[TVT our experience five years and six months later]. / Nuestra experiencia a cinco años y medio en TVT.

OBJECTIVE: We present the outcome of urinary incontinence surgery after TVT more than five year of follow-up. Efficacy was evaluated in terms of complete cure of incontinence, complications, and patient satisfaction. MATERIAL AND METHODS: A sample of 369 female with genuine stress incontinence or mixed incontinence who had a TVT performed in our hospital between 1998-2003 were evaluated. Sample average age was 59.9 years. A total of 326 patients (85%) had genuine stress incontinence and 56 (15%) mixed incontinence. Preoperative evaluation was base on: clinical history and physical examination, stress test, flowmetry and post voided residual. Cistometry was indicated only in patients with previous surgery and mixed incontinence. Severity of incontinence was graded clinically. Primary outcome measure was complete cure of incontinence defined as lack of objective and subjective leakage. In addition a phone survey about patient satisfaction with the surgery was carried out. RESULTS: The average follow up was 35 months (6-67). A total of 317 were complete continent (86%). By contrast, 52 patients (14%) had leakages jet. The novo urgency rate was 7% and a 5.7% of patients were reoperated to cut the mesh because of obstruction. Nevertheless, the reoperation rate was low and only a patient showed a massive haematoma which needed to be evacuated. CONCLUSION: Bursch Technique through suprapubic route has been classically considered the gold standard procedure for stress urinary incontinence for the last decades, having been substituted nowadays by tension-free suburethral mesh sling whose most important advantages are: Simplicity of the method, lower cost and higher comfort for the patient due to the fact that we have chaged in-patient surgery program for ambulatory one with similar results in order to sanation. Anyway we will have to check if the preliminary good results and no complications persist in the follow-up.

[Segmental testicular infarction]. / Infarto segmentario de testículo.

We report the case of a 47 years old man previously diagnosed of left hidrocele. After having a recent mild left testicular pain, an ultrasonografic study revealed a solid hipoecoic testicular lesion rounded by a big hidrocele, suggesting a testicular neoplasm. Radical inguinal orchiectomy was made and pathologic study showed segmental testicular infarction. No malignancy was found. We review the literature of the topic.

Nuestra experiencia a cinco años y medio en TVT / TVT our experience five years and six month later

Objetivo: Presentar los resultados de eficacia de TVT a cinco años en términos de curación de incontinencia y complicaciones para el tratamiento de la IUE y de satisfacción personal con el resultado de la intervención. Material y métodos: Un total de 369 incontinentes con una edad media de 59,9 años fueron implantadas con el sistema TVT en nuestro hospital pacientes desde 1998 hasta 2003. De ellas, 326 pacientes (85%) presentaban IUE pura y 56 (15%) incontinencia mixta con predominio de esfuerzo. La evaluación preoperatorio se realizó mediante historia clínica, exploración física, prueba de esfuerzo, flujometría y medición residuo postmiccional. La cistomanometría sólo se indicó en pacientes con urgencia o antecedentes de cirugía previa. El grado de severidad de la incontinencia se catalogó clínicamente. Como criterio de curación completa se consideró la ausencia de pérdidas objetivas y subjetivas. Se realizó encuesta telefónica para estudiar el grado de satisfacción de la paciente. Resultados: El seguimiento medio fue de 35 meses con un rango entre 6 y 67 meses. Del total de pacientes, 317 presentaban continencia completa, lo que representa un 86%. Por el contrario, 52 pacientes (14%) presentaban escapes de orina. La tasa de urgencia de novo fue del 7% y la de corte de TVT por obstrucción de 5,7%. El porcentaje de reintervenciones, con sólo un caso de hematoma masivo. Conclusiones: Hasta ahora se ha considerado siempre como patrón oro de las intervenciones de incontinencia de la orina, la técnica suprapúbica de Bursch, quizás la más contrastada en el tiempo, pero en la actualidad está siendo sustituida por las técnicas de malla suburetral sin tensión, cuya principal ventaja, es la simplicidad del método, su menor costo económico y la mayor comodidad para la paciente, pues convertimos una cirugía con varios días de ingreso, en una cirugía ambulatoria, con unos resultados hasta el momento similares en tasa de curación, Pero habrá que comprobar que los resultados a largo plazo de las mallas, si se mantienen en el tiempo y no aparecen complicaciones derivadas de la malla

