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"apellidos" => "Villavicencio" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480612000022" "doi" => "10.1016/j.acuro.2011.11.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480612000022?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612001114?idApp=UINPBA00004N" "url" => "/21735786/0000003600000005/v1_201304251846/S2173578612001114/v1_201304251846/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173578612001138" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2012.08.010" "estado" => "S300" "fechaPublicacion" => "2012-05-01" "aid" => "407" "copyright" => "AEU" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Urol Esp. 2012;36:312-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1914 "formatos" => array:3 [ "EPUB" => 14 "HTML" => 1571 "PDF" => 329 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">History</span>" "titulo" => "Human and professional aspects of Mr. Pedro Cifuentes Díaz (1881–1960)" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "312" "paginaFinal" => "319" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Semblante humano y profesional de D. Pedro Cifuentes Díaz (1881–1960)" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 737 "Ancho" => 951 "Tamanyo" => 123893 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Surgical pathology class with José Rivera Sans, 1898 (Cifuentes in the third position from right to left).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Angulo, M. Pérez-Albacete, J.C. Angulo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Angulo" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Pérez-Albacete" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Angulo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480612000332" "doi" => "10.1016/j.acuro.2012.01.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480612000332?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612001138?idApp=UINPBA00004N" "url" => "/21735786/0000003600000005/v1_201304251846/S2173578612001138/v1_201304251846/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Casuistry</span>" "titulo" => "Laparoscopic treatment of urachal remnants" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "320" "paginaFinal" => "324" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Castanheira de Oliveira, F. Vila, R. Versos, D. Araújo, A. Fraga" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Castanheira de Oliveira" "email" => array:1 [ 0 => "manuelantonielo@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Vila" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Versos" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Araújo" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Fraga" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Urología, Hospital de Santo Antonio, Oporto, Portugal" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento laparoscópico de los remanentes uracales" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 731 "Ancho" => 950 "Tamanyo" => 112105 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Endoscopic view of urachal sinus exerting compression on the bladder dome.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Urachal anomalies resulting from the incomplete regression of this vestigial remnant of the allantois include urachal cyst, vesicourachal diverticulum, umbilical–urachal sinus and urachal fistula, depending on which part remains patent. These anomalies occur in 1/5000 adults and are usually asymptomatic and diagnosed incidentally only during routine exams or abdominal surgery for other causes.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> When symptomatic, these conditions normally present with umbilical discharge or an infra-umbilical mass. Although diagnosis is mainly clinical, different procedures can be used in the diagnostic workup, with ultrasound and CT (computerized tomography) scan being the most useful.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As a result of the high rate of recurring symptoms and the risk of malignancy, surgical excision of the whole urachal tract represents the standard treatment for this group of conditions.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–7</span></a> Open surgery has been the traditional approach, but with the advent of the minimally invasive techniques, several case reports and small series of laparoscopic excision have been reported since the mid 1990s.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> We present our experience with the laparoscopic management of these patients.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">Three male patients with mean age of 39 years old (range 24–50 years) were diagnosed with and treated for a urachal remnant at our institution between March 2008 and May 2009. The first two patients had an asymptomatic urachal cyst incidentally found during a routine ultrasound. The third patient presented with umbilical discharge and suprapubic pain. The ultrasonography revealed a urachal sinus exerting compression on the bladder dome.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The diagnostic assessment performed for all three patients included clinical history, pre-operative workup, urinalysis, imaging studies, and cystoscopy. CT scan confirmed the ultrasound findings (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and in a case revealed the urachal sinus with intravesical formation consistent with bladder septum or tumor. Cystoscopy showed a mass protruding from the dome, resulting from the sinus compression (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The first two patients had no endoscopic findings. Operating time, estimated blood loss, peri- and post-operative complications, hospital length of stay, pathological findings, and follow-up were reviewed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Surgical technique</span><p id="par0025" class="elsevierStylePara elsevierViewall">After induction of general anesthesia, the patients were positioned supine and placed in the Trendelenburg position. A nasogastric tube for stomach decompression and a Foley catheter for bladder instillation were placed. The main surgeon stood on the right side of the patient, the assisting surgeon on the left side and the monitor was placed at the foot of the table.