Análisis del síndrome de vejiga hiperactiva y de la incontinencia urinaria en mujeres laboralmente activas entre 25–64 años. Estudio EPICC / Analysis of overactive bladder and urinary incontinence in working women aged between 25 and 64 years. EPICC study

Introducción: Los síntomas urinarios de vejiga hiperactiva (VH) e incontinencia urinaria (IU) tienen un elevado impacto personal y económico. Este trabajo se centra en el análisis detallado de VH e IU (sintomatología derivada, hábitos de consulta y consumo de recursos) en una muestra de mujeres laboralmente activas de 25–64 años. Material y métodos: Trabajo enmarcado en el Estudio EPICC de la Asociación española de urología (epidemiológico, observacional, multicéntrico, ámbito nacional) y centrado en el análisis detallado de la muestra de mujeres laboralmente activas de 25–64 años (N=3090) y del subgrupo de mujeres con VH y/o IU (N=307). Resultados: El 4,01% de la muestra presentó únicamente IU, el 2,69% únicamente VH y el 3,24% ambas patologías. Se observó asociación entre la presencia de IU y/o VH e infecciones urinarias frecuentes, hipertensión y diabetes. En la muestra de sujetos con IU y/o VH el 28,01% tenía problemas para retener orina y el 16,94% tenía pérdidas diarias; el 27,36% sufría diariamente deseos incontrolables de orinar; el 57,65% no había consultado al médico, el 35,40% había consultado al especialista, el 23,13% deseaba consultar al especialista en incontinencia; el 28,01% había recibido tratamiento, de ellas al 55,81% se les prescribió fisioterapia y al 25,58% tratamiento farmacológico. Conclusión: Se presentan datos sobre presencia de VH y IU en mujeres laboralmente activas de 25–64 años y sobre la magnitud de las afecciones y uso de recursos sanitarios en sujetos con IU y/o VH, a fin de contribuir al mejor diagnóstico de estos trastornos y manejo de pacientes y recursos (AU)

Introduction: Urinary symptoms Overactive Bladder (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 women aged 25–64. Material and Methods: Study 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 women aged 25–64 (N=3090) and of the subgroup of individuals with VH and/or IU (N=307).Results4.01% of the subjects presented UI alone, 2.69% OAB alone, 3.24% presented both pathologies. There exists association between UI and/or VH presence and frequent urinary infections, hypertension and diabetes. Taking into account individuals with UI and/or OAB, 28.01% had problems to retain urine, and 16.94% suffered leakage daily; 27.36% suffered uncontrollable urge to urinate daily; 57.65% had never sought medical advice, 35.40% had visited an specialist, 23.13% would like to visit an specialist in incontinence; 28.01% had received treatment, from which 55.81% had received physiotherapy and 25.58% pharmacologic treatment. Conclusion: In this study, specific data about VH and IU in working women aged 25–64 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)

[Analysis of overactive bladder and urinary incontinence in working women aged between 25 and 64 years. EPICC study]. / Análisis del síndrome de vejiga hiperactiva y de la incontinencia urinaria en mujeres laboralmente activas entre 25-64 años. Estudio EPICC.

INTRODUCTION: Urinary symptoms Overactive Bladder (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 women aged 25-64. MATERIAL AND METHODS: Study 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 women aged 25-64 (N=3090) and of the subgroup of individuals with VH and/or IU (N=307). RESULTS: 4.01% of the subjects presented UI alone, 2.69% OAB alone, 3.24% presented both pathologies. There exists association between UI and/or VH presence and frequent urinary infections, hypertension and diabetes. Taking into account individuals with UI and/or OAB, 28.01% had problems to retain urine, and 16.94% suffered leakage daily; 27.36% suffered uncontrollable urge to urinate daily; 57.65% had never sought medical advice, 35.40% had visited an specialist, 23.13% would like to visit an specialist in incontinence; 28.01% had received treatment, from which 55.81% had received physiotherapy and 25.58% pharmacologic treatment. CONCLUSION: In this study, specific data about VH and IU in working women aged 25-64 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.

