Usefulness of bladder-prostate ultrasound in the diagnosis of obstruction/hyperactivity in males with BPH.

OBJECTIVE: To determine the utility of prostate ultrasound in the diagnosis of infravesical obstruction (IVO) and detrusor hyperactivity(DH). METHODS: Prospective study with 39 patients consulting for LUTS. Clinical history was compiled, IPSS was determined, a digital rectal exam was performed, abdominal ultrasound was used to calculate detrusor thickness/weight, prostate volume, and middle lobe length (MLL). Urodynamic study (UD) was performed with determination of the Abrams-Griffiths number and ICS nomogram. Mean values were compared with Mann-Whitney U-test, and ROC curves were plotted determining the cutoff points for optimum sensitivity/specificity. RESULTS: Mean age was 63.1 years (SD: 7.8), with a mean IPSS score of 14 (SD: 6). 53.8% of the patients presented IVO at UD evaluation, and 43.6% DH. The differences between free flowmetry Qmax(p=0.015) and MLL (p=0.003) between patients with and without IVO proved significant. The ROC curves yielded an AUC for middle lobe length of 0.772, with a maximum sensitivity and specificity cutoff point at 10.5 mm (sensitivity 90%, specificity 73%, PPV 76%, NPV 85%). There were no significant differences in any parameter between patients with and without DH. CONCLUSION: Ultrasound MLL measurement in patients with LUTS offers high sensitivity/specificity in diagnosing IVO, with a cutoff point of 10.5 mm. In our study it wasn't effective in the noninvasive diagnosis of DH.

Utilidad de la ecografía vésico-prostática en el diagnóstico de obstrucción/hiperactividad en varones con HBP / Usefulness of bladder-prostate ultrasound in the diagnosis of obstruction/hyperactivity in males with BPH

OBJETIVO: Determinar la utilidad de la ecógrafía prostática para el diagnóstico de obstrucción infravesical(OIV) y del detrusor hiperactivo(DH).MÉTODOS: Estudio prospectivo sobre 39 pacientes que consultaron por STUI. Se realizó historia clínica, IPSS, tacto rectal, ecografía abdominal midiendo grosor del detrusor, peso del detrusor, volumen prostático, longitud lóbulo medio(LLM) y estudio urodinámico (EUD) con obtención del número de Abrams-Griffiths y nomograma ICS. Se compararon medias con el test de U Mann-Whitney y se construyeron curvas ROC determinando los puntos de corte óptimos de sensibilidad y especificidad, con una significación estadística p < 0.05.RESULTADOS: La edad media de los 39 pacientes fue 63,1 años(DE:7,8 años) con IPSS medio de 14 puntos(DE:6) siendo la puntuación media de los síntomas de urgencia de 5,9 puntos(DE:3,1).El 53,8% de pacientes presentaron OIV en el EUD y el 43,6% DH. Resultaron significativas las diferencias entre el Qmax de la flujometría libre(p=0,015) y la LLM(p=0,003) entre los pacientes con OIV y los que no . Las curvas ROC mostraron un área bajo la curva para la LLM de 0,772 con punto de mayor sensibilidad y especificidad en 10,5mm(S:90%,E:73%,VPP:76%,VPN:85%). No hubieron diferencias en ningún parámetro entre pacientes con y sin DH.CONCLUSIONES: La medición de la LLM mediante ecografía en pacientes con STUI presenta una alta sensibilidad/especificidad para el diagnóstico de OIV con punto de corte 10,5mm. Es bien tolerada, económica y rápida. En nuestro estudio no se ha mostrado como una prueba eficaz en el diagnóstico no invasivo del hiperactividad del DH(AU)

