Influence of bladder lithiasis on lower urinary tract dynamics in patients with spinal cord injury.

STUDY DESIGN: A prospective and a case-matched control study. OBJECTIVES: To study the lower urinary tract dysfunction associated with bladder lithiasis in patients with spinal cord injury (SCI). SETTING: Toledo (Spain). METHODS: We have carried out a urodynamic study in 30 patients with SCI with lithiasis in their bladder before and 3 months after bladder endoscopic lithotripsy. This second study was compared with the urodynamic findings of a different group of 30 patients with SCI, without a history of bladder lithiasis, paired with cases by gender and date of urodynamic study. RESULTS: We have found that the prevalence of neurogenic detrusor overactivity (NDO) was significantly different after bladder lithotripsy, although the cystomanometric capacity was significantly increased. A group of patients with lithiasis showed a maximum flow rate, a voiding maximum detrusor pressure and the detrusor contractility parameter Wmax lower than that in controls. On the other hand, a voiding abdominal straining was found to be significantly greater than that in controls. CONCLUSIONS: Bladder lithiasis affects the presence of NDO in patients with SCI. Patients with SCI who develop bladder lithiasis present a lower detrusor contractility power compared with those who do not.

[Clinical trial to evaluate trospium chloride (Uraplex) effectiveness and tolerance in patients with detrusor instability incontinence and its impact on quality of life]. / Ensayo clínico para evaluar la eficacia y tolerancia del cloruro de trospio (Uraplex) en pacientes con incontinencia por inestabilidad del detrusor y su repercusión en la calidad de vida.

OBJECTIVE: To determine the efficacy, tolerance and quality-of-life effects of trospium chloride in women with overactive bladder. METHODS: An open, prospective multicenter trial was conducted on 75 women with urinary incontinence from overactive bladder (ICS criteria, urodynamic evaluation). Trospium chloride was administered at a dose of 20 mg twice daily for 8 weeks. Neurological examination and cystometry were performed at the start of the trial. Quality of life was evaluated by analogue visual scales (faces scale) and EUROQOL (health status scale). At the 4th week, urodynamic, clinical, quality-of-life and tolerance evaluations were performed. Clinical and tolerance data and quality of life index were assessed at the 8th week. RESULTS: 8 of the 75 patients did not complete the study. Thus, analysis of the therapeutic efficacy was performed in 67 patients, while description and tolerance analyses were performed for the overall group of patients. Urodynamic parameters significantly improved at 4 weeks: maximum bladder capacity (232.09 ml pre-treatment vs 315.83 ml post-treatment) and first desire to void (100.9 ml pre-treatment vs 156.7 ml post-treatment). Incontinence clinical items also improved. All quality-of-life indixes significantly increased at the 4 and 8 weeks control evaluation. Excellent or very good tolerance was observed in 89.5% of the patients. CONCLUSIONS: The results of the study corroborate the efficacy and tolerance of trospium chloride in the management of overactive bladder in women. Improvement in patient quality of life was also observed.

[Simplified Ramírez urethropexy in the treatment of genuine stress urinary incontinence in women. Multicenter study of clinical and urodynamic results]. / Uretropexia simplificada de Ramírez en el tratamiento de la incontinencia urinaria de esfuerzo genuina en la mujer. Estudio multicéntrico sobre los resultados clínicos y urodinámicos.

OBJECTIVES: To evaluate the clinical and urodynamic data of a multicenter study on female urinary stress incontinence undergoing surgical repair with the Ramírez simplified urethropexy. METHODS: Clinical, urodynamic and videocystographic data were analyzed in a multicenter series of 340 female patients with urinary stress incontinence (mean age 51.7 +/- 9.7 years) before and after the Ramírez urethropexy technique (mean follow-up 21.7 months). RESULTS: Post surgical urinary continence was 78.4%. Cystocele repair was demonstrated in 57.7%. Urge incontinence decreased in 17.1%. Daytime frequency statistically significantly decreased in 19%. Urinary obstructive symptoms increased in 19.3%. Bladder instability significantly decreased posturethropexy. Peak urinary flow rate and mean urinary flow rate diminished in 65% and 59%, respectively. Postvoiding residual urine increased significantly. No statistical correlation between posturethropexy continence and videocystographic bladder neck morphology was observed. CONCLUSIONS: The clinical and urodynamic data obtained in our series indicate that the Ramírez urethropexy technique, a simple and fast procedure, may be considered an alternative treatment in female urinary stress incontinence.

[Urodynamic results of the treatment of urinary incontinence with peripheral electric stimulation]. / Resultados urodinámicos del tratamiento de la incontinencia urinaria con estimulación eléctrica periférica.

OBJECTIVES: To evaluate the urodynamic results achieved by electrostimulation in patients with different types of urinary incontinence. METHODS: 37 patients (32 females and 5 males) with urinary incontinence were treated with peripheral electrical stimulation. The urodynamic diagnosis were: detrusor instability (24.3%), stress urinary incontinence (24.3%), mixed urinary incontinence (48.6%), and bladder hyper-reflexia (2.7%). Rectal and vaginal electrodes were utilized. The therapeutic frequencies were 10 Hz, 20 Hz and 50 Hz. RESULTS: Detrusor instability disappeared in the cases treated with the 10 Hz frequency (79%) and in one case treated with the 50 Hz frequency. A significantly increased bladder capacity and decreased first micturition sensation were observed in this patient group. All patients with stress urinary incontinence were treated with high frequency (50 Hz), which achieved positive results in 44%. In the group of patients with mixed urinary incontinence. 45% remained unchanged. Treatment failed to achieve satisfactory results in the single case of detrusor hyperreflexia in this series. CONCLUSION: Peripheral electrical stimulation is a valid alternative in the treatment of male and female incontinence. Satisfactory results were achieved with the 10 Hz frequency in 89% of the patients with bladder instability and with the 50 Hz frequency in 44% of the patients with stress urinary incontinence.