Long-Term Outcomes of the Altis® Single-Incision Sling: Up to 10 Years' Follow-up.

INTRODUCTION AND HYPOTHESIS: Single-incision slings (SIS) have emerged as a less invasive alternative to conventional slings for stress urinary incontinence (SUI) treatment. However, long-term efficacy and safety results remain uncertain owing to a lack of studies. MATERIAL AND METHODS: A retrospective review of 155 patients treated with Altis® for SUI between February 2012 and June 2017, held in 2022, as a continuation of a prospective study in which all patients (197) were reviewed for 2 years after surgery (1, 6, 12, and 24 months). Preoperative demographic data, comorbidities, and pressure-flow studies were also recorded. Continence status and satisfaction rates were assessed using the International Consultation on Incontinence Questionnaire-short form (ICIQ-SF) and the Patient Global Impression of Improvement (PGI-I) respectively. The assessment in the 2022 retrospective review was performed via a telephone survey. RESULTS: Mean follow-up time after surgery was 85.3 months (82.5-88.1). In 2022, complete continence was present in 75.4% of the patients. The presence of urinary urgency conditioned the ICIQ-SF score (10.9 vs 1.7 points, p < 0.01), with the ICIQ-SF = 0 in 84.5% of the patients with no associated urgency. Satisfaction assessed by the PGI-I was high, with 84.6% of the patients showing improvement. De novo urgency was present in 37,9% of the patients by 2022. Urinary tract infections were the most frequent complication (9.7%), with only 5 documented cases of mesh erosion. CONCLUSIONS: Altis® SIS is a safe and effective device for SUI treatment, with satisfaction rates comparable with those of the conventional slings. Persistence or development of urinary urgency influences the results.

Estudio comparativo entre pacientes sometidos a colposacropexia laparoscópica con y sin cirugía previa para el tratamiento del prolapso apical / Comparative study between patients undergoing colposacropexy laparoscopic surgery with and without prior surgery for the treatment of apical prolapse

Introducción: La colposacropexia esel tratamiento de elección para el prolapso apical. Losestudios que comparan esta técnica como cirugía primaria para el prolapso de órganos pélvicos (POP), consu éxito en los POP recidivados tras cirugía son escasos.Material y método: Análisis retrospectivo de unaserie de pacientes con diagnóstico de POP sometidas acolposacropexia laparoscópica, comparando un gruposin cirugía previa para el prolapso, con otro que harecidivado tras cirugía previa (con o sin malla). Nuestroobjetivo fue analizar las diferencias respecto al tiempoquirúrgico (de piel a piel), complicaciones intraoperatorias, estancia media, resolución de los síntomas y recidiva. Como datos preoperatorios se compararon: edad,índice de masa corporal (IMC), paridad, histerectomíaprevia, exploración física, sintomatología y flujometría; y como datos peri/postoperatorios: seguimiento, duración intervención, complicaciones intra y postoperatorias, estancia media, exploración física (clasificaciónBaden-Walker), resolución síntomas y flujometría.Resultados: Han sido intervenidas 23 pacientes en12 meses. Nueve (39,1%) eran POP recidivados trascirugía previa, 6 (66,7%) de ellas con algún tipo demalla. Seguimiento (media meses): 6,44 ± 4,19 (cxprevia) vs 4,79 ± 4,00. Ambos grupos fueron comparables respecto a las variables preoperatorias. Laspacientes intervenidas previamente presentaban mayordispareunia (p<0,05). No encontramos diferencias enel resto de síntomas entre ambos grupos. No hubo diferencias en duración de la intervención, estancia media, ni respecto a las complicaciones intraoperatorias(p>0,05) entre ambos grupos. La sensación de bultovaginal, la urge-incontinencia y la dispareunia se resolvieron en todas las pacientes. La flujometría mejoró enambos grupos (p>0,05).Conclusiones: La colposacropexia laparoscópicaes una técnica eficaz y segura para la corrección delPOP tras cirugía previa, con o sin malla.(AU)

