[Contasure Needleless: a single incision tot for the surgical treatment of stress urinary incontinence]. / Contasure needleless: TOT de una sola incision para el tratamiento de la incontinencia de urinaria de esfuerzo.

SUMMARY OBJECTIVES: The aim of this study is to describe the surgical technique, and assess the complications and middle-term results of the Contasure Needleless (Neomedic International), a single incision TOT sling for the surgical treatment of stress urinary incontinence. The main concept of this device is that it is not a mini-sling, it has 138% more surface area. We are analyzing the results of a minimally invasive solution that is a TOT like sling with the same known benefits of a TOT and the advantages of a single incision technique. The surface area to support the urethra of the Needleless is very similar to the surface area of the TOT. (16% less surface area of tissue ingrowths) It is 100% macroporous polypropylene without any additional material. METHODS: 120 patients were evaluated retrospectively. They were all treated of SUI with the Contasure Needleless.Female patients were evaluated under clinical study protocol consisting in cough test, urodynamic and Quality Of Life questionnaire, before and after the procedure. INCLUSION CRITERIA: patients with genuine SUI and patients with SUI plus concomitant procedures as prolapse. EXCLUSION CRITERIA: patients with ISD and or neurogenic incontinence. Anesthesia used: general (30%) or epidural (70%), patients with associated pathology. PROCEDURE: The 114 mm long and tension-free mesh was placed beneath the midurethra. The central part is 12 mm wide. The sling can be repositioned during surgery due to the 22 mm wide T-Pocket Positioning System located at the 2 edges. These pockets fixed the sling to the surrounding tissue in order to have the proper tissue in growth and anchoring. A 20mm sub urethral incision was made to dissect the paraurethral spaces only up to the ischiopubic ramus. A surgical forceps with the T-pocket folded was inserted into the dissected spaces and penetrates at the contra lateral side, like the standard transobturator technique. The forceps was introduced until the fascia of the Internal Obturator muscle was perforated. Then the forceps is opened to extend the pocket inside the muscle fibers for fixation. RESULTS: 120 patients with a mean age of 55 years (from 36 to 79) and a mean number of deliveries of 3 (0-7). Follow-up period: 24 months. SUCCESS RATE: 100 patients (84%) Improved rate: 10 patients (8%) Failure rate: 10 (8%) Mean operating time of sling procedure alone: 9 minutes (4-12). COMPLICATIONS: 3 patients had mesh extrusion solved with estrogens and 2 patients required short term catheterization due to voiding difficulties and no patients had inguinal pain. CONCLUSIONS: The results of the study suggest that the Contasure Needleless can be considered a minimally invasive TOT with no-needles and maintaining the same cure rate than our TOT cases at 2 years follow up.

Contasure Needleless: TOT de una sola incisión para el tratamiento de la incontinencia de urinaria de esfuerzo / Contasure needleless: a single incision TOT for the surgical treatment of stress urinary incontinence

