Nuestra experiencia con minicintas (TVT Secur y MiniArc) en la cirugía de la incontinencia urinaria de esfuerzo / Our experience with mini tapes (TVT secur and miniarc) in the surgery for stress urinary incontinence

Objetivos: El objetivo de esta publicación es describir la técnica quirúrgica, evaluar las complicaciones y los resultados a corto plazo de las cintas TVT secur y MiniArc. Material y Método: entre Octubre de 2006 y Agosto 2007 se realizó corrección quirúrgica con TVT SecurTM, Women’s Health & Urology, Ethicon, Johnson & Johnson, colocando la cinta en forma de hamaca, a 51 pacientes, 38 de ellas con incontinencia de esfuerzo pura y 13 con incontinencia mixta y con una edad media de 57 años.Entre Septiembre 2007 y Febrero de 2008 se intervino con cinta AMS MiniarcTM swing system, colocada en hamaca, a 41 pacientes, 33 pacientes con incontinencia de esfuerzo pura y 8 con incontinencia mixta, con une dad media de 58 años. Todos los procedimientos se realizan con sedoanalgesia y en régimen de Cirugía Mayor Ambulatoria. Las pacientes fueron controladas en consultas externas al mes, 3 meses y al año. Se les realizó historia clínica y cuestionario ICIQ- SF al que le añadimos una pregunta para cuantificar el grado de satisfacción, así como exploración física. Comparamos los resultados de ambas técnicas y realizamos estudio estadístico mediante test de Student. [Análisis con el programa informático SPSS (V14.0)]. Resultados: La mediana de seguimiento en el grupo TVT secur fue de 328 días (rango 163-522 días) y en el grupo MiniArc de 101 días (rango 41-209 días). De las 92 paciente intervenidas, 51 con TVT secur y 41 con MiniArc solo registramos una complicación quirúrgica con TVT secur que fue una perforación vesical. Considerando como curación objetiva que la paciente en la exploración física realizada en consulta con vejiga llena presente un test de esfuerzo negativo. En el grupo TVT secur el 80,4% de las pacientes están curadas y en el grupo de MiniArc el 90,2% no existiendo diferencias significativas entre ambos grupos ( p 0,095). Para evaluar la curación subjetiva utilizamos el test ICIQ-SF y la pregunta de satisfacción y observamos como, en el control al mes y tercer mes no existen diferencias significativas, estando el 90% de las pacientes satisfechas. En el control anual, sólo realizado en el grupo TVT secur, el 80 % de las pacientes se encuentran muy satisfechas. Conclusión: Estas nuevas cintas presentan un número menor de complicaciones permiten la posibilidad de colocación con anestesia local pero todavía son necesarios estudios aleatorizados con un mayor seguimiento (AU)

Background: The purpose of this publication is to describe the surgical technique, assess complications and short-term results of TVT secur and MiniArc tapes. Materials and Methods: From October 2006 to August 2007 it was carried out the surgical correction with TVT SecurTM, Women’s Health & Urology, Ethicon, Johnson & Johnson, placing the tape as a hammock, to 51 patients, 38 of them with pure stress incontinence and 13 with mixed incontinence and with an average age of 57 years. From September 2007 to February 2008 41 patients, 33 of them with pure stress incontinence and 8 with mixed incontinence, with an average of age of 58 years were operated with AMS MiniarcTM swing system tape, posted on hammock. All procedures were performed with sedoanalgesia and Ambulatory Surgery regime. Patients were monitored in outpatient visits one month, 3 months and one year after surgical procedure .Medical history and questionnaire and ICIQ-SF, to which we added a question to quantify the degree of satisfaction, as well as physical examination, were done. We compared the results of both technical procedures and statistical survey was conducted by Student test. [Analysis with SPSS software (V14.0)]. Results: The median follow-up in TVT secur group was 328 days (range 163-522 days) and 101 days (range 41-209 days) in the MiniArc group. We only had one (TVT secur group) surgical complication in all the series (92 patients) being a bladder perforation. Taking in to account that we read a negative test effort as an objective cure in the TVT secur group, 80.4% patients are cured and 90.2% in the MiniArc group without significant difference between both groups (p 0095). To assess the subjective healing we utilized the ICIQ-SF test and the satisfaction extra-question and we noted that there is no significant difference between the first and third month controls. (90%of patients satisfied). 80% of patients were completely satisfied in the first year control that was only performed to TVT secur group. Conclusion: These new tapes show fewer complications that the TVT-O and TOT tapes and allow the possibility of placement with local anesthesia but further studies are needed (AU)

