Cognitive function assessment in elderly patients with overactive bladder treated with transdermal oxybutynin. / Evaluación de la función cognitiva en pacientes de edad avanzada con vejiga hiperactiva tratados con oxibutinina transdémica.

INTRODUCTION AND OBJECTIVES: Older patients with overactive bladder under antimuscarinic treatment are especially susceptible to cognitive impairment. The aim was to assess short term changes in cognitive function in elderly patients with overactive bladder treated with transdermal oxybutynin. MATERIALS AND METHODS: Observational, retrospective, multicentre study in patients with overactive bladder aged 65-80 years undergoing treatment with transdermal oxybutynin. Before and after one month of treatment, cognitive function using the Memory Alteration Test and Clock-Drawing Test, changes in symptoms with validated questionnaires, patient perception of treatment response using Treatment Benefit Scale and treatment adherence with the modified Morisky-Green test, were assessed. RESULTS: From 85 eligible patients, 70 completed the assessment (mean age: 71.4±4.5; BMI: 28.7±3.1kg/m2). No cognitive impairment was observed after one month with transdermal oxybutynin: Memory Alteration Test (+1 point; 95%CI: 0.0-1.5), Clock-Drawing Test (0 points; 95%CI: 0.0-0.0). A statistically significant improvement (P<.001) was observed in all urinary storage symptoms, except stress urinary incontinence. There was an improvement in the Bladder Control Self-Assessment Questionnaire (symptom score: -2.27; 95%CI: -2.8, -1.7; P<.001; bother score: -2.73; 95%CI: -3.3, -2.1; P<.001). 70% of patients reported either a stable or improved bladder condition according to the Patient Perception of Bladder Condition questionnaire. 72.8% of patients reported that their urinary problems had improved or greatly improved with an 84.3% treatment adherence. CONCLUSIONS: No cognitive impairment was observed in elderly patients after one month of treatment with transdermal oxybutynin; urinary urgency symptoms improved and there was adequate treatment adherence.

Assessment of the psychometric properties of the Spanish language version of questionnaire ICIQ-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS).

OBJECTIVES: To evaluate the psychometric properties of the Spanish version of the ICIQ-Male Lower Urinary Tract Symptoms Questionnaire (ICIQ-MLUTS): Feasibility (% of completion and ceiling/ground effects), reliability (Test-retest), convergent validity (vs Bladder Control Self-Assessment Questionnaire [BSAQ] and vs International Prostate Symptom Score [I-PSS]) and criterion validity (according to presence or absence of symptoms). MATERIAL AND METHODS: This was an observational, non-interventionist and multicenter study. 223 male patients with lower urinary tract symptoms (LUTS), predominantly storage symptoms and aged 18-65, took part in the study. Patients completed the ICIQ-MLUTS (test), I-PSS and BSAQ questionnaires and referred their urinary symptoms in a single visit, with the exception of a subgroup composed by 49 patients that completed the questionnaire again 15 days after initial visit to evaluate test-retest reliability. The questionnaire includes 13 items divided in 2 sub-scales: Voiding symptoms (V) from 0-20 and Incontinence symptoms (I) from 0-24. RESULTS: Percentage of patients that completed all items: 98.84%. Ground effect is 0 and ceiling effect was under 6% in both sub-scales. Test-retest reliability: Intraclass correlation coefficient (ICC) ranged from 0.68 to 0.88, except on Delay. Kappa shows a good agreement, between 0.60 and 0.81, except for Nocturia. Convergent validity: Correlation (Spearman) between the questionnaire sub-scales scores and the rest of measures is statistically significant (P < .01 and P < .05). Criterion validity: Statistically significant differences (P < .05) between scores on ICIQ-MLUTS, from patients that refer experiencing symptoms and those who do not. CONCLUSION: The Spanish version of the ICIQ-MLUTS questionnaire shows adequate feasibility, reliability and validity.

