A standard for terminology in chronic pelvic pain syndromes: A report from the chronic pelvic pain working group of the international continence society.

AIMS: Terms used in the field of chronic pelvic pain (CPP) are poorly defined and often confusing. An International Continence Society (ICS) Standard for Terminology in chronic pelvic pain syndromes (CPPS) has been developed with the aim of improving diagnosis and treatment of patients affected by chronic pelvic pain syndromes. The standard aims to facilitate research, enhance therapy development and support healthcare delivery, for healthcare providers, and patients. This document looks at the whole person and all the domains (organ systems) in a systematic way. METHODS: A dedicated working group (WG) was instituted by the ICS Standardisation Steering Committee according to published procedures. The WG extracted information from existing relevant guidelines, consensus documents, and scientific publications. Medline and other databases were searched in relation to each chronic pelvic pain domain from 1980 to 2014. Existing ICS Standards for terminology were utilized where appropriate to ensure transparency, accessibility, flexibility, and evolution. Consensus was based on majority agreement. RESULTS: The multidisciplinary CPPS Standard reports updated consensus terminology in nine domains; lower urinary tract, female genital, male genital, gastrointestinal, musculoskeletal, neurological aspects, psychological aspects, sexual aspects, and comorbidities. Each is described in terms of symptoms, signs and further evaluation. CONCLUSION: The document presents preferred terms and definitions for symptoms, signs, and evaluation (diagnostic work-up) of female and male patients with chronic pelvic pain syndromes, serving as a platform for ongoing development in this field. Neurourol. Urodynam. 36:984-1008, 2017. © 2016 Wiley Periodicals, Inc.

Overactive bladder - 18 years - Part I.

Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals - including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

Overactive bladder - 18 years - Part II.

Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics - pillars of the overactive bladder pharmacotherapy - started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning - as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder - 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Overactive bladder - 18 years - Part II

ABSTRACT Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Overactive bladder - 18 years - Part I

ABSTRACT Abstract: Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals – including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

Detection of a tadalafil analogue as an adulterant in a dietary supplement for erectile dysfunction.

INTRODUCTION: Several cases of adulteration of dietary supplements with tadalafil, sildenafil, and vardenafil, or their unapproved analogues have been reported worldwide. Mainly, the presence of the latter represents a serious health risk to consumers as their efficacy and toxic effects have not been assessed and may result in unpredictable adverse effects. AIM: To investigate the suspected adulteration with synthetic phosphodiesterase type 5 (PDE-5) inhibitors in a dietary supplement marketed in Argentina for the treatment of erectile dysfunction (ED). METHODS: The content of the capsules of the dietary supplement (sample A) was analyzed by thin layer chromatography (TLC) and high-performance liquid chromatography (HPLC) diode-array detection. From the organic extract of sample A, a major compound was purified by column chromatography (CC). The isolated compound was identified by proton nuclear magnetic resonance (1H NMR) and carbon NMR (13C NMR), heteronuclear single quantum coherence, distortionless enhancement by polarization transfer (DEPT 135), electrospray ionization mass spectrometry, and ultraviolet, and infrared (Fourier transform infrared spectroscopy) spectroscopy. MAIN OUTCOME MEASURE: Proof of adulteration of herbal products with synthetic PDE-5 inhibitors. RESULTS: By TLC and HPLC analysis, a major compound was detected in sample A organic extract. The purification of this extract by CC led to the isolation of a pure compound which was identified according to its spectral data as (6R,12aR)-2-amino-6-(1,3-benzodioxol-5-yl)-2,3,6,7,12,12a-hexahydropyrazino [1',2':1,6] pyrido [3,4-b] indole-1,4-dione or aminotadalafil. CONCLUSIONS: An unapproved PDE-5 inhibitor analogue, which was identified as aminotadalafil, has been detected in a dietary supplement. This study represents the first report in Latin America and one of the few independent studies of an adulteration with an unapproved PDE-5 inhibitor of an herbal product for ED treatment.

Role of cystoscopy and hydrodistention in the diagnosis of interstitial cystitis/bladder pain syndrome.

There are controversies about whether cystoscopy with or without hydrodistention (HD) plays a role in the diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS). We reviewed the recommendations of various societies and associations of greater impact in this complex disease, analyzing the indications, technique, findings and complications of this procedure.

