Diagnostic accuracy of uroflowmetry parameters to predict infravesical obstruction / Exactitud diagnóstica de los parámetros de la flujometría para predecir la obstrucción infravesical

Objective: to evaluate the performance statistics of average flow (Qave), voiding time (Vtime), and time to maximum flow (TQmax), in addition to maximum flow (Qmax), for diagnosis of infravesical obstruction. Methods: we reviewed urodynamic studies performed in men > 40 years. Obstruction was considered a grade 3-6 in the Schäfer nomogram. Sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and the receiver operator characteristic (ROC) curve were calculated for the different components of free uroflowmetry. Results: we analyzed 432 studies. Patients with obstruction had lower values of Qmax and Qave, and higher values of Vtime and TQmax. Considering different thresholds, Qmax had sensitivity, specificity, LR + and LR- values of 12-83%, 50-97%, 1.7-4.46 and 0.32-0.9, respectively; Qave had sensitivity, specificity, LR + and LR- values of 65-95%, 21-66%, 1.22-1.94 and 0.19-0.53, respectively; Vtime had sensitivity, specificity, LR + and LR- values of 49-85%, 26-67%, 1.15-1.54, and 0.57-0.74, respectively; TQmax had a sensitivity, specificity, LR + and LR- of 36-81%, 22-72%, 1.04-1.33 and 0.85-0.87, respectively. The areas under the ROC curves for Qmax, Qave, Vtime and TQmax were 0.75 (95% CI = 0.71-0.79, p < 0.001), 0.71 (95% CI = 0.66-0.75, p < 0.001), 0.62 (95% CI = 0.57-0.67, p < 0.001) and 0.55 (95% CI = 0.5-0.6, p = 0.03), respectively. Conclusions: Qave, Vtime, and TQmax showed a statistically significant discriminatory capacity to predict infravesical obstruction, and therefore they have clinical value as a complement to the information provided by Qmax.

Objetivo: evaluar las estadísticas de desempeño del flujo promedio (Qave), el tiempo de evacuación (Vtime) y el tiempo hasta el flujo máximo (TQmax), además del flujo máximo (Qmax), para el diagnóstico de obstrucción infravesical. Métodos: revisamos urodinamias realizadas en hombres > 40 años. La obstrucción se consideró un grado 3-6 en el nomograma de Schäfer. Se calcularon la sensibilidad, la especificidad, la razón de verosimilitud positiva (LR +), la razón de verosimilitud negativa (LR-) y la curva característica operativa del receptor (ROC) para los diferentes componentes de la flujometría libre. Resultados: analizamos 443 estudios. Los pacientes con obstrucción tenían valores más bajos de Qmax y Qave, y valores más altos de Vtime y TQmax. Considerando diferentes umbrales, el Qmax tuvo valores de sensibilidad, especificidad, LR + y LR- de 12-83%, 50-97%, 1.7-4.46 y 0.32-0.9, respectivamente; Qave tuvo valores de sensibilidad, especificidad, LR + y LR- de 65-95%, 21-66%, 1.22-1.94 y 0.19-0.53, respectivamente; Vtime tuvo valores de sensibilidad, especificidad, LR + y LR- de 49-85%, 26-67%, 1.15-1.54 y 0.57-0.74, respectivamente; TQmax tuvo una sensibilidad, especificidad, LR + y LR- de 36-81%, 22-72%, 1.04-1.33 y 0.85-0.87, respectivamente. Las áreas bajo las curvas ROC para Qmax, Qave, Vtime y TQmax fueron 0,75 (95% CI = 0.71-0.79, p < 0,001), 0.71 (95% CI = 0.66-0.75, p < 0,001), 0.62 (95% CI = 0.57-0.67, p < 0,001) y 0.55 (95% CI = 0.5-0.6, p = 0.03), respectivamente. Conclusiones: Qave, Vtime y TQmax mostraron una capacidad discriminatoria estadísticamente significativa para predecir la obstrucción infravesical, por lo que tienen valor clínico como complemento de la información proporcionada por el Qmax.