OBJETIVO: El objetivo de este estudio es describir la técnica quirúrgica, medir la seguridad, resultados y posibles complicaciones a medio plazo de una técnica sin agujas Contasure Needleless (Neomedic International) un TOT de una sola incisión para el tratamiento quirúrgico de la incontinencia urinaria de esfuerzo.Un concepto básico de esta malla es que no es un Minislings, el Contasure Needleless es un TOT de una sola incisión posee una superficie de fibrosis 138% mayor que los minisling. Analizarémos el resultado de este procedimiento mínimamente invasivo. El área de soporte uretral del Contasure Needleless es muy similar al TOT (un 16% menor). El material es 100% polipropileno macro poroso.MÉTODO: 120 pacientes fueron evaluadas retrospectivamente. Todas las pacientes fueron operadas por incontinencia urinaria de esfuerzo con Contasure Needleless. El protocolo clínico que se siguió en todas estas pacientes fue test de esfuerzo, estudio urodinámico y cuestionario de calidad de vida antes y después del procedimiento. El criterio de inclusión fueron pacientes con incontinencia urinaria de esfuerzo en muchos casos con cirugía asociada. Pacientes con déficit intrínseco del esfínter o incontinencia neurógena fueron excluidas del estudio. La anestesia fue general en un 30% de las pacientes y epidural en un 70%.Se coloco una malla de polipropileno libre de tensión en la uretra media de 114 mm de largo (Contasure Needleless). La parte central la malla tiene 12mm ancho. La Malla puede ser ajustada durante la cirugía, posee dos bolsillos a cada lado. Estos bolsillos ayudan en un primer momento a mantener la malla y mas adelante proporcionaran un soporte a la malla debido a la fibrosis. Se hace una incisión suburetral de 20mm y se disecan los espacios parauretrales hasta la rama isquiopubica. Una Bengolea se introduce en los bolsillos y se cierra, después se inserta en los espacios disecados hasta penetrar el musculo obturador interno abriendo el bolsillo una vez penetrado el musculo, los mismos pasos se realizan en el lado contrario.RESULTADOS:120 pacientes con una edad media de 55 años (36 a 79) y una media de 3 partos (0-7). Seguimiento medio: 24 meses. De los 120 pacientes 100 de ellos (84%) están totalmente curados, Mejorados 10 pacientes (8%) y fracasos un 10 (8%). El tiempo medio de operación de colocación de la malla fue de 9 minutos (4-12). Complicaciones: 3 pacientes tuvieron una extrusión vaginal de la malla resuelta con estrógenos y 2 pacientes tuvieron dificultades temporales de vaciado, ningún paciente sufrió de dolor inguinal.CONCLUSIONES: Los resultados del estudio sugieren que el Contasure Needleless puede ser considerado un tratamiento de elección para tratamiento quirúrgico de la incontinencia urinaria de esfuerzo .Es un tratamiento mínimamente invasivo, sin el uso de agujas y mantiene resultados similares de curación a dos años de seguimiento que el TOT convencional (AU)

OBJECTIVES: The aim of this study is to describe the surgical technique, and assess the complications and middle-term results of the Contasure Needleless (Neomedic International), a single incision TOT sling for the surgical treatment of stress urinary incontinence.The main concept of this device is that it is not a mini-sling, it has 138% more surface area. We are analyzing the results of a minimally invasive solution that is a TOT like sling with the same known benefits of a TOT and the advantages of a single incision technique. The surface area to support the urethra of the Needleless is very similar to the surface area of the TOT. (16% less surface area of tissue ingrowths) It is 100% macroporous polypropylene without any additional material.METHODS: 120 patients were evaluated retrospectively. They were all treated of SUI with the Contasure Needleless. Female patients were evaluated under clinical study protocol consisting in cough test, urodynamic and Quality Of Life questionnaire, before and after the procedure. Inclusion criteria: patients with genuine SUI and patients with SUI plus concomitant procedures as prolapse. Exclusion criteria: patients with ISD and or neurogenic incontinence. Anesthesia used: general (30%) or epidural (70%), patients with associated pathology(AU)

PROCEDURE: The 114 mm long and tension-free mesh was placed beneath the midurethra. The central part is 12mm wide. The sling can be repositioned during surgery due to the 22mm wide T-Pocket Positioning System located at the 2 edges. These pockets fixed the sling to the surrounding tissue in order to have the proper tissue in growth and anchoring. A 20mm sub urethral incision was made to dissect the paraurethral spaces only up to the ischiopubic ramus. A surgical forceps with the T-pocket folded was inserted into the dissected spaces and penetrates at the contra lateral side, like the standard transobturator technique. The forceps was introduced until the fascia of the Internal Obturator muscle was perforated. Then the forceps is opened to extend the pocket inside the muscle fibers for fixation.RESULTS: 120 patients with a mean age of 55 years (from 36 to 79) and a mean number of deliveries of 3 (0-7). Follow-up period: 24 months. Success rate: 100 patients (84%) Improved rate: 10 patients (8%) Failure rate: 10 (8%) Mean operating time of sling procedure alone: 9 minutes (4-12).Complications: 3 patients had mesh extrusion solved with estrogens and 2 patients required short term catheterization due to voiding difficulties and no patients had inguinal pain.CONCLUSIONS: The results of the study suggest that the Contasure Needleless can be considered a minimally invasive TOT with no-needles and maintaining the same cure rate than our TOT cases at 2 years follow up(AU)

[Changes in detrusor contractility in bladder hyperreflexia]. / Afectación de la contractilidad del detrusor en la hiperreflexia vesical.

