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Nephron-sparing surgery is currently considered the gold standard treatment for T1 renal tumors. As laparoscopic partial nephrectomy (LPN) represents a technically challenging procedure, robotic surgery has been increasingly used during the last few years in the field of nephron-sparing surgery. The aim of this review is to analyze the techniques and outcomes of robotic partial nephrectomy (RPN).Currently available evidence shows that RPN is a feasible and safe procedure for small localized renal tumors and also for selected complex renal tumors. Early comparative studies have demonstrated similar perioperative outcomes between RPN and LPN. With a trend toward, a shorter ischemia time in the RPN. However oncological follow-up is limited and further prospective trials are awaited to confirm benefits at robotic approach during partial nephrectomy.
Editorial
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OBJECTIVES: To review the present evidence supporting the use of single-incision slings for treatment of female stress urinary incontinence.METHODS: A Pubmed search was performed using words as stress urinary incontinence, slings, singleincision slings, mini-sling, TVT-Secur™, MiniArc™, TFS, Arcusto-Arcus™ and Ajust™. This search was complemented by a review of the references from the papers found in the initial search. Only papers written in English, with a minimum of 30 cases and 6 months follow up were analyzed.RESULTS: Sixteen papers were found with the defined characteristics, 4 of them being comparative studies. Most studies include a low number of patients with followup not exceeding 12 months. Techniques are easy and seem to require a short learning curve, exception being TVT-Secur™. Operating time is short and complications are few and mild. Generally, results at 12 months are close to those reported after conventional slings. In two comparative studies Mini-Arc™ was as effective as a transobturator comparator. However in two additional comparisons, single incision slings had worse outcomes than the conventional comparator.CONCLUSION: Some single-incision slings look promising in most series and even as effective as conventional sub-urethral slings at short term evaluation. However, no experience reported by independent authors can be found. Therefore, at this moment a clear statement in favor of the widespread use of single-incision slings cannot be made. More studies must define the efficacy of these techniques against conventional sub-urethral slings. In addition, comparisons among available singleincision slings should define one ideal model.
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Penile cancer is a radiocurable disease. The different types of radiotherapy (RT)-brachytherapy, plesiotherapy, external beam radiation therapy-have proven valid in the treatment of the primary tumor allowing preservation of the penis and sexual function. RT is even an option in candidates for surgery who reject surgery for clinical or personal reasons. A high nodal recurrence rate has been observed after inguinal lymphadenectomy, specially in patients at high risk of relapse. Technological advances in the field of RT, new imaging techniques, and more modern equipment enable RT to enhance local control and improve survival in patients with this condition.Palliative RT can exercise a decompressive effect that makes possible tumor size reduction in cases of inguinal-pelvic recurrence in patients with lymphedema and thus improve quality of life.In this article, we review the current role of RT in the treatment of penile cancer. We also present two cases that illustrate the main indications.
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OBJECTIVES: The aim of this study was to evaluate the influence of retransplantation in graft and recipient survival.METHODS: We carried out a retrospective study in 419 renal transplants and studied the influence of retransplantation in graft and patient survival.A homogeneity study was performed between the two groups with a Student`s T and a chi-square tests. Graft survival analysis was performed with Kaplan-Meyer and log rank tests.RESULTS: Of 419 transplants, 370 (88.3%) were first transplantations, 45(10.7%) second transplantations and 4(1%) third ones. Mean follow-up of the whole group was 72.5 months (+/-54.1 SD).There were no differences in follow-up between groups (Mean Follow-up 73.1 months +/-54.4 SD in first transplantations vs. 61.6 months +/-51.2 SD in repeat transplantation. p >0.05). The actuarial graft survival showed no differences between patients with first transplantation and those with a repeat one. [3 and 5-year SV of 89% (95% CI: 87-91%) and 84% (95% CI: 82-86%) Vs 88% (95% CI; 83-93%) and 85% (95% CI; 80-90%) respectively].After adjusting for all the heterogeneity variables we still did not find differences on graft survival.The actuarial recipient survival showed no differences between patients with first transplantation and those with a repeat one. [3 and 5 year SV of 98% and 96% Vs. 97%].CONCLUSIONS: There are no differences of graft and recipient survival between patients with a first transplantation and those with a repeat one.