Disfunción urinaria en la enfermedad de Parkinson: una revisión práctica / Urinary dysfunction in Parkinson's disease: a practical review

Resumen La enfermedad de Parkinson (EP) es una enfermedad multisistémica de naturaleza neurodegenerativa, que clínicamente se caracteriza por presencia de síntomas motores como bradicinesia, rigidez, temblor en reposo e inestabilidad postural. Sin embargo, también pueden estar presentes síntomas no motores que constituyen trastornos del ánimo, trastornos del sueño, disfunción cognitiva o disfunción autonómica. Dentro de las disfunciones autonómicas, los síntomas urinarios se han documentado en los pacientes con enfermedad de Parkinson. Los síntomas urinarios más comunes son la nicturia, urgencia urinaria, aumento de la frecuencia miccional e incontinencia de urgencia. El presente artículo hace una revisión narrativa de la literatura actual sobre los mecanismos fisiopatológicos, manifestaciones clínicas, diagnóstico y tratamiento de la disfunción urinaria en pacientes con enfermedad de Parkinson.

Parkinson's disease (PD) is a neurodegenerative multisystemic diseases, which is clinically characterized by the presence of motor symptoms such as bradykinesia, rigidity, resting tremor, and postural instability. However, non-motor symptoms constituting mood disorders, sleep disorders, cognitive dysfunction, or autonomic dysfunction may also be present. Within autonomic dysfunctions, urinary symptoms have been documented in patients with Parkinson's disease. The most common urinary symptoms are nocturia, urinary urgency, increased urinary frequency, and urge incontinence. This article makes a narrative review of the current literature on the pathophysiological mechanisms, clinical manifestations, diagnosis and treatment of urinary dysfunction in patients with Parkinson's disease.

Disfunción miccional en el adulto. Un artículo docente / Voiding dysfunction in the adult. A teaching article

Voiding dysfunction is defined as an abnormally slow and/or incomplete micturition, and can be divided in bladder outlet obstruction (BOO) and detrusor underactivity (or hypocontractility). BOO is characterized by reduced urine flow rate and increased detrusor pressure, and can be of anatomical or functional origin. Detrusor underactivity encompasses a reduced urine flow rate associated to low pressure and/or poorly sustained detrusor contraction, and its etiology is multifactorial. Lower urinary tract symptoms are classified as storage, voiding and post micturition symptoms, may be objectively quantified with specific questionnaires, and don't correlate properly with voiding dysfunction. Patients' evaluation requires a directed physical examination of the abdomen, pelvis and genitals focused to detect anatomical and neurological abnormalities. Voiding dysfunction can be demonstrated non-invasively using uroflowmetry and pelvic ultrasound. Uroflowmetry allows determining urinary flow characteristics and their most important parameters are voided volume, maximum flow rate and shape of the curve. Pelvic ultrasound permits to estimate prostatic size and post void residual, suspect detrusor hypertrophy (due to BOO) and detect bladder stones. Invasive test must be reserved for special cases of confirmed voiding dysfunction: cystoscopy when there is concomitant hematuria, urethrocystography to study urethral stenosis and urodynamics to differentiate BOO from detrusor underactivity. (AU)

Voiding symptoms obtained by open versus directed anamnesis as predictors of voiding dysfunction in women

