[Cystoscopy in the assessment of patients with bladder pain syndrome: Results of a national multicenter observational study.] / La cistoscopia en la evaluación del síndrome de dolor vesical: resultados de un estudio observacional multicéntrico nacional.

OBJECTIVES: To study the use and results of cystoscopy and bladder hydrodistension in the objective assessment of patients with Bladder Pain Syndrome (BPS), in routine clinical practice. MATERIAL AND METHODS: Observational, non-interventional, national, multicenter study carried out in Functional Urology and Urodynamic Units of Spain belonging to the IFU Group. 273 women with BPS who underwent cystoscopy at baseline as a diagnostic tool according to clinical criteria and following the routine clinical practice of each center, were studied. The pre and post hydrodistension findings and the scores of the symptom and Health-Related Quality of Life (HRQoL) questionnaires were described: BPIC-SS, PPBC, PGI-S and EQ-5D-5L. RESULTS: The mean age (SD) was 59 (14) years with a high presence of bladder symptoms: increased voiding frequency (81.7%), nocturia (74%) and urgency (60.4%). 40.7% of cystoscopies were performed under anesthesia and 73.7% uses a standard rigid cystoscope. Hunner lesions were observed in 9.9% of the patients, hypervascularizations (46.2%), glomerulations (23.4%), mild bleeding (6.6%) and scars (2.2%). After hydrodistension, a greater number of grade 1 and 2 lesions were observed. In 51.6% of the patients there were no changes, but in 27.5% slight changes were observed and in 11.4% moderate or severe changes. Symptom and HRQoL questionnaire scores showed no association with cystoscopy findings before and after hydrodistension. CONCLUSIONS: The value of the cystoscopic findings in the SDV has yet to be defined, although it plays a fundamental role in the differential diagnosis. In this observational study, we did not find a correlation of the cystoscopic findings with the symptoms of the patients, measured by validated questionnaires, nor with the HRQoL.

OBJETIVO: Analizar el uso y resultados de la cistoscopia y la hidrodistensión vesical para la evaluación objetiva de pacientes con Síndrome de Dolor Vesical (SDV), en el contexto de práctica clínica habitual.MATERIAL Y MÉTODOS: Estudio observacional, no intervencionista, multicéntrico de ámbito nacional, realizado en Unidades de Urología Funcional y Urodinámica de España pertenecientes al Grupo IFU en el que se analizaron 273 mujeres con SDV a las que se les realizó una cistoscopia a nivel basal como herramienta diagnóstica según criterio clínico y siguiendo la práctica clínica habitual de cada centro. Se describieron los hallazgos pre y post hidrodistensión y las puntuaciones de los cuestionarios de síntomas y de Calidad de Vida Relacionada con la Salud (CVRS): BPIC-SS, PPBC, PGI-S y EQ-5D-5L. RESULTADOS: La edad media (DE) fue de 59 (14) años con gran presencia de síntomas vesicales: frecuencia miccional aumentada (81,7%), nocturia (74,0%) y urgencia (60,4%). El 40,7% de las cistoscopias se realizaron bajo anestesia y en el 73,7% se empleó un cistoscopio rígido estándar. Se observaron lesiones de Hunner en un 9,9% de las pacientes, hipervascularizaciones (46,2%), glomerulaciones (23,4%), sangrado leve (6,6%) y cicatrices (2,2%). Tras la hidrodistensión se observó un mayor número de lesiones grado 1 y 2. En el 51,6% de las pacientes no hubo cambios, pero en el 27,5% se observaron cambios leves y en el 11,4% cambios moderados o graves. Las puntuaciones de los cuestionarios de síntomas y CVRS no mostraron asociación con los hallazgos de la cistoscopia antes y después de la hidrodistensión. CONCLUSIONES: El valor de los hallazgos cistoscópicos en el SDV está aún por definir, aunque juega un papel fundamental en el diagnóstico diferencial. En este estudio observacional no encontramos correlación de los hallazgos cistoscópicos con los síntomas de las pacientes, medidos por cuestionarios validados, ni con la CVRS.

