Consensus update on the therapeutic approach to patients with neurogenic detrusor overactivity.

INTRODUCTION AND OBJECTIVES: A Consensus document on the management of patients with neurogenic detrusor overactivity (NDO) was published in 2018. The present document aims to update its recommendations regarding treatment considering the new evidence available, and to contribute to the standardization of the management of this disorder. METHODS: The methodology used was based on a systematic review and the Nominal Group Technique. The clinical coordinator (CC) and the Consensus update group (CUG) defined the questions to be updated and carried out a systematic review to identify the new available evidence. After being evaluated by the expert panel, the relevant recommendations were updated and agreed in a consensus meeting. RESULTS: A total of 3210 publications were identified and 26 publications that met the inclusion criteria were included. The CUG updated 18 recommendations on the therapeutic approach to NDO. Unanimous consensus was reached on all of them. CONCLUSIONS: Previous recommendations need to be revised due to the availability of new drugs, the increasing evidence on the use of botulinum toxin or neuromodulation procedures, and new surgical options.

Ventral Approach for the Non-transecting Bulbar Urethroplasty.

BACKGROUND: Nowadays, short bulbar strictures refractory to one endoscopic treatment attempt could be managed with non-transecting urethroplasty technique as a first option.1 Jordan et al2 and Bugeja et al3 described a dorsal approach, sparing vessels, and spongiosum in the hope of a decrease of surgical side effects. OBJECTIVE: To describe the step-by-step technique of the ventral approach for the non-transecting bulbar urethroplasty in distal and mid short bulbar strictures. MATERIALS AND METHODS: We performed a prospective observational study of a cohort of patients who underwent a ventral non-transecting bulbar urethroplasty for short mid or distal bulbar strictures from January 2016 to December 2018. We included 10 patients. SURGICAL TECHNIQUE: A ventral midline urethrotomy is made and extended to assure a good caliber lumen both distally and proximally (20 Fr). The mucosal scar tissue is marked and a mucosectomy is performed, preserving the spongiosum.We bring the distal and proximal edges of healthy mucosa together without tension with a 5/0 absorbable monofilament. Ventral stricturotomy is closed over a 20F catheter, in a Heinike-Mikulics fashion, with 5/0 absorbable monofilament for the mucosal anastomosis and a 4/0 absorbable monofilament for the spongioplasty. RESULTS: Mean age was 56,50 years (+/-17,27) and mean stricture length was 1,06cm (+/-1,82). The majority of strictures (90%) were located in the mid bulb. After a mean follow up of 27,25 months (+/-12,12), 9 patients remain recurrence-free (87,5%). A significant mean increase in Qmax was observed (12+/-4,53 ml/s, p=0,04). Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROMS), items (Questions 1-6) related to urinate symptoms also showed a significant improvement(p=0,03). We didn't find any significant decrease in erectile function with this technique. CONCLUSION: The ventral approach for mid and distal short bulbar strictures is a feasible and reproducible technique with a significant increase in Qmax and improvement in USS-PROMS. Preliminary results show no decrease in erectile function.

Evolución de pacientes varones con detrusor hipoactivo y tratamiento conservador. Seguimiento a cinco años / Evolution of male patients with detrusor underactivity and conservative treatment. Five-year follow-up

INTRODUCCIÓN: El objetivo del trabajo fue comparar la evolución de pacientes varones con detrusor hipoactivo (DU) neurógeno (DUN) frente a DU no neurógeno (DUNoN) y establecer factores de riesgo para predecir la necesidad de cateterismo limpio intermitente (CLI) en el seguimiento. MATERIAL Y MÉTODOS: Estudio longitudinal, descriptivo, sobre una cohorte de pacientes con diagnóstico de DU. Se revisaron 2.496 estudios urodinámicos (2008-2018). Se incluyeron pacientes con DU (ICS2002 y/o Bladder contraction index [< 100]) sin tratamiento. Se excluyeron pacientes en CLI o tratamiento intervencionista. Se realizó seguimiento semestralmente con flujometría. Se indicó CLI ante residuos elevados (RPM) > 200 mL o eficiencia de vaciado (EV) < 50%. Se comparó la necesidad de CLI durante el seguimiento o la aparición de complicaciones (infecciones urinarias [ITU], litiasis vesical). RESULTADOS: Se encontraron 172 (6,89%) varones con DU. En 106 (61,6%) se evidenció causa neurológica. Finalmente se incluyeron 62 pacientes con seguimiento medio de 4,9 años (+/-2,6). De ellos, 33 (53%) fueron DUN y 29 (47%) DUNoN. No se apreciaron diferencias en la aparición de ITU (p = 0,34) o litiasis vesicales (p = 0,39). Seis pacientes con DUN precisaron CLI frente a ninguno con DUNoN (p = 0,04). Los pacientes que requirieron CLI presentaron mayor RPM [p = 0,009]) y menor EV [p = 0,017]). También se apreciaron diferencias en el tiempo hasta la necesidad de CLI (log rank: 0,009), siendo este de 15,1 meses (4-38). En el análisis multivariante ninguna de las variables pudo demostrarse como factor predictivo de necesidad de CLI. CONCLUSIONES: La causa más frecuente de DU es la lesión neurológica. Los pacientes con DUN permanecen estables sin necesidad de CLI. No hemos detectado factores de riesgo que identifiquen a los pacientes en riesgo de necesitar CLI

