[Female urinary incontinence: clinical-urodynamic correlation]. / Incontinencia urinaria femenina: correlación clínico-urodinámica.

OBJECTIVES: To determine the diagnostic utility of the urinary symptoms and physical examination in the urodynamic diagnosis of the type of female urinary incontinence. METHODS: A descriptive longitudinal study was conducted in 100 women undergoing urodynamic evaluation. The patients were asked about the urinary symptoms and were evaluated by physical examination and cystomanometry. RESULTS: A statistically significant correlation was found for age and clinical type of urinary incontinence. A strong trend was observed for clinical type of urinary incontinence and cystocele grade, and the urodynamic type of incontinence. A low sensitivity was found for the clinical type in relation to the urodynamic type of incontinence. CONCLUSIONS: Urinary incontinence clinical data do not permit determination of the urodynamic type of incontinence.

[Diabetic neurocystopathy: multivariate study]. / La neurocistopatía diabética: estudio multivariante.

OBJECTIVE: To analyze the prevalence of urodynamic disorders and the factors associated with bladder instability in patients with diabetes mellitus. METHODS: We conducted a clinical and urodynamic study on 138 diabetic patients (71 males, 51%; 67 females, 49%) with a mean age of 64.04 years. Patient evaluation included patient history, neurological physical examination, cystometry, pressure-flow test, filling videocystography and selective EMG of the periurethral sphincter. Data obtained were analyzed by multivariant logistic regression analysis, taking the probability of developing bladder instability as a dependent variable. RESULTS: Bladder instability was the most frequent urodynamic finding (52%), followed by lower urinary tract obstruction (44%), involvement of bladder contractility (41%) and stress urinary incontinence (22%). Lower motor neuron (S2-S4) pudendal nerve lesion was observed in 33% of the cases and 24% had upper motor neuron involvement. Multivariant analysis showed age and stress urinary incontinence (inverse correlation) to be the only independent variables for bladder instability. The other variables that correlated with instability (but dependent on the foregoing variables) were involvement of bladder contractility and type of diabetes (higher probability for diabetes type II). No correlation was found for sex, duration of the diabetes, stroke (CVA), urinary obstruction or pudendal nerve lesion. CONCLUSIONS: Bladder instability was found to be the most frequent urodynamic disorder in diabetic patients. The probability of developing bladder instability increases with age and decreases in patients with stress urinary incontinence.

[Pressure-flow studies in the diagnosis of micturition disorders in the female]. / Los estudios presión-flujo en el diagnóstico de disfunción miccional de la mujer.

OBJECTIVE: To determine the utility of the pressure-flow studies in the diagnosis of voiding dysfunction in women. METHODS: A case-control study was conducted on 80 women. These subjects were divided into two groups: 24 controls with a maximum flow percentile greater than or equal to 50 and no residual volume, and 56 cases with a maximum flow percentile less than or equal to 10. The clinically and statistically significant parameters of the pressure-flow study were entered into a multiple regression logistic equation as explanation variables of voiding dysfunction. RESULTS: The clinical variables that influenced voiding dysfunction were age and the presence of stress urinary incontinence. The urethral resistance average (URA) was found to be the only significant urodynamic parameter. Patients with stress urinary incontinence showed a lower probability of voiding dysfunction. Age and URA directly correlated with the probability of voiding dysfunction. CONCLUSIONS: The URA was found to be the only significant urodynamic parameter. The contractility parameters [power at maximum flow (Pw) and maximum power per bladder unit surface (Wmax)] were not found to be useful as detrusor contractility index in women.

[Vesicourethral dysfunction in the acquired immunodeficiency syndrome (AIDS)]. / Disfunción vesicouretral en el síndrome de inmunodeficiencia adquirida (SIDA).

OBJECTIVES: Ten patients with AIDS and voiding disorders were assessed to determine the most common type of lower urinary tract dysfunction and its possible usefulness in detecting neurological disease. METHODS: A complete urodynamic evaluation was performed. RESULTS: The most common symptom was urge incontinence and the most common urodynamic finding was detrusor-external sphincter dyssynergia. Of the 5 patients found to have a neurological disorder, only 3 had demonstrable functional disorder of the lower urinary tract (2 patients had detrusor hyperreflexia: one of them had a history of encephalopathy from HIV and the other patient had polyneuritis; the third patient had myelitis and a urodynamically diagnosed sympathetic decentration. CONCLUSIONS: Knowing the functional disorders of patients with AIDS can avoid complications and improve patient quality of life. Furthermore, it can be useful in detecting an existing neurological lesion or one that may develop in the future.

[Involvement of epidermal growth factor receptor (EGFR) in the etiopathogenesis of prostatic proliferative processes]. / Implicación del receptor del factor de crecimiento epidérmico (EGFR) en la etiopatogenia de los procesos proliferativos prostáticos.

