Magnetic resonance imaging to evaluate anterior pelvic prolapse: H line is the key.

INTRODUCTION: The aim of the study is to compare clinical staging of anterior pelvic prolapse with magnetic resonance imaging (MRI) staging, using the pubococcygeal line (PCL), the midpubic line (MPL), and the H line as reference lines. Moreover, we aim to analyze interrater reliability of each reference line. MATERIAL AND METHODS: Forty-two women with pelvic organ prolapse (POP) symptoms were studied using the pelvic organ prolapse quantification on physical examination. Two different observers calculated anterior POP using the three MRI reference lines, retrospectively. Agreement between MRI and clinical staging was estimated using Pearson correlation for the quantitative measurements and kappa index for the stages. Interrater reliability was estimated using the intraclass correlation coefficient (ICC). RESULTS: Correlation between physical examination and the H line was high by both observers (r = 0.86 and r = 0.76, p < 0.01). The correlation was lower using MPL (r = 0.76 and r = 0.65, p < 0.01). The results of comparing MRI staging and physical examination were: κ = 0.618 and κ = 0.602 for the H line, κ = 0.273 and κ = 0.267 for MPL and κ = -0.105 and κ = -0.140 for PCL. The results of interrater reliability were: ICC of 0.968 for the H line, ICC of 0.788 for MPL, and ICC of 0.737 for PCL. CONCLUSION: Anterior POP staging using MRI H line as a reference presents a better agreement with clinical staging than PCL or MPL. The H line has better interrater reliability. The H line could replace the current lines.

[Urinary tract hemangiopericytoma treated with radical surgery and neoadjuvant chemotherapy. Report of two cases.] / Hemangiopericitoma en la via urinaria tratados con cirugía radical y quimioterapia neoadyuvante. A propósito de dos casos.

OBJECTIVE: Hemangiopericytoma is a tumor of vascular origin. It is very rare in the prostate. They are generally aggressive tumors. Currently, the treatment of choice is radical surgery. In the literature, there are less than 50 cases described, and neoadjuvant treatment has not been reported in any article. This treatment presents positive responses in another type of sarcomas. Our goal is to report two cases of malignant hemangiopericytoma. The first case was treated with radical surgery and the second case was treated with neoadjuvant chemotherapy before surgery. METHODS: The first case is a 40 year old male. Obstructive urinary symptoms were his first symptoms. A prostate mass with tumor characteristics was seen on ultrasound. After transrectal biopsy, he was diagnosed with hemangiopericitoma. Because the tumor size, neoadjuvant chemotherapeutic prior to radical surgery was decided. The second case is a 77 year old male with an incidental diagnosis of renal mass. After radical nephrectomy, he was diagnosed with hemangiopericitoma. He did not receive adjuvant chemotherapy. RESULTS: In the first case, after neoadjuvant therapy, tumor size was reduced significantly. A pelvic exenteration with radical cystoprostatectomy and rectal resection and Bricker type urinary diversion and colostomy were carried out. In the second case controls after radical nephrectomy were correct and he did not need any treatment. CONCLUSIONS: In urinary tumors, the prostate hemangiopericytoma is a rare entity. Currently, neoadjuvant chemotherapy is not established as treatment for these tumors. For other sarcomas neoadyuvant treatment has good response. In our case, a good result was obtained with neoadjuvant chemotheraphy before surgery. However, a greater number of cases are necessary to establish the use of neoadjuvant chemotherapy in urinary hemangiopericytomas.

OBJETIVO: El hemangiopericitoma es un tumor de origen vascular muy infrecuente en la próstata. Son tumores de características agresivas y actualmente el tratamiento de elección es la cirugía radical. En la literatura existen descritos menos de 50 casos de hemangiopericitomas, y ninguno con tratamiento neoadyuvante. Dicho tratamiento neoadyuvante está descrito en otro tipo de sarcomas con buenas respuestas. Presentamos dos casos de un hemangiopericitoma maligno, uno tratado sólo con cirugía radical y otro con neoadyuvancia quimioterápica previa a la cirugía radical.MATERIAL Y MÉTODOS: El primer caso es un varón de 40 años con síntomas urinarios obstructivos. Se diagnosticó de hemangiopericitoma tras realización de biopsia transrectal. Se decidió neoadyuvancia quimioterápica previa a la cirugía. El segundo paciente es un varón de 74 años con hallazgo accidental de masa renal. Tras nefrectomía radical se diagnosticó de hemangiopericitoma. RESULTADOS: Tras la neoadyuvancia, en el primer paciente, se realizó una cistoprostatectomía radical y una resección de recto con derivación urinaria tipo Bricker y colostomía. El segundo paciente no precisó tratamiento adyuvante tras la cirugía radical. CONCLUSIONES: El hemangiopericitoma es una entidad rara en los tumores urinarios. Actualmente la neoadyuvancia quimioterápica no está establecida como pilar del tratamiento de estos tumores, aunque en otros campos donde los sarcomas son más frecuentes, si que se objetiva mejor respuesta. En nuestro caso obtuvimos una buena respuesta con dicha neoadyuvancia previa a la cirugía, aunque es necesario un mayor seguimiento a una mayor cohorte de pacientes para establecer el uso de la quimioterapia neoadyuvante en los hemangiopericitomas urinarios.