La cistoscopia en la evaluación del síndrome de dolor vesical: resultados de un estudio observacional multicéntrico nacional / Cystoscopy in the evaluation of bladder pain syndrome: results of a national multicenter observational study

Objetivo: Analizar el uso y resultados dela cistoscopia y la hidrodistensión vesical para la evaluación objetiva de pacientes con Síndrome de DolorVesical (SDV), en el contexto de práctica clínica habitual.Material y métodos: Estudio observacional, nointervencionista, multicéntrico de ámbito nacional, realizado en Unidades de Urología Funcional y Urodinámica de España pertenecientes al Grupo IFU en el quese analizaron 273 mujeres con SDV a las que se lesrealizó una cistoscopia a nivel basal como herramientadiagnóstica según criterio clínico y siguiendo la prácticaclínica habitual de cada centro. Se describieron los hallazgos pre y post hidrodistensión y las puntuaciones de los cuestionarios de síntomas y de Calidad de Vida Relacionada con la Salud (CVRS): BPIC-SS, PPBC, PGI-Sy EQ-5D-5L.Resultados: La edad media (DE) fue de 59 (14) añoscon gran presencia de síntomas vesicales: frecuenciamiccional aumentada (81,7%), nocturia (74,0%) y urgencia (60,4%). El 40,7% de las cistoscopias se realizaron bajo anestesia y en el 73,7% se empleó uncistoscopio rígido estándar. Se observaron lesiones deHunner en un 9,9% de las pacientes, hipervascularizaciones (46,2%), glomerulaciones (23,4%), sangradoleve (6,6%) y cicatrices (2,2%). Tras la hidrodistensiónse observó un mayor número de lesiones grado 1 y2. En el 51,6% de las pacientes no hubo cambios,pero en el 27,5% se observaron cambios leves y en el11,4% cambios moderados o graves. Las puntuacionesde los cuestionarios de síntomas y CVRS no mostraronasociación con los hallazgos de la cistoscopia antes ydespués de la hidrodistensión. Conclusiones: El valor de los hallazgos cistoscópicos en el SDV está aún por definir, aunque juega unpapel fundamental en el diagnóstico diferencial. En esteestudio observacional no encontramos correlación delos hallazgos cistoscópicos con los síntomas de las pacientes, medidos por cuestionarios validados, ni con laCVRS.(AU)

Objetives: To study the use and resultsof cystoscopy and bladder hydrodistension in the objective assessment of patients with Bladder Pain Syndrome(BPS), in routine clinical practice.Material and methods: Observational, non-interventional, national, multicenter study carried out inFunctional Urology and Urodynamic Units of Spain belonging to the IFU Group. 273 women with BPS whounderwent cystoscopy at baseline as a diagnostic toolaccording to clinical criteria and following the routineclinical practice of each center, were studied. The preand post hydrodistension findings and the scores of thesymptom and Health-Related Quality of Life (HRQoL)questionnaires were described: BPIC-SS, PPBC, PGI-Sand EQ-5D-5L.Results: The mean age (SD) was 59 (14) years witha high presence of bladder symptoms: increased voiding frequency (81.7%), nocturia (74%) and urgency(60.4%). 40.7% of cystoscopies were performed under anesthesia and 73.7% uses a standard rigid cystoscope. Hunner lesions were observed in 9.9% of thepatients, hypervascularizations (46.2%), glomerulations(23.4%), mild bleeding (6.6%) and scars (2.2%). Afterhydrodistension, a greater number of grade 1 and 2lesions were observed. In 51.6% of the patients therewere no changes, but in 27.5% slight changes wereobserved and in 11.4% moderate or severe changes.Symptom and HRQoL questionnaire scores showed noassociation with cystoscopy findings before and afterhydrodistension.Cconclusions: The value of the cystoscopic findingsin the SDV has yet to be defined, although it plays afundamental role in the differential diagnosis. In this observational study, we did not find a correlation of thecystoscopic findings with the symptoms of the patients,measured by validated questionnaires, nor with theHRQoL.(AU)

Increased urinary markers of kidney damage in the institutionalized frail elderly due to recurrent urinary tract infections.

