Punto G: enfoque anatómico y seguridad del paciente / G-spot: anatomical approach and patient safety

Se investiga la región uretro-vaginal (pared posterior de la uretra ­ pared anterior de la vagina), en el área que corresponde a la descripción del "punto G", con el fin de colaborar a la discusión respecto de si existe una estructura morfológica que lo identifique. Se destaca una mayor y ocasional distribución venosa en esta zona, que puede explicar el fenómeno fisiológico descrito por Gräfenberg. Para los ginecólogos, urólogos y sexólogos, el conocimiento de la anatomía funcional de esa región tiene importancia para tratar las disfunciones orgásmicas además de la incontinencia urinaria. Esta situación controvertida influye en el marco actual de la seguridad del paciente

The urethro-vaginal region (posterior wall of the urethra ­ anterior wall of the vagina) is investigated, in the area that corresponds to the description of the "G-spot", in order to contribute to the discussion regarding whether there is a morphological structure that identifies it. A greater and occasional venous distribution in this area stands out, which may explain the physiological phenomenon described by Gräfenberg. For gynecologists, urologists and sexologists, knowledge of the functional anatomy of that region is important to treat orgasmic dysfunctions in addition to urinary incontinence. This controversial situation influences the current framework of patient safety

Ectopia ureteral em cães: relato de dois casos / Urethral ectopia in dogs: report of two cases / Ectopia uretral en perros: relato de dos casos

O presente trabalho descreve dois casos distintos de ectopia ureteral em cães atendidos no Hospital de Medicina Veterinária da Universidade Federal da Bahia. O primeiro relata a presença de ureter ectópico intramural unilateral direito em uma cadela da raça poodle, de aproximadamente um ano de idade, que apresentava como sequela a hidronefrose e hidroureter, sendo necessária a ureteronefrectomia direita para resolução do caso. O segundo caso refere-se à presença de ureter ectópico extramural bilateral em uma cadela da raça Husky Siberiano, de seis anos de idade, cujo prognóstico foi desfavorável em virtude de alterações irreversíveis em todo trato urinário. Em ambos os casos, evidenciou-se a importância do diagnóstico precoce para evitar o desencadeamento de sequelas e garantir a resolução do problema.(AU)

This study describes two distinct cases of urethral ectopia in dogs examined at the Veterinary Hospital of the Federal University of Bahia. The first one reports the presence of a right unilateral intramural ectopic ureter in a one-year-old female Poodle that had hydro nephrosis and hydro ureter and that needed right ureter nephrectomy to solve the problem The second case is the presence of a bilateral extramural ectopic ureter in a six-year-old female Siberian Husky whose prognostic was unfavorable due to irreversible alterations throughout the urinary tract. In both cases, it was evident how important an early diagnostic is to avoid sequelae and ensure the problem solution.(AU)

Este estudio describe dos casos distintos de ectopia uretral en perros atendidos en el Hospital de Medicina Veterinario de la Universidad Federal de Bahía. El primer caso relata la presencia de uréter ectópico intramural unilateral derecho, en una perra de la raza poodle, de aproximadamente un año de edad, que presentaba como secuela la hidronefrosis e hidrouréter, haciéndose necesario la ureteronefrectomia derecha para resolución del caso. El segundo caso se refiere a presencia de uréter ectópico extramural bilateral en una perra de la raza Husky Siberiano, de seis años de edad, cuyo pronóstico fue desfavorable en virtud de alteraciones irreversibles en todo tracto urinario. En los dos casos, se evidenció la importancia del diagnóstico precoz para evitar el desencadenamiento de secuelas y garantizar la resolución del problema.(AU)

Impacto de la fisioterapia para la reducción del suelo pélvico en la calidad de vida de pacientes con incotinencia urinaria / Impact of the physiotherapy for the reduction of the pelvic floor in the quality of life of patient with urinary incotinencia

