RESUMO
PURPOSE: To compare surgery outcomes and safety of button bipolar enucleation of the prostate vs laparoscopic simple prostatectomy in patients with large prostates (> 80 g) in a two-center cohort study. METHODS: All patients with lower urinary tract symptoms due to benign prostatic enlargement (Prostate volume > 80 cc) undergoing button bipolar enucleation of the prostate (BTUEP) or laparoscopic simple prostatectomy (LSP) in two centers were enrolled. Data on clinical history, physical examination, urinary symptoms, uroflowmetry and prostate volume were collected at 0, 1, 3 6, 12, 24 and 36 months. Early and long-term complications were recorded. RESULTS: Overall, 296 patients were enrolled. Out of them, 167/296 (56%) performed a LSP and 129/296 (44%) performed a BTUEP. In terms of efficacy both procedures showed durable results at three years with a reintervention rate of 8% in the LSP group and of 5% in the BTUEP group. In terms of safety, BTUEP and LSP presented similar safety profiles with a 9% of transfusion rate and no major complications. CONCLUSION: LSP and BTUEP are safe and effective in treating large-volume adenomas with durable results at three years when performed in experienced centers.
Assuntos
Eletrocirurgia , Laparoscopia , Prostatectomia/métodos , Hiperplasia Prostática/patologia , Hiperplasia Prostática/cirurgia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Aim of our study was to evaluate learning curve of the Millin simple prostatectomy analyzing three expert laparoscopic surgeons. METHODS: Learning curve of 3 expert laparoscopic surgeons with excellent radical prostatectomy training was evaluated. Surgeon 1 had more than 20 years of experience, while other surgeons had 10 years of experience. The first 45 procedures of the surgeons were considered for analysis. The cumulative sum (CUSUM) technique, one of the methods developed to monitor the performance and quality of the industrial sector, was adopted to analyze learning curves. The variables included to evaluate learning curve of the surgeons were: operative time (OT), hospitalization (HO) and complication rate. RESULTS: Overall 135 patients were included in the analysis. Median age was 68 (64/74), median prostate volume was 83 (75/97), median Q
Assuntos
Laparoscopia , Cirurgiões , Idoso , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Curva de Aprendizado , Masculino , Duração da Cirurgia , Prostatectomia/métodos , Cirurgiões/educaçãoRESUMO
OBJECTIVE: Report a case of a scrotum-perinea lGranular Cell Tumor (GCT) in pediatric age. METHODS: To report a case. RESULTS: A 12 years old men with a multiple GCT history, located in both extremities, abdomen and scrotum perineal region. Surgical excision of all lesions and a genetic studyare performed to rule out Noonan syndrome. CONCLUSION: GCT or Abrikossoff tumor is a tumor witha very low incidence, especially in pediatric age. The most frequent form of presentation a solitary nodule and the most common behavior is in the form of a benign tumor. Immunohistochemistryis crucial for its diagnosis, the main characteristicis positivity for the S100 protein. Although scrotal location is very rare, it must be considered in the differential diagnosis of scrotal mass. Surgical excision is the treatment of choice.
OBJETIVO: Exposición de un caso de Tumor de Células Granulares (TCG) escroto-perineal en edad pediátrica.MÉTODOS: Presentación de un caso clínico. RESULTADOS: Se trata de un paciente de 12 años de edad con historia de TCG múltiples, localizados en ambas extremidades, abdomen y región escroto-perineal. Se realiza exéresis quirúrgica de todas las lesiones y se lleva a cabo estudio genético para descartar síndrome de Noonan.CONCLUSIÓN: El TCG o Tumor de Abrikossoff es un tumor con una incidencia muy baja, sobre todo en edad pediátrica. La forma de presentación más frecuente es la de nódulo solitario y el comportamiento más habitual es como tumor benigno. La inmunohistoquímica resulta crucial para su diagnóstico, siendo lo más característico su positividad para la proteína S-100. Aunque la localización escrotal es muy poco frecuente, hay que considerarla en el diagnóstico diferencial de masa escrotal. La exéresis quirúrgica es el tratamiento de elección.
