[Laparoscopic adrenalectomy. Reflections after 24 procedures]. / Adrenalectomía laparoscópica. Consideraciones a propósito de 24 procedimientos.

INTRODUCTION AND OBJECTIVES: Laparoscopic adrenalectomy has gained rapid recognition since publication of the first case in 1992. Currently it is the technique of choice for the surgical treatment of the adrenal gland. Our objective in this paper is to share our experience with this technique and offer some practical advice on how to approach it. MATERIALS AND METHODS: Between May 1998 and August 2006 we did a total of 24 laparoscopic adrenalectomies in 22 patients (15 men, 7 women). The right gland was removed in 13 cases and the left in 11. Surgery was bilateral in two cases (one was MEN II, the other bilateral cortical hyperplasia). Average age was 49.5 +/- 14.3 years (range 24 to 78). Clinical diagnosis was: Pheochromocytoma (n = 10), Cushing (n = 6), Conn (n = 4), metastases from lung carcinoma (n = 2) and non-functioning tumor (n = 2). For surgery, all patients were in total lateral decubitus with a pillow to increase the costal-iliac space. We used four trocars on the right side and three on the left. Abdominal access was by Hasson trocar after minilaparotomy. We kept pneumoperitoneal pressure below 12 mmHg; a Veress needle was not used for this procedure. RESULTS: Open surgery was required in one case. Time operation was between 59 and 400 minutes (mean 182 +/- 98 min.). In the first 12 cases average time was 261 +/- 77 minutes and in the final 12 cases was 103 +/- 21 minutes (p < 0.001). Tumour diameter was between 1.3 and 6 cm (mean 3.08 +/- 1.25 cm) and tumour weight was between 8 and 92g (mean 30.13 +/- 21 g). Except in one case with 600 ml blood loss, bleeding was less than 100 ml (n = 23, range: 10-100, mean 43.26 +/- 25ml). We only had intraoperative complications in two cases: perforation of the liver by the laparoscope retractor (at the beginning of the series) and injury to the spleen capsule. Both complications were resolved laparoscopically. Cases by histologic type were: nine cortical adenomas, nine pheochromocytomas, three nodular hyperplasias, two metastases from lung carcinoma, and one adrenal pseudocyst. Discharge from hospital was between three and five days (mean 3.62 +/- 0.82) with a statistical difference (p < 0.001) between twelve first cases and the last ones. CONCLUSIONS: The adrenal laparoscopic approach is currently the technique of choice for removing adrenal tumours although with malign tumours or over 7 cm in diameter there are some contraindications and disadvantages relative to open surgery. There is inevitably a learning curve but satisfactory results are quickly attainable.

Prostatectomía radical laparoscópica. ¿Sólo en Centros de excelencia? / Laparoscopic radical prostatectomy. Only ar centres of expertise

