¿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)

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.

Evaluación de la función cognitiva en pacientes de edad avanzada con vejiga hiperactiva tratados con oxibutinina transdémica / Cognitive function assessment in elderly patients with overactive bladder treated with transdermal oxybutynin

Introducción y objetivos: Los pacientes mayores con vejiga hiperactiva bajo tratamiento antimuscarínico son especialmente susceptibles al deterioro cognitivo. El objetivo fue evaluar los cambios a corto plazo en la función cognitiva de pacientes de edad avanzada con vejiga hiperactiva tratados con oxibutinina transdérmica. Materiales y métodos: Estudio observacional retrospectivo multicéntrico en pacientes entre 65 y 80 años de edad, con vejiga hiperactiva, que reciben tratamiento con oxibutinina transdérmica. Antes y después de un mes de tratamiento, se evaluó la función cognitiva mediante el test de alteración de memoria y el test del dibujo del reloj, los cambios en los síntomas con cuestionarios validados, la percepción del paciente ante su respuesta al tratamiento utilizando la escala de beneficio del tratamiento y la adherencia al tratamiento con el test de Morisky-Green modificado. Resultados: De 85 pacientes elegibles, 70 completaron la evaluación (promedio de edad: 71,4 ± 4,5; IMC: 28,7 ± 3,1 kg/m2). No se observó deterioro cognitivo tras un mes de tratamiento con oxibutinina transdérmica: Test de alteración de memoria (+1 punto; IC 95%: 0-1,5), test del dibujo del reloj (0 puntos; IC 95%: 0-0). Se observó una mejoría estadísticamente significativa (p < 0,001) en todos los síntomas de almacenamiento urinario, excepto en la incontinencia de esfuerzo. Hubo una mejora en el cuestionario de autoevaluación de control de la vejiga (grado de los síntomas: -2,27; IC 95%: -2,8, -1,7; p < 0,001; grado de molestias: -2,73; IC 95%: -3,3, -2,1; p < 0,001). El 70% de los pacientes informaron una condición de vejiga estable o mejorada según el cuestionario de Percepción de la Condición de la Vejiga del Paciente. El 72,8% de los pacientes informó que sus problemas urinarios habían mejorado o mejorado notablemente con un 84,3% de adherencia al tratamiento. Conclusiones: No se observó deterioro cognitivo en pacientes de edad avanzada tras de un mes de tratamiento con oxibutinina transdérmica. Los síntomas de incontinencia urinaria mejoraron y hubo una adecuada adherencia al tratamiento

Introduction and objectives: Older patients with overactive bladder under antimuscarinic treatment are especially susceptible to cognitive impairment. The aim was to assess short term changes in cognitive function in elderly patients with overactive bladder treated with transdermal oxybutynin. Materials and methods: Observational, retrospective, multicentre study in patients with overactive bladder aged 65-80 years undergoing treatment with transdermal oxybutynin. Before and after one month of treatment, cognitive function using the Memory Alteration Test and Clock-Drawing Test, changes in symptoms with validated questionnaires, patient perception of treatment response using Treatment Benefit Scale and treatment adherence with the modified Morisky-Green test, were assessed. Results: From 85 eligible patients, 70 completed the assessment (mean age: 71.4 ± 4.5; BMI: 28.7 ± 3.1 kg/m2). No cognitive impairment was observed after one month with transdermal oxybutynin: Memory Alteration Test (+1 point; 95%CI: 0.0-1.5), Clock-Drawing Test (0 points; 95%CI: 0.0-0.0). A statistically significant improvement (p < 0.001) was observed in all urinary storage symptoms, except stress urinary incontinence. There was an improvement in the Bladder Control Self-Assessment Questionnaire (symptom score: -2.27; 95%CI: -2.8, -1.7; p < 0.001; bother score: -2.73; 95%CI: -3.3, -2.1; p < 0.001). 70% of patients reported either a stable or improved bladder condition according to the Patient Perception of Bladder Condition questionnaire. 72.8% of patients reported that their urinary problems had improved or greatly improved with an 84.3% treatment adherence. Conclusions: No cognitive impairment was observed in elderly patients after one month of treatment with transdermal oxybutynin; urinary urgency symptoms improved and there was adequate treatment adherence

Síndrome de dolor vesical: prevalencia y práctica clínica habitual en mujeres que acuden a Unidades de Urología Funcional y Urodinámica en España / Bladder pain syndrome: Prevalence and routine clinical practice in women attending functional urology and urodynamics units in Spain

