Outcomes of laparoscopic adrenalectomy Conventional technique versus laparo-endoscopic single-site surgery. / Resultados de la suprarrenalectomía laparoscópica: técnica convencional vs puerto único laparoscópico.

OBJECTIVE: Perform a comparative analysis of the outcomes of conventional laparoscopic adrenalectomy (LC) and the newly introduced laparo-endoscopic single-site surgery (LESS) over ten years. MATERIAL AND METHOD: We retrospectively reviewed the experience of a single surgeon from our medical centre with laparoscopic adrenalectomy, either through LC or LESS, with 75 patients between August 2005 and June 2015. Here we describe: age, sex, size, lateralization, preoperative diagnosis, total operating time, intraoperative bleeding, conversion to open surgery, mean hospital stay, intra- and postoperative complications and histopathology report. We used Fischer's and the Chi-squared tests to compare categorical data and Student's T-test for a comparison of the means with a normal distribution. Statistical significance was determined when p<0.05. RESULTS: LC was performed in 51 patients, and LESS in 24 patients. No statistical significance was found for total operating time (LC: 103.9±13.21min vs. LESS: 101.46±13.65min; p=0.07), estimated bleeding (LC: 258.82±136.92cc vs. LESS: 131,25±36,74cc; p=0.46), intraoperative complications (5 cases in LC, none in LESS; p=0.47), nor for postoperative complications (two in LC vs. one in LESS; p=0.69), as catalogued according to the modified Clavien classification system. We detected a statistical significance difference in the comparisons of the mean hospital stay, which was reduced in LESS (LC: 3.55±0.69 days vs. LESS: 2.21±0.31 days; p=0.01). CONCLUSIONS: Adrenalectomy with LC is the approach of choice for surgical treatment of adrenal pathologies. The LESS technique is safe, improves the cosmetic results, and does not increase mortality if performed by experienced teams.

[Renal artery aneurysm. Laparoscopic nephrectomy, ex-vivo reconstruction and autotrasplantation]. / Aneurisma de arteria renal. Nefrectomía laparoscópica, reconstrucción en banco y autotrasplante.

We report a case of severe hypertensive patient with poor response regardless 5 drugs, that is diagnosed with right renal artery aneurysm, during the study of his HTN. Conservative surgery was performed by extracting laparoscopic kidney graft,ex-vivo pedicle reconstruction, followed by transplant in right iliac fossa utilizing the ilioinguinal incision used for the extraction, without need for two incisions. We perform a brief discussion of surgery indications of surgery in these patients.

Aneurisma de arteria renal. Nefrectomía laparoscópica, reconstrucción en banco y autotrasplante / Renal artery aneurysm. Laparoscopic nephrectomy, ex-vivo reconstruction and autotransplantation

Se presenta un caso de paciente hipertenso severo con mala respuesta a pesar de 5 fármacos, el cual es diagnosticado de aneurisma en arteria renal derecha, durante el estudio de su HTA. Se realiza cirugía conservadora renal haciendo extracción laparoscópica del injerto, reconstrucción en banco del pedículo, y posterior trasplante en fosa ilíaca derecha aprovechado la incisión ilioinguinal empleada para la extracción, sin necesidad de dos incisiones. Se realiza breve discusión de indicaciones de la cirugía en estos pacientes (AU)

We report a case of severe hypertensive patient with poor response regardless 5 drugs, that is diagnosed with right renal artery aneurysm, during the study of his HTN. Conservative surgery was performed by extracting laparoscopic kidney graft, ex-vivo pedicle reconstruction, followed by transplant in right iliac fossa utilizing the ilioinguinal incision used for the extraction, without need for two incisions. We perform a brief discussion of surgery indications of surgery in these patients (AU)

[Early biochemical failure after radical prostatectomy for prostate cancer. Impact factors?]. / Recidiva bioquímica precoz tras prostatectomía radical retropúbica por cáncer de próstata. Factores implicados. Influye el tiempo de espera entre biopsia y cirugía?

