Curva de aprendizaje de la ecografía renal en una unidad docente pluriprofesional / Renal ultrasound learning curve performed in a multiprofessional teaching unit

Introducción: El objetivo de esta experiencia fue analizar un módulo formativo inserto en la práctica asistencial de un departamento de urología con la participación de enfermeras especializadas en ecografía urológica como monitoras. Material y métodos: Participaron en el estudio 12 estudiantes de medicina carentes de cualquier conocimiento de ultrasonografía. Su formación corrió a cargo de dos enfermeras con gran experiencia en ecografía. Después de dos sesiones de entrenamiento, se analizó la concordancia entre sus hallazgos en la exploración de los riñones y los de un urólogo especialista. Para analizar la experiencia desde todos los puntos de vista, se exploró el grado de aceptación del módulo formativo por parte de los usuarios y la tolerancia de los profesionales involucrados en términos de síndrome de desgaste profesional (SDP). Por último, se calcularon los costes. Resultados: El coeficiente kappa de concordancia entre el experto y los estudiantes fue bueno (≥ 0,67) en el 58,3% de los casos. No se detectaron rasgos de SDP entre los involucrados en la experiencia. La participación de las enfermeras como monitoras redujo el coste del operativo en un 25% en comparación con los costes en los que se podría haber incurrido caso de docentes urólogos senior. Conclusiones: Las enfermeras pueden proporcionar los rudimentos de la formación en ecografía a legos en la materia. La exploración de individuos con cálculos renales o ureterohidronefrosis se traduce en una mayor concordancia entre observadores. El usuario involucrado acepta de buen grado la experiencia. El operativo resulta inocuo para el personal participante.

Introduction: The objective of this experience was to analyze a training module inserted in the care practice of an urology department, with the participation of nurses specialized in urological ultrasound as monitors. Material and methods: Twelve medical students with no knowledge of ultrasonography participated in the study. His training was carried out by two nurses with extensive experience in ultrasound. After two training sessions, the agreement between their kidney examination findings and those of a specialist urologist was analyzed. To analyze the experience from all points of view, the degree of acceptance of the training module by the users was explored, as well as the tolerance of the professionals involved in terms of professional burnout syndrome (PBS). Finally, the costs of the operation were calculated. Results: The kappa coefficient of agreement between the expert and the students was good (≥ 0.67) in 58.3% of the cases. No traits of PBS were detected among involved in the experience. The participation of nurses as monitors reduced the cost of the operation by 25% compared to the costs that could have been incurred if they had been senior urologist teachers. Conclusions: Nurses can provide the rudiments of sonography training to laymen. Examination of individuals with kidney stones or ureterohydronephrosis results in greater interobserver agreement. In general, the user involved willingly accepts the experience. The operation is harmless for the participating staff.

Large study (283 women) on the effectiveness of Manosar®: 2 g of d-mannose + 140 mg of proanthocyanidins (PAC), of prolonged release. / Amplio estudio (283 mujeres) sobre la eficacia de Manosar®: 2 g de d-manosa + 140 mg de proantocianidinas (PAC), de liberación prolongada frente a 240 mg de PAC de liberación prolongada en la prevención a 6 meses por vía oral de las infecciones urinarias recurrentes.

OBJECTIVE: To compare the efficacy and safety in the prophylasis of urinary tract infections (UTIs) with a food supplement that contains D-mannose like active ingredient (Manosar®), in comparison to another preparation in which the active ingredient are the proanthocyanidins (PAC), both of them, in prolonged released, after, they was administered for 24 weeks. METHODS: A multicenter, randomized and double blind experimental study was carried out. 283 women with a history of recurrent UTIs without evidence of complication were included. They were randomized 1: 1 in two groups. In one group, 1 oral sachet of Manosar® a day was administered, and in the other group 1 oral sachet of a compound of 240 mg of continuous-release PAC. Prior to inclusion in the study, the episode of UTI was confirmed at least by the clinical symptoms and positivity of the Combur test. RESULTS: Valid data were obtained from 184 patients with an average age of 49.5 years: 90 received Manosar® and 94 isolated PAC. A total of 72 patients suffered an UTI due to E.coli: 25 patients in the arm with Manosar® versus 47 patients in the isolated PAC group, this difference being statistically significant (p=0.002). The free time of new UTI recurrences was 98.6 days in the group treated with Manosar® and 84.6 days in the group with isolated PAC. CONCLUSION: The oral taking of a daily sachet of Manosar® is effective and safe in preventing recurrent UTIs in women, being superior to the oral taking of isolated PAC.

