Adenomectomía laparoscópica: 10 años de experiencia / Laparoscopic adenomectomy: 10 years of experience

Introducción: Los síntomas del tracto urinario inferior secundarios al aumento del volumen prostático están asociados con la edad, y se están volviendo más prevalentes por el aumento de la esperanza de vida. Presentamos nuestra experiencia con la adenomectomía laparoscópica transperitoneal para el manejo de la obstrucción infravesical de origen prostático. Materiales y métodos: Se realizó una revisión retrospectiva de los pacientes sometidos a una adenomectomía laparoscópica entre 2005 y 2015. Se registró la edad, el flujo máximo y el residuo posmiccional pre y posquirúrgicos, el tiempo quirúrgico, el sangrado operatorio, el peso y la anatomía patológica, los días de sondaje y hospitalización y las complicaciones. Resultados: Se incluyeron 80 pacientes con una edad media de 70 años. El Qmáx medio prequirúrgico fue 8,21 ml/s y el posterior 22,52 ml/s. La media del residuo posmiccional previo fue 91,4 ml y el posterior 14,2ml. El tiempo quirúrgico medio fue 137,7 minutos. Fue necesaria la conversión a cirugía abierta en un caso por lesión intestinal. El sangrado intraoperatorio medio fue 227,6 ml. La estancia hospitalaria media fueron 5,46 días, y el tiempo de sondaje 4,86 días. Tuvimos 13 complicaciones que se registraron según el sistema Clavien-Dindo, siendo 3 de gravedad. El peso medio de la pieza quirúrgica fue 80,02 g. La anatomía patológica mostró hiperplasia benigna en 75 casos y cáncer de próstata en los 5 restantes. Conclusión: La adenomectomía laparoscópica es una técnica segura, reproducible y con los mismos resultados funcionales de la cirugía abierta. Nuestra serie muestra que este abordaje es útil, seguro y con una baja tasa de complicaciones

Introduction: Lower urinary tract symptoms secondary to increased prostate volume are associated with ageing and are becoming more prevalent due to increased life expectancy. We present our experience with transperitoneal laparoscopic adenomectomy for the management of bladder outlet obstruction caused by benign prostatic enlargement. Materials and methods: We performed a retrospective review of patients who underwent laparoscopic adenomectomy between 2005 and 2015. We recorded age, maximum flow and postvoid residual urine (preoperative and postoperative), surgical time, operative bleeding, weight and pathology, complications and duration of catheterisation and hospitalisation. Results: We included 80 patients with a mean age of 70 years. The mean preoperative and postoperative Qmax was 8.21 mL/s and 22.52 mL/s, respectively. The mean preoperative and postoperative postvoid residual urine was 91.4 mL and 14.2 mL, respectively. The mean surgical time was 137.7 min. Conversion to open surgery was necessary in one case due to intestinal injury. The mean intraoperative bleeding was 227.6 mL. The mean hospital stay was 5.46 days, and the catheterisation time was 4.86 days. There were 13 complications, which were recorded according to the Clavien-Dindo system, 3 of which were severe. The mean weight of the surgical specimen was 80.02 g. Pathology showed benign hyperplasia in 75 cases and prostate cancer in the remaining 5. Conclusion: Laparoscopic adenomectomy is a safe, reproducible technique with the same functional results as open surgery. Our series shows that this approach is useful and safe and has a low rate of complications

Laparoscopic adenomectomy: 10 years of experience. / Adenomectomía laparoscópica: 10 años de experiencia.

INTRODUCTION: Lower urinary tract symptoms secondary to increased prostate volume are associated with ageing and are becoming more prevalent due to increased life expectancy. We present our experience with transperitoneal laparoscopic adenomectomy for the management of bladder outlet obstruction caused by benign prostatic enlargement. MATERIALS AND METHODS: We performed a retrospective review of patients who underwent laparoscopic adenomectomy between 2005 and 2015. We recorded age, maximum flow and postvoid residual urine (preoperative and postoperative), surgical time, operative bleeding, weight and pathology, complications and duration of catheterisation and hospitalisation. RESULTS: We included 80 patients with a mean age of 70 years. The mean preoperative and postoperative Qmax was 8.21mL/s and 22.52mL/s, respectively. The mean preoperative and postoperative postvoid residual urine was 91.4mL and 14.2mL, respectively. The mean surgical time was 137.7min. Conversion to open surgery was necessary in one case due to intestinal injury. The mean intraoperative bleeding was 227.6mL. The mean hospital stay was 5.46 days, and the catheterisation time was 4.86 days. There were 13 complications, which were recorded according to the Clavien-Dindo system, 3 of which were severe. The mean weight of the surgical specimen was 80.02g. Pathology showed benign hyperplasia in 75 cases and prostate cancer in the remaining 5. CONCLUSION: Laparoscopic adenomectomy is a safe, reproducible technique with the same functional results as open surgery. Our series shows that this approach is useful and safe and has a low rate of complications.

