Transperitoneal vs. Retroperitoneal Approach in Laparoscopic Partial Nephrectomy for Posterior Renal Tumors: A Retrospective, Multi-Center, Comparative Study.

Purpose: The aim of our study is to compare the perioperative, functional, and oncological outcomes of laparoscopic transperitoneal partial nephrectomy (LTPN) and laparoscopic retroperitoneal partial nephrectomy (LRPN) for posterior cT1 renal tumors. Methods: We retrospectively collected data on all patients who consecutively underwent LTPN and LRPN for posterior cT1 renal tumors in three different centers from January 2015 to January 2023. Patients with a single, unilateral, cT1 renal mass, located in the posterior renal surface were included. Patients' data regarding perioperative, functional, and oncological outcomes were collected from medical records and statistically analyzed and compared. Results: A total of 128 patients was obtained, with 53 patients in the LPTN group and 75 patients in the LRPN group. Baseline characteristics were similar. Warm ischemia time (WIT) (18.8 vs. 22.6 min, p = 0.002) and immediate postoperative eGFR drop (-6.1 vs. -13.0 mL/min/1.73 m2, p = 0.047) were significantly lower in the LPTN group. Estimated blood loss (EBL) (100 vs. 150 mL, p = 0.043) was significantly lower in the LRPN group. All other perioperative and functional outcomes and complications were similar between the groups. The positive surgical margin (PSM) rate was lower in the LRPN group, although without statistical significance (7.2% vs. 13.5%, p = 0.258). Surgical success defined by Trifecta (WIT ≤ 25 min, no PSM, and no major postoperative complication) was similar between both approaches. Conclusions: LTPN has significantly shorter WIT and a significantly smaller drop in immediate eGFR when compared to LRPN for posterior renal tumors. On the other hand, LRPN has significantly less EBL than LTPN. LRPN demonstrated fewer PSMs than LTPN, albeit without statistical significance. In terms of overall surgical success, as defined by Trifecta, both approaches achieved similar results.

Reconstruction of the Denonvillier's fascia and posterior ligament of the external urethral sphincter: Assessment of its effect on urinary continence after laparoscopic radical prostatectomy.

OBJECTIVES: Some studies have shown that rhabdosphincter reconstruction provides an earlier return to continence after radical prostatectomy. We aim to study the impact of this procedure in urinary continence along with comparing two specific surgical techniques for posterior reconstruction. MATERIALS AND METHODS: We studied a group of patients who were submitted to LRP with No Rhabdosphincter Reconstruction (NRR) and another group with Posterior Reconstruction of the Rhabdosphincter (PRR). The latter was further divided into two groups: "Rocco type stitch" group and "Bollens type stitch" group. We used three questionnaires (IIEF-5, ICIQ-SF and IPSS) to assess urinary continence and erectile function 90 days after surgery. RESULTS: Patients of PRR group had a better full continence rate than patients of NRR group at 90 days (96.6% vs 33.3%, p < 0.001). Concerning urinary incontinence (p = 0.116), lower urinary tract symptoms (p = 0.543) and postoperative complication rates (p = 0.738), our results suggested that there were no differences between the techniques studied. CONCLUSIONS: Posterior reconstruction of the rhabdosphincter has significant benefits for urinary continence recovery on patients undergoing radical prostatectomy. No differences were observed in continence recovery between the two techniques analyzed. Additionally, reconstruction of the rhabdosphincter appears to be a safe procedure with no increased risk of postoperative complications.

Does 3D Ultrasound Enhance the Diagnosis of Bladder Tumours in Patients with Haematuria?

Purpose. Bladder cancer is a frequent cause of haematuria in elderly patients, and bladder ultrasound (US) is a valuable tool in diagnosing these malignancies. We examined the accuracy of 3D bladder US in diagnosing bladder tumors in patients with haematuria. Patients and Methods. Twenty-one patients observed in the emergency department for haematuria underwent a kidney and bladder US. Patients with normal or uncertain bladder US findings underwent a 3D US and a cystoscopy. Results. In 5 (23.8%) patients, the 3D US detected bladder tumours not seen in 2D US. All these patients were found to have bladder tumours on cystoscopy. Another 5 (23.8%) patients with uncertain findings on 2D US had normal 3D US and cystoscopy. 3D US showed a sensitivity of 83.3% and a specificity of 100% with a positive predicted value and negative predictive values of 100% and 93.8%, respectively. Conclusion. 3D US was more sensitive than 2D US in diagnosing bladder tumours in patients with haematuria.

