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A multi-attribute analysis by means of the general multi-attribute analysis (GMAA) decision support system was performed in order to rank different strategies for good water quality with respect to trophic state, and good conditions for waterfowl, in the lagoon Ringkøbing Fjord, Denmark. The remedial strategies included nutrient abatement and the construction of facilities to increase the water exchange between the lagoon and the sea. The analysis showed that it is essential to keep the mean annual salinity level constant, since a drastic change in salinity may cause massive destruction of the macrophyte belt with large effects on the water quality and waterfowl abundance. It may be cost-effective to build and maintain a saltwater pumping station or a second sluice to increase the seawater inflow. Further nutrient abatement may not be cost-effective, at least not on time-scales shorter than 20 years, but the utility from nutrient abatement increases if a second sluice is built additionally. However, all of the remedial strategies, except decreasing the salinity, were projected to cause rather small changes in the effect variables compared to the no action alternative.

Objective: The purpose of this study was to evaluate results and complications of TVT in a large series from different hospital centers in Spain., Method: We retrospectively studied the results of TVT placement from 6 centers with 272 consecutive patients (median follow-up was 636 days). All types of stress urinary incontinence with a surgical indication were included and no previous conditions were established regarding the indication. No protocol was used for either the intervention or postoperative support measures. Data collection was protocolized and carried out using a common questionnaire that was completed by an urologist at each center from 3 to 6 months after the intervention and then annually. All patients who underwent intervention were asked about their satisfaction with the outcome. Multivariate studies were made to identify the factors that influenced the recovery of continence and the occurrence of complications., Results: 92.1% of patients were continent and 2.4% have not shown any improvement. 91.6% of the patients claimed to be satisfied whereas only 2.7% were dissatisfied. After four years only 2.8% of patients showed mild incontinence with time and 0.4% had moderate incontinence. Only previous surgery for incontinence was found to be significantly unfavorable factor for achieving postoperative continence., Conclusion: We have reproduced a scenario closer to daily clinical reality than the results of series from a single institution or analyses using stricter selection criteria. This multicenter study verifies the viability and reproducibility of TVT with minimal complications in centers where patients are not selected and where not all urologists are specialized in urinary incontinence.

Bladder cancer is one of the most common diseases treated by urologists. In this article, we will try to review some of the controversies and all the available data which come from the systematic review and meta-analysis.