INTRODUCTION: The objective of the study was to compare the evolution of male patients with neurogenic detrusor underactivity (NDU) versus non-neurogenic DU (NNDU) and to establish risk factors to predict the need for clean intermittent catheterization (CIC) during the follow-up period. MATERIAL AND METHODS: Longitudinal, descriptive study of a cohort of patients diagnosed with DU, and 2,496 urodynamic studies (2008-2018) were reviewed. Patients with DU (ICS 2002 and/or Bladder contraction index (< 100)) without treatment were included. Patients with CIC or interventional treatment were excluded. Follow-up included flowmetry every six months. CIC was indicated in cases of high residual volume (PVR) > 200 mL or voiding efficiency (VE) < 50%. The need for CIC during follow-up or the appearance of complications (urinary tract infections (UTI), bladder lithiasis) were compared. RESULTS: DU was found in 172 (6.89%) men. Neurological causes were observed in 106 (61,6%) cases. Finally, 62 patients were included with a mean follow-up of 4.9 years (+/- 2.6). Of these patients, 33 (53%) presented NDU and 29 (47%) NNDU. Six patients with NDU needed CIC versus none with NNDU (p = 0.04). Patients requiring CIC had higher PVR (p = 0.009) and lower VE (p = 0.017)), and there were also differences in terms of time until the need for CIC (log Rank: 0.009), which was 15.1 months [4-38]. In the multivariate analysis, none of the variables showed to be predictive of the need for CIC. CONCLUSIONS: The most common cause of DU is neurologic injury. Patients with NDU remain stable without requiring CIC. We have not detected any risk factors that identify patients at risk of needing CIC

Evolution of male patients with detrusor underactivity and conservative treatment. Five-year follow-up. / Evolución de pacientes varones con detrusor hipoactivo y tratamiento conservador. Seguimiento a cinco años.

INTRODUCTION: The objective of the study was to compare the evolution of male patients with neurogenic detrusor underactivity (NDU) versus non-neurogenic DU (NNDU) and to establish risk factors to predict the need for clean intermittent catheterization (CIC) during the follow-up period. MATERIAL AND METHODS: Longitudinal, descriptive study of a cohort of patients diagnosed with DU, and 2,496 urodynamic studies (2008-2018) were reviewed. Patients with DU (ICS 2002 and/or Bladder contraction index (< 100)) without treatment were included. Patients with CIC or interventional treatment were excluded. Follow-up included flowmetry every six months. CIC was indicated in cases of high residual volume (PVR) > 200 mL or voiding efficiency (VE)<50%. The need for CIC during follow-up or the appearance of complications (urinary tract infections (UTI), bladder lithiasis) were compared. RESULTS: DU was found in 172 (6.89%) men. Neurological causes were observed in 106 (61,6%) cases. Finally, 62 patients were included with a mean follow-up of 4.9 years (+/- 2.6). Of these patients, 33 (53%) presented NDU and 29 (47%) NNDU. Six patients with NDU needed CIC versus none with NNDU (p = 0.04). Patients requiring CIC had higher PVR (p = 0.009) and lower VE (p = 0.017)), and there were also differences in terms of time until the need for CIC (log Rank: 0.009), which was 15.1 months [4-38]. In the multivariate analysis, none of the variables showed to be predictive of the need for CIC. CONCLUSIONS: The most common cause of DU is neurologic injury. Patients with NDU remain stable without requiring CIC. We have not detected any risk factors that identify patients at risk of needing CIC.

Síntomas urinarios en pacientes con esclerosis lateral amiotrófica / No disponible

No disponible

Oral quality of life after buccal mucosal graft harvest for substitution urethroplasty. More than a bite?

INTRODUCTION: The aim of our study was to analyze the oral quality of life (QoL) in patients with urethral stricture treated with BMG by using a validated questionnaire (OIDP). MATERIALS AND METHODS: A prospective, single-arm, observational single-centre study of a cohort of patients scheduled for BMG Urethroplasty was conducted. OIDP assesses the impact of oral conditions on daily activities including an oral QoL question (0-10). The questionnaire was self-administered before, 3 months postoperatively and at the end of the study. Means, pre- and postoperatively, were compared. Multivariate analysis was performed to analyze the risk factors for a low quality of life (<8) after surgery. RESULTS: We included 41 patients (2013-2017). The mean preoperative oral QoL was 9.33 points (SD1.16). Preoperative mean OIDP dimensional score and global score were 0,5 (SD:0.02) and 0,8%. The most frequently preoperative altered aspect was hygiene. Mean oral QoL, 3 months after surgery, was 8,56 (SD1.89) and OIDP dimensional score and global score were 0,67 (SD0.21) and 1,1%. Mean oral QoL at the end of the study (mean 3,12 years) was 8,50 (SD1.13). OIDP dimensional score and global score were 0,7 (SD 0.16) and 1,1%.The most frequently altered aspect at the end of the study was eating. No statistical (p = 0.07) decrease in oral QoL was found. The increase in OIDP dimensional and global score was also not statistically significant. Neither age nor smoking, diabetes mellitus, cardiovascular morbidity, previous OIDP score, width, length of the graft, or surgery success could explain a low oral QoL alter graft harvesting. CONCLUSIONS: BMG harvesting is not free of problems at the donor site. Eating seems to be the most affected aspect after surgery. Nevertheless, those sequelae do not induce a reduction in oral QoL.