[ESSIC criteria for the diagnosis of bladder pain syndrome/interstitial cystitis (BPS/IC) and comparison with the NIDDK criteria].

OBJECTIVES: To apply the diagnostic criteria of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the criteria of the European Society for Study of Interstitial Cystitis (ESSIC) in our population with Bladder Pain Syndrome /interstitial cystitis (BPS/IC). METHODS: A cohort of 36 patients with the endoscopic clinical diagnosis of BPS/IC were evaluated retrospectively in the Hospital de Clinicas José de San Martin and Urology Center CDU over a period of 5 year. Cystoscopy with diagnostic and therapeutic hydrodistention was applied a to all patients. The NIDDK criteria were applied to the patients with endoscopic clinical diagnosis of BPS/IC. The new criteria proposed by the ESSIC were contrasted and results were compared. RESULTS: Of a total of 36 patients treated, 33 were women and 3 were men with ages between 30 and 75 years, 100% presented pain or urgency. Glomerulation or Hunner lesions appeared in 30 patients (83%). 35 patients (97%) had urinary frequency >8/day, and 22 patients (61%) had bladder capacity <350 cc. Only 22 patients (61%) completed the strict diagnostic criteria of the NIDDK. On the other hand, using the new criteria proposed by the ESSIC for the diagnosis of BPS/IC 35 patients (97%) were included in this pathology, with normal cystoscopy in 6 patients (17%) and 14 patients (39%) with bladder capacity >350 cc. CONCLUSION: The widest diagnostic criteria of the ESSIC allow the inclusion of more patients in the certainty diagnosis of BPS/IC than the NIDDK criteria, facilitating the diagnosis of this strange urological disease.

Criterios para el diagnóstico del síndrome de dolor veesical/cistitis intersticial (SDV/CI) de la ESSIC y su comparacion con los criterios del NIDDK / Essic criteria for the diagnosis of bladder pain syndrome/interstitial cystitis (BPS/IC)and comparison with the Niddk criteria

OBJETIVO: Aplicar los criterios diagnósticos del National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) y los criterios de la European Society for Study of Interstitial Cystitis (ESSIC), en nuestra población de síndrome de dolor vesical/cistitis intersticial (SDV/CI). MÉTODOS: Se evaluó retrospectivamente un cohorte de 36 pacientes en el Hospital de Clínicas José de San Martin y Centro de Urología CDU, con diagnóstico clínico endoscópico de SDV/CI, en un periodo de 5 años. En todos los pacientes se realizó cistoscopia con hidrodistensión diagnóstica y terapéutica. Se tomaron los pacientes con diagnóstico clínico endoscópico de SDV/CI, y se le aplicaron los criterios del NIDDK. Luego se los contrastó con los nuevos criterios propuestos por la ESSIC y se compararon los resultados. RESULTADOS: De un total de 36 pacientes tratados, 33 fueron mujeres y 3 hombres de edades entre 30 y 75 años, el 100% con dolor o urgencia, glomerulaciones o lesiones de Hunner en 30 pacientes (83%), frecuencia urinaria >8/día en 35 pacientes (97%), y capacidad vesical <350cc en 22 pacientes (61%). Solamente 22 pacientes (61%) cumplieron los criterios estrictos del NIDDK para diagnóstico. En cambio, utilizando los nuevos criterios propuestos por la ESSIC para el diagnóstico de SDV/CI 35 pacientes (97%) quedan incluidos dentro de ésta patología, con cistoscopia normal en 6 pacientes (17%) y 14 pacientes (39%) con capacidad vesical >350cc. CONCLUSIÓN: Los criterios diagnósticos más amplios de la ESSIC permiten incluir como diagnóstico de certeza de SDV/CI a mayor número de pacientes que los criterios del NIDDK, facilitando de este modo el diagnóstico de éste raro cuadro urológico(AU)

