Caracterización clínica de las disfunciones de piso pélvico en mujeres chilenas sintomáticas que consultan en un hospital universitario / Clinical characterization of pelvic floor dysfunctions in symptomatic Chilean women who visit an academic hospital

INTRODUCCIÓN: La prevalencia de las disfunciones de piso pélvico (DPP) puede llegar hasta un 25%, y esta incrementando con los años. El objetivo de este estudio es mostrar las características clínicas de pacientes sintomáticas sometidas a cistometría simple en el Hospital La Florida, entre diciembre del 2015 y marzo 2020. MÉTODOS: Es un estudio retrospectivo transversal. Se evaluaron los datos de todos los resultados de cistometrías simples de pacientes derivadas por sintomatología de piso pélvico entre los años 2015 y 2020. RESULTADOS: Se evaluaron 1.211 cistometrías simples. El motivo de derivación más frecuente fue prolapso de órganos pélvicos + incontinencia de orina (IO) (39.6%). 13.5% tuvieron resultado normal. 58% presentó test de esfuerzo positivo. 22.5% tenían prueba de estrés con vejiga vacía positiva. 17.6% presentó IO oculta. 21.9% de IO mixta. De las pacientes derivadas por vejiga hiperactiva o IO mixta, en el 14.2% se constató la presencia de contracciones no inhibidas y en el 34.8% la presencia de urgencia. CONCLUSIONES: Nuestro estudio aporta información sobre las DPP en la mujer chilena en un hospital universitario.

INTRODUCTION: Prevalence of pelvic floor dysfunctions (PFD) can be as high as 25%, and it is increasing over the years. The objective if this study is to show the clinical characteristics of symptomatic patients undergoing simple cystometry at La Florida Hospital, between December 2015 and March 2020. METHODS: This is a cross-sectional study. The data of all simple cystometries of patients derived for pelvic floor symptoms between 2015 and 2020 were evaluated. RESULTS: 1211 simple cystometries were evaluated. The most frequent reason for referral was pelvic organ prolapse + urinary incontinence (UI) (39.6%). 13.% had a normal result. 58% presented positive stress test. 22.% had a positive empty stress test. 17.6% had occult UI. 21.9% mixed UI. Of the patients referred by overactive bladder or mixed UI, 12.2% had detrusor contractions and 34.8% had urgency. CONCLUSIONS: Our study provides information on PFD in Chilean women in a university hospital. .

Uso de estudio urodinámico simple, para diagnóstico de incontinencia urinaria de esfuerzo / Use of a simple urodynamic study to diagnose of stress urinary incontinence

INTRODUCCIÓN: La incontinencia urinaria es un problema muy frecuente. El diagnóstico diferencial incluye varias condiciones. La Incontinencia Urinaria de Esfuerzos es la más común y su tratamiento es fundamentalmente quirúrgico. Debido a que el diagnóstico de Incontinencia Urinaria de Esfuerzo no es confiable cuando se basa en la historia y las complicaciones asociadas a la cirugía son potencialmente complejas de manejar, se vuelve imperativo objetivar el diagnóstico. MÉTODO: Se presenta un descripción retrospectiva de los resultados obtenidos de la examinación de pacientes con incontinencia urinaria mediante evaluación urodinámica simple y estandarizada. RESULTADOS: Se evaluó a 303 pacientes, de las cuales el 75,3% finalmente fue sometida a cirugía antiincontinencia. En el resto de las pacientes se encontró desde evaluación normal a variadas disfunciones miccionales. CONCLUSIONES: Es importante la implementación de herramientas de evaluación objetivas y estandarizadas como medida de seguridad y de gestión de listas de espera. Nuestros resultados son similares a los reportados en la literatura.

INTRODUCTION: Urinary incontinence is a very frequent problem. The differential diagnosis includes some conditions. Stress urinary incontinence is the most common condition and its treatment is primarily surgical. Because the diagnosis of stress urinary incontinence is not reliable when it is based on the history and the complications associated with surgery are potentially complex to manage, it becomes imperative to objectively demonstrate the diagnosis. METHODS: We present a retrospective description of the results obtained from the examination of patients with urinary incontinence through simple and standardized urodynamic evaluation. RESULTS: A total of 303 patients were evaluated, of whom 75,25% were finally submitted to anti-incontinence surgery. In the rest of the patients it was found from normal evaluation to varied voiding dysfunctions. CONCLUSIONS: It is important to implement objective and standardized evaluation tools as a safety measure and management of the waiting lists. Our results are similar to those reported by literature.

