Search

Resumen Objetivo Evaluar la seguridad y eficacia de la tecnica de control de la vena cava inferior retrohepatica por acceso anterior (RIVCA, por retrohepatic inferior vena cava control through an anterior approach) en el carcinoma de celulas renales (CCR) con trombo tumoral nivel iii a. Pacientes y metodos Serie inicial de 6 casos que presentan CCR con trombo tumoral nivel iii a intervenidos de nefrectomia radical y trombectomia tumoral mediante la tecnica RIVCA entre 2018-2019. El objetivo de la tecnica RIVCA es obtener un control completo de la vena cava inferior retrohepatica por encima de la porcion craneal del trombo tumoral, pero excluyendo las venas hepaticas mayores con el fin de preservar la circulacion hepatocava natural. Se proporciona la descripcion paso a paso del procedimiento. Se registraron prospectivamente los rasgos de la enfermedad, asi como las caracteristicas y los resultados quirurgicos. Resultados La nefrectomia radical y la trombectomia tumoral se completaron en todos los casos. La tecnica RIVCA no aumento significativamente el tiempo quirurgico (rango: 14-22 min). La media de sangrado estimado fue de 325 cc (rango: 250-400). No se requirio transfusion de sangre intraoperatoria en ningun caso. La media de unidades de concentrados de hematies transfundidos por paciente en el periodo postoperatorio fue de 1,3 (rango: 0-2). No hubo casos de embolia pulmonar intraoperatoria ni se produjeron complicaciones mayores (Clavien-Dindo III-V) en el periodo postoperatorio a 30 dias. La estancia hospitalaria postoperatoria (mediana) fue de 8 dias (rango: 5-11). Conclusiones La tecnica RIVCA aplicada a los casos de CCR y trombo tumoral nivel iii a proporciona un control completo de la vena cava inferior retrohepatica por encima de la porcion craneal del trombo tumoral, a la vez que evita la inestabilidad hemodinamica intraoperatoria al mantener la precarga cardiaca a traves del circuito portocava. Esta tecnica puede limitar la morbilidad operatoria (embolia pulmonar intraoperatoria y hemorragia masiva), convirtiendose asi en un complemento de gran utilidad en casos de CCR con trombo tumoral de nivel iii a.

Introduction Pelvic kidney is a rare congenital anomaly. The ectopic kidney is more susceptible to developing lithiasis. The management of this type of lithiasis is a challenge. The objective of this paper was to conduct a review of available literature on the treatment of stone in ectopic kidney. Material and methods Description of a case of transperitoneal laparoscopic pyelolithotomy for the treatment of inferior calyceal lithiasis in a right pelvic kidney. A literature review was performed by using Pubmed. The following terms and combination terms were searched: “pelvic ectopic kidney”, “ureterorenoscopy”, “extracorporeal lithotripsy”, “PCNL”, “pyelolithotomy”. We incluyed original articles, meta-analysis, review and case reports. Results 130 articles were excluded by title or duplication. 62 abstracts articles and them 50 full text articles were evaluated. Stone free rate were 75% (SLW), 85% (URSf), 85%–90% (PCNL) and 100% (laparoscopic pyelolithotomy). The literature on treatment on pelvic kidney is poor. Conclusion Factors such stone size, density and location, and upper urinary tract abnormalities, influence the choice of therapeutic approach (retrograde, percutaneous and/or laparoscopic/robotic). Laparoscopic pyelolithotomy is a safe and minimally invasive treatment option for large kidney stones with unfavorable anatomy for the endoscopic approach.

Background Lymph node dissection(LND) remains the gold standard in the staging and treatment of locally advanced penile cancer(PC) 1 . Objective To describe our initial experience with a new minimally invasive inguinal and pelvic single-access laparoscopic approach 2 ,for performing LND in PC, first described in Urology by our group in 2015 3 : the Pelvic and Inguinal Single Access(PISA) technique (Fig. 1). Material Between 2015 and 2018, 10 consecutive patients with different PC stages and indication of inguinal LND (cN0 and ≥pT1G3 or cN1/cN2) 1 were operated by means of the PISA technique (Table 1). Intraoperative frozen section(FS) 4 analysis was carried out routinely and if ≥2 inguinal nodes(pN2) or extracapsular nodal extension(pN3) are detected 1 , 5 , ipsilateral pelvic LND was performed sequentially as a single-stage procedure and using the same surgical incisions. If this condition occurs bilaterally in the inguinal LND, the pelvic LND will be bilateral. The video shows the PISA technique in a step-by-step. Instrumental requirements: 30°laparoscopy optic, monopolar scissors,Ligasure (Covidien Surgical,Minneapolis,MN,USA) vascular sealant, extraction-bag, bipolar forceps and 5-mm endo-clip(Hem-o-lok)are required. Results Intraoperative and postsurgical variables are shown in Table 2. Inguinal LND was bilateral in all cases. Pelvic LND was required in 40% of patients. Total operative time was 120-170 minutes. Median estimated blood loss(EBL) was 66(30-100)cc, but no blood transfusion was required. No intraoperative complications were noted. 40% of patients had postoperative complications (10% major complication- symptomatic inguinal lymphocele). Median lenght of hospital stay(LOS)was 5.8(3-10) days. Median inguinal drain removal was 4.7 days. The pathological analysis outcomes are shown in Table 3. Mean number of lymph nodes removed by inguinal LND was 10.25(8-14). Conclusion PISA technique allow a minimally invasive inguinal and pelvic LND using the same set of incisions and carry it out in the same surgical procedure. PISA technique in PC LND seems to be safe, with a low rate of major complications and preserving oncological efficacy.

Resumen Introduccion Existe muy poca literatura espanola que compare resultados oncologicos tras prostatectomia radical (PR) segun la via de abordaje y la metodologia es inadecuada. Objetivo Comparar los resultados oncologicos en cuanto a margenes quirurgicos (MQ) y recidiva bioquimica (RB) entre PR abierta (PRA) y laparoscopica (PRL). Material y metodos Comparacion de 2 cohortes (307 con PRA y 194 con PRL) entre 2007 y 2015. El estado de los MQ se clasificaron como positivos o negativos y la RB como la elevacion del PSA despues de la PR > 0,4 ng/ml. Para el contraste de variables cualitativas se utilizo el test Chi-cuadrado y ANOVA para las cuantitativas. Para evaluar los factores predictores de los MQ se ha realizado un analisis multivariante mediante regresion logistica. Para evaluar los factores predictores de RB se ha realizado un analisis multivariable mediante regresion de Cox. Resultados El 43,5% de pacientes tuvieron un Gleason 7 (3 + 4) en la pieza quirurgica y un 31,7% MQ positivos siendo el estadio patologico mas frecuente pT2c en el 61,9%. No existieron diferencias significativas entre ambos grupos, excepto la afectacion extracapsular (p = 0,001), mas frecuente en la PRL. La mediana de seguimiento fue de 49 meses, evidenciando RB en el 23% de pacientes, sin diferencias significativas entre cohortes. En el analisis multivariable solo el grupo de riesgo D’Amico se comporto como factor predictor independiente de MQ positivos y el score de Gleason y los MQ positivos como factores predictores independientes de RB. Conclusion La via de abordaje no influyo en el estado de MQ ni en la RB.

ObjectivesThis study analyzes the subjective emotional impact COVID-19 deaths have had on healthcare, social services, and funeral services professionals, it explores the different implications, and analyzes the different reactions of health and social care professionals and funeral professionals to the volume of deaths.MethodsThis work is based on a qualitative, phenomenological, and interpretative approach through in-depth interviews with 42 informants, including 36 social and healthcare professionals, as well as 6 family members of those who died from COVID-19 in Madrid. The interviews were processed through a qualitative, interpretative, categorical analysis.ResultsHealthcare professionals were overexposed to a significant number of deaths under dramatic circumstances. Many of these professionals had difficulties processing their experiences and expressed the need for psychological help. The fact that certain professionals had previous exposure to high mortality rates was not a protective factor. Some coping differences were seen between healthcare professionals and professionals dedicated to the care of the deceased (undertakers or firemen), particularly in the degree to which they personalized the care they provided.ConclusionThe overexposure to death with the circumstances that existed during the state of emergency had a significant emotional impact on the professionals, which can lead to mental health problems in the near term.

