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)

Abdominal Aortic Aneurysm Complicated With Aorto-Left Retroaortic Renal Vein Fistula.

We present the case of a male with a fistula from an infrarenal aortic aneurysm to the left renal vein resolved with an endovascular prosthesis. Few cases have been reported in the literature.

Resultados del trasplante renal de donante vivo en receptores pediátricos, con injertos obtenidos por laparoscopia / Results of living donor kidney transplant in pediatric recipients, with graft obtained by laparoscopy

Objetivo. Analizar los resultados del trasplante renal de donante vivo relacionado (TDVR) en nuestro centro. Pacientes y método. Entre diciembre de 2005 y 2008 se han realizado en nuestro centro 34 trasplantes renales en receptores pediátricos, de los que 7 (20,58%) han sido TDVR con injertos obtenidos por vía laparoscópica. El donante fue la madre en 4 casos y el padres entres. La edad media de los donantes fue de 43 años (38-48) y la de los receptores de 12,5 años (9-17). Cuatro fueron un primer trasplante (uno (..) (AU)

Objective. Analyze the results of the living related donor kidney transplant (LRDKT) in our center. Patients and methods. Between December 2005 and 2008, 34 kidney transplants in pediatric recipients were performed in our center, 7(20.58%) of which were LRDKT with grafts obtained via laparoscopy. The donor was the mother in 4 cases and the father in 3. Mean age of the donors was 43 years (38-48) and of the recipients 12.5 years (9-17).Four were a first transplant (one of them planned) and three (..) (AU)

[Results of living donor kidney transplant in pediatric recipients, with graft obtained by laparoscopy]. / Resultados del trasplante renal de donante vivo en receptores pediátricos, con injertos obtenidos por laparoscopia.

OBJECTIVE: Analyze the results of the living related donor kidney transplant (LRDKT) in our center. PATIENTS AND METHODS: Between December 2005 and 2008, 34 kidney transplants in pediatric recipients were performed in our center, 7 (20.58%) of which were LRDKT with grafts obtained via laparoscopy. The donor was the mother in 4 cases and the father in 3. Mean age of the donors was 43 years (38-48) and of the recipients 12.5 years (9-17). Four were a first transplant (one of them planned) and three retransplantations. RESULTS: Cold ischemia time was < 2 hours in every case while warm ischemia did not show significant differences with the cadaveric donor transplant. None had initial graft dysfunction. No vascular complications occurred, but there was a urinary fistula secondary to ureteral necrosis, resolved with a new reimplantation. Survival of the patient and graft is 100%, superior to that of the cadaveric grafts within the same period. Current mean plasma creatinine is 0.8 mg/dl (0.7-1.39) and mean creatinine clearance is 80 cc/min/1.73 m2 (75-90). No donor had surgical complication and all maintain good kidney function. CONCLUSIONS: The short term results of the LRDKT with grafts obtained by laparoscopy in our center are similar to those described by groups with large experience, which makes it possible to continue offering it with guarantee.

[Ureteral meatotomy associated with vesicostomy, a possible urinary derivation?]. / Meatotomía ureteral asociada a vesicostomía, una posibilidad de derivación urinaria?

AIM: To show our experience in urinary derivation by ureteral meatotomy associated with vesicostomy. METHODS: We reviewed uni or bilateral ureteral meatotomy associated with vesicostomy carried out in our institution between 1989 and 2006. We report 20 patients (15 boys and 5 girls) with ages ranging from 1 month to 13-years-old (median 4,4-years-olds). Nine (45%) had neuropathic bladder, 6 (30%) posterior urethral valves and 5 (25%) vesicoureteral stenosis. RESULTS: Improvement of the ureteral dilatation controlled by ultrasound was demonstrated in 100% of the patients. Improvement of the renal function was observed in the group of patients (5) with renal failure. COMPLICATIONS: 2 bladder prolapses, 1 calculus and 1 postoperative bladder bleeding. CONCLUSIONS: Ureteral meatotomy associated with vesicostomy is an effective urinary derivation in children with obstructive urological conditions with an important dilatation in which ureteral reimplantation seems to be difficult. This derivation avoids bladder dysfunction and the management of the vesicostomy is comfortable by the use of a bag or the nappies.

[Biofeedback and electrostimulation in the treatment of non monosymptomatic enuresis]. / Biofeedback y electroestimulación como tratamiento de la enuresis no monosintomática.