Evaluation of the Boll Weevil Anthonomus grandis Boheman (Coleoptera: Curculionidae) suppression program in the state of Goiás, Brazil.

The boll weevil Anthonomus grandis Boheman (Coleoptera: Curculionidae) is the most important cotton pest in Brazil. A large-scale field-testing of a Boll Weevil Suppression Program (BWSP) was implemented to assess its technical and operational feasibility for boll weevil suppression in the state of Goiás, Brazil. The pilot plan focused on 3,608 ha of cotton during the 2006/2007 and 6,011 ha in the 2007/2008 growing seasons; the areas were divided into four inner zones with an outer buffer zone. We analyzed data on boll weevil captures using pheromone traps installed in the BWSP fields, on the detection of the first insect and the first damaged floral bud, greatest damage, and number of insecticide applications. The nonparametric Mann-Whitney U test was used to evaluate the differences between presuppression and suppression years. Fourteen pheromone-baited trapping evaluations were used to compare the weevil populations from 2006/2007 and 2007/2008 growing seasons. The BWSP regime reduced in-season boll weevil captures from 15- to 500-fold compared to presuppression levels in the preceding year. The low capture rates were related to delays in infestation and damage by weevils. The smaller population size measured by trapping and field monitoring reduced the number of required insecticide treatments. The BWSP strategy was efficient in suppressing populations of this pest and is a viable program for cotton production in subtropical and tropical regions, with long-term economic and environmental benefits.

Reproductive dormancy in boll-weevil from populations of the midwest of Brazil.

The boll weevil (Anthonomus grandis Boheman) (Coleoptera: Curculionidae) is an introduced pest in Brazil, which in 30 yr has successfully expanded to various eco-regions and became the most important pest of cotton (Gossypium hirsutum, Malvaceae). Given the limited knowledge about the adaptive mechanisms that allowed successful establishment of the pest population in a tropical region, in this work we studied the potential of the Midwest population of boll weevils to enter a reproductive dormancy and identified the importance of the feeding source for induction of dormancy. We investigated morphological and physiological characters as indicators of the dormancy. We also investigated the occurrence of reproductive dormancy in boll weevils populations from cotton farms of the Midwestern region of Brazil during the cotton and noncotton seasons of 2009 and 2010. The studies revealed that boll weevils entered facultative reproductive dormancy; however, unlike what has been observed for boll weevils from temperate and subtropical regions, the hypertrophy of fat body and hexamerin levels did not straightly correlated to reproductive dormancy. The food source and field conditions during early adult development were decisive factor for the induction of reproductive dormancy. The incidence of reproductive dormancy increased progressively as the phenology of cotton plant advanced, reaching approximately 90% at the end of the crop season. During the noncotton season, the boll weevil was predominantly found in reproductive dormancy, especially females; however, there is evidence of use of multiple adaptive strategies to colonize the next harvest.

Cuidado crítico en la paciente obstétrica. Complicaciones, intervenciones y desenlace maternofetal / Critical care in the obstetric patient: Complications, interventions and maternal and fetal outcomes

Introducción A pesar de los grandes avances de la medicina, aún se siguen presentando muertes por causas obstétricas en todo el mundo, muchas de estas prevenibles, dado que existen fallas en el reconocimiento de las patologías obstétricas y no obstétricas que pueden comprometer el embarazo. Objetivo Describir las características de la paciente obstétrica crítica, su comportamiento, intervenciones y desenlace maternofetal. Materiales y métodos Estudio descriptivo retrospectivo de pacientes obstétricas que ingresaron en la Unidad de Cuidados Intensivos (UCI) de la Clínica de Maternidad Rafael Calvo de Cartagena, Colombia, durante un lapso de 28 meses. Se registraron las causas de ingreso, características de las pacientes, complicaciones por sistemas, intervenciones realizadas y mortalidad materna y perinatal. Resultados Ingresaron en el momento del estudio 214 pacientes. La edad promedia fue 24 años (DE±7,2). La principal causa de ingreso fueron los trastornos hipertensivos asociados al embarazo. La mediana de estancia en UCI fue de 4, con un rango intercuartil de 2–6 días. El 64,5% de las pacientes eran multíparas y solo el 50,5% tenía control prenatal. El 14% ingresaron embarazadas en la unidad. El 60% de las pacientes requirieron algún tipo de intervención. Las principales complicaciones que se encontraron fueron renales. La mortalidad del grupo estudiado fue del 8,4%. El 100% era multípara, el 61,1% no tenía control prenatal y el 27,7% era menor de 20 años. La mortalidad perinatal fue del 26,6%. Conclusión Nuestra UCI tiene un alto número de ingresos de pacientes obstétricas. Se encontró que las pacientes con peor desenlace fueron multíparas, sin control prenatal y requirieron más intervenciones (AU)