Resumen Introduccion Pocos son los estudios que comparan la prostatectomia radical abierta (PRA) con la prostatectomia radical laparoscopica (PRL) y sus resultados funcionales, como la continencia urinaria (CU), que es uno de los objetivos prioritarios tras el control oncologico. Objetivos Comparar la CU postoperatoria en los pacientes con adenocarcinoma de prostata localizado intervenidos mediante PRA frente a PRL. Material y metodos Comparacion de dos cohortes (312 con PRA y 206 con PRL) entre los anos 2007 y 2015. El estado de CU se recogio a los 3, 6, 12, 18 y 24 meses. Para el manejo estadistico hemos agrupado la continencia en: a) CU, pacientes que no precisaron absorbentes, y b) incontinencia urinaria (IU), pacientes que precisaron absorbentes. Para el contraste de variables cualitativas se ha utilizado el test de la chi cuadrado para las variables cualitativas y ANOVA para las cuantitativas. Analisis multivariable mediante regresion logistica para la variable dependiente IU. La significacion estadistica se considero cuando existio una p Resultados En el 51,7% se realizo conservacion neurovascular. A los 24 meses de la cirugia, el 72,4% presentaban CU, de los cuales el 87,8% con PRA frente al 78,1% con PRL (p = 0,004). El 22,7% presentaron recidiva bioquimica (RB), siendo el 83% tratados con radioterapia de rescate (RTR). Los pacientes con RTR presentaron mayor porcentaje de IU frente a los que no la recibieron (p = 0,036). Se objetivo mayor porcentaje de estenosis de la anastomosis en PRA (p = 0,03). Conclusiones La PRL, la no preservacion de los fasciculos neurovasculares y la RTR se relacionaron directamente con la CU postoperatoria.

Introduction There are very few articles comparing open radical prostatectomy (ORP) vs. laparoscopic radical prostatectomy (LRP) and their functional results or urinary continence (UC), which is one of the most important objectives to pursue after oncological results. Objectives to compare postoperative UC in patients with localized prostatic adenocarcinoma treated with OPR or LRP. Materials and Methods Comparison between two patient cohorts (312 for ORP and 206 for LRP) between 2007−2015. The UC was evaluated at 3, 6, 12, 18 and 24 months. Continence was defined and classified as follows: a) UC, no need of pads, and b) urinary incontinence (UI), use of pads. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variable UI. Statistical significance when p Results Nerve-sparing was performed in 51,7% cases. At 24 months after surgery, 72,4% patients had UC, of which 87,7% were from the ORP group and 78,1% in the LRP group (p = 0,004). 22,7% of patients experienced biochemical recurrence (BR), with 83% treated with salvage radiotherapy (SRT), presenting greater UI percentage (p = 0,036). ORP patients showed a higher percentage of anastomosis stricture (p = 0,03). Conclusions LRP, non-nerve sparing, and SRT were directly related to postoperative IU.

Introduction The complications associated to the placement of the reservoir are infrequent but potentially serious. Therefore, technical alternatives have been developed for the performance of the procedure in different locations (ectopic). The aim of this review is to revise the evidence available on the different options for the ectopic placement of the reservoir. Material and method Narrative review based on a bibliographical search limited to PubMed-indexed relevant manuscripts, in Spanish or English, for the period 2000–2019, using “penile prosthesis”, “ectopic reservoir”, radical prostatectomy”, “radical cystectomy”, “pelvic radiotherapy”, and “renal transplantation” as key words. Non original articles and reviews were not considered eligible. A total of 11 manuscripts were included. Results Pelvic alterations after surgery and/or radiotherapy increase the difficulty in the placement of the prosthesis reservoir. In order to minimize the risk of complications, different modifications have been performed on the devices, and technical innovations have been developed for the submuscular placement of the reservoir. The available evidence regarding the functionality and complications of these techniques is limited to single institution, low volume, and retrospective series with short follow-up periods. The functionality seems to be adequate using the adapted devices. The complications are infrequent and mild in severity. Conclusions Although the available evidence is still limited, the ectopic placement of the reservoir may be considered a safe, effective, and reproducible technique. In addition, it may result particularly useful in cases of altered pelvic anatomy.

Resumen Introduccion Las complicaciones asociadas al emplazamiento del reservorio son infrecuentes pero pueden ser potencialmente graves, motivo por el cual se han desarrollado alternativas tecnicas para el emplazamiento en lugares diferentes al habitual (ectopico). El objetivo de este trabajo es revisar, de acuerdo con la evidencia disponible, las diferentes opciones para el emplazamiento ectopico del reservorio. Material y metodo Revision narrativa basada en una busqueda bibliografica de articulos relevantes indexados en PubMed, en ingles o castellano, publicados en el periodo 2000-2019, empleando las palabras clave: «protesis de pene», «reservorio ectopico», «prostatectomia radical», «cistectomia radical», «radioterapia pelvica» y «trasplante renal». Se descartaron los articulos no originales, casos aislados y revisiones. Se revisaron un total de 11 trabajos. Resultados Las alteraciones de la anatomia de la pelvis tras cirugia o radioterapia generan una dificultad anadida al emplazamiento del reservorio. Para minimizar el riesgo de complicaciones se han modificado los dispositivos y las tecnicas que permiten el emplazamiento submuscular. La evidencia relativa a funcionalidad y complicaciones se limita a series retrospectivas, de instituciones unicas, bajo volumen y escaso seguimiento. La funcionalidad es adecuada con los dispositivos adaptados; las complicaciones, infrecuentes y de escasa gravedad. Conclusiones Aunque la evidencia es baja, el emplazamiento ectopico del reservorio puede considerarse una tecnica segura, eficaz y reproducible. Ademas, puede resultar particularmente util en casos de anatomia pelvica alterada.

Resumen Introduccion y objetivos Las Guidelines de la AEU de 2017, consideran el acceso laparoscopico o asistido por robot como procedimientos en investigacion. La curva de aprendizaje se define por el numero minimo de casos que es necesario realizar para reproducir la tecnica considerada como estandar. El objetivo de este estudio es analizar en el mismo servicio, la implantacion de un programa de cistectomia laparoscopica (CRL), comparandolo con un programa consolidado y estandarizado de cistectomia abierta (CRA). Material y metodo Analisis de cohortes retrospectivo de dos grupos de cistectomias: CRL (n = 196) (2006-2016) frente a CRA (n = 96) (2003-2005). Comparacion de la evolucion en el tiempo de los siguientes parametros: tiempo quirurgico, las necesidad de transfusion, el estado de los margenes quirurgicos de reseccion, las complicaciones postoperatorias, la duracion de la estancia hospitalaria y las recidivas. Se han definido 3 periodos de tiempo para CRL: implantacion (2006-09) (CRLI), desarrollo (2010-14) (CRL-D) y consolidacion (2015-16) (CRL-C); comparandose cada uno de ellos con el grupo control (CRA). Para el contraste de variables cualitativas se ha utilizado el test de la Chi cuadrado y para las variables numericas el test de Anova. Resultados La CRL, en comparacion con la CRA, presento un mayor tiempo quirurgico en las fases de CRL-I y CRL-D, observando una tendencia de menores tiempos operatorios que la CRA en el periodo de consolidacion. La CRL presenta ademas menor trasfusion intraoperatoria en los 3 periodos y postoperatoria en CRL-D y CRL-C, menos complicaciones totales en CRL-D y CRL-C, menos complicaciones graves (Clavien≥3) en las 3 fases; asi como una disminucion de la mortalidad y estancia hospitalaria desde la fase de CRL-I, consolidandose esta disminucion en los otros dos periodos de estudio. No hemos observado diferencias significativas entre CRA y CRL en cuanto a margenes quirurgicos y recurrencias ni en el total de la serie ni en la comparacion entre los distintos periodos, lo que avala la seguridad de la CRL, desde su inicio. Conclusiones La CRL frente a CRA mejora desde su implantacion el porcentaje de transfusiones, de complicaciones y la estancia hospitalaria, con seguridad oncologica, a expensas de un mayor tiempo quirurgico en las fases de implantacion y desarrollo. Sin embargo, en nuestra serie observamos una tendencia de menores tiempos quirurgicos que la CRA en el periodo de consolidacion. En nuestro servicio el abordaje laparoscopico se ha validado en el tratamiento de la cistectomia radical.

Introduction and objectives The AEU Guidelines of 2017 consider laparoscopic and robot-assisted approaches as investigational procedures. The surgical learning curve is defined as the minimum number of cases that a surgeon has to perform in order to reproduce a technique considered as standard. The aim of this study is to analyze, within our department, the implementation of a laparoscopic radical cystectomy (LRC) program compared with a well consolidated and standardized open radical cystectomy (ORC) program. Material and methods Retrospective cohort analysis of two cystectomy groups: LRC (n = 196) (20062016) vs ORC (n = 96) (2003–2005). Comparison of the evolution over time of the following parameters: operative time, blood transfusion rates, resection margins, postoperative complications, hospital stay and recurrence. Three time periods have been defined for LRC: implementation (2006–09) (LRC-I), development (2010–14) (LRC-D) and consolidation (2015–16) (LRC-C); comparing each of them with the control group (ORC). The chi-square test was used for the comparison of the qualitative variables and the Anova test for the numerical ones. Results When compared to ORC, LRC presented longer operative times in LRC-I and LRC-D periods. We observed a trend toward shorter operative time than ORC in the consolidation period (LRC-C). LRC also presented lower intraoperative transfusion rates in all periods and lower postoperative rates in CRL-D and CRL-C. Overall complications in LRC-D and LRC-C were lower in LRC, having fewer major complications (Clavien ≥ 3) in the 3 periods. A decrease in mortality and hospital stay after the LRC-I phase was also observed. These results were consolidated during the two last periods of the study. We have not observed significant differences between ORC and LRC when comparing surgical margins and recurrence rates, neither in the total series, nor in the comparison between the different periods. These results endorse the oncologic safety of LRC from the beginning of the implementation process. Conclusions When compared to ORC, LRC improves perioperative transfusion rates, complications and hospital stay from its implementation period, maintaining oncological safety. On the contrary, longer operative times during implementation and development were observed. However, in our series, we observed a trend toward shorter operative times than ORC approach in the consolidation period. We have validated the laparoscopic approach for radical cystectomy in our service.

