Histological changes due to intravesical instillation of mitomycin C.

OBJECTIVE: Transurethral resection (TUR) is highly effective in the local control of superficial bladder cancer. However, the recurrence rate can reach 80% of the cases. Adjuvant intravesical chemotherapy may decrease significantly tumor recurrence. We describe a bladder adverse reaction to mitomycin C as adjuvant therapy for non-invasive bladder cancer METHODS: Three patients with diagnosis of pTa G1 urothelial carcinoma were treated by TUR plus an instillation of 40 mg. of mitomicin C. A month later, the patients were attended for dysuria and hematuria. Cystoscopy and bladder biopsy were performed in all cases. RESULTS: Multiple sessile lesions suspicious of tumor recurrence were found on cystoscopy. The histopathological diagnosis disclosed the existence of severe atypia of the urothelium and stromal changes similar to those observed after radiotherapy CONCLUSIONS: Adjuvant intravesical chemotherapy with mitomycin C may cause local reactions with macroscopic patterns similar to tumoral recurrences.

Cambios histológicos provocados por la instilación intravesical de mitomicina C / Histological changes due to intravesical instillation of Mitomycin C

OBJETIVO: La resección transuretral (RTU) es un tratamiento altamente eficiente en el control local del cáncer vesical superficial. Sin embargo, la tasa de recurrencia puede llegar al 80% de los casos. La quimioterapia intravesical adyuvante puede disminuir significativamente la recidiva tumoral. Este artículo describe una reacción adversa intravesical al uso de Mitomicina C como terapia adyuvante del cáncer vesical no invasor. MÉTODOS: Tres pacientes con el diagnóstico de un carcinoma de urotelio pTa G1, fueron tratados mediante RTU más una instilación vesical de 40 mg de Mitomicina C. Posteriormente, los pacientes consultaron por síndrome disúrico y hematuria. Se realizó una cistoscopía más biopsia vesical. RESULTADOS: Como hallazgo cistoscópico se encontraron múltiples lesiones sésiles cuyo informe biópsico descartó la presencia de tumor CONCLUSIÓN: La quimioterapia adyuvante intravesical con mitomicina C puede producir reacciones adversas endoluminales con patrones macroscópicos similares a los de una recidiva tumoral(AU)

OBJECTIVE: Transurethral resection (TUR) is highly effective in the local control of superficial bladder cancer. However, the recurrence rate can reach 80% of the cases. Adjuvant intravesical chemotherapy may decrease significantly tumor recurrence. We describe a bladder adverse reaction to mitomycin C as adjuvant therapy for non-invasive bladder cancer. METHODS: Three patients with diagnosis of pTa G1 urothelial carcinoma were treated by TUR plus an instillation of 40 mg. of mitomicin C. A month later, the patients were attended for dysuria and hematuria. Cystoscopy and bladder biopsy were performed in all cases.RESULTS: Multiple sessile lesions suspicious of tumor recurrence were found on cystoscopy. The histopathological diagnosis disclosed the existence of severe atypia of the urothelium and stromal changes similar to those observed after radiotherapy. CONCLUSIONS: Adjuvant intravesical chemotherapy with mitomycin C may cause local reactions with macroscopic patterns similar to tumoral recurrences(AU)

[Laparoscopic simple nephrectomy with transvaginal notes assistance and the use of standard laparoscopic instruments]. / Nefrectomía laparoscópica simple con asistencia de notes transvaginal y uso de instrumentos laparoscópicos estándar.

INTRODUCTION: Natural orifice transluminal endoscopic surgery (NOTES) is an emerging technique, which allows to performed surgical procedures avoiding any surgical scars. However there are some problems due to the lack of equipment available for these procedures. The aim of these study is to present our initial experience with the transvaginal nephrectomy NOTES using standard laparoscopic instruments. MATERIAL AND METHODS: Two female patients 23 and 29 years old, both of them with diagnosis of recurrent urinary tract infection and renal atrophy. A transvaginal simple nephrectomy was performed using a transvaginal Access for the camera port and two abdominal work ports of 10 and 3 mm. RESULTS: Total operation room time was 120 min in the first case and 40 min. in the second with an average blood loss of 200 cc. There were no perioperative complications, and both patients was discharged 36 hours after the surgery CONCLUSION: Laparoscopic nephrectomy with transvaginal NOTES assistance is technically feasible with the use of standard laparoscopic instruments. Special Access trocars and instruments development for this procedure will allow to perform a pure technique without the use of abdominal incisions.

