Adverse Events and Complications After Primary ACL Reconstruction With Quadriceps Tendon Autograft: A Systematic Review.

Background: Anterior cruciate ligament reconstruction (ACLR) surgery with quadriceps tendon (QT) grafts, both with and without a patellar bone plug, have gained popularity in recent years in the primary and revision settings. Postoperative complications occur with the use of QT autografts. Purpose: To systematically review the incidence of postoperative complications after primary ACLR QT autograft and compare complication rates in patients undergoing all-soft tissue QT grafts versus QT grafts with a patellar bone plug (QTPB). Study Design: Systematic review; Level of evidence, 4. Methods: A literature search using the 2020 PRISMA guidelines was performed by querying PubMed, Embase, and Scopus databases from database inception through August 2022. Included were evidence level 1 to 4 human clinical studies in English that reported complications after primary ACLR with QT autograft. The incidence of complications within the included studies was extracted. Differences in the incidence of postoperative complications between ACLR with QT with and without a patellar bone plug were calculated. Results: A total of 20 studies from 2004 to 2022, comprised of 2381 patients (2389 knees; 68.3% male) with a mean age of 27 years (range, 12-58 years), were identified. The mean follow-up was 28.5 months (range, 6-47 months). The total incidence of complications was 10.3%, with persistent postoperative knee pain being the most common (10.8%). Patients who underwent ACLR with all-soft tissue QT grafts had a 2.7-times increased incidence of anterior knee pain (23.3% vs 8.6%) and reoperations (5.9% vs 3.2%) when compared with QTPB grafts (P < .01 for both). There was no appreciable difference in total complications, graft failures, ACLR revisions, cyclops lesions, or range of motion deficit (P > .05 for all). Patellar fractures occurred exclusively after QTPB (2.2%). Conclusion: Complications after primary ACLR using QT autograft were recorded in 10.5% of knees, with anterior knee pain being the most common. No difference was reported in the overall incidence of complications with the use of the QT versus QTPB grafts; however, anterior knee pain was 2.7 times greater with use of a soft tissue quadriceps graft.

Current Concepts in Patellar Tendinopathy: An Overview of Imaging, Pathogenesis, and Nonoperative and Operative Management.

¼ Approximately 1 in 3 high-impact athletes develops patellar tendinopathy (PT), with the proximal insertion of the patellar tendon being the most commonly affected anatomical site.¼ Nonoperative treatment options are effective in reducing pain and restoring functionality in most patients with PT. However, operative intervention should be considered when conservative management fails.¼ A comprehensive review of the literature on surgical procedures, including both open and arthroscopic approaches, was conducted with a specific focus on clinical outcomes and return to sports.¼ Both open surgery and arthroscopic surgery for PT have demonstrated favorable success rates and return-to-sport outcomes, with arthroscopic treatment potentially expediting the recovery process.

Higher Rates of Residual Postoperative Instability after Anterior Cruciate Ligament Reconstruction in Female Patients: A Systematic Review of Level II Studies.

Purpose: To compare revision rates and residual postoperative instability after anterior cruciate ligament (ACL) reconstruction based on biological sex. Methods: A systematic review was conducted according to the 2020 PRISMA guidelines. PubMed, Embase, MEDLINE, and Cochrane library databases were queried from database inception through October 2022. Level I and II prospectively-enrolling human clinical studies that compared revision rates and physical examination of postoperative stability after ACL reconstruction between male and female patients were included. Outcomes were stratified by patient sex and quantitatively compared using a χ2 test. Study quality was assessed using the MINORS criteria. Results: Four studies consisting of 406 patients (50% males) with a mean age of 25 years (range, 13.9-62 years) were identified. Mean follow-up time was 34.4 months (range, 22-60 months). Hamstring tendon autografts were used in 62% of ACL reconstructions in males and in 65% of ACL reconstructions in females, whereas bone-patellar tendon-bone autografts were used in 38% and 35% of procedures in males and females, respectively. A residual positive Lachman test result was more frequently reported among females compared to males (5.8% vs 0.6%; P = 0.03). No significant difference in revision rates or residual pivot-shift on examination was observed between males and females (P = 0.38 and P = 0.08, respectively). Conclusion: Female patients undergoing ACL reconstruction have higher reported rates of residual anterior instability with Lachman than male patients. However, no sex-based differences were identified with residual pivot-shift on examination or rate of revision ACL surgery. Level of Evidence: II; Systematic Review of level II studies.

