Simultaneous Cystectomy and Nephroureterectomy due to Synchronous Upper Urinary Tract Tumors and Invasive Bladder Cancer: Open and Laparoscopic Approaches.

INTRODUCTION: It is not unusual for bladder tumors to appear following transitional cell carcinoma of the upper urinary tract (UUT), with involvement of the UUT, following invasive bladder cancer, being less common. The synchronous presence of transitional cell carcinoma of the bladder and of the UTT is exceptional. METHODS: Fifteen simultaneous cystectomies with nephroureterectomies were performed due to synchronous UUT and invasive bladder cancers (1997-2009). Surgery was performed using an open approach in 10 patients, while the last 5 procedures were performed laparoscopically. RESULTS: The mean age was 68.7 years. Mean surgery time was 348.6 minutes. Mean blood loss was 816 ml. Acute renal failure was the most frequent postoperative complication being present in 5 patients (33%). There was 1 case of a leak in the ureter-intestinal anastomosis (open approach), which required placement of a left-sided percutaneous nephrostomy. There were 2 cases of postoperative mortality, both in the open approach series and with intestinal neobladder. Mean follow-up time for the whole series was 21.25 months. Eight cases experienced metastatic progression of the disease (mean follow-up 17 months). CONCLUSION: Though multi-site studies with longer follow-up and a greater numbers of patients are needed, the moment at which urothelial tumors appear seems to influence their prognosis, with lower survival rates for tumors that synchronically appear.

Urinary tract endometriosis: clinical, diagnostic, and therapeutic aspects.

OBJECTIVES: To describe our experience at La Paz University Hospital with 12 patients with urinary tract endometriosis, an uncommon pathologic finding, the most extensive series published by Spanish investigators to our knowledge. METHODS: We performed a retrospective analysis of 12 cases of urinary tract endometriosis diagnosed from 1993 to 2008. RESULTS: The mean patient age was 37.75 years. Of the 12 patients, 5 had bladder involvement and 7 had ureteral involvement, 2 bilateral, 2 left, and 3 right. In those with bladder endometriosis, the diagnosis was made by cystoscopy and biopsy in 4 patients. Treatment consisted of laparoscopic hysterectomy and partial cystectomy in 1 patient and exploratory laparotomy, transvesical resection, and transurethral resection of the bladder in 3 patients. One of the patients who underwent transurethral resection of the bladder experienced 2 relapses. The first relapse was treated with transurethral resection of the bladder and the second with laparoscopic partial cystectomy. In the patients with ureteral endometriosis, the diagnosis was mainly established by magnetic resonance imaging. Treatment consisted of ureteroneocystostomy in 5 patients (bilateral in 1) and laparoscopic ureterolysis in 2, with later ureteral resection and end-to-end anastomosis in 1 of them. The patient who underwent bilateral ureteroneocystostomy finally required right autotransplantation because of early ureteral relapses. CONCLUSIONS: Urinary tract endometriosis is an uncommon pathologic finding. Surgery is the treatment of choice. We believe partial cystectomy should be considered as an initial option in selected cases, depending on the extent and location of lesions. For cases of ureteral endometriosis, the initial technique depends on the location and depth of the lesion.

[Paraurethral ballon implantation in the treatment of male urinary incontinence. La Paz University Hospital experience]. / Implante de balones parauretrales como tratamiento de la incontinencia urinaria masculina. Experiencia del Hospital Universitario La Paz.

OBJECTIVES: We want to show our experience with paraurethral balloon implantation in the treatment of male urinary incontinence. METHODS: We retrospectively reviewed our series from March 2003 to March 2007, including 69 male patients with urinary incontinence, most of them after radical prostatectomy. RESULTS: 6 patients did not have their first follow-up visit after surgery. Mean follow-up was 22 months (3-48). 57.14% of the patients (36/63 do not need pads, and 12.69% use one safety pad (8/63); therefore 69.83% (44/63) of the patients are dry or use one safety pad. If we stratify patients by incontinence severity, 81.25% of the patients with mild incontinence and 59.25% with moderate incontinence are dry. Nevertheless, only 35% of the patients with severe incontinence are dry (no protection). CONCLUSIONS: In our experience, we believe that paraurethral balloon implantation could be the first therapeutic option for mild and moderate male urinary incontinence.

Implante de balones parauretrales como tratamiento de la incontinencia urinaria masculina. Experiencia del Hospital Universitario la Paz / Paraurethral balloon implantation in the treatment of male urinary incontinence. La Paz University Hospital experience

Objetivo: Queremos expresar nuestra experiencia con el implante de balones parauretrales, como tratamiento de la incontinencia urinaria masculina. Métodos: Hemos revisado de forma retrospectiva nuestra serie desde marzo del 2003 a marzo del 2007, que incluye a 69 pacientes con incontinencia urinaria masculina, la mayoría tras prostatectomía radical. Resultados: 6 pacientes están pendientes de su primera revisión tras la cirugía. Con un seguimiento medio de 22 meses (3-48) el 57.14% de los pacientes (36/63) no precisan protección y el 12.69% usan una compresa de seguridad (8/63), por tanto el 69.83% (44/63) de los pacientes están secos o usan una compresa de seguridad. Si estratificamos a los pacientes según el grado de su incontinencia, el 81,25% de los pacientes con incontinencia leve están secos y el 59.25% de los pacientes en el grupo de incontinencia moderada. Sin embargo, solo el 35% de los pacientes con incontinencia severa están secos (sin protección). Conclusión: Según nuestra experiencia, pensamos que el implante de balones parauretrales podría ser la primera opción terapéutica para la incontinencia urinaria masculina leve y moderada (AU)

Objectives: We want to show our experience with paraurethral balloon implantation in the treatment of male urinary incontinence. Methods: We retrospectively reviewed our series from March 2003 to March 2007, including 69 male patients with urinary incontinence, most of them after radical prostatectomy. Results: 6 patients did not have their first follow-up visit after surgery. Mean follow-up was 22 months (3-48). 57.14% of the patients (36/63 do not need pads, and 12.69% use one safety pad (8/63); therefore 69.83% (44/63) of the patients are dry or use one safety pad. If we stratify patients by incontinence severity, 81.25% of the patients with mild incontinence and 59.25% with moderate incontinence are dry. Nevertheless, only 35% of the patients with severe incontinence are dry (no protection). Conclusions: In our experience, we believe that paraurethral balloon implantation could be the first therapeutic option for mild and moderate male urinary incontinence (AU)