Resumen Introduccion Existen muy pocos estudios que comparen la prostatectomia radical abierta (PRA) con la prostatectomia radical laparoscopica (PRL). Objetivos Comparar el tiempo quirurgico, las complicaciones postoperatorias y la estancia hospitalaria en los pacientes con cancer de prostata clinicamente localizado tratados mediante PRA y PRL. Material y metodos Comparacion de dos cohortes (312 con PRA y 206 con PRL) entre 2007 y 2015. Las complicaciones postoperatorias se recogieron siguiendo las recomendaciones de las guias clinicas de la EAU y se agruparon segun la clasificacion de Clavien-Dindo. Para el contraste de variables cualitativas se utilizo el test Chi-cuadrado y ANOVA para las cuantitativas. Analisis multivariable mediante regresion logistica para variables dependientes cualitativas y mediante regresion lineal para las variables dependientes continuas. Resultados La mediana de duracion fue de 3:05 horas para la PRA y de 4:35 para la PRL (p = 0,0001). El 26,4% de pacientes presentaron alguna complicacion en el postoperatorio. El 31,2% de PRA y el 19,3% de PRL (p = 0,003). La mediana de estancia fue de 4 dias. En el grupo de PRA fue de 4 dias, mientras que en el de PRL fue de 3 (p = 0,008). La PRL (p = 0,0001), la realizacion de linfadenectomia (p = 0,02) y la conservacion neurovascular (p = 0,01) fueron factores predictores independientes de prolongacion del tiempo quirurgico. La PRL fue un factor protector independiente de complicaciones (OR = 0,48 p = 0,007). El tipo de prostatectomia no influyo en la estancia hospitalaria. Conclusiones La prostatectomia laparoscopica consumio mayor tiempo quirurgico, presento menor porcentaje de complicaciones y no influyo en la estancia hospitalaria.

Introduction There are very few articles comparing open radical prostatectomy (OPR) with laparoscopic radical prostatectomy (LRP). Objetives To compare the surgical time, the postoperative complications and the hospital stay in patients with localized prostate cancer treated with ORP or LRP. Materials and methods Comparison between two patients cohorts (312 with ORP and with 206 LRP) between 2007-2015. Postoperative complications were collected as defined in to the EAU Guidelines recommendations and they were classified according to the Clavien-Dindo classification. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variables and a lineal regression with dependent continuous variables. Results The mean duration of ORP was 3:05 h and 4:35 h for LRP (p = 0,0001). The 26.4 % of the patients presented any postoperative complication. 31.2 % of ORP and 19.3 % of LRP (p = 0,003). The mean of hospital stay was 4 days. In ORP group was 4 days in contrast to LRP with 3 days (p = 0,008). The LRP (p = 0,0001), lymphadenectomy (p = 0,02) and nerve-sparing (p = 0,01) were independent predictor factors of extension of surgical time. LRP was a protector independent factor of complications (OR = 0,48 p = 0,007). The type of prostatectomy didn’t influence in the length of hospital stay. Conclusions LRP showed higher surgical time, less complications and it didn’t influence the hospital stay.

To review the current situationof biomarkers used in the diagnosis, prognosis,treatment response and relapse of testicular cancer.A non systematic review was performedof clinical guidelines and articles published within thelast years regarding biomarkers in testicular cancer.The most commonly used biomarkersare alphafetoprotein (AFP) and beta human corionicgonadotropin (β-HCG).The enzyme lactate dehydrogenase (LDH) is presentin multiple tissues and is elevated in advancedgerminal tumors. A few micro molecules of RNA (micro-RNA) have demonstrated to be specifically elevatedin testicular germinal tumors. However, its clincalbenefit, as well as its standardization is currently underinvestigation.Classic biomarkers AFP, β-HCG,and LDH are of some utility confirming the diagnosisif they are elevated. However, its limited sensibility isnot enough to rely the diagnosis on themselves. Thereare promising results with Micro-RNA but its daily usedoes not seem imminent..-Revisar la situación actualde los biomarcadores utilizados en el diagnóstico, pronóstico,monitorización de la respuesta al tratamiento,y detección de la recidiva del cáncer de testículo.MÉTODOS:.- Realizamos una revisión no sistemáticatanto de guías de práctica clínica como de artículospublicados en los últimos años sobre los biomarcadoresen cáncer de testículo, en conjunto, y cadauno en particular..- Los dos marcadores más extendidosy utilizados son la alfafetoproteína (AFP), y la Betagonadotropina coriónica humana (β-HCG).La lactato deshidrogenasa (LDH) es una enzimapresente en diversos tejidos y que se encuentra elevadaen algunos tumores germinales, especialmenteen estados más avanzados. Algunas moléculas pequeñasde ácido ribonucleico circulante en sangre (Micro-RNA) han demostrado estar elevadas de maneramás constante y específica en los tumores germinalestesticulares. Sin embargo su utilidad práctica aún estáen evaluación, así como su sistematización para facilitarla extensión de su uso..- Los marcadores clásicos AFP,β-HCG, y LDH son de cierta utilidad confirmatoria encaso de estar elevados. Pero su limitada sensibilidadno permite fundamentar en ellos el diagnóstico. Losresultados obtenidos con los Micro-RNA son muchomás prometedores, sin embargo su incorporación a lapráctica diaria no parece inminente.

During the direst months of the COVID-19 pandemic, thousands of people died alone. This study analyzes these deaths, which occurred without the presence of loved ones, and seeks to a) examine the significance for relatives, as well as professionals, of dying alone, b) determine if these solitary deaths can be considered dignified, or good deaths, and c) evaluate if the treatment of the cadavers and the funeral rites transpired with the desired dignity and sensitivity. The study was carried out in the autonomous community of Madrid using a qualitative, phenomenological, and interpretative approach through in-depth interviews of 49 informants, professionals and relatives. Interviews were conducted between July and November of 2020, followed by an interpretive, categorical, qualitative analysis. Among the key findings are that during the most critical months, deaths lacked the desired dignity, even though the involved professionals did their best to accompany and dignify the deaths.

The circumstances surrounding the deaths during the COVID‐19 pandemic and the subsequent mourning process transpired in completely atypical conditions. This study analyses the experience of losing a loved one without traditional, culture‐specific rituals for saying goodbye, explores the different factors affecting the onset of mourning by family members and studies the existence of complicating risk factors associated with grief from this distinct type of loss. A qualitative, phenomenological and interpretive research study was undertaken through in‐depth interviews of 48 informants, key and general, in the autonomous Community of Madrid. The interviews were conducted between July and November of 2020 and were followed by an interpretive categorical qualitative analysis. The principal results include (a) the finding that deaths caused by the pandemic are, due to their characteristics, a complicating factor for bereavement, (b) evidence that the professionals who supported these deaths with a holistic approach, facilitating the process for the family members, have been a determining factor in enabling the beginning of the mourning process and reducing anguish for the family members and (c) the conclusion that a need exists for a resignification of the funeral rite. Finally, before future crises, it is recommended that access protocols be developed for relatives, including methods that permit them to say goodbye to their loved ones, no matter the situation.

Resumen Introduccion La cirugia minimamente invasiva en la cistectomia no ha tenido el mismo desarrollo que en otras cirugias urologicas, entre otros motivos por la falta de estudios publicados que definan las ventajas de este abordaje frente a la cirugia abierta. Objetivos El principal objetivo de este estudio es establecer el papel de la cirugia minimamente invasiva, laparoscopia, en la cistectomia radical frente a la cirugia abierta en un analisis de complicaciones perioperatorias. Material y metodo Analisis de cohortes retrospectivo de complicaciones perioperatorias de 2 series homogeneas de cistectomias: laparoscopica (n = 196) frente a abierta (n = 197). Identificacion mediante analisis multivariante de factores independientes predictores de complicaciones perioperatorias. Resultados En el analisis comparativo entre el abordaje laparoscopico y el abierto observamos una menor tasas de trasfusion perioperatoria (p 3; p Conclusiones En nuestro estudio identificamos el abordaje laparoscopico como protector de complicaciones en la cistectomia radical. El abordaje abierto casi triplica el riesgo de tener complicaciones.

Introduction Minimally invasive surgery regarding cystectomy has not had the same development as other urological surgeries. This could be due to the lack of published studies defining the advantages of this approach versus open surgery. Objectives The main objective of this study is to establish the role of minimally invasive surgery, laparoscopic radical cystectomy, versus open surgery by analyzing their perioperative complications. Material and method Retrospective cohort analysis of perioperative complications of 2 homogeneous series of cystectomies: laparoscopic (n = 196) versus open (n = 197). Identification of independent predictors of perioperative complications by multivariate analysis. Results In the comparative analysis between laparoscopic cystectomies and open cystectomies we observed a lower rate of perioperative blood transfusion (p 3; p Conclusions We have identified the laparoscopic approach as a complication shield for radical cystectomy. The open approach almost triples the risk of complications.

