[Systematic review of the treatment with pessaries in the pelvic organ prolapse (POP).] / Revisión sistemática del tratamiento con pesarios en el prolapso de órganos pélvicos (POP).

Pelvic organ prolapse (POP) has a general incidence of > 10% in the female population of the Western world. The pessary is a silicone device, inserted into the vagina to provide support to the pelvic organs. It is used as a conservative treatment to improve prolapse symptoms.OBJECTIVES: To evaluate the effectiveness of pessary treatment in pelvic organ prolapse through a systematic review of the current literature.MATERIAL AND METHODS: A Scoping Review was carried out based on the PRISMA guidelines for the development of systematic reviews. The PICO research question was asked, the sources of information were selected, and the eligibility criteria were established. Subsequently, the descriptors in health sciences and keywords, combined with Boolean operators, were appliedin each of the search engines. RESULTS: A total of 19 references were included in the analysis of this work. To delimit the data extraction, the information was divided into four dimensions: improvements in symptoms related to POP and quality of life, sexual function; discontinuation, justification for discontinuation and complications. CONCLUSIONS: The pessary produces positive effects on the quality of life of women with POP, with good satisfaction rates. The main reasons for the interruption include: inability to retain the pessary, discomfort, and the desire for surgery.

El prolapso de órganos pélvicos (POP) presenta una incidencia general de >10% en la población femenina del mundo occidental. El pesario es un dispositivo de silicona, se introduce en la vagina para proveer soporte a los órganos pélvicos. Se utiliza como tratamiento conservador para mejorar los síntomas del prolapso. OBJETIVO: Evaluar la efectividad del tratamiento del pesario en los prolapsos de órganos pélvicos mediante una revisión sistemática de la literatura actual. MATERIAL Y MÉTODOS: Se llevó a cabo una Scoping Review sustentada en las directrices PRISMA para el desarrollo de revisiones sistemáticas. Se planteó la pregunta de investigación PICO, se seleccionaron las fuentes de información y establecieron los criterios de elegibilidad. Posteriormente se aplicaron los descriptores en ciencias de la salud y palabras clave, combinados con operadores boleanos, en cada uno de los buscadores. RESULTADOS: Un total de 19 referencias fueron incluidas en el análisis del presente trabajo. Para delimitar la extracción de datos se procedió a dividir la información en cuatro dimensiones: mejoras en los síntomas relacionados con el POP y la calidad de vida, función sexual; discontinuación, justificación de la interrupción y complicaciones. CONCLUSIONES: El pesario produce efectos positivos en la calidad de vida de las mujeres con POP, con buenas tasas de satisfacción. Las principales razones para la interrupción incluyen: incapacidad de retener el pesario, incomodidad y el deseo de cirugía.

Revisión sistemática del tratamiento con pesarios en el prolapso de órganos pélvicos (pop) / Systematic review of pessary treatment in pelvic organ prolapse (pop)

Objetivo: Evaluar la efectividad del tratamiento delpesario en los prolapsos de órganos pélvicos medianteuna revisión sistemática de la literatura actual.Material y métodos: Se llevó a cabo una ScopingReview sustentada en las directrices PRISMA para el desarrollo de revisiones sistemáticas. Se planteó la pregunta de investigación PICO, se seleccionaron las fuentesde información y establecieron los criterios de elegibilidad. Posteriormente se aplicaron los descriptores en ciencias de la salud y palabras clave, combinados conoperadores boleanos, en cada uno de los buscadores.Resultados: Un total de 19 referencias fueron incluidas en el análisis del presente trabajo. Para delimitarla extracción de datos se procedió a dividir la información en cuatro dimensiones: mejoras en los síntomasrelacionados con el POP y la calidad de vida, funciónsexual; discontinuación, justificación de la interrupcióny complicaciones.Conclusiones: El pesario produce efectos positivosen la calidad de vida de las mujeres con POP, conbuenas tasas de satisfacción. Las principales razonespara la interrupción incluyen: incapacidad de retener elpesario, incomodidad y el deseo de cirugía.(AU)

