[Leiomyosarcoma within a bladder diverticulum]. / Leiomiosarcoma en el seno de un divertículo vesical.

Sarcomas are a rare entity among malignant tumours of the bladder. This paper presents the case of a male patient with leiomyosarcoma within a vesical diverticulum. The approach undertaken was diverticulectomy and, since the tumour was limited to the diverticulum and no metastatic disease was present, no other adjuvant therapy was considered.

Evaluation of the impact of the urinary symptoms on quality of life of patients with painful bladder syndrome/chronic pelvic pain and radiation cystitis: EURCIS study.

OBJECTIVES: To evaluate the impact of urinary symptoms of Painful Bladder/Pelvic Pain Syndrome and Radiation Cystitis (PBCPPS) on the Quality of Life, and self-esteem of the patient. MATERIAL AND METHODS: An observational, multicenter, epidemiological and cross-sectional study was performed on patients with Painful Bladder/Chronic Pelvic Pain Syndrome and Radiation Cystitis. Data was recorded on severity of urinary symptoms and QoL impairment using the PUF Score. The patients evaluated the QoL deterioration grade through the King's Health Questionnaire (KHQ), and the level of their anxiety and self-esteem with the Goldberg's Anxiety Scale (GAS) and Rosenberg's Self-Esteem Scale (RSES), respectively. Post-hoc comparisons were performed between the results of the KHQ of this study and a sample of patients with urinary incontinence (UI). Results on RSES were analyzed with data from the general population and from patients with erectile dysfunction. RESULTS: A total of 530 cases, mostly female patients, who had been diagnosed with PBCPPS, were analyzed. High levels of deterioration in QoL were described: KHQ scores were significantly higher when compared with patients with UI (P<.01). Involvement of self-esteem was higher in patients with RC and men, who obtained scores similar to those of patients with erectile dysfunction. CONCLUSIONS: Patients with Painful Bladder Syndrome/Chronic Pelvic Pain Syndrome and Radiation Cystitis present high levels of anxiety, and significant reductions in both quality of life and self-esteem. Especially for men, this affectation is similar to that caused by erectile dysfunction.

Evaluación del impacto de la sintomatología urinaria en la calidad de vida de los pacientes con síndrome de vejiga dolorosa/dolor pélvico crónico y cistitis rádica: estudio EURCIS / Evaluation of the impact of the urinary symptoms on quality of life of patients with painful bladder syndrome/chronic pelvic pain and radiation cystitis: EURCIS study

Objetivos: Evaluar el impacto que tiene la sintomatología urinaria secundaria a síndrome de vejiga dolorosa/dolor pélvico crónico (SVDPC) y cistitis rádica (CR) en la calidad de vida (CV) y la autoestima del paciente. Material y métodos: Estudio observacional epidemiológico transversal multicéntrico en pacientes con cuadros de SVDPC o CR. Se registraron datos acerca de la gravedad de los síntomas urinarios con la escala PUF. Los pacientes valoraron el grado de deterioro de su CV por medio del cuestionario de salud de King (CSK), así como su nivel de ansiedad y autoestima mediante las escalas de Goldberg y de Rosenberg (EAR), respectivamente. Los resultados del CSK se compararon post hoc con una muestra de pacientes con incontinencia urinaria (IU), mientras que los de la EAR se analizaron frente a los obtenidos en población general y pacientes con disfunción eréctil. Resultados: Se analizaron un total de 530 casos de pacientes, en su mayoría del sexo femenino y con diagnóstico de SVDPC. Se describieron niveles altos de deterioro en la CV en la mayoría de pacientes, con puntuaciones del CSK significativamente mayores en comparación con las muestras de pacientes con IU (p < 0,01). La afectación en la autoestima fue mayor en pacientes con CR y en hombres, que obtuvieron puntuaciones similares a las de pacientes con disfunción eréctil. Conclusiones: Los pacientes con SVDPC y CR, además de tener niveles elevados de ansiedad, presentan disminuciones significativas tanto en la CV como en la autoestima que, particularmente para los varones, es similar a la producida por la disfunción eréctil

