Factors Influencing Postoperative Overactive Bladder after Adjustable Trans-Obturator Male System Implantation for Male Stress Incontinence following Prostatectomy.

We aimed to determine the risk factors for postoperative overactive bladder (OAB) in patients treated with an adjustable trans-obturator male system (ATOMS) for stress incontinence after radical treatment of prostate cancer. A prospective study was performed on 56 patients implanted with an ATOMS for PPI. Clinical and urodynamic information was recorded before and after ATOMS implantation. We built a multivariate model to find out the clinical and urodynamic factors that independently influenced postoperative OAB and the prognostic factors that influenced the efficacy of medical treatment of OAB. We found that the clinical risk factors were the preoperative intensity of urinary incontinence (number of daily pads used and amount of urinary leakage), International Consultation on Incontinence Questionnaire (ICIQ) score, postoperative number of ATOMS adjustments, final cushion volume, and incontinence cure. The urodynamic data associated with OAB were cystometric bladder capacity, voided volume, volume at initial involuntary contraction (IC), maximum flow rate, bladder contractility index (BCI), and urethral resistance (URA). The prognostic factors for the efficacy of oral treatment of OAB were the volume at the first IC (direct relationship) and the maximum abdominal voiding pressure (inverse relationship). The multivariate model showed that the independent clinical risk factors were the daily pad count before the implantation and the ICIQ score at baseline and after treatment. The independent urodynamic data were the volume at the first IC (inverse relationship) and the URA value (direct relationship). Both predictive factors of treatment efficacy were found to be independent. Detrusor overactivity plays an important role in postoperative OAB, although other urodynamic and clinical factors such as the degree of urethral resistance and abdominal strength may influence this condition.

Update on Adjustable Trans-Obturator Male System (ATOMS) for Male Incontinence after Prostate Cancer Surgery.

(1) Background: The adjustable trans-obturator male system (ATOMS) is a surgical device developed to treat post-prostatectomy incontinence (PPI) after prostate cancer treatment. We review the current literature on this anti-incontinence device with the intention of assessing the effectiveness, safety and duration of the silicone-covered scrotal port (SSP) ATOMS, the only generation of the device that is currently available. (2) Material and Methods: Non-systematic literature review is performed. Forty-eight full-text articles are assessed for eligibility. Case reports, expert opinions or commentaries without specific data reported (n = 6), studies with patients who underwent intervention before 2014 (IP or SP ATOMS; n = 10), and studies with incontinence after transurethral resection of the prostate (TUR-P; n = 2) are excluded for analysis. Thirty studies with SSP ATOMS are included in a qualitative synthesis that incorporates systematic reviews (n = 3), articles partially overlapping with other previously published studies (e.g., follow-up or series updates; n = 9), and studies focusing on specific populations (n = 8). Only articles revealing outcomes of SSP ATOMS were included in the quantitative synthesis of results (n = 10). (3) Results: the pooled data of 1515 patients from the 10 studies with SSP ATOMS confirmed very satisfactory results with this device after adjustment: dry rate: 63-82%, improved rate: 85-100%, complication rate: 7-33%, device infection rate: 2.7-6.2% and explant rate: 0-19%. The durability of the device is reassuring, with 89% of devices in place 5 years after implantation. (4) Conclusion: Despite the absence of randomized controlled studies, the literature findings confirm results of SSP ATOMS appear equivalent to those of artificial urinary sphincters (AUSs) in terms of continence, satisfaction and complications, but with a lower rate of revision in the long-term. A prospective study identified that patients with daily pad test results <900 mL and a Male Stress Incontinence Grading Scale (MSIGS) of not 4 (i.e., early and persistent stream or urine loss) are the best candidates. Future studies centered on the elder population at higher risk of impaired cognitive ability and in patients including radiation as prostate cancer treatment are needed.

ATOMS (Adjustable Trans-Obturator Male System) in Patients with Post-Prostatectomy Incontinence and Previously Treated Urethral Stricture or Bladder Neck Contracture.

(1) Background: Male stress incontinence in patients with previously treated urethral or bladder neck stricture is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is unknown. (2) Methods: All patients with primary ATOMS implants in our institution between 2014 and 2021 were included. The outcomes of patients with previously treated urethral or bladder neck stricture (≥6 months before ATOMS implant) and stable 16Ch urethral caliber were compared to those without a history of stricture. The primary endpoint was the dry patient rate, defined as the pad test ≤ 20 mL/day, and complication rate, including device removal. The secondary variable was self-perceived satisfaction using the Patient Global Impression of Improvement (PGI-I) scale. Wilcoxon rank sum test, Fisher's exact test and logistic regression were performed. (3) Results: One hundred and forty-nine consecutive patients were included, twenty-one (14%) previously treated for urethral or bladder neck stricture (seven urethroplasty, nine internal urethrotomy and five bladder neck incision). After ATOMS adjustment, 38% of the patients with treated stricture were continent compared to 83% of those without (p < 0.0001). After weighted matched observations using propensity score pairing, the proportion of continent patients without a previous stricture was 56% (p = 0.236). Complications occurred in 29% of the patients with stricture and in 20% of those without (p = 0.34). The severity of the complications was distributed evenly among the groups (p = 0.42). Regarding self-perceived satisfaction with the implant, 90% of the patients with stricture perceived the results satisfactorily (PGI-I 1−3) compared to 97% of the rest (p = 0.167). Stricture was associated with radiotherapy (p < 0.0001) and time from prostatectomy to implantation (p = 0.012). There was a moderate correlation between previous stricture and the severity of incontinence, both evaluated according to the 24-h pad test (Rho = 0.378; p < 0.0001) and the ICIQ-SF questionnaire (Rho = 0.351; p < 0.0001). Multivariate analysis for the factors predictive of failure after ATOMS adjustment revealed previous stricture (OR 4.66; 95% CI 1.2−18.87), baseline 24-h pad test (per 100 mL, OR 1.28; 95% CI 1.09−1.52) and final cushion volume (per mL, OR 1.34; 95% CI 1.19−1.55). This model predicted dryness with an AUC of 92%. After the PSMATCH procedure using a propensity score, the model remained unchanged, with the previous stricture (OR 8.05; 95% CI 1.08−110.83), baseline 24-h pad test (per 100 mL, OR 1.53; 95% CI 1.15−2.26) and final cushion volume (per mL, OR 1.45; 95% CI 1.17−2) being independent predictors and an AUC of 93%. (4) Conclusions: ATOMS can be used to treat male stress incontinence in patients with a history of stricture, although the effectiveness of the device is reduced. On the other hand, the security and perceived satisfaction were equivalent for both groups.

[Urodynamic AUR in Guillain-Barré syndrome post-infection by coronavirus Sars-CoV-2. A bibliographic review.] / Urodinámica de la RAO en el síndrome De Guillain-Barré post-infección por coronavirus Sars-Cov-2. Revisión bibliográfica.