Introduction: Colposacropexy is thetreatment of choice for apical prolapse. Studies comparing this technique as primary surgery for pelvic organprolapse (POP), with its success in recurrent POPs aftersurgery, are scarce.Material and methods: Retrospective analysisof a series of patients diagnosed with POP who under went laparoscopic colposacropexy, comparing a groupwithout previous prolapse surgery with another groupthat has recurred after previous surgery (with or without mesh). Our objective was to analyze the differences regarding surgical time (skin to skin), intraoperativecomplications, mean stay, resolution of symptoms andrecurrence. As preoperative data, we compared: age,body mass index (BMI), parity, previous hysterectomy,physical examination, symptoms, and flowmetry; andas peri/postoperative data: follow-up, intervention duration, intra and postoperative complications, mean stay,physical examination (Baden-Walker classification),symptom resolution and flowmetry.Results: Twenty-three patients have been operated onin 12 months. Nine (39.1%) were recurrent POPs afterprevious surgery, 6 (66.7%) of them with some type ofmesh. Follow-up (mean months): 6.44 ± 4.19 (previouscx) vs. 4.79 ± 4.00. Both groups were comparablewith respect to preoperative variables. Previously operated patients had greater dyspareunia (p<0.05). Wedid not find differences in the rest of symptoms betweenboth groups. There were no differences in the durationof the intervention, mean stay, or regarding intraoperative complications (p>0.05) between both groups. Sensation of vaginal lump, urge incontinence and dyspareunia resolved in all patients. Flowmetry improved in bothgroups (p>0.05).Conclusions: Laparoscopic colposacropexy is aneffective and safe technique to correct POP after previous surgery, with or without mesh.

Comparative study between patients undergoing laparoscopic colposacropexy with and without prior surgery for the treatment of apical prolapse. / Estudio comparativo entre pacientes sometidos a colposacropexia laparoscópica con y sin cirugía previa para el tratamiento del prolapso apical.

INTRODUCTION: Colposacropexy is the treatment of choice for apical prolapse. Studies comparing this technique as primary surgery for pelvic organprolapse (POP), with its success in recurrent POPs after surgery, are scarce. MATERIALS AND METHODS: Retrospective analysis of a series of patients diagnosed with POP who underwent laparoscopic colposacropexy, comparing a group without previous prolapse surgery with another group that has recurred after previous surgery (with or without mesh). Our objective was to analyze the differences regarding surgical time (skin to skin), intraoperative complications, mean stay, resolution of symptoms and recurrence. As preoperative data, we compared: age, body mass index (BMI), parity, previous hysterectomy, physical examination, symptoms, and flowmetry; and as peri/postoperative data: follow-up, intervention duration, intra and postoperative complications, mean stay, physical examination (Baden-Walker classification), symptom resolution and flowmetry. RESULTS: Twenty-three patients have been operated on in 12 months. Nine (39.1%) were recurrent POPs after previous surgery, 6 (66.7%) of them with some type of mesh. Follow-up (mean months): 6.44 ± 4.19 (previous cx) vs. 4.79 ± 4.00. Both groups were comparable with respect to preoperative variables. Previously operated patients had greater dyspareunia (p<0.05). We did not find differences in the rest of symptoms between both groups. There were no differences in the duration of the intervention, mean stay, or regarding intraoperative complications (p>0.05) between both groups. Sensation of vaginal lump, urge incontinence and dyspareunia resolved in all patients. Flowmetry improved in both groups (p>0.05). CONCLUSIONS: Laparoscopic colposacropexy is an effective and safe technique to correct POP after previous surgery, with or without mesh.

