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The aim of the present study is to compare two analgesic techniques for ultrasound transrectal biopsy. Oral analgesia vs periprosthetic nerve blockade with 2% mevicaine.A total of 200 patients were randomized prospectively into 2 groups, namely group I: 100 patients treated with metamizol, oral morphine 30 minutes before the procedure, and group II: 100 patients anesthesied with periprosthetic nerve blockade with 2% mepivacaine. Both groups were treated with bromacepán 3 mg 30 minutes before the biopsy. The first intention was to obtain 10 core TRUS-guided biopsy in all patients underwent. After the procedure, a ten visual analogue pain score (VAS) from 0 = no discomfort to 10 = severe pain was administered to the biopsied patients and a global estimation of pain associated with the procedure was obtained. Test T de Student was used for statistical analysis.There were no significant differences in age, PSA and prostate volume. 3 core TRUS-guided biopsy were obtain in group I (3 +/- 1.3), and 10 in group II (5 +/- 1.2) In the periprosthetic block group (II) 95% of patients referred no pain after the procedure (VAS = 0), 2% middle pain (VAS = 5-6) and 3% strong pain (VAS = 7-8); while patients in group I referred 12.5% no pain, 42.4% middle pain, 20% strong pain. The level of pain reported by this group of patients was significantly different from those reported by patients who performed prostate biopsy with periprosthetic nerve blockade. (por = 0.05). There were no significant differences in major complications.The use of bilateral periprosthetic block with mepivacaine is a very effective and useful technique, well tolerated by the patient, which almost completely abolishes the pain and discomfort associated with the prostate biopsy procedure. And also allows increase the number of cores.

Introducción: La intención de este estudio es comparar la efectividad de dos técnicas analgésicas, una oral frente al bloqueo con anestesia local de los nervios periprostáticos, en la realización de la biopsia prostática ecodirigida. Material y métodos: Un Total de 200 pacientes se han randomizado en dos grupos. Grupo I: 100 pacientes tratados con metamizol y morfina oral 30 minutos antes de la realización de la biopsia. Grupo II: 100 pacientes a los que se los ha anestesiado con mepivacaína al 2% en las bandeletas. Previamente a ambos grupos de pacientes se les suministró bromacepán 3 mg 30 minutos antes de la prueba. Después de la biopsia a los pacientes se les pidió que graduaran su dolor mediante una escala analógica visual, graduada de 0 (no dolor) a 10 dolor insoportable. Los datos obtenidos se manejaron estadísticamente con el test T de Student. Resultados: Ambos grupos no presentaron diferencias significativas con respecto a la edad, PSA y volumen prostático. Se obtuvieron en el grupo I, 3 biopsias por lóbulo (3±1,3), y en el II grupo 5 (5±1,2). En éste grupo el 95% de los pacientes no experimentaron dolor alguno tras la biopsia (VAS = 0), el 2% un dolor moderado (VAS=5-6), y el 3% un dolor intenso (VAS=7-8). Los pacientes del grupo I refirieron ningún dolor en 12,5%, dolor moderado el 42, 4% , y dolor intenso el 20% . Encontrándose diferencia significativa entre ambos grupos (p

Resumen Introduccion La intencion de este estudio es comparar la efectividad de dos tecnicas analgesicas, una oral frente al bloqueo con anestesia local de los nervios periprostaticos, en la realizacion de la biopsia prostatica ecodirigida. Material y metodos Un Total de 200 pacientes se han randomizado en dos grupos. Grupo I: 100 pacientes tratados con metamizol y morfina oral 30 minutos antes de la realizacion de la biopsia. Grupo II: 100 pacientes a los que se los ha anestesiado con mepivacaina al 2% en las bandeletas. Previamente a ambos grupos de pacientes se les suministro bromacepan 3 mg 30 minutos antes de la prueba. Despues de la biopsia a los pacientes se les pidio que graduaran su dolor mediante una escala analogica visual, graduada de 0 (no dolor) a 10 dolor insoportable. Los datos obtenidos se manejaron estadisticamente con el test T de Student. Resultados Ambos grupos no presentaron diferencias significativas con respecto a la edad, PSA y volumen prostatico. Se obtuvieron en el grupo I, 3 biopsias por lobulo (3±1,3), y en el II grupo 5 (5±1,2). En este grupo el 95% de los pacientes no experimentaron dolor alguno tras la biopsia (VAS = 0), el 2% un dolor moderado (VAS=5-6), y el 3% un dolor intenso (VAS=7-8). Los pacientes del grupo I refirieron ningun dolor en 12,5%, dolor moderado el 42, 4%, y dolor intenso el 20%. Encontrandose diferencia significativa entre ambos grupos (p≤0,05) con respecto al dolor, pero no con respecto a las complicaciones referidas. Conclusion La biopsia de prostata ecodirigida es una prueba muy bien tolerada bajo anestesia local con mepivacaina, disminuyendo el dolor asociado a la biopsia, lo cual permite realizar en el mismo acto una mayor toma de cilindros.