Introducción y objetivos: El síndrome de dolor vesical (SDV) está catologado como enfermedad rara y su diagnóstico representa un desafío debido al solapamiento de sus síntomas con los asociados al síndrome de vejiga hiperactiva. El objetivo fue estimar la prevalencia del SDV y conocer el perfil de síntomas y la práctica clínica en pacientes que acuden a unidades de Urología Funcional y Urodinámica. Material y métodos: Estudio epidemiológico en el cual participaron 37 unidades de Urología Funcional y Urodinámica de España. La prevalencia se estudió considerando ambos sexos. Se evaluó la práctica clínica en 319 mujeres con SDV (nuevo diagnóstico o en revisión). Se recogieron retrospectivamente datos clínicos y sociodemográficos. Se analizaron los resultados de análisis de orina, cistoscopia, biopsia, exploración física, diario miccional, así como de los 4 cuestionarios disponibles: Patient Perception of Bladder Condition; Bladder Pain/Interstitial Cystitis Symptom Score; EuroQoL-5 Dimensions-5L y Patient Global Impression of Severity. Resultados: El 5,4% (503) de los pacientes que acudieron a estas unidades (9.312) tenían diagnóstico de SDV (90% [453] mujeres). Las pruebas más realizadas según historia clínica y anamnesis fueron: análisis de orina, ecografía vesical y cistoscopia. Los síntomas/comorbilidades más frecuentes fueron: dolor en la región vesical, frecuencia miccional aumentada, nicturia, ansiedad y depresión. La evaluación diagnóstica determinó dolor en hidrodistensión (86,9%), biopsia positiva (59,2%), dolor miofascial pélvico (28,4%), fenotipo urológico (97,8%) y frecuencia miccional aumentada (88,7%). Los cuestionarios reflejaron el elevado grado de afectación de la calidad de vida de estos pacientes. Conclusiones: La prevalencia del SDV en las unidades de Urología Funcional y Urodinámica en España es baja. No se observa homogeneidad en cuanto al diagnóstico entre los diferentes centros participantes. Por ello, sería necesario establecer una metodología común de manejo de pacientes con SDV en estas unidades, con herramientas específicas para esta patología

Introduction and objectives: Bladder pain syndrome (BPS) is classified as a rare chronic debilitating disease and its diagnosis presents a challenge because its symptoms overlap with those associated with overactive bladder syndrome. The aim of the routine study was to estimate the prevalence of BPS and discover to study the profile of symptoms and clinical practice for patients attending functional urology and urodynamics units. Material and methods: An epidemiological study in which 37 functional urology and urodynamics units in Spain participated. The prevalence was studied in both sexes. Clinical practice was evaluated for 319 women with BPS (new diagnosis or under review). Clinical and sociodemographic data were collected retrospectively. The results were studied of urine tests, cystoscopy, biopsy, physical examination, bladder diary, and those of the four available questionnaires: Patient Perception of Bladder Condition; Bladder Pain/Interstitial Cystitis Symptom Score; EuroQoL-5 Dimensions-5L and Patient Global Impression of Severity. Results: Five point four percent (503) of the patients who attended these units (9,312) had a diagnosis of BPS (90% [453] females). The tests that were performed most according to the clinical history and anamnesis were: urine test, bladder ultrasound and cystoscopy. The most common symptoms/comorbidities were: pain in the bladder region, increased urinary frequency, nocturia, anxiety and depression. Diagnostic assessment determined pain on hydrodistension (86.9%), positive biopsy (59.2%), myofascial pelvic pain (28.4%), urological phenotype (97.8%), and increased urinary frequency (88.7%). The questionnaires reflected how much the quality of life of these patients was affected. Conclusions: The prevalence of BPS in functional urology and urodynamics units in Spain is low. No homogeneity was observed in terms of diagnosis between the different participating centres. Therefore, a common methodology is required for the management of patients with BPS in these units, with tools specific to this disorder

Bladder pain syndrome: Prevalence and routine clinical practice in women attending functional urology and urodynamics units in Spain. / Síndrome de dolor vesical: prevalencia y práctica clínica habitual en mujeres que acuden a Unidades de Urología Funcional y Urodinámica en España.

INTRODUCTION AND OBJECTIVES: Bladder pain syndrome (BPS) is classified as a rare chronic debilitating disease and its diagnosis presents a challenge because its symptoms overlap with those associated with overactive bladder syndrome. The aim of the routine study was to estimate the prevalence of BPS and discover to study the profile of symptoms and clinical practice for patients attending functional urology and urodynamics units. MATERIAL AND METHODS: An epidemiological study in which 37 functional urology and urodynamics units in Spain participated. The prevalence was studied in both sexes. Clinical practice was evaluated for 319 women with BPS (new diagnosis or under review). Clinical and sociodemographic data were collected retrospectively. The results were studied of urine tests, cystoscopy, biopsy, physical examination, bladder diary, and those of the four available questionnaires: Patient Perception of Bladder Condition; Bladder Pain/Interstitial Cystitis Symptom Score; EuroQoL-5 Dimensions-5L and Patient Global Impression of Severity. RESULTS: Five point four percent (503) of the patients who attended these units (9,312) had a diagnosis of BPS (90% [453] females). The tests that were performed most according to the clinical history and anamnesis were: urine test, bladder ultrasound and cystoscopy. The most common symptoms/comorbidities were: pain in the bladder region, increased urinary frequency, nocturia, anxiety and depression. Diagnostic assessment determined pain on hydrodistension (86.9%), positive biopsy (59.2%), myofascial pelvic pain (28.4%), urological phenotype (97.8%), and increased urinary frequency (88.7%). The questionnaires reflected how much the quality of life of these patients was affected. CONCLUSIONS: The prevalence of BPS in functional urology and urodynamics units in Spain is low. No homogeneity was observed in terms of diagnosis between the different participating centres. Therefore, a common methodology is required for the management of patients with BPS in these units, with tools specific to this disorder.

