[Is there a correlation between abdominal leak pressure point, incontinence severity and quality of life in patients with stress urinary incontinence?] / Existe una correlación entre punto de presión de pérdida abdominal, severidad de incontinencia y calidad de vida?

OBJECTIVES: To evaluate if there is a correlation between the abdominal leak pressure point (ALPP) of the urodynamic study and several tools to evaluate severity and quality of life associated to stress urine incontinence (SUI). METHODS: Prospective correlation study of women referred to urodynamic study for stress urinary incontinence in Centro Urológico Profesor Bengió between September 2014 and October 2015. Anamnesis, physical examination (where the SUI was demonstrated), ICIQSF urine incontinence questionnaire and incontinence impact questionnaire (IIQ-7) were performed to every patient. Uroflowmetry and complete urodynamic study were performed in all cases. Intrinsic sphincter deficiency (ISD) was defined as ALPP value ≤ 60 cm H2O. The relation between abdominal leak pressure point (ALPP) and incontinence severity measurements and quality of life (daily protectors, Sandvik score, ISIQ-SF score and short IIQ7 score) was evaluated with the Spearman coefficient correlation. RESULTS: 105 females were studied. Mean ALPP was 84 H2O cm (30-170). 21 and 84 patients had ALPP values lower and higher than 60 H2O cm respectively. There were no differences between the groups when general and demographic characteristics were evaluated. No correlation between ALPP and incontinence severity measurements was demonstrated: daily protectors (ρ 0.10; p NS), Sandvik severity score (ρ 0.05; p NS), ISIQ-SF score (ρ 0.0004; p NS) and IIQ7 Score (ρ 0.06; p NS). When patients with IED (ALPP ≤ 60 cm H2O) and those without IED DEI (ALPP > 60 cm H2O) were analyzed, there was no statistically significant difference between the groups in the comparison according to severity and quality of life questionnaires. CONCLUSIONS: In this series, there is not a significant correlation between abdominal leak pressure point and severity and quality of life measurements in patients with stress urinary incontinence.

[Comparison of the symptoms of overactive bladder in women with mixed urinary incontinence and idiopathic urge urinary incontinence.] / Comparación de los síntomas de vejiga hiperactiva en mujeres con incontinencia urinaria mixta e incontinencia urinaria de urgencia pura.

INTRODUCTION: Various authors argued that the voiding urgency component in mixed urinary incontinence (MUI) is different than urge urinary incontinence (UUI). In this last case they suggest that incontinence in MUI could be overdiagnosed in patients with SUI, misunderstanding the leak as UUI. OBJETIVES: To evaluate clinical and urodynamic characteristics of patients with MUI and pure UUI. METHODS: A retrospective study of our urodynamics database was performed evaluating 450 women with MUI and UUI. Patients with neurogenic bladder, fistulae, urethral diverticula, previous urogynecologic surgery, known infravesical obstruction, previous pelvic radiotherapy, urinary tract infection or psychiatric drugs intake. A full clinical history, physical exam, uroflowmetry, filling cystometry and pressure flow study were performed. RESULTS: There is no difference relative to age, menopause and number of births. The presence of nocturia was bigger in the UUI group (66.4% vs. 46.1%, p 0.0004) the same as increased voiding frequency (53.6% vs. 34.6%, p 0.0006). The presence of urethral hypermobility and SUI in the physical exam was greater than MUI, meanwhile the presence of reduced vaginal trophism was bigger in the UUI group. Differences in sensibility or specificity were not found. The presence of overactive detrusor was 56.4% in pure UUI vs. 33.2% in MUI (p<0.0001). No differences in pressure flow study were found. CONCLUSIONS: There is a significant difference in the clinical and urodynamic parameters between patients with MUI and pure UUI. The urgency in patients with pure UUI could be related to overactive detrusor. It is probable that many patients with MUI just have pure SUI which could lead to positive effects in the outcomes of anti-incontinence surgery.

OAB score: A clinical model that predicts the probability of presenting overactive detrusor in the urodynamic study

ABSTRACT Purpose To create a predictive model of involuntary detrusor contraction (IDC) to improve the diagnostic accuracy of overactive detrusor (OAD), associating overactive bladder (OAB) symptoms with other clinical parameters in the female population. Materials and Methods A total of 727 women were studied retrospectively. In all of them, urodynamic study was conducted for urogynecological causes. Demographics information, personal history, symptoms, physical exam, a 3-day frequency/volume chart and urinary culture, were collected in all patients and they subsequently underwent uroflowmetry and urodynamic studies. A logistic regression model was performed in order to determine independent predictors of presence of IDC. Odd ratio (OR) estimation was used to assign a score to each one of the significant variables (p≤0.05) in the logistic regression model. We performed a ROC curve in order to determine the predictive ability of the score in relation to the presence of OAD. Results presence of OAD was evident in 210 women (29%). In the logistic regression analysis, independent predictors of OAD were urgency, urgency incontinence, nocturia, absence of SUI symptoms, diabetes mellitus, reduction of vaginal trophism and bladder capacity below 150 mL. The probability of IDC diagnosis increases as the score raises (Score 0: 4% until Score ≥10: 88%). Sensitivity was 71% and specificity 72%. The area under the curve of OAB score was 0.784 (p>0.001). Conclusions OAB score is a clinical tool that shows higher diagnostic accuracy than OAB symptoms alone to predict overactive detrusor.

