Tratamiento de la incontinencia urinaria de esfuerzo femenina con minicintas MiniArc: resultados a 4 años / Stress Urinary Incontinence Surgery With Sling Miniarc: A 4-year Results

Objetivos: El objetivo de esta publicación es describir de forma retrospectiva los resultados de la colocación de la cinta AMS MiniArc a 4 años de seguimiento como tratamiento de la incontinencia urinaria (IU). Material y método: Presentamos un estudio de cohortes retrospectivo de 135 pacientes, 110 (81,5%) tenían incontinencia urinaria de esfuerzo y 25 (18,5%) incontinencia urinaria mixta. Todos los procedimientos se realizaron con anestesia local y en régimen de cirugía mayor ambulatoria. Las pacientes fueron controladas en consultas externas a los 6 meses (control 1), al año (control 2) y una vez al año (control 3, 4 y 5). Se les realizó una historia clínica y el cuestionario ICIQ-SF, al que le añadimos una pregunta para cuantificar el grado de satisfacción, así como la exploración física. Consideramos curación objetiva que la paciente en la exploración física con vejiga llena presentara un test de esfuerzo negativo. Para valorar la curación subjetiva evaluamos las respuestas al cuestionario ICIQ-SF y la pregunta de satisfacción de los resultados de la cirugía. Para el estudio estadístico de los datos descriptivos y de los resultados se aplicó la comparación de media «t» de Student utilizando el programa SPSS (V 19.0). Resultados: La mediana de seguimiento fue de 59 meses (rango entre 33-72 meses). Observamos que el 86,7% de las pacientes presentaban curación objetiva a los 4 años. Si analizamos los resultados según el tipo de incontinencia que presentaban las pacientes, con incontinencia urinaria mixta estuvieron curadas en el 80,8% y las pacientes con incontinencia urinaria de esfuerzo en el 89,2%. Con el cuestionario ICIQ-SF y la pregunta de satisfacción observamos un descenso medio en la puntuación de 12,7 puntos, con un 85,7% de las pacientes muy satisfechas. Conclusión: La colocación de AMS MiniArcs supone un dispositivo eficaz para el tratamiento quirúrgico de la incontinencia urinaria femenina a medio plazo, pero los resultados deben interpretarse con precaución dadas las limitaciones del estudio

Objetives: The aim of this publication is to describe retrospectively the results of the surgical technique of AMS MiniArc for the treatment of female urinary incontinence, evaluate its results at 4 years follow-up. Material and methods: We present a retrospective cohort study of 135 patients, 110 (81.5%) had urinary incontinence and 25 (18.5%) mixed urinary incontinence. All these procedures were performed with local anesthesia and in «out patient surgery». Patients were monitored in the outpatient clinic at 6 months (control 1), one year (control 2) and annually (control 3, 4, and 5). During the following up, clinical history was made in every woman with ICIQ-SF questionnaire, that included a fourth question to evaluate the degree of satisfaction after surgery, as well as physical examination. We considered objective cure when negative stress with full bladder. We use the SPSS program (V19.0) for statiscal analysis of the results. Results: The mean follow-up was of 59 months (range from 33-72 months). When evaluating the success rate of anti-incontinence surgery,86.7% of patients showed objective cured (80.8% with MUI and 89.2% with SUI). The ICIQ-SF decreased average of 12.7 points, 85.7% patients were very or fairly satisfied. Conclusion: The AMS MiniArc is an optim anti-incontinence procedure a medium term. But the results should be interpreted with caution given the limitations of the study

Stress urinary incontinence surgery with sling MiniArc: a 4-year results.

OBJETIVES: The aim of this publication is to describe retrospectively the results of the surgical technique of AMS MiniArc for the treatment of female urinary incontinence, evaluate its results at 4 years follow-up. MATERIAL AND METHODS: We present a retrospective cohort study of 135 patients, 110 (81.5%) had urinary incontinence and 25 (18.5%) mixed urinary incontinence. All these procedures were performed with local anesthesia and in "out patient surgery". Patients were monitored in the outpatient clinic at 6 months (control 1), one year (control 2) and annually (control 3, 4, and 5). During the following up, clinical history was made in every woman with ICIQ-SF questionnaire, that included a fourth question to evaluate the degree of satisfaction after surgery, as well as physical examination. We considered objective cure when negative stress with full bladder. We use the SPSS program (V19.0) for statistical analysis of the results. RESULTS: The mean follow-up was of 59 months (range from 33 to 72 months). When evaluating the success rate of anti-incontinence surgery, 86.7% of patients showed objective cured (80.8% with MUI and 89.2% with SUI). The ICIQ-SF decreased average of 12.7 points, 85.7% patients were very or fairly satisfied. CONCLUSION: The AMS MiniArc is an optim anti-incontinence procedure a medium term. But the results should be interpreted with caution given the limitations of the study.

