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.

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.

[Prostate carcinosarcoma.] / Carcinosarcoma de próstata.

OBJECTIVE: To report a new case of prostatic carcinosarcoma, an uncommon and locally and distance aggressive tumor. METHOD: We analyzed one case diagnosed in our Center, from clinical and pathological diagnosis to death, describing the treatments received. RESULT: Patient presented a huge pelvic mass and a pulmonary metastasis that was treated with cystoprostatectomy and bilateral cutaneous ureterostomy with the diagnosis of carcinosarcoma of the prostate. He received 8 cycles of Docetaxel with bone progression and then 3 cycles of doxorubicin, suspending treatment due to progression. The survival was 18 months. CONCLUSIONS: Prostate carcinosarcoma is a very aggressive neoplasia that does not respond to the usual treatments of prostate cancer.

Interest areas for training in endourology, laparoscopy and robotics: results of a multicentric survey among Spanish residents.

OBJECTIVES: To determine the current status of the training of Urology Resident's in Laparoscopic surgery, robotics and endourology. METHODS: We performed a survey among Spanish Urology Residents between 2011 and may 2012. We designed a survey that was disseminated through the web page of the Spanish Society of Laparoscopic and Robotic surgery (SECLA) (www.seclaendosurgery.com) to all residents from every Spanish hospital. The survey was divided in four blocks: General data, data of the Training Hospital, data of the surgical procedures (endoscopic, laparoscopic and robotic) and training features. We performed a descriptive study of the results. RESULTS: 36 Urology residents out of a total of 384 answered the survey (9,3%). In reference to endoscopic procedures 25% of the residents had never been involved on a percutaneous nephrostomy (n=36), and did not expect to do it. On the contrary, 77% have performed ureterorrenoscopy as first surgeon (n=36) and 25% have participated in more than 10 procedures. 54.4% of the participants took part as surgeons in percutaneous nephrolithotomies (n=28) and 79% looked forward to do them. Participation of residents in Da Vinci Robot assisted laparoscopic procedures is low. Laparoscopic procedures are very attractive and their participation is reduced as procedure complexity increases. CONCLUSIONS: 41.6% of participants think their training is adequate whereas 58,3% think it is not. 88% think their training could improve through courses and seminars and acquiring a greater degree of responsibility.

Robotic Anderson-Hynes dismembered pyeloplasty: initial experience.

INTRODUCTION: The introduction of the da Vinci(®) robotic system in 2000 has been a new step forward in the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study was to analyse our initial experience with robot-assisted dismembered Anderson-Hynes pyeloplasty and to perform a bibliographic review on the topic. PATIENTS AND METHODS: We performed 11 robot-assisted pyeloplasties between March 2007 and April 2011. UPJO diagnosis was made on clinical presentation and imaging techniques (CT scan and intravenous urography). All patients underwent basal and diuretic isotopic renograms to evaluate the degree of obstruction and impaired renal function. Median follow-up was 10 (range 1-26) months. RESULTS: Mean patient age was 38.8 (range 23-62) years. There were six women (55%) and five men (45%). All cases were primary surgeries. In four patients the cause of UPJO was a crossing vessel; the other seven patients had intrinsic obstruction. One case was associated with extraction of a calyceal lithiasis. Mean operative time was 189.4 min (125-270 min). Average time from robotic arms docking was 116.5 (range 55-180) min. Average hospital stay was 4.18 (range 2-8) days. Conversion to open or laparoscopic surgery was not necessary in any case and there were no postoperative complications. Postoperative radiological evaluation and renograms showed good results in all cases. CONCLUSIONS: Robotic surgery offers better ergonomics, enhanced three-dimensional (3D) vision and more precise movements, easing intracorporeal suturing.These advantages make robotic pyeloplasty a reproducible technique that combines the high success rates of open surgery and the benefits of laparoscopic surgery.

Surgical repair and analysis of penile fracture complications.

BACKGROUND: The objective of this study is to describe and analyze the experience over a period of 10 years at our center through a retrospective study of a series of diagnosed and treated cases of penile fracture. MATERIAL AND METHODS: From 2005 to 2009 the Urology Department of the Hospital Clínico San Carlos of Madrid carried out a retrospective case study of a total of 15 cases of penile fracture. The diagnosis was reached through physical exploration of the patient aided by a penile ultrasound; the immediate treatment performed on the patients was emergency surgical repair. RESULTS: From the total in the series (n = 15), only 1 case was associated with a complete urethral fracture (6.6%). Surgical repair was performed in all cases; the average hospital stay was 2.6 days (range 1-5), and the most frequent long-term complication was erectile dysfunction in 3 of 15 cases (20%). CONCLUSIONS: A penis fracture diagnosis is mostly clinical; complementary tests, such as ultrasound, are helpful but not definitive. Surgical treatment consists of an incision that allows adequate exposure of the corpora cavernosa and urethra to repair the suspected lesions found upon diagnosis. Ambulatory follow-up is essential to diagnose and treat possible complications.