OBJECTIVES: Classically, it was understood detrusor contractility was affected in bladder areflexia but not in hyperreflexia. We aim to demonstrate that there is some detrusor contractility affectation in bladder hyperreflexias, although it may seem paradoxical at first sight. METHODS: Neuro-urologic study was performed in a series of 68 consecutive patients with bladder hyperreflexia (neurogenic detrusor hyperactivity), referred to the unit of functional urology for urodynamic evaluation. All patients underwent clinical history, post void residual determination, cystomanometry, voiding pressure-flow test, videourodynamics and selective EMG of the periurethral sphincter. Detrusor contractile potency was measured with W 80-20. Terminology follows the ICS standard. Data processing was performed using the statistical software SPSS 12.0. RESULTS: This series includes 14 males (58.8%) and 28 females (41.2%), of all ages (adults more frequent). 88.2% of the cases had acquired neurological diseases (trauma 30.9%; medical 33.8%; degenerative 35.3%), and 11.8% congenital neurological diseases (myelodysplasia). Most frequent type of neurological lesion was detrusor-sphincter dyssynergia: 59 cases (79.4%); 22 patients (32.4%) had undergone previous treatment of their vesicourethral dysfunction. The amplitude of detrusor involuntary contractions was wider in detrusor-bladder neck dyssynergia. Detrusor isotonic contractility (W 80-20) was significantly affected, mainly in neurological lesions of traumatic nature and less in degenerative lesions (p = 0.01). CONCLUSIONS: We demonstrated that bladder contractility is affected in bladder hyperreflexias (neurogenic detrusor hyperactivity), more important in traumatic lesions without relationship with the type of neurological associated lesion, which could be related to a bladder structural change, or with a change in the central neurological tracts (without requirement of presence of dyssynergia).

Afectación de la contractilidad del detrusor en la hiperreflexia vesical / Changes in detrusor contractility in bladder hyperrreflexia

Objetivo: Clásicamente se entendía que en las arreflexias vesicales existía una afectación de la contractilidad del detrusor, pero no así en las hiperreflexias vesicales. En nuestro trabajo se pretende demostrar que una afectación en la contractilidad del detrusor se presenta en las hiperreflexias vesicales, aunque a simple vista parezca paradójico. Método: Se realizó un estudio neurourológico en una serie consecutiva de 68 pacientes con hiperreflexia vesical (hiperactividad del detrusor neurogénica), remitidas a la unidad de Urología Funcional para valoración urodinámica. Todos los pacientes fueron sometidos a historia clínica, medición del residuo postmiccional, cistomanometría, test presión detrusor-flujo miccional, videourodinámica y EMG selectiva del esfínter periuretral. La potencia contráctil del detrusor se midió con W80-20. La terminología siguió las normas de la ICS. El procesamiento de los datos se realizó mediante el paquete estadístico SPSS 12.0. Resultados: La serie se refirió a 40 varones (58.8%) y 28 mujeres (41.2%), de todas las edades (más frecuentemente adultos). El 88.2% correspondió a patología neurológica adquirida (traumática 30.9%; médica 33.8%; degenerativa 35.3%), y 11.8 % a patología neurológica congénita (mielodisplasia). El tipo de lesión neurológica más frecuente fue la disinergia detrusor/esfínter periuretral: 59 casos (79.4%); 22 pacientes (32.4%) habían sido sometidos a tratamiento previo de la disfunción vesicouretral. La amplitud de las contracciones involuntarias del detrusor fue mayor en las disinergias detrusor/cuello vesical. La contractilidad isotónica del detrusor (W80-W20) estaba afectada significativamente sobre todo en las lesiones neurológicas de naturaleza traumática y menos en las degenerativas (p=0.01). Conclusiones: Se ha demostrado una afectación de la contractilidad vesical en las hiperrreflexias vesicales (hiperactividad del detrusor neurogénica), más acentuada en las lesiones de naturaleza traumática sin relación al tipo de lesión neurourológica asociada a la hiperreflexia vesical, que podía estar en relación con una alteración estructural vesical, o bien con una alteración a nivel de las vías neurológicas centrales (sin la necesidad de la existencia de una disinergia) (AU)