Abstract: Introduction: Despite major advances in medicine, deaths due to obstetric causes still occurworldwide. Many of these deaths are preventable since they are caused by failure to recognizeobstetric and non-obstetric disorders that can compromise pregnancy.Objectives: To describe the characteristics of critically-ill obstetric patients, as well ascomplications, interventions and maternal and fetal outcomes. Materials and methods: A retrospective, descriptive study of obstetric patients admitted intothe intensive care unit (ICU) of the Rafael Calvo Maternity Clinic of Cartagena, Colombia, overa 28-month period was performed. Causes for admission, patient characteristics, complicationsby organ system, the interventions performed, and maternal and perinatal mortality wereregistered. Results: A total of 214 patients were included in the study. The mean age was 24 years (SD±7.2).The main cause for admission was pregnancy-induced hypertension. The median length of ICUstay was 4 days (interquartile range: 2—6 days). Of these patients, 64.5% were multiparousand only 50.5% had documented antenatal care. Fourteen percent were admitted to the ICU while still pregnant. Sixty percent of the patients required some type of intervention. The maincomplications were renal. Mortality was 8.4%. Of the patients who died, all were multiparous,61.1% had no antenatal care and 27.7% were aged less than 20 years. Perinatal mortality was26.6%.Conclusions: Our ICU has a high admissions rate of obstetric patients. We found that patientswith poor outcomes were multiparous, without antenatal care and required a greater numberof interventions (AU)

Evidence of bacterial biofilms in nasal polyposis.

INTRODUCTION: The pathogeny of chronic rhinosinusitis with nasal polyposis (CRS/NP) has not been elucidated. Bacterial exotoxins have been implicated in many inflammatory chronic diseases, such as chronic otitis, chronic tonsillitis, cholesteatomas, and more recently CRS/NP. We propose that the bacteria in CRS/NP are not only present in a planktonic state, but also occur in microbial communities as biofilms. OBJECTIVE: To determine and characterize the presence of biofilms in CRS/NP. METHODS: We performed a prospective study in 12 patients undergoing endoscopic sinus surgery for nasal polyposis. Ten patients without CRS/NP who underwent septoplasty were included as a control group. Tissue samples were obtained from the inferior turbinate mucosae. The bacteria were isolated and typified and the material was examined in vitro using a spectrophotometer, and in vivo using optical microscopy and confocal scanning laser microscopy. RESULTS: Moderate to high in vitro biofilm-forming capacity was detected in 9 out of 12 patients with CRS/NP (mean [SD] optical density values of between 0.284 [0.017] and 3.337 [0.029]). The microorganisms isolated were Staphylococcus (5 patients), Streptococcus viridans, Pseudomonas aeruginosa, Enterococcus faecalis and Streptococcus viridans/Corynebacterium. Biofilms were demonstrated in vivo in 2 patients and no biofilm structures were evident in any of the controls. CONCLUSION: This study demonstrates the presence of bacterial biofilms in patients with CRS/NP. This chronic inflammatory factor might contribute to nasal mucosa damage, increased inflammatory cells in tissue, and the subsequent hyperplasic process.

