¿Existe concordancia entre vejiga hiperactiva e hiperactividad del detrusor en varones con síntomas predominantemente de llenado derivados a Unidades de Urología Funcional y Urodinámica? / Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units?

Objetivo Estudiar el grado de concordancia diagnóstica entre vejiga hiperactiva (VH) e hiperactividad del detrusor (HD) en varones con síntomas del tracto urinario inferior (STUI) predominantemente de llenado, y el perfil clínico y urodinámico según presencia de HD y grado de obstrucción del tracto urinario inferior (OTUI).Material y métodos Estudio epidemiológico, transversal, multicéntrico y nacional. Se cumplimentaron: diario miccional de 3 días (DM3d), International Prostate Symptom Score (IPSS) y Cuestionario de Autoevaluación del Control de la Vejiga (CACV). Se determinó el volumen prostático (Vp) por ecografía y se realizó estudio urodinámico (EUD). Se analizó la prevalencia de VH y HD y la concordancia (kappa). Se realizó un análisis descriptivo de características clínicas y urodinámicas; posteriormente se comparó su frecuencia según presencia de HD y OTUI.ResultadosSe evaluaron 445 pacientes con edad media±DE de 54,8±9,9 años. Según el DM3d, un 89,8% presentaba frecuencia miccional aumentada, un 87,9% nicturia, un 72,8% urgencia y un 31,9% incontinencia urinaria de urgencia (IUU). Un 36,8% tenía OTUI. El 54,5% presentaba VH y HD. La concordancia diagnóstica entre HD y VH fue baja (κ=0,1702). Más pacientes con HD que sin ella presentaron urgencia (DM3d y CACV; p<0,001), IUU (DM3d; p=0,008) y nicturia (CACV; p<0,001). Hubo diferencias en IPSS-vaciado, flujo máximo (Qmax) y residuo posmiccional (p<0,05) según el grado de obstrucción.ConclusionesEn pacientes varones de 18 a 65 años con STUI predominantemente de llenado derivados a unidades especializadas, aproximadamente la mitad tienen coexistencia de VH y HD y un tercio tenía obstrucción. Hay baja concordancia diagnóstica entre VH y HD (AU)

Objective To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction.Material and methods Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction.ResultsA total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ=0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p<0.001), UUI (3dBD; p=0.008) and nocturia (B-SAQ; p<0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p<0.05) according to the obstruction degree.ConclusionsApproximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor (AU)

Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units?

OBJECTIVES: To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction. MATERIAL AND METHODS: Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction. RESULTS: A total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ = 0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p < 0.001), UUI (3dBD; p = 0.008) and nocturia (B-SAQ; p < 0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p < 0.05) according to the obstruction degree. CONCLUSIONS: Approximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor.

Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units? / ¿Existe concordancia entre vejiga hiperactiva e hiperactividad del detrusor en varones con síntomas predominantemente de llenado derivados a Unidades de Urología Funcional y Urodinámica?

OBJECTIVE: To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction. MATERIAL AND METHODS: Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction. RESULTS: A total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ=0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p<0.001), UUI (3dBD; p=0.008) and nocturia (B-SAQ; p<0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p<0.05) according to the obstruction degree. CONCLUSIONS: Approximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor.

[Installed Capacity Perception Survey for the Training of Residents Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico]. / Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte.

INTRODUCTION: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. MATERIAL AND METHODS: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. RESULTS: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. CONCLUSIONS: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and 90% without regular scientific production.