[Complications of female urinary incontinence surgery with mini-sling system]. / Complicaciones de la cirugía de incontinencia urinaria femenina con minicintas.

OBJECTIVE: To evaluate the complications of urinary incontinence (UI) surgery with mini-sling system. Describe its diagnosis and management. MATERIAL AND METHOD: We make a descriptive analysis of the complications of the surgery in a group of 155 women with UI surgically treated with mini-sling system (50 TVT-Secur and 105 MiniArc) from October 2006 to November 2008. All patients were evaluated with clinical history, physical examination and two questionnaires of QoL (ICIQ-SF and EQ-5D). When urethral obstruction was suspected, we included urineculture, post-void residual urine measurement and urodynamics. The complications were grouped into three categories: intraoperatory, early (within de first month after surgery) and late complications (after a month). We use the SPSS program (V 14.0) for statistical analysis of the results. RESULTS: The average age was 56 years (range 33-82) and 180 days for the following-up (range 26-817). We had a complication rate of 20% (22% TVT-Secur, 17% MiniArc). We reported one intraoperatory complication corresponding to a bladder perforation (0.64%), managed conservatively with catheterization. All early complications were reported in the MiniArc group: one obturator fossa hematoma (0.64%) spontaneously resolved, groin pain in 4 patients (2.5%) successfully treated with NSAIDs and one urethral obstruction (0.64%) that required mesh cutting. Late complications included: 8 vaginal erosions (5%), 4 required tape excision and vaginal wall closure; 2 were treated with vaginal estrogens, and the other 2 were asymptomatic so we did nothing. 6 patients (3.8%) showed urethral obstruction: we performed mesh cutting in 5, whereas one patient improved with intermittent catheterization. Urge symptoms were reported in 10 patients (6.45%) and successfully managed with anticholinergic agents. 2 patients suffered from recurrent infections (1.3%) confirmed by antibiogram, treating isolated episodes. CONCLUSIONS: Urinary incontinence surgery with mini-sling system is not free of complications (20%). Most of them are mild and can be successfully treated conservatively.

Complicaciones de la cirugía de incontinencia urinaria femenina con minicintas / Complications of female urinary incontinence surgery with mini-sling system

Objetivo: Evaluar las complicaciones de la cirugía antiincontinencia con minicintas, así como describir su diagnóstico y manejo. Material y métodos: Realizamos un análisis descriptivo de las complicaciones en un grupo de 155 mujeres con incontinencia urinaria intervenidas con minicintas (50 TVT-Secur y 105 MiniArc) entre octubre de 2006 y noviembre de 2008. Durante el seguimiento, los controles incluyeron anamnesis, exploración física y cuestionarios de calidad de vida (ICIQ-SF y EQ-5D), incluyendo uroflujometría con residuo posmiccional, urodinámica y urocultivo ante sospecha de obstrucción. Para analizar las complicaciones, fueron clasificadas en intraoperatorias, precoces (primer mes tras la cirugía) y tardías (pasado un mes). El análisis estadístico de los resultados lo realizamos mediante el programa informático SPSS (V 14.0). Resultados: La mediana de edad de las pacientes estudiadas fue de 56 años (rango 33–82). La mediana de seguimiento fue de 180 días (26–817). La tasa de complicaciones fue del 20% (el 22% para TVT-Secur y el 17% para MiniArc). Como complicaciones intraoperatorias registramos una perforación vesical con TVT-Secur (0,64%), que se trató con sondaje vesical. Las complicaciones precoces, todas registradas en el grupo de MiniArc, fueron un hematoma en la fosa obturatriz (0,64%) que evolucionó a la curación, dolor inguinal en 4 pacientes (2,5%) tratados con AINE y obstrucción uretral en un caso (0,64%) que precisó corte de la malla. Las complicaciones tardías incluyeron 8 erosiones vaginales (5%), 4 requirieron exéresis del material y cierre de la pared vaginal, 2 fueron tratadas con estrógenos vaginales y en 2 pacientes asintomáticas optamos por abstención terapéutica. Cinco pacientes presentaron dificultad miccional (3,22%): 4 precisaron corte de la cinta por obstrucción y una paciente mejoró con autocateterismos. La urgencia de novo en 10 mujeres (6,45%) se trató con éxito con anticolinérgicos. Dos pacientes presentaron ITU de repetición (1,3%), tratando los episodios aisladamente. Conclusiones: La cirugía de incontinencia urinaria con minicintas no está exenta de complicaciones (20%), la mayoría son leves y con posibilidad de manejo con éxito de forma conservadora (AU)