INTRODUCTION AND OBJECTIVE: The SARS-CoV-2 coronavirus infection has beenassociated with the development of the novo genitourinarysymptoms and neurological symptomssecondary to peripheral nervous system damage.One of the neurological pathologies described associatedwith the infection has been Guillain-Barrésyndrome (GBS). We conducted a review of the literatureon SARS-CoV-2 infection and its relationshipwith lower urinary tract symptoms (LUTS), such asurinary retention (AUR). Bladder alterations derivedfrom neurological involvement by SARS-CoV-2,such as GBS, were also analyzed. An own case ispresented. MATERIAL AND METHODS: A literature searchwas performed using a combination of keywords(MeSH terms): "COVID", "COVID-19", "SARS-CoV-2","Urinary retention" and "Guillain-Barre Syndromeand Urodynamics". We searched for articles publishedup to March 2021. All articles identified fromthe bibliographic search were analyzed, using thePICOS criteria (participants, intervention, comparisons,results, type of study) to assess the eligibilityof the articles. Both prospective and retrospectivestudies, clinical cases and published systematicreviews were included. RESULTS: Findings in the academic literatureabout the associations between COVID-19 and RAO,LUTS and Guillain-Barré Syndrome are discussed,as well as their possible pathogenic mechanisms,A summary of relevant studies on urodynamic findingsin GBS patients is also provided. The resultsare summarized in attached tables. A case of AURassociated with COVID-19 and Guillain-Barré Syndromeis provided, with its urodynamic findings. CONCLUSION: Although the association betweenurinary symptoms and SARS-CoV-2 is not well described,there seems to be evidence of a possibleassociation, at least temporary, between the presentationof SARS-Cov-2 infection and the developmentof GBS with secondary LUT neurophysiologyalterations.

INTRODUCCIÓN Y OBJETIVO: La infecciónpor coronavirus SARS-CoV-2 se ha asociadoa la aparición de síntomas genitourinarios de novo,además de síntomas neurológicos secundarios al dañodel sistema nervioso periférico. Una de las patologíasneurológicas descritas asociadas a la infección ha sidoel síndrome de Guillain-Barré (SGB). Realizamos unarevisión de la literatura sobre la infección por SARSCoV-2 y su relación con los síntomas del tracto urinarioinferior (STUI), como la retención urinaria (RAO).Se analizaron también las alteraciones vesicales derivadasde la afectación neurológica por SARS-CoV-2,como el SGB. Se presenta un caso propio. MATERIAL Y MÉTODOS: Se realizó una búsquedade la literatura utilizando una combinación de palabrasclave (términos MeSH): "COVID", "COVID-19","SARS-CoV-2", "Urinary retention" y "Guillain-BarreSyndrome and Urodynamics". Se realizaron búsquedasde artículos publicados hasta marzo de 2021. Todos los artículos identificados a partir de la búsquedabibliográfica fueron analizados, utilizando los criteriosPICOS (participantes, intervención, comparaciones,resultados, tipo de estudio) para evaluar la elegibilidadde los artículos. Se incluyeron tanto estudios prospectivos,retrospectivos, casos clínicos y revisiones sistemáticaspublicadas. RESULTADOS: Se discuten los hallazgos en la literaturade las asociaciones entre COVID-19 y RAO, STUIy Síndrome de Guillain-Barré, así como sus posiblesmecanismos patogénicos. También se aporta un resumende trabajos relevantes sobre hallazgos urodinámicosen pacientes con SGB. Los resultados seresumen en tablas anexas. Se aporta un caso de RAOasociado a COVID-19 y Síndrome de Guillain-Barrécon sus hallazgos urodinámicos. CONCLUSIÓN: A pesar de la asociación entre síntomasurinarios y SARS-CoV-2 no está bien descrita, pareceque hay indicios de una posible asociación, al menostemporal entre la presentación de infección porcoronavirus SARS-Cov-2 y el desarrollo de un SGB conalteraciones de la neurofisiología del TUI secundaria.

Urodinámica de la rao en el Síndrome de Guillain-Barré post-infección por coronavirus SARS-COV-2. Revisión bibliográfica / Rao urodynamics in Guillain-Barré Syndrome post-infection by SARS-COV-2 coronavirus. Bibliographic review

INTRODUCCIÓN Y OBJETIVO: La infección por coronavirus SARS-CoV-2 se ha asociadoa la aparición de síntomas genitourinarios de novo,además de síntomas neurológicos secundarios al dañodel sistema nervioso periférico. Una de las patologíasneurológicas descritas asociadas a la infección ha sidoel síndrome de Guillain-Barré (SGB). Realizamos unarevisión de la literatura sobre la infección por SARSCoV-2 y su relación con los síntomas del tracto urinario inferior (STUI), como la retención urinaria (RAO).Se analizaron también las alteraciones vesicales derivadas de la afectación neurológica por SARS-CoV-2,como el SGB. Se presenta un caso propio.MATERIAL Y MÉTODOS: Se realizó una búsquedade la literatura utilizando una combinación de palabras clave (términos MeSH): “COVID”, “COVID-19”,“SARS-CoV-2”, “Urinary retention” y “Guillain-BarreSyndrome and Urodynamics”. Se realizaron búsquedas de artículos publicados hasta marzo de 2021. Todos los artículos identificados a partir de la búsquedabibliográfica fueron analizados, utilizando los criteriosPICOS (participantes, intervención, comparaciones,resultados, tipo de estudio) para evaluar la elegibilidadde los artículos. Se incluyeron tanto estudios prospectivos, retrospectivos, casos clínicos y revisiones sistemáticas publicadas.RESULTADOS: Se discuten los hallazgos en la literatura de las asociaciones entre COVID-19 y RAO, STUIy Síndrome de Guillain-Barré, así como sus posiblesmecanismos patogénicos. También se aporta un resumen de trabajos relevantes sobre hallazgos urodinámicos en pacientes con SGB. Los resultados seresumen en tablas anexas. Se aporta un caso de RAOasociado a COVID-19 y Síndrome de Guillain-Barrécon sus hallazgos urodinámicos.CONCLUSIÓN: A pesar de la asociación entre síntomas urinarios y SARS-CoV-2 no está bien descrita, parece que hay indicios de una posible asociación, al menos temporal entre la presentación de infección porcoronavirus SARS-Cov-2 y el desarrollo de un SGB

INTRODUCTION AND OBJECTIVE: The SARS-CoV-2 coronavirus infection has beenassociated with the development of the novo genitourinary symptoms and neurological symptomssecondary to peripheral nervous system damage.One of the neurological pathologies described associated with the infection has been Guillain-Barrésyndrome (GBS). We conducted a review of the literature on SARS-CoV-2 infection and its relationshipwith lower urinary tract symptoms (LUTS), such asurinary retention (AUR). Bladder alterations derived from neurological involvement by SARS-CoV-2,such as GBS, were also analyzed. An own case ispresented.MATERIAL AND METHODS: A literature searchwas performed using a combination of keywords(MeSH terms): “COVID”, “COVID-19”, “SARS-CoV-2”,“Urinary retention” and “Guillain-Barre Syndromeand Urodynamics”. We searched for articles published up to March 2021. All articles identified fromthe bibliographic search were analyzed, using thePICOS criteria (participants, intervention, comparisons, results, type of study) to assess the eligibility of the articles. Both prospective and retrospective studies, clinical cases and published systematicreviews were included.RESULTS: Findings in the academic literatureabout the associations between COVID-19 and RAO,LUTS and Guillain-Barré Syndrome are discussed,as well as their possible pathogenic mechanisms,A summary of relevant studies on urodynamic findings in GBS patients is also provided. The resultsare summarized in attached tables. A case of AURassociated with COVID-19 and Guillain-Barré Syndrome is provided, with its urodynamic findings.CONCLUSION: Although the association betweenurinary symptoms and SARS-CoV-2 is not well described, there seems to be evidence of a possibleassociation, at least temporary, between the presentation of SARS-Cov-2 infection and the development of GBS with secondary LUT neurophysiologyalterations.

