Priapism Produced by Penile Metastasis from Colon Cancer.

INTRODUCTION AND OBJECTIVE: The penile metastasis is a rare clinical entity. The objective is to present the first documented case report of penile metastasis from right colon. CLINICAL CASE: A case of a 78-year-old man who was diagnosed with penile metastasis from right colon. The patient came to our consultation complaining of colic pain in the kidney and swelling of the penile which finally result in a malignant priapism. The diagnosis was histopathologic and was treated with chemotherapy and died few months later. CONCLUSION: Metastatic lesions in the penile are extremely rare; only 300 cases have been reported in the literature. It is a sign of bad prognosis. The mechanism of metastatic spread to the penis is not well established. Even there are several treatment options, is usually paliative.

Endometriosis ureteral en paciente monorrena. Presentación del caso y revisión de la literatura / Ureteral endometriosis in a single-kidney patient. Case report and literatura review

La endometriosis se define como la presencia de tejido endometrial funcionante localizado de manera ectópica fuera de la cavidad uterina. La afectación del aparato urinario es poco frecuente evidenciándose únicamente en el 5% de las pacientes con endometriosis. Presentamos el caso de una paciente de 44 años monorrena izquierda, que ingresa en el servicio de urología por hidronefrosis y dolor en fosa renal de un mes de evolución. Se realiza estudio de uropatía obstructiva izquierda evidenciándose efecto masa en uréter distal izquierdo. Dados los hallazgos y los antecedentes de la paciente (monorrena izquierda) se decide realizar ureterectomía y vejiga psoica, con toma de biopsia intraoperatoria. El estudio histopatológico de la pieza reveló el diagnóstico de endometriosis ureteral. La paciente en la actualidad se encuentra asintomática y con función renal normal (AU)

Endometriosis is defined as the presence of ectopic endometrial tissue outside the normal confines of the uterine cavity. Urinary tract involvement is uncommon, its incidence being about 5%. We report the case of a 44 year-old patient with a single left kidney admitted to the urology department of our hospital diagnosed with left-sided hydronephrosis. She also complained of pain in the left renal fossa for more than a month. A study of left obstructive uropathy was performed, revealing a mass effect in the left distal ureter. Given the findings and the patient's history (a single left kidney), we decided to perform ureterectomy and to fix the bladder to the psoas, as well as to perform an intraoperative biopsy. The histopathological report of the surgical specimen confirmed the previous diagnosis of ureteral endometriosis. The patient is currently asymptomatic and has normal renal function (AU)

Sellado intravesical del uréter terminal en la nefroureterectomía / Intravesical sealing of distal uréter in nephroureterctomy

OBJETIVO: Estudiar la eficacia y fiabilidad de una nueva técnica mínimamente invasora para el tratamiento del uréter terminal en la nefroureterectomía por tumor urotelial, tanto abierta como laparoscópica.MÉTODOS: Estudio retrospectivo observacional de 14 pacientes a los que se practicó la técnica de sellado intravesical del uréter terminal y desinserción endoscópica del mismo previamente a la nefroureterectomía (11 laparoscópicas, 3 abiertas) indicada por tumor de urotelio superior durante el periodo de julio de 2003 a noviembre de 2007. El procedimiento se llevó a cabo en 11 varones y 3 mujeres con edad media de 59,5 (rango: 35-70 años). El tumor asentó en la pelvis renal en 12 casos, y en el uréter proximal en 2 casos. El estadio correspondió a Ta - T1 en 10 pacientes, T2 en 3 y T3 en 1 caso. El grado tumoral fue G3 en 9 casos y G2 en los 5 restantes.La desinserción se realizó mediante un cuchillete de Collins. Para evitar el contacto de la orina con el espacio retroperitoneal se procedió al cierre precoz del meato mediante una grapa introducida a través de un puerto transvesical.RESULTADOS: El tiempo quirúrgico total de la nefroureterectomía fue de 231,15 minutos (rango: 200-340). La tasa de complicaciones para la intervención valorada globalmente (nefroureterectomía) fue de 28,4%, y la tasa de las relacionadas solo con este procedimiento técnico (cierre transvesical del meato y desinserción) fue de 14,2%.Todos los pacientes fueron dados de alta tras la retirada de la sonda vesical, siendo la estancia hospitalaria media de 10,14 días (rango: 6-22).Con un seguimiento medio de 25,3 meses (rango: 12-64) no hemos registrado recidivas locales en el retroperitoneo. En un paciente hubo recidiva vesical. Otro paciente desarrolló una metástasis en glándula suprarrenal que se trató satisfactoriamente(AU)