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The peritoneal cavity was assessed using the Hasson open technique, and a pneumoperitoneum was created by insufflating CO<span class="elsevierStyleInf">2</span> until a sustained intra-abdominal pressure of 12<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg was reached. Three trocar ports were then inserted. The 12-mm port, used for passage of a 30° optic camera, which allows for better visualization of the anterior abdominal wall structures, was positioned in the midline, halfway between the umbilicus and the xiphoid process. A 10-mm port for the instrumentation (i.e. diathermy unit, dissector, scissors, and needle holder) was placed under direct vision at the umbilical level, laterally to the right rectus abdominis muscle, to avoid injury to the epigastric vessels. A final 5-mm port for auxiliary instruments (i.e. grasper) was also placed under direct vision at the same level as the 10-mm trocar, but to the left flank (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The procedure began by dissecting intra-peritoneal adhesions. The urachus and medial umbilical ligaments were visualized (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). A small midline peritoneal incision was performed just below the umbilicus, and the peritoneum between the two medial ligaments was dissected, using a combination of blunt and sharp dissection, liberating the urachus from its attachments to the transversalis fascia. Once the bladder was reached, a small patch of the vesical dome was resected and subsequently closed with a 2/0 continuous absorbable suture. The urachus was placed in a specimen bag (EndoCatch Gold, Tyco, U.S.A.) and removed through the 12-mm port incision. The bladder was then filled with sterile saline to rule out leaks. Hemostasis was reassessed and a surgical drain was put in place. Finally, the fascial and the skin incisions were closed with absorbable sutures and metallic staples respectively.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Mean operating time was 94 (49–158) min and mean estimated blood loss was 40<span class="elsevierStyleHsp" style=""></span>ml. All specimens were removed intact. In the patient with urachal sinus, further to the laparoscopic excision, it was necessary to perform an additional periumbilical open incision, from where the specimen was removed.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In terms of intra-operative complications, one patient had a minor intra-peritoneal bladder rupture, successfully managed with a 2/0 absorbable suture. After bladder refilling, no leakage was noted. The surgical drain was removed at 24<span class="elsevierStyleHsp" style=""></span>h and the median length of stay was 2 days. The Foley catheter was removed 8 days after the surgery to ensure a safe closure of the bladder wall. The pathological examination revealed urachal remnants with urothelial cells displaying inflammatory changes.</p><p id="par0050" class="elsevierStylePara elsevierViewall">These patients were followed-up for a mean time of 9 months (7–13). During this period, no post-operative complications were noticed. One patient had an episode of cystitis, managed successfully with appropriate antibiotherapy. At the time of follow-up, no patient showed clinical or imaging evidence of recurrent urachal pathology.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Cabrolius published in 1550 the first case of treatment of a symptomatic urachal remnant.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> There are currently over 300 reported cases in the literature worldwide.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Urachal anomalies can be either congenital, if the obliteration process is incomplete by the time of birth, or acquired, if partial or complete repermeabilization occurs following the normal involution of this structure.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Depending on which segment remains patent, four different types of urachal remnants may occur: (i) urachal fistula, (ii) vesico-urachal diverticulum, (iii) urachal–umbilical sinus, and (iv) urachal cyst.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The last one is the most common (30%) of urachal remnants.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> An isolated segment of the urachus remains patent, having communication with neither the bladder nor the umbilicus.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,11</span></a> It forms when desquamation and degeneration of the urachal epithelium occurs.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Urachal cysts are usually small and asymptomatic, but can present at any age if they become large and infected. The most common clinical presentation is hypogastric pain with a palpable mass, fever, and voiding symptoms. As the urachus is located in the prevesical space of Retzius, this generally prevents the infection from spreading to superficial layers of the anterior abdominal wall. <span class="elsevierStyleItalic">Staphylococcus</span> spp. and other skin flora-species are the most frequently involved organisms.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,11</span></a> However, in some cases, a cyst can rupture into the coelomic cavity with subsequent peritonitis, or even fistulize through the skin or into intra-abdominal organs.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,13,14</span></a> Urachal anomalies may also be associated with other findings such as vesico-ureteral reflux, hypospadias, meatal stenosis, cryptorchidism, anal atresia, omphalocele, and uretero-pelvic obstruction syndrome.