[Obstruction of the lower urinary tract: contractile capacity of the detrusor and obstruction degree. Analysis of pressure/flow curves]. / Obstrucción del tracto urinario inferior: capacidad contráctil del detrusor y grado de obstrucción. Análisis de las curvas de presión/flujo.

OBJECTIVES: This study attempts to optimize information from pressure/flow curves of patients with obstructive symptoms. METHODS: We performed a computerized analysis of the pressure/flow ratio of 50 consecutive patients with benign prostatic hyperplasia and irritative and obstructive symptoms. All patients were evaluated urodynamically. This model (pressure/flow diagram) will allow application of this test (expressed as flow and pressure measurements) to urethral outflow resistance and detrusor power or energy. Outflow obstruction is classified into seven categories (O-VI) and detrusor contractility in four (very weak, weak, normal and strong). RESULTS: The suitability of urodynamic analysis was demonstrated. Those cases considered as indeterminate by the conventional method can be obviated by computerized analysis. The degree of obstruction and the contractile capacity were determined in these cases. CONCLUSIONS: This method provides more accurate information on pathophysiology of voiding, allowing for better diagnosis of outflow obstruction or poor detrusor contractility and avoids the diagnosis of "undetermined".

[Radical prostatectomy: usefulness of selective electromyography of the periurethral sphincter in the assessment of urinary continence]. / Prostatectomía radical: utilidad de la electromiografía selectiva del esfínter periuretral en la valoración de la continencia urinaria.

The exact mechanisms of urinary continence in patients submitted to radical prostatectomy remain unknown. The aim of our study was to evaluate these mechanisms of continence through a complete urodynamic study, with a special emphasis on selective electromyography of the periurethral aphincter. Of a total of 10 consecutive patients who underwent radical prostatectomy between 1990-1993, a complete clinical control of urinary continence was demonstrated in 7 patients. The complete urodynamic work-up and particularly selective electromyography of the periurethral sphincter permitted evaluating the distal sphincteric mechanism and the degree of functional capacity. All of the cases showed loss of motor units, diminished electromyographic sphincter activity and incomplete lesion of the inferior motor neuron. The present study analyzed the pathophysiological, clinical and urodynamic aspects of these patients.

[Psoas abscess: considerations on 6 cases]. / Abscesos del psoas: consideraciones sobre seis casos.

We present six cases of psoas abscess, three primary and three secondary. The etiologic, pathogenic and therapeutic considerations are outlined. Staphylococcal infections prevail in the primary abscesses. The diagnostic difficulties are considerable but nowadays are facilitated by echography and TAC. In the secondary ones, the psoas abscess is an epiphenomenon of a more easily recognised clinical syndrome. It is surprising how these septic processes are increasingly placed in the hands of urologists in recognition of their mastery of retroperitoneal surgery.

[Spontaneous rupture of the ureter caused by an impacted stone]. / Rotura espontánea del uréter por impacto litiásico.

We report a case of spontaneous rupture of the ureter from an impacted calculus, paradigm of diagnostic and therapeutic difficulties of these uncommon pathologic conditions. Spontaneous rupture of the ureter from an impacted calculus should be considered in cases of persistent renal colic and atypical presentation. Diagnosis is based on urographic evidence of urinary extravasation. This should be differentiated from nephric colic from urinary extravasation arising from the renal fornices which is relatively common in nephric colic. Treatment must always include drainage of the urinoma, ureteroraphy, and urinary diversion. However, a controversy exists on the advantages and disadvantages of nephrostomy versus ureteral splinting.