Association of physical therapy techniques can improve pain and urinary symptoms outcomes in women with bladder pain syndrome. A randomized controlled trial

ABSTRACT Purpose: to verify the effects of biofeedback (BF) and manual therapy (MT) associated with transcutaneous electrical nerve stimulation (TENS) or postural exercises (PE) in the treatment of bladder pain syndrome (BPS) in women regarding pain and urinary symptoms. Materials and Methods: a parallel-randomized controlled trial was conducted in BPS patients diagnosed according to NIH clinical criteria. Two specialized physiotherapists applied demographic and validated questionnaires of perineal and suprapubic pain (VAS), urinary symptoms and problems (ICSI and ICPI) and sexual function (FSFI) and a physical assessment was made to identify myofascial trigger points. Thirty-one women, mean age 51.8 ± 10.9 were randomized in three groups of treatment consisting of ten weekly sessions of BF and MT (Conventional group); BF, MT, and TENS (TENS group); and BF, MT, and PE (Postural group). Results: Postural group improved perineal and suprapubic pain after treatment (p<0.001 and p=0.001, respectively), and the suprapubic pain improvement remained persistent at 3 months of follow up (p=0.001). Postural group improved urinary symptoms and problems after treatment (p<0.001 and p=0.005, respectively) and during follow up (p<0.001 and p=0.001). Conclusions: Biofeedback and manual therapy associated with postural exercises showed a significant improvement in perineal and suprapubic pain and urinary symptoms after treatment and during follow-up. Both results suggest a possible role for the use of this physiotherapy technique to treat BPS patients. Longer follow-up and a larger number of patients are necessary to confirm these conclusions.

Cross-cultural adaptation and validation of the neurogenic bladder symptom score questionnaire for brazilian portuguese

ABSTRACT Objective: To cross-culturally adapt and check for the reliability and validity of the neurogenic bladder symptom score questionnaire to Brazilian Portuguese, in patients with spinal cord injury and multiple sclerosis. Materials and Methods: The questionnaire was culturally adapted according to international guidelines. The Brazilian version was applied in patients diagnosed with neurogenic bladder due to spinal cord injury or multiple sclerosis, twice in a range of 7 to 14 days. Psychometric properties were tested such as content validity, construct validity, internal consistency, and test-retest reliability. Results: Sixty-eight patients participated in the study. Good internal consistency of the Portuguese version was observed, with Cronbach α of 0.81. The test-retest reliability was also high, with an Intraclass Correlation Coefficient of 0.86 [0.76 - 0.92] (p<0.0001). In the construct validity, the Pearson Correlation revealed a moderate correlation between the Portuguese version of the NBSS and the Qualiveen-SF questionnaire (r = 0.66 [0.40-0.82]; p <0.0001). Conclusions: The process of cross-cultural adaptation and validation of the NBSS questionnaire for the Brazilian Portuguese in patients with neurogenic lower urinary tract dysfunction was concluded.

Update on complications of synthetic suburethral slings

ABSTRACT Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings.

Evaluation of the metabolism of glycosaminoglycans in patients with interstitial cystis

Introduction: Painful bladder syndrome/interstitial cystitis (PBS/IC) pathogenesis is not fully known, but evidence shows that glycosaminoglycans (GAG) of bladder urothelium can participate in its genesis. The loss of these compounds facilitates the contact of urine compounds with deeper portions of bladder wall triggering an inflammatory process. We investigated GAG in urine and tissue of PBS/IC and pure stress urinary incontinence (SUI) patients to better understand its metabolism. Materials and Methods: Tissue and urine of 11 patients with PBS/IC according to NIDDK criteria were compared to 11 SUI patients. Tissue samples were analyzed by histological, immunohistochemistry and immunofluorescence methods. Statistical analysis were performed using t Student test and Anova, considering significant when p < 0.05. Results: PBS/IC patients had lower concentration of GAG in urine when compared to SUI (respectively 0.45 ± 0.11 x 0.62 ± 0.13 mg/mg creatinine, p < 0.05). However, there was no reduction of the content of GAG in the urothelium of both groups. Immunofluorescence showed that PBS/IC patients had a stronger staining of TGF-beta, decorin (a proteoglycan of chondroitin/dermatan sulfate), fibronectin and hyaluronic acid. Conclusion: the results suggest that GAG may be related to the ongoing process of inflammation and remodeling of the dysfunctional urothelium that is present in the PBS/IC. .

