Quistes de rafe medio en el varón. Presentación de nuestra experiencia y revisión de la literatura / Median raphe cysts in men. Presentation of our experience and literature review

Objetivos: Presentar nuestra experiencia en el diagnóstico y tratamiento de los quistes de rafe medio atendidos en nuestro servicio en los últimos 25 años. Material y método: Realizamos un estudio retrospectivo de 28 varones afectos de quistes de rafe medio intervenidos en nuestro servicio desde junio de 1990 a marzo de 2015. Se analizan la edad de presentación, el motivo de consulta, las manifestaciones clínicas, los hallazgos en el estudio histológico, el tratamiento realizado y la evolución tras su exéresis. Resultados: La mayor parte de los pacientes (22; 79%) estaban asintomáticos y consultaron por el defecto estético; 4 casos (14%) presentaron alteraciones miccionales y 2 (7%) refirieron molestias durante el acto sexual. En todos los casos el tratamiento consistió en la extirpación quirúrgica del quiste, obteniendo excelentes resultados estéticos y funcionales, sin recidiva de la lesión en ninguno de los pacientes durante un seguimiento medio de más de 10 años. El tipo histológico más frecuentemente encontrado fue el de células transicionales en 15 casos (54%), seguido del tipo mixto (transicional y escamoso) en 11 casos (39%); en un caso (6%) fue de tipo escamoso puro y en otro caso (6%) el epitelio fue de tipo glandular. Conclusiones: Los quistes de rafe medio constituyen un tipo infrecuente de disembrioplasia que pueden localizarse en cualquier punto del rafe medio, desde el meato balánico hasta los márgenes del ano. Generalmente son asintomáticos y su tratamiento de elección es la extirpación quirúrgica

Objectives: To present our experience with the diagnosis and treatment of median raphe cysts treated in our department in the last 25 years. Material and method: We conducted a retrospective study of 28 men with median raphe cysts who underwent surgery in our department from June 1990 to March 2015. We analysed the age of presentation, reason for consultation, clinical manifestations, histological findings, treatment and outcome after exeresis. Results: The majority of the patients (22; 79%) were asymptomatic and consulted for the aesthetic defect. Four cases (14%) presented urinary abnormalities, and 2 cases (7%) reported discomfort during sexual intercourse. In all cases, the treatment consisted of surgical extirpation of the cysts, with excellent aesthetic and functional results and no lesion recurrence in any of the patients during a mean follow-up of more than 10years. The most common histological type was the transitional cell type in 15 cases (54%), followed by the mixed type (transitional and squamous) in 11 cases (39%). One case (6%) was pure squamous type, and in another case (6%) the epithelium was glandular. Conclusions: Median raphe cysts are an uncommon type of disembryoplasia that can occur in any location of the median raphe, from the balanic meatus to the edges of the anus. These cysts are generally asymptomatic and their treatment of choice is surgical extirpation

Median raphe cysts in men. Presentation of our experience and literature review. / Quistes de rafe medio en el varón. Presentación de nuestra experiencia y revisión de la literatura.

OBJECTIVES: To present our experience with the diagnosis and treatment of median raphe cysts treated in our department in the last 25years. MATERIAL AND METHOD: We conducted a retrospective study of 28men with median raphe cysts who underwent surgery in our department from June 1990 to March 2015. We analysed the age of presentation, reason for consultation, clinical manifestations, histological findings, treatment and outcome after exeresis. RESULTS: The majority of the patients (22; 79%) were asymptomatic and consulted for the aesthetic defect. Four cases (14%) presented urinary abnormalities, and 2 cases (7%) reported discomfort during sexual intercourse. In all cases, the treatment consisted of surgical extirpation of the cysts, with excellent aesthetic and functional results and no lesion recurrence in any of the patients during a mean follow-up of more than 10years. The most common histological type was the transitional cell type in 15 cases (54%), followed by the mixed type (transitional and squamous) in 11 cases (39%). One case (6%) was pure squamous type, and in another case (6%) the epithelium was glandular. CONCLUSIONS: Median raphe cysts are an uncommon type of disembryoplasia that can occur in any location of the median raphe, from the balanic meatus to the edges of the anus. These cysts are generally asymptomatic and their treatment of choice is surgical extirpation.

