Urodynamic Differences between Complete and Incomplete Spinal Cord Injuries with Neurogenic Detrusor Overactivity.

OBJECTIVE: To analyze if there are urodynamic differences in patients with neurogenic detrusor overactivity (NDO) secondary to spinal cord injury (SCI) depending on whether the SCI is complete or incomplete according to the American Spinal Injury Association (ASIA) classification. METHODS: A retrospective and comparative study was carried out, including 194 patients with suprasacral SCI and NDO. Maximum cystometric capacity (MCC), volume at first involuntary contraction (VIC), compliance, maximum pressure of the detrusor during filling cystometry (MaxDetP), detrusor leak point pressure (LeakDetP) and postvoid residual urine volume (PVR) were analysed. Means were compared with Student t test for independent samples, with statistical significance p < 0.05. RESULTS: SCI was complete (ASIA A) in 51 patients (26.3%) and incomplete (ASIA B-E) in 143 (73.7%). The comparison of means showed significant differences regarding MCC (278.5 ± 102.6 mL in ASIA A vs. 321.6 ± 127.1 mL in ASIA B-E; p = 0. 018) and VIC (161 ± 85.1 and 210 ± 114.4 mL -respectively; p = 0.006). There were no differences regarding MaxDetP (58.8 ± 26.9 vs. 49.3 ± 35.6 cm H2O), LeakDetP (44.6 ± 25.3 vs. 48.3 ± 26.7 cm H2O), PVR (155.3 ± 94.2 vs. 118.5 ± 129.8) or compliance (29.9 ± 25.3 vs. 48.3 ± 26.7 cm H2O). CONCLUSIONS: In our serie incomplete SCI (ASIA B-E) showed differences from complete ones (ASIA A) regarding MCC and VIC, but not regarding LeakDetP, MaxDetP, PVR or compliance.

Adherence to the European Association of Urology Guidelines Regarding the Therapeutic Indications for the Treatment of Urinary Lithiasis: A Spanish Multicenter Study.

INTRODUCTION: Urinary lithiasis involves a major source of morbidity and economic costs. The aim of this study was to evaluate the adherence to the European Association of Urology Guidelines on Urolithiasis with regard to treatment among Spanish urologists. METHODS: A total of 723 patients were included in a prospective study between May 1, 2014, and July 31, 2014. The study involved 8 hospitals responsible of urolithiasis in a geographical area of Spain (Comunidad Valenciana) with approximately 4,500,000 inhabitants. Data were collected about the demographic characteristics of the patients, the characteristics of the stones, and the indicated treatment, in order to analyze the adherence to the clinical guidelines. A 90% threshold was used in concordance with the indications in the guidelines. RESULTS: Adherence to guidelines was poor in chemolysis, distal and ureteral calculi, and >2 cm renal calculi. Adherence was high in <2 cm renal calculi. CONCLUSIONS: In our study, the overall adherence to the clinical guidelines regarding the therapeutic indication for urinary lithiasis has been low. In the case of both renal and ureteral stones, the adherence in small lithiasis has been greater, compared with larger ones. In our survey, a trend has been observed in favor of endoscopic procedures even in large lithiasis.

Maintenance of the response to dimethyl sulfoxide treatment using hyperbaric oxygen in interstitial cystitis/painful bladder syndrome: a prospective, randomized, comparative study.

INTRODUCTION: Interstitial cystitis (IC)/painful bladder syndrome (PBS) is a difficult disease to manage and creates critical limitations in patients' daily lives. Our objective was to determine the efficacy of hyperbaric oxygen (HBO) therapy in the maintenance of response after the administration of intravesical dimethyl sulfoxide (DMSO). MATERIALS AND METHODS: We conducted an open, prospective, randomized, comparative pilot study with women diagnosed with IC/PBS according to the European Society for the Study of Interstitial Cystitis criteria. In the first phase, DMSO was given to all patients. In the second phase, we used 1:1 randomization and administered HBO to 10 women. The evaluated variables were pain (through a visual analog scale), frequency and urgency of voids, nocturia, and quality of life using the O'Leary-Sant Interstitial Cystitis Score/Problem Index and the King's Health Questionnaire. In the second phase, we measured the length of time that clinical improvement was maintained. RESULTS: The mean age was 47.6 years (SD 18.4). Out of 20 patients, 14 experienced clinical improvement after DMSO in all of the evaluated symptoms (p < 0.05; 95% CI). After the second phase, all patients who received HBO had a more substantive and prolonged maintenance of the effects of DMSO. CONCLUSIONS: In this study, HBO improved the maintenance of the beneficial effects of DMSO among women with IC/PBS.