Objective: We present the outcome of urinary incontinence surgery after TVT more than five year of follow-up. Efficacy was evaluated in terms of complete cure of incontinence, complications, and patient satisfaction. Material y methods: A sample of 369 female with genuine stress incontinence or mixed incontinence who had a TVT performed in our hospital between 1998-2003 were evaluated. Sample average age was 59.9 years. A total of 326 patients (85%) had genuine stress incontinence and 56 (15%) mixed incontinence. Preoperative evaluation was base on: clinical history and physical examination, stress test, flowmetry and post voided residual. Cistometry was indicated only in patients with previous surgery and mixed incontinence. Severity of incontinence was graded clinically. Primary outcome measure was complete cure of incontinence defined as lack of objective and subjective leakage. In addition a phone survey about patient satisfaction with the surgery was carried out. Results: The average follow up was 35 months (6-67). A total of 317 were complete continent (86%). By contrast, 52 patients (14%) had leakages jet. The novo urgency rate was 7% and a 5,7% of patients were reoperated to cut the mesh because of obstruction. Nevertheless, the reoperation rate was low and only a patient showed a massive haematoma which needed to be evacuated. Conclusión: Bursch Technique through suprapubic route has been classically considered the gold standard procedure for stress urinary incontinence for the last decades, having been substituted nowadays by tension-free suburethral mesh sling whose most important advantages are: Simplicity of the method, lower cost and higher comfort for the patient due to the fact that we have chaged in-patient surgery program for ambulatory one with similar results in order to sanation. Anyway we will have to check if the preliminary good results and no complications persist in the follow-up

Infarto segmentario de testículo / Segmental testicular infarction

Presentamos el caso de un varón de 47 años diagnosticado meses antes de hidrocele izquierdo que en estudio sonográfico reciente, realizado por dolorimiento testicular, presentaba lesión sólida nodular sugestiva de neoplasia testicular izquierda. Fue sometido a orquiectomía radical. El análisis de la pieza quirúrgica demostró la presencia de infarto segmentario con ausencia de tumor. Revisamos la bibliografía sobre el tema

We report the case of a 47 years old man previously diagnosed of left hidrocele. After having a recent mild left testicular pain, an ultrasonografic study revealed a solid hipoecoic testicular lesion rounded by a big hidrocele, suggesting a testicular neoplasm. Radical inguinal orchiectomy was made and pathologic study showed segmental testicular infarction. No malignancy was found. We review the literature of the topic

[Ambulatory major surgery: our experience]. / Cirugía mayor ambulatoria: nuestra experiencia.

INTRODUCTION: The first Surgery Ambulatory Unit was created in 1990, at the Hospital de Viladecans although in 1982 Polo et al. had commenced a programme of strictly ambulatory surgery. The Spanish Services of Urology are going to be incorporated to this new style of labour, and, by the moment, with excellent results. MATERIAL AND METHODS: We realize a description of the functioning of our service inside the Unit of Ambulatory Major Surgery, and a descriptive analysis of our activity in above mentioned unit since February 2000(creation date) to May 2001. RESULTS: 118 patients were operated, being 15% women and 85% men. The most frequent surgery done were: hydrocelectomy, orchiopexy, varicocelectomy, vesical distensions, Nesbit technique and internal urethrotomy. From the whole of the patients, none was increased, and the complication tax was similar to the conventional surgery patients. This kind of surgery suppose 17% in 2000 and 19% in 2001 of the whole of surgery, with clear increasing tendency in the last months. CONCLUSIONS: The Ambulatory Major Surgery is an effective and efficient care pattern in which Urology Services are included, so that the degree of satisfaction of the patients and the quality offered is similar to the inpatient surgery.

Cirugía mayor ambulatoria: nuestra experiencia / Ambulatory major surgery: Our experience