Assuntos
Neoplasias dos Genitais Masculinos , Tumor de Células Granulares , Neoplasias Cutâneas , Criança , Neoplasias dos Genitais Masculinos/diagnóstico , Neoplasias dos Genitais Masculinos/cirurgia , Tumor de Células Granulares/diagnóstico , Tumor de Células Granulares/cirurgia , Humanos , Masculino , Períneo , Escroto/cirurgiaRESUMO
BACKROUND: The aim of our study was to analyze outcomes and safety of laparoscopic simple prostatectomy (LSP) in a high-volume center. METHODS: A consecutive series of men with lower urinary tract symptoms and large prostates (>80 cc) prospectively enrolled between November 2015 and December 2017 in one center. All patients underwent laparoscopic simple prostatectomy. Outcomes were evaluated considering the trifecta favorable outcome which was defined as a combination of the following items: 1) no perioperative complications; 2) postoperative IPSS <8; 3) postoperative Q
Assuntos
Adenoma/cirurgia , Laparoscopia/métodos , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Idoso , Estudos de Coortes , Hemoglobinas/análise , Humanos , Tempo de Internação , Sintomas do Trato Urinário Inferior/complicações , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Antígeno Prostático Específico/análise , Qualidade de Vida , Resultado do TratamentoRESUMO
OBJECTIVES: To report the case and iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and the treatment of this surgical complication. METHODS: 69 year-old woman status post renal transplantation who presents right lower extremity edema and worsening renal function. A liquid collection was demonstrated by ultrasound and computerized tomography, compatible with lymphocele after biochemical study of the liquid obtained by percutaneous puncture. RESULTS: The patient underwent laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcome. CONCLUSION: Lymphocele is a common pathology after a renal transplantation which needs to be treated depending on its clinical manifestations. There mainly are two therapeutic alternatives depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from very selected cases, laparoscopic approach is currently considered, because of its security and effectiveness, the first choice when a surgical treatment is prescribed.
Assuntos
Transplante de Rim/efeitos adversos , Perna (Membro) , Linfocele/etiologia , Idoso , Feminino , Humanos , Linfocele/diagnóstico , Linfocele/cirurgiaRESUMO
SUMMARY OBJECTIVES: To describe a clinical case of ureteral inguinal hernia and to comment briefly about the topic. METHODS: 80 year-old patient with, hypertension, left inguinal hernia surgery, right hemicolectomy for colon adenocarcinoma and cholecystectomy. Intravenous urogram casually found that the right ureter was leaving the abdominal cavity though the right inguinal duct and then returned to the abdomen. RESULTS: CT scan confirmed the diagnosis. Due to the advanced age of the patient, comorbidities and the absence of symptoms, conservative treatment was decided. CONCLUSIONS: Ureteral hernias through the inguinal duct are uncommon. There are 2 types: paraperitoneal and extraperitoneal. The most common is the paraperitoneal (80%) which is accompanied by hernia sac and can appear with other abdominal organs. The extraperitoneal often accompanied by retroperitoneal fat. Both types of hernias are usually indirect. Treatment is usually herniorrhaphy.
