[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).

[Effect of antibiotic-impregnated catheters on the incidence of infection after cerebrospinal fluid shunting]. / Efecto de los catéteres impregnados con antibiótico en la incidencia de infección tras procedimientos de derivación de líquido cefalorraquídeo.

BACKGROUND AND OBJECTIVE: Infection is a major complication after cerebrospinal fluid (CSF) shunt systems insertion. Antibiotic-impregnated (AI) catheters seem to reduce infection rate in clinical practice. The objective of this study was to determine if the use of AI catheters reduces Staphylococcus spp. infection rate, as it is the most commonly isolated organism. PATIENTS AND METHOD: Authors retrospectively reviewed all patients who underwent rifampin-impregnated and clindamycin-impregnated catheters at our hospital. These included external ventricular catheters (inserted from January 2006 to January 2007) and internalized shunts (inserted from January 2004 to January 2007). They also reviewed patients who underwent insertion of non-impregnated external catheters and internalized shunts during the same periods. Overall infection rate, Staphylococcus spp. infection rate and gram negative bacilli infection rate were compared in both groups by means of chi2 test. RESULTS: Sixty-five procedures with AI catheters and 66 procedures with non-AI catheters were performed. Overall infection rate as well as Staphylococcus spp. infection rate were significantly lower in the AI catheters cohort (p = 0.046 and p = 0.029, respectively), without increasing gram negative bacilli infections. CONCLUSIONS: The use of rifampin and clindamycin-impregnated catheters is a useful tool to reduce Staphylococcus spp. infections after CSF shunting procedures. However, future clinical trials are required to confirm these results.

Efecto de los catéteres impregnados con antibiótico en la incidencia de infección tras procedimientos de derivación de líquido cefalorraquídeo / Effect of antibiotic-impregnated catheters on the incidence of infection after cerebrospinal fluid shunting

FUNDAMENTO Y OBJETIVO: La infección es una de las principales complicaciones asociadas a la colocaciónde sistemas de derivación de líquido cefalorraquídeo (LCR). La utilización de catéteres impregnados con antibiótico (IA) parece disminuir la tasa de infección posquirúrgica en la práctica clínica. El objetivo de este trabajo ha sido determinar si el uso de sistemas IA reduce el riesgo de infección posquirúrgica por Staphylococcus spp., principal agente de infección.PACIENTES Y MÉTODO: Se identificó retrospectivamente a todos los pacientes a quienes se habían implantado catéteres impregnados con rifampicina y clindamicina en nuestro centro, incluidos catéteres externos (desde enero de 2006 hasta enero de 2007) y sistemas de derivación interna (desde enero de 2004 hasta enero de 2007), y a aquellos a quienes se habían implantado catéteres externos y sistemas de derivación interna sin IA durante los mismos períodos de tiempo. Mediante la prueba de la 2 se analizó y comparó el porcentaje de infección global, por Staphylococcus spp. y por bacilos gramnegativos en ambas cohortes.RESULTADOS: Se registraron 65 procedimientos con catéteres IA y 66 procedimientos con catéteresno impregnados. Tanto el porcentaje de infección global como el porcentaje de infección por Staphylococcus spp. fueron significativamente menores en el grupo con catéteres IA (p = 0,046 y p = 0,029, respectivamente), sin que se observara un aumento significativo de las infecciones por bacilos gramnegativos.CONCLUSIONES: El uso de sistemas de derivación de LCR impregnados con rifampicina y clindamicina parece una herramienta útil para reducir la aparición de complicaciones infecciosas posquirúrgicas por Staphylococcus spp. Deben llevarse a cabo estudios prospectivos, aleatorizados y doble ciego para confirmar estos resultados

BACKGROUND AND OBJECTIVE: Infection is a major complication after cerebrospinal fluid (CSF)shunt systems insertion. Antibiotic-impregnated (AI) catheters seem to reduce infection rate inclinical practice. The objective of this study was to determine if the use of AI catheters reducesStaphylococcus spp. infection rate, as it is the most commonly isolated organism.PATIENTS AND METHOD: Authors retrospectively reviewed all patients who underwent rifampin-impregnatedand clindamycin-impregnated catheters at our hospital. These included external ventricular catheters (inserted from January 2006 to January 2007) and internalized shunts (inserted from January 2004 to January 2007). They also reviewed patients who underwent insertionof non-impregnated external catheters and internalized shunts during the same periods. Overall infection rate, Staphylococcus spp. infection rate and gram negative bacilli infection rate were compared in both groups by means of 2 test.RESULTS: Sixty-five procedures with AI catheters and 66 procedures with non-AI catheters were performed. Overall infection rate as well as Staphylococcus spp. infection rate were significantly lower in the AI catheters cohort (p = 0.046 and p = 0.029, respectively), without increasing gram negative bacilli infections.CONCLUSIONS: The use of rifampin and clindamycin-impregnated catheters is a useful tool to reduceStaphylococcus spp. infections after CSF shunting procedures. However, future clinical trials are required to confirm these results

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)