Anatomical outcomes and complications of sacrocolpopexy using Surelift Uplift mesh: A multicentric observational study.

OBJECTIVE: The study evaluated the anatomical and functional outcomes, as well as the safety data of laparoscopic sacrocolpopexy (LSC) for pelvic organ prolapse (POP) using a lightweight macroporous mesh. METHODS: A multicentric observational study was developed including five expert centers between March 2011 and December 2019. Inclusion criteria were female patients with symptomatic ≥stage II POP (POP-Q classification), who underwent a LSC. A lightweight and macroporous mesh device (Surelift Uplift) was used. Baseline anatomical positions were evaluated using POP-Q stage. The anatomical outcomes and procedural complications were assessed during the postoperative period. Primary outcomes were anatomical success, defined as POP-Q stage ≤I, and subjective success, defined as no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse. RESULTS: A total of 325 LSCs were analyzed with a median patient age of 66 (interquartile range [IQR] 61-73). After a median follow-up of 68 months (IQR 46.5-89), anatomical success was found in 88.9%, whereas subjective success was seen in 98.5% of the patients. Recurrent prolapse presented as cystocele (1.5%). Reported complications were bladder (4.6%) or rectum lesions (0.6%), de novo urinary incontinence (12.9%), and mesh extrusion (1.2%). CONCLUSIONS: LSC provides significant clinical improvement and excellent anatomical results, with a low risk of serious complications for women with ≥2 grade POP in a real clinical practice setting.

Bladder Capacity in Women With Overactive Bladder Syndrome: A Cross-sectional Study.

OBJECTIVE: To evaluate bladder capacity in women with idiopathic overactive bladder syndrome (OAB) through bladder diary, cystomanometry, and uroflowmetry and assess the concordance of the different measures of bladder capacity. A secondary objective is to describe the relationship between bladder capacity and urinary frequency in OAB patients. METHODS: An observational cross-sectional multicentric study was conducted, including female patients diagnosed with idiopathic OAB. All participants underwent a urodynamic study and completed a 3-day bladder diary (3dBD). Different parameters were used to calculate bladder capacity: maximum cystometric capacity (MCC) assessed at the end of filling cystometry, voided volume (VV) during the uroflowmetry, maximum voided volume (VVmax), and average voided volume (VVmed), both assessed through the 3dBD. Reproducibility analysis was performed to assess the agreement among the different bladder capacity measures. Intraclass correlation coefficient (ICC) and weighted Kappa index were used. Bladder capacity parameters were also assessed in relation to urinary frequency. RESULTS: Bladder capacity measures were diminished in this population, except for VVmax. Poor correlation was found between the different bladder capacity variables (ICC and weighted Kappa index <0.4). Twenty-four-hour frequency and average VV present a weak negative linear relationship (Pearson coefficient -0.344). CONCLUSION: MCC and average VV are reduced in OAB patients. MCC does not correlate well with functional bladder volumes determined by voiding diary in the OAB population.

Genitourinary tract symptoms in patients admitted with COVID-19: Exploring changes in frequency by determinants and pandemic waves.

Background: Urothelial cells exhibit increased expression of angiotensin-converting enzyme-2 receptor, which is the binding site of severe acute respiratory syndrome coronavirus 2 to cells. The frequency and distribution of genitourinary tract symptoms in patients diagnosed with coronavirus disease 2019 (COVID-19) is unknown. Objective: We explored trends in genitourinary tract symptoms by gender and each of six pandemic waves in patients admitted for COVID-19, and related them with severity, death and length of hospitalization. Design Setting and Participants: A retrospective study took place in our institution of COVID-19 admitted patients. Only patients with RT-PCR or antigen test confirmed SARS-CoV-2 infection were included. Demographic, clinical, and genitourinary symptoms were explored. Outcome Measurements and Statistical Analysis: COVID-19 patients with genitourinary tract symptoms were compared with those without. Statistical comparisons were conducted by parametric and nonparametric tests for quantitative variables, and χ 2 test for qualitative variables. Results and limitations: Out of a total of 4,661 COVID-19 patients, genitourinary symptoms were found in 21,1%. These symptoms were more frequent in patients admitted for longer than 30 days, except for urinary incontinence (UI) and erectile dysfunction (ED). Acute kidney injury (AKI) and urinary tract infections (UTI) had a higher presence in the 5th (16.7%; 12.8% respectively) and 3rd wave (13.3%; 12.6% respectively). Genitourinary symptoms were higher for those patients admitted in critical care units. Frequency of AKI, UI, UTI and acute urinary retention (AUR) were higher for patients who were finally deceased (26.2%; 3.5%; 13.6% and 3.6% respectively). Conclusions: A high frequency of genitourinary symptoms in patients admitted for COVID-19 was observed, whose frequency and distribution varied according to pandemic waves. Specific genitourinary conditions were associated with worse outcomes and poorer prognosis.

