Functional outcomes of pediatric laparoscopic pyeloplasty: post-operative functional recovery is superior in infants compared to older children.

AIM: Laparoscopic pyeloplasty (LP) is less popular and considered less successful in infants compared to older children. There are few reports analyzing the functional results of LP in relation to age of surgery. The aim of this paper is to compare the functional results of LP in infants (group 1) with children over 1 year of age (group 2). MATERIAL AND METHODS: The data of all children undergoing LP between August 2016 and July 2019 were retrospectively analyzed for patient details and follow-up. Only children (n = 135) with at least 1-year follow-up and completed post-operative ultrasound and diuretic renogram were included. All children underwent pre-operative and post-operative ultrasound and diuretic renogram; pre-operative, operative and post-operative parameters were compared between both groups. Statistical analysis was done using software; Mann-Whitney U test, Student t test, and Fisher's exact test were applied. RESULTS: There were 71 infants (group 1) and 64 children > 1 year (group 2). Pre-operatively, all kidneys had SFU grade 3 or 4 HDN and 131/135 kidneys had a renal pelvic APD > 20 mm; all kidneys had unequivocal obstruction on DR. At surgery, the preferred drainage method was intra-operative antegrade placement of a JJ stent in 68 (96%) group 1 and 63 (98%) group 2 children. The remaining 4 cases (3 group 1, 1 group 2) had a nephrostomy with trans-anastomotic external stent placement, because the JJ stent could not be negotiated into the bladder. The demographic data and comparison of pre- and post-operative parameters between both groups are summarized in Tables 1 and 2, respectively. Group 1 had significantly more children with antenatal diagnosis of HDN (87% vs 56%, p = 0.0005). The 36 children with antenatal diagnosis in group 2 were initially followed expectantly; the indication for pyeloplasty was deterioration of SRF on serial DR, urinary infection, and pain, in 13, 14, and 9 children, respectively. The operating time was significantly longer in group 2 (p = 0.0001). There was no difference in the success of LP or complication rate in both groups. Group 2 had significantly more children with extrinsic obstruction (1.4% vs 17%, p = 0.001). All children underwent post-operative US and DR; a significant reduction in hydronephrosis (APD) on follow-up was noted in both groups (p = 0.0001). The mean pre-operative SRF in both groups was comparable (p = 0.088). The mean SRF in both groups improved significantly after LP; however, the mean post-operative SRF was significantly higher in group 1 when compared to group 2 (p = 0.0001). Furthermore, group 1 had significantly more kidneys demonstrating > 10% increase in SRF after LP (53% vs 26%, p = 0.0003). CONCLUSIONS: The safety profile and success of LP in infants was comparable to older children. Infant LP took shorter time to perform, while older children had increased incidence of extrinsic obstruction. Infant kidneys demonstrated better functional improvement than older children after LP. These findings should encourage more surgeons to utilize LP for pyeloplasty even in infants.

Enhanced recovery program for minimally invasive and vaginal urogynecologic surgery.

INTRODUCTION AND HYPOTHESIS: Enhanced recovery protocols (ERPs) are evidenced-based interventions designed to standardize perioperative care and expedite recovery to baseline functional status after surgery. There remains a paucity of data addressing the effect of ERPs on pelvic reconstructive surgery patients. METHODS: An ERP was implemented at our institution including: patient counseling, carbohydrate loading, avoidance of opioids, goal-directed fluid resuscitation, immediate postoperative feeding and early ambulation. Patients undergoing elective pelvic reconstructive surgery before and after implementation of the ERP were identified in this cohort study. RESULTS: One hundred eighteen patients underwent pelvic reconstructive surgery within the ERP compared with 76 historic controls. Reductions were seen in length of hospital stay (29.9 vs. 27.9 h, p = 0.04), total morphine equivalents (37.4 vs. 19.4 mg, p < 0.01) and total intravenous fluids administered (2.7 l vs. 1.5 l, p < 0.0001). Hospital discharges before noon doubled (32.9 vs. 60.2%, p < 0.01). More patients in the ERP group ambulated on the day of surgery (17.1 vs. 73.7%, p < 0.01) and ambulated at least two times the day following surgery (34.2 vs. 72.9%, p < 0.01). No differences were seen in average pain scores (highest pain score 7.39 vs. 7.37, p = 0.95), hospital readmissions (3.9 vs. 3.4%, p = 0.84), or postoperative complications (6.58 vs. 8.47%, p = 0.79). Patient satisfaction significantly improved. ERP was not associated with an increase in 30-day total hospital costs. CONCLUSIONS: Implementation of ERP for pelvic reconstructive surgery patients was associated with a reduced length of hospital stay, improved patient satisfaction, and decreased administration of intravenous fluids and opioids without an increase in complications, readmissions, or hospital costs.

