The role of clean intermittent catheterization in the treatment for detrusor underactivity. / El cateterismo vesical intermitente en la insuficiencia contráctil del detrusor.

OBJECTIVE: To study the influence of clean intermittent catheterization (CIC) on the lower urinary tract function in patients with urinary retention (UR) due to detrusor underactivity (DU). MATERIAL AND METHODS: A longitudinal study was carried out on 49 patients (28 men, 21 women) of mean age 55years, who underwent CIC for UR secondary to DU. The mean CIC frequency was 3.15 times/day. Patients' clinical data were collected, and they underwent urodynamic study before and after CIC, with a mean interval of 4years. Fisher's exact test was used for the analysis of categorical variables and Student's t test for parametric variables. The level of significance was set at 0.05 for a two-tailed test. RESULTS: The second urodynamic study showed a significantly increased bladder compliance, the Bladder Outlet Obstruction Index (BOOI) and the Bladder Contractility Index (BCI) also increased but without reaching statistical significance. There was a significantly higher percentage of benign prostatic hyperplasia (BPH) and acontractile detrusor cases among the group of patients whose BCI improved after CIC, with significantly lower CIC time. CONCLUSIONS: CIC improved bladder compliance in the patients of our series. The BCI improved in BPH patients and in patients with acontractile detrusor.

Influence of bladder lithiasis on lower urinary tract dynamics in patients with spinal cord injury.

STUDY DESIGN: A prospective and a case-matched control study. OBJECTIVES: To study the lower urinary tract dysfunction associated with bladder lithiasis in patients with spinal cord injury (SCI). SETTING: Toledo (Spain). METHODS: We have carried out a urodynamic study in 30 patients with SCI with lithiasis in their bladder before and 3 months after bladder endoscopic lithotripsy. This second study was compared with the urodynamic findings of a different group of 30 patients with SCI, without a history of bladder lithiasis, paired with cases by gender and date of urodynamic study. RESULTS: We have found that the prevalence of neurogenic detrusor overactivity (NDO) was significantly different after bladder lithotripsy, although the cystomanometric capacity was significantly increased. A group of patients with lithiasis showed a maximum flow rate, a voiding maximum detrusor pressure and the detrusor contractility parameter Wmax lower than that in controls. On the other hand, a voiding abdominal straining was found to be significantly greater than that in controls. CONCLUSIONS: Bladder lithiasis affects the presence of NDO in patients with SCI. Patients with SCI who develop bladder lithiasis present a lower detrusor contractility power compared with those who do not.

Other radiological lesions of the Lower Urinary Tract in patients after isolated pelvic radiotherapy and combined with surgery. / Otras lesiones radiológicas del tracto urinario inferior (TUI) en pacientes sometidos a radioterapia pélvica en monoterapia y combinada con cirugía.

INTRODUCTION: The cystographic study of patients who have undergone radiotherapy (RT) and pelvic surgeries is uncommon in the literature, not described in patients without complications, and mostly related to urinary fistulae. OBJECTIVE: The study of the lower urinary tract (LUT) by cystography in these patients, with a description of some other types of radiation lesions. METHODS: 127 cystographies have been performed (88 men and 39 women) in consecutive patients undergoing radiotherapy (RT) (48 monotherapy and 79 cases combined with surgery), with a mean age of 69.6 years, and a mean time from radiation of 215 months (17 years). A General Electric X ray equipment has been used. We studied: behavior of the bladder neck at rest and during micturition, assessment of vesicoureteral reflux (VUR), bladder morphology (BM), urethral strictures (UE) and fistulas (F). RESULTS: We observed: Filling phase bladder neck incompetence (BNI) (37.8%), bladder smooth morphology (60.6%), coughing urinary incontinence (UI) (26.4%), basal cystocele (64.7%) and Valsalva cystocele (96.6%), a normal opening bladder neck (96,1%), reduction of the urethral diameter during voiding (41.3%), and vesicoureteral reflux (VUR) (13.2%). Five cases of filling BNI, were all related to prostate cancer (PC) (one of them with colon cancer as well). There were six cases of fistulae (4.14%), five of them women. Forty two patients (28.96%) had reduced urethral lumen, thirty five of them affecting the posterior urethra (83%), five (11.9%) the anterior and, finally, two cases of mixed lesion (5%). 95% were patients with PC without concurrent interventions (67%). Significant differences were found regarding the gender and the background of pelvic surgery. The filling BNI (p=0.007), the irregular bladder morphology (p=0.004) and the reduction of the urethral lumen (p<0.001) have been found to be more common in male patients, while the coughing UI was more common in women (p=0.007). The study shows that BNI (p=0.046), VUR (p=0.02) and the IU due to cough (p=0.03) were more frequent in operated patients, while reduced urethral lumen was less common (p<0.01). Patients with VUR present more time from radiotherapy, but not in other cystography variables. There was a relationship between RT and the BNI, stress urinary incontinence, anterior urethral stricture and VUR. The risk factor was increased by surgery. CONCLUSIONS: Bladder neck incompetence, stress UI, anterior urethral stricture and VUR have been related to radiotherapy. Surgery increased the risk factor in operated patients.