Adaptación al español de las Good Urodynamic Practices de la International Continence Society / Adaptation to Spanish of the ICS Good Urodynamic Practices

El grupo de trabajo de estandarización de la Sociedad Internacional de Continencia ha actualizado las directrices de Buenas Prácticas en Urodinámica de dicha sociedad. Estas GUP2016 basadas en la evidencia han definido los términos y estándares para la práctica de la Urodinámica tanto en los gabinetes como para la práctica individual, en el control de calidad durante la cistomanometría o el estudio de presión-flujo. Además, el grupo de trabajo ha incluido recomendaciones previas a la prueba e información sobre la preparación del paciente, así como recomendaciones para realizar el informe urodinámico. Basándose en la estandarización previa de la Sociedad Internacional de Continencia y en la evidencia actual, se ha detallado la práctica de la uroflujometría, la cistomanometría y el estudio de presión-flujo, con el objetivo de que esta actualización de las Buenas Prácticas en Urodinámica ayude a mejorar la calidad de la clínica e investigación en Urodinámica

The standardisation working group of the International Continence Society has updated the Good Urodynamic Practice directives. This evidence-based ICS-GUP2016 has defined the terminology and standards of Urodynamic practice, for the laboratory and for individual practice, in quality control during cystometry and pressure-flow analysis. In addition, the working group included recommendations prior to the test and information about how to prepare the patient, as well as recommendations for the reporting of urodynamics. Based on earlier International Continence Society standardisations and current evidence, the practice of uroflowmetry, cystometry and pressure-flow study have been detailed with a view to ensuring that this Good Urodynamic Practice update contributes towards improving clinical and research quality in urodynamics

Validación de la versión española del cuestionario Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS). Un instrumento útil para el diagnóstico del síndrome de dolor vesical / Validation of the Spanish version of the Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS) questionnaire. A useful tool for the diagnosis of bladder pain syndrome

Objetivos: Evaluar las propiedades psicométricas de la versión española del cuestionario Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS) en el diagnóstico de pacientes con síndrome de dolor vesical (SDV) en las Unidades de Urología Funcional, Femenina y Urodinámica en España. Material y métodos: La adaptación de la versión española del BPIC-SS fue evaluada en 243 pacientes con SDV. Los pacientes completaron los cuestionarios EQ-5D-5L, Patient Perception of Bladder Condition (PPBC) y el cuestionario de impresión global según la gravedad de la sintomatología (CGI-S). Se evaluó la consistencia, la fiabilidad test-retest en pacientes sin cambios clínicos a los 15 días, la validez de criterio y la sensibilidad al cambio en pacientes con cambios clínicos a los 6 meses. El punto de corte para discriminar pacientes con SDV de otras patologías similares se analizó mediante curva ROC. Resultados: La puntuación media (DE) del BPIC-SS (0-38) fue de 16,2 (12,0) puntos. El alfa de Cronbach fue de 0,92 y el coeficiente correlación intraclase (CCI) fue de 0,82, oscilando entre 0,5-0,9 por ítem. La validez convergente determinó una correlación de 0,63 con PPBC y -0,40 con la Escala Visual Analógica (EVA) del EQ-5D-5L, y el tamaño del efecto en pacientes que mejoraron su estado clínico fue de 1,9. Se ha establecido como punto de corte para el diagnóstico de SDV una puntuación del BPIC-SS superior o igual a 12 puntos (87,5% de sensibilidad y 91,9% de especificidad). Conclusiones: La versión española del cuestionario BPIC-SS es un instrumento válido, fiable y sensible al cambio para la evaluación de pacientes con SDV

