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.

Is Extracorporeal Shock Wave Lithotripsy a Treatment Option for Renal Colic?

BACKGROUND: Renal colic is characterized by sharp, intense flank pain. Nonsteroidal anti-inflammatory drugs are the treatment of choice, although extracorporeal shock wave lithotripsy (SWL) is a noninvasive alternative for pain management. The objective of our study is to present results obtained using rapid SWL to treat renal colic in our center. METHODS: We analyzed 214 patients undergoing rapid shockwave extracorporeal lithotripsy between October 2014 and June 2018: 69.63% were male, and 30.37% female, with a mean age of 47.35 years (range, 16-84). The average stone size was 6.71 mm (3-16). Stone locations were as follows: The pelviureteric junction (PUJ) (10.75%), proximal ureter (45.79%), midureter (24.77%), and distal ureter (18.69%). RESULTS: Pain relief was achieved in 81.31% of the patients. The rates of successful pain control according to stone location were 65.22% when the stone was located in the PUJ, 79.59% in the proximal ureter, 88.68% in the midureter, and 85.00% in the distal ureter. Complete or partial stone resolution was achieved 4 weeks postoperatively in 78.50% of cases (64.95% and 13.55%, respectively). According to the stone location, the overall rate of resolution (complete + partial) was 90.00% for distal ureteral stones, 86.80% in the midureter, 73.47% in the proximal ureter, and 60.86% in the PUJ. 44 patients (20.56%) demonstrated complications. The most common complications were persistent pain, acute renal failure and fever. CONCLUSIONS: Immediate SWL was found to be a safe and effective treatment option for pain related to renal colic in 81% of the patients studied.

Is Extracorporeal Shock Wave Lithotripsy a Treatment Option for Renal Colic?

Background: Renal colic is characterized by sharp, intense flank pain. Nonsteroidal anti-inflammatory drugs are the treatment of choice, although extracorporeal shock wave lithotripsy (SWL) is a noninvasive alternative for pain management. The objective of our study is to present results obtained using rapid SWL to treat renal colic in our center. Methods: We analyzed 214 patients undergoing rapid shockwave extracorporeal lithotripsy between October 2014 and June 2018: 69.63% were male, and 30.37% female, with a mean age of 47.35 years (range, 16–84). The average stone size was 6.71 mm (3–16). Stone locations were as follows: The pelviureteric junction (PUJ) (10.75%), proximal ureter (45.79%), midureter (24.77%), and distal ureter (18.69%). Results: Pain relief was achieved in 81.31% of the patients. The rates of successful pain control according to stone location were 65.22% when the stone was located in the PUJ, 79.59% in the proximal ureter, 88.68% in the midureter, and 85.00% in the distal ureter. Complete or partial stone resolution was achieved 4 weeks postoperatively in 78.50% of cases (64.95% and 13.55%, respectively). According to the stone location, the overall rate of resolution (complete + partial) was 90.00% for distal ureteral stones, 86.80% in the midureter, 73.47% in the proximal ureter, and 60.86% in the PUJ. 44 patients (20.56%) demonstrated complications. The most common complications were persistent pain, acute renal failure and fever. Conclusions: Immediate SWL was found to be a safe and effective treatment option for pain related to renal colic in 81% of the patients studied (AU)

Value of Music and Nitrous Oxide for Pain Control during Extracorporeal Shock Wave Lithotripsy (ESWL).

OBJECTIVES: To compare the efficacy of 4 different analgesic regimens that include music and nitrous oxide during the treatment of renal lithiasis with ambulatory extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: A single-centre, longitudinal, prospective, randomized, open and parallel group study was conducted. Patients with renal lithiasis were included and were randomized to Group A (basal analgesia: midazolam (1 mg), fentanyl (0.05 mg) and dexketoprofen (50 mg)), Group B (basal analgesia and nitrous oxide), Group C (basal analgesia and music) and Group D (basal analgesia, nitrous oxide and music). For the measurement of pain, a visual analogue scale ranging from 0 (no pain) to 100 (maximum pain imaginable) was used. Patient satisfaction was assessed using a Likert questionnaire. The epidemiological data of the patients in terms of lithiasis, previous clinical and ESWL sessions, and pain measured with the VAS before, during (maximum) at the end of the session and at discharge were recorded. Data on complications were also collected, as was the patients' subjective evaluation of the treatment and their satisfaction. The ESWL procedure was performed with a Storz Modulith SLX-F2® lithotripter. A maximum of 4000 waves were applied at a frequency of 1.5 Hz. RESULTS: Eighty patients were included (20 per group). None of the analgesia guidelines proved to be superior to the others for pain control during the ESWL session. Patients younger than 50 years had significantly higher values for the maximum VAS. Only 13.75% of patients required rescue analgesia. A total of 77.5% described their experience as good, very good or excellent, regardless of the assigned group. CONCLUSIONS: The addition of nitrous oxide and/or music did not result in a statistically significant improvement over the basal analgesia regimen of midazolam, fentanyl and dexketoprofen; however, the degree of patient satisfaction was very high.