Cognitive function assessment in elderly patients with overactive bladder treated with transdermal oxybutynin. / Evaluación de la función cognitiva en pacientes de edad avanzada con vejiga hiperactiva tratados con oxibutinina transdémica.

INTRODUCTION AND OBJECTIVES: Older patients with overactive bladder under antimuscarinic treatment are especially susceptible to cognitive impairment. The aim was to assess short term changes in cognitive function in elderly patients with overactive bladder treated with transdermal oxybutynin. MATERIALS AND METHODS: Observational, retrospective, multicentre study in patients with overactive bladder aged 65-80 years undergoing treatment with transdermal oxybutynin. Before and after one month of treatment, cognitive function using the Memory Alteration Test and Clock-Drawing Test, changes in symptoms with validated questionnaires, patient perception of treatment response using Treatment Benefit Scale and treatment adherence with the modified Morisky-Green test, were assessed. RESULTS: From 85 eligible patients, 70 completed the assessment (mean age: 71.4±4.5; BMI: 28.7±3.1kg/m2). No cognitive impairment was observed after one month with transdermal oxybutynin: Memory Alteration Test (+1 point; 95%CI: 0.0-1.5), Clock-Drawing Test (0 points; 95%CI: 0.0-0.0). A statistically significant improvement (P<.001) was observed in all urinary storage symptoms, except stress urinary incontinence. There was an improvement in the Bladder Control Self-Assessment Questionnaire (symptom score: -2.27; 95%CI: -2.8, -1.7; P<.001; bother score: -2.73; 95%CI: -3.3, -2.1; P<.001). 70% of patients reported either a stable or improved bladder condition according to the Patient Perception of Bladder Condition questionnaire. 72.8% of patients reported that their urinary problems had improved or greatly improved with an 84.3% treatment adherence. CONCLUSIONS: No cognitive impairment was observed in elderly patients after one month of treatment with transdermal oxybutynin; urinary urgency symptoms improved and there was adequate treatment adherence.

Adaptación cultural al español (España) del cuestionario Overactive Bladder Family Impact Measure (OAB-FIM) / Cultural adaptation to Spanish (Spain) of the questionnaire

Objetivo: El OAB-FIM se desarrolló como una medida del impacto de la vejiga hiperactiva en los familiares que conviven con el paciente. El objetivo fue realizar la adaptación cultural al español (España) del cuestionario OAB-FIM. Métodos: La adaptación incluyó una fase de validación conceptual y lingüística, y otra de medición de las propiedades psicométricas en 25 familiares (edad media 63,0 años [DE: 14,3], siendo el 44% mujeres) con convivencia habitual con pacientes con vejiga hiperactiva, de ambos géneros y ≥18 años. Se midieron equivalencia conceptual y lingüística, fiabilidad interna, validez de constructo y validez de contenido. Se valoró la aplicabilidad y carga de administración. Resultados: El OAB-FIM fue equivalente conceptual y lingüísticamente al original, manteniendo sus 6 dominios: social, viajes, preocupación, irritabilidad, sueño y sexual. El acuerdo interjueces ubicó correctamente a todos los ítems en su dominio, excepto el 10, que se ubicó más en preocupación que en irritabilidad, motivando su reformulación. Un 2,95% de ítems estuvieron ausentes. Los efectos suelo y techo de los ítems variaron, respectivamente, entre 20-28% y 0-16%. El tiempo medio para cumplimentar el cuestionario fue de 5,2 minutos (DE: 2,8) y un 24% necesitó algún tipo de ayuda. El coeficiente α-Cronbach varió entre 0,948-0,839. Las correlaciones con escalas similares en el familiar fueron moderadas-altas (0,407-0,753) o pequeñas-moderadas con las administradas al paciente (0,004-0,423). Conclusión: Se ha obtenido una versión española (España) del OAB-FIM conceptual y lingüísticamente equivalente al original. El cuestionario ha mostrado buena consistencia interna y validez de contenido y constructo, además de ser aplicable

Objective: The OAB-FIM was developed as a measure of the impact of an overactive bladder (OAB) on relatives who live with the patient. The objective of this study was conduct a cultural adaptation to Spanish (Spain) of the OAB-FIM questionnaire. Methods: The adaptation included a conceptual and linguistic validation phase, as well as a phase for measuring the psychometric properties in 25 relatives [mean age, 63.0 years (SD, 14.3); 44% women] who regularly live with patients with OAB, who are of either sex and 18 years of age or older. We measured conceptual and linguistic equivalence, internal reliability, construct validity and content validity. We assessed the applicability and administration load. Results: The OAB-FIM was conceptually and linguistically equivalent to the original, maintaining its 6 domains: social, travel, worry, irritability, sleep and sex. The interagreement correctly placed all items in their domain, except for number 10, which was placed more in worry than in irritability, motivates its reformulation. Some 2.95% of the items were missing. The floor and ceiling effects of the items varied, respectively, between 20-28%, and 0-16%. The mean time for completing the questionnaire was 5.2minutes (SD, 2.8), and 24% of the participants required some type of assistance. The α-Cronbach coefficient varied between 0.948-0.839. The correlations with similar scales in the family were moderate-high (0.407-0.753) or small-moderate with those administered to the patient (0.004-0.423). Conclusion: We obtained a Spanish (Spain) version of the OAB-FIM that was conceptually and linguistically equivalent to the original. The questionnaire showed good internal consistency, content and construct validity and applicability

Cultural adaptation to Spanish (Spain) of the "Overactive Bladder - Family Impact Measure (OAB-FIM)" questionnaire. / Adaptación cultural al español (España) del cuestionario Overactive Bladder Family Impact Measure (OAB-FIM).