Introduction and objective Minimally invasive surgery represents an attractive surgical approach in radical cystectomy. However, its effect on the oncological results is still controversial due to the lack of definite analyses. The objective of this study is to evaluate the effect of the laparoscopic approach on cancer-specific mortality. Material and method A retrospective cohort study of two groups of patients in a pT0-2pN0R0 stage, undergoing open radical cystectomy (ORC) (n = 191) and laparoscopic radical cystectomy (LRC) (n = 74). Using Cox regression, an analysis has been carried out to identify the predictor variables in the first place, and consequently, the independent predictor variables related to survival. Results 90.9% were males with a median age of 65 years and a median follow-up period of 65.5 (IQR 27.75–122) months. Patients with laparoscopic access presented a significantly higher ASA index (p = 0.0001), a longer time between TUR and cystectomy (p = 0.04), a lower rate of intraoperative transfusion (p = 0.0001), a lower pT stage (p = 0.002) and a lower incidence of infection associated with surgical wounds (p = 0.04). When analyzing the different risk factors associated with cancer-specific mortality, we only found the ORC approach (versus LRC) as an independent predictor of cancer-specific mortality (p = 0.007). Open approach to cystectomy multiplied the risk of mortality by 3.27. Conclusions In our series, the laparoscopic approach does not represent a risk factor compared to the open approach in pT0-2N0R0 patients.

Introduction In patients with high-risk localized prostate cancer (HRPCa), multimodal treatment plays a fundamental role. Objective To compare relapse-free survival (RFS) in patients with HRPCa, treated primarily with radiotherapy (RT) + hormone therapy (HT) versus radical prostatectomy (RP) and salvage RT (sRT) ± HT when biochemical recurrence (BCR) appears. Material and methods Retrospective analysis of 226 patients with HRPCa (1996–2008), treated primarily with RT + HT (n = 137) or RP (n = 89). The Kaplan–Meier method has been used to evaluate survival and the log-rank test has been used to evaluate the contrast between the different categories of the variables. Multivariate analysis has been performed using Cox regression to determine variables with an impact on RFS with statistical significance (p Results The median follow-up of the series was 111 (IQR 85–137.5) months. After RT + HT, 32 (23.4%) patients relapsed, and after RP 41 (46.1%) cases, (p = 0.0001). When comparing the primary treatments, the RFS at 5 and 10 years was higher after RT + HT versus RP in monotherapy (p = 0.001). The primary treatment with RT + HT reduced the risk of BCR when compared to the RP (HR = 0.41, p = 0.002). The estimation of the RFS at 5 and 10 years after RP + sRT ± HT was 89.7 and 87.1%, while after primary RT + HT was 91.6 and 71.1%, respectively (p = 0.01). The only factor that behaved as an independent predictor of RFS was the multimodal treatment with RP + sRT ± HT when BCR showed up (HR = 2.39, p = 0.01). Conclusion In HRPCa, multimodal treatment with RP + sRT ± HT if BCR, significantly improves RFS with respect to treatment with RT + HT.

Resumen Introduccion En pacientes con cancer de prostata localizado de alto riesgo (CPAR) el tratamiento multimodal juega un papel fundamental. Objetivo Comparar la supervivencia libre de recidiva (SLR) en pacientes con CPAR tratados de forma primaria con radioterapia (RT) + hormonoterapia (HT) frente a prostatectomia radical (PR) rescatados con RT de rescate (RTR) con o sin HT tras recidiva bioquimica (RB). Material y metodos Analisis retrospectivo de 226 pacientes con CPAR (1996-2008), tratados de forma primaria con RT + HT (n = 137) o PR (n = 89). Utilizamos el metodo de Kaplan-Meier para evaluar la supervivencia y el test de log-rank para evaluar las diferencias entre las distintas categorias de las variables. Se realiza analisis multivariante mediante regresion de Cox para determinar variables con impacto en la SLR con significacion estadistica (p Resultados La mediana de seguimiento de la serie fue de 111 (RIC 85-137,5) meses. Tras RT + HT recidivaron 32 (23,4%) pacientes, y 41 (46,1%) tras PR (p = 0,0001). Al comparar los tratamientos primarios, la SLR a los 5 y 10 anos fue mayor tras RT + HT frente a PR en monoterapia (p = 0,001). El tratamiento primario con RT + HT redujo a mas de la mitad el riesgo de RB al compararse con la PR (HR = 0,41, p = 0,002). La estimacion de la SLR a los 5 y 10 anos despues de PR + RTR ± HT fue de 89,7 y 87,1%, mientras que tras RT + HT primaria fue de 91,6 y 71,1%, respectivamente (p = 0,01). El unico factor que se comporto como predictor independiente de SLR fue el tratamiento multimodal mediante PR + RTR ± HT cuando se presento la RB (HR = 2,39, p = 0,01). Conclusion En CPAR el tratamiento multimodal con PR + RTR ± HT si RB mejora significativamente la SLR con respecto al tratamiento con RT + HT.

Resumen Introduccion y objetivos No existe evidencia de alto nivel sobre que tratamiento primario proporciona una ventaja de supervivencia global (SG) y supervivencia cancer especifica(SCE) en cancer de prostata localizado de alto riesgo (CPAR). Nuestro objetivo es analizar las diferencias en supervivencia, asi como sus factores predictores, en este grupo de pacientes segun su tratamiento primario (prostatectomia radical [PR] o radioterapia y bloqueo androgenico [RT + HT]). Material y metodos Estudio retrospectivo de 286 pacientes con CPAR diagnosticados entre 1996-2008, tratados mediante PR (n = 145) o RT + HT (n = 141). La supervivencia se evaluo con el metodo de Kaplan-Meier. La existencia de diferencias significativas entre las distintas variables se analizo mediante el test de log-rank. Para la identificacion de factores de riesgo se utilizo un analisis uni y multivariante mediante regresion de Cox. Resultados La mediana de seguimiento fue de 117,5 (IQR 87-158) meses. La SG fue mayor (p = 0,04) en los pacientes con PR, mientras que no existieron diferencias (p = 0,44) en la SCE entre ambos grupos. El tipo de tratamiento primario no se relaciono con la SG ni SCE. La edad (p = 0,002), la aparicion durante el seguimiento de un segundo tumor (p = 0,0001) y el estadio cT3a (p = 0,009) se comportaron como variables predictoras independientes de SG. Ninguna de las variables se comporto como variable predictora independiente de SCE, aunque la recidiva bioquimica tras tratamiento de rescate (p = 0,058) y la aparicion de un segundo tumor durante el seguimiento presentaron una tendencia importante a la significacion estadistica, reduciendo este ultimo la mortalidad cancer especifica (hazard ratio 0,16, intervalo de confianza del 95% 0,02-1,18, p = 0,07). Conclusiones El tratamiento primario no se relaciono con la SG ni SCE en pacientes con CPAR.

Introduction and aim The main aim of the study was to establish the oncological safety of the laparoscopic approach to radical cystectomy for high-risk, non-organ-confined urothelial tumours. Material and methods A retrospective cohort study of 216 stage pT3-4 cystectomies operated between 2003 and 2016; using an open approach (ORC, n = 108), and using a laparoscopic approach (LRC, n = 108). Results Both groups have similar pathological features except, in G3 TUR, there were more lyphadenectomies and greater pN+, and more adjuvant chemotherapies using the LRC. The median follow-up of the series was 15 (IQR: 8–10.5) months. Sixty-eight point one percent of the series relapsed, with no differences between either group (p = 0.11). The estimated differences for cancer-specific survival was greater in the LRC group (p = 0.03), as was overall survival (p = 0.009). There were no differences between either group in estimated recurrence-free survival (p = 0.26). The type of surgical approach (p = 0.03), pTpN stage (p = 0.0001), and administration of adjuvant chemotherapy (p = 0.003) were related to cancer-specific mortality (CSM) in the univariate analysis. Only the pTpN stage (p = 0.0001), and not giving adjuvant chemotherapy (p = 0.003) behaved as independent predictive factors of CSM. Conclusion The type of surgical approach to cystectomy (ORC vs. LRC) did not influence CSM. Lymph node involvement and not giving adjuvant chemotherapy were identified as predictive factors of CSM. Our study supports the oncological safety of the laparascopic approach for cystectomy in patients with locally advanced muscle-invasive bladder tumours.