OBJETIVO: Comparar la eficacia y seguridad de la profilaxis de las infecciones del tracto urinario (ITUs) con un complemento alimenticio que contiene D-manosa como principio activo principal (Manosar®), en comparación con otro preparado cuyo principio activo único son las proantocianidinas (PAC), ambos de liberación continuada, tras su administración durante24 semanas.MÉTODOS: Estudio experimental multicéntrico, aleatorizado y doble ciego. Se incluyeron 283 mujeres con historia de ITUs recurrentes sin evidencias de complicación. Se randomizaron 1:1 en dos grupos. En un grupo se administró 1 sobre diario oral de Manosar®, y en el otro 1 sobre diario oral de un compuesto de 240 mg de PAC de liberación continuada. Previo a la inclusión en el estudio se confirmó el episodio de ITU al menos por la sintomatología clínica y positividad del test de Combur. RESULTADOS: Se obtuvieron datos válidos de 184 pacientes con edad media de 49,5 años: 90 recibieron Manosar® y 94 PAC aislado. Un total de 72 pacientes padecieron una ITU por E.coli: 25 pacientes en el brazo con Manosar® frente a 47 pacientes en el grupo de PAC aislado, siendo esta diferencia estadísticamente significativa (p=0,002). El tiempo libre de nuevas recurrencias de ITU fue de 98,6 días en el grupo tratado con Manosar® y de 84,6 días en el grupo con PAC aislado.CONCLUSIÓN: La toma oral de un sobre al día de Manosar® es eficaz y segura en la prevención de las ITUs recurrentes en la mujer, siendo superior a la toma oral de PAC aislado.

[Efficacy and safety of D-mannose (2 g), 24h prolonged release, associated with Proanthocyanidin (PAC), versus isolate PAC, in the management of a series of women with recurrent urinary infections.] / Eficacia y tolerancia terapéutica de la D­manosa (2 g) de liberación prolongada 24 horas (asociada a proantocianidinas), frente a proantocianidinas aisladas en el manejo de una serie de mujeres con infecciones urinarias recurrentes.

OBJECTIVE: To compare the efficacy and safety of dietary supplement "Manosar®" composed of D-mannose (2 g), 24 h prolonged release, associated with Proanthocyanidin (PAC) (140 mg), ursolic acid (7.98 mg), A, C, and D vitamins and the oligoelement zinc, versus 240 mg of PAC in recurrent urinary tract infections (UTI), for a designed follow-up of 24 weeks, in women. METHODS: A multicenter randomized experimental double-blind study was carried out. The study was approved by review board of "Complejo Hospitalario de Toledo" (Spain), and all patients gave informed consent. A total of 150 women with non complicated UTI were screened for participation. Valid data was obtained from 93, with mean age of 48 years. Fortyfour patients were assigned to the Manosar® group and 51 patients to the PAC group. Patients were followed during six months. A previous UTI was defined based on a combination of symptoms and a positive reactive urine trip. Confirmation of a new UTI was based on symptoms, reactive urine strip and urine culture. RESULTS: Thirty-three patients (35%) had an UTI during the six months follow-up. The percentage of UTI of the Manosar® group during this period was 24%, while the percentage of the PAC group was 45% (p〈0.05). The disease-free time for the Manosar® group was 95 days, while this time was 79 days for the PAC group. The incidence of side effects was low. Diarrhea was the most frequent side-effect in both groups. CONCLUSION: Manosar® (oral once a day) is more effective than single dose PAC (240 mg daily orally) to prevent recurrent UTI in women.

[Emphisematous cystitis with multiorganic embolism: Case report.] / Cistitis enfisematosa con embolismo multiorgánico: a propósito de un caso.

OBJECTIVE: We present an unusual case of emphysematous cystitis with multiple septic embolisms to several organs. METHOD AND RESULTS: Case description and selection of related pictures. Review of the existing literature. CONCLUSIONS: Emphysematous cystitis is a rare condition but potentially severe. Prognosis depends on a rapid diagnosis and treatment.

