Gustavo Trujillo

Hospital Moinhos de Vento, Pôrto de São Francisco dos Casaes, Rio Grande do Sul, Brazil

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Publications (4)6.92 Total impact

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    ABSTRACT: Rectovesical fistula (RVF) is a rare complication of radical prostatectomy. A 57-year-old man underwent open radical prostatectomy with recognized rectal injury, primary closure of the rectal wall, and loop colostomy. The patient developed urine leakage per rectum after colostomy closure. We diverted the fecal stream with end colostomy and placed a suprapubic tube. An open transsacral (Kraske) repair failed 1 month later. We have previously described the laparoscopic approach, and report the technique and results of our first robotic assisted operation. The operative steps were as follows: (1) cystoscopy, (2) RVF catheterization (3) five-port transperitoneal laparoscopic initial dissection (4) mobilization of omental pedicle flap, (4) cystotomy extending toward the fistulous tract, (5) robot docking (6) dissection of the rectovesical plane, (7) interrupted rectal closure, (8) omental interposition, (9) bladder closure, and (10) drain placement. Operative time was 180 minutes. Hospital stay was 1 day. The suprapubic tube was removed at 2 months after normal cystography. Bowel continuity was restored at 4 months, with no fistula recurrence at 1-month follow-up. We await longer follow-up and experience in larger series. For now, robotic repair of rectovesical fistula appears feasible and represents an attractive alternative to open and laparoscopic approaches.
    Urology 08/2008; 72(6):1344-6. · 2.42 Impact Factor
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    ABSTRACT: To present our experience with laparoscopic rectourinary fistula (RUF) repair. RUF is a rare entity that can develop after ablative or extirpative prostate surgery. Successful management often requires an aggressive approach. Several techniques have been described for surgical correction. From October 2004 to October 2005, 3 patients were treated for RUF. The mean age was 63 years (range 58 to 68). RUF developed after open simple prostatectomy, open radical prostatectomy, and transurethral prostate resection. The operative steps were dependent on the location of the fistulous tract (bladder-prostate-urethra). When the fistula involved the prostatic capsule, the technique included capsulectomy and urethrovesical anastomosis. When the bladder was involved, a transvesical approach was used, involving dissection of the fistulous tract, closure of the rectum, tissue interposition, and bladder closure. The mean operative time was 247 minutes (range 230 to 270). The mean hospital stay was 2.6 days (range 2 to 3). No complications occurred. At a mean follow-up of 12 months (range 7 to 19), all patients were free of fistula recurrence. Laparoscopic repair of RUF is feasible and represents an attractive alternative to the standard approaches. The laparoscopic technique facilitates concomitant colostomy and tissue interposition without the need for patient repositioning or an additional incision.
    Urology 10/2007; 70(3):515-8. · 2.42 Impact Factor
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    ABSTRACT: Groin dissection remains the gold standard for the treatment of penile carcinoma that has metastasized to the inguinal lymph nodes. However, it is associated with wound-related complications. Modified groin dissection offers a less-radical approach without compromising oncologic outcomes. We present our technique for endoscopic lymphadenectomy for penile carcinoma (ELPC). Eight patients with clinical stage T(2) N(0-3)M(0) penile carcinoma underwent ELPC. Preoperative Doppler ultrasound mapping of the inguinal lymph nodes and the saphenous vein was performed. Fourteen lymphadenectomies, including superficial with or without deep inguinal and pelvic-node dissection, were completed in eight patients. The median operative time was 91 minutes (range 50-150 minutes), and the mean number of nodes removed was 9 (range 4-15). No perioperative complications occurred. Lymphoceles developed in three groins (23%). No wound-related complications were seen. The ELPC is a safe and feasible technique that appears to diminish the wound-related complications associated with the standard open approach.
    Journal of Endourology 05/2007; 21(4):364-7; discussion 367. · 2.07 Impact Factor
  • European Urology Supplements - EUR UROL SUPPL. 01/2006; 5(2):336-336.

Publication Stats

52 Citations
6.92 Total Impact Points

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Institutions

  • 2007
    • Hospital Moinhos de Vento
      Pôrto de São Francisco dos Casaes, Rio Grande do Sul, Brazil