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Objectives To evaluate the results of erectile function rehabilitation with sildenafil after laparoscopic radical prostatectomy (LRP). Materials and methods We have evaluated on a retrospective way a subgroup of LRP with neurovascular bundles sparing that have followed a treatment schedule for erectile function rehabilitation based on sildenafil citrate. We defined the initial erectile function state as penetrate without drugs, with drugs and do not penetrate. A comparison with the erectile function after the treatment was performed. Data were analyzed at our biostatistics section. Results We selected a total of 33 patients, 7 with unilateral neurovascular bundles sparing and 26 with bilateral neurovascular bundles sparing treated with sildenafil citrate after surgery. The recuperation rate of erectile function with bilateral sparing was 80.7%. This success rate reaches 87.5% in patients Conclusions Laparoscopic radical prostatectomy with neurovascular bundles sparing offers a high preservation rate of erectile function on expert surgeons. The maintenance treatment with phosphodiesterase-5 inhibitors may offer benefits for the erectile function rehabilitation and it has to be initiated as soon as possible.

Our aim is to present a novel mutation of the Birt-Hogg-Dubé Syndrome.We present a case report of a 70-year-old male with three solid nodulary lesions of 4, 2.6, and 3 cm each in the right kidney, and two lesions of 1.5 and 1.3 cm in the left kidney.Needle biopsy was performed. The pathological analysis of right kidney lesions revealed a renal tumor suggestive of chromophobe renal cell carcinoma and medullar tumor with zones that suggested oncocytosis. Genetic test results were positive for a novel heterozygous mutation c.1198GA; p.V400I in exon 11 of the FLCN gene.In patients presenting with bilateral multifocal renal tumors of oncocytic hybrid histology, Birt- Hogg-Dubé syndrome should be the first diagnosis in mind. The mutation found in this patient has not been previously described in the literature in the context of BHD.

Introduction Stress urinary incontinence (SUI) is a condition of social dimension which generally per tains to women of various age. The only effective treatments of SUI are surgical procedures. The use of tension-free vaginal tape (TVT) ensures low invasiveness but also carries the risk of complications. One of the complications may be migration of the tape into the urinary bladder creating conditions for urinary stones. There is a number of treatment methods for cystolithiasis, among them the optical lithotripter, ultrasound and pneumatic probes, and recently, the holmium laser. Material and methods From January 2009 to February 2010, six women suffering from bladder stones were treated at our department. All patients had previously undergone SUI procedures and over time, thread or tape had penetrated into the urinary bladder. The stone diameters were in the range of 1.6 cm–3.5 cm. Lithotripsy was performed with the use of an 80 W holmium YAG laser as an endoscopic procedure: beam frequency length of 2100 nm and applied energy was in the range of 0.2–3.5 J. Results The urinary bladder stones were disintegrated and suctioned out. During the same pro- cedure, the threads or tape from the SUI procedure were excised from the bladder. All patients were discharged from the hospital in good general condition after two days. Conclusions The holmium laser is an effective treatment for patients with bladder stone complications after SUI procedures when threads or tape have migrated and penetrated the bladder wall. The procedure is straightforward and safe for patients.

INTRODUCTION We have performed laparoscopic pyeloplasty (LP) in our department since 2004. Our goal is to describe, step by step, the approach of kidney stones during transperitoneal laparoscopic pyeloplasty and the outcomes after the procedure. MATERIAL AND METHODS Twelve patients with kidney stones treated by transperitoneal laparoscopic pyeloplasty were found. The hospital records with clinical features, supplementary tests, and imaging studies were reviewed for demographic, procedural, and efficacy data. RESULTS Kidney stones were found in 12 of 62 patients (19%) who had undergone transperitoneal laparoscopic pyeloplasty. Eight cases were treated using a flexible cystoscope and a nitinol N-Circle basket; in the remaining four cases the stones were extracted using laparoscopic grasping instruments. We want to emphasize a case of horseshoe kidney associated with ureteropelvic junction (UPJ) obstruction and a kidney stone in which the procedure was performed successfully. CONCLUSIONS Laparoscopic pyeloplasty has now emerged as a standard approach to UPJ obstruction. Associated renal abnormalities or kidney stones add complexity to the procedure, however, as shown in our results, centers with experience in the laparoscopic approach of reconstructive urology make this technique feasible.