Neurological status predicts response to alpha-blockers in men with voiding dysfunction and Parkinson's disease

OBJECTIVES: To evaluate predictors of the response to doxazosin, a selective alpha-adrenoceptor antagonist, when used for the treatment of lower urinary tract symptoms in men with Parkinson's disease. METHODS: In a prospective study, 33 consecutive men (mean age 59.2±7.0 years) with Parkinson's disease and lower urinary tract symptoms were evaluated. Neurological dysfunction was assessed with the Unified Parkinson's Disease Rating Scale. Urological assessment was performed at baseline and after 12 weeks of treatment with 4 mg/day of extended-release doxazosin, including symptom evaluation with the International Continence Society male short-form questionnaire, an assessment of the impact of lower urinary tract symptoms on quality of life and urodynamics. Clinical and urodynamic predictors of response were specifically evaluated. RESULTS: Compared with the score at baseline, the total International Continence Society male short-form score was reduced after doxazosin administration, from 17.4±7.5 to 11.1±6.9 (p<0.001). The impact of lower urinary tract symptoms on quality of life was also significantly reduced, from 1.8±1.1 to 1.0±1.0 (p<0.001) and the maximum urinary flow varied from 9.3±4.4 to 11.2±4.6 ml/s (p = 0.025). The severity of neurological impairment ...

Can the learning of laparoscopic skills be quantified by the measurements of skill parameters performed in a virtual reality simulator?

Purpose To ensure patient safety and surgical efficiency, much emphasis has been placed on the training of laparoscopic skills using virtual reality simulators. The purpose of this study was to determine whether laparoscopic skills can be objectively quantified by measuring specific skill parameters during training in a virtual reality surgical simulator (VRSS). Materials and Methods Ten medical students (with no laparoscopic experience) and ten urology residents (PGY3-5 with limited laparoscopic experience) were recruited to participate in a ten-week training course in basic laparoscopic skills (camera, cutting, peg transfer and clipping skills) on a VRSS. Data were collected from the training sessions. The time that individuals took to complete each task and the errors that they made were analyzed independently. Results The mean time that individuals took to complete tasks was significantly different between the groups (p < 0.05), with the residents being faster than the medical students. The residents' group also completed the tasks with fewer errors. The majority of the subjects in both groups exhibited a significant improvement in their task completion time and error rate. Conclusion The findings in this study demonstrate that laparoscopic skills can be objectively measured in a VRSS based on quantified skill parameters, including the time spent to complete skill tasks and the associated error rate. We conclude that a VRSS is a feasible tool for training and assessing basic laparoscopic skills. .

Laparoscopic ureteropyeloanastomosis in the treatment of duplex system

PURPOSE: Duplex system is one of the most common anomalies of upper urinary tract. Anatomical and clinical presentation determine its treatment. Usually, the upper moiety has a poor function and requires resection, but when it is not significantly impaired, preservation is recommended. Laparoscopic reconstruction with upper pole preservation is presented as an alternative treatment. MATERIALS AND METHODS: Four female patients with duplex system, one presenting with recurrent urinary tract infection and the others with urinary incontinence associated to infrasphincteric ectopic ureter, were treated. Surgical procedure envolved a laparoscopic ureteropyeloanastomosis of the upper pole ureter to the pelvis of the lower moiety, with prior insertion of a double J stent. RESULTS: Surgical time varied from 120 to 150 minutes, with minimal blood loss in all cases. Follow-up varied from 15 to 30 months, with resolution of the clinical symptoms and preservation of the upper moiety function. CONCLUSION: Laparoscopic ureteropyeloanatomosis is a feasible and safe minimally invasive option in the treatment of duplex system.

Cranberries and lower urinary tract infection prevention

Lower urinary tract infections are very common diseases. Recurrent urinary tract infections remain challenging to treat because the main treatment option is long-term antibiotic prophylaxis; however, this poses a risk for the emergence of bacterial resistance. Some options to avoid this risk are available, including the use of cranberry products. This article reviews the key methods in using cranberries as a preventive measure for lower urinary tract infections, including in vitro studies and clinical trials.

