[Hand-assisted laparoscopic nephrectomy]. / Nefrectomia laparoscópica mano-asistida.

INTRODUCTION AND OBJECTIVES: To present the number of cases of hand-assisted laparoscopic nephrectomy. This study evaluates our results and difficulties of starting a progresive programme of laparoscopy. MATERIAL AND METHOD: Between november 2003 and november 2005, 35 hand-assisted laparoscopic nephrectomies were carried out, of a total of 45 laparoscopic nephrectomies. 22 radical nephrectomies, 3 simple nephrectomies and 10 nephroureterectomies. The average age of patients was 66 years (47-89). On average, they were overweight (IMC 28,3), with approximately 38% being obese. ASA 2.3 (1-4). The tumors measured 4.8cm on average, and 80% of these were T1. In 28.6% of the cases, they had previously undergone abdominal surgery. RESULTS: One was undertaken in 2003, 17 in 2004, and 17 in 2005. The surgery time was 140 minutes, 130 minutes (80-210) in radical nephrectomies, 135 minutes (120-150) in simple nephrectomies and 163 minutes (80-240) in the nephroureterectomy. Patients began an oral diet 1.7 days later, and were able to get up 1.7 days later. In the case of obese patients, they began an oral diet 2.3 days later and were able to get up (2.4 days) later than those non obese cases. (1.5 and 1.4 days respectively). The average stay has been 5.8 days (3-15). The average stay of the cases without complications was 4.2 days and those that encountered complications 9.7 days. In no cases was there a need for a blood transfusion. In 11.4% we had major complications with an average stay of 11.7 days. In 5.7% of cases there were reconversions, and 5.7% of cases were reoperated. 17.1% had minor complications, with an average stay of 8.8 days CONCLUSIONS: The advantage of hand-assisted nephrectomy is that it allows one to begin a laparoscopy, with a reduced learning time, and with satisfactory results, allowing the incorporation of laparoscopy surgery in hospitals with a reduced annual volume.

[Radical laparoscopic cystectomy]. / Cistectomía radical laparoscópica.

Radical laparoscopic cystectomy is being adopted by most groups with proven experience in laparoscopic surgery, especially by those who have already completed the learning curves in radical laparoscopic prostatectomy. It is still considered a highly complex technique, which has not yet been mastered in many Urology Units. In this article, we review the surgical technique and available literature on this approach, with special emphasis on its indications, advantages and most frequent morbidity.

Nefrectomía laparoscópica mano-asistida / Hand-assisted laparoscopic nephrectomy

Introducción y Objetivos: Presentamos nuestra casuística de nefrectomías laparoscópicas mano-asistidas. Se valoran nuestros resultados y las dificultades del inicio de un programa progresivo de laparoscopia. Material: Desde noviembre 2003 hasta noviembre 2005 se han realizado 35 nefrectomías laparoscópicas Mano-asistidas, de un total de 45 nefrectomías laparoscópicas. 22 nefrectomías radicales, 3 nefrectomías simples y 10 nefroureterectomías. Media de edad 66 años (47-89). Tenían una media de sobrepeso (IMC 28,3); 38% eran obesos. ASA 2,3 (1-4). Los tumores tenían 4,8 cm de tamaño medio; 80% eran T1. El 28,6% habían sido operados previamente de cirugía abdominal. Resultados: Se realizaron 1 en 2003, 17 en 2004, y 17 en 2005. El tiempo quirúrgico ha sido 140 minutos, 130 minutos (80-210) en nefrectomías radicales, 135 minutos (120-150) en nefrectomías simples y 163 minutos (80-240) en nefroureterectomías. Los pacientes iniciaron dieta oral en 1,7 días y se levantaron en 1,7 días. Los obesos iniciaron la dieta (2,3 días) y se levantaron (2,4 días) más tarde que los no obesos (1,5 y 1,4 días respectivamente). La estancia media ha sido 5,8 días (3-15); en los no complicados 4,2 días y en los que han tenido complicaciones 9,7 días. En ningún caso se trasfundió. Hemos tenido 11,4% de complicaciones mayores con EM de 11,7 días. Un 5,7% de reconversiones y 5,7% de reoperaciones. Y 17,1% de complicaciones menores, con EM de 8,8 días. Conclusiones: La nefrectomía mano-asistida es una técnica que por sus ventajas permite un inicio en la laparoscopia, con menor curva de aprendizaje, y resultados satisfactorios, permitiendo incorporar la cirugía laparoscópica a hospitales con un menor volumen anual

