[Laparoscopic nephron-sparing surgery. 5 years' experience]. / Cirugía conservadora de parénquima renal laparoscópica. Cinco años de experiencia.

INTRODUCTION: Laparoscopic nephron-sparing surgery is among the most complex urological procedures currently performed. Open surgery continues to be the gold standard of care, but the laparoscopic approach is gaining ground slowly but surely. Our 5 years' experience is reported. MATERIALS AND METHODS: From September 2004 to March 2009, 38 laparoscopic nephron-sparing procedures were performed at our hospital. A transperitoneal laparoscopic approach was used in all cases, with en bloc clamping of renal hilum in most patients. RESULTS: Mean operating time was 141 min, mean intraoperative bleeding 130 mL, mean warm ischemia time 24 min, and mean hospital stay 3.3 days. Bleeding was the most common complication (requiring transfusion in 13.5% of patients). Positive surgical margins were found in 5.4% of patients. CONCLUSIONS: Adequate selection of the patient (tumor size, location) and the procedure to be used, surgeon experience, and surgical skills are essential for achieving good oncological results and for minimizing the complications of this demanding procedure.

[Laparoscopic adrenalectomy. Five-year experience]. / Suprarrenalectomía laparoscópica. Experiencia de 5 años.

OBJECTIVE: Adrenal conditions requiring surgery are uncommon and are usually seen in several surgical departments. Our experience in laparoscopic management of adrenal pathology after almost five years of use of laparoscopy for retroperitoneal conditions at our center is reported. MATERIALS AND METHODS: A total of 37 laparoscopic adrenalectomies were performed over 53 months for benign and malignant conditions. The transperitoneal approach was used in most cases (97%) because of the greater surgeon experience with this route. Pregnancy and suspected periadrenal infiltration were considered as absolute contraindications. RESULTS: Mean operating time was 90 minutes, mean intraoperative bleeding 80 ml, and mean hospital stay was 2 days. The main complication was one death. A malignancy was found in 4 patients (10%), while all other patients (90%) had a benign condition, including 8 pheochromocytomas. CONCLUSIONS: Laparoscopy is considered to be the gold standard for benign adrenal conditions. When the malignant mass is a single metastasis from a primary tumor, the laparoscopic approach appears to be reliable. When the malignant lesion is a primary adrenal tumor, laparoscopic management is more controversial, although the results reported by experienced surgeons in their series appear to be adequate.

Cirugía conservadora de parénquima renal laparoscópica. Cinco años de experiencia / Laparoscopic nephron-sparing surgery. 5 years’ experience

Objetivo: La cirugía renal conservadora de parénquima laparoscópica es una de las técnicas más complejas que se pueden realizar en Urología en el momento actual. En la actualidad, la técnica abierta continúa siendo el gold standard, aunque lentamente la laparoscopia se va implantando. Presentamos nuestra serie de casi 5 años. Material y métodos: Desde septiembre de 2004 hasta marzo de 2009 se han realizado 38 cirugías conservadoras de parénquima renal por vía laparoscópica. Todas ellas se han realizado con el abordaje transperitoneal, con un clampaje en bloque del hilio renal en la mayoría de los casos. Resultados: El tiempo quirúrgico medio es de 141min, sangrado intraoperatorio medio de 130cm3, con un tiempo medio de clampaje de 24min y una estancia media postoperatoria de 3,3 días. La complicación más frecuente es el sangrado (transfusión, el 13,5%). El porcentaje de márgenes positivos es del 5,4%. Conclusiones: Con el fin de obtener unos buenos resultados oncológicos y reducir al mínimo las complicaciones, es fundamental la buena selección del caso (tamaño y localización del tumor) así como de la técnica que se va a emplear. La experiencia del cirujano y sus recursos laparoscópicos son de vital importancia (AU)

Introduction: Laparoscopic nephron-sparing surgery is among the most complex urological procedures currently performed. Open surgery continues to be the gold standard of care, but the laparoscopic approach is gaining ground slowly but surely. Our 5 years’ experience is reported. Materials and Methods: From September 2004 to March 2009, 38 laparoscopic nephron-sparing procedures were performed at our hospital. A transperitoneal laparoscopic approach was used in all cases, with en bloc clamping of renal hilum in most patients. Results: Mean operating time was 141min, mean intraoperative bleeding 130mL, mean warm ischemia time 24min, and mean hospital stay 3.3 days. Bleeding was the most common complication (requiring transfusion in 13.5% of patients). Positive surgical margins were found in 5.4% of patients. Conclusions: Adequate selection of the patient (tumor size, location) and the procedure to be used, surgeon experience, and surgical skills are essential for achieving good oncological results and for minimizing the complications of this demanding procedure (AU)