Compression or obstruction: Prospective analysis of the function of the Adjustable Transobturator Male System (ATOMS) based on preand postoperative urodynamic data.

INTRODUCTION: This analysis, based on pre- and postoperative urodynamic data, is the first to elucidate the influence of the Adjustable Transobturator Male System (ATOMS, A.M.I. GmbH, Feldkirch, Austria) on the lower urinary tract and disclose possible obstructive properties. METHODS: A prospective study was performed in patients who had stress urinary incontinence and were scheduled for ATOMS implantation after radical prostatectomy. Apart from continence assessment (24-hour pad test, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-SF]), urodynamic testing was done with International Continence Society (ICS)-standardized pressure-flow analysis before and after ATOMS implantation/adjustment. The Wilcoxon signed-rank test was used for statistical analysis. RESULTS: The analysis included 12 consecutive patients from two centers (mean age 69 years) with a mean followup of 246 days. Median urine leakage dropped from 240 (72-1250) to 70 (0-700) g/24 hours postoperatively, with a pad reduction of 4 to 0.9 pads/ day. Pressure-flow analysis revealed a significant change only in the bladder outlet obstruction index (BOOI). The bladder contractility index, intravesical pressure conditions, and uroflowmetry were not significantly affected. None of the patients showed de novo obstruction postoperatively in the ICS analysis. CONCLUSIONS: The ATOMS significantly increases the BOOI in conjunction with good continence results. However, no case reached pathological level according to the BOOI and thus there is no potential danger to the lower urinary tract or urethral integrity.

Influence of ATOMS implant on the voiding phase of patients with post-prostatectomy urinary incontinence.

OBJECTIVE: To assess changes in voiding phase, especially urethral resistance after post-prostatectomy urinary incontinence (PPI) treatment with the Adjustable TransObturator Male System (ATOMS). MATERIAL AND METHODS: A longitudinal prospective study was performed on 45 men treated with ATOMS for PPI, with the intention to evaluate the changes produced by the implant on the voiding phase. Patients with preoperative urodynamic study were offered postoperative urodynamic evaluation, and both studies were compared. The following urodynamic date were evaluated: maximum voiding detrusor pressure, detrusor pressure at maximum flow rate, maximum flow rate (Qmax), voiding volume, post-void residue, bladder outlet obstruction index (BOOI), urethral resistance factor (URA), and bladder contractility index (BCI). The statistical analysis used were the mean comparison test for dependent groups (Student's t test) for parametric variables and the Wilcoxon test for non-parametric variables. The signification level was set at 95% bilateral. RESULTS: A total of 37 patients (82.2%) used zero pads/day at the time of urodynamic postoperative evaluation and pad-test evolved from 592 ± 289 ml baseline to 25 ± 40 ml (p = 0.0001). Significant differences were observed in Qmax (15 ± 8.3 before and 11 ± 8.3 after surgery; p = 0.008), voiding volume (282 ± 130.7 before and 184 ± 99.92 after surgery). BOOI (-12 ± 23.9 before and -2 ± 21.4 after surgery; p = 0.025) and BCI (93 ± 46.4 before and 76 ± 46.0 after surgery; p = 0.044). In no case did we observe postoperative bladder outlet obstruction, according to URA parameter below 29 cm H2 O in all cases. There was not a significant variation either in post-void urinary residual volume (15 ± 47.4 before and 14 ± 24.2 after surgery, p = 0.867). CONCLUSIONS: The ATOMS implant induces a decrease of Qmax, voided volume, and bladder contractility and an increase of BOOI. However, our findings suggest that ATOMS device does not cause bladder outlet obstruction.

[Prevalence and risk factors for lower urinary tract symptoms after robotic sacrocolpopexy.] / Prevalencia y factores de riesgo de síntomas del tracto urinario inferior post sacrocolpopexia robótica.

OBJECTIVES: To analyse the outcomes of Robotic Sacrocolpopexy (RSC) on resolution of Lower urinary tract Symptoms (LUTS) associated to pelvic organ prolapses (POP) and to determine the risk factors for preoperative LUTS presence. MATERIAL AND METHODS: A longitudinal study was carried out on 51 females mean aged (± standard deviation) 66 ± 9 years, who underwent RSC. A preoperative evaluation was made on the degree and type of POP, and the presence of the LUTS stress urinary incontinence (SUI), urgency and voiding difficulty. An urodynamic study was also performed. The presence of LUTS was evaluated again six months after being operated on. The statistical test used were the Mcnermar test for dependent variables, the Fisher's exact test and the t Student's mean comparison test. The signification level was set at p < 0.05 bilaterally. RESULTS: A significate decrease of postoperative SUI and voiding difficult was observed. However, urgency did not significantly diminish. Transobturatice free-tension mesh ( TOT) implementation in patients with evident or occult (with POP reduction) urodynamic SUI significantly decreased the prevalence of symptomatic SUI. The only significate risk factor was the preoperative presence of urgency regarding its postoperative prevalence. CONCLUSIONS: Robotic sacrocolpopexy significantly improves postoperative voiding difficult. TOT implement in patients with positive POP reduction test is useful to prevent postoperative symptomatic SUI.

OBJETIVOS: Analizar los resultados de la sacrocolpopexia laparoscópica (LSC) robótica en la resolución de los síntomas funcionales del tracto urinario inferior (LUTS) asociados a los prolapsos pélvicos (POP) y determinar los posibles factores de riesgo para la presencia de LUTS postoperatorios.MATERIAL Y MÉTODOS: Se realizó un estudio longitudinal de 51 mujeres de edad media (± desviación típica) 66 ± 9 años intervenidas de LSC robótica por POP. Preoperatoriamente se evaluó el grado y tipo de POP, la presencia de los LUTS incontinencia urinaria de esfuerzo (SUI), y urgencia y dificultad miccionales, y se realizó un estudio urodinámico. A los 6 meses de la cirugía se volvió a evaluar la presencia de LUTS. Los test estadísticos utilizados fueron el test de Mcnemar para variables dependientes y el test exacto de Fisher y la prueba de comparación de medias de la t de Student para variables independientes. El nivel de significación se fijó en p < 0,05 bilateral. RESULTADOS: Se comprobó una disminución postoperatoria significativa de la SUI y la dificultad miccional, pero no de la urgencia miccional. La implantación de una malla transobturatiriz (TOT) en pacientes con incontinencia de esfuerzo urodinámica evidente o Post reducción del POP (incontinencia de esfuerzo oculta) disminuyo significativamente la prevalencia de SUI sintomática postoperatoria. El único factor de riesgo significativo fue la presencia preoperatoria de urgencia miccional respecto a la prevalencia postoperatoria de ese LUTS. CONCLUSIONES: La LSC robótica mejora significativamente la dificultad miccional preoperatoria. La implantación de un TOT en pacientes con test de reducción del POP positivo es útil para prevenir la SUI sintomática postoperatoria.

