[Female incontinence: urodynamic evaluation]. / Incontinencia femenina: evaluación urodinámica.

OBJECTIVE: To evaluate the functional studies in women with stress urinary incontinence. METHODS: Emphasis is placed on comprehensive understanding of stress urinary incontinence in women as well as Urodynamic techniques and findings which apply to women with this condition. RESULTS: Although prospective randomized controlled trials to evaluate the clinical efficacy, cost-effectiveness and effect on quality of life of a pre-operative Urodynamic assessment are necessary, to date only Urodynamic Investigation (Non-invasive uroflowmetry, filling cystometrogram, valsalva leak point pressure, pressure-flow studies and urethral profile) provide enough information for treatment decisions and prognosis in cases of female urinary incontinence.

[Urinary incontinence surgery: TVT procedure]. / Tratamiento quirúrgico de la incontinencia: TVT.

The T.V.T. procedure has become a technique for Urinary incontinence and its different presentations. Many trials have reported the efficacy of this technique for different situations, as well as its results and complications. We review the literature and analyze the results and complications, comparing this technique with other such procedures.

[Radical prostatectomy in stage pT3C stage prostatic adenocarcinoma]. / Prostatectomía radical en adenocarcinoma de próstata estadio pT3C.

OBJECTIVES: To assess the efficacy of surgery in pT3c patients; to discern whether this is an independent influential factor for survival and clinical factor for diagnostic prediction. MATERIAL AND METHODS: Forty-five pT3c (TNM 1982) patients from a cohort of 220 subjects with T1-T2 prostate cancer who underwent radical prostatectomy. Mean and median follow-up: 42 and 36 months, respectively. RESULTS: pT3 stage accounts for 20% (45/220) patients. They display a significantly higher mean PSA (25 +/- 2 ng/ml) (0.001), worse Gleason (0.0002) and clinical stage (0.0003), greater margins involvement (0.0007), and biochemical (0.02), local (0.05) and metastatic (0.001) progression. Independent influential factors are: PSA > 20 ng/ml; T2bc and Gleason 7-10. From these values patients can be divided into 3 risk groups: a) Group I (0-1 unfavourable variables): risk of seminal vesicle involvement 7%; Group II (2 unfavourable variables): risk 47%; Group III (3 unfavourable variables): risk 61%. Progression-free survival: significantly lower than patients with pT2 (58 +/- 8% vs 66 +/- 6% at 5 years) (0.002), but similar to those with pT3ab (0.91). Seminal vesicle involvement is not an independent influential factor (Cox's multivariate study). Influential factors are PSA, Gleason and clinical stage. CONCLUSIONS: pT3c tumours are not an independently influential group in progression-free survival. Progression-free survival is lower than pT2 but similar to pT3ab. Their poor prognosis is dependent on association to negatively influential clinico-pathological factors.

Prostatectomía radical en adenocarcinoma de próstata estadio pT3c / Radical prostatectomy in pT3C prostate adenocarcinoma

OBJETIVOS: Valorar la eficacia de la cirugía en pacientes pT3c; saber si constituye un factor de influencia independiente en la supervivencia y los factores clínicos de predicción diagnóstica. MATERIAL Y MÉTODOS: Se estudian 45 pacientes pT3c (TNM 1982) de una serie de 220 pacientes con cáncer de prós-tata T1-T2 sometidos a prostatectomía radical. Media y mediana de seguimiento: 42 y 36 meses respectivamente. RESULTADOS: El grupo pT3 constituye el 20 por ciento (45/220) de los pacientes. Tiene un PSA medio (25 ñ 2 ng/ml) significativamente más elevado (0,001), peor Gleason (0,0002) y estadio clínico (0,0003), mayor afectación de márgenes (0,0007), progresión bioquímica (0,02), local (0,05) y metastásica (0,001). Los factores de influencia independiente son: PSA > 20 ng/ml; T2bc y Gleason 7-10. Con ellos se forman tres grupos de riesgo: a) Grupo I (0-1 variable desfavorable): riesgo de afectación de vesícula seminal 7 por ciento; Grupo II (2 variables desfavorables): riesgo 47 por ciento; Grupo III (3 variables des-favorables): riesgo 61 por ciento. Supervivencia Libre de progresión: es significativamente menor que la de los pT2 (58 ñ 8 por ciento vs 66 ñ 6 por ciento en 5 años) (0,002), pero similar a la de los pT3ab (0,91).La afectación de vesícula seminal no es un factor de influencia independiente (estudio multivariado de Cox). Los factores influyentes son PSA, Gleason y estadio clínico. CONCLUSIONES: Los pT3c no son un grupo de influencia independiente en la supervivencia libre de progresión. Evidencian peor supervivencia libre de progresión que los pT2 e igual que los pT3ab. Su mal pronóstico depende de su asociación a factores clínico-patológicos de influencia negativa. (AU)