Risk factors to develop autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury.

AIMS: The risk factors for developing autonomic dysreflexia (AD) during urodynamic (UD) examination in patients with spinal cord injury (SCI) above Th6 still remain unclear. The main goal of our study is to investigate the risk factors that could be associated with AD in these particular patients. DESIGN: Cross sectional survey. SUBJECT AND METHODS: The study was carried out in 83 patients with SCI above Th6 who were submitted to our center for a UD examination. AD was defined as a rise in systolic blood pressure above 15 mm Hg with a pulse rate below 60 beats per minute. RESULTS: The prevalence rate of AD among our patients was 54%. Univariate analysis of our study showed the following risk factors: patient's age, SCI completeness, traumatic etiology, indwelling catheter, presence of chills or sweating, anticholinergic treatment, maximum detrusor voiding pressure, detrusor pressure at maximum flow rate, detrusor external sphincter dyssynergia, and bladder outlet obstruction. Using multivariate logistic regression, we found that there are only two independent risk factors: patient's age equal to or above 45 years of age (OR = 10.995) and maximum detrusor voiding pressure equal to or above 31 cm H2 O (OR = 3.879). CONCLUSIONS: According to our results, the patient's age and maximum detrusor voiding pressure should be considered at the time of performing a UD examination in order to prevent the sudden onset of AD in patients with SCI above Th6. Neurourol. Urodynam. 36:171-175, 2017. © 2015 Wiley Periodicals, Inc.

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.

Post Pelvic Radiotherapy Affectation of the Lower Urinary Tract Peripheral Innervation in Men.

INTRODUCTION: The periurethral electromyography (EMGs) alterations in men who underwent pelvic radiotherapy (RT), either isolated or combined with surgery, have not been frequently described in the literature. OBJECTIVE: The study aimed to compare the EMG's data in men undergoing RT versus the non-irradiated control group. MATERIAL AND METHODS: The study included 61 consecutive males, who had undergone RT (27 of them had been operated) and 99 control consecutive patients who underwent a retrospective assessment. The EMGs were performed using a concentric electrode needle perineally, localizing the sphincter by visual and auditory signal (electromyograph MMS Solar Active). RESULTS: 14.8% denervation, 62.9% reinnervation, 14.9% denervation + reinnervation and 7.4% EMG normal. The age (p < 0.001) and neurogenic bladder data (p < 0.001) are risk factors. The smaller the prostate size (obtained by rectal examination) post-RT, the more the chance for an abnormal EMG (p < 0.001). The fact of having had received RT (p < 0.001) is the only risk factor. CONCLUSION: RT produces lesions over the pudendal nerve, showing denervation even in late periods. The surgery did not behave as a risk factor.

The 3-day bladder diary is a feasible, reliable and valid tool to evaluate the lower urinary tract symptoms in women.

AIMS: To evaluate the feasibility (% of completion), reliability (test-retest and inter-observer) and validity (convergent vs. questionnaires and vs. urodynamic study-UDS) of the 3-day bladder diary (3dBD) in women with lower urinary tract symptoms (LUTS). METHODS: Epidemiological, descriptive, cross-sectional and prospective study. Fourteen Functional Urology and Urodynamic Units participated. One hundred thirty-six women with mean age (SD) 55.2 (13.8) years with LUTS, without bladder catheterization and who were able to fill in the 3dBD were included. An UDS was performed. They filled in the 3dBD in two times separated by 15 days (test and retest), the International Consultation on Incontinence-Short Form (ICIQ-UI SF) and the Bladder Control Self-Assessment Questionnaire (BSAQ). RESULTS: One hundred ten women completed 3dBD for test and retest. Feasibility: each 3dBD has 42 variables, 77.2% women completed 80%. Test-retest reliability: there were not differences in the proportion of patients classified as positive for each symptom (urgency: P = 0.3173; incontinence: P = 1; nocturia: P = 0.0522; frequency: P = 0.4386). The Intraclass Correlation Coefficient (ICC) ranged from 0.67 to 0.92, except for night time VVmax which was lower (0.54). Inter-observer reliability: ICC ranged from 0.64 to 0.99, except for day time VVmax (0.29) and the number of urgency episodes (0.45). VALIDITY: Spearman correlation coefficients for ICIQ-UI SF and BSAQ ranged from 0.4 to 0.6 (P < 0.0001) and for UDS were lower (P < 0.05). CONCLUSIONS: The 3dBD showed good feasibility, reliability and validity to be used in the assessment of LUTS in women.