What Should Be Known by a Urologist About the Medical Management of COVID-19's Patients?

PURPOSE OF REVIEW: The alarming number of confirmed COVID-19 cases put a strain on the healthcare systems, which had to reallocate human and technical resources to respond to the emergency. Many urologists became integrated into multidisciplinary teams, dealing with this respiratory illness and its unknown management. It aims to summarize the epidemiological, clinical, diagnostical, and therapeutical characteristics of COVID-19, from a practical perspective, to ease COVID-19 management to non-physician staff. RECENT FINDINGS: We performed a narrative review of the literature regarding COVID-19, updated to May 8th, 2020, at PubMed and COVID resource platforms of the main scientific editorials. COVID-19, characterized by fever, myalgias, dyspnea, and dry cough, varies widely from asymptomatic infection to death. Arrhythmias and thrombotic events are prevalent. Lymphopenia and inflammatory reactant elevation on laboratory, as well as bilateral and peripheral ground-glass opacities or consolidations on X-Ray, are usually found in its assessment. Little is known about SARS-CoV-2 immunology. To date, no therapy has demonstrated efficacy in COVID-19. Of-level or compassionate-use therapies are prescribed in the context of clinical trials. We should become familiar with specific adverse events and pharmacological interactions. The COVID-19 pandemic has paralyzed the urological activity, and its long-term consequences are unpredictable. Despite not being used to deal with respiratory diseases, the urologists become easily qualified to manage COVID-19 by following protocols and being integrated into multidisciplinary teams, helping to overcome the pandemic.

[Management of neurourological patients during the COVID-19 pandemic.] / Manejo del paciente neurourológico durante la pandemia COVID-19.

OBJECTIVES:  To report the recommendations of an expert panel to reorganize Neurourology units and to prioritize examinations and both conservative and surgical treatments during the COVID-19 pandemic. MATERIALS AND METHODS: Non-systematic review of the literature and national experts' opinion summarizing the recommendations in the diagnosis, management, and follow-up of neurourological patients during the COVID-19 pandemic. A modified nominal group technique was used due to extraordinary meeting and mobility restrictions during COVID-19 pandemic. RESULTS: Neurourological patients have special physiological and pathological characteristics that make them more vulnerable to SARS-CoV-2 infection. For prioritization purposes, they encompass in Functional Urology patients and their management is considered non-urgentor delayable with no specific deadline of recovery from normality. However, it is important to identify individual situations jeopardising the upper urinary tract, urinary retention or predisposing to urinary infections/sepsis. A classification is provided prioritizing conservative/outpatient management and the surgical treatment of the events occurring in neurourological patients during the COVID-19 pandemic. CONCLUSIONS: In neurourological patients we can find exceptional clinical situations in which a delayed treatment could develop irreversible changes in the upper urinary tract, advocating a more urgent treatment inspecific scenarios.

