[Treatment of female stress urinary incontinence with TVT system (tension-free vaginal tape): complications in our first 100 cases]. / Tratamiento de la incontinencia urinaria de esfuerzo con el sistema TVT: complicaciones en nuestros primeros 100 casos.

INTRODUCTION: The TVT system is the most common surgical technique of female stress urinary incontinence, because of the simplicity. good clinical results and rare complications. MATERIAL AND METHODS: From april, 1999 to march. 2004, it has been done in our department 100 TVT systems with the revision of the result over the six following months. The average follow-up rate was 10.36 months (R: 1-54 months) and looses mean the 11% of the cases. All the patients presented stress incontinence and their average age was 56.6 years old (30-80). The 12% of the cases have been previously operated of urinary incontinence. 21 patients presented previous surgery of pelvic floor. In the 17% of the cases, TVT systems was associated to another surgical technique: 15% of them was operated of cystocele, 1% of them had surgical correction of rectocele, 1% of them had a strong surgery of pelvic floor, that included TVT system, correction of pelvic floor and hysterectomy. RESULTS: We obtained 65% of successful cases, defined as objective confirmation of absence of looses from the observer and the subjective reference of the patient: 17% of clear improvement (clear decrease of looses from the patient and subjective improvement) and 7% of failure of the technique. The total percentage of appearance of novo post-surgery urgency is 9%. There were complications in the 12% of the cases: there were three cases of bladder perforation, two of them intra-operative and one of them deferred and associated to an infection of surgical wound; another three cases of residue in the immediate post-operative that were resolved with bladder catheterization: one case of acute urinary retention that was treated with bladder catheterization with suprapubic cistostomy: one case of chemical peritonitis corrected with a conservative treatment; two cases of vaginal extrusion of sling, which were resolved with the section of the outer sling; one patient presented a hipogastric hematoma resolved with conservative measures: and one patient presented pelvic discomfort with spontaneous resolution. CONCLUSIONS: We consider the TVT system as an effective surgical technique in the treatment of the female stress urinary incontinence. It is a simple technique with a short stay in the hospital and rare complications.

Tratamiento de la incontinencia urinaria de esfuerzo con el sistema TVT: complicaciones en nuestros primeros 100 casos / Treatment of female stress urinary incontinence with TVT system (tension-free vaginal tape): complications in our first 100 cases

Introducción: El sistema TVT (Tension-free Vaginal Tape) es la técnica quirúrgica de elección en los últimos años de la incontinencia urinaria de esfuerzo femenina (IUE), dada la facilidad de la técnica, buenos resultados clínicos y escasas complicaciones. Material y métodos: Desde Abril de 1999 a Marzo 2004 se han implantado en nuestro servicio 100 sistemas TVT con revisión de los resultados a los 6 meses, y un seguimiento medio de 10,36 meses (R: 1-54 meses), con una pérdida de seguimiento en el 11% de los casos. Todas las mujeres estudiadas presentaban incontinencia de esfuerzo, siendo la edad media de 56,5 años (30-80). Un 12% habían sido intervenidas previamente de IUE. Presentan cirugía previa del suelo pélvico 21 pacientes. En un 17% de los casos se realizó TVT asociado a otra técnica quirúrgica: 15% cistorrafia anterior, 1% corrección de rectocele, 1% cirugía compleja del suelo pélvico que incluye TVT, corrección de cistocele e histerectomía. Resultados: Obtenemos un 65% de éxitos (comprobación objetiva de la ausencia de escape por parte del médico y referencia subjetiva de la paciente), un 17% de mejoría (disminución clara de escapes por parte de la paciente y mejoría subjetiva) y un 7% de fracaso de la técnica. El porcentaje global de aparición de urgencia de novo posquirúrgica es del 9%. Existieron un 12% de complicaciones; 3 casos(3%) de perforación vesical, 2 de ellos intraoperatorios y 1 diferida junto con infección de la herida quirúrgica; 3 episodios (3%) de residuos altos en el postoperatorio inmediato, resueltos con autosondajes, y un caso de RAO (1%) dado de alta con cistostomía suprapúbica; un caso (1%) de peritonitis química tras retirada de talla vesical resuelta con tratamiento conservador; dos casos (2%) de extrusión vaginal de la bandeleta, con sección de la porción de malla exteriorizada en ambos casos; un (1%) paciente presenta hematoma hipogástrico que se resuelve con medidas conservadoras; un 1 % de los pacientes (1 caso) presentó molestias pélvicas subcrónicas con resolución espontánea. Conclusiones: Consideramos el sistema TVT una técnica quirúrgica eficaz en el tratamiento de la incontinencia urinaria femenina de esfuerzo. Es una técnica sencilla, con baja estancia hospitalaria y escasas complicaciones (AU)