AIM: To show our experience with biofeedback and electrostimulation techniques in the treatment of non monosymptomatic enuresis. METHODS: We reviewed biofeedback and electrostimulation techniques in the treatment of complicated enuresis carried out in our institution between 1995 and 2000. We report 99 patients (65 girls and 34 boys) with ages ranging from 5 to 14 years old. A complete urodinamy study divided the patients into 5 groups: detrusor-sphincter dysfunction (DSD) (47 patients), detrusor overactivity (DO) (25 patients), urge syndrome (US) (15 patients), sphincter hypertony (SH) (10 patients) and "retentionist" bladder (RB) (2 patients). Success was defined as less than three wet nights in a month. Biofeedback and electrostimulation program was designed in 10 sessions per week (20 minutes each session) with SIGMAX-Biomedical software. Tibial electrostimulation with SANS-UroSurge equipment was indicated when biofeedback and electrostimulation techniques failed (12 sessions per week, 30 minutes each session). RESULTS. The success rate has been 78.9% in DSD group, 80% in DO group, 85% in US group, 75% in SH group, 100% in RB group. CONCLUSIONS: Effectiveness of biofeedback and electrostimulation techniques in the treatment of non monosymptomatic enuresis has been reported and seems to be permanent in time.

Meatotomía ureteral asociada a vesicostomía, ¿una posibilidad de derivación urinaria? / Ureteral meatotomy associated with vesicostomy, a possible urinary derivation?

Objetivo. Mostrar nuestra experiencia en la derivación urinaria mediante meatotomía ureteral uni o bilateral asociada a vesicostomía. Material y métodos. Hemos realizado un estudio retrospectivo sobre una serie de 20 pacientes (15 niños y 5 niñas), sometidos a meatotomíaureteral junto con vesicostomía cutánea en nuestro servicio, entre los años 1989 y 2006. La edad media fue de 4,4 años (1 mes-13años). Nueve pacientes (45%) presentaban vejiga neuropática (7 con reflujo vesicoureteral secundario), 6 niños (30%) válvulas de uretra posterior, 3 estenosis vésico-ureterales bilaterales y 2 unilaterales(25%).Resultados. En el 100% de los niños se observó disminución ecográfica de la dilatación ureteropielocalicial tras la derivación; 5 de los casos que presentaban alteración de la función renal, mejoraron tras la intervención, controlado mediante el aclaramiento de creatinina. Como complicaciones se produjo prolapso vesical por la ostomía en 2 pacientes, litiasis en 1 y sangrado vesical postoperatorio en 1.Conclusiones. La meatotomía ureteral asociada a vesicostomía cutánea es una opción válida en niños que presentan una uropatía obstructiva vesical o infravesical con importante dilatación del tracto urinario superior en los que la reimplantación ureteral no se considera que pueda tener éxito. Evita la desfuncionalización vesical y el manejo dela vesicostomía resulta cómodo con bolsa o pañal (AU)

Aim. To show our experience in urinary derivation by ureteralmeatotomy associated with vesicostomy. Methods. We reviewed unior bilateral ureteral meatotomy associated with vesicostomy carried outin our institution between 1989 and 2006. We report 20 patients (15boys and 5 girls) with ages ranging from 1 month to 13 years old (median4,4 years ols). Nueve (45%) had neuropathic bladder, 6 (30%) posterior urethral valves and 5 (25%) vesicoureteral stenosis. Results. Improvement of the ureteral dilatation controlled by ultrasound was demonstrated in 100% of the patients. Improvement of the renal function was observed in the group of patients (5) with renal failure. Complications: 2 bladder prolapses, 1 calculus and 1 postoperative bladder bleeding. Conclusions. Ureteral meatotomy associated with vesicostomy is an effective urinary derivation in children with obstructive urologicalconditions with an important dilatation in which ureteral reimplantation seems to be difficult. This derivation avoids bladder dysfunction and the management of the vesicostomy is comfortable by the use of a (..) (AU)

Biofeedback y electroestimulación como tratamiento de la enuresis no monosintomática / Biofeedback and electrostimulation in the treatment of non monosymptomatic enuresis

