[Multilocular cystic nephroma. Report of three new cases]. / Nefroma quístico multilocular. Aportación de 3 nuevos casos.

OBJECTIVE: To analyze the presentation of multilocular cystic nephroma and its diagnostic-therapy scheme. METHODS: We report the three last new cases presenting in our department in a period of three years. RESULTS: Multilocular cystic nephroma is a benign lesion, rare that appears both in adult age, generally asymptomatic, and in children, frequently as a palpable mass. Differential diagnosis with malignant tumours is required. CONCLUSIONS: The great variety of clinical presentations, differential diagnosis and places of origin of the cases is demonstrated, being this a reflection of our daily medical practice, in which we cannot reach definitive diagnosis with imaging tests, being the Bosniak's classification very useful for the setting of indication for surgery, which will give definitive diagnosis of multilocular cystic nephroma or what is more important will rule out malignancy.

Nefroma quístico multilocular aportación de 3 nuevos casos / Multilocular cystic nephroma. Report or three new cases

OBJETIVO: Analizar la forma con la cual se nos presenta el nefroma quístico multilocular y el enfoque diagnóstico- terapéutico que debemos realizar.MÉTODOS: Aportamos los 3 últimos nuevos casos que se nos han presentado en nuestro servicio en un periodo de 3 años.RESULTADO: El nefroma quístico multilocular es una lesión benigna, poco frecuente apareciendo en edad adulta, habitualmente de forma asintomática, y en edad infantil frecuentemente como masa palpable. Requiere realizar diagnostico diferencial con tumoraciones malignas.CONCLUSIONES: Se demuestra la gran variedad de presentaciones clínicas, diagnósticos diferenciales y lugares de procedencia de los casos, siendo esto un reflejo de nuestra practica médica diaria sin poder llegar al diagnostico definitivo mediante pruebas de imagen, siendo muy útil la aplicación de la clasificación de Bosniak para indicar la intervención quirúrgica que nos dará el diagnostico definitivo de nefroma quístico multilocular o lo que es más importante, nos descartará proceso maligno(AU)

OBJECTIVE: To analyze the presentation of multilocular cystic nephroma and its diagnostic-therapy scheme.METHODS: We report the three last new cases presenting in our department in a period of three years.RESULTS: Multilocular cystic nephroma is a benign lesion, rare that appears both in adult age, generally asymptomatic, and in children, frequently as a palpable mass. Differential diagnosis with malignant tumours is required.CONCLUSIONS: The great variety of clinical presentations, differential diagnosis and places of origin of the cases is demonstrated, being this a reflection of our daily medical practice, in which we cannot reach definitive diagnosis with imaging tests, being the Bosniak’s classification very useful for the setting of indication for surgery, which will give definitive diagnosis of multilocular cystic nephroma or what is more important will rule out malignancy(AU)

Aplicación del láser en la nefrolitotomía percutánea / The use of laser for percutaneous nephrolithotomy

Objetivo: El índice no despreciable de cálculos residuales tras la litotricia extracorpórea está haciendo replantear las indicaciones de la nefrolitotomía percutánea (NLP). El láser, de la mano de los nefroscopios flexibles, juega un gran papel en este terreno. Los láseres de Nd-YÁG pulsado, el de colorante y el de Álexandrita han dado paso al láser de holmium YÁG en el tratamiento endourológico de la litiasis urinaria. Métodos: En las nefrolitotomías percutáneas de cálculos de gran volumen suele requerirse de más de un tipo de litotritor, y geralmente se prefieren por su alto rendimiento los litotritores balísticos o electrokinéticos. El láser de holmium encuentra sus mejores indicaciones en el tratamiento de los cálculos caliciales alejados de la pelvis y sólo accesibles a través de un nefroscopio flexible. También son buenas indicaciones para el mismo las «midi y mini percs», la litiasis renal en la infancia y algunos cálculos terrosos, de poca consistencia. Según las características anatómicas del riñón y de localización, número, tamaño y dureza del cálculo pueden utilizarse fibras de 200, 365 ó 500 mm. Debido a que el láser horada al cálculo como si se tratara de una barrena térmica, éste puede romperse de varias maneras: aplicando la fibra de cuarzo entre sus capas, horadando todo su interior antes de fragmentar su superficie o taladrarlo en múltiples puntos para debilitarlo y crear amplias líneas de fractura. Para acelerar la rotura puede optarse por utilizar fibras más gruesas o por modificar la programación de datos del equipo incrementando su potencia, si bien esto conlleva un potencial riesgo para el riñón. Resultados: El teórico 100% de buenos resultados se ve reducido por la interferencia de múltiples factores técnicos y anatómicos: tamaño, número, situación y dureza del cálculo, así como por las posibilidades de alcanzar a ver el cálculo y poder confrontar el extremo de la fibra contra el mismo. Conclusiones: Aunque el láser de holmium presta un magnífico papel a la hora de evitar o reducir el número de cálculos residuales, en ocasiones su eficacia se ve superada por la de la litotricia electrohidráulica (AU)

