Clinical approach to occult urinary incontinence: Multicenter cohort study / Enfoque clínico de la incontinencia urinaria oculta: estudio multicéntrico de cohortes

Objective: To compare the impact of pelvic organ prolapse (POP) surgery with that of combined surgery for prolapse and stress urinary incontinence (SUI) in patients with no SUI symptoms and a positive stress test result. Material and methods: We performed a subanalysis of a prospective observational cohort study in 39 gynecological units specialized in pelvic floor disorders in Spain (CIRPOP-IUE). The study population comprised patients with symptomatic grade ≥II POP with an indication for treatment using vaginal surgery. All patients underwent a standard stress test, with and without reduction of the prolapse. Patients were classified into 3 groups (Group 1, SUI symptoms and positive stress test result; Group 2, absence of symptoms and positive stress test result; and Group 3, absence of symptoms and negative stress test result). Depending on the type of surgery performed, a descriptive analysis of symptoms before surgery and 1 year after was performed in group 2. Results: Group 2 comprised 87 patients (83 patients at the follow-up visit). Of these, 32 (38.5%) underwent surgery for prolapse only and 51 (61.4%) combined surgery for prolapse and urinary incontinence. De novo symptomatic SUI was recorded in 7.3% of patients who underwent combined surgery and in 29.2% of patients who underwent prolapse surgery only. Conclusion: Postsurgical urinary incontinence symptoms were less frequent in patients who underwent combined surgery for prolapse and incontinence

Objetivos: evaluar el impacto de la cirugía de prolapso de órganos pélvicos versus cirugía combinada de prolapso e incontinencia urinaria de esfuerzo en pacientes sin síntomas de incontinencia urinaria de esfuerzo y con test de esfuerzo positivo. Material y métodos: subanálisis de un estudio observacional multicéntrico de cohortes prospectivas. Se incluyeron pacientes con prolapso de órganos pélvicos sintomático, de grado II o superior, que iban a ser sometidas a cirugía del prolapso vía vaginal. Se realizó un test de esfuerzo estandarizado a todas las pacientes, con y sin prolapso de órganos pélvicos reducido. Todas las mujeres fueron clasificadas en tres grupos (Grupo 1: síntomas de incontinencia urinaria de esfuerzo y test de esfuerzo positivo, grupo 2: ausencia de síntomas y test de esfuerzo positivo y grupo 3: ausencia de síntomas y test de esfuerzo negativo). Se realizó un análisis descriptivo de los síntomas, antes de la cirugía y un año después, según el tipo de cirugía aplicada en las pacientes del grupo 2. Resultados: se incluyeron 87 pacientes en el grupo 2 (83 pacientes en la visita poscirugía). De estas, 32 (38,5%) y 51 (61,4%) fueron sometidas a cirugía solo de prolapso y combinada de prolapso e incontinencia, respectivamente. El 7,3% de las pacientes con cirugía combinada y el 29,2% de las pacientes con cirugía solo de prolapso, desarrollaron incontinencia urinaria de esfuerzo sintomática de novo. Conclusión: la presencia de síntomas de incontinencia urinaria tras la cirugía fue menos frecuente en el grupo sometido a cirugía combinada de prolapso e incontinencia

Neoplasia vulvar intraepitelial / Vulvar intraepithelial neoplasia

Objetivo: realizar una revisión de la literatura a propósito de un caso de neoplasia vulvar intraepitelial de alto grado tratada con imiquimod tópico. Conclusión: el tratamiento tópico con imiquimod constituye una alternativa al tratamiento quirúrgico de la neoplasia vulvar intraepitelial. En el caso que se presenta se logró la completa desaparición de la lesiones tras doce semanas de tratamiento. Existen otros tratamientos tópicos que pueden ser tenidos en cuenta, como el 5-fluoracilo o cidofovir. Dada la posibilidad de recurrencias, se debe realizar un seguimiento estrecho de estas pacientes durante al menos cinco años (AU)

Objective: To review the literature and present a clinical case of vulvar intraepithelial neoplasia that was treated with topical Imiquimod. Conclusion: Topical treatment with Imiquimod is an alternative to surgical treatment of vulvar intraepithelial neoplasia. In the case presented, complete disappearance of the lesions was achieved after twelve weeks of treatment. There are other treatments that can be taken into account, such as 5-fluoracil and cidofovir. Given the possibility of recurrence, these patients should be closely followed during at least five years (AU)

Bandas suburetrales libres de tensión transobturatriz in-out: indicación y resultados asociados / Transobturator suburethral slings. Indication and results associated