Suprarrenalectomía laparoscópica. Experiencia de 5 años / Laparoscopic adrenalectomy. Five-year experience

Objetivo: la patología adrenal susceptible de indicación quirúrgica es poco frecuente y normalmente se encuentra dividida entre varios servicios quirúrgicos. Presentamos nuestra experiencia en el manejo laparoscópico tras casi 5 años de implantación de la laparoscopia en la patología retroperitoneal en nuestro centro. Material y métodos: en 53 meses se han realizado un total de 37 suprarrenalectomías por patología benigna y maligna. El abordaje más frecuentemente empleado es el transperitoneal (97%) debido a la mayor experiencia del cirujano con esta vía. La paciente embarazada y la sospecha de infiltración periadrenal se han tomado como contraindicaciones absolutas. Resultados: el tiempo quirúrgico medio es de 90 minutos, sangrado intraoperatorio de 80 cc, estancia media postoperatoria de dos días y la principal complicación ha sido un exitus. En4 ocasiones la patología es maligna (10%), el resto (90%) benigna, con 8 feocromocitomas. Conclusiones: la laparoscopia se considera el patrón oro para la patología benigna adrenal. Cuando la lesión es de naturaleza maligna, en caso de ser una metástasis única procedente de otro tumor primario, parece que el abordaje laparoscópico es fiable. Cuando la lesión maligna es primaria adrenal existe más controversia en este tipo de abordaje, si bien es cierto que en series de cirujanos experimentados los resultados parecen adecuados (AU)

Objective: Adrenal conditions requiring surgery are uncommon and are usually seen in several surgical departments. Our experience in laparoscopic management of adrenal pathology after almost five years of use of laparoscopy for retroperitoneal conditions a tour center is reported. Materials and methods: A total of 37 laparoscopic adrenalectomies were performed over 53months for benign and malignant conditions. The transperitoneal approach was used in most cases (97%) because of the greater surgeon experience with this route. Pregnancy and suspected periadrenal infiltration were considered as absolute contraindications. Results: Mean operating time was 90 minutes, mean intraoperative bleeding 80 ml, and mean hospital stay was 2 days. The main complication was one death. A malignancy was found in 4 patients (10%), while all other patients (90%) had a benign condition, including8 pheochromocytomas. Conclusions: Laparoscopy is considered to be the gold standard for benign adrenal conditions. When the malignant mass is a single metastasis from a primary tumor, the laparoscopic approach appears to be reliable. When the malignant lesion is a primary adrenal tumor, laparoscopic management is more controversial, although the results reported by experienced surgeons in their series appear to be adequate (AU)

Lesión de los cuerpos cavernosos por arma de fuego. Presentación de un caso y revisión de la literatura / Corpora cavernosa lesion by gunshot. Case study and literature review

La rotura de los cuerpos cavernosos es una lesión de muy baja incidencia. La causa más frecuente es un traumatismo durante el coito. Aún más excepcional es la producida por arma de fuego, en la que lo más habitual es la lesión concomitante de otras estructuras. Mostramos el caso de un paciente que presentó lesión de los cuerpos cavernosos por arma de fuego y se le realizó una exploración quirúrgica de urgencia. Se revisa la literatura existente y se comprueba que, siempre que haya una herida genital por arma de fuego, lo primero que se debe hacer es estabilizar al paciente y lo segundo, una exploración quirúrgica de la región afectada (AU)

Rupture of the corpora cavernosa is a very rare lesion. It occurs most commonly during intercourse. A far more exceptional cause is a gunshot wound; in this case, there are frequently concomitant lesions to other structures. We present the case of a man who suffered a lesion to the corpora cavernosa due to a gunshot and underwent emergency surgery. We reviewed existing literature and verified that the first step in managing a genital gunshot wound is to stabilise the patient, following which we should surgically explore the affected area (AU)

Corpora cavernosa lesion by gunshot. Case study and literature review.

Rupture of the corpora cavernosa is a very rare lesion. It occurs most commonly during intercourse. A far more exceptional cause is a gunshot wound; in this case, there are frequently concomitant lesions to other structures. We present the case of a man who suffered a lesion to the corpora cavernosa due to a gunshot and underwent emergency surgery. We reviewed existing literature and verified that the first step in managing a genital gunshot wound is to stabilise the patient, following which we should surgically explore the affected area.

