Randomized and Open Trial to Assess the Effectiveness of the Guided Pelvic Floor Exercises Pre-Radical Robotic Prostatectomy on the Improvement of Urinary Incontinence. Initial Results.

INTRODUCTION AND OBJECTIVES: Radical prostatectomy has an impact on urinary continence. Many factors are involved in continence. The objective of this study is evaluate the effect of guided Pelvic Floor Exercises prior to robotic radical prostatectomy (RRP) on the rate of urinary incontinence compared with written information. MATERIAL AND METHOD: randomized study of 62 patients who are waiting for PRR. They were rondomized in two groups: experimental group (exercises guided by a physiotherapist) or a control group (written information). Primary objective was the continence rate measured by pad test and ICIQ-SF one month after the intervention, Secondary objectives were incontinence severity, quality of life with SF-36 and KHQ questionnaires and the correlation between incontinence and quality of life. RESULTS: We found no differences in continence rate between groups after the intervention. We found differences in "emotional problems" and "personal relationships", in favor of the control group. There is a correlation between the amount of urine leakage and age, urgency and all the domains of the KHQ questionnaire except general quality of life, as well as in the areas "energy/fatigue" and "social function" of the SF-36. CONCLUSIONS: Physiotherapist-guided exercises before RRP do not seem to offer advantages compared to written information, in terms of the incontinence rate and its severity one month after the surgery. Urinary incontinence is correlated with age, urgency, and deterioration in quality of life.

Anatomical predictors of long-term urinary incontinence after robot-assisted laparoscopic prostatectomy: A systematic review.

AIMS: There is scarce evidence of anatomical risk factors that might affect long-term post-prostatectomy incontinence (PPI) in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). This systematic review aims to identify anatomical measurements in preoperative magnetic resonance imaging (MRI) that might be associated with increased risk of urinary incontinence (UI) 1 year after RALP. METHODS: A comprehensive search on Pubmed and Scopus databases up to November 2020 was performed. Eight articles met the inclusion criteria and were finally selected. RESULTS: The selected studies included 1146 patients. Seven articles focused on membranous urethral length (MUL); all of them related MUL to long-term PPI in univariate analysis and five of them in multivariate analysis. Four studies presented MUL difference to measure the magnitude of the effect. Average MUL (mm) was 15.9 (SD, 2.6), 16.1 (95% confidence interval [CI]: 13.9-18.9), 12.1 (95% CI 9.7-14.9) and 14.5 in continent patients and 13.9 (SD, 2.9), 10 (95% CI: 8.7-12.1), 10.3 (95% CI: 8.7-12.4) and 9.3 in incontinent patients, with statistically significant differences in all cases. Five studies presented the odds ratio as a result; although there was substantial heterogeneity in the methods used to obtain it, there was consistency in finding an inverse association between MUL and PPI. Other measurements including prostatic-urethral angle, membranous urethral thickness, intraprostatic urethral length and intravesical prostatic protrusion have been reported in few studies, and no association with long-term PPI was found. Levator ani muscle thickness was related to long-term PPI in one article. CONCLUSION: Greater MUL on preoperative MRI is associated with lower risk of UI 1 year after RALP.

[The efficacy of endoscopic treatment for secondary vesicoureteral reflux. Analysis of a series of 142 cases]. / Eficacia del tratamiento endoscópico del reflujo vesicoureteral secundario. Analisis de una serie de 142 casos.

OBJECTIVES: To evaluate the rate of secondary or complicated vesicoureteral reflux (VUR) among the total number of VUR cases treated in our institution. To determine the efficacy of the endoscopic treatment in secondary or complicated VUR depending on etiology and grade. METHOD: We review our experience with endoscopic treatment for VUR from 1992 to 2006. We have used three different materials: polytetrafluoroethylen (Teflon), polydimethyls iloxane (Macroplastique) and dextranomer/hyaluronic acid copolymer (Deflux). 479 ureters with VUR were treated in 402 patients; 124 patients and 142 ureters of them were secondary or complicated VUR cases. All patients were followed up with urinary tract ultrasound and radiological or isotopic voiding cystogram. Success is defined as VUR disappearance or improvement to grade I VUR without urinary infection after removing antibiotic prophylaxis. RESULTS: The success rate has been 71.13% after the first injection, 85.92% after the second injection and 90.14% after the third injection. Mean subureteral dose has been 0.65 ml. The complications rate has been 0%. CONCLUSIONS: The endoscopic treatment in secondary or complicated VUR is a minimally invasive procedure. It seems to be more difficult than in primary VUR cases, but its low morbidity and efficacy indicate this may be a proper first option in selected patients. In cases of VUR secondary to neurogenic bladder dysfunction it seems to be less successful, probably because of a worse control of the high bladder pressure.

