Effect of pelvic organ prolapse repair on detrusor overactivity in women following incontinence surgery: A multivariate analysis.

AIMS: To determine the effect of pelvic organ prolapse (POP) repair on post-operative detrusor overactivity (DO) in women who have underwent incontinence surgery, using multivariate analysis. METHODS: A retrospective study was carried out on a cohort of 105 women who underwent incontinence surgery. In 39 of the patients this surgery was associated with pelvic organ prolapse repair. Clinical and urodynamic data were collected pre- and 3 months post-operatively. A multivariate statistical analysis was performed to detect confounding factors which could influence on the risk factors associated with post-operative detrusor overactivity. RESULTS: On univariate analysis, the following pre-operative factors were associated with post-operative detrusor overactivity: symptomatic mixed urinary incontinence, rectocele, detrusor overactivity, voided volume on free uroflowmetry, maximum cystomanometric capacity, and performing concomitant pelvic organ prolapse repair. Multivariate analysis, by means of confounding factors elimination, revealed that only pre-operative rectocele and detrusor overactivity were independent risk factors. CONCLUSIONS: The pelvic organ prolapse repair acts as a confounding factor. Women with a pre-operative rectocele and detrusor overactivity are on a greater risk to develop post-operative detrusor overactivity and, therefore, they should be informed.

Risk factors to develop autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury.

AIMS: The risk factors for developing autonomic dysreflexia (AD) during urodynamic (UD) examination in patients with spinal cord injury (SCI) above Th6 still remain unclear. The main goal of our study is to investigate the risk factors that could be associated with AD in these particular patients. DESIGN: Cross sectional survey. SUBJECT AND METHODS: The study was carried out in 83 patients with SCI above Th6 who were submitted to our center for a UD examination. AD was defined as a rise in systolic blood pressure above 15 mm Hg with a pulse rate below 60 beats per minute. RESULTS: The prevalence rate of AD among our patients was 54%. Univariate analysis of our study showed the following risk factors: patient's age, SCI completeness, traumatic etiology, indwelling catheter, presence of chills or sweating, anticholinergic treatment, maximum detrusor voiding pressure, detrusor pressure at maximum flow rate, detrusor external sphincter dyssynergia, and bladder outlet obstruction. Using multivariate logistic regression, we found that there are only two independent risk factors: patient's age equal to or above 45 years of age (OR = 10.995) and maximum detrusor voiding pressure equal to or above 31 cm H2 O (OR = 3.879). CONCLUSIONS: According to our results, the patient's age and maximum detrusor voiding pressure should be considered at the time of performing a UD examination in order to prevent the sudden onset of AD in patients with SCI above Th6. Neurourol. Urodynam. 36:171-175, 2017. © 2015 Wiley Periodicals, Inc.

Post Pelvic Radiotherapy Affectation of the Lower Urinary Tract Peripheral Innervation in Men.

INTRODUCTION: The periurethral electromyography (EMGs) alterations in men who underwent pelvic radiotherapy (RT), either isolated or combined with surgery, have not been frequently described in the literature. OBJECTIVE: The study aimed to compare the EMG's data in men undergoing RT versus the non-irradiated control group. MATERIAL AND METHODS: The study included 61 consecutive males, who had undergone RT (27 of them had been operated) and 99 control consecutive patients who underwent a retrospective assessment. The EMGs were performed using a concentric electrode needle perineally, localizing the sphincter by visual and auditory signal (electromyograph MMS Solar Active). RESULTS: 14.8% denervation, 62.9% reinnervation, 14.9% denervation + reinnervation and 7.4% EMG normal. The age (p < 0.001) and neurogenic bladder data (p < 0.001) are risk factors. The smaller the prostate size (obtained by rectal examination) post-RT, the more the chance for an abnormal EMG (p < 0.001). The fact of having had received RT (p < 0.001) is the only risk factor. CONCLUSION: RT produces lesions over the pudendal nerve, showing denervation even in late periods. The surgery did not behave as a risk factor.

The 3-day bladder diary is a feasible, reliable and valid tool to evaluate the lower urinary tract symptoms in women.

AIMS: To evaluate the feasibility (% of completion), reliability (test-retest and inter-observer) and validity (convergent vs. questionnaires and vs. urodynamic study-UDS) of the 3-day bladder diary (3dBD) in women with lower urinary tract symptoms (LUTS). METHODS: Epidemiological, descriptive, cross-sectional and prospective study. Fourteen Functional Urology and Urodynamic Units participated. One hundred thirty-six women with mean age (SD) 55.2 (13.8) years with LUTS, without bladder catheterization and who were able to fill in the 3dBD were included. An UDS was performed. They filled in the 3dBD in two times separated by 15 days (test and retest), the International Consultation on Incontinence-Short Form (ICIQ-UI SF) and the Bladder Control Self-Assessment Questionnaire (BSAQ). RESULTS: One hundred ten women completed 3dBD for test and retest. Feasibility: each 3dBD has 42 variables, 77.2% women completed 80%. Test-retest reliability: there were not differences in the proportion of patients classified as positive for each symptom (urgency: P = 0.3173; incontinence: P = 1; nocturia: P = 0.0522; frequency: P = 0.4386). The Intraclass Correlation Coefficient (ICC) ranged from 0.67 to 0.92, except for night time VVmax which was lower (0.54). Inter-observer reliability: ICC ranged from 0.64 to 0.99, except for day time VVmax (0.29) and the number of urgency episodes (0.45). VALIDITY: Spearman correlation coefficients for ICIQ-UI SF and BSAQ ranged from 0.4 to 0.6 (P < 0.0001) and for UDS were lower (P < 0.05). CONCLUSIONS: The 3dBD showed good feasibility, reliability and validity to be used in the assessment of LUTS in women.