Objectives: Classically, it was understood detrusor contractility was affected in bladder areflexia but not in hyperreflexia. We aim to demonstrate that there is some detrusor contractility affectation in bladder hyperreflexias, although it may seem paradoxical at first sight. Methods: Neuro-urologic study was performed in a series of 68 consecutive patients with bladder hyperreflexia (neurogenic detrusor hyperactivity), referred to the unit of functional urology for urodynamic evaluation. All patients underwent clinical history, post void residual determination, cystomanometry, voiding pressure-flow test, videourodynamics and selective EMG of the periurethral sphincter. Detrusor contractile potency was measured with W 80-20. Terminology follows the ICS standard. Data processing was performed using the statistical software SPSS 12.0. Results: This series includes 14 males (58.8%) and 28 females (41.2%), of all ages (adults more frequent). 88.2% of the cases had acquired neurological diseases (trauma 30.9%; medical 33.8%; degenerative 35.3%), and 11.8% congenital neurological diseases (myelodysplasia). Most frequent type of neurological lesion was detrusor-sphincter dyssynergia: 59 cases (79.4%); 22 patients (32.4%) had undergone previous treatment of their vesicourethral dysfunction. The amplitude of detrusor involuntary contractions was wider in detrusor-bladder neck dyssynergia. Detrusor isotonic contractility (W 80-20) was significantly affected, mainly in neurological lesions of traumatic nature and less in degenerative lesions (p = 0.01). Conclusions: We demonstrated that bladder contractility is affected in bladder hyperreflexias (neurogenic detrusor hyperactivity), more important in traumatic lesions without relationship with the type of neurological associated lesion, which could be related to a bladder structural change, or with a change in the central neurological tracts (without requirement of presence of dyssynergia) (AU)

Inactivation of p16 by CpG hypermethylation in renal cell carcinoma.

OBJECTIVE: Renal carcinoma develops as a consequence of the accumulation of several genetic aberrations. Alterations in the p16 gene have been described in many tumors. Methylation of its promoter in CpG islands is the most common mechanism of inactivation of this gene. The aim of this study was to establish whether p16 gene methylation leads to a loss of the encoded protein in 57 patients with renal carcinoma, and if this aberration has any value in predicting disease progression in these patients. METHODS: Gene promoter methylation was determined by deoxyribonucleic acid treated with sodium bisulfite to subsequently amplify methylated and unmethylated regions rich in CpG islands. The p16 protein product was detected for immunohistochemical examination. RESULTS: Hypermethylation of the p16 gene was detected in 22.9% of the patients, none of whom had the protein product. A lack of p16 protein was confirmed in 52.9% of the tumors, indicating another genetic alteration or posttranscriptional modifications preventing the codification of this protein. Through multivariate analysis of overall survival, gene methylation was found to have independent prognostic value: the absence of alteration confers an undefined risk of death. CONCLUSIONS: Of the molecular modifications described for renal carcinoma, aberrations in the p16 gene are frequent. In these patients, methylation of the p16 gene promoter seems to afford a protective effect against the risk of death.