[Our experience with mini tapes (TVT Secur and MiniArc) in the surgery for stress urinary incontinence]. / Nuestra experiencia con minicintas (TVT Secur y MiniArc) en la cirugía de la incontinencia urinaria de esfuerzo.

BACKGROUND: The purpose of this publication is to describe the surgical technique, assess complications and short-term results of TVT secur and MiniArc tapes. MATERIALS AND METHODS: From October 2006 to August 2007 it was carried out the surgical correction with TVT Secur,Women's Health & Urology, Ethicon, Johnson & Johnson, placing the tape as a hammock, to 51 patients, 38 of them with pure stress incontinence and 13 with mixed incontinence and with an average age of 57 years. From September 2007 to February 2008 41 patients, 33 of them with pure stress incontinence and 8 with mixed incontinence, with an average of age of 58 years were operated with AMS Miniarc swing system tape, posted on hammock. All procedures were performed with sedoanalgesia and Ambulatory Surgery regime. Patients were monitored in outpatient visits one month, 3 months and one year after surgical procedure. Medical history and questionnaire and ICIQ-SF, to which we added a question to quantify the degree of satisfaction, as well as physical examination, were done. We compared the results of both technical procedures and statistical survey was conducted by Student test. [Analysis with SPSS software (V14.0)]. RESULTS: The median follow-up in TVT secur group was 328 days (range 163-522 days) and 101 days (range 41-209 days) inthe MiniArc group. We only had one (TVT secur group) surgical complication in all the series (92 patients) being a bladder perforation. Taking into account that we read a negative test effort as an objective cure in the TVT secur group, 80.4% patients are cured and 90.2% inthe MiniArc group without significant difference between both groups (p 0095). To assess the subjective healing we utilized the ICIQ-SF test and the satisfaction extra-question and we noted that there is no significant difference between the first and third month controls. (90% of patients satisfied). 80% of patients were completely satisfied in the first year control that was only performed to TVT secur group. CONCLUSION: These new tapes show fewer complications that the TVT-O and TOT tapes and allow the possibility of placement with local anesthesia but further studies are needed.

[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.

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

[Minimal prostatic adenocarcinomas in the biopsy treated with radical prostatectomy]. / Adenocarcinomas minimos de próstata en la biopsia sometidos a prostatectomía radical.

FUNDAMENTALS: Valuation about clinical pathologyc facts of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy. METHODS: Retrospective analysis of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy in front of the remaining radical prostatectomies. RESULTS: In 20 patients (7.6%) out of the 260 having undergone a radical prostatectomy between 1992 and 2004 the biopsy was informed as "minimal adenocarcinoma". These patients ranged 58 to 73 years with PSA levels from 5.2 to 17.1 ng/ml. Everyone except one were clinically T1c. At the definitive pathological study the Gleason was 6, 4, 3 and 2 in 3, 3, 8 and 4 patients respectively, with one having a minimal adenocarcinoma not graded and another one with a PIN ?. 3 showed only 1 focus with a tumoral volume less than 5% of the tissue (84.2% with significant tumor or multifocal). The final staging was 1 pT0 (PIN ?), 7 pT2a, 11 pT2b and 1 pT3a (62.5% bilaterals). Relating to the remaining patients under prostatectomy, patients with minimal adenocarcinoma presented significative differences in Gleason sum (p < 0.029) and staging (p = 0.02); no in PSA mean (p = 0.243). SUMMARY: Minimal adenocarcinomas of the prostate at the biopsy are significant but do present lower staging and grading in relation with the rest of patients.

