Juan Morote Robles

Pieloplastia abierta frente a laparoscópica: revisión de nuestra serie y descripción de nuestra técnica de pieloplastia laparoscópica

Resumen Introduccion y objetivos La pieloplastia ha sido desde siempre el tratamiento de eleccion en nuestro centro para la estenosis pieloureteral y, desde hace 4 anos, hemos optado por el abordaje laparoscopico a la hora de llevar a cabo esta tecnica. Queremos comparar el resultado de las pieloplastias abiertas (PA) y laparoscopicas (PL) llevadas a cabo en nuestro centro durante los ultimos 8 anos, asi como describir nuestra tecnica de PL. Material y metodos Revisamos de forma retrospectiva las pieloplastias llevadas a cabo en nuestro centro entre junio de 2000 y junio de 2008, analizando en cada caso el motivo de consulta, la funcionalidad del rinon afectado, el tiempo quirurgico, el sangrado intraoperatorio, la presencia de litiasis renal o de vaso polar, los dias de estancia, las posibles complicaciones y el resultado obtenido. Resultados Se han practicado un total de 30 pieloplastias, 15 PA y 15 PL (50%). El tiempo quirurgico fue de media de 167,6 minutos para las PL (100-240) y de 106 min para las PA (75-180) (p 0,05). El sangrado intraoperatorio fue desdenable en todos los casos y no hubo complicaciones intraoperatorias, si bien 9 (30%) pacientes presentaron complicaciones postoperatorias: 5 de 15 PL (33,3%) y 4 de 15 PA (26,7%) (p > 0,05). La fistula urinaria fue la complicacion mas frecuente, presentandose en 3 de los 30 pacientes (10%). El exito de la intervencion se confirmo en los 15 pacientes intervenidos de PA (100%) y en 14 de los 15 pacientes intervenidos de PL (93,3%) (p > 0,05). Conclusiones Por su menor morbilidad y sus resultados equivalentes a la PA, la PL es hoy dia la tecnica de eleccion en nuestro centro a pesar de requerir de una cierta habilidad en el manejo de la laparoscopia y de un tiempo quirurgico habitualmente mas largo.Introduction and objectives: Pyeloplasty has always been the treatment of choice for ureteropelvic junction obstruction at our center, where a laparoscopic approach has been used in the last 4 years to perform this procedure. Results of open pyeloplasty (OP) and laparoscopic pyeloplasty (LP) performed at our center in the past 8 years are compared, and our laparoscopic procedure is described. Materials and methods: Pyeloplasties performed at our center from June 2000 to June 2008 were retrospectively reviewed. Clinical presentation, involved kidney function, operating time, intraoperative bleeding, presence of kidney stones or crossing vessels, length of hospital stay, potential complications, and results obtained were analyzed in each case. Results: Thirty pyeloplasties were performed, 15 OPs and 15 LPs (50%). Mean operating time was 167.6 minutes for LP (100-240) and 106 minutes for OP (75-180) (P 0.05). Intraoperative bleeding was negligible in all patients and no peroperative complications occurred. However, 9 patients (30%) experienced postoperative complications, 5 out of 15 LPs (33.3%) and 4 out of 15 OPs (26.7%) (P>0.05). Urinary fistula was the most common complication, occurring in 3 of the 30 patients (10%). Procedure was successful in all 15 patients undergoing OP (100%) and in 14 of the 15 patients undergoing LP (93.3%) (P>0.05). Conclusions: LP is currently the procedure of choice at our center because of its lower morbidity and similar results as compared to OP, despite the need for a certain laparoscopic skill and a usually longer operating time.

EMBOLIZACION ARTERIAL PARA EL TRATAMIENTO DEL TRAUMATISMO DEL RIÑON EN HERRADURA

Resumen es: OBJETIVO: Comunicar un caso de traumatismo en un rinon en herradura que se resolvio de forma conservadora mediante embolizacionsupra-selectiva. METODOS: ...

Skeletal complications of ADT: disease burden and treatment options.

