ABSTRACT Purpose: Robotic assisted radical prostatectomy (RARP) presents challenges for the surgeon, especially during the initial learning curve. We aimed to evaluate early and mid-term functional outcomes and complications related to vesicourethral anastomosis (VUA), in patients who underwent RARP, during the initial experience in an academic hospital. We also assessed possible predictors of postoperative incontinence and compared these results with the literature. Materials and Methods: We prospectively collected data from consecutive patients that underwent RARP. Patients with at least 6 months of follow-up were included in the analysis for the following outcomes: time to complete VUA, continence and complications related to anastomosis. Nerve-sparing status, age, BMI, EBL, pathological tumor staging, and prostate size were evaluated as possible factors predicting early and midterm continence. Results were compared with current literature. Results: Data from 60 patients was assessed. Mean time to complete VUA was 34 minutes, and console time was 247 minutes. Continence in 6 months was 90%. Incidence of urinary leakage was 3.3%, no patients developed bladder neck contracture or postoperative urinary retention. On multivariate analysis, age and pathological staging was associated to 3-month continence status. Conclusion: Our data show that, during early experience with RARP in a public university hospital, it is possible to achieve good results regarding continence and other outcomes related to VUA. We also found that age and pathological staging was associated to early continence status.

ABSTRACT Introduction: Ganglioneuromas are rare benign neoplasms of the sympathetic nervous system. We describe the case of an incidentally found ganglioneuroma in a woman. To our knowledge this is the first described case of robotic excision of a retroperitoneal ganglioneuroma. Case: A 41-year-old female had an incidental retroperitoneal mass found during a routine US. CT scan and MRI showed an 8.3cm homogeneous mass, adjacent to left kidney upper pole, with peripheral contrast enhancement. Metabolic tests were normal. Patient was positioned in a left flank position and five ports were introduced transperitoneally. A 4-arm Da Vinci SI was docked at a 45° angle to the table. Lesion was dissected along with left adrenal gland, beginning at the left renal hilum and proceeding cephalad. Results: Operating time was 325min and blood loss was 50ml. Patient was discharged after 72hours. There were no postoperative complications. Pathology showed ganglionic cells with neural tissue, and normal adrenal. Discussion: Ganglioneuromas rare benign tumors originating from neural crest and typically affect young adults. Most frequent locations are posterior mediastinum, retroperitoneum and adrenal gland. As in this case, ganglioneuromas are usually silent, slow growing tumors discovered incidentally or by mass effect. US and CT imaging may suggest the diagnosis while MRI findings can be specific for ganglioneuroma. Percutaneous biopsy is an option. Although benign, usually requires surgical excision for treatment. Conclusions: Our case shows that a robotic approach is feasible and allows for meticulous and safe dissection of vascular structures, facilitating adequate hemostasis while maintaining oncological principles.

A nefropatia diabética (ND) é uma importante complicação crônica do diabetes melito (DM), sendo uma das principais causas dos novos casos de diálise e está associada ao aumento da mortalidade. Os principais fatores de risco são a hiperglicemia, a hipertensão arterial sistêmica (HAS), a dislipidemia e a susceptibilidade genética. O sistema renina-angiotensina (SRA) tem papel importante na gênese e na progressão da ND e existem evidências de interação entre este sistema e as endotelinas. As endotelinas são peptídeos com potente ação vasoconstritora que atuam modulando o tono vasomotor, a proliferação celular e a produção hormonal. Estes peptídeos agem por meio de dois receptores (ET-A e ET-B), que são expressos nas células endoteliais e no músculo liso vascular. A ativação destes receptores nas células renais leva à complexa cascata de alterações, resultando proliferação e hipertrofia das células mesangiais, vasoconstrição das arteríolas aferentes e eferentes e acúmulo de matriz extracelular. Essas alterações hemodinâmicas renais estão associadas com o aparecimento e a progressão da doença renal no DM. Níveis plasmáticos elevados de endotelina-1 (ET-1) têm sido relatados em pacientes com DM e há algumas evidências que sugerem que o aumento da produção de ET-1 poderia levar a dano glomerular. O uso de drogas antagonistas do receptor da ET-1 em situações de DM experimental tem mostrado propriedades nefroprotetoras, reforçando a importância deste sistema na ND.

Diabetic Nephropathy (DN) is a major chronic complication of diabetes mellitus (DM), and one of the main causes of new cases for dialysis, being associated with increasing mortality. The main risk factors for DN are hypertension, hyperglycemia, dyslipidemia, and genetic susceptibility. The renin-angiotensin system (RAS) plays an important role in genesis and progression of DN and there is evidence of an interrelationship between this system and the endothelins. Endothelins are powerful vasoconstrictor peptides and act as modulators of vasomotor tone, cell proliferation, and hormone production. These peptides act through two types of receptors (ET-A and ET-B) and are expressed on endothelial cells and vascular smooth-muscle cells. Activation of this receptor in renal cells leads to a complex signaling cascade resultanting in stimulation of mesangial cell hypertrophy, proliferation, contraction, and extracellular matrix accumulation. These hemodinamic renal alterations are associated with the onset and progress of renal disease in DM. Elevated endothelin-1 (ET-1) levels have been reported in patients with DM. There is evidence suggesting that an increase in the production of ET-1 leads to glomerular damage. The use of ET receptor antagonists has been reported as renoprotective, correcting the early hemodynamic abnormalities in experimental DM, reinforcing the importance of this system in DN.