Balanitis Xerotica Obliterans Associated With Differentiated Penile Intraepithelial Neoplasia and "Bramble-Bush" Elastic Fibers Accumulation: A Finding Not Specific for Penicillamine Intake.

We describe the association of balanitis xerotica obliterans and differentiated penile intraepithelial neoplasia (PeIN) with dermal elastosis and "bramble-bush" elastic fibers in a diabetic patient with no history of penicillamine intake. An 84-year-old man presented with urethral obstruction syndrome that required postectomy, meatotomy, and foreskin excision. Histopathological examination revealed changes of lichen sclerosus and differentiated PeIN. Orcein staining showed striking dermal elastosis and transepidermal elimination of elastic fibers. At higher magnification, multiple serrations and buds arising from the borders of the elastic fibers were observed giving the so-called bramble-bush appearance. Balanitis xerotica obliterans is considered a premalignant disease, and 14% of patients have evidence of PeIN. The differentiated subtype can be difficult to diagnose because of the minimal basal cell atypia, so a striking dermal elastosis, which may even occur before the neoplasm becomes invasive, may facilitate its diagnosis. The term "acquired perforating dermatosis" seems appropriate to describe those cases of perforating elastosis that occurs in adults with systemic diseases. The bramble-bush appearance of elastic fibers is not specific for penicillamine-induced elastopathy, and it may occur in other diseases, such as diabetes mellitus. This peculiar morphology of elastic fibers may be related to the enzymatic imbalance between matrix metalloproteinases and lysyl oxidase, an enzyme required for the cross-linking of elastic fibers.

Morphological keys in the differential diagnosis of bladder inverted papilloma. Study of two types, trabecular and glandular.

OBJECTIVE: Inverted papilloma of the urinary bladder is an uncommon urothelial neoplasm that may be specially difficult to distinguish from urothelial carcinoma. METHODS: Two patients with obstructive symptoms and hematuria have been studied. In the transurethral resection, accidentally, one showed a papillary lesion in the context of nodular hyperplasia of the prostate, where as the other showed a polypoid tumor of the urinary bladder RESULTS: Histologically, in both cases, a bladder inverted papilloma was demonstrated, originating from the surface transitional epithelium. Basal cells exhibited peripheral palisading pattern in the trabecular form. In the glandular type, Dogiel or umbrella cells into the gland-like structures, were recognized. Immunohistochemical stains for p53 and Ki-67 were negative. Umbrella cells were positive for cytokeratin 20. CONCLUSIONS: Two cases of bladder inverted papilloma with relevant morphological aspects are presented, which we consider useful for the differential diagnosis with urothelial carcinoma.

Use of a barbed suture for the urethro-vesical anastomosis during the learning curve of the endoscopic extraperitoneal radical prostatectomy.

OBJECTIVES: The performance of the urethrovesical anastomosis is one of the most difficult steps in urologic laparoscopy. Many different techniques have been developed to improve this step and, recently, new sutures such as the V-loc (R) barbed system have been created. In the present study we analyze the usefulness of this suture for diminishing the time employed for the anastomosis suture during the learning curve of laparoscopic radical prostatectomy. METHOD: We performed a prospective comparative study between two groups. The first group included the first 50 cases of a novel surgeon using this barbed suture, and we compared these procedures with 50 consecutives cases of an experienced surgeon. We compared preoperative parameters, surgical and suturing times, as well as drain and catheter duration, and hospital stay. RESULTS: We did not find statistically significant differences in any pre or postoperative parameters between both groups. Although surgical time was lower in the control group this difference was not statistically significant. The time used to perform the suture was lower in the study group, and we found significant differences between both groups. Neither drain nor bladder catheter times were different between groups. CONCLUSIONS: In the absence of prospective randomized trials comparing barbed or not barbed running sutures, our study shows that the use of the V-loc® system improves the times needed for the urethrovesical anastomosis during the learning curve of laparoscopic radical prostatectomy.

Remeex® System Effectiveness in Male Patients with Stress Urinary Incontinence.