Objectives: The non negligible number of residual stones after extracorporeal lithotripsy is leading to a revision of the indications of percutaneous nephrolithotomy (PCNL). The laser, managed with flexible nephroscopes, plays an important role in this field. Pulsed Nd: YAG, dye and alexandrite lasers have given way to the holmium:yag laser in the endourological treatment of urinary lithiasis. Methods: More than one lithotripter are often required for percutaneous nephrolithotomy of great volume stones, and ballistic and electrokinetic lithotripters are generally preferred due to their high performance. The best indications for Holmium laser is the treatment of caliceal stones far from the pelvis, only accessible through flexible nephroscopes. Midi and minipercs, renal lithiasis in children and some earthy calculi, of low consistency, are also good indications for it. Depending on the anatomical characteristics of the kidney and localization, number, size and hardness of the stone 200,365, or 500 nanometer fibers may be employed. Due to the fact that the laser drills a hole in the stone like if it is a thermal barrier, it may break in different ways: applying the quartz fiber in between the layers, drilling all the interior before breaking the surface, or drilling multiple points to weaken it and creating broad fracture lines. To accelerate the breaking process one can choose to use larger fibers or to modify the settings of the equipment increasing the potency, although this has some potential risk for the kidney. Results: The theoretical 100% of good results is reduced due to multiple technical and anatomical factors: size, number, localization, and hardness of the stone, as well as the possibility of reaching and seeing the calculus and being able to place the tip of the fiber against it. Conclusions: Although the holmium laser develops an excellent role at the time of avoiding leaving residual calculi or diminishing the number of them, sometimes the electrohydraulic lithotripsy is more effective (AU)

Cirugía mínimamente invasiva en urología pediátrica dentro de un servicio de urología general / Minimally invasive surgery in pediatric patients within a general urology department

Objetivo: Los avances en cirugía minimamente invasiva en urología en los últimos años han permitido la paulatina y constante introducción de la endourología y laparoscopia en pacientes pediátricos. Realizamos una revisión de nuestra experiencia, como hospital general, de la cirugía minimamente invasiva realizada en los últimos 10 años en pacientes pediátricos. Métodos: Se analizan retrospectivamente las intervenciones en el ámbito de la endourología y laparoscopia realizadas durante el periodo entre 1997 y 2007 en niños de hasta 16 años, recogiendo datos sobre la edad y sexo de los pacientes, tipo de patologías, técnicas empleadas, anestesia realizada e incidencias perioperatorias. Resultados: Se realizaron 72 intervenciones quirúrgicas en pacientes con un rango de edad entre 28 días y 16 años y una media de 6,8 años. El 56% son varones y el 44% niñas. 28 intervenciones por Reflujo Vesico Renal (RVRj (38,8º%), 17 intervenciones por patología litiásica (23,6%) de las cuales 4 fueron cistolitotricias, 9 uretero-rrenolitotricia, 1 nefrolitectomía percutánea (NLP) pura y 3 mixtas. 9 intervenciones sobre ureteroceles (12,5%), 7 por obstrucciones uretrales (9,7%), 3 criptorquidias diagnósticas laparoscópicas (4,1 %), 2 intervenciones mediante laparoscopia por patología quistita (2,7%) y otras 2 laparoscopias para realización de biopsia renal (2,7%) y un síndrome de la unión pieloureteral intervenido mediante laparoscopia. Un caso de nefrostomía percutánea en decúbito supino de urgencia tras pieloplastia abierta con posterior intervención mediante resección percutáneo de granuloma. Un caso de inyección de toxina botulínica en detrusor. Conclusiones: La consolidación en nuestro servicio de la endourología, y mas recientemente la laparoscopia infantil, contribuyendo a mejorar la calidad asistencial en el paciente pediátrico lográndose gracias a un conocimiento previo en técnicas endourológicas generales y de unos medios técnicos y humanos adecuados (AU)