CONCLUSIONES: El cierre precoz del uréter terminal mediante grapa transvesical previo a su desinserción endoscópica en la nefroureterectomía constituye una técnica segura desde el punto de vista oncológico, con una tasa de complicaciones aceptable, que evita el segundo tiempo abierto para el manejo del uréter terminal(AU)

OBJECTIVES: To study the effectiveness and reliability of a new minimally invasive technique for the treatment of the terminal ureter in nephroureterectomy due to transitional cell carcinoma, both in open and laparoscopic procedures.METHODS: Observational retrospective study of 14 patients that underwent intravesical sealing and endoscopic excision of terminal ureter, before ureterectomy (11 laparoscopic, 3 open), due to an upper urinary tract tumor, between July 2003 and November 2007. This procedure was performed on 11 males and 3 females, average age 59.5 years, (range: 35-70). The tumor settled on the renal pelvis in 12 cases and on the proximal ureter in 2. Stage was Ta – T1 in 10 patients, T2 in 3, and T3 in 1. Tumor grade was G3 in 9 cases and G2 in 5.Excision was carried out with a Collins knife. In order to avoid contact between the urine and retroperitoneal space, the meatus was quickly sealed with a clip introduced by means of a transvesical trocar.RESULTS: Total surgical time of nephroureterectomy was 231.15 minutes (range 200-340). Global complication rate for the procedure was 28.4%, but the rate for the cases associated with this technique (meatus sealing and disinsertion) was 14.2%.All patients were discharged after removing bladder catheter. Mean hospital stay was 10.14 days (range: 6-22).After an average follow-up of 25.3 months (range: 12-64), no retroperitoneal recurrence has been reported. One of the patients had bladder recurrence and another one developed metastasis to the suprarenal gland that was treated satisfactorily.CONCLUSIONS: Quick sealing of distal ureter by transvesical application of a clip before its endoscopic excision in nephrourecterectomy is a sound technique from an oncological point of view, with an acceptable complication rate that avoids a second open time to manage distal ureter(AU)

[Long-term follow-up of antegrade endopyelotomy. Factors that influence the outcome]. / Seguimiento a largo plazo de la endopielotomía anterógrada. Factores que influyen en el resultado.

OBJECTIVE: To find out the outcomes of endopyelotomy alter a long-term follow-up and determine the variables that may influence the results. MATERIAL AND METHODS: We review the results obtained in 77 patients that underwent antegrade endopyelotomy with ureteropelvic junction obstruction, after 10-year follow-up. We used the Kaplan-Meier curve in order to determine the probable failure rate at a certain point. We took measurements of the pyelocalix area and studied its shape to find out the influence of hydronephrosis in the outcomes. Other variables, such as renal function, previous surgery, lithiasis and renal malformation associated, were analysed. RESULTS: Mean follow-up was 149.26 months. Faliure rate probability was 26.9, 34.5 and 36.8% a year, 5 years and 10 years later, respectively. Major failure concentration occurred in the first 20 months. Mean pyelocalix area success was 19.70 +/- 8.32 cm2 vs 30.19 +/- 11.07 cm2 of failure, (p=0,018). There were no differences between the values of the shape factor in either success and failure. (0,87 vs 0.88, p= 0.135, respectively). Renal function (45.1% success vs 40,9% failure, p=0,625), previous surgery (62% success after previous surgery vs 64.7% first procedure, p=0.843), and lithiasis associated (69.3% success through lithiasis vs 61.1% without lithiasis, p=0.541) did not affect the outcomes. Concomitance of hydronephrosis and renal malformation affected the outcomes negatively. CONCLUSION: Endopyelotomy success rate reduces long-term follow-up, however, after the fifth year it becomes stable. Selecting cases to apply this technique according to the value of hydronephrosis area could improve the results.