Relationship between Mental Disorders, Smoking or Alcoholism and Benign Prostate Disease.

INTRODUCTION: Mental disorders, smoking, or alcoholism and benign prostate disease are highly prevalent in men. AIMS: To identify the relationship between mental disorders, smoking, or alcoholism and benign prostate disease. METHODOLOGY: A prospective multicenter study that evaluated prostate health status in 558 men from the community. Groups: GP-men who request a prostate health examination and whose medical history includes a mental disorder, smoking, or alcoholism prior to a diagnosis of benign prostate disease; GU-men who request a prostate health examination and whose medical history includes a benign prostate disease prior to a diagnosis of mental disorder, smoking, or alcoholism. VARIABLES: age, body mass index (BMI), prostate specific antigen (PSA), follow-up of the mental disorder, smoking or alcoholism, time elapsed between urological diagnosis and the mental disorder, smoking or alcoholism diagnosis, status of the urological disease (cured or not cured), concomitant diseases, surgical history, and concomitant treatments. Descriptive statistics, Student's t-test, Chi2, multivariate analysis. RESULTS: There were no mental disorders, smoking, or alcoholism in 51.97% of men. Anxiety, smoking, major depressive disorder, pathological insomnia, psychosis, and alcoholism were identified in 19.71%, 13.26%, 5.73%, 4.30%, 2.87%, and 2.15% of individuals, respectively. Nonbacterial prostatitis (31.54%), urinary tract infection (other than prostatitis, 24.37%), prostatic intraepithelial neoplasia (13.98%), and prostatodynia (1.43%) were prostate diseases. Unresolved symptomatic benign prostate disease was associated with anxiety, depression, and psychosis (p = 0.002). Smoking was the disorder that men managed to eliminate most frequently. The dominant disorder in patients with symptomatic benign prostatic disease was alcoholism (p = 0.006). CONCLUSIONS: Unresolved symptomatic benign prostatic disease is associated with anxiety, depression, and psychosis. Alcoholism is associated with a worse prognosis in the follow-up of symptomatic benign prostatic disease.

A randomized controlled trial to assess the efficacy and cost-effectiveness of urinary catheters with silver alloy coating in spinal cord injured patients: trial protocol.

BACKGROUND: Patients with non-acute spinal cord injury that carry indwelling urinary catheters have an increased risk of urinary tract infection (UTIs). Antiseptic Silver Alloy-Coated Silicone Urinary Catheters seems to be a promising intervention to reduce UTIs; however, actual evidence cannot be extrapolated to spinal cord injured patients. The aim of this trial is to make a comparison between the use of antiseptic silver alloy-coated silicone urinary catheters and the use of standard urinary catheters in spinal cord injured patients to prevent UTIs. METHODS/DESIGN: The study will consist in an open, randomized, multicentre, and parallel clinical trial with blinded assessment. The study will include 742 spinal cord injured patients who require at least seven days of urethral catheterization as a method of bladder voiding. Participants will be online centrally randomized and allocated to one of the two study arms (silver alloy-coated or standard catheters). Catheters will be used for a maximum period of 30 days or removed earlier if the clinician considers it necessary. The main outcome will be the incidence of UTIs by the time of catheter removal or at day 30 after catheterization, the event that occurs first. Intention-to-treat analysis will be performed, as well as a primary analysis of all patients. DISCUSSION: The aim of this study is to assess whether silver alloy-coated silicone urinary catheters improve ITUs in spinal cord injured patients. ESCALE is intended to be the first study to evaluate the efficacy of the silver alloy-coated catheters in spinal cord injured patients. TRIAL REGISTRATION: NCT01803919.

