Design, fabrication, and evaluation of 3-D-printed cystotomy spoons as a retrieval method in dogs.

OBJECTIVE: Current cystotomy methods often implement the use of off-label devices, resulting in urocystolith extraction difficulty and potentially leading to postoperative complications and discomfort for the patient. The objective of this study was to create 3 novel 3-D printed cystotomy spoons that offer a dedicated solution for removing urocystoliths from a patient's urinary bladder. ANIMALS: Clinical use of the 3 novel 3-D printed cystotomy spoons were ultimately evaluated in 4 dogs and 1 cat that presented for urocystotlith removal at 3 different veterinary hospitals in northwest Arkansas. METHODS: The novel cystotomy spoons were designed using SolidWorks, 3-D printed with a Dental Surgical Guide resin, and underwent prototype testing that included chlorhexidine soaking, autoclave sterilization, 3-point bend testing, and Finite Element Analysis. The efficiency of the spoons was then evaluated through a limited proof-of-concept study utilizing a postoperative questionnaire for the participating clinicians. RESULTS: Practitioner feedback indicated positive experiences using 1 or more of the novel 3-D printed cystotomy spoons while performing a cystotomy surgery. However, successful use of the spoons was ultimately limited to dogs in the 23 to 34 kg weight range. CLINICAL RELEVANCE: Novel 3-D printed cystotomy spoons have the potential to mediate urocystolith extraction difficulty and reduce postoperative complications. Additionally, this research demonstrates how veterinarians might develop custom 3-D models and prints to meet patient-specific needs. As such, further development could impact the standard of healthcare and the veterinary industry by promoting the use of additive manufacturing in veterinary medicine.

Can Concomitant Bladder Neck Incision and Primary Valve Ablation Reduce Early Re-admission Rate and Secondary Intervention?

OBJECTIVE: To assess the effect of bladder neck morphology and its incision (BNI) in patients with posterior urethral valve (PUV) on early reintervention rate. PATIENTS AND METHODS: Infants undergoing PUV ablation (PVA) before 24 months of age and had at least 18 months of follow-up, were categorized into three groups according to the bladder neck appearance on baseline radiological and endoscopic examination: group 1; normal bladder neck underwent PVA, group 2; high bladder neck underwent PVA plus BNI, group 3; high bladder neck underwent PVA only. Early reintervention was defined as the need for check cystoscopy because of persistent renal function deterioration, worsening hydronephrosis and/or unsatisfactory VCUG improvement during the 1st six months post primary PVA. RESULTS: Between 2000 and 2017, a total of 114 patients underwent PVA and met the study criteria with a median follow-up of 58 (18-230) months. For group 1, 16 (22.9%) patients needed readmission. Check cystoscopy was free and no further intervention was performed in 5(7.5%) and re-ablation was performed in 11(15.7%) patients. For group 2, 3(14.3%) patients needed reintervention. Re-ablation and re-ablation plus BNI were performed in 1(4.8%) and 2(9.5%), respectively. For group 3, cystoscopy was free in 1(4.3%), re-ablation and re-ablation plus BNI were performed 2(8.7%) and 1(4.3%), respectively. There were no significant differences in the re-admission and re-intervention rates among the three study groups (p=0.65 and p=0.50, respectively). CONCLUSION: In morphologically high bladder neck associated PUV, concomitant BNI with PVA doesn't reduce early re-intervention rate.

Natural Orifice Transluminal Endoscopic Surgery for Correction of Vesicovaginal Fistulas after Hysterectomy Due to Morbidly Adherent Placenta.

BACKGROUND: Vesicovaginal fistula (VVF) is a difficult-to-treat complication of obstetric hysterectomy. There are multiple management options, with a preference for surgical repair via abdominal or vaginal approach. We describe a transurethral natural orifice transluminal endoscopic surgery (NOTES) using barbed suture, in 3 cases of VVF after hysterectomy due to morbidly adherent placenta (MAP). CASES: Three patients with VVFs after hysterectomy due to MAP underwent a transurethral endoscopic suture repair. Two patients had complete resolution of the fistula, and the third required additional repair by laparotomy; however, a decrease was observed in the size of the VVF after the initial endoscopic repair. CONCLUSION: The transurethral NOTES approach for VVF after MAP hysterectomy is a minimally invasive procedure that is valid as an initial approach for this type of complication.