[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)

[Impact of urinary incontinence and overactive bladder syndrome on health-related quality of life of working middle-aged patients and institutionalized elderly patients]. / Impacto de la incontinencia urinaria y del síndrome de vejiga hiperactiva en la calidad de vida relacionada con la salud de pacientes de mediana edad laboralmente activos y mayores de 65 años institucionalizados.

INTRODUCTION: Health-related quality of life (HRQoL) is considered by patients with urinary symptoms as the main outcome variable. Descriptive data about HRQoL in patients with urinary incontinence (UI) and/or overactive bladder (OAB) are reported. These data may serve as a reference for comparison purposes. MATERIALS AND METHODS: Data were taken from EPICC, a national, multicenter, observational, epidemiological study. Data from representative samples of four population groups were analyzed: working patients of both sexes aged 50-64 years, and institutionalized elderly patients of both sexes with no cognitive impairment. In addition to demographic and clinical data, HRQoL data from the Overactive Bladder Questionnaire (OAB-q SF) and the SF-12 Health Survey were also analyzed. RESULTS: Of the total patients in the EPICC study, 26.53% completed the HRQoL questionnaires. Patients with both UI and OAB symptoms had poorer scores than those with OAB or UI respectively in the PCS (41.34 vs. 47.17 and 45) and MCS (46.01 vs. 49.04 and 47.78) of the SF-12, and in the symptom (32.21 vs. 19.19 and 16.65) and quality of life (82.32 vs. 86.72 and 89.45) dimensions of the OAB-q SF. Impact of OAB and UI on HRQoL was higher in men over 65 years of age as compared to women of the same age (76.76 vs. 82.79). CONCLUSIONS: Concurrent symptoms of both UI and VH have a greater impact on HRQoL than those of either UI or VH alone. Impact on HRQoL is similar in middle-aged men and women, but higher in elderly men.

Impacto de la incontinencia urinaria y del síndrome de vejiga hiperactiva en la calidad de vida relacionada con la salud de pacientes de mediana edad laboralmente activos y mayores de 65 años institucionalizados / Impact of urinary incontinence and overactive bladder syndrome on health-related quality of life of working middle-aged patients and institutionalized elderly patients

Introducción: La calidad de vida relacionada con la salud (CVRS) es considerada por los pacientes con síntomas urinarios como el principal indicador de resultados. Se presentan datos descriptivos de la CVRS de sujetos con incontinencia urinaria (IU) y/o vejiga hiperactiva (VH), que servirán de marco de referencia poblacional para comparaciones. Material y métodos: Datos extraídos del estudio EPICC, estudio epidemiológico, observacional, multicéntrico y de ámbito nacional. Se analizaron los datos de muestras representativas de cuatro grupos de la población: mujeres y varones de entre 50–64 años, laboralmente activos, y mujeres y varones mayores de 65 años, institucionalizados, con nivel cognitivo conservado. Además de datos sociodemográficos y clínicos, se analizaron los datos de los cuestionarios de CVRS: cuestionario sobre vejiga hiperactiva OAB-q SF y cuestionario de salud SF-12. Resultados: Del total de incluidos en el estudio EPICC, el 26,53% respondió los cuestionarios de CVRS. Los pacientes que presentaban síntomas de VH y de IU, respecto de los que tenían síntomas de VH o de IU, tuvieron peores puntuaciones en la dimensión física del cuestionario de salud SF-12 (41,34 vs. 47,17 y 45) y en la dimensión mental del cuestionario de salud SF-12 (46,01 vs. 49,04 y 47,78) y en síntomas (32,21 vs. 19,19 y 16,65) y calidad de vida (82,32 vs. 86,72 y 89,45) del OAB-q SF. El impacto de la VH y la IU sobre la CVRS fue superior en varones de más de 65 años respecto a las mujeres de la misma edad (76,76 vs. 82,79). Conclusiones: La presentación conjunta de síntomas de VH y de IU ocasiona mayor impacto en la CVRS que la presentación aislada de VH o IU. El impacto sobre la CVRS es similar en varones y mujeres en la mediana edad pero superior en varones de más de 65 años (AU)