INTRODUCCIÓN: La colposacropexia es el tratamiento de elección para el prolapso apical. Los estudios que comparan esta técnica como cirugía primaria para el prolapso de órganos pélvicos (POP), consu éxito en los POP recidivados tras cirugía son escasos.MATERIAL Y MÉTODOS: Análisis retrospectivo de una serie de pacientes con diagnóstico de POP sometidas a colposacropexia laparoscópica, comparando un grupo sin cirugía previa para el prolapso, con otro que ha recidivado tras cirugía previa (con o sin malla). Nuestro objetivo fue analizar las diferencias respecto al tiempo quirúrgico (de piel a piel), complicaciones intraoperatorias, estancia media, resolución de los síntomas y recidiva. Como datos preoperatorios se compararon: edad, índice de masa corporal (IMC), paridad, histerectomía previa, exploración física, sintomatología y flujometría; y como datos peri/postoperatorios: seguimiento, duración intervención, complicaciones intra y postoperatorias, estancia media, exploración física (clasificación Baden-Walker), resolución síntomas y flujometría.RESULTADOS: Han sido intervenidas 23 pacientes en12 meses. Nueve (39,1%) eran POP recidivados tras cirugía previa, 6 (66,7%) de ellas con algún tipo de malla. Seguimiento (media meses): 6,44 ± 4,19 (cx previa) vs 4,79 ± 4,00. Ambos grupos fueron comparables respecto a las variables preoperatorias. Las pacientes intervenidas previamente presentaban mayor dispareunia (p <0,05). No encontramos diferencias en el resto de síntomas entre ambos grupos. No hubo diferencias en duración de la intervención, estancia media, ni respecto a las complicaciones intraoperatorias (p>0,05) entre ambos grupos. La sensación de bultovaginal, la urge-incontinencia y la dispareunia se resolvieron en todas las pacientes. La flujometría mejoró en ambos grupos (p>0,05).CONCLUSIONES: La colposacropexia laparoscópica es una técnica eficaz y segura para la corrección del POP tras cirugía previa, con o sin malla.

[Prostate carcinosarcoma.] / Carcinosarcoma de próstata.

OBJECTIVE: To report a new case of prostatic carcinosarcoma, an uncommon and locally and distance aggressive tumor. METHOD: We analyzed one case diagnosed in our Center, from clinical and pathological diagnosis to death, describing the treatments received. RESULT: Patient presented a huge pelvic mass and a pulmonary metastasis that was treated with cystoprostatectomy and bilateral cutaneous ureterostomy with the diagnosis of carcinosarcoma of the prostate. He received 8 cycles of Docetaxel with bone progression and then 3 cycles of doxorubicin, suspending treatment due to progression. The survival was 18 months. CONCLUSIONS: Prostate carcinosarcoma is a very aggressive neoplasia that does not respond to the usual treatments of prostate cancer.

Carcinosarcoma de próstata / Prostate carcinosarcoma

OBJETIVO: Reportar un nuevo caso de carcinosarcoma prostático, un tumor infrecuente y agresivo localmente y a distancia. MÉTODO: Se ha analizado un único caso diagnosticado en nuestro Centro, desde el diagnóstico clínico y anatomopatológico hasta el éxitus, describiéndose los tratamientos recibidos por el mismo. RESULTADO: Paciente que presenta gran masa pélvica y una metástasis pulmonar que es sometido a cistoprostatectomia y ureterostomía cutánea bilateral con el diagnóstico de carcinosarcoma de próstata. Recibió 8 ciclos de Docetaxel objetivándose progresión ósea y posteriormente 3 ciclos de Doxorrubicina suspendiéndose por progresión. La supervivencia fue de 18 meses. CONCLUSIONES: El carcinosarcoma prostático es una neoplasia muy agresiva que no responde a los tratamientos habituales del cáncer de próstata

OBJECTIVE: To report a new case of prostatic carcinosarcoma, an uncommon and locally and distance aggressive tumor. METHOD: We analyzed one case diagnosed in our Center, from clinical and pathological diagnosis to death, describing the treatments received. RESULT: Patient presented a huge pelvic mass and a pulmonary metastasis that was treated with cystoprostatectomy and bilateral cutaneous ureterostomy with the diagnosis of carcinosarcoma of the prostate. He received 8 cycles of Docetaxel with bone progression and then 3 cycles of doxorubicin, suspending treatment due to progression. The survival was 18 months. CONCLUSIONS: Prostate carcinosarcoma is a very aggressive neoplasia that does not respond to the usual treatments of prostate cancer

Interest areas for training in endourology, laparoscopy and robotics: results of a multicentric survey among Spanish residents.