OBJECTIVE: To characterize the impact on kidney injury of recurrent urinary tract infections (RUTI) in the frail elderly. METHODS: Prospective observational study in 200 frail elderly subjects for 1 year. Groups: GA (n = 100): subjects without RUTI, GB (n = 100): subjects with RUTI. Variables: age, concomitant diseases, glomerular filtration rate (GFR), urine neutrophil gelatinase-associated lipocalin (NGAL) at the beginning (NGAL-1) and end (NGAL-2) of the study, urine N-acetyl glucosaminidase (NAG) at the beginning (NAG-1) and the end (NAG-2) of the study, urine transforming growth factor-beta 1 (TGFß-1). Descriptive statistics, Mann-Whitney test, Chi-squared test, Fisher's exact test, and multivariate analysis were used. RESULTS: Mean age was 84.33 (65-99) years old, with no difference between GA and GB. Mean NGAL-1 was 1.29 ng/ml (0.04-8). There was lower in GA than in GB. Mean NGAL-2 was 1.41 ng/ml (0.02-9.22). NGAL-2 was lower in GA than in GB. Mean NAG-1 was 0.38 UU.II/ml (0.01-2.63. NAG-1 in GA was lower than in GB. Mean NAG-2 was 0.44 UU.II/ml (0-3.41). NAG-2 was lower in GA compared with GB. Mean TGFß-1 was 23.43 pg/ml (0.02-103.76). TGFß-1 was lower in GA than GB. There were no differences in the presence of secondary diagnoses between GA and GB. NAG-2 and NGAL-1 were the most determining factors of renal function; in GA it was NGAL-2, followed by NAG-1; in GB it was NGAL-1, followed by NAG-2. CONCLUSION: Frail elderly with RUTI have higher urinary levels of renal injury markers, specifically NGAL, NAG, and TGFß-1, chronically in periods between urinary tract infection (UTI). Urinary markers of renal injury, specifically NGAL, NAG, and TGFß-1, identify early deterioration of renal function, compared with serum creatinine, or albuminuria, in frail elderly with recurrent urinary infections.

Position of Ibero-American Society of Neurourology and UroGynecology (SINUG) on the use of vaginal meshes in pelvic organ prolapse.

AIMS: Pelvic organ prolapse (POP) is a very prevalent condition with a great impact on women's quality of life. At present, there is great controversy regarding the use of mesh in POP surgery. To understand the current moment, it is advisable to make a brief summary of the historical evolution of mesh use for pelvic floor pathology. The aim of this paper is to establish the position of the Ibero-American Society of Neurourology and UroGynecology (SINUG for its acronym in Spanish) regarding vaginal mesh reconstructive surgery. METHODS: A working committee from the SINUG's scientific board performed a literature search about the use of vaginal meshes for pelvic organ prolapse reconstructive surgery and about the position of different societies. We analyzed the evolution into three periods: before the Food and Drug Administration (FDA) statement, FDA statement, and after the statement. SINUG drew up a position statement regarding vaginal mesh reconstructive surgery, based on the available scientific evidence and the evolution of its use in different contexts. RESULTS: Before mesh appearance in the 1990s, native tissue repair was the surgical treatment of choice for POP. Vaginal mesh reconstructive surgery has been frequently accompanied by procedure underestimation by inexperienced surgeons, besides inadequate diagnoses and indications. This situation led to the presentation of serious complications including mesh extrusion, exposure, and contraction. CONCLUSIONS: Once reviewed the available evidence and the position of different societies, SINUG presents its vision in this communication, which is a summary of the document prepared by the society's scientific board.

Profilaxis farmacológica de la tromboembolia venosa en la prostatectomía radical / Pharmacological venous thromboembolism prophylaxis in radical prostatectomy

ANTECEDENTES Y OBJETIVO: El tromboembolismo pulmonar es una de las causas más comunes de muerte no quirúrgica en pacientes sometidos a cirugía urológica abdominopélvica. Desde el inicio de la profilaxis para la enfermedad tromboembólica venosa los episodios de trombosis venosa profunda y tromboembolia pulmonar han descendido considerablemente. Nuestro objetivo es analizar los predictores de la enfermedad tromboembólica, la variabilidad clínica en la utilización de la profilaxis farmacológica para esta enfermedad y los resultados de su aplicación. MATERIAL Y MÉTODOS: Estudio retrospectivo multicéntrico de 610 pacientes intervenidos mediante prostatectomía radical entre diciembre de 2013 y noviembre de 2014 en 7hospitales generales de España, Italia y Portugal. Se clasificó a los pacientes según sus características basales en grupos de riesgo trombótico y grupos de riesgo hemorrágico. Se evaluaron los eventos tromboembólicos venosos que se presentaron en los diferentes grupos. RESULTADOS: La edad media fue de 65,22años (48-78). El índice de masa corporal medio fue de 26,7 y la mediana del riesgo de ASA fue 2. En todos los pacientes se inició la deambulación en las primeras 24h. En el 4,1% se utilizó compresión neumática intermitente y en el 84,6%, profilaxis farmacológica con heparinas de bajo peso molecular. Solo en el 3,4% se utilizó la combinación de profilaxis mecánica con la farmacológica. Se observó disminución de la incidencia de eventos tromboembólicos en los pacientes que recibieron profilaxis farmacológica, con una reducción absoluta del riesgo del 6,8%. No se objetivó aumento del riesgo hemorrágico en los pacientes que recibieron profilaxis tromboembólica. CONCLUSIONES: En este estudio sobre pacientes sometidos a prostatectomía radical no hubo diferencia en las complicaciones hemorrágicas derivadas del uso de profilaxis farmacológica para la enfermedad tromboembólica venosa. La profilaxis farmacológica reduce el riesgo de presentar un evento tromboembólico en pacientes sometidos a prostatectomía radical, si bien este riesgo no se asocia con la técnica de abordaje

