Rupture of vesicourethral anastomosis following radical retropubic prostatectomy

OBJECTIVE: Rupture of vesicourethral anastomosis following radical retropubic prostatectomy is a complication that requires immediate management. We evaluated the morbidity of this rare complication. MATERIALS AND METHODS: We analyzed retrospectively 5 cases of disruption of vesicourethral anastomosis during post-operative period in a consecutive series of 1,600 radical retropubic prostatectomies, performed by a single surgeon. RESULTS: It occurred in a ratio of 1:320 prostatectomies (0,3%). Management was conservative in all the cases with an average catheter permanence time of 28 days, being its removal preceded by cystography. Two cases were secondary to bleeding, 1 followed the change of vesical catheter and 2 by unknown causes after removing the Foley catheter. Only one patient evolved with urethral stenosis, in the period ranging from 6 to 120 months. CONCLUSION: Rupture of vesicourethral anastomosis is not related to the surgeon's experience, and conservative treatment has shown to be effective.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of UrologyUNIFESP, EPM, Department of UrologySciEL

Re: Lack of association between Matrix Metalloproteinase-1 (MMP-1) promoter polymorphism and risk of renal cell carcinoma

Federal University of São Paulo Section of NephrologyFederal University of São Paulo Section of UrologyInstitute of Energetic and Nuclear ResearchUNIFESP, Section of NephrologyUNIFESP, Section of UrologySciEL

Cirurgia laparoscópica robotizada a distância: experiência inicial

Robotic surgery is an option to laparoscopy that may offer some benefits including the possibility of performing surgery when the surgeon is geographically away from the patient and faster tireless repetitive movements with greater precision. At present, robot-assisted surgery has been done routinely in several institutions around the world, however, to the best of our knowledge, it is the first time such procedure is performed in our academic environment and herein is reported the first telerobotic-assisted laparoscopic cystectomy performed in a domestic pig at our institution using the Zeus®robotic system (Computer Motion, EUA). The procedure was performed using two different operating rooms geographically apart from each other. The assistant was in an operating room that was set with the operating table and the pig as well as with the Zeus® robotic arms. In the other operating room, the surgeon was seated in the control console with a three-dimensional imaging five meters away from the operating table connected with electric cables. The assistant surgeon established the pneumoperitoneum and five trocars were placed in a fan configuration. The surgeon started performing the surgery using three out of the five ports taking control of the laparoscope (voice control) and manual control of laparoscopic instruments connected to the robotic arms using the joysticks. The other two ports were used by the assistant for traction and clips placement that was also necessary for exchanging the many laparoscopic instruments connected to the robot. The laparoscopic total cystectomy was successfully performed in 25 minutes with no complications. The truly benefits as well as the cost-effectiveness of the robotic surgery in our environment is yet to be determined after experience acquisition with telerobotic before start performing such procedures routinely in humans. The present report shows the technical feasibility of telerobotic surgery in a developing country.A cirurgia totalmente robotizada é uma opção à laparoscopia que pode proporcionar alguns benefícios, entre os quais a realização dos incansáveis movimentos de repetição com maior precisão e rapidez e com o cirurgião localizado em ambiente geograficamente diferente do paciente. Relatamos, em nossa instituição, a primeira cistectomia totalmente robotizada à distância em um porco (raça Landrace) doméstico com o sistema robótico Zeus® (Computer Motion, EUA). A cirurgia foi realizada em duas salas geograficamente separadas, sendo que em uma delas, o porco foi posicionado na mesa cirúrgica bem como os braços do sistema Zeus® fixados de forma segura. Na seqüência, o assistente introduziu os cinco trocateres em forma de leque pela via transperitoneal após obtenção do pneumoperitônio pelo método fechado. Em outra sala, o cirurgião principal comandava os braços do robô através de controles manuais sentado dentro do console de comando do sistema Zeus ®, auxiliado por imagem de vídeo em três dimensões transmitida pelo laparoscópio, que era comandado por sistema de voz, pelo cirurgião. A distância do console de comando e da mesa cirúrgica era de 5 metros e estes estavam conectados por cabos elétricos. A cistectomia total foi realizada em 25 minutos sem intercorrências. O assistente auxiliou apenas nas manobras de troca de instrumento do sistema Zeus ®, apresentação dos tecidos e introdução do clipador, utilizando apenas dois trocartes. Os reais benefícios do sistema robótico em nosso meio ainda será determinado através da aquisição de maior experiência com o sistema e pelo início da realização deste procedimento em humanos.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of SurgeryUNIFESP, EPM, Department of SurgerySciEL

Renal shrinking with hypertonic saline solution for laparoscopic nephrectomy: from the lab to clinical practice

BV UNIFESP: Teses e dissertaçõe

Impact of Radial and Partial Nephrectomy on Rental Function in Patients with Renal Cancer

Objective: To evaluate renal function in renal cancer patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN) (open or laparoscopic ORN, OPN, LRN or LPN) and to identify risk factors contributing to renal function loss. Methods: We analysed 228 consecutive renal cancer patients admitted for OPN, LPN, ORN or LRN. the variables analysed were age, gender, weight, type of surgery (radical versus partial), type of surgical access (open versus laparoscopic), preoperative renal function and history of hypertension, diabetes or malignancy. Absolute renal function was calculated as the difference in glomerular filtration rate (AGFR) between the renal function before (GFR(0)) and 12 months after surgery (GFR(12)). the relative renal function of patients undergoing PN and RN was evaluated by the change in chronic kidney disease stage. Results: LRN caused the greatest loss in absolute renal function, followed by ORN, LPN and OPN. A GFR of >= 60 ml/min was noted for 90(68.7%) patients before and 65 (49.6%) patients after RN and for 80 (82.5%) patients before and 74 (76.3%) patients after PN. the chronic kidney disease stage dropped to 4 or 5 in the case preoperative weight and type of surgery (radical versus partial) had a significant impact on renal function. Conclusion: Renal function significantly decreased in patients undergoing RN, irrespective of the access route. Patients With preoperative poor renal function are at risk of postoperative end-stage renal disease. (c) 2014 S. Karger AG, BaselUniversidade Federal de São Paulo, Div Urol, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Div Urol, BR-04024002 São Paulo, BrazilWeb of Scienc