Outcomes of transurethral resection (TUR) of intravesical mesh after suburethral slings in the treatment of urinary stress incontinence.

OBJECTIVE: The objective of this study was to determine the efficacy as well as the complications associated with transurethral removal (TUR) of intravesical mesh after suburethral sling, transobturator tape-TOT (Monarc™) or "minisling" (MiniArc(®)), in the treatment of female urinary stress incontinence (USI). MATERIAL AND METHODS: retrospective and consecutive study on 9 women with bladder perforation after midurethral slings (3 Monarc™ and 6 MiniArc®) placement for urinary stress incontinence. To remove the mesh, transurethral resection with an electrode loop (TUR-E) was used. The technique included: location and total removal of mesh with bipolar resectoscope up to healthy tissue. RESULTS: The median age was 61 years (49-70 years). The median time between midurethral sling placement and onset the sympltoms was 13 months (1-79 months). and between sling placement and mesh removal was 16 months (1-91 months). Five women (55.5%) developed bladder stones. Mean operating time was 29.4 ± 10.4 minutes and mean length of hospital stay was 2.6 ± 0.5 days. The median follow-up after mesh removal was 38 months (range, 14 to 109 months). No complications were found. CONCLUSIONS: The use of transurethral resection of intravesical mesh after suburethral slings is easy and the results obtained by our surgical team are excellent.

Tratamiento de la incontinencia urinaria de esfuerzo femenina mediante cintillas suburetrales: estudio retrospectivo comparativo observacional de 2 técnicas quirúrgicas / Treatment of Female Stress Urinary Incontinence Using Suburethral Slings: Comparative, Retrospective, Observational Study of Two Surgical Techniques

Objetivo: El tratamiento de la incontinencia urinaria femenina ha sufrido una revolución en los últimos años por la aparición en el mercado de las cintillas suburetrales. El objetivo de este estudio es comparar 2 técnicas quirúrgicas para el tratamiento de la incontinencia urinaria de esfuerzo: Monarc™ (cintilla suburetral transobturadora) y MiniArc® (mini-cintilla suburetral de incisión única). Material y métodos: Estudio retrospectivo observacional comparativo desde enero de 2005 hasta diciembre de 2011 con 317 mujeres diagnosticadas de incontinencia urinaria de esfuerzo. Doscientas catorce fueron tratadas con la cintilla suburetral transobturadora Monarc™ y 103 con la mini-cintilla MiniArc®. Los resultados han sido tratados con el programa informático SPSS v 15 y el nivel de significación estadística ha sido p ≤ 0,005. Resultados: Los 2 grupos de pacientes son homogéneos en cuanto a la edad, el número de partos, la presencia de incontinencia urinaria de urgencia o histerectomía previa. Diferencias significativas en estancia hospitalaria, tiempo quirúrgico y complicaciones precoces a favor del Miniarc®, pero no en las tardías donde no hay diferencias significativas globales. El 84% de las pacientes tratadas con la cintilla transobturadora Monarc™ están curadas frente al 72% en las que colocamos un MiniArc® con diferencia significativa. Conclusión: Debemos realizar un mayor número de estudios de alta calidad de carácter prospectivo y aleatorizados, con mayor número de pacientes y tiempo de seguimiento para confirmar o rechazar la diferencia que hemos encontrado en la tasa de éxito a favor de cintilla suburetral transobturador Monarc™ (AU)

Objective: The treatment of female stress urinary incontinence has undergone a revolution in recent years due the emergence on the market of suburethral slings. The aim of this study is to compare two surgical techniques for treating stress urinary incontinence: Monarc™ (transobturator suburethral sling) and MiniArc® (single-incision suburethral mini-sling). Material and methods: Comparative, retrospective, observational study from January 2005 to December 2011 on 317 women diagnosed with stress urinary incontinence. Of these, 214 were treated with the Monarc™ transobturator suburethral sling, and 103 were treated with the MiniArc® mini-sling. The results were treated with SPSS v.15 software, and the statistical significance was P ≤ 0.005. Results: The two patients groups were homogeneous in terms of age, number of births, presence of urgency urinary incontinence and prior hysterectomy. There were significant differences in hospital stay, surgical time and early complications in favour of the MiniArc®, technique, but overall there were no significant differences in the late complications. Some 84% of the patients treated with the Monarc™ transobturator sling were cured compared with the 72% of patients in whom we implanted a MiniArc®, a difference that was statistically significant. Conclusion: We need to perform more high-quality, prospective and randomised studies with larger numbers of patients and longer follow-up times to confirm or disprove the difference that we found in the success rate for the Monarc™ transobturator suburethral sling (AU)

Treatment of female stress urinary incontinence using suburethral slings: comparative, retrospective, observational study of two surgical techniques.

