Retrospective Study of Cystic Echinococcosis in a Recent Cohort of a Referral Center for Liver Surgery.

BACKGROUND: Cystic echinococcosis (CE) is a zoonosis endemic in Spain caused by the larval stage of the cestode Echinococcus granulosus and is one of the 18 neglected tropical diseases recognized by the WHO. The aim of this study was to describe the epidemiological and clinical data of CE in a surgical referral hospital. METHODS: A retrospective descriptive study of all adults' patients diagnosed with CE and followed at Vall d'Hebron University Hospital in Barcelona, Spain, between 2000 and 2015. RESULTS: We found 151 cases, 78 (51.7%) women, and median age at diagnosis was 68 (range, 15-92) years. Diagnosis was a radiological finding in 97 (64.2%) and the most frequent location was the liver [135 (89.4%) patients]. Nearly 80% of the cysts were calcified and serology was positive in 48 (51.6%). The WHO-IWGE classification was only available in 70 of the 104 (67.3%) cases of liver cysts that had an ultrasound. First therapeutic plan was "watch and wait" followed by surgery. International recommendations were not always followed, particularly in CE4 and CE5 stages, and 20% needed a change of treatment because of progression or recurrence. Patients treated surgically were younger, more symptomatic, and had larger and less calcified cysts in multiple sites. Serology was not useful for CE diagnosis and neither serology nor calcification of the cyst helped to predict viability. CONCLUSIONS: The formation of multidisciplinary teams in reference hospitals could help to improve CE diagnosis, its management, and follow-up, since international recommendations are not usually followed.

[Laparoscopic management of ureteroileal stenosis: Long term follow up.] / Manejo laparoscópico de la estenosis uretero­ileal con seguimiento a largo plazo.

OBJECTIVE: To describe the laparoscopic approach for uretero-ileal anastomosis strictures and to analyse our long term series. METHODS: A retrospective review was performed evaluating our series of patients with benign ureteroileal anastomosis strictures treated laparoscopically from 2011 to 2017. Demographics and perioperative data were obtained and analyzed. Complications were described with the Clavien-Dindo classification. The surgical technique was described and a literature review was performed. RESULTS: Eleven procedures were performed in ten patients. Mean blood loss was 180 ml. All the operations were performed laparoscopically without conversion. Mean hospital stay was 10 days (4-23). Early complications were Clavien-Dindo I y II: Two cases of limited anastomosis leakage, one lymphorrea, one paralitic ileum and one accidental descent of the ureteral catheter. Mean follow-up was 56 months (12-179) No late complications have been described. CONCLUSION: Based on our series with 5 year follow up, the laparoscopic approach for uretero-ileal anastomosis strictures is feasible and safe.

Manejo laparoscópico de la estenosis uretero-ileal con seguimiento a largo plazo / Laparoscopic management of ureteroileal stenosis: Long term follow up

OBJETIVO: El objetivo de este artículo es la descripción de la técnica laparoscópica para el tratamiento de las estenosis uretero-ileales tras la cistectomía radical y analizar nuestra serie a largo plazo. MÉTODOS: Se realizó una revisión retrospectiva de los pacientes tratados laparoscópicamente de EUI tras cistectomía radical desde el Enero de 2011 (año en el que se implementó la técnica) hasta Marzo de 2017. Se tomaron los datos perioperatorios y se clasificaron según la graduación Clavien-Dindo. Asimismo, se describió la técnica quirúrgica y se realizó una búsqueda en la literatura del tema. RESULTADOS: Diez pacientes con EUI fueron tratados laparoscópicamente realizando un total de 11 cirugías. La pérdida sanguínea intraoperatoria media fue de 180 ml. No hubo conversión a cirugía abierta. La estancia hospitalaria media fue 10 días (4-23). Las complicaciones postoperatorias tempranas fueron Clavien-Dindo I y II e incluyen dos fugas limitadas de la anastomosis, una linforrea, un íleo paralítico y un descenso accidental de catéter ureteral. La media de seguimiento de los pacientes fue 56 meses (rango 12-179). Hasta el momento no se observaron complicaciones tardías. CONCLUSIONES: El tratamiento laparoscópico de las EUI es seguro, factible y eficaz según nuestra experiencia con seguimiento de casi 5 años

OBJECTIVE: To describe the laparoscopic approach for uretero-ileal anastomosis strictures and to analyse our long term series. METHODS: A retrospective review was performed evaluating our series of patients with benign uretero-ileal anastomosis strictures treated laparoscopically from 2011 to 2017. Demographics and perioperative data were obtained and analyzed. Complications were described with the Clavien-Dindo classification. The surgical technique was described and a literature review was performed. RESULTS: Eleven procedures were performed in ten patients. Mean blood loss was 180 ml. All the operations were performed laparoscopically without conversion. Mean hospital stay was 10 days (4-23). Early complications were Clavien-Dindo I y II: Two cases of limited anastomosis leakage, one lymphorrea, one paralitic ileum and one accidental descent of the ureteral catheter. Mean follow-up was 56 months (12-179) No late complications have been described. CONCLUSION: Based on our series with 5 year follow up, the laparoscopic approach for uretero-ileal anastomosis strictures is feasible and safe

Laparoscopic Management of Ureteroileal Anastomosis Strictures: Initial Experience.