Excreção urinária de glicosaminoglicanos em crianças com bexiga neurogênica secundária a mielomeningocele / Urinary excretion of glycosaminoglycans in children with neurogenic bladder secondary to myelomeningocele

A excreção urinária de glicosaminoglicanos (GAG) está alterada em várias patologias do trato urinário; o padrão de excreção pode estar associado com o estado da doença. A excreção urinária de GAG em crianças com bexiga neurogênica (BN) secundária a mielomeningocele (MMC) pode também estar alterada, mas até a presente data não há detalhamento epidemiológico dos pacientes e não se correlacionou o padrão de excreção com grau de disfunção vesical. Analisamos a excreção urinária de um grupo bem definido de crianças de 17 pacientes com MMC, 10 meninos e 7 meninas (média de idade +- DP de 4,6 +- 2,9 anos) foram obtidas durante o exame cistométrico. As amostras do grupo controle foram obtidas de 18 crianças normais, 13 meninos e 5 meninas (6,9 +- 2,2 anos). Todas as crianças não estavam com infecção urinária, tinham função renal normal e não estavam sob tratamento farmacológico. A quantificação do GAG urinário total foi expressa em ug de ácido hexurônico/mg de creatinina e a proporção dos diferentes tipos de GAGs sulfatados foi obtida por eletroforese em gel de agarose. A avaliação cistométrica foi realizada utilizando aparelho de urodinâmica Dynapack modelo MPX816 (Dynamed, São Paulo, Brasil), a partir da qual o escore cistométrico foi calculado de acordo com procedimento recente publicado [14]. Não observamos diferença significativa na excreção urinária de GAG total entre meninos e meninas tanto no grupo com MMC (0,913 +- 0,528 vs 0,867 +- 0,434, p>0,05) como no grupo controle (0,546 +- 0,240 vs 0,699 +- 0,296, p>0,05). Os resultados mostraram também que a excreção de GAG urinário não se correlacionou com a idade tanto no grupo com MMC (r = -0,28, p>0,05) como no grupo controle (r = -0,40, p>0,05). Entretanto, a comparação dos dois grupos mostrou que o grupo com MMC excretava 52% a mais de GAG total que o grupo controle (0,894 +- 0,477 vs 0,588 +- 0,257, p<0,04). Nesses pacientes a excreção de GAG total não se correlacionou com a complacência vesical...

Urinary glycosaminoglycan (GAG) excretion is altered in a number of urinary tract disorders, and the excretion pattern may be associated with disease state and/or outcome. GAG excretion in children with neurogenic bladder secondary to myelomeningocele (MMC) may be affected, but existing data lack more detailed demographics and does not correlate excretion pattern with severity of bladder dysfunction. Here we analyzed GAG excretion in a well defined group of children with MMC and correlated the results with cystometric score. Urine specimens from 17 patients (10 boys, 7 girls) mean age +- SD, 4.6 +- 2.9 years) were obtained during cystometry. Control specimens were from 18 normal children (13 boys, 5 girls) (6.9 +- 2.2 years). All children were free from urinary infection, had normal renal function, and were not under pharmacological treatment. Total urinary GAG was assayed as ug hexuronic acid/mg urinary creatinin e, and sulfated GAGs were determined by agarose gel electrophoresis. Cistometry was done using a Dynapack MPX816 (Dynamed, São Paulo, Brazil), from wich a cystometry score was calculated according to a recent procedure [14]. There were no significant differences in total GAG excretion between male and female individuals in the MMC (0.913 +- 0.528 vs 0.867 +- 0.434, p>0.05) and control (0.546 +- 0.240 vs 0.699+- 0.296, p>0.05) groups. Also, urinary GAG did not correlated with age in the MMC (r = -0.28, p>0.05) and control (r = -0.40, p>0.05) groups. However, MMC patients excreted 52% more GAG than controls (0.894 +- 0.477 vs 0.588 +- 0.257, p<0.04). In these patients, total GAG excretion was not associated with vesical complicance alone (r = -0.18, p>0.05), but was significantly and negatively correlated (r = -0.56, p<0.05) with cystometric score. On average, MMC patients with worst scores (<9) excreted 81% more GAG than those with better scores (>9) (1.157 +- 0.467 vs 0.639 +- 0.133, p<0.04). Chondroitin sulfate prevailed in both groups...

Long term evaluation of functional and morphological bladder alterations on alloxan-induced diabetes and aging: experimental study in rats / Avaliação funcional e morfológica tardia de alterações na bexiga secundárias ao diabetes induzido por aloxano e no envelhecimento: estudo experimental em ratos

PURPOSE: to evaluate structural and functional effects of Alloxan- induced diabetes and aging on bladder of rats. METHODS: evaluations were performed in three groups: A - 8 weeks of age, B - 44 weeks of age, C - 44 weeks of age with alloxan-induced diabetes. Muscle layer thickness, extracellular matrix fibrosis and collagen were quantified on digital images of bladder samples. Cystometric evaluations before surgical vesical denervation (SVD), included maximum cystometric capacity (MCC), maximum bladder pressure (MBP), bladder contraction frequency (VCF), duration of bladder contraction (DC), threshold pressure (TP) and bladder compliance (BC). After SVD, maximum cystometric capacity (MCC), BC and maximum urethral closing pressure (MUCP) were also measured. RESULTS: Reduced extracellular matrix fibrosis concentration and contraction strength were found in the bladders of group C. Before SVD, bladder compliance was not different between groups. Alterations were observed in MCC after SVD. CONCLUSIONS: We did not notice smooth muscle hypertrophy in Alloxan-induced diabetic rats after 44 weeks. There was alteration in the total and relative amount of fibrosis and collagen. The cystometric studies support the idea that this morphological alterations are important to determine the different bladder functional patterns found in the aging and the Alloxan-induced diabetic animals.

