Physical exam in the evaluation of bladder pain syndrome (BPS): A key component for differential diagnosis. / La exploración física en la evaluación del síndrome de dolor vesical (SDV): un importante elemento para la orientación terapéutica.

OBJECTIVES: To describe in more detail the usual clinical practice regarding physical examination (PE) in Bladder Pain Syndrome (BPS) and to evaluate if the performance of PE relates to changes in severity of symptoms and in Health Related Quality of Life (HRQoL). MATERIAL AND METHODS: Epidemiological, observational, national and multicentric study that included 319 patients with BPS (79 of new diagnosis and 240 in follow-up). Demographic and clinical data were collected. The diagnostic study was performed according to the usual clinical practice, including as the case: PE and biopsy. The patients completed the "Bladder Pain/Interstitial Cystitis Symptom Score" (BPIC-SS) and "EuroQoL-5D-5L" (EQ-5D-5L) questionnaires. To describe the continuous variables, the mean, standard deviation (SD) and quartiles analyzed were used, and for categorical variables, number and percentage of patients by response category. The questionnaires' results were described according to the visual analog scale (VAS). Health status was evaluated in patients with myofascial pain. RESULTS: PE was performed in 296 cases. 28.4% of the patients presented pelvic myofascial pain. The variation of the BPIC-SS score in the explored patients was 7.77 points, compared to 1.73 in the unexplored ones. The variations in EQ-5D-5L were 0.13 and 0.04 points, respectively. CONCLUSIONS: Myofascial involvement was observed in 28.4% of the 296 cases of BPS who receiveda PE. It is important to implement a systematic, comprehensive method of PE at the national level in order to achieve a more precise characterization of BPS and a better evolution of the patient's symptoms and HRQoL.

OBJETIVOS: Conocer en mayor detalle la práctica clínica habitual de la exploración física (EF) del Síndrome de Dolor Vesical (SDV) y evaluar los cambios en síntomas y Calidad de Vida Relacionada con la Salud (CVRS) según los resultados de la EF.MATERIAL Y MÉTODOS: Estudio epidemiológico, observacional, nacional y multicéntrico que incluyó 319 pacientes con SDV (79 de nuevo diagnóstico y 240 en seguimiento). Se recogieron datos demográficos y clínicos. El estudio diagnóstico se realizó según práctica  clínica habitual, incluyendo según el caso: EF y biopsia. Las pacientes cumplimentaron los cuestionarios "BladderPain/Interstitial Cystitis-Symptom Score" (BPIC-SS) y "EuroQoL-5D-5L" (EQ-5D-5L). Para describir las variables continuas se utilizaron la media, desviación estándar (DE) y cuartiles analizados y para las cualitativas, el número y porcentaje de pacientes por categoría de respuesta. Los resultados de los cuestionarios se describieron según la escala visual analógica (EVA). Se evaluó el estado de salud en pacientes con dolor miofascial. RESULTADOS: Se realizó EF en 296 casos. El 28,4% de los pacientes presentaban dolor miofascial. La variación de la puntuación BPIC-SS en los pacientes explorados fue de 7,77 puntos, en comparación con los 1,73 en los no explorados. Las variaciones en EQ-5D-5L fueron 0,13 y 0,04 puntos, respectivamente. CONCLUSIONES: La implicación miofascial se observó en el 28,4% de los 296 casos de SDV sometidos a EF. Es importante implementar un método sistemático e integral de EF a nivel nacional para lograr una caracterización más precisa del SDV y una mejor evolución de los síntomas y CVRS del paciente.

La exploración física en la evaluación del síndrome de dolor vesical (SDV): un importante elemento para la orientación terapéutica / Physical exam in the evaluation of bladder pain syndrome (BPS): A key component for differential diagnosis

OBJETIVOS: Conocer en mayor detalle la práctica clínica habitual de la exploración física (EF) del Síndrome de Dolor Vesical (SDV) y evaluar los cambios en síntomas y Calidad de Vida Relacionada con la Salud (CVRS) según los resultados de la EF. MATERIAL Y MÉTODOS: Estudio epidemiológico, observacional, nacional y multicéntrico que incluyó 319 pacientes con SDV (79 de nuevo diagnóstico y 240 en seguimiento). Se recogieron datos demográficos y clínicos. El estudio diagnóstico se realizó según práctica clínica habitual, incluyendo según el caso: EF y biopsia. Las pacientes cumplimentaron los cuestionarios "BladderPain/Interstitial Cystitis-Symptom Score" (BPIC-SS) y "EuroQoL-5D-5L" (EQ-5D-5L). Para describir las variables continuas se utilizaron la media, desviación estándar (DE) y cuartiles analizados y para las cualitativas, el número y porcentaje de pacientes por categoría de respuesta. Los resultados de los cuestionarios se describieron según la escala visual analógica (EVA). Se evaluó el estado de salud en pacientes con dolor miofascial. RESULTADOS: Se realizó EF en 296 casos. El 28,4% de los pacientes presentaban dolor miofascial. La variación de la puntuación BPIC-SS en los pacientes explorados fue de 7,77 puntos, en comparación con los 1,73 en los no explorados. Las variaciones en EQ-5D-5L fueron 0,13 y 0,04 puntos, respectivamente. CONCLUSIONES: La implicación miofascial se observó en el 28,4% de los 296 casos de SDV sometidos a EF. Es importante implementar un método sistemático e integral de EF a nivel nacional para lograr una caracterización más precisa del SDV y una mejor evolución de los síntomas y CVRS del paciente

