Laparoscopic Nephrectomy for the Management of Xanthogranulomatous Pyelonephritis: Still a Challenging Procedure.

OBJECTIVE: The aim of the study was to assess the feasibility of laparoscopic nephrectomy (LN) in the treatment of patients with xanthogranulomatous pyelonephritis (XGP). METHODS: Retrospective review of medical records of 17 patients (mean age 60.0 ± 13.3 years) who underwent LN by a single surgeon from 2010 to 2018. Sociodemographic and clinical data including diagnosis, presenting clinical features, surgical management, and postoperative course were analyzed. RESULTS: LN was successfully performed in 15 (88.2%) patients. Two (12.5%) patients with disseminated disease were electively converted to open nephrectomy (ON) due to failure to progress. Two (11.8%) patients experienced intraoperative complications (grades 3b and 4b). Among patients in whom LN was successfully performed (n = 15), the mean operative time was 198.0 ± 107.1 min and was shorter when no intraoperative complications occurred (169.0 ± 48.1 min). Three (20%) of these patients required transfusions and nine (60.0%) required postoperative pelvic drainage (PD). Six (40%) patients experienced postoperative complications: one grade 1, four grade 2, and one grade 5. Mean hospital stay was 4.4 ± 4.3 days, and 3.4 ± 2.2 for those experiencing manageable or no complications. Among patients without postoperative complications (n = 6), mean hospital stay was shorter when no PD was placed (1.6 vs 2.6 days). CONCLUSION: LN is a feasible surgical option in patients with XGP although given the nature of XGP, it is associated with complications-nearly all manageable-which makes it a challenging surgical procedure. Advanced laparoscopic skills and experiences are needed. Dissemination of the disease is associated with the occurrence of more severe complications and conversion to ON. PD placement seems associated with shorter hospital stay.

[Laparoscopic uretero-ureterostomy for iatrogenic lesions of the distal uréter.] / Uretero­ureterostomía laparoscópica en las lesiones iatrogénicas del uréter distal.

OBJECTIVES: The most frequent ureteral lesions are iatrogenic, mainly due to gynecologic and urologic procedures. The resolution and repair of these lesions, when they require surgery, is often the performance of ureteroneocystostomy. We describe the technique for the repair of distal ureter lesions that preserves both anatomy and function of the urinary tract (1). The operation consists in dissection and extraction of the distal ureteral stump from its intramural tract to get at least 1 cm of free ureter, percutaneous insertion of a ureteral stent, checking the absence of tension between proximal ureter and distal dissected stump, end to end anastomosis and reinsertion of the distal ureter in the previously dissected bladder muscle layer. We present 4 cases of ureteral injury after laparoscopic simple total hysterectomy for uterine myomas with complete section of the distal ureter, that were operated 3-5 days after injury, performing laparoscopic repair surgery. We performed clinical and radiological control with intravenous urography demonstrating ureteral continuity normalization and good renal function. We believe that repair of the urinary tract with anatomical and physiological preservation must be the first option in the laparoscopic treatment of complete distal ureteral injuries, and intramural ureter dissection when needed avoids the performance of ureteroneocystostomy. It is necessary to keep progressing in the technique improvement, and to increase the number of cases and experience.

Uretero-ureterostomía laparoscópica en las lesiones iatrogénicas del uréter distal / Laparoscopic uretero-ureterostomy for iatrogenic lesions of the distal uréter

OBJETIVO: Las lesiones ureterales más frecuentes son las iatrógenas, fundamentalmente debidas a procedimientos ginecológicos y urológicos. Habitualmente la resolución y reparación de estas lesiones, cuando precisan cirugía, es la realización de una ureteroneocistostomía. Describimos una técnica para la reparación de lesiones de ureter distal que preserva tanto la anatomía como la función de la vía urinaria (1). La cirugía consiste en la disección y extracción del muñón ureteral distal de su trayecto intramural, para conseguir al menos 1 centímetro de uréter libre, colocación de stent ureteral por vía percutánea, comprobación de ausencia de tensión entre uréter proximal y muñón distal disecado, anastomosis término-terminal y reinserción de uréter distal en capa muscular vesical previamente disecada para la anastomosis. Presentamos 4 casos de lesión ureteral tras histerectomía total simple laparoscópica por miomas con sección completa de uréter distal, que se intervienen entre 3 y 5 días tras la lesión, realizando cirugía de reparación por vía laparoscópica. Se realiza control clínico y radiológico con urografía observando normalización de la continuidad ureteral y buen funcionalismo renal. Pensamos que la reparación con preservación anatómica y fisiológica de la vía urinaria, debe ser la primera opción en el tratamiento laparoscópico de las lesiones completas de uréter distal, y que la disección del uréter intramural en casos necesarios evita la realización de una ureteroneocistostomía. Es preciso seguir avanzando en el perfeccionamiento de la técnica y aumentar el número de casos y la experiencia

