Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy during the learning curve: does the surgical approach affect the complication rate?

Purpose: To compare the perioperative complication rate obtained with the transperitoneal laparoscopic radical prostatectomy (TLRP) and with the extraperitoneal LRP (ELRP) during the learning curve (LC). Materials and Methods: Data of the initial 40 TLRP (Group 1) were retrospectively compared with the initial 40 ELRP (Group 2). Each Group of patients was operated by two different surgeons. Results: The overall surgical time (175 min x 267.6 min; p < 0.001) and estimated blood loss (177.5 mL x 292.4 mL; p < 0.001) were statistically better in the Group 1. Two intraoperative complications were observed in Group 1 (5 percent) represented by one case of bleeding and one case of rectal injury, whereas four complications (10 percent) were observed in Group 2, represented by two cases of bleeding, one bladder and one rectal injuries (p = 0.675). Open conversion occurred once in each Group (2.5 percent). Overall postoperative complications were similar (52.5 percent x 35 percent; p = 0.365). Major early postoperative complications occurred in three and in one case in Group 1 and 2, respectively. Group 1 had two peritonitis (fecal and urinary), leading to one death in this group. Conclusions: No statistical differences in overall complication rates were observed. The transperitoneal approach presented more serious complications during the early postoperative time and this fact is attributed to the potential chance of intraperitoneal peritonitis not observed with the extraperitoneal route.

Magnetic resonance in diagnosis of ureterocele

Ultrasonography is the main non-invasive technique for screening of ureterocele, but presents some difficulties for its diagnosis. Other supplementary diagnostic methods have the disadvantage of being invasive or using ionizing radiation. Magnetic resonance (MR) has a high sensitivity for diagnosing urinary tract malformations in adults and children. We report one case of ureterocele in a 1-year old child with the purpose of presenting its diagnosis through MR.