J. Morote Robles

Resección transuretral de próstata bipolar vs monopolar: análisis peroperatorio de los resultados

BIPOLAR VERSUS MONOPOLAR TRANSURETHRAL RESECTION OF THE PROSTATE: PEROPERATIVE ANALYSIS OF THE RESULTS Objective: To analyse the differences in the postoperative period between bipolar and monopolar resection of the prostate in the endoscopic surgery of the benign prostatic hyperplasia. Methods: 45 patients were prospectively randomized. Twenty-one underwent monopolar resection (Storz Ch 26, 30o) and 24 underwent bipolar resection (Olympus ch 26, 30o). Results: Mean age in the bipolar group was 69,5 years versus 67,3 in the monopolar group; mean flow before surgery (7,7 ml/s vs 7,2 ml/s); ecographic prostate volume (39,5 cc vs 42,7 cc); resection volume 13 g vs 12,6 g and mean resection time was 39,7 vs 42,5 min. Cut capacity was considered notable-excellent in 90% of the patients in the bipolar group vs 50% in the monopolar group (p=0,01); adherence of fragments were considered abundant or very abundant in 0% vs 60% (p=0,01); coagulation capacity was excellent-notable in 25% vs 75% (p=0,03). There were no significant differences on the days of catheterization (2,92 vs 3,1), continuous irrigation (1,79 vs 2,05), hospitalization (3,63 vs 3,67), hematocrite descent (3,48 vs 3,32) and plasmatic sodium (0,52 vs 1,16), neither on episodes of acute urine retention (only one patient in the monopolar group). Conclusions: In our experience, TURP with SurgMaster resector in prostate smaller than 70 g offers better peroperative qualities for the surgeon (better cut capacity, less adherence of fragments) than the monopolar resection, with similar postoperative outcomes.

Angiomiolipomas renales: presentación, tratamiento y resultado de 20 casos

RENAL ANGIOMYOLIPOMA: PRESENTATION, TREATMENT AND RESULTS OF 20 CASES Introduction: Renal angiomyolipoma is a benign tumour, but its spontaneous rupture may become threatening for patients live. Both surgery and selective arterial embolization are accepted treatments for this lesion. Objectives: Analyze renal angyolipoma treated in our center, their clinical outcome and treatment purposed in each case. Material and Methods: We retrospectively analyse 20 cases of patients with renal angiomyolipoma treated in our centre from March 1996 to March 2006. We describe tumour characteristics, treatment followed and results obtained. Results: Patients suffering from tuberous sclerosis (20%) showed multiple bilateral tumours, with size similar to the rest of patients. Diagnosis of tuberous sclerosis was the only factor attached to spontaneous rupture of those lesions. Four of 9 emer- gency embolized patients (44.4%) required from second treatment because of recurrent haemorrhage, and 4 of the 16 emboliza- tion episodes (25%) presented post-embolization syndrome, both with no predicting factors attached. Reduction of less than one third of the inicial diameter was observed in 58.4% of embolized tumours, which used to be multiple, bilateral and of size larger to the rest. No significative differences were observed in plasmatic creatinine after and before treatments. Conclusions: Renal angiomyolipoma may behave in an aggressive way in patients with tuberous sclerosis. No predicting fac- tors of recurrent haemorrhage or post-embolization syndrome were observed. Both surgery and arterial embolization have pro- ved not to compromise renal function in treated patients.

El modelo porcino en la cirugía experimental del trasplante renal

Resumen Introduccion y objetivos La extraccion renal laparoscopica de donante vivo se esta convirtiendo en una tecnica cada vez mas habitual a pesar de su lenta curva de aprendizaje. En enero de 2006 se puso en marcha en nuestro centro un protocolo de autotrasplante en modelo porcino que pretendia evaluar diferencias entre la extraccion por via abierta y por via laparoscopica, y que permitia asi mismo entrenar a los residentes en la realizacion de estas tecnicas. Material y metodos Hasta dia de hoy hemos llevado a cabo un total de 25 experimentos, de los cuales 7 han sido sometidos a extraccion por via laparoscopica (28%) y 18 por via abierta (72%), si bien solo el 44% de los animales ha sobrevivido hasta el final del protocolo. Resultados En este trabajo se detalla la forma de iniciar una experiencia de estas caracteristicas, se analizan las complicaciones que se han encontrado y se hace una revision de la literatura en cuanto al manejo de estos animales. Conclusiones La cirugia experimental en modelo porcino se ha convertido en nuestro centro en una herramienta fundamental para la formacion del residente, y podria facilmente ser adaptada por otros hospitales.

