[Long-term results of a phase III multicentre trial of the adjustable male sling for treating urinary incontinence after prostatectomy: minimum 3 years]. / Resultados a largo plazo del estudio multicéntrico fase III del tratamiento de la incontinencia de orina post prostatectomía con un sling masculino ajustable: seguimiento mínimo 3 años.

OBJECTIVE: To communicate long-term results of the multicentre phase III trial post-prostatectomy urinary incontinence (PPI) treated with an adjustable male sling. PATIENTS AND METHODS: 48 PPI patients were included in this trial from April 2003 to September 2004. 39 post radical prostatectomy and 9 post adenomectomy. 19 wore 5 pads per day (3-8) each weight 83 gr (17-198). 29 wore condom catheter or penile clamp The Argus was implanted through perineal approach. Using needles, the sling was transferred to the abdominal wall where it was adjusted by washers. The adjustment was done with retrograde urethral pressure from 45 to 55 cm water. Clinical data were updated till September 2007. The mean follow-up was 45 months (36-54) and median age was 67 years (52-77). The evaluation was: the ICIQ-SF score and qualification as Dry: no pads, Improved: 1 pad and Failed: 2 or more pads in 24 hr, including those with slings removed. RESULTS: 47 were evaluated, resulting: 31 (66%) Dry, 6 (12.8%) Improved and 10 (21%) Failed. The ICIQ-SF score changed from 19.5 to 6. Of the 31 dry pts, 5 required one adjustment. 10 pts failed, 9 after sling removal, 6 due to erosion and 3 for infection. One patient failed with the sling in place, 6 erosions were registered: 4 in the urethra, 1 into the bladder and 1 through the abdominal wall. Perineal pain persisted in 2. One patient was excluded, died in September 2006. CONCLUSIONS: Argus has demonstrated its efficacy in long- term follow-up. The social continence rate was about 80%. The important complication was erosion or infection.

Resultados a largo plazo del estudio multicéntrico fase III del tratamiento de la incontinencia de orina post prostatectomía con un sling masculino ajustable: seguimiento mínimo 3 años / Long term results of a phase III multicentre trial of the adjustable male sling for treating urinary incontinence after prostatectomy: minimum 3 years

Objetivo: Comunicar los resultados a largo plazo del estudio multicéntrico fase III del tratamiento de la incontinencia post- prostatectomía (IPP) con un Sling masculino ajustable (Argus®) 1.Pacientes y métodos: 48 pacientes con IPP, 39 post radical y 9 post adenomectomía, ingresaron entre abril de 2003 y septiembre de 2004. 19 usaban 5 paños por día (3-8) pesando 83 gr. (17-198) por paño. 29 usaban clamp peniano o colector externo. El seguimiento promedio fue de 45 meses (36 -54). La edad fue de 67años (52-77). Fueron evaluados con el cuestionario ICIQ-SF y la calificación de seco (sin paños), mejora (1 paño) y falla (2 o más paños en 24 hs), incluyéndose a los slings extraídos. El Argus se implantó por vía perineal, transfiriéndolo con agujas al abdomen para ser ajustado y fijado con arandelas. El ajuste se realizó por presión uretral retrograda (PUR) entre 45 y 55cm de agua. Resultados: Evaluamos 47 de 48 pacientes (1, falleció antes de 3 años) resultando secos, mejorados y fallados, 31(66%), 6 (12.8%)y 10 (21%) respectivamente. ICIQ-SF cambió de 19,5 a 6 (1-21). 5 de 31 secos, debieron reajustarse una vez. Fallaron 10 pacientes: 9 Argus retirados: 6 (12,8%) por erosión, 3 (6,2%) por infección y 1 usa 3 paños diarios. Hubieron 6 erosiones: 4 uretrales, 1 vesical y 1 parietal abdominal. El dolor persistió en 2 casos. Las complicaciones menores se resolvieron espontáneamente antes de2 meses. Conclusiones: El Argus® demostró ser eficaz en el control de la IPP en el largo plazo en casi el 80% de los pacientes evaluados. La infección y la erosión fueron las complicaciones más importantes y los desafíos a resolver (AU)

