[A Spanish multicenter trial of TVT for female urinary incontinence]. / TVT para la incontinencia urinaria femenina: estudio multicéntrico español.

OBJECTIVE: The purpose of this study was to evaluate results and complications of TVT in a large series from different hospital centers in Spain. METHOD: We retrospectively studied the results of TVT placement from 6 centers with 272 consecutive patients (median follow-up was 636 days). All types of stress urinary incontinence with a surgical indication were included and no previous conditions were established regarding the indication. No protocol was used for either the intervention or postoperative support measures. Data collection was protocolized and carried out using a common questionnaire that was completed by an urologist at each center from 3 to 6 months after the intervention and then annually. All patients who underwent intervention were asked about their satisfaction with the outcome. Multivariate studies were made to identify the factors that influenced the recovery of continence and the occurrence of complications. RESULTS: 92.1% of patients were continent and 2.4% have not shown any improvement. 91.6% of the patients claimed to be satisfied whereas only 2.7% were dissatisfied. After four years only 2.8% of patients showed mild incontinence with time and 0.4% had moderate incontinence. Only previous surgery for incontinence was found to be significantly unfavorable factor for achieving postoperative continence. CONCLUSION: We have reproduced a scenario closer to daily clinical reality than the results of series from a single institution or analyses using stricter selection criteria. This multicenter study verifies the viability and reproducibility of TVT with minimal complications in centers where patients are not selected and where not all urologists are specialized in urinary incontinence.

TVT para la incontinencia urinaria femenina: estudio multicéntrico español / A spanish multicenter trial of TVT for female urinary incontinence

Objetivo: Evaluar resultados y complicaciones del TVT en una gran serie multicéntrica española. Método: Estudio retrospectivo de 272 pacientes consecutivas con colocación de TVT en 6 centros españoles (mediana seguimiento 636 días). Se incluyó cualquier tipo de incontinencia de esfuerzo con indicación quirúrgica. No se utilizó protocolo de uniformidad para la intervención ni cuidados postoperatorios. Recogida de datos, estandarizada a 3, 6 meses y anualmente tras intervención. Se realizó estudio multivariado para identificar factores influyentes en la recuperación de la continencia y aparición de complicaciones. Se valoró la satisfacción de la paciente respecto a la intervención. Resultados: El 92,1% de las pacientes obtuvieron la continencia frente al 2,4% que no mostraron ninguna mejoría. A los cuatro años sólo el 2,8% de las pacientes mostraron incontinencia mínima y el 0,4% incontinencia moderada en el tiempo. Solo se encontró como factor influyente (desfavorable) para continencia postoperatoria el antecedente de cirugía previa anti-incontinencia. 91,6% declararon estar satisfechas mientras que sólo el 2,7% estaban insatisfechas. Conclusión: Creemos haber reproducido un escenario cercano a la realidad clínica diaria. El estudio multicéntrico verifica la viabilidad y reproducibilidad de los resultados del TVT con mínimas complicaciones en pacientes no seleccionadas y en centros donde no todos los urólogos están especializados en incontinencia urinaria (AU)

Objective: The purpose of this study was to evaluate results and complications of TVT in a large series from different hospital centers in Spain. Method: We retrospectively studied the results of TVT placement from 6 centers with 272 consecutive patients (median follow-up was 636 days). All types of stress urinary incontinence with a surgical indication were included and no previous conditions were established regarding the indication. No protocol was used for either the intervention or postoperative support measures. Data collection was protocolized and carried out using a common questionnaire that was completed by an urologist at each center from 3 to 6 months after the intervention and then annually. All patients who underwent intervention were asked about their satisfaction with the outcome. Multivariate studies were made to identify the factors that influenced the recovery of continence and the occurrence of complications. Results: 92.1% of patients were continent and 2.4% have not shown any improvement. 91.6% of the patients claimed to be satisfied whereas only 2.7% were dissatisfied. After four years only 2.8% of patients showed mild incontinence with time and 0.4% had moderate incontinence. Only previous surgery for incontinence was found to be significantly unfavorable factor for achieving postoperative continence. Conclusion: We have reproduced a scenario closer to daily clinical reality than the results of series from a single institution or analyses using stricter selection criteria. This multicenter study verifies the viability and reproducibility of TVT with minimal complications in centers where patients are not selected and where not all urologists are specialized in urinary incontinence (AU)

Patologia neoplásica del urotelio / Neoplasic pathology of urothelium

Los tumores vesicales ocupan una parte importante de nuestra actividad. En esta revisión, reconociendo la imposibilidad de ser completa, vamos a repasar algunos de los puntos más controvertidos y de más actualidad y aquella información que surge de las revisiones sistemáticas y de meta-análisis (AU)

[Signet-ring cell neoplasm. Unusual histologic variety as primary bladder tumor]. / Neoplasia de células en anillo de sello. Una variedad histológica rara como tumor vesical primario.