OBJECTIVE: The treatment of female stress urinary incontinence has undergone a revolution in recent years due the emergence on the market of suburethral slings. The aim of this study is to compare two surgical techniques for treating stress urinary incontinence: Monarc™ (transobturator suburethral sling) and MiniArc(®) (single-incision suburethral mini-sling). MATERIAL AND METHODS: Comparative, retrospective, observational study from January 2005 to December 2011 on 317 women diagnosed with stress urinary incontinence. Of these, 214 were treated with the Monarc™ transobturator suburethral sling, and 103 were treated with the MiniArc(®) mini-sling. The results were treated with SPSS v.15 software, and the statistical significance was P≤.005. RESULTS: The two patients groups were homogeneous in terms of age, number of births, presence of urgency urinary incontinence and prior hysterectomy. There were significant differences in hospital stay, surgical time and early complications in favour of the MiniArc(®), technique, but overall there were no significant differences in the late complications. Some 84% of the patients treated with the Monarc™ transobturator sling were cured compared with the 72% of patients in whom we implanted a MiniArc(®), a difference that was statistically significant. CONCLUSION: We need to perform more high-quality, prospective and randomised studies with larger numbers of patients and longer follow-up times to confirm or disprove the difference that we found in the success rate for the Monarc™ transobturator suburethral sling.

[Comparison between Valdivia position and prone position in percutaneous nephrolithotomy]. / Comparacin entre la posición de Valdivia y la posición prona en la nefrolitectomía percutánea (NLP).

INTRODUCTION: Although the supine position created by Dr. Valdivia two decades ago to perform the procedure known as percutaneous nephrolitectomy (PNL) presents advantages against the prone position in some aspects concerning anesthesia and surgical ergonomy, its use has failed to spread widely among the urology community due to certain technical difficulties, a lower rate of calculi clearing and a higher rate of complications, in spite of the fact that the scarce comparative studies do not show enough data to support this opinion. The present study compares both positions considering the technical difficulties encountered, their effectiveness and their results and complications. MATERIAL AND METHODS: A series of 50 patients that underwent PCNL by prone position is compared retrospectively with another series of 54 patients that underwent consecutively PCNL by prone position. All procedures were performed under general anesthesia, the inferior calyx approach was the one used the most over the supracostal approach, and the sole tract over the multi-tract approach was predominant. Dilatation of the nephrostomy tract was done, in most of the cases, with a high-pressure balloon catheter. The stone surface treated was 399.93+/-58.2 mm2 for the supine group, and 416.36+/-46.54 mm2 for the prone one (p=0.456). The management of the stones was carried out by ultrasonic or ballistic fragmentation, and a small group of patients underwent direct stone removal. RESULTS: As far as demographic parameters and operative variables such as number of tracts performed, calyx election, type of tract dilatation and kind of energy used for fragmentation, both groups were homogeneous. In 3 cases of each group there was a failure to access the kidney. The rate of failure was 6%, and 5.56%, for the supine and prone groups, respectively (p=0.716). Average operating time was 74.55+/-25.54 and 91.82+/-24.82 minutes, respectively, p=0.123. A postoperative x-ray showed a stone-free rate of 76% for the supine group and 74% for the prone group, p=0.308. ESWL was the supplementary treatment for 12% of the patients in the supine group, and for 12.96% of the patients in the prone group p= 0.478, and a second procedure was performed on 4 (8%) patients in the supine group and on 3 (5.56%) in the prone one, p=0.697. Hospital stay was the same for both groups (5.89+/-4.7 for the supine group, and 5.5+/-4.09 for the prone one, p=0.694). As far as analgesia required, 6.89+/-4.87 was administered for the supine against 6.18+/-4.09 for the prone, p=0.580. The complications rate was very low for both groups and also very similar; one of the patients in the supine group suffered a lesion to the colon. CONCLUSION: Valdivia position is as feasible as the prone position for PCNL. Success rates, as far as stone clearing, and complications are similar for both positions.

