Radical robot-assisted laparoscopic nephrectomy with thrombectomy in the vena cava. / Nefrectomía radical laparoscópica asistida por robot con trombectomía en vena cava.

BACKGROUND: Renal cell carcinoma has a natural tendency to extend through the renal vein. When the thrombus reaches the vena cava, thrombectomy and the necessary reconstruction of the vena cava are typically performed by open pathway. Robot-assisted technology provides advantages for performing this complex technique, using a minimally invasive access. MATERIAL AND METHODS: We present the technique we employed in the first case performed in our department. After performing renal artery embolisation, we conducted the surgery with the Vinci S robotic system. The main steps of the surgery are as follows: detachment and Kocher manoeuvre; release of the lower renal pole; clamping and sectioning of the renal artery; endocavitary ultrasound to locate the thrombus; placement of tourniquets in the vena cava below and above the renal veins and in the left renal vein; closure of the 3 tourniquets; opening of the vena cava; resection and extraction of the thrombus; suture of the vena cava; opening of the tourniquets; complete release of the kidney; bagging and extraction of the specimen. RESULTS: The surgery was performed without complications. The patient required a transfusion of 2 units of packed red blood cells and was discharged with modest renal failure (creatinine level of 1.60mg/dl). CONCLUSIONS: Radical nephrectomy with thrombectomy in the vena cava is a technique susceptible to severe complications and has, to date, been performed in few centres. We believe that the technique is reproducible and has clear advantages for our patients.

[Schwannoma of the penis]. / Schwanoma de pene.

OBJECTIVE: To present a rare site of schwannoma and review the literature. METHODS/RESULTS: A case of a young male patient who consulted for removal of a penile lipoma is presented. The small, regular, well-circumscribed tumor localized under Buck's fascia on the dorsal penile aspect was excised. The anatomopathological analysis showed a schwannoma. CONCLUSION: A review of the literature showed schwannoma of the penis to be very uncommon. For this reason, we were prompted to report this case.

[Quality perceived in the care process by patients treated with prostatectomy for cancer. Results of a qualitative study]. / Calidad en el proceso asistencial por parte de pacientes prostatectomizados por cáncer. Resultados de una investigación cualitativa.

OBJECTIVE: To analyze the care process and treatment outcomes from the perspective of patients undergoing prostatectomy. METHODS: A qualitative study based on depth interviews was performed in 12 of 14 patients who had undergone prostatectomy for localized prostate cancer at a regional hospital. An intentional survey was carried out. Patients were informed about the survey through a letter and by telephone and were asked to decide where they wished the interview to be held. All patients were interviewed by one of the authors who was unrelated with the hospital. The interviews were recorded and transcribed with the patients' consent and the assurance of confidentiality. We performed qualitative analysis of the transcriptions, interviewer's notes and patient hospital discharge reports, and validation through discussion of the results after deleting all identity-related data. RESULTS: Transmission of the care process experiences transcends the presumable adequacy to the conventional phases of diagnosis, treatment and outcome. Patient assessment varied according to the functional results achieved, previous symptoms, patient expectations and interpretation of the information provided. Due to this variability, the urologist's approach should be individualized to each patient from the outset, before the definitive diagnosis is made, and should continue long after surgery. In this regard, substantial shortcomings in urologist-patient communication were found. CONCLUSIONS: The approach to the perspectives of patients with localized prostate cancer is a necessary component that has not been sufficiently developed by the urologist during the clinical management of this disease or its subsequent assessment. Apart from the changes in attitude that the foregoing may entail, it is advisable to incorporate quantitative and qualitative measures that support patient assessment of quality of life and its variability, into the daily practice of all the health professionals involved.

[Splenosis: underdiagnosed entity]. / Esplenosis: una entidad infradiagnosticada.

OBJECTIVE: To report a case of renal splenosis in a patient that had previously undergone splenectomy due to traumatic rupture. METHODS/RESULTS: A 42-year-old patient consulted for pancreatitis. A CT scan disclosed a mass behind the tail of pancreas, MRI assessment with gadolinium enhancement showed a left renal mass which was surgically resected. Histopathological analysis of the surgical specimen demonstrated splenic tissue. CONCLUSIONS: Splenosis should be considered in splenectomized patients with lesions compatible with tumors and should be distinguished from hyperplasia of accessory spleens.

[Primary retroperitoneal hydatid cyst]. / Quiste hidatídico retroperitoneal primario.

OBJECTIVE: To review the pathogenesis, clinical features and treatment of a rarely observed site of presentation of hydatid cyst. METHODS/RESULTS: A case of an isolated retroperitoneal hydatid cyst is presented. Diagnosis was based on the immunodiagnostic test and radiological examination. Treatment was by surgery. CONCLUSIONS: Isolated retroperitoneal hydatic cyst is rare. The abdominal mass is the most frequent sign, and less frequently, concomitant compressive syndrome. Diagnosis is based on the biological examinations, percutaneous puncture and radiological findings. Treatment is by surgery. Azoles are useful for intraoperative ruptured cysts and to reduce the risk of recurrence.

