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SCHU-17: Retroperitoneal Laparoscopic Radical Nephrectomy: Our Initial Experience
SOCIEDAD CHILENA DE UROLOG´IA
neum. In this way, the whole gland was explored. Preoperative imaging studies were fundamental to perform this technique. Results: All operations were successful, without intraoperative or postoperative complications. There were 75 adrenal microlesions; 59 of those patients had primary hyperaldosteronism (49 adenomas; 10 cortical hyperplasias); 7 adenomas were nonfunctional, 3 patients had Cushing syndrome. The remainder included 2 pheochromocytomas, 2 myelopilomas, 1 metastasis and 1 malignant melanoma. Four patients were converted to open surgery, and 2 of these were missed targets (tumor size ⱕ 1.5 cm). There were signficant statistical differences in the diagnostic accuracy rate of between CT Scan and ultrasonography (94.7% vs. 56.0%, P⬍0.01). Conclusion: Although laparoscopic adrenalectomy is the gold standard for benign adrenal tumors, sometimes microlesions are not found intraoperatively, and the patient must be converted to open surgery. The diagnostic accurate rate of CT scanning is obviously better than ultrasonography for adrenal microlesions. Freeing the medial part of the adrenal gland adjacent to the retroperitoneum first and then exploring the whole adrenal tissue are the key points of the procedure. SCHU-17 Retroperitoneal Laparoscopic Radical Nephrectomy: Our Initial Experience Moraga V1,3, Vidal A1, Estrugo A1, Morales R, Flores H 1 Urology Unit, Hospital Clı´nico San Borja Arriara ´ n, Santiago, Chile; 2Department of Urology, Universidad de Chile, Santiago, Chile; 3UROMED, Medical Center, Santiago, Chile; 4URONORTE, Medical Center, Antofagasta, Chile; 5Hospital Salvador Allende, Calama, Chile Introduction and Objectives: Laparoscopic surgery is nowadays considered the standard of care for T1 and T2 renal cell carcinoma. The advantages of laparoscopic surgery are less postoperative pain and shorter hospital stays with equivalent cancer control rates. The approach in laparoscopic surgery can be transperitoneal or retroperitoneal. We show our experience with retroperitoneal laparoscopic radical nephrectomy (RLRN) in patients diagnosed with renal tumors. Materials and Methods: From September 2006 to June 2008, 25 consecutives patients underwent RLRN performed by the same surgical team. The group consisted of 12 females and 13 males with a
S8
median age of 66.5 years (range 48 – 79) and a mean body mass index of 26.5 (range 22 – 34.7). Surgery was performed according to the technique described by Rassweiler and Gill. Results: According to the TNM classification, 6 patients had T1a tumors, 12 had T1b and 7 had T2. The procedure was successful in all patients. Median operative time was 217 min (range 130 - 315), mean blood loss was 173 cc (20-600). No blood transfusions were required. Intra operative complications were present in 3 cases, with one conversion. Two postoperative complications were registered. Median days to discharge were 3 (range 2 - 6). Conclusions: RLRN is a feasible, safe and reproducible technique for the treatment of renal cell carcinoma; it allows for a good post-operative recovery and quick return to normal life. The retroperitoneal approach has some advantages, like quick access and control of the renal pedicle, avoiding the peritoneal cavity. It also offers urologists the opportunity to work in their “natural environment”. It should be considered as an alternative to other minimally invasive approaches. SCHU-18 Embryonal Rhabdomyosarcoma of the Urachus Presenting as Acute Abdomen: A Case Report Letelier N, Castillo AM, Zubieta R, Lo ´ pez PJ, Gana R, Retamal G Section of Pediatric Urology, Hospital Excequiel Gonza ´ lez Corte´s, Santiago, Chile Introduction and Objectives: Rhabdomyosarcoma is the most frequent soft tissue sarcoma in childhood. Most of them are located in the genitourinary system. However, urachal rhabdomyosarcomas are extremely rare, more frequent in young children, usually presenting as a painless infraumbilical mass. We describe the case of a previously healthy patient admitted with acute abdomen. At surgery, a mass located in the path of the remnant urachus, was found. Light and electronic microscopy together with immunohistochemical studies confirmed the diagnosis of embryonal rhabdomyosarcoma of the urachus. Materials and Methods: A previously healthy 3-year-old male, was submitted to surgery because of an acute abdomen. At surgery, a massive hemoperitoneum and a friable mass, 6 ⫻ 4 cm, gelatinous mass, was found. The mass was adhered to the omentum, colon and abdominal wall. There was a tract from the umbilicus to