Laparoscopic radiofrequency for small renal masses. What is the best imaging technique?

OBJECTIVES: The diagnosis of low clinical stage renal cancer has risen up during the last years thanks to the advances on radiological imaging tools. As a result, several minimally invasive techniques have appeared which offer the same oncological results than conventional/laparoscopic surgery without their morbidity. One of these techniques is percutaneous radiofrequency (RF). In this paper we expose the oncological and functional outcomes of percutaneous RF after a review of the literature. METHODS: We made a search using the principal medical libraries as the Cochrane Central of clinical controlled trials, Medline and the Excerpta Medica database.We used the following terms: "renal radiofrequency ablation US guided", "renal radiofrequency ablation CT guided ", "renal radiofrequency ablation MR guided"," renal radiofrequency ablation "," renal radiofrequency ablation image guided". A methodological and clinical expert analyzed each abstract.All studies where renal cancer or small renal masses were treated were included. We excluded series with hereditary renal cancer only or metastatic cancer, technical series and those where tumor recurrence or other oncological criteria were not evaluated. Data collection included patient age, tumor size, follow up and oncological data. The oncological data evaluated included: tumor local recurrence (radiological or pathologic evidence of residual disease after initial treatment, independently of time to recurrence, accordingly to the recommendations of the Working group on image guided tumor ablation) or distant metastases. RESULTS: There were a total of 1621 papers. Only 24 met the inclusion criteria, and we only found 1 controlled trial, and several retrospective studies and series of cases. A total of 11, 10 y 3 for US, CT and MR guided RF, respectively, with a follow up of 1-57 months, with a total of 1764 tumors in 1524 patients. Tumor size was 1 to 8.9cm and local recurrence between 0%-5.06%. CONCLUSIONS: Surgical treatment remains the "gold standard" for clinical stage I renal cancer because we do not have enough long term scientific information to be sure that percutaneous renal RF offers the same oncological results than surgery, but percutaneous renal RF is an option for those patients that are not candidates to surgery.

Radiofrecuencia percutánea renal, ¿qué técnica de imagen es la mejor? / Laparosocpic radiofrecuency for small renal masses

OBJETIVO: En la actualidad, gracias a las técnicas de diagnóstico por la imagen, se ha incrementado la cantidad de carcinomas renales (RC) de bajo estadio clínico (masas renales pequeñas, SRMs). En respuesta a ello, ha surgido una gran cantidad de técnicas mínimamente invasivas cuyo objetivo es ofrecer los mismos resultados oncológicos pero minimizar los efectos secundarios del tratamiento quirúrgico clásico o por laparoscopia. Una de estas técnicas es la Radiofrecuencia percutánea. En este trabajo se exponen las diferentes técnicas descritas para llevarla a cabo así como los resultados oncológicos y funcionales de la misma haciendo una revisión de la literatura existente. MÉTODOS: Se obtuvieron los estudios de las principales bibliotecas médicas existentes (Cochrane Central de Ensayos Controlados, Biblioteca Nacional de Medicina EE.UU. base de datos Excerpta Medica) .Para la búsqueda se utilizaron los siguientes términos: «renal radiofrequency ablation US guided», «renal radiofrequency ablation CT guided», «renal radiofrequency ablation MR guided», «renal radiofrequency ablation», «renal radiofrequency ablation image guided». Cada resumen se analiza por un experto metodológico y clínico. Se incluyeron los estudios con RC/ SRMs que fueron tratados por vía percutánea con radiofrecuencia guiada mediante US, CT o MR. Excluimos aquellas series sólo con pacientes con RC hereditario o metastásico, las series puramente técnicas y aquellas que no evaluaron la recurrencia del tumor o de otros criterios de valoración oncológicos fueron. La media de los datos relativos a la edad del paciente, tamaño del tumor, y la duración del seguimiento fueron extraídos de las series publicadas. Los resultados oncológicos que evaluamos fueron: recurrencia local del tumor (evidencia radiológica o patológica de enfermedad residual después del tratamiento inicial, sin importar el tiempo hasta la recurrencia, de acuerdo con las recomendaciones del Grupo de Trabajo sobre la ablación del tumor guiada por imágenes), o metástasis a distancia. RESULTADOS: Identificamos 1621 títulos. Después de la selección por el título y el resumen, se obtuvieron a continuación las copias completas de papel de 24 estudios que eran potencialmente elegibles para su inclusión en la revisión. De estos, se identificó sólo un estudio controlado aleatorizado, se identificaron varias series de casos y estudios retrospectivos. Un total de 11, 10 y 3 para RF guiada por ECO, TC y RMN respectivamente. Con un seguimiento global de 1-57 meses, un total de 1764 tumores en 1524 pacientes con un seguimiento de entre 1-56,4 meses. El tamaño de tumor tratado fue de 1-8,9cm siendo las tasas de recurrencia local de 0-15,06%. CONCLUSIONES: El tratamiento quirúrgico se mantiene como «patrón oro» para los tumores renales estadio clínico I, dado que actualmente no disponemos de suficiente evidencia científica a largo plazo como para aseverar que la RF percutánea puede llegar a sustituir a la cirugía, sin embargo, la RF ofrece una opción de tratamiento en aquellos pacientes que no son candidatos a cirugía con unas tasas de éxito adecuadas siempre que se haya superado la curva de aprendizaje de la técnica (AU)

