Inducción con timoglobulina: ¿incrementa el riesgo hemorrágico en receptores renales sensibilizados? / Could thymoglobulin increase hemorrhagic risk in the perioperative transplantation period of sensitized kidney recipients?

Objetivo: Se ha descrito que la timoglobulina podría aumentar el riesgo de infecciones y neoplasias, en comparación con basiliximab. La leucocitopenia y la trombocitopenia también son más frecuentes en los primeros días tras el trasplante en los pacientes tratados con timoglobulina.Nuestro objetivo fue analizar las complicaciones hemorrágicas en este subconjunto de pacientes.Material y métodos: Se evaluaron las complicaciones hemorrágicas en 515 trasplantes renales realizados en nuestra institución entre 2012 y 2018. Se comparó a los pacientes tratados con timoglobulina (grupo 1, N=91) con los tratados con basiliximab (grupo 2, N=424).Resultados: Encontramos diferencias en cuanto al descenso plaquetario: 95.142,2 (55.339,6) en el grupo 1 y 52.364,3 (69.116,6) en el grupo 2 (p=0,001), número de pacientes con trombocitopenia grave (< 7.5000/mm3) (20,8% vs. 3,7%, p=0,001), número de concentrados de hematíes transfundidos (3,25 [0,572] vs. 2,2 [0,191], p=0,028) y porcentaje de pacientes que requirieron reintervención por sangrado (18,2% vs. 7,7%, p=0,046). En un análisis multivariable de regresión lineal múltiple (la variable dependiente fue el número de concentrado de hematíes transfundidos), solo la edad (OR 0,037, IC del 95%, 0,003-0,070) y el tipo de inmunosupresión (OR 1,592, IC del 95%, 1,38-2,84) tuvieron significación estadística.Conclusiones: El uso de timoglobulina en el período perioperatorio del trasplante podría aumentar las complicaciones hemorrágicas. En nuestra serie, la trombocitopenia grave y el sangrado activo que requirió reintervención, fueron 6 y 2,5 veces más frecuente, respectivamente, en el grupo de pacientes con timoglobulina. En lugar de suspender el uso de este agente inmunosupresor, se podría ajustar la dosis para continuar con el tratamiento.Se debe evaluar el uso de timoglobulina en el postoperatorio de estos pacientes (AU)

Objective: It has been described that thymoglobulin could increase the risk of infections and malignancies, in comparison to basiliximab. Leukopenia and thrombocytopenia are also more common within the first days after transplantation among thymoglobulin patients. Our objective was to analyze bleeding complications in this subset of patients.Material and methods: Bleeding complications were evaluated among 515 renal transplants carried out at our institution between 2012 and 2018. We compared patients treated with thymoglobulin (Group 1, N=91) with those treated with basiliximab (Group 2, N=424).Results: We found differences in platelet decrease:95142.2 (55,339.6) in Group 1 and 52,364.3 (69,116.6) in Group 2 (P=.001), number of patients with severe thrombocytopenia (<75,000/mm3) (20.8% vs. 3.7%, P=.001), number of blood units transfused (3.25 (0.572) vs. 2.2 (0.191, P=.028) and percentage of patients that required surgery due to bleeding (18.2% vs. 7.7%, P=.046). In a multiple lineal regression multivariable analysis (dependent variable was number of blood units transfused), only age [OR 0.037, 95% CI (0.003-0.070)] and type of immunosuppression [OR 1.592, 95% CI (1.38-2.84)] showed statistical significance.Conclusions: The use of thymoglobulin in the perioperative transplantation period could increase bleeding complications. In our series, in the group of patients with thymoglobulin, severe thrombocytopenia was 6 times more frequent, and active bleeding that required surgery was also 2.5 times more frequent. One way to continue with the use of this immunosuppression agent, might be to adjust the dose instead of discontinuing it. The use of thymoglobulin should be a factor to consider in the postoperative period of these patients (AU)

Carcinoma intraductal de próstata concomitante y respuesta al tratamiento hormonal en el carcinoma de próstata metastásico / Concomitant intraductal carcinoma of the prostate and response to hormonal therapy in metastatic prostate carcinoma