ABSTRACT Objectives To determine the differences between voiding symptoms obtained by open anamnesis (VS-Open) versus voiding symptoms obtained by directed anamnesis (VS-Directed) to predict voiding dysfunction in women. Materials and Methods Retrospective study of women with prior anti-incontinence surgery evaluated during 5 years. In a standardized clinical history taking, each patient was asked to answer question number five of the UDI-6 questionnaire ("Do you experience any difficulty emptying your bladder?"). If the answer was positive, the following voiding symptoms spontaneously described by the patient were documented: slow urine stream, straining to void, intermittent stream and feeling of incomplete bladder emptying, which were considered VS-Open. If the answer to this question was negative or if the patient had not reported the four voiding symptoms, she was asked in a directed manner about the presence of each o Ninety-one women are analyzed. Eighteen patients presented voiding dysfunction (19.8%), There was a statistical association between voiding dysfunction and the presence of any VS-Open (p = 0.037) and straining to void obtained by open anamnesis (p = 0.013). Sensitivity, specificity, PPV, NPV, positive likelihood ratio and negative likelihood ratio, respectively, were 44.4% and 27.8%, 80.8% and 94.5%, 36.3% and 55.6%, 85.5% and 84.1%, 2.324 and 5.129, and 0.686 and 0.764. There was no statistical association between voiding dysfunction and VS-Directed. Conclusions VS-Open may predict better voiding dysfunction than VS-Directed in women.

Translation and Linguistic Validation of the Korean Version of the Dysfunctional Voiding Symptom Score

Although studies on pediatric dysfunctional voiding are increasing, there have not been enough efforts to validate the Dysfunctional Voiding Symptom Score (DVSS) questionnaire. Therefore, we aimed to translate and validate the DVSS into Korean. The DVSS questionnaire was validated between January and October, 2013. Two bilinguals independently translated the English version of the DVSS questionnaire into Korean, and then reconciled the forward translation of the Korean version. The original DVSS was back-translated into English, then assessed for equivalence to the original. Cognitive debriefing interviews with 5 patients to test the interpretation of the translation were made, then modified and distributed to 48 patients for re-evaluation. A statistical analysis of inter-scale correlation, and test re-test consistency was performed with the Cronbach's alpha coefficient. The changes from patient interviews were reflected in the final version. In an intra-class correlation, the Cronbach's alpha was high in all of the questions (0.97, P < 0.001). Test re-test Cronbach's alpha analysis of reproducibility was higher than 0.8 for all of the 10 questions (P < 0.001). Translation and linguistic validation of Korean version of the DVSS questionnaire was completed by a proper process, with high reliability and validity.

Diagnóstico de enfermagem Eliminação urinária prejudicada em pessoas com Diabetes Mellitus / Nursing diagnosis "Altered urinary elimination" in persons with Diabetes Mellitus / Diagnóstico de enfermería "Eliminación urinaria alterada" en personas con Diabetes Mellitus

Estudo exploratório descritivo com o objetivo de descrever os diagnósticos de enfermagem em pessoas com diabetes mellitus que apresentaram diagnóstico de enfermagem Eliminação urinária prejudicada. Os dados foram obtidos através do exame físico e a técnica de entrevista dirigida. Após a coleta de dados, procedeu-se a identificação dos diagnósticos de enfermagem nomeados de acordo com a Taxonomia II da NANDA, utilizando o processo de raciocínio diagnóstico de Risner. Das 31 pessoas entrevistadas, identificou-se 10 (32 por cento) sujeitos que apresentaram o diagnóstico de enfermagem eliminação urinária prejudicada. Conhecer os fatores relacionados e as caracteristicas definidoras desse diagnóstico possibilita que o enfermeiro trace intervenções de enfermagem que preservem a função renal, e consequentemente a nefropatia diabética.

This is a exploratory descriptive study, to identify and describe the nursing diagnoses in people with diabetes mellitus and nursing diagnosis Urinary elimination altered. Data were collected by the researcher using the technique of physical examination and interview addressed. After collecting data, it is the identification of the nursing diagnoses appointed according to the NANDA Taxonomy II, using Risner's reasoning diagnostic process. Interviews of 31 persons, it was 10 (32 percent) subjects who had the nursing diagnosis of impaired urinary elimination. Know the related factors and defining characteristics of this diagnosis allows the nurse trace of nursing interventions to preserve renal function, and hence to diabetic nephropathy.