Value of Music and Nitrous Oxide for Pain Control during Extracorporeal Shock Wave Lithotripsy (ESWL)

Objectives: To compare the efficacy of 4 different analgesic regimens that include music and nitrous oxide during the treatment of renal lithiasis with ambulatory extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: A single-centre, longitudinal, prospective, randomized, open and parallel group study was conducted. Patients with renal lithiasis were included and were randomized to Group A (basal analgesia: midazolam (1 mg), fentanyl (0.05 mg) and dexketoprofen (50 mg)), Group B (basal analgesia and nitrous oxide), Group C (basal analgesia and music) and Group D (basal analgesia, nitrous oxide and music). For the measurement of pain, a visual analogue scale ranging from 0 (no pain) to 100 (maximum pain imaginable) was used. Patient satisfaction was assessed using a Likert questionnaire. The epidemiological data of the patients in terms of lithiasis, previous clinical and ESWL sessions, and pain measured with the VAS before, during (maximum) at the end of the session and at discharge were recorded. Data on complications were also collected, as was the patients’ subjective evaluation of the treatment and their satisfaction. The ESWL procedure was performed with a Storz Modulith SLX-F2® lithotripter. A maximum of 4000 waves were applied at a frequency of 1.5 Hz. Results: Eighty patients were included (20 per group). None of the analgesia guidelines proved to be superior to the others for pain control during the ESWL session. Patients younger than 50 years had significantly higher values for the maximum VAS. Only 13.75% of patients required rescue analgesia. A total of 77.5% described their experience as good, very good or excellent, regardless of the assigned group. Conclusions: The addition of nitrous oxide and/or music did not result in a statistically significant improvement over the basal analgesia regimen of midazolam, fentanyl and dexketoprofen; however, the degree of patient satisfaction was very high (AU)

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.

[Cystoscopy in the assessment of patients with bladder pain syndrome: Results of a national multicenter observational study.] / La cistoscopia en la evaluación del síndrome de dolor vesical: resultados de un estudio observacional multicéntrico nacional.

OBJECTIVES: To study the use and results of cystoscopy and bladder hydrodistension in the objective assessment of patients with Bladder Pain Syndrome (BPS), in routine clinical practice. MATERIAL AND METHODS: Observational, non-interventional, national, multicenter study carried out in Functional Urology and Urodynamic Units of Spain belonging to the IFU Group. 273 women with BPS who underwent cystoscopy at baseline as a diagnostic tool according to clinical criteria and following the routine clinical practice of each center, were studied. The pre and post hydrodistension findings and the scores of the symptom and Health-Related Quality of Life (HRQoL) questionnaires were described: BPIC-SS, PPBC, PGI-S and EQ-5D-5L. RESULTS: The mean age (SD) was 59 (14) years with a high presence of bladder symptoms: increased voiding frequency (81.7%), nocturia (74%) and urgency (60.4%). 40.7% of cystoscopies were performed under anesthesia and 73.7% uses a standard rigid cystoscope. Hunner lesions were observed in 9.9% of the patients, hypervascularizations (46.2%), glomerulations (23.4%), mild bleeding (6.6%) and scars (2.2%). After hydrodistension, a greater number of grade 1 and 2 lesions were observed. In 51.6% of the patients there were no changes, but in 27.5% slight changes were observed and in 11.4% moderate or severe changes. Symptom and HRQoL questionnaire scores showed no association with cystoscopy findings before and after hydrodistension. CONCLUSIONS: The value of the cystoscopic findings in the SDV has yet to be defined, although it plays a fundamental role in the differential diagnosis. In this observational study, we did not find a correlation of the cystoscopic findings with the symptoms of the patients, measured by validated questionnaires, nor with the HRQoL.

