Urodynamic approach to female urinary incontinence refractory to treatment with anticholinergics.

OBJECTIVES: The administration of empirical anticholinergic treatment is widespread in women with urinary incontinence and has produced varied results. The objective of our paper is to determine the effectiveness of anticholinergics for the treatment of female urinary incontinence and to determine by urodynamics the possible causes that may explain the resistance to anticholinergics to obtain urodynamic predictors of success or failure. METHODS: We evaluated 182 women over 14 years of age with urinary incontinence that had previously been treated with anticholinergics for at least three months. The patients underwent a complete medical history including clinical history, physical examination, and urodynamic and lower urinary tract video-radiologic studies. Statistical analysis was performed using SPSS 17.0 for Windows. RESULTS: Clinical therapeutic efficacy was demonstrated in 39.6% of cases. Cystometric bladder capacity was decreased in 89.2%of patients that did not improve clinically with anticholinergics (p=0.01). Detrusor overactivity was urodynamically demonstrated in 51% of cases (p=0.05) among patients without clinical improvement with anticholinergic treatment. This hyperactivity was demonstrated during early bladder filling (<100ml). Urodynamic stress urinary incontinence (SUI) was demonstrated in 26.5% of patients without clinical improvement after treatment (p=0.04). Lower urinary tract obstruction was urodynamically demonstrated in 20.6% of patients with no clinical improvement (p=0.05). Urodynamic data did not demonstrate a relationship between detrusor overactivity, a high-grade cystocele ( 37.4% of total), and irregular bladder morphology (11.5% of total). CONCLUSIONS: It is important to conduct urodynamic study before starting anticholinergic treatment of females with urinary incontinence to identify therapeutic data of poor prognosis, such as SUI and lower urinary tract obstruction, thus optimizing the therapeutic efficacy of anticholinergics.

Aproximación urodinámica al tratamiento refractario de la incontinencia urinaria femenina con anticolinérgicos / Urodynamic approach to female urinary incontinence refractory to treatment with anticholinergics

OBJETIVO: Está muy difundida la aplicación del tratamiento anticolinérgico empírico en la incontinencia urinaria femenina con diferentes resultados. En nuestro trabajo se ha investigado la eficacia de los anticolinérgicos en el tratamiento de la incontinencia urinaria femenina, así como determinar urodinámicamente las posibles causas que expliquen la resistencia al mismo e intentar obtener predictores urodinámicos de éxito o fracaso. MÉTODOS: Se han evaluado 182 casos de mujeres mayores de 14 años con incontinencia urinaria, que habían sido tratadas con anticolinérgicos previamente durante al menos tres meses, a las que se les realizó historia clínica completa con anamnesis, exploración física, estudio urodinámico y videorradiológico del tracto urinario inferior. El análisis estadístico de los datos se realizó con el programa SPSS 17.0 para Windows. RESULTADOS: Se demostró eficacia terapéutica clínica en el 39,6% de los casos. La capacidad vesical cistomanométrica estaba disminuida en el 89,2% de las pacientes que no mejoraron clínicamente con los anticolinérgicos (p=0,01). La hiperactividad del detrusor fue demostrada urodinámicamente en el 51% de los casos (p=0,05) entre las pacientes sin mejoría clínica con el tratamiento anticolinérgico. Esta hiperactividad se demostró precozmente en el llenado vesical (<100ml). Se demostró urodinámicamente IUE en el 26,5% de las pacientes sin mejoría clínica postratamiento (p=0,04). Se demostró urodinámicamente obstrucción del TUI en el 20,6% de los casos sin mejoría clínica (p=0,05). Los datos videourodinámicos no demostraron una relación entre la hiperactividad del detrusor, el cistocele de alto grado (37,4% del total) y la morfología vesical irregular (11,5% del total)(AU)

CONCLUSIONES: Es importante la realización de un estudio urodinámico previo al tratamiento anticolinérgico de la incontinencia urinaria femenina para identificar los datos de mal pronóstico terapéutico como son la incontinencia urinaria de esfuerzo y la obstrucción del tracto urinario inferior, optimizando así la eficacia terapéutica de los anticolinérgicos(AU)