INTRODUCCIÓN: La primera Unidad de Cirugía sin Ingreso se creó en 1990 en el hospital de Villadecans, aunque ya en 1982 Polo y cols., comenzaron un programa de intervenciones estrictamente ambulatorias. Los servicios de Urología españoles se van incorporando poco a poco a este nuevo estilo de trabajo y de momento con excelentes resultados. MATERIAL Y MÉTODOS: Realizamos una descripción del funcionamiento de nuestro servicio dentro de la Unidad de Cirugía Mayor Ambulatoria (CMA) y un análisis descriptivo de nuestra actividad en dicha unidad desde febrero de 2000 (fecha de creación) hasta mayo de 2001. RESULTADOS: Se intervienen a 118 pacientes. Siendo 15 per cent mujeres y el 85 per cent hombres. Las intervenciones realizadas más frecuentes fueron: hidrocelectomías, orquidopexias, varicocelectomías, distensiones vesicales, técnica de Nesbit y uretrotomías internas. De todos los pacientes intervenidos ninguno requirió ingreso y el índice de complicaciones fue similar a los pacientes operados en régimen de cirugía convencional. Estas intervenciones suponen el 17 per cent en el año 2000 y el 19 per cent en el 2001 con una clara tendencia a aumentar en los últimos meses. CONCLUSIONES: La CMA es un modelo asistencial eficaz y eficiente en el cual los servicios de urología tienen cabida dado que el grado de satisfacción de los pacientes y la calidad que ofrece es igual que la cirugía con ingreso. INTRODUCCIÓN: La primera Unidad de Cirugía sin Ingreso se creó en 1990 en el hospital de Villadecans, aunque ya en 1982 Polo y cols., comenzaron un programa de intervenciones estrictamente ambulatorias. Los servicios de Urología españoles se van incorporando poco a poco a este nuevo estilo de trabajo y de momento con excelentes resultados. MATERIAL Y MÉTODOS: Realizamos una descripción del funcionamiento de nuestro servicio dentro de la Unidad de Cirugía Mayor Ambulatoria (CMA) y un análisis descriptivo de nuestra actividad en dicha unidad desde febrero de 2000 (fecha de creación) hasta mayo de 2001. RESULTADOS: Se intervienen a 118 pacientes. Siendo 15 per cent mujeres y el 85 per cent hombres. Las intervenciones realizadas más frecuentes fueron: hidrocelectomías, orquidopexias, varicocelectomías, distensiones vesicales, técnica de Nesbit y uretrotomías internas. De todos los pacientes intervenidos ninguno requirió ingreso y el índice de complicaciones fue similar a los pacientes operados en régimen de cirugía convencional. Estas intervenciones suponen el 17 per cent en el año 2000 y el 19 per cent en el 2001 con una clara tendencia a aumentar en los últimos meses. CONCLUSIONES: La CMA es un modelo asistencial eficaz y eficiente en el cual los servicios de urología tienen cabida dado que el grado de satisfacción de los pacientes y la calidad que ofrece es igual que la cirugía con ingreso (AU)

[Extrinsic ureteral obstruction secondary to appendiceal mucocele]. / Obstrucción ureteral extrínseca secundaria a mucocele apendicular.

OBJECTIVE: To report a case of extrinsic ureteral obstruction arising from mucocele of the appendix and review the clinical, diagnostic and therapeutic aspects of this appendiceal pathology of interest in urology. METHODS: A 71-year-old female patient that had previously undergone radical gynecological surgery and postoperative radiotherapy presented with right lumbar pain. Patient evaluation by ultrasound, IVP and CT showed a pelvic mass causing right extrinsic ureteral obstruction. Release and reinsertion of the right ureter and appendectomy were performed. RESULTS: The anatomopathological study showed an appendiceal mucinous cystadenoma. The patient is asymptomatic after surgery. CONCLUSIONS: Appendiceal mucocele is a dilatation of the vermiform appendix due to collection of mucoid material that is frequently produced by a cystadenoma. The presenting feature is usually that of acute appendicitis. The definitive diagnosis is based on the anatomopathological findings. Treatment is by appendectomy for the benign tumors and by right hemicolectomy in a second stage procedure for malignant tumors. This appendiceal pathology should be taken into account in the differential diagnosis of right extrinsic ureteral obstruction.

[Camey II type orthotopic bladder replacement and its complications: 10-year experience]. / Sustitución vesical ortotópica tipo Camey II y sus complicaciones: 10 años de experiencia.

BASIS: To evaluate the complications on patients undergoing radical cystectomy with Camey II ileal orthotopic neobladder. METHODS: To review our series of 61 radical cystectomies performed between 1990 and 1999 for bladder cancer. The complications were divided in early (30 days or less) and late. RESULTS: A patient died at the immediate postoperative. It appeared 35 early complications on 30 patients: 8 related with neobladder (urinary fistula and urinary infection) and 27 not related, being the most frequent those appearing at bowel site, with 10 early surgeries (16.4%). After evaluating 55 patients for late complications, 39 presented some kind of complication: 38 related with neobladder and 13 not related, 30 patients underwent surgery, being 19 of them under endoscopic way. 74.4% of continents by day and 31.4% at night. CONCLUSIONS: Despite the acceptable functional results, the orthotopic bladder substitution presents a not comptemtible rate of complications. In other way, a lack of standard criteria make difficult the comparation with other series and types of bladder substitution.

