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Objetives The aim of this publication is to describe retrospectively the results of the surgical technique of AMS MiniArc for the treatment of female urinary incontinence, evaluate its results at 4 years follow-up. Material and methods We present a retrospective cohort study of 135 patients, 110 (81.5%) had urinary incontinence and 25 (18.5%) mixed urinary incontinence. All these procedures were performed with local anesthesia and in “out patient surgery”. Patients were monitored in the outpatient clinic at 6 months (control 1), one year (control 2) and annually (control 3, 4, and 5). During the following up, clinical history was made in every woman with ICIQ-SF questionnaire, that included a fourth question to evaluate the degree of satisfaction after surgery, as well as physical examination. We considered objective cure when negative stress with full bladder. We use the SPSS program (V19.0) for statistical analysis of the results. Results The mean follow-up was of 59 months (range from 33 to 72 months). When evaluating the success rate of anti-incontinence surgery, 86.7% of patients showed objective cured (80.8% with MUI and 89.2% with SUI). The ICIQ-SF decreased average of 12.7 points, 85.7% patients were very or fairly satisfied. Conclusion The AMS MiniArc is an optim anti-incontinence procedure a medium term. But the results should be interpreted with caution given the limitations of the study.

Resumen Objetivos El objetivo de esta publicacion es describir de forma retrospectiva la tecnica quirurgica y evaluar las complicaciones y los resultados de la colocacion de la cinta AMS MiniArc ® swing system para el tratamiento de la incontinencia urinaria. Material y metodo Presentamos un estudio retrospectivo sobre la colocacion de cinta AMS MiniArc ® swing system. Entre agosto de 2007 y marzo de 2009 colocamos dicha cinta en hamaca a 135 pacientes, 110 (81,5%) tenian incontinencia urinaria de esfuerzo y 25 (18,5%) incontinencia urinaria mixta con un edad mediana de 55 anos (rango entre 27–82 anos). Todos los procedimientos se realizaron con anestesia local y en regimen de cirugia mayor ambulatoria. Las pacientes fueron controladas en consultas externas al mes (control 1), entre los 3–6 meses (control 2) y al ano (control 3). Se les realizo una historia clinica y el cuestionario ICIQ-SF, al que le anadimos una pregunta para cuantificar el grado de satisfaccion, asi como la exploracion fisica. Consideramos como curacion objetiva que la paciente en la exploracion fisica realizada en la consulta con la vejiga llena presentara un test de esfuerzo negativo. Analizamos los resultados y el analisis descriptivo y de comparacion de medias con la t de student mediante el programa informatico SPSS (V14.0). Resultados La mediana de seguimiento fue de 495 dias (rango entre 181–777 dias). En las 135 pacientes intervenidas registramos como complicaciones intraoperatorias 2 perforaciones vesicales. Como complicaciones precoces registramos 1 paciente con hematoma en la fosa obturatriz que evoluciono espontaneamente a curacion y 4 pacientes (2,9%) con dolor leve a nivel inguinal no incapacitante. Como complicaciones tardias, 4 pacientes (2,9%) presentaron extrusion de la malla y 3 pacientes (2,2%) necesitaron corte unilateral de la cinta por presentar obstruccion. En 9 pacientes (6,6%) se presento urgencia de novo, 5 de las cuales (3,7%) fueron temporales entre 2–6 meses, y 4 (2,96%) persistentes y tratadas mediante anticolinergicos. Observamos que el 91,9 % de las pacientes estaban curadas al ano. Si analizamos los resultados segun el tipo de incontinencia que presentaban, las pacientes con incontinencia urinaria mixta estuvieron curadas en el 88% y las pacientes con incontinencia urinaria de esfuerzo en el 92,7%. Con el cuestionario ICIQ-SF y la pregunta de satisfaccion, observamos un descenso medio en la puntuacion de 12,7 puntos, con un 90% de las pacientes muy o bastante satisfechas. Conclusion La colocacion de esta minicinta AMS MiniArc ® swing system es una herramienta mas para el tratamiento quirurgico de la incontinencia urinaria, y la ventaja fundamental respecto a sus predecesoras es la posibilidad de realizar la cirugia con anestesia local consiguiendo dar la tension adecuada a la cinta in situ. Pero debe demostrar sus resultados a largo plazo teniendo como referencia al «gold standard» de la TVT.