BACKGROUND: When conservative management fails, patients with stress urinary incontinence (SUI) are considered for surgical treatment. Simpler, more economical and less invasive surgical techniques, such as the Remeex® system, have been developed. OBJECTIVES: To analyze the objective effectiveness of the Remeex® system in the treatment of male stress urinary incontinence. To study survival and complication rates of the Remeex® system in male SUI patients. MATERIALS AND METHODS: Prospective observational study between July 2015 and May 2020. Group A (n = 7; GA) patients with mild SUI. Group B (n = 22; GB) patients with moderate SUI. Group C (n = 18; GC) patients with severe SUI. Effectiveness was assessed by the number of patients achieving complete and partial dryness. Complete dryness was defined as patients using 0-1 safety pads per day; partial dryness as a >50% reduction in the number of pads used. Results were analyzed using descriptive statistics, Student's t-test. Chi2, Fisher's exact test, ANOVA, and multivariate analysis. Significance was set at p < 0.05. RESULTS: Mean age 69.76 years, mean follow-up 33.52 months. Objective effectiveness was observed in 89.36% of patients with incontinence. The effectiveness was 85.71% in GA, 90.91% in GB and 88.89% in GC. There were no significant differences among groups (p = 1.0000). 34.04% of patients with an implant required at least one readjustment, while 66.00% did not require any. There were no significant differences among groups (p = 0.113) Chi2 = 4.352. 95.74% of implants remained in place by the end of follow-up. We observed complications in 17.02% of patients. CONCLUSIONS: Remeex® system is an effective and safe method for male stress urinary incontinence treatment, regardless of the severity of the incontinence, with high survival and low complication and removal rates. System readjustments are required in one-third of the cases.

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.

[Surgical treatment of renal tumours with venous extension]. / Tratamiento quirúrgico del tumor renal con extensión venosa.

OBJECTIVES: Renal carcinoma accounts for 3% of malignant urological tumors. The existence of tumor thrombus in the venous system is more infrequent, and, despite it was believed until recently its presence worsened the diagnosis of the disease, currently it is accepted that in the absence of metastatic or lymph node disease, surgery is the treatment of choice and potentially curative for these tumors. METHODS: Between June 2003 and November 2007 eight patients with renal disease and venous thrombus underwent surgery; two of them wereT3c and six T3b; in five of them surgery was carried out in association with the heart surgery team in our centre. Three of them underwent surgery with extracorporeal circulation. Mean patient age was 56 years. RESULTS: Tumor thrombus was grade I in one patient, grade II in 4 patients, grade III in one patient, and grade IV in two patients. In all patients with tumor grade > or = III, as well as two with grade II, surgery was performed in conjunction with the department of heart surgery. The operation with extracorporeal circulation, deep hypothermia, cardioplegia, and antegrade and retrograde brain perfusion was performed in grades III and IV. Midline incision was performed, with or without sternotomy, depending on the level of the thrombus. Hemorrhage was the most frequent perioperative complication. DISCUSSION: It is essential to know the exact level of the cephalic extreme of the tumor thrombus to design the proper surgical strategy; for that, we can use MRI, CT scan or ultrasound. Therefore, surgical approach, multidisciplinary cooperation and use of extracorporeal circulation will depend on such extension of the thrombus and concurrent factors of the patient. A good surgical strategy, as well as early surgery may avoid the use of venous filters preoperatively. CONCLUSIONS: Venous wall invasion seems to be related with a greater incidence of lymph node disease, but these patients are candidates to intention-to-cure radical surgery. Thrombus level is not a prognostic factor per se, but it should be taken into consideration for surgical planning. After radical surgery survival rates achieved are similar to those of tumors without venous thrombus.

[Penile cellulitis after oral sex]. / Celulitis de pene tras sexo oral.

OBJECTIVE: Nowadays, there is the high prevalence of sexual intercourse including oral sex, which implies some peculiarities in the infections, balanitis and ceIlulitis they may produce. METHODS: We report two new cases of penile cellulitis treated in the urology department in our hospital. DISCUSSION: We review the indications of prophylaxis, and the medical and surgical treatment both referred in the literature and carried out in our patients. CONCLUSIONS: When dealing with balanitis and penile cellulitis, the history should include explicit references to the practice of oral sex. Early medical or surgical treatment has a favourable influence on the evolution of the lesions.