[Vesicoureteral reflux after pediatric kidney transplantation]. / Reflujo vesicoureteral tras trasplante renal en la edad pediátrica.

OBJECTIVES: We analyze the frequency of vesicoureteral reflux and the factors that favor its appearance after kidney transplantation in pediatric patients. METHODS: This retrospective analysis examined the prevalence of posttransplant vesicoureteral reflux in a total of 201 kidney transplants performed in children at our centre between 1978 and 2006. In patients who required corrective surgery for this problem, we analyzed pretransplant residual diuresis, pretransplant pathology and posttransplant problems related to vesicoureteral reflux. We also analyzed the form of presentation, whether reflux was to the graft or to the native kidney, degree of reflux, and surgical technique used to correct reflux. RESULTS: Twelve patients (5.9%) needed surgery to correct reflux to the graft (10 children) or to the native kidney (2 children). Reflux presented as urinary tract infection in 11 children and progressive graft failure in 1. Urethrovesical disorders that favoured vesicoureteral reflux were present in 10 patients (noncompliant bladder, detrusor overactivity, posterior urethral valves, urethral stenosis). Lengthening the submucosal tunnel stopped urinary tract infections in all 12 patients, whereas 6-month voiding cystourethrograms showed resolution in 10 patients and reduction in the degree of reflux in 2. CONCLUSION: The high percentage of posttransplant vesicoureteral reflux in pediatric patients was related with higher frequency of vesicourethral pathology in children who received the transplant. In children with pretransplant urethrovesical anomalies we recommend an initial technique which utilizes a longer submucosal tunnel during implantation, such as the Lich-Gregoir.

Eficacia del tratamiento endoscópico del reflujo vesicoureteral secundario. Análisis de una serie de 142 casos / The efficacy of endoscopic treatment for secondary vesicoureteral reflux. Analysis of a series of 142 cases

Objetivo: Analizar la proporción de reflujos vesicoureterales secundarios o complicados del total de reflujos vesicoureterales tratados en nuestro centro. Determinar la eficacia del tratamiento endoscópico en dicho tipo de reflujo según la etiología que lo produce y según el grado. Método: Revisamos nuestra serie desde que iniciamos el tratamiento endoscópico del reflujo en el año 1992 hasta diciembre del 2006, empleando tres materiales distintos: pasta de politetrafluoroetileno (Teflon®), polidimetilsiloxano (Macroplastique®) y dextranómero-copolímero de ácido hialurónico (Deflux®). Hemos tratado a 402 pacientes y 479 unidades excretoras, de los que 124 pacientes y 142 unidades excretoras correspondían a una etiología secundaria. Se han seguido de forma sistemática mediante ecografía y CUMS o cistografía isotópica. Definimos el éxito del tratamiento como la desaparición del RVU o el descenso a grado I sin ITU tras retirar la profilaxis antibiótica. Resultados: Se resolvieron en el primer intento el 71,13% de los reflujos secundarios, mejorando al 85,92% en el segundo intento y al 90,14% en el tercero. El volumen medio inyectado ha sido de 0,65 ml. La tasa de complicaciones ha sido del 0%. Conclusiones: El tratamiento endoscópico del reflujo vesicoureteral secundario es un procedimiento minimamente invasivo, que puede realizarse en regimen ambulatorio, técnicamente algo más difícil que en los casos de reflujo vesicoureteral primario, pero con muy baja morbilidad y muy eficaz en casos seleccionados, por lo que pensamos que debe ser considerado la primera opción de tratamiento. La menor eficacia la hemos obtenido en los casos de reflujos secundarios a vejiga neurógena, probablemente en relación a un mal control de las altas presiones vesicales (AU)

Objectives: To evaluate the rate of secondary or complicated vesicoureteral reflux (VUR) among the total number of VUR cases treated in our institution. To determine the efficacy of the endoscopic treatment in secondary or complicated VUR depending on etiology and grade. Method: We review our experience with endoscopic treatment for VUR from 1992 to 2006. We have used three different materials: polytetrafluoroethylen (Teflon®), polydimethylsiloxane(Macroplastique®) and dextranomer/hyaluronic acid copolymer (Deflux®). 479 ureters with VUR were treated in 402 patients ; 124 patients and 142 ureters of them were secondary or complicated VUR cases. All patients were followed up with urinary tract ultrasound and radiological or isotopic voiding cystogram. Success is defined as VUR disappearance or improvement to grade I VUR without urinary infection after removing antibiotic prophylaxis. Results: The success rate has been 71.13% after the first injection, 85.92% after the second injection and 90.14% after the third injection. Mean subureteral dose has been 0.65 ml. The complications rate has been 0%. Conclusions: The endoscopic treatment in secondary or complicated VUR is a minimally invasive procedure. It seems to be more difficult than in primary VUR cases, but its low morbidity and efficacy indicate this may be a proper first option in selected patients. In cases of VUR secondary to neurogenic bladder dysfunction it seems to be less successful, probably because of a worse control of the high bladder pressure (AU)

