Inyección de la toxina botulínica en el esfínter urinario: experiencia y resultados / The use of botulinum toxin in urinary sphincter: Experience and outcomes

Objetivo. Presentamos la experiencia de nuestro centro con la inyección de la toxina botulínica tipo A (TB) en el esfínter urinario de los pacientes con disfunción de vaciado. Material y método. Se inyectó TB en el esfínter urinario a 20 pacientes entre diciembre de 2003 y agosto de 2011 para el tratamiento de distintas disfunciones de vaciado refractarias a tratamiento convencional. Se utilizaron 4 vías de inyección: transuretral, parameatal en mujeres, transrectal en varones y transvaginal. Las dosis utilizadas oscilaron entre 50 y 200U. Resultados. Obtuvimos resultados satisfactorios en 11 pacientes (55%) según criterios clínicos. La duración del efecto osciló entre los 3 y 7 meses. No registramos complicaciones significativas relacionadas con la inyección, y la tolerancia al dolor fue buena. Conclusiones. La inyección de TB en el esfínter urinario es una técnica segura y eficaz para el tratamiento de diversos trastornos del tracto urinario inferior, pero sus resultados deben interpretarse cautelosamente, sobre todo en función de los parámetros utilizados para medir la eficacia (AU)

Objective. We present the experience of our center with the injection of type A botulinum toxin (BT) in urinary sphincter in patients with voiding dysfunction. Material and methods. BT was injected in the urinary sphincter of 20 patients between December 2003 and August 2011 in order to treat different voiding dysfunctions refractory to conventional treatment. Four injection methods were used: transurethral, paraurethral, transrectal and transvaginal. The doses used ranged from 50 to 200 units. Results. Satisfactory outcomes were obtained in 11 patients (55%) according to the clinical criteria. The effect lasted from 3 to 7 months. No major complications were registered and pain tolerance was good. Conclusions. The injection of BT in the urinary sphincter is safe and effective for the treatment of different lower urinary tract disorders, however its results should be interpreted with caution, above all based on the parameters used to measure the efficacy (AU)

Topical EMLA for pain control during extracorporeal shock wave lithotripsy: prospective, comparative, randomized, double-blind study.

Patient collaboration in external shock wave lithotripsy (ESWL) is critical for its correct application, making proper analgesic selection indispensable. The aim of this study was to evaluate the efficacy of combined application of EMLA and intravenous (i.v.) pethidine compared with pethidine plus placebo cream in patients undergoing ESWL for ureteral and/or renal lithiasis. Prospective, controlled, randomized, double-blind study was conducted in patients receiving ESWL for renal and/or ureterolithiasis. The patients were randomly assigned to receive i.v. pethidine plus either EMLA cream (group A) or placebo hydrating cream (group B). Evaluated were type, location, and size of lithiasis, patient's sex, age, body mass index, comorbidity, Visual Analogue Scale (VAS) score of pain, and degree of lithiasis fragmentation. EMLA cream provided significantly better pain relief and lithiasis fragmentation and more completed ESWL treatment. Topical application of EMLA cream combined with i.v. pethidine improved VAS scores and lithiasis fragmentation and decreased the rate of withdrawal from ESWL procedure versus i.v. pethidine plus placebo therapy.

Prognostic nomogram for disease-free survival in patients with renal adenocarcinoma.

OBJECTIVE: The aim of this study was to develop a postoperative prognostic nomogram for disease-free survival in patients with renal adenocarcinoma. MATERIALS AND METHODS: A total of 224 patients with organ-confined or locally advanced renal adenocarcinoma were treated with radical or partial nephrectomy. The variables included in the model were age, histological type, pathological stage, Fuhrman grade and DNA ploidy. Tumor recurrence was defined as any clinical evidence of recurrence. The probability of progression-free survival was calculated using the Kaplan-Meier estimate, and multivariate analysis was performed using a Cox regression. The nomogram was created using the data obtained from the Cox regression. RESULTS: Tumor recurrence was detected in 89 patients (39.74%). The median progression-free time in these patients was 9.55 months (range 0-133). Of these patients, 70.9% relapsed during the first 2 years, and only 15 patients (6.9%) were alive but ill at the end of the study. The probability of progression-free survival at 5 and 10 years was 66.64 and 61.97%, respectively. We performed a statistical validation of the model with accurate predictions that were discriminated with a confidence interval of 0.75 (comparing the predicted and actual probability). According to the nomogram obtained, patients with low-grade, diploid, organ-confined tumors would be candidates for follow-up not exceeding 5 years due to the low probability of recurrence (<40 points). CONCLUSION: The nomogram we developed is clinically relevant and can provide prognostic information for both patients and researchers. In addition, it can be used by researchers during the monitoring protocols that categorize patients based on their relative risk of disease progression.

