The outcomes of mini-laparoscopic pyeloplasty in children - brazilian experience

ABSTRACT Objetive Pelvicureteric junction (PUJ) obstruction is the main cause of hydronephrosis in childhood. Open pyeloplasty has been the gold standard treatment of this condition with success rate above 90%. The role of laparoscopic pyeloplasty (LP) in children is less well defined and has slowly emerged as an alternative procedure. We report outcomes of our initial experience with LP in 38 children from 2 months of age. Materials and Methods From June 2015 to December 2017 38 children aged 2-60 months (mean age 1.7 years) underwent LP for correction of PUJ obstruction. The mean pre operative anteroposterior diameter of the renal pelvis (APD) was 43,5mm and all patients had hydronephrosis (APD 21.4-76 mm) and obstructed curve on diuretic renogram. Anderson-Hynes pyeloplasty was the performed technique. Results are reported. Results Mean operative time was 107 minutes (70-180) with no conversion to open procedure. Pain control was needed mainly in the first 12hs. Mean hospitalization was 2 days (1-5). There were complications in 5 children not affecting the final outcome. Two patients had a re-obstruction requiring a second procedure with good result. The mean follow up was 18 months (13-36). The mean reduction on the postoperative APD was 41% - p<0,001 (end APD 5 to 41mm). Overall success rate was 94,7%. All children had good cosmetic results. Conclusions This is a small series limited by short follow up, however its data suggest that LP has good functional and cosmetic results, not compromising the success of the open procedure, regardless patient age.

Esquistossomose de vesícula seminal: vesiculectomia seminal videolaparoscópica / Schistosomiasis of the seminal vesicle: laparoscopic seminal vesiculectomia

Objetivo: Relatar um caso de esquistossomose mansonide vesícula seminal, com cirurgia de vesiculectomiavideolaparoscópica transperitoneal. Relato de caso: Paciente66 anos, masculino, natural de Teófilo Otoni (nortede Minas Gerais), com queixa inicial de hemospermia.Sem outras queixas. PSA: 4,2 ng/dl. História de ressecçãotransuretral de próstata em 2004, com anátomo--patológico descrevendo hiperplasia prostática benigna.Alterações em ultrasson transretal e em ressonância nuclearmagnética de pelve: U.S.T.R.: massa de localizaçãoextraprostática, com volume de 96cm3 . Próstata de 19g e com sinais sugestivos de prostatite crônica. R.N.M.pelve: Imagem medindo 8,4 x 8,5 x 7,7 cm, localizada natopografia das vesículas seminais, sugerindo neoplasia.Submetido Vesiculectomia Seminal por videolaparoscopiatransperitoneal. Anátomo-patológico (AP) e imuno--histoquímica: Hiperplasia fibromuscular associada àesquistossomose mansoni (ovos com espícula lateral),sem evidências de malignidade. Considerações finais:O achado de esquistossomose de próstata e vesículaseminal no Brasil é raro. Em nossa revisão, não encontramosnenhum relato de esquistossomose mansoniisolada de vesícula seminal, com tratamento através decirurgia videolaparoscópica.

Objective: Report a case of seminal vesicle of schistosomiasiswith laparoscopic surgery transperitoneal vesiculecomia.Case report: pacient 66 years old, male, he wasborn in Teófilo Otoni (northen Minas Gerais), with initialcomplaint of hemospermia. PSA: 4,2ng/dl. History of transurethralresection of the prostate in 2004, the pathologicalexamination is describing benign prostatic hyperplasia.Alteration in pelvis transrectal ultrasound and resonancemagnetic imaging (MRI): hypoechoic heterogeneous mass,extraprostatic location, with a volume of 96 cm3. Prostate19g and signs suggestive of chronic prostatitis. MRI pelvis:image with signal intensity and heterogeneous uptakeof contrast, measuring 8,4 x 8,5 x 7,7 cm, located in thetopography of the seminal vesicles, image is suggestingmalignancy. Submitted by video laparoscopic transperitonealvesiculectomia seminal. Pathological and immunohistochemistry:fibromuscular hyperplasia associated withschistosomiasis mansoni (eggs with lateral spike), withoutevidence of malignancy. Conclusion: The find of schistosomiasisof the prostate and seminal vesicles in Brazil is rare.In our review, we found no report of schistosoma mansoniisolated from seminal vesicle treated by video laparoscopicsurgery. After surgical treatment, use of praziquantelwas prescribed 50mg/kg in two divided doses.