Seguimiento a largo plazo de la endopielotomía anterógrada. Factores que influyen en el resultado / Long-term follow-up of antegrade endopyelotomy. Factors that influence the outcome

Objetivo: Conocer los resultados de la endopielotomía con un seguimiento a largo plazo y determinar las variables que influyen en los mismos. Material y Métodos: Se revisan los resultados de la endopielotomía anterógrada realizada en 77 pacientes con obstrucción de la unión pieloureteral (OUPU) con un seguimiento superior a 10 años. Se utilizó la curva de Kaplan-Meier para conocer la probabilidad de fracaso en un determinado momento. Se realizó planimetría del área pielocalicial y se estudio su factor de forma para conocer la influencia de la hidronefrosis en el resultado. Se estudiaron otras variables como el grado de función renal, cirugía previa, coexistencia de litiasis y malformación renal asociada. Resultados: El seguimiento medio fue de 149,26 meses. La probabilidad de fracaso fue de 26,9%, 34,5% y 36,8% al año, 5 años y 10 años respectivamente. La mayor concentración de fracasos se produjo dentro de los 20 primeros meses. El área pielocalicial media en los éxitos fue de 19,70±8,32 cm2 vs 30,19±11,07 cm2 en los fracasos, (p=0,018).No hubo diferencias entre los valores del factor de forma en los éxitos y en los fracasos (0,87 vs 0,88, p= 0,135, respectivamente). La función renal (45,1% en éxitos vs 40,9% en fracasos, p=0,625), la cirugía previa (62% de éxito con cirugía previa vs 64,7% en primarias, p=0,843), y la asociación con litiasis (69,3% éxito con litiasis vs 61,1% sin litiasis, p=0,541) no influyeron el resultado. La concomitancia de hidronefrosis y malformación renal afectó negativamente el resultado. Conclusión: La tasa de éxito de la endopielotomía disminuye en seguimientos a largo plazo, si bien a partir del quinto año se mantiene estable. Seleccionar casos para esta técnica de acuerdo al área de la hidronefrosis podría mejorar el resultado (AU)

Objective: To find out the outcomes of endopyelotomy alter a long-term follow-up and determine the variables that may influence the results. Material and Methods: We review the results obtained in 77 patients that underwent antegrade endopyelotomy with ureteropelvic junction obstruction, after 10- year follow-up. We used the Kaplan-Meier curve in order to determine the probable failure rate at a certain point. We took measurements of the pyelocalix area and studied its shape to find out the influence of hydronephrosis in the outcomes. Other variables, such as renal function, previous surgery, lithiasis and renal malformation associated, were analysed. Results: Mean follow-up was 149.26 months. Faliure rate probability was 26.9, 34.5 and 36.8% a year, 5 years and 10 years later, respectively. Major failure concentration occurred in the first 20 months. Mean pyelocalix area success was 19.70±8.32 cm2 vs 30.19±11.07 cm2 of failure, (p=0,018). There were no differences between the values of the shape factor in either success and failure. (0, 87 vs 0.88, p= 0.135, respectively). Renal function (45.1% success vs 40,9% failure, p=0,625), previous surgery (62% success after previous surgery vs 64.7% first procedure, p=0.843), and lithiasis associated (69.3% success through lithiasis vs 61.1% without lithiasis, p=0.541) did not affect the outcomes. Concomitance of hydronephrosis and renal malformation affected the outcomes negatively. Conclusion: Endopyelotomy success rate reduces long-term follow-up, however, after the fifth year it becomes stable. Selecting cases to apply this technique according to the value of hydronephrosis area could improve the results (AU)

[Intraoperative complications and morbidity of laparoscopic radical prostatectomy (LRP) during the learning curve]. / Complicaciones intraoperatorias y morbilidad de la prostatectomía radical laparoscópica (PRL) durante el periodo de aprendizaje.

OBJECTIVES: To analyze the complications and morbidity during our learning curve of laparoscopic radical prostatectomy (LRP) and compare them with other published series. METHODS: We review the 25 first laparoscopic radical prostatectomies performed in our department, evaluating the operative technique and other features such as surgical time, blood loss, complications and conversion to open surgery. We also evaluate morbidity, postoperative hospital stay, and functional features such as potency and continence. RESULTS: LRP was completed in 22 patients. Overall intraoperative complication rate was 32%. 3 cases were converted to open surgery due to technical difficulties or intraoperative complications. We had complications in 4 patients, that were not severe (bladder injury 2 cases, and epigastric artery injury another 2) and where solved without difficulties during the operation. The most severe intraoperative complication was related to the anesthesia procedure at the time of extubation of a patient who required tracheotomy. There were no severe postoperative complications, being leakage from the anastomosis the most common (7 cases). All of them were managed conservatively, although this resulted in a mean hospital stay of 10.8 days. 2 patients required endoscopic procedures in the immediate postoperative time for bladder catheter repositioning. All patients suffered erectile dysfunction and the continence rate at 3 months was 77.2%. CONCLUSIONS: Although LRP is a long operation and difficult during the learning curve, its complication rate is acceptable because they are not severe and can be managed in a relatively easy way.

