Purely robotic ileocystoplasty in children: why not? First case in Spain. / Ampliación vesical pediátrica mediante abordaje robótico puro: ¿por qué no? Primer caso en España.

INTRODUCTION: We present the first case of pediatric ileocystoplasty using a purely robotic approach in Spain. CASE REPORT: 12-year-old male with neurogenic bladder of low capacity and high pressures. After failure of conservative treatment, bladder augmentation with ileum patch was decided upon. Surgery was carried out using a purely robotic approach with 4 robotic and 2 accessory ports. Surgery duration was 380 minutes in total, without intraoperative complications. He was discharged 2 weeks after cystographic control. During 32-months follow-up, he has remained continent. DISCUSSION: The minimal invasion, surgical precision and ergonomics made the robotic approach an optimal option for complex surgical techniques. Given the little availability of the robot and the low pediatric volume, its standardization is a challenge. Our accumulated experience is consistent with the current literature and shows promising surgical and esthetic results. We hope this case report will contribute to the divulgation and progressive introduction of robotic surgery in our daily lives.

INTRODUCCION: Presentamos el primer caso de abordaje robótico pediátrico puro en España. CASO CLINICO: Varón de 12 años con vejiga neurógena de escasa capacidad y altas presiones sin respuesta al tratamiento conservador, abogando por una ileocistoplastia de aumento. Se lleva a cabo un abordaje robótico puro con 4 puertos robóticos y 2 accesorios, de 380 minutos de duración total sin complicaciones intraoperatorias. Es dado de alta a las 2 semanas previo control cistográfico. Tras 32 meses de seguimiento continúa continente. COMENTARIOS: La mínima invasión, mayor precisión y ergonomía del abordaje robótico, hacen de éste una opción óptima para técnicas quirúrgicas complejas. Dada la difícil disponibilidad del robot y el escaso volumen pediátrico, resulta un reto su normalización en este campo. Nuestra experiencia coincide con la literatura, mostrando resultados quirúrgicos y estéticos prometedores. Esperamos este reporte contribuya a la difusión e introducción progresiva de la cirugía robótica en nuestra rutina.

Ampliación vesical pediátrica mediante abordaje robótico puro: ¿por qué no? Primer caso en España / Purely robotic ileocystoplasty in children: why not? First case in Spain

Introducción: Presentamos el primer caso de abordaje robóticopediátrico puro en España. Caso clínico. Varón de 12 años con vejiga neurógena de escasacapacidad y altas presiones sin respuesta al tratamiento conservador,abogando por una ileocistoplastia de aumento. Se lleva a cabo un abordaje robótico puro con 4 puertos robóticos y 2 accesorios, de 380 minutosde duración total sin complicaciones intraoperatorias. Es dado de alta alas 2 semanas previo control cistográfico. Tras 32 meses de seguimientocontinúa continente. Comentarios: La mínima invasión, mayor precisión y ergonomíadel abordaje robótico, hacen de este una opción óptima para técnicasquirúrgicas complejas. Dada la difícil disponibilidad del robot y el escasovolumen pediátrico, resulta un reto su normalización en este campo.Nuestra experiencia coincide con la literatura, mostrando resultados quirúrgicos y estéticos prometedores. Esperamos este reporte contribuya a ladifusión e introducción progresiva de la cirugía robótica en nuestra rutina.(AU)

Introduction: We present the first case of pediatric ileocystoplastyusing a purely robotic approach in Spain. Case report: 12-year-old male with neurogenic bladder of low capacity and high pressures. After failure of conservative treatment, bladderaugmentation with ileum patch was decided upon. Surgery was carriedout using a purely robotic approach with 4 robotic and 2 accessoryports. Surgery duration was 380 minutes in total, without intraoperativecomplications. He was discharged 2 weeks after cystographic control.During 32-months follow-up, he has remained continent. Discussion. The minimal invasion, surgical precision and ergonomics made the robotic approach an optimal option for complex surgicaltechniques. Given the little availability of the robot and the low pediatricvolume, its standardization is a challenge. Our accumulated experienceis consistent with the current literature and shows promising surgical andesthetic results. We hope this case report will contribute to the divulga-tion and progressive introduction of robotic surgery in our daily lives.(AU)

Immunomagnetic quantification of circulating tumoral cells in patients with prostate cancer: clinical and pathological correlation.