[Improved rehabilitation after major urological surgery : what role for the general practitioner ?] / Réhabilitation améliorée après chirurgie urologique majeure : quel rôle pour le médecin généraliste ?

Enhanced recovery after surgery (ERAS) is a multimodal concept aiming to reduce surgical stress and prevent postoperative complications. Once adapted to urologic patients in 2013, this protocol evolves continuously and many international centers have now implemented it. This article resumes ERAS key principles for general practitioners as they can have a significant impact on patient's optimization before surgery.

Le protocole de réhabilitation améliorée après chirurgie est un concept de prise en charge multimodale visant à anticiper puis gérer de manière optimale le stress chirurgical inhérent à toute intervention. Adapté depuis 2013 à l'urologie, il évolue régulièrement et les centres internationaux qui appliquent ses principes sont toujours plus nombreux. Avant une chirurgie majeure, il existe un potentiel d'optimisation d'un patient auquel le généraliste peut participer activement. Cet article résume à l'attention d'un médecin généraliste les principaux points constituant cette démarche.

Abordaje integral de un caso complejo de continuidad de cuidados a un paciente cistectomizado / No disponible

El manejo inefectivo del régimen terapéutico es uno de los diagnósticos que con más frecuencia se le presenta al profesional enfermero durante su desarrollo profesional. Es fundamental que el enfermero desarrolle un plan de cuidados de forma óptima para que el paciente adquiera una correcta adhesión al tratamiento terapéutico y mejore su calidad de vida, así como prevenir las posibles complicaciones ante el no cumplimiento de tal tratamiento. Atendimos en nuestra unidad a un paciente de 56 años con diagnóstico de carcinoma infiltrante de vejiga que iba a ser intervenido de cistectomía. Controla su diabetes sin seguir con el plan terapéutico de su médico de familia, tampoco ha conseguido dejar su hábito tabáquico. Esto nos pone alerta de los posibles problemas posquirúrgicos y al alta

Nursing staff is exposed to ineffective management of therapeutic regimen during their professional development. It is essential for the nursing staff to develop an optimum self-care plan so that the patient can adhere to treatment and improve his quality of life. This will help the patient to anticipate possible complications related to non-compliance for treatment of the disease. A 56 years old patient with an infiltrating bladder cancer was admitted to our unit. The patient poorly controls diabetes, does not follow an appropriate treatment plan and has not stopped smoking. This is putting the patient at great danger due to post-operative complications and problems as a result of discharge from hospital

Perfil del paciente sometido a resección transuretral de neoplasia vesical / No disponible