Introduction and objectives There is no high-level evidence as to which primary treatment provides an overall survival (OS) or cancer-specific survival (CSS) advantage in high-risk localised prostate cancer (HRLPC). Our aim was to analyse the differences in survival and predictive factors in this group of patients, according to their primary treatment (radical prostatectomy (RP) or radiotherapy and androgen blockade (RT + HT)). Material and methods A retrospective study of 286 HRLPC patients diagnosed between 1996 and 2008, treated by RP (n = 145) or RT + HT (n = 141). Survival was assessed using the Kaplan–Meier method. Significant differences between the different variables were analysed using the log-rank test. A uni and multivariate Cox regression analysis was performed to identify risk factors. Results The median follow-up was 117.5 (IQR 87–158) months. The OS was longer (p = 0.04) in the RP patients, while there were no differences (p = 0.44) in CSS between either group. The type of primary treatment was not related to OS or CSS. Age (p = 0.002), the onset during follow-up of a 2nd tumour (p = 0.0001), and stage cT3a (p = 0.009) behaved as independent predictive variables of OS. None of the variables behaved as an independent predictive variable of CSS, although biochemical recurrence after rescue treatment (p = 0.058), and the onset of a 2nd tumour during follow-up showed a significant trend to statistical significance, the latter reducing specific cancer mortality (HR .16, 95%CI 0.02–1.18, p = 0.07). Conclusions Primary treatment did not relate to OS or CSS in patients with HRPC.

Resumen Introduccion y objetivo La cirugia minimamente invasiva representa un abordaje quirurgico atractivo en la cistectomia radical. Sin embargo, a la espera de estudios definitivos todavia es controvertido el efecto que pudiera tener en los resultados oncologicos. El objetivo de este estudio es evaluar el efecto del abordaje laparoscopico sobre la mortalidad cancer-especifica. Material y metodo Estudio de cohortes retrospectivo de dos grupos de pacientes en estadio pT0-2pN0R0 sometidos a cistectomia radical abierta (CRA) (n = 191) y laparoscopica (CRL) (n = 74). Se realizo un analisis mediante regresion de Cox para identificar primero las variables predictoras y posteriormente las variables predictoras independientes relacionadas con la supervivencia. Resultados El 90,9% fueron varones; la mediana de edad fue de 65 anos y la mediana de seguimiento, de 65,5 (IQR 27,75-122) meses. Los pacientes con acceso laparoscopico presentaron de forma significativa un mayor indice ASA (p = 0,0001), un mayor tiempo entre la reseccion transuretral (RTU) y la cistectomia (p = 0,04), una menor tasa de transfusion intraoperatoria (p = 0,0001), un menor estadio pT (p = 0,002) y una menor incidencia de infeccion asociada a herida quirurgica (p = 0,04). Al analizar los distintos factores de riesgo asociados a mortalidad cancer-especifica, solo encontramos el abordaje mediante CRA frente a CRL como factor predictor independiente de mortalidad cancer-especifica (p = 0,007). El acceso abierto a la cistectomia multiplico el riesgo de mortalidad por 3,27. Conclusiones En nuestra serie, cuando limitamos los distintos factores identificados asociados a mortalidad cancer-especifica analizando pacientes pT0-2N0R0, el abordaje laparoscopico no representa un factor de riesgo frente al abordaje abierto.

Introduction and objectives The onset of second primary tumours should be considered in high-risk prostate cancer patients in the natural course of the disease. Our aim was to evaluate the influence of primary treatment with curative intent for these patients on the development of second primary tumours. Material and methods A retrospective study of 286 patients diagnosed between 1996 and 2008, treated by radical prostatectomy (n = 145) or radiotherapy and androgen blockade (n = 141). The homogeneity of both series was analyzed using the Chi-squared test for the qualitative variables, and the Student's t-test for the quantitative variables. A multivariate Cox regression analysis was performed to assess whether the type of primary treatment influenced the development of second tumours. Results The median age was 66 years, and the median follow-up was 117.5 months. At the end of follow-up, 60 patients (21%) had developed a second primary tumour. In the prostatectomy group it was located in the pelvis in 13 (9%) cases, and those treated with radiotherapy and hormonotherapy in 8 (5.7%) cases (p = 0.29). The most common organ sites were: colo-rectal in 17 (28.3%) patients, the lung in 11 (18.3%), and the bladder in 6 (10%) patients. In the multivariable analysis, the risk of a second tumour doubled for those treated with radiotherapy and hormonotherapy (HR = 2.41, 95% CI: 1.31–4.34, p = 0.005) compared to the patients treated by prostatectomy. Age and rescue radiotherapy did not behave as independent predictive factors. Conclusions The onset of a second primary tumour was related with the primary treatment given; thus the risk for those treated with radiotherapy and androgen deprivation therapy more than doubled.

Resumen Introduccion y objetivos La aparicion de segundos tumores primarios en pacientes con cancer de prostata de alto riesgo debe tenerse en cuenta en la evolucion natural de la enfermedad. Nuestro objetivo es evaluar la influencia del tratamiento primario con intencion curativa de dichos pacientes en el desarrollo de segundos tumores primarios. Material y metodos Estudio retrospectivo de 286 pacientes diagnosticados entre 1996 y 2008, tratados mediante prostatectomia radical (n = 145) o radioterapia y bloqueo androgenico (n = 141). La homogeneidad de ambas series fue analizada con el test de la Chi-cuadrado para las variables cualitativas y la t de Student para las cuantitativas. Se realizo un analisis multivariante mediante regresion de Cox, para evaluar si el tipo de tratamiento primario influia en el desarrollo de segundos tumores. Resultados La mediana de edad fue de 66 anos, y la mediana de seguimiento de 117,5 meses. Al final del seguimiento, 60 pacientes (21%) habian desarrollado un segundo tumor primario. En el grupo de prostatectomia se localizo en la pelvis en 13 (9%) casos y en 8 (5,7%) casos en los tratados con radioterapia y hormonoterapia (p = 0,29). Las localizaciones mas frecuentes por organos fueron: colorrectal en 17 (28,3%) pacientes, pulmon en 11 (18,3%) y vejiga en 6 (10%) pacientes. En el analisis multivariable, los tratados con radioterapia y hormonoterapia duplicaban el riesgo de segundo tumor (HR = 2,41, IC95%: 1,31-4,34; p = 0,005) con respecto a los pacientes tratados con prostatectomia. La edad y la radioterapia de rescate no se comportaron como factores predictores independientes. Conclusiones La aparicion de un segundo tumor primario se relaciono con el tratamiento primario administrado; asi, los tratados con radioterapia y privacion androgenica multiplicaron por mas de 2 su riesgo.

Objective To evaluate the safety and efficacy of the retrohepatic inferior vena cava control through an anterior approach (RIVCA) technique in renal cell carcinoma (RCC) with level IIIa tumor thrombus. Patients and methods Initial series of 6 cases presenting RCC and level IIIa tumor thrombus who underwent radical nephrectomy and tumor thrombectomy using the RIVCA technique between 2018–2019. RIVCA technique aims to gain complete control of the retrohepatic inferior vena cava above the cranial end of the tumor thrombus, but excluding the major hepatic veins in order to preserve the natural hepato-caval shunt. A step-by-step description of the procedure is provided. Disease features, operative characteristics, and surgical outcomes were registered prospectively. Results Radical nephrectomy and tumor thrombectomy were completed in all cases. RIVCA technique did not increase operative time significantly (range: 14–22 min). Mean estimated blood loss was 325 cc (range: 250–400). Blood transfusion was not required intraoperatively in any of the cases. Mean postoperative transfusion rate was 1.3 red blood cells packed units (range: 0–2). There were no cases of intraoperative pulmonary embolism or major complications (Clavien-Dindo III-V) in the period of 30 days postoperatively. Median postoperative length of stay was 8 days (range: 5–11). Conclusions The RIVCA technique applied to cases of RCC and level IIIa tumor thrombus provides complete control of the retrohepatic inferior vena cava above the tumor thrombus cranial end, while prevents intraoperative hemodynamic instability by maintaining cardiac preload through the porto-caval shunt. This technique may limit operative morbidity (intraoperative pulmonary embolism and massive hemorrhage), thus becoming a helpful adjunct to be used in cases of RCC with level IIIa tumor thrombus.

Penile metastasis is a very rare clinical entity. The primary origin is usually genitourinar y followed by the gastrointestinal. MATERIAL AND METHODS: Review of the available literature on a case of penile metastasis of urothelial bladder carcinoma.Penile metastasis is an exceptional entity despite the rich vascularization of this organ. Less than 500 cases have been described. Most cases manifestas exophytic or nodular lesions. Its association with disseminated disease conditions its palliative management in a large part of the cases, as well as an unfavorable prognosis. In selected cases, surgical treatment can be chosen. CONCLUSIONS: Since its clinical presentation is variable, clinical suspicion is important in the presence of a skin lesion of torpid evolution taking into account the patient's oncological history.La metástasis peneana es una entidad clínica muy poco frecuente. El origen primario suele ser genitourinario seguido del gastrointestinal. MATERIAL Y MÉTODOS: Revisión de la literatura disponible a propósito de un caso de metástasis peneana de carcinoma urotelial de vejiga. RESULTADOS: La metástasis peneana es una entidad excepcional a pesar de la rica vascularización de este órgano. Se han descrito menos de 500 casos hasta la fecha. La mayor parte de los casos se manifiestan como lesiones exofíticas o nodulares. Su asociación a enfermedad diseminada, condiciona su manejo paliativo en gran parte de los casos, así como un pronóstico desfavorable. En casos seleccionados puede optarse por tratamiento quirúrgico.Dado que su presentación clínica es variable, es importante la sospecha clínica ante la presencia de una lesión cutánea de evolución tórpida teniendo en cuenta los antecedentes oncológicos del paciente.