[Transumbilical laparoscopic simple nephrectomy using a flexible cystoscope and standard laparoscopic instruments]. / Nefrectomía simple laparocópica transumbilical con el uso de cistoscopio flexible e instrumentos laparsocópicos estándar.

OBJECTIVES: We present our initial experience with transumbilical surgery in a simple nephrectomy performed with a flexible cystoscope and standard laparoscopic instruments. METHODS: A 15 year-old child, with severe left renal parenchyma atrophy, secondary to recurrent urinary tract infection (UTI) complicated with left pyelonephritis. Decision for simple nephrectomy was taken and we planned to perform a single port laparoscopic nephrectomy. In the lumbotomy position, two 5mm ports were insertend through a 3 cm umbilical incision. One trocar permitted the progression of the flexible cystoscope (Olympus) and the other the entrance of the PKS Plasma Trissector. The latter was then changed for a 10mm port to allow the entrance of the Weck clips. A Maryland grasper for countertraction was placed without port in the lef-upper quadrant and progressed directly into de peritoneal cavity under direct vision. RESULTS: The standard laparoscopic steps were duplicated uneventfully. Mean operative time was 90 minutes and mean blood loss was 200 mL. Hospital stay was 18 hours. No transfusion was needed. CONCLUSION: Single port urologic surgery will expand in the future. There is lack of commercial availability of the ideal hardware needed for the procedures. Versatility of urologic instruments allow for its use in different settings.

Nefrectomía laparoscópica simple con asistencia de notes transvaginal y uso de instrumentos laparoscópicos estándar / Laparoscopic simple nephrectomy with transvaginal notes assistance and the use of standard laparoscopic instruments

Introducción: La cirugía endoscópica transluminal a través de orificios naturales (NOTES™) es una tecnología emergente, que permite realizar procedimientos quirúrgicos sin el uso de incisiones abdominales. Sin embargo existen limitaciones respecto al equipamiento disponible para simular la cirugía tradicional. Nuestro objetivo es presentar nuestra experiencia con la técnica de nefrectomía transvaginal NOTES con el uso de instrumentos laparoscópicos estándar. Materiales y Métodos: Presentamos dos pacientes de sexo femenino de 23 y 26 años, ambas con diagnóstico de infecciones urinarias recurrentes y atrofia renal secundaria. Se les realizó una nefrectomía simple con asistencia de NOTES, utilizando un puerto de trabajo transvaginal para la cámara y dos puertos adicionales de 10 (umbilical) y 3 mm en el abdomen. Resultados: El procedimiento total duró 120 min en el primer caso y 40 minutos en el segundo, con una pérdida sanguínea promedio de 200 cc. (0-200). No se reportan complicaciones, siendo ambas pacientes dadas de alta 36 horas después de su cirugía. Conclusión: La nefrectomía laparoscópica con asistencia de NOTES transvaginal es técnicamente posible con el uso de instrumentos laparoscópicos estándar. El desarrollo y acceso a trócares y pinzas especiales para la técnica NOTES™, permitirá realizar una técnica pura sin el uso de incisiones abdominales (AU)

Introduction: Natural orifice transluminal endoscopic surgery (NOTES) is an emerging technique, which allows to performed surgical procedures avoiding any surgical scars. However there are some problems due to the lack of equipment available for these procedures. The aim of these study is to present our initial experience with the transvaginal nephrectomy NOTES using standard laparoscopic instruments. Material and Methods: Two female patients 23 and 29 years old, both of them with diagnosis of recurrent urinary tractinfection and renal atrophy. A transvaginal simple nephrectomy was performed using a transvaginal. Access for the cameraport and two abdominal work ports of 10 and 3mm.Results: Total operation room time was 120 min in the first case and 40 min. in the second. With an average blood loss of 200 cc. There were no perioperative complications, and both patients was discharged 36 hours after the surgery. Conclusion: Laparoscopic nephrectomy with transvaginal NOTES assistance is technically feasible with the use of standard laparoscopic instruments. Special Access trocars and instruments development for this procedure will allow to performa pure technique without the use of abdominal incisions (AU)

[Urologic Notes: where are we and where we are going]. / Cirugía endoscópica transluminal por orificios naturales en Urologia: Dónde estamos y hacia dónde vamos.

