The 3-day bladder diary is a feasible, reliable and valid tool to evaluate the lower urinary tract symptoms in women.

AIMS: To evaluate the feasibility (% of completion), reliability (test-retest and inter-observer) and validity (convergent vs. questionnaires and vs. urodynamic study-UDS) of the 3-day bladder diary (3dBD) in women with lower urinary tract symptoms (LUTS). METHODS: Epidemiological, descriptive, cross-sectional and prospective study. Fourteen Functional Urology and Urodynamic Units participated. One hundred thirty-six women with mean age (SD) 55.2 (13.8) years with LUTS, without bladder catheterization and who were able to fill in the 3dBD were included. An UDS was performed. They filled in the 3dBD in two times separated by 15 days (test and retest), the International Consultation on Incontinence-Short Form (ICIQ-UI SF) and the Bladder Control Self-Assessment Questionnaire (BSAQ). RESULTS: One hundred ten women completed 3dBD for test and retest. Feasibility: each 3dBD has 42 variables, 77.2% women completed 80%. Test-retest reliability: there were not differences in the proportion of patients classified as positive for each symptom (urgency: P = 0.3173; incontinence: P = 1; nocturia: P = 0.0522; frequency: P = 0.4386). The Intraclass Correlation Coefficient (ICC) ranged from 0.67 to 0.92, except for night time VVmax which was lower (0.54). Inter-observer reliability: ICC ranged from 0.64 to 0.99, except for day time VVmax (0.29) and the number of urgency episodes (0.45). VALIDITY: Spearman correlation coefficients for ICIQ-UI SF and BSAQ ranged from 0.4 to 0.6 (P < 0.0001) and for UDS were lower (P < 0.05). CONCLUSIONS: The 3dBD showed good feasibility, reliability and validity to be used in the assessment of LUTS in women.

[Paired kidneys in transplant]. / Riñones parejos en trasplante.

OBJECTIVES: Many factors affect the graft and patient survival on the renal transplant outcome. These factors depend so much of the recipient and donor. We accomplished a study trying to circumvent factors that depend on the donor. We checked the paired kidneys originating of a same donor cadaver. PATIENTS AND METHOD: We examined the risk factors in the evolution and follow-up in 278 couples of kidney transplant. We describe their differences, significance, the graft and patient survival, their functionality in 3 and 5 years and the risk factors implicated in their function. We study immunogenic and no immunogenic variables, trying to explain the inferior results in the grafts that are established secondly. We regroup the paired kidneys in those that they did not show paired initial function within the same couple. RESULTS: The results yield a discreet deterioration in the graft and patient survival for second group establish, superior creatinina concentration, without obtaining statistical significance. The Cox regression study establishes the early rejection (inferior to three months) and DR incompatibility values like risk factors. CONCLUSIONS: This model of paired kidneys would be able to get close to best-suited form for risk factors analysis in kidney transplant from cadaver donors, if more patients examine themselves in the same way. The paired kidneys originating from the same donor do not show the same function in spite of sharing the same conditions of the donor and perioperative management.

[Papillary renal carcinoma presenting as hydronephrosis]. / Hidronefrosis como cáncer papilar renal.

BACKGROUND: We describe a new case of incidental renal papillary carcinoma. We perform a bibliographic review. METHODS: The papillary renal cell carcinoma is a variant of renal carcinoma. They classify in two subtypes that have relation with their prognosis. We presented one case of renal papillary carcinoma in a male of 76 years, play-acting as severe hydronephrosis. RESULTS: We describe the findings and final pathological result associated with a synchronic metastasis in the ipsilateral ureter. CONCLUSIONS: We describe the findings and final pathological result associated with a synchronic metastasis in the ipsilateral ureter.