UNLABELLED: Does delay from biopsy to surgery have any influence? OBJECTIVES: To determine wether WT may impact on the EBF (before one year) alter RRP in our series, and to study other factors that may impact on this issue. MATERIAL AND METHODS: We study 310 RRP. Inclusion criteria are: one year follow up, no hormonal manipulation neither previous radiotherapy. Patients are divide in two groups attending WT. Group A < 90 days (n: 148), Group B > 90 days (n: 162). We study EBF (2 or more PSA determinations >= 0.2 ng/ml), and the impact of previous PSA, biopsy Gleason, Gleason of the specimen (G), pT stage (pT), and WT. T of Student or W of Wilcoxon are used to determine the homogeneity of the two groups. Chi Square of Pearson to compare the two group's EBF and pT attending to WT and EBF attending to pT. U of Mann Whitney is used to study EBF attending to G. Multivariate logistic regresion (LR) is used to study the impact of the variables on EBF. RESULTS: There are no differences between the two groups in age (p<0.129), PSA (p<0.479), biopsy's Gleason (p<0.913). There are no differences in EBF nor in pT attending to WT. Significant statystical differences are founded in EBF attending to pT and G. T3 tumors have more chance of recurrence than T2. EBF is more frecuent as G increases. In logistic regresion of the global serie, independent variables for progression are: Previous PSA and pT. Nor biopsy's Gleason nor specimen's Gleason, nor WT, impact on the EBF. CONCLUSIONS: Biopsy Gleason and WT do not impact on EBF. WT do not impact on pT. In our serie differences on EBF are lead by previous PSA and pT. Also Gleason of the especimen seems to impact on EBF, but in lower proportion, with no significance in multivariate analysis.

Recidiva bioquímica precoz tras prostatectomía radical retropúbica por cáncer de próstata. Factores implicados. ¿Influye el tiempo de espera entre biopsia y cirugía? / Early biochemical failure radical prostatectomy for prostate cancer. Impact factors?

Objetivos: Estudiar diferentes factores que pueden influir en la recidiva bioquímica precoz (RBP) (primer año tras cirugía), tras prostatectomía radical retropúbica (PRR). Material y métodos: Estudiamos 310 PRR. Criterios de inclusión: al menos un año de seguimiento, ausencia de bloqueo hormonal o radioterapia previa. Los pacientes fueron divididos inicialmente en 2 grupos según el tiempo de espera. Grupo A <90días (n: 148), Grupo B > 90 días (n: 162). Estudiamos RBP (2 o más determinaciones de PSA >= 0,2 ng/ml) y la influencia del PSA previo, el Gleason de la biopsia, el Gleason del espécimen, estadio pT, y tiempo de espera. Para estudiar la homogeneidad existente entre los dos grupos usamos la t de Student o W de Wilcoxon. Estudiamos la RBP y el estadio pT en los dos grupos usando la chi cuadrado de Pearson, que también nos sirve para estudiar en los dos grupos la RBP en relación al estadio pT. El test de la U de mann-Whitney lo usamos para estudiar en la serie global la RBP según el Gleason del espécimen. Por último se realiza una Regresión logística multivariante para estudiar la influencia de todas las variables en la RBP en la serie global. Resultados: No encontramos diferencias entre los dos grupos en edad (p< 0,129), ni PSA (p< 0,479), ni Gleason de biopsia(p<0,913). No se encontraron diferencias en RBP ni en estadio pT según el tiempo de espera. Hallamos diferencias estadísticamente significativas en RBP si estudiamos estadio pT y Gleason de la pieza. Los T3 tienen más incidencia de recurrencia que losT2 y hay más incidencia de RBP según aumenta el Gleason de la pieza. En la regresión logística de la serie global las variables independientes de progresión son: PSA previo y estadio pT. Ni el Gleason de la biopsia ni el Gleason del espécimen, ni el tiempo de espera entre biopsia y cirugía influyen en la RBP. Conclusiones: El Gleason de la biopsia y el tiempo de espera no influyen en la RBP. El tiempo de espera tampoco influye en el estadio T final. En nuestra serie las diferencias en RBP vienen dadas por el PSA previo y pT. El Gleason del espécimen parece influir en la RBP, pero en menor proporción sin significado en el análisis multivariante (au)