Análisis del valor pronóstico de la trombosis tumoral venosa en el adenocarcinoma renal / Prognostic value of venous tumor thrombus in renal cell carcinoma

Objetivo: Analizar el valor pronóstico de la trombosis tumoral venosa en el carcinoma de células renales (CCR).Material y métodos: Estudio retrospectivo de 167 pacientes con carcinoma de células renales (estadio pT3) intervenidos mediante nefrectomía radical y linfadenectomía (julio de 1969 a mayo de 2008). Para el análisis se seleccionaron los pacientes con afectación venosa (73 pacientes; 43,7%). Para el análisis de supervivencia, se utilizaron las curvas de Kaplan-Meyer y el test de log-rank. El análisis multivariante se realizó mediante regresión de Cox. Resultados: En 30 pacientes (41,1%) existía afectación ganglionar, y en 9 pacientes (12,3%) enfermedad metastásica. El subtipo histológico más frecuente fue el carcinoma convencional en 50 pacientes (68,5%), seguido del indiferenciado en 11 pacientes (15,5%) y el cromófobo en 9 pacientes (12,3%). El 57% de los tumores fueron de alto grado (Furhman 3-4). El nivel de trombotumoral se extendía hasta la vena renal en 61 pacientes (83,6%), hasta la cava infradiafragmática en 9 pacientes (12,3%), y en 3 casos (4,1%) al atrio. El análisis de supervivencia mostró peor supervivencia en aquellos pacientes con trombosis tumoral venosa (p=0,001) y con invasión de la pared venosa (p=0,0042) pero no en función del nivel del trombo (p= 0,12). El análisis multivariante identificó el grado de Furhman y la trombosis tumoral venosa como factores pronósticos independientes de supervivencia. Conclusiones: En nuestra serie la trombosis tumoral venosa es un factor pronóstico independiente de supervivencia, junto al grado nuclear de Furhman. Ni el nivel de extensión cefálica del trombo ni la invasión de la pared venosa mostraron valor pronóstico independiente (AU)

Objective: To evaluate the prognostic value of venous tumor thrombus in renal cell carcinoma. Material and methods: A retrospective study of 167 patients with renal cell carcinoma and stage pT3 who underwent radical nephrectomy and extended lymphadenectomy from July 1969 to May 2008 was conducted. Patients with any kind of venous involvement were selected for the analysis (73 patients; 43.7%). The Kaplan Meier survival curves and log-rank test for comparisons were used for the survival analysis. Multivariate analysis was done by Coxregression. Results: Lymph node involvement was present in 30 patients (41.1%) and metastatic disease in9 patients (12.3%). The most frequent histologic renal cell carcinoma subtype was 50 (68.5%) conventional carcinoma, followed by non differentiated in 11 (15.5%), and chromophobe in9 (12.3%). High grade tumors (Furhman 3-4) were present in 57% of the cases. Venous thrombus level extended to renal vein in 61 patients (83.6%), to inferior vena cava in 9 patients (12.3%) and to the cardiac right atrium in 3 cases (4.1%). The survival analysis showed worse survival in those patients with venous tumor thrombosis (p=.001) and with vein wall invasion (p=0.0042), but not in function on the level of the thrombus (p=0.12). The multivariate analysis identified the Furhman grade and venous tumor thrombosis as independent survival prognostic factors. Conclusions: In our series, venous tumor thrombosis, together with the Furhman nuclear grade, is an independent survival prognostic factor. However, neither cephalic extension of the thrombusn or the invasion of the vein wall showed independent prognostic value (AU)

[Prognostic value of venous tumor thrombus in renal cell carcinoma]. / Análisis del valor pronóstico de la trombosis tumoral venosa en el adenocarcinoma renal.

