Revista mexicana de urologia最新文献

Background

Diverticular disease of the colon is common in the western world. After the first episode of diverticulitis, many patients benefit from medical therapy, but 10-20% develop abscesses, obstruction, or fistula.

Aim

To describe the laparoscopic treatment of sigmoidovesical fistula secondary to diverticular disease.

Material and methods

An observational, retrospective study was conducted on 10 consecutive patients within the time frame of 2011-2015 that had undergone: 1) colovesical fistula resection and primary closure of the bladder and sigmoid colon or 2) laparoscopic sigmoidectomy with the NOSE technique (transanal extraction of the specimen and colorectal anastomosis with primary closure of the bladder).

Results

Ten patients were operated on within the time frame of February 2011 and February 2015. The mean age of the patients was 60.7(49-71) years. Sigmoidectomy with primary anastomosis was performed on 4 patients and resection and primary closure on 6 patients. Surgery duration was 140.4 (80-210) min, blood loss was 195 (80-210) ml, and length of time before beginning oral diet was 4.3 (3–5) days. The drain was left in place in all the patients for 10 days and the transurethral catheter for 2 weeks. Up to the present time, none of the patients has presented with fistula recurrence or data consistent with intestinal anastomosis stricture.

Conclusions

Reports on the use of laparoscopy for the treatment of colovesical fistulas have demonstrated acceptable results. Only a few studies concentrate exclusively on colovesical fistula; in general the reports include other types of fistula (colovaginal and colocutaneous), as well. Colovesical fistula is a pathology that can be resolved safely and efficaciously through laparoscopy.

Background

To know the frequency, associations, and impact of climacturia on the function of orgasm after definitive surgical treatment of prostate cancer in Mexican patients.

Material and methods

A questionnaire was applied between January 2003 and January 2013 to know the aspects of climacturia (frequency, quantity of urine leakage, mechanisms used by the patient, and the level of discomfort and coping).

Results

A total of 122 patients were selected and 84 met the inclusion criteria. The mean age was 55.3 years. A total of 45.2% of the patients stated that they presented with climacturia, resulting in a prevalence of 0.45. Of those patients, 23.6% said they rarely experienced the condition, 47.3% occasionally, 10.5% often, 13.15% the majority of the time, and 5.26% all the time. In relation to patient satisfaction and negative perception during sexual intercourse, 23 patients stated that it was not a significant problem. Only 9 patients said that it represented an important level of discomfort for their partner.

Conclusions

There is a high number of patients with climacturia following radical prostatectomy and the condition is not necessarily associated with a negative impact on sexual satisfaction.

Objective

The aim of this study was to determine the relation of prostate-specific antigen to histopathologic and biochemical indicators in patients with a clinical prostate cancer diagnosis.

Material and methods

A cross-sectional study was conducted on patients 50 years and older that had a clinical diagnosis of prostate cancer within the time frame of March 2012 and August 2014. Prostate-specific antigen levels and histopathologic and biochemical data were analyzed through descriptive statistics, the Spearman correlation, ROC curves, and contingency tables.

Results

The median age of the patients was 71 years and the median prostate-specific antigen value was 8.1 ng/ml (2 ng/ml to 3,685 ng/ml). Pathologic study confirmed prostate cancer diagnosis in 50 patients. There was an association between prostate-specific antigen levels and Gleason score (p < 0.05), as well as between prostate-specific antigen and gamma-glutamyl transferase (p < 0.05).

Conclusions

Gamma-glutamyl transferase determination is suggested for increasing prostate-specific antigen sensitivity and specificity. The number of patients was a limitation of our study.

Adrenal tissue ectopia is uncommon. Its incidence in adults is not known, but there are 9 case reports in the international medical literature on ectopic adrenal tissue in the hernial sac.

We present herein 2 cases of ectopic adrenal tissue in the hernial sac of the spermatic cord, reviewing its pathogenesis, and attempting to justify the medical importance of its report in the literature.

Two men in the third decade of life underwent left inguinal hernioplasty and varicocelectomy with a histopathologic report of adrenal tissue nodules along the extension of spermatic cord lipoma.

Despite the low frequency of these cases, extirpation of the ectopic tissue is recommended, given that cases of neoplasia and endocrinologic complications due to this type of ectopia have been documented.

Pelvic organ prolapse is not a life-threatening condition, but it alters the quality of life in women. A woman has an 11% possibility of having pelvic floor dysfunction during her lifetime that will require surgical treatment. The main etiology is complex and multifactorial. We present herein the case of a woman with grade IV pelvic organ prolapse plus stress urinary incontinence. Physical examination revealed bladder prolapse at 6 cm below the vaginal introitus and a positive Marshall test. Computed axial tomography (CAT) identified hydronephrosis of the right kidney, dilated ureters, and a bladder, uterus, and rectum that dropped beyond the vaginal canal. Hysterectomy plus laparoscopic colposacropexy plus anterior and posterior colpoperineoplasty with polypropylene sling placement were performed. Surgery duration was 300 min, blood loss was 95 ml, and hospital stay was 2 days. The Marshall test was negative 60 days after the operation and control CAT scan showed there was no hydronephrosis.

Laparoscopic colposacropexy had become the criterion standard for vaginal prolapse management because it achieves anatomic recovery and lasting urinary, intestinal, sexual, and psychosocial function.

Genital lymphedema has generally been treated through plastic and reconstructive surgery.

The aim of this article was to present an alternative technique for the functional and esthetic treatment of penile lymphedema with a urologic approach.