OBJECTIVE: To determine the utility of prostate ultrasound in the diagnosis of infravesical obstruction (IVO) and detrusor hyperactivity(DH).METHODS: Prospective study with 39 patients consulting for LUTS. Clinical history was compiled, IPSS was determined, a digital rectal exam was performed, abdominal ultrasound was used to calculate detrusor thickness/weight, prostate volume, and middle lobe length (MLL). Urodynamic study (UD) was performed with determination of the Abrams-Griffiths number and ICS nomogram. Mean values were compared with Mann-Whitney U-test, and ROC curves were plotted determining the cutoff points for optimum sensitivity/specificity.RESULTS: Mean age was 63.1 years (SD: 7.8), with a mean IPSS score of 14 (SD: 6). 53.8% of the patients presented IVO at UD evaluation, and 43.6% DH. The differences between free flowmetry Qmax(p=0.015) and MLL (p=0.003) between patients with and without IVO proved significant. The ROC curves yielded an AUC for middle lobe length of 0.772, with a maximum sensitivity and specificity cutoff point at 10.5 mm (sensitivity 90%, specificity 73%, PPV 76%, NPV 85%). There were no significant differences in any parameter between patients with and without DH.CONCLUSION: Ultrasound MLL measurement in patients with LUTS offers high sensitivity/specificity in diagnosing IVO, with a cutoff point of 10.5 mm. In our study it wasn’t effective in the noninvasive diagnosis of DH(AU)

[Prevalence of nocturnal enuresis in the Valencian Community. Pediatric section of the National Incontinence Survey. The EPICC Study]. / Prevalencia de la enuresis nocturna en la Comunidad Valenciana. Sección infantil del estudio nacional de incontinencia. Estudio EPICC.

OBJECTIVE: To ascertain the prevalence of enuresis among primary school children in Spain. MATERIALS AND METHODS: A multicenter, observational, cross-sectional, epidemiologic, regional study. After sample size calculation, a total of 1687 questionnaires were sent to schools. Nocturnal enuresis was defined as <>. RESULTS: The prevalence of enuresis found in primary school children aged 6-11 years was 7.8%, decrease with age, and was significantly greater in boys (70%). Children without enuresis were taller and had a greater weight than those with enuresis, but the differences were not statistically significant. No differences were found in the family or educational setting between children with and without enuresis. Seventy-three percent of children with enuresis had a family history of the condition. The disorder also occurred in some sibling of 21% of children with enuresis who had siblings. Fifty-five percent of the bedwetting population had primary enuresis. Thirty-one percent of children with enuresis reported losses every night, 38% at least once a week, and 31% at least once a month. Eighty-seven percent of this population was under treatment for this condition. As regards subjective symptoms, 96.9% said they felt fine, but there were more bedwetting children who reported feeling a little bit uncomfortable (76.7% vs 23.1%; P=.004). CONCLUSIONS: Enuresis is a common disorder which is significantly more frequent in boys as compared to girls and whose prevalence decreases with age. It has a significant hereditary component. Most enuresis sufferers take measures against urine losses.

Prevalencia de la enuresis nocturna en la Comunidad Valenciana. Sección infantil del Estudio Nacional de Incontinencia. Estudio EPICC / Prevalence of nocturnal enuresis in the Valencian Community. Pediatric section of the National Incontinence Survey. The EPICC Study

Objetivo: Conocer la prevalencia de la enuresis entre los niños de enseñanza primaria en nuestro medio. Material y métodos: Estudio epidemiológico, observacional, transversal, multicéntrico, de ámbito regional. Previo cálculo del tamaño muestral, se repartieron 1.687 encuestas. Se definió la enuresis nocturna como incontinencia urinaria intermitente mientras los niños duermen, con una frecuencia de al menos 1 escape al mes. Resultados: La prevalencia de enuresis encontrada en niños de enseñanza primaria con edades comprendidas entre los 6 y los 11 años fue del 7,8%, disminuye con la edad y fue significativamente mayor en los niños (70%). Los niños sin enuresis presentaban mayor peso y talla que los enuréticos, aunque no se encontraron diferencias estadísticamente significativas. No se encontraron diferencias en cuanto al ámbito familiar ni educacional. El 73% de los niños presentó antecedentes familiares. El 21% de los enuréticos con hermanos, alguno de ellos también presenta este trastorno. El 55% presentaba una enuresis primaria. El 31% tenía escapes todas las noches, el 38% al menos un escape a la semana y el 31% alguno al mes. El 87% de esta población aplicaba alguna medida para los escapes. En cuanto a la sintomatología subjetiva, el 96,9%se sentían bien, aunque había una proporción mayor de niños que decían sentirse regularen el grupo de los enuréticos (el 76,7 frente al 23,1%; p = 0,004).Conclusiones: La enuresis es un trastorno frecuente, en niños significativamente más que en niñas, y cuya prevalencia disminuye con la edad. Tiene un importante componente hereditario. La mayoría toma medidas frente a los escapes (AU)

