Outcomes of a Series of Patients with Post-Prostatectomy Incontinence Treated with an Adjustable Transobturator Male System or Artificial Urinary Sphincter.

INTRODUCTION: A prospective evaluation of outcomes in a series of patients with post-prostatectomy incontinence (PPI) treated with two different devices is presented. METHODS: Consecutive patients with PPI underwent interventions with an adjustable transobturator male system (ATOMS) or artificial urinary sphincter (AUS). Decisions were based on patient preference after physician counselling. Patient characteristics and operative and postoperative parameters including dryness, satisfaction, complications, revision and device durability were evaluated. RESULTS: One hundred twenty-nine patients were included: 102 (79.1%) received ATOMS and 27 (20.9%) AUS. Mean follow-up was 34.9 ± 15.9 months. No difference was observed between patient age (p = 0.56), ASA score (p = 0.13), Charlson index (p = 0.57) and radiation (p = 0.3). BMI was higher for AUS (27.1 vs. 29.7; p = 0.003) and also baseline incontinence severity (7.9% mild, 44.1% moderate and 48% severe for ATOMS vs. 11.1% moderate and 88.9% severe for AUS; p = 0.0007). Differential pad test was higher for AUS (- 470 vs. - 1000 ml; p < 0.0001) and so was ICIQ-SF (15.62 vs. 18.3; p < 0.001), but total dryness (76.5 vs. 66.7%; p = 0.33), social continence (90.2 vs. 85.2%; p = 0.49) and satisfaction (92.2 vs. 88.9%; p = 0.69) were equivalent. The postoperative complication rate was similar (22.6 vs. 29.6%; p = 0.4). The surgical revision rate was higher for AUS (6.9 vs. 22.2%; p = 0.029) and also the explant rate but did not reach statistical significance (4.9 vs. 14.8%; p = 0.09). Time to explant was shorter for AUS (log-rank p = 0.021). Regression analysis revealed radiation (p = 0.003) and incontinence severity (p = 0.029) predict total dryness, while complications (p < 0.005) and type of device (p = 0.039) independently predict surgical revision. CONCLUSIONS: Both ATOMS and AUS are effective devices. Pad test change for AUS exceeds that of ATOMS. The revision rate is higher for AUS, and durability is superior for ATOMS. The satisfaction rate is equivalent. Larger series and longer follow-up are needed to compare both devices more appropriately. According to our experience, the AUS is not the only gold standard for PPI.

Systematic review and meta-analysis comparing Adjustable Transobturator Male System (ATOMS) and male Readjustment Mechanical External (REMEEX) system for post-prostatectomy incontinence.

OBJECTIVE: To assess the efficacy and safety of Adjustable Transobturator Male System (ATOMS) compared to male Readjustment Mechanical External (REMEEX) system for post-prostatectomy incontinence (PPI). MATERIAL AND METHODS: A systematic review and meta-analysis on adjustable device ATOMS compared to male REMEEX is presented. Studies on female or neurogenic incontinence were excluded. Primary objectives were evaluation of dryness (the proportion of patients with no-pad or one safety pad/day after device adjustment) and improvement between devices. Secondary objectives were complications and explant rate. They were estimated using a random-effect model. Statistical heterogeneity among studies was assessed using Cochran's Q test, Higgins's I2 statistics and tau2. RESULTS: Combined data of 29 observational studies with 1919 patients showed an equivalent proportion of patients treated with radical prostatectomy (p = .125) and previous radiation (p = .126). Dryness rate was 69.3% for ATOMS and 53.4% for male REEMEX (p = .008). Improvement rate was 90.8% for ATOMS and 80.2% for REMEEX (p = .007). Complication rate was 18.9% for ATOMS and 35.8% for REMEEX (p = .096) and explant rate was 5.5% for ATOMS and 13.9% for REMEEX (p = .027). Significant heterogeneity was evidenced, due to absence of randomized studies, variable incontinence severity baseline, difficulties for a common reporting of complications and difference in the follow-up. Differences observed between devices remained statistically significant when only studies with silicone-covered scrotal port (SSP) ATOMS and male REMEEX system II were considered. CONCLUSIONS: Despite the absence of direct comparison and the limitations observed ATOMS appears more effective than male REMEEX to treat PPI, and with less explant rate as reported in the literature.