Objetivo: Evaluar las complicaciones de la cirugía antiincontinencia con minicintas, así como describir su diagnóstico y manejo. Material y métodos: Realizamos un análisis descriptivo de las complicaciones en un grupo de 155 mujeres con incontinencia urinaria intervenidas con minicintas (50 TVT-Secur y 105 MiniArc) entre octubre de 2006 y noviembre de 2008. Durante el seguimiento, los controles incluyeron anamnesis, exploración física y cuestionarios de calidad de vida (ICIQ-SF y EQ-5D), incluyendo uroflujometría con residuo posmiccional, urodinámica y urocultivo ante sospecha de obstrucción. Para analizar las complicaciones, fueron clasificadas en intraoperatorias, precoces (primer mes tras la cirugía) y tardías (pasado un mes). El análisis estadístico de los resultados lo realizamos mediante el programa informático SPSS (V 14.0). Resultados: La mediana de edad de las pacientes estudiadas fue de 56 años (rango 33-82). La mediana de seguimiento fue de 180 días (26-817). La tasa de complicaciones fue del 20% (el 22% para TVT-Secur y el 17% para MiniArc). Como complicaciones intraoperatorias registramos una perforación vesical con TVT-Secur (0,64%), que se trató con sondaje vesical. Las complicaciones precoces, todas registradas en el grupo de MiniArc, fueron un hematoma en la fosa obturatriz (0,64%) que evolucionó a la curación, dolor inguinal en 4 pacientes (2,5%) tratados con AINE y obstrucción uretral en un caso (0,64%) que precisó corte de la malla. Las complicaciones tardías incluyeron 8 erosiones vaginales (5%), 4 requirieron exéresis del material y cierre de la pared vaginal, 2 fueron tratadas con estrógenos vaginales y en 2 pacientes asintomáticas optamos por abstención terapéutica. Cinco pacientes presentaron dificultad miccional (3,22%): 4 precisaron corte de la cinta por obstrucción y una paciente mejoró con autocateterismos. La urgencia de novo en 10 mujeres (6,45%) se trató con éxito con anticolinérgicos. Dos pacientes presentaron ITU de repetición (1,3%), tratando los episodios aisladamente. Conclusiones: La cirugía de incontinencia urinaria con minicintas no está exenta de complicaciones (20%), la mayoría son leves y con posibilidad de manejo con éxito de forma conservadora. Objective: To evaluate the complications of urinary incontinence (UI) surgery with mini-sling system. Describe its diagnosis and management. Material and method: We make a descriptive analysis of the complications of the surgery in a group of 155 women with UI surgically treated with minisling system (50 TVT-Secur and 105 MiniArc) from October 2006 to November 2008. All patients were evaluated with clinical history, physical examination and two questionnaires of QoL (ICIQ-SF and EQ-5D). When urethral obstruction was suspected, we included urineculture, post-void residual urine measurement and urodinamycs. The complications were grouped into three cathegories: intraoperatory, early (within de first month after surgery) and late complications (after a month). We use the SPSS program (V 14.0) for statistical analysis of the results. Results: The average age was 56 years (range 33-82) and 180 days for the following-up (range 26-817). We had a complication rate of 20% (22% TVT-Secur, 17% MiniArc). We reported one intraoperatory complication corresponding to a bladder perforation (0.64%), managed conservatively with catheterization. All early complications were reported in the MiniArc group: one obturator fossa hematoma (0.64%) spontaneously resolved, groin pain in 4 patients (2.5%) successfully treated with NSAIDs and one urethral obstruction (0.64%) that required mesh cutting. Late complications included: 8 vaginal erosions (5%), 4 required tape excison and vaginal wall closure; 2 were treated with vaginal estrogens, and the other 2 were asymptomatic so we did nothing. 6 patients (3.8%) showed urethral obstruction: we performed mesh cutting in 5, whereas one patient improved with intermittent catheterization. Urge symptoms were reported in 10 patients (6.45%) and successfully managed with anticholinergic agents. 2 patients suffered from recurrent infections (1.3%) confirmed by antibiogram, treating isolated episodes.

Objectives The objective of this article is to describe, retrospectively, the surgical technique for placing the AMS MiniArc ® sling system used for the treatment of urinary incontinence, and evaluate its results and complications. Material and method We present a retrospective study about the placement of the AMS MiniArc ® tape sling system. From August 2007 to March 2009, we placed the tape in a hammock position in 135 patients, 110 (81.5%) of whom had stress urinary incontinence, and 25 (18.5%) mixed incontinence. The patients’ median age was 55 years (range: 27–82 years). All the procedures were performed with local anesthesia and as ambulatory major surgery. The patients were followed up in the outpatient clinic at one month (check-up 1), between 3 and 6 months (check-up 2), and at one year (check-up 3). The clinical history and physical examination were done, and the ICIQ-SF was given, to which we added one question to evaluate satisfaction. A negative stress test with full bladder performed at the office during the physical examination was considered objective cure. The results analysis, descriptive analysis, and means comparison with Student's t-test were done with the SPSS program (V 14.0). Results Median follow-up was 495 days (range: 181–777 days). Among the 135 operated patients, the intraoperative complications were two bladder perforations. Early complications included one case of hematoma in the obturator fossa which resolved spontaneously, and four cases (2.9%) with mild, non-incapacitating, inguinal pain. The late complications included four cases (2.9%) of mesh extrusion, and three (2.2%) who required the unilateral cutting of the mesh due to obstruction. In nine patients (6.6%) there was a de novo urgency, five of which (3.7%) were temporary (2–6 months), and four (2.96%) were persistent and treated with anticholinergics. At one year, 91.9% of patients were cured. Of the patients with mixed incontinence, 88% were cured, as were 92.7% of those with stress incontinence. The ICIQ-SF and the question about satisfaction showed a mean decrease of 12.7 points, with 90% of patients very satisfied or quite satisfied. Conclusion The AMS MiniArc ® sling system is one more surgical tool to treat urinary incontinence; the main advantage over its predecessors is the possibility of operating with local anesthesia, which permits to adjust the sling's tension in situ. However, further studies are required in order to demonstrate long-term results compared to the gold standard TVT

Resumen TVT: 3 Anos de experiencia Introduccion Desde la descripcion de la tecnica de TVT para el tratamiento de la incontinencia urinaria de esfuerzo en 1996, se han colocado unas 150.000 unidades. En noviembre de 1998 iniciamos esta tecnica en nuestro servicio, en este articulo analizamos nuestros casos en estos tres anos. Material y metodos Hemos intervenido a 142 pacientes, con una edad media de 59 anos. En el 57% de ellas, ademas de realizar TVT, asociamos reparacion de defectos anatomicos pelvicos. Resultados Con un seguimiento medio de 17 meses y mediana de 14 meses el 93% de las pacientes estan curadas. Los fracasos aparecieron de forma precoz en los 6 primeros meses de seguimiento. Como complicaciones aparecieron un 4,8% de perforaciones vesicales, retenciones post-operatorias de menos de 30 dias en el 17%, retenciones a largo en el 2%, hematomas post-quirurgicos en el 2,7% y urgencia de novo en el 9%. La cirugia se realizo en 10 pacientes con antecedentes de cirugia pelviana anti-incontinencia con buenos resultados en todos los casos. Conclusiones Es una tecnica quirurgica sencilla, que requiere un corto tiempo quirurgico, y que puede ser realizada en regimen de cirugia mayor ambulatoria. Es una tecnica no exenta de complicaciones aunque la proporcion de ellas es baja y con unos resultados que siguen siendo alentadores (aunque debemos esperar que nuestros estudios a largo plazo coincidan con los ya publicados con tasas de exito del 84,7%).