Objective: To evaluate the complications of urinary incontinence (UI) surgery with mini-sling system. Describe its diagnosis and management. Material and method: We make a descriptive analysis of the complications of the surgery in a group of 155 women with UI surgically treated with minisling system (50 TVT-Secur and 105 MiniArc) from October 2006 to November 2008. All patients were evaluated with clinical history, physical examination and two questionnaires of QoL (ICIQ-SF and EQ-5D). When urethral obstruction was suspected, we included urineculture, post-void residual urine measurement and urodinamycs. The complications were grouped into three cathegories: intraoperatory, early (within de first month after surgery) and late complications (after a month). We use the SPSS program (V 14.0) for statistical analysis of the results. Results: The average age was 56 years (range 33–82) and 180 days for the following-up (range 26–817). We had a complication rate of 20% (22% TVT-Secur, 17% MiniArc). We reported one intraoperatory complication corresponding to a bladder perforation (0.64%), managed conservatively with catheterization. All early complications were reported in the MiniArc group: one obturator fossa hematoma (0.64%) spontaneously resolved, groin pain in 4 patients (2.5%) successfully treated with NSAIDs and one urethral obstruction (0.64%) that required mesh cutting. Late complications included: 8 vaginal erosions (5%), 4 required tape excison and vaginal wall closure; 2 were treated with vaginal estrogens, and the other 2 were asymptomatic so we did nothing. 6 patients (3.8%) showed urethral obstruction: we performed mesh cutting in 5, whereas one patient improved with intermittent catheterization. Urge symptoms were reported in 10 patients (6.45%) and successfully managed with anticholinergic agents. 2 patients suffered from recurrent infections (1.3%) confirmed by antibiogram, treating isolated episodes. Conclusions: Urinary incontinence surgery with mini-sling system is not free of complications (20%). Most of them are mild and can be successfully treated conservatively (AU)

Sistema REMEEX® para el tratamiento de la incontinencia de esfuerzo masculina: nuestra experiencia / REMEEX® system for the treatment of male urinary stress incontinence: Our experience

Introducción: Presentamos un estudio retrospectivo sobre los resultados obtenidos por nuestro servicio en el tratamiento de la incontinencia urinaria de esfuerzo masculina con el sistema REMEEX®. Material y métodos: Entre febrero de 2007 y diciembre de 2009 se intervinieron con el sistema REMEEX® 14 pacientes varones diagnosticados de incontinencia urinaria de esfuerzo moderada-severa. El origen de la incontinencia fue secundario a prostatectomía radical abierta (n=9), laparoscópica (n=4) y RTU prostática (n=1). Evaluamos las complicaciones obtenidas en tres grupos: intraoperatorias, precoces (menos de 1 mes) y tardías (más de 1 mes). Evaluamos el estado de los pacientes tras 1, 3, 6 y 12 meses de seguimiento. Resultados: La mediana de edad fue de 68,5 años (rango: 62–71). El tiempo mediano de seguimiento fue de 18,6 meses (rango: 10,1–35,2). La media de reajustes fue de 3,7 (rango: 1–6). Un total de 12 pacientes fue reajustado en el postoperatorio inmediato (24–72h tras la intervención). En tres ocasiones (21,4%) fue necesario retirar todo el sistema, uno por infección precoz y dos porque no deseaban más reajustes. La complicación intraoperatoria más frecuente fue la perforación vesical con 4 casos (28,5%). La complicación precoz más encontrada fueron 5 episodios de retención aguda de orina (35,7%). Al año, un 41,7% de los pacientes está totalmente continente (5/12) y un 33,3% presenta leves escapes (4/12). Conclusiones: El sistema REMEEX® para la incontinencia urinaria masculina, según nuestra experiencia, presenta un porcentaje de éxito al año (pacientes continentes o con mínimos escapes) del 75%, con una alta incidencia de complicaciones menores.Los reajustes, sobre todo durante los primeros seis meses, son frecuentes y es necesario un estrecho seguimiento. Necesitamos trabajos que evalúen la efectividad de este sistema a más largo plazo (AU)

