Randomized and Open Trial to Assess the Effectiveness of the Guided Pelvic Floor Exercises Pre-Radical Robotic Prostatectomy on the Improvement of Urinary Incontinence. Initial Results.

INTRODUCTION AND OBJECTIVES: Radical prostatectomy has an impact on urinary continence. Many factors are involved in continence. The objective of this study is evaluate the effect of guided Pelvic Floor Exercises prior to robotic radical prostatectomy (RRP) on the rate of urinary incontinence compared with written information. MATERIAL AND METHOD: randomized study of 62 patients who are waiting for PRR. They were rondomized in two groups: experimental group (exercises guided by a physiotherapist) or a control group (written information). Primary objective was the continence rate measured by pad test and ICIQ-SF one month after the intervention, Secondary objectives were incontinence severity, quality of life with SF-36 and KHQ questionnaires and the correlation between incontinence and quality of life. RESULTS: We found no differences in continence rate between groups after the intervention. We found differences in "emotional problems" and "personal relationships", in favor of the control group. There is a correlation between the amount of urine leakage and age, urgency and all the domains of the KHQ questionnaire except general quality of life, as well as in the areas "energy/fatigue" and "social function" of the SF-36. CONCLUSIONS: Physiotherapist-guided exercises before RRP do not seem to offer advantages compared to written information, in terms of the incontinence rate and its severity one month after the surgery. Urinary incontinence is correlated with age, urgency, and deterioration in quality of life.

Anatomical predictors of long-term urinary incontinence after robot-assisted laparoscopic prostatectomy: A systematic review.

AIMS: There is scarce evidence of anatomical risk factors that might affect long-term post-prostatectomy incontinence (PPI) in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). This systematic review aims to identify anatomical measurements in preoperative magnetic resonance imaging (MRI) that might be associated with increased risk of urinary incontinence (UI) 1 year after RALP. METHODS: A comprehensive search on Pubmed and Scopus databases up to November 2020 was performed. Eight articles met the inclusion criteria and were finally selected. RESULTS: The selected studies included 1146 patients. Seven articles focused on membranous urethral length (MUL); all of them related MUL to long-term PPI in univariate analysis and five of them in multivariate analysis. Four studies presented MUL difference to measure the magnitude of the effect. Average MUL (mm) was 15.9 (SD, 2.6), 16.1 (95% confidence interval [CI]: 13.9-18.9), 12.1 (95% CI 9.7-14.9) and 14.5 in continent patients and 13.9 (SD, 2.9), 10 (95% CI: 8.7-12.1), 10.3 (95% CI: 8.7-12.4) and 9.3 in incontinent patients, with statistically significant differences in all cases. Five studies presented the odds ratio as a result; although there was substantial heterogeneity in the methods used to obtain it, there was consistency in finding an inverse association between MUL and PPI. Other measurements including prostatic-urethral angle, membranous urethral thickness, intraprostatic urethral length and intravesical prostatic protrusion have been reported in few studies, and no association with long-term PPI was found. Levator ani muscle thickness was related to long-term PPI in one article. CONCLUSION: Greater MUL on preoperative MRI is associated with lower risk of UI 1 year after RALP.

Shwannoma benigno suprarrenal / Bening adrenal schuwannoma

Objetivo: Aportamos un nuevo caso de Schwannoma benigno retroperitoneal de localización suprarrenal.Método: Varón de 53 años diagnosticado de HBP moderada en tratamiento con alfa-bloqueantes. Refiere en la última revisión molestias en flanco derecho de dos meses de evolución sin otra sintomatología acompañante; la evaluación radiológica mediante ECO y TAC, y el estudio endocrino preoperatorio sugirieron tumor adrenal no funcionante que se extirpó quirúrgicamente RESULTADOS: El estudio histopatológico informó que se trataba de un Schwannoma benigno yuxta adrenal.Conclusiones: Es un tumor retroperitoneal poco frecuente.La existencia de cambios quísticos en un tumor retroperitoneal es relativamente frecuente en los Schwannomas y puede sugerir el diagnóstico. En el caso que presentamos no existían estructuras quísticas (AU)