A pooled analysis of the efficacy of fesoterodine for the treatment of overactive bladder, and the relationship between safety, co-morbidity and polypharmacy in patients aged 65 years or older.

Background: overactive bladder (OAB) is a common condition in older persons. Antimuscarinic treatment remains the mainstay of treatment of OAB but clinicians have been reluctant to prescribe this to older patients. This study examined efficacy and safety information from patients >65 in fesoterodine trials to reaffirm efficacy and to explore the relationships between treatment emergent adverse events (TEAEs), coexisting medication and co-morbidity. Methods: data from 10 double-blind, placebo-controlled studies were analysed. A logistic regression analysis, where TEAE incidence was predicted by treatment, prior antimuscarinic treatment, number of coexisting medications, number of concomitant diseases and all possible combinations of two-way interaction terms with treatment was conducted. Results: of 4,040 patients who participated in trials; fesoterodine treatment was associated with statistically significant reductions in all disease-related and patient-reported outcomes compared to placebo. There was a significant increase in the likelihood of reporting a TEAE in association with the number of coexistent medications (odds ratio (OR) = 1.028, 95% CI: 1.0143-1.044, P < 0.003). The OR of having a TEAE with increase in the number of concomitant diseases was 1.058 (95% CI: 1.044-1.072, P < 0.0001). Central nervous system (CNS) events were few. Discussion: fesoterodine treatment led to clinically meaningful improvements across all included patient reported outcomes. The number of concomitant conditions had the greatest influence on the likelihood of an adverse event being reported. CNS TEAE were not associated with fesoterodine dose and were low across all categories of concomitant disease and coexisting medication.

Results of simplified urethropexy in the recovery of continence after radical laparoscopic prostatectomy.

PURPOSE: To analyze the effectiveness of simplified urethropexy in the evolution of urinary incontinence after radical laparoscopic prostatectomy. PATIENTS AND METHODS: Between January 2007 and December 2008, 104 patients were included in a randomized trial to assess the effectiveness of simplified urethropexy. The simplified urethropexy technique was performed on conclusion of a urethrovesical anastomosis with running suture and, before cutting the suture material, a suture was applied using the same material with a needle through the pubic tubercle, tightening it and securing it with a Hem-o-lok. Fifty-one patients qualified for the trial in the simplified urethropexy group (group 1) and another 51 in the control group without urethropexy (group 2). Incontinence was defined as the lack of the need for protection for normal life, and the degree of continence was compared at 3, 6, and 12 months after surgery. RESULTS: Surgery lasted 141 minutes in group 1 and 139 in group 2 (NS). There were no secondary complications such as urine retention, osteitis pubis, or bladder perforation. After 3 months, 47.1% of patients in each group declared continence (NS). After 6 months, 72.6% of patients in group 1 and 66.7% in group 2 (P<0.05) declared continence. After 12 months, 92.2% of patients in group 1 and 84.3% in group 2 declared continence. CONCLUSIONS: In our experience, simplified urethropexy is a simple, nontime-consuming technique that shows a slight clinical improvement in continence within 6 and 12 months, without reaching significant differences with the Fisher Test. It would be necessary to perform a trial with a greater number of patients to confirm these data.

[The meaning of erection, genitality, and other representations of urologic topics in the paleolithic imaginary]. / El significado de la erección, la genitalidad y otras representaciones de indole urológico en el imaginario paleolítico.

The history of urology starts with written documents making express reference to procedures, practices and descriptions of morbid processes related with the male genitourinary tract. Oddly, the most recent prehistoric period, the superior Paleolithic (from approximately 40.000 years to 12.000 years ago; the longest period since our species entered the history of humanity) also has graphic documents expressing how the human being understood the physiologic phenomena and how he observed the pathologic processes of this organism. The representations with genitality expressions enable us to understand the meaning of erection from the Paleolithic perspective, and even the possible existence of a culture based on preputial retraction or rituals of circumcision. Several urologic disorders such us phimosis, paraphimosis, discharge, priapism, and even scrotal mass appear represented at that time and constitute the first sign of knowledge of what can be called primitive urologic knowledge.