Abdominal strength in voiding cystometry: a risk factor for recurrent urinary tract infections in women.

INTRODUCTION AND HYPOTHESIS: Recurrent urinary tract infections are a common condition in women. The aim of this study is the evaluation of lower urinary tract dysfunctions that are risk factors for recurrent urinary tract infections in women. METHODS: We conducted a case-control study in 49 women with recurrent urinary tract infections (rUTIs) and 49 control women without rUTIs, comparing the urinary symptoms and urodynamic data of both groups. RESULTS: The main significant differences between these groups were age (the women were older in the control group) and the value of abdominal pressure during voiding cystometry (this was higher in the group with rUTIs). After controlling age as a confounding factor, it was confirmed that the value of maximum abdominal pressure during voiding was the only factor to facilitate the rUTIs and the ideal cut-off was 28 cm H(2)O. CONCLUSIONS: Abdominal strength in the voiding phase constitutes a risk factor for recurrent urinary tract infections in women.

Endoscopic treatment of vesicoureteral reflux with non-simultaneous involuntary detrusor contraction in chronic spinal cord injury patients with neurogenic detrusor overactivity.

OBJECTIVE: To analyze whether it is correct to use endoscopic treatment via bulking agents of vesicoureteral reflux (VUR) seen on video urodynamics with non-simultaneous involuntary detrusor contraction in chronic spinal cord injury (SCI) patients with neurogenic detrusor overactivity (NDO). METHODS: A retrospective study was performed with a cohort of 76 patients (age 48.9 ± 14.4 years) (mean ± standard deviation) of both sexes with chronic SCI who underwent endoscopic treatment of VUR during the years 2008 to 2011. Patients were subjected to clinical examinations and video urodynamic studies preoperatively and 22 ± 11.4 months after the intervention. RESULTS: Resolution of VUR was achieved in 46 cases (61%). Cured patients had a statistically significant younger age and showed stress urinary incontinence more frequently. On the contrary, a greater grade of VUR, presence of bilateral reflux and presence of NDO were positively associated with treatment failure. The variables that independently influenced the cure of the reflux were NDO and reflux grade. CONCLUSIONS: The failure rate was high in patients with NDO, even though the reflux was not synchronous with involuntary detrusor contraction, and therefore these patients should have NDO eradicated before doing any anti-reflux procedures.

Reliability of ambulatory urodynamics in patients with spinal cord injuries.

OBJECTIVE: To determine the test-retest repeatability of the urodynamic parameters commonly utilized in ambulatory urodynamics (AM) for patients with neurogenic lower urinary tract dysfunction (NLUTD). METHODS: A test-retest repeatability study was performed on 64 consecutive patients with stable spinal cord injuries who underwent two AM studies 24 hr apart. RESULTS: The mean age was 43.2 years, with 47 males and 17 females. A significant intraclass correlation coefficient (ICC) was found between the two studies with respect to the functional bladder capacity (FBC; 0.74), the maximum detrusor pressure during the involuntary detrusor contraction (P(detmaxIDC); 0.84), and the post-void residual (PVR; 0.76). Of note, the ICC of the end filling detrusor pressure (P(detfill)) was not significant (0.25). The correlation with respect to the presence of involuntary detrusor contraction (IDC) was significant but low (κ = 0.40). Based on the logistic regression analysis, the variables that influenced the concordance with respect to the presence of the IDC were P(detmaxIDC) (directly) and P(detmax) (inversely). The variable that that influenced the concordance with respect to P(detmaxIDC) was PVR (directly). The variable that influenced the concordance with respect to PVR was the FBC (directly). CONCLUSIONS: AM is reliable for the reproduction of the main urodynamic parameters investigated in patients with NLUTD, except for the end filling detrusor pressure, which was a non-reliable parameter. The concordance of AM can be improved primarily by taking into account the values of the maximum detrusor pressure during involuntary detrusor contraction (P(detmaxIDC)).

