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Orozco Fariñas R, Iglesias Prieto JI, Cisneros Ledo J, Massarrah Halabi J, Mancebo Gómez JM, Perez-Castro Ellendt E. [Neuroectodermic renal tumor. Case report and bibliographic review.]. ARCH ESP UROL 2019; 72:570-580. [PMID: 31274122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We report the case of a 16 year old female who underwent left radical nephrectomy for a 13.2 cm neuroectodermic renal tumor and posterior chemo and radiotherapy in the Quiron Hospitals in Madrid and Complejo Hospitalario de Toledo, with a current survival of 14 months. Medical literature was reviewed for the historical, clinical, etiopathogenic, diagnostic, prognostic, therapeutic and survival features. We estimate the number of published cases to date. We also address the treatment performed and its results under a critical view.
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Affiliation(s)
- Rodolfo Orozco Fariñas
- Servicio de Litotricia y Endourología del Hospital Quirón La Luz de Madrid. Madrid. España
| | | | - Jesús Cisneros Ledo
- Servicio de Urología del Hospital Virgen de La Paloma y del Hospital Moncloa. Madrid. España
| | - Jorge Massarrah Halabi
- Servicio de Litotricia y Endourología del Hospital Quirón La Luz de Madrid. Madrid. España
| | - José Mª Mancebo Gómez
- Servicio de Litotricia y Endourología del Hospital Quirón La Luz de Madrid. Madrid. España
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Carrion DM, Álvarez-Maestro M, Gómez Rivas J, González-Peramato P, Cisneros Ledo J. Extramedullary plasmacytoma of the testicle. ARCH ESP UROL 2017; 70:845-847. [PMID: 29205163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We present the case of a patient diagnosed with a testicular extramedullary plasmacytoma (EMP), and perform a brief review of the literature of this pathology. METHODS A 64 year-old male patient, with history of multiple myeloma successfully treated three years before, presented with left testicular swelling. Initial work-up was compatible with a testicular tumor and radical inguinal orchiectomy was performed. RESULTS Histologic examination of the testis revealed extensive intertubular infiltration by CD138 and CD56 atypical plasma cells, with diffuse staining for IgA, compatible with EMP. CONCLUSIONS Invasion of the testis in multiple myeloma patients as a recurrence of the disease is an extremely rare condition, as EMPs are more common in other organ systems. Initial treatment should be the same as a primary testicular tumor with radical inguinal orchiectomy, and definitive diagnosis is established in histologic analysis.
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Affiliation(s)
- Diego M Carrion
- Department of Urology. Hospital Universitario La Paz. Madrid. Spain
| | | | - Juan Gómez Rivas
- Department of Urology. Hospital Universitario La Paz. Madrid. Spain
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Gomez Rivas J, Cisneros Ledo J. [Principles of urinary tract reconstructive surgery.]. ARCH ESP UROL 2017; 70:379-384. [PMID: 28530617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION In the last 15 years, the role of laparoscopic surgery has progressively increased to include reconstructive procedures such as pyeloplasty and management of ureteral stricture, in addition to being a field in continuous development, this refers to the improvement of ergonomics, new instruments and new techniques. We present a review on basic features of laparoscopic reconstructive surgery in urology. ACQUISITION OF EVIDENCE For this review, an exhaustive literature search was performed in PUBMED, MEDILNE, BioMed central and others, with the keywords: reconstructive surgery, urology, laparoscopy. Only articles including urologic procedures in the adult and published in the last 6 years, were selected for this review. SYNTHESIS OF EVIDENCE One of the objectives of any urological reconstructive procedure is to treat any segment of the genitourinary tract that is obstructed due to scar tissue following trauma or iatrogenic causes. After the excision of such segment or scar, a mobilization of the 2 healthy extremities of the urinary tract must be performed in order to proceed with a tension-free anastomosis. Occasionally, if there is tension, a mobilization of the organs at each side of the lesion should be performed to reduce the tension of the anastomosis; also, it should be a water-tight anastomosis to ensure good functional results. Another type of procedure is to perform laparoscopic repair surgery of pelvic organ prolapse in which the vaginal anatomy should be adequately restored, with good function maintained (sexual, urinary, intestinal) and durability. CONCLUSIONS With the worldwide expansion of minimally invasive surgery in the area of laparoscopy and robotics, it has been possible to reproduce many of the reconstructive techniques that have followed the evolutionary course of surgery from the open to the robot assisted technique, which has made clear that such therapeutic options exist and are reproducible with good results.