OBJECTIVES: To describe in more detail the usual clinical practice regarding physical examination (PE) in Bladder Pain Syndrome (BPS) and to evaluate if the performance of PE relates to changes in severity of symptoms and in Health Related Quality of Life (HRQoL). MATERIAL AND METHODS: Epidemiological, observational, national and multicentric study that included 319 patients with BPS (79 of new diagnosis and 240 in follow-up). Demographic and clinical data were collected. The diagnostic study was performed according to the usual clinical practice, including as the case: PE and biopsy. The patients completed the "Bladder Pain/ Interstitial Cystitis Symptom Score" (BPIC-SS) and "EuroQoL- 5D-5L" (EQ-5D-5L) questionnaires. To describe the continuous variables, the mean, standard deviation (SD) and quartiles analyzed were used, and for categorical variables, number and percentage of patients by response category. The questionnaires' results were described according to the visual analog scale (VAS). Health status was evaluated in patients with myofascial pain. RESULTS: PE was performed in 296 cases. 28.4% of the patients presented pelvic myofascial pain. The variation of the BPIC-SS score in the explored patients was 7.77 points, compared to 1.73 in the unexplored ones. The variations in EQ-5D-5L were 0.13 and 0.04 points, respectively. CONCLUSIONS: Myofascial involvement was observed in 28.4% of the 296 cases of BPS who received a PE. It is important to implement a systematic, comprehensive method of PE at the national level in order to achieve a more precise characterization of BPS and a better evolution of the patient's symptoms and HRQoL

Position of Ibero-American Society of Neurourology and UroGynecology (SINUG) on the use of vaginal meshes in pelvic organ prolapse.

AIMS: Pelvic organ prolapse (POP) is a very prevalent condition with a great impact on women's quality of life. At present, there is great controversy regarding the use of mesh in POP surgery. To understand the current moment, it is advisable to make a brief summary of the historical evolution of mesh use for pelvic floor pathology. The aim of this paper is to establish the position of the Ibero-American Society of Neurourology and UroGynecology (SINUG for its acronym in Spanish) regarding vaginal mesh reconstructive surgery. METHODS: A working committee from the SINUG's scientific board performed a literature search about the use of vaginal meshes for pelvic organ prolapse reconstructive surgery and about the position of different societies. We analyzed the evolution into three periods: before the Food and Drug Administration (FDA) statement, FDA statement, and after the statement. SINUG drew up a position statement regarding vaginal mesh reconstructive surgery, based on the available scientific evidence and the evolution of its use in different contexts. RESULTS: Before mesh appearance in the 1990s, native tissue repair was the surgical treatment of choice for POP. Vaginal mesh reconstructive surgery has been frequently accompanied by procedure underestimation by inexperienced surgeons, besides inadequate diagnoses and indications. This situation led to the presentation of serious complications including mesh extrusion, exposure, and contraction. CONCLUSIONS: Once reviewed the available evidence and the position of different societies, SINUG presents its vision in this communication, which is a summary of the document prepared by the society's scientific board.

Position of the Ibero-American Society of Neurourology and Urogynecology in relation to the use of synthetic suburethral meshes for the surgical treatment of female stress incontinence.

AIMS: The aim of this paper is to stablish de position of the Ibero-American Society of Neurourology and Urogynecology (SINUG) in relation to the use of suburethral meshes for the surgical treatment of female stress incontinence. METHODS: Tension-free mid-urethral slings (MUS) have become the most popular procedure for the treatment of stress urinary incontinence (SUI). In July 2018, the British government announced a pause in the use of meshes for both pelvic organ prolapse (POP) and urinary incontinence (UI) treatment without differentiating whether the meshes were used for treating UI or POP. The decision was taken to stop their use until the publication of the updated UI and POP guidelines of the British National Health Service, which is available from April 2019. SINUG has reviewed the evidence and official position of different societies in relation to the safety and efficacy of MUS in the surgical treatment of incontinence differentiating them from meshes used to repair POP. RESULTS: Data from synthetic mesh manufacturers indicate that in 2010, 300 000 women underwent surgical procedures to repair POP and approximately 260 000 were operated on for SUI. According to these estimates, approximately more than 80% of the surgical techniques for UI treatment were performed transvaginally with meshes. CONCLUSIONS: Once reviewed evidence and position of different societies, the SINUG presents its vision in this communication, which is a summary of the document analysing the state of topic prepared by the society.