BACKGROUND: A ureteroileal anastomosis stricture (UAS) is one of the most frequent complications after radical cystectomy. Open surgical repair is the treatment of choice but is associated with morbidity. OBJECTIVE: To describe the efficacy and safety of laparoscopic management for benign secondary UAS. DESIGN, SETTING, AND PARTICIPANTS: A review was performed of the 11 initial procedures performed at our academic center from December 2010 to December 2014, with mean follow-up of 38 mo (range 12-169). Patients included had benign ureteroileal strictures longer than 1cm. SURGICAL PROCEDURE: A pure laparoscopic approach was systematically used, involving a two-step procedure for left and a one-step procedure for right ureteral stenosis. MEASUREMENTS: Perioperative data were collected and complications were assessed using the Clavien-Dindo grading system. Outcomes and follow-up data were analyzed. RESULTS AND LIMITATIONS: A descriptive statistical analysis was performed for 11 surgeries in ten patients. The median stricture length was 2.4cm. No conversion to open surgery was required. The mean blood loss was 180ml and the mean hospital stay was 10 d. Early complications included limited lymphorrhea (n=1), limited anastomotic leakage (n=2), and accidental descent of a ureteral catheter (n=1) that was replaced with radiologic intervention. The mean follow-up was 38 mo (range 12-169). No late complications were reported. After 1 yr of follow-up, six patients had good glomerular filtration rates, all patients were asymptomatic, and no stenotic relapses were detected. CONCLUSIONS: This laparoscopic technique for the management of benign secondary UAS is feasible, with good results and without long-term complications. This minimally invasive approach reduces the morbidity associated with open surgery while retaining good success rates. PATIENT SUMMARY: We describe a novel laparoscopic approach for patients with a ureteroileal anastomosis stricture after radical cystectomy to avoid the complications associated with open surgery. The surgery was found to be viable and safe with good long-term results.

[Lithiasis in complete ureteral duplication and prostate cancer: combined surgery treatment]. / Lithiasis in complete ureteral duplication and prostate cancer: combined surgery treatment.

The diagnosis of congenital anomalies of the urogenital tract in the adult is uncommon. Complete ureteral duplication represents a congenital anomaly of the ureters, usually draining a duplex kidney, with a second orifice entering the bladder, urethra or other structures. In the majority of cases, this pathology is completely asymptomatic; sometimes it's diagnosed because of complications such as infections, hydronephrosis, lithiasis, or in the evaluation of the urinary tract. Early diagnosis of localized prostatic adenocarcinoma is increased due to worldwide use of PSA screening and the optimization of multiple biopsy, increasing radical surgery treatments. The association between these two pathologies is a rare event. We present the case of a 69-years old man diagnosed for localized prostatic cancer and bilateral complete ureteral duplication, megaureter and stenosis of left superior ureteral meatus, leading in the prostatic urethra. Terminal ureter with the ectopic meatus opening in prostatic urethra was occupied by stones. A combined surgical procedure was undertaken: radical prostatectomy, ectopic ureter section, lithiasis removal and reimplantation of left ectopic ureter into the bladder. There is no case described of the association of this urogenital anomaly and prostate cancer and the combined management of both.

[Percutaneous treatment of a primary renal aspergilloma in a patient with AIDS]. / Percutaneous treatment of a primary renal aspergilloma in a patient with AIDS.

Primary renal aspergillosis is a very rare complication of AIDS which usually have fatal outcome (53% of mortality). The immune status of the patient and the early and correct therapeutic approach are the main factors that predict disease advancement. The new antiretroviral therapies improve the CD4 cell count and permit to treat these patients as immuno-competent. The local approach with antifungal drugs instillations, percutaneous drainage combined with systemic antifungal therapy can increase the number of patients that may benefit from a conservative treatment. We report a case of a 44-year-old homosexual patient with AIDS since 1991 in stage IVc (CDC--Centers for Disease Control and Prevention) in antiretroviral treatment. In September 1999 he came because of left low back pain. Laboratory data showed leucocytosis. Urinalysis revealed the presence of white and red blood cells and a negative urine culture. The abdominal ultrasound examination, the intravenous pyelogram and finally the computerized tomography confirm the presence of solid material that occupied the renal pelvis and the middle and superior caliceal group of the left kidney associated with lymph nodes enlargement. An echo-guided needle aspiration allowed us to identify Aspergillus fumigatus. Local instillations with amfotericina B through a nephrostomy and systemic antifungal drugs resolved the urinary infection.