Multicenter retrospective study on benign testicular tumors in children: save as much as you can please.

BACKGROUND: Testicular tumors (TT) are infrequent in pediatric patients, representing 1% of pediatric solid tumors; benign testicular tumors (BTT) are the most common. We present a multicenter study aiming to describe the incidence, histology and surgical technique of BTT, with special emphasis on which approach could present better outcomes. METHODS: The records of pediatric patients diagnosed with BTT between 2005 and 2020 from 8 centers in 5 different countries in Latin-America, were reviewed. RESULTS: Sixty two BTTs were identified. 73% tumors presented as a testicular mass, and 97% underwent testicular ultrasound as the initial imaging study, all of them had findings suggestive of a benign tumor. 87% had preoperative tumor markers (AFP and BHCG). In 66%, an intraoperative biopsy was done and 98% of the intraoperative biopsies were concordant with the final pathology report. Tumorectomy was performed in 81% of patients and total orchiectomy in the remaining 19%. Six percentage of patients underwent a subsequent orchiectomy. Mean follow-up was 39 months (1-278 months) where no cases of atrophy were observed clinically or on ultrasound. Fertility was not evaluated in this series. CONCLUSIONS: Proper management of BTTs is essential to avoid unnecessary orchiectomies. Preoperative ultrasound associated with intraoperative biopsy seems accurate in identifying benign pathology, thus enabling conservative testicular surgery with safety margins. Based on this multicenter series, we suggest performing an intraoperative biopsy with subsequent tumorectomy preserving healthy testicular tissue in BTT.

Effect of Antibiotic Prophylaxis on Infectious Complications in Patients with Asymptomatic Bacteriuria Undergoing Urologic Surgery / Efecto de la profilaxis antibiótica sobre las complicaciones infecciosas en pacientes con bacteriuria asintomática programados a cirugía urológica

Objectives To identify the effect of duration of surgical antibiotic prophylaxis (SAP) and other variables on infectious postsurgical complications in patients with asymptomatic bacteriuria (ASB) undergoing urological surgery. Methods We conducted an observational study of a cohort of patients with ASB scheduled for urologic surgery at three health service providers in Colombia. The study population comprised all patients with planned urologic surgery who had ASB prior to surgery from April 2018 to January 2019. The intervention evaluated was the duration of preoperative SAP, and the outcome variable was the development of any postoperative infectious complications for up to 30 days after the procedure. Results The present study included 184 patients with ASB scheduled for urologic surgery. The median duration of preoperative SAP (p = 0.49) or of 1 dose SAP (risk ratio [RR] = 1.24; 95% confidence interval [CI]: 0.45­3.39) were not statistically different in patients with postsurgical infectious complications. Infectious complications were more frequent among patients with benign prostatic hyperplasia (RR = 6.57; 95%CI: 1.98­21.76) and hospitalization in the preceding 3 months (RR = 8.32; 95%CI: 2.69­25.71). Conclusion One dose of antimicrobial therapy is sufficient to avoid infectious complications in patients with ASB. There were other factors associated with postsurgical infectious complications, such as benign prostatic hyperplasia and hospitalization in the preceding 3 months.

Objetivos Identificar el efecto de la duración de la profilaxis antibiótica quirúrgica (PAQ) y otras variables sobre las complicaciones infecciosas posquirúrgicas en pacientes con bacteriuria asintomática (BA) sometidos a cirugía urológica. Métodos Se realizó un estudio observacional de una cohorte de pacientes con BA programados para cirugía urológica en tres instituciones de salud en Colombia. La población de estudio comprendió a todos los pacientes programados para cirugía urológica y con BA en el periodo de Abril del 2018 a Enero 2019. La intervención evaluada fue la duración de la PAQ preoperatoria, y la variable de resultado fue el desarrollo de cualquier complicación infecciosa posoperatoria hasta 30 días después del procedimiento. Resultados El estudio incluyó a 184 pacientes con BA programados para cirugía urológica. La mediana de duración de la PAQ preoperatoria (p = 0,49) o 1 dosis de PAQ (razón de riesgo [RR]: 1,24; intervalo de confianza [IC] del 95%: 0,45 a 3,39) no fueron estadísticamente diferentes en pacientes con complicaciones infecciosas posquirúrgicas. Las complicaciones infecciosas fueron más frecuentes entre los pacientes con hiperplasia prostática benigna (RR: 6,57; IC del 95%: 1,98 a 21,76) y hospitalización en los 3 meses anteriores (RR: 8,32; IC del 95%: 2,69 a 25,71). Conclusión Una dosis de terapia antimicrobiana es suficiente para evitar complicaciones infecciosas en pacientes con BA. Hubo otros factores asociados con complicaciones infecciosas posquirúrgicas, como hiperplasia prostática benigna y hospitalización en los tres meses anteriores.