OBJECTIVES: To detect and enumerate circulating prostatic tumor cells (CTC) in the peripheral blood of patients with prostate cancer (PC) and study the relationship between CTCs and clinical-pathological parameters. METHODS: Prospective three-arm study: 26 patients (p) with localised PC (LPC); 24 P with metastatic PC (MPC) and 30 healthy volunteer controls. A single 7.5 ml sample of peripheral blood was retrieved; CTCs were isolated using an immunomagnetic method based on the CellSearch system (Veridex). CTCs were identified as nucleated cells negative for CD45 (leukocytes) and positive for cytokeratins. (8, 18 y 19) The relationship between CTC numbers and PSA levels, Gleason score and TNM classification was studied. RESULTS: Only 10% of the healthy controls had 1 CTC/7.5 mL, none of the patients with localised PC had more than 3 CTCs (88% < or = 2 CTCs), and patients with MPC had significantly higher CTC levels [m: 29 (1-178)] compared with the other two groups (P: 0.000). A positive correlation was demonstrated between the CTC count and PSA levels, tumor size, and presence or absence of enlarged lymph nodes. Gleason score was the only parameter that did not show any correlation with CTC levels, and although the number of CTCs was higher in patients with visceral metastases [m: 297 (0-416)] compared with bone metastases patients [m: 68 (9.5-168)] , these differences were not significant. CONCLUSIONS: Immunomagnetic analysis permits CTCs to be enumerated in peripheral blood and could be a possible way to correctly stage and make a reasonable prognosis of metastatic disease.

Cuantificación inmunogenética de células tumorales circulantes en pacientes con cáncer de próstata: correlación clínica y patológica / Immunomagnetic quantification of circulating tumoral cells in patients with prostate cáncer: clinical and pathological correlation

OBJETIVOS: Detección y cuantificación de células tumorales prostáticas circulantes (CTC) en sangre periférica de pacientes con cáncer de próstata (CP) y estudiar la relación de las CTCs con los parámetrosclínico-patológicos.MÉTODOS: Estudio prospectivo con tres brazos: 26 pacientes (p) con CP localizado (CPL); 24p con CP metastático(CPM) y 30 controles voluntarios sanos. Se extrajouna única muestra de 7,5 mL de sangre periférica y se aislaron las CTC según un método inmunomagnéticobasado en el sistema CellSearch (Veridex). Las CTCs fueron identificadas como células nucleadas negativas para el CD45 (leucocitos) y positivas para las citoqueratinas(8, 18 y 19). Se estudiaron las relaciones del número de CTCs con los niveles de PSA, Gleason y clasificación TNM.RESULTADOS: Sólo el 10% de controles sanos tenían 1 CTC/7,5 mL, ninguno de los pacientes con CP localizadotuvo más de 3 CTC (88% ≤ 2 CTC) y aquellos con CPM presentaban niveles de CTCs significativamente más altos [m: 29 (1-178)] comparados con los otros dos grupos (P: 0.000). Se demostró una correlación positiva entre el número de CTC y cifras de PSA, con el tamaño del tumor y con la presencia o no de adenopatías.El grado Gleason fue el único parámetro que no mostró correlación con los niveles de CTC y aunque el número de CTC fue mayor en aquellos con metástasis viscerales [m: 297 (0-416)] comparado con los que tenían metástasis óseas [m: 68 (9,5-168)] estas diferenciasno fueron significativas.CONCLUSIONES: El análisis inmunomagnético nos permite cuantificar las CTC en sangre periférica y podríapresentar una posibilidad para lograr una estadificacióncorrecta y estimar un pronóstico adecuado de la enfermedad metastática(AU)

OBJECTIVES: To detect and enumerate circulating prostatic tumor cells (CTC) in the peripheral blood of patients with prostate cancer (PC) and study the relationship between CTCs and clinical-pathological parameters. METHODS: Prospective three-arm study: 26 patients (p) with localised PC (LPC); 24 P with metastatic PC (MPC) and 30 healthy volunteer controls. A single 7.5 ml sample of peripheral blood was retrieved; CTCs were isolated using an immunomagnetic method based on the CellSearch system (Veridex). CTCs were identified as nucleated cells negative for CD45 (leukocytes) and positive for cytokeratins. (8, 18 y 19) The relationship between CTC numbers and PSA levels, Gleason score and TNM classification was studied.RESULTS: Only 10% of the healthy controls had 1 CTC/7.5 mL, none of the patients with localised PC had more than 3 CTCs (88% ≤ 2 CTCs), and patients with MPC had significantly higher CTC levels [m: 29 (1-178)] compared with the other two groups (P: 0.000). A positive correlation was demonstrated between the CTC count and PSA levels, tumor size, and presen-ce or absence of enlarged lymph nodes. Gleason score was the only parameter that did not show any correlation with CTC levels, and although the number of CTCs was higher in patients with visceral metasta-ses [m: 297 (0-416)] compared with bone metastases patients [m: 68 (9.5-168)], these differences were not significant(AU)

[Spontaneous extraperitoneal bladder perforation in an elderly patient with genitalia prolapse]. / Rotura vesical espontánea en paciente senil con prolapso genital.

