Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Laparoscopic single port surgery (LESS) offers certain advantages, such as the reduction of surgical trauma, less postoperative pain, less need for analgesics and excellent aesthetic results. The use of a single surgical port provides the opportunity to combine procedures in a single session. We present the case of a 59-year-old patient with a history of left renal colic and recurrent urinary tract infections, as well as long-standing biliary colic, both treated symptomatically. The tomographic study demonstrates the presence of atrophic left kidney, without uptake contrast, as well as concomitant biliary pathology. She undergoes laparoscopic nephrectomy and cholecystectomy with LESS technique, with adequate surgical and aesthetic results. The LESS technique is a viable option in the minimally invasive management of different pathologies. Performing simultaneous surgical procedures for the same approach could avoid the need for another hospitalization and another surgery; doing it, through a single port, provides adequate aesthetic results, as well as allowing the approach of anatomical sites distant from each other through a single incision.

Background: Urinary incontinence is defined as involuntary urine leakage. The International Consultation on Incontinence (ici) estimates a 25-45% prevalence of urinary incontinence worldwide. Kegel exercises are included in the clinical management of incontinence, to increase the strength of urethral closure. However, reports in the medical literature state that 25% of the population utilizes poor technique in performing those exercises, producing a worse prognosis in relation to the natural history of the disease. The aim of the present study was to evaluate the efficacy of the Kegel exercises in a population with urinary incontinence, measuring urethral pressure response.   Materials and methods: An observational and prospective study was conducted on 38 patients with urinary incontinence. The demographic variables of the patients were collected, and they were given a 5 min explanation of the exercises. Maximum urethral closure pressure and urethral pressure were measured to the point of functional pressure of the urethral sphincter. After the performance of the Kegel maneuver, patients were assessed in relation to an increase in the maximum urethral closure pressure. Results: Of the 38 patients, only 52% achieved an increase in urethral pressure with the Kegel exercises. A lack of response to the exercises was found in patients that presented with overweight (p=0.015). Conclusion: The performance of Kegel exercises had a limited response in patients with urinary incontinence and there was a lack of effectiveness on urethral pressure in overweight patients. 

Background. Acute urinary retention is a common urologic emergency. It rarely presents in children, in whom it has been associated with a wide variety of causes, such as mechanical obstruction (stones or strictures), constipation, infection and inflammation, fecal impaction, neurologic and gynecologic diseases, malignancy, or behavioral or idiopathic etiology, among others. Clinical case: A 2-year-old boy, with no family history of kidney stones, presented with sudden abdominal pain accompanied by crying during micturition. Cystostomy was performed in the emergency room and the patient was referred to the specialist at our hospital center for evaluation. Physical examination revealed a foreign body in the urethra. Urethrocystoscopy was immediately carried out with a pediatric urethrocystoscope, and a stone in the anterior urethra was found. Discussion. Urinary stones in children are an uncommon pathology and are rarely a cause of acute urinary retention (2%). It is more common in boys and in the anterior urethra. Pediatric patients with posterior urethral stones have continuous urine dripping and those with anterior urethral stones present with acute urinary retention. The use of endoscopic equipment is safe for resolving urethral stones and should be considered the first treatment option, when available.

Background: Spontaneous renal hematoma is a rare pathology. Accurate diagnosis can prevent life-threatening complications. The aim of the present study was to report our experience in patients diagnosed with spontaneous renal hematoma. Materials and methods: The case series included 17 patients with spontaneous renal hematoma that were seen at our hospital within the time frame of 2016-2018. Disease etiology, progression, and treatment data were retrieved from the clinical records of the patients. Results: Twelve (70%) of the patients were women, 5 (30%) were men, and their mean age was 53.6 years. Abdominal computed axial tomography was the diagnostic method utilized in all the patients. Fourteen patients were treated surgically (nephrectomy) and 3 were managed conservatively. The most frequent cause of spontaneous renal hematoma was pyelonephritis (35%), followed by malignant tumor in 18% of the cases. The pathology was labelled as idiopathic in 29% of the patients. Conclusions: In the present case series, spontaneous renal hematoma was more frequent in women. The main cause was pyelonephritis, followed by malignant tumor. The most frequent treatment was nephrectomy, but conservative management can be carried out in selected cases.