To report our experience with laparoscopic pyeloplasty in the treatment of pyeloureteral junction obstruction.Between August 2001 and August 2004 14 patients with the diagnosis of pyeloureteral junction obstruction underwent laparoscopic repair. Seven cases had the obstruction on the left side and the other seven on the right side. We describe the technique of laparoscopic dismembered Anderson-Hynes type pyeloplasty, performed to 12 patients in our series. The remainder 2 patients underwent Foley's Y-V plasty and the Fenger's technique.Mean operative time was 199.7 minutes (r: 126-290). There were not intraoperative complications. Mean hospital stay was 4.63 days (r: 3-9). One case of double J catheter obstruction can be cited as late postoperative complication. Only one of the 14 cases suffered a recurrence of the stenosis after double J catheter retrieval.Laparoscopic pyeloplasty has become the operation of choice in cases of hydronephrosis secondary to crossing vessel, when there is great pyelic dilation, and for the treatment of failures of previous endopyelotomy.

To analyze the complications and morbidity during our learning curve of laparoscopic radical prostatectomy (LRP) and compare them with other published series.We review the 25 first laparoscopic radical prostatectomies performed in our department, evaluating the operative technique and other features such as surgical time, blood loss, complications and conversion to open surgery. We also evaluate morbidity, postoperative hospital stay, and functional features such as potency and continence.LRP was completed in 22 patients. Overall intraoperative complication rate was 32%. 3 cases were converted to open surgery due to technical difficulties or intraoperative complications. We had complications in 4 patients, that were not severe (bladder injury 2 cases, and epigastric artery injury another 2) and where solved without difficulties during the operation. The most severe intraoperative complication was related to the anesthesia procedure at the time of extubation of a patient who required tracheotomy. There were no severe postoperative complications, being leakage from the anastomosis the most common (7 cases). All of them were managed conservatively, although this resulted in a mean hospital stay of 10.8 days. 2 patients required endoscopic procedures in the immediate postoperative time for bladder catheter repositioning. All patients suffered erectile dysfunction and the continence rate at 3 months was 77.2%.Although LRP is a long operation and difficult during the learning curve, its complication rate is acceptable because they are not severe and can be managed in a relatively easy way.

To evaluate the role of ureteroscopy (rigid and flexible) in the follow-up protocol for transitional cell tumors treated conservatively in our department by endourological procedures, and to review the articles on this topic available in the literature.From February 1997 to June 2003, 10 patients (12 renal units) with upper urinary tract urothelial tumor treated conservatively by endourological procedures were followed by cytology, cystoscopy, retrograde ureteropyelography, and ureteroscopy (rigid and flexible), quarterly during the first year, semi-annually during the second year, and yearly thereafter in order to detect tumor recurrence.Mean follow-up was 31.9 months (R 14-65). Two patients died: one because of a previous metacronous bladder tumor and the other after distant progression. One patient was lost to followup. A total of 42 ureteroscopies were performed (31 flexible and 11 rigid). Flexible ureteroscopy was performed in 6 patients and rigid ureteroscopy in three; neither was feasible in one patient so that follow-up was done by cytology, cystoscopy and urography. Tumor recurrence was detected in 2 patients but ureteroscopy did not inform about tumor stage. Flexible ureteroscopy failed in another patient in which rigid ureteroscopy was feasible. Although this latter was technically easier to perform, procedure discomfort was worse.The follow-up of transitional cell tumors of the upper urinary tract should be very strict because of the high risk of tumor relapse. Ureteroscopy, mainly flexible, is standing out as the most effective procedure to watch these tumors.

Laparoscopic technique has been developed with the aim to decrease the morbidity of the open radical prostatectomy.From january 2002 to may 2002, 8 patients were treated for prostate cancer with laparoscopic radical prostatectomy. Unilateral linfadenectomy has been carried out in only one patient. We usually employ the transperitoneal technique published by the Montsouris Institute, with some modifications.The main surgical time was 356 minutes (540-240). Transfusion wasn't needed in any case. Intraoperative complications were: 2 bladder injuries, 1 bleeding of the epigastric artery. Postoperative complications were: 1 ileus, 2 compressive neurapraxia, 4 anastomotic fistutas. All complications were treated conservatively. No patient were converted to open surgery. Surgical limits were negatifs in all cases, and the PSA rate was less than 0.1 ng/ml in the first month follow up.Laparoscopic radical prostatectomy is a difficult technique, but we think that, the learning curve is getting lower and lower than in the first series. Oncologic results with this technique is similar to the open one. However, laparoscopic approach shows us some benefits such as less bleeding, less time catheterisation, less hospital stay, better continence, better sexual function, better stetic result, less postoperative pain, and finally an earlier back to work.