El significado de la erección, la genitalidad y otras representaciones de índole urológico en el imaginario paleolítico / The meaning of erection, genitality, and other representations of urologic topics in the paleolithic imaginary

La Historia de la Urología comienza con documentos escritos que hacen referencia expresa a procedimientos, prácticas y descripciones de procesos mórbidos relacionados con el aparato urinario y genital masculino. Curiosamente, durante la época prehistórica más reciente, el Paleolítico superior (desde hace aproximadamente 40.000 a 12.000 años; la época más larga desde que nuestra especie entra en escena en la historia de la humanidad) tiene también documentos gráficos que expresan cómo el hombre entendía los fenómenos fisiológicos y cómo observaba los procesos patológicos de su organismo. Las representaciones con genitalidad expresa permiten inferir el significado de la erección desde la mentalidad paleolítica, e incluso la posible existencia de una cultura de retracción prepucial o de ritos de circuncisión. Patologías de índice urológico como la fimosis, la parafimosis, la supuración, el priapismo e incluso masa escrotal, aparecen representadas en dicha época y constituyen los primeros indicios de lo que podemos denominar un saber urológico primitivo

The history of urology starts with written documents making express reference to procedures, practices and descriptions of morbid processes related with the male genitourinary tract. Oddly, the most recent prehistoric period, the superior Paleolithic (from approximately 40.000 years to 12.000 years ago; the longest period since our species entered the history of humanity) also has graphic documents expressing how the human being understood the physiologic phenomena and how he observed the pathologic processes of this organism. The representations with genitality expressions enable us to understand the meaning of erection from the Paleolithic perspective, and even the possible existence of a culture based on preputial retraction or rituals of circumcision. Several urologic disorders such us phimosis, paraphimosis, discharge, priapism, and even scrotal mass appear represented at that time and constitute the first sign of knowledge of what can be called primitive urologic knowledge

[Renal carcinoma metastatic to the peritoneum. Case report]. / Carcinoma renal metastásico a peritoneo. A propósito de un caso.

OBJECTIVE: We describe the case of a young male presenting with non-specific abdominal symptoms on follow-up after radical nephrectomy for renal carcinoma leading to the finding of local recurrence and peritoneal metastases. A second exploratory laparotomy was carried out for tumor reduction, but it was followed by fast peritoneal recurrence. Despite the treatment with alpha interferon, three months later he developed multiple hepatic metastases. CONCLUSIONS: Peritoneal involvement by renal cell carcinoma is rare and implies a bad prognosis.

Carcinoma renal metastásico a peritoneo. A propósito de un caso / Renal carcinoma metastatic to the peritoneum. Case report

OBJETIVO: Aportar un caso de carcinoma renal que presentó implantes peritoneales en su evolución. MÉTODO/RESULTADOS: Describimos el caso de un varón joven que en el seguimiento de su patología neoplásica tras nefrectomía radical presenta sintomatología abdominal inespecífica que conduce al descubrimiento de implantes peritoneales y recidiva local. Se realizó una segunda cirugía exploradora y de citorreductora, con recidiva peritoneal rápida. A los tres meses y a pesar del tratamiento que siguió con Interferón-α, el paciente presento metástasis hepáticas múltiples. CONCLUSIONES: La afectación peritoneal por carcinoma de células renales es un hecho infrecuente y que confiere un mal pronóstico

OBJECTIVE: We describe the case of a young male presenting with non-specific abdominal symptoms on follow-up after radical nephrectomy for renal carcinoma leading to the finding of local recurrence and peritoneal metastases. A second exploratory laparotomy was carried out for tumor reduction, but it was followed by fast peritoneal recurrence. Despite the treatment with alpha interferon, three months later he developed multiple hepatic metastases. CONCLUSIONS: Peritoneal involvement by renal cell carcinoma is rare and implies a bad prognosis

[Diet and bladder cancer]. / Dieta y cáncer de vejiga.

OBJECTIVES: To perform an update on the bibliography about the influence of dietetic factors on bladder cancer. METHODS: Bibliography search in various databases (PubMed, Ovid) on each one of the dietetic agents that can influence on the incidence of bladder tumors. RESULTS/CONCLUSIONS: There is a growing number of evidences that a great number of substances present in our usual diet have an influence on bladder cancer.