BACKGROUND AND AIM: Pulmonary thromboembolism is one of the most common causes of non-surgical death in patients following urological abdominopelvic surgery. Since the beginning of prophylaxis for venous thromboembolic disease, episodes of deep vein thrombosis and pulmonary thromboembolism have decreased. Our objective is to analyse the prognosis factors of thromboembolic disease, the clinical variability in the use of pharmacological prophylaxis and the results of its application. MATERIAL AND METHODS: Retrospective multicentric study of 610 patients undergoing radical prostatectomy between December 2013 and November 2014, in 7general hospitals in Spain, Italy and Portugal. Patients were classified according to their baseline characteristics into thrombotic risk groups and haemorrhagic risk groups. The venous thromboembolic events that occurred in the different groups were analysed. RESULTS: The average age was 65.22years (48-78). The average body mass index was 26.7 and the average ASA risk 2.1. In all patients, early mobilization began in the first 24hours. In 4.1% intermittent pneumatic compression was used and 84.6% received pharmacological prophylaxis with low molecular weight heparins. Only 3.4% used the combination of mechanical prophylaxis with pharmacological prophylaxis. We observed a decrease in the incidence of thromboembolic events in the patients who received pharmacological prophylaxis, with an absolute risk reduction of 6.8%. There was no increase in the risk of haemorrhage in the patients who received pharmacological prophylaxis. CONCLUSIONS: In this study on patients undergoing radical prostatectomy, there was no difference in haemorrhagic complications derived from the use of pharmacological prophylaxis for venous thromboembolic disease. Pharmacological prophylaxis reduces the risk of presenting a thromboembolic event in patients undergoing radical prostatectomy, although this risk is not associated with the approach technique

Consensus document on the multidisciplinary management of neurogenic lower urinary tract dysfunction in patients with multiple sclerosis.

AIM: Neurogenic lower urinary tract dysfunction (NLUTD) is very common in multiple sclerosis (MS) patients. Early diagnosis and treatment are crucial to avoid irreversible damage and improve quality of life. Our aim was to develop recommendations to improve NLUTD identification in MS patients, along with their referral and management. METHODS: A multidisciplinary group of 14 experts in the management of patients with MS and NLUTD (nine urologists, three neurologists, and two rehabilitators) was selected. A comprehensive review of the literature was undertaken and a set of recommendations was generated and submitted to a Delphi panel of 114 experts. Recommendations were presented according to the grade of agreement (GA). RESULTS: Early diagnosis in asymptomatic patients with risk factors for complications is recommended (GA 94%). Postvoid residual volume should be measured if changes in urinary symptoms (GA 87%), preferably ultrasound-guided (GA 86%). Early referral to urologist is recommended if urinary incontinence (GA 91%), significant post-void residual volume (94%), quality of life impairment (GA 98%) and recurrent urinary infections (GA 97%). The initial evaluation should include physical examination (GA 99%) and urodynamics including cystometry (GA 89%), pressure-flow study (90%) and electromyography (GA 70%). The panel recommends multidisciplinary collaboration (GA 100%) with a rehabilitation specialist and trained nurses in the management of NLUTD (GA 99%). CONCLUSIONS: Multidisciplinary management for patients with NLUTD due to MS is advised, including urologists, neurologists, rehabilitation, and nurses. Panel recommends early diagnosis with post-void residual volume in symptomatic patients before referring to urologist and urodynamics when referred.

Pharmacological venous thromboembolism prophylaxis in radical prostatectomy. / Profilaxis farmacológica de la tromboembolia venosa en la prostatectomía radical.