Estudio de tipo exploratorio para identificar y describir los diagnósticos de enfermería en personas con diabetes mellitus y Eliminación urinaria alterada. Los datos fueron recolectados por el investigador mediante la técnica de entrevista y examen físico requerido. Después de recoger los datos, es la identificación de los diagnósticos de enfermería designado de acuerdo con la taxonomía NANDA II, mediante el proceso del razonamiento diagnóstico de Risner. Fue entrevistados 31 personas, fue identificado de 10 (32 por ciento) los sujetos que tenían el diagnóstico de enfermería de perjudicar la eliminación urinaria. Conozca los factores relacionados con la definición y características de este diagnóstico permite localizar a la enfermera de intervenciones de enfermería para preservar la función renal y, por ende, a la nefropatía diabética.

Equivalência conceitual, de itens e semântica da versão brasileira do instrumento Dysfunctional Voiding Scoring System (DVSS) para avaliação de disfunção do trato urinário inferior em crianças / Conceptual, item, and semantic equivalence of the Brazilian version of the Dysfunctional Voiding Scoring System (DVSS) instrument for evaluating lower urinary tract dysfunction in children

Investiga-se a equivalência conceitual, de itens e semântica entre o instrumento Dysfunctional Voiding Scoring System (DVSS), utilizado para avaliar a disfunção funcional do trato urinário inferior em crianças, concebido em inglês e uma versão em português. Na primeira etapa realizou-se a avaliação da equivalência conceitual e de itens, seguida de duas traduções do instrumento original para o português. Na segunda etapa foram realizadas 63 entrevistas, com crianças de 3 a 10 anos e responsáveis, e modificação de itens segundo dificuldades de interpretação. Na terceira etapa foi realizada a retradução do instrumento em português para o inglês e avaliação da equivalência semântica. Na quarta etapa, a versão pré-teste foi aplicada em vinte duplas de crianças de 3 a 10 anos e responsáveis. Apresenta-se o instrumento em português com equivalência conceitual, de itens e semântica. Sugere-se que a aplicação do DVSS seja realizada por meio de entrevista por profissional treinado e não baseada em autopreenchimento como proposto no instrumento original.

This article investigates the conceptual, item, and semantic equivalence between the Dysfunctional Voiding Scoring System (DVSS) originally developed in English and a Portuguese-language version for use in Brazil. The instrument is used to evaluate lower urinary tract dysfunction in children. The first stage evaluated the conceptual and item equivalence, followed by two independent translations of the original instrument into Portuguese. In the second stage, 63 individuals were interviewed and items were modified according to difficulties in interpretation. In the third stage, the Portuguese instrument was back-translated into English, and the semantic equivalence was evaluated, based on referential and general (connotative) meaning. In the fourth stage, the pre-test version of the instrument was applied to 20 individuals from the target population. The Portuguese version of the instrument is presented with conceptual, item, and semantic equivalence. Nevertheless, unlike the original instrument, DVSS information collection was more adequate for the Brazilian population when performed through interviews as compared to self-applied questionnaires.

Men's Lower Urinary Tract Symptoms Are Also Mental and Physical Sufferings for Their Spouses

Lower urinary tract symptoms (LUTS) in men may have an adverse effect on spouse health-related quality of life (HRQL), and these effects are probably influenced by cultural and perceptional differences. This study was conducted to explore the impact of LUTS in Korean men on their spousal HRQL in relation to symptom severities and other demographic parameters. A total of 130 spouses, whose husbands had a nocturia, frequency of greater than once per night, who shared a bed with their husbands, and accompanied husbands at consultation, were subsequently enrolled and asked to complete a structured questionnaire. Almost all spouses (98%) suffered one or more inconveniences that affected HRQL to some degree. Sleep disturbance was rated to be most inconvenient. The sleep disturbances were significantly correlated with nocturia frequency and husband co-morbidity. Husband's LUTS caused partners to feel fatigued (62%), embarrassed (79%), concerned about the possibilities of cancer (69%) and surgery (81%), sexual life deteriorated (58%), and dissatisfied, unhappy, or terrible (36%). Spouse's perception on HRQL was found to be well correlated with husband's quality of life. Men with LUTS need to understand that their LUTS is also mental and physical sufferings for their spouses.