Prevalencia y factores de riesgo de síntomas del tracto urinario inferior post sacrocolpopexia robótica / Prevalence and risk factors of lower urinary tract symptoms after robotic sacrocolpopexy

Objetivos: Analizar los resultados de lasacrocolpopexia la paroscópica (LSC) robótica en la resolución de los síntomas funcionales del tracto urinarioinferior (LUTS) asociados a los prolapsos pélvicos (POP)y determinar los posibles factores de riesgo para la presencia de LUTS postoperatorios.Material y métodos: Se realizó un estudio longitudinal de 51 mujeres de edad media (± desviacióntípica) 66 ± 9 años intervenidas de LSC robótica porPOP. Preoperatoriamente se evaluó el grado y tipo dePOP, la presencia de los LUTS incontinencia urinaria deesfuerzo (SUI), y urgencia y dificultad miccionales, y serealizó un estudio urodinámico. A los 6 meses de lacirugía se volvió a evaluar la presencia de LUTS. Los testestadísticos utilizados fueron el test de Mcnemar paravariables dependientes y el test exacto de Fisher y la prueba de comparación de medias de la t de Studentpara variables independientes. El nivel de significaciónse fijó en p < 0,05 bilateral.Resultados: Se comprobó una disminución postoperatoria significativa de la SUI y la dificultad miccional,pero no de la urgencia miccional. La implantación deuna malla transobturatiriz (TOT) en pacientes con incontinencia de esfuerzo urodinámica evidente o Post reducción del POP (incontinencia de esfuerzo oculta) disminuyo significativamente la prevalencia de SUI sintomáticapostoperatoria. El único factor de riesgo significativofue la presencia preoperatoria de urgencia miccionalrespecto a la prevalencia postoperatoria de ese LUTS.Conclusiones: La LSC robótica mejora significativamente la dificultad miccional preoperatoria. La implantación de un TOT en pacientes con test de reduccióndel POP positivo es útil para prevenir la SUI sintomáticapostoperatoria.(AU)

Objetives: To analyse the outcomes ofRobotic Sacrocolpopexy (RSC) on resolution of Lowerurinary tract Symptoms (LUTS) associated to pelvic organprolapses (POP) and to determine the risk factors for preoperative LUTS presence.Material and methods: A longitudinal study wascarried out on 51 females mean aged (± standard deviation) 66 ± 9 years, who underwent RSC. A preoperative evaluation was made on the degree and type of POP, and the presence of the LUTS stress urinary incontinence (SUI), urgency and voiding difficulty. An urodynamic study was also performed. The presence of LUTSwas evaluated again six months after being operatedon. The statistical test used were the Mcnermar test fordependent variables, the Fisher’s exact test and the tStudent’s mean comparison test. The signification levelwas set at p < 0.05 bilaterally.Results: A significate decrease of postoperative SUIand voiding difficult was observed. However, urgencydid not significantly diminish. Transobturatice free-tensionmesh ( TOT) implementation in patients with evident oroccult (with POP reduction) urodynamic SUI significantlydecreased the prevalence of symptomatic SUI. The onlysignificate risk factor was the preoperative presence ofurgency regarding its postoperative prevalence.Conclusions: Robotic sacrocolpopexy significantlyimproves postoperative voiding difficult. TOT implementin patients with positive POP reduction test is useful toprevent postoperative symptomatic SUI.(AU)

Amplio estudio (283 mujeres) sobre la eficacia de Manosar(R): 2 g de d-manosa + 140 mg de proantocianidinas (PAC), de liberación prolongada frente a 240 mg de PAC de liberación prolongada en la prevención a 6 meses por vía oral de las infecciones urinarias recurrentes / Large study (283 women) on the effectiveness of Manosar(R): 2 g of d-mannose + 140 mg of proanthocyanidins (PAC), of prolonged release

OBJETIVO: Comparar la eficacia y seguridad de la profilaxis de las infecciones del tracto urinario (ITUs) con un complemento alimenticio que contiene D-manosa como principio activo principal (Manosar(R)), en comparación con otro preparado cuyo principio activo único son las proantocianidinas (PAC), ambos de liberación continuada, tras su administración durante24 semanas. MÉTODOS: Estudio experimental multicéntrico, aleatorizado y doble ciego. Se incluyeron 283 mujeres con historia de ITUs recurrentes sin evidencias de complicación. Se randomizaron 1:1 en dos grupos. En un grupo se administró 1 sobre diario oral de Manosar®, y en el otro 1 sobre diario oral de un compuesto de 240 mg de PAC de liberación continuada. Previo a la inclusión en el estudio se confirmó el episodio de ITU al menos por la sintomatología clínica y positividad del test de Combur. RESULTADOS: Se obtuvieron datos válidos de 184 pacientes con edad media de 49,5 años: 90 recibieron Manosar(R) y 94 PAC aislado. Un total de 72 pacientes padecieron una ITU por E.coli: 25 pacientes en el brazo con Manosar(R) frente a 47 pacientes en el grupo de PAC aislado, siendo esta diferencia estadísticamente significativa (p = 0,002). El tiempo libre de nuevas recurrencias de ITU fue de 98,6 días en el grupo tratado con Manosar(R) y de 84,6 días en el grupo con PAC aislado. CONCLUSIÓN: La toma oral de un sobre al día de Manosar(R) es eficaz y segura en la prevención de las ITUs recurrentes en la mujer, siendo superior a la toma oral de PAC aislado

OBJECTIVE: To compare the efficacy and safety in the prophylasis of urinary tract infections (UTIs) with a food supplement that contains D-mannose like active ingredient (Manosar(R)), in comparison to another preparation in which the active ingredient are the proanthocyanidins (PAC), both of them, in prolonged released, after, they was administered for 24 weeks. METHODS: A multicenter, randomized and double blind experimental study was carried out. 283 women with a history of recurrent UTIs without evidence of complication were included. They were randomized 1: 1 in two groups. In one group, 1 oral sachet of Manosar(R) a day was administered, and in the other group 1 oral sachet of a compound of 240 mg of continuous-release PAC. Prior to inclusion in the study, the episode of UTI was confirmed at least by the clinical symptoms and positivity of the Combur test. RESULTS: Valid data were obtained from 184 patients with an average age of 49.5 years: 90 received Manosar(R) and 94 isolated PAC. A total of 72 patients suffered an UTI due to E.coli: 25 patients in the arm with Manosar(R) versus 47 patients in the isolated PAC group, this difference being statistically significant (p = 0.002). The free time of new UTI recurrences was 98.6 days in the group treated with Manosar(R) and 84.6 days in the group with isolated PAC. CONCLUSION: The oral taking of a daily sachet of Manosar(R) is effective and safe in preventing recurrent UTIs in women, being superior to the oral taking of isolated PAC

Large study (283 women) on the effectiveness of Manosar®: 2 g of d-mannose + 140 mg of proanthocyanidins (PAC), of prolonged release. / Amplio estudio (283 mujeres) sobre la eficacia de Manosar®: 2 g de d-manosa + 140 mg de proantocianidinas (PAC), de liberación prolongada frente a 240 mg de PAC de liberación prolongada en la prevención a 6 meses por vía oral de las infecciones urinarias recurrentes.

