Open surgery for urethral foreign body.

The introduction of foreign bodies in the urethra are uncommon. Given its rarity, the approach to this condition is not standardized but it is highlighted that minimally invasive procedures should be prioritized depending on its feasibility. In the present study, we report a case of a 60-year-old male patient with bipolar disorder and a foreign body impacted in the bulbar urethra with open surgical resolution after a failed endoscopic treatment. We perform an analysis into the diagnostic and therapeutic methods used, with postoperative results.

La introducción de cuerpos extraños uretrales es poco frecuente, razón por la cual, la mayoría de las publicaciones disponibles en la literatura son reportes de casos aislados o pequeñas series con gran heterogeneidad. Existen distintas aproximaciones frente a esta afección, desde métodos menos invasivos hasta cirugías abiertas más complejas. Presentamos un caso de cuerpo extraño impactado en uretra bulbar con el objetivo de analizar métodos diagnósticos empleados y aproximaciones terapéuticas concluyendo en la resolución quirúrgica convencional. Se evaluaron resultados postoperatorios.

Open surgery for urethral foreign body / Tratamiento quirúrgico convencional de cuerpo extraño uretral

Abstract The introduction of foreign bodies in the urethra are uncommon. Given its rarity, the approach to this condition is not standardized but it is highlighted that minimally invasive procedures should be prioritized depending on its feasibility. In the present study, we report a case of a 60-year-old male patient with bipolar disorder and a foreign body impacted in the bulbar urethra with open surgical resolution after a failed endoscopic treatment. We perform an analysis into the diagnostic and therapeutic methods used, with postopera tive results.

Resumen La introducción de cuerpos extraños uretrales es poco frecuente, razón por la cual, la mayoría de las publicaciones disponibles en la literatura son reportes de casos aislados o pequeñas series con gran heteroge neidad. Existen distintas aproximaciones frente a esta afección, desde métodos menos invasivos hasta cirugías abiertas más complejas. Presentamos un caso de cuerpo extraño impactado en uretra bulbar con el objetivo de analizar métodos diagnósticos empleados y aproximaciones terapéuticas concluyendo en la resolución quirúrgica convencional. Se evaluaron resultados postoperatorios.

[Active surveillance for testicular tumors: adherence and safety.] / Adherencia y seguridad de la vigilancia activa en tumores de testículo.

INTRODUCTION: The active surveillance (AS) of testicular tumors (seminoma and non-seminoma) is the most frequent management option in the stage I disease. Relapses generally occurred within the first 3 years and <5% appear after this time cut-off point is fulfilled. Therefore, the adherence is one of the most important pillars in the AS protocol. The aim of this study is to evaluate the adherence to the AS protocol in a community hospital and, in turn, evaluate the safety of it emphasizing in the relapse-free rate in patients with and without risk factors. MATERIALS AND METHODS: A retrospective study of all the patients included in the AS protocol with seminoma tumors (ST) or non-seminoma tumors (NST) stage I was performed. Postoperative controls were performed according to the NCCN (National Comprehensive Cancer Network) recommendations. Different variables were taken into account, emphasizing in the risk factors: testicular tumor >4cm and the rete testis invasion in the ST, the linfovascular invasion and the percentage>40% of embrionary carcinoma in the NST. Adherence to the AS protocol was evaluated, focusing on those patients who lost it and what time it occurred. RESULTS: A total of 64 patients were included. The median follow-up was 36 months (IC 21-48 months). 12 patients lost the follow-up during the protocol with a median follow-up of 27.5 months (IC 16-30 months). A 21.8% of patients entered in the AS protocol with some associated risk factor. Adherence follow-up was successful in the first year (96.8%) and decreased over time (92.2% at 24 months and 86.3% at 36 months). CONCLUSION: We presented an important adherence to the AS protocol in patients with clinical stage I testicular cancer and in our series there no recurrences after 36 months of follow-up.