Introduction: The TVT system is the most common surgical technique of female stress urinary incontinence, because of the simplicity, good clinical results and rare complications. Material and methods: From april, 1999 to march, 2004, it has been done in our department 100 TVT systems with the revision of the result over the six following months. The average follow-up rate was 10, 36 months (R: 1-54 months) and looses mean the 11% of the cases. All the patients presented stress incontinence and their average age was 56,6 years old (30-80). The 12% of the cases have been previously operated of urinary incontinence. 21 patients presented previous surgery of pelvic floor. In the 17% of the cases, TVT systems was associated to another surgical technique: 15% of them was operated of cystocele, 1% of them had surgical correction of rectocele, 1%of them had a strong surgery of pelvic floor, that included TVT system, correction of pelvic floor and hysterectomy. Results: We obtained 65% of successful cases, defined as objective confirmation of absence of looses from the observer and the subjective reference of the patient; 17% of clear improvement (clear decrease of looses from the patient and subjective improvement) and 7% of failure of the technique. The total percentage of appearance of novo post-surgery urgency is 9%. There were complications in the 12% of the cases: there were three cases of bladder perforation, two of them intra-operative and one of them deferred and associated to an infection of surgical wound; another three cases of residue in the immediate post-operative that were resolved with bladder catheterization; one case of acute urinary retention that was treated with bladder catheterization with suprapubic cistostomy; one case of chemical peritonitis corrected with a conservative treatment; two cases of vaginal extrusion of sling, which were resolved with the section of the outer sling; one patient presented a hipogastric hematoma resolved with conservative measures; and one patient presented pelvic discomfort with spontaneous resolution. Conclusions: We consider the TVT system as an effective surgical technique in the treatment of the female stress urinary incontinence. It is a simple technique with a short stay in the hospital and rare complications (AU)

Neuromodulación de raíces sacras. Experiencia de nuestro centro 1998-2003. A propósito de 18 implantes definitivos de neuromodulación / Sacral root neuromodulation. Experience in our site: 1998-2003, concerning 18 definite neuromodulation implants

OBJETIVO: La neuromodulacion de raíces sacras es una técnica eficaz para el tratamiento de la Disfunción Miccional Crónica (DMC), refractaria a tratamientos convencionales. En la actualidad están surgiendo nuevas indicaciones en el ámbito urológico, como el dolor pélvico crónico y la cistitis intersticial. Diversos grupos de cirujanos digestivos están optando por esta técnica para el tratamiento de patología rectal (estreñimiento, disfunción esfinteriana). Este trabajo aporta nuestra experiencia en el tratamiento de pacientes con DMC y los resultados comparativos al año del implante de todos los pacientes. MATERIAL Y MÉTODOS: Desde diciembre de 1998 a julio del 2003 hemos realizados 18 implantes definitivos de neuromodulacion. La indicación principal fue la DMC, en un 62,5% de los pacientes. El seguimiento de los pacientes lo realizamos al mes, tres meses, y posteriormente cada seis meses. Este se realiza mediante diario miccional y cuestionario de calidad de vida. El implante del electrodo en los 16 primeros pacientes se ha realizado mediante cirugía abierta, mientras que los 2 siguientes se ha colocado el electrodo mediante técnica percutánea, utilizando el kit “Tined Lead”. RESULTADOS: Comparamos resultados al año del implante en todos los pacientes. Se han realizado 18 implantes de neuromodulación de los cuales 14 (77,7%) han sido en mujeres y 4 (22,3%) en varones. La edad media es de 52,56 años. La indicación del implante en un 72,2% de los pacientes fue por DMC, un 22,1% por incontinencia mixta (urinaria y fecal), y un 5,5% fue por cistopatía intersticial. La mejoría de los síntomas al año del implante, medidos por el calendario miccional y el cuestionario de calidad de vida fue de 76,4%. La mejoría clínica fue mayor en los pacientes con síntomas de urgencia, que los pacientes con predominio de la sintomatología de vaciado