Resumen Introduccion La primera Unidad de Cirugia sin Ingreso se creo en 1990 en el hospital de Villadecans, aunque ya en 1982 Polo y cols., comenzaron un programa de intervenciones estrictamente ambulatorias. Los servicios de Urologia espanoles se van incorporando poco a poco a este nuevo estilo de trabajo y de momento con excelentes resultados. Material y Metodos Realizamos una descripcion del funcionamiento de nuestro servicio dentro de la Unidad de Cirugia Mayor Ambulatoria (CMA) y un analisis descriptivo de nuestra actividad en dicha unidad desde febrero de 2000 (fecha de creacion) hasta mayo de 2001. Resultados Se intervienen a 118 pacientes. Siendo 15% mujeres y el 85% hombres. Las intervenciones realizadas mas frecuentes fueron: hidrocelectomias, orquidopexias, varicocelectomias, distensiones vesicales, tecnica de Nesbit y uretrotomias internas. De todos los pacientes intervenidos ninguno requirio ingreso y el indice de complicaciones fue similar a los pacientes operados en regimen de cirugia convencional. Estas intervenciones suponen el 17% en el ano 2000 y el 19% en el 2001 con una clara tendencia a aumentar en los ultimos meses. Conclusiones La CMA es un modelo asistencial eficaz y eficiente en el cual los servicios de urologia tienen cabida dado que el grado de satisfaccion de los pacientes y la calidad que ofrece es igual que la cirugia con ingreso.

Resumen fundamento Evaluar las complicaciones en los pacientes sometidos a cistectomia radical con sustitucion vesical ortotopica tipo Camey II Metodos Se han revisado las historias clinicas de 61 pacientes sometidos a cistectomia radical con sustitucion vesical tipo Camey II por neoplasia de vejiga, entre 1990 y 1999. Las complicaciones fueron divididas en precoces (30 dias o menos) y tardias Resultados Un paciente fallecio en el post-operatorio inmediato. Se presentaron 35 complicaciones en 30 pacientes: 8 relacionadas con la neovejiga (fistulas urinarias e infecciones urinarias) y 27 sin relacion con ella, siendo las mas frecuentes las originadas a nivel intestinal, con un numero de reintervenciones precoces de 10 (16,4%). De los 55 pacientes evaluados para las complicaciones tardias 39 presentaron algun tipo de complicacion: 38 relacionadas con la neovejiga y 13 no relacionadas, con reintervenciones en 30 pacientes siendo 19 endoscopicas. La continencia diurna se ha obtenido en el 74,4% de los pacientes y la nocturna en el 31,4% Conclusiones A pesar de los resultados funcionales aceptables, la sustitucion vesical ortotopica presenta una tasa de complicaciones no desdenable. Por otro lado, la falta de unanimidad de criterios hace que la comparacion con otras series y otros tipos de sustitucion vesical sea dificil

Resumen Objetivo Presentar un caso de cancer de prostata de largo tiempo de evolucion y seguimiento, en el cual se ha evidenciado la aparicion de metastasis cutaneas a nivel de hipogastrio, raiz de extremidades inferiores y zona inguinal Metodos Paciente diagnosticado de cancer de prostata, tratado con prostatectomia radical y seguido en consultas de urologia durante diez anos de evolucion de la enfermedad neoplasica Resultados Aparicion de metastasis cutaneas de un adenocarcinoma de prostata, tras diez anos de una cirugia radical, en la cual la anatomia patologica demostro la infiltracion local a nivel de vesiculas seminales Conclusiones Las metastasis cutaneas del adenocarcinoma de prostata son extremadamente infrecuentes, apareciendo en la mayoria de las ocasiones en procesos de muy larga evolucion, y en los cuales la enfermedad neoplasica no ha podido ser controlada

The aim of this publication is to describe retrospectively the results of the surgical technique of AMS MiniArc for the treatment of female urinary incontinence, evaluate its results at 4 years follow-up.We present a retrospective cohort study of 135 patients, 110 (81.5%) had urinary incontinence and 25 (18.5%) mixed urinary incontinence. All these procedures were performed with local anesthesia and in "out patient surgery". Patients were monitored in the outpatient clinic at 6 months (control 1), one year (control 2) and annually (control 3, 4, and 5). During the following up, clinical history was made in every woman with ICIQ-SF questionnaire, that included a fourth question to evaluate the degree of satisfaction after surgery, as well as physical examination. We considered objective cure when negative stress with full bladder. We use the SPSS program (V19.0) for statistical analysis of the results.The mean follow-up was of 59 months (range from 33 to 72 months). When evaluating the success rate of anti-incontinence surgery, 86.7% of patients showed objective cured (80.8% with MUI and 89.2% with SUI). The ICIQ-SF decreased average of 12.7 points, 85.7% patients were very or fairly satisfied.The AMS MiniArc is an optim anti-incontinence procedure a medium term. But the results should be interpreted with caution given the limitations of the study.

The inverted papilloma is a rare urothelial tumor, and its localization at the prosthatic urethra is also exceptional. We present a case of inverted papilloma of the prostatic urethra in a 72 years-old male, with symptoms of urinary flow obstruction. The diagnose is obtained after urethrocistoscopy and transurethral resection at the same time. We discuss about the etiology, clinical presentation, diagnose and treatment of this rare tumor, making special attention to its malignancy ability.