Reflujo vesicoureteral tras trasplante renal en la edad pediátrica / Vesicoureteral reflux after pediatric kidney transplantation

Objetivo: Analizamos la frecuencia de reflujo vesicoureteral tras trasplante renal (TR) en edad pediátrica y los factores que lo favorecen. Métodos: Entre 1978 y 2006 se realizaron en nuestro centro 201 TR pediátricos. En un análisis retrospectivo se revisó la prevalencia de RVU postrasplante. En aquellos que precisaron cirugía correctora de RVU postrasplante se analizó: diuresis residual pretrasplante, patología previa al TR o adquirida tras éste relacionada con RVU. Además se analizó forma de presentación, si el reflujo era al injerto o a los riñones nativos, grado de éste y técnica quirúrgica empleada para corregirlo. Resultados: Doce pacientes (5,9%) precisaron cirugía antireflujo. En 10 el reflujo fue al injerto y en 2 al riñón nativo. El reflujo se presentó como infección del tracto urinario (ITU) en 11 casos y deterioro progresivo de la función del injerto en 1. En 10 pacientes se detectó patología uretrovesical favorecedora de reflujo vesicoureteral (vejigas no compliantes, hiperactividad del detrusor (HDD), válvulas de uretra posterior (VUP), estenosis de uretra, etc..). Tras ampliación del túnel submucoso desaparecieron las ITU en los 12 casos, mientras que la C.U.M.S a los 6 meses mostró resolución en 10 casos y disminución del grado de reflujo en 2. Conclusión: El mayor porcentaje de reflujo vesico-ureteral postrasplante en la edad pediátrica, se relaciona con la mayor frecuencia de patología uretrovesical en los niños receptores del trasplante. La realización de un túnel submucoso más amplio durante el implante, en aquellos niños con patología uretrovesical pretrasplante, podría reducir el porcentaje de esta complicación (AU)

Objectives: We analyze the frequency of vesicoureteral reflux and the factors that favor its appearance after kidney transplantation in pediatric patients. Methods: This retrospective analysis examined the prevalence of posttransplant vesicoureteral reflux in a total of 201 kidney transplants performed in children at our centre between 1978 and 2006. In patients who required corrective surgery for this problem, we analyzed pretransplant residual diuresis, pretransplant pathology and posttransplant problems related to vesicoureteral reflux. We also analyzed the form of presentation, whether reflux was to the graft or to the native kidney, degree of reflux, and surgical technique used to correct reflux. Results: Twelve patients (5.9%) needed surgery to correct reflux to the graft (10 children) or to the native kidney (2 children). Reflux presented as urinary tract infection in 11 children and progressive graft failure in 1. Urethrovesical disorders that favoured vesicoureteral reflux were present in 10 patients (noncompliant bladder, detrusor overactivity, posterior urethral valves, urethral stenosis). Lengthening the submucosal tunnel stopped urinary tract infections in all 12 patients, whereas 6-month voiding cystourethrograms showed resolution in 10 patients and reduction in the degree of reflux in 2. Conclusion: The high percentage of posttransplant vesicoureteral reflux in pediatric patients was related with higher frequency of vesicourethral pathology in children who received the transplant. In children with pretransplant urethrovesical anomalies we recommend an initial technique which utilizes a longer submucosal tunnel during implantation, such as the Lich-Gregoir (AU)

[Giant adrenal myelolipoma]. / Mielolipoma adrenal gigante.

OBJECTIVE: We report a case of a giant myelolipoma of the adrenal gland METHODS/RESULTS: A case of a giant myelolipoma of the adrenal gland, an uncommon non-functioning tumour of the adrenal cortex comprised of haematopoietic and adipose tissue, that had been detected incidentally during evaluation with CT because of its characteristic fatty composition. The clinical features, diagnosis and treatment are discussed.

