Videolaparoscopic lower pole heminephrectomy for treatment of a duplex kidney.

INTRODUCTION: In a duplicated renal collecting system, or duplex kidney, the most frequent pathology presenting at the lower pole is the vesicoureteral reflux (VUR), which could lead to urinary tract infections (UTI) or even renal dysplasia. Under some circumstances, such as recurrent UTIs or impaired kidney function, heminephrectomy of the pathologic moiety is indicated. However, there are only few academic videos of laparoscopic lower pole heminephrectomy in the pediatric population available in literature. Therefore, we present a descriptive video of this procedure. METHODS: This video exhibits a case report of a 15-month-old male patient who underwent a videolaparoscopic lower pole heminephrectomy as treatment of a refluxing non-functional lower moiety of a right duplex kidney. Moreover, the patient presented a refluxing contralateral ureter which was endoscopically corrected at the same time. RESULTS: A laparoscopic right lower pole heminephrectomy associated with an endoscopic contralateral reflux treatment was performed. No complication occurred during hospital stay or at 30-day follow up. CONCLUSION: Videolaparoscopic lower pole heminephrectomy is a safe and feasible procedure in the pediatric population. Associating an endoscopic correction of the contralateral side reflux at the same moment shows no additional morbidity or complication.

[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)

Exéresis laparoscópica de divertículo vesical gigante / Laparoscopic exeresis of a giant vesical diverticle

Las divertículos vesicales en adultos son causados principalmente por obstrucción infravesical. Su tratamiento está indicado en casos de presencia de síntomas del tracto urinario inferior resistentes a tratamiento médico, infecciones de vías urinarias, litiasis intradiverticulares, obstrucción ureteral y cáncer intradiverticular. Las vías de abordaje quirúrgico son: abierta (intravesical, extravesical o combinada), endoscópica (resección del cuellos diverticular, fulguración de mucosa diverticular ó ambas), laparoscópica (transperitoneas o extraperitoneal) y robótica. Les presentamos el caso de un divertículo vesical de gran tamaño acompañado de importantes síntomas de tracto urinario inferior, tratado mediante diverticulectomía laparoscópica (AU)

Bladder diverticula mainly are secondary to infrabladder obstruction. Its treatment is indicated in case of low urinary tract obstruction resistant to medical treatment, urinary infections, intradiverticular stones, uretheral obstruction and intradiverticular carcinoma. Their surgical approach are: open surgery, endoscopic, laparoscopic and robotic. We show a patient with an important low urinary tract sintomatology treated with laparoscopic diverticulectomey (AU)

[Transurethral treatment of massive hematuria post retropubic adenomectomy]. / Tratamiento por vía transuretral de la hematuria masiva postadenomectomía retropúbica.

INTRODUCTION AND OBJECTIVES: to evaluate the frequency of reoperation caused by massive hematuria in the postoperation of open prostatectomy in benign prostatic hyperplasia (BHP) at our hospital. At the same time, we also want to evaluate the effectiveness and possible secondary effects of using transurethral approach to solve this surgical complications. MATERIAL AND METHODS: we analyzed retrospectively 540 open surgeries in benign prostatic hyperplasia, carried out from 1998 to 2005. We evaluated effectiveness, average surgery time and complications in case of endoscopic review. RESULTS: a reoperation was necessary in 2.5% of all 540 cases. In all the cases reoperated, hemorrhage was controlled using transurethral approach. Average surgery time was 37 minutes and secondary effects observed were not important. CONCLUSIONS: transurethral approach is a simple and effective technique in the treatment of massive hematuria after open prostatectomy in BPH. Surgery time spent is acceptable, and early and delayed complications observed have been few and cannot, in our opinion, be imputed only to this tech-

Tratamiento por vía transuretral de la hematuria masiva postadenomectomía retropúbica / Transurethral treatment of massive hematuria post retropubic adenomectomy

Introducción y objetivos: Evaluar la frecuencia de reintervención por hematuria postadenomectomía en nuestro centro al igual que la efectividad y los posibles efectos secundarios del abordaje transuretral como tratamiento resolutivo en el postoperatorio inmediato. Material y métodos: Se analizaron retrospectivamente 540 adenomectomías retropúbicas realizadas en el periodo 1998-2005. Se evaluó la efectividad, el tiempo quirúrgico medio de reintervención y las complicaciones en los casos en que se realizó la revisión endoscópica. Resultados: En un 2,5% del total de adenomectomías retropúbicas fue necesaria por hematuria la revisión endoscópica. En todos estos casos se logró por esta vía el control hemostático. El tiempo quirúrgico medio fue de 37 minutos y los efectos secundarios observados insignificantes. Conclusiones: La vía transuretral es una técnica simple y eficaz en el tratamiento de la hematuria masiva postadenomectomía retropúbica. El tiempo quirúrgico empleado es aceptable y las complicaciones observadas a largo plazo son mínimas y no pueden atribuirse únicamente a dicha técnica

Introduction and objectives: to evaluate the frequency of reoperation caused by massive hematuria in the postoperation of open prostatectomy in benign prostatic hyperplasia (BHP) at our hospital. At the same time, we also want to evaluate the effectiveness and possible secondary effects of using transurethral approach to solve this surgical complications. Material and methods: we analyzed retrospectively 540 open surgeries in benign prostatic hyperplasia, carried out from 1998 to 2005. We evaluate the effectiveness, average surgery time and complications in case of endoscopic review. Results: a reoperation was necessary in 2.5% of all 540 cases. In all the cases reoperated, hemorrhage was controlled using transurethral approach. Average surgery time was 37 minutes and secondary effects observed were not important. Conclusions: transurethral approach is a simple effective technique in the treatment of massive hematuria after open prostatectomy in BPH. Surgery time spent is aceptable, and early and delayed complications observed have been few and cannot, in our opinion, be imputed only to this technique

Síndrome de dolor lumbar-hematuria o loin pain-hematuria syndrome: importancia del diagnóstico diferencial / Loin pain hematuria syndrome: importance of the differential diagnosis

El síndrome de dolor lumbar-hematuria (SDL-H) o loin pain-hematuria syndrome puede ser idiopático o asociarse a otras entidades como la ptosis renal o los síndromes de dilatación venosa pelviana o retroperitoneal. El diagnóstico del SDL-H se obtiene por exclusión, una vez descartados procesos trascendentes como neoplasias, obstrucción urinaria, litiasis e infección-inflamción. Pruebas complementarias como la UIV, TC, RM, ec-doppler y renograma pueden definir un diagnóstico etiológico más preciso. El tratamiento es analgésico, aunque puede variar en función de la gravedad de la sintomatología y los procesos patológicos renales o de vía urinaria asociados, llegando a ser necesario la nefropexia o el autotrasplante

Loin pain-hematuria syndrome, can be idiopathic or associated with other malignancies included nephroptosis or retroperitoneal or pelvic venous congestion syndrome. Diagnosis is obtained by exclusion after rule out neoplastic disease, urine obstruction, stomes and infection-inflammation. TC scan, magnetic resonance, Doppler echography, renogram and ureteroscopy are useful to establish an etiologic diagnosis. Treatment is analgesic moreover related to the symptomatology and the malignancies associated and could be necessary autotransplant and nephropexia