Objectives: To evaluate the impact of urinary symptoms of Painful Bladder/Pelvic Pain Syndrome and Radiation Cystitis (PBCPPS) on the Quality of Life, and self-esteem of the patient. Material and methods: An observational, multicenter, epidemiological and cross-sectional study was performed on patients with Painful Bladder/Chronic Pelvic Pain Syndrome and Radiation Cystitis. Data was recorded on severity of urinary symptoms and QoL impairment using the PUF Score. The patients evaluated the QoL deterioration grade through the King's Health Questionnaire (KHQ), and the level of their anxiety and self-esteem with the Goldberg's Anxiety Scale (GAS) and Rosenberg's Self-Esteem Scale (RSES), respectively. Post-hoc comparisons were performed between the results of the KHQ of this study and a sample of patients with urinary incontinence (UI). Results on RSES were analyzed with data from the general population and from patients with erectile dysfunction. Results: A total of 530 cases, mostly female patients, who had been diagnosed with PBCPPS, were analyzed. High levels of deterioration in QoL were described: KHQ scores were significantly higher when compared with patients with UI (P < 0.01). Involvement of self-esteem was higher in patients with RC and men, who obtained scores similar to those of patients with erectile dysfunction. Conclusions: Patients with Painful Bladder Syndrome/Chronic Pelvic Pain Syndrome and Radiation Cystitis present high levels of anxiety, and significant reductions in both quality of life and self-esteem. Especially for men, this affectation is similar to that caused by erectile dysfunction

[Sphincter reeducation in non-coordinated urination syndrome]. / Reeducación esfinteriana en el síndrome de micción no coordinada.

OBJECTIVE: The bladder re-education programs were initially associated with treatment of women with vesical instability. However, little has been published on the efficiency of the re-education techniques in the uncoordinated voiding syndrome of the Hinman syndrome. This study evaluated the urodynamic results of sphincter re-education in the treatment of the uncoordinated voiding syndrome. METHODS: Our series comprised 50 consecutive patients with uncoordinated voiding syndrome. The mean age was 11.9 years; 82% were females and 18% males. All patients underwent a complete urodynamic study with external perineal electromyography and videocystography. The sphincter re-education protocol was comprised of a manual pre-voiding training phase, an electromyographic pre-voiding training phase and a voiding training phase. Upon completing the re-education process, a new urodynamic study was performed and during the follow-up period, uroflowmetry studies were carried out with external perineal electromyography at 3, 6 and 12 months. Based on the response of the detrusor during voiding, we have classified the uncoordinated voiding syndrome into three types: type A, in which voiding is achieved through voluntary contraction of the detrusor; and type C, in which voiding is achieved through abdominal pressure. RESULTS: The clinical results obtained by sphincter re-education at one-year follow-up were: 42% cured, 22% improved, 2% relapsed and 14% showed no response. The remaining 20% were excluded from the treatment protocol. CONCLUSIONS: It is likely that the three types of the uncoordinated voiding syndrome are merely different physiopathological stages of the same vesico-urethral dysfunction. We consider sphincter re-education to be the treatment of choice for this type of patients.

[Distal detubularized sigmoidoplasty (Canarian neobladder). Midterm functional evaluation]. / Sigmoidoplastia distal destubulizada (Neovejiga Canaria). Valoración funcional a medio plazo.