Avaliação de um sistema especialista em diagnóstico de enfermagem relacionados à eliminação urinária / Evaluación de un sistema especialista en diagnósticos de enfermeria relacionados a la eliminiación urinária / Evaluation of an expert system on nursing diagnoses related to urinary elimination

Foi desenvolvido e avaliado um sistema especialista em diagnósticos de enfermagem relacionados à eliminação urinária, segundo a taxionomia da NANDA. Para coleta de dados utilizou-se um roteiro e um checklist com as características definidoras. Os diagnósticos obtidos por consenso entre três especialistas foram considerados padrão-ouro. Foram testados 197 casos. O Sistema mostrou ser adequado para a determinação dos diagnósticos 'incontinência urinária (IU) por pressão', 'IU por impulso', 'retenção urinária ' e 'IU total', com sensibilidade e especificidade superiores a 98 por cento. A pequena casuística não possibilitou avaliar a acurácia em relação à 'eliminação urinária prejudicada', 'IU reflexa' e 'IU funcional'. Esta experiência de desenvolvimento e avaliação poderá ser aplicada na criação de outros sistemas especialistas.

An expert system on nursing diagnoses related to urinary elimination, according NANDA's taxonomy, was developed and evaluated. Data were collected using a form and a checklist of defining characteristics. The obtained consensus diagnoses by three specialists were considered gold standard. 197 cases were tested. The system proved to be adequate for determining diagnoses such as 'stress urinary incontinence', 'urge urinary incontinence', 'urinary retention' and 'total urinary incontinence' with sensitivity and specificity above 98 percent. The accuracy evaluation in relation to 'impaired urinary elimination', 'reflex urinary incontinence' and 'functional urinary incontinence' was not possible to be established due to the small size of the sample. The experience in developing and evaluating this program can be applied in creating other expert systems.

Fue desarrollado y avaluado un sistema especialista en diagnósticos relacionados a la eliminación urinaria, usando la taxonomia de NANDA. Para colectar los datos fue utilizado un programa de entrevista y un checklist conteniendo las características definidoras. Los diagnósticos obtenidos por concordancia de tres especialistas fueron considerados como prototipo-oro. Fueran testados 197 casos. El sistema desarrollado, mostró ser adecuado en la determinación de los diagnósticos 'incontinencia urinaria por presión', 'incontinencia urinaria por impulso', 'retención urinaria' e 'incontinencia urinaria total' con sensibilidad y especificidad superior a 98 por ciento. Debido a pequeña casuística, no fue posible avaluar los diagnósticos 'eliminación urinaria perjudicada', 'incontinencia urinaria refleja' e 'incontinencia urinaria funcional'. Esta experiencia de desenvolvimiento e avaluación podrá ser aplicada en la creación de otros sistemas.

Diagnóstico e manejo das disfunções miccionais em crianças sem anormalidades neurológicas ou / Diagnostic and management of mictional dysfunctions in children without neurological or anatomical abnormalities

As disfunções miccionais incluem a enurese, a urgência miccional, alterações funcionais do detrusor. Existem fatores comportamentais afetando o treinamento no uso de banheiro e há também inibição da maturação do controle urinário normal. O objetivo deste trabalho foi revisar o manejo terapêutico de disfunções urinárias em crianças sem desordens neurológicas e sem compromentimento anatômico. Revisou-se literatura médica atual, enfatizando metanálises, estudos randomizados e controlados, documentos da biblioteca mdigital Cochrene. Entre os tratamentos encontram-se medidas dietéticas, registro das micções, "biofeedback", urofluxometria, eletromiografia, medicamentos, entre outros. Existem poucos estudos controlados, além de dificuldades metodológicas. Os resultados são muito próximos entre si quando comparados, sendo que alguns autores questionam a existência de evidências científicas para estes tratamentos.