TNF/IL-1/NIK/NF-kappa B transduction pathway: a comparative study in normal and pathological human prostate (benign hyperplasia and carcinoma).

AIMS: Tumour necrosis factor (TNF)-alpha induces death or cell proliferation by activation of nuclear factor (NF)-kappaB, also activated by interleukin (IL)-1 alpha. The aim was to investigate upstream and downstream components of NIK transduction pathway in normal (NP), benign prostatic hyperplasia (BPH), prostatic intraepithelial neoplasia (PIN) and prostatic carcinoma (PC). METHODS AND RESULTS: Immunohistochemistry and Western blotting were performed. In NP, the cytoplasm of epithelial cells was intensely immunoreactive to IL-1 receptor-associated kinase (IRAK), TNF receptor-associated factor (TRAF)-6, NF-kappaB inducing kinase (NIK), I kappa kappa alpha/beta, I kappaB alpha and p-I kappaB; weakly to NF-kappaB-p50; and negative to NF-kappaB-p65. BPH samples were intensely immunoreactive to IRAK, TRAF-6, NIK, I kappa kappa alpha/beta, I kappaB alpha, p-I kappaB; weakly to NF-kappaB-p50 and NF-kappaB-p65. Whereas low-grade PIN showed intermediate results between NP and BPH, results in high-grade PIN were similar to those found in PC (low Gleason). In PC, immunoreactivity was intense for IRAK, TRAF-6, NIK, I kappa kappa alpha/beta (increasing with Gleason), I kappaB alpha, p-I kappaB (decreasing with Gleason); weak for NF-kappaB-p50 and NF-kappaB-p65 (decreasing with Gleason). Nuclear NF-kappaB was observed in PC. CONCLUSIONS: NF-kappaB enhances cell proliferation, but also ATF-2 or Elk-1. Since IL-1 and TNF-alpha are related to inflammation and their immunoexpression increases in PC, inhibition of these cytokines might be a possible target for PC treatment, because they decrease the activity of all transduction pathway members that activate transcription factors such as NF-kappaB, Elk-1 or ATF-2.

Cirugía retroperitoneal laparoscópica. Experiencia del Hospital Universitario La Paz / Retroperitoneal laparoscopic surgery. Experience at the Hospital Universitario La Paz

Objetivo: Con la popularización de la prostatectomía radical laparoscópica, dicha técnica vuelve a tomar un papel importante en el funcionamiento de los servicios de urología. Nuestra mayor experiencia en laparoscopia hace que cada vez realicemos más intervenciones mediante este abordaje. En este sentido, la cirugía retroperitoneal probablemente se beneficie más claramente que la prostática de la cirugía mínimamente invasiva. En este artículo describimos nuestra serie de casi 4 años. Métodos: El periodo analizado abarca desde Junio 2004 hasta Marzo 2008, durante el cual se han llevado a cabo 288 cirugías retroperitoneales (179 nefrectomías, 109 procedimientos varios). La vía de abordaje ha sido tranperitoneal en la gran mayoría de los casos. Resultados: La estancia hospitalaria media fue de 3,6 días para las nefrectomías y 3 días para los otros procedimientos. La tasa de transfusión de las nefrectomías es del 5% y un 2% de reconversión. En las cirugías variadas el porcentaje de transfusión fue del 6% y no existió ninguna reconversión. Conclusiones: La expansión de la laparoscopia en Urología debe venir acompañada de una buena selección de pacientes y una progresiva adquisición de experiencia por parte del cirujano. Determinadas intervenciones deberán ser abordadas únicamente en caso de gran experiencia (AU)

Objectives: With the popularisation of laparoscopic radical prostatectomy, the above technique has once again taken on an important role in the work of urology departments. Our extensive experience in laparoscopy means that we are performing increasingly more interventions using this approach. In the context of minimally invasive surgical procedures, this is probably bringing clearer benefits to retroperitoneal surgery than to prostatic surgery. In this article, we describe our series over nearly 4 years. Methods: The period analysed covers June 2004 to March 2008, during which time 288 retroperitoneal operations were performed (184 nephrectomies, 113 other procedures). In the majority of cases, the route of approach was transperitoneal. Results: The mean hospital stay was 3.6 days for the nephrectomies and 3 days for the other procedures. The transfusion rate for the nephrectomies was 5% and there was a conversion rate of in 2%. In the other types of surgery, the transfusion rate was 6% and there were no conversions. Conclusions: The expansion of laparoscopy in Urology has to be accompanied good patient selection and the progressive acquiring of experience on the part of the surgeon. Certain interventions should only be tackled in cases where there is extensive experience (AU)

[Leukemic infiltration of the urinary bladder. A new case and literature review]. / Infiltración vesical por leucemia linfoblástica aguda. A propósito de un caso y revisión de la literatura.