OBJECTIVE: Sacral root neuromodulation is an effective technique for the treatment of Chronic Micturition Dysfunction (CMD) refractory to conventional therapy. New indications such as chronic pelvic pain and interstitial cystitis are currently making their way within the urologic setting. Several groups of gastric surgeons are now choosing this technique for the management of rectal diseases (constipation, sphincter dysfunction). This paper contributes our experience in the treatment of patients with CMD and the comparative results at one year from implant in all patients. MATERIAL AND METHODS: From December 1998 through July 2003, 18 neuromodulation definite implants were performed. The main indication was CMD in 62.5% patients. Follow up of patients was done at one month and three months, and every six months thereafter. Follow up is conducted through a micturition diary and QoL questionnaire. Electrode implant in the first 16 patients was achieved by open surgery. The next 2 patients had the electrode placed by a percutaneous technique using the “Tined Lead” kit. RESULTS: Results at one year after implant were compared in all patients. The total number of neuromodulation implants placed was 18, 14 (77.7%) of which were women and 4 (22.3%) men. Mean age was 52.56 years. Implant indication was CMD in 72.2% patients, mixed incontinence (urinary and faecal) in 22.1%, and interstitial cystic disease in 5.5%. Symptoms improvement at one year from implant, as determined by a micturition diary and QoL questionnaire was 76.4%. Clinical improvement was greater in patients with urgency symptoms than in patients with predominance of voiding symptoms

[Sacral root neuromodulation. Experience in our site: 1998-2003, concerning 18 definite neuromodulation implants]. / Neuromodulación de raíces sacras. Experiencia de nuestro centro 1998-2003. A propósito de 18 implantes definitivos de neuromodulación.

OBJECTIVE: Sacral root neuromodulation is an effective technique for the treatment of Chronic Micturition Dysfunction (CMD) refractory to conventional therapy. New indications such as chronic pelvic pain and interstitial cystitis are currently making their way within the urologic setting. Several groups of gastric surgeons are now choosing this technique for the management of rectal diseases (constipation, sphincter dysfunction). This paper contributes our experience in the treatment of patients with CMD and the comparative results at one year from implant in all patients. MATERIAL AND METHODS: From December 1998 through July 2003, 18 neuromodulation definite implants were performed. The main indication was CMD in 62.5% patients. Follow up of patients was done at one month and three months, and every six months thereafter. Follow up is conducted through a micturition diary and QoL questionnaire. Electrode implant in the first 16 patients was achieved by open surgery. The next 2 patients had the electrode placed by a percutaneous technique using the "Tined Lead" kit. RESULTS: Results at one year after implant were compared in all patients. The total number of neuromodulation implants placed was 18, 14 (77.7%) of which were women and 4 (22.3%) men. Mean age was 52.56 years. Implant indication was CMD in 72.2% patients, mixed incontinence (urinary and faecal) in 22.1%, and interstitial cystic disease in 5.5%. Symptoms improvement at one year from implant, as determined by a micturition diary and QoL questionnaire was 76.4%. Clinical improvement was greater in patients with urgency symptoms than in patients with predominance of voiding symptoms.

[Surgical management and complications of urinary stress incontinence: our experience in 385 patients operated on during the last 25 years]. / Manejo quirúrgico y complicaciones de la I.U.E: nuestra experiencia en 385 pacientes operadas en los últimos 25 años.

We present the results and complications found and compared in 2 large series of patients who underwent a surgical procedure to avoid Urinary Stress Incontinence in our hospital. From january of 1994 to december of 2001 we collected 195 patients with an average age of 57.9 y we compared them with a prior series of 189 patients collected between january of 1976 and december of 1993, with an average age of 53.6. The continence rate was similar in both series (70.8% pre-94 and 74.5% post 94), slight incontinence 22.7% pre-94 and 19.2% post-94 and for complete incontinence 6.3% pre-94 and 6.2% post-94. The Burch procedure was the most common and also shows the greatest effectiveness in our trial involving 113 cases and a continence rate of 74.3% in the first series and 144 cases and 77% respectively in the second series. The most common complications were very similar in both groups: tract urinary infection (5.2% and 9% first and second group), surgical wound infection (4.2% and 2.2% respectively). We conclude that in spite of the introduction of new and useful surgical procedure (TVT, periurethal substances injection...) the greatest long term success rate still corresponds to the Burch colposuspension.

