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

Background: The performance of robotic-assisted radical prostatectomy (RARP) is increasing worldwide. In Mexico, 13 hospitals are equipped to carry out robotic surgery. In other countries, the procedure has been shown to reduce surgical morbidity, as well as providing the same effectiveness in oncologic and functional results offered by open prostatectomy. Objective: To report the results of the initial experience with RARP at the Centro Médico Naval and the short-term patient follow-up. Material and Methods: A retrospective review of the patients that underwent RARP at our unit and that had a postoperative follow-up of at least 6 months was conducted. The time frame of the study was from March 19, 2016 to April 30, 2018. Results: Forty-eight RARPs were performed. Mean age of the patients was 64.7 years and mean preoperative PSA was 10.4 ng/dl.  Nineteen percent of the patients were classified as low-risk, 29% as intermediate-risk, and 52% as high-risk. In mean values, surgery duration was 240 minutes, blood loss was 223 ml, and hospital stay was 3.87 days. Nerve sparing was performed in 56.3% of the patients. Standard lymphadenectomy was carried out in 68.8% of the cases and the extended procedure in 31.2%. The positive surgical margin rate was 45.8%. A total of 14.6% patients had biochemical failure and 12.5% received postoperative external beam radiotherapy. Mean follow-up time was 9 months. We documented a complete continence rate of 91.3% and the quality of erectile function was sufficient for having sexual intercourse in 53.5% of the patients.   Conclusions: The perioperative and functional morbidity results for the beginning of our learning curve were similar to those reported in the international literature, despite the high-risk characteristics of our population.

Prostate cancer is the neoplasia that has the greatest impact on the male population. Its known risk factors are age, race, and genetics, whereas others, such as sexual behavior, have not been established. Objective: To measure the association of sexual behavior and other factors with prostate cancer in a Mexican population. Materials and methods: A paired case-control study was conducted, in which the cases were patients with adenocarcinoma of the prostate and the controls were patients with no PCa, paired by ± 3 years of age. The study variable data were obtained through a confidential medical interview and hospital case records. Results: Beginning sexual relations after 18 years of age had an OR of 2.82 (95% CI 1.27-6.25), being single had an OR of 16.4 (95% CI 5.42-49.65), sexual intercourse with sex workers had an OR of  8.75 (95% CI 3.66-20.9), and a history of a sexually transmitted disease had an OR of 2.49 (95% CI 1.24-4.99). Conclusions: A late beginning of sexual relations, being single, sexual intercourse with sex workers, and a history of a sexually transmitted disease were the male sexual behaviors associated with the risk for presenting with prostate cancer. We found no association with the number of sexual partners or the frequency of sexual intercourse.

Antecedentes: El carcinoma de células renales corresponde del 2% al 3% de todas las neoplasias malignas en el adulto. Con una incidencia 84,400 casos y se le atribuyen más de 34,000 muertes por año. El cáncer renal tiene predilección por invadir al sistema venoso en el 10 % de los casos, pudiendo afectar la vena renal y la vena cava inferior con presencia de trombos tumorales. Caso clínico: Paciente masculino de 48 años de edad, con antecedentes de tabaquismo, sin enfermedades crónico degenerativas. Con cuadro clínico de dos meses de evolución con dolor y aumento del perímetro abdominal, perdida ponderal y edema de miembro pélvico derecho. Al examen físico con presencia de tumor hemiabdominal derecho y edema de miembro pélvico derecho. La tomografía contrastada revela un tumor renal derecho y presencia de trombo tumoral a nivel auricular. El ecocardiograma transesofágico demostró presencia de trombo tumoral en aurícula derecha. Conclusión: La nefrectomía radical, la trombectomía con cavotomía y atriotomía son el manejo estándar con la finalidad de establecer un tratamiento con intención curativa en pacientes con carcinoma de células renales y trombos tumorales supra diafragmáticos.

Liquid silicone has been utilized as a medical material for decades. In urology, it has been used to enhance the girth of the penis through subcutaneous tissue injection. Said practice can produce a granulomatous inflammatory reaction with local deformity, resulting in a foreign body reaction called “siliconoma”. We present herein the case of a patient with penile lipogranuloma secondary to the injection of an unknown substance that required surgical treatment to excise the affected tissue and cover the defect with cutaneous grafts. It is our opinion that such an enhancement practice is not justified, given its possible catastrophic consequences.

