Robotic surgery for locally advanced T4 rectal cancer: feasibility and oncological quality.

For T4 rectal tumours and local recurrences (LR) of rectal cancer, a radical resection beyond TME, sometimes by multi-visceral resection, is important to obtain safe margins and improve survival. The use of the laparoscopic approach (LA) for these cases is still controversial and associated with a high rate of conversion. However, robotic surgery might offer some advantages that can overcome some of the limitations of LA. Therefore, we aimed to analyse the postoperative outcomes and medium-term oncological results of robotic surgery for locally advanced rectal cancer (pathological T4) and LR. A retrospective analysis was performed including patients who had undergone robotic rectal resection in a single institution over an 11-year period, and had a T4 tumour confirmed in the pathological report. Primary endpoint was to analyse postoperative complications (30-day) and the rate of conversion. Secondary endpoints include pathological assessment of the quality of the specimen, local recurrence and survival [2-year disease-free survival (DFS) and overall survival (OS)]. A total of 41 patients were analysed, including a total of 24 patients (60%) that required a multivisceral resection. The median distance from the tumour to the anorectal junction was 7 (4-12) cm. Conversion to open surgery was necessary in 2 cases (5%). The overall morbidity rate was 78% (n = 32), with 37% of major complications, most of them urinary (n = 7). Median length of hospital stay (LOS) was 13 (7-27) days. The 30-day mortality rate was 7% (n = 3). An R0 resection was achieved in 85.4% of the cases (n = 35) due to 6 cases of the positive circumferential resection margin. 2-year disease-free survival (DFS) and overall survival (OS) for the T4 tumours were 72% and 85%, respectively. There were 8 cases of local recurrence (22.2%); 6 of them met the selection criteria for salvage surgery. Robotic surgery for locally advanced T4 rectal cancer and multi-visceral resections is safe and feasible, with a low rate of conversion and an acceptable rate of postoperative morbidity in this subgroup of patients. Oncological results have shown to be comparable with the laparoscopic series published, preserving a good quality of the resected specimen. However, comparative studies and a longer follow-up period is needed to confirm the oncologic findings and to support the general adoption of the robotic system for these complex interventions.

Arterial Fistulas in Urinary Diverted Patients: A Report of 5 Cases.

OBJECTIVE: Arterio-urinary fistulae are a rare but potentially lethal complication that may arise after pelvic surgery, such as radical cystectomy. Historically, open surgery was the gold standard treatment, but currently endovascular treatment has gained prominence. METHODS: We report our centre experience in endovascular treatment of cystectomy-related arterial fistulae and review the reported literature on the topic. During the postoperative period of radical cystoprostatectomy five patients presented different ranges of haematuria, and one presented rectal bleeding, four of them with haemodynamic instability. An urgent three-phase computed tomography was performed, showing active bleeding in 2 patients, while the rest of the patients presented indirect signs of fistulae. An angiography was performed, showing contrast extravasation in 60% of the cases and vessel wall irregularity in 40%. Five arteriourinary fistulae and one arterioenteric fistula were urgently treated with a covered stent placement, sealing the site of the fistula in the artery. RESULTS: Immediate results were satisfactory in all cases; however, one patient died secondary to fistula-related causes 15 days post-treatment. No stent thrombosis or rebleeding have been registered during follow-up. In this review, reported results and complications after covered stent placement are shown, and controversial topics such as antibiotic coverage and antithrombotic treatment after endovascular treatment are also reviewed.

[Complications and mortality after radical nephrectomy in a low-volume hospital.] / Complicaciones y mortalidad tras nefrectomía radical en un hospital de bajo volumen quirúrgico.