Objetives: To evaluate the effectiveness of pessarytreatment in pelvic organ prolapse through a systematicreview of the current literature.Material and methods: A Scoping Review wascarried out based on the PRISMA guidelines for thedevelopment of systematic reviews. The PICO researchquestion was asked, the sources of information wereselected, and the eligibility criteria were established. Subsequently, the descriptors in health sciences and keywords, combined with Boolean operators, were appliedin each of the search engines.Results: A total of 19 references were included in theanalysis of this work. To delimit the data extraction, theinformation was divided into four dimensions: improvements in symptoms related to POP and quality of life,sexual function; discontinuation, justification for discontinuation and complications.Conslcusions: The pessary produces positive effectson the quality of life of women with POP, with goodsatisfaction rates. The main reasons for the interruptioninclude: inability to retain the pessary, discomfort, andthe desire for surgery.(AU)

Nosocomial SARS-CoV-2 infection in urology departments: Results of a prospective multicentric study.

OBJECTIVE: To evaluate the coronavirus disease 2019 perioperative infection rate and mortality rate of patients undergoing urological surgeries during the early pandemic period in Spain. METHODS: This was a non-interventional multicenter prospective study carried out from 9 March to 3 May 2020 in two urology departments in Madrid, Spain. Clinical, microbiological and radiological data of patients who underwent surgery were collected from computerized medical records. RESULTS: A total of 148 patients were included in the study, and 141 were analyzed for nosocomial infection risk, after excluding previous and concomitant severe acute respiratory syndrome coronavirus type 2 infections. Elective surgeries represented 76.6% of the procedures, whereas emergent surgeries represented 23.4%. Preoperative screening was carried out with polymerase chain reaction test in 34 patients, all were negative. A total of 14 patients also had chest X-ray (not suspicious in all cases). Three patients (2.1%) developed severe acute respiratory syndrome coronavirus type 2 nosocomial infection (symptoms developed between the third day after surgery to the 14th day after hospital discharge). Time from admission to a compatible clinical case was 5.5 days (4-12 days). Two patients underwent surgery with concomitant diagnosis of coronavirus disease. The mortality rate due to severe acute respiratory syndrome coronavirus type 2 infection is 0.7%, and the specific mortality rate in patients undergoing surgery with community-acquired coronavirus disease 2019 infection was 50% (1/2). CONCLUSIONS: The nosocomial severe acute respiratory syndrome coronavirus type 2 infection rate was low in patients undergoing urological surgical procedures during the peak of the pandemic in Madrid. With appropriate perioperative screening, urological surgical activity can be carried out in safety conditions.

Role of robotic surgery in functional urology.

Three-dimensional, high-definition images, small instruments with endowrist technology, ergonomic position and the easiness to teach, are possibly the main reasons why robotic surgery will continue to gain ground to others forms of surgery. The current applications of robotics in functional urology are: the correction of pelvic organ prolapse, the correction of female stress urinary incontinence (artificial urinary sphincter) and the treatment of chronic pelvic pain (pudendal nerveneurolysis). In this paper, we explain our robotic techniques in these three scenarios, as well as, provide the most updated data of our series.

Las imagen tridimensional de alta definición,los instrumentos pequeños con tecnología "endowrist"(endo-muñeca), la posición ergonómica y lafacilidad para enseñar son posiblemente las razonesprincipales por las que la cirugía robótica continuaráganando terreno sobre otras formas de cirugía. Las aplicacionesactuales de la robótica en urología funcionalson: la corrección del prolapso de órganos pélvicos, lacorrección de la incontinencia urinaria de esfuerzo (esfínterurinario artificial) y el tratamiento del dolor pélvicocrónico (neurolisis del nervio pudendo). En este artículoexplicamos nuestras técnicas robóticas en estos tres escenariosy también presentamos los datos más actualizadosde nuestras series.