Assuntos
Hérnia Inguinal , Doenças Ureterais , Idoso de 80 Anos ou mais , Hérnia Inguinal/diagnóstico por imagem , Humanos , Masculino , Radiografia , Doenças Ureterais/diagnóstico por imagemRESUMO
Objetivo: Exposición de un caso de Tumorde Células Granulares (TCG) escroto-perineal en edad pediátrica.Métodos: Presentación de un caso clínico.Resultados: Se trata de un paciente de 12 años de edadcon historia de TCG múltiples, localizados en ambas extremidades, abdomen y región escroto-perineal. Se realizaexéresis quirúrgica de todas las lesiones y se lleva a caboestudio genético para descartar síndrome de Noonan.Conclusiones: El TCG o Tumor de Abrikossoff es un tumor con una incidencia muy baja, sobre todo en edad pediátrica. La forma de presentación más frecuente es la denódulo solitario y el comportamiento más habitual es comotumor benigno. La inmunohistoquímica resulta crucial para su diagnóstico, siendo lo más característico su positividadpara la proteína S-100. Aunque la localización escrotal esmuy poco frecuente, hay que considerarla en el diagnóstico diferencial de masa escrotal. La exéresis quirúrgica esel tratamiento de elección.(AU)
Objetive: Report a case of a scrotum-perineal Granular Cell Tumor (GCT) in pediatric age.Methods: To report a case.Results: A 12 years old men with a multiple GCT history,located in both extremities, abdomen and scrotumperinealregion. Surgical excision of all lesions and a genetic studyare performed to rule out Noonan syndrome.Conclusion: GCT or Abrikossoff tumor is a tumor witha very low incidence, especially in pediatric age. The mostfrequent form of presentation a solitary nodule and the mostcommon behavior is in the form of a benign tumor. Immunohistochemistry is crucial for its diagnosis, the main characteristic is positivity for the S100 protein. Although scrotallocation is very rare, it must be considered in the differentialdiagnosis of scrotal mass. Surgical excision is the treatmentof choice.(AU)
Assuntos
Humanos , Masculino , Criança , Tumor de Células Granulares , Pacientes Internados , Exame Físico , Proteínas S100 , Pediatria , Cirurgia GeralRESUMO
OBJECTIVE: To report the case and the iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and treatment of this surgical complication. METHODS: 69 year-old woman who undergone renal transplantation and presented right lower extremity edema and worsening renal function. It was demonstrated by ultrasound and computerized tomography a liquid collection, compatible with lymphocele after biochemical study of the liquid which was obtained by percutaneous puncture. RESULTS: The patient underwent a laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcomes. CONCLUSION: Lymphocele is a common pathology after a renal transplantation, which needs to be treated depending on its clinical manifestations. There are mainly two therapeutic alternatives, depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from highly selected cases, laparoscopic approach is currently considered first choice when a surgical treatment is prescribed due to its security and effectiveness.
Assuntos
Transplante de Rim/efeitos adversos , Linfocele/etiologia , Idoso , Feminino , Humanos , Linfocele/patologiaRESUMO
OBJETIVOS: Presentar nuestra experiencia con cuatro casos de quistes de las glándulas de Skene de gran tamaño, realizar una revisión de la literatura publicada y conocer así los distintos diagnósticos diferenciales y el manejo a seguir.MÉTODOS: Cuatro mujeres remitidas a nosotros desde su ginecólogo por presentar masas parauretrales refractarias a tratamiento conservador con posible afectación de la uretra distal.CONCLUSIONES: El quiste de la glándula de Skene es una patología que raramente tratan los urólogos debido a su escasa repercusión clínica pero cuando nos es remitida por los ginecólogos es importante realizar un estudio completo del aparato urinario para realizar así un diagnóstico diferencial certero que excluya patologías malignas o alteraciones del aparato urinario. El tratamiento de elección en los casos refractarios es quirúrgico, realizando una exéresis completa del quiste y reparando las posibles lesiones de la pared uretral. En todos los casos la evolución fue favorable sin presentar recidiva o complicaciones fistulosas(AU)
