[Special needs of schoolchildren with diabetes mellitus. Point of view of parents and teachers]. / Necesidades del niño escolarizado con diabetes mellitus. Visión de padres y profesores.

BACKGROUND: The daily care of a diabetic (IDDM) child is essential for the short and long term evolution of the disease, and must include the hours the child spends in school. The presence of Trained personnel are needed who will be able to intervene in time if a serious complication, such as hypoglycemia, occurs. Their presence can help to ensure correct control of the disease and avoid long term complications. OBJECTIVES: To understand of the day to day life of children with IDDM, focusing on their school hours. To understand the attitude of primary and secondary school teachers towards pupils with IDDM. PATIENTS AND METHODOLOGY: Descriptive and transversal study on IDDM patients between the ages of 3 and 18, treated within the Healthcare Area number 3 in the Madrid Region, and their teachers. Two different kinds of surveys were distributed: the 1st survey by Fundación para la Diabetes (Foundation for Diabetes) contained 80 questions aimed at patients between the ages of 3 and 18 and their parents. Questions were related to patient's daily life and school environment. The 2nd survey, which allowed free response, was aimed at primary and secondary school teachers about their own experiences working as professionals with pupils with IDDM. RESULTS: Fifty questionnaires addressed to parents and patients were valid in our remit, and we emphasize the following: the ages of major participation were 10 to 14 years; 86% of children knew how to measure blood glucose and 66% how to administer insulin; 74% had no problems with school integration, however, up to 50% of children under 6 years had suffered a problem occasionally; on the 50% of the occasions when a patient needed insulin administration during school hours, it was done by a relative; 66% of hypoglycaemias were resolved by the patient. Health personnel is present only in 8% of the schools studied; 98% of those surveyed think teachers should have written instructions on the signs and symptoms and action to be taken if a hypoglycemia occurs. Questionnaires for teachers were answered by 54% of them (76 of a total of 140), we would like to point out the following: 71% of them recognise having a diabetic pupil; the degree of teacher knowledge on diabetes, rated on a scale from 1 to 7 shows a median of 3 and a mode of 4; 47% of teachers feel insecure when having a diabetic pupil because they do not have instructions on actions to take in case a complication occurs; 97% of teachers affirm to know what a hypoglycaemia is, however only 67% and 57% of them recognise its signs and symptoms and know how to act when they occur. CONCLUSIONS: The school integration and acceptance of pupils with IDDM is good, according to both teachers and parents. Children with IDDM take responsibility for their disease at an early age and are able to develop certain skills. However they still need help, which they get from their family even during school hours. Generally, teachers are willing to learn new skills to be able to help these children, however, further training is required to improve the understanding and management of this disease.

[Bladder schistosomiasis. Etiologic diagnosis of detrusor contraction insufficiency]. / Esquistosomiasis vesical. Diagnóstico etiológico de la insuficiencia de contracción del detrusor.

This paper reports a case of bladder bilharziasis with histopathological exam and different patterns of urodynamic evaluation. The need for urodynamics is emphasized in order to avoid diagnostic and therapeutic mistakes.

[Brucellar orchitis with abscess]. / Orquitis brucelosa abscesificada.

A clinical case of orchitis with brucellosis etiology is presented. Testicular symptomatology appeared from the beginning of the brucellosis's general clinical picture. It envolved painfully and increased the testicular size, with no mictional symptoms, expanding progressively in spite of specific brucellosis therapy given from the beginning, towards formation of an intratesticular abscess which required orchiectomy, a way of progression we have not found in the related literature. The main differential diagnosis must be done with tuberculosis orchitis. Since our country had the largest incidence of brucellosis in Europe, and it is possible that in many cases a orchiepididymarial condition can become apparent in the initial phases, this is an etiology that should be taken into account among specific orchiepididymitis.

[Diversions of the upper urinary tract] in oncologic patients]. / Derivaciones del tracto urinario superior en pacientes oncológicos.

Herein it is described the survival rate, the quality of life and the complications of the upper urinary tract diversion in 22 pluri-treated tumoral patients (both male and female, average 65.2 years old). Cancer etiology has been: colon-rectum neoplasia (36.3%), bladder carcinoma (36.3%), prostate carcinoma (9.9%), ovary cancer (4.5%), abdominal wall desmoid tumor (4.5%), pheochromocytoma (4.5%) and gastric carcinoma (4.5%). Urinary diversions type has been: percutaneous nephrostomy (40.9%), ureteral stent (31.8%), both (13.6%) and cutaneous ureterostomy (13.6%). Urinary diversions were performed unilateral in 90.9%. The average survival has been 4.8 months. The quality of life was poor in 68.1%. The following complications were observed: urinary infection (45.4%), hematuria (36.3%), diversion catheter lose (34.8%) and obstruction (27.2%). Urinary diversion in pluri-treated cancer patients must be carefully indicated to prevent negative aspects upon psychophysic and social activity of the patients.