OBJECTIVES: To determine the current status of the training of Urology Resident's in Laparoscopic surgery, robotics and endourology. METHODS: We performed a survey among Spanish Urology Residents between 2011 and may 2012. We designed a survey that was disseminated through the web page of the Spanish Society of Laparoscopic and Robotic surgery (SECLA) (www.seclaendosurgery.com) to all residents from every Spanish hospital. The survey was divided in four blocks: General data, data of the Training Hospital, data of the surgical procedures (endoscopic, laparoscopic and robotic) and training features. We performed a descriptive study of the results. RESULTS: 36 Urology residents out of a total of 384 answered the survey (9,3%). In reference to endoscopic procedures 25% of the residents had never been involved on a percutaneous nephrostomy (n=36), and did not expect to do it. On the contrary, 77% have performed ureterorrenoscopy as first surgeon (n=36) and 25% have participated in more than 10 procedures. 54.4% of the participants took part as surgeons in percutaneous nephrolithotomies (n=28) and 79% looked forward to do them. Participation of residents in Da Vinci Robot assisted laparoscopic procedures is low. Laparoscopic procedures are very attractive and their participation is reduced as procedure complexity increases. CONCLUSIONS: 41.6% of participants think their training is adequate whereas 58,3% think it is not. 88% think their training could improve through courses and seminars and acquiring a greater degree of responsibility.

Áreas de interés en el aprendizaje de endourología, cirugía laparoscópica y robótica: resultados de una encuesta multicéntrica en residentes españoles / Interest areas for training in endourology, laparoscopy and robotics: results of a multicentric survey among spanish residents

OBJETIVO: Determinar el estado actual de la formación de los residentes de Urología, en España en cirugía laparoscópica, robótica y endourológica. MÉTODOS: Se realizó una encuesta (Figura 1) dirigida a los residentes españoles, durante el periodo comprendido entre los años 2011 y mayo de 2012. Diseñamos una encuesta que fue difundida a través de la página web (www.seclaendosurgery.com) de la Sociedad Española de Cirugía Laparoscópica y Robótica (SECLA) a todos los residentes en formación en cualquier centro hospitalario español. La encuesta se dividió en cuatro bloques: datos generales, datos generales del centro donde se realiza la residencia, datos de técnicas quirúrgicas (endoscópicas, laparoscópicas y robóticas) y aspectos formativos. Se realizó un estudio descriptivo de los resultados. RESULTADOS: Sobre un total de 384 residentes en Urología, 36 contestaron a la encuesta (9,3%). Los datos obtenidos referidos a procedimientos endoscópicos demostrarón que un 25 % de los encuestados nunca ha participado en la colocación de una nefrostomía percutánea (n=36), ni espera hacerlo. Por el contrario, un 77 % afirma haber realizado como cirujano una ureterorrenoscopia (n=36). y el 25% lo hizo en más de diez procedimientos. El 54’4 % de los encuestados ha participado como cirujano en nefrolitectomías percutáneas (n=28) y el 79% espera hacerlo. La participación de los residentes en los procedimientos asistidos por robot da Vinci es baja. Los procedimientos laparoscópicos son de gran interés y su participación se reduce según se incrementa el grado de complejidad del procedimiento. CONCLUSIÓN: El 41,6% de los encuestados piensa que su formación es adecuada mientras que el 58,3% piensa que no lo es. El 88% piensan que su formación se podría mejorar con cursos y seminarios y adquiriendo mayor grado de responsabilidad en quirófano y el 50% que su formación se podría complementar con rotaciones externas y/o fellowships

OBJECTIVES: To determine the current status of the training of Urology Resident`s in Laparoscopic surgery, robotics and endourology. METHODS: We performed a survey among Spanish Urology Residents between 2011 and may 2012. We designed a survey that was disseminated through the web page of the Spanish Society of Laparoscopic and Robotic surgery (SECLA) (www.seclaendosurgery.com) to all residents from every Spanish hospital. The survey was divided in four blocks: General data, data of the Training Hospital, data of the surgical procedures (endoscopic, laparoscopic and robotic) and training features. We performed a descriptive study of the results. RESULTS: 36 Urology residents out of a total of 384 answered the survey (9,3%). In reference to endoscopic procedures 25% of the residents had never been involved on a percutaneous nephrostomy (n=36), and did not expect to do it. On the contrary, 77% have performed ureterorrenoscopy as first surgeon (n=36) and 25% have participated in more than 10 procedures. 54.4% of the participants took part as surgeons in percutaneous nephrolithotomies (n=28) and 79% looked forward to do them. Participation of residents in Da Vinci Robot assisted laparoscopic procedures is low. Laparoscopic procedures are very attractive and their participation is reduced as procedure complexity increases. CONCLUSIONS: 41.6% of participants think their training is adequate whereas 58,3% think it is not. 88% think their training could improve through courses and seminars and acquiring a greater degree of responsibility

Robotic Anderson-Hynes dismembered pyeloplasty: initial experience.

