Long-Term Outcomes of the Altis® Single-Incision Sling: Up to 10 Years' Follow-up.

INTRODUCTION AND HYPOTHESIS: Single-incision slings (SIS) have emerged as a less invasive alternative to conventional slings for stress urinary incontinence (SUI) treatment. However, long-term efficacy and safety results remain uncertain owing to a lack of studies. MATERIAL AND METHODS: A retrospective review of 155 patients treated with Altis® for SUI between February 2012 and June 2017, held in 2022, as a continuation of a prospective study in which all patients (197) were reviewed for 2 years after surgery (1, 6, 12, and 24 months). Preoperative demographic data, comorbidities, and pressure-flow studies were also recorded. Continence status and satisfaction rates were assessed using the International Consultation on Incontinence Questionnaire-short form (ICIQ-SF) and the Patient Global Impression of Improvement (PGI-I) respectively. The assessment in the 2022 retrospective review was performed via a telephone survey. RESULTS: Mean follow-up time after surgery was 85.3 months (82.5-88.1). In 2022, complete continence was present in 75.4% of the patients. The presence of urinary urgency conditioned the ICIQ-SF score (10.9 vs 1.7 points, p < 0.01), with the ICIQ-SF = 0 in 84.5% of the patients with no associated urgency. Satisfaction assessed by the PGI-I was high, with 84.6% of the patients showing improvement. De novo urgency was present in 37,9% of the patients by 2022. Urinary tract infections were the most frequent complication (9.7%), with only 5 documented cases of mesh erosion. CONCLUSIONS: Altis® SIS is a safe and effective device for SUI treatment, with satisfaction rates comparable with those of the conventional slings. Persistence or development of urinary urgency influences the results.

Is Extracorporeal Shock Wave Lithotripsy a Treatment Option for Renal Colic?

BACKGROUND: Renal colic is characterized by sharp, intense flank pain. Nonsteroidal anti-inflammatory drugs are the treatment of choice, although extracorporeal shock wave lithotripsy (SWL) is a noninvasive alternative for pain management. The objective of our study is to present results obtained using rapid SWL to treat renal colic in our center. METHODS: We analyzed 214 patients undergoing rapid shockwave extracorporeal lithotripsy between October 2014 and June 2018: 69.63% were male, and 30.37% female, with a mean age of 47.35 years (range, 16-84). The average stone size was 6.71 mm (3-16). Stone locations were as follows: The pelviureteric junction (PUJ) (10.75%), proximal ureter (45.79%), midureter (24.77%), and distal ureter (18.69%). RESULTS: Pain relief was achieved in 81.31% of the patients. The rates of successful pain control according to stone location were 65.22% when the stone was located in the PUJ, 79.59% in the proximal ureter, 88.68% in the midureter, and 85.00% in the distal ureter. Complete or partial stone resolution was achieved 4 weeks postoperatively in 78.50% of cases (64.95% and 13.55%, respectively). According to the stone location, the overall rate of resolution (complete + partial) was 90.00% for distal ureteral stones, 86.80% in the midureter, 73.47% in the proximal ureter, and 60.86% in the PUJ. 44 patients (20.56%) demonstrated complications. The most common complications were persistent pain, acute renal failure and fever. CONCLUSIONS: Immediate SWL was found to be a safe and effective treatment option for pain related to renal colic in 81% of the patients studied.

Value of Music and Nitrous Oxide for Pain Control during Extracorporeal Shock Wave Lithotripsy (ESWL).

OBJECTIVES: To compare the efficacy of 4 different analgesic regimens that include music and nitrous oxide during the treatment of renal lithiasis with ambulatory extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: A single-centre, longitudinal, prospective, randomized, open and parallel group study was conducted. Patients with renal lithiasis were included and were randomized to Group A (basal analgesia: midazolam (1 mg), fentanyl (0.05 mg) and dexketoprofen (50 mg)), Group B (basal analgesia and nitrous oxide), Group C (basal analgesia and music) and Group D (basal analgesia, nitrous oxide and music). For the measurement of pain, a visual analogue scale ranging from 0 (no pain) to 100 (maximum pain imaginable) was used. Patient satisfaction was assessed using a Likert questionnaire. The epidemiological data of the patients in terms of lithiasis, previous clinical and ESWL sessions, and pain measured with the VAS before, during (maximum) at the end of the session and at discharge were recorded. Data on complications were also collected, as was the patients' subjective evaluation of the treatment and their satisfaction. The ESWL procedure was performed with a Storz Modulith SLX-F2® lithotripter. A maximum of 4000 waves were applied at a frequency of 1.5 Hz. RESULTS: Eighty patients were included (20 per group). None of the analgesia guidelines proved to be superior to the others for pain control during the ESWL session. Patients younger than 50 years had significantly higher values for the maximum VAS. Only 13.75% of patients required rescue analgesia. A total of 77.5% described their experience as good, very good or excellent, regardless of the assigned group. CONCLUSIONS: The addition of nitrous oxide and/or music did not result in a statistically significant improvement over the basal analgesia regimen of midazolam, fentanyl and dexketoprofen; however, the degree of patient satisfaction was very high.