Se presenta el caso de un paciente varón afecto de una fibrosis retroperitoneal postraumática, a cuyo diagnóstico se llegó a partir de dolor lumbar como síntoma principal. El diagnóstico se efectuó en base a los estudios mediante CT y RM, los cuales demostraron una gran masa de tejido de partes blandas que rodeaban la aorta. El tratamiento consistió en dosis de prednisona que inicialmente se instauró a 40 mg cada 24 horas, y posteriormente se fue reduciendo de forma gradual hasta la remisión de los signos y síntomas, y consecuentemente de los estudios de imagen. El tratamiento con corticoides se mantuvo durante un año. Dos años y medio el paciente está libre de síntomas sin recidiva de su proceso. We present the case of a male patient with post traumatic retroperitoneal fibrosis whose main clinical expression was low-back pain. Diagnosis was established using CAT-scan and MRI, which revealed a large mass of soft tissue that almost entirely enveloped the abdominal aorta. Treatment with 40 mg of prednisone every 24 hours was established. This dose was reduced gradually, and progressive remission of clinical signs and symptoms was achieved, with a significant improvement of subsequent imaging-test results. Treatment was continued for one year. Two and a half years later the patient remains symptom-free, with no recurrence of his condition.

Resumen Introduccion El nodulo fusocelular post-quirurgico urinario es una lesion proliferativa benigna que simula anatomopatologicamente a los sarcomas. En este estudio presentamos un caso localizado en pelvis renal Caso Mujer con litiasis coraliforme en rinon izquierdo a la que se le practica LEOC y nefroscopia, debido a la gran superficie de la litiasis, la paciente se reinterviene 4 semanas mas tarde para realizacion de 2o tiempo. En este procedimiento encontramos una lesion exofitica de 2 cm en pelvis renal que se extrae facilmente con una pinza de cuerpos extranos Discusion Estas lesiones estan englobadas dentro del conjunto de pseudotumores inflamatorios yatrogenicos, cuya etiopatogenia es secundaria a una reparacion del organo ante una agresion. El diagnostico diferencial debe establecerse con los sarcomas Conclusion Es importante que tanto los urologos como lo anatomopatologos sospechen la existencia de esta lesion ante un antecedente reciente de cirugia, ya que un error diagnostico nos puede llevar a realizar una cirugia radical innecesaria

Resumen Los tumores vesicales benignos de origen mesenquimal tienen una incidencia de aparicion muy baja, de ellos el mas frecuente es el leiomioma Aportamos un nuevo caso, planteando una discusion en cuanto a las pruebas complementarias necesarias para su diagnostico

To evaluate the complications of urinary incontinence (UI) surgery with mini-sling system. Describe its diagnosis and management.We make a descriptive analysis of the complications of the surgery in a group of 155 women with UI surgically treated with mini-sling system (50 TVT-Secur and 105 MiniArc) from October 2006 to November 2008. All patients were evaluated with clinical history, physical examination and two questionnaires of QoL (ICIQ-SF and EQ-5D). When urethral obstruction was suspected, we included urineculture, post-void residual urine measurement and urodynamics. The complications were grouped into three categories: intraoperatory, early (within de first month after surgery) and late complications (after a month). We use the SPSS program (V 14.0) for statistical analysis of the results.The average age was 56 years (range 33-82) and 180 days for the following-up (range 26-817). We had a complication rate of 20% (22% TVT-Secur, 17% MiniArc). We reported one intraoperatory complication corresponding to a bladder perforation (0.64%), managed conservatively with catheterization. All early complications were reported in the MiniArc group: one obturator fossa hematoma (0.64%) spontaneously resolved, groin pain in 4 patients (2.5%) successfully treated with NSAIDs and one urethral obstruction (0.64%) that required mesh cutting. Late complications included: 8 vaginal erosions (5%), 4 required tape excision and vaginal wall closure; 2 were treated with vaginal estrogens, and the other 2 were asymptomatic so we did nothing. 6 patients (3.8%) showed urethral obstruction: we performed mesh cutting in 5, whereas one patient improved with intermittent catheterization. Urge symptoms were reported in 10 patients (6.45%) and successfully managed with anticholinergic agents. 2 patients suffered from recurrent infections (1.3%) confirmed by antibiogram, treating isolated episodes.Urinary incontinence surgery with mini-sling system is not free of complications (20%). Most of them are mild and can be successfully treated conservatively.

Resumen Objetivo Evaluar las complicaciones de la cirugia antiincontinencia con minicintas, asi como describir su diagnostico y manejo. Material y metodos Realizamos un analisis descriptivo de las complicaciones en un grupo de 155 mujeres con incontinencia urinaria intervenidas con minicintas (50 TVT-Secur y 105 MiniArc) entre octubre de 2006 y noviembre de 2008. Durante el seguimiento, los controles incluyeron anamnesis, exploracion fisica y cuestionarios de calidad de vida (ICIQ-SF y EQ-5D), incluyendo uroflujometria con residuo posmiccional, urodinamica y urocultivo ante sospecha de obstruccion. Para analizar las complicaciones, fueron clasificadas en intraoperatorias, precoces (primer mes tras la cirugia) y tardias (pasado un mes). El analisis estadistico de los resultados lo realizamos mediante el programa informatico SPSS (V 14.0). Resultados La mediana de edad de las pacientes estudiadas fue de 56 anos (rango 33–82). La mediana de seguimiento fue de 180 dias (26–817). La tasa de complicaciones fue del 20% (el 22% para TVT-Secur y el 17% para MiniArc). Como complicaciones intraoperatorias registramos una perforacion vesical con TVT-Secur (0,64%), que se trato con sondaje vesical. Las complicaciones precoces, todas registradas en el grupo de MiniArc, fueron un hematoma en la fosa obturatriz (0,64%) que evoluciono a la curacion, dolor inguinal en 4 pacientes (2,5%) tratados con AINE y obstruccion uretral en un caso (0,64%) que preciso corte de la malla. Las complicaciones tardias incluyeron 8 erosiones vaginales (5%), 4 requirieron exeresis del material y cierre de la pared vaginal, 2 fueron tratadas con estrogenos vaginales y en 2 pacientes asintomaticas optamos por abstencion terapeutica. Cinco pacientes presentaron dificultad miccional (3,22%): 4 precisaron corte de la cinta por obstruccion y una paciente mejoro con autocateterismos. La urgencia de novo en 10 mujeres (6,45%) se trato con exito con anticolinergicos. Dos pacientes presentaron ITU de repeticion (1,3%), tratando los episodios aisladamente. Conclusiones La cirugia de incontinencia urinaria con minicintas no esta exenta de complicaciones (20%), la mayoria son leves y con posibilidad de manejo con exito de forma conservadora.

