Capacidad vesical funcional mediante ultrasonido en pacientes con enuresis primaria monosintomática / Functional bladder capacity by ultrasound in patients with monosymptomatic primary enuresis

La enuresis primaria monosintomática es un problema clínico común que afecta del 5 al 10% de los niños en edad escolar. La etiología exacta no se conoce, pero se ha propuesto una capacidad vesical funcional disminuida como factor predisponente. Existen pocos reportes en la literatura del uso de ultrasonido para su evaluación. Objetivo: Determinar si la capacidad vesical funcional medida por ultrasonido está disminuida en enuresis primaria monosintomática comparada con población sana. Pacientes y Método: Estudio trasversal analítico de febrero de 2014 a mayo de 2015 incluyendo 40 pacientes con enuresis y 40 sin enuresis, 5 a 15 años de edad, midiendo la capacidad vesical funcional mediante ecógrafo Siemens Acuson S2000TM con transductor 3,5 y 5 MHz por un solo operador cegado. Se realizó estadística descriptiva y analítica mediante el programa IBM SPSS 20 TM. Resultados: Los pacientes con enuresis presentaron menor capacidad vesical funcional 171,7 ml vs controles 225,5 ml (p = 0,025). Resultó factor de riesgo OR = 2,81 (IC 95%: 1,06-7,42) tener un familiar de primera línea con antecedente de enuresis y OR = 4,0 (IC 95%: 1,48-10,78) para segunda línea. La capacidad vesical funcional presentó correlación débil con la capacidad vesical normal estimada mediante la fórmula de Kaefer. Conclusión: La capacidad vesical funcional es menor en quien padece enuresis que en los que no la padecen y existe poca correlación con las fórmulas que determinan la capacidad vesical normal esperada como la de Kaefer. Se reafirmó que el antecedente hereditario de enuresis juega un papel importante como factor de riesgo.

Nocturnal enuresis is a common clinical problem affecting 5% to 10% of school-age children. Etiology is not known but a diminished functional bladder capacity it has been proposed as a predisposing factor. There exist only a few studies evaluating it by ultrasound. Objective: To identify if there is a difference of the functional bladder capacity measured by ultrasound between nocturnal enuresis group and healthy children. Patients and Method: A cross-sectional study from February 2014 to May 2015 including two groups, nocturnal enuresis and a control group of 40 patients each, 5 to 15 years old. A single blinded operator measured the functional bladder capacity by ultrasound with an Acuson S2000 SiemensTM 3.5 and 5 MHz transducer. Analytics and descriptive statistics were performed using IBM SPSS 20TM software. Results: Patients with enuresis showed a decreased functional bladder capacity vs. controls (171.7 ml vs 225.5 ml; p = 0.025). A history of first-degree relative with enuresis increased the risk of having enuresis OR = 2.81 (95% CI: 1.06-7.42), a second-degree relative presented OR = 4.0 (95% CI: 1.48-10.78). Functional bladder capacity presented a weak correlation with the bladder capacity estimated by Kaefer’s formula. Conclusion: The functional bladder capacity is lower in the patients with nocturnal enuresis when compared to control group. There is little correlation between functional bladder capacity and Kaefer’s formula to determine the normal bladder capacity. We reaffirmed that the family history with enuresis strongly increases the risk of developing nocturnal enuresis.

Estudio piloto de eficacia de imipramina en el tratamiento del síndrome de dolor vesical / Pilot study of the effectiveness of imipramine in the treatment of bladder pain syndrome

El síndrome de dolor vesical (SDV) es un cuadro que forma parte del dolor pelviano crónico (DPC), donde el origen del dolor esta en mecanismos de neuromodulación. En este sentido, los antidepresivos tricíclicos (ATC), especialmente amitriptilina, son la terapia de primera línea. Sin embargo, los efectos adversos dificultan la adherencia a la terapia. Imipramina, otro ATC, presenta menores efectos adversos, aunque su eficacia no ha sido evaluada en SDV. Objetivo: Evaluar la eficacia de imipramina en el tratamiento de SDV en un estudio piloto. Metodología: Veinte pacientes con diagnóstico de SDV, fueron tratadas con imipramina 25 mg cada 8 horas vía oral durante 30 días. Se evaluó intensidad de dolor según EVA antes y al término del tratamiento. Además se evaluó sintomatología urinaria utilizando el cuestionario PUF. Resultados: Diecinueve pacientes completaron el tratamiento. Una paciente abandonó el tratamiento por síntomas gastrointestinales. Ocho de 19 pacientes mostraron una mejoría total del dolor al término del tratamiento. Tres pacientes más lograron una respuesta completa con 3 meses de tratamiento con imipramina. La intensidad del dolor según EVA y la puntuación en el cuestionario PUF mejoraron significativamente al término del tratamiento. Efectos secundarios a imipramina fueron referidos por 4 de 19 pacientes, y fueron menores. Conclusión: Imipramina mostró ser una terapia efectiva en el manejo de SDV, con efectos adversos menores. Se requieren estudios comparativos con mayor número de pacientes para considerar su utilidad clínica en el manejo del SDV...