INTRODUCCIÓN: La vigilancia activa (VA) de tumores testiculares seminoma (TS) y no-seminomas (TNS) es en la actualidad, la opción de manejo más frecuente utilizada en tumores testiculares estadio clínico I. Las recaídas dentro de este seguimiento se presentan generalmente dentro de los 3 años y <5% se presentan después de este periodo. La adherencia en la VA termina siendo un pilar fundamental.OBJETIVO: El objetivo de este trabajo es evaluar la adherencia al protocolo de vigilancia activa, y a su vez evaluar la seguridad de esta opción de manejo haciendo hincapié en la tasa libre de recaída en pacientes con y sin factores de riesgo.MATERIALES Y MÉTODOS: Se realizó un estudio retrospectivo de todos los pacientes incluidos en un protocolo de VA (TS y TNS estadio I). Se tomaron en cuenta diferentes variables, realizando hincapié en la evaluación de los diferentes factores de riesgo, tomando como tal en TS al tamaño testicular > de 4 cm y a la invasión de la rete testis en el resultado anatomopatológico. En cuanto a los TNS, la ILV y un porcentaje >40% de CE fueron los factores de riesgo evaluados. Se evaluó la adherencia al seguimiento del protocolo de VA, haciendofoco en aquellos pacientes que se perdieron del mismo y en qué momento ocurrió.RESULTADOS: Un total de 64 pacientes fueron incluidos a protocolo de VA. La mediana de seguimiento fue de 36 meses (IC 21-48 meses). De todos los pacientes incluidos en este estudio, 12 de ellos perdieron el seguimiento durante el esquema propuesto, presentando una mediana de seguimiento de 27,5 meses (IC 16-30 meses). Un 21,8% de pacientes ingresó al protocolo de VA con algún factor de riesgo asociado. La adherencia al seguimiento fue exitosa en el primer año con un porcentaje de adhesión que alcanzó el 96,8% y fue descendiendo con el paso del tiempo (92,2% a los 24 meses y 86,3% a los 36 meses).CONCLUSIÓN: En nuestra serie, se evidenció una marcada adhesión al protocolo de VA en pacientes con diagnóstico de tumor testicular estadio clínico I, sin registrar recurrencias después de los 36 meses de seguimiento.

Adherencia y seguridad de la vigilancia activa en tumores de testículo / Adherence and safety of active surveillance in testicular tumors

Introducción: La vigilancia activa(VA) de tumores testiculares seminoma (TS) y no-seminomas (TNS) es en la actualidad, la opción de manejomás frecuente utilizada en tumores testiculares estadioclínico I. Las recaídas dentro de este seguimiento sepresentan generalmente dentro de los 3 años y <5% sepresentan después de este periodo. La adherencia en laVA termina siendo un pilar fundamental.Objetivo: El objetivo de este trabajo es evaluar la adherencia al protocolo de vigilancia activa, y a su vezevaluar la seguridad de esta opción de manejo haciendo hincapié en la tasa libre de recaída en pacientescon y sin factores de riesgo. Materiales y métodos: Se realizó un estudio retrospectivo de todos los pacientes incluidos en un protocolode VA (TS y TNS estadio I). Se tomaron en cuenta diferentes variables, realizando hincapié en la evaluaciónde los diferentes factores de riesgo, tomando como talen TS al tamaño testicular > de 4 cm y a la invasiónde la rete testis en el resultado anatomopatológico. Encuanto a los TNS, la ILV y un porcentaje >40% de CEfueron los factores de riesgo evaluados. Se evaluó laadherencia al seguimiento del protocolo de VA, haciendo foco en aquellos pacientes que se perdieron del mismo y en qué momento ocurrió.Resultados: Un total de 64 pacientes fueron incluidosa protocolo de VA. La mediana de seguimiento fue de36 meses (IC 21-48 meses). De todos los pacientesincluidos en este estudio, 12 de ellos perdieron el seguimiento durante el esquema propuesto, presentandouna mediana de seguimiento de 27,5 meses (IC 16-30meses). Un 21,8% de pacientes ingresó al protocolo deVA con algún factor de riesgo asociado.La adherencia al seguimiento fue exitosa en el primeraño con un porcentaje de adhesión que alcanzó el96,8% y fue descendiendo con el paso del tiempo(92,2% a los 24 meses y 86,3% a los 36 meses).Conclusión: En nuestra serie, se evidenció una marcada adhesión al protocolo de VA en pacientes con...(AU)