OBJECTIVE: To evaluate the prognostic value of venous tumor thrombus in renal cell carcinoma. MATERIAL AND METHODS: A retrospective study of 167 patients with renal cell carcinoma and stage pT3 who underwent radical nephrectomy and extended lymphadenectomy from July 1969 to May 2008 was conducted. Patients with any kind of venous involvement were selected for the analysis (73 patients; 43.7%). The Kaplan Meier survival curves and log-rank test for comparisons were used for the survival analysis. Multivariate analysis was done by Cox regression. RESULTS: Lymph node involvement was present in 30 patients (41.1%) and metastatic disease in 9 patients (12.3%). The most frequent histologic renal cell carcinoma subtype was 50 (68.5%) conventional carcinoma, followed by nondifferentiated in 11 (15.5%), and chromophobe in 9 (12.3%). High grade tumors (Furhman 3-4) were present in 57% of the cases. Venous thrombus level extended to renal vein in 61 patients (83.6%), to inferior vena cava in 9 patients (12.3%) and to the cardiac right atrium in 3 cases (4.1%). The survival analysis showed worse survival in those patients with venous tumor thrombosis (p=.001) and with vein wall invasion (p=.0042), but not in function on the level of the thrombus (p=.12). The multivariate analysis identified the Furhman grade and venous tumor thrombosis as independent survival prognostic factors. CONCLUSIONS: In our series, venous tumor thrombosis, together with the Furhman nuclear grade, is an independent survival prognostic factor. However, neither cephalic extension of the thrombus nor the invasion of the vein wall showed independent prognostic value.

Causas, características y evolución a medio plazo de la retención aguda de orina en las mujeres remitidas a una Unidad de Urodinámica / Causes, Characteristics and Mid-Term Course of Acute Urinary Retention in Women Referred to a Urodynamics Unit

Objetivos: La retención aguda de orina (RAO) es poco frecuente en mujeres y puede relacionarse con distintas patologías. Sólo algunas pacientes son remitidas a una Unidad de Urodinámica para un estudio más exhaustivo. Se pretende describir las características y causas de RAO en las mujeres derivadas a nuestra unidad y analizar su evolución a medio plazo. Material y métodos: Estudio descriptivo retrospectivo (enero 1982- diciembre 2006) incluyendo las mujeres derivadas a la Unidad de Urodinámica tras sufrir una RAO. Se revisaron las historias clínicas con especial énfasis en antecedentes personales, exploración física, así como estudio urodinámico completo durante el episodio de RAO y una vez superado este. Resultados: Se incluyeron 202 mujeres, con una mediana de edad de 57 años (12- 87). Previamente 59 pacientes (28,7%) presentaban síntomas de vaciado. Los patrones urodinámicos que se encontraron fueron: 65 hipocontractilidad vesical (32,2%), 64 estudio normal (31,7%), 37 acontractilidad (18,3%), 21 obstrucción infravesical (10,4%) y 15 ausencia de relajación de suelo pélvico (7,4%). Las principales causas de RAO fueron: 53 neurológica (26,2%); 46 causa desconocida (22,8%); 19 ginecológica (9,4%); 22 diabetes mellitus (10,9%); y 16 urológica (7,9%). Deterioraron la función renal 14 mujeres (6,9%). Tras la RAO 106 mujeres (52,4%) necesitaron continuar con algún tipo de tratamiento. Conclusiones: En nuestra serie la RAO en mujeres suele ser consecuencia de una enfermedad neurológica o uroginecológica subyacente, aunque en un porcentaje importante de pacientes no se logra filiar la causa. La mitad de las pacientes se recuperaron totalmente y no precisaron ningún tipo de tratamiento (AU)

Objectives: Acute urinary retention (AUR) is uncommon in women and can be related to different conditions. Only some patients are referred to the urodynamics units for a more extensive study. We intend to describe the characteristics and causes of AUR in women referred to our unit and to analyze their middle term evolution. Material and Methods: We performed a descriptive retrospective study (January 1982-December 2006), including the women referred to our Uro-Neurology and Urodynamics Unit after suffering an AUR. Medical charts were reviewed with special emphasis on medical history, physical examination, and also complete urodynamics study during the AUR event and after its resolution. Results: A total of 202 women were included, median age of 57 years (12-87 years). Prior to the AUR, 59 women (28.7%) reported voiding symptoms. The urodynamics findings were: 65 (32.2%) detrusor hypocontractility; 64 (31.7%) normal study; 37 (18.3%) detrusor acontractility; 21 (10.4%) bladder outlet obstruction; 15 (7.4%) poor pelvic floor relaxation. The causes of the AUR were: 53 neurological (26.2%); 46 unknown (22.8%); 19 gynecological (9.4%); 22 diabetes mellitus (10.9%); 16 urological (7.9%). Renal insufficiency was observed in 14 patients (6.9%). After the AUR 106 women (52.4%) needed some kind of prolonged treatment. Conclusions: In our experience, AUR in the female is mainly related to underlying neurologic/urogynecologic disease, even though the etiology could not be known in a significant percentage of patients. Half of the patients recovered completely and did not require any treatment (AU)