Introducción y objetivo: La mayoría de los cánceres de próstata (CP) se clasifican como adenocarcinoma acinar. El carcinoma intraductal de la próstata (CIDP) es una entidad histológica distinta que se cree que representa la propagación retrógrada del adenocarcinoma acinar invasivo en los conductos prostáticos y acinos.Hemos analizado el impacto del CIDP en pacientes con cáncer de próstata resistente a la castración metastásico (CPRCm) y sin tratamiento hormonal previo (hormone-naïve).Pacientes y métodosEvaluamos retrospectivamente a 118 pacientes con CPRCm con diagnóstico inicial de cáncer de prostata metastásico (CPM) desde mayo del 2010 hasta septiembre del 2018. El grupo uno incluyó 81 personas con CPM con adenocarcinoma acinar y el grupo dos estuvo compuesto por 37 pacientes con CPM con CIDP.ResultadosLa edad media de presentación fue de 76 años (IQR 73,4 a 78,7) en el grupo uno y de 74 años (68,5 a 80,6) en el grupo dos. El valor medio del PSA en el momento del diagnóstico fue de 619 ng/mL (IQR 85 a 1.113) y 868 ng/mL (IQR 186 a 1.922), respectivamente. El tiempo hasta la resistencia a la castración fue de 24,7 meses (IQR 16,7 a 32,7) en el grupo uno y 10,2 meses (IQR 4,2 a 16,2) en el grupo dos (p = 0,007). El tiempo hasta la progresión en los pacientes con cáncer de próstata resistente a la castración (CPRC) fue: 10,6 meses (IQR 5,6 a 15,6) y 6,2 meses (3,2 a 9,2), respectivamente (p = 0,05). La supervivencia global fue de 57,9 meses en el grupo uno (IC 95% 56,4 a 59,5) y de 38 meses (IC 95% 19,9 a 48,06) en el grupo dos (p = 0,001). En el análisis multivariante, el subtipo de adenocarcinoma fue estadísticamente significativo p 0,014, IC 95% (Hazard Ratio [HR] 0,058, 0,006 a 0,56).ConclusionesEl CIDP parece ser un subtipo de CP que se asocia con una respuesta más corta al tratamiento hormonal cuando se compara con el adenocarcinoma acinar en pacientes con cáncer metastásico. (AU)

Introduction and objective: Most prostate cancers are classified as acinar adenocarcinoma. Intraductal carcinoma of the prostate (IDC-P) is a distinct histologic entity that is believed to represent retrograde spread of invasive acinar adenocarcinoma into prostatic ducts and acini.We have analyzed the impact of IDC-P in hormonal naïve and castration resistant metastatic prostate cancer patients.Patients and methodsWe retrospectively evaluated 118 metastatic castration resistant prostate cancer (mCRPC) patients who were initially diagnosed with distant metastases from May 2010 to September 2018. Group 1 patients included 81 metastatic PCa patients with acinar adenocarcinoma and Group 2 included 37 metastatic PCa patients with IDC-P.ResultsMean age at presentation was 76 years (IQR 73.4-78.7) in group 1 and 74 years (68.5-80.6) in group 2. Mean PSA at diagnosis was 619 ng/mL (IQR 85-1113) and 868 ng/mL (IQR 186-1922), respectively. Time to castration resistance was 24.7 months (IQR 16.7-32.7) in group 1 and 10.2 months (IQR 4.2-16.2) in group 2 (p = 0.007). Time to progression in CPRC patients was: 10.6 months (IQR 5.6-15.6) and at 6.2 months (3.2-9.2), respectively (p = 0.05). Overall survival was 57.9 months in group 1(CI 95% 56.4-59.5) and 38 months (CI 95% 19.9-48.06) in group 2 (p = 0.001). In the multivariate analysis, adenocarcinoma subtype was statistically significant p 0.014, CI 95% (HR 0.058, 0.006-0.56).ConclusionsIDC-P seems to be a subtype of prostate cancer that is associated with a shorter response to hormonal treatment when compared to acinar adenocarcinoma in metastatic patients. New drugs in CRPC scenario as abiraterone and enzalutamide also obtained less response in IDC-P patients. In daily clinical practice it might be interesting to take into account that patients with IDC-P may present shorter responses to first and second line hormonal treatments. (AU)

Concomitant intraductal carcinoma of the prostate and response to hormonal therapy in metastatic prostate carcinoma.