OBJECTIVES: To evaluate the complications and 30-day mortality rates following open radical nephrectomy and laparoscopic radical nephrectomy using the Clavien-Dindo classification system in a low-volume hospital. METHODS: We conducted a retrospective analysis of 263 patients who underwent open or laparoscopic radical nephrectomy (1996-2016) in our local district general hospital. Postoperative complications and 30- day mortalities were evaluated using the Clavien-Dindo classification. The predictors of postoperative complications were assessed using multivariate logistic regression analysis. RESULTS: We found that, compared to open radical nephrectomy, laparoscopic resulted in a significantly longer operative time (112.6±41 vs 199.3±61 minutes, p <  0.01) and a shorter hospital stay (8.5±2.4 vs 5.7±3 days, p < 0.001). The most common complications were bleeding or hematoma (4.9%) and problems associated with the wound (4.5%). There were no significant differences between the ORN and LRN groups in terms of complications based on the Clavien-Dindo classification. On multivariate analysis, a longer operative time (Odds Ratio, 1.009; 95% confidence interval, 1.002- 1.015; p = 0.010) and higher body mass index (Odds Ratio, 0.898; 95% confidence interval, 0.822-0.981; p = 0.017) were found to be significant predictors of complications after nephrectomy. CONCLUSIONS: Our study demonstrated that complication and 30-day mortality rates were low. There was a greater number of low-grade complications, and there were no significant differences in these rates between open and laparoscopic radical nephrectomy. A longer operative time and a higher BMI were predictors of possible complications. We provide additional evidence to support the feasibility of performing open or laparoscopic radical nephrectomy in low-volume hospitals.

OBJETIVOS: Evaluar la tasa de complicaciónes y mortalidad a 30 días después de nefrectomía radical abierta o laparoscópica utilizando el sistema de clasificación Clavien-Dindo en un hospital de bajo volumen quirúrgico.MÉTODOS: Realizamos un análisis retrospectivo de 263 pacientes a los que se les practicó nefrectomía radical laparoscópica o abierta (1996-2016). Las complicaciones postoperatorias y la mortalidad a 30 días fueron evaluadas utilizando la clasificación de Clavien-Dindo. Analizamos los factores predictores de complicaciones postoperatorias mediante análisis multivariado con regresión logística. RESULTADOS: Comparado a la nefrectomía abierta, la nefrectomía radical laparoscópica resultó en un mayor tiempo quirúrgico (112,6±41 vs 199,3±61 minutos, p < 0,01) y una menor estancia hospitalaria (8,5±2,4 vs 5,7±3 días, p <  0,001). Las complicaciones más frecuentes fueron sangrado o hematoma (4,9%) y problemas asociados a la herida (4,5%). No hubo diferencias significativas entre cirugía abierta o laparoscópica evaluando las complicaciones mediante la clasificación de Clavien-Dindo. En el análisis multivariado, un tiempo quirúrgico prolongado (Odds Ratio, 1.009; 95% intervalo de confianza, 1.002-1.015; p = 0,010) y un mayor índice de masa corporal (Odds Ratio, 0,898; 95% intervalo de confianza, 0,822-0,981; p = 0,017) fueron predictores significativos de complicaciones. CONCLUSIONES: Nuestro estudio muestra que la tasa de complicaciones y mortalidad a 30 días fueron bajas, con un mayor número de complicaciones de bajo grado y sin diferencias significativas entre cirugía abierta o laparoscópica. Un tiempo quirúrgico prolongado y mayor índice de masa corporal fueron predictores de posibles complicaciones. Aportamos evidencia adicional apoyando la realización de nefrectomía radical laparoscópica o abierta en hospitales de bajo volumen quirúrgico.

Complicaciones y mortalidad tras nefrectomía radical en un hospital de bajo volumen quirúrgico / Complications and mortality after radical nephrectomy in a low-volume hospital

