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.

Predicting results of daily-practice cystoscopies.

OBJECTIVE: Our objective was to elaborate a predictive model of bladder cancer, in an unselected clinical population submitted to cystoscopy. MATERIALS AND METHODS: We recruited consecutive patients that underwent cystoscopy due to suspicion of bladder cancer or surveillance of a previously diagnosed bladder cancer. Urine cytology and a BTA-stat® (BTA) test were carried out for all patients. To avoid an assessment bias, the BTA-tests, cytologies and cystoscopies were conducted in a blinded fashion. We used logistic regression to predict cystoscopy results from cytology, BTA-test and clinical variables. RESULTS: From August 2011 to July 2012, we recruited 244 patients and 237 were valid for analysis. Newly diagnosed and surveillance cases were 13% and 87% respectively. Cytology and BTA-test sensitivities were 57.9% (CI 95: 42.2-72.1) and 63.2% (CI 95: 47.3-76.6) with specificities of 84.4% (CI 95: 78.7-88.8) and 82.9% (CI 95: 77.1-87.5). The predictive model included the BTA-test, cytology, time since previous tumour, and treatment with mitomicin or BGC during the last three months. The model predictive accuracy (AUC) was .85 (.78-.92), and dropped to 0.79 when excluding the BTA-test (P=.026). For the surveillance of bladder cancer, a 10% threshold on the model predicted probabilities resulted in an overall negative predictive value of 95.7%, and 95.0% in low grade tumours. CONCLUSION: In a cost containment environment, our prediction model could be used to space out cystoscopies in patients with previous, low grade tumours, resulting in a more efficient use of resources in the healthcare system.

Assessment of the psychometric properties of the Spanish language version of questionnaire ICIQ-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS).

OBJECTIVES: To evaluate the psychometric properties of the Spanish version of the ICIQ-Male Lower Urinary Tract Symptoms Questionnaire (ICIQ-MLUTS): Feasibility (% of completion and ceiling/ground effects), reliability (Test-retest), convergent validity (vs Bladder Control Self-Assessment Questionnaire [BSAQ] and vs International Prostate Symptom Score [I-PSS]) and criterion validity (according to presence or absence of symptoms). MATERIAL AND METHODS: This was an observational, non-interventionist and multicenter study. 223 male patients with lower urinary tract symptoms (LUTS), predominantly storage symptoms and aged 18-65, took part in the study. Patients completed the ICIQ-MLUTS (test), I-PSS and BSAQ questionnaires and referred their urinary symptoms in a single visit, with the exception of a subgroup composed by 49 patients that completed the questionnaire again 15 days after initial visit to evaluate test-retest reliability. The questionnaire includes 13 items divided in 2 sub-scales: Voiding symptoms (V) from 0-20 and Incontinence symptoms (I) from 0-24. RESULTS: Percentage of patients that completed all items: 98.84%. Ground effect is 0 and ceiling effect was under 6% in both sub-scales. Test-retest reliability: Intraclass correlation coefficient (ICC) ranged from 0.68 to 0.88, except on Delay. Kappa shows a good agreement, between 0.60 and 0.81, except for Nocturia. Convergent validity: Correlation (Spearman) between the questionnaire sub-scales scores and the rest of measures is statistically significant (P < .01 and P < .05). Criterion validity: Statistically significant differences (P < .05) between scores on ICIQ-MLUTS, from patients that refer experiencing symptoms and those who do not. CONCLUSION: The Spanish version of the ICIQ-MLUTS questionnaire shows adequate feasibility, reliability and validity.

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.

[A study of spontaneous regeneration of defected short nerve gaps in rats]. / Estudio de la regeneración espontánea en defectos nerviosos de poca longitud en ratas.

Nerve trunk gaps can be repaired with different anastomosis methods. We investigate if spontaneous regeneration can yield results similar to artificial repair, and have compared the degree of nerve regeneration in nerve defects of extratemporal facial nerve trunk in Wistar rats. The lesions measured 4 millimeters long. Three groups were studied: 0. Normal nerve (control). 1. No treatment (therapeutic abstention). 2. Autografts. The considered parameters were: clinical outcome (degree of postoperative facial function, aspect of the defectuous region, nerve conduction latency, and number of axons that managed to penetrate the defect as well as their morphometric characteristics (nerve area). Our conclusion is that in this model placement of autografts yielded significantly better results in all the parameters studied, in spite of the scant defect length. These results likewise allow us to use this model to compare repair by means of different graft types.