Multidrug-resistant Escherichia coli isolated from a dog with a history of urolithiasis: case report / Escherichia coli multirresistente isolada de cão com histórico de urolitíase: relato de caso

Bacterial resistance is a reality in both human and veterinary health, it limits the therapeutic arsenal and raises the costs of the patient's treatment. A dog with signs of cystitis received treatment with 5mg/kg enrofloxacin at three consecutive times, with low effectiveness. The presence of urethral uroliths was identified and urohydropulsion was done. The animal presented a new obstruction, for which a cystotomy was performed, but continued with signs of infection. Uroculture and antimicrobial susceptibility test were then performed. Escherichia coli was identified, which was resistant to 13 antibiotics, being sensitive only to piperacillin-tazobactam and amikacin. In the screening test for ß-lactamase, the production of ESßL was detected. The qPCR indicated the presence of the bla CTXm, bla DHA, bla OXA, bla IMP, bla TEM, bla GIM, bla SIM, bla SPM and bla SME genes, which may lead to a phenotypic resistance profile for ampicillin, amoxicillin-clavulanate, aztreonam, cefepime cefoxitin, cefuroxime, ceftazidime, ceftriaxone, imipenem, and piperacillin-tazobactam. This case reaffirms the value that laboratory analysis adds to the diagnosis and treatment of cystitis and urolithiasis, which can define the direction of evolution of the prognosis and the speed at which the patient's health will be restored.(AU)

A resistência bacteriana aos antibióticos é uma realidade, tanto na saúde humana quanto veterinária, limita o arsenal terapêutico e eleva os custos relacionados ao tratamento do paciente. Um cão, com sinais de cistite, recebeu tratamento com enrofloxacina, na dose de 5mg/kg, em três momentos seguidos, com baixa efetividade. Identificou-se presença de urólitos uretrais e foi feita uro-hidropropulsão. O animal apresentou nova obstrução, para a qual foi realizada uma cistotomia, mas continuou com sinais de infecção. Realizou-se, então, urocultura e teste de antibiograma. Foi identificada Escherichia coli, que se mostrou resistente a 13 antibióticos, sendo sensível somente à piperacilina-tazobactam e amicacina. No teste de triagem para ß-lactamase, detectou-se a produção de ESßL. A qPCR indicou presença dos genes blaCTXm, blaDHA, blaOXA, blaIMP, blaTEM, blaGIM, blaSIM, blaSPM e blaSME, que podem conduzir um perfil fenotípico de resistência para ampicilina, amoxicilina-ácido clavulânico, aztreonam, cefepima, cefoxitina, cefuroxima, ceftazidima, ceftriaxona, imipenem, piperacilina-tazobactam. Este caso reafirma o valor que a análise laboratorial agrega ao diagnóstico e tratamento da cistite e da urolitíase, podendo definir o sentido de evolução do prognóstico e a velocidade em que a saúde do paciente será restabelecia.(AU)

Multidrug-resistant Escherichia coli isolated from a dog with a history of urolithiasis: case report / Escherichia coli multirresistente isolada de cão com histórico de urolitíase: relato de caso

Bacterial resistance is a reality in both human and veterinary health, it limits the therapeutic arsenal and raises the costs of the patient's treatment. A dog with signs of cystitis received treatment with 5mg/kg enrofloxacin at three consecutive times, with low effectiveness. The presence of urethral uroliths was identified and urohydropulsion was done. The animal presented a new obstruction, for which a cystotomy was performed, but continued with signs of infection. Uroculture and antimicrobial susceptibility test were then performed. Escherichia coli was identified, which was resistant to 13 antibiotics, being sensitive only to piperacillin-tazobactam and amikacin. In the screening test for ß-lactamase, the production of ESßL was detected. The qPCR indicated the presence of the bla CTXm, bla DHA, bla OXA, bla IMP, bla TEM, bla GIM, bla SIM, bla SPM and bla SME genes, which may lead to a phenotypic resistance profile for ampicillin, amoxicillin-clavulanate, aztreonam, cefepime cefoxitin, cefuroxime, ceftazidime, ceftriaxone, imipenem, and piperacillin-tazobactam. This case reaffirms the value that laboratory analysis adds to the diagnosis and treatment of cystitis and urolithiasis, which can define the direction of evolution of the prognosis and the speed at which the patient's health will be restored.(AU)

