Perioperative complications and surgical oncology outcomes in an initial study from 84 patients submitted to laparoscopic radical cystectomy.

OBJECTIVES: The Gold Standard treatment for a non-metastatic, invasive bladder cancer is an open radical cystoprostatectomy (ORCP). Laparoscopic radical cystoprostatectomy (LRCP) is still an experimental technique in evaluation. We describe our perioperative results defined as surgical and safety oncology variables. METHODS: Every patient who underwent a LRCP between January 2007 and July 2011 in the urology department of the University Public Hospital was evaluated. We perform a descriptive retrospective analysis. RESULTS: We evaluated 84 patients, 72 males and 12 females, with a mean age of 68 (44-79). A Bricker diversion was performed in 80 patients, a Camey II bladder replacement was performed in 3 patients, and a Studer bladder replacement was performed in 1 patient. Seventeen patients (20.23%) presented with previous abdominal surgery, and 6 patients (7.14%) presented a medical history of urological surgery. The mean surgery time was 257.57 minutes (180-420). The mean hospital stay was 11.875 days (standard deviation (SD): 6.28). The onset of tolerance to surgery occurred after 3.7 days (SD: 2.21).The transfusion rate after surgical intervention was 20.2%. The mean number of nodes removed, by means of ilio-obturator lymphadenectomy, was 17 (13-19). There were no intraoperative complications. Early complications (less than 1 month after the intervention) occurred in 28 patients (33.3% ).There were no post-operative deaths. There were late complications (starting one month after the intervention) in 7 patients (8.3% ). CONCLUSIONS: Our study demonstrated that LRCP is safe and reproducible and represents a minimally invasive option for patients with infiltrative bladder cancer.

Complicaciones perioperatorias y resultados oncológicos quirúrgicos en una serie inicial de 84 pacientes sometidos a cistectomía radical laparoscópica / Perioperative complications and surgical oncology outcomes in an initial study from 84 patients submitted to laparoscopic radical cystectomy

OBJETIVO: La cistectomía radical abierta es el estándar oro para el tratamiento del cáncer vesical infiltrante. La cistectomía radical laparoscópica (CPRL) continúa siendo una técnica experimental en evaluación. Describimos nuestros resultados perioperatorios definidos como complicaciones quirúrgicas y variables de seguridad oncológica. MÉTODOS: Revisión retrospectiva de una base de datos de cumplimentación retrospectiva de pacientes intervenidos con CRPL en el periodo comprendido entre enero del 2007 hasta julio del 2011 en un Hospital Universitario público. RESULTADOS: Fueron intervenidos 84 pacientes (72 varones y 12 mujeres), con una edad media de 68 años (44 –79). En 80 pacientes se realizó derivación tipo Bricker, en 3 sustitución vesical tipo Camey II, y en 1 sustitución vesical tipo Studer, de manera extracorpórea en todos ellos. 17 Pacientes (20,23%) presentaban cirugía abdominal previa y 6 (7,14%) presentaban antecedentes de cirugía urológica previa. El tiempo operatorio medio fue de 257,57 minutos (180-420 minutos). El tiempo medio de la estancia hospitalaria fue de 11,875 días (desviación estándar (DE): 6,28). El inicio de la tolerancia fue al 3,7 días (DE: 2,21). La tasa de transfusión posterior a la intervención quirúrgica fue del 20,2%. La mediana de ganglios extirpados, mediante linfadenectomía ilio-obturatriz bilateral, fue de 17 (13-19).No se registraron complicaciones intraoperatorias. 28 pacientes (33,3%) desarrollaron complicaciones en el postoperatorio temprano (primer mes), sin registrarse ningún fallecimiento. 7 Pacientes (8,3%) presentaron complicaciones tardías (a partir del mes de la cirugía). CONCLUSIONES: Nuestra serie pone de manifiesto que la técnica de CPRL es segura y reproducible, por lo que se trata de una alternativa mínimamente invasiva para los pacientes con cáncer vesical infiltrante (AU)

OBJECTIVES: The gold standard treatment for a non-metastatic, invasive bladder cancer is an open radical cystoprostatectomy (ORCP). Laparoscopic radical cystoprostatectomy (LRCP) continues being an experimental technique in evaluation. We describe our perioperative results defined as surgical complications and oncologic safety variables. METHODS: From January 2007 to July 2011, all patients undergoing laparoscopic radical cystoprostatectomy (LRCP) in the Urology Department of a public University Hospital were evaluated. We perform a descriptive retrospective analysis. RESULTS: We evaluated 84 patients, 72 males and 12 females, with a mean age of 68 years (44-79). A Bricker urinary diversion was performed in 80 patients, a Camey II bladder replacement was performed in 3 patients, and a Studer bladder replacement was performed in 1 patient. Seventeen patients (20.23%) presented with past medical history of abdominal surgery, and 6 patients (7.14%) history of urological surgery. The mean operative time was 257.57 minutes (180-420). Mean hospital stay was 11.875 days (standard deviation (SD): 6.28). The onset of oral tolerance occurred at 3.7 days (SD: 2.21). The transfusion rate after surgical intervention was 20.2%. The mean number of nodes removed, by means of iliac-obturator lymph node dissection, was 17 (13-19). There were no intraoperative complications. Complications occurred in 28 patients (33.3%) as early complications (less than 1 month after the intervention). There were no post-operative deaths. There were late complications (starting one month after the intervention) in 7 patients (8.3%). CONCLUSIONS: Our study demonstrated that LRCP is safe and reproducible and represents a minimally invasive option for patients with infiltrative bladder cancer (AU)

[Penile silicone granuloma]. / Granuloma de silicona en el pene "siliconoma".