OBJECTIVE: To compare the efficacy and safety in the prophylasis of urinary tract infections (UTIs) with a food supplement that contains D-mannose like active ingredient (Manosar®), in comparison to another preparation in which the active ingredient are the proanthocyanidins (PAC), both of them, in prolonged released, after, they was administered for 24 weeks. METHODS: A multicenter, randomized and double blind experimental study was carried out. 283 women with a history of recurrent UTIs without evidence of complication were included. They were randomized 1: 1 in two groups. In one group, 1 oral sachet of Manosar® a day was administered, and in the other group 1 oral sachet of a compound of 240 mg of continuous-release PAC. Prior to inclusion in the study, the episode of UTI was confirmed at least by the clinical symptoms and positivity of the Combur test. RESULTS: Valid data were obtained from 184 patients with an average age of 49.5 years: 90 received Manosar® and 94 isolated PAC. A total of 72 patients suffered an UTI due to E.coli: 25 patients in the arm with Manosar® versus 47 patients in the isolated PAC group, this difference being statistically significant (p=0.002). The free time of new UTI recurrences was 98.6 days in the group treated with Manosar® and 84.6 days in the group with isolated PAC. CONCLUSION: The oral taking of a daily sachet of Manosar® is effective and safe in preventing recurrent UTIs in women, being superior to the oral taking of isolated PAC.

OBJETIVO: Comparar la eficacia y seguridad de la profilaxis de las infecciones del tracto urinario (ITUs) con un complemento alimenticio que contiene D-manosa como principio activo principal (Manosar®), en comparación con otro preparado cuyo principio activo único son las proantocianidinas (PAC), ambos de liberación continuada, tras su administración durante24 semanas.MÉTODOS: Estudio experimental multicéntrico, aleatorizado y doble ciego. Se incluyeron 283 mujeres con historia de ITUs recurrentes sin evidencias de complicación. Se randomizaron 1:1 en dos grupos. En un grupo se administró 1 sobre diario oral de Manosar®, y en el otro 1 sobre diario oral de un compuesto de 240 mg de PAC de liberación continuada. Previo a la inclusión en el estudio se confirmó el episodio de ITU al menos por la sintomatología clínica y positividad del test de Combur. RESULTADOS: Se obtuvieron datos válidos de 184 pacientes con edad media de 49,5 años: 90 recibieron Manosar® y 94 PAC aislado. Un total de 72 pacientes padecieron una ITU por E.coli: 25 pacientes en el brazo con Manosar® frente a 47 pacientes en el grupo de PAC aislado, siendo esta diferencia estadísticamente significativa (p=0,002). El tiempo libre de nuevas recurrencias de ITU fue de 98,6 días en el grupo tratado con Manosar® y de 84,6 días en el grupo con PAC aislado.CONCLUSIÓN: La toma oral de un sobre al día de Manosar® es eficaz y segura en la prevención de las ITUs recurrentes en la mujer, siendo superior a la toma oral de PAC aislado.

Long-term outcome of adjustable transobturator male system for stress urinary incontinence in the Iberian multicentre study.

AIM: The aim of this study is to evaluate long-term durability and effectiveness of the adjustable transobturator male system (ATOMS). MATERIALS AND METHODS: The retrospective multicenter Iberian ATOMS study (n = 215) was updated to evaluate long-term continence status, complications, explants, and secondary treatments. Mean follow-up from surgery to March 2020 was 60.6 ± 18.4 months (range, 39-91). Eleven patients deceased of an unrelated causes. Kaplan-Meier curves were performed to evaluate device durability and incontinence free of recurrence interval. The multivariate analysis defined the population at risk of device explant. RESULTS: A total of 155 patients were dry at the last follow-up visit (72.1%); 99 (46%) used no pads and 56 (26%) used a security pad/day with urine loss less than 10 mL; 96% of dry patients after adjustment remained free of incontinence 1 year later, 93.6% 2 years later, 91.1% 3 years later, 89.2% 5 years later, and 86.7% 8 years later. Complications during follow-up occurred in 43 of 215 (20%). In total, 25 (11.6%) devices were explanted and causes were inefficacy 11 (44%), inefficacy and pain 3 (12%), port erosion 10 (40%), and wound infection 1 (4%). The secondary implant was performed in 11 (5.1%) cases, 6 artificial urinary sphincter and 5 repeated ATOMS. Time to explant was associated to complications (P < .0001), baseline stress urinary incontinence (SUI) severity (P = .01), and former irradiation (P = .03). Multivariate analysis revealed complications (hazard ratio [HR] = 8.71; 3.83-19.82), baseline SUI severity (>5 compared to 1-2 pads/day; HR = 14.9; 1.87-125), and irradiation before ATOMS (HR = 2.26; 1.02-5.18) predicted earlier ATOMS explant. Three cases received radiation after implant without complication. CONCLUSIONS: ATOMS device is efficacious and safe in the long term. Determinants for device explant include complications, baseline severity of incontinence, and previous irradiation. Currently, the durability of the device after 5 years is reassuring.

Do voiding urodynamic parameters predict the success of adjustable transobturator male system (ATOMS) to treat postprostatectomy urinary incontinence?

OBJECTIVE: To evaluate whether urodynamic voiding risk factors can be predictive of failure of postprostatectomy urinary incontinence (PPI) treatment with adjustable transobturator male system (ATOMS). MATERIALS AND METHODS: We carried out a longitudinal study on 77 males treated for PPI with ATOMS. Patients were submitted preoperatively to a urodynamic study. The postoperative outcome was checked by pad-test. Treatment success was defined as daily pad-test below 10 mL. Statistical analysis used were Fisher exact test, χ2 lineal by lineal test, Student t test, and logistic regression analysis. The signification level was set at 95% bilateral. RESULTS: Treatment was successful in 54 patients (70%) achieving continence. The urodynamic parameters that related to postoperative continence outcome were the cystometric bladder capacity (direct relationship with continence (P = .019), type of voiding (more probability to achieve continence in patients who voided voluntarily followed by patients with involuntary voiding and abdominal straining voiding) (P = .034), Bladder Outlet Obstruction Index (BOOI) (inversely related with continence) (P = .025), and maximum voiding abdominal pressure (inversely related with continence) (P = .049). Multivariate analysis showed that cystometric bladder capacity (odds ratio [OR], 1.01; confidence interval [CI], 1.02-1.00), BOOI (OR, 0.97; CI, 0.99-0.94), and maximum abdominal bladder pressure (OR, 0.97; CI, 0.98-0.94) were independent risk factors to predict treatment success after ATOMS implant. CONCLUSIONS: The study of functional voiding parameters is useful to know the risk factors that influence postoperative outcome of PPI with ATOMS device. These findings could be of primary importance to facilitate optimum patient selection for this implant and therefore improve operative results.