Introduction Lymphadenectomy (LND) has recently attracted considerable interest from urological surgeons, as extended lymphadenectomy might have a role in accurate staging or improving patient survival in those patients with urological malignancies. Upper tract urothelial carcinoma (UTUC) is a relatively rare neoplasm, accounting for about 5% of all urothelial cancers. Up to 30% of patients with muscle-invasive UTUC have metastasis in the regional lymph nodes (LNs), which represents a well-established poor prognostic factor. Material and methods A medline search was conducted to identify original articles and review articles addressing the role of lymphadenectomy LND in UTUC. Keywords included lymphadenectomy, lymph node excision, nephroureterectomy, and upper tract urothelial carcinoma. Results LND instead of lymphadenectomy has recently attracted considerable interest from urological surgeons and might have a potential role in improving the oncological outcome in patients with urothelial carcinoma. LND ideally improves disease staging; thereby, we need to find the way to identify the patients who could really benefit from adjuvant systemic theraphy. Template-based LND with Radical Nephroureterectomy (RNU) for high risk disease is gaining support based on accumulating retrospective data and supports its utility as a potentially therapeutic maneuver. RNU is still the gold standard treatment for UTUC, but minimal invasive procedures such as laparoscopic RNU and Robot Assisted Nephroureterectomy (RANU) are becoming more employed in recent years and should be used by expert hands. Conclusions Therapeutic benefits of LND and nodal status on disease free survival (DFS) and Cancer Free Survival (CSS) remains controversial. Although most of the data comes from retrospective studies, we encourage performing well designed, prospective, and multicentre studies to clarify this in the coming years.

Resumen Introduccion La cirugia retroperitoneal constituye la indicacion mas indiscutible para el abordaje laparoscopico. Todavia persisten indicaciones de cirugia abierta en funcion de la complejidad del caso y de la experiencia del cirujano. Objetivos El objetivo principal es comunicar nuestra experiencia de nefrectomia radical laparoscopica en pacientes con tumores ?7 cm o con piezas quirurgicas cuyo peso haya sido ?700 g. Analizaremos sus caracteristicas, la tasa de complicaciones intraoperatorias, el tiempo quirurgico, el curso postoperatorio asi como la estancia postoperatoria. Material y metodos Desde julio del 2004 hasta julio del 2008 hemos realizado un total de 104 nefrectomias radicales laparoscopicas. Hemos seleccionado un subgrupo de 41 pacientes con criterios de pieza quirurgica de gran tamano. Resultados El tiempo quirurgico medio ha sido de 184,3 minutos. Hemos tenido un caso de reconversion a cirugia abierta y un fallecimiento intraoperatorio por causa cardiologico. La estancia media global ha sido de 3,51 dias. La tasa de complicaciones y el curso postoperatorio son comparables a toda la serie. Discusion La nefrectomia laparoscopica es tecnicamente menos compleja que la prostatectomia radical laparoscopica. Sin embargo, sus posibles complicaciones entranan una gravedad mucho mayor. Los casos mas complejos han de ser abordados por via laparoscopica solo cuando existe una dilatada experiencia. En general, en nuestro centro relegamos a cirugia abierta las piezas que sobrepasan la linea media y los casos con trombo tumoral que afecte a la vena renal principal y a la VCI.

Introduction In 2008, our department introduced a modified technique of laparoscopic radical cystectomy in which the prostatic capsule is spared in selected patients with bladder cancer. The different series published are mostly using the standard open procedure. The aim of this study is to describe this technique using the laparoscopic approach and present our preliminary results. Material and methods This study includes 20 patients selected by clinical analysis and imaging criteria operated using laparoscopic radical cystectomy with prostate capsule sparing at our department in the period between 2008 and 2012. Results Patient mean age was 58 years. Mean operative time was 390 minutes. Median follow-up was 36 months. No patient had bladder cancer recurrence. Only one patient died of disease progression, as the pathological findings was a pT3 pN1 Mx. Mean PSA before surgery: 1.3 ng/ml (03-2), mean PSA after surgery 1.0 ng/ml (0.08-1.7). No patients had prostate cancer recurrence. Satisfactory daytime and night-time continence was achieved. 90% of patients have sexual function preserved. Conclusions Prostate-sparing radical cystectomy remains one of the most controversial topics in urology today. The laparoscopic approach could be an alternative to conventional radical cystoprostatectomy in well selected patients, done in experienced institutions in order to find better functional results, with a low disease progression and recurrence rate.

Introduction The treatment of ureteropelvic junction has evolved considerably over the past 20 years, resulting in new surgical techniques, but traditional open surgery remains the gold standard treatment. Currently, less invasive techniques are used for the treatment of ureteropelvic junction obstruction. The purpose of our study is to compare the surgical and functional results between laparoscopic and open pyeloplasty performed at our department during the last 12 years. Material and methods This is a retrospective review of 92 cases performed in a period of 12 years. Two groups were compared: 30 patients were treated with open surgery (OP) and 62 with a laparoscopic approach (LP). Demographics, clinical presentation, functionality of the affected kidney, presence of polar vessels, kidney stones, hospital stay, complications and functional results were statistically analyzed. Results The mean age was 42 years. The most common clinical presentation was kidney or ureteral pain: 60% (OP) vs. 52% (LP). The right side was affected in 59%; presence of crossing vessels was 47% (OP) vs. 58% (LP); presence of kidney stones was 20% (OP) vs. 19% (LP), with an average hospital stay of 5.86 days (OP) vs. 3.36 days (LP) p

We present what is to our knowledge, the first case of laparoscopic ureteral reimplantation reported in the renal transplant. The ureteral stenosis is one of the most difficult renal transplant complications to deal with. With the development of the endourological approach, this treatment has become the first treatment option for these patients. The patient is a 28-year-old female who received a renal allograft from a cadaver donor in 2008. Ureteral stenosis was diagnosed. The laparoscopic approach seems to be a good option over the open approach, with the benefits related with laparoscopic surgery.