Objetivo. Mostrar nuestra experiencia con las técnicas de biofeedbacky electro estimulación en el tratamiento de la enuresis no monosintomática. Material y métodos. Se analizaron los datos de 99 niños atendidos entre 1995 y 2000 por enuresis no monosintomática con edades comprendidas entre 5 y 14 años (65 niñas y 34 niños). Se les realizó estudio urodinámico completo para definir a los pacientes en cinco grupos: disfunción vesicoesfinteriana (47 pacientes), hiperactividad de detrusor (25 pacientes), urgencia sensorial (15 pacientes), hipertonía de esfínter (10 pacientes) y vejiga “retencionista” (2 pacientes). Se consideró como éxito menos de 3 noches húmedas al mes. El biofeedbacky la electroestimulación consistieron en 10 sesiones semanales de20 minutos con el equipo SIGMAX-Biomedical. Se indicó estimulación tibial en patologías en las que fracasaron tratamientos anteriores(12 sesiones de 30 minutos con el equipo SANS de UroSurge).Resultados. El éxito al fin del tratamiento fue del 78,9% en la disfunción vesicoesfinteriana, del 80% en la hiperactividad del detrusor, del 85% en la urgencia sensorial, del 75% en la hipertonía de esfínter y del 100% en la vejiga “retencionista”.Conclusiones. Los llamados “tratamientos alternativos” como el biofeedback y la electro estimulación son eficaces en el tratamiento dela enuresis no monosintomática. Esta eficacia se mantiene en el tiempo y es independiente de la disfunción miccional hallada (AU)

Aim. To show our experience with biofeedback and electrostimulation techniques in the treatment of non monosymptomatic enuresis. Methods. We reviewed biofeedback and electrostimulation techniques in the treatment of complicated enuresis carried out in our institution between 1995 and 2000. We report 99 patients (65 girls and 34boys) with ages ranging from 5 to 14 years old. A complete urodinamy study divided the patients into 5 groups: detrusor-sphincter dysfunction(DSD) (47patients), detrusor over activity (DO) (25 patients), urge syndrome(US) (15 patients), sphincter hypertony (SH) (10 patients) and “retentionist” bladder (RB) (2 patients). Success was defined as less than three wet nights in a month. Biofeedback and electrostimulation program was designed in 10 sessions per week (20minutes each session)with SIGMAX-Biomedical software. Tibial electrostimulation with SANS-UroSurge equipment was indicated when biofeedback and electrostimulation techniques failed (12 sessions per week,30 minute seach session).Results. The success rate has been 78,9% in DSD group, 80% in DO group , 85% in US group, 75% in SH group, 100% in RB group. Conclusions. Effectiveness of biofeedback and electrostimulation echniques in the treatment of non monosymptomatic enuresis has been reported and seems to be permanent in time (AU)

Cambios recientes en la mortalidad por cáncer de próstata en España: estudio de tendencias en el período 1991-2005 / Recent changes in prostate cancer mortality in Spain. Trends analysis from 1991 to 2005

Objetivo: Describir la evolución de la mortalidad por cáncer de próstata en España en el periodo 1991-2005. Sujetos y métodos: Realizamos un análisis de tendencia de las tasas estandarizadas de mortalidad (población estándar Europea) mediante análisis de regresión “joinpoint”, el cual nos permite estimar el porcentaje de cambio anual de las tasas y localizar cambios significativos en la tendencia. Resultados: Las tasas de mortalidad estandarizada alcanza su máximo valor en 1996. El análisis “joinpoint” identifica dos periodos diferentes en la tendencia de las tasas estandarizadas: uno inicial de incremento entre 1991 y 1996 (2,1% de incremento anual) y un segúndo periodo comenzando en 1996, en el que las tasas descienden un -2,7% anual. Conclusión: La tendencia de la mortalidad por cancer de prostata en España es similar a la de otras áreas industrializadas, con un incremento en las tasas estandarizadas que sufren un descenso hacia el final de la década pasada. El descenso en la mortalidad por cáncer de próstata es ahora evidente en 14 de las17 Comunidades Autónomas. El incremento del cribaje oportunistico con PSA y una mejora en el tratamiento, posiblemente actuando en combinación, constituye la hipótesis más plausible (AU)

Objetive: To describe the evolution of prostate cancer mortality in Spain during the period 1991-2005. Subjects and methods: A trend analysis for age standardized mortality rates (European standard population) was performed, using joinpoint regression analysis, which allows estimation of the annual percent change of rates and to find significant changes in such trend. Results: Age standardized mortality rates in Spain reached their peak value in 1996. The joinpoint analysis identified two different periods in the trend of the age standardized rates: a first one of increase in rates between 1991 and 1996 (2.1% annual increase) and a second period starting in 1996, in which rates decline at an annual rate of 2.7%.Conclusion: The tendency of prostate cancer seen in Spain resembles that of industrialized areas, with an increase in its age standardized death rates that suffers a downturn by the end of the past decade. Mortality declines for prostate cancer are now evident in 14 out of the 17 Autonomous Communities. Increases in PSA screening and better treatment of early-stage disease, possibly acting in combination, remain plausible hypotheses (AU)

[Congenital lumbar hernia and bilateral renal agenesis]. / Hernia lumbar congénita bilateral y agenesia renal.

