Magnetic resonance imaging to evaluate anterior pelvic prolapse: H line is the key.

INTRODUCTION: The aim of the study is to compare clinical staging of anterior pelvic prolapse with magnetic resonance imaging (MRI) staging, using the pubococcygeal line (PCL), the midpubic line (MPL), and the H line as reference lines. Moreover, we aim to analyze interrater reliability of each reference line. MATERIAL AND METHODS: Forty-two women with pelvic organ prolapse (POP) symptoms were studied using the pelvic organ prolapse quantification on physical examination. Two different observers calculated anterior POP using the three MRI reference lines, retrospectively. Agreement between MRI and clinical staging was estimated using Pearson correlation for the quantitative measurements and kappa index for the stages. Interrater reliability was estimated using the intraclass correlation coefficient (ICC). RESULTS: Correlation between physical examination and the H line was high by both observers (r = 0.86 and r = 0.76, p < 0.01). The correlation was lower using MPL (r = 0.76 and r = 0.65, p < 0.01). The results of comparing MRI staging and physical examination were: κ = 0.618 and κ = 0.602 for the H line, κ = 0.273 and κ = 0.267 for MPL and κ = -0.105 and κ = -0.140 for PCL. The results of interrater reliability were: ICC of 0.968 for the H line, ICC of 0.788 for MPL, and ICC of 0.737 for PCL. CONCLUSION: Anterior POP staging using MRI H line as a reference presents a better agreement with clinical staging than PCL or MPL. The H line has better interrater reliability. The H line could replace the current lines.

Cysticlean® a highly pac standardized content in the prevention of recurrent urinary tract infections: an observational, prospective cohort study.

BACKGROUND: The present study was aimed at determining the prophylactic efficacy of American cranberry (AC) extract (Cysticlean®) in women with recurrent symptomatic postcoital urinary tract infections (PCUTI), non-consumer of AC extract in the past 3 months before inclusion, and to determine changes in their quality of life (QoL). METHODS: This was a single center, observational, prospective study in a total of 20 women (mean age 35.2 years; 50.0% were married). Patients were followed up for 3 and 6 months during treatment. RESULTS: The number of PCUTIs in the previous 3 months prior to start the treatment with Cysticlean® was 2.8±1.3 and it was reduced to 0.2±0.5 at Month 6 (P<0.0001), which represent a 93% improvement. At baseline, the mean score on the VAS scale (range from 0 to 100) for assessing the QoL was 62.4±19.1, increasing to 78.2±12.4 at Month 6 (P=0.0002), which represents a 20% improvement. All patients had an infection with positive urine culture at baseline, after 6 months there were only 3 symptomatic infections (P<0.001). The most common bacterium was Escherichia coli. CONCLUSIONS: Prophylaxis with American cranberry extract (Cysticlean®) could be an alternative to classical therapies with antibiotics. Further studies are needed to confirm results obtained in this pilot study.

Dose and aging effect on patients reported treatment benefit switching from the first overactive bladder therapy with tolterodine ER to fesoterodine: post-hoc analysis from an observational and retrospective study.

BACKGROUND: Previous randomized studies have demonstrated that fesoterodine significantly improves the Overactive Bladder (OAB) symptoms and their assessment by patients compared with tolterodine extended-release (ER). This study aimed to assess the effect of aging and dose escalation on patient-reported treatment benefit, after changing their first Overactive Bladder (OAB) therapy with tolterodine-ER to fesoterodine in daily clinical practice. METHODS: A post-hoc analysis of data from a retrospective, cross-sectional and observational study was performed in a cohort of 748 OAB adults patients (OAB-V8 score ≥8), who switched to fesoterodine from their first tolterodine-ER-based therapy within the 3-4 months before study visit. Effect of fesoterodine doses (4 mg vs. 8 mg) and patient age (<65 yr vs. ≥65 yr) were assessed. Patient reported treatment benefit [Treatment Benefit Scale (TBS)] and physician assessment of improvement with change [Clinical Global Impression of Improvement subscale (CGI-I)] were recorded. Treatment satisfaction, degree of worry, bother and interference with daily living activities due to urinary symptoms were also assessed. RESULTS: Improvements were not affected by age. Fesoterodine 8 mg vs. 4 mg provides significant improvements in terms of treatment benefit [TBS 97.1% vs. 88.4%, p < 0.001; CGI-I 95.8% vs. 90.8% p < 0.05)], degree of worry, bother and interference with daily-living activities related to OAB symptoms (p <0.05). CONCLUSIONS: A change from tolterodine ER therapy to fesoterodine with dose escalation to 8 mg in symptomatic OAB patients, seems to be associated with greater improvement in terms of both patient-reported-treatment benefit and clinical global impression of change. Improvement was not affected by age.