Dieta y cáncer de vejiga / Diet and bladder cancer

OBJETIVO: Realizar una revisión actual de la bibliografía de la influencia ejercida por factores dietéticos sobre el cáncer vesical. MÉTODOS: Búsqueda de la bibliografía existente en diferentes bases de datos (Pubmed, Ovid) sobre cada uno de los agentes dietéticos que pueden influir la incidencia de los tumores vesicales. RESULTADOS/CONCLUSIONES: Cada vez existen más evidencias que un gran número de sustancias presentes en nuestra dieta habitual ejercen una influencia en el cáncer de vejiga

OBJECTIVES: To perform an update on the bibliography about the influence of dietetic factors on bladder cancer. METHODS: Bibliography search in various databases (PubMed, Ovid) on each one of the dietetic agents that can influence on the incidence of bladder tumors. RESULTS/CONCLUSIONS: There is a growing number of evidences that a great number of substances present in our usual diet have an influence on bladder cancer

[Testicular microlithiasis]. / Microlitiasis testicular.

OBJECTIVES: Testicular microlithiasis, characterized by the existence of microscopic calcifications within the seminiferous tubules, is rare, generally an incidental finding during a scrotal ultrasound. METHODS: We report the case of a 45-year-old male without risk factors for the development of a germ cell testicular tumor with the diagnosis of bilateral testicular microlithiasis. RESULTS: The patient was followed yearly with testicular ultrasound, without evidence of germ cell tumor over a four-year follow-up period. CONCLUSIONS: Although the clinical significance of testicular microlithiasis is under debate due to the various controversies found in the literature about its association or not with testicular tumors, as well as the various protocols for initial management and adequate intervals for follow-up, it seems reasonable to perform an ultrasound yearly independently of the existence or not of associated risk factors.

[Transvaginal mesh perineal repair of the rectovaginal septum in the treatment of rectocele and enterocele. Outcomes in 77 patients]. / La perineoplastia protésica del tabique rectovaginal, vía transvaginal, en el tratamiento del rectocele y enterocele. Resultados de 77 casos.

OBJECTIVE: Anatomical and functional outcomes after transvaginal perineoplasty of the vaginal septum using polypropylene mesh in 77 patients with rectocele, enterocele, or both were studied. The frequency of other associated pelvic floor defects was also analyzed. PATIENTS AND METHOD: Between 1997 and May 2005, 77 patients underwent surgery (30 for enterocele, 33 for rectocele and 14 for both defects). In all patients, complete dissection of the rectovaginal space, resection of the redundant vaginal wall tissue, suturing of the polypropylene mesh to the lateral bundles of the puborectal muscle, and posterior colporrhaphy were performed. In enteroceles, Douglas' pouch was resected before the mesh was placed. RESULTS: During follow-up, there were 3 minimal vaginal dehiscences requiring partial extirpation of the mesh in 2 (12.1%), and 1 (1.2%) rectocele recurrence. No subsequent mesh extrusions or recurrences were detected during follow-up. The frequency of associated pelvic floor disorders was 92%. CONCLUSIONS: In our experience, placement of polypropylene mesh in the rectovaginal septum with lateral suturing to puborectal muscle bundles provides excellent results compared with other approaches and meshes that are not sutured and fixed in the rectovaginal space, leading to mesh infection, extrusion or complete removal.

La perineoplastia protésica del tabique rectovaginal, vía transvaginal, en el tratamiento del rectocele y enterocele. Resultados de 77 casos / Transvaginal mesh perineal repair of the rectovaginal septum in the treatment of rectocele and enterocele. Outcomes in 77 patients

