[Influence of age on laparoscopic colposacropexy]. / Influencia de la edad en el rendimiento de la colposacropexia laparoscópica.

OBJECTIVES: To evaluate the influence of age on laparoscopic colposacropexy (LCS) outcome and complications for pelvic organ prolapse. MATERIAL AND METHODS: A retrospective and comparative study of 105 patients who underwent standard LCS for Baden-Walker graded pelvic organ prolapse from February 2002 to March 2015. They were categorized into two groups according to age. Group 1 consisted in ≤ 50 years old patients and included 55 women. Group 2 included 50 women who were ≥ 60 years old. Outcomes and complications were compared in both groups. RESULTS: Previous history of abdominal surgery or surgery for pelvic floor disorders was significantly greater in group 2 (43.6 vs 70%). There was no significant difference regarding urinary stress incontinence, urge incontinence or severe organ prolapse between groups (47.2 vs 36%; 1.8 vs 8% and 90.9 vs 92% for Groups 1 and 2 respectively). Although a statistically significant greater proportion of vaginal vault prolapse was present in the elderly group (16.3 vs 38%), the same LCS surgical technique was used in both groups of patients. Despite operating time was significantly greater in the younger group (205.8 ± 53.4 minutes in Group 1 vs 182 ± 42.3 minutes in Group 2), hospital stay was similar in both groups (2.9 ± 1.1 days vs 3.0 ± 1.9 days in group 1 and group 2 respectively). Postoperative complications were not severe and there were no clinically significant differences between groups (20 vs 14%). We found no statistically differences between groups when comparing cure rates (87 vs 92%) in groups 1 and 2 respectively, patient satisfaction and postoperative anatomical findings. CONCLUSIONS: LCS has shown excellent cure rates in both young and elder female patients with pelvic organ prolapse.

Analysis of spontaneously passed urinary tract stones.

Most studies on epidemiology, composition, and recurrence of renal calculi include both spontaneously passed calculi and those retrieved after surgical manipulation or shock wave lithotripsy. The present study exclusively focused on epidemiology, composition, and recurrence of spontaneously expelled stones in patients from North and East Mallorca (Spain) which represents a geographically specific non-urban region of a developed country. The study involved 136 patients who spontaneously passed 205 renal calculi. All calculi were classified and sub-classified according to composition after macroscopic and microscopic examination. We also analyzed prevalence, gender, age, and stone recurrence rate over a period of 3 years. The peak incidence of spontaneously stone passage is within the fourth to sixth decade. Overall male to female ratio was 3/1. Calcium oxalate was the most prevalent composition (64.8%) followed by uric acid (25.3%), mixed stones (5.3%) and calcium phosphate calculi (4.3%). Uric acid stones were the most recurrent (50%) followed by calcium oxalate monohydrate papillary calculi (26.4%), calcium oxalate monohydrate un-attached calculi (19.2%), calcium oxalate dihydrate calculi (18.3%), calcium phosphate calculi (14%), and mixed calculi (12.5%). In conclusion, spontaneously passed stones in Mallorcan population have similar epidemiology, composition, and recurrence rate from that found in other developed countries. Calcium oxalate stones are largely the most spontaneously passed type of calculi and uric acid stones are the most frequently recurred. These findings are also found to be similar to those reported in previous studies examining both spontaneously and non-spontaneously passed stones.

El esfínter urinario FlowSecureTM en el tratamiento de la incontinencia urinaria de esfuerzo post prostatectomia radical / FlowSecureTMartificial urinary sphincter for the treatment of stress urinary incontinence after radical prostatectomy

OBJETIVO: Difundir el concepto y técnica quirúrgica de implantación de una nueva prótesis para el tratamiento de la incontinencia urinaria de esfuerzo, el esfínter urinario artificial FlowSecureTM.MÉTODOS: La prótesis consiste en una sola pieza de silicona llena de suero salino que consta de: (1) Un reservorio regulador de presión, (2) un reservorio de asistencia al estrés, (3) una bomba de control con un puerto autosellable y (4) un manguito. Una de su principales características es que el puerto autosellable permite ajustar la presión del sistema dependiendo de las necesidades clínicas del paciente cuantas veces sea necesario.RESULTADOS: La técnica quirúrgica es simple y el nivel de continencia obtenido excelente. La única complicación inherente al diseño del FlowSecureTM es la perforación del manguito durante el acto de presurización, pero ya se ha corregido diseñando una nueva bomba de control que no se puede pinchar. Es frecuente el edema/hematoma escrotal autolimitado que se evita minimizando el tiempo de utilización del trocar. El resto de complicaciones son comunes al AMS-800TM y a cualquier prótesis implantable.CONCLUSIONES: A pesar de los buenos resultados a medio plazo, es necesario esperar a que exista un mayor número de pacientes con el esfínter FlowSecureTM y un mayor seguimiento para determinar el papel definitivo que esta prótesis desempeña en el tratamiento de la incontinencia de esfuerzo(AU)