Comparación entre la posición de Valdivia y la posición prona en la nefrolitectomía percutánea (NLP) / Comparison between Valdivia position and prone position in percutaneous nephrolithotomy

Introducción: La posición supina, ideada por Valdivia hace dos décadas para la nefrolitectomía percutánea (NLP), a pesar de aventajar a la posición prona en aspectos concernientes a la anestesia y a la ergonomía quirúrgica, no ha tenido una amplia difusión en la comunidad urológica debido a que se ha asociado a una mayor dificultad técnica, menor tasa de limpieza de cálculos y mayor tasa de complicaciones, aunque los escasos estudios comparativos existentes no sustenten estos argumentos. En este trabajo se comparan ambas posiciones en la NLP analizando los resultados desde el punto de vista de la dificultad técnica, la eficacia en la resolución de la litiasis y de las complicaciones. Material y Métodos: Una serie de 50 pacientes a los que se les realizó una NLP en posición supina fue comparada de forma retrospectiva con otra de 54 pacientes intervenidos consecutivamente por NLP en posición prona. Todas las intervenciones fueron realizadas bajo anestesia general, predominando los abordajes del cáliz inferior y los trayectos únicos sobre los múltiples en ambos grupos. La dilatación del tracto de nefrostomía se realizó mayoritariamente con catéter balón de alta presión. El área litiásica media tratada fue de 399,93+58,2 mm2 en el grupo supino y de416,36+46,54 mm2 para el prono, (p= 0,456). La manipulación de la litiasis se llevó a cabo mediante fragmentación ultrasónica, mecánica y en un reducido número de pacientes se realizó extracción directa con pinzas. Resultados: Ambos grupos fueron semejantes en cuanto a los parámetros demográficos y a variables referentes a la técnica quirúrgica como el número de trayectos realizados, cáliz elegido para la punción, tipo de dilatación del tracto de nefrostomía o clase de energía utilizada en la fragmentación. Se fracasó en el acceso a las cavidades renales en 3 casos en cada grupo (6% para el grupo supino y 5,56% para el prono, (p= 0,716)). El tiempo operatorio medio fue de 74,55+25,54 min. para el grupo supino frente a 91,82+24,82 min. para el prono, (p=0,123). En el postoperatorio inmediato se observó, mediante una radiografía simple, una tasa de limpieza de cálculo de 76% para el grupo en supino y del 74% para el grupo en prono, (p= 0,308). Se empleó LEOCH como tratamiento complementario en el 12% de los pacientes del grupo supino y en el 12,96% del prono, (p=0,478), y se realizó una segunda NLP por litiasis residual en 4 (8%) y en 3 pacientes (5,56%) del grupo supino y del prono respectivamente (p=0,697). Hubo equivalencia en el postoperatorio de ambos grupos en cuanto a los días de hospitalización (5,89+4,7 para el supino vs 5,5+4,09 para el prono, p= 0,694), y en cuanto a la analgesia que precisaron (6,89+4,87 dosis en el supino frente a 6,18+4,09 dosis en el prono, (p=0,580). No hubo diferencias entre la tasa de complicaciones, que fue baja para ambos grupos, si bien, en un caso del grupo supino se produjo una lesión del colon. Conclusión: La posición de Valdivia es igual de factible que la posición prona en la NLP. Las tasas, tanto de éxito en cuanto a resolución litiásica, como de complicaciones son similares entre ambas posiciones (AU)

