Role of robotic surgery in functional urology.

Three-dimensional, high-definition images, small instruments with endowrist technology, ergonomic position and the easiness to teach, are possibly the main reasons why robotic surgery will continue to gain ground to others forms of surgery. The current applications of robotics in functional urology are: the correction of pelvic organ prolapse, the correction of female stress urinary incontinence (artificial urinary sphincter) and the treatment of chronic pelvic pain (pudendal nerveneurolysis). In this paper, we explain our robotic techniques in these three scenarios, as well as, provide the most updated data of our series.

Las imagen tridimensional de alta definición,los instrumentos pequeños con tecnología "endowrist"(endo-muñeca), la posición ergonómica y lafacilidad para enseñar son posiblemente las razonesprincipales por las que la cirugía robótica continuaráganando terreno sobre otras formas de cirugía. Las aplicacionesactuales de la robótica en urología funcionalson: la corrección del prolapso de órganos pélvicos, lacorrección de la incontinencia urinaria de esfuerzo (esfínterurinario artificial) y el tratamiento del dolor pélvicocrónico (neurolisis del nervio pudendo). En este artículoexplicamos nuestras técnicas robóticas en estos tres escenariosy también presentamos los datos más actualizadosde nuestras series.

Prospective long-term results, complications and risk factors in pelvic organ prolapse treatment with vaginal mesh.

OBJECTIVE: To assess the long-term results and complications of pelvic organ prolapse treatment with transvaginal mesh. STUDY DESIGN: Prospective observational study of 75 women who underwent surgery between 2005 and 2008 by the same surgeon. 44 patients (58,7%) underwent concomitant treatment of stress urinary incontinence. Anatomical criterion for failure was prolapse grade >I in any compartment. Analysis of functional features consisted of an assessment of urinary, sexual, and defecation symptoms, and pelvic pain. Subjective global evaluation of the treatment was carried out through the Visual Analogue Scale (VAS). Analysis of the early and late complications and their medical or surgical management was performed. Evaluation of risk factors for failure of treatment and extrusion was carried out through logistic regression. RESULTS: The median follow-up was 5,3 years. The anatomical results showed correction in 91,3% of the patients. Median subjective VAS evaluation: 9/10. Urinary symptoms improved after the surgery. Constipation and dyspareunia rates worsened. Pelvic pain improved. There were two early complications: one rectal perforation, repaired intraoperatively and one pulmonary embolism, managed medically. Late complications: 9 extrusions (3 managed with topical oestrogen, 3 with expectant management, and 3 reoperated, one twice), one cervix elongation and one forgotten gauze (both reoperated), 4 de novo pain managed successfully conservatively. 58,8% of the complications occurred after one year. Risk factors analyzed showed no statistical significance. CONCLUSIONS: Vaginal mesh provides favorable anatomical, functional and subjective outcomes in long-term follow-up. The number of complications is relatively low, but many complications occurred a long-time after surgery.