Laparoscopic pelvic lymphadenectomy for prostatic cancer.

Development of laparoscopic techniques has converted lymphadenectomy into a real alternative to current laparotomy technique. The limitation of diagnostic imaging methods to know ganglion involvement in prostate cancer as well the high incidence of false negatives in frozen intrasurgical biopsies following open-surgery lymphadenectomy has pushed us since november of 1990 to develop laparoscopic lymphadenectomy with staging. This study analyses the diverse diagnostic imaging methods and continues with a precise description of the laparoscopic technique. The authors summarize the results of our series and finish the article with a review of the most controversial aspects as well as the diagnostic value, advantages and disadvantages with respect to open surgery techniques, complications and indications of this technique at the present moment.

[Current indications for laparoscopic surgery in urology]. / Indicaciones actuales de cirugía laparoscópica en urología.

More than four years have elapsed since the first laparoscopic pelvian lymphadenectomy for the staging of prostate cancer was performed. The early impact of the procedure involved the broadening and gradual application of laparoscopy to the group of organs and diseases of our specialty, mainly with therapeutical purposes. Urologists are able to reproduce nowadays many of the traditional surgical procedures through these methods. The present paper tries to conduct an update of the different techniques applied up to now on the different structures (genitalia, prostate, bladder, ureter, kidney, adrenals, pelvian nodes and other) and to analyze objectively some specific indications based on the experience gathered by several authors and our own.

[Laparoscopic surgery instrumentation]. / Instrumental en cirugía laparoscópica.

Today the urologist can perform many of the conventional surgical procedures by laparoscopic methods, which could not have been developed and improved without technological support. Industry has continued to provide solutions to each new requirement of laparoscopic surgery through more ergonomic materials and instruments. The different equipment and instruments for performing laparoscopic procedures are analyzed and described in the present article.

[Laparoscopic lymphadenectomy]. / Linfadenectomía laparoscópica.

The limitations of the diagnostic imaging methods in determining lymph node involvement in pelvic tumors (prostatic cancer) and the high incidence of false negatives in the intraoperative frozen biopsies done during open lymphadenectomy have prompted us to develop laparoscopic staging lymphadenectomy since November, 1990. The different imaging and invasive diagnostic methods are briefly analyzed in the present article. The laparoscopic lymphadenectomy procedure is described in detail and a summary of our series is presented.

[Laparoscopic nephrectomy: a case report]. / Nefrectomía laparoscópica: caso report.

Presentation and clinical picture outline of a patient who underwent transperitoneal laparoscopy-assisted nephrectomy. The procedure lasted 4 hours and the patient was discharged 72 hours later without incidence or complications. The paper describes the technique (presently unique and for selective indications), as well as the resources that the extensive laparoscopic experience of our group put into practice to perform the first successful laparoscopic nephrectomy in humans in our country.

[Laparoscopic ureterolithectomy. A new option]. / Ureterolitectomía laparoscópica. Un nuevo recurso.

An integral conception of patients with various diseases can benefit from the contemporary technological developments which allow to differentiated non-invasive approaches as diagnostic and therapeutical resources. This kind of patient has allowed further development of laparoscopic surgery in urology derived from the addition of reported conditions: obstructive prostate carcinoma, juxta-vesical gross lithiasis imbedded for 2 years, complexity of ureteroscopic access, large volume for extracorporeal lithotripsy and the need to know the extend of nodular affectation.

[Trigono-cervico-prostatic incision]. / Incisión trígono-cérvico-prostática.

Trigone-cervico-prostatic incision is a surgical alternative in the treatment of urinary obstruction induced by small size prostate. Twenty-three patients were treated in our unit with this procedure, 17 because they were carriers of small size prostate and 6 because they were high risk surgical patients in which the simplicity and swiftness of this technique were essential. Good results have been obtained both clinical and in urological flow in 95.7% cases. The only complication was one stenosis of the urethra requiring internal urethrotomy but there were no cases of vesical cervix contracture or urinary incontinence. Average follow-up was 12.5 months. It is concluded that this is a valid, low morbidity alternative that can be offered to patients with small sized and symptomatic prostate.