the bladder dome. Biopsy of the surgical specimen showed an embryonal rhabdomyosarcoma of the urachus. Immunohistochemical stains for actin, Mic z and desmin together with electron microscopy confirmed the diagnosis. Results: Complete gross resection was performed. Metastatic disease was ruled out by staging exams. The patient was classified as a group II, stage III. Subsequently, he received the VAC chemotherapy regime (vincristine, actinomycin D, cyclophosphamide) and conventional radiotherapy. He developed dysfunctional voiding secondary to radiotherapy, which was treated medically with complete resolution. After treatment completion, imaging studies showed no evidence of residual disease. Conclusions: Although rhabdomyosarcomas are frequent during childhood, the urachal location is extremely rare; we only found 4 cases in a systematic review of the literature. They present as an infraumbilical mass together with constipation; our patient’s presentation with an acute abdomen is unusual. He as treated with complete surgical resection, adjuvant chemotherapy and radiotherapy. Currently, with a follow-up of 11 months, he remains disease-free. SCHU-19 Results of a Conservative Approach in Pyeloureteral Tumors Bengio RG, El Hay M, Bengio V, Orellana SDB, Arribillaga L, Bengio RH Professor Bengio Urologic Center, Cordoba, Argentina Introduction and Objectives: The upper urinary tract is an unusual location for urologic tumors, accounting for approximately 5% of them. Tumors are more frequent in the pyelocalicilar area compared to the ureter; in the latter, the distal portion is more frequently involved. We present our experience with conservative surgery for urothelial tumors of the upper urinary tract. Material and Methods: Between 1996 and 2006, 24 patients with upper urinary tract tumors were diagnosed and treated at our center. Pre-operative tests included urinary cytology, cystoscopy, urinary retrograde ureteropyelography and urinalysis. Some patients had ureteroscopy and computed tomography with reconstruction. Of the 24 patients, 6 were treated conservatively: In 5 of them, upper ureterectomy with neoureter-bladder-anastomosis was performed, while one monorenous patient underwent segmentary ureterectomy of the middle ureter. Concomitant
UROLOGY 72 (Supplement 5A), November 2008
neum. In this way, the whole gland was explored. Preoperative imaging studies were fundamental to perform this technique. Results: All operations were successful, without intraoperative or postoperative complications. There were 75 adrenal microlesions; 59 of those patients had primary hyperaldosteronism (49 adenomas; 10 cortical hyperplasias); 7 adenomas were nonfunctional, 3 patients had Cushing syndrome. The remainder included 2 pheochromocytomas, 2 myelopilomas, 1 metastasis and 1 malignant melanoma. Four patients were converted to open surgery, and 2 of these were missed targets (tumor size ⱕ 1.5 cm). There were signficant statistical differences in the diagnostic accuracy rate of between CT Scan and ultrasonography (94.7% vs. 56.0%, P⬍0.01). Conclusion: Although laparoscopic adrenalectomy is the gold standard for benign adrenal tumors, sometimes microlesions are not found intraoperatively, and the patient must be converted to open surgery. The diagnostic accurate rate of CT scanning is obviously better than ultrasonography for adrenal microlesions. Freeing the medial part of the adrenal gland adjacent to the retroperitoneum first and then exploring the whole adrenal tissue are the key points of the procedure. SCHU-17 Retroperitoneal Laparoscopic Radical Nephrectomy: Our Initial Experience Moraga V1,3, Vidal A1, Estrugo A1, Morales R, Flores H 1 Urology Unit, Hospital Clı´nico San Borja Arriara ´ n, Santiago, Chile; 2Department of Urology, Universidad de Chile, Santiago, Chile; 3UROMED, Medical Center, Santiago, Chile; 4URONORTE, Medical Center, Antofagasta, Chile; 5Hospital Salvador Allende, Calama, Chile Introduction and Objectives: Laparoscopic surgery is nowadays considered the standard of care for T1 and T2 renal cell carcinoma. The advantages of laparoscopic surgery are less postoperative pain and shorter hospital stays with equivalent cancer control rates. The approach in laparoscopic surgery can be transperitoneal or retroperitoneal. We show our experience with retroperitoneal laparoscopic radical nephrectomy (RLRN) in patients diagnosed with renal tumors. Materials and Methods: From September 2006 to June 2008, 25 consecutives patients underwent RLRN performed by the same surgical team. The group consisted of 12 females and 13 males with a