Is lower urinary tract dysfunction an early marker of Portuguese type familial amyloidotic polyneuropathy in women? Preliminary results.

Type 1 Portuguese Familial Amyloid Polyneuropathy was first observed in 1939 and described in 1951 by Corino Andrade. FAP is a rare autosomal dominant disease caused by a mutant gene in chromosome 18, characterized by a variant transthyretin in which valine is substituted for methionine at position 30 (ATTR V30M), affecting mainly young adults. ATTR V30M positivity does not imply disease, but the disease is only present with ATTR V30M in serum. The clinical manifestations of FAP on the pelvic floor and genitourinary system are frequent at early disease onset. Phenotypic diversity can depend on modulating agents in the deposition of the mutant TTR, such as incomplete penetration and environmental influence. Functional vesicourethral disorders appear to be primarily at the bladder filling phase, namely diminished bladder sensation, and associated with a decrease in detrusor contractility during the emptying phase. Unbalanced voiding takes place in this context, with high post-void residuals, increasing the rate of co-morbidity, namely recurrent urinary tract infections and chronic renal failure.This study describes the lower urinary tract dysfunctions in ATTR V30M positive carriers, particularly during the asymptomatic period and early stages of the disease, and additionaly it describes its association with the clinical evolution of the disease. In the preliminary phase of the study, the lower urinary tract dysfunction in FAP-women may present itself as an early manifestation in asymptomatic patients. Uroflowmetry and the evaluation of post-voiding residual volume are non-invasive and low cost tests that should be done during routine initial evaluation. Reduced bladder sensation and poor detrusor contractility may be considered initial markers of FAP. The neurogenic factor (bladder afferent neurons) appears to be mechanical in nature with myogenic repercussions. This further aggravates the bladder underactivity secondary to pelvic efferent parasympathetic neuropathy and amyloid infiltration in the bladder wall. Early diagnostic and therapeutic intervention may avoid secondary end stage renal disease.

Study of the prevalence and interobserver reproducibility of radiologic images suggestive of urethral diverticula in men with spinal cord injury.

OBJECTIVES: To determine the prevalence of radiologic images suggestive of urethral diverticula (UD) in men with spinal cord injury (SCI) and to study the interobserver diagnostic reproducibility. METHODS: Radiological studies (i.e. voiding cystourethrography and retrograde urethrography) performed over 1 year on men with SCI were independently reviewed by 3 researchers (1 urologist and 2 radiologists). RESULTS: The prevalence of UD was found to be between 4.2 and 9.8% of the patients, the higher figure obtained when including also the doubtful images. The kappa index of agreement between the researchers was low (between 0.15 and 0.40). The factors that significantly influenced agreement were localization in the prostatic urethra (p = 0.021), localization in the penile urethra (p = 0.000) and fusiform morphology (p = 0.004). Logistic regression analysis showed that the variables that independently influenced diagnostic agreement were the following: localization in the penile urethra (in favor of agreement) and fusiform morphology (against agreement). CONCLUSIONS: Radiologic images suggestive of UD constitute a frequent finding in men with SCI and raise important diagnostic problems.

Factors Influencing Postoperative Overactive Bladder after Adjustable Trans-Obturator Male System Implantation for Male Stress Incontinence following Prostatectomy.

We aimed to determine the risk factors for postoperative overactive bladder (OAB) in patients treated with an adjustable trans-obturator male system (ATOMS) for stress incontinence after radical treatment of prostate cancer. A prospective study was performed on 56 patients implanted with an ATOMS for PPI. Clinical and urodynamic information was recorded before and after ATOMS implantation. We built a multivariate model to find out the clinical and urodynamic factors that independently influenced postoperative OAB and the prognostic factors that influenced the efficacy of medical treatment of OAB. We found that the clinical risk factors were the preoperative intensity of urinary incontinence (number of daily pads used and amount of urinary leakage), International Consultation on Incontinence Questionnaire (ICIQ) score, postoperative number of ATOMS adjustments, final cushion volume, and incontinence cure. The urodynamic data associated with OAB were cystometric bladder capacity, voided volume, volume at initial involuntary contraction (IC), maximum flow rate, bladder contractility index (BCI), and urethral resistance (URA). The prognostic factors for the efficacy of oral treatment of OAB were the volume at the first IC (direct relationship) and the maximum abdominal voiding pressure (inverse relationship). The multivariate model showed that the independent clinical risk factors were the daily pad count before the implantation and the ICIQ score at baseline and after treatment. The independent urodynamic data were the volume at the first IC (inverse relationship) and the URA value (direct relationship). Both predictive factors of treatment efficacy were found to be independent. Detrusor overactivity plays an important role in postoperative OAB, although other urodynamic and clinical factors such as the degree of urethral resistance and abdominal strength may influence this condition.

