Overactive bladder - 18 years - Part I

ABSTRACT Abstract: Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals – including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

Overactive bladder - 18 years - Part II

ABSTRACT Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Concurrent validity, internal consistency and responsiveness of the portuguese version of the king's health questionnaire (KHQ) in women after stress urinary incontinence surgery

OBJECTIVE: To evaluate the concurrent validity, internal consistency and responsiveness of King's Health Questionnaire (KHQ) in patients who underwent sling procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: We performed a prospective open label multicenter study in 4 tertiary referral centers. Sixty-eight female patients were enrolled with urodynamically diagnosed urinary stress incontinence. Patients were treated using surgical procedures, mostly (73 percent) with the synthetic sling procedure, which has been considered one of the gold standard methods for the treatment of urinary incontinence. The patients were assessed before and after one month of postoperative follow up, using the KHQ in its validated Portuguese version. Patients also underwent preoperative urodynamic test, Stamey incontinence grading, pad usage and the assessment of number of pads used per day. After surgery, patients underwent stress test, Stamey incontinence grading pad usage and the assessment of number of pads used per day. RESULTS: The concurrent validity showed good correlations in some domains of KHQ to clinical parameters. The internal consistency was higher after treatment compared to preoperative values. Objective parameters, such as pad usage and the assessment of number of pads used per day, had significant correlation with changes in post-treatment scores on KHQ. The responsiveness expressed in terms of standardized effect size (SES) and standardized response mean (SRM) was large. CONCLUSION: The results showed moderate concurrent validity, strong internal consistency and high responsiveness for KHQ, indicating that it is suitable for measuring outcomes in clinical trials among female patients with stress urinary incontinence.

Evaluacion de la memoria declarativa asociada con u n contenido emocional en una muestra colombiana / Evaluation de declarative memory asociated with emotional contents in colombian sample

Diversos estudios han documentado que los contenidos emocionales incrementan la memoria a largo plazo. El presente estudio es una adaptación de paradigmas previamente usados en investigaciones en Norteamérica y Brasil, que muestran la influencia de la emoción sobre la retención a largo plazo de la memoria explícita. Una muestra de 62 adultos saludables de alto y bajo nivel educativo fue distribuida aleatoriamente en dos grupos que observaron una misma serie de 11 diapositivas acompañadas por narraciones diferentes. Un grupo fue expuesto a una historia emocionalmente "neutra" y el otro grupo a una historia "de alertamiento emocional". Inmediatamente después a la presentación audiovisual, se les pidió a los participantes que asignaran un valor de emocionalidad a la historia. Los individuos que asistieron a la historia "de alertamiento emocional" atribuyeron un índice de emocionalidad más elevado que aquellos del grupo "neutro" (t=3.672, p<0.05). Diez días después, se les pidió que recordaran libremente detalles tanto visuales como auditivos de la historia y contestaran un cuestionario de selección múltiple sobre la misma. Las personas que observaron la historia emocional recordaron más detalles de la historia (t=2.830, p<0.05) y obtuvieron un mejor puntaje en el cuestionario de reconocimiento que el grupo que observó la historia con contenido neutro (t=2.800, p<0.05). Estos hallazgos confirman que los contenidos emocionales implementados en esta prueba incrementan la memoria declarativa a largo plazo e indican la posibilidad de aplicar este instrumento tanto en investigaciones clínicas como básicas en varios contextos culturales y en particular en poblaciones de habla castellana

Laparoscopic Burch surgery: is there any advantage in relation to open approach?

INTRODUCTION: Surgery represents the main therapeutic modality for stress urinary incontinence. In incontinent patients with urethral hypermobility, the retropubic colposuspension by Burch technique is one of the surgeries that present better long-term results. Current trends towards performing minimally invasive techniques led proposing the Burch surgery through videolaparoscopy. The laparoscopic technique's long-term efficacy is a highly controversial issue. However, even if late results turn out to be satisfactory, the assumed advantages of laparoscopy (faster recovery, less pain, early return to daily activities, etc.) must be evident, in order to justify the use of this minimally invasive surgical access. MATERIALS AND METHODS: We reviewed our records and analyzed the medical charts of 26 female patients who underwent Burch surgery by open approach and 36 female patients by laparoscopic approach, between May 1999 and February 2001. The satisfaction level, surgical complication rates, surgery length, hospital stay and return to daily activities were analyzed. RESULTS: Mean age was 42 years, ranging from 27 to 68 years. Epidemiological data from both groups were not statistically different. Patients operated by laparoscopic route had a shorter hospital stay (p = 0.002) and a faster return to their daily activities (p < 0.001). However, there were no statistical differences in the following parameters: surgical time (p = 0.11), surgical complications (p = 0.98), patient satisfaction immediately (p = 0.77) and 90 days following surgery (p = 0.84), surgery acceptance (p = 0.85), indication of this surgery to a friend (p = 0.93) and score given to the procedure (p = 0.68). CONCLUSIONS: Even if the efficacy of both methods is similar, we did not observe significant advantages of laparoscopic surgery over open surgery, concerning the recovery in recent post-operative period.