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Persistent urachal remnants have an incidence of 1/5000 adults and 2/300,000 children.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,17</span></a> Despite being rare, a physician must always consider this diagnosis in cases presenting with periumbilical mass and inflammation or umbilical discharge.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> When symptomatic, the differential diagnosis should include other clinical conditions such as appendicitis, omphalitis, adnexial torsion, and vitelline duct anomalies (e.g. Meckel's diverticulum).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The diagnosis is often established by clinical history and physical examination, especially in children, but imaging exams are normally used to confirm the diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,16,18</span></a> In that context, ultrasonography is very useful with a diagnostic accuracy of over 90%.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Abdominal CT or MRI are suitable alternatives in cases where ultrasound does not offer a conclusive diagnosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> A sinogram may be used in patients with umbilical drainage, although some authors reported no advantages of this diagnostic modality.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Cystoscopy and cystography are of no use, except in cases where malignant disease is suspected.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Because of the frequent association with vesicoureteral reflux, some authors propose that a voiding cystourethrography should be performed.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Surgical excision is advocated as the traditional treatment to avoid recurrent disease and future malignant transformation.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–7</span></a> However, there have been reported cases of spontaneous resolution with no intervention<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and there is still controversy on whether or not an incidental, asymptomatic urachal remnant should be treated. Although its malignancy potential has been described,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> urachal carcinoma, particularly adenocarcinoma, accounts for only 0.17–0.34% of bladder cancers<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and some authors have actually found no association between incidental urachal remnants detected in early childhood and malignant transformation later in life.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,19</span></a> For this reason, several authors propose that active surveillance is a more appropriate approach.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,6,16</span></a> The surgical approach should include resection of the whole tract extending from the umbilicus to the bladder, with a small bladder cuff to prevent the 30% risk of recurrence in case of partial excision.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,16</span></a> For an uncomplicated urachal remnant, it should be a one-stage procedure. In cases where the remnants are infected, it is still a matter of debate whether it should be done in one or two stages. In the traditional approach, the treatment should initially be conservative, with drainage and antibiotic therapy, followed by resection at a later stage. Some authors have challenged this option proposing that, with effective antibiotherapy, one-stage management can be safe and successfully accomplished.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> However, McCollum et al. in their series concluded that the risk of postoperative complications surpasses the benefits of a one-stage intervention, thus supporting the traditional approach.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,21</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Since the first published case of laparoscopic treatment of a urachal cyst by Trondsen et al. in 1993,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> a growing number of case reports<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,13,15,22,23</span></a> and small series<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,17,18,21</span></a> have been described in the literature. As in open surgery, laparoscopy should follow the same principles of complete removal of the urachal remnants, extending from the umbilicus to the bladder dome. For that purpose, we adopted the port positioning system used by Caddedu et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and Khurana and Borzi,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> in which the 30° laparoscope is placed in the midline above the umbilicus, and the two assisting trocars are placed laterally to both recti muscles. We feel that this positioning offers the easiest and most natural way of visualization and manipulation of the anterior abdominal structures. Although the lateral positioning of the laparoscope allows for a better definition of the whole urachal tract, as proposed by Cutting et al. <a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and Turial et al.,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> in our experience, that approach was not necessary. One limitation that we came across with was the inability to remove the suprafascial segment of the urachal sinus.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,4</span></a> This step of the procedure had to be done by classic open incision, which can be seen as a pitfall of this technique. Mean operative time was 94<span class="elsevierStyleHsp" style=""></span>min, which concurs with other series and was only longer because, in the patient with urachal sinus, an external excision of the umbilical suprafascial segment had to be performed. Blood loss was minimal and although one patient suffered a small bladder rupture during the intervention, this was effectively managed with a tight suture. No postoperative complications were observed.