Tratamento conservador de trauma renal grave após litotripsia extracorpórea por ondas de choque / Conservative treatment of severe renal trauma after extracorporeal shockwave lithotripsy

Subcapsular and perinephric hematomas are relatively common after shock-wave lithotripsy, but high-grade kidney injuries are extremely rare. We present the first case of a high-grade kidney injury after shock-wave lithotripsy managed conservatively. A 57-year-old white female patient with left 1.5cm superior ureteral calculi was submitted to shock-wave lithotripsy.

Urinary incontinence following surgery for BPH: the role of aging on the incidence of bladder dysfunction

PURPOSE: The reported incidence of urinary incontinence (UI) due to bladder dysfunction following surgery of BPH is variable. We described the causes of incontinence in a large group of men that developed this unsual complication and analyzed the influence of age on the prevalence of bladder dysfunction. MATERIALS AND METHODS: We wvaluated a total of 125 patients with urinary incontinence following surgical treatment for BPH : Transurethral resection of the prostate (81men) and open prostatectomy (44 men). A third group of 21 patients with incontinence following radical prostatectomy was used for comparison. All patients underwent urodynamic analysis. Urethral Sphincter Insufficiency (USI)was defined as involuntary loss of urine induced by Valsalva maneuver in the absence of a detrusor contraction. Bladder dysfunction was defined as detrusor overactivity and/or decreased compliance. RESULTS: Urethral sphincter insufficiency was the most common etiology of urinary incontinence in the three groups of patients. However, bladder dysfunction was observed in 59.3 percent, 56.8 percent and 57.1 percent of patients who underwent transurethral resection, open prostatectomy and radical prostatectomy, respectively. Median patient age was 69 and 75 years for patients with and without bladder dysfunction, respectively. A logistic regression model for the presence of bladder dysfunction showed that age was a statistically significant predictor. CONCLUSIONS: Urethral Sphincter insufficiency is the main cause of incontinence following surgery for BPH. Bladder dysfunction may be the isolated cause of incontinence in approximately 25 percent of patients. The chances of bladder dysfunction rises 5.3 percent for each year added to patient age. Patients older than 70 years have twice the probablility of post procedural incontinence.

Learning curve for radical retropubic prostatectomy

PURPOSE: The learning curve is a period in which the surgical procedure is performed with difficulty and slowness, leading to a higher risk of complications and reduced effectiveness due the surgeon's inexperience. We sought to analyze the residents' learning curve for open radical prostatectomy (RP) in a training program. MATERIALS AND METHODS: We conducted a prospective study from June 2006 to January 2008 in the academic environment of the University of São Paulo. Five residents operated on 184 patients during a four-month rotation in the urologic oncology division, mentored by the same physician assistants. We performed sequential analyses according to the number of surgeries, as follows: = 10, 11 to 19, 20 to 28, and = 29. RESULTS: The residents performed an average of 37 RP each. The average psa was 9.3 ng/mL and clinical stage T1c in 71 percent of the patients. The pathological stage was pT2 (73 percent), pT3 (23 percent), pT4 (4 percent), and 46 percent of the patients had a Gleason score 7 or higher. In all surgeries, the average operative time and estimated blood loss was 140 minutes and 488 mL. Overall, 7.2 percent of patients required blood transfusion, and 23 percent had positive surgical margins. CONCLUSION: During the initial RP learning curve, we found a significant reduction in the operative time; blood transfusion during the procedures and positive surgical margin rate were stable in our series.

Fatores determinantes para a escolha da especialidade médica no Brasil / Defining factors for choosing medical specialty in Brazil

Fundamento. A escolha da especialidade médica é complexa e multifatorial. A importância dos diferentes fatores varia mundialmente e está associada a diferentes valores e sistemas de educação. O objetivo do estudo é identificar os fatores que determinam essa escolha no Brasil. Métodos. Um questionário foi enviado, via internet (eletronic mail), para graduandos dos seis anos do curso de medicina, solicitando informações demográficas e a avaliação de fatores que influenciam na escolha da especialidade médica. Resultados. A idade média foi de 22 anos. Quanto à influência de familiares, 42,5% dos alunos têm pelo menos um médico como parente próximo, sendo as especialidades mais comuns desse parente: Pediatria, Ginecologia e Obstetrícia e Oftalmologia. A quantidade de respondentes que declararam certeza da carreira a ser seguida ao entrar na faculdade foi 19%, enquanto essa certeza foi de 22,2% na ocasião da pesquisa. Afinidade pela especialidade e estilo de vida foram fatores avaliados como importantes ou muito importantes por mais de 95% dos respondentes. Urgência em ganhar dinheiro rápido, tempo curto de residência, alto rendimento inicial e influência familiar foram os fatores avaliados como menos importantes pelos respondentes na escolha de sua especialidade. Quase metade dos respondentes (49,7%) descartaram uma especialidade que cogitaram fortemente, as principais razões para isso foram ter descoberto não ter afinidade pela especialidade pela qualidade de vida. Conclusões. Afinidade e estilo de vida são os fatores determinantes da escolha e da rejeição de especialidade médica em nosso meio.