Introduction: Although the supine position created by Dr. Valdivia two decades ago to perform the procedure known as percutaneous nephrolitectomy (PNL) presents advantages against the prone position in some aspects concerning anesthesia and surgical ergonomy, its use has failed to spread widely among the urology community due to certain technical difficulties, a lower rate of calculi clearing and a higher rate of complications ,in spite of the fact that the scarce comparative studies do not show enough data to support this opinion. The present study compares both positions considering the technical difficulties encountered, their effectiveness and their results and complications. Material and Methods: A series of 50 patients that underwent PCNL by prone position is compared retrospectively with another series of 54patients that underwent consecutively PCNL by prone position. All procedures were performed under general anesthesia, the inferior calyx approach was the one used the most over the supracostal approach, and the sole tract over the multi-tract approach was predominant. Dilatation of the nephrostomy tract was done, in most of the cases, with a high-pressure balloon catheter. The stone surface treated was 399.93+58.2 mm2 for the supine group, and 416.36+46.54 mm2 for the prone one (p=0.456). The management of the stones was carried out by ultrasonic or ballistic fragmentation, and a small group of patients underwent direct stone removal. Results: As far as demographic parameters and operative variables such as number of tracts performed, calyx election, type of tract dilatation and kind of energy used for fragmentation, both groups were homogeneous. In 3 cases of each group there was a failure to access the kidney. The rate of failure was 6%, and 5.56%, for the supine and prone groups, respectively (p=0.716). Average operating time was 74.55+25.54 and 91.82+24.82 minutes, respectively, p=0.123. A postoperative x-ray showed a stone-free rate of 76% for the supine group and 74% for the prone group, p=0.308. ESWL was the supplementary treatment for 12% of the patients in the supine group, and for 12.96% of the patients in the prone group p=0.478, and a second procedure was performed on 4 (8%) patients in the supine group and on 3 (5.56%) in the prone one, p=0.697. Hospital stay was the same for both groups (5.89± 4.7 for the supine group, and 5.5 ± 4.09 for the prone one, p= 0.694). As far as analgesia required, 6.89 ± 4.87 was administered for the supine against 6.18±4.09 for the prone, p= 0.580. The complications rate was very low for both groups and also very similar; one of the patients in the supine group suffered a lesion to the colon. Conclusion: Valdivia position is as feasible as the prone position for PCNL. Success rates, as far as stone clearing, and complications are similar for both positions (AU)

[TRUS-guided biopsy: comparison of two anesthetic methods]. / Biopsia prostática ecodirigida: comparación de dos métodos anestésicos.

PURPOSE: The aim of the present study is to compare two analgesic techniques for ultrasound transrectal biopsy. Oral analgesia vs periprosthetic nerve blockade with 2% mevicaine. PATIENTS AND METHODS: A total of 200 patients were randomized prospectively into 2 groups, namely group I: 100 patients treated with metamizol, oral morphine 30 minutes before the procedure, and group II: 100 patients anesthesied with periprosthetic nerve blockade with 2% mepivacaine. Both groups were treated with bromacepán 3 mg 30 minutes before the biopsy. The first intention was to obtain 10 core TRUS-guided biopsy in all patients underwent. After the procedure, a ten visual analogue pain score (VAS) from 0 = no discomfort to 10 = severe pain was administered to the biopsied patients and a global estimation of pain associated with the procedure was obtained. Test T de Student was used for statistical analysis. RESULTS: There were no significant differences in age, PSA and prostate volume. 3 core TRUS-guided biopsy were obtain in group I (3 +/- 1.3), and 10 in group II (5 +/- 1.2) In the periprosthetic block group (II) 95% of patients referred no pain after the procedure (VAS = 0), 2% middle pain (VAS = 5-6) and 3% strong pain (VAS = 7-8); while patients in group I referred 12.5% no pain, 42.4% middle pain, 20% strong pain. The level of pain reported by this group of patients was significantly different from those reported by patients who performed prostate biopsy with periprosthetic nerve blockade. (p < or = 0.05). There were no significant differences in major complications. CONCLUSIONS: The use of bilateral periprosthetic block with mepivacaine is a very effective and useful technique, well tolerated by the patient, which almost completely abolishes the pain and discomfort associated with the prostate biopsy procedure. And also allows increase the number of cores.

[Laparoscopic treatment of ovarian vein syndrome]. / Tratamiento laparoscópico del síndrome de la vena ovárica.

OBJECTIVE: We report a case of Ovarian Vein Syndrome, describe its clinical symptoms and discuss its diagnosis and management including laparoscopic surgery treatment. MATERIALS AND METHODS: A 36-year-old female with right kidney recurring pain was studied by means of abdominal RX, urography, CT, MRI and ultrasonography and finally diagnosed from Ovarian Vein Syndrome. The case was resolved with laparoscopic surgery. CONCLUSIONS: Ovarian Vein Syndrome is an uncommon disorder. Differential diagnosis must be done with external processes that cause ureteral obstruction. Surgery is the first line treatment when clinical symptoms are present and, in our opinion,laparoscopic surgery is the best approach to treat this pathology.

