Performance of the artificial urinary sphincter implantation in men with urinary incontinence: Results from a contemporary long-term real-world nationwide analysis.

PURPOSE: The artificial urinary sphincter (AUS) is one of the most effective surgical treatments for male urinary incontinence regardless of its severity. Current knowledge comes from high-volume centers, but little is known about the performance of this surgery from community practices. This study aims to report contemporary AUS performance in a nationwide observational study in Colombia. METHODS: Male patients who underwent AUS surgery with AMS 800™ between 2000 and 2020 in more than 17 centers and four cities were identified. Pre, intra, and postoperative characteristics were evaluated, mainly addressing patient reported outcomes measurements in the postoperative period. Retrospective and prospective data collection and descriptive analysis were completed. Kaplan-Meier analysis was used to determine AUS survival rate. RESULTS: Out of an initial 667 cases, a total of 215 patients met inclusion and exclusion criteria and were included. Mean age was 67 ± 9.4 years, and mean follow-up was 6.0 ± 4.4 years with maximum range of 14 years. The etiology of urinary incontinence was prostate cancer surgery in 141 (81%) of the cases. The rest of the cases were related to benign prostatic disease or spinal cord injury. It is noteworthy that out of 115 patients, only 59 (51.3%) reported previous formal pelvic floor rehabilitation. Subjective severity of urinary incontinence determined by a visual analog scale showed a decrease in 4.5 points after sphincter implantation. Sphincter removal was required in 50 (23.2%) cases. The main reasons for implant removal were urethral erosion and infection. The sphincter survival rate at 2, 5, 8, 10, and 14 years was 76%, 70%, 60%, 57%, and 17%, respectively. Of the subjects at the last follow-up with the device still in place, 80.7% defined their urinary condition as "does not cause or causes minor discomfort," and 99% would recommend the device to a friend or relative in the same condition. CONCLUSIONS: This series from a community-based practice shows the lack of adherence to clinical practice guidelines and the lack of standardized data collection. In contrast, this study provides real-world data on explantation and revision rates, allows physicians to inform patients and to have clear metrics for a shared decision-making process before the procedure.

Effectiveness of the Remeex system™ in Colombian women with recurrent stress urinary incontinence or intrinsic sphincter deficiency.

INTRODUCTION AND HYPOTHESIS: We report our experience with the Remeex system™ in women with recurrent stress urinary incontinence (SUI) or intrinsic sphincter deficiency (ISD). METHODS: A multicenter retrospective study was conducted in women who underwent an adjustable sling procedure between 2011 and 2016. We used urodynamic studies (UDS) preoperatively and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and cough stress test (CST) pre- and postoperatively. Primary outcomes were subjective (no leakage reported by the patient) and objective (no leakage during CST) cure and improvement rates (reduction of ≥4 points in ICIQ-SF). Descriptive and inferential statistics were employed. RESULTS: A total of 50 patients were included. Mean age was 62 years (SD ± 11.35). Median follow-up was 19.5 months [interquartile range (IQR) 12.95-41.38]. Urinary incontinence (UI) was described as moderate and severe by 8 (16%) and 42 (84%) patients, respectively, and 25 (50%) had stress-predominant mixed urinary incontinence (MUI). Objective and subjective cure rates were 90% and 48%, respectively, while 82% of patients achieved improvement. Impact of UI on quality of life (QoL) improved from 10 (IQR 9-10) to 2 (IQR 0-5) (p < 0.0001). Clavien-Dindo II complications occurred in 14 (28%) patients, and one (2%) had IIIa. Tape erosion occurred in one (2%) patient, and five (10%) required readjustments. Logistic regression identified MUI [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.02-10.89] and vaginal atrophy (OR 4.2, 95% CI 1.06-16.03) as predictors of low subjective cure rate. CONCLUSIONS: Adjustable slings represent a valuable and safe option in the management of recurrent SUI or ISD, with improvement in QoL. Results should be carefully interpreted due to our small sample and retrospective design.

[Renal lymphangioma]. / Linfangioma renal.

OBJECTIVES: To report a rare case of renal lymphangioma in a 30-year-old female consulting with left flank pain. METHODS: We perform a bibliographic review and present the clinical, radiological and pathologic features. RESULTS: The patient underwent surgical treatment: radical nephrectomy. Final pathology report showed a renal lymphangioma. CONCLUSIONS: Renal lymphangioma is a mesenchymal tumor of benign behavior which poses several diagnostic difficulties, both radiologically and histologically. This tumor may be confused with other renal tumors, including clear cell renal carcinoma.