OBJETIVO: Analizar el uso y resultados de la cistoscopia y la hidrodistensión vesical para la evaluación objetiva de pacientes con Síndrome de Dolor Vesical (SDV), en el contexto de práctica clínica habitual.MATERIAL Y MÉTODOS: Estudio observacional, no intervencionista, multicéntrico de ámbito nacional, realizado en Unidades de Urología Funcional y Urodinámica de España pertenecientes al Grupo IFU en el que se analizaron 273 mujeres con SDV a las que se les realizó una cistoscopia a nivel basal como herramienta diagnóstica según criterio clínico y siguiendo la práctica clínica habitual de cada centro. Se describieron los hallazgos pre y post hidrodistensión y las puntuaciones de los cuestionarios de síntomas y de Calidad de Vida Relacionada con la Salud (CVRS): BPIC-SS, PPBC, PGI-S y EQ-5D-5L. RESULTADOS: La edad media (DE) fue de 59 (14) años con gran presencia de síntomas vesicales: frecuencia miccional aumentada (81,7%), nocturia (74,0%) y urgencia (60,4%). El 40,7% de las cistoscopias se realizaron bajo anestesia y en el 73,7% se empleó un cistoscopio rígido estándar. Se observaron lesiones de Hunner en un 9,9% de las pacientes, hipervascularizaciones (46,2%), glomerulaciones (23,4%), sangrado leve (6,6%) y cicatrices (2,2%). Tras la hidrodistensión se observó un mayor número de lesiones grado 1 y 2. En el 51,6% de las pacientes no hubo cambios, pero en el 27,5% se observaron cambios leves y en el 11,4% cambios moderados o graves. Las puntuaciones de los cuestionarios de síntomas y CVRS no mostraron asociación con los hallazgos de la cistoscopia antes y después de la hidrodistensión. CONCLUSIONES: El valor de los hallazgos cistoscópicos en el SDV está aún por definir, aunque juega un papel fundamental en el diagnóstico diferencial. En este estudio observacional no encontramos correlación de los hallazgos cistoscópicos con los síntomas de las pacientes, medidos por cuestionarios validados, ni con la CVRS.

La cistoscopia en la evaluación del síndrome de dolor vesical: resultados de un estudio observacional multicéntrico nacional / Cystoscopy in the evaluation of bladder pain syndrome: results of a national multicenter observational study

Objetivo: Analizar el uso y resultados dela cistoscopia y la hidrodistensión vesical para la evaluación objetiva de pacientes con Síndrome de DolorVesical (SDV), en el contexto de práctica clínica habitual.Material y métodos: Estudio observacional, nointervencionista, multicéntrico de ámbito nacional, realizado en Unidades de Urología Funcional y Urodinámica de España pertenecientes al Grupo IFU en el quese analizaron 273 mujeres con SDV a las que se lesrealizó una cistoscopia a nivel basal como herramientadiagnóstica según criterio clínico y siguiendo la prácticaclínica habitual de cada centro. Se describieron los hallazgos pre y post hidrodistensión y las puntuaciones de los cuestionarios de síntomas y de Calidad de Vida Relacionada con la Salud (CVRS): BPIC-SS, PPBC, PGI-Sy EQ-5D-5L.Resultados: La edad media (DE) fue de 59 (14) añoscon gran presencia de síntomas vesicales: frecuenciamiccional aumentada (81,7%), nocturia (74,0%) y urgencia (60,4%). El 40,7% de las cistoscopias se realizaron bajo anestesia y en el 73,7% se empleó uncistoscopio rígido estándar. Se observaron lesiones deHunner en un 9,9% de las pacientes, hipervascularizaciones (46,2%), glomerulaciones (23,4%), sangradoleve (6,6%) y cicatrices (2,2%). Tras la hidrodistensiónse observó un mayor número de lesiones grado 1 y2. En el 51,6% de las pacientes no hubo cambios,pero en el 27,5% se observaron cambios leves y en el11,4% cambios moderados o graves. Las puntuacionesde los cuestionarios de síntomas y CVRS no mostraronasociación con los hallazgos de la cistoscopia antes ydespués de la hidrodistensión. Conclusiones: El valor de los hallazgos cistoscópicos en el SDV está aún por definir, aunque juega unpapel fundamental en el diagnóstico diferencial. En esteestudio observacional no encontramos correlación delos hallazgos cistoscópicos con los síntomas de las pacientes, medidos por cuestionarios validados, ni con laCVRS.(AU)

