-6cm) and we used ureteroscopic protector sheath in all cases. The lithotripter system used in all cases was Ho:YAG Laser with 200 and 365 micras fibers RESULTS: The stone-free rate (SFR) in the immediate postoperative period was 77% (77/100 patients). Residual stones, defined as stone fragments visualized in the operating room via fluoroscopy and directly with the flexible ureteroscope. Three months after surgery, the SFR was 92.7% (89/96 patients) confirmed by intravenous urography. Regarding complications, we had 5 patients with ureteral lesions during protector sheath pass and 9 patients that presented at the emergency room with pain secondary to the double J catheter. CONCLUSIONS: Flexible URS for of renal lithiasis can be defended in stones measuring up to 2 cm in diameter, based on our treatment algorithm.

URS Flexible. Técnica y resultados / Flexible ureterorenoscopy (URS): technique and results

OBJETIVO: Los objetivos fundamentales de éste trabajo son dos. Por una parte exponer la técnica empleada en nuestro Servicio ya que difiere en algunos aspectos importantes de las publicadas en otros centros, explicando en algunos casos pequeños detalles que pueden ayudar al mejor desarrollo de la técnica. Por otra parte, exponemos los resultados de una serie de 100 casos.MÉTODOS: Presentamos nuestra serie reciente de URS Flex para el tratamiento de la litiasis renal. Para ello hemos revisado de forma retrospectiva éste tratamiento desde Enero de 2007 hasta Marzo de 2010. El tamaño medio de la litiasis tratada es de 1.5cm (0.5-6cms) y en todos los casos utilizamos vainas protectoras del ureteroscopio. La litotricia empleada en todos los casos fue láser de holmio con fibras de 200 y 365 micrasRESULTADOS: El porcentaje de pacientes que quedaron libres de litiasis (stone free rate-SFR) tras la cirugía en el postoperatorio inmediato fue de 77/100 pacientes (77%) contabilizando como resto litiásico fragmentos visualizados mediante la fluoroscopia del quirófano y la visión directa del URS Flex. A los 3 meses de la cirugía 89/96 pacientes (92.7%) estaban libres de litiasis comprobado mediante urografía intravenosa.Respecto a las complicaciones destacar 5 pacientes con lesión ureteral durante la colocación de la vaina protectora y 9 pacientes que acudieron a urgencias en el postoperatorio por molestias secundarias al catéter doble J.CONCLUSIÓN: Como conclusión podemos defender el tratamiento de las litiasis renales mediante URS Flex hasta un tamaño máximo de 2 cm siguiendo nuestro algoritmo terapéutico(AU)

OBJECTIVES: This paper has two main objectives: First, to expose the URS technique used in our Department because there are important differences with respect to others centres published, explaining same aspect that can benefit to the better development of the technique. Second, we present the results of a series of 100 cases. Flexible ureterorenoscopy (Flex URS) has been little used to date, mainly because of the technical difficulties created by the deficient quality of the instruments used, such as ureteroscopes offering scant visibility, poor illumination, a small working channel, deficient quality of the forceps and baskets, etc. METHODS: We present our recent series of flexible URS for the treatment of renal lithiasis.We performes a retrospective analysis of this treatment corresponding to the period between January 2007 and March 2010. In this period we have treated 100 patients.The medium size of the stone treated is 1.5cm (0.5-6cm) and we used ureteroscopic protector sheath in all cases. The lithotripter system used in all cases was Ho:YAG Laser with 200 and 365 micras fibersRESULTS: The stone-free rate (SFR) in the immediate postoperative period was 77% (77/100 patients). Residual stones, defined as stone fragments visualized in the operating room via fluoroscopy and directly with the flexible ureteroscope.Three months after surgery, the SFR was 92.7% (89/96 patients) confirmed by intravenous urography. Regarding complications, we had 5 patients with ureteral lesions during protector sheath pass and 9 patients that presented at the emergency room with pain secondary to the double J catheter.CONCLUSIONS: Flexible URS for of renal lithiasis can be defended in stones measuring up to 2 cm in diameter, based on our treatment algorithm(AU)

Reparación laparoscópica de la fístula vesicovaginal (O’Connor laparoscópico) / Laparoscopic repair of the vesicovaginal fistula (laparoscopic O’Connor repair