[Micropapillary carcinoma of the bladder: case report and review of the literature]. / Carcinoma micropapilar de vejiga: aportación de un caso y revisión de la bibliografía.

Micropapillary carcinoma is an uncommon pathologic variant of bladder carcinoma with aggressive behavior. Its usual presentation is like a high grade and high stage carcinoma and associated with other histologic types in different proportion. It doesn't differ clinically from normal transitional cell carcinoma of the bladder. Studies of molecular markers are still contradictories. Treatment should be early and aggresive, based on surgical therapy as radiotherapy and chemotherapy have shown limited results. We report a 72 year old man suffering from low urinary tract symptoms for years and recently presented gross hematuria. He was diagnosed as high stage micropapillary carcinoma. One year after radical cystectomy and subsequent chemotherapy based on carboplatin and gemcitabine, progression of the disease was shown on CT and the patient died 14 months after the diagnosis.

Adenocarcinomas mínimos de próstata en la biopsia sometidos a prostatectomía radical / Minimal prostatic adenocarcinomas in the biopsy treated with radical prostatectomy

Fundamento: Valoración de datos clínico-patológicos de pacientes sometidos a prostatectomía radical por mínimo adenocarcinoma prostático en la biopsia. Métodos: Análisis retrospectivo de pacientes intervenidos de prostatectomía radical por mínimo adenocarcinoma, frente al resto de prostatectomías radicales. Resultados: En 20 pacientes (7,6 %), de los 260 sometidos a prostatectomía radical entre 1992 y 2004, se definió la biopsia como 'mínimo adenocarcinoma'. Tenían edades entre 58 y 73 años y los PSA entre 5,2 y 17,1 ng/ml. Todos, excepto uno eran clínicamente T1c. En la anatomía-patológica definitiva el Gleason fue de 6, 4, 3 y 2, en 3, 3, 8 y 4 pacientes respectivamente, con uno con mínimo adenocarcinoma no graduado y sólo un PIN-III en otro. Tres presentaron un solo foco con un volumen tumoral inferior al 5% del tejido (el 84,2 % con tumor significativo). El estadio final fue 1 pT0 (PIN III), 7 pT2a, 11 pT2b y 1 pT3a (62,5% bilaterales). Con respecto al resto de pacientes prostatectomizados, los pacientes con mínimo adenocarcinoma presentaron diferencias significativas en los Gleason (p=0,029) y los estadios (p= 0,02); no en la media del PSA (p=0,243). CONCLUSIONES: Los adenocarcinomas de próstata mínimos en la biopsia son significativos, aunque presentan estadios y grados inferiores al resto (AU)

Fundamentals: Valuation about clinical pathologyc facts of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy. Methods: Retrospective analysis of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy in front of the remaining radical prostatectomies. Results: In 20 patients (7,6%) out of the 260 having undergone a radical prostatectomy between 1992 and 2004 the biopsy was informed as 'minimal adenocarcinoma'. These patients ranged 58 to 73 years with PSA levels from 5.2 to 17.1 ng./ml. Everyone except one were clinically T1c. At the definitive pathological study the Gleason was 6, 4, 3 and 2 in 3, 3, 8 and 4 patients respectively, with one having a minimal adenocarcinoma not graded and another one with a PIN III. 3 showed only 1 focus with a tumoral volume less than 5% of the tissue (84.2% with significant tumor or multifocal). The final staging was 1 pT0 (PIN III ), 7 pT2a, 11 pT2b and 1 pT3a (62.5% bilaterals). Relating to the remaining patients under prostatectomy, patients with minimal adenocarcinoma presented significative differences in Gleason sum (p < 0.029) and staging (p = 0.02); no in PSA mean (p =0,243). Summary: Minimal adenocarcinomas of the prostate at the biopsy are significant but do present lower staging and grading in relation with the rest of patients (AU)

