[A diagnostic algorithm based on transrectal echography in failure of surgery correcting stress urinary incontinence]. / Algoritmo diagnóstico basado en la ecografía transrectal en los fracasos de la cirugía correctora de la incontinencia urinaria de stress.

Transrectal ultrasound is a dynamic imaging diagnostic technique for the study of stress urinary incontinence (SUI). The highest efficiency is obtained in the study of failed corrective surgery of SUI. Our group studied 23 patients reporting clinical SUI after undergoing corrective surgery, 23.3% patients with transrectal ultrasound showed no condition that could justify it (bladder neck hypermobility, intrinsic sphincteral incompetence, calcification of suspension threads, urethra diverticulum...); 34.8% showed bladder neck hypermobility, indicative of failed corrective surgery; 34.8% showed presence of open urethra at rest, an echographic sign of intrinsic sphincteral incompetence; and in 4.3% cases the existence of intravesical calcifications of the suspension threads was diagnosed. Transrectal ultrasound can become the choice test to perform in this group of patients, leading to the performance of other diagnostic tests and offering an adequate customized solution for each patient's problem.

[Echographic diagnosis of female urethral diverticulum]. / Diagnóstico ecográfico del divertículo uretral femenino.

OBJECTIVE: To describe the utility of transrectal ultrasound as an alternative imaging technique in the diagnosis of diverticulum of the female urethra. METHODS/RESULTS: A 35-year-old female that had been initially diagnosed as having a benign tumor of the vagina is described. The voiding cystogram, positive pressure urethrography with a double balloon catheter and urethroscopy were falsely negative for urethral diverticulum of the female urethra. Subsequent evaluation by transrectal ultrasound disclosed on oval-shaped, anechoic lesion located posteriorly to base of the bladder. CONCLUSIONS: Transrectal ultrasound could be the diagnostic imaging technique of choice in patients suspected as having diverticulum of the female urethra.

[Comparative analysis of various techniques for the repair of stress urinary incontinence in women. Review of our experience]. / Análisis comparativo de diferentes técnicas para la corrección de la incontinencia de stress en la mujer. Revisión de nuestra experiencia.

OBJECTIVE: We aim to expose our experience in the surgical correction of stress urinary incontinence (SUI) and to analyze the possible factors that could modify the outputs of this type of surgery. METHODS: We have studied 114 women who underwent surgery (60 Raz, 36 Burch, and 18 vaginal wall sling), with a mean follow-up time of 10.5 months. RESULTS: We have not succeeded in demonstrating that preoperative factors such as age, irritative voiding symptoms; history of prior hysterectomy or urethropexia, neurological disease, diabetes or recurrent urinary tract infections; the finding of cistocele, a positive Bonney-Marchetti test or bladder unstability, play any role in the outputs. The failure rate was 16.7% for vaginal wall sling procedure, 35% Raz, and 33.3% Burch. "Survival" analysis did not demonstrate differences related to the procedure or the surgeon. We discovered and important decrease of continence rate with time from the intervention. Higher incidence of postoperative pain, urinary retention and greater residual urine were detected with transvaginal procedures. There was no difference in the incidence of wound infection. CONCLUSIONS: We don't believe that the selection of candidates for this type of surgery should be carried out in base to the above mentioned preoperative factors. Also, we observed a consistent decrease of postoperative continence with time. Finally, we have detected a greater incidence of complications after transvaginal procedures.

[Idiopathic retroperitoneal fibrosis simulating pelvic tumor with distal ureter infiltration. Report of a case]. / Fibrosis retroperitoneal idiopática simulando un tumor pélvico que infiltra el uréter distal. Descripción de un caso.

OBJECTIVE: To describe a case of idiopathic retroperitoneal fibrosis with an unusual form of presentation. Similar cases reported in the literature are briefly reviewed. METHODS/RESULTS: Herein we describe a 50-year-old female patient with idiopathic retroperitoneal fibrosis presenting as a single, unilateral, pelvic focus that enveloped and infiltrated the distal ureter. Treatment and outcome are described and the possible options in similar cases are discussed. CONCLUSION: After discarding the more common causes of extrinsic or intrinsic ureteral obstruction, retroperitoneal fibrosis should be considered since it can mimic other conditions, as in the case described.

[Usefulness of ultrasonography in the assessment of acute pyelonephritis]. / Utilidad de la ecografía en la evaluación de la pielonefritis aguda.