Urodynamic approach to female urinary incontinence refractory to treatment with anticholinergics.

OBJECTIVES: The administration of empirical anticholinergic treatment is widespread in women with urinary incontinence and has produced varied results. The objective of our paper is to determine the effectiveness of anticholinergics for the treatment of female urinary incontinence and to determine by urodynamics the possible causes that may explain the resistance to anticholinergics to obtain urodynamic predictors of success or failure. METHODS: We evaluated 182 women over 14 years of age with urinary incontinence that had previously been treated with anticholinergics for at least three months. The patients underwent a complete medical history including clinical history, physical examination, and urodynamic and lower urinary tract video-radiologic studies. Statistical analysis was performed using SPSS 17.0 for Windows. RESULTS: Clinical therapeutic efficacy was demonstrated in 39.6% of cases. Cystometric bladder capacity was decreased in 89.2%of patients that did not improve clinically with anticholinergics (p=0.01). Detrusor overactivity was urodynamically demonstrated in 51% of cases (p=0.05) among patients without clinical improvement with anticholinergic treatment. This hyperactivity was demonstrated during early bladder filling (<100ml). Urodynamic stress urinary incontinence (SUI) was demonstrated in 26.5% of patients without clinical improvement after treatment (p=0.04). Lower urinary tract obstruction was urodynamically demonstrated in 20.6% of patients with no clinical improvement (p=0.05). Urodynamic data did not demonstrate a relationship between detrusor overactivity, a high-grade cystocele ( 37.4% of total), and irregular bladder morphology (11.5% of total). CONCLUSIONS: It is important to conduct urodynamic study before starting anticholinergic treatment of females with urinary incontinence to identify therapeutic data of poor prognosis, such as SUI and lower urinary tract obstruction, thus optimizing the therapeutic efficacy of anticholinergics.

Idiopathic thrombosis of the superficial scrotal veins (Mondor's disease) during the postoperative period of an umbilical herniorraphy.

OBJECTIVE: Mondor's disease is a superficial thrombophlebitis and usually occurs in the anterior and lateral chest. The scrotal vein thrombosis is a fairly rare disease. METHODS: Thirty-four year old male who consulted for inguinal tumor and pain in the postoperative period of an umbilical hernia repair, which resulted in a subsequent scrotal vein thrombosis treated conservatively. RESULTS: It was resolved with conservative treatment, with recanalization of the scrotal veins. CONCLUSION: Mondor's disease is a rare entity, related to multiple etiological factors. The diagnosis is made easily with Doppler ultrasound and most resolve with conservative treatment.

[The impact of COVID-19 on urology restructuring and organization.] / Impacto de la COVID-19 sobre la reestructuración y organización en urología.

Desde que el 31 de diciembre de 2019, se informó el primer caso de neumonía de etiología desconocida en la ciudad de Wuhan (China), la humanidad desconocía cómo iba a cambiar la vida tal cual la conocíamos y los profundos cambios que se iban a suscitar. La Organización Mundial de la Salud (OMS) el 12 de enero de 2020 reporta una nueva cepa de coronavirus que causaba el Síndrome Respiratorio Agudo Severo CoronaVirus 2 (SARS-CoV-2) (1) caracterizado por un cuadro clínico que variaba desde el portador asintomático hasta casos mortales de neumonía, insuficiencia respiratoria y fallo multiorgánico...

Desde que el 31 de diciembre de 2019, se informó el primer caso de neumonía de etiología desconocida en la ciudad de Wuhan (China), la humanidad desconocía cómo iba a cambiar la vida tal cual la conocíamos y los profundos cambios que se iban a suscitar. La Organización Mundial de la Salud (OMS) el 12 de enero de 2020 reporta una nueva cepa de coronavirus que causaba el Síndrome Respiratorio Agudo Severo CoronaVirus 2 (SARS-CoV-2) (1)caracterizado por un cuadro clínico que variaba desde el portador asintomático hasta casos mortales de neumonía, insuficiencia respiratoria y fallo multiorgánico...

[Urodynamic AUR in Guillain-Barré syndrome post-infection by coronavirus Sars-CoV-2. A bibliographic review.] / Urodinámica de la RAO en el síndrome De Guillain-Barré post-infección por coronavirus Sars-Cov-2. Revisión bibliográfica.

INTRODUCTION AND OBJECTIVE: The SARS-CoV-2 coronavirus infection has beenassociated with the development of the novo genitourinarysymptoms and neurological symptomssecondary to peripheral nervous system damage.One of the neurological pathologies described associatedwith the infection has been Guillain-Barrésyndrome (GBS). We conducted a review of the literatureon SARS-CoV-2 infection and its relationshipwith lower urinary tract symptoms (LUTS), such asurinary retention (AUR). Bladder alterations derivedfrom neurological involvement by SARS-CoV-2,such as GBS, were also analyzed. An own case ispresented. MATERIAL AND METHODS: A literature searchwas performed using a combination of keywords(MeSH terms): "COVID", "COVID-19", "SARS-CoV-2","Urinary retention" and "Guillain-Barre Syndromeand Urodynamics". We searched for articles publishedup to March 2021. All articles identified fromthe bibliographic search were analyzed, using thePICOS criteria (participants, intervention, comparisons,results, type of study) to assess the eligibilityof the articles. Both prospective and retrospectivestudies, clinical cases and published systematicreviews were included. RESULTS: Findings in the academic literatureabout the associations between COVID-19 and RAO,LUTS and Guillain-Barré Syndrome are discussed,as well as their possible pathogenic mechanisms,A summary of relevant studies on urodynamic findingsin GBS patients is also provided. The resultsare summarized in attached tables. A case of AURassociated with COVID-19 and Guillain-Barré Syndromeis provided, with its urodynamic findings. CONCLUSION: Although the association betweenurinary symptoms and SARS-CoV-2 is not well described,there seems to be evidence of a possibleassociation, at least temporary, between the presentationof SARS-Cov-2 infection and the developmentof GBS with secondary LUT neurophysiologyalterations.

