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We present the case of a patient who had a large pseudocyst in the right adrenal gland, which was ruptured following blunt abdominal trauma, leading to a voluminous hemorrhage in retroperitoneum. A 29-year old female patient was admitted in the emergency room following a fall from stairs with trauma in right flank. She underwent a computerized tomography that evidenced a large retroperitoneal collection, with no apparent renal damage. She was submitted to surgery, where a large ruptured cyst was observed, originating from the upper portion of the right adrenal gland. Cystic diseases of adrenal gland are rare. Highly voluminous cysts can be damaged in cases of blunt trauma to the lumbar region leading to large hematomas in retroperitoneum.

Adoption and development of robotic surgery in some public hospitals of Latin-America have been hindered by high costs.

This is the 16 years follow-up of the European Randomized study of Screening for Prostate Cancer (ERSPC) that was initiated in 1993 and previously published with 9, 11, and 13 years of follow-up (1-3). This trail try to elucidate the effect of regular prostate-specific antigen (PSA) screening on prostate cancer (PCa) mortality. This paper shows that the absolute reduction in PCa mortality still increases with longer follow-up, while the relative risk reduction remains at 20% since the initial report (1-3). There is still a 41% excess incidence in the screening arm. The median follow-up from diagnosis is modest (8.8 years in the screening arm and 5.4 years in the control arm) given the natural course of PCa. The number needed to diagnose for averting one PCa death was 18 in this update paper and was much higher in the previous ones. This high level evidence publication shows that the absolute effect of screening on PCa mortality increases with longer follow-up.

PURPOSE:To assess comparative results of robot-assisted radical laparoscopic prostatectomy (RARP) performed by surgeons without any experience in laparoscopic prostatectomy and the open procedure performed by surgeons with large experience. METHODS:We analyzed 84 patients (50 subjected to robotic surgery) from June 2012 to September 2013. Data were prospectively collected in a customized database. Two surgeons carried out all the RARP cases. These two surgeons and six more performed the open cases. The perioperative outcomes between the two groups were analyzed with a minimum followup of 12 months. RESULTS:The corporal mass index (BMI) was higher in the open group (p=0.001). There was more operatve time, less hospitalization and blood loss, better trifecta and pentafecta and earlier continence (p=0.045) in the robotic group (p=0.001). There was no difference in positive surgical margins but with greater extraprostatic extension in the open group (p=0.002). CONCLUSIONS:Robot-assisted radical prostatectomy is a safe procedure even in the hands of surgeons with no previous experience.Besides this, better operative outcomes can be reached with this modern approach.

Objective To assess the learning curve in robot-assisted radical prostatectomy (RARP) performed by surgeons without previous experience in laparoscopic prostatectomy. Materials and Methods We analyzed 119 patients submitted to RARP performed by two surgeons without previous experience in laparoscopic prostatectomy, with emphasis on the relevant outcomes such as continence, erectile function, and oncologic control with a minimum follow-up of 24 months. We used Fisher's exact test and the chi-square test to investigate the existence of a relationship between the variables and analysis of variance (ANOVA) to verify possible statistically significant differences between groups, at the 5% level. Results The patients' age varied from 41 to 72 years (mean = 61.09), with 68 (57.14%) cases having intermediate or high risk. There was a consistent decline in operative time. Of the 119 patients, 80.67% were continent 6 months after surgery and 89.07% 12 months afterward, while 35.29% were potent 6 months after surgery and 60.50% 12 months following surgery. Twelve months after surgery, the trifecta outcome rate was 51.26% and the pentafecta rate was 31.09%. There was progressive postoperative improvement and maintenance of continence and sexual potency until the last patient was operated in our sample. Conclusions Robot-assisted radical prostatectomy does not require previous experience in laparoscopic radical prostatectomy, but the learning curve is not short to achieve the plateau.

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Due the low alpha/beta ratio, the hypofractionation of the external radiotherapy treatment of prostate cancer can increase the therapeutic ratio and reduce the health-care cost and improve the patient comfort. It can be done by moderate hypofractionation (using 2.4-3.4 Gy) or by ultra-hypofractionation (at least 5 Gy per fraction) (1-3). This phase 3 non-inferiority randomized trial is the first to report on the efficacy and side-effects on ultra-fractionation compared with conventional and has the PSA relapse and clinical failure as primary endpoint. The most relevant secondary endpoints were the overall survival and prostate cancer-specific survival and the median follow-up time was 5yr. The ultra-hypofractionation was non-inferior to the conventional fractionation (HR 1.002) and no significant differences were found in terms of relevant urinary or gastrointestinal toxicity.