Usefulness of Dynamic Urethral Resistance Relation (DURR) measurement for differential diagnosis between static and dynamic urinary obstruction in male spinal cord injury patients.

OBJECTIVE: To study the validity of Dynamic Urethral Resistance Relation (DURR) for differential diagnosis between static and dynamic urinay obstruction in male spinal cord injury patients. METHODS: A case-control study was conducted. The case group consisted of 24 male patients with spinal cord injury, aged under 40 years, with detrusor-periurethral sphincter dyssynergia and bladder outlet obstruction (BOO) according to the urethral resistance factor (URA). The control group consisted of 24 male patients with no neurological lesions, aged over 49 years, diagnosis of benign prostatic hyperplasia (BPH) and BOO according to Schäfer's minimum urethral opening pressure (Pmuo) and the URA. A pressure/flow study was performed in both groups, and the DURR was recorded graphically. RESULTS: Both groups showed significantly different DURR characteristics with respect to the number of spikes (higher in the case group), the intensity of the first three spikes and the maximum duration of the spikes (significantly longer in the case group). The patients in the case group had a DURR characterized by at least three spikes, located throughout the whole voiding cycle (pattern A). The patients in the control group had a DURR mainly characterized by a spike located at the start of micturition and a maximum second spike located at the end of micturition (pattern B). CONCLUSIONS: Pattern A showed a sensitivity with respect to the dynamic obstruction of 79% and a specificity of 100%. The sensitivity of pattern B with respect to the diagnosis of static obstruction was 71% and the specificity was 100%.

[Changes in detrusor contractility in bladder hyperreflexia]. / Afectación de la contractilidad del detrusor en la hiperreflexia vesical.

OBJECTIVES: Classically, it was understood detrusor contractility was affected in bladder areflexia but not in hyperreflexia. We aim to demonstrate that there is some detrusor contractility affectation in bladder hyperreflexias, although it may seem paradoxical at first sight. METHODS: Neuro-urologic study was performed in a series of 68 consecutive patients with bladder hyperreflexia (neurogenic detrusor hyperactivity), referred to the unit of functional urology for urodynamic evaluation. All patients underwent clinical history, post void residual determination, cystomanometry, voiding pressure-flow test, videourodynamics and selective EMG of the periurethral sphincter. Detrusor contractile potency was measured with W 80-20. Terminology follows the ICS standard. Data processing was performed using the statistical software SPSS 12.0. RESULTS: This series includes 14 males (58.8%) and 28 females (41.2%), of all ages (adults more frequent). 88.2% of the cases had acquired neurological diseases (trauma 30.9%; medical 33.8%; degenerative 35.3%), and 11.8% congenital neurological diseases (myelodysplasia). Most frequent type of neurological lesion was detrusor-sphincter dyssynergia: 59 cases (79.4%); 22 patients (32.4%) had undergone previous treatment of their vesicourethral dysfunction. The amplitude of detrusor involuntary contractions was wider in detrusor-bladder neck dyssynergia. Detrusor isotonic contractility (W 80-20) was significantly affected, mainly in neurological lesions of traumatic nature and less in degenerative lesions (p = 0.01). CONCLUSIONS: We demonstrated that bladder contractility is affected in bladder hyperreflexias (neurogenic detrusor hyperactivity), more important in traumatic lesions without relationship with the type of neurological associated lesion, which could be related to a bladder structural change, or with a change in the central neurological tracts (without requirement of presence of dyssynergia).

Afectación de la contractilidad del detrusor en la hiperreflexia vesical / Changes in detrusor contractility in bladder hyperrreflexia