Description: An 18-year-old male sought medical attention due to hematuria and acute urinary retention. The patient had an emergency cystoscopy, after which he underwent radical prostatectomy. The pathology study stated prostate rhabdomyosarcoma. Relevance: There are very few cases reported both in Mexico and in the international literature. Thus, diagnostic suspicion is low, and once suspected, the disease is a therapeutic and multidisciplinary challenge. Clinical implications: Hematuria and obstructive prostatic growth in patients younger than the fourth decade of life are characteristics that should lead to the suspicion of this type of neoplasia. Conclusions: Prostate sarcomas are rare tumors and their natural history is not well understood. Local and distant progression is rapid, with a mean 2-year survival, despite multimodal therapeutic management. The main survival factors are complete tumor resection, early-stage local disease, and low tumor grade. New chemotherapy protocols are needed to prolong patient survival, as has been demonstrated in other types of sarcomas in the extremities.  

Background: Penile fracture is a urologic emergency and is defined as the rupture of the tunica albuginea of the cavernous body in erection, with or without urethral involvement. The aim of the present study was to describe the preservation of erectile function in patients with a history of penile fracture managed through surgical repair. Methods: An observational, descriptive, analytic, and retrospective study was conducted on 32 patients diagnosed with penile fracture that were seen at the Urology Department of the Hospital General de Mexico, within the time frame of 2005 to 2019. The following variables were retrieved from their clinical records and analyzed: age at the time of fracture, sexual preference, marital status, mechanism of trauma, anatomic condition, medical-surgical care time, recovery time, penile curvature, erectile dysfunction (IIEF-5), fibrosis or urethral stricture as post-trauma complications, and follow-up duration. Results: Intercourse was the mechanism of injury in 24 (75%) patients and sexual behavior was promiscuous in 16 (50%) patients. Regarding sexual preference, 31 cases were registered as heterosexual (97%) and the most frequent sexual position associated with penile fracture was "partner on top" in 12 patients (38%). Surgery duration was 720 minutes (12 hours) in 6 (19%) patients. On average, intercourse was resumed two months ± 1.3 months after the trauma. Currently, most of the patients have not presented with erectile dysfunction 19 (60%). Conclusion: The majority of patients that receive timely surgical care upon diagnosis (before 35 hours have passed) have better prognosis and a favorable outcome in terms of erectile function, preventing fracture sequelae.

Objective: To determine the presence of urinary incontinence in obese women and the postoperative effect of bariatric surgery at months 3, 6, and 12. Materials and methods: An observational, prospective, and longitudinal study was conducted on obese women that underwent bariatric surgery within the time frame of April to July 2017. Inferential statistics with a bivariate analysis were performed using the chi-square test. Results: Sixty-seven patients were included in the study. A total of 73.1% presented with some type of urinary incontinence. Their mean age was 42.7 years, mean preoperative weight was 108.3 kg, and mean body mass index was 42.7 kg/m2. The most frequent type of urinary incontinence was stress incontinence (55.1%), 65.3% of the patients presented with mild urinary incontinence, and quality of life was negatively affected in 30.6%. One year after surgery, mean body mass index was 30.9 kg/m2 and 13.4% of the patients continued to present with urinary incontinence, all of which were cases of stress incontinence. The postoperative improvement of urinary incontinence was statistically significant in relation to the three types of incontinence (p=0.001), frequency (p<0.001), and quality of life (p<0.001). Urinary incontinence was completely resolved in 81.6% of the patients. Conclusions: Weight loss after bariatric surgery greatly resolved urinary incontinence, showing that weight reduction should be considered a first-line therapy for managing that syndrome. The primary aim of bariatric surgery is to reduce cardiovascular morbidity, but the recovery from and/or improvement of urinary incontinence should be routinely evaluated, offering another important long-term benefit.  