Introduction and objectives: To present the number of cases of hand-assisted laparoscopic nephrectomy. This study evaluates our results and difficulties of starting a progresive programme of laparoscopy. Material and Method: Between november 2003 and november 2005, 35 hand-assisted laparoscopic nephrectomies were carried out, of a total of 45 laparoscopic nephrectomies. 22 radical nephrectomies, 3 simple nephrectomies and 10 nephroureterectomies. The average age of patients was 66 years (47-89). On average, they were overweight (IMC 28,3), with approximately 38% being obese. ASA 2.3 (1-4). The tumors measured 4.8cm on average, and 80% of these were T1. In 28.6% of the cases, they had previously undergone abdominal surgery. Results: One was undertaken in 2003, 17 in 2004, and 17 in 2005. The surgery time was 140 minutes, 130 minutes (80-210) in radical nephrectomies, 135 minutes (120-150) in simple nephrectomies and 163 minutes (80-240) in the nephroureterectomy. Patients began an oral diet 1.7 days later, and were able to get up 1.7 days later. In the case of obese patients, they began an oral diet 2.3 days later and were able to get up (2.4 days) later than those non obese cases. (1.5 and 1.4 days respectively). The average stay has been 5.8 days (3-15). The average stay of the cases without complications was 4.2 days and those that encountered complications 9.7 days. In no cases was there a need for a blood transfusion. In 11.4% we had major complications with an average stay of 11.7 days. In 5.7% of cases there were reconversions, and 5.7% of cases were reoperated. 17.1% had minor complications, with an average stay of 8.8 days Conclusions: The advantage of hand-assisted nephrectomy is that it allows one to begín a laparoscopy, with a reduced learning time, and with satisfactory results, allowing the incorporation of laparoscopy surgery in hospitals with a reduced annual volume

Cistectomía Radical Laparoscópica / Radical laparoscopic cystectomy

La cistectomía radical laparoscópica está siendo introducida en la mayoría de los grupos que tienen demostrada experiencia en cirugía laparoscópica y sobre todo en aquellos que han superado la curva de aprendizaje en prostatectomía radical laparoscópica. Se considera aún una técnica de alta complejidad, que no está aún al alcance de la mayoría de los Servicios de Urología. Revisamos en este trabajo la técnica quirúrgica así como la literatura al respecto, haciendo hincapié en sus indicaciones, ventajas y morbilidad más habitual

Radical laparoscopic cystectomy is being adopted by most groups with proven experience in laparoscopic surgery, especially by those who have already completed the learning curves in radical laparoscopic prostatectomy. It is still considered a highly complex technique, which has not yet been mastered in many Urology Units. In this article, we review the surgical technique and available literature on this approach, with special emphasis on its indications, advantages and most frequent morbidity

[Benign retroperitoneal schwannoma in patient with antecedents of Willm's tumor in the infancy]. / Schwannoma retroperitoneal benigno en paciente con antecedentes de tumor de Wilms en la infancia.

We report a case of benign retroperitoneal schwannoma diagnosed casual in a 23 years old woman treated of a Wilm's tumour twenty years ago. A review of the on this unusual tumour is included.

[Testicular torsion in the geriatric patient. Review of the literature apropos of a case]. / Torsión testicular en el paciente geriátrico. Y revisión de la literatura: a propósito de un caso.

Testicular torsion in adult, is an uncommonly etiology, but we should make differencial diagnosis in every person over thirty years old, with acute scrotum. The wrong diagnosis raises the incidence orchiectomy in adults for vascular etiology. We report a male of 74 years old with acute scrotum and review of the literature.