Objetivo: Clásicamente se entendía que en las arreflexias vesicales existía una afectación de la contractilidad del detrusor, pero no así en las hiperreflexias vesicales. En nuestro trabajo se pretende demostrar que una afectación en la contractilidad del detrusor se presenta en las hiperreflexias vesicales, aunque a simple vista parezca paradójico. Método: Se realizó un estudio neurourológico en una serie consecutiva de 68 pacientes con hiperreflexia vesical (hiperactividad del detrusor neurogénica), remitidas a la unidad de Urología Funcional para valoración urodinámica. Todos los pacientes fueron sometidos a historia clínica, medición del residuo postmiccional, cistomanometría, test presión detrusor-flujo miccional, videourodinámica y EMG selectiva del esfínter periuretral. La potencia contráctil del detrusor se midió con W80-20. La terminología siguió las normas de la ICS. El procesamiento de los datos se realizó mediante el paquete estadístico SPSS 12.0. Resultados: La serie se refirió a 40 varones (58.8%) y 28 mujeres (41.2%), de todas las edades (más frecuentemente adultos). El 88.2% correspondió a patología neurológica adquirida (traumática 30.9%; médica 33.8%; degenerativa 35.3%), y 11.8 % a patología neurológica congénita (mielodisplasia). El tipo de lesión neurológica más frecuente fue la disinergia detrusor/esfínter periuretral: 59 casos (79.4%); 22 pacientes (32.4%) habían sido sometidos a tratamiento previo de la disfunción vesicouretral. La amplitud de las contracciones involuntarias del detrusor fue mayor en las disinergias detrusor/cuello vesical. La contractilidad isotónica del detrusor (W80-W20) estaba afectada significativamente sobre todo en las lesiones neurológicas de naturaleza traumática y menos en las degenerativas (p=0.01). Conclusiones: Se ha demostrado una afectación de la contractilidad vesical en las hiperrreflexias vesicales (hiperactividad del detrusor neurogénica), más acentuada en las lesiones de naturaleza traumática sin relación al tipo de lesión neurourológica asociada a la hiperreflexia vesical, que podía estar en relación con una alteración estructural vesical, o bien con una alteración a nivel de las vías neurológicas centrales (sin la necesidad de la existencia de una disinergia) (AU)

Objectives: Classically, it was understood detrusor contractility was affected in bladder areflexia but not in hyperreflexia. We aim to demonstrate that there is some detrusor contractility affectation in bladder hyperreflexias, although it may seem paradoxical at first sight. Methods: Neuro-urologic study was performed in a series of 68 consecutive patients with bladder hyperreflexia (neurogenic detrusor hyperactivity), referred to the unit of functional urology for urodynamic evaluation. All patients underwent clinical history, post void residual determination, cystomanometry, voiding pressure-flow test, videourodynamics and selective EMG of the periurethral sphincter. Detrusor contractile potency was measured with W 80-20. Terminology follows the ICS standard. Data processing was performed using the statistical software SPSS 12.0. Results: This series includes 14 males (58.8%) and 28 females (41.2%), of all ages (adults more frequent). 88.2% of the cases had acquired neurological diseases (trauma 30.9%; medical 33.8%; degenerative 35.3%), and 11.8% congenital neurological diseases (myelodysplasia). Most frequent type of neurological lesion was detrusor-sphincter dyssynergia: 59 cases (79.4%); 22 patients (32.4%) had undergone previous treatment of their vesicourethral dysfunction. The amplitude of detrusor involuntary contractions was wider in detrusor-bladder neck dyssynergia. Detrusor isotonic contractility (W 80-20) was significantly affected, mainly in neurological lesions of traumatic nature and less in degenerative lesions (p = 0.01). Conclusions: We demonstrated that bladder contractility is affected in bladder hyperreflexias (neurogenic detrusor hyperactivity), more important in traumatic lesions without relationship with the type of neurological associated lesion, which could be related to a bladder structural change, or with a change in the central neurological tracts (without requirement of presence of dyssynergia) (AU)

Prevalencia de alteraciones urodinámicas en las infecciones urinarias recidivantes de la mujer / Prevalence of urodynamic anomalies in women with urinary tract infection