Role of robotic surgery in functional urology / Papel de la cirugía robótica en la urología funcional

Three-dimensional, high-definition images, small instruments with endowrist technology, ergonomic position and the easiness to teach, are possibly the main reasons why robotic surgery will continue to gain ground to others forms of surgery. The current applications of robotics in functional urology are: the correction of pelvic organ prolapse, the correction of female stress urinary incontinence (artificial urinary sphincter) and the treatment of chronic pelvic pain (pudendal nerve neurolysis). In this paper, we explain our robotic techniques in these three scenarios, as well as, provide the most updated data of our series

Las imagen tridimensional de alta definición, los instrumentos pequeños con tecnología "endowrist" (endo-muñeca), la posición ergonómica y la facilidad para enseñar son posiblemente las razones principales por las que la cirugía robótica continuará ganando terreno sobre otras formas de cirugía. Las aplicaciones actuales de la robótica en urología funcional son: la corrección del prolapso de órganos pélvicos, la corrección de la incontinencia urinaria de esfuerzo (esfínter urinario artificial) y el tratamiento del dolor pélvico crónico (neurolisis del nervio pudendo). En este artículo explicamos nuestras técnicas robóticas en estos tres escenarios y también presentamos los datos más actualizados de nuestras series

[Congenital bladder diverticula and vesicoureteral reflux]. / Divertículos vesicales congénitos en la infancia y reflujo vésicoureteral.

OBJECTIVES: To analyze our series of primary congenital diverticula (PCD) and their association with vesicoureteral reflux. METHODS: We have taken care of 23 children with PCD. Eleven of them had big diverticula (> 2 cm) and twelve small. In the first group, 4 children had vesicoureteral reflux and 5 in the second group. In group A, ureteral reimplantation was performed at the time of diverticulum excision. Nor diverticula neither refluxes were operated in group B. RESULTS: We analyze separately results in both groups. Group A: Patients were operated including diverticulum excision. There were not recurrences except in one case with Ehler-Danlos Syndrome. No reimplanted ureter showed postoperative reflux. Nevertheless, one case with multiple bladder diverticula without reflux presented reflux after the excision of several diverticula without reimplantation. Group B: Small diverticula did not undergo surgery Spontaneous outcome of reflux was similar to that of the general population without diverticula. CONCLUSIONS: Bladder diverticula are frequently associated with vesicoureteral reflux. The presence of reflux is not an absolute condition for surgical or endoscopic treatment. When diverticula are big in size (Group A) the indication for surgery comes from recurrent infection or voiding disorders, not from reflux. If they undergo surgery, ureteral reimplantation is performed in the case they had reflux or for technical reasons like bladder wall weakness. When diverticula are small (Group B) the presence of reflux does not condition treatment, being the rate of spontaneous resolution similar to the general population.

Divertículos vesicales congénitos en la infancia y reflujo vésico-ureteral / Congenital bladder diverticula and vesicoureteral reflux

Objetivo: Analizar nuestra serie de divertículos congénitos primarios (DVCP) y su relación con el reflujo vésico-ureteral. Métodos: En 10 años hemos asistido a 23 niños con DVCP. Once eran divertículos grandes (más de 2 cm de diámetro) y doce eran pequeños. En el primer grupo, 4 niños tenían reflujo vésico-ureteral y en el segundo cinco. En el grupo A se reimplantaron los uréteres refluyentes al extirpar el divertículo. En el grupo B no se operó en ningún caso el divertículo o el reflujo. Resultados: Analizaremos por separado los resultados de ambos grupos. Grupo A: fueron operados, extirpándose el/los divertículo/s. Sólo recidivaron los divertículos en el caso de síndrome de Ehlers-Danlos. En todos los casos reimplantados no hubo reflujo post-operatorio. Sin embargo, apareció un reflujo post-cirugía en un caso de vejiga polidiverticular, a la que se le extirparon varios divertículos sin reimplante. Grupo B: los divertículos pequeños no fueron operados. La evolución espontánea del reflujo fue similar a la de la población general sin divertículos. Conclusiones: Los divertículos vesicales se asocian con frecuencia a reflujo vésico-ureteral. La presencia del reflujo no constituye, en el momento actual, un condicionante absoluto del tratamiento quirúrgico o endoscópico. Cuando los divertículos son grandes (Grupo A), la indicación quirúrgica está dada por las infecciones recidivantes, los trastornos miccionales y no por la presencia de reflujo. Si se operan, se reimplanta el uréter porque tiene reflujo o porque hay razones técnicas de debilidad parietal. Cuando los divertículos son pequeños (Grupo B), la presencia de reflujo no condiciona el tratamiento, siendo la tasa de resolución espontánea similar a la de la población general (AU)