Bladder pain syndrome (BPS) is a symptom which is part of chronic pelvic pain (CPP), where the origin of the pain is in the neuromodulation mechanisms. In this context, tricyclic antidepressants (TCAs), especially amitriptyline, are a first line therapy. However, adverse effects make continuing with the therapy difficult. Imipramine, another TCA, has lesser adverse effects, although its effectiveness has not been evaluated in BPS. Objective: Evaluate the effectiveness of imipramine in the treatment of BPS in a pilot study. Methodology: Twenty patients with a diagnosis of BPS were treated taking 25 mg of imipramine orally every 8 hours, for 30 days. The intensity of the pain following PIS was evaluated before and after the treatment. In addition, the urinary symptomatology was evaluated using the PUF questionnaire. Results: Nineteen patients completed the treatment. One patient abandoned the treatment due to gastrointestinal symptoms. Eight of the 19 patients had completely recovered at the end of the treatment. Three other patients achieved a complete recovery after 3 months of treatment with imipramine. The intensity of the pain following the PIS, and the score on the PUF questionnaire, significantly improved by the end of the treatment. Secondary effects to imipramine were referred by 4 of the 19 patients, and these were minor. Conclusion: Imipramine was shown to be an effective therapy for dealing with BPS, with minor adverse effects. Comparative studies are required with a higher number of patients to consider its clinical use in the handling of BPS...

Prevalence and conditions associated with chronic pelvic pain in women from São Luís, Brazil

The objective of the present study was to estimate the prevalence of chronic pelvic pain in the community of São Luís, capital of the State of Maranhão, Northeastern Brazil, and to identify independent conditions associated with it. A cross-sectional study was conducted, including a sample of 1470 women older than 14 years predominantly served by the public health system. The interviews were held in the subject's home by trained interviewers not affiliated with the public health services of the municipality. The homes were visited at random according to the city map and the prevalence of the condition was estimated. To identify the associated conditions, the significant variables (P=0.10) were selected and entered in a multivariate analysis model. Data are reported as odds ratio and 95% confidence interval, with the level of significance set at 0.05. The prevalence of chronic pelvic pain was 19.0%. The independent conditions associated with this diagnosis were: dyspareunia (OR=3.94), premenopausal status (OR=2.95), depressive symptoms (OR=2.33), dysmenorrhea (OR=1.77), smoking (OR=1.72), irregular menstrual flow (OR=1.62), and irritative bladder symptoms (OR=1.90). The prevalence of chronic pelvic pain in Sao Luís is high and is associated with the conditions cited above. Guidelines based on prevention and/or early identification of risk factors may reduce the prevalence of chronic pelvic pain in São Luís, Brazil.

Diverticulitis vesical: reporte de un caso y revisión de la literatura / Bladder diverticulitis: case report and literature review

Se presenta un caso de diverticulitis vesical en un paciente de 60 años con antecedente de obstrucción crónica al tracto de salida vesical (estenosis uretral), quien consulta por dolor pelviano inespecífico. Por lo anterior se realiza Resonancia Magnética (RM) de pelvis, que demuestra la presencia de un divertículo vesical de pared engrosada con cambios inflamatorios, los que comprometen además, la grasa peri-vesical. Este divertículo había sido detectado en RM pelviana un año antes. Se comenta el caso clínico, sus hallazgos a la RM y revisión de la literatura...

We report a case of bladder diverticulitis in a 60 years old patient with a history of chronic lower urinary tract obstruction (urethral stricture), who consulted for nonspecific pelvic pain. Pelvic magnetic resonance imaging (MRI) was obtained, demonstrating the presence of a bladder diverticulum with a thick wall and inflammatory changes involving the perivesical fat. The diverticulum had been detected on pelvic MRI a year earlier. We discuss the clinical case, the MRI findings and a review of the literature....