The prostatic growth factors require a membrane specific receptor to which they must bind in order to carry out their biological activities correctly. The aim of this study was to isolate and quantify the epidermal growth factor receptor in prostatic tissue and indirectly determine the growth factors acting on it (EGF, TGF alpha, PDGF, NGF, IGF). From September, 1992 to June, 1993, we studied 55 patients. These were divided into two groups: the first group comprised 49 patients with benign prostatic hyperplasia (BPH) and 6 patients with prostatic carcinoma comprised the second group. Samples of the prostate were obtained following suprapubic (12 cases), TUR (38 cases), radical prostatectomy (1 case) and transrectal biopsy (4 cases). The EGFR was determined by radioimmunoassay (EGFR-RIA, Vienna Lab, Labordiagnostica GmbH). For the overall group of patients, we obtained mean EGFR values of 6.36 +/- 0.59 fmol/mg of protein and a positivity of 96.36% and 100% for BPH and malignant proliferative processes, respectively. The foregoing data show that EGFR was isolated from the tissue we analyzed and has an evident role in the regulation of prostate growth.

[Role of growth factors in the etiopathogenesis of benign prostatic hyperplasia]. / Implicaciones de los factores de crecimiento en la etiopatogenia de la hiperplasia prostática benigna.

A comment is made on the role growth factors play on the regulation of prostate growth. These factors require the mediation of an specific membrane receptor to which they have to bind in order to exercise their action correctly. The objective of the present job is to carry out a comprehensive review of each and every growth factor involved in prostate growth: family of the epidermal growth factor, family of the beta-transforming growth factor, and family of the fibroblast growth factor. As a final conclusion, it should be mentioned that the two prostate growth-regulating factors more extensively studied and with greater etiopathogenic relevance in benign prostate hyperplasia, are the epidermal growth factor and, more particularly, the fibroblast growth factor.

[The usefulness of the carbohydrate antigen CA-50 in the prognosis of transitional-cell bladder carcinomas]. / Utilidad del antígeno carbohidratado CA 50 en el pronóstico en los carcinomas vesicales de células transicionales.

The carbohydrate antigen CA 50 is expressed in the epithelial tissue during the process of neoplastic transformation; i.e., transitional cell bladder carcinoma. The present study evaluated the biological behaviour of the CA 50 antigen in malignant superficial, deep localized and disseminated bladder tumors. One hundred subjects were entered into the study: 30 carefully selected healthy subjects comprised the first group and 70 patients with a diagnosed transitional cell bladder carcinoma comprised the second group. The serum CA 50 antigen was determined by immunofluorometric assay (Delfia CA 50 kit). Our results indicate that the carbohydrate CA 50 antigen can be utilized as a prognostic marker in patients with malignant bladder tumors. The serum antigen levels were higher for the more undifferentiated tumors and those in the advanced stages.

[Urological surgery in the octogenarian: excessive preconceptions?]. / Cirugía urológica en el octogenario: demasiados prejuicios?

We reviewed the records of 277 patients aged 80 or older that had been considered for surgery during the period 1980-1990. We analyzed the surgical risk (Goldman and ASA score), patient history, type of surgery and the post-operative course (Karnofsky index) in order to identify the risk factors and to permit objective and practical selection of patients amenable to surgical treatment. Overall, regardless of sex, the benign (35%) and malignant (18%) diseases of the prostate and bladder neoplasms (30%) accounted for more than 80% of the surgical procedures. The early postoperative complications were shown to be influenced by the type of surgery (emergency surgery), the approach (open surgery), the presence of preoperative urinary tract infections and the ASA score. Regardless of the cure rate, the analysis of the postoperative course and data gleaned from telephone interviews indicate that 61.5% of the patients probably had a very good or good quality of life at 6 months. In the non-operated group 1 out of 10 procedures that had been anticipated was not performed and many had a malignant disease. Although there were more patients with fair/poor quality of life in the patient group that did not undergo surgery than in the operated group (42.8% versus 28.5%, respectively), patient general condition at 6 months was very good or good in 50% of the patients that were followed or interviewed. The use of the preoperative evaluation methods and our clinical experience can eliminate subjective evaluation and permit developing safe and precise surgical programs.

[Leiomyoma of the lower urinary tract]. / Leiomiomas de tracto urinario inferior.

Tumors of mesothelial origin account for 1-5% of all vesical neoplasms. Leiomyomas, although rare, are the most frequently encountered. Three patients diagnosed as having leiomyoma are presented. Two had leiomyoma of the bladder and one had leiomyoma of the distal urethra. The etiopathogenesis, diagnosis and treatment of this tumor type are discussed.

[Benign hypertrophy of the prostate: pathogenic aspects]. / Hiperplasia benigna de la próstata (HBP): aspectos patogénicos.

In 106 male human cadavers the incidence of benign prostatic hyperplasia was found to be 63%. The present review confirmed age to be a determinant factor of the first order in the development of adenoma of the prostate. A delay in the presentation of BPH was observed in the cirrhotic alcoholic. Surprisingly, prostatic hyperplasia was not observed in those who had died from genitourinary, gastric or malignant hematologic diseases. No evidence of BPH was observed in 68.4% of patients who had died of cancer.