Objetivos: Presentar la experiencia adquirida en la técnica de la prostatectomía radical laparoscópica en un hospital general con un área de influencia de 200.000 habitantes, analizando los resultados preliminares de nuestra serie. Material y Métodos: Entre diciembre de 2002 y agosto de 2005 se seleccionaron un total de 26 pacientes para prostatectomía radical laparoscópica, 25 vía transperitoneal y 1 extraperitoneal. La edad media fue de 62,3 ± 5,3 años (rango 52-69). El PSA medio fue de 9,16 ± 4,2 ng/ml (rango 5,26-24,3). El estadio clínico preoperatorio fue T1c en 10 (38,4%) T2a en 8 (30,8%) y T2ben 8 (30,8%) pacientes respectivamente. La media preoperatoria del grado de Gleason fue de 6 ± 0,8 (rango 4-7). Tres pacientes tenían bloqueo neoadyuvante en el momento de la cirugía (11,5%). En 2 casos se realizó linfadenectomía bilateral simultánea. No se realizó en ningún caso la técnica de preservación de nervios erectores. Resultados: La cirugía se completó en 20 pacientes. El seguimiento medio ha sido de 12,4 ± 8,6 meses (rango 3-34). No hubo muertes derivadas de la cirugía. En los primeros 10 casos hubo 6 reconversiones. En los 16 restantes 0. El tiempo quirúrgico medio para toda la serie fue de 303,5 ± 95,1 minutos (rango 150-540). En los 14 primeros casos el tiempo quirúrgico medio fue332,14 ± 92,58 y 236,6 ± 66,5 minutos en los últimos 6 casos (p<0.02). El sangrado medio fue de 90,25 ± 46,5 cc (rango 40-250). Complicaciones postoperatorias observamos en 4 pacientes (15,38%). El estadio patológico fue pT2a en 3 (15%), pT2b en10 (50%), pT3a en 3 (15%) y pT3b en 4 (20%) pacientes respectivamente. Márgenes positivos se encontraron en 3 casos (11,5%):1 pT2b (ápex), 1 pT3a y 1 pT3b. La estancia media fue de 4,7 ± 3,1 días (rango 3-18). La sonda vesical se mantuvo de media 12,7± 2,7 días (rango 7-21). Descontados los pacientes que precisaron reconversión, el 85% (17 pacientes) referían continencia (no compresa) a los 3 meses de seguimiento. Conclusiones: La experiencia de nuestro grupo en el manejo de otros procedimientos de cirugía laparoscópica urológica avanzada, ha permitido que la prostatectomía radical laparoscópica sea una técnica factible de realizar en un entorno de baja adscripción poblacional, consiguiendo una rápida curva de aprendizaje y con unos resultados similares a los de la cirugía convencional (AU)

Objectives: To present and evaluate our experience and initial results in radical laparoscopic prostatectomy which we have been using for two and an half years in our General Hospital (covering a total population of 200.000 inhabitants). Material and Methods. Between December 2002 and August 2005, were selected 26 patients for radical laparoscopic prostatectomy (25 transperitoneal and 1 extraperitoneal). Mean age was 62.3 ± 5.3 years (range 52-69). Mean PSA level was 9.16 ± 4.20 ng/mL (range 5.26 to 24.3). Pre-operative classification was T1c in 10 patients (38.4%), T2a in 8 (30.8%) and T2b in 8. Mean Gleason Score was 6 ± 0.8 (range 4-7). Three patients had undergone preoperatively neo-adjuvant hormonal blockage (11.5%). Simultaneous bilateral inguinal lymphadenectomy was performed in two patients. In no case did we consider a nerve sparing approach. Results. The procedure was accomplished in 20 patients. Mean follow-up was 12.4 ± 8.6 months (range 3 - 34). There was no perioperative mortality. Conversion to open surgery was required six times in the ten first cases but not thereafter. Mean operating time for the whole series was 303 ± 95 minutes (range 150-540) but with a distinct difference between the first fourteen and the last six cases: 332 ± 92,58 versus 236.6 ± 66.5 (p<0.02). Mean blood loss was 90.25 ± 46.5 ml. There were early postoperative complications in 4 patients (15.38%). Final pathological staging was: T2a in three patients (15%), T2b (50%) in 10, T3a (15%) in three and T3b (20%) in four. Positive margins were found in three cases (11.5%): T2b, T3a and T3b. Mean hospitalisation time was 4.7 ± 3.1 days. Provided there was no urinary leakage, the urinary catheter was removed at 12.7 ± 2.7 days. Full continence at three months was achieved in 17 of the patients (85%) who had undergone the full laparoscopic procedure. Conclusions: Our previous experience in other major laparoscopic procedures has allowed us to perform radical laparoscopic prostatectomy with a fast learning curve even in a setting of a relatively low population. Initial long term results seem similar to those achieved with conventional surgery (AU)

[Laparoscopic radical prostatectomy. Only at centers of expertise]. / Prostatectomía radical laparoscópica. Sólo en centros de excelencia?