Infection of the artery at or around the anastomotic site is an ominous complication commonly presenting as a leak and/or local dissolution of the arterial wall.Narrative review based on relevant PubMed, EMBASE, and Scielo indexed English or Spanish-written articles for the period January 2000-December 2019. A pooled analysis regarding etiology was performed. Based on the results obtained with this approach, a diagnostic/therapeutic algorithm is suggested in order to optimize its clinical management.Arterial pseudoaneurysms are pseudocapsuled contained hematomas generated as the result of an arterial leaking. They are infrequent (1% of cases), mostly related with infection (contamination of preservation fluid or sepsis) and located at the arterial anastomotic site in renal transplantation recipients. Although they are frequently diagnosed in symptomatic patients days/weeks after transplantation, they may remain unnoticed for long periods being diagnosed incidentally. Color coded-Doppler ultrasound confirms the clinical suspicion. Angio CT-scan and angiography are used for surgical planning or endovascular treatment, respectively. The etiological diagnosis is made on a basis of excised tissue culture. The decision-making process regarding the treatment approach, mostly relies on clinical presentation and anatomical location. Therapeutic options include ultrasound-guided percutaneous thrombin injection, endovascular treatment, and surgery.Mycotic pseudoaneurysms in renal transplantation recipients may pose a significant challenge in cases of spontaneous rupture, given the risk for massive bleeding and death. Adequate management requires accurate diagnosis. Early endovascular stenting remains the treatment of choice in hemodynamically unstable patients. Percutaneous injection and vascular reconstruction present variable success rates in preserving graft function.

The aim of this study is to evaluate the influence of laparoscopy in patients with renal cancer treated with radical nephrectomy in terms of surgical time, hospital stay, postoperative complications and survival.MATERIAL AND METHODS: Retrospective study of 570 patients with renal cancer treated with radical nephrectomyin stage ≤pT3a. Differences between groups were analysed using ANOVA test for quantitative variables and Chi squared test for qualitative. In order to evaluate possible risk factors for longer hospital stay and surgical time, multivariate analysis was performed (lineal regression). For complications we performed binary logistic regression. Overall survival (OS), recurrence free survival (RFS) and cancer specific survival (CSS) were estimated using Kaplan Meier and compared using Log Rank test. Univariate and multivariate analysis was performed using Cox regression in order to identify independent risk factors for overall, cancer specific and recurrence mortality.Two cohorts: 361 (63.3%) open radical nephrectomies (ORN) and 209 (36.7%) laparoscopic (LRN). Surgical time was longer in LRN (p=0.001) globally. After the period when the learning curve was over these differences were no longer significant. Hospital stay was shorter in LRN (p=0.0001). cT stage (p=0.005) and surgical access (p=0.001) acted as independent risk factors for longer surgical time. 33,5% (121 patients) of the ORN had some sort of postoperative complication vs. 11% (23 patients) in the LRN group (p=0.0001). These differences were observed in the Clavien-Dindo's grade II group. Independent risk factors for postoperative complications observed were: ASA≥III (OR=1.82, p=0.004) and stage pT3a (OR=2.29,p=0.0001). Laparoscopy acted as a protective factor for complications (OR=0,26, p=0.0001). Surgical access did not influence RFS (HR=0.87, p=0.50), CSS(HR=0.69, p=0.12).Laparoscopic access to RN in patients with renal cancer in ≤pT3a stage increased surgical time only in the first years, reduced hospital stayand postoperative complications and did not influence RFS, OS or CSS.El objetivo del estudio es evaluarla influencia de la laparoscopia en pacientes concáncer renal tratados con nefrectomía radical (NR) en términos de tiempo quirúrgico, estancia media, complicaciones postoperatorias y supervivencia.MATERIAL Y MÉTODO: Análisis retrospectivo de 570 pacientes con cáncer renal tratados con NR en estadio ≤pT3a comparando cohorte de acceso abierto (NRA) y laparoscópico (NRL). Contraste de variables cualitativas con el test de Chi cuadrado y cuantitativas con ANOVA. Para identificar factores de riesgo (FR) de tiempo quirúrgico y estancia media se utilizó regresión lineal multivariante y para complicaciones la regresión logística binaria. Estimación de la supervivencia libre de recidiva (SLR), global (SG) y cáncer específica (SCE) mediante Kaplan-Meier y test de log-rank para analizar las diferencias. Análisis multivariante mediante regresión de Cox para identificar variables predictoras independientes (VPI) de SLR y SCE. Todos los cálculos se han realizado con el paquete estadístico IBM® SPSS® statisticsv-21.Dos cohortes: 361 (63,3%) NRA y 209(36,7%) NRL. El tiempo de cirugía fue mayor en NRL (p=0,001) de forma global siendo las diferencias entre ambas en el periodo tras la curva de aprendizaje no significativas. La estancia media fue menor en NRL(p=0,0001). El estadio cT (p=0,005) y la vía de acceso (p=0,001) se comportaron como VPI de prolongación del tiempo quirúrgico. El 33,5% (121 casos) de las NRA presentaron algún tipo de complicación en el postoperatorio, frente al 11% (23 casos) de las NRL (p=0,0001). Esta diferencia se observó en complicaciones tipo II de Clavien. VPI de complicaciones postoperatorias: ASA≥III (OR=1,82, p=0,004) y el estadio pT3a (OR=2,29, p=0,0001). La laparoscopia se comportó como factor protector de complicaciones (OR=0,26, p=0,0001). La vía de acceso no influyó en la SLR (HR=0,87, p=0,50) ni en la SCE (HR=0,69,p=0,12).El acceso laparoscópico a la nefrectomía radical en pacientes con cáncer renal en estadio ≤pT3a aumentó el tiempo quirúrgico pero solo en los primeros años, presentó menor estancia y complicacionespostoperatorias y no influyó en la SG,SLR y SCE.

Approximately, 25% of the patients with ESRD will enter the waiting list for kidney transplantation. Among these patients, almost 15% will require a retransplantation surgery. This review aims to summarize the most recent information on different controversial issues regarding retransplantation, to provide the reader with a clear and updated view on the topic. Despite current evidence is mainly based on retrospective, small, single-center experiences, it seems clear that retransplantation remains a surgical and immunological challenge, for which the perioperative management still remains crucial to avoid mishaps. Different surgical approaches have been tested, but the general consensus advocates for the heterotopic extraperitoneal in first instance. Although higher immunological risk and complication rates are reported invariably in the available series, the benefits in terms of overall survival are superior to those obtained under dialysis, thus still representing the most recommended option for this group of patients.

Background and objective Surgery on renal tumors with venous tumor thrombus presents a high complication rate and non-negligible perioperative mortality. Our objective was to analyze the postoperative complications, their relationship with the level of the tumor thrombus and its potential predisposing factors. Materials and methods A retrospective analysis was conducted in 101 patients with renal and venous tumor thrombus operated on between 1988 and 2017. Two patients were excluded because of intraoperative pulmonary thromboembolism and exitus (2%). The postsurgical complications were classified according to Clavien–Dindo classification system. To compare the qualitative variables, we employed the chi-squared test. We performed a multivariate analysis using binary logistic regression to identify the independent predictors. Results Some type of postsurgical complication occurred in 34 (34.3%) patients, 11 (11.1%) of which were severe (Clavien III–V). There were significant differences in the total complications (p = 0.003) and severe complications (Clavien ≥ III; p = 0.03) depending on the level of the tumor thrombus.

Resumen Introduccion y objetivo La cirugia de los tumores renales con trombosis venosa esta gravada con un porcentaje elevado de complicaciones y con una mortalidad perioperatoria no despreciable. Nuestro objetivo es analizar las complicaciones postoperatorias, su relacion con el nivel del trombo y sus posibles factores favorecedores. Materiales y metodos Analisis retrospectivo de 101 pacientes con tumores renales con trombosis venosa intervenidos entre 1988 y 2017. Se descartaron 2 pacientes por TEP intraoperatorio y exitus (2%). Las complicaciones posquirurgicas se clasificaron segun Clavien-Dindo. Para el contraste de variables cualitativas se ha utilizado el test de la Chi cuadrado. Se realizo un analisis multivariante mediante regresion logistica binaria para identificar las variables predictoras independientes. Resultados En 34 (34,3%) pacientes se produjo algun tipo de complicacion posquirurgica, siendo en 11 (11,1%) graves (Clavien III-IV). Existen diferencias significativas en las complicaciones totales (p = 0,003) y las graves (Clavien ≥ III) (p = 0,03) segun el nivel del trombo tumoral.