Risk factors of urethral diverticula in male patients with spinal cord injury.

STUDY DESIGN: A case-control study in a series of 55 males with urethral diverticula (UD) and their correspondent control, matched by age and time of radiological assessments. OBJECTIVES: To evaluate the risk factors to develop UD in males with spinal cord injury (SCI) and the place in the urethra where they are, most commonly, allocated. SETTING: Toledo, Spain. METHODS: Clinical histories and urodynamic studies, of all patients, were reviewed. The study was completed with a telephone survey according to an established protocol. RESULTS: The univariate analysis study showed the following risk factors: the age of onset of the spinal injury, the sphincterotomy procedure, personal history of lower urinary tract infections (LUTIs) and the chronic need of either indwelling catheter (IC) or the external condom drainage (ECD). Regarding the location of the UD, we have found the stress urinary incontinence as the only risk factor to develop UD in the prostatic urethra.On the other hand, we can conclude that the sphincterotomy, the ECD, the personal history of LUTIs and the detrusor external sphincter dyssynergia seem to be risk factors to develop diverticula in the bulbo-membranous urethra. Finally, we could point out the IC as the only risk factor for penile UD. Multivariate analysis showed that all of these risk factors were independent among them except the age of the onset of the injury and the ECD for UD in the bulbo-membranous urethra. CONCLUSION: According to our study, there is evidence of some specific risk factors for the development of UD in male patients with SCI, and therefore we should adopt the appropriate preventive measures to prevent them.

Factors that influence the urodynamic results of botulinum toxin in the treatment of neurogenic hyperactivity.

OBJECTIVES: To determine the urodynamic efficacy and factors that influence the urodynamic results of treatment of neurogenic detrusor hyperactivity with intradetrusor injection of botulinum toxin type A (BTX-A) in patients with spinal cord injury (SCI). MATERIAL AND METHODS: A retrospective study was conducted with a cohort of 70 patients composed of 40 men and 30 women with stable SCI (mean age, 39 ± 13.3 years) who underwent an intradetrusor injection of 300 IUs of BTX-A. A urodynamic study was conducted prior to the injection and 6 ± 4.3 months after the treatment. New urodynamic studies were subsequently performed up to an interval of 16 ± 12.2 months. RESULTS: The BTX-A significantly increased (p < .05) the cystomanometric bladder capacity, the bladder volume of the first involuntary contraction of the detrusor and the postvoid residue. We observed a decrease that tended towards statistical significance (p < .1) of the maximum detrusor pressure and the maximum urine flow. Neither the bladder accommodation nor the urethral resistance index (bladder outlet obstruction index) varied significantly. The increase in vesical capacity was maintained in 50% of the sample for more than 32 months. Age, sex, anticholinergic treatment and lesion age showed no influence in terms of the increase in bladder capacity. The indwelling urinary catheter (IUC) was the only statistically significant negative factor. CONCLUSIONS: The urodynamic effect of BTX-A is maintained for a considerable time interval. The IUC negatively influences the result of the treatment.

