José Manuel Quílez Fenoll

Hospital Universitario San Juan De Alicante, Alicante, Valencia, Spain

Are you José Manuel Quílez Fenoll?

Claim your profile

Publications (13)5.72 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Evaluation of a new mesh for incontinence (TVA/TOA) which enables the degree of tension applied during surgery to be readjusted at the post-operative stage. 62 patients treated with the TVA mesh and monitored over a 14-month period (SD 7.8, range 6-38). In 33 patients (53%) some other pelvic prolapse was corrected. Evaluation was carried out by clinical report, examination of bladder full of 250 saline solution, flowmetry and urinary residue. 40 patients filled in 4 quality of life questionnaires (QoL; ICIQ-SF; PGI-S; PGI-I). 42 patients were found to be objectively continent in the post-operative evaluation. Of these, it was necessary to reduce tension in 7 cases (11%) due to urinary obstruction (flow < 10 ml/sec and/or residue). The tension of the mesh was tightened in 20 patients (32%) due to continue with a certain degree of incontinence. All patients were discharged as continent and with no residue. In the last revision, 58 patients (93%) proved to be objectively continent and 4 (6.5%) showed a notable improvement in their incontinence. The Q(MAX) is 19.8 ml/sec (SD 9.8). The mictional urgency had disappeared or improved in 32 of the patients who had this prior to operation (76%) and had appeared in 3 of the patients who didn't (15%). The clinical report showed a high level of consensus with the ICIQ-SF survey (Kappa = 0.89) regarding stress incontinence, diminishing clearly (Kappa= 0.13) when urge incontinence was taken into account. 34 (85%) patients scored over 95 out of 110 in the QoL. 30 (75%) scored less than 6 in ICIQ-SF. 32 (80%) showed a perception of normality and 4 (10%) slight illness in the PGI-S. In the PGI-I 29 (72.5%) were much better and 11 (27.5%) quite a lot better. A relation exists between urgency and dismissed quality of life. With the TVA (trans-vaginal adjustable) mesh it is possible to adjust the tension originally applied during surgery at the post-operative stage, so that any defects or excesses can be corrected.
    Actas urologicas españolas 03/2006; 30(2):186-94. · 1.14 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: TVA AND TOA. NEW ADJUSTABLE MESH FOR THE TREATMENT OF FEMALE STRESS INCONTINENCE. PRELIMINARIES RESULTED Objectives: Evaluation of a new mesh for incontinence (TVA/TOA) which enables the degree of tension applied during sur- gery to be readjusted at the post-operative stage. Patients and Method: 62 patients treated with the TVA mesh and monitored over a 14-month period (SD 7.8, range 6-38). In 33 patients (53%) some other pelvic prolapse was corrected. Evaluation was carried out by clinical report, examination of blad- der full of 250 saline solution, flowmetry and urinary residue. 40 patients filled in 4 quality of life questionnaires (QoL; ICIQ-SF; PGI-S; PGI-I). Results: 42 patients were found to be objectively continent in the post-operative evaluation. Of these, it was necessary to reduce tension in 7 cases (11%) due to urinary obstruction (flow< 10 ml/sec and/or residue). The tension of the mesh was tigh- tened in 20 patients (32%) due to continue with a certain degree of incontinence. All patients were discharged as continent and with no residue. In the last revision, 58 patients (93%) proved to be objectively continent and 4 (6.5%) showed a notable impro- vement in their incontinence. The Q MAX is 19.8 ml/sec (SD 9.8). The mictional urgency had disappeared or improved in 32 of the patients who had this prior to operation (76%) and had appeared in 3 of the patients who didn't (15%). The clinical report sho- wed a high level of consensus with the ICIQ-SF survey (Kappa = 0.89) regarding stress incontinence, diminishing clearly (Kappa= 0.13) when urge incontinence was taken into account. 34 (85%) patients scored over 95 out of 110 in the QoL. 30 (75%) scored less than 6 in ICIQ-SF. 32 (80%) showed a perception of normality and 4 (10%) slight illness in the PGI-S. In the PGI-I 29 (72.5%) were much better and 11 (27.5%) quite a lot better. A relation exists between urgency and dismissed quality of life. Conclusion: With the TVA (trans-vaginal adjustable) mesh it is possible to adjust the tension originally applied during sur- gery at the post-operative stage, so that any defects or excesses can be corrected.