Objectives: To determine wether WT may impact on the EBF (before one year) alter RRP in our series, and to study other factors that may impact on this issue. Material and methods: We study 310 RRP. Inclusion criteria are: one year follow up, no hormonal manipulation neither previous radiotherapy. Patients are divide in two groups attending WT. Group A < 90 days (n: 148), Group B > 90 days (n: 162). We study EBF (2 or more PSA determinations >= 0.2 ng/ml), and the impact of previous PSA, biopsy Gleason, Gleason of the specimen (G), pT stage (pT), and WT. T of Student or W of Wilcoxon are used to determine the homogeneity of the two groups. Chi Square of Pearson to compare the two group’s EBF and pT attending to WT and EBF attending to pT. U of Mann Whitney is used to study EBF attending to G. Multivariate logistic regresion (LR) is used to study the impact of the variables on EBF. Results: There are no differences between the two groups in age (p< 0.129), PSA (p< 0.479), biopsy´s Gleason (p<0.913). There are no differences in EBF nor in pT attending to WT. Significant statystical differences are founded in EBF attending to pT and G. T3 tumors have more chance of recurrence than T2. EBF is more frecuent as G increases. In logistic regresion of the global serie, independent variables for progression are: Previous PSA and pT. Nor biopsy´s Gleasonnor specimen´s Gleason, nor WT, impact on the EBF. Conclusions: Biopsy Gleason and WT do not impact on EBF. WT do not impact on pT. In our serie differences on EBF are lead by previous PSA and pT. Also Gleason of the especimen seems to impact on EBF, but in lower proportion, with no significance in multivariate analysis (AU)

[Bladder neoplasm after nephroureterectomy for upper urinary tract tumor. Does distal ureter surgery influx on the evolution?]. / Neoplasia vesical tras nefroureterectomía por tumores de urotelio superior. La cirugía del uréter distal influye en la evolución?

OBJECTIVE: To compare evolution in patients with urothelial upper tract tumor (UUTT) in whom we performed the classic open approach to the distal ureter with those in whom whe performed the endoscopic approach. We study the bladder recurrences in each group and the factors which may influx on the evolution. MATERIAL AND METHODS: Retrospective review of nephroureterectomies in our department in the last 20 years. Group A (n:24): double incision (lumbar and pelvic incision), Group B (n:29): endoscopical approach of the distal ureter and classic lumbar incision. A descriptive study is first performed in which we review: sex, and patients age, background transuretral resection of bladder tumor (TURBT), UUTT side, and UUTT location (calices, pelvis or urether). Pathological stage and tumor grade are also exposed. Secondly, a review of the bladder recurrences in each group is performed. In order to find differences between de groups we used the Fisher's Exact test. RESULTS: We observed that in terms of bladder recurrence there is a statistically significant difference between the two groups favoring Group B (p < 0.036), which means that there are less bladder recidives when perform endoscopic approach of distal ureter. Noneless due to the groups inhomogeneity in tumor stage, grade, and location, this differences seem to be associated to these sigues, more than to the approach to the ureter as an independant variable. In that concerning to the eventual relationship between bladder recidive and background of previous TURBT, we have not found any differences between the two groups but there are statystically significant difference in the global series. The small number of recurrences (13) does not allow us to establish a well based conclusion on this issue, but it seems that the background of previous TURBT is an important factor that may influx in posterior bladder recurrences. CONCLUSIONS: In our results, endoscopic approach of distal ureter in nephroureterectomy for UUTT does seems to positively influx in the posterior chance of bladder recurrences. But the studied sample is small and the two groups have not been aleatorized because of ethical reasons. May the low number of cases affect the test's statistical potency. It seems that previous TURBT may conditionate these recurrences, as we show in global serie. It should be necessary a prospective and statistically analised multicenter trial to understand if distal ureter approach influx on the evolution of these tumors.