OBJECTIVE: The OAB-FIM was developed as a measure of the impact of an overactive bladder (OAB) on relatives who live with the patient. The objective of this study was conduct a cultural adaptation to Spanish (Spain) of the OAB-FIM questionnaire. METHODS: The adaptation included a conceptual and linguistic validation phase, as well as a phase for measuring the psychometric properties in 25 relatives [mean age, 63.0 years (SD, 14.3); 44% women] who regularly live with patients with OAB, who are of either sex and 18 years of age or older. We measured conceptual and linguistic equivalence, internal reliability, construct validity and content validity. We assessed the applicability and administration load. RESULTS: The OAB-FIM was conceptually and linguistically equivalent to the original, maintaining its 6 domains: social, travel, worry, irritability, sleep and sex. The interagreement correctly placed all items in their domain, except for number 10, which was placed more in worry than in irritability, motivates its reformulation. Some 2.95% of the items were missing. The floor and ceiling effects of the items varied, respectively, between 20-28%, and 0-16%. The mean time for completing the questionnaire was 5.2minutes (SD, 2.8), and 24% of the participants required some type of assistance. The α-Cronbach coefficient varied between 0.948-0.839. The correlations with similar scales in the family were moderate-high (0.407-0.753) or small-moderate with those administered to the patient (0.004-0.423). CONCLUSION: We obtained a Spanish (Spain) version of the OAB-FIM that was conceptually and linguistically equivalent to the original. The questionnaire showed good internal consistency, content and construct validity and applicability.

Diagnostic performance of power doppler and ultrasound contrast agents in early imaging-based diagnosis of organ-confined prostate cancer: Is it possible to spare cores with contrast-guided biopsy?

OBJECTIVES: To evaluate the diagnostic performance of gray scale transrectal ultrasound-B-mode US (BMUS), power Doppler (PDUS), and sonographic contrast (CEUS) in early imaging-based diagnosis of localized prostate cancer (PCa) and to compare the diagnostic profitability of randomized biopsy (RB), US-targeted prostate biopsy by means of PDUS and CEUS. MATERIAL AND METHODS: A single-center, prospective, transversal, epidemiological study was conducted from January 2010 to January 2014. We consecutively included patients who an imaging study of the prostate with BMUS, PDUS, and CEUS was performed, followed by prostate biopsy due to clinical suspicion of prostate cancer (PSA 4-20ng/mL and/or rectal exam suggestive of malignancy). The diagnostic performance of BMUS, PDUS, and CEUS was determined by calculating the Sensitivity (S), Specificity (Sp), Predictive values (PV), and diagnostic odds ratio (OR) of the diagnosis tests and, for these variables, in the population general and based on their clinical stage according to rectal exam (cT1 and cT2). PCa detection rates determined by means of a randomized 10-core biopsy scheme were compared with detection rates of CEUS-targeted (SonoVue) 2-core biopsies. RESULTS: Of the initial 984 patients, US contrast SonoVue was administered to 179 (18.2%). The PCa detection rate by organ of BMUS/PDUS in the global population was 38% versus 43% in the subpopulation with CEUS. The mean age of the patients was 64.3±7.01years (95% CI, 63.75-64.70); mean total PSA was 8.9±3.61ng/mL (95% CI, 8.67-9.13) and the mean prostate volume was 56.2±29cc (95% CI, 54.2-58.1). The detection rate by organ of targeted biopsy with BMUS, PDUS, and CEUS were as follows: Global population (10.6, 8.2, 24.5%), stage cT1 (5.6, 4.2, 16.4%), and stage cT2 (32.4, 22.3, 43.5%). Comparing the detection rates of the CEUS-targeted biopsy and randomized biopsy, the following results were obtained: Global population (24.5% vs. 41.8%), stage cT1 (16% vs. 35%), and stage cT2 (43.5% vs. 66.6%), with a p value<0.05. Following the "core-by-core" analysis, the detection rates by core of CEUS-targeted biopsy versus randomized biopsy were: Global population (16% vs. 13%), stage cT1 (30.3% vs. 28%), and stage cT2 (48% vs. 37%), with a p value>0.05. The NNT for CEUS-targeted biopsy was 83.3. CONCLUSIONS: The low sensitivity, specificity, positive predictive and negative predictive values of gray scale-B-mode, PDUS and CEUS represent scant diagnostic performance of these variables in prostate cancer detection. Prostate cancer detection rates yielded by randomized biopsy were superior than the detection rate of targeted biopsy using B-mode, PDUS and CEUS; as a result, randomized biopsy versus CEUS-targeted biopsies cannot be excluded from biopsy strategy plans for the diagnosis of prostate cancer.