OBJECTIVES: To apply the diagnostic criteria of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the criteria of the European Society for Study of Interstitial Cystitis (ESSIC) in our population with Bladder Pain Syndrome /interstitial cystitis (BPS/IC). METHODS: A cohort of 36 patients with the endoscopic clinical diagnosis of BPS/IC were evaluated retrospectively in the Hospital de Clinicas José de San Martin and Urology Center CDU over a period of 5 year. Cystoscopy with diagnostic and therapeutic hydrodistention was applied a to all patients. The NIDDK criteria were applied to the patients with endoscopic clinical diagnosis of BPS/IC. The new criteria proposed by the ESSIC were contrasted and results were compared. RESULTS: Of a total of 36 patients treated, 33 were women and 3 were men with ages between 30 and 75 years, 100% presented pain or urgency. Glomerulation or Hunner lesions appeared in 30 patients (83%). 35 patients (97%) had urinary frequency >8/day, and 22 patients (61%) had bladder capacity <350cc. Only 22 patients (61%) completed the strict diagnostic criteria of the NIDDK. On the other hand, using the new criteria proposed by the ESSIC for the diagnosis of BPS/IC 35 patients (97%) were included in this pathology, with normal cystoscopy in 6 patients (17%) and 14 patients (39%) with bladder capacity >350cc. CONCLUSION: The widest diagnostic criteria of the ESSIC allow the inclusion of more patients in the certainty diagnosis of BPS/IC than the NIDDK criteria, facilitating the diagnosis of this strange urological disease(AU)

Adaptación y validación del Faces-20-ESP: Re-conociendo el funcionamiento familiar enChillán, Chile / Adaptation and validation of faces 20-ESP: family functioning awareness in Chillán, Chile

En este artículo presentamos el proceso de adaptación y validación al contextolocal de la Escala Breve de Evaluación Familiar Faces 20 ESP realizada en la ciudad de Chillán,Chile. Los resultados obtenidos nos demostraron una semejanza altamente significativa frente a losencontrados en la versión original, lo que da cuenta de la fiabilidad y validez del instrumento para elestudio del funcionamiento familiar, sentando importantes precedentes académicos para posterioresinvestigaciones.Con base en el análisis comparativo, pudimos observar que en las familias estudiadas no existendiferencias estadísticamente significativas tanto en cohesión como en adaptabilidad, entre lostipos ensambladas y nucleares. Esto evidencia empíricamente que no es posible atribuir un tipo defuncionamiento determinado a una configuración familiar específica, lo que posiblemente contengaimplicancias teóricas futuras.

[Urodynamic evaluation of the efficacy of botulin toxin in refractory neurogenic hyperactive detrusor muscle]. / Evaluación urodinámica de la eficacia de la toxina botulínica en el detrusor hiperactivo neurogénico refractario.

OBJECTIVES: Proper treatment of neurogenic hyperactive detrusor muscle is responsible for several features essential for life such as renal function, and quality of life relevant issues such as urinary incontinence. Anticholinergic drugs allow treatment in most cases, but their failure in cases of refractory neurogenic hyperactive detrusor is a challenge. To evaluate the efficacy of detrusor injection of type A botulin toxin in patients with refractory neurogenic hyperactive detrusor, on the following urodynamic parameters: maximum cystomanometric capacity, detrusor compliance, reflex volume, maximum detrusor pressure and post void residual. METHODS: Prospective study in 16 patients with the diagnosis of neurogenic hyperactive detrusor refractory to anticholinergic therapy. Urodynamic studies were performed 30 and 60 days before the procedure and after at least two weeks from stopping anticholinergic therapy. 300 units of type A botulin toxin (BTX-A) were endoscopically injected in 30 punction sites, 10 units per ml each punction. Urodynamic control was performed 30 to 45 days after injection. RESULTS: Six of the 16 patients in the study where females and 11 males; mean age was 39.5 years (22 to 63 years). Urodynamic results: mean maximum capacity on cystomanometry before BTXA was 204.73 ml and after BTX-A 381.87 ml. Maximum detrusor capacity before was 91.46 H2O cm whereas post-treatment was 41.2 H2O cm. Mean final filling pressure was 68 H2O cm before treatment and 34 H2O cm after. Mean reflex volume was 111.33 ml before and 310.8 ml after. Finally, mean post void residual before BTX-A was 129.6 ml whereas post-BTX-A was 345.9 ml. CONCLUSIONS: The injection of 300 U of type A botulin toxin in the detrusor muscle has demonstrated to be effective and safe for the treatment of refractory neurogenic hyperactive detrusor. There were statistically significant differences in the urodynamic parameters before and after the injection. There were no significant adverse events.

