[Initial series of radical prostatectomy in a general hospital: review and comparative of national and international series]. / Serie inicial de prostatectomía radical laparoscópica en un hospital general: revisión y comparativa de series nacionales e internacionales.

INTRODUCTION AND OBJECTIVES: The radical prostatectomy is a technique that has shown competitive oncological and functional results, that is why it has become to be a routine procedure in many leading centers. Nevertheless, the difficulty of learning and its initial cost, could question its implantation as a routine technique in centers that are not a point of reference. We have carried out a descriptive study of our initial series analyzing the surgical technique, post surgical immediate results, and oncological and functional short-term outcomes, comparing them with other series in national and international centers. METHODS: From February, 2006 to August, 2007 we performed 69 laparoscopical procedures in our center, of which 34 were radical prostatectomies. The average age of the series were 63 years (50-72), with a prostate average weight by transrectal ultrasound of 35 gr. (17-72), and a median PSA of 6ng/ml (4-35). The clinical stages were: T1c 59%, T2a 12%, T2b 17%, T2c 12%; with Gleason combined of: 2+2 in 3%, 3+3 in 35%, 3+4 in 15%, 4+3 in 44%, 4+5 in 3%. RESULTS: Out of the 34 cases initiated by laparoscopy, 30 were concluded laparoscopically, with a surgical average time of 261 minutes (150-380). The pathological stages were: pT2a 3%, pT2b 18%, pT2c 41%, pT3a 32%, pT3b 6%. With Gleason of: 3+3 in 26%, 3+4 in 14%, 4+3 in 47%, 4+4 in 9%, 4+5 in 3%. We obtained 29% of positive margins (50% pT3a, 20% pT3b, 20% pT2b, 10% pT2c). Four cases were converted to open surgery, one due to subcutaneous emphysema, one to enlarged surgical time, one bleeding, and one rectal injury. The continence (0-1 pads) at the first month was 62%, reaching 84% at 6 months. The erection, remained in 50% of the patients at the first month, in the four cases of intrafascial dissection. CONCLUSIONS: Laparoscopic radical prostatectomy is a technique of difficult learning, and initially requires higher surgical time than open surgery. Nevertheless, we prove that it is a reliable technique with competitive oncological and functional results, early recovery and little bleeding even in the initial series. Therefore, it should be considered an option for the treatment of prostate cancer also in not leading centers.

[Adenocarcinoma in a ileal conduit after cystectomy for bladder exstrophy]. / Adenocarcinoma en conducto ileal después de cistectomía por extrofia vesical.

Exstrophy of the urinary bladder is an uncommon congenital anormaly for wich cystectomy was recommended because of a high risk of developing carcinoma. We report a patient treated by cystectomy and ileal loop diversion, who, 34 years later, developed carcinoma of the ileal loop. It is the third report of a tumor developing in a ileal conduit constructed after cystectomy for bladder exstrophy.

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)

Serie inicial de prostatectomía radical laparoscópica en un hospital general: revisión y comparativa de series nacionales e internacionales / Initial series of radical prostatectomy in a general hospital: review and comparative of national and international series

Serie inicial de prostatectomía radical laparoscópica en un hospital general: revisión y comparativa de series nacionales e internacionales. Introducción y objetivos: La prostatectomía radical laparoscópica es una técnica que ha demostrado unos resultados oncológicos y funcionales competitivos, por lo que se ha convertido en un procedimiento rutinario en muchos centros punteros. No obstante, la dificultad de aprendizaje y su coste inicial, pueden cuestionar su implantación como técnica rutinaria, en centros que no sean de referencia. Realizamos un estudio descriptivo de nuestra serie inicial analizando la técnica quirúrgica, resultados posquirúrgicos inmediatos, y oncológicos y funcionales a corto plazo, comparándolos con otras series en centros nacionales e internacionales. Métodos: De febrero 2006 a agosto 2007 realizamos 69 procedimientos laparoscópicos en nuestro centro, de los cuales 34 fueron prostatectomías radicales. La edad media de la serie fue de 63 años (50-72), con un peso prostático medio por ecografía transrectal de 35 gr.(17-72), y una mediana de PSA de 6 ng/ml (4-35). Los estadios clínicos fueron: T1c 59%, T2a 12%, T2b 17%, T2c 12%; con Gleason: 2+2en 3%, 3+3 en 35%, 3+4 en 15%, 4+3 en 44%, 4+5 en 3%.Resultados: De los 34 casos iniciados por laparoscopia, se terminaron 30, con un tiempo quirúrgico medio de 261 minutos (150-380).Se convirtieron 4 casos a cirugía abierta, 1 por enfisema subcutáneo, 1 por prolongación del tiempo quirúrgico, 1 por sangrado, 1 por lesión rectal. Los estadios patológicos fueron: pT2a 3%, pT2b 18%, pT2c 41%, pT3a 32%, pT3b 6%. Con Gleason de: 3+3 en 26%, 3+4 en 14%, 4+3en 47%, 4+4 en 9%, 4+5 en 3%. Obtuvimos un 29% de márgenes positivos (50% pT3a, 20% pT3b, 20% pT2b, 10% pT2c). La continencia (0-1 compresas) al mes, fue del 62%, llegando al 84% a los 6 meses. La erección al mes, se conservó en un 50% de los pacientes, en los cuatro casos de disección intrafascial. Conclusiones: la prostatectomía radical laparoscópica es una técnica de difícil aprendizaje, y exige un tiempo quirúrgico inicial superiora la cirugía abierta. No obstante, comprobamos que se trata de una técnica segura, con unos resultados oncológicos y funcionales competitivos, una recuperación temprana y un escaso sangrado, incluso en series iniciales. Por ello, también debería considerarse una opción para el tratamiento del cáncer de próstata en centros de segundo nivel (AU)