OBJECTIVES: The diagnosis of low clinical stage renal cancer has risen up during the last years thanks to the advances on radiological imaging tools. As a result, several minimally invasive techniques have appeared which offer the same oncological results than conventional/laparoscopic surgery without their morbidity. One of these techniques is percutaneous radiofrequency (RF). In this paper we expose the oncological and functional outcomes of percutaneous RF after a review of the literature. METHODS: We made a search using the principal medical libraries as the Cochrane Central of clinical controlled trials, Medline and the Excerpta Medica database. We used the following terms: «renal radiofrequency ablation US guided», «renal radiofrequency ablation CT guided», «renal radiofrequency ablation MR guided», «renal radiofrequency ablation», «renal radiofrequency ablation image guided». A methodological and clinical expert analyzed each abstract.All studies where renal cancer or small renal masses were treated were included. We excluded series with hereditary renal cancer only or metastatic cancer, technical series and those where tumor recurrence or other oncological criteria were not evaluated. Data collection included patient age, tumor size, follow up and oncological data. The oncological data evaluated included: tumor local recurrence (radiological or pathologic evidence of residual disease after initial treatment, independently of time to recurrence, accordingly to the recommendations of the Working group on image guided tumor ablation) or distant metastases. RESULTS: There were a total of 1621 papers. Only 24 met the inclusion criteria, and we only found 1 controlled trial, and several retrospective studies and series of cases. A total of 11, 10 y 3 for US, CT and MR guided RF, respectively, with a follow up of 1-57 months, with a total of 1764 tumors in 1524 patients. Tumor size was 1 to 8.9cm and local recurrence between 0%-15.06%. CONCLUSIONS: Surgical treatment remains the «gold standard» for clinical stage I renal cancer because we do not have enough long term scientific information to be sure that percutaneous renal RF offersthe same oncological results than surgery, but percutaneous renal RF is an option for those patients that are not candidates to surgery (AU)

Are urology residents ready to treat premature ejaculation after their training?