[Prognostic factors for the efficacy of Silodosin in the treatment of symptomatic Benign Prostatic Hyperplasia. Subanalysis of the URAL study.] / Factores pronósticos de la eficacia de la Silodosina en el tratamiento de la Hiperplasia Benigna Prostática sintomática. Subanálisis del estudio URAL.

OBJECTIVE: To identify the prognostic factors influencing the clinical and urodynamics results on symptomatic benign prostatic hypertrophy (BHP) treatment in a series of patients with silodosin therapy from the URAL study. METHODS: A retrospective study was performed in a cohort of 318 patients with BPH which underwent silodosine treatment, during at least 12 weeks. RESULTS: Univariate analysis demonstrated that the variables in relationship with a decrease of urinary symptoms` punctuation postreatment (measured with the IPSS Questionnaire), a maximum peak flow (Q max) postreatment equal or superior to 15 ml/s, a postreatment postvoid residual lower to 100 ml, and a postreatment obstruction index ( Bladder Outlet Obstruction Index: BOOI) equal or lower to 20 cm H2O, presented such both as a clinical and urodynamic character. The multivariate analysis demonstrated that a decreased punctuation of IPSS Questionnaire postreatment was in relationship to: a pretreatment cystometry bladder capacity (direct relationship), pretreatment Qmax (direct relationship), pretreatment postvoid residual (inverse relationship), and pretreatment BOOI (inverse relationship). CONCLUSION: The urodynamic study was very useful in the assessment of the prognostic factors in these patients.

[Preliminary data of the Spanish contribution to the European Randomized Study on Screening of Prostate Cancer (ERSPC)]. / Datos preliminares de la contribución española al estudio randomizado europeo de screening del cancer de próstata (ERSPC).

OBJECTIVES: Data from the participation of our department in the ERSPC study in terms of detection and PSA diagnostic yield, staging, therapeutic management and mortality in the context of a multicentric randomized screening study for prostate cancer. METHODS: Patients were recruited between February 1996 and June 1999, randomized in screening and control arms, with several rounds for screening patients with four-year intervals, with PSA analysis and sextant prostate biopsy (t PSA > 4 ng/ml before May 1998, tPSA > 2.99 ng/ml after May 1998). These tests were not done in the control group. All deaths were studied (date and cause) RESULTS: A total of 4278 patients were included, 24 16 in the screening arm (56.4%) and 1862 in the control arm (43.5%), with an age between 45 and 70 years (mean age 57.8 years, 95 CI 57.6-58.0). Median follow-up was 8.77 years. 142 prostate cancers were found, 113 in the screening arm (accumulated detection rate 4.7%) and 29 in the control arm (1.6%). Detection rates were 1.7%, 2.2% and 0% in the first, second and third round respectively. Organ confined cancers (T1 and T2) were 102 in the screening arm (90.3%) and 24 in the control arm (82.8%), p = 0.254 . Metastatic disease was found in six patients (4.2% out of 142), 3 in the screening arm ( 2.7%) and three in the control arm (10.3%), p = 0.187. Radical prostatectomy was the most frequently performed treatment: 47 cases in the screening arm (41.6%), 10 in the control arm (34.5%). 151 patients have died, 82 in the screening arm and 69 in the control arm. Only 3 of this deaths were secondary to prostate cancer, all of them in the screening arm (p = 0.308). CONCLUSIONS: We observed a non significant tendency to lower clinical stages in patients undergoing screening. Radical surgery was the treatment of choice in patients with prostate cancer. Even with the current follow-up in the series (close to 9 years), no differences have been observed in terms of prostate cancer mortality between both study arms.

[Impact of the weather on the serum levels of prostatic specific antigen (PSA)]. / Impacto de la climatología sobre el nivel sérico de antígeno especifico prostático (PSA).