Objetives: To study the use and resultsof cystoscopy and bladder hydrodistension in the objective assessment of patients with Bladder Pain Syndrome(BPS), in routine clinical practice.Material and methods: Observational, non-interventional, national, multicenter study carried out inFunctional Urology and Urodynamic Units of Spain belonging to the IFU Group. 273 women with BPS whounderwent cystoscopy at baseline as a diagnostic toolaccording to clinical criteria and following the routineclinical practice of each center, were studied. The preand post hydrodistension findings and the scores of thesymptom and Health-Related Quality of Life (HRQoL)questionnaires were described: BPIC-SS, PPBC, PGI-Sand EQ-5D-5L.Results: The mean age (SD) was 59 (14) years witha high presence of bladder symptoms: increased voiding frequency (81.7%), nocturia (74%) and urgency(60.4%). 40.7% of cystoscopies were performed under anesthesia and 73.7% uses a standard rigid cystoscope. Hunner lesions were observed in 9.9% of thepatients, hypervascularizations (46.2%), glomerulations(23.4%), mild bleeding (6.6%) and scars (2.2%). Afterhydrodistension, a greater number of grade 1 and 2lesions were observed. In 51.6% of the patients therewere no changes, but in 27.5% slight changes wereobserved and in 11.4% moderate or severe changes.Symptom and HRQoL questionnaire scores showed noassociation with cystoscopy findings before and afterhydrodistension.Cconclusions: The value of the cystoscopic findingsin the SDV has yet to be defined, although it plays afundamental role in the differential diagnosis. In this observational study, we did not find a correlation of thecystoscopic findings with the symptoms of the patients,measured by validated questionnaires, nor with theHRQoL.(AU)

Prospective Observational Cohort Study of the Efficacy of Bacterial Immune Prophylaxis in the Prevention of Uncomplicated, Recurrent Urinary Tract Infections.

OBJECTIVE: To investigate the long-term prophylactic effect of a vaccine on lower urinary tract infections (UTI) of bacterial and the impact of the intensity of the symptoms on the quality of life (QoL). METHODS: Adult female could be enrolled in this study if they had acute UTI at the enrolment visit and bacterial microbiological count of ≥103 CFU/mL of Escherichia coli. RESULTS: A total of 21 patients were included. Fifteen days after the administration of a vaccine for 3 months, the number of infections dropped almost to zero. Significant differences were observed in the QoL score (p < 0.05). The safety profile was good. CONCLUSIONS: In patients diagnosed with recurrent UTI and treated for 3 months with the vaccine the number of UTI episodes fell very quickly (15 days), and patients remained free of episodes and improved their QoL significantly for 1 year. These results suggest that bacterial vaccines are a possible effective alternative in the prevention of recurrent UTI.

[Current status of laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse.] / Estado actual de la Colposacropexia Laparoscópica (CSPL) en la corrección del Prolapso de Órganos Pélvicos (POP).

OBJECTIVES: Surgical restoration of pelvic floor anatomy in pelvic organ prolapse (POP) should avoid extensive areas that may injure healthy tissues and lead to scar fibrosis producing dysfunctional rigidity. Laparoscopic sacrocolpopexy corrects POP by lifting pelvic elements with a minimally invasive procedure.Various current strategies and approaches make it a diverse procedure. METHODS: We performed a bibliographic review on the published experience about abdominal sacrocolpopexy over the last 20 years. We analyze the philosophy of each technique, advantages, disadvantages, and results. RESULTS: Among current theories that explain how is the anatomy and function of the pelvic floor, the comprehensive theory of the pelvic floor announces that anatomical deviation produces pelvic dysfunction (diagnostic algorithm)(1). Surgical invasion with reconstructive purposes may hide results if the true physiopathology of the defects found is not known. Although current diagnostic tools cannot solve the problem as a whole, results of different techniques are much better than those of previous times. CONCLUSIONS: Laparoscopic sacrocolpopexy is an adequate strategy that restores anatomy in POP, mainly apical, and function with minimal invasion. Technical development and better knowledge of the female pelvis functional anatomy is enabling today a more precise understanding of its physiopathology, so it facilitates the design of site-specific operations. Various surgical approaches and techniques are offered depending on the defect, where combined procedures give good solutions. It is necessary to have an appropriate surgical training to obtain the better competence, and a safe and correct repair.

Estado actual de la Colposacropexia Laparoscópica (CSPL) en la corrección del Prolapso de Órganos Pélvicos (POP) / Current status of laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse

OBJETIVO: La restauración quirúrgica de la anatomía del suelo pélvico en el POP (Prolapso Órganos Pélvicos) debe evitar la disección de extensas áreas, que lesionan tejidos sanos y la fibrosis cicatricial que produce rigidez no funcionante. La colposacropexia laparoscópica (CSPL) corrige el POP al suspender los elementos pélvicos descendidos con mínima invasión (CMI). Distintas estrategias y abordajes actuales hacen que sea un procedimiento diverso. MÉTODOS: Se realiza revisión bibliográfica de la experiencia publicada sobre colposacropexia abdominal (CSPA) en los últimos 20 años. Se analiza la filosofía de cada técnica, ventajas, inconvenientes, y resultados. RESULTADOS: Dentro de las teorías actuales que explican cómo es la anatomía y la funcionalidad del suelo pélvico la Teoría Integral del Piso Pélvico (TSI) anuncia que la desviación anatómica produce disfunción pélvica (algoritmo diagnóstico) (1). La intrusión quirúrgica con fines reparadores puede enmascarar los resultados si no se conoce la verdadera fisiopatología de los defectos encontrados. Si bien las herramientas actuales de diagnóstico no logran resolver la problemática en su totalidad, los resultados de las diferentes técnicas hoy son mucho mejores que abordajes de épocas anteriores. CONCLUSIONES: La CSPL es una adecuada estrategia que consigue restaurar la anatomía del POP, principalmente apical, restaurando la función con invasión mínima. El desarrollo técnico y el mejor conocimiento de la anatomía funcional de la pelvis femenina esta hoy permitiendo comprender con mayor precisión su fisiopatología lo que facilita diseñar el tipo de cirugía sitio-específica. Se ofertan vías de abordajes y técnicas diferentes según el defecto, donde los procedimientos combinados ofrecen buenas soluciones. Es preciso un entrenamiento quirúrgico apropiado para obtener la mejor competencia, y una correcta y segura reparación

OBJECTIVES: Surgical restoration of pelvic floor anatomy in pelvic organ prolapse (POP) should avoid extensive areas that may injure healthy tissues and lead to scar fibrosis producing dysfunctional rigidity. Laparoscopic sacrocolpopexy corrects POP by lifting pelvic elements with a minimally invasive procedure Various current strategies and approaches make it a diverse procedure. METHODS: We performed a bibliographic review on the published experience about abdominal sacrocolpopexy over the last 20 years. We analyze the philosophy of each technique, advantages, disadvantages, and results. RESULTS: Among current theories that explain how is the anatomy and function of the pelvic floor, the comprehensive theory of the pelvic floor announces that anatomical deviation produces pelvic dysfunction (diagnostic algorithm)(1). Surgical invasion with reconstructive purposes may hide results if the true physiopathology of the defects found is not known. Although current diagnostic tools cannot solve the problem as a whole, results of different techniques are much better than those of previous times. CONCLUSIONS: Laparoscopic sacrocolpopexy is an adequate strategy that restores anatomy in POP, mainly apical, and function with minimal invasion. Technical development and better knowledge of the female pelvis functional anatomy is enabling today a more precise understanding of its physiopathology, so it facilitates the design of site-specific operations. Various surgical approaches and techniques are offered depending on the defect, where combined procedures give good solutions. It is necessary to have an appropriate surgical training to obtain the better competence, and a safe and correct repair

[Expert opinion about the use of transdermic oxybutynin in Spain for the treatment of adult overactive bladder.] / Opinión de expertos sobre el uso de la oxibutinina transdérmica en España para el tratamiento de la vejiga hiperactiva en adultos.

OBJECTIVES: To define the different characteristics of transdermal oxybutynin (TO) for the treatment of overactive bladder in adults, to know the barriers for the use of this drug and to establish proposals to minimize these barriers. METHODS: Local sessions were held with 111 urologists from all over the country divided into 12 sessions. They were moderated by a brainstorming technique led by an external consultant. RESULTS: 75% of experts believe that tolerability and clinical efficacy (50%) are the most important attributes to choose this formulation, being the lack of scientific publications the least valued (12%). These opinions were based on their own clinical experience with TO or on scientific publications, without establishing comparison with other treatment options. The main barriers would be administrative obstacles (84%), difficulty in its use (54%) and the lack/rejection of the transdermal administration by the patient (33%). Actions were proposed to correct the 8 most significant barriers, such as better training for specialists (both Urology and other specialties) and for patients, creating informative materials to reinforce health education in managing patches, generating greater volume of scientific evidence to support their use in overactive bladder and clearly identifying the profile of patients who will benefit most from this therapeutic strategy. CONCLUSIONS: Although oxybutynin has been standard treatment of overactive bladder in recent years the conclusion of this working group is that its new transdermal formulation offers a better-tolerated alternative for patients, and, therefore the necessary tools to generate more evidence should be implemented to increase the proper use among specialists and patients.

