Anatomical outcomes and complications of sacrocolpopexy using Surelift Uplift mesh: A multicentric observational study.

OBJECTIVE: The study evaluated the anatomical and functional outcomes, as well as the safety data of laparoscopic sacrocolpopexy (LSC) for pelvic organ prolapse (POP) using a lightweight macroporous mesh. METHODS: A multicentric observational study was developed including five expert centers between March 2011 and December 2019. Inclusion criteria were female patients with symptomatic ≥stage II POP (POP-Q classification), who underwent a LSC. A lightweight and macroporous mesh device (Surelift Uplift) was used. Baseline anatomical positions were evaluated using POP-Q stage. The anatomical outcomes and procedural complications were assessed during the postoperative period. Primary outcomes were anatomical success, defined as POP-Q stage ≤I, and subjective success, defined as no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse. RESULTS: A total of 325 LSCs were analyzed with a median patient age of 66 (interquartile range [IQR] 61-73). After a median follow-up of 68 months (IQR 46.5-89), anatomical success was found in 88.9%, whereas subjective success was seen in 98.5% of the patients. Recurrent prolapse presented as cystocele (1.5%). Reported complications were bladder (4.6%) or rectum lesions (0.6%), de novo urinary incontinence (12.9%), and mesh extrusion (1.2%). CONCLUSIONS: LSC provides significant clinical improvement and excellent anatomical results, with a low risk of serious complications for women with ≥2 grade POP in a real clinical practice setting.

Comparative anatomy of the ovine and human pelvis for laparoscopic sacrocolpopexy: evaluating the effectiveness of the ovine model.

INTRODUCTION AND HYPOTHESIS: Laparoscopic sacrocolpopexy (LSC) is a functional reconstructive surgery used to treat pelvic organ prolapse (POP) in middle-aged women. Although LSC is widely used, its implementation is hindered by perceived technical difficulties and surgical learning curves. Surgeons require adequate experience with LSC prior to performing the procedure on patients to improve their quality of life. This study is aimed at demonstrating the effectiveness of the ovine model (OM) for training and research in LSC, while also comparing anatomical differences between ovine and human models during the procedure. METHODS: The animal model and training were provided by the Jesús Usón Minimally Invasive Surgery Centre. Urologists and gynecologists with experience in LSC participated in a course and their findings were recorded and documented. RESULTS: Differences in patient positioning, trocar placement, and reperitonealization were identified between the ovine and human models. Hysterectomy is always performed in the ovine model, whereas it is not mandatory in humans. There are also differences in the dissection of the levator ani muscle and attachment point of the posterior mesh to the uterus between the two models. Despite differences in some areas, the ovine pelvic structure and vagina are similar in size to those of humans. CONCLUSIONS: The ovine model is a valuable tool for surgeons in their learning curve for LSC, allowing for safe and effective practice prior to performing the procedure on patients. The use of the OM can help to improve the quality of life for women affected by pelvic organ prolapse.

[UPOINT phenotypic classification of a sample of female patients with bladder pain syndrome: Results of a national multicentric observational study.] / Clasificación fenotípica UPOINT de una muestra de mujeres con síndrome de dolor vesical: resultados de un estudio observacional multicéntrico nacional.

OBJECTIVES: To study the possibility of classifying patients with BPS by UPOINT phenotypes and their correlation with the results of different BPS diagnostic tools. MATERIAL AND METHODS: Epidemiological, observational, longitudinal and multicentric study performed according to clinical practice. A total of 319 women with BPS were included, 79 with new diagnosis and 240 in follow-up. Sociodemographic and clinical data were collected together with results of cystoscopy, biopsy and physical examination. Patients completed a 3-day Bladder Diary (3dBD) and Patient Reported Outcomes (PROs). All the patients were classified according to the 6 UPOINT domains and their distribution was described according to the clinical history, diagnostic tests, urinary symptoms and PROs' scores. RESULTS: 92.8% of the patients had affectation in more than one phenotype, however, there were no remarkable differences in the clinical and sociodemographic variables according to the number of affected domains. The percentage of patients with 3C classification was higher in the urinary (8.2%), organ-specific (9.0%) and neurological (10.9%) phenotypes. Around 90% had high voiding frequency, regardless of the phenotype. The improvement reported by the PROs was superior in the neurological and tenderness phenotypes. The worst scores were associated with a greater number of affected domains. CONCLUSIONS: The present study is the first one carried out in Spain on a phenotypic classification of women with BPS, with data from routine clinical practice. The results point out that patients with several domains affected present more affectation on the BPS, worse HRQo Land higher anxiety.