Introducción: La causa más frecuente de fístula vesicovaginal en los países desarrollados es la histerectomía, mientras que en países del tercer mundo es el periodo relacionado con el trabajo del parto. Cualquier lesión iatrogénica quirúrgica implica dificultades añadidas de diversa índole en el momento de su resolución. Material y método: Comunicamos el primer caso de fístula vesicovaginal resuelta por vía laparoscópica realizada en nuestro centro. Presentamos el caso de una mujer de 50 años sometida a una histerectomía por vía abdominal, que presenta un cuadro compatible con fístula vesicovaginal. Es remitida a nuestro servicio tras un intento infructuoso de resolución por vía vaginal. Describimos el procedimiento laparoscópico de fistulorrafia vesicovaginal. Resultados: El procedimiento quirúrgico duró aproximadamente 3,5 h. La paciente inició tolerancia oral a las 48 h, recuperó el tránsito intestinal normal al quinto día y fue dada de alta al octavo día postoperatorio. Tras más de un año y medio de seguimiento, la paciente se encuentra asintomática. Conclusiones: La resolución por vía laparoscópica de la fístula vesicovaginal es perfectamente factible y segura y, siempre que reproduzcamos los principios que aplicamos en cirugía abierta, ofrece la misma tasa de éxito con la menor morbilidad posible (AU)

Introduction: The most frequent cause of vesicovaginal fistula in developed countries is hysterectomy, while in the third world it is related to time in labour. Any surgical iatrogenic trauma implies encountering added difficulties of various kinds when repairing the condition. Material and method: We report the first case of vesicovaginal fistula to be resolved laparoscopically in our department. The patient is a woman 50 years of age who had undergone an abdominal hysterectomy 8 months previously, and who presented a syndrome compatible with vesicovaginal fistula. She was referred to our division after an unsuccessful attempt at vaginal repair. We will now describe the laparoscopic vesicovaginal fistula repair procedure. Results: The surgical procedure lasted approximately 3 hours and 30 minutes. The patient began oral intake 48 hours after surgery, normal intestinal transit was restored by the 5thday, a cystography was performed on the 7th day, and the patient was discharged on the8th day. The patient remains asymptomatic after more than a year and a half. Conclusions: Laparoscopic resolution of vesicovaginal fistula is perfectly feasible and safe. If we consistently reproduce the principles applied in the open surgery, it offers the same success rate with the lowest possible morbidity (AU)

Balones parauretrales (Pro-ACT) en la incontinencia urinaria postquirúrgica del cáncer de próstata / Paraurethral adjustable continence therapy devise (Pro-ACT) in the treatment of urinary incontinence after prostatic surgery

OBJETIVO: Las campañas destinadas a la detección precoz del cáncer de próstata han diagnosticado una mayor cantidad de pacientes con enfermedad órgano-confinada susceptibles de tratamiento con intención curativa.Uno de estos tratamientos es la prostatectomía radical que a pesar de los avances técnicos con el advenimiento de la cirugía laparoscópica o robótica sigue teniendo como efecto secundario la aparición de una incontinencia de orina que condiciona la calidad de vida de los pacientes.MÉTODOS/RESULTADOS: Nos hemos basado en la experiencia personal del Servicio de Urología de La Paz describimos la técnica y nuestros resultados comparándolos con una revisión bibliográfica de otras técnicas utilizadas para el tratamiento de la incontinencia post-prostatectomía radical de la base de datos Medline.CONCLUSIONES: La colocación de balones parauretrales ProAct es el tratamiento de elección en nuestro medio para las incontinencias urinarias leves-moderadas postprostatectomía radical por su alta tasa de éxito con escasa morbilidad, facilidad técnica y adecuado costo económico y de recursos(AU)

OBJECTIVES: Prostate cancer early detection campaigns have led to the diagnosis of a greater number of patients with organ-confined disease candidates for intention-to-cure treatment. Radical prostatectomy is one of these treatments; despite the technical advances with the development of laparoscopic or robotic operations it still has urine incontinence as a side effect affecting patient`s quality of life.METHODS/RESULTS: Based on the experience in the Urology Department at Hospital La Paz we describe the technique and our results, comparing with a bibliographic review of other techniques used for the treatment of urinary incontinence after radical prostatectomy from the Medline database.CONCLUSIONS: The insertion of the paraurethral ProACTTM is the treatment of choice for mild-moderate incontinence after radical prostatectomy in our environment due to its high success rate and low morbidity, technical easiness, and adequate cost and resources requirements(AU)

[Renal live donor. Open and laparoscopic experience at La Paz Hospital]. / Donante vivo renal. Experiencia de cirugía abierta y laparoscópica. Hospital La Paz.

