Biomedical subjects

Gonzalo Vitagliano

Publications and source records attributed to Gonzalo Vitagliano.

4 recordsLinked to original sources

PubMed2006

Laparoscopic partial cystectomy in the management of bladder endometriosis: report of two cases.

Endometriosis is the proliferation of endometrial tissue outside the normal confines of the myometrium or uterine cavity. Endometriosis involving the urinary tract occurs in approximately 1% to 2% of cases. The bladder is affected in 80% of these patients. The diagnosis of vesical endometriosis is difficult, and it should be confirmed by cystoscopy with biopsy. Laparoscopic examination represents the gold standard for the diagnosis of pelvic endometriosis. Urinary bladder endometriosis may be treated surgically or medically with hormone-suppressive therapy. However, medical treatments usually are only palliative, and symptoms generally recur on discontinuation. We report our experience in two patients with vesical endometriosis who were managed successfully with cystoscopy-assisted laparoscopic partial cystectomy.

Adult↗

PubMed2006

[Inverted papilloma of the bladder].

OBJECTIVES: To report a series of patients with bladder inverted papilloma, pointing out the clinical features, presentations, treatment options and outcomes. We also perform a bibliography review oriented to the diagnostic criteria, treatment options and prognosis of the inverted papilloma. METHODS: We reviewed the medical charts of all patients with the diagnosis of bladder inverted papilloma treated by our group between July 1996 and June 2003. RESULTS: 16 cases of inverted papilloma of the bladder were diagnosed in ten males and six females, with a mean age of 53.1 yr. (range 31-72). The most frequent reason for consultation was voiding urgency (43.7%), followed by hematuria (37.5%). In 14/16 patients the lesion was localized in the bladder trigone. Transurethral resection of the lesion was performed in all patients. Two cases (12.5%) presented associated transitional cell carcinoma. CONCLUSIONS: The inverted papilloma is a rare pathologic entity Despite the absence of agreement about its aggressiveness or innocuousness we consider its potential malignancy should be taken into consideration after the evidence of recurrences and its association with transitional cell carcinoma.

Adult↗

PubMed2006

[Transperitoneal laparoscopic bladder diverticulectomy].

OBJECTIVES: To report the first case of bladder diverticulectomy in a female patient. METHODS: 74-year-old female patient with a two-year history of recurrent lower urinary tract infection and the diagnosis of big bladder diverticulum. A laparoscopic bladder diverticulectomy was performed. RESULTS: Operative time was 90 minutes. The patient had a satisfactory outcome with the drainage being retrieved on postoperative day three and discharged home the same day with bladder catheter. The catheter was retrieved on postoperative day 7. Cystography showed a normal bladder without diverticulum. CONCLUSIONS: We considered that laparoscopic surgery of the bladder diverticulum is an alternative, completely comparable to classic surgery, and it should be considered an option in the management of bladder diverticula requiring surgery.

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PubMedDate not supplied

Management of rectal injury during laparoscopic radical prostatectomy.

PURPOSE: Because laparoscopic radical prostatectomy remains a challenging procedure, rectal injury is always a potential complication. We review the incidence of rectal injuries at our institution in the first 110 consecutive laparoscopic extraperitoneal radical prostatectomies. MATERIALS AND METHODS: Nine (8%) out of the first 110 laparoscopic extraperitoneal radical prostatectomies performed between December 2001 and February 2004, were complicated by rectal injury. Mean patient age was 64.9 years (range 52 to 74) and mean prostate specific antigen was 11.45 ng/mL (range 4.8 to 37.4). Median preoperative Gleason score was 6 (range 4 to 8) and clinical stage was T1c, T2a, T2b in 6, 2 and 1 patient, respectively. Mean operative time was 228 minutes (range 150 to 300). RESULTS: From 9 injuries, 6 were diagnosed and repaired intraoperatively and 3 were diagnosed postoperatively. From the 6 cases of intraoperative diagnosis and repair, 3 patients healed primarily without colostomy and a recto-urinary fistula was evidenced by pneumaturia in the remaining three. These 3 patients were managed conservatively with urethral catheterization during 30 days. One of the patients required secondary fistula repair by anterior transphincteric, transanal surgical approach (ASTRA). Urinary fistula was diagnosed postoperatively on 3 patients. A diverting colostomy was performed on one patient with secondary fistula repair by ASTRA. Another patient required laparotomy due to peritonitis and urinary fistula was later managed with ASTRA. On the third patient conservative management with urethral catheter was successful. All fistulas repaired with ASTRA evolved uneventfully. There was no perioperative mortality. CONCLUSIONS: Rectal injury during laparoscopic radical prostatectomy can be managed intraoperatively or by a minimally invasive procedure without the need of colostomy. Laparoscopic radical prostatectomy is a challenging procedure and is associated with a very flat learning curve; the incidence of rectal injuries is prone to diminish with experience.

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