Our experience in the treatment of male stress urinary incontinence with the male Remeex system.

OBJECTIVES: We show our experience in the treatment of post-prostatectomy stress urinary incontinence with the male Remeex system (MRS). We also describe the elements of the system, its therapeutic indications, technical implantation and appropriate adjustment. METHODS: From March 2007 to January 2009 five male patients aged 57 to 71 years (mean age 66 years) with postprostatectomy stress urinary incontinence were operated on to insert a suburethral readjustable sling (Remeex). All patients had severe urinary incontinence with deterioration of their quality of life. The evolution period ranged from 2 to 10 years with an average of 3.5 years, requiring from 5 to 8 pads a day. RESULTS: All patients are continent after a mean follow up of 15.4 months (range 6-28 months). Only two of them use one security pad when they perform physical efforts. The Incontinence Impact Questionnaire (7) scores before surgery and 6 months after diminished from 68+/-7 to 10+/-3. All patients are very satisfied. CONCLUSIONS: MRS is a valid therapeutic option for post-prostatectomy incontinence, being a reproducible technique, of easy execution, that allows readjustment through a suprapubic incision under local anesthesia as an outpatient procedure. It has a low complication rate with excellent and endured results.

[Green light laser efficacy in patients with prostatic hyperplasia treatment with 5-alpha reductase inhibitors]. / Eficacia de la fotovaporización prostática con láser verde en el tratamiento de la hiperplasia prostática en pacientes en tratamiento con inhibidores de la 5-alfa-reductasa.

INTRODUCTION: High prevalence of BPH and gradual ageing of the population, combined with the existence of effective medical treatments for this condition, has led to an increasing use of surgery in patients on long-term treatment with 5-alpha reductase inhibitors (5-ARIs). Initially, patients treated with 5-ARIs were not considered good candidates for photoselective vaporization of the prostate with green laser. OBJECTIVE: To assess, using a retrospective study based on our experience, wheter long-term treatment (longer than 6 months) with 5-alpha reductase inhibitors decreases effectiveness of photoselective vaporization of the prostate with green light laser in BPH. MATERIALS AND METHODS: From September 2005 to January 2008, 102 patients underwent photoselective vaporization of the prostate with green light laser. Of these, 25 patients (24.5%) had been treated with 5-ARIs for at least 6 months, and the remaining 77 patients (75.5%) were used as controls. A retrospective study was conducted to compare the pre- and postoperative clinical and functional parameters of patients with and without prior 5-RAI therapy. RESULTS: No statistically significant differences were found between the treated and control groups in preoperative prostatic volume (50 mL vs 49 mL), IPSS (17.6 vs 17.8), postvoiding residue (16% vs 18%), or PSA (1.4 ng/mL vs 2.2 ng/mL). Similarly, while differences were seen in energy spread (180 kJ vs 175 kJ for the treated and control groups respectively) and operating time (63 min vs 57 min), these were not statistically significant. No between-group differences were found either in clinical or flow rate parameters one month after surgery (IPSS 13.8 vs 14 and Qmax 13.9 mL/s vs 14.5 nL/s in the treated and control groups respectively). Surgeons reported a better visualization of the endoscopic field that was attributed to less bleeding during the procedure. CONCLUSIONS: Our results show no statistically significant differences in peroperative and preoperative parameters between patients with and without treatment with 5-alpha reductase inhibitors. We therefore think that photoselective vaporization of the prostate with green light laser is a safe and effective technique in patients treated with 5-ARIs.