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Affiliation(s)
- Juan Gomez Rivas
- Servicio de Urología. Hospital Universitario La Paz. Madrid. España
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Alvarez-Maestro M, Rivas JG, Gregorio SAY, Guerin CDC, Gómez ÁT, Ledo JC. Current role of lymphadenectomy in the upper tract urothelial carcinoma. Cent European J Urol 2016; 69:384-390. [PMID: 28127455 PMCID: PMC5260448 DOI: 10.5173/ceju.2016.834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
| | - Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
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Rivas JG, Gregorio SAY, Gómez ÁT, Alvarez-Maestro M, Sebastián JD, Ledo JC. Laparoscopic radical cystectomy with prostate capsule sparing. Initial experience. Cent European J Urol 2016; 69:25-31. [PMID: 27123320 PMCID: PMC4846727 DOI: 10.5173/ceju.2016.723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 11/17/2015] [Accepted: 12/12/2015] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
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Rivas JG, Gregorio SAY, Ledo JC, Gómez ÀT, Sebastián JD, de la Peña Barthel JJ. The role of perioperative blood transfusion on postoperative outcomes and overall survival in patients after laparoscopic radical cystectomy. J Cancer Res Ther 2016; 12:146-9. [PMID: 27072228 DOI: 10.4103/0973-1482.146125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Juan Gómez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
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Rivas JG, Gregorio SAY, Sánchez LC, Portella PF, Gómez ÁT, Ledo JC, Sebastián JD, Barthel JJDLP. Evolution in the treatment of the ureteropelvic junction obstruction syndrome. Laparoscopic versus open pyeloplasty. Cent European J Urol 2015; 68:384-8. [PMID: 26568887 PMCID: PMC4643695 DOI: 10.5173/ceju.2015.536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 01/29/2015] [Accepted: 05/12/2015] [Indexed: 11/22/2022] Open
Abstract
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 <0.05. Post-operative complications were observed in 3 (OP) vs. 5 (LP) patients, with a success rate comparable between groups. CONCLUSIONS In our department, we recommend LP as the standard treatment for ureteropelvic junction obstruction because of the equal success rate compared to OP and the benefits of a minimally invasive surgery.
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Affiliation(s)
- Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
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Fontana PP, Gregorio SAY, Rivas JG, Sánchez LC, Ledo JC, Gómez ÁT, Sebastián JD, Barthel JJDLP. Perioperative and survival outcomes of laparoscopic radical cystectomy for bladder cancer in patients over 70 years. Cent European J Urol 2015; 68:24-9. [PMID: 25914834 PMCID: PMC4408395 DOI: 10.5173/ceju.2015.01.498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 11/12/2014] [Accepted: 01/10/2015] [Indexed: 12/27/2022] Open
Abstract
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 43% >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 had less comorbidities when compared with 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.
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Affiliation(s)
| | | | - Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
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Alonso Gregorio S, Gómez Rivas J, Cuello Sánchez L, Tabernero Gómez Á, Cisneros Ledo J, de la Peña Barthel JJ. Erectile function rehabilitation after laparoscopic radical prostatectomy. Rev Int Androl 2015. [DOI: 10.1016/j.androl.2014.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gregorio SAY, Rivas JG, Molina SS, Gómez AT, Ledo JC, Sebastián JD, Barthel JJDLP. Laparoscopic radical prostatectomy training for residents: Hospital Universitario La Paz model. Cent European J Urol 2014; 67:247-52. [PMID: 25247081 PMCID: PMC4165673 DOI: 10.5173/ceju.2014.03.art7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/20/2014] [Accepted: 06/17/2014] [Indexed: 11/22/2022] Open
Abstract
Introduction In the last decade, we have seen the advance of laparoscopic surgery in urology. All laparoscopic procedures in our department are performed by staff members and are assisted by a single resident, ensuring resident training in laparoscopic surgery. The aim of this study is to evaluate the results of the Hospital La Paz training program for residents in the field of laparoscopic surgery. Material and methods We have done a retrospective review of LRP performed by the residents in our department. We also evaluated different variables. Descriptive statistical analysis was done and the results were compared with the descriptive analysis of the initial series of our department. Results We reviewed 82 patients, with an average age of 61.6 years. Most cases were pT1c at diagnosis. Average surgical time was 288 minutes, with a transfusion rate of 9.7% and a intra and postoperative complication rates of 1.2% and 7.3%. The mean hospital stay was 3.3 days. Histological results of this series are: 76.8% of pT2 and 23.2% of pT3. The biochemical relapse rate is 15.8%. Global surgical margin rate is 20.7%. The global continence rate is 52.4%. Conclusions The outcomes of LRP performed by residents are similar to the ones reported in the initial series of our department. The fact that 84.6% of the residents formed in this period actually belong to different laparoscopic units supports the success of La Paz Hospital training model.
