[TVT our experience five years and six months later]. / Nuestra experiencia a cinco años y medio en TVT.

OBJECTIVE: We present the outcome of urinary incontinence surgery after TVT more than five year of follow-up. Efficacy was evaluated in terms of complete cure of incontinence, complications, and patient satisfaction. MATERIAL AND METHODS: A sample of 369 female with genuine stress incontinence or mixed incontinence who had a TVT performed in our hospital between 1998-2003 were evaluated. Sample average age was 59.9 years. A total of 326 patients (85%) had genuine stress incontinence and 56 (15%) mixed incontinence. Preoperative evaluation was base on: clinical history and physical examination, stress test, flowmetry and post voided residual. Cistometry was indicated only in patients with previous surgery and mixed incontinence. Severity of incontinence was graded clinically. Primary outcome measure was complete cure of incontinence defined as lack of objective and subjective leakage. In addition a phone survey about patient satisfaction with the surgery was carried out. RESULTS: The average follow up was 35 months (6-67). A total of 317 were complete continent (86%). By contrast, 52 patients (14%) had leakages jet. The novo urgency rate was 7% and a 5.7% of patients were reoperated to cut the mesh because of obstruction. Nevertheless, the reoperation rate was low and only a patient showed a massive haematoma which needed to be evacuated. CONCLUSION: Bursch Technique through suprapubic route has been classically considered the gold standard procedure for stress urinary incontinence for the last decades, having been substituted nowadays by tension-free suburethral mesh sling whose most important advantages are: Simplicity of the method, lower cost and higher comfort for the patient due to the fact that we have chaged in-patient surgery program for ambulatory one with similar results in order to sanation. Anyway we will have to check if the preliminary good results and no complications persist in the follow-up.

Nuestra experiencia a cinco años y medio en TVT / TVT our experience five years and six month later

Objetivo: Presentar los resultados de eficacia de TVT a cinco años en términos de curación de incontinencia y complicaciones para el tratamiento de la IUE y de satisfacción personal con el resultado de la intervención. Material y métodos: Un total de 369 incontinentes con una edad media de 59,9 años fueron implantadas con el sistema TVT en nuestro hospital pacientes desde 1998 hasta 2003. De ellas, 326 pacientes (85%) presentaban IUE pura y 56 (15%) incontinencia mixta con predominio de esfuerzo. La evaluación preoperatorio se realizó mediante historia clínica, exploración física, prueba de esfuerzo, flujometría y medición residuo postmiccional. La cistomanometría sólo se indicó en pacientes con urgencia o antecedentes de cirugía previa. El grado de severidad de la incontinencia se catalogó clínicamente. Como criterio de curación completa se consideró la ausencia de pérdidas objetivas y subjetivas. Se realizó encuesta telefónica para estudiar el grado de satisfacción de la paciente. Resultados: El seguimiento medio fue de 35 meses con un rango entre 6 y 67 meses. Del total de pacientes, 317 presentaban continencia completa, lo que representa un 86%. Por el contrario, 52 pacientes (14%) presentaban escapes de orina. La tasa de urgencia de novo fue del 7% y la de corte de TVT por obstrucción de 5,7%. El porcentaje de reintervenciones, con sólo un caso de hematoma masivo. Conclusiones: Hasta ahora se ha considerado siempre como patrón oro de las intervenciones de incontinencia de la orina, la técnica suprapúbica de Bursch, quizás la más contrastada en el tiempo, pero en la actualidad está siendo sustituida por las técnicas de malla suburetral sin tensión, cuya principal ventaja, es la simplicidad del método, su menor costo económico y la mayor comodidad para la paciente, pues convertimos una cirugía con varios días de ingreso, en una cirugía ambulatoria, con unos resultados hasta el momento similares en tasa de curación, Pero habrá que comprobar que los resultados a largo plazo de las mallas, si se mantienen en el tiempo y no aparecen complicaciones derivadas de la malla