OBJETIVO: Comprobar los datos urodinámicos en las pacientes con infecciones urinarias recidivantes en orden a demostrar una causa que las justifique. MÉTODOS: Se realiza un estudio transversal comparativo en una serie de 114 mujeres, de edad media 51.9 años (desviación típica: 23.5 años), divididas en dos grupos de 57 mujeres cada uno: grupo con infecciones urinarias recidivantes (ITU), y grupo sin infecciones urinarias recidivantes (no ITU). A las pacientes se les sometió a interrogatorio clínico, exploración física y estudio videourodinámico. Los datos fueron almacenados en una base de datos Access y posteriormente importados al programa de análisis estadísticos SPSS. Se aplicaron el test exacto de Fisher, Chi-Cuadrado de Pearson, y t de Student. Se calculó la curva ROC. Se elaboró un modelo multivalente de regresión logística. RESULTADOS: Únicamente se demostraron diferencias significativas en los valores del flujo miccional máximo (menor en el grupo ITU), volumen residuo postmiccional (mayor en el grupo ITU), y presión de la contracción involuntaria del detrusor (menor en el grupo ITU). No obstante, la única variable independiente fue el residuo postmiccional, constituyéndose las dos restantes en variables dependientes. El punto de corte ideal entre residuo postmiccional e infección urinaria correspondió a un residuo de 48.5 ml. El coeficiente de determinación del modelo fue de 0.13. No se demostraron relaciones significativas de las infecciones urinarias con (entre otras): la presencia y grado de cistocele, así como con la hiperactividad del detrusor e incontinencia urinaria de esfuerzo. CONCLUSIONES: El residuo postmiccional explicaría el 13 % de las infecciones urinarias recidivantes de la mujer. El resto se debería a otros factores no incluidos en el modelo (AU)

OBJECTIVES: To check the urodynamic data in patients with recurrent urinary tract infection in order to demonstrate a cause justifying them. METHODS: We performed a transverse comparative study in a series of 114 women, with a mean age of 51.9 yr. (typical deviation: 23.5 yr.), divided into groups of 57 women each: group I with recurrent urinary tract infection (UTI) and group II without recurrent urinary tract infection (no UTI). Patients underwent history , physical examination, and video-urodynamic study. All data were collected in an Access database and subsequently imported to the SPSS statistical analysis software. Fisher’s exact test, Pearson’s chisquare, and Student’s t-test were applied. ROC curve was calculated. A logistic regression multivalue model was elaborated. RESULTS: significant differences were only found in the values of maximum voiding flow (lower in the UTI group), post void residual volume (greater in the UTI group), and pressure of the involuntary detrusor contraction (lower in the UTI group). Nevertheless, post void residual was the only independent variable, becoming the other two dependent variables. The ideal cut point between post void residual and urinary tract infection was 48.5 ml. The determination coefficient for the model was 0.13. No significant relationships were found between urinary tract infection and, among others, presence and degree of cystocele, detrusor hyperactivity, and stress urinary incontinence. CONCLUSIONS: Postvoid residual would explain 13% of the recurrent urinary tract infection in women. The remainder would be secondary to other factors not included in the model (AU)

[Cystocele and stress urinary incontinence associated with lower urinary tract obstruction]. / Incontinencia urinaria de esfuerzo asociada a obstrucción del tracto urinario inferior en el cistocele.