Objectives: To analyze our series of primary congenital diverticula (PCD) and their association with vesicoureteral reflux. Methods: We have taken care of 23 children with PCD. Eleven of them had big diverticula ( 2 cm) and twelve small. In the first group, 4 children had vesicoureteral reflux and 5 in the second group. In group A, ureteral reimplantation was performed at the time of diverticulum excision. Nor diverticula neither refluxes were operated in group B. Results: We analyze separately results in both groups. Group A: Patients were operated including diverticulum excision. There were not recurrences except in one case with Ehler-Danlos Syndrome. No reimplanted ureter showed postoperative reflux. Nevertheless, one case with multiple bladder diverticula without reflux presented reflux after the excision of several diverticula without reimplantation. Group B: Small diverticula did not undergo surgery. Spontaneous outcome of reflux was similar to that of the general population without diverticula. Conclusions: Bladder diverticula are frequently associated with vesicoureteral reflux. The presence of reflux is not an absolute condition for surgical or endoscopic treatment. When diverticula are big in size (Group A) the indication for surgery comes from recurrent infection or voiding disorders, not from reflux. If they undergo surgery, ureteral reimplantation is performed in the case they had reflux or for technical reasons like bladder wall weakness. When diverticula are small (Group B) the presence of reflux does not condition treatment, being the rate of spontaneous resolution similar to the general population (AU)

Primary congenital bladder diverticula in children.

OBJECTIVES: To present the symptoms, treatment, evolution, and pathologic findings of primary (nonobstructive) diverticula in childhood. Primary (nonobstructive) diverticula are not frequent in childhood. Bladder diverticula have classically been defined as "hernias of the mucosa through muscular fibers of the bladder wall." METHODS: From September 1985 through September 2005, we treated 11 children categorized has having primary congenital bladder diverticula. At diagnosis, their ages ranged between 7 months and 9 years (mean 4.6 years). Ten were boys and one was a girl. The main reason for consultation was febrile urinary infection (n = 5), recurrent urinary infections (n = 3), enuretic syndrome (n = 1), gross hematuria (n = 1), and pain in the right iliac fossa (n = 1). One child had Ehlers-Danlos syndrome. All the diverticula were larger than 2 cm in diameter. Of the 11 children, 10 underwent surgery. Clinical observation was chosen for the 9-month-old infant. RESULTS: All 10 operated children had developed favorably at a follow-up of 2 to 20 years (mean 9.3). The 9-month-old child continued under observation for 5 years. We observed no diverticulum recurrence and no postoperative vesicoureteral reflux in the reimplanted children. Pathologic examination was performed of the excised diverticula in 7 cases, and muscular fibers were found in all of them; however, most of the fibers were very fine, particularly at the dome of the diverticulum. CONCLUSIONS: The results of our study have shown that urinary tract infection is the most common symptom of bladder diverticula. Surgical treatment provided good results, without any recurrence or morbidity. The bladder diverticula were lined with fine muscular fibers.