OAB score: a clinical model that predicts the probability of presenting overactive detrusor in the urodynamic study.

PURPOSE: To create a predictive model of involuntary detrusor contraction (IDC) to improve the diagnostic accuracy of overactive detrusor (OAD), associating overactive bladder (OAB) symptoms with other clinical parameters in the female population. MATERIALS AND METHODS: A total of 727 women were studied retrospectively. In all of them, urodynamic study was conducted for urogynecological causes. Demographics information, personal history, symptoms, physical exam, a 3-day frequency/volume chart and urinary culture, were collected in all patients and they subsequently underwent uroflowmetry and urodynamic studies. A logistic regression model was performed in order to determine independent predictors of presence of IDC. Odd ratio (OR) estimation was used to assign a score to each one of the significant variables (p≤0.05) in the logistic regression model. We performed a ROC curve in order to determine the predictive ability of the score in relation to the presence of OAD. RESULTS: presence of OAD was evident in 210 women (29%). In the logistic regression analysis, independent predictors of OAD were urgency, urgency incontinence, nocturia, absence of SUI symptoms, diabetes mellitus, reduction of vaginal trophism and bladder capacity below 150 mL. The probability of IDC diagnosis increases as the score raises (Score 0: 4% until Score ≥10: 88%). Sensitivity was 71% and specificity 72%. The area under the curve of OAB score was 0.784 (p>0.001). CONCLUSIONS: OAB score is a clinical tool that shows higher diagnostic accuracy than OAB symptoms alone to predict overactive detrusor.

Cirugía conservadora en los tumores renales / Conservative surgery in renal tumors

El incremento de la incidencia del cáncer renal en los últimos 15 años puede ser explicado, al menos parcialmente, por el empleo intensivo de los métodos de diagnóstico por imágenes de la patología abdominal. Como resultante de ello se ha registrado un importante aumento de diagnósticos incidentales de tumores pequeños, localizados y asintomáticos. Estas características colocaron progresivamente en un primer plano a las técnicas quirúrgicas orientadas a la preservación de arénquima o conservadoras. Las mismas habían estado reservadas para situaciones imperativas, en caso de tumores bilaterales o en riñones únicos, pero este abordaje comenzó a ampliar su indicación a pacientes con tumor renal unilateral y riñón contralateral sano. Muy tempranamente nos interesó esta concepción del tratamiento de tumores renales incidentales y nos propusimos introducirnos en la misma siguiendo dos líneas de trabajo. Por un lado comprobar si la enucleación tumoral, una de las técnicas de exéresis, permitía la extirpación completa del tumor sin dejar tejido neoplásico residual en el parénquima remanente. Esto se llevó a cabo por medio de la práctica de la enucleación de tumores de distinto tamaño en piezas de nefrectomía radical (ENUCLEACIÓN EX VIVO). Por otro parte, comprobar los resultados clínicos de la enucleación IN-VIVO de tumores de pequeño tamaño. La experiencia “ex – vivo” fue realizada sobre 43 especimenes, y nos permitió corroborar que los tumores de un diámetro menor a 4 cm podrían ser resecados tomando como plano de clivaje la pseudocápsula que los separa del parénquima renal,conjuntamente con una delgada lámina de tejido renal aparentemente sano que incrementaba las posibilidades de ausencia de cáncer residual. Cuando los tumores tuvieron un diámetro mayor a los 4 cm se pudo constatar histológicamente un 13% de compromiso del margen de resección quirúrgico.

Cirugía conservadora en los tumores renales / Conservative surgery in renal tumors

El incremento de la incidencia del cáncer renal en los últimos 15 años puede ser explicado, al menos parcialmente, por el empleo intensivo de los métodos de diagnóstico por imágenes de la patología abdominal. Como resultante de ello se ha registrado un importante aumento de diagnósticos incidentales de tumores pequeños, localizados y asintomáticos. Estas características colocaron progresivamente en un primer plano a las técnicas quirúrgicas orientadas a la preservación de arénquima o conservadoras. Las mismas habían estado reservadas para situaciones imperativas, en caso de tumores bilaterales o en riñones únicos, pero este abordaje comenzó a ampliar su indicación a pacientes con tumor renal unilateral y riñón contralateral sano. Muy tempranamente nos interesó esta concepción del tratamiento de tumores renales incidentales y nos propusimos introducirnos en la misma siguiendo dos líneas de trabajo. Por un lado comprobar si la enucleación tumoral, una de las técnicas de exéresis, permitía la extirpación completa del tumor sin dejar tejido neoplásico residual en el parénquima remanente. Esto se llevó a cabo por medio de la práctica de la enucleación de tumores de distinto tamaño en piezas de nefrectomía radical (ENUCLEACION EX VIVO). Por otro parte, comprobar los resultados clínicos de la enucleación IN-VIVO de tumores de pequeño tamaño. La experiencia ¶ex ¹ vivo÷ fue realizada sobre 43 especimenes, y nos permitió corroborar que los tumores de un diámetro menor a 4 cm podrían ser resecados tomando como plano de clivaje la pseudocápsula que los separa del parénquima renal,conjuntamente con una delgada lámina de tejido renal aparentemente sano que incrementaba las posibilidades de ausencia de cáncer residual. Cuando los tumores tuvieron un diámetro mayor a los 4 cm se pudo constatar histológicamente un 13% de compromiso del margen de resección quirúrgico.(AU)