BACKGROUND AND AIM: Pulmonary thromboembolism is one of the most common causes of non-surgical death in patients following urological abdominopelvic surgery. Since the beginning of prophylaxis for venous thromboembolic disease, episodes of deep vein thrombosis and pulmonary thromboembolism have decreased. Our objective is to analyse the prognosis factors of thromboembolic disease, the clinical variability in the use of pharmacological prophylaxis and the results of its application. MATERIAL AND METHODS: Retrospective multicentric study of 610 patients undergoing radical prostatectomy between December 2013 and November 2014, in 7general hospitals in Spain, Italy and Portugal. Patients were classified according to their baseline characteristics into thrombotic risk groups and haemorrhagic risk groups. The venous thromboembolic events that occurred in the different groups were analysed. RESULTS: The average age was 65.22years (48-78). The average body mass index was 26.7 and the average ASA risk 2.1. In all patients, early mobilization began in the first 24hours. In 4.1% intermittent pneumatic compression was used and 84.6% received pharmacological prophylaxis with low molecular weight heparins. Only 3.4% used the combination of mechanical prophylaxis with pharmacological prophylaxis. We observed a decrease in the incidence of thromboembolic events in the patients who received pharmacological prophylaxis, with an absolute risk reduction of 6.8%. There was no increase in the risk of haemorrhage in the patients who received pharmacological prophylaxis. CONCLUSIONS: In this study on patients undergoing radical prostatectomy, there was no difference in haemorrhagic complications derived from the use of pharmacological prophylaxis for venous thromboembolic disease. Pharmacological prophylaxis reduces the risk of presenting a thromboembolic event in patients undergoing radical prostatectomy, although this risk is not associated with the approach technique.

Position of the Ibero-American Society of Neurourology and Urogynecology in relation to the use of synthetic suburethral meshes for the surgical treatment of female stress incontinence.

AIMS: The aim of this paper is to stablish de position of the Ibero-American Society of Neurourology and Urogynecology (SINUG) in relation to the use of suburethral meshes for the surgical treatment of female stress incontinence. METHODS: Tension-free mid-urethral slings (MUS) have become the most popular procedure for the treatment of stress urinary incontinence (SUI). In July 2018, the British government announced a pause in the use of meshes for both pelvic organ prolapse (POP) and urinary incontinence (UI) treatment without differentiating whether the meshes were used for treating UI or POP. The decision was taken to stop their use until the publication of the updated UI and POP guidelines of the British National Health Service, which is available from April 2019. SINUG has reviewed the evidence and official position of different societies in relation to the safety and efficacy of MUS in the surgical treatment of incontinence differentiating them from meshes used to repair POP. RESULTS: Data from synthetic mesh manufacturers indicate that in 2010, 300 000 women underwent surgical procedures to repair POP and approximately 260 000 were operated on for SUI. According to these estimates, approximately more than 80% of the surgical techniques for UI treatment were performed transvaginally with meshes. CONCLUSIONS: Once reviewed evidence and position of different societies, the SINUG presents its vision in this communication, which is a summary of the document analysing the state of topic prepared by the society.

Modelo propuesto en la remodelación de la vejiga inducida por la obstrucción a la salida de la vejiga en humanos: implicaciones en la práctica clínica / Proposed model in the bladder remodeling induced by bladder outlet obstruction in humans: implications in clinical practice

No disponible

Healthcare resource utilization and cost among males with lower urinary tract symptoms with a predominant storage component in Spain: The epidemiological, cross-sectional MERCURY study.

AIMS: To assess the relationship between storage-predominant LUTS and healthcare resource consumption and cost among males in Spain. METHODS: In this non-interventional, cross-sectional study, urologists enrolled males with storage-predominant LUTS and recorded the consumption of healthcare resources (medical visits, diagnostic tests/monitoring, treatment, and hospitalizations) within the previous 6 months. The cost of healthcare resources was calculated from unit costs extracted from a Spanish eHealth database. Severity of LUTS was assessed by the Bladder Self-Assessment Questionnaire (BSAQ) and patients were stratified by symptom score (<6 or ≥6) to assess the relationship between LUTS severity and healthcare resource consumption and cost. RESULTS: Among 610 enrolled patients (BSAQ symptom score <6, n = 191; BSAQ symptom score ≥6, n = 419), the majority (87.7%) consumed healthcare resources during the previous 6 months in the form of medical visits (86.2%), diagnostic tests/monitoring (83.4%), and treatment (85.9%). Patients with BSAQ symptom scores ≥6 used more healthcare resources compared with patients with BSAQ symptom scores <6. The most common treatments for LUTS were α-blockers used as monotherapy (n = 229 [37.5%]) or in combination with antimuscarinics (n = 227 [37.2%]). The estimated median annual cost was €1070 per patient, consisting of diagnostic tests/monitoring (54.6%), medical visits (20.5%), and treatment (29.6%), and was higher in patients with BSAQ symptom score ≥6 (€1127) than in patients with BSAQ symptom score <6 (€920; P < 0.001). CONCLUSIONS: More severe LUTS are associated with higher healthcare consumption and cost. These findings highlight the importance of symptom management in LUTS patients to help minimize healthcare consumption and cost.