OBJECTIVES: To show our experience with 4 cases of cysts of the Skene´s gland and a review of the published literature.METHODS/RESULTS: Diagnosis and treatment of 4 cases of Skene´s gland cyst.CONCLUSIONS: Skene´s gland cyst is a lesion that rarely is treated by Urologists, because it doesnt usually have clinical repercussion, but when it´s derived to us we have to make a complete study of the urinary tract to exclude complications or different serious lesions. Surgery is the treatment of choice, making a complete excision of the lesion and repair of urethral injuries. All cases evolved well without recurrence or fistulous complications(AU)
Assuntos
Humanos , Masculino , Adulto , Glândulas Exócrinas , Procedimentos Cirúrgicos Urológicos Masculinos/instrumentação , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos , Cistos/cirurgia , Cistos/patologia , Infecções Sexualmente Transmissíveis/diagnóstico , Drenagem , Cateterismo Urinário , Cistos/cirurgiaRESUMO
OBJETIVO: Comunicar el caso y la iconografía de un linfocele postrasplante renal y revisar la literatura sobre diagnóstico y tratamiento de esta complicación quirúrgicaMÉTODOS: Mujer de 69 años sometida a trasplante renal, que se presenta con edema en miembro inferior derecho y deterioro de función renal. Se demostró con ecografía y TAC una colección líquida, compatible con linfocele tras estudio bioquímico del líquido obtenido por punción percutánea.RESULTADOS: Se somete a la paciente a una marsupialización del linfocele por vía laparoscópica, con buenos resultados quirúrgicos.CONCLUSIONES: El linfocele es una entidad frecuente tras el trasplante renal, precisando tratamiento según las manifestaciones clínicas. Existen fundamentalmente dos alternativas terapéuticas, dependiendo del tamaño: escleroterapia y marsupialización quirúgica. Salvo casos muy seleccionados, el abordaje laparoscópico se considera actualmente, por su seguridad y eficacia, de primera elección cuando se indica tratamiento quirúrgico(AU)
OBJECTIVE: To report the case and the iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and treatment of this surgical complication.METHODS: 69 year-old woman who undergone renal trans-plantation and presented right lower extremity edema and worsening renal function. It was demonstrated by ultrasound and computerized tomography a liquid collection, compatible with lymphocele after biochemical study of the liquid which was obtained by percutaneous puncture.RESULTS: The patient underwent a laparoscopic intraperito-neal drainage of the lymphocele, with good surgical outco-mes.CONCLUSION: Lymphocele is a common pathology after a renal transplantation, which needs to be treated depending on its clinical manifestations. There are mainly two therapeu-tic alternatives, depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from highly selected cases, laparoscopic approach is currently considered first choice when a surgical treatment is prescribed due to its security and effectiveness(AU)
Assuntos
Humanos , Feminino , Idoso , Linfocele/diagnóstico , Linfocele/cirurgia , Linfocele/terapia , Transplante de Rim , Laparoscopia , Hipercolesterolemia , HipertensãoRESUMO
OBJETIVOS: Describir caso clínico de hernia ureteral inguinal y luego comentar brevemente tema.MÉTODOS: Paciente 80 años hipertenso con hernia inguinal izquierda operada, hemicolectomia derecha por adenocarcinoma de colon y colecistectomia. En urografía intravenosa como hallazgo se identifica uréter derecho en posición ectópica que sale de la cavidad abdominal por región inguinal derecha para luego volver al abdomen.RESULTADOS: Se realiza TAC que confirma diagnostico. Debido a la edad avanzada del paciente, comorbilidades y ausencia de síntomas, se decidió actitud expectante. CONCLUSIONES: Las hernias urterales a través del conducto inguinal son poco frecuentes. Existen 2 tipos: paraperitoneal y extraperitoneal. La más frecuente es la paraperitoneal (80%) donde se acompaña de saco herniario y pueden aparecer otros órganos intra abdominales. La extraperitoneal suele acompañarse de grasa retroperitoneal. Ambos tipos de hernias suelen se indirectas. El tratamiento suele ser la herniorrafia(AU)