OBJECTIVES: The association of stress urinary incontinence secondary to urethral hypermobility and lower urinary tract obstruction in the same patient with cystocele is rare, and even represents a contradiction. The objective of our work is to treat to define the characteristics that identify this entity, in comparison with isolated stress urinary incontinence or lower urinary tract obstruction in patients with cystocele. METHODS: We performed a retrospective study in 1168 cases of cystocele in which urodynamic studies were performed. All patients underwent history and neurological and uro-gynecologycal physical examination. The urodynamic study included uroflowmetry, cystomanometry, voiding pressure/flow tests and voiding cystourethrograms. All data were collected in an Excel 2000 database and statistical analysis was performed with the SPSS software. RESULTS: A- General data: 25 cases qualified for the study in group I (isolated stress urinary incontinence with urethral hypermobility); 24 cases in group II (lower urinary tract obstruction); and 14 cases in group III (astress urinary incontinence associated with lower urinary tract obstruction). The proportion of each group in the whole group of cystoceles corresponded to a 4/1/0.05 ratio respectively. Mean age was 58.4 years for group I, 68.2 for group II and 71.2 for group III. A Statistically significant lower age was demonstrated for group I (p < 0.0005). B- The symptom "sensation of vaginal lump" was less frequent in group I (32%). A significant difference was demonstrated (p = 0.02). C- Group I showed a lower increase of daily voiding frequency (32%), p = 0.02. D- Group I showed less night-time voiding frequency (1 episode)(p < 0.04). E- Urinary incontinence with cough was less frequent in group 1 (84%) (p = 0.0004). F- Group I had more bladder capacity (243.6 ml) (p < 0.05).G- Group I showed less urethral resistances (URA = 37.9 cm H2O) (p = 0.01). H- W80-W20 was higher in group I: 1.3 W/m2 (p < 0.05). I- The symptom "sensation of vaginal lump appeared more often in group II (70.8%) (p = 0.02). J- Radiological degree of cystocele was greater in group II1 (1.7) (p < 0.05). K- Detrusor hyperactivity was more frequent in group III (64.3%) (p = 0.00009). L- No significant differences were found between groups II-III when comparing type of obstruction. CONCLUSIONS: The group of isolated stress urinary incontinence (group I) is characterized by a younger age, less frequency of sensation of vaginal lump, less daily frequency and nocturia, and urodynamic data of greater bladder capacity, lower urethral resistance and normal detrusor contractility. The group of isolated lower urinary tract obstruction (group II) could be characterized by a more frequent sensation of vaginal lump and increase of the radiological cystocele. The group of stress urinary incontinence associated with lower urinary tract obstruction had a higher percentage of cases of detrusor hyperactivity. All these data might enable a proper identification of different risk elements in the groups.

Incontinencia urinaria de esfuerzo asociada a obstrucción del tracto urinario en el cistocele / Cystocele and stress urinary incontinence associated with lower urinary tract obstruction

Objetivo: La asociación de incontinencia urinaria de esfuerzo por hipermovilidad uretral y obstrucción del tracto urinario inferior en un mismo paciente con cistocele, es rara, e incluso presenta una apariencia contradictoria. El objetivo de nuestro trabajo consistiría en tratar de definir las características que permitieran identificar a esta entidad, frente a la incontinencia urinaria de esfuerzo y obstrucción del tracto urinario inferior aisladas, en pacientes con cistocele. Métodos: Se realizó un estudio retrospectivo en 1.116 de casos de cistocele sometidos a investigación urodinámica. Todas las pacientes fueron sometidas a historia clínica, exploración física neurourológica y uroginecológica. El estudio urodinámico consistió en una flujometría, cistomanometría, test presión detrusor/flujo miccional y cistouretrografías. Se recogieron los datos en el programa Excel 2000 y el tratamiento estadístico se realizó con el paquete SPSS. Resultados: A – Datos generales: Se clasificaron para este estudio en el grupo I (incontinencia de esfuerzo aislada por hipermovilidad uretral) 25 casos; en el grupo II (obstrucción tracto urinario inferior) 24 casos; y en el grupo III (incontinencia urinaria esfuerzo asociada a obstrucción tracto urinario inferior) 14 casos. La proporción de los tres grupos en la totalidad de los cistoceles, correspondió a una relación 4/1/0.05 para los grupos I-II-III respectivamente. La edad media correspondió a 58.4 años para grupo I, 68.2 para grupo II y 71.2 para el grupo III. Se demostró una diferencia significativa de menor edad para el grupo I (p<0.0005). B – El síntoma de sensación de bulto en vagina fue menor en el grupo I (32 %); se demostró una diferencia significativa de (p=0.02); C – El incremento de la frecuencia miccional diurna fue menor en el grupo I (32 %) p=0.02. D – La frecuencia miccional nocturna fue menor en el grupo I (1 episodio) (p<0.004). E – El síntoma de incontinencia urinaria a la tos fue más frecuente en el grupo I (84 %) (p=0.0004). F – Fue mayor en el grupo I la capacidad vesical (243.6 ml.) (p<0.05). G – El URA fue menor en el grupo I, con un valor de 37.9 cm. H2O (p=0.01). H – El W80-W20 fue mayor en el grupo I: 1.3W/m2 p<0.05. y mayor en el grupo II (70.8 %) (p=0.02). I – El grado radiológico de cistocele fue mayor en el grupo II (1.7) (p<0.05). J – La hiperactividad del detrusor fue más frecuente en el grupo III (64.3 %) (p=0.00009). K – No se demostraron diferencias significativas en el tipo de obstrucción entre los grupos II-III. Conclusiones: El grupo de incontinencia urinaria de esfuerzo aislada (grupo I) se caracterizaría por una menor edad, con una menor frecuencia de sensación de bulto en vagina, menor frecuencia miccional diurna y nocturna y unos datos urodinámicos de mayor capacidad vesical, menor resistencia uretral y contractilidad normal del detrusor. El grupo de obstrucción aislada del tracto urinario inferior (grupo II) se caracterizaría por una mayor frecuencia de bulto en vagina, e incremento del grado de cistocele radiológico. El grupo de incontinencia urinaria de esfuerzo asociada a obstrucción del tracto urinario inferior, se acompañó de un mayor porcentaje de casos de hiperactividad del detrusor. Todos estos datos podrían permitir la correcta identificación de los diferentes elementos de riesgo, en los distintos grupos (AU)