    Actas urologicas españolas 01/2006; 30(2). · 1.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Primary localized amyloidosis of the urinary bladder generally has a benign course. On the contrary, secondary amyloidosis, a consequence of systemic amyloidosis, may have massive bleeding and produce complications such as bladder rupture or life-threatening hemodynamic problems requiring desperate hemostatic procedures such as hypogastric artery embolization or ligature, or cystectomy. We report one case in which hemostasis was achieved by a Mickulicz transurethral bladder tamponage. 58 year old female with very aggressive rheumatoid arthritis and secondary renal amyloidosis under chronic hemodialysis presenting with severe hematuria after hip replacement. An inflamed bladder was found, the biopsy of which showed edema in all layers with blood vessel walls enlarged by amiloyd deposits. After several unsuccessful transurethral hemostatic procedures, intravesical formalin irrigation was carried out together with a Mikulicz type gauze packaging after urethral dilation. The gauze was withdrawn three days later without bleeding recurrence; however she presented subsequent neurological impairment and finally died 14 days after the last urological procedure. Transurethral packaging of the urinary bladder in a woman with massive hematuria is a hemostatic option that we recommend to be used before other more dramatic or invasive options are chosen.
    Archivos españoles de urología 06/2005; 58(4):347-50.
  • Archivos españoles de urología 02/2005; 58(1).
  • [Show abstract] [Hide abstract]
    ABSTRACT: Female urethral divertilum is a rare disease; its diagnosis has increased with the use of new diagnostic technologies. It must be suspected in women consulting for chronic irritative symptoms without response to conventional treatments. Transvaginal surgical excision is the most accepted therapeutic option. We reviewed their clinical presentations, diagnostic findings, and therapeutic options and report our experience. We retrospectively reviewed our case series, finding 4 patients with the diagnosis of female urethral diverticulum; we performed a bibliographic review. Urethral diverticulum is a rare clinical entity which has to be included in the differential diagnosis of women with chronic lower urinary tract symptoms. Clinical presentation may vary from asymptomatic to rich voiding symptoms. The most frequently used diagnostic method is voiding cystourethrogram; other techniques such as transvaginal ultrasound or MRI are very useful for complicated cases. Surgical treatment by transvaginal diverticulectomy with closure in several layers is the most frequent approach. Postoperative complications are rare.
    Archivos españoles de urología 01/2005; 58(1):4-8.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To report our experience in the diagnosis and treatment of the lower urinary tract obstruction after urinary incontinence corrective surgery, analysing the different techniques performed, retropubic or vaginal urethrolysis. We report a series of 14 patients with the diagnosis of obstruction after incontinence corrective surgery. They were classified in 2 groups, those who underwent retropubic procedures (5 cases) and those who underwent prolene mesh sling procedures (9 cases). We detail preoperative clinical-urodynamic parameters, and postoperative bladder outlet obstruction confirmation. Retropubic urethrolysis was performed in all patients after retropubic surgery, with the association of hysterectomy if indicated. The performance of a new sling- urethropexy was individualized. In three cases of retropubic surgery repeated urethropexy was not done. Unilateral section was performed in the sling series for all except one case of double section. A new mesh sling was performed in two cases; two cases did not undergo reoperation. Urethrolysis results were evaluated both subjectively by satisfaction degree scales and objectively by clinical-urodynamic evaluation, comparing clinical data and urodynamic parameters using the proper statistical test. In the retropubic surgery group all patients are continent. Satisfaction degree is: very satisfied 3 patients and 2 quite satisfied. Two presented with voiding urgency not needing anticholinergic drugs, and their urodynamic data returned to normal values without post void residual. The obstructed patients in the sling group reported minimal urgency after urethrolysis in 2 cases. Two patients have stress urinary incontinence: one of them is better than before and refused to undergo a new operation; the other one, who repeated sling, developed a clinical picture of urgency-incontinence again, underwent second section and continues having stress urinary incontinence. Among 7 patients undergoing sling, 4 are very satisfied, 1 quite satisfied, 1 somewhat satisfied and 1 not at all satisfied. Voiding difficulties have disappeared in all cases; comparisons between pre and postoperative urodynamics maximum flow, detrusor pressure at maximum flow and postvoid residual show statistically significant differences. Post-urethrolysis parameters return to preoperative values. The immediate development of symptoms after surgical correction of urinary stress incontinence is the best diagnostic criteria for obstruction. Detrusor muscle responds to obstruction, but sometimes its response is so minimal that it is difficult to diagnose urodynamically. The knowledge of preoperative values helps to confirm the diagnosis. In any case, urodynamic parameters did not influence the success of urethrolysis. Urethrolysis is an effective operation to cure symptoms secondary to obstruction after incontinence corrective surgery. When a sling has been the procedure performed, probably it is not worth to perform a standard urethrolysis; a simple section of one of the branches seems to be enough to improve symptoms. Currently, there is not scientific evidence about the convenience or not of bladder neck-urethral re-suspension after urethrolysis. The only case-scenario in which it is clearly indicated is that when there is stress incontinence in addition to obstructive symptoms.