Objective: We present the outcome of urinary incontinence surgery after TVT more than five year of follow-up. Efficacy was evaluated in terms of complete cure of incontinence, complications, and patient satisfaction. Material y methods: A sample of 369 female with genuine stress incontinence or mixed incontinence who had a TVT performed in our hospital between 1998-2003 were evaluated. Sample average age was 59.9 years. A total of 326 patients (85%) had genuine stress incontinence and 56 (15%) mixed incontinence. Preoperative evaluation was base on: clinical history and physical examination, stress test, flowmetry and post voided residual. Cistometry was indicated only in patients with previous surgery and mixed incontinence. Severity of incontinence was graded clinically. Primary outcome measure was complete cure of incontinence defined as lack of objective and subjective leakage. In addition a phone survey about patient satisfaction with the surgery was carried out. Results: The average follow up was 35 months (6-67). A total of 317 were complete continent (86%). By contrast, 52 patients (14%) had leakages jet. The novo urgency rate was 7% and a 5,7% of patients were reoperated to cut the mesh because of obstruction. Nevertheless, the reoperation rate was low and only a patient showed a massive haematoma which needed to be evacuated. Conclusión: Bursch Technique through suprapubic route has been classically considered the gold standard procedure for stress urinary incontinence for the last decades, having been substituted nowadays by tension-free suburethral mesh sling whose most important advantages are: Simplicity of the method, lower cost and higher comfort for the patient due to the fact that we have chaged in-patient surgery program for ambulatory one with similar results in order to sanation. Anyway we will have to check if the preliminary good results and no complications persist in the follow-up

[Minimal prostatic adenocarcinomas in the biopsy treated with radical prostatectomy]. / Adenocarcinomas minimos de próstata en la biopsia sometidos a prostatectomía radical.

FUNDAMENTALS: Valuation about clinical pathologyc facts of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy. METHODS: Retrospective analysis of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy in front of the remaining radical prostatectomies. RESULTS: In 20 patients (7.6%) out of the 260 having undergone a radical prostatectomy between 1992 and 2004 the biopsy was informed as "minimal adenocarcinoma". These patients ranged 58 to 73 years with PSA levels from 5.2 to 17.1 ng/ml. Everyone except one were clinically T1c. At the definitive pathological study the Gleason was 6, 4, 3 and 2 in 3, 3, 8 and 4 patients respectively, with one having a minimal adenocarcinoma not graded and another one with a PIN ?. 3 showed only 1 focus with a tumoral volume less than 5% of the tissue (84.2% with significant tumor or multifocal). The final staging was 1 pT0 (PIN ?), 7 pT2a, 11 pT2b and 1 pT3a (62.5% bilaterals). Relating to the remaining patients under prostatectomy, patients with minimal adenocarcinoma presented significative differences in Gleason sum (p < 0.029) and staging (p = 0.02); no in PSA mean (p = 0.243). SUMMARY: Minimal adenocarcinomas of the prostate at the biopsy are significant but do present lower staging and grading in relation with the rest of patients.

Adenocarcinomas mínimos de próstata en la biopsia sometidos a prostatectomía radical / Minimal prostatic adenocarcinomas in the biopsy treated with radical prostatectomy

Fundamento: Valoración de datos clínico-patológicos de pacientes sometidos a prostatectomía radical por mínimo adenocarcinoma prostático en la biopsia. Métodos: Análisis retrospectivo de pacientes intervenidos de prostatectomía radical por mínimo adenocarcinoma, frente al resto de prostatectomías radicales. Resultados: En 20 pacientes (7,6 %), de los 260 sometidos a prostatectomía radical entre 1992 y 2004, se definió la biopsia como 'mínimo adenocarcinoma'. Tenían edades entre 58 y 73 años y los PSA entre 5,2 y 17,1 ng/ml. Todos, excepto uno eran clínicamente T1c. En la anatomía-patológica definitiva el Gleason fue de 6, 4, 3 y 2, en 3, 3, 8 y 4 pacientes respectivamente, con uno con mínimo adenocarcinoma no graduado y sólo un PIN-III en otro. Tres presentaron un solo foco con un volumen tumoral inferior al 5% del tejido (el 84,2 % con tumor significativo). El estadio final fue 1 pT0 (PIN III), 7 pT2a, 11 pT2b y 1 pT3a (62,5% bilaterales). Con respecto al resto de pacientes prostatectomizados, los pacientes con mínimo adenocarcinoma presentaron diferencias significativas en los Gleason (p=0,029) y los estadios (p= 0,02); no en la media del PSA (p=0,243). CONCLUSIONES: Los adenocarcinomas de próstata mínimos en la biopsia son significativos, aunque presentan estadios y grados inferiores al resto (AU)

