RESUMEN
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has significant variability in its presentation. In this study, we present 2 novel cases of prostatitis in which "buzz" is described as the primary pain symptom. These cases describe patients with the primary complaint of "cell phone-like buzzing" within the perineum, with accompanying urinary symptoms consistent with prostatitis. CP/CPPS is a multifactorial disease within which psychological, inflammatory, neurologic, and neuromuscular etiologies are at play. As in other disease descriptions, a buzzing sensation represents the interaction of multiple pathways that have significant overlay with CP/CPPS. As such, we believe buzzing might represent a new symptom of CP/CPPS.
Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Varicocele/cirugía , Varicocele/congénito , Varicocele/fisiopatología , Neoplasias Urogenitales/cirugía , Neoplasias Urogenitales/diagnóstico , Neoplasias Urogenitales/tratamiento farmacológico , Sistema Urogenital/anatomía & histología , Sistema Urogenital/anomalías , Sistema Urogenital/cirugía , Enfermedades Renales/cirugía , Enfermedades Renales/congénito , Enfermedades Renales/fisiopatología , Infertilidad Masculina , Terapia por Láser , Trasplante de RiñónAsunto(s)
Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Varicocele/cirugía , Varicocele/congénito , Varicocele/fisiopatología , Neoplasias Urogenitales/cirugía , Neoplasias Urogenitales/diagnóstico , Neoplasias Urogenitales/tratamiento farmacológico , Sistema Urogenital/anatomía & histología , Sistema Urogenital/anomalías , Sistema Urogenital/cirugía , Enfermedades Renales/cirugía , Enfermedades Renales/congénito , Enfermedades Renales/fisiopatología , Infertilidad Masculina , Terapia por Láser , Trasplante de RiñónAsunto(s)
Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Varicocele/cirugía , Varicocele/congénito , Varicocele/fisiopatología , Neoplasias Urogenitales/cirugía , Neoplasias Urogenitales/diagnóstico , Neoplasias Urogenitales/tratamiento farmacológico , Sistema Urogenital/anatomía & histología , Sistema Urogenital/anomalías , Sistema Urogenital/cirugía , Enfermedades Renales/cirugía , Enfermedades Renales/congénito , Enfermedades Renales/fisiopatología , Infertilidad Masculina , Terapia por Láser , Trasplante de RiñónAsunto(s)
Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Varicocele/cirugía , Varicocele/congénito , Varicocele/fisiopatología , Neoplasias Urogenitales/cirugía , Neoplasias Urogenitales/diagnóstico , Neoplasias Urogenitales/tratamiento farmacológico , Sistema Urogenital/anatomía & histología , Sistema Urogenital/anomalías , Sistema Urogenital/cirugía , Enfermedades Renales/cirugía , Enfermedades Renales/congénito , Enfermedades Renales/fisiopatología , Infertilidad Masculina , Terapia por Láser , Trasplante de RiñónRESUMEN
OBJECTIVE: Describe a unique simplified experimental technique for total laparoscopic gastrocystoplasty in a porcine model. MATERIAL AND METHODS: We performed laparoscopic gastrocystoplasty on 10 animals. The gastroepiploic arch was identified and carefully mobilized from its origin at the pylorus to the beginning of the previously demarcated gastric wedge. The gastric segment was resected with sharp dissection. Both gastric suturing and gastrovesical anastomosis were performed with absorbable running sutures. The complete procedure and stages of gastric dissection, gastric closure, and gastrovesical anastomosis were separately timed for each laparoscopic gastrocystoplasty. The end-result of the gastric suturing and the bladder augmentation were evaluated by fluoroscopy or endoscopy. RESULTS: Mean total operative time was 5.2 (range 3.5 - 8) hours: 84.5 (range 62 - 110) minutes for the gastric dissection, 56 (range 28 - 80) minutes for the gastric suturing, and 170.6 (range 70 to 200) minutes for the gastrovesical anastomosis. A cystogram showed a small leakage from the vesical anastomosis in the first two cases. No extravasation from gastric closure was observed in the postoperative gastrogram. CONCLUSIONS: Total laparoscopic gastrocystoplasty is a feasible but complex procedure that currently has limited clinical application. With the increasing use of laparoscopy in reconstructive surgery of the lower urinary tract, gastrocystoplasty may become an attractive option because of its potential advantages over techniques using small and large bowel segments.