Comparative study between patients undergoing laparoscopic colposacropexy with and without prior surgery for the treatment of apical prolapse. / Estudio comparativo entre pacientes sometidos a colposacropexia laparoscópica con y sin cirugía previa para el tratamiento del prolapso apical.

INTRODUCTION: Colposacropexy is the treatment of choice for apical prolapse. Studies comparing this technique as primary surgery for pelvic organprolapse (POP), with its success in recurrent POPs after surgery, are scarce. MATERIALS AND METHODS: Retrospective analysis of a series of patients diagnosed with POP who underwent laparoscopic colposacropexy, comparing a group without previous prolapse surgery with another group that has recurred after previous surgery (with or without mesh). Our objective was to analyze the differences regarding surgical time (skin to skin), intraoperative complications, mean stay, resolution of symptoms and recurrence. As preoperative data, we compared: age, body mass index (BMI), parity, previous hysterectomy, physical examination, symptoms, and flowmetry; and as peri/postoperative data: follow-up, intervention duration, intra and postoperative complications, mean stay, physical examination (Baden-Walker classification), symptom resolution and flowmetry. RESULTS: Twenty-three patients have been operated on in 12 months. Nine (39.1%) were recurrent POPs after previous surgery, 6 (66.7%) of them with some type of mesh. Follow-up (mean months): 6.44 ± 4.19 (previous cx) vs. 4.79 ± 4.00. Both groups were comparable with respect to preoperative variables. Previously operated patients had greater dyspareunia (p<0.05). We did not find differences in the rest of symptoms between both groups. There were no differences in the duration of the intervention, mean stay, or regarding intraoperative complications (p>0.05) between both groups. Sensation of vaginal lump, urge incontinence and dyspareunia resolved in all patients. Flowmetry improved in both groups (p>0.05). CONCLUSIONS: Laparoscopic colposacropexy is an effective and safe technique to correct POP after previous surgery, with or without mesh.

INTRODUCCIÓN: La colposacropexia es el tratamiento de elección para el prolapso apical. Los estudios que comparan esta técnica como cirugía primaria para el prolapso de órganos pélvicos (POP), consu éxito en los POP recidivados tras cirugía son escasos.MATERIAL Y MÉTODOS: Análisis retrospectivo de una serie de pacientes con diagnóstico de POP sometidas a colposacropexia laparoscópica, comparando un grupo sin cirugía previa para el prolapso, con otro que ha recidivado tras cirugía previa (con o sin malla). Nuestro objetivo fue analizar las diferencias respecto al tiempo quirúrgico (de piel a piel), complicaciones intraoperatorias, estancia media, resolución de los síntomas y recidiva. Como datos preoperatorios se compararon: edad, índice de masa corporal (IMC), paridad, histerectomía previa, exploración física, sintomatología y flujometría; y como datos peri/postoperatorios: seguimiento, duración intervención, complicaciones intra y postoperatorias, estancia media, exploración física (clasificación Baden-Walker), resolución síntomas y flujometría.RESULTADOS: Han sido intervenidas 23 pacientes en12 meses. Nueve (39,1%) eran POP recidivados tras cirugía previa, 6 (66,7%) de ellas con algún tipo de malla. Seguimiento (media meses): 6,44 ± 4,19 (cx previa) vs 4,79 ± 4,00. Ambos grupos fueron comparables respecto a las variables preoperatorias. Las pacientes intervenidas previamente presentaban mayor dispareunia (p <0,05). No encontramos diferencias en el resto de síntomas entre ambos grupos. No hubo diferencias en duración de la intervención, estancia media, ni respecto a las complicaciones intraoperatorias (p>0,05) entre ambos grupos. La sensación de bultovaginal, la urge-incontinencia y la dispareunia se resolvieron en todas las pacientes. La flujometría mejoró en ambos grupos (p>0,05).CONCLUSIONES: La colposacropexia laparoscópica es una técnica eficaz y segura para la corrección del POP tras cirugía previa, con o sin malla.

[Cystoscopy in the assessment of patients with bladder pain syndrome: Results of a national multicenter observational study.] / La cistoscopia en la evaluación del síndrome de dolor vesical: resultados de un estudio observacional multicéntrico nacional.

