[Treatment of stress urinary incontinence with perineal biofeedback by using superficial electrodes]. / Tratamiento de la incontinencia urinaria de esfuerzo con biofeedback perineal con electrodos de superficie.

PURPOSE: We analyze the pelvic floor muscles treatment outcomes by using biofeedback (BFB) with electromyography with superficial electrodes in women diagnosed as having stress urinary incontinence (SUI). Besides, we compare this treatment with pelvic floor muscle exercises (PFME) plus vaginal electrostimulation. METHODS: 85 women with stress urinary incontinence, aged 42 - 74 years. We divided the patients in two groups: Group 1 (N = 50): This patients carry out a perineal biofeedback with superficial electrodes without electrostimulation, and Group 2 (N = 35): This patients were treated with pelvis floor muscle exercices and vaginal electrostimulation. All patients carry out two session per week (of 30 minutes each one) during ten weeks. We assess the outcomes through international urinary incontinence questionnaires (IU-5 and ICIQ-SF) and urinary incontinence related quality of life test (King's questionnaire). Student t-test and Fisher Exact test were used, p < 0.05 was considered statistically significant. RESULTS: No difference was found in the age average of both groups. 84% of patients of group 1 and 80% of patients of group 2 were cured with the treatment. We assumed they were cured when incontinence episodes not happened or they do not need to use absorbent materials. In the Group 1, 50% of patients in the fourth week and 84% in the tenth week were cured. In the Group 2, 71.42% of patients in the fourth week and 80% in the tenth week were cured. In the Group 2, eight patients (22.85%) complained side effects. Both groups improved the quality of life similarly. CONCLUSION: Grade 1 and grade 2 stress urinary incontinence treatment by using perineal biofeedback with superficial electrodes electromyography is better or similar to more invasive treatments. Also pelvic floor muscle exercices plus vaginal electrostimulation have good outcomes although some patients complain side effects. Both conservative treatments are effective and feasible.

[Computerized image analysis applied to urology research]. / Análisis de imagen computarizado aplicado a la investigación urológica.

Diagnosis with the aid of imaging techniques in urology had developed dramatically over the last few years as a result of using state-of-the-art technology that has added digital angiology to the last generation apparatus for ultrasound. Computerized axial tomography and nuclear magnetic resonance allow very high rates of diagnostic possibilities that only a decade ago were not extended to routine use. Each of these examination procedures has its own limits of sensitivity and specificity which vary as a function of the pathoanatomical characteristics depending on the condition to be explored, although none reaches yet absolute values. With ultrasound, CAT and NMR, identification of the various diseases rely on the analysis of densities although with a significant degree of the examiner's subjectivity in the diagnostic judgement. The logic evolution of these techniques is to eliminate such subjective component and translate the features which characterize each disease in quantifiable parameters, a challenge made feasible by computerized analysis. Thanks to technological advances in the field of microcomputers and the decreased cost of the equipment, currently it is possible for any clinical investigator with average resources to use the most sophisticated imaging analysis techniques for the post-processing of the images obtained, opening in the scope of practical investigation a pathway that just a few years ago was exclusive to only certain organizations due to the high cost involved.

[Lesions of the ureter in obstetric-gynecologic surgery]. / Lesiones del uréter en cirugía obstetro-ginecológica.

The chapter of injuries to the ureter during obstetric-gynaecological surgery continues to be ignored in the literature published over the last decades, in spite of its prevalence in the practice. This has motivated our review and update of this issue. The interest of urological diagnostic procedures prior to surgery and conduit examination at any time during the operation exert some influence on the prevention of this pathology. Preoperative finding and reconstruction lead to better results, which benefit from the use of the urinary route, thus leaving the gut route and self-transplantation for exceptional situations. A new iatrogenic pathology has emerged from the most frequent use of gynaecological endoscopic surgery.

[Statistical study of a series of cryptorchism cases]. / Estudio estadístico de una serie de criptorquidias.