Carcinoma micropapilar de vejiga: aportación de un caso y revisión de la bibliografía / Micropapillary carcinoma of the bladder: case report and review of the literature

El carcinoma micropapilar (CMP) es una variante anatomopatológica infrecuente de carcinoma vesical de comportamiento agresivo. Se presenta habitualmente como carcinoma de alto grado, en estadios avanzados y asociado a otras formas histológicas en proporciones variables. No manifiesta signos clínicos diferenciales con el carcinoma vesical típico. Los estudios de marcadores moleculares son todavía contradictorios. El tratamiento debería ser precoz y agresivo, fundamentalmente quirúrgico, dado que la Radioterapia y la Quimioterapia han demostrado escasa eficacia hasta el momento. Presentamos el caso de un varón de 72 años con síntomas miccionales de larga evolución y hematuria macroscópica de reciente aparición que se diagnosticó de CMP en estadio avanzado. Al año dela cistectomía radical asociada a quimioterapia con carboplatino y gemcitabina se evidenció progresión rápida de la enfermedad y falleció a los 14 meses (AU)

Micropapillary carcinoma is an uncommon pathologic variant of bladder carcinoma with aggressive behavior. Its usual presentation is like a high grade and high stage carcinoma and associated with other histologic types in different proportion. It doesn´t differ clinically from normal transitional cell carcinoma of the bladder. Studies of molecular markers are still contradictories. Treatment should be early and aggresive, based on surgical therapy as radiotherapy and chemotherapy have shown limited results. We report a 72 years old man suffering from low urinary tract symptoms for years and recently presented gross hematuria. He was diagnosed as high stage micropapillary carcinoma. One year after radical cystectomy and subsequent chemotherapy based on carboplatin and gemcitabine , progression of the disease was shown on CT and the patient died 14 months after the diagnosis (AU)

[TVT: three years of experience]. / TVT: 3 años de experiencia.

INTRODUCTION: Since the description of the TVT technique as a therapy to stress urinary incontinence, in 1996, about 150000 subjects have undergone it. This technique was first used in our centre in november 1998. This article is aimed to contain our view of its evolution in the past three years. MATERIALS AND METHODS: 142 patients of an average of 59 years old have been operated on. In 57% of the cases, we also focused on the solutions to anatomic pelvis disorders. RESULTS: After a follow-up of 17 months and a mean of 14 months, 93% of the cases succeeded. Failures arose during the first six months of therapy. We found the following complications: 4.8% of bladder perforations, 17% of postoperative retentions of no longer than 30 days, 2% of long-term retentions, 2.7% of postsurgical hematomas, and 9% of urge incontinence. Surgery was performed on 10 patients who had undergone surgery against bladder incontinence before, and all the cases proved success. CONCLUSIONS: This technique is simple and only requires a short surgical time, and it can be applied for major ambulatory surgery. Although it is possible to encounter complications, they rarely occur and results are still encouraging. However, it is now necessary to verify that our long-term studies match with the success rates of 84.7%.