Objetivos: Evaluar la tasa de complicaciónes y mortalidad a 30 días después de nefrectomía radical abierta o laparoscópica utilizando el sistema de clasificación Clavien-Dindo en un hospital de bajo volumen quirúrgico. Métodos: Realizamos un análisis retrospectivo de 263 pacientes a los que se les practicó nefrectomía radical laparoscópica o abierta (1996-2016). Las complicaciones postoperatorias y la mortalidad a 30 días fueron evaluadas utilizando la clasificación de Clavien-Dindo. Analizamos los factores predictores de complicaciones postoperatorias mediante análisis multivariado con regresión logística. Resultados: Comparado a la nefrectomía abierta, la nefrectomía radical laparoscópica resultó en un mayor tiempo quirúrgico (112,6 ± 41 vs 199,3 ± 61 minutos, p < 0,01) y una menor estancia hospitalaria (8,5 ± 2,4 vs 5,7 ± 3 días, p < 0,001). Las complicaciones más frecuentes fueron sangrado o hematoma (4,9%) y problemas asociados a la herida (4,5%). No hubo diferencias significativas entre cirugía abierta o laparoscópica evaluando las complicaciones mediante la clasificación de Clavien-Dindo. En el análisis multivariado, un tiempo quirúrgico prolongado (Odds Ratio, 1.009; 95% intervalo de confianza, 1.002-1.015; p = 0,010) y un mayor índice de masa corporal (Odds Ratio, 0,898; 95% intervalo de confianza, 0,822-0,981; p = 0,017) fueron predictores significativos de complicaciones. Conclusiones: Nuestro estudio muestra que la tasa de complicaciones y mortalidad a 30 días fueron bajas, con un mayor número de complicaciones de bajo grado y sin diferencias significativas entre cirugía abierta o laparoscópica. Un tiempo quirúrgico prolongado y mayor índice de masa corporal fueron predictores de posibles complicaciones. Aportamos evidencia adicional apoyando la realización de nefrectomía radical laparoscópica o abierta en hospitales de bajo volumen quirúrgico

Objectives: To evaluate the complications and 30-day mortality rates following open radical nephrectomy and laparoscopic radical nephrectomy using the Clavien-Dindo classification system in a low-volume hospital. Methods: We conducted a retrospective analysis of 263 patients who underwent open or laparoscopic radical nephrectomy (1996-2016) in our local district general hospital. Postoperative complications and 30-day mortalities were evaluated using the Clavien-Dindo classification. The predictors of postoperative complications were assessed using multivariate logistic regression analysis. Results: We found that, compared to open radical nephrectomy, laparoscopic resulted in a significantly longer operative time (112.6 ± 41 vs 199.3 ± 61 minutes, p < 0.01) and a shorter hospital stay (8.5 ± 2.4 vs 5.7 ± 3 days, p < 0.001). The most common complications were bleeding or hematoma (4.9%) and problems associated with the wound (4.5%). There were no significant differences between the ORN and LRN groups in terms of complications based on the Clavien-Dindo classification. On multivariate analysis, a longer operative time (Odds Ratio, 1.009; 95% confidence interval, 1.002-1.015; p = 0.010) and higher body mass index (Odds Ratio, 0.898; 95% confidence interval, 0.822-0.981; p = 0.017) were found to be significant predictors of complications after nephrectomy. Conclusions: Our study demonstrated that complication and 30-day mortality rates were low. There was a greater number of low-grade complications, and there were no significant differences in these rates between open and laparoscopic radical nephrectomy. A longer operative time and a higher BMI were predictors of possible complications. We provide additional evidence to support the feasibility of performing open or laparoscopic radical nephrectomy in low-Volume hospitals

Carcinoma urotelial de pelvis renal en riñón ectópico presacro / Transitional Cell Carcinoma of the Renal Pelvis on Presacral Ectopic Kidney

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Bladder endometriosis and endocervicosis: presentation of 2 cases with endoscopic management and review of literature.

Urinary tract endometriosis and endocervicosis are an uncommon pathologic finding, with a common embryological origin. We present 2 cases of female patients with bladder mass. The first one was a finding of a nodular formation in the bladder during study of a nonviable foetus and the second was an incidental finding of a neoformation in the fundus of the bladder during the realization of an ultrasound. In both cases, we performed a surgical management with transurethral resection. Histopathological examination revealed a bladder endometrioma in the first case and endocervicosis with associated endometriosis in the second.

Microvejiga tras BCG / Microbladder after the BCG therapy

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[Mondor's disease vs. sclerosing lymphangitis of the penis]. / Enfermedad de Mondor versus linfangitis esclerosante de pene.

OBJECTIVE: Two cases of Mondor's disease and one case of non-venereal sclerosing lymphangitis of the penis are reviewed. We analyze the differences between both processes based on the existing literature about these pathologies. METHOD: Two clinical cases of Mondor's disease and other one with non-venereal sclerosing lymphangitis are reported. RESULTS: Due to the spontaneous and good outcome of both pathologies, the diagnosis and follow-up are difficult in both processes. CONCLUSIONS: Doppler ultrasound has a great importance for the differential diagnosis between both processes. The treatment is based on steroidal anti-inflammatories as well as sexual abstinence.

