[Occlusive urethral systems: can they constitute an alternative in the management of female stress incontinence?]. / Sistemas oclusivos uretrales: pueden constituir una alternativa en el manejo de la incontinencia urinaria femenina de esfuerzo?

OBJECTIVE: To determine the utility of the urethral plug in the management of female stress urinary incontinence. METHODS: A prospective clinical study was conducted in 20 female patients with stress urinary incontinence in order to evaluate the efficacy of a new urethral plug. The mean age was 59.6 +/- 6.2 years (range 40-66). The study design included 3 visits (4 weeks). The results were considered "positive" when urinary incontinence decreased and the patient referred a subjective sensation of improvement, and "negative" if otherwise. RESULTS: Positive results were demonstrated in 8 patients (40%). Ten patients (50%) refused to continue, mainly due to urinary tract infection in 7 cases (35%), difficulties in plug use (loss of plugs, anomalous urethral anatomy, cystocele,...) in 6 cases (30%) and urethral mucosa irritation in one case (5%). No plug migrated into the bladder. The initial urinary incontinence grade in the positive cases were: minor in 4 (50%), mild in 2 (25%) and severe in 2 (25%). We found no statistical relationship between the urinary incontinence grade and clinical results. The patients used a median of 5 plugs per day. Of the 10 patients who completed the study, 5 (50%) refused to continue using the plug and 5 (50%) decided to continue using the plug in combination with electrostimulation and/or pelvic floor exercises. CONCLUSIONS: The use of the urethral plug in the management of female stress urinary incontinence is not an alternative to surgical treatment or pelvic floor rehabilitation. However, it could be useful for patients who are unwilling or unfit for surgery. Finally, the urethral plug is an alternative to the use of collecting systems or devices in female stress urinary incontinence.

[Simplified Ramírez urethropexy in the treatment of genuine stress urinary incontinence in women. Multicenter study of clinical and urodynamic results]. / Uretropexia simplificada de Ramírez en el tratamiento de la incontinencia urinaria de esfuerzo genuina en la mujer. Estudio multicéntrico sobre los resultados clínicos y urodinámicos.

OBJECTIVES: To evaluate the clinical and urodynamic data of a multicenter study on female urinary stress incontinence undergoing surgical repair with the Ramírez simplified urethropexy. METHODS: Clinical, urodynamic and videocystographic data were analyzed in a multicenter series of 340 female patients with urinary stress incontinence (mean age 51.7 +/- 9.7 years) before and after the Ramírez urethropexy technique (mean follow-up 21.7 months). RESULTS: Post surgical urinary continence was 78.4%. Cystocele repair was demonstrated in 57.7%. Urge incontinence decreased in 17.1%. Daytime frequency statistically significantly decreased in 19%. Urinary obstructive symptoms increased in 19.3%. Bladder instability significantly decreased posturethropexy. Peak urinary flow rate and mean urinary flow rate diminished in 65% and 59%, respectively. Postvoiding residual urine increased significantly. No statistical correlation between posturethropexy continence and videocystographic bladder neck morphology was observed. CONCLUSIONS: The clinical and urodynamic data obtained in our series indicate that the Ramírez urethropexy technique, a simple and fast procedure, may be considered an alternative treatment in female urinary stress incontinence.

[Survival in stage T2-T3A bladder cancer treated with radical cystectomy]. / Supervivencia del cáncer de vejiga estadio T2-T3A tratado mediante cistectomía radical.

OBJECTIVE: The optimal treatment for patients with localized muscle-infiltrating urothelial carcinoma (Jewett stage B or T2-T3a of the TNM classification, UICC 1992) continues to be a controversy. The present study analyzed the survival rate in patients with stage T2-T3a bladder cancer who had been treated by radical cystectomy. METHODS: The records of 50 patients with T2-T3a NO tumor, submitted to pelvic lymphadenectomy and radical cystoprostatectomy, were reviewed to determine the prognosis in this group of patients. Seventeen patients (34%) received three courses of systemic chemotherapy (CMV) prior to cystectomy. RESULTS: The overall 5-year survival rate was 73%; 76% for those with T2 (n = 30) and 67% for those with T3a (n = 20) (log-rank, p = 0.27). No statistically significant differences were observed for age (less than or over 65 years), tumor growth pattern (papillary or flat), tumor size (less or greater than 5 cms) or treatment (with or without induction CMV). However, patients with G1-2 tumor had a better survival rate (94% at 5 years) than those with G3 tumor (51%), a difference with statistical significance (log-rank, p = 0.047). The Cox regression analysis showed no independent variable of prognostic significance. CONCLUSION: Muscle-infiltrating urothelial carcinoma is highly curable by radical surgery. Some authors believe it is unnecessary to distinguish T2-T3a lesions; therefore a critical review of the TNM classification appears to be warranted. We are unable to distinguish patients with a better prognosis that might benefit from less aggressive therapeutic options. Similarly, the therapeutic benefits of induction chemotherapy prior to cystectomy in patients with stage T2-T3a tumor could not be demonstrated.

[Spontaneous perinephric hematoma in a case of AIDS]. / Hematoma perinéfrico espontáneo en un caso de SIDA.

