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.

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.

Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units?

OBJECTIVES: To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction. MATERIAL AND METHODS: Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction. RESULTS: A total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ = 0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p < 0.001), UUI (3dBD; p = 0.008) and nocturia (B-SAQ; p < 0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p < 0.05) according to the obstruction degree. CONCLUSIONS: Approximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor.

Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units? / ¿Existe concordancia entre vejiga hiperactiva e hiperactividad del detrusor en varones con síntomas predominantemente de llenado derivados a Unidades de Urología Funcional y Urodinámica?

OBJECTIVE: To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction. MATERIAL AND METHODS: Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction. RESULTS: A total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ=0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p<0.001), UUI (3dBD; p=0.008) and nocturia (B-SAQ; p<0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p<0.05) according to the obstruction degree. CONCLUSIONS: Approximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor.

Review of the experience and evidence of Pygeum africanum in urological practice. / Revisión sobre la experiencia y evidencias del Pygeum africanum en Urología.

CONTEXT: Pygeum africanum(P. africanum) is still being employed in urology practice for the treatment of lower urinary tract symptoms secondary to benign prostate hyperplasia. EVIDENCE ACQUISITION: A non-exhaustive review has been carried out about P. africanum, its mechanisms of action "in vitro" as well as "in vivo", clinical trials and routine clinical practice. EVIDENCE SYNTHESIS: The conclusions of the review and the reflections of the authors on the use of P. africanum are described. CONCLUSIONS: Although with an evidence level IV (based on expert opinion) the use of P. africanum seems to be an option in the urological therapeutic arsenal.

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.

¿Existe concordancia entre vejiga hiperactiva e hiperactividad del detrusor en varones con síntomas predominantemente de llenado derivados a Unidades de Urología Funcional y Urodinámica? / Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units?

Objetivo Estudiar el grado de concordancia diagnóstica entre vejiga hiperactiva (VH) e hiperactividad del detrusor (HD) en varones con síntomas del tracto urinario inferior (STUI) predominantemente de llenado, y el perfil clínico y urodinámico según presencia de HD y grado de obstrucción del tracto urinario inferior (OTUI).Material y métodos Estudio epidemiológico, transversal, multicéntrico y nacional. Se cumplimentaron: diario miccional de 3 días (DM3d), International Prostate Symptom Score (IPSS) y Cuestionario de Autoevaluación del Control de la Vejiga (CACV). Se determinó el volumen prostático (Vp) por ecografía y se realizó estudio urodinámico (EUD). Se analizó la prevalencia de VH y HD y la concordancia (kappa). Se realizó un análisis descriptivo de características clínicas y urodinámicas; posteriormente se comparó su frecuencia según presencia de HD y OTUI.ResultadosSe evaluaron 445 pacientes con edad media±DE de 54,8±9,9 años. Según el DM3d, un 89,8% presentaba frecuencia miccional aumentada, un 87,9% nicturia, un 72,8% urgencia y un 31,9% incontinencia urinaria de urgencia (IUU). Un 36,8% tenía OTUI. El 54,5% presentaba VH y HD. La concordancia diagnóstica entre HD y VH fue baja (κ=0,1702). Más pacientes con HD que sin ella presentaron urgencia (DM3d y CACV; p<0,001), IUU (DM3d; p=0,008) y nicturia (CACV; p<0,001). Hubo diferencias en IPSS-vaciado, flujo máximo (Qmax) y residuo posmiccional (p<0,05) según el grado de obstrucción.ConclusionesEn pacientes varones de 18 a 65 años con STUI predominantemente de llenado derivados a unidades especializadas, aproximadamente la mitad tienen coexistencia de VH y HD y un tercio tenía obstrucción. Hay baja concordancia diagnóstica entre VH y HD (AU)

Objective To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction.Material and methods Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction.ResultsA total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ=0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p<0.001), UUI (3dBD; p=0.008) and nocturia (B-SAQ; p<0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p<0.05) according to the obstruction degree.ConclusionsApproximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor (AU)

[Urinary calculi in myelomeningocele adults]. / Litiasis urinaria en adultos con mielomeningocele.

