Treatment of urachal disorders: The open and laparoscopic surgery approach. / Abordaje laparoscópico de la patología uracal. Nuestra serie.

INTRODUCTION: The present study analyzes cases of urachal abnormalities treated with laparoscopic approach in our hospital. CASE DESCRIPTION: A retrospective descriptive study of urachal disorders with laparoscopic surgery approach performed at our hospital in the period 1999-2015. Patients' clinical data are presented (radiological findings, surgical data, pathology findings, complications and a follow-up of each patient). RESULTS: 7 Adults presented complicated urachal disorders treated laparoscopically. The average age was 43.1 years old (DE ±11). The mean surgical time of laparoscopic management was 154.2 minutes (range 120-240). Mean hospital stay was 4.9 days (DE ±1.1). There were no early or late postoperative complications. CONCLUSION: Laparoscopic removal of urachal remnants is a safe and reproducible technique.

Treatment of urachal disorders: the open and laparoscopic surgery approach

INTRODUCTION: The present study analyzes cases of urachal abnormalities treated with laparoscopic approach in our hospital. CASE DESCRIPTION: A retrospective descriptive study of urachal disorders with laparoscopic surgery approach performed at our hospital in the period 1999-2015. Patients` clinical data are presented (radiological findings, surgical data, pathology findings, complications and a follow-up of each patient). RESULTS: 7 Adults presented complicated urachal disorders treated laparoscopically. The average age was 43.1 years old (DE ±11). The mean surgical time of laparoscopic management was 154.2 minutes (range 120-240). Mean hospital stay was 4.9 days (DE ±1.1). There were no early or late postoperative complications. CONCLUSION: Laparoscopic removal of urachal remnants is a safe and reproducible technique

INTRODUCCIÓN: El objetivo de nuestro trabajo es el análisis de los casos tratados con abordaje laparoscópico de patología uracal en nuestro hospital. DESCRIPCIÓN DE LOS CASOS: Presentamos un estudio descriptivo retrospectivo de la patología uracal tratada laparoscópicamente en nuestro centro desde 1999 al 2015. Se recogieron datos de las variables clínicas de los pacientes (pruebas de imagen, abordaje quirúrgico, anatomía patológica, complicaciones y seguimiento). RESULTADOS: Se detectaron 7 pacientes con patología uracal complicada que fueron tratados con abordaje laparoscópico. La media de edad fue de 43,1±11 años. La media del tiempo quirúrgico fue de 154,2 minutos (120-240). La estancia hospitalaria media fue de 4,9 (DE ±1,1) días. No hubo complicaciones postoperatorias. CONCLUSIÓN: La extirpación laparoscópica de los remanentes uracales es una técnica segura y reproducible

Perioperative complications and surgical oncology outcomes in an initial study from 84 patients submitted to laparoscopic radical cystectomy.

OBJECTIVES: The Gold Standard treatment for a non-metastatic, invasive bladder cancer is an open radical cystoprostatectomy (ORCP). Laparoscopic radical cystoprostatectomy (LRCP) is still an experimental technique in evaluation. We describe our perioperative results defined as surgical and safety oncology variables. METHODS: Every patient who underwent a LRCP between January 2007 and July 2011 in the urology department of the University Public Hospital was evaluated. We perform a descriptive retrospective analysis. RESULTS: We evaluated 84 patients, 72 males and 12 females, with a mean age of 68 (44-79). A Bricker diversion was performed in 80 patients, a Camey II bladder replacement was performed in 3 patients, and a Studer bladder replacement was performed in 1 patient. Seventeen patients (20.23%) presented with previous abdominal surgery, and 6 patients (7.14%) presented a medical history of urological surgery. The mean surgery time was 257.57 minutes (180-420). The mean hospital stay was 11.875 days (standard deviation (SD): 6.28). The onset of tolerance to surgery occurred after 3.7 days (SD: 2.21).The transfusion rate after surgical intervention was 20.2%. The mean number of nodes removed, by means of ilio-obturator lymphadenectomy, was 17 (13-19). There were no intraoperative complications. Early complications (less than 1 month after the intervention) occurred in 28 patients (33.3% ).There were no post-operative deaths. There were late complications (starting one month after the intervention) in 7 patients (8.3% ). CONCLUSIONS: Our study demonstrated that LRCP is safe and reproducible and represents a minimally invasive option for patients with infiltrative bladder cancer.

