Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer

ABSTRACT Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.

External validation of nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes

ABSTRACT Introduction Penile cancer (PC) occurs less frequently in Europe and in the United States than in South America and parts of Africa. Lymph node (LN) involvement is the most important prognostic factor, and inguinal LN (ILN) dissection can be curative; however, ILN dissection has high morbidity. A nomogram was previously developed based on clinicopathological features of PC to predict ILN metastases. Our objective was to conduct an external validation of the previously developed nomogram based on our population. Materials and methods We included men with cN0 ILNs who underwent ILN dissection for penile carcinoma between 2000 and 2014. We performed external validation of the nomogram considering three different external validation methods: k-fold, leave-one-out, and bootstrap. We also analyzed prognostic variables. Performance was quantified in terms of calibration and discrimination (receiver operator characteristic curve). A logistic regression model for positive ILNs was developed based on clinicopathological features of PC. Results We analyzed 65 men who underwent ILN dissection (cN0). The mean age was 56.8 years. Of 65 men, 24 (36.9%) presented with positive LNs. A median 21 ILNs were removed. Considering the three different methods used, we concluded that the previously developed nomogram was not suitable for our sample. Conclusions In our study, the previously developed nomogram that was applied to our population had low accuracy and low precision for correctly identifying patients with PC who have positive ILNs.

Initial experience of video endoscopic inguinal Lymphadenectomy in a center located at northeast brazilian region

ABSTRACT Introduction: Video endoscopic inguinal lymphadenectomy - VEIL - has emerged as an alternative to reduce post-surgical complications (PSC) in patients with penile cancer submitted to inguinal lymphadenectomy (IL). In some series, these PSC are observed in more than 50% of patients. The objectives of the present study are to describe the initial experience of VEIL in a Hospital in Teresina, PI, Brazil, and to analyze PSC incidence. Material and Methods: Retrospective descriptive study of patients submitted to VEIL from March 2014 to November 2015. Data were collected regarding surgical time, bleeding, complications, lymph node number, conversion, global complications, drainage time, cellulitis, lymphocele, cutaneous necrosis, miocutaneous necrosis and hospitalization time. Results: 20 lower limbs of 11 patients were operated. Mean age was 51.4 (24-72) years. Mean surgical time was 85 (60-120) minutes. No patient showed intrasurgical complications, bleeding > 50 mL or conversion. Three surgeries evolved with lower limb edema, 2 with lymphoceles and one patient had cutaneous necrosis and another bulging of surgical wound. Mean time of hospitalization was 4 (2-11) days. A mean of 5.8 (1-12) lymph nodes were dissected in each surgery. Conclusion: VEIL is a safe and easy technique with lower incidence of PSC that can be reproduced in small centers.

Transanal Minimally Invasive Surgery (TAMIS) to Treat Vesicorectal Fistula: A New Approach

ABSTRACT Purpose: Vesicorectal fistula is one of the most devastating postoperative complications after radical prostatectomy. Definitive treatment is difficult due to morbidity and recurrence. Despite many options, there is not an unanimous accepted approach. This article aimed to report a new minimally invasive approach as an option to reconstructive surgery. Materials and Methods: We report on Transanal Minimally Invasive Surgery (TAMIS) with miniLap devices for instrumentation in a 65 year old patient presenting with vesicorectal fistula after radical prostatectomy. We used Alexis® device for transanal access and 3, 5 and 11 mm triangulated ports for the procedure. The surgical steps were as follows: cystoscopy and implant of guide wire through fistula; patient at jack-knife position; transanal access; Identification of the fistula; dissection; vesical wall closure; injection of fibrin glue in defect; rectal wall closure. Results: The operative time was 240 minutes, with 120 minutes for reconstruction. No perioperative complications or conversion were observed. Hospital stay was two days and catheters were removed at four weeks. No recurrence was observed. Conclusions: This approach has low morbidity and is feasible. The main difficulties consisted in maintaining luminal dilation, instrumental manipulation and suturing.