[Urinary tract hemangiopericytoma treated with radical surgery and neoadjuvant chemotherapy. Report of two cases.] / Hemangiopericitoma en la via urinaria tratados con cirugía radical y quimioterapia neoadyuvante. A propósito de dos casos.

OBJECTIVE: Hemangiopericytoma is a tumor of vascular origin. It is very rare in the prostate. They are generally aggressive tumors. Currently, the treatment of choice is radical surgery. In the literature, there are less than 50 cases described, and neoadjuvant treatment has not been reported in any article. This treatment presents positive responses in another type of sarcomas. Our goal is to report two cases of malignant hemangiopericytoma. The first case was treated with radical surgery and the second case was treated with neoadjuvant chemotherapy before surgery. METHODS: The first case is a 40 year old male. Obstructive urinary symptoms were his first symptoms. A prostate mass with tumor characteristics was seen on ultrasound. After transrectal biopsy, he was diagnosed with hemangiopericitoma. Because the tumor size, neoadjuvant chemotherapeutic prior to radical surgery was decided. The second case is a 77 year old male with an incidental diagnosis of renal mass. After radical nephrectomy, he was diagnosed with hemangiopericitoma. He did not receive adjuvant chemotherapy. RESULTS: In the first case, after neoadjuvant therapy, tumor size was reduced significantly. A pelvic exenteration with radical cystoprostatectomy and rectal resection and Bricker type urinary diversion and colostomy were carried out. In the second case controls after radical nephrectomy were correct and he did not need any treatment. CONCLUSIONS: In urinary tumors, the prostate hemangiopericytoma is a rare entity. Currently, neoadjuvant chemotherapy is not established as treatment for these tumors. For other sarcomas neoadyuvant treatment has good response. In our case, a good result was obtained with neoadjuvant chemotheraphy before surgery. However, a greater number of cases are necessary to establish the use of neoadjuvant chemotherapy in urinary hemangiopericytomas.

OBJETIVO: El hemangiopericitoma es un tumor de origen vascular muy infrecuente en la próstata. Son tumores de características agresivas y actualmente el tratamiento de elección es la cirugía radical. En la literatura existen descritos menos de 50 casos de hemangiopericitomas, y ninguno con tratamiento neoadyuvante. Dicho tratamiento neoadyuvante está descrito en otro tipo de sarcomas con buenas respuestas. Presentamos dos casos de un hemangiopericitoma maligno, uno tratado sólo con cirugía radical y otro con neoadyuvancia quimioterápica previa a la cirugía radical.MATERIAL Y MÉTODOS: El primer caso es un varón de 40 años con síntomas urinarios obstructivos. Se diagnosticó de hemangiopericitoma tras realización de biopsia transrectal. Se decidió neoadyuvancia quimioterápica previa a la cirugía. El segundo paciente es un varón de 74 años con hallazgo accidental de masa renal. Tras nefrectomía radical se diagnosticó de hemangiopericitoma. RESULTADOS: Tras la neoadyuvancia, en el primer paciente, se realizó una cistoprostatectomía radical y una resección de recto con derivación urinaria tipo Bricker y colostomía. El segundo paciente no precisó tratamiento adyuvante tras la cirugía radical. CONCLUSIONES: El hemangiopericitoma es una entidad rara en los tumores urinarios. Actualmente la neoadyuvancia quimioterápica no está establecida como pilar del tratamiento de estos tumores, aunque en otros campos donde los sarcomas son más frecuentes, si que se objetiva mejor respuesta. En nuestro caso obtuvimos una buena respuesta con dicha neoadyuvancia previa a la cirugía, aunque es necesario un mayor seguimiento a una mayor cohorte de pacientes para establecer el uso de la quimioterapia neoadyuvante en los hemangiopericitomas urinarios.

[Report of two cases of malignant mesothelioma of the tunica vaginalis.] / Analisis de dos casos de mesotelioma maligno de la túnica vaginal.

