Multilocular cystic nephroma: A clinical case.

OBJECTIVE: To describe the clinical presentation, preoperative diagnostic possibilities, and treatment of cystic nephroma. METHODS: We describe a case of cystic nephroma in an adult male and show that, both in our patient and in the literature, a definitive diagnosis can only be obtained postoperatively, even when there is a reasonable clinical suspicion. CONCLUSIONS: Cystic nephroma is rare, and some authors consider it a questionable entity. However, it should be distinguished from renal cystic neoplasms, which can resemble the condition.

Nefroma quístico multilocular: a propósito de un caso / Multilocular cystic nephroma: A clinical case

OBJETIVO: Mostrar la presentación clínica, las posibilidades diagnosticas preoperatorias y el tratamiento del nefroma quístico. MÉTODOS: Se presenta un caso de nefroma quístico en un varón adulto, comprobando en nuestro caso y en la revisión de la literatura que aunque exista una razonable sospecha clínica, el diagnóstico cierto solo es posible postcirugía. CONCLUSIONES: El nefroma quístico es de frecuencia escasa y por algunos autores es considerada una entidad dudosa, pero hay que tratar de distinguirla de neoplasias quísticas renales, que pueden simular este proceso

OBJECTIVE: To describe the clinical presentation, preoperative diagnostic possibilities, and treatment of cystic nephroma.METHODS: We describe a case of cystic nephroma in an adult male and show that, both in our patient and in the literature, a definitive diagnosis can only be obtained postoperatively, even when there is a reasonable clinical suspicion.CONCLUSIONS: Cystic nephroma is rare, and some authors consider it a questionable entity. However, it should be distinguished from renal cystic neoplasms, which can resemble the condition

[Impact of surgical treatment of female stress urinary incontinence on the quality of life of patients]. / Impacto de la cirugía de la incontinencia urinaria de esfuerzo en la calidad de vida de las pacientes.

OBJECTIVES: To evaluate the quality of life of patients with stress urinary incontinence (SUI) operated in the Department of Urology at the Complejo Hospitalario Universitario in Albacete (CHUA). METHODS: Between November 2001 and December 2005, 126 patients with SUI have completed a questionnaire in our centre, before and after undergoing surgery with sling techniques. The questionnaire was the King's Health Questionnaire (KHQ), which is a specific instrument for the measurement of quality of life in patients with urinary incontinence. RESULTS: Mean patient's age was 57.09 years (DE: 9.57). Twelve women (9.5%) had history of previous urinary incontinence surgery. Mean urinary incontinence evolution time was 114.48 months, with a median of 96 months. 38 patients (30.2%) did not present cystocele, 61 (48.4%) presented grade III cystocele, 25 (19.8%) grade II, and 2 (1.6%) grade I. Before surgery, the scale with best score was Personal relationships, with a mean score of 26.8, whereas the scale with worst scores was Impact of urinary incontinence, with a mean score of 82.96. All operations performed consisted in various techniques of transvaginal slings, except one case (0.8%) in which the Kelly technique was performed. Impact of urinary incontinence was the scale with a greater number of patients improving after surgery; 82.9% of the patients (101 cases) gave a better score. The scales showing greater differences of the mean value comparing before/after surgery were impact of urinary incontinence, limitation on the daily life activity, and limitation on social activity. Personal relationships and General health were the two with the smallest improvements. CONCLUSIONS: Surgery demonstrated to improve the symptoms secondary to this disease, therefore, it results in an improvement of the quality of life that is evident in all scales of the questionnaire, mainly in the impact of urinary incontinence, limitations on physical activity, limitations on daily life, and limitation on social activity scales.

Impacto de la cirugía de la incontinencia urinaria de esfuerzos en la calidad de vida de las pacientes / Impact of stress urinary incontinence surgery on quality of life

OBJETIVO: Valorar la calidad de vida de las pacientes con incontinencia urinaria de esfuerzo (IUE), intervenidas en el Servicio de Urología del Complejo Hospitalario Universitario de Albacete (CHUA).MÉTODO: Entre noviembre de 2001 y diciembre de 2005, se han encuestado en nuestro centro a 126 pacientes afectas de IUE, antes y después de ser intervenidas con técnicas de cabestrillo, mediante el King’s Health Questionnaire (KHQ), el cual es un instrumento específico para la medida de la calidad de vida en pacientes con incontinencia urinaria.RESULTADOS: La edad media de las pacientes fue de 57,09 años (DE: 9,57). Tuvieron antecedentes de cirugía por incontinencia urinaria 12 mujeres (9,5%). La media de evolución de la incontinencia urinaria fue 114,48 meses, con una mediana de 96 meses. No presentaban ningún grado de cistocele 38 pacientes (30,2%) y del resto de mujeres con cistocele, en 61 casos éste fue de grado III (48,4%); en 25 de grado II (19,8%) y en 2 de grado I (1,6%). Antes de la cirugía la escala mejor puntuada fue la de Relaciones personales con una puntuación media de 26,8, mientras que la escala peor puntuada fue la del Impacto de la incontinencia urinaria, con una puntuación media de 82,96. Todas las cirugías realizadas consistieron en diversas técnicas de cabestrillo por vía transvaginal, salvo un caso (0,8%) en el que se realizó según técnica de Kelly. La escala que mayor número de pacientes mejoraron tras la cirugía, fue la del Impacto de la Incontinencia Urinaria, la cual puntuaron mejor un 82,9% (101 casos) de las enfermas. Las escalas que presentaron mayor diferencia de medias entre las puntuaciones de antes y después de la cirugía fueron la del Impacto de la I.U., la de limitaciones de la actividad física, limitación de la actividad de la vida diaria y limitación de actividad social. Las que mejoraron en menor medida fueron las de relaciones personales y salud general(AU)

