La interdisciplinariedad en la cirugía urológica mínimamente invasiva / Interdisciplinarity in Minimally Invasive Urologic Surgery

Introducción: La interdisciplinariedad es el resultado de la puesta en práctica de varias disciplinas, que permite afrontar el objeto de estudio de modo integral y promover el desarrollo de nuevas intervenciones para la solución de problemas. En el campo de la medicina involucra la contribución de diversas disciplinas y la participación de especialistas de diversas áreas que integra el pensamiento de diferentes profesiones o tecnologías para lograr un resultado común. Objetivos: Exponer una visión integral acerca de cómo la interdisciplinariedad ha permitido el desarrollado de la cirugía mínimamente invasiva en la especialidad de urología. Métodos: Se realizó una revisión sistemática y crítica de artículos reportados sobre la interdisciplinariedad en el campo de la cirugía mínimo invasiva, en idioma español e inglés, desde 2005 hasta 2022, en sitios Web (PubMed, SciELO, MedLine, Lilacs y Science Direct. Se referenciaron 22 artículos de los consultados. Conclusiones: Las evidencias reportadas y consultadas ofrecen una visión integral de las diversas intervenciones que certifican la interdisciplinariedad en el campo de la cirugía urológica mínimamente invasiva, que fortalece el marco curricular de la especialidad y permite alcanzar un nivel de profesionalidad significativo, evidenciado en un excelente desempeño profesional(AU)

Introduction: Interdisciplinarity results from implementing several disciplines, allowing to address the object of study comprehensively, as well as promote the development of new interventions to solve problems. In the field of medicine, it involves the contribution of various disciplines and the participation of specialists from different areas, integrating the thinking from different professions or technologies to achieve a common result. Objectives: To present a comprehensive perspective of how interdisciplinarity has allowed the development of minimally invasive surgery in the specialty of urology. Methods: A systematic and critical review was carried out with reported articles on interdisciplinarity in the field of minimally invasive surgery, in Spanish and English, from 2005 to 2022, in Web sites (PubMed, SciELO, MedLine, Lilacs and Science Direct). Twenty-two of the consulted articles were referenced. Conclusions: The reported and consulted evidence offers a comprehensive perspective of the various interventions certifying interdisciplinarity in the field of minimally invasive urologic surgery, which strengthens the curricular framework of the specialty and allows to achieve a significant level of professionalism, evidenced through excellent professional performance(AU)

Implementación artesanal del sistema VAC en pacientes con Gangrena de Fournier: serie de casos

La fascitis necrosante es una infección de los tejidos blandos profundos que provoca la destrucción progresiva de la fascia muscular y subcutánea. Una de sus presentaciones es la Gangrena de Fournier (GF) para el cual el diagnóstico debe de ser preciso y asociado a desbridamiento quirúrgico precoz y antibioticoterapia de amplio espectro. Si existe retraso del manejo, la repercusión en el pronóstico es negativa. Entre las opciones actuales para el tratamiento destaca una técnica para mejorar la limpieza y granulación del área cruenta mediante el uso del dispositivo tecnológico y el sistema de cierre asistido por vacío (VAC). Describimos el manejo y la técnica de la terapia VAC implementado artesanalmente en una serie de casos de pacientes masculinos con diagnóstico de GF, en respuesta a los escasos recursos económicos de los pacientes que generalmente son afectados en nuestro medio; proponiendo una opción más económica, segura y replicable para nuestro entorno.

Necrotizing fasciitis is a deep soft tissue infection that causes progressive destruction of the muscle fascia and subcutaneous . One of its presentations is Fournier's Gangrene (FG) for which the diagnosis must be accurate and associated with early surgical debridement and broad-spectrum antibiotic therapy. If management is delayed, the impact on prognosis is negative. Current treatment options include a technique to improve cleaning and granulation of the cruciate area using a technological device and the vacuum assisted closure system (VAC). We describe a handmade technique of VAC therapy implemented in a series of cases of male patients diagnosed with FG, in response to the scarce economic resources of patients who are generally affected in our environment; proposing a more economical, safe and replicable option for our environment.

Tratamiento del síndrome de vejiga hiperactiva mediante estimulación transcutánea bilateral del nervio tibial posterior / Treatment of overactive bladder syndrome by bilateral transcutaneous posterior tibial nerve stimulation

Resumen OBJETIVO: Determinar si la estimulación transcutánea bilateral del nervio tibial posterior disminuye los síntomas de la vejiga hiperactiva y mejora la calidad de vida. MATERIALES Y MÉTODOS: Estudio de cohorte simple, retrospectivo, efectuado en pacientes atendidas en la clínica de Urología Ginecológica del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes en la Ciudad de México, del 8 de octubre de 2021 al 14 de julio de 2022 a quienes se aplicó terapia de electroestimulación bilateral transcutánea del nervio tibial posterior para tratar el síndrome de vejiga hiperactiva.Parámetros de estudio: severidad, calidad de vida y diario miccional en las sesiones 1, 6 y 12. Para la comparación al inicio y al final del tratamiento se utilizó estadística descriptiva y prueba de t pareada; la p < 0.05 se consideró estadísticamente significativa. RESULTADOS: Se estudiaron 25 pacientes: 23 con disminución del puntaje en el cuestionario de calidad de vida King's Health de 24.5 entre las sesiones 1 y 12 (p < 0.001). La disminución del puntaje de severidad de síntomas (Overactive Bladder Symptom Severity [OABSS]) fue de 16.6 entre las sesiones 1 y 12 (p < 0.001). Se observó mejoría significativa en todos los parámetros del diario miccional. CONCLUSIÓN: En esta muestra, la estimulación transcutánea bilateral del nervio tibial posterior disminuyó de manera importante los síntomas de vejiga hiperactiva y mejoró la calidad de vida.