Introduction: The active surveillance(AS) of testicular tumors (seminoma and non-seminoma)is the most frequent management option in the stageI disease. Relapses generally occurred within the first3 years and <5% appear after this time cut-off pointis fulfilled. Therefore, the adherence is one of the mostimportant pillars in the AS protocol. The aim of this studyis to evaluate the adherence to the AS protocol in acommunity hospital and, in turn, evaluate the safety of itemphasizing in the relapsefree rate in patients with andwithout risk factors.Materials and methods: A retrospective study ofall the patients included in the AS protocol with seminoma tumors (ST) or non-seminoma tumors (NST) stage Iwas performed. Postoperative controls were performedaccording to the NCCN (National ComprehensiveCancer Network) recommendations. Different variableswere taken into account, emphasizing in the risk factors:testicular tumor >4cm and the rete testis invasion in theST, the linfovascular invasion and the percentage>40%of embrionary carcinoma in the NST. Adherence to theAS protocol was evaluated, focusing on those patientswho lost it and what time it occurred.Results: A total of 64 patients were included. Themedian follow-up was 36 months (IC 21-48 months).12 patients lost the follow-up during the protocol with amedian follow-up of 27.5 months (IC 16-30 months). A21.8% of patients entered in the AS protocol with someassociated risk factor.Adherence follow-up was successful in the first year(96.8%) and decreased over time (92.2% at 24 monthsand 86.3% at 36 months).Conclusion: We presented an important adherence to the AS protocol in patients with clinical stage Itesticular cancer and in our series there no recurrencesafter 36 months of follow-up.(AU)

Antegrade Ejaculation Preservation Technique with GreenLight XPS 180-W: Functional Ejaculatory Results.

Introduction: Ejaculatory dysfunction is a common complication of surgeries for benign prostatic obstruction. It causes a clear deterioration in quality of life. Techniques have been developed to attempt to preserve antegrade ejaculation (AE). Our objective was to analyze results of ejaculatory function using an AE preservation technique during anatomical vaporization with XPS 180-W. Methods: Between 2017 and 2019, sexually active patients were treated using this technique by the same surgical team. A questionnaire (MSHQ-EjD Short Form) was mailed, patients who did not answer were contacted by phone or personally during follow-up. Responses were analyzed. Voiding function was evaluated using International Prostatic Symptoms Score (IPSS), Qmax, and postvoid residual volume. t-Test for paired samples was used to compare conformity of patients with and without AE and voiding results. A p < 0.05 was considered statistically significant. Results: In total, 77 of 112 patients (68.8%) completed questionnaires and were included. Mean age was 64.1 years (standard deviation [SD] 6.9) and median prostate size was 57.2 g (interquartilic range 30-85). A total of 68 of 77 (88.3%) patients reported AE. Of these, 58 (85.3%) reported AE always or most of the time and 10 (14.7%) reported AE half of the time. In total, 42 (61.7%) patients had preserved strength or slightly less than before the procedure, and 33 (48.5%) reported the same or slightly less volume than before. In terms of satisfaction, the average response values of patients with preserved AE and ejaculatory disfunction were 0.97 (SD 1.12) and 2.7 (SD 1.78), respectively (p = 0.000). Pre- and postoperative variables were as follows: mean Qmax was 11.6 mL/sec vs 19.6 (p = 0.00), mean IPSS was 13.8 vs 8.9 (p = 0.000), and mean postvoiding residual urine was 125.3 vs 33.1 mL (p = 0.00), respectively. Conclusion: It is feasible to perform the AE preservation technique with anatomical vaporization XPS 180-W. In our medium size prostate series, we had a satisfactory patient perception of the ejaculatory function and satisfactory voiding function results.

Individual patient risk of progression of urinary bladder papillary tumors estimated from biomarkers at initial transurethral resection of bladder tumor.