OBJECTIVE: Paratesticular mesothelioma isan infrequent tumor and only 250 cases have been published.It originates in the scrotal tunica vaginalis. It represents0.3-1.4% of mesotheliomas and it predominates inpatients with history of asbestos exposure and old age. Itsdiagnosis is usually casual. Our objective is to present thecases that occurred in our service with malignant paratesticularmesothelioma and to carry out a review of the currentliterature on this pathology. METHODS: We report two cases diagnosed with malignantparatesticular mesothelioma that happened in the lasttwo years. RESULT: The first case was a 73-year-old male with asymptomatichydrocele. The second was a 57-year-oldmale who had testicular pain and hydrocele. Both werediagnosed of mesothelioma after hydrocelectomy. The firsttreatment was radical orchiectomy in both cases. The firstpatient did not need more treatments. The second patientpresented pulmonary nodules, lymphadenopathy and localrelapse, which was treated with chemotherapy and localresection. CONCLUSION: Paratesticular mesothelioma is an infrequenttumor. Scrotal mass associated with hydrocele is thetypical form of presentation. Surgical treatment consists ofradical orchiectomy. They have poor prognosis because inmost cases there is rapid local and dissemination.

OBJETIVO: El mesotelioma paratesticular es  un tumor infrecuente, con menos de 250 casos publicados, originado en la túnica vaginal escrotal. Representa el 0,3-1,4% de los mesoteliomas. Predomina en pacientes añosos, con la exposición al asbesto y su diagnóstico sueleser casual. Nuestro objetivo es presentar dos casos ocurridos en nuestro servicio con mesotelioma paratesticular maligno y realizar una revisión de la literatura actual sobre dicha patologia.MÉTODO: Aportamos dos casos diagnosticados de mesotelioma paratesticular maligno acontecidos en nuestro servicio durante los últimos dos años. RESULTADO: El primer caso es un varón de 73 años que debutó con hidrocele sin dolor. El segundó es un varón de 57 años que inició su clínica con un cuadro de dolor testicular e hidrocele. En ambos se diagnostica de mesotelioma maligno de la túnica vaginal tras hidrocelectomía. Se realiza como tratamiento inicial una orquiectomía radical en ambos pacientes. El primer paciente no precisó ningún tratamiento adicional. El segundo paciente presentó nódulos pulmonares y adenopatías junto con recidiva local, que se trató con quimioterapia y resección local.CONCLUSIÓN: El mesotelioma paratesticular es un tumor infrecuente, sin una clínica especifica. Su forma típica de presentación es una masa escrotal indolora asociada a hidrocele.El tratamiento quirúrgico consiste en orquiectomía radical. En la mayoría de los casos existe una rápida diseminación local y a distancia que otorgan a estos tumores un mal pronóstico.

Cost-effectiveness analysis of fesoterodine flexible dose in newly diagnosed patients with overactive bladder in routine clinical practice in Spain.

OBJECTIVE: To carry out cost-effectiveness analysis from the Spanish National Health System perspective, of treating overactive bladder (OAB), in newly diagnosed patients with two flexible doses of fesoterodine in routine clinical practice. PATIENTS AND METHODS: Economic evaluation of flexible-dose fesoterodine in newly diagnosed patients, including two treatment groups: standard escalating from 4 to 8 mg or fast escalating to 8 mg. Costs were estimated from health care resources utilization related to OAB, and were expressed in 2015 Euros. Quality-adjusted life-years (QALYs) were obtained from overactive bladder questionnaire-short form. Univariate and probabilistic sensitivity analyses were carried out. RESULTS: Three hundred and ninety symptomatic OAB patients treated with fesoterodine and newly diagnosed (141 in fast escalating group and 249 in standard escalating) were analyzed. Adjusted health care total costs were not statistically different; difference -€4.1 (confidence interval: -153.3; 25.1) P=0.842. QALYs were higher in fast escalating to high dose vs standard escalating group, resulting in a cost of -€16,020/QALY gained for fast escalating vs standard escalating group. CONCLUSION: When the cost-effectiveness threshold is set at a maximum value of €30,000/QALY gained, fesoterodine fast escalating group was cost-effective vs standard escalating group 67.6% of the time. The treatment with fesoterodine, in female patients newly diagnosed, fast escalating to 8 mg was a cost-effective option relative to escalating traditionally from 4 to 8 mg, in the management of OAB in routine clinical practice, from the Spanish National Health System perspective.