To describe the surgical technique of AMS MiniArc swing system for the treatment of female urinary incontinence, evaluate its results and complications.We performed a retrospective study of surgery with AMS Miniarc swing system. From august 2007 to march 2009, 135 patients with urinary incontinence (UI) underwent AMS MiniArc swing system surgery in hammock way. 110 patients (81.5%) suffered from stress urinary incontinence (SUI) and 25 (18.5) from mixed (MUI). The average age was 55 years-old. All these procedures were performed wigh local anesthesia and inOut patient Surgery. We evaluate every patient a month later, between 3-6 months later, and a year after surgery. During the following up, clinical history was made in every women with ICIQ-SF questionnaire, that included a fourth question to evaluate the degree of satisfaction after surgery, as well as physical examination. We considered objective cure when negative stress test with full bladder. We use the SPSS program (V 14.0) for statistical analysis of the results (Student's t-test).With a mean follow-up of 495 days (range from 181 to 777), early complications included: 2 bladder perforations during sling placement, inguinal pain in 4 patients and one obturator hematoma (resolved spontaneously). The long-term postoperative complications were: 4 tape exposures in vagina (2.9%), urethral obstruction in 3 patients (2.2%) that required urethrolysis and net section, and irritative symptoms of frequency and urgency reported in 9 patients (6.6%), 5 out of 9 were temporary (between 2 and 6 months) whereas the remaining 4 required anticholinergic agents due to persistent symptoms. When evaluating the success rates of anti-incontinence surgery, 91.9% of patients showed objective cure (88% with MUI and 92.7% with SUI) since we demonstrated no loss of urine by physical examination with full bladder. The ICIQ-SF score (fourth question included) decreased an average of 12.7 points. 90% of patients were very or fairly satisfied.The AMS Minarc swing system is an optim anti-incontinence procedure. Its main advantage might be the possibility of performing this procedure under local anesthesia, in order to test and adjust the sling's tension according to the person's needs. Despite its promising results, further studies are required in order to arrive at more precise conclusions, taking into account that the TVT remains the gold standard surgical technique of SUI.

Objetivos: El objetivo de esta publicación es describir de forma retrospectiva la técnica quirúrgica y evaluar las complicaciones y los resultados de la colocación de la cinta AMS MiniArc® swing system para el tratamiento de la incontinencia urinaria. Material y método: Presentamos un estudio retrospectivo sobre la colocación de cinta AMS MiniArc® swing system. Entre agosto de 2007 y marzo de 2009 colocamos dicha cinta en hamaca a 135 pacientes, 110 (81,5%) tenían incontinencia urinaria de esfuerzo y 25 (18,5%) incontinencia urinaria mixta con un edad mediana de 55 años (rango entre 27-82 años). Todos los procedimientos se realizaron con anestesia local y en régimen de cirugía mayor ambulatoria. Las pacientes fueron controladas en consultas externas al mes (control 1), entre los 3-6 meses (control 2) y al año (control 3). Se les realizó una historia clínica y el cuestionario ICIQ-SF, al que le añadimos una pregunta para cuantificar el grado de satisfacción, así como la exploración física. Consideramos como curación objetiva que la paciente en la exploración física realizada en la consulta con la vejiga llena presentara un test de esfuerzo negativo. Analizamos los resultados y el análisis descriptivo y de comparación de medias con la t de student mediante el programa informático SPSS (V14.0). Resultados: La mediana de seguimiento fue de 495 días (rango entre 181-777 días). En las 135 pacientes intervenidas registramos como complicaciones intraoperatorias 2 perforaciones vesicales. Como complicaciones precoces registramos 1 paciente con hematoma en la fosa obturatriz que evolucionó espontáneamente a curación y 4 pacientes (2,9%) con dolor leve a nivel inguinal no incapacitante. Como complicaciones tardías, 4 pacientes (2,9%) presentaron extrusión de la malla y 3 pacientes (2,2%) necesitaron corte unilateral de la cinta por presentar obstrucción. En 9 pacientes (6,6%) se presentó urgencia de novo, 5 de las cuales (3,7%) fueron temporales entre 2-6 meses, y 4 (2,96%) persistentes y tratadas mediante anticolinérgicos. Observamos que el 91,9 % de las pacientes estaban curadas al año. Si analizamos los resultados según el tipo de incontinencia que presentaban, las pacientes con incontinencia urinaria mixta estuvieron curadas en el 88% y las pacientes con incontinencia urinaria de esfuerzo en el 92,7%. Con el cuestionario ICIQ-SF y la pregunta de satisfacción, observamos un descenso medio en la puntuación de 12,7 puntos, con un 90% de las pacientes muy o bastante satisfechas. Conclusión: La colocación de esta minicinta AMS MiniArc® swing system es una herramienta más para el tratamiento quirúrgico de la incontinencia urinaria, y la ventaja fundamental respecto a sus predecesoras es la posibilidad de realizar la cirugía con anestesia local consiguiendo dar la tensión adecuada a la cinta in situ. Pero debe demostrar sus resultados a largo plazo teniendo como referencia al «gold standard» de la TVT.

