Tratamiento quirúrgico ambulatorio de la incontinencia urinaria de esfuerzo femenina bajo anestesia local-sedación con cabestrillo transobturatriz de incisión única (Contasure-Needleless) / Outpatient Surgical Treatment of Female Stress Urinary Incontinence Under Local Anesthesia-sedation With Contrasure Needleless Incision

Objetivo: Evaluar los resultados obtenidos en el tratamiento quirúrgico ambulatorio de la incontinencia urinaria de esfuerzo femenina (IUE) con el empleo de un TOT de una sola incisión Contasure-Needleless (Neomedic-Internacional). Pacientes y método: Entre enero de 2007 y diciembre de 2011 hemos intervenido con anestesia local-sedación y en régimen estrictamente ambulatorio a 96 pacientes afectas de IUE mediante la colocación de cabestrillo suburetral sin tensión Needlelees. Se evalúan los criterios de inclusión y alta, así como los resultados obtenidos y el grado de satisfacción mediante la elaboración de un cuestionario. En todas las pacientes se realizó test de esfuerzo, estudio urodinámico y cuestionario de calidad de vida (ICIQ-SF) antes del procedimiento y al menos 3 meses después de la intervención. Resultados: La tolerancia al procedimiento fue buena. El tiempo quirúrgico fue inferior a 10 min y el de permanencia en el hospital hasta el alta menor de 2 h. Los resultados obtenidos son superponibles a los alcanzados con anestesia epidural e ingreso, siendo el grado de satisfacción con el tratamiento recibido superior al 90%. Conclusiones: La práctica totalidad de pacientes afectas son candidatas a incluirse en un programa de cirugía ambulatoria, mejorando ostensiblemente la relación coste-eficacia, no disminuyendo por ello la calidad asistencial ni el grado de satisfacción. Asimismo, el sistema Contasure-Needleless cumple los criterios de cirugía de mínima invasión, proporcionando una mayor estabilidad del cabestrillo que las «minibandas» de tercera generación, en virtud de una mayor longitud de la malla así como un menor dolor postoperatorio respecto al TOT convencional, por no precisar incisiones cutáneas

Objective: To evaluate the results obtained from out-patient surgical treatment of female stress urinary incontinence (SUI) with the use of trans-obturator tape (TOT) of a single Contrasure-Needleless incision (Neomedic-International). Patients and method: We performed an intervention with local anesthesia-sedation in outpatient regime between January 2007 and December 2011 on 96 patients affected by SUI using the placement of Needleless tension-free suburethral sling. Inclusion and discharge criteria and the results obtained as well as satisfaction grade were evaluated by a questionnaire. All the patients underwent a stress test, urodynamic study and quality of life questionnaire (ICIQ-SF) prior to and at least 3 months after the intervention. Results: Tolerance to the procedure was good. Surgical time was less than 10 min and stay in the hospital up to discharge less than 2 h. The results obtained are superimposable to those reached with epidural anesthesia and hospitalization, the grade of satisfactions with the treatment received being superior to 90%. Conclusions: Almost all of the patients affected are candidates for inclusion in an outpatient surgery program. This noticeably improves the cost-efficacy ratio, without decreasing the health care or grade of satisfaction. Furthermore, the Contasure-Needleless system fulfills the criteria for minimally invasive surgery, providing better stability of the sling than the third generation ‘minibands’ due to the greater length of the mesh and less post-operative pain regarding the conventional TOT as no cutaneous incisions are required

Outpatient surgical treatment of female stress urinary incontinence under local anesthesia-sedation with contrasure needleless incision.

OBJECTIVE: To evaluate the results obtained from out-patient surgical treatment of female stress urinary incontinence (SUI) with the use of trans-obturator tape (TOT) of a single Contrasure-Needleless incision (Neomedic-International). PATIENTS AND METHOD: We performed an intervention with local anesthesia-sedation in outpatient regime between January 2007 to December 2011 on 96 patients affected by SUI using the placement of Needleless tension-free suburethral sling. Inclusion and discharge criteria and the results obtained as well as satisfaction grade were evaluated by a questionnaire. All the patients underwent a stress test, urodynamic study and quality of life questionnaire (ICIQ-SF) prior to and at least 3 months after the intervention. RESULTS: Tolerance to the procedure was good. Surgical time was less than 10 minutes and stay in the hospital up to discharge less than 2hours. The results obtained are superimposable to those reached with epidural anesthesia and hospitalization, the grade of satisfactions with the treatment received being superior to 90%. CONCLUSIONS: Almost all of the patients affected are candidates for inclusion in an outpatient surgery program. This noticeably improves the cost-efficacy ratio, without decreasing the health care or grade of satisfaction. Furthermore, the Contasure-Needleless system fulfills the criteria for minimally invasive surgery, providing better stability of the sling than the third generation "minibands" due to the greater length of the mesh and less post-operative pain regarding the conventional TOT as no cutaneous incisions are required.