Study of the prevalence and interobserver reproducibility of radiologic images suggestive of urethral diverticula in men with spinal cord injury.

OBJECTIVES: To determine the prevalence of radiologic images suggestive of urethral diverticula (UD) in men with spinal cord injury (SCI) and to study the interobserver diagnostic reproducibility. METHODS: Radiological studies (i.e. voiding cystourethrography and retrograde urethrography) performed over 1 year on men with SCI were independently reviewed by 3 researchers (1 urologist and 2 radiologists). RESULTS: The prevalence of UD was found to be between 4.2 and 9.8% of the patients, the higher figure obtained when including also the doubtful images. The kappa index of agreement between the researchers was low (between 0.15 and 0.40). The factors that significantly influenced agreement were localization in the prostatic urethra (p = 0.021), localization in the penile urethra (p = 0.000) and fusiform morphology (p = 0.004). Logistic regression analysis showed that the variables that independently influenced diagnostic agreement were the following: localization in the penile urethra (in favor of agreement) and fusiform morphology (against agreement). CONCLUSIONS: Radiologic images suggestive of UD constitute a frequent finding in men with SCI and raise important diagnostic problems.

Bladder Capacity in Women With Overactive Bladder Syndrome: A Cross-sectional Study.

OBJECTIVE: To evaluate bladder capacity in women with idiopathic overactive bladder syndrome (OAB) through bladder diary, cystomanometry, and uroflowmetry and assess the concordance of the different measures of bladder capacity. A secondary objective is to describe the relationship between bladder capacity and urinary frequency in OAB patients. METHODS: An observational cross-sectional multicentric study was conducted, including female patients diagnosed with idiopathic OAB. All participants underwent a urodynamic study and completed a 3-day bladder diary (3dBD). Different parameters were used to calculate bladder capacity: maximum cystometric capacity (MCC) assessed at the end of filling cystometry, voided volume (VV) during the uroflowmetry, maximum voided volume (VVmax), and average voided volume (VVmed), both assessed through the 3dBD. Reproducibility analysis was performed to assess the agreement among the different bladder capacity measures. Intraclass correlation coefficient (ICC) and weighted Kappa index were used. Bladder capacity parameters were also assessed in relation to urinary frequency. RESULTS: Bladder capacity measures were diminished in this population, except for VVmax. Poor correlation was found between the different bladder capacity variables (ICC and weighted Kappa index <0.4). Twenty-four-hour frequency and average VV present a weak negative linear relationship (Pearson coefficient -0.344). CONCLUSION: MCC and average VV are reduced in OAB patients. MCC does not correlate well with functional bladder volumes determined by voiding diary in the OAB population.

Patients with initial nodal involvement due to breast cancer who have received neoadjuvant chemotherapy: Combined sentinel node-radioguided surgery of the pathological node.

OBJECTIVE: To study the feasibility and usefulness of ultrasound-guided pre-chemotherapy marking of pathologic lymph node followed by sentinel lymph node biopsy (SLNB)-pathologic node radioguided biopsy (ROLL) combined technique, in axillary involvement breast cancer patients undergoing neoadjuvant chemotherapy (NACT). MATERIAL AND METHODS: Prospective diagnostic study of 30 patients with breast cancer and cN1 axillary staging with NACT indication. Before NACT, the biopsied node was marked with a clip (MBN). After NACT an ultrasound was performed and in case of good response a SLNB (99mTc-nanocolloids) plus targeted axillary dissection MBN ROLL biopsy (99mTc-albumin macroaggregates) was performed. Axillary lymph node dissection (ALND) was performed if SLNB and/or MBN were positive for tumor cells. The localization-removal rate of the sentinel lymph node (SLN) and MBN were evaluated. False-negative rate (FNR) and positive predictive value (PPV) of SLNB alone were also evaluated. RESULTS: Thirty patients were included in the study. SLN could be detected in all patients while MBN was successfully removed in 27 (90%). The SLN coincided with MBN in 15 patients (50%). In 12 patients SLNB was negative while MBN positive, leading to a FNR of 44.4% for SLNB alone. We found a PPV of 37% for the SLNB. In 5 patients (18.5%) both SLNB and MBN were negative, avoiding ALND. CONCLUSIONS: SLNB-MBN radioguided biopsy ROLL combined technique is a useful and accessible procedure for accurate axillary restaging after NACT, avoiding the high rate of FNR of SLNB alone in this group of patients and avoiding a great number of ALND.

