Análisis de las recomendaciones en contra del cribado con antígeno prostático específico en cáncer de próstata / Analysis of recommendations against prostate cancer screening with prostate specific antigen

No disponible

[Open versus laparoscopic pyeloplasty: review of our series and description of our laparoscopic pyeloplasty procedure]. / Pieloplastia abierta frente a laparoscópica: revisión de nuestra serie y descripción de nuestra técnica de pieloplastia laparoscópica.

INTRODUCTION AND OBJECTIVES: Pyeloplasty has always been the treatment of choice for ureteropelvic junction obstruction at our center, where a laparoscopic approach has been used in the last 4 years to perform this procedure. Results of open pyeloplasty (OP) and laparoscopic pyeloplasty (LP) performed at our center in the past 8 years are compared, and our laparoscopic procedure is described. MATERIALS AND METHODS: Pyeloplasties performed at our center from June 2000 to June 2008 were retrospectively reviewed. Clinical presentation, involved kidney function, operating time, intraoperatory bleeding, presence of kidney stones or crossing vessels, length of hospital stay, possible complications, and results obtained were analyzed in each case. RESULTS: Thirty pyeloplasties were performed, 15 OP and 15 LP (50%). Mean operating time was 167.6 minutes for LP (100-240) and 106 minutes for OP (75-180) (P< .0001). Mean hospital stay was 6.6 days (4-16) for LP and 9.1 days for OP (5-26) (P.05). Intraoperative bleeding was negligible in all patients and no peroperative complications occurred. However, 9 patients (30%) experienced postoperative complications, 5 out of 15 LPs (33.3%) and 4 out of 15 OPs (26.7%) (P.05). Urinary fistula was the most common complication, occurring in 3 of the 30 patients (10%). Procedure was successful in all 15 patients undergoing OP (100%) and in 14 of the 15 patients undergoing LP (93.3%) (P.05). CONCLUSIONS: LP is currently the procedure of choice at our center because of its lower morbidity and similar results to OP, despite the need for a certain laparoscopic skill and a usually longer operating time.

Pieloplastia abierta frente a laparoscópica: revisión de nuestra serie y descripción de nuestra técnica de pieloplastia laparoscópica / Open versus laparoscopic pyeloplasty: review of our series and description of our laparoscopic pyeloplasty procedure

Introducción y objetivos: La pieloplastia ha sido desde siempre el tratamiento de elección en nuestro centro para la estenosis pieloureteral y, desde hace 4 años, hemos optado por el abordaje laparoscópico a la hora de llevar a cabo esta técnica. Queremos comparar el resultado de las pieloplastias abiertas (PA) y laparoscópicas (PL) llevadas a cabo en nuestro centro durante los últimos 8 años, así como describir nuestra técnica de PL. Material y métodos: Revisamos de forma retrospectiva las pieloplastias llevadas a cabo en nuestro centro entre junio de 2000 y junio de 2008, analizando en cada caso el motivo de consulta, la funcionalidad del riñón afectado, el tiempo quirúrgico, el sangrado intraoperatorio, la presencia de litiasis renal o de vaso polar, los días de estancia, las posibles complicaciones y el resultado obtenido. Resultados: Se han practicado un total de 30 pieloplastias, 15 PA y 15 PL (50%). El tiempo quirúrgico fue de media de 167,6 minutos para las PL (100-240) y de 106 min para las PA (75-180) (p < 0,0001). La estancia media en el caso de las PL fue de 6,6 días (4-16) frente a 9,1 días para las PA (5-26) (p > 0,05). El sangrado intraoperatorio fue desdeñable en todos los casos y no hubo complicaciones intraoperatorias, si bien 9 (30%) pacientes presentaron complicaciones postoperatorias: 5 de 15 PL (33,3%) y 4 de 15 PA (26,7%) (p > 0,05). La fístula urinaria fue la complicación más frecuente, presentándose en 3 de los 30 pacientes (10%).El éxito de la intervención se confirmó en los 15 pacientes intervenidos de PA (100%) y en14 de los 15 pacientes intervenidos de PL (93,3%) (p > 0,05).Conclusiones: Por su menor morbilidad y sus resultados equivalentes a la PA, la PL es hoy día la técnica de elección en nuestro centro a pesar de requerir de una cierta habilidad en el manejo de la laparoscopia y de un tiempo quirúrgico habitualmente más largo (AU)