Snapping Hip Syndrome: Pathoanatomy, Diagnosis, Nonoperative Therapy, and Current Concepts in Operative Management.

¼ Asymptomatic snapping hip affects 5% to 10% of the population; when pain becomes the primary symptom, it is classified as snapping hip syndrome (SHS).¼ The snap can be felt on the lateral side of the hip (external snapping hip), often attributed to an iliotibial band interaction with the greater trochanter, or on the medial side (internal snapping hip), often attributed to the iliopsoas tendon snapping on the lesser trochanter.¼ History and physical examination maneuvers can help distinguish the etiology, and imaging may help confirm diagnosis and rule out other pathologies.¼ A nonoperative strategy is used initially; in the event of failure, several surgical procedures are discussed in this review along with their pertinent analyses and key points.¼ Both open and arthroscopic procedures are based on the lengthening of the snapping structures. While open and endoscopic procedures both treat external SHS, endoscopic procedures typically have lower complication rates and better outcomes when treating internal SHS. This distinction does not appear to be as noticeable in the external SHS.

Reproducibility of Bartonícek and Haraguchi classifications of the posterior malleolus fractures.

BACKGROUND: Two of the most commonly used classifications for the posterior malleolus fracture are Haraguchi and Bartonícek. Both classifications are based on the morphology of the fracture. This study makes an inter- and intra-observer agreement analysis of the mentioned classifications. METHODS: 39 patients with ankle fractures who met inclusion criteria were selected. All the fractures were analyzed and classified twice by each of the 20 observers using Bartonícek and Haraguchi's classifications, with a window period of at least 30 days between the two rounds. RESULTS: Analysis was made by Kappa coefficient (ƙ). The global intraobserver value was ƙ = 0.627 in the Bartonícek classification and ƙ = 0.644 in the Haraguchi one. The first round global interobserver ƙ = 0.589 (0.574-0.604) on the Bartonícek classification and ƙ = 0.534 (0.517-0.551) on the Haraguchi one. Second round coefficients were ƙ = 0.601 (0.585-0.616) and ƙ = 0.536 (0.519-0.554), respectively. The best agreement was when there was involvement of the posteromedial malleolar zone with ƙ = 0.686 and ƙ = 0.687 in Haraguchi II and ƙ = 0.641 and ƙ = 0.719 in Bartonícek III. No differences were observed in Kappa values when an experience-based analysis was made. CONCLUSION: Bartonícek and Haraguchi classifications of the posterior malleolus fracture have both substantial intraobserver agreement but moderate to substantial agreement in interobserver analysis. LEVEL OF EVIDENCE: IV.

Complication Rates After Medial Patellofemoral Ligament Reconstruction Range From 0% to 32% With 0% to 11% Recurrent Instability: A Systematic Review.

PURPOSE: To review the incidence of complications following primary medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. METHODS: A literature search was conducted by querying PubMed and Scopus databases from database inception through August 2022 according to the 2020 Preferred Reporting Items for Systematic Review and Meta-analysis guidelines using the terms "Medial Patellofemoral Ligament," "MPFL," "reconstruction," "patellar," and "instability." Inclusion criteria included studies reporting complications following primary MPFL reconstruction for recurrent patellar instability. Exclusion criteria consisted of studies reporting on patients undergoing concurrent osteotomy procedures, revision reconstruction, and biomechanical or anatomic studies. The incidence of specific complications was aggregated from the included studies. RESULTS: Twenty-eight studies, consisting of 1,478 patients (n = 1521 knees), with a mean age of 23.3 years (mean range, 19-34.3 years) were identified. The overall incidence of complications ranged from 0% to 32.3% of knees. Failure ranged from 0% to 10.7% of knees, whereas patellar fractures occurred in 0% to 8.3% of knees, primarily in patients treated with full-length transverse tunnel or 2-tunnel techniques. All patellar fractures occurred in patients with patellar tunnels ranging from 4.5 to 6.0 mm in diameter. The incidence of postoperative knee stiffness/range of motion deficit ranged from 0% to 20%. Persistent anterior knee pain, ranged from 0% to 32.3%. CONCLUSIONS: Complications following primary MPFL reconstruction ranged from 0% to 32.3% of knees, primarily consisting of residual anterior knee pain. Failure ranged from 0% to 10.7% of knees, whereas patellar fractures were reported in 0% to 8.3% of knees. Fractures primarily occurred with a full-length transverse tunnel or 2-tunnel techniques, whereas all fractures occurred with patellar tunnels ranging from 4.5 mm to 6.0 mm in diameter. LEVEL OF EVIDENCE: IV; Systematic Review of Level I-IV studies.