Objective: To communicate long- term results of the multicentre phase III trial post-prostatectomy urinary incontinence (PPI) treated with an adjustable male sling1.Patients and Methods: 48 PPI patients were included in this trial from april 2003 to september 2004. 39 post radical prostatectomy and 9 post adenomectomy. 19 wore 5 pads per day (3-8) each weight 83gr (17-198). 29 wore condom catheter or penile clamp. The Argus was implanted through perineal approach. Using needles, the sling was transferred to the abdominal wall where it was adjusted by washers. The adjustment was done with retrograde urethral pressure from 45 to 55 cm water. Clinical data were updated till September 2007. The mean follow-up was 45 months (36-54) and median age was 67 years (52-77). The evaluation was: the ICIQ-SF score and qualification as Dry: no pads, Improved: 1 pad and Failed: 2 or more pads in 24 hr, including those with slings removed. Results: 47 were evaluated, resulting: 31 (66%) Dry, 6 (12.8%) Improved and 10 (21%) Failed. The ICIQ-SF score changed from 19.5to 6. Of the 31 dry pts, 5 required one adjustment. 10 pts failed, 9 after sling removal, 6 due to erosion and 3 for infection. One patientfailed with the sling in place, 6 erosions were registered: 4 in the urethra, 1 into the bladder and 1 through the abdominal wall. Perineal pain persisted in 2. One patient was excluded, died in September 2006.Conclusions: Argus® has demonstrated its efficacy in long- term follow-up. The social continence rate was about 80%. The important complication was erosion or infection (AU)

Painless inter epididymal testicular torsion of the spermatic cord.

Inter epididymal testicular torsion of the spermatic cord is extremely rare and usually diagnosed at surgery. We present an unusual case of spermatic cord torsion in a 14-year-old male patient. It is important to highlight that the torsion occurred only on the distal half of the epididymis leaving the head untwisted and edematous. In addition, the fact that this condition was painless made this case extremely rare and motivated our presentation.

Painless inter epididymal testicular torsion of the spermatic cord

Inter epididymal testicular torsion of the spermatic cord is extremely rare and usually diagnosed at surgery. We present an unusual case of spermatic cord torsion in a 14-year-old male patient. It is important to highlight that the torsion occurred only on the distal half of the epididymis leaving the head untwisted and edematous. In addition, the fact that this condition was painless made this case extremely rare and motivated our presentation.

Resultados significativamente superiores en continencia y micción con la neovejiga colónica derecha parcialmente destubulizada. Trece años de experiencia / Results in continence and micturition remarkably superior with a right colonic neobladder with partial detubulization. Thirteen years of experience

Objetivos: Mostrar luego de 13 años de experiencia contínua, los resultados en lo que a continencia y micción se refiere de la neovejiga colónica derecha, como así también los fundamentos fisiológicos y urodinámicos de los mismos. Materiales y Métodos: Entre febrero de 1993 y marzo de 2006 a 43 pacientes cistectomizados, por presentar cáncer de vejiga, se les reconstruyo el tracto urinario inferior utilizando un reservorio construido con colon derecho destubulizado y reconfigurado y ciego intacto. A todos los pacientes se les realizo cistografías al retirar el catéter uretral, a 32 estudios urodinámicos y a 5 videourodinámicos. Resultados: Cuarenta y un pacientes (95,4 porciento) orinan con un flujo máximo de más de 25 ml/seg. La continencia diurna y nocturna fue completa e inmediata en el 97 porciento y 93 porciento respectivamente, un paciente requiere cateterismo intermitente, otro permanece incontinente y los dos restantes lograron continencia nocturna satisfactoria. Se define como continencia completa e inmediata al control de la orina sin necesidad de usar paño protector desde el momento en que se retira el catéter uretral, satisfactoria al uso de no mas de un pañal por día y micción espontánea y efectiva a la evacuación del reservorio con un flujo medio de 10 ml/seg. sin residuo postmiccional. Conclusión: Los resultados con esta nueva neovejiga colónica derecha, en lo que a continencia y micción se refiere, son significativamente superiores a los logrados con otros procedimientos descriptos en la literatura

Resultados significativamente superiores en continencia y micción con la neovejiga colónica derecha parcialmente destubulizada. Trece años de experiencia / Results in continence and micturition remarkably superior with a right colonic neobladder with partial detubulization. Thirteen years of experience