Introduction and objectives: Pyeloplasty has always been the treatment of choice for ureteropelvic junction obstruction at our center, where a laparoscopic approach has been used in the last 4 years to perform this procedure. Results of open pyeloplasty (OP) and laparoscopic pyeloplasty (LP) performed at our center in the past 8 years are compared, and our laparoscopic procedure is described. Materials and methods: Pyeloplasties performed at our center from June 2000 to June 2008were retrospectively reviewed. Clinical presentation, involved kidney function, operating time, intraoperatory bleeding, presence of kidney stones or crossing vessels, length of hospital stay, possible complications, and results obtained were analyzed in each case. Results: Thirty pyeloplasties were performed, 15 OP and 15 LP (50%). Mean operating time was 167.6 minutes for LP (100-240) and 106 minutes for OP (75-180) (P<0.0001). Mean hospitalstay was 6.6 days (4-16) for LP and 9.1 days for OP (5-26) (P>.05). Intraoperative bleeding was negligible in all patients and no peroperative complications occurred. However, 9 patients (30%) experienced postoperative complications, 5 out of 15 LPs (33.3%) and 4 out of 15 Ops (26.7%) (P>0.05). Urinary fistula was the most common complication, occurring in 3 of the30 patients (10%).Procedure was successful in all 15 patients undergoing OP (100%) and in 14 of the 15patients undergoing LP (93.3%) (P>0.05). Conclusions: LP is currently the procedure of choice at our center because of its lower morbidity and similar results to OP, despite the need for a certain laparoscopic skill and ausually longer opertating time (AU)

[Implantation technique of the artificial urinary sphincter "FlowSecure" in the bulbar urethra]. / Técnica de implantación del esfínter urinario artificial "FlowSecure" en uretra bulbar.

BACKGROUND: Artificial urinary sphincter "FlowSecure" is a prosthesis designed for stress urinary incontinence that has achieved excellent results. Although implantation is easy, some urologist used to other prosthesis may find difficult the change to this new technique. This article shows how easily and quickly this new sphincter can be implanted and discuss the differences with the artificial sphincter AMS-800. METHODS: Following the case of a patient who was implanted artificial urinary sphincter "FlowSecure" in our center we describe with pictures the technique of implantation and give some advices to make this quicker and easier. RESULTS: Surgical time was 90 minutes. Patient presented uneventful recovery, urethral catheter was removed 24 hours after surgery and discharge was done 72 hours after surgery. Three months after implantation patient describes complete resolution of his stress urinary incontinence. CONCLUSIONS: Artificial urinary sphincter "FlowSecure" is easy and quick to implant, and as its use is extended we would compare if results are better than those of the AMS-800 model.

Técnica de implantación del esfínter urinario artificial FlowsecureTM en uretra bulbar / Implantation technique of the artificial urinary sphincter “flow secure™” in the bulbar urethra

OBJETIVO: El esfínter urinario FlowSecureTM es una prótesis para la incontinencia urinaria de esfuerzo que ha proporcionado unos excelentes resultados hasta el día de hoy. Si bien su colocación es sencilla, los urólogos acostumbrados a la colocación de otros tipos de prótesis pueden encontrar inconveniente el cambio a esta nueva técnica. Este artículo pretende demostrar que este nuevo esfínter se puede colocar de forma rápida y sencilla, así como discutir las diferencias respecto del modelo AMS-800TM.MÉTODOS: A raíz de un paciente al que se colocó el esfínter urinario FlowSecureTM en nuestro centro se describe mediante dibujos la técnica de colocación y se apuntan ciertos consejos prácticos que hacen más fácil y rápida su colocación.RESULTADO: El tiempo quirúrgico fue de 90 minutos. El paciente presentó un postoperatorio correcto, retirándose la sonda vesical a las 24 horas y siendo dado de alta a las 72 horas. A los 3 meses de la intervención el paciente refiere resolución completa de su incontinencia urinaria de esfuerzo.CONCLUSIONES: El esfínter urinario FlowSecureTM resulta una prótesis de colocación rápida y sencilla, y a medida que su utilización se vaya extendiendo podremos valorar si sus resultados a largo plazo son mejores que los del modelo AMS-800TM(AU)

OBJECTIVES: Artificial urinary sphincter “FlowSecureTM” is a prosthesis designed for stress urinary incontinence that has achieved excellent results. Although implantation is easy, some urologist used to other prosthesis may find difficult the change to this new technique. This article shows how easily and quickly this new sphincter can be implanted and discuss the differences with the artificial sphincter AMS-800TM.METHODS: Following the case of a patient who was implanted artificial urinary sphincter “FlowSecureTM” in our center we describe with pictures the technique of implantation and give some advices to make this quicker and easier RESULTS: Surgical time was 90 minutes. Patient presen-ted uneventful recovery, urethral catheter was removed 24 hours after surgery and discharge was done 72 hours after surgery. Three months after implantation patient describes complete resolution of his stress urinary incontinence.CONCLUSIONS: Artificial urinary sphincter “FlowSecu-reTM” is easy and quick to implant, and as its use is extended we would compare if results are better than those of the AMS-800TM model(AU)

[Laparoscopic radical cystectomy in clinically localized (T2) bladder tumors]. / Cistectomía radical laparoscópica en los tumores vesicales clínicamente localizados (T2).

