Results of simplified urethropexy in the recovery of continence after radical laparoscopic prostatectomy.

PURPOSE: To analyze the effectiveness of simplified urethropexy in the evolution of urinary incontinence after radical laparoscopic prostatectomy. PATIENTS AND METHODS: Between January 2007 and December 2008, 104 patients were included in a randomized trial to assess the effectiveness of simplified urethropexy. The simplified urethropexy technique was performed on conclusion of a urethrovesical anastomosis with running suture and, before cutting the suture material, a suture was applied using the same material with a needle through the pubic tubercle, tightening it and securing it with a Hem-o-lok. Fifty-one patients qualified for the trial in the simplified urethropexy group (group 1) and another 51 in the control group without urethropexy (group 2). Incontinence was defined as the lack of the need for protection for normal life, and the degree of continence was compared at 3, 6, and 12 months after surgery. RESULTS: Surgery lasted 141 minutes in group 1 and 139 in group 2 (NS). There were no secondary complications such as urine retention, osteitis pubis, or bladder perforation. After 3 months, 47.1% of patients in each group declared continence (NS). After 6 months, 72.6% of patients in group 1 and 66.7% in group 2 (P<0.05) declared continence. After 12 months, 92.2% of patients in group 1 and 84.3% in group 2 declared continence. CONCLUSIONS: In our experience, simplified urethropexy is a simple, nontime-consuming technique that shows a slight clinical improvement in continence within 6 and 12 months, without reaching significant differences with the Fisher Test. It would be necessary to perform a trial with a greater number of patients to confirm these data.

Surgical approach to a large left adrenocortical mass with associated tumour thrombosis of the left renal vein: preservation of the ipsilateral kidney.

A sixty-years-old male with diagnosis of a left adrenal mass (146 x 99 x 126 mm) with associated tumour thrombosis of the left renal vein with no clear signs of thrombosis of the inferior vena cava was admitted for elective surgery Finally an adrenalectomy and excision of tumour thrombus preserving the ipsilateral kidney was made. Despite of the complex vascular management, this kind of approaches allow to preserve normal renal function in patients with future nephrotoxic treatment like cisplatin.

Nefroureterectomía abierta y laparoscópica en tumores uroteliales del tracto urinario superior: experiencia inicial / Open and laparoscopic nephroureterectomy for urothelial tumors of the upper urinary tract: initial experience

Objetivo: El desarrollo de la laparoscopia en urología permite el abordaje de tumores del tracto urinario superior con una seguridad oncológica cada vez mayor, aunque todavía se sigue considerando el abordaje abierto como la técnica de elección. Presentamos nuestra experiencia laparoscópica en los últimos 4 años frente a la técnica abierta. Material y métodos: Entre 1995 y 2009 se ha realizado un total de 95 nefroureterectomías por tumor, 70 por vía abierta y 25 laparoscópicas. El abordaje por lumbotomía con desinserción endoscópica del uréter ha sido el más frecuente en cirugía abierta, y en laparoscopia, se ha realizado en todos los casos un acceso transperitoneal, con rodete vesical en la mayoría de los casos (56%). Resultados: En las nefroureterectomías abiertas la media de tiempo quirúrgico fue 205 (130-300) min, con una media de sangrado de 525 (100-1.800) ml y transfusión en 17 (24,2%) ocasiones. La media de estancia fue 8,4 (3-30) días. En las nefroureterectomías laparoscópicas, la media de tiempo quirúrgico fue 189 (120-270) min, con una media de sangrado de 130 (100-400) ml y transfusión en 4 (16%) ocasiones. La media de estancia fue 4,5 (2-28) días. Conclusiones: Los pacientes intervenidos por laparoscopia presentaron una menor tasa de transfusión y una estancia hospitalaria más corta. El control oncológico fue similar con ambas técnicas, si bien la laparoscopia precisa de un mayor seguimiento y mayor número de casos (AU)