A resistência bacteriana aos antibióticos é uma realidade, tanto na saúde humana quanto veterinária, limita o arsenal terapêutico e eleva os custos relacionados ao tratamento do paciente. Um cão, com sinais de cistite, recebeu tratamento com enrofloxacina, na dose de 5mg/kg, em três momentos seguidos, com baixa efetividade. Identificou-se presença de urólitos uretrais e foi feita uro-hidropropulsão. O animal apresentou nova obstrução, para a qual foi realizada uma cistotomia, mas continuou com sinais de infecção. Realizou-se, então, urocultura e teste de antibiograma. Foi identificada Escherichia coli, que se mostrou resistente a 13 antibióticos, sendo sensível somente à piperacilina-tazobactam e amicacina. No teste de triagem para ß-lactamase, detectou-se a produção de ESßL. A qPCR indicou presença dos genes blaCTXm, blaDHA, blaOXA, blaIMP, blaTEM, blaGIM, blaSIM, blaSPM e blaSME, que podem conduzir um perfil fenotípico de resistência para ampicilina, amoxicilina-ácido clavulânico, aztreonam, cefepima, cefoxitina, cefuroxima, ceftazidima, ceftriaxona, imipenem, piperacilina-tazobactam. Este caso reafirma o valor que a análise laboratorial agrega ao diagnóstico e tratamento da cistite e da urolitíase, podendo definir o sentido de evolução do prognóstico e a velocidade em que a saúde do paciente será restabelecia.(AU)

Tumor maligno da bainha de nervo periférico e osteopatia hipertrófica em cadela / Malignant peripheral nerve sheath tumor and hypertrophic osteopathy in a bitch

Background: Malignant peripheral nerve sheath tumors (MPNSTs) are rare, aggressive, relapsing, metastatic cutaneousneoplasms of mesenchymal origin. So far, no account on the association of this disease with hypertrophic osteopathy (HO)in dogs is available in the literature. Current theories on the possible causes of HO suggest that this disease may be triggered by a primary neoplasm as well as by its metastasis. The objective of this work is to report the clinical, cytological,radiographic, histopathological, and immunohistochemical aspects of a dog affected by MPNST and HO.Case: A 13-year-old female mongrel dog was presented with a history of ulcerated nodular lesion on the skin of the flank.Several ulcerated and non-ulcerated tumors were observed on the thorax, neck, and head at the physical exam. Cytological examination of the nodules revealed presence of mesenchymal cells with a malignant aspect. Complete blood countrevealed anemia. There were no alterations in the biochemical tests performed. Thoracic radiographs showed presence of anodular interstitial pattern in the cranial, medial, and caudal lobes of the lungs. To improve quality of life of the patient, theveterinary team opted for surgical excision of the tumoral ulcerations. Slight claudication in the pelvic limbs was noticedprior to the surgery. Histopathological analyses of the excised nodules verified the existence of malignant mesenchymalneoplasia, which was categorized as peripheral nerve sheath tumor after immunohistochemical examination. Additionalcutaneous tumors emerged after surgical excision, along with increased claudication, edema, and pain in the legs. Completeblood count revealed persistent anemia, lymphopenia, monocytosis, and neutrophilia. Radiographs showed an increasein the number and size of the nodules. Radiography of the limbs showed presence of palisading periosteal reaction, andincreased...(AU)

Tumor maligno da bainha de nervo periférico e osteopatia hipertrófica em cadela / Malignant peripheral nerve sheath tumor and hypertrophic osteopathy in a bitch