OBJECTIVE: To review the wide spectrum of urological manifestations in the HIV-infected population. METHODS: We report a case of spontaneous perinephric hematoma (non-traumatic) in a young male drug user with HIV infection. The patient was submitted to emergency nephrectomy after acute bleeding secondary to a subcapsular hematoma. He had no previous history of trauma. RESULTS: No underlying disorder was found and it is not known if the association with HIV infection is merely casual or not. This is an uncommon condition that is usually secondary to benign or malignant renal tumors, vascular anomalies and inflammatory disorder. In some cases, however, the underlying cause is never found. CONCLUSION: It must be emphasized that HIV-infected patients may consult for diverse urological disorders whose differential diagnosis may be difficult to establish.

[Retroperitoneal fibrosis secondary to treatment with L-dopa analogues for Parkinson disease]. / Fibrosis retroperitoneal secundaria a tratamiento con análogos de L-dopa por enfermedad de Parkinson.

OBJECTIVES: The present study describes two patients with retroperitoneal fibrosis following prolonged use of bromocriptine and pergolide for Parkinson's disease. Both patients also presented severe atheromatosis. METHODS: Similar cases reported in the literature are reviewed and the possible relationship between the use of the ergotamine derivate and severe atheromatosis is discussed. RESULTS: Both patients, a 67-year-old male and a 62-year-old female, improved after discontinuing bromocriptine, despite severe damage of renal function. CONCLUSIONS: Retroperitoneal fibrosis may develop in patients with bilateral ureteral obstruction, especially those who have received drugs that have been reported to cause the foregoing condition.

[Malacoplakia of the prostate and seminal vesicle. Ultrastructural study and review of the literature]. / Malacoplakia de la próstata y vesícula seminal. Estudio ultraestructural y revisión de la literatura.

OBJECTIVES: The present study describes a case of malacoplakia of the genitourinary tract arising in the seminal vesicle and prostate and reviews similar cases previously reported in the literature. METHOD: A 67-year-old male consulted for hemospermia and voiding symptoms. Prostatic neoplasm was suspected on the basis of the clinical and radiological findings. RESULTS: The diagnosis was made only after biopsy and histological analysis. Electron microscopy is a very useful tool. Long-term antibiotic therapy may achieve optimal results. Treatment with fluoroquinolones was successful. CONCLUSION: To avoid unwarranted radical approaches, we underscore the possibility that prostatic pseudotumors may be misinterpreted as neoplasia. Malacoplakia is diagnosed only by histology and requires medical treatment.

[Obstruction of the lower urinary tract: contractile capacity of the detrusor and obstruction degree. Analysis of pressure/flow curves]. / Obstrucción del tracto urinario inferior: capacidad contráctil del detrusor y grado de obstrucción. Análisis de las curvas de presión/flujo.

OBJECTIVES: This study attempts to optimize information from pressure/flow curves of patients with obstructive symptoms. METHODS: We performed a computerized analysis of the pressure/flow ratio of 50 consecutive patients with benign prostatic hyperplasia and irritative and obstructive symptoms. All patients were evaluated urodynamically. This model (pressure/flow diagram) will allow application of this test (expressed as flow and pressure measurements) to urethral outflow resistance and detrusor power or energy. Outflow obstruction is classified into seven categories (O-VI) and detrusor contractility in four (very weak, weak, normal and strong). RESULTS: The suitability of urodynamic analysis was demonstrated. Those cases considered as indeterminate by the conventional method can be obviated by computerized analysis. The degree of obstruction and the contractile capacity were determined in these cases. CONCLUSIONS: This method provides more accurate information on pathophysiology of voiding, allowing for better diagnosis of outflow obstruction or poor detrusor contractility and avoids the diagnosis of "undetermined".

[Radical prostatectomy: usefulness of selective electromyography of the periurethral sphincter in the assessment of urinary continence]. / Prostatectomía radical: utilidad de la electromiografía selectiva del esfínter periuretral en la valoración de la continencia urinaria.

The exact mechanisms of urinary continence in patients submitted to radical prostatectomy remain unknown. The aim of our study was to evaluate these mechanisms of continence through a complete urodynamic study, with a special emphasis on selective electromyography of the periurethral aphincter. Of a total of 10 consecutive patients who underwent radical prostatectomy between 1990-1993, a complete clinical control of urinary continence was demonstrated in 7 patients. The complete urodynamic work-up and particularly selective electromyography of the periurethral sphincter permitted evaluating the distal sphincteric mechanism and the degree of functional capacity. All of the cases showed loss of motor units, diminished electromyographic sphincter activity and incomplete lesion of the inferior motor neuron. The present study analyzed the pathophysiological, clinical and urodynamic aspects of these patients.

[Study, treatment and follow-up of 379 patients with urinary tract lithiasis]. / Estudio, tratamiento y seguimiento de 379 pacientes con litiasis del aparato urinario.

Between May 1988 and December 1989, 369 patients were seen at our lithiasis unit. During that time the Unit had neither "percutaneous nephroscope" nor "ureterorenoscope". Twenty-three percent of the patients were not susceptible to therapy either due to spontaneous extrusion of their lithiasis or because it was not considered indicated. Of the remaining 77% (296 cases) 94.5% were referred for extracorporeal lithotrity with shock waves, of which 89.8 were monotherapy and 4.7% a combination with other strategies (medico-lithic, surgical, endoscopic extrusion). At the time of collecting the results, 216 patients had undergone some treatment. In those receiving shock waves, an EDAP piezoelectric lithotripter was used in 19.9% and a HM3-Dornier in 80% of the cases. Taking into consideration the overall resulted from last examination of each patient, 67% were free from lithiasic residues, 25% had residues under 4 mm, and 7.7% residues over 4 mm. 19.4% of the patients developed some kind of complication and 9 patients had to be admitted to hospital.