Fundamentals: Valuation about clinical pathologyc facts of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy. Methods: Retrospective analysis of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy in front of the remaining radical prostatectomies. Results: In 20 patients (7,6%) out of the 260 having undergone a radical prostatectomy between 1992 and 2004 the biopsy was informed as 'minimal adenocarcinoma'. These patients ranged 58 to 73 years with PSA levels from 5.2 to 17.1 ng./ml. Everyone except one were clinically T1c. At the definitive pathological study the Gleason was 6, 4, 3 and 2 in 3, 3, 8 and 4 patients respectively, with one having a minimal adenocarcinoma not graded and another one with a PIN III. 3 showed only 1 focus with a tumoral volume less than 5% of the tissue (84.2% with significant tumor or multifocal). The final staging was 1 pT0 (PIN III ), 7 pT2a, 11 pT2b and 1 pT3a (62.5% bilaterals). Relating to the remaining patients under prostatectomy, patients with minimal adenocarcinoma presented significative differences in Gleason sum (p < 0.029) and staging (p = 0.02); no in PSA mean (p =0,243). Summary: Minimal adenocarcinomas of the prostate at the biopsy are significant but do present lower staging and grading in relation with the rest of patients (AU)

[Ambulatory major surgery: our experience]. / Cirugía mayor ambulatoria: nuestra experiencia.

INTRODUCTION: The first Surgery Ambulatory Unit was created in 1990, at the Hospital de Viladecans although in 1982 Polo et al. had commenced a programme of strictly ambulatory surgery. The Spanish Services of Urology are going to be incorporated to this new style of labour, and, by the moment, with excellent results. MATERIAL AND METHODS: We realize a description of the functioning of our service inside the Unit of Ambulatory Major Surgery, and a descriptive analysis of our activity in above mentioned unit since February 2000(creation date) to May 2001. RESULTS: 118 patients were operated, being 15% women and 85% men. The most frequent surgery done were: hydrocelectomy, orchiopexy, varicocelectomy, vesical distensions, Nesbit technique and internal urethrotomy. From the whole of the patients, none was increased, and the complication tax was similar to the conventional surgery patients. This kind of surgery suppose 17% in 2000 and 19% in 2001 of the whole of surgery, with clear increasing tendency in the last months. CONCLUSIONS: The Ambulatory Major Surgery is an effective and efficient care pattern in which Urology Services are included, so that the degree of satisfaction of the patients and the quality offered is similar to the inpatient surgery.

Cirugía mayor ambulatoria: nuestra experiencia / Ambulatory major surgery: Our experience