Objectives: The advances of minimally invasive surgery in urology over the last years have enabled a progressive and constant implementation of endourology and laparoscopy in pediatric patients. We perform a review of our experience, as a general hospital, with minimally invasive surgery performed in pediatric patients over the last ten years. Methods: We retrospectively analyzed the endourological and laparoscopic operations performed between 1997 and 2007 in children up to the age of 16 years, collecting data about patient's age and gender, type of disease, techniques, anesthesia, and perioperative events. Results: seventy-two surgical operations were performed in patients with an age range between 28 days and 16 years, with a mean age of 6.8 years. 56% of the patients were boys and 44% girls. Indications for surgery was vesicoureteral reflux (VUR) in 28 cases (38.8%); lithiasis 17 cases (23.6%) which were distributed in 4 cystolithotripsies, 9 ureterorenoscopy with lithotripsy, one pure percutaneous nephrolithotomy and three mixed; ureterocele 9 cases (12.5%); urethral obstruction 7 cases (9.7%); 3 diagnostic laparoscopies for cryptorchidism (4.1%), 2 laparoscopic procedures for cystic pathology (2.7%), another 2 laparoscopic renal biopsies (2.7%), and one laparoscopic repair of a ureteropyelic junction syndrome; 1 case of emergency percutaneous nephrostomy in the supine position after open pyeloplasty with subsequent reoperation with percutaneous resection of a granuloma; and 1 case of botulin toxin injection into the detrusor muscle. Conclusions: The consolidation of pediatric endourology in our department, and more recently laparoscopy, has contributed to improve the quality of care in pediatric patients; it has been achieved thanks to our previous know-how in general endourological techniques and the existence of adequate technical and human resources (AU)

[The use of laser for percutaneous nephrolithotomy]. / Aplicación del láser en nefrolitotomía percutánea.

OBJECTIVES: The non negligible number of residual stones after extracorporeal lithotripsy is leading to a revision of the indications of percutaneous nephrolithotomy (PCNL). The laser, managed with flexible nephroscopes, plays an important role in this field. Pulsed Nd: YAG, dye and alexandrite lasers have given way to the holmium:yag laser in the endourological treatment of urinary lithiasis. METHODS: More than one lithotripter are often required for percutaneous nephrolithotomy of great volume stones, and ballistic and electrokinetic lithotripters are generally preferred due to their high performance. The best indications for Holmium laser is the treatment of caliceal stones far from the pelvis, only accessible through flexible nephroscopes. Midi and minipercs, renal lithiasis in children and some earthy calculi, of low consistency, are also good indications for it. Depending on the anatomical characteristics of the kidney and localization, number, size and hardness of the stone 200, 365, or 500 nanometer fibers may be employed. Due to the fact that the laser drills a hole in the stone like if it is a thermal barrier, it may break in different ways: applying the quartz fiber in between the layers, drilling all the interior before breaking the surface, or drilling multiple points to weaken it and creating broad fracture lines. To accelerate the breaking process one can choose to use larger fibers or to modify the settings of the equipment increasing the potency, although this has some potential risk for the kidney. RESULTS: The theoretical 100% of good results is reduced due to multiple technical and anatomical factors: size, number, localization, and hardness of the stone, as well as the possibility of reaching and seeing the calculus and being able to place the tip of the fiber against it. CONCLUSIONS: Although the holmium laser develops on excellent role at the time of avoiding leaving residual calculi or diminishing the number of them, sometimes the electrohydraulic lithotripsy is more effective.