INTRODUCCIÓN: Es fundamental que los médicos residentes de ortopedia (traumatología) sean altamente competentes en todos los aspectos, considerando el equilibrio entre la oferta, demanda, necesidad y contexto. Es primordial identificar la capacidad y calidad instalada para su formación en México. MATERIAL Y MÉTODOS: Estudio observacional, transversal, muestreo no probabilístico-conglomerados, en dos fases. El instrumento tiene ocho dominios, 57 variables y 4,867 ítems. Sesenta profesores de postgrado de 20 estados, 50 sedes hospitalarias, 22 programas universitarios. RESULTADOS: 1,038 años de experiencia (inteligencia colectiva), 17 años de experiencia/profesor (01 a 50 años). Se identificó: patología aguda 30 (2 a 90%), patología crónica 30 (5 a 96%), pacientes 15 años, 10 (3 a 30%), pacientes entre 15 y 65 años, 47 (2 a 78%), pacientes 65 años, 20 (2 a 60%), número de camas/sede 20 (2 a 510), número de consultorios 3 (1 a 48), el número de procedimientos quirúrgicos/sede al año a nivel nacional fue de 960 (50 a 24,650). La media nacional por médico residente es de 362 cirugías/año con 1,450 momentos quirúrgicos/año. CONCLUSIONES: Las necesidades y recursos para la formación de médicos especialistas en ortopedia/traumatología son en alto grado heterogéneos, por lo cual se debería adaptar a las necesidades epidemiológicas de la región de influencia, en un ámbito de transición epidemiológica. Sesenta y dos punto dos por ciento expresó no tener o tener deficiente infraestructura académica y científica en su sede, más de 50% sin rotación al extranjero y 90% sin producción científica regular.

Posicionamiento de la Asociación Española de Urología ante el documento de la Sociedad Española de Oncología Médica sobre la administración de tratamientos médicos a los pacientes oncológicos / Positioning statement of the Spanish Association of Urology on the document published by the Spanish Society of Medical Oncology about the use of medical treatments in oncological patients

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Carga del cuidado en cuidadores familiares de personas con enfermedad crónica en la región amazónica de Colombia / Care burden in family caregiving of people suffering chronic disease in Amazon region of Colombia / Carga do cuidado em cuidadores familiares de pessoas com doença crónica na região amazónica da Colômbia

Objetivo: caracterizar y determinar el nivel de carga del cuidado que experimenta un grupo de cuidadores familiares de personas con enfermedad crónica no trasmisible (ECNT) que habitan en la región amazónica de Colombia. Metodología: estudio descriptivo de corte transversal hecho en el municipio de Leticia y zonas aledañas, entre 2 012-2 013, con un grupo de 50 cuidadores familiares de personas con enfermedad crónica no transmisible. Los instrumentos de recolección empleados fueron el GCC-UN-C© y la entrevista para la percepción de carga del cuidado de Zarit en su versión de 22 preguntas. Resultados: la caracterización de los cuidadores familiares de personas con ECNT de la región amazónica colombiana muestra que estos son, en su mayoría, mujeres, adultas jóvenes, de estratos muy bajos, quienes cuidan a sus familiares hace más de 19 meses y lo hacen por más de siete horas diarias. Estos cuidadores tienen un estado de funcionalidad bueno, al igual que un adecuado estado mental y cuentan con apoyo familiar y, en algunos casos, de acción social. No tienen conocimiento ni acceso a tecnologías de información y comunicación (TIC). La mayoría percibe tener carga con su responsabilidad de cuidado. Conclusiones: con base en la caracterización que señala las condiciones de dificultad que tienen los cuidadores familiares de personas con ECNT que habitan en la región amazónica de Colombia y el nivel de carga del cuidado que perciben, es urgente hacer un llamado al Sistema General de Seguridad Social en Salud para definir políticas de apoyo para estas personas que se encuentran en un alto riesgo de enfermar, con las graves consecuencias que ello tendría tanto para ellos mismos como para las personas con ECNT a las que cuidan.

Objective: To characterize and determine the care burden of family caregivers of people suffering chronic noncommunicable diseases (NCDs) living in the Amazon region of Colombia. Methodology: Cross-sectional, descriptive study conducted in the city of Leticia and surrounding areas between 2 012 and 2 013 with a group of 50 family caregivers of people suffering chronic noncommunicable diseases. The data collection tools used were GCC-UN-C© and Zarit caregiver burden interview (22-question version). Results: The characterization of family caregivers of people suffering NCDs in the Amazon region of Colombia shows that they are mainly lower class, young adult women who have cared for their relatives for more than 19 months and do so for over seven hours per day. These caregivers function adequately and are in good mental condition; they also have help from family and, in some cases, receive assistance from social services. They are not knowledgeable about nor have access to information and communications technologies (ICT). Most perceive their caregiving responsibility as a burden. Conclusions: Based on this characterization, which describes the care burden and the difficult conditions common to family caregivers of people suffering NCDs in the Amazon region of Colombia, it is an urgent matter to contact the General System of Social Security in Health to put in place policies that support these caregivers who are at risk of becoming ill, considering the serious consequences this would mean for them and for the NCD patients they care for.

