Are uroflowmetry and post - void residual urine tests necessary in children with primary nocturnal enuresis?

ABSTRACT Objectives: To examine the benefits of repetitive uroflowmetry and post void residual urine (PVR) tests in children with primary nocturnal enuresis (PNE). Material and methods: Children aged ≥6 years with PNE who visited our clinics for management of enuresis were included for study. Patients were requested to complete a questionnaire including baseline characteristics and Dysfunctional Voiding Symptom Score (DVSS), 2-day bladder diary, and Rome III criteria for constipation. Two uroflowmetry and PVR tests were requested. Children with congenital or neurogenic genitourinary tract disorders were excluded. All children underwent urotherapy and desmopressin combined with anticholinergics or laxatives if indicated. The definition of abnormal flow patterns (≥1 abnormal), elevated PVR (≥1 abnormal), small maximal voided volume (MVV), nocturnal polyuria (NP) and response to treatment complied with the ICCS standardization document. Kaplan-Meier survival analysis and Cox proportional-hazards regression tests were used to evaluate the predictors of response. Results: In total, 100 children aged 8.5±2.3 years were enrolled for study (M: F=66:34) with 7.3±7.4 months of follow-up. Poor correlation was observed between DVSS/small MVV and PVR (p>0.05). Univariate analysis revealed that elevated PVR is associated with significantly less hazard of complete response to medical treatment (HR: 0.52, p=0.03), while not significantly associated with abnormal flow patterns, NP, constipation or small MVV. Multivariate analysis revealed that only elevated PVR (HR 0.30, 95% CI 0.12-0.80) and NP (HR 2.8, 95% CI 1.10-7.28) were significant predictors for complete response. Conclusions: In managing pediatric enuresis, elevated PVR is a significant predictor for lower chance of complete response to treatment whether they had high DVSS or not.

An unusual presentation of urethral duplication presenting with chronic bladder retention, left scrotal transposition and left renal agenesis

ABSTRACT Introduction and objective Urethral duplication is a rare congenital anomaly, with roughly 200 cases reported in the literature (1). It is more frequent in males, with few cases reported in females. The clinical presentation differs according to the anatomical variant present. The duplication most commonly occurs in the sagittal plane with one urethra located ventrally and the other dorsally (2). Usually the ventral urethra is the more functional of both. Duplications occurring in the coronal plane are quite rare and they are usually associated with bladder duplication (3). The purpose of this paper was to present a video of a boy with an unusual urethral duplication form. Materials and Methods Patient was born premature due to oligohydramnios at 7 months-gestational age and he has initial diagnosis of hypospadia. Since then, he presented at least 7 febrile UTI and mother complained of difficult micturition and a presence of a mass at lower abdomen. Patient was referred to our institution and we identified urethral duplication with a glandar and scrotal meatus, palpable bladder and left penile-hemiscrotum transposition. US and CT-scan showed left kidney agenesis and overdistended bladder. VCUG and retrograde urethrography showed duplication, presence of contrast in the seminal vesicles and complete catheterizing of both urethras was not possible. Results The topic urethra was dysplastic and not patent to a 4Fr plastic tube so we were unable to access it endoscopically. We performed initially a Mitrofanoff procedure to allow CIC and treat chronic retention. Six months later, we assessed both urethras surgically and concluded that dorsal urethra was dysplastic after 3cm still in the penile area and scrotal urethra was not possible to be catheterized. We excised the ventral urethra because of dribbling complaints up to bulbar area and reconstructed the scrotal transposition, keeping the topic urethra for cosmetic issues. Patient had excellent outcome, performs CIC every 4 hours and has not presented further UTI episodes. Discussion and conclusion The urethral duplication is an anomaly that has multiple anatomical presentations. There are several theories about the etiology, but none can explain all types of presentations. There is also more than one rating available, and the Effmann classification is the most detailed. The case exemplifies this varied spectrum of anatomic urethral duplication. It resembles the urethral duplication type IIa-Y, however, ventral urethra meatus was located in penoscrotal area and both urethras were at least partially hypoplastic/dysplastic associated with obstruction and bladder retention. In determining how to best manage a patient with Y-type urethral duplication, the caliber and quality of the orthotopic urethra must first be assessed. Published reports suggest that best outcomes are those using the ventral duplicated urethra for the reconstruction (4). In this case, none of urethras were functional and a supravesical outlet channel had to be provided. The treatment of this condition requires an individualized planning and a vast technical knowledge of reconstructive surgery.