Introduction: We evaluate the effectiveness of REMEEX® (readjustable sling) for the treatment of male urinary stress incontinence (SUI). Materials and method: Between February 2007 and December 2009, 14 male patients with mild to severe SUI were operated with the use of REMEEX® system. The origin of incontinence was radical open prostatectomy (n=9), laparoscopic prostatectomy (n=4) and TUR (n=1). We evaluate postoperatively complications in three groups: intraoperatively, early complications (before 1 month) and late complications (after 1 month). Follow up was done at 1, 3, 6 and 12 months after intervention. Results: The mean age was 68,5 years (range: 62–71). The average follow-up time was 18,6 months (range: 10,1–35,2). The mean of readjustment was 3,7 (range: 1–6). Twelve patients were readjusted during the early period (24–72h after intervention). The mesh was removed in 3 cases (21,4%) owing to infection in one and the others because patients didn't want more system readjustment. There were four (28,5%) intraoperative bladder perforations. The early complication more frequent was acute urinary retention with five cases (35,7%). To the year of follow-up 41,7% of the patients are totally continent (5/12) and 33,3% presents light urinary incontinence (4/12). Conclusions: The REMEEX® system for the treatment of male SUI presents (in our experience) a 75% of good results (continent patients or patients with light urinary incontinence) at the year of follow-up with a high rate of light complications. Readjustment are frequent at the first six months after intervention and it′s necessary an intense follow-up. We need more studies that evaluate the long-term efficiency of this system (AU)

[REMEEX® system for the treatment of male urinary stress incontinence: our experience]. / Sistema REMEEX® para el tratamiento de la incontinencia de esfuerzo masculina: nuestra experiencia.

INTRODUCTION: We evaluate the effectiveness of REMEEX® (readjustable sling) for the treatment of male urinary stress incontinence (SUI). MATERIALS AND METHOD: Between February 2007 and December 2009, 14 male patients with mild to severe SUI were operated with the use of REMEEX® system. The origin of incontinence was radical open prostatectomy (n=9), laparoscopic prostatectomy (n=4) and TUR (n=1). We evaluate postoperatively complications in three groups: intraoperatively, early complications (before 1 month) and late complications (after 1 month). Follow up was done at 1, 3, 6 and 12 months after intervention. RESULTS: The mean age was 68,5 years (range: 62-71). The average follow-up time was 18,6 months (range: 10,1-35,2). The mean of readjustment was 3,7 (range: 1-6). Twelve patients were readjusted during the early period (24-72h after intervention). The mesh was removed in 3 cases (21,4%) owing to infection in one and the others because patients didn't want more system readjustment. There were four (28,5%) intraoperative bladder perforations. The early complication more frequent was acute urinary retention with five cases (35,7%). To the year of follow-up 41,7% of the patients are totally continent (5/12) and 33,3% presents light urinary incontinence (4/12). CONCLUSIONS: The REMEEX® system for the treatment of male SUI presents (in our experience) a 75% of good results (continent patients or patients with light urinary incontinence) at the year of follow-up with a high rate of light complications. Readjustment are frequent at the first six months after intervention and it's necessary an intense follow-up. We need more studies that evaluate the long-term efficiency of this system.

[Stress urinary incontinence surgery with MiniArc swing system: our experience]. / Nuestra experiencia con minicintas MiniArc en la cirugía de la incontinencia urinaria de esfuerzo.

