Tratamiento laparoscópico de los remanentes uracales / Laparoscopic Treatment of Urachal Remnants

Objetivos: El uraco es una estructura vestigial obliterada derivada de la alantoides. El fracaso de este proceso de involución origina remanentes uracales evidentes. La cirugía es el tratamiento a elegir, ya que previene tanto la reaparición de los síntomas como la transformación maligna. El propósito de este estudio es presentar nuestra experiencia en el manejo laparoscópico de esta patología. Material y métodos: Tres pacientes del sexo masculino (mediana de edad de 39 años) se sometieron a extirpación laparoscópica de los remanentes uracales. Dos pacientes fueron diagnosticados con un quiste asintomático y un paciente con un seno uracal con secreción umbilical. Se utilizó una técnica de tres puertos para eliminar todo el tracto del uraco desde el ombligo hasta la cúpula vesical, junto con una pequeña parte de la vejiga. Resultados: La mediana de tiempo operatorio fue de 94 minutos y la pérdida de sangre fue mínima. Un paciente sufrió una pequeña rotura vesical intraoperatoria que se solucionó exitosamente con un cierre adecuado. No se observaron complicaciones postoperatorias y todos los pacientes fueron dados de alta al segundo día después de la operación. Dos años después no hubo pruebas de reaparición. Conclusiones: Los remanentes uracales se pueden tratar con éxito con la cirugía laparoscópica, con ventajas en términos de morbilidad, recuperación y resultado estético. Todavía se necesitan muchos estudios comparativos para establecerla definitivamente como el tratamiento estándar por excelencia (AU)

Objectives: The urachus is a vestigial obliterated structure derived from the alantois. Failure of this involution process originates patent urachal remnants. Surgery is the treatment of choice as it prevents both recurrence of symptoms and malignant transformation. The purpose of this study is to present our experience in the laparoscopic management of this pathology. Material and methods: Three male patients (mean age 39 years) underwent laparoscopic excision of urachal remnants. Two patients were diagnosed with an asymptomatic cyst and one patient with urachal sinus presenting with umbilical discharge. A three-port technique was used to remove the whole urachus tract from the umbilicus to the bladder dome, together with a small bladder patch. Results: Mean operating time was 94 min and blood loss was minimal. One patient had small intra-operative bladder rupture, successfully managed with adequate closure. No postoperative complications were observed and all patients were discharged on the second postoperative day. Two years later there was no evidence of recurrence. Conclusions: Urachal remnants can be successfully treated by laparoscopic surgery, with advantages in terms of morbidity, recovery and cosmetic outcome. Large number, comparative studies are still needed to definitely establish it as the gold standard treatment (AU)

[Laparoscopic treatment of urachal remnants]. / Tratamiento laparoscópico de los remanentes uracales.

OBJECTIVES: The urachus is a vestigial obliterated structure derived from the alantois. Failure of this involution process originates patent urachal remnants. Surgery is the treatment of choice as it prevents both recurrence of symptoms and malignant transformation. The purpose of this study is to present our experience in the laparoscopic management of this pathology. MATERIAL AND METHODS: Three male patients (mean age 39 years) underwent laparoscopic excision of urachal remnants. Two patients were diagnosed with an asymptomatic cyst and one patient with urachal sinus presenting with umbilical discharge. A three-port technique was used to remove the whole urachus tract from the umbilicus to the bladder dome, together with a small bladder patch. RESULTS: Mean operating time was 94 min and blood loss was minimal. One patient had small intra-operative bladder rupture, successfully managed with adequate closure. No post-operative complications were observed and all patients were discharged on the second postoperative day. Two years later there was no evidence of recurrence. CONCLUSIONS: Urachal remnants can be successfully treated by laparoscopic surgery, with advantages in terms of morbidity, recovery and cosmetic outcome. Large number, comparative studies are still needed to definitely establish it as the gold standard treatment.

Comparative study of gene expression in patients with varicocele by microarray technology.