OBJECTIVE: The aim of this report is to evaluate the medium term clinical and urodynamic results of the distal detubularized sigmoid neobladder, which we have called the "Canarian neobladder". METHODS: Since April, 1992, we have performed 26 orthotopic neobladder substitution using this particular technique. Ten patients were excluded from the study: two patients with early cancer progression; one female patient; one patient that had died a few days after the operation and 6 patients with less than 16 months follow-up. The remaining 16 patients were evaluated and had a mean follow-up of 22 months (range 6-54). We have performed clinical, urodynamic, radiographic and metabolic evaluation every six months during the first year and every 12 months thereafter. Clinical evaluation included daytime frequency, daytime and night-time urinary incontinence, urge and patient satisfaction with the clinical results. Flowmetry, cystometry and pressure-flow test were performed. The upper urinary tract was evaluated by renal ultrasound or pyelography. Entero-ureteral reflux was discarded by cystography. The International Continence Society terminology was utilized and clearly specified if otherwise. RESULTS: 87.5% of the patients were continent during the daytime and only two cases had diurnal urinary incontinence. Seventy-five percent of the patients had night-time incontinence and required external devices for its management. At two years follow-up, the mean diurnal frequency was 180 minutes and the mean bladder capacity was 338.2. First sensation was noted at 70.6% of bladder capacity. The neobladder pressure at maximum capacity during the filling phase was less than 30 cm H2O in all cases. Involuntary bladder contractions were demonstrated during cystomanometry in 93.7%. The pressure-flow test demonstrated neobladder contraction in 50% of cases and combined with abdominal straining in 50%. The foregoing allowed application of passive urethral resistance ratio (PURR) parameters, showing mean PURR initial values of 39.1 cm H2O and mean PURR curvature values of 0.17 cm H2O (mil/sec)2. The mean postvoiding urine was 37.5 ml. We diagnosed entero-ureteral reflux in 25% of patients and upper urinary tract dilatation due to a distal ureteral stricture in 2 patients. Mild outlet obstruction was diagnosed in 50% of the cases and were submitted to endoscopic section of the entero-urethral anastomosis. CONCLUSIONS: The distal sigmoid detubularized neobladder achieves a high rate of daytime continence with adequate frequency. However, the night-time incontinence rate was also high. The neobladder functional capacity remained stable throughout follow-up. Voiding was obtained as a result of neobladder contraction; thus postvoiding urine was minimal and patients did not require self-catheterization.

[The clinical and urodynamic aspects of enteroplasty]. / Aspectos clínicos y urodinámicos de las enteroplastias.

A study was conducted in 24 patients to determine the usefulness of the intestinal segments used in bladder replacement surgery. Continence and voiding were analyzed, particularly the more important functional symptoms of the lower urinary tract and the urodynamic behaviour of the intestinal reservoirs/conduits. The Bricker ileal conduits (8 cases) showed poor accommodation during the filling phase, making its use as a reservoir little advisable. In general, bladder augmentation (9 cases) with intestinal segments were shown to be useful reservoirs, but of limited capacity for voiding. The ileal reservoirs (7 cases) used for bladder substitution had, in general, compensated voiding, but with defects in the filling phase.

[Retrovesical hydatid cyst]. / Quiste hidatídico retrovesical.

Hydatid disease is not an uncommon entity in endemic areas. However, the finding of an isolated cyst in the retrovesical region is less frequent. One such case is described herein. The diagnosis and therapeutic aspects are discussed.

[Leiomyoma of the lower urinary tract]. / Leiomiomas de tracto urinario inferior.

Tumors of mesothelial origin account for 1-5% of all vesical neoplasms. Leiomyomas, although rare, are the most frequently encountered. Three patients diagnosed as having leiomyoma are presented. Two had leiomyoma of the bladder and one had leiomyoma of the distal urethra. The etiopathogenesis, diagnosis and treatment of this tumor type are discussed.

[Renal metastasis from breast carcinoma: a new case and review of the literature]. / Metástasis renal de un carcinoma de mama: un nuevo caso y revisión de la literatura.

OBJECTIVES: Breast carcinoma is the most common malignant tumor in the female. A vast majority of the cases present metastasis at the time of diagnosis. A case of breast carcinoma metastatic to the kidney is described to emphasize that in the presence of a renal mass, a secondary or metastatic tumor should be suspected. The literature is briefly reviewed. METHODS: We report on the diagnosis and treatment of an expanding left renal mass in a female patient with a previous history of multiorgan tumors (ovarian, breast and small bowel) or different histological types that had been diagnosed and treated at different periods. RESULTS: Following radical nephrectomy, analysis of the surgical specimen disclosed a metastatic tumor from breast carcinoma. No subsequent treatment was required and the patient is well 6 months postoperatively. CONCLUSIONS: Metastasis from a primary tumor must be suspected in patients with a previous history of tumor presenting with a renal mass. Renal metastasis presents in the advanced stages of tumor dissemination. Treatment depends on patient general condition and the stage of the primary and metastatic tumors.