Background: Malignant peripheral nerve sheath tumors (MPNSTs) are rare, aggressive, relapsing, metastatic cutaneousneoplasms of mesenchymal origin. So far, no account on the association of this disease with hypertrophic osteopathy (HO)in dogs is available in the literature. Current theories on the possible causes of HO suggest that this disease may be triggered by a primary neoplasm as well as by its metastasis. The objective of this work is to report the clinical, cytological,radiographic, histopathological, and immunohistochemical aspects of a dog affected by MPNST and HO.Case: A 13-year-old female mongrel dog was presented with a history of ulcerated nodular lesion on the skin of the flank.Several ulcerated and non-ulcerated tumors were observed on the thorax, neck, and head at the physical exam. Cytological examination of the nodules revealed presence of mesenchymal cells with a malignant aspect. Complete blood countrevealed anemia. There were no alterations in the biochemical tests performed. Thoracic radiographs showed presence of anodular interstitial pattern in the cranial, medial, and caudal lobes of the lungs. To improve quality of life of the patient, theveterinary team opted for surgical excision of the tumoral ulcerations. Slight claudication in the pelvic limbs was noticedprior to the surgery. Histopathological analyses of the excised nodules verified the existence of malignant mesenchymalneoplasia, which was categorized as peripheral nerve sheath tumor after immunohistochemical examination. Additionalcutaneous tumors emerged after surgical excision, along with increased claudication, edema, and pain in the legs. Completeblood count revealed persistent anemia, lymphopenia, monocytosis, and neutrophilia. Radiographs showed an increasein the number and size of the nodules. Radiography of the limbs showed presence of palisading periosteal reaction, andincreased...

Urolitíase vesical e piometra em cadela da raça poodle

O presente trabalho tem como objetivo relatar a ocorrência de Urolitíase Vesical, com presença de setenta e seis cálculos na vesícula urinaria, associando a piometra em uma cadela idosa da raça Poodle. Os urólitos podem ocorrer em qualquer segmento do trato urinário, sendo mais frequentemente encontrado na bexiga e uretra, principalmente em animais de meia idade. A piometra é um processo inflamatório que acomete o trato genital de fêmeas caninas ainda não castradas, geralmente de idade mais avançada. O tratamento de eleição neste caso foi cirúrgico, enfatizando-se cistotomia para remoção dos cálculos, associado a ovário-histerectoma.

The present study aims to report the occurrence of bladder Urolithiasis, with presence of seventy - six calculi in the urinary vesicle, associating the pyometra in an elderly dog of the Poodle breed. Uroliths can occur in any segment of the urinary tract, being most often found in the bladder and urethra, especially in middle-aged animals. Pyometra is an inflammatory process that affects the genital tract of unbrushed canine females, usually of a more advanced age. The treatment of choice in this case was surgical, emphasizing cystotomy for removal of the stones, associated with ovary-hysterectomy.

Urolitíase vesical e piometra em cadela da raça poodle

O presente trabalho tem como objetivo relatar a ocorrência de Urolitíase Vesical, com presença de setenta e seis cálculos na vesícula urinaria, associando a piometra em uma cadela idosa da raça Poodle. Os urólitos podem ocorrer em qualquer segmento do trato urinário, sendo mais frequentemente encontrado na bexiga e uretra, principalmente em animais de meia idade. A piometra é um processo inflamatório que acomete o trato genital de fêmeas caninas ainda não castradas, geralmente de idade mais avançada. O tratamento de eleição neste caso foi cirúrgico, enfatizando-se cistotomia para remoção dos cálculos, associado a ovário-histerectoma.(AU)

The present study aims to report the occurrence of bladder Urolithiasis, with presence of seventy - six calculi in the urinary vesicle, associating the pyometra in an elderly dog of the Poodle breed. Uroliths can occur in any segment of the urinary tract, being most often found in the bladder and urethra, especially in middle-aged animals. Pyometra is an inflammatory process that affects the genital tract of unbrushed canine females, usually of a more advanced age. The treatment of choice in this case was surgical, emphasizing cystotomy for removal of the stones, associated with ovary-hysterectomy.(AU)

Laparoscopic approach for intravesical surgery using pneumovesicum in the management of anterior colporrhaphy mesh erosion and stones around the bladder neck.

