Triple neurectomía transperitoneal laparoscópica y con asistencia robótica para el tratamiento del dolor inguinal crónico: descripción de la técnica, nuestra experiencia y resultados preliminares / Robot-assisted laparoscopic triple neurectomy for chronic inguinal pain: Description of the technique, our experience and preliminary results

Introducción. El dolor inguinal crónico o inguinodinia posthernioplastia es una complicación relativamente común y que puede llegar a ser muy incapacitante. El tratamiento quirúrgico mediante triple neurectomía es una opción terapéutica ante el fracaso de tratamientos previos (terapia oral, local o neuromodulación).ObjetivoDescripción retrospectiva de la técnica quirúrgica y resultados de la triple neurectomía laparoscópica y con asistencia robótica en el tratamiento de la inguinodinia crónica.Material y métodosSe describen los criterios de inclusión/exclusión, así como la técnica quirúrgica empleada en 7 pacientes intervenidos en el Complejo Asistencial Universitario de León (Servicio de Urología) tras no responder a otras alternativas terapéuticas.ResultadosLos pacientes presentaban dolor crónico inguinal reportando una valoración en la escala EVA del dolor prequirúrgica de 7,43 sobre 10. Tras la cirugía, dicha valoración se redujo a 3,71 al primer día postoperatorio y a 4,2 puntos al año de la intervención. El alta hospitalaria se produjo a las 24h de la cirugía y no se reportaron complicaciones relevantes.ConclusionesLa triple neurectomía laparoscópica o con asistencia robótica es una técnica segura, reproducible y eficaz en el tratamiento del dolor inguinal crónico refractario a otros tratamientos. (AU)

Introduction. Chronic inguinal pain or inguinodynia following hernioplasty is a relatively common complication that can be very incapacitating. Surgical treatment by triple neurectomy is a therapeutic option when previous treatments (oral/local therapy or neuromodulation) have failed.ObjectiveRetrospective description of the surgical technique and results of laparoscopic and robot-assisted triple neurectomy for chronic inguinodynia.Material and methodsWe describe the inclusion/exclusion criteria as well as the surgical technique applied in 7 patients operated on at the University Health Care Complex of León (Urology Department) after failure of other treatment options.ResultsThe patients presented chronic groin pain, reporting a preoperative pain VAS of 7.43 out of 10. After surgery, this score was reduced to 3.71 on the first postoperative day and to 4.2 points one year after surgery. Hospital discharge occurred 24hours after surgery with no relevant complications being reported.ConclusionsLaparoscopic or robot-assisted triple neurectomy is a safe, reproducible, and effective technique for the treatment of chronic groin pain refractory to other treatments. (AU)

Robot-assisted laparoscopic triple neurectomy for chronic inguinal pain: Description of the technique, our experience and preliminary results.

INTRODUCTION: Chronic inguinal pain or inguinodynia following hernioplasty is a relatively common complication that can be very incapacitating. Surgical treatment by triple neurectomy is a therapeutic option when previous treatments (oral/local therapy or neuromodulation) have failed. OBJECTIVE: Retrospective description of the surgical technique and results of laparoscopic and robot-assisted triple neurectomy for chronic inguinodynia. MATERIAL AND METHODS: We describe the inclusion/exclusion criteria as well as the surgical technique applied in 7 patients operated on at the University Health Care Complex of León (Urology Department) after failure of other treatment options. RESULTS: The patients presented chronic groin pain, reporting a preoperative pain VAS of 7.43 out of 10. After surgery, this score was reduced to 3.71 on the first postoperative day and to 4.2 points one year after surgery. Hospital discharge occurred 24 h after surgery with no relevant complications being reported. CONCLUSIONS: Laparoscopic or robot-assisted triple neurectomy is a safe, reproducible, and effective technique for the treatment of chronic groin pain refractory to other treatments.

[Spontaneous extraperitoneal bladder perforation in an elderly patient with genitalia prolapse]. / Rotura vesical espontánea en paciente senil con prolapso genital.

There are many etiologic reasons which explain the bladder perforation. Bladder injuries happen most commonly in poli-traumatisms (traffic accident), blunt trauma, penetrating injury and iatrogenic injury (surgery, laparoscopic...). However, there is not always a vigorous, direct, extern and blunt agent causing the rupture. In the case reported the extraperitoneal bladder rupture started after a smooth perineal injury caused when the patient seated down. The patient already suffered from a cystocele III/IV plus uterine prolapse for a long time ago.