CONCLUSIONES: La cirugía demostró una mejoría en los síntomas que produce dicha patología repercutiendo, por tanto, en una mejoría de su calidad de vida, como es patente en todas las escalas del cuestionario y sobre todo en las escalas del Impacto de la I.U., limitación de la actividad física, limitación de la actividad de la vida diaria y limitación de la actividad social(AU)

OBJECTIVES: To evaluate the quality of life of patients with stress urinary incontinence (SUI) operated in the Department of Urology at the Complejo Hospitalario Universitario in Albacete (CHUA).METHODS: Between November 2001 and December 2005, 126 patients with SUI have completed a questionnaire in our centre, before and after undergoing surgery with sling techniques. The questionnaire was the King’s Health Questionnaire (KHQ), which is a specific instrument for the measurement of quality of life in patients with urinary incontinence.RESULTS: Mean patient`s age was 57.09 years (DE: 9.57). Twelve women (9.5%) had history of previous urinary incontinence surgery. Mean urinary incontinence evolution time was 114.48 months, with a median of 96 months. 38 patients (30.2%) did not present cystocele, 61 (48.4%) presented grade III cystocele, 25 (19.8%) grade II, and 2 (1.6%) grade I. Before surgery, the scale with best score was Personal relationships, with a mean score of 26.8, whereas the scale with worst scores was Impact of urinary incontinence, with a mean score of 82.96.All operations performed consisted in various techniques of transvaginal slings, except one case (0.8%) in which the Kelly technique was performed.Impact of urinary incontinence was the scale with a greater number of patients improving after surgery; 82.9% of the patients (101 cases) gave a better score. The scales showing greater differences of the mean value comparing before/after surgery were impact of urinary incontinence, limitation on the daily life activity, and limitation on social activity. Personal relationships and General health were the two with the smallest improvements(AU)

CONCLUSIONS: Surgery demonstrated to improve the symptoms secondary to this disease, therefore, it results in an improvement of the quality of life that is evident in all scales of the questionnaire, mainly in the impact of urinary incontinence, limitations on physical activity, limitations on daily life, and limitation on social activity scales(AU)

[Ambulatory surgery in a urology department. Analysis of the period 2003-2006]. / Cirugía ambulatoria en un Servicio de Urología. Análisis del período 2003-2006.

OBJECTIVES: When talking about day surgery we have to differentiate between minor and major ambulatory surgery. Ambulatory surgery enables the patient to stay in the hospital not more than a few hours, showing similar safety and efficacy than conventional surgery. The objective of this paper is to evaluate the results of an ambulatory surgery program. METHODS: Descriptive retrospective study of the results of the Ambulatory Surgery in a Urology Department, including 4,185 patients in a four-year period, from January 1st 2003 to December 31st 2006. RESULTS: In the study period the global substitution rate was 83.6%. The hospital admission rate was 2.5%, most of which were early admissions. Major complications appeared in 26 patients (0.6%), being major bleeding the predominant one. Most complications were minor or mild, and pain at the site of the surgical wound was the most frequent problem found. CONCLUSIONS: The increase and continuous promotion of ambulatory surgery are more than justified. The high satisfaction among patients undergoing this type of surgery, with a very low number of complications registered, provides us with a valuable tool for health-care expenditure control.

[Voiding symptoms changes after vaginal sling surgery for female stress urinary incontinence]. / Cambios en la sintomatología miccional de la incontinencia urinaria de esfuerzo tras la cirugía con técnicas de cabestrillo transvaginal.

