Complicaciones viscerales y gastrointestinales en la cirugía urológica robótica / Visceral and gastrointestinal complications in robotic urologic surgery

Introducción: Con el uso generalizado de técnicas mínimamente invasivas la cirugía urológica asistida por robot ha sido ampliamente adoptada. A pesar de su infrecuencia, las complicaciones viscerales y gastrointestinales podrían poner en peligro la vida. Objetivos: Identificar las principales lesiones gastrointestinales que ocurren en una cirugía urológica asistida por robot. Conocer la incidencia general y cómo es su manejo. Adquisición de la evidencia: Búsqueda en PubMed de artículos relacionados con complicaciones viscerales y gastrointestinales en cirugía urológica asistida por robot, escritos en inglés o español. Se revisaron publicaciones relevantes, así como revisiones de literatura y capítulos de libros. Síntesis de la evidencia: Junto con las lesiones vasculares, las lesiones viscerales y gastrointestinales se encuentran entre las complicaciones más peligrosas. Un estudio preoperatorio completo para individualizar las características de cada paciente y el uso correcto de la toma de imágenes podría ayudarnos a evitar complicaciones en primer lugar. Conocer todos los pasos arriesgados en los diferentes procedimientos urológicos robóticos nos permitirá anticipar los daños. El conocimiento de las lesiones principales y más peligrosas en los diferentes órganos abdominales y pélvicos es altamente recomendable. El diagnóstico precoz y la evaluación de las lesiones nos permitirán un manejo agudo durante la cirugía. El retraso en el reconocimiento podría convertir una lesión reparable a una situación potencialmente mortal. Conclusiones: A pesar de los beneficios innegables del enfoque robótico, hay lesiones gastrointestinales menores y mayores que todos los cirujanos urológicos deben saber. Los relacionados con la colocación de trocares son especialmente importantes. El diagnóstico y el manejo inmediatos son obligatorios

Introduction: with the widespread use of minimally invasive techniques, robot-assisted urologic surgery has become widely adopted. Despite their infrequency, visceral and gastrointestinal complications could be life-threatening. Objectives: To identify the main gastrointestinal injuries that occur in a robot-assisted urologic surgery. To know the overall incidence and how is their management. Acquisition of the evidence: Search in PubMed of articles related to visceral and gastrointestinal complications in robot-assisted urology surgery, written in English or Spanish. Relevant publications as well literature reviews and chapters from books were reviewed. Synthesis of the evidence: Along with vascular injuries, visceral and gastrointestinal lesions are among most dangerous complications. A complete preoperative study to individualize each patient characteristics and the correct use of imaging could help us to avoid complications in the first place. To know all the risky steps in the different robotic urologic procedures will let us anticipate the damage. Knowledge of main and most dangerous injuries in the different abdominal and pelvic organs is fully recommended. Early diagnosis and evaluation of lesions will let us an acute management during surgery. Recognition delay could change a repairable injury into a life-threatening situation. Conclusions: Despite the undeniable benefits of robotic approach, there are minor and major gastrointestinal injuries that all urologic surgeons must know. Those related with trocar placement are especially important. Immediate diagnosis and management is mandatory

Visceral and gastrointestinal complications in robotic urologic surgery. / Complicaciones viscerales y gastrointestinales en la cirugía urológica robótica.

INTRODUCTION: with the widespread use of minimally invasive techniques, robot-assisted urologic surgery has become widely adopted. Despite their infrequency, visceral and gastrointestinal complications could be life-threatening. OBJECTIVES: To identify the main gastrointestinal injuries that occur in a robot-assisted urologic surgery. To know the overall incidence and how is their management. ACQUISITION OF THE EVIDENCE: Search in PubMed of articles related to visceral and gastrointestinal complications in robot-assisted urology surgery, written in English or Spanish. Relevant publications as well literature reviews and chapters from books were reviewed. SYNTHESIS OF THE EVIDENCE: Along with vascular injuries, visceral and gastrointestinal lesions are among most dangerous complications. A complete preoperative study to individualize each patient characteristics and the correct use of imaging could help us to avoid complications in the first place. To know all the risky steps in the different robotic urologic procedures will let us anticipate the damage. Knowledge of main and most dangerous injuries in the different abdominal and pelvic organs is fully recommended. Early diagnosis and evaluation of lesions will let us an acute management during surgery. Recognition delay could change a repairable injury into a life-threatening situation. CONCLUSIONS: Despite the undeniable benefits of robotic approach, there are minor and major gastrointestinal injuries that all urologic surgeons must know. Those related with trocar placement are especially important. Immediate diagnosis and management is mandatory.

Carcinoma microcítico vesical: experiencia a lo largo de 22 años / Microcytic carcinoma of the urinary bladder: Experience over 22 years