Case Report
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OBJECTIVE: To analyze a new case of primary localized amyloidosis of the ureter, describing the differential diagnosis with ureteral tumors and its pathogenic mechanism.METHOD: Description of the case of a male patient who presented clinical symptoms of renoureteral pain and hematuria and an image suspected of ureteral tumour undergoing laparoscopic nephroureterectomy. The pathological study confirmed amyloidosis of the ureter, AL by immunohistochemistry.RESULTS: This report further extends the slightly more than 50 published cases of primary localized amyloidosis of the ureter the clinical signs of which , pain and haematuria, are similar, showing stenosis and enlargement in an area of the ureteral wall on imaging techniques. In the majority of cases the diagnosis was obtained postoperatively, being necessary to exclude generalized and secondary affectation.CONCLUSIONS: Emphasis must be placed on the differential diagnosis of tumors of the ureter, especially in single-kidney patients, by using ureteroscopy and biopsy or preferably a careful cytological study. In our case a local inflammatory phenomenon could have been the basis of its pathogenesis.
Case Report
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OBJECTIVE: To describe a case of retroperitoneal mature teratoma presenting as metastasis of a testicular mixed germ cell tumor in a thirty year old man who had lumbar and abdominal pain and mass sensation in the left hemiabdomen.METHODS: Abdominal ultrasound and thoracic-abdominal-pelvic CT multidetector scan were performed, and then after a Doppler ultrasound study of the testicles. Surgical treatment was performed: orchiectomy and retroperitoneal lesion resection.RESULTS: Imaging studies showed a big cystic lesion in the left retroperitoneal space, 13 x 12 x 11 cm, well defined, with thin septa, displacing the kidney; and a solid-cystic 4 cm left testicular tumor, with multiple septa, solid poles and arterial flows with low resistances. Thoracic extension study did not show any finding. The histopathologic results of the orchiectomy and retroperitoneal resection pieces were, respectively, testicular mixed germ cell tumor (seminoma, with intratubular seminoma foci and teratoma) and mature cystic teratoma.CONCLUSIONS: Germ cell tumors derive from multipotencial cells with a large capacity of differentiation, and the nodal paraaortic chains are a natural way of dissemination of these neoplasms. Because of that, in the presence of a retroperitoneal lesion in a young patient we have to rule out testicular tumor metastasis. The retroperitoneal mature cystic teratoma must be considered as a lesion with malignant potential.
Case Report
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OBJECTIVE: Remember that kidney cancer is a disease whose incidence is increasing due to increased use of additional imaging tests, which is changing the way of diagnosis, making the classic clinical syndrome synonymous with advanced illness.METHODS: We report the case of a patient with a right renal tumor with renal vein involvement that in the natural course of the disease showed a vaginal metastasis of clear renal cell carcinoma, which was treated with surgical excision.RESULTS: This case is a clear example of how unpredictable is the clinical evolution of this disease and how little we know about the way of dissemination.CONCLUSIONS: Local excision, with or without radiotherapy, or radiotherapy alone are recommended in cases of unique metastasis after nephrectomy.
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OBJECTIVE: Urinary lithiasis is a very frequent urological disease but bladder lithiasis is very uncommon.Patients usually refer voiding symptoms and hematuria. The diagnosis is made after imaging tests.We report a clinical case describing a giant bladder stone and perform a bibliographic review.METHODS: A 43 year old man with the diagnosis of giant bladder stone (more than 10 cm diameter).We searched Medline using the terms: giant bladder stone, giant bladder lithiasis, bladder lithiasis, giant bladder lithiasis.RESULTS: We made the diagnosis of giant bladder stone after a simple kidney, ureter and bladder (KUB) X Ray. The treatment for this patient was a cystolithotomy.We found more than 230 reports at Medline and chose the most referred ones and the last 10 years reports.CONCLUSIONS: Giant bladder lithiasis is a very rare pathology. The gold standard for diagnosis is cystoscopy but sometimes with a KUB Xray or an ultrasound is enough.Because of its size, cistolitotomy is the correct treatment for giant bladder stone.
