Risk factors to develop autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury.

AIMS: The risk factors for developing autonomic dysreflexia (AD) during urodynamic (UD) examination in patients with spinal cord injury (SCI) above Th6 still remain unclear. The main goal of our study is to investigate the risk factors that could be associated with AD in these particular patients. DESIGN: Cross sectional survey. SUBJECT AND METHODS: The study was carried out in 83 patients with SCI above Th6 who were submitted to our center for a UD examination. AD was defined as a rise in systolic blood pressure above 15 mm Hg with a pulse rate below 60 beats per minute. RESULTS: The prevalence rate of AD among our patients was 54%. Univariate analysis of our study showed the following risk factors: patient's age, SCI completeness, traumatic etiology, indwelling catheter, presence of chills or sweating, anticholinergic treatment, maximum detrusor voiding pressure, detrusor pressure at maximum flow rate, detrusor external sphincter dyssynergia, and bladder outlet obstruction. Using multivariate logistic regression, we found that there are only two independent risk factors: patient's age equal to or above 45 years of age (OR = 10.995) and maximum detrusor voiding pressure equal to or above 31 cm H2 O (OR = 3.879). CONCLUSIONS: According to our results, the patient's age and maximum detrusor voiding pressure should be considered at the time of performing a UD examination in order to prevent the sudden onset of AD in patients with SCI above Th6. Neurourol. Urodynam. 36:171-175, 2017. © 2015 Wiley Periodicals, Inc.

Post Pelvic Radiotherapy Affectation of the Lower Urinary Tract Peripheral Innervation in Men.

INTRODUCTION: The periurethral electromyography (EMGs) alterations in men who underwent pelvic radiotherapy (RT), either isolated or combined with surgery, have not been frequently described in the literature. OBJECTIVE: The study aimed to compare the EMG's data in men undergoing RT versus the non-irradiated control group. MATERIAL AND METHODS: The study included 61 consecutive males, who had undergone RT (27 of them had been operated) and 99 control consecutive patients who underwent a retrospective assessment. The EMGs were performed using a concentric electrode needle perineally, localizing the sphincter by visual and auditory signal (electromyograph MMS Solar Active). RESULTS: 14.8% denervation, 62.9% reinnervation, 14.9% denervation + reinnervation and 7.4% EMG normal. The age (p < 0.001) and neurogenic bladder data (p < 0.001) are risk factors. The smaller the prostate size (obtained by rectal examination) post-RT, the more the chance for an abnormal EMG (p < 0.001). The fact of having had received RT (p < 0.001) is the only risk factor. CONCLUSION: RT produces lesions over the pudendal nerve, showing denervation even in late periods. The surgery did not behave as a risk factor.

[Usefulness of urodynamics in the treatment of mixed urinary incontinence in women with suburethral slings]. / Utilidad de la urodinámica en el tratamiento de la incontinencia urinaria femenina mixta con slings suburetrales.

OBJECTIVE: The urodynamic results in suburethral slings (SS), are contradictory. We evaluate a series on patients with stress urinary incontinence (associated or not with bladder hyperactivity) that underwent suburethral slings (SS) operations. METHODS: 42 women (age 62±12 years) with urinary incontinence underwent suburethral slings (86% TOT, 12% TVT, 2% others), 36% of them with simultaneous pelvic organ prolapse correction. Medical history and a pre and postsurgery urodynamic studies (according to ICS instructions, except when specified) were performed. RESULTS: After surgery, the improvement of urinary incontinence was lower in patients with previous detrusor hyperactivity (DH) than without DH (60% vs 81 %), and the bladder capacity (BC) was lower (123±36 ml) in patients with previous mixed urinary incontinence (MUI) versus no MUI (241±83 ml) (p=0.004). The decrease of BC was higher with previous MUI (184±92 ml vs 123±36 ml) versus no MUI (240±91 ml vs 237±78 ml), and the DH was more frequent in previous MUI and DH. There was a significant decrease of maximum flow rate (Qmax) (p=0.000) (although without clinical manifestation), and post void residual urine (p=0.007). We demonstrated a significant increase (p=0.001) of mean urethral resistance (URA): 12±9 cm H2O versus 15±12 cm H2O (without reaching obstruction range), and an improvement of detrusor contractility (W80-20): (3±4 W/m2; vs 6±17 W/m2;). CONCLUSION: We demonstrated worst results in MUI in patients with urinary incontinence undergoing SS. The urodynamic study gives a better prognosis reliability in the treatment of female urinary incontinence with SS.