[Determination of P53 in infiltrative primary bladder tumors as a prognostic factor for understaging]. / La determinación de p53 en tumor vesical primario infiltrante como factor pronóstico de subestadiaje.

OBJECTIVES: To determine if p53 expression in patients with infiltrative bladder cancer is a prognostic factor on clinical staging and cancer specific survival. METHODS: Immunohistochemical analysis of p53 in 34 patients (33 males and 1 female) undergoing radical cystectomy for infiltrative bladder cancer, with a mean follow-up of 16 months. RESULTS: p53 overexpression was detected in 18 patients (64%). In the p53 positive group two patients were stage T1G3, 18 patients T2, 1 patient T3, and 2 patients T4. In the negative group a better correspondence between TUR and cystectomy stage was found, with stage worsening only in 3 patients. On follow-up, p53 positive patients showed worse outcomes due to their worse stages, although no statistical differences were found (p = 0.24). In the group of patients following a bladder sparing protocol (n = 6), p53 negative patients had complete remission of the disease. CONCLUSIONS: We see significant differences on understaging/more aggressive local outcome in p53 positive patients, with no greater mortality in this group. P53 expression does not contraindicate the inclusion of a patient in a bladder sparing protocol, although larger studies would be necessary to confirm these results.

La determinación de P53 en tumor vesical primario infiltrante como factor pronóstico de subestadiaje / Determination of P53 in infiltrative primary bladder tumors as a prognostic factor for understaging

OBJETIVO: Determinar si la expresión de p53 en pacientes con carcinoma vesical infiltrante tiene valor pronóstico en el estadiaje clínico y supervivencia del tumor.MÉTODOS: El análisis inmunohistoquímico de p53 se realizó en 34 pacientes (33 hombres y 1 mujer) tratadoscon cistectomía por carcinoma vesical infiltrante con seguimiento medio de 16 meses.RESULTADOS: Se detectó sobreexpresión de p53 en 18 pacientes (64%). En el grupo con positividad p53 se encontraron 2 pacientes con estadio T1G3, 18 pacientesT2, 1 paciente T3 y 2 pacientes T4. En el grupo con negatividad inmunohistoquímica se encontró una mejor correspondencia entre el estadiaje de la RTU y de la cistectomíaencontrándose empeoramiento del estadio en solo 3 pacientes. Tras el seguimiento los pacientes p53 positivos presentaron peor evolución al tener peor estadio,aunque no significativa estadísticamente (p 0,24). En los pacientes que pasaron a protocolo de conservaciónvesical (n=6), los p53 negativos experimentaron una remisión completa de la enfermedad.CONCLUSIONES: Observamos una diferencia significativade infraestadiaje/evolución local más agresiva en pacientes p53 positivos y no mayor mortalidad en este grupo. La expresión de p53 no contraindica la entrada de un paciente en protocolo de conservación vesical aunque serán necesarios estudios más amplios para confirmar estos resultados

OBJECTIVES: To determine if p53 expression in patients with infiltrative bladder cancer is a prognostic factor on clinical staging and cancer specific survival. METHODS: Immunohistochemical analysis of p53 in 34 patients (33 males and 1 female) undergoing radical cystectomy for infiltrative bladder cancer, with a mean follow-up of 16 months. RESULTS: p53 overexpression was detected in 18 patients (64%). In the p53 positive group two patients were stage T1G3, 18 patients T2, 1 patient T3, and 2 patients T4. In the negative group a better correspondence between TUR and cystectomy stage was found, with stage worsening only in 3 patients. On follow-up, p53 positive patients showed worse outcomes due to their worse stages, although no statistical differences were found (p = 0.24). In the group of patients following a bladder sparing protocol (n = 6), p53 negative patients had complete remission of the disease. CONCLUSIONS: We see significant differences on understaging/more aggressive local outcome in p53 positive patients, with no greater mortality in this group. P53 expression does not contraindicate the inclusion of a patient in a bladder sparing protocol, although larger studies would be necessary to confirm these results