Extensive emphysematous pyelonephritis in a renal allograft: case report and review of literature

Emphysematous pyelonephritis (EPN) is an acute, severe necrotizing infection of the renal parenchyma and perirenal tissue, which results in the presence of gas within the renal parenchyma, collecting system, or perinephric tissue. EPN of renal allograft is rare, with only 23 cases reported in Western literature. Here, we report a patient treated successfully with surgery. We also review the literature, focusing on old and new suggested classification systems for EPN.

Tumor adenomatoide de epidídimo: El tumor más frecuente de las estructuras paratesticulares

PARATESTICULARES Introduccion: Los tumores paratesticulares son neoplasias poco frecuentes aunque habitualmente benignas que suelen ser tributarias de extirpacion local. Dentro de ellos se considera que los tumores adenomatoides de epididimo constituyen el subgrupo mas frecuente. Objetivos: Analizar los casos de tumores paratesticulares intervenidos en nuestro centro, asi como el diagnostico y tratamiento de los tumores adenomatoides de epididimo. Material y metodos: Se revisan de forma retrospectiva 8 pacientes con tumores paratesticulares intervenidos entre julio de 1997 y julio 2007. Se analiza en cada caso la forma de presentacion, la orientacion diagnostica que aportaba la prueba de imagen, el tratamiento indicado para cada paciente y el diagnostico definitivo. Resultados: La edad media de los pacientes fue de 44,1 anos (22-69), consultando la mayoria de ellos por tumoracion escrotal de aparicion subaguda que presentaban en la ecografia un tamano medio de 2,8 cm (1,5-7). Se practico la extirpacion local en todos los casos a excepcion de un paciente con sospecha de un teste accesorio malignizado y otro con una lesion aparentemente intratesticular de gran tamano. Solo en dos casos se practico una biopsia peroperatoria. El diagnostico fue en 4 casos de tumor adenomatoide de epididimo, en dos casos de pseudotumor fibroso de epididimo, en un caso de leiomioma de epididimo y en otro de angiolipoma de cordon espermatico. Solo en un caso diagnosticado de tumor adenomatoide de epididimo la ecografia informaba de tumoracion solida sugestiva del diagnostico definitivo. Conclusiones: Los tumores adenomatoides de epididimo son tumores poco frecuentes que se pueden diagnosticar a cualquier edad. La ecografia puede orientar el diagnostico pero su capacidad para diferenciarlos es baja. La naturaleza habitualmente benigna tanto del tumor adenomatoide de epididimo como del resto de tumores paratesticulares obligaria a practicar como primera opcion la extirpacion local de los mismos y, ante cualquier duda, deberia practicarse una biopsia peroperatoria.

Prostatectomía radical laparoscópica versus abierta

COMPARISON BETWEEN OPEN AND LAPAROSCOPIC APPROACH IN RADICAL PROSTATECTOMY Introduction. To evaluate the differences between laparoscopic (LRP) and open radical prostatectomy (ORP). Material and Methods. From 2004 to 2005 180 Radical prostatectomies (RP) were performed, 105 laparoscopical and 75 by an open approach. Different urologists have acted as first surgeon; 51% of them, fully experienced ones in OPR, and 56% in LRP. Differences in operative time, estimated blood loss (difference of pre and post operative hematocrite), and duration of hospitalization were compared. Additionally, we have also analysed surgical and oncologic control of the specimen defined by the following variables: Malignant margins (MM) (positive margin in a pT3 specimen), and benign/malign surgical incision (BSI/MSI). Results. Groups were similar concerning age, clinical stage and Gleason score, and there are only differences in PSA. Mean operative time was significantly higher in LRP (172 minutes) versus ORP (145 minutes) (p<0.001). Difference of pre and post operative hematocrite was also higher in the open group (10.7 vs 9,2) (p=0.03), together with hospital stay, which was one day longer in the ORP group (p=0.001). ORP group had a higher rate of benign surgical incisions (48.7% vs 26.7%) (p=0.001). Regarding oncologic results, LRP presented a 5.4 % of positive margins, which compared signifi- cantly with a 16.9% rate in the open group (p=0.023). However, no differences concerning malignant surgical incisions were observed. Conclusion. With no differences in clinical and pathological stage, LRP offers a significant reduction of surgical aggressiveness on the specimen, together with a better MM control. We also observe a clear decrease in blood loss and hospital stay. Therefore, we conclude that LRP in our environment is a valid approach of surgical prostate cancer treat- ment in spite of a longer operative time (27 minutes) and a steep learning curve.