[Ureteral stenosis after kidney transplantation: treatment with a self-expanding metal prosthesis]. / Estenosis ureteral post-transplante renal: tratamiento con prótesis metálica autoexpandible.

OBJECTIVE: To determinate the efficacy in the treatment of ureteral estenoses after renal transplantation with metallic self-expandable stent. MATERIALS AND METHODS: From october of 1995 to april of 2002, 8 ureteral obstruction post renal transplantation have treated by means of implants of a metallic self-expandable stent (6 men and 2 women). The average time of pursuit was of 30 months (rank 2-53 months). In this work the severity and location of the estenosis are analysed, the method of implant of the stent, the permeability of the same one, the levels of creatinine pre and postimplant and the complications derived from the same one. RESULTS: The treatment was effective in the 100% of the patients (8/8), with an average reduction of the creatinine of 36% (rank 13.6%-59.6%). The complications were minimum and the hospital stay was short. CONCLUSIONS: In the patients with: chronic deterioration of the graft with short functional expectation, patient with high surgical risk and reestenosis after ureteral reimplantation by previous ureteral estenosis, the use of a metallic self-expandable stent, constitutes technique of election given its efficacy and low associate morbidity.

Torsión testicular en el paciente geriátrico y revisión de la literatura: a propósito de un caso / Testicular torsion in adults and literature revision: a propos of one case

La torsión testicular en el adulto, es una nosología infrecuente aunque debe de entrar dentro del diagnostico diferencial de cualquier adulto de mas de treinta años, con cuadro de escroto agudo. El retraso e incorrecto diagnóstico, aumenta la frecuencia de orquiectomías por procesos vasculares en el adulto frente al niño. Presentamos el caso de varón de 74 años con escroto agudo, y revisión de la literatura (AU)

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[Surgical management and complications of urinary stress incontinence: our experience in 385 patients operated on during the last 25 years]. / Manejo quirúrgico y complicaciones de la I.U.E: nuestra experiencia en 385 pacientes operadas en los últimos 25 años.

We present the results and complications found and compared in 2 large series of patients who underwent a surgical procedure to avoid Urinary Stress Incontinence in our hospital. From january of 1994 to december of 2001 we collected 195 patients with an average age of 57.9 y we compared them with a prior series of 189 patients collected between january of 1976 and december of 1993, with an average age of 53.6. The continence rate was similar in both series (70.8% pre-94 and 74.5% post 94), slight incontinence 22.7% pre-94 and 19.2% post-94 and for complete incontinence 6.3% pre-94 and 6.2% post-94. The Burch procedure was the most common and also shows the greatest effectiveness in our trial involving 113 cases and a continence rate of 74.3% in the first series and 144 cases and 77% respectively in the second series. The most common complications were very similar in both groups: tract urinary infection (5.2% and 9% first and second group), surgical wound infection (4.2% and 2.2% respectively). We conclude that in spite of the introduction of new and useful surgical procedure (TVT, periurethal substances injection...) the greatest long term success rate still corresponds to the Burch colposuspension.

[Bladder malacoplakia with lymphatic involvement and an aggressive course]. / Malacoplaquia vesical con afectación ganglionar y curso agresivo.

Malacoplakia is an unusual chronical granulomatous disorder. In the urinary tract is more frequent in female, in 75 percent of cases involve the bladder. Pelvis extension of this disease is infrequent, and even less frequent is the involvement of pelvic and retroperitoneal lymph nodes. We present the second case in the literature of bladder malacoplakia with extravesical and pelvic node involvement.