Asunto(s)
Gastrectomía/métodos , Laparoscopía/métodos , Vejiga Urinaria/cirugía , Anastomosis Quirúrgica , Animales , Cistectomía/métodos , Estudios de Factibilidad , Femenino , Modelos Animales , Sus scrofa , Factores de TiempoRESUMEN
OBJECTIVE: Describe a unique simplified experimental technique for total laparoscopic gastrocystoplasty in a porcine model. MATERIAL AND METHODS: We performed laparoscopic gastrocystoplasty on 10 animals. The gastroepiploic arch was identified and carefully mobilized from its origin at the pylorus to the beginning of the previously demarcated gastric wedge. The gastric segment was resected with sharp dissection. Both gastric suturing and gastrovesical anastomosis were performed with absorbable running sutures. The complete procedure and stages of gastric dissection, gastric closure, and gastrovesical anastomosis were separately timed for each laparoscopic gastrocystoplasty. The end-result of the gastric suturing and the bladder augmentation were evaluated by fluoroscopy or endoscopy. RESULTS: Mean total operative time was 5.2 (range 3.5 - 8) hours: 84.5 (range 62 - 110) minutes for the gastric dissection, 56 (range 28 - 80) minutes for the gastric suturing, and 170.6 (range 70 to 200) minutes for the gastrovesical anastomosis. A cystogram showed a small leakage from the vesical anastomosis in the first two cases. No extravasation from gastric closure was observed in the postoperative gastrogram. CONCLUSIONS: Total laparoscopic gastrocystoplasty is a feasible but complex procedure that currently has limited clinical application. With the increasing use of laparoscopy in reconstructive surgery of the lower urinary tract, gastrocystoplasty may become an attractive option because of its potential advantages over techniques using small and large bowel segments.
Asunto(s)
Animales , Femenino , Laparoscopía/métodos , Procedimientos de Cirugía Plástica/métodos , Anastomosis Quirúrgica , Cistectomía/métodos , Estudios de Factibilidad , Gastrectomía/métodos , Modelos Animales , Sus scrofa , Factores de TiempoRESUMEN
OBJECTIVE: To report our experience with laparoscopic-assisted nephroureterectomy for upper tract transitional cell carcinomas after radical cystectomy and urinary diversion. MATERIALS AND METHODS: Seven patients (53-72 years-old) underwent laparoscopic-assisted nephroureterectomy 10 to 53 months after radical cystectomy for transitional cell carcinoma at our institution. Surgical technique, operative results, tumor features, and outcomes of all patients were retrospectively reviewed. RESULTS: Mean operative time was 305 minutes with a significant amount of time spent on the excision of the ureter from the urinary diversion. Estimate blood loss and length of hospital stay averaged 180 mL and 10.8 days, respectively. Intraoperative and postoperative complications occurred in two patients each. There was one conversion to open surgery. Pathology confirmed upper-tract transitional cell carcinoma in all cases. Metastatic disease occurred in two patients after a mean follow-up of 14.6 months. CONCLUSIONS: Nephrouretectomy following cystectomy is a complex procedure due to the altered anatomy and the presence of many adhesions. A laparoscopic-assisted approach can be performed safely in properly selected cases but does not yield the usual benefits seen with other laparoscopic renal procedures.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Carcinoma de Células Transicionales/cirugía , Cistectomía/métodos , Neoplasias Renales/cirugía , Laparoscopía/métodos , Nefrectomía/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Biopsia , Carcinoma de Células Transicionales/patología , Estudios de Seguimiento , Complicaciones Intraoperatorias , Neoplasias Renales/patología , Recurrencia Local de Neoplasia/etiología , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento , Uréter/cirugía , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
Since its initial description, the laparoscopic retroperitoneal lymph node dissection has evolved considerably, from a purely diagnostic tool performed to stage germ cell testicular cancer to a therapeutic operation that fully duplicates the open technique. Herein, we describe the current technique employed at our institution, along with illustrations of all surgical steps, and delineate the refinements of the technique over time.