TVT: 3 años de experiencia / TVT: three years of experience

INTRODUCCIÓN: Desde la descripción de la técnica de TVT para el tratamiento de la incontinencia urinaria de esfuerzo en 1996, se han colocado unas 150.000 unidades. En noviembre de 1998 iniciamos esta técnica en nuestro servicio, en este artículo analizamos nuestros casos en estos tres años. MATERIAL Y MÉTODOS: Hemos intervenido a 142 pacientes, con una edad media de 59 años. En el 57 por ciento de ellas, además de realizar TVT, asociamos reparación de defectos anatómicos pélvicos. RESULTADOS: Con un seguimiento medio de 17 meses y mediana de 14 meses el 93 por ciento de las pacientes están curadas. Los fracasos aparecieron de forma precoz en los 6 primeros meses de seguimiento. Como complicaciones aparecieron un 4,8 por ciento de perforaciones vesicales, retenciones post-operatorias de menos de 30 días en el 17 por ciento, retenciones a largo en el 2 por ciento, hematomas post-quirúrgicos en el 2,7 por ciento y urgencia de novo en el 9 por ciento. La cirugía se realizó en 10 pacientes con antecedentes de cirugía pelviana anti-incontinencia con buenos resultados en todos los casos. CONCLUSIONES: Es una técnica quirúrgica sencilla, que requiere un corto tiempo quirúrgico, y que puede ser realizada en régimen de cirugía mayor ambulatoria. Es una técnica no exenta de complicaciones aunque la proporción de ellas es baja y con unos resultados que siguen siendo alentadores (aunque debemos esperar que nuestros estudios a largo plazo coincidan con los ya publicados con tasas de éxito del 84,7 por ciento) (AU)

Leiomioma de escroto: aportación de un caso / Leiomyoma of scrotum: contribution of one case

El leiomioma escrotal es un tumor raro de comportamiento benigno, asintomático, originado en el músculo dartos y cuyo tratamiento de elección es quirúrgico. Presentamos un nuevo caso en un paciente varón de 68 años con una masa escrotal de 10 años de evolución que, tras ser extirpada, el diagnóstico anatomopatológico fue de leiomioma (AU)

Scrotal leiomyoma is a benign rare tumour, asymptomatic, which origin is the dartos muscle and the election treatment is surgical. We report a new case in a 68-year-old patient with a 10 years history of a scrotal tumour and anatomopathological diagnostic post surgery was leiomyoma (AU)

[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.

[Syringocele of the Cowper's gland]. / Siringocele de la glándula de Cowper.

OBJECTIVE: To report an additional case of syringocele of Cowper's glands and briefly review its etiopathogenesis, diagnosis and treatment. METHODS/RESULTS: A 26-year-old male consulted for a recent voiding syndrome and chronic postvoid dribbling. A voiding cystourethrogram demonstrated a syringocele, which was confirmed during endoscopic treatment. CONCLUSIONS: Syringocele or cystic dilatation of Cowper's gland duct usually has a congenital etiology. There are four morphological types: simple, perforated, imperforate and ruptured. Diagnosis is made by voiding cystourethrography and confirmed by endoscopy. Transperineal ultrasound was also utilized for the diagnosis. Treatment is by endoscopic incision.

[Leiomyoma of the bladder. Report of a case]. / Leiomioma de vejiga. A propósito de un caso.

Benign bladder tumors of mesenchymal origin have a very low appearance incidence, being the most frequent the leiomyoma. We report new case, making a discussion about the complementary tests needed for the diagnose.

[Post-surgical spindle cell nodule in kidney pelvis]. / Nódulo fusocelular post-quirúrgico en pelvis renal.

INTRODUCTION: The postoperative spindle cell nodule of the urinary tract is a being proliferative lesion similar to sarcoma in the microscopic exam. We present a case of modulein renal pelvis location. CASE: A woman presenting a stag horn lithiasis in left kidney was treated by LOC and percutaneous nephroscopy. Because of the large size of the stone a second intervention was required four weeks later. Then we discovered a 2 cm exophytic lesion in renal pelvis and removed it easily with a forceps. DISCUSSION: This kind lesion belong to the group of iatrogenic inflammatory pseudotumours, which are secondary to an injury that leads to a tissular repairing response. Differential diagnostic includes sarcomas. CONCLUSION: It is important that Urology and pathology specialist think of this tumour in patients having a recent surgical intervention. A mistake in the diagnosis would lead us to an unnecessary radical surgery.