OBJECTIVES: The administration of empirical anticholinergic treatment is widespread in women with urinary incontinence and has produced varied results. The objective of our paper is to determine the effectiveness of anticholinergics for the treatment of female urinary incontinence and to determine by urodynamicsthe possible causes that may explain the resistance to anticholinergics to obtain urodynamic predictors of success or failure. METHODS: We evaluated 182 women over 14 years of age with urinary incontinence that had previously been treated with anticholinergics for at least three months. The patients underwent a complete medical history including clinical history, physical examination, and urodynamic and lower urinary tract video-radiologic studies. Statistical analysis was performed using SPSS 17.0 for Windows. RESULTS: Clinical therapeutic efficacy was demonstrated in 39.6% of cases. Cystometric bladder capacity was decreased in 89.2% of patients that did not improve clinically with anticholinergics (p=0.01). Detrusor overactivity was urodynamically demonstrated in 51% of cases (p = 0.05) among patients without clinical improvement with anticholinergic treatment. This hyperactivity was demonstrated during early bladder filling (<100ml). Urodynamic stress urinary incontinence (SUI) was demonstrated in 26.5% of patients without clinical improvement after treatment (p=0.04). Lower urinary tract obstruction was urodynamicallydemonstrated in 20.6% of patients with no clinical improvement (p=0.05). Urodynamic data did not demonstrate a relationship between detrusor overactivity, a high-grade cystocele (37.4% of total), and irregular bladder morphology (11.5% of total). CONCLUSIONS: It is important to conduct urodynamic study before starting anticholinergic treatment of females with urinary incontinence to identify therapeutic data of poor prognosis, such as SUI and lower urinary tract obstruction, thus optimizing the therapeutic efficacy of anticholinergics(AU)

[High power 980 nm diode laser: preliminary results in the treatment of benign prostatic hyperplasia]. / Láser de diodo-980 mm de alta potencia: resultados preliminares en el tratamiento de la hiperplasia benigna de próstata.

BACKGROUND: A clinical evaluation of the use of a 980 nm diode laser in the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH), focused on perioperatory morbidity and results in a short-term follow-up. METHODS: Fifteen patients were included in the study. All of them were evaluated by IPSS and Quality of Life (QoL) questionnaires, digital rectal examination, PSA, ultrasound scan and uroflowmetry. Prostate vaporization was performed with a laser of diode at 980 nm (Intermedic, Barcelona, Spain) using a 600 microns side-fire fiber. In the follow-up any event was recorded, as well as the IPSS and QoL scores and Qmax. RESULTS: Mean age of the patients was 66.7 years(45-75). The range of prostate volume was 20-76 cc (median 41.3 cc). Mean delivered energy was 161,012 kJ (78,3-243). No patient showed either a significant hematic loss or fluid absorption syndrome. A 22F urethral three-way catheter was inserted and removed between 12-40 hours in the postoperatory period. After a mean follow-up of 5,5 months (2-9) the average IPSS and QOL questionnaires scores changed, respectively, from 22,4 (19-26) and from 3 (2-4) to an average of 6,8 (1-13) (p0,01) and 1,4(0- 3), respectively, at the end of follow-up (p 0,01). Qmax increased from 6,4 ml/s (5-11,9) baseline to 19,7 ml/s (13,9-24 (p 0,01). No patient showed urinary incontinence. Retreatment was not needed though three patients needed a short-time catheterization (24 hours) after developing acute urinary retention in the first 48h hours. CONCLUSIONS: Our preliminary results suggest that prostate vaporization using 980 nm diode laser with output power up to 120 W, is effective and associated to minimal morbidity.

