Cabestrillo subtrigonal con aponeurosis abdominal en el tratamiento de incontinencia urinaria de esfuerzo compleja / Subtrigonal sling with abdominal fascia for treatment of complex stress urinary incontinence

Objetivo: Describir la técnica de cabestrillo subtrigonal con fascia abdominal y demostrar su utilidad en la resolución de la incontinencia urinaria de esfuerzo compleja. Material y métodos: Estudio de cohorte longitudinal y observacional en mujeres adultas que acudieron al Servicio de Urodinamia, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, para tratamiento de incontinencia urinaria de esfuerzo recidivante o con factores de riesgo para recidiva, asociada o no a incontinencia urinaria de urgencia. Resultados: Entre 1995 y 2006 incluimos 40 pacientes; el seguimiento fue de 41.95 meses (rango 9 a 106) y el promedio de edad de 55 años. En 35 pacientes (87.5 %) fue resuelta la incontinencia urinaria de esfuerzo, dos pacientes mejoraron (5 %) y tres persistieron (7.5 %) con la incontinencia. De las 40 pacientes, 18 presentaban incontinencia urinaria de urgencia y solo en siete de éstas (39 %) se resolvió después de la cirugía. La incontinencia urinaria de urgencia de novo se presentó en 12 (30 %). Una tuvo hernia crural, dos hernia posincisional y dos requirieron transfusión sanguínea. Ninguna evidenció problemas de vaciamiento urinario posterior a la cirugía. Conclusiones: Los resultados con la técnica descrita son eficaces y duraderos en pacientes con incontinencia urinaria de esfuerzo recidivante o factores de riesgo para recidiva. No se observó disfunción de vaciamiento vesical, sin embargo, hubo hernias abdominales. El abordaje de mínima invasión para colocar las cintas sintéticas en posición subtrigonal podría mantener la eficacia con mínima morbilidad.

BACKGROUND: The aim of this study was to describe the technique of subtrigonal sling with abdominal fascia and demonstrate its usefulness in resolving complex stress urinary incontinence (SUI). METHODS: We performed a cohort, longitudinal, observational study in adult females who attended the Urodynamics Department of the Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, with recurrent SUI or with risk factors for recurrence, whether or not associated with urge urinary incontinence (UUI). RESULTS: Between 1995 and 2006, 40 patients were included. Mean follow-up was 41.95 months (9-106), and the average patient age was 55 years. In 35 patients (87.5%) SUI was resolved, in two patients (5%) it improved, and in three patients (7.5%) it persisted. Of the 40 study patients, 18 had UUI and in only 7/18 patients (39%) was it resolved postoperatively. UUI de novo was noted in 12/40 patients (30%). One patient presented crural hernia, two patients presented postincisional hernia and two patients required blood transfusion. No patient presented acute urinary retention or urinary voiding problems postoperatively. CONCLUSIONS: Results obtained by this surgical technique are effective and long-lasting in patients with complex SUI. We did not observe bladder emptying dysfunction but there were formations of abdominal wall hernias. The minimally invasive approach consisting of the subtrigonal placement of synthetic tapes may maintain efficacy with minimal morbidity.

Obstrucción de conductos eyaculadores / Ejaculatory duct obstruction

BACKGROUND: Prostatic cysts are rare lesions with a reported incidence from 1 to 7.9%. They have been associated with primary infertility. The main characteristic is the benign course and positive prognosis after correct surgical management. CLINICAL CASES: We present three clinical cases, two with primary infertility and another with a history of primary infertility who presented with recurrent hemospermia and refractory medical treatment. All patients had hypospermia and alteration of the seminal parameters represented by moderate oligospermia (MOS), asteno- and teratozoospermia, in addition to hemospermia in two patients. Diagnosis was confirmed by transrectal ultrasound. Transurethral resection (TUR) of the cyst was performed in two cases and resection of the veru montanum in one, obtaining improvement in the seminal parameters after 1 month of follow-up and acceptable parameters for spontaneous conception at 6 months. CONCLUSIONS: Infertility associated with partially obstructed ejaculatory ducts may be suspected clinically by hypospermia. Transrectal ultrasound is essential to confirm the diagnosis. TUR of this lesion reestablishes the free passage of semen in almost all patients, with potential recovery of fertility 6 months after treatment.

Dos métodos para la toma de biopsia transrectal de próstata ecodirigida: sistemática versus ecosospechosa / Two methods for transrectal ultrasound-guided biopsy of the prostate: systematic vs guided for suspect echogenic lesion

OBJECTIVE: We undertook this study to determine the efficiency of ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. suspicious sonographic areas. METHODS: Medical files and histopathological reports were reviewed of patients who were treated at the Specialties Hospital of the 21st Century Medical National Center in Mexico City with suspicion of prostate cancer (T1, T2 and PSA <10 ng/ml). Patients had ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. hypoechoic suspicious sonographic areas. Studies were carried out from January 1, 2005 to July 2006. RESULTS: Of 145 selected patients submitted to ultrasound-guided transrectal prostate biopsy, systematic extended biopsy (group I) was carried out in 73 (50.3%), taking on average 11.75 cylinders per patient. In 72 (49.6%) patients, biopsies were taken on suspicious sonographic areas (group II), taking on average 4.02 cylinders. In group I, 36 (49.3%) patients were positive vs. group II, where 20 (27.7%) patients were positive (p <0.01) with an estimation of risk in favor of group I, determining a probability 2.5 times higher of positivity with this technique (95% confidence interval: range 1.2-5) and a better performance in 22%. CONCLUSIONS: Systematic extended ultrasound-guided transrectal prostate biopsy represents a technique with a higher rate of efficiency than using ultrasound-guided transrectal prostate biopsy in suspicious sonographic areas and has proven over time to be the superior prostate biopsy technique for diagnosis of prostate cancer. It must be considered the method of choice.