Influence of laparoscopic surgery on the outcomes of radical cystectomy within a multimodal rehabilitation protocol.

INTRODUCTION AND OBJECTIVE: The implementation of Enhanced Recover After Surgery (ERAS) multimodal rehabilitation protocols in radical cystectomy has shown to improve outcomes in hospital stay and complications. The aim of this analysis is to evaluate the impact of laparoscopic surgery on radical cystectomy within a multimodal rehabilitation program. MATERIAL AND METHODS: The study was carried out in a third level center between 2011 and 2020 including patients with bladder cancer submitted to radical cystectomy according to an ERAS (Enhanced Recovery After Surgery) protocol and the Spanish Multimodal Rehabilitation Group (GERM) with 20 items to be fulfilled. RESULTS: A total of 250 radical cystectomies were performed throughout the study period, 42.8% by open surgery (OS) and 57.2% by laparoscopic surgery (LS). The groups are comparable in demographic and clinical variables (p > 0.05). Operative time was longer in the LS group (248.4 ±â€¯55.0 vs. 286.2 ±â€¯51.9 min; p < 0.001). However, bleeding was significantly lower in the LS group (417.5 ±â€¯365.7 vs. 877.9 ±â€¯529.7 cc; p < 0.001), as was the need for blood transfusion (33.6% vs. 58.9%; p < 0.001). Postoperative length of stay (11.5 ±â€¯10.5 vs. 20.1 ±â€¯17.2 days; p < 0.001), total and major complications were also significantly lower in this group (LS). The readmission rate was lower in the LS group but not significantly (36.4% vs. 29.4%; p = 0.237). The difference between 90-day mortality in both groups was not statistically significant (2.8% LS vs. 4.3% OS; p = 0.546). The differences were maintained in the multivariate models. CONCLUSIONS: Laparoscopic surgery within a multimodal rehabilitation program increases operative time but significantly decreases intraoperative bleeding, transfusion requirements, postoperative length of stay, and complications.

Urinary tract infection as the main cause of admission in cystectomized patients. / La infección del tracto urinario como causa principal de ingreso en pacientes cistectomizados.

INTRODUCTION AND OBJECTIVES: Radical cystectomy with urinary diversion associated with extended pelvic lymphadenectomy continues to be the treatment of choice in muscle invasive bladder cancer. Sixty-four percent of patients submitted to this procedure present postoperative complications, with urinary infection being responsible in 20-40% of cases. The aim of this project is to assess the rate of urinary infection as a cause of re-admission after cystectomy, and to identify protective and predisposing factors for urinary infection in our environment. Finally, we will evaluate the outcomes after the establishment of a prophylactic antibiotic protocol after removal of ureteral catheters. MATERIAL AND METHODS: Retrospective descriptive study of cystectomized patients in the Urology Service of the Hospital Clínico Universitario of Zaragoza, from January 2012 to December 2018. A urinary tract infection (UTI) prevention protocol after catheter removal is established for all patients since October 2017. RESULTS: UTI is responsible for 54.7% of readmissions, with 55.1% of these being due to UTI after removal of ureteral catheters. Of the patients who received with prophylaxis, 9.5% presented UTIs after withdrawal, compared to 10.6% in the group of patients without prophylaxis. The patient who is re-admitted for UTI after withdrawal has a mean catheter time of 24.3±7.2 days, compared to 24.5±7.4 days for patients in the group without UTI (P=.847). CONCLUSIONS: The type of urinary diversion performed is not related to the rate of urinary infection. The regression model does not identify antibiotic prophylaxis, nor catheter time, as independent factors of UTI after catheter removal.

[Transurethral prostatic resection with bipolar scalpel]. / Resección transuretral de próstata con bisturí bipolar.

UNLABELLED: FUNDAMENTAL: [corrected] To show our initial experience in the TUR of prostate with bipolar axipolar bistoury. MATERIAL AND METHODS: Five patients with an average age of 72 years old, were operated between may and june 2002. They showed important increased in questionnaire symptoms (IPSS). The average ecographic volume has been 57.4 g. We employed Gyrus resector and physiological salt solution for continue irrigation. RESULTS: The average operative time was 70 minutes. None of the patients showed hyponatremia needed blood transfusion. In all the cases the sound was removed 48 hours after operation, one of them have urinary retention (UR) and need sound tow more days. Hospital stay was tree days except the patient how had UR. At 1 and 6 month there is improvement in the IPSS. CONCLUSIONS: TUR of prostate with bipolar axipolar bistoury can avoid the secondary effects of glicine and allows us to work with prostates of bigger volumes due to we have more time to do it. Nevertheless bigger and better studies are required to value the effectiveness of this new technology opposite the TUR of prostate with monopolar bistoury which keeps being the gold standard.