[Repair of facial nerve gaps with cryopreserved allografts in rats immunosuppressed with cyclosporin A]. / Reparación de lesiones del nervio facial mediante aloinjertos criopreservados en ratas inmunodeprimidas con ciclosporina A.

UNLABELLED: The aim of this study is to assess the feasibility of peripheral nerve allografts pretreated utilizing cold storage and cyclosporin A to improve the facial nerve regeneration in Wistar rat. Three groups were designed: Normal Wistar rats. 4 millimeters nerve gaps repaired with cryopreserved nerve allografts. 4 millimeters nerve gaps repaired with cryopreserved nerve grafts and treated with cyclosporin A. At 16 weeks post-engraftment the animals were evaluated: Facial palsy grading system. Electrophysiologic latency. Axonal counting. Nervous fiber area immediately distal to the graft. The facial function of the experimental groups was similar to the control rats while the latency and morphometric parameters was poor than the normal rats. CONCLUSIONS: 1. Cryopreserved nerve allografts in facial nerve repair in rats are useful in the aquisition of a facial functional nerve recovery as much in immunosuppressed animal as not. 2. Cryopreservation of nerve allografts results a good method of storage of nerve grafts. 3. Cyclosporin A immunosuppression improved not much the grading facial palsy in this model but the electrophysiologic and morphometry is significantly better.

[Effects of chronic alcohol drinking on rat's prostate. Experimental study]. / Efectos de la ingesta crónica de alcohol sobre la próstata de la rata. Estudio experimental.

OBJECTIVE: We have studies both the morphologic and morphometric modifications that the alcohol induces in subjected rats to chronic intake of alcohol and to evaluate the reversibility of this alterations after suppressing the ingesta of alcohol. MATERIAL AND METHODS: The animals underwent diverse outlines of chronic intake of alcohol and diverse morphometric parameters of the prostate were valued at the level of optic microscopy. RESULTS: Two morphologic prostatic patterns was observed according to the studied group of animals (experimental or control). It seems to be that the dose of alcohol was the factor that more it influenced in the morphometric variations of the cells.

Efectos de la ingesta crónica de alcohol sobre la próstata de la rata. Estudio experimental / Effects of chronic alcohol intake in the rate prostate. Experiment study

OBJETIVO: Estudio de las modificaciones morfológicas y morfométricas, que el alcohol induce en ratas sometidas a ingesta crónica de alcohol, y evaluar la reversibilidad de dichas alteraciones tras suprimir la ingesta de alcohol. MATERIAL Y MÉTODOS: Los animales se sometieron a diversos esquemas de ingesta crónica de alcohol, y se valoraron diversos parámetros morfométricos prostáticos al nivel de microscopia óptica. RESULTADOS: Se observaron dos patrones morfológicos prostáticos según el grupo de animales estudiado (experimental o control). Parece ser que la dosis de alcohol fue el factor que más influyó en las variaciones morfométricas celulares (AU)

[Cryopreservation of neural allografts for the nerve reconstruction in experimental surgery]. / Criopreservación de aloneuroinjertos para reconstrucción nerviosa en cirugía experimental.

The possibility of clinical employment of nervous allografts depends on the likehood of its storage and also of the need of decreasing its antigenecity. We report our methodology for cryo-preservation and storage of nervous grafts, in view of animal experimentation as well as a re-examination of other methods in order to remember grafts storages done in previous epochs.

[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.

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)

[Morphometric correlation at the experimental level of renogram with renal arterial stenosis]. / Estudio de la correlación morfométrica a nivel experimental del renograma con la estenosis de la arteria renal.