Opinión de expertos sobre el uso de la oxibutinina transdérmica en España para el tratamiento de la vejiga hiperactiva en adultos / Expert opinión about the use of transdermic oxybutynin in Spain for the treatment of adult overactive bladder

OBJETIVO: Definir las características diferenciales de la oxibutinina transdérmica (OT) en el tratamiento de la vejiga hiperactiva en pacientes adultos, conocer las barreras de uso y establecer propuestas para minimizar estas barreras. MÉTODOS: Se realizaron 12 sesiones de ámbito local a las que acudieron 111 urólogos en total de todo el territorio nacional, que fueron moderadas mediante una técnica de brainstorming dirigida por un consultor externo. RESULTADOS: El 75% de los expertos opina que la tolerabilidad y la eficacia clínica (50%) son los 'atributos' más importantes para escoger esta formulación, siendo el menos valorado la escasez de publicaciones científicas (12%), basándose en su propia experiencia clínica con OT o la referida en publicaciones científicas, sin establecer comparación con otras alternativas de tratamiento. Las principales 'barreras' para su uso serían las trabas administrativas (84%), la dificultad en su manejo (54%) y el desconocimiento-rechazo de la vía transdérmica por parte del paciente (33%). Se acordaron acciones para subsanar las 8 barreras más significativas, como mayor formación para especialistas (tanto Urología como otras especialidades) y para pacientes, creación de materiales informativos para reforzar la educación en el manejo de parches, generar mayor volumen de evidencia científica que avale su uso en la vejiga hiperactiva e identificar claramente los perfiles de pacientes más beneficiarios de esta estrategia terapéutica. CONCLUSIONES: Este grupo de expertos identificó la tolerabilidad y eficacia como los dos atributos clave que debe tener un fármaco para el tratamiento de la vejiga hiperactiva, de los cuales la OT destaca en el primero de ellos. Además, deben emprenderse acciones formativas, educativas y de investigación a todos los actores implicados con el fin de superar las barreras que dificultan el correcto manejo de este fármaco

OBJECTIVES: To define the different characteristics of transdermal oxybutynin (TO) for the treatment of overactive bladder in adults, to know the barriers for the use of this drug and to establish proposals to minimize these barriers. METHODS: Local sessions were held with 111 urologists from all over the country divided into 12 sessions. They were moderated by a brainstorming technique led by an external consultant. RESULTS: 75% of experts believe that tolerability and clinical efficacy (50%) are the most important attributes to choose this formulation, being the lack of scientific publications the least valued (12%). These opinions were based on their own clinical experience with TO or on scientific publications, without establishing comparison with other treatment options. The main barriers would be administrative obstacles (84%), difficulty in its use (54%) and the lack/rejection of the transdermal administration by the patient (33%). Actions were proposed to correct the 8 most significant barriers, such as better training for specialists (both Urology and other specialties) and for patients, creating informative materials to reinforce health education in managing patches, generating greater volume of scientific evidence to support their use in overactive bladder and clearly identifying the profile of patients who will benefit most from this therapeutic strategy. CONCLUSIONS: Although oxybutynin has been standard treatment of overactive bladder in recent years the conclusion of this working group is that its new transdermal formulation offers a better-tolerated alternative for patients, and, therefore the necessary tools to generate more evidence should be implemented to increase the proper use among specialists and patients

[Cystic displasia of the testis. Review of literature]. / Displasia quística de rete testis: revisión de la literatura.

OBJECTIVE: Review this pathology nowadays. METHODS: We search in Medline/PubMed database for reviews about cystic dysplasia of the testis. We review and discuss the relevant literature about it. RESULTS: Cystic dysplasia of the testis (CDT) is a rare benign disease, associated with upper urinary tract malformations. Its most frequent clinical manifestation is the increase of testicular size; the presence of cysts is demonstrated by ultrasound. No consensus exists in its treatment, it oftenly requires histological confirmation, performing testicle-sparing surgery. CONCLUSION: CDT needs to be taken into account in the differential diagnosis of childhood testicular tumors.

[Clinical presentation of renal cell carcinoma in renal transplant]. / Presentación clínica del carcinoma de células renales en el trasplante renal.

OBJECTIVES: To analyze the clinical presentation and therapeutic response of renal cell carcinoma (RCC) of the renal graft. METHODS: Analysis of the cases described in our centre and review of current literature. RESULTS: RCC has a higher incidence in transplant patients, affecting the graft in less than 10% of the cases. Detection is usually a casual event during follow-up due to the absence of innervation, although its presentation may be as an acute abdomen in case of breakage of the graft. Conventional treatment consists of transplant nephrectomy, but partial nephrectomy has been performed in recent years with good results. The modification of immunosuppression is a routine measure after treatment. CONCLUSIONS: The incidence of RCC after renal transplants in our series is 0.7%, of which 22% are originated in the graft. The clinical presentation of the primitive RCC of the graft is variable. Partial nephrectomy is technically feasible and oncologically safe in the treatment of RCC of the renal graft.