INTRODUCTION AND OBJECTIVES: The improvements in the management of newborns with myelomeningocele (MMC) have obtained a big increase in survival, allowing them to get longevity like never before, but data regarding urologic diseases during adult age are still missing. We herein evaluate the features of urinary lithiasis in adults born with MMC and the therapies used for its treatment. MATERIAL AND METHOD: We review 52 patients diagnosed at birth of MMC, between 18 and 40 years old, treated in our institution, with a mean follow-up of 6.7 years. RESULTS: 10 patients (19.2%) were diagnosed of urolithiasis. Three developed kidney calculi and one of them, with 7 more patients, developed bladder calculi (15.3%). The neurological level was < or = L2 in 3 cases, L2-S1 in 5, and > or = S1 in the other two. The type of neurogenic dysfunction of inferior urinary tract was multiple lesion of lower motor neurone in 6 cases, upper motor neurone in 1 case, multiple mixed lesion in 1 case and in case it was impossible to determine. Two patients had a bladder augmentation procedure and one of these with other 3 patients had a non-functional AMS-800 artificial urinary sphincter. Bladder stones were treated endoscopically in 14 procedures and by suprapubic cystolithotomy in 4 procedures, combined with removal of AMS-800 in 3 of them. One patient spontaneously passed a small stone. In one case, 2 ESWL and 2 percutaneous nephrolithotomies were needed. Three patients developed multiple recurrences during follow-up. CONCLUSIONS: Urinary lithiasis is common in adults with MMC. Some distinct features of these patients, together with their anatomical configuration and some therapies used in them, cause diagnostic, therapeutic and prophylaxis issues for the calculi they may develop.

Urological disease and tobacco. A review for raising the awareness of urologists. / Enfermedad urológica y el tabaco. Una revisión para la concienciación del urólogo.

CONTEXT: Smoking is the leading cause of preventable death in our community. Its relationship with urological disease is well documented. OBJECTIVE: To present an updated review on the relationship between urological disease and tobacco consumption and the importance of involving urologists in smoking prevention. ACQUISITION AND SYNTHESIS OF EVIDENCE: We conducted a review of current literature, primarily by searching PubMed and using as the main base the report on the consequences of smoking on health performed by the Surgeon General. CONCLUSION: Urologists play an essential role in informing patients of the relationship between smoking and urological disease. It is the duty of every urologist to play a more active role in educating patients and promoting smoking cessation.

The value of oxybutynin in transdermal patches for treating overactive bladder.

CONTEXT: There is currently a broad therapeutic arsenal of drugs for treating overactive bladder syndrome (OAB). However, there is still a need for new compounds and for improving known drugs in terms of efficacy, compliance and tolerability. OBJECTIVE: To report the scientific evidence on the safety and efficacy of transdermal oxybutynin (OXY-TDS) for treating OAB. MATERIAL AND METHODS: A systematic review without time restrictions was conducted until May 2015 in the MEDLINE/PubMed database. We also performed a manual review of abstracts published in international urogynaecology congresses. RESULTS: The evaluated studies show that patients treated with OXY-TDS experience a significant reduction in urinary incontinence episodes compared with placebo, which is comparable to that observed in patients treated with oral oxybutynin or with tolterodine. In all of the studies, we observed improvements in symptoms from the second or third week of treatment and in a sustained manner until the end of treatment (6, 12 or 24 weeks). The clinical practice study also showed improved quality of life, achieving benefits in numerous patient profiles, with an efficacy independent of previous treatments. The safety of the drug was demonstrated in the various patient profiles. CONCLUSIONS: OXY-TDS represents an effective alternative for the symptomatic treatment of adult patients with OAB, which, thanks to its pharmacokinetic profile, better tolerability, different administration method and dosage, could represent an added value in treating special populations.

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.

[Bladder schistosomiasis. Etiologic diagnosis of detrusor contraction insufficiency]. / Esquistosomiasis vesical. Diagnóstico etiológico de la insuficiencia de contracción del detrusor.

This paper reports a case of bladder bilharziasis with histopathological exam and different patterns of urodynamic evaluation. The need for urodynamics is emphasized in order to avoid diagnostic and therapeutic mistakes.

[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.

[Results of electric stimulation in the treatment of post-prostatectomy urinary incontinence]. / Resultados de la electroestimulación en el tratamiento de la incontinencia urinaria post-prostatectomía.