Rotura vesical espontánea en paciente senil con prolapso genital / Spontaneous extraperitoneal bladder perforation in an elderly patient with genitalia prolapse

Son múltiples y diversas las causas etiológicas de la rotura vesical. Los politraumatismos (accidentes de tráfico), el traumatismo directo abdominal, cerrado o abierto, y las lesiones y atrogénicas (cirugía abierta, endocirugía, cateterismo uretral) figuran entre las más frecuentes; sin embargo, la rotura vesical no siempre exige para su producción un enérgico, violento, directo y evidente agente externo que la provoque. En el caso que a continuación se comunica, la rotura vesical extraperitoneal tuvo su origen en un leve traumatismo perineal ocasionado al sentarse la paciente , la cual presentaba y padecía desde mucho tiempo atrás un cistocele grado III/IV acompañado de prolapso uterino (AU)

There are many etiologic reasons which explain the bladder perforation. Bladder injuries happen most commonly in poli-traumatisms (traffic accident), blunt trauma, penetrating injury and iatrogenic injury (surgery, laparoscopic…). However, there is not always a vigorous, direct, extern and blunt agent causing the rupture. In the case reported the extraperitoneal bladder rupture started after a smooth perineal injury caused when the patient seated down. The patient already suffered from a cystocele III/IV plus uterine prolapsed for a long time ago (AU)

[Periurethral injections of dextranomer/hyaluronic acid copolymer in the treatment of female stress urinary incontinence: description of the technique and bibliographic review]. / Inyecciones periuretrales de copolímero de dextranómero/ácido hialurónico como tratamiento de la incontinencia urinaria de esfuerzo en la mujer: descripción de la técnica y revision de la literatura.

OBJECTIVES: The system enables a non endoscopic, outpatient treatment of the female stress urinary incontinence. The article intends to familiarize the readers with the procedure. METHODS: We describe the technique, graphically, with all steps, and perform a bibliographic review. RESULTS: In accordance to the main clinical studies reviewed, the periurethral injection of dextranomer/ hyaluronic acid copolymer has an efficacy of near 75%, with a simple, reproducible technique with rare adverse events. CONCLUSIONS: The treatment with this type of periurethral injections may be valid as a minimally invasive treatment of the female stress urinary incontinence, because of its efficacy, tolerability and reproducibility.

Inyecciones periureterales de copolímero de dextranómero/ácido hialurónico como tratamiento de la incontinencia urinaria de esfuerzo en la mujer: descripción de la técnica y revisión de la literatura / Periuretheral injections of dextranomer/hyaluronic acid copolymer in the treatment of female stress urinary incontinence: description of the technique and bibliographic review

OBJETIVO: El sistema permite un tratamiento no endoscopio y ambulatorio de la incontinencia urinaria de esfuerzo en la mujer. En este artículo se pretende conseguir la familiarización con el procedimiento. METODOS: Descripción de la técnica de forma gráfica con los pasos correspondientes y revisión de la literatura. RESULTADO: La inyección periuretral de copolimero de dextranomero/acido hialuronico como se deduce de la revisión de los principales estudios clínicos tiene una eficacia cercana al 75% con una técnica sencilla, reproducible y con escasos efectos adversos. CONCLUSIONES: El tratamiento con este tipo de inyecciones periuretrales puede ser válido como manejo minimamente invasivo de la incontinencia urinaria de esfuerzo, por su eficacia, tolerabilidad y reproducibilidad

OBJECTIVES: The system enables a non endoscopic, outpatient treatment of the female stress urinary incontinence. The article intends to familiarize the readers with the procedure. METHODS: We describe the technique, graphically, with all steps, and perform a bibliographic review. RESULTS: In accordance to the main clinical studies reviewed, the periurethral injection of dextranomer/ hyaluronic acid copolymer has an efficacy of near 75%, with a simple, reproducible technique with rare adverse events. CONCLUSIONS: The treatment with this type of periurethral injections may be valid as a minimally invasive treatment of the female stress urinary incontinence, because of its efficacy, tolerability and reproducibility