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Introduction: The increased incidenceof diagnosis of kidney tumours has driveninvestigation in the area. It is known that the risk ofmalignancy is correlated with tumour size, but thereare still no specific and objective parameters to characterizethe degree of aggressiveness and to be ableto guide a treatment reliably. OBJECTIVE: To identify the relationship betweenrenal tumour size and the incidence of tumour aggressivecharacteristics., Patients and Methods: A retrospective analysisof our series of renal cancers operated between 1998and 2018 was performed. The specific and cumulativeincidence of aggressive characteristics was studied.The following where considered as aggressive characteristics:Presence of sarcomatoid or epidermoiddifferentiation, tumour necrosis, stage pT3-4, histologicalhigh grade (3-4) and the presence of histologicalaggressive variants., Results: A total of 651 patients that had undergonerenal mass surgery were analysed. In tumours below2 cm the appearance of aggressive characteristicsoccurred in less than 5%. For renal masses greaterthan 2 cm, each centimetre increase correlated with arise in cumulative incidence of 2-3% for each characteristicstudied., Conclusions: In tumours below 2cm and patientswith significant comorbidities active surveillance maybe a reliable alternative to surgery.

Objectives: The intraoperative goaldirected fluid therapy (GDT) has become the base of perioperative management in the fast-track protocols. This program using technology to estimate cardiac output, with the aim of minimizing splanchnic hypoperfusion. However, there is insufficient evidence to confirm its application in radical laparoscopic cystectomy., Methods: In a retrospective study, we have included 52 patients that were scheduled for radical cystectomy. In group A (n=32) patients were treated following GDT. Group B (n=18) included patients before the GDT introduction in our practice. The main objective was to assess the length of hospital stay and the permanence in intensive care units. Other variables of the study were the use of intraoperative blood products, fluid-therapy and medical and surgical complications. Statistical analysis was performed using the Mann Whitney U test for non-parametric variables and the Chi-square test for qualitative variables. Fisher's exact test was used when the sample size required it., Results: The average length of hospital stay was 13.4 SD (11.0-15.9) days in group A versus 11.6 SD (8.9-14.3) days in group B (p<0.364) . The average stay in critical care unit was 25.4 hours (16.1-34.6) in group A versus 21.0 (14.9-27.1) hours in group B with no significant differences between groups. The use of blood products was 0.41 packed red blood cells in group A versus 0.49 in group B with no statistically significant differences. The average volume of crystalloid administered was 1145 ml in group A versus 2382 ml in group B (p<0.001) . In group A 656 ml of colloids were administered versus 266 ml in group B (p<0.001) . There were no statistically significant differences in the incidence of complications., Conclusions: The use of a Goal Directed Fluid Therapy in radical cystectomy is related to a greater use of colloids than crystalloids, although its implementation does not affect hospital stay length or postoperative complications. In a multimodal perioperative program a single factor, as it is for the GDT, has little effect as an independent variable, and the combination of strategies has, more likely, a greater effect.

Introduction: In the last 15 years, the role of laparoscopic surgery has progressively increased to include reconstructive procedures such as pyeloplasty and management of ureteral stricture, in addition to being a field in continuous development, this refers to the improvement of ergonomics, new instruments and new techniques. We present a review on basic features of laparoscopic reconstructive surgery in urology., Acquisition of Evidence: For this review, an exhaustive literature search was performed in PUBMED, MEDILNE, BioMed central and others, with the keywords: reconstructive surgery, urology, laparoscopy. Only articles including urologic procedures in the adult and published in the last 6 years, were selected for this review., Synthesis of Evidence: One of the objectives of any urological reconstructive procedure is to treat any segment of the genitourinary tract that is obstructed due to scar tissue following trauma or iatrogenic causes. After the excision of such segment or scar, a mobilization of the 2 healthy extremities of the urinary tract must be performed in order to proceed with a tension-free anastomosis. Occasionally, if there is tension, a mobilization of the organs at each side of the lesion should be performed to reduce the tension of the anastomosis; also, it should be a water-tight anastomosis to ensure good functional results. Another type of procedure is to perform laparoscopic repair surgery of pelvic organ prolapse in which the vaginal anatomy should be adequately restored, with good function maintained (sexual, urinary, intestinal) and durability., Conclusions: With the worldwide expansion of minimally invasive surgery in the area of laparoscopy and robotics, it has been possible to reproduce many of the reconstructive techniques that have followed the evolutionary course of surgery from the open to the robot assisted technique, which has made clear that such therapeutic options exist and are reproducible with good results.