La incontinencia urinaria tiene elevada prevalencia, preferentemente en mujeres, con efectos en la Calidad de Vida (CV). Estimamos la CV de pacientes con incontinencia urinaria y el impacto de la fisioterapia para reeducación del suelo pélvico sobre sus indicadores. Aplicamos a 21 pacientes el cuestionario de CV para incontinencia urinaria (I-QOL), al inicio del tratamiento, al tercero, sexto mes y al alta. Utilizamos terapia integral modificadora de estilos de vida, electroestimulación superficial y/o intracavitaria, magnetoterapia, y kinesiología educativa-reeducativa del suelo pélvico. Valoramos mejoría física por uso de colectores, test de compresa y diario miccional. Los indicadores de continencia se transformaron positivamente. Los valores del I-QOL mejoraron desde el tercer mes; se duplicaron en algunos pacientes al sexto mes y al alta. El incremento total fue de 48,5 a 83 puntos al sexto mes del tratamiento, por lo que concluimos que los mejoraron los indicadores de la calidad de vida de pacientes incontinentes.

The urinary incontinence has high prevalence preferably among women, rebound in quality of Life. We evaluated Quality of Life of patient with urinary incontinence and the impact of the physiotherapy for the pelvic floor reeducation on QL indicators. We apply I-QOL questionnaire for urinary incontinence to 21 patients, at beginning treatment, the third and sixth month and to the high one. We used integral and modifier therapy of lifestyles, superficial electrotherapy y/o intracavitary, magnetotherapy, and educational-reeducational exercises of pelvic floor. Physical improvement was considered by collectors use, compress test and miccional daily. The indicators of continence transformed positively and values of I-QOL improved from third month, being duplicated in some patients to the sixth month and the high one. Total increase was from 48,5 to 83 at six month and we concluded that improved indicators of the quality of life in incontinent patients.

Quality of life two years after radical prostatectomy, prostate brachytherapy or external beam radiotherapy for clinically localised prostate cancer: the Catalan Institute of Oncology/Bellvitge Hospital experience.

OBJECTIVE: The objective was to compare the short- and long-term impact of 3 different treatment modalities on health-related quality of life (HRQOL) in patients treated for localised prostate cancer at a single centre in Catalonia, Spain. MATERIAL AND METHODS: This was a longitudinal, prospective study of 304 patients from a single centre in Catalonia, Spain. Patients underwent 1 of 3 treatment procedures: radical prostatectomy (114 patients), external beam radiation (134) or interstitial brachytherapy (56). HRQOL was assessed by both general and specific questionnaires, including the SF-36 health survey and the Expanded Prostate Cancer Index Composite (EPIC). Interviews were administered prior to treatment and at months 1, 3, 6, 12 and 24. One-way analysis of variance and generalised estimating equations models were constructed to assess between group differences in HRQOL. RESULTS: After initial deterioration, HRQOL scores partially recovered, although significant differences between treatment groups persisted at two years. Worsening of urinary incontinence was especially marked for the radical prostatectomy group (11.45, p=0.005), while deterioration in the urinary irritative/obstructive domain was worse following brachytherapy treatment (4.76, p=0.025). Decline in sexual function was significantly greater for the radical prostatectomy group than for the brachytherapy group (18.74, p<0.001). No significant between-group differences were observed in bowel domain scores. CONCLUSIONS: Quality of life 2 years after treatment for prostate cancer shows wide variability. Radical prostatectomy had the largest negative impact on the sexual and urinary incontinence domains. Differences between external radiation and brachytherapy were relatively small. Brachytherapy led to a moderate increase in urinary irritation compared to the other 2 groups.

Morphometric analysis of the urethra of castrated female rats treated with tamoxifen.