We report a case of a patient with a secondary injury of external iliac artery and vein in the L 4-L 5 laminectomy and discectomy course. An inmediatily vein suture and ilio-iliac by-pass with Dacron was made. In the postoperatory a yatrogenic lumbar ureter section was discovered and treated with renal autotransplantation. We review the options described in the literature in the management of these complex ureteral injuries.

Introduction Radical cystectomy in elderly patients is a controversial issue that has noticed an increase in importance overtime because of the lengthening average life span. Our objective was to determine if there were significant differences in the perioperative outcomes of patients over 70 years with bladder cancer treated with laparoscopic radical cystectomy (LRC) compared to those of younger patients. Material and methods We selected 180 patients who underwent LRC in our department in the period between 2005-2012. We divided them into 2 groups: 57% 70 years, and we compared the different parameters such as: comorbidities, intraoperative and post-operative complications, TNM stage and overall survival. Results The group 70 years. Heterotopic urinary diversion was the diversion of choice in the elderly patients (97.4%). Paralytic ileus and the worsening of renal function were the only complications with statistical differences between the groups. Mean hospital length of stay was not significantly different between the groups. Younger and older patients had similar pathological staging : pT1 or less: 26,2 vs. 18.2%, pT2: 19.4 vs. 16.9%, pT3 38.8 vs. 37.7% and pT4 15.6 vs. 17.2%. Kaplan-Meier curves did not show significant differences in survival. Conclusions Laparoscopic radical cystectomy in the elderly patient has similar rates of perioperative morbidity when compared with the younger patient and may be offered as a treatment option in selected elderly patients.

Introduction To observe the renal function recovery measured by diuretic renography in short and medium follow–up of patients with transperitoneal Anderson–Hynes laparoscopic pyeloplasty. Material and methods We performed a retrospective review from our series of laparoscopic pyeloplasties, and we applied the following selection criteria: 1) to have at least two MAG3 diuretic renography during the follow–up, performed with a gap of 4–6 months between them; 2) to have at least one year follow–up. Fulfilling these criteria, we have selected 35 patents of 62. Results During follow–up, statistically significant improvement comparing with the pre–surgical value has been observed in diuretic renography in the operated kidney in all selected patients during the time of follow up in terms of: functional uptake ratio (FUR), furosemide excretion and total excretion. No statistically significant differences were found in excretion time and spontaneous excretion parameters. By dividing patients in two age groups 40 years we found no statistically significant differences between them in relation to the improvement of the FUR. Conclusions Laparoscopic pyeloplasty not only corrects the UPJO, it also may recover renal function demonstrated after one year follow up with diuretic renography. Laparoscopic pyeloplasty should be procedure of choice even in those patients with poor renal function at diagnosis, whenever there are chances of recovering renal function, regardless patients age.

Introduction. Laparoscopic pyeloplasty was first described by Schuessler. During the last decade, this technique has been developed in order to achieve the same results as open surgery, with lower rates of morbidity and complications. In this study we review our experience using laparoscopic pyeloplasty as the gold standard for the treatment of the ureteropelvic junction obstruction (UPJO). Material and methods. We performed a retrospective review of 62 laparoscopic pyeloplasties carried out at our center. In the last 2 years we used 3 mm and 5 mm ports in order to achieve better cosmetics results. Demographic data is described and the functionality of the affected kidney and surgical data, among others were analyzed statistically. In the case of bilateral statistical tests were considered significant as those with p values

Introduction: There are different studies in the last decades focused on general surgery patients and the impact of perioperative blood transfusion (PBT) in cancer patients' survival, and most of them have supported an independent association between PBT and worse survival in those with solid tumor malignancies. The aim of this study is to evaluate the impact of perioperative blood transfusion on the postoperative outcomes and survival of patients after LRC. Materials and Methods: We performed a retrospective study analyzing our series of 218 patients surgically treated with LRC form 2005 to 2012. One-way analysis of variance test was used. Survival was estimated using the Kaplan - Meier method and was compared with log – rank and the Cox regression model was used to evaluate the association of PBT with the outcomes. Results: The PBT rate of LRC series was 16%. Patients' age, comorbidities and pathological stage were not related to the PBT rate. A statistically significant relationship was found between the PBT rate and the appearance of infectious complications. Overall 3 years survival estimated with the Kaplan-Meier method was significantly worse in the transfused group: 41.38% versus 63.57% for non-transfused patients. PBT was not a significant independent predictor factor in the survival of patients after LRC. The main independent factor was the TNM classification. Conclusions: Many studies including ours have reported a lower survival rate in patients who receive PBT after oncological surgery. There was a relationship between infectious complications and PBT. We have to make efforts to limit the use of blood products in patients surgically treated with radical cystectomy for bladder cancer.

