Juan Gómez Rivas

Traumatic rupture of the corpus cavernosum: surgical management and clinical outcomes. A 30 years review

Introduction Penile trauma (PT) with associated rupture of the corpus cavernosum, also called penile fracture, is a urological emergency and surgical treatment is usually the choice of management. Our objective is to report our experience after 30 years in the diagnosis and therapeutic options of PT and evaluate the clinical outcomes after the treatment. Material and methods From January 1983 to January 2013, 27 patients were identified. Data was analyzed and is presented in absolute numbers, range, percentage and mean. Results Mean age of patients was 30.7 years, range from 19 to 37. All the patients came complaining of penile swelling and hematoma, and more than half of them (60.7%) reported hearing a snap sound. Some rare causes were identified in our series such as self–mutilation, avulsion, firearm and electrocution. Clinical presentation was diagnostic in all the patients, and the diagnosis was verified by penile ultrasonography in most cases (60.7%). Mean surgery time: 94 minutes. Urethral repair was required in 2 patients. Mean hospital stay was 2 days. Good functional results are shown during follow up. Conclusions Rupture of the corpus cavernosum is a rare condition and is generally diagnosed by clinical findings. Emergency surgical exploration and treatment is the best guarantee of good functional and cosmetic results.

Perioperative and survival outcomes of laparoscopic radical cystectomy for bladder cancer in patients over 70 years

Introduction Radical cystectomy in elderly patients is a controversial issue that has noticed an increase in importance overtime because of the lengthening average life span. Our objective was to determine if there were significant differences in the perioperative outcomes of patients over 70 years with bladder cancer treated with laparoscopic radical cystectomy (LRC) compared to those of younger patients. Material and methods We selected 180 patients who underwent LRC in our department in the period between 2005-2012. We divided them into 2 groups: 57% <70 years and 43% >70 years, and we compared the different parameters such as: comorbidities, intraoperative and post-operative complications, TNM stage and overall survival. Results The group <70 years had less comorbidities when compared with the group >70 years. Heterotopic urinary diversion was the diversion of choice in the elderly patients (97.4%). Paralytic ileus and the worsening of renal function were the only complications with statistical differences between the groups. Mean hospital length of stay was not significantly different between the groups. Younger and older patients had similar pathological staging : pT1 or less: 26,2 vs. 18.2%, pT2: 19.4 vs. 16.9%, pT3 38.8 vs. 37.7% and pT4 15.6 vs. 17.2%. Kaplan-Meier curves did not show significant differences in survival. Conclusions Laparoscopic radical cystectomy in the elderly patient has similar rates of perioperative morbidity when compared with the younger patient and may be offered as a treatment option in selected elderly patients.

Laparoscopic radical prostatectomy training for residents: Hospital Universitario La Paz model

Introduction In the last decade, we have seen the advance of laparoscopic surgery in urology. All laparoscopic procedures in our department are performed by staff members and are assisted by a single resident, ensuring resident training in laparoscopic surgery. The aim of this study is to evaluate the results of the Hospital La Paz training program for residents in the field of laparoscopic surgery. Material and methods We have done a retrospective review of LRP performed by the residents in our department. We also evaluated different variables. Descriptive statistical analysis was done and the results were compared with the descriptive analysis of the initial series of our department. Results We reviewed 82 patients, with an average age of 61.6 years. Most cases were pT1c at diagnosis. Average surgical time was 288 minutes, with a transfusion rate of 9.7% and a intra and postoperative complication rates of 1.2% and 7.3%. The mean hospital stay was 3.3 days. Histological results of this series are: 76.8% of pT2 and 23.2% of pT3. The biochemical relapse rate is 15.8%. Global surgical margin rate is 20.7%. The global continence rate is 52.4%. Conclusions The outcomes of LRP performed by residents are similar to the ones reported in the initial series of our department. The fact that 84.6% of the residents formed in this period actually belong to different laparoscopic units supports the success of La Paz Hospital training model.

Transperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction.

Introduction Laparoscopic pyeloplasty was first described by Schuessler. During the last decade, this technique has been developed in order to achieve the same results as open surgery, with lower rates of morbidity and complications. In this study we review our experience using laparoscopic pyeloplasty as the gold standard for the treatment of the ureteropelvic junction obstruction (UPJO). Material and methods We performed a retrospective review of 62 laparoscopic pyeloplasties carried out at our center. In the last 2 years we used 3 mm and 5 mm ports in order to achieve better cosmetics results. Demographic data is described and the functionality of the affected kidney and surgical data, among others were analyzed statistically. In the case of bilateral statistical tests were considered significant as those with p values <0.05. Results The most frequent reason for consultation was ureteral pain. Patients mean age was 40 years and 94% of them had preoperative renogram showing a full or partial obstructive pattern. The right side was affected in 61% of cases and the left in the remaining 39%. The presence of stones was observed in 12 patients and crossing vessels in 58% of cases. The average stay was 3.72 days. Post–surgery complications were observed in two patients. The operative time was 178 minutes. Mean follow–up was 45 months and a success was achieved in 91%. Conclusions The transperitoneal laparoscopic pyeloplasty has become the gold standard for the treatment of ureteropelvic junction stenosis in our center because of high success rate, shorter postoperative stay, and low intra and postoperative complications.

