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 (AU)

Introducción y Objetivos: La prostatectomía radicaltiene un gran impacto en la continencia urinaria. Muchosfactores intervienen en la continencia. El objetivo de esteestudio es evaluar el efecto en la tasa de incontinencia deorina de los Ejercicios de Suelo Pélvicos guiados previos ala prostatectomía radical robótica (PRR), frente a la información escrita.Material y Método: Ensayo clínico en el que se incluyen 62 pacientes en lista de espera para PRR, aleatorizándolos a un grupo experimental (ejercicios guiados porfisioterapeuta) o control (información escrita). El objetivoprimario fue la tasa de continencia medida por test de compresa y el cuestionario ICIQ-SF al mes de la intervención,Fueron objetivos secundarios, la severidad de incontinencia, la calidad de vida con cuestionarios SF-36 y KHQ, y lacorrelación entre la incontinencia y la calidad de vida.Resultados: No encontramos diferencias en la tasade incontinencia entre los grupos tras la intervención. Encontramos diferencias en “problemas emocionales” y “relaciones personales”, a favor del grupo control. Existe correlación entre la cantidad de las pérdidas de orina y la edad,la urgencia miccional y todos los dominios del cuestionarioKHQ excepto la calidad de vida general, así como en lasáreas “energía/fatiga” y “función social” del SF-36.Conclusiones: Los ejercicios guiados por fisioterapeuta antes de PRR no parecen ofrecer ventajas frente ala información escrita, en la tasa de incontinencia y severidad de la misma al mes de la intervención. La incontinenciade orina se correlaciona con la edad, la urgencia miccionaly el deterioro en la calidad de vida. (AU)

[Treatment of the dysfunction of the pelvic floor]. / Tratamiento de la disfunción del suelo pélvico.

The perineum is formed by muscle-aponeurotic elements that are integrated under the control of the nervous system. Their alterations are responsible for urogynecological, coloproctologic and sexual pathologies. In order to obtain a successful treatment, it is obliged not to forget the role that plays the perineum in those pathologies. The treatment of the dysfunction of the pelvic floor groups conservative techniques and procedures like changes in life habits, behavioural therapy, biofeedback, electroestimulation (neuromodulation and peripheral electrical stimulation) and training with muscular exercises of the pelvic floor (perineal rehabilitation). The objective of all of them is to improve or to obtain the urinary continence, the strengthening of its musculature to be able to balance pelvic static, to improve the local vascularization and the anorrectal function besides securing a satisfactory sexuality.

[Primary signet ring cell adenocarcinoma of the bladder]. / Adenocarcinoma vesical primario de células en anillo de sello.

An additional case of signet ring cell adenocarcinoma of the bladder is described. This tumor type is considered to be uncommon; however, recent studies have reported a higher incidence. The etiopathogenesis and clinical features are discussed. Because it is silent and very aggressive, it is always diagnosed late and the outcome is poor. Treatment is by surgery since radio and chemotherapy have been shown to be little effective.

[Ureteral revascularization in kidney transplantation. Report of a case]. / Revascularización ureteral en el transplante renal. A propósito de un caso.

We present uretero-pyeloplasty as a new surgical approach to stricture of the pyelo-ureteric junction in the transplant recipient. The foregoing is more frequently found in kidneys that are placed in the inverted anatomic position. The surgical procedure is performed without difficulty and at the same time permits us to evidence the presence of a new ureteral revascularization from the recipient after the interruption of vascular supply of the donor kidney.