[Importance of nocturia and its impact on quality of sleep and quality of life in patient with benign prostatic hyperplasia]. / Importancia de la nocturia y su impacto en la calidad del sueño y en la calidad de vida en el paciente con hiperplasia benigna de próstata.

INTRODUCTION: Nocturia is the main cause of insomnia or sleep interruption in adult men, which has a negative impact on daily activities, quality of life (QoL) and quality of sleep (QoS). The assessment of nocturia and its impact on QoL and QoS in patients suffering from benign prostatic hyperplasia (BPH) has been poor in terms of clinical research, moreover there is a lack of specific methods to assess this impact. OBJECTIVES: The objectives of BPH treatment should include the improvement of patient's QoL by controlling both diurnal and nocturnal symptoms. In order to assess how nocturia affects QoL and also QoS, some specific tools, such as N-QoL questionnaire or the number of Hours of Undisturbed Sleep (HUS), have been recently developed. Therefore, it would be interesting to assess how nocturia reduction due to LUTS/BPH treatment can impact on some objective parameters such as HUS and also how nocturia reduction improves QoS and QoL. This assessment should be developed during the application of pharmacological treatments in clinical practice by means of these specific tools. With the aim of tackling nocturia as an urologic problem in patients with LUTS/BPH, as well as knowing the physiology of sleep and the effect of nocturia on the sleep and QoL, a meeting of expert urologists, that gathered about fifty specialists of all around Spain, was held in Madrid. This article presents the main ideas and concepts exposed in this meeting. CONCLUSIONS: Nocturia is a symptom with a high prevalence in older patients with STUI/BPH. The PreNoc study has showed a Nocturia prevalence in Spain of 83% in patients > or =60 years old diagnosed of BPH. Nocturia is the most bothersome symptom in patients with STUI/BPH.

Quality-of-life assessment in patients with benign prostatic hyperplasia: effects of various interventions.

A literature search was conducted to review quality-of-life (QOL) measurement in patients with benign prostatic hypertrophy (BPH). The different QOL instruments are discussed in relation to their correlation with symptom evaluation in studies of treatment options for BPH. Symptom evaluation of BPH has been standardised internationally with the International Prostatic Symptom Score (IPSS), but there is neither agreement nor data to decide which QOL instrument is preferable. The most widely used QOL instrument is the disease-specific QOL single question added to the IPSS. Other QOL instruments have been used, but none has gained unanimous approval. The results of QOL assessments obtained from comparative clinical studies of treatment options for BPH are discussed. These studies compare treatment options such as watchful waiting, drug treatment and surgery. Disease-specific QOL domains (interference with daily activities) tend to improve more with treatment interventions than general health measures (i.e. general well-being). The use of QOL instruments to evaluate patients with BPH, and their many treatment options, is still open to debate with regard to which instruments are preferred and their importance to the clinical evaluation of the patient. The challenge remains to find an acceptable disease-specific QOL instrument that adds information to currently used disease measures of BPH.

[Vesico-scrotal hernia with hypocontractile detrusor]. / Hernia vesico escrotal con detrusor hipocontráctil.

OBJECTIVE: To present a case of massive inguinoscrotal hernia associated with low detrusor contractility. METHODS/RESULTS: A 70-year-old male patient with a history of diabetes and a previous diagnosis of low contractile bladder presented with urinary retention. Acute renal failure secondary to ureteral obstruction and inguinal bladder herniation was diagnosed. The direct bilateral hernia was repaired. Postoperative urodynamic evaluation showed an acontractile bladder. Intermittent catheterization was started, with satisfactory functional result and improvement of renal function. CONCLUSIONS: Massive bladder hernia can present as acute renal failure without lower urinary tract obstruction. The underlying impaired detrusor contractility can be diagnosed by urodynamic evaluation. Surgical treatment, with self-catheterization if required, achieves good results with preservation of renal function.

