Resultados y complicaciones de la técnica TVT en el tratamiento de la incontinencia de esfuerzo femenina

OBJECTIVES

To evaluate the efficacy and safety of Tension-free vaginal tape (TVT) for treatment of female stress urinary incontinence (SUI). To determine the mid-term outcome of TVT performed during other pelvic floor reconstructive procedures.

PATIENTS AND METHODS

100 women with SUI undergoing TVT procedure under spinal anesthesia from January 2000 to November 2002 were studied. 76 women were treated with TVT alone. 24 patients were treated with TVT and pelvic floor reconstruction: we repaired 24 cystoceles grade II-III, 3 rectoceles and 4 concomitant vaginal histerectomies.

RESULTS

Mean age was 49.3 years (range 35-78). Mean parity: 2 (range 0-6) and mean operative time was 38 minutes (range 20 to 50). The postoperative hospital stay was 24 hours for women treated with TVT alone. Only 1 patient (1%) need bladder catheterization during 7 days due to urinary retention. Mean followup was 18 months (range 12-48). Objective cure rate was 95%. In our study the rate of de novo post-operative urge symptoms (16%) was the most frequent complication. Bladder injury was the most grave problem and it happened in 1 patient (1%).

CONCLUSION

The results confirm the feasibility and safety of TVT for treatment of SUI. Moreover, TVT procedure is economical and efectiveness. Pelvic floor defects, benign uterine disorders and SUI can be safely treated with TVT and vaginal procedures during the same surgical time.

[Cystectomy in superficial bladder tumours. Analysis of criterion include and prediction factors]

INTRODUCTION

Though usually the treatment of a superficial bladder tumour consists in transurethral resection, exceptionally because of several clinical conditions, in this kind of patients a radical cystectomy may be suitable.

PATIENTS AND METHOD

From june 1986 through december 2001, 127 radical cystectomies were performed. A series of 25 patients with a radical cystectomy performed in superficial bladder tumours were analysed. Indications, anatomo-pathological correlation and clinical evolution with survival curves are analysed.

RESULTS

The mean time of follow-up was 47 months. Extensive GIIIpT1 tumours (40%) were the chief indication. The remaining of the series consisted in carcinoma uncontrollable by endoscopy and refractory to chemotherapy. Anatomo-pathological correlation coincided in 48% of patients, existing supra and understaging in 25% and 28% respectively. A period of 54 months was without relapse. Seven patients died during the evolution (28%), and 18 patients are alive without disease. 128,48 months were the mean actuarial survival.

CONCLUSIONS

GIIIpT1 tumours were the chief indication of our series. The significant percentage of understaging, poor morbidity and good survival curves are emphasized. Because of these results we consider that radical cystectomies are a viable choice for selected patients with superficial vesical tumour.

[Vesico-sphincter dysfunction in 108 cases of multiple sclerosis]

OBJECTIVE

To study vesicosphincteric dysfunction in 108 patients with multiple sclerosis.

METHODS

We reviewed the clinical records of 108 patients with multiple sclerosis and analyzed those with voiding symptoms ascribable to multiple sclerosis. These patients underwent complete urodynamic assessment and complementary tests according to their symptoms. The Blaivas classification was used for the clinical classification of multiple sclerosis.

RESULTS

64 of the 108 patients presented voiding symptoms ascribable to multiple sclerosis (59.2%). The clinical features presented as episodes in 75% and were progressive in 25% of the cases. In 6% of the patients, the voiding symptoms were the first symptoms of multiple sclerosis. Urodynamic assessment showed detrusor hyperreflexia in 73% of the patients, hyporeflexia in 14%, and 13% showed normal urodynamics. All complications were infective; no patient showed upper urinary tract complications.

CONCLUSIONS

Vesicosphincteric dysfunction in multiple sclerosis is frequent. Most of the patients present bladder hyperreflexia. The urological complications are usually infective. Involvement of the upper urinary tract is rare.

[Incidental diagnosis of bladder carcinoma]

OBJECTIVE

To analyze the prognostic factors of incidentally diagnosed bladder carcinomas with special reference to the complementary diagnostic tests.