Displasia quística de rete testis: revisión de la literatura / Cystic displasia of the testis. Review of literature

Objetivo: Revisión de la Displasia Quística de Rete Testis en el momento actual. Material y Métodos: Búsqueda bibliográfica en la base de datos Medline/PubMed del término “Cystic dysplasia of the testis”, con análisis de las revisiones bibliográficas encontradas. Resultados: La displasia quística de rete testis (DQRT) es una rara enfermedad benigna, asociada a malformaciones del tracto urinario superior. Su manifestación clínica más frecuente es el aumento de tamaño testicular, demostrándose la presencia de los quistes ecográficamente. No existe consenso en el tratamiento, optándose en la mayoría de los casos por la confirmación anatomopatológica con conservación del parénquima testicular. Conclusión: La DQRT es una enfermedad que debe ser tenida en cuenta en el diagnóstico diferencial de la masa escrotal infantil (AU)

Objetive: Review this pathology nowadays. Methods: We search in Medline/PubMed database for reviews about cystic dysplasia of the testis. We review and discuss the relevant literature about it. Results: Cystic dysplasia of the testis (CDT) is a rare benign disease, associated with upper urinary tract malformations. Its most frequent clinical manifestation is the increase of testicular size; the presence of cysts is demonstrated by ultrasound. No consensus exists in its treatment, it oftenly requires histological confirmation, performing testicle-sparing surgery. Conclusion: CDT needs to be taken into account in the differential diagnosis of childhood testicular tumors (AU)

Presentación clínica del carcinoma de células renales en el trasplante renal / Clinical presentation of renal cell carcinoma in renal transplant

OBJETIVO: Analizar la presentación clínica y la actitud terapéutica ante la afectación del injerto por un Carcinoma de células renales (CCR).MÉTODOS: Análisis de los casos descritos en nuestro Centro y revisión de la literatura actual.RESULTADOS: El CCR presenta una incidencia superior en los pacientes trasplantados, afectando en menos del 10% al injerto. La ausencia de inervación hace que habitualmente sea un hallazgo casual durante el seguimiento, aunque su presentación puede llegar a ser como un abdomen agudo en caso de rotura del injerto. El tratamiento convencional es la trasplantectomía, realizándose en los últimos años la nefrectomía parcial con buenos resultados. La modificación de la inmunosupresión es una medida habitual tras el tratamiento.CONCLUSIONES: La incidencia de CCR post-TR en nuestra serie es del 0,7%, originándose el 22% de los mismos en el injerto. La presentación clínica del CCR primitivo del injerto es variable. La nefrectomía parcial es técnicamente posible y oncológicamente segura en el tratamiento del CCR del injerto renal(AU)

OBJECTIVES: To analyze the clinical pre-sentation and therapeutic response of renal cell carcinoma (RCC) of the renal graft.METHODS: Analysis of the cases described in our cen-tre and review of current literature.RESULTS: RCC has a higher incidence in transplant patients, affecting the graft in less than 10% of the cases. Detection is usually a casual event during follow-up due to the absence of innervation, although its presentation may be as an acute abdomen in case of breakage of the graft. Conventional treatment consists of transplant nephrectomy, but partial nephrectomy has been performed in recent years with good results. The modification of immunosuppression is a routine measure after treatment.CONCLUSIONS: The incidence of RCC after renal transplants in our series is 0.7%, of which 22% are origi-nated in the graft. The clinical presentation of the primitivaveRCC of the graft is variable. Partial nephrectomy is technically feasible and oncologically safe in the treatment of RCC of the renal graft(AU)

Carcinoma vesical linfoepitelioma-like: revisión de la literatura y aportación de un nuevo caso / Bladder lymphoepithelioma-like carcinoma. Bibliographic review and case report