INTRODUCCIÓN Y OBJETIVO: La infecciónpor coronavirus SARS-CoV-2 se ha asociadoa la aparición de síntomas genitourinarios de novo,además de síntomas neurológicos secundarios al dañodel sistema nervioso periférico. Una de las patologíasneurológicas descritas asociadas a la infección ha sidoel síndrome de Guillain-Barré (SGB). Realizamos unarevisión de la literatura sobre la infección por SARSCoV-2 y su relación con los síntomas del tracto urinarioinferior (STUI), como la retención urinaria (RAO).Se analizaron también las alteraciones vesicales derivadasde la afectación neurológica por SARS-CoV-2,como el SGB. Se presenta un caso propio. MATERIAL Y MÉTODOS: Se realizó una búsquedade la literatura utilizando una combinación de palabrasclave (términos MeSH): "COVID", "COVID-19","SARS-CoV-2", "Urinary retention" y "Guillain-BarreSyndrome and Urodynamics". Se realizaron búsquedasde artículos publicados hasta marzo de 2021. Todos los artículos identificados a partir de la búsquedabibliográfica fueron analizados, utilizando los criteriosPICOS (participantes, intervención, comparaciones,resultados, tipo de estudio) para evaluar la elegibilidadde los artículos. Se incluyeron tanto estudios prospectivos,retrospectivos, casos clínicos y revisiones sistemáticaspublicadas. RESULTADOS: Se discuten los hallazgos en la literaturade las asociaciones entre COVID-19 y RAO, STUIy Síndrome de Guillain-Barré, así como sus posiblesmecanismos patogénicos. También se aporta un resumende trabajos relevantes sobre hallazgos urodinámicosen pacientes con SGB. Los resultados seresumen en tablas anexas. Se aporta un caso de RAOasociado a COVID-19 y Síndrome de Guillain-Barrécon sus hallazgos urodinámicos. CONCLUSIÓN: A pesar de la asociación entre síntomasurinarios y SARS-CoV-2 no está bien descrita, pareceque hay indicios de una posible asociación, al menostemporal entre la presentación de infección porcoronavirus SARS-Cov-2 y el desarrollo de un SGB conalteraciones de la neurofisiología del TUI secundaria.

[Prevalence and risk factors for lower urinary tract symptoms after robotic sacrocolpopexy.] / Prevalencia y factores de riesgo de síntomas del tracto urinario inferior post sacrocolpopexia robótica.

OBJECTIVES: To analyse the outcomes of Robotic Sacrocolpopexy (RSC) on resolution of Lower urinary tract Symptoms (LUTS) associated to pelvic organ prolapses (POP) and to determine the risk factors for preoperative LUTS presence. MATERIAL AND METHODS: A longitudinal study was carried out on 51 females mean aged (± standard deviation) 66 ± 9 years, who underwent RSC. A preoperative evaluation was made on the degree and type of POP, and the presence of the LUTS stress urinary incontinence (SUI), urgency and voiding difficulty. An urodynamic study was also performed. The presence of LUTS was evaluated again six months after being operated on. The statistical test used were the Mcnermar test for dependent variables, the Fisher's exact test and the t Student's mean comparison test. The signification level was set at p < 0.05 bilaterally. RESULTS: A significate decrease of postoperative SUI and voiding difficult was observed. However, urgency did not significantly diminish. Transobturatice free-tension mesh ( TOT) implementation in patients with evident or occult (with POP reduction) urodynamic SUI significantly decreased the prevalence of symptomatic SUI. The only significate risk factor was the preoperative presence of urgency regarding its postoperative prevalence. CONCLUSIONS: Robotic sacrocolpopexy significantly improves postoperative voiding difficult. TOT implement in patients with positive POP reduction test is useful to prevent postoperative symptomatic SUI.