We expose you one case of leukemic infiltration of the urinary bladder. This kind of infiltration is rare so we reviewed the literature finding 14 cases since 1932. Although this hematological infiltration is very unusual, it should be considered in patients with leukemia and hematuria.

Infiltración vesical por leucemia linfoblástica aguda. A propósito de un caso y revisión de la literatura / Leukemic infiltration of the urinary bladder. A new case and literature review

Exponemos el caso de un paciente con infiltración vesical por Leucemia Aguda Linfoblástica. Debido a lo infrecuente de su presentación, revisamos la literatura publicada hasta el momento encontrando14 casos desde 1932. Aunque excepcional, en un paciente que presenta hematuria de novo o repetida y ha tenido como antecedentes alguna enfermedad hematológica, debemos pensar en la infiltración vesical por la leucemia como posible diagnóstico diferencial (AU)

We expose you one case of leukemic infiltration of the urinary bladder. This kind of infiltration is rare so we reviewed the literature finding 14 cases since 1932. Although this hematological infiltration is very unusual, it should be considered in patients with leukemia and hematuria (AU)

[Laparoscopic nephron sparing surgery. Initial experience]. / Cirugía renal laparoscópica conservadora de parénquima. Experiencia inicial.

We present our initial experience in laparoscopic nephron sparing surgery. It's a technically advanced procedure requiring considerable minimally invasive expertise. This technique is particularly attractive compared to an open conventional procedure with its larger incision and associated morbidity.

Cirugía renal laparoscópica conservadora de parénquima. Experiencia inicial / Laparoscopic nephron sparing surgery. Initial experience

Presentamos nuestra experiencia inicial en cirugía renal laparoscópica conservadora de parénquima. Se trata de una cirugía exigente que requiere de una considerable experiencia en cirugía mínimamente invasiva. Esta técnica es particularmente atractiva comparada con la cirugía clásica abierta, debido a la incisión que precisa esta última y a la morbilidad que conlleva

We present our initial experience in laparoscopic nephron sparing surgery. It´s a technically advanced procedure requiring considerable minimally invasive expertise. This technique is particularly attractive compared to an open conventional procedure with its larger incision and associated morbidity

Suprarrenalectomía abierta y laparoscópica. Revisión de 10 años / Open and laparoscopic adrenalectomy. 10 years review

Presentamos los resultados de la revisión de los 10 últimos años de suprarrenalectomías abiertas realizadas en nuestro Servicio, así como el impacto de la suprarrenalectomía laparoscópica introducida en el último año dentro del programa de cirugía laparoscópica retroperitoneal del Hospital Universitario La Paz. La primera adrenalectomía laparoscópica se realizó tras 21 intervenciones retroperitoneales. La experiencia inicial ha sido lo suficientemente buena como para reducir progresivamente las contraindicaciones y aumentar el número de cirugías realizadas con dicha técnica

We present a 10 years open adrenalectomy review in our Service and the beginning of laparoscopic adrenalectomy in the last year as a part of the retroperitoneal laparoscopic program at the Hospital Universitario La Paz . The first laparoscopic adrenalectomy was done after 21 retroperitoneal laparoscopic surgeries. Our initial experience has been so good that we have reduced the contraindications for this technique and we have increased the number of laparoscopic surgery cases

[Open and laparoscopic adrenalectomy. 10 years review]. / Suprarrenalectomía abierta y laparoscópica. Revisión de 10 años.

We present a 10 years open adrenalectomy review in our Service and the beginning of laparoscopic adrenalectomy in the last year as a part of the retroperitoneal laparoscopic program at the Hospital Universitario La Paz . The first laparoscopic adrenalectomy was done after 21 retroperitoneal laparoscopic surgeries. Our initial experience has been so good that we have reduced the contraindications for this technique and we have increased the number of laparoscopic surgery cases.