En el marco del LXIX Congreso Nacional de la Sociedad Mexicana de Urología, se realizó la presentación del I Foro para Pacientes Uro Oncológicos, el cual está previsto se lleve a cabo los días 9 y 10 de Agosto del 2019, en la Ciudad de México.

Background: Sacral neuromodulation is a minimally invasive technique to modulate spinal reflexes that influence the bladder, bowel, external urethral sphincter and pelvic floor to improve and restore voiding and evacuation functions. Its main therapeutic indications are urgency urinary incontinence, urgency-frequency syndrome, non-obstructive emptying alterations, chronic urinary retention, chronic pelvic pain, fecal incontinence and constipation. In our country there have been few studies that evaluate the efficacy and safety of this therapy. Objetive: To evaluate the therapeutic effectiveness, safety and quality of life of patients with chronic voiding dysfunction treated with Sacral Neuromodulation at the Hospital Central Militar. Material and Methods: From January 2010 to June 30, 2018, a review of the patient´s files treated with Sacral Neuromodulation therapy due to voiding dysfunction and who were refractory to medical treatment, to make an assessment of quality of life through employment of the instrument SF-36 v2 (Mexican version) and ICIQSF, effectiveness with the use of the results of the voiding diaries and urodynamic parameters, and the complications of the procedure were classified according to the Clavien Dindo scale. The IBM SPSS 22.0 statistical system was used. Results: We included 41 patients in the study with the following diagnoses: detrusor-sphincter dyssynergia, overactive bladder and hypertonic urinary sphincter, located by gender (16 male and 25 female). 100% of the patients presented improvement of the symptoms with the trial phase of the therapy and a final neurostimulator was placed with the following results: more than 65% improvement in the quality of life was obtained with quantitative and qualitative parameters, as well as as in the variables of bladder capacity and post voiding volume. Discussion and conclusions: As reported in the world literature, the results were similar in terms of effectiveness, improvement in quality of life and safety of Sacral Neuromodulation therapy. Percentages of success greater than 50% have been reported in the total cessation of incontinence episodes. Sacral neuromodulation is a minimally invasive and durable therapy for the treatment of voiding dysfunction of non-obstructive etiology. In cases in which Neuromodulation tests are not effective, this treatment has the advantage of being reversible. It is necessary to continue with the development of studies that can verify in the medium and long term, through urodynamic parameters, the efficacy of this treatment.

INTRODUCTION Ganglioneuromas are rare tumors that arise from the neural crest tissue, characterized by benign behavior and slow growth, located most frequently in the posterior mediastinum and rarely in the adrenal gland. Its diagnosis is generally incidental and asymptomatic. CASE REPORT A 56-year-old male, asymptomatic, who comes to assessment due to the finding of incidental adrenal mass in simple tomography, requested due to microscopic hematuria. Contrast tomography was performed, finding a left adrenal tumor of 4 cm diameter, with enhanced attenuation less than 20 HU. Metabolites of catecholamines in urine and blood within normal parameters. A laparoscopic adrenalectomy was performed. The histopathological study corresponds to adrenal Ganglioneuroma. DISCUSSION The diagnosis of adrenal ganglioneuroma represents a diagnostic challenge, due to its silent clinical presentation, some authors suggest that the findings in contrast-enhanced tomography of a metabolically nonfunctioning adrenal mass with unenhanced attenuation less than 40 HU, and the presence of punctiform calcifications should suggest ganglioneuroma, however the differentiation between neural crest tumors is histopathological. In the presence of an adrenal mass bigger than 4 cm, regardless of its behavior and clinical characteristics, surgical management is indicated, as it corresponds to the most appropriate diagnostic and treatment method.