Introduction and objectives: The radical prostatectomy is a technique that has shown competitive oncological and functional results, that is why it has become to be a routine procedure in many leading centers. Nevertheless, the difficulty of learning and its initial cost, could question its implantation as a routine technique in centers that are not a point of reference. We have carried out a descriptive study of our initial series analyzing the surgical technique, post surgical immediate results, and oncological and functional short-term outcomes, comparing them with other series in national and international centers. Methods: From February, 2006 to August, 2007 we performed 69 laparoscopical procedures in our center, of which 34 were radical prostatectomies. The average age of the series were 63 years (50-72), with a prostate average weight by transrectal ultrasound of 35 gr.(17-72), and a median PSA of 6ng/ml (4-35). The clinical stages were: T1c 59%, T2a 12%, T2b 17%, T2c 12%; with Gleason combined of:2+2 in 3%, 3+3 in 35%, 3+4 in 15%, 4+3 in 44%, 4+5 in 3%.Results: Out of the 34 cases initiated by laparoscopy, 30 were concluded laparoscopically, with a surgical average time of 261 minutes (150-380). The pathological stages were: pT2a 3%, pT2b 18%, pT2c 41%, pT3a 32 %, pT3b 6%. With Gleason of: 3+3 in 26%, 3+4 in 14%, 4+3 in47%, 4+4 in 9%, 4+5 in 3%. We obtained 29 % of positive margins (50% pT3a, 20% pT3b, 20% pT2b, 10% pT2c). Four cases were converted to open surgery, one due to subcutaneous emphysema, one to enlarged surgical time, one bleeding, and one rectal injury. The continence (0-1 pads) at the first month was 62%, reaching 84% at 6 months. The erection, remained in 50% of the patients at the first month, in the four cases of intrafascial dissection. Conclusions: Laparoscopic radical prostatectomy is a technique of difficult learning, and initially requires higher surgical time than open surgery. Nevertheless, we prove that it is a reliable technique with competitive oncological and functional results, early recovery and little bleeding even in the initial series. Therefore, it should be considered an option for the treatment of prostate cancer also in not leading centers (AU)

Adenocarcinoma en conducto ileal después de cistectomía por extrofia vesical / Adenocarcinoma in a ileal conduit after cystectomy for bladder exstrophy

La extrofia vesical es una patología congénita poco frecuente. Hace años se recomendó la realización decistectomía profiláctica por el riesgo de desarrollar carcinoma en la vejiga extrófica. Presentamos un caso de extrofia vesical tratado con cistectomía y conducto ileal, desarrollando 34 años después, un adenocarcinoma tipo intestinal en el asa del conducto ileal. Éste es el tercer caso de tumor descrito en un conducto ileal construido después de la cistectomía por extrofia vesical (AU)

Exstrophy of the urinary bladder is an uncommon congenital anormaly for wich cystectomy was recommended because of a high risk of developing carcinoma. We report a patient treated by cystectomy and ileal loop diversion, who, 34 years later, developed carcinoma of the ileal loop. It is the third report of a tumor developing in a ileal conduit constructed after cystectomy for bladder exstrophy (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.

HIFU: ¿una nueva opción terapéutica en el tratamiento del adenocarcinoma prostático? / HIFU: a new therapeutic option in the treatment of prostatic adenocarcinoma

Presentamos un caso de adenocarcinoma prostático tratado mediante ultrasonido de alta frecuencia (HIFU). El HIFU ofrece una nueva alternativa en el tratamiento oncológico mediante la destrucción tisular utilizando ondas de choque de alta frecuencia. Su uso en tumores pancreáticos, vesicales, prostático, renales y hepáticos (tanto primarios como secundarios) se está extendiendo en los últimos años. Su focalización sobre las células tumorales disminuye teóricamente los efectos secundarios asociados a otras técnicas terapéuticas

We report a new case of prostate Cancer treated by “High intensity focused ultrasound” (HIFU). HIFU offers a new way of oncological treatment based on tissue destroyed by high intensity focused ultrasound waves. HIFU is not suitable for all types of cancer. It´s used on Pancreatic cancer, bladder cancer, prostate cancer, kidney cancer and primary and secondary liver cancer. As it only used waves to kill the cancer cells, it doesn´t have as many side effects as other types of cancer treatments already in use