Social Media in Urology: opportunities, applications, appropriate use and new horizons.

Introduction Social Media (SoMe) includes a broad spectrum of public use platforms like Twitter, YouTube or Facebook that have changed the way humans interact and communicate. Considering the high usage rates for various SoMe platforms among urologists, we aimed to perform a review regarding opportunities, applications, appropriate use and new horizons of SoMe in urology. Material and methods Literature review. Results We are currently experiencing an explosion in the use of SoMe in healthcare and urology due to the clear offer of advantages in communication, information sharing, enhanced experience of meetings and conferences, as well as, for networking. However, SoMe is an open environment and recommendations should be implemented on the appropriate use in order to respect ethical considerations and not break the harmony of the doctor-patient relationship. SoMe activity has become an important part of our participation in scientific meetings. Conclusions SoMe represents a vibrant area of opportunities for the communication of knowledge in health care and so their potential applications today are unquestionable; however, its development in the urological community is still in its infancy. At present the benefits include communication between associations, urologists, residents, other health care professionals and patients. Further efforts are focusing on standardizing the language used through SoMe and finding out how we can objectively quantify the impact of the information published in SoMe.

Evolution in the treatment of the ureteropelvic junction obstruction syndrome. Laparoscopic versus open pyeloplasty.

Introduction The treatment of ureteropelvic junction has evolved considerably over the past 20 years, resulting in new surgical techniques, but traditional open surgery remains the gold standard treatment. Currently, less invasive techniques are used for the treatment of ureteropelvic junction obstruction. The purpose of our study is to compare the surgical and functional results between laparoscopic and open pyeloplasty performed at our department during the last 12 years. Material and methods This is a retrospective review of 92 cases performed in a period of 12 years. Two groups were compared: 30 patients were treated with open surgery (OP) and 62 with a laparoscopic approach (LP). Demographics, clinical presentation, functionality of the affected kidney, presence of polar vessels, kidney stones, hospital stay, complications and functional results were statistically analyzed. Results The mean age was 42 years. The most common clinical presentation was kidney or ureteral pain: 60% (OP) vs. 52% (LP). The right side was affected in 59%; presence of crossing vessels was 47% (OP) vs. 58% (LP); presence of kidney stones was 20% (OP) vs. 19% (LP), with an average hospital stay of 5.86 days (OP) vs. 3.36 days (LP) p <0.05. Post-operative complications were observed in 3 (OP) vs. 5 (LP) patients, with a success rate comparable between groups. Conclusions In our department, we recommend LP as the standard treatment for ureteropelvic junction obstruction because of the equal success rate compared to OP and the benefits of a minimally invasive surgery.

Renal function recovery after laparosocopic pyeloplasty

Introduction To observe the renal function recovery measured by diuretic renography in short and medium follow–up of patients with transperitoneal Anderson–Hynes laparoscopic pyeloplasty. Material and methods We performed a retrospective review from our series of laparoscopic pyeloplasties, and we applied the following selection criteria: 1) to have at least two MAG3 diuretic renography during the follow–up, performed with a gap of 4–6 months between them; 2) to have at least one year follow–up. Fulfilling these criteria, we have selected 35 patents of 62. Results During follow–up, statistically significant improvement comparing with the pre–surgical value has been observed in diuretic renography in the operated kidney in all selected patients during the time of follow up in terms of: functional uptake ratio (FUR), furosemide excretion and total excretion. No statistically significant differences were found in excretion time and spontaneous excretion parameters. By dividing patients in two age groups <40 years and >40 years we found no statistically significant differences between them in relation to the improvement of the FUR. Conclusions Laparoscopic pyeloplasty not only corrects the UPJO, it also may recover renal function demonstrated after one year follow up with diuretic renography. Laparoscopic pyeloplasty should be procedure of choice even in those patients with poor renal function at diagnosis, whenever there are chances of recovering renal function, regardless patients age.