OBJETIVOS: Analizar los resultados de la sacrocolpopexia laparoscópica (LSC) robótica en la resolución de los síntomas funcionales del tracto urinario inferior (LUTS) asociados a los prolapsos pélvicos (POP) y determinar los posibles factores de riesgo para la presencia de LUTS postoperatorios.MATERIAL Y MÉTODOS: Se realizó un estudio longitudinal de 51 mujeres de edad media (± desviación típica) 66 ± 9 años intervenidas de LSC robótica por POP. Preoperatoriamente se evaluó el grado y tipo de POP, la presencia de los LUTS incontinencia urinaria de esfuerzo (SUI), y urgencia y dificultad miccionales, y se realizó un estudio urodinámico. A los 6 meses de la cirugía se volvió a evaluar la presencia de LUTS. Los test estadísticos utilizados fueron el test de Mcnemar para variables dependientes y el test exacto de Fisher y la prueba de comparación de medias de la t de Student para variables independientes. El nivel de significación se fijó en p < 0,05 bilateral. RESULTADOS: Se comprobó una disminución postoperatoria significativa de la SUI y la dificultad miccional, pero no de la urgencia miccional. La implantación de una malla transobturatiriz (TOT) en pacientes con incontinencia de esfuerzo urodinámica evidente o Post reducción del POP (incontinencia de esfuerzo oculta) disminuyo significativamente la prevalencia de SUI sintomática postoperatoria. El único factor de riesgo significativo fue la presencia preoperatoria de urgencia miccional respecto a la prevalencia postoperatoria de ese LUTS. CONCLUSIONES: La LSC robótica mejora significativamente la dificultad miccional preoperatoria. La implantación de un TOT en pacientes con test de reducción del POP positivo es útil para prevenir la SUI sintomática postoperatoria.

[High dynamic risk cystoceles]. / Cistoceles de alto riesgo urodinamico.

OBJECTIVES: To assess the bladder compliance in a series of cystoceles referred for urodynamic study. METHODS: Retrospective study of a series of patients with cystocele undergoing medical history, videurodynamic study, pelvic MRI and lower urinary tract, urological ultrasound and cystoscopy. We Excluded cases with neurogenic dysfunction and urinary infection. The terminology followed the criteria of the ICS, if not specified otherwise. The series includes 3333 cases of cystocele 616 of which are grade III cystocele. There were 3 cases with low bladder compliance; this is 0.0009% of total (1:1000) and 0.5% of grade III cystocele (1:200) RESULTS: All cases of cystocele whith low compliance were associated with feeling of a bulk in the vagina and functional symptoms of lower urinary tract(LUTS). No urinary incontinence was related to cough. These patients also showed urodynamic alterations in the voiding phase, type hypo / acontractile detrusor and postvoid residual. The patients were subjected to various techniques of abdominal and transvaginal cystocele repair (with preventive anti-incontinence surgery), getting a vagina bulk disappearance, improvement of symptoms of lower urinary tract function, normalization of bladder compliance and detrusor contractility, with elimination of the postvoid residual. CONCLUSIONS: Although they are not frequent, high-risk cystoceles should be discarded in high-grade cystocele that apart from low bladder accommodation, have a hipo/acontractile detrusor and postvoid residual. Surgical correction of cystocele not only reduces the bulk and LUTS, but normalizes urodynamic alterations.

[Correlation of bladder thickness on ultrasound with clinical and urodynamic data in symptomatic benign prostatic hyperplasia]. / Correlación del grosor ecográfico vesical con los datos clínicos y urodinámicos en la hiperplasia benigna de próstata (HBP) sintomática.

OBJECTIVES: Our objective is to verify the diagnostic usefulness of ultrasound measurement of the thickness of the bladder wall, and the correlation with clinical/ urodynamic findings in patients with symptomatic BPH. METHODS: We performed a prospective cross-sectional study (cross-sectional study '') in a series of 74 males (age chi= 72.4 S = 7.1 (56-84 years) with symptomatic BPH. Patients completed the IPSS and determined the plasma level of PSAt (ng / ml). Before performing the urodynamic study, was determined by transabdominal ultrasonography (3.5 MHz transducer): prostate volume (cc) by the ellipsoid formula, and bladder wall thickness (mm) measured on the anterior bladder wall. Statistical analysis was performed using ANOVA, the Pearson correlation, and ROC curve. RESULTS: It was a significant correlation of the sonographic thickness of the bladder wall with the IPSS (p = 0001, r = 0.38) (parameter in turn highly correlated with prostate volume and PSA (p = 0.01, r = 0.62)), as well as the detrusor hyperactivity (p = 0.03, r =0.21), cut off ROC curve: 3.85 mm. Instead, it was not shown a significant correlation between the sonographic thickness of the bladder wall and the urodynamic diagnosis of obstruction (Abrams and number Griffths p = 0223, r = 0.14) or the detrusor contractile power, measured in power at peak flow (Pw) (p = 0642 r =- 0.55), nor with age (p = 0303, r = 0.12). Neither correlation was observed with other non-invasive urodynamic measures (the maximum urinary flow flowmetry (p = 0318, r = 0.12) and percentage postmicturition residual (p = 0696, r = 0.05)). CONCLUSIONS: The ultrasound measurement of bladder wall thickness, although it has not proved useful ness in our series in the diagnosis of the voiding phase (lower urinary tract obstruction and detrusor contractility impairment), on the contrary it can be introduced as a diagnostic technique for non-invasive studies in the alterations of the filling phase, in the form of detrusor hyperactivity in also patients with symptomatic BPH, and present a significant correlation with prostate growth.

Renal capsule leiomyoma: case report.