[Artificial sphincter in severe urinary incontinence: 9 years of experience]. / Esfínter artificial en incontinencia urinaria severa: nueve años de experiencia.

OBJECTIVE: To present the results achieved with the artificial urinary sphincter in the treatment of 44 patients with severe urinary incontinence. METHODS: From April 1990 to December 1998, an artificial urinary sphincter was implanted in 44 patients with severe urinary incontinence, aged 21 to 82 years (mean 56). These patients were categorized into the following groups: Group A comprised 24 males, aged 37 to 82 years (mean 66), who had undergone previous prostatic procedures. Four of them had undergone radical retropubic prostatectomy. The remaining 20 had undergone a total of 34 de-obstructive procedures (mean 1.7 procedures/patient; range 1-3); 28 were endoscopic procedures and 6 open prostatectomy. One of them had a previous ileocystoplasty due to severely low compliance. Ten were completely incontinent and were using a condom catheter (7), penile clamp (2) or permanent indwelling Foley catheter (1). The rest used a mean of 3.7 pads per day. Group B comprised 11 males with a complex urologic history: 9 had neurogenic dysfunction, 1 had bladder exstrophy and 1 had a previous cystectomy and Studer neobladder. Eight were using a condom catheter. The cuff was placed in the bulbar urethra in 8 (4-4.5 cm) and in the bladder neck in 4 (9-10 cm). Group C comprised 9 women with type III stress incontinence after failed previous interventions (range 1-4, mean 2.7). All of these patients required at least 3 pads per day (mean 4.5). The cuff was placed in the bladder neck with diameters ranging from 5 to 10 cm. RESULTS: The mean follow-up was 28.5 months (range 8-96). One patient died two years after implantation of the artificial sphincter which was never activated. In group A, 83% are socially continent and 17 do not require pads. Three of the 20 patients with the artificial sphincter have undergone a total of 4 surgical revisions. In group B, the social continence rate was 63% with a 36% revision rate. Four patients required a complete change of the system. In group C, The continence rate with revision was 66%. One patient underwent two successive successful revisions and 3 required removal of the device, accounting for a failure rate of 33%. Definitive removal of the artificial sphincter was required in 3 females and 5 males. Aside from one male who refused a new implant, the rest were considered unsuitable for a new device. Six patients underwent at least one reoperation to change one or more parts of the system. Continence was recovered in 66% after the revision. CONCLUSIONS: The artificial urinary sphincter achieves a good continence rate in patients with severe incontinence, although careful patient follow-up is required.

Relationship between systemic joint laxity, TMJ hypertranslation, and intra-articular disorders.

The aim of this study was to evaluate the correlation between general joint hypermobility, temporomandibular joint (TMJ) hypertranslation and signs and symptoms of TMJ intra-articular disorders. One hundred twenty individuals constituted the sample, divided into two groups: Group I (symptomatic) included 60 patients with complaints of joint noises, pain, or jaw locking, and Group II (nonsymptomatic) included 60 people with no TMD complaints. The Beighton's hypermobility score addressed the systemic laxity while lateral x-rays taken in both closed and full open mouth positions measured TMJ mobility (condyle hypertranslation). No association was found between intra-articular disorders and systemic hypermobility (p > 0.05). A significant negative correlation (p < 0.05) was found between age and systemic hypermobility, while no correlation was detected between systemic and TMJ hypermobility (condyle hypertranslation).

Outcome of colposuspension in patients with stress urinary incontinence and abnormal cystometry.