[Clinical and urodynamic risk factors of recurrent urinary tract infections in patients with multiple sclerosis.] / Factores de riesgo clínicos y urodinámicos de infecciones urinarias recurrentes en pacientes con esclerosis múltiple.

OBJECTIVES: To determine the risk factors of recurrent urinary infections (rUTIs) in patients with Multiple Sclerosis (MS). METHODS: A retrospective cohort study was conducted including 114 patients with MS, 84 women (74%) and 30 men (26%), with a mean age of 49. They underwent videourodynamic study and selective sphincter electromyography due to urinary symptoms (LUTS). Clinical data (both neurological and urological) and videourodynamic data (including free flowmetry, cystomanometry and pressure flow study) were collected. In 37 patients (32%), the presence of rTUIs was demonstrated. RESULTS: Statistically significant differences were demonstrated between the patients with and without rUTIs with respect to the following clinical variables: the time of evolution of the symptoms (greater in the case of rUTIs), time from the diagnosis of MS (higher in the case of rUTIs), EDSS score (Expanded Disability Staus Scale) (higher in the case of rUTIs) and the EM type [higher frequency of rUTIs in the progressive types (primary and secondary)]. Urodynamic variables with significant differences were: maximum flow in free flowmetry (lower in patients with rUTIs), voiding volume in free flowmetry (lower in patients with rUTIs), micturition efficiency (higher percentage of residual urine in patients with rUTIs), stress urinary incontinence (SUI) (higher frequency of rUTIs in patients with SUI), detrusor pressure at maximum flow (lower in patients with rUTIs) and bladder contractility index (lower in patients with rUTI). No significant difference was demonstrated in relation to the presence and type of neurogenic lower urinary tract dysfunction (NLUTD). CONCLUSIONS: The severity and duration of MS is a risk factor for rUTIs. Urodynamic risk factors are compatible with a lower contractile capacity in patients with rUTIs, while the existence of NLUTD would not imply any specific risk factor.

OBJETIVO: Determinar los factores de riesgo de infecciones urinarias recurrentes (rUTIs) en pacientes con Esclerosis Múltiple (EM).MÉTODOS: Se realizó un estudio de cohortes retrospectivo en 114 pacientes, 84 mujeres (74%) y 30 varones (26%), de edad media 49 años con EM sometidos a estudio videourodinámico y electromiografía selectiva esfinteriana por presentar síntomas urinarios (LUTS). Se recogieron los datos clínicos (tanto neurológicos como urológicos) y videourodinámicos (incluyendo flujometría libre, cistomanometría y estudio presión flujo). En 37 pacientes (32%) se demostró la presencia de rTUIs. RESULTADOS: Se demostraron diferencias estadísticamente significativas entre los pacientes con y sin rUTIs respecto de las siguientes variables clínicas: el tiempo de evolución de los síntomas (mayor en el caso de rUTIs), antigüedad de la EM (mayor en el caso de rUTIs), la puntuación EDSS (Expanded Disability Staus Scale) (mayor en el caso de rUTIs) y el tipo EM [mayor frecuencia de rUTIs en los tipos progresivos (primario y secundario)]. Las variables urodinámicas con diferencias significativas fueron: el flujo máximo en la flujometría libre (menor en pacientes con rUTIs), el volumen miccional en la flujometría libre (menor en pacientes con rUTIs), la eficiencia miccional (mayor porcentaje de residuo en pacientes con rUTIs), la incontinencia urinaria de esfuerzo (SUI) (mayor frecuencia de rUTIs en pacientes con SUI), la presión del detrusor a flujo máximo (menor en pacientes con rUTIs) y el índice de contractilidad vesical (menor en pacientes con rUTI). No se demostró ninguna diferencia significativa en relación con la presencia y tipo de disfunción neurógena del tracto urinario inferior (NLUTD). CONCLUSIONES: La gravedad y duración de la EM constituye un factor de riesgo para las rUTIs. Los factores de riesgo urodinámicos son compatibles con una menor capacidad contráctil en los pacientes con rUTIs, mientras que la existencia NLUTD no supondría ningún factor de riesgo específico.

Factores de riesgo clínicos y urodinámicos de infecciones urinarias recurrentes en pacientes con esclerosis múltiple / Clinical and urodynamic risk factors of recurrent urinary tract infections in patients with multiple sclerosis

OBJETIVO: Determinar los factores de riesgo de infecciones urinarias recurrentes (rUTIs) en pacientes con Esclerosis Múltiple (EM). MÉTODOS: Se realizó un estudio de cohortes retrospectivo en 114 pacientes, 84 mujeres (74%) y 30 varones (26%), de edad media 49 años con EM sometidos a estudio videourodinámico y electromiografía selectiva esfinteriana por presentar síntomas urinarios (LUTS). Se recogieron los datos clínicos (tanto neurológicos como urológicos) y videourodinámicos (incluyendo flujometría libre, cistomanometría y estudio presión flujo). En 37 pacientes (32%) se demostró la presencia de rTUIs. RESULTADOS: Se demostraron diferencias estadísticamente significativas entre los pacientes con y sin rUTIs respecto de las siguientes variables clínicas: el tiempo de evolución de los síntomas (mayor en el caso de rUTIs), antigüedad de la EM (mayor en el caso de rUTIs), la puntuación EDSS (Expanded Disability Staus Scale) (mayor en el caso de rUTIs) y el tipo EM [mayor frecuencia de rUTIs en los tipos progresivos (primario y secundario)]. Las variables urodinámicas con diferencias significativas fueron: el flujo máximo en la flujometría libre (menor en pacientes con rUTIs), el volumen miccional en la flujometría libre (menor en pacientes con rUTIs), la eficiencia miccional (mayor porcentaje de residuo en pacientes con rUTIs), la incontinencia urinaria de esfuerzo (SUI) (mayor frecuencia de rUTIs en pacientes con SUI), la presión del detrusor a flujo máximo (menor en pacientes con rUTIs) y el índice de contractilidad vesical (menor en pacientes con rUTI). No se demostró ninguna diferencia significativa en relación con la presencia y tipo de disfunción neurógena del tracto urinario inferior (NLUTD). CONCLUSIONES: La gravedad y duración de la EM constituye un factor de riesgo para las rUTIs. Los factores de riesgo urodinámicos son compatibles con una menor capacidad contráctil en los pacientes con rUTIs, mientras que la existencia NLUTD no supondría ningún factor de riesgo específico