[Causes, characteristics and mid-term course of acute urinary retention in women referred to a urodynamics unit]. / Causas, características y evolución a medio plazo de la retención aguda de orina en las mujeres remitidas a una Unidad de Urodinámica.

OBJECTIVES: Acute urinary retention (AUR) is uncommon in women and can be related to different conditions. Only some patients are referred to the urodynamics units for a more extensive study. We intend to describe the charcteristics and causes of AUR in women referred to our unit and to analyze their middle term evolution. MATERIAL AND METHODS: We performed a descriptive retrospective study (January 1982-December 2006), including the women referred to our Uro-Neurology and Urodynamics Unit after suffering an AUR. Medical charts were reviewed with special emphasis on medical history, physical examination, and also complete urodynamics study during the AUR event and after its resolution. RESULTS: A total of 202 women were included, median age of 57 years (12-87 years). Prior to the AUR, 59 women (28.7%) reported voiding symptoms. The urodynamics findings were: 65 (32.2%) detrusor hypocontractility; 64 (31.7%) normal study; 37 (18.3%) detrusor acontractility; 21 (10.4%) bladder outlet obstruction; 15 (7.4%) poor pelvic floor relaxation. The causes of the AUR were: 53 neurological (26.2%); 46 unknown (22.8%); 19 gynecological (9.4%); 22 diabetes mellitus (10.9%); 16 urological (7.9%). Renal insufficiency was observed in 14 patients (6.9%). After the AUR 106 women (52.4%) needed some kind of prolonged treatment. CONCLUSIONS: In our experience, AUR in the female is mainly related to underlying neurologic/urogynecologic disease, even though the etiology could not be known in a significant percentage of patients. Half of the patients recovered completely and did not require any treatment.

¿Debe emplearse de manera sistemática el cateterismo ureteral en los implantes renales? / Should ureteral catheterization be systematically used in kidney transplants?

Objetivo: evaluar si el uso sistemático de catéter ureteral doble J en las ureteroneocistostomías de los trasplantes renales reduce la tasa de complicaciones. Material y métodos: estudio prospectivo comparativo no aleatorizado de grupos paralelos, en194 trasplantes renales. Se establecieron dos grupos homogéneos: 111 pacientes con catéter doble J y otro de 83 pacientes sin catéter. Analizamos la incidencia de complicaciones entre ambos grupos, mediante análisis univariante comparativo (test de X2) y el análisis multivariante (regresión logística). Resultados: en el grupo con catéter las complicaciones globales aparecieron en el 22,2% frente al 43,3% del grupo sin catéter (p = 0,04). En función del reimplante ureteral aparecieron complicaciones en el 38,12% del reimplante tipo Paquin frente al 20,3% en Lich-Gregoir (p = 0,09). Enel grupo con catéter se evidenció una (0,9%) fístula urinaria frente a 5 (6%) del grupo sin catéter (p = 0,08), y 3 (2,7%) estenosis de la anastomosis ureterovesical en el grupo con catéter frente a 7 (8,4%) del grupo sin él (p = 0,13). El análisis multivariante demostró que la no utilización de catéter aumenta el riesgo de sufrir complicaciones relacionadas con el reimplante (OR 2,55;IC 95%: 1,37-4,75). El riesgo de fístula aumentó significativamente al no colocar catéter (OR:9,19; IC 95%: 1,01-84,7). No hubo diferencias entre ambos grupos en cuanto a las infecciones del tracto urinario, produciéndose tres (2,7%) en el grupo con catéter y una (1,2%) en el grupo sin catéter (p = 0,63). Conclusiones: la colocación de catéter doble J reduce las complicaciones relacionadas con el reimplante ureteral sin aumentar la morbilidad asociada a su uso (AU)