INTRODUCTION AND OBJECTIVE: Perforation of the bladder or urethra and erosion of the mesh after cystocele repair surgery are not uncommon and have potentially serious complications. Traditionally, surgical management of such complications has involved excision of the mesh using either a transurethral approach or open surgery. In this video, we present our experience of laparoscopic transvesical surgery for exposed mesh and stone. MATERIALS AND METHODS: Patient was placed in the lithotomy position under general anesthesia and a 30° operating cystoscope was inserted under direct vision. After filling the bladder with 300 mL normal saline, a 5 - mm VersaStep™ bladeless trocar was placed 2 cm above the pubic symphysis. Two more 5 mm trocars were placed bilaterally at 3 cm intervals from the initial trocar site. The pneumovesicum state was maintained at 8 - 12 mmHg and a 5 mm telescope was introduced. Using a curved dissector and curved Mayo scissors, the exposed mesh was mobilized and removed. Interrupted 4 - 0 Vicryl sutures were used to close the defect. To localize the ureteral orifice, intravenous Indigo Carmine was used. The bladder stones were removed through the urethra using a stone basket, guided using a ureteral stent pusher. RESULTS: Total operation time was 55 min and the Foley catheter was removed at post - operative day 5 after postoperative cystography. CONCLUSIONS: Excellent visualization of mesh exposure and ureteral orifice was possible under aparoscopic transvesical surgery, and reconstruction including the mucosa and muscle layer was able to be achieved. This method is useful and feasible, with minimal invasiveness and an early post - operative recovery.

Pseudotumor vesical a causa de un dispositivo intrauterino / Vesical pseudotumor due to an intra-uterine device

Se describe el caso clínico de una paciente atendida en el Hospital Oncológico Docente Provincial Conrado Benítez García de Santiago de Cuba por presentar una perforación en la vejiga y desplazamiento de un dispositivo intrauterino hacia la cavidad vesical, lo cual generó la formación de litiasis y, consecuentemente, la aparición de frecuentes infecciones urinarias y dolor en bajo vientre, sin mejoría alguna ante la terapéutica aplicada. Se decidió realizar una cistotomía para extraer la litiasis compacta junto con la T de cobre; la paciente evolucionó favorablemente y los síntomas desaparecieron

The case report of a patient assisted in Conrado Benítez García Teaching Provincial Cancer Hospital in Santiago de Cuba is described, due to a bladder perforation and displacement of an intra-uterine device toward the vesical cavity, which generated the lithiasis formation and, consequently, emergence of frequent urinary infections and pain in lower abdomen, without any improvement with therapy. It was decided to carry out a cystotomy to extract the lithiasis compacted with the copper T; the patient had a favorable clinical course and the symptoms disappeared

Murine model for the evaluation of candiduria caused by Candida tropicalis from biofilm.

To evaluate the pathophysiology of catheter-associated candiduria, the bladders of female mice were infected with Candida tropicalis. One group was implanted with a catheter fragment with preformed biofilm by cystotomy technique, while another group received, in separate, a sterile catheter fragment and a correspondent yeast suspension. The bladder tissues were examined by histopathology and the quantity of colony forming units was evaluated. All the animals presented inflammation and the presence of C. tropicalis was observed in the tissue within 72 h of the introduction of biofilm, while 75% of the mice remained infected after 144 h. However, only 50% of animals from the group infected with C. tropicalis in suspension (planktonic yeasts), exhibited such signs of infection over time. The cystotomy technique is therefore viable in mice, and is an effective model for evaluating the pathogenesis of candiduria from catheter biofilms. The model revealed the potential of C. tropicalis infectivity and demonstrated more effective evasion of the host response in biofilm form than the planktonic yeast.