METHODS

308 cases of carcinoma of the bladder were reviewed. These were divided into two groups: those that had been diagnosed on the basis of the clinical features and those that had been incidentally detected. The prognostic factors of size, grade, histological type, and pathological stage were analyzed.

RESULTS

Local tumor stage was the only statistically significant prognostic factor. 14.7% of the superficial and 3.6% of the infiltrating carcinomas had been incidentally diagnosed. Ultrasound was the most frequently utilized diagnostic method (87.2%).

CONCLUSIONS

In our series, the incidentally diagnosed carcinoma of the bladder has a higher probability of being a superficial lesion than those that are symptomatic and therefore the prognosis is better. Since ultrasound was the most frequently utilized diagnostic method, it might be advisable to assess the bladder in patients undergoing abdominal ultrasound evaluation.

[Epidemiologic data of uro-oncologic pathology in a urology service of a university general hospital. Comments regarding cancer of the prostate]

Data from 92, 93 and 94 tumoral records is analyzed based on the first visit system, staging at time of diagnosis, intervals between visits and management. After finding data unsatisfactory, a program for health care improvement is developed in order to secure diagnosis at earlier stages which may allow for curative radical treatment. The program was implemented in 1995. Results are communicated, and compared with those from previous years; the effectiveness of the program is verified.

[Early diagnosis by opportunistic screening in cancer of the prostate. Results of a 1-year protocol. Comparison with historical data]

RATIONALE

The high prevalence of Prostate Cancer (PC) and long survival of patients with advanced disease, added to the high cost of palliative treatment (hormone therapy), versus the existence of curative therapies at earlier stages, fully justify the campaigns for early diagnosis. The objective of the study was to increase the number of cases diagnosed at local stages, using an opportunistic screening methodology.

METHODS

All male patients between 50-70 years of age, seen over one year in Urology and primary care in CAP-Barceloneta because of urinary symptomatology, were included in a screening program. This cohort were performed total PSA determination and digital rectal examination. When digital rectal examination was suspicious and/or PSA values higher than 4 ng/ml, they underwent echo-guided prostate biopsy.

RESULTS

A total of 595 male were seen; 43.9% met the inclusion criteria; 39.4% were rated as suspicious, neoplasia being confirmed in 51% of these. Prevalence of PC in this cohort was 20.1%, half of them in local stage.

CONCLUSIONS

Populational screening in PC has proven to be ineffective from a health care standpoint, as opposed to opportunistic screening. Overdiagnosis was not significant, although there were more cases diagnosed in organ-confined stages, this is, eligible for curative therapy; thus, hormone therapy and the resulting morbidity were significantly decreased; quality of life of patients under curative treatment was improved; there was a large reduction of health care costs and, although it will have to be further confirmed in large multicentre series, we believe survival was improved.

[Bladder involvement in non-Hodgkin's lymphoma. Diagnosis and therapeutic response]

Presentation of one case of non-Hodgkin lymphoma (NHL) in a 76 year-old, female patient presenting with giant abdominal mass, secondary tumoral vesical infiltration and bilateral obstructive uropathy diagnosed by UIV, CAT and cystoscopy-biopsy. Transitory deobstruction with 'pig-tail' catheter allowed administration of therapy with multiple chemotherapy with excellent response. The radiological, endoscopic and histopathological findings, as well as the incidence of the uncommon vesical pathologies are reviewed.

[Eosinophilic cystitis as a special form of response to mitomycin C. Analysis and comments on our cases]

We analyzed 29 cases of eosinophilic cystitis in a group of 80 patients with lower urothelial carcinoma who had been treated with mitomycin-C. Only 6 cases (20.7%) had presented symptoms and signs compatible with acute cystitis. The remaining patients had been diagnosed histopathologically by routine follow-up bladder biopsy. Urine cytology revealed abundant eosinophils in 58.6% of the patients with eosinophilic cystitis while urine culture was negative for all patients. No patient had a previous history of allergy or asthma. We discuss the possible etiopathogenic mechanisms of this rare nosologic entity, the relationship to the immune system and the role of the foregoing in the capacity to control urothelial carcinoma locally.