Neoplasia vesical tras nefroureterectomía por tumores de urotelio superior. ¿La cirugía del uréter distal influye en la evolución? / Bladder neoplasm after nephroureterectomy for upper urinary tract tumor. Does distal ureter surgery influx on the evolution?

Objetivo. Comparar la evolución de los pacientes con tumor de urotelio superior (TUS) en los cuales realizamos, durante la nefroureterectomía, abordaje clásico abierto de desinserción del uréter distal con aquellos en los que realizamos abordaje endoscópico. Estudiamos el índice de recurrencias vesicales en cada grupo y los factores que pueden influir en la evolución. Material y métodos. Se realiza una revisión retrospectiva de las nefroureterectomías realizadas en nuestro Servicio en los últimos 20 años. Se dividen en dos grupos. Grupo A (n: 29): doble incisión (lumbar y pélvica), Grupo B (n: 24): abordaje endoscópico del uréter distal e incisión lumbar clásica. Se realiza en primer lugar un estudio descriptivo en el que se expone: sexo y edad del paciente, antecedentes de resección vesical previa por tumor (RTU-V), lado del TUS, y localización (cálices, pelvis o uréter). También revisamos estadio patológico y grado tumoral. En segundo lugar se realiza una revisión de las recidivas vesicales en cada grupo. Para establecer posibles diferencias utilizamos el Test exacto de Fisher. Resultados. Observamos diferencias estadísticamente significativas en términos de recurrencias vesicales a favor del grupo B (p<0.036), lo que significa que existen menos recidivas vesicales en nuestra serie en el grupo de cirugía endoscópica. Sin embargo debido a la inhomogeneidad de los grupos en estadio, grado y localización tumoral, esta diferencia parece más bien atribuible a estas características, más que a la vía de abordaje como factor independiente. En lo referente a la relación entre la recidiva vesical y antecedentes de RTU-V no hemos encontrado diferencias entre los grupos pero si existe diferencia en la serie global. El escaso número de recurrencias (13) no nos permite establecer una conclusión clara en este problema, aunque parece que el antecedente de neoplasia previa de vejiga influye en la posibilidad de recurrencia vesical. Conclusiones. En nuestro resultado el abordaje endoscópico en la nefroureterectomía por TUS parece influir en la posterior aparición de menos recidivas en vejiga, sin embargo la muestra es corta y los grupos no son homogéneos porque el abordaje del uréter no se ha aleatorizado por razones éticas obvias. Si parece existir relación entre la existencia de antecedentes de RTU-V y la aparición de recidivas posteriores, como mostramos en la serie global. En cualquier caso son necesarios estudios prospectivos randomizados multicéntricos para conocer si el abordaje del uréter distal influye en la posterior aparición de recidivas vesicales

Objective. To compare evolution in patients with urothelial upper tract tumor (UUTT) in whom we performed the classic open approach to the distal ureter with those in whom whe performed the endoscopic approach. We study the bladder recurrences in each group and the factors which may influx on the evolution. Material and methods. Retrospective review of nephroureterectomies in our department in the last 20 years. Group A (n:24): double incision (lumbar and pelvic incision), Group B (n:29): endoscopical approach of the distal ureter and classic lumbar incision. A descriptive study is first performed in which we review: sex, and patients age, background transuretral resection of bladder tumor (TURBT), UUTT side, and UUTT location (calices, pelvis or urether). Pathological stage and tumor grade are also exposed. Secondly, a review of the bladder recurrences in each group is performed In order to find differences between de groups we used the Fisher´s Exact test. Results. We observed that in terms of bladder recurrence there is a statistically significant difference between the two groups favoring Group B (p< 0.036), which means that there are less bladder recidives when perform endoscopic approach of distal ureter. Noneless due to the groups inhomogeneity in tumor stage, grade, and location, this differences seem to be associated to these sigues, more than to the approach to the ureter as an independant variable. In that concerning to the eventual relationship between bladder recidive and background of previous TURBT, we have not found any differences between the two groups but there are statystically significant difference in the global series. The small number of recurrences (13) does not allow us to establish a well based conclusion on this issue, but it seems that the background of previous TURBT is an important factor that may influx in posterior bladder recurrences. Conclusions. In our results, endoscopic approach of distal ureter in nephroureterectomy for UUTT does seems to positively influx in the posterior chance of bladder recurrences. But the studied sample is small and the two groups have not been aleatorized because of ethical reasons. May the low number of cases affect the test´s statistical potency. It seems that previous TURBT may conditionate these recurrences, as we show in global serie. It should be necessary a prospective and statistically analised multicenter trial to understand if distal ureter approach influx on the evolution of these tumors