Introduction: Health-related quality of life (HRQoL) is considered by patients with urinary symptoms as the main outcome variable. Descriptive data about HRQoL in patients with urinary incontinence (UI) and/or overactive bladder (OAB) are reported. These data may serve as a reference for comparison purposes. Materials and methods: Data were taken from EPICC, a national, multicenter, observational, epidemiological study. Data from representative samples of four population groups were analyzed: working patients of both sexes aged 50-64 years, and institutionalized elderly patients of both sexes with no cognitive impairment. In addition to demographic and clinical data, HRQoL data from the Overactive Bladder Questionnaire (OAB-q SF) and the SF-12 Health Survey were also analyzed. Results: Of the total patients in the EPICC study, 26.53% completed the HRQoL questionnaires. Patients with both UI and OAB symptoms had poorer scores than those with OAB or UI respectively in the PCS (41.34 vs. 47.17 and 45) and MCS (46.01 vs. 49.04 and 47.78) of the SF-12, and in the symptom (32.21 vs. 19.19 and 16.65) and quality of life (82.32 vs. 86.72 and 89.45) dimensions of the OAB-q SF. Impact of OAB and UI on HRQoL was higher in men over 65 years of age as compared to women of the same age (76.76 vs. 82.79). Conclusions: Concurrent symptoms of both UI and VH have a greater impact on HRQoL than those of either UI or VH alone. Impact on HRQoL is similar in middle-aged men and women, but higher in elderly men (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)

Las pruebas funcionales urodinámicas en el diagnóstico de la vejiga neurógena / Urodynamic functional tests in diagnosis of neurogenic bladder

Las pruebas urodinámicas son un conjunto de técnicas de exploración funcional del tracto urinario inferior que tienen como objeto caracterizar la disfunción vesicoesfinteriana que padece el paciente. Incluyen la flujometría, cistomanometría, estudio de presión y flujo, perfil de presión uretral y los distintos estudios combinados (cistomanometría con electromiografía y estudios videourodinámicos). Con estos estudios podremos caracterizar las alteraciones del detrusor (hiperactivo, hipoactivo o acontráctil) y de la uretra (obstructiva o incompetente), definiendo con precisión qué mecanismo funcional explica la incontinencia urinaria o la disfunción de vaciado que padece el paciente. Un estudio urodinámico no debe interpretarse de forma aislada, sino que es muy importante valorarlo de forma conjunta con la clínica que presenta el paciente, sus antecedentes personales y los hallazgos de la exploración física dirigida. Este artículo pretende revisar las distintas pruebas funcionales urodinámicas, sus resultados e interpretación como herramienta fundamental para caracterizar el funcionamiento vesicouretral

Urodynamic tests are a combination of functional examination techniques of the lower urinary tract whose objective is to characterize vesical-sphincter dysfunction suffered by the patient. They include uroflowmetry, cystometry, pressure and flow study, urethral pressure profile and different combined studies (cystomanometer with electromyography and videourodynamic studies). With these studies, we could characterize the alterations of the detrusor (hyperactive, hypoactive or acontractile) and the urethra (obstructive or incompetent), accurately defining what functional mechanism explains urinary incontinence or emptying dysfunction suffered by the patient. A urodynamic study should not be interpreted alone. It is very important to assess it together with the symptoms presented by the patient, his/her personal background, and the findings of the directed physical examination. This article aims to review the different urodynamic functional tests, their results and interpretation as fundamental tool to characterize vesicouretral functioning

Terminología de la función del tracto urinario inferior / Terminology for lower urinary tract function

No disponible

[Peripheral nerve evaluation:indications, technique and results]. / Exploración de raíces sacras: indicaciones, técnica y resultados.