UNLABELLED: Laparoscopic live donor nephrectomy is a rare operation in our country because the complexity of the technique and the expansion of the cadaveric donor. We present our open and laparoscopic live donor nephrectomy from 1984. MATERIAL AND METHODS: From 1984 to 2007 we have done 84 live donor nephrectomies; 64 open, 20 laparoscopic surgeries. The transperitoneal approach is preferred in laparoscopy and lumbotomy for the open surgery. RESULTS: In the open technique the operating time is 112 min (70-155), ischaemia time 20 seconds (15-47) and postoperative hospital stay 4,8 days (3-9). Laparoscopic cases, the operating time is 146 min (90-210), ischaemia time 3 min 15 sec (2-3, 25 min) and postoperative hospital stay 3,4 days (2-9). CONCLUSIONS: The laparoscopic live donor nephrectomy is a difficult and demanding technique. It should be done by experienced team in laparoscopic renal surgery. The kidney from a live donor is a very good alternative for the cronic renal failure. It should be offered in our main hospitals.

Donante vivo renal. Experiencia de cirugía abierta y laparoscópica. Hospital La Paz / Renal live donor. Open and laparoscopic experience at La Paz Hospital

La extracción renal laparóscopica es una técnica escasamente implantada en nuestro país, debido principalmente a la dificultad técnica que supone y a la gran cantidad de donante cadáver que encontramos en nuestro medio. Presentamos y analizamos nuestra serie de donante vivo abierto y laparoscópico desde 1984. Material y Métodos: Desde 1984 hasta 2007 se han realizado 84 extracciones renales de donante vivo; 64 por cirugía abierta, 20 laparoscópicas. El abordaje transperitoneal ha sido el elegido en el caso de la laparoscopia y la lumbotomía en la abierta. Resultados: En la técnica abierta el tiempo quirúrgico medio es de 112 min (70-155), el tiempo medio de isquemia caliente es de 20 segundos (15-47) y la estancia media es de 4,8 días (3-9). En los casos realizados por laparoscopia, el tiempo quirúrgico medio es de 146 min (90-210), el tiempo de isquemia caliente es de 3 min y 15 seg (2-3,25) y la estancia media es de 3,4 días (2-9). Conclusiones: El abordaje laparoscópico es una técnica que no está exenta de riesgos y que no deben ser despreciados. Debe ser realizado por equipos con experiencia en cirugía renal laparoscópica. En lo referente al riñón obtenido de donante vivo, sin duda se trata de una magnífica solución para pacientes en estado de insuficiencia renal crónica. Es un recurso que deben ofrecer los principales hospitales de nuestro país (AU)

Laparoscopic live donor nephrectomy is a rare operation in our country because the complexity of the technique and the expansion of the cadaveric donor. We present our open and laparoscopic live donor nephrectomy from 1984. Material and Methods: From 1984 to 2007 we have done 84 live donor nephrectomies; 64 open, 20 laparoscopic surgeries. The transperitoneal approach is preferred in laparoscopy and lumbotomy for the open surgery. Results: In the open technique the operating time is 112min (70-155), ischaemia time 20 seconds (15-47) and postoperative hospital stay 4,8 days (3-9). Laparoscopic cases, the operating time is 146 min (90-210), ischaemia time 3 min 15 sec (2-3,25 min) and postoperative hospital stay 3,4 days (2-9). Conclusions: The laparoscopic live donor nephrectomy is a difficult and demanding technique. It should be done by experienced team in laparoscopic renal surgery. The kidney from a live donor is a very good alternative for the cronic renal failure. It should be offered in our main hospitals (AU)

[Paraurethral adjustable continence therapy device (Pro-ACT) in the treatment of urinary incontinence after prostatic surgery]. / Balones parauretrales (Pro-ACT) en la incontinencia urinaria postqurúrgica del cáncer de próstata.

OBJECTIVES: Prostate cancer early detection campaigns have led to the diagnosis of a greater number of patients with organ-confined disease candidates for intention-to-cure treatment. Radical prostatectomy is one of these treatments; despite the technical advances with the development of laparoscopic or robotic operations it still has urine incontinence as a side effect affecting patient's quality of life. METHODS/RESULTS: Based on the experience in the Urology Department at Hospital La Paz we describe the technique and our results, comparing with a bibliographic review of other techniques used for the treatment of urinary incontinence after radical prostatectomy from the Medline database. CONCLUSIONS: The insertion of the paraurethral ProACT is the treatment of choice for mild-moderate incontinence after radical prostatectomy in our environment due to its high success rate and low morbidity, technical easiness, and adequate cost and resources requirements.

Laparoscopic repair of the vesicovaginal fistula (laparoscopic O'Connor repair).