OBJECTIVES To report our experience with laparoscopic radical prostatectomy (LRP) for the treatment of localized prostate carcinoma in two renal transplant recipients and a review of the literature. PATIENTS AND METHODS We retrospectively identified all patients who had undergone LRP for clinically localized prostate cancer between 2002 and 2008 at our institution (n = 1150). Of these patients, two were renal transplant recipients (one with donor renal transplant cadaver and the other with prior transplantectomy). We reviewed all available clinicopathological data and the scientific literature. RESULTS The two patients underwent successful LRP with no major complications. The mean (range) operative time was 200 (180–220) min with a mean estimated blood loss of 300 (200–400) mL. There were no changes in renal graft function as measured by serum creatinine level. At pathology, the surgical margins were negative and disease was organ-confined in each case. The two patients tolerated the procedure well and had a mean (range) hospital stay of 3.5 (3–4) days. CONCLUSIONS The data from our two patients suggest that LRP, as an accepted minimally invasive treatment for a middle-aged man with organ-confined prostate cancer, is a technically feasible and safe treatment of localized prostate cancer in renal transplant recipients.

The retroperitoneal surgery is the clearer indication for the laparoscopic approach. Still there are indications for open surgery because of the complexity of the patient and the surgeon experience.The main objective is to report our experience of laparoscopic radical nephrectomies in patient with tumors greater than 7 cm. or surgical specimens with more than 700 g of weight. We analyze their characteristics, complications rate, surgical time, postoperative outcome and hospital stay.Since July 2004 to July 2008 we have performed 104 laparoscopic radical nephrectomies. We have selected 41 patients with characteristics of big surgical specimens.The average surgical time has been of 184,3 min. Only 1 case has been converted into open surgery and only 1 intraoperative death because of cardiologic arrhythmia. The average hospital stay has been of 3,51 days. The complications rate and postoperative outcome are similar to the whole series.Laparoscopic nephrectomy is technically less complex than radical prostatectomy. However, their possible complication implies a much bigger severity. The more complex cases must be approach laparoscopically only after a wide experience. Actually, in our department we usually indicate an open approach when surgical specimen crossover the abdominal middle line and in those cases where the tumoral thrombus affect the main renal vein and/or the vena cava.

Introducción: La cirugía retroperitoneal constituye la indicación más indiscutible para el abordaje laparoscópico. Todavía persisten indicaciones de cirugía abierta en función de la complejidad del caso y de la experiencia del cirujano. Objetivos: El objetivo principal es comunicar nuestra experiencia de nefrectomía radical laparoscópica en pacientes con tumores ≥ a 7 cm. o con piezas quirúrgicas cuyo peso haya sido ≥ a 700gr. Analizaremos sus características, la tasa de complicaciones intraoperatorias, el tiempo quirúrgico, el curso postoperatorio así como la estancia postoperatoria. Material y Métodos: Desde julio del 2004 hasta julio del 2008 hemos realizado un total de 104 nefrectomías radicales laparoscópicas. Hemos seleccionado un subgrupo de 41 pacientes con criterios de pieza quirúrgica de gran tamaño. Resultados: El tiempo quirúrgico medio ha sido de 184,3 minutos. Hemos tenido un caso de reconversión a cirugía abierta y un fallecimiento intraoperatorio por causa cardiológico. La estancia media global ha sido de 3,51 días. La tasa de complicaciones y el curso postoperatorio son comparables a toda la serie. Discusión: La nefrectomía laparoscópica es técnicamente menos compleja que la prostatectomía radical laparoscópica. Sin embargo, sus posibles complicaciones entrañan una gravedad mucho mayor. Los casos más complejos han de ser abordados por vía laparoscópica sólo cuando existe una dilatada experiencia. En general, en nuestro centro relegamos a cirugía abierta las piezas que sobrepasan la línea media y los casos con trombo tumoral que afecte a la vena renal principal y a la VCI. Introduction: The retroperitoneal surgery is the clearer indication for the laparoscopic approach. Still there are indications for open surgery because of the complexity of the patient and the surgeon experience. Objectives: The main objective is to report our experience of laparoscopic radical nephrectomies in patient with tumors greater than 7 cm. or surgical specimens with more than 700 gr. of weight. We analyze their characteristics, complications rate, surgical time, postoperative outcome and hospital stay. Materials and methods: Since july 2004 to july 2008 we have performed 104 laparoscopic radical nephrectomies. We have selected 41 patients with characteristics of big surgical specimens. Results: The average surgical time has been of 184,3 min. Only 1 case has been converted into open surgery and only 1 intraoperative death because of cardiologic arrhythmia. The average hospital stay has been of 3,51 days. The complications rate and postoperative outcome are similar to the whole series. Discussion: Laparoscopic nephrectomy is technically less complex than radical prostatectomy. However, their possible complication implies a much bigger severity. The more complex cases must be approach laparoscopically only after a wide experience. Actually, in our department we usually indicate an open approach when surgical specimen crossover the abdominal middle line and in those cases where the tumoral thrombus affect the main renal vein and/or the vena cava.