Trauma testicular / Testicle trauma

Objetivo: descrição de um caso de paciente jovem, que sofreu um trauma testicular durantetreinamento em aula de arte marcial, com discussão das principais causas, diagnóstico etratamento. Relato de caso: paciente de 16 anos, com trauma testicular devido a um chute,evoluindo com dor e posterior abordagem cirúrgica. Considerações finais: a anamnese e examefísico, com exames de imagem quando necessários, são as melhores armas para um diagnósticocorreto e precoce para o trauma testicular, indicando o melhor tratamento a ser feito.

Objective: Description of a case report of a young patient whosuffered a testicular injury during training in martial arts class, with discussion of themain causes, diagnosis and treatment. Case report: Patient aged 16 years, withtesticular trauma due to a kick, there was pain and posterior surgical approach.Final considerations: A good anamnesis and physical examination, with imagingstudies when necessary, they are the best weapons for a correct and earlydiagnosis for testicular trauma, indicating the best treatment to be done

Retroperitoneal bilateral laparoscopic adrenalectomy for metastasis of transitional cell carcinoma of the bladder

We report a rare case of transitional cell carcinoma of the bladder metastasizing to bilateral adrenal glands without other metastasis. A 73-year-old male underwent radical cystoprostatectomy due to bladder cancer in 2006. Two years later, a CT scan showed a bilateral solitary adrenal tumor. Bilateral retroperitoneal laparoscopic adrenalectomy revealed metastatic transitional cell carcinoma. The patient has been doing well without evidence of recurrence, being supported by adrenocortical steroids. Although laparoscopic resection for malignant adrenal tumors is still controversial, we consider that retroperitoneal laparoscopic adrenalectomy may be an optional treatment for metastatic adrenal tumors, provided no other sites of metastasis exist.

Schwannoma retroperitoneal benigno tratado por retroperitoneoscopia: relato de caso / Retroperitoneal benign schwannoma treated by retroperioneal laparoscopic approach: a case report

Apesar da laparoscopia ser amplamente utilizada na abordagem de doenças retroperitoneais, ainda são poucos os relatos de ressecção laparoscópica de tumores retroperitoneais. Este estudo descreve um caso de Schwannoma retroperitoneal benigno tratado por retroperitoneoscopia e discute a dificuldade no diagnóstico e as vantagens do acesso retroperioneal por via laparoscópica.

In spite laparoscopy has been widely utilized in the management of retroperitoneals pathologies, there are still few reports of laparoscopic resections of retroperitoneals tumors. We report a case of a retroperitoneal benign Schwannoma treated by retroperitoneoscopy. The troubles on diagnostic and advantages of the retroperitoneal approach by laparoscopic way are discussed.

Implante de prótese peniana maleável: análise de 87 pacientes consecutivos / Malleable penile prothesis: analysis of 87 consecutive patients

Este é um estudo retrospectivo observacional que descreve a experiência com 87 pacientes submetidos a implante de prótese peniana em Serviço de Urologia. O acompanhamento foi feito no Hospital Governador Israel Pinheiro (HGIP) em pacientes operados entre junho de 1999 e fevereiro de 2006. Foram avaliadas as características dos pacientes, a etiologia da disfunção erétil e as complicações no per e pós-operatórios imediato e tardio do implante de prótese peniana maleável.