Pablo Francisco Martínez

Estudio randomizado sobre continencia urinaria postprostatectomía radical con rehabilitación perineal kiesica previa

La incontinencia urinaria es una de las principales complicaciones luego de la realizacion de prostatectomia radical (PR). La rehabilitacion kinesica preoperatoria, podria ser de utilidad como tratamiento preventivo de esta complicacion. Demostrar la utilidad de la kinesiologia perineal preoperatoria en la recuperacion precoz de la continencia urinaria post prostatectomia radical. METODOS Ensayo Clinico Controlado Randomizado Aleatorizado. 38 pacientes fueron divididos en dos grupos de 19 previo a la realizacion de la PR. El primer grupo (K) recibio tratamiento kinesico preoperatorio, mientras que el segundo grupo (NK) no (grupo control). Se evaluo la continencia de orina a los 14, 30 y 60 dias post extraccion de sonda. RESULTADOS No hubo diferencias epidemiologicas y de biologia tumoral entre grupos. El porcentaje de pacientes continentes en el grupo K al los 14, 30 y 60 dias, respectivamente fue de 47,36%, 47,36% y 78,9%, respectivamente, mientras que en el grupo NK fueron de 47,36%, 47,36% y 89,4%, respectivamente (p>0,05). CONCLUSIONES Los ejercicios kinesicos perineales previos a la prostatectomia radical, no disminuyeron los tiempos de recuperacion de la continencia urinaria ni la ocurrencia de la misma.

MP59-02 CHARACTERISTICS AND PERIOPERATIVE OUTCOMES FOLLOWING SURGICAL TREATMENT FOR RENAL CELL CARCINOMA IN VERY ELDERLY PATIENTS (≥75 YEARS): DATA FROM THE LATIN AMERICAN RENAL CANCER GROUP (LARCG)

benoit peyronnet*, Rennes, France; lauranne tondut, rennes, France; jean-christophe bernhard, bordeaux, France; christophe vaessen, paris, France; nicolas doumerc, toulouse, France; philippe sebe, benjamin pradere, rennes, France; bertrand guillonneau, paris, France; zine-eddine khene, rennes, France; francois-xavier nouhaud, rouen, France; nicolas brichart, orleans, France; thomas seisen, paris, France; jean-baptiste beauval, toulouse, France; gregory verhoest, quentin alimi, romain mathieu, rennes, France; adham rammal, orleans, France; alexandre de la taille, creteil, France; herve baumert, paris, France; stephane droupy, nimes, France; franck bruyere, tours, France; morgan roupret, paris, France; karim bensalah, rennes, France

Helicopter Emergency Medical Services in Buenos Aires: An Operational Overview

As part of the emergency medical care system, helicopter emergency medical services (HEMS) have a different crew composition from the traditional team. HEMS consist of a pilot, doctor, and firefighter with rescue skills and training in basic life support on board an air ambulance. This allows the adaptation to different environments and increases the varieties of air procedures normally performed. HEMS began operating relatively recently in Buenos Aires. Yet, in 3 years, its use grew to such an extent that in 2015 it tripled, and by 2016 the number of medical assists was 4 times greater than in 2014. Furthermore, over the 3-year study period, 92% to 95% of assisted victims were traffic accident casualties requiring primary care. The HEMS crew is informed about the availability of resources in the acute care general hospitals and can therefore transfer patients to the most appropriate trauma center in the shortest time. However, 75% to 85% of the time, the choice of destination is strongly influenced by the availability of a helipad and the operational safety that it provides.

V1-12 ROBOTIC-ASSISTED RADICAL PROSTATECTOMY AND CONTINENT URINARY STOMA (MITROFANOFF) IN A 7 YEAR CHILD.

INTRODUCTION AND OBJECTIVES: Urethrectomy with appendicovesicostomy is a treatment option for low stage urethral cancer. We present a novel minimally-invasive surgical approach which allows for robotic appendicovesicostomy to be performed simultaneously with open urethrectomy. METHODS: A 71 year-old man presented with clinically-localized squamous cell carcinoma of the urethra. He underwent a traditional open urethrectomy with simultaneous robotic-assisted bladder neck closure, omental J flap interposition, and appendicovesicostomy. The robot was side-docked to allow for a perineal surgeon to work in tandem with the robotic surgeon. RESULTS: Total operating room time was 391 minutes. Robotic console time was 281 minutes. Length of stay was four days. There were no complications, and no secondary procedures were required. Final pathology demonstrated T2 squamous cell carcinoma with negative margins. At 6 months follow up, the patient is continent and cancer-free. CONCLUSIONS: Simultaneous extirpative surgery and minimally-invasive urinary tract reconstruction is possible for patients with urethral cancer. Side-docking the robot allows for two surgical teams to work concurrently. This approach may be applicable to other procedures requiring both open perineal and laparoscopic intraabdominal access.

La incidencia de márgenes quirúrgicos positivos tras prostatectomía radical asistida por robot: ¿tiene la experiencia del cirujano influencia en todos los estadios patológicos?

OBJECTIVE The aim of this study is to analyze the clinical and surgical features of patients who underwent robotic-assisted radical prostatectomy (RARP) at our institution, and the impact of the surgeons experience in the oncological results related to pathological stage. MATERIAL AND METHODS An analysis of 300 RARP consecutively performed by the same urologist was conducted. Patients were divided into 3 groups of 100 patients in chronological order, according to surgery date. All patients had organ-confined clinical stage. Variables which could impact in positive margins rates were analyzed. Finally, positive surgical margins (PSM) in regard to pathological stage and surgeons experience were compared and analyzed. RESULTS No significant differences were found in variables which could impact in PSM rates. The overall PSM rate was 21%, with 28% in the first group, 20% in the second, and 16% in the third (P = .108). Significant lineal decreasing tendency was observed (P = .024). In pT2 patients, the overall PSM rate was 16.6%, with 27%, 13.8%, and 7.3% in each group respectively (P = .009). A significant difference was found between group 1 and group 3 (P = .004). In pT3 patients, the surgeons experience was not significantly associated with margin reductions with an overall PSM rate of 27.7% (28.2%, 28.6%, and 26.7% in each group respectively). CONCLUSIONS Clinical and surgical features in our patients did not vary over time. We found a significant reduction of PSM related to surgeons experience in pT2 patients. Contrariwise, the margin status remained stable despite increasing experience in pT3 patients.