INTRODUCCIÓN: La primera Unidad de Cirugía sin Ingreso se creó en 1990 en el hospital de Villadecans, aunque ya en 1982 Polo y cols., comenzaron un programa de intervenciones estrictamente ambulatorias. Los servicios de Urología españoles se van incorporando poco a poco a este nuevo estilo de trabajo y de momento con excelentes resultados. MATERIAL Y MÉTODOS: Realizamos una descripción del funcionamiento de nuestro servicio dentro de la Unidad de Cirugía Mayor Ambulatoria (CMA) y un análisis descriptivo de nuestra actividad en dicha unidad desde febrero de 2000 (fecha de creación) hasta mayo de 2001. RESULTADOS: Se intervienen a 118 pacientes. Siendo 15 per cent mujeres y el 85 per cent hombres. Las intervenciones realizadas más frecuentes fueron: hidrocelectomías, orquidopexias, varicocelectomías, distensiones vesicales, técnica de Nesbit y uretrotomías internas. De todos los pacientes intervenidos ninguno requirió ingreso y el índice de complicaciones fue similar a los pacientes operados en régimen de cirugía convencional. Estas intervenciones suponen el 17 per cent en el año 2000 y el 19 per cent en el 2001 con una clara tendencia a aumentar en los últimos meses. CONCLUSIONES: La CMA es un modelo asistencial eficaz y eficiente en el cual los servicios de urología tienen cabida dado que el grado de satisfacción de los pacientes y la calidad que ofrece es igual que la cirugía con ingreso. INTRODUCCIÓN: La primera Unidad de Cirugía sin Ingreso se creó en 1990 en el hospital de Villadecans, aunque ya en 1982 Polo y cols., comenzaron un programa de intervenciones estrictamente ambulatorias. Los servicios de Urología españoles se van incorporando poco a poco a este nuevo estilo de trabajo y de momento con excelentes resultados. MATERIAL Y MÉTODOS: Realizamos una descripción del funcionamiento de nuestro servicio dentro de la Unidad de Cirugía Mayor Ambulatoria (CMA) y un análisis descriptivo de nuestra actividad en dicha unidad desde febrero de 2000 (fecha de creación) hasta mayo de 2001. RESULTADOS: Se intervienen a 118 pacientes. Siendo 15 per cent mujeres y el 85 per cent hombres. Las intervenciones realizadas más frecuentes fueron: hidrocelectomías, orquidopexias, varicocelectomías, distensiones vesicales, técnica de Nesbit y uretrotomías internas. De todos los pacientes intervenidos ninguno requirió ingreso y el índice de complicaciones fue similar a los pacientes operados en régimen de cirugía convencional. Estas intervenciones suponen el 17 per cent en el año 2000 y el 19 per cent en el 2001 con una clara tendencia a aumentar en los últimos meses. CONCLUSIONES: La CMA es un modelo asistencial eficaz y eficiente en el cual los servicios de urología tienen cabida dado que el grado de satisfacción de los pacientes y la calidad que ofrece es igual que la cirugía con ingreso (AU)

[Inverted papilloma of the prostatic urethra]. / Papiloma invertido de uretra prostática.

The inverted papilloma is a rare urothelial tumor, and its localization at the prosthatic urethra is also exceptional. We present a case of inverted papilloma of the prostatic urethra in a 72 years-old male, with symptoms of urinary flow obstruction. The diagnose is obtained after urethrocistoscopy and transurethral resection at the same time. We discuss about the etiology, clinical presentation, diagnose and treatment of this rare tumor, making special attention to its malignancy ability.

Papiloma invertido de uretra prostática / Inverted papilloma of the prostatic urethra

El papiloma invertido es un raro tumor urotelial, y su localización en uretra prostática también es excepcional. Presentamos un caso de papiloma invertido de uretra prostática en un varón de 72 años con clínica de obstrucción al flujo urinario. El diagnóstico se obtuvo tras uretrocistoscopia y resección transuretral en el mismo acto. Discutimos sobre la etiología, forma de presentación clínica, diagnóstico y tratamiento de este raro tumor, haciendo especial hincapié en su capacidad de malignización (AU)

[Small renal cell carcinoma of the prostate with cerebral metastasis]. / Carcinoma de célula pequeña de próstata con metástasis cerebral.

Presentation of one case of non-differentiated small cell prostate carcinoma, not associated to adenocarcinoma, in a male patient diagnosed with Benign Prostate Hyperplasia and Lymphoproliferative Syndrome, seen at the clinic due to worsening of mictional symptomatology. The diagnosis of non-differentiated carcinoma was reached through transrectal biopsy of a prostate node. Initial staging after diagnosis was T4a, N2, M1c (TNM, 1992), as liver and brain metastasis were already present. No bone or lung involvement was found. Specific Prostate Antigen value was 7.4 ng/ml, Carcino-Embryonary Antigen (CAE) was normal and ACTH slightly elevated. Differential diagnosis was primarily established with lymphoma. Using immunohistochemical techniques, the tumoral cells were positive for low molecular weight Keratin (CAM 5.2) and specific neuronal Enolase; negative for specific prostate antigen, prostate acid phosphatase, common leucocyte antigen and ACTH. The initial treatment consisted in one course of carboplatin plus VP-16 chemotherapy. The patient died six months after diagnosis.

