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Description: The Holmium: yttrium-aluminum-garnet (Ho:YAG) laser has become the gold-standard intracorporeal lithotripsy device since it was first introduced in the 1980’s. More recently, the Thulium Fiber Laser (TFL) was introduced into the clinical setting, with the potential to address some of the inherent limitations with Ho:YAG devices. In particular, early experience suggested the TFL provided enhanced dusting and fragmenting capabilities, less retropulsion and better stone free rates compared to the Ho:YAG laser. Relevance: Should the initial claims of the TFL’s better dusting properties be confirmed, this would be a significant advancement in the field. The ability to dust larger stones more rapidly could enhance the role of ureteroscopy and reduce the need for more invasive procedures. Conclusion: The initial experience with the TFL is promising and suggests an advantage over Ho:YAG laser lithotripsy. Properly conducted prospective randomized trials are required to further delineate the advantages, disadvantages and to optimize patient outcomes.

Pentafecta is currently the standard in the comprehensive evaluation of patients undergoing radical prostatectomy, the objective of this study is the evaluation of oncological and functional outcomes in patients with prostate cancer of high risk undergoing robot-assisted radical prostatectomy.Descriptive, retrospective study of 20 cases with a diagnosis of high-risk prostate cancer. The high-risk group is composed of a prostate-specific antigen equal or greater than 20 ng/mL, Gleason score equal or greater than 8, or clinical stages T2/T3 treated with robotic approach.Biochemical control was achieved from the first six weeks after the surgical event. 75% (n = 15) had negative surgical margins. 100% of the patients (n = 20) presented urinary continence immediately after removal of the urinary catheter. Erectile function was preserved at 3, 6 and 12 months in 100% of the patients who underwent neuropreservation but with use of an PDE inhibitor. (n = 5). Complications were reported in 10% (Clavien-Dindo I-II).Robot-assisted radical prostatectomy in patients with high-risk prostate cancer is considered an appropriate treatment option in selected patients. A different experimental design is needed to define the advantages or disadvantages of this approach, as well as to determine its role and application in clinical practice.Pentafecta es el estándar en la evaluación integral de los pacientes sometidos a prostatectomía radical. El objetivo de este estudio es evaluar y describir los desenlaces oncológicos y funcionales en pacientes con cáncer de próstata de alto riesgo sometidos a prostatectomía radical asistida por robot.Estudio descriptivo, retrospectivo, de 20 pacientes con diagnóstico de cáncer de próstata de alto riesgo. El grupo de alto riesgo se compone por pacientes con antígeno prostático específico mayo o igual a 20 ng/ml, reporte histopatológico con Gleason mayor o igual a 8 y/o estadios clínicos T2/T3 tratados con abordaje robótico.El control bioquímico se alcanzó a partir de las primeras 6 semanas posterior al evento quirúrgico. El 75% (n = 15) presentaron márgenes quirúrgicos negativos. El 100% de los pacientes (n = 20) presentaron continencia urinaria inmediatamente después del retiro de la sonda vesical. La función eréctil se conservó a 3, 6 y 12 meses en el 100% de los pacientes a los que se realizó neuropreservación, pero con uso de inhibidor de la fosfodiesterasa (n = 5). Se reportaron complicaciones en el 10% de los casos (Clavien-Dindo I-II).La prostatectomía radical asistida por robot en pacientes con cáncer de próstata de alto riesgo se considera una opción de tratamiento adecuada en casos seleccionados. Se necesita un diseño experimental distinto para definir las ventajas o desventajas de este abordaje, así como determinar su papel y aplicación en la práctica clínica.

