Sergio Alonso y Gregorio

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.

Laparoscopic transperitoneal radical prostatectomy in renal transplant recipients: a review of the literature.

To report our experience with laparoscopic radical prostatectomy (LRP) for the treatment of localized prostate carcinoma in two renal transplant recipients and a review of the literature.

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.

Neurofibroma de la vejiga: caso clínico y revisión de la literatura

Resumen es: Objetivo: La prevalencia de la enfermedad es 1 de cada 3000 nacimientos vivos, siendo mas frecuente en hombres que en mujeres con una relacion 3:1 en tod...

Pharmacological characterization of native α7 nicotinic ACh receptors and their contribution to depolarization‐elicited exocytosis in human chromaffin cells

BACKGROUND AND PURPOSE Expression of α7 nicotinic acetylcholine receptors (nAChRs) and their role in exocytosis have not yet been examined in human chromaffin cells.

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.

Nefroureterectomía laparoscópica: nueva posición para el manejo ureteral

OBJETIVOS El principal reto de la nefroureterectomia laparoscopica es el manejo del ureter distal que ademas tendra una repercusion importante en el resultado oncologico en muchos de los casos. Presentamos nuestra experiencia en este aspecto, teniendo en cuenta que las 5 ultimas nefroureterectomias laparoscopicas las hemos realizado con una posicion de Trendelemburg forzado, lo que ha supuesto un manejo mas comodo y seguro del ureter distal. METODOS Desde agosto hasta diciembre de 2006 se han realizado 5 nefroureterectomias con rodete vesical puramente laparoscopico con el paciente en posicion de Trendelemburg forzado, muy similar a la posicion empleada en las cistectomias o prostatectomias radicales laparoscopicas. RESULTADOS El tiempo quirurgico medio es de 182 minutos (170-210). El sangrado medio intraoperatorio es de 100cc y ninguno de estos pacientes ha precisado transfusion. El tiempo hospitalario medio es de 4 dias. CONCLUSIONES Creemos que esta posicion es una buena alternativa para el manejo del ureter distal en el abordaje laparoscopico. Se trata de una tecnica muy similar a la cirugia abierta, que hoy por hoy continua siendo el gold Standard.

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.