[Impact of bladder irritative symptoms and detrusor instability on the outcome of urethropexy]. / Repercusión de los síntomas irritativos vesicales e inestabilidad del detrusor en los resultados de la uretropexia.

OBJECTIVES: To evaluate the repercussion of irritative urinary symptoms and bladder instability on the results of urethropexy for urinary stress incontinence. METHODS: A clinical and urodynamic study was carried out in 70 adult women submitted to urethropexy (Kelly, Raz, Marshall-Marchetti-Krantz, Burch or simplified Ramirez technique). RESULTS: The urge incontinence symptom was associated with coughing incontinence is 38 (60%) of the patients submitted to urethropexy. This symptom decreased to 42% (27 patients) after urethropexy. The average score of diurnal urinary frequency was 23% less posturethropexy. The simplified Ramirez technique had the lowest diurnal urinary frequency score [1.17 +/- 1.07 (0 to 3)]. Bladder instability with urinary stress incontinence (mixed incontinence) was found in 21 (30%) patients before urethropexy. The incidence of bladder instability after urethropexy was significantly greater in this group (52%) than in the patients with isolated urinary stress incontinence (17%). However, urethropexy also corrected bladder instability in 30% of the women with mixed incontinence. The Kelly technique produced the lowest incidence of bladder instability after urethropexy (14%). CONCLUSIONS: Urethropexy significantly decreases the irritative urinary symptoms associated with stress urinary incontinence. In some cases, bladder instability associated with stress incontinence (mixed incontinence) may disappear following urethropexy. In most cases bladder instability continues after urethropexy.

[Effects of urethropexy on urination. A price to pay?]. / Afectación de la micción posturetropexia. Un precio a pagar?

OBJECTIVES: To evaluate the voiding repercussions of urethropexy. METHODS: We carried out a clinical and urodynamic study in 70 patients subjected to different techniques of urethropexy (Kelly, Raz, Marshall-Marchetti-Krantz, Burch and simplified Ramirez) for stress urinary incontinence. We evaluated the voiding repercussions of urethropexy. RESULTS: There was a significant increase in the obstructive symptoms with urethropexy (29% of the patients) although there was no relationship with the variation of the urinary flow rate. It also significantly diminished the urinary flow rate (85% of the patients) and increased the postvoiding volume significantly (3.68 times the average before surgery). The increase in postvoiding volume occurred more frequently in patients with diminished urinary flow rate before urethropexy (60% of the cases). The Raz technique showed less urodynamic data of voiding disturbances. CONCLUSIONS: Urethropexy causes voiding disturbance. We believe the decrease in urinary flow rate is related to the increase in urethral resistance produced by urethropexy. In the cases with previously diminished urinary flow rate, reduction in bladder contractility is added to the former mechanism.

[Infantile enuresis: epidemiologic, clinical, urodynamic, and radiologic data of a consecutive series of 100 cases]. / Enuresis infantil: datos epidemiológicos, clínicos, urodinámicos y radiológicos de una serie consecutiva de 100 casos.

The present paper reports the epidemiological, clinical, urodynamic and cystographic data of 100 consecutive patients (mean age 9.59 years) with nocturnal enuresis. These patients were divided into three groups: group I (4 to 7 years old), 23 patients; group II (8 to 11 years old), 51 patients; and group III (12 to 14 years old), 26 patients. Nocturnal enuresis was more frequent in group II (51%). It was more prevalent in males (51%) of groups I and II. Isolated nocturnal enuresis was more frequent (54%) than nocturnal enuresis associated with diurnal symptoms (46%) in all age groups. Urinary infection was observed in 16% and was more prevalent in girls (68.7%). Detrusor instability was the most common urodynamic finding (40%), particularly in group II and girls. Uncoordinated voiding was the second most common urodynamic finding (24%), particularly in group II and girls. Lower urinary tract infection was observed in 1% (males). No abnormal urodynamic data were observed in 19%. Neurogenic bladder was observed in 16%, mainly in group II (31%). Vesicoureteral reflux was detected in 18%, mainly in girls (66.6%) and a postvoiding residual urine in 10%. A diagnostic and prognostic system and a therapeutic strategy based on our data are proposed.