Antecedentes y objetivos. El cáncer de vejiga es el séptimo tipo de cáncer más frecuentemente diagnosticado en los varones a nivel mundial. Su presentación clínica suele ser con síntomas de hematuria macro o microscópica. La resección endoscópica transuretral (RTU) es el pilar diagnóstico y terapéutico. El objetivo del presente trabajo fue describir el perfil del paciente que ingresa en una unidad de Urología para RTU de vejiga con el fin de detectar los posibles riesgos que puedan presentar. Pacientes y métodos. Estudio retrospectivo transversal descriptivo y analítico que incluyó 108 pacientes atendidos en la Unidad de Gestión Clínica de Urología del Hospital Universitario a los que se practicó RTU vesical a lo largo del año 2016. Los datos fueron obtenidos de las correspondientes historias clínicas electrónicas de urología y anestesia. Se recogieron las siguientes variables: edad, sexo, duración de la hospitalización, peso corporal y altura para obtención del índice de masa corporal (IMC), hábito tabáquico, ingesta habitual de alcohol, diagnóstico previo o tratamiento para hipertensión, dislipemia, diabetes mellitus y antecedentes de cáncer, así como estimación del riesgo anestésico mediante clasificación ASA (American Society of Anesthesiologists) y valoración funcional con escala NYHA (New York Heart Association) y determinaciones analíticas prequirúrgicas de hemograma y bioquímica plasmática. Resultados. El 91,7 por mil de los pacientes sometidos a RTU vesical fueron varones y la edad fue de 69,9 ± 11,3 años. Un 20,4 por mil era fumador. Un 38,0 por mil de los pacientes presentó sobrepeso y un 38,9 por mil obesidad. La prevalencia de hipertensión, dislipemia, diabetes y cáncer previo fue del 63,9 por mil el 40,7 por mil , el 25,9 por mil y el 25,9 por mil , respectivamente. Un 62,0 por mil presentaba un riesgo anestésico ASA de clase II, seguido de un 25,9 por mil que lo presentaba clase III. La valoración funcional mediante escala NYHA más prevalente, 93,5 por mil , fue la de clase I. La cifra media de hemoglobina fue de 12,4 ± 2,2 g/dl. La duración media de hospitalización fue de 2,8 ± 4,4 días. En conclusión, el perfil del paciente sometido a RTU vesical es varón, de edad avanzada, con sobrepeso u obesidad además de elevada prevalencia de otros factores de riesgo cardiovascular como HTA, dislipemia y diabetes, con riesgo anestésico clase II, es decir con enfermedad sistémica leve, controlada y no incapacitante, sin limitación de la actividad física de causa cardíaca y con anemia leve

Background and objectives. Bladder cancer is the seventh most commonly diagnosed cancer in men worldwide. Its clinical presentation is usually with symptoms of macro or microscopic hematuria. Transurethral endoscopic resection (TUR) is the diagnostic and therapeutic mainstay. The objective of the present study was to describe the profile of the patient who enters a urology unit for bladder TUR in order to detect possible risks that they may present. Patients and Methods. A descriptive and analytical cross-sectional retrospective study that included 108 patients treated at the Urology Clinical Unit of the University Hospital, who underwent TUR throughout 2016. The data were obtained from the corresponding electronic medical histories of surgery and anesthesia. The following variables were collected: age, sex, duration of hospitalization, body weight and height to obtain body mass index (BMI), smoking habits, habitual alcohol intake, previous diagnosis or treatment for hypertension, dyslipidemia, diabetes mellitus, cancer, as well as anesthesia risk estimation using the American Society of Anesthesiologists (ASA) and NYHA (New York Heart Association) functional assessment and pre-surgical blood chemistry and biochemical analytical determinations. Results. Ninety-one percent of the patients undergoing bladder TUR were male and the age was 69.9 ± 11.3 years, 20.4 per-mille were smokers, 38.0 per-mille of the patients were overweight and 38.9 per-mille were obese. The prevalence of hypertension, dyslipidemia, diabetes and previous cancer was 63.9 per-mille , 40.7 per-mille , 25.9 per-mille and 25.9 per-mille , respectively. A 62.0 per-mille presented a class II ASA anesthetic risk, followed by 25.9 per-mille that presented class III ASA. The most prevalent NYHA functional assessment, 93.5 per-mille , was class I. The mean hemoglobin level was 12.4 ± 2.2 g / dl. The mean duration of hospitalization was 2.8 ± 4.4 days. In conclusion, the profile of the patient submitted to bladder TUR is a male, elderly with overweight or obesity, as well as a high prevalence of other cardiovascular risk factors such as hypertension, dyslipidemia and diabetes, with a class II anesthesia risk, with mild systemic disease, non-disabling, without limitation of physical activity of cardiac cause and with mild anemia

[Use of Vitaprost (tablets and rectal suppositories) for patients rehabilitation after invasive diagnostic urological interventions].