BACKGROUND: The natural orifice translumenal endoscopic Surgery (NOTES) approach has been successfully reported by several surgical teams in different specialties. Urologic teams have recently presented several experimental and clinical experiences with the technique. Our aim is to review the initial experience with NOTES in minimal access urological surgery.

Nefrectomía simple laparoscópica transumbilical con el uso de cistoscopio flexible e instrumentos laparoscópicos estándar / Transumbilical laparoscopic simple nephrectomy using a flexible cystoscope and standard laparoscopic instruments

Objetivo: Presentar nuestra experiencia inicial con la cirugía transumbilical en una nefrectomía simple realizada con un cistoscopio flexible e instrumentos laparoscópicos estándar.MÉTODOS: Paciente de 15 años de edad, con diagnóstico de atrofia renal izquierda, secundaria a infección urinaria recurrente. Se decidió una nefrectomía simple y se planeó realizarla por vía laparoscópica a través de un puerto único. En posición de lumbotomía y a través de una incisión transumbilical de 3 cm., dos puertos de 5mm fueron colocados en el ombligo. Un trócar permite la progresión del cistoscopio flexible (Olympus ®) y el otro la entrada del disector bipolar Este último fue cambiado por un puerto de 10 mm para permitir la entrada de los clips de Weck. Se introdujo un grasper Maryland en el cuadrante superior izquierdo, sin puerto, para la contra tracción, el cual fue avanzado directamente en la cavidad peritoneal bajo visión directa.RESULTADO: Los pasos estándar de la cirugía laparoscópica se replicaron sin inconvenientes. El tiempo quirúrgico fue de 90 minutos y la pérdida sanguínea de 200 ml. La estadía hospitalaria fue de 18 horas. No se necesitó transfusión.CONCLUSIONES: La cirugía urológica de puerto único se ampliará en el futuro. Hay una falta de disponibilidad comercial de los insumos ideales para el desarrollo de esta cirugía. La versatilidad de los instrumentos urológicos permitirá su uso en diferentes contextos(AU)

Summary.- OBJECTIVES:We present our initial expe-rience with transumbilical surgery in a simple nephrec-tomy performed with a flexible cystoscope and standard laparoscopic instruments.METHODS: A 15 year-old child, with severe left renal parenchyma atrophy, secondary to recurrent urinary tract infection (UTI) complicated with left pyelonephritis. Decision for simple nephrectomy was taken and we planned to perform a single port laparoscopic nephrectomy. In the lumbotomy position, two 5mm ports were insertend through a 3 cm umbilical incision. One trocar permitted the progression of the flexible cystoscope (Olympus®) and the other the entrance of the PKS Plasma Trissecdificultator®. The latter was then changed for a 10mm port to allow the entrance of the Weck clips. A Maryland grasper for countertraction was placed without port in the left-upper quadrant and progressed directly into de peritoneal cavity under direct vision.RESULTS: The standard laparoscopic steps were dupli-cated uneventfully. Mean operative time was 90 minutes and mean blood loss was 200 mL. Hospital stay was 18 hours. No transfusion was needed.CONCLUSION: Single port urologic surgery will ex-pand in the future. There is lack of commercial availa-bility of the ideal hardware needed for the procedures. Versatility of urologic instruments allow for its use in di-fferent settings(AU)

Cirugía endoscópica transluminal por orificios naturales en urologia: Dónde estamos y hacia donde vamos / Urologic Notes: Where are we and where are we going?

La cirugía endoscópica por orificios naturales ha sido reportada con éxito por numerosos grupos en distintas especialidades. Recientemente, grupos urológicos han reportado experiencias clínicas y experimentales con este abordaje. Nuestro objetivo es revisar la experiencia inicial con la cirugía endoscópica por orificios naturales, como parte de la cirugía mínimamente invasiva(AU)

The natural orifice translumenal endoscopic Surgery (NOTES) approach has been successfully reported by several surgical teams in different specialties. Urologic teams have recently presented several experimental and clinical experiences with the technique. Our aim is to review the initial experience with NOTES in minimal access urological surgery(AU)

[Robotically assisted urologic endoscopic surgery]. / Cirugía endoscópica urológica asistida por robot.