A study was made on a series of 348 patients with uni- and bilateral cryptorchid, a right location being predominant in the former cases, and in the canaliculus the most common testicular one. The associated pathology is usually irrelevant. In view of the results revealed by optical and ultrastructural histological study, the introduction of definitive corrective medical treatment appears to be essential within 2 years. Despite existing discrepancies with regard to dosage and efficacy of hormonal therapy with HCG or LH-RH analogues we believe they should be used at doses no higher than 12000 IU of HCG in order to achieve a decrease or ease the surgical treatment. Higher doses would damage the testicle or produce early puberty with growth failure. Scrotum-bound funiculolysis is the procedure accomplishing a larger amount of therapeutic success and in our experience the results are conditioned to the testicle's anatomic location. In the event of abdominal testicles or with high canaliculus location, a section of the spermatic canals could be performed followed later by auto-transplantations using microsurgery procedures.

[Morphometric and stereologic nuclear values obtained from the study of a population suffering from nasopharyngeal carcinoma]. / Valores morfométricos y estereológicos nucleares obtenidos en el estudio de una población con carcinoma de nasofaringe.

Computer nuclear morphometry and stereology are attractive methods because its objectivity and cheapness allowing histologic diagnosis when identifying minimal variations respectively the normality and also detect negligible disparities between anormal cells which could escape to the assessment of the pathologist. We present the data gained from several morphogenic and stereologic parameters resulting of measurements of tumoral cells procured from 40 patients with nasopharyngeal carcinomata. Middle values have been: nuclear area 27.70 microns 2; nuclear perimeter 20.80 microns; nuclear factor of form 0.81 microns; nuclear outline index 4.01; nuclear orientation angle 87.29 degrees; nuclear ellipsiticity 704.14; nuclear regularity 61.83; middle lineal length 4.30, middle linear distance 107.94; and nuclear volume 118.80 microns 3. Our series is the largest studied till now of all found in the literature. Comparison our data with those of previous publications.

[Prognostic value of morphometry and nuclear stereology in laryngeal epidermoid carcinoma]. / Valor pronóstico de la morfometría y estereología nuclear en el carcinoma epidermoide laríngeo.

BACKGROUND AND METHODS: A series of 70 consecutive patients with laryngeal carcinoma treated by induction chemotherapy is reported. The prediction of the response to induction chemotherapy was evaluated by nuclear morphometric and stereological analysis of the tumor cells. RESULTS: Statistically significant differences were found in the nuclear form factor (FF, p < 0.021) and nuclear contour index (NCI, p < 0.017) between the groups of patients with a complete response (CR), partial response (PR) or no response (NR) to induction chemotherapy. Comparison of the groups of patients with partial response or complete response to IC with the group with no response yielded statistically significant differences in the nuclear form factor (FF, p < 0.002), nuclear contour index (NCI, p < 0.0032) and nuclear orientation angle (NOA, p < 0.036). CONCLUSION: Nuclear morphometric analysis of the tumor cells was a useful tool for predicting response to induction chemotherapy in a significant number of the patients with laryngeal tumors in our series.

[Risk factors for failure after transobturator vaginal tape for urinary incontinence]. / Factores de riesgo de fracaso de la corrección quirúrgica de la incontinencia urinaria de esfuerzo mediante cinta suburetral transobturatriz.

OBJECTIVE: To identify risk factors leading to treatment failure in a sample of 302 women with stress urinary incontinence (SUI) treated by transobturator vaginal tape (TOT) with a medium follow-up of 4 years (range 1-6). MATERIAL AND METHODS: A population based cohort study with prospectively data from 302 women, aged 41-81 years underwent TOT between April 2003-November 2010. Data were collected by validated questionnaire on urinary incontinence, the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), and clinical data-records. Continence was achieved in 262 (Group A) and 40 continued with incontinence (Group B). We investigated the relationship between age, SUI evolution time, type and number of childbirths (eutocic, dystocic, nulliparous, multiparous status) and medical and/or surgical backgrounds. The ICIQ-SF questionnaire was used to describe whether the surgery outcomes were successful or not. RESULTS: Group A were younger (p=0.0001), had less SUI evolution time (p=0.017); more eutocic childbirths (p=0.000018). Group B had more dystocic childbirth (p=0.022), previous tension free vaginal tape (TVT) or TOT (p=0.03.), antidepressant-anxiolytic drugs (p=0.003), antihypertensive drugs (p=0.0005), type 1 diabetes (p=0.02), arterial hypertension (p=0.0007), respiratory diseases (p=0.025). Differences were not found with regard to nulliparous (p=0.701), multiparous status (p=0.42), obesity (p=0.18), intestinal disorders (p=0.59), oophorectomy (p=0.19), caesarean (p=0.17), prolapse surgery (p=0.29), hysterectomy (p=0.57), allergies (p=0.48), arthritis (p=0.22), arthrosis (p=0.44), depression (p=0.74), type 2 diabetes (p=0.44), smoking patterns (p=0.28), fibromyalgia (p=0.47). CONCLUSIONS: Elderly women, with long evolution SUI, dystocic delivery, previous TVT or TOT appear as independent risk factors associated to TOT failure. These factors may make the indication of another surgical approach recommendable.