OBJECTIVE: We present a case of leiomyoma of the renal capsule in a 49 year-old woman that was detected incidentally during an abdominal study for gastroesophageal reflux. We discuss the clinical, radiological and pathological diagnosis of renal leiomyoma as well as its treatment alternatives. METHODS: Ultrasonography, CT and MRI were performed. A conventional pathological analysis including immunohistochemistry was performed after radical nephrectomy. RESULTS: Ultrasonography detected a solid hypoechoic mass poorly vascularized in the upper pole of the right kidney. CT and MRI detected a well-delimited mass showing soft tissue density without extension to the neighbor structures and without lymphadenopathies. Radical nephrectomy was performed. Microscopically, the mass was made of a low-grade fusocellular proliferation with cells staining with antibodies against smooth muscle markers. The mass was in continuity with the renal capsule and compressed slightly the renal parenchyma without damaging it. CONCLUSIONS: Renal leiomyomas are unfrequent benign tumors that should be suspected in young and middle aged women showing asymptomatic, well delimited and hypoechoic renal tumors with soft tissue density in CT scans. When vascular structures are not involved by the tumor, a conservative surgical intervention could be the first therapeutic option. Microscopically, renal leiomyomas are low-grade fusocellular tumors showing a smooth muscle immunohistochemical profile.

Large study (283 women) on the effectiveness of Manosar®: 2 g of d-mannose + 140 mg of proanthocyanidins (PAC), of prolonged release. / Amplio estudio (283 mujeres) sobre la eficacia de Manosar®: 2 g de d-manosa + 140 mg de proantocianidinas (PAC), de liberación prolongada frente a 240 mg de PAC de liberación prolongada en la prevención a 6 meses por vía oral de las infecciones urinarias recurrentes.

OBJECTIVE: To compare the efficacy and safety in the prophylasis of urinary tract infections (UTIs) with a food supplement that contains D-mannose like active ingredient (Manosar®), in comparison to another preparation in which the active ingredient are the proanthocyanidins (PAC), both of them, in prolonged released, after, they was administered for 24 weeks. METHODS: A multicenter, randomized and double blind experimental study was carried out. 283 women with a history of recurrent UTIs without evidence of complication were included. They were randomized 1: 1 in two groups. In one group, 1 oral sachet of Manosar® a day was administered, and in the other group 1 oral sachet of a compound of 240 mg of continuous-release PAC. Prior to inclusion in the study, the episode of UTI was confirmed at least by the clinical symptoms and positivity of the Combur test. RESULTS: Valid data were obtained from 184 patients with an average age of 49.5 years: 90 received Manosar® and 94 isolated PAC. A total of 72 patients suffered an UTI due to E.coli: 25 patients in the arm with Manosar® versus 47 patients in the isolated PAC group, this difference being statistically significant (p=0.002). The free time of new UTI recurrences was 98.6 days in the group treated with Manosar® and 84.6 days in the group with isolated PAC. CONCLUSION: The oral taking of a daily sachet of Manosar® is effective and safe in preventing recurrent UTIs in women, being superior to the oral taking of isolated PAC.

OBJETIVO: Comparar la eficacia y seguridad de la profilaxis de las infecciones del tracto urinario (ITUs) con un complemento alimenticio que contiene D-manosa como principio activo principal (Manosar®), en comparación con otro preparado cuyo principio activo único son las proantocianidinas (PAC), ambos de liberación continuada, tras su administración durante24 semanas.MÉTODOS: Estudio experimental multicéntrico, aleatorizado y doble ciego. Se incluyeron 283 mujeres con historia de ITUs recurrentes sin evidencias de complicación. Se randomizaron 1:1 en dos grupos. En un grupo se administró 1 sobre diario oral de Manosar®, y en el otro 1 sobre diario oral de un compuesto de 240 mg de PAC de liberación continuada. Previo a la inclusión en el estudio se confirmó el episodio de ITU al menos por la sintomatología clínica y positividad del test de Combur. RESULTADOS: Se obtuvieron datos válidos de 184 pacientes con edad media de 49,5 años: 90 recibieron Manosar® y 94 PAC aislado. Un total de 72 pacientes padecieron una ITU por E.coli: 25 pacientes en el brazo con Manosar® frente a 47 pacientes en el grupo de PAC aislado, siendo esta diferencia estadísticamente significativa (p=0,002). El tiempo libre de nuevas recurrencias de ITU fue de 98,6 días en el grupo tratado con Manosar® y de 84,6 días en el grupo con PAC aislado.CONCLUSIÓN: La toma oral de un sobre al día de Manosar® es eficaz y segura en la prevención de las ITUs recurrentes en la mujer, siendo superior a la toma oral de PAC aislado.

Physical exam in the evaluation of bladder pain syndrome (BPS): A key component for differential diagnosis. / La exploración física en la evaluación del síndrome de dolor vesical (SDV): un importante elemento para la orientación terapéutica.

OBJECTIVES: To describe in more detail the usual clinical practice regarding physical examination (PE) in Bladder Pain Syndrome (BPS) and to evaluate if the performance of PE relates to changes in severity of symptoms and in Health Related Quality of Life (HRQoL). MATERIAL AND METHODS: Epidemiological, observational, national and multicentric study that included 319 patients with BPS (79 of new diagnosis and 240 in follow-up). Demographic and clinical data were collected. The diagnostic study was performed according to the usual clinical practice, including as the case: PE and biopsy. The patients completed the "Bladder Pain/Interstitial Cystitis Symptom Score" (BPIC-SS) and "EuroQoL-5D-5L" (EQ-5D-5L) questionnaires. To describe the continuous variables, the mean, standard deviation (SD) and quartiles analyzed were used, and for categorical variables, number and percentage of patients by response category. The questionnaires' results were described according to the visual analog scale (VAS). Health status was evaluated in patients with myofascial pain. RESULTS: PE was performed in 296 cases. 28.4% of the patients presented pelvic myofascial pain. The variation of the BPIC-SS score in the explored patients was 7.77 points, compared to 1.73 in the unexplored ones. The variations in EQ-5D-5L were 0.13 and 0.04 points, respectively. CONCLUSIONS: Myofascial involvement was observed in 28.4% of the 296 cases of BPS who receiveda PE. It is important to implement a systematic, comprehensive method of PE at the national level in order to achieve a more precise characterization of BPS and a better evolution of the patient's symptoms and HRQoL.