OBJECTIVE: To determine if individual, instead of group, patient progression risk could be predicted using p53, Ki67 and CK20 biomarker percentage values at initial transurethral resection of bladder tumor specimens. METHODS: This was an observational study where biomarkers were measured with no knowledge of tumor outcome. Initial bladder tumor specimens were classified as non-invasive and invasive to sub-epithelium (pT1). Percentages of stained biomarker cells were tested as progression predictors from non-invasive to pT1 and pT1 to pT2. Progression probability was correlated with biomarker percentages resulting in a regression equation. RESULTS: We studied 112 patients (median age = 67, range 37-91, males 83/112 (73%), with median follow-up of 39 months (range 1.7-140). Mean biomarker values were higher in stage pT1 than in non-invasive (all p < 0.001). Cut-off points separating progression from non-progression groups in stage pT1 were higher than in non-invasive for all biomarkers. Correlation R values for progression probability vs. biomarker percentages varied from 0.7 to 0.9 (all p < 0.001), regression slopes from 0.1 to 0.8 and intercepts from 11 to 35. A novel individual progression probability was calculated as the product of biomarker percentage of stained cells and slope, plus the prevalence-adjusted intercept. CONCLUSIONS: Identification of individual risk of progression in patients with non-muscle-invasive bladder tumors was possible using p53- and Ki67-derived progression probability using a regression equation. Combining biomarker-derived progression probability to tumor stage pT1 improves progression to pT2 predictive accuracy.

Laparoscopic partial nephrectomy using the Simon clamp: our experience in 18 cases. / Clamp de Simon para nefrectoméa parcial laparoscópica, nuestra experiencia en 18 casos.

OBJECTIVE: Kidney tumors represent 2- 3% of adult tumors. Partial nephrectomy is the standard of care for the treatment of localized tumors. Minimizing ischemia time is critical for postoperative renal function. The aim of this paper is to present our experience in laparoscopic partial nephrectomy with selective renal parenchymal compression using the Simon clamp. METHODS: We analyzed the record of patients that underwent surgery for renal tumors between January 2011 and June 2016 at our institution. Cases treated conwith this technique were selected. Demographic variables, operative, and postoperative outcomes were analyzed. RESULTS: 323 nephrectomies were performed and 18 cases treated with this technique were analyzed. Average age was 56.27 years (34- 75) with 10 female cases. BMI was 25.01 kg/m2 (21.2- 34.3). 17 cases were lower pole and one upper pole with 11 right and 7 left. Average surgical time was 83.25 minutes (43- 120); renal ischemia time was 21.36 minutes (12- 40) with an estimated blood loss of 91 ml (0- 400). Average tumor diameter was 2.6 cm (1.8 to 5.3). Glomerular filtration rate preoperative and immediate postoperative was 83 ml/min and 87 ml/min (p=0.42) respectively. Average length of stay was 2.75 days (1- 7). All cases had negative margins. With a mean follow up of 23.1 months (1- 58) no recurrences were observed. CONCLUSIONS: Laparoscopic partial nephrectomy using the Simon clamp for vascular control is a feasible technique for selected cases with polar exophytic tumors. Immediate postoperative glomerular filtration rate showed no significant changes and oncological control in our experience was satisfactory.

Clamp de Simon para nefrectomía parcial laparoscópica, nuestra experiencia en 18 casos / Laparoscopic partial nephrectomy using the Simon clamp: our experience in 18 cases

Objetivo: Los tumores renales representan el 2-3% de los tumores del adulto. La nefrectomía parcial es el gold standard para el tratamiento de los tumores localizados. Minimizar el tiempo de isquemia es determinante para la función renal posoperatoria. El objetivo de este trabajo es presentar nuestra experiencia en nefrectomía parcial laparoscópica con compresión selectiva del parénquima renal utilizando el clamp de Simon. Métodos: Se realizó una revisión de los pacientes con tumor renal operados entre enero de 2011 y junio 2016 en esta institución. Se seleccionaron los casos tratados con esta técnica. Se analizaron variables demográficas, operatorias, posoperatorias y resultados. Resultados: Se realizaron 323 nefrectomías y se analizaron los 18 casos tratados con esta técnica. La edad promedio fue 56,27 años (34-75) con 10 casos de sexo femenino. El Índice de masa corporal fue 25,01 kg/m2 (21,2-34,3). 17 casos fueron de polo inferior y uno de polo superior con 11 derechos y 7 izquierdos. El tiempo quirúrgico promedio fue 83,25 minutos (43-120); tiempo de isquemia renal de 21,36 minutos (12-40) y sangrado estimado promedio de 91 ml (0-400). El diámetro tumoral promedio fue 2,6 cm (1,8 a 5,3). La tasa de filtrado glomerular preoperatoria y posoperatoria inmediata fue 83 ml/min y 87 ml/min (p=0,42). El tiempo medio de internación fue 2,75 días (1-7). Todos los casos presentaron márgenes negativos. Con un seguimiento medio de 23,1 meses (1-58) no se observaron recidivas. Conclusiones: La nefrectomía parcial laparoscópica utilizando el clamp de Simon para control vascular es una técnica factible para casos seleccionados con tumores exofíticos polares. La tasa de filtrado glomerular posoperatoria inmediata no presentó modificaciones significativas y el control oncológico fue satisfactorio (AU)