    Archivos españoles de urología 12/2002; 55(9):1107-14.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the results of a comprehensive treatment of female stress urinary incontinence combining prolene mesh sling and proper gynaecologic repair depending on the kind of prolapse or pelvic floor dysfunction. To analyse short and long term clinical and urodynamic outcomes, and the effect on quality of life and economics associated with female urinary incontinence. Prospective study including 102 consecutive patients with urinary incontinence; recruitment started in June 1996, ended in March 2002 for this analysis but it continues open currently. History of neurourologic disorders, radiotherapy, oncological diseases, gynaecological diseases and previous surgeries data were recorded in all subjects. History and physical examination were done evaluating urinary symptoms, duration of urinary incontinence, and urinary symptoms oriented examination (incontinence, urgency and urgency-incontinence), as well as gynaecological examination evaluating and grading cystocele, rectocele, uterine prolapse, enterocele and dome prolapse. Complete urodynamics were performed before and after surgery. Surgery was indicated as a complete pelvic floor dysfunction repair including prolene mesh sling in all cases with urinary stress incontinence, hysterectomy or not depending on the existence of prolapse, and anterior/posterior colpoperineorrhaphy with or without mesh. Results on urinary continence, complications and their treatment were evaluated in the postoperative period, on discharge, at 6 months and yearly thereafter. Average age was 63.8 years (27-82 years, SD 11.2). 39.3% of the patients were over age 70. Mean follow-up was 4.25 years (12-75 months, SD 11.9). The cost of pads for urinary incontinence was 2741.17 Euros per patient (456,117 pesetas). 32.3% of the patients had risk factors for urinary incontinence surgical treatment failure and 18.8% had a leak point pressure below 30 H20 cm. 22.3% cases presented with detrusor instability before surgery. 102 sling procedures, 20 hysterectomies, 26 anterior plasties, 14 posterior plasties, 10 mesh cystocele repair, 1 posterior mesh, and 2 enterocele sacral promontory fixation were performed, accounting a total of 173 surgical procedures during 102 anaesthesia procedures. 9 additional procedures were necessary for the treatment of complications. Stress continence was achieved in 99.01% cases. In half of the patients with preoperative urgency-incontinence it continued during the first postoperative year. 11 cases have postoperative bladder instability, 7 of which had it preoperatively and 4 were de novo. 5 cases needed sling section/reconfiguration because of excess tension (non effective sling). 3 cases needed sling tight stretching/reconfiguration because of less than adequate tension. 2 cases of accidental bladder performation were treated with primary closure and urinary diversion. One case of infection-abscess in the mesh left anchoring stitch was drained under local anaesthesia. There were 6 cases of suprapubic, inguinal and rectal pain (8.1%), in all of them it disappeared within 9 months. There were 2 cases of wound infection. The prolene mesh sling can offer long term cure for stress urinary incontinence in almost all cases (99.01%), including the complicated ones. 91.1% of the patients underwent one surgical procedure only, and 8.8% required additional procedures. Results stand the test of time with a clinical-urodynamic follow up of 4.25 years. The voiding urgency referred by 81% of the women with large prolapses is associated with demonstrated bladder instability in 63% of the cases. Voiding urgency as well as bladder instability disappeared in all cases but one, being this fact prolapse-correction dependent, so that pelvic prolapse correction plays a decisive role. De novo bladder instability is uncommon (3.9%) and appears randomly in this series.