INTRODUCTION: The management of premature ejaculation (PE) among urology residents (URs) in the era of standard definition and new treatments is unknown. AIM: To determine how future urologists currently address PE and to review their adherence to guidelines. METHODS: A specifically designed survey on the preferred approaches to the treatment of PE was given to residents during the Eighth European Urology Education Programme. The results were tabled, and descriptive statistics were used to analyze differences in practice patterns. MAIN OUTCOMES MEASURES: The responses are compared with clinical guidelines and recommendations. RESULTS: A total of 360 URs attended the recommendation course, and 140 answered the survey (response rate: 38.8%). Seventeen (12.1%) of the respondents considered PE to be a very common sexual dysfunction, 62 (44.3%) considered PE to be frequent, 33 (23.6%) considered this condition uncommon, and 28 (20%) did not consider PE to be a dysfunction. Regarding incidents, 67 residents (47.9%) treated one patient per week. To assess PE, 132 (94.3%) used sexual history, 37 (26.4%) used physical examination, 38 (27.1%) used questionnaires, and 4 (2.9%) used laboratory testing. The preferred initial management strategy for PE was psychological/behavioral therapy for 65 (46.4%) residents. Topical anesthetic, andrological referral, and prescription of selective serotonin reuptake inhibitors (SSRIs) on demand were favored by 34 (24.3%), 19 (13.6%), and 8 (12.9%) of the respondents, respectively. Other options were psychiatric referral, which was preferred by two (1.4%) respondents, and prescription of daily SSRIs, which was preferred by two (1.4%) respondents. The preferred secondary treatment for patients who did not improve initially was prescription of SSRIs for on demand, which was 46 (32.9%) respondents. In cases where patients had concomitant erectile dysfunction (ED), 16 (11.4%) URs treated only the ED and 60 (42.9%) treated both conditions. CONCLUSIONS: The majority of URs follow the established guidelines for diagnosis of PE, but not for treatment. The URs have an insufficient medical education in sexual medicine.

Oxigenoterapia Hiperbárica (OHB) en el manejo de la cistitis hemorrágica radioinducida / Hyperbaric Oxygen Therapy for the management of hemorrhagic radio-induced cystitis

OBJETIVO: La Cistitis rádica (CRAD) es una enfermedad inflamatoria vesical que se presenta de forma más grave como hematuria anemizante. Los tratamientos clásicos no consiguen controlar la enfermedad a medio-largo plazo ya que no actúan sobre su patogénesis. Evaluamos la respuesta clínica de pacientes con cistitis radioinducida tras ser tratados mediante Oxigenoterapia Hiperbárica.MÉTODOS: Estudio prospectivo en el que se incluyen 38 pacientes, 21 hombres y 17 mujeres, edades desde los 46 a los 75 (media de edad de 66.5 años) sometidos a radioterapia (RT) pélvica, diagnosticados de CRAD +/- proctitis radioinducida (PRAD) y que clínicamente referían hematuria, y síndrome miccional. El tratamiento se aplicó en una cámara de tipo multiplaza, los pacientes respiraban O2 al 100% a una presión ambiental de 2-2,5 ATAs (atmósferas de presión ambiental). Recibieron una media de 29.9 sesiones (rango 10-48 sesiones), el seguimiento medio fue de 56 meses (rango 4-72 meses).RESULTADOS: La hematuria se ha resuelto hasta la fecha de forma completa en 35 pacientes, un paciente presenta actualmente hematurias no anemizantes ocasionales, a razón de una 1 trimensual. Requiriendo reingreso 6 de ellos, 5 por hematuria anemizante y 1 por pielonefritis aguda obstructiva. El tratamiento fue bien tolerado por los pacientes, 1 experimentó barotrauma que requirió de miringotomía.CONCLUSIONES: La CRAD puede tratarse de forma satisfactoria mediante OHB, consiguiendo mejoría clínica, desde las primeras sesiones en la mayoría de ocasiones, con una tolerancia más que aceptable por parte de los pacientes(AU)

OBJECTIVES: Radio-induced cystitis (RADC) is an inflammatory bladder disease that presents as anemic-hematuria in its most serious form. Classic treatments can not control the disease in the mid-to-long term because they don`t treat the pathogenesis of the disease. Thus, we evaluated the effectiveness of hyperbaric oxygen (HBO) therapy as a potential treatment for patients with RADC.METHODS: This prospective study included 38 patients, 21 men and 17 women, mean age of 66.5 years (46-75), who had been subjected to pelvic radiotherapy (RT), with the diagnosis of RADC with or without radio-induced proctitis (RADP), gross hematuria and lower seurinarytract symptoms. HBO treatment was applied in a multi-place chamber; patients breathed pure oxygen (100%) at 2-2.5 atmospheres of pressure (ATAs). Patients received an average of 31.2 sessions (10-48 sessions) and the median follow-up period was 56 months (4-72 months).RESULTS: Hematuria was completely resolved in 34 of the 38 patients. After HBO 6 patients required readmission, 5 for anemic hematuria and 1 for acute obstructive pyelonephritis. In general, patients tolerated treatment well; however, one patient experienced barotrauma requiring myringotomy.CONCLUSIONS: HBO can be used to satisfactorily treat RADC, leading to clinical improvements that begin during the initial sessions in the majority of cases, and with a more than acceptable level of patient tolerance(AU)