[Ureteroscopy in the follow-up protocol for upper urinary tract urothelial tumors treated endoscopically]. / La ureteroscopia en el protocolo del seguimiento del tumor del urotelio superior tratado por via endoscópica.

OBJECTIVES: To evaluate the role of ureteroscopy (rigid and flexible) in the follow-up protocol for transitional cell tumors treated conservatively in our department by endourological procedures, and to review the articles on this topic available in the literature. METHODS: From February 1997 to June 2003, 10 patients (12 renal units) with upper urinary tract urothelial tumor treated conservatively by endourological procedures were followed by cytology, cystoscopy, retrograde ureteropyelography, and ureteroscopy (rigid and flexible), quarterly during the first year, semi-annually during the second year, and yearly thereafter in order to detect tumor recurrence. RESULTS: Mean follow-up was 31.9 months (R 14-65). Two patients died: one because of a previous metacronous bladder tumor and the other after distant progression. One patient was lost to followup. A total of 42 ureteroscopies were performed (31 flexible and 11 rigid). Flexible ureteroscopy was performed in 6 patients and rigid ureteroscopy in three; neither was feasible in one patient so that follow-up was done by cytology, cystoscopy and urography. Tumor recurrence was detected in 2 patients but ureteroscopy did not inform about tumor stage. Flexible ureteroscopy failed in another patient in which rigid ureteroscopy was feasible. Although this latter was technically easier to perform, procedure discomfort was worse. CONCLUSIONS: The follow-up of transitional cell tumors of the upper urinary tract should be very strict because of the high risk of tumor relapse. Ureteroscopy, mainly flexible, is standing out as the most effective procedure to watch these tumors.

[Laparoscopic pyeloplasty. Our experience]. / Pieloplastia laparoscópica. Nuestra experiencia.

OBJECTIVES: To report our experience with laparoscopic pyeloplasty in the treatment of pyeloureteral junction obstruction. METHODS: Between August 2001 and August 2004 14 patients with the diagnosis of pyeloureteral junction obstruction underwent laparoscopic repair. Seven cases had the obstruction on the left side and the other seven on the right side. We describe the technique of laparoscopic dismembered Anderson-Hynes type pyeloplasty, performed to 12 patients in our series. The remainder 2 patients underwent Foley's Y-V plasty and the Fenger's technique. RESULTS: Mean operative time was 199.7 minutes (r: 126-290). There were not intraoperative complications. Mean hospital stay was 4.63 days (r: 3-9). One case of double J catheter obstruction can be cited as late postoperative complication. Only one of the 14 cases suffered a recurrence of the stenosis after double J catheter retrieval. CONCLUSIONS: Laparoscopic pyeloplasty has become the operation of choice in cases of hydronephrosis secondary to crossing vessel, when there is great pyelic dilation, and for the treatment of failures of previous endopyelotomy.

[Splenic hematoma after extracorporeal lithotripsy: apropos of a case]. / Hematoma de bazo tras litotricia extracorpórea: a propósito de un caso.

OBJECTIVE: To emphasise a case of splenic hematoma secondary to ESWL. METHODS: We report the case of a 69 year old patient with the diagnosis of left kidney stone who underwent ESWL. The treatment was performed with an electric lithotripter after pre-treatment antibiotic prophylaxis; 2000 shock waves of 18 Kv were given to the patient. RESULTS: Patient presented abdominal pain and hematocrit descent after lithotripsy. The diagnosis of splenic hematoma was established after abdominal ultrasound and CT-scan and the patient was treated conservatively. He required a posterior emergency splenectomy secondary to infection of the hematoma, with the result of death secondary to septic shock. CONCLUSION: Splenic lesion is an exceptional complication after ESWL. There are no studies about the effect of shock waves on the spleen, having been reported only four cases. It is believed that extreme care should be taken in cases with splenic pathology: leukaemia, lymphoma, etc.