    Archivos españoles de urología 12/2002; 55(9):1057-74.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the usefulness of preoperative hormone therapy in patients with organ-confined prostatic carcinoma undergoing radical prostatectomy. 7 patients with localized prostatic carcinoma are presented. All patients were submitted to radical prostatectomy; 4 had been randomly selected for preoperative hormone therapy. Histological examination showed no nodal involvement in all cases. The tumor could not be identified (Po) in two of the four patients who received hormone therapy. The other two patients were staged down; the Gleason score remained unchanged in one and increased in the other. The patients who did not receive preoperative hormone therapy showed concordant clinical and pathological stages, except one in whom infiltration of the prostatic capsule was observed. No difference was found concerning the facility in performing surgery between the treated and untreated patients. Hormonal deprivation eliminated the tumor burden in two cases that might have been completely hormone sensitive, with no correlation in the pretreatment histological grade. Clinical downstaging is achieved by this treatment modality. However, further studies in larger series comparing the percentages of downstaging, histological downgrading, absence of tumor cells in the surgical specimen and impact on survivorship are warranted.
    Archivos españoles de urología 11/1996; 49(8):819-23.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Twenty four patient with neurogenic bladder undergoing vesical enlargement were pre-operatively evaluated to determine the need to perform also an anti-incontinence technique. None of them had such a technique performed, so as to control whether our prediction was correct. Each patient had one or more video-urodynamic studies performed to evaluate adjustment and the likely vesical hyperreflexia, critical incontinence pressure, and the presence of leaks with cough and cervicourethral morphology at different filling times. Critical incontinence pressure and presence of contrast leaks with cough, the latter demanded with moderate intravesical pressures, have been the parameters which better predicted the likely incontinence, with reliability over 90%. With regard to myelodysplastic bladders, the study shows the relevance of the detrusor as a cause of incontinence and sustains the practice of implementing only the cervical cuff without the remaining components when the artificial sphincter is chosen as the anti-incontinence technique, when the likely cause, whether sphincter or detrusor, is unclear at the time of considering vesical enlargement.
    Actas urologicas españolas 01/1995; 19(10):777-82. · 1.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Report of a case of renal and urinary tract leishmaniasis in a 61-year old male patient. The ureteral lesion responded favourably to treatment, unlike the renal one which required conservative surgery. Review of the literature stressing the fact that no other case has been found of kidney and urinary tract involvement. It is concluded that in the future, at least in those areas with a high prevalence of leishmaniasis, this condition should be taken into account as differential diagnosis when facing a toxic picture with renal involvement of the calyceal ecstasies type.
    Actas urologicas españolas 01/1995; 19(10):789-94. · 1.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We describe an additional case of primary amyloidosis of the bladder whose form of presentation warranted a differential diagnosis from carcinoma of the bladder. The diagnosis was made on the histological findings and the immunohistochemical analyses revealed amyloid fibrils that reacted against the light chain lambda antiserum. The treatment of choice was TUR, which resolves the condition in most of the cases. Conservative surgery, however, does not prevent new deposits and undetected residual lesions may persist, which may warrant other complementary procedures in these patients. After the diagnosis has been made, it is important to discard systemic amyloidosis.
    Archivos españoles de urología 01/1994; 46(10):864-7.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Presentation of one case of aggressive angiomyxoma with vesical location in a 31-year-old female patient who underwent partial surgery, and who 8 years later remains disease-free. Emphasis is made on the low frequency of these tumours, of which only 26 cases are described in the international literature. All these cases have been located in soft areas of the pelvis and the perineum, with the exception of the one presented here, the first one with a vesical location. Clinical behaviour is characterized by the absence of metastasis and a great tendency to local relapse, 70% of cases reported.
    Actas urologicas españolas 11/1993; 17(9):611-3. · 1.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To describe the filling and voiding urinary dynamics of enterocystoplasty and continent urinary diversion. The different behaviour of the tubularized and detubularized intestinal segments and the different sphincteric lesions related with various surgical techniques are described. The possible causes of incontinence are discussed and the literature briefly reviewed. We underscore the importance of detubularizing the intestinal segment and preserving the sphincteric system as far as possible. Furthermore, voiding using abdominal pressure may cause post void residual urine, dilatation of the neobladder and renal changes. If warranted, self-catheterization should be performed.
    Archivos españoles de urología 50(6):609-15.