OnabotulinumtoxinA en vejiga hiperactiva: Recomendaciones de consenso basadas en la evidencia / OnabotulinumtoxinA in overactive bladder: Evidence-based consensus recommendations

Objetivo: Ofrecer un conjunto de recomendaciones que sean de utilidad para aquellos urólogos que se inician en el tratamiento de la hiperactividad vesical con OnabotulinumtoxinA. Métodos: Se realizó una búsqueda bibliográfica, hasta diciembre del año 2013, y una posterior lectura crítica de las publicaciones seleccionadas. Los coordinadores elaboraron un documento que fue sometido a la revisión de los miembros del Grupo español para el uso de toxina botulínica en urología. Resultados: El grupo de expertos considera que OnabotulinumtoxinA puede ser utilizada en el síndrome de vejiga hiperactiva con incontinencia urinaria de urgencia secundaria a hiperactividad del detrusor neurógena o idiopática en los que el tratamiento conservador y médico de primera línea haya fracasado, no sea tolerado o exista contraindicación para su uso. El tratamiento en la mayoría de los casos se realiza con anestesia local intravesical, si bien también se puede realizar bajo anestesia epidural o general. Es obligatorio informar de la posibilidad de necesitar autosondaje o sondaje temporal y comprobar que serán capaces de hacerlo, si se precisa, antes de realizar el tratamiento, así como de la necesidad de efectuar una profilaxis antibiótica para disminuir el riesgo de infección urinaria. Se recomiendan al menos 2 visitas de seguimiento: a los días 7-14 tras la inyección y la segunda a los 2-3 meses. Se indicará la reinyección cuando el efecto del tratamiento disminuya. Conclusión: Estas guías pueden ayudar al clínico en su toma de decisiones diaria y limitar los potenciales riesgos asociados con el uso incorrecto de este fármaco

Objective: To offer a set of useful recommendations for urologists who are starting to provide treatment of overactive bladders with onabotulinumtoxinA. Methods: A literature search to December 2013 was conducted, as well as a subsequent critical reading of the selected publications. The coordinators prepared a document that was submitted for review by the members of the Spanish Group for the use of Botulinum Toxin in Urology. Results: The expert group considered that onabotulinumtoxinA may be used for overactive bladder syndrome with urinary urge incontinence secondary to neurogenic or idiopathic detrusor overactivity for patients for whom conservative treatment and first-line medical treatment has failed, is not tolerated or is contraindicated. Treatment in most cases was performed with local intravesical anesthesia, although it can also be performed under epidural or general anesthesia. Patients must be informed of the possibility of requiring self-catheterization or temporary catheterization. Clinicians should ensure that the patients are capable of performing this catheterization before the treatment is conducted. Patients must also be informed of the need for antibiotic prophylaxis to reduce the risk of urinary tract infections. At least 2 follow-up visits are recommended: the first at days 7-14 after the injection and the second at 2-3 months. Reinjection is indicated when the effect of the treatment decreases. Conclusion: These guidelines can help clinicians in their daily decisions and limit the potential risks associated with the incorrect use of the drug

OnabotulinumtoxinA in overactive bladder: Evidence-based consensus recommendations.

OBJECTIVE: To offer a set of useful recommendations for urologists who are starting to provide treatment of overactive bladders with onabotulinumtoxinA. METHODS: A literature search to December 2013 was conducted, as well as a subsequent critical reading of the selected publications. The coordinators prepared a document that was submitted for review by the members of the Spanish Group for the use of Botulinum Toxin in Urology. RESULTS: The expert group considered that onabotulinumtoxinA may be used for overactive bladder syndrome with urinary urge incontinence secondary to neurogenic or idiopathic detrusor overactivity for patients for whom conservative treatment and first-line medical treatment has failed, is not tolerated or is contraindicated. Treatment in most cases was performed with local intravesical anesthesia, although it can also be performed under epidural or general anesthesia. Patients must be informed of the possibility of requiring self-catheterization or temporary catheterization. Clinicians should ensure that the patients are capable of performing this catheterization before the treatment is conducted. Patients must also be informed of the need for antibiotic prophylaxis to reduce the risk of urinary tract infections. At least 2 follow-up visits are recommended: the first at days 7-14 after the injection and the second at 2-3 months. Reinjection is indicated when the effect of the treatment decreases. CONCLUSION: These guidelines can help clinicians in their daily decisions and limit the potential risks associated with the incorrect use of the drug.

Inyección de la toxina botulínica en el esfínter urinario: experiencia y resultados / The use of botulinum toxin in urinary sphincter: Experience and outcomes

Objetivo. Presentamos la experiencia de nuestro centro con la inyección de la toxina botulínica tipo A (TB) en el esfínter urinario de los pacientes con disfunción de vaciado. Material y método. Se inyectó TB en el esfínter urinario a 20 pacientes entre diciembre de 2003 y agosto de 2011 para el tratamiento de distintas disfunciones de vaciado refractarias a tratamiento convencional. Se utilizaron 4 vías de inyección: transuretral, parameatal en mujeres, transrectal en varones y transvaginal. Las dosis utilizadas oscilaron entre 50 y 200U. Resultados. Obtuvimos resultados satisfactorios en 11 pacientes (55%) según criterios clínicos. La duración del efecto osciló entre los 3 y 7 meses. No registramos complicaciones significativas relacionadas con la inyección, y la tolerancia al dolor fue buena. Conclusiones. La inyección de TB en el esfínter urinario es una técnica segura y eficaz para el tratamiento de diversos trastornos del tracto urinario inferior, pero sus resultados deben interpretarse cautelosamente, sobre todo en función de los parámetros utilizados para medir la eficacia (AU)