Comparison of ambulatory versus video urodynamics in patients with spinal cord injury.

OBJECTIVE: To compare the data obtained through video urodynamics (VUD) with those obtained through one voiding cycle ambulatory urodynamics monitoring (AUM) in patients with spinal cord injury (SCI). METHODS: A comparative study was conducted in 69 patients with SCI (mean age±s.d. 44±16.9 years), 51 men and 18 women, who were subjected to AUM and VUD. RESULTS: A lack of agreement was observed between the two tests with respect to the cystometric capacity (CC) (ml) (275±197.2 AUM versus 416±198.3 VUD), filling pressure (cm H2O) (4±5.3 AUM versus 9±12.5 VUD), bladder compliance (ml cm(-1) H2O) (116±114.9 AUM versus 161±179.4 VUD), maximum detrusor contraction pressure (cm H2O) (87±65.2 AUM versus 47±35.0 VUD), post-void residual (ml) (206±201.5 AUM versus 308±237.7 VUD) and stress urinary incontinence (kappa index: -0.052). Only the CC obtained in the AUM was in agreement with the mean bladder volume gathered from the frequency-volume chart. Agreement was observed with respect to the presence of neurogenic detrusor overactivity (kappa index: 0.307) and bladder outlet obstruction index (cm H2O) (17±48.0 AUM versus 15±18.7 VUD). There was no clear association between AUM parameters and bladder neck morphology, the presence of radiological detrusor-external sphincter dyssynergy or vesicoureteral reflux observed in the VUD. CONCLUSION: The differences between both methods discourage the use of AUM with just one voiding cycle in the evaluation of patients with SCI.

Sexual dysfunction in men with spinal cord injury: a case-control study.

The objective of this study is to confirm that spinal cord injury (SCI) alters the neurological pathways of sexual function (SF) and to ascertain whether other differences exist among men with SCI compared with men without SCI (WSCI) and sexual dysfunction (SD). The method comprise a case study of 98 men with SCI and SD, and 89 men with WSCI and SD as controls. A questionnaire was administered to these men regarding their SF, anxiety, depression, self-esteem and quality of life. Additionally, a penile eco-Doppler study was performed after a prostaglandin E1 (PGE1) injection, in addition to neurophysiological tests of the innervation pathways of SF. The mean age of cases (39.35 years) was significantly lower than the control group (48.5 years). The SCI group had a higher frequency of ejaculatory disorders, and the WSCI group had a higher frequency of decreased sexual desire, erectile dysfunction (ED) and premature ejaculation. The WSCI group had greater anxiety and depression than the SCI group. The systolic velocities of both cavernous arteries were higher in the SCI group. Significant differences were observed in electromyography of the bulbocavernosus muscle, pudendal sensory thresholds, somatosensory potentials, genital sympathetic potentials and electromyography of the cavernous bodies after PGE1 injection. SCI causes significant alterations in the innervation pathways of SF.

Usefulness of electromyography of the cavernous corpora (CC EMG) in the diagnosis of arterial erectile dysfunction.

Electromyography (EMG) of the corpora cavernosa (CC-EMG) is able to record the activity of the erectile tissue during erection, and thus has been used as a diagnostic technique in patients with erectile dysfunction (ED). The present study examines the usefulness of the technique in the diagnosis of arterial ED. A cross-sectional study was made of 35 males with a mean age of 48.5 years (s.d. 11.34), referred to our center with ED for >1 year. The patients were subjected to CC-EMG and a penile Doppler ultrasound study following the injection of 20 µg of prostaglandin E1 (PGE1). The patients were divided into three groups according to their response to the intracavernous injection of PGE1: Group 1 (adequate erection and reduction/suppression of EMG activity); Group 2 (insufficient erection and persistence of EMG activity); and Group 3 (insufficient erection and reduction/suppression of EMG activity). Patient classification according to response to the intracavernous injection of PGE1 was as follows: Group 1: six patients (17%), Group 2: 18 patients (51%), and Group 3: 11 patients (31%). Patients diagnosed with arterial insufficiency according to Doppler ultrasound (systolic arterial peak velocity <30 mm s(-1) in both arteries) were significantly older than those without such damage (54.5 versus 41.8 years, respectively; s.d. 11.12). The patients in Group 3 showed a significantly lower maximum systolic velocity in both arteries than the subjects belonging to Group 2. Likewise, a statistically significant relationship was observed between the diagnosis of arterial insufficiency and patient classification in Group 3. The confirmation of insufficient erection associated with reduction/suppression of EMG activity showed a sensitivity of 66.7% (confidence interval between 50 and 84%) and a specificity of 92.9% (confidence interval between 84 and 100%) in the diagnosis of arterial ED. Owing to the high specificity of CC-EMG response to the injection of PGE1, this test is considered useful as a screening technique in the diagnosis of arterial ED.