A História do estudo urodinâmico / The Urodynamic studies history

O estudo urodinâmico é definido pela Sociedade Internacional de Continência como a avaliação morfológica, fisiológica, bioquímica e hidrodinâmica do trasmporte urinário. São vários os parâmetros avaliados durante a fase de enchimento ou esvaziamento vesical. O estudo é indispensável para o diagnóstico das disfunções vesicais, pois muitas vezes os sintomas urinários são similares, mesmo quando as etiologias são diferentes. Este artigo revê a história do estudo urodinâmico, cujo primeiro registro de medida da pressão vesical ocorreu de forma acidental, em 1882. Ao longo dos anos, observamos uma tendência à padronização da terminologia do trato urinário inferior, e dos parâmetros do estudo urodinâmico. Os equipamentos também evoluíram e atualmente a videourodinâmica e a urodinâmica ambulatorial são instrumentos importantes no estabelecimento de diagnósticos mais precisos.

Síndrome de mala eliminación / Dysfunctional elimination syndrome

El Síndrome de Mala Eliminación (SME) comprende la alteración en la evacuación a nivel intestinal y urinario, en distintos grados y formas de presentación clínica. Diversos estudios muestran el origen de esta patología en una alteración a nivel de la musculatura del piso pelviano. El objetivo de esta revisión es entregarle al pediatra una visión general de este concepto, usa cada vez más utilizado en la literatura internacional, destacando la importancia de la sospecha clínica, diagnóstico y manejo precoz. Los resultados de estudios internacionales avalan la necesidad del tratamiento conjunto de la afección urinaria y gastrointestinal, para lograr mayor porcentaje de mejoría. El enfoque conjunto de la incontinencia y la constipación, más la amplia gama de situaciones clínicas que cada uno de ellos conlleva, es el objetivo que persigue introducir este nuevo síndrome.

A Comparative Study of Patient Experiences of Conventional Fluoroscopic and Four-Hour Ambulatory Urodynamic Studies

We assessed several emotional variables in patients experiencing conventional urodynamic and ambulatory urodynamic monitoring (AUM) to verify the hypothesis that AUM is tolerated as well as conventional urodynamics. A total of 33 women and 7 men from 23 to 72 years of age who were undergoing both procedures were prospectively included in this study. Prior to and immediately after the procedures, each patient completed a self-administered questionnaire. Answers were given on a visual analogue scale. The degree of anxiety was higher for conventional urodynamics than for AUM (p = 0.045), while the degree of boredom experienced during AUM was higher than that during conventional urodynamics (p= 0.013). There was no significant difference in the degree of shame or bother experienced by the patients during the two procedures. In general, patients tolerated both examinations extremely well. The examiner-rated degree of intolerance during conventional urodynamics was influenced by the subjective pain score (p=0.001), while all other emotional variables except bother were not significantly related with the degree of intolerance during AUM (p=0.007). A total of 74.4% and 84.6% responded that they were willing to repeat conventional urodynamics and AUM, respectively, which were not significantly different. Although AUM produced a significantly higher level of boredom than conventional urodynamics, our data demonstrates that patients are as tolerant of AUM as they are of conventional urodynamic procedures.

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.

Preoperative diagnosis of urinary bladder involvement in adenocarcinoma of colon and rectum.