Objectives: The association of stress urinary incontinence secondary to urethral hypermobility and lower urinary tract obstruction in the same patient with cystocele is rare, and even represents a contradiction. The objective of our work is to treat to define the characteristics that identify this entity, in comparison with isolated stress urinary incontinence or lower urinary tract obstruction in patients with cystocele. Methods: We performed a retrospective study in 1168 cases of cystocele in which urodynamic studies were performed. All patients underwent history and neurological and uro-gynecologycal physical examination. The urodynamic study included uroflowmetry, cystomanometry, voiding pressure/flow tests and voiding cystourethrograms. All data were collected in an Excel 2000 database and statistical analysis was performed with the SPSS software. Results: A- General data: 25 cases qualified for the study in group I (isolated stress urinary incontinence with urethral hypermobility); 24 cases in group II (lower urinary tract obstruction); and 14 cases in group III (astress urinary incontinence associated with lower urinary tract obstruction). The proportion of each group in the whole group of cystoceles corresponded to a 4/1/0.05 ratio respectively. Mean age was 58.4 years for group I, 68.2 for group II and 71.2 for group III. A Statistically significant lower age was demonstrated for group I (p < 0.0005). B-The symptom “sensation of vaginal lump” was less frequent in group I (32%). A significant difference was demonstrated (p = 0.02). C- Group I showed a lower increase of daily voiding frequency (32%), p = 0.02. D- Group I showed less night-time voiding frequency (1 episode)(p < 0.04).E-Urinary incontinence with cough was less frequent in group I (84%) (p = 0.0004). F- Group I had more bladder capacity (243.6 ml) (p < 0.05).G-Group I showed less urethral resistances (URA = 37.9 cm H2O) (p = 0.01). H- W80-W20 was higher in group I: 1.3 W/m2 (p < 0.05). I-The symptom “sensation of vaginal lump appeared more often in group II (70.8%) (p = 0.02). J-Radiological degree of cystocele was greater in group II (1.7) (p< 0.05). K- Detrusor hyperactivity was more frequent in group III (64.3%) (p = 0.00009). L- No significant differences were found between groups II-III when comparing type of obstruction. Conclusions: The group of isolated stress urinary incontinence (group I) is characterized by a younger age, less frequency of sensation of vaginal lump, less daily frequency and nocturia, and urodynamic data of greater bladder capacity, lower urethral resistance and normal detrusor contractility. The group of isolated lower urinary tract obstruction (group II) could be characterized by a more frequent sensation of vaginal lump and increase of the radiological cystocele. The group of stress urinary incontinence associated with lower urinary tract obstruction had a higher percentage of cases of detrusor hyperactivity. All these data might enable a proper identification of different risk elements in the groups (AU)

[Prevalence of urodynamic anomalies in women with recurrent urinary tract infection]. / Prevalencia de alteraciones urodinámicas en las infecciones urinarias recidivantes de la mujer.