Laparoscopic Treatment of Vesicovaginal Fistula

Introduction Vesicovaginal fistula is a rare disease with great impact for the patients. Laparoscopic repair can be an interesting option in selected cases with goods results but few experience is reported.Objectives Detailed demonstration of our laparoscopic vesicovaginal fistula repair technique. Initial results for ten patients are provided Methods: We treated all cases by the same technique. The surgical steps were: Patient positioning in Lloyd-Davis; Cystoscopy and implant of guide wire on fistula and ureteral catheters (that was removed after procedure); Transperitoneal access and 4 or 5 ports in V or W shape; Opening the bladder wall; Dissection between bladder and vagina for tension free repair; Fistula resection; Vagina repair with Vicryl 3-0; Bladder repair with Vicryl 3-0; Peritoneum/omentum interposition; Positioning 20 Fr urethral catheter.Results Mean age was 50 years. Mean number of fistulas was 1,2. The most common etiology was gynecologic surgery (7). Mean operative time was 2,5 (1,8-3,2) hours. Mean blood loss was 150 (100-200)mL. Complication rate was 10% (one case of urinary infection treated conservatively). Mean hospital stay was 1,2 (1-2) days. Mean return to normal and activities was 20 (15-30) days. For nine patients mean sexual intercourse time was 3 (1-6) months. Success rate after 1 year was 90% (one case of recurrence in patient with previous radiotherapy). Mean follow-up was 36 (12-60) months.Conclusions Laparoscopic repair is feasible, reproducible and present all advantages of minimally invasive surgical procedure. Long term results are similar to conventional open approaches.

Efectividad de la terapia triple antirretroviral en lactante menor con diagnóstico de SIDA categoría C / Effectiveness of triple antiretroviral therapy in a young infant diagnosed with AIDS category C

La falta de medicación antirretroviral durante el embarazo, la no aplicación del protocolo de prevención perinatal del VIH-1 y VIH-2 (PACTG 076) en el momento de la cesárea y la administración de inhibidores de la transcriptasa inversa al recién nacido, es la respuesta más directa a la falta de acciones de protección para los niños (as) que nacen de sus progenitoras que se encuentran viviendo con el virus de la inmunodeficiencia humana (VIH). En el caso de la nena de 4 meses de edad que nace de un vientre donde se encontraba el presente el VIH, presentan una evolución clínica, inmunológica y virológica que progresivamente la va llevando al estado de caquexia, además de presentar procesos infecciosos secundarios a oportunistas, que se complican con una sepsis determinando la necesidad de ventilación asistida. La administración de forma inmediata de los antirretrovirales (ARV) recomendados por el Programa Nacional de Lucha Contra el VIH/SIDA, sin incluso contar con resultados de carga viral materna, tampoco de la pacientita se asocia dos inhibidores nucleótidos de la transcriptasa inversa, con un inhibidor de la transcriptasa inversa no nucleósido, y los antimicóticos y antimicrobianos adecuados, la respuesta clínica, celular es satisfactoria, así ocurrió con la lactante menor que tratamos. Es cierto que nuestra preferencia es hacer asociaciones con principios químicos de mejor acción sobre este virus, como en nuestro caso ante la evidencia de que la nevirapina nos produjo al quinto día de tratamiento una reacción de alergia (la literatura relata que los casos de esta naturaleza generalmente evolucionan a la muerte), habiéndose además asociado antihistamínicos por vía venosa, y la administración de un inhibidor de la proteasa viral que también es un químico asociado (lopinavir + Ritonavir), habiéndose obtenido una respuesta espectacular, a pesar del fondo de caquexia en que se encontraba la lactante menor de 4 meses de edad. Todo estos acontecimientos de ver cada día más casos de mujeres embarazadas que se enteran de ser portadoras de este virus cuando sus bebes evolucionan atípicamente y/o se encuentran en situaciones clínicas gravísimas, tendrían un mejor pronóstico si se decidiera considerar al VIH/SIDA como el problema de salud número uno en nuestro país.