Efficacy and tolerability of the hexanic extract of Serenoa repens compared to tamsulosin in moderate-severe LUTS-BPH patients.

In a subset analysis of data from a 6-month, multicenter, non-interventional study, we compared change in symptoms and quality of life (QoL), and treatment tolerability, in men with moderate to severe lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) receiving tamsulosin (TAM, 0.4 mg/day) or the hexanic extract of Serenoa repens (HESr, 320 mg/day) as monotherapy. Symptoms and QoL were assessed using the IPSS and BII questionnaires, respectively. Patients in the treatment groups were matched using two statistical approaches (iterative and propensity score matching). Within the iterative matching approach, data was available from a total of 737 patients (353 TAM, 384 HESr). After 6 months, IPSS scores improved by a mean (SD) of 5.0 (4.3) points in the TAM group and 4.5 (4.7) points in the HESr group (p = 0.117, not significant). Improvements in QoL were equivalent in the two groups. TAM patients reported significantly more adverse effects than HESr patients (14.7% vs 2.1%; p < 0.001), particularly ejaculation dysfunction and orthostatic hypotension. These results show that HESr is a valid treatment option for men with moderate/severe LUTS/BPH; improvements in urinary symptoms and QoL were similar to those observed for tamsulosin, but with considerably fewer adverse effects.

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.

The American Society of Anesthesiologists Physical Status (ASA-PS) Risk Group Classification Can Be Used to Anticipate Functional Recovery Outcomes after the Surgical Treatment of Female Urinary Incontinence with Transobturator Suburethral Tape.

INTRODUCTION: Stress urinary incontinence (SUI) has an incidence of 15-80% in women. One of the most widely used surgical techniques for treatment is the placement of a suburethral transobturator tape (TOT). Although this technique has a relatively low morbidity rate, it is not exempt from intraoperative or postoperative complications, which can have an impact on functional recovery, understood as the return to routine life prior to the intervention. AIMS: To assess the time for functional recovery in women operated on for SUI by TOT; to identify complications and related factors, according to anaesthetic risk, which condition the time to functional recovery; and proposals for improvements in the prevention of possible complications and in reducing functional recovery time. MATERIALS AND METHODS: A non-concurrent prospective observational multicenter study of 891 women undergoing TOT for stress urinary incontinence since 1 April 2003, who were successful in achieving urinary continence (completely dry). Study groups: GA (n = 443): patients with ASA I risk. GB (n = 306): patients with ASA II risk. GC (n = 142): patients with anaesthetic risk ASA III. Investigated variables: age, body mass index, follow-up time, secondary diagnoses, surgical history, obstetric-gynecological history, toxic habits, and complications derived from surgery: bleeding, pain, infection. Descriptive statistics, Student's t test, Chi2, Fisher, ANOVA, multivariate analysis, significance for p < 0.05. RESULTS: Mean age was 60.10 years (SD13.38), with no difference between groups. Mean body mass index (BMI) was 26.55 kg/m2 (SD 4.51), lowest in GA. GB had more HT (38.6%) than GC (23.23%), more type 2 diabetes (19.83% versus 10.56%), and more respiratory disorders (6.97% versus 2.11%). There were more women with anxiety in GB (19.3%) than in GC (6.33%) (p = 0.0221) and GA (10.51%) (p = 0.0004). There was more hypothyroidism in GB (16.08%) compared to GC (2.11%) and GA (9.07%). There was more history of curettage in GC (11.97%) versus GB (5.63%); and more pelvic surgery in GB (71.31%) and GC (66.9%) compared to GA (32.57%). There were more concomitant treatments with benzodiazepines in GC (27.46%) and GB (28.41%) than in GA (8.86%), and more parapharmacy treatments in GB (17.96%) than in GC (6.33%). Following the operation, 113 patients had some sign or symptom that required medical attention: in GA 48 (10.83%), in GB 49 (16.06%), in GC 16 (13.22%). Mean days until functional recovery in patients with complications: in GA 5.72 (SD2.05); bleeding 3 (SD1), pain 6.40 (SD1.34), and infection 7.33 (SD0.57), with fewer days for bleeding than for pain or infection. GB: 27.96 (SD 28.42), bleeding 3 (SD0), pain 46.69 (SD31.36), infection 10.83 (SD3.90); lowest for patients with bleeding. GC: 9.44 (SD 2.50); for bleeding 7.66 (SD2. 08), pain 10.66 (SD1.15), infection 10 (SD3.46); no differences. Overall, for women with bleeding, the time was 4.16 days (SD1.94); less in GA and GB than in GC. Pain, at 31.33 days (SD 30.70), was the factor that most delayed functional recovery; in GB women, it took longer to return to work due to pain (45.96, SD31.36) compared to GA (6.4, SD 1.34) and GC (10.66, SD1.15). In women with infection, overall mean time was 10.11 days (SD 3.61) with no difference between groups. CONCLUSIONS: Mean time for the return to normal activity in patients who underwent TOT for SUI is 5 days if there are no complications, and 16.91 days if there are any. The ASA-SP risk group classification can be used to anticipate functional outcomes. An ASA-PS risk-based functional recovery forecasting protocol should be adapted, especially ASA II patients who may present with long-term disabling postoperative pain. Preventive management measures are proposed that favour functional recovery.