OBJETIVOS: Estudiar la posibilidad de clasificar a las pacientes con SDV por los fenotipos UPOINT y su correlación con los resultados de otras herramientas diagnósticas para SDV. MATERIAL Y MÉTODOS: Estudio epidemiológico, observacional, longitudinal y multicéntrico realizado según la práctica clínica habitual. Se incluyeron 319 mujeres con SDV, 79 de nuevo diagnóstico y 240 en seguimiento. Se recogieron datos sociodemográficos y clínicos y resultados de la cistoscopia, biopsia y exploración física. Las pacientes cumplimentaron un diario miccional de 3 días y los Patient Reported Outcomes (PROs). Todas las pacientes fueron clasificadas según los 6 dominios UPOINT y se describió su distribución según la historia clínica, pruebas diagnósticas, síntomas urinarios y las puntuaciones de los PROs. RESULTADOS: El 92,8% de las pacientes tenían afectación en más de un fenotipo, sin embargo, no hubo diferencias destacables en las variables clínicas y sociodemográficas según el número de dominios afectados. El porcentaje de pacientes con clasificación 3C fue mayor en los fenotipos urológico (8,2%), órgano-específico (9,0%) y neurológico (10,9%). Alrededor del 90% presentaron frecuencia miccional elevada, independientemente del fenotipo. La mejoría reportada por los PROs fue superior en los fenotipos neurológico y tenderness. Las peores puntuaciones se asociaron a un mayor número de dominios afectados. CONCLUSIONES: El presente estudio es el primero realizado en España sobre una clasificación fenotípica de mujeres con SDV, basándose en datos de práctica clínica habitual. Los resultados obtenidos señalan una tendencia a que pacientes con afectación de varios dominios fenotípicos presentan mayor afectación por el SDV, peor CVRS y mayor ansiedad.

Clasificación fenotípica upoint de una muestra de mujeres con síndrome de dolor vesical: resultados de un estudio observacional multicéntrico nacional / Upoint phenotypic classification of a sample of women with bladder pain syndrome: results of a national multicenter observational study

Objetivos: Estudiar la posibilidad declasificar a las pacientes con SDV por los fenotiposUPOINT y su correlación con los resultados de otrasherramientas diagnósticas para SDV.Material y métodos: Estudio epidemiológico, observacional, longitudinal y multicéntrico realizado segúnla práctica clínica habitual. Se incluyeron 319 mujerescon SDV, 79 de nuevo diagnóstico y 240 en seguimiento. Se recogieron datos sociodemográficos y clínicosy resultados de la cistoscopia, biopsia y exploraciónfísica. Las pacientes cumplimentaron un diario miccional de 3 días y los Patient Reported Outcomes (PROs).Todas las pacientes fueron clasificadas según los 6 dominios UPOINT y se describió su distribución según lahistoria clínica, pruebas diagnósticas, síntomas urinariosy las puntuaciones de los PROs. Resultados: El 92,8% de las pacientes tenían afectación en más de un fenotipo, sin embargo, no hubodiferencias destacables en las variables clínicas y sociodemográficas según el número de dominios afectados.El porcentaje de pacientes con clasificación 3C fue mayor en los fenotipos urológico (8,2%), órgano-específico(9,0%) y neurológico (10,9%). Alrededor del 90% presentaron frecuencia miccional elevada, independiente-mente del fenotipo. La mejoría reportada por los PROsfue superior en los fenotipos neurológico y tenderness.Las peores puntuaciones se asociaron a un mayor número de dominios afectados.Conclusiones: El presente estudio es el primerorealizado en España sobre una clasificación fenotípicade mujeres con SDV, basándose en datos de prácticaclínica habitual. Los resultados obtenidos señalan unatendencia a que pacientes con afectación de variosdominios fenotípicos presentan mayor afectación por elSDV, peor CVRS y mayor ansiedad.(AU)