[Urinary incontinence and bacteriuria in women]. / Incontinencia urinaria y bacteriuria en la mujer.

We analyzed the urodynamic data and their relationship with significant bacteriuria in 103 consecutive female patients (mean age = 55.7 yrs) with urinary incontinence. Significant bacteriuria was observed in 25.2% of the cases. E. coli was the pathogen most frequently isolated (70.3%). Significant bacteriuria was demonstrated in 29.3% of the patients with urge-incontinence. The most frequent type of incontinence in patients with bacteriuria was no urodynamic reproduction of urinary incontinence (42.8%). Bladder instability was not associated with significant bacteriuria (27.2%). Significant bacteriuria was observed in 75% of the patients with lower urinary tract obstruction, 66.6% of the patients who voided by abdominal straining and 26.3% of those with postvoiding residual urine. These findings indicate that urine culture should be done in patients with no urodynamic reproduction of urinary incontinence. There was no statistically significant correlation between urge-incontinence/bladder instability and significant bacteriuria. Consequently, antibiotics should not be used routinely in female urinary incontinence.

[Role of the bladder neck in urinary continence in women after urethropexy]. / Participación del cuello vesical en la continencia urinaria femenina posturetropexia.

We conducted a clinical, radiological and urodynamic study in 70 patients submitted to different urethropexy techniques (Kelly, Raz, Marshall-Marchetti-Krantz, Burch, simplified Ramírez) to determine the importance of the bladder neck in the treatment of urinary incontinence. Urethropexy achieved a significant increase in the percentage of patients with an open bladder neck during the filling phase. However, the opening of the bladder neck posturethropexy did not influence urinary continence.

[Comparative results of different types of urethropexy in the treatment of stress urinary incontinence in women]. / Resultados comparativos de los diferentes tipos de uretropexia en el tratamiento de la incontinencia urinaria de esfuerzo femenina.

We conducted a clinical and urodynamic study in 70 patients who had undergone different urethropexy procedures for stress urinary incontinence. Urethropexy had achieved positive results in 87% of the patients. Incontinence persisted in 21% of the patients. Urethropexy significantly reduced the urge-incontinence and frequency associated with this disorder. Anterior urethropexy did not increase the incidence of poor results in the present series since no patient had intrinsic urethral involvement. The suprapubic and the combined techniques achieved the following cure rates: Marshall-Marchetti-Krantz (92%), Burch (100%), Ramírez simplified (80%), Raz (60%). The cure rate for the Kelly vaginal technique was found to be lower (57%).

[Renal carcinoma with tumor embolism of the supradiaphragmatic inferior vena cava: therapeutic alternatives and review of the literature]. / Carcinoma renal con trombo tumoral en vena cava inferior supradiafragmática: opciones terapéuticas y revisión de la literatura.

We report a case of a man with a left renal cancer and vena caval thrombus extending to the right atrium, that was not possible to remove because infiltration of the posterior plane was detected intraoperatively. The patient was rehospitalized for intractable haematuria. He underwent selective embolization of the left renal artery with ethanol and coil. There were no complications and the patient is well seven months after the procedure. We review the literature on the diagnostic and therapeutic options in such cases. We can conclude that it is necessary to know the exact stage of the primary cancer in order to choose the best treatment. MRI or dynamic CT should be utilized to determine the presence of infiltration of adjacent structures or distant metastasis. Radical nephrectomy and the removal of the caval thrombus afford the only possibility of survival in these patients.

[Fracture of the penis: value of echo-Doppler-color]. / Fractura de pene: valor del eco-doppler-color.