Abstract OBJECTIVE: To determine whether bilateral transcutaneous stimulation of the posterior tibial nerve reduces symptoms of overactive bladder and improves quality of life. MATERIALS AND METHODS: Simple, retrospective, cohort study carried out in patients attended at the gynaecological urology clinic of the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes in Mexico City, from 8 October 2021 to 14 July 2022 to whom bilateral transcutaneous electrostimulation therapy of the posterior tibial nerve was applied to treat overactive bladder syndrome. Study parameters: severity, quality of life and voiding diary in sessions 1, 6 and 12. Descriptive statistics and paired t-test were used for comparison at baseline and at the end of treatment; p < 0.05 was considered statistically significant. RESULTS: Twenty-five patients were studied: 23 with a decrease in King's Health quality of life score of 24.5 between sessions 1 and 12 (p < 0.001). The decrease in symptom severity score (OABSS) was 16.6 between sessions 1 and 12 (p < 0.001). Significant improvement was observed in all voiding diary parameters. CONCLUSION: In this sample, bilateral transcutaneous posterior tibial nerve stimulation significantly decreased overactive bladder symptoms and improved quality of life.

Evidências tecnológicas para assistência ambulatorial e domiciliar em urologia pediátrica: revisão de escopo / Technological evidence for outpatient and home care in pediatric urology: a scoping review

RESUMO Objetivo mapear as evidências sobre as tecnologias baseadas na internet e sua aplicabilidade no cuidado ambulatorial e domiciliar em urologia pediátrica. Métodos trata-se de revisão de escopo, com buscas conduzidas em seis bases de dados, sem limite de tempo, nos idiomas português, inglês e espanhol. Resultados 2.200 artigos foram obtidos, sendo 19 publicações elegíveis para a amostra final. As tecnologias baseadas na internet mais utilizadas foram telessaúde e telemedicina (47,3%), programas de intervenção online (21,0%) e aplicativos móveis (15,8%), com uma taxa menor de uso de serious game s, mídias sociais e vídeos de micção (5,3%), majoritariamente no contexto domiciliar. Conclusão o mapeamento das evidências tecnológicas na assistência ambulatorial e domiciliar em urologia pediátrica permitiu identificar os tipos de tecnologia e suas aplicações voltadas para o autogerenciamento dos sintomas e autoeficácia, para o monitoramento e acompanhamento do cuidado urológico. Contribuições para a prática: as evidências sintetizadas contribuem para uma prática profissional expandida, qualificada e inovadora junto à população pediátrica com sintomas urinários e intestinais, características relacionadas a uma prática avançada de enfermagem, além de favorecer diagnóstico precoce e maior adesão terapêutica, particularmente por apoiar intervenções personalizadas às necessidades do paciente pediátrico e sua família.

ABSTRACT Objective to map the evidence on web-based technologies and their applicability in outpatient and home care in pediatric urology. Methods this is a scoping review, with searches conducted in six databases, with no time limit, in Portuguese, English, and Spanish. Results 2,200 articles were obtained, with 19 publications eligible for the final sample. The most used web-based technologies were telehealth and telemedicine (47.3%), online intervention programs (21.0%), and mobile apps (15.8%), with a lower rate of use of serious games, social media, and urination videos (5.3%), mostly in the home setting. Conclusion the mapping of technological evidence in outpatient and home care in pediatric urology allowed us to identify the types of technology and their applications focused on self-management of symptoms and self-efficacy, for monitoring and follow-up of urologic care. Contributions to practice: the synthesized evidence contributes to an expanded, qualified, and innovative professional practice with the pediatric population with urinary and bowel symptoms, characteristics related to advanced nursing practice, in addition to favoring early diagnosis and greater therapeutic adherence, particularly by supporting interventions tailored to the needs of the pediatric patient and his family.

Migración de catéter ureteral doble-J a vena cava inferior, una complicación inusual / Migration of double-J ureteral catheter into the inferior vena cava, an unusual complication

La colocación de catéteres ureterales doble-J es uno de los procedimientos más realizados en Urología, con bajas tasas de complicaciones graves. No obstante, pueden ocurrir y requieren de una identificación y tratamiento precoz. Presentamos el caso de un varón de 73 años intervenido de una prostatectomía radical, al que se le coloca un catéter doble-J por sospecha de lesión ureteral durante la intervención, con inestabilidad hemodinámica en el postoperatorio inmediato secundaria a la migración del catéter a la vena cava inferior

Double-J ureteral catheter placement is one of the most commonly performed procedures in Urology, with low rates of severe complications. Nevertheless, they can occur and require early identification and treatment. We present the case of a 73-year-old man who underwent radical prostatectomy and placement of a double-J catheter due to suspected ureteral injury during the surgery, with hemodynamic instability in the immediate postoperative period secondary to intracaval migration of the catheter.

Comparative analysis between open transvesical and laparoscopic adenomectomy in the treatment of benigne prostatic hyperplasia in a tertiary hospital in Curitiba-PR: a retrospective study / Análise comparativa entre adenomectomia transvesical aberta e videolaparoscópica no tratamento da hiperplasia prostática benigna em hospital terciário de Curitiba - PR: estudo retrospectivo

ABSTRACT Objective: the aim of this study was to compare the results of open and videolaparoscopic transvesical prostatectomy techniques in the treatment of benign prostatic hyperplasia (BPH) in a tertiary hospital. Methods: we reviewed medical records of patients who underwent transvesical adenectomy due to BPH between March 2019 and March 2021 at the urology service of Hospital de Clínicas do Paraná (HCPR), 42 patients were included in the open transvesical prostatectomy group and 22 in the videolaparoscopic group. Then, a comparison was made between the techniques in terms of surgical time, bleeding, length of stay, need for intensive care, among others, in addition to postoperative outcome. Results: the mean surgical time was shorter in the open technique compared to the laparoscopic technique (141 min vs 274 min). The videolaparoscopic group had a shorter mean hospital stay (3.5 days vs 6.36 days). There was no statistical significance in the comparison regarding the need for an intensive care unit, as well as in the assessment of postoperative bleeding. Conclusion: comparatively, the techniques demonstrated a similar outcome, with a low rate of complications and satisfactory results for the treatment of BPH. The laparoscopic technique is a surgery with a shorter hospital stay, but at the expense of a longer surgical time.

