Impacto de los síntomas de vejiga hiperactiva sobre la actividad laboral: estudio ACTIVHA / Impact of overactive bladder symptoms on work activity: The ACTIVHA study

Objetivos: Analizar el impacto de los síntomas de vejiga hiperactiva (VH) sobre la actividad laboral de pacientes en España. Método: Estudio observacional, multicéntrico y transversal con 149 urólogos y 131 ginecólogos de España que incluyeron pacientes diagnosticados de VH según criterio clínico, en edad laboral (18-65 años). Se recogieron datos sociodemográficos, clínicos y de actividad laboral. Los pacientes cumplimentaron el Cuestionario de Autoevaluación del Control de la Vejiga (CACV) y el Work Productivity and Activity Impairment Questionnaire-General Health (WPAI-GH). Se evaluó el impacto de cada síntoma sobre la actividad diaria y laboral. Los resultados se estratificaron según género y presencia de urgencia e incontinencia urinaria (IU) según el CACV. Resultados: Se evaluaron 768 pacientes (89% mujeres), con una media (DE) de edad de 52,5 (9,3) años y 2,6 (2,6) años de evolución de VH. La sintomatología más frecuente según el paciente fue urgencia (89,8%), seguida de nicturia (75,7%), incontinencia urinaria de urgencia (68,5%) y frecuencia (68,2%). El 96% adoptaron medidas adaptativas para la VH. Según el CACV, 543 pacientes (71%) presentaban urgencia y de estos, 294 (54%) presentaban IU. El síntoma que más afectaba la actividad laboral fue la frecuencia (59,8%). Según el WPAI-GH, los pacientes refirieron un impacto del 32% durante la jornada laboral (41% en pacientes con urgencia e IU) y una pérdida de tiempo de trabajo del 6,5% (un 9,9% en pacientes con urgencia e IU). Conclusiones: Los síntomas de VH impactan negativamente sobre la actividad laboral, especialmente en pacientes que presentan urgencia e IU

Objectives: To analyse the impact of overactive bladder (OAB) symptoms on the work activity of patients in Spain. Method: An observational, multicentre cross-sectional study was conducted with 149 urologists and 131 gynaecologists of Spain and included patients diagnosed with OAB, according to clinical judgment, who were of working age (18-65 years). We collected sociodemographic, clinical and work activity data. The patients filled out the Bladder Control Self-Assessment Questionnaire (B-SAQ) and the Work Productivity and Activity Impairment Questionnaire-General Health (WPAI-GH). The effect of each symptom on the daily and occupational activity was assessed. The results were stratified according to sex and the presence of emergency and urinary incontinence (UI) according to the B-SAQ. Results: We assessed 768 patients (89% women), with a mean (SD) age of 52.5 (9.3) years and 2.6 (2.6) years of OAB progression. The most common symptoms according to the patients were urgent urination (89.8%), nocturia (75.7%), urge incontinence (68.5%) and frequent urination (68.2%). Ninety-six percent of the patients adopted adaptive measures for their OAB. According to the B-SAQ, 543 patients (71%) presented urgent urination; of these, 294 (54%) showed UI. The symptom that most affected work activity was frequent urination (59.8%). According to the WPAI-GH, the patients reported an impact of 32% during the workday (41% in patients with urgent urination and UI) and a loss of work time of 6.5% (9.9% in patients with urgent urination and UI). Conclusions: The symptoms of OAB negatively affect work activity, especially in patients who have urgent urination and UI

Impact of overactive bladder symptoms on work activity: The ACTIVHA study. / Impacto de los síntomas de vejiga hiperactiva sobre la actividad laboral: estudio ACTIVHA.

OBJECTIVES: To analyse the impact of overactive bladder (OAB) symptoms on the work activity of patients in Spain. METHOD: An observational, multicentre cross-sectional study was conducted with 149 urologists and 131 gynaecologists of Spain and included patients diagnosed with OAB, according to clinical judgment, who were of working age (18-65 years). We collected sociodemographic, clinical and work activity data. The patients filled out the Bladder Control Self-Assessment Questionnaire (B-SAQ) and the Work Productivity and Activity Impairment Questionnaire-General Health (WPAI-GH). The effect of each symptom on the daily and occupational activity was assessed. The results were stratified according to sex and the presence of emergency and urinary incontinence (UI) according to the B-SAQ. RESULTS: We assessed 768 patients (89% women), with a mean (SD) age of 52.5 (9.3) years and 2.6 (2.6) years of OAB progression. The most common symptoms according to the patients were urgent urination (89.8%), nocturia (75.7%), urge incontinence (68.5%) and frequent urination (68.2%). Ninety-six percent of the patients adopted adaptive measures for their OAB. According to the B-SAQ, 543 patients (71%) presented urgent urination; of these, 294 (54%) showed UI. The symptom that most affected work activity was frequent urination (59.8%). According to the WPAI-GH, the patients reported an impact of 32% during the workday (41% in patients with urgent urination and UI) and a loss of work time of 6.5% (9.9% in patients with urgent urination and UI). CONCLUSIONS: The symptoms of OAB negatively affect work activity, especially in patients who have urgent urination and UI.