Hematoma de bazo tras litotricia extracorpórea: a propósito de un caso / Splenic haematoma after external shock wave lithotripsy (ESWL)

OBJETIVO: Destacar un caso de hematoma esplénico secundario a tratamiento con ESWL.MÉTODOS: Presentamos el caso de un paciente de 69 años, al que se dio ESWL tras el diagnóstico de litiasis renal izquierda. Previa profilaxis antibiótica el tratamiento se realizó con un litotritor eléctrico recibiendo el paciente 2000 pulsos de 18 Kv. RESULTADO: Tras la litotricia el paciente presentó dolor abdominal y descenso de hematocrito. Mediante la realización de una ecografía y TAC abdominal el paciente fue diagnosticado de hematoma de bazo y tratado conservadoramente. Posteriormente se realizó una esplenectomía de urgencia por infección del hematoma, falleciendo el paciente de shock séptico. CONCLUSIÓN: La lesión del bazo, es una complicación francamente excepcional. Al aparecer publicados sólo cuatro casos, en la literatura, no existen estudios de los efectos de la litotricia sobre el bazo. Se cree que hay que ser extremadamente cuidadosos, ante la litotricia, en pacientes con bazos patológicos: leucemia, linfoma, etc (AU)

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[Glomerular morphologic protection after acute ischemia through the administration of Surgiran: (PGE1 and Alfadex, glucose cyclic oligomer). Morphometric study]. / Protección morfológica glomerular tras isquemia aguda mediante la administración de Surgiran: (PGE1 y Alfadex, oligómero cíclico de la glucosa). Estudio morfométrico.

OBJECTIVE: To quantify the morphologic protection of PGE1 on renal glomerulus following normothermic acute renal ischemia. METHODS: This experimental study was carried out in 48 adult male Wistar rats. A simple right nephrectomy was performed in all rats. The rats were divided into two groups: one group was perfused with PGE1 and the other group with saline solution immediately after acute renal ischemia, which was produced by non-traumatic vascular clamping. The ischemia times were 15 and 60 minutes. The recovery period ranged from 24 hours to 7 days. After this period the animals were anesthetized and sacrificed. Histological and morphometric analyses of the right kidneys of the control group and the left kidneys of the study group were performed. RESULTS: The mortality was 31% (18.5% for the group perfused with PGE1 and 11.4% for the group perfused with saline solution). Kidneys of rats perfused with saline solution weighed more than the kidneys of rats perfused with PGE1 (1.771 +/- 0.455 and 1.55 +/- 0.34, respectively). Acute tubular necrosis was observed after 60 minutes' ischemia and was more evident in the saline than in the PGE1 group. The morphometric study showed no significant differences between the control (normal) and the PGE1 group for glomerular diameter (p < or = 0.101), sphericity factor (p < or = 0.239), glomerular perimeter (p < or = 0.092) and glomerular volume (p < or = 0.059). However, significant differences were found between the control and the saline perfusion group for area (p < or = 0.000), diameter (p < or = 0.000), perimeter (p < or = 0.000) and volume (p < or = 0.000). CONCLUSIONS: Kidney weight after ischemia increased more in the saline than in the PGE1-treated group since the edema in the renal parenchyma is attenuated by the anti-inflammatory and cytoprotective effects of PGE1. The morphometric study showed that in comparison to saline, PGE1 exerts a cytoprotective effect, although it is not considerable.

Protección morfológica glomerular tras isquemia aguda mediante la administración de Surgiran®: (PGE1 y Alfadex, oligómero cíclico de la glusosa). Estudio morfométrico / Glomerular morphologic protection after acute ischemia with Surgicam (PGE, and Alfadex, a glucose cyclic oligomere): A morphometric study