INTRODUCTION: The introduction of the da Vinci(®) robotic system in 2000 has been a new step forward in the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study was to analyse our initial experience with robot-assisted dismembered Anderson-Hynes pyeloplasty and to perform a bibliographic review on the topic. PATIENTS AND METHODS: We performed 11 robot-assisted pyeloplasties between March 2007 and April 2011. UPJO diagnosis was made on clinical presentation and imaging techniques (CT scan and intravenous urography). All patients underwent basal and diuretic isotopic renograms to evaluate the degree of obstruction and impaired renal function. Median follow-up was 10 (range 1-26) months. RESULTS: Mean patient age was 38.8 (range 23-62) years. There were six women (55%) and five men (45%). All cases were primary surgeries. In four patients the cause of UPJO was a crossing vessel; the other seven patients had intrinsic obstruction. One case was associated with extraction of a calyceal lithiasis. Mean operative time was 189.4 min (125-270 min). Average time from robotic arms docking was 116.5 (range 55-180) min. Average hospital stay was 4.18 (range 2-8) days. Conversion to open or laparoscopic surgery was not necessary in any case and there were no postoperative complications. Postoperative radiological evaluation and renograms showed good results in all cases. CONCLUSIONS: Robotic surgery offers better ergonomics, enhanced three-dimensional (3D) vision and more precise movements, easing intracorporeal suturing.These advantages make robotic pyeloplasty a reproducible technique that combines the high success rates of open surgery and the benefits of laparoscopic surgery.

Tratamiento quirúrgico de la fractura de cuerpos cavernosos con rotura completa de uretra / Surgical treatment of corpora cavernosa fracture with complete urethral rupture

OBJETIVO: Analizar de una manera breve y concisa el diagnóstico y tratamiento de las fracturas de ambos cuerpos cavernosos y uretra.MÉTODOS: Se presenta un caso raro de fractura de ambos cuerpos cavernosos asociada a rotura completa de uretra.RESULTADO/CONCLUSIONES: El diagnóstico de las fracturas de pene puede ser realizado exclusivamente basado en la historia clínica y en los hallazgos de la exploración física. El tratamiento de elección es quirúrgico y tiene como objetivo permitir la micción y restaurar el pene a su estado original para prevenir complicaciones como la disfunción eréctil(AU)

OBJECTIVE: To analyze in a short and concise way the diagnosis and treatment of traumatic fracture of both corpora cavernosa and urethra.METHODS: We present our experience with a rare case of traumatic fracture of both corpora cavernosa associated to complete urethral rupture.RESULTS/CONCLUSIONS: The diagnosis of penile fractures can be done with the clinical history and physical examination only. Surgery is the best treatment, the main objective of which is to enable voiding and restore the anatomy of the penis to prevent complications such as erectile dysfunction(AU)

Surgical repair and analysis of penile fracture complications.

BACKGROUND: The objective of this study is to describe and analyze the experience over a period of 10 years at our center through a retrospective study of a series of diagnosed and treated cases of penile fracture. MATERIAL AND METHODS: From 2005 to 2009 the Urology Department of the Hospital Clínico San Carlos of Madrid carried out a retrospective case study of a total of 15 cases of penile fracture. The diagnosis was reached through physical exploration of the patient aided by a penile ultrasound; the immediate treatment performed on the patients was emergency surgical repair. RESULTS: From the total in the series (n = 15), only 1 case was associated with a complete urethral fracture (6.6%). Surgical repair was performed in all cases; the average hospital stay was 2.6 days (range 1-5), and the most frequent long-term complication was erectile dysfunction in 3 of 15 cases (20%). CONCLUSIONS: A penis fracture diagnosis is mostly clinical; complementary tests, such as ultrasound, are helpful but not definitive. Surgical treatment consists of an incision that allows adequate exposure of the corpora cavernosa and urethra to repair the suspected lesions found upon diagnosis. Ambulatory follow-up is essential to diagnose and treat possible complications.