Sustitución vesical ortotópica tipo Camey II y sus complicaciones: 10 años de experiencia / Camey II ileal orthotopic neobladder and its complications. 10 years of experience

FUNDAMENTO: Evaluar las complicaciones en los pacientes sometidos a cistectomía radical con sustitución vesical ortotópica tipo Camey II. MÉTODOS: Se han revisado las historias clínicas de 61 pacientes sometidos a cistectomía radical con sustitución vesical tipo Camey II por neoplasia de vejiga, entre 1990 y 1999. Las complicaciones fueron divididas en precoces (30 días o menos) y tardías. RESULTADOS: Un paciente falleció en el post-operatorio inmediato. Se presentaron 35 complicaciones en 30 pacientes: 8 relacionadas con la neovejiga (fístulas urinarias e infecciones urinarias) y 27 sin relación con ella, siendo las más frecuentes las originadas a nivel intestinal, con un número de reintervenciones precoces de 10 (16,4 por ciento). De los 55 pacientes evaluados para las complicaciones tardías 39 presentaron algún tipo de complicación: 38 relacionadas con la neovejiga y 13 no relacionadas, con reintervenciones en 30 pacientes siendo 19 endoscópicas. La continencia diurna se ha obtenido en el 74,4 por ciento de los pacientes y la nocturna en el 31,4 por ciento. CONCLUSIONES: A pesar de los resultados funcionales aceptables, la sustitución vesical ortotópica presenta una tasa de complicaciones no desdeñable. Por otro lado, la falta de unanimidad de criterios hace que la comparación con otras series y otros tipos de sustitución vesical sea difícil (AU)

[T.V.T. (tension-free vaginal tape). New surgical technique in the treatment of stress urinary incontinence]. / T.V.T. (cinta libre de tensión) nueva técnica quirúrgica para el tratamiento de la incontinencia urinaria de esfuerzo.

OBJECTIVES: To describe the tension-free vaginal tape procedure (TVT) for treatment of female stress urinary incontinence and the short-term results. METHODS/RESULTS: From November 1998 to May 1999, the TVT procedure was performed in 20 patients with genuine stress urinary incontinence. All patients had a bladder catheter for 24 hours after surgery. Only one patient required intermittent catheterization for one month due to high quantities of post-void residual urine. There were no intraoperative complications. Early postoperatively one patient presented a hematoma in the posterior rectal aspect which was managed conservatively. At 4.5 months mean follow-up, 95% of the patients are continent and one is incontinent due to incorrect positioning of the prolene band. CONCLUSIONS: Although the initial results appear to be encouraging, further studies are warranted to determine the long-term efficacy of this technique.

[Laparoscopic extraperitoneal suspension of the neck of the bladder in stress incontinence: midterm results]. / Suspensión extraperitoneal laparoscópia del cuello vesical en la incontinencia de esfuerzo: resultados a medio plazo.

OBJECTIVE: There are few reports on the medium- and long-term outcomes of laparoscopic suspension of the bladder neck. METHODS: Our medium-term results in 24 patients with genuine stress urinary incontinence who underwent surgery from March, 1994 to July, 1996 are presented. The patients had a mean follow-up of 18 months. RESULTS: Although the initial results were encouraging, some failures appeared in the medium-term and incontinence recurred in 20%. CONCLUSIONS: The overall outcomes of laparoscopic suspension of the bladder neck did not differ from those achieved with the original technique of Pereyra-Stamey and the mean operating time was longer. The mean length of stay did not decrease and the rate of postoperative complications was similar. All the foregoing reasons have led us to abandon this procedure in the treatment of genuine stress urinary incontinence.

[Small cell undifferentiated carcinoma of the urinary bladder: report of a case]. / Carcinoma indiferenciado de células pequeñas en la vejiga urinaria: presentación de un caso.

Small cell carcinoma of the urinary bladder is an uncommon tumor. We report a case in a 80 year-old man. The patient had gross hematuria. Urographic and echographic studies revealed a sold tumor on the right wall of bladder. Pathologic study revealed a deeply invasive tumor composed of small, uniform, round and spindled shaped cells with hyperchromatic nuclei and numerous mitosis. The immunohistochemical reaction was positive for Neuron Especific Enolase and Keratin. No metastasis were found at clinical stating (T2 No Mo). We discuss the differencial diagnosis, prognosis and histogenesis of this tumor.

[Bladder bilharziasis: report of a case]. / Bilharziosis vesical: a propósito de un caso.

Herein we describe a case of vesical bilharziasis in a Spanish patient who became infected during a trip to an endemic area. The characteristic features of the disease and particularly its relationship to squamous type bladder tumors are discussed with a special focus on treatment with Praziquantel.

[Uretroperitoneal treatment of residual spheroids after prostatic adenomectomy]. / R.T.U. de esferoides residuales tras adenomectomía prostática.

After essential comments on the etiopathogenic, clinical, diagnostic and therapeutic aspects of "residual spheroid after a prostatic adenomectomy", the authors present nine cases of this pathology, found in the course of a review of 2,000 urinary endoscopies, which were treated successfully by means of U.T.R.