S8
median age of 66.5 years (range 48 – 79) and a mean body mass index of 26.5 (range 22 – 34.7). Surgery was performed according to the technique described by Rassweiler and Gill. Results: According to the TNM classification, 6 patients had T1a tumors, 12 had T1b and 7 had T2. The procedure was successful in all patients. Median operative time was 217 min (range 130 - 315), mean blood loss was 173 cc (20-600). No blood transfusions were required. Intra operative complications were present in 3 cases, with one conversion. Two postoperative complications were registered. Median days to discharge were 3 (range 2 - 6). Conclusions: RLRN is a feasible, safe and reproducible technique for the treatment of renal cell carcinoma; it allows for a good post-operative recovery and quick return to normal life. The retroperitoneal approach has some advantages, like quick access and control of the renal pedicle, avoiding the peritoneal cavity. It also offers urologists the opportunity to work in their “natural environment”. It should be considered as an alternative to other minimally invasive approaches. SCHU-18 Embryonal Rhabdomyosarcoma of the Urachus Presenting as Acute Abdomen: A Case Report Letelier N, Castillo AM, Zubieta R, Lo ´ pez PJ, Gana R, Retamal G Section of Pediatric Urology, Hospital Excequiel Gonza ´ lez Corte´s, Santiago, Chile Introduction and Objectives: Rhabdomyosarcoma is the most frequent soft tissue sarcoma in childhood. Most of them are located in the genitourinary system. However, urachal rhabdomyosarcomas are extremely rare, more frequent in young children, usually presenting as a painless infraumbilical mass. We describe the case of a previously healthy patient admitted with acute abdomen. At surgery, a mass located in the path of the remnant urachus, was found. Light and electronic microscopy together with immunohistochemical studies confirmed the diagnosis of embryonal rhabdomyosarcoma of the urachus. Materials and Methods: A previously healthy 3-year-old male, was submitted to surgery because of an acute abdomen. At surgery, a massive hemoperitoneum and a friable mass, 6 ⫻ 4 cm, gelatinous mass, was found. The mass was adhered to the omentum, colon and abdominal wall. There was a tract from the umbilicus to
the bladder dome. Biopsy of the surgical specimen showed an embryonal rhabdomyosarcoma of the urachus. Immunohistochemical stains for actin, Mic z and desmin together with electron microscopy confirmed the diagnosis. Results: Complete gross resection was performed. Metastatic disease was ruled out by staging exams. The patient was classified as a group II, stage III. Subsequently, he received the VAC chemotherapy regime (vincristine, actinomycin D, cyclophosphamide) and conventional radiotherapy. He developed dysfunctional voiding secondary to radiotherapy, which was treated medically with complete resolution. After treatment completion, imaging studies showed no evidence of residual disease. Conclusions: Although rhabdomyosarcomas are frequent during childhood, the urachal location is extremely rare; we only found 4 cases in a systematic review of the literature. They present as an infraumbilical mass together with constipation; our patient’s presentation with an acute abdomen is unusual. He as treated with complete surgical resection, adjuvant chemotherapy and radiotherapy. Currently, with a follow-up of 11 months, he remains disease-free. SCHU-19 Results of a Conservative Approach in Pyeloureteral Tumors Bengio RG, El Hay M, Bengio V, Orellana SDB, Arribillaga L, Bengio RH Professor Bengio Urologic Center, Cordoba, Argentina Introduction and Objectives: The upper urinary tract is an unusual location for urologic tumors, accounting for approximately 5% of them. Tumors are more frequent in the pyelocalicilar area compared to the ureter; in the latter, the distal portion is more frequently involved. We present our experience with conservative surgery for urothelial tumors of the upper urinary tract. Material and Methods: Between 1996 and 2006, 24 patients with upper urinary tract tumors were diagnosed and treated at our center. Pre-operative tests included urinary cytology, cystoscopy, urinary retrograde ureteropyelography and urinalysis. Some patients had ureteroscopy and computed tomography with reconstruction. Of the 24 patients, 6 were treated conservatively: In 5 of them, upper ureterectomy with neoureter-bladder-anastomosis was performed, while one monorenous patient underwent segmentary ureterectomy of the middle ureter. Concomitant
UROLOGY 72 (Supplement 5A), November 2008