OBJECTIVES: To analyze the impact of season and weather parameters on serum PSA values in men without prostate cancer. METHODS: Retrospective study including medical records from the Spanish arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). EXCLUSION CRITERIA: prostate cancer diagnosis, PSA > = 10 ng/ml, or PSA > = 3 ng/ml and/or digital rectal examination abnormalities unless a negative prostate biopsy was provided. Univariate relationships between PSA value, season and several weather parameters were assessed. A multivariate logistic regression model was used to identify independent predictors of a PSA value > = 3 ng/ml. RESULTS: A total of 2,147 men entered into the study. Median age and PSA level were 57 years and 0.9 ng/ml respectively. A non-significant trend to higher PSA levels was observed during autumn and winter. Multivariate logistic regression analysis identified only maximum temperature (p < 0.001), minimum temperature (p = 0.001) and age (p < 0.001) as independent predictors of a PSA value > = 3 ng/ml. Mean age-adjusted PSA levels at maximum temperatures of < = 15 degrees C, 16-20 degrees C, 21-25 degrees C and > =26 degrees C were 1.25, 1.20, 1.17 and 1.09 ng/ml respectively. CONCLUSIONS: PSA levels are slightly higher during cold weather conditions. Because of the small magnitude of this PSA increment we do not recommend to change biopsy indication based solely on climatic parameters.

[Cystic ectasia of the rete testis]. / Ectasia quística de la rete testis.

OBJECTIVES: The cystic ectasia of the rete testis is a benign entity with a typical ultrasound appearance as a collection of small hypoechoic structures in the confluence of the mediastinum testis. The clinical importance of these entity remains on doing an adequate differential diagnosis with testicular neoplasias with a cystic component. METHODS: We retrospectively reviewed the database of the Ultrasound Unit in the Department of Urology looking for patients with a diagnosis of cystic ectasia of the rete testis over a six-year period. RESULTS: Three cases of cystic ectasia of the rete testis were diagnosed over the six-year period, in all the indication for ultrasound was testicular pain. Mean patient age was 62 years. No patient developed testicular tumor on follow-up. CONCLUSIONS: The knowledge of the ultrasound characteristics found in the cystic ectasia of the rete testis helps to make a proper diagnosis of this benign entity without the need of indication of testicular biopsy.

[Subcapsular orchiectomy in the treatment of prostate cancer: results]. / Resultados de la orquiectomía subalbugínea en el cáncer de próstata.

OBJECTIVES: To analyze the role of orchiectomy in the management of metastasic prostate cancer in our environment. METHODS: We studied 76 patients with the diagnosis of prostate cancer who underwent subcapsular orchiectomy. RESULTS: Mean age was 72 years, median Gleason score was 7, and only 17% had organ confined tumors. Mean follow-up was 2.3 yr. and hospital stay median three days. Ten of the 76 patients in the study died from cancer, being overall five-year survival 75%. Regarding cost analysis, surgical castration was cheaper in the long-term but has the disadvantage of its greater psychological impact. CONCLUSIONS: Orchiectomy is a valid hormonal blockade option when estimated patient survival is longer than one year.

[Stone Cone: a device that prevents ureteral stone migration during intracorporeal lithotripsy]. / Stone Cone: un dispositivo que previene la migración de litiasis ureteral durante la litotricia intracorpórea.

OBJECTIVES: Proximal migration of stone fragments during ureteroscopic lithotripsy is a common problem influenced by pressure of irrigation solution, type of energy for lithotripsy, site and degree of fixation of the stone to the ureteral wall, and degree of proximal ureteral dilation. The Stone Cone (Boston Scientific & Spencer) is a device that helps to prevent proximal migration of fragments and favours a safe extraction during ureteroscopic lithotripsy. TECHNIQUE: The Stone Cone is an helical device made of stainless steel and nitinol alloy, which consists of an internal guide wire and a sheath-like radiopaque catheter with a 3 Fr. calibre. Once the cone is placed above the stone it is maintained in that position during lithotripsy to avoid fragment migration. The external catheter is used to coil and unroll the cone, and allows access to place the cone above the stone. METHODS: We describe two cases of urinary calculi in the left lumbar ureter treated by ureteroscopy and intracorporeal lithotripsy with holmium YAG laser using the Stone Cone to avoid migration of fragments. RESULTS: One month after surgery no lithiasic fragments were observed in the imaging tests. CONCLUSIONS: The Stone Cone decreases the need to perform repeated ureteral instrumentations, and is also a safer and simpler method for the extraction of stone fragments. The use of Stone Cone seems to have more advantages than Dormia's basket during ureteroscopic lithotripsy in terms of lower incidence of residual fragments and reoperation rate.

[Idiopathic local bladder amyloidosis]. / Amiloidosis vesical primaria localizada idiopática.