Manejo quirúrgico de la endometriosis vésico-ureteral y sus complicaciones / Surgical management of deep endometriosis

La endometriosis ureteral es una infrecuente localización de endometriosis profunda, que puede condicionar una grave disminución de la función renal de forma silenciosa. Se presenta el caso de una paciente con fibrosis peritoneal secundaria a endometriosis profunda, cuya inespecífica sintomatologia conllevó un retraso diagnóstico, permitiendo el desarrollo de hidronefrosis. Es necesario descartar la presencia de endometriosis profunda en mujeres en edad fértil con hidronefrosis de etiología desconocida.

Deep endometriosis rarely entails ureteral involvement. It may be responsible of asymptomatic loss of renal function. A 35-year-old woman, gravida 1, para 1, was managed for peritoneal fibrosis due to deep infiltrating endometriosis. The nonspecific symptoms let a delayed diagnosis and a subsequent hydronephrosis. It must be excluded the existence of deep endometriosis in women of childbearing age with hydronephrosis of unknown etiology.

Complications rates of non-oncologic urologic procedures in population-based data: a comparison to published series

PUSPOSE: Published single institutional case series are often performed by one or more surgeons with considerable expertise in specific procedures. The reported incidence of complications in these series may not accurately reflect community-based practice. We sought to compare complication and mortality rates following urologic procedures derived from population-based data to those of published single-institutional case series. MATERIALS AND METHODS: In-hospital mortality and complications of common urologic procedures (percutaneous nephrostomy, ureteropelvic junction obstruction repair, ureteroneocystostomy, urethral repair, artificial urethral sphincter implantation, urethral suspension, transurethral resection of the prostate, and penile prosthesis implantation) reported in the U.S.’s National Inpatient Sample of the Healthcare Cost and Utilization Project were identified. Rates were then compared to those of published single-institution series using statistical analysis. RESULTS: For 7 of the 8 procedures examined, there was no significant difference in rates of complication or mortality between published studies and our population-based data. However, for percutaneous nephrostomy, two published single-center series had significantly lower mortality rates (p < 0.001). The overall rate of complications in the population-based data was higher than published single or select multi-institutional data for percutaneous nephrostomy performed for urinary obstruction (p < 0.001). CONCLUSIONS: If one assumes that administrative data does not suffer from under reporting of complications then for some common urological procedures, complication rates between population-based data and published case series seem comparable. Endorsement of mandatory collection of clinical outcomes is likely the best way to appropriately counsel patients about the risks of these common urologic procedures.

Síndrome megabexiga microcólon hipoperistaltismo intestinal: sobrevida até a adolescência / Megacystis-microcolon-intestinal hypoperistalsis syndrome: survival to adolescence

A síndrome megabexiga microcólon hipoperistaltismo intestinal (SMMHI) é uma doença rara, de provável herança genética, com prognóstico reservado, já no primeiro ano de vida. Relata-se um caso de SMMHI em criança do sexo feminino, atualmente com 16 anos de idade, com o objetivo de ressaltar o prognóstico favorável, não esperado, com sobrevida até a adolescência, de uma síndrome rara. Chama-se a atenção para a possibilidade de estabelecer o diagnóstico no período perinatal e para a importância de realizar o estudo urodinâmico.

Rotura espontánea de vejiga urinaria post parto vaginal / Spontaneous rupture of urinary bladder

Antecedentes: La rotura de la vejiga en el post parto es una condición poco común y cuando ocurre se convierte en una emergencia que requiere un diagnóstico y tratamiento inmediato. Caso clínico: Paciente de 41 años, multípara de 4, se presenta al Servicio de Urgencia 4 días después del parto, con distensión abdominal progresiva asociado a oliguria y dolor abdominal de tres días de duración. Los exámenes de laboratorio revelaron presencia de marcada elevación de las concentraciones de urea y creatinina. La ecografía abdominal reveló la presencia de ascitis con hígado y riñones de aspecto normales. Las condiciones de la paciente empeoran y se decide efectuar laparotomía exploradora, encontrándose una lesión vertical en la cara posterior de vejiga de 5 cm, orina libre en abdomen y signos de peritonitis. Se efectúa sutura vesical. No se reconoce rotura uterina. Se retira sonda vesical al décimo día y es dada de alta con buena función vesical. Conclusión: La rotura espontánea de la vejiga urinaria post parto es extremadamente rara. Un diagnóstico temprano y la exploración inmediata disminuye la morbilidad y mortalidad en esta condición.