Therapy based on androgenic deprivation is one of the standard treatments that many prostate cancer patients receive. Moreover, its use is increasing owing to a clear expansion of the indications for this therapy in patients with localized prostate cancer. Despite classically being considered to be well tolerated, androgenic deprivation has adverse effects. Of these, the loss of mineral bone mass is particularly notable and can lead to osteoporosis, as well as an increased risk of bone fracture. Some fractures, such as hip fractures, may have serious consequences. Useful procedures such as bone densitometry can aid in the diagnosis of these conditions. Once diagnosed, decreases in mineral bone mass can be managed by dietary recommendations, general changes in lifestyle or medication. We review the most important randomized controlled trials evaluating different drugs (bisphosphonates, denosumab and toremifene) in the prevention of bone loss and in the reduction in fracture risk in prostate cancer patients treated with androgen-deprivation therapy. Following the applicable recommendations, urologists must carefully monitor the bone health of prostate cancer patients subjected to androgenic deprivation to obtain an early diagnosis and apply the appropriate general and/or therapeutic measures if necessary.

Cistectomía radical laparoscópica en los tumores vesicales clínicamente localizados (T2)

La cistectomia radical laparoscopica se ha desarrollado a partir de la expansion de la prostatectomia radical laparoscopica. Esta tecnica permite un abordaje poco invasivo para el tratamiento de los tumores vesicales infiltrantes de la capa muscular con disminucion del sangrado y una mas rapida recuperacion postoperatoria. METODOS Entre septiembre de 2004 y enero de 2007 se han realizado 54 cistectomias radicales por via laparoscopica, 48 en estadio T2 y de estas ultimas 43 (90%) eran varones y 5 (10%) mujeres. La edad media fue de 64 anos (27-88a). La linfadenectomia se practico por acceso laparoscopico en todos los casos, obteniendo una media de 13 ganglios (4-24). La derivacion urinaria se realizo por la incision de extraccion del especimen en todos los casos menos uno que se realizo completamente intracorporeo, siendo ureteroileostomia cutanea tipo Bricker en 30 casos (62%), neovejiga ortotopica tipo Padovana en 17 casos (35%) y ureterostomia cutanea en un caso (2%). RESULTADOS El tiempo quirurgico medio de todo el procedimiento fue de 287 minutos (180-480), 270 minutos para los casos con derivacion tipo Bricker y de 316 para los casos con una neovejiga. El indice de transfusion fue del 25%. El tiempo medio de ileo paralitico fue de 5 dias (2-10d) con un tiempo medio de ingreso para los pacientes con Bricker de 13 dias (6-34) y de 16 dias (8-30) para las neovejigas. El control oncologico, con un seguimiento medio de 10,8 meses (0,4-30m), presenta una supervivencia cancer especifica del 90% con un tiempo medio de supervivencia estimado de 28 meses (IC 95% 26-30). La supervivencia media global ha sido del 79% con un tiempo de supervivencia de 26 meses (IC 95% 23-29). CONCLUSIONES La cistectomia radical laparoscopica es una tecnica factible que ofrece ventajas. Permite una exeresis con un menor sangrado y un postoperatorio mas llevadero. Estudios aleatorizados deberian demostrar estas ventajas para confirmar si puede llegar a ser la tecnica de eleccion. La realizacion de la derivacion urinaria por la laparotomia, obligada para la extraccion de la pieza quirurgica, optimiza los resultados de la derivacion y el tiempo quirurgico total sin reducir los beneficios de la exeresis laparoscopica.OBJECTIVES: Laparoscopic radical cystectomy has been developed after the expansion of laparoscopic radical prostatectomy. This technique makes possible a minimally invasive approach to muscle-invasive bladder cancer with less blood loss and faster postoperative recovery. METHODS: From September 2004 to January 2007, 54 laparoscopic radical cystectomies were performed, 48 of them in stage T2, from which 43 (90%) were male and 5 (10%) female patients. Mean age was 64 years (27-881. Lymphadenectomy was carried out by laparoscopic approach in all cases, with a mean of 13 nodes obtained (4-24). Urinary diversion was done through the incision needed to extract the specimen in all cases but one that was completed completely intracorporeally; constructing a Bricker-type ureteroileostomy in 30 (62%) cases, orthotopic neobladder (Vesica Ileale Padovana) in 17 cases (35%), and cutaneous ureterostomy in 1 case (2%). RESULTS: Mean surgical time for the whole procedure was 287 minutes (180-480), 270 minutes for Bricker-type derivation cases and 316 minutes for neobladder cases. Blood transfusion rate was 25%. Mean ileal paralysis was 5 days (2-10) with a mean hospital stay of 13 days (6-34) for Bricker cases and 16 days (8-30) for neobladder cases. Oncological control, after a mean follow-up of 10,8 months (0,4-30), showed a cancer-specific survival of 90% with a mean survival time of 28 months (95% CI 26-30). Global mean survival was 79% with a mean survival of 26 months (95% CI 23-29). CONCLUSIONS: Laparoscopic radical cystectomy is a feasible technique that offers some advantages. It allows excision with less blood loss and an easier postoperative period. Randomized studies should demonstrate these advantages to confirm this approach as the technique of choice. Urinary diversion performed through the laparotomy incision, necessary to extract the specimen, optimizes derivation results and whole surgical time without reducing the beneficial effects of the laparoscopic exeresis.