RESUMO Objetivo: o objetivo deste estudo foi comparar o resultado das técnicas de prostatectomia transvesical aberta e videolaparoscópica no tratamento de hiperplasia prostática benigna (HPB) em um hospital terciário. Métodos: foram revisados prontuários de pacientes submetidos a adenectomia transvesical devido a HPB entre março de 2019 a março de 2021 no serviço de urologia do Hospital de Clínicas do Paraná (HCPR), sendo incluídos 42 pacientes no grupo prostatectomia transvesical aberta e 22 no grupo videolaparoscópico. Em seguida foi feita a comparação entre as técnicas nos quesitos tempo cirúrgico, sangramento, tempo de internamento, necessidade de terapia intensiva, entre outras, além de desfecho pós-operatório. Resultados: o tempo cirúrgico médio foi menor na técnica aberta em comparação com a técnica videolaparoscópica (141 min vs 274 min). O grupo videolaparoscópico apresentou um tempo médio de internamento menor (3,5 dias vs 6,36 dias). Não houve significância estatística na comparação quanto a necessidade de unidade de terapia intensiva, assim como na avaliação do sangramento pós-operatório. Conclusão: comparativamente, as técnicas demonstraram um desfecho semelhante, com baixa taxa de complicações e resultados satisfatórios para o tratamento da HPB. Sendo a técnica videolaparoscópica uma cirurgia com menor tempo de internamento, porém às custas de um maior tempo cirúrgico. .

Nephrometry scoring systems: their importance for the planning of nephron-sparing surgery and the relationships among them / Escores nefrométricos: sua importância para o planejamento da nefrectomia parcial e as relações entre eles

Abstract In recent years, the development of new imaging techniques and scoring systems have improved the diagnosis and management of small renal masses. Imaging-based nephrometry scoring systems play an interesting role in the planning of nephron-sparing surgery, providing surgeons with the information necessary to determine the complexity of the renal mass, to deliver the appropriate postoperative care, and to predict adverse outcomes. The aim of this study was to review nephrometry scoring systems, evaluating their characteristics and the relationships among them. The urology and radiology communities should decide which nephrometry scoring system will prevail and be used in daily practice.

Resumo O diagnóstico e o manejo das pequenas massas renais têm sido aprimorados nos últimos anos com o desenvolvimento de técnicas de imagem e escores que desempenham papel interessante no planejamento da nefrectomia parcial, fornecendo informações importantes ao cirurgião para determinar o tipo de tratamento em relação a complexidade da massa renal, cuidados pós-operatórios e previsão de complicações após as cirurgias. O objetivo deste estudo é revisar os escores de nefrometria, suas características e relações entre eles no cenário da cirurgia. Os serviços de urologia e radiologia devem decidir qual é o melhor escore de nefrometria para ser utilizado na prática diária.

Correção cirúrgica de pênis embutido com utilização de enxertia: relato de caso / Surgical correction of buried penis with a skin graft: case report

Introdução: Pênis embutido é uma patologia rara relacionada à redução do comprimento peniano. É descrita com maior incidência em crianças, porém acomete também adultos. Nesta população está associado principalmente a obesidade e acúmulo de gordura em região suprapúbica, sendo considerada uma afecção de difícil manejo e tratamento. A intervenção cirúrgica é a base do tratamento e o objetivo principal é o retorno da função urinária e sexual. Múltiplas técnicas cirúrgicas são descritas para reconstrução em pacientes com pênis embutido e devem ser adaptadas para as características apresentadas pelo paciente. Relato de Caso: Nesse artigo é relatada a abordagem de um paciente com pênis embutido, utilizando-se da técnica cirúrgica de lipoaspiração superficial e dermolipectomia associada à fixação da base do pênis em sínfise púbica com o uso de enxerto de pele parcial. Conclusão: A técnica apresentada demonstrou bons resultados funcionais pós-operatórios, devido apresentar melhora clínica das queixas iniciais do paciente, e estéticos, verbalizados pelo paciente e pela responsável legal em virtude do baixo nível cognitivo do paciente.

Introduction: Buried penis is a rare pathology related to the reduction of penile length. It is described with a higher incidence in children, but it also affects adults. This population is mainly associated with obesity and fat accumulation in the suprapubic region, being considered a pathology that is difficult to manage and treat. Surgical intervention is the basis of treatment, and the main objective is the return of urinary and sexual function. Multiple surgical techniques are described for reconstruction in patients with buried penis and must be adapted to the characteristics presented by the patient. Case Report: This article reports the surgical technique of dermolipectomy associated with the fixation of the base of the penis in pubic symphysis and a partial skin graft to approach a patient with a buried penis. Conclusion: The presented technique showed good functional postoperative results due to clinical improvement of the patients' initial complaints and aesthetic ones, verbalized by the patient and the legal guardian due to the patient's low cognitive level.

Sarcoma fibromixoide de baixo grau em região paratesticular: um relato de caso / Low-grade fibromyxoid sarcoma in paratesticular area: a case report

Objetivos: relatar um caso raro de sarcoma fibromixoide de baixo grau (SFMBG) em uma localização incomum de modo a reforçar aspectos histopatológicos e imunoistoquímicos relevantes para o reconhecimento desta entidade e o adequado diagnóstico diferencial de massas paratesticulares. Relato de caso: homem de 20 anos, com massa escrotal à direita, cuja análise histopatológica demonstrou a presença de tecido fibroso com áreas mixoides e predominância de células fusiformes. A imunoistoquímica foi positiva para vimentina, com índice de Ki67 de 2%, e negativa para S100, CD-34, beta-catenina, desmina e miogenina. Conclusões: caso raro de SFMBG na região paratesticular que reforça a importância da histopatologia e da imunoistoquímica no diagnóstico desse tumor. Apesar da característica histológica benigna, o SFMBG apresenta altas taxas de recorrência e metástases, sendo essencial o seguimento do paciente.

Objectives: to report a rare case of low-grade fibromyxoid sarcoma (LGFMS) in an unusual location in order to reinforce histopathological and immunohistochemical aspects relevant to the recognition of this entity and the adequate differential diagnosis of paratesticular masses. Case report: 20-year-old man, with a right scrotal mass and histopathological analysis showing the presence of fibrous tissue with myxoid areas and a predominance of spindle cells. Immunohistochemistry was positive for vimentin, with a Ki67 index of 2%, and negative for S100, CD-34, beta-catenin, desmin and myogenin. Conclusions: rare case of LGFMS in the paratesticular region that reinforces the importance of histopathology and immunohistochemistry in the diagnosis of this tumor. Despite the benign histological characteristic, LGFMS has high rates of recurrence and metastasis, and patient follow-up is essential.