OBJECTIVES: To study the use and results of cystoscopy and bladder hydrodistension in the objective assessment of patients with Bladder Pain Syndrome (BPS), in routine clinical practice. MATERIAL AND METHODS: Observational, non-interventional, national, multicenter study carried out in Functional Urology and Urodynamic Units of Spain belonging to the IFU Group. 273 women with BPS who underwent cystoscopy at baseline as a diagnostic tool according to clinical criteria and following the routine clinical practice of each center, were studied. The pre and post hydrodistension findings and the scores of the symptom and Health-Related Quality of Life (HRQoL) questionnaires were described: BPIC-SS, PPBC, PGI-S and EQ-5D-5L. RESULTS: The mean age (SD) was 59 (14) years with a high presence of bladder symptoms: increased voiding frequency (81.7%), nocturia (74%) and urgency (60.4%). 40.7% of cystoscopies were performed under anesthesia and 73.7% uses a standard rigid cystoscope. Hunner lesions were observed in 9.9% of the patients, hypervascularizations (46.2%), glomerulations (23.4%), mild bleeding (6.6%) and scars (2.2%). After hydrodistension, a greater number of grade 1 and 2 lesions were observed. In 51.6% of the patients there were no changes, but in 27.5% slight changes were observed and in 11.4% moderate or severe changes. Symptom and HRQoL questionnaire scores showed no association with cystoscopy findings before and after hydrodistension. CONCLUSIONS: The value of the cystoscopic findings in the SDV has yet to be defined, although it plays a fundamental role in the differential diagnosis. In this observational study, we did not find a correlation of the cystoscopic findings with the symptoms of the patients, measured by validated questionnaires, nor with the HRQoL.

OBJETIVO: Analizar el uso y resultados de la cistoscopia y la hidrodistensión vesical para la evaluación objetiva de pacientes con Síndrome de Dolor Vesical (SDV), en el contexto de práctica clínica habitual.MATERIAL Y MÉTODOS: Estudio observacional, no intervencionista, multicéntrico de ámbito nacional, realizado en Unidades de Urología Funcional y Urodinámica de España pertenecientes al Grupo IFU en el que se analizaron 273 mujeres con SDV a las que se les realizó una cistoscopia a nivel basal como herramienta diagnóstica según criterio clínico y siguiendo la práctica clínica habitual de cada centro. Se describieron los hallazgos pre y post hidrodistensión y las puntuaciones de los cuestionarios de síntomas y de Calidad de Vida Relacionada con la Salud (CVRS): BPIC-SS, PPBC, PGI-S y EQ-5D-5L. RESULTADOS: La edad media (DE) fue de 59 (14) años con gran presencia de síntomas vesicales: frecuencia miccional aumentada (81,7%), nocturia (74,0%) y urgencia (60,4%). El 40,7% de las cistoscopias se realizaron bajo anestesia y en el 73,7% se empleó un cistoscopio rígido estándar. Se observaron lesiones de Hunner en un 9,9% de las pacientes, hipervascularizaciones (46,2%), glomerulaciones (23,4%), sangrado leve (6,6%) y cicatrices (2,2%). Tras la hidrodistensión se observó un mayor número de lesiones grado 1 y 2. En el 51,6% de las pacientes no hubo cambios, pero en el 27,5% se observaron cambios leves y en el 11,4% cambios moderados o graves. Las puntuaciones de los cuestionarios de síntomas y CVRS no mostraron asociación con los hallazgos de la cistoscopia antes y después de la hidrodistensión. CONCLUSIONES: El valor de los hallazgos cistoscópicos en el SDV está aún por definir, aunque juega un papel fundamental en el diagnóstico diferencial. En este estudio observacional no encontramos correlación de los hallazgos cistoscópicos con los síntomas de las pacientes, medidos por cuestionarios validados, ni con la CVRS.

Prospective Observational Cohort Study of the Efficacy of Bacterial Immune Prophylaxis in the Prevention of Uncomplicated, Recurrent Urinary Tract Infections.

OBJECTIVE: To investigate the long-term prophylactic effect of a vaccine on lower urinary tract infections (UTI) of bacterial and the impact of the intensity of the symptoms on the quality of life (QoL). METHODS: Adult female could be enrolled in this study if they had acute UTI at the enrolment visit and bacterial microbiological count of ≥103 CFU/mL of Escherichia coli. RESULTS: A total of 21 patients were included. Fifteen days after the administration of a vaccine for 3 months, the number of infections dropped almost to zero. Significant differences were observed in the QoL score (p < 0.05). The safety profile was good. CONCLUSIONS: In patients diagnosed with recurrent UTI and treated for 3 months with the vaccine the number of UTI episodes fell very quickly (15 days), and patients remained free of episodes and improved their QoL significantly for 1 year. These results suggest that bacterial vaccines are a possible effective alternative in the prevention of recurrent UTI.