Asunto(s)
Laparoscopía/métodos , Escisión del Ganglio Linfático/métodos , Neoplasias de Células Germinales y Embrionarias/cirugía , Neoplasias Testiculares/cirugía , Humanos , Masculino , Espacio RetroperitonealRESUMEN
Since its initial description, the laparoscopic retroperitoneal lymph node dissection has evolved considerably, from a purely diagnostic tool performed to stage germ cell testicular cancer to a therapeutic operation that fully duplicates the open technique. Herein, we describe the current technique employed at our institution, along with illustrations of all surgical steps, and delineate the refinements of the technique over time.
Asunto(s)
Humanos , Masculino , Laparoscopía/métodos , Escisión del Ganglio Linfático/métodos , Neoplasias de Células Germinales y Embrionarias/cirugía , Neoplasias Testiculares/cirugía , Espacio RetroperitonealRESUMEN
OBJECTIVE: To report our experience with laparoscopic-assisted nephroureterectomy for upper tract transitional cell carcinomas after radical cystectomy and urinary diversion. MATERIALS AND METHODS: Seven patients (53-72 years-old) underwent laparoscopic-assisted nephroureterectomy 10 to 53 months after radical cystectomy for transitional cell carcinoma at our institution. Surgical technique, operative results, tumor features, and outcomes of all patients were retrospectively reviewed. RESULTS: Mean operative time was 305 minutes with a significant amount of time spent on the excision of the ureter from the urinary diversion. Estimate blood loss and length of hospital stay averaged 180 mL and 10.8 days, respectively. Intraoperative and postoperative complications occurred in two patients each. There was one conversion to open surgery. Pathology confirmed upper-tract transitional cell carcinoma in all cases. Metastatic disease occurred in two patients after a mean follow-up of 14.6 months. CONCLUSIONS: Nephrouretectomy following cystectomy is a complex procedure due to the altered anatomy and the presence of many adhesions. A laparoscopic-assisted approach can be performed safely in properly selected cases but does not yield the usual benefits seen with other laparoscopic renal procedures.
Asunto(s)
Carcinoma de Células Transicionales/cirugía , Cistectomía/métodos , Neoplasias Renales/cirugía , Laparoscopía/métodos , Nefrectomía/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Anciano , Biopsia , Carcinoma de Células Transicionales/patología , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/etiología , Estudios Retrospectivos , Resultado del Tratamiento , Uréter/cirugía , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
BACKGROUND AND PURPOSE: To assess the safety and feasibility of transcontinental telementored and telepresence surgery, we report on two procedures carried out with participation by surgeons in Baltimore in the United States and São Paulo and Recife in Brazil. PATIENTS AND METHODS: Over a period of 3 months, a laparoscopic bilateral varicocelectomy and a percutaneous renal access for a percutaneous nephrolithotomy were performed. The mentoring surgeon (LRK) was the same for both procedures. He used a 650-MHz personal computer fitted with a Z360 video COder/ DECoder (CODEC) and a Z208 communication board (Zydacron Corp, Manchester, NH) that comprise the core of the telesurgical station. In the first case, a surgical robot, AESOP 3000 (Computer Motion Inc.), was attached to a laparoscope, and the remote surgeon drove the robot via a controller on the remote computer. In the second case, another robot (Percutaneous Access to the Kidney; PAKY) was used for percutaneous needle placement into the renal collecting system. RESULTS: The two procedures were completed successfully. In the first case, the operative time was 25 minutes, with minimal estimated blood loss. The patient was discharged home the next day. At 3-month follow-up, there was no scrotal pain or varicocele. In the second case, access to the urinary tract was achieved with the first needle pass, and percutaneous nephrolithotomy was uneventful. Blood loss was minimal, and the patient was discharged home on the second postoperative day. At 3-month follow-up, the patient was free of urinary stones and of symptoms. CONCLUSIONS: The first transcontinental telementored and telepresence urologic surgical procedures have been reported previously. The success observed with the novel surgical techniques has motivated great interest. The cases reported here demonstrate that several types of procedures can be mentored safely and effectively with telemedicine technology.