OBJECTIVES: To determine the risk factors of recurrent urinary infections (rUTIs) in patients with Multiple Sclerosis (MS). METHODS: A retrospective cohort study was conducted including 114 patients with MS, 84 women (74%) and 30 men (26%), with a mean age of 49. They underwent videourodynamic study and selective sphincter electromyography due to urinary symptoms (LUTS). Clinical data (both neurological and urological) and videourodynamic data (including free flowmetry, cystomanometry and pressure flow study) were collected. In 37 patients (32%), the presence of rTUIs was demonstrated. RESULTS: Statistically significant differences were demonstrated between the patients with and without rUTIs with respect to the following clinical variables: the time of evolution of the symptoms (greater in the case of rUTIs), time from the diagnosis of MS (higher in the case of rUTIs), EDSS score (Expanded Disability Staus Scale) (higher in the case of rUTIs) and the EM type [higher frequency of rUTIs in the progressive types (primary and secondary)]. Urodynamic variables with significant differences were: maximum flow in free flowmetry (lower in patients with rUTIs), voiding volume in free flowmetry (lower in patients with rUTIs), micturition efficiency (higher percentage of residual urine in patients with rUTIs), stress urinary incontinence (SUI) (higher frequency of rUTIs in patients with SUI), detrusor pressure at máximum flow (lower in patients with rUTIs) and bladder contractility index (lower in patients with rUTI). No significant difference was demonstrated in relation to the presence and type of neurogenic lower urinary tract dysfunction (NLUTD). CONCLUSIONS: The severity and duration of MS is a risk factor for rUTIs. Urodynamic risk factors are compatible with a lower contractile capacity in patients with rUTIs, while the existence of NLUTD would not imply any specific risk factor

Cambios funcionales en la fase miccional de varones diagnosticados de detrusor hipoactivo no neurogénico sometidos a cateterización vesical / Functional changes during the voiding phase in males with non-neurogenic detrusor underactivity undergoing bladder catheterization

Objetivos: Determinar los cambios urodinámicos de la fase miccional en varones con hipocontractilidad del detrusor (DU) sometidos a cateterismo vesical por retención urinaria. Métodos: De un total de 64 pacientes con retención urinaria, se realizó un estudio de seguimiento en 17 varones de edad media 77 años, diagnosticados urodinámicamente de DU por presentar un Índice de Contractilidad Vesical (BCI) menor de 100, sometidos a sonda vesical a permanencia (16 casos) o cateterismo vesical limpio intermitente (1 caso) por retención aguda de orina (14 casos), o residuo postmiccional patológico (3 casos). Los pacientes fueron sometidos a un segundo estudio urodinámico a los 13 meses de seguimiento de media. Las pruebas estadísticas utilizadas fueron el test exacto de Fisher para variables cualitativas y el test de comparación de media de la t de Student para variables paramétricas. El nivel de significación se fijó en p < 0,05 bilateral. Resultados: En el segundo estudio urodinámico, se observó un aumento significativo de la presión máxima del detrusor, la presión a flujo máximo, el BCI y el Índice de Obstrucción de Salida Vesical (BOOI) y del número de pacientes que orinaron durante el estudio presión/ flujo. Conclusiones: El cateterismo vesical en varones con DU mejora significativamente la contractilidad vesical y permiten desenmascarar obstrucciones del tracto urinario inferior que estaban ocultas por una insuficiente presión del detrusor en relación a la DU de estos pacientes. Esto podría tener no sólo aplicaciones diagnósticas, sino pronósticas y terapéuticas

Objectives: To investigate urodynamic changes during the voiding phase in males with detrusor underactivity (DU) undergoing bladder catheterization for urinary retention. Methods: From a total of 64 patients with urinary retention, a follow-up study was performed in 17 males with a mean age of 77 years. Patients received a urody namic diagnosis of DU based on a Bladder Contractility Index (BCI) score of <100 and underwent permanent bladder catheterization (16 cases) or clean intermittent catheterization (1 case) for acute urinary retention (14 cases), or post void residual urine (3 cases). Patients underwent a second urodynamic study after a mean 13 months of follow-up. Fisher’s exact test was used with categorical variables and Student’s t test with parametric variables. The level of significance was set at p < 0.05 for a two-sided test. Results: The second urodynamic study showed a significant increase in maximal detrusor pressure, pressure at maximum flow rate, BCI score, Bladder Outlet Obstruction Index (BOOI) score, and number of patients who urinated during the pressure-flow study. Conclusions: Bladder catheterization in men with DU significantly improves bladder contractility and revealed obstructions of the lower urinary tract that were masked by insufficient detrusor pressure in relation to the DU of these patients. These findings could have diagnostic as well as prognostic and therapeutic applications

[Functional changes during the voiding phase in males with non-neurogenic detrusor underactivity undergoing bladder catheterization.] / Cambios funcionales en la fase miccional de varones diagnosticados de detrusor hipoactivo no neurogénico sometidos a cateterización vesical.

OBJECTIVES: To investigate urodynamic changes during the voiding phase in males with detrusor underactivity (DU) undergoing bladder catheterization for urinary retention. METHODS: From a total of 64 patients with urinary retention, a follow-up study was performed in 17 males with a mean age of 77 years. Patients received a urodynamic diagnosis of DU based on a Bladder Contractility Index (BCI) score of < 100 and underwent permanent bladder catheterization (16 cases) or clean intermittent catheterization (1 case) for acute urinary retention (14 cases), or post void residual urine (3 cases). Patients underwent a second urodynamic study after a mean 13 months of follow-up. Fisher's exact test was used with categorical variables and Student's t test with parametric variables. The level of significance was set at p < 0.05 for a two-sided test. RESULTS: The second urodynamic study showed a significant increase in maximal detrusor pressure, pressure at maximum flow rate, BCI score, Bladder Outlet Obstruction Index (BOOI) score, and number of patients who urinated during the pressure-flow study. CONCLUSIONS: Bladder catheterization in men with DU significantly improves bladder contractility and revealed obstructions of the lower urinary tract that were masked by insufficient detrusor pressure in relation to the DU of these patients. These findings could have diagnostic as well as prognostic and therapeutic applications.

OBJETIVOS: Determinar los cambios urodinámicos de la fase miccional en varones con hipocontractilidad del detrusor (DU) sometidos a cateterismo vesical por retención urinaria. MÉTODOS: De un total de 64 pacientes con retención urinaria, se realizó un estudio de seguimiento en 17 varones de edad media 77 años, diagnosticados urodinámicamente de DU por presentar un Índice de Contractilidad Vesical (BCI) menor de 100, sometidos a sonda vesical a permanencia (16 casos) o cateterismo vesical limpio intermitente (1 caso) por retención aguda de orina (14 casos), o residuo postmiccional patológico (3 casos). Los pacientes fueron sometidos a un segundo estudio urodinámico a los 13 meses de seguimiento de media. Las pruebas estadísticas utilizadas fueron el test exacto de Fisher para variables cualitativas y el test de comparación de media de la t de Student para variables paramétricas. El nivel de significación se fijó en p < 0,05 bilateral. RESULTADOS: En el segundo estudio urodinámico, se observó un aumento significativo de la presión máxima del detrusor, la presión a flujo máximo, el BCI y el Índice de Obstrucción de Salida Vesical (BOOI) y del número de pacientes que orinaron durante el estudio presión/ flujo. CONCLUSIONES: El cateterismo vesical en varones con DU mejora significativamente la contractilidad vesical y permiten desenmascarar obstrucciones del tracto urinario inferior que estaban ocultas por una insuficiente presión del detrusor en relación a la DU de estos pacientes. Esto podría tener no sólo aplicaciones diagnósticas, sino pronósticas y terapéuticas.