OBJECTIVES: Laparoscopic radical cystectomy has been developed after the expansion of laparoscopic radical prostatectomy. This technique makes possible a minimally invasive approach to muscle-invasive bladder cancer with less blood loss and faster postoperative recovery. METHODS: From September 2004 to January 2007, 54 laparoscopic radical cystectomies were performed, 48 of them in stage T2, from which 43 (90%) were male and 5 (10%) female patients. Mean age was 64 years (27-881. Lymphadenectomy was carried out by laparoscopic approach in all cases, with a mean of 13 nodes obtained (4-24). Urinary diversion was done through the incision needed to extract the specimen in all cases but one that was completed completely intracorporeally; constructing a Bricker-type ureteroileostomy in 30 (62%) cases, orthotopic neobladder (Vesica Ileale Padovana) in 17 cases (35%), and cutaneous ureterostomy in 1 case (2%). RESULTS: Mean surgical time for the whole procedure was 287 minutes (180-480), 270 minutes for Bricker-type derivation cases and 316 minutes for neobladder cases. Blood transfusion rate was 25%. Mean ileal paralysis was 5 days (2-10) with a mean hospital stay of 13 days (6-34) for Bricker cases and 16 days (8-30) for neobladder cases. Oncological control, after a mean follow-up of 10,8 months (0,4-30), showed a cancer-specific survival of 90% with a mean survival time of 28 months (95% CI 26-30). Global mean survival was 79% with a mean survival of 26 months (95% CI 23-29). CONCLUSIONS: Laparoscopic radical cystectomy is a feasible technique that offers some advantages. It allows excision with less blood loss and an easier postoperative period. Randomized studies should demonstrate these advantages to confirm this approach as the technique of choice. Urinary diversion performed through the laparotomy incision, necessary to extract the specimen, optimizes derivation results and whole surgical time without reducing the beneficial effects of the laparoscopic exeresis.

[Laparoscopic radical prostatectomy. Review of our first year]. / Prostatectomía radical laparoscópica. Revisión del primer año.

OBJECTIVES: To present our series of laparoscopic radical prostatectomy, comparing to the published results up to date. METHODS: From november 2001 to november 2002, we have practiced 27 laparoscopic radical prostatectomies without lymphadenectomy. We have used the Montsouris technique with some modifications. All cases started by laparoscopy are included in the report. RESULTS: Laparoscopic approach was indicated in 27 patients; 17 cases were completed and 10 converted to open surgery. Among the last 17 consecutive cases only two were converted. Mean operative time was 296 minutes (190-480 minutes, MAY: SD 60). Global morbidity was 18.5%, without severe complications, reoperations or mortality. Transfusion rate was 11%. There was not any incontinent patient and three patients developed an anastomostic stenosis. 57% of previously potent patients have erections with a follow-up over six months. Positive surgical margins incidence is 33% overall and 17.6% in laparoscopic cases. Only one of the patients with a follow-up above six months has a biological (PSA) recurrence (7%). CONCLUSIONS: Laparoscopic radical prostatectomy is feasible, reproducible and within reach of interested urologists. It may substitute, once sufficient experience is acquired, conventional surgery.

Prostatectomía radical laparoscópica. Revisión del primer año / Laparoscopic radical prostatectomy. Review of our first year

OBJETIVOS: Presentar nuestra serie de prostatectomía radical laparoscópica, comparándola con los resultados publicados hasta el momento. MÉTODOS: Desde noviembre de 2001hasta noviembre de 2002 hemos realizado 27 prostatectomías radicales laparoscópicas sin linfadenectomía. La cirugía se ha practicado según la técnica de Montsouris con algunas modificaciones. Se han incluido todos los casos iniciados por vía laparoscópica. RESULTADOS: Se ha indicado el abordaje laparoscópico en 27 pacientes, habiendo completado 17 y reconvertido a cirugía abierta 10 casos. Entre los últimos 17 casos consecutivos sólo se han reconvertido dos. El tiempo quirúrgico medio ha sido de 296 minutos (190-480 minutos, ds 60). Han presentado una morbilidad global del 18,5 por ciento, sin complicaciones graves, reintervenciones o mortalidad. El índice de transfusión ha sido del 11 por ciento. No tenemos ningún caso de incontinencia urinaria y tres pacientes han presentado estenosis de la anastomosis. Un 57 por ciento de los pacientes previamente potentes con seguimiento superior a seis meses tienen erecciones. La incidencia de márgenes quirúrgicos positivos es del 33 por ciento globalmente y del 17,6 por ciento en las laparoscópicas. Sólo uno de los pacientes con un seguimiento superior a seis meses ha presentado una recidiva biológica (PSA) (7 por ciento). CONCLUSIONES: La técnica de la prostatectomía radical laparoscópica es factible, reproducible y al alcance de aquellos urólogos con interés. Puede sustituir, una vez adquirida la experiencia necesaria, a la cirugía convencional (AU)