Schwannoma retroperitoneal benigno en paciente con antecedentes de tumor de wilms en la infancia / Benign retroperitoneal schwannoma in patient with antecedents of wilm´s tumor in the infancy

Se presenta un caso de schwannoma benigno retroperitoneal como hallazgo incidental en una joven de 23 años tratada de un tumor de Wilms a los tres años. Se incluye una revisión de la literatura de este tumor tan infrecuente (AU)

Estenosis ureteral post-trasplante renal: tratamiento con prótesis metálica autoexpandible / Ureteral obstruction after renal transplantation: treatment with metallic self-expandable

OBJETIVO: Determinar la eficacia del empleo de prótesis metálicas autoexpandibles en el tratamiento de las estenosis ureterales post-trasplante renal. MATERIAL Y MÉTODOS: Desde octubre de 1995 a abril de 2002, se han tratado 8 estenosis ureterales postTR mediante el implante de una prótesis metálica autoexpandible (6 hombres y 2 mujeres). El tiempo medio de seguimiento fue de 30 meses (rango 2-53 meses). En este trabajo se analizan la severidad y localización de la estenosis, el método de implante de la prótesis, la permeabilidad de la misma, los niveles de creatinina pre y postimplante y las complicaciones derivadas del mismo. RESULTADOS: El tratamiento fue efectivo en el 100 por ciento de los pacientes (8/8), con un descenso medio de la creatinina del 36 por ciento (rango 13,6 por ciento-59,6 por ciento). Las complicaciones fueron mínimas y la estancia hospitalaria fue corta. CONCLUSIONES: En los pacientes con: deterioro crónico del injerto con expectativa funcional corta, pacientes con alto riesgo quirúrgico y reestenosis tras reimplantación ureterovesical por estenosis ureteral previa, el empleo de una prótesis metálica autoexpandible constituye la técnica de elección dada su eficacia y baja morbilidad asociada (AU)

OBJECTIVE: To determinate the efficacy in the treatment of ureteral estenoses after renal transplantation with metallic self-expandable stent. MATERIALS AND METHODS: From october of 1995 to april of 2002, 8 ureteral obstruction post renal transplantation have treated by means of implants of a metallic self-expandable stent (6 men and 2 women). The average time of pursuit was of 30 months (rank 2-53 months). In this work the severity and location of the estenosis are analysed, the method of implant of the stent, the permeability of the same one, the levels of creatinine pre and postimplant and the complications derived from the same one. RESULTS: The treatment was effective in the 100% of the patients (8/8), with an average reduction of the creatinine of 36% (rank 13,6%-59,6%). The complications were minimun and the hospital stay was short. CONCLUSIONS: In the patients with: chronic deterioration of the graft with short functional expectation, patient with high surgical risk and reestenosis after ureteral reimplantation by previous ureteral estenosis, the use of a metallic self-expandable stent, constitutes technique of election given its efficacy and low associate morbidity (AU)

Manejo quirúrgico y complicaciones de la I.U.E.: Nuestra experiencia en 385pacientes operadas en los últimos 25 años / Surgical management and urinary stress incontinence complications: our experience in 385 female operated patients during the last 25 years

Se presentan los resultados y complicaciones obtenidos y comparados en dos grandes series de pacientes operadas de Incontinencia Urinaria de Esfuerzo (I.U.E) en nuestro servicio. Desde enero de 1994 a diciembre de 2001 hemos recogido 195 pacientes con una edad media de 57,9 y las hemos comparado con una serie previa de 189 pacientes que comprende desde enero de 1976 hasta diciembre de 1993 con una edad media de 53,6 años. La tasa de pacientes continentes en ambas series fue similar (70,8 por ciento pre-94 y 74,5 por ciento post-94), leve incontinente en 22,7 por ciento pre-94 y 19,2 por ciento post-94 e incontinente 6,3 por ciento pre-94 y 6,2 por ciento post-94.La técnica de Burch es la más empleada y corresponde a la más eficaz en el estudio con 113 pacientes y un 74,3 por ciento de pacientes continentes en la primera serie y 144 pacientes con 77 por ciento continentes en la segunda serie. Las complicaciones más frecuentes fueron las mismas en las dos series: infección del tracto urinario (5,2 por ciento y 9 por ciento en primera y segunda serie) e infección de herida quirúrgica (4,2 por ciento y 2,2 por ciento respectivamente).Concluimos que a pesar de la introducción de nuevas y útiles técnicas correctoras (TVT, inyección de sustancias periuretrales...) la mayor tasa de éxito a largo plazo continúa siendo la colposuspensión tipo Burch (AU)

Malacoplaquia vesical con afectación ganglionar y curso agresivo / Bladder malacoplaquia with nodal involvement and agressive course

