J.J. De La Peña Barthel

Lesión iatrogénica de uréter lumbar y vasos ilíacos tras discectomía lumbar: tratamiento urológico mediante autotrasplante renal

We report a case of a patient with a secondary injury of external iliac artery and vein in the L 4-L 5 laminectomy and discectomy course. An inmediatily vein suture and ilio-iliac by-pass with Dacron was made. In the postoperatory a yatrogenic lumbar ureter section was discovered and treated with renal autotransplantation. We review the options described in the literature in the management of these complex ureteral injuries.

A review of penile cancer

Cancer of the penis is a rare tumour in Europe and mainly affects the elderly patient population. The aim of this paper was to analyse and study the characteristics of this tumour, in our patient population. Materials and Methods. A retrospective study was conducted on penile tumours diagnosed and treated in the Urology Department of the Hospital Universitario La Paz, Madrid, in the last ten years. Results. A total of 34 patients were diagnosed and treated. The mean age at presentation was 71.27 years. The mean time between symptoms and the first consultation was 12.54 months with a median of 6 months. The most common form of presentation was balanoposthitis (32%) and the most common site in our series was the glans. Partial penectomy was performed in 22 cases, total amputation in 8, and local excision in 3. Discussion. Carcinoma of the penis is a pathology which mostly affects elderly patients; in our series, the highest incidence was observed in patients in the group aged 75–84 years. The most common histological type was epidermoid carcinoma in its various forms of presentation. We recorded a mortality of 23%. Conclusion. Penile carcinoma is a rare pathology which affects elderly persons and is diagnosed late.Cancer of the penis is a rare tumour in Europe and mainly affects the elderly patient population. The aim of this paper was to analyse and study the characteristics of this tumour, in our patient population. Materials and Methods. A retrospective study was conducted on penile tumours diagnosed and treated in the Urology Department of the Hospital Universitario La Paz, Madrid, in the last ten years. Results. A total of 34 patients were diagnosed and treated. The mean age at presentation was 71.27 years. The mean time between symptoms and the first consultation was 12.54 months with a median of 6 months. The most common form of presentation was balanoposthitis (32%) and the most common site in our series was the glans. Partial penectomy was performed in 22 cases, total amputation in 8, and local excision in 3. Discussion. Carcinoma of the penis is a pathology which mostly affects elderly patients; in our series, the highest incidence was observed in patients in the group aged 75–84 years. The most common histological type was epidermoid carcinoma in its various forms of presentation. We recorded a mortality of 23%. Conclusion. Penile carcinoma is a rare pathology which affects elderly persons and is diagnosed late.

The role of perioperative blood transfusion on postoperative outcomes and overall survival in patients after laparoscopic radical cystectomy

INTRODUCTIONnThere are different studies in the last decades focused on general surgery patients and the impact of perioperative blood transfusion (PBT) in cancer patients survival, and most of them have supported an independent association between PBT and worse survival in those with solid tumor malignancies. The aim of this study is to evaluate the impact of perioperative blood transfusion on the postoperative outcomes and survival of patients after LRC.nnnMATERIALS AND METHODSnWe performed a retrospective study analyzing our series of 218 patients surgically treated with LRC form 2005 to 2012. One-way analysis of variance test was used. Survival was estimated using the Kaplan - Meier method and was compared with log - rank and the Cox regression model was used to evaluate the association of PBT with the outcomes.nnnRESULTSnThe PBT rate of LRC series was 16%. Patients age, comorbidities and pathological stage were not related to the PBT rate. A statistically significant relationship was found between the PBT rate and the appearance of infectious complications. Overall 3 years survival estimated with the Kaplan-Meier method was significantly worse in the transfused group: 41.38% versus 63.57% for non-transfused patients. PBT was not a significant independent predictor factor in the survival of patients after LRC. The main independent factor was the TNM classification.nnnCONCLUSIONSnMany studies including ours have reported a lower survival rate in patients who receive PBT after oncological surgery. There was a relationship between infectious complications and PBT. We have to make efforts to limit the use of blood products in patients surgically treated with radical cystectomy for bladder cancer.

Enterocistoplastia de ampliación laparoscópica: experiencia inicial

Resumen Objetivo Analizar la experiencia inicial de nuestro grupo en la realizacion de enterocistoplastia de ampliacion por via laparoscopica. Pacientes y metodos Describimos la tecnica de enterocistoplastia de ampliacion con segmento ileal realizada completamente mediante abordaje laparoscopico. Presentamos los casos de dos pacientes diagnosticados de vejiga hiperreflexica refractaria a tratamiento medico que fueron sometidos a esta intervencion. En ambos casos la tecnica se realizo sin complicaciones intraoperatorias, aunque requirio un tiempo quirurgico de 6 y 4,5 horas respectivamente. Los resultados con un seguimiento de 12 y 6 meses fueron satisfactorios en ambos, consiguiendo una vejiga de baja presion con una buena continencia. Conclusiones La enterocistoplastia de ampliacion laparoscopica es una tecnica compleja, que requiere una amplia experiencia, sobre todo en sutura laparoscopica. Reproduce absolutamente a la tecnica abierta y aporta las ventajas inherentes al abordaje laparoscopico.

Uso de gel de lidocaína intrarectal en las biopsias transrectales ecodirigidas de próstata

Resumen Objetivo Valoramos de una manera cuantitativa el grado de molestias y dolor de las biopsias y evaluamos la eficacia del gel de lidocaina intrarectal. Metodo Realizamos un total de 140 biopsias transrectales de prostata ecodirigidas (BTPE) por sospecha de adenocarcinoma prostatico. Los pacientes fueron incluidos de forma aleatoria y homogenea en dos brazos, uno recibio gel de lidocaina, 20 mg (Xylocaina®), intrarectal (grupo 1, n = 71) y el otro placebo, lubricante sin anestesia, (grupo 2, n = 28), diez minutos antes del procedimiento. Resultados La mediana global de dolor fue de 3,7 (0 no dolor y 10 maximo de dolor) y de molestias de 3,5. Los pacientes del grupo 1 (Xylocaina®) mostraron una tendencia a presentar menos dolor y molestias aunque no alcanzo el grado de significacion deseado (p = 0,7 y p = 0,5, respectivamente). Conclusiones En nuestro medio no obtenemos los resultados descritos por otros grupos en cuanto a la disminucion del dolor con el uso de gel intrarectal de anestesia topica. No hemos encontrado diferencias significativas en cuanto a nivel de PSA, biopsias previas realizadas, uso del gel de lidocaina y grado de informacion recibida que afecten al grado de molestias y dolor.

Tratamiento endourológico percutáneo de litiasis ureteral obstructiva en injerto renal

Resumen En el rinon trasplantado la aparicion de litiasis representa una de las complicaciones menos frecuentes, sin embargo, dadas las caracteristicas de estos pacientes, se asocia a una elevada morbilidad. Varias on las causas responsables de esta enfermedad: se han identificado factores metabolicos, infecciosos, farmacos, cuerpos extranos, asi como la presencia previa de litiasis en el propio injerto. Desde el punto de vista del tratamiento, dado que son pacientes con un rinon unico funcionante, la agresion a que este sea sometido debe ser lo menor posible. Presentamos un caso de litiasis ureteral obstructiva de gran dureza, en un injerto renal, resuelta mediante acceso percutaneo anterogrado con ureteroscopio flexible, con exito.