OBJETIVO: Con este trabajo pretendemos cuantificar morfológicamente la protección de la PGE1 sobre el glomérulo renal tras un periodo de isquemia renal aguda normotérmica.MÉTODOS: 48 ratas adultas machos de la raza Wistar fueron empleadas. Todas ellas fueron sometidas a nefrectomía derecha simple. Se dividieron en dos grandes grupos: a uno se le perfundió PGE1 y a otro suero fisiológico inmediatamente a la isquemia renal aguda que se produjo mediante un clamp vascular atraumático. Los tiempos de isquemia fueron de 15 minutos y 1 hora. Los periodos de recuperación del animal osciló entre 24 horas y 7 días. Pasado este tiempo los animales fueron anestesiados y sacrificados. Ambos riñones, derechos (grupo control) e izquierdos (experimentales), han sido estudiados histológica y morfométricamente.RESULTADOS: La mortalidad del estudio fue de 31 por ciento (18,5 por ciento del grupo de PGE1 y 11,4 por ciento del grupo de suero fisiológico). El peso de los riñones experimentales con fisiológico fue mayor que el grupo de PGE1 (1,771ñ0,455 y 1,55ñ0,34 respectivamente). A partir de los 60 minutos de isquemia se observaron lesiones de necrosis tubular aguda, que eran más evidentes en los grupos sometidos a suero fisiológico que a PGE1.Desde el punto de vista morfométrico no se encontró diferencia significativa entre el grupo control (normalidad) con el grupo experimental con PGE1 respecto al diámetro glomerular (P 0,101), factor de esfericidad (P 0,239), perímetro glomerular (P0,092) y Volumen glomerular (P 0,059), mientras que sí que se encontró entre el grupo control y el grupo de suero fisiológico con respecto al área (P 0,000), Diámetro (p0,000), perímetro (P£0,000) y volumen (P 0,000).CONCLUSIÓN: El aumento de peso renal experimentado tras la isquemia es menor en el grupo tratado con PGE1, que en el de suero fisiológico, al disminuir el edema que se forma el parénquima renal, gracias a su capacidad antiinflamatoria y citoprotectora. La PGE1 produce, frente al suero fisiológico, un efecto citoprotector, medido morfométricamente, aunque éste se puede considerar como discreto (AU)

[Radical cystectomy. Bladder substitution (in women)]. / Cistectomía radical. Sustitución vesical (en mujer).

OBJECTIVES: To report our experience with a series of 10 patients undergoing radical cystectomy with bladder substitution. We were supported by a better knowledge of the female continence anatomical mechanisms and the demonstration of the oncological viability of the urethral remnant. METHODS: From 1994 to 2002 10 women underwent radical cystectomy with bladder substitution by means of a modified anterior pelvic exanteration; technical modifications to achieve continence preservation are based on: preservation of the distal 2/3 of urethra, pubourethral ligaments and endopelvic fascia, and limitation of lateral vaginal dissection to avoid damage to the striated sphincter innervation. To avoid the neocystocele effect the vagina is fixed to the uterosacral ligaments and to the sacral promontory. RESULTS: Bladder capacity is 332.9 +/- 35.6 ml with a flow of 17.7 ml/sec. Complete continence wax achieved in 8 patients, the remainder 2 present grade II urinary stress incontinence. All of them empty their neobladder satisfactorily; only one patient needed a bladder re-education program. One bladder fistula and diarrhoea in one patient are the complications to be highlighted. CONCLUSIONS: The results obtained with orthotopic neobladder in females, achieving a high satisfaction level and quality of life, stimulate us to continue with this technique.

Plastia de sustitución vesical ortotópica en la mujer. Modificaciones técnicas en la exenteración anterior: resultado en 9 casos / Orthopic bladder substitution in the female. technical modifications in anterior exenteration: Results in 9 casos

OBJETIVO: Presentamos los resultados obtenidos en nuestra serie de nueve mujeres intervenidas de cistectomía con plastia de sustitución. Nos basamos en un mejor conocimiento de los mecanismos anatómicos de la continencia femenina y la demostración de la viabilidad del remanente uretral desde el punto de vista oncológico. MÉTODOS: Desde 1994 a 1999 nueve mujeres han sido operadas de cistectomía radical con plastia de sustitución, mediante una exenteración pelviana anterior. Las modificaciones de la técnica quirúrgica se basan en: conservar los dos tercios distales de la uretra, conservar los ligamentos pubouretrales, preservar la fascia endopélvica y limitar la disección látero vaginal, para guardar así la inervación del esfínter estriado, consiguiendo conservar la continencia. RESULTADOS: La capacidad vesical es de 332,9 ñ 35,6 ml con una flujometría de 17,7 ñ 2,9 ml/ seg. Se ha conseguido continencia total en 7 mujeres, las dos restantes presentan una incontinencia de esfuerzo grado II. Ninguna de ellas presenta problemas de vaciado vesical. Entre las complicaciones destaca una fístula vesical, y diarrea en una paciente. CONCLUSIONES: Los resultados obtenidos en la mujer nos animan a seguir con esta técnica, ya que se consigue un alto nivel de satisfacción y calidad de vida (AU)