Prostatectomía radical laparoscópica extraperitoneal. Experiencia preliminar / Extra peritoneal laparoscopic radical prostactectomy. Preliminary results

OBJETIVOS: Presentar nuestra experienciainicial en la práctica de la prostatectomía radicallaparoscópica por via extraperitoneal. Se describe latécnica quirúrgica y se revisan las dificultades técnicas,los costes de tiempo y las complicaciones.MÉTODOS: Entre Enero y Mayo de 2005 hemos indicado17 prostatectomías radicales laparoscópicas porvia extraperitoneal en nuestro centro. Dos de ellas serealizaron con ayuda de un maestro. La técnica empleada,de la que se hace una somera descripción, es lade Bruselas.RESULTADOS: De las 17 cirugías, se ha completado elprocedimiento íntegramente por laparoscopia en ochocasos. De los casos realizados sin ayuda externa y queson los que se analizan en este trabajo, 6 han sido íntegramentelaparoscópicos y 9 han requerido reconversión a cirugía abierta. De los últimos 6 únicamente sereconvirtió 1. El tiempo quirúrgico medio ha sido 304minutos (355 para las completadas por laparoscopia).La tasa de transfusión es del 13% . Los márgenes positivoshan sido del 26% (16% en los laparoscópicospuros). No ha habido complicaciones mayores ni íleosparalíticos prolongados. En un caso se tuvo que recolocarla sonda a los 7 días de la intervención. La reconversiónde la vía extraperitoneal a cirugía abierta no escompleja al no estar abierta la cavidad peritoneal perorequiere de experiencia previa en cirugía abierta puestoque los planos no se observan con facilidad.CONCLUSIONES: La prostatectomía radical laparoscópicaextraperitoneal es factible en un centro de nuestrascaracterísticas siempre y cuando se disponga deun equipo con experiencia previa en laparoscopia yse este dispuesto a invertir un considerable esfuerzoespecialmente en lo que respecta al número de horasde quirófano. El aprendizaje no se ha traducido encomplicaciones importantes

OBJECTIVES: Presentation of our initial experience with the practice of the laparoscopic radical prostatectomy through the extraperitoneal access (ELRP). We describe the proceeding and its technical difficulties, time consumption and complications. METHODS: From January to May 2005 we have indicated 17 ELRP in our institution. Two of them were performed with the help of a mentor. We followed the Brussels technique but without preservation of the neuro vascular bundles. RESULTS: Laparoscopic approach was indicated in 17 patients, 8 of them were completed and 9 converted to open surgery. Of the cases performed without external aid (which are the analysed in this communication), 6 were pure laparoscopic and 9 were permuted to open. Of the last 6, only one was not completed by laparoscopy. Mean operative time was 304 minutes (355 for the pure laparoscopy cases). Transfusion rate was 13%. Positive surgical margins were observed in 26% of the cases (16% of the complete laparoscopic procedures). There were not major complications. Not ileus was observed. In one case, bladder catheter had to be replaced after 7 days because it was not properly placed during surgery. Conversion to open surgery during extraperitoneal laparoscopic proceeding is not very difficult but previous surgical experience is required. CONCLUSIONS: ELPR is feasible in an institution like ours but is necessary a team with previous experience in laparoscopic surgery and the aim of invest a big effort, specially regarding operative time. Initial learning curve has not caused any important complication

[Extra peritoneal laparoscopic radical prostatectomy. Preliminary results]. / Prostatectomía radical laparoscopica extraperitoneal. Experiencia preliminar.

OBJECTIVES: Presentation of our initial experience with the practice of the laparoscopic radical prostatectomy through the extraperitoneal access (ELRP). We describe the proceeding and its technical difficulties, time consumption and complications. METHODS: From January to May 2005 we have indicated 17 ELRP in our institution. Two of them were performed with the help of a mentor. We followed the Brussels technique but without preservation of the neuro vascular bundles. RESULTS: Laparoscopic approach was indicated in 17 patients, 8 of them were completed and 9 converted to open surgery. Of the cases performed without external aid (which are the analysed in this communication), 6 were pure laparoscopic and 9 were permuted to open. Of the last 6, only one was not completed by laparoscopy. Mean operative time was 304 minutes (355 for the pure laparoscopy cases). Transfusion rate was 13%. Positive surgical margins were observed in 26% of the cases (16% of the complete laparoscopic procedures). There were not major complications. Not ileus was observed. In one case, bladder catheter had to be replaced after 7 days because it was not properly placed during surgery. Conversion to open surgery during extraperitoneal laparoscopic proceeding is not very difficult but previous surgical experience is required. CONCLUSIONS: ELPR is feasible in an institution like ours but is necessary a team with previous experience in laparoscopic surgery and the aim of invest a big effort, specially regarding operative time. Initial learning curve has not caused any important complication.