We report a new case of congenital lumbar hernia. This is first case reported of congenital lumbar hernia and bilateral renal agenesis. We review literature and describe associated malformations reported that would be role out in every case of congenital lumbar hernia.

Enuresis: micción no controlada / Enuresis: uncontrollable urination

La enuresis se define como una micción normal, inconsciente e involuntaria durante el sueño (día o noche), al menos una vez a la semana, a partir de los 5 años de edad. Se clasifica como enuresis monosintomática cuando no se encuentra una causa con que relacionarla, y síndrome enurético cuando se acompaña de otros síntomas urológicos. Se considera primaria si sucede desde siempre y secundaria si aparece tras un periodo de control. Se trata de un problema frecuente de consulta en la práctica pediátrica, y el 14,9% de los niños son catalogados como enuréticos a los 5 años de edad. Su etiología es multifactorial, implicándose factores genéticos, madurativos, psicológicos, alteraciones del sueño y despertar y hormonales. El enfoque diagnóstico es distinto según la edad del niño y si la consulta se realiza por primera vez, si se realiza en una de pediatría o en una consulta de urodinámica. El tratamiento debe ser combinado e individualizado según el caso, asociándose normas básicas con refuerzo positivo, entrenamiento vesical, alarmas, desmopresina, imipramina, anticolinérgicos, biofeedback y electroestimulación

Enuresis is defined as normal, unconscious and involuntary urine loss in children over the age of five years, that occurs at least once a week while they are sleeping (during the day or night). Monosymptomatic or uncomplicated enuresis is considered in the absence of other symptoms associated with the urogenital tract. Polysymptomatic or enuretic syndrome is associated with other urological symptoms. At five years of age, 14.9% of children wet the bed. Numerous etiologic factors (genetic, developmental, psychological, sleep-wake disorders, hormonal) have been proposed. The diagnostic approach varies depending on the age of the child and on the attending physician. Treatment must be individualized and combined, based on positive reinforcement systems, bladder training, bed-wetting alarms, desmopressin, imipramine, biofeedback and electrostimulation

Hernia lumbar congénita bilateral y agenesia renal / Congenital lumbar hernia and bilateral renal agenesis

Presentamos un nuevo caso de hernia lumbar congénita bilateral. Este es el primer caso que asocia una agenesia renal bilateral. Hacemos una revisión de la literatura y una descripción minuciosa de las malformaciones asociadas que deben descartarse ante un caso de hernia lumbar congénita

We report a new case of congenital lumbar hernia. This is first case reported of congenital lumbar hernia and bilateral renal agenesis. We review literature and describe associated malformations reported that would be role out in every case of congenital lumbar hernia

[Xanthogranulomatous pyelonephritis in childhood. A case report]. / Pielonefritis xantogranulomatosa en la infancia. A propósito de un caso.

Xanthogranulomatous pyelonephritis is an uncommon chronic inflammatory renal disorder. Most cases have been described in middle aged women and it is extremely rare in children. We report a case of a 4 year old girl who suffered from recurrent urinary tract infection and antibiotic therapy resistance. She had low growth-rate and palpable left renal mass on examination and was confirmed by radiological findings. We performed left kidney partial resection and then histological examination showed focal xanthogranulomatous pyelonephritis. The focal form of the disease may respond to antibiotic treatment although usually an enucleation or partial resection must be performed. In conclusion xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass and recurrent urinary tract infection in childhood.