Solitary Aspergillus mycetoma of the kidney.

A case of Aspergillus mycetoma of the kidney in a patient with lymphoblastoma receiving intensive cytostatic and steroid drugs is reported. Only four cases of Aspergillus infection of the kidney have so far been reported. Aspergillus infection of the kidney without disseminated fungal disease is a very rare clinical entity. In an extensive review of the world literature we have found only four cases previously reported [1-3], three in insulin-dependent diabetic patients and one in a patient with a ureteropelvic junction obstruction. Herein we describe the first case of a right kidney mycetoma in a patient with lymphoblastoma and treated intensively with cytostatic drugs and steroids.

[Cystine calculi: x-ray diffraction study. Infrared spectroscopy and SEM]. / Cálculos de cistina: estudio por difracción a rayos X. Espectroscopía por infrarrojos y MEB.

The present study investigated cystinuria and cystine calculi. Inexplicably, of 987 calculi that had been analyzed ultrastructurally at the Department of Urology of the University Hospital of Salamanca over a period of 15 years only 3 (0.3%) were cystine. The foregoing finding does not coincide with the 0.5-1% incidence reported in the world literature. Apart from the chemical analyses, infrared spectroscopy disclosed the typical findings of multiple bands 1600-625 cm-1. Analysis by x-ray diffraction revealed a slight variation from the ASTM values. One of the calculi, which we considered to be a mixed calculus (probably of calcium phosphate), showed a peak at 43 degrees, instead of the usual 34.5. Scanning electron microscopy disclosed two forms of crystallization: The typical hexagonal form of cystine stones and the rectangular form of different sizes. The material comprising the matrix was observed in many areas, covering and joining the crystals as if it were cement. Whenever possible, treatment of these recurrent calculi should be conservative. Some advocate the use of ESWL, although others consider these calculi to be extremely hard and, therefore, not amenable to ESWL. Chemical dissolution is advocated by some, although its critics consider it to be of little use. Concerning prophylaxis, forced fluids and alkalinization may reduce recurrence. Ultrastructural studies have provided further insight into the structure and composition of cystine calculi. The foregoing may be useful in determining the most appropriate form of treatment based upon stone size, shape, composition (pure or mixed), etc.

Genitourinary tuberculosis in Spain: review of 81 cases.

Cases of genitourinary tuberculosis diagnosed at the Hospital Clínico Universitario between January 1978 and December 1989 were studied. Genitourinary tuberculosis was the most frequent type of extrapulmonary tuberculosis diagnosed, accounting for 81 (40.9%) of 198 cases. Fifty-one patients (63%) were men. The mean ages of male and female patients were 48.4 years and 51.1 years, respectively (range, 21-75 years). Cases were widely distributed among most age groups; patients were most often 30-69 years of age. Constitutional symptoms were less frequent than local, urinary tract-related symptoms. Only 23.5% of patients had a known history of tuberculosis. Pyuria plus hematuria with sterile cultures was the commonest urinary finding. The results of intravenous pyelography were abnormal in 95% of cases. Ziehl-Neelsen staining gave positive results in 48% of cases. Cultures became positive after a mean (ISD) of 2.3 +/- 1.5 weeks. Sequelae were documented in 42% of cases, but only one death due to genitourinary tuberculosis was recorded.