Láser de diodo-980 mm de alta potencia: resultados preliminares en el tratamiento de la hiperplasia benigna de próstata / High power 980 NM Diode Laser: preliminary results in the treatment of benign prostatic hyperplasia

OBJETIVO: Evaluar clínicamente la utilización de un láser de diodo de 980 nm en el tratamiento de la uropatía obstructiva infravesical secundaria a hiperplasia benigna de próstata (HBP), poniendo énfasis en la morbilidad perioperatoria y los resultados en un seguimiento a corto plazo.MÉTODOS: Quince pacientes fueron incluidos en el estudio. Todos fueron evaluados mediante los cuestionarios IPSS y de calidad de vida (CV), tacto rectal, PSA, ecografía y flujometría. Se procedió a la vaporización prostática con un láser de diodo de 980 nm (120 W; Intermedic; Barcelona, España) utilizando una fibra de disparo lateral de 600 micras. En el seguimiento se recogió cualquier incidencia, así como la puntuación en los cuestionarios IPSS y CV así como en el pico de flujo máximo.RESULTADOS: La edad media de los pacientes fue de 66,7 años (45-75). El rango del volumen prostático fue 20-76 cc (media 41,3 cc). La media de energía utilizada fue de 161,012 kJ (78,3-243). Ningún paciente presentó una pérdida hemática significativa ni síndrome de absorción líquida. En todos los casos se colocó un catéter uretral 22F que se retiró entre las 12-40 horas postoperatorias. Tras un seguimiento medio de 5,5 meses (2-9), la puntuación media en el cuestionario IPSS y en el de CV variaron, respectivamente, de una media de 22,4 (19-26) y de 3 (2-4) previa a la intervención, hasta una media de 6,8 (1-13) (p<0,01) en el cuestionario IPSS y de 1,4 (0-3) en el de CV al final del seguimiento (p<0,01). De igual modo, el flujo máximo se incrementó de 6,4 ml/s (5-11,9) en el preoperatorio a 19,7 ml/s (13,9-24) en el postoperatorio (p<0,01).Ningún paciente presenta incontinencia. No se ha requerido la repetición del procedimiento, si bien tres pacientes precisaron un sondaje transitorio en las primeras 48h (dos de los pacientes eran portadores de sonda vesical antes del tratamiento)(AU)

CONCLUSIONES: Nuestros resultados preliminares sugieren que la vaporización prostática con láser de diodo de 980 nm utilizando potencias de hasta 120 W es efectiva y asociada a escasa morbilidad(AU)

OBJECTIVES: A clinical evaluation of the use of a 980 nm diode laser in the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH), focused on perioperatory morbidity and results in a short-term follow-up.METHODS: Fifteen patients were included in the study. All of them were evaluated by IPSS and Quality of Life (QoL) questionnaires, digital rectal examination, PSA, ul-trasound scan and uroflowmetry. Prostate vaporization was performed with a laser of diode at 980 nm (Inter-medic; Barcelona, Spain) using a 600 microns side-fire fiber. In the follow-up any event was recorded, as well as the IPSS and QoL scores and Qmax.RESULTS: Mean age of the patients was 66.7 years(45-75). The range of prostate volume was 20-76 cc (median 41.3 cc). Mean delivered energy was 161,012 kJ (78,3-243). No patient showed either a significant hematic loss or fluid absorption syndrome. A 22F urethral three-way catheter was inserted and removed between 12-40 hours in the postoperatory period. After a mean follow-up of 5,5 months (2-9) the average IPSS and QOL questionnaires scores changed, respectively, from 22,4 (19-26) and from 3 (2 -4) to an average of 6,8 (1 – 13) (p<0,01) and 1,4 (0 – 3), respectively, at the end of follow-up (p <0,01). Qmax increased from 6,4 ml/s (5-11,9) baseline to 19,7 ml/s (13,9-24 (p <0,01). No patient showed urinary incontinence. Retreatment was not nee-ded though three patients needed a short-time catheterization (24 hours) after developing acute urinary retention in the first 48h hours.CONCLUSIONS: Our preliminary results suggest that prostate vaporization using 980 nm diode laser with output power up to 120 W, is effective and associated to minimal morbidity(AU)