Objective: To assess if the systematic use of double J ureteral catheters in ureteroneocystostomies of kidney transplants reduces the rate of complications. Materials and methods: Non-randomized prospective, comparative study of parallel groups in194 kidney transplants. We established two equal groups, 111 patients with double J catheter and another of 83 catheter-free patients. We studied the incidence of complications between both groups by means of a univariate comparative study (X2 test) and a multivariate analysis(logistic regression). Results: In the catheter group, the overall complications appeared in 22.2% as opposed to43.3% of the catheter-free group (p = 0.04). Depending on the ureteral transplant, complications appeared in 38.12% of the Paquin type reimplantation as opposed to the 20.3% in Lich-Gregoir (p = 0.09). There was evidence of 1 (0.9%) urinary fistula in the catheter group as opposed to 5 (6%) in the catheter-free group (p = 0.08), and 3 (2.7%) ureterovesical anastomosis stricture in the group with catheter against 7 (8.4%) of the catheter-free group (p = 0.13). The multivariate analysis showed that not using the catheter increases the risk of suffering complications related to reimplantation (OR: 2.55; IC 95%, 1.37-4.75). The risk of fistula increased significantly when a catheter was not placed (OR 9.19, IC 95%, 1.01-84.7). There were no differences between the two groups as regards urinary tract infections; there were 3 (2.7%) in the catheter group and 1(1.2%) in the catheter-free group (p = 0,63). Conclusions: The placement of a double J catheter reduces complications related to ureteral reimplantation without increasing the morbidity associated with their use (AU)

[Should ureteral catheterization be systematically used in kidney transplants?]. / ¿Debe emplearse de manera sistemática el cateterismo ureteral en los implantes renales?

OBJECTIVE: To assess if the systematic use of double J ureteral catheters in ureteroneocystostomies of kidney transplants reduces the rate of complications. MATERIALS AND METHODS: Non-randomized prospective, comparative study of parallel groups in 194 kidney transplants. We established two equal groups, 111 patients with double J catheter and another of 83 catheter-free patients. We studied the incidence of complications between both groups by means of a univariate comparative study (X2 test)and a multivariate analysis (logistic regression). RESULTS: In the catheter group, the overall complications appeared in 22.2% as opposed to 43.3% of the catheter-free group (p=0.04). Depending on the ureteral transplant, complications appeared in 38.12% of the Paquin type reimplantation as opposed to the 20.3% in Lich-Gregoir (p=0.09). There was evidence of 1 (0.9%) urinary fistula in the catheter group as opposed to 5 (6%) in the catheter-free group (p=0.08), and 3 (2.7%) ureterovesical anastomosis stricture in the group with catheter against 7 (8.4%) of the catheter-free group (p=0.13). The multivariate analysis showed that not using the catheter increases the risk of suffering complications related to reimplantation (OR: 2.55; IC 95%, 1.37-4.75). The risk of fistula increased significantly when a catheter was not placed (OR 9.19, IC 95%, 1.01-84.7). There were no differences between the two groups as regards urinary tract infections; there were 3 (2.7%) in the catheter group and 1 (1.2%) in the catheter-free group (p=0,63). CONCLUSIONS: The placement of a double J catheter reduces complications related to ureteral reimplantation without increasing the morbidity associated with their use.

Alternativas a la vía transuretral para la inyección de toxina botulínica en esfínter urinario / Botulinum toxin inyection in urinary sphincter: alternative approaches

Objetivo: Presentamos las vías transrectal en varones y transvaginal en mujeres como alternativas a la vía transuretral para la inyección de toxina botulínica (TB) en esfínter urinario, así como nuestros resultados. Material y Método: Se inyectó TB en esfínter urinario a 9 pacientes entre diciembre de 2008 y agosto de 2010para el tratamiento de distintas disfunciones de vaciado refractarias a tratamiento convencional. La vía utilizada fue transrectal en 7 varones y transvaginal en 2 mujeres. Las dosis utilizadas oscilaron entre 50 y200 U. Registramos resultados y complicaciones. Resultados: Obtuvimos resultados satisfactorios en 6pacientes (66 por ciento) según criterios clínicos. La duración del efecto osciló entre los 3 y 7 meses. No registramos complicaciones significativas relacionadas con la inyección y la tolerancia al dolor fue buena. Conclusiones: La vía transrectal en varones y transvaginal en mujeres son alternativas válidas y seguras para la inyección de TB en esfínter urinario.