Fast recovery after radical cystectomy. A multidisciplinary challenge

Radical cystectomy nowadays is the treatment of choice for muscle-invasive bladder cancer. Despite many efforts, the overall, cancer-specific survival and complication rate of patients after this procedure has not changed in the last few decades. In the recent years many fast recovery protocols or “fast track” programs have been designed to become the basis of perioperative management after colorectal surgery, vascular, thoracic, and even more recently radical cystectomy [1, 2]. These programs attempt to modify the physiological and psychological responses to major surgery, contributing to the reduction of post- surgical complications and hospital stay, and to the improvement of the cardiopulmonary and bowel function after surgery; this is translated into a faster recovery for patients [3, 4]. Nowadays, there are only a few studies based on the use of fast recovery protocols in urological surgery, this is why the authors of the paper “Alvimopan: A cost-effective tool to decrease cystectomy length of stay” [5] should be congratulated on presenting their experience concerning this topic. Arumainayagam et al. in 2007 implemented a fast recovery protocol which led to a significant reduction in hospital stay and an equivalent reduction in morbidity for patients undergoing radical cystectomy compared with traditional clinical guidelines [1]. The usage of a minimally invasive approach is included in the 22 items of the ERAS society recommendations [4]. Minimally invasive pelvic surgery has been shown to decrease the inflammatory response when compared to the open approach. Recently, laparoscopic and robotic radical cystectomy has been increasingly performed in the treatment of bladder cancer and merits special consideration. While open radical cystectomy and pelvic lymph node dissection remain the gold standard in treating non-metastatic muscle invasive bladder cancer, this major surgery is still associated with high morbidity close to 70% in some cases. Numerous centers have reported in the last years their experience with laparoscopic or robotic approach [6]. Unfortunately, most of these studies reported retrospective data or prospective comparative data. Despite these limitations, laparoscopic and robot-assisted radical cystectomy seem to be associated with overall lower perioperative complications, and shorter hospital stay with equivalent short term oncological safety. Future high quality, high volume controlled studies should help in reaching definitive conclusions. Intestinal complications are one of the most common problems after radical cystectomy. The etiology of ileus is multifactorial with a combination of central and peripheral nervous system, hormonal influences, neurotransmitter and local inflammatory pathways. Surgical stress, bowel manipulation, opioids and intraoperative fluids can break the standard homeostasis in the gastrointestinal tract and produce postoperative ileus and impaired function of gastrointestinal absorption; so the prevention and management of this complication should be with a multidisciplinary team (Nutrition, Anesthesiology and Urologist). Factors that help to reduce this are epidural anesthesia, minimally invasive surgery, fine tissue manipulation, avoidance of fluid overload, and early oral feeding. In addition, the routine use of nasogastric tube decompression should be avoided after surgery because of the higher incidence of fever, atelectasis and pneumonia in patients who carry it, and if any nasogastric tube is used during surgery it should be removed before extubation. Since 2012 our department has been exercising the application of an “early recovery protocol after surgery” program for patients undergoing laparoscopic radical cystectomy and urinary diversion with the collaboration of the Anesthesiology and Reanimation Department, and the Nutrition Unit of our hospital. We hope to have positive results in the years to come. The usage of fast recovery programs as the presented in this article using the Alvimopan shows that this is a feasible multidisciplinary challenge and is useful in the recovery of patients undergoing radical cystectomy, demonstrated by a shorter hospital stay without the increasing risk of postoperative complications. Future multicenter collaborations evaluating prospective cohorts of urological patients following identical standardized care pathways should be performed.

Perceived Role of Social Media in Urologic Knowledge Acquisition Among Young Urologists: A European Survey

BACKGROUND Social media (SoMe) are increasingly being integrated into personal and professional life, with urology being a leading medical specialty in SoMe adoption. OBJECTIVE We aimed to assess the perceived role of SoMe in urologic knowledge acquisition among young urologists across Europe. DESIGN, SETTING, AND PARTICIPANTS Members of the European Society of Residents in Urology designed a 20-item online survey via surveymonkey.com. The survey was designed in accordance with Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines and was distributed via e-mail and social media in 23 European countries to urology residents and young urologists. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Statistical Package for the Social Sciences (SPSS) software was used for descriptive statistics and statistical analysis. For comparative analysis the Mann-Whitney U test was used. RESULTS AND LIMITATIONS A total of 316 young urologists with a mean age of 31.2±3.9 yr responded to the survey. Of the respondents, 99% use SoMe in a personal and/or professional way. YouTube and LinkedIn are the most frequently used platforms for professional use. SoMe were ranked in third place as an information source for urologic news/updates, lying behind journals and websites but ahead of congresses and books. Video content from YouTube or other sources was ranked as a preferred tool to see/understand surgical techniques ahead of websites and reference books. 61% follow urologic associations, 47% follow urologic events, 44% follow urologic journals, and 39% follow urologic experts on SoMe. The perceived influence of SoMe on urology knowledge was rated as moderate to high by 63% and as low to none by 37% of young urologists. Of the respondents, 44% apply guidelines on the appropriate use of SoMe in urology. CONCLUSIONS SoMe play a significant role in knowledge acquisition by young urologists in Europe. Physicians, organizations, and institutions should strive to spread and provide valuable educational content through SoMe. PATIENT SUMMARY Social media can be valuable for education in urology because it is useful to keep abreast of new developments in this field of medicine.

Laparoscopic simple prostatectomy, a lost child of laparoscopic surgery.

Benign prostatic hyperplasia (BPH) requiring surgery has become a significant public health challenge in recent times as a result of the increase in population longevity. Furthermore, most of these patients have associated comorbidities and treatments, particularly with antiplatelet and anticoagulant drugs causing limitations in the surgical options such as open simple prostatectomy, or even transurethral procedures, which already have high complication rates.