Objective: To ascertain the prevalence of enuresis among primary school children in Spain. Materials and methods: A multicenter, observational, cross-sectional, epidemiologic, regional study. After sample size calculation, a total of 1687 questionnaires were sent to schools. Nocturnal enuresis was defined as «loss of urine occurring during sleep, at least once a month». Results: The prevalence of enuresis found in primary school children aged 6-11 years was 7.8%, decrease with age, and was significantly greater in boys (70%).Children without enuresis were taller and had a greater weight than those with enuresis, but the differences were not statistically significant. No differences were found in the family or educational setting between children with and without enuresis. Seventy-three percent of children with enuresis had a family history of the condition. The disorder also occurred in some sibling of 21% of children with enuresis who had siblings. Fifty-five percent of the bedwetting population had primary enuresis. Thirty-one percent of children with enuresis reported losses every night, 38% at least once a week, and 31% at least once a month. Eighty-seven percent of this population was under treatment for this condition. As regards subjective symptoms, 96.9% said they felt fine, but there were more bedwetting children who reported feeling a little bit uncomfortable (76.7% vs 23.1%; P=.004).Conclusions: Enuresis is a common disorder which is significantly more frequent in boys as compared to girls and whose prevalence decreases with age. It has a significant hereditary component. Most enuresis sufferers take measures against urine losses (AU)

Prognostic value of p53, Ki-67, microstaging and microvessel density in pT1G3 bladder tumors: creation of risk groups for progression.

OBJECTIVE: New predictive factors for bladder tumor progression have been analyzed in many publications, often with contradictory results. Very few papers have referred specifically to T1G3 tumors. Our objective was to find new, clinically useful markers which either alone or in association with classical prognostic factors would allow the early selection of the correct therapeutic approach. MATERIAL AND METHODS: This was a retrospective study of 83 patients with T1G3 bladder tumors who were initially treated with transurethral resection + bacillus Calmette-Guérin therapy, with a minimum follow-up period of 3 years. We analyzed eight variables. New factors considered were: the level of submucosal invasion; microvessel density; and immunostaining for Ki-67 and p53. Independent prognostic variables for progression were established using logistic regression analysis, and risk groups were created from mathematical models. RESULTS: Five variables were determined as unfavorable: tumor multiplicity; tumor size >3 cm; carcinoma in situ; T1b substage; and p53 positivity. The first three factors predicted progression in only 32% of cases, while the addition of the new prognostic factors (T1b substage and p53 positivity) increased this rate to 65%. We established four risk groups, with rates of progression of 67% and 100% in the high-risk and very high-risk groups, respectively. For inclusion in these groups, both new predictive factors had to be unfavorable; if either one were absent then the three classical factors had to be present. CONCLUSIONS: Microstaging and p53 positivity have a prognostic value for predicting progression in T1G3 tumors, providing 33% more information than that obtained with classical prognostic factors alone. The application of mathematical models identifies risk groups and allows the use of an early and more aggressive treatment.

A chemosensitivity test for superficial bladder cancer based on three-dimensional culture of tumour spheroids.