Background. Choosing medical specialty is complex and depends on multiple factors. The importance of the different factors varies across the world, according to different values and systems of education. The purpose of this study is to identify the determining factors involved in this choice among medical students in Brazil. Methods. A questionnaire was sent by email to medical students from first to sixth year of a selected institution, asking demographic information and the evaluation of factors that may influence the choice of the medical specialty. Results. The mean age was 22 years. Regarding the influence of relatives, 42.5% of the students has at least one physician as a close relative, the most common specialties of this relative were: Pediatrics, Gynecology and Obstetrics and Ophthalmology. 19% of the respondents declared being sure of the career when they entered University, while 22.2% of them were sure about the choice at the occasion of the study. Affinity for the specialty and lifestyle were evaluated as important or very important by more than 95% of respondents. Urge to earn money fast, short time of medical residency, high initial profit and family influence were the factors evaluated as less important by the respondents. Almost half of the respondents (49.7%) rejected a specialty they had strongly cogitated once. The main reasons for this were the lifestyle and the fact that they discovered not having affinity for the specialty. Conclusions. Affinity and medical lifestyle are the defining factors in choosing and rejecting a medical specialty in Brazil.

Experience with different botulinum toxins for the treatment of refractory neurogenic detrusor overactivity

Purpose: To report our experience with the use of the botulinum toxin-A (BoNT/A) formulations Botox® and Prosigne® in the treatment of neurogenic detrusor overactivity (NDO). Materials and methods: At a single institution, 45 consecutive patients with refractory urinary incontinence due to NDO received a single intradetrusor (excluding the trigone) treatment with botulinum toxin type A 200 or 300 units. Botox was used for the first 22 patients, and Prosigne for the subsequent 23 patients. Evaluations at baseline and week 12 included assessment of continence and urodynamics. Safety evaluations included monitoring of vital signs, hematuria during the procedure, hospital stay, and spontaneous adverse event reports. Results: A total of 42 patients were evaluated (74 percent male; mean age, 34.8 years). Significant improvements from baseline in maximum cystometric capacity (MCC), maximum detrusor pressure during bladder contraction, and compliance were observed in both groups (P < 0.05). Improvement in MCC was significantly greater with Botox versus Prosigne (+103.3 percent vs. +42.2 percent; P = 0.019). Continence was achieved by week 12 in 16 Botox recipients (76.2 percent) and 10 Prosigne recipients (47.6 percent; P = 0.057). No severe adverse events were observed. Mild adverse events included 2 cases of transient hematuria on the first postoperative day (no specific treatment required), and 3 cases of afebrile urinary tract infection. Conclusions: Botox and Prosigne produce distinct effects in patients with NDO, with a greater increase in MCC with Botox. Further evaluation will be required to assess differences between these formulations.

Urinary glycosaminoglycans excretion and the effect of dimethyl sulfoxide in an experimental model of non-bacterial cystitis