Clinical Benefit of Tamsulosin and the Hexanic Extract of Serenoa Repens, in Combination or as Monotherapy, in Patients with Moderate/Severe LUTS-BPH: A Subset Analysis of the QUALIPROST Study.

To investigate whether tamsulosin (TAM) and the hexanic extract of Serenoa repens (HESr) are more effective in combination than as monotherapy in men with moderate-to-severe lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH). Subset analysis of data from a 6-month, multicenter observational study. Patients received either tamsulosin (0.4 mg/day) or HESr (320 mg/day) alone or in combination. Primary endpoints were change in symptoms and quality of life. Tolerability was also assessed. Seven hundred and nine patients were available for intention to treat (ITT) analysis, 263 treated with tamsulosin, 262 with HESr, and 184 with TAM + HESr. After 6 months, International Prostate Symptom Score (IPSS) scores improved by a mean (standard deviation) of 7.2 (5.0) points in the TAM + HESr group compared to 5.7 (4.3) points with TAM alone and 5.4 (4.6) points with HESr (p < 0.001). Quality of life showed greatest improvement with combination therapy (p < 0.02). Adverse effects were reported by 1.9% of patients receiving HESr, 13.3% receiving TAM, and 12.0% receiving TAM + HESr (p < 0.001). In men with moderate/severe LUTS/BPH, combination treatment with TAM + HESr produced more effective symptom relief and greater improvement in quality of life than with either treatment alone, with acceptable tolerability.

[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.

[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.

[Spanish consensus document for the diagnosis, treatment and management of neurogenic bladder.] / Documento de consenso español para el diagnóstico, el tratamiento y el manejo de la vejiga neurógena.

OBJECTIVES: The purpose of this document is to establish practical recommendations on neurogenic bladder (NB) management based on scientific evidence and medical and nursing perspective in Spinal Cord Injury (SCI) Units as a first multidisciplinary consensual approach in Spain. METHODS: This paper reports results from the first modified Delphi consensus building exercise on this procedure. A committee of recognised opinion-leaders in rehabilitation and urology with special interest in NB was constituted. A working group formed by rehabilitation doctors, urologists and nursing staff of SCI and Neurorehabilitation Units of a number of Spanish hospitals and specialised centres associated with the panel of NB experts have prepared this document. RESULTS: This review provided an overview of the main aspects described by the different clinical guidelines already available and highlighted the need to focus on recommendations in special priority situations in which there was no consensus. In view of the considerable impact this condition has on quality of life, patients should be offered help to better understand the disorder and they should be taught how to use the treatment techniques to obtain satisfactory results and promote their autonomy. CONCLUSIONS: This article presents a version of guidelines for patients with NB. The guidelines define the clinical profile of patients to provide the best evidence- based care and also an overview of the current drug and surgical treatments of NB.