OBJECTIVE: To analyze the prognostic value of preoperative cystometric alterations in the outcome of women undergoing colposuspension for stress incontinence. PATIENTS AND METHODS: Over a 5 year period, 220 women were operated on for stress urinary incontinence using the Burch or Marshall colposuspension techniques. An abnormal cystometry was found pre-operatively in 44 (20%), which was associated with urge incontinence in 11 (25%). Cystometric abnormalities comprised 3 subgroups: detrusor instability (DI), low bladder compliance (LBC) and small detrusor contractions (SDC). Women with an abnormal cystometry had responded partially to anticholinergic therapy. Detailed postoperative questioning was undertaken to differentiate stress from urge incontinence, as well as storage symptoms. Results of patients with cystometric abnormalities were compared to an age-matched group of 44 patients with a stable bladder on the preoperative study. RESULTS: Bladder compliance was statistically lower in the preoperative CMG of patients with abnormal cystometry (p < 0.005). Groups were followed for a mean of 39 (abnormal CMG) and 36 months (stable bladder), respectively. The presence of the aforementioned cystometric alterations was not associated with lower cure rates of the stress incontinence. However, the group with DI referred more postoperative storage symptoms. "De novo" DI was found in 20% of patients with a previously stable bladder who referred storage symptoms postoperatively. CONCLUSIONS: Small detrusor contractions are not a contraindication for colposuspension. Patients with DI and low bladder compliance who also have stress incontinence showed more storage symptoms on postoperative evaluation.

[Percutaneous urethral suspension with bone anchorage (Vesica) in the treatment of stress urinary incontinence. Results after a year of follow-up]. / Suspensión uretral percutánea con anclaje óseo (vesica) en el tratamiento de la incontinencia urinaria de esfuerzo. Resultados tras un año de seguimiento.

OBJECTIVES: Evaluation of efficacy of percutaneous bladder neck suspension with bone anchors in women with stress incontinence with no previous treatment. PATIENTS AND METHODS: Fourteen women (mean age 48, range 37-74) were operated. All had a stable bladder and objective leakage, either by pad test of by physical examination. Ten were evaluated by a incontinence questionnaire. Mean incontinence time before the procedure was 3.9 years. All needed pads (mean 3.3 pads/day). The surgical technique is described. RESULTS: Mean surgical time was 80 minutes. In three patients there was bladder perforation during the procedure, that was solved by delaying the catheter withdraw. Mean postoperative stay was 4.2 days, with good tolerance, and one patient was discharged with a cystostomy. After a minimum follow-up of one year (mean 17.5 months), eleven patients have improved their continence (6 dry, 5 socially acceptable incontinence < pads/day) and 3 have recurrence. Postoperative pad test was < or = 10 g in patients without improvement and over 20 g in patients who failed. Mean postoperative total score in the questionnaire decreased from 10.1 to 2.5 in patients who improved and didn't change in patients who failed. CONCLUSION: Percutaneous bladder neck suspension is a useful alternative to open interventions, due to its low morbidity and lower postoperative stay.

[Complete urodynamic office evaluation; a method for the delivery of health care]. / Visita completa de urodinamia; una modalidad asistencial.

INTRODUCTION: The goal of the study was to evaluate the usefulness of the complete urodynamic office evaluation. This assistance modality consists on the realisation in the same moment of the clinical chart, physical examination, urodynamic study, report, therapeutic indications, program of other complementary studies, hospitalisation or discharge from the outpatient office. PATIENTS AND METHODS: During 1 year complete urodynamic office evaluation was performed to 100 patients (87 female, 13 male) All patients were directed to our department to perform a urodynamic test, most of them due to incontinence. Different kinds of urodynamic tests were performed in 91 patients, with a medium of 2 studies per test. Abnormalities were detected in 59 cases. RESULTS: After the complete urodynamic office evaluation, 16 patients were programmed for surgery, 26 were discharged from outpatient office, 37 were directed to follow up in the outpatient setting, 2 were hospitalised, and 19 were lost of follow up. CONCLUSIONS: The complete urodynamic office evaluation allowed us to get the diagnostic and therapeutic approach in 98% of patients, employing a standard of 90 minutes. Twenty six percent of patients could be discharged from our center. Sixteen patients were operated on following this unique visit, that means an important reduction in the usual assistance delay.