The successful experience with the drug Vitaprost in the treatment of chronic prostatitis, and the emerging research evidence on the use of the drug in the treatment of urinary disorders served as a prerequisite to conduct a prospective study comparing the effectiveness of the combined application of rectal suppositories Vitaprost forte and Vitaprost tablets (production of JSC Nizhpharm, STADA CIS) in the rehabilitation of patients who had undergone invasive urologic procedures. 90 patients who underwent prostate biopsy (63) and urethrocystoscopy with bladder biopsy (27) were followed from January to July 2015. All patients were randomized to the control group (n=50) and the intervention group (n=40). Patients assigned to the control group were treated with standard anti-inflammatory therapy, and intervention group besides standard therapy received rectal suppositories Vitaprost forte for 10 days with the transition to Vitaprost pills also for 10 days. Treatment efficacy was evaluated by comparing the subjective and objective measures before and after biopsy in both groups, and rates of complications and adverse events. The both formulations of Vitaprost were well tolerated. Objective parameters (Qmax, prostate volume) in groups at 1 month did not differ significantly. However, there was a statistically significant greater reduction in subjective indicators (I-PSS, QoL) in the study group (12,4+/-1,1 and 2,1+/-0,4 points, respectively) compared with the control group (15,8+/-1,9 and 3,2+/-0,6 points, respectively). Also, patients treated with Vitaprost, had significantly higher scores in IIEF and Well-Being Index on a visual analog scale. Vitaprost use resulted in reduced risk of acute urinary retention and frequency of hematospermia. To conclude, the combined use of Vitaprost forte and Vitaprost in the rehabilitation of patients after invasive urologic interventions is beneficial in terms of improvement of patients subjective and objective indicators.

Conservative laparoscopic management of urinary tract endometriosis (UTE): surgical outcome and long-term follow-up.

OBJECTIVE: To evaluate surgical outcome and long-term follow-up of conservative laparoscopic management of urinary tract endometriosis (UTE). DESIGN: Prospective study. SETTING: Tertiary-care university hospital. PATIENT(S): Women with laparoscopic diagnosis and histologic confirmation of urinary bladder or ureteral endometriosis who agreed to undergo long-term follow-up after laparoscopic management. INTERVENTION(S): (1) Laparoscopic partial cystectomy for bladder endometriosis. (2) Uretric endometriosis laparoscopically managed by: uretrolysis only; segmental ureterectomy and terminoterminal anastomosis; or segmental ureterectomy and uretrocystoneostomy. MAIN OUTCOME MEASURE(S): Variables assessed were: preoperative findings, operative details (type and site of UTE, type of intervention, perioperative complications), and long-term follow-up (persistence/recurrence of preoperative urinary symptoms, if present, and anatomic relapse of the disease). RESULT(S): Mean operating time was 152.8+/-41.7 minutes. Mean drop in hemoglobin was 1.9+/-1.6 g/dL. Average hospital stay was 6 days. After surgery, 11 women had fever>38 degrees C and four presented transient urinary retention. During a follow-up period of 36 months, endometriosis recurred in eight patients with no evidence of bladder or ureteral reinvolvement, and there was a significant reduction in the mean score of dysuria and suprapubic pain maintained during the whole follow-up period. CONCLUSION(S): Results of long-term follow-up demonstrate significant reduction in preoperative symptoms with no anatomic relapse.

Improvement of quality of life, anxiety and depression after surgery in patients with stress urinary incontinence: results of a longitudinal short-term follow-up.