Profile of oab patient on treatment with flexible-dose antimuscarinic drugs in daily clinical practice. / Perfil del paciente con vejiga hiperactiva tratado con dosis flexible de antimuscarínicos en la práctica clínica diaria.

OBJECTIVE: To describe the profile of the overactive bladder (OAB) patient on treatment with flexible-dose antimuscarinic treatment in daily clinical practice. METHODS: This was an observational, retrospective and multicenter study, carried out at 88 public and private hospitals. Adult patients diagnosed with OAB who initiated flexible-dose antimuscarinic treatment. Type of antimuscarinic, dose, concomitant treatments, treatment benefit and treatment adherence were recorded. RESULTS: This was a pluripathological (83.5% and polymedicated 73.4%) population, comprised of 846 patients, mostly women (74.5%) with a mean (SD) age of 61.3 (12.1) years and more than one year of OAB evolution. Main initially prescribed antimuscarinics were fesoterodine (66.5%) and solifenacine (30.0%). Overall, 68.2% of the patients started treatment with the low dosage; at the follow-up visit 47.0% changed the dosage (84.2% increased the dosage, 15.8% decreased the dosage). Patients who changed the dosage showed a significantly greater morbidity, worse OAB symptoms, greater health resources use, and worse adherence to treatment compared with those that maintained the high dosage all the time. CONCLUSION: No differences were found regarding the demographic or clinical characteristics that allow us to identify which patients should receive the different options of available dose of antimuscarinic drugs, although greater benefits seem to be achieved with the use of the highest or the lowest dose from the outset than with the change of dose.

[Primary bladder neck obstruction in males]. / Obstrucción primaria del cuello vesical en el varon.

OBJECTIVES: To report our experience on the diagnosis and treatment of this rare type of infravesical functional obstruction. METHODS: Over the last ten years we diagnosed and treated 32 males with this entity. We evaluate previous treatments and time to diagnosis. Clinical, radiological, endoscopic, and urodynamic features are evaluated, as well as results obtained with the administration of alpha-adrenergic blockers and endoscopic transurethral incision of the bladder neck. RESULTS: Patient age ranged from 26 to 48 years (Mean 38.2). All patients presented significant long-lasting lower urinary tract symptoms, having received various non-specific treatments. Uroflowmetry showed a peak of mean flow of 9.8 +/- 3.2 cc/s, being the voiding detrusor pressure 98 +/- 25 cm H2O, with significant post void residual volume in 21 patients (188 +/- 62 cc). Medical treatment with alpha-adrenergic blockers only achieved significant subjective improvement in four patients. Twenty one patients underwent unilateral endoscopic bladder neck incision, obtaining objective and subjective improvements all of them. CONCLUSIONS: Endoscopic bladder neck incision is the treatment of choice of this dysfunction, being imperative to inform the patient of the risk of retrograde ejaculation as a postoperative sequel, since this entity appears in young males, for whom fertility may be a priority.

[The usefulness of virtual endoscopy and CT urography in the diagnosis of upper urinary tract tumors]. / Utilidad de la endoscopia virtual y el Uro-Tc en el diagnóstico de tumores del tracto urinario superior.

OBJECTIVES: Upper urinary tract (UUT) tumors are a relatively low incidence pathology which often represents a diagnostic challenge for the urologist, because several imaging tests are usually necessary to achieve the final diagnosis. Over the last years CT scan has suffered a notable development and nowadays, with the arrival of new image processing hardware and software, it is possible to detect small urothelial lesions and to perform 3-D urinary tract reconstruction and virtual endoscopic navigation. METHODS: Between January 2004 and June 2005 we performed a total of 15 examinations in 15 patients for the study of asymptomatic hematuria of probable upper urinary tract origin. The technique included three phases to obtain images: basal phase, vascular phase and excretory phase. Processing and image analysis was performed by one radiologist. RESULTS: A total of 10 tumors were diagnosed, with pathological confirmation in all cases. We did not register any complication secondary to the technique, and all patients tolerated well the exam. CONCLUSIONS: The CT urography is a safe, well-tolerated, highly sensitive and efficient imaging test, very useful in the diagnosis of renal and UUT pathology. It may become the only imaging test performed in the study of asymptomatic hematuria and the test of choice for the study of urological tumoral pathology.