OBJECTIVES: The most frequent ureteral lesions are iatrogenic, mainly due to gynecologic and urologic procedures. The resolution and repair of these lesions, when they require surgery, is often the performance of ureteroneocystostomy. We describe the technique for the repair of distal ureter lesions that preserves both anatomy and function of the urinary tract (1). The operation consists in dissection and extraction of the distal ureteral stump from its intramural tract to get at least 1 cm of free ureter, percutaneous insertion of a ureteral stent, checking the absence of tension between proximal ureter and distal dissected stump, end to end anastomosis and reinsertion of the distal ureter in the previously dissected bladder muscle layer. We present 4 cases of ureteral injury after laparoscopic simple total hysterectomy for uterine myomas with complete section of the distal ureter, that were operated 3-5 days after injury, performing laparoscopic repair surgery. We performed clinical and radiological control with intravenous urography demonstrating ureteral continuity normalization and good renal function. We believe that repair of the urinary tract with anatomical and physiological preservation must be the first option in the laparoscopic treatment of complete distal ureteral injuries, and intramural ureter dissection when needed avoids the performance of ureteroneocystostomy. It is necessary to keep progressing in the technique improvement, and to increase the number of cases and experience

Collecting duct carcinoma of the kidney. A contribution of 4 new cases.

OBJECTIVE: Collecting duct carcinoma of the kidney is a rare and aggressive subtype of renal cell carcinoma with low cancer-specific survival. We reviewed our series of collecting duct tumours retrospectively. METHODS/RESULTS: We performed a retrospective analysis of the collecting duct carcinomas of the kidney treated in our unit between January 2007 and December 2012. The variables analysed were: age, gender, reason for consultation, side affected, ASA score according to anaesthetic risk, surgical treatment, tumour size, Fuhrman grade, lymphovascular invasion, TNM staging (2009 classification), adjuvant treatment and survival time. Four collecting duct carcinomas were identified. Mean patient age was 61 years. Constitutional syndrome and lower back pain were the most frequent reasons for consultation (75%), followed by hematuria. The surgical treatment was laparoscopic radical nephrectomy in 100% of the cases, with lymphadenectomy in 2 patients due to lymph node disease detected on imaging studies. The 4 patients were initially treated with temsirolimus as adjuvant therapy with no response. Two patients were given second-line treatment with sunitinib without any response. All 4 patients died from their disease with a mean survival of 9.5 months (rang: 4-15 months). CONCLUSIONS: Collecting duct carcinoma of the kidney is a rare and aggressive renal parenchymal tumour. Long-term survival rate is low, because the only potentially curative treatment seems to be surgery if it is performed in patients with localised tumours.

Carcinoma renal del túbulo colector. aportación de 4 nuevos casos / Collecting duct carcinoma of the kidney. a contribution of 4 new cases