Prevalencia de alteraciones urodinámicas en las infecciones urinarias recidivantes de la mujer / Prevalence of urodynamic anomalies in women with urinary tract infection

OBJETIVO: Comprobar los datos urodinámicos en las pacientes con infecciones urinarias recidivantes en orden a demostrar una causa que las justifique. MÉTODOS: Se realiza un estudio transversal comparativo en una serie de 114 mujeres, de edad media 51.9 años (desviación típica: 23.5 años), divididas en dos grupos de 57 mujeres cada uno: grupo con infecciones urinarias recidivantes (ITU), y grupo sin infecciones urinarias recidivantes (no ITU). A las pacientes se les sometió a interrogatorio clínico, exploración física y estudio videourodinámico. Los datos fueron almacenados en una base de datos Access y posteriormente importados al programa de análisis estadísticos SPSS. Se aplicaron el test exacto de Fisher, Chi-Cuadrado de Pearson, y t de Student. Se calculó la curva ROC. Se elaboró un modelo multivalente de regresión logística. RESULTADOS: Únicamente se demostraron diferencias significativas en los valores del flujo miccional máximo (menor en el grupo ITU), volumen residuo postmiccional (mayor en el grupo ITU), y presión de la contracción involuntaria del detrusor (menor en el grupo ITU). No obstante, la única variable independiente fue el residuo postmiccional, constituyéndose las dos restantes en variables dependientes. El punto de corte ideal entre residuo postmiccional e infección urinaria correspondió a un residuo de 48.5 ml. El coeficiente de determinación del modelo fue de 0.13. No se demostraron relaciones significativas de las infecciones urinarias con (entre otras): la presencia y grado de cistocele, así como con la hiperactividad del detrusor e incontinencia urinaria de esfuerzo. CONCLUSIONES: El residuo postmiccional explicaría el 13 % de las infecciones urinarias recidivantes de la mujer. El resto se debería a otros factores no incluidos en el modelo (AU)

OBJECTIVES: To check the urodynamic data in patients with recurrent urinary tract infection in order to demonstrate a cause justifying them. METHODS: We performed a transverse comparative study in a series of 114 women, with a mean age of 51.9 yr. (typical deviation: 23.5 yr.), divided into groups of 57 women each: group I with recurrent urinary tract infection (UTI) and group II without recurrent urinary tract infection (no UTI). Patients underwent history , physical examination, and video-urodynamic study. All data were collected in an Access database and subsequently imported to the SPSS statistical analysis software. Fisher’s exact test, Pearson’s chisquare, and Student’s t-test were applied. ROC curve was calculated. A logistic regression multivalue model was elaborated. RESULTS: significant differences were only found in the values of maximum voiding flow (lower in the UTI group), post void residual volume (greater in the UTI group), and pressure of the involuntary detrusor contraction (lower in the UTI group). Nevertheless, post void residual was the only independent variable, becoming the other two dependent variables. The ideal cut point between post void residual and urinary tract infection was 48.5 ml. The determination coefficient for the model was 0.13. No significant relationships were found between urinary tract infection and, among others, presence and degree of cystocele, detrusor hyperactivity, and stress urinary incontinence. CONCLUSIONS: Postvoid residual would explain 13% of the recurrent urinary tract infection in women. The remainder would be secondary to other factors not included in the model (AU)

[Cystocele and stress urinary incontinence associated with lower urinary tract obstruction]. / Incontinencia urinaria de esfuerzo asociada a obstrucción del tracto urinario inferior en el cistocele.