Influence of secondary diagnoses in the development of urinary incontinence after radical prostatectomy.

OBJECTIVE: To study whether there are factors related to secondary diagnoses (SDg) present in patients with prostate cancer that influence the development of urinary incontinence after radical prostatectomy (RP). MATERIALS AND METHODS: A retrospective multicenter observational study was performed reviewing the medical records of 430 men who underwent RP due to organ-confined prostate cancer in 9 different hospitals. Two study groups were distinguished: Group A (GA): Patients without urinary incontinence after RP; Group B (GB): patients with any degree of post-surgical urinary incontinence. RESULTS: Average age at surgery was 63.42 years (range 45-73). 258 patients were continent after surgery and 172 patients complaint of any degree of incontinence after RP. A higher percentage of healthy patients was found in group A (continent after surgery) than in group B (p = 0.001). The most common SDg prior to surgery were hypertension, lower urinary tract symptoms, dyslipidemia, diabetes mellitus and erectile dysfunction, but none did show a greater trend towards post-surgical incontinence. CONCLUSIONS: A better health status prior to surgery is associated to a lower incidence of new-onset urinary incontinence after radical prostatectomy. However, no correlation was found between the most common medical disorders and the development of post-surgical urinary incontinence.

[Expert opinion about the use of transdermic oxybutynin in Spain for the treatment of adult overactive bladder.] / Opinión de expertos sobre el uso de la oxibutinina transdérmica en España para el tratamiento de la vejiga hiperactiva en adultos.

OBJECTIVES: To define the different characteristics of transdermal oxybutynin (TO) for the treatment of overactive bladder in adults, to know the barriers for the use of this drug and to establish proposals to minimize these barriers. METHODS: Local sessions were held with 111 urologists from all over the country divided into 12 sessions. They were moderated by a brainstorming technique led by an external consultant. RESULTS: 75% of experts believe that tolerability and clinical efficacy (50%) are the most important attributes to choose this formulation, being the lack of scientific publications the least valued (12%). These opinions were based on their own clinical experience with TO or on scientific publications, without establishing comparison with other treatment options. The main barriers would be administrative obstacles (84%), difficulty in its use (54%) and the lack/rejection of the transdermal administration by the patient (33%). Actions were proposed to correct the 8 most significant barriers, such as better training for specialists (both Urology and other specialties) and for patients, creating informative materials to reinforce health education in managing patches, generating greater volume of scientific evidence to support their use in overactive bladder and clearly identifying the profile of patients who will benefit most from this therapeutic strategy. CONCLUSIONS: Although oxybutynin has been standard treatment of overactive bladder in recent years the conclusion of this working group is that its new transdermal formulation offers a better-tolerated alternative for patients, and, therefore the necessary tools to generate more evidence should be implemented to increase the proper use among specialists and patients.

Opinión de expertos sobre el uso de la oxibutinina transdérmica en España para el tratamiento de la vejiga hiperactiva en adultos / Expert opinión about the use of transdermic oxybutynin in Spain for the treatment of adult overactive bladder