[Participation of the pudendal innervation in the detrusor overactivity of the detrusor and in the overactive bladder syndrome]. / Participación de la inervación pudenda en la hiperactividad del detrusor y el síndrome de vejiga hiperactiva.

OBJECTIVES: The functional symptoms of the filling phase and detrusor overactivity are two inter-related dysfunctions of the lower urinary tract. We have aimed to study the participation of the lesion of the pudendal nerve in both urinary dysfunctions. MATERIAL AND METHODS: A cross-sectional cutoff study in a series of 108 women was carried out. The study consisted in the questioning on the presence of functional symptoms of the lower urinary tract, cystomanometry and determination of peripheral pudendal nerve latency time, selective electromyography of the external anal sphincter and determination of the sacral reflex latency time. RESULTS: A tendency was observed towards significance between the presence of pollakiuria amplitude of motor unit potentials (greater in presence of pollakiuria) and the presence of urgency-incontinence and time of sacral latency (greater in the presence of urge incontinence) and a significant relation between the score on the King's Health Questionnaire and peripheral pudendal nerve latency time. Regarding detrusor hyperactivity, greater sacral latency time was observed in patients with overactivity with tendency towards significance. CONCLUSIONS: There is a relation between pudendal innervation alterations and presence of symptoms in the filling phase and detrusor overactivity. This relation would explain the therapeutic action of the perineal rehabilitation on these dysfunctions.

[Study of the influence of pelvic prolapse in the lower urinary tract micturation phase in the female]. / Estudio de la influencia de los prolapsos pélvicos en la fase miccional del tracto urinario inferior femenino.

OBJECTIVES: Pelvic floor prolapse is a frequent condition in the woman, which in addition to anatomical alterations, may cause lower urinary tract dysfunction. We intend to verify the alterations of the micturation phase in patients with pelvic prolapse. MATERIAL AND METHODS: A cross-sectional cut off study was performed in a series of 102 women, mean age 66.8 years (standard deviation 9.6 years), diagnosed of urinary obstruction and pelvic prolapse and a prospective longitudinal study in a cohort of 21 patients of the previous series operated on for the prolapse. The patients were subjected to clinical examinations to determine the type and grade of public prolapse and to a urodynamic study. RESULTS: A significant direct correlation was observed between the grade of cystocele and uterine prolapse and a significant correlation, but in inverse sense, between the grade of uterine prolapse and that of the enterocele. The patients with a greater grade of uterine prolapse had greater urethral resistance by the URA parameter. A tendency towards significance regarding the postsurgical variation of the Urethral Resistance Average (URA) that decreased after the surgery, and the W80-20 (detrusor contractility), that increased after it, was observed. CONCLUSIONS: Pelvic prolapses affect the micturation phase. This involvement occurs both in the case of the cystoceles as well as in uterine prolapses and in the posterior compartments (rectocele and enterocele). Furthermore, an improvement is observed in the bladder contractility with the surgery of the pelvic prolapse.