Introducción: La cirugía retroperitoneal constituye la indicación más indiscutible para el abordaje laparoscópico. Todavía persisten indicaciones de cirugía abierta en función de la complejidad del caso y de la experiencia del cirujano. Objetivos: El objetivo principal es comunicar nuestra experiencia de nefrectomía radical laparoscópica en pacientes con tumores ≥ a 7 cm. o con piezas quirúrgicas cuyo peso haya sido ≥ a 700gr. Analizaremos sus características, la tasa de complicaciones intraoperatorias, el tiempo quirúrgico, el curso postoperatorio así como la estancia postoperatoria. Material y Métodos: Desde julio del 2004 hasta julio del 2008 hemos realizado un total de 104 nefrectomías radicales laparoscópicas. Hemos seleccionado un subgrupo de 41 pacientes con criterios de pieza quirúrgica de gran tamaño. Resultados: El tiempo quirúrgico medio ha sido de 184,3 minutos. Hemos tenido un caso de reconversión a cirugía abierta y un fallecimiento intraoperatorio por causa cardiológico. La estancia media global ha sido de 3,51 días. La tasa de complicaciones y el curso postoperatorio son comparables a toda la serie. Discusión: La nefrectomía laparoscópica es técnicamente menos compleja que la prostatectomía radical laparoscópica. Sin embargo, sus posibles complicaciones entrañan una gravedad mucho mayor. Los casos más complejos han de ser abordados por vía laparoscópica sólo cuando existe una dilatada experiencia. En general, en nuestro centro relegamos a cirugía abierta las piezas que sobrepasan la línea media y los casos con trombo tumoral que afecte a la vena renal principal y a la VCI.

The treatment of the invasive bladder cancer and the recurrent T1G3 is clearly established in radical cystectomy and pelvic linphadenectomy. One of the fields where the laparoscopic approach implies more doubts is the treatment of bladder cancer, because it requires experience enough in pelvic laparoscopic surgery and the urinary diversion implies great technical difficulties to the laparoscopic approach.The main goal of this article is to report our results with the urinary diversion after laparoscopic radical cystectomy where the ureteral anastomosis has been performed by a laparoscopic approach.From January 2005 to December 2007 we have performed 67 laparoscopic radical cistectomies. We conducted 28 laparoscopic urinary diversions with our technique: 7 neobladder with an average age of 54, 85 years and 21 ileal conduit with an average age of 69, 15 years.The averagesurgical time for enterocistoplasty with laparoscopic urethral and ureteral anastomosis is of 5 hours and 30 minutes. For the cutaneous ureteroileostomy with laparoscopic ureteral anastomosis the average surgical time has been of 4 hours and 30 minutes. We have had 1 case of urinary leakage in the laparoscopic neobladder and 3 cases in the laparoscopic ileal conduit (14%). We have not intestinal dehiscence nor ileal-ureteric stenosis. The average hospital stay for laparoscopic neobladder is for the 85% of cases of 13.6 days, and of 11.8 days for the 77.7% of ileal ureteric laparoscopies.The laparoscopic radical cystectomy is still a procedure reserved for groups with great experience in laparoscopic surgery. Nowadays, the most accepted procedure by most groups includes perform the cystectomy by a laparoscopic approach and the urinary diversion by an open approach. There is no evidence of the advantages of laparoscopic urinary diversion. It is necessary to perform comparative studies to clearly define the role of laparoscopic surgery in the urinary diversion.