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Okegawa et al.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> compared open and laparoscopic surgery and showed better outcomes for the latter in terms both of hospital length of stay and time to return to activities of daily living. Sánchez et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and Turial et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> confirmed these positive results. Despite the increasing evidence, we still feel that large, multicentric, prospective randomized trials comparing the two techniques are needed to definitely confirm laparoscopic surgery as the treatment of choice for urachal remnant disease.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres101615" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objectives" 2 => "Material and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec88782" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres101614" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivos" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec88781" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Surgical technique" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec88782" "palabras" => array:4 [ 0 => "Urachus" 1 => "Urachal remnants" 2 => "Laparoscopy" 3 => "Surgery" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec88781" "palabras" => array:4 [ 0 => "Uraco" 1 => "Remanentes uracales" 2 => "Laparoscopia" 3 => "Cirugía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The urachus is a vestigial obliterated structure derived from the alantois. Failure of this involution process originates patent urachal remnants. Surgery is the treatment of choice as it prevents both recurrence of symptoms and malignant transformation. The purpose of this study is to present our experience in the laparoscopic management of this pathology.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Three male patients (mean age 39 years) underwent laparoscopic excision of urachal remnants. Two patients were diagnosed with an asymptomatic cyst and one patient with urachal sinus presenting with umbilical discharge. A three-port technique was used to remove the whole urachus tract from the umbilicus to the bladder dome, together with a small bladder patch.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mean operating time was 94<span class="elsevierStyleHsp" style=""></span>min and blood loss was minimal. One patient had small intra-operative bladder rupture, successfully managed with adequate closure. No post-operative complications were observed and all patients were discharged on the second postoperative day. Two years later there was no evidence of recurrence.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Urachal remnants can be successfully treated by laparoscopic surgery, with advantages in terms of morbidity, recovery and cosmetic outcome. Large number, comparative studies are still needed to definitely establish it as the gold standard treatment.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El uraco es una estructura vestigial obliterada derivada de la alantoides. El fra-caso de este proceso de involución origina remanentes uracales evidentes. La cirugía es el tratamiento a elegir, ya que previene tanto la reaparición de los síntomas como la transfor-mación maligna. El propósito de este estudio es presentar nuestra experiencia en el manejo laparoscópico de esta patología.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Tres pacientes del sexo masculino (mediana de edad de 39 años) se sometieron a extirpación laparoscópica de los remanentes uracales. Dos pacientes fueron diag-nosticados con un quiste asintomático y un paciente con un seno uracal con secreción umbilical. Se utilizó una técnica de tres puertos para eliminar todo el tracto del uraco desde el ombligo hasta la cúpula vesical, junto con una pequeña parte de la vejiga.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La mediana de tiempo operatorio fue de 94 minutos y la pérdida de sangre fue mínima. Un paciente sufrió una pequeña rotura vesical intraoperatoria que se solucionó exito-samente con un cierre adecuado. No se observaron complicaciones postoperatorias y todos los pacientes fueron dados de alta al segundo día después de la operación. Dos años después no hubo pruebas de reaparición.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los remanentes uracales se pueden tratar con éxito con la cirugía laparoscópica, con ventajas en términos de morbilidad, recuperación y resultado estético. Todavía se necesitan muchos estudios comparativos para establecerla definitivamente como el tratamiento estándar por excelencia.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Castanheira de Oliveira M, et al. Tratamiento laproscópico de los remanentes uracales. Actas Urol Esp. 2012;36:320–4.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0100" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0040" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 693 "Ancho" => 950 "Tamanyo" => 97553 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Urachal sinus (arrow).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 731 "Ancho" => 950 "Tamanyo" => 112105 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Endoscopic view of urachal sinus exerting compression on the bladder dome.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1832 "Ancho" => 1523 "Tamanyo" => 96914 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Port positioning.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 763 "Ancho" => 991 "Tamanyo" => 178023 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Exposed urachus.</p>" ] ] 4 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 33694392 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:2 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manejo laparoscópico de las anomalías sintomáticas del uraco" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I.A. 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