Quadratus Lumborum Block for Upper Tract Urological Surgery in Pediatric Patients / Bloqueo del cuadrado lumbar para cirugía urológica del tracto superior en pacientes pediátricos

Objective Among regional blocks, the quadratus lumborum fascial plane block (QLB) has been well described, but the description of its use and efficacy for pediatric patients undergoing upper abdominal urologic surgery is limited. We present a case series examining the use of the QLB for postoperative pain management in children undergoing upper tract surgery. Methods From August 2019 to August 2020, through a chart review, we identified 5 patients who had undergone a QLB for upper urinary tract surgery via a flank incision. Posterior QLB was performed after induction of general anesthesia. A single injection of 0.5mL/kg of either 0.25% or 0.5% ropivacaine with 1mcg/kg of clonidine was administered. Patients received fentanyl IV (1 mcg/kg), and acetaminophen IV (15mg/kg) as adjuvants during the operation. Postoperative pain was managed with oral acetaminophen and ibuprofen. Results The average postoperative pain score during the entire admission was 1, with the lowest being 0 and highest, 3. No administration of rescue narcotics was required in the postanesthesia care unit or on the floor. The average length of stay ranged from 0 to 1 day. No complications associated with the regional QLB were identified. Conclusions Our series suggests the QLB may be considered as a regional anesthetic option to minimize narcotic requirements for children undergoing upper abdominal urological surgery via flank incision. Additional studies are needed to compare the efficacy of the QLB versus alternate regional anesthetic blocks for upper tract urological surgery via flank incision in children and to determine effective dosing and use of adjuvants

Objetivo Entre los bloqueos regionales, el bloqueo del plano fascial del cuadrado lumbar (BCL) ha sido bien descrito; sin embargo, tiene una descripción limitada de su uso y eficacia en pacientes pediátricos sometidos a cirugía urológica abdominal superior. Presentamos una serie de casos que examinan el uso del BCL en el manejo del dolor posoperatorio en niños sometidos a cirugía urológica del tracto superior. Métodos De agosto de 2019 a agosto de 2020, mediante revisión de historias clínicas, se identificaron 5 pacientes sometidos al BCL para cirugía del tracto urinario superior por incisión en el flanco. El BCL posterior se realizó después de la inducción de la anestesia general. Solo se administró una inyección de 0,5 ml/kg de ropivacaína al 0,25% o al 0,5% con 1 mcg/kg de clonidina. Los pacientes recibieron fentanilo IV (1 mcg/kg) y acetaminofén IV (15 mg/kg) como adyuvantes durante la operación. El dolor posoperatorio se manejó con acetaminofén e ibuprofeno oral. Resultados El puntaje promedio de dolor posoperatorio para todo el ingreso fue de 1, siendo el más bajo 0 y el más alto, 3. No se requirieron administraciones de narcóticos de rescate en la unidad de recuperación posanestésica ni en la planta de hospitalización. La estancia media fue de 0 a 1 día. No se identificaron complicaciones asociadas con el BCL regional. Conclusiones Nuestra revisión sugiere que el BCL puede ser considerado una opción anestésica regional para minimizar los requerimientos de narcóticos en niños sometidos a cirugía urológica abdominal superior por incisión en el flanco. Se necesitan estudios adicionales para comparar la eficacia de BCL en comparación con la de los bloqueos anestésicos regionales alternativos para la cirugía urológica del tracto superior por incisión en el flanco en niños y para determinar la efectividad de la dosificación y del uso de adyuvantes.

Melanoma metastásico a vejiga / Metastatic melanoma to the bladder / Melanoma metastático na bexiga

Introducción. El compromiso tumoral metastásico del melanoma al tracto genitourinario es frecuente, pero, la metástasis a vejiga es rara, constituye menos del 2% de los casos. Sin embargo, en autopsias realizadas a pacientes con melanoma se ha encontrado metástasis en la vejiga en entre un 18% y un 37% de los casos, lo que la convierte en la segunda en incidencia posterior al adenocarcinoma gástrico. La media de supervivencia suele ser entre 6 - 7.5 meses. El objetivo de este trabajo es presentar el caso de un melanoma metastásico a vejiga, entidad poco frecuente y poco diagnosticada por ser la mayoría de las veces asintomática. Presentación del caso. Paciente femenina de 62 años, con antecedente de melanoma al nivel del primer artejo del pie, con manejo quirúrgico y farmacológico. Consultó por hematuria. La cistoscopia evidenció una lesión única sólida, eritematosa, con necrosis y fácil sangrado y se indicó realizar resección transuretral (RTU). La patología demostró compromiso por melanoma ulcerado metastásico. Se inició manejo de segunda línea (Pembrolizumab) y presentó progresión a miembros superiores y recaída a nivel vesical. La paciente falleció un año después. Discusión. Las metástasis de melanoma al tracto genitourinario son frecuentes, pero las metástasis vesicales aisladas son raras. El tratamiento suele ser RTU de la lesión, cistectomía, quimioterapia y radioterapia. La RTU es curativa para las lesiones restringidas al epitelio, aunque la cistectomía radical suele ser la terapia de elección ante un paciente con un tumor localizado. El Pembrolizumab ha demostrado aumentar la supervivencia. El pronóstico depende del tamaño y profundidad de la invasión. Conclusiones. El compromiso vesical metastásico es poco frecuente y diagnosticado, puede estar presente en pacientes con melanoma, síntomas irritativos urinarios no específicos y hematuria. Suele ser de mal pronóstico, y requiere de manejo quirúrgico asociado a manejo sistémico.