There are many etiologic reasons which explain the bladder perforation. Bladder injuries happen most commonly in poli-traumatisms (traffic accident), blunt trauma, penetrating injury and iatrogenic injury (surgery, laparoscopic...). However, there is not always a vigorous, direct, extern and blunt agent causing the rupture. In the case reported the extraperitoneal bladder rupture started after a smooth perineal injury caused when the patient seated down. The patient already suffered from a cystocele III/IV plus uterine prolapse for a long time ago.

Rotura vesical espontánea en paciente senil con prolapso genital / Spontaneous extraperitoneal bladder perforation in an elderly patient with genitalia prolapse

Son múltiples y diversas las causas etiológicas de la rotura vesical. Los politraumatismos (accidentes de tráfico), el traumatismo directo abdominal, cerrado o abierto, y las lesiones y atrogénicas (cirugía abierta, endocirugía, cateterismo uretral) figuran entre las más frecuentes; sin embargo, la rotura vesical no siempre exige para su producción un enérgico, violento, directo y evidente agente externo que la provoque. En el caso que a continuación se comunica, la rotura vesical extraperitoneal tuvo su origen en un leve traumatismo perineal ocasionado al sentarse la paciente , la cual presentaba y padecía desde mucho tiempo atrás un cistocele grado III/IV acompañado de prolapso uterino (AU)

There are many etiologic reasons which explain the bladder perforation. Bladder injuries happen most commonly in poli-traumatisms (traffic accident), blunt trauma, penetrating injury and iatrogenic injury (surgery, laparoscopic…). However, there is not always a vigorous, direct, extern and blunt agent causing the rupture. In the case reported the extraperitoneal bladder rupture started after a smooth perineal injury caused when the patient seated down. The patient already suffered from a cystocele III/IV plus uterine prolapsed for a long time ago (AU)

[Periurethral injections of dextranomer/hyaluronic acid copolymer in the treatment of female stress urinary incontinence: description of the technique and bibliographic review]. / Inyecciones periuretrales de copolímero de dextranómero/ácido hialurónico como tratamiento de la incontinencia urinaria de esfuerzo en la mujer: descripción de la técnica y revision de la literatura.

OBJECTIVES: The system enables a non endoscopic, outpatient treatment of the female stress urinary incontinence. The article intends to familiarize the readers with the procedure. METHODS: We describe the technique, graphically, with all steps, and perform a bibliographic review. RESULTS: In accordance to the main clinical studies reviewed, the periurethral injection of dextranomer/ hyaluronic acid copolymer has an efficacy of near 75%, with a simple, reproducible technique with rare adverse events. CONCLUSIONS: The treatment with this type of periurethral injections may be valid as a minimally invasive treatment of the female stress urinary incontinence, because of its efficacy, tolerability and reproducibility.

Inyecciones periureterales de copolímero de dextranómero/ácido hialurónico como tratamiento de la incontinencia urinaria de esfuerzo en la mujer: descripción de la técnica y revisión de la literatura / Periuretheral injections of dextranomer/hyaluronic acid copolymer in the treatment of female stress urinary incontinence: description of the technique and bibliographic review

OBJETIVO: El sistema permite un tratamiento no endoscopio y ambulatorio de la incontinencia urinaria de esfuerzo en la mujer. En este artículo se pretende conseguir la familiarización con el procedimiento. METODOS: Descripción de la técnica de forma gráfica con los pasos correspondientes y revisión de la literatura. RESULTADO: La inyección periuretral de copolimero de dextranomero/acido hialuronico como se deduce de la revisión de los principales estudios clínicos tiene una eficacia cercana al 75% con una técnica sencilla, reproducible y con escasos efectos adversos. CONCLUSIONES: El tratamiento con este tipo de inyecciones periuretrales puede ser válido como manejo minimamente invasivo de la incontinencia urinaria de esfuerzo, por su eficacia, tolerabilidad y reproducibilidad

OBJECTIVES: The system enables a non endoscopic, outpatient treatment of the female stress urinary incontinence. The article intends to familiarize the readers with the procedure. METHODS: We describe the technique, graphically, with all steps, and perform a bibliographic review. RESULTS: In accordance to the main clinical studies reviewed, the periurethral injection of dextranomer/ hyaluronic acid copolymer has an efficacy of near 75%, with a simple, reproducible technique with rare adverse events. CONCLUSIONS: The treatment with this type of periurethral injections may be valid as a minimally invasive treatment of the female stress urinary incontinence, because of its efficacy, tolerability and reproducibility