Objectives: Validation of the Spanish version of the Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS) questionnaire to evaluate its utility for the diagnosis of Bladder Pain Syndrome (BPS) patients in the Female and Urodynamics Urology Functional Units in Spain. Material and methods: The Spanish adaptation of the BPIC-SS questionnaire was evaluated in 243 BPS patients. EQ-5D-5L, Patient Perception of Bladder Condition (PPBC) and global impression questionnaire (CGI-S) were collected. Consistency, test-retest reliability in patients without clinical changes at 15 days, criterion validity and sensitivity to change were assessed in BPS patients with clinical changes at 6 months. The cut-off point for discriminating BPS patients from other similar pathologies (Hyperactive Bladder or other urinary pathologies) was analysed using ROC curve. Results: Mean (SD) BPIC-SS score (0-38) was 16.2 (12.0) points. Cronbach's alpha was 0.92 and intraclass coefficient correlation (ICC) was 0.82, ranging from 0.5-0.9 per item. Convergent validity determined a Spearman correlation of 0.63 with PPBC and -0.40 with EQ-5D-5L Visual Analogue Scale (VAS) and the effect size obtained in patients who improved their clinical status was 1.9. A score greater than or equal to 12 points in the BPIC-SS has been established as the best cut-off point for the diagnosis of BPS (87.5% sensitivity and 91.9% specificity). Conclusions: The Spanish version of the BPIC-SS is a valid and reliable instrument for the diagnosis and follow-up of patients with BPS in Spain

Adaptation to Spanish of the ICS Good Urodynamic Practices. / Adaptación al español de las Good Urodynamic Practices de la International Continence Society.

The standardisation working group of the International Continence Society has updated the Good Urodynamic Practice directives. This evidence-based ICS-GUP2016 has defined the terminology and standards of Urodynamic practice, for the laboratory and for individual practice, in quality control during cystometry and pressure-flow analysis. In addition, the working group included recommendations prior to the test and information about how to prepare the patient, as well as recommendations for the reporting of urodynamics. Based on earlier International Continence Society standardisations and current evidence, the practice of uroflowmetry, cystometry and pressure-flow study have been detailed with a view to ensuring that this Good Urodynamic Practice update contributes towards improving clinical and research quality in urodynamics.

Validation of the Spanish version of the Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS) questionnaire. A useful tool for the diagnosis of bladder pain syndrome. / Validación de la versión española del cuestionario Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS). Un instrumento útil para el diagnóstico del síndrome de dolor vesical.

OBJECTIVES: Validation of the Spanish version of the Bladder Pain/Interstitial Cystitis-Symptom Score (BPIC-SS) questionnaire to evaluate its utility for the diagnosis of Bladder Pain Syndrome (BPS) patients in the Female and Urodynamics Urology Functional Units in Spain. MATERIAL AND METHODS: The Spanish adaptation of the BPIC-SS questionnaire was evaluated in 243 BPS patients. EQ-5D-5L, Patient Perception of Bladder Condition (PPBC) and global impression questionnaire (CGI-S) were collected. Consistency, test-retest reliability in patients without clinical changes at 15 days, criterion validity and sensitivity to change were assessed in BPS patients with clinical changes at 6 months. The cut-off point for discriminating BPS patients from other similar pathologies (Hyperactive Bladder or other urinary pathologies) was analysed using ROC curve. RESULTS: Mean (SD) BPIC-SS score (0-38) was 16.2 (12.0) points. Cronbach's alpha was 0.92 and intraclass coefficient correlation (ICC) was 0.82, ranging from 0.5-0.9 per item. Convergent validity determined a Spearman correlation of 0.63 with PPBC and -0.40 with EQ-5D-5L Visual Analogue Scale (VAS) and the effect size obtained in patients who improved their clinical status was 1.9. A score greater than or equal to 12 points in the BPIC-SS has been established as the best cut-off point for the diagnosis of BPS (87.5% sensitivity and 91.9% specificity). CONCLUSIONS: The Spanish version of the BPIC-SS is a valid and reliable instrument for the diagnosis and follow-up of patients with BPS in Spain.

Diagnóstico y tratamiento del paciente con hiperactividad neurogénica del músculo detrusor. Revisión sistemática / A systematic review of the diagnosis and treatment of patients with neurogenic hyperactivity of the detrusor muscle

Introducción: La hiperactividad neurogénica del detrusor (HND) es una observación urodinámica caracterizada por contracciones involuntarias del detrusor durante la fase de llenado causada por una enfermedad neurológica subyacente. Las complicaciones frecuentes y graves que pueden derivar de la HND aconsejan la elaboración de protocolos asistenciales para el correcto manejo de enfermos con HND. Objetivo: El propósito de este trabajo es homogeneizar criterios para la toma de decisiones en el manejo de pacientes con diagnóstico o sospecha de HND, prestando atención a la medicina personalizada. Adquisición de la evidencia: Se realizó una revisión sistemática no exhaustiva de la literatura sobre aspectos del diagnóstico y tratamiento de la HND; a partir de ella, se emitieron recomendaciones por consenso nominal de un grupo de especialistas en Urología. Síntesis de la evidencia: En general, el diagnóstico de HND vendrá dado por una correcta historia clínica, la exploración física y el diario miccional antes de realizar cualquier investigación diagnóstica. Los objetivos principales del tratamiento son proteger el tracto urinario superior, restaurar la función del tracto inferior y mejorar la continencia y la calidad de vida de estos pacientes. El tratamiento consiste en varios escalones encaminados a obtener un correcto almacenamiento vesical que permita micciones suficientemente espaciadas en el tiempo. El seguimiento debe personalizarse según las necesidades de cada paciente. Conclusiones: La identificación y el manejo de la HND resultan importantes para reconducir positivamente la función del tracto urinario inferior, en cuanto a llenado y vaciado, y mejorar la calidad de vida de los pacientes con HND