The use of Electronic Health Records (EHR) has been irregular due to having to overcome barriers to their introduction. We describe our 8 years experience in using EHR to monitor quality control in the Urology Department of a tertiary Hospital.Retrospective analysis of the development and implementation of the EHR from 2001 to 2008 and the structural changes in the health care process and their results. Structural changes involved the introduction of computer terminals at all point where Health information is generated. In the Health care process a consensus was reached on coding diagnosis (221) and treatments (110), making it easier to gather information in the future. Health care registers have been simplified with pre-written texts in Anamnesis (6), Diagnosis and treatment (8), Interventions (11), and in-hospital treatments (15). Furthermore there are documents such as Informed Consents, (21) recommendations or information documents (10). A total of 5,571 discharge reports have been generated, 54,616 specialised surgery reports and 17,186 out-patient tests. Analysis of the EHR data enables us to study health care activity (extracorporeal lithotripsy, nosocomial infection, repetition of processes, etc.), specific problems (repeating prostate biopsies, increases in vesical surgery, etc.) or results of a technique (prostate biopsies, incontinence surgery, etc.).An EHR with multiple functions enables us to have accessible guides to clinical practice, a less variable clinical practice and better information on the patient. Being able to analyse data and to study the results of health activities, EHR is becoming an essential tool in improving health care.

The purpose of this publication is to describe the surgical technique, assess complications and short-term results of TVT secur and MiniArc tapes.From October 2006 to August 2007 it was carried out the surgical correction with TVT Secur,Women's HealthUrology, Ethicon, JohnsonJohnson, placing the tape as a hammock, to 51 patients, 38 of them with pure stress incontinence and 13 with mixed incontinence and with an average age of 57 years. From September 2007 to February 2008 41 patients, 33 of them with pure stress incontinence and 8 with mixed incontinence, with an average of age of 58 years were operated with AMS Miniarc swing system tape, posted on hammock. All procedures were performed with sedoanalgesia and Ambulatory Surgery regime. Patients were monitored in outpatient visits one month, 3 months and one year after surgical procedure. Medical history and questionnaire and ICIQ-SF, to which we added a question to quantify the degree of satisfaction, as well as physical examination, were done. We compared the results of both technical procedures and statistical survey was conducted by Student test. [Analysis with SPSS software (V14.0)].The median follow-up in TVT secur group was 328 days (range 163-522 days) and 101 days (range 41-209 days) inthe MiniArc group. We only had one (TVT secur group) surgical complication in all the series (92 patients) being a bladder perforation. Taking into account that we read a negative test effort as an objective cure in the TVT secur group, 80.4% patients are cured and 90.2% inthe MiniArc group without significant difference between both groups (p 0095). To assess the subjective healing we utilized the ICIQ-SF test and the satisfaction extra-question and we noted that there is no significant difference between the first and third month controls. (90% of patients satisfied). 80% of patients were completely satisfied in the first year control that was only performed to TVT secur group.These new tapes show fewer complications that the TVT-O and TOT tapes and allow the possibility of placement with local anesthesia but further studies are needed.

Resumen Objetivos El objetivo de esta publicacion es describir la tecnica quirurgica, evaluar las complicaciones y los resultados a corto plazo de las cintas TVT secur y MiniArc. Material y Metodo entre Octubre de 2006 y Agosto 2007 se realizo correccion quirurgica con TVT SecurTM, Women’s Health & Urology, Ethicon, Johnson & Johnson, colocando la cinta en forma de hamaca, a 51 pacientes,38 de ellas con incontinencia de esfuerzo pura y 13 con incontinencia mixta y con una edad media de 57anos.Entre Septiembre 2007 y Febrero de 2008 se intervino con cinta AMS MiniarcTM swing system, colocada en hamaca, a 41 pacientes, 33 pacientes con incontinencia de esfuerzo pura y 8 con incontinencia mixta, con un edad media de 58 anos. Todos los procedimientos se realizan con sedoanalgesia y en regimen de Cirugia Mayor Ambulatoria. Las pacientes fueron controladas en consultas externas al mes, 3 meses y al ano. Se les realizo historia clinica y cuestionario ICIQ- SF al que le anadimos una pregunta para cuantificar el grado de satisfaccion, asi como exploracion fisica. Comparamos los resultados de ambas tecnicas y realizamos estudio estadistico mediante test de Student. [Analisis con el programa informatico SPSS (V14.0)]. Resultados La mediana de seguimiento en el grupo TVT secur fue de 328 dias (rango 163-522 dias) y en el grupo MiniArc de 101 dias (rango 41-209 dias). De las 92 paciente intervenidas, 51 con TVT secur y 41 con MiniArc solo registramos una complicacion quirurgica con TVT secur que fue una perforacion vesical. Considerando como curacion objetiva que la paciente en la exploracion fisica realizada en consulta con vejiga llena presente un test de esfuerzo negativo. En el grupo TVT secur el 80,4% de las pacientes estan curadas y en el grupo de MiniArc el 90,2% no existiendo diferencias significativas entre ambos grupos( p 0,095). Para evaluar la curacion subjetiva utilizamos el test ICIQ-SF y la pregunta de satisfaccion y observamos como, en el control al mes y tercer mes no existen diferencias significativas, estando el 90% de las pacientes satisfechas. En el control anual, solo realizado en el grupo TVT secur, el 80 % de las pacientes se encuentran muy satisfechas. Conclusion Estas nuevas cintas presentan un numero menor de complicaciones permiten la posibilidad de colocacion con anestesia local pero todavia son necesarios estudios aleatorizados con un mayor seguimiento.

Valuation about clinical pathologyc facts of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy.Retrospective analysis of patients having undergone a radical prostatectomy due to a minimal prostate adenocarcinoma shown at the biopsy in front of the remaining radical prostatectomies.In 20 patients (7.6%) out of the 260 having undergone a radical prostatectomy between 1992 and 2004 the biopsy was informed as "minimal adenocarcinoma". These patients ranged 58 to 73 years with PSA levels from 5.2 to 17.1 ng/ml. Everyone except one were clinically T1c. At the definitive pathological study the Gleason was 6, 4, 3 and 2 in 3, 3, 8 and 4 patients respectively, with one having a minimal adenocarcinoma not graded and another one with a PIN ?. 3 showed only 1 focus with a tumoral volume less than 5% of the tissue (84.2% with significant tumor or multifocal). The final staging was 1 pT0 (PIN ?), 7 pT2a, 11 pT2b and 1 pT3a (62.5% bilaterals). Relating to the remaining patients under prostatectomy, patients with minimal adenocarcinoma presented significative differences in Gleason sum (p0.029) and staging (p = 0.02); no in PSA mean (p = 0.243).Minimal adenocarcinomas of the prostate at the biopsy are significant but do present lower staging and grading in relation with the rest of patients.

