Sistema masculino transobturador ajustable (ATOMS(R)) como tratamiento de la incontinencia urinaria de esfuerzo secundaria a resección transuretral de la próstata / Adjustable transobturator male system (ATOMS(R)) as treatment of stress urinary incontinence secondary to transurethral resection of the prostate

Objetivos: Estudio de viabilidad para evaluar la eficacia y la seguridad del sistema masculino transobturador ajustable (ATOMS(R)) para la incontinencia urinaria de esfuerzo (IUE) masculina después de la resección transuretral de la próstata. Materiales y métodos: Se implantó ATOMS(R) a 20 pacientes con IUE causada por resección transuretral de la próstata con o sin radioterapia. La severidad de la incontinencia fue evaluada como leve (2 compresas/día), moderada (3-5 compresas/día) o severa (≥6 compresas/día), y se consideró paciente seco aquel sin compresas o con una compresa de seguridad al día. Se investigó el cambio en el recuento de compresas (pad-count) y en el peso de las compresas (pad-test), así como otros parámetros operatorios, la satisfacción del paciente con el procedimiento, y el número y grado de complicaciones (Clavien-Dindo). Resultados: La mediana de edad fue de 76,5 años. Cinco pacientes habían recibido radioterapia pélvica (3 por cáncer de próstata, 2 por cáncer rectal) y 2 (10%) habían tenido esfínter urinario artificial con erosión uretral y fallo mecánico, respectivamente. La IUE preoperatoria fue leve en 4 (20%), moderada en 7 (35%) y severa en 9 (45%). La mediana de relleno del sistema fue de 13,5 ml. La mediana de pad-test disminuyó de 375 ± 855 ml basal a 10 ± 31,5 ml y el pad-count, de 4 ± 3 a 0 ± 1,5 tras el ajuste (1 ± 3 rellenos). La IUE postoperatoria fue leve en 2 (10%) pacientes, moderada en uno (5%) y severa en 2 (10%). La tasa de satisfacción fue del 80%, igual para pacientes con o sin radioterapia previa. Ningún paciente tuvo retención urinaria al retirar el catéter. Hubo complicaciones en 3 (15%) casos, todas menores. Tras una mediana de seguimiento de 38,5meses no se ha retirado ningún sistema; 19 (95%) pacientes se consideran mejor que antes y 11 (55%) muchísimo mejor. Conclusión: Según la eficacia a corto plazo y la satisfacción del paciente, ATOMS(R) puede considerarse una alternativa realista para IUE después de la resección transuretral de la próstata, incluso en pacientes radiados. La ausencia de erosión uretral y la escasez de problemas hacen esta alternativa especialmente atractiva para pacientes con destreza disminuida, edad avanzada y tratamientos previos fallidos

Objectives: Feasibility study to evaluate efficacy and safety of Adjustable Transobturator Male System (ATOMS(R)) for male stress urinary incontinence (SUI) after transurethral resection of the prostate. Materials and methods: Twenty patients were implanted ATOMS(R) for SUI caused by transurethral resection of the prostate with or without radiotherapy. Incontinence severity was evaluated as mild (2 pads/day), moderate (3-5 pads/day) or severe (≥ 6pads/day), and dryness as none or one security pad/day. Changes in pad-test and pad-count after adjustment were investigated, together with operative parameters, patient satisfaction with the procedure, and number and grade of complications (Clavien-Dindo). Results: Median age was 76.5 years. Five patients received previous pelvic radiation (3 prostate, 2 rectal cancer) and 2 (10%) previous failed artificial urinary sphincter with urethral erosion and mechanical failure, respectively. Preoperative SUI was mild in 4 (20%), moderate in 7 (35%) and severe in 9 (45%). Median filling of the system was 13.5 ml. Median pad-test decreased from 375 ± 855 ml baseline to 10 ± 31.5 ml and pad-count from 4 ± 3 to 0 ± 1.5 after adjustment (1 ± 3 fillings). Postoperative SUI distribution was mild in 2 (10%), moderate in one (5%) and severe in 2 (10%). Satisfaction rate was 80%, equal for transurethral resection of the prostate with/without previous radiotherapy. No patient had urinary retention after catheter removal. Complications presented in 3 (15%) patients, all minor. After median 38.5mo follow-up no system has been removed, 19 (95%) self-considered better than before and 11 (55%) very much better. Conclusion: Based on short-term efficacy and patient satisfaction ATOMS(R) can be considered a realistic alternative for SUI after transurethral resection of the prostate, even after irradiation. Absence of urethral erosion and very limited problems make this alternative especially attractive for cases with diminished dexterity, advanced age and previous failed treatments