OBJETIVO: Definir las características diferenciales de la oxibutinina transdérmica (OT) en el tratamiento de la vejiga hiperactiva en pacientes adultos, conocer las barreras de uso y establecer propuestas para minimizar estas barreras. MÉTODOS: Se realizaron 12 sesiones de ámbito local a las que acudieron 111 urólogos en total de todo el territorio nacional, que fueron moderadas mediante una técnica de brainstorming dirigida por un consultor externo. RESULTADOS: El 75% de los expertos opina que la tolerabilidad y la eficacia clínica (50%) son los 'atributos' más importantes para escoger esta formulación, siendo el menos valorado la escasez de publicaciones científicas (12%), basándose en su propia experiencia clínica con OT o la referida en publicaciones científicas, sin establecer comparación con otras alternativas de tratamiento. Las principales 'barreras' para su uso serían las trabas administrativas (84%), la dificultad en su manejo (54%) y el desconocimiento-rechazo de la vía transdérmica por parte del paciente (33%). Se acordaron acciones para subsanar las 8 barreras más significativas, como mayor formación para especialistas (tanto Urología como otras especialidades) y para pacientes, creación de materiales informativos para reforzar la educación en el manejo de parches, generar mayor volumen de evidencia científica que avale su uso en la vejiga hiperactiva e identificar claramente los perfiles de pacientes más beneficiarios de esta estrategia terapéutica. CONCLUSIONES: Este grupo de expertos identificó la tolerabilidad y eficacia como los dos atributos clave que debe tener un fármaco para el tratamiento de la vejiga hiperactiva, de los cuales la OT destaca en el primero de ellos. Además, deben emprenderse acciones formativas, educativas y de investigación a todos los actores implicados con el fin de superar las barreras que dificultan el correcto manejo de este fármaco

OBJECTIVES: To define the different characteristics of transdermal oxybutynin (TO) for the treatment of overactive bladder in adults, to know the barriers for the use of this drug and to establish proposals to minimize these barriers. METHODS: Local sessions were held with 111 urologists from all over the country divided into 12 sessions. They were moderated by a brainstorming technique led by an external consultant. RESULTS: 75% of experts believe that tolerability and clinical efficacy (50%) are the most important attributes to choose this formulation, being the lack of scientific publications the least valued (12%). These opinions were based on their own clinical experience with TO or on scientific publications, without establishing comparison with other treatment options. The main barriers would be administrative obstacles (84%), difficulty in its use (54%) and the lack/rejection of the transdermal administration by the patient (33%). Actions were proposed to correct the 8 most significant barriers, such as better training for specialists (both Urology and other specialties) and for patients, creating informative materials to reinforce health education in managing patches, generating greater volume of scientific evidence to support their use in overactive bladder and clearly identifying the profile of patients who will benefit most from this therapeutic strategy. CONCLUSIONS: Although oxybutynin has been standard treatment of overactive bladder in recent years the conclusion of this working group is that its new transdermal formulation offers a better-tolerated alternative for patients, and, therefore the necessary tools to generate more evidence should be implemented to increase the proper use among specialists and patients

The 3-day bladder diary is a feasible, reliable and valid tool to evaluate the lower urinary tract symptoms in women.

AIMS: To evaluate the feasibility (% of completion), reliability (test-retest and inter-observer) and validity (convergent vs. questionnaires and vs. urodynamic study-UDS) of the 3-day bladder diary (3dBD) in women with lower urinary tract symptoms (LUTS). METHODS: Epidemiological, descriptive, cross-sectional and prospective study. Fourteen Functional Urology and Urodynamic Units participated. One hundred thirty-six women with mean age (SD) 55.2 (13.8) years with LUTS, without bladder catheterization and who were able to fill in the 3dBD were included. An UDS was performed. They filled in the 3dBD in two times separated by 15 days (test and retest), the International Consultation on Incontinence-Short Form (ICIQ-UI SF) and the Bladder Control Self-Assessment Questionnaire (BSAQ). RESULTS: One hundred ten women completed 3dBD for test and retest. Feasibility: each 3dBD has 42 variables, 77.2% women completed 80%. Test-retest reliability: there were not differences in the proportion of patients classified as positive for each symptom (urgency: P = 0.3173; incontinence: P = 1; nocturia: P = 0.0522; frequency: P = 0.4386). The Intraclass Correlation Coefficient (ICC) ranged from 0.67 to 0.92, except for night time VVmax which was lower (0.54). Inter-observer reliability: ICC ranged from 0.64 to 0.99, except for day time VVmax (0.29) and the number of urgency episodes (0.45). VALIDITY: Spearman correlation coefficients for ICIQ-UI SF and BSAQ ranged from 0.4 to 0.6 (P < 0.0001) and for UDS were lower (P < 0.05). CONCLUSIONS: The 3dBD showed good feasibility, reliability and validity to be used in the assessment of LUTS in women.

[Posterior nutcracker syndrome: retroaortic renal vein associated with arteriovenous fistula and renal cancinoma. Report of a case and review of literature]. / Síndrome del cascanueces posterior: vena renal retroaórtica asociada a fístula arteriovenosa y carcinoma renal. A propósito de un caso y revisión de la literatura.