OBJECTIVE: The objective of this study was to compare the effect of incontinence surgery and pelvic floor training on quality of life (QOL), anxiety and depression in patients with stress urinary incontinence (SUI). METHODS: In a prospective longitudinal study, females with proven SUI were asked to complete a set of standardized questionnaires (sociodemographic data sheet, FACT-G, I-QOL, HADS) before and eight weeks after treatment. The comparison groups consisted of a surgical treatment group and a conservative group that underwent supervised pelvic floor training for eight weeks. RESULTS: From the 67 female patients included in the study a number of 53 patients completed both assessment time points (mean age 57.4, mean years of SUI 7.6). The surgical treatment group consisted of 32 patients of which 21 patients received a modified Burch colposuspension and 11 patients a tension-free mid-urethral tape suspension. The 21 patients in the conservative group attended eight once-weekly supervised pelvic floor training sessions. After treatment the surgical intervention group showed a significantly higher improvement of QOL (FACT-G and I-QOL) and anxiety (HADS) than the pelvic floor training group. CONCLUSION: For female patients with SUI surgery yielded a better outcome than pelvic floor training with regard to quality of life and anxiety.

Dynamic Hydrodistention classification of the ureter and the double HIT method to correct vesicoureteral reflux / Clasificación de la hidrodistensión dinámica del uréter y el método doble de hiperdistensión-implante en el tratamiento del reflujo vesicoureteral

Objectives: The objective of this monograph is to familiarize the reader with dynamic hydrodistention classification of the ureter and Hydrodistention Implantation Technique (HIT) methodology for the endoscopic correction of vesicoureteral reflux (VUR). The indications, current success rates, complications, and potential future applications of these methods are reviewed. Methods: Hydrodistention (HD) of the ureteral orifice and distal ureter permits visualization of the intraureteral submucosal injection site and assessment of the degree of ureteral coaptation. We have designated 4 levels of HD. H0 denotes absence of ureteral dilation, H1 indicates dilation of the ureteral orifice only. H2 allows visualization of the intramural ureter, and H3 allows visualization of the extramural ureter. The Double HIT method is a systematic technique that utilizes HD to both classify the ureter and gauge the degree of ureteral coaptation secondary to bulking during endoscopic injection. The needle is inserted at the mid ureteral tunnel at the 6 o'clock position. The first injection coapts the detrusor tunnel (until H1 or H0 is achieved), while a second implant within the most distal intramural tunnel leads to complete coaptation of the ureteral orifice (H0). Results: HD grade correlated significantly with VUR grade. Normal ureters rarely hydrodistended. While non-refluxing contralateral ureters demonstrated low HD grades, all contralateral ureters that subsequently developed VUR showed H2 or H3. The HIT method has not only been employed for primary VUR (90% cure), but also for repeat endoscopic injections (90%), VUR associated with paraureteral diverticula (81%), complex cases such as post-reimplantation (88%), neurogenic bladders (78%), duplication anomalies (80%), and in adults (88%). Furthermore, injection of contralateral VUR-negative but hydrodistending ureters may be treated to prevent new contralateral VUR. While decreasing success was seen with increasing VUR grade with the STING method, superior success rates have been realized with the HIT method. Conclusions: The dynamic hydrodistention classification reflects the competency of the ureterovesical junction. The HIT and Double HIT methods achieve superior cure rates and are likely to become the method of choice for the treatment of primary as well as complex cases of VUR (AU)