[Efficacy and safety of D-mannose (2 g), 24h prolonged release, associated with Proanthocyanidin (PAC), versus isolate PAC, in the management of a series of women with recurrent urinary infections.] / Eficacia y tolerancia terapéutica de la D­manosa (2 g) de liberación prolongada 24 horas (asociada a proantocianidinas), frente a proantocianidinas aisladas en el manejo de una serie de mujeres con infecciones urinarias recurrentes.

OBJECTIVE: To compare the efficacy and safety of dietary supplement "Manosar®" composed of D-mannose (2 g), 24 h prolonged release, associated with Proanthocyanidin (PAC) (140 mg), ursolic acid (7.98 mg), A, C, and D vitamins and the oligoelement zinc, versus 240 mg of PAC in recurrent urinary tract infections (UTI), for a designed follow-up of 24 weeks, in women. METHODS: A multicenter randomized experimental double-blind study was carried out. The study was approved by review board of "Complejo Hospitalario de Toledo" (Spain), and all patients gave informed consent. A total of 150 women with non complicated UTI were screened for participation. Valid data was obtained from 93, with mean age of 48 years. Fortyfour patients were assigned to the Manosar® group and 51 patients to the PAC group. Patients were followed during six months. A previous UTI was defined based on a combination of symptoms and a positive reactive urine trip. Confirmation of a new UTI was based on symptoms, reactive urine strip and urine culture. RESULTS: Thirty-three patients (35%) had an UTI during the six months follow-up. The percentage of UTI of the Manosar® group during this period was 24%, while the percentage of the PAC group was 45% (p〈0.05). The disease-free time for the Manosar® group was 95 days, while this time was 79 days for the PAC group. The incidence of side effects was low. Diarrhea was the most frequent side-effect in both groups. CONCLUSION: Manosar® (oral once a day) is more effective than single dose PAC (240 mg daily orally) to prevent recurrent UTI in women.

Eficacia y tolerancia terapéutica de la D-manosa (2 g) de liberación prolongada 24 horas (asociada a proantocianidinas), frente a proantocianidinas aisladas en el manejo de una serie de mujeres con infecciones urinarias recurrentes / Efficacy and safety of D-mannose (2 g), 24h prolonged release, associated with Proanthocyanidin (PAC), versus isolate PAC, in the management of a series of women with recurrent urinary infections

Objetivo: Comparar la eficacia y seguridad de un complemento alimenticio (Manosar®) (2 gramos de D-manosa, 140 mg de PAC y 7,98 mg de ácido ursólico junto con las vitaminas A, C y E, y el oligoelemento Zinc) en la recurrencia de la ITU y su comparación con un compuesto basado con 240 mg proantocianidinas (PAC aislado), con una duración de administración esperada de 24 semanas. Métodos: Estudio experimental multicéntrico, aleatorizado y doble ciego. Aprobado por el Comité Ético de Investigación clínica del "Complejo Hospitalario de Toledo". Todos los pacientes firmaron el consentimiento. Se incluyeron 150 mujeres con historia de ITU recurrentes sin evidencias de complicación. Se obtuvieron datos válidos de 93 pacientes con edad media de 47,62 años. 42 recibieron Manosar y 51 PAC aislado. Controles cada 30 días durante 6 meses. La confirmación del episodio clínico previo de ITU fue definido al menos por la sintomatología clínica y tira de orina Combur (positiva a leucocito-esterasa y/o nitritos). La confirmación del nuevo episodio incidente durante el estudio fue confirmado por la sintomatología clínica, tira de orina y urinocultivo. Resultados: 33 pacientes (35,48%) padecieron una ITU durante el periodo de 6 meses de seguimiento. En el grupo tratado con Manosar® se observó ITU a los seis meses en un 23,8%, mientras que en el grupo control (PAC aislado) fue de 45,1% (p<0,05). El tiempo libre de enfermedad fue de 78,81 días en el grupo control (PAC aislado) y de 94,7 días en el grupo tratado con Manosar®. Se observó una baja incidencia de acontecimientos adversos, siendo la diarrea el más frecuente en ambos grupos. Conclusión: La toma oral de Manosar®, un sobre al día, es más eficaz que la toma oral de 240 mg de PAC aislado, un sobre al día, en la prevención de las infecciones urinarias de repetición en la mujer (AU)

Objetive: To compare the efficacy and safety of dietary supplement "Manosar®" composed of D-mannose (2 g), 24 h prolonged release, associated with Proanthocyanidin (PAC) (140 mg), ursolic acid (7.98 mg), A, C, and D vitamins and the oligoelement zinc, versus 240 mg of PAC in recurrent urinary tract infections (UTI), for a designed follow-up of 24 weeks, in women. Methods: A multicenter randomized experimental double-blind study was carried out. The study was approved by review board of "Complejo Hospitalario de Toledo" (Spain), and all patients gave informed consent. A total of 150 women with non complicated UTI were screened for participation. Valid data was obtained from 93, with mean age of 48 years. Fortyfour patients were assigned to the Manosar® group and 51 patients to the PAC group. Patients were followed during six months. A previous UTI was defined based on a combination of symptoms and a positive reactive urine trip. Confirmation of a new UTI was based on symptoms, reactive urine strip and urine culture. Results: Thirty-three patients (35%) had an UTI during the six months follow-up. The percentage of UTI of the Manosar® group during this period was 24%, while the percentage of the PAC group was 45% (p<0.05). The disease-free time for the Manosar® group was 95 days, while this time was 79 days for the PAC group. The incidence of side effects was low. Diarrhea was the most frequent side-effect in both groups. Conclusion: Manosar® (oral once a day) is more effective than single dose PAC (240 mg daily orally) to prevent recurrent UTI in women (AU)

Effect of pelvic organ prolapse repair on detrusor overactivity in women following incontinence surgery: A multivariate analysis.

AIMS: To determine the effect of pelvic organ prolapse (POP) repair on post-operative detrusor overactivity (DO) in women who have underwent incontinence surgery, using multivariate analysis. METHODS: A retrospective study was carried out on a cohort of 105 women who underwent incontinence surgery. In 39 of the patients this surgery was associated with pelvic organ prolapse repair. Clinical and urodynamic data were collected pre- and 3 months post-operatively. A multivariate statistical analysis was performed to detect confounding factors which could influence on the risk factors associated with post-operative detrusor overactivity. RESULTS: On univariate analysis, the following pre-operative factors were associated with post-operative detrusor overactivity: symptomatic mixed urinary incontinence, rectocele, detrusor overactivity, voided volume on free uroflowmetry, maximum cystomanometric capacity, and performing concomitant pelvic organ prolapse repair. Multivariate analysis, by means of confounding factors elimination, revealed that only pre-operative rectocele and detrusor overactivity were independent risk factors. CONCLUSIONS: The pelvic organ prolapse repair acts as a confounding factor. Women with a pre-operative rectocele and detrusor overactivity are on a greater risk to develop post-operative detrusor overactivity and, therefore, they should be informed.