Manejo quirúrgico y complicaciones de la I.U.E.: Nuestra experiencia en 385pacientes operadas en los últimos 25 años / Surgical management and urinary stress incontinence complications: our experience in 385 female operated patients during the last 25 years

Se presentan los resultados y complicaciones obtenidos y comparados en dos grandes series de pacientes operadas de Incontinencia Urinaria de Esfuerzo (I.U.E) en nuestro servicio. Desde enero de 1994 a diciembre de 2001 hemos recogido 195 pacientes con una edad media de 57,9 y las hemos comparado con una serie previa de 189 pacientes que comprende desde enero de 1976 hasta diciembre de 1993 con una edad media de 53,6 años. La tasa de pacientes continentes en ambas series fue similar (70,8 por ciento pre-94 y 74,5 por ciento post-94), leve incontinente en 22,7 por ciento pre-94 y 19,2 por ciento post-94 e incontinente 6,3 por ciento pre-94 y 6,2 por ciento post-94.La técnica de Burch es la más empleada y corresponde a la más eficaz en el estudio con 113 pacientes y un 74,3 por ciento de pacientes continentes en la primera serie y 144 pacientes con 77 por ciento continentes en la segunda serie. Las complicaciones más frecuentes fueron las mismas en las dos series: infección del tracto urinario (5,2 por ciento y 9 por ciento en primera y segunda serie) e infección de herida quirúrgica (4,2 por ciento y 2,2 por ciento respectivamente).Concluimos que a pesar de la introducción de nuevas y útiles técnicas correctoras (TVT, inyección de sustancias periuretrales...) la mayor tasa de éxito a largo plazo continúa siendo la colposuspensión tipo Burch (AU)

[Posterior sacral root neuromodulation in the treatment of chronic urinary dysfunction]. / Neuromodulación de raíces sacras posteriores en el tratamiento de la disfunción miccional crónica.

OBJECTIVES: To describe the effectiveness of sacral root neuromodulation in ameliorating symptoms of refractory voiding disfunction in our center. MATERIAL AND METHODS: During the period from december 1998 throught december 2001, 31 Percutaneous Nerve Evaluation (PNE) was performed to 20 patients with refractory voiding dysfunction; a sacral nerve stimulation device was implanted in 10 patients (8 female, 2 male). The median age was 49 years. Refractory voiding dysfunction included: mixed disorders (30%), idiopathic nonobstructive chronic urinary retention (20%), urgency/frequency (20%), faecal and urinary incontinence with absence of sphincter defect (20%) and frequency (10%). RESULTS: The 2 patients with frequency/urgency decreased their symptoms more than 50%, bladders were emptied without post-void residual urine in 2 patients with urinary retention, faecal and urinary incontinence in 2 patients and mixed disorders in other 3, reduced their symptoms more than 90% without residual urine. The frequency improved more than 50% in 1 patient. CONCLUSIONS: Sacral Root Neuromodulation is a successful treatment in some cases of idiopathic chronic micturition dysfunction which don't respond to pharmacotheraphy or bladder retraining. The effects of neuromodulation are long-lasting and associated morbidity is low.

Neuromodulación de raíces sacras posteriores en el tratamiento de la disfunción miccional crónica / Sacral root neuromodulation as a treatment of chronic micturition dysfunction