Introducción: El tratamiento del cáncer vesical infiltrante y el carcinoma superficial de alto grado recidivante está claramente establecido en la cistectomía radical y linfadenectomía pelviana. Uno de los campos que más dudas plantea en su abordaje por vía laparoscópica es el tratamiento radical del cáncer vesical, que exige experiencia en cirugía laparoscópica pelviana y en el que la derivación urinaria presenta grandes dificultades técnicas a su abordaje laparoscópico. Objetivos: El objetivo fundamental de este artículo es comunicar nuestros resultados con las derivaciones urinarias tras cistectomía radical laparoscópica en las que hemos llevado a cabo las anastomosis ureteroileales por vía laparoscópica. Material y Métodos: Desde enero del 2005 hasta diciembre 2007 hemos completado 67 cistectomías radicales laparoscópicas. Hemos realizado un total de 28 derivaciones urinarias laparoscópicas según nuestra técnica, siendo en 7 pacientes enterocistoplastias de sustitución con una edad media de 54,85 años y en 21 pacientes ureteroileostomía cutánea con una edad media de 69,15 años. Resultados: El tiempo quirúrgico medio de la enterocistoplastia con anastomosis uretral y ureteral laparoscópicas es de 5 h y 30 min. Para la ureteroileostomía cutánea con anastomosis ureteral laparoscópica el tiempo quirúrgico medio ha sido de 4hs. y 30 min. Hemos tenido 1 caso de fuga urinaria en las neovejigas laparoscópicas y 3 casos en los conductos ileales laparoscópicos (14%). No hemos tenido ningún caso de dehiscencia intestinal ni de estenosis ureteroileal. La estancia media de las neovejigas es de 13,6 días para el 85% de los casos y de 11,8 días para el 77,7% de las ureteroileostomías laparoscópicas. Discusión: La cistectomía radical laparoscópica constituye un procedimiento todavía relegado a centros con gran experiencia en cirugía laparoscópica. El procedimiento más aceptado por la mayoría de los grupos incluye realizar la cistectomía por vía laparoscópica y la derivación urinaria por vía abierta. No existen evidencias sobre las posibles ventajas de las derivaciones urinarias por vía laparoscópica. En cualquier caso, son necesarios estudios comparativos para definir claramente el papel de la cirugía laparoscópica en las derivaciones urinarias. Introduction: The treatment of the invasive bladder cancer and the recurrent T1G3 is clearly established in radical cystectomy and pelvic linphadenectomy. One of the fields where the laparoscopic approach implies more doubts is the treatment of bladder cancer, because it requires experience enough in pelvic laparoscopic surgery and the urinary diversion implies great technical difficulties to the laparoscopic approach. Objetives: The main goal of this article is to report our results with the urinary diversion after laparoscopic radical cystectomy where the ureteral anastomosis has been performed by a laparoscopic approach. Methods: From January 2005 to December 2007 we have performed 67 laparoscopic radical cistectomies. We conducted 28 laparoscopic urinary diversions with our technique: 7 neobladder with an average age of 54,85 years and 21 ileal conduit with an average age of 69,15 years. Results: The averagesurgical time for enterocistoplasty with laparoscopic urethral and ureteral anastomosis is of 5 hours and 30 minutes. For the cutaneous ureteroileostomy with laparoscopic ureteral anastomosis the average surgical time has been of 4 hours and 30 minutes. We have had 1 case of urinary leakage in the laparoscopic neobladder and 3 cases in the laparoscopic ileal conduit (14%). We have not intestinal dehiscence nor ileal-ureteric stenosis. The average hospital stay for laparoscopic neobladder is for the 85% of cases of 13,6 days , and of 11,8 days for the 77,7% ofileal ureteric laparoscopies. Discussion: The laparoscopic radical cystectomy is still a procedure reserved for groups with great experience in laparoscopic surgery. Nowadays, the most accepted procedure by most groups includes perform the cystectomy by a laparoscopic approach and the urinary diversion by an open approach. There is no evidence of the advantages of laparoscopic urinary diversion. It is necessary to perform comparative studies to clearly define the role of laparoscopic surgery in the urinary diversion.

Resumen Introduccion El tratamiento del cancer vesical infiltrante y el carcinoma superficial de alto grado recidivante esta claramente establecido en la cistectomia radical y linfadenectomia pelviana. Uno de los campos que mas dudas plantea en su abordaje por via laparoscopica es el tratamiento radical del cancer vesical, que exige experiencia en cirugia laparoscopica pelviana y en el que la derivacion urinaria presenta grandes dificultades tecnicas a su abordaje laparoscopico. Objetivos El objetivo fundamental de este articulo es comunicar nuestros resultados con las derivaciones urinarias tras cistectomia radical laparoscopica en las que hemos llevado a cabo las anastomosis ureteroileales por via laparoscopica. Material y Metodos Desde enero del 2005 hasta diciembre 2007 hemos completado 67 cistectomias radicales laparoscopicas. Hemos realizado un total de 28 derivaciones urinarias laparoscopicas segun nuestra tecnica, siendo en 7 pacientes enterocistoplastias de sustitucion con una edad media de 54,85 anos y en 21 pacientes ureteroileostomia cutanea con una edad media de 69,15 anos. Resultados El tiempo quirurgico medio de la enterocistoplastia con anastomosis uretral y ureteral laparoscopicas es de 5 h y 30 min. Para la ureteroileostomia cutanea con anastomosis ureteral laparoscopica el tiempo quirurgico medio ha sido de 4hs. y 30 min. Hemos tenido 1 caso de fuga urinaria en las neovejigas laparoscopicas y 3 casos en los conductos ileales laparoscopicos (14%). No hemos tenido ningun caso de dehiscencia intestinal ni de estenosis ureteroileal. La estancia media de las neovejigas es de 13,6 dias para el 85% de los casos y de 11,8 dias para el 77,7% de las ureteroileostomias laparoscopicas. Discusion La cistectomia radical laparoscopica constituye un procedimiento todavia relegado a centros con gran experiencia en cirugia laparoscopica. El procedimiento mas aceptado por la mayoria de los grupos incluye realizar la cistectomia por via laparoscopica y la derivacion urinaria por via abierta. No existen evidencias sobre las posibles ventajas de las derivaciones urinarias por via laparoscopica. En cualquier caso, son necesarios estudios comparativos para definir claramente el papel de la cirugia laparoscopica en las derivaciones urinarias.