OBJECTIVES: To evaluate the changes in voiding symptoms in female patients with stress urinary incontinence (SUI) undergoing transvaginal sling techniques over a five-year period in the Department of Urology at the University Hospital of Albacete. METHODS: Between November 2001 and December 2005 126 patients with SUI (mean age 57.09 years; 36-78) underwent transvaginal sling techniques (Sling in Fast, TVK TOT). All patients were evaluated clinically and urodynamically. RESULTS: Average body mass index (BMI) was 28.14 kg/m2 (SD 4.66; 95% CI: 27.32-28.96). 92 patients (73%) presented between 2-4 previous pregnancies. 99 patients (80.9%) have had birth labour between 2 and 4 times. All of them were vaginal birth labours except 12 cases (9.5%) in which caesarean section had been performed. Daytime voiding frequency after surgery was over 120 minutes in 112 patients (88.9%). Night-time voiding frequency was equal or less than twice in 110 patients (87.3%). 104 patients (82.5%) presented at least two leaking episodes per day, and 105 patients (83.3%) needed to wear one pad per day or less during the last week before follow-up visit. The number of urinary leak episodes per day diminished in 114 patients (90.5%) with a mean decrease of 9.65 episodes (95% CI: 8.56-10.79) (p < 0.0001). Ninety-four patients (76.4%) were completely dry. CONCLUSIONS: Development of new surgical techniques for the treatment of SUI have improved results and diminished the number of complications, an expression of which is the favourable evolution of voiding changes after surgery.

Cambios en la sintomatología miccional de la incontinencia urinaria de esfuerzo tras la cirugía con técnicas de cabestrillo transvaginal / Voiding symptoms changes after vaginal sling surgery for female stress urinary incontinence

Objetivo: Evaluar los cambios en la sintomatología miccional de las pacientes con incontinencia urinaria de esfuerzo (IUE), intervenidas con técnicas de cabestrillo transvaginal, durante un periodo de cinco años en el Servicio de Urología del Complejo Hospitalario Universitario de Albacete (CHUA). Método: Entre noviembre de 2001 y diciembre de 2005, se han intervenido en nuestro centro a 126 pacientes (36-78; media 57,09 años) afectas de IUE, mediante técnicas de cabestrillo transvaginal (Técnicas de Sling In Fast, TVT y TOT). Todas las pacientes fueron evaluadas mediante clínica y urodinamia. Resultados: El índice de masa corporal (IMC) medio fue de 28,14 Kg/m2 (DE: 4,66; IC 95%: 27,32-28,96). 92 pacientes (73%) presentaban entre 2 y 4 embarazos. 99 pacientes (80,9%) presentaban entre 2 y 4 partos. Todos los partos fueron vaginales a excepción de 12 casos (9,5%) en que se practicó cesárea. Tras la cirugía la frecuencia miccional diurna fue superior a 120 minutos en 112 pacientes (88,9%), con respecto a la nocturna 110 pacientes (87,3%), se levantaban por la noche a orinar menos de 2 veces. 104 pacientes (82,5%) presentaban menos de 2 episodios de escape a día y 105 pacientes (83,3%) necesitaban como mucho usar una compresa al día durante la última semana tras la cirugía. Disminuyó en número de escapes al día tras la cirugía en 114 pacientes (90,5%), con una disminución media de 9,65 escapes (IC: 95%; 8,56-10,79) (p<0,0001). 94 pacientes (76,4%) estaban totalmente secas. Conclusiones: El desarrollo de nuevas técnicas quirúrgicas para el tratamiento de la IUE, ha favorecido los resultados y ha disminuido el número de complicaciones, manifestándose en la evolución favorable de los cambios miccionales tras la cirugía (AU)

Objectives: To evaluate the changes in voiding symptoms in female patients with stress urinary incontinence (SUI) undergoing transvaginal sling techniques over a five-year period in the Department of Urology at the University Hospital of Albacete. Methods: Between November 2001 and December 2005 126 patients with SUI (mean age 57.09 years; 36-78) underwent transvaginal sling techniques (Sling in Fast, TVT, TOT). All patients were evaluated clinically and urodynamically. Results: Average body mass index (BMI) was 28.14 kg/m2 (SD 4.66; 95% CI: 27.32-28.96). 92 patients (73%) presented between 2-4 previous pregnancies. 99 patients (80.9%) have had birth labour between 2 and 4 times. All of them were vaginal birth labours except 12 cases (9.5%) in which caesarean section had been performed. Daytime voiding frequency after surgery was over 120 minutes in 112 patients (88.9%). Night-time voiding frequency was equal or less than twice in 110 patients (87.3%). 104 patients (82.5%) presented at least two leaking episodes per day, and 105 patients (83.3 %) needed to wear one pad per day or less during the last week before follow-up visit. The number of urinary leak episodes per day diminished in 114 patients (90.5 %) with a mean decrease of 9.65 episodes ( 95 % CI : 8.56-10.79 ) (p < 0 . 0001 ). Ninety-four patients (76.4 % ) were completely dry. Conclusions : Development of new surgical techniques for the treatment of SUI have improved results and diminished the number of complications , an expression of which is the favourable evolution of voiding changes after surgery (AU)