Evaluación urodinámica de la eficacia de la toxina botulínica en el detrusor hiperactivo neurogénico refractario / Urodynamic evaluation of the efficacy of botulin toxin in refractory neurogenic hyperactive detrusor muscle

Objetivos: Del correcto tratamiento del detrusor hiperactivo neurogénico dependen aspectos fundamentales para la vida como la suficiencia renal hasta aspectos de importancia relevante para la calidad de vida como la incontinencia urinaria. Los fármacos anticolinérgicos permiten el tratamiento en la mayoría de los casos, pero su fracaso en el detrusor hiperactivo neurogénico refractario constituye un desafío. Evaluar de la eficacia de la inyección intradetrusorial de toxina botulínica tipo A en pacientes con detrusor hiperactivo neurogénico refractario, en los siguientes parámetros urodinámicos: capacidad cistomanométrica máxima, acomodación del detrusor, volumen de reflejo, presión máxima del detrusor y residuo postmiccional. Métodos: Estudio prospectivo en 16 pacientes con diagnóstico de detrusor hiperactivo neurogénico refractario a la terapia anticolinérgica. Se realizó investigación urodinámica 30 a 60 días previos al procedimiento y luego de la interrupción de por lo menos 2 semanas de la terapia anticolinérgica. Se realizó la inyección endoscópica de 300 U de Toxina Botulínica tipo A (BTX-A) en 30 sitios de punción, a 10 unidades por ml por punción. Se realizó el control urodinámico 30 a 45 días posteriores a la inyección. Resultados: De los 16 pacientes estudiados 5 eran mujeres y 11 hombres, la edad media fue de 39,5 años (22 a 63 años). Los resultados urodinámicos hallados fueron: Capacidad cistomanométrica máxima media pre BTX-A fue de 204.73 ml y la posterior fue de 381.87 ml. La presión máxima del detrusor media previa fue de 91.46 cm H2O mientras que la posterior fue 41.2 cm H2O. La presión de fin de llenado media previa fue de 68 cm H2O y la posterior 34 cm H2O. El volumen reflejo medio previo fue de 111.33 ml, mientras que el posterior fue de 310.8 ml. Por último el residuo postmiccional pre-BTX-A medio fue de 129.6 ml mientras que el post-BTX-A de 345.9 ml. Conclusiones: La inyección de 300 U de toxina botulínica tipo A en el detrusor ha demostrado ser eficaz y segura para el tratamiento del detrusor hiperactivo neurogénico refractario. En los parámetros urodinámicos se observaron diferencias estadísticamente significativas antes y después de la inyección. No se presentaron efectos adversos significativos (AU)

Objectives: Proper treatment of neurogenic hyperactive detrusor muscle is responsible for several features essential for life such as renal function, and quality of life relevant issues such as urinary incontinence. Anticholinergic drugs allow treatment in most cases, but their failure in cases of refractory neurogenic hyperactive detrusor is a challenge. To evaluate the efficacy of detrusor injection of type A botulin toxin in patients with refractory neurogenic hyperactive detrusor, on the following urodynamic parameters: maximum cystomanometric capacity, detrusor compliance, reflex volume, maximum detrusor pressure and post void residual. Methods: Prospective study in 16 patients with the diagnosis of neurogenic hyperactive detrusor refractory to anticholinergic therapy. Urodynamic studies were performed 30 and 60 days before the procedure and after at least two weeks from stopping anticholinergic therapy. 300 units of type A botulin toxin (BTX-A) were endoscopically injected in 30 punction sites, 10 units per ml each punction. Urodynamic control was performed 30 to 45 days after injection. Results: Six of the 16 patients in the study where females and 11 males; mean age was 39.5 years (22 to 63 years). Urodynamic results: mean maximum capacity on cystomanometry before BTX A was 204.73 ml and after BTX-A 381.87 ml. Maximum detrusor capacity before was 91.46 H2O cm whereas post-treatment was 41.2 H2O cm. Mean final filling pressure was 68 H2O cm before treatment and 34 H2O cm after. Mean reflex volume was 111.33 ml before and 310.8 ml after. Finally, mean post void residual before BTX-A was 129.6 ml whereas post-BTX-A was 345.9 ml. Conclusions: The injection of 300 U of type A botulin toxin in the detrusor muscle has demonstrated to be effective and safe for the treatment of refractory neurogenic hyperactive detrusor. There were statistically significant differences in the urodynamic parameters before and after the injection. There were no significant adverse events (AU)