Transvesical peritoneoscopy with rigid scope: feasibility study in human male cadaver.

BACKGROUND: Transvesical port refers to the method of accessing the abdominal cavity through a natural orifice (i.e., urethra) under endoscopic visualization. Since its introduction in 2006, various reports have been published describing different surgical interventions using a rigid ureteroscope in a porcine model. The aim of this study was to test the access and feasibility of peritoneoscopy by using a rigid ureteroscope in a human male cadaver. METHODS: Two adult male cadavers were used to perform the procedures. A rigid ureteroscope was used for the creation of transvesical access into the peritoneal cavity. Peritoneoscopy, liver biopsy, and identification and manipulation of the ileocecal appendix were performed. RESULTS: Transvesical access into the peritoneal cavity was quickly established. The rigid ureteroscope easily allowed visualization of the abdominal cavity with good image quality. Liver biopsy and manipulation of ileocecal appendix were carried out without difficulties. CONCLUSIONS: Peritoneoscopy, liver biopsy, and ileocecal appendix manipulation using a rigid ureteroscope through a transvesical port is feasible in a cadaver model. The development of a specific rigid scope for the transvesical port might herald a promising future for this NOTES access.

Úlcera de presión por prótesis de pene / Pressure ulcer secondary to penile prostheses

No disponible

[Bladder exstrophy adenocarcinoma in an adult woman. Case report]. / Adenocarcinoma sobre extrofia vesical en mujer adulta. A propósito de un caso.

OBJECTIVE: To report a clinical case of bladder exstrophy adenocarcinoma. METHODS: 57-year-old female presenting with a hypogastric mass. The biopsy of the mass revealed bladder adenocarcinoma. We performed radical cystectomy. RESULTS: Pathologic study was compatible with moderately differentiated adenocarcinoma. CONCLUSIONS: After six months of follow-up patient is disease-free.

Adenocarcinoma sobre extrofia vesical en mujer adulta. A propósito de un caso / Bladder exstrophy adenocarcinoma in an adult woman. Case report

OBJETIVOS: Aportamos un caso clínico de adenocarcinoma sobre extrofia vesical. METODOS: Paciente de 57 años de edad, a la exploración física evidenció una tumefacción hipogástrica. Efectuamos biopsia de la masa revelando adenocarcinoma vesical. Realizamos cistectomía radical. RESULTADOS: El estudio anatomo-patológico de la masa fue compatible con un adenocarcinoma moderadamente diferenciado de la vejiga infiltrando muscular. CONCLUSIONES: La paciente a los 6 meses se encuentra libre de tumor (AU)

OBJECTIVE: To report a clinical case of bladder exstrophy adenocarcinoma. METHODS: 57-year-old female presenting with a hypogastric mass. The biopsy of the mass revealed bladder adenocarcinoma. We performed radical cystectomy. RESULTS: Pathologic study was compatible with moderately differentiated adenocarcinoma. CONCLUSIONS: After six months of follow-up patient is disease-free

Emergency ureteroscopic management of ureteral stones: why not?