["Post micturition residual; urodynamic"]. / <>

OBJECTIVES: To study the possible correlation between the existence of postmicturition residual (PR), both in men as in women, with other urodynamic parameters. MATERIAL AND METHODS: A retrospective study in a series of 121 patients (33 male, 88 female), age X=68.22 and SD=12.904 (16-90 years), with a significative PR had been underwent a videourodynamic study. All cases of neurogenic vesicourethral dysfunctions and post pelvic radiotherapy were excluded. Statistical study was performed between the PR and the presence of urinary symptoms, urodynamic data, and findings of physical examination. The study was conducted, both descriptive and with statistical correlations. We used the Spearman Rho and compared with the median chi-square. RESULTS: We found a positive correlation (men and women), between the PR and bladder capacity (p=0.001) and between the PR free flowmetry and PR test pdet/flow (r=0.450 p=0.001). In women, a positive correlation was found between the PR and the urethral resistance (URA) (p=0.001), and between PR and voiding by abdominal pressure (p<0,05). We found a negative correlation in men between the PR and the parameters of detrusor contraction (W80-W20) (p<0.05). Not found statistically significant correlation between the PR and cystometry, nor with the urodynamic diagnosis of obstruction, associated radiological semiology, hyperactive bladder and emptying symptoms in men. CONCLUSIONS: The PR behaved more as a parameter measurement of detrusor contractility, than a parameter of the lower urinary tract obstruction. The PR was not associated with any clinic or associated radiologic semiology.

[Bilateral testicular tumours]. / Tumores bilaterales de testículo.

OBJECTIVES: To study the incidence and characteristic of the bilateral tumours of testicle. MATERIAL AND METHODS: It was carried out a retrospective study on a database of testiculars tumours 98 tried in our service among the years 1979 and 2004. RESULTS: We registered 4 cases of bilateral tumours (4,1%) in the series. The interval of appearance of the second tumor oscillated between 14 months and 4 and a half years (being the medium of 47 months). In three cases the initial tumour was an embryonic Carcinoma and in one a tumour of Lydia. In two cases the second tumour was of the same type histological (embryonic Ca and tumour of Leydig), while in the other two cases of embryonic Ca, the second tumour was a seminoma and a teratocarcinoma. Regarding the histology of the first tumour, it was observed that only 3 of the 27 embryonic Ca (11%) of our series, they experienced a second neoplasia in front of 1 of the 2 tumours of Leydig (50%). CONCLUSIONS: The incidence of bilateral tumours in our series was of 4,1%. In our series the risk of the second tumour seems to be higher in patients with Leyding tumours, therefore the lesser number of tumours do not allow us to know significantly conclusions.

[Penis epidermoid tumors review]. / Revisión de los tumores epidermoides de pene.

OBJECTIVES: To study the characteristics and evolution of the epidermoid penis tumours. MATERIAL AND METHODS: It was carried out a retrospective study on the epidermoid penis tumours treated in our center between 1981 and 2005. RESULTS: 16 tumours penis epidermoides were diagnosed. The average age of the patients was of 71.7 years (interval between 54 and 90 years). In 80% of the cases they are diagnosed in advanced stadiums (T3 and T4). The most habitual presentation forms are the ulcerous lesions (53%) and papilar (33%). The average diameter of the lesion was 2.3 cm, and the most frequent localization the glands (53%) and balano prepucial (33%). They were carried out 7 local scissions, 8 partial penectomies, one total penectomy, and an local scission pluslocal treatment with 5-fluoracile. With a follow-up of 24 months 5 relapses took place, mainly in patients subjected to local excision of the lesion (p = 0.06 log-rank test). CONCLUSIONS: The epidermoid carcinoma of the penis is a tumoral lesion characteristic of advanced ages that is diagnosed later and treated in not very aggressive way. Therefore it is frequent the advanced stadiums and the tumour relapses.

[Scrotal leiomyosarcoma with bone metastasis]. / Leiomiosarcoma escrotal con metástasis óseas.

A case of scrotum leiomyosarcoma is presented in a 87 year-old patient. It debuts as a painless lesion in left hemiescrotum, of one year of evolution. Bony metastasis were observed in the moment of the diagnosis. We carried out a literature revision proving the rarity of this lesion type (only 27 cases have been described), and that, contrary to another leiomiosarcomas type, their aggressive evolution is not habitual in this localization.