Background: Partial nephrectomy has become standard treatment for T1 tumors (£ 7 cm), solitary kidney, bilateral tumors, and hereditary cancer. There are few studies in Mexico that report on said procedure. Aim: To know the clinical characteristics, perioperative morbidity, and functional and oncologic results of partial nephrectomy at the Instituto Nacional De Cancerología Materials and methods: A retrospective, analytic study was conducted on patients that underwent partial nephrectomy within the time frame of 2000 to 2018, reporting the oncologic and perioperative results. Results: Seventy-nine patients that underwent partial nephrectomy were analyzed. A total of 82 procedures were performed. Mean patient age was 52 years. Clinical stage was T1a and T1b in 62 (74.6%) and 20 (24.4%) cases, respectively. Warm ischemia was utilized in 39 (47.6%) patients and n ischemia was used in 35 (42.7%). Mean surgery duration was 162 min, mean blood loss was 449 ml, and mean hospital stay was 2.1 days. Open surgery was performed on 70 (85.4%) patients and 12 (14.6%) patients underwent the laparoscopic procedure. There were early complications in 17 (20%) patients that included 9 (11%) transfusions. Clear cell renal cell carcinoma was reported in 66 (80.5%) cases and surgical margins were negative in 73 (89%). Cancer-specific survival was 100% and overall survival was 92% at five years. The mean preoperative estimated glomerular filtration rate was 88 ml/min and it was 79 ml/min at one year. Renal ischemia influenced the decrease in the glomerular filtration rate. Conclusions: The results of the present study are similar to those reported in other international referral centers, making the performance of partial nephrectomy in T1 tumors a safe procedure in our population.

Wunderlich syndrome, also known as spontaneous retroperitoneal hematoma, is a rare complication of varied etiology. Fifty percent of cases are associated with renal angiomyolipoma. The most common symptom is abdominal pain, and Lenk’s triad is seen in 20% of patients, which consists of abdominal pain (67%), palpable abdominal mass (54%), and hypovolemic shock (26%). The diagnostic study of choice is abdominal tomography with intravenous contrast medium. However, angiography has diagnostic and therapeutic usefulness in patients that are candidates for angioembolization. The treatment of choice depends on the clinical status of the patient, presentation of the pathology, and in some cases, previous kidney function. In the majority of cases, treatment is nephrectomy, but successful management through partial nephrectomy or selective angioembolization has been described in selected patients with insidious disease progression, hemodynamic stability, and involvement of both kidneys, among others. We present herein the case of a 19-year-old female, who in her first days of physiologic puerperium, came to the emergency room because of abdominal pain and gross hematuria. Abdominal ultrasound revealed a heterogeneous lesion on the right kidney. An abdominal computed axial tomography scan with intravenous contrast medium identified an image suggestive of a right renal hematoma. Due to the patient’s sudden hemodynamic decline, right nephrectomy was performed. The pathology study ruled out the presence of angiomyolipoma or other neoplasia or abnormal condition in the surgical specimen.

Objective: To determine the frequency, risk factors, and impact on quality of life of urinary incontinence in older women. Materials and Methods: An analytic, observational, cross-sectional study was conducted on a population of women over 60 years of age. Sociodemographic, gynecologic/obstetric, and lifestyle variables, were collected, along with clinical histories, and the patients answered the International Consultation on Incontinence Questionnaire (iciq-sf). Results: Ninety-six women were included in the study and their mean age was 71 ±0.66 years. Of the study participants, 56.25% presented with urinary incontinence. A total of 37.04% had urge incontinence, 33.33% presented with stress incontinence, 16.67% had mixed incontinence, and 13% of the cases of incontinence were unclassifiable.  The variables associated with urinary incontinence were: number of births (p=0.027), having had 3 or more children (p=0.032), and diabetes mellitus (p=0.028). Mixed urinary incontinence was the type that was most associated with compromised quality of life (p<0.001). Limitations and implications: The study was conducted utilizing self-applied questionnaires. The sample was recruited from an educational program for older adults with a middle-to-high socioeconomic status. Originality. The study was conducted in Yucatán, Mexico, and no previous descriptive studies on incontinence have been carried out on that population. Discussion and conclusions. Urinary incontinence affected more than half of the women studied, with compromised quality of life classified as moderate. A high number of deliveries was the most outstanding risk factor.