Técnica de implantación del esfínter urinario artificial "FlowSecureTM" en uretra bulbar

Resumen es: Objetivo: El esfinter urinario FlowSecureTM es una protesis para la incontinencia urinaria de esfuerzo que ha proporcionado unos excelentes resultados ha...

MP79-07 USEFULNESS OF KIDNEY PREIMPLANTATION BIOPSIES FROM DECEASED DONORS FOR KIDNEY TRANSPLANT ALLOCATION

INTRODUCTION AND OBJECTIVES: The number of discarded kidneys for transplantation approaches 25% in the Spanish transplant registry. The main cause(w50%) is the presence of advanced histological lesions in kidney pre-implantation biopsies. Transplants results with expanded criteria donors are poorer than results with standard donors and kidneys with advanced histological lesions are not used in many transplant centers. AIM: To analyze transplant results from deceased donors using pre-implantation biopsies to evaluate expanded donors in our renal transplant unit. METHODS: Since 2009 all kidneys offered to our transplant unit were accepted for clinical examination. A pre-implantation kidney biopsy is obtained in patients with expanded criteria. Pre-implantation biopsies are processed in paraffin and pathologists cathegorizes the biopsies according to the Banff criteria (from 0 to 3). Individual scores are added and a pre-implantation score ranging from 0 to 15 is obtained. In general, kidneys with a pre-implantation donor score > 7 are discarded. An old-for-old policy is applied for kidney allocation with a donor/recipient age difference lower than 15 years. Kidneys with a donor biopsy score >5 were only transplanted in recipients older than 60 years RESULTS: Between 2009 and 2013 we evaluated 404 kidneys and 41 (10%) were discarded. Only 20 kidneys (5%) were discarded due to a pre-implantation biopsy score >7. Thus, 362 transplants were performed and according to our protocol in 254 cases (70%) a pre-implantation biopsy was obtained. Donors with a pre-implantation biopsy were older (61 10 vs. 39 10 years, p 5, n1⁄479) have a similar renal function at 1 year (45 14 vs. 46 15 mL/min) and a similar 5-year graft survival (81.4% vs. 83.5%) than transplants from kidneys with lower scores (1 to 5). CONCLUSIONS: Careful evaluation and selection of deceased donors and renal transplant recipients allows to reduce the number of discarded kidneys (10% in our unit) and to maintain standard transplant results.

Cierre de fístula neovésico-vaginal en paciente con neovejiga tipo studer mediante abordaje transvaginal con interposición de colgajo de Martius

Resumen es: Objetivo: Presentamos el caso de una fistula neovesico-vaginal en una paciente, asi como su cierre mediante interposicion de colgajo de Martius. Se reali...

Pelvis renal bífida

108 Paciente mujer de 20 años de edad con antecedentes quirúrgicos de nefrectomía derecha en la infancia por anulación funcional secundaria a reflujo vésico-ureteral, controlada por los Servicios de Nefrología y Urología y que presentaba infecciones urinarias de repetición. La ecografía reno-vesical de control no mostró hallazgos significativos. En el estudio urodinámico se evidenció una fase de llenado estable y una fase de vaciado con un flujo bajo y de altas presiones indicativo de patrón obstructivo. En la actualidad sigue tratamiento alfa-bloqueante y profilaxis antibiótica intermitente con buena evolución clínica. La urografía endovenosa se muestra sin cambios en los últimos años: pelvis renal bífida con ureter de calibre normal pero elongado a nivel de la unión uretero-vesical y vejiga trabeculada con divertículos y de aspecto piriforme. La pelvis renal bífida tiene una incidencia del 10% y representa una variante de la normalidad, asociándose en ocasiones a un aumento de frecuencia de reflujo vésico-ureteral e infecciones urinarias de repetición.