OBJECTIVES: Comprehensive evaluation of surgical procedures remains the cornerstone of quality control. Robotic surgery has become a popular surgical option in urology. We review the English medical literature on urological robot-assisted endoscopic surgery (URAES) in order to assess the trends of medical publications regarding this subject. METHODS: All Studies addressing URAES were included. Information for this review was obtained by Pub Med searches from 2003 to 2008. Keywords used in our search included: "robotic urologic surgery", "robotic assisted urological surgery". Only articles published in English were included in this review. RESULTS: We identified 383 studies. 366 articles corresponded to clinical series of different topics regarding robotics in urology; 13 articles presented comparisons of robotic surgery versus either pure laparoscopic or open surgery in urological procedures such as radical cistectomy (1), radical prostatectomy (10) and pyeloplasty (2). Four studies corresponded to randomized control trials, addressing robotic telerounding (2), kidney percutaneous access (1) and camera holding devices for endoscopic surgery (1). CONCLUSIONS: URAES is an emerging surgical option for urological operations like radical prostatectomy, pyeloplasty and radical cystectomy. There is lack of high-level evidence information to support the idea of robotic surgery as the upcoming surgical gold standard in urology. Surgical evolution will favour the potential benefits of robotic technology, but there is need for design and performance of prospective randomized trials in robotic urologic surgery in order to consolidate the application of this novel technology.

Cirugía endoscópica urológica asistida por robot / Robotically assited urologic endoscopic surgery

Objetivo: La evaluación comprensiva de los procedimientos quirúrgicos sigue siendo la piedra angular del control de calidad. La Cirugía Robótica se ha convertido en una popular opción quirúrgica en urología. Realizamos una revisión de la literatura médica en Inglés de Cirugía urológica endoscópica robóticamente asistida (CUERA) con el fin de evaluar las tendencias de las publicaciones médicas en relación con este tema. Métodos: La información para este estudio se obtuvo mediante búsquedas en PubMed desde el 2003 al 2008. Las palabras claves utilizadas en la búsqueda incluyeron: «cirugía urológica robótica», «cirugía endoscópica asistida por robot». Sólo artículos publicados en inglés fueron incluidos en esta revisión. Resultados: Se identificaron 383 estudios. De estos, 366 correspondían a series de artículos clínicos de diferentes temas relacionados con la robótica en urología; 13 artículos presentados realizaron comparaciones de cirugía ya sea robótica, laparoscópica o abierta en procedimientos como la cistectomía radical (CR) (1), prostatectomía radical (PR) (10) y pieloplastia (P) (2). Cuatro estudios correspondieron a pruebas de control randomizadas y abordaron telerounding (T) (2), acceso renal percutáneo (ARP) (1) y el sostén robótico de la cámara en cirugía endoscópica (SRC) (1). Conclusiones: CUERA es una nueva opción quirúrgica urológica para cirugías como la prostatectomía radical, pieloplastia y cistectomía radical. Hay información con bajo nivel de evidencia que apoye la idea de la cirugía robótica como el próximo estándar de oro quirúrgico en urología. Existe una evolución quirúrgica en favor de los posibles beneficios de la tecnología robótica, pero hay necesidad de realizar estudios prospectivos controlados y randomizados en cirugía robótica urológica con el fin de consolidar la aplicación de esta novedosa tecnología (AU)

Objectives: Comprehensive evaluation of surgical procedures remains the cornerstone of quality control. Robotic surgery has become a popular surgical option in urology. We review the English medical literature on urological robot-assisted endoscopic surgery (URAES) in order to assess the trends of medical publications regarding this subject. Methods: All Studies addressing URAES were included. Information for this review was obtained by Pub Med searches from 2003 to 2008. Keywords used in our search included: «robotic urologic surgery», «robotic assisted urological surgery». Only articles published in English were included in this review. Results: We identified 383 studies. 366 articles corresponded to clinical series of different topics regarding robotics in urology; 13 articles presented comparisons of robotic surgery versus either pure laparoscopic or open surgery in urological procedures such as radical cistectomy (1), radical prostatectomy (10) and pyeloplasty (2). Four studies corresponded to randomized control trials, addressing robotic telerounding (2), kidney percutaneous access (1) and camera holding devices for endoscopic surgery (1). Conclusions: URAES is an emerging surgical option for urological operations like radical prostatectomy, pyeloplasty and radical cystectomy. There is lack of high-level evidence information to support the idea of robotic surgery as the upcoming surgical gold standard in urology. Surgical evolution will favour the potential benefits of robotic technology, but there is need for design and performance of prospective randomized trials in robotic urologic surgery in order to consolidate the application of this novel technology (AU)