Hemangiopericitoma en la via urinaria tratados con cirugía radical y quimioterapia neoadyuvante. A propósito de dos casos / Urinary tract hemangiopericytoma treated with radical surgery and neoadjuvant chemotherapy. Report of two cases

Objetivo: El hemangiopericitoma es un tumor de origen vascular muy infrecuente en la próstata. Son tumores de características agresivas y actualmente el tratamiento de elección es la cirugía radical. En la literatura existen descritos menos de 50 casos de hemangiopericitomas, y ninguno con tratamiento neoadyuvante. Dicho tratamiento neoadyuvante está descrito en otro tipo de sarcomas con buenas respuestas. Presentamos dos casos de un hemangiopericitoma maligno, uno tratado sólo con cirugía radical y otro con neoadyuvancia quimioterápica previa a la cirugía radical. Material y métodos: El primer caso es un varón de 40 años con síntomas urinarios obstructivos. Se diagnosticó de hemangiopericitoma tras realización de biopsia transrectal. Se decidió neoadyuvancia quimioterápica previa a la cirugía. El segundo paciente es un varón de 74 años con hallazgo accidental de masa renal. Tras nefrectomía radical se diagnosticó de hemangiopericitoma. Resultados: Tras la neoadyuvancia, en el primer paciente, se realizó una cistoprostatectomía radical y una resección de recto con derivación urinaria tipo Bricker y colostomía. El segundo paciente no precisó tratamiento adyuvante tras la cirugía radical. Conclusiones: El hemangiopericitoma es una entidad rara en los tumores urinarios. Actualmente la neoadyuvancia quimioterápica no está establecida como pilar del tratamiento de estos tumores, aunque en otros campos donde los sarcomas son más frecuentes, si que se objetiva mejor respuesta. En nuestro caso obtuvimos una buena respuesta con dicha neoadyuvancia previa a la cirugía, aunque es necesario un mayor seguimiento a una mayor cohorte de pacientes para establecer el uso de la quimioterapia neoadyuvante en los hemangiopericitomas urinarios

Objective: Hemangiopericytoma is a tumor of vascular origin. It is very rare in the prostate. They are generally aggressive tumors. Currently, the treatment ofchoice is radical surgery. In the literature, there are less than 50 cases described, and neoadjuvant treatment has not been reported in any article. This treatment presents positive responses in another type of sarcomas. Our goal is to report two cases of malignant hemangiopericytoma. The first case was treated with radical surgery and the second case was treated with neoadjuvant chemotherapy before surgery. Methods: The first case is a 40 year old male. Obstructive urinary symptoms were his first symptoms. A prostate mass with tumor characteristics was seen on ultrasound. After transrectal biopsy, he was diagnosed with hemangiopericitoma. Because the tumor size, neoadjuvant chemotherapeutic prior to radical surgery was decided. The second case is a 77 year old male with an incidental diagnosis of renal mass. After radical nephrectomy, he was diagnosed with hemangiopericitoma. He did not receive adjuvant chemotherapy. Results: In the first case, after neoadjuvant therapy, tumor size was reduced significantly. A pelvic exenteration with radical cystoprostatectomy and rectal resection and Bricker type urinary diversion and colostomy were carried out. In the second case controls after radical nephrectomy were correct and he did not need any treatment. Conclusions: In urinary tumors, the prostate hemangiopericytoma is a rare entity. Currently, neoadjuvant chemotherapy is not established as treatment for these tumors. For other sarcomas neoadyuvant treatment has good response. In our case, a good result was obtained with neoadjuvant chemotheraphy before surgery. However, a greater number of cases are necessary to establish the use of neoadjuvant chemotherapy in urinary hemangiopericytomas

[Report of two cases of malignant mesothelioma of the tunica vaginalis.] / Analisis de dos casos de mesotelioma maligno de la túnica vaginal.

OBJECTIVE: Paratesticular mesothelioma isan infrequent tumor and only 250 cases have been published.It originates in the scrotal tunica vaginalis. It represents0.3-1.4% of mesotheliomas and it predominates inpatients with history of asbestos exposure and old age. Itsdiagnosis is usually casual. Our objective is to present thecases that occurred in our service with malignant paratesticularmesothelioma and to carry out a review of the currentliterature on this pathology. METHODS: We report two cases diagnosed with malignantparatesticular mesothelioma that happened in the lasttwo years. RESULT: The first case was a 73-year-old male with asymptomatichydrocele. The second was a 57-year-oldmale who had testicular pain and hydrocele. Both werediagnosed of mesothelioma after hydrocelectomy. The firsttreatment was radical orchiectomy in both cases. The firstpatient did not need more treatments. The second patientpresented pulmonary nodules, lymphadenopathy and localrelapse, which was treated with chemotherapy and localresection. CONCLUSION: Paratesticular mesothelioma is an infrequenttumor. Scrotal mass associated with hydrocele is thetypical form of presentation. Surgical treatment consists ofradical orchiectomy. They have poor prognosis because inmost cases there is rapid local and dissemination.

OBJETIVO: El mesotelioma paratesticular es  un tumor infrecuente, con menos de 250 casos publicados, originado en la túnica vaginal escrotal. Representa el 0,3-1,4% de los mesoteliomas. Predomina en pacientes añosos, con la exposición al asbesto y su diagnóstico sueleser casual. Nuestro objetivo es presentar dos casos ocurridos en nuestro servicio con mesotelioma paratesticular maligno y realizar una revisión de la literatura actual sobre dicha patologia.MÉTODO: Aportamos dos casos diagnosticados de mesotelioma paratesticular maligno acontecidos en nuestro servicio durante los últimos dos años. RESULTADO: El primer caso es un varón de 73 años que debutó con hidrocele sin dolor. El segundó es un varón de 57 años que inició su clínica con un cuadro de dolor testicular e hidrocele. En ambos se diagnostica de mesotelioma maligno de la túnica vaginal tras hidrocelectomía. Se realiza como tratamiento inicial una orquiectomía radical en ambos pacientes. El primer paciente no precisó ningún tratamiento adicional. El segundo paciente presentó nódulos pulmonares y adenopatías junto con recidiva local, que se trató con quimioterapia y resección local.CONCLUSIÓN: El mesotelioma paratesticular es un tumor infrecuente, sin una clínica especifica. Su forma típica de presentación es una masa escrotal indolora asociada a hidrocele.El tratamiento quirúrgico consiste en orquiectomía radical. En la mayoría de los casos existe una rápida diseminación local y a distancia que otorgan a estos tumores un mal pronóstico.