OBJECTIVES: To present and evaluate our experience and initial results in radical laparoscopic prostatectomy which we have been using for two and an half years in our General Hospital (covering a total population of 200.000 inhabitants). MATERIAL AND METHODS: Between December 2002 and August 2005, were selected 26 patients for radical laparoscopic prostatectomy (25 transperitoneal and 1 extraperitoneal). Mean age was 62.3 +/- 5.3 years (range 52-69). Mean PSA level was 9.16 +/- 4.20 ng/mL (range 5.26 to 24.3). Pre-operative classification was Tlc in 10 patients (38.4%), T2a in 8 (30.8%) and T2b in 8. Mean Gleason Score was 6 +/- 0.8 (range 4-7). Three patients had undergone preoperatively neo-adjuvant hormonal blockage (11.5%). Simultaneous bilateral inguinal lymphadenectomy was performed in two patients. In no case did we consider a nerve sparing approach. RESULTS: The procedure was accomplished in 20 patients. Mean follow-up was 12.4 +/- 8.6 months (range 3 - 34). There was no perioperative mortality. Conversion to open surgery was required six times in the ten first cases but not thereafter. Mean operating time for the whole series was 303 +/- 95 minutes (range 150-540) but with a distinct difference between the first fourteen and the last six cases: 332 +/- 92.58 versus 236.6 +/- 66.5 (p<0.02). Mean blood loss was 90.25 +/- 46.5 ml. There were early postoperative complications in 4 patients (15.38%). Final pathological staging was: T2a in three patients (15%), T2b (50%) in 10, T3a (15%) in three and T3b (20%) in four. Positive margins were found in three cases (11.5%): T2b, T3a and T3b. Mean hospitalisation time was 4.7 +/- 3.1 days. Provided there was no urinary leakage, the urinary catheter was removed at 12.7 +/- 2.7 days. Full continence at three months was achieved in 17 of the patients (85%) who had undergone the full laparoscopic procedure. CONCLUSIONS: Our previous experience in other major laparoscopic procedures has allowed us to perform radical laparoscopic prostatectomy with a fast learning curve even in a setting of a relatively low population. Initial long term results seem similar to those achieved with conventional surgery.

[Estimation of the cost in the medical treatment of benign prostatic hyperplasia in Navarre, Spain]. / Aproximación al coste del tratamiento médico de la hiperplasia benigna de próstata en la Comunidad Foral de Navarra.

We evaluate the cost and trends in the medical treatment of out patients suffering from lower urinary tract symptoms suggestive of clinical benign prostatic hyperplasia in Navarre (Spain) between 1998/2002. The estimated number of patients increased each year, to 10% of the male population over the age of 50 in 2002, with a cost of Euros 2,557,236 equivalent to 2.4% of the total drug expenditure spending of out patients (Euros 106.6 million). The use of tamsulosin tripled and the cost doubled to Euros 807,467 (31.5%) of the total), while the rest of alpha-blockers, wit the exception of doxazosin, was stationary. Phytotherapy decreased by a third and finasteride follows a slow upward trend. The introduction of reference prices set by the Health Department in 2001 to reduce medical budget, led to an initial decrease in cost, offsetted in the following year due to the incorporation of new patients. In this period, surgery for prostate adenoma diminished from 382 patients in 1998 to 270 in 2002 (-30%).

Aproximación al coste del tratamiento médico de la hiperplasia benigna de próstata en la comunidad foral de Navarra / Estimation of the cost in the medical treatment of bening prostatic hyperplasia in Navarra, Spain