[Enterocystoplasty in the treatment of interstitial cystitis]. / La enterocistoplastia en el tratamiento de la cistitis intersticial.

OBJECTIVE: To evaluate supratrigonal cystectomy and enterocystoplasty in patients with interstitial cystitis. METHODS: We reviewed four women with interstitial cystitis with infructuos conservative treatment and performed supratrigonal cystectomy and enterocystoplasty. All the patients fulfilled the NHI criteria with increased voiding frequency by night (mean 7.3 times). In 3 cases urodynamic study was available. We used is the four patients ileon as segment for the enterocystoplasty. RESULTS: Mean postoperative follow up was 60 months. In all cases the suprapubic pain disappeared and night voiding frequency reduced (mean 2.2 times). We don't have mayor complications. One patient needs self catheterism 3 years after surgery. CONCLUSION: In patients with interstitial cystitis to be operated supratrigonal cystectomy and enterocystoplasty is the most effective method.

La enterocistoplastia en el tratamiento de la cistitis intersticial / The ehterocystoplasty in the management of the interstitial cystitis

OBJETIVO: Analizar la cistectomía supratrigonal con enterocistoplastia en los pacientes con cistitis intersticial. MÉTODO: Se revisaron cuatro mujeres diagnosticadas de cistitis intersticial en las que fracasaron los tratamientos conservadores y fueron sometidas a cistectomía supratrigonal con enterocistoplastia. Todas las pacientes cumplían los criterios diagnósticos de la NIH con un aumento de frecuencia miccional nocturna (media 7,3 micciones/noche). Se realizó estudio urodinámico en tres casos. En las cuatro pacientes se empleó íleon para la enterocistoplastia. RESULTADOS: El seguimiento medio post-operatorio es de 60 meses. En todos los casos desapareció el dolor suprapúbico y la frecuencia miccional nocturna descendió (media 2,2 micciones/ noche). No tuvimos complicaciones quirúrgicas mayores. Una paciente requirió cateterismo intermitente a los tres años de la intervención. Alguna paciente ha presentado episodio de infección urinaria. CONCLUSIONES: Consideramos que en los pacientes con cistitis intersticial que deben ser opera-dos la cistectomía supratrigonal con enterocistoplastia es el método quirúrgico más efectivo (AU)

[Endoscopic resolution of complications caused by urethrovesical suspension]. / Resolución endoscópica de complicaciones en suspensión uretrovesical.

We presented a total of ten women which referred a varied syntomatology secondary to a bladder foreign body due to the suture employed in the stress incontinence surgery in which urethrovesical suspension techniques were performed. In these patients, to six a Marshall-Marchetti-Krantz technique was practised, to three modified Burch procedure and to the left a suspension according to Raz method. It is described the varied clinic they presented, the necessity of endoscopic study to confirm and the results after solving the 90% of these cases using endoscopic techniques. It is concluded that is not mandatory the employment of non absorbable suture to perform the suspension techniques and in the opposite of the usual tendency of the authors recurring to open surgery, this complication can be solved endoscopically and in ambulatory regime in the most of these cases.