La malacoplaquia es un proceso inflamatorio granulomatoso crónico poco frecuente. En el tracto urinario es más frecuente en el sexo femenino, estando afectada la vejiga en el 75 por ciento de los casos. La extensión pélvica de la malacoplaquia es muy poco frecuente y aún menos frecuente es la afectación ganglionar a nivel pelviano y retroperitoneal. Se presenta el segundo caso en la literatura de malacoplaquia vesical con afectación extravesical y ganglionar pelviana (AU)

[Posterior sacral root neuromodulation in the treatment of chronic urinary dysfunction]. / Neuromodulación de raíces sacras posteriores en el tratamiento de la disfunción miccional crónica.

OBJECTIVES: To describe the effectiveness of sacral root neuromodulation in ameliorating symptoms of refractory voiding disfunction in our center. MATERIAL AND METHODS: During the period from december 1998 throught december 2001, 31 Percutaneous Nerve Evaluation (PNE) was performed to 20 patients with refractory voiding dysfunction; a sacral nerve stimulation device was implanted in 10 patients (8 female, 2 male). The median age was 49 years. Refractory voiding dysfunction included: mixed disorders (30%), idiopathic nonobstructive chronic urinary retention (20%), urgency/frequency (20%), faecal and urinary incontinence with absence of sphincter defect (20%) and frequency (10%). RESULTS: The 2 patients with frequency/urgency decreased their symptoms more than 50%, bladders were emptied without post-void residual urine in 2 patients with urinary retention, faecal and urinary incontinence in 2 patients and mixed disorders in other 3, reduced their symptoms more than 90% without residual urine. The frequency improved more than 50% in 1 patient. CONCLUSIONS: Sacral Root Neuromodulation is a successful treatment in some cases of idiopathic chronic micturition dysfunction which don't respond to pharmacotheraphy or bladder retraining. The effects of neuromodulation are long-lasting and associated morbidity is low.

Neuromodulación de raíces sacras posteriores en el tratamiento de la disfunción miccional crónica / Sacral root neuromodulation as a treatment of chronic micturition dysfunction

OBJETIVOS: Describir la experiencia de nuestro centro en el tratamiento con neuromodulación de raíces sacras posteriores de pacientes con disfunción miccional crónica tras el fracaso de tratamiento conservador. MATERIAL Y MÉTODOS: Desde diciembre de 1998 a diciembre de 2001, hemos realizado a 20 pacientes 31 test de estimulación de nervios periféricos (ENP), y 10 implantes definitivos (8 fueron mujeres y 2 varones). Edad media: 49 años. El cuadro clínico más frecuente fueron los trastornos mixtos (30 per cent), seguidos por retencionistas crónicos (20 per cent), urgencia/frecuencia miccional (20 per cent), incontinencia urinaria y fecal con integridad esfinteriana (20 per cent) y cuadro de frecuencia miccional elevada (10 per cent). RESULTADOS: Los 2 pacientes con frecuencia e incontinencia por urgencia mejoraron la sintomatología más del 50 per cent. Los 2 pacientes con retención urinaria crónica completa recuperación micción espontánea sin residuo post-miccional, 3 pacientes con trastornos mixtos redujeron sus síntomas más del 90 per cent sin residuo post-miccional significativo. Los pacientes con incontinencia fecal y urinaria mejoraron su sintomatología más de un 90 per cent. El paciente con cuadro de frecuencia miccional elevada también redujo los síntomas más del 50 per cent. La única complicación post-quirúrgica fue seroma de herida quirúrgica en 3 casos. CONCLUSIONES: La neuromodulación de raíces sacras es útil en los casos de disfunción miccional crónica idiopática que no responden a tratamiento farmacológico y/o de reeducación. La neuromodulación de raíces sacras produce, en pacientes seleccionados, una mejoría prolongada y la técnica presenta escasa morbilidad (AU)

[Comparative study of ureteral anastomosis with or without double-J catheterization in renal transplantation]. / Estudio comparativo entre anastomosis ureteral con o sin cateterización con doble j en trasplante renal.

