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 metastasis from primary bladder tumour.

OBJECTIVE: We present a case of cutaneous metastasis caused by a bladder tumor. METHODS: 68 year old male, diagnosed with an ISUP high grade urothelial carcinoma, affecting the whole bladder wall, including the perivesicular fat and macroscopic metastasis in the left ilio-obturator chain (T3N2MO), who presents painless induration on the dorsal surface of the glans penis with non-exudative ulcerated areas, evolving over several months. Given the negative serology result, the lesion was biopsied for anatomopathological study. RESULTS: The histopathological study of the lesion corresponded to a cutaneous metastasis from high grade urothelial carcinoma. CONCLUSION: Approximately 370 cases of penile metastasis have been described and the primary tumor is located in the bladder in 30-35% of them. Presentation of these lesions is very heterogeneous and requires anatomopathological study of the lesion for definitive diagnosis.

Metástasis peneana de un tumor primario vesical / Penile metastasis from primary bladder tumour

OBJETIVO: Presentamos un caso de una metástasis cutánea originada desde un tumor vesical. MÉTODOS: Varón de 68 años diagnosticado de un carcinoma urotelial de alto grado de la ISUP con afectación de toda la pared vesical incluida la grasa perivesical y macrometástasis en la cadena ilio-obturatriz izquierda (T3N2MO) que presenta una induración en la cara dorsal del glande, no dolorosa y con áreas ulceradas no exudativas, de varios meses de evolución. Dado el resultado negativo de la serología, se biopsió la lesión para su estudio anatomopatológico. RESULTADOS: El estudio histopatológico de la lesión correspondía a una metástasis cutánea de carcinoma urotelial de alto grado. CONCLUSIÓN: Existen aproximadamente 370 casos de metástasis peneana descritos y en el 30-35% de los casos el tumor primario se localiza en la vejiga. La presentación de estas lesiones es muy heterogénea precisando para el diagnóstico definitivo el estudio anatomopatológico de la lesión (AU)

OBJECTIVE: We present a case of cutaneous metastasis caused by a bladder tumor. METHODS: 68 year old male, diagnosed with an ISUP high grade urothelial carcinoma, affecting the whole bladder wall, including the perivesicular fat and macroscopic metastasis in the left ilio-obturator chain (T3N2MO), who presents painless induration on the dorsal surface of the glans penis with non-exudative ulcerated areas, evolving over several months. Given the negative serology result, the lesion was biopsied for anatomopathological study. RESULTS: The histopathological study of the lesion corresponded to a cutaneous metastasis from high grade urothelial carcinoma. CONCLUSION: Approximately 370 cases of penile metastasis have been described and the primary tumor is located in the bladder in 30-35% of them. Presentation of these lesions is very heterogeneous and requires anatomopathological study of the lesion for definitive diagnosis (AU)

[Tumors of the upper urinary tract. Our experience]. / Tumores del tracto urinario superior. Nuestra experiencia.

OBJECTIVES: To study the clinical presentation, diagnosis, treatment, and evolution of upper urinary tract tumours. METHODS: We carried out a retrospective study on the upper urinary tract tumours treated in our centre, HCU Valladolid, between 1994 and 2007. RESULTS: 65 tumours were diagnosed, although only 59 were valid for the study. Mean patient age was 68 years (interval between 46 and 88 years). 47 were men and 12 women. The most common symptom on presentation was hematuria (79.9%). Urography was the most frequently used diagnostic technique (96.6%) and nephroureterectomy with transurethral resection of the intramural ureter was the most common surgical treatment performed, carried out in 28 cases. 9 patients underwent percutaneous treatment with only one recurrence, and 2 patients received ureteroscopic treatment. 50.9% of the lesions were classified as superficial tumours. The 5 and 10-year survival rates were 55 and 47%. CONCLUSIONS: Upper urinary tract tumours are an unusual disease characteristic of medium-advanced ages. Nowadays nephroureterectomy by open surgery or laparoscopy is the standard treatment. Conservative endoscopic procedures have more and more importance and present excellent results in highly selected cases.

[Renal hydatidosis]. / Hidatidosis renal.

OBJECTIVE: Our purpose is to report a case of renal hydatidosis and its treatment. METHODS: The characteristics of the case are presented and discussed. RESULTS AND CONCLUSIONS: The hydotic disease is a parasitic infestation caused by the larvae from echinococcosis granulosus. The kidney ranks third among all visceral localitations, compromising only 2% to 4% of all cases. Most of patients are asymptomatic for years and the correct preoperative diagnosis is difficult.

Hidatidosis renal / Renal hydatidosis

OBJETIVO: Nuestro objetivo es comunicar un nuevo caso de hidatidosis renal y su tratamiento. MÉTODOS: Realizamos una presentación y comentarios de las características del caso clínico. RESULTADOS/CONCLUSIONES: La hidatidosis es una parasitosis causada por la larva del echinococcus granulosus. De todas las localizaciones viscerales, el riñón ocupa el tercer lugar, encontrándose afectado tan sólo en un 2% a 4% de los casos. La mayoría de los pacientes permanecen asintomáticos durante años, siendo difícil establecer un correcto diagnóstico preoperatorio

OBJECTIVE: Our purpose is to report a case of renal hydatidosis and its treatment. METHODS: The characteristics of the case are presented and discussed. RESULTS AND CONCLUSIONS: The hydatic disease is a parasitic infestation caused by the larvae from echinococcosis granulosus. The kidney ranks third among all visceral localitations, compromising only 2% to 4% of all cases. Most of patients are asymptomatic for years and the correct preoperative diagnosis is difficult