OBJETIVO: El carcinoma de los conductos colectores es un raro y agresivo subtipo histológico de carcinoma de células renales con baja supervivencia cáncer-específica. Revisamos de manera retrospectiva nuestra serie de tumores del túbulo colector. MÉTODOS/RESULTADOS: Analizamos de manera retrospectiva los carcinomas renales del túbulo colector tratados en nuestra unidad desde enero del 2007 a diciembre del 2012. Las variables analizadas han sido: edad, sexo, motivo de consulta, lado de afectación, puntuación ASA según riesgo anestésico, tratamiento quirúrgico, tamaño del tumor, grado de Fuhrman, invasión linfovascular, estadificación TNM (clasificación 2009), tratamiento adyuvante y tiempo de supervivencia. Se identificaron 4 carcinomas de conductos colectores. La edad media de los pacientes fue de 61 años. El sindrome constitucional y el dolor lumbar fueron los motivos de consulta mas frecuentes (75%), seguido de la hematuria. El tratamiento quirúrgico fue la nefrectomia radical laproscópica en el 100% de los casos, realizandose linfadenectomia en 2 pacientes por afectación ganglionar detectada en estudios de imagen. Como terapia adyuvante, los 4 pacientes fueron tratados inicialmente con temsirolimus sin obtener respuesta. 2 pacientes recibieron tratamiento de segunda línea con sunitinib sin objetivar tampoco respuesta. Los 4 pacientes fallecieron por su enfermedad con una suprevivencia media de 9,5 meses (rango: 4-15 meses). CONCLUSIONES: El carcinoma de células renales del conducto colector es un tumor del parénquima renal raro y agresivo. La tasa de supervivencia a largo plazo es baja, porque el único tratamiento potencialmente curativo parece ser la cirugía si se plantea en pacientes con tumor localizado

OBJECTIVE: Collecting duct carcinoma of the kidney is a rare and aggressive subtype of renal cell carcinoma with low cancer-specific survival. We reviewed our series of collecting duct tumours retrospectively. METHODS/RESULTS: We performed a retrospective analysis of the collecting duct carcinomas of the kidney treated in our unit between January 2007 and December 2012. The variables analysed were: age, gender, reason for consultation, side affected, ASA score according to anaesthetic risk, surgical treatment, tumour size, Fuhrman grade, lymphovascular invasion, TNM staging (2009 classification), adjuvant treatment and survival time. Four collecting duct carcinomas were identified. Mean patient age was 61 years. Constitutional syndrome and lower back pain were the most frequent reasons for consultation (75%), followed by hematuria. The surgical treatment was laparoscopic radical nephrectomy in 100% of the cases, with lymphadenectomy in 2 patients due to lymph node disease detected on imaging studies. The 4 patients were initially treated with temsirolimus as adjuvant therapy with no response. Two patients were given second-line treatment with sunitinib without any response. All 4 patients died from their disease with a mean survival of 9.5 months (range: 4-15 months). CONCLUSIONS: Collecting duct carcinoma of the kidney is a rare and aggressive renal parenchymal tumour. Longterm survival rate is low, because the only potentially curative treatment seems to be surgery if it is performed in patients with localised tumours

Laparoscopic dissection of the intramural ureter to repair a complete transection of the distal ureter: Initial experience with a new minimally invasive technique that preserves the anatomy of the urinary tract.

We report 2 patients with ureteral injury after a simple total laparoscopic hysterectomy for uterine myoma with a complete resection of the distal ureter. One patient had unilateral injury and the other 2 patients had bilateral injury. The surgical laparoscopic repair procedure was carried out 3 to 5 days after the injury. Surgery involved intramural dissection of the distal ureteral stump to expose at least 1 cm of the ureter, percutaneous ureteral stent placement, elimination of tension between the proximal ureter and the dissected distal stump, end-to-end anastomosis, and reinsertion of the distal ureter into the bladder muscle layer, which was previously dissected for the anastomosis.

Cáncer de testículo bilateral metacrónico. Aportación de un caso y revisión de la literatura / Metachronous bilateral testicular cancer. Contribution of a case and literature review

El cáncer testicular bilateral supone el 5% de todos los tumores de testículo. La edad media de aparición es de los 15 a los 35 años, y el 65% de ellos se presentan metacrónicamente. El factor de riesgo más importante en el desarrollo del cáncer testicular bilateral es la presencia de neoplasia intratubular de células germinales. El tratamiento de elección es la orquiectomía radical, aunque en algunos casos seleccionados se puede realizar una cirugía conservadora del testículo. Presentamos un caso de tumor testicular de células germinales bilateral metacrónico y realizamos una revisión de la literatura médica (AU)

Bilateral testicular cancer accounts for 5% of all testicular tumours. The average age of onset is 15-35 years, and 65% of cases are metachronous. The most important risk factor for the development of bilateral testicular cancer is the presence of intratubular germ cell neoplasia. The treatment of choice is radical orchiectomy, although in some selected cases conservative surgery can be performed. We report one case of metachronous bilateral testicular germ cell tumour and conduct a review of the literature