A literature search was conducted to review quality-of-life (QOL) measurement in patients with benign prostatic hypertrophy (BPH). The different QOL instruments are discussed in relation to their correlation with symptom evaluation in studies of treatment options for BPH. Symptom evaluation of BPH has been standardised internationally with the International Prostatic Symptom Score (IPSS), but there is neither agreement nor data to decide which QOL instrument is preferable. The most widely used QOL instrument is the disease-specific QOL single question added to the IPSS. Other QOL instruments have been used, but none has gained unanimous approval. The results of QOL assessments obtained from comparative clinical studies of treatment options for BPH are discussed. These studies compare treatment options such as watchful waiting, drug treatment and surgery. Disease-specific QOL domains (interference with daily activities) tend to improve more with treatment interventions than general health measures (i.e. general well-being). The use of QOL instruments to evaluate patients with BPH, and their many treatment options, is still open to debate with regard to which instruments are preferred and their importance to the clinical evaluation of the patient. The challenge remains to find an acceptable disease-specific QOL instrument that adds information to currently used disease measures of BPH.
The Remeex re-adjustable sling provides a good cure rate for rSUI and ISD at long-term follow-up. The complications rate is acceptable since most complications are clavien II. The ability to re-adjust the sling tension during the follow-up allowed us to achieve cure for recurrence after the initial procedure, and to relieve obstruction in every case attempted.
Urinary artificial sphincter (UAS) is currently the gold standard treatment for urinary incontinence after radical prostatectomy. 5-25% of the patients under-going radical prostatectomy develop urinary incontinence. This complication generates important deterioration in the quality of life of these patients. Conservative and minimally invasive treatments, such as Kegel exercises, use of pads, drugs, and electrostimulation, or minor surgery have been used without success. This review summarizes the advantages and complications of the urinary artificial sphincter and its efficacy in the management of urinary incontinence after radical prostatectomy.
L a obstrucción infravesical en la mujer es una entidad poco frecuente en el 3% y el 8% de todas las pacientes con clínica de tramo urinario inferior. De éstas, en un 13% se logra demostrar la presencia de una estenosis uretral mediante uretrocistografía y estudios de Presión-Flujo 1 . Su incidencia es claramente menor que en el hombre, ya sea por su menor longitud, su mayor movilidad o por presentar menor protección por parte del hueso pélvico en toda su longitud 2 .Existe escasa bibliografía sobre su causa, diagnóstico y tratamiento; y muchos artículos se centran en las patologías pediátricas. Parece que el tratamiento para las estenosis primarias en mujeres adultas es la dilatación uretral o la uretrotomía endoscópica, pero éstas presenta una alta tasa de recidivas 3 , existiendo cierta controversia sobre cuál es la técnica de elección en estenosis recidivadas.El objetivo del presente artículo es describir la etiología, el diagnóstico y el tratamiento de la estenosis uretral femenina, haciendo hincapié en el tratamiento de las estenosis recidivadas o complejas. Consideraciones anatómicasTal y como veremos más adelante, es imprescindible conocer la anatomía uretral y sus relaciones, no sólo para el tratamiento de las estenosis sino también a la hora de evitar posibles lesiones uretrales durante cirugías del área pélvica.Karam et al. realizan un estudio mediante reconstrucción 3D tras tinción histoquímica de las fibras musculares y nerviosas del esfínter y la uretra femenina en fetos humanos 4 . Dicho estudio confirma que el tercio proximal está formado por un esfínter circular de musculatura lisa, el tercio medio Original Estenosis uretral en la mujer: Etiología, diagnóstico y tratamientoCristina Gutiérrez Ruiz, Fernando Rodríguez-Escovar, Carlos Errando Smet, Pedro Arañó Bertrán, Humberto Villavicencio Mavrich Servicio de Urología. Fundació Puigvert. Barcelona, España ResumenLa estenosis uretral en la mujer es una causa poco frecuente de obstrucción infravesical, entidad ya de por sí poco habitual en el sexo femenino. La mayoría de los casos son secundarios a procedimientos quirúrgicos del área urogenital, la fibrosis periuretral es el mecanismo de acción implicado independientemente de la causa. Existe cierta controversia en cuanto a los criterios diagnósticos pero parece claro que se trata de obstrucciones estructurales que afectan al tercio medio y distal de la uretra. No existe un consenso en cuanto al tratamiento, pero maniobras menos agresivas como las dilataciones o la uretrotomia interna son las técnicas de elección para las estenosis primarias, teniendo en cuenta el alto porcentaje de recidivas que presentan. Las técnicas de reconstrucción uretral mediante el uso de diversos tipos de injertos o flaps estarían indicadas en aquellos casos recidivados o bien en los que existe un defecto parcial o total uretral.Palabras clave: Uretra femenina. Estenosis. Tratamiento. Uretroplastia. Female Urethral Stricture: Etiology, diagnostic and treatment AbstractFemale urethral stricture is an infrequent cause of bl...
Female urethral stricture is an infrequent cause of bladder outlet obstruction, which is also a rare clinical entity in women. The most frequent etiology is the previous urogenital surgery. Periurethral fibrosis is the final cause regardless the etiology. Considerably controversie surrounds in the diagnostic criteria but the estrictures are structural obstructions which involve media and distal third of the female urethra. There is no treatment consensus, but less agresive maneuvers such as dilatations and urethrotomies are chosen to treat primary estrictures, although the high recurrence rates. Reconstructive tecniques with the use of several flaps and grafts should be considered in recurrent cases and when there is a partial or total urethral defect.
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