INTRODUCTION: Sacral nerve neuromodulation is a new treatment modality for patients with chronic voiding dysfunction (CVD). The aim of this treatment is to restore the disbalanced micturition reflexes by electrical stimulation ot the sacral roots. Peripheral Nerve Evaluation (PNE) is the first step needed to determine wether sacral nerve stimulation for the control of lower urinary tract dysfunction is appropriate for a given patient, yielding accurate information about the location, integrity and function of sacral nerves, and motor and sensorial responses to electrical stimulation. PATIENTS AND METHOD: 43 PNE in 28 patients (13 man and 15 women) were performed between january 2000 and november 2001 (mean age 56.3 years old, 22-76). Every patient have been diagnosed of CVD: 13 Urinary Urge Incontinence (UUI). 5 Urgency-Frequency Syndrome (UFS), 7 Dysfunctional Voiding (DV) and 3 Mixed Syndromes (1 patient UFS + DV and two patients with UUI + DV). RESULTS: Every acute stimulation showed positive sensory and motor responses. There was premature lead migration in 8 PNE (18.6%), preventing an appropriate evaluation of the temporal stimulation. 35 PNE were evaluated after a 6.5 days period (3-15) of electrical stimulation. There were no significative complications, and PNE was well tolerated. Good clinical results (> 50% reduction in symptoms) were observed in 7/13 patients with UUI (53.8%), 2/5 patients with UFS (40%), 1/7 patients with DV (14.2%) and 1/3 patients with mixed syndromes (UUI + DV) (33.3%). 11 of 28 patients with CVD (39.2%) have been selected as candidates for permanent implantation. CONCLUSION: Actually, PNE is the first step needed to determine wether sacral nerve stimulation for the control of lower urinary tract dysfunction is appropriate for a given patient. With PNE we can select properly adequate candidates for permanent implantation. It is an easy and well tolerated technique, and can be performed in any medical center in an outpatient basis.

Exploración de raíces sacras: indicaciones, técnica y resultados / Peripheral nerve evaluation: indications, technique and results

INTRODUCCIÓN: La neuromodulación mediante estimulación electrica de las raíces sacras constituye una alternativa terapéutica novedosa en el tratamiento de la disfunción miccional crónica (DMC). Pretende regular y devolver el equilibrio miccional alterado mediante impulsos eléctricos aplicados sobre las raíces sacras. La exploración de raíces sacras (ERS) es fundamental para considerar a un paciente candidato al implante definitivo del estimulador de la raíz sacra, comprobándose la integridad del arco reflejo sacro, la localización anatómica de la raíz y la respuesta sensitiva y motora del paciente. PACIENTES Y MÉTODO: Entre enero de 2000 y noviembre de 2001 hemos efectuado un total de 43 ERS en 28 pacientes (13 hombres y 15 mujeres), con edades entre 22 y 76 años (edad media 56,3). Todos los pacientes habían sido diagnosticados de DMC con los siguientes síndromes clínicos: 13 Incontinencia Urinaria de Urgencia (IUU), 5 Síndrome de Frecuencia-Urgencia (SFU), 7 Disfunción de Vaciado (DV) y 3 cuadros mixtos (1 paciente SFU+DV y dos pacientes IUU+DV). RESULTADOS: En las 43 ERS se obtuvo respuesta sensitivo y motora adecuada durante la fase aguda. En 8 ERS (18,6 por ciento) se produjo una movilización precoz del electrodo que impidió la evaluación de la estimulación temporal. Las 35 ERS restantes (81,4 por ciento) se evaluaron tras un periodo medio de estimulación de 6,7 días (3-15). No se produjeron complicaciones significativas y la exploración fue bien tolerada por todos los pacientes. Los resultados fueron satisfactorios (>50 por ciento de mejoría) en 7 pacientes (53,8 por ciento) con IUU, 2 pacientes (40 por ciento) con SFU, 1 (14,2 por ciento) con DV y 1 (33,3 por ciento) con síndrome mixto (IUU+DV). Así, del total de 28 pacientes con DMC sometidos a ERS, 11 han sido candidatos al implante del estimulador definitivo, lo que supone el 39,2 por ciento de los candidatos a esta terapia. CONCLUSIONES: Actualmente la ERS se considera una prueba previa imprescindible para la implantación de un marcapasos urinario definitivo. Con ella seleccionamos a los pacientes en los que presuntamente este tratamiento ofrecerá buenos resultados. Es una técnica sencilla, bien tolerada y que se puede efectuar ambulatoriamente en cualquier centro (AU)

[The development and preliminary validation of the IU-4 questionnaire for the clinical classification of urinary incontinence]. / Elaboración y validación preliminar del cuestionario para la clasificación clínica de la incontinencia urinaria IU-4.