Analisis de dos casos de mesotelioma maligno de la túnica vaginal / No disponible

Objetivo: El mesotelioma paratesticular es un tumor infrecuente, con menos de 250 casos publicados, originado en la túnica vaginal escrotal. Representa el 0,3-1,4% de los mesoteliomas. Predomina en pacientes añosos, con la exposición al asbesto y su diagnóstico suele ser casual. Nuestro objetivo es presentar dos casos ocurridos en nuestro servicio con mesotelioma paratesticular maligno y realizar una revisión de la literatura actual sobre dicha patologia. Método: Aportamos dos casos diagnosticados de mesotelioma paratesticular maligno acontecidos en nuestro servicio durante los últimos dos años. Resultado: El primer caso es un varón de 73 años que debutó con hidrocele sin dolor. El segundó es un varón de 57 años que inició su clínica con un cuadro de dolor testicular e hidrocele. En ambos se diagnostica de mesotelioma maligno de la túnica vaginal tras hidrocelectomía. Se realiza como tratamiento inicial una orquiectomía radical en ambos pacientes. El primer paciente no precisó ningún tratamiento adicional. El segundo paciente presentó nódulos pulmonares y adenopatías junto con recidiva local, que se trató con quimioterapia y resección local. Conclusión: El mesotelioma paratesticular es un tumor infrecuente, sin una clínica especifica. Su forma típica de presentación es una masa escrotal indolora asociada a hidrocele. El tratamiento quirúrgico consiste en orquiectomía radical. En la mayoría de los casos existe una rápida diseminación local y a distancia que otorgan a estos tumores un mal pronóstico

Objective: Paratesticular mesothelioma is an infrequent tumor and only 250 cases have been published. It originates in the scrotal tunica vaginalis. It represents 0.3-1.4% of mesotheliomas and it predominates in patients with history of asbestos exposure and old age. Its diagnosis is usually casual. Our objective is to present the cases that occurred in our service with malignant paratesticular mesothelioma and to carry out a review of the current literature on this pathology. Methods: We report two cases diagnosed with malignant paratesticular mesothelioma that happened in the last two years. Result: The first case was a 73-year-old male with asymptomatic hydrocele. The second was a 57-year-old male who had testicular pain and hydrocele. Both were diagnosed of mesothelioma after hydrocelectomy. The first treatment was radical orchiectomy in both cases. The first patient did not need more treatments. The second patient presented pulmonary nodules, lymphadenopathy and local relapse, which was treated with chemotherapy and local resection. Conclusion: Paratesticular mesothelioma is an infrequent tumor. Scrotal mass associated with hydrocele is the typical form of presentation. Surgical treatment consists of radical orchiectomy. They have poor prognosis because in most cases there is rapid local and dissemination

Perfil del paciente con vejiga hiperactiva tratado con dosis flexible de antimuscarínicos en la práctica clínica diaria / Profile of oab patient on treatment with flexible-dose antimuscarinic drugs in daily clinical practice

OBJETIVO: Describir en el entorno de la práctica clínica diaria, el perfil del paciente con vejiga hiperactiva (VH) tratado con dosis flexible de antimuscarícos. MÉTODOS: Estudio observacional, retrospectivo y multicéntrico llevado a cabo en 88 Hospitales públicos y privados. Se incluyeron pacientes adultos, diagnosticados de VH que iniciaron tratamiento con algún antimuscarínico a dosis flexible. Se recogió tipo de antimuscarínico, dosis, tratamientos concomitantes, beneficio aportado y cumplimiento terapéutico. RESULTADOS: Población constituida por 846 pacientes mayores de 60 años, pluripatológica (83,5%) y polimedicada (73,4%), formada mayoritariamente por mujeres (74,5%) y con más de un año de evolución de la VH. Principales antimuscarínicos inicialmente prescritos: fesoterodina (66,9%) y solifenacina (31,0%). El 68,2% de los pacientes iniciaron el tratamiento con la dosis baja. En la visita de seguimiento, el 47,0% modificó dosis (84,2% aumentaron la dosis, 15,8% disminuyeron la dosis). Los grupos que tuvieron que modificar dosis presentaron significativamente mayor morbilidad, peor sintomatología, mayor empleo de recursos sanitarios y peor cumplimiento terapéutico que el grupo de pacientes tratados siempre a dosis alta. CONCLUSIÓN: En determinados pacientes, el empleo desde el inicio del tratamiento antimuscarínico de dosis- flexible a la dosis más alta, podría proporcionar mayor beneficio terapéutico, adherencia y menor empleo de recursos sanitarios que el escalado de dosis

OBJECTIVE: To describe the profile of the overactive bladder (OAB) patient on treatment with flexible-dose antimuscarinic treatment in daily clinical practice. METHODS: This was an observational, retrospective and multicenter study, carried out at 88 public and private hospitals. Adult patients diagnosed with OAB who initiated flexible-dose antimuscarinic treatment. Type of antimuscarinic, dose, concomitant treatments, treatment benefit and treatment adherence were recorded. RESULTS: This was a pluripathological (83.5%) and polymedicated (73.4%) population, comprised of 846 patients, mostly women (74.5%) with a mean (SD) age of 61.3 (12.1) years and more than one year of OAB evolution. Main initially prescribed antimuscarinics were fesoterodine (66.5%) and solifenacine (30.0%). Overall, 68.2% of the patients started treatment with the low dosage; at the follow-up visit 47.0% changed the dosage (84.2% increased the dosage, 15.8% decreased the dosage). Patients who changed the dosage showed a significantly greater morbidity, worse OAB symptoms, greater health resources use, and worse adherence to treatment compared with those that maintained the high dosage all the time. CONCLUSION: No differences were found regarding the demographic or clinical characteristics that allow us to identify which patients should receive the different options of available dose of antimuscarinic drugs, although greater benefits seem to be achieved with the use of the highest or the lowest dose from the outset than with the change of dose

Cost-effectiveness analysis of fesoterodine flexible dose in newly diagnosed patients with overactive bladder in routine clinical practice in Spain.