Aim: Our primary aim was to report the prevalence of recurrent stricture following primary pyeloplasty and the secondary treatment performed. The secondary aim was to identify the clinical or surgical factors related to recurrent ureteropelvic junction obstruction (UPJO). Materials and methods: A retrospective study was conducted on patients diagnosed with UPJO at the Hospital General de Mexico “Dr. Eduardo Liceaga”, between 2011-2019. Patients that underwent primary pyeloplasty, and developed recurrent UPJO, underwent secondary treatment, and had follow-up ³6 months were included in the study. A descriptive analysis was carried out. Results: A total of 52 patients underwent open or laparoscopic pyeloplasty as primary treatment and 6 of them (11.5%) presented with recurrent UPJO at 44 months (median). Two of those patients presented with a non-functioning kidney and underwent simple laparoscopic nephrectomy and the remaining 4 patients underwent transperitoneal laparoscopic redo pyeloplasty as secondary treatment. The mean age of the patients with recurrence was 46 years, their mean BMI was 32.57±5 kg/m2, and two of them had urinary diversion prior to the primary pyeloplasty. Surgery duration was longer for laparoscopic redo pyeloplasty versus primary pyeloplasty (192 minutes versus 113 minutes) and intraoperative bleeding was similar (52cc versus 52.9cc). The surgical and histologic finding in laparoscopic redo pyeloplasty was peri-ureteral fibrosis. No aberrant vessels were found. Stricture was longer than 15 mm in the patients that underwent laparoscopic redo pyeloplasty (n=4). Obesity, lithiasis, and stricture length >15mm were more frequent in the patients with recurrence. Conclusions: The prevalence of UPJO in our study population was 11.5%, which concurs with international parameters. Laparoscopic redo pyeloplasty is a useful tool in cases of UPJO.

The purpose of this chapter is to provide a step-by-step description of the robot-assisted radical cystectomy with an intra-corporeal neo-bladder technique and a recent review of its outcomes. The procedure is also known as anterior pelvic exenteration or cysto-prostatectomy in the case of female or male respectively. Radical cystectomy (RC) is the gold standard treatment for muscle-invasive bladder cancer, but there are also several surgical indications for non-muscle-invasive bladder cancer. In the past years, minimally invasive surgery and the da Vinci system technology have played a major role in this procedure, with description of brand-new techniques and specific approaches for the creation of a continent urinary reservoir. The following chapter provides a detailed description of the robot-assisted radical cystectomy (RARC) with Y-shaped intra-corporeal bladder as well as a literary review of distinct perioperative, functional and oncological outcomes from the available RARC randomized controlled trials. Despite its high cost and complexity, the intra-corporeal technique has become widely popular around the world and is used more frequently each time. The described data in this chapter, demonstrates that morbidity can be reduced whilst simultaneously offer non-inferior oncological results and less intraoperative blood loss in contrast to the open RC approach.

INTRODUCCION El ureter retrocavo es una anomalia congenita rara que requiere manejo quirurgico. OBJETIVO Reportar los resultados en el manejo laparoscopico para ureter retrocavo y hacer una revision bibliografica. METODO Estudio retrospectivo, descriptivo, transversal, en pacientes con diagnostico de ureter retrocavo que fueron sometidos a plastia laparoscopica de ureter retrocavo. RESULTADOS Cuatro pacientes sometidos a plastia laparoscopica por diagnostico de ureter retrocavo, 1 hombre y 3 mujeres, con una media de edad de 40.7 anos. La media del tiempo operatorio fue de 138.2 minutos. La perdida de sangre cuantificada transoperatoria media fue de 23.7 ml. Ningun paciente presento complicaciones transoperatorias ni posoperatorias. Los pacientes permanecieron hospitalizados hasta su egreso una media de 2.5 dias. Todos los pacientes presentaron mejoria de su sintomatologia. CONCLUSIONES El ureter retrocavo es una condicion rara y aun no existe un consenso sobre su diagnostico, tratamiento y seguimiento. El manejo quirurgico laparoscopico es una opcion para el tratamiento de estos pacientes. INTRODUCTION The retrocave ureter is a rare congenital anomaly that requires surgical management. OBJECTIVE Report the results in laparoscopic management for retrocave ureter and literature review. METHOD Retrospective, descriptive, cross-sectional study in patients with a diagnosis of retrocave ureter who were sometimes a laparoscopic retrocave ureter. RESULTS Four patients sometimes underwent laparoscopic plasty for diagnosis of retrocave ureter, 1 man and 3 women, with a mean age of 40.7 years. The mean operative time was 138.2 minutes. The mean intraoperative quantified blood loss was 23.7 ml. No patient presented transoperative or postoperative complications. The patients remained hospitalized until their progress with an average of 2.5 days. All patients visualize improvement in their symptoms. CONCLUSION The retrocave ureter is a rare condition and there is still no consensus on its diagnosis, treatment and follow-up. Laparoscopic surgical management is an option for the treatment of these patients.

