Alberto Jurado

Percutaneous lithotripsy in Valdivia-Galdakao decubitus position: our experience.

Percutaneous nephrolithotripsy (PNL) is actually the first therapeutic option to resolve complex renal stones. Our department initiated its experience in 1985 and treated the first 585 patients in ventral decubitus, as the original technique was described. Then, in 1998, the dorsal decubitus was adopted (Valdivia Uria), in which 695 patients were treated. Since 2006 the Valdivia Galdakao variant has been used. The Valdivia Galdakao position is an intermediate dorsal decubitus with extension of its homolateral lower limb and flexion of the contralateral. It is a practical way to place the patient for percutaneous renal surgery, avoiding hyperextensions and hyperflexions that can result in articular damage. It preserves cardiovascular and ventilatory dynamics and allows a better access to the respiratory tract. In this position, the bowel slips away from the puncture area lowering the risk of its damage. A single lumbar and genital sterile surgical field is created allowing antegrade and retrograde simultaneous endoscopic and even laparoscopic access, increasing efficiency and safety of the minimal invasive procedures. Between April 2006 and March 2008, 175 PNLs were performed in our department with the patient in Valdivia Galdakao position. The aim of this article is to describe our experience in this decubitus confirming that the Valdivia Galdakao is a safe, practical and versatile position that should be considered as first choice when a percutaneous renal surgery is indicated.

Tomografía computada como predictor de composición y fragilidad de la litiasis urinaria al tratamiento con litotricia extracorporea por ondas de choque in vitro

OBJECTIVES To evaluate the ability of non contrast computed tomography (NCCT) to predict stone composition and fragility for treatment with extracorporeal shock wave lithotripsy (ESWL). METHODS 27 stones of about 10 mm from patients who had undergone different endourological procedures were collected. All patients had been evaluated with NCCT. To perform in vitro ESWL an experimental device was designed. Three thousand pulses were applied with 17.2 Kv intensity using an electromagnetic generator (Lithostar) to all stones. Composition of each fragment was studied with crystallographic study. Results were statistically analyzed with Student Test, Chi2 Test and multivariate study. RESULTS In vitro ESWL had a success rate of 59.26%. Average stone HU, grouped by composition: cistine 1015 HU, Calcium monohydrate oxalate 1193 HU, uric acid 419 HU, dihydrate calcium oxalate 2122 HU, struvite 1543 HU and basic phosphate magnesium 1517 HU. A statistically significant relationship was found between values which were lower than 500 HU and uric acid composition (p=0.0006), as well as values higher than 2000 HU and composition of dihydrated calcium acid (p=0.0244). In the group of stones with less than 1000 HU (n=11) efficacy was 81.1%, whereas it was 43.75% in the others (p=0.0479). We found a statistically significant relationship between uric acid and effectiveness (p=0.021). There was not statistically significant relationship between size and treatment effectiveness. CONCLUSIONS The use of NCCT will allow predicting stone composition and fragility.

Catecholamine-Induced Myocarditis in Pheochromocytoma

A 25-year-old man arrived at the emergency room of his community hospital complaining of abdominal pain, headaches, and palpitations that had appeared suddenly while he was playing soccer. He had no history of hypertension. An abdominal ultrasound revealed a tumor located in the right adrenal gland. He was subsequently transferred to our hospital for further evaluation. On admission, he presented acute pulmonary edema with severe hypertension (blood pressure, 220/120 mm Hg). He was admitted to the coronary care unit. Intravenous vasodilators and loop diuretics were administered, with rapid recovery of clinical status. ECG showed sinus rhythm, a heart rate of 80 bpm, and T-wave inversion in the DI, DII, and AVL leads. Transthoracic echocardiography revealed left …

Functional and oncologic outcomes after nephron-sparing surgery in a solitary kidney: 10 years of experience