Fístula uretrocavernosa por fractura penena / Urethrocavernous fistula due to penile fracture

La fractura de pene con laceración de la uretra se presenta con dolor y hematoma, detumescencia, fallo en la erección y uretrorragia. Describimos el tercer caso publicado en la literatura de fistula uretrocavernosa por fractura peneana ocurrida durante el coito (AU)

Penile fracture with urethral laceration usually presents with pain and haematoma, detumescence, erectile failure and blood loss through urethral meatus. We describe the third published case of urethrocavernous fistula following blunt penile trauma sustained durind sexual intercourse (AU)

[Complex reconstructive surgery of cervico-urethral sclerosis after radical prostatectomy, due to endoscopic solution failure]. / Cirugía reconstructiva compleja de la esclerosis cervico-uretral tras prostatectomía radical, por fracaso de la solución endoscópica.

The sclerosis of the cervico-urethral union is one of the complications that may arise after a radical prostatectomy, in most cases, the endoscopic treatment usually solves it. We introduce repair by open approach of a sclerosis cervico-urethral after radical prostatectomy that did not respond to endoscopic management. The surgical technique had two times, the first perineal and a second time with hypogastric approach. After six months of this complex surgery an artificial sphincter was placed to patient. The patient is asymptomatic and continent after three years of follow up surgery.

Cirugía reconstructiva compleja de la esclerosis cérvico-uretral tras prostatectomía radical, por fracaso de la solución endoscópica / Complex reconstructive surgery of cervico-urethral sclerosis after radical prostatectomy, due endoscopic solution failure

La esclerosis de la unión cérvico-uretral es una de las complicaciones que pueden aparecer tras una prostatectomía radical, el tratamiento endoscópico suele ser resolutivo en la mayoría de los casos. Presentamos la reparación vía abierta de una esclerosis cérvico-uretral tras prostatectomía radical que no respondió al manejo endoscópico. La técnica quirúrgica constó de un primer tiempo perineal y un segundo tiempo con abordaje hipogástrico. A los 6 meses de esta compleja cirugía se colocó un esfínter artificial al paciente. Tras 3 años de seguimiento el paciente se encuentra asintomático y continente (AU)

The sclerosis of the cervico-urethral union is one of the complications that may arise after a radical prostatectomy, in most cases, the endoscopic treatment usually solves it. We introduce repair by open approach of a sclerosis cervico-urethral after radical prostatectomy that did not respond to endoscopic management. The surgical technique had two times, the first perineal and a second time with hypogastric approach. After six months of this complex surgery an artificial sphincter was placed to patient. The patient is asymptomatic and continent after three years of follow up surgery (AU)

[Urethrocavernous fistula due to penile fracture]. / Fistula uretrocavernosa por fractura penena.

Penile fracture with urethral laceration usually presents with pain and haematoma, detumescence, erectile failure and blood loss through urethral meatus. We describe the third published case of urethrocavernous fistula following blunt penile trauma sustained durind sexual intercourse.

Polytetrafluoroethylene and autologous fat endoscopic injection for a prostato-perineal fistula.

PURPOSE: Prostato-perineal fistula is a rare abnormality. We present a simple endoscopic technique to manage this complicated problem. MATERIALS AND METHODS: We report on a 34-year-old man with a prostato-perineal fistula after multiple surgeries for imperforate anus. The patient underwent an endoscopic injection of polytetrafluoroethylene and autologous fat in the fistulous tract. RESULTS: Two endoscopic procedures with the injection of polytetrafluoroethylene and autologous fatty tissue around the prostatic urethral orifice were necessary to occlude the fistula. CONCLUSIONS: The endoscopic injection of polytetrafluoroethylene and autologous fat was an easy, well tolerated and long lasting solution in this patient.