Seguimiento a largo plazo en el tratamiento de la incontinencia urinaria masculina con el sistema Remeex / Long-term follow-up for the treatment of male urinary incontinence with the Remeex system

Objetivos: Poner de manifiesto nuestra experiencia en el tratamiento de la incontinencia urinaria de esfuerzo (IUE) posprostatectomía con el sistema Remeex masculino (SRM). Asimismo, describimos los elementos que componen dicho sistema, técnica de implantación y su adecuado ajuste. Igualmente, pretendemos comprobar si las últimas modificaciones realizadas en dicho dispositivo, que constituye el SRM-II, han supuesto un menor número de reajustes de la malla. Material y método: Desde marzo de 2007 hasta marzo de 2014 hemos intervenido a 24 varones afectos de IUE posprostatectomía con edades comprendidas entre 55 y 78 años (media 67 años), mediante la colocación de una malla suburetral de tensión regulable tipo Remeex. Todos ellos presentaban una incontinencia urinaria severa con gran afectación de su calidad de vida. Resultados: Todos los pacientes, excepto en 2 casos que precisaron retirada del sistema, se mantienen secos, necesitando ocasionalmente 9 de ellos (39%) compresa de seguridad si realizan ejercicio físico intenso. El número medio de reajustes fue de 2,4 (rango 0-6). La puntuación del Incontinence Impact Questionnaire realizado antes de la intervención y 6 meses después pasa de 79±7 puntos a 11±3, siendo el grado de satisfacción muy elevado. Conclusiones: El SRM constituye una opción terapéutica válida para la incontinencia posprostatectomía, siendo una técnica reproducible, de fácil ejecución, con una baja tasa de complicaciones, proporcionando unos resultados excelentes y duraderos. Asimismo, parece existir una clara tendencia a la disminución del número de reajustes con el nuevo SRM-II

Objectives: To relate our experience in treating postprostatectomy stress urinary incontinence (SUI) with the male Remeex system (MRS). We also list the elements that comprise this system, the implantation technique and its proper adjustment. Similarly, we attempt to determine whether the latest changes made to this device, which constitute the MRS-II, have resulted in fewer mesh readjustments. Material and method: From March 2007 to March 2014, we operated on 24 men with postprostatectomy SUI between the ages of 55 and 78 years (mean, 67 years), through the placement of a Remeex suburethral tension-adjustable sling. All patients had severe urinary incontinence, with considerable impact on their quality of life. Results: All patients, except for 2 who required the removal of the system, remained continent. Nine of the patients (39%) occasionally required incontinence pads when performing intense physical exercise. The mean number of adjustments was 2.4 (range 0-6). The score on the Incontinence Impact Questionnaire (IIQ 7) performed before the surgery and 6 months after, went from 79±7 points to 11±3, with a very high degree of satisfaction. Conclusions: The MRS is a valid therapeutic option for postprostatectomy incontinence and is a reproducible technique that is easy to perform, has a low rate of complications and provides excellent and lasting results. There is also a clear trend towards reducing number of adjustments with the new MRS-II

Long-term follow-up for the treatment of male urinary incontinence with the Remeex system. / Seguimiento a largo plazo en el tratamiento de la incontinencia urinaria masculina con el sistema Remeex.

OBJECTIVES: To relate our experience in treating postprostatectomy stress urinary incontinence (SUI) with the male Remeex system (MRS). We also list the elements that comprise this system, the implantation technique and its proper adjustment. Similarly, we attempt to determine whether the latest changes made to this device, which constitute the MRS-II, have resulted in fewer mesh readjustments. MATERIAL AND METHOD: From March 2007 to March 2014, we operated on 24 men with postprostatectomy SUI between the ages of 55 and 78 years (mean, 67 years), through the placement of a Remeex suburethral tension-adjustable sling. All patients had severe urinary incontinence, with considerable impact on their quality of life. RESULTS: All patients, except for 2 who required the removal of the system, remained continent. Nine of the patients (39%) occasionally required incontinence pads when performing intense physical exercise. The mean number of adjustments was 2.4 (range 0-6). The score on the Incontinence Impact Questionnaire (IIQ 7) performed before the surgery and 6 months after, went from 79±7 points to 11±3, with a very high degree of satisfaction. CONCLUSIONS: The MRS is a valid therapeutic option for postprostatectomy incontinence and is a reproducible technique that is easy to perform, has a low rate of complications and provides excellent and lasting results. There is also a clear trend towards reducing number of adjustments with the new MRS-II.