Se estudia el coste y evolución del tratamiento médico ambulatorio de los pacientes afectos de clínica de prostatismo sugestiva de hiperplasia benigna de próstata en la Comunidad Foral de Navarra en el periodo 1998/2002. El número estimado de pacientes en tratamiento se incrementa cada año, llegando al 10% de la población masculina mayor de 50 años en el 2002, con un coste para el ente gestor de 2.557.236 € , el 2,4% del gasto médico farmacéutico extrahospitalario total (106,6 millones €). En dicho periodo, la tamsulosina triplica su uso y dobla el coste hasta los 807.467 € (31,5% del total) mientras que el resto de alfa-bloqueantes, con la excepción de la doxazosina, prácticamente se estacionan. La fitoterapia baja su utilización en casi un tercio y el coste en un 50%. El finasteride mantiene una línea ascendente con una cuota de mercado actual del 15%. La introducción de los precios de referencia el año2001 disminuye inicialmente el gasto, pero esta reducción queda sin efecto ya el año siguiente ante la incorporación de nuevos pacientes en tratamiento. En el mismo periodo, la cirugía por adenoma de próstata (cerrada y abierta) pasó de 265 y 117 pacientes en 1998 a 195 y 75, respectivamente, en el año 2002 (-30%) (AU)

We evaluate the cost and trends in the medical treatment of out patients suffering from lower urinary tract symptoms suggestive of clinical benign prostatic hyperplasia in Navarre (Spain) between 1998/2002.The estimated number of patients increased each year, to 10% of the male population over the age of 50in 2002, with a cost of € 2.557.236 equivalent to 2.4% of the total drug expenditure spending of outpatients (€ 106.6 million). The use of tamsulosin tripled and the cost doubled to € 807.467 (31.5%) of the total), while the rest of alpha-blockers, wit the exception of doxazosin, was stationary. Phytotherapy decreased by a third and finasteride follows a slow upward trend. The introduction of reference prices set by the Health Department in 2001 to reduce medical budget, led to an initial decrease in cost, offsetted in the following year due to the incorporation of new patients. In this period, surgery for prostate adenoma diminished from 382 patients in 1998 to 270 in 2002 (-30%) (AU)

[Therapeutic approach in adrenal melanoma. Review of the literature]. / Actitud terapéutica en el melanoma suprarrenal. Revisión de la literatura.

OBJECTIVE: To review the treatment strategies for adrenal melanoma and to emphasize the role of curative surgical resection and adjuvant treatment in selected patients with melanoma metastatic to the adrenal gland versus chemotherapy alone in the treatment of patients with advanced malignant melanoma. METHODS: A case of adrenal gland metastasis of a cutaneous melanoma (Clark IV, Breslow 5 mm.) treated by excision one year before that was referred to the Urology Department for Wünderlich syndrome is presented. RESULTS: The analyzed series of programmed adrenalectomy for adrenal metastases from melanoma describe survivals of 26 (3), 36 (9), 59 (3) and 72 (5) months. In our case the patient died at home one month later due to stroke, although concomitant brain metastasis is suspected. Autopsy was not performed. CONCLUSIONS: In the differential diagnosis of an incidentaloma, metastatic disease is likely in a patient with a history of malignant disease. The frequency of malignant melanoma among metastatic adrenal disease varies between 1% and 8.6%; the majority are asymptomatic and incidental findings. We believe that in selected patients with advanced malignant melanoma, with no major coexisting morbidity factors who have isolated melanoma metastatic to the adrenal gland or with limited extra-adrenal sites of disease, curative surgical resection and adjuvant treatment may improve their survival. It must be emphasized that all patients should be followed after surgical resection of the primary tumor because it will facilitate staging of the disease and avoid emergency situations of ruptured friable metastases that make complete resection difficult.

[Differential diagnosis of epididymal leiomyoma. Report of a new case]. / Diagnósticos diferenciales del leiomioma de epidídimo. Aportación de un nuevo caso.

OBJECTIVE: A case of epididymal leiomyoma is presented. This lesion is uncommon and sometimes misdiagnosed. The literature is briefly reviewed. METHODS/RESULTS: A 29-year-old patient presented with a tumor in the tail of the right epididymis that was initially diagnosed as scrotal hematoma or complex cyst in the tail of the epididymis. RESULTS/CONCLUSIONS: Ultrasound has an important role in distinguishing testicular from epididymal tumors. However, if the diagnosis is unclear, surgical resection and subsequent anatomopathological analysis must be performed.