ABSTRACT Objectives: To evaluate functional and oncologic outcomes of partial nephrectomy (PN) in patients with a solitary kidney. Materials and Methods: A retrospective analysis of patients with a solitary kidney undergoing nephron-sparing surgery between March 2003 and March 2013 was performed. GFR was recorded before the procedure and 3 months after surgery, thus establishing a change (cGFR). Several variables that may influence cGFR were analyzed. Complications are herein described, namely bleeding, fistula, acute renal failure and end-stage renal disease (ESRD). Local recurrence and margin status are also described. Survival rates were calculated using the Kaplan Meier method (2 patients with metastasis at the time of surgery were excluded from the analysis). Results: Forty-five patients were available for analysis. Median follow-up was 27.56 months (r 3-96). Mean cGFR was-7.12mL/min (SD 2.1). Variables significantly related with lower GFR after surgery were loss of renal mass (p=0.01)) and male gender (p=0.03). Four patients (8.8%) experienced hemorrhage. Nine patients (20%) developed a urinary fistula. Only one patient with bleeding required open surgery. Two patients (4.4%) needed transient dialysis. Three patients (6.6%) developed ESRD. Four patients (8.8%) had positive surgical margins (PSMs) and four patients (88%) had local recurrence (2 of these had PSMs). Five patients (11.1%) died during follow-up. Four patients (8.8%) died because of renal cancer. Estimated 2-year overall survival, disease-free survival and cancer specific survival rates were 88.4% (CI 95% 70.5-96); 87.7% (CI 95% 68.1-96) and 92.4% (CI 95% 75-98), respectively. Conclusion: Loss of renal mass and male gender were associated with lower postoperative GFR. Our outcomes were comparable with those in the World literature.

Abstract 12: Serum carbonic anhydrase IX (CAIX) as diagnostic biomarker in clear cell renal cell carcinoma (ccRCC) patients .

Proceedings: AACR 104th Annual Meeting 2013; Apr 6-10, 2013; Washington, DC Clinicians face important pitfalls in the treatment of Renal cell carcinoma (RCC), such as absence of symptoms in early stages of the disease, its high metastatic potential and its resistance to conventional therapy. These facts emphasize the requirement of early diagnosis to optimize the chance of cure. ccRCC, the most common histological type of RCC, is considered a cell metabolic disease which develops from the activation of pseudohypoxic pathways. The transmembrane enzyme CAIX, involved in pH homeostasis and expressed in ccRCC tumors, is considered to be one of the best cellular biomarkers of hypoxia. Our aim was to study the role of serum CAIX as diagnostic biomarker of ccRCC, taking into account that serum contains a rich untapped source of disease-specific information. Employing a quantitative ELISA test (RD MW test p<0.001). Then, we analyzed whether already established clinicopathological variables in RCC were associated with serum CAIX levels, finding a remarkable correlation with tumor size (Spearman test p<0.01). Then, we investigated the usefulness of serum CAIX in the follow-up of these patients. Interestingly in 20/30 (66.7%) ccRCC patients values of CAIX decreased after tumor removal (S2 vs S1). We conclude that serum CAIX could be a useful diagnostic biomarker in ccRCC patients. This would be of relevant importance as there is a lack of molecular biomarkers for this pathology. Citation Format: Maria Elena Knott, Myriam Nunez, Maria Natalia Gandur Quiroga, Gaston Boggio, Julieta Grasselli, Guillermo Gueglio, Pedro Rondot Radio, Mariano Brzesinski, Leonardo Pasik, Carla Pulero, Ana Alvarez, Hector Malagrino, Patricio Garcia Marchinena, Alberto Jurado, Elisa Bal de Kier Joffe, Maria Guadalupe Pallotta, Lydia I. Puricelli. Serum carbonic anhydrase IX (CAIX) as diagnostic biomarker in clear cell renal cell carcinoma (ccRCC) patients . [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 12. doi:10.1158/1538-7445.AM2013-12