[Laparoscopic lymphadenectomy for lymphatic staging in prostatic cancer: preliminary experience]. / Linfadenectomía laparoscópica para estadiaje ganglionar en cáncer prostático: experiencia inicial.

The current diagnostic methods, primarily transrectal ultrasound scanning (supported with ultrasound-directed biopsy), CAT and tumoral markers, allow an earlier and more reliable diagnosis of prostatic neoplasias. The chances of diagnosing these tumours while in low stages (A, B, and C without affecting the seminal vesicle) imply a higher indication for radical surgery (prostatectomy) with an intention to cure. However, the prognosis and therefore the indication will be determined by the presence of regional nodular affectation. Imaging diagnostic methods (lymphography, CAR, NMR) have been proven incapable of providing an acceptable degree of diagnostic safety, therefore staging lymphadenectomy continues to be mandatory. Laparoscopic lymphadenectomy allows to meet requirements of surgical radicality comparable to those of traditional open surgery while showing an irrefutable decrease of morbidity and being more convenient for the patient. Our early experience with this surgical technique of staging in prostatic neoplastic pathology is illustrated.

[Open adenomectomy: review of 223 cases]. / Adenomectomía abierta: revisión de 223 casos.

A retrospective study was undertaken to determine the results achieved in 223 patients with prostatic hypertrophy who underwent open surgery during a period spanning 5 years. Good results were achieved in 88.34% of the cases, the mortality rate was 0.44%, and the post-operative morbidity rate was 31.3%. Urinary infection was the most common complication during this period (21.01%). Late post-operatively, we observed the following low incidence of urethral stenosis and lodge sclerosis, 1.79% and 2.24%, respectively. Six patients (2.69%) were permanently incontinent and one required surgery for recurrent obstruction of prostatic origin.

[Transureteral resection of the prostate. Review of 20 consecutive operations (5 yr)]. / RTU de próstata. Revisión de 210 intervenciones consecutivas (cinco años).

In the present study we reviewed our results in the treatment of prostatic obstruction of adenomatous origin over a period of 5 years and with a follow-up of 1 to 6 years. Of the 210 patients considered evaluable, good results were achieved in 84.28%, with mortality and morbidity rates of 0.45% and 22.82%, respectively. Infections were the most commonly observed complications in the early post-operative period. Urethral stenosis, the most common cause for reoperation, was observed in 9.04% in the late post-operative period.

[Retroperitoneal fibrosis caused by extensive perirenal hematoma]. / Fibrosis retroperitoneal por hematoma perirrenal extenso.

We report a case of direct renal trauma with formation of subcapsular hematoma in an anticoagulated patient. After an initial conservative approach, patient condition spontaneously evolved to subcapsular rupture resulting in perirenal spread of the hematoma enveloping the ureter up to the sacral level thus causing severe hydronephrosis. Surgical exploration permitted ureterolysis and postoperative radiologic work up revealed patency. We briefly discuss the current controversy relative to the different therapeutic approaches.

[Systemic candidiasis and ureteral fungus ball. Ketoconazole and irrigating solutions in the management of urinary candidiasis]. / Candidiasis sistémica y fungus ball ureteral. Ketoconazol y soluciones irrigantes en el manejo de la candidiasis urinaria.

A case of systemic candidiasis is presented in a patient with one kidney in the post-operative period from a cysto-prostatouretrectomy with Bricker ureteroileal derivation, performed due to multifocal superficial vesical tumour non controllable by endoscopy. The clinical picture developed with anuria and temporary diuresis periods associated to a severe septic picture; a deep Candida albicans infection was demonstrated by laboratory tests and a fungus ball ureteral obstruction was demonstrated by radiology. Urinary derivation by means of percutaneous nephrostomy, associated with oral treatment with ketoconazole and local treatment with amphotericin B solution intermittently irrigated through the nephrostomy allowed the patient's resuperation and the fungus ball was spontaneously ejected after 30 days of treatment. The different forms of presentation of urinary candidiasis are discussed together with the diagnostic methods and present therapeutical options, with special reference to the imidazole derivative ketoconazole and irrigation solutions.