Since the description of the TVT technique as a therapy to stress urinary incontinence, in 1996, about 150000 subjects have undergone it. This technique was first used in our centre in november 1998. This article is aimed to contain our view of its evolution in the past three years.142 patients of an average of 59 years old have been operated on. In 57% of the cases, we also focused on the solutions to anatomic pelvis disorders.After a follow-up of 17 months and a mean of 14 months, 93% of the cases succeeded. Failures arose during the first six months of therapy. We found the following complications: 4.8% of bladder perforations, 17% of postoperative retentions of no longer than 30 days, 2% of long-term retentions, 2.7% of postsurgical hematomas, and 9% of urge incontinence. Surgery was performed on 10 patients who had undergone surgery against bladder incontinence before, and all the cases proved success.This technique is simple and only requires a short surgical time, and it can be applied for major ambulatory surgery. Although it is possible to encounter complications, they rarely occur and results are still encouraging. However, it is now necessary to verify that our long-term studies match with the success rates of 84.7%.

The first Surgery Ambulatory Unit was created in 1990, at the Hospital de Viladecans although in 1982 Polo et al. had commenced a programme of strictly ambulatory surgery. The Spanish Services of Urology are going to be incorporated to this new style of labour, and, by the moment, with excellent results.We realize a description of the functioning of our service inside the Unit of Ambulatory Major Surgery, and a descriptive analysis of our activity in above mentioned unit since February 2000(creation date) to May 2001.118 patients were operated, being 15% women and 85% men. The most frequent surgery done were: hydrocelectomy, orchiopexy, varicocelectomy, vesical distensions, Nesbit technique and internal urethrotomy. From the whole of the patients, none was increased, and the complication tax was similar to the conventional surgery patients. This kind of surgery suppose 17% in 2000 and 19% in 2001 of the whole of surgery, with clear increasing tendency in the last months.The Ambulatory Major Surgery is an effective and efficient care pattern in which Urology Services are included, so that the degree of satisfaction of the patients and the quality offered is similar to the inpatient surgery.

To report an additional case of syringocele of Cowper's glands and briefly review its etiopathogenesis, diagnosis and treatment.A 26-year-old male consulted for a recent voiding syndrome and chronic postvoid dribbling. A voiding cystourethrogram demonstrated a syringocele, which was confirmed during endoscopic treatment.Syringocele or cystic dilatation of Cowper's gland duct usually has a congenital etiology. There are four morphological types: simple, perforated, imperforate and ruptured. Diagnosis is made by voiding cystourethrography and confirmed by endoscopy. Transperineal ultrasound was also utilized for the diagnosis. Treatment is by endoscopic incision.

Benign bladder tumors of mesenchymal origin have a very low appearance incidence, being the most frequent the leiomyoma. We report new case, making a discussion about the complementary tests needed for the diagnose.

To evaluate the complications on patients undergoing radical cystectomy with Camey II ileal orthotopic neobladder.To review our series of 61 radical cystectomies performed between 1990 and 1999 for bladder cancer. The complications were divided in early (30 days or less) and late.A patient died at the immediate postoperative. It appeared 35 early complications on 30 patients: 8 related with neobladder (urinary fistula and urinary infection) and 27 not related, being the most frequent those appearing at bowel site, with 10 early surgeries (16.4%). After evaluating 55 patients for late complications, 39 presented some kind of complication: 38 related with neobladder and 13 not related, 30 patients underwent surgery, being 19 of them under endoscopic way. 74.4% of continents by day and 31.4% at night.Despite the acceptable functional results, the orthotopic bladder substitution presents a not comptemtible rate of complications. In other way, a lack of standard criteria make difficult the comparation with other series and types of bladder substitution.

The postoperative spindle cell nodule of the urinary tract is a being proliferative lesion similar to sarcoma in the microscopic exam. We present a case of modulein renal pelvis location.A woman presenting a stag horn lithiasis in left kidney was treated by LOC and percutaneous nephroscopy. Because of the large size of the stone a second intervention was required four weeks later. Then we discovered a 2 cm exophytic lesion in renal pelvis and removed it easily with a forceps.This kind lesion belong to the group of iatrogenic inflammatory pseudotumours, which are secondary to an injury that leads to a tissular repairing response. Differential diagnostic includes sarcomas.It is important that Urology and pathology specialist think of this tumour in patients having a recent surgical intervention. A mistake in the diagnosis would lead us to an unnecessary radical surgery.

To report a case of retroperitoneal bronchogenic cyst, an anomaly during the development of the primitive anterior intestine from which the bronchi and lungs are developed.A 38-year-old male presented with left lumbar pain. Patient evaluation disclosed a left adrenal polycystic mass which was removed by surgery. Pathological analysis of the surgical specimen demonstrated a bronchogenic cyst. This case is compared with some of the few cases reported in the literature.Retroperitoneal bronchogenic cyst is a cause of retroperitoneal tumors in the splenic or hepato-renal region. Although it is uncommon, it should be taken into account when making the differential diagnosis.

The inverted papilloma is a rare urothelial tumor, and its localization at the prosthatic urethra is also exceptional. We present a case of inverted papilloma of the prostatic urethra in a 72 years-old male, with symptoms of urinary flow obstruction. The diagnose is obtained after urethrocistoscopy and transurethral resection at the same time. We discuss about the etiology, clinical presentation, diagnose and treatment of this rare tumor, making special attention to its malignancy ability.