MP59-02 CHARACTERISTICS AND PERIOPERATIVE OUTCOMES FOLLOWING SURGICAL TREATMENT FOR RENAL CELL CARCINOMA IN VERY ELDERLY PATIENTS (≥75 YEARS): DATA FROM THE LATIN AMERICAN RENAL CANCER GROUP (LARCG)

benoit peyronnet*, Rennes, France; lauranne tondut, rennes, France; jean-christophe bernhard, bordeaux, France; christophe vaessen, paris, France; nicolas doumerc, toulouse, France; philippe sebe, benjamin pradere, rennes, France; bertrand guillonneau, paris, France; zine-eddine khene, rennes, France; francois-xavier nouhaud, rouen, France; nicolas brichart, orleans, France; thomas seisen, paris, France; jean-baptiste beauval, toulouse, France; gregory verhoest, quentin alimi, romain mathieu, rennes, France; adham rammal, orleans, France; alexandre de la taille, creteil, France; herve baumert, paris, France; stephane droupy, nimes, France; franck bruyere, tours, France; morgan roupret, paris, France; karim bensalah, rennes, France

V6-03 SYNCHRONOUS AND SIMULTANEOUS POSTERIOR REROPERITONEOSCOPIC BILATERAL ADRENALECTOMY.

INTRODUCTION AND OBJECTIVES: Retroperitoneal lymph node dissection (RPLND) is an important component of the management of testicular germ cell tumor (GCT) but its surgical morbidity is not insignificant. Herein we describe our updated experience with a midline extraperitoneal (EP) approach to RPLND for seminomatous and nonseminomatous GCT. METHODS: Between 2010 and 2015, from a prospectively collected IRB approved database, 122 consecutive patients underwent RPLND. Patients requiring aortic resection, retrocrural dissection or access to intraperitoneal disease were excluded. The remaining 69 patients underwent midline EP-RPLND. All post-chemotherapy (PC) cases underwent bilateral template dissection; all primary cases underwent extended ipsilateral templates. Perioperative and long-term outcomes were analyzed and a descriptive analysis using SAS was performed. RESULTS: 68 patients underwent midline EP-RPLND successfully (98.6%). Median age was 28 years (range1⁄417-55). Median follow up was 15.3 months (IQR: 5.7-24.3). On pre-operative imaging the size of retroperitoneal mass or lymphadenopathy was <2 cm in 29 patients, 2-5 cm in 15 patients, and >5 cm in 24 patients, of which 19 were >10cm. 3 patients underwent cavectomy. Median EBL was 325 mL (IQR: 200-612.5). Median number of lymph nodes (LN) resected was 36 (IQR: 24.5-49); median number of positive nodes was 1 (IQR: 04). Median return of bowel function was 2 days (1-3) and LOS was 3 days (2-4). There were no cases of ileus. 13 patients (19.1%) had complications within 90-days: 12 were Clavien grade 2 (17.6%), there was 1 grade 3b complication (1.5%). Antegrade ejaculation rates were 91.6% in the primary group and 96.8% in the PC group. CONCLUSIONS: Midline EP-RPLND can be performed safely without compromising completeness of resection. This approach is associated with a faster return of bowel function, lower rates of ileus and shorter LOS.

V1-12 ROBOTIC-ASSISTED RADICAL PROSTATECTOMY AND CONTINENT URINARY STOMA (MITROFANOFF) IN A 7 YEAR CHILD.

INTRODUCTION AND OBJECTIVES: Urethrectomy with appendicovesicostomy is a treatment option for low stage urethral cancer. We present a novel minimally-invasive surgical approach which allows for robotic appendicovesicostomy to be performed simultaneously with open urethrectomy. METHODS: A 71 year-old man presented with clinically-localized squamous cell carcinoma of the urethra. He underwent a traditional open urethrectomy with simultaneous robotic-assisted bladder neck closure, omental J flap interposition, and appendicovesicostomy. The robot was side-docked to allow for a perineal surgeon to work in tandem with the robotic surgeon. RESULTS: Total operating room time was 391 minutes. Robotic console time was 281 minutes. Length of stay was four days. There were no complications, and no secondary procedures were required. Final pathology demonstrated T2 squamous cell carcinoma with negative margins. At 6 months follow up, the patient is continent and cancer-free. CONCLUSIONS: Simultaneous extirpative surgery and minimally-invasive urinary tract reconstruction is possible for patients with urethral cancer. Side-docking the robot allows for two surgical teams to work concurrently. This approach may be applicable to other procedures requiring both open perineal and laparoscopic intraabdominal access.