RATIONALE: To prepare and validate a simple and self-administered questionnaire for the clinical rating of patients with urinary incontinence (UI) for use in the clinical practice. METHODS: The questionnaire was prepared based on a review of the literature on urinary incontinence and the views of 7 urodynamic urologists. The initial questionnaire UI-5 included 5 items related to UI symptoms that divided patients into three categories: stress incontinence (UEI), urge incontinence (UUI) or mixed urinary incontinence (MUI). An additional question evaluates the impact of UI type on the quality of life. The of construct validity was analyzed correlating the responses to UI-5 items and the question on quality of life. The area under the ROC curve was calculated for each UI type correlating the UI-5 scores and the results of the urodynamic test. The cut-off values for each scale were determined based on sensitivity (SE) and specificity (SP). RESULTS: The study included 188 females with UI (73.4% with UEI, 13.3% with UUI and 13.3% with MUI; based on the urodynamics). Only 4.3% patients did not answer some UI-5 items. One item related to the protective material used was excluded as it was not related to UI types, and so the final questionnaire included only 4 items (UI-4). The results show that UI-4 discriminates the different types of incontinence: UEI (SE: 0.69/SP: 0.76; 1 item), UUI (SE: 0.83/SP: 0.65; 2 items), MUI (SE: 0.72/SP: 0.65; 1 item). 100% patients with MUI, 84% with UUI and 59.9% with UEI report some impact on their quality of life. CONCLUSIONS: UI-4 is simple, valid and easy to administer, and can be particularly valuable in the clinical rating of UI in settings where urodynamic testing is not easily available such is primary health care.

Prevalence of urinary incontinence among Spanish older people living at home.

OBJECTIVE: To estimate the prevalence and characteristics of urinary incontinence (UI) in the noninstitutionalized elderly population of Madrid, Spain. METHODS: We carried out a cross-sectional study in a representative sample of all community-dwelling people aged 65 or over. Subjects were interviewed in their homes. The question: Do you currently experience any difficulty in controlling your urine? . In other words, does your urine escape involuntarily? was used to identify UI. Type of UI, use of absorbents and specific drugs were also assessed, as well as consultation behavior. RESULTS: 589 persons were interviewed (response rate: 71.2%). The prevalence of UI was 15.5%. No significant difference was observed between men and women. Urge UI was the main type for men and mixed UI for women. Use of pads was referred by 20.2%. A total of 34.3% of subjects never went to the doctor for their problem (25.2% of men and 39.4% of women). CONCLUSION: Compared to other populations the overall prevalence of UI in Spanish elders living at home is relatively high. A very small difference by gender was found, although a lower response rate in women could in part explain this unexpected finding.

[Urinary and sexual alterations in multiple sclerosis]. / Alteraciones urinarias y sexuales en la esclerosis múltiple.

Urinary and sexual symptoms in patients with multiple sclerosis (MS) are frequent, although this question has scarcely been addressed in our country. The aim of this study is to prospectively evaluate the presence of such symptoms in 77 MS patients. We have valued the neurological involvement and the degree of functional disability through the Minimum Dossier of Disability for Multiple Sclerosis. The urinary and sexual symptoms were collected through a directed survey. We have performed an urodynamic study in order to evaluate the bladder function. Urinary symptoms wire observed in 81.8% of patients, with predominance of the mixed syndrome (52%). Males show greater neurological affectation and functional disability, as well as greater urinary symptoms frequency (91%). The most frequent symptoms have been urgency (66.6%), frequency (60.3%) and dysuria (53.8%). The complications have been scarce, of infectious type (14.28%) and with female predominance. The most frequent urodynamic finding has been the detrusor hyperreflexia (60%). The minimum dossier of Disability for Multiple Sclerosis is useful to establish comparative parameters with other studies and with more specific urologic data. The presence of urinary symptoms in multiple sclerosis correlated with the degree of neurological (pyramidal and cerebellar) involvement and of functional disability in the Dysfunction Status Escale.