OBJECTIVES: The association of stress urinary incontinence secondary to urethral hypermobility and lower urinary tract obstruction in the same patient with cystocele is rare, and even represents a contradiction. The objective of our work is to treat to define the characteristics that identify this entity, in comparison with isolated stress urinary incontinence or lower urinary tract obstruction in patients with cystocele. METHODS: We performed a retrospective study in 1168 cases of cystocele in which urodynamic studies were performed. All patients underwent history and neurological and uro-gynecologycal physical examination. The urodynamic study included uroflowmetry, cystomanometry, voiding pressure/flow tests and voiding cystourethrograms. All data were collected in an Excel 2000 database and statistical analysis was performed with the SPSS software. RESULTS: A- General data: 25 cases qualified for the study in group I (isolated stress urinary incontinence with urethral hypermobility); 24 cases in group II (lower urinary tract obstruction); and 14 cases in group III (astress urinary incontinence associated with lower urinary tract obstruction). The proportion of each group in the whole group of cystoceles corresponded to a 4/1/0.05 ratio respectively. Mean age was 58.4 years for group I, 68.2 for group II and 71.2 for group III. A Statistically significant lower age was demonstrated for group I (p < 0.0005). B- The symptom "sensation of vaginal lump" was less frequent in group I (32%). A significant difference was demonstrated (p = 0.02). C- Group I showed a lower increase of daily voiding frequency (32%), p = 0.02. D- Group I showed less night-time voiding frequency (1 episode)(p < 0.04). E- Urinary incontinence with cough was less frequent in group 1 (84%) (p = 0.0004). F- Group I had more bladder capacity (243.6 ml) (p < 0.05).G- Group I showed less urethral resistances (URA = 37.9 cm H2O) (p = 0.01). H- W80-W20 was higher in group I: 1.3 W/m2 (p < 0.05). I- The symptom "sensation of vaginal lump appeared more often in group II (70.8%) (p = 0.02). J- Radiological degree of cystocele was greater in group II1 (1.7) (p < 0.05). K- Detrusor hyperactivity was more frequent in group III (64.3%) (p = 0.00009). L- No significant differences were found between groups II-III when comparing type of obstruction. CONCLUSIONS: The group of isolated stress urinary incontinence (group I) is characterized by a younger age, less frequency of sensation of vaginal lump, less daily frequency and nocturia, and urodynamic data of greater bladder capacity, lower urethral resistance and normal detrusor contractility. The group of isolated lower urinary tract obstruction (group II) could be characterized by a more frequent sensation of vaginal lump and increase of the radiological cystocele. The group of stress urinary incontinence associated with lower urinary tract obstruction had a higher percentage of cases of detrusor hyperactivity. All these data might enable a proper identification of different risk elements in the groups.

Incontinencia urinaria de esfuerzo asociada a obstrucción del tracto urinario en el cistocele / Cystocele and stress urinary incontinence associated with lower urinary tract obstruction

Objetivo: La asociación de incontinencia urinaria de esfuerzo por hipermovilidad uretral y obstrucción del tracto urinario inferior en un mismo paciente con cistocele, es rara, e incluso presenta una apariencia contradictoria. El objetivo de nuestro trabajo consistiría en tratar de definir las características que permitieran identificar a esta entidad, frente a la incontinencia urinaria de esfuerzo y obstrucción del tracto urinario inferior aisladas, en pacientes con cistocele. Métodos: Se realizó un estudio retrospectivo en 1.116 de casos de cistocele sometidos a investigación urodinámica. Todas las pacientes fueron sometidas a historia clínica, exploración física neurourológica y uroginecológica. El estudio urodinámico consistió en una flujometría, cistomanometría, test presión detrusor/flujo miccional y cistouretrografías. Se recogieron los datos en el programa Excel 2000 y el tratamiento estadístico se realizó con el paquete SPSS. Resultados: A – Datos generales: Se clasificaron para este estudio en el grupo I (incontinencia de esfuerzo aislada por hipermovilidad uretral) 25 casos; en el grupo II (obstrucción tracto urinario inferior) 24 casos; y en el grupo III (incontinencia urinaria esfuerzo asociada a obstrucción tracto urinario inferior) 14 casos. La proporción de los tres grupos en la totalidad de los cistoceles, correspondió a una relación 4/1/0.05 para los grupos I-II-III respectivamente. La edad media correspondió a 58.4 años para grupo I, 68.2 para grupo II y 71.2 para el grupo III. Se demostró una diferencia significativa de menor edad para el grupo I (p<0.0005). B – El síntoma de sensación de bulto en vagina fue menor en el grupo I (32 %); se demostró una diferencia significativa de (p=0.02); C – El incremento de la frecuencia miccional diurna fue menor en el grupo I (32 %) p=0.02. D – La frecuencia miccional nocturna fue menor en el grupo I (1 episodio) (p<0.004). E – El síntoma de incontinencia urinaria a la tos fue más frecuente en el grupo I (84 %) (p=0.0004). F – Fue mayor en el grupo I la capacidad vesical (243.6 ml.) (p<0.05). G – El URA fue menor en el grupo I, con un valor de 37.9 cm. H2O (p=0.01). H – El W80-W20 fue mayor en el grupo I: 1.3W/m2 p<0.05. y mayor en el grupo II (70.8 %) (p=0.02). I – El grado radiológico de cistocele fue mayor en el grupo II (1.7) (p<0.05). J – La hiperactividad del detrusor fue más frecuente en el grupo III (64.3 %) (p=0.00009). K – No se demostraron diferencias significativas en el tipo de obstrucción entre los grupos II-III. Conclusiones: El grupo de incontinencia urinaria de esfuerzo aislada (grupo I) se caracterizaría por una menor edad, con una menor frecuencia de sensación de bulto en vagina, menor frecuencia miccional diurna y nocturna y unos datos urodinámicos de mayor capacidad vesical, menor resistencia uretral y contractilidad normal del detrusor. El grupo de obstrucción aislada del tracto urinario inferior (grupo II) se caracterizaría por una mayor frecuencia de bulto en vagina, e incremento del grado de cistocele radiológico. El grupo de incontinencia urinaria de esfuerzo asociada a obstrucción del tracto urinario inferior, se acompañó de un mayor porcentaje de casos de hiperactividad del detrusor. Todos estos datos podrían permitir la correcta identificación de los diferentes elementos de riesgo, en los distintos grupos (AU)