Hidronefrosis como cáncer papilar renal / Papillary renal carcinoma presenting as hydronephrosis

OBJETIVO: Describir un nuevo caso de carcinoma papilar incidental. Revisión de la literatura.MÉTODOS: El carcinoma papilar renal (CRP) es una variante dentro del carcinoma renal. Se clasifican en dos subtipos que tienen relación con su pronóstico. Presentamos un caso de CRP en un varón de 76 años, simulando una hidronefrosis evolucionada.RESULTADO/CONCLUSIONES: Se describen los hallazgos y el posterior resultado histológico asociado de una metástasis sincrónica en el uréter ipsilateral(AU)

OBJECTIVE: We describe a new case of incidental renal papillary carcinoma. We perform a bibliographic review.METHODS: The papillary renal cell carcinoma is a variant of renal carcinoma. They classify in two subtypes that have relation with their prognosis. We presented one case of renal papillary carcinoma in a male of 76 years, play-acting as severe hydronephrosis.RESULTS/DISCUSSION: We describe the findings and final pathological result associated with a synchronic metastasis in the ipsilateral ureter(AU)

Riñones parejos en trasplante / Paired kidneys in transplant

Objetivos: Muchos factores afectan la supervivencia del injerto y paciente en el resultado de un trasplante renal. Estos factores dependen tanto del receptor como del donante. Realizamos un estudio intentando obviar factores que dependen del donante. Revisamos los riñones parejas provenientes de un mismo donante cadáver. Pacientes y métodos: Analizamos los factores de riesgo en la evolución y seguimiento de 556 trasplantes renales que corresponden a 278 parejas de riñones. Describimos sus diferencias, su significación, la supervivencia de injerto y paciente, su funcionalidad a 3 y 5 años y los factores de riesgo implicados en su función. Se estudian variables inmunológicas y no inmunológicas intentando explicar los resultados inferiores en los injertos que se implantan en segundo lugar. Se reagrupan los riñones parejos en aquellos que no mostraron función pareja inicial dentro de la misma pareja. Resultados: Los resultados arrojan un discreto empeoramiento en la supervivencia de injerto y paciente para el grupo de segundo implante, cifras superiores de creatinina, sin obtener significación estadística. El estudio por regresión de Cox solo establece como factores de riesgo el rechazo precoz (inferior a tres meses) y la tasa de incompatibilidad DR. Conclusiones: Este modelo de riñones parejos podría acercarnos de forma más adecuada al análisis de los factores de riesgo en trasplante de donante cadáver, si más pacientes se analizan de la misma forma. Los riñones parejas provenientes del mismo donante no muestran igual función a pesar de compartir las mismas condiciones del donante y del manejo peroperatorio (AU)

Objectives: Many factors affect the graft and patient survival on the renal transplant outcome. These factors depend so much of the recipient and donor. We accomplished a study trying to circumvent factors that depend on the donor. We checked the paired kidneys originating of a same donor cadaver. Patients and method: We examined the risk factors in the evolution and follow-up in 278 couples of kidney transplant. We describe their differences, significance, the graft and patient survival, their functionality in 3 and 5 years and the risk factors implicated in their function. We study immunogenic and no immunogenic variables, trying to explain the inferior results in the grafts that are established secondly. We regroup the paired kidneys in those that they did not show paired initial function within the same couple. Results: The results yield a discreet deterioration in the graft and patient survival for second group establish, superior creatinina concentration, without obtaining statistical significance. The Cox regression study establishes the early rejection (inferior to three months) and DR incompatibility values like risk factors. Conclusions: This model of paired kidneys would be able to get close to best-suited form for risk factors analysis in kidney transplant from cadaver donors, if more patients examine themselves in the same way. The paired kidneys originating from the same donor do not show the same function in spite of sharing the same conditions of the donor and perioperative management (AU)

[Urodynamic assessment of the voiding phase in childhood]. / Valoración urodinámica de la fase miccional en la infancia.