Resolución endoscópica de complicaciones en suspensión uretrovesical / Endoscopic resolution of complications in urethrovesical suspension

Presentamos un total de diez mujeres que referían una sintomatología diversa por cuerpo extraño intravesical, debido a la sutura empleada en la cirugía de incontinencia de estrés en las que se realizaron diversas técnicas de suspensión uretrovesical. En estas pacientes, a seis se les había practicado la técnica de Marshall-Marchetti-Krantz 1 , a tres el procedimiento modificado de Burch 2,3 , y a la restante una suspensión según el método de Raz 4 .Se describe la clínica tan variada que presentaron,la necesidad de estudio endoscópico para la confirmación y resultados tras la resolución del 90 por ciento de estos casos mediante técnicas endoscópicas. Se concluye que no es obligado el empleo de sutura irreabsorbible para realizar la técnica de suspensión y que, en contra de la tendencia general de los autores empleando la cirugía abierta, esta complicación se resuelve endoscópicamente y de modo ambulatorio en la mayoría de los casos (AU)

[Bladder leiomyosarcoma in a young man with a transplant. Report of a case]. / Leiomiosarcoma vesical en joven trasplantado. Aportación de un caso.

Contribution of one case of a 24-year-old patient, with a renal graft, who was diagnosed with vesical leyomiosarcoma. Radical cystectomy with ureterosygmoidostomy was performed. The rarity of vesical sarcoma, both in normal population or among those undergoing transplantation, as well as the greater tendency of transplanted patients to suffer malignant neoplasia, are emphasised.

[Bladder paraganglioma. Report of a case and review of the Spanish literature]. / Paraganglioma vesical. Presentación de un caso y revisión de la literatura española.

Paragangliomas are rare tumours of the bladder accounting for 0.06% of all vesical tumours. This paper reports one case of vesical paraganglioma in a young female patient that has the singularity of being associated to melanin pigmentation. A review is made of cases treated in Spain, adding some comments on the signs and symptoms presented, as well as the diagnostic and therapeutical methods used in this unusual condition.

[Ureteroscopy with pseudoanalgesia in the treatment of ureteral lithiasis]. / La ureteroscopia con sedoanalgesia en el tratamiento de la litiasis ureteral.

Presentation of the results obtained in 35 patients with ureteral lithiasis treated over a two-year interval by means of ureteroscopy with pseudoanalgesia at the Hospital Insular, with a 89% success rate. We conclude that in selected cases, the use of peg ureteroscopy or pneumatic lithotrite is a valid therapeutical option since it is well-tolerated and has the benefit of a short or null hospitalization.

Pressure-controlled reperfusion improves postischemic recovery of LV-hypertrophied rat hearts.

The influence of pressure-controlled postischemic reperfusion (Rp) on functional and metabolic parameters in hearts of sham-operated rats and hypertrophied hearts of rats with aortic constriction were studied. Hypertrophied hearts are considered to be more susceptible to ischemia. The hearts were perfused in the Langendorff-technique for thirty minutes at 35 degrees C with Krebs-Henseleit bicarbonate buffer at a perfusion pressure (PP) of 75 mmHg and for five minutes at 15 degrees C with St. Thomas' Hospital cardioplegic solution at a PP of 60 mmHg. After a period of global ischemia of forty minutes' duration at 15 degrees C, reperfusion was started either abruptly (aRp: PP 75 mmHg immediately) or gently (gRp: PP 75 mmHg within thirty minutes); it lasted for forty-five minutes. Intraventricular peak systolic pressure (ISP) was monitored and energy-rich compounds (ATP, ADP, AMP, CrP, free Cr) were analyzed. In normal hearts, metabolic recovery was not affected by the mode of reperfusion, but functional recovery (ISP) averaged 88% of the preischemic control value after gRp as compared with 73% after aRp. In hypertrophied hearts, gentle reperfusion ameliorated both metabolic and functional recovery. At forty-five minute recovery, CrP averaged 5.1 mumol/g ww after aRp and 6.6 mumol/g ww after gRp (p less than 0.01), and ISP amounted to 73% of the preischemic control after aRp and to 85% after gRp.