Radical prostatectomy is currently the standard of care for localized prostate cancer. In the last decade, the minimally invasive surgery, especially the robotic surgery has been growing and open techniques are less frequent performed. A non-systematic review of the literature is performed, highlighting the current situation of the perineal radical prostatectomy in the minimally invasive era, its indications, and functional and oncological outcomes. Radical perineal prostatectomy, when compared with other surgical approaches, still experience favorable outcomes. Urologist might be abandoning an underused surgical approach.
OBJECTIVES: To determine the impact of implementing a joint action protocol on prostatic disease on the referrals to Urology from Primary Care in a health care area. METHODS: We drafted a protocol for managing patients consulting for clinical signs and symptoms associated to benign prostatic hyperplasia (BPH) and to test PSA in asymptomatic males. At the same time, three e-mail addresses were opened for consultations generated from Primary Care, and joint sessions were carried out in the primary health care centers. We measured the impact of the protocol by assessing the adequacy of prostatic disease referrals to Urology, as well as by determining the course of the total number of referrals in three peripheral specialized health care centers (PSHCC).RESULTS: From January 2011, a better compliance to the referrals to Urology protocol for prostatic disease has been produced, going from 47% (assessment prior to implementing the protocol) to 64%. These results are especially good when we consider referrals associated to PSA, which went from a compliance of 33% to 84%.Regarding the course of the referrals to Urology, the referral rate (referrals per 1000 inhabitants) has decreased by 15% (from 13,8 to 11,7).CONCLUSIONS: The collaboration between Urology and Primary health care, by means of implementing joint protocols, and also by establishing new communication channels (e-mail, joint sessions), achieves a better adequacy of patients referred for prostatic disease, as well as a reduction in the total number of referrals.
OBJECTIVES: To evaluate the treatment of Peyronie´s disease (PD) with verapamil and dexamethasone iontophoresis. METHODS: Twenty nine patients with PD were treated by means of a Miniphysionizer” dispositive 3 sessions a week during 4 consecutive weeks. 5mL of a combination of verapamil (10mg.) and dexamethasone (4mg.) were transdermally administered with a 2.5 mA current during 20 min. The aim is to evaluate treatment efficacy in correcting penile curvature (Kelami test), plaque size (penis ultrasound (US)) improvement of pain and,other parameters like erectile function (EF), intercourse capacity or adverse effects of the treatment, which were evaluated with questionnaires. RESULTS: All patients completed the treatment protocol (12 sessions) and a total number of 348 sessions of iontophoresis were performed. After treatment, 3 patients (10.7%) continued with pain, but it disappeared in 25 of them (89.3%). A decrease of the size of the plaque was observed in 13 patients (44.8%), even disappearance in 4 patients (13.8%). No patient had curvature decrease after treatment. However, EF (IIEF score) and ability for intercourse improved in 3 (10.3%) and 4 patients (13.8%) respectively.CONCLUSION: Verapamil and dexamethasone iontophoresis is a safe and reliable treatment resolving painful erections in the acute phase of PD. However its efficacy in solving penile curvature and erectile dysfunction (ED) is more limited.
OBJECTIVES: The performance of the urethrovesical anastomosis is one of the most difficult steps in urologic laparoscopy. Many different techniques have been developed to improve this step and, recently, new sutures such as the V-loc (R) barbed system have been created. In the present study we analyze the usefulness of this suture for diminishing the time employed for the anastomosis suture during the learning curve of laparoscopic radical prostatectomy.METHOD: We performed a prospective comparative study between two groups. The first group included the first 50 cases of a novel surgeon using this barbed suture, and we compared these procedures with 50 consecutives cases of an experienced surgeon. We compared preoperative parameters, surgical and suturing times, as well as drain and catheter duration, and hospital stay.RESULTS: We did not find statistically significant differences in any pre or postoperative parameters between both groups. Although surgical time was lower in the control group this difference was not statistically significant. The time used to perform the suture was lower in the study group, and we found significant differences between both groups. Neither drain nor bladder catheter times were different between groups. CONCLUSIONS: In the absence of prospective randomized trials comparing barbed or not barbed running sutures, our study shows that the use of the V-loc® system improves the times needed for the urethrovesical anastomosis during the learning curve of laparoscopic radical prostatectomy.