Introduction. Metastatic tumor compromise of melanoma to the genitourinary tract is frequent, but metastasis to the bladder is rare, representing less than 2% of cases. However, autopsies performed on patients with melanoma have found metastases in the bladder in 18-37% of cases, making it the second incidence after gastric adenocarcinoma. The median survival is usually 6 to 7.5 months. The objective of this work is to present the case of a metastatic melanoma to the bladder, a rare and underdiagnosed condition because most of the time it is asymptomatic. Case Presentation. 62-year-old female patient, with a history of melanoma at the level of the first toe, with surgical and pharmacological management. The reason for consultation was hematuria. Cystoscopy revealed a single solid, erythematous lesion with necrosis and easy bleeding, and a transurethral resection (TUR) was indicated. The pathology found compromise for metastatic ulcerated melanoma. Second-line treatment (Pembrolizumab) was started and presented progression to the upper limbs and relapse at the bladder level. The patient died a year later. Discussion. Melanoma metastases to the genitourinary tract are common, but isolated bladder metastases are rare. Treatment is usually TUR of the lesion, cystectomy, chemotherapy, and radiation therapy. TUR is curative for lesions restricted to the epithelium, although radical cystectomy is usually the therapy of choice in patients with a localized tumor. Pembrolizumab has been shown to increase survival. The prognosis depends on the size and depth of the invasion. Conclusions. Metastatic bladder compromise is rare and underdiagnosed, it may be present in patients with melanoma, non-specific urinary irritative symptoms, and hematuria. It tends to have a poor prognosis, and requires surgical management associated with systemic management.

Introdução. O comprometimento do tumor metastático do melanoma no trato geniturinário é comum, mas a metástase na bexiga é rara, constituindo menos de 2% dos casos. Entretanto, em autópsias realizadas em pacientes com melanoma, foi encontrada metástase na bexiga entre 18% e 37% dos casos, o que a torna a segunda em incidência após o adenocarcinoma gástrico. A média de sobrevivência é geralmente entre 6 - 7,5 meses. O objetivo deste trabalho é apresentar o caso de um melanoma metastático na bexiga, uma entidade pouco frequente e subdiagnosticada, pois na maioria das vezes é assintomática. Apresentação do caso. Paciente do sexo feminino, 62 anos, com antecedentes de melanoma no nível do hálux, com manejo cirúrgico e farmacológico. Ela consultou por hematúria. A cistoscopia revelou uma única lesão sólida, eritematosa com necrose e sangramento fácil, e foi indicada uma ressecção transuretral (RTU). A patologia mostrou comprometimento de melanoma ulceroso metastático. O tratamento de segunda linha (Pembrolizumab) foi iniciado e a patologia avançou para os membros superiores e uma recaída no nível da bexiga. A paciente morreu um ano depois. Discussão. As metástases de melanoma para o trato geniturinário são frequentes, mas as metástases vesicais isoladas são raras. O tratamento é geralmente RTU da lesão, cistectomia, quimioterapia e radioterapia. A RTU é curativa para lesões restritas ao epitélio, embora a cistectomia radical seja geralmente a terapia de escolha para um paciente com um tumor localizado. O Pembrolizumab demonstrou aumentar a sobrevivência. O prognóstico depende do tamanho e da profundidade da invasão. Conclusões. O comprometimento vesical metastático é raro e subdiagnosticado, pode estar presente em pacientes com melanoma, sintomas irritantes urinários não específicos e hematúria. Geralmente tem um prognóstico negativo e requer manejo cirúrgico em associação com manejo sistêmico.

Disfunción sexual femenina: una mirada a los últimos 44 años. Análisis bibliométrico / Female Sexual Dysfunction: Looking Back at the Last 44 Years. A Bibliometric Analysis

Objetivo La disfunción sexual femenina (DSF) es un trastorno prevalente que afecta la calidad de vida de las mujeres y combina factores biológicos, psicológicos e interpersonales. Su estudio ha sido de poco interés, en campos como la investigación y el tratamiento, debido a la dificultad en la medición de las respuestas sexuales en las mujeres y otros factores, como el tabú acerca de la sexualidad femenina. Este estudio caracteriza las tendencias de publicaciones científicas acerca del tema, para que los urólogos puedan comprender la necesidad de realizar la búsqueda de este trastorno en la práctica diaria. Métodos Se realizó una búsqueda de la literatura en las bases de datos PubMed, FABUMED y Scopus, utilizando la estrategia «((«female sexual dysfunction¼ [Title/Abstract])¼. Se realizó un análisis bibliométrico descriptivo, de corte retrospectivo, de la literatura médica obtenida en MEDLINE. A través de las herramientas estadísticas FABUMED, PubReminer y Scopus, se recopilaron los datos y se obtuvo los resultados de las variables que posteriormente fueron analizadas de forma estadística y descriptiva. Con base en esta información, elaboramos tablas y gráficas en Microsoft Office Excel 2017. Adicionalmente, realizamos un análisis de mapeo bibliométrico utilizando el programa VOSviewer. Para la obtención del factor de impacto (FI), utilizamos el Journal Citation Reports 2017/2018. Resultados Desde 1975 hasta 2019, se publicaron 1.292 estudios, y la tasa anual de publicación permaneció estable entre 1975 y 2000. Pero, a partir del año 2000, se evidenció un aumento en el número de publicaciones, con un crecimiento del 92,1%. De las veinte revistas con más publicaciones, sólo cuatro son de urología. Los países con más publicaciones fueron: Estados Unidos (31,4%), Reino Unido (12,9%), Italia (8,9%), Turquía (5,9%), y Australia (4%). Estos datos son muy diferentes a los de los países de América Latina, en los que se encontraron muy pocas publicaciones, como Colombia, con tan sólo tres estudios. Conclusiones Este análisis bibliométrico mostró las diferentes tendencias y tasas de publicación de estudios sobre DSF, y evidenció una baja tasa de producción con relación a otras temáticas, sobre todo en las revistas urológicas, con predominio de mujeres como autores, aunque en los últimos años se ha identificado un crecimiento importante y sostenido. Se hace evidente la necesidad de desarrollar estrategias para mejorar la formación tanto en los niveles de posgrado como de pregrado y, así, generar más adhesión a este tema en una especialidad quirúrgica como la nuestra.