Los quistes suprarrenales son una afección rara. Su diagnóstico y su tratamiento son un desafío debido a la escasa información, lo que genera incertidumbre respecto al mejor manejo.Presentamos tres casos de quistes suprarrenales que recibieron tratamiento de mínima invasión con cirugía laparoscópica, sin presentar complicaciones y con una evolución favorable.Las nuevas técnicas quirúrgicas de mínima invasión ofrecen una oportunidad terapéutica que permite preservar estructuras y obtener material necesario para su diagnóstico histopatológico, así como la resolución de la sintomatología.Adrenal cysts are a rare entity; their diagnosis and treatment are challenging due to the lack of information, generating uncertainty regarding the best management.We present three cases of adrenal cysts that received minimally invasive treatment with laparoscopic surgery, without complications and with a favorable evolution.The new minimally invasive surgical techniques offer a therapeutic opportunity that allows preserving structures and obtaining the necessary material for histopathological diagnosis, as well as a resolution of the symptoms.

Antecedentes Los quistes suprarrenales son una afeccion rara. Su diagnostico y su tratamiento son un desafio debido a la escasa informacion, lo que genera incertidumbre respecto al mejor manejo. Casos clinicos Presentamos tres casos de quistes suprarrenales que recibieron tratamiento de minima invasion con cirugia laparoscopica, sin presentar complicaciones y con una evolucion favorable. Discusion Las nuevas tecnicas quirurgicas de minima invasion ofrecen una oportunidad terapeutica que permite preservar estructuras y obtener material necesario para su diagnostico histopatologico, asi como la resolucion de la sintomatologia. Background Adrenal cysts are a rare entity; their diagnosis and treatment are challenging due to the lack of information, generating uncertainty regarding the best management. Case reports We present three cases of adrenal cysts that received minimally invasive treatment with laparoscopic surgery, without complications and with a favorable evolution. Discussion The new minimally invasive surgical techniques offer a therapeutic opportunity that allows preserving structures and obtaining the necessary material for histopathological diagnosis, as well as a resolution of the symptoms.

ObjectiveTo determine the prevalence of ED and associated risk factors among young Mexicans between 18 and 40 years of age.MethodsAn observational, cross-sectional, descriptive and analytic study was conducted. Data collection was achieved through a questionnaire. Participants completed the Urologic Health Survey for Men and the International Index of Erectile Function (IIEF-5) questionnaire. The study also included sociodemographic, clinical, and sexual behavior variables.ResultsOf the 373 questionnaires filled out, only 160 were answered completely and used for the analysis. The mean age was 25.59±5.45 years. The prevalence of ED was 33.7% (mild 17.5%, mild-to-moderate 8.1%, moderate 6.3%, and severe 1.9%). The mean score for non-ED males was 24.38±0.94 versus 15.41±4.81 in the ED group. Univariate analysis showed a significant difference in the items of age (p

Introduction Orgasmic dysfunction (OD) is defined as the inability to achieve an orgasm, markedly diminished intensity of orgasmic sensations, or marked delay of orgasm during any kind of sexual stimulation. OD definition and method of diagnosis vary widely across studies. Aim The aim of this study was to identify the prevalence and risk factors that predispose Mexican women to OD. Methods A representative sample of women from Mexico City was surveyed using an online website. Women between 18 to 40 years old were selected, and the orgasm domain from the Female Sexual Function Index was used to identify OD. A cutoff point was calculated using a construct with a histogram and calculated median. A univariate and multivariate analysis was conducted to examine the relationship between potential risk factors and sexual function. Main Outcome Measures OD prevalence; significant risk factors on multivariate analysis. Results OD prevalence was 18.3%. Univariate analysis showed younger age (P = 0.01), lower degree of education (P = 0.02), single marital status (P = 0.038), and dissatisfaction with the thickness and/or size of partner's penis (P = 0.01) as significant variables related to OD. In multivariate analysis, younger age (P = 0.01) and dissatisfaction with the thickness/size of partner's penis (hazard ratio 3.04, P = 0.01) remained significant. Conclusion OD is a prevalent alteration in young women. Marital status, education, and dissatisfaction with thickness/size of partner's penis are definitely related variables. Villeda Sandoval CI, Calao-Perez M, Enriquez Gonzalez AB, Gonzalez-Cuenca E, Ibarra-Saavedra R, Sotomayor M, and Castillejos Molina RA. Orgasmic dysfunction: Prevalence and risk factors from a cohort of young females in Mexico. J Sex Med 2014;11:1505–1511.