Objetivo: El objetivo de esta monografía es familiarizar al lector con la clasificación de la hidrodistensión dinámica del uréter y la metodología de la técnica de hidrodistensión-implante para la corrección endoscópica del reflujo vesicoureteral (RVU). Revisamos las indicaciones, la tasa de éxitos actual, sus complicaciones y las potencialesaplicaciones de estos métodos en el futuro. Métodos: La hidrodistensión del orificio ureteral y el uréter distal permite la visualización del sitio de inyección de la submucosa ureteral y la evaluación del grado de coaptación ureteral. Hemos designado cuatro niveles de hidrodistensión. H0 ausencia de dilatación ureteral, H1 dilatación sólo del orificio ureteral, H2 permite la visualización del uréter intramural y H3 permite la visualización del uréter extramural. El método de doble hidrodistensión-implante es una técnica sistemática que utiliza la hidrodistensión para clasificar el uréter y evaluar el grado de coaptación ureteral después de la inyección endoscópica de sustancias de relleno. La aguja se inserta en el túnel medio ureteral a las 6 horarias. La primera inyección coapta el túnel en el detrusor (hasta conseguir H1 o H0), mientras que una segunda inyección más distal en el túnel intramural lleva una coaptación completa del orificio ureteral (H0). Resultados: El grado de hidrodistensión se correlacionó significativamente con el grado de RVU. Mientras que los uréteres contralaterales no refluyentes demostraban grados bajos de hiperdistensión, todos los uréteres que desarrollaron reflujo vesicoureteral posterior mostraban H2 o H3. El método de hidrodistensión-implante no se ha empleado sólo para RVU primario (90% de curaciones), sino también para inyecciones endoscópicas repetidas (90%), RVU asociado con divertículo paraureteral (8I%), casos complejos como después de reimplante (88%), vejiga neurógena (78%), anomalías con duplicación (80%), y en adultos (88%). Además, el uréter contralateral no refluyente que presenta hidrodistensión puede tratarse para prevenir el RVU de novo. Mientras que con el método STING las tasas de éxito disminuyen al aumentar el grado del RVU, con el método de hidro distensión-implante se han visto mejores tasas de éxitos. Conclusiones: La clasificación de la hidrodistensión dinámica refleja la competencia de la unión ureterovesical. Los métodos de hidrodistensión-implante simple y doble consiguen tasas de curación superiores y probablemente se convertirán en el método de elección para el tratamiento del RVU primario y de los casos complejos (AU)

Tratamiento quirúrgico de duplicidad peneana completa / Surgical treatment of complete penile duplication

La duplicidad peneana es una anomalía rara, con una incidencia de 1 entre 5.500.000. Normalmente está asociada a otras malformaciones como duplicidad vesical, cloaca, ano imperforado, duplicidad de recto y sigma y a deformidades vertebrales. Los autores presentan la técnica quirúrgica que aplicaron para la resolución de un caso raro de duplicidad peneana completa en un individuo de sexo masculino, de cuatro años de edad, sin otras malformaciones sistémicas asociadas (AU)

Penile duplication is a rare anomaly with an incidence of 1 in 5,500,000. It is almost associated with other malformations like double bladder, presence of the cloaca, imperforate anus, duplication of the recto sigmoid and vertebral deformities. The authors present the surgical technique to resolve a rare case of complete penile duplication in a 4years old child, without any other malformation (AU)

Efficacy, safety and hospital costs of tension-free vaginal tape and pubovaginal sling in the surgical treatment of stress incontinence.

AIM: The efficacy, safety and hospital costs of the tension-free vaginal tape procedure were compared with the pubovaginal sling operation. METHODS: A total of 60 women urodynamically diagnosed as having stress or mixed urinary incontinence were operated on using either the tension-free vaginal tape or pubovaginal sling operation in a prospective manner. Preoperative characteristics of the women were not significantly different for the groups. The women were followed for up to 24 months. RESULTS: In the tension-free vaginal tape group, the operation time was shorter, numbers of analgesics postoperatively required were less and hospital charges were less expensive compared to those in the pubovaginal sling operation (P < 0.01). Kaplan-Meier survival analysis showed a marginal significant difference (P = 0.059) in the objective cumulative cure rates at 24 months between the groups receiving the former (70.3%) and latter (48.3%) procedures. Subjective cure rates were not significantly different (P = 0.101). In both groups, an improvement in quality of life was significant and surgical complications were identical. De novo urge incontinence developed in 6% and 10% in the former and latter, respectively. CONCLUSIONS: The tension-free tape was significantly superior to the pubovaginal sling in terms of operation time, postoperative pain, and hospital charges, but not in cure rates. A longer follow up with a larger sample size is necessary to draw definite conclusions.

Elastin content of the renal pelvis and ureter determines post-pyeloplasty recovery.