OBJECTIVE: The diagnosis of acute pyelonephritis (APN) is based fundamentally on the clinical and bacteriological findings. Radiology is useful in ruling out obstructive causes that often require surgical management. The present study analyzed the role of renal ultrasonography (US) in patients with clinical symptoms, signs and history compatible with APN that have normal plain abdominal x-rays. METHODS: 87 patients who consulted our emergency services with symptoms and signs compatible with APN were reviewed. Patients who referred renal colic and those with a previous history of urological disease other than uncomplicated recurrent urinary tract infection were excluded. Patients with a plain abdominal x-ray compatible with lithiasis were excluded. Renal US evaluation was performed by the urologist to rule out hydronephrosis. RESULTS: 37 (42.5%) of the 87 patients had an abnormal US scan. These patients were evaluated again by US or IVP, or both (one case). Obstructive uropathy was demonstrated in only 5 cases (5.8%). These foregoing 5 patients were treated by surgery. CONCLUSIONS: In our series, renal US evaluation indicated surgical treatment in 5.8% of patients with clinical features of APN and a plain abdominal x-ray with no evidence of lithiasis. This incidence is likely to be lower in the outpatient setting. It is difficult to propose a standard approach in the management of these patients. It may therefore be more reasonable to utilize US and IVP in those patients who do not respond to antibiotic therapy.

[A paratesticular myxoid liposarcoma as a simulator of a hernial process. A case report]. / Liposarcoma mixoide paratesticular como simulador de proceso herniario. Descripción de un caso.

OBJECTIVE: To describe a case of paratesticular liposarcoma in a 69-year-old male. The literature is briefly reviewed and the prognostic and therapeutic aspects are discussed. METHODS/RESULTS: The patient was submitted to surgery. Pathological analysis of the surgical specimen disclosed a myxoid liposarcoma with undifferentiated pleomorphic areas. Patient follow up has shown no recurrence or metastasis. CONCLUSIONS: This tumor type develops in scrotal soft tissue, slowly increasing scrotal size, and should be distinguished from inguinoscrotal hernia. Together with physical examination, ultrasonography is generally useful. Treatment is by radical orchiectomy through an inguinal approach; the role of adjuvant therapy remains unclear. It has a good prognosis, with frequent local relapses; metastatic spread is uncommon.

[Value of transrectal ultrasonography in the assessment of failures of stress urinary incontinence surgery in women]. / Valor de la ecografía transrectal en la evaluación de los fracasos de la cirugía de la incontinencia urinaria de esfuerzo femenina.

OBJECTIVES: To describe the role of transrectal ultrasonography as an alternative imaging technique in the evaluation of women who continue to be incontinent following surgical management of female stress urinary incontinence. METHODS: The means of independent samples of transrectal ultrasound parameters of two groups of patients (group I, patients who were continent after surgery; group II, patients who remained incontinent after surgery) were compared. RESULTS: Patients who were continent after surgery showed scanty caudal and dorsal mobility of the bladder neck and proximal urethra during the periods of increased intraabdominal pressure. The US finding in this group of patients is characterized by a funnel surrounding the bladder neck and the proximal urethra. The existence of an intrinsically incompetent sphincter can also be determined with this technique. CONCLUSIONS: Transrectal ultrasonography constitutes an alternative imaging technique in the evaluation of women who continue to be incontinent following surgical management of female stress urinary incontinence. It permitis determining whether incontinence is due to a failed procedure, the existence of an intrinsically incompetent sphincter, or whether other causes of incontinence should be investigated.

[Identification of factors conditioning urinary cytology in bladder cancer]. / Identificación de los factores que condicionan la citología urinaria en el cáncer vesical.

OBJECTIVES: To identify the clinical and tumoral aspects related with urinary cytology as a means of validating current criteria or determining the usefulness of this test in the diagnosis of bladder tumors. METHODS: 96 patients that were posteriorly diagnosed as having primary transitional cell carcinoma of the bladder were initially evaluated by urinary cytology. The diagnoses were positive, negative or inconclusive cytology. Any abnormality (for both inconclusive and positive cytologies) were considered as compatible with tumor. To determine the relationship between patient characteristics and tumors, and the results of cytology, standard univariate statistical analysis was performed. To eliminate the confounding factors, a multivariate analysis was performed. RESULTS: Cytology was positive on 44 (45.8%), inconclusive on 22 (23%) and negative on 30 (31.2%) occasions. Age > or = 55 years (p < 0.05), grade (p < 0.05), tumor aspect (p < 0.01) and size (p < 0.001) were associated with a higher frequency of cytologies compatible with tumor. Multiple regression analysis identified tumor size as the only independent variable related with the cytologies compatible with tumor [odds ratio = 8.68 (2.7-26.9)]. CONCLUSIONS: If, as the results of the present analysis suggest, the real effect of cytological analysis in the initial diagnosis of bladder tumors is the anticipation of different features of tumor grade and stage (as patient age, tumor size, aspect and number), its utility would be very limited since other more precise tests (US, cystoscopy...) that provide this information are available.

[Usefulness of cystomanometry in the assessment of urinary irritative symptoms]. / Valor de la cistomanometría en la evaluación de la sintomatología irritativa miccional.

