Luis Hidalgo Togores

Reparación laparoscópica de la fístula vesicovaginal (O'Connor laparoscópico)

Resumen Introduccion La causa mas frecuente de fistula vesicovaginal en los paises desarrollados es la histerectomia, mientras que en paises del tercer mundo es el periodo relacionado con el trabajo del parto. Cualquier lesion iatrogenica quirurgica implica dificultades anadidas de diversa indole en el momento de su resolucion. Material y metodo Comunicamos el primer caso de fistula vesicovaginal resuelta por via laparoscopica realizada en nuestro centro. Presentamos el caso de una mujer de 50 anos sometida a una histerectomia por via abdominal, que presenta un cuadro compatible con fistula vesicovaginal. Es remitida a nuestro servicio tras un intento infructuoso de resolucion por via vaginal. Describimos el procedimiento laparoscopico de fistulorrafia vesicovaginal. Resultados El procedimiento quirurgico duro aproximadamente 3,5 h. La paciente inicio tolerancia oral a las 48 h, recupero el transito intestinal normal al quinto dia y fue dada de alta al octavo dia postoperatorio. Tras mas de un ano y medio de seguimiento, la paciente se encuentra asintomatica. Conclusiones La resolucion por via laparoscopica de la fistula vesicovaginal es perfectamente factible y segura y, siempre que reproduzcamos los principios que aplicamos en cirugia abierta, ofrece la misma tasa de exito con la menor morbilidad posible.

Ureterorrenoscopia (URS) flexible: técnica y resultados

Resumen es: Objetivo: Los objetivos fundamentales de este trabajo son dos. Por una parte exponer la tecnica empleada en nuestro Servicio ya que difiere en algunos as...

Implante de balones parauretrales como tratamiento de la incontinencia urinaria masculina: Experiencia del Hospital Universitario La Paz

OBJETIVOS Queremos expresar nuestra experiencia con el implante de balones parauretrales, como tratamiento de la incontinencia urinaria masculina. METODOS Hemos revisado de forma retrospectiva nuestra serie desde marzo del 2003 a marzo del 2007, que incluye a 69 pacientes con incontinencia urinaria masculina, la mayoria tras prostatectomia radical. RESULTADOS 6 pacientes estan pendientes de su primera revision tras la cirugia. Con un seguimiento medio de 22 meses (3-48) el 57.14% de los pacientes (36/63) no precisan proteccion y el 12.69% usan una compresa de seguridad (8/63), por tanto el 69.83% (44/63) de los pacientes estan secos o usan una compresa de seguridad. Si estratificamos a los pacientes segun el grado de su incontinencia, el 81,25% de los pacientes con incontinencia leve estan secos y el 59.25% de los pacientes en el grupo de incontinencia moderada. Sin embargo, solo el 35% de los pacientes con incontinencia severa estan secos (sin proteccion). CONCLUSIONES Segun nuestra experiencia, pensamos que el implante de balones parauretrales podria ser la primera opcion terapeutica para la incontinencia urinaria masculina leve y moderada.

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.

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.

Balones parauretrales (Pro-ACT TM) en la incontinencia urinaria postquirúrgica del cáncer de próstata

OBJECTIVES Prostate cancer early detection campaigns have led to the diagnosis of a greater number of patients with organ-confined disease candidates for intention-to-cure treatment. Radical prostatectomy is one of these treatments; despite the technical advances with the development of laparoscopic or robotic operations it still has urine incontinence as a side effect affecting patients quality of life. METHODS/RESULTS Based on the experience in the Urology Department at Hospital La Paz we describe the technique and our results, comparing with a bibliographic review of other techniques used for the treatment of urinary incontinence after radical prostatectomy from the Medline database. CONCLUSIONS The insertion of the paraurethral ProACT is the treatment of choice for mild-moderate incontinence after radical prostatectomy in our environment due to its high success rate and low morbidity, technical easiness, and adequate cost and resources requirements.

Estenosis ureterointestinales: Tratamiento endourológico

Resumen es: OBJETIVO: El objetivo de este estudio ha sido revisar el resultado de las estenosis ureterointestinales tratadas de forma endourologica y comparar nuestr...

Laparoscopic ureteral reimplantation in a renal transplant.

We present what is to our knowledge, the first case of laparoscopic ureteral reimplantation reported in the renal transplant. The ureteral stenosis is one of the most difficult renal transplant complications to deal with. With the development of the endourological approach, this treatment has become the first treatment option for these patients. The patient is a 28-year-old female who received a renal allograft from a cadaver donor in 2008. Ureteral stenosis was diagnosed. The laparoscopic approach seems to be a good option over the open approach, with the benefits related with laparoscopic surgery.

Donante vivo renal: Experiencia de cirugía abierta y laparoscópica. Hospital La Paz

Resumen La extraccion renal laparoscopica es una tecnica escasamente implantada en nuestro pais, debido principalmente a la dificultad tecnica que supone y a la gran cantidad de donante cadaver que encontramos en nuestro medio. Presentamos y analizamos nuestra serie de donante vivo abierto y laparoscopico desde 1984 Material y Metodos Desde 1984 hasta 2007 se han realizado 84 extracciones renales de donante vivo; 64 por cirugia abierta, 20 laparoscopicas. El abordaje transperitoneal ha sido el elegido en el caso de la laparoscopia y la lumbotomia en la abierta. Resultados En la tecnica abierta el tiempo quirurgico medio es de 112 min (70-155), el tiempo medio de isquemia caliente es de 20 segundos (15-47) y la estancia media es de 4,8 dias (3-9). En los casos realizados por laparoscopia, el tiempo quirurgico medio es de 146 min (90-210), el tiempo de isquemia caliente es de 3 min y 15 seg (2-3,25) y la estancia media es de 3,4 dias (2-9). Conclusiones El abordaje laparoscopico es una tecnica que no esta exenta de riesgos y que no deben ser despreciados. Debe ser realizado por equipos con experiencia en cirugia renal laparoscopica. En lo referente al rinon obtenido de donante vivo, sin duda se trata de una magnifica solucion para pacientes en estado de insuficiencia renal cronica. Es un recurso que deben ofrecer los principales hospitales de nuestro pais.