Objectives Female sexual dysfunction (FSD) is a prevalent disorder that affects the quality of life of women and combines biological, psychological, and interpersonal factors. There has been a lack of interest in studying FSD in such fields as research and treatment, due to the difficulty in measuring the sexual responses of women and other factors such as the taboo surrounding female sexuality. The present study portrays the trends in the scientific publications on the subject, so urologists can perceive and understand the need for research about this disorder in the daily practice. Methods A comprehensive review on the topic was performed through a PubMed, FABUMED, and Scopus databases using the search strategy "female sexual dysfunction", as well as a retrospective, descriptive, bibliometric analysis of the medical literature retrieved from MEDLINE. Data was collected through the FABUMED, PubReMiner, and Scopus statistical tools, and, based on the results obtained for the variables, which were later submitted to a statistical and descriptive analysis. Based on this data, tables and graphs were developed using the Microsoft Office Excel 2017 software. Moreover, we performed a bibliometric mapping analysis using the VOSviewer software. In order to obtain the impact factor (IF), we used the Journal Citation Reports 2017/2018. Results From 1975 to 2019, 1,292 studies were published; yearly publication rate remained stable from1975 to 2000, but after year 2000, an increase in the number of publications was evidenced, with a growth of 92.1%. But as of the year 2000, an increase in the number of publications was evidenced, with a growth of 92.1%. Of the twenty journals with the most publications, only four are on urology. The countries with the greatest number of publications were: the United States (31.4%), the United Kingdom (12.9%), Italy (8.9%), Turkey (5.9%), and Australia (4%). This data differs from that of Latin American countries, in which few publications were found, such as in Colombia, with only three studies. Conclusions The present bibliometric analysis showed the different trends and publication rates of studies on FSD, showing a low production rate as compared with that of other urological topics, especially in Urological journals, with a predominance of women as authors, although in recent years an important and sustained growth has been identified. The need to develop strategies to improve training at both the graduate and undergraduate levels and thus generate more adherence to these issues in a surgical specialty like ours is evident.

Percepción de acoso o discriminación durante la residencia de urología en Colombia / Perception of Harrasment or Discrimination during Urology Residency in Colombia

Objetivos El maltrato laboral (acoso, abuso o discriminación) ejercido de manera persistente contra un individuo genera un ambiente de trabajo hostil y lleva a agotamiento, con un impacto psicológico importante y la posibilidad de aparición de síntomas depresivos. En Colombia, no contamos con publicaciones al respecto. El objetivo de nuestro trabajo es conocer la percepción de los residentes de urología en cuanto a discriminación de género y acoso laboral, verbal y sexual durante su formación. Metodos Estudio observacional, descriptivo, de corte transversal, por medio de encuestas anónimas. Evaluamos las características demográficas, la percepción de acoso, el tipo de acoso, si éste afectó el rendimiento laboral del residente, y por parte de quién lo percibió. Resultados Obtuvimos respuestas de 82/115 (71,3%) residentes, en su mayoría hombres (45 [56%]). En total, 66% (54) reportaron haber experimentado acoso laboral; y 35,4% (29) reportaron haber experimentado discriminación de género, siendo más frecuente en las mujeres (17; 58,6%). El acoso verbal fue reportado por un 64,6% (53), y afectó el trabajo de un 92,5%. La percepción de acoso laboral fue similar entre hombres y mujeres (32 [69.5%] hombres y 21 [61.1%] de mujeres). En total, 7 (19%) mujeres reportaron acoso sexual. Con respecto a la fuente de acoso, 39 (65,8%) fue por profesores, 26 (45%), por otros residentes, y 17 (35.4%), por pacientes. Conclusión La percepción de acoso durante la residencia de urología en Colombia es real, y afecta el trabajo de los residentes. Este acoso es mayor por parte de los hombres, y es principalmente generado por profesores. Consideramos nuestro trabajo el punto de partida para continuar investigando un tema de importancia a nivel nacional y internacional.

Purpose Workplace bullying (harassment, abuse, or discrimination), practiced persistently against an individual, can generate a hostile workplace environment, consequently leading to exhaustion, with poor psychological outcomes, and the onset of symptoms such as loss of confidence, fatigue, depressive thoughts, desertion, and suicidal thoughts. There are no publications regarding this issue in Colombia. Our objective is to describe the residents' perception of gender and workplace discrimination and verbal/sexual harassment during their urological training. Methods Observational, descriptive, cross-sectional study with anonymous surveys. We evaluated the demographic characteristics and the residents' perception of harassment, the type of harassment, how it affected their performance during residency, and from whom it was perceived. Results We were able to obtain answers from 82/115 residents (71.3%), most of them men (45 [56%]). In total, 66% (54) reported workplace harassment; and 35.4% (29) felt gender discrimination, most of them women (17; 58.6%). Verbal abuse was reported by 64.6% (53), and it affected the work of 92.5%. The paerception of workplace harassment was similar among both men and women (32 [69.5%] men and 21 [61.1%] women). A total of 7(19%) women reported sexual abuse. Regarding the source of the abuse, 39 (65.8%) was by professors, 26 (45%), by other residents, and 17 (35.4%), by patients. Conclusion The perception of harassment during urology residency in Colombia is real, and it affects the work of residents. This abuse is greater on the part of men, and is mainly perpetrated by professors. We consider our work the starting point to continue researching a topic of national and international importance.

Lipogranuloma Esclerosante Escrotal Primario. Reporte de caso y revisión de la literatura / Primary Scrotal Sclerosing Lipogranuloma. Case report and literature review

RESUMEN El lipogranuloma esclerosante es una condición extraña y benigna que puede afectar cualquier órgano, especialmente los genitales externos masculinos. Se suele presentar como masas subcutáneas en escroto, periné y pene. Aunque la mayoría de los casos son secundarios a aplicación de cuerpos extraños como parafina, vaselina o silicona con propósitos estéticos para aumentar el tamaño del pene, también puede deberse a degeneración lipídica endógena, secundaria a trauma, infecciones o reacciones alérgicas. No existe consenso en cuanto a su manejo ni datos sobre su prevalencia al ser una entidad poco reportada; se ha descrito el manejo con ciclos cortos de corticoides sistémicos, y cirugía en los casos recidivantes. El objetivo de este trabajo es reportar el caso de un paciente que acudió con induración y eritema en pene y escroto, quien negaba la aplicación de sustancias exógenas y que fue llevado a biopsia de la lesión, con diagnóstico de lipogranuloma esclerosante. MÉD.UIS.2021;34(2): 97-102.

ABSTRACT Sclerosing lipogranuloma is a noncommon and benign disease that could affect any system in the body, especially the male external genitalia. It is usually presented as a subcutaneous mass in scrotum, perineum and penis. Although, most cases are secondary to the injection of foreign bodies such as paraffin, petrolatum or silicone for cosmetic purposes to increase penis size, it could also be due to endogenous lipid degeneration, secondary to trauma, infections or allergic reactions. There is no unanimity regarding its management or data on its prevalence as it is a poorly reported entity. Management with short cycles of systemic corticosteroids and surgery in relapsing cases have been described. The purpose of this article is to present a case of a patient with induration and erythema in penis and scrotum, who denied the application of exogenous substances and has a reported biopsy of the lesion with diagnosis of sclerosing lipogranuloma. MÉD.UIS.2021;34(2): 97-102.