OBJECTIVES: To diffuse the concept and implantation surgical technique of a new prosthesis for the treatment of stress urinary incontinence, the Flow Secure artificial urinary sphincter.METHODS: The prosthesis is a single silicone piece filled with saline solution which has the following parts: (1) Pressure regulation reservoir, (2) assistance reservoir for stress situations, (3) control pump with self-sealant port and (4) a cuff. One of the main characteristics is the self-sealant port enables pressure adjustment depending of the clinical needs of the patient as many times as necessary.RESULTS: The surgical technique is simple and the level of continence achieved excellent. The only complication inherent to the Flow Secure design is perforation of the cuff during the act of pressurization, but it has been coArchrrected by designing a new control pump which can not be punctured. Self limited scrotal edema/hematoma are frequent; they can be avoided minimizing the time of trocar use. The remainder complications are common with the AMS 800 and other implantable prosthesis.CONCLUSIONS: Despite midterm good results, we need to wait for a greater number of patients with the Flow Secure sphincter and longer follow up to determine the definitive role of this prosthesis for the treatment of urinary incontinence(AU)

[Follow-up of the FlowSecure artificial urinary sphincter]. / Seguimiento del esfínter urinario artificial FlowSecure.

The AMS-800 artificial urinary sphincter has been the only prosthesis available for treatment of stress urinary incontinence refractory to other therapeutic modalities for the past 25 years. The relatively high rate of complications occurring with the AMS-800 device during this time led to introduce a number of changes in its design that resulted in a new prostheses, the FlowSecure artificial sphincter. The FlowSecure artificial urinary sphincter is an adjustable prosthesis filled with normal saline without contrast. Plain X-rays cannot therefore be used for monitoring, and ultrasound is the most adequate radiographic technique for evaluation. In addition to calculating the post-void residue, ultrasound allows for verifying prosthesis status and for calculating the urethral occluding pressure. A detailed clinical history and flow rate measurement should be used together with the ultrasound scan to functionally assess patients with the FlowSecure device in order to determine the need for adjusting system pressure to the minimum pressure required for total continence.

Seguimiento del esfínter urinario artificial FlowSecure / Follow-up of the FlowSecure artificial urinary sphincter

El esfínter urinario artificial AMS-800 ha sido la única prótesis disponible para el tratamiento de la incontinencia urinaria de esfuerzo refractaria a otras modalidades terapéuticas durante los últimos 25 años. La tasa relativamente elevada de complicaciones derivadas de su utilización durante este tiempo provocó una serie de modificaciones en su diseño, lo que dio como resultado la aparición en el mercado del esfínter urinario artificial Flow Secure. El esfínter urinario artificial Flow Secure es una prótesis ajustable rellena de suero salino sin contraste, por lo que la radiografía simple no es útil para su seguimiento; la ecografía es la técnica radiológica más adecuada para su valoración. Además de calcular el residuo posmiccional, la ecografía permite verificar el estado de la prótesis y calcular la presión a la que está siendo sometida la uretra por el esfínter. Al uso de la ecografía debe de añadirse la utilización de flujometría y de una historia clínica detallada. Estos últimos son los elementos adecuados para realizar una valoración funcional correcta del paciente portador de la prótesis, ya que permiten valorar la necesidad de ajustar la presión del sistema a la continencia del paciente, si esto fuera necesario (AU)

The AMS-800 artificial urinary sphincter has been the only prosthesis available for treatment of stress urinary incontinence refractory to other therapeutic modalities for the past 25 years. The relatively high rate of complications occurring with the AMS-800 device during this time led to introduce a number of changes in its design that resulted in a new prostheses, the Flow Secure artificial sphincter. The Flow Secure artificial urinary sphincter is an adjustable prosthesis filled with normal saline without contrast. Plain X-rays cannot therefore be used for monitoring, and ultrasound is the most adequate radiographic technique for evaluation. In addition to calculating the post-void residue, ultrasound allows for verifying prosthesis status and for calculating the urethral occluding pressure. A detailed clinical history and flow rate measurement should be used together with the ultrasound scan to functionally assess patients with the Flow Secure device in order to determine the need for adjusting system pressure to the minimum pressure required for total continence (AU)

[Implantation technique of the artificial urinary sphincter "FlowSecure" in the bulbar urethra]. / Técnica de implantación del esfínter urinario artificial "FlowSecure" en uretra bulbar.