Purpose: Advances in urological laparoscopy have increased the oncological safety of this approach for managing upper urinary tract tumours, although the open surgical route remains the method of choice. We present our experience with the laparoscopic approach hover the past four years and compare it to open surgery. Materials and methods: Between 1995 and 2009 a total of 95 nephroureterectomies were carried out for tumours: 70 by open surgery and 25 by laparoscopy. Lumbotomy with endoscopic detachment of the ureter was the most common approach in open surgery, while transperitoneal access was used for laparoscopy in all cases, with laparoscopic bladder cuff resection in most patients (56%). Results: Mean procedure time for the open nephroureterectomies was 205 (130-300) min, with a mean blood loss of 525 (100-1,800) ml and 17 (24.2%) transfusions. The mean hospital stay was 8.4 (3-30) days. Mean procedure time for the laparoscopic nephroureterectomies was 189 (120-270) min, with a mean blood loss of 130 (100-400) ml and 4 (16%) transfusions. The mean hospital stay was 4.5 (2-28) days. Conclusions: The patients who underwent the laparoscopic procedure had a lower transfusion rate and shorter hospital stay. Oncological control was similar for both approaches, although a longer follow-up and a larger series of cases are still needed for the laparoscopic approach (AU)

[Prostatic specific antigen (PS), pro-inflammatory cytokines, and prostatic pathology (benign prostatic hyperplasia and cancer). Relationship with malignancy]. / Antígeno prostático-específico, citoquinas pro-inflamatorias y patología prostática (hiperplasia benigna y cáncer). Relación con la malignidad.

OBJECTIVES: Cancer is a complex process in which cytokines play an important role. Cytokines are low-molecular weight soluble proteins involved in cellular transmission signals and several disorders. Pro-inflammatory cytokines (IL-1, TNF-alpha and IL-6) are involved in prostate cancer development. The aim of this study was to relate the expression (analyzed by Western blot and immuno-histochemistry) of several pro-inflammatory cytokines (IL-1, TNF-alpha and IL-6) with serum levels of prostate-specific antigen (PSA) in normal (no pathological samples) as pathological samples (hyperplasia and cancer), in order to elucidate their possible role in tumor progression. We are also discussing the possible use of these cytokines as a potential therapeutic target. METHODS: This study was carried out in 5 normal, 25 benign prostatic hyperplastic (BPH) and 17 prostate cancer (PC) human prostates. Immunohistochemical and Western blot analysis were performed. Serum levels of PSA were assayed by a PSA DPC immulite assays (Diagnostics Products Corporation, Los Angeles, CA). RESULTS: In BPH, IL-1alpha, IL-6 and TNF-alpha were only expressed in patients with PSA serum levels of 0-4 ng/ml or 4-20 ng/ml, but not in the group >20 ng/ml. In PC these cytokines were only expressed in patients with PSA serum levels >4 ng/ml, although the expression of these cytokines was elevated when PSA levels were >20 ng/ml. CONCLUSIONS: In PC there might be an association between high expression of pro-inflammatory cytokines (IL-1, TNFalpha and IL-6), elevated serum levels of PSA and cancer progression. A better understanding of the biologic mechanism of this association may improve the finding of new targets for therapy in these patients.

[Laparoscopic radical nephrectomy. Procedure, results, and complications]. / Nefrectomía radical laparoscópica. Técnica, resultados y complicaciones.

Surgery is the treatment of choice for clear cell renal carcinoma not responding to chemotherapy, radiotherapy, or immunotherapy. The surgical procedure used has evolved over time in the past 40 years, mainly because of the development and widespread use of diagnostic procedures such as ultrasonography and CT. As a direct consequence, parenchymal-sparing surgery was no longer only used for patients with solitary kidneys and its indication started to be extended to patients with tumors up to 4 cm in diameter, in whom it has been shown to be a safe and effective alternative to radical nephrectomy. The other important milestone in development of renal cancer surgery undoubtedly was the revolution started in the 90s with advent of laparoscopic renal surgery, which has become established over the past 20 years approximately. Laparoscopic surgery initially raised concern about oncological safety, but clinical series with sufficiently long follow-up times and large sample sizes are now available to consider the laparoscopic approach as a reliable procedure. Technological development has caused the laparoscopic technique to be no longer seen as a procedure for the future, but rather as an absolutely current technique which should be implemented in most urology departments. Implementation of any new procedure usually involves a number of complications which we should be prepared to assume, while making every effort to try and prevent them. It is therefore essential to develop, and to implement using common sense, a training program on the procedure. Selection of patients and conditions to be treated is a crucial part of such a program.