Objetivos: Mostrar luego de 13 años de experiencia contínua, los resultados en lo que a continencia y micción se refiere de la neovejiga colónica derecha, como así también los fundamentos fisiológicos y urodinámicos de los mismos. Materiales y Métodos: Entre febrero de 1993 y marzo de 2006 a 43 pacientes cistectomizados, por presentar cáncer de vejiga, se les reconstruyo el tracto urinario inferior utilizando un reservorio construido con colon derecho destubulizado y reconfigurado y ciego intacto. A todos los pacientes se les realizo cistografías al retirar el catéter uretral, a 32 estudios urodinámicos y a 5 videourodinámicos. Resultados: Cuarenta y un pacientes (95,4 porciento) orinan con un flujo máximo de más de 25 ml/seg. La continencia diurna y nocturna fue completa e inmediata en el 97 porciento y 93 porciento respectivamente, un paciente requiere cateterismo intermitente, otro permanece incontinente y los dos restantes lograron continencia nocturna satisfactoria. Se define como continencia completa e inmediata al control de la orina sin necesidad de usar paño protector desde el momento en que se retira el catéter uretral, satisfactoria al uso de no mas de un pañal por día y micción espontánea y efectiva a la evacuación del reservorio con un flujo medio de 10 ml/seg. sin residuo postmiccional. Conclusión: Los resultados con esta nueva neovejiga colónica derecha, en lo que a continencia y micción se refiere, son significativamente superiores a los logrados con otros procedimientos descriptos en la literatura(AU)

An adjustable male sling for treating urinary incontinence after prostatectomy: a phase III multicentre trial.

OBJECTIVE: To evaluate the efficacy and safety of a new adjustable bulbourethral sling (Argus, Promedon SA, Cordoba, Argentina) in the treatment of male stress urinary incontinence (SUI) after prostate surgery. PATIENTS AND METHODS: In all, 48 patients with SUI because of prostatic surgery for prostate cancer (39) or benign prostatic hyperplasia (nine) had a new sling implanted in a multicentre trial at six institutions between April 2003 and September 2004. All patients were fully evaluated, including a questionnaire (International Consultation on Incontinence Questionnaire-Short Form, ICIQ-SF, range 0-21), endoscopy, and urodynamic evaluation. The Argus system comprises a 4.2 x 2.6 x 0.9 cm thick silicone foam pad for soft bulbar urethral compression. The pad is attached to the silicone cone columns that, after being passed with needles from the perineum to the abdominal wall, are adjusted with silicone washers to regulate and keep the desired tension against the urethra. The pad and washers are radio-opaque, which allows their position to be assessed during follow-up. The surgical technique was one described previously, with some modifications. RESULTS: At a mean (range) follow-up of 7.5 (1-17.5) months, 35 (73%) of the 48 patients were dry, five (10%) were improved, and eight (17%) were incontinent, including four (8%) who needed sling adjustment. The mean (range) ICIQ-SF improved from 19.2 (12-21) to 4 (0-21). There were three (6%) urethral perforations during surgery that were resolved by re-passing the needle. The sling was removed in three men (6%) due to erosion and in two (4%) due to infection. Seven (15%) cases of acute urinary retention resolved spontaneously, except for one that needed the sling loosening. No cases of chronic retention were reported. There was perineal discomfort and mild dysuria soon after surgery that resolved spontaneously after a few weeks. CONCLUSION: This new adjustable male sling safely and effectively controls sphincter incontinence in men after prostate surgery, with an acceptably low complication rate. The early results are encouraging; the Argus is a valid alternative to the artificial urinary sphincter, the standard therapy for this condition.

Total and immediate daytime and nighttime continence with a right colonic neobladder--What makes it possible? An 11-year followup.

PURPOSE: We report the long-term functional results of the colonic neobladder and provide the physiological and urodynamic foundations for them. MATERIALS AND METHODS: From March 1993 to February 2004, 38 patients with cystectomy received a neobladder constructed from detubularized, remodeled right colon and intact cecum following our design at the urology service at our institution. Most patients underwent urodynamics and videourodynamics as postoperative followup. We defined total continence as not using any protection whatsoever (neither pads nor a night alarm), which was immediate upon removing the urethral catheter. RESULTS: A total of 37 patients achieved total daytime continence immediately and the remaining 1 was totally continent after 30 days (100%). Nighttime continence was total and immediate in 36 patients (92%) and satisfactory in 2. Micturition was immediate, satisfactory and total in 37 patients with an average maximum flow of more than 26 ml per second. The patient who did not achieve micturition required clean intermittent catheterization. Videourodynamic studies revealed that continence resulted from the low pressure developed in the large capacity reservoir (more than 600 ml) and from intact intestine haustral contractions, which ejected urine toward the detubularized and remodeled area. In turn, micturition was attained through a combination of abdominal wall tension and mass contractions of the nondetubularized segment, which generated a pressure of more than 100 cm. CONCLUSIONS: The functional results of this new neobladder are significantly greater than those achieved with other procedures already described in the literature because of the different way in which it functions.