Vascular retroperitoneal alterations are little frequent and nevertheless, more diagnosed. We presented a case of association very little frequents in which a vascular congenital malformation is related to the presence of a renal arteriovenous fistula and a left renal carcinoma in a patient who only presented hematuria. These vascular variations must be considered at the moment for planning a surgery with the purpose of making it safer and to avoid complications. The case is discussed and literature is reviewed.

Síndrome del cascanueces posterior: Vena renal retroaórtica asociada a fístula arteriovenosa y carcinoma renal. A propósito de un caso y revisión de la literatura / Posterior nutcracker syndrome: retroaortic renal vein associated with arteriovenous fistula and renal cancinoma. Report of a case and review of literature

Las alteraciones vasculares del retroperitoneo son poco frecuentes y sin embargo, cada vez más diagnosticadas. Presentamos un caso de asociación muy poco frecuente en el que se relaciona una malformación congénita vascular con la presencia de una fístula arteriovenosa renal y un carcinoma renal izquierdo en una paciente que sólo presentó hematuria. Estas variaciones vasculares deben ser consideradas en el momento de planificar una cirugía con la finalidad de hacerla más segura y con menos complicaciones. Se discute el caso y se revisa la literatura (AU)

Vascular retroperitoneal alterations are little frequent and nevertheless, more diagnosed. We presented a case of association very little frequents in which a vascular congenital malformation is related to the presence of a renal arteriovenous fistula and a left renal carcinoma in a patient who only presented hematuria. These vascular variations must be considered at the moment for planning a surgery with the purpose of making it safer and to avoid complications. The case is discussed and literature is reviewed (AU)

[Squamous cell carcinoma in a duplicated renal pelvis after percutaneous nephrolithotomy]. / Carcinoma de células escamosas en pelvis renal bífida, tras nefrolitotomía percutánea.

OBJECTIVE: To describe the clinical case of a patient presenting a squamous cell carcinoma in a duplicated renal pelvis, after percutaneous nephrolithotomy. METHODS/RESULTS: 60-year-old male patient who was diagnosed of a squamous cell carcinoma of the renal pelvis in the pathological study of a lower pole nephrectomy after percutaneous nephrolithotomy for staghorn calculi in the left lower pole renal moiety. The patient suffered a bladder recurrence one year and a half later. A radical cystoprostatectomy was performed, but the patient died in a few months due to metastasis. CONCLUSIONS: Squamous cell carcinoma of the renal pelvis is a rare tumor with poor prognosis, associated with stone disease and chronic infection. Taking biopsies from suspicious lesions during percutaneous nephrolithotomy may help early diagnosis and improve survival.

Carcinoma de células escamosas en pelvis renal bífida tras nefrolitotomía percutánea / Squamous cell carcinoma in a duplicated renal pelvis after percutaneous nephrolithotomy

Objetivo: Describir un caso clínico de un paciente que presenta un carcinoma de células escamosas en una pelvis renal bífida, tras la realización de una nefrolitotomía percutánea. Métodos/Resultados: Paciente varón de 68 años de edad, diagnósticado de carcinoma escamoso de pelvis renal, tras el estudio histológico de una nefrectomía polar inferior posterior a una nefrolitotomía percutánea por una litiasis coraliforme en hemirriñón izquierdo. El paciente sufrió una recidiva vesical un año y medio más tarde, se practicó una cistoprostratectomía radical, pero el fallecimiento se dio a los pocos meses ante la presencia de metástasis. Conclusiones: El carcinoma de células escamosas de pelvis renal, es un tumor raro y de mal pronóstico, generalmente asociado con enfermedad litiásica e infección crónica. La realización de biopsias de zonas sospechosas durante la nefrolitotomía percutánea puede ayudar al diagnóstico precoz del tumor, con la consiguiente mejoría de la supervivencia (AU)

Objective: To describe the clinical case of a patient presenting a squamous cell carcinoma in a duplicated renal pelvis, after percutaneous nephrolithotomy. Methods/Results: 60-year-old male patient who was diagnosed of a squamous cell carcinoma of the renal pelvis in the pathological study of a lower pole nephrectomy after percutaneous nephrolithotomy for staghorn calculi in the left lower pole renal moiety. The patient suffered a bladder recurrence one year and a half later. A radical cystoprostatectomy was performed, but the patient died in a few months due to metastasis. Conclusions: Squamous cell carcinoma of the renal pelvis is a rare tumor with poor prognosis, associated with stone disease and chronic infection. Taking biopsies from suspicious lesions during percutaneous nephrolithotomy may help early diagnosis and improve survival (AU)