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Affiliation(s)
| | - Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
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Gregorio SAY, Rivas JG, Sánchez LC, Gómez AT, Ledo JC, Togores LH, Barthel JJDLP. Laparoscopic ureteral reimplantation in a renal transplant. Cent European J Urol 2013; 66:366-8. [PMID: 24707388 PMCID: PMC3974480 DOI: 10.5173/ceju.2013.03.art32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 07/17/2013] [Accepted: 07/19/2013] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
| | - Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
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Rivas JG, Gregorio SAY, Eastmond MAP, Gómez AT, Ledo JC, Togores LH, Barthel JJDLP. Transperitoneal laparoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction. Cent European J Urol 2013; 66:361-6. [PMID: 24707387 PMCID: PMC3974479 DOI: 10.5173/ceju.2013.03.art31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 06/26/2013] [Accepted: 07/05/2013] [Indexed: 11/22/2022] Open
Abstract
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 <0.05. Results The most frequent reason for consultation was ureteral pain. Patients mean age was 40 years and 94% of them had preoperative renogram showing a full or partial obstructive pattern. The right side was affected in 61% of cases and the left in the remaining 39%. The presence of stones was observed in 12 patients and crossing vessels in 58% of cases. The average stay was 3.72 days. Post–surgery complications were observed in two patients. The operative time was 178 minutes. Mean follow–up was 45 months and a success was achieved in 91%. Conclusions The transperitoneal laparoscopic pyeloplasty has become the gold standard for the treatment of ureteropelvic junction stenosis in our center because of high success rate, shorter postoperative stay, and low intra and postoperative complications.
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Affiliation(s)
- Juan Gómez Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
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Pérez-Utrilla Pérez M, Aguilera Bazán A, Alonso Dorrego JM, Vitón Herrero R, Cisneros Ledo J, de la Peña Barthel J. Simultaneous Cystectomy and Nephroureterectomy due to Synchronous Upper Urinary Tract Tumors and Invasive Bladder Cancer: Open and Laparoscopic Approaches. Curr Urol 2012; 6:76-81. [PMID: 24917718 DOI: 10.1159/000343514] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 04/10/2012] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION It is not unusual for bladder tumors to appear following transitional cell carcinoma of the upper urinary tract (UUT), with involvement of the UUT, following invasive bladder cancer, being less common. The synchronous presence of transitional cell carcinoma of the bladder and of the UTT is exceptional. METHODS Fifteen simultaneous cystectomies with nephroureterectomies were performed due to synchronous UUT and invasive bladder cancers (1997-2009). Surgery was performed using an open approach in 10 patients, while the last 5 procedures were performed laparoscopically. RESULTS The mean age was 68.7 years. Mean surgery time was 348.6 minutes. Mean blood loss was 816 ml. Acute renal failure was the most frequent postoperative complication being present in 5 patients (33%). There was 1 case of a leak in the ureter-intestinal anastomosis (open approach), which required placement of a left-sided percutaneous nephrostomy. There were 2 cases of postoperative mortality, both in the open approach series and with intestinal neobladder. Mean follow-up time for the whole series was 21.25 months. Eight cases experienced metastatic progression of the disease (mean follow-up 17 months). CONCLUSION Though multi-site studies with longer follow-up and a greater numbers of patients are needed, the moment at which urothelial tumors appear seems to influence their prognosis, with lower survival rates for tumors that synchronically appear.