Leiomioma de bexiga em um cão / Bladder leiomyoma in a male dog

Background: In dogs, neoplasms of the urinary bladder are uncommon; among urinary bladder tumors, transitional cell carcinoma is the most frequent type. Urinary bladder leiomyomas are rare mesenchymal tumors whose etiology is associated with urinary retention and exposure to carcinogens. Diagnosis of this neoplasm can be determined by histopathological analysis, and treatment is surgical. The aim of this report is to describe a case of leiomyoma in the urinary bladder of a dog.Case: A 10-year-old male mongrel dog was examined at the Veterinary Hospital of Federal University of Paraíba, where a mass in the urinary bladder was identified, and was estimated to have been developing over the course of a month. Hematuria, congested ocular mucosa, and engorged episcleral vessels were observed during the physical examination. Ultrasonographic examination confirmed distension of the urinary bladder, which exhibited anechoic content and echogenic sediment. A neoplasm measuring 8 x 3.39 cm was detected in the bladder wall. This neoplasm had mixed echogenicity, heterogeneous echotexture, and well-defined borders. Color Doppler ultrasonography allowed observation of vascularization inside the mass. The animal was subjected to cystotomy to excise the mass, which was slightly adhered to the inner wall of the bladder. After this procedure, the excised specimen was submitted for histopathological analysis. Macroscopic examination revealed that the mass was firm, lobulated, nodular, and resistant to cutting. The sample was fixed in 10% formalin; the fragments were processed and stained with hematoxylin and eosin (HE) or Massons trichrome (MT) for analysis by optical microscopy. The histopathological examination revealed that the mass was encapsulated, had well-delimited borders composed by bundles of elongated cells with no atypical characteristics. These cells exhibited a slightly eosinophilic cytoplasm that contained moderate to abundant fusiform nuclei.[...](AU)

Cistotomia no tratamento da urolitíase canina / Cystotomy in the treatment of canine urolithiasis

Urolithiasis has great relevance among conditions affecting the urinary tract of dogs. Uroliths are most commonly found in the bladder and urethra. The most common clinical signs are dysuria, strangury and polaquiuria. Urolithiasis is diagnosed through the association between anamnesis, clinical examination, clinical signs, imaging, hematology, and urinalysis. Treatment may be conservative or surgical. The cystotomy comprises the most performed surgical technique in cases of urolithiasis. This work aims to report a cystotomy for removal of bladder stones in a 2 year old Chow Chow dog, attended at a veterinary clinic in Fortaleza. The surgical procedure was uneventful, with the total removal of existing urinary stones. The animal recovered well and continues without report of urinary obstructions until the present moment of the elaboration of this work.

Leiomioma de bexiga em um cão / Bladder leiomyoma in a male dog

Background: In dogs, neoplasms of the urinary bladder are uncommon; among urinary bladder tumors, transitional cell carcinoma is the most frequent type. Urinary bladder leiomyomas are rare mesenchymal tumors whose etiology is associated with urinary retention and exposure to carcinogens. Diagnosis of this neoplasm can be determined by histopathological analysis, and treatment is surgical. The aim of this report is to describe a case of leiomyoma in the urinary bladder of a dog.Case: A 10-year-old male mongrel dog was examined at the Veterinary Hospital of Federal University of Paraíba, where a mass in the urinary bladder was identified, and was estimated to have been developing over the course of a month. Hematuria, congested ocular mucosa, and engorged episcleral vessels were observed during the physical examination. Ultrasonographic examination confirmed distension of the urinary bladder, which exhibited anechoic content and echogenic sediment. A neoplasm measuring 8 x 3.39 cm was detected in the bladder wall. This neoplasm had mixed echogenicity, heterogeneous echotexture, and well-defined borders. Color Doppler ultrasonography allowed observation of vascularization inside the mass. The animal was subjected to cystotomy to excise the mass, which was slightly adhered to the inner wall of the bladder. After this procedure, the excised specimen was submitted for histopathological analysis. Macroscopic examination revealed that the mass was firm, lobulated, nodular, and resistant to cutting. The sample was fixed in 10% formalin; the fragments were processed and stained with hematoxylin and eosin (HE) or Masson’s trichrome (MT) for analysis by optical microscopy. The histopathological examination revealed that the mass was encapsulated, had well-delimited borders composed by bundles of elongated cells with no atypical characteristics. These cells exhibited a slightly eosinophilic cytoplasm that contained moderate to abundant fusiform nuclei.[...]