INTRODUCTION AND OBJECTIVE: Most prostate cancers are classified as acinar adenocarcinoma. Intraductal carcinoma of the prostate (IDC-P) is a distinct histologic entity that is believed to represent retrograde spread of invasive acinar adenocarcinoma into prostatic ducts and acini. We have analyzed the impact of IDC-P in hormonal naïve and castration resistant metastatic prostate cancer patients. PATIENTS AND METHODS: We retrospectively evaluated 118 metastatic castration resistant prostate cancer (mCRPC) patients who were initially diagnosed with distant metastases from May 2010 to September 2018. Group 1 patients included 81 metastatic PCa patients with acinar adenocarcinoma and Group 2 included 37 metastatic PCa patients with IDC-P. RESULTS: Mean age at presentation was 76 years (IQR 73.4-78.7) in group 1 and 74 years (68.5-80.6) in group 2. Mean PSA at diagnosis was 619 ng/mL (IQR 85-1113) and 868 ng/mL (IQR 186-1922), respectively. Time to castration resistance was 24.7 months (IQR 16.7-32.7) in group 1 and 10.2 months (IQR 4.2-16.2) in group 2 (P = .007). Time to progression in CPRC patients was: 10.6 months (IQR 5.6-15.6) and at 6.2 months (3.2-9.2), respectively (P = .05). Overall survival was 57.9 months in group 1(CI 95% 56.4-59.5) and 38 months (CI 95% 19.9-48.06) in group 2 (P = .001). In the multivariate analysis, adenocarcinoma subtype was statistically significant P .014, CI 95% (HR 0.058, 0.006-0.56) CONCLUSIONS: IDC-P seems to be a subtype of prostate cancer that is associated with a shorter response to hormonal treatment when compared to acinar adenocarcinoma in metastatic patients. New drugs in CRPC scenario as abiraterone and enzalutamide also obtained less response in IDC-P patients. Once IDC-P is identified, clinicians could extrapolate the relative poor response to hormonal therapy. Consequently, follow-up of these patients in this scenario should be more strict.

Cistectomía radical laparoscopica en los tumores vesicales clínicamente localizados. (T2) / Laparoscopic radical cystectomy in clinically localized (T2) bladder tumors

Objetivo: La cistectomía radical laparoscópica se ha desarrollado a partir de la expansión de la prostatectomía radical laparoscópica. Esta técnica permite un abordaje poco invasivo para el tratamiento de los tumores vesicales infiltrantes de la capa muscular con disminución del sangrado y una más rápida recuperación postoperatoria. Métodos: Entre septiembre de 2004 y enero de 2007 se han realizado 54 cistectomías radicales por vía laparoscópica, 48 en estadio T2 y de estas últimas 43 (90%) eran varones y 5 (10%) mujeres. La edad media fue de 64 años (27-88a). La linfadenectomía se practicó por acceso laparoscópico en todos los casos, obteniendo una media de 13 ganglios (4-24). La derivación urinaria se realizó por la incisión de extracción del espécimen en todos los casos menos uno que se realizó completamente intracorpóreo, siendo ureteroileostomía cutánea tipo Bricker en 30 casos (62%), neovejiga ortotópica tipo Padovana en 17 casos (35%) y ureterostomía cutánea en un caso (2%). Resultados: El tiempo quirúrgico medio de todo el procedimiento fue de 287 minutos (180-480), 270 minutos para los casos con derivación tipo Bricker y de 316 para los casos con una neovejiga. El índice de transfusión fue del 25%. El tiempo medio de íleo paralítico fue de 5 días (2-10d) con un tiempo medio de ingreso para los pacientes con Bricker de 13 días (6-34) y de 16 días (8-30) para las neovejigas. El control oncológico, con un seguimiento medio de 10,8 meses (0,4-30m), presenta una supervivencia cáncer específica del 90% con un tiempo medio de supervivencia estimado de 28 meses (IC 95% 26-30). La supervivencia media global ha sido del 79% con un tiempo de supervivencia de 26 meses (IC 95% 23-29). Conclusiones: La cistectomía radical laparoscópica es una técnica factible que ofrece ventajas. Permite una exéresis con un menor sangrado y un postoperatorio más llevadero. Estudios aleatorizados deberían demostrar estas ventajas para confirmar si puede llegar a ser la técnica de elección. La realización de la derivación urinaria por la laparotomía, obligada para la extracción de la pieza quirúrgica, optimiza los resultados de la derivación y el tiempo quirúrgico total sin reducir los beneficios de la exéresis laparoscópica (AU)