Complicaciones perioperatorias y resultados oncológicos quirúrgicos en una serie inicial de 84 pacientes sometidos a cistectomía radical laparoscópica / Perioperative complications and surgical oncology outcomes in an initial study from 84 patients submitted to laparoscopic radical cystectomy

OBJETIVO: La cistectomía radical abierta es el estándar oro para el tratamiento del cáncer vesical infiltrante. La cistectomía radical laparoscópica (CPRL) continúa siendo una técnica experimental en evaluación. Describimos nuestros resultados perioperatorios definidos como complicaciones quirúrgicas y variables de seguridad oncológica. MÉTODOS: Revisión retrospectiva de una base de datos de cumplimentación retrospectiva de pacientes intervenidos con CRPL en el periodo comprendido entre enero del 2007 hasta julio del 2011 en un Hospital Universitario público. RESULTADOS: Fueron intervenidos 84 pacientes (72 varones y 12 mujeres), con una edad media de 68 años (44 –79). En 80 pacientes se realizó derivación tipo Bricker, en 3 sustitución vesical tipo Camey II, y en 1 sustitución vesical tipo Studer, de manera extracorpórea en todos ellos. 17 Pacientes (20,23%) presentaban cirugía abdominal previa y 6 (7,14%) presentaban antecedentes de cirugía urológica previa. El tiempo operatorio medio fue de 257,57 minutos (180-420 minutos). El tiempo medio de la estancia hospitalaria fue de 11,875 días (desviación estándar (DE): 6,28). El inicio de la tolerancia fue al 3,7 días (DE: 2,21). La tasa de transfusión posterior a la intervención quirúrgica fue del 20,2%. La mediana de ganglios extirpados, mediante linfadenectomía ilio-obturatriz bilateral, fue de 17 (13-19).No se registraron complicaciones intraoperatorias. 28 pacientes (33,3%) desarrollaron complicaciones en el postoperatorio temprano (primer mes), sin registrarse ningún fallecimiento. 7 Pacientes (8,3%) presentaron complicaciones tardías (a partir del mes de la cirugía). CONCLUSIONES: Nuestra serie pone de manifiesto que la técnica de CPRL es segura y reproducible, por lo que se trata de una alternativa mínimamente invasiva para los pacientes con cáncer vesical infiltrante (AU)

OBJECTIVES: The gold standard treatment for a non-metastatic, invasive bladder cancer is an open radical cystoprostatectomy (ORCP). Laparoscopic radical cystoprostatectomy (LRCP) continues being an experimental technique in evaluation. We describe our perioperative results defined as surgical complications and oncologic safety variables. METHODS: From January 2007 to July 2011, all patients undergoing laparoscopic radical cystoprostatectomy (LRCP) in the Urology Department of a public University Hospital were evaluated. We perform a descriptive retrospective analysis. RESULTS: We evaluated 84 patients, 72 males and 12 females, with a mean age of 68 years (44-79). A Bricker urinary diversion was performed in 80 patients, a Camey II bladder replacement was performed in 3 patients, and a Studer bladder replacement was performed in 1 patient. Seventeen patients (20.23%) presented with past medical history of abdominal surgery, and 6 patients (7.14%) history of urological surgery. The mean operative time was 257.57 minutes (180-420). Mean hospital stay was 11.875 days (standard deviation (SD): 6.28). The onset of oral tolerance occurred at 3.7 days (SD: 2.21). The transfusion rate after surgical intervention was 20.2%. The mean number of nodes removed, by means of iliac-obturator lymph node dissection, was 17 (13-19). There were no intraoperative complications. Complications occurred in 28 patients (33.3%) as early complications (less than 1 month after the intervention). There were no post-operative deaths. There were late complications (starting one month after the intervention) in 7 patients (8.3%). CONCLUSIONS: Our study demonstrated that LRCP is safe and reproducible and represents a minimally invasive option for patients with infiltrative bladder cancer (AU)

