Robotic Management of Complex Vesicourethral Anastomosis Stenosis With Transperineal Urethral Advancement: A Step-by-Step Technique.

BACKGROUND: Vesicourethral anastomosis stenosis (VUAS) refers to the diameter narrowing of a vesicourethral anastomosis (VUA). It is a known complication after radical prostatectomy that nowadays presents in less than 1% of these cases. When the lumen narrows sufficiently to impede urine flow, obstructive symptoms arise. While the incidence of VUAS used to be notably higher prior to the widespread use of the robotic approach, traditional procedures still fail in up to 42% of cases. Initial management typically involves endoscopic procedures, such as dilation, incision, or resection. If these approaches prove ineffective, VUA reconstruction is warranted. Following the resection of the unhealthy urethra, a potential drawback is the insufficient length of the healthy proximal urethral to reach the bladder without tension. In such cases, urinary diversion with an ileal conduit is an option. However, when the patient prefers to maintain an orthotopic urinary tract configuration, there is limited guidance in the literature regarding surgical techniques. OBJECTIVE: To outline the indications, describe the step-by-step technique, and evaluate the outcomes of transperineal urethral advancement to facilitate a tension-free VUA. MATERIALS: We first discuss the indications to identify which patients are candidates for this procedure. Then, a step-by-step description of the robotic VUA revision assisted by transperineal urethral mobilization is presented. Detailed steps and helpful hints are included. Finally, we outline the postoperative pathway and expected outcomes. RESULTS: This technique allows patients with VUAS to preserve the orthotopic configuration of the urinary tract when a tension-free anastomosis proves challenging. Although urinary incontinence is expected, an artificial urinary sphincter could be placed in the following months. CONCLUSION: The robotic management of complex vesicourethral anastomosis stenosis with transperineal urethral advancement is a feasible and safe procedure that requires the interdisciplinary management of robotic and reconstructive urologists.

Robotic-assisted Simple Prostatectomy: An Intrafascial Approach for a Prostate of 470 g.

BACKGROUND: Simple prostatectomy has been established as a management option for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with glands larger than 80 cc.1 Robotic-assisted simple prostatectomy (RASP) has been established as a safe and effective management option. This has been reported in multiple studies comparing it with the open approach where no statistically significant differences in complication rates have been found.2 The intrafascial approach is intended to add multiple benefits, such as not requiring continuous bladder irrigation and resection of a larger percentage of the adenoma, potentially leading to a lower reoperation rate and diagnosis of prostate cancer in patients in which this was missed preoperatively.3 OBJECTIVE: To present the resection of a very large prostate can lead to significant intraoperative challenges. Therefore, we demosntrate our intrafascial robotic management of a 470g prostate. MATERIALS AND METHODS: A 56-year-old with LUTS (IPSS: 34) for over 6 years, complicated with multiple episodes of urinary retention. PSA: 20.6 ng/mL. MRI reported a 463 cc prostate volume without focal lesions. First, the retropubic space was developed. Cystotomy was performed at the anterior bladder neck. A plane between the prostatic capsule and the surrounding fascia was dissected while carefully preserving the neurovascular bundles. Due to its large size, the prostate was divided into segments to facilitate its extraction. Hemostatic control and vesicourethral anastomosis were performed. RESULTS: Discharged on postoperative day 1 with a Jackson-Pratt drain and Foley catheter removed on days 6 and 9, respectively. Pathology was negative for malignancy. Patient-reported improvement of LUTS (IPSS: 3) and preservation of erectile function (SHIM: 23) at the 3-month follow-up. CONCLUSION: The intrafascial technique can be useful in cases where a large-sized prostate hinders a transvesical approach. Additionally, it allows for an easier piecemeal of the gland. A larger series is needed to determine its potential benefits.

La relación entre los procesos de lecto-escritura y la música desde la perspectiva neurocognitiva / The relationship between reading and writing and music processes from neurocognitive perspective

La relación entre la música y el lenguaje ha sido ampliamente estudiada desde diversas perspectivas y en general se atribuyen a la música efectos sobre los procesos cognitivos, aunque no queda claro el porqué de dichos efectos, encontrando relaciones específicas con otros aspectos como la prosodia, la memoria, la percepción tonal, a lo cual se agrega que ambos procesos comparten características fonético-fonológicas y visuales que se encuentran alojados en estructuras cerebrales compartidas. El presente artículo es un estudio documental, a partir de estudios neurocientíficos, evolutivos y psicológicos que tiene como objetivo analizar las relaciones neuro-anatómicas, fonológicas y visuales del procesamiento del lenguaje que intervienen en la música, buscando conocer si existen vías compartidas, producto del proceso evolutivo que expliquen el desarrollo del proceso de la lecto-escritura, y su relación con características musicales y con ello reconocer los efectos cognitivos de la música sobre los procesos lingüísticos con una base neurocognitiva. Para ello se analiza en primer lugar la relación entre la música y el lenguaje como antecedente acústico a la representación visual del lenguaje. La conclusión es que el procesamiento acústico del ambiente dio paso tanto al lenguaje como a la música, generando estructuras complejas, pero debido a la necesidad de representación gráfica y con fines prácticos, se desarrollaron alfabetos distintos, aunque bajo los mismos principios, lo cual permite comprender el porqué las vías neuronales se comparten tanto en los procesos lingüísticos como en la música, por lo que se encuentran relaciones estrechas en su desarrollo a nivel cerebral...

The relationship between music and language has been extensively studied from different perspectives, and generally have been attributed effects of music on cognitive processes, although it is unclear why these effects are produced, more than finding specific relations with other aspects such as prosody, memory, tonal perception, which is added that both processes share phonetic- phonological and visual features that are hosted on brain structures. This article is a documentary study from neuroscientists, evolutionary and psychological studies, to analyse the neuro - anatomical and visual - phonological processing relationships with the music shared with language, seeking to know if there are common pathways, product of the evolutionary practice of reading and writing, and their relationship to musical characteristics which can allow to recognize cognitive effects of music on language processes with neurocognitive basis to recognize a clear relationship between music and language as acoustic background to the visual representation of language. The conclusion is that acoustic environmental processing ushered in both language and music, creating complex structures due to the need for graphical representation for practical purposes, human beings developed different alphabets, but under the same principles that allow us to understand why the neural pathways are shared both linguistic processes like music, are close relationships in their development in the brain...