OBJECTIVES: To check the urodynamic data in patients with recurrent urinary tract infection in order to demonstrate a cause justifying them. METHODS: We performed a transverse comparative study in a series of 114 women, with a mean age of 51.9 yr. (typical deviation: 23.5 yr.), divided into groups of 57 women each: group I with recurrent urinary tract infection (UTI) and group II without recurrent urinary tract infection (no UTI). Patients underwent history, physical examination, and video-urodynamic study. All data were collected in an Access database and subsequently imported to the SPSS statistical analysis software. Fisher's exact test, Pearson's chi-square, and Student's t-test were applied. ROC curve was calculated. A logistic regression multivalue model was elaborated. RESULTS: significant differences were only found in the values of maximum voiding flow (lower in the UTI group), post void residual volume (greater in the UTI group), and pressure of the involuntary detrusor contraction (lower in the UTI group). Nevertheless, post void residual was the only independent variable, becoming the other two dependent variables. The ideal cut point between post void residual and urinary tract infection was 48.5 ml. The determination coefficient for the model was 0.13. No significant relationships were found between urinary tract infection and, among others, presence and degree of cystocele, detrusor hyperactivity, and stress urinary incontinence. CONCLUSIONS: Postvoid residual would explain 13% of the recurrent urinary tract infection in women. The remainder would be secondary to other factors not included in the model.

Validity of cuff-uroflow as a diagnostic technique for bladder outlet obstruction in males.

OBJECTIVE: To investigate the validity of the cuff-uroflow method as a diagnostic technique for bladder outlet obstruction (BOO) in males. MATERIAL AND METHODS: A cross-sectional study was carried out on a consecutive series of 93 males (mean age 54.1 years) referred on presenting with lower urinary tract symptoms. The patients were subjected to measurement of the isovolumetric pressure (Pcuff.op) and its corresponding flow (Qcuff.op) by means of the cuff-uroflow method. Subsequently, a study was carried out of the conventional pressure-flow, calculating the degree of BOO according to the provisional International Continence Society (ICS) nomogram. RESULTS: There was a statistical relationship between the Pcuff.op and Qcuff.op values and the degree of BOO according to the provisional ICS nomogram: patients with BOO had a lower value of Qcuff.op and a higher value of Pcuff.op than those without BOO. Using a logistic regression model a nomogram was constructed to link Pcuff.op with Qcuff.op. This nomogram was divided into three areas (obstructed, indeterminate and not obstructed). Most patients (44.1% of the sample) were situated in the indeterminate area. If those patients were excluded, the nomogram gave a sensitivity for the diagnosis of obstruction of 100% and a specificity of 55.6%. The overall rate of correct diagnosis was 84.6%. CONCLUSIONS: The parameters obtained using the cuff-uroflow method were related to the presence of BOO. According to the provisional ICS nomogram, this method showed a better sensitivity than specificity for the diagnosis of BOO.

Reproducibility of non-invasive urodynamics, using the cuff-uroflow, for the diagnosis of bladder outlet obstruction in males.

OBJECTIVE: To determine the repeatability of the parameters obtained from non-invasive urodynamics, using the cuff-uroflow, for the diagnosis of bladder outlet obstruction. MATERIAL AND METHODS: The study was carried out in a consecutive series of 34 males with functional urinary tract symptoms. The test-retest reproducibility of isometric pressure, flow in response to isovolumetric pressure and the energy transfer ratio obtained at two different times using the cuff-uroflow method was determined. RESULTS: Very good agreement for the flow in response to isovolumetric pressure measurement (intraclass correlation coefficient 0.96) and good agreement for the isovolumetric pressure measurement (intraclass correlation coefficient 0.87) and the energy transfer ratio (intraclass correlation coefficient 0.84) were demonstrated. The patients were classified into three groups according to the value of the energy transfer ratio, and it was found that there was very good agreement between the groups into which patients were classified as a result of the first and second measurements (kappa index 0.81). CONCLUSIONS: The parameters obtained with the cuff-uroflow are reliable and the energy transfer ratio allows one to classify patients into reproducible groups.