OBJECTIVES: Three-dimensional (3D) spheroids are a good model for studying in vitro chemosensitivity because they reproduce unicellular and multicellular mechanisms of drug resistance. We aimed to develop a chemosensitivity test for intravesical drugs and to also verify the effects of verapamil (VPM) and ciprofloxacin (CIPRO). METHODS: Cold cup biopsies from 40 superficial bladder tumours were taken, fragmented, and left in culture. 3D-spheroids were obtained and transferred into a 24 multiwell dish containing (1) wells 1-3: 1 mg/ml epirubicin (EPI); (2) 4-6: 1 mg/ml EPI+0.5 mg/ml VPM; (3) 7-9: 1 mg/ml adriamycin (ADR); (4) 10-12: 1 mg/ml thiotepa (THIO); (5) 13-15: 1 mg/ml mitomycin C (MMC); (6) 16-18: 1mg/ml EPI+0.2 mg/ml CIPRO; (7) 19-21: 0.2 mg/ml CIPRO; (8) 22-24: controls. Sensitivity was calculated by using the trypan blue assay. RESULTS: Evaluability of clinically relevant tests (G1-G2 lesions) was 84% (21 of 25 patients). MMC was the best agent (p<0.001) with mean sensitivity being 50%, followed by THIO (37%), EPI (7%), and ADR (3%). We found no significant difference (p=0.370) between CIPRO and the control, or between EPI+CIPRO and EPI alone (p=0.550). VPM markedly enhanced sensitivity to EPI compared with EPI alone (97% vs. 7%, p<0.001). CONCLUSIONS: Our assay allows determining sensitivity to several drugs in superficial bladder tumours. It might be used in clinical practice to select the best drug for each patient. It also has experimental utility in investigating the effect of new drugs or combinations. VPM reverted resistance to EPI. CIPRO showed no effect on bladder tumour spheroids.

Clasificación, etiología, diagnóstico y tratamiento de las prostatitis. Otros tipos de prostatitis / Classification, etiology, diagnosis and treatment of prostatitis. Other types of prostatitis. Acute and chronic prostatitis

El síndrome "prostatitis" representa una entidad nosológica con una prevalencia muy relevante y, por tanto, con unas connotaciones enormes en cuanto a impacto económico, sanitario y de calidad de vida para los pacientes. Con una sintomatología ambigua, métodos de diagnóstico controvertidos y tratamientos largos y de resultados irregulares, se ha convertido en una de esas patologías que, sin comprometer la vida del paciente, resultan un tanto incómodas tanto para el paciente como para el profesional que intenta ayudarle y no siempre lo consigue. Aunque en la mayoría de los casos se acepta una etiología infecciosa, existen serias controversias tanto respecto a los métodos diagnósticos utilizados como a la interpretación de los mismos. Recientemente, el National Institutes of Health de Estados Unidos ha propuesto una nueva clasificación de esta patología que sustituye a la otra vigente en los últimos 20 años y que, en principio, permitiría una mejor aproximación al diagnóstico y tratamiento de esta patología tan insidiosa

Prostatitis is a highly prevalent nosologic entity and hence has an enormous financial impact on health systems as well as negative repercussions on patients' quality of life. The symptoms are ambiguous, diagnostic methods are controversial and treatments are long and produce inconsistent results; consequently, although not life-threatening, prostatitis has become one of those diseases that is difficult both for the patient and for the physician who attempts to help, sometimes without success. Although an infectious etiology is accepted in most cases, there are major controversies about both the diagnostic methods used and their interpretation. Recently the National Institutes of Health in the USA has proposed a new classification of this disease to substitute that used for the last twenty years. This new classification may provide a more effective approach to the diagnosis and treatment of this insidious disease

[Classification, etiology, diagnosis and treatment of prostatitis. Other types of prostatitis. Acute and chronic prostatitis]. / Clasificación, etiología, diagnóstico y tratamiento de las prostatitis. Otros tipos de prostatitis.

Prostatitis is a highly prevalent nosologic entity and hence has an enormous financial impact on health systems as well as negative repercussions on patients' quality of life. The symptoms are ambiguous, diagnostic methods are controversial and treatments are long and produce inconsistent results; consequently, although not life-threatening, prostatitis has become one of those diseases that is difficult both for the patient and for the physician who attempts to help, sometimes without success. Although an infectious etiology is accepted in most cases, there are major controversies about both the diagnostic methods used and their interpretation. Recently the National Institutes of Health in the USA has proposed a new classification of this disease to substitute that used for the last twenty years. This new classification may provide a more effective approach to the diagnosis and treatment of this insidious disease.