Objetivo: caracterizar e determinar o nível de carga do cuidado que experimenta um grupo de cuidadores familiares de pessoas com doenças crónica não transmissível (ECNT) que habitam na região amazónica da Colômbia. Metodologia: estudo descritivo de corte transversal feito no município de Leticia e zonas próximas, entre 2 012-2 013, com um grupo de 50 cuidadores familiares de pessoas com doenças crónica não transmissível. Os instrumentos de recolecção empregados foram o GCC-UN-C© e a entrevista para a percepção de carga do cuidado de Zarit em sua versão de 22 perguntas. Resultados: a caracterização dos cuidadores familiares de pessoas com ECNT da região amazónica colombiana mostra que estes são, em sua maioria, mulheres, adultas jovens, de estratos econômicos baixos, quem cuidam a seus familiares há mais de 19 meses e o fazem por mais de sete horas diárias. Estes cuidadores têm um estado de funcionalidade bom, ao igual que um adequado estado mental e contam com apoio familiar e, em alguns casos, de ação social. Não têm conhecimento nem acesso a tecnologias de informação e comunicação (TIC). A maioria percebe ter carga com sua responsabilidade de cuidado. Conclusões: com base na caracterização que sinala as condições de dificuldade que têm os cuidadores familiares de pessoas com ECNT que habitam na região amazônica da Colômbia o nível de carga do cuidado que percebem, é urgente fazer um chamado ao Sistema Geral de Segurança Social em Saúde para definir políticas de apoio para estas pessoas que se encontram num alto risco de adoecer, com as graves consequências que isso teria tanto para eles mesmos como para as pessoas com ECNT às que cuidam.

Automated system for on-line determination of dimethylarsinic and inorganic arsenic by hydride generation-atomic fluorescence spectrometry.

A multisyringe flow-injection approach has been coupled to hydride generation-atomic fluorescence spectrometry (HG-AFS) with UV photo-oxidation for dimethylarsinic (DMA), inorganic As and total As determination, depending on the pre-treatment given to the sample (extraction or digestion). The implementation of a UV lamp allows on-line photo-oxidation of DMA and the following arsenic detection, whereas a bypass leads the flow directly to the HG-AFS system, performing inorganic arsenic determination. DMA concentration is calculated by the difference of total inorganic arsenic and measurement of the photo-oxidation step. The detection limits for DMA and inorganic arsenic were 0.09 and 0.47 µg L(-1), respectively. The repeatability values accomplished were of 2.4 and 1.8%, whereas the injection frequencies were 24 and 28 injections per hour for DMA and inorganic arsenic, respectively. This method was validated by means of a solid reference material BCR-627 (muscle of tuna) with good agreement with the certified values. Satisfactory results for DMA and inorganic arsenic determination were obtained in several water matrices. The proposed method offers several advantages, such as increasing the sampling frequency, low detection limits and decreasing reagents and sample consumption, which leads to lower waste generation.

[TVA and TOA. New adjustable mesh for the treatment of female stress incontinence. Preliminaries results]. / TVA y TOA. Nuevas mallas ajustables de tensión en el tratamiento de la incontinencia urinaria de esfuerzo. Resultados preliminares.

