Consensus update on the therapeutic approach to patients with neurogenic detrusor overactivity.

INTRODUCTION AND OBJECTIVES: A Consensus document on the management of patients with neurogenic detrusor overactivity (NDO) was published in 2018. The present document aims to update its recommendations regarding treatment considering the new evidence available, and to contribute to the standardization of the management of this disorder. METHODS: The methodology used was based on a systematic review and the Nominal Group Technique. The clinical coordinator (CC) and the Consensus update group (CUG) defined the questions to be updated and carried out a systematic review to identify the new available evidence. After being evaluated by the expert panel, the relevant recommendations were updated and agreed in a consensus meeting. RESULTS: A total of 3210 publications were identified and 26 publications that met the inclusion criteria were included. The CUG updated 18 recommendations on the therapeutic approach to NDO. Unanimous consensus was reached on all of them. CONCLUSIONS: Previous recommendations need to be revised due to the availability of new drugs, the increasing evidence on the use of botulinum toxin or neuromodulation procedures, and new surgical options.

Microhamartomatosis biliar múltiple (complejos de von meyenburg): diagnóstico diferencial de metástasis en paciente oncológico / Multiple bile-duct microhamartomas (von meyenburg complexes): differential diagnosis of metastasis in an oncological patient

La microhamartomatosis biliar múltiple o enfermedad deVon Meyenburg es una malformación benigna que puede simular enfermedad metastásica hepática, fundamentalmente en pacientes oncológicos. Se presenta el caso clínico de un paciente con neoplasia colónica y hallazgos intraoperatorios de lesiones hepáticas compatibles macroscópicamente con metástasis que demostraron corresponder a esta entidad en el informe patológico. (AU)

Multiple bile-duct microhamartomas (Von Meyenburg disease) is a benign malformation that simulates metastatic liver disease,mainly in case of oncologic patients. We present a case of a patient with colon neoplasia and liver intraoperative findings compatiblewith metastases that finally corresponded to this entity in the pathological report. (AU)

[Monophasic Salmonella Typhimurium outbreak due to the consumption of roast pork meat]. / Brote de Salmonella Typhimurium monofásica asociada al consumo de carne asada de cerdo.

This report presents an outbreak of monophasic Salmonella enteric serovar Typhimurium fagotipe 4, 5, 12: i:-, in a motorcycle concentration in Valladolid. Information was collected to one hundred and twelve affected from seven Spanish Autonomous Communities. The epidemiological investigation associated the outbreak with the consumption of roast pork with sauce sandwiches sold at a street market in that event.

Diagnóstico y tratamiento del paciente con hiperactividad neurogénica del músculo detrusor. Revisión sistemática / A systematic review of the diagnosis and treatment of patients with neurogenic hyperactivity of the detrusor muscle

Introducción: La hiperactividad neurogénica del detrusor (HND) es una observación urodinámica caracterizada por contracciones involuntarias del detrusor durante la fase de llenado causada por una enfermedad neurológica subyacente. Las complicaciones frecuentes y graves que pueden derivar de la HND aconsejan la elaboración de protocolos asistenciales para el correcto manejo de enfermos con HND. Objetivo: El propósito de este trabajo es homogeneizar criterios para la toma de decisiones en el manejo de pacientes con diagnóstico o sospecha de HND, prestando atención a la medicina personalizada. Adquisición de la evidencia: Se realizó una revisión sistemática no exhaustiva de la literatura sobre aspectos del diagnóstico y tratamiento de la HND; a partir de ella, se emitieron recomendaciones por consenso nominal de un grupo de especialistas en Urología. Síntesis de la evidencia: En general, el diagnóstico de HND vendrá dado por una correcta historia clínica, la exploración física y el diario miccional antes de realizar cualquier investigación diagnóstica. Los objetivos principales del tratamiento son proteger el tracto urinario superior, restaurar la función del tracto inferior y mejorar la continencia y la calidad de vida de estos pacientes. El tratamiento consiste en varios escalones encaminados a obtener un correcto almacenamiento vesical que permita micciones suficientemente espaciadas en el tiempo. El seguimiento debe personalizarse según las necesidades de cada paciente. Conclusiones: La identificación y el manejo de la HND resultan importantes para reconducir positivamente la función del tracto urinario inferior, en cuanto a llenado y vaciado, y mejorar la calidad de vida de los pacientes con HND

Background: Neurogenic detrusor hyperactivity (NDH) is a urodynamic observation characterised by involuntary detrusor contractions during the filling phase that are caused by an underlying neurological disease. The common and severe complications that can result from NDH warrant the preparation of healthcare protocols for the proper management of patients with NDH. Objective: The aim of this study is to standardise the criteria for the decision-making process in the management of patients with diagnosed or suspected NDH, providing personalised medical care. Acquisition of evidence: We performed a systematic noncomprehensive literature review on the aspects of the diagnosis and treatment of NDH. Based on the review, recommendations were issued by nominal consensus of a group of urology specialists. Synthesis of the evidence: In general, the diagnosis of NDH is arrived at by a proper review of the medical history, physical examination and voiding diary before performing any diagnostic study. The main treatment objectives are to protect the upper urinary tract, restore function of the lower tract and improve these patients’ continence and quality of life. The treatment consists of several steps aimed at obtaining proper bladder storage that allows for sufficiently spaced voidings. The follow-up should be personalised based on each patient's needs. Conclusions: The identification and management of NDH is important for positively redirecting the function of the lower urinary tract, in terms of filling and voiding, thereby improving the patients' quality of life

A systematic review of the diagnosis and treatment of patients with neurogenic hyperactivity of the detrusor muscle. / Diagnóstico y tratamiento del paciente con hiperactividad neurogénica del músculo detrusor. Revisión sistemática.

BACKGROUND: Neurogenic detrusor hyperactivity (NDH) is a urodynamic observation characterised by involuntary detrusor contractions during the filling phase that are caused by an underlying neurological disease. The common and severe complications that can result from NDH warrant the preparation of healthcare protocols for the proper management of patients with NDH. OBJECTIVE: The aim of this study is to standardise the criteria for the decision-making process in the management of patients with diagnosed or suspected NDH, providing personalised medical care. ACQUISITION OF EVIDENCE: We performed a systematic noncomprehensive literature review on the aspects of the diagnosis and treatment of NDH. Based on the review, recommendations were issued by nominal consensus of a group of urology specialists. SYNTHESIS OF THE EVIDENCE: In general, the diagnosis of NDH is arrived at by a proper review of the medical history, physical examination and voiding diary before performing any diagnostic study. The main treatment objectives are to protect the upper urinary tract, restore function of the lower tract and improve these patients' continence and quality of life. The treatment consists of several steps aimed at obtaining proper bladder storage that allows for sufficiently spaced voidings. The follow-up should be personalised based on each patient's needs. CONCLUSIONS: The identification and management of NDH is important for positively redirecting the function of the lower urinary tract, in terms of filling and voiding, thereby improving the patients' quality of life.