PURPOSE: We reproduced a non-bacterial experimental model to assess bladder inflammation and urinary glycosaminoglycans (GAG) excretion and examined the effect of dimethyl sulfoxide (DMSO). MATERIALS AND METHODS: Female rats were instilled with either protamine sulfate (PS groups) or sterile saline (control groups). At different days after the procedure, 24 h urine and bladder samples were obtained. Urinary levels of hyaluronic acid (HA) and sulfated glycosaminoglycans (S-GAG) were determined. Also to evaluate the effect of DMSO animals were instilled with either 50 percent DMSO or saline 6 hours after PS instillation. To evaluate the effect of DMSO in healthy bladders, rats were instilled with 50 percent DMSO and controls with saline. RESULTS: In the PS groups, bladder inflammation was observed, with polymorphonuclear cells during the first days and lymphomononuclear in the last days. HA and S-GAG had 2 peaks of urinary excretion, at the 1st and 7th day after PS injection. DMSO significantly reduced bladder inflammation. In contrast, in healthy bladders, DMSO produced mild inflammation and an increase in urinary HA levels after 1 and 7 days and an increase of S-GAG level in 7 days. Animals instilled with PS and treated with DMSO had significantly reduced levels of urinary HA only at the 1st day. Urinary S-GAG/Cr levels were similar in all groups. CONCLUSIONS: Increased urinary levels of GAG were associated with bladder inflammation in a PS-induced cystitis model. DMSO significantly reduced the inflammatory process after urothelial injury. Conversely, this drug provoked mild inflammation in normal mucosa. DMSO treatment was shown to influence urinary HA excretion.

Prolonged irritative voiding symptoms due to Enterobius vermicularis bladder infestation in an adult patient

Enterobius vermicularis (pinworm) is one of the most prevalent intestinal parasites in the world. The urinary tract is rarely affected and few cases have been reported. We report a case of bladder infestation by mature female worms of E. vermicularis in a woman presenting with irritative voiding symptoms.

Is the ability to perform transurethral resection of the prostate influenced by the surgeon's previous experience?

PURPOSE: To evaluate the influence of the urologist's experience on the surgical results and complications of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Sixty-seven patients undergoing transurethral resection of the prostate without the use of a video camera were randomly allocated into three groups according to the urologist's experience: a urologist having done 25 transurethral resections of the prostate (Group I - 24 patients); a urologist having done 50 transurethral resections of the prostate (Group II - 24 patients); a senior urologist with vast transurethral resection of the prostate experience (Group III - 19 patients). The following were recorded: the weight of resected tissue, the duration of the resection procedure, the volume of irrigation used, the amount of irrigation absorbed and the hemoglobin and sodium levels in the serum during the procedure. RESULTS: There were no differences between the groups in the amount of irrigation fluid used per operation, the amount of irrigation fluid absorbed or hematocrit and hemoglobin variation during the procedure. The weight of resected tissue per minute was approximately four times higher in group III than in groups I and II. The mean absorbed irrigation fluid was similar between the groups, with no statistical difference between them (p=0.24). Four patients (6 percent) presented with TUR syndrome, without a significant difference between the groups. CONCLUSION: The senior urologist was capable of resecting four times more tissue per time unit than the more inexperienced surgeons. Therefore, a surgeon's experience may be important to reduce the risk of secondary TURP due to recurring adenomas or adenomas that were incompletely resected. However, the incidence of complications was the same between the three groups.

Pudendal somatosensory evoked potentials in normal women

OBJECTIVE: Somatosensory evoked potential (SSEP) is an electrophysiological test used to evaluate sensory innervations in peripheral and central neuropathies. Pudendal SSEP has been studied in dysfunctions related to the lower urinary tract and pelvic floor. Although some authors have already described technical details pertaining to the method, the standardization and the influence of physiological variables in normative values have not yet been established, especially for women. The aim of the study was to describe normal values of the pudendal SSEP and to compare technical details with those described by other authors. MATERIALS AND METHODS: The clitoral sensory threshold and pudendal SSEP latency was accomplished in 38 normal volunteers. The results obtained from stimulation performed on each side of the clitoris were compared to ages, body mass index (BMI) and number of pregnancies. RESULTS: The values of clitoral sensory threshold and P1 latency with clitoral left stimulation were respectively, 3.64 ± 1.01 mA and 37.68 ± 2.60 ms. Results obtained with clitoral right stimulation were 3.84 ± 1.53 mA and 37.42 ± 3.12 ms, respectively. There were no correlations between clitoral sensory threshold and P1 latency with age, BMI or height of the volunteers. A significant difference was found in P1 latency between nulliparous women and volunteers who had been previously submitted to cesarean section. CONCLUSIONS: The SSEP latency represents an accessible and reproducible method to investigate the afferent pathways from the genitourinary tract. These results could be used as normative values in studies involving genitourinary neuropathies in order to better clarify voiding and sexual dysfunctions in females.