Objectives: Laparoscopic radical cystectomy has been developed after the expansion of laparoscopic radical prostatectomy. This technique makes possible a minimally invasive approach to muscle-invasive bladder cancer with less blood loss and faster postoperative recovery. Methods: From September 2004 to January 2007, 54 laparoscopic radical cystectomies were performed, 48 of them in stage T2, from which 43 (90%) were male and 5 (10%) female patients. Mean age was 64 years (27-88). Lymphadenectomy was carried out by laparoscopic approach in all cases, with a mean of 13 nodes obtained (4-24). Urinary diversion was done through the incision needed to extract the specimen in all cases but one that was completed completely intracorporeally; constructing a Bricker-type ureteroileostomy in 30 (62%) cases, orthotopic neobladder (Vesica Ileale Padovana) in 17 cases (35%), and cutaneous ureterostomy in 1 case (2%). Results: Mean surgical time for the whole procedure was 287 minutes (180-480), 270 minutes for Bricker-type derivation cases and 316 minutes for neobladder cases. Blood transfusion rate was 25%. Mean ileal paralysis was 5 days (2-10) with a mean hospital stay of 13 days (6-34) for Bricker cases and 16 days (8-30) for neobladder cases. Oncological control, after a mean follow-up of 10,8 months (0,4-30), showed a cancer-specific survival of 90% with a mean survival time of 28 months (95% CI 26-30). Global mean survival was 79% with a mean survival of 26 months (95% CI 23-29). Conclusions: Laparoscopic radical cystectomy is a feasible technique that offers some advantages. It allows excision with less blood loss and an easier postoperative period. Randomized studies should demonstrate these advantages to confirm this approach as the technique of choice. Urinary diversion performed through the laparotomy incision, necessary to extract the specimen, optimizes derivation results and whole surgical time without reducing the beneficial effects of the laparoscopic exeresis (AU)

[Presentation of a new case of primary clear cell adenocarcinoma of the urethra and its surgical management]. / Presentación de un nuevo caso de adenocarcinoma de células claras uretral y su manejo quirúrgico.

OBJECTIVE: To present a new case of a primary clear cell adenocarcinoma of the urethra and its surgical management. MATERIAL AND METHODS: We describe the clinical, diagnosis, treatment and development of this kind of tumor. Review of the literature. CONCLUSIONS: It is an unusual type of cancer associated with poor prognosis. Currently the construction of a continent urinary diversion using the Mitrofanoff principle has many indications as our case. Laparoscopic radical cystectomy can be done by experienced groups without adding much more technical difficulties; there are no long-term oncological outcome data but we believe in some functional advantages.

[Laparoscopic radical prostatectomy: learning curve with a mentor training program]. / Prostatectomía radical laparoscópica: la curva de aprendizaje con tutor.

INTRODUCTION: We describe and evaluate the results of our mentor training program for laparoscopic radical Prostatectomy (LRP). MATERIAL AND METHODS: From March 2004 through December 2005, we have performed 105 (LRP). Three groups have been analysed: Group 1: The mentor as the first surgeon with the trainee acting as the assistant. Group 2: The trainee as the first surgeon with the mentor acting as the assistant. Group 3: The trainee as the first surgeon with another trainee/resident as the assistant. We have evaluated operative, postoperative data and surgical/oncological control. RESULTS: There was no statistical difference in mean operative time in Groups 2 and 3 (200'-198'), but there was a difference from Group 1 (148,4') (p<0,05) we have observed a progressive operative time decrease only in Group 1. Blood loss, surgical-oncological control, pathological stage and hospital stay have been similar in the three groups. CONCLUSIONS: Skills for LRP can be effectively and safely taught by the presence of an experienced mentor. Waiting for long term results according to potency and continence, it was not associated to higher patient risk, neither to a worse surgical/oncologic outcome. We consider that this program is reproducible and allows a shorter learning curve.

[Comparison between open and laparoscopic approach in radical prostatectomy]. / Prostatectomia radical laparoscópica versus abierta.