Biceps Tenodesis in Patients Age 35 Years and Younger Yields Favorable Clinical Outcomes With Variable Rates of Return to Sport and Complications: A Systematic Review.

PURPOSE: To systematically evaluate reported clinical outcomes, return-to-sport (RTS) rates, and complications following biceps tenodesis in patients aged 35 years and younger and compare outcomes between overhead and nonoverhead athletes. METHODS: A literature search was performed by querying Scopus, EMBASE, and PubMed computerized databases from database inception through August 2022 in accordance with the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Studies that evaluated clinical outcomes following biceps tenodesis in patients aged 35 years or younger were included. Study quality was assessed via the Methodological Index for Non-Randomized Studies criteria. Clinical outcomes, RTS rates, and complications were aggregated. RESULTS: Nine studies from 2011 to 2022 comprising 161 patients (mean age, 25 years; range, 19.7-28.9 years) were included. At an average follow-up of 59 months, postoperative American Shoulder and Elbow Surgeons score ranged from 81.6 to 96 and the mean visual analog scale score ranged from 0 to 2.1. Mean overall RTS rate ranged from 35% to 100% for the entire patient cohort 35% to 86% among overhead athletes, and 46% to 100% among nonoverhead athletes. Among the overhead athletes, 24 were baseball pitchers. 17% to 100% able to return to sport at any level. Complications were reported in 0% to 19% of patients. 0 to 18% of patients underwent revision surgery. CONCLUSIONS: Biceps tenodesis in patients 35 years of age and younger yields a wide variability in reported RTS rates, excellent clinical outcome scores, and low but variable reported rates of complications, reoperations, and failure. LEVEL OF EVIDENCE: IV; Systematic Review of Level III and IV studies.

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.

Validación de la versión española del cuestionario King's Health para la evaluación de la calidad de vida relacionada con la incontinencia urinaria en pacientes con lesión medular / Validation of the Spanish version of the King's Health questionnaire for evaluating quality of life related to urinary incontinence in patients with spinal cord injury

Background and objective: To determine the validity of the Spanish version of the King's Health Questionnaire (KHQ) in patients with spinal cord injury. Patients and methods: A cross-sectional study, including a total of 120 patients with spinal cord injury. The feasibility, cross-cultural validity, and internal consistency of the KHQ were evaluated. Results: The dimensions with the highest scores were: impact of urinary symptoms, personal relations, and physical limitations. The following groups presented a significantly poorer HRQoL: persons of advanced age in personal relations (P=0.042), women in limitations of daily life activities (P=0.009) and in the impact of urinary incontinence (P<0.01), paraplegic patients in personal relations, and patients with incomplete cord lesions in sleeping and energy (P<0.01). Patients with an external condom catheter presented a better HRQoL with significant differences in the dimension, limitations of daily life activities (P=0.04). The KHQ showed good internal consistency (Cronbach alpha 0.91). Conclusion:KHQ is a valid instrument for evaluating HRQoL related with urinary incontinence in patients with spinal cord injury (AU)

Fundamento y objetivo: Evaluar la validez de la versión española del King's Health Questionnaire (KHQ) en pacientes lesionados medulares (LM). Pacientes y método: Estudio transversal de 120 pacientes con lesión medular. Se evaluaron propiedades de factibilidad, validez transversal y consistencia interna del cuestionario KHQ. Resultados:Las dimensiones con mayor puntuación fueron: “impacto de síntomas urinarios”, “relaciones personales” y “limitaciones físicas”. Presentaron peor calidad de vida: pacientes de mayor edad, en las relaciones personales (p=0,042); las mujeres, en las limitaciones de las actividades de la vida diaria (p=0,009) y el impacto de la incontinencia urinaria (p<0,01); los parapléjicos, en las relaciones personales y las lesiones incompletas en el sueño y energía (p<0,01). Presentaron mejor calidad de vida: pacientes con colector permanente, siendo las diferencias significativas en la dimensión de “limitaciones en las actividades cotidianas” (p=0,04). La consistencia interna del cuestionario fue buena (alfa Cronbach 0,91). Conclusión: El KHQ es un instrumento válido para evaluar la calidad de vida relacionada con la incontinencia urinaria en pacientes con LM (AU)