Cistotomia no tratamento da urolitíase canina / Cystotomy in the treatment of canine urolithiasis

Urolithiasis has great relevance among conditions affecting the urinary tract of dogs. Uroliths are most commonly found in the bladder and urethra. The most common clinical signs are dysuria, strangury and polaquiuria. Urolithiasis is diagnosed through the association between anamnesis, clinical examination, clinical signs, imaging, hematology, and urinalysis. Treatment may be conservative or surgical. The cystotomy comprises the most performed surgical technique in cases of urolithiasis. This work aims to report a cystotomy for removal of bladder stones in a 2 year old Chow Chow dog, attended at a veterinary clinic in Fortaleza. The surgical procedure was uneventful, with the total removal of existing urinary stones. The animal recovered well and continues without report of urinary obstructions until the present moment of the elaboration of this work.(AU)

Mitomicina C: Una Nueva Alternativa para la Estenosis de Cuello Vesical / Mitomycin C: A New Alternative for Bladder Neck Stenosis

Introducción: La mitomicina C es un agente quimiotera-péutico en virtud a su actividad antiproliferativa y anti-biótica. Se evalúa el resultado de la cervicotomía radial endoscópica combinada con la inyección intralesional de mitomicina C para el tratamiento de las estenosis severas de cuello vesical luego del fracaso del trata-miento tradicional. Materiales y método: Revisión retrospectiva de los pa-cientes con estenosis severa de cuello vesical intervenidos entre julio de 2013 y agosto de 2015 con la utilización de mitomicina C. El 54.5% de los pacientes había fracasado al menos una vez con la realización de cervicotomía interna y/o resección endoscópica de cuello vesical. En nuestra intervención se realizaron tres o cuatro incisiones endoscópicas con corte frío en el cuello de la vejiga, seguido por la inyección intralesional de 0.3 a 0.4 mg/ml de mitomicina C en cada sitio de incisión. Resultados: Un total de 11 pacientes fueron tratados con incisión endoscópica con corte frío en el cuello de la vejiga combinado con la inyección de mitomicina C. Antes de la operación, 4 pacientes (36%) eran usuarios de cistotomía. En un seguimiento medio de 9 meses (rango 1-20) 9 pacientes (82%) se encuentran con micción espontánea posterior a un procedimiento, mientras que 2 pacientes (18%) lograron dicho objetivo después de 2 procedimientos con utilización de mitomicina C. Conclusiones: El tratamiento para la estenosis del cuello vesical con cervicotomía radial endoscópica con corte frío combinada con inyección intralesional de mitomicina C, resultó en la permeabilidad del cuello vesical en el 82% de los pacientes después de 1 procedimiento y en el 100% después de 2 procedimientos. Aunque los primeros resultados son prometedores, se requiere de estudios prospectivos y aleatorizados con seguimiento prolongado en el tiempo para validar estos hallazgos.

Introduction: The mitomycin C is a chemotherapeutic agent by virtue of its antiproliferative and antibiotic ac-tivity. We evaluated the outcome of endoscopic radial cervicotomy combined with intralesional mitomycin C injection for the treatment of severe bladder neck ste-nosis after traditional treatment failure.Materials and methods: It was a retrospective review of patients with severe bladder neck stenosis who had a surgery between July 2013 and August 2015 with mi-tomycin C. The 54.5% of patients had failed at least 1 time with internal cervicotomy and/or endoscopic re-section of the bladder neck. In our intervention, three or four endoscopic incisions were performed with a cold cut in the neck of the bladder, followed by intralesio-nal injection of 0.3 to 0.4 mg / ml of the mitomycin C at each incision site.Results: A total of 11 patients were treated with endos-copic incision with a cold cut in the neck of the bladder combined with mitomycin C injection. Before the sur-gery 4 patients (36%) were cystostomy users. At a mean follow-up of 9 months (range 1-20), 9 patients (82%) had spontaneous urine after 1 procedure, while 2 patients (18%) achieved this goal after 2 procedures using mi-tomycin C.Conclusions: The treatment for bladder neck stenosis with endoscopic radial cervicotomy with cold cut com-bined with intralesional mitomycin C injection resulted in bladder neck permeability in 82% of patients after 1 procedure and 100% after 2 procedures. Although the first results are promising, some prospective and rando-mized studies with long-term monitoring are required to validate these findings.

Laparoscopic single port cystolithotomy using pneumovesicum

ABSTRACT Purpose: Currently, several modalities are used to manage bladder stones. We report laparoscopic single port cystolithotomy using stone basket via pneumovesicum method.