[Primary neuroectodermal tumor (PNET) of the kidney: 26 cases. Current status of its diagnosis and treatment]. / Tumor neuroectodérmico primitivo renal (PNET): 26 casos. Estado actual de su diagnóstico y tratamiento.

OBJECTIVE: To report a case of primitive neuroectodermal tumor (PNET) of the kidney and review the literature and the 25 cases previously reported as PNET. METHODS: A 39-year-old man who consulted for nephric colic is described. Ultrasound evaluation disclosed a mass arising from the left kidney. The clinical, radiological and pathologic features, treatment and differential diagnosis of small cell tumors are discussed, as well as the important role of immunohistochemical techniques (positive staining with O13 or 12E7 antibodies) and cytogenetic analysis [a characteristic chromosomal translocation t(11;22) (q24;q12) or variant translocation, such as t(21;22) (q22;q12), may be detected by fluorescence in situ hybridization (FISH) or polymerase chain reaction-reverse transcriptase (PCR-RT)]. RESULTS: Survival of our patient was 20 months. Only three of the 25 previously reported cases had a longer survival: 60, 48 and 24 months. Mean survival was 10 months. 95.24% of the cases were positive for NSE. Immunostaining (CD99) was performed in 16 patients and was found to be positive in all cases. Cytogenetic and molecular analyses were performed in 11 cases; PCR-RT was negative in two, as well as in the case described herein. CONCLUSIONS: PNET is a highly aggressive neoplasm that tends to recur locally and to metastasize. Despite the poor response to standard therapy combining surgical resection, postoperative irradiation and chemotherapy, the results might change due to current research on genetic therapy based on creating antisense oligonucleotides against the EWS-FLI 1 fusion gene.

[Retroperitoneal bronchogenic cyst mimicking adrenal gland tumor]. / Quiste broncogénico retroperitoneal simulando un tumor suprarrenal.

OBJECTIVE: To report a case of retroperitoneal bronchogenic cyst, an anomaly during the development of the primitive anterior intestine from which the bronchi and lungs are developed. METHODS/RESULTS: A 38-year-old male presented with left lumbar pain. Patient evaluation disclosed a left adrenal polycystic mass which was removed by surgery. Pathological analysis of the surgical specimen demonstrated a bronchogenic cyst. This case is compared with some of the few cases reported in the literature. CONCLUSIONS: Retroperitoneal bronchogenic cyst is a cause of retroperitoneal tumors in the splenic or hepato-renal region. Although it is uncommon, it should be taken into account when making the differential diagnosis.

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

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

[Stromal tumor of the rectum and leiomyosarcoma of the prostate as a cause of urinary syndrome attributable to BPH]. / Tumor estromal de recto y leiomiosarcoma de próstata como causa de síndrome miccional atribuible a HBP.

OBJECTIVE: To discuss the classifications of patients with lower urinary tract symptoms ascribed to BPH, in order to define the indication for treatment for patients with similar features but of a different etiology. The literature is also reviewed. METHODS/RESULTS: Two patients, aged 62 and 63 years, diagnosed as having BPH were found to have a gastrointestinal stromal tumor (GIST) and a leiomyosarcoma of the prostate, respectively. The first patient had undergone retropubic resection. Frozen section analysis revealed a GIST. The second patient had undergone TURP twice. A perineal biopsy at the last medical examination showed a leiomyosarcoma of the prostate. This patient finally underwent pelvic tumorectomy. The international classification of BPH is discussed: PQSF (P: prostatic weight determined by transrectal US or DRE; Q: quality of life assessment; S: international prostate symptom score (IPSS); F: maximum urinary flow rate by uroflowmetry--Qmax). CONCLUSIONS: The classifications are practical, but should be improved. In our view, details useful in orienting the diagnosis could be lost by oversimplification.

[High-flow priapism in the pediatric age: review]. / Priapismo de alto flujo en edad pediátrica: revisión.