[Acute peritonitis after radical cystectomy. Experience at our hospital and bibliographic review]. / Peritonitis aguda tras cistectomía radical. Experiencia en nuestro hospital y revisión de la bibliografía.

OBJECTIVES: The characteristics of the patients may favour the appearance of complications. Taking into account the high morbimortality of the process, we believe that is convenient knowing main features of acute peritonitis in postoperatory in our surgical area. METHODS: We have retrospectively studied the radical cystectomies having postoperative peritonitis. Variables considered can be classified in four main categories: patient physiology, operation, peritonitis and morbimortality. RESULTS: During considered time, 9 of 80 cystectomies showed complications related with peritonitis (11,25%). Except one patient, 44-year-old, all others where 50-year-old or older males. 5 surgeries were curative and 4 palliative. 5 of the peritonitis appeared during first week. Initial mechanism was dehiscence, necrosis or hypertension (6.2 and 1 respectivelly). In 6 patients, origin was ureteroileal anastomosis, 2 intestinal anastomosis and I cutaneous ureterostomy. 3 of 9 patients died due to peritonitis. CONCLUSIONS: The incidence of intra-abdominal complications during the immediate post operative period of radical cystectomy is high and, often, difficult to diagnose. In patients subjected to this surgery as a palliative method, possibility of showing complications is higher. To correct this medical profile, early intervention is fundamental, determining patient prognosis.

Peritonitis aguda tras cistectomía radical. Experiencia en nuestro hospital y revisión de la bibliografía / Acute peritonitis after radical cystectomy. Experience at our hospital and bibliographic review

OBJETIVO: Las características de los pacientes que actualmente se intervienen podrían favorecer la aparición de complicaciones (tumores avanzados, pluripatología, etc.).Teniendo en cuenta la elevada morbimortalidad del proceso, creemos necesario conocer las características principales de la peritonitis aguda postoperatoria en nuestro área quirúrgica. MÉTODOS: Se estudian las cistectomías radicales realizadas que presentaron en el postoperatorio peritonitis. Las variables a estudio fueron clasificadas en cuatro categorías: fisiología del paciente, intervención, peritonitis y morbimortalidad. RESULTADOS: En el plazo estudiado, 9 de las 80 cistectomías se complicaron con peritonitis (11,25%). Todos ellos varones por encima de 50 años excepto un paciente de 44 años. La intención quirúrgica fue en 5 de ellos curativa y paliativa en 4. 5 de las peritonitis aparecieron dentro de la primera semana. El mecanismo inicial fue por dehiscencia, necrosis o hiperpresión (6,2 y 1 respectivamente) y el origen fue en la anastomosis urétero-ileal en 6 pacientes, en 2 la anastomosis intestinal y en 1 la ureterostomía cutánea. 3 de los 9 pacientes fallecen consecuencia de la peritonitis (3,75% del total) CONCLUSIONES: La incidencia de las complicaciones intraabdominales en el postoperatorio inmediato de las cistectomías radicales es elevada y muchas veces difícil de diagnosticar. En los pacientes sometidos a esta intervención con carácter paliativo, la posibilidad de presentar complicaciones es mayor. La actuación precoz en estos casos es fundamental para corregir el cuadro clínico, condicionando el pronóstico del paciente