Diagnóstico fotodinámico con hexaminolevulinato en el cáncer vesical no músculo invasivo: experiencia del grupo BLUE / Hexaminolevulinate photodynamic diagnosis in non-muscle invasive bladder cancer: experience of the BLUE group

Objetivos: El diagnóstico fotodinámico (DFD) con hexaminolevulinato se ha empezado a utilizar recientemente para mejorar la detección del cáncer vesical no músculo invasivo. Nuestro objetivo principal fue comparar el rendimiento diagnóstico de DFD frente a endoscopia con luz blanca convencional (LB) en nuestro medio. Material y métodos: Se realizó cistoscopia fluorescente con hexaminolevulinato en el momento de la RTU a 305 pacientes de 7 hospitales españoles. Todas las lesiones detectadas con LB y DFD fueron enumeradas y registradas en una base de datos online. Se analizó histopatológicamente cada lesión por separado. En 148 pacientes se tomaron además biopsias múltiples aleatorias (BMA). Resultados: Se biopsiaron un total de 1.659 lesiones: 522 identificadas con DFD y LB, 237 sólo con DFD, 19 sólo con LB y 881 BMA. De 600 neoplasias diagnosticadas DFD detectó 563, LB 441 y BMA 29 (20 CIS). La tasa media de sobredetección de DFD sobre LB fue del 31,9% globalmente, pero en el caso del CIS fue del 209%. La sensibilidad de DFD fue 93,8% y la de LB 78,2%. La especificidad de DFD fue 81,5% y la de LB 90,5%. En el 23% de los pacientes se detectó al menos una lesión neoplásica más con DFD que con LB. Conclusión: La RTU con hexaminolevulinato mejora el rendimiento diagnóstico y la calidad de la resección del cáncer vesical superficial, especialmente del CIS. La mayor sensibilidad de DFD es a costa de una menor especificidad. En nuestro estudio BMA rescató algunos falsos negativos de DFD para detectar CIS (AU)

Objectives: Photodynamic diagnosis (PDD) with hexaminolevulinate has been recently used to improve detection of non-muscle invasive bladder cancer. Our main purpose was to quantify the benefit of PDD vs. conventional white light cystoscopy (WL) in our area. Material and methods: Fluorescence-guided cystoscopy using hexaminolevulinate was performed at the time of the transurethral resection (TUR) in 305 patients from 7 Spanish hospitals. All lesions found with WL and PDD were numbered and recorded in an online database. Each lesion was sent separately for pathology analysis. Random biopsies were also obtained in 148 patients. Results: A total of 1659 lesions were biopsied: 522 were identified with PDD and WL, 237 only with PDD, 19 only with WL and 881 random biopsies. Of the 600 tumors, PDD detected 563, WL 441 and random biopsies 29 (20 CIS). The mean overdetection rate for PDD over WL was 31.9% for all types of lesions, but it was 209% for carcinoma in situ (CIS). Sensitivity was 93.8% for PDD and 78.2% for WL. Specificity was 81.5% for PDD and 90.5% for WL. In 23% of patients, PDD detected at least one additional neoplastic lesion compared to WL. Conclusions: Hexaminolevulinate fluorescence cystoscopy improves detection and resection of non-muscle invasive bladder cancer, especially of CIS. Sensitivity of PDD is higher than WL, but specificity is lower. In our study, random biopsies were able to detect some CIS not visible under PDD (AU)

[Hexaminolevulinate photodynamic diagnosis in non-muscle invasive bladder cancer: experience of the BLUE group]. / Diagnóstico fotodinámico con hexaminolevulinato en el cáncer vesical no músculo invasivo: experiencia del grupo BLUE.

OBJECTIVES: Photodynamic diagnosis (PDD) with hexaminolevulinate has been recently used to improve detection of non-muscle invasive bladder cancer. Our main purpose was to quantify the benefit of PDD vs. conventional white light cystoscopy (WL) in our area. MATERIAL AND METHODS: Fluorescence-guided cystoscopy using hexaminolevulinate was performed at the time of the transurethral resection (TUR) in 305 patients from 7 Spanish hospitals. All lesions found with WL and PDD were numbered and recorded in an online database. Each lesion was sent separately for pathology analysis. Random biopsies were also obtained in 148 patients. RESULTS: A total of 1659 lesions were biopsied: 522 were identified with PDD and WL, 237 only with PDD, 19 only with WL and 881 random biopsies. Of the 600 tumors, PDD detected 563, WL 441 and random biopsies 29 (20 CIS). The mean overdetection rate for PDD over WL was 31.9% for all types of lesions, but it was 209% for carcinoma in situ (CIS). Sensitivity was 93.8% for PDD and 78.2% for WL. Specificity was 81.5% for PDD and 90.5% for WL. In 23% of patients, PDD detected at least one additional neoplastic lesion compared to WL. CONCLUSIONS: Hexaminolevulinate fluorescence cystoscopy improves detection and resection of non-muscle invasive bladder cancer, especially of CIS. Sensitivity of PDD is higher than WL, but specificity is lower. In our study, random biopsies were able to detect some CIS not visible under PDD.