Objective. We present the experience of our center with the injection of type A botulinum toxin (BT) in urinary sphincter in patients with voiding dysfunction. Material and methods. BT was injected in the urinary sphincter of 20 patients between December 2003 and August 2011 in order to treat different voiding dysfunctions refractory to conventional treatment. Four injection methods were used: transurethral, paraurethral, transrectal and transvaginal. The doses used ranged from 50 to 200 units. Results. Satisfactory outcomes were obtained in 11 patients (55%) according to the clinical criteria. The effect lasted from 3 to 7 months. No major complications were registered and pain tolerance was good. Conclusions. The injection of BT in the urinary sphincter is safe and effective for the treatment of different lower urinary tract disorders, however its results should be interpreted with caution, above all based on the parameters used to measure the efficacy (AU)

Alternativas a la vía transuretral para la inyección de toxina botulínica en esfínter urinario / Botulinum toxin inyection in urinary sphincter: alternative approaches

Objetivo: Presentamos las vías transrectal en varones y transvaginal en mujeres como alternativas a la vía transuretral para la inyección de toxina botulínica (TB) en esfínter urinario, así como nuestros resultados. Material y Método: Se inyectó TB en esfínter urinario a 9 pacientes entre diciembre de 2008 y agosto de 2010para el tratamiento de distintas disfunciones de vaciado refractarias a tratamiento convencional. La vía utilizada fue transrectal en 7 varones y transvaginal en 2 mujeres. Las dosis utilizadas oscilaron entre 50 y200 U. Registramos resultados y complicaciones. Resultados: Obtuvimos resultados satisfactorios en 6pacientes (66 por ciento) según criterios clínicos. La duración del efecto osciló entre los 3 y 7 meses. No registramos complicaciones significativas relacionadas con la inyección y la tolerancia al dolor fue buena. Conclusiones: La vía transrectal en varones y transvaginal en mujeres son alternativas válidas y seguras para la inyección de TB en esfínter urinario.

Objective: To present our institution experience and outcomes with transrectal and transvaginal injection of botulinum toxin (TB) in urinary sphincter to treat voiding disfunction. Material and methods: We injected TB in 9 patients since December 2008 to august 2010 in order to treat different voiding disfunctions. We use the transrectal approach in 7 men and the transvaginal method in 2 women. The dose used ranged from 50 to 200 units. Outcomes and complications were registered. Results: Satisfactory outcomes were obtained in 6 patients (66 pert cent) according to clinical criteria. The duration of the effect was from 3 to 7 months. No major complications were registered and pain was well tolerated. Conclusions: Transrectal and transvaginal approaches are effective and safe for the injection of TB in urinary sphincter.

[Analysis of overactive bladder and urinary incontinence in males in the age range between 50 and 65 years. EPICC study]. / Análisis del síndrome de vejiga hiperactiva y de la incontinencia urinaria en varones en la franja de edad de los 50 a los 65 años. Estudio EPICC.

INTRODUCTION: The Overactive Bladder syndrome (OAB) and Urinary Incontinence (UI) result in an important personal and economic impact. This work concentrates on the detailed analysis of OAB and UI (derived symptoms and tendencies in medical consultation and resource consumption), in a sample of working men aged 50-65. MATERIAL AND METHODS: This study is within the framework of the EPICC study of the Spanish Association of Urology (epidemiologic, observational, multicentric, national study) and concentrates on the detailed analysis of the characteristics of the sample of working men aged 50-65 (N

Análisis del síndrome de vejiga hiperactiva y de la incontinencia urinaria en varones en la franja de edad de los 50 a los 65 años. Estudio EPICC / Analysis of overactive bladder and urinary incontinence in males in the age range between 50 and 65 years. EPICC study

Introducción: El síndrome de Vejiga Hiperactiva (VH) y la Incontinencia Urinaria (IU) tienen un elevado impacto tanto personal como económico. Este trabajo se centra en el análisis detallado de la VH y la IU (sintomatología derivada y tendencias en consulta y consumo de recursos) en una muestra de varones laboralmente activos de entre 50 y 65 años. Material y métodos: El presente trabajo se enmarca en Estudio EPICC de la Asociación Española de Urología (estudio epidemiológico, observacional, multicéntrico y de ámbito nacional) y se centra en el análisis detallado de las características de la muestra de varones laboralmente activos, con edades comprendidas entre los 50–65 años (N=1071) y del subgrupo de sujetos con VH y/o IU (N=55). Resultados: El 0,56% de la muestra presentó IU, el 3,55% VH y el 1,03% ambas patologías. En la muestra de sujetos con IU y/o VH el 45,45% tiene problemas para retener orina y el 16,36% tiene pérdidas a diario; el 45,45% sufre deseos incontrolables de orinar diariamente; el 23,64% no ha consultado al médico, el 65,45% ha consultado al urólogo, el 14,55% desea consultar al especialista en incontinencia; el 40% ha recibido tratamiento, de ellos el 81,82% recibió tratamiento farmacológico. Conclusión: Se presentan datos específicos sobre presencia de VH y IU en la muestra especificada y sobre la magnitud de las afecciones y uso de recursos sanitarios en sujetos con IU y/o VH, con el fin de contribuir a un mejor diagnóstico de estos trastornos y manejo de pacientes y recursos (AU)