OBJETIVOS: Conocer en mayor detalle la práctica clínica habitual de la exploración física (EF) del Síndrome de Dolor Vesical (SDV) y evaluar los cambios en síntomas y Calidad de Vida Relacionada con la Salud (CVRS) según los resultados de la EF.MATERIAL Y MÉTODOS: Estudio epidemiológico, observacional, nacional y multicéntrico que incluyó 319 pacientes con SDV (79 de nuevo diagnóstico y 240 en seguimiento). Se recogieron datos demográficos y clínicos. El estudio diagnóstico se realizó según práctica  clínica habitual, incluyendo según el caso: EF y biopsia. Las pacientes cumplimentaron los cuestionarios "BladderPain/Interstitial Cystitis-Symptom Score" (BPIC-SS) y "EuroQoL-5D-5L" (EQ-5D-5L). Para describir las variables continuas se utilizaron la media, desviación estándar (DE) y cuartiles analizados y para las cualitativas, el número y porcentaje de pacientes por categoría de respuesta. Los resultados de los cuestionarios se describieron según la escala visual analógica (EVA). Se evaluó el estado de salud en pacientes con dolor miofascial. RESULTADOS: Se realizó EF en 296 casos. El 28,4% de los pacientes presentaban dolor miofascial. La variación de la puntuación BPIC-SS en los pacientes explorados fue de 7,77 puntos, en comparación con los 1,73 en los no explorados. Las variaciones en EQ-5D-5L fueron 0,13 y 0,04 puntos, respectivamente. CONCLUSIONES: La implicación miofascial se observó en el 28,4% de los 296 casos de SDV sometidos a EF. Es importante implementar un método sistemático e integral de EF a nivel nacional para lograr una caracterización más precisa del SDV y una mejor evolución de los síntomas y CVRS del paciente.

[Urodynamic evaluation in prostate cancer patients with urinary incontinence]. / Valoración urodinámica en el cáncer de próstata con incontinencia.

OBJECTIVES: Update on the urodynamic evaluation in patients with prostate cancer who have incontinence. METHODS: To review the urodynamic studies in prostate cancer patients who suffer from incontinence, irrespective of the treatment carried out. RESULTS: The largest amount of information on urodynamic studies in patients with prostate cancer and incontinence was found in those with post-prostatectomy incontinence. There is much more limited work on irradiated patients, and after medical treatment. CONCLUSION: The urodynamic study in these patients may help clarify the etiopathogenic mechanisms of incontinence, try to predict risk factors before treatment and help the therapeutic decision making. Further studies are needed, especially in patients undergoing radiotherapy, to further assess the mechanisms involved in lower urinary tract abnormalities that occur in these patients.

[Functional changes during the voiding phase in males with non-neurogenic detrusor underactivity undergoing bladder catheterization.] / Cambios funcionales en la fase miccional de varones diagnosticados de detrusor hipoactivo no neurogénico sometidos a cateterización vesical.

OBJECTIVES: To investigate urodynamic changes during the voiding phase in males with detrusor underactivity (DU) undergoing bladder catheterization for urinary retention. METHODS: From a total of 64 patients with urinary retention, a follow-up study was performed in 17 males with a mean age of 77 years. Patients received a urodynamic diagnosis of DU based on a Bladder Contractility Index (BCI) score of < 100 and underwent permanent bladder catheterization (16 cases) or clean intermittent catheterization (1 case) for acute urinary retention (14 cases), or post void residual urine (3 cases). Patients underwent a second urodynamic study after a mean 13 months of follow-up. Fisher's exact test was used with categorical variables and Student's t test with parametric variables. The level of significance was set at p < 0.05 for a two-sided test. RESULTS: The second urodynamic study showed a significant increase in maximal detrusor pressure, pressure at maximum flow rate, BCI score, Bladder Outlet Obstruction Index (BOOI) score, and number of patients who urinated during the pressure-flow study. CONCLUSIONS: Bladder catheterization in men with DU significantly improves bladder contractility and revealed obstructions of the lower urinary tract that were masked by insufficient detrusor pressure in relation to the DU of these patients. These findings could have diagnostic as well as prognostic and therapeutic applications.