Antígeno prostático-específico, citoquinas proinflamatorias y patología prostática (Hiperplasia benigna y Cáncer). Relación con la malignidad / Prostatic specific antigen (PSA), pro-inflammatory cytokines, and prostatic pathology (Benifn prostatic hyperpalsia and cancer). Relationship with malignancy

OBJETIVO: El cáncer es un proceso complejo en el cual las citoquinas juegan un importante papel. Las citoquinas son proteínas solubles de bajo peso molecular, que participan en la transmisión celular y en diferentes patologías. Las citoquinas pro-inflamatorias (IL-1, TNF-α e IL-6) están muy relacionadas con el desarrollo del cáncer de próstata. El objetivo de nuestro trabajo consistió en relacionar la expresión (mediante inmunocitoquímica y Western blot) de diferentes citoquinas pro-inflamatorias (IL-1, TNF-α e IL-6) con los niveles de antígeno prostático específico (PSA) en suero, tanto en pacientes normales (sin patología prostática) como en condiciones patológicas (hiperplasia y cáncer), así como su posible papel en la progresión tumoral. Se discutirá el posible uso de estas citoquinas como diana terapéutica.MÉTODOS: Este estudio se ha realizado en 5 pacientes normales, 25 pacientes diagnosticados de hiperplasia benigna de próstata (HBP) y 17 pacientes de cáncer (CP). Se han realizado análisis de Western blot e inmunocitoquímica. Los niveles séricos de PSA se midieron mediante un “PSA DPC immulite assays” (Diagnostics Products Corporation, Los Angeles, CA).RESULTADOS: En HBP, IL-1α, IL-6 y TNF-α, solo se expresan en pacientes con niveles séricos de PSA de 0-4 ng/ml ó 4-20 ng/ml, pero no en el grupo >20 ng/ml. En cáncer, estas citoquinas se expresan en pacientes con niveles séricos de PSA >4 ng/ml, aunque la expresión de estas citoquinas se eleva considerablemente cuando los niveles de PSA son >20 ng/ml.CONCLUSIONES: En cáncer, podría existir una asociación entre elevada expresión de citoquinas pro-inflamatorias (IL-1, TNF-α e IL-6), elevados niveles séricos de PSA y progresión del cáncer. Un mejor conocimiento de los mecanismos biológicos de esta asociación, podrían ayudarnos a encontrar una posible diana terapéutica para los pacientes con patología prostática(AU)

OBJECTIVES: Cancer is a complex pro-cess in which cytokines play an important role. Cytoki-nes are low-molecular weight soluble proteins involved in cellular transmission signals and several disorders. Pro-inflammatory cytokines (IL-1, TNF-α and IL-6) are involved in prostate cancer development. The aim of this study was to relate the expression (analyzed by Western blot and immuno-histochemistry) of several pro-inflammatory cytokines (IL-1, TNF-α and IL-6) with serum levels of prostate-specific antigen (PSA) in normal (no pathological samples) as pathological samples (hyperplasia and cancer), in order to elucidate their possible role in tumor progression. We are also discussing the possible use of these cytokines as a potential therapeutic target.METHODS: This study was carried out in 5 normal, 25 benign prostatic hyperplastic (BPH) and 17 prostate cancer (PC) human prostates. Immunohistochemical and Western blot analysis were performed. Serum levels of PSA were assayed by a PSA DPC immulite assays (Diag-nostics Products Corporation, Los Angeles, CA)RESULTS: In BPH, IL-1α, IL-6 and TNF-α were only ex-pressed in patients with PSA serum levels of 0-4 ng/ml or 4-20 ng/ml, but not in the group >20 ng/ml. In PC these cytokines were only expressed in patients with PSA serum levels >4 ng/ml, although the expression of these cytokines was elevated when PSA levels were >20 ng/ml.CONCLUSIONS: In PC there might be an association between high expression of pro-inflammatory cytokines (IL-1, TNFα and IL-6), elevated serum levels of PSA and cancer progression. A better understanding of the biologic mechanism of this association may improve the finding of new targets for therapy in these patients(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.