Cambios fisiológicos y consideraciones anestésicas en cirugía robótica no cardíaca / Physiological changes and anaesthetic considerations in non-cardiac robotic surgery

Resumen: La cirugía robótica ofrece numerosas ventajas sobre la cirugía laparoscópica convencional y la cirugía abierta. El anestesiólogo debe conocer los cambios que suceden en el paciente al ser sometido a cirugía robótica en el campo de la ginecología, urología, cirugía general, torácica y transoral. Los cambios fisiológicos son múltiples e involucran todos los sistemas: cardiovascular, respiratorio, neurológico, digestivo, renal; por lo que es de suma importancia el conocimiento de éstos para evitar complicaciones durante el período perioperatorio. De igual manera, es importante conocer el protocolo de seguridad para el retiro de los brazos del robot al verse con la necesidad de convertir la cirugía a laparoscópica o abierta. Se resumen las principales consideraciones anestésicas así como los cuidados específicos que el anestesiólogo debe tener durante cirugía robótica no cardíaca.

Abstract: Robotic surgery offers numerous advantages over conventional laparoscopic or open surgery. The anesthesiologist must have full knowledge of the physiological changes that happen when the patient undergoes robotic surgery; it being gynecological, urological, general surgery, thoracic or trans-oral surgery. There are multiple changes during robotic surgery involving the cardiovascular, respiratory, neurologic, digestive and renal systems. It is of utter importance the full knowledge of these changes in order to avoid complications during and after surgery. Also, it is important to fully know the emergency protocol for undocking if need be, to convert to laparoscopic or open surgery. We have summarized the main anesthetic considerations as well as the key points of care anesthesiologists must have during non-cardiac robotic surgery.

Anesthetic management of a patient with multiple sclerosis - case report / Controle anestésico de paciente com esclerose múltipla - relato de caso

Abstract Background and objectives: Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, and hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. Case report: A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively. Conclusion: The use of neuromuscular blockers (depolarizing and non-depolarizing) is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.

Resumo Justificativa e objetivos: Esclerose múltipla é doença desmielinizante do cérebro e da medula espinhal, caracterizada por fraqueza muscular, disfunção cognitiva, perda da memória, alterações de personalidade. Fatores que promovem exacerbação da doença são estresse, trauma físico, infecções, cirurgias, hipertermia. O objetivo é descrever a abordagem anestésica de um caso encaminhado a cirurgia urológica. Relato de caso: Paciente do sexo feminino, 44 anos, portadora de esclerose múltipla, com o diagnóstico de nefrolitíase, é encaminhada a ureterolitotripsia endoscópica. Optou-se por anestesia geral balanceada com midazolam, propofol e remifentanil em infusão alvo-controlada, sevoflurano sob máscara laríngea e ventilação espontânea. Tendo apresentado dificuldade ventilatória por tórax rígido, optou-se por interromper a infusão de remifentanil. Não se registraram outras intercorrências nem exacerbação da doença no pós-operatório. Conclusão: O uso de bloqueadores neuromusculares (tanto despolarizantes como não-despolarizantes) constitui um problema nestes pacientes. Como não havia necessidade de relaxamento muscular neste caso, eles foram omitidos. Concluímos que a associação de propofol e sevoflurano foi satisfatória, não resultando em instabilidade hemodinâmica nem exacerbação da doença.