OBJETIVOS: avaliar alterações estruturais e funcionais da bexiga de ratos machos, associadas ao diabetes induzido por aloxano e ao envelhecimento. MÉTODOS: três grupos de animais: A - 8 semanas de idade; B- 44 semanas de idade; C - 44 semanas de idade com diabetes induzido por aloxano, foram avaliados. Realizadas medidas de espessura da camada muscular, fibrose de matriz extracelular e quantidade de colágeno, através de análise de imagem digital dos tecidos. Realizados também testes cistométricos, antes da desnervação vesical cirúrgica (DVC), para avaliar capacidade vesical (CV), intensidade máxima de contração vesical (IMCV) e complacência vesical. Após a DVC, foram avaliadas capacidade vesical após a desnervação (CVAD), complacência vesical (CV) e pressão de perda uretral (PPU). RESULTADOS: não foi observada hipertrofia da camada muscular nas bexigas; houve diminuição da concentração de fibrose da matriz extracelular e diminuição da força contrátil, e aumento da capacidade vesical no grupo C. CONCLUSÕES: a atrofia da camadas muscular da bexiga esta relacionada ao diabetes induzido por aloxano. O envelhecimento, como fenômeno isolado, provoca alterações nos parâmetros funcionais, porém associado ao diabetes, gera alterações na IMCV, CV e CVAD. Existe correlação entre alterações estruturais e funcionais nos animais diabéticos após a desnervação.

Evaluación vesical urodinámica en pacientes con insuficiencia renal crónica en etapa avanzada / Urodynamics evaluation in patiens with end-stage renal disease

Introducción: La Insuficiencia Renal Crónica en etapa avanzada es una condición incompatible con la vida. En la actualidad los diversos tipos de sustitución de la función renal (Diálisis) permiten la vida de estos pacientes, sin embargo, su calidad de vida se ve deteriorada. El tratamiento definitivo de la enfermedad es el trasplante renal. Sin embargo, para que este procedimiento sea efectivo, es necesario contar con múltiples condiciones, entre ellas una vejiga que cumpla completamente con su función original, la cual puede estar comprometida con el paso de los años en que cesa la producción de orina (Anuria). Pacientes y método: Se diseñó estudio prospectivo, de diciembre de 2004 a diciembre 2005, que evalúa a los pacientes en anuria, referidos desde policlínico de nefrología para estudio pretrasplante mediante Urodinamia y Cistoscopía, con el fin de evidenciar los cambios experimentados por la vejiga. Resultados: Durante diciembre de 2004 y diciembre de 2005 se estudiaron 29 pacientes en anuria, 16 pacientes desexo femenino y 13 varones, el 45 por ciento diabéticos, el 72 por ciento con menos de 10 años de Insuficiencia Renal Crónica y 90 por ciento con menos de 10 años en diálisis. De los hallazgos en la urodinamia, 62,1 por ciento presentaban una Hiperactividad Idiopática del Detrusor y un 48 por ciento una disminución en la Acomodación Vesical. Conclusión: Concluimos que existen cambios funcionales en la vejiga que se ve sometida a una disminución en la producción de orina durante el tiempo, y que no existe la necesidad de realizar estudios urodinámicos en todos los pacientes en espera de trasplante. Sin embargo, existen ciertas condiciones en las que debe realizarse como rutina. Los resultados concuerdan con la bibliografía revisada, donde se observa que, conforme disminuye la producción de orina diaria, existe disminución en la Capacidad Vesical, en la Acomodación Vesical, y un aumento en la Hiperactividad del Detrusor.

Introduction: The End-Stage Renal Disease is a life incompatible condition. Nowadays, dialysis allows patients to live with a limited complications rate, nevertheless, quality of life is diminished in this population. Renal transplant (RT) constitutes a feasible and reliable treatment for patients with renal failure patients. Multiple conditions should be preoperatively evaluated in renal transplant patients. Bladder function remains an important factor to asses in preoperatory evaluations of kidney recipients. Patients and Methods: Between December 2004 and December 2005, 29 nine kidney receptors wereprospectively evaluated with cystoscopy and urodynamics. The aim of the study was to assess bladder functional changes induced by anury in this cohort. Results: The population of the study was composed by 29 patients, 16 female and 13 male. Forty five percent of patients’ harbored diabetes mellitus, 72 percent had less than 10 years with End Stage Renal Disease and 90 percent had less than 10 years in dialysis. Urodynamic evaluation evidenced 62 percent of overactive bladder and 48 percent diminution in bladder compliance. Conclusion: Bladder functional changes are verified in patients in anury due to renal failure. These conditions might influence preoperative evaluation of patients undergoing RT. The most important variations verified in bladder function are diminution in bladder capacity and compliance, and increase of detrusor activity.