OBJECTIVE: To report one case of primary bladder amyloidosis. METHODS: We studied a male patient with asymptomatic hematuria by means of transurethral resection. RESULTS: Pathologic features were consistent with amyloidosis of the bladder wall. We cannot prove either sites of amyloid deposits or an etiology for this disease. CONCLUSIONS: Local idiopathic bladder amyloidosis is a very rare disease and the most common presenting symptom is painless hematuria. It may be difficult to differentiate between this disease and a urothelial bladder neoplasia.

["Mini-percutaneous" percutaneous nephrolithotomy: technique and indications]. / Técnica e indicaciones de la nefrolitotomía percutánea "mini-percutánea".

OBJECTIVES: Since Helal and Jackman developed the mini-percutaneous ("mini-perc") percutaneous nephrolithotomy (PCNL) for the treatment of pediatric renal lithiasis various authors have used is technique in adults with the aim to preserve renal parenchyma and diminish morbidity associated with the standard PCNL. METHODS: We describe the surgical technique of "mini-perc" PCNL in the treatment of renal lithiasis. RESULTS: We review various case series from the literature of "mini perc" PCNL for the treatment of adult renal lithiasis, its current indications, percentages of stone free patients, and associated problems, mainly the required instruments. CONCLUSIONS: Morbidity associated with "miniperc" PCNL seems to be lower than with the standard PCNL, but the use a smaller calibre tract with the only aim to preserve renal parenchyma does not offer advantages. It is a complementary technique to the standard PCNL; however, the diameter of the percutaneous access is not well defined yet and depends on the calibre of the instruments used.

[Epidemiological trends in prostate cancer over the last years]. / Tendencias epidemiologicas en cancer de prostata durante los ultimos años.

OBJECTIVES: To analyze the evolution of prostate cancer (PCa) in our community health area over the last years, in terms of incidence, clinical-epidemiological characteristics, and cancer-specific mortality. METHODS: Retrospective analysis of the medical records of patients with PCa in our hospital over the 1991-2003 period. We calculated the annual incidence rates for our community health area as well as its trend over the period of study. Changes of several clinical-epidemiological parameters over time were studied. The evolution of PCa mortality was also analyzed. RESULTS: 730 patients with PCa were evaluated. Median age and PSA at diagnosis were 69 years and 11.4 ng/ml, respectively. 60.5% tumors were detected in a localized clinical stage, and 18.6% were metastasic. 30.4% of PCa in the study (the most numerous group) had a Gleason score between 5 and 6. A constant increase of PCa incidence was observed with an annual percentage increase of 5.5% (p < 0.001). Standardized incidence rate for the year 2003 Spanish population pyramid was 100.9 cases/100,000 males. A significant trend to a greater proportion of PCa cases diagnosed by uncontrolled screening was observed, being the cases currently detected after symptoms only a small proportion (p < 0.001). Decreases in the age at diagnosis (p < 0.001), PSA level (p < 0.001), proportion of advanced clinical stages (p < 0.001), as well as proportion of cancers with well-differentiated Gleason score (2-4) (p < 0.001) were also detected. PCa mortality adjusted by the population pyramid was 8.7 deaths/100,000 males in the year 2003. CONCLUSIONS: We found an increase in the incidence of prostate cancer in our community health area over the last years, parallel to an increase in the proportion of cases detected by screening in asymptomatic population. Because of that, tumors currently detected tend to appear in younger ages, with lower PSA levels, and localized clinical stages.

[Descriptive analysis of adverse events associated with transrectal prostatic biopsy after 603 procedures]. / Análisis descriptivo de los efectos adversos de la biopsia trans- rectal prostática en 603 procedimientos.