[Ileovesical fistula in Crohn's disease]. / Fístula ileovesical en la enfermedad de Crohn.

OBJECTIVE: To discuss the clinical presentation, complementary evaluation procedures and treatment of ileovesical fístula, an uncommon complication of Crohn's disease. METHODS/RESULTS: After the clinical presentation, complementary evaluation procedures were performed to confirm the diagnosis in all cases. Treatment was based on the patient's general condition; surgery was performed in two cases and one case was carefully followed. CONCLUSIONS: Ileovesical fístula is an uncommon complication of Crohn's disease. Occasionally, the urological symptoms may precede the digestive symptoms, therefore this condition should be suspected particularly if the complementary evaluation procedures are not very sensitive. Surgery is the treatment of choice.

[Polycystic kidney in the adult and kidney transplantation. Our experience]. / Riñón poliquístico del adulto y transplante renal. Nuestra experiencia.

OBJECTIVES: To determine the need for nephrectomy prior to renal transplantation in patients with adult polycystic renal disease. METHODS: We reviewed the records of 54 (31 females, 23 males) of 62 patients with polycystic renal disease that had been treated at our center from 1951 to 1994. Eight of the earlier cases, whose complete clinical data were unavailable, were excluded from the study. The patients were classified into three groups: nephrectomized transplanted, nephrectomized non-transplanted and non-nephrectomized transplanted patients. RESULTS: No patient had required nephrectomy due to a tumor. No surgical difficulty during transplantation had been reported in the non-nephrectomized patients. Nephrectomy had been performed in most of the cases for hematuria or preparatory to renal transplantation. The infections complications (11.76%) were resolved with antibiotic therapy. CONCLUSIONS: In the absence of renal tumor and given the low prevalence of complicated cysts, in our view it is unnecessary to perform nephrectomy routinely prior to renal transplantation in patients with adult polycystic renal disease. Nephrectomy should be reserved for cases with severe cystic complications, such as severe intracystic hemorrhage, hematuria causing anemia, pyonephrosis, or patients with grossly enlarged kidneys in whom we suspect that technical difficulties might arise at the time of transplantation.

[Lithiasis in renal transplantation]. / Litiasis en trasplante renal.

Lithiasis as a post-renal transplantation complication is rare and of delayed appearance. After having revised 320 transplantations performed at the Fundación Puigvert 8 cases were found, which implies a two-fold increased incidence over other series studied and greater than the prevalence in the normal population. We confirmed the existence of lithogenous factors in 7 of the 8 cases, and found that in 50% of them the calculus composition was urate, what explained the differences versus normal population in terms of treatment with cyclosporin and the personal background. Two therapeutic schemes may be outlined based on the chemical composition of the calculus, and thus ultrasound-guided ESWL is chosen as chronic therapy when calculi have a calcic origin whereas medical management is used when their nature is uric, even though we understand that treatment must be individualized in each case. We have obtained good results in all 8 cases without compromising neither the renal function nor the graft viability.

[Carcinoma of the residual ureter many years after nephrectomy: an evasive cause of hematuria and a high risk tumor]. / Carcinoma del uréter residual muchos años después de la nefrectomía: una causa esquiva de hematuria y un tumor de alto riesgo.

Any of the diseases of the upper urinary tract (lithiasis, tumor or fistula) can develop in the residual distal ureteral stump after simple or radical nephrectomy. It may take months or years before they manifest since this segment of the ureter is not involved in urinary function and is generally not visible on the IVP or US. These circumstances lead to difficulties and diagnostic errors and considerable delay in instituting appropriate treatment. Two patients with tumor of the residual ureteral stump are described. One had undergone simple nephrectomy for renal tuberculosis 38 years earlier and the other for a urothelial tumor 10 years ago. The delay in diagnosing the cause of these patients' symptoms prompted us to review the literature on the diseases of the ureteral stump, a subject that is little known and represents a challenge to the urologist.

[Simplified technique of nephroureterectomy]. / Técnica simplificada de nefroureterectomía.

A simplified technique for nephroureterectomy is described. This technique consists of resection of the intramural ureter followed by lumbar nephrectomy and traction of the previously detached distal ureter. The use of this technique is advocated because it is easy to perform and radical from the oncologic viewpoint.