[First results of our experience with the Fabian's prosthesis]. / Primeros resultados de nuestra experiencia con la prótesis de Fabián.

Report on our experience with Fabian's prothesis as alternative therapy to benign prostate hyperplasia (B.P.H.) surgery. Throughout 1990 ten patients with various surgical contraindications were implanted the above device. In spite of the series small size (10 patients) and short follow-up (4 to 11 months), we believe the 70% good results obtained is very encouraging and can either be of help to banish the ominous indwelling vesical catheter, a permanent evidence of Urologists' failure in the prostate obstructive disease, or it will allow us to relief patients with B.P.H. non-secondary to other more aggressive therapies.

[Calcifications in renal adenocarcinoma. Image assessment in 17 cases]. / Estudio de las calcificaciones en el adenocarcinoma renal. Valoración de las imágenes en 17 casos.

Of 60 renal adenocarcinoma tumors that had been diagnosed at our hospital between 1984 and 1990, 17 had presented intratumoral calcification. These 17 tumors with calcification were studied to assess the sensitivity of different techniques relative to detection, localization and morphologic characterization of the calcifications. We can conclude from the study that the use of CT and US not only raised detection rate (28%), but also permitted more precise evaluation of the calcified tumor mass. Furthermore, tumor spread beyond the calcified area was found to be a sign of malignancy.

[Cutaneous metastasis of epithelioid sarcoma of the penis: report of a case]. / Metástasis cutánea de un sarcoma epitelioide de pene: a propósito de un caso.

Exposition of one case of skin metastasis in a 35 year-old patient, diagnosed 10 years previously with epithelioid sarcoma of the penis, which was treated with total penectomy. The singularity of this case lies in the rarity of a pineal site for this tumour, as well as the infrequency of the skin metastasis. It should be noted the significance of long-term follow-up in this patients, since quite frequently they develop metastasis following a long asymptomatic period.

[Wunderlich disease. First manifestation of a renal adenocarcinoma]. / Enfermedad de Wünderlich. Primera manifestación de un adenocarcinoma renal.

We present a case of the classical Wünderlich syndrome or circumscribed extracapsular renal hematoma in a 54-year-old male patient who had consulted for an inguinal mass and hemiscrotal ecchymosis. The patient had referred an episode of intense pain in the left renal fossa and the clinical picture of syncope 3-4 days earlier. Surgery disclosed severe perirenal hemorrhage from an undiagnosed renal adenocarcinoma that had ruptured.

[Giant hydronephrosis: conservative treatment by endopyelotomy]. / Hidronefrosis gigante: tratamiento conservador mediante endopielotomía.

A case of giant hydronephrosis in the right kidney and inferior pelvis of the left kidney in a 60-years-old female patient with nonspecific abdominal symptoms and signs is reported. Because involvement was bilateral and the patient insisted on conservative treatment, we performed a bilateral percutaneous endopyelotomy. The excellent results achieved were demonstrated by ultrasound. This however was not true for the functional results due to the irreversible renal lesion.

[Percutaneous endo-retro-pyelotomy: an elective treatment method in stenosis of the uretero-pelvic junction]. / Endoureteropielotomía percutánea: un tratamiento de elección en las estenosis de la UPU.

Fifteen adult patients diagnosed as having congenital stricture of the ureteropelvic junction were treated by percutaneous endoureteropyelotomy. Our results were clinically satisfactory in 85.7% (excellent acured 57.1%, good/with occasional mild discomfort 28.5%). Radiologically, 64.2% were normal and 14.2% had mild ectasia but good renal function. No clinical improvement was observed in 14.2% and 21.4% had persistent hydronephrosis indicating the procedure had failed. The most important complication was intraoperative hemorrhage from effraction of an inferior polar artery which required a conventional lumbotomy procedure and Anderson-Hynes pyeloplasty. The foregoing results, with the limitations inherent in data from a small series, indicate that endoureteropyelotomy is the procedure of choice in the treatment of congenital UPJ strictures in the adult patient.