ABSTRACT
INTRODUCCIÓN: El objetivo del trabajo fue comparar la evolución de pacientes varones con detrusor hipoactivo (DU) neurógeno (DUN) frente a DU no neurógeno (DUNoN) y establecer factores de riesgo para predecir la necesidad de cateterismo limpio intermitente (CLI) en el seguimiento. MATERIAL Y MÉTODOS: Estudio longitudinal, descriptivo, sobre una cohorte de pacientes con diagnóstico de DU. Se revisaron 2.496 estudios urodinámicos (2008-2018). Se incluyeron pacientes con DU (ICS2002 y/o Bladder contraction index [< 100]) sin tratamiento. Se excluyeron pacientes en CLI o tratamiento intervencionista. Se realizó seguimiento semestralmente con flujometría. Se indicó CLI ante residuos elevados (RPM) > 200 mL o eficiencia de vaciado (EV) < 50%. Se comparó la necesidad de CLI durante el seguimiento o la aparición de complicaciones (infecciones urinarias [ITU], litiasis vesical). RESULTADOS: Se encontraron 172 (6,89%) varones con DU. En 106 (61,6%) se evidenció causa neurológica. Finalmente se incluyeron 62 pacientes con seguimiento medio de 4,9 años (+/-2,6). De ellos, 33 (53%) fueron DUN y 29 (47%) DUNoN. No se apreciaron diferencias en la aparición de ITU (p = 0,34) o litiasis vesicales (p = 0,39). Seis pacientes con DUN precisaron CLI frente a ninguno con DUNoN (p = 0,04). Los pacientes que requirieron CLI presentaron mayor RPM [p = 0,009]) y menor EV [p = 0,017]). También se apreciaron diferencias en el tiempo hasta la necesidad de CLI (log rank: 0,009), siendo este de 15,1 meses (4-38). En el análisis multivariante ninguna de las variables pudo demostrarse como factor predictivo de necesidad de CLI. CONCLUSIONES: La causa más frecuente de DU es la lesión neurológica. Los pacientes con DUN permanecen estables sin necesidad de CLI. No hemos detectado factores de riesgo que identifiquen a los pacientes en riesgo de necesitar CLI
INTRODUCTION: The objective of the study was to compare the evolution of male patients with neurogenic detrusor underactivity (NDU) versus non-neurogenic DU (NNDU) and to establish risk factors to predict the need for clean intermittent catheterization (CIC) during the follow-up period. MATERIAL AND METHODS: Longitudinal, descriptive study of a cohort of patients diagnosed with DU, and 2,496 urodynamic studies (2008-2018) were reviewed. Patients with DU (ICS 2002 and/or Bladder contraction index (< 100)) without treatment were included. Patients with CIC or interventional treatment were excluded. Follow-up included flowmetry every six months. CIC was indicated in cases of high residual volume (PVR) > 200 mL or voiding efficiency (VE) < 50%. The need for CIC during follow-up or the appearance of complications (urinary tract infections (UTI), bladder lithiasis) were compared. RESULTS: DU was found in 172 (6.89%) men. Neurological causes were observed in 106 (61,6%) cases. Finally, 62 patients were included with a mean follow-up of 4.9 years (+/- 2.6). Of these patients, 33 (53%) presented NDU and 29 (47%) NNDU. Six patients with NDU needed CIC versus none with NNDU (p = 0.04). Patients requiring CIC had higher PVR (p = 0.009) and lower VE (p = 0.017)), and there were also differences in terms of time until the need for CIC (log Rank: 0.009), which was 15.1 months [4-38]. In the multivariate analysis, none of the variables showed to be predictive of the need for CIC. CONCLUSIONS: The most common cause of DU is neurologic injury. Patients with NDU remain stable without requiring CIC. We have not detected any risk factors that identify patients at risk of needing CIC
Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Urinary Bladder, Underactive/therapy , Intermittent Urethral Catheterization/methods , Follow-Up Studies , Risk Factors , Urinary Bladder, Underactive/etiology , Recurrence , Urodynamics , Multivariate AnalysisABSTRACT