OBJECTIVES: To establish the incidence of complications secondary to performance of transrectal prostatic biopsy, and to establish the hypothetical relationship between the rate of fever and the type of antibiotic prophylaxis employed. METHODS: All patients undergoing transrectal prostatic biopsy between January 1992 and December 2003 were included in this prospective nonrandomized study. Patients were given a self-administered questionnaire to obtain data about complications related to biopsy that included the following variables: fever, hematuria, rectal bleeding, hemospermia, voiding difficulties, acute urinary retention, need to visit primary care physician or an emergency department, hospital admissions and need of medication. The incidence of observed complications was calculated and the relationship between post-biopsy fever and type of antibiotic prophylaxis employed (oral ciprofloxacin vs. intramuscular tobramycin) was studied by means of the chi-square test, using the SPSS 11.5 for Windows; a p < 0.05 was considered significant. RESULTS: Overall, 705 questionnaires were received; 603 (85.5%) were considered valid for processing. Almost three quarters (73.9%) of the patients undergoing biopsy presented some complications, being hematuria the most frequent (53% of the cases). 40 patients presented fever (6.64%). Among 360 patients treated with oral ciprofloxacin for three days 16 developed fever (4.4%), in comparison to 24 patients out of 243 treated with intramuscular tobramycin (9.87%) (p = 0.009). CONCLUSIONS: Ultrasound guided transrectal prostatic biopsy is associated with frequent complications, although most of them are mild. The most frequent complication is hematuria; fever is the most severe. To prevent post-biopsy fever, antibiotic prophylaxis with ciprofloxacin for three days is more effective than single dose intramuscular tobramycin. However, prospective randomize studies are required to confirm it.

[Preliminary results in a series of patients with prostate cancer who underwent radical prostatectomy]. / Resultados preliminares de una serie de pacientes con cáncer de próstata sometidos a prostatectomía radical.

OBJECTIVES: To analyze the preliminary results in our series of radical retropubic prostatectomies (RRP) in terms of complications; and to evaluate also its efficacy in disease control (cancer progression and survival). METHODS: We reviewed the charts of 139 patients who underwent radical prostatectomy. Preoperative data such as age at the time of diagnosis, serum PSA, presence of suspicious digital rectal examination (DRE), clinical stage, and Gleason's score on biopsy. Complications noted after RRP were studied. Survival analysis (Kaplan-Meier) was performed to study clinical and biochemical progression in relation to factors such as baseline PSA, pathologic Gleason's score, pathologic stage, affected surgical margins and capsular penetration. Univariate comparison of factors was performed using the log-rank test. Multivariate analysis (Cox model) was also carried out to identify predictive variables (or risk factors) for progression. RESULTS: 127 patients were available for progression assessment (91.4%). Overall, 19 complications were registered in the immediate postoperative period. 89 patients (91.8%) stated being continent in their last follow-up visit. Complete erectile dysfunction (ED) was noted in 74 patients (76.3%), partial ED in fifteen (15.5%), and 8 (8.2%) reported not they have not problems with their erectile function after surgery. Thirty-four patients (26.8%) presented biochemical progression, being the mean time to progression for the whole series 5.8 years (standard error 0.38). 2 and 5-year probability to remain free of biochemical progression were 71.2% and 58.8%, respectively. Only preoperative PSA (p = 0.023) and Gleason's score in the surgical specimen (p = 0.001) were identified as predictive variables for biochemical progression on the univariate analysis (log-rank). CONCLUSIONS: Radical prostatectomy offers acceptable results in terms of tolerability and short and mid-term survival. Preoperative PSA or Gleason's score in the surgical specimen may help to predict subsequent outcome of the disease.

[Comparative analysis of complications between different surgical techniques in the treatment of urinary stress incontinence at our centre]. / Análisis comparativo de complicaciones entre las diferentes técnicas empleadas para el tratamiento quirúrgico de la incontinencia urinaria de esfuerzo en nuestro medio.

OBJECTIVES: Surgical repair is the most effective treatment for stress urinary incontinence (SUI) currently. Nevertheless, this method is not without complications. The objective of this work is to compare the incidence of complications between different groups of surgical techniques employed for the treatment of SUI in our patients. METHODS: We performed a retrospective analysis of patients diagnosed of SUI who underwent surgery at our department between January 1991 and December 1999, grouping patients in three categories depending on the procedure: abdominal technique, abdomino-vaginal techniques, and sling procedures. Complications were grouped into two categories: major and minor complications. Chi-square and Fisher's test were used for the association analysis of complications' frequencies. All confidence intervals and level of statistical significance were calculated for a p value < 0.05. RESULTS: 5.16% of the patients undergoing surgery for SUI suffered major complications. Globally, the most frequent complications were suprapubic pain (33%), wound seroma and/or infection (20%), postoperative acute urinary retention (AUR) (26%), and presence of significant post void residual (24%), being the sling procedure with a greater number of postoperative complications, as much in postoperative pain, as in AUR, as in presence of post void residual (p < 0.05). CONCLUSIONS: Sling procedures present a significantly higher percentage of complications when compared with abdominal and combined techniques.