Objetivo: El carcinoma linfoepitelial o carcinoma linfoepitelioma-like es un raro tumor cuya histología recuerda a los linfoepiteliomas de la nasofaringe. Se ha descrito su presencia en múltiples localizaciones, pero en la vejiga tan sólo se han descrito 55 casos en la literatura. Presentamos un nuevo caso de carcinoma linfoepitelial vesical y hacemos una revisión de todos los publicados anteriormente, con la intención de definir sus características e intentar obtener una pauta terapéutica y pronóstica aplicable a esta patología. Métodos: Se ha revisado la literatura relativa al carcinoma linfoepitelial y se han analizado las características epidemiológicas, los tratamientos recibidos y la evolución de los 56 casos publicados (incluido el nuestro), tanto de forma global como en función de los subtipos histológicos, según la clasificación de Amin y cols. Resultados: Se han descrito 56 casos, 40 en hombres y 16 mujeres, con una media de edad de 69 años. Se diagnosticaron 19 del subtipo puro (33,9%), 20 del predominante (35,7%) y 11 del focal (19,6%) sin indicarse la histología en 6 de ellos (10,7%). En cuanto a los estadíos tumorales, el 10,7% (6) fueron T1, el 57,1% (32) fueron T2 y el 30,4% (17) fueron T3. En el 58,9% de los casos el tratamiento fue la RTU, en el 35,7% la cistectomía radical y en el 5,4% la cistectomía parcial. Un 42,9% no recibieron tratamiento adyuvante, un 30,4% recibieron quimioterapia y un 19,6% radioterapia. La supervivencia global con una media de seguimiento de 34,5 meses, y una mediana de 25 fue de 67,9%, un 64,3% libres de enfermedad. Si diferenciamos por subtipos histológicos, el 84,3% de los puros, el 100% de los predominantes y el 76,7% de los focales se presentaron con histologías infiltrantes (T2/T3). Un 78,9% de los puros, un 45% de los predominantes y un 45,5% de los focales fueron tratados con RTU. El 83% de los puros recibió tratamiento adyuvante, mientras que el 60% de los predominantes y el 63% de los focales no recibieron ninguna adyuvancia. La supervivencia libre de enfermedad en los estadíos T2/T3 fue de 87,5% para los puros con una mediana de seguimiento de 39 meses, del 75% para los predominantes con una mediana de 22 meses y del 0% para los focales con una mediana de 18 meses. Conclusiones: En el momento actual no se puede definir un protocolo terapéutico especifico para los pacientes afectos de carcinoma linfoepitelial vesical, aunque teniendo en cuenta la aparente buena evolución de los subtipos puro y predominante y la mala del subtipo focal, parece que la RTU podría ser una buena alternativa en determinados pacientes con histología pura o predominante, incluso en estadíos infiltrantes. En cambio, en el subtipo focal el tratamiento radical con cistectomía y adyuvancia sistémica parece la mejor alternativa (AU)

Objective: Lymphoepithelial-carcinoma or lymphoepithelioma-like carcinoma is a rare tumour, the histology of which remembers nasal pharyngeal is lymphoepitheliomas. Their presence has been described in multiple localizations, but only 55 cases have been described in the bladder. We present a new case of bladder lymphoepithelial carcinoma and performed a review of all published cases, with the aim of defining its characteristics and try to obtain a therapeutic and prognostic guide applicable to this disease. Methods: We reviewed the literature related to lymphoepithelial carcinoma and epidemiological characteristics, treatments administered, and outcomes of the 56 published cases (including ours) have been analyzed, both globally and as a function of histological subtypes following the classification of Amin et al. Results: 56 cases have been described, 40 males and 16 women, with a mean age of 69 years. Nineteen of the pure subtype (33.9%), 20 of the predominant type (35.7%) and I I focal (19.6%) were diagnosed, without any indications of histology in six of them (10.7%). Regarding tumor stages: 10.7% (6) were TI, 57. I% (32) T2, and 30.4% (I7) T3. 58.9% of the cases underwent transurethral resection (TUR), 35.7% radical cystectomy, and 5.4% partial cystectomy. 42.9% did not receive any adjuvant treatment, 30.4% received chemotherapy, and I9.6% radiotherapy. Overall survival was 67.9%, 64.3% disease-free, with a mean and median follow up of 34.5 and 25 months respectively. If we differentiate histological subtypes, 84.3% of the pure, 100% of the predominant, and 76.7% of focal presented infiltration (T2/T3). 78.9% of the pure, 45% of the predominant and 45.5% of the focal underwent TUR. 83% of the pure receive adjuvant treatment, whereas 60% of the predominant and 63% of the focal types did not receive any adjuvant treatment. Disease-free survival for stages T2/T3 was 87.5% for the pure with a median follow up of 39 months, 75% for the predominant with a median follow-up of 22 months and 0% for the focal with a median follow-up of I8 months. Conclusions: Currently, no specific therapeutic protocol can be established for patients with bladder lymphoepithelial carcinoma, although taking into consideration the apparent good outcome of the pure and predominant subtypes and the bad outcome of the focal subtype, it seems that TUR may be a good alternative in selected patients with pure our predominant histology, even with infiltrative stages. Oppositely, radical treatment with cystectomy and systemic adjuvant treatment seems to be the best choice for focal subtypes (AU)