OBJETIVOS: Exponer las recomendaciones de un comité de expertos para la reorganización de las unidades de neurourología y la priorización de estudios y tratamientos durante la pandemia COVID-19.MATERIAL Y MÉTODOS: Revisión no sistemática de la literatura científica y opinión de expertos nacionales  para resumir las recomendaciones en el diagnóstico, tratamiento y seguimiento de los pacientes neurourológicos durante la pandemia COVID-19. Se utiliza una técnica de grupo nominal modificada debido a las restricciones extraordinarias de reunión y movilidad durante la pandemia COVID-19. RESULTADOS: Los pacientes neurourológicos poseen características fisiopatológicas especiales que les hace más vulnerables frente a la infección por SARS-CoV-2. Han sido englobados en general en el grupo de la Urología Funcional, relegando su manejo al de las situaciones no urgentes y demorables sin plazo concreto de recuperación de la normalidad. Sin embargo, es importante identificar situaciones específicas en las que exista compromiso funcional del aparato urinario superior, retención urinaria, o desarrollo de infecciones/sepsis urinaria. Se realiza una clasificación según el nivel de prioridad tanto del manejo ambulatorio y conservador como del tratamiento quirúrgico de eventos relacionados con pacientes neurourológicos durante la pandemia COVID-19. CONCLUSIONES: En los pacientes neurourológicos encontramos situaciones clínicas excepcionales en las que un retraso de su tratamiento puede conllevar alteraciones irreversibles en el tracto urinario superior, dada su condición de vejiga de riesgo funcional, por lo que debe individualizarse un manejo más precoz en ciertos escenarios.

Manejo de la hiperplasia benigna de próstata durante la pandemia COVID-19 / Benign prostatic hyperplasia management during COVID-19 pandemia

OBJETIVOS: Exponer las recomendaciones de un comité de expertos para la reorganización de las unidades de neurourología y la priorización de estudios y tratamientos durante la pandemia COVID-19. MATERIAL Y MÉTODOS: Revisión no sistemática de la literatura científica y opinión de expertos nacionales para resumir las recomendaciones en el diagnóstico, tratamiento y seguimiento de los pacientes neurourológicos durante la pandemia COVID-19. Se utiliza una técnica de grupo nominal modificada debido a las restricciones extraordinarias de reunión y movilidad durante la pandemia COVID-19. RESULTADOS: Los pacientes neurourológicos poseen características fisiopatológicas especiales que les hace más vulnerables frente a la infección por SARS-CoV-2. Han sido englobados en general en el grupo de la Urología Funcional, relegando su manejo al de las situaciones no urgentes y demorables sin plazo concreto de recuperación de la normalidad. Sin embargo, es importante identificar situaciones específicas en las que exista compromiso funcional del aparato urinario superior, retención urinaria, o desarrollo de infecciones/sepsis urinaria. Se realiza una clasificación según el nivel de prioridad tanto del manejo ambulatorio y conservador como del tratamiento quirúrgico de eventos relacionados con pacientes neurourológicos durante la pandemia COVID-19. CONCLUSIONES: En los pacientes neurourológicos encontramos situaciones clínicas excepcionales en las que un retraso de su tratamiento puede conllevar alteraciones irreversibles en el tracto urinario superior, dada su condición de vejiga de riesgo funcional, por lo que debe individualizarse un manejo más precoz en ciertos escenarios

OBJECTIVES: To report the recommendations of an expert panel to reorganize Neurourology units and to prioritize examinations and both conservative and surgical treatments during the COVID-19 pandemic. MATERIALS AND METHODS: Non-systematic review of the literature and national experts' opinion summarizing the recommendations in the diagnosis, management, and follow-up of neurourological patients during the COVID-19 pandemic. A modified nominal group technique was used due to extraordinary meeting and mobility restrictions during COVID-19 pandemic. RESULTS: Neurourological patients have special physiological and pathological characteristics that make them more vulnerable to SARS-CoV-2 infection. For prioritization purposes, they encompass in Functional Urology patients and their management is considered non-urgent or delayable with no specific deadline of recovery from normality. However, it is important to identify individual situations jeopardising the upper urinary tract, urinary retention or predisposing to urinary infections/sepsis. A classification is provided prioritizing conservative/outpatient management and the surgical treatment of the events occurring in neurourological patients during the COVID-19 pandemic. CONCLUSIONS: In neurourological patients we can find exceptional clinical situations in which a delayed treatment could develop irreversible changes in the upper urinary tract, advocating a more urgent treatment in specific scenarios

Manejo del paciente neurourológico durante la pandemia COVID-19 / Management of neurourological patients during the COVID-19 pandemic