To describe the tension-free vaginal tape procedure (TVT) for treatment of female stress urinary incontinence and the short-term results.From November 1998 to May 1999, the TVT procedure was performed in 20 patients with genuine stress urinary incontinence. All patients had a bladder catheter for 24 hours after surgery. Only one patient required intermittent catheterization for one month due to high quantities of post-void residual urine. There were no intraoperative complications. Early postoperatively one patient presented a hematoma in the posterior rectal aspect which was managed conservatively. At 4.5 months mean follow-up, 95% of the patients are continent and one is incontinent due to incorrect positioning of the prolene band.Although the initial results appear to be encouraging, further studies are warranted to determine the long-term efficacy of this technique.

To review the literature on high flow priapism in children and analyze the etiology, pathophysiological mechanism, diagnostic tests, treatment and complications.The literature is reviewed and an additional case of posttraumatic arterial priapism in an 11 year-old boy treated at our hospital is presented.24 cases of high flow priapism in children were found; 18 had a history of genitoperineal trauma, 5 had sickle cell anemia and one child had Fabry's disease. Diagnosis was based on patient history, intracavernous blood gases and echo doppler findings. Fourteen patients with posttraumatic priapism, one patient with sickle cell anemia and the child with Fabry's disease were treated by pudendal arteriography with embolization. The immediate results and erectile function were good.Genitoperineal trauma is the most common cause of arterial priapism in children. High flow must be considered in children with sickle cell disease and priapism that do not respond to conventional treatment. Pudendal arteriography with embolization is the treatment of choice. Erectile function is recovered after treatment.

We report a new case of symptomatic myelolipoma of the adrenal gland. We analyse clinical, diagnostic, histopathologic and therapeutic aspects.Surgical excision was performed by lumbotomy. The patient was asymptomatic after surgery.Adrenal myelolipoma is norfunctioning benign tumour constituted by fat tissue and small islands of haemathopoyetic in a variable rate. The patients are usually asymptomatic. In symptomatic patients the most common symptoms are nonspecific abdominal pain, haematuria and hypertension. The diagnosis is achieved by ultrasound, CT and PAFF. The management is controversial: Surgical treatment or watching are options depending on the size and/or symptoms.

To review our series of nephrogenic adenoma and compare our results with those reported in the literature.The records of our Department of Pathology were reviewed to determine the cases of nephrogenic adenoma diagnosed at our center. The clinical features, diagnostic aspects, pathological findings, treatment and outcome are presented.Nephrogenic adenoma is a rare lesion, probably arising from nephrogenic metaplasia caused by injury to the urothelial mucosa. The site of presentation is frequently the bladder, followed by the urethra. The diagnosis is based on the histopathological findings, which can be occasionally equivocal. The cases described in the present series were benign. To date there is no established therapeutic approach. We performed TUR in two patients, antibiotic therapy was administered in one patient and 4 patients were managed conservatively. Two of our patients had no control evaluation following biopsy of the lesion. In 2 of the 4 patients that were managed conservatively, the lesion remitted spontaneously.

There are few reports on the medium- and long-term outcomes of laparoscopic suspension of the bladder neck.Our medium-term results in 24 patients with genuine stress urinary incontinence who underwent surgery from March, 1994 to July, 1996 are presented. The patients had a mean follow-up of 18 months.Although the initial results were encouraging, some failures appeared in the medium-term and incontinence recurred in 20%.The overall outcomes of laparoscopic suspension of the bladder neck did not differ from those achieved with the original technique of Pereyra-Stamey and the mean operating time was longer. The mean length of stay did not decrease and the rate of postoperative complications was similar. All the foregoing reasons have led us to abandon this procedure in the treatment of genuine stress urinary incontinence.

To evaluate the efficacy of surgical treatment of angiomyolipoma.We present a case of multiple, bilateral renal angiomyolipoma in a patient with tuberous sclerosis, who was treated by conservative surgery.The patient is clinically asymptomatic one year after surgery and both kidneys are functioning correctly as shown by pyelography.We recommend conservative surgical treatment of symptomatic or developing angiomyolipomas.

From January, 1988 to December, 1993, we have performed 35 percutaneous endopyelotomy procedures; 100 had acquired and 25 had congenital stricture. The UPJ was cut posterolaterally with an electric device in 34 cases. The mean follow up was 45.6 months. There were 6 failures (17.1%) that were resolved with the Anderson-Hynes technique (5 cases) and nephrectomy (1 case). There was 1 intraoperative complication (2.86%), a lesion to the accessory inferior pole artery that required open surgery. However, 80% of the cases were successfully treated by endourological techniques.

The present study compared the results achieved with ESWL using the Dornier MFL 5000 lithotriptor in 133 patients who received analgesics alone during treatment versus 141 patients who received analgesics plus sedation with midazolam. Both patient groups received the maximum tolerated energy and shock waves necessary to fragment the calculi. The patients who received analgesics plus midazolam tolerated the maximum energy of the lithotriptor (30 Kv), which permitted reducing the total number of shock waves required for fragmentation by 49%. Furthermore, the number of retreatments dropped by 38% (1.15 versus 1.53 sessions per renal unit) and the time required for treatment was reduced by 40% (p0.01).

We report on two cases of spontaneous perirenal hematoma secondary to ruptured angiomyolipoma in a patient with tuberous sclerosis and another patient with a simple renal cyst. The diagnostic and therapeutic aspects of this rare disease entity are discussed.

Enlargement of Cowper gland ductus (syringocoeles) is an uncommon lesion, normally found in children and young adults. The paper presents a case of one adult syringocoele, treated through transurethral route, and reviews the lesion's etiology, clinic, radiology and therapy.

A new technique to achieve, elongation of frenulum is described. The procedure is simple, exsanguine, and can be performed quickly. The results obtained with this procedure is similar to those obtained with traditional techniques.