OBJETIVOS: Describir la experiencia de nuestro centro en el tratamiento con neuromodulación de raíces sacras posteriores de pacientes con disfunción miccional crónica tras el fracaso de tratamiento conservador. MATERIAL Y MÉTODOS: Desde diciembre de 1998 a diciembre de 2001, hemos realizado a 20 pacientes 31 test de estimulación de nervios periféricos (ENP), y 10 implantes definitivos (8 fueron mujeres y 2 varones). Edad media: 49 años. El cuadro clínico más frecuente fueron los trastornos mixtos (30 per cent), seguidos por retencionistas crónicos (20 per cent), urgencia/frecuencia miccional (20 per cent), incontinencia urinaria y fecal con integridad esfinteriana (20 per cent) y cuadro de frecuencia miccional elevada (10 per cent). RESULTADOS: Los 2 pacientes con frecuencia e incontinencia por urgencia mejoraron la sintomatología más del 50 per cent. Los 2 pacientes con retención urinaria crónica completa recuperación micción espontánea sin residuo post-miccional, 3 pacientes con trastornos mixtos redujeron sus síntomas más del 90 per cent sin residuo post-miccional significativo. Los pacientes con incontinencia fecal y urinaria mejoraron su sintomatología más de un 90 per cent. El paciente con cuadro de frecuencia miccional elevada también redujo los síntomas más del 50 per cent. La única complicación post-quirúrgica fue seroma de herida quirúrgica en 3 casos. CONCLUSIONES: La neuromodulación de raíces sacras es útil en los casos de disfunción miccional crónica idiopática que no responden a tratamiento farmacológico y/o de reeducación. La neuromodulación de raíces sacras produce, en pacientes seleccionados, una mejoría prolongada y la técnica presenta escasa morbilidad (AU)

[Treatment of female stress urinary incontinence with the TVT (tension-free vaginal tape) system: our experience]. / Tratamiento de la incontinencia urinaria de esfuerzo femenina con el sistema TVT (Tensión free Vaginal Tape): nuestra experiencia.

INTRODUCTION: The TVT system is a new surgical procedure for female stress urinary incontinence. The object of this study is to report our initial experience with this technique. We report our results and complications too. MATERIAL AND METHODS: From April 1999 to July 2000, 23 systems TVT was implanted in our hospital. The patients were followed for a 6 to 21 month period. All the patients had stress incontinence. The mean age was 59 years. Gynaecological surgery was associated in 4 patients. One of them was excluded because a diagnosis mistake. TVT implies the implantation of a prolene tape around mid-urethra via a minimal vaginal incision. RESULTS: 17 patients (77.27%) had a significantly improved in the post-operative evaluation. The mean post-surgical stay in the hospital was 1.7 days. A bladder base was damaged during the surgery. No urinary retention, erosion or urethral lesion were found. CONCLUSIONS: We consider the TVT operation to be a safe and effective surgical procedure for the treatment of female urinary stress incontinence. This surgery is easy to lean, fast, cheap and with a low rate of complications.

Tratamiento de la incontinencia urinaria de esfuerzo femenina con el sistema TVT (Tensión free Vaginal Tape): nuestra experiencia / TVT system for treatment of females stress urinary incontinence: our experience

INTRODUCCIÓN: El sistema TVT (tensión-free vaginal tape), es una nueva técnica quirúrgica para el tratamiento de la incontinencia de esfuerzo femenina. El objetivo de este trabajo es presentar nuestra experiencia inicial con la técnica, dando nuestros resultados y complicaciones. MATERIAL Y MÉTODOS: Desde Abril de 1999 hasta Julio de 2000 se implantaron en nuestro servicio 23 sistemas TVT, con un tiempo de seguimiento de entre 6 y 21 meses. Todas las pacientes presentaban incontinencia urinaria de esfuerzo. La edad media era de 59 años. Se asoció cirugía ginecológica concomitante en 4 pacientes. Una se excluye del estudio por error diagnóstico. El sistema TVT supone el implante de una fina banda de prolene sobre la uretra media mediante la realización de una mínima incisión. RESULTADOS: De las 22 pacientes, 17 (77,27 por ciento) tuvieron una clara mejoría entre 6 y 21 meses tras la cirugía. La estancia media post-operatoria fue de 1,7 días. Se produjo una lesión intraoperatoria de la base vesical. No tenemos casos de retención de orina post-quirúrgica, erosión o fístula uretral. CONCLUSIONES: Consideramos al sistema TVT una técnica quirúrgica eficaz para el tratamiento de la incontinencia urinaria femenina de esfuerzo. Es una técnica fácil de aprender, de rápida ejecución, económica y con pocas complicaciones (AU)

[Epidermoid carcinoma of the scrotum]. / Carcinoma epidermoide de escroto.