Wunderlich syndrome as first manifestation of infective endocarditis.

Infective endocarditis (IE) presents with several signs and symptoms that are mainly heart-related and the result of bacteremia. We describe the case of a woman with severe renal hemorrhage due to a septic embolic cortical infarction, who was also receiving anticoagulation therapy because of cardiopathy, whose retroperitoneal hematoma was the first manifestation of IE.

[Urinary tract infection in pregnancy and menopause]. / Infección urinaria en el embarazo y menopausia.

OBJECTIVES: To review the topic of urinary tract infections (UTI) during pregnancy and menopause. UTI during pregnancy and menopause have great relevance in the field of urologic infections; during pregnancy because of the particularities involved in its diagnosis and treatment and potential consequences to the fetus and mother; menopausal UTI because this group of women is numerous and represents a growing section of the general population pyramid, due to the aging of population in developed countries associated with longer life expectancies and grater demand for quality of life. METHODS AND RESULTS: We performed a bibliographic review combined with our personal experience. During pregnancy there are several functional and anatomical changes that condition not only a higher risk of UTI, but also an additional treatment difficulty due to antimicrobial pharmacokinetics alterations and potential damage to the fetus. Despite efforts to find an easy, fast and reliable test for bacteriuria detection, urine culture continues to be the first diagnostic test for its detection and follow up during pregnancy. Penicillin derivates and cephalosporins continue to be the first choice because their lack of adverse effects on either fetus or mother. Alternative options like phosphomicin and aztreonam although they show low toxicity there is need for more studies supporting their suitability for the treatment of pregnancy UTIs. Menopausal female UTI have their different features from those in younger women. Hormonal alterations derived from gonadal atrophy associate functional changes in the vaginal ecosystem, making it prone to enterobacteriaceae colonization as a first step up to the urinary tract. This associated with genitourinary tract anatomical alterations inherent t aging make UTI extraordinary prevalent in this growing segment of population. Treatment lines focus on hormonal alteration correction and proper antimicrobial prophylaxis and vaccines in a close future. CONCLUSIONS: UTIs during pregnancy and menopause have differential features that require different diagnostic and treatment approaches.

Tratamiento de la litiasis renal cálcica. LEOC, NLP, cirugía abierta / Treatment of renal calcium stones: ESWL, PNL, open surgery

OBJETIVO: El objetivo del siguiente trabajo es una revisión y exposición, tanto de nuestra experiencia como de la literatura y del tratamiento actual de la litiasis renal cálcica. MÉTODOS: Se evalúan los resultados e indicaciones terapéuticas con los siguientes resultados y conclusiones. RESULTADOS/CONCLUSIONES: La litiasis piélica es la indicación ideal de la LEOC con tasas de resolución que fluctúan del 33 al 90 por ciento, influyendo sobre todo el tamaño del cálculo y también su composición. En la litiasis calicial los resultados son superponibles a la litasis piélica, excepto en los situados en cáliz inferior, en la que la tasa global de resolución completa oscila del 50 al 75 por ciento, mientras que con el tratamiento con NLP se alcanzan cifras del 90 por ciento, además cuando el ángulo infundíbulo-piélico es menor de 90º la tasa de resolución es aún menor. En la litiasis intradiverticular la tasa de resolución oscila entre el 4-58 por ciento obteniéndose los mejores resultados cuando el cálculo es pequeño y el cuello del divertículo es visible en la urografía. La litiasis coraliforme es la más compleja y por tanto la que más dificultades ofrece en el tratamiento con LEOC, sólo en el coraliforme tipo I su tratamiento con ondas de choque ofrece unos buenos resultados con un 72 por ciento de limpieza y una media de 3,5 sesiones por paciente (AU)