OBJECTIVE: To describe the surgical technique of AMS MiniArc swing system for the treatment of female urinary incontinence, evaluate its results and complications. METHOD: We performed a retrospective study of surgery with AMS Miniarc swing system. From august 2007 to march 2009, 135 patients with urinary incontinence (UI) underwent AMS MiniArc swing system surgery in hammock way. 110 patients (81.5%) suffered from stress urinary incontinence (SUI) and 25 (18.5) from mixed (MUI). The average age was 55 years-old. All these procedures were performed wigh local anesthesia and in <>. We evaluate every patient a month later, between 3-6 months later, and a year after surgery. During the following up, clinical history was made in every women with ICIQ-SF questionnaire, that included a fourth question to evaluate the degree of satisfaction after surgery, as well as physical examination. We considered objective cure when negative stress test with full bladder. We use the SPSS program (V 14.0) for statistical analysis of the results (Student's t-test). RESULTS: With a mean follow-up of 495 days (range from 181 to 777), early complications included: 2 bladder perforations during sling placement, inguinal pain in 4 patients and one obturator hematoma (resolved spontaneously). The long-term postoperative complications were: 4 tape exposures in vagina (2.9%), urethral obstruction in 3 patients (2.2%) that required urethrolysis and net section, and irritative symptoms of frequency and urgency reported in 9 patients (6.6%), 5 out of 9 were temporary (between 2 and 6 months) whereas the remaining 4 required anticholinergic agents due to persistent symptoms. When evaluating the success rates of anti-incontinence surgery, 91.9% of patients showed objective cure (88% with MUI and 92.7% with SUI) since we demonstrated no loss of urine by physical examination with full bladder. The ICIQ-SF score (fourth question included) decreased an average of 12.7 points. 90% of patients were very or fairly satisfied. CONCLUSION: The AMS Minarc swing system is an optim anti-incontinence procedure. Its main advantage might be the possibility of performing this procedure under local anesthesia, in order to test and adjust the sling's tension according to the person's needs. Despite its promising results, further studies are required in order to arrive at more precise conclusions, taking into account that the TVT remains the gold standard surgical technique of SUI.

Nuestra experiencia con minicintas MiniArc® en la cirugía de la incontinencia urinaria de esfuerzo / Stress urinary incontinence surgery with MiniArc swing system: Our experience

Objetivos: El objetivo de esta publicación es describir de forma retrospectiva la técnica quirúrgica y evaluar las complicaciones y los resultados de la colocación de la cinta AMS MiniArc® swing system para el tratamiento de la incontinencia urinaria. Material y método: Presentamos un estudio retrospectivo sobre la colocación de cinta AMS MiniArc® swing system. Entre agosto de 2007 y marzo de 2009 colocamos dicha cinta en hamaca a 135 pacientes, 110 (81,5%) tenían incontinencia urinaria de esfuerzo y 25 (18,5%) incontinencia urinaria mixta con un edad mediana de 55 años (rango entre 27–82 años). Todos los procedimientos se realizaron con anestesia local y en régimen de cirugía mayor ambulatoria. Las pacientes fueron controladas en consultas externas al mes (control 1), entre los 3–6 meses (control 2) y al año (control 3). Se les realizó una historia clínica y el cuestionario ICIQ-SF, al que le añadimos una pregunta para cuantificar el grado de satisfacción, así como la exploración física. Consideramos como curación objetiva que la paciente en la exploración física realizada en la consulta con la vejiga llena presentara un test de esfuerzo negativo. Analizamos los resultados y el análisis descriptivo y de comparación de medias con la t de student mediante el programa informático SPSS (V14.0). Resultados: La mediana de seguimiento fue de 495 días (rango entre 181–777 días). En las 135 pacientes intervenidas registramos como complicaciones intraoperatorias 2 perforaciones vesicales. Como complicaciones precoces registramos 1 paciente con hematoma en la fosa obturatriz que evolucionó espontáneamente a curación y 4 pacientes (2,9%) con dolor leve a nivel inguinal no incapacitante. Como complicaciones tardías, 4 pacientes (2,9%) presentaron extrusión de la malla y 3 pacientes (2,2%) necesitaron corte unilateral de la cinta por presentar obstrucción. En 9 pacientes (6,6%) se presentó urgencia de novo, 5 de las cuales (3,7%) fueron temporales entre 2–6 meses, y 4 (2,96%) persistentes y tratadas mediante anticolinérgicos. Observamos que el 91,9 % de las pacientes estaban curadas al año. Si analizamos los resultados según el tipo de incontinencia que presentaban, las pacientes con incontinencia urinaria mixta estuvieron curadas en el 88% y las pacientes con incontinencia urinaria de esfuerzo en el 92,7%. Con el cuestionario ICIQ-SF y la pregunta de satisfacción, observamos un descenso medio en la puntuación de 12,7 puntos, con un 90% de las pacientes muy o bastante satisfechas. Conclusión: La colocación de esta minicinta AMS MiniArc® swing system es una herramienta más para el tratamiento quirúrgico de la incontinencia urinaria, y la ventaja fundamental respecto a sus predecesoras es la posibilidad de realizar la cirugía con anestesia local consiguiendo dar la tensión adecuada a la cinta in situ. Pero debe demostrar sus resultados a largo plazo teniendo como referencia al «gold standard» de la TVT (AU)