Metástasis peneana de adenocarcinoma prostático. A propósito de un caso / Penile metastasis of prostatic adenocarcinoma. Case report

OBJETIVO: Los tumores metastásicos del pene son muy infrecuentes. Suelen ser una manifestación tardía de la neoplasia primitiva, siendo un signo de mal pronóstico.Se aporta un caso de metastatización peneana de rara presentación cuyo tumor primario fue un adenocarcinoma prostático.MÉTODOS: Se presenta un paciente de 77 años que acude a nuestra Institución con hematuria y retención aguda de orina, detectándose durante la exploración múltiples lesiones induradas en el pene. El paciente es sometido a ecografía Doppler, con posterior biopsia peneana, prostática y estudio de extensión. Actualmente en tratamiento con bloqueo hormonal completo.RESULTADOS: El estudio histológico de la biopsia peneana demostró una metástasis peneana procedente de adenocarcinoma prostático.El estudio histológico de la biopsia prostática objetivó un adenocarcinoma grado combinado Gleason 8 (4+4).CONCLUSIÓN: A pesar de las diferentes alternativas terapéuticas posibles, éstas serán con fin paliativo, ya que la supervivencia media de estos pacientes es inferior al año(AU)

OBJECTIVE: Penile metastases are late manifestations of a primary tumor, and they are a sign of poor prognosis.We report a case of a rare presentation: penile metastases from prostate cancer.METHODS: 77 year-old male presented hematuria and acute urinary retention; on physical examination multiple hard lesions were detected. The patient underwent a Doppler ultrasound, subsequent penile and prostate biopsy, and staging study. Currently he is being treated with complete androgen blockade.RESULTS: A histological study of the penile biopsy showed penile metastasis from prostate adenocarcinoma.The histological study of prostate biopsy confirmed Gleason 8 (4 +4) adenocarcinoma.CONCLUSIONS: Despite of the different therapeutic alternatives for treatment of symptomatic penile metastases, it would be with palliative target; due to the median survival of these patients is less than a year(AU)

[Suburethral readjustable sling (Remeex) for the treatment of female urinary incontinence: personal surgical technique]. / Cabestrillo de tension regulable "Remeex" en el tratamiento de la incontinencia urinaria femenina: tecnica quirúrgica personal.

OBJECTIVES: Currently there is not agreement about the adequate tension for each patient with female stress urinary incontinence treated with urethral slings. The adjustable tension sling Remeex (external mechanic regulation) allows adjustment to ideal tension trying to avoid or minimize possible reoperations. The objective of these paper is to describe the components of the Remeex system, its indications, and the surgical technique to implant and adjust it. INDICATIONS: The Remeex system is indicated for female urinary incontinence in cases of urethral hypermobility, fixed urethra, primary sphincteric dysfunction, failure of other incontinence repaired techniques, and urinary incontinence in bladder hyperreflexia. STUDY PROTOCOL: The diagnosis is made with appropriate history and physical examination and completed with voiding cystourethrogram and urodynamic study, urinary tract ultrasound and, optionally, urethrocystoscopy. Remeex prosthesis characteristics: The system has three elements: polypropylene mesh, pressure tensor, and disconnection tool. TECHNIQUE: 1. Anesthesia: It maybe performed under general or spinal anesthesia. 2. Preparation and patient position. 3. Surgical technique step-by-step:--Abdominal access: 4-6 cm suprapubic incision and development of a supra- aponeurotic space to place the pressure tensor.--Vaginal access: longitudinal incision 1 cm from the urethra meatus, dissection of the vesicovaginal plane, and development of the space to place the polypropylene mesh.--Combined abdominal-vaginal access: bilateral punction with a 20 cm suture-passing needle from the abdomen to the vagina and passage of the mesh from the paraurethral espace threading its sutures in the pressure tensor system, and closure of the incisions.--Cystoscopy.--Tension adjustment and postoperative control. CONCLUSIONS: 1. It is an easy to implant system and a reproducible operation. 2. This technique avoids the morbidity of abdominal operations. 3. It allows the readjustment after surgery through a small suprapubic incision under local anesthesia. 4. Good results have been described in the short and mid-term.