RATIONALE: A reduction of the renal size seen with the nephrogram (intravenous urography) has been described in renal artery stenosis. Such reduction, however, has not been quantified and the evolution is unknown in terms of duration of stenosis evolution. METHODS: Experimental study in rats which underwent controlled stenosis of a renal artery, with evaluation, using planimetry of the area and perimeter of the nephrogram, of the consequences such stenosis had at different observation intervals (30, 90 and 180 days). The effects of the stenosis relative to the duration of the experiment is also evaluated. RESULTS: The area and perimeter of the nephrogram become reduced in kidneys with artery stenosis. Besides, this reduction increases over time. CONCLUSION: The area and perimeter of the nephrogram are a useful method to study renal artery stenosis in rats.

[Testicular epidermoid cyst]. / Quiste epidermoide testicular.

Epidermoid cysts are benign tumours that can affect testicles. Incidence is rare, having been described until now in less than 200 cases. Contribution of one study case of testicular epidermoid cyst and discussion of issues on histogenesis, ultrasound diagnosis and therapy approaches.

[Paratesticular lipoma]. / Lipoma paratesticular.

In spite of being the most frequent benign tumour of the spermatic cord, absolute frequency of this neoplasia is very low. We discuss here a case report of an spermatic cord lipoma with several years evolution. Although ultrasound is useful for clinical diagnosis, exploratory scrototomy and surgical exeresis of the mass is the only reliable diagnosis and viable treatment.

[Testicular changes produced by alcohol]. / Alteraciones testiculares producidas por el alcohol.

Acting as a direct toxic through different mechanisms, alcohol causes many hormonal changes which induce sexual function impairment and fertility problems. We have used 36 white Wistar Lewis rats, divided in three large groups: 10% alcoholic, 25% alcoholic and control group for 55 and 95 days. The parameters studied were the rat's ponderal evolution, testicular volume and weight, testes and body weights ratio, as well as testes density and seminiferous tubule area. We found a decreased ponderal gain in animals receiving high doses of alcohol. Decreased testicular volume and increased density in long-term alcohol regime. At high dose and medium-term increased testicular weights were seen as compared to total weight of the rat. The area of the seminiferous tubule is reduced in all alcoholic groups.

[Renal hydatidosis. Our experience]. / Hidatidosis renal. Nuestra experiencia.

Presentation of five cases of renal hydatidic cysts. Revision of literature with regard to their clinical presentation form, diagnostic methods and surgical approach for management.

[The morphometric changes of chronic ischemia in the hepatocyte. An experimental study in the rat]. / Alteraciones morfométricas de la isquemia crónica sobre el hepatocito. Estudio experimental en la rata.

The effects of chronic ischemia on the rat hepatocyte are morphometrically analyzed in the present study. Rats Wistar-Lewis are used. Rats underwent a stenosis of the celiac artery by using a metallic guide. The interval between the experimentation until the sacrifice was 15, 30, 90, 180, and 360 days. We have performed a morphometric study using a semiautomated image analyzer system (VIDS III, Analytical Measuring Systems). Morphological disturbances in the chronic ischemia periods above mentioned can be measured: an increase in the hepatocyte area starting from 90 days of experimentation and also an increase in the hepatocyte perimeter starting from 30 days of ischemia. On the other hand, both the nuclear area and the nuclear perimeter are increased in every period studied. The number of hepatocytes per microscopic field doesn't show any change in relation to ischemia time. Cellular swelling suggests some degree of cellular hypoxia in contradiction with other observations.

[Prostatic melanosis]. / Melanosis prostática.

Melanin presence in the prostate can be accurately localized in epithelial cells (nevus) or in the stroma (prostatic melanosis). This article describes a new case and compiles all recorded cases as well as the theories concerning their origin.

[Morphometric study of the effects of gastric ischemia on the glandular portion of the stomach of the rat]. / Estudio morfométrico de los efectos de la isquemia gástrica sobre la porción glandular del estómago de la rata.

An experimental study was made of the effects of stenosis of the celiac trunk on the glandular portion of the stomach of the rat. We used male Wistar rats weighing 250-300 grams. After general anesthesia and laparotomy, the celiac trunk was dissected and narrowed with a metal ring. The animals were sacrificed at 15, 30, 90, 180 and 360 days. A gross and morphometric study was made of different parameters on photographs of fundal and antral preparations stained with hematoxylin-eosin. Under the conditions described, controlled stenosis of the celiac trunk produces quantitative modifications in the glandular portion of the rat's stomach.