INTRODUCTION: To evaluate the differences between laparoscopic (LRP) and open radical prostatectomy (ORP). MATERIAL AND METHODS: From 2004 to 2005 180 Radical prostatectomies (RP) were performed, 105 laparoscopical and 75 by an open approach. Different urologists have acted as first surgeon; 51% of them, fully experienced ones in OPR, and 56% in LRP. Differences in operative time, estimated blood loss (difference of pre and post operative hematocrite), and duration of hospitalization were compared. Additionally, we have also analysed surgical and oncologic control of the specimen defined by the following variables: Malignant margins (MM) (positive margin in a pT3 specimen), and benign/malign surgical incision (BSI/MSI). RESULTS: Groups were similar concerning age, clinical stage and Gleason score, and there are only differences in PSA. Mean operative time was significantly higher in LRP (172 minutes) versus ORP (145 minutes) (p < 0.001). Difference of pre and post operative hematocrite was also higher in the open group (10.7 vs 9.2) (p = 0.03), together with hospital stay, which was one day longer in the ORP group (p = 0.001). ORP group had a higher rate of benign surgical incisions (48.7% vs 26.7%) (p = 0.001). Regarding oncologic results, LRP presented a 5.4% of positive margins, which compared significantly with a 16.9% rate in the open group (p = 0.023). However, no differences concerning malignant surgical incisions were observed. CONCLUSION: With no differences in clinical and pathological stage, LRP offers a significant reduction of surgical aggressiveness on the specimen, together with a better MM control. We also observe a clear decrease in blood loss and hospital stay. Therefore, we conclude that LRP in our environment is a valid approach of surgical prostate cancer treatment in spite of a longer operative time (27 minutes) and a steep learning curve.

Presentación de un nuevo caso de adenocarcinoma de células claras uretral y su manejo quirúrgico / Presentation of a new case of primary clear cell adenocarcinoma of the urethra and its surgical management

Objetivo: presentar un caso de adenocarcinoma uretral de células claras y su manejo quirúrgico. Material y métodos: se describe la clínica, diagnóstico, tratamiento y evolución, de este tipo de tumor. Revisión de la literatura. Conclusión: es un tipo de tumor infrecuente que se asocia a mal pronóstico. La conformación de un reservorio con mecanismo de continencia tipo Mitrofanoff tiene su vigencia en este tipo de indicación. La cistectomía laparoscópica es una técnica realizable por grupos con cierto bagaje laparoscópico sin añadir grandes dificultades técnicas; no existe todavía un seguimiento a largo plazo como para valorar resultados oncológicos, pero sí se vislumbran ciertas ventajas funcionales

Objective: To present a new case of a primary clear cell adenocarcinoma of the urethra and its surgical management. Material and methods: We describe the clinical, diagnosis, treatment and development of this kind of tumor. Review of the literature. Conclusions: It is an unusual type of cancer associated with poor prognosis. Currently the construction of a continent urinary diversion using the Mitrofanoff principle has many indications as our case. Laparoscopic radical cystectomy can be done by experienced groups without adding much more technical difficulties; there are no long-term oncological outcome data but we believe in some functional advantages

Prostatectomía radical laparoscópica versus abierta / Comparison between open and laparoscopic approach in radical prostatectomy