OBJECTIVES: To describe a clinical case of ureteral inguinal hernia and to comment briefly about the topic.METHODS: 80 year-old patient with, hypertension, left inguinal hernia sugery, right hemicolectomy for colon adenocarcinoma and cholecystectomy. Intravenous urogram casually found that the right ureter was leaving the abdominal cavity though the right inguinal duct and then returned to the abdomen.RESULTS: CT scan confirmed the diagnosis. Due to the advanced age of the patient, comorbidities and the absence of symptoms, conservative treatment was decided.CONCLUSIONS: Ureteral hernias through the inguinal duct are uncommon. There are 2 types: paraperitoneal and extraperitoneal. The most common is the paraperitoneal (80%) which is accompanied by hernia sac and can appear with other abdominal organs. The extraperitoneal often accompanied by retroperitoneal fat. Both types of hernias are usually indirect. Treatment is usually herniorrhaphy(AU)
Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Hérnia Inguinal/complicações , Obstrução Ureteral/etiologia , Urografia , Tomografia Computadorizada por Raios XRESUMO
OBJETIVOS: Comunicar el caso y la iconografía de un linfocele postrasplante renal y revisar la literatura sobre diagnóstico y tratamiento de esta complicación quirúrgicaMÉTODOS: Mujer de 69 años sometida a trasplante renal, que se presenta con edema en miembro inferior derecho y deterioro de función renal. Se demostró con ecografía y TAC una colección líquida, compatible con linfocele tras estudio bioquímico del líquido obtenido por punción percutánea. RESULTADOS: Se somete a la paciente a una marsupialización del linfocele por vía laparoscópica, con buenos resultados quirúrgicos.CONCLUSIONES: El linfocele es una entidad frecuente tras el trasplante renal, precisando tratamiento según las manifestaciones clínicas. Existen fundamentalmente dos alternativas terapéuticas, dependiendo del tamaño: escleroterapia y marsupialización quirúgica. Salvo casos muy seleccionados, el abordaje laparoscópico se considera actualmente, por su seguridad y eficacia, de primera elección cuando se indica tratamiento quirúrgico(AU)
OBJECTIVES: To report the case and iconography of a lymphocele after renal transplantation and to review the literature about the diagnosis and the treatment of this surgical complication.METHODS: 69 year-old woman status post renal transplantation who presents right lower extremity edema and worsening renal function. A liquid collection was demonstrated by ultrasound and computerized tomography, compatible with lymphocele after biochemical study of the liquid obtained by percutaneous puncture.RESULTS: The patient underwent laparoscopic intraperitoneal drainage of the lymphocele, with good surgical outcome.CONCLUSION: Lymphocele is a common pathology after a renal transplantation which needs to be treated depending on its clinical manifestations. There mainly are two therapeutic alternatives depending on the size of the lymphocele: sclerotherapy and surgical intraperitoneal drainage. Apart from very selected cases, laparoscopic approach is currently considered, because of its security and effectiveness, the first choice when a surgical treatment is prescribed(AU)
Assuntos
Humanos , Feminino , Idoso , Linfocele , Linfocele/diagnóstico , Linfocele/epidemiologia , Linfocele/etiologia , Linfocele/cirurgia , Linfocele/terapia , Transplante de Rim , Transplante de Rim/métodos , Transplante de Rim/efeitos adversos , Escleroterapia , Escleroterapia/métodosRESUMO
Hombre de 73 años que acude al servicio de urgencias por dolor abdominal. Al examen físico se palpa masa que ocupa hipocondrio derecho. Angio TAC muestra masa abdominal de 12 cm dependiente de glándula suprarrenal derecha. Analítica de orina muestra elevación de metanefrinas y normetanefrinas. La gamagrafía fue compatible con feocromocitoma. Se realiza extirpación quirúrgica de masa y la anatomía patológica describe hemorragia suprarrenal sin malignidad.
A 73 year old man, came to the emergency department referring abdominal pain. A palpable mass occupying right upper quadrant on physical examination was identified. CT angiography showed a 12 cm abdominal mass dependent of the right adrenal. Urinalysis showed elevation of metanephrines and normetanephrines. Gamagraphy scan was compatible with pheochromocytoma. Surgical resection of the mass was performed and pathology described an adrenal hemorrhage without malignancy.