[Spontaneous retroperitoneal hemorrhage]. / Hemorragia retroperitoneal espontánea.

OBJECTIVE: The etiology of spontaneous retroperitoneal hemorrhage is analyzed and the clinical, diagnostic and therapeutic aspects are discussed. METHODS/RESULTS: Two cases of spontaneous retroperitoneal hemorrhage from a ruptured adenocarcinoma of the kidney are reported. Both patients presented the characteristic Lenk's triad. Definitive diagnosis was made on the CT findings and treatment was by nephrectomy. CONCLUSIONS: The most common cause of retroperitoneal hemorrhage arising from the kidney is a tumor. Treatment is based on the underlying cause of the underlying cause of the hemorrhage and the patient's hemodynamic status.

[Verrucous carcinoma of the penis: local excision with the Mohs micrographic technique]. / Carcinoma verrucoso de pene: exéresis local mediante técnica micrográfica de Mohs.

OBJECTIVES: We report on two cases of verrucous carcinoma of the penis that had been treated conservatively by local excision using the Mohs micrographic technique. METHODS/RESULTS: The clinical features, diagnosis and treatment of verrucous carcinoma of the penis are discussed. CONCLUSIONS: Local excision according to the Mohs micrographic technique may suffice in cases with non-invasive verrucous carcinoma of the penis. If the lesion involves the penile shaft, partial or total amputation of the glans penis is indicated, depending on the degree of involvement. Lymphadenectomy does not appear to be necessary since lymph node metastasis is rare.

[Uses of endoscopic video-camera in open surgery]. / Usos de la vídeo-cámara endoscópica en cirugía abierta.

OBJECTIVES: To describe a method to obtain images of open surgery at the lowest possible cost. The images provide useful information for patient records and teaching. METHODS: We have utilized a submersible endoscopic camera with no special features, close up lenses or automatic focussing device and a color printer. RESULTS: The quality of the images are similar to those obtained with a more sophisticated video camera. The pictures were processed with a video printer. CONCLUSIONS: We believe that using the endoscopic camera in open surgery is a low-cost alternative to the more sophisticated video camera systems.

[Melanin in the prostate gland]. / Melanina en la glándula prostática.

We report two rare cases of prostatic melanosis incidentally discovered on pathological examination of specimens from a prostate biopsy (adenocarcinoma) and open surgery (benign hyperplasia). We describe the features and discuss the hypotheses relative to this disease entity.

[Fibrous pseudotumor of the tunica vaginalis testis]. / Pseudotumor fibroso de la túnica vaginal testicular.

A case of fibrous pseudotumor of the tunica vaginalis in a 54-year-old male patient with no remarkable previous clinical history is described. The diagnosis was made following near total removal of the tunica vaginalis which presented firm nodules of different sizes and whitish fibrous plaques. We discuss the pathological findings in this lesion which may raise doubts when making the differential diagnosis from other benign paratesticular conditions and, above all, true neoplastic disease.

[Giant calculus in a diverticulum of the anterior urethra]. / Gran litiasis en un diverticulo de uretra anterior.

A case of lithiasis in a front diverticulum of the urethra in male is presented. The unusual presentation it had together with the lack of frequency was pointed out, commenting briefly the diagnostic methods and ways of treatment.

[Adenomatoid tumor of the albuginea testis]. / Tumor adenomatoide de albugínea testicular.

We present a rare case of adenomatoid tumour situated in the testicular albuginea. We comment on its treatment, which we are of the opinion should be conservative.

[Torsion of the spermatic cord]. / Torsión del cordón espermático.

We report on 55 cases of torsion of spermatic cord. We describe the clinical features and the findings on physical examination as well as other factors such as patient age, past history of transient painful episodes which should prompt us to consider this condition. In our view, immediate surgical exploration is justified in all cases of acute scrotum in patients in the second-third decade of life in whom this condition is suspected. This approach has allowed us to achieve testicular salvage in 76% of the cases immediately postoperatively. Contralateral fixation is mandatory. The possibility that unilateral testicular torsion might cause subsequent infertility from lesion to the contralateral testis probably due to an autoimmune mechanism has led to a reconsideration of radically conservative management of testicular torsion. Testes whose viability is doubtful should be removed. If untwisting and fixation is performed, patients should be followed closely for a long period to evaluate patient fertility.

[Isolated angiomyolipoma of the kidney]. / Angiomiolipoma renal aislado.

We report on four cases of renal angiomyolipoma. Treatment was by conservative surgery in two cases, and regular control for the remaining two cases. The different diagnostic methods and therapeutic modalities are discussed.

[Bilateral pheochromocytoma]. / Feocromocitoma bilateral.

We report a case of bilateral adrenal pheochromocytoma in a young, male patient who consulted for arterial hypertension. The adrenal tumors had been accurately diagnosed by abdominal ultrasonography and confirmed by CT. The incidence of bilateral involvement in pheochromocytoma is briefly discussed and the methods currently utilized for topographic localization of the tumor are described.