Tratamiento laparoscópico del síndrome de la vena ovárica / Laparoscopic treatment of ovarian vein syndrome

Objetivo: Presentamos un caso de síndrome de la vena ovárica, describimos su presentación clínica y discutimos su diagnóstico y tratamiento incluyendo la cirugía laparoscópica. Material y Métodos: Mujer de 36 años de edad con clínica de cólico renal derecho recurrente que tras ser estudiada mediante radiología de abdomen, urografías, TAC, RM y ecografía es diagnosticada finalmente de síndrome de la vena ovárica. El caso se resuelve con cirugía laparoscópica. Conclusiones: El síndrome de la vena ovárica es una entidad poco frecuente. El diagnóstico diferencial se debe hacer con procesos extrínsecos que producen obstrucción ureteral. El tratamiento es quirúrgico cuando produce síntomas y pensamos que actualmente debe hacerse por vía laparoscópica

Objective: We report a case of Ovarian Vein Syndrome, describe its clinical symptoms and discuss its diagnosis and management including laparoscopic surgery treatment. Materials and Methods: A 36-year-old female with right kidney recurring pain was studied by means of abdominal RX, urography, CT, MRI and ultrasonography and finally diagnosed from Ovarian Vein Syndrome. The case was resolved with laparoscopic surgery. Conclusions: Ovarian Vein Syndrome is an uncommon disorder. Differential diagnosis must be done with external processes that cause ureteral obstruction. Surgery is the first line treatment when clinical symptoms are present and, in our opinion, laparoscopic surgery is the best approach to treat this pathology

[Laparoscopic radical prostatectomy. Preliminary experience]. / Prostatectomía radical laparoscópica: experiencia preliminar.

OBJECTIVE: Laparoscopic technique has been developed with the aim to decrease the morbidity of the open radical prostatectomy. MATERIAL AND METHODS: From january 2002 to may 2002, 8 patients were treated for prostate cancer with laparoscopic radical prostatectomy. Unilateral linfadenectomy has been carried out in only one patient. We usually employ the transperitoneal technique published by the Montsouris Institute, with some modifications. RESULTS: The main surgical time was 356 minutes (540-240). Transfusion wasn't needed in any case. Intraoperative complications were: 2 bladder injuries, 1 bleeding of the epigastric artery. Postoperative complications were: 1 ileus, 2 compressive neurapraxia, 4 anastomotic fistutas. All complications were treated conservatively. No patient were converted to open surgery. Surgical limits were negatifs in all cases, and the PSA rate was less than 0.1 ng/ml in the first month follow up. CONCLUSION: Laparoscopic radical prostatectomy is a difficult technique, but we think that, the learning curve is getting lower and lower than in the first series. Oncologic results with this technique is similar to the open one. However, laparoscopic approach shows us some benefits such as less bleeding, less time catheterisation, less hospital stay, better continence, better sexual function, better stetic result, less postoperative pain, and finally an earlier back to work.

[Treatment of stenosis in uretero-intestinal anastomosis]. / Tratamiento de las estenosis en las anastomosis uretero-intestinales.

UNLABELLED: We report our experience in the treatment of uretero-enteric anastomotic strictures. Our incidence in this complication is 3.8% in orthotopic bladder substitution and 8.3% in ileal conduict. MATERIAL AND METHODS: We have treated this complication in 6 patients with orthotopic bladder substitution and 4 with ileal conduict. We tried to perform a dilatation with a high pressure balloon and to place a Double-J catheter. RESULTS: In 4 cases we could not introduce the guidewire through the stricture because there was a total stop. In the others 6 cases, one is doing well without Double-J, another one did not tolerate the catheter and we performed an open surgical reanastomosis, 2 kept the catheters until their death due to metastases and the other two continue alive with their catheter periodically replaced. CONCLUSIONS: The direct uretero-enteric anastomoses present less stenoses risk. Endourological techniques should be the first option in treatment of these patients.