The aim of the present study was to evaluate gene expression profile by microarray technology and validation by real-time PCR in paired samples of testicular biopsies (pre-surgery and post-surgery) in two patients with varicocele. The microarray analysis showed increased expression levels after surgery in 215 and 52 genes in patient 1 and 2, respectively, as well as decreased expression levels in 65 genes in patient 1 and 358 genes in patient 2. Real-time PCR confirmed the differential expression of the five selected genes: MT1M, PHLDA1 and INSL3 had decreased expression levels and CCIN and PRM2 increased expression levels compared with pre-surgery biopsies. In conclusion, both techniques showed decreased expression levels of genes involved in stress situations associated with varicocele and increased expression levels of genes involved in normal function of spermatogenesis.

[Multiple schwannoma of the penis]. / Schwanoma mútiple del pene.

Schwannoma or neurilemmoma designate a tumour that originates in the Schwann cells of peripheral nerves, therefore occurring anywhere in the body. They are very rare in the penis. In the literature are reported twenty seven cases of penile schwannoma. We report a case of multiple schwannoma of the penis and make a brief literature revision about this rare pathology.

[Leiomyoma of the bladder. Analysis of a collection of 90 cases]. / Leiomioma de vejiga. Análisis de agregación de 90 casos.

INTRODUCTION: Bladder leiomyomas (BL) are rare. Most publications regarding these tumours are reports of isolated cases; therefore they don't allow an evaluation of diagnostic and treatment procedures. MATERIAL & METHODS: We preformed a pooled analysis of 90 cases of BL reported in the literature. RESULTS: Mean age was 45.3 (19 to 85 years), 68 (75.6%) were women. Filling symptoms were the most frequently reported (50%), followed by voiding symptoms (24.4%). Twenty four patients (26.7%) were asymptomatic. Tumours were endoluminal in 46 patients (51.1%), intramural in 27 (30%) and extravesical in 15 (16.7%). A laparotomy was performed in 56 patients (62.2%), with enucleation in 29 (32.2%), partial cystectomy in 25 (27.8%) and total cystectomy in 2 (2.2%). A transurethral resection was preformed in 27 (30%) and a transvaginal resection in 5 (5.6%). Two patients underwent conservative treatment. In 3 cases there were reports of recurrence and one patient got a vesicovaginal fistula. CONCLUSIONS: Although BL are rare, when evaluating bladder tumours, imaging techniques can make suspect of this neoplasm. Surgical treatment of these tumours has a very high success rate. Usually an enucleation or a transurethral resection is sufficient to render the patient tumour free, avoiding a more iatrogenic surgery.

Leiomioma de vejiga. Análisis de agregación de 90 casos / Bladder leiomyoma. A pooled analysis of 90 cases

INTRODUCCIÓN: Los leiomiomas de vejiga (LV) son tumores raros. La mayoría de las publicaciones relativas a estos tumores describen casos aislados, no permitiendo evaluar estrategias diagnósticas y terapéuticas. MATERIAL Y MÉTODO: Realizamos un análisis de agregación de 90 casos de LV descritos en la literatura internacional. RESULTADOS: La edad media al diagnóstico fue de 45,3 años (19-85 años), 68 (75,6 por ciento) eran mujeres. Los síntomas más frecuentes eran de almacenamiento (50 por ciento) seguidos de los de vaciado (24,4 por ciento). Veinticuatro pacientes (26,7 por ciento) estaban asintomáticos. Cuarenta y seis tumores (51,1 por ciento) tenían crecimiento endoluminal, 27 (30 por ciento) eran intramurales y 15 (16,7 por ciento) extravesicales. A 56 pacientes (62,2 por ciento) se les realizó una laparotomía, con enucleación en 29 (32,2 por ciento), cistectomía parcial en 25 (27,8 por ciento) y cistectomía total en 2 (2,2 por ciento). Veintisiete (30 por ciento) fueron sometidos a resección transuretral y 5 pacientes (5,6 por ciento) a una enucleación transvaginal. Dos pacientes no fueron sometidos a ningún tratamiento. Fueron descritas 3 recidivas y una fístula vesicovaginal como única complicación. CONCLUSIONES: Aunque el LV sea un tumor raro, en el estudio de una neoformación vesical, los estudios de imagen, pueden hacer sospechar este diagnóstico. El tratamiento quirúrgico tiene una alta tasa de éxito. En la mayoría de los casos, la resección transuretral o la enucleación es suficiente, evitando así una cirugía más iatrogénica (AU)