Enfermedad de Mondor versus linfangitis esclerosante de pene / Mondor´s disease vs. sclerosing lymphangitis of the penis

Objetivo: Resaltar la diferencia entre Enfermedad de Mondor y Linfangitis Esclerosante del Pene mediante el análisis de tres casos clínicos y la revisión de la literatura existente. Métodos: Describimos dos casos clínicos compatibles con el diagnóstico de enfermedad de Mondor y otro compatible con Linfangitis. Resultado: La buena y muchas veces espontánea resolución de estas dos patologías dificulta el diagnóstico y seguimiento de estos pacientes. Conclusiones: La abstinencia sexual es una de las medidas más efectiva para la pronta resolución de ambos procesos. Para el diagnóstico diferencial entre ambas entidades es de gran utilidad el eco-doppler peneano. El tratamiento farmacológico principal se basa en antiinflamatorios (AU)

Objective: Two cases of Mondor's disease and one case of non-venereal sclerosing lymphangitis of the penis are reviewed. We analyze the differences between both processes based on the existing literature about these pathologies. Method: Two clinical cases of Mondor's disease and other one with non-venereal sclerosing lymphangitis are reported. Results: Due to the spontaneous and good outcome of both pathologies, the diagnosis and follow-up are difficult in both processes. Conclusions: Doppler ultrasound has a great importance for the differential diagnosis between both processes. The treatment is based on steroidal anti-inflammatories as well as sexual abstinence (AU)

[Testicular seminoma in a patient with Kartagener's syndrome]. / Seminoma en paciente con Síndrome de Kartagener.

OBJECTIVE: To present the association between Seminoma and Kartagener's Syndrome (KS), and its relation with infertility. METHODS: We report one case of Seminoma in a patient with Kartagener's Syndrome, focussing on the possible relation between both pathologies and fertility. Bibliographic references are discussed. RESULTS: Orchyectomy was performed on a patient with Kartagener's Syndrome and testicular tumour. The pathology result was Seminoma. Azoospermia was obtained twice in the post operative espermiogram, not being easy to establish the implication of each pathology (KS or Seminoma) in infertility. CONCLUSIONS: A patient with KS and Seminoma plus azoospermia is reported, with a great outcome from the oncological point of view. Bibliographic references are described. The association between KS and Seminoma is exceptional in the literature.

Vasovasostomía: nuestra experiencia / Vasovasostomy: our experience

OBJETIVO: Desde agosto de1997 hasta diciembre de 2004 hemos realizado 47 vasovasostomíascon la finalidad de revertir la vasectomía, de las que conocemos el resultado de 42, con un seguimiento de al menos 6 meses. La edad media ha sido de 40`7 años y la de sus parejas de 30`8 años.MÉTODO: Los 22 primeros casos se realizaron en 2 planos y 20 en solo uno. En todos los casos se utilizó microscopio óptico.RESULTADOS: La tasa global de presencia de espermatozoidesen el eyaculado ha sido de 71`42% y la de embarazo a término del 32`45%, no encontrando diferencias según la técnica empleada.CONCLUSIONES: Mejor pronóstico a menor edad del paciente y en las recanalizaciones precoces, en cuanto a la presencia de espermatozoides. El índice de embarazoses similar entre las recanalizaciones precoces o tardías

OBJECTIVES: From August 1997 to December 2004 we performed 47 vasovasostomies for vasectomy reversal in the same number of patients. Only 42 patients are available for follow-up, with a mean follow-up of at least six months. Mean age is 40.7 years for the patients and 30.8 for the couples. METHODS: The two-layer technique was applied under microscope magnification in the first 22 patients; single layer technique was performed in the others. RESULTS: Overall spermatozoid patency rate was 71.42%, and pregnancy rate was 32.45%. Surgical technique did not have influence on results. CONCLUSIONS: Better prognosis is expected in young men; the longer the interval between vasectomy and reversal, the lower the patency rate. Regarding pregnancy rate, it is not influenced by delay of reversal