[Uncoordinated urinary syndrome. New aspects of an old problem]. / Síndrome de micción no coordinada. Nuevos aspectos de un viejo problema.

Uncoordinated voiding, since it was described by F. Hinman in 1973, have remained an ambiguous concept. Its clinical aspects are well known, but an urodynamic definition and therapeutic guidelines are lack. Through this work, we are going to discuss clinical and urodynamic aspects of Uncoordinated Voiding Syndrome, and to evaluate sphincterian re-education techniques in this cases. We present a series of 50 consecutive patients with a diagnosis of Uncoordinated Voiding Syndrome. Mean age was 11.9 years old. There were 82% of female patients and only 18% male patients. A complete urodynamic study was accomplished in all patients, including video-cistometrography and superficial perineal electromiography to confirm the diagnosis. Therapeutic protocol consisted of three steps: 1 Manual pre-micturition training stage. 2. Electromiographic pre-micturition training stage. 3. Micturitional training stage. Most common clinic findings in our series were: enuresis (74%). urge-incontinence (70%), recurrent urinary tract infection (50%), intestinal disturbances (32%) and voiding difficult (20%). Based on our urodynamic findings, we have distinguished three sub-types of Uncoordinated Voiding Syndrome: I Type A, means micturition is achieved through a detrusor involuntary contraction. II. Type B, means micturition is achieved through a detrusor voluntary contraction. III. Type C, means micturition is achieved through abdominal straining. The most important urodynamic data in Uncoordinated Voiding Syndrome was independently of maximum flow, the absence of relaxation or increased perineal electromiographic activity during uroflowmetry. Pressure-flow test was fundamental to characterize Uncoordinated Voiding Syndrome. In our serie, 58% of patients were classified as type A, 28% as type B and 14% as type C. Sphincterian re-education obtained 64% of positive results, with 42% of patients being cured and 29% of them being improved. No result was obtained in 14% of patients. Two percent of patients relapsed after a remission period. Twenty percent of patients were excluded of the study because diverse reasons. Once treatment finished, clinical results remained stable during follow-up.

[High pressure filling bladder]. / Vejigas de alta presión de llenado.

A complete urodynamic study was carried out on 41 consecutive patients presenting in the cystomanometry a vesical filling pressure at maximum capacity higher than 30 cm H2O. Two groups were evident: group I with neurogenic etiology, and group II without an obvious neurogenic etiology. From its results it can be seen that a diminished vesical accommodation is not a urodynamic fact restricted to vesicourethral neurogenic dysfunction, but it happens in several non-neurogenic conditions. Within the neurogenic group, the urodynamic element most frequently associated to a diminished vesical accommodation was an inferior motor neuron-like vesicourethral dysfunction. An increased vesical filling pressure was not enough to produce urinary incontinence, being also necessary an added factor to prompt involuntary loss of urine.

[Uncoordinated urination syndrome]. / Síndrome de micción no coordinada.

Fourteen male and female patients aged 8 to 21 (mean 12.57 years) underwent clinical and urodynamic evaluation. These patients had different lower urinary tract symptoms, and flow changes and increased perineal muscle activity during voiding were demonstrated urodynamically. The urodynamic work up consisted of flowmetry, cystomanometry, detrusor pressure-flow test, videocystourethrography and electromyography of the periurethral sphincter. The urinary symptoms were nocturnal enuresis in 6 cases (42.85%), urinary infection in 6 (42.85%), difficulty in voiding in 4 (28.57%), urgency incontinence in 4 (28.57%), voiding urgency in 2 (14.28%) and diurnal urgency and frequency in 1 case (7.18%). The following 3 voiding bladder behaviour patterns were observed; 1) involuntary micturition from bladder instability (7 cases, 50%), 2) micturition from voluntary bladder contraction (2 cases, 14.28%) and 3) absence of bladder contractile activity with voiding achieved using the abdominal muscles (5 cases, 35.71%). Decompensated voiding was observed in 21% of the overall group. Of these, 75% belonged to the group that used the abdominal muscles to void. Dilatation of the proximal or prostatic urethra was frequently accompanied by bladder instability (57%). The urodynamic data may be useful in determining the outcome of treatment.