Embolização seletiva das artérias prostáticas no tratamento da hiperplasia protática benigna / Selective arterial prostatic embolization to treat benign prostatic hyperplasia

Hiperplasia prostática benigna (HPB) é considerada a neoplasia masculina mais comum, além de ser a principal causa de sintomas do trato urinário baixo (STUB) em homens idosos. Se não tratada ou mal tratada, poderá levar o paciente a quadro de retenção urinária aguda, incontinência e infecção do trato urinário, progredindo em gravidade com a idade. Apesar do desenvolvimento de técnicas alternativas, a ressecção transuretral da próstata (RTU) continua sendo considerada o tratamento cirúrgico padrão ouro para HPB. Não obstante, a RTU pode estar associada a muitas comorbidades como, sangramento, sintomas urinários irritativos, disfunção sexual e ejaculação retrógrada. Por essa razão, o desenvolvimento de modalidades de tratamentos minimamente invasivos para o tratamento de HPB constitui um campo interessante de pesquisa clínica. Os objetivos deste estudo foram: (1) avaliar a viabilidade, a segurança e a eficácia da embolização das artérias prostáticas (EAP) nos pacientes com retenção urinária devido à HPB, (2) avaliar a porcentagem de redução volumétrica da próstata e a qualidade de vida após a EAP nos pacientes com retenção urinária devido à HPB. No presente estudo, Fase I prospective centro único, 11 pacientes portadores de retenção urinária devido à HPB foram tratados por meio da EAP entre agosto de 2009 e novembro de 2011. Exame físico, questionários de sintomas e qualidade de vida (International Prostate Symptom Score (IPSS) e Quality of Life (QoL)), dosagem do antígeno prostático específico (PSA), exames de imagens de ultrassom (US) e ressonância magnética (RM), e estudos urodinâmicos foram realizados antes e 1, 3, 6, e 12 meses depois da EAP. O tamanho da próstata variou de 30 a 90 gramas, e as embolizações foram realizadas com microesferas (Embospheres) de 300-500?m. O sucesso técnico (EAP bilateral) foi atingido em 75%, e o sucesso clínico (retirada do cateter vesical de demora e melhora dos sintomas) foi obtido em 91% (10 de 11 pacientes) dos casos...

Benign prostatic hyperplasia (BPH) is considered the most common neoplasm in men and is the main cause of lower urinary tract symptoms (LUTS) in the aging male. If left untreated or not effectively treated, can lead to acute urinary retention, incontinence, and urinary tract infections, progressing in severity with age. Despite the development of alternative techniques, transurethral resection of the prostate (TURP) is still considered the gold standard surgical treatment for BPH. However, TURP procedures can be associated with substantial morbidities such as bleeding, irritative urinary symptoms, erectile dysfunction and ejaculatory disorders. For this reason, the development of minimally invasive modalities for treatment of BPH has constituted an interesting field of research. The study objectives were: (1) to evaluate the feasibility, safety and efficacy of the prostatic artery embolization (PAE) in patients with urinary retention due to BPH, (2) to evaluate the percentage of reduction in prostate volume and quality of life after PAE in patients with urinary retention due to BPH. In the present study, a single-center prospective phase I study, 11 patients with urinary retention due to BPH were treated by PAE between August 2009 and November 2011. Physical examination, International Prostate Symptom Score (IPSS) and Quality of Life (QoL), prostate specific antigen (PSA) measurement, ultrasound (US) and magnetic resonance imaging (MRI), and urodynamic tests were performed at baseline, 1, 3, 6 and 12 months after PAE. Prostate size ranged from 30 to 90g, and embolizations were performed with 300- 500-?m Embosphere microspheres. Technical success (ie, bilateral PAE) was obtained in 75%, and clinical success (ie, catheter removal and symptom improvement) was obtained in 91% (10 of 11patients) of the cases. Postembolization syndrome manifested as mild pain in the perineum, retropúbica area, and/ or urethra. No major complications were observed. At the first year...

Efectividad de las cirugías para incontinencia urinaria de esfuerzo a 18-24 meses de su realización en pacientes atendidas en el Hospital Militar Escuela Doctor Alejandro Dávila Bolaños ADB en el período julio-diciembre 2009 / Effectiveness of surgery for stress urinary incontinence at 18-24 months of its implementation in patients treated at the Military Training Hospital Doctor Alejandro Dávila Bolaños ADB in the period July-December 2009