Objetives: To study the possibility ofclassifying patients with BPS by UPOINT phenotypesand their correlation with the results of different BPS diagnostic tools.Materials and methods: Epidemiological, observational, longitudinal and multicentric study performed according to clinical practice. A total of 319 women withBPS were included, 79 with new diagnosis and 240in follow-up. Sociodemographic and clinical data werecollected together with results of cystoscopy, biopsyand physical examination. Patients completed a 3-dayBladder Diary (3dBD) and Patient Reported Outcomes(PROs). All the patients were classified according to the6 UPOINT domains and their distribution was describedaccording to the clinical history, diagnostic tests, urinarysymptoms and PROs’ scores.Results: 92.8% of the patients had affectation in morethan one phenotype, however, there were no remarkable differences in the clinical and sociodemographicvariables according to the number of affected domains.The percentage of patients with 3C classification washigher in the urinary (8.2%), organspecific (9.0%) andneurological (10.9%) phenotypes. Around 90% hadhigh voiding frequency, regardless of the phenotype.The improvement reported by the PROs was superior inthe neurological and tenderness phenotypes. The worstscores were associated with a greater number of affected domains. Conclusions: The present study is the first one carried out in Spain on a phenotypic classification of women with BPS, with data from routine clinical practice. Theresults point out that patients with several domains affected present more affectation on the BPS, worse HRQoLand higher anxiety.(AU)

[Urinary lithiasis treatment by laparoscopy. Combined techniques.] / Tratamiento de la litiasis con laparoscopia. Técnicas combinadas.

Over the last 30 years, the treatment of urinary lithiasis has changed dramatically. With the advent of extracorporeal lithotripsy and the advances on ureterorenoscopy and percutaneous nephrolithotomy, the need to turn to open and laparoscopic/robotic surgery has diminished. The objective of this article is to review the different indications for open and/or laparoscopic treatment of urinary lithiasis, to achieve its complete elimination with the less invasive possible means and trying to minimize the number of secondary procedures as well as complications.

Tratamiento de la litiasis con laparoscopia. Técnicas combinadas / Urinary lithiasis treatment by laparoscopy. Combined techniques

Durante los últimos 30 años, el tratamiento de la litiasis urinaria ha cambiado drásticamente. Con el advenimiento de la litotricia extracorpórea y los avances en la ureteroscopia, y la nefrolitotomía percutánea, la necesidad de recurrir a la cirugía abierta y laparoscópica/robótica ha disminuido. El objetivo de este artículo es la revisión de las diferentes indicaciones del tratamiento abierto y/o laparoscópico de la litiasis urinaria, para conseguir la eliminación completa de la misma con los medios menos invasivos posibles y tratando de minimizar el número de procedimientos secundarios así como las complicaciones

Over the last 30 years, the treatment of urinary lithiasis has changed dramatically. With the advent of extracorporeal lithotripsy and the advances on ureterorenoscopy and percutaneous nephrolithotomy, the need to turn to open and laparoscopic/robotic surgery has diminished. The objective of this article is to review the different indications for open and/or laparoscopic treatment of urinary lithiasis, to achieve its complete elimination with the less invasive possible means and trying to minimize the number of secondary procedures as well as complications

Leiomyoma of the seminal vesicles: laparoscopic excision.

Leiomyoma of the seminal vesicles is an extremely rare type of benign tumor of the genitourinary system and can cause lower urinary tract symptoms. Despite their low incidence, these tumors can be identified with transrectal ultrasound of the seminal vesicles during prostate examination. The removal of these tumors is facilitated by a laparoscopic approach.

Robotic Anderson-Hynes dismembered pyeloplasty: initial experience.

INTRODUCTION: The introduction of the da Vinci(®) robotic system in 2000 has been a new step forward in the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study was to analyse our initial experience with robot-assisted dismembered Anderson-Hynes pyeloplasty and to perform a bibliographic review on the topic. PATIENTS AND METHODS: We performed 11 robot-assisted pyeloplasties between March 2007 and April 2011. UPJO diagnosis was made on clinical presentation and imaging techniques (CT scan and intravenous urography). All patients underwent basal and diuretic isotopic renograms to evaluate the degree of obstruction and impaired renal function. Median follow-up was 10 (range 1-26) months. RESULTS: Mean patient age was 38.8 (range 23-62) years. There were six women (55%) and five men (45%). All cases were primary surgeries. In four patients the cause of UPJO was a crossing vessel; the other seven patients had intrinsic obstruction. One case was associated with extraction of a calyceal lithiasis. Mean operative time was 189.4 min (125-270 min). Average time from robotic arms docking was 116.5 (range 55-180) min. Average hospital stay was 4.18 (range 2-8) days. Conversion to open or laparoscopic surgery was not necessary in any case and there were no postoperative complications. Postoperative radiological evaluation and renograms showed good results in all cases. CONCLUSIONS: Robotic surgery offers better ergonomics, enhanced three-dimensional (3D) vision and more precise movements, easing intracorporeal suturing.These advantages make robotic pyeloplasty a reproducible technique that combines the high success rates of open surgery and the benefits of laparoscopic surgery.