OBJECTIVE: To carry out cost-effectiveness analysis from the Spanish National Health System perspective, of treating overactive bladder (OAB), in newly diagnosed patients with two flexible doses of fesoterodine in routine clinical practice. PATIENTS AND METHODS: Economic evaluation of flexible-dose fesoterodine in newly diagnosed patients, including two treatment groups: standard escalating from 4 to 8 mg or fast escalating to 8 mg. Costs were estimated from health care resources utilization related to OAB, and were expressed in 2015 Euros. Quality-adjusted life-years (QALYs) were obtained from overactive bladder questionnaire-short form. Univariate and probabilistic sensitivity analyses were carried out. RESULTS: Three hundred and ninety symptomatic OAB patients treated with fesoterodine and newly diagnosed (141 in fast escalating group and 249 in standard escalating) were analyzed. Adjusted health care total costs were not statistically different; difference -€4.1 (confidence interval: -153.3; 25.1) P=0.842. QALYs were higher in fast escalating to high dose vs standard escalating group, resulting in a cost of -€16,020/QALY gained for fast escalating vs standard escalating group. CONCLUSION: When the cost-effectiveness threshold is set at a maximum value of €30,000/QALY gained, fesoterodine fast escalating group was cost-effective vs standard escalating group 67.6% of the time. The treatment with fesoterodine, in female patients newly diagnosed, fast escalating to 8 mg was a cost-effective option relative to escalating traditionally from 4 to 8 mg, in the management of OAB in routine clinical practice, from the Spanish National Health System perspective.

Profile of oab patient on treatment with flexible-dose antimuscarinic drugs in daily clinical practice. / Perfil del paciente con vejiga hiperactiva tratado con dosis flexible de antimuscarínicos en la práctica clínica diaria.

OBJECTIVE: To describe the profile of the overactive bladder (OAB) patient on treatment with flexible-dose antimuscarinic treatment in daily clinical practice. METHODS: This was an observational, retrospective and multicenter study, carried out at 88 public and private hospitals. Adult patients diagnosed with OAB who initiated flexible-dose antimuscarinic treatment. Type of antimuscarinic, dose, concomitant treatments, treatment benefit and treatment adherence were recorded. RESULTS: This was a pluripathological (83.5% and polymedicated 73.4%) population, comprised of 846 patients, mostly women (74.5%) with a mean (SD) age of 61.3 (12.1) years and more than one year of OAB evolution. Main initially prescribed antimuscarinics were fesoterodine (66.5%) and solifenacine (30.0%). Overall, 68.2% of the patients started treatment with the low dosage; at the follow-up visit 47.0% changed the dosage (84.2% increased the dosage, 15.8% decreased the dosage). Patients who changed the dosage showed a significantly greater morbidity, worse OAB symptoms, greater health resources use, and worse adherence to treatment compared with those that maintained the high dosage all the time. CONCLUSION: No differences were found regarding the demographic or clinical characteristics that allow us to identify which patients should receive the different options of available dose of antimuscarinic drugs, although greater benefits seem to be achieved with the use of the highest or the lowest dose from the outset than with the change of dose.

Cysticlean® a highly pac standardized content in the prevention of recurrent urinary tract infections: an observational, prospective cohort study.

BACKGROUND: The present study was aimed at determining the prophylactic efficacy of American cranberry (AC) extract (Cysticlean®) in women with recurrent symptomatic postcoital urinary tract infections (PCUTI), non-consumer of AC extract in the past 3 months before inclusion, and to determine changes in their quality of life (QoL). METHODS: This was a single center, observational, prospective study in a total of 20 women (mean age 35.2 years; 50.0% were married). Patients were followed up for 3 and 6 months during treatment. RESULTS: The number of PCUTIs in the previous 3 months prior to start the treatment with Cysticlean® was 2.8±1.3 and it was reduced to 0.2±0.5 at Month 6 (P<0.0001), which represent a 93% improvement. At baseline, the mean score on the VAS scale (range from 0 to 100) for assessing the QoL was 62.4±19.1, increasing to 78.2±12.4 at Month 6 (P=0.0002), which represents a 20% improvement. All patients had an infection with positive urine culture at baseline, after 6 months there were only 3 symptomatic infections (P<0.001). The most common bacterium was Escherichia coli. CONCLUSIONS: Prophylaxis with American cranberry extract (Cysticlean®) could be an alternative to classical therapies with antibiotics. Further studies are needed to confirm results obtained in this pilot study.

Dose and aging effect on patients reported treatment benefit switching from the first overactive bladder therapy with tolterodine ER to fesoterodine: post-hoc analysis from an observational and retrospective study.

BACKGROUND: Previous randomized studies have demonstrated that fesoterodine significantly improves the Overactive Bladder (OAB) symptoms and their assessment by patients compared with tolterodine extended-release (ER). This study aimed to assess the effect of aging and dose escalation on patient-reported treatment benefit, after changing their first Overactive Bladder (OAB) therapy with tolterodine-ER to fesoterodine in daily clinical practice. METHODS: A post-hoc analysis of data from a retrospective, cross-sectional and observational study was performed in a cohort of 748 OAB adults patients (OAB-V8 score ≥8), who switched to fesoterodine from their first tolterodine-ER-based therapy within the 3-4 months before study visit. Effect of fesoterodine doses (4 mg vs. 8 mg) and patient age (<65 yr vs. ≥65 yr) were assessed. Patient reported treatment benefit [Treatment Benefit Scale (TBS)] and physician assessment of improvement with change [Clinical Global Impression of Improvement subscale (CGI-I)] were recorded. Treatment satisfaction, degree of worry, bother and interference with daily living activities due to urinary symptoms were also assessed. RESULTS: Improvements were not affected by age. Fesoterodine 8 mg vs. 4 mg provides significant improvements in terms of treatment benefit [TBS 97.1% vs. 88.4%, p < 0.001; CGI-I 95.8% vs. 90.8% p < 0.05)], degree of worry, bother and interference with daily-living activities related to OAB symptoms (p <0.05). CONCLUSIONS: A change from tolterodine ER therapy to fesoterodine with dose escalation to 8 mg in symptomatic OAB patients, seems to be associated with greater improvement in terms of both patient-reported-treatment benefit and clinical global impression of change. Improvement was not affected by age.