OBJECTIVES: The aim of this study was to evaluate the effects of tamoxifen on the weight and thickness of the urethral epithelium of castrated female rats. METHODS: Forty castrated adult female Wistar-Hannover rats were randomly divided into two groups: Group I (n=20) in which the animals received only the vehicle (propylene glycol) and Group II (n=20) in which the rats received tamoxifen 250microg/day by gavage. After 30 days of treatment, all animals were sacrificed and the urethra was immediately removed for weighing. Next, the urethra was divided into the proximal and distal segments, which were fixed in 10% formaldehyde and submitted to routine histological techniques for morphometric study. The data were analyzed using the weighted minimum mean-square error method and Student's t-test for two independent samples (p<0.05). RESULTS: There was a significant increase in the mean weight of the urethra in the rats of Group II compared to the control group, 32.0+/-2.0mg and 22.0+/-1.6mg, respectively (p<0.001). The mean thickness of the distal urethral epithelium of the animals treated with tamoxifen was significantly greater than that of the control group, 42.8+/-2.0microm and 36.6+/-1.5microm, respectively (p<0.001). There was no statistically significant difference between the two groups with respect to the epithelial thickness of the proximal urethra (p=0.514). CONCLUSION: Treating castrated adult rats with 250microg/day of tamoxifen for 30 days may increase the weight of the urethra and the thickness of the distal urethral epithelium.

Morbilidad asociada a la cinta vaginal libre de tensión, tratamiento quirúrgico para la corrección de la incontinencia urinaria femenina causada por estrés Datos a corto plazo, Bogotá / Morbility associated with tension-free vaginal tape, surgical treatment for the correction of female urinary incontinence caused by stress data in the short term, Bogota

Objetivo: Describir los resultados terapéuticos de 14 pacientes con incontinencia urinaria de estrés a quienes se les corrigió su incontinencia mediante la colocación de la cinta vaginal libre de tensión (obturador). Materiales y Métodos: Se realizó un estudio descriptivo de seguimiento a 14 pacientes operadas. A todas las pacientes se les realizó evaluación urodinámica previa. Se utilizó un cuestionario en 5 ocasiones: previo a la cirugía, a las 24 horas, una semana después, al mes y seis o más meses después. Las pacientes estimaron la severidad de sus síntomas de incontinencia mediante la escala Visual Análoga y mediante el cuestionario: "Symptom Severity Index and Symptom impact Index for stress incontinente in women (versión corta). Se realizó un análisis descriptivo y se utilizó una prueba t de Student pareada (p <0.05). Resultados: La mediana de la edad fue de 55 años (DE 11.46, rango 44-78) La mediana de tiempo quirúrgico 81.4 minutos (rango 30-120). No se presentaron complicaciones intraoperatorias ni postoperatorias inmediatas. Durante el postoperatorio temprano se presentaron 3 complicaciones en 4 pacientes. El alta se dio a las 14.5 horas. En el postoperatorio tardío se presentó una tasa de complicaciones de 69.23 por cien. Las complicaciones tardías reportadas fueron: persistencia de incontinencia deurgencia de novo, incontinencia de urgencia de novo, infección urinaria, disuria, hiperactividad del detrusor y vaginosis. Se observó que 76.92 por cien, obtuvo curación subjetiva de su incontinencia seis o mas meses postoperatorio. Las diferencias registradas en la Escala Visual Análoga y el cuestionario de calidad de vida antes de la cirugía y seis o más meses postoperatorios fueron estadísticamente significantes (P 0.0001). Conclusión: La técnica de TVT puede llegar a ser considerada como un procedimiento mínimamente invasivo y seguro para la corrección de la incontinencia urinaria femenina.

Complicaciones relacionadas con los procedimientos realizados con intención curativa en cáncer de próstata: Incontinencia urinaria y disfunción eréctil / Complications related to procedures performed with curative intent in prostate cancer: Urinary incontinence and erectile dysfunction

El manejo del Cáncer de Próstata con intención curativa ya sea mediante prostatectomía radical retropúbica, prostatectomía radical perineal, braquiterapia de baja o de alta tasa o radioterapia tiene consecuencias para el paciente en cuanto a calidad de vida se refiere. Realizamos una revisión de la literatura para evaluar los reportes de complicaciones de cada uno de estos manejos para determinar el estado actual de los efectos secundarios de estas terapias.

Trigonal injection of botulinum toxin-A does not cause vesicoureteral reflux in neurogenic patients.