Utilidad de la urodinámica en el tratamiento de la incontinencia urinaria femenina mixta con slings suburetrales / Usefulness of urodynamics in the treatment of mixed urinary incontinence in women with suburethral slings

OBJETIVO: Los resultados urodinámicos en casos de slings suburetrales (SUS) son contradictorios. Valoramos una serie de pacientes con incontinencia urinaria de esfuerzo IUE, asociada o no a hiperactividad vesical (HV) sometidas a SUS. MÉTODOS: 42 mujeres incontinentes (edad 62±12 años) tratadas con SUS (86% TOT, 12% TVT, 2% otros), 36% con corrección simultánea de prolapso pélvico. Se realizó historia clínica y estudio urodinámico (EUD) (pre/postcirugía), según normas ICS, excepto cuando se especifica. RESULTADOS: Postcirugía la mejoría de la IU fue menor en casos con hiperactividad del detrusor (HD) previa que sin HD (60% vs 81%), y la capacidad vesical (CV) fue menor (123±36 ml) en los casos de incontinencia urinaria mixta (IUM) previa vs sin IUM (241±83 ml) (p = 0,004). El descenso de la CV fue mayor con IUM previa (184±92 ml vs 123±36 ml) vs sin IUM previa (240 ±91 ml vs 237±78 ml), siendo la HD más frecuente en los casos de IUM y HD previa. Hubo disminución del flujo miccional máximo (p = 0,000) (aunque sin repercusión clínica) y del residuo postmiccional (p = 0,007) (ambas significativas) postcirugía. Se demostró incremento significativo (p = 0,001) de la resistencia uretral (URA: 'Urethral Resistance Average') (12±9 cm H2O vs 15±12 cm H2O), sin llegar a rangos de obstrucción y mejoría de la contractilidad del detrusor (W80-W20) (3±4 Watios/m2 vs 6±17 Watios/m2). CONCLUSIÓN: Se demostraron en nuestra serie peores resultados en los casos de IUM, sometidos a cirugía antincontinencia con SUS. El EUD completo ofrece una mayor fiabilidad pronóstica en el tratamiento de la IU en la mujer con SUS

OBJECTIVE: The urodynamic results in suburethral slings (SS), are contradictory. We evaluate a series on patients with stress urinary incontinence (associated or not with bladder hyperactivity) that underwent suburethral slings (SS) operations. METHODS: 42 women (age 62±12 years) with urinary incontinence underwent suburethral slings (86% TOT, 12% TVT, 2% others), 36% of them with simultaneous pelvic organ prolapse correction. Medical history and a pre and postsurgery urodynamic studies (according to ICS instructions, except when specified) were performed. RESULTS: After surgery, the improvement of urinary incontinence was lower in patients with previous detrusor hyperactivity (DH) than without DH (60% vs 81 %), and the bladder capacity (BC) was lower (123±36 ml) in patients with previous mixed urinary incontinence (MUI) versus no MUI (241±83 ml) (p = 0.004). The decrease of BC was higher with previous MUI (184±92 ml vs 123±36 ml) versus no MUI (240±91 ml vs 237±78 ml), and the DH was more frequent in previous MUI and DH. There was a significant decrease of maximum flow rate (Qmax) (p = 0.000) (although without clinical manifestation), and post void residual urine (p = 0.007). We demonstrated a significant increase (p = 0.001) of mean urethral resistance (URA): 12±9 cmH2O versus 15±12 cmH2O (without reaching obstruction range), and an improvement of detrusor contractility (W80-20): (3±4 W/m2 vs 6±17 W/m2))

Otras lesiones radiológicas del tracto urinario inferior (TUI) en pacientes sometidos a radioterapia pélvica en monoterapia y combinada con cirugía / Other radiological lesions of the Lower Urinary Tract in patients after isolated pelvic radiotherapy and combined with surgery