OBJETIVO: El objetivo de este documento es establecer recomendaciones prácticas sobre el manejo de la vejiga neurógena (VN) en función de la evidencia científica y las perspectivas médicas y de enfermería en Unidades de Lesionados Medulares (ULM) como un primer enfoque de consenso multidisciplinar en España.MÉTODOS: En este artículo se presentan los resultados del primer ejercicio de consenso basado en metodología Delphi modificada sobre este procedimiento. Se constituyó un comité del que formaron parte reconocidos expertos en rehabilitación y urología, especializados en el manejo de VN. Este documento ha sido elaborado por un grupo de trabajo formado por médicos especialistas en rehabilitación, urólogos y personal de enfermería de ULM y unidades de Neurorrehabilitación de varios hospitales y centros especializados españoles asociados con el panel de expertos sobre VN. RESULTADOS: Esta revisión ofrece un resumen de los principales aspectos descritos en diversas guías clínicas ya disponibles y destaca la necesidad de centrarse en recomendaciones sobre situaciones especialmente prioritarias sobre las que actualmente no existe consenso. En vista del considerable impacto de esta enfermedad sobre la calidad de vida, los pacientes deben recibir ayuda para que comprendan mejor su enfermedad y también deben recibir formación sobre el uso de técnicas de tratamiento para conseguir resultados satisfactorios y fomentar su autonomía. CONCLUSIONES: En este artículo se presenta una versión de la guía para el manejo de pacientes con VN. Las guías definen el perfil clínico de los pacientes para ofrecer la mejor asistencia basada en la evidencia y también un resumen de los tratamientos farmacológicos y quirúrgicos actuales para la VN.

[Current status of Urological Education in Spain.] / Estado actual de la formación urológica en España.

INTRODUCTION: Urology is a medicalsurgical specialty that deals with the study, diagnosis and treatment of medical and surgical conditions of the urinary tract and retroperitoneum in both sexes and of the male genital tract without age limit. The traditional method of training is based on the imitation of the skills and behaviors of the tutors, creating variability in the training between different centers and giving a passive role to resident internal physicians (MIR). LEGISLATIVE FRAMEWORK: The 2006 BOE establishes the specific formative content in its theoretical, practical and scientific facets. At the beginning of the MIR training period, the first year focuses on general surgical training and the remaining four on specific urological training. The current legislative framework that regulates our specialty is one of the oldest, with no prospect of renewal, since this would be carried out with the development of the trunk project, currently paralyzed after the judgment of the Supreme Court. Therefore, we are in a situation of uncertainty with a legal framework in renewal plans. CURRENT STATE OF TRAINING: a National survey shows the degree of surgical participation of the MIR is low, as well as training on models and course attendance. In addition, the self-confidence they feel for interventions that could be considered of low complexity is high, for activities such as consultation is moderate and for interventions of moderate-high complexity is low. CONCLUSION: The current training program is upgradeable. New studies and efforts should aim to standardize the acquisition of surgical and non-surgical skills, guarantee access to surgical training courses, establish a minimum of required interventions per year and at the end of residency, foster academic training, participation in research of residents and achieve an objective assessment of the specialty.

[Training program in oncologic urology. Future prospectives.] / Programa formativo en urología oncológica. Perspectivas de futuro.

Urology is a medical-surgical specialty that deals with the study, diagnosis and treatment of the medical and surgical diseases of the urinary apparatus and retroperitoneum in both sexes and the male genital apparatus without age limit, due to congenital, traumatic, septic, metabolic, obstructive and oncological conditions. Urologic oncology is the broadest urological part, where research and new advances make continuous learning essential. In this chapter we treat all academic features related with training in the field of Urooncology.

[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.