Objective: To present our institution experience and outcomes with transrectal and transvaginal injection of botulinum toxin (TB) in urinary sphincter to treat voiding disfunction. Material and methods: We injected TB in 9 patients since December 2008 to august 2010 in order to treat different voiding disfunctions. We use the transrectal approach in 7 men and the transvaginal method in 2 women. The dose used ranged from 50 to 200 units. Outcomes and complications were registered. Results: Satisfactory outcomes were obtained in 6 patients (66 pert cent) according to clinical criteria. The duration of the effect was from 3 to 7 months. No major complications were registered and pain was well tolerated. Conclusions: Transrectal and transvaginal approaches are effective and safe for the injection of TB in urinary sphincter.

Liposarcoma desdiferenciado de alto grado de cordón espermático. A propósito de un caso / High grade dedifferenciated liposarcoma. Case report and review of the literature

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[Nocturnal enuresis. A frequent problem with a difficult estimation of its prevalence]. / La enuresis nocturna. Un trastorno frecuente con una prevalencia difícil de estimar.

INTRODUCTION: Nocturnal enuresis is a disorder with a maintained historical interest. Not only the multifactorial etiopathology, also its prevalence. OBJECTIVE: We consider reviewing the literature for knowing the problematic in the calculation of the prevalence of this disease. MATERIAL AND METHOD: We searched in Pubmed database with Mesh terms: "Enuresis", "Nocturnal Enuresis", we added in the search box terms bedwetting and epidemiology or prevalence. We included manuscripts in English and Spanish with more than 1000 patients as sample, we also included review papers. We analyzed the methodology and the prevalence, when it was possible, we stratified results in age, sex and the frequency of wet nights. RESULTS: The analyzed study's methodology is heterogeneous. Therefore comparisons are difficult. Due to the difficulty within the interpretation of the overall frequency, the results are not interesting unless methodology, age range of the sample and diagnosis criteria are previously detailed. CONCLUSIONS: An own epidemiology study is necessary in order to solve our problematic.

La enuresis nocturna. Un trastorno frecuente con una prevalencia difícil de estimar / Nocturnal enuresis. A frequent problem with a difficult estimation of its prevalence

Introducción: La enuresis nocturna es un trastorno con un interés histórico mantenido, no solo en cuanto a su patogenia, probablemente multifactorial pero todavía hoy desconocida, sino también en cuanto a su frecuencia. Objetivo: Nos planteamos revisar la literatura médica al respecto para conocer la problemática en el cálculo de su casuística. Material y método: Realizamos una búsqueda en la base de datos PubMed, mediante los términos Mesh «enuresis», «nocturnal enuresis» y «bedwetting», e incluimos en el cuadro de búsqueda los términos «epidemiology OR prevalence». Incluimos todos los trabajos en lengua inglesa o española. Seleccionamos los trabajos con una muestra mayor de 1.000 pacientes, e incluimos estos y los artículos de revisión. Procedemos al análisis de la metodología empleada por los grupos más relevantes, así como los resultados globales de frecuencia; además, cuando es posible, estratificamos los resultados por edad, sexo y frecuencia de los escapes. Resultados: La metodología de los trabajos analizados es heterogénea y las comparaciones se hacen, por tanto, difíciles. La prevalencia global es difícil de estimar y dar resultados globales carece de interés pues para interpretarlos es necesario pormenorizar la metodología, la muestra y los criterios diagnósticos. Conclusiones: Se hace necesario un estudio epidemiológico propio que resuelva nuestra problemática (AU)

Introduction: Nocturnal enuresis is a disorder with a maintained historical interest. Not only the multifactorial etiopathology, also its prevalence. Objective: We consider reviewing the literature for knowing the problematic in the calculation of the prevalence of this disease. Material and method: We searched in Pubmed database with Mesh terms: “Enuresis”, “Nocturnal Enuresis”, we added in the search box terms bedwetting and epidemiology or prevalence. We included manuscripts in English and Spanish with more than 1000 patients as sample, we also included review papers. We analyzed the methodology and the prevalence, when it was possible, we stratified results in age, sex and the frequency of wet nights. Conclusions: An own epidemiology study is necessary in order to solve our problematic (AU)