Method: We performed a retrospective study of surgery with AMS Miniarc swing system. From august 2007 to march 2009, 135 patients with urinary incontinence (UI) underwent AMS MiniArc swing system surgery in hammock way. 110 patients (81.5%) suffered from stress urinary incontinence (SUI) and 25 (18.5) from mixed (MUI). The average age was 55 years-old. All these procedures were performed wigh local anesthesia and in «Out patient Surgery». We evaluate every patient a month later, between 3–6 months later, and a year after surgery. During the following up, clinical history was made in every women with ICIQ-SF questionnare, that included a fourth question to evaluate the degree of satisfaction after surgery, as well as physical examination. We considered objective cure when negative stress test with full bladder. We use the SPSS program (V 14.0) for statistical analysis of the results (Student′s t-test). Results: With a mean follow-up of 495 days (range from 181 to 777), early complications included: 2 bladder perforations during sling placement, inguinal pain in 4 patients and one obturator hematoma (resolved spontaneously). The long-term postoperative complications were: 4 tape exposures in vagina (2.9%), urethral obstruction in 3 patients (2.2%) that required urethrolysis and net section, and irritative symptoms of frequency and urgency reported in 9 patients (6.6%), 5 out of 9 were temporary (between 2 and 6 months) whereas the remaining 4 required anticholinergic agents due to persistent symtoms. When evaluating the success rates of anti-incontinence surgery, 91.9% of patients showed objective cure (88% with MUI and 92.7% with SUI) since we demonstrated no loss of urine by physical examination with full bladder. The ICIQ-SF score (fourth question included) decreased an average of 12.7 points. 90% of patients were very or fairly satisfied. Conclusion: The AMS Minarc swing system is an optim anti-incontinence procedure. Its main advantage might be the possibility of performing this procedure under local anesthesia, in order to test and adjust the sling′s tension according to the person′s needs. Dispite its promising results, further studies are required in order to arrive at more precise conclusions, taking into account that the TVT remains the gold standard surgical technique of SUI (AU)

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

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

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

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

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

TOT en el tratamiento de la incontinencia de esfuerzo: nuestra experiencia, comparándola con la TVT / TOT in the treatment of the stress urinary incontinence: our experience, comparing it with the TVT

Introducción: En el año 2004 iniciamos la técnica de TOT para el tratamiento de la incontinencia urinaria de esfuerzo. En este estudio comparamos los resultados con las series publicadas de TOT y con la serie de TVT realizadas en nuestro servicio. Material y métodos: Hemos intervenido a 171 pacientes, con una edad media de 57,7 años. En el 167% de ellas, además de realizar TOT, asociamos reparación de defectos anatómicos pélvicos. Resultados: Con un seguimiento medio de 12 meses y mediana de 14 meses, el 87% de las pacientes están curadas. Los fracasos aparecieron de forma precoz en los 3 primeros meses de seguimiento. Como complicaciones aparecieron, retenciones post-operatorias de menos de 30 días en el 2,7%, retenciones a largo en el 4,8%, hematomas post-quirúrgicos en el 1,3%, extrusión de la malla en el 2% y urgencia de novo en el 2.3%. Conclusiones: La TOT es una técnica no exenta de complicaciones aunque la proporción de ellas es baja y con unos resultados que son alentadores. Se trata de una técnica quirúrgica sencilla, que como toda técnica, tiene una curva de aprendizaje. Requiere un corto tiempo quirúrgico (menor que la TVT) y puede ser realizada en régimen de Cirugía Mayor Ambulatoria. Las dos técnicas (TVT/TOT) han demostrado ser similares en cuanto a tasas de curación aunque en la serie de TOT es levemente más baja. Las diferencias de las complicaciones se dan en los porcentajes aunque siempre escasas