Adjustable transobturator male system (ATOMS®) as treatment of stress urinary incontinence secondary to transurethral resection of the prostate. / Sistema masculino transobturador ajustable (ATOMS®) como tratamiento de la incontinencia urinaria de esfuerzo secundaria a resección transuretral de la próstata.

OBJECTIVES: Feasibility study to evaluate efficacy and safety of Adjustable Transobturator Male System (ATOMS®) for male stress urinary incontinence (SUI) after transurethral resection of the prostate. MATERIALS AND METHODS: Twenty patients were implanted ATOMS® for SUI caused by transurethral resection of the prostate with or without radiotherapy. Incontinence severity was evaluated as mild (2 pads/day), moderate (3-5 pads/day) or severe (≥6pads/day), and dryness as none or one security pad/day. Changes in pad-test and pad-count after adjustment were investigated, together with operative parameters, patient satisfaction with the procedure, and number and grade of complications (Clavien-Dindo). RESULTS: Median age was 76.5years. Five patients received previous pelvic radiation (3 prostate, 2 rectal cancer) and 2 (10%) previous failed artificial urinary sphincter with urethral erosion and mechanical failure, respectively. Preoperative SUI was mild in 4 (20%), moderate in 7 (35%) and severe in 9 (45%). Median filling of the system was 13.5ml. Median pad-test decreased from 375±855ml baseline to 10±31.5ml and pad-count from 4±3 to 0±1.5 after adjustment (1±3fillings). Postoperative SUI distribution was mild in 2 (10%), moderate in one (5%) and severe in 2 (10%). Satisfaction rate was 80%, equal for transurethral resection of the prostate with/without previous radiotherapy. No patient had urinary retention after catheter removal. Complications presented in 3 (15%) patients, all minor. After median 38.5mo follow-up no system has been removed, 19 (95%) self-considered better than before and 11 (55%) very much better. CONCLUSION: Based on short-term efficacy and patient satisfaction ATOMS® can be considered a realistic alternative for SUI after transurethral resection of the prostate, even after irradiation. Absence of urethral erosion and very limited problems make this alternative especially attractive for cases with diminished dexterity, advanced age and previous failed treatments.

Granuloma piógeno. Cirugía menor de alta resolución en atención primaria / Pyogenic granuloma. Minor high-resolution surgery in primary care

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Síndrome de las piernas inquietas. ¿Se conoce en atención primaria? / Restless legs syndrome. Is it recognised in primary care?

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[Renal abscess in patients diagnosed with AIDS and disseminated tuberculosis]. / Abscesos renales en pacientes diagnosticados de SIDA con tuberculosis diseminada.

Presentation of two cases of renal abscess formation in patients with stage IV C-1 AIDS and active associated tuberculosis. The microorganism isolated in the first case was S. aureus. Culture of the second cases was artefacted since antibiotic administration had already been started. Also, both patients showed abdominal abscesses, at spleen and liver level in the first case, and prostatic level in the second case, both compatible with Mycobacterium tuberculosis dissemination. Both cases showed a lethal evolution. The role played by the immunodeficiency as a precipitating agent in the extrapulmonary tuberculosis and in the formation of renal abscesses is analyzed.