Anesthetic management of a patient with multiple sclerosis - case report.

BACKGROUND AND OBJECTIVES: Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, and hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. CASE REPORT: A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively. CONCLUSION: The use of neuromuscular blockers (depolarizing and non-depolarizing) is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.

[Anesthetic management of a patient with multiple sclerosis - case report]. / Controle anestésico de paciente com esclerose múltipla - relato de caso.

BACKGROUND AND OBJECTIVES: Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. CASE REPORT: A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively. CONCLUSION: The use of neuromuscular blockers (depolarizing and non-depolarizing) is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.

Laparoscopic-assisted prepubic urethrostomy in a cat with urethral stenosis / Uretrostomia pré-púbica videoassistida em um felino com estenose uretral

Urethrostomy is a surgical technique used in cases of partial or total obstruction of the urethra, and the laparoscopic approach may be a treatment option. Due to the scarcity of studies involving the technique, this paper reports the case of laparoscopic-assisted pre-pubic urethrostomy (hybrid laparoscopic) in a cat with urethral stricture. A five-years-old cat presenting recurrent feline lower urinary tract disease (FLUTD) had undergone to perineal urethrostomy two years and nine months ago. After this procedure, the patient underwent another four corrective surgeries without success. Laboratory tests (blood count and biochemical) and image diagnosis were realized. The patient was subjected to laparoscopic-assisted pre-pubic urethrostomy and it was achieved therapeutic success and adequate patient quality of life. It is concluded that this technique is feasible and safe in cats, making it a possible choice of surgical treatment for urethral stricture.(AU)

A uretrostomia é técnica cirúrgica utilizada em casos de obstrução parcial ou total da uretra, e na abordagem laparoscópica pode ser uma opção de tratamento. Devido à escassez de estudos envolvendo essa técnica, este trabalho relata o caso de uretrostomia pré-púbica videoassistida (laparoscópica híbrida) em um felino com estenose uretral. O paciente de cinco anos de idade apresentando histórico de doença do trato urinário inferior dos felinos (DTUIF) recorrente, havia sido submetido a uretrostomia perineal há dois anos e nove meses. Depois desse procedimento, o paciente passou por mais quatro cirurgias corretivas sem sucesso. Após realização de exames laboratoriais (hemograma e bioquímicos) e de imagem, o animal foi submetido a uretrostomia pré-púbica laparoscópica híbrida, obtendo-se sucesso terapêutico e possibilitando ao paciente adequada qualidade de vida. Conclui-se que esta técnica é viável e segura em gatos, tornando-a uma possível escolha de tratamento cirúrgico para estenose uretral.(AU)

Laparoscopic-assisted prepubic urethrostomy in a cat with urethral stenosis / Uretrostomia pré-púbica videoassistida em um felino com estenose uretral

Urethrostomy is a surgical technique used in cases of partial or total obstruction of the urethra, and the laparoscopic approach may be a treatment option. Due to the scarcity of studies involving the technique, this paper reports the case of laparoscopic-assisted pre-pubic urethrostomy (hybrid laparoscopic) in a cat with urethral stricture. A five-years-old cat presenting recurrent feline lower urinary tract disease (FLUTD) had undergone to perineal urethrostomy two years and nine months ago. After this procedure, the patient underwent another four corrective surgeries without success. Laboratory tests (blood count and biochemical) and image diagnosis were realized. The patient was subjected to laparoscopic-assisted pre-pubic urethrostomy and it was achieved therapeutic success and adequate patient quality of life. It is concluded that this technique is feasible and safe in cats, making it a possible choice of surgical treatment for urethral stricture.