OBJECTIVES: The characteristics of the patients may favour the appearance of complications. Taking into account the high morbimortality of the process, we believe that is convenient knowing main features of acute peritonitis in postoperatory in our surgical area. METHODS: We have retrospectively studied the radical cystectomies having postoperative peritonitis. Variables considered can be classified in four main categories: patient physiology, operation, peritonitis and morbimortality. RESULTS: During considered time, 9 of 80 cystectomies showed complications related with peritonitis (11,25%). Except one patient, 44-year-old, all others where 50-year-old or older males. 5 surgeries were curative and 4 palliative. 5 of the peritonitis appeared during first week. Initial mechanism was dehiscence, necrosis or hypertension (6.2 and 1 respectivelly). In 6 patients, origin was ureteroileal anastomosis, 2 intestinal anastomosis and 1 cutaneous ureterostomy. 3 of 9 patients died due to peritonitis. CONCLUSIONS: The incidence of intra-abdominal complications during the immediate post operative period of radical cystectomy is high and, often, difficult to diagnose. In patients subjected to this surgery as a palliative method, possibility of showing complications is higher. To correct this medical profile, early intervention is fundamental, determining patient prognosis

[Psoas muscle abscess: bibliographic review]. / Absceso de psoas: revisión de la bibliografía.

OBJECTIVES: To report the clinical characteristics, diagnosis and treatment of psoas abscess. METHODS/RESULTS: We report the case of a 77 year old female patient who was diagnosed of psoas abscess. Due to the unspecific symptoms, she was initially treated as a renal colic. Ultrasound was the test that oriented us to the diagnosis. Percutaneous drainage was effective, checking the resolution using CT Scan. CONCLUSIONS: Psoas abscess is an uncommon pathology the presenting features of which are usually unspecific. CT Scan is the astronomer diagnostic tests and percutaneous drainage has good results and is less aggressive therapeutic option for this disease.

Absceso de psoas: revisión de la bibliografía / Psoas muscle abscess: bibliographic review

OBJETIVO: Presentar las características clínicas,diagnostico y tratamiento del absceso de psoas.MÉTODO / RESULTADOS: Presentamos el caso de una mujer de 77 años diagnosticada de absceso de psoas. Debido a la inexpecificidad de sus síntomas se trató al inicio como un cólico nefrítico complicado, siendo la ecografíala prueba diagnóstica que nos orientó en el diagnóstico.Mediante drenaje percutáneo el tratamiento fue eficaz, comprobándose la resolución mediante TAC.CONCLUSIONES: El absceso de psoas es una patología poco común cuyas características de presentación son normalmenteinespecíficas. El TAC es el método estándar de diagnóstico y el drenaje percutáneo tiene buenos resultadosy es la opción terapéutica menos agresiva para esta enfermedad

OBJETIVES: To report the clinical characteristics, diagnosis and treatment of psoas abscess.METHODS/RESULTS: We report the case of a 77 year old female patient who was diagnosed of psoas abscess. Due to the unspecific symptoms, she was initially treated as a renal colic. Ultrasound was the test that oriented us to the diagnosis. Percutaneous drainage was effective, checking the resolution using CT Scan.CONCLUSIONS: Psoas abscess is an uncommon pathology the presenting features of which are usually unspecific. CT Scan is the astronomer diagnostic tests and percutaneous drainage has good results and is less aggressive therapeutic option for this disease

[Transurethral resection with saline solution: a technological achievement not yet assimilated by the urological community]. / La resección transuretral con solución sauna: un logro tecnológico aún no asimilado por la urología.

OBJECTIVES: To objectively demonstrate the advantages provided by TURP with saline solution (an adjustment made possible thanks to the technological development of new high frequency current generators), although it surprisingly has been received with scepticism in the urological community. METHODS: A first group of 51 patients (group A) underwent low hydraulic pressure TURP with a pulsed bipolar system (Gyrus Plasmakinetic, with large loop) using physiologic saline solution as irrigation. A second group of 49 patients underwent low hydraulic pressure TURP with a conventional monopolar system (Erbe 350) using glycine-ethanol solution. RESULTS: A better surgical performance was obtained in the first group, as well as a lower degree of bleeding. No intraoperative complications appear in either group. Only one case of late hematuria was registered one month after surgery in a patient of group A. CONCLUSIONS: Pulsed bipolar TURP has a minimal thermal in-depth diffusion, achieves vessel hemostasis by dessication instead of charring, has an extremely precise cutting quality, does not produce neuromuscular stimulation, and makes the use of saline solution irrigation possible. All these translate to lower tissue injury, null risk of sequelae secondary to electric current leak, a finer technique, a lower risk of accidental perforation, and the possibility of duplicate or triplicate the surgical time without risk, especially when working with low hydraulic pressure.