Pudendal nerve latency time in normal women via intravaginal stimulation

INTRODUCTION & OBJECTIVES: Studies of motor conduction for the efferent functional assessment of the pudendal nerve in women with pelvic dysfunctions have been conducted through researching distal motor latency times. The transrectal approach has been the classic approach for this electrophysiological examination. The objective of the present study is to verify the viability of the transvaginal approach in performing the exam, to establish normal values for this method and to analyze the influence of age, stature and parity in the latency value of normal women. MATERIALS AND METHODS: A total of 23 volunteers without genitourinary pathologies participated in this study. In each, pudendal motor latency was investigated through the transvaginal approach, which was chosen due to patientÆs higher tolerance levels. RESULTS: The motor response represented by registering the M-wave was obtained in all volunteers on the right side (100 percent) and in 13 volunteers on the left side (56.5 percent). The mean motor latency obtained in the right and left was respectively: 1.99 ± 0.41 and 1.92 ± 0.48 milliseconds (ms). There was no difference between the sides (p = 0.66). Latency did not correlate with age, stature or obstetric history. The results obtained in the present study were in agreement with those found by other researchers using the transrectal approach. CONCLUSION: The vaginal approach represents an alternative for pudendal nerve distal motor latency time, with similar results to those achieved through the transrectal approach. Normative values obtained herein might serve as a comparative basis for subsequent physiopathological studies.

Magnetic resonance imaging urodynamics: technique development and preliminary results

OBJECTIVES: In this preliminary study we report the development of the video urodynamic technique using magnetic resonance imaging (MRI). MATERIALS AND METHODS: We studied 6 women with genuine stress urinary incontinence, diagnosed by history and physical examination. Urodynamic examination was performed on multichannel equipment with the patient in the supine position. Coughing and Valsalva maneuvers were performed at volumes of 150, 250 and 350 mL. Simultaneously, MRI was carried out by using 1.5 T GE Signa CV/i high-speed scanner with real time fluoroscopic imaging possibilities. Fluoroscopic imaging was accomplished in the corresponding planes with T2-weighted single shot fast spin echo sequences at a speed of about 1 frame per second. Both studies were recorded and synchronized, resulting in a single video urodynamic examination. RESULTS: Dynamic MRI with cine-loop reconstruction of 1 image per second demonstrated the movement of all compartment of the relaxed pelvis during straining with the concomitant registration of abdominal and intravesical pressures. In 5 patients, urinary leakage was demonstrated during straining and the Valsalva leak point pressure (VLPP) was determined as the vesical pressure at leak subtracted from baseline bladder pressure. Mean VLPP was 72.6 cm H2O (ranging from 43 to 122 cm H2O). CONCLUSIONS: The concept of MRI video urodynamics is feasible. In a clinical perspective, practical aspects represent a barrier to daily use and it should be recommended for research purposes.

Assessment of urodynamic bladder behavior on filling with solutions representing physiological extremes of urinary osmolarity

OBJECTIVE: Verify if there is any difference in sensitive and motor bladder response in the presence of solutions with different osmolarities, simulating physiological extremes of urinary osmolarity. MATERIALS AND METHODS: Thirty-three patients (24 men and 9 women) with mean age of 46.4 years (8 to 87 years) took part in this study. They were all subjected to 2 consecutive urodynamic examinations. In each exam, the vesical filling was accomplished by using a hyperosmolar (1000 mOsm/L) or hypo-osmolar (100 mOsm/L) sodium chloride solution in similar speed. The sequence in which each solution was instilled was determined by a double blind draw. The urodynamic results obtained from the infusion of both solutions were compared, regardless the sequence of administration. RESULTS: Fifteen patients (45.4 percent) showed detrusor hyperactivity, 12 of whom with neurological antecedents. The mean age of those with detrusor hyperactivity was 45.8 years, against 46.9 for those without hyperactivity. The infusion of the hyperosmolar/hypo-osmolar solution generated the following results, when comparing patients without vs. with detrusor hyperactivity: initial sensation of vesical filling (mL): 167.5 / 159.2 vs. 134.9 / 157.3 (p > 0.05); volume of occurrence of the first involuntary bladder contraction (mL): 163.9 / 151.9 (p > 0.05); detrusor micturition pressure (cm H2O): 24.0 / 24.4 vs. 13.8 / 27.5 (p > 0.05). CONCLUSION: The vesical filling with solutions simulating extreme urinary osmolarities, accomplished with similar speed and without previous identification, did not likewise alter the sensitive and motor urodynamic behavior in the current study.