Introduction: In the year 2004 begin the technique of TOT for the treatment of the urinary incontinence of effort. In this study we compare the results with the published series of TOT and with the series of TVT carried out in our service. Material and methods: We have intervened to 171 patients, with a 57.7 year-old half age. In their 16%, besides carrying out TOT, we associate repair of anatomical pelvic defects. Results: After a follow-up of 12 months and a mean of 14, 87% of the cases succeeded. Failures arose during the first three months of therapy. As complications they appeared post-operative retentions of less than 30 days in 2.7%, retentions to long in 4.8%, post-surgical hematomas in 1.3%, extrusion of the mesh in 2% and novo urgency in 2.3%. Conclusions: TOT is a technique it doesn’t exempt of complications although their proportion is low and with some results that they are encouraging. It is about a surgical simple technique that as all technique, he/she has a learning curve. It requires a surgical (smaller than TVT) short time and it can be carried out in régime of bigger Ambulatory Surgery. The two techniques (TVT / TOT) have demonstrated to be similar as for cure rates although in the series of TOT it is slightly more baja. Las differences of the complications they are given in the percentages although always scarce

[TOT in the treatment of the stress urinary incontinence: our experience, comparing it with the TVT]. / TOT en el tratamiento de la incontinencia de esfuerzo: nuestra experiencia, comparándola con la TVT.

INTRODUCTION: In the year 2004 begin the technique of TOT for the treatment of the urinary incontinence of effort. In this study we compare the results with the published series of TOT and with the series of TVT carried out in our service. MATERIAL AND METHODS: We have intervened to 171 patients, with a 57.7 year-old half age. In their 16%, besides carrying out TOT, we associate repair of anatomical pelvic defects. RESULTS: After a follow-up of 12 months and a mean of 14, 87% of the cases succeeded. Failures arose during the first three months of therapy. As complications they appeared post-operative retentions of less than 30 days in 2.7%, retentions to long in 4.8%, post-surgical hematomas in 1.3%, extrusion of the mesh in 2% and novo urgency in 2.3%. CONCLUSIONS: TOT is a technique it doesn't exempt of complications although their proportion is low and with some results that they are encouraging. It is about a surgical simple technique that as all technique, he/she has a learning curve. It requires a surgical (smaller than TVT) short time and it can be carried out in regime of bigger Ambulatory Surgery. The two techniques (TVT / TOT) have demonstrated to be similar as for cure rates although in the series of TOT it is slightly more baja. Las differences of the complications they are given in the percentages although always scarce.

[TVT our experience five years and six months later]. / Nuestra experiencia a cinco años y medio en TVT.

OBJECTIVE: We present the outcome of urinary incontinence surgery after TVT more than five year of follow-up. Efficacy was evaluated in terms of complete cure of incontinence, complications, and patient satisfaction. MATERIAL AND METHODS: A sample of 369 female with genuine stress incontinence or mixed incontinence who had a TVT performed in our hospital between 1998-2003 were evaluated. Sample average age was 59.9 years. A total of 326 patients (85%) had genuine stress incontinence and 56 (15%) mixed incontinence. Preoperative evaluation was base on: clinical history and physical examination, stress test, flowmetry and post voided residual. Cistometry was indicated only in patients with previous surgery and mixed incontinence. Severity of incontinence was graded clinically. Primary outcome measure was complete cure of incontinence defined as lack of objective and subjective leakage. In addition a phone survey about patient satisfaction with the surgery was carried out. RESULTS: The average follow up was 35 months (6-67). A total of 317 were complete continent (86%). By contrast, 52 patients (14%) had leakages jet. The novo urgency rate was 7% and a 5.7% of patients were reoperated to cut the mesh because of obstruction. Nevertheless, the reoperation rate was low and only a patient showed a massive haematoma which needed to be evacuated. CONCLUSION: Bursch Technique through suprapubic route has been classically considered the gold standard procedure for stress urinary incontinence for the last decades, having been substituted nowadays by tension-free suburethral mesh sling whose most important advantages are: Simplicity of the method, lower cost and higher comfort for the patient due to the fact that we have chaged in-patient surgery program for ambulatory one with similar results in order to sanation. Anyway we will have to check if the preliminary good results and no complications persist in the follow-up.

[Segmental testicular infarction]. / Infarto segmentario de testículo.

We report the case of a 47 years old man previously diagnosed of left hidrocele. After having a recent mild left testicular pain, an ultrasonografic study revealed a solid hipoecoic testicular lesion rounded by a big hidrocele, suggesting a testicular neoplasm. Radical inguinal orchiectomy was made and pathologic study showed segmental testicular infarction. No malignancy was found. We review the literature of the topic.