Objetivos. Analizar las diferencias entre la prostatectomía radical abierta (PRA) y la prostatectomía radical laparoscópica (PRL). Material y métodos. Se evalúan 180 cirugías prostáticas radicales realizadas en el 2004 y 2005, de las cuales 105 (58%) fueron laparoscópicas (PRL) y 75 (42%) por vía abierta. Más de la mitad de las intervenciones se realizaron por cirujanos expertos: 51% en las PRL y 56% en las PRA. Se compararon las variables: tiempo quirúrgico, sangrado intraoperatorio (diferencia entre hematocrito prequirúrgico y postquirúrgico) y los días de ingreso. El control oncológico y quirúrgico se evaluaron mediante los parámetros: margen maligno (MM) (margen positivo en un pT3) e incisión quirúrgica benigna (IQB) y maligna (IQM). Resultados. Los dos grupos son comparables respecto a la edad, estadio clínico, Gleason de la biopsia y volumen, sólo difiriendo en el valor de PSA. La media del tiempo quirúrgico fue significativamente mayor en la PRL (172 minutos) versus la PRA (145 minutos). La diferencia del hematocrito fue mayor en la PRA (10,7 puntos) respecto a la PRL (9,2 puntos) (p=0,03), así como los días de ingreso, representando un día más en la PRA (p=0,001). Un 26,7% de las PRL han presentado IQB, frente a un 48,7 % en las PRA (p=0,001). Desde el punto de vista oncológico se han observado un 5,4% de MM en las PRL versus un 16,9% en las PRA. (p=0,023). No obstante, no se han observado diferencias respecto a las IQM. Conclusión. En la PRL, a igualdad de estadio clínico y patológico, se observa un mejor control de los márgenes junto con una menor afectación quirúrgica de la pieza. También existe una menor pérdida sanguínea así como una reducción de los días de ingreso. Por tanto, se puede concluir que la PRL es, en nuestro entorno, una técnica válida para el tratamiento del cáncer de próstata organoconfinado, a pesar de un mayor tiempo quirúrgico (27 minutos) y de la dificultad de su aprendizaje

Introduction. To evaluate the differences between laparoscopic (LRP) and open radical prostatectomy (ORP). Material and Methods. From 2004 to 2005 180 Radical prostatectomies (RP) were performed, 105 laparoscopical and 75 by an open approach. Different urologists have acted as first surgeon; 51% of them, fully experienced ones in OPR, and 56% in LRP. Differences in operative time, estimated blood loss (difference of pre and post operative hematocrite), and duration of hospitalization were compared. Additionally, we have also analysed surgical and oncologic control of the specimen defined by the following variables: Malignant margins (MM) (positive margin in a pT3 specimen), and benign/malign surgical incision (BSI/MSI). Results. Groups were similar concerning age, clinical stage and Gleason score, and there are only differences in PSA. Mean operative time was significantly higher in LRP (172 minutes) versus ORP (145 minutes) (p<0.001). Difference of pre and post operative hematocrite was also higher in the open group (10.7 vs 9,2) (p=0.03), together with hospital stay, which was one day longer in the ORP group (p=0.001). ORP group had a higher rate of benign surgical incisions (48.7% vs 26.7%) (p=0.001). Regarding oncologic results, LRP presented a 5.4 % of positive margins, which compared significantly with a 16.9% rate in the open group (p=0.023). However, no differences concerning malignant surgical incisions were observed. Conclusion. With no differences in clinical and pathological stage, LRP offers a significant reduction of surgical aggressiveness on the specimen, together with a better MM control. We also observe a clear decrease in blood loss and hospital stay. Therefore, we conclude that LRP in our environment is a valid approach of surgical prostate cancer treatment in spite of a longer operative time (27 minutes) and a steep learning curve

[Bipolar versus monopolar transurethral resection of the prostate: peroperative analysis of the results]. / Resección transuretral de próstata bipolar vs monopolar: análisis peroperatorio de los resultados.

OBJECTIVE: To analyse the differences in the postoperative period between bipolar and monopolar resection of the prostate in the endoscopic surgery of the benign prostatic hyperplasia. METHODS: 45 patients were prospectively randomized. Twenty-one underwent monopolar resection (Storz Ch 26, 30 degrees) and 24 underwent bipolar resection (Olympus ch 26, 30 degrees). RESULTS: Mean age in the bipolar group was 69,5 years versus 67,3 in the monopolar group; mean flow before surgery (7,7 ml/s vs 7,2 ml/s); ecographic prostate volume (39,5 cc vs 42,7 cc); resection volume 13 g vs 12,6 g and mean resection time was 39,7 vs 42,5 min. Cut capacity was considered notable-excellent in 90% of the patients in the bipolar group vs 50% in the monopolar group (p=0,01); adherence of fragments were considered abundant or very abundant in 0% vs 60% (p=0,01); coagulation capacity was excellent-notable in 25% vs 75% (p=0,03). There were no significant differences on the days of catheterization (2,92 vs 3,1), continuous irrigation (1,79 vs 2,05), hospitalization (3,63 vs 3,67), hematocrite descent (3,48 vs 3,32) and plasmatic sodium (0,52 vs 1,16), neither on episodes of acute urine retention (only one patient in the monopolar group). CONCLUSIONS: In our experience, TURP with SurgMaster resector in prostate smaller than 70 g offers better peroperative qualities for the surgeon (better cut capacity, less adherence of fragments) than the monopolar resection, with similar postoperative outcomes.