OBJECTIVE: Objective of the study was to compare urinary symptoms, urinalysis, computed tomography, intravenous pyelography, ultrasonography between colorectal adenocarcinoma with urinary bladder involvement and without urinary bladder involvement. MATERIAL AND METHOD: Patients with adenocarcinoma of the colon and rectum who had the first operation between January 1999 and October 2004 were included in the present study. All patients were divided into the bladder adhesion group and nonadhesion group. Sex, sites of tumor, urinary symptoms and preoperative investigations were compared. RESULTS: 453 patients were included in the present study with 264 males and 189 females (sex ratio M:F = 1.4:1). 26 cases (5.7%) had bladder adhesion. Males had more chance of having bladder involvement. Sigmoid and rectum were the most common sites of bladder adhesion. All cases with urinary symptoms had bladder involvement. Urinalysis and computed tomography had a sensitivity of 59% and 61%, respectively. All cases whose computed tomography showed bladder involvement had bladder adhesion during surgery. Cystoscopy had a sensitivity of 75%. Ultrasonography and IVP did not help in detection of bladder invasion. CONCLUSION: History of urinary symptoms, urinalysis, computed tomography should be routinely performed in patients with adenocarcinoma of the sigmoid and rectum to detect urinary bladder involvement and to inform modes of urinary tract diversion to patients before surgery.

Voiding dysfunction and urodynamic abnormalities in elderly patients

Disfunções do trato urinário inferior são uma causa importante de morbidade e diminuição da qualidade de vida em homens e mulheres idosos. Com o envelhecimento progressivo da população, é importante compreender os distúrbios miccionais mais comuns nesta população. A maioria dos problemas miccionais em homens idosos tem origem multifatorial, requerendo uma avaliação ampla dos órgãos do trato urinário inferior, da capacidade funcional e neurológica dos pacientes e dos problemas clínicos coexistentes. A avaliação urodinâmica é uma ferramenta importante na investigação de pacientes idosos com sintomas do trato urinário inferior. Ela não é necessária em todos os casos e só deve ser indicada após a exclusão de problemas não urológicos e potencialmente reversíveis que poderiam causar ou contribuir para os sintomas miccionais. Embora os exames urodinâmicos possam revelar diagnósticos comuns como obstrução vesical ou incontinência urinária de esforço, na população idosa é freqüente a ocorrência de achados como hiperatividade detrusora e falência da contratilidade vesical, com implicações prognósticas e terapêuticas importantes. O objetivo deste artigo é descrever os problemas urológicos mais comuns nos idosos e discutir as indicações e características dos exames urodinâmicos nestas condições.

Disúria e polaciúria: sintomas realmente sugestivos de infecção do trato urinário? / Dysuria and polaciuria: really a suggestive symptom of urinary tract infection?

Infecção do trato urinário (ITU) é considerada uma das infecções mais comuns na população, sendo responsável por significativa morbidade no sexo feminino. Na rotina dos consultórios médicos ambulatoriais, o tratamento das ITU não complicadas em mulheres adultas é iniciado com base na anamnese, já que a maioria das ITU é acompanhada por sintomas como disúria e polaciúria. O presente estudo visou determinar a correlação entre os sintomas clássicos de ITU e o diagnóstico efetivo desta patologia, caracterizado pela urocultura positiva, atravé de um inquérito epidemiológico realizado com mulheres com idade entre 15 a 55 anos. Das 191 mulheres avaliadas, 56 (29%) apresentaram sintomas sugestivos de ITU. Das 16 mulheres que apresentaram disúria, 2 (12,5%)tiveram o diagnóstico de ITU confirmnado. A presença de disúria e polaciúria ocorreu em 27 mulheres sendo que 5 (18,5%) destas apresentavam realmente ITU. Os coeficientes de correlação entre disúria, polaciúria e a soma destes sintoma com o resultado da cultura foram inferiores a 0,5, demonstrando que não ocorreu correlação significativa entre estas variáveis. Este estudo sugere que a anamnese não deve ser utilizada como critério único para diagnóstico das ITU e que este deve ser confirmado sempre que possível com exames laboratoriais.