Objetivo. Describir las características de las pacientes a las que se indica esta técnica, y valorar los resultados asociados. Sujetos y métodos. Se incluyeron todas las pacientes (162) intervenidas con esta técnica entre junio del 2005 y diciembre del 2010 en el Hospital Universitario de Fuenlabrada. Resultados. Características medias: edad, 51,64años; IMC, 28,92kg/m2, y 2,31 partos vaginales. Diagnóstico urodinámico en el 96,3%: incontinencia de esfuerzo pura en el 68,5% y mixta de predominio de esfuerzo del 25,9%. Complicaciones intraoperatorias: 3,1%; 1,2% de erosiones de malla. Porcentaje de curación global objetivo, 92%, y subjetivo, 80,3%. Conclusiones. Bajo porcentaje de complicaciones, todas ellas resueltas. Porcentajes de curación altamente satisfactorios, tanto en la incontinencia urinaria de esfuerzo pura como en mixtas de predominio de esfuerzo. La urodinamia previa a la cirugía permite realizar buenas indicaciones quirúrgicas y orientar sobre el pronóstico de la intervención (AU)

Objective. To describe the characteristics of treated patients and assess the results obtained. Subjects and methods. All patients (n=162) who underwent this technique between June 2005 and December 2010 at the Hospital de Fuenlabrada were included. Results. The mean age was 51.64 years, mean body max index was 28.92kg/m2 and the mean number of vaginal deliveries was 2.31. Urodynamic diagnosis was performed in 96.3%, with findings of pure stress incontinence in 68.5%, mixed incontinence and stress incontinence in 25.9%. Intraoperative complications occurred in 3.1%. Mesh erosions were found in 1.2%. The overall objective cure rate was 92% and the subjective cure rate was 80.3%. Conclusions. The complications rate was low and all complications were resolved. Cure rates were highly satisfactory both in pure stress urinary incontinence and in mixed urinary incontinence with a predominance of stress incontinence. Urodynamic studies before surgery allow good surgical indications and guide postsurgical prognosis (AU)

[Spanish registry of the TRT Reemex system in women with stress urinary incontinence (SUI)]. / Registro español del sistema TRT Remeex en mujeres con incontinencia urinaria de esfuerzo.

OBJECTIVES: Due to the absence of randomized studies, the Spanish Reemex Working Group started a registry to analyze and review the results of a large group of patients with mid-term and long-term follow-up to obtain conclusions based on clinical experience. METHODS: A registry of 715 patients who underwent surgical intervention for insertion of the SUI readjustable prosthesis Reemex TRT (tension free readjustable tape) in 15 Spanish hospitals (40% urology departments, 60% gynecology departments). The registry was established to evaluate the safety and efficacy of the sling adjustability concept in the surgical treatment of female SUI. The Spanish Working Group was able to evaluate results of the Reemex system in 683 patients of a total of 715. Mean age was 59.9 yr (range 21-87) with a mean follow-up of 23 months (6-93). The group includes: 30.2% patients with mixed incontinence, 73.1% patients with urodynamic intrinsic sphincteric deficit, 35.7% patients with previous history of failed surgical interventions for urinary incontinence, and 54.3% previous pelvic floor associated operations. All patients were evaluated preoperatively with history, physical examination and urinary incontinence questionnaire. Each follow-up visit included incontinence questionnaire, physical examination and stress test. RESULTS: Cure rate was 92.2%, with 6.9% improvement and 0.9% failures. Readjustment was performed in 416 patients (60.9%) as a second phase of surgery over the following 24-48 hours, before hospital discharge. 80 patients (11.7%) were readjusted in the mid- or long-term (between 6 and 8 months after surgery). The level of support of the sling was successfully reduced in three patients between 6 and 14 months after surgery. No other patient suffered voiding difficulties in the long-term. 1.7% of the patients needed extraction of the tensor due to persistent abdominal wall seroma. 0.8% presented vaginal extrusion of the sling. CONCLUSIONS: The Reemex system is a minimally invasive technique with consistent results and even improved in heterogeneous groups of patients including intrinsic sphincter defficiency, reoperations, mixed incontinence and associated pathologies.