Linfangioma renal / Renal lymphangioma

OBJETIVO: Presentar un caso inusual de linfangiomarenal, en una mujer de 30 años quien consultópor dolor en el flanco izquierdo.MÉTODOS: Revisión de la literatura, presentación y discusiónde los hallazgos clínicos, radiológicos y de histopatología.RESULTADOS: La paciente es llevada a tratamiento quirúrgico,nefrectomía radical, con diagnóstico de lesión tumoralmaligna, el resultado patológico final fue linfangiomarenal.CONCLUSIÓN: El linfangioma renal es un tumor mesenquimatosode comportamiento benigno y que presentaciertas dificultades diagnósticas, tanto radiográfica comomicroscópicamente. Este tumor puede ser confundido conotros tumores renales, incluyendo el carcinoma de célulasrenales

OBJECTIVES: To report a rare case of renal ;;lymphangioma in a 30-year-old female consulting with left ;;flank pain. ;;METHODS: We perform a bibliographic review and present ;;the clinical, radiological and pathologic features. ;;RESULTS: The patient underwent surgical treatment: radical ;;nephrectomy. Final pathology report showed a renal ;;lymphangioma. ;;CONCLUSIONS: Renal lymphangioma is a mesenchymal ;;tumor of benign behavior which poses several diagnostic ;;difficulties, both radiologically and histologically. This ;;tumor may be confused with other renal tumors, including ;;clear cell renal carcinoma

[Myocardial ischemia caused by an anomalous circumflex coronary artery]. / Isquemia miocárdica causada por una arteria circunfleja anómala.

The case of a 71-year-old male patient, with symptoms of dizzines and atypical chest pain and a positive isotopic exercise stress test, is reported. Coronary angiography demostrated an anomalous origin of the left circumflex coronary artery from right coronary ostium but no obstructive atherosclerotic coronary lesions. The possible relation between the congenital coronary anomaly and the clinical manifestations of the patient is discussed.

Isquemia miocárdica causada por una arteria circunfleja anómala / Myocardial Ischemia Caused by an Anomalous Circumflex Coronary Artery

Presentamos el caso de un varón de 71 años con mareos y molestias torácicas atípicas, que presentó un test de esfuerzo con isótopos positivo. Se realizó una coronariografía que puso de manifiesto una arteria circunfleja que se originaba en el ostium coronario derecho y que no presentaba lesiones ateroscleróticas asociadas. Se discute la posible relación entre la clínica del paciente y la circunfleja anómala (AU)

The situation of the City of Mendoza, Argentina, in a seismic emergency

The development if the structure of land use in this city is analyzed since its creation up to now. Three well-defined stages are distinguished separated by two fundamental events: 1) the March 20, 1861, earthquake which stands out from the rest because it was the most destructive one in Argentina, destroying the city of Mendoza and killing 6,000 people out of a population of 18,000; and 2) the sudden urban growth in the 1950s which unified small surrounding urban centres with the original one, establishing the base of the presente city called Gran Mendoza with 800,000 inhabitants. The seismic hazard estimation was carried out considering the following aspects: seismicity, potential seismic sources, attenuation relations and local soil conditions , thus maximum acceleration maps with 10

probability of exceedance were obtained for different ranges of time.(AU)

Results of seismic microzonations performed in the main two urban centers of the Argentinian seismic region

Microzonation studies were performed by INPRES in two urban centers of western Argentina, San Juan and Mendoza, which are located in the region of highest seismic hazard of this country. Probabilistic seismic hazard maps of the areas were obtained combining the information given by : potential seismic sources, attenuation relations and subsurface conditions. The potential levels of ground motion amplitudes were estimated for three characteristics earthquakes, which correspond to: 10 percent probability of exceedance in 10,50 and 250 years. Peak accelerations varying from 0.20 g to 0.70 g were obtained. Spectral shapes for structural design were recommended. An inventory of existing constructions was done grouping them in different types and evaluating their structural safety. Of a total of aproximately 200,000 constructions, 63 percent were classified as earthquake resistant and the remaining 37 percent as non earthquake resistant. Taking into account, in a combined way, the probable levels of ground motion and the construction types, damage potentials were estimated in a qualitatively way (AU)