OBJECTIVES: To describe a single-center experience in the emergency ureteroscopic management of ureteral stones. METHODS: We retrospectively considered the data from 144 patients (mean age 49.6 years, range 23 to 82) who had had obstructive ureteral stones and had undergone emergency ureteroscopy with stone retrieval. Intracorporeal pneumatic lithotripsy was performed when necessary. At the end of the procedure, a ureteral catheter was systematically left in place in 100 patients (69.4%) and removed within 24 hours. In the remaining 44 patients, a double-J stent was preferred and was removed within 30 days, depending on the clinical course. Stone-free status was defined as the complete absence of fragments at 1 month of follow-up. RESULTS: The calculi were more frequently localized in the distal ureter than in the proximal one (90.3% versus 9.7%, respectively). The overall mean stone diameter was 9.1 mm (range 5 to 20). The overall stone-free rate was 92.4%. A greater stone-free rate was obtained in those with stones less than 10 mm (95.8%) than in those with stones larger than 10 mm (89%, P = 0.002). Similarly, a significantly better outcome occurred for those with stones located in the distal ureter (94.6%) than for those with stones in the proximal one (71.4%, P = 0.004). The overall complication rate was 4.2%. The mean hospital stay was 2.5 days (range 1 to 7). CONCLUSIONS: In our experience, emergency ureteroscopy in cases of obstructive ureteral stones proved to be safe and effective. It has the main advantage of offering both immediate relief from pain and stone fragmentation. Additional extensive studies are warranted to corroborate these findings.

[Transperitoneal laparoscopic adrenalectomy: initial experience]. / Adrenalectomía transperitoneal laparoscópica: experiencia inicial.

OBJECTIVES: Since the first published report in 1992, laparoscopic adrenalectomy has been widespread and it is now accepted as the standard treatment option in most of benign diseases of the adrenal gland. Aim of the present study is to describe our initial experience with laparoscopic adrenalectomy. METHODS: Between May 2001 and December 2005, 15 patients were submitted to laparoscopic adrenalectomy for benign diseases of the adrenal gland. We analyzed patients characteristics (sex, age, initial diagnosis), operative and perioperative results (operative time, blood loss, time to first oral intake) and complications. RESULTS: Mean operative time was 143 minutes. Blood loss was minimal. Mean hospital stay was 90 hours. There was no need for open conversion and complication rate was low. CONCLUSIONS: Laparoscopic surgery of the adrenal gland is a safe and effective option which offers quality of life benefits to the patients.

[Tubulovillous adenocarcinoma of the renal pelvis. Case report]. / Adenocarcinoma túbulovelloso de la pelvis renal. A propósito de un caso.

OBJECTIVE: To present a case of tubulovillous renal pelvis adenocarcinoma. METHODS/RESULTS: An 81 year-old patient presented at Emergency Department with sepsis. CT scan showed a staghorn calculus with signs suggestive of pyonefrosis. A nephrectomy was performed and pathological exam revealed tubulovillous renal pelvis adenocarcinoma. CONCLUSIONS: Renal pelvis adenocarcinoma is a rare disease. It is usually accompanied by chronic urinary infections, on inflammatory state and staghorn calculi. The best therapeutic option is nephrectomy and the prognosis is poor.

[Penile abscess. Case report]. / Absceso del pene. A propósito de un caso.

OBJECTIVE: To report one case of penile abscess, with special reference to diagnostic and therapeutic aspects. METHODS: One case of penile abscess is presented in a patient referred for penile swelling. RESULTS: During surgical exploration it showed to be a corpora cavernosum rupture with drainage of a small volume of purulent fluid. CONCLUSIONS: Penile abscess is uncommon. High frequency ultrasonography is a reliable diagnostic imaging method. We were able to incise the affected area of the corpus cavernosum and glans safely, and with appropriate antibiotics this patient was treated successfully.

Adrenalectomía transperitoneal laparoscópica: experiencia inicial / Transperitoneal laparoscopic adrenalectomy: initial experience

OBJETIVOS: La primera publicación sobre la realización de una adrenalectomía por vía laparoscópica fue presentada en 1992. Desde entonces esta técnica ha sufrido una evolución, siendo actualmente aceptada como el tratamiento estándar de la mayoría de la patología benigna de la glándula adrenal. Con este artículo tratamos de mostrar nuestra experiencia inicial de adrenalectomías laparoscópicas. MÉTODOS: Entre mayo de 2001 a diciembre de 2005 fueron incluidas 15 adrenalectomías por vía laparoscópica en pacientes que presentaban patología de la glándula adrenal benigna. Realizamos un análisis de la edad, sexo, patología, tamaño de la lesión, tiempo quirúrgico, pérdidas hemáticas, complicaciones e inicio de la primera ingestión oral. RESULTADOS: El tiempo quirúrgico fue de 143 minutos, las pérdidas hemáticas mínimas y la estancia hospitalaria de 90 horas. No se tuvo que reconvertir ninguna intervención y mínimas complicaciones intra y postoperatorias. CONCLUSIONES: La cirugía laparoscópica de la glándula adrenal es una opción segura, eficaz y con gran repercusión en la calidad de vida del paciente