INTRODUCTION: The most frequent cause of vesicovaginal fistula in developed countries is hysterectomy, while in the third world it is related to time in labour. Any surgical iatrogenic trauma implies encountering added difficulties of various kinds when repairing the condition. MATERIAL AND METHOD: We report the first case of vesicovaginal fistula to be resolved laparoscopically in our department. The patient is a woman 50 years of age who had undergone an abdominal hysterectomy 8 months previously, and who presented a syndrome compatible with vesicovaginal fistula. She was referred to our division after an unsuccessful attempt at vaginal repair. We will now describe the laparoscopic vesicovaginal fistula repair procedure. RESULTS: The surgical procedure lasted approximately 3 hours and 30 minutes. The patient began oral intake 48 hours after surgery, normal intestinal transit was restored by the 5th day, a cystography was performed on the 7th day, and the patient was discharged on the 8th day. The patient remains asymptomatic after more than a year and a half. CONCLUSIONS: Laparoscopic resolution of vesicovaginal fistula is perfectly feasible and safe. If we consistently reproduce the principles applied in the open surgery, it offers the same success rate with the lowest possible morbidity.

[Paraurethral ballon implantation in the treatment of male urinary incontinence. La Paz University Hospital experience]. / Implante de balones parauretrales como tratamiento de la incontinencia urinaria masculina. Experiencia del Hospital Universitario La Paz.

OBJECTIVES: We want to show our experience with paraurethral balloon implantation in the treatment of male urinary incontinence. METHODS: We retrospectively reviewed our series from March 2003 to March 2007, including 69 male patients with urinary incontinence, most of them after radical prostatectomy. RESULTS: 6 patients did not have their first follow-up visit after surgery. Mean follow-up was 22 months (3-48). 57.14% of the patients (36/63 do not need pads, and 12.69% use one safety pad (8/63); therefore 69.83% (44/63) of the patients are dry or use one safety pad. If we stratify patients by incontinence severity, 81.25% of the patients with mild incontinence and 59.25% with moderate incontinence are dry. Nevertheless, only 35% of the patients with severe incontinence are dry (no protection). CONCLUSIONS: In our experience, we believe that paraurethral balloon implantation could be the first therapeutic option for mild and moderate male urinary incontinence.

Implante de balones parauretrales como tratamiento de la incontinencia urinaria masculina. Experiencia del Hospital Universitario la Paz / Paraurethral balloon implantation in the treatment of male urinary incontinence. La Paz University Hospital experience

Objetivo: Queremos expresar nuestra experiencia con el implante de balones parauretrales, como tratamiento de la incontinencia urinaria masculina. Métodos: Hemos revisado de forma retrospectiva nuestra serie desde marzo del 2003 a marzo del 2007, que incluye a 69 pacientes con incontinencia urinaria masculina, la mayoría tras prostatectomía radical. Resultados: 6 pacientes están pendientes de su primera revisión tras la cirugía. Con un seguimiento medio de 22 meses (3-48) el 57.14% de los pacientes (36/63) no precisan protección y el 12.69% usan una compresa de seguridad (8/63), por tanto el 69.83% (44/63) de los pacientes están secos o usan una compresa de seguridad. Si estratificamos a los pacientes según el grado de su incontinencia, el 81,25% de los pacientes con incontinencia leve están secos y el 59.25% de los pacientes en el grupo de incontinencia moderada. Sin embargo, solo el 35% de los pacientes con incontinencia severa están secos (sin protección). Conclusión: Según nuestra experiencia, pensamos que el implante de balones parauretrales podría ser la primera opción terapéutica para la incontinencia urinaria masculina leve y moderada (AU)

Objectives: We want to show our experience with paraurethral balloon implantation in the treatment of male urinary incontinence. Methods: We retrospectively reviewed our series from March 2003 to March 2007, including 69 male patients with urinary incontinence, most of them after radical prostatectomy. Results: 6 patients did not have their first follow-up visit after surgery. Mean follow-up was 22 months (3-48). 57.14% of the patients (36/63 do not need pads, and 12.69% use one safety pad (8/63); therefore 69.83% (44/63) of the patients are dry or use one safety pad. If we stratify patients by incontinence severity, 81.25% of the patients with mild incontinence and 59.25% with moderate incontinence are dry. Nevertheless, only 35% of the patients with severe incontinence are dry (no protection). Conclusions: In our experience, we believe that paraurethral balloon implantation could be the first therapeutic option for mild and moderate male urinary incontinence (AU)

[Ureteroenteric strictures: endourological treatment]. / Estenosis ureterointestinales: tratamiento endourológico.