La resección transuretral con solución salina: un logro tecnológico aún no asimilado por la urología / Transurethral resection with saline solution: a technological achievement not yet assimilated by the urological community

OBJETIVO: Demostrar objetivamente lasventajas que reporta el uso de la R.T.U.P. con soluciónsalina (logro posible gracias al desarrollo tecnológicode los los nuevos generadores de corrientes de alta frecuencia),pero que curiosamente ha sido recibida porlos urólogos con cierto escepticismo.MÉTODOS: A un primer grupo de 51 pacientes (grupoA) se les sometió a R.T.U.P., a baja presión hidráulica,con un sistema bipolar por pulsos (Gyrus Plasmakinetic,con asa large loop) y empleando suero fisiológicocomo líquido irrigante. A un segundo grupo, de 49pacientes se les practicó una R.T.U.P., a baja presiónhidráulica, con un sistema monopolar convencional(Erbe 350) y empleando solución de glicina con etanolcomo líquido irrigante.RESULTADOS: En el primer grupo de pacientes se obtuvoun mejor rendimiento quirúrgico y menor grado dehemorragia. No se produjeron complicaciones intraoperatoriasen ambos grupos. Solo se registró un casode hemorragia tardía al mes de la intervención en unpaciente del grupo A.CONCLUSIONES: La R.T.U. bipolar por pulsos, tieneuna mínima inercia térmica en profundidad, es capazde hemostasiar los vasos por desecación en vez de carbonización,dispone de una calidad de corte extremadamentepreciso, no provoca estímulo neuromuscular yhace posible el uso de una solución salina como mediode irrigación. Todo ello se traduce en un menor dañotisular, nulo riesgo de secuelas por fugas de corriente,una técnica más depurada, un menor riesgo de perforacionesaccidentales, y la posibilidad de duplicar o triplicarsin riesgo el tiempo quirúrgico, especialmente sise trabaja con baja presión hidráulica

OBJECTIVES: To objectively demonstrate ;;the advantages provided by TURP with saline solution ;;(an adjustment made possible thanks to the technological ;;development of new high frequency current generators), ;;although it surprisingly has been received with scepticism ;;in the urological community. ;;METHODS: A first group of 51 patients (group A) ;;underwent low hydraulic pressure TURP with a pulsed ;;bipolar system (Gyrus Plasmakinetic, with large loop) ;;using physiologic saline solution as irrigation. A second ;;group of 49 patients underwent low hydraulic pressure ;;TURP with a conventional monopolar system (Erbe 350) ;;using glycine-ethanol solution. ;;RESULTS: A better surgical performance was obtained ;;in the first group, as well as a lower degree of bleeding. ;;No intraoperative complications appear in either ;;group. Only one case of late hematuria was registered ;;one month after surgery in a patient of group A. ;;CONCLUSIONS: Pulsed bipolar TURP has a minimal ;;thermal in-depth diffusion, achieves vessel hemostasis ;;by dessication instead of charring, has an extremely ;;precise cutting quality, does not produce neuromuscular ;;stimulation, and makes the use of saline solution irrigation ;;possible. All these translate to lower tissue injury, null ;;risk of sequelae secondary to electric current leak, a ;;finer technique, a lower risk of accidental perforation, ;;and the possibility of duplicate or triplicate the surgical ;;time without risk, especially when working with low ;;hydraulic pressure

[Laparoscopic treatment of varicocele]. / Tratamiento del varicocele por laparoscopia.