OBJECTIVE: To analyze the therapeutic approach in epidermoid or squamous cell carcinoma of the scrotum, a rare tumor that is of interest for clinical and historical reasons. METHODS/RESULTS: A case of epidermoid carcinoma of the scrotum is described. The patient had undergone urethroplasty in 1972, using preputial free graft, according to the technique of Ben Johnson. Right scrotectomy and orchidectomy were performed and partial urethrectomy with inguinal lymphadenectomy 6 weeks later. At 24 months' follow-up, the patient has no tumor recurrence. CONCLUSION: Malignant tumors of the scrotum are rare. Squamous cell carcinoma is the most frequent tumor type. Radical surgery with inguinal lymphadenectomy is the treatment of choice. It must be distinguished from verrucous carcinoma, a tumor that requires a different therapeutic approach and for which radical surgery is not indicated.

[The development and preliminary validation of the IU-4 questionnaire for the clinical classification of urinary incontinence]. / Elaboración y validación preliminar del cuestionario para la clasificación clínica de la incontinencia urinaria IU-4.

RATIONALE: To prepare and validate a simple and self-administered questionnaire for the clinical rating of patients with urinary incontinence (UI) for use in the clinical practice. METHODS: The questionnaire was prepared based on a review of the literature on urinary incontinence and the views of 7 urodynamic urologists. The initial questionnaire UI-5 included 5 items related to UI symptoms that divided patients into three categories: stress incontinence (UEI), urge incontinence (UUI) or mixed urinary incontinence (MUI). An additional question evaluates the impact of UI type on the quality of life. The of construct validity was analyzed correlating the responses to UI-5 items and the question on quality of life. The area under the ROC curve was calculated for each UI type correlating the UI-5 scores and the results of the urodynamic test. The cut-off values for each scale were determined based on sensitivity (SE) and specificity (SP). RESULTS: The study included 188 females with UI (73.4% with UEI, 13.3% with UUI and 13.3% with MUI; based on the urodynamics). Only 4.3% patients did not answer some UI-5 items. One item related to the protective material used was excluded as it was not related to UI types, and so the final questionnaire included only 4 items (UI-4). The results show that UI-4 discriminates the different types of incontinence: UEI (SE: 0.69/SP: 0.76; 1 item), UUI (SE: 0.83/SP: 0.65; 2 items), MUI (SE: 0.72/SP: 0.65; 1 item). 100% patients with MUI, 84% with UUI and 59.9% with UEI report some impact on their quality of life. CONCLUSIONS: UI-4 is simple, valid and easy to administer, and can be particularly valuable in the clinical rating of UI in settings where urodynamic testing is not easily available such is primary health care.

[Usefulness of the urodynamic study of the lower urinary tract in renal transplantation]. / Utilidad del estudio urodinámico del tracto urinario inferior en el trasplante renal.

OBJECTIVES: To analyze the indications, diagnostic cost-effectiveness and therapeutic implications of urodynamic assessment of the lower urinary tract in two groups of patients: 1) those awaiting renal transplantation and those with a functioning renal graft and voiding disturbances. METHODS: The first group comprised 22 patients who were evaluated before renal transplantation for a total of 32 urodynamic studies. The second group comprised 10 patients with a functioning renal graft for a total of 14 post-transplant urodynamic studies. The etiology of the chronic renal failure, indications for urodynamic assessment and videourodynamic findings in both groups were compared. RESULTS: Interstitial nephropathy associated with vesicoureteral reflux was the most common cause of chronic renal failure in the pre-transplant group, whereas glomerular nephropathy was the most common cause of chronic renal failure in the posttransplant group. Vesicoureteral reflux was the most frequent videourodynamic finding and was associated with other urodynamic disturbances in 75% of the cases. Lower urinary tract obstruction was the most common finding in the posttransplant group. CONCLUSIONS: The indications for urodynamic study in patients awaiting renal transplantation are: 1) interstitial nephropathy associated with vesicoureteral reflux, neurogenic bladder and congenital malformations; 2) patients aged 45 or older with a flowmetry suggesting obstruction; 3) those with urinary diversion, and 4) systemic diseases potentially associated with neurological damage.

[Prediction of continence in patients with neurogenic bladder who will be treated with bladder augmentation]. / Predicción de la continencia en pacientes con vejiga neurógena a quienes se va a realizar una ampliación vesical.