[Current status of radical laparoscopic prostatectomy]. / Estado actual de la prostatectomía radical laparoscópica.

Laparoscopic surgery can be said to have come of age when it was first indicated for cancer conditions. Advances in this field are largely due to the French school, which has made it a standard practise in prostate cancer. It complies with the principles required for cancer as well as conventional surgery, but it remains to be verified whether its long-term results, both from tumoral and functional perspectives, are not only similar to those of classical surgery, but even better. In fact, increasing numbers of clinical groups are incorporating this technique in their daily work.

Resección transuretral de próstata bipolar vs monopolar: análisis peroperatorio de los resultados / Bipolar versus monopolar transuretrhral resection of the prostate: preoperative analysis of the results

Objetivo: Analizar a corto plazo las posibles diferencias entre el resector bipolar y el resector monopolar convencional en la cirugía endoscópica de la hiperplasia benigna de próstata. Material y métodos: Estudio prospectivo randomizado de 45 pacientes. Veintiún pacientes fueron intervenidos con resector monopolar (Storz Ch 26, 30º) y 24 con resector bipolar (Olympus ch 26, 30º). Resultados: La edad media fue de 69,5 años en el grupo bipolar frente a 67,3 del monopolar; flujo máximo medio previo a la cirugía (7,7 ml/seg vs 7,2 ml/seg); volumen ecográfico prostático (39,5 cc vs 42,7 cc); volumen de resección (13 gr vs 12,6 gr), y el tiempo de resección medio fue de 39,7 min vs 42,5 min. La capacidad de corte se calificó como notable-excelente en el 90% de los casos en el grupo bipolar frente a un 50% del monopolar (p=0,01). La adherencia de fragmentos al asa de resección se consideró abundante o muy abundante en 0% vs 60% (p=0,01). La capacidad de coagulación fue excelente-notable en 25% vs 75% (p=0,03). No hubo diferencias significativas en cuanto a los días de sondaje (2,92 vs 3,1), días de lavado (1,79 vs 2,05), días de ingreso (3,63 vs 3,67), disminución HTO (3,48 puntos vs 3,32) y Na plasmático (0,52 mg/dl vs 1,16) ni en los episodios de retención aguda de orina (sólo 1 paciente en el grupo monopolar). Conclusiones: En nuestra experiencia, la RTUP con SurgMaster en próstatas menores de 70 gr ofrece unas mejores prestaciones peroperatorias al cirujano (mejor capacidad de corte, menor adherencia de fragmentos) frente a la resección monopolar clásica, con similares resultados postoperatorios

Objective: To analyse the differences in the postoperative period between bipolar and monopolar resection of the prostate in the endoscopic surgery of the benign prostatic hyperplasia. Methods: 45 patients were prospectively randomized. Twenty-one underwent monopolar resection (Storz Ch 26, 30º) and 24 underwent bipolar resection (Olympus ch 26, 30º). Results: Mean age in the bipolar group was 69,5 years versus 67,3 in the monopolar group; mean flow before surgery (7,7 ml/s vs 7,2 ml/s); ecographic prostate volume (39,5 cc vs 42,7 cc); resection volume 13 g vs 12,6 g and mean resection time was 39,7 vs 42,5 min. Cut capacity was considered notable-excellent in 90% of the patients in the bipolar group vs 50% in the monopolar group (p=0,01); adherence of fragments were considered abundant or very abundant in 0% vs 60% (p=0,01); coagulation capacity was excellent-notable in 25% vs 75% (p=0,03). There were no significant differences on the days of catheterization (2,92 vs 3,1), continuous irrigation (1,79 vs 2,05), hospitalization (3,63 vs 3,67), hematocrite descent (3,48 vs 3,32) and plasmatic sodium (0,52 vs 1,16), neither on episodes of acute urine retention (only one patient in the monopolar group). Conclusions: In our experience, TURP with SurgMaster resector in prostate smaller than 70 g offers better peroperative qualities for the surgeon (better cut capacity, less adherence of fragments) than the monopolar resection, with similar postoperative outcomes