INTRODUCTION: The objective of the study was to compare the evolution of male patients with neurogenic detrusor underactivity (NDU) versus non-neurogenic DU (NNDU) and to establish risk factors to predict the need for clean intermittent catheterization (CIC) during the follow-up period. MATERIAL AND METHODS: Longitudinal, descriptive study of a cohort of patients diagnosed with DU, and 2,496 urodynamic studies (2008-2018) were reviewed. Patients with DU (ICS 2002 and/or Bladder contraction index (< 100)) without treatment were included. Patients with CIC or interventional treatment were excluded. Follow-up included flowmetry every six months. CIC was indicated in cases of high residual volume (PVR) > 200 mL or voiding efficiency (VE)<50%. The need for CIC during follow-up or the appearance of complications (urinary tract infections (UTI), bladder lithiasis) were compared. RESULTS: DU was found in 172 (6.89%) men. Neurological causes were observed in 106 (61,6%) cases. Finally, 62 patients were included with a mean follow-up of 4.9 years (+/- 2.6). Of these patients, 33 (53%) presented NDU and 29 (47%) NNDU. Six patients with NDU needed CIC versus none with NNDU (p = 0.04). Patients requiring CIC had higher PVR (p = 0.009) and lower VE (p = 0.017)), and there were also differences in terms of time until the need for CIC (log Rank: 0.009), which was 15.1 months [4-38]. In the multivariate analysis, none of the variables showed to be predictive of the need for CIC. CONCLUSIONS: The most common cause of DU is neurologic injury. Patients with NDU remain stable without requiring CIC. We have not detected any risk factors that identify patients at risk of needing CIC.
Subject(s)
Conservative Treatment , Intermittent Urethral Catheterization , Urinary Bladder, Neurogenic/therapy , Urinary Bladder, Underactive/therapy , Adult , Aged , Follow-Up Studies , Humans , Intermittent Urethral Catheterization/statistics & numerical data , Longitudinal Studies , Male , Middle Aged , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Despite the significant clinical benefits of beta-blockers in heart failure with reduced ejection fraction (HFrEF), prescription for and adherence to these agents is reported to be poor. There are few data on the use and tolerance of beta-blocker therapy in patients with HFrEF in South Africa and it is unknown whether these patients would benefit from further heart rate-lowering therapy. METHODS: Data from all patients with HFrEF attending the heart failure clinic of Charlotte Maxeke Johannesburg Academic Hospital from January 2000 to December 2014 were retrospectively collected. We first determined the rates of beta-blocker intolerance in this population and then categorised the patients according to their most recent dose of beta-blocker (low, moderate or target dose) in order to identify factors associated with beta-blocker intolerance. Lastly, we used the data to identify patients who would be suitable for further treatment with heart rate-lowering therapy. RESULTS: Five hundred patients, with a median follow up of 58.7 months, were identified during the study period. Black South Africans constituted the majority (66.4%) and most patients had HFrEF due to hypertension (32.8%). At the last recorded clinic visit at the end of the study period, 489 patients (97.8%) were taking a beta-blocker with 59.8% prescribed a beta-blocker at target dose. Consistent with previous data, bradycardia was the commonest cause for failing to reach target beta-blocker dose. Only 61 (12%) patients were on no (n = 11) or low (n = 50) dose of beta-blocker at final clinic visit. As per current guidelines, only 10.6% (n = 53) of this cohort of patients would qualify for further treatment with heart rate-lowering therapy. CONCLUSIONS: In a dedicated heart failure clinic in South Africa, beta-blockers were well-tolerated in the treatment of HFrEF. The potential role of specific heart rate-lowering therapy in patients treated adequately with heart failure medication and proper up-titration of beta-blockers is relatively small.