[Skin metastasis as the first manifestation of dissemination of bladder cancer]. / Metástasis cutáneas como primera manifestación de diseminación en tumor vesical.

Cutaneous metastases of vesical carcinoma are an uncommon finding and generally appear amid multisystemic dissemination. We present a case of appearance of multiple cutaneous metastases in the immediate postoperative period of a patient subjected to radical cystectomy, in which this affection was the only sign of metastatic seeding. We discuss the etiopathogeny and possible evolution of similar cases.

[Signet ring cell adenocarcinoma of the bladder]. / Adenocarcinoma vesical de células en anillo de sello.

A case of primary signet-ring cell adenocarcinoma of the urinary bladder is described. The etiopathogenesis, pathological and clinical features, prognosis and treatment of this tumor type are discussed and the literature reviewed.

[Massive secondary psoriasiform dermatitis secondary to intravesical administration of mitomycin C]. / Dermatitis psoriasiforme masiva secundaria a instilación intravesical de mitomycin C.

We report on a patient who had been submitted to vesical diverticulectomy. Pathological examination of the surgical specimen revealed G2T1 urothelial carcinoma. Intravesical chemotherapy with mitomycin C was instituted. Following the sixth instillation, the patient developed widespread psoriasiform dermatitis and required admission to hospital. Remission was achieved with drug withdrawal and symptomatic treatment. The literature is reviewed.

[Ultrasonic diagnosis of prostatic adenocarcinoma. Prospective study of a sample of 159 patients]. / Diagnóstico ecográfico del adenocarcinoma de próstata. Estudio prospectivo sobre una muestra de 159 pacientes.

We studied the value of transrectal echography as the diagnostic means of prostate pathology. We carried out a prospective analysis of a sample of 159 patients, on whom we have anatomopathological documentation which we use as the reliability control for the clinical exploration by means of rectal touch and ultrasonography with transrectal transducer. We have obtained 137 prostate fibromuscular hyperplasias, 3 inflammatory pathologies and 19 adenocarcinomas. A 100% sensitivity in the echographic diagnosis of prostate adenocarcinoma was achieved for this sample.

[Immediate complications of radical cystectomy. Intestinal fistula: our experience in the treatment with somatostatin]. / Complicaciones inmediatas de la cistectomía radical. Fístula intestinal: nuestra experiencia en el tratamiento con somatostatina.

During the period of time between November 1986 and May 1988, 14 total cystectomies with one-step urinary derivations were performed in our Service. The surgical techniques utilized include: 7 Bricker, 2 Camey, 1 ileocecal segment derivation, 2 cutaneous transureterostomies and 2 cutaneous ureterostomies. Among the complications observed there were 3 intestinal fistulas which were treated at first in a conservative way with parenteral nutrition and somatostatin. An immediate response was obtained in all three cases with a decrease in the fistula deficit. Surgical treatment was required in two patients after a lack of response to conservative treatment. The fistula closed in the third patient, to open again spontaneously 15 days later. It was controlled with conservative means and closed again 45 days later.

Transplant of a pediculate segment of vas deferens. Experimental study.

A new surgical technique has been used on white New Zealand rabbits. A segment of vas deferens was transplanted to the contralateral deferens with the intention of improving treatment for certain cases of infertility caused by obstruction. Evaluation of the technique was carried out by repeated seminograms, deferentovesiculography and histological studies of the transplanted deferens segment and the corresponding testicle. The viability of this surgical technique has been shown using the rabbit as an experimental specimen.

Cavernosography in diagnosis of metastatic tumors of the penis: 5 new cases and a review of the literature.

Secondary tumors of the penis are rare, with 266 cases having been reported. We describe 5 new cases studied by cavernosography. The primary tumors were bladder cancer in 3 patients and prostatic cancer in 2. Cavernosography suggested the diagnosis, which was confirmed by a guided biopsy or fine needle aspiration biopsy. The prognosis has been poor, with the average survival being less than 9 months.