[Morbidity and risk factors of transrectal prostate biopsy]. / Morbilidad y factores de riesgo de la biopsia transrectal prostática.

OBJECTIVES: To evaluate the incidence of minor complications that rarely need treatment (haematuria, hematospermia and rectal bleeding) and major complications (fever and shock) in patients undergoing transrectal biopsy of the prostate and to identify risk factors. PATIENTS AND METHODS: We present an analytic and prospective study where we evaluated 146 patients subjected to transrectal biopsy of the prostate from December 2007 to September 2008. Complications rates and variables were analyzed. RESULTS: Eight patients (5,5%) suffered fever and seven (4,8%) of them were admitted. One of the patients (0,7%) suffered shock. The median of time between biopsy and fever was 3.5 days (1-10 days). Haematuria and hematospermia were more frequent in patients younger than 65 years (p<0.05) and fever and sepsis were more frequent in patients with prostate volume smaller than 55mL (p<0.05). CONCLUSIONS: The complications of the transrectal biopsy of the prostate are frequent, autolimited and they rarely suppose a health hazard for the patients. The most frequent are haematuria and hemospermia, specially in younger patients, whereas infectious complications are rarer and in our study are more frequent in patients with smaller prostates. We must take into account that the information to the patient is very important after a prostate biopsy, so we can avoid useless consultations (for example with haematuria) and it will enable to identify important signs like fever earlier.

Morbilidad y factores de riesgo de la biopsia transrectal prostática / Morbidity and risk factors of transrectal prostate biopsy

Objetivos: Analizar la incidencia de complicaciones menores que no requirieron tratamiento médico (hematuria, hematospermia y rectorragia) y mayores (fiebre y sepsis) en los pacientes sometidos a biopsia transrectal prostática (BTRP) e identificar posibles factores de riesgo. Material y métodos: Presentamos un estudio analítico, consecutivo, descripitivo, de una cohorte de 146 pacientes sometidos a BTRP desde diciembre de 2007–septiembre de 2008. Se analizaron los signos y síntomas que sufrieron y las variables edad, volumen prostático, resultado y el hecho de ser la primera biopsia o una sucesiva. Resultados: En ese periodo 8 (5,5%) de los pacientes sufrieron fiebre, 7 (4,8%) de los cuales requirieron ingreso, con una mediana de estancia hospitalaria de 3 días. Un paciente (0,7%) presentó shock séptico. La mediana del tiempo de latencia, entre la BTRP y la aparición de fiebre fue de 3,5 días (rango de 1–10 días). La hematuria y la hemospermia fueron más frecuentes en menores de 65 años (p<0,05) y la fiebre en los pacientes con volúmenes prostáticos menores de 55mL (p<0,05). Conclusiones: Las complicaciones de la biopsia transrectal prostática son frecuentes, autolimitadas y muy raramente ponen en peligro la vida del paciente. Las más frecuentes son la hematuria y la hemospermia, dándose en pacientes de menor edad, mientras que las complicaciones infecciosas son más raras y en nuestra muestra son más frecuentes en pacientes con volúmenes prostáticos menores. Consideramos de gran importancia informar al paciente de las complicaciones que pueden aparecer tras la BTRP, evitando así consultas innecesarias en los servicios de urgencias por los síntomas menores y permitiendo controlar precozmente el desarrollo de infecciones graves (AU)

Objectives: To evaluate the incidence of minor complications that rarely need treatment (haematuria, hematospermia and rectal bleeding) and major complications (fever and shock) in patients undergoing transrectal biopsy of the prostate and to identify risk factors. Patients and methods: We present an analitic and prospective study where we evaluated 146 patients subjected to transrectal biopsy of the prostate from December 2007 to September 2008. Complications rates and variables were analized. Results: Eight pacients (5,5%) suffered fever and seven (4,8%) of them were admitted. One of the pacients (0,7%) suffered shock. The median of time between biopsy and fever was 3.5 days (1–10 days). Haematuria and hematospermia were more frequent in patients younger than 65 years (p<0.05) and fever and sepsis were more frequent in patients with prostate volume smaller than 55mL (p<0.05). Conclusions: The complications of the transrectal biopsy of the prostate are frequent, autolimited and they rarely suppose a health hazard for the patients. The most frequent are haematuria and hemospermia, specially in younger patients, whereas infectious complications are rarer and in our study are more frequent in patients with smaller prostates. We must take into account that the information to the patient is very important after a prostate biopsy, so we can avoid useless consultations (for example with haematuria) and it will enable to identify important signs like fever earlier (AU)

[Does cystocele have a role in bladder outlet obstruction]. / ¿Es realmente el cistocele un factor de obstrucción infravesical?