AIMS: We evaluated the effect of botulinum toxin type A (BTX-A) injections in the trigone on the antireflux mechanism and evaluated its short-term efficacy. MATERIALS AND METHODS: Between April and December 2006, 21 patients (10 men and 11 women) were prospectively evaluated. All were incontinent due to refractory NDO and underwent detrusor injection of 300 units of BTX-A, including 50 units into the trigone. Baseline and postoperative evaluation after eight weeks included cystogram, urinary tract ultrasound and urodynamics. RESULTS: At baseline, 20 patients had no vesicoureteral (VUR) and one had grade II unilateral VUR. Postoperative evaluation revealed no cases of de novo VUR and the patient with preinjection VUR had complete resolution of the reflux. Ultrasound showed 5 (23.8%) patients with hydronephrosis before BTX-A injection and only one (4.8%) at the followup evaluation (p=0.066). After treatment, 9 (42.8%) patients became dry, 11 (52.4%) were improved and one (4.8%) had no improvement. Improved patients received antimuscarinic treatment and 8 (38.1%) became dry, with a final total continence rate of 80.1%. Cystometric capacity increased from 271+/-92 to 390+/-189 ml (p=0.002), reflex volume varied from 241+/-96 to 323+/-201 ml (p=0.020) and maximum detrusor pressure reduced from 66+/-39 to 38+/-37 cm H(2)O (p<0.001). CONCLUSIONS: Our results confirm the safety of trigone injections of BTX-A in terms of development of VUR and upper urinary tract damage. Whether they are beneficial for patients with NDO or other causes of voiding dysfunction will need further studies.

Transobturator crossover readjustable sling for severe female incontinence: technique and preliminary results.

We present a technique that provides circumferential coaptation of the urethra as a salvage procedure for severe subset of patients. We prospectively evaluated 16 patients who had a transobturator crossover sling. Adjustable hybrid slings were used, and silicone washers were used over the anchoring columns to keep them in place and to facilitate any posterior readjustment. Mean age was 58 years and mean follow-up was 12 months. At presentation, patients had undergone at least two anti-incontinence procedures and wore a mean of six pads daily. There was a mean 93.7% overall cure in symptoms. There was one intraoperative complication (urethra perforation) that was resolved by closing the urethral wall. De novo urge incontinence developed in 2/16 patients. All patients (3/16) who had preoperative urge incontinence achieved resolution after the procedure. The transobturator crossover sling is an effective salvage procedure that may be considered in a selected subset of female patients with a nonfunctional urethra.

Principales síndromes geriátricos y su repercusión en el bienestar del adulto mayor / Principal geriatric syndromes and his(its) repercussion in the well-being of the major adult

El número de adultos mayores con síndromes geriátricos auto-reportado en el área urbana es de 154 que corresponde a 37,5% y en el área rural 56 que corresponde a 55,4%. Siendo la población urbana total de 410 entrevistados y la rural de 101 personas, los porcentajes indican que los adultos mayores del área rural padecen con mayor frecuencia los 4 grandes síndromes geriátricos.Además en el área rural existe mayor prevalencia de los 4 grandes síndromes geriátricos. La mayoría de los adultos mayores tanto del área rural como urbana refieren que su estado de salud esta entre regular y mala. Los síndromes geriátricos están con porcentajes más elevados en los adultos mayores de 75 años la pérdida estructural y funcional de todos los órganos y sistemas del cuerpo humano es de manera paulatina y progresiva conforme avanza la edad, siendo así que los síndromes geriátricos se agudizan en este grupo de edad.La mayor proporción de adultos mayores que sufren caídas perciben y reportan su salud como regular en un 50% de los casos del área rural y 31,7% en urbano. La prevalencia de mala salud auto percibida es de 39,3% en área urbana y 16% en área rural. Porcentajes pequeños de adultos mayores consideran tener mala salud 11% en urbano y 11,8% en provincias. Este hecho probablemente se deba a que la incontinencia urinaria en personas geriátricas implica frustración y vergüenza, hecho que los lleva en muchos casos a negar el padecimiento o no tratar con un profesional de salud, quien certifique el síndrome. Encubriendo de esta manera el deterioro de la salud y dejando abierta la posibilidad de una errónea referencia de bueno o regular estado de salud

Orthotopic ileal neobladder: the influence of reservoir volume and configuration on urinary continence and emptying properties.