To assess the effectiveness and tolerability of zoledronic acid in prostate cancer patients with bone metastases at the hormone-sensitive (HS) and hormone-independent (HI) stages.A nationwide, observational, prospective, open and multi-centre trial was devised, with a total of 218 male patients diagnosed with prostate cancer at the HS stage (36%) or HI stage (64%) who were administered zoledronic acid (4 mg/IV/month for 6 months) in addition to their specific oncological treatment. Effectiveness was assessed by the following means: 1) Assessment of the improvement in pain and mobility; 2) Incidence and time to onset of skeletal-related events (SREs) and 3) Analysis of bone markers. Tolerability was assessed by means of registering the number and type of adverse effects. A satisfaction survey was carried out amongst the patients after the end of the trial.Out of the 218 patients, 170 (78%) were evaluable for effectiveness. A decrease in pain ratings at rest and during movement was observed in all patients, whether in the HS or HI groups (p0.0001). Improved mobility was observed likewise (p = 0.005), as was quality of life. The global incidence of skeletal events was 11.2%, with a time to onset of SREs of 10.7 months. There were no significant differences observed between HS vs. HI patients. Osteolysis markers (N-telopeptide) decreased significantly with the treatment across both the HS and HI groups. For safety reasons. 212 patients were evaluable (97.2%). The incidence of adverse drug reactions was 16% (34/212) and was found to be significantly higher in HS patients (22.4%) compared with HI patients (11.9%). Overall, the tolerability of zoledronic acid was good, with no significant morbidity in either group (HS and HI). 66% of the patients reported feeling satisfied or very satisfied.Zoledronic acid proved effective in the relief of pain, improving mobility and quality of life as well as reducing or delaying the occurrence of skeletal-related events in prostate cancer patients presenting metastatic bone disease, regardless of the phase, whether HS or HI, they found themselves in. Tolerability and patient satisfaction were rates as good.

Resumen Objetivos Evaluar la efectividad y tolerabilidad del acido zoledronico en pacientes con cancer de prostata y metastasis oseas en fase hormonosensible (HS) y hormonoindependiente (HI) Material y Metodos Se diseno un estudio de ambito nacional, observacional, prospectivo, abierto, y multicentrico, Se incluyeron un total de 218 varones diagnosticados de cancer de prostata en fase HS (36%) o HI (64%) que recibieron, ademas del tratamiento oncologico especifico, acido zoledronico (4 mg/IV/mes durante 6 meses) Se evaluo la efectividad mediante: 1) Evaluacion de la mejoria del dolor y movilidad; 2) Incidencia y tiempo de aparicion de eventos esqueleticos (TEE); y 3) Analisis de marcadores oseos La tolerabilidad se estudio registrando el numero y tipo de efectos adversos. Se realizo una encuesta de satisfaccion al paciente tras finalizar el tratamiento Resultados De los 218 pacientes, 170 (78%) fueron evaluables para efectividad. En todos ellos, ya fueran del grupo HS o HI, se observo una disminucion de la puntuacion del dolor en reposo y en movimiento (p>0,0001), una mejora en la movilidad (p=0,005), y en la calidad de vida La incidencia global de eventos esqueleticos fue del 11,2%, con un TEE de 10,7 meses. No hubo diferencias significativas entre los pacientes HS respecto a los HI. Los marcadores de osteolisis (N-telopeptido) descendieron significativamente con el tratamiento, tanto en los HS como HI Para seguridad fueron evaluables 212 pacientes (97,2%). La incidencia de las reacciones adversas fue del 16% (34/212), siendo significativamente mayor en los pacientes HS (22,4%) con respecto a los HI (11,9%). Globalmente la tolerabilidad al acido zoledronico fue buena, sin morbilidad significativa entre ambos grupos (HS y HI) Un 66% de los pacientes contestaron sentirse satisfechos o muy satisfechos Conclusiones El acido zoledronico se mostro eficaz para aliviar el dolor, mejorar la movilidad y aumentar la calidad de vida y reducir o retrasar los eventos esqueleticos en los pacientes con cancer de prostata con enfermedad osea metastasica sintomatica, independientemente de la fase, HS o HI en que se encuentren. La tolerabilidad y la satisfaccion de los pacientes fue buena