Objetivo Identificar factores pronósticos de recurrencia y mortalidad cáncer-específica en pacientes con tumor de urotelio superior tratados con cirugía. Material y Métodos Análisis retrospectivo de pacientes con tumor de urotelio superior operados entre 1999 y 2011 (139 pacientes). Se recogieron variables demográficas, clínicas, diagnósticas y patológicas así como el tratamiento, las complicaciones y la evolución. Análisis descriptivo mediante la prueba de la Chi cuadrado para variables categóricas y el test ANOVA para variables continuas. Análisis univariante y multivariante mediante modelo de riesgos proporcionales de Cox. Significación estadística si p Resultados En el análisis multivariante se identificaron como factores predictores independientes de recurrencia: crecimiento sólido tumoral (HR = 4,02; p Conclusión En nuestra serie, la existencia de tumor vesical previo o sincrónico, el crecimiento tumoral sólido y el alto grado citológico se comportaron como factores pronósticos de recurrencia. La hidronefrosis, el tumor vesical previo o sincrónico, el estadio pT3–4 y el crecimiento tumoral sólido, se comportaron como factores pronósticos de mortalidad cáncer-específica.

Acute thrombophlebitis of spermatic vein is an unusual pathology involving, in most of the cases, the left side, and whose etiology remains uncertain. Most of them are found during a a differential diagnosis in acute testicular pain. We introduce the case of a 29 years old male with abusive cocaine consumption, admitted to hospital due to severe testicular pain. Doppler-ultrasound examination was undertaken, showing right spermatic vein flux alteration. Conservative management was decided and anticoagulant and non-esteroidal anti-inflammatory drugs were started. Eco-doppler is the most specific and sensible technique for diagnosis of these cases, while TC can always confirm etiologic diagnosis. Treatment was initially conservative based on anticoagulation. Hematological study is necessary in order to determine coagulation alterations.

Context Bladder cancer is the cause of more than 150,000 deaths per year. The overall rate of survival is approximately 45%, with a 10-year recurrence-free rate of 50–59%, with no changes in the last decade. Objective Due to a lack of agreement on the follow-up of cystectomy or on a uniform treatment when faced with the various types of recurrence, we have analyzed the most recent literature in an attempt to unify the criteria for the diagnosis and treatment of bladder cancer. Acquisition of evidence Review of Spanish and English publications in the medical literature in the last 10 years, highlighting the most significant series in terms of the number of patients, follow-up time, as well as the existing meta-analyses. Synthesis of the evidence Recurrence after cystectomy can occur in the urinary apparatus (upper urinary tract or distal urethra) and local (cystectomy bed) and/or distant metastases. Despite strict control, more than 60% of the relapses are discovered based on symptoms and not by the routine follow-up test. Locoregional and distant relapses are more common the more advanced the stage at the time of cystectomy, going from 11–21% in pT2N0 to 52–72% when there is lymphocytic N+ involvement. Recurrence in the urethra and/or upper urinary track has other prognostic factors such as multiplicity, the presence of Cis and involvement of prostatic stroma. There are various treatments for tumor relapses. Increasingly, the patient's comorbidity is considered when deciding on the therapeutic strategy. Treatments are typically multimodal and include surgery, radiotherapy and chemotherapy. Conclusion The follow-up of patients who undergo cystectomy should be individualized, taking into account the prognostic factors of recurrence and the patient's comorbidity, assuming that in some cases, multimodal treatment is indicated.

Resumen Contexto El cancer de vejiga es la causa de mas de 150.000 muertes/ano. La tasa de supervivencia global es de aproximadamente un 45% con un periodo libre de recurrencia a diez anos del 50-59%, sin cambios en la ultima decada. Objetivo Al no existir un acuerdo en el seguimiento tras cistectomia ni un tratamiento uniforme ante los distintos tipos de recidiva, analizamos la literatura mas reciente para intentar unificar criterios en su diagnostico y tratamiento. Adquisicion de evidencia Revision de las publicaciones en castellano e ingles de la literatura medica en los ultimos diez anos, destacando las series mas importantes en numero de pacientes, tiempo de seguimiento, asi como los metanaalisis existentes. Sintesis de la evidencia La recurrencia tras cistectomia puede producirse en el aparato urinario (tracto urinario superior o uretra distal), local (lecho de la cistectomia) y/o metastasis a distancia. A pesar de un control estricto, mas del 60% de las recidivas se descubren en base a la sintomatologia y no en las pruebas rutinarias de seguimiento. Las recidivas locorregionales y a distancia son mas frecuentes cuanto mas avanzado es el estadio en el momento de la cistectomia, pasando del 11-21% en pT2N0 al 52-72% cuando existe afectacion linfatica N+. La recidiva a nivel uretral y/o en el aparato urinario superior tiene otros factores pronosticos como la multiplicidad, presencia de Cis, afectacion del estroma prostatico, etc. Los tratamientos de las recidivas tumorales son diversos y, cada vez mas, se considera la comorbilidad del paciente a la hora de decidir la estrategia terapeutica. Habitualmente los tratamientos son multimodales, incluyendo cirugia, radio y quimioterapia. Conclusion El seguimiento de los pacientes sometidos a cistectomia debe ser personalizado teniendo en cuenta los factores pronosticos de recurrencia y la comorbilidad del paciente, asumiendo que, en algunos de ellos, estara indicado el tratamiento multimodal.

Prostate cryotherapy has been consolidated as an alternative minimally invasive treatment.To exposed its historical development, its action mechanism and the surgical technique. Regarding its indications, we expose the different option of treatment- primary cryotherapy, salvage and focal- emphasizing its oncological results in the absence of randomized studies.Cryotherapy is a safe technique with low complication rate, although incidence of erectile dysfunction is 40-90% in case of full-gland cryotherapy. Nowadays, it is recommended as a therapeutic alternative for low and intermediate risk localized prostate cancer, although in clinical trials. Recurrence-free survival is close to 96% in low-risk tumors and 90% in intermediate-risk tumors. On the other hand, it is a salvage treatment option for local recurrence after radiotherapy. Focal therapies including focal cryoablation have an important development, with recurrence-free survival of 75%.Waiting for randomized studies that provide more scientific evidence, available retrospective studies show cryotherapy as a safe and effective treatment option in patients with localized prostate cancer.INTRODUCCIÓN: La crioterapia prostática se ha ido consolidando como una alternativa de tratamiento mínimamente invasiva.Exponer el desarrollo histórico de la crioterapia, su mecanismo de acción sobre el tejido prostático así como la técnica quirúrgica. Se discuten los distintos escenarios – crioterapia primaria, de rescate y focalhaciendo énfasis en sus resultados oncológicos a falta de estudios randomizados.La crioterapia es una técnica segura con un bajo índice de complicaciones, aunque destaca una incidencia de disfunción eréctil del 40-90% en el caso de crioterapia de glándula completa. En la actualidad se recomienda como alternativa terapéutica en el cáncer de próstata localizado de riesgo bajo e intermedio, aunque dentro de ensayos clínicos. La supervivencia libre de recidiva bioquímica es cercana al 96% en tumores de bajo riesgo y al 90% en tumores de riesgo intermedio. Por otro lado, es una opción de tratamiento de rescate en el caso de recidiva local tras radioterapia siempre que se cumplan una serie de criterios (Gleason ≤7 y PSA10ng/ml). La mejora en las técnicas de imagen está permitiendo el desarrollo de terapias focales incluyendo la crioablación focal, con supervivencia libre de recidiva bioquímica del 75%.A la espera de estudios randomizados que aporten mayor evidencia científica, los estudios retrospectivos disponibles muestran la crioterapia como una opción de tratamiento segura y eficaz en pacientes con cáncer de próstata localizado.