Our experience in the treatment of male stress urinary incontinence with the male Remeex system.

OBJECTIVES: We show our experience in the treatment of post-prostatectomy stress urinary incontinence with the male Remeex system (MRS). We also describe the elements of the system, its therapeutic indications, technical implantation and appropriate adjustment. METHODS: From March 2007 to January 2009 five male patients aged 57 to 71 years (mean age 66 years) with postprostatectomy stress urinary incontinence were operated on to insert a suburethral readjustable sling (Remeex). All patients had severe urinary incontinence with deterioration of their quality of life. The evolution period ranged from 2 to 10 years with an average of 3.5 years, requiring from 5 to 8 pads a day. RESULTS: All patients are continent after a mean follow up of 15.4 months (range 6-28 months). Only two of them use one security pad when they perform physical efforts. The Incontinence Impact Questionnaire (7) scores before surgery and 6 months after diminished from 68+/-7 to 10+/-3. All patients are very satisfied. CONCLUSIONS: MRS is a valid therapeutic option for post-prostatectomy incontinence, being a reproducible technique, of easy execution, that allows readjustment through a suprapubic incision under local anesthesia as an outpatient procedure. It has a low complication rate with excellent and endured results.

Nuestra experiencia en el tratamiento de la incontinencia urinaria de esfuerzo masculina mediante cabestrillo suburetral regulable tipo Remeex / Our experience in the treatment of male stress urinary incontinence with the male remeex system

OBJETIVO: Poner de manifiesto nuestra experiencia en el tratamiento de la incontinencia urinaria de esfuerzo postprostatectomía con el sistema Remeex masculino (SRM). Asimismo, describimos los elementos que componen dicho sistema, sus indicaciones terapéuticas, técnica de implantación y su adecuado ajuste.MÉTODO: Desde marzo de 2007 hasta enero de 2009 hemos intervenido a cinco varones afectos de incontinencia urinaria de esfuerzo postprostatectomía con edades comprendidas entre 57 y 71 años (media 66 años), mediante la colocación de una malla suburetral de tensión regulable tipo Remeex. Todos ellos presentaban una incontinencia urinaria severa con gran afectación de su calidad de vida y de un tiempo de evolución entre 2 y 10 años (media 3,5 años), precisando todos ellos entre 5 y 8 compresas diarias.RESULTADOS: Todos los pacientes se mantienen secos en un tiempo de seguimiento medio de 15,4 meses (rango 6-28 meses), precisando ocasionalmente 2 de ellos compresa de seguridad si realizan ejercicio intenso. La puntuación del Incontinence Impact Questionnaire (IIQ 7) realizado antes de la intervención y a los 6 meses después, pasa de 68 ± 7 puntos a 10 ± 3, siendo el grado de satisfacción muy elevado.CONCLUSIONES: El SRM constituye una opción terapéutica válida para la incontinencia postprostatectomía, siendo una técnica reproducible, de fácil ejecución, que permite su reajuste mediante una pequeña incisión suprapúbica bajo anestesia local y en régimen ambulatorio estricto, con una baja tasa de complicaciones proporcionando unos resultados excelentes y duraderos(AU)

OBJECTIVES: We show our experience in the treatment of post-prostatectomy stress urinary incontinence with the male Remeex system (MRS). We also describe the elements of the system, its therapeutic indications, technical implantation and appropriate adjustment.METHODS: From March 2007 to January 2009 five male patients aged 57 to 71 years (mean age 66 years) with post-prostatectomy stress urinary incontinence were operated on to insert a suburethral readjustable sling (Remeex). All patients had severe urinary incontinence with deterioration of their quality of life. The evolution period ran-ged from 2 to 10 years with an average of 3.5 years, requiring from 5 to 8 pads a day.RESULTS: All patients are continent after a mean follow up of 15.4 months (range 6-28 months). Only two of them use one security pad when they perform physical efforts. The Incontinen-ce Impact Questionnaire (7) scores befo-re surgery and 6 months after diminished from 68±7 to 10±3. All patients are very satisfied.CONCLUSIONS: MRS is a valid therapeutic option for post-prostatectomy incontinence, being a reproducible technique, of easy execution, that allows readjustment through a suprapubic incision under local anesthesia as an outpatient procedure. It has a low complication rate with excellent and endured results(AU)

La resección transuretral de próstata bajo anestesia local y sedación es segura y bien tolerada / Transurethral resection of the prostate under local anesthesia-sedation

El actual envejecimiento de la población comporta un incremento del número de varones afectados de hiperplasia benigna de próstata (HBP) con diversas enfermedades asociadas que limitan su tratamiento quirúrgico. Por otra parte, la creación de nuevas unidades de cirugía mayor ambulatoria (CMA) en España es un hecho imparable, pues cada vez es mayor el número de servicios de urología que se integran en este sistema organizativo de la asistencia quirúrgica. Con este estudio pretendemos poner de manifiesto la eficacia y seguridad del empleo de anestesia local y sedación para el tratamiento endoscópico de la HBP en pacientes de alto riesgo quirúrgico-anestésico, así como en pacientes seleccionados susceptibles de ser intervenidos en régimen ambulatorio. Consideramos que tanto la incisión transuretral de próstata como la resección transuretral de próstata realizadas bajo anestesia local y sedación son métodos seguros, eficaces y bien tolerados, los cuales, aunque puedan emplearse en pacientes muy seleccionados en régimen de CMA, están fundamentalmente indicados en pacientes años os y cuando el riesgo quirúrgico- anestésico es elevado, ya que pueden ser realizados como cirugía de estadía breve.