Introduction: The Overactive Bladder syndrome (OAB) and Urinary Incontinence (UI) result in an important personal and economic impact. This work concentrates on the detailed analysis of OAB and UI (derived symptoms and tendencies in medical consultation and resource consumption), in a sample of working men aged 50-65. Material and methods: This study is within the framework of the EPICC study of the Spanish Association of Urology (epidemiologic, observational, multicentric, national study) and concentrates on the detailed analysis of the characteristics of the sample of working men aged 50–65 (N=1071) and of the subgroup of individuals with VH and/or IU (N=55). Results: 0.56% of the subjects presented UI, 3.55% OAB, 1.03% presented both pathologies. Taking into account those individuals with UI and/or OAB, 45.45% had problems to retain urine, and 16.36% suffered leakage daily; 45.45% suffered uncontrollable urge to urinate daily; 23.64% had never sought medical advice, 65.45% had visited an urologist, 14.55% would like to visit an specialist in incontinence; 40% had received treatment, from which 81.82 had received pharmacologic treatment. Conclusion: In this study, specific data about VH and IU in the reported sample are presented, including those referring to the magnitude of these conditions and use of sanitary resources in subjects with UI and/or OAB, aiming at contributing to a better diagnose and handling of patients and resources (AU)

[Nocturnal enuresis. A frequent problem with a difficult estimation of its prevalence]. / La enuresis nocturna. Un trastorno frecuente con una prevalencia difícil de estimar.

INTRODUCTION: Nocturnal enuresis is a disorder with a maintained historical interest. Not only the multifactorial etiopathology, also its prevalence. OBJECTIVE: We consider reviewing the literature for knowing the problematic in the calculation of the prevalence of this disease. MATERIAL AND METHOD: We searched in Pubmed database with Mesh terms: "Enuresis", "Nocturnal Enuresis", we added in the search box terms bedwetting and epidemiology or prevalence. We included manuscripts in English and Spanish with more than 1000 patients as sample, we also included review papers. We analyzed the methodology and the prevalence, when it was possible, we stratified results in age, sex and the frequency of wet nights. RESULTS: The analyzed study's methodology is heterogeneous. Therefore comparisons are difficult. Due to the difficulty within the interpretation of the overall frequency, the results are not interesting unless methodology, age range of the sample and diagnosis criteria are previously detailed. CONCLUSIONS: An own epidemiology study is necessary in order to solve our problematic.

La enuresis nocturna. Un trastorno frecuente con una prevalencia difícil de estimar / Nocturnal enuresis. A frequent problem with a difficult estimation of its prevalence

Introducción: La enuresis nocturna es un trastorno con un interés histórico mantenido, no solo en cuanto a su patogenia, probablemente multifactorial pero todavía hoy desconocida, sino también en cuanto a su frecuencia. Objetivo: Nos planteamos revisar la literatura médica al respecto para conocer la problemática en el cálculo de su casuística. Material y método: Realizamos una búsqueda en la base de datos PubMed, mediante los términos Mesh «enuresis», «nocturnal enuresis» y «bedwetting», e incluimos en el cuadro de búsqueda los términos «epidemiology OR prevalence». Incluimos todos los trabajos en lengua inglesa o española. Seleccionamos los trabajos con una muestra mayor de 1.000 pacientes, e incluimos estos y los artículos de revisión. Procedemos al análisis de la metodología empleada por los grupos más relevantes, así como los resultados globales de frecuencia; además, cuando es posible, estratificamos los resultados por edad, sexo y frecuencia de los escapes. Resultados: La metodología de los trabajos analizados es heterogénea y las comparaciones se hacen, por tanto, difíciles. La prevalencia global es difícil de estimar y dar resultados globales carece de interés pues para interpretarlos es necesario pormenorizar la metodología, la muestra y los criterios diagnósticos. Conclusiones: Se hace necesario un estudio epidemiológico propio que resuelva nuestra problemática (AU)

Introduction: Nocturnal enuresis is a disorder with a maintained historical interest. Not only the multifactorial etiopathology, also its prevalence. Objective: We consider reviewing the literature for knowing the problematic in the calculation of the prevalence of this disease. Material and method: We searched in Pubmed database with Mesh terms: “Enuresis”, “Nocturnal Enuresis”, we added in the search box terms bedwetting and epidemiology or prevalence. We included manuscripts in English and Spanish with more than 1000 patients as sample, we also included review papers. We analyzed the methodology and the prevalence, when it was possible, we stratified results in age, sex and the frequency of wet nights. Conclusions: An own epidemiology study is necessary in order to solve our problematic (AU)

[Urological findings in spinal cord ischemia]. / Manifestaciones urológicas de los accidentes vásculo-medulares.