[Study, treatment and follow-up of 379 patients with urinary tract lithiasis]. / Estudio, tratamiento y seguimiento de 379 pacientes con litiasis del aparato urinario.

Between May 1988 and December 1989, 369 patients were seen at our lithiasis unit. During that time the Unit had neither "percutaneous nephroscope" nor "ureterorenoscope". Twenty-three percent of the patients were not susceptible to therapy either due to spontaneous extrusion of their lithiasis or because it was not considered indicated. Of the remaining 77% (296 cases) 94.5% were referred for extracorporeal lithotrity with shock waves, of which 89.8 were monotherapy and 4.7% a combination with other strategies (medico-lithic, surgical, endoscopic extrusion). At the time of collecting the results, 216 patients had undergone some treatment. In those receiving shock waves, an EDAP piezoelectric lithotripter was used in 19.9% and a HM3-Dornier in 80% of the cases. Taking into consideration the overall resulted from last examination of each patient, 67% were free from lithiasic residues, 25% had residues under 4 mm, and 7.7% residues over 4 mm. 19.4% of the patients developed some kind of complication and 9 patients had to be admitted to hospital.

[Doxazosin treatment of disorders of the voiding phase in benign prostatic hyperplasia]. / Tratamiento con Doxazosina de las alteraciones de la fase miccional en la hiperplasia prostática benigna.

OBJECTIVE: To analyze the clinical and urodynamic efficacy of treatment with doxazosin during 6 months for voiding phase disorders in patients with BPH. METHODS: A prospective clinical and urodynamic study (before and after treatment) was performed in 65 consecutive male patients with BPH, aged 54-79 years (mean 66.7), to evaluate the results of treatment with doxazosin 4 mg/day during 6 months. Clinical evaluation included patient history and the International Prostatic Symptom Score (IPSS) and urodynamic evaluation included uroflowmetry with post-void residual data and pressure-flow test. A static urethral pressure profile was associated with the urodynamic voiding study. RESULTS: The IPSS score improved significantly from 19.8 +/- 4.8 before treatment to 11.9 +/- 4.6 after treatment (p < 0.001). Urinary symptoms improved significantly more markedly after treatment (coeff. -0.45939) in patients with a lower IPSS score. The symptomatic improvement demonstrated by the IPSS did not correlate with the DRE or the transabdominal US prostatic volume. Mean maximum flow rate before treatment was 9.13 ml/sec and increased to 16.23 ml/sec after treatment (p < 0.01). Postvoid residual dropped from 21.7% to 12.5% (p < 0.01). In the pressure-flow test, foot-point PURR dropped significantly from 69 cms H2O to 45.9 cms H2O (p < 0.001). The PURR curvature diminished from 0.27416 to 0.15964 cms H2O (ml/sec2) (p < 0.01). A statistically significant improvement of the compressive (p < 0.001) and constrictive (p < 0.05) elements of lower urinary tract obstruction was observed. The urethral functional length of the urethral profile showed a significant reduction (pre-treatment: 5.56 cms; post-treatment 4.31 cms) (p < 0.05). A statistical correlation was found between the urethral functional length and the foot-point PURR post-treatment. CONCLUSIONS: Adrenergic blockade with doxazosin reduces both the compressive and constrictive elements of lower urinary tract obstruction in the voiding phase in patients with BPH, although no statistical correlation with the IPSS could be demonstrated.

[The doxazosin treatment of the changes in the bladder filling phase in benign prostatic hyperplasia]. / Tratamiento con doxazosina de las alteraciones de la fase de llenado vesical en la hiperplasia prostática benigna.