OBJETIVOS: Determinar los cambios urodinámicos de la fase miccional en varones con hipocontractilidad del detrusor (DU) sometidos a cateterismo vesical por retención urinaria. MÉTODOS: De un total de 64 pacientes con retención urinaria, se realizó un estudio de seguimiento en 17 varones de edad media 77 años, diagnosticados urodinámicamente de DU por presentar un Índice de Contractilidad Vesical (BCI) menor de 100, sometidos a sonda vesical a permanencia (16 casos) o cateterismo vesical limpio intermitente (1 caso) por retención aguda de orina (14 casos), o residuo postmiccional patológico (3 casos). Los pacientes fueron sometidos a un segundo estudio urodinámico a los 13 meses de seguimiento de media. Las pruebas estadísticas utilizadas fueron el test exacto de Fisher para variables cualitativas y el test de comparación de media de la t de Student para variables paramétricas. El nivel de significación se fijó en p < 0,05 bilateral. RESULTADOS: En el segundo estudio urodinámico, se observó un aumento significativo de la presión máxima del detrusor, la presión a flujo máximo, el BCI y el Índice de Obstrucción de Salida Vesical (BOOI) y del número de pacientes que orinaron durante el estudio presión/ flujo. CONCLUSIONES: El cateterismo vesical en varones con DU mejora significativamente la contractilidad vesical y permiten desenmascarar obstrucciones del tracto urinario inferior que estaban ocultas por una insuficiente presión del detrusor en relación a la DU de estos pacientes. Esto podría tener no sólo aplicaciones diagnósticas, sino pronósticas y terapéuticas.

[Clinical and urodynamic risk factors of recurrent urinary tract infections in patients with multiple sclerosis.] / Factores de riesgo clínicos y urodinámicos de infecciones urinarias recurrentes en pacientes con esclerosis múltiple.

OBJECTIVES: To determine the risk factors of recurrent urinary infections (rUTIs) in patients with Multiple Sclerosis (MS). METHODS: A retrospective cohort study was conducted including 114 patients with MS, 84 women (74%) and 30 men (26%), with a mean age of 49. They underwent videourodynamic study and selective sphincter electromyography due to urinary symptoms (LUTS). Clinical data (both neurological and urological) and videourodynamic data (including free flowmetry, cystomanometry and pressure flow study) were collected. In 37 patients (32%), the presence of rTUIs was demonstrated. RESULTS: Statistically significant differences were demonstrated between the patients with and without rUTIs with respect to the following clinical variables: the time of evolution of the symptoms (greater in the case of rUTIs), time from the diagnosis of MS (higher in the case of rUTIs), EDSS score (Expanded Disability Staus Scale) (higher in the case of rUTIs) and the EM type [higher frequency of rUTIs in the progressive types (primary and secondary)]. Urodynamic variables with significant differences were: maximum flow in free flowmetry (lower in patients with rUTIs), voiding volume in free flowmetry (lower in patients with rUTIs), micturition efficiency (higher percentage of residual urine in patients with rUTIs), stress urinary incontinence (SUI) (higher frequency of rUTIs in patients with SUI), detrusor pressure at maximum flow (lower in patients with rUTIs) and bladder contractility index (lower in patients with rUTI). No significant difference was demonstrated in relation to the presence and type of neurogenic lower urinary tract dysfunction (NLUTD). CONCLUSIONS: The severity and duration of MS is a risk factor for rUTIs. Urodynamic risk factors are compatible with a lower contractile capacity in patients with rUTIs, while the existence of NLUTD would not imply any specific risk factor.

OBJETIVO: Determinar los factores de riesgo de infecciones urinarias recurrentes (rUTIs) en pacientes con Esclerosis Múltiple (EM).MÉTODOS: Se realizó un estudio de cohortes retrospectivo en 114 pacientes, 84 mujeres (74%) y 30 varones (26%), de edad media 49 años con EM sometidos a estudio videourodinámico y electromiografía selectiva esfinteriana por presentar síntomas urinarios (LUTS). Se recogieron los datos clínicos (tanto neurológicos como urológicos) y videourodinámicos (incluyendo flujometría libre, cistomanometría y estudio presión flujo). En 37 pacientes (32%) se demostró la presencia de rTUIs. RESULTADOS: Se demostraron diferencias estadísticamente significativas entre los pacientes con y sin rUTIs respecto de las siguientes variables clínicas: el tiempo de evolución de los síntomas (mayor en el caso de rUTIs), antigüedad de la EM (mayor en el caso de rUTIs), la puntuación EDSS (Expanded Disability Staus Scale) (mayor en el caso de rUTIs) y el tipo EM [mayor frecuencia de rUTIs en los tipos progresivos (primario y secundario)]. Las variables urodinámicas con diferencias significativas fueron: el flujo máximo en la flujometría libre (menor en pacientes con rUTIs), el volumen miccional en la flujometría libre (menor en pacientes con rUTIs), la eficiencia miccional (mayor porcentaje de residuo en pacientes con rUTIs), la incontinencia urinaria de esfuerzo (SUI) (mayor frecuencia de rUTIs en pacientes con SUI), la presión del detrusor a flujo máximo (menor en pacientes con rUTIs) y el índice de contractilidad vesical (menor en pacientes con rUTI). No se demostró ninguna diferencia significativa en relación con la presencia y tipo de disfunción neurógena del tracto urinario inferior (NLUTD). CONCLUSIONES: La gravedad y duración de la EM constituye un factor de riesgo para las rUTIs. Los factores de riesgo urodinámicos son compatibles con una menor capacidad contráctil en los pacientes con rUTIs, mientras que la existencia NLUTD no supondría ningún factor de riesgo específico.