OBJECTIVES: To review the outcomes of the ureteroenteric strictures treated by endourological techniques in our department, and to compare our long-term results with other reported series with similar follow-up and number of patients. METHODS: We retrospectively reviewed 27 ureteroenteric strictures treated from March 1994 to June 2003, with a mean follow-up of 30.2 months (1 day-53 months). 13 cases underwent ballon dilation + permanent double J catheter (3 of them antegrade) 8 patients underwent endoscopical incision + double J catheter (5 of them with Acucise). RESULTS: 12/21 (57,14%) renal units improved and/or remained stable. We emphasize the absence of peroperative complications except 1 case that had a very poor oncological prognosis and died of septicemia 1 day after balloon dilation. CONCLUSIONS: Endourological treatment of ureteroenteric strictures has demonstrated to provide good fuctional results on the short and mid-term in patients that open surgery, although being the treatment of choice, would be too aggressive due to their disease, age, morbid conditions,....

Estenosis ureterointestinales: tratamiento endourológico / Ureteroenteric strictures: endourological treatment

OBJETIVO: El objetivo de éste estudio hasido revisar el resultado de las estenosis ureterointestinalestratadas de forma endourológica y compararnuestros resultados a largo plazo, con lo publicado enotras series de similares características en tiempo deseguimiento y número de pacientes.MÉTODOS: Desde Marzo de 1994 a Junio de 2003,hemos revisado de forma retrospectiva, el tratamientode 27 estenosis ureterointestinales, con un seguimientomedio de 30.2 meses (1 día - 53 meses).En 6 casos, no se culminó tratamiento endourológico.Se realizaron 13 dilataciones + catéter doble J permanente(3 de forma anterógrada).Tratamos 8 casos con endoureterotomías + catéterdoble J (5 con Acucise*).RESULTADOS: Conseguimos mejorar y/o estabilizar lafunción renal en 12/21 unidades renales (57.14%). Adestacar la ausencia de complicaciones en el intra ypostoperatorio inmediato excepto 1 paciente con dilatación+ c. doble J y muy mal pronóstico oncológico,que falleció al día siguiente por sepsis.CONCLUSIONES: El tratamiento endourológico hademostrado proporcionar buenos resultados funcionalesa corto y medio plazo, en pacientes que por supatología de base, edad, comorbilidad... la cirugíaabierta, sería una opción terapéutica más agresiva,pese a ser el tratamiento de elección en situaciones ideales

OBJECTIVES: To review the outcomes of the ureteroenteric strictures treated by endourological techniques in our department, and to compare our long-term results with other reported series with similar follow-up and number of patients. METHODS: We retrospectively reviewed 27 ureteroenteric strictures treated from March 1994 to June 2003, with a mean follow-up of 30.2 months (1 day-53 months). 13 cases underwent ballon dilation + permanent double J catheter(3 of them antegrade) 8 patients underwent endoscopical incision + double J catheter (5 of them with Acucise®) RESULTS: 12/21(57,14%) renal units improved and/or remained stable. We emphasize the absence of peroperative complications except 1 case that had a very poor oncological prognosis and died of septicemia 1 day after balloon dilation. CONCLUSIONS: Endourological treatment of ureteroenteric strictures has demonstrated to provide good fuctional results on the short and midterm in patients that open surgery, although being the treatment of choice, would be too aggressive due to their disease, age, morbid conditions,…

[Chemoprophylaxis and endoscopical treatment of upper urinary tract tumors recurrences]. / Quimioprofilaxis y tratamiento endoscópico de las recidivas de los tumores del tracto urinario superior.

OBJECTIVES: Upper urinary tract tumors are a rare condition. We review our experience in the diagnosis of upper urinary tract tumors and their recurrences, emphasizing the management of recurrences. METHODS: From January 1980 to June 2002 139 endourological procedures were carried out in 94 patients with the working diagnosis of upper urinary tract tumor. RESULTS: The overall treatment failure rate was 18.7 with ureteroscopy being the least efficient technique. CONCLUSIONS: In our experience, there is an indication for conservative endourological treatment in superficial low grade G1-2 tumors smaller than 2 cm.

Leiomiosarcoma de vena cava inferior: aportación de un nuevo caso y revisión de la literatura / Leimyosarcoma of the interior vena cava: case report and literature review

OBJETIVOS Y MÉTODOS: Bajo el formato de casos clínicos aportamos un nuevo caso de este raro tumor y revisamos la literatura haciendo especial énfasis en su etiología, diagnóstico y tratamiento. RESULTADOS: Con cirugía radical y un corto ciclo de radioterapia la paciente está asintomática y libre de enfermedad a los 12 meses de la intervención. CONCLUSIONES: El leiomiosarcoma de la vena cava inferior es un raro y agresivo tumor que debe ser tratado mediante cirugía agresiva y radical para un correcto control de la enfermedad (AU)

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