OBJECTIVE: To analyze the clinical and urodynamic efficacy of treatment with doxazosin during 6 months for bladder filling phase disorders in patients with BPH. METHODS: A prospective clinical and urodynamic study was performed in 65 males with BPH, aged 54-79 years (mean 66.7), who had been treated with doxazosin (4 mg/day) during 6 months. Clinical [International Prostatic Symptom Score (IPSS)] and urodynamic evaluations (cystometry and filling cystography) before and after treatment were performed. IPSS data were obtained according to the WHO recommendation following validation and translation into Spanish. RESULTS: The IPSS score improved significantly from 19.8 +/- 4.8 before treatment to 11.9 +/- 4.6 after treatment (p < 0.001). All the patients were normotensive before and after treatment (systolic and diastolic blood pressures 135.9/78.9 and 135.4/77.8 mmHg, respectively). No tachycardia was observed before (71.9 +/- 5.8) or after treatment (71.8 +/- 5.9). A relationship between the lower IPSS before treatment and urinary symptoms improvement was demonstrated (coef.-0.45939). We found no relationship between prostate volume (digital rectal examination or transabdominal ultrasonography) and IPSS modifications after treatment. Bladder instability decreased significantly from 71.6% before treatment to 33.3% after treatment (p < 0.01). Instability pressure also diminished from 99.2 cms H2O to 60.3 cms H2O after doxazosin treatment (p < 0.001). We found no significant relationship between IPSS and bladder instability post-treatment. CONCLUSIONS: Adrenergic blockade with doxazosin 4 mg/day for 6 months achieves a significant decrease in the bladder instability associated with prostatic obstruction in patients with BPH, although no statistical correlation with the IPSS could be demonstrated.

[Changes in the urethral pressure profile after vaginal electrostimulation in the treatment of stress urinary incontinence]. / Modificación del perfil de presión uretral post-electroestimulación vaginal en el tratamiento de la incontinencia urinaria de esfuerzo.

OBJECTIVE: To assess the changes in urethral pressure measurement after vaginal electrostimulation for the treatment of genuine urinary stress incontinence. METHODS: A clinical study, cystometry and urethral pressure profile were conducted on 15 female patients with urinary stress incontinence. RESULTS: The clinical results showed that electrostimulation was effective in 60% of the patients. The maximum urethral pressure and the functional urethral length increased after electrostimulation (from 47.72 +/- 16.47 cm H2O to 58.27 +/- 14.09 cm H2O, and from 3.9 +/- 1.56 cm to 5.25 +/- 1.69 cm, respectively). There was no relationship between the clinical improvement and the increment of both parameters. However, the increase of the maximum urethral pressure was higher in patients with improvement of incontinence (from 42.5 +/- 3.53 cm H2O to 49.65 +/- 11.26 cm H2O). CONCLUSIONS: Electrostimulation increases both the maximum urethral pressure and the functional urethral length. However, there is no relationship between these parameters and the effects of electrostimulation on urinary incontinence.

[Effects of urethropexy on urination. A price to pay?]. / Afectación de la micción posturetropexia. Un precio a pagar?

OBJECTIVES: To evaluate the voiding repercussions of urethropexy. METHODS: We carried out a clinical and urodynamic study in 70 patients subjected to different techniques of urethropexy (Kelly, Raz, Marshall-Marchetti-Krantz, Burch and simplified Ramirez) for stress urinary incontinence. We evaluated the voiding repercussions of urethropexy. RESULTS: There was a significant increase in the obstructive symptoms with urethropexy (29% of the patients) although there was no relationship with the variation of the urinary flow rate. It also significantly diminished the urinary flow rate (85% of the patients) and increased the postvoiding volume significantly (3.68 times the average before surgery). The increase in postvoiding volume occurred more frequently in patients with diminished urinary flow rate before urethropexy (60% of the cases). The Raz technique showed less urodynamic data of voiding disturbances. CONCLUSIONS: Urethropexy causes voiding disturbance. We believe the decrease in urinary flow rate is related to the increase in urethral resistance produced by urethropexy. In the cases with previously diminished urinary flow rate, reduction in bladder contractility is added to the former mechanism.

[Urodynamics of urinary incontinence post radical prostatectomy]. / Urodinámica de la incontinencia urinaria postprostatectomía radical.

OBJECTIVE: To determine the urodynamic characteristics of urinary incontinence after radical retropubic prostatectomy. METHODS: We conducted a clinical and urodynamic study on 25 patients who had undergone radical retropubic prostatectomy due to localized prostate adenocarcinoma. RESULTS: 68% of the patients completely recovered urinary continence. The maximum rate of urinary continence recovery was found between the third and fourth month postprostatectomy. A relationship was demonstrated between preoperative hormone blockade, duration of the surgery and urinary continence. Videocystography demonstrated an incompetent proximal continence mechanism in all radical prostatectomy patients. All incontinent patients presented stress urinary incontinence. Denervation potentials of the periurethral sphincter was demonstrated by electromyography in 80% of incontinent patients. These potentials were not present in the continent patients. Reinnervation potentials were present in 50% of the continent patients and in 20% of the incontinent patients (significant differences). No relationship was found between other urodynamic data and post-radical prostatectomy urinary incontinence. CONCLUSIONS: The surgical difficulty influences the preservation of urinary continence. A high percentage of patients submitted to radical prostatectomy recover urinary continence with time. Urinary incontinence following radical prostatectomy is based on the distal sphincteric mechanism. Patients who remain incontinent four months postoperatively and with electromyographically demonstrated denervation potentials of the periurethral sphincter can be considered to be candidates for treatment of incontinence without waiting any further.