BACKGROUND: Artificial urinary sphincter "FlowSecure" is a prosthesis designed for stress urinary incontinence that has achieved excellent results. Although implantation is easy, some urologist used to other prosthesis may find difficult the change to this new technique. This article shows how easily and quickly this new sphincter can be implanted and discuss the differences with the artificial sphincter AMS-800. METHODS: Following the case of a patient who was implanted artificial urinary sphincter "FlowSecure" in our center we describe with pictures the technique of implantation and give some advices to make this quicker and easier. RESULTS: Surgical time was 90 minutes. Patient presented uneventful recovery, urethral catheter was removed 24 hours after surgery and discharge was done 72 hours after surgery. Three months after implantation patient describes complete resolution of his stress urinary incontinence. CONCLUSIONS: Artificial urinary sphincter "FlowSecure" is easy and quick to implant, and as its use is extended we would compare if results are better than those of the AMS-800 model.

Técnica de implantación del esfínter urinario artificial FlowsecureTM en uretra bulbar / Implantation technique of the artificial urinary sphincter “flow secure™” in the bulbar urethra

OBJETIVO: El esfínter urinario FlowSecureTM es una prótesis para la incontinencia urinaria de esfuerzo que ha proporcionado unos excelentes resultados hasta el día de hoy. Si bien su colocación es sencilla, los urólogos acostumbrados a la colocación de otros tipos de prótesis pueden encontrar inconveniente el cambio a esta nueva técnica. Este artículo pretende demostrar que este nuevo esfínter se puede colocar de forma rápida y sencilla, así como discutir las diferencias respecto del modelo AMS-800TM.MÉTODOS: A raíz de un paciente al que se colocó el esfínter urinario FlowSecureTM en nuestro centro se describe mediante dibujos la técnica de colocación y se apuntan ciertos consejos prácticos que hacen más fácil y rápida su colocación.RESULTADO: El tiempo quirúrgico fue de 90 minutos. El paciente presentó un postoperatorio correcto, retirándose la sonda vesical a las 24 horas y siendo dado de alta a las 72 horas. A los 3 meses de la intervención el paciente refiere resolución completa de su incontinencia urinaria de esfuerzo.CONCLUSIONES: El esfínter urinario FlowSecureTM resulta una prótesis de colocación rápida y sencilla, y a medida que su utilización se vaya extendiendo podremos valorar si sus resultados a largo plazo son mejores que los del modelo AMS-800TM(AU)

OBJECTIVES: Artificial urinary sphincter “FlowSecureTM” is a prosthesis designed for stress urinary incontinence that has achieved excellent results. Although implantation is easy, some urologist used to other prosthesis may find difficult the change to this new technique. This article shows how easily and quickly this new sphincter can be implanted and discuss the differences with the artificial sphincter AMS-800TM.METHODS: Following the case of a patient who was implanted artificial urinary sphincter “FlowSecureTM” in our center we describe with pictures the technique of implantation and give some advices to make this quicker and easier RESULTS: Surgical time was 90 minutes. Patient presen-ted uneventful recovery, urethral catheter was removed 24 hours after surgery and discharge was done 72 hours after surgery. Three months after implantation patient describes complete resolution of his stress urinary incontinence.CONCLUSIONS: Artificial urinary sphincter “FlowSecu-reTM” is easy and quick to implant, and as its use is extended we would compare if results are better than those of the AMS-800TM model(AU)

[FlowSecure artificial urinary sphincter for the treatment of stress urinary incontinence after radical prostatectomy]. / El esfínter urinario FlowSecure en el tratamiento de la incontinencia urinaria de esfuerzo post prostatectomía radical.

OBJECTIVES: To diffuse the concept and implantation surgical technique of a new prosthesis for the treatment of stress urinary incontinence, the Flow Secure artificial urinary sphincter. METHODS: The prosthesis is a single silicone piece filled with saline solution which has the following parts: (1) Pressure regulation reservoir, (2) assistance reservoir for stress situations, (3) control pump with self-sealant port and (4) a cuff. One of the main characteristics is the self-sealant port enables pressure adjustment depending of the clinical needs of the patient as many times as necessary. RESULTS: The surgical technique is simple and the level of continence achieved excellent. The only complication inherent to the Flow Secure design is perforation of the cuff during the act of pressurization, but it has been corrected by designing a new control pump which can not be punctured. Self limited scrotal edema/hematoma are frequent; they can be avoided minimizing the time of trocar use. The remainder complications are common with the AMS 800 and other implantable prosthesis. CONCLUSIONS: Despite midterm good results, we need to wait for a greater number of patients with the Flow Secure sphincter and longer follow up to determine the definitive role of this prosthesis for the treatment of urinary incontinence.