A uretrostomia é técnica cirúrgica utilizada em casos de obstrução parcial ou total da uretra, e na abordagem laparoscópica pode ser uma opção de tratamento. Devido à escassez de estudos envolvendo essa técnica, este trabalho relata o caso de uretrostomia pré-púbica videoassistida (laparoscópica híbrida) em um felino com estenose uretral. O paciente de cinco anos de idade apresentando histórico de doença do trato urinário inferior dos felinos (DTUIF) recorrente, havia sido submetido a uretrostomia perineal há dois anos e nove meses. Depois desse procedimento, o paciente passou por mais quatro cirurgias corretivas sem sucesso. Após realização de exames laboratoriais (hemograma e bioquímicos) e de imagem, o animal foi submetido a uretrostomia pré-púbica laparoscópica híbrida, obtendo-se sucesso terapêutico e possibilitando ao paciente adequada qualidade de vida. Conclui-se que esta técnica é viável e segura em gatos, tornando-a uma possível escolha de tratamento cirúrgico para estenose uretral.

Laparoscopic-assisted prepubic urethrostomy in a cat with urethral stenosis / Uretrostomia pré-púbica videoassistida em um felino com estenose uretral

Urethrostomy is a surgical technique used in cases of partial or total obstruction of the urethra, and the laparoscopic approach may be a treatment option. Due to the scarcity of studies involving the technique, this paper reports the case of laparoscopic-assisted pre-pubic urethrostomy (hybrid laparoscopic) in a cat with urethral stricture. A five-years-old cat presenting recurrent feline lower urinary tract disease (FLUTD) had undergone to perineal urethrostomy two years and nine months ago. After this procedure, the patient underwent another four corrective surgeries without success. Laboratory tests (blood count and biochemical) and image diagnosis were realized. The patient was subjected to laparoscopic-assisted pre-pubic urethrostomy and it was achieved therapeutic success and adequate patient quality of life. It is concluded that this technique is feasible and safe in cats, making it a possible choice of surgical treatment for urethral stricture.

A uretrostomia é técnica cirúrgica utilizada em casos de obstrução parcial ou total da uretra, e na abordagem laparoscópica pode ser uma opção de tratamento. Devido à escassez de estudos envolvendo essa técnica, este trabalho relata o caso de uretrostomia pré-púbica videoassistida (laparoscópica híbrida) em um felino com estenose uretral. O paciente de cinco anos de idade apresentando histórico de doença do trato urinário inferior dos felinos (DTUIF) recorrente, havia sido submetido a uretrostomia perineal há dois anos e nove meses. Depois desse procedimento, o paciente passou por mais quatro cirurgias corretivas sem sucesso. Após realização de exames laboratoriais (hemograma e bioquímicos) e de imagem, o animal foi submetido a uretrostomia pré-púbica laparoscópica híbrida, obtendo-se sucesso terapêutico e possibilitando ao paciente adequada qualidade de vida. Conclui-se que esta técnica é viável e segura em gatos, tornando-a uma possível escolha de tratamento cirúrgico para estenose uretral.

Laparoscopic-assisted prepubic urethrostomy in a cat with urethral stenosis / Uretrostomia pré-púbica videoassistida em um felino com estenose uretral

Urethrostomy is a surgical technique used in cases of partial or total obstruction of the urethra, and the laparoscopic approach may be a treatment option. Due to the scarcity of studies involving the technique, this paper reports the case of laparoscopic-assisted pre-pubic urethrostomy (hybrid laparoscopic) in a cat with urethral stricture. A five-years-old cat presenting recurrent feline lower urinary tract disease (FLUTD) had undergone to perineal urethrostomy two years and nine months ago. After this procedure, the patient underwent another four corrective surgeries without success. Laboratory tests (blood count and biochemical) and image diagnosis were realized. The patient was subjected to laparoscopic-assisted pre-pubic urethrostomy and it was achieved therapeutic success and adequate patient quality of life. It is concluded that this technique is feasible and safe in cats, making it a possible choice of surgical treatment for urethral stricture.