[Role of the bladder neck in urinary continence in women after urethropexy]. / Participación del cuello vesical en la continencia urinaria femenina posturetropexia.

We conducted a clinical, radiological and urodynamic study in 70 patients submitted to different urethropexy techniques (Kelly, Raz, Marshall-Marchetti-Krantz, Burch, simplified Ramírez) to determine the importance of the bladder neck in the treatment of urinary incontinence. Urethropexy achieved a significant increase in the percentage of patients with an open bladder neck during the filling phase. However, the opening of the bladder neck posturethropexy did not influence urinary continence.

[Comparative results of different types of urethropexy in the treatment of stress urinary incontinence in women]. / Resultados comparativos de los diferentes tipos de uretropexia en el tratamiento de la incontinencia urinaria de esfuerzo femenina.

We conducted a clinical and urodynamic study in 70 patients who had undergone different urethropexy procedures for stress urinary incontinence. Urethropexy had achieved positive results in 87% of the patients. Incontinence persisted in 21% of the patients. Urethropexy significantly reduced the urge-incontinence and frequency associated with this disorder. Anterior urethropexy did not increase the incidence of poor results in the present series since no patient had intrinsic urethral involvement. The suprapubic and the combined techniques achieved the following cure rates: Marshall-Marchetti-Krantz (92%), Burch (100%), Ramírez simplified (80%), Raz (60%). The cure rate for the Kelly vaginal technique was found to be lower (57%).

[Impact of bladder irritative symptoms and detrusor instability on the outcome of urethropexy]. / Repercusión de los síntomas irritativos vesicales e inestabilidad del detrusor en los resultados de la uretropexia.

OBJECTIVES: To evaluate the repercussion of irritative urinary symptoms and bladder instability on the results of urethropexy for urinary stress incontinence. METHODS: A clinical and urodynamic study was carried out in 70 adult women submitted to urethropexy (Kelly, Raz, Marshall-Marchetti-Krantz, Burch or simplified Ramirez technique). RESULTS: The urge incontinence symptom was associated with coughing incontinence is 38 (60%) of the patients submitted to urethropexy. This symptom decreased to 42% (27 patients) after urethropexy. The average score of diurnal urinary frequency was 23% less posturethropexy. The simplified Ramirez technique had the lowest diurnal urinary frequency score [1.17 +/- 1.07 (0 to 3)]. Bladder instability with urinary stress incontinence (mixed incontinence) was found in 21 (30%) patients before urethropexy. The incidence of bladder instability after urethropexy was significantly greater in this group (52%) than in the patients with isolated urinary stress incontinence (17%). However, urethropexy also corrected bladder instability in 30% of the women with mixed incontinence. The Kelly technique produced the lowest incidence of bladder instability after urethropexy (14%). CONCLUSIONS: Urethropexy significantly decreases the irritative urinary symptoms associated with stress urinary incontinence. In some cases, bladder instability associated with stress incontinence (mixed incontinence) may disappear following urethropexy. In most cases bladder instability continues after urethropexy.

[Surgical treatment of male hypospadias with pediculated transversal preputial flap technique: a 10-year follow-up]. / Tratamiento quirúrgico del hipospadias masculino con técnica de colgajo prepucial transversal pediculado: seguimiento de 10 años.

OBJECTIVES: The study was conducted to evaluate the long-term follow-up micturition data, sexual function and cosmetic results of hypospadias surgical repair. METHODS: 14 males (mean age 19.6 yrs) submitted to hypospadias surgical repair with the pedicled preputial tubulized flap technique 10 years ago were evaluated. RESULTS: The most frequent site of the anomaly was the distal third of penis (85.6%). The micturition data were excellent and urinary flow rates were normal in 92.8%. Erection and ejaculation were normal in all patients. Penile curvature persisted in 14.2%; 64.2% of the patients had sexual intercourse (completely satisfactory in 66.6%), penis size was normal in 78.6% and 66.6% of the patients were married and had children. No longterm follow-up complications were observed. CONCLUSIONS: The technique achieved excellent cosmetic and functional results.

[True post-micturition urinary incontinence of the male]. / La genuina incontinencia urinaria postmiccional del varón.