OBJECTIVES: Evaluation of a new mesh for incontinence (TVA/TOA) which enables the degree of tension applied during surgery to be readjusted at the post-operative stage. PATIENTS AND METHOD: 62 patients treated with the TVA mesh and monitored over a 14-month period (SD 7.8, range 6-38). In 33 patients (53%) some other pelvic prolapse was corrected. Evaluation was carried out by clinical report, examination of bladder full of 250 saline solution, flowmetry and urinary residue. 40 patients filled in 4 quality of life questionnaires (QoL; ICIQ-SF; PGI-S; PGI-I). RESULTS: 42 patients were found to be objectively continent in the post-operative evaluation. Of these, it was necessary to reduce tension in 7 cases (11%) due to urinary obstruction (flow < 10 ml/sec and/or residue). The tension of the mesh was tightened in 20 patients (32%) due to continue with a certain degree of incontinence. All patients were discharged as continent and with no residue. In the last revision, 58 patients (93%) proved to be objectively continent and 4 (6.5%) showed a notable improvement in their incontinence. The Q(MAX) is 19.8 ml/sec (SD 9.8). The mictional urgency had disappeared or improved in 32 of the patients who had this prior to operation (76%) and had appeared in 3 of the patients who didn't (15%). The clinical report showed a high level of consensus with the ICIQ-SF survey (Kappa = 0.89) regarding stress incontinence, diminishing clearly (Kappa= 0.13) when urge incontinence was taken into account. 34 (85%) patients scored over 95 out of 110 in the QoL. 30 (75%) scored less than 6 in ICIQ-SF. 32 (80%) showed a perception of normality and 4 (10%) slight illness in the PGI-S. In the PGI-I 29 (72.5%) were much better and 11 (27.5%) quite a lot better. A relation exists between urgency and dismissed quality of life. CONCLUSION: With the TVA (trans-vaginal adjustable) mesh it is possible to adjust the tension originally applied during surgery at the post-operative stage, so that any defects or excesses can be corrected.

TVA y TOA. Nuevas mallas ajustables de tensión en el tratamiento de la incontinencia urinaria de esfuerzo. Resultados preliminares / TVA and TOA. New adjustable mesh for the treatment of female stress incontinence preliminaries resulted

Objetivos: Valoración de una nueva malla de incontinencia (TVA/TOA) que permite postoperatoriamente ajustar la tensión dada en quirófano. Pacientes y Métodos: 62 pacientes tratados con la malla TVA, seguimiento medio de 14 meses (DS 7,8, rango 6-38). En 33 pacientes (53%) se añadió corrección de algún prolapso. La valoración se ha realizado mediante historia clínica, exploración con vejiga llena con 250 cc de suero salino, flujometría y residuo. 40 pacientes han rellenado 4 cuestionarios de calidad de vida. (QoL; ICIQ-SF; PGI-S y PGI-I). Resultados: 42 pacientes eran continentes en la valoración post-operatoria. De estos, fue necesario disminuir la tensión en 7 (11%) por obstrucción urinaria (flujo< 10 ml/seg y/o residuo). En 20 pacientes (32%) se aumentó la tensión por continuar algún grado de incontinencia. Todos fueron dados de alta continentes y sin residuo. En la última revisión, 58 (93%) son totalmente continentes y 4 (6,5%) han mejorado notablemente su incontinencia. El QMAX es 19,8 ml/s (DS 9,8). La urgencia miccional ha desaparecido o mejorado en 32 (76%) de los pacientes que la presentaban preoperatoriamente y ha aparecido en 3 (15%) de los que no la presentaban. La historia clínica muestra un alto grado de concordancia con el cuestionario ICIQ-SF (Kappa= 0,89) en cuanto a incontinencia de esfuerzo se refiere, disminuyendo ostensiblemente (Kappa= 0,13) cuando se toma en consideración la incontinencia por urgencia. De los 40 pacientes que completaron los cuestionarios de calidad de vida, 34 (85%) tienen una puntuación superior a 95 sobre 110 en el QoL. 30 (75%) tiene una puntuación inferior a 6 en ICIQ-SF. 32 (80%) tienen una percepción de normalidad y 4 (10%) de enfermedad leve en el PGI-S. En el PGI-I 29 (72,5%) están mucho mejor y 11 (27,5%) bastante mejor. Existe relación directa entre urgencia miccional y pérdida de calidad de vida. Conclusión: La malla TVA (transvaginal ajustable) permite ajustar la tensión dada en quirófano, permitiendo corregir los defectos y los excesos