Registro español del sistema TRT Reemex en mujeres con incontinencia urinaria de esfuerzo / Spanish registry of the TRT Reemex system in women with stress urinary incontinence (SUI)

OBJETIVO: En ausencia de estudios randomizados,el Grupo de Trabajo Español Remeex inició un registro para analizar y revisar resultados en un gran grupo de pacientes con seguimiento a medio y largo plazo, para obtener conclusiones basadas en experienciasclínicas.MÉTODOS: Se analizan prospectivamente los datos procedentes del registro de 715 pacientes que fueron operadas con una prótesis de incontinencia reajustable Remeex TRT (Tensión free Readjustable Tape) en 15 hospitalesespañoles, servicios de Urología 40% y Ginecología60%. El registro se realizó para evaluar la seguridady eficacia del concepto de ajustabilidad del sling para el tratamiento quirúrgico de la Incontinencia Urinariade Esfuerzo Femenina. El grupo de trabajo español pudo evaluar los resultados del Sistema Remeex en 683 pacientes de un grupo total de 715. La edad media fue de 59.9 (rango 21-87) con un periodo de seguimiento medio de 23 meses (6-93). El grupo incluye: 30.2% de pacientes con Incontinencia Mixta, 33.1% de pacientes con Déficit Esfinteriano Intrínseco urodinámico, 35.7% de pacientes sometidas a intervenciones previas de Incontinencia,y el 54.3% a cirugías asociadas del suelo pélvico. Todas las pacientes fueron analizadas pre-operatoriamentemediante historia clínica, examen físico y cuestionario de incontiencia. En cada seguimiento, las pacientes rellenaron un cuestionario de incontinencia, se sometieron a examen físico y test de esfuerzo.RESULTADOS: El índice de curación valorado en la últimarevisión fue del 92.2%, 6.9% de los pacientes mejorarony el 0.9% de las pacientes fueron consideradas fracasos. La capacidad de reajuste fue utilizada en 416 casos (60.9%) de las pacientes como una segunda fase de la cirugía durante las siguientes 24-48 horas, antesdel alta hospitalaria. 80 pacientes (11.7%) fueron reajustadas a medio o largo plazo (entre 6 y 8 meses después de la cirugía). En tres pacientes el nivel de soporte del cabestrillo fue reducido con éxito entre 6 y 14 meses después de la cirugía. Ninguna otra pacientesufrió dificultades de vaciado a largo plazo. Como complicaciones, al 1.7% de las pacientes se les extrajo el varitensor, debido a la persistencia de seroma abdominal.Un 0.8% presentaron exposición del cabestrillo en la pared vaginal.CONCLUSIONES: El sistema Remeex es una técnica mínimamenteinvasiva con resultados consistentes y mejoradosincluso en grupos de pacientes no homogéneos, en los que se incluyen pacientes con déficit esfinteriano intrínseco, pacientes reintervenidas, incontinencia mixta y patología asociada

OBJECTIVES: Due to the absence ofrandomized studies, the Spanish Reemex Working Group started a registry to analyze and review the results of a large group of patients with mid-term and long-term follow-up to obtain conclusions based on clinicalexperience.METHODS: A registry of 715 patients who underwent surgical intervention for insertion of the SUI readjustable prosthesis Reemex TRT (tension free readjustable tape) in 15 Spanish hospitals (40% urology departments,60% gynecology departments). The registry was established to evaluate the safety and efficacy of the sling adjustability concept in the surgical treatment of female SUI. The Spanish Working Group was able to evaluate results of theReemex system in 683 patients of a total of 715. Mean age was 59.9 yr. (range 21-87) with a mean follow-up of 23 months (6-93). The group includes: 30.2% patients with mixed incontinence, 73.1% patients with urodynamic intrinsic sphincteric deficit, 35.7% patients with previous history of failed surgical interventions for urinaryincontinence, and 54.3% previous pelvic floor associated operations. All patients were evaluated preoperatively with history, physical examination and urinaryincontinence questionnaire. Each follow-up visit included incontinence questionnaire, physical examination and stress test.RESULTS: Cure rate was 92.2%, with 6.9% improvement and 0.9% failures. Readjustment was performed in 416 patients (60.9%) as a second phase of surgery over the following 24-48 hours, before hospital discharge. 80 patients (11.7%) were readjusted in the mid- or long-term (between 6 and 8 months after surgery). The level of support of the sling was successfully reduced in three patients between 6 and 14 months after surgery. No other patient suffered voiding difficulties in the long-term. 1.7% of the patients needed extraction of the tensor due to persistent abdominal wall seroma. 0.8% presented vaginal extrusion of the sling.CONCLUSIONS: The Reemex system is a minimallyinvasive technique with consistent results and evenimproved in heterogeneous groups of patients including intrinsic sphincter defficiency, reoperations, mixedincontinence and associated pathologies