Background: Neurogenic detrusor hyperactivity (NDH) is a urodynamic observation characterised by involuntary detrusor contractions during the filling phase that are caused by an underlying neurological disease. The common and severe complications that can result from NDH warrant the preparation of healthcare protocols for the proper management of patients with NDH. Objective: The aim of this study is to standardise the criteria for the decision-making process in the management of patients with diagnosed or suspected NDH, providing personalised medical care. Acquisition of evidence: We performed a systematic noncomprehensive literature review on the aspects of the diagnosis and treatment of NDH. Based on the review, recommendations were issued by nominal consensus of a group of urology specialists. Synthesis of the evidence: In general, the diagnosis of NDH is arrived at by a proper review of the medical history, physical examination and voiding diary before performing any diagnostic study. The main treatment objectives are to protect the upper urinary tract, restore function of the lower tract and improve these patients’ continence and quality of life. The treatment consists of several steps aimed at obtaining proper bladder storage that allows for sufficiently spaced voidings. The follow-up should be personalised based on each patient's needs. Conclusions: The identification and management of NDH is important for positively redirecting the function of the lower urinary tract, in terms of filling and voiding, thereby improving the patients' quality of life

A systematic review of the diagnosis and treatment of patients with neurogenic hyperactivity of the detrusor muscle. / Diagnóstico y tratamiento del paciente con hiperactividad neurogénica del músculo detrusor. Revisión sistemática.

BACKGROUND: Neurogenic detrusor hyperactivity (NDH) is a urodynamic observation characterised by involuntary detrusor contractions during the filling phase that are caused by an underlying neurological disease. The common and severe complications that can result from NDH warrant the preparation of healthcare protocols for the proper management of patients with NDH. OBJECTIVE: The aim of this study is to standardise the criteria for the decision-making process in the management of patients with diagnosed or suspected NDH, providing personalised medical care. ACQUISITION OF EVIDENCE: We performed a systematic noncomprehensive literature review on the aspects of the diagnosis and treatment of NDH. Based on the review, recommendations were issued by nominal consensus of a group of urology specialists. SYNTHESIS OF THE EVIDENCE: In general, the diagnosis of NDH is arrived at by a proper review of the medical history, physical examination and voiding diary before performing any diagnostic study. The main treatment objectives are to protect the upper urinary tract, restore function of the lower tract and improve these patients' continence and quality of life. The treatment consists of several steps aimed at obtaining proper bladder storage that allows for sufficiently spaced voidings. The follow-up should be personalised based on each patient's needs. CONCLUSIONS: The identification and management of NDH is important for positively redirecting the function of the lower urinary tract, in terms of filling and voiding, thereby improving the patients' quality of life.

Hidrodistensión bajo anestesia más inyección de Onabotulinumtoxin A en pacientes con síndrome de dolor vesical refractario a tratamiento conservador / Hydrodistension plus Onabotulinumtoxin A in bladder pain syndrome refractory to conservative treatments

Introducción: En el síndrome de dolor vesical (SDV) refractario a tratamientos conservadores, la guía europea contempla la hidrodistensión (HD) vesical bajo anestesia y la inyección de Onabotulinumtoxin A (OnabotA) de manera conjunta. El objetivo fue evaluar nuestra experiencia en la aplicación de la técnica. Material y métodos: Estudio prospectivo de 25 pacientes con SDV sometidos a HD más inyección submucosa de 100 U de OnabotA en trígono. Las lesiones de Hunner fueron tratadas endoscópicamente mediante resección o electrocoagulación. Se realizaron 38 procedimientos (25 primeras intervenciones y 13 reintervenciones). Para estudiar la modificación clínica se evaluó la mejoría subjetiva (escalas TBS y PGIC), la escala visual analógica (EVA) para dolor, el cuestionario BPIC-SS y el diario miccional de 3 días. Para el análisis de datos se emplearon los test de Wilcoxon, Kruskal-Wallis, Kaplan-Meier y Log-Rank. Resultados: Observamos mejoría subjetiva en 21 pacientes (84%), en 47% de ellos mejoría importante, en 41,2% moderada y en 11,8% leve. No hubo mejoría en 4 pacientes. Se objetivó una reducción postratamiento en la EVA de dolor (de 7,1 a 1,8 puntos; p = 0,001), en la frecuencia miccional diurna (de 11,8 a 7,5; p = 0,012) y nocturna (de 5,9 a 3,6; p = 0,003) y en el cuestionario BPIC-SS (de 27,9 a 11,2 puntos; p = 0,042). El grado de mejoría no tuvo relación con la edad, con la presencia de lesiones vesicales ni con el tratamiento de las recaídas. La mediana en la duración de la mejoría fue de 7 meses (IC 95%: 5,69-8,31) de manera global, aunque en los pacientes menores de 65 años fue algo mayor. Se produjeron complicaciones leves en el 23,7% de los casos. Conclusiones: La realización conjunta de HD más inyección de OnabotA es una opción terapéutica válida en el SDV refractario, con buenos resultados clínicos y manteniendo la efectividad en los retratamientos