OBJETIVOS: Exponer las recomendaciones de un comité de expertos para la reorganización de las unidades de neurourología y la priorización de estudios y tratamientos durante la pandemia COVID-19. MATERIAL Y MÉTODOS: Revisión no sistemática de la literatura científica y opinión de expertos nacionales para resumir las recomendaciones en el diagnóstico, tratamiento y seguimiento de los pacientes neurourológicos durante la pandemia COVID-19. Se utiliza una técnica de grupo nominal modificada debido a las restricciones extraordinarias de reunión y movilidad durante la pandemia COVID-19. RESULTADOS: Los pacientes neurourológicos poseen características fisiopatológicas especiales que les hace más vulnerables frente a la infección por SARS-CoV-2. Han sido englobados en general en el grupo de la Urología Funcional, relegando su manejo al de las situaciones no urgentes y demorables sin plazo concreto de recuperación de la normalidad. Sin embargo, es importante identificar situaciones específicas en las que exista compromiso funcional del aparato urinario superior, retención urinaria, o desarrollo de infecciones/sepsis urinaria. Se realiza una clasificación según el nivel de prioridad tanto del manejo ambulatorio y conservador como del tratamiento quirúrgico de eventos relacionados con pacientes neurourológicos durante la pandemia COVID-19. CONCLUSIONES: En los pacientes neurourológicos encontramos situaciones clínicas excepcionales en las que un retraso de su tratamiento puede conllevar alteraciones irreversibles en el tracto urinario superior, dada su condición de vejiga de riesgo funcional, por lo que debe individualizarse un manejo más precoz en ciertos escenarios

OBJECTIVES: To report the recommendations of an expert panel to reorganize Neurourology units and to prioritize examinations and both conservative and surgical treatments during the COVID-19 pandemic. MATERIALS AND METHODS: Non-systematic review of the literature and national experts' opinion summarizing ther ecommendations in the diagnosis, management, and follow-up of neurourological patients during the COVID-19 pandemic. A modified nominal group technique was used due to extraordinary meeting and mobility restrictions during COVID-19 pandemic. RESULTS: Neurourological patients have special physiological and pathological characteristics that make them more vulnerable to SARS-CoV-2 infection. For prioritization purposes, they encompass in Functional Urology patients and their management is considered non-urgent or delayable with no specific deadline of recovery from normality. However, it is important to identify individual situations jeopardising the upper urinary tract, urinary retention or predisposing to urinary infections/sepsis. A classification is provided prioritizing conservative/outpatient management and the surgical treatment of the events occurring in neurourological patients during the COVID-19 pandemic. CONCLUSIONS: In neurourological patients we can find exceptional clinical situations in which a delayed treatment could develop irreversible changes in the upper urinary tract, advocating a more urgent treatment in specific scenarios

Sintomatología del tracto urinario inferior y disfunción eréctil / Lower urinary tract symptoms and erectile dysfunction

La relación entre los síntomas del tracto urinario inferior (STUI) y la disfunción eréctil (DE) es el resultado de su mayor asociación en edades avanzadas. Sin embargo, varias investigaciones demuestran que los síntomas urinarios se relacionan en forma independiente con disfunción sexual y menor satisfacción. Asimismo, la gravedad de los STUI se correlaciona con la magnitud de la disfunción sexual en todos los grupos etarios, lo cual sugiere una posible relación causal.Una serie de hipótesis se han formulado para explicar la existencia de una fisiopatología común entre STUI y DE. En la actualidad, esta relación entre STUI y DE está apoyada por cuatro teorías, no mutuamente excluyentes, que incluyen (a) la hiperactividad autonómica y la hipótesis de síndrome metabólico, (b) los cambios en la sintetasa de óxido nítrico / óxido nítrico (NOS / NO) de la vía guanina monofosfatasa en la próstata y el pene, (c) la activación de Rho-kinasa y la vía de la endotelina, y (d) las consecuencias fisiopatológicas de la aterosclerosis pélvica.Dada la contribución del funcionamiento sexual en el mantenimiento de la calidad de vida, en la elección del tratamiento para el paciente con hiperplasia prostática benigna deben tomarse en cuenta los posibles efectos negativos sobre la función sexual.El enfoque terapéutico combinado de estas dos entidades (DE y STUI) provoca un beneficio sobre el paciente tanto en la sintomatología urinaria como en la esfera sexual, aunque se precisan estudios controlados con placebo para confirmar estos datos y dilucidar el papel de la terapia de combinación para el tratamiento de estas dos condiciones(AU)

The relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) is the result of their greater association in advanced age. Nevertheless, several investigations show that urinary tract symptoms have an independent relationship with sexual dysfunction and lower satisfaction. Likewise, the severity of LUTS correlates with the magnitude of sexual dysfunction in all age groups, which suggests a possible causal relationship.A series of hypothesis have been posed to explain the existence of a common physiopathology for LUTS and ED. Currently, this relationship between LUTS and ED is supported on four theories, which are not mutually excluding, (a) autonomic hyperactivity and metabolic syndrome hypothesis, (b) changes in nitric oxide/nitric oxide (NOS/NO) synthetase in the guanine monophosphatase pathway in penis and prostate, (c) the activation of Rho kinase and the endothelin pathway, and (d) the physiopathological consequences of pelvic arteriosclerosis.Given the contribution of sexual function to keep the quality of life, possible negative effects on sexual function should be taken into consideration when choosing treatment for benign prostatic hyperplasia.The combined therapeutic approach of these two entities (ED and LUTS) brings a benefit to the patient both in urinary symptoms and sexual sphere, although placebo controlled studies are required to confirm these data and to ascertain the role of combination therapy in the treatment of both conditions(AU)

[Renal autotransplantation: a valid option in the resolution of complex cases]. / Autotrasplante renal: una alternativa valida en la resolucion de casos complejos.

OBJECTIVES: To analyze the current indications for renal autotransplantation, as well as the technical features, complications and long-term follow-up of the technique. METHODS: From 1990 to 2005 we have performed autotransplantation in 10 patients, 7 adults and 3 children. The indication was established due to vascular pedicle pathology in 8 cases and ureteral lesion in 2. The cause of vascular pathology was: atherosclerotic stenosis (4), dysplastic stenosis (2), Takayasu's disease stenosis (1), and renal artery aneurysm (1). The patients with ureteral lesion had ureteral stenosis secondary to Crohn's disease in one case, initially solved by ureteral stent and subsequently obstructed by lithiasic encrustation, and ureteral avulsion in the other case. The vascular grafts employed in the 8 cases with vascular reconstruction were: hypogastric artery 7 cases, and sophena vein in one case. Ureteral reimplantation was necessary in 5 cases after bench surgery; in other five cases vascular reconstruction was performed without ureteral division. All grafts were perfused with 4 degrees C lactate ringer or Wisconsin solution and protected with surface cold ischemia. Ischemia times ranged from 42 to 89 minutes. RESULTS: Nine kidneys (90%) functioned after autotransplantation, 8 of them had immediate function, and one had delayed graft function after a six-day period of acute tubular necrosis. The kidney with arterial stenosis secondary to Takayasu's disease never functioned. The cause of graft loss was renal vein thrombosis. Postoperative mortality was zero. After a mean follow-up of 72+/- 13 months mean serum creatinine is 1.6+- 0.4 mg/dl (1.1-2.4) and 70% (7/10) of the patients have normal blood pressure without antihypertensive medication. CONCLUSIONS: Currently, renal autotransplantation, with or without extracorporeal vascular reconstruction, is a complex technique with exceptional indications, but it allows recovering renal units with vascular pathology not amenable to angioplasty or in situ revascularization. It is also a valid alternative to ileal ureteral substitution in cases of extensive ureteral lesion.

Autotrasplante renal: Una alternativa válida en la resolución de casos complejos / Renal autotransplantation: a valid option in the resolution of complex cases