[Experience with endoscopic urethrocervicopexy: long-term results]. / Experiencia con la uretrocervicopexia endoscópica: resultados a largo plazo.

With the purpose of evaluating the long-term results of percutaneous endoscopic urethrocervicopexy performed in our unit since 1987, using a modified Stamey's technique, in the treatment of stress urinary incontinence in women, 51 patients who had undergone surgery up to June 92 were retrospectively studied. Mean time since surgery was 35 months, and satisfactory results during this time were accomplished in 60.5%, bearing in mind that the patients are totally "dry" and do not require sanitary towels. Comparison of our results and those contributed by other authors in the literature, indicating the decrease over time in the number of good results, and that between three to four years after intervention, the stress urinary incontinence reappears in one third of the women. Finally, we try to provide an statistical correlation of the cases in which continence was not achieved, including the patient's personal features or their medical-surgical background.

[Prenatal torsion of the spermatic cord]. / Torsión prenatal de cordón espermático.

OBJECTIVES: Considerations on a case of prenatal torsion of the spermatic cord. METHODS: Review of cases reported in the literature. RESULTS: Testicular torsion rarely occurs in the perinatal period. Nearly a hundred cases with surgical confirmation have been reported. CONCLUSIONS: Prenatal torsion is almost exclusively extravaginal, while postnatal extravaginal torsion is extremely rare. The possibility of finding a viable testis is extremely remote. The treatment should be directed at minimizing any potential perioperative complications by scheduling an elective operation after the neonate is medically stable.

[Wilms' tumor. The experience of the University Clinical Hospital of Zaragoza]. / Tumor de Wilms. Experiencia del Hospital Clínico Universitario de Zaragoza.

OBJECTIVES: The present study reviewed the records of patients with Wilms' tumor treated at the University Hospital of Zaragoza from January, 1980 to January, 1995. METHODS: A retrospective study was conducted in 12 patients (5 boys and 7 girls) with Wilms' tumor, aged 9 months to 9.5 years, with special reference to the clinical symptoms and signs. RESULTS: In 9 of the 12 cases, the tumor was localized to the left kidney and 3 cases had right-sided involvement. No patient showed an unfavorable histological finding, intraoperative rupture or the associated phenotypic manifestations that are frequently described in cases with this tumor type. CONCLUSION: The mortality and survival rates are comparable with those reported by other authors in our country.

Resección transuretral de próstata con bisturí bipolar / Transuretral resection of prostate with bipolar electrobisturi

FUNDAMENTO: Presentar nuestra experiencia inicial en la RTU de próstata con bisturí bipolar axipolar. MATERIAL Y MÉTODO: Los sujetos de estudio han sido 5 pacientes con una edad media de 72 años intervenidos, entre mayo y junio de 2002. Todos presentaban valores elevados en el cuestionario de síntomas (IPSS). El volumen ecográfico medio fue 57,4 g. Se empleó el resector Gyrus® y suero fisiológico para irrigación. RESULTADOS: La duración media de la intervención fue de 70 minutos. Ningún paciente presentó hiponatremia ni precisó transfusión. En todos los casos se retiró la sonda a las 48 horas, produciéndose una retención aguda de orina (RAO), que precisó sonda dos días más. Todos fueron dados de alta al tercer día, salvo el paciente que presentó el episodio de RAO. Al mes y a 6 meses hay una mejoría mantenida del IPSS. CONCLUSIONES: La RTU de próstata con bisturí bipolar axipolar puede evitar los efectos secundarios de la reabsorción de glicina y permite abordar próstatas de mayor volumen al disponer de más tiempo para hacerlo. No obstante, hacen falta estudios más amplios para valorar la eficacia de esta nueva tecnología, frente a la RTU de próstata con bisturí monopolar que sigue siendo el patrón oro (AU)