[Valencia's scientific contribution to the consolidation of Urology as a speciality. Bibliometric classification by subject, author and journal. Historical documentary analysis]. / Aportación cientifica valenciana en la consolidación de la Urología como especialidad. Bibliometría por materias, autores y revistas. Análisis documental histórico.

OBJECTIVES: Urology, as other medical-surgical specialities, had its consolidation process in the mid 19th century. This phenomenon in the history of medicine occurs around certain authors, which in the case of urology in Valencia was Dr. Raphael Molla Rodrigo, and several key elements such as development of lithotripsy and cystoscopy, as cited by prestigious authors in the second national meeting of history of medicine in Salamanca in 1965. For this process a spreading media is necessary, either regional or national, for posterior bibliometric analysis. METHODS: We performed a retrospective study of urological publications in the area of Valencia to know the main areas of knowledge, main authors and publications. Regarding this latter we point out Cronica medica, Revista Valenciana de Ciencias Médicas, Archivos Españoles de Urología y Policlínica. As authors, Rafael Molla Rodrigo, Victor Molla Fambuena and Rafael Alcalá Santaella stand out. Genitourinary tuberculosis and surgical procedures with their complications are among the most commonly treated topics. RESULTS: Dr. Rafael Molla Rodrigo is the author with the highest number of articles and the one who contributed to the consolidation of the speciality nationwide with his extensive scientific contributions. Genitourinary tuberculosis is extensively treated, and surgical procedures and their complications are in second place. The journal in which we were able to find more articles was Cronica Medica, due to its greater diffusion among general practitioners. CONCLUSIONS: We emphasize Dr. Rafael Molla as the main author, genitourinary-tuberculosis as the main topic and the journal Cronica Médica as the most commonly used media.

[Bladder squamous metaplasia: report of one case and bibliographic review]. / Metaplasia escamosa vesical, a propósito de un caso. Revisión de la uteratura.

OBJECTIVES: We report a new case of squamous metaplasia because of its interest and subtle differential diagnosis with other bladder pathologies. METHODS: We report the case of a male patient with history of previous neoplasia with an exophytic lesion of the bladder wall discovered on follow-up. Pathological diagnosis after TUR was bladder squamous metaplasia. RESULTS: Follow-up is performed by ultrasound, cystoscopy, and urine cytology in adherence to clinical guidelines due to the possibility of transformation into squamous cell carcinoma. CONCLUSIONS: Urothelium is able to develop non neoplastic transformations such as squamous metaplasia. The importance of such transformations depends on proper diagnosis and follow-up due to their ability to transform into a neoplastic process.

[Orthotopic bladder substitution in the treatment of interstitial cystitis]. / Sustitución vesical ortotópica en el tratamiento de la cistitis intersticial.

OBJECTIVES: To point out the efficacy of supra trigonal cystectomy with orthotopic substitution iliocystoplasty in the treatment of advanced interstitial cystitis (IC). METHODS: We study the results obtained in four women suffering IC nonrespondent to conservative treatment who underwent the procedure. All patients comply with classic diagnostic criteria of IC, presenting long-lasting symptoms, between 4 and 8 years (mean 5.6), and voiding frequency of near one-hour day and night. RESULTS: Mean postoperative follow-up was 32 months (18 to 56); post operative evaluation included clinical evaluation, ultrasound, urodynamic studies, and radiological tests. Suprapubic pain disappeared in all cases, as well as pre-op lower urinary tract symptoms, with good control of urinary frequency day and night being evident in the immediate postoperative period. All patients referred high satisfaction with the outcome. CONCLUSIONS: When conservative treatment fails, supratrigonal cystectomy with orthotopic neobladder substitution is a valid therapeutic option in IC patients who comply with classic diagnostic criteria.

[Outpatient surgical treatment of female stress urinary incontinence]. / Tratamiento quirúrgico ambulatorio de la incontinencia urinaria de esfuerzo femenina.