Mielolipoma adrenal gigante / Giant adrenal myelolipoma

OBJETIVOS: Presentar un caso de mielolipomagigante de la glándula suprarrenal.MÉTODOS/RESULTADOS: El mielolipoma gigante de laglándula suprarrenal es un tumor raro no funcionante de lacorteza suprarrenal compuesto por tejido hematopoyético yadiposo que fue descubierto de forma accidental medianteTAC.CONCLUSIONES: La conducta terapéutica es expectanteen tumores pequeños y quirúrgica para los casos sintomáticosy tumores mayores de 4 cm en los que el riesgo de rupturaespontánea con hemorragia retroperitoneal es muy alto

OBJECTIVE: We report a case of a giant ;;myelolipoma of the adrenal gland ;;METHODS/RESULTS: A case of a giant myelolipoma of ;;the adrenal gland, an uncommon non-functioning tumour of ;;the adrenal cortex comprised of haematopoietic and adipose ;;tissue, that had been detected incidentally during ;;evaluation with CT because of its characteristic fatty composition. ;;The clinical features, diagnosis and treatment are ;;discussed

[Bladder augmentation and urinary diversion in kidney transplant candidates]. / Ampliación vesical y derivación urinaria en pacientes candidatos a trasplante renal.

OBJECTIVES: Kidney transplantation (KT) is the treatment of choice for patients with end stage renal disease (ESRD). 6% of the patients develop ESRD due to congenital or acquired lower urinary tract anomalies, which sometimes imply the need of an additional surgical procedure to make the patient suitable for transplantation. METHODS: We review 6 cases of KT receptors (three of them pediatric) to whom some kind of reconstruction of the lower urinary tract with bowel was performed over the last 10 years. RESULTS: Most frequent etiologies: neurogenic bladder (3), small and contracted bladder after genitourinary tuberculosis, urethral valves, and transitional cell carcinoma with radical cystoprostatectomy and bilateral nephrectomy. Surgical techniques: Bladder augmentation with colon (3), Bricker's defunctionalized ileal loop (2), and Goodwin 's ileal bladder augmentation; all of them were performed between 8 and 147 months before transplant. COMPLICATIONS: UTI in 2 patients. Recurrent stenosis of the ileal loop in one patient who required endoscopic balloon dilation and stent placement in the stenotic segment with poor results and finally requiring loop reconstruction. Another patient developed stenosis of the ureteroneocystostomy anastomosis and reimplant was performed. All of them had good outcome. One case had a subacute kidney rejection episode with good response to steroids. No graft was lost. Current serum creatinine values are between 0.69 and 2.6. CONCLUSIONS: The use of bowel in patients with pathologic bladders is as safe method to allow these patients to receive a kidney transplant when bladder rehabilitation has not been possible with conservative measures.

[Arterial priapism in a prepuberal patient. Conservative treatment]. / Priapismo arterial en paciente prepúber. Tratamiento conservador.

OBJECTIVES: To report the case of a 7-year-old patient with high flow priapism solved with conservative treatment. METHODS: We performed history and physical examination, complementary tests including general blood tests (serum ions, hemogram and coagulation tests), peripheral blood smear, Doppler ultrasound and selective arteriography which led to the diagnosis of high flow priapism. Due to the absence of arteriovenous fistula conservative treatment was chosen. RESULTS: Patient improved clinically after five days, with penile detumescence and spontaneous erections were preserved. CONCLUSIONS: Conservative treatment is a valid option in patients with arterial priapism, mainly in those cases in whom performing embolization of a small fistula seen on arteriography is not possible or when such AV communication is not demonstrated.

[Bladder mucormycosis. Report of one case]. / Mucormicosis vesical. A propósito de un caso.

OBJECTIVES: To report one case of an opportunistic bladder infection by fungus of the Mucorales order. METHODS: An old patient with permanent bladder catheter due to cerebral vascular accident presented with hematuria associated with change in his general health status, and a bladder mass on ultrasound Cystoscopy and cold biopsy were performed RESULTS: Pathology reported bladder mucormycosis. CONCLUSIONS: Mucormycosis is an opportunistic infection by fungus of the Mucorales order, which disseminate hematogenously from an entrance. Diagnosis is usually histological, seeing characteristic hyphae and ischemic or hemorrhagic necrosis. Bladder involvement is very uncommon. Treatment is based on the combination of debridement of the necrotic areas and intravenous antifungal drugs (amphotericin B).