Background: Bladder rupture in an uncommon condition and when it occurs is converted in an emergency and require immediate diagnosis and treatment. Case report: A 41-year-old patient, IV para, assisted four days after vaginal delivery with progressive abdominal distention, associated with oliguria and abdominal pain of three days of duration. Laboratory showed the presence of a marked elevation of urea and creatinine concentrations. Abdominal ultrasonography revealed the presence of ascites with normal liver and kidneys. Patients conditions worsened and a laparotomy is done, where a 5 cm vertical lesion of bladder in his posterior face were found, with free urine in abdomen and peritonitis signs. Bladder was sutured. Uterine rupture is not recognized. Foley catheter was withdrawn to the tenth day and the patient was discharged with good bladder function. Conclusions: Postpartum spontaneous bladder rupture is extremely rare. Early diagnosis and immediate exploration diminish morbidity and mortality in this condition.

Recurrencia del prolapso de õrganos pelvicos en la sala de ginecología del HEODRA en el período comprendido de enero del 2005-enero 2008 / Recurrencia of the prolapse of pelvic organs in the room of gynecology of the HEODRA in the understood period of January of the 2005 - January 2008

Se realizo un estudio de seguimiento de una cohorte en la sala de ginecología del Hospital Escuela Oscar Danilo Rosales Arguello (HEODRA). Se capto un total de 117 pacientes en el período comprendido de Enero 2005 a Noviembre 2007, todas estas pacientes fueron sometidas a procedimientos quirúrgicos para corrección del prolapso de órganos pélvicos entre ellos hicterectomía vaginal, colporrafia anterior, colpoperineoplastia y reparación de enterocele a cuatro pacientes. El 91 porciento de las pacientes eran amas de casa y otras ocupaciones encontradas fueron comerciantes 2.6 y domesticas 2.6 porciento. Los antecedentes patologicos personales mas frecuentes que se observaron fueron Diabetes Mellitus tipo 2, colagenopatia 3.8 porciento. La mayoría de las pacientes eran gran multíparas 73.1 porciento multíparas 26.9 porciento. El tipo de lesión prequirúrgica que predominó fue el cistocele grado III con 73.1 porciento seguido de prolapso uterino grado III en 61 porciento y rectocele grado II en el 5.19 porciento de los casos. La cirugía correctora de acuerdo al defecto presente en cada caso en particular fue colporrafia anterior 100 porciento, colpoperineoplastia 100 porciento, histerectomía vaginal 97.6 porciento mientras que la reparacion del engerocele fue de 1.3 porciento. En la evaluación realizada a los 12 meses posterior a la cirugia la recurrencia del compoartimiento anterior fue del 29 porciento y del compartimiento posterior del 3.8 porciento, dando una recurrencia total de 33.3 porciento. El prolapso de cúpula y la recurrencia del enterocele no se observaron en un año de seguimiento...

Coexistencia de un hamartoma vascular vesical y carcinoma papilar urotelial: reporte de un caso / Coexistence of a urinary bladder vascular hamartoma and urotelial papilar carcinoma: case report

El hamartoma de la vejiga urinaria es una entidad infrecuente, no hemos encontrado casos reportados en la literatura asociado a carcinoma papilar del urotelio; ambos se pueden presentar como una masa solevantada de la mucosa y es necesario el examen histopatológico para diferenciarlos. Presentamos el caso de un hombre de 73 años de edad en el que coexisten ambas entidades.

The hamartoma of urinary bladder is a infrecuent entity, we have not found case in the literature associated to urotelial papilar carcinoma, both can appear a tumor mass and the histopathology examination is necessary to differentiate them. The differential diagnosis between both tumors needs to the histopathology testing. We present a case of 73 years male in which both entities coexist.

Vesicoperitoneal fistula--an unusual cause of tense ascites.

We report a 55-year-old man who developed tense ascites due to vesicoperitoneal fistula. He had undergone surgery 32 years ago for excision of an infected urachal cyst, the tract and the umbilicus.

Vesicocutaneous fistula arising from a bladder diverticulum.

A 55-year-old man presented with intermittent episodes of urinary leak through the left groin following an abscess drainage at that site at the age of 5 years. Since then he had been suffering from recurrent urinary tract infections and urinary leak, which used to be treated symptomatically. Intravenous urogram (IVU), voiding cystourethrogram (VCU), and cystoscopy done in our institution revealed a bladder diverticulum with a stone in situ, which was communicating with the fistulous opening located in the left groin. Diverticulectomy and excision of the fistulous tract cured the patient. A long-standing fistula arising from a bladder diverticulum at relatively distant site is of extreme rarity. Vesicocutaneous fistula from an iatrogenic injury to vesical diverticulum resulting from a groin surgery has not been reported so far.