OBJECTIVES: To evaluate the results of the outpatient surgical treatment of genuine female stress urinary incontinence (SUI) over a five year period since the integration of the Department of Urology in the Ambulatory Surgery Unit at our hospital "Consorcio Hospital General Universitario de Valencia" (CHGUV). METHODS: Between January 2000 and December 2004 26 patients (ages 49-78; mean age 69.8 yr) with the diagnosis of SUI underwent tension-free suburethral mesh sling (TVT) outpatient operations under local anesthesia-sedation at the ambulatory surgery unit of the CHGUV. All patients had clinical and urodynamic evaluation, excluding those presenting genital prolapse or non compliance with the social requirements for ambulatory surgery. Previous anti-incontinence surgery was not an exclusion criterion. We evaluate inclusion and discharge criteria, results and satisfaction degree measured by a questionnaire. RESULTS: 22 patients (85%) had genuine SUI and 4 (15%) had mixed UI with predominance of the stress component. 54% (14) of the patients were ASA I, 31% (8) ASA II, and 15% (4) well compensated ASA III. Operation tolerance under local anesthesia (20-30 ml 1% lidocaine) was good in all patients, having used additional sedation-analgesia (propofol-remifentanil IV perfusion) in 10 of them (38%). Mean operative time was 30 minutes (25-45) and stay at the unit discharge was 100 min. (80-140). All patients were discharged the same day. None of them required readmission or presented urinary retention after catheter removal. SUI disappeared in all of them. Three patients presented postoperative urge incontinence responsive to oral anticolinergic drugs. Our results are similar to those obtained with epidural anesthesia and hospital admission, being the degree of satisfaction with treatment higher than 95%. CONCLUSIONS: The development of new, revolutionary systems for the treatment of SUI has simplified the surgical treatment of this entity, so that we can say a high percentage of patients may be included in an ambulatory surgery program, significantly improving cost-efficacy without diminishment of health-care quality or patient satisfaction.

[The treatment of hydrocele as ambulatory surgery]. / Tratamiento del hidrocele en cirugia mayor ambulatoria.

OBJECTIVES: To evaluate the results of this surgical treatment of hydrocele over the first four years of integration of the Urology Department in the Major Ambulatory Surgery Unit in our Hospital. METHODS: From January 2000 to July 2004 we have performed 167 hydrocelectomies as ambulatory surgery in 152 patients (15 cases bilateral) with ages ranging from 16-87 years (mean 52.6). All procedures were performed under local anesthesia, using between 10-15ml of 1% lidocaine. The Lord's vaginalis plication technique was employed in 92% of the cases, leaving resection techniques for the remaining 8%, which presented certain degree of enlargement of the tunica vaginalis. We evaluated inclusion and discharge criteria, results, and degree of satisfaction by means of a questionnaire. RESULTS: Results are equivalent to those of inpatient surgery. Only one patient required admission to the hospital due to a postoperative complication, which was clearly independent of the ambulatory character of the process. Satisfaction with treatment was higher than 95%. CONCLUSIONS: Almost all patients with hydrocele are candidates to ambulatory surgery, significantly improving the cost-efficacy rate, without diminishing the quality of care or patient satisfaction.

[Genitourinary tuberculosis in the urologic works of Professor Rafael Mollá Rodrigo]. / La tuberculosis genitourinaria en la obra urológica del profe- sor Rafael Mollá Rodrigo (1862--1930). Análisis documental histórico de su obra.

OBJECTIVES: Professor Rafael Molla Rodrigo is considered by some the author who contributed with his scientific work and solid technique to consolidate Urology as a speciality in Valencia. Such importance is also perceived in a national level, as demonstrated by the fact that he belonged to the first board of the Spanish Association of Urology and contributed to its foundation in the two-year period 1910--1911, from his position of head of the department of Surgical Therapy and Operations at the Central University. Genitourinary tuberculosis is one of the most outstanding chapters of his extensive works. METHODS: We reviewed all his works, selecting all original articles about genitourinary tuberculosis. Original articles have been obtained from the journals Revista de Higiene y Tuberculosis, La Medicina Valenciana, Revista Valenciana de Ciencias Médicas y Policínica, and from his two most important books, Clinical Lessons In Urology and Clinical Lessons in Urology and Genitourinary Surgery. RESULTS: Throughout his work he analyzes features of relevance about this disease, such as diagnosis, about which he emphasizes the clinical and bacteriological difficulties, and treatment, which was only feasible by precocious nephrectomy. CONCLUSIONS: He dedicates a great part of his work to the study of this pathology and defends a precocious diagnosis in order to perform the only treatment that had demonstrated efficacy. He also exposes the symptoms and variety of clinical presentations, as well as diagnosis through separate kidney catheterization with the aim to determine unilateral involvement.