Nefrectomía radical laparoscopica. Técnica, resultados y complicaciones / Laparoscopic radical nephrectomy. Procedure, results, and complications

El tratamiento de elección del carcinoma renal de células claras es un tratamiento quirúrgico, siendo un tumor que no responde a quimioterapia, radioterapia o inmunoterapia. Dicho tratamiento quirúrgico ha ido variando a lo largo del tiempo en los últimos 40 años, debido sobre todo al desarrollo y universalización de los sistemas de diagnóstico como la ecografía y la TAC. Como consecuencia directa, la cirugía conservadora de parénquima deja de ser empleada solamente en pacientes monorrenos y comienza a extenderse sus indicaciones en pacientes con tumores de hasta 4 cm de diámetro, demostrando ser una alternativa segura y eficaz a la nefrectomía radical. El otro hito importante en el desarrollo del tratamiento quirúrgico del cáncer renal es sin duda la revolución iniciada en la década de los 90 con el inicio de la cirugía renal laparoscópica, que ha venido implantándose en los últimos 20 años aproximadamente. En unos comienzos dubitativos en lo que a seguridad oncológica se refiere, actualmente contamos con series lo suficientemente extensas en tiempo de seguimiento y tamaño muestral, como para pensar que se trata de una técnica lo suficientemente fiable. El desarrollo de la tecnología ha ayudado a que la técnica laparoscópica ya no se vea como una técnica de futuro, sino de absoluta actualidad que debería estar implantada en la mayoría de los servicios de Urología. Toda implantación de una nueva técnica suele acarrear una serie de complicaciones que debemos estar dispuestos a asumir y a intentar poner todos los medios a nuestro alcance para evitarlas. Ante esta situación, es fundamental desarrollar un programa de formación y de inicio en la técnica llevado a cabo con sentido común, en el cual la selección de los pacientes y de las patologías a abordar es primordial (AU)

Surgery is the treatment of choice for clear cell renal carcinoma not responding to chemotherapy, radiotherapy, or immunotherapy. The surgical procedure used has evolved over time in the past 40 years, mainly because of the development and widespread use of diagnostic procedures such as ultrasonography and CT. As a direct consequence, parenchymal-sparing surgery was no longer only used for patients with solitary kidneys and its indication started to be extended to patients with tumors up to 4 cm in diameter, in whom it has been shown to be a safe and effective alternative to radical nephrectomy. The other important milestone in development of renal cancer surgery undoubtedly was the revolution started in the 90s with advent of laparoscopic renal surgery, which has become established over the past 20 years approximately. Laparoscopic surgery initially raised concern about oncological safety, but clinical series with sufficiently long follow-up times and large sample sizes are now available to consider the laparoscopic approach as a reliable procedure. Technological development has caused the laparoscopic technique to be no longer seen as a procedure for the future, but rather as an absolutely current technique which should be implemented in most urology departments. Implementation of any new procedure usually involves a number of complications which we should be prepared to assume, while making every effort to try and prevent them. It is therefore essential to develop, and to implement using common sense, a training program on the procedure. Selection of patients and conditions to be treated is a crucial part of such a program (AU)

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)

Open and laparoscopic nephroureterectomy for urothelial tumors of the upper urinary tract: initial experience.