La resección transuretral de próstata bajo anestesia local y sedación es segura y bien tolerada / Transurethral resection of the prostate under local anesthesia-sedation

El actual envejecimiento de la población comporta un incremento del número de varones afectados de hiperplasia benigna de próstata (HBP) con diversas enfermedades asociadas que limitan su tratamiento quirúrgico. Por otra parte, la creación de nuevas unidades de cirugía mayor ambulatoria (CMA) en España es un hecho imparable, pues cada vez es mayor el número de servicios de urología que se integran en este sistema organizativo de la asistencia quirúrgica. Con este estudio pretendemos poner de manifiesto la eficacia y seguridad del empleo de anestesia local y sedación para el tratamiento endoscópico de la HBP en pacientes de alto riesgo quirúrgico-anestésico, así como en pacientes seleccionados susceptibles de ser intervenidos en régimen ambulatorio. Consideramos que tanto la incisión transuretral de próstata como la resección transuretral de próstata realizadas bajo anestesia local y sedación son métodos seguros, eficaces y bien tolerados, los cuales, aunque puedan emplearse en pacientes muy seleccionados en régimen de CMA, están fundamentalmente indicados en pacientes años os y cuando el riesgo quirúrgico- anestésico es elevado, ya que pueden ser realizados como cirugía de estadía breve.(AU)

[Green light laser efficacy in patients with prostatic hyperplasia treatment with 5-alpha reductase inhibitors]. / Eficacia de la fotovaporización prostática con láser verde en el tratamiento de la hiperplasia prostática en pacientes en tratamiento con inhibidores de la 5-alfa-reductasa.

INTRODUCTION: High prevalence of BPH and gradual ageing of the population, combined with the existence of effective medical treatments for this condition, has led to an increasing use of surgery in patients on long-term treatment with 5-alpha reductase inhibitors (5-ARIs). Initially, patients treated with 5-ARIs were not considered good candidates for photoselective vaporization of the prostate with green laser. OBJECTIVE: To assess, using a retrospective study based on our experience, wheter long-term treatment (longer than 6 months) with 5-alpha reductase inhibitors decreases effectiveness of photoselective vaporization of the prostate with green light laser in BPH. MATERIALS AND METHODS: From September 2005 to January 2008, 102 patients underwent photoselective vaporization of the prostate with green light laser. Of these, 25 patients (24.5%) had been treated with 5-ARIs for at least 6 months, and the remaining 77 patients (75.5%) were used as controls. A retrospective study was conducted to compare the pre- and postoperative clinical and functional parameters of patients with and without prior 5-RAI therapy. RESULTS: No statistically significant differences were found between the treated and control groups in preoperative prostatic volume (50 mL vs 49 mL), IPSS (17.6 vs 17.8), postvoiding residue (16% vs 18%), or PSA (1.4 ng/mL vs 2.2 ng/mL). Similarly, while differences were seen in energy spread (180 kJ vs 175 kJ for the treated and control groups respectively) and operating time (63 min vs 57 min), these were not statistically significant. No between-group differences were found either in clinical or flow rate parameters one month after surgery (IPSS 13.8 vs 14 and Qmax 13.9 mL/s vs 14.5 nL/s in the treated and control groups respectively). Surgeons reported a better visualization of the endoscopic field that was attributed to less bleeding during the procedure. CONCLUSIONS: Our results show no statistically significant differences in peroperative and preoperative parameters between patients with and without treatment with 5-alpha reductase inhibitors. We therefore think that photoselective vaporization of the prostate with green light laser is a safe and effective technique in patients treated with 5-ARIs.

Eficacia de la fotovaporización prostática con láser verde en el tratamiento de la hiperplasia prostática en pacientes en tratamiento con inhibidores de la 5-alfa-reductasa / Green light laser efficacy in patients with prostatic hyperplasia treatment with 5-alpha reductase inhibitors

Introducción: El progresivo envejecimiento de la población y la elevada prevalencia de la hiperplasia benigna prostática (HBP), unidos a la existencia de tratamientos médicos efectivos para esta afección, produce que cada vez más indiquemos la cirugía en pacientes tratados a largo plazo con inhibidores de la 5-alfa-reductasa (5ARI). En un principio, los pacientes tratados con 5ARI no se consideraban buenos candidatos para la fotovaporización prostática con láser verde. Objetivo: En el siguiente trabajo, mediante un estudio retrospectivo basado en nuestra experiencia, pretendemos dilucidar si el tratamiento a largo plazo (mas de 6 meses) con inhibidores de la 5ARI reduce la eficacia del tratamiento con láser verde en pacientes afectados de HBP. Material y métodos: Entre septiembre de 2005 y enero de 2008 hemos tratado a 102 pacientes mediante fotovaporización prostática con láser verde, de los que 25 (24,5%) se encontraban en tratamiento con 5ARI durante al menos 6 meses; los otros 77 (75,5%) pacientes formaron el grupo control. Realizamos un estudio retrospectivo en el que comparamos los parámetros clínicos y funcionales pre y postoperatorios de los pacientes tratados con 5ARI respecto a los que no lo estaban. Resultados: No encontramos diferencias estadísticamente significativas en cuanto a volumen prostático (50 cc y 49 cc), IPSS (17,6 y 17,8), residuo posmiccional (16% y 18%) o antígeno prostático específico (PSA) (1,4 ng/ml y 2,2 ng/ml) preoperatorios entre los grupos tratamiento y control, respectivamente. Del mismo modo, si bien existieron diferenciasen cuanto a la energía usada (180 kJ y 175 kJ) y el tiempo quirúrgico empleado (63 min y 57 min), ambas fueron más elevadas en el grupo tratado con 5ARI, estas diferencias no resultaron significativas estadísticamente. Tampoco encontramos diferencias en los parámetros clínicos (IPSS 13,8 y 14 al primer mes) ni flujométricos (Qmáx 13,9 ml/s y 14,5ml/s en la revisión al primer mes) entre pacientes tratados y no tratados. Subjetivamente, se apreció una mejor visualización del campo endoscópico atribuida a un menor sangrado durante la intervención. Conclusiones: Nuestros resultados no demuestran diferencias estadísticamente significativas entre pacientes con y sin tratamiento con inhibidores de la 5ARI en cuanto a parámetros intra y preoperatorios, por lo que pensamos que este tratamiento no disminuye la eficacia de la fotovaporización prostática con láser verde (AU)