[Management of male sterility in patients taking anabolic steroids]. / Manejo de la esterilidad masculina en pacientes consumidores de esteroides anabolizantes.

OBJECTIVES/METHODS: To review the incidence of male infertility secondary to intake of anabolic products and our experience and outcomes with treatment. There is a variety of such substances (testosterone, nandrolone, stanozolol, etc.) in their intake may be unique or combinations, both orally or parenterally. Comparisons between patients and case series are difficult because of the hiding of this practice and various consumption practices and doses employed. RESULTS/CONCLUSIONS: Most of the patients recover normal spermatogenesis does by stopping intake of anabolic substances. The period of time until recovery is 6.35 months. Patients not recovering after six months were given tamoxifen 20 mg/24-hour, if having a normal or inhibited hypothalamus-hypophysis axis. Duration of abuse, doses, and anarchical consumption maderesponse to treatment with antiestrogen drugs or gonadotropins unpredictable in patients not responding to conservative treatment.

[Symptomatic hydronephrosis during pregnancy]. / Acerca de la hidronefrosis sintomática en la gestante.

OBJECTIVES: Hydronephrosis is common during pregnancy, affecting 90% of pregnant women. It is usually asymptomotic, but a small percentage of patients show clinical symptoms requiring treatment. We want to report our experience in the diagnosis and treatment of symptomatic obstructive uropathy in pregnant women. METHODS: We retrospectively evaluate the results obtained in 162 pregnant women suffering symptomatic hydronephrosis who received care at our department over the last 12 years. RESULTS: Conservative treatment was effective in most patients, 39 patients required more aggressive therapy. Thirty-five patients underwent insertion of a doubleJ catheter, 2 patients percutaneous nephrostomy, and another 2 ureteroscopy and extraction of ureteral lithiasis. CONCLUSIONS: The most frequent etiology of symptomatic hydronephrosis during pregnancy is external compression by the gravid uterus, followed by ureteral lithiasis. We consider conservative treatment as the treatment of choice, leaving ureteral double J cotheter insertion or percutaneous nephrostomy for the refractory cases. Ureteroscopy is a new diagnostic and therapeutic option when other less aggressive meosures fail.

[Urologic work and biography of Prof. Rafael Alcalá Santaella (1896-1959). Historical document analysis]. / Obra urológica y biografía del Profesor Rafael Alcalá Santaella (1896-1959). Análisis documental histórico.

OBJECTIVES: We find that Urology at the end of the 20th century was a consolidated speciality as a result of years of evolution and development, and the studies and works of authors whose contributions are considered today the basements of our speciality. So we think that Urology should be understood with its historical references, because, as Aristotle said "... thinks are better understood when one has got to clearly see how they were formed..." Numerous specialists contributed to this; among them we can cite Prof. Rafael Alcala Santaella, the object of this bibliographic and scientific works compilation paper. METHODS: We reviewed all his scientific works. Original articles have been obtained from Medicina Ibera, Revista Española de Cirugía y Urología, and Cirugía, Urología y Ginecología. His most important urologic work is Clinic Urology (1942), divided in 3 volumes. For his biography we used the biographic and bibliographic historical source of Spanish urology over the 20th-century and direct family members interviews. RESULTS: He analyzed topics as important as voiding disorders and the study of urine pyuria. He gave special importance to the study of prostatic pathology, its diagnosis by means of cystourethrography, and the modification of surgical techniques, as well as the results of urinary diversions performed in his department. CONCLUSIONS: Due to his extensive scientific and technical contributions he is one of the most outstanding figures of Valencia's Urology over the first half of the 20th century, together with Rafael Molla Rodrigo and Nicasio Benlloch Giner.