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Affiliation(s)
| | | | | | - Rebeca Vitón Herrero
- Hospital General Universitario Ciudad Real, Servicio de Cirugía General, Ciudad Real, Spain
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Maestro MÁ, Gómez AT, Alonso y Gregorio S, Ledo JC, de la Peña Barthel J, Martínez-Piñeiro L. Laparoscopic transperitoneal radical prostatectomy in renal transplant recipients: a review of the literature. BJU Int 2010; 105:844-8. [DOI: 10.1111/j.1464-410x.2009.08911.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aguilera Bazán A, Pérez Utrilla M, Girón M, Cisneros Ledo J, de la Peña Barthel J. [Laparoscopic radical nephrectomy. Procedure, results, and complications]. Actas Urol Esp 2009; 33:544-9. [PMID: 19658308 DOI: 10.1016/s0210-4806(09)74188-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Surgery is the treatment of choice for clear cell renal carcinoma not responding to chemotherapy, radiotherapy, or immunotherapy. The surgical procedure used has evolved over time in the past 40 years, mainly because of the development and widespread use of diagnostic procedures such as ultrasonography and CT. As a direct consequence, parenchymal-sparing surgery was no longer only used for patients with solitary kidneys and its indication started to be extended to patients with tumors up to 4 cm in diameter, in whom it has been shown to be a safe and effective alternative to radical nephrectomy. The other important milestone in development of renal cancer surgery undoubtedly was the revolution started in the 90s with advent of laparoscopic renal surgery, which has become established over the past 20 years approximately. Laparoscopic surgery initially raised concern about oncological safety, but clinical series with sufficiently long follow-up times and large sample sizes are now available to consider the laparoscopic approach as a reliable procedure. Technological development has caused the laparoscopic technique to be no longer seen as a procedure for the future, but rather as an absolutely current technique which should be implemented in most urology departments. Implementation of any new procedure usually involves a number of complications which we should be prepared to assume, while making every effort to try and prevent them. It is therefore essential to develop, and to implement using common sense, a training program on the procedure. Selection of patients and conditions to be treated is a crucial part of such a program.
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Alonso y Gregorio S, Sánchez S, Soler C, Rando A, Girón M, Tabernero Gómez ÁJ, Aguilera A, Cisneros Ledo J, Peña Barthel JDL. Nefrectomía radical laparoscópica en piezas quirúrgicas de gran tamaño. Actas Urol Esp 2009. [DOI: 10.4321/s0210-48062009000700007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Aguilera Bazán A, Pérez Utrilla M, Girón M, Cisneros Ledo J, de la Peña Barthel J. Nefrectomía radical laparoscopica: Técnica, resultados y complicaciones. Actas Urol Esp 2009. [DOI: 10.4321/s0210-48062009000500012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Aguilera Bazán A, Alonso y Gregorio S, Pérez Utrilla M, Cansino Alcaide R, Cisneros Ledo J, De la Peña J. Nefroureterectomía laparoscópica: nueva posición para el manejo ureteral. ARCH ESP UROL 2007; 60:675-8. [PMID: 17847742 DOI: 10.4321/s0004-06142007000600009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The main challenge of laparoscopic nephroureterectomy is the management of distal ureter, which also will have an important repercussion in the oncological outcome of many cases. We present our experience in such aspect, considering that we performed the last five laparoscopic nephroureterectomies in forced Trendelemburg position, resulting in a more comfortable and safe management of the distal ureter. METHODS Between August and December 2006 we performed five purely laparoscopic nephroureterectomies with bladder cuff positioning the patient in forced Trendelemburg, a position similar to that of laparoscopic radical cystectomy or prostatectomy. RESULTS Mean surgical time was 182 minutes (170-210). Mean blood loss was 100 cc and no patient required transfusion. Mean hospital stay was four days. CONCLUSIONS We believe this position is a good alternative for the management of the distal ureter during the laparoscopic approach. The technique is very similar to open surgery, which continues being the gold standard today.
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García Mediero JM, Alonso Dorrego JM, Nuñez Mora C, Pastor Arquero T, De Fata FR, Cisneros Ledo J, Perez Mies B, Picazo García ML, de la Peña Barthel YJJ. [Early-onset sarcomatoid renal carcinoma. Report of a new case and comparison of the same case with another appearing at a mature age]. ARCH ESP UROL 2002; 55:843-7. [PMID: 12380314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE AND METHODS We report two new cases of this rare and aggressive tumour; one case appeared in the earliest age reported in the literature (case #2). We also review etiological, diagnostic and therapeutic features. RESULTS Despite aggressive surgery and adjuvant chemotherapy it has a very poor prognosis, with disease progression within 6 months in both cases. CONCLUSIONS Sarcomatoid renal cell carcinoma is an infrequent entity, extremely aggressive and requires radical surgery at the time of diagnosis due to its advanced stage, although results are poor. It can also appear in young people with the same aggressiveness than in adult age.
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Affiliation(s)
- José María García Mediero
- Servicio de Urología y Departamento de Anatomía Patológica, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, España.
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