Renal capsule leiomyoma: case report.

OBJECTIVE: We present a case of leiomyoma of the renal capsule in a 49 year-old woman that was detected incidentally during an abdominal study for gastroesophageal reflux. We discuss the clinical, radiological and pathological diagnosis of renal leiomyoma as well as its treatment alternatives. METHODS: Ultrasonography, CT and MRI were performed. A conventional pathological analysis including immunohistochemistry was performed after radical nephrectomy. RESULTS: Ultrasonography detected a solid hypoechoic mass poorly vascularized in the upper pole of the right kidney. CT and MRI detected a well-delimited mass showing soft tissue density without extension to the neighbor structures and without lymphadenopathies. Radical nephrectomy was performed. Microscopically, the mass was made of a low-grade fusocellular proliferation with cells staining with antibodies against smooth muscle markers. The mass was in continuity with the renal capsule and compressed slightly the renal parenchyma without damaging it. CONCLUSIONS: Renal leiomyomas are unfrequent benign tumors that should be suspected in young and middle aged women showing asymptomatic, well delimited and hypoechoic renal tumors with soft tissue density in CT scans. When vascular structures are not involved by the tumor, a conservative surgical intervention could be the first therapeutic option. Microscopically, renal leiomyomas are low-grade fusocellular tumors showing a smooth muscle immunohistochemical profile.

Leiomioma de la cápsula renal: Presentación de un caso / Renal capsule leiomyoma: case report

OBJETIVO: Presentamos un caso de leiomioma de la cápsula renal en una mujer de 49 años que fue encontrado de manera incidental durante un estudio ecográfico abdominal por reflujo gastroesofágico. A partir de este caso discutimos el diagnóstico clínico, radiológico y anatomopatológico de los leiomiomas renales así como su tratamiento.MÉTODOS: La paciente fue estudiada mediante ecografía, TC y RM. Tras la nefrectomía radical se realizó el estudia anatomopatológico convencional de la pieza quirúrgica incluyendo técnica inmunohistoquímica.RESULTADO: Ecográficamente se detectó una masa sólida, hipoecoica y pobremente vascularizada en el polo superior del riñón derecho. La TC y la RM detectaron una masa bien delimitada de densidad de partes blandas sin afectación local o regional y sin adenopatías. Se realizó una nefrectomía radical. Microscópicamente la masa estaba constituida por una proliferación fusocelular de bajo grado cuyas células se marcaban con anticuerpos contra antígenos de músculo liso. La masa estaba en continuidad con la cápsula renal y comprimía ligeramente el parénquima renal sin producir lesiones relevantes en él.CONCLUSIONES: Los leiomiomas renales son tumores infrecuentes que se deben sospechar ante mujeres jóvenes o de edad media con tumores renales asintomáticos, bien delimitados, hipoecoicos y con densidad de partes blandas en la TC. Si no hay afectación de estructuras vasculares, se podría optar por una intervención quirúrgica conservadora. Microscópicamente son tumores fusocelulares de bajo grado con el perfil inmunohistoquímico típico de los tumores del músculo liso (AU)

OBJECTIVE: We present a case of leiomyoma of the renal capsule in a 49 year-old woman that was detected incidentally during an abdominal study for gastroesophageal reflux. We discuss the clinical, radiological and pathological diagnosis of renal leiomyoma as well as its treatment alternatives.METHODS: Ultrasonography, CT and MRI were performed. A conventional pathological analysis including immunohistochemistry was performed after radical nephrectomy.RESULTS: Ultrasonography detected a solid hypoechoic mass poorly vascularized in the upper pole of the right kidney. CT and MRI detected a well-delimited mass showing soft tissue density without extension to the neighbor structures and without lymphadenopathies. Radical nephrectomy was performed. Microscopically, the mass was made of a low-grade fusocellular proliferation with cells staining with antibodies against smooth muscle markers. The mass was in continuity with the renal capsule and compressed slightly the renal parenchyma without damaging it.CONCLUSIONS: Renal leiomyomas are unfrequent benign tumors that should be suspected in young and middle aged women showing asymptomatic, well delimited and hypoechoic renal tumors with soft tissue density in CT scans. When vascular structures are not involved by the tumor, a conservative surgical intervention could be the first therapeutic option. Microscopically, renal leiomyomas are low-grade fusocellular tumors showing a smooth muscle immunohistochemical profile (AU)