Presentación de un nuevo caso de adenocarcinoma de células claras uretral y su manejo quirúrgico

OBJECTIVE: To present a new case of a primary clear cell adenocarcinoma of the urethra and its surgical management. MATERIAL AND METHODS: We describe the clinical, diagnosis, treatment and development of this kind of tumor. Review of the literature. CONCLUSIONS: It is an unusual type of cancer associated with poor prognosis. Currently the construction of a continent urinary diversion using the Mitrofanoff principle has many indications as our case. Laparoscopic radical cystectomy can be done by experienced groups without adding much more technical difficulties; there are no long-term oncological outcome data but we believe in some functional advantages.PRESENTATION OF A NEW CASE OF PRIMARY CLEAR CELL ADENOCARCINOMA OF THE URETHRA AND ITS SURGICAL MANAGEMENT Objective: To present a new case of a primary clear cell adenocarcinoma of the urethra and its surgical management. Material and methods: We describe the clinical, diagnosis, treatment and development of this kind of tumor. Review of the literature. Conclusions: It is an unusual type of cancer associated with poor prognosis. Currently the construction of a continent urinary diversion using the Mitrofanoff principle has many indications as our case. Laparoscopic radical cystectomy can be done by experienced groups without adding much more technical difficulties; there are no long-term oncological outcome data but we believe in some functional advantages.

Pseudotumor inflamatorio vesical

Resumen Pseudotumor Inflamatorio Vesical Objetivo Presentar un nuevo caso de pseudotumor inflamatorio vesical. Material y metodo Se describe la clinica, diagnostico y tratamiento de un caso de pseudotumor inflamatorio de localizacion vesical en un varon de 22 anos sin antecedentes urologicos de interes. Conclusiones El pseudotumor inflamatorio es una lesion benigna poco frecuente y de etiologia desconocida. El principal diagnostico diferencial morfologico es el rabdomiosarcoma vesical. El estudio inmunohistoquimico es fundamental en el diagnostico, caracterizacion y diferenciacion de ambas patologias. Su caracter benigno obliga a un tratamiento conservador siempre que sea posible.

Schwanoma retroperitoneal benigno, exéresis por laparoscopia

Resumen Schwanoma retroperitoneal benigno, exeresis por laparoscopia Los Schwanomas son tumores raramente localizados en el retroperitoneo, ya que habitualmente se encuentran en nervios craneales o perifericos. Raramente se diagnostican preoperatoriamente ya que ninguna de las tecnicas de imagen es capaz de determinarlos con certeza. La RMN parece la prueba de eleccion. La exeresis quirurgica completa es el tratamiento estandar. El caso que presentamos corresponde a un schwanoma retroperitoneal benigno como hallazgo a partir de dolor lumbar, en el describimos por primera vez la reseccion laparoscopica de este tipo de tumores

Carcinoma linfoepitelioma-like puro primario de vejiga

Resumen Objetivo Presentar un nuevo caso de carcinoma linfoepitelioma-like vesical puro. Material y metodos Se describe la clinica, diagnostico, tratamiento y evolucion de este tipo de tumor. Revision de la literatura. Conclusiones Se trata de un tumor vesical infrecuente que requiere de un analisis anatomopatologico cuidadoso y confirmacion mediante tecnicas de inmunohistoquimica. La forma focal se asocial a peor pronostico. La cistectomia radical es el gold estandar. Este tipo de tumor presenta sensibilidad a radioterapia y quimioterapia, pudiendose utilizar ambas como tratamiento adyuvante.