Introduction: For bladder pain syndrome (BPS) refractory to conservative treatment, the European guidelines consider bladder hydrodistention (HD) under anaesthesia and the injection of Onabotulinumtoxin A (OnabotA) jointly. The objective of this study was to assess our experience in implementing this technique. Material and methods: A prospective study of 25 patients with BPS who underwent HD plus a submucosal injection of 100 U of OnabotA in trigone. The Hunner lesions were treated endoscopically using resection or electrocoagulation. Thirty-eight procedures were performed (25 first interventions and 13 reoperations). To study the clinical change, we evaluated the subjective improvement (Treatment Benefit Scale [TBS] and Patient Global Impression of Change [PGIC] scales), the visual analogue scale (VAS) for pain, the Bladder Pain/Interstitial Cystitis Symptom Score (BPIC-SS) questionnaire and the voiding diary for 3 days. For the data analysis, we employed the Wilcoxon, Kruskal-Wallis, Kaplan-Meier and log-rank tests. Results: We observed subjective improvement in 21 patients (84%), which was significant in 47% of these patients, moderate in 41.2% and slight in 11.8%. Four patients did not improve. A post-treatment reduction in the pain VAS (from 7.1 to 1.8 points; P = .001), in daytime (from 11.8 to 7.5; P = .012) and night-time (from 5.9 to 3.6; P = .003) voiding frequency and in the BPIC-SS (from 27.9 to 11.2 points;P = .042). The degree of improvement was not related to age, the presence of bladder lesions or the treatment of relapses. The median duration of improvement was 7 months (95% CI 5.69-8.31), although this duration was somewhat longer for the patients younger than 65 years. Mild complications occurred in 23.7% of the cases. Conclusions: The joint implementation of HD plus OnabotA is a valid therapeutic option in refractory BPS, which provides good clinical results and maintains its effectiveness in retreatments

Hydrodistension plus Onabotulinumtoxin A in bladder pain syndrome refractory to conservative treatments. / Hidrodistensión bajo anestesia más inyección de Onabotulinumtoxin A en pacientes con síndrome de dolor vesical refractario a tratamiento conservador.

INTRODUCTION: For bladder pain syndrome (BPS) refractory to conservative treatment, the European guidelines consider bladder hydrodistention (HD) under anaesthesia and the injection of Onabotulinumtoxin A (OnabotA) jointly. The objective of this study was to assess our experience in implementing this technique. MATERIAL AND METHODS: A prospective study of 25 patients with BPS who underwent HD plus a submucosal injection of 100 U of OnabotA in trigone. The Hunner lesions were treated endoscopically using resection or electrocoagulation. Thirty-eight procedures were performed (25 first interventions and 13 reoperations). To study the clinical change, we evaluated the subjective improvement (Treatment Benefit Scale [TBS] and Patient Global Impression of Change [PGIC] scales), the visual analogue scale (VAS) for pain, the Bladder Pain/Interstitial Cystitis Symptom Score (BPIC-SS) questionnaire and the voiding diary for 3 days. For the data analysis, we employed the Wilcoxon, Kruskal-Wallis, Kaplan-Meier and log-rank tests. RESULTS: We observed subjective improvement in 21 patients (84%), which was significant in 47% of these patients, moderate in 41.2% and slight in 11.8%. Four patients did not improve. A post-treatment reduction in the pain VAS (from 7.1 to 1.8 points; P=.001), in daytime (from 11.8 to 7.5; P=.012) and night-time (from 5.9 to 3.6; P=.003) voiding frequency and in the BPIC-SS (from 27.9 to 11.2 points; P=.042). The degree of improvement was not related to age, the presence of bladder lesions or the treatment of relapses. The median duration of improvement was 7 months (95% CI 5.69-8.31), although this duration was somewhat longer for the patients younger than 65 years. Mild complications occurred in 23.7% of the cases. CONCLUSIONS: The joint implementation of HD plus OnabotA is a valid therapeutic option in refractory BPS, which provides good clinical results and maintains its effectiveness in retreatments.

How should we address the diagnosis of overactive bladder in women?