INTRODUCCIÓN: Con intención de disminuir la morbilidad de la prostatectomá radical, se ha desarrollado la técnica de la prostatectomía radical laparoscópica (PRL). Presentamos en este trabajo nuestra experiencia preliminar. MATERIAL Y MÉTODOS: Desde el 24 de enero del 2002 hasta el 5 de mayo del 2002, hemos operado 8 pacientes. A uno realizamos linfadenectomía unilateral. Se utiliza una técnica transperitoneal con algunas variantes a la descrita en el Instituto Montsouris. RESULTADOS: El tiempo quirúrgico medio ha sido de 356 minutos (540-240). Ningún paciente ha precisado de transfusión. Complicaciones intraoperatorias: dos lesiones vesicales y una lesión de arteria epigástrica. Complicaciones post-operatorias: un ileo paralítico, dos neuropraxias, cuatro fístulas de la anastomosis. Todas se resolvieron con medidas conservadoras y ningún paciente precisó reconversión a cirugía abierta. Ninguno presentó bordes positivos. De los pacientes controlados todos tenían PSA inferior a 0,1 al mes de la intervención. CONCLUSIONES: La PRL es una técnica difícil pero creemos que la curva de aprendizaje no será tan larga como en las primeras series. Los resultados oncológicos son similares a la cirugía abierta, pero ofrece pequeñas ventajas en muchos aspectos (sangrado, días de sondaje, estancia hospitalaria, retorno a la actividad, continencia, función sexual, cosmética, dolor post-operatorio...). OBJETIVE: Laparoscopic technique has been developped with the aim to decrese the morbidity of the open radical prostatectomy. MATERIAL AND METHODS: From january 2002 to may 2002, 8 patients were treated for prostate cancer with laparoscopic radical prostatectomy. Unilateral linfadenectomy has been carried out in oly one patient. We usually employ the transperitoneal technique published by the Montsouris Institute, with some modifications. RESULTS: The main surgical time was 356 minuts (540-240). Transfusion wasn't needed in any case. Intraoperative complications were: 2 bladder injuries, 1 bleeding of the epigastric artery. Postoperative complications were: 1 ileus, 2 compressive neurapraxia, 4 anastomotic fistutas. All complications were treated conservatively. No patient were converted to open surgery. Surgical limits were negatifs in all cases, and the PSA rate was less than 0.1 ng/ml in the first month follow up. CONCLUSION: Laparoscopic radical prostatectomy is a dificult technique, but we think that, the learning curve is getting lower and lower than in the first series. Oncologic results with this technique is similar to the open one. However, laparoscopic approach shows us some benefits such as less bleeding, less time catheterisation, less hospital stay, better continence, better sexual fonction, better stetic result, less postoperative pain, and finally an earlier back to work.

To report our experience with a series of 10 patients undergoing radical cystectomy with bladder substitution. We were supported by a better knowledge of the female continence anatomical mechanisms and the demonstration of the oncological viability of the urethral remnant.From 1994 to 2002 10 women underwent radical cystectomy with bladder substitution by means of a modified anterior pelvic exanteration; technical modifications to achieve continence preservation are based on: preservation of the distal 2/3 of urethra, pubourethral ligaments and endopelvic fascia, and limitation of lateral vaginal dissection to avoid damage to the striated sphincter innervation. To avoid the neocystocele effect the vagina is fixed to the uterosacral ligaments and to the sacral promontory.Bladder capacity is 332.9 +/- 35.6 ml with a flow of 17.7 ml/sec. Complete continence wax achieved in 8 patients, the remainder 2 present grade II urinary stress incontinence. All of them empty their neobladder satisfactorily; only one patient needed a bladder re-education program. One bladder fistula and diarrhoea in one patient are the complications to be highlighted.The results obtained with orthotopic neobladder in females, achieving a high satisfaction level and quality of life, stimulate us to continue with this technique.

Resumen "Prostatectomia Radical Laparoscopica: Experiencia Preliminar" Introduccion Con intencion de disminuir la morbilidad de la prostatectoma radical, se ha desarrollado la tecnica de la prostatectomia radical laparoscopica (PRL). Presentamos en este trabajo nuestra experiencia preliminar. Material y Metodos Desde el 24 de enero del 2002 hasta el 5 de mayo del 2002, hemos operado 8 pacientes. A uno realizamos linfadenectomia unilateral. Se utiliza una tecnica transperitoneal con algunas variantes a la descrita en el Instituto Montsouris. Resultados El tiempo quirurgico medio ha sido de 356 minutos (540-240). Ningun paciente ha precisado de transfusion. Complicaciones intraoperatorias: dos lesiones vesicales y una lesion de arteria epigastrica. Complicaciones post-operatorias: un ileo paralitico, dos neuropraxias, cuatro fistulas de la anastomosis. Todas se resolvieron con medidas conservadoras y ningun paciente preciso reconversion a cirugia abierta. Ninguno presento bordes positivos. De los pacientes controlados todos tenian PSA inferior a 0,1 al mes de la intervencion. Conclusiones La PRL es una tecnica dificil pero creemos que la curva de aprendizaje no sera tan larga como en las primeras series. Los resultados oncologicos son similares a la cirugia abierta, pero ofrece pequenas ventajas en muchos aspectos (sangrado, dias de sondaje, estancia hospitalaria, retorno a la actividad, continencia, funcion sexual, cosmetica, dolor post-operatorio').