Pielonefritis xantogranulomatosa en la infancia. A propósito de un caso / Xanthogranulomatous pyelonephritis in childhood. A case report

La pielonefritis xantogranulomatosa es una rara inflamación crónica del parénquima renal. Predomina en mujeres de edad media y es extremadamente rara en niños. Presentamos el caso de una niña de 4 años de edad, con infecciones del tracto urinario de repetición y mala respuesta a tratamiento médico. La paciente tenía retraso pondo-estatural y una masa en hemiabdomen izquierdo a la exploración y en las pruebas de imagen. Se realizó heminefrectomía superior izquierda, con posterior confirmación histopatológica de pielonefritis xantogranulomatosa focal. El tratamiento más frecuente de la forma focal es la nefrectomía parcial, aunque a veces responde a tratamiento antibiótico. Como conclusión la pielonefritis xantogranulomatosa debe ser considerada dentro de un diagnóstico diferencial de un niño con un riñón aumentado de tamaño e infecciones recurrentes (AU)

Xanthogranulomatous pyelonephritis is an uncommon chronic inflammatory renal disorder. Most cases have been described in middle aged women and it is extremely rare in children. We report a case of a 4 years old girl who suffered from recurrent urinary tract infection and antibiotic therapy resistance. She had low growth-rate and palpable left renal mass on examination and was confirmed by radiological findings. We performed left kidney partial resection and then histological examination showed focal xanthogranulomatous pyelonephritis. The focal form of the disease may respond to antibiotic treatment although usually an enucleation or partial resection must be performed. In conclusion xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass and recurrent urinary tract infection in childhood (AU)

[Transurethral prostatic resection with bipolar scalpel]. / Resección transuretral de próstata con bisturí bipolar.

UNLABELLED: FUNDAMENTAL: [corrected] To show our initial experience in the TUR of prostate with bipolar axipolar bistoury. MATERIAL AND METHODS: Five patients with an average age of 72 years old, were operated between may and june 2002. They showed important increased in questionnaire symptoms (IPSS). The average ecographic volume has been 57.4 g. We employed Gyrus resector and physiological salt solution for continue irrigation. RESULTS: The average operative time was 70 minutes. None of the patients showed hyponatremia needed blood transfusion. In all the cases the sound was removed 48 hours after operation, one of them have urinary retention (UR) and need sound tow more days. Hospital stay was tree days except the patient how had UR. At 1 and 6 month there is improvement in the IPSS. CONCLUSIONS: TUR of prostate with bipolar axipolar bistoury can avoid the secondary effects of glicine and allows us to work with prostates of bigger volumes due to we have more time to do it. Nevertheless bigger and better studies are required to value the effectiveness of this new technology opposite the TUR of prostate with monopolar bistoury which keeps being the gold standard.

[Adrenal metastases of Ewing's sarcoma. Report of one case]. / Metastasis suprarrenal de sarcoma de Ewing. A propósito de un caso.

Adrenal metastases are more frequent than primary adrenal carcinoma. The most frequent are, in this order: breast and lung cancer, stomach and kidney carcinomas, adrenal gland contralateral tumors and melanoma. Less frequent are tumours of the bladder, colon, esophagus, gall bladder, liver, pancreas, prostate, stomach and uterus. The rest of the tumours rarely spread toward adrenal glands. The metastases to the adrenal glands caused by sarcomas are rare and normally they happen in the contest of a massive metastases affecting several organs at the same time. We present a case of a patient affected by adrenal metastases of Ewing's sarcoma who has been referred to us for surgical treatment because it is a unique metastases (there is no sing of more illnesses in other organs at the time of the exploration).

Resección transuretral de próstata con bisturí bipolar / Transuretral resection of prostate with bipolar electrobisturi

FUNDAMENTO: Presentar nuestra experiencia inicial en la RTU de próstata con bisturí bipolar axipolar. MATERIAL Y MÉTODO: Los sujetos de estudio han sido 5 pacientes con una edad media de 72 años intervenidos, entre mayo y junio de 2002. Todos presentaban valores elevados en el cuestionario de síntomas (IPSS). El volumen ecográfico medio fue 57,4 g. Se empleó el resector Gyrus® y suero fisiológico para irrigación. RESULTADOS: La duración media de la intervención fue de 70 minutos. Ningún paciente presentó hiponatremia ni precisó transfusión. En todos los casos se retiró la sonda a las 48 horas, produciéndose una retención aguda de orina (RAO), que precisó sonda dos días más. Todos fueron dados de alta al tercer día, salvo el paciente que presentó el episodio de RAO. Al mes y a 6 meses hay una mejoría mantenida del IPSS. CONCLUSIONES: La RTU de próstata con bisturí bipolar axipolar puede evitar los efectos secundarios de la reabsorción de glicina y permite abordar próstatas de mayor volumen al disponer de más tiempo para hacerlo. No obstante, hacen falta estudios más amplios para valorar la eficacia de esta nueva tecnología, frente a la RTU de próstata con bisturí monopolar que sigue siendo el patrón oro (AU)