OBJECTIVES: To report our experience with one case of penile silicone granuloma, that has clinical interest for its unfrequent presentation. METHODS/RESULTS: We report the case of a patient with sexual dysfunction secondary to subcutaneous injection of liquid silicone in the penis resulting in a penile granuloma and migration of the particles to the penile root and midline scrotal raphe. We proceeded to the surgical excision of the granuloma and migrated particles, repairing the penile defect with scrotal skin. CONCLUSIONS: Subcutaneous injection of liquid silicone is a practice that does not have any justification because of its devastating effects and requires major perations for the elimination of the injected material.

Granuloma de silicona en el pene "siliconoma" / Penile silicone granuloma

OBJETIVO: Mostrar la experiencia adquiridacon un caso de “siliconoma” peneano, de interés clínicopor su infrecuente presentación.METODO /RESULTADOS: Presentamos el caso de unpaciente con alteración de la función sexual secundaria ala inyección subcutánea de silicona líquida en el pene,dando lugar a la formación de un granuloma “siliconoma”peneano y a la migración de partículas del compuesto araíz de pene y a rafe medio escrotal. Se procedió a laextirpación quirúrgica del “siliconoma “ peneano y de laspartículas migradas reparando el defecto peneano conpiel escrotal.CONCLUSIONES: La inyección subcutánea de siliconalíquida es una práctica no justificada que produce efectosdevastadores y requiere cirugías importantes para la eliminacióndel material inyectado

OBJECTIVES: To report our experience with ;;one case of penile silicone granuloma, that has clinical ;;interest for its unfrequent presentation. ;;METHODS/RESULTS: We report the case of a patient with ;;sexual dysfunction secondary to subcutaneous injection of ;;liquid silicone in the penis resulting in a penile granuloma ;;and migration of the particles to the penile root and midline ;;scrotal raphe. We proceeded to the surgical excision of ;;the granuloma and migrated particles, repairing the penile ;;defect with scrotal skin. ;;CONCLUSIONS: Subcutaneous injection of liquid silicone ;;is a practice that does not have any justification because ;;of its devastating effects and requires major perations for ;;the elimination of the injected material

[Renal malacoplakia: report of a new case]. / Malacoplaquia renal: presentación de un nuevo caso.

OBJECTIVES: Malacoplakia is a chronic granulomatous disease which can involve different areas of the body, being the genital renal system the most frequent site. We describe a case of unilateral renal malacoplakia. METHODS/RESULTS: We report the case of a female patient with the clinical working diagnosis of renal cell carcinoma that required drainage of a homolateral abscess which cultured positive for E. Coli. Nephrectomy was performed. Pathologic study showed the presence of Michaelis-Gutmann bodies, patognomonic of malacoplakia.

Malacoplaquia renal: presentación de un nuevo caso / Renal malacoplakia: report of a new case

OBJETIVO: La malacoplaquia es un procesogranulomatoso crónico, que puede afectar a distintas partesdel organismo, siendo el aparato genitourinario el lugar másfrecuente de asiento de esta enfermedad. Se describe uncaso de malacoplaquia renal unilateral.METODO/RESULTADO: Presentamos una paciente con diagnósticoclínico de hipernefroma, que precisó nefrostomía porabsceso renal homolateral, con cultivo positivo para E. Coli.Se realizó nefrectomía. El estudio histológico objetivó la presenciade cuerpos de Michaelis-Gutmann patognomónicosde malacoplaquia.CONCLUSIONES:La malacoplaquia renal unilateral es unproceso granulomatoso crónico de difícil diagnóstico clínico,siendo en el estudio anatomopatológico de la pieza denefrectomía donde se encuentran los cuerpos de Michaelis-Gutmann. La evolución después de la nefrectomía suele serfavorable

OBJECTIVES: Malacoplakia is a chronicgranulomatous disease which can involve differentareas of the body, being the genital renal system themost frequent site. We describe a case of unilateralrenal malacoplakia.METHODS/RESULTS: We report the case of a femalepatient with the clinical working diagnosis of renal cellcarcinoma that required drainage of a homolateral abscesswhich cultured positive for E.Coli. Nephrectomy wasperformed. Pathologic study showed the presence ofMichaelis-Gutmann bodies, patognomonic of malacoplakia

Lymphoepithelioma-like carcinoma of the bladder: three cases with clinicopathological and p53 protein expression study.

Lymphoepithelioma-like carcinoma of the bladder is an uncommon neoplasm, of which 49 cases have been described in the English literature, none of which has been studied for p53 protein expression. We studied three muscle-infiltrating cases of this tumor using immunohistochemical, in situ hybridization and polymerase chain reaction (PCR) methods. The three cases were positive for epithelial markers and negative for lymphoid antigens in the tumoral syncytial areas. The intensive infiltrate of small cells was negative for epithelial and positive for lymphoid markers. This population was mainly made up of cytotoxic T-lymphocytes, positive for TIA-1. p53 protein was intensely positive in more than 90% of the epithelial component nuclei, being negative in the lymphoid cells. PCR study did not show mutations on p53. Both lymphocytes and epithelium were negative for Epstein-Barr virus markers, such as the latent membrane protein and EBER (Epstein-Barr-encoded RNA). The prognosis was very good after radiotherapy and chemotherapy treatment, preserving the bladder despite the muscle infiltration. The presence of an intense cytotoxic T-lymphocyte population may be related to this good prognosis. Both aspects, p53 protein status and T-lymphoid population, had never been studied before in bladder lymphoepithelioma-like carcinoma.