Objectives: Evaluation of a new mesh for incontinence (TVA/TOA) which enables the degree of tension applied during surgery to be readjusted at the post-operative stage. Patients and Method: 62 patients treated with the TVA mesh and monitored over a 14-month period (SD 7.8, range 6-38). In 33 patients (53%) some other pelvic prolapse was corrected. Evaluation was carried out by clinical report, examination of bladder full of 250 saline solution, flowmetry and urinary residue. 40 patients filled in 4 quality of life questionnaires (QoL; ICIQ-SF; PGI-S; PGI-I). Results: 42 patients were found to be objectively continent in the post-operative evaluation. Of these, it was necessary to reduce tension in 7 cases (11%) due to urinary obstruction (flow< 10 ml/sec and/or residue). The tension of the mesh was tightened in 20 patients (32%) due to continue with a certain degree of incontinence. All patients were discharged as continent and with no residue. In the last revision, 58 patients (93%) proved to be objectively continent and 4 (6.5%) showed a notable improvement in their incontinence. The QMAX is 19.8 ml/sec (SD 9.8). The mictional urgency had disappeared or improved in 32 of the patients who had this prior to operation (76%) and had appeared in 3 of the patients who didn’t (15%). The clinical report showed a high level of consensus with the ICIQ-SF survey (Kappa = 0.89) regarding stress incontinence, diminishing clearly (Kappa= 0.13) when urge incontinence was taken into account. 34 (85%) patients scored over 95 out of 110 in the QoL. 30 (75%) scored less than 6 in ICIQ-SF. 32 (80%) showed a perception of normality and 4 (10%) slight illness in the PGI-S. In the PGI-I 29 (72.5%) were much better and 11 (27.5%) quite a lot better. A relation exists between urgency and dismissed quality of life. Conclusion: With the TVA (trans-vaginal adjustable) mesh it is possible to adjust the tension originally applied during surgery at the post-operative stage, so that any defects or excesses can be corrected

[Techniques and current practice of urodynamics. Problems and traps]. / Técnica y actualidad de la urodinámica. Problemas y retos.

Development of urodynamics particularly during the past decade are highlighted, as well as a number of issues to be faced in the near future: research into the etiopathogenesis of different conditions, finding more sensitive and specific diagnostic procedures to overcome the current ones, establishing more comprehensive indications for urodynamics examinations and, as a result of all the above achieving greater improvement of certain surgical procedures. Both the technique and interpretation of the different urodynamic examinations, as well as the more recent innovations, implementation issues and controversies are detailed to a highly up-to-date level. Neuromodulation and ambulatory urodynamics deserve thoughtful consideration in this paper. Finally, attention is given to the controversies and future challenges such as urodynamic research providing accurate diagnosis of lower urinary tract obstruction in women, establishing the indication of urodynamic studies in women with urinary exertional incontinence, outlining the indications of neuromodulation and ambulatory urodynamics, applicability of artificial intelligence systems, improvement of artificial sphincter materials, tissue growth for bladder enlargement and actual prevention of myelodysplasia.

Técnica y actualidad de la urodinámica. Problemas y retos / Urodynamics technique and current situation. Issues and challenges

El presente artículo pone de manifiesto el avance experimentado por la urodinámica fundamentalmente en la última década, así como los problemas a los que tendrá que hacer frente en el futuro: investigación en la etiopatogenia de diferentes enfermedades, buscar procedimientos diagnósticos más sensibles y específicos que los actuales, establecer indicaciones más exhaustivas para las exploraciones urodinámicas y con ello, conseguir el perfeccionamiento de determinados procedimientos quirúrgicos. Se detalla la técnica e interpretación de las diferentes exploraciones urodinámicas a un nivel muy actual, así como las novedades existentes, las dificultades de aplicación y controversias. La neuromodulación y la urodinámica ambulatoria merecen detalle en este artículo. Finalmente se muestran las controversias y retos de futuro, como son la investigación urodinámica que proporcione de forma precisa el diagnóstico de la obstrucción del tracto urinario inferior en la mujer, establecer la indicación del estudio urodinámico en la mujer con incontinencia urinaria de esfuerzo, perfilar las indicaciones de la neuromodulación y de la urodinámica ambulatoria, aplicabilidad de sistemas de inteligencia artificial, mejorar los materiales del esfínter artificial, desarrollo de tejidos para realizar ampliaciones vesicales y la prevención real de la mielodisplasia (AU)