OBJECTIVE: To determine the more useful parameters of urethral resistance and bladder contractile power to explain the values of maximum flow and postvoid residual urine observed in free uroflowmetry and appropriately assess the voiding dynamics in childhood. METHODS: A cross-sectional study was carried out in 68 children (46 girls and 22 boys) with a mean age of 8.9 years. These children were subjected to free uroflowmetry in order to determine the maximum flow rate and the postvoid residual urine, and to a complete urodynamic study with perineal surface electromyography in order to determine the parameters of urethral resistance and bladder contractile power. A univariate linear regression model was built from these parameters for explanatory purposes. The independent variables were the parameters of the urodynamic study and the outcome variables were the value of the maximum flow in the free uroflowmetry and the proportion of postvoid residual urine in relation to the voiding volume of the free uroflowmetry. The resulting models were validated in order to determine its loss of predicting power (shrinkage). For this purpose, we used two other independent series: one comprised 50 patients (34 girls and 16 boys) extracted from the same sample as the derived model, and the other comprised 85 patients (53 girls and 32 boys) from another population. RESULTS: The multivariate model demonstrated that the maximum flow of the free uroflowmetry has a direct relationship with the square root of the voiding volume and the bladder contractile power [measured by Schafer's projected isometric pressure (PIP)] and an inverse relationship with the urethral resistance measured by means of a parameter (URA) and with the presence of electromyographic perineal activity (EMG) during voiding. Similarly, the proportion of postvoid residual urine has a direct relationship with the urethral resistance (measured by means of the parameter URA) and with the inverse function of the projected isometric pressure (I/PIP). The shrinkage of the multivariate models, when compared with other series, ranged from 26.9% and 1.3%. CONCLUSIONS: The urodynamic evaluation of the lower urinary tract in childhood can be carried out appropriately by means of the determination of the urethral resistance by the parameter URA and of the bladder contractile power by the projected isometric pressure (PIP), obtaining as a limit of normal values a URA of 16 cm H2O and a PIP of 105 cm H2O.

Valoración urodinámica de la fase miccional en la infancia / Voiding urodynamic assessment in childhood

OBJETIVOS: Determinar que parámetros de resistencia uretral y potencia contráctil vesical son más útiles para explicar los valores de flujo máximo y residuo postmiccional observados en la flujometría libre, y valorar adecuadamente la dinámica miccional en la infancia. MÉTODOS: Se realizó un estudio de corte en una serie de 68 niños (46 niñas y 22 niños varones) de edad media 8,9 años. Los niños fueron sometidos a una flujometría libre para determinar el flujo miccional máximo y el residuo postmiccional, y un estudio urodinámico completo, con electromiografía perineal, para determinar los parámetros de resistencia uretral y potencia contráctil vesical. A partir de estos parámetros se elaboró un modelo de regresión lineal multivariante con fines explicativos, utilizando como variables independientes los parámetros del estudio urodinámico, y como variables resultados el valor del flujo máximo en la flujometría libre y la proporción de residuo postmiccional respecto al volumen miccional de la flujometría libre. El modelo resultante fue validado, en orden de determinar su pérdida de poder predictivo ("shrinkage"), con otras dos series independientes: una serie formada por 50 pacientes (34 niñas y 16 niños) extraídos de la misma población del modelo derivado, y otra serie de 85 pacientes (53 niñas y 32 niños) extraída de otra población diferente. RESULTADOS: El modelo multivariante determinó que el flujo máximo de la flujometría libre depende directamente de: la raíz cuadrada del volumen miccional y la potencia contráctil vesical medida mediante la presión isométrica proyectada (PIP) de Schäfer, e inversamente de: la resistencia uretral medida mediante el parámetro URA y de la presencia de actividad EMG perineal durante la micción. Análogamente la proporción del residuo postmiccional fue directamente proporcional a la resistencia uretral medida mediante el parámetro URA y a la función inversa de la presión isométrica proyectada (1/PIP). La pérdida del poder predictivo ("shrinkage") del modelo al compararlo con otras series, osciló entre el 26,9 por ciento y el 1,3 por ciento. CONCLUSIONES:. La valoración urodinámica del tracto urinario inferior en la infancia se puede realizar adecuadamente mediante la determinación de la resistencia uretral por el parámetro URA y de la potencia contráctil vesical por la presión isométrica proyectada (PIP), obteniéndose como límite de la normalidad en nuestra serie una URA de 16 cm H2O, y una PIP de 105 cm H2O (AU)