OBJECTIVE: To report a case of ureteral inverted papilloma (IP) with laparoscopic resolution.METHODS: We report the case of a 30-year-old male patient who consulted for asymptomatic hematuria with the radiological finding of a filling defect at the distal right ureter. Ureteroscopy biopsy was not diagnostic, so laparoscopic ureterectomy with a Boari flap technique was performed. The pathology report showed a ureteral inverted papilloma.CONCLUSION: Laparoscopic ureteral replacement by Boari flap is a safe surgical alternative for defects in the distal ureter with the advantages of a minimally invasive procedure.
OBJECTIVE: Present the case of a patient with a discontinuous intrabdominal splenogonadal fusion with an associated germ cell tumor.METHODS: A case of a man of 29 years with bilateral cryptorchidism and left intra-abdominal discontinuous splenogonadal fusion associated with seminoma as an accidental finding in the context of a robotic pyeloplasty due to ipsilateral ureteropelvic junction stenosis.RESULTS: The total operative time was 80 minutes (atrophic gonad removal and pyeloplasty by the Anderson-Hynes technique) with an estimated blood loss less than 100 cc. The hospitalization time was less than 36 hrs. The pathology and immunohistochemical report was compatible with intratubular germ cell neoplasia (seminoma).CONCLUSION: The splenogonadal fusion is an uncommon pathology. While a high clinical suspicion may avoid unnecessary orchiectomy in young patients, its association with disorders such as cryptorchidism should make us suspect the possible presence of a concomitant germ cell neoplasia.
OBJECTIVE: Calyceal fistula is a rare complication of renal transplantation that may lead to graft loss. This article reports a case of functional recuperation of a graft that seemed condemned to failure.METHODS: 31 year old male patient, submitted to living donor renal transplant, in which was necessary to ligate a superior polar artery found during donor nephrectomy, due to its short length. This resulted in development of a calyceal fistula, unsolved with conservative treatment by percutaneous drainage. A new surgical intervention revealed a large upper pole area of necrotic tissue, corresponding to the obliterated artery irrigation zone.RESULTS: Debridement and calyceal suture were performed and a posterior pyelography confirmed fistula closure. Presently, he is asymptomatic, with stabilized graft function.CONCLUSION: Calyceal fistulas are complications of difficult resolution. However, the present case demonstrates that with an appropriate treatment it is possible to save a graft with no apparent solution at the first place
OBJECTIVE: To present a new case of renal infarction.METHODS: We report the case of an 84-year-old woman presenting with right flank colic pain of 24 hours of evolution and past history of acute myocardial infarction four months before.CONCLUSION: Renal infarction is a rare condition; in most of the cases it does not show specific symptoms and usually overlap with other more common urologic procedures, which results in a delay in diagnosis and treatment. The most conclusive imaging tests are i.v contrast CT scan or Doppler ultrasound but definitive diagnosis is achieved by angiography or CT angiography. Treatment is conservative, with parenteral and oral anticoagulation; invasive management is rare.
OBJECTIVE: To present one case of adrenal ganglioneuroma incidentally diagnosed in an adult.METHODS/RESULTS: 44-year-old woman with a 2.3 cm incidentaloma in the left adrenal gland diagnosed by CT scan. At 6 months, MRI was performed and a left adrenal nodule 3.7 cm was shown. Due to the progressive growth of the mass, surgery was indicated and left laparoscopic adrenalectomy was carried out. The final pathologic diagnosis was adrenal ganglioneuroma.CONCLUSIONS: The ganglioneuroma is a tumor composed of Schwann cells and ganglion cells. Its location in the adrenal gland is unusual, most frequently affecting other regions. Being asymptomatic lesions, they are often detected incidentally when performing imaging tests. There are radiological features that differentiate them from other adrenal masses. The treatment of choice is surgery, with adrenalectomy