Indicaciones de estudio urodinámico / Indications of urodynamic study

The basic objective of urodynamics is to reproduce the patient's symptoms while evaluating the lower urinary tract directly, with objective quantification of parameters, correlating the symptoms with the findings of the test. Traditionally, it is used: a) to diagnose lower urinary tract dysfunction, quantify its severity and determine the most significant abnormality, b) to predict the consequences of lower urinary tract dysfunction on the upper urinary tract, c) to predict the results of therapeutic interventions and possible complications and d) to investigate the causes of treatment failures. In this article we will refer to the indications of urodynamics taking into account the recommendations of the main international urological societies: 1) in women with urinary incontinence, with emphasis on those who have stress urinary incontinence and who will undergo surgery, 2) in men with non-neurogenic lower urinary tract symptoms suggestive of benign prostatic hyperplasia, and 3) in patients with neurologic involvement of the lower urinary tract ("neurogenic bladder"), considering the classification of neurological disorders according to the risk over the upper urinary tract. (AU)

Evaluación clínica del paciente con síntomas del tracto urinario inferior / Clinical evaluation of the patient with lower urinary tract symptoms

Lower urinary tract symptoms are divided into three groups, storage, voiding and post micturition symptoms. Their level of agreement with urodynamic investigation is poor. Clinicalhistory should be complemented by the application of validated symptom questionnaires and the recording of urinary events. Here we refer to: a) the International Consultation onIncontinence Questionnaire, Short Form (ICIQ-SF), b) the Urogenital Distress Inventory - Short Form (UDI-6) and Incontinence Impact Questionnaire – Short Form (IIQ-7), c) the urinary incontinence Severity Index and d) the American Urological Association Symptom Index. The recordings of urinary events can be done in three main forms: a) micturition time chart, b)frequency volume chart, and c) bladder diary. The International Consultation on Incontinence Questionnaire bladder diary (ICIQ bladder diary) is the only one validated. Physical exam should include abdominal and genital examination, covering pelvic organ prolapse quantification in women, prostate evaluation in men, pelvic floor muscle function evaluation in both genders, and a neurologic examination focused on evaluation of the sacral nerves. It is useful to supplementthe physical examination with the evaluation of the mobility of the bladder neck and proximal urethra through the Q-tip test, and with the quantification of urine leakage through the pad test.

Teste do vermelho congo com estimulo pela insulina para avaliacao da integralidade vagal apos vagotomia. / Congo red test with insulin stimulation for evaluation of vagal integrity after vagotomy

Os autores propoem um metodo para a avaliacao da integralidade vagal apos vagotomia, baseado nas propriedades tintoriais do indicador de pH vermelho congo. O metodo consiste na realizacao do teste de Hollander com injecao intravenosa de 0,2-0,3U de insulina por kg de peso (nao ultrapassando 20U). Imediatamente apos completar o teste de Hollander (120 min apos a injecao da insulina), com a glicemia em niveis iguais ou inferiores a 50 mg%, a mucosa gastrica e endoscopicamente tinta com vermelho congo. Nas areas com pH abaixo de 3,4 (niveis estabelecidos para viragem do vermelho congo a 1% de diluicao), a mucosa aparece corada em negro, denotando acao mediada pelo vago em funcao do estimulo hipoglicemico induzido pela insulina, por tanto, fibras vagais gastricas intactas.Esse teste foi empregado em l0 pacientes submetidos a vagotomia troncular e operacao de drenagem, por ulcera duodenal, ha mais de 5 anos. Observamos em 6 pacientes areas tintas em negro, denotando vagotomia incompleta. Comparando com outros metodos para avaliacao da vagotomia, o teste do vermelho congo com estimulo hipoglicemico induzido pela insulina mostrou-se mais sensivel