[Hepatitis C as a risk factor of diabetes mellitus type 2]. / Hepatitis C como factor de riesgo de diabetes mellitus tipo 2.

INTRODUCTION: Hepatitis C virus (HCV) has been implicated as a risk factor for the development of diabetes mellitus, type 2 (DM2). Our aim is to check if HCV infection in our patients is a risk for the development of DM2. In that case, we study if the possible pathogenic mechanism could be related with an increase in iron deposits. PATIENTS AND METHOD: A consecutive series of 305 patients that attended to our service for measurement of anti-HCV antibodies was collected. HCV-antibodies were identified by second generation ELISA and confirmed by immunoblot. We detected viral RNA in 56% of these patients by polymerase chain reaction. The control group was made up of 137 patients. In every case, we analyzed the plasma levels of glucose, ferritin and other biochemical parameters. RESULTS: We found 13% of diabetics in the patient with viral RNA, 9.3% in the infected patients without RNA and 3.9% in the controls. The average of the ferritin level for the infected patients was 256 mg/l and for the controls was 151 mg/l (p = 0.01). The diabetic patients had ferritin levels of 346 mg/l and non-diabetic patients had 218 mg/l (p = 0.038). The presence of HCV-antibodies showed a 2.78 odds ratio for diabetes risk. DISCUSSION: Our results showed a relationship between HCV infection and diabetes mellitus type 2, so that the percentage of diabetics increased parallelly with the degree of viral activity and the variable "presence of HCV-antibodies" was the one that most contributed to the risk. Although our results would support the role of the iron metabolism in the development of diabetes, follow-up studies of a cohort of patients infected by HCV would be necessary to contrast this statement.

[Assessment of effectiveness and security of bladder neck cerclage after transvesical prostatectomy]. / Evaluación de la eficacia y seguridad del cerclaje cervical temporal tras una adenomectomía prostática.

INTRODUCTION: The Bladder neck cerclage diminishes the risk of bleeding after transvesical prostatectomy, but it increases the risk of suffering postoperative bladder neck sclerosis. Our objective is to value the effectiveness and therapeutic security of the temporary bladder neck cerclage after transvesical prostatectomy. MATERIAL AND METHODS: It was carried out a prospective and longitudinal study in a cohort of 25 age patients mean age 68,5 years (standard deviation, 2,6 years), subjected to transvesical prostatectomy (Freyer) with bladder neck cerclage using polipropilene number 1 suture, that was retired at the 24 hours of the surgery. To value the hemostatic utility of bladder neck cerclage, it was measured the hematocrit and hemoglobin concentration at the 24 hours of the intervention. To evaluate the appearance of obstructive sequels, the maximum urinary flow was measured three months after the surgery. RESULTS: It was observed a mean hematocrit at the 24 hours of surgery of 7,3%, and a mean decrease of the hemoglobin at the 24 hours of the surgery of 2,7 gr/dl. In any cases the postoperative hemoglobin concentration was inferior to 8 mg/dl, therefore, it was not necessary transfusion. The uroflowmetry carried out at 3 months of surgery showed that 24 of the 25 intervened patients presented a maximum flow superior to 15 ml/sg. CONCLUSIONS: The temporary bladder neck cerclage is a good hemostatic technique. The precocious cercalge retreat avoids the late sequels (bladder neck sclerosos), that originates the permanent cerclage.

[Testicular neoplasms. Evaluation of the experience during 25 years in a military hospital]. / Tumores testiculares. Evaluación de la experiencia durante 25 años en un hospital militar.