OBJECTIVE: To review the literature on high flow priapism in children and analyze the etiology, pathophysiological mechanism, diagnostic tests, treatment and complications. METHODS: The literature is reviewed and an additional case of posttraumatic arterial priapism in an 11 year-old boy treated at our hospital is presented. RESULTS: 24 cases of high flow priapism in children were found; 18 had a history of genitoperineal trauma, 5 had sickle cell anemia and one child had Fabry's disease. Diagnosis was based on patient history, intracavernous blood gases and echo doppler findings. Fourteen patients with posttraumatic priapism, one patient with sickle cell anemia and the child with Fabry's disease were treated by pudendal arteriography with embolization. The immediate results and erectile function were good. CONCLUSIONS: Genitoperineal trauma is the most common cause of arterial priapism in children. High flow must be considered in children with sickle cell disease and priapism that do not respond to conventional treatment. Pudendal arteriography with embolization is the treatment of choice. Erectile function is recovered after treatment.

[Colonic perforation in percutaneous surgery of the kidney. Report of two cases]. / Perforación colónica en la cirugía renal percutánea. Presentación de dos casos.

We show our experience about iatrogenic damage of colon secondarily to percutaneous surgery of the kidney. One of them treated by means of open surgery, the other by conservative procedures. Making discussion on risk factors, as well as the diagnostic therapeutical aspects.

[Ureterocervicopexy with bone anchors by the abdominal approach: medium-term results]. / Uretrocervicopexia con arpón por vía abdominal: resultados a medio plazo.

OBJECTIVE: To analyze the short- and medium-term results of the Burch-like urethropexy with bone anchors in the treatment of genuine stress urinary incontinence. METHODS: We performed the conventional Burch technique which was modified with the use of 4 bone anchors for bony fixation. Forty-four female patients with genuine stress urinary incontinence were operated on from November, 1995 to November, 1997. RESULTS: The patients had a bladder catheter indwelling for 4 to 9 days and only 3 of them required intermittent catheterization during two months. All patients recovered spontaneous micturition. The postoperative urinary continence was 93% at a mean follow-up of 11 months. CONCLUSIONS: Although our initial results seem encouraging, a continuous and objective follow-up is warranted to assess the long-term efficacy of this technique.

[Nephrogenic adenoma: study of 9 cases, including one of the urethra in a 14-year-old male]. / Adenoma nefrogénico: estudio de nueve casos, incluyendo uno de uretra en un varón de 14 años.

OBJECTIVES: To review our series of nephrogenic adenoma and compare our results with those reported in the literature. METHOD: The records of our Department of Pathology were reviewed to determine the cases of nephrogenic adenoma diagnosed at our center. The clinical features, diagnostic aspects, pathological findings, treatment and outcome are presented. RESULTS/CONCLUSIONS: Nephrogenic adenoma is a rare lesion, probably arising from nephrogenic metaplasia caused by injury to the urothelial mucosa. The site of presentation is frequently the bladder, followed by the urethra. The diagnosis is based on the histopathological findings, which can be occasionally equivocal. The cases described in the present series were benign. To date there is no established therapeutic approach. We performed TUR in two patients, antibiotic therapy was administered in one patient and 4 patients were managed conservatively. Two of our patients had no control evaluation following biopsy of the lesion. In 2 of the 4 patients that were managed conservatively, the lesion remitted spontaneously.

[Adrenal gland myelolipoma. Report of a new case]. / Mielolipoma suprarrenal. Aportación de un nuevo caso.

OBJECTIVE: We report a new case of symptomatic myelolipoma of the adrenal gland. We analyse clinical, diagnostic, histopathologic and therapeutic aspects. METHOD AND RESULTS: Surgical excision was performed by lumbotomy. The patient was asymptomatic after surgery. DISCUSSION: Adrenal myelolipoma is norfunctioning benign tumour constituted by fat tissue and small islands of haemathopoyetic in a variable rate. The patients are usually asymptomatic. In symptomatic patients the most common symptoms are nonspecific abdominal pain, haematuria and hypertension. The diagnosis is achieved by ultrasound, CT and PAFF. The management is controversial: Surgical treatment or watching are options depending on the size and/or symptoms.

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

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