[Inguinoscrotal bladder hernias]. / Hernias Vesicales inguinoescrotales.

OBJECTIVES: Despite the high incidence of inguinal hernias. In the general population, only a small percentage of them involve the bladder. Bladder wall weakness and bladder outlet obstruction are involved in its pathogenesis. We present our experience in the diagnosis and treatment of this rare disease. METHODS: A total of eight patients have been diagnosed of inguinoscrotal bladder hernia and treated in our center over the last 18 years. In most cases, retrograde and voiding cystourethrograms, prostatic and bladder ultrasound, and uroflowmetry have been performed. The treatment varied depending on the characteristics of the herniated bladder tissues and bladder capacity. The treatment of bladder outlet obstruction varied depending on the etiology. RESULTS: Two patients presented at the emergency room of our centre, the others were diagnosed at the outpatient clinics of our department. Resection of the herniated bladder tissue was carried out in four patients due to the quality of the tissue; bladder-pexy to the abdominis rectus muscles was performed in one patient; hernia repair with bladder reintroduction was the treatment in the other four cases. Bladder outlet obstruction was treated in six cases. Seven patients showed clinical improvement, showing normal bladder morphology on post operative cystogram. CONCLUSIONS: Bladder hernia is a rare pathology often presenting in mid age males. It should be suspected in every male with lower urinary tract obstructive symptoms and associated inguinal hernia. Retrograde and voiding cystourethrogram are the radiological diagnostic tests of choice to evaluate this disease. The treatment of choice is that of the hernia and bladder outlet obstruction.

[Dorsal meatoplasty for the treatment of meatal stenosis in patients with balanitis xerotica obliterans]. / La meatoplastia dorsal para el tratamiento de la estenosis de meato en pacientes con balanitis xerótica obliterante.

OBJECTIVES: To present our experience in the treatment of meatal stenosis secondary to balanitis xerotica obliterans with the dorsal meatoplasty technique. METHODS: We have performed dorsal meatoplasty in 15 patients suffering stenosis of the penile meatus secondary to balanitis xerotica obliterans. All cases were performed under local anesthesia, using an inverted V incision plasty following the original of technique from Malone. RESULTS: All patients showed an improvement in uroflowmetry as well as an excellent aesthetic result, with low incidence of scattered urinary stream; there was a high satisfaction index evaluated by a questionnaire. CONCLUSIONS: Dorsal meatoplasty with inverted V incision is an easy-to-perform technique, which may be done under local anesthesia, avoids the development of post-operative hypospadias, and achieves excellent aesthetic and functional results with a low recurrence rate; therefore, we consider it should be included in the list of frequently performed procedures of the urologist.

[Greenlight KTP-laser photovaporization. Initial experience in a public hospital]. / Fotovaporización prostática con láser verde-KTP. Experiencia inicial en un hospital público.

OBJECTIVES: Despite the fact that transurethral resection of the prostate (TURP) continues being the gold standard for the surgical treatment of benign prostatic hyperplasia (BPH), the good results obtained with the use of new energy sources have led to their use in daily practice. METHODS: Between September 2005 and January 2007, we have treated 63 patients with KTP laser photoselective vaporization of the prostate (PVP) in our service. Preoperatively we asked for IPSS, performed physical exam, digital rectal exam, abdominal , renal, bladder and prostatic ultrasound measuring postvoid residual volume, as well as flowmetry and PSA determination. Patients were revised after 1, 3, 6 and 12 months, undergoing uroflowmetry, IPSS, ultrasound and PSA; a satisfaction survey was also fulfilled at this interviews. RESULTS: Mean age was 67 years (range 58-85) and mean preoperative prostatic volume was 48cc (range 34-67), mean preoperative IPSS was 17.7 and mean maximum flow 8.1 mL/s. 12 patients presented post void residual volume larger than 100 mL. Most patients presented medium or high anaesthetic risk. Mean operative time was 64 minutes (range 45-95). In most cases we used just one fibre, and mean energy released was 175,000 Joules (range 85,000-24,000). Mean hospital stay was 32.2 hours (range 19-55). In postoperative revisions we could state a significant decrease of IPSS, improvement in maximum flow, and also good or very good satisfaction degree in about 80% of the patients. Only 3 of them presented hematuria that needed to be attended by the urologist, none of them needed transfusion. One patient was admitted for severe urinary infection and eight patients referred irritative low urinary tract symptoms in their first postoperative checkup. CONCLUSIONS: KTP laser PVP is a safe, reproducible technique with optimal short and middle term outcomes, which should be considered as the first choice surgical treatment in elderly patients, patients with chronic anaemic diseases or anticoagulated, and patients with high anaesthesic or surgical risk.