Eficacia y seguridad de la toxina botulínica administrada en el esfínter uretral externo vía transperineal guiada mediante ecografía transrectal y electromiografía en la retención urinaria crónica secundaria a una lesión medular / Efficacy and safety of botulinum toxin in external urethral sphincter by transperineal way guided transrectal ultrasound and electromyography on chronic urinary retention due to spinal cord injury

Fundamento y objetivo: Evaluar la eficacia y seguridad de la toxina botulínica en la hipertonía esfinteriana en pacientes con lesión medular (LM). Pacientes y método: Ensayo clínico no controlado en varones con hipertonía esfinteriana secundaria a LM. Se aplicaron 100 U de Botox® vía transperineal en esfínter uretral externo guiado con electromiografía y ecografía transrectal. Se determinaron los siguientes parámetros: volumen urinario residual (VR), presión uretral máxima de cierre (PUMc), volumen de micción (M) y porcentaje de micción (MP). Se valoró la incidencia de disfunción eréctil mediante cuestionario International Index of Erectil Function (IIEF-5 items). Resultados: Se incluyeron 19 varones, con una media de edad de 40 años (extremos 22-56). El tiempo medio de seguimiento fue de 546 días (20 meses). Se realizó una infiltración cada 6 meses de promedio, con una media de 2,7 infiltraciones por paciente (extremos 1-7). El VR disminuyó 59,3ml (p=0,03), la micción aumentó 52ml (p=0,018) y el MP mejoró el 17,2% (p=0,011), mientras que los cambios en PUMc no fueron significativos. No empeoró la disfunción eréctil presentada ya previamente (IIEF-5: 11,4 a 13). Conclusión: La infiltración con toxina botulínica aplicada a esfínter uretral externo vía transperineal parece ser una eficaz y segura opción terapéutica (AU)

Background: To assess the efficacy and safety of botulinum toxin for sphincter hypertonia in patients with spinal cord injury (SCI). Patients and methods: Non-control clinical trial on men with neurogenic detrussor-sphincter dyssynergia (DSD) due to SCI. 100 IU of Botox® were injected through the transperineal way on external urethral sphincter under electromyography and transrectal ultrasound guidance. The following parameters were determined: post-void residual (PVR), maximum urethral pressure (MUP), miction volume (M) and miction percentage (MP). The incidence of erectile dysfunction was evaluated using the International Index of Erectile Function questionnaire (IIEF-5 items). Results: 19 men with an average age of 40years (ED 22-56) were included. The average time of monitoring was 546days (20 months). As an average, an infiltration was done every 6 months, with an average of 2.7 infiltrations per patient (1-7). PVR dropped by 59.3ml, p=0.03; miction raised to 52ml, p=0.018; MP was improved by 17.2%, p=0.011. Changes on MUP were not significant. Erectile dysfunction was not worse than the initial one (IIEF-5: 11.4 to 13). Conclusion: The infiltration of the toxin into the sphincter through the transperineal way seems to be an effective and safe therapeutic option (AU)

[Validation of the Spanish version of the King's Health questionnaire for evaluating quality of life related to urinary incontinence in patients with spinal cord injury]. / Validación de la versión española del cuestionario King's Health para la evaluación de la calidad de vida relacionada con la incontinencia urinaria en pacientes con lesión medular.

BACKGROUND AND OBJECTIVE: To determine the validity of the Spanish version of the King's Health Questionnaire (KHQ) in patients with spinal cord injury. PATIENTS AND METHODS: A cross-sectional study, including a total of 120 patients with spinal cord injury. The feasibility, cross-cultural validity, and internal consistency of the KHQ were evaluated. RESULTS: The dimensions with the highest scores were: impact of urinary symptoms, personal relations, and physical limitations. The following groups presented a significantly poorer HRQoL: persons of advanced age in personal relations (P=0.042), women in limitations of daily life activities (P=0.009) and in the impact of urinary incontinence (P<0.01), paraplegic patients in personal relations, and patients with incomplete cord lesions in sleeping and energy (P<0.01). Patients with an external condom catheter presented a better HRQoL with significant differences in the dimension, limitations of daily life activities (P=0.04). The KHQ showed good internal consistency (Cronbach alpha 0.91). CONCLUSION: KHQ is a valid instrument for evaluating HRQoL related with urinary incontinence in patients with spinal cord injury.