Development of urodynamics particularly during the past decade are highlighted, as well as a number of issues to be faced in the near future: research into the etiopathogenesis of different conditions, finding more sensitive and specific diagnostic procedures to overcome the current ones, establishing more comprehensive indications for urodynamics examinations and, as a result of all the above achieving greater improvement of certain surgical procedures. Both the technique and interpretation of the different urodynamic examinations, as well as the more recent innovations, implementation issues and controversies are detailed to a highly up-to-date level. Neuromodulation and ambulatory urodynamics deserve thoughtful consideration in this paper. Finally, attention is given to the controversies and future challenges such as urodynamic research providing accurate diagnosis of lower urinary tract obstruction in women, establishing the indication of urodynamic studies in women with urinary exertional incontinence, outlining the indications of neuromodulation and ambulatory urodynamics, applicability of artificial intelligence systems, improvement of artificial sphincter materials, tissue growth for bladder enlargement ad actual prevention of myelodysplasia (AU)

[Long course metastasis in renal adenocarcinoma. Adrenal gland involvement]. / Enfermedad mestastásica de larga evolución en el adenocarcinoma renal. Afectación suprarrenal.

OBJECTIVES: To report two cases of metachronic adrenal metastasis (one contralateral and the other bilateral) from renal cell carcinoma with long survival. METHODS: Two patients with clear cell renal carcinoma that developed metastasis to the adrenals are described. Each patient had undergone three operations for solitary metastasis during the 8-years follow-up. The indications for the surgical management of solitary metastasis, morbidity, prognosis and recent investigational treatment possibilities reported in the literature are analyzed. RESULTS: Resection of the renal cell carcinoma achieved a survival of more than 8 years with a good quality of life and no significant surgical complications. The outcome, however, is poor. CONCLUSIONS: Although there was no lymph node involvement and the tumor was localized to the renal parenchyma, one patient developed solitary lung metastasis and contralateral adrenal metastasis 4 and 8 years after the initial diagnosis, respectively. In the other case, contralateral adrenal metastasis appeared three years later. The possibility of long-term metastasis to the adrenal gland should be taken into account due to renal vein involvement. Preservation of the adrenal gland at the initial surgery (lower pole tumor) led to adrenal metastasis 8 years after the initial diagnosis. The prognosis is poor in both cases and the situation is discouraging for the urologist.

[Painful erections related to sleeping]. / Erecciones dolorosas relacionadas con el sueño.

Case report of sleep-related painful erections in a 34 year-old male with grade C3 HIV infection. Due to severe impairment of the patient's general condition, no proper diagnostic studies were performed to gain deeper knowledge of the symptom's pathological etiology. Empirical therapy was started based on evidence from the literature consulted, and the results seen were optimal. This paper contributes a brief review of a condition infrequently seen by the vast majority of urologists.

[Disjunction patterns: the morphological and ultrastructural bases of bladder instability in the male]. / Patrones de disyunción: bases morfológicas y ultraestructurales de la inestabilidad vesical del varón.

OBJECTIVE: To apply the new protocols and recent contributions on detrusor ultrastructural morphology in order to standardize criteria and evaluate our findings relative to the ultrastructural morphology, the presence of a dysfunction pattern, changes in nerve supply and formation of a chained cellular syncytium in hyperactive detrusor bladder instability in the male. METHODS: We studied 480 ultrastructural preparations of detrusor muscle from 32 male patients with bladder outlet obstruction with and without urodynamically demonstrated bladder hyperactivity. Bladder biopsies were obtained from the anterior aspect of the bladder and prepared according to the standard procedures for ultrastructural study. Semiquantitative nerve supply ultrastructural patterns, syncytial composition, and complete and incomplete disjunction were analyzed. RESULTS: Lower urinary tract obstruction was demonstrated in all patients; 6 of these patients had involuntary phasic detrusor contractions during filling. No significant decrease in nerve supply was found in isolated obstruction or in bladder hyperactivity. No axonal degeneration was observed in any of the patients and the myelin sheath structure was normal. Nerve effector endings were also normal. Four patients with hyperactive detrusor showed complete and two incomplete disjunction pattern. Incomplete disjunction pattern was also demonstrated in two patients with isolated obstruction. CONCLUSIONS: The change in the properties of the detrusor muscle in the unstable bladder is due to a complete reduction in excitatory nerve relation to smooth muscle. Having established the concept of common final myogenic pathway that explains involuntary detrusor contraction, complete dysfunction ultrastructural patterns have been defined with univocal relation to hyperactive detrusor. These patterns indicate the existence of a syncytium of chained muscle cells with changes in the excitation threshold that are absent in the normal stable detrusor. Two ultrastructural components sustain this hypothesis: 1) the major loss observed in intermediate cellular unions that are thought to mediate in the mechanical coupling of cellular contraction and 2) the presence in all the microscopic fields of abutments in the narrow cellular unions like gap-junctions, which mediate the electrical coupling. In the present study we have found this pattern in 4 out of 6 patients with hyperactive detrusor, and congruent with other studies, the incomplete disjunction pattern could be the prelude of bladder hyperactivity.