OBJECTIVES: Since the first published report in 1992, laparoscopic adrenalectomy has been widespread and it is now accepted as the standard treatment option in most of benign diseases of the adrenal gland. Aim of the present study is to describe our initial experience with laparoscopic adrenalectomy. METHODS: Between May 2001 and December 2005, 15 patients were submitted to laparoscopic adrenalectomy for benign diseases of the adrenal gland. We analyzed patients characteristics (sex, age, initial diagnosis), operative and perioperative results (operative time, blood loss, time to first oral intake) and complications. RESULTS: Mean operative time was 143 minutes. Blood loss was minimal. Mean hospital stay was 90 hours. There was no need for open conversion and complication rate was low. CONCLUSIONS: Laparoscopic surgery of the adrenal gland is a safe and effective option which offers quality of life benefits to the patients

Adenocarcinoma tubulovelloso de la pelvis renal. A propósito de un caso / Tubulovillous adenocarcinoma of the renal pelvis. Case report

OBJETIVO: Presentar un caso de adenocarcinoma túbulovelloso de la pelvis renal. MÉTODO/RESULTADOS: Paciente de 81 años de edad, se presenta en el servicio de urgencias con un cuadro infeccioso grave, en la TAC presencia de cálculo coraliforme de la pelvis renal con signos sugestivos de pionefrosis. Se procede a la nefrectomía revelando en el estudio histológico adenocarcinoma túbulovelloso de la pelvis renal. CONCLUSIONES: El adenocarcinoma de la pelvis renal es una neoplasia infrecuente. Se relaciona con infecciones crónicas, inflamación y con la presencia de cálculos coraliformes de la pelvis renal. La opción terapeútica más adecuada es la nefrectomía. El adenocarcinoma túbulovelloso de la pelvis renal tiene un pronóstico sombrío

OBJECTIVE: To present a case of tubulovillous renal pelvis adenocarcinoma. METHODS/RESULTS: An 81 year-old patient presented at Emergency Departament with sepsis. CT scan showed a staghorn calculus with signs suggestive of pyonefrosis. A nephrectomy was performed and pathological exam revealed tubulovillous renal pelvis adenocarcinoma. CONCLUSIONS: Renal pelvis adenocarcinoma is a rare disease. It is usually accompanied by chronic urinary infections, an inflammatory state and staghorn calculi. The best therapeutic option is nephrectomy and the prognosis is poor

Absceso del pene. A propósito de un caso / No disponible

OBJETIVO: Este trabajo pretende aportar un caso clínico más a la literatura de esta infrecuente entidad haciendo hincapié en aspectos del diagnóstico y del tratamiento. MÉTODO: Se presenta un paciente que consulta por tumefacción peniana resultando ser un absceso de pene. RESULTADO: Al efectuar el acto quirúrgico constatamos una fractura del cuerpo cavernoso con pequeña salida de pus por el orificio de la fractura. CONCLUSIONES: El absceso de pene es de aparición clínica poco frecuente. La ultrasonografia de alta frecuencia nos permite identificarlo. En cuanto al tratamiento abogamos por el drenaje y la cobertura con antibióticos de amplio espectro de acción (AU)

OBJECTIVE: To report one case of penile abscess, with special reference to diagnostic and therapeutic aspects. METHODS: One case of penile abscess is presented in a patient referred for penile swelling. RESULTS: During surgical exploration it showed to be a corpora cavernosum rupture with drainage of a small volume of purulent fluid. CONCLUSIONS: Penile abscess is uncommon. High frequency ultrasonography is a reliable diagnostic imaging method. We were able to incise the affected area of the corpus cavernosum and glans safely, and with appropriate antibiotics this patient was treated successfully (AU)