Lesões de pele ocasionadas por procedimento robótico versus aberto / Skin injuries occasioned by robotic procedure versus open

Objetivo: identificar fatores associados a lesões de pele decorrentes de cirurgias urológicas robóticas versus convencionais em adultos/idosos. Método: revisão integrativa, etapas: Construção do protocolo de pesquisa; Formulação da pergunta - prática baseada em evidência, utilizando o acrônimo PICO; Definição dos descritores das estratégias de busca em cada uma das bases de dados selecionadas, que deviam ser variadas; Determinação, seleção e revisão dos critérios de inclusão e exclusão; Avaliação crítica dos estudos; Coleta de dados utilizando instrumentos que analisassem em pares; e Síntese dos resultados/dados agrupados por semelhança. Resultados: a estratégia de busca gerou 207 artigos. Resultando para análise final 7 artigos. Conclusão: são necessários novos estudos clínicos, que abordem os prejuízos e benefícios relacionados ao posicionamento cirúrgico robótico e abertos, direcionando assim, intervenções de enfermagem acuradas aos pacientes sob maior risco.(AU)

Objective: to identify factors associated with skin lesions resulting from robotic versus conventional urological surgery in adults / elderly. Method: integrative review, stages: Construction of the research protocol; Formulation of the question - evidence-based practice, using the acronym PICO; Definition of search strategy descriptors in each of the selected databases, which should be varied; Determination, selection and review of inclusion and exclusion criteria; Critical evaluation of studies; Data collection using instruments that analyzed in pairs; and Summary of results / data grouped by similarity. Results: the search strategy generated 207 articles. Resulting in 7 articles for final analysis. Conclusion: further clinical studies are needed, addressing the losses and benefits related to robotic and open surgical positioning, thus directing accurate nursing interventions to patients at higher risk.(AU)

Objetivo: identificar los factores asociados a las lesiones cutáneas resultantes de la cirugía urológica robótica versus convencional en adultos / ancianos. Método: revisión integradora, etapas: construcción del protocolo de investigación; Formulación de la pregunta - práctica basada en evidencia, utilizando el acrónimo PICO; Definición de descriptores de estrategias de búsqueda en cada una de las bases de datos seleccionadas, que deben ser variadas; Determinación, selección y revisión de criterios de inclusión y exclusión; Evaluación crítica de estudios; Recolección de datos utilizando instrumentos que se analizaron por parejas; y Resumen de resultados / datos agrupados por similitud. Resultados: la estrategia de búsqueda generó 207 artículos. Resultando en 7 artículos para el análisis final. Conclusión: se necesitan más estudios clínicos que aborden las pérdidas y beneficios relacionados con el posicionamiento quirúrgico robótico y abierto, dirigiendo así intervenciones de enfermería precisas a los pacientes de mayor riesgo.(AU)

HCAM la historia de un grande / HCAM the story of a great

Prólogo. La obra recopiló los hitos históricos, las acciones en gestión y la visión futura de las Unidades Médicas, Administrativas y de Enfermería, en homenaje a los 50 años de función del Hospital de Especialidades Carlos Andrade Marín como ícono de la Seguridad Social del Ecuador, entre el periodo 1970 a diciembre 2020. Cada autor registró el título entrelazado un pensamiento, previo a la cronología de los hechos suscitados en los servicios brindados en beneficio de los pacientes que se atendieron en esta casa de salud. La obra se clasificó en capítulos por Unidades Médicas: Críticas, Clínicas, Quirúrgicas, Administrativas y de Enfermería, se incluyeron tablas, figuras, producción médica, patologías, cambios de técnicas o procedimientos y sustentó su accionar con citas textuales y referen-cias bibliográficas. Además, se narraron mejoras continuas transmitidas de los ilustres y legados maestros, especialistas médicos por varias generaciones, en conjunto con el personal de salud con vocación de servicio, en una reflexión profunda con mensajes vivos de su accionar. En las modalidades de publicación se realizaron aportes de visión nacional e internacional en los ámbitos asistenciales, administrativos, docente, de investigación y producción científica de alto nivel del contexto y naturaleza del emblemático hospital. Finalmente, se agradece a los funcionarios y ex trabajadores que colaboraron durante el proceso de construcción de la obra, así como a ex colaboradores que motivaron aportes de experiencias y la apreciación personal.

Prologue. The work compiled the historical milestones, management actions and future vision of the Medical, Administrative and Nursing Units, in tribute to the 50 years of function of the Carlos Andrade Marin Specialty Hospital as an icon of the Social Security of Ecuador, between 1970 and December 2020. Each author recorded the title intertwined with a thought, prior to the chronology of the events that took place in the services provided for the benefit of patients who were treated in this health center. The work was classified in chapters by Medical Units: Critical, Clinical, Surgical, Administrative and Nursing, and included tables, figures, medical production, pathologies, changes in techniques or procedures, and supported his actions with textual quotations and bibliographical references. In addition, continuous improvements were narrated and transmitted from the illustrious and legacy masters, medical specialists for several generations, together with the health personnel with vocation of service, in a deep reflection with living messages of their actions. In the publication modalities, contributions of national and international vision were made in the care, administrative, teaching, research and scientific production of high level of the context and nature of the emblematic hospital. Finally, we would like to thank the employees and former workers who collaborated during the construction process, as well as former collaborators who contributed with their experiences and personal appreciation.

Hidronefrosis Unilateral Gigante en Adulto

Resumen La hidronefrosis gigante es una entidad urológica que se define por la presencia de más de 1.000 ml de líquido en el sistema colector renal o un riñón que representa más del 1,6% del peso corporal. La causa más común es la obstrucción de la unión ureteropiélica, siendo una presentación poco común en adultos y que puede provocar complicaciones a largo plazo como hipertensión, ruptura del riñón, insuficiencia renal y cambios malignos. La nefrectomía es el tratamiento de elección. Se presenta el caso de un paciente de 21 años de edad, sometido a una nefrectomía laparoscópica transperitoneal derecha obteniendo un riñón excluido con aproximadamente 2600 ml de orina sui generis. Se informa este caso, porque es una patología poco descrita en la literatura, con un número limitado de casos en adultos y para demostrar la posibilidad de abordaje laparoscópico.