[Current status of laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse.] / Estado actual de la Colposacropexia Laparoscópica (CSPL) en la corrección del Prolapso de Órganos Pélvicos (POP).

OBJECTIVES: Surgical restoration of pelvic floor anatomy in pelvic organ prolapse (POP) should avoid extensive areas that may injure healthy tissues and lead to scar fibrosis producing dysfunctional rigidity. Laparoscopic sacrocolpopexy corrects POP by lifting pelvic elements with a minimally invasive procedure.Various current strategies and approaches make it a diverse procedure. METHODS: We performed a bibliographic review on the published experience about abdominal sacrocolpopexy over the last 20 years. We analyze the philosophy of each technique, advantages, disadvantages, and results. RESULTS: Among current theories that explain how is the anatomy and function of the pelvic floor, the comprehensive theory of the pelvic floor announces that anatomical deviation produces pelvic dysfunction (diagnostic algorithm)(1). Surgical invasion with reconstructive purposes may hide results if the true physiopathology of the defects found is not known. Although current diagnostic tools cannot solve the problem as a whole, results of different techniques are much better than those of previous times. CONCLUSIONS: Laparoscopic sacrocolpopexy is an adequate strategy that restores anatomy in POP, mainly apical, and function with minimal invasion. Technical development and better knowledge of the female pelvis functional anatomy is enabling today a more precise understanding of its physiopathology, so it facilitates the design of site-specific operations. Various surgical approaches and techniques are offered depending on the defect, where combined procedures give good solutions. It is necessary to have an appropriate surgical training to obtain the better competence, and a safe and correct repair.

[Expert opinion about the use of transdermic oxybutynin in Spain for the treatment of adult overactive bladder.] / Opinión de expertos sobre el uso de la oxibutinina transdérmica en España para el tratamiento de la vejiga hiperactiva en adultos.

OBJECTIVES: To define the different characteristics of transdermal oxybutynin (TO) for the treatment of overactive bladder in adults, to know the barriers for the use of this drug and to establish proposals to minimize these barriers. METHODS: Local sessions were held with 111 urologists from all over the country divided into 12 sessions. They were moderated by a brainstorming technique led by an external consultant. RESULTS: 75% of experts believe that tolerability and clinical efficacy (50%) are the most important attributes to choose this formulation, being the lack of scientific publications the least valued (12%). These opinions were based on their own clinical experience with TO or on scientific publications, without establishing comparison with other treatment options. The main barriers would be administrative obstacles (84%), difficulty in its use (54%) and the lack/rejection of the transdermal administration by the patient (33%). Actions were proposed to correct the 8 most significant barriers, such as better training for specialists (both Urology and other specialties) and for patients, creating informative materials to reinforce health education in managing patches, generating greater volume of scientific evidence to support their use in overactive bladder and clearly identifying the profile of patients who will benefit most from this therapeutic strategy. CONCLUSIONS: Although oxybutynin has been standard treatment of overactive bladder in recent years the conclusion of this working group is that its new transdermal formulation offers a better-tolerated alternative for patients, and, therefore the necessary tools to generate more evidence should be implemented to increase the proper use among specialists and patients.

[Cystic displasia of the testis. Review of literature]. / Displasia quística de rete testis: revisión de la literatura.

OBJECTIVE: Review this pathology nowadays. METHODS: We search in Medline/PubMed database for reviews about cystic dysplasia of the testis. We review and discuss the relevant literature about it. RESULTS: Cystic dysplasia of the testis (CDT) is a rare benign disease, associated with upper urinary tract malformations. Its most frequent clinical manifestation is the increase of testicular size; the presence of cysts is demonstrated by ultrasound. No consensus exists in its treatment, it oftenly requires histological confirmation, performing testicle-sparing surgery. CONCLUSION: CDT needs to be taken into account in the differential diagnosis of childhood testicular tumors.

[Clinical presentation of renal cell carcinoma in renal transplant]. / Presentación clínica del carcinoma de células renales en el trasplante renal.

OBJECTIVES: To analyze the clinical presentation and therapeutic response of renal cell carcinoma (RCC) of the renal graft. METHODS: Analysis of the cases described in our centre and review of current literature. RESULTS: RCC has a higher incidence in transplant patients, affecting the graft in less than 10% of the cases. Detection is usually a casual event during follow-up due to the absence of innervation, although its presentation may be as an acute abdomen in case of breakage of the graft. Conventional treatment consists of transplant nephrectomy, but partial nephrectomy has been performed in recent years with good results. The modification of immunosuppression is a routine measure after treatment. CONCLUSIONS: The incidence of RCC after renal transplants in our series is 0.7%, of which 22% are originated in the graft. The clinical presentation of the primitive RCC of the graft is variable. Partial nephrectomy is technically feasible and oncologically safe in the treatment of RCC of the renal graft.