OBJECTIVES: To analyze the value of cystometry in evaluating patients with irritative voiding symptoms with no remarkable previous medical history. METHODS: 79 patients (24 males, 55 females; mean age 49.6 years) with irritative voiding symptoms and no remarkable previous medical history comprised the study. The patients underwent physical and neurourological examination. The urodynamic assessment included uroflowmetry, filling cystometry, pressure/flow study (and urethral pressure in some cases). Uninhibited detrusor contractions were registered. RESULTS: Cystometry failed to detect involuntary detrusor contractions in 68 of the 79 patients (86.1%) with no relevant medical history. Detrusor instability was not found in 41 of 52 women (78.9%) with irritative voiding symptoms and stress incontinence without neurological disease. Involuntary contractions were not observed in 14 of 16 patients (87.5%) with irritative symptoms with a diagnosis of infravesical obstruction. On the other hand, 33 of 68 patients (48.5%) with irritative complaints and a history of neurologic disease showed no hyperreflexia. A statistically significant difference was found between this latter group of patients and those with no remarkable previous medical history (p < 0.001). CONCLUSIONS: Our results indicate that filling cystometry is of little value in the assessment of patients with irritative voiding symptoms and no remarkable previous medical history, but is more useful in patients with irritative symptoms and neurological disease. Careful history-taking and physical examination should detect the underlying problem in the majority of patients.

[Conservative treatment of muscle-infiltrating bladder tumors with TUR]. / Tratamiento conservador mediante RTU de los tumores vesicales musculoinfiltrantes.

OBJECTIVES: The absence of tumor in up to 10% of cystectomy specimens of patients with invasive bladder cancer justify the search for non aggressive therapies. The present study attempts to establish the safety and curative capacity of TUR alone for patients with superficial muscle-infiltrating bladder cancer. METHODS: Over a period of 18 months, 12 patients with superficial muscle-infiltrating bladder cancer (T2) were diagnosed at our department, TUR was repeated in 9 of the 12 patients. The extension study was negative in all 9 patients. RESULTS: The mean follow up was 12.8 months (range 7-70 months). Local recurrence was found in 4 patients (44.4%) who were submitted to another TUR; 3 were superficial and 1 invasive (with the same muscle involvement as at the initial diagnosis). The tumor-free survival rate was 9.3 months. No patient showed tumor progression. CONCLUSION: The percentage and nature of local recurrence, tumor-free survival and the progression rate (which was not observed during the short follow up period) indicate that TUR is a treatment option that must be taken into account in selected patients with invasive bladder cancer.

[Transrectal ultrasonography technique in stress urinary incontinence in women]. / Técnica de la ecografía transrectal en la incontinencia urinaria de esfuerzo femenina.

OBJECTIVES: This study describes the use of transrectal ultrasound as an alternative to cystography in the assessment of female stress urinary incontinence. The procedure and the different parameters that must be evaluated are also described herein. METHODS: The patients were evaluated in the standing position and saggital sections were obtained with a transrectal transducer. The bladder was filled with saline and the test was done at rest using the Valsalva maneuver with or without a bladder catheter. RESULTS: In these patients with female stress urinary incontinence, bladder neck movement was dorsal and caudad, the most important observation being bladder neck descent. Furthermore, we found an increased posterior urethrovesical angle. CONCLUSIONS: Transrectal US is an alternative imaging technique in the assessment of patients with stress urinary incontinence that is easy to learn and avoids exposure of the patients to radiation.

[Diagnostic and therapeutic retrograde ureterorenoscopy (URS)]. / Ureterorrenoscopia retrograda (URS) diagnostica y terapeutica.

Presentation of results obtained in 50 procedures of retrograde ureterorenoscopy (URS), and discussion based on the literature and our results, on the current indications for URS with regard to extracorporeal lithofragmentation (ECL) for the treatment of pelvic ureteral lithiasis and the diagnosis and/or treatment of other conditions. Fifty URS were performed in 47 patients between February 1992 and March 1994: 35 were conducted to treat ureteral lithiasis, achieving a 97% success rate and a mean post-surgery hospital stay of 48 hours; and for diagnostic and/or therapeutic reasons. There were no major complications, and a description is made of minors cases. We prefer to use URS in those cases of distal ureteral lithiasis, as compared to ECL, because of its level of efficacy (higher than or equal to ECL), low cost/benefit ratio, low morbidity and shorter hospital stay involved. The paper emphasizes the major diagnostic and therapeutical indications for URS, and finally, it is noted that URS can avoid undertaking other more aggressive urinary by-passes, since it allows to catheterize the ureters where a false intramural route is conducted.

["Supreme" dressing in the prevention of hematoma and edema in scrotal surgery]. / Vendaje "sumo" en la prevención del hematoma y edema en cirugía escrotal.

An efficient compression can reduce the complications of an inadequate hemostasis following scrotal surgery. The main difference between the "sumo" and previously described compressive methods lies in the use of both pelvic brims as main loading points for the dressing. Similar features are provided by standard scrotal supports but the compression they are able to achieve is minimal compared to that of "sumo" dressing.