A uretrostomia é técnica cirúrgica utilizada em casos de obstrução parcial ou total da uretra, e na abordagem laparoscópica pode ser uma opção de tratamento. Devido à escassez de estudos envolvendo essa técnica, este trabalho relata o caso de uretrostomia pré-púbica videoassistida (laparoscópica híbrida) em um felino com estenose uretral. O paciente de cinco anos de idade apresentando histórico de doença do trato urinário inferior dos felinos (DTUIF) recorrente, havia sido submetido a uretrostomia perineal há dois anos e nove meses. Depois desse procedimento, o paciente passou por mais quatro cirurgias corretivas sem sucesso. Após realização de exames laboratoriais (hemograma e bioquímicos) e de imagem, o animal foi submetido a uretrostomia pré-púbica laparoscópica híbrida, obtendo-se sucesso terapêutico e possibilitando ao paciente adequada qualidade de vida. Conclui-se que esta técnica é viável e segura em gatos, tornando-a uma possível escolha de tratamento cirúrgico para estenose uretral.

Successful trial of "no-scalpel" vasectomy.

PIP: Reports from a study comparing complications and pain between 2 groups of vasectomized men are presented. The former group underwent vasectomy by traditional, surgical methods, while the latter experienced the "no- scalpel" approach. The study was conducted by PROFAMILIA in Bogota, Colombia, during the period April 1988-January, 1989, to provide comparison information on the "no-scalpel" technique in which neither bleeding occurs nor stitching is required. Though not statistically significant, men opting for the "no-scalpel" approach reported fewer complications than did men undergoing traditional procedures. Moreover, less post-operative pain was reported among the "no-scalpel" group. This similar, more efficient, and shorter procedure may have great appeal to potential acceptors of vasectomy. The method's attributes, including the need for less equipment, also represent cost-saving programmatic advantages over traditional procedures.^ieng

[Reversal of vasectomy with microsurgery]. / Reversão da vasectomia com microcirurgia.

PIP: Microsurgery techniques have greatly increased the possibility of success in reversal of vasectomy. This paper presents the results of 21 operations of vas reanastomosis conducted on men aged 22-53, who had been vasectomized for an average of 2-7 years. The operation was always done under general anesthesia and reconstruction was always bilateral. There were no surgical complications, and evaluation of results was done by spermogram at 30 and at 120 days after the operation. Spermograms were normal in 18 patients, or 85% of cases, and pregnancy occurred in 15, or 75% of cases. In 3 cases spermograms were normal but no pregnancy had occurred 1 year after the operation. There were 3 cases of oligospermia. The importance of the age of the patients and of the length of time between vasectomy and reversal as factors influencing the success of the operation is still not very clear.^ieng

[East Asia 1976-1977: a general view]. / Asia Oriental 1976-1977: un panorama general.

PIP: Most East Asian countries have national family planning programs combined with projects to improve nutrition and jobs in rural areas. The countries which have had a rapid industrial development, such as Taiwan or Singapore, have seen their birth rate decrease sharply during the past 20 years. In most countries the government discourages large families and promotes vasectomy and minilaparotomy; abortion has been legalized almost everywhere. Information through radio and television play an important role, but not quite as important as that of fieldworkers who go from home to home in areas not reached by mass media. Cost for these programs is heavily paid by the U.S., and all programs are evaluated in the country of origin. Results are very encouraging and sometimes excellent, as in the case of South Korea, where about 45% of women practice contraception, and fertility rate has decreased from 6.0 in 1960, to 3.5 in 1975.^ieng

[Vasectomy]. / Vasectomia.

PIP: Selection of vasectomy patients must be done very conscientiously; only emotionally mature people should be selected, with stable marriages, and 2-3 children over 6. Written authorization from both spouses is indispensable, at least in Mexico. Operative procedures are simple and safe, and can be performed under local anesthesia; a 1-day rest is advisable. Complications include infection, epididymitis and granuloma; such occurrences, however, are extremely rare and easily treatable.^ieng

Male sterilization is Guatemala.

PIP: During 1973-1975, 968 Guatemalan men underwent vasectomies. The majority of these were skilled and unskilled workers, the sectors of Guatemalan society believed to be most conservative. A survey of the men indicated that, until the time of the vasectomy, the females in these relationships had taken major responsibility for contraception. It seems that the role of the male in family planning is changing in Guatemala. Men seem to be genuinely concerned for the well being of the family. It is predicted that, once the vasectomy program is well established, information regarding it will spread through word-of-mouth contacts.^ieng