Objetive: Kidney tumors represent 2-3% of adult tumors. Partial nephrectomy is the standard of care for the treatment of localized tumors. Minimizing ischemia time is critical for postoperative renal function. The aim of this paper is to present our experience in laparoscopic partial nephrectomy with selective renal parenchymal compression using the Simon clamp. Methods: We analyzed the record of patients that underwent surgery for renal tumors between January 2011 and June 2016 at our institution. Cases treated conwith this technique were selected. Demographic variables, operative, and postoperative outcomes were analyzed. Results: 323 nephrectomies were performed and 18 cases treated with this technique were analyzed. Average age was 56.27 years (34-75) with 10 female cases. BMI was 25.01 kg/m2 (21.2-34.3). 17 cases were lower pole and one upper pole with 11 right and 7 left. Average surgical time was 83.25 minutes (43- 120); renal ischemia time was 21.36 minutes (12-40) with an estimated blood loss of 91 ml (0-400). Average tumor diameter was 2.6 cm (1.8 to 5.3). Glomerular filtration rate preoperative and immediate postoperative was 83 ml/min and 87 ml/min (p=0.42) respectively. Average length of stay was 2.75 days (1-7). All cases had negative margins. With a mean follow up of 23.1 months (1-58) no recurrences were observed. Conclusions: Laparoscopic partial nephrectomy using the Simon clamp for vascular control is a feasible technique for selected cases with polar exophytic tumors. Immediate postoperative glomerular filtration rate showed no significant changes and oncological control in our experience was satisfactory (AU)

Laparoscopic partial nephrectomy with selective polar clamping using the simon clamp: initial experience.

OBJECTIVE: To report our initial experience in 3 cases of laparoscopic partial nephrectomy with selective parenchymal clamping using a novel laparoscopic clamp. METHODS: A total of 3 laparoscopic partial nephrectomies were performed using the Simon clamp (Aesculap). Mean patient age was 67 years (range 60 to 74 years), two patients were males. All patients had an ASA score of 2. Mean tumor size was 2.2 cm (range 2 to 2.4 cm) and all tumors were of the lower pole. Two tumors were on the right kidney and one on the left kidney. RESULTS: Mean operative time was 100 minutes (range 70 to 120 min). Mean operative bleeding was 16 ml (range 0 to 50 ml). Mean warm ischemia time of the renal pole was 33 minutes (range 30 to 40 min). All patients were discharged on postoperative day 2. There was no intra or postoperative complications. Surgical margins were negative in all cases. CONCLUSION: The Simon clamp allows for tumor resection without bleeding and for renal defect repair without collateral renal injury. We hope that in the future the development of other instruments will allow for selective clamping in any tumor location.

Nefrectomía parcial laparoscópica con clampaje selectivo polar utilizando Clamp de Simon: experiencia inicial / Laparoscopic partial nephrectomy with selective polar cplamping using the Simon Lamp: Initial experience

OBJETIVO: Presentar nuestra experiencia inicial en tres casos en los cuales se realizó el clampaje selectivo del polo inferior renal mediante la utilización de un novedoso clamp laparoscópico. MÉTODO: Se realizaron tres nefrectomías laparoscópicas parciales utilizando el clamp de Simon, evitando realizar el clampaje hiliar. Los pacientes presentaron una edad promedio de 67 años (rango 60 a 74 años) dos pacientes eran masculinos. Todos presentaban un riesgo anestésico ASA II. El tamaño tumoral promedio fue de 2.2 cm (rango 2 a 2.4 cm) y todos los tumores eran de polo inferior. Dos tumores eran derechos y uno izquierdo. RESULTADO: El tiempo operatorio promedio fue de 100 minutos (rango 70 a 120 min). El sangrado promedio fue de 16 ml (rango 0 a 50 ml). El tiempo promedio de isquemia caliente del polo clampado fue de 33 minutos (rango 30 a 40 min). Todos los pacientes fueron dados de alta al segundo día postoperatorio. No hubo complicaciones peri ni post operatorias. Todos los márgenes quirúrgicos fueron negativos. CONCLUSIÓN: El clamp de Simon permite una resección tumoral sin sangrado y una reparación del lecho tumoral en ausencia de daño renal colateral. Esperamos que en un futuro se desarrollen otros tipos de instrumentos que permitan la aplicación del clampaje selectivo a cualquier situación tumoral(AU)