OBJECTIVE: To analyze the impact of the use of the routine double-J stent in the incidence of urological complications, like fistula, stenosis, ureteral obstruction and urinary tract infection. METHODS: A retrospective study was conducted on two groups of patients: 28 without double-J stent and 28 with it. We reviewed urological complications: stenosis, fistula and obstruction. We paid special attention to urinary tract infection and other inherents complications to the use of double-J stents. RESULTS: A patient from the double-J stended group (3.6%) developed a urinary fistula and there were no obstructions. 13 patients (46.6%) had a positive urinary culture in the first month post RT. Two urinary fistulas and 4 obstructions were developed in the non-stended group. Six major complications of the urinary tract. 14 patients (50%) had a positive urinary culture in the first month post RT. CONCLUSIONS: The use of double-J stent across uterovesical anastomosis decreases the post-RT ureteral complications. Stent placement does not increase the risk of urinary tract infection in the early post-RT.

[Treatment of female stress urinary incontinence with the TVT (tension-free vaginal tape) system: our experience]. / Tratamiento de la incontinencia urinaria de esfuerzo femenina con el sistema TVT (Tensión free Vaginal Tape): nuestra experiencia.

INTRODUCTION: The TVT system is a new surgical procedure for female stress urinary incontinence. The object of this study is to report our initial experience with this technique. We report our results and complications too. MATERIAL AND METHODS: From April 1999 to July 2000, 23 systems TVT was implanted in our hospital. The patients were followed for a 6 to 21 month period. All the patients had stress incontinence. The mean age was 59 years. Gynaecological surgery was associated in 4 patients. One of them was excluded because a diagnosis mistake. TVT implies the implantation of a prolene tape around mid-urethra via a minimal vaginal incision. RESULTS: 17 patients (77.27%) had a significantly improved in the post-operative evaluation. The mean post-surgical stay in the hospital was 1.7 days. A bladder base was damaged during the surgery. No urinary retention, erosion or urethral lesion were found. CONCLUSIONS: We consider the TVT operation to be a safe and effective surgical procedure for the treatment of female urinary stress incontinence. This surgery is easy to lean, fast, cheap and with a low rate of complications.

[Urethro-vesical foreign bodies]. / Cuerpos extraños uretro-vesicales.

We report the case of a squizoid 45 year old man who presented an acute urinary retention and had several foreign bodies in the urethra and bladder.

Estudio comparativo entre anastomosis ureteral con o sin cateterización con doble J en trasplante renal / Comparative study about the use of double-J stent across ureteral anastomosis in renal transplantation

OBJETIVO: Analizar la influencia de la cateterización de la reimplantación ureterovesical del trasplante renal (TR) con catéter tipo doble J (DJ) en la incidencia de complicaciones urológicas tipo fístula, estenosis, obstrucción e infecciones del tracto urinario. MÉTODO: De manera retrospectiva se comparan dos grupos homogéneos de pacientes: 28 sin catéter tipo doble J (DJ) y 28 con él. En el periodo de seguimiento se estudia la incidencia de fístulas urinarias, estenosis y procesos obstructivos de la vía urinaria. Se presta especial atención a los procesos infectivos de la vía urinaria como a las complicaciones inherentes de la cateterización ureteral. RESULTADOS: En el grupo con DJ se evidenció una fístula urinaria (3,6 por ciento) y ningún proceso obstructivo. Trece pacientes (46,4 por ciento) presentaron cultivos de orina positivos en el primer mes pos-TR. En el grupo sin DJ se evidenciaron dos fístulas urinarias (7,1 por ciento) y cuatro episodios obstructivos (14,3 por ciento), existiendo un total de 6 complicaciones mayores de la vía urinaria. Catorce pacientes (50 por ciento) presentaron cultivos de orina positivos en el primer mes post-TR.CONCLUSIONES: La cateterización de la ureteroneocistostomía en el TR disminuye la incidencia de fístulas urinarias y de fenómenos obstructivos ureterales. No aumenta la incidencia de infecciones urinarias en el postrasplante inmediato (AU)