Empleo de la oxigenoterapia hiperbárica en Urología / Hypebaric oxygen treatment in urology

OBJETIVO: La oxigenoterapia hiperbárica (OHB) se ha empleado de forma existosa en numerosas patologías que derivan de la hipoxia tisular gracias al aporte extra de oxígeno que permite a los tejidos.En este trabajo se realiza una revisión exhaustiva acerca de toda la literatura existente en 2010 en la que se emplea OHB en patología urológica.MÉTODOS: Realizamos una búsqueda en Medline introduciendo los términos “hyperbaric oxygen”, “radic cistitis”, “interstitial cistitys”, “ hemorraghic cistitys”, “urological/pelvic fistula” y “Fournier´s gangrene”.Las búsquedas se centraron en estudios en humanos únicamente publicados en cualquier idioma.RESULTADOS: 56 trabajos publicados, 1 ensayo clínico controlado aleatorizado (ECA), 7 revisiones (review) y 48 series de casos (SC) de los que tan solo uno fué prospectivo en los que se exponen a un total de 695 pacientes. Sólo en un estudio se emplearon mediciones de oxígeno tisular para definir la hipoxia. El número de las sesiones de terapia de oxígeno hiperbárico varió desde 4 hasta 44 sesiones. (media 19,2 sesiones/paciente)CONCLUSIONES: La evidencia que se extrae de la mayoría de trabajos consultados procede de series de casos, de modo que es baja, sin embrago, en la mayoría de estudios los resultados en cuanto al manejo de los pacientes es bueno o muy bueno así que parece que la OHB puede ser de gran utilidad en enfermedades urológicas que deriven de hipoxia tisular(AU)

OBJECTIVES: Hyperbaric oxygen therapy (HBO) has been successfully used in several disorders derived from tissue hypoxia, due to the extra oxygen supply to the tissues it enables.In this manuscript we performed a systematic review including all the existing data published until 2010 about HBO in urologic disorders.METHODS: We performed a Medline search using the terms “hyperbaric oxygen”, “radical cystitis”, “interstitial cystitis”, “hemorrhagic cystitis”, “urological/pelvic fistula” and “Fournier´s gangrene”. The search was restricted to human clinical trials published in any language. RESULTS: We found 56 papers: 1 randomized controlled trial, 7 reviews and 48 case reports; only one of them was a prospective study. A total of 695 patients were included. Just one study used tissue oxygen measurement to define hypoxia. The number of hyperbaric oxygen therapy sessions ranged from 4 to 44 (mean 19.2 sessions/patient).CONCLUSIONS: The level of evidence from most reviewed papers is low because most of them are case series. Nevertheless, results of most of those studies regarding patient management are good or very good. So it seems that HBO can be very useful in urological diseases related to tissue hypoxia(AU)

Hypebaric oxygen treatment in urology.

OBJECTIVES: Hyperbaric oxygen therapy (HBO) has been successfully used in several disorders derived from tissue hypoxia, due to the extra oxygen supply to the tissues it enables. In this manuscript we performed a systematic review including all the existing data published until 2010 about HBO in urologic disorders. METHODS: We performed a Medline search using the terms "hyperbaric oxygen", "radical cystitis", "interstitial cystitis", "hemorrhagic cystitis", "urological/pelvic fistula"and "Fournier's gangrene". The search was restricted to human clinical trials published in any language. RESULTS: We found 56 papers: 1 randomized controlled trial, 7 reviews and 48 case reports; only one of them was a prospective study. A total of 695 patients were included. Just one study used tissue oxygen measurement to define hypoxia. The number of hyperbaric oxygen therapy sessions ranged from 4 to 44 (mean 19.2 sessions/patient). CONCLUSIONS: The level of evidence from most reviewed papers is low because most of them are case series. Nevertheless, results of most of those studies regarding patient management are good or very good. So it seems that HBO can be very useful in urological diseases related to tissue hypoxia.