Investigación de resultados tras derivación urinaria (calidad de vida) / Data analysis after urinary derivation (quality of life)

No disponible

Tratamiento de las estenosis en las anastomosis uretero-intestinales / Treatment of uretero-enteric anastomotic strictures

Presentamos nuestra experiencia en el tratamiento de las estenosis en las anastomosis uretero-intestinales. Nuestra incidencia en esta complicación en las sustituciones vesicales ortotópicas es del 3,8 por ciento, y en las ileostomías cutáneas del 8,3 por ciento. MATERIAL Y MÉTODOS: Hemos tratado esta complicación a 6 pacientes con plastia de sustitución vesical ortotópica y 4 con ileostomía cutánea. Intentamos realizar una dilatación de la estenosis con balón de alta presión y dejar una sonda doble J. RESULTADOS: En 4 casos no logramos cateterizar la estenosis por existir un stop completo. De los otros 6 pacientes uno está bien sin doble J, otro no toleró la sonda y tuvimos que realizar una reanastomosis abierta, 2 mantuvieron la sonda hasta su fallecimiento por metástasis y otros 2 viven actualmente con sonda y cambios periódicos. CONCLUSIONES: Las anastomosis directas del uréter en el intestino tienen menos riesgo de estenosis. Las técnicas endourológicas deben ser la primera opción en el tratamiento de estos pacientes (AU)

[Penile incarceration with metal rings]. / Incarceración peneana por anillos metálicos.

Contribution of a case report of penial incarceration following placement of three thick metal rings and its resolution. Literature review.

[Orthotopic substitutive cystoplasty in women. Technical modifications in anterior exenteration: results in 9 cases]. / Plastia de sustitución vesical ortotópica en la mujer. Modificaciones técnicas en la exenteración anterior: resultado en 9 casos.

OBJECTIVE: The results obtained in 9 female patients who underwent bladder substitution after a modified anterior pelvic exenteration are presented. METHODS: From 1994 to 1999, 9 women underwent bladder substitution after a modified anterior pelvic exenteration that preserved the two distal thirds of the urethra, the pubourethral ligaments and endo-pelvic fascia and limited laterovaginal dissection to preserve the innervation of the striated sphincter for continence. RESULTS: The bladder capacity was 332.9 +/- 35.6 ml and urinary flow was 17.7 +/- 2.9 ml/sec. Seven patients are completely continent and two patients have stress incontinence grade II. None of the patients had difficulty with bladder emptying. Fistula (one case) and diarrhea (one case) were the most important complications. CONCLUSIONS: Our approach is based on a better understanding of the anatomical mechanisms of female continence and the viability of the remaining urethra from the oncologic perspective. This technique achieves a high level of patient satisfaction and quality of life.

Incarceración peneana por anillos metálicos / Penial incarceration by metal rings

Presentamos un caso de incarceración peneana, tras la colocación de tres gruesos anillos metálicos y su resolución, así como una revisión de la literatura (AU)

[Laparoscopic approach of Dielt's syndrome]. / Tratamiento laparoscópico del síndrome de Dielt.

Dielt's syndrome is generally known as nephritic colic due to the dilation of the urinary tract that results from a renal ptosis. In spite of renal ptosis being a commonly seen occurrence, sometimes it can be the cause of a serious painful clinical manifestation. This paper presents one case successfully treated through laparoscopic nephropexy. It also includes a discussion on the various diagnostic and therapeutical techniques.

[Tuberculosis and renal cancer]. / Tuberculosis y cáncer renal.

The association of tuberculosis and renal adenocarcinoma is very uncommon. In general, the condition presents clinically, radiologically and biologically, as a tuberculosis while the diagnosis of renal carcinoma came as a pathoanatomical finding following nephrectomy. We contribute one case report of tuberculosis and renal adenocarcinoma in association that initially presented with tumoral signs and symptoms in a 34-year-old female patient. The patient, with no previous background, was later diagnosed TBC. A review is made on the pathogenesis, epidemiology and pathoanatomical diagnosis of tuberculosis. It is hypothesized that the tuberculosis damage may be a reactivation secondary to a renal tumour.

[Primary abscess of the psoas. Report of a case]. / Absceso primario de psoas. A propósito de un caso.

Psoas abscess is an uncommon condition at the present time. The initial anodyne signs and symptoms make diagnosis difficult. It can be diagnosed and rated as primary when the origin is not found, or secondary when a focus for infection spreading is detected. Drainage either percutaneously or by open surgery, and antibiotic therapy are the choice treatment, achieving an important survival rate. This paper presents a new case of psoas abscess, including a revision of the diagnosis and treatment of this condition.