[Efficacy and safety of botulinum toxin in external urethral sphincter by transperineal way guided transrectal ultrasound and electromyography on chronic urinary retention due to spinal cord injury]. / Eficacia y seguridad de la toxina botulínica administrada en el esfínter uretral externo vía transperineal guiada mediante ecografía transrectal y electromiografía en la retención urinaria crónica secundaria a una lesión medular.

BACKGROUND: To assess the efficacy and safety of botulinum toxin for sphincter hypertonia in patients with spinal cord injury (SCI). PATIENTS AND METHODS: Non-control clinical trial on men with neurogenic detrussor-sphincter dyssynergia (DSD) due to SCI. 100 IU of Botox® were injected through the transperineal way on external urethral sphincter under electromyography and transrectal ultrasound guidance. The following parameters were determined: post-void residual (PVR), maximum urethral pressure (MUP), miction volume (M) and miction percentage (MP). The incidence of erectile dysfunction was evaluated using the International Index of Erectile Function questionnaire (IIEF-5 items). RESULTS: 19 men with an average age of 40 years (ED 22-56) were included. The average time of monitoring was 546 days (20 months). As an average, an infiltration was done every 6 months, with an average of 2.7 infiltrations per patient (1-7). PVR dropped by 59.3 ml, p=0.03; miction raised to 52 ml, p=0.018; MP was improved by 17.2%, p=0.011. Changes on MUP were not significant. Erectile dysfunction was not worse than the initial one (IIEF-5: 11.4 to 13). CONCLUSION: The infiltration of the toxin into the sphincter through the transperineal way seems to be an effective and safe therapeutic option.

[Urological outcome of patients with sacral agenesis: 20 years follow-up]. / Evolución urológica de pacientes con agenesia de sacro: 20 años de seguimiento.

OBJECTIVES: Complete or partial sacral agenesis is a rare malformation consisting in the absence of one or more sacral vertebrae. It is part of a caudal regression syndrome and it may be associated with other congenital anomalies (Currarino Syndrome). It does not have an established etiology but is associated with insulin-dependent diabetes mellitus in the mother (1%). The objective of this is study was to retrospectively analyze the urological outcome of patients with sacral agenesis in our case series. METHODS: Retrospective analysis of 14 patients between 1975 and 2005. We evaluated reason for consultation, urological status, continence outcome, urological complications, hospital admissions and number of office visits. RESULTS: No patient had history of diabetic mother The number of male/female patients were similar. Mean age at first visit was 13.2 years and main reason for consultation was urinary incontinence. 60% of the patients presented associated myelomeningocele. 70% had a normal upper urinary tract at the beginning of follow-up; 10 patients presented some degree of incontinence (70%). Mean follow-up was 19.7 years (7-30): 50% of the patients keep a normal upper urinary tract. All of them have presented symptomatic urinary tract infection. The main urological reason for hospital admission was programmed surgery (7). The mean number of visits per year was 1.9. CONCLUSIONS: Sacral agenesis is a rare congenital malformation requiring an early diagnosis to avoid mid-term urological complications. These patients need life-long urological follow-up. The mean reason for consultation is urinary incontinence secondary to neurogenic bladder which may be satisfactorily treated in most cases.

Evolución urológica de pacientes con agenesia de sacro: 20 años de seguimiento / Urological outcome of patients with sacral agenesis: 20 years follow-up

OBJETIVO: La agenesia sacra total ó parcial es una malformación infrecuente que consiste en la ausencia de una ó más vértebras sacras. Forma parte del síndrome de regresión caudal y se puede asociar a otras anomalías congénitas (síndrome de Currarino). No tiene una etiología establecida pero se asocia a madres diabéticas insulinodependientes (1%). El objetivo de este estudio ha sido analizar retrospectivamente la evolución urológica de los pacientes con agenesia sacra de nuestra serie. MÉTODOS: Análisis retrospectivo de 14 pacientes entre 1975 y 2005. Se valoró el motivo de consulta, situación urológica y neurológica de entrada, tiempo de seguimiento, evolución de la continencia, complicaciones urológicas, ingresos hospitalarios y número de visitas ambulatorias. RESULTADOS: Ningún paciente tenía antecedentes de madre diabética. La distribución por sexos fue similar. Todos los casos fueron de agenesia total. La edad media en la primera visita fue de 13,2 años y el principal motivo de consulta fue la incontinencia urinaria. El 60% de pacientes presentaban mielomeningocele asociado. El 70% tenían el tracto urinario superior normal al inicio del seguimiento; 10 pacientes presentaban algún grado de incontinencia (70%). El tiempo medio de seguimiento ha sido de 19,7 años (7-30): el 50% de los pacientes mantienen el tracto urinario superior normal. El 65% de los pacientes se mantienen continentes. Todos han presentado infección urinaria sintomática. El motivo urológico principal de ingreso hospitalario ha sido la cirugía programada (7). El número medio de visitas anuales por paciente ha sido de 1,9. CONCLUSIONES: La agenesia de sacro es una malformación congénita infrecuente que requiere un diagnóstico precoz para evitar complicaciones urológicas a medio plazo. Estos pacientes son subsidiarios de un control urológico de por vida. El principal motivo de consulta es la incontinencia urinaria por vejiga neurógena que puede ser tratada satisfactoriamente en la mayoría de los casos