OBJECTIVE: A case of traumatic rupture of the corpora cavernosa evaluated by color Doppler ultrasonography is presented. METHODS: A 43-year-old male consulted for a large penile hematoma that had presented 16 hours earlier during sexual intercourse. The patient was evaluated by Doppler ultrasound using a 5 Mhz linear probe. The vascular integrity of the penis was demonstrated by color Doppler ultrasonography of the cavernous arteries and penile veins. RESULTS: Disruption at the base of the right corpus cavernosum associated with a small hematoma appeared as adjacent hypoechoic images. The color Doppler ultrasonic evaluation demonstrated the integrity of the arteries and cavernous veins and no pulsation of the hematoma, indicating conservative management. Four months after the trauma, no changes in erectile function or penile deviation have been observed. CONCLUSIONS: Color Doppler ultrasound is a useful diagnostic imaging technique in the assessment and follow-up of penile trauma.

[True post-micturition urinary incontinence of the male]. / La genuina incontinencia urinaria postmiccional del varón.

Herein we describe 3 cases of male urinary incontinence that had consulted for intense dribbling at the end of voiding. The urodynamic study identified the true postmicturition urinary incontinence in the male, whose origin was ascribed to alterations in the terminal phase of voiding, arising from localized disorders in the posterior or anterior urethra. The major significance of the true postmicturition urinary incontinence in the male lies in the need to distinguish it from other types of urinary incontinence with more clinical importance.

[Obstructive uropathy as a complication of aortic disease and reconstructive peripheral vascular surgery: report of 4 cases and review of the literature]. / Uropatía obstructiva como complicación de la patología aórtica y de la cirugía reconstructiva vascular periférica: presentación de 4 casos y revisión de la literatura.

OBJECTIVES: Ureteral injury can be a complication of peripheral vascular reconstructive surgery or aneurysm of the abdominal aorta. The present study analyses 4 cases of obstructive uropathy; 3 following peripheral vascular reconstructive surgery and 1 from aneurysm of the abdominal aorta. METHODS: All 4 patients were prospectively evaluated. RESULTS: Both renal units were compromised in all 4 cases. The initial management consisted of internal urinary diversion with a double J catheter. Ureterolysis was performed in one case of unresolved uropathy secondary to prior bypass surgery. One case with uropathy due to infection of the vascular prosthetic graft required graft replacement. CONCLUSIONS: The risk of ureteral injury is likely to be seen more often due to the increasing number of operations on the vascular tree and enhanced survival of patients with aortic aneurysm. Prevention of the foregoing complication includes doing US and/or IVP early postoperatively and in the first 4 months following surgery. Patient management is initially conservative.

[Continuing neurologic assessment in myelodysplasia]. / Evaluación neurourológica continuada en la mielodisplasia.

OBJECTIVES: Myelodysplasia produces a neurological lesion with unpredictable urodynamic sequelae. The present study describes our experience in 18 patients with myelodysplasia and vesicourethral dysfunction. METHODS: The study comprised 18 patients (11 males and 7 females) with myelodysplasia and vesicourethral dysfunction. Patient median age was 15.7 years (range 7 months-57 years) and the mean follow-up was 20 months (range 7-47 months). After physical and neurological examination, all patients underwent a complete urodynamic evaluation, including selective electromyography of the periurethral sphincter and videocystography. The urodynamic studies were repeated regularly during follow-up. RESULTS: 14 patients (67.7%) showed a lower motor neuron vesicourethral dysfunction; 2 (11.1%) had upper motor neuron lesion and 2 (11.1%) mixed motor neuron lesion. During the study period, no alterations were observed in the urodynamic pattern of patients with upper or mixed motor neuron lesions, but 9 patients (64.2%) with lower motor neuron lesions showed changes in the urodynamic pattern compared with the first evaluation, with alterations in bladder compliance being the most frequent. CONCLUSIONS: Alterations in bladder compliance may arise from neurogenic and nonneurogenic factors. Our findings indicate the need for close urodynamic surveillance of patients with myelodysplasia and vesicourethral dysfunction.