OBJETIVO: Analizar las indicaciones actuales del auto-trasplante renal (ATR), así como los aspectostécnicos, complicaciones y seguimiento a largo plazo de esta técnica. MÉTODOS: Desde 1990 a 2005 se han llevado a cabo un ATR en 10 pacientes, 7 adultos y 3 niños. La indicación fue por patología del pedículo vascular en 8 casos y por lesión ureteral en 2. En los 8 casos con patología vascular, ésta se distribuyó en: estenosis por ateromatosis (4), estenosis por displasia (2), estenosispor enfermedad de Takayasu (1) y aneurisma de arteria renal (1). Los dos pacientes con lesión ureteral correspondieron a una estenosis ureteral secundaria a Enfermedad de Crohn inicialmente resuelta mediante stent ureteral, que posteriormente se obstruyó por incrustación litiásica; y una por avulsión ureteral yatrógena post-ureteroscopia. En los 8 casos en que fue necesaria la reconstrucción vascular los injertos vasculares utilizados fueron: en 7 pacientes arteria hipogástrica y en 1 vena sáfena. En 5 casos fue necesario llevar a cabo una reimplantación ureteral tras la cirugía de banco, mientras que en otros 5 la reconstrucción vascular se realizó sin desinsercción ureteral. En todos los casos los injertos fueron perfundidos con Ringer Lactato o Wisconsina 4ºC y protegidos con isquemia fría de superficie. Los tiempos de isquemia oscilaron entre 42 y 89 min. RESULTADOS: Nueve (90%) riñones fueron funcionantes tras el ATR teniendo 8 de ellos función inmediata tras la intervención y uno de ellos función retardada tras un período de necrosis tubular de 6 días de duración. El riñón nunca funcionante correspondió al de la estenosis arterial secundaria a enfermedad de Takayasu. La causa de la pérdida del injerto fue la trombosis de la vena renal. La mortalidad postoperatoria de la serie fue nula (0%). Con un tiempo medio de seguimiento de 72+-13 meses la creatinina media es de 1,6+-0,4 mg/dl (1,1-2,4) y el 70% (7/10) de los pacientes están normotensos sin necesidad de medicación hipotensora. CONCLUSIONES: El ATR, con o sin reconstrucción vascular extracorpórea, es una técnica compleja que tiene indicaciones excepcionales en la actualidad, pero que permite rescatar unidades renales afectas de patología vascular no subsidiarias de angioplastia o revascularización in situ. Así mismo, es una alternativa válida a la interposición de ileon en casos de lesión ureteral extensa (AU)

OBJECTIVES: To analyze the current indications for renal autotransplantation, as well as the technical features, complications and long-term follow-up of the technique. METHODS: From 1990 to 2005 we have performed autotransplantation in 10 patients, 7 adults and 3 children. The indication was established due to vascular pedicle pathology in 8 cases and ureteral lesion in 2. The cause of vascular pathology was: atherosclerotic stenosis (4), dysplastic stenosis (2), Takayasu’s disease stenosis (1), and renal artery aneurysm (1). The patients with ureteral lesion had ureteral stenosis secondary to Crohn’s disease in one case, initially solved by ureteral stent and subsequently obstructed by lithiasic encrustation, and ureteral avulsion in the other case. The vascular grafts employed in the 8 cases with vascular reconstruction were: hypogastric artery 7 cases, and saphena vein in one case. Ureteral reimplantation was necessary in 5 cases after bench surgery; in other five cases vascular reconstruction was performed without ureteral division. All grafts were perfused with 4ºC lactate ringer or Wisconsin solution and protected with surface cold ischemia. Ischemia times ranged from 42 to 89 minutes. RESULTS: Nine kidneys (90%) functioned after autotransplantation, 8 of them had immediate function, and one had delayed graft function after a six-day period of acute tubular necrosis. The kidney with arterial stenosis secondary to Takayasu’s disease never functioned. The cause of graft loss was renal vein thrombosis. Postoperative mortality was zero. After a mean follow-up of 72+/- 13 months mean serum creatinine is 1.6+- 0.4 mg/dl (1.1-2.4) and 70% (7/10) of the patients have normal blood pressure without antihypertensive medication. CONCLUSIONS: Currently, renal autotransplantation, with or without extracorporeal vascular reconstruction, is a complex technique with exceptional indications, but it allows recovering renal units with vascular pathology not amenable to angioplasty or in situ revascularization. It is also a valid alternative to ileal ureteral substitution in cases of extensive ureteral lesion

[Ultrasound for the diagnosis of female urinary incontinence]. / Ecografía en el diagnóstico de la incontinencia urinaria femenina.