Twenty four patient with neurogenic bladder undergoing vesical enlargement were pre-operatively evaluated to determine the need to perform also an anti-incontinence technique. None of them had such a technique performed, so as to control whether our prediction was correct. Each patient had one or more video-urodynamic studies performed to evaluate adjustment and the likely vesical hyperreflexia, critical incontinence pressure, and the presence of leaks with cough and cervicourethral morphology at different filling times. Critical incontinence pressure and presence of contrast leaks with cough, the latter demanded with moderate intravesical pressures, have been the parameters which better predicted the likely incontinence, with reliability over 90%. With regard to myelodysplastic bladders, the study shows the relevance of the detrusor as a cause of incontinence and sustains the practice of implementing only the cervical cuff without the remaining components when the artificial sphincter is chosen as the anti-incontinence technique, when the likely cause, whether sphincter or detrusor, is unclear at the time of considering vesical enlargement.

[Treatment of urinary incontinence with the artificial sphincter AUS-800. Our experience]. / Tratamiento de la incontinencia urinaria con el esfínter artificial AUS-800. Nuestra experiencia.

The present study reviewed the first 25 incontinence prostheses implanted at the Urology Services of the Ramón y Cajal Hospital. The literature is briefly reviewed and the indications for the AUS-800 incontinence prosthesis are discussed.

[Enterocystoplasty in the treatment of myelodysplastic bladder]. / La enterocistoplastia en el tratamiento de la vejiga mielodisplásica.

Over the last five years 18 myelodisplastic patients with neurogenic bladder have undergone in our Unit a surgical operation consisting in vesical enlargement with patch-like bowels. They all had incontinence and urinary infections and there was a high percentage of pyelonephritic events. A report on the results from 13 patients whose post-operative evolution is longer than one year is included. Eleven patients were completely and two partially continent; pyelonephritic events have ceased or became more spaced; renal function, assessed by UIV is within normal values or shows improvement in 22 renal units while only one patient, out of 11 pre-operative cases, continues having vesico-renal reflux.

[Acute anuric renal failure in a patient with diabetic neurogenic bladder]. / Fracaso renal agudo anúrico en paciente con vejiga neurógena diabética.

Herein we describe a patient with noninsulin dependent diabetes mellitus who developed acute anuric renal failure following eye surgery. This condition, ascribable to diabetic neurogenic bladder and probably to the use of anticholinergic agents, improved following placement of a urethral catheter. The physiopathological mechanisms and treatment are discussed.

[Diagnostic yield of the urodynamic study of the upper urinary tract in the orthotopic and transplanted kidney]. / Rentabilidad diagnóstica del estudio urodinámico del tracto urinario superior, en el riñón ortotópico y trasplantado.

Urodynamic pressure-flow studies (Whitaker test) of 28 kidneys (21 orthotopic and 7 transplanted) with equivocal obstruction of the upper urinary tract (UUT) yielded a sensitivity rate of 77.7% and a specificity rate of 75% in the orthotopic kidney, and sensitivity and specificity rates of 75% in the transplanted kidney. Trauma to the transplanted kidney (denervation, ischemia and surgery) does not modify the urodynamic of the pyelocaliceal system, thus conferring on the test the same diagnostic reliability as in the orthotopic kidney.

[Urinary de-diversion, technical modification for creating a low-pressure bladder]. / Desderivación urinaria, modificación técnica para la creación de una vejiga de baja presión.

Urinary unidiversion permits the possibility of enhancing the quality of life and probably the survivorship of previously diverted patients. A modification of this technique is described which utilizes Brickne's loop and a segment of the sigmoid to create a low pressure bladder, thus sparing more intestine. The good result achieved with this technique is underscored. In our view, urinary undiversion must meet the following two conditions: to enhance patient quality of life and not to deteriorate renal function .

[Instability of the detrusor. Treatment with oxybutynin chloride (Ditropan) in children]. / Inestabilidad del detrusor. Tratamiento con cloruro de oxibutinina (Ditropan) en niños.

We study the effect of oxybutynin chloride (Ditropan) in a random sample of 24 children with ages ranging from 5 to 14 years, diagnosed as having vesical instability from both the clinical and urodynamic standpoints. These effects were evaluated after a period of treatment that ranged from 10 to 36 months (x = 20). We obtained overall clinical improvement in 87.5%, and improvement of urodynamic alterations in 83.3% of the patients. We single out the beneficial effect of oxybutynin chloride with prolonged treatments, in instability of the detrusor, as well as its good tolerance.