Cabestrillo de tensión regulable "remeex" en el tratamiento de la incontinencia urinaria femenina: técnica quirúrgica personal / No disponible

OBJETIVO: Describir los elementos que componen el sistema Remeex femenino, sus indicaciones y la técnica quirúrgica mediante la que se implanta y ajusta adecuadamente. METODO: Indicaciones: Las indicaciones para la utilización del sistema Remeex en incontinencia urinaria femenina son hipermobilidad uretral, uretra fija, disfunción esfinteriana primaria, fracaso de otras técnicas antiincontinencia, incontinencia urinaria en hiperrreflexia vesical1,2. Protocolo de estudio: El diagnóstico se rea- liza con una adecuada historia y exploración física y se completa con uretrocistografía y estudio urodinámico, ecografía urológica y opcionalmente uretrocistoscopia. Características de la prótesis Remeex: Este sistema esta compuesto por los siguientes elementos: malla de poli- propileno, baritensor, introductor y desacoplador. TECNICA: 1. Anestesia El procedimiento puede realizarse bajo anestesia raquídea o general. 2. Preparación y colocación de la paciente. 3. Técnica quirúrgica paso a paso. 1) Acceso Abdominal. Incisión suprapúbica de 4-6 cm, creación de un lecho supraaponeurotico, para alojar el baritensor. 2) Acceso vaginal. Incisión longitudinal a 1cm del meato uretral, disección del plano vésico-vaginal y creación de un lecho que permita colocar la malla de polipropileno. 3) Acceso combinado abdomino-vaginal. Maniobra de puncion mediante una aguja pasahilos de 20 cm en sentido abdominovaginal (bilateral), paso de los dos extremos de la malla a través del espacio parauretral, enhebrado de los hilos en el sistema baritensor de la prótesis Remeex y cierre de las incisiones vaginales y abdominales. 3. Uretrocistoscopia - Ajuste de tensión y control postoperatorio. CONCLUSIONES: 1. Es una técnica reproducible y el sistema es fácil de implantar. 2. Esta técnica evita la morbilidad de las técnicas abdominales. 3. Permite realizar. 4. Permite reajuste al cabo del tiempo con anestesia local a través de una pequeña incisión suprapúbica. 5. Se han descrito buenos resultados a corto y medio plazo (AU)

OBJECTIVES: Currently, there is not agreement about the adequate tension for each patient with female stress urinary incontinence treated with urethral slings. The adjustable tension sling Remeex (external mechanic regulation) allows adjustment to ideal tension trying to avoid or minimize possible reoperations. The objective of these paper is to describe the components of the Remeex system, its indications, and the surgical technique to implant and adjust it. METHODS: Indications: The Remeex system is indicated for female urinary incontinence in cases of urethral. hypermobility, fixed urethra, primary sphincteric dysfunction, failure of other incontinence repaired techniques, and urinary incontinence in bladder hyperreflexia. Study protocol: The diagnosis is made with appropriate history and physical examination and completed with voiding cystourethrogram and urodynamic study, urinary tract ultrasound and, optionally, urethrocystoscopy. Remeex prosthesis characteristics: The system has three elements: polypropylene mesh, pressure tensor, and disconnection tool. TECHNIQUE: 1. Anesthesia: It maybe performed under general or spinal anesthesia. 2. Preparation and patient position. 3. Surgical technique step-by-step: - Abdominal access: 4-6 cm suprapubic incision and development of a supra- aponeurotic space to place the pressure tensor. - Vaginal access: longitudinal incision 1 cm from the urethra meatus, dissection of the vesicovaginal plane, and development of the space to place the polypropylene mesh. - Combined abdominal-vaginal access: bilateral punction with a 20 cm suture-passing needle from the abdomen to the vagina and passage of the mesh from the paraurethral espace threading its sutures in the pressure tensor system, and closure of the incisions. - Cystoscopy. - Tension adjustment and postoperative control. CONCLUSIONS: 1. It is an easy to implant system and a reproducible operation. 2. This technique avoids the morbidity of abdominal operations. 3. It allows the readjustment after surgery through a small suprapubic incision under local anesthesia. 4. Good results have been described in the short and midterm (AU)