OBJECTIVE: To report our initial experience in 3 cases of laparoscopic partial nephrectomy with selective parenchymal clamping using a novel laparoscopic clamp. METHODS: A total of 3 laparoscopic partial nephrectomies were performed using the Simon clamp (Aesculap). Mean patient age was 67 years (range 60 to 74 years), two patients were males. All patients had an ASA score of 2. Mean tumor size was 2.2 cm (range 2 to 2.4 cm) and all tumors were of the lower pole. Two tumors were on the right kidney and one on the left kidney. RESULTS: Mean operative time was 100 minutes (range 70 to 120 min). Mean operative bleeding was 16 ml (range 0 to 50 ml). Mean warm ischemia time of the renal pole was 33 minutes (range 30 to 40 min). All patients were discharged on postoperative day 2. There was no intra or postoperative complications. Surgical margins were negative in all cases. CONCLUSION: The Simon clamp allows for tumor resection without bleeding and for renal defect repair without collateral renal injury. We hope that in the future the development of other instruments will allow for selective clamping in any tumor location(AU)

[Laparoscopic radical cystectomy with vaginal specimen extraction. Case report]. / Cistectomía radical laparoscópica con extracción de pieza por vagina. Caso clínico.

OBJECTIVE: To report a case of laparoscopic radical cystectomy and pelvic lymphadenectomy with vaginal extraction of the surgical specimen in an elderly patient with muscle invasive bladder tumor. METHOD: A 78 year old patient with history of hematuria was diagnosed of muscle invasive bladder cancer. Laparoscopic radical cystectomy and pelvic lymphadenectomy with vaginal extraction of the surgical specimen was performed without incident. RESULTS: Operative time was 240 minutes, surgical bleeding was 200 ml and hospital stay 8 days. The patient evolved uneventfully and remains disease free after 9 months of follow-up. CONCLUSION: Laparoscopic radical cystectomy provides adequate oncologic results with decreased morbidity, making this surgery an attractive alternative for the management of patients in a delicate condition.

Cistectomía radical laparoscópica con extracción de pieza por vagina. Caso clínico / Laparoscopic radical cystectomy with vaginal specimen extraction. Case report

OBJETIVO: Presentar la utilidad de una técnica minimamente invasiva como herramienta terapéutica en el tratamiento de un paciente de edad avanzada portador de cáncer de vejiga musculoinvasor.MÉTODO: Paciente femenina de 78 años con cáncer de vejiga avanzado que debuta con hematuria. Se realiza cistectomía radical con linfadenectomía pelviana por vía laparoscópica con extracción de pieza quirúrgica por vía vaginal. RESULTADOS: El tiempo operatorio fue de 240 minutos con un sangrado de 200 ml y una estadía hospitalaria de 8 días. La paciente evolucionó favorablemente y tras un seguimiento de 6 meses se encuentra sin evidencia de recidiva tumoral.CONCLUSIÓN: El bajo impacto quirúrgico permite que este abordaje pueda ser utilizado en casos seleccionados para evitar la severa morbilidad indefectiblemente asociada a la progresión local del cáncer de vejiga avanzado(AU)

OBJECTIVE: To report a case of laparoscopic radical cystectomy and pelvic lymphadenectomy with vagi-nal extraction of the surgical specimen in an elderly patient with muscle invasive bladder tumor.METHOD: A 78 year old patient with history of hematuria was diagnosed of muscle invasive bladder cancer. Lapa-roscopic radical cystectomy and pelvic lymphadenectomy with vaginal extraction of the surgical specimen was performed without incident.RESULTS: Operative time was 240 minutes, surgical blee-ding was 200 ml and hospital stay 8 days. The patient evolved uneventfully and remains disease free after 9 months of follow-up.CONCLUSION: Laparoscopic radical cystectomy provides adequate oncologic results with decreased morbidity, making this surgery an attractive alternative for the management of patients in a delicate condition(AU)