A male patient had a past history of left testicular tumor, left radical orchiectomy, inguinoscrotal radiotherapy, secondary penile and scrotal lymphedema, and a left inguinal reservoir to palliate the scrotal lymphedema. He presented with an important deformation of the penis, micturition difficulty, and repeat balanoposthitis and so the decision was made to perform resection of the penile lymphedema and the corresponding reconstruction.

There were no complications during or after the procedure and good cicatrization and reduced penile lymphedema were observed.

The different conservative as well as surgical treatments that exist offer variable results. The management of these techniques is important for the urologist so that an integrated approach with other specialists can be carried out that will provide the patient with the best results.

Background

The era of prostate-specific antigen screening has produced an increase in the incidence of localized prostate cancer. Radical surgery is the gold standard for patients that are candidates for curative tratment.

Aim

To describe the initial experience with laparoscopic radical prostatectomy (LRP) at a tertiary care referral center.

Material and method

The cohort of patients that underwent radical prostatectomy within the time frame of January 2013 to June 2015 was reviewed. Eleven patients that underwent LRP, all operated on by the same surgeon, were included in the study. Demographic variables, comorbidities, and preoperative, intraoperative, and postoperative variables were analyzed. Biochemical recurrence and surgical margins were the oncologic variables evaluated. Descriptive statistics using the SPSS® version 20 statistical software package were carried out, performing frequency, means plus standard deviation, and median with range analyses.

Results

The mean age of the patients was 62.7 years with a standard deviation of ± 7.3. The majority of the presurgical cases were low-risk. A presurgical understaging trend was observed, given that 33% of patients were classified as high-risk after LRP. Follow-up time was 8 months (± 3.1). Two laparoscopic surgeries were converted for the surgeon's convenience to perform urethrovesical anastomosis. Blood loss, surgery duration, and hospital stay means were 380 ml (240-2,500), 300 min (105-615), and 4 days (3-10), respectively. The transfusion rate was 18% and the mean time with transurethral catheter was 7.9 days (6-9.7). Bilateral nerve-sparing surgery was performed in 100% of the cases. Urinary continence was achieved in 72.7% of the cases at one month after surgery, with an improvement trend from the third month to one year of follow-up. Erectile function was preserved in 55% of the cases and the positive margin rate was 45%. Prostate-specific antigen was undetectable at one month after LRP in 64% of the cases. The so-called trifecta outcome was met at one month after surgery in 36% of the patients and an incidence of 18% was reported in relation to postoperative complications.

Conclusions

We presented the initial experience with LRP at our hospital. LRP appears to be a safe technique with acceptable functional and oncologic results. Ours is a first series that must be updated as the learning curve moves closer to reaching its final plateau.

Background

The correct choice for the percutaneous puncture site is key to the success of any percutaneous nephrolithotomy. The ideal puncture should maximize the effectiveness of the procedure in terms of stone-free rate and minimize the risk for complications. It is necessary to correctly choose the calyx to be accessed; in certain cases the upper calyx is the ideal site.

Aims

To report our experience with the percutaneous approach to the upper pole with patients in the supine position.

Methods

A retrospective, observational, descriptive study was carried out on patients with stones in the renal pelvis or upper calyx treated through percutaneous nephrolithotomy.

Results

A total of 17 patients were included in the study, and 17 kidney units were treated. All 17 patients (100%) underwent general anesthesia. Nine (53%) of the patients were men and 8 (47%) were women, with a mean age of 45.8 years (range: 18-72). Stone site was the right kidney in 10 (59%) patients and the left in 7 (41%). A total of 13 (76%) patients were symptomatic. The mean body mass index was 27 kg/m² (range: 20-34). ASA classification was I in 13 (76.4%) patients, II in 3 (17.6%) patients, and III in one (5.8%) patient. Eight (47%) patients underwent previous treatments. Procedure success or stone-free rate was achieved in 14 (82.3%) patients with the first treatment and in 17 (100%) with the second treatment.

Discussion

Current knowledge of the pleural and diaphragmatic anatomy, the use of real time ultrasound for percutaneous puncture, and the development of new surgical techniques have considerably reduced the risk for intrathoracic complications.

Conclusions

Access to the upper calyx with the patient in the supine position is safe and reproducible. This approach provides excellent vision of the entire pyelocaliceal system and should be reserved for cases in which the lower calyx is not the best option.

Introduction

Squamous cell carcinoma is a rare tumor, making up from 2 to 5% of the urogenital tumors. However, because our hospital is a referral center that manages large numbers of patients, approximately 5-7 cases are seen per year. Inguinal lymph node dissection is one of the treatments for these lesions and is being performed more frequently as a minimally invasive procedure.

Objective

Our aim was to describe the surgical technique for robotic-assisted inguinal lymphadenectomy in cancer of the penis. We present herein the case of a 73-year-old man with symptom progression of one year and 6 months and increased volume at the level of the glans penis. A biopsy was taken, after which he underwent radical penectomy with perineal urethrostomy. The histopathologic study reported well differentiated verrucous squamous cell carcinoma that invaded the corpus spongiosum and the urethra (T3N0M0G1). Four weeks later he underwent robotic-assisted inguinal lymphadenectomy of the superficial and deep lymph nodes.

Conclusions

Robotic-assisted inguinal lymphadenectomy, aside from its high cost, is a feasible technique when carried out in specialized centers that reduces morbidity, blood loss, and hospital stay.