Herein we describe 3 cases of male urinary incontinence that had consulted for intense dribbling at the end of voiding. The urodynamic study identified the true postmicturition urinary incontinence in the male, whose origin was ascribed to alterations in the terminal phase of voiding, arising from localized disorders in the posterior or anterior urethra. The major significance of the true postmicturition urinary incontinence in the male lies in the need to distinguish it from other types of urinary incontinence with more clinical importance.

[The clinical and flowmetric results of the treatment of benign prostatic hyperplasia with doxazosin]. / Resultados clínicos y flujométricos del tratamiento de la hiperplasia benigna de próstata con doxazosina.

OBJECTIVE: To evaluate the clinical efficacy of doxazosin for 6 months in the treatment of benign prostatic hyperplasia (BPH). METHODS: A prospective clinical and uroflowmetric study was conducted on 65 males with BPH treated with doxazosin 4 mg daily for 6 months. Patient mean age was 66.7 years (range 45-79). Clinical evaluation (IPSS and andrologic data) and blood analyses were performed before and after treatment. IPSS data were obtained according to the WHO validation and Spanish translation. RESULTS: A significant improvement was found between the mean pre- and post-treatment IPSS scores (19.8 +/- 4.8 vs 11.9 +/- 4.6; p < 0.001). Maximum flow rate before treatment was 9.13 ml/sec, which increased to 16.23 ml/sec after treatment (p < 0.001). Postvoid residual urine dropped from 21.7% to 12.5% (p < 0.01). All the patients were normotensive before (135.9 mean systolic and 78.9 mean diastolic blood pressure) and after treatment (135.4 mean systolic and 77.8 mean diastolic blood pressure). Mean heart rate was similar before and after treatment (71.9 +/- 5.8 vs 71.8 +/- 5.9). A relationship between low IPSS score before treatment and urinary symptoms improvement was demonstrated (coeff. -0.45939). No relationship was found between prostate volume (digital rectal examination or transabdominal ultrasound) and improvement in the IPSS score. No statistical relationship was found between the IPSS and postvoid residual urine or peak flow. No modifications of sexual activity was demonstrated with doxazosin treatment. Pre- and post-treatment blood analytical data fell within the normal ranges. Transient side effects were observed in 12 patients (20%): headache in 6 patients (10%), fatigue in 6 (10%), dizziness in 3 (5%) and somnolence in (5%). CONCLUSIONS: Doxazosin, at a daily dose of 4 mg daily for 6 months, is a safe and effective treatment in patients with BPH.

[Retroperitoneal abscess: analysis of 26 cases]. / Absceso retroperitoneal: análisis de 26 casos.

Herein we present the experience of our hospital, which spans a period of 10 years, in the diagnosis and treatment of retroperitoneal abscess. The clinical features, origin and localization of the abscesses are described. We underscore the diagnostic value of ultrasound (US) and computerized tomography (CT) which afford a sensitivity of 86.3% and 100%, respectively. An increased incidence of abscess from gram-positive bacteria was observed in i.v. drug addicts.

[Penile metastases. Report of 3 new cases and review of the national literature]. / Metástasis peneanas. Aportación de tres nuevos casos y revisión de la literatura nacional.

Penile metastasis from primary tumors at other sites are extremely rare. To our knowledge, Alonso Gorrea reported the first case in the Spanish literature in 1980. Since then, 20 cases have been reported. Three additional cases of penile metastasis from tumors at other sites are described herein. The pathogenesis, symptoms, prognosis and treatment of this tumor type are discussed.

[Urothelial tumors of the upper urinary tract: epidemiologic study, diagnostic assessment, and treatment]. / Tumores uroteliales del tracto urinario superior: estudio epidemiológico, evaluación diagnóstica y terapéutica.

OBJECTIVES: The result of an epidemiological study and evaluation of diagnosis and treatment of transitional cell tumors of the upper urinary tract are presented. MATERIAL AND METHODS: A retrospective study was conducted on 34 patients with transitional cell tumor of the upper urinary tract. RESULTS: The most common symptom was intermittent hematuria. Smoking was found to be the most important risk factor and 41.7% of the cases previously had a bladder cancer. IVP was the diagnostic technique most commonly utilized (61.7%). Nephroureterectomy was performed in 58.8% of the cases. Six cases had recurrence of the upper urinary tract tumor. There were 9 deaths (26.5%). CONCLUSIONS: The epidemiological data are similar to those of larger series. The tumors appear to develop in the presence of generalized urothelial disease. The low incidence of recurrence in the ipsilateral ureteral meatus indicates that resection of the distal ureter may not be required in patients at high risk.