Objetivo. Se estudian de forma prospectiva los resultados anatómicos y funcionales de la perineoplastia del tabique rectovaginal, con malla de polipropileno y por vía transvaginal, en 77 pacientes con rectocele, enterocele o ambas patologías asociadas. También se analiza la frecuencia de otras patologías asociadas del suelo pélvico. Pacientes y método. Entre 1997 y mayo de 2005 se interviene quirúrgicamente a 77 pacientes, de las cuales 30 presentaban un enterocele, 33 un rectocele y en 14 casos se presentaban ambas patologías asociadas. En todas se realiza una disección completa del espacio rectovaginal, resección de la pared vaginal redundante, sutura de la malla a los haces laterales del músculo puborrectal con polipropileno y una colporrafia posterior. En el enterocele se reseca previamente el saco de Douglas antes de la colocación de la malla. Resultados. En el seguimiento de las pacientes se han registrado 3 mínimas dehiscencias vaginales que requirieron en 2 (12,1%) casos la extirpación parcial de malla, así como 1 (1,2%) recidiva de rectocele. No se han registrado extrusiones posteriores de malla ni recidivas durante el seguimiento. La frecuencia de patología asociada del suelo pélvico ha sido de un 92%. Conclusiones. La colocación de mallas de polipropileno en el tabique rectovaginal por la vía transvaginal, y suturadas lateralmente a los haces del músculo puborrectal, aporta en nuestra experiencia unos excelentes resultados frente a otras vías de abordaje y con mallas que no se suturan y fijan en el tabique rectovaginal dando lugar a infecciones de la malla, extrusiones o retiradas totales de ésta (AU)

Objective. Anatomical and functional outcomes after transvaginal perineoplasty of the vaginal septum using polypropylene mesh in 77 patients with rectocele, enterocele, or both were studied. The frequency of other associated pelvic floor defects was also analyzed. Patients and method. Between 1997 and May 2005, 77 patients underwent surgery (30 for enterocele, 33 for rectocele and 14 for both defects). In all patients, complete dissection of the rectovaginal space, resection of the redundant vaginal wall tissue, suturing of the polypropylene mesh to the lateral bundles of the puborectal muscle, and posterior colporrhaphy were performed. In enteroceles, Douglas' pouch was resected before the mesh was placed. Results. During follow-up, there were 3 minimal vaginal dehiscences requiring partial extirpation of the mesh in 2 (12.1%), and 1 (1.2%) rectocele recurrence. No subsequent mesh extrusions or recurrences were detected during follow-up. The frequency of associated pelvic floor disorders was 92%. Conclusions. In our experience, placement of polypropylene mesh in the rectovaginal septum with lateral suturing to puborectal muscle bundles provides excellent results compared with other approaches and meshes that are not sutured and fixed in the rectovaginal space, leading to mesh infection, extrusion or complete removal (AU)

Microlitiasis testicular / Testicular microlithiasis

OBJETIVO: La microlitiasis testicular (MT), que se caracteriza por la existencia de microcalcificacionesdentro de los túbulos seminíferos, es poco frecuente y generalmente constituye un hallazgo incidental durante la realización de la ecografía escrotal.MÉTODO: Presentamos un caso de un varón de 45 años de edad, sin factores de riesgo para el desarrollo de un tumor testicular de células germinales, diagnosticado de una microlitiasis testicular bilateral.RESULTADOS: El paciente ha sido sometido a control evolutivoanual con ecografía testicular, sin desarrollar un tumorgerminal durante un seguimiento de 4 años.CONCLUSIONES: Aunque el significado clínico de la MT está en debate debido a las diferentes controversias halladasen la literatura sobre su asociación o no con el tumor testicular, así como los diferentes protocolos de manejo inicial y de los intervalos adecuados para su vigilancia y seguimiento, parece razonable realizar un control ecográficoanual, independientemente de la existencia o no de factores de riesgo asociados

OBJECTIVES: Testicular microlithiasis,characterized by the existence of microscopic calcifications within the seminiferous tubules, is rare, generally anincidental finding during a scrotal ultrasound.METHODS: We report the case of a 45-year-old male without risk factors for the development of a germ celltesticular tumor with the diagnosis of bilateral testicularmicrolithiasis.RESULTS: The patient was followed yearly with testicular ultrasound, without evidence of germ cell tumor over a four-year follow-up period.CONCLUSIONS: Although the clinical significance oftesticular microlithiasis is under debate due to the various controversies found in the literature about its association or not with testicular tumors, as well as the various protocols for initial management and adequate intervals for follow-up, it seems reasonable to perform an ultrasound yearly independently of the existence or not of associated risk factors