[Transperitoneal laparoscopic adrenalectomy]. / Suprarrenalectomía laparoscópica transperitoneal.

OBJECTIVES: To present our results with transperitoneal laparoscopic adrenalectomy after completion of 70 procedures. MATERIAL AND METHODS: Between July 2002 and December 2010, transperitoneal laparoscopic adrenalectomy was performed in 70 patients with the following diagnoses: Conn syndrome (22 cases), nonfunctioning adenomas (18), Cushing syndrome (10), pheochromocytomas (7), myelolipomas (4), metastasis after treatment of primary nonadrenal tumors (6), ganglioneuroma (1), adrenal gland hematoma (1) and adrenal carcinoma (1). We describe the size, surgical and hospitalization times, blood loss, need for transfusion, surgical complications and rate of conversion to open surgery. RESULTS: Of 70 patients, 35 were men and 35 women (1:1) with a mean age of 58.2 years (range, 82.2- 29.1). The most common site was left (58%) compared to right (42%). The mean size of the surgical specimen was 5.11 cm, mean surgical time was 119.2 minutes (50-240) and mean operative bleeding was 140.6 (30-800) cc. Only 3 patients required blood transfusion. The mean time until oral feeding was 17 hours, and the mean hospital stay was 4.3 (2-15) days. Complications included 2 cases of surgical infections, 1 of prolonged paralytic ileus, and 1 of splenic laceration and 1 of intestinal perforation which both which required reconversion to open surgery (4.28%). CONCLUSIONS: Laparoscopic adrenalectomy is a safe procedure, with a low percentage of complications and a short hospital stay. The choice of this approach will depend on the surgeon's experience with the lesion etiology and size in each case.

[Ureterocalicostomy: a forgotten surgical technique?]. / La ureterocalicostomía: ¿una cirugía olvidada?

INTRODUCTION: ureterocalicostomy is a surgical technique that is rarely indicated and that urologists currently apply very occasionally. MATERIALS AND METHOD: a patient with a right pyelical retraction cicatricial process, which resulted in obstructive uropathy of the upper and mid caliceal system, excluding the lower caliceal system is presented. We performed a surgical exploration and ureterocalicostomy with successful result. In the very long term, the patient is cured and has normal kidney functionalism. RESULTS: we present the technical results of the surgery and, from a present-day perspective, we review the indications of this technique and the determining factors required to obtain good results. CONCLUSION: ureterocalicostomy is a technique that present-day urologists have almost forgotten, which still maintains some indications and premises effective. For this reason, urologists dedicated to reconstructive surgery must know this technique and include it in their surgical arsenal.

[Quality of life in patients with urinary incontinence]. / Calidad de vida en las pacientes con incontinencia urinaria.

OBJECTIVE: To assess the quality of life of female patients with urinary stress incontinence (USI) who were attended at the urology department of the University Hospital at Albacete. METHOD: Between November 2001 and December 2005, 126 patients with USI were surveyed in our hospital using the King's Health Questionnaire (KHQ), which is a specific instrument to measure the quality of life among female patients with urinary incontinence (UI). RESULTS: The mean age of patients was 57.09 años (SD: 9.57) and the mean BMI was 28.14 Kg/m2 (SD: 4.66). The mean evolution of UI was 114.48 months, with a median of 96 months. During the last week of the study period, a total of 73 women (57.94%) had more than 10 urine leaks a day. As regards the number of sanitary towels used a day, 82.5% (104 cases) stated they used less than 6. The urodynamic diagnosis was described as normal in 8 cases (6.3%), 16 cases (12.7%) were diagnosed as mixed urinary incontinence and, finally, 102 cases (81%) suffered genuine USI. The best scores were presented in the Personal Relationships scale with a mean score of 26.8, whereas the worse scores were noted in that of Impact of Urinary Incontinence, whose mean score was 82.96. Generally, the lowest scores (better quality of life) were obtained in the youngest age groups. Scores in the scales of General Health, Impact on daily activities, Impact on physical activity, Impact on social activity and Emotions, were significantly higher in patients who had undergone a histerectomy. Patients whose evolution of urinary incontinence was longer presented lower scores in the Personal Relationships scale (r=0.179; p=0.045). CONCLUSIONS: The quality of life of female patients with U.I. is affected, which limits both their physical activity and image. Their quality of life worsens with age, a greater extent of incontinence, greater urinary symptomatology and when episodes of urinary infection are associated.

Factors determining analgesic and sedative drug requirements during extracorporeal shock wave lithotripsy.

PURPOSE: The aim of this study was to determine what factors influence the analgesic and sedative requirements during extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: A retrospective study was carried out on 2,103 lithotripsy treatments performed over a 7-year period using an electromagnetic lithotriptor. Treatment with analgesics and anxiolytic drugs administered during ESWL was evaluated, and two new variables to determine the analgesic and sedative requirements were defined. A multivariant analysis model was established to determine which variables are related to or could predict the analgesic and/or sedative drug requirements. RESULTS: The most frequently used sedative drug was potassium chlorazepate which was used in 2,059 patients at a mean total dose of 25.6 mg. Pethidine was used in 2, 006 patients at a mean total dose of 56.3 mg, and fentanyl in 995 patients at a dose of 93.3 microg. In 52.4% of patients analgesic requirements were low, and in 76.6% sedative requirements were low. In 21.1% of patients analgesic drug requirements were high, and in 1. 8% of patients sedative drug requirements were high. The multivariant analysis showed that those requiring most analgesics were, the younger patients (p = 0.003), those who received a higher number of shock waves (p < 0.001) and those who needed more sedation (p < 0.001). Those who received the greatest amount of sedatives were women (p = 0.0026); younger patients (p < 0.001); those treated with higher voltages (p = 0.032), and patients with the highest analgesic requirements (p < 0.001). CONCLUSIONS: Predicting the analgesic drug requirements prior to ESWL is very difficult. The present study shows that young age, a greater discharge of shock waves and a high sedative drug requirement are factors clearly related to greater analgesic drug requirements. Higher sedative drug requirements are needed by women, younger patients, those receiving high discharge voltages and those with higher analgesic requirements.

[Kock's ileal reservoir: clinical course and current experience with 73 patients]. / El reservorio ileal de Kock: evolución y experiencia actual en 73 pacientes.

Between October 1985 and December 1993 a total of 73 patients underwent surgery for Kock's ileal reservoir (as continent urostomy in 23 patients, orthotopic vesical substitution in 36, ileo-anal reservoir in 8, and enterocystoplasty for vesical expansion [hemiKock] in 6). Overall post-operative mortality was 5.4% (3 cases in continent urostomy and 1 in pelvic-urethral reservoir). A total of 58 patients were controlled at medium and long term. In continent urostomy early complications represented 17.3%, similar to those in pelvic-urethral (16%). Late complications of continent stoma were 35% with 25% re-operations achieving complete continence in 70% of cases. In the pelvic-urethral procedure, late complications were 22.8% with 11.4% of re-operations with complete daytime continence in 82% of patients during the day and only 54% during the night. Best results for continence were obtained with the ileo-anal reservoir (functional rectosigmoid neo-bladder): 100% during the day and 87.5% during the night. Currently, a large number of patients can preserve urinary continence after radical pelvic surgery or in severe vesical dysfunctions with urinary incontinence which can not be solved using other alternatives.

[Spleno-gonadal fusion: a clinical case]. / Fusión espleno-gonadal: caso clínico.

The presence of splenic tissue in the scrotum, creating a spleno-gonadal fusion, is a very rare condition within benign intra-scrotal tumours. Accidental discovery in a 68 year-old male following histopathological study allows us to make a few considerations and review the literature.