Mucormicosis vesical.A propósito de un caso / Bladder mucormyscosis. Report of one case

OBJETIVOS: Presentación de un caso de infección vesical oportunista por hongos del orden de los Mucorales. MÉTODOS: Hematuria en paciente añoso y con sondaje permanentea consecuencia de un accidente vásculo-cerebral, que cursó con afectación del estado general y masa vesical vista en ecografía. Se practicaron cistoscopia y biopsia fría. RESULTADOS: Diagnóstico histológico de Mucormicosis vesical. CONCLUSIONES: La Mucormicosis es una infección oportunistapor hongos del orden de los Mucorales, que se disemina vía hematógena a partir de una puerta de entrada. El diagnóstico suele ser histológico, observándose hifas características y necrosis hemorrágica o isquémica . La afectación vesical es muy infrecuente. El tratamiento se basa en la combinación de desbridamiento de las zonas necróticas y antifúngicos endovenosos (anfotericina B) (AU)

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Tratamiento rehabilitador en la incontinencia urinaria de esfuerzo femenina / Pelvic floor exercise in the treatment of female urinary stress incontinence

OBJETIVOS: Conocer los resultados de un programa de rehabilitación perineal en el tratamiento de la incontinencia urinaria de esfuerzo femenina. MÉTODOS: Fase informativa, con explicaciones a la paciente de su enfermedad, de su anatomía, de los objetivos que se pretenden alcanzar y de cómo desarrollar los ejercicios. Fase de tratamiento con desarrollo durante seis semanas de la musculatura perineal mediante ejercicios perineales asistidos por biofeedback visual y acústico. Fase de seguimiento, con visitas periódicas al mes, 3 meses, 6 meses y un año, con control de la evolución de la musculatura, refuerzo a la motivación y mejoría de los síntomas. RESULTADOS: 412 mujeres rehabilitadas en cuatro años, con 45,9 por ciento de curaciones, 38,8 por ciento de mejorías y 15,3 por ciento de fracasos. CONCLUSIONES: La rehabilitación del suelo pélvico puede curar la incontinencia urinaria de esfuerzo femenina y disminuye el número de cirugías y el gasto hospitalario en el tratamiento de la incontinencia (AU)

[Benign adrenal schwannoma]. / Shwannoma benigno suprarrenal.

OBJECTIVE: We report a new case of benign retroperitoneal schwannoma arising from the adrenal gland. METHODS: 53 year old male with history of moderate benign prostatic hyperplasia under alpha blocker therapy who referred right flank discomfort for two months prior to last visit, without any other symptoms; radiologic examination with Ultrasound and CT scan and preoperative endocrine study were suggestive of non functioning adrenal tumour which was surgically extirpated. RESULTS: Anatomopathological report showed a benign juxta-adrenal schwannoma. CONCLUSIONS: It is an uncommon retroperitoneal tumour. The presence of cystic changes within a retroperitoneal tumour is relatively frequent in schwannomas and may suggest its diagnosis. The case we report did not have cystic structures.

Shwannoma benigno suprarrenal / Bening adrenal schuwannoma

Objetivo: Aportamos un nuevo caso de Schwannoma benigno retroperitoneal de localización suprarrenal.Método: Varón de 53 años diagnosticado de HBP moderada en tratamiento con alfa-bloqueantes. Refiere en la última revisión molestias en flanco derecho de dos meses de evolución sin otra sintomatología acompañante; la evaluación radiológica mediante ECO y TAC, y el estudio endocrino preoperatorio sugirieron tumor adrenal no funcionante que se extirpó quirúrgicamente RESULTADOS: El estudio histopatológico informó que se trataba de un Schwannoma benigno yuxta adrenal.Conclusiones: Es un tumor retroperitoneal poco frecuente.La existencia de cambios quísticos en un tumor retroperitoneal es relativamente frecuente en los Schwannomas y puede sugerir el diagnóstico. En el caso que presentamos no existían estructuras quísticas (AU)

[Rehabilitation in female stress urinary incontinence]. / Tratamiento rehabilitador en la incontinencia urinaria de esfuerzo femenina.

OBJECTIVES: To know the results of a pelvic floor muscle training program in the treatment of female stress urinary incontinence. METHODS: Information phase: patient is informed about the disease, her anatomy, the objectives to be reached and how to perform the exercises. Treatment phase: 6 weeks of visual and auditory biofeedback assisted pelvic floor exercises to develop the pelvic floor muscles. Follow-up phase: one, 3, 6 month and 1 year visits with control for muscle evolution, motivation reinforcement and improvement of the symptoms. RESULTS: 412 Women underwent pelvic floor rehabilitation in a 4 year period, 45.9% were cured, 38.8% improved and 15.3% were treatment failures. CONCLUSIONS: Pelvic floor rehabilitation can cure female urinary stress incontinence and diminishes the number of surgical procedures and hospital costs in the treatment of urinary incontinence.