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

Abstract Bladder cancer is the eleventh most common malignancy worldwide and carries high morbidity and mortality. For its diagnosis, multiple imaging tools such as CT urography and cystoscopy, which remain the gold standard to this day, have been used. A narrative review was performed in multiple databases (Medline, Scopus, ScienceDirect). Photodynamic diagnosis, as well as tomography bladder reconstruction for virtual cystoscopy, are diagnostic methods that have been introduced more recently. Likewise, contrast ultrasound and particularly bladder multiparametric MRI with the VI-RADS classification have been proposed as novel alternatives. The latter could end up changing the diagnostic paradigm, however, more studies are required to recommend their widespread use, which would still be limited by their availability.

With the increasing diversity in the population of the United States, efforts and interest in diversity in healthcare have followed.  The article offers an insightful review of recent studies evaluating the role of women and underrepresented minorities (URM) in Urology in order to better understand the state of Latinas in Urology.  We review the representation of women in urology residency in the United State (U.S.), international medical graduates (IMGs) in urology, and the most recent initiatives developed by urologists to increase diversity in the urological community to better reflect the communities served.

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Objetivo: El cáncer de vejiga representa el séptimo cáncer más frecuente con una morbimortalidad muy variable debido a estrategias de detección, tratamiento y seguimiento, siendo la cistectomía radical (CR) el tratamiento que ofrece el mejor control oncológico. Se ha reportado una tasa de morbilidad entre un 30-93% a 30 días y una mortalidad mayor al 8%. Esta variabilidad obedece a la escasez de reportes estandarizados utilizando escalas como Clavien-Dindo. Debido a la poca evidencia de publicaciones sobre complicaciones asociadas a CR, decidimos realizar un reporte estandarizado de estas, usando la escala de CD de las CR realizadas en nuestro hospital con la meta de averiguar la incidencia y gravedad real de estas. Materiales y métodos: Análisis retrospectivo de una base mantenida prospectivamente de CR realizadas en nuestro centro entre 1994 y 2019. Se incluyeron todos los pacientes mayores de 18 años, sometidos a una CR en el periodo de estudio y se excluyeron a todos los pacientes con documentación incompleta del postoperatorio inmediato a 30 días. Se utilizó estadística descriptiva para la presentación de los datos. Se aplicó la prueba de Kolmogorov-Smirnov para determinar la distribución de los datos. Se realizó un análisis inferencial de comparación de medias utilizando la prueba T de Student para las variables con distribución normal y con pruebas no paramétricas (prueba de U de Mann-Whitney) para aquellas con distribución no normal. Resultados: La media de edad de la población de estudio fue de 61.16 años (DE 10.1). Los pacientes sin complicación mayor presentaron un IMC de 2.45 kg/m2 menor en comparación con los pacientes con complicación mayor (IC95% -4.7 a -0.18). El sangrado y tiempo quirúrgico, así como el tipo de derivación no se asoció significativamente con la complicación mayor. Limitaciones del estudio: Estudio retrospectivo, por lo que no se le pudo calcular el SAS a la totalidad de nuestra población. Cohorte reducida de pacientes en un centro de tercer nivel de atención con un número restringido de camas en hospitalización, lo cual disminuye de manera considerable el poder estadístico del estudio para encontrar eventos de baja frecuencia (mortalidad). El ampliar el seguimiento a más de 30 días podría modificar la incidencia de complicaciones. Originalidad: Nuestra serie es la primera en utilizar un sistema estandarizado (escala Clavien-Dindo) para reportar complicaciones posquirúrgicas en pacientes sometidos a CR en México. Conclusiones: La CR continúa siendo una de las cirugías con mayor morbilidad. La aplicación de escalas estandarizadas para el reporte de complicaciones asociadas a la CR nos permitiría establecer estrategias de prevención y establecer criterios homogéneos de vigilancia con otras especialidades.

Abstract Kidney transplantation is the best renal replacement therapy for end-stage renal disease. Living donation constitutes the highest proportion of transplants in our country; donation nephrectomy requires assessment of renal function, which will influence the surgical planning of the kidney to donate. Methods We made a comparison between the evolutions of patients who underwent right nephrectomy versus left nephrectomy, for donation purposes in our center. Results Out of a total of 395 cases, 86 (21.7%) were right nephrectomies. With significant differences in the proportion of intraoperative complications, 2% for left nephrectomy and none for right nephrectomy; and more patients with postoperative complications (Clavien-Dindo II) for the left nephrectomy group, with a statistically significant difference (p = 0.02) Discussion and Conclusions Adequate surgical planning of the kidney to donate is required to ensure renal function after the donation event, as well as verification of the safety of the surgical act in the donor and the recipient, this must be collegiate and individualized for each transplant binomial.  

Clinical case description: A 65-year-old male who came to the emergency room due to non-clot-forming holomictional hematuria. Diagnostic approach is started, identifying in the medical history the diagnosis of prostate adenocarcinoma stage 4 without radiotherapy. Due to the patient's symptoms, surgical treatment is performed, where squamous carcinoma of the prostate is reported. Therefore, the evolution and treatment of the patient is monitored Relevance: It is known that patients with squamous cell carcinoma of the prostate have a short survival from the moment of diagnosis. There are few case reports on this entity and its treatment of choice. Clinical implications: There is not a enough data to determine the management of this type of patients. The reported incidence is minimal and there is no specific treatment for these patients. Conclusion: Squamous cell carcinoma of the prostate is a rare entity. There is little information on the possible management and prognosis in this type of cancer is adverse. Therefore, it is of the utmost importance to open new areas of research on this type of cancer.

Clinical case description: We report the case of a patient who underwent a double-pigtail ureteral stent (DPS) retrograde placement, following a complicated right renal colic. After two days with persisting pain and hematuria, a CT-Scan revealed a proximal pigtail misplacement into the inferior vena cava (IVC). In a multidisciplinary approach, an endourological removal was performed, pulling the distal loop with a cystoscope, while the vascular surgery team performed femoral access and phlebography during and after the DPS removal to prevent bleeding from IVC. Abdominal access for laparotomy was ready, anticipating potential bleeding. Relevance: DPS retrograde placement is a very frequent, usually uneventful procedure, but major complications may occur, such as the one described in the present case. It is important to know the risk of intravascular misplacement of the DPS, especially in cases of bad evolution or hematuria. Conclusion: DPS intravascular migration is a rare but potentially severe complication. An early detection and a multidisciplinary collaboration between the urology and vascular surgery teams is paramount to perform a minimally invasive removal and prevent major events.

  Case description: It was described the etiology, presentation and diagnosis of a patient with a diverticulum of the prostatic urethra that underwent total robot-assisted prostatectomy for resolution of a complicated history of recurrent paraurethral and perineal abscesses. Relevance: First case performed in our work center of total robot-assisted prostatectomy for prostatic diverticulum treatment. Improvement symptomatic and quality of life at the short term are benefits of this technic. Clinical implications: Total robot-assisted prostatectomy should be considered as an effective option in patients with a prior complicated evolution of prostatic diverticulum. Conclusions: Each patient must be individualized, being the total robot-assisted prostatectomy an option in complex cases, however, more patient candidates need to be identified for standardization of the technique.