Urinary incontinence during pregnancy and postpartum. Associated risk factors and influence of pelvic floor exercises.

OBJECTIVES: To determine the prevalence of urinary incontinence (UI) before pregnancy, in the third trimester and postpartum. To analyze its influence on quality of life and associated potential risk factors and the efficacy of pelvic floor exercises. METHODS: Prospective study in 413 pregnant women. The modified ICIQ-SF incontinence questionnaire was given to the pregnant women at the end of the third quarter. This questionnaire was administered by telephone at 3 and 6 months postpartum. The influence of several risk factors for UI in pregnancy and postpartum were analyzed. Patients with persistent UI at 6 months postpartum were trained to do pelvic floor exercises. RESULTS: Patients with UI before pregnancy were excluded from the study. UI in the third trimester was 31%. Analyzed risk factors did not condition a higher percentage of UI. Prevalence of UI was 11.3% at 3 months postpartum and 6.9% at 6 months. 70% of the incontinent patients already had it during pregnancy and it appeared de novo post-delivery in 30% of the patients. Prevalence of UI after delivery was higher in women with UI in pregnancy and lower in caesarean cases. Most women improved with pelvic floor exercises. CONCLUSIONS: Analysed risk factors did not significantly increase UI in pregnancy. Prevalence of UI after delivery is higher in women with UI in pregnancy and lower in caesarean cases. Postpartum pelvic floor exercises for three months in patients with persistent stress UI at 6 months postpartum clearly improved the degree of continence.

Fibrous pseudotumor affecting the tunica vaginalis, epididymis and seminal duct.

OBJECTIVE: To report one case of advanced fibrous pseudotumour. METHODS: A 34-year-old patient presented with a painless lump on the right side of the scrotum. Examination revealed a hard tissue thickening attached to the tail and body of the right epididymis. The results of the ultrasound study were not clear and multiple differential diagnosis were considered. The lesion was surgically removed by partial right epididymectomy and resection of the affected tunica vaginalis and ductus deferens for anatomopathological study. RESULTS: The histopathological study revealed an evolved fibrous pseudotumour with bone metaplasia. CONCLUSION: Fibrous pseudotumour is a benign paratesticular lesion that grows slowly and painlessly. It is usually diagnosed by chance or in associated processes such as hydrocele. Differential diagnosis with malignant tumors avoids unnecessary radical treatment.

[Prognostic factors in renal cancer with venous thrombus survival analysis.] / Factores pronósticos en cáncer renal con trombo en vena. Análisis de supervivencia.

OBJECTIVES: To analyze surgery for renal cancer with venous thrombus at different levels, perioperative complications and prognostic factors associated to overall, cancer-specific and disease-free survival. MATERIAL AND METHODS: Retrospective analysis of 42 cases of renal cancer with venous thrombus performed between 2005 and 2015. The level reached by the thrombus was established according to the Mayo Clinic classification. Postoperative complications were staged according to Clavien-Dindo classification. RESULTS: Most frequent in males. Mean age 65.7 years. 16.6% were tumors with level II thrombus. Subcostal approach was performed in 58.9%. Extracorporeal circulation with cardiac arrest and hypothermia was established in 2 patients. Resection of metastatic disease was performed in 3 patients during radical nephrectomy. Reoperation was 2.3% while, perioperative mortality was 4.7%. 30% presented with metastases at diagnosis. Twenty patients progressed at 15.5 months (3-55). Overall survival was 60 months. The cancer-specific mortality was 75%. Disease-free survival was 30% at 55 months. CONCLUSIONS: Surgical treatment of renal cancer with venous thrombus requires a multidisciplinary management. The surgical technique varies according to the level reached by the venous thrombus. Tumor stage is the most important prognostic factor. Thrombus level influences prognosis, with longer survival for patients with tumor thrombus confined to the renal vein (pT3a) in comparison to tumors with thrombus in the atrium (pT3c).

[Small cell carcinoma of the bladder: Our experience]. / CARCINOMA DE CÉLULAS PEQUEÑAS DE VEJIGA.

OBJECTIVES: Small cell carcinoma of the bladder shows low incidence and poor survival; thus, treatment algorithms based on randomized studies are unavailable. The aim of the present study is to review our case series. METHODS: Observational retrospective study of 10 patients diagnosed with small cell carcinoma of the bladder between 2006 and 2013. RESULTS: Mean age was 65.7 years; There was only one female in the cohort. In all cases hematuria was the fist symptom. 4 cases presented high-grade papillary urothelial carcinoma with small cell carcinoma. Radical cystectomy was performed in 40% patients, in combination with chemotherapy, radiotherapy or both. Median survival was 330 days (IC 95%: 40.757- 619.243) and only one patient showed complete response. CONCLUSIONS: Even when small cell carcinoma of the bladder is a low incidence tumor, its prognosis is worse than that of urothelial carcinoma. Although further randomized studies are needed to best define treatment, this study shows that survival at local stages is optimized by neoadjuvant chemotherapy, followed by radical resection, as the literature suggests.

Indicaciones y complicaciones de la embolización renal: análisis retrospectivo / Indications and complications of renal embolization: a retrospective analysis

La embolización renal es un procedimiento intervencionista, cuyas aplicaciones terapéuticas han variado a lo largo del tiempo. Realizamos una revisión retrospectiva de 48 embolizaciones, analizando las causas y complicaciones asociadas a esta técnica. Nuestra indicación principal fue la embolización prequirúrgica de tumores renales de gran tamaño, aunque la indicación de mayor relevancia clínica actual es el tratamiento conservador de fístulas arterio-venosas iatrogénicas, angiomiolipomas o traumatismos renales con sangrado activo. La complicación menor más frecuente es el síndrome post-embolización (52.8 por ciento), situación que remite fácilmente con tratamiento médico. Como complicaciones mayores destacan la sepsis y la migración de material embolígeno, ambos muy poco frecuentes en nuestra serie...

Renal embolization is an interventional procedure, whose therapeutic applications have varied over time. We conducted a retrospective review of 48 embolizations, analyzing the causes and complications associated with this technique. Our main indication was the preoperative embolization of large renal tumors, although the most relevant indication today is the conservative treatment of iatrogenic arteriovenous fistula, angiomyolipomas or renal trauma with active bleeding. The most common minor complication is post-embolization syndrome (52.8 percent), a situation that is easily managed with medical treatment. Major complications include sepsis and migration of embolic material and both are very rare in our series...