Introduction: High prevalence of BPH and gradual ageing of the population, combined with the existence of effective medical treatments for this condition, has led to an increasing use of surgery in patients on long-term treatment with 5-alpha reductase inhibitors (5-ARIs). Initially, patients treated with 5-ARIs were not considered good candidates for photoselective vaporization of the prostate with green laser. Objective: To assess, using a retrospective study based on our experience, wheter long-term treatment (longer than 6 months) with 5-alpha reductase inhibitors decreases effectiveness of photoselective vaporization of the prostate with green light laser in BPH. Materials and methods: From September 2005 to January 2008, 102 patients underwent photoselective vaporization of the prostate with green light laser. Of these, 25 patients (24.5%) had been treated with 5-ARIs for at least 6 months, and the remaining 77 patients (75.5%) were used as controls. A retrospective study was conducted to compare the pre and postoperative clinical and functional parameters of patients with and without prior 5-RAI therapy. Results: No statistically significant differences were found between the treated and control groups in preoperative prostatic volume (50 mL vs 49 mL), IPSS (17.6 vs 17.8), postvoiding residue (16% vs 18%), or PSA (1.4 ng/mL vs 2.2 ng/mL). Similarly, while differences were seen in energy spread (180 kJ vs 175 kJ for the treated and control groups respectively) and operating time (63 min vs 57 min), these were not statistically significant. No between group differences were found either in clinical or flow rate parameters one month after surgery (IPSS 13.8 vs 14 and Qmax 13.9mL/s vs 14.5 nL/s in the treated and control groups respectively). Surgeons reported a better visualization of the endoscopic field that was attributed to less bleeding during the procedure. Conclusions: Our results show no statistically significant differences in peroperative and preoperative parameters between patients with and without treatment with 5-alphareductase inhibitors. We therefore think that photoselective vaporization of the prostate with green light laser is a safe and effective technique in patients treated with 5-ARIs (AU)

[The usefulness of virtual endoscopy and CT urography in the diagnosis of upper urinary tract tumors]. / Utilidad de la endoscopia virtual y el Uro-Tc en el diagnóstico de tumores del tracto urinario superior.

OBJECTIVES: Upper urinary tract (UUT) tumors are a relatively low incidence pathology which often represents a diagnostic challenge for the urologist, because several imaging tests are usually necessary to achieve the final diagnosis. Over the last years CT scan has suffered a notable development and nowadays, with the arrival of new image processing hardware and software, it is possible to detect small urothelial lesions and to perform 3-D urinary tract reconstruction and virtual endoscopic navigation. METHODS: Between January 2004 and June 2005 we performed a total of 15 examinations in 15 patients for the study of asymptomatic hematuria of probable upper urinary tract origin. The technique included three phases to obtain images: basal phase, vascular phase and excretory phase. Processing and image analysis was performed by one radiologist. RESULTS: A total of 10 tumors were diagnosed, with pathological confirmation in all cases. We did not register any complication secondary to the technique, and all patients tolerated well the exam. CONCLUSIONS: The CT urography is a safe, well-tolerated, highly sensitive and efficient imaging test, very useful in the diagnosis of renal and UUT pathology. It may become the only imaging test performed in the study of asymptomatic hematuria and the test of choice for the study of urological tumoral pathology.

Utilidad de la endoscopia virtual y el uro-tc en el diagnóstico de tumores del tracto urinario superior / The usefulness of virtual endoscopy and CT urography in the diagnosis of upper urinary tract tumors

OBJETIVO: Los tumores del tracto urinario superior (TTUS) conforman una patología de incidencia relativamente baja que a menudo suponen un reto diagnóstico para el urólogo ya que, suelen ser necesarias varias pruebas de imagen para alcanzar el diagnóstico definitivo. En los últimos años la tomografía computerizada ha alcanzado un notable desarrollo, y gracias a la aparición de nuevo hardware y software de procesamiento de imágenes actualmente es posible detectar lesiones uroteliales de pequeño tamaño, así como realizar reconstrucciones tridimensionales del tracto urinario y navegación endoscópica virtual por el interior del mismo. MÉTODOS: Entre enero del 2004 y junio de 2005 hemos realizado un total de 15 exploraciones a 15 pacientes durante el estudio de hematuria asintomática de probable origen en el tracto urinario superior, todas ellas indicadas por el Servicio de Urología de nuestro hospital. La técnica incluyó tres fases en la adquisición de imágenes: fase basal, fase vascular y fase excretora. El procesado y análisis de las imágenes fue realizado por un solo radiólogo. RESULTADOS: Un total de 10 tumores fueron diagnosticados, obteniendo en todos los casos confirmación anatomopatológica. No registramos ninguna complicación derivada de la propia técnica, y todos los pacientes toleraron bien la exploración. CONCLUSIÓN: El Uro-TC es una prueba segura, bien tolerada, con una elevada sensibilidad y eficiencia, muy útil en el diagnóstico de la patología renal y del TUS, susceptible de ser utilizada en el futuro como única prueba de imagen radiológica en el estudio de hematuria asintomática y como prueba de elección en el estudio de patología tumoral urológica