Introducción: El carcinoma microcítico vesical (CMCV) o carcinoma de células pequeñas es una enfermedad infrecuente, agresiva, de mal pronóstico y alto poder metastásico; se presenta en edades y estadios avanzados. Presentamos nuestra casuística evaluando su comportamiento y los tratamientos aplicados. Material y método: Revisión retrospectiva de pacientes diagnosticados de CMCV en nuestro hospital entre febrero de 1992 y febrero de 2014. Analizamos características demográficas, clínicas y propias del tumor, los tratamientos aplicados y la supervivencia. Análisis estadístico descriptivo del seguimiento medio (SM), supervivencia global (SG) y supervivencia cáncer específica (SCE) mediante el programa SPSS versión 15.0. Resultados: En esos 22 años se diagnosticaron 20 pacientes con CMCV (solo 2 mujeres), con edad media de 75 años. El síntoma predominante fue la hematuria macroscópica (75%). Tras la RTU-V inicial y el diagnóstico anatomopatológico el 35% (7 pacientes) no recibió tratamiento adicional, el 15% (3 pacientes) recibió quimiorradioterapia (QRT), el 10% (2 pacientes) RTU el 15% (3 pacientes) quimioterapia (QT) el 5% (un paciente) RTU asociada a QRT, el 5% (un paciente) cirugía radical, el 5% (un paciente) cirugía radical asociada a QRT adyuvante, el 5% (un paciente) cirugía paliativa (ligadura de arterias hipogástricas) asociada a QT adyuvante y el 5% (un paciente) radioterapia (RT) hemostática. Con un SM de 13,8 meses, la SG fue de 14,48 meses (IC 95%: 6,22-22,75) y la SCE 18,04 meses (IC 95%: 6,51-29,57), permaneciendo únicamente 2 pacientes vivos (10%) al final del estudio. Conclusión: El CMCV es una neoplasia vesical infrecuente y agresiva que se diagnostica más frecuentemente en varones de edad y estadios avanzados, de pronóstico desfavorable y escasa supervivencia. Debido a su estadio local avanzado al diagnóstico la cistectomía es aplicable en muy contados casos, debiendo recurrir a un tratamiento multimodal, aún por definir

Introduction: Microcytic carcinoma of the urinary bladder or bladder Small Cell Carcinoma (SCC) is a rare entity, characterised by an aggressive behaviour, with a poor prognosis, elevated metastatic potential, and is commonly found in older patients and in advanced disease stages. Here we present our experiences with the behaviour of the disease and the treatments applied. Material and method: This was a retrospective study on patients diagnosed with bladder SCC in our hospital between February 1992 and February 2014. We analysed the demographic and clinical characteristics of the tumour, the applied treatments and survival. We performed a descriptive statistical analysis of the median follow-up time, Overall Survival (OS) and Cancer-Specific Survival (CSS), using the SPSS statistical package v. 15.0. Results: Over 22 years, 20 patients with an average age of 75 years were diagnosed with bladder SCC (2 female). The predominant symptom was macroscopic haematuria (75%). After the first transurethral resection (TUR) of the bladder and the histological diagnosis, 35% (7 patients) did not receive additional treatment, 15% (3 patients) were treated with chemoradiotherapy (CRT), 10% (2 patients) with TUR, 15% (3 patients) with chemotherapy (QT), 5% (1 patient) with TUR associated to CRT, 5% (1 patient) with radical surgery, 5% (1 patient) with radical surgery treatment followed by adjuvant CRT, 5% (1 patient) with palliative surgery (hypogastric arteriae ligation) followed by adjuvant QT and 5% (1 patient) with hemostatic radiotherapy (RT). With a median follow-up time of 13.8 months, the OS was 14.48 months (95% CI: 6.22 - 22.75) and the CSS 18.04 months (95% CI: 6.51-29.57). Only 10% (2 patients) survived till the end of the study. Conclusion: Microcytic carcinoma of the urinary bladder is a rare and aggressive entity commonly diagnosed in males of advanced age and in advanced disease stages. It has a poor prognosis and reduced survival. Due to its aggressiveness previous to the initial diagnosis, a cystectomy is only possible in very few cases; therefore multimodal treatment is necessary. This treatment is yet to be defined

Microcytic carcinoma of the urinary bladder: Experience over 22 years.

INTRODUCTION: Microcytic carcinoma of the urinary bladder or bladder Small Cell Carcinoma (SCC) is a rare entity, characterised by an aggressive behaviour, with a poor prognosis, elevated metastatic potential, and is commonly found in older patients and in advanced disease stages. Here we present our experiences with the behaviour of the disease and the treatments applied. MATERIAL AND METHOD: This was a retrospective study on patients diagnosed with bladder SCC in our hospital between February 1992 and February 2014. We analysed the demographic and clinical characteristics of the tumour, the applied treatments and survival. We performed a descriptive statistical analysis of the median follow-up time, Overall Survival (OS) and Cancer-Specific Survival (CSS), using the SPSS statistical package v. 15.0. RESULTS: Over 22 years, 20 patients with an average age of 75 years were diagnosed with bladder SCC (2 female). The predominant symptom was macroscopic haematuria (75%). After the first transurethral resection (TUR) of the bladder and the histological diagnosis, 35% (7 patients) did not receive additional treatment, 15% (3 patients) were treated with chemoradiotherapy (CRT), 10% (2 patients) with TUR, 15% (3 patients) with chemotherapy (QT), 5% (1 patient) with TUR associated to CRT, 5% (1 patient) with radical surgery, 5% (1 patient) with radical surgery treatment followed by adjuvant CRT, 5% (1 patient) with palliative surgery (hypogastric arteriae ligation) followed by adjuvant QT and 5% (1 patient) with hemostatic radiotherapy (RT). With a median follow-up time of 13.8 months, the OS was 14.48 months (95% CI: 6.22 - 22.75) and the CSS 18.04 months (95% CI: 6.51-29.57). Only 10% (2 patients) survived till the end of the study. CONCLUSION: Microcytic carcinoma of the urinary bladder is a rare and aggressive entity commonly diagnosed in males of advanced age and in advanced disease stages. It has a poor prognosis and reduced survival. Due to its aggressiveness previous to the initial diagnosis, a cystectomy is only possible in very few cases; therefore multimodal treatment is necessary. This treatment is yet to be defined.