PURPOSE: We evaluated the collagen-to-smooth muscle tissue matrix ratio and percentage of elastin in the renal pelvis, ureteropelvic junction (UPJ) and ureter, and compared these findings with the degree of obstruction, patient age and post-pyeloplasty renal recovery. MATERIALS AND METHODS: We analyzed histological sections from 75 patients with UPJ obstruction. Nine patients were excluded owing to bilateral UPJ obstruction and an improper specimen. We divided the specimen obtained from pyeloplasty into 3 parts, namely the renal pelvis above the obstruction, the obstructed UPJ portion and the ureter below the obstruction. To examine the collagen and smooth muscle, sections were stained using Masson's trichrome, and elastic van Giesson stain was used for elastin, smooth muscle and collagen. Collagen, smooth muscle and elastin populations were identified, and the tissue matrix ratio and percentage of elastin were calculated by color image analysis. RESULTS: In patients with lower ratios of collagen-to-smooth muscle in the UPJ proper hydronephrosis was more improved postoperatively (p = 0.049). In patients with a lower percentage of elastin in the renal pelvis, UPJ and ureter hydronephrosis was more improved postoperatively (p <0.0001). CONCLUSIONS: Because the UPJ portion was resected during pyeloplasty, the renal pelvis and the ureter remaining after pyeloplasty are likely to be related to improved hydronephrosis. A higher percentage of elastin in the renal pelvis and ureter contributes to inelasticity and low compliance, and results in a slower recovery from hydronephrosis after pyeloplasty.

Disfunción miccional postcirugía de incontinencia de orina femenina: análisis de 34 casos / Mictional dysfunction caused by Burch procedure in female stress incontinence: analysis of 34 cases

Uno de los principales esquemas de manejo de la IO femenina, actualmente, es la cirugía. Una proporción de mujeres persiste con alteraciones miccionales diversas luego de su aplicación, o las desarrollan de novo. Se presenta a un grupo de pacientes en esta condición. Análisis retrospectivo de informes urodinámicos de pacientes derivadas a la Unidad de Urodinamia de Clínica Las Condes, entre enero de 1998 y octubre 1999. Se seleccionaron los estudios de mujeres mayores de 15 años, que presentaron alguna disfunción miccional (preexistente o de novo) y que hubieran sido sometidas a cirugía de IO. Previo al examen urodinámico se realizó anamnesis por urólogo. Se revisan un total de 834 estudios urodinámicos, de los cuales 34 cumplen criterios: edad promedio de 55,5 años (33 a 88). Presentación clínica como IOE en 38 porciento, IO Mixta 32 por ciento, Obstructiva-irritativa sin IO(Ob/Irr) 2,5 por ciento y otras, 6 por ciento. Del total, un 38 por ciento había sido sometida a operación de Burch, 18 por ciento a plastías por vía vaginal, 32 por ciento a otros procedimientos (MMK, Burch por LPC, sling) y un 12 porciento a más de un tipo de cirugía de IO. De las pacientes con IOE pura (13 pacientes), 31 por ciento presentan algún tipo de inestabilidad, 38 por ciento confirman su IOE pura, y 15 porciento presentan IO tipo 3. Durante la fase miccional, el 77 por ciento es normal, un 15 por ciento con algún grado de UOB y un 8 por ciento con hipocontractibilidad del Detrusor. Del grupo que se presenta con sintomatología Ob/Irr pura (8 pacientes), el 37 por ciento presenta inestabilidad mientras que el 63 por ciento tiene fase de continencia normal. Durante la fase miccional, el 75 porciento muestra UOB, mientras que el 12 por ciento presenta hipocontractibilidad del Detrusor y el 12 porciento es normal. El grupo con sintomatología mixta (11 pacientes), presenta inestabilidad en el 73 por ciento, y la fase miccional está básicamente normal (aunque el 18 porcientotiene UOB). Desde el punto de vista de la técnica quirúrgica, los pacientes sometidos a Burch se presentaron con sintomatología mixta Ob/Irr, mientras que los pacientes con UOB pura correspondieron mayoritariamente a cirugía por vía vaginal o Burch laparoscópico (LPC).