We report a case of primary signet-ring cell adenocarcinoma of the urinary bladder. It is a extremely rare tumor. Gross hematuria is the commonest clinical presentation as well as this case. Our patient presented with advanced tumour invasion into perivesical fat at dome. The treatment was partial cystectomy together with quimiotherapy. Medical literature are reviewed with special remark on histopathology and its bladder origin.

Neoplasia de células en anillo de sello. Una variedad histológica rara como tumor vesical primario / Signet-ring cell neoplasms. A rare histologic variety like primary vesical tumor

Presentamos un caso de carcinoma vesical primario de células en anillo de sello, siendo este tipo de tumor extremadamente raro. Al igual que la mayoría de los casos descritos, la forma de presentación fue la hematuria y el estadio elevado. La opción terapéutica elegida fue la cistectomía parcial más quimioterapia. Hacemos una revisión de la literatura y destacamos, desde un punto de vista histológico, su origen vesical (AU)

[Neoplastic pathology of the urothelium]. / Patologia neoplásica del urotelio.

Bladder cancer is one of the most common diseases treated by urologists. In this article, we will try to review some of the controversies and all the available data which come from the systematic review and meta-analysis.

[Second resection in patients with Ta-T1 bladder tumors]. / Segunda resección en pacientes con tumores vesicales Ta-T1.

OBJECTIVES: To study the incidence of "residual/recurrence" tumor after a second bladder resection (2nd TUR). METHODS: 40 patients with new or recurrent superficial bladder tumor underwent repeat transurethral resection within 3 months after the initial resection. 37 patients were staged as Ta-T1. We study the incidence of tumor after the 2nd TUR both macroscopically detected or included in the bladder scar. We also study the influence of possible factors as the time between both resections, stage, grade, number of tumor size, localization in the bladder, primary or recurrent tumor and tumor pattern. RESULTS: After the 2nd TUR we found tumor in 14 of 37 (37.8%) Ta-T1 bladder tumors. Among the 14 tumors, 10 (71.5%) were macroscopically visible tumors and 4 cases the tumor were found after resection of the bladder scar of the first resection. We did not find relation between the presence of tumor in the 2nd TUR and any of the variables. CONCLUSIONS: After a TUR of superficial bladder tumor the complete removal of tumor is not always achieved. The early 3 months cystoscopy may not find residual tumor. Although we have found tumor in 37.8% in the 2a TUR we can not recommend routine 2nd TUR in superficial bladder cancer.

Segunda resección en pacientes con tumores vesicales Ta-T1 / Second TUR in patients with stage Ta-T1 transicional cell carcinoma of the bladder

OBJETIVO: Estudiar la incidencia de tumor "residual/recidivante" tras segunda resección precoz (2ª RTU), y que factores influyen en su hallazgo. MATERIAL Y MÉTODO: Estudio prospectivo de 40 pacientes con neoplasia vesical superficial a los que se les realizó una 2ª RTU precoz. Como posibles factores de riesgo de hallazgo de tumor se estudiaron el intervalo de tiempo entre ambas RTU, el estadio, el grado, el número de implantes tumorales, el tamaño de los implantes, localización dentro de la vejiga, tumor primario o recidivante y el patrón tumoral. RESULTADOS: Al realizar la 2ª RTU se confirmó histológicamente tumor en 14 (37,8 por ciento) de 37 pacientes con tumores Ta-T1 (excluimos aquellos con afectación focal de la muscular): 10 (71,5 por ciento) eran tumores macroscópicamente visibles, en 4 casos (28,5 por ciento) se encontró tumor al biopsiar las áreas de cicatriz/edema de la resección anterior. No encontramos asociación entre la presencia de tumor en la 2ª RTU y ninguna de las variables en estudio. CONCLUSIONES: La erradicación de tumor vesical superficial mediante RTU no se consigue en un elevado porcentaje de pacientes. La cistoscopia a los tres meses no puede excluir tumor residual. Aunque hemos encontrado 37,8 por ciento de tumor en la 2ª RTU, actualmente no podemos recomendarla de forma rutinaria en los tumores vesicales superficiales (AU)

Prevalence of primary Sjögren's syndrome in patients with multiple sclerosis.

Sixty-four consecutive patients with clinically or laboratory-supported definite multiple sclerosis (MS) were evaluated prospectively for evidence of primary Sjögren's syndrome (SS). This diagnosis was established when a patient had objective keratoconjunctivitis sicca, xerostomia, or both together with positive labial salivary gland biopsy. We found 2 patients (3.1%) with clinical evidence of primary SS. Whether this association is fortuitous or whether there is pathogenetic linkage between MS and primary SS remains to be established.