[Assessment of effectiveness of and tolerance to oxybutynin in the treatment of unstable bladder in women]. / Evaluación de la efectividad y tolerancia de la oxibutinina en el tratamiento de la vejiga inestable en la mujer.

Unstable bladder is a frequent syndrome in women and is due in the most part because of detrusor involuntary contractions, mainly due to detrusor denervation, which produces voiding hypersensitivity and loss of cortical inhibition control, clinical manifestations are: frequency, nicturia, urgency and urge incontinence. Historically the most effective treatment has been muscular relaxing agents and anticholinergic agents. We present a prospective, double blind, cross, placebo control study to evaluate efficacy and tolerance of oxybutynin in women with unstable bladder. We included 44 adult women with unstable bladder, 22 unitially received oxybutynin 5 mg t.i.d. and 22 placebo 5 mg t.i.d. aleatory in both groups through 6 weeks, later wash-out period was performed and those women in which initially received oxybutynin were administered placebo and those women in which initially received placebo, were administered oxybutynin, for another six weeks. Five patients which initiated the study with oxybutynin abandoned the study, 2 of them for intolerance and 3 for unknown causes. Two women in which initially received placebo abandoned follow-up too. A total of 74 subjects (37 for each branch of study) had an age average of 51.7. Symptoms scoring decreased from 13 to 11 and 6 points with placebo and oxybutynin respectively (p = 0.001). The analog visual scale of symptoms decreased from 77% to 62.5% and 40% with placebo and oxybutynin respectively (p = 0.003). The overall rate of improvement evaluated through symptoms scoring was from 27% with placebo and 72.9% with oxybutynin (p = 0.000) and evaluated through analog visual scale of symptoms was from 40% with placebo and 78.3% with oxybutynin (p = 0.002). The vesical volume at first voiding sensation increased from 129 ml to 134 ml and 187 ml with placebo and oxybutynin respectively (p = 0.021) and the maximum cystometric capacity increased from 231 ml to 236 ml and 301 ml with placebo and oxybutynin respectively. The most frequent adverse effect in both groups was mouth dryness and it presented in 7 (19%) and 34 (91%) patients with placebo and oxybutynin respectively (p = 0.000). Only 5 of 44 patients (11.3%) with oxybutynin and 2 of 44 patients (4.4%) with placebo abandoned follow up (p = 0.14). We concluded that oxybutynin improve significantly the unstable bladder symptoms in women, possibly by increasing functional bladder capacity and decreasing voiding sensitivity, with good tolerance of mouth dryness in the majority of patients.

La esfinterotomía endoscópica en el tratamiento de la disfunción del vaciamiento vesical por apertura inadecuada de la uretra en la mujer: informe preliminar / Endoscopic esphincterotomy in the treatment of disfunctiona bladder emptying caused by inadequate opening in females: preliminary report

La disfunción del vaciamiento vesical por apertura inadecuada de la uretra en la mujer (Disinergia esfinteriana), es una de las causas más frecuentes de infección de vías urinarias, y es un trastorno que reúne aspectos de diagnóstico y tratamiento controvertidos. El diagnóstico de presunción debe apoyarse en la demostración de una obstrucción funcional al flujo urinario, por medio de historia clínica, exámenes de laboratorio, estudios radiológicos y estudio urodinámico. Se informa un nuevo procedimiento, denominado esdinterotomía endoscópica anteromedial con corte frío, para el tratamiento de la disinergia esfinteriana en la mujer. Se han sometido a esta técnica operatoria 58 pacientes, con un promedio de edad de 47.5 años. Son 40 pacientes las que se han sometido a seguimiento mínimo de seis meses (promedio 12 meses), y son las analizadas en este artículo. Antes de la operación, de la 40 pacientes 92 por ciento tenían más de 12 puntos en el índice de síntomas de la American Urological Association (AUA), y sólo los tenían 15 por ciento después de la misma (p< 0.01). El promedio del índice se disminuyó de 21 a 9 puntos (p< 0.01). Todas las pacientes tenían antecedentes de infección urinaria recurrente y posterior a la esfinterotomía, 721.5 por ciento se encontraban libres de infección. Los promedios de las tasas de flujo máximo y medio aumentaron de 23.1 a 32 ml/seg y de 10.4 a 14 ml/seg (p < 0.0001), respectivamente. Los promedios de orina residual, tiempo de vaciamiento, presión máxima del detrusor, longitud uretral funcional, y presión máxima de cierre uretral disminuyeron de 209 a 58 ml, de 50 a 34 segundos (p 0.01), de 57 a 34 cm H2O, de 32 a 24 mm (p< 0.001), y de 93 a 57 cm H2O (p< 0.0001), respectivamente, con una caída del promedio del área total de cierre uretral de 1627 a 797 mm/cm H2O (p< 0.001). Antes de la operación, 58 por ciento de las pacientes cursaba con algún tipo de incontinencia urinaria de grado variable, que sólo persistió en 30 por ciento de ellas después del procedimiento. Se realizó un procedimiento de uretrovesicosuspensión a ocho pacientes con incontinencia urinaria. La esfinterotomía endoscópica con corte frío es una alternativa razonable para el tratamiento de la obstrucción funcional en la mujer

[Extracorporeal lithotripsy in children]. / Litotripsia extracorpórea en niños.

14 patients of pediatric age with renal and ureteral calculi were treated with extracorporeal shock wave lithotripsy (Piezolith 2300). Three of the 14 patients had bilateral renal calculi. There were nine male and five female patients with an average age of 9.7 years. Most of the calculi were the renal pelvis. four calculi were smaller than 10 mm, 12 were between 10 and 20 mm and one was a partial staghorn calculi. A double "J" stent way placed in two patients, one with an ureterostomy and another with a partial staghorn calculi. The average number of shock waves received for patient was 4275 with an average voltage of 582 bars. Only 2 patients (16.6%) required sedation, six patients (47%) required more than one session of lithotripsy. The results at 3 months showed that 71.4% of the patients were free of stones. Hematuria was present in all the patients, hyperthermia greater than 38 degrees C and renal colic were present in 21.4% of the cases, two patients with retained ureteral calculi were rendered stone free by endoscopic procedures. In conclusion our results are similar to those reported in the world literature. The use of ultrasound for stone localization prevents unnecessary radiation of the children, and finally with the machine employed most of the treatments can be performed without anesthesia.

[Renal transplants from anencephalic donors]. / Trasplante renal de donador anencéfalo.

Kidney transplants are carried out as any other surgical procedure at specialized third level hospitals. For over 20 years, in Mexico, transplants have been done with kidneys originating from cadavers. Even though this has been of tremendous help, there is still a shortage of donors. Two successful cases of kidney transplants are presented where the donor was an anencephalic neonate and where segments of the aorta and vena cava were used to keep alive the kidney tissue enough for the corporal surface of a child and also that of an adult.