OBJECTIVES: Current trends in the treatment of varicocele are focused on outpatient procedures of high and complete ligature of the spermatic vascular pedicle or percutaneous embolization. Laparoscopic varicocelectomy competes with them and other minimally invasive techniques such as chemical or thermal sclerosing therapy of the spermatic veins. METHODS: We perform a bibliographic review of the Spanish and Anglo-Saxon literature with the aim of evaluating the real weight of the laparoscopic technique, and at the same time show our personal experience. RESULTS: We found 8 papers in Spanish and 187 in English. Although the interest for laparoscopic varicocelectomy among Spanish urologists is very low, in other countries there is moderate interest for it, being in competition, though in disadvantage, with other outpatient minimally invasive techniques performed under local or regional anesthesia. CONCLUSIONS: Microlaparoscopy improves the overall position of this technique, mainly in cases of bilateral varicocele whenever an "en bloc" ligature of the spermatic artery and vein is performed.

[Intraurethral foreign bodies]. / Cuerpos extraños intrauretrales.

OBJECTIVES: We report a case of urethral foreign bodies in a patient with posttraumatic psychiatric disorders. METHODS: The patient presents with clinical signs of scrotal abscess. Many foreign bodies were removed from the bulbar urethra; one urinary stone formed around one of them required lithotripsy. RESULTS: Treatment included removal of the foreign bodies, abscess drainage, and administration of wide spectrum antibiotics. CONCLUSIONS: Urethral foreign bodies are exceptional, and may present with many symptoms making diagnosis difficult. We noted symptoms and diagnosis in our case, and additionally the therapeutic options proposed in the literature.

[Laparoscopic nephroureterectomy for upper urinary tract urothelial tumors]. / Nefroureterectomía laparoscópica en tumores de uroteuo alto.

OBJECTIVES: We present our 11 year experience with 15 laparoscopic nephroureterectomy procedures for upper urinary tract urothelial tumor. METHODS/RESULTS: The tumor site was pyelocalyceal in 9 cases, ureteral in 4, and multifocal in one. All cases were urothelial tumors grade II or III; stage was Ta-T1 in 9 cases, T2 in three, T3 in two, and T4 in one. Transperitoneal approach was performed in 14 cases, whereas only one retroperitoneal. Hand assisted laparoscopy was performed in five cases. Seven specimens were extracted after morcellation without any recorded tumor seeding attributable to this manoeuvre. We recorded one case of sudden death due to pulmonary embolism 48 hours after the procedure, one case of intestinal obstruction secondary to an ileal loop hernia through the parietal orifice of one of the trocars, and one case of unstable angina pectoris. Two patients died because of disease progression, one of them after bladder recurrence. CONCLUSIONS: We think that hand assisted laparoscopy is a good indication for nephroureterectomy for upper urinary tract urothelial tumor. We propose a new procedure to avoid possible tumor cell spilling at the time of ureterectomy, which simplifies the operation very much at the same time.

Nefroureterectomía laparoscópica en tumores de urotelio alto / Laparoscopic nephroureterectomy for upper urinary tract urothelial tumors

OBJETIVO: Presentamos nuestra experiencia a lo largo de 11 años, en los que hemos llevado a cabo 15 nefroureterectomías laparoscópicas por tumor de urotelio alto.MÉTODO Y RESULTADOS: El tumor era de localización pielocalicial en 9 casos, ureteral en 4 y multifocal en uno. En todos los casos se trataba de tumores uroteliales de grado II o III, en nueve casos el estadio era TaT1, en tres T2, en dos T3 y en uno T4.En catorce casos se realizó un abordaje transperitoneal y tan solo en uno retroperitoneal. En cinco casos se realizó laparoscopia manoasistida. En 7 casos la pieza se extrajo mediante "morcellación", sin que se registrasen siembras tumorales atribuibles a esta maniobra.Registramos un caso de muerte fulminante por embolia pulmonar a las 48 horas de la intervención, un caso de oclusión intestinal por herniación de asa ileal por el orificio parietal de uno de los trócares y un caso de angor inestable. Dos pacientes fallecieron por progresión de la enfermedad, uno de ellos por recidiva a nivel vesical.CONCLUSIÓN: Creemos que la laparoscopia manoasistida tiene una magnífica indicación en los casos de nefroureterectomía por tumor de urotelio alto.Proponemos un nuevo procedimiento que evita la posible fuga de células tumorales en el momento de la ureterectomía y que al mismo tiempo simplifica mucho la intervención. (AU)