Radical cystectomy (RC) with pelvic lymphadenectomy is the treatment of choice in patients with muscle invasive bladder cancer (MIBC).To identify clinical and pathological variables that influence global mortality (GM) and cancer specific mortality (CSM) in patients with urothelial bladder tumor (UBT) treated with RC. METHODS: Retrospective analysis of 517 patients diagnosed with UBT and treated with RC between 1986 and 2009. Demographic, clinical, surgical and pathological variables, as well as complications and evolution after RC were collected. A comparative analysis was carried out with Chi square and ANOVA test. Survival analysis was performed with the Kaplan-Meier method and the long-rank test. Univariate and multivariate analysis were performed using Cox regression to identify independent predictors of GM and CSM. RESULTS: 91% of the patients were males with a median age of 66 years. The most frequent local pathological stage was pT3 (32.6%), with lymph node involvement in 23.8% of the patients. After a median follow-up of 34 months, 170 patients were alive and 311 had died from any cause (63.5%), being UBT the cause of death in 225 patients (45%). Rates of global survival and cancer specific survival at 5 and 10 years were 45%/34.3% and 52.5%/46.6% respectively. On the multivariate analysis age ( p = 0.004), ASA ( p = 0.000), the existence of hydronephrosis ( p = 0.01), pT ( p = 0.000) and pN ( p = 0.003) were identified as independent predictors of GM, as well as pT ( p = 0.000) and pN ( p = 0.002) for CSM. CONCLUSIONS: Age, anesthetic risk, presence of hydronephrosis, pT and pN stage were identified as independent predictors of GM, as well as pT and pN stage for CSM.INTRODUCCIÓN: La cistectomía radical (CR) con linfadenectomía pélvica es el tratamiento de elección en los pacientes con tumor vesical músculoinfiltrante (TVMI). OBJETIVO: Identificar variables clínicas y patológicas que influyen en la mortalidad global (MG) y cáncer-específica (MCE) en pacientes con tumor urotelial vesical (TUV) tratados con CR. MATERIAL Y MÉTODOS: Análisis retrospectivo de 517 pacientes diagnosticados de TUV y tratados con CR entre 1986 y 2009. Se recogieron variables demográficas, clínicas, quirúrgicas y patológicas, así como complicaciones acontecidas y evolución tras CR. Análisis comparativo con test de Chi Cuadrado y ANOVA. Cálculo de supervivencia con el método de Kaplan-Meier y test de long-rank. Análisis univariante y multivariante mediante regresión de Cox para identificar variables predictoras independientes de MG y MCE. RESULTADOS: El 91% de los pacientes fueron varones con mediana de edad de 66 años. El estadio patológico local más frecuente fue el pT3 (32,6%), con afectación ganglionar en el 23,8% de los pacientes. Tras mediana de seguimiento de 34 meses, 170 pacientes estaban vivos y 311 habían fallecido por cualquier causa (63,5%), siendo el TUV la causa de muerte en 225 pacientes (45%). Se objetivaron tasas de supervivencia global y cáncer específica a 5 y 10 años del 45/34,3% y del 52,5/46,6% respectivamente. En el análisis multivariante se identificaron la edad ( p = 0,004), el ASA ( p = 0,000), la existencia de hidronefrosis ( p = 0,01), el pT ( p = 0,000) y el pN ( p = 0,003) como variables predictoras independientes de MG, así como el pT ( p = 0,000) y pN ( p = 0,002) para MCE. CONCLUSIONES: La edad, el riesgo anestésico, la presencia de hidronefrosis, el estadio pT y pN se identificaron como variables predictoras independientes de MG, así como el estadio pT y pN para MCE.

Resumen Objetivo Disenar un sumatorio de riesgo para la seleccion de pacientes para radioterapia adyuvante despues de prostatectomia. Material y metodo Estudio retrospectivo de 629 pacientes con cancer de prostata localizado y pN0-pNx tratados con prostatectomia y con un PSA a los 2-3 meses 0,4 ng/ml. Analisis multivariante mediante regresion de Cox. Asignacion de puntuacion (0-2) en funcion del HR de las variables significativas. El sumatorio de las puntuaciones definio el sumatorio de riesgo. Resultados El 19,7% pT3, 24,2% Gleason ≥ 8 y el 26,3% de margenes quirurgicos positivos. Mediana de seguimiento de 82 meses. Recidiva bioquimica el 26,6%. El Gleason = 7 (4 + 3) (HR = 2,01, p = 0,008), el Gleason ≥ 8 (HR = 3,07, p Conclusion Los pacientes con un sumatorio de riesgo ≤ 2 no se beneficiarian de radioterapia adyuvante, mientras que los pacientes con un sumatorio de riesgo ≥ 3 pudieran beneficiarse de radioterapia adyuvante.

Objective To design a risk summation to select patients for adjuvant radiation therapy after prostatectomy. Materials and method A retrospective study was conducted on 629 patients with localized prostate cancer (pN0–pNx) who were treated with prostatectomy and with a prostate-specific antigen (PSA) value 0.4 ng/ml. A multivariate Cox regression analysis was performed. A score (0–2) was assigned according to the hazard ratio of the significant variables. The score summation defined the risk summation. Results A total of 19.7% of the patients were pT3, 24.2% had a Gleason score ≥8, and 26.3% had positive surgical margins. The median follow-up was 82 months. Some 26.6% of the patients experienced biochemical recurrence. The identified prognostic variables independent of biochemical recurrence were a Gleason score = 7 (4 + 3) (HR, 2.01; p = .008), a Gleason score ≥8 (HR, 3.07; p 50% survival free of biochemical recurrence at 5 and 8 years. In contrast, the patients with a risk summation ≥3 had Conclusion The patients with a risk summation ≤2 did not benefit from adjuvant radiation therapy, while the patients with a risk summation ≥3 might benefit from adjuvant radiation therapy.

Urethrorrhagia after radicalprostatectomy(RP) is very uncommon, regardless of the surgicalapproach used. Arterio-urethral fistula formation betweeninternal pudendal artery branches(IPA) and bulbarurethra is an exceptional finding.We report what we consider the first series oftwo cases (one has already been published) of urethrorrhagiaafter open retropubic RP due to urethrovascular fistulaformation with its origin in the IPA or in one of its terminalbranches.Both cases were diagnosed with contrast-enhancedCT, confirmed with arteriography, and they weretreated with superselective transarterial embolization(STE)with spongostan. After 5 years, the first case maintainserectile function using tadalafil on demand. The other caseis in the 2nd postoperative month.Severe urethrorrhagia after RP is an exceptionalcomplication. The existence of an arterio-urethralfistula must be considered when both urethrorrhagia andabnormal bulbar enhancement in CT are present. Arteriographyallows to confirm the diagnosis, most frequently involvingIPA distal branches. STE is an effective and safetreatment.La uretrorragia tras prostatectomía radical (PR) es muy infrecuente, independientemente del abordaje quirúrgico utilizado. La formación de fístulas arterio-uretrales entre ramas de la arteria pudenda interna (API) y la uretra bulbar, es un hallazgo excepcional.MATERIAL Y MÉTODOS: Presentamos la primera serie de 2 casos (uno ya publicado) de uretrorragia tras PR retropúbica abierta debidos a la formación de una fístula vascular con origen en la API o una de sus ramas terminales. RESULTADOS: Ambos casos fueron diagnosticados mediante TC con contraste intravenoso, confirmados con arteriografía, y tratados con embolización transarterial supraselectiva (STE) con espongostán. Tras 5 años, el primer caso conserva la función eréctil con tadalafilo a demanda. El 2º caso se encuentra en el 2º mes postoperatorio.CONCLUSIÓN: La uretrorragia severa tras PR es una complicación excepcional. Se debe sospechar la presencia de una fístula arterio-uretral ante la coexistencia de uretrorragia y realce bulbar anómalo en la TC, que suele ser la prueba de elección en el enfoque diagnóstico. La arteriografía permite confirmar los hallazgos, que suelen interesar a ramas dislates del territorio de la API. La STE es un tratamiento efectivo y seguro.

Prostate cancer is a disease that presents a wide spectrum from low aggressiveness localized to disseminated cancer. Locally advanced prostate cancer (LAPC) is a particularly difficult to manage phase of this spectrum.We review the definition, diagnosis and treatment of this phase of the disease.We performed a non systematic literature review of the most relevant features of this pathology.LAPC is more aggressive than organ confined disease. Its clinical diagnosis is not always easy. Local treatment, in spite of being aggressive with potential sequelae, seems to be advantageous in terms of patient survival.Prostate cancer local staging is currently based on multiparametric magnetic resonance imaging (mpMRI). Local radical treatment with surgery or radiotherapy, with probable addition of systemic treatment, offers promising results for disease control and quality of life improvement.

Retroperitoneal fibrosis is a disease that may condition a severe involvement of various organs, mainly upper urinary tract, even causing renal insufficiency. It was first described by Albarran in 1905 and it is also known as Ormonds disease. The correct diagnosis includes, in many cases, the performance of one or more tests: CT scan, MRI, renal scan, etc. It is often necessary the insertion of double J catheters on percutaneous nephrostomy tubes with the aim to preserve renal function. Initial treatment is medical, based on corticoids, and , less frequent, immunosuppressive or chemotherapy drugs. Surgery is the treatment of choice when ureteral entrapment by the fibrous plaque is not solved with medical treatment. Such operation may be performed with a conventional open approach (laparotomy) or by pure, hand assisted laparoscopic surgery, or robotic surgery. In all cases, the technique involves freeing the ureters from the fibrous plaque that entraps them, leaving them intraperitoneal, and it is recommendable to wrap them with an omental flap. The implantation of minimally invasive techniques has made that, in groups with experience in laparoscopy, open surgery is being abandoned and the laparoscopic approach indication is increasing. Our group has performed 10 laparoscopic ureterolysis from 2005. In two patients, it was bilateral. Despite surgical repair, two renal units were lost, keeping the rest with different levels of renal function depending on the preoperative level of disease. We did not have major complications and the mean hospital stay was 5.5 days. Although, there is not important published scientific evidence about this technique and it is unlikely we will have it in an immediate future, due to the rarity of this disease, and the different degree of involvement that conditions. It is not unreasonable to propose that, based on the literature reviewed and our own experience, laparoscopic approaches, despite being complex, may solve the ureteral entrapment with similar results to open surgery but less morbidity and shorter hospital stay.