Verrucous carcinoma of the bladder with koilocytosis unassociated with vesical schistosomiasis

CONTEXTO: O carcinoma verrucoso de bexiga é uma neoplasia maligna muito rara, histologicamente semelhante ao condiloma acuminado. Normalmente apresenta-se associado à esquistossomose vesical (bilharzíase). Apenas 13 casos não relacionados à bilharzíase foram descritos até o momento, sendo que em nenhum deles foi relatada presença de coilocitose, um achado característico da infecção pelo papiloma vírus humano. RELATO DE CASO: Apresentamos um caso de carcinoma verrucoso de bexiga não relacionado à bilharzíase com presença de coilocitose e ausência de papiloma vírus humano. A literatura relacionada ao assunto é discutida.

Resiniferatoxin for detrusor instability refractory to anticholinergics

PURPOSE: We have evaluated the clinical and urodynamic effects of intravesical instillation of resiniferatoxin in patients with idiopathic detrusor instability refractory to anticholinergics. MATERIALS AND METHODS: There were 30 women, median age 56 years old with detrusor instability for over 6 months and a history of anticholinergic use with no response or intolerable collateral effects. A 50 nM solution of resiniferatoxin was prepared for intravesical instillation. All patients were evaluated for urinary symptoms, as well as for urodynamic assessments before and 30 days after instillation. Tolerability was analyzed during the instillation. RESULTS: A clinical improvement was observed in 30 percent of the patients with urinary urgency and in 33 percent of the patients with urge-incontinence. The mean maximum cystometric capacity before application was 303.9 ± 78.9 and after application 341 ± 84.6. No significant difference was observed (p = 0.585). The mean maximum amplitude of the contractions diminished from 47.86 ± 29.64 to 38.72 ± 30.77 (p = 0.002). CONCLUSIONS: Resiniferatoxin, in this concentration, proved to be useful in a small percentage of patients regarding clinical detrusor instability. Maximum amplitude of the involuntary contractions was significantly reduced and in 33 percent patients the involuntary contractions disappeared. Further studies with different concentrations are recommended.

Fatores de risco para infecção do trato urinário em crianças e adolescentes portadores de disfunção vesical que realizam o cateterismo vesical intermitente limpo / Risk factors for urinary tract infection in children and adolescents treated with clean intermittent catheterization

Trata-se de estudo de caso longitudinal, que teve como objetivo identificar fatores de risco para infecção do trato urinário (ITU) nas criaças e adolescentes tratados com cateterismo vesical intermitente limpo (CIL)...

Urodynamic study of children with voiding problems.

Twenty high risk children aged 5-12 years with various voiding problems were studied prospectively by urodynamics to evaluate the function of their urinary bladder and its continence mechanism. None of them had neuropathic bladder or any obstruction distal to bladder neck. Fourteen out of twenty (70%) had abnormal findings on urodynamics evaluation; 8 (40%) had non-neurogenic neurogenic bladder (NNNB); 3 (15%) had small capacity hypertonic bladder (SCHB); 2 (10%) had atonic bladder (AB) and 1 (5%) had hyperreflexic bladder (HB). We conclude that urodynamic abnormalities are as frequent in high risk Indian children as they are in developed countries. The high risk children should be subjected to urodynamic studies more frequently than being done hitherto and be directed to proper therapeutic modality.

Manejo de la sonda Foley en relación al síndrome de retención urinaria posterior a cirugía vaginal / Management of Foley catheter in relation to urinary retention after vaginal surgery

El síndrome de retención urinaria postoperatorio es una complicación frecuente en la cirugía vaginal y para obviarlo, en muchos centros se propicia el uso de drenaje vesical transuretral por tres a cinco dias, con o sin reeducación vesical. Con el fin de determinar si el tiempo de permanencia del drenaje y la reeducación vesical influyen sobre la ocurrencia de este síndrome, se estudiaron en forma prospectiva y randomizada 106 pacientes sometidas a cirugía vaginal en nuestro servicio, divididas en tres grupos: el primero constituído por 36 pacientes a las que se les retiró el drenaje vesical a las 24 horas; el segundo compuesto por 37 pacientes en las que el drenaje fue retirado a las 72 horas y el tercero que reunió a 33 pacientes en las que la sonda fue retirada a las 72 horas previa reeducación vesical. Nuestros resultados muestran que las pacientes que presentaron con menor frecuencia retención urinaria postoperatoria, fueron aquellas que tuvieron un menor tiempo de drenaje vesical (24,3 por ciento vs 30,7 por ciento y 43 por ciento) por lo que se concluye que el mantener la sonda Foley por más de 24 horas y realizar reeducación vesical, no disminuye la frecuencia del síndrome de retención urinaria y que sólo constituye un mayor riesgo de infección urinaria y de prolongación del tiempo de hospitalización