Clinical and urodynamic studies were conducted in 19 patients undergoing intrarectal electrostimulation due to post-prostatectomy urinary incontinence. It was corroborated that patients referring incontinence with isolated coughing presented better clinical outcome (80% positive results) than those who also referred urgency-incontinence (44%). Patients with stress incontinence showed positive clinical results post-stimulation in 78% cases. Patients with vesical instability, in 40% cases and patients with mixed incontinence, in 60%. In contrast, elimination of vesical instability was urodynamically proven in 60% cases, but in only 22% with stress incontinence. In mixed incontinence (instability + stress) the instability persisted only in 20% while stress incontinence persisted in 80% cases. The above data would advocate electric stimulation as a therapeutical alternative in post-prostatectomy urinary incontinence.

[Clinical results of the treatment of urinary incontinence with peripheral electric stimulation]. / Resultados clínicos del tratamiento de la incontinencia urinaria con estimulación eléctrica periférica.

A series of 126 patients, 98 women (78%) and 29 male (22%), average 50.2 years old, with different types of urinary incontinence (incontinence at cough, urge-incontinence, post-prostatectomy incontinence and nocturnal enuresis), has been treated with periferic electrostimulation to evaluate the clinical value of this type of treatment. Extrahospitalary management with electrostimulation by vaginal in 39 cases (30.9%) or rectal in 87 cases (69.1%) electrodes was performed. Frequencies has been different in urge-incontinence (10 Hz) and urinary incontinence at coughing (50 Hz). Average treatment duration was 3.3 months. Incontinence intensity decreased significantly with electrostimulation treatment (51-62%). Non statistical differences between other parameters (age, sex, clinical features, clinical incompetence type, cistocele grade) was observed. Positive results in larger period treatment (over 3 months) was obtained (p < 0.005). Best results were obtained with 10 Hz and 50 Hz frequencies (p < 0.05). Therapeutic results, good tolerance (89%), easy application for the patient and absence of secondary effects could made electrostimulation as an alternative therapy in all type of urinary incontinence.

[Endoscopic myocapsulotomy. Evaluation of the short-term clinical and urodynamic results]. / Miocapsulotomía endoscopia (MC). Evaluación de los resultados clínicos y urodinámicos a corto plazo.

Clinical and urodynamic evaluation of a series of 35 patients aged between 49 and 85 years. Clinical symptoms presented post-miocapsulotomy reduction both in obstructive and irritative signs and symptoms in 97.2% and 91.6% cases, respectively. Likewise, a decrease in peak flow and peak flow percentile was shown in 80.5% and 80% of cases, respectively. Vesical instability was seen in 90.9% and 55.5% of cases in pre- and post-operative studies respectively. An statistically significant post-operative drop (p < 0.05) in the detrusor's peak pressure during miction, (76.6 vs. 56 cm H2O), was confirmed. From our results it may be concluded that MC is a useful surgical technique in the treatment of prostatic obstruction, with the advantage versus other techniques that very frequently it preserves the proximal urinary continence mechanism and the sexual sphincter.

[Therapeutic effectiveness and safety of prazosin in the symptomatic treatment of benign prostatic hypertrophy]. / Eficacia y seguridad terapéuticas de prazosin en el tratamiento sintomático de la hipertrofia prostática benigna.

74 patients diagnosed as suffering from benign prostatic hypertrophy (BPH) were treated with prazosin for 8 weeks. We look at the evolution of the symptomatology and the urodynamic and morphologic parameters during the treatment and they are compared with the basal ones. The irritative symptoms (nocturia, pollakiuria, imperiosity and dysuria), evaluated by means of a quantitative scale, undergo significant statistical improvement. The same occurred with the obstructive symptoms. Urodynamically, an increase took place in total vesical capacity, maximum, and mean flow, as well as a drop or reduction in non-inhibited contractions. 27 patients suffered adverse effects, which obliged 8 of them to abandon the treatment. Global efficacy was excellent in 20% and good in 52%, whilst it was fair and ineffective in 19 and 9%, respectively.

[Clinical and urodynamic results of the treatment of bladder instability with intravaginal/intrarectal electric stimulation]. / Resultados clínicos y urodinámicos del tratamiento de la inestabilidad vesical con estimulación eléctrica intravaginal/intrarrectal.

Twenty-six male and female patients with urinary incontinence due to vesical instability underwent intravaginal/intra-rectal electrostimulation therapy. Positive clinical results were achieved in 65.3% of the cases. During subsequent urodynamic study, 80% of these cases showed absence of vesical instability. Based on these results, intravaginal/intra-rectal electrostimulation would constitute an option for the treatment of urinary incontinence due to vesical instability.