OBJECTIVES: Upper urinary tract (UUT) tumors are a relatively low incidence pathology which often represents a diagnostic challenge for the urologist, because several imaging tests are usually necessary to achieve the final diagnosis. Over the last years CT scan has suffered a notable development and nowadays, with the arrival of new image processing hardware and software, it is possible to detect small urothelial lesions and to perform 3-D urinary tract reconstruction and virtual endoscopic navigation. performed a total of 15 examinations in 15 patients for the study of asymptomatic hematuria of probable upper urinary tract origin. The technique included three phases to obtain images: basal phase, vascular phase and excretory phase. Processing and image analysis was performed by one radiologist. RESULTS: A total of 10 tumors were diagnosed, with pathological confirmation in all cases. We did not register any complication secondary to the technique, and all patients tolerated well the exam. CONCLUSIONS: The CT urography is a safe, well- tolerated, highly sensitive and efficient imaging test, very useful in the diagnosis of renal and UUT pathology. It may become the only imaging test performed in the study of asymptomatic hematuria and the test of choice for the study of urological tumoral pathology

[Primary bladder neck obstruction in males]. / Obstrucción primaria del cuello vesical en el varon.

OBJECTIVES: To report our experience on the diagnosis and treatment of this rare type of infravesical functional obstruction. METHODS: Over the last ten years we diagnosed and treated 32 males with this entity. We evaluate previous treatments and time to diagnosis. Clinical, radiological, endoscopic, and urodynamic features are evaluated, as well as results obtained with the administration of alpha-adrenergic blockers and endoscopic transurethral incision of the bladder neck. RESULTS: Patient age ranged from 26 to 48 years (Mean 38.2). All patients presented significant long-lasting lower urinary tract symptoms, having received various non-specific treatments. Uroflowmetry showed a peak of mean flow of 9.8 +/- 3.2 cc/s, being the voiding detrusor pressure 98 +/- 25 cm H2O, with significant post void residual volume in 21 patients (188 +/- 62 cc). Medical treatment with alpha-adrenergic blockers only achieved significant subjective improvement in four patients. Twenty one patients underwent unilateral endoscopic bladder neck incision, obtaining objective and subjective improvements all of them. CONCLUSIONS: Endoscopic bladder neck incision is the treatment of choice of this dysfunction, being imperative to inform the patient of the risk of retrograde ejaculation as a postoperative sequel, since this entity appears in young males, for whom fertility may be a priority.

Obstrucción primaria del cuello vesical en el varón / Primary bladder nexk obstruction in males

OBJETIVO: Presentar nuestra experiencia en el diagnóstico y tratamiento de esta infrecuente modalidad de obstrucción funcional infravesical. MÉTODO: Durante los últimos 10 años hemos diagnosticado y tratado a 32 varones afectos de esta entidad. Se evalúan los diversos tratamientos previos recibidos así como el tiempo transcurrido hasta la realización del diagnóstico. Se valoran las manifestaciones clínicas, radiológicas, endoscópicas y urodinámicas así como los resultados obtenidos con la administración de bloqueadores alfa-adrenérgicos y con la incisión transuretral endoscópica del cuello vesical. RESULTADOS: La edad de los pacientes osciló entre 26 y 48 años (media 38,2). Todos ellos presentaban síntomas significativos del tacto urinario inferior de larga evolución, habiendo recibido diversos tratamientos inespecíficos. El estudio flujométrico evidenció un pico de flujo medio de 9,8 ± 3,2 cc/s, siendo la presión del detrusor durante el vaciado de 98 ± 25 cm H20, existiendo un residuo postmiccional significativo en 21 pacientes de 188 ± 62 cc. Con tratamiento médico mediante la administración de bloqueadores alfa-adrenérgicos únicamente obtuvimos mejorías subjetivas significativas en 4 pacientes. En 21 casos realizamos incisión unilateral endoscópica del cuello vesical, obteniendo mejorías objetivas y subjetivas en todos ellos. CONCLUSIONES: La incisión endoscópica del cuello vesical representa el tratamiento de elección de esta disfunción, siendo imperativo informar al paciente del riesgo de eyaculación retrógrada como secuela postoperatoria, ya que esta entidad ocurre en sujetos jóvenes, en los que la fertilidad puede ser una prioridad

OBJECTIVES: To report our experience on the diagnosis and treatment of this rare type of infravesical functional obstruction. METHODS: Over the last ten years we diagnosed and treated 32 males with this entity. We evaluate previous treatments and time to diagnosis. Clinical , radiological, endoscopic, and urodynamic features are evaluated, as well as results obtained with the administration of alpha-adrenergic blockers and endoscopic transurethral incision of the bladder neck. RESULTS: Patient age ranged from 26 to 48 years (Mean 38.2). All patients presented significant long-lasting lower urinary tract symptoms, having received various non-specific treatments. Uroflowmetry showed a peak of mean flow of 9.8+- 3.2 cc/s, being the voiding detrusor pressure 98+- 25 cm H2O, with significant post void residual volume in 21 patients (188+- 62 cc). Medical treatment with alpha-adrenergic blockers only achieved significant subjective improvement in four patients. Twenty one patients underwent unilateral endoscopic bladder neck incision, obtaining objective and subjective improvements all of them. CONCLUSIONS: Endoscopic bladder neck incision is the treatment of choice of this dysfunction, being imperative to inform the patient of the risk of retrograde ejaculation as a postoperative sequel, since this entity appears in young males, for whom fertility may be a priority