El estudio cistográfico en pacientes sometidos a radioterapia (RTP) y cirugías pélvicas es infrecuente en la literatura, no descrita en pacientes sin complicaciones, referidas fundamentalmente a fístulas urinarias. OBJETIVO: Estudio cistográfico del TUI, en estos pacientes, con descripción de otros tipos de lesiones radiológicas. MÉTODOS:127 cistografías (88 hombres y 39 mujeres), en pacientes consecutivos sometidos a RTP (monoterapia 48, con cirugía 79), edad media 69,6 años, y tiempo medio desde la radiación 215 meses (17 años) (frente a grupo control), mediante equipo General Electric®, estudiando: comportamiento del cuello vesical en reposo y durante la micción, valoración de reflujo vésico-ureteral (RVU), morfología vesical (MV), estenosis uretrales (EU) y fístulas (F). RESULTADOS: Se observa incompetencia del cuello vesical al llenado (ICV) (37,8%), morfología vesical lisa y uniforme (60,6%), apertura miccional del cuello normal (96,1%), incontinencia urinaria a la tos (IU) (26,4%), cistocele basal (64,7%) y en Valsalva (96,6%) de las mujeres, así como disminución de la luz uretral miccional (41,3%) y RVU (13,2%). 5 casos de ICV al llenado, todos cáncer de próstata (CP) (uno de ellos también cáncer de colon). 6 fístulas (4,14%), 5 mujeres . 42 pacientes (28,96%) disminución de la luz uretral, 35 uretra posterior (83%), 5 (11,90%) anterior aislada (11,90%) y 2 mixtos (5%). El 95 % eran pacientes con CP y sin intervenciones concurrentes (67%). Se encontraron diferencias significativas de hombres vs mujeres (ICV al llenado (p = 0,007), morfología vesical irregular (p = 0,004) y disminución de luz uretral (p < 0,001) más frecuente en hombres, e IU (p = 0,007) en mujeres ) y entre pacientes con/sin intervenciones pélvicas: ICV (p = 0,046), RVU (p = 0,02), IU a la tos (p = 0,03) (más frecuentes en pacientes intervenidos) y disminución de la luz uretral (p < 0,01) (menos frecuente). Los pacientes con RVU presentan mayor tiempo transcurrido desde la radioterapia, no así en otras variables cistográficas. CONCLUSIONES: La RTP se relacionó con incompetencia del cuello, IU de esfuerzo, estenosis uretral anterior y RVU. La cirugía incrementó el factor de riesgo en pacientes intervenidos

INTRODUCTION: The cystographic study of patients who have undergone radiotherapy (RT) and pelvic surgeries is uncommon in the literature, not described in patients without complications, and mostly related to urinary fistulae. OBJECTIVE: The study of the lower urinary tract (LUT) by cystography in these patients, with a description of some other types of radiation lesions. METHODS: 127 cystographies have been performed (88 and 39 ) in consecutive patients undergoing radiotherapy (RT) (48 monotherapy and 79 cases combined with surgery), with a mean age of 69.6 years, and a mean time from radiation of 215 months (17 years). A General Electric X ray equipment has been used. We studied: behavior of the bladder neck at rest and during micturition, assessment of vesicoureteral reflux (VUR), bladder morphology (BM), urethral strictures (UE) and fistulas (F). RESULTS: We observed: Filling phase bladder neck incompetence (BNI) (37.8%), bladder smooth morphology (60.6%), coughing urinary incontinence (UI) (26.4%), basal cystocele (64.7%) and Valsalva cystocele (96.6%), a normal opening bladder neck (96,1%), reduction of the urethral diameter during voiding (41.3%), and vesicoureteral reflux (VUR) (13.2%). Five cases of filling BNI, were all related to prostate cancer (PC) (one of them with colon cancer as well). There were six cases of fistulae (4.14%), five of them women. Forty two patients (28.96%) had reduced urethral lumen, thirty five of them affecting the posterior urethra (83%), five (11.9%) the anterior and, finally, two cases of mixed lesion (5%). 95% were patients with PC without concurrent interventions (67%). Significant differences were found regarding the gender and the background of pelvic surgery. The filling BNI (p = 0.007), the irregular bladder morphology (p = 0.004) and the reduction of the urethral lumen (p < 0.001) have been found to be more common in male patients, while the coughing UI was more common in women (p = 0.007). The study shows that BNI (p = 0.046), VUR (p = 0.02) and the IU due to cough (p = 0.03) were more frequent in operated patients, while reduced urethral lumen was less common (p < 0.01). Patients with VUR present more time from radiotherapy, but not in other cystography variables. There was a relationship between RT and the BNI, stress urinary incontinence, anterior urethral stricture and VUR. The risk factor was increased by surgery. CONCLUSIONS: Bladder neck incompetence, stress UI, anterior urethral stricture and VUR have been related to radiotherapy. Surgery increased the risk factor in operated patients