[Urological works and biography of Dr. Felipe Alcalá Santaella Nuñez (1927-1977). Historical documentary analysis]. / Obra urológica y biografía del doctor Felipe Alcala-Santaella Núnez (1927-1977). Análisis documental histórico.

OBJECTIVES: In the middle of the 20th century, Urology in Valencia was fully consolidated as a surgical speciality since Prof. Molla started it about the end of the 19th century; Dr. Felipe Alcala Santaella Nuñez stands out as the chairman of the Department of Urology of the "Hospital Provincial de Valencia", after his father Dr. Rafael Alcalá Santaella. He achieved to form a group of renowned professionals, some of which still are in active practice. METHODS: We reviewed all his scientific work and the journals it was published in, mainly Archivos Espaioles de Urologia, through the Department of Medical History of the University of Valencia. His biography was reconstructed using the "Biographic and Bibliographic History of Spanish Urology" by Drs. E. Maganto Pavón and M. Pérez Albacete, as well as direct interviews with family members. DISCUSSION: We emphasize the magnificent approach to the clinical presentations of tuberculosis he does in his doctoral thesis, analyzing its types by location, main features, and most adequate treatment. He also emphasized the importance of relapse in lithiasic patients and recommendations to be follow, as well as the condition of bladder neoplasias. CONCLUSIONS: We consider Dr. Felipe Alcalá Santaella Nuñez as a wide-experience-professional who mode solid contributions to the regional urology in his times, thanks to his excellent surgical abilities and dedication.

[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.

[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.

[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.

[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.

[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.

[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.

Nuestra experiencia en el tratamiento de la incontinencia urinaria de esfuerzo masculina mediante cabestrillo suburetral regulable tipo Remeex / Our experience in the treatment of male stress urinary incontinence with the male remeex system

OBJETIVO: Poner de manifiesto nuestra experiencia en el tratamiento de la incontinencia urinaria de esfuerzo postprostatectomía con el sistema Remeex masculino (SRM). Asimismo, describimos los elementos que componen dicho sistema, sus indicaciones terapéuticas, técnica de implantación y su adecuado ajuste.MÉTODO: Desde marzo de 2007 hasta enero de 2009 hemos intervenido a cinco varones afectos de incontinencia urinaria de esfuerzo postprostatectomía con edades comprendidas entre 57 y 71 años (media 66 años), mediante la colocación de una malla suburetral de tensión regulable tipo Remeex. Todos ellos presentaban una incontinencia urinaria severa con gran afectación de su calidad de vida y de un tiempo de evolución entre 2 y 10 años (media 3,5 años), precisando todos ellos entre 5 y 8 compresas diarias.RESULTADOS: Todos los pacientes se mantienen secos en un tiempo de seguimiento medio de 15,4 meses (rango 6-28 meses), precisando ocasionalmente 2 de ellos compresa de seguridad si realizan ejercicio intenso. La puntuación del Incontinence Impact Questionnaire (IIQ 7) realizado antes de la intervención y a los 6 meses después, pasa de 68 ± 7 puntos a 10 ± 3, siendo el grado de satisfacción muy elevado.CONCLUSIONES: El SRM constituye una opción terapéutica válida para la incontinencia postprostatectomía, siendo una técnica reproducible, de fácil ejecución, que permite su reajuste mediante una pequeña incisión suprapúbica bajo anestesia local y en régimen ambulatorio estricto, con una baja tasa de complicaciones proporcionando unos resultados excelentes y duraderos(AU)

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 post-prostatectomy 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 ran-ged 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 Incontinen-ce Impact Questionnaire (7) scores befo-re 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(AU)