[Urinary stress incontinence in women under 40 years of age]. / Incontinencia urinaria de esfuerzo en mujeres menores de 40 años.

OBJECTIVE: To analyze the therapeutic approach in young females with stress urinary incontinence. METHODS: A retrospective study was conducted on 35 females less than 40 years of age who had undergone surgery for stress urinary incontinence. These patients had a mean follow-up of 3.5 years (range one month to 18 years) and a previous history of 3.9 years mean duration. Retropubic urethral suspension according to the MMK or Burch procedure was performed in all patients. RESULTS: 65.7% became completely continent, 20% were continent for at least two months, and 1.43% continued to be incontinent after surgery. The postoperative complication rate was 31%; of these complications, 4 referred inguinal pain and there were 3 cases of wound infection. Those who had a failed procedure showed no changes with respect to their preoperative urodynamic status, although two patients presented clinical features of urgency. The best surgical results were achieved in the older patients, although the differences were not statistically significant. However, statistically significant differences were found for the time to surgery; i.e., the patients with a shorter history of urinary incontinence remained incontinent after surgery. CONCLUSION: Surgical treatment of stress urinary incontinence in females less than 40 years of age achieves satisfactory results, with a success rate similar to that of the general population regardless of the age, and appears to be closely related with the period of time the patient has been incontinent before undergoing surgery.

[Quantification of urine leaks: standardized one-hour pad test]. / Cuantificación del escape de orina: prueba del pañal estandarizada de una hora ("pad test").

OBJECTIVE: To assess the feasibility and diagnostic performance of the one hour pad test proposed by ICS. PATIENTS AND METHODS: The pad test was performed in 20 women referred for incontinence. Five were included in a surgical protocol and 15 had inconsistent medical history. Their mean age was 52.5 years, the mean time of incontinence was 3.4 years and they used a mean of 3.5 pads/day. Six showed leakage on physical examination (PE) and 2 during previous cystometry. RESULTS: The test is well tolerated and lasts one hour and 15 minutes. The test was positive in 17 (mean leakage = 168 g). Leakage was not related to duration of incontinence, number of pads or cystometric capacity. A weak negative correlation (r = -0.52) was found between leakage and voided volume on uroflowmetry performed after the test. All patients who leaked on PE had a positive test and a significantly higher leakage compared to patients who didn't leak on PE. CONCLUSION: The pad test is a feasible outpatient procedure in the context of a Urodynamics Unit, providing objective information on leakage in most patients.

[Diagnosis of bladder neck obstruction in women]. / Diagnostic de l'obstruction sous vésicale chez la femme.

Bladder outlet obstruction in women is a rare entity, and difficult to diagnose. In our series most of the patients had previous history of gyneco-obstetric or urological procedures. Cystometry enabled us to diagnose the coexistence of bladder instability and obstruction in 48% of the patients. We did not find statistically significant differences between the patients with and without BI in terms of degree of obstruction measured by uroflowmetry and pressure/flow studies. Pressure/flow studies and Uroflowmetry had been the essential key in the diagnosis of obstruction in our series. Cysto-urethrography and urethroscopy were normal in over 50% of patients. The urethral calibration was abnormal in 16% of the cases.

[Retropubic urethral suspension. A surgery "without complications"?]. / Suspensión uretral retropúbica. Una cirugía "sin complicaciones"?

OBJECTIVE: To describe a case of bladder neck suspensión with special reference to the complications associated with this procedure. METHODS/RESULTS: Herein we describe a patient who developed most of the reported associated complications following two bladder neck suspension procedures: bilateral ureteral ligation, osteitis pubis, retropubic hematoma, eventration and recurrence of urinary stress incontinence. Finally, after two reoperations, the complications were resolved and the patient is continent. CONCLUSIONS: Bladder neck suspension is usually associated with a low complication rate. However, associated complications may appear in the same patient, accounting for a significant morbidity.