Objective: To compare the results of the surgical approach between the abdominal and vaginal techniques in simple and complex vesicovaginal fistula repair, suggesting the safest surgical approach. Materials and methods: An analytic, cross-sectional, retrospective study with convenience sampling was conducted on females with a history of simple and complex vesicovaginal fistulas that underwent surgical repair with the abdominal or vaginal technique at the Urology Service of the Hospital General de México within the time frame of February 2015 to February 2018. After a thorough review of the medical records, the following study variables were determined: hospital stay, surgery duration, intraoperative blood loss, complications according to the Clavien classification, and the risk for refistulization. The data were analyzed using measures of central tendency and dispersion. Results: Sixty patients that underwent simple or complex vesicovaginal fistula repair were divided into two groups according to the surgical technique employed: 30 patients with the abdominal approach and 30 patients with the vaginal approach.  Mean patient age was 42.58 ± 11.3 years and the past histories were hysterectomy due to a benign cause in 37 (62%) patients, hysterectomy due to an oncologic cause in 11 (18%) patients, childbirth in 6 (10%) patients, and infection in 6 (10%) patients. Mean fistula size determined through cystoscopy was 0.73 ± 0.52 cm. The patients that underwent transvaginal surgery had fewer complications, compared with those treated with the abdominal technique (6% vs 33%), p = 0.012. Conclusions: Vesicovaginal fistula repair through the transvaginal approach is recommended for its reduced hospital stay, less intraoperative bleeding, shorter surgery duration, lower recurrence rate, lower complication rate, higher success rate, and faster recovery. It can be performed as a first surgical option.  

Aim. To determine the concordance between ultrasonography and urotomography for screening and early diagnosis in patients with suspected urolithiasis. Material and methods. 140 patients older than 18 years old with suspected urolithiasis were studied. An ultrasonography scan was performed to determine the stone presence and their size. Subsequently, patients were examined using a simple phase urotomograph and stones were classified by their location, size and density. The stones sizes were also determined (screening). Moreover, concordances, sensitivity and specificity for both imaging methods were estimated. Results. When using urotomography, kidney stones were observed in 94 patients, ureter stones in 26 patients and bladder stones in 20 patients. In comparison, ultrasonography identified kidney, ureter and bladder stones in 84% (79 vs 94 patients), 84.6% (22 vs 26 patients) and 100% (20 vs 20 patients) of the analyzed population, respectively. Estimated concordances in kidney, ureters and bladder were 61% (88% sensitivity, 90% specificity), 75% (95% sensitivity, 90% specificity) and 98% (99% sensitivity and specificity) respectively. Conclusions. Ultrasonography is a reliable method for the early diagnosis of patients with clinical suspicion of urolithiasis. The method has high sensitivity when it is operated by specialized professionals.

Introduction: Benign prostatic hyperplasia BPH is a prevalent pathology. Depending on the severity of the symptoms of the lower urinary tract, the need for medical or surgical management, which has as a gold standard, transurethral resection of the prostate by bipolar system TURP-B is defined. Aim: : To determine the current state of the different surgical techniques to compare its efficacy and safety in the treatment of benign prostatic hyperplasia. Methods: A search was performed in five databases PUBMED, Embase, Lilacs, Science Direct and Greynet. Meta-analyzes, systematic reviews and randomized clinical trials were evaluated, determining the efficacy and safety of surgical techniques for the treatment of BPH between 2006 and 2016. Results: From 2505 articles chosen by title and summary, 94 articles were chosen for review of the full text. Different surgical techniques were found; TURP by monopolar or bipolar method, open prostatectomy, plasma vaporization, laser techniques, minimally invasive ablative techniques. Most articles compare TURP-B (gold standard) vs other surgical methods; focusing on clinical outcomes based on IPSS score, Qmax, PVR and Qol scales; Observing similar results among all the techniques. Conclusions: TURP-B is the most practiced technique for the management of BPH, with good results compared to TURP-M. Similar results between TURP-B with HoLEP, ThuLEP, Greenlight laser, TUMT. The decision of the surgical technique will be chosen according to the surgeon's expertise and the characteristics of each patient. The results presented here are heterogeneous and require further investigation.