OBJECTIVE: To evaluate the influence of the volume and configuration of the neobladder on urinary continence and reservoir emptying in orthotopic urinary reservoirs using intestinal segments for bladder replacement after radical cystectomy. PATIENTS AND METHODS: Fifty-nine patients who had had a radical cystectomy and urinary reconstruction with an orthotopic ileal neobladder were followed for > or = 1 year; 27 (group 1) had the ileal neobladder created with a shorter intestinal segment (40 cm) in an elongated shape ('J'), and 32 (group 2) had their reservoir made more spherical with a longer ileal loop (60-65 cm). The rates of urinary continence, enuresis, neobladder capacity and postvoid residual urine were evaluated first at 3-6 months and again 1 year after surgery in both groups. RESULTS: At 3-6 months after surgery urinary incontinence and enuresis were more common in group 1, but at 1 year had the same frequency in both groups, at respectively 11% and 44% in group 1, and 13% and 47% in group 2 (P > 0.05). The neobladder capacity and postvoid residual urine were significantly higher in group 2, at > 600 mL and > 100 mL, respectively, in 14% and 14% of the patients in group 1 and 57% and 52% of those in group 2 (P < 0.05). Urinary retention requiring intermittent catheterization did not occur in group 1 but did in 19% of group 2. CONCLUSION: The orthotopic spherical ileal neobladder with a large initial volume is apparently not associated with better continence rates and is prone to developing progressive enlargement, which can lead to neobladder atony and progressive emptying failure, increasing the chance of complete urinary retention.

Avaliação inicial da incontinência urinária na mulher / Evaluation of the urinary incontinence in the women

Os autores fazem uma revisão sobre a avaliação inicial da paciente com incontinência urinária, incluindo métodos diagnósticos. O objetivo é fornecer informações que permitam uma melhor compreensão e investigação desse problema

A morphologic and morphometric study of the vesical mucosa and urethra of castrated female rats following estrogen and/or progestogen replacement.

PURPOSE: The aim of this study was to analyze the morphologic and morphometric changes in the urethra and vesical mucosa following hormonal replacement METHODS: We analyzed the changes in the urethra and vesical mucosa of 35 castrated adult female rats that had been subjected to estrogen and/or progestogen replacement. RESULTS: Estrogen replacement, whether or not accompanied with progestogen replacement, provoked metaplasia, hyperplasia and an increased occurrence of stratified epithelia. In the proximal urethra hypoestrogenism caused a higher occurrence of pseudo-stratified and transition epithelia, whereas in the urethral-vesical junction it caused a higher frequency of pseudo-stratified epithelia. The thickness of the epithelium increased following estrogen replacement whereas only a trend towards an increase of the propria lamina thickness was identified. Nuclear volume was only altered in the bladder epithelium. CONCLUSION: Estrogen replacement acted both morphometrically and morphologically on the lower urinary tract.

[Value of the Q-tip test in patients with urinary incontinence]. / Valor de la Prueba del Hisopo en pacientes con incontinencia urinaria.

We evaluated the accuracy of the Q-tip test to measure uretrhovesical junction mobility in patient's histories of urinary incontinence, and pelvic relaxation. A retrospective study of 183 files of patients with urinary incontinence and anterior vaginal wall relaxation in the Instituto Nacional de Perinatología (INPer) between march 1994 and may 1995. All patients underwent a systematic diagnosis evaluation with detailed history and physical examination including Q-test, neurology examination, urinary, urine culture, uretrhoscopy and urodinamic studies. We correlated Q-tip test pelvic relaxation to measure urethrovesical junction mobility. They were placed in three groups. Group I formed by stres incontinence, group II formed by mixed incontinence and group III formed by recurrent incontinence. Mean age 46.3 years (29-72), almost all the patients were multiparas, menopausal status in 72, with hormonal treatment 48. Q-tip test was not different between the groups. Group I had cystocele II with hipermobility statistically significant difference, the same in group II. No differences were found in the group III. We concluded that urethral position and mobility as measure by the Q-tip test are related to defects in interior vaginal support, but not to specific urologic diagnosis.