[Impact of bladder irritative symptoms and detrusor instability on the outcome of urethropexy]. / Repercusión de los síntomas irritativos vesicales e inestabilidad del detrusor en los resultados de la uretropexia.

OBJECTIVES: To evaluate the repercussion of irritative urinary symptoms and bladder instability on the results of urethropexy for urinary stress incontinence. METHODS: A clinical and urodynamic study was carried out in 70 adult women submitted to urethropexy (Kelly, Raz, Marshall-Marchetti-Krantz, Burch or simplified Ramirez technique). RESULTS: The urge incontinence symptom was associated with coughing incontinence is 38 (60%) of the patients submitted to urethropexy. This symptom decreased to 42% (27 patients) after urethropexy. The average score of diurnal urinary frequency was 23% less posturethropexy. The simplified Ramirez technique had the lowest diurnal urinary frequency score [1.17 +/- 1.07 (0 to 3)]. Bladder instability with urinary stress incontinence (mixed incontinence) was found in 21 (30%) patients before urethropexy. The incidence of bladder instability after urethropexy was significantly greater in this group (52%) than in the patients with isolated urinary stress incontinence (17%). However, urethropexy also corrected bladder instability in 30% of the women with mixed incontinence. The Kelly technique produced the lowest incidence of bladder instability after urethropexy (14%). CONCLUSIONS: Urethropexy significantly decreases the irritative urinary symptoms associated with stress urinary incontinence. In some cases, bladder instability associated with stress incontinence (mixed incontinence) may disappear following urethropexy. In most cases bladder instability continues after urethropexy.

[The usefulness of micturition flow acceleration in the diagnosis of bladder instability]. / Utilidad de la aceleración del flujo miccional en el diagnóstico de la inestabilidad vesical.

The acceleration of flow rate (ml/sg2) is a urodynamic parameter derived from free flow uroflowmetry. The present study was conducted to determine the role of this new parameter as an alternative to the standard filling cystometry in the diagnosis of detrusor instability in nocturnal enuresis, prostatism and female urinary incontinence. We have observed that it is not a useful parameter due to the large overlapping of the patients with unstable and normal bladder. For this reason it is not possible to establish significant predictive values.

[Urological surgery in the octogenarian: excessive preconceptions?]. / Cirugía urológica en el octogenario: demasiados prejuicios?

We reviewed the records of 277 patients aged 80 or older that had been considered for surgery during the period 1980-1990. We analyzed the surgical risk (Goldman and ASA score), patient history, type of surgery and the post-operative course (Karnofsky index) in order to identify the risk factors and to permit objective and practical selection of patients amenable to surgical treatment. Overall, regardless of sex, the benign (35%) and malignant (18%) diseases of the prostate and bladder neoplasms (30%) accounted for more than 80% of the surgical procedures. The early postoperative complications were shown to be influenced by the type of surgery (emergency surgery), the approach (open surgery), the presence of preoperative urinary tract infections and the ASA score. Regardless of the cure rate, the analysis of the postoperative course and data gleaned from telephone interviews indicate that 61.5% of the patients probably had a very good or good quality of life at 6 months. In the non-operated group 1 out of 10 procedures that had been anticipated was not performed and many had a malignant disease. Although there were more patients with fair/poor quality of life in the patient group that did not undergo surgery than in the operated group (42.8% versus 28.5%, respectively), patient general condition at 6 months was very good or good in 50% of the patients that were followed or interviewed. The use of the preoperative evaluation methods and our clinical experience can eliminate subjective evaluation and permit developing safe and precise surgical programs.

[Cutaneous and gynecologic metastases disclosing renal-cell carcinoma: the diagnostic and therapeutic implications]. / Metástasis cutáneas y ginecológicas reveladoras del carcinoma de células renales: implicaciones diagnósticas y terapéuticas.

The spread of is uncommon renal cell carcinoma to the female genital system it is even more uncommon to observe metastasis or its symptoms or signs, masking or preceding the clinical manifestations of the primary lesion. In the course of nephrectomy due to renal tumor, the early ligation of the gonadal vein during the control maneuvers of the vascular pedicle can reduce the risk of posterior genital metastasis. Similarly, the skin is an uncommon site of metastasis. The appearance of cutaneous metastasis from renal cell carcinoma may precede the detection of the underlying tumor, although most of the cutaneous metastases are observed after the primary lesion has been detected. In patients with solitary skin metastasis and no evidence of spread to other organ systems, nephrectomy and excision of the metastatic lesion have permitted a survival of 35% at 5 years.

[Penile metastases. Report of 3 new cases and review of the national literature]. / Metástasis peneanas. Aportación de tres nuevos casos y revisión de la literatura nacional.

Penile metastasis from primary tumors at other sites are extremely rare. To our knowledge, Alonso Gorrea reported the first case in the Spanish literature in 1980. Since then, 20 cases have been reported. Three additional cases of penile metastasis from tumors at other sites are described herein. The pathogenesis, symptoms, prognosis and treatment of this tumor type are discussed.