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Objectives: To evaluate the influence of age on laparoscopic colposacropexy (LCS) outcome and complications for pelvic organ prolapse., Material and Methods: A retrospective and comparative study of 105 patients who underwent standard LCS for Baden-Walker graded pelvic organ prolapse from February 2002 to March 2015. They were categorized into two groups according to age. Group 1 consisted in ≤ 50 years old patients and included 55 women. Group 2 included 50 women who were ≥ 60 years old. Outcomes and complications were compared in both groups., Results: Previous history of abdominal surgery or surgery for pelvic floor disorders was significantly greater in group 2 (43.6 vs 70%). There was no significant difference regarding urinary stress incontinence, urge incontinence or severe organ prolapse between groups (47.2 vs 36%; 1.8 vs 8% and 90.9 vs 92% for Groups 1 and 2 respectively). Although a statistically significant greater proportion of vaginal vault prolapse was present in the elderly group (16.3 vs 38%), the same LCS surgical technique was used in both groups of patients. Despite operating time was significantly greater in the younger group (205.8 ± 53.4 minutes in Group 1 vs 182 ± 42.3 minutes in Group 2), hospital stay was similar in both groups (2.9 ± 1.1 days vs 3.0 ± 1.9 days in group 1 and group 2 respectively). Postoperative complications were not severe and there were no clinically significant differences between groups (20 vs 14%). We found no statistically differences between groups when comparing cure rates (87 vs 92%) in groups 1 and 2 respectively, patient satisfaction and postoperative anatomical findings., Conclusions: LCS has shown excellent cure rates in both young and elder female patients with pelvic organ prolapse.

Objectives: To diffuse the concept and implantation surgical technique of a new prosthesis for the treatment of stress urinary incontinence, the Flow Secure artificial urinary sphincter., Methods: The prosthesis is a single silicone piece filled with saline solution which has the following parts: (1) Pressure regulation reservoir, (2) assistance reservoir for stress situations, (3) control pump with self-sealant port and (4) a cuff. One of the main characteristics is the self-sealant port enables pressure adjustment depending of the clinical needs of the patient as many times as necessary., Results: The surgical technique is simple and the level of continence achieved excellent. The only complication inherent to the Flow Secure design is perforation of the cuff during the act of pressurization, but it has been corrected by designing a new control pump which can not be punctured. Self limited scrotal edema/hematoma are frequent; they can be avoided minimizing the time of trocar use. The remainder complications are common with the AMS 800 and other implantable prosthesis., Conclusions: Despite midterm good results, we need to wait for a greater number of patients with the Flow Secure sphincter and longer follow up to determine the definitive role of this prosthesis for the treatment of urinary incontinence.

The AMS-800 artificial urinary sphincter has been the only prosthesis available for treatment of stress urinary incontinence refractory to other therapeutic modalities for the past 25 years. The relatively high rate of complications occurring with the AMS-800 device during this time led to introduce a number of changes in its design that resulted in a new prostheses, the FlowSecure artificial sphincter. The FlowSecure artificial urinary sphincter is an adjustable prosthesis filled with normal saline without contrast. Plain X-rays cannot therefore be used for monitoring, and ultrasound is the most adequate radiographic technique for evaluation. In addition to calculating the post-void residue, ultrasound allows for verifying prosthesis status and for calculating the urethral occluding pressure. A detailed clinical history and flow rate measurement should be used together with the ultrasound scan to functionally assess patients with the FlowSecure device in order to determine the need for adjusting system pressure to the minimum pressure required for total continence., (Copyright 2009 AEU. Published by Elsevier España, S.L. All rights reserved.)

Background: Artificial urinary sphincter "FlowSecure" is a prosthesis designed for stress urinary incontinence that has achieved excellent results. Although implantation is easy, some urologist used to other prosthesis may find difficult the change to this new technique. This article shows how easily and quickly this new sphincter can be implanted and discuss the differences with the artificial sphincter AMS-800., Methods: Following the case of a patient who was implanted artificial urinary sphincter "FlowSecure" in our center we describe with pictures the technique of implantation and give some advices to make this quicker and easier., Results: Surgical time was 90 minutes. Patient presented uneventful recovery, urethral catheter was removed 24 hours after surgery and discharge was done 72 hours after surgery. Three months after implantation patient describes complete resolution of his stress urinary incontinence., Conclusions: Artificial urinary sphincter "FlowSecure" is easy and quick to implant, and as its use is extended we would compare if results are better than those of the AMS-800 model.