[Neurologic changes in patients with multiple sclerosis]. / Alteraciones neurourológicas en pacientes afectos de esclerosis múltiple.

OBJECTIVE: To evaluate the presence of urinary symptoms in 77 patients with multiple sclerosis. METHODS: The neurological compromise and the degree of functional disability were evaluated through the Minimum Dossier of Disability for Multiple Sclerosis. The pertinent data for the urinary symptoms were collected through a directed survey. A urodynamic study was performed to evaluate bladder function. RESULTS: 81.8% of the patients had urinary symptoms, the most prevalent being the mixed syndrome (52%). Neurological involvement and functional disability were greater in the male patients and there was a higher incidence of urinary symptoms (91%). Urgency (66.6%), frequency (60.3%) and dysuria (53.8%) were the most common urinary symptoms. The complication rate was low; infection was the most common complication (14.28%) and was more prevalent in the females. Detrusor hyperreflexia (60%) was the most frequent urodynamic finding. CONCLUSIONS: Urinary symptoms are frequent in multiple sclerosis (81.8%), the most prevalent being the mixed syndrome. Neurological involvement and functional disability are greater in the male patients and there is a higher incidence of urinary symptoms. There is a significant correlation between the severity of neurological compromise (pyramidal and cerebellar) and the degree of functional disability and the presence of urinary symptoms.

A multicentre study of the hospital care of 1500 patients with myelomeningocele.

The purpose of this paper is to describe the medical attention that is given to patients affected by myelomeningocele in Spain. We have used information extracted from the 'Multicentre study of patients suffering from spina bifida in Spain'. This material was collected between 1986 and 1988 from experiences with 1500 patients all over our country. 52.9% of the patients were male, and 47% female, and of the total number, 72.2% were under 15 years of age. Most of these patients attended public hospitals (78.5%) and on average each one had been admitted about seven times. The cost of hospitalisation of the sample has been assessed. Urology, orthopaedic surgery and rehabilitation are the specialties most involved. The most frequent complications were those related to the urinary system (66.1%).

[Sexual dysfunction in Parkinson's disease]. / Disfunción sexual en la enfermedad de Parkinson.

Sexual activity, function and libido in 50 patients with idiopathic Parkinson's disease and no signs of mental deterioration were evaluated by an estructured questionnaire. The sample included 36 men and 14 women with a mean age of 57.9 +/- 10.1 years and a mean time elapsed since onset of 7.01 +/- 3.9 years. We found decreased sexual activity in 68% and a lack of libido admitted by 26%. Although the decrease in sexual activity was found more often in women, this dysfunction was not statistically significant. Decreased sexual desire, however, was statistically significant. Erectile dysfunction was found in 38.8% and was more frequent in patients over 61 years of age.

Ambulation in patients with myelomeningocele: a study of 1500 patients.

Data from 1500 patients affected by spina bifida have been collected in a multicentre study in Spain from 1986 to 1988. This paper is concerned with a part of the data, specifically regarding the walking of patients and certain factors that influence the prognosis for ambulation. The neurological level of lesion most commonly present was lumbosacral (65.6%). Hydrocephalus was frequent (62% of the sample), and has significant implications regarding prognosis for walking. Hip dislocation (32%) and scoliosis (22.9%) were orthopaedic problems noted in our sample. Pressure sores appeared in 31.7% of the patients. The onset of walking ability has been studied; 15% of the sample started walking at an age older than 5 years. Finally, different modalities of ambulation are described according to the use of ancillary devices, and in independence in activities of daily living.