Nuestra experiencia a cinco años y medio en TVT / TVT our experience five years and six month later

Objetivo: Presentar los resultados de eficacia de TVT a cinco años en términos de curación de incontinencia y complicaciones para el tratamiento de la IUE y de satisfacción personal con el resultado de la intervención. Material y métodos: Un total de 369 incontinentes con una edad media de 59,9 años fueron implantadas con el sistema TVT en nuestro hospital pacientes desde 1998 hasta 2003. De ellas, 326 pacientes (85%) presentaban IUE pura y 56 (15%) incontinencia mixta con predominio de esfuerzo. La evaluación preoperatorio se realizó mediante historia clínica, exploración física, prueba de esfuerzo, flujometría y medición residuo postmiccional. La cistomanometría sólo se indicó en pacientes con urgencia o antecedentes de cirugía previa. El grado de severidad de la incontinencia se catalogó clínicamente. Como criterio de curación completa se consideró la ausencia de pérdidas objetivas y subjetivas. Se realizó encuesta telefónica para estudiar el grado de satisfacción de la paciente. Resultados: El seguimiento medio fue de 35 meses con un rango entre 6 y 67 meses. Del total de pacientes, 317 presentaban continencia completa, lo que representa un 86%. Por el contrario, 52 pacientes (14%) presentaban escapes de orina. La tasa de urgencia de novo fue del 7% y la de corte de TVT por obstrucción de 5,7%. El porcentaje de reintervenciones, con sólo un caso de hematoma masivo. Conclusiones: Hasta ahora se ha considerado siempre como patrón oro de las intervenciones de incontinencia de la orina, la técnica suprapúbica de Bursch, quizás la más contrastada en el tiempo, pero en la actualidad está siendo sustituida por las técnicas de malla suburetral sin tensión, cuya principal ventaja, es la simplicidad del método, su menor costo económico y la mayor comodidad para la paciente, pues convertimos una cirugía con varios días de ingreso, en una cirugía ambulatoria, con unos resultados hasta el momento similares en tasa de curación, Pero habrá que comprobar que los resultados a largo plazo de las mallas, si se mantienen en el tiempo y no aparecen complicaciones derivadas de la malla

Objective: We present the outcome of urinary incontinence surgery after TVT more than five year of follow-up. Efficacy was evaluated in terms of complete cure of incontinence, complications, and patient satisfaction. Material y methods: A sample of 369 female with genuine stress incontinence or mixed incontinence who had a TVT performed in our hospital between 1998-2003 were evaluated. Sample average age was 59.9 years. A total of 326 patients (85%) had genuine stress incontinence and 56 (15%) mixed incontinence. Preoperative evaluation was base on: clinical history and physical examination, stress test, flowmetry and post voided residual. Cistometry was indicated only in patients with previous surgery and mixed incontinence. Severity of incontinence was graded clinically. Primary outcome measure was complete cure of incontinence defined as lack of objective and subjective leakage. In addition a phone survey about patient satisfaction with the surgery was carried out. Results: The average follow up was 35 months (6-67). A total of 317 were complete continent (86%). By contrast, 52 patients (14%) had leakages jet. The novo urgency rate was 7% and a 5,7% of patients were reoperated to cut the mesh because of obstruction. Nevertheless, the reoperation rate was low and only a patient showed a massive haematoma which needed to be evacuated. Conclusión: Bursch Technique through suprapubic route has been classically considered the gold standard procedure for stress urinary incontinence for the last decades, having been substituted nowadays by tension-free suburethral mesh sling whose most important advantages are: Simplicity of the method, lower cost and higher comfort for the patient due to the fact that we have chaged in-patient surgery program for ambulatory one with similar results in order to sanation. Anyway we will have to check if the preliminary good results and no complications persist in the follow-up

Infarto segmentario de testículo / Segmental testicular infarction

Presentamos el caso de un varón de 47 años diagnosticado meses antes de hidrocele izquierdo que en estudio sonográfico reciente, realizado por dolorimiento testicular, presentaba lesión sólida nodular sugestiva de neoplasia testicular izquierda. Fue sometido a orquiectomía radical. El análisis de la pieza quirúrgica demostró la presencia de infarto segmentario con ausencia de tumor. Revisamos la bibliografía sobre el tema

We report the case of a 47 years old man previously diagnosed of left hidrocele. After having a recent mild left testicular pain, an ultrasonografic study revealed a solid hipoecoic testicular lesion rounded by a big hidrocele, suggesting a testicular neoplasm. Radical inguinal orchiectomy was made and pathologic study showed segmental testicular infarction. No malignancy was found. We review the literature of the topic

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

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

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

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

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

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

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

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

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