OBJECTIVE: Determine the degree of completion, agreement and diagnostic performance of various instruments for assessing the presence and intensity of urgency and other symptoms of idiopathic overactive bladder (OAB) and determine which is the best diagnostic combination. MATERIAL AND METHODS: Observational, noninterventional, cross-sectional multicentre study on 247 women aged 18 years or older, with a clinical diagnosis of OAB, evaluated in 55 functional urology and urodynamic units. The women completed the Patient Perception of Intensity of Urgency Scale questionnaire, an independent bladder control self-assessment questionnaire (B-SAQ), the Overactive Bladder Questionnaire Short-Form and a 3-day voiding diary (VD3d), and they underwent a urodynamic study (UDS). The degree of completion and agreement among the instruments was assessed using the Kappa index (95% CI) and Cramér's V. The diagnostic performance of each tool and their combination was studied using absolute frequencies of positive cases for each OAB symptom. RESULTS: The patients mean age was 57.66 years (SD, 13.43). There was a high degree of completion (>85%). The agreement among the instruments was poor or moderate, and there was no agreement with the UDS. The best combination of tools for the diagnosis of OAB in women was the B-SAQ and VD3d. CONCLUSIONS: The degree of completion of all instruments was high, the agreement between them was poor-moderate and not significant for the UDS. The instruments that had the best diagnostic performance for assessing urgency and other OAB symptoms, providing data on their severity and discomfort, were the B-SAQ and the VD3d.

Consenso de la Asociación Española de Urología en el diagnóstico y manejo del síndrome de dolor vesical / Recommendations for the Diagnosis and Management of Bladder Pain Syndrome. Spanish Urological Association Consensus Document

Introducción: El síndrome de dolor vesical/cistitis intersticial (SDV/CI) y otras enfermedades vesicales comparten una sintomatología común, como la presencia de los síntomas miccionales y la repercusión negativa sobre la calidad de vida de los pacientes. Para su correcto diagnóstico y manejo clínico es importante distinguir entre sus diferentes modalidades clínicas y criterios diagnósticos de exclusión adecuados. Objetivo: El propósito de este trabajo ha sido homogeneizar los criterios para la toma de decisiones en el manejo del SDV, tanto en su diagnóstico y tratamiento inicial como en su seguimiento. Material y método: Se utilizó metodología de grupo nominal, utilizando para la elaboración de las recomendaciones las evidencias científicas sobre el SDV extraídas de una revisión sistemática (no exhaustiva) de la literatura, junto con el juicio experto de especialistas. Resultados: El diagnóstico del SDV debe hacerse basándose en la historia clínica del paciente, prestando importancia al dolor y a los síntomas miccionales y a la exclusión de otras enfermedades de sintomatología parecida. El tratamiento del SDV debe dirigirse a la restauración de la función vesical normal, la prevención de recaídas de los síntomas y la mejora de la calidad de vida de los pacientes. Para ello es recomendable empezar con un tratamiento conservador y adoptar tratamientos menos conservadores conforme el nivel de gravedad clínica aumenta. También se recomienda abandonar tratamientos ineficaces y replantearse otras opciones terapéuticas. Conclusiones: La rápida identificación de la enfermedad resulta importante para intentar influir positivamente en los indicadores de morbilidad y la calidad asistencial de estos pacientes

Introduction: Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) and other bladder pathologies share common manifestations, such as the presence of mictional symptoms and a negative impact on the patient's quality of life. To be properly diagnosed and clinically managed, it is important to distinguish between its clinical modalities and diagnostic criteria for adequate exclusion. Objective: The purpose of this study was to standardize criteria for making decisions in BPS management, for its diagnosis, initial treatment and follow-up. Material and method: A nominal group methodology was employed, using scientific evidence on BPS taken from a systematic (non-exhaustive) literature review for developing recommendations along with specialist expert opinions. Results: The diagnosis of BPS should be made based on the patient's clinical history, with emphasis on pain and mictional symptoms as well as excluding other pathologies with similar symptomatology. BPS treatment should be directed towards restoring normal bladder function, preventing symptom relapse and improving patients’ quality of life. It is therefore advisable to start with conservative treatment and to adopt less conservative treatments as the level of clinical severity increases. It is also recommended to abandon ineffective treatments and reconsider other therapeutic options conclusions

Recommendations for the Diagnosis and Management of Bladder Pain Syndrome. Spanish Urological Association Consensus Document.

INTRODUCTION: Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) and other bladder pathologies share common manifestations, such as the presence of mictional symptoms and a negative impact on the patient's quality of life. To be properly diagnosed and clinically managed, it is important to distinguish between its clinical modalities and diagnostic criteria for adequate exclusion. OBJECTIVE: The purpose of this study was to standardize criteria for making decisions in BPS management, for its diagnosis, initial treatment and follow-up. MATERIAL AND METHOD: A nominal group methodology was employed, using scientific evidence on BPS taken from a systematic (non-exhaustive) literature review for developing recommendations along with specialist expert opinions. RESULTS: The diagnosis of BPS should be made based on the patient's clinical history, with emphasis on pain and mictional symptoms as well as excluding other pathologies with similar symptomatology. BPS treatment should be directed towards restoring normal bladder function, preventing symptom relapse and improving patients' quality of life. It is therefore advisable to start with conservative treatment and to adopt less conservative treatments as the level of clinical severity increases. It is also recommended to abandon ineffective treatments and reconsider other therapeutic options. CONCLUSIONS: Quickly identifying the pathology is important when trying to positively influence morbidity and care quality for these patients.