OBJECTIVES: The testicular tumors are frequent in the young adult, coinciding with the incorporation to the Military Service. The objective of our work is to evaluate the tumoral characteristic, its evolution with the time and the result of the treatments used in our center for this type of tumors. MATERIAL AND METHODS: We carried out a retrospective longitudinal study in a cohort of 98 patients with an average age of 28.6 years, subjected to orchiectomy for testicular tumor in our center between 1979 to 2004. In the study, we collected data referred to the age of the patients, the tumoral characteristic, the outcome of the treatment and the evolution of the tumor. RESULTS: In 61% of the cases, the affected testicle was the right (significant differences). The most common histologyc type was the non seminomatous germ cell tumors (NSGCT) (65.3%). Followed by the pure seminomas (27.6%), and non germinal cell tumors (NGC) (7.1%). The NSGCT was diagnosed to a average age (23.2 years) significantly smaller that the other two types. The stage I was the most frequent (58%). The seminomas presented a stage I in a significantly bigger frequency (80%) that the others tumors. The data picked up during the 25 years didn't show a significant variation regarding the tumoral characteristic. The survival análisis indicated that the tumoral characteristic with better pronostic regarding the probability of tumoral recurrences were the seminomas and the tumoral stages I and II. CONCLUSIONS: The non seminomatous germ cell tumors (NSGCT) are the most frequent testicular tumors in young adults. Most of the tumors are diagnosed in initial stages, and their pronostic is better in the case of the seminomas and in the stages I and II.

[A comparative study of the renal damage produced after the extracorporeal shock wave lithotripsy according to the lithiasis location]. / Estudio comparativo del daño renal producido tras la litotricia según la localización litiásica.

INTRODUCTION: The Extracorporeal shock waves lithotripsy (ESWL) is fundamental in the treatment of lithiasis. However, there are evidences that it can produce renal damage. The objective of our study is to determine the degree of affectation of the glomerular and tubular function after ESWL, and the influence of the lithiasis location on the type of renal damage. MATERIAL AND METHODS: A prospective longitudinal study was carried out in 14 patients with normal renal function subjected to ESWL. We determined the basal level, and the levels at the 24 hours, at the 4th and the 10th day post ESWL of: microalbuminuria (MA) (that values the glomerular function), and N-acetyl glucosamide (NAG) and alanine aminopeptidase (AAP), (that value the tubular function). RESULTS: The basal levels of of MA, NAG and AAP didn't show significant differences in connection with the localization of the stones. A significant increase was observed of the three parameters only 24 hours post ESWL. No significant differences were observed between the variation of the microalbuminuria levels, AAP and NAG and the treatment in relation to the localization of the stones. CONCLUSIONS: It exists a glomerular and tubular damage after ESWL. This damage is not related with the pelvic or calicial location of the stones. In patient with previous normal renal function, the renal damage recovers at the 4th day post ESWL.

[Experimental study of the expression of the bladder wall proteins in bladder outlet obstruction in the rabbit]. / Estudio experimental de la expresión de las proteínas de la pared vesical en la obstrucción del tracto urinario inferior en el conejo.

OBJECTIVES: To determine the relationship of the bladder wall levels of the contractile proteins: whole actin, beta-actin, alpha-sarcomeric-actina caldesmon and of the Heat Stress Protein HSP-70, with the partial bladder outlet obstruction. MATERIAL AND METHODS: It was carried out an experimental study on 43 New-Zealand rabbits. These animals were divided into a control group and six experimental groups with partial bladder outlet obstruction induced by an incomplete tie around the urethra. The experimental groups were defined according the day when the animals were sacrified: at 24 hours, 7 days, 15 days, 1 month, 3 months and 6 months of the obstruction. It was determined in all animals the muscular bladder wall concentration of whole actin, beta-actin, alpha-sarcomeric-actin, caldesmon and HSP-70 protein, according to Western Blotting technique. The results were analyzed by means of ANOVA, using the Scheffe post hoc method. RESULTS: The bladder weight of the obstructed animals increased significantly in two stages: until the day 15 and between the day 15 and the end of the study, corresponding to theoretical phases of initial hypertrophy and compensation. The level of whole actin showed a significant decrease at the beginning of compensation phase, while the beta-actin level increased in the phase of initial hypertrophy and the alpha-sarcomeric-actin level increased at the end of the compensation phase, while the caldesmon and the HSP-70 made it at the end of the initial hypertrophy phase. CONCLUSIONS: Analysing our data we conclued that the determination of the caldesmon levels is the marker that better adjusts to the changes associated with partial bladder outlet obstruction in the rabbit.