INTRODUCTION: Spinal cord ischemia is a circulatory disorder of acute or subacute establishment and neurological clinic of medullar section, usually incomplete. We describe clinical and anatomical characteristics, as well as diagnostic methods and therapeuthic used in these patients. MATERIAL AND METHODS: Since 1987 to 2007, 65 patients were diagnosed of spinal cord ischemia in our hospital. Clinical interview, neurological examination and image study were performed. Urodynamic study was performed after medullar shock phase, including cystometry, pressure flow study and external urinary sphincter electromyography. We have reviewed treatment applied in these patients. RESULTS: 65 patients (27 women and 38 men), median age 63 years (15-87). 28 patients (43%) presented high lesion (upper to T7), 32 (49%) middle (T7-L2) and 4 (6%) low lesion (below L2). Flaccid paraplegia and acute urinary retention were the most frequent clinical findings at the begining. Aetiology was determined mainly by Magnetic Resonance. Urodynamic study revealed: 9 patients (47.4%) with high spinal cord lesion and detrusor overactivity (with or without dyssynergia), and 6 (31.5%) with arreflexia; 11 patients (47.8%) with middle spinal cord lesion and detrusor overactivity and 7 patients with arreflexia (30.4%); one patient with low spinal cord lesion and detrusor overactivity, and another one with arreflexia (33%). CONCLUSIONS: There is a good correlation among lesion level and clinical findings in traumatic spinal cord injuries, but this is not the same in spinal cord ischemia. Probably, incomplete and patched lesions in vascular spinal cord injuries could explain this lack of correlation. Therefore, it is mandatory to performe an exhaustive neurological and urological evaluation of these patients in order to select the best treatment and prevent upper urinary tract damage in the future.

Manifestaciones urológicas de los accidentes vásculo-medulares / Urological findings in spinal cord ischemia

Introducción: Nuestro objetivo es describir las características anatomoclínicas de los accidentes vasculomedulares, así como los métodos diagnósticos y terapéuticos empleados. Material y Métodos: Estudio retrospectivo desde 1982 hasta 2007, que incluye a 65 pacientes diagnosticados de AVM. Se realizó anamnesis general con exploración neurológica completa y estudio diagnóstico por imagen. La evaluación urodinámica consistió en cistomanometría, estudio de presión flujo y electromiografía del esfínter externo tras la fase de shock medular. Resultados: De los 65 pacientes (27 mujeres-38 hombres), con una mediana de edad de 63 años (15-87 años), 28pacientes (43%) presentaron lesión alta (superior a T7), 32 (49%)lesión media (entre T7-L2) y 4 (6%) baja (inferior a L2). El debut clínico más frecuente fue la paraplejía fláccida con retención aguda de orina. La etiología del AVM se determinó mediante pruebas de imagen, principalmente Resonancia Magnética. El estudio urodinámico mostró los siguientes resultados: lesión medular alta con hiperactividad vesical (asociando o no disinergia) 9 pacientes (47,4%) y 6 pacientes(31,5%) con arreflexia; lesión medular media con hiperactividad 11 pacientes (47,8%) y con arreflexia 7 pacientes (30,4%); lesión medular baja con hiperactividad un paciente (33%), arreflexia en otro (33%). Conclusiones: No existe una clara correlación entre el nivel anatómico lesionado y el comportamiento vésico esfinteriano. Esto es debido a que las lesiones medulares de origen vascular suelen ser incompletas y parcheadas, afectándose diferentes niveles. Es necesario, por tanto, realizar una exhaustiva exploración neurológica y urológica en estos pacientes, para poder establecer el patrón funcional que nos permita indicar el tratamiento idóneo (AU)

Introduction: Spinal cord ischemia is a circulatory disorder of acute or subacute establishment and neurological clinic of medullar section, usually incomplete. We describe clinical and anatomical characteristics, as well as diagnostic methods and therapeuthic used in these patients. Material and methods: since 1987 to 2007, 65 patients were diagnosed of spinal cord ischemia in our hospital. Clinical interview, neurological examination and image study were performed. Urodynamic study was performed after medullar shock phase, including cystometry, pressure flow study and external urinary sphincter electromyography. We have reviewed treatment applied in these patients. Results: 65 patients (27 women and 38 men), median age 63 years (15-87). 28 patients (43%) presented high lesion (upper to T7), 32 (49%) middle (T7-L2) and 4 (6%) low lesion (below L2). Flaccid paraplegia and acute urinary retention were the most frequent clinical findings at the begining. Aetiology was determined mainly by Magnetic Resonance. Urodynamic study revealed: 9 patients (47,4%) with high spinal cord lesion and detrusor overactivity (with or without dyssynergia), and 6 (31,5%) with arreflexia; 11 patients (47,8%) with middle spinal cord lesion and detrusor overactivity and 7 patients with arreflexia (30,4%); one patient with low spinal cord lesion and detrusor overactivity, and another one with arreflexia (33%).Conclusions: there is a good correlation among lesion level and clinical findings in traumatic spinal cord injuries, but this is not the same in spinal cord ischemia. Probably, incomplete and patched lesions in vascular spinal cord injuries could explain this lack of correlation. Therefore, it is mandatory to performe an exhaustive neurological and urological evaluation of these patients in order to select the best treatment and prevent upper urinary tract damage in the future (AU)