The lack of antiretroviral medication during pregnancy, failure to apply the protocol perinatal HIV-1 and HIV-2 (PACTG 076) at the time of cesarean delivery and administration of inhibitors of reverse transcriptase newborn is the more directly to the lack of protective actions for children (as) that arise from their mothers who are living with human immunodeficiency virus (HIV) response. In the case of the baby 4 months of age born from a womb where HIV was present, present a clinical, immunological and virological evolution is progressively moving the state of cachexia, besides presenting secondary to opportunistic infectious processes which are complicated by sepsis determining the need for assisted ventilation. The administration immediately antiretroviral (ARV) recommended by the National Programme for the Fight Against HIV/AIDS, without even having maternal viral load results, either of two nucleotides pacientita reverse transcriptase inhibitors dela associated with an inhibitor of non-nucleoside reverse transcriptase and appropriate antifungal and antimicrobial, clinical, cellular response is satisfactory, so it happened with the lowest infant who try. It is true that our preference is to make partnerships with chemical principles of best action on this virus, as in our case given the evidence that nevirapine we came on the fifth day of treatment an allergic reaction (literature reports that cases of this nature death usually evolve), having further associated antihistamines intravenously, and administration of a viral protease inhibitor which is also an associated chemical (lopinavir + ritonavir), a dramatic response being obtained, despite the background of cachexia that infants under 4 months of age was. All these events to see more and more cases of pregnant women who learn to be carriers of this virus when their babies evolve atypically and / or are in very serious clinical situations, would have a better prognosis if it decides to treat HIV/AIDS as the number one health problem in our country.

Câncer de pênis: estudo retrospectivo de 99 casos / Penile Neoplasm: retrospective study of 99 cases

O objetivo do presente estudo é uma análise descritiva dos pacientes com câncer de pênis tratados em nossa instituição. Pacientes e métodos: Estudo transversal descritivo de 99 pacientes com câncer de pênis atendidos no Hospital São Marcos no período de 1998 a 2002. Analisaram-se as variáveis relacionadas à epidemiologia e ao tratamento do câncer de pênis. Resultados: A idade variou de 28 a 89 anos com média de 59,2 anos. Os estadiamentos mais freqüentes foram II, III e IV, respectivamente. O tratamento cirúrgico empregado foi a penectomia parcial em 45 casos e a penectomia total em 21 casos. Com um seguimento médio de 17,6 meses, 20,2 por cento dos pacientes estão vivos sem doença, 71 por cento estão vivos com doença e 68,7 por cento não retornaram para seguimento. Conclusão: O estadiamento mais freqüente foi do tipo II e o tratamento cirúrgico mais realizado foi a nectomia parcial

Estudio de gasometria y hematocrito en vena umbilical de recien nacido de la altura / Umbilical, cord venous blood gases and packed red cells in newborns at high altitude

MARCO TEÓRICO: el ambiente hipóxico-hiperbárico de la altura tiene influencia sobre el hematocrito y los gases en sangre. MATERIAL Y MÉTODO: se determinó dichos valores en sangre venosa de cordón umbilical de recién nacidos sanos, nacidos de madres que cursaron embarazo y parto en la altura (3600 metros sobre el nivel del mar). RESULTADOS: en una muestra de 100 niños, el pH fue de 7,279 ± 0,0712, PCO2 de 41,8 ± 10,66, bicarbonato de 17,231 ± 2,612, y PO2 de 20,062 ± 6,471. El hematocrito fue de 16,248 ± 2,355. No se encontró diferencias significativas con datos publicados a nivel del mar. DISCUSIÓN: se concluye que los datos de referencia de la literatura pueden ser utilizados en neonatos nacidos en la altura.

BACKGROUND: the hypoxic-hypobaric environment at high altitude has an effect on packed red cell volume (PRC) and blood gases. METHODS: these parameters were measured in umbilical cord venous blood of healthy neonates, born of mothers who underwent pregnancy and delivery at high altitude (3.600 meters above sea level). RESULTS: in a sample of 100 babies, the values found are as follows: pH: 7,279 ± 0,0712; PCO2 :41,8 ± 10,66; bicarbonate: 17,231 ± 2,612; and PO2 : 20,062 ± 6,471. PRC was 16,248 ± 2,355. No significant difference was found with reference values published at sea level. DISCUSSION: We conclude that reference levels can be applied to neonates born at high altitude.