Fístula reno-duodenal en el contexto de un tumor renal / Renal-Duodenal fistula in the context of a renal tumor

No disponible

Surgical implantation of the new FlowSecure artificial urinary sphincter in the female bladder neck.

OBJECTIVE: To report implantation of the new FlowSecure artificial urinary sphincter with conditional occlusion in a female bladder neck, describe surgical technique and suggest minor modifications to accommodate the device for universal female implantation. PATIENT AND METHODS: A spina bifida female patient with urodynamically proven stress incontinence due to sphincteric incompetence associated to atonic detrusor was implanted with the new artificial sphincter. Operating time was one and a half hours. The cuff was adjusted to the bladder neck with no problems. Excess belt removed from the cuff was preserved and used for loose fixation of tubing and reservoirs in the right paravesical space. The control pump was placed in the right labia. The prosthesis was implanted at atmospheric pressure zero. RESULTS: The device was easily implanted. There were no perioperative complications. Catheter was removed 24 h post-implantation and patient achieved immediate total continence. There was no need for device pressurization at subsequent follow-up. The patient needed intermittent self-catheterization for emptying her bladder because of impaired detrusor contractility. CONCLUSIONS: Despite that the new FlowSecure artificial urinary sphincter has only been used for bulbar urethral implantation, we have successfully implanted the device in a female bladder neck with excellent clinical results. Cuff lengthening and connecting tubes shortening would probably enable all female patients to be suitable for implantation. To the best of our knowledge, this is the first time the device has been implanted in a bladder neck.

El esfínter urinario artificial / The artificial urinary sphincter

OBJETIVOS: Revisar la literatura sobre el esfínter urinario artificial para describir su funcionamiento, técnica de implantación, indicaciones, resultados y complicaciones así como el posible futuro de la prótesis en el tratamiento de la incontinencia de esfuerzo. MÉTODOS: Se consultaron dos bases electrónicas de datos, "Medline" (Index Medicus on line) y Embase (Excerpta Medica on line) para revisar la literatura sobre el esfínter urinario artificial publicada entre 1974 (fecha en que Foley describió el primer esfínter artificial) y Octubre de 1999. Se identificaron 352 artículos, pero sólo se consideraron los que especificaban los criterios de selección del paciente, el tipo de prótesis empleada, los resultados y complicaciones, y la mediana del tiempo de seguimiento. También se incluyeron las publicaciones de aspectos históricos y de nuevos prototipos. Se excluyeron los resultados publicados por los autores de este artículo para evitar los "sesgos del autor" (preferencias del autor) y se minimizaron los "sesgos de la torre de Babel" (pérdida de información por barrera lingüística) al revisar los artículos publicados en lengua española, inglesa y francesa. RESULTADOS: El modelo AMS-800 es el único disponible hoy en día. Los resultados son excelentes siempre que la indicación sea correcta y el peri-operatorio meticuloso. El candidato ideal es aquel con incontinencia de esfuerzo genuina y función vesical normal, pero la presencia de hiper o hiporreflexia no es contraindicación absoluta si se corrige antes, durante, o después de la implantación de la prótesis. La técnica quirúrgica es relativamente simple y la única dificultad consiste en elegir el manguito y reservorio adecuados. Las complicaciones incluyen atrofia uretral, erosión, infección e inestabilidad vesical y son menos frecuentes en mujeres con incontinencia de esfuerzo tipo III y en la incontinencia tras cirugía prostática y más frecuentes en pacientes con incontinencia tras traumatismo pélvico, incontinencia por malformación congénita y vejiga neurógena. Los fallos mecánicos de la prótesis han disminuido a medida que ésta ha ido mejorando. Hay nuevos prototipos hidráulicos y no hidráulicos que pr sumiblemente disminuirán la incidencia de complicaciones, pero habrá que esperar a que se comiencen a implantar para conocer sus resultados. CONCLUSIONES: Los pacientes con incontinencia urinaria de esfuerzo tienen, ahora más que nunca, grandes posibilidades de recuperar la continencia. Cuando la incontinencia persiste a pesar de haber utilizado todas las opciones terapéuticas medico-quirúrgicas disponibles aún queda una última esperanza: el esfínter urinario artificial (AU)