[Valsalva minimal leak point pressure: a useful approximation to type III female urinary incontinence]. / Presión mínima de escape con Valsalva: una útil aproximación a la incontinencia urinaria femenina tipo III.

OBJECTIVE: It has been reported that anatomic female urinary incontinence with complex sphincteric malposition can coexist with intrinsic damage of the sphincter itself. In this study we analyzed the utility of measuring minimum abdominal pressure at standardized bladder capacities that causes urinary incontinence in order to quantify intrinsic sphincteric damage in female urinary incontinence. METHODS: The study comprised 50 women with urinary incontinence aged 36-78 years (mean 59.4), ICS standardized complete urodynamic study was performed. Minimum leak point pressure with Valsalva maneuver in decumbent and standing positions was determined during the filling phase of cystomanometry and it was defined as a measure of the abdominal pressure expressed as total baldder pressure without involuntary detrusor activity and exercised at standardized bladder capacities that originates objective urinary incontinence. Minimum leak point pressure for each bladder capacity was evaluated. Leak point pressures below 60 cm H2O indicate intrinsic sphincteric damage; pressures between 60 and 90 cm H2O indicate intrinsic damage and malposition or urethral hypermobility may coexist, and leak pressures over 90 cm H2O are related to complex sphincteric malposition. RESULTS: 5 women showed severe sphincteric deficiency (type III) and urinary incontinence was demonstrated with 50 ml bladder capacity and 30 cm H2O of abdominal pressure without detrusor activity. Thirty-five women (70%) had type II urinary incontinence. Of these, 10 (28.5%) showed intrinsic sphincteric damage in addition to malpositioning of the sphincteric complex at leak point pressures between 60 and 90 cm H2O. The rest of the women showed Blaivas' type 0 and I urinary incontinence. CONCLUSIONS: Valsalva minimum leak point pressure is a reproducible, reliable, useful and easily measured parameter in diagnosing female stress urinary incontinence. It allows approximation of the abdominal pressure to the level at which urinary leakage is produced during the filling phase of cystomanometry and gives us an idea of the extent of the intrinsic sphincteric damage, if any. Not only is sphincter damage demonstrated in type III urinary incontinence, but that it may also coexist to a varying degree with complex sphincteric malposition.

[Effect of aging on detrusor function in males]. / Influencia del envejecimiento en el funcionalismo del detrusor en el varón.

OBJECTIVE: The present study analyzed the effects of aging on detrusor function in the male. METHODS: The study comprised 200 male patients with prostatism that had undergone complete urodynamic evaluation. The relation of patient age and the clinical and urodynamic data were analyzed. RESULTS: Aging correlates with an increased urinary frequency and a reduced urinary volume and maximum flow rate. Bladder instability was significantly considerably more frequent in those over 80 years of age and the detrusor gradually manages lower maximum voiding pressures with increasing age. On the other hand, urodynamically diagnosed lower urinary tract obstruction and compromise of detrusor contractility are not age-dependent. CONCLUSION: Aging is associated with changes in lower urinary tract function, such as increased urinary frequency, reduced urinary volume, bladder instability is more frequent, reduced maximum voiding pressures, but does not impair detrusor contractility.

[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.