OBJECTIVES: The value of ultrasonography for the study of female urinary incontinence has been redefined over the last years. METHODS: We review the literature about the value of ultrasound in the workup of females with urinary incontinence, mainly transperineal ultrasound for the female stress urinary incontinence (SUI). RESULTS: Many papers have been published over the last few years. Upper urinary tract ultrasound has not a place in the workup of genuine female SUI. Transperineal ultrasound allows to evaluate the mobility of the bladder neck and urethra, the thickness of the bladder wall, the funnel shape of the bladder neck, the presence of SUI or pelvic organ prolapse (POP), to visualize mesh implants, to help with biofeedback, and to evaluate changes after surgical treatment. CONCLUSIONS: Ultrasounds in general, and transperineal or translabial ultrasound in particular, are in the process of becoming the standard diagnostic method in urogynecology. Their wide availability, the standardization of parameters, the possibility of evaluating not only the bladder but also the levator ani muscle or pelvic organ prolapses (POP) contribute to this fact. It allows to obtain data in a non invasive way before and after therapy.

Ecografía en el diagnóstico de la incontiencia urinaria femenina / Ultrasound for the diagnosis of female urinary incontinence

OBJETIVO: El valor de la Ecografía en el estudio de la Incontinencia Urinaria Femenina (IUF) ha sido redefinido en los últimos años MÉTODOS: Se revisa la literatura sobre el valor de la Ecografía en el estudio de las mujeres con Incontinencia urinaria, fundamentalmente en la ecografía transperineal en la Incontinencia Urinaria de esfuerzo femenina RESULTADOS: En los últimos años son numerosos los trabajos publicados. La ecografía del TUS tiene poco lugar en la evaluación de la IUF de esfuerzo pura. La ecografía transperineal permite evaluar movilidad del cuello vesical y uretra, grosor de la pared vesical, embudización del cuello, presencia de IUF de esfuerzo, presencia de prolapso de órganos pelvianos (POP), visualización de mallas, ayudar al biofeedback y valorar cambios tras tratamiento quirúrgico. CONCLUSIONES: Los ultrasonidos y en particular la ECO transperineal o translabial está en proceso de convertirse un método diagnóstico estándar en uroginecología. A ello contribuye su amplia disponibilidad, estandarización de los parámetros y la posibilidad de evaluar no sólo la vejiga, sino también el elevador del ano o los Prolapsos de órganos pelvianos (POP). Permite obtener, de forma no invasiva datos pre y postratamiento

OBJECTIVES: The value of ultrasonography for the study of female urinary incontinence has been redefined over the last years. METHODS: We review the literature about the value of ultrasound in the workup of females with urinary incontinence, mainly transperineal ultrasound for the female stress urinary incontinence (SUI). RESULTS: Many papers have been published over the last few years. Upper urinary tract ultrasound has not a place in the workup of genuine female SUI. Transperineal ultrasound allows to evaluate the mobility of the bladder neck and urethra, the thickness of the bladder wall, the funnel shape of the bladder neck, the presence of SUI or pelvic organ prolapse (POP), to visualize mesh implants, to help with biofeedback, and to evaluate changes after surgical treatment. CONCLUSIONS: Ultrasounds in general, and transperineal or translabial ultrasound in particular, are in the process of becoming the standard diagnostic method in urogynecology. Their wide availability, the standardization of parameters, the possibility of evaluating not only the bladder but also the levator ani muscle or pelvic organ prolapses (POP) contribute to this fact. It allows to obtain data in a non invasive way before and after therapy

[Treatment of upper urinary tract tumors. Report of our experience]. / Tratamiento de los tumores del tracto urinario superior. Aportación de nuestra experiencia.

OBJECTIVES: The objective of this article is to perform a comprehensive exposition of the various non-endourological treatment options for upper urinary tract tumors in order to set the bases to choose the most adequate surgical indication depending on tumors' and patients' characteristics; we consider the various surgical approaches, and the historic evolution from the classic indication established by Albarran (radical nephroureterectomy with bladder cuff) to the current ones more conservative. We also consider the role of radiotherapy and chemotherapy in the treatment of these tumors. METHODS/RESULTS: We refer to the conclusions of various authors and their large series published in the literature, series considered classic already, and provide support adding our experience by reviewing 223 patients treated from 1977 to 2003 with a mean follow-up of 45 months (maximum 238 months). CONCLUSIONS: We can state that it is acceptable to indicate less aggressive ways of treatment (nephroureterectomy without bladder cuff, distal or partial ureterectomy, and conservative operations) if the oncological radicality requirements are met, remembering that site, tumor grade and stage are determinant in the outcome.