Consensus document of the Spanish Urological Association on the management of uncomplicated recurrent urinary tract infections.

INTRODUCTION: The clinical manifestations of urinary infections, commonly mild and uncomplicated, have resulted in a generally empirical therapeutic decision-making process, which does not help fight resistances to antibacterial agents, thus causing a high rate of recurrence. OBJECTIVE: This study seeks to reduce the clinical variability in the diagnosis and treatment of uncomplicated recurrent urinary tract infections (RUTIs). MATERIAL AND METHOD: The consensus document was developed using a nominal group methodology, using scientific evidence on RUTIs extracted from a systematic (noncomprehensive) literature review, along with the expert judgment of specialists and their experience in clinical practice. RESULTS: RUTIs are considered the manifestation of at least 3 episodes of uncomplicated infection, with a positive culture in the past 12 months, in addition to (for men) the absence of structural or functional abnormalities. We maintain that the treatment should be empiric when suspecting RUTIs (prior to obtaining a urine sample for culture) in those patients who have a high probability of recurrence, associated risk factors and/or urinary or general symptoms, such as fever and chills. Homogeneous criteria are recommended for the diagnosis and treatment in order to fight the increased rates of resistance that the microorganisms develop against antimicrobial agents. CONCLUSION: Imprecision in the identification of the infection requires a search for agreements on homogenized criteria and decision algorithms that guide the management of these patients.

Consenso experto sobre la evidencia científica disponible acerca del uso de toxina botulínica en vejiga hiperactiva / Expert consensus on scientific evidence available on the use of botulinum toxin in overactive bladder

Objetivos: La vejiga hiperactiva (VH) es una enfermedad que afecta negativamente la calidad de vida y con un porcentaje elevado de pacientes refractarios a la medicación. Se pretende explorar la opinión técnica de un panel experto y alcanzar consenso en el criterio profesional en relación con la evidencia científica disponible sobre VH y Onabotulinumtoxin A (OnabotA), mediante el debate de un panel de especialistas expertos. Material y métodos: Encuesta realizada mediante el método Delphi a 42 panelistas con 93 ítems repartidos en 4 áreas estratégicas, que incluyen criterios y recomendaciones clínicas que pueden ayudar a mejorar en diferentes niveles el abordaje actual del paciente con VH. Se consideraron los avances recientes en la materia, las áreas de controversia y la valoración de sus posibilidades reales de aplicación a los distintos ámbitos asistenciales de nuestro sistema sanitario. Resultados: Todos los expertos consultados completaron las 2 tandas del cuestionario. En la primera se apreció un consenso de criterio en 64 de 93 (68,8%) cuestiones analizadas, y en la segunda ronda 83 (89,25%) de los ítems consultados, estableciéndose un acuerdo entre los panelistas respecto a: 1) definición, clasificación, detección y diagnóstico diferencial; 2) tratamiento médico; 3) tratamiento quirúrgico; y 4) papel de OnabotA en el tratamiento de la VH. Conclusiones: El consenso logrado se ajusta ampliamente a la más reciente evidencia científica en VH. Los panelistas consideran que puede plantearse una modificación en la definición actual de VH, y que parece necesario mejorar las herramientas de cribado. El tratamiento médico de la VH debe ser individualizado, escalonado y progresivo. OnabotA (Botox(R)) podría implicar ventajas con respecto a otros tratamientos, y se posiciona como una alternativa segura y eficaz para tratar la VH refractaria a fármacos

Objectives: Overactive bladder (OAB) is a pathology impairing patients’ quality of life and with a high percentage of patients who are refractory to medication. In this paper, technical opinion of an «expert panel» is assessed in order to gain the most reliable professional consensus on scientific evidence available on the criteria of use of Onabotulinumtoxin A (OnabotA) in OAB. Material and methods: according to DELPHI method, 42 panelists answered a survey of 93 items divided into four strategic areas including clinical criteria and recommendations in order to improve, at different levels, the current approach to patients with OAB. The recent advances in the field, areas of controversy and their real application possibilities in the different areas of our health care system were taken into consideration. Results: Two rounds of the questionnaire were completed by all experts. In the first round, a criteria consensus was reached for 64 of 93 (68.8%) questions analyzed; in the second round the consensus reached was for 83 items evaluated (89.25%). An agreement among panelist was reached for: 1) definition, classification, detection and differential diagnosis; 2) medical treatment; 3) surgical treatment; 4) role of OnabotA in the treatment of OAB. Conclusions: the consensus is broadly in line with the latest scientific evidence on OAB. The panelists believe that it is necessary to propose a change in the current definition of OAB and that it seems necessary to improve the screening tools too. Medical treatment of OAB must be tailored to each patient, staged and progressive. The use of OnabotA (Botox(R)) could imply therapeutic advantages with respect to other treatments, and positions itself as a safe and effective alternative to treat drug refractory OAB