Estado actual de la prostatectomía radical laparoscópica / Current status of radical laparoscopic prostatectomy

La cirugía laparoscópica puede considerarse que ha alcanzado la mayoría de edad al indicarse en la patología oncológica, y debe su desarrollo a las escuelas francesas que sistematizaron su empleo en el cáncer prostático. Cumple los principios que ha de seguir la cirugía oncológica, al igual que la cirugía convencional, pero queda aún por demostrar que los resultados a largo plazo, tanto desde el punto de vista tumoral como el funcional sean mejores que la cirugía clásica. Cada vez son más los grupos que están incorporando estas técnicas a su quehacer diario

Laparoscopic surgery can be said to have come of age when it was first indicated for cancer conditions. Advances in this field are largely due to the French school, which has made it a standard practise in prostate cancer. It complies with the principles required for cancer as well as conventional surgery, but it remains to be verified whether its long-term results, both from tumoral and functional perspectives, are not only similar to those of classical surgery, but even better. In fact, increasing numbers of clinical groups are incorporating this technique in their daily work

[Dermatomyositis and small cell tumor of the kidney]. / Dermatomiositis y tumor renal de células pequeñas.

Dermatomyositis is an inflammation of the striated muscle with an important leukocyte infiltrate which is accompanied by a characteristic cutaneous exanthema. In the international classification we find DM associated with neoplasm in 10% of cases. It is accepted that neoplasms are related to DM if it does not exceed it in two years (prior o after the onset of the disease. The most commonly associated are lung, ovary and breast cancers. In the pas ten years only two cases of DM associated to renal cancer (both in renal cell cancers) have been published. In this article we present a case history of a woman with a DM associated to a renal oat-cell carcinoma. Also, we will review the literature on this theme and will evaluate the predictive parameters of the presence of malignancies in this pathology.

[Barcelona pouch. An external continent urinary diversion]. / Barcelona Pouch. Una derivación urinaria externa continente.

OBJECTIVES: To describe a new technique for external continent urinary diversion based on the Vesica Ileale Padovana technique (VIP) with a continent hydraulic valve, which obviates the need for external permanent collecting urinary systems. METHODS: An ileal neobladder was created following the VIP technique to which we added a modified Benchekroun continent hydraulic valve utilizing mechanical sutures. RESULTS: A continent heterotopic neobladder was achieved. The technique was easy to perform and permitted preservation of the upper urinary tract due to the pouch's low internal pressures. CONCLUSIONS: In our view, this technique is a valid alternative in patients unamenable to orthotopic diversion and are able to perform self-catheterization.

[Simplified vasovasostomy]. / Vaso-vasostomía simplificada.

OBJECTIVES: A simplified technique to repair seminal duct obstruction is described. METHODS: Optical magnification, a channeled instrument as a suture guide that we have developed and fibrin glue are utilized. RESULTS: This technique is safe, reduces operating time and achieves similar results as with a surgical microscope. CONCLUSIONS: This technique facilitates repair of small caliber structures, reduces the operating time and does not require large microscopic systems.

[New compound needle for percutaneous renal puncture]. / Nueva aguja compuesta para la punción renal percutánea.

OBJECTIVE: We have developed a needle for direct percutaneous access in order to introduce the flexible wire with a single puncture, without creating two parallel tracks, thereby affording a lower morbidity than the conventional technique. METHOD: The needle consists of an internal and an external device, with different lengths and diameters, that let us first create the access to the urinary tract with the inner device and then dilate with the outer device in order to introduce the metallic wire with a single puncture, sliding the outer over the inner device. RESULTS: We can achieve the same number of percutaneous accesses with less morbidity since less punctures are required to create the track. CONCLUSION: This is a useful needle for any type percutaneous access.

[Cyst of the seminal vesicle associated with renal dysgenesis and ipsilateral ectopic ureter. Apropos of 3 clinical cases]. / Kyste de la vésicule séminale associée à une dysgénésie rénale et à un uretère ectopique ipsilatéral. Présentation de 3 cas cliniques.

We discuss the cystic pathology of seminal vesicles, and its relation with ureteral ectopy, as well as the therapeutic options for both entities. We present our experience in the resolution of three typical cases.