Se realizó un estudio descriptivo, de corte transversal, con el objetivo de determinar la Efectividad de la Cirugía de Burch y Colocación de cinta vaginal libre de tensión a 18-24 meses. La muestra estuvo constituida por 26 pacientes: 11 pacientes con Cirugía de Burch (42%) y 15 pacientes con Colocación de Cinta Vaginal libre de tensión (58%). Las pacientes con Cirugía de Burch y Colocación de Cinta Vaginal libre de tensión son predominantemente mujeres con edad entre 35 – 50 años (80% y 53%, respectivamente), y con antecedente de 1-3 partos (72% y 60%, respectivamente). Las pacientes con Cirugía de Burch no tienen comorbilidades asociadas (100%), mientras que las pacientes con Colocación de Cinta Vaginal libre de tensión son obesas en un 40%. Las pacientes con Cirugía de Burch presentaban cistocele en un 18% y rectocele en un 18 % previo a la cirugía. La efectividad de la Cirugía de Burch es comparable con la efectividad de la Colocación de Cinta Vaginal libre de tensión a 18-24 meses de su realización para tratamiento de Incontinencia Urinaria de Esfuerzo tanto por sus tasas de continencia subjetiva (82 % y 80%, respectivamente) como por sus tasas de continencia objetiva (91 % y 87 %, respectivamente). La Incontinencia de Urgencia es el tipo de incontinencia que complica a las pacientes que se les realizó Cirugía de Burch y/o Colocación de Cinta Vaginal libre de tensión, con frecuencia de presentación similares (9 % y 13 %, respectivamente). La Cirugía de Burch parece ser una técnica más segura para tratar la Incontinencia Urinaria de Esfuerzo por su menor tasa de complicaciones en comparación con la Colocación de Cinta Vaginal libre de tensión (18 % vrs. 40 %). La Colocación de Cinta Vaginal libre de tensión no es tratamiento del cistocele, resolviendo sólo en el 60 % de los casos...

Retención urinaria en el niño: ¿un motivo de alarma? / Uretic retention in a child: is it a reason of alarm?

En nuestra práctica médica diaria hemos encontrado pacientes de edad pediátrica con retención urinaria en los que no se ha seguido un algoritmo adecuado para su estudio; exponemos brevemente estos dos casos a consideración para evidenciar la importancia de una atención inmediata en niños con esta sintomatología.

In our daily medical practice we have found patients of pediatric age with uretic retention with whom there has not been followed a suitable algorithm to its study; we expound briefly these two cases to consideration to evidence the importance on inmediate attention of children with this symptomatology.

Intermittent bladder urinary retention in a young woman: an unusual presentation of partial urethral duplication

A singular case of female accessory urethra associated to a mobile bladder stone with an unusual clinical presentation is reported. The role of perineal ultrasound is emphasized as a useful diagnostic tool to study female urethra in a static and dynamic setting, including cases of partial or complete urethral duplication.

Formação de cálculo uretral ao redor de um corpo estranho: relato de um caso / Formation of an urethral calculus around a foreign body: a case report

Os cálculos uretrais primários são raros no ocidente. O seu desenvolvimento freqüentemente está associado a alterações prévias do fluxo urinário, como divertículos uretrais, áreas de estenose ou corpos estranhos impactados. Os autores relatam um caso de um paciente de 77 anos de idade que se apresentou com queixa de retenção urinária aguda e dor na região genital. O diagnóstico de uretrolitíase foi feito e, mediante estudos radiográficos, um objeto estranho, cilindro de madeira, foi identificado no interior do cálculo.

Influência do controle hídrico na retençäo urinária aguda pós-operatória nas cirurgias anorretais / Fluid control influencing postoperative urinary retention after anorectal operations

Quarenta pacientes submetidos a cirurgia proctológica orificial foram estudados prospectivamente com objetivo de avaliar a influência da administraçäo de fluidos peri-operatórios sobre a incidência de retençäo urinária pós-operatória. Esta populaçäo foi randomizada em dois grupos: um grupo controle (n = 20) submetido a hidrataçäo usualmente utilizada pelo serviço de anestesia e outro experimental (n = 20) mantido com 1,25 ml/kg/h de fluidos. Foram incluidos apenas pacientes sem patologias associadas. A analgesia pós-operatória foi rigorosamente a mesma. Os grupos se equiparavam quanto a sexo, idade, patologia proctológica, tempo cirurgico e tipo de anestesia. Houve, entretanto, uma diminuiçäo significativa na taxa de retençäo urinária daqueles pacientes com controle hídrico (10 porcento) quando comparados com o grupo controle (40 porcento) (p<0,05)

Hiperplasia benigna da próstata: tratamento näo cirúrgico / Prostatic hypertrophy: non surgical treatment

Säo apresentadas e discutidas as alternativas näo cirúrgicas ao clássico e eficaz tratamento cirúrgico da Hiperplasia Benigna da Próstata, concluindo-se serem amplamente promissores os métodos alternativos de tratamento em estudo