OBJECTIVE: Advances in urological laparoscopy have increased the oncological safety of this approach for managing upper urinary tract tumours, although the open surgical route remains the method of choice. This article describes our experience of the laparoscopic approach over the past four years compared to open surgery. MATERIALS AND METHODS: Between 1995 and 2009 a total of 95 nephroureterectomies were carried out to remove tumours: 70 by open surgery and 25 by laparoscopy. Lumbotomy with endoscopic detachment of the ureter was the most common approach in open surgery, while transperitoneal access was used for laparoscopy in all cases, with laparoscopic bladder cuff resection in most patients (56%). RESULTS: The mean procedure time for open nephroureterectomies was 205 min (130-300), with a mean blood loss of 525 ml (100-1,800) involving 17 (24.2%) transfusions. The mean hospital stay was 8.4 days (3-30). The mean procedure time for the laparoscopic nephroureterectomies was 189 min (120-270), with a mean blood loss of 130 ml (100-400) and 4 (16%) transfusions. The mean hospital stay was 4.5 (2-28) days. CONCLUSIONS: The patients who underwent the laparoscopic procedure had a lower transfusion rate and shorter hospital stay. Oncological control was similar for both approaches, although laparoscopy requires greater monitoring and a larger caseload.

[Laparoscopic nephroureterectomy: new position for the management of distal ureter]. / Nefroureterectomía laparoscópica: nueva posición para el manejo ureteral.

OBJECTIVES: The main challenge of laparoscopic nephroureterectomy is the management of distal ureter, which also will have an important repercussion in the oncological outcome of many cases. We present our experience in such aspect, considering that we performed the last five laparoscopic nephroureterectomies in forced Trendelemburg position, resulting in a more comfortable and safe management of the distal ureter. METHODS: Between August and December 2006 we performed five purely laparoscopic nephroureterectomies with bladder cuff positioning the patient in forced Trendelemburg, a position similar to that of laparoscopic radical cystectomy or prostatectomy. RESULTS: Mean surgical time was 182 minutes (170-210). Mean blood loss was 100 cc and no patient required transfusion. Mean hospital stay was four days. CONCLUSIONS: We believe this position is a good alternative for the management of the distal ureter during the laparoscopic approach. The technique is very similar to open surgery, which continues being the gold standard today.

Nefroureterectomía laparoscópica: nueva posición para el manejo ureteral / Laparoscopic nephroureterectomy: new position for the management of distal ureter

Objetivo: El principal reto de la nefroureterectomía laparoscópica es el manejo del uréter distal que además tendrá una repercusión importante en el resultado oncológico en muchos de los casos. Presentamos nuestra experiencia en este aspecto, teniendo en cuenta que las 5 últimas nefroureterectomías laparoscópicas las hemos realizado con una posición de Trendelemburg forzado, lo que ha supuesto un manejo más cómodo y seguro del uréter distal. Métodos: Desde agosto hasta diciembre de 2006 se han realizado 5 nefroureterectomías con rodete vesical puramente laparoscópico con el paciente en posición de Trendelemburg forzado, muy similar a la posición empleada en las cistectomías o prostatectomías radicales laparoscópicas. Resultados: El tiempo quirúrgico medio es de 182 minutos (170-210). El sangrado medio intraoperatorio es de 100cc y ninguno de estos pacientes ha precisado transfusión. El tiempo hospitalario medio es de 4 días. Conclusiones: Creemos que esta posición es una buena alternativa para el manejo del uréter distal en el abordaje laparoscópico. Se trata de una técnica muy similar a la cirugía abierta, que hoy por hoy continúa siendo el gold Standard (AU)

Objectives: The main challenge of laparoscopic nephroureterectomy is the management of distal ureter, which also will have an important repercussion in the oncological outcome of many cases. We present our experience in such aspect, considering that we performed the last five laparoscopic nephroureterectomies in forced Trendelemburg position, resulting in a more comfortable and safe management of the distal ureter. Methods: Between August and December 2006 we performed five purely laparoscopic nephroureterectomies with bladder cuff positioning the patient in forced Trendelemburg, a position similar to that of laparoscopic radical cystectomy or prostatectomy. Results: Mean surgical time was 182 minutes (170-210). Mean blood loss was 100 cc and no patient required transfusion. Mean hospital stay was four days. Conclusions: We believe this position is a good alternative for the management of the distal ureter during the laparoscopic approach. The technique is very similar to open surgery, which continues being the gold standard today (AU)