Objective: To report implantation of the new FlowSecure artificial urinary sphincter with conditional occlusion in a female bladder neck, describe surgical technique and suggest minor modifications to accommodate the device for universal female implantation., Patient and Methods: A spina bifida female patient with urodynamically proven stress incontinence due to sphincteric incompetence associated to atonic detrusor was implanted with the new artificial sphincter. Operating time was one and a half hours. The cuff was adjusted to the bladder neck with no problems. Excess belt removed from the cuff was preserved and used for loose fixation of tubing and reservoirs in the right paravesical space. The control pump was placed in the right labia. The prosthesis was implanted at atmospheric pressure zero., Results: The device was easily implanted. There were no perioperative complications. Catheter was removed 24 h post-implantation and patient achieved immediate total continence. There was no need for device pressurization at subsequent follow-up. The patient needed intermittent self-catheterization for emptying her bladder because of impaired detrusor contractility., Conclusions: Despite that the new FlowSecure artificial urinary sphincter has only been used for bulbar urethral implantation, we have successfully implanted the device in a female bladder neck with excellent clinical results. Cuff lengthening and connecting tubes shortening would probably enable all female patients to be suitable for implantation. To the best of our knowledge, this is the first time the device has been implanted in a bladder neck., (2007 S. Karger AG, Basel)

Crystal precipitation in urine results from factors such as ionic strength, pH, soluble complexes formation, formation site and retention of initial solid particle. Among the most frequent causes are poor diuresis and changes in urine pH, their influence being quantified in different ways. Effects of water diuresis such as prophylaxis for urinary calculi are due to the intrinsic properties of the water contained in the urine, solid particles dragging, action on urine infection and changes in urine pH. Urinary flow has an influence on pH, so that its decrease coincides with concentrate urine and low pH, whereas its increase involves the presence of dilute urine and high pH. The purpose of this study is to understand the relationship between increased urine volume due to greater water intake and changes in urine pH, as well as the physiological intervening mechanisms.

Electric stimulation of the greater splanchnic nerve produced short-lasted maximum effects on the renal function ranging between 4 to 8 minutes, during which glomerular filtration and diuresis were annulled, to later increase up to values close to those of the controls in spite of stimulation being maintained, and become stabilized after discontinuation at values similar to the previous control. Analogous changes occurred in blood pressure, central venous pressure, heart and respiratory rates, which consisted in maximum effects during the first minute of stimulation, to immediately initiate a gradual return to control values with fluctuations that translate the activation of regulatory mechanisms. These results show that neuroadrenergic effects due to electric stimulation of the greater splanchnic nerve which cause vasoconstriction and ischaemia of the renal parenchyma, as well as other cardiovascular alterations, are significant but short-lasted, suggesting that they do not necessary result by themselves in irreversible organic lesions.

Functional impairment of transplanted kidneys may occur due to circumstances related either directly or indirectly to the donor, the graft or the receptor. In most publications, renal damage is frequently attributed to ischaemia phenomena, mainly host ischaemia, either because of intraoperative interruption of blood flow for an exceedingly long interval, until perfusion and cooling of the removed kidneys, by the duration of cold ischaemia for organ preservation, or during the implant procedure. Also due to the activation of neuroadrenergic reflexes as a consequence of the mechanical stimulation of sympathetic nervous endings during dissection of the vascular pedicle. Earlier studies in animals have demonstrated that direct, low frequency electric stimulation of the splanchnic nerve involves reversible changes in sodium renal excretion, but it does not modify glomerular filtration; when nerve stimulation is done with high frequency there is a decline of renal blood flow and glomerular filtration. The present study tries to associate some of the causes of hot ischaemia during the agony of the corpse donor and to evaluate those that may be caused by sympathetic efference during removal.

Over the last ten years a true revolution has developed in the resolution of renal and excretory tract calculi. Modern technology has made available to urologists a wide variety of procedures to be used for the fragmentation and removal of calculi, providing few complications, and more satisfaction and speed. The results have surprised urologists, patients and the entire community, up to the point where all interest in the etiological diagnosis and medical management of the lithiatic condition has been lost. Treatment, however, can only be considered complete when formation of new calculi is stopped; and progress to achieve this objective has also been relevant. The purpose of this paper is to explain the reasons for which surgical and medical management should not be competitive but complementary. Surgical procedures are directed to existing calculus, whereas medical measures focus on prophylaxis.