INTRODUCTION: Controversy exists as to whether cystocele has a causative role in bladder outlet obstruction (BOO). OBJECTIVE: To assess the relationship between cystocele and bladder outlet obstruction. MATERIALS AND METHODS: Two hundred women undergoing a urodynamic study from December 2007 to December 2008 were retrospectively assessed. Patients were divided into two groups: Group A: Patients with no cystocele (Grade 0) and Grade I cystocele Group B: Patients with Grade II-IV cystocele. EXCLUSION CRITERIA: 1. Absence of flowmetry or voided volume < 150 ml. 2. Neurological disorders. 3. History of urogenital surgery. Bladder outlet obstruction was defined as follows: Postvoid residue (PVR) > 20%; peak flow (Qmax) < 15 ml/sec; detrusor pressure at maximum flow (PdetQmax) > 25 cm H2O. RESULTS: Group A included 64% of patients, and Group B the remaining 36%. A pathological PVR > 20% was found in 26.6% and 40.3% of patients in Group A and Group B respectively (p=0.04). A Qmax < 15 mL/sec was seen in 15.6% and 27.8% of Group A and Group B patients respectively (p=0.03). A PdetQmax > 25 cm H2O was found in 26.3% and 47.8% of Group A and Group B patients respectively (p=0.01). CONCLUSIONS: A statistically significant association exists between cystocele and bladder outlet obstruction.

¿Es realmente el cistocele un factor de obstrucción infravesical? / Does cystocele have a role in bladder outlet obstruction?

Introducción: existen controversias con respecto a si la presencia de cistocele, y el grado de este, es un factor de obstrucción del tracto urinario inferior (TUI).Objetivos: valorar la relación entre el cistocele y la obstrucción infravesical. Material y métodos: evaluamos retrospectivamente a 200 mujeres sometidas a estudio urodinámico, entre diciembre de 2007 y diciembre de 2008.Se clasificó a las pacientes en 2 grupos: Grupo A: ausencia de cistocele (grado 0) y grado I. Grupo B: cistocele grado II-IV. Criterios de exclusión: 1. Ausencia de flujometría libre o volumen vaciado < 150 ml. 2. Existencia de patología neurológica. 3. Antecedentes de cirugía urogenital. Definimos obstrucción del TUI según los siguientes parámetros: volumen residual postmiccional (VRP) > 20%; flujo máximo (Qmáx) < 15 ml/s; y presión del detrusor en el flujo máximo (PDetQmáx) > 25 cmH2O. Resultados: el grupo A incluyó al 64,0% de las pacientes y el grupo B al 36% restante. Seapreció volumen residual postmiccional (VRP) patológico en el 26’6% en el grupo A y en el 40,3% en el grupo B (p= 0,04); Qmáx < 15ml/s en 15,6% en el grupo A y en el 27,8% en el grupo B (p= 0,03); PDetQmáx > 25 cmH2O en el 26,3% en el grupo A y en el 47,8% en el grupo B (p= 0,01). Conclusiones: existe una asociación estadísticamente significativa entre el cistocele y parámetros de obstrucción infravesical (AU)

Introduction: Controversy exists as to whether cystocele has a causative role in bladder outlet obstruction (BOO).Objective: To assess the relationship between cystocele and bladder outlet obstruction. Materials and methods: Two hundred women undergoing a urodynamic study from December 2007 to December 2008 were retrospectively assessed. Patients were divided into two groups: Group A: Patients with no cystocele (Grade 0) and Grade I cystocele Group B: Patients with Grade II-IV cystocele. Exclusion criteria: 1. Absence of flowmetry or voided volume < 150 ml.2. Neurological disorders. 3. History of urogenital surgery. Bladder outlet obstruction was defined as follows: Postvoid residue (PVR) > 20%; peak flow(Qmax) < 15 ml/sec; detrusor pressure at maximum flow (PdetQmax) > 25 cm H2O. Results: Group A included 64% of patients, and Group B the remaining 36%. A pathological PVR > 20% was found in 26.6% and 40.3% of patients in Group A and Group B respectively (p=0.04). A Qmax < 15 mL/sec was seen in 15.6% and 27.8% of Group A and Group B patients respectively (p=0.03). A PdetQmax > 25 cm H2O was found in 26.3% and 47.8% of Group Aand Group B patients respectively (p=0.01). Conclusions: A statistically significant association exists between cystocele and bladder outlet obstruction (AU)