OBJECTIVES: Complete or partial sacral agenesis is a rare malformation consisting in the absence of one or more sacral vertebrae. It is part of a caudal regression syndrome and it may be associated with other congenital anomalies (Currarino Syndrome). It does not have an established etiology but is associated with insulin-dependent diabetes mellitus in the mother (1%). The objective of this is study was to retrospectively analyze the urological outcome of patients with sacral agenesis in our case series. METHODS: Retrospective analysis of 14 patients between 1975 and 2005. We evaluated reason for consultation, urological status, continence outcome, urological complications, hospital admissions and number of office visits. RESULTS: No patient had history of diabetic mother. The number of male/female patients were similar. Mean age at first visit was 13.2 years and main reason for consultation was urinary incontinence. 60% of the patients presented associated myelomeningocele. 70% had a normal upper urinary tract at the beginning of follow-up; 10 patients presented some degree of incontinence (70%). Mean follow-up was 19.7 years (7-30): 50% of the patients keep a normal upper urinary tract. All of them have presented symptomatic urinary tract infection. The main urological reason for hospital admission was programmed surgery (7). The mean number of visits per year was 1.9. CONCLUSIONS: Sacral agenesis is a rare congenital malformation requiring an early diagnosis to avoid mid-term urological complications. These patients need life-long urological follow-up. The mean reason for consultation is urinary incontinence secondary to neurogenic bladder which may be satisfactorily treated in most cases

Validez del cuestionario king's health para la evaluación de la calidad de vida en pacientes con incontinencia urinaria / Validity of the king's Health Questionnaire in the assessment of quality of life in patients with urinary incontinence

Fundamento: Evaluar la validez de la versión española del cuestionario de calidad de vida King's Health Questionnaire (KHQ) en mujeres con diferentes tipos de incontinencia urinaria (IU). Pacientes y métodos: Se seleccionó consecutivamente a 77 mujeres diagnosticadas por prueba urodinámica de incontinencia urinaria de esfuerzo (IUE), 51 de urgencia (IUU) y 34 mixta (IUM). Las pacientes completaron los cuestionarios KHQ y el SF-36 en el momento de la inclusión en el estudio, a los 15 días y al mes. Resultados: No se observaron diferencias significativas en las características sociodemográficas ni en la calidad de vida entre los diferentes tipos de IU. Las pacientes con IUU e IUM tenían una mayor frecuencia urinaria y urgencia miccional que las que presentaban IUE, y las pacientes con IUE e IUM tenían mayor número de escapes que las de IUU. Las correlaciones entre las dimensiones de los cuestionarios KHQ y SF-36 fueron moderadas a altas. Las mujeres con mayor frecuencia urinaria, más urgencia miccional, más episodios de incontinencia a la semana y uso de compresas y pañales percibían una peor calidad de vida. Los cambios en estas variables clínicas se correlacionaron con los cambios en la calidad de vida relacionada con la salud (CVRS). La consistencia interna de las dimensiones fue buena (0,65-0,92), así como la fiabilidad test-retest (0,68-0,88). Las dimensiones más sensibles al cambio después de un mes de tratamiento fueron el impacto de la IU, la gravedad de la IU y la escala de síntomas (tamaño del efecto superior a 0,6). Conclusión: El KHQ es un instrumento válido para evaluar la calidad de vida en pacientes con distintos tipos de IU. La mejoría en la frecuencia urinaria, urgencia miccional, número de escapes y el cambio en el tipo de material protector producen un aumento de la CVRS. (AU)