Objectives: The association of stress urinary incontinence secondary to urethral hypermobility and lower urinary tract obstruction in the same patient with cystocele is rare, and even represents a contradiction. The objective of our work is to treat to define the characteristics that identify this entity, in comparison with isolated stress urinary incontinence or lower urinary tract obstruction in patients with cystocele. Methods: We performed a retrospective study in 1168 cases of cystocele in which urodynamic studies were performed. All patients underwent history and neurological and uro-gynecologycal physical examination. The urodynamic study included uroflowmetry, cystomanometry, voiding pressure/flow tests and voiding cystourethrograms. All data were collected in an Excel 2000 database and statistical analysis was performed with the SPSS software. Results: A- General data: 25 cases qualified for the study in group I (isolated stress urinary incontinence with urethral hypermobility); 24 cases in group II (lower urinary tract obstruction); and 14 cases in group III (astress urinary incontinence associated with lower urinary tract obstruction). The proportion of each group in the whole group of cystoceles corresponded to a 4/1/0.05 ratio respectively. Mean age was 58.4 years for group I, 68.2 for group II and 71.2 for group III. A Statistically significant lower age was demonstrated for group I (p < 0.0005). B-The symptom “sensation of vaginal lump” was less frequent in group I (32%). A significant difference was demonstrated (p = 0.02). C- Group I showed a lower increase of daily voiding frequency (32%), p = 0.02. D- Group I showed less night-time voiding frequency (1 episode)(p < 0.04).E-Urinary incontinence with cough was less frequent in group I (84%) (p = 0.0004). F- Group I had more bladder capacity (243.6 ml) (p < 0.05).G-Group I showed less urethral resistances (URA = 37.9 cm H2O) (p = 0.01). H- W80-W20 was higher in group I: 1.3 W/m2 (p < 0.05). I-The symptom “sensation of vaginal lump appeared more often in group II (70.8%) (p = 0.02). J-Radiological degree of cystocele was greater in group II (1.7) (p< 0.05). K- Detrusor hyperactivity was more frequent in group III (64.3%) (p = 0.00009). L- No significant differences were found between groups II-III when comparing type of obstruction. Conclusions: The group of isolated stress urinary incontinence (group I) is characterized by a younger age, less frequency of sensation of vaginal lump, less daily frequency and nocturia, and urodynamic data of greater bladder capacity, lower urethral resistance and normal detrusor contractility. The group of isolated lower urinary tract obstruction (group II) could be characterized by a more frequent sensation of vaginal lump and increase of the radiological cystocele. The group of stress urinary incontinence associated with lower urinary tract obstruction had a higher percentage of cases of detrusor hyperactivity. All these data might enable a proper identification of different risk elements in the groups (AU)