Objetivos: Evaluar la efectividad y tolerabilidad del ácido zoledrónico en pacientes con cáncer de próstata y metástasis óseas en fase hormonosensible (HS) y hormonoindependiente (HI). Material y Métodos: Se diseñó un estudio de ámbito nacional, observacional, prospectivo, abierto, y multicéntrico, Se incluyeron un total de 218 varones diagnosticados de cáncer de próstata en fase HS (36%) o HI (64%) que recibieron, además del tratamiento oncológico específico, ácido zoledrónico (4 mg/IV/mes durante 6 meses). Se evaluó la efectividad mediante: 1) Evaluación de la mejoría del dolor y movilidad; 2) Incidencia y tiempo de aparición de eventos esqueléticos (TEE); y 3) Análisis de marcadores óseos. La tolerabilidad se estudió registrando el número y tipo de efectos adversos. Se realizó una encuesta de satisfacción al paciente tras finalizar el tratamiento. Resultados: De los 218 pacientes, 170 (78%) fueron evaluables para efectividad. En todos ellos, ya fueran del grupo HS o HI, se observó una disminución de la puntuación del dolor en reposo y en movimiento (p

Objetivos: La persistencia del uraco en el adulto es relativamente rara, siendo frecuente la presistencia de remanentes. Sobre él pueden desarrollarse diversos procesos patológicos, incluyendo neoplasias benignas y malignas, siendo la mas frecuente el adenocarcinoma. MÉTODOS Y Resultados: Describimos un caso de carcinoma papilar urotelial de uraco en una paciente de 73 años de edad a la que se le practica tumorectomía y cistectomía parcial. Conclusiones: Es importante el reconocimiento del uraco como estructura vestigial, así como el conocimiento de las lesiones desarrolladas sobre él.

We report a case of a patient with a secondary injury of external iliac artery and vein in the L4-L5 laminectomy and discectomy course. An immediately vein suture and ilio-iliac by-pass with Dacron was made. In the postoperative a iatrogenic lumbar ureter section was discovered and treated with renal autotransplantation. We review the options described in the literature in the management of these complex ureteral injuries.

To analyze the results of the first two years of application of the clinical pathway for transurethral resection (TUR) of bladder tumors at La Paz University Hospital.We developed a clinical pathway of 4 hospital stays (5 days) for TUR of the bladder that included the following: matrix-verification, treatments prescribed, verification of changes, patient information sheet and patient satisfaction questionnaire. The information for the evaluation of the results were obtained from the pathway records and data on the activities of the Urology services. To assess the results for efficiency in the use of resources, the mean duration of hospital stay of patients in the pathway were compared with that of a control group comprised of 50 randomly selected patients submitted to TUR of the bladder in 1997.From June 1998 to May 2000, 481 of the 494 (97.4%) treated patients entered the clinical pathway.In our experience, the clinical pathway for the urinary bladder is a useful instrument for developing the clinical management of this condition. It reduces the unwanted changes in patient care and hospital stay, carries a low incidence of complications and readmissions, and achieves a high degree of patient satisfaction.

To present an additional case of leiomyosarcoma of the inferior vena cava and review the literature, with special reference to the etiology, diagnosis and treatment of this rare tumor.The patient was submitted to radical surgery and short course radiotherapy. Twelve months thereafter, the patient is asymptomatic and disease-free.Leiomyosarcoma of the inferior vena cava is a rare and aggressive tumor. Treatment is by aggressive and radical surgery.

Self-injuries are relatively common and usually consist in incisive injuries on the penis and the scrotum. This paper presents one case of genital self-injury by injection of petrol on the back of the penis. A description is offered of the clinical form of presentation, as well as the good evolution following medical treatment. Finally, a revision of likely complications is included.

Introduction The Enhanced Recovery After Surgery program (ERAS), has become the basis of perioperative management after colorectal surgery, vascular, thoracic, and more recently the radical cystectomy. The aim of this study is to show our initial experience using an ERAS protocol. Materials and methods A total of 47 laparoscopic radical cystectomies (LRC) were compared in this study. For retrospective data analysis, the patients were divided into two groups: Group A included patients who underwent LRC before the ERAS protocol was implemented; and Group B included patients who underwent LRC after the ERAS protocol was implemented. Results Hospital stay was significantly shorter (p = 0,04) in Group B with a median of 11.73 days versus 17.53 days in Group A. The paralytic ileus is the most common complication in both groups, and only two complications seem to be lower between groups; central vein catheter infection in Group A was 14.2% versus 5.2% in Group B and paralytic ileus in Group A was 35.7% versus 21.0% in Group B. There was no statistical difference between groups in the appearance of minor or major complications. Conclusion The combination of minimally invasive surgery and an ERAS protocol is a feasible multidisciplinary challenge and is useful in the recovery of patients undergoing LRC.