Abstract Giant hydronephrosis is a urological entity defined by the presence of more than 1,000 ml of fluid in the renal collecting system or a kidney that represents more than 1.6% of body weight. The most common cause is obstruction of the ureteropelvic junction, being an uncommon presentation in adults and can lead to long-term complications such as hypertension, kidney rupture, renal failure and malignant changes. Nephrectomy is the treatment of choice. We present the case of a 21-year-old patient who underwent a right transperitoneal laparoscopic transperitoneal nephrectomy obtaining a kidney with approximately 2600 ml of sui generis urine. The reason for reporting this case is that this is a pathology rarely described in the literature, with a limited number of cases in adults, and to demonstrate the possibility of a laparoscopic approach.

Reintroducción de la circuncisión como una técnica quirúrgica reconstructiva / Reintroduction of Circumcision as a Technique Reconstructive Surgical

La circuncisión es una cirugía practicada frecuentemente en urología. Sin tener en cuenta los principios básicos de la cirugía reconstructiva, puede generar procesos de cicatrización anómalos, con resultados estéticos y funcionales inadecuados, fimosis secundaria, cicatrización hipertrófica, queloide o "pene enterrado." El objetivo de este video es recordar la importancia de operar con las directrices de una cirugía reconstructiva, resaltando el cuidado de los tejidos y el uso de suturas de bajo calibre, para prevenir complicaciones y resultados insatisfactorios, resaltando la preservación de las zonas postuladas por Firlit. Se sospecha que las complicaciones de este procedimiento son subestimadas por los especialistas. El manejo cuidadoso de los tejidos, el uso de suturas de bajo calibre y los puntos subcuticulares con poca tensión, son medios para optimizar el proceso de cicatrización, evitando la isquemia y las cicatrices hipertróficas, basados en el fundamento de que esta es una cirugía no solo funcional, sino reconstructiva y estética. La circuncisión es un procedimiento que debe conservar la funcionalidad y estética del pene, por lo que debe ser realizado bajo las directrices de una cirugía

Circumcision is a frequently practiced surgical procedure in urology. Without considering the basic principles of reconstructive surgery, it can result in abnormal cicatrization processes, with inadequate aesthetic or functional results, secondary phimosis, hypertrophic or keloid scarring, or even "buried penis." The objective of this video is to remind the importance of operating with the principles of reconstructive surgery, highlighting the careful handling of tissues and the use of low-caliber sutures, to prevent complications and unsatisfactory results, preserving the areas postulated by Firlit. The complications of this procedure are suspected to be underestimated by specialists. Careful tissue management, the use of low-caliber sutures and subcuticular points with no tension are means to optimize the healing process, avoiding ischemia and hypertrophic scars, based on the fact that this is a surgery that is not only functional, but reconstructive and aesthetic as well. Circumcision is a procedure that must preserve the functionality and aesthetics of the penis and it must be performed under the principles of reconstructive surgery.

Thirty years of the health care service for ostomy patients in Juiz de Fora and surroundings / Trinta anos do serviço de atenção à saúde da pessoa ostomizada de Juiz de Fora e região

ABSTRACT Objective: to establish the epidemiological profile of ostomized patients treated at the Health Care Service for Ostomy Patients in Juiz de Fora and region (SASPO/JF) and to quantify the pathologies that led to the stoma as well as the ostomy-related complications. Method: a retrospective study was carried out with the analysis of 496 medical records of patients registered at HCSOP/JF over 30 years and who remained in at the service in June 2018. The following variables were considered: age, sex, pathology that led to the stoma, type, time, location and complications of stomas. Results: 53.43% were male patients and 46.57% female. The average age was 56.24 years among men and 58.40 years among women. Eight patients had two types of ostomies simultaneously and a total of 504 ostomies were as follows: 340 colostomies (67.46%), 117 ileostomies (23.21%) and 47 urostomies (9.33%). Additionally, 47.65% of the colostomies and 76.92% of the ileostomies were temporary, while all urostomies were permanent. In 70.24% of cases, the reason for making the stoma was malignancy. There were 277 stomas with one or more complications (54.96%). Conclusions: most of the ostomized patients were over 50 years old and the main diagnosis that led to the stoma was malignancy. Ileostomies had a higher percentage of complications than colostomies and urostomies and, for all types of stomas, the most frequent complication was dermatitis.

RESUMO Objetivo: elaborar o perfil epidemiológico dos pacientes estomizados atendidos no Serviço de Atenção à Saúde da Pessoa Ostomizada de Juiz de Fora e região (SASPO/JF) e quantificar tanto as patologias que levaram à confecção, quanto as complicações presentes nas estomias. Método: realizado estudo retrospectivo com análise de 496 prontuários de pacientes cadastrados no SASPO/JF ao longo de 30 anos e que permaneciam em atendimento no serviço em junho de 2018. Foram consideradas as seguintes variáveis: idade, sexo, patologia que levou à confecção do estoma, tipo, caráter temporal, localização e complicações das estomias. Resultados: 53,43% dos pacientes eram do sexo masculino e 46,57% do sexo feminino. A média de idade entre os homens foi de 56,24 anos e entre as mulheres foi de 58,40 anos. Oito pacientes apresentaram dois tipos de estomias simultaneamente e o total de 504 estomias foi distribuído da seguinte forma: 340 colostomias (67,46%), 117 ileostomias (23,21%) e 47 urostomias (9,33%). Além disso, 47,65% das colostomias e 76,92% das ileostomias foram temporárias, enquanto todas as urostomias foram permanentes. Em 70,24% dos casos, o motivo para confecção do estoma foi a neoplasia maligna. Foram encontrados 277 estomas com uma ou mais complicações (54,96%). Conclusão: as estomias predominaram em pacientes com mais de 50 anos e o principal diagnóstico que levou à confecção dos estomas foi a neoplasia maligna. As ileostomias apresentaram maior percentual de complicações do que as colostomias e urostomias e, para todos os tipos de estomas, a complicação mais frequente foi a dermatite.