¿Existe concordancia entre vejiga hiperactiva e hiperactividad del detrusor en varones con síntomas predominantemente de llenado derivados a Unidades de Urología Funcional y Urodinámica? / Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units?

Objetivo Estudiar el grado de concordancia diagnóstica entre vejiga hiperactiva (VH) e hiperactividad del detrusor (HD) en varones con síntomas del tracto urinario inferior (STUI) predominantemente de llenado, y el perfil clínico y urodinámico según presencia de HD y grado de obstrucción del tracto urinario inferior (OTUI).Material y métodos Estudio epidemiológico, transversal, multicéntrico y nacional. Se cumplimentaron: diario miccional de 3 días (DM3d), International Prostate Symptom Score (IPSS) y Cuestionario de Autoevaluación del Control de la Vejiga (CACV). Se determinó el volumen prostático (Vp) por ecografía y se realizó estudio urodinámico (EUD). Se analizó la prevalencia de VH y HD y la concordancia (kappa). Se realizó un análisis descriptivo de características clínicas y urodinámicas; posteriormente se comparó su frecuencia según presencia de HD y OTUI.ResultadosSe evaluaron 445 pacientes con edad media±DE de 54,8±9,9 años. Según el DM3d, un 89,8% presentaba frecuencia miccional aumentada, un 87,9% nicturia, un 72,8% urgencia y un 31,9% incontinencia urinaria de urgencia (IUU). Un 36,8% tenía OTUI. El 54,5% presentaba VH y HD. La concordancia diagnóstica entre HD y VH fue baja (κ=0,1702). Más pacientes con HD que sin ella presentaron urgencia (DM3d y CACV; p<0,001), IUU (DM3d; p=0,008) y nicturia (CACV; p<0,001). Hubo diferencias en IPSS-vaciado, flujo máximo (Qmax) y residuo posmiccional (p<0,05) según el grado de obstrucción.ConclusionesEn pacientes varones de 18 a 65 años con STUI predominantemente de llenado derivados a unidades especializadas, aproximadamente la mitad tienen coexistencia de VH y HD y un tercio tenía obstrucción. Hay baja concordancia diagnóstica entre VH y HD (AU)

Objective To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction.Material and methods Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction.ResultsA total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ=0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p<0.001), UUI (3dBD; p=0.008) and nocturia (B-SAQ; p<0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p<0.05) according to the obstruction degree.ConclusionsApproximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor (AU)

Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units?

OBJECTIVES: To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction. MATERIAL AND METHODS: Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction. RESULTS: A total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ = 0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p < 0.001), UUI (3dBD; p = 0.008) and nocturia (B-SAQ; p < 0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p < 0.05) according to the obstruction degree. CONCLUSIONS: Approximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor.

Is there concordance between overactive bladder and detrusor overactivity in men with predominant storage urinary symptoms referred to Functional Urology and Urodynamics Units? / ¿Existe concordancia entre vejiga hiperactiva e hiperactividad del detrusor en varones con síntomas predominantemente de llenado derivados a Unidades de Urología Funcional y Urodinámica?

OBJECTIVE: To assess the diagnostic concordance of overactive bladder (OAB) and detrusor overactivity (DO) in male patients with predominant storage lower urinary tract symptoms (LUTS) and evaluate their clinical and urodynamic profile according to DO presence and degree of obstruction. MATERIAL AND METHODS: Epidemiological, cross-sectional multicenter study. A 3-day bladder diary (3dBD), International Prostate Symptom Score (IPSS) and Bladder Control Self-Assessment Questionnaire (B-SAQ) questionnaires were analyzed. Prostate volume was determined by ultrasound. Urodynamic study (UDS) tests were performed. The prevalence of OAB and DO and the degree of clinical concordance (kappa index) were investigated. Descriptive analysis of clinical variables and UDS results was performed, followed by comparisons based on the presence of DO and degree of obstruction. RESULTS: A total of 445 patients were included. The mean age was (SD) 54.8 (9.9) years. According to 3dBD, 89.9% presented increased urinary frequency, 87.9% nocturia, 72.1% urgency, and 31.9% urge urinary incontinence (UUI). Obstruction was present in 36.8%. Concomitant OAB and DO were present in 54.5%. The degree of diagnostic concordance between OAB and DO was low (κ=0.1772). There were more patients with DO presenting urgency (3dBD and B-SAQ; p<0.001), UUI (3dBD; p=0.008) and nocturia (B-SAQ; p<0.001). Differences were found in terms of prostate volume, IPSS-voiding, maximum flow (Qmax) and post-void residual (p<0.05) according to the obstruction degree. CONCLUSIONS: Approximately 50% of male patients aged 18-65 years old with predominant storage LUTS, referred to specialized units, have both OAB and DO. Obstruction is present on 1/3. Diagnostic concordance between OAB and DO is poor.

Posicionamiento de la Asociación Española de Urología ante el documento de la Sociedad Española de Oncología Médica sobre la administración de tratamientos médicos a los pacientes oncológicos / Positioning statement of the Spanish Association of Urology on the document published by the Spanish Society of Medical Oncology about the use of medical treatments in oncological patients

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[TVA and TOA. New adjustable mesh for the treatment of female stress incontinence. Preliminaries results]. / TVA y TOA. Nuevas mallas ajustables de tensión en el tratamiento de la incontinencia urinaria de esfuerzo. Resultados preliminares.

OBJECTIVES: Evaluation of a new mesh for incontinence (TVA/TOA) which enables the degree of tension applied during surgery to be readjusted at the post-operative stage. PATIENTS AND METHOD: 62 patients treated with the TVA mesh and monitored over a 14-month period (SD 7.8, range 6-38). In 33 patients (53%) some other pelvic prolapse was corrected. Evaluation was carried out by clinical report, examination of bladder full of 250 saline solution, flowmetry and urinary residue. 40 patients filled in 4 quality of life questionnaires (QoL; ICIQ-SF; PGI-S; PGI-I). RESULTS: 42 patients were found to be objectively continent in the post-operative evaluation. Of these, it was necessary to reduce tension in 7 cases (11%) due to urinary obstruction (flow < 10 ml/sec and/or residue). The tension of the mesh was tightened in 20 patients (32%) due to continue with a certain degree of incontinence. All patients were discharged as continent and with no residue. In the last revision, 58 patients (93%) proved to be objectively continent and 4 (6.5%) showed a notable improvement in their incontinence. The Q(MAX) is 19.8 ml/sec (SD 9.8). The mictional urgency had disappeared or improved in 32 of the patients who had this prior to operation (76%) and had appeared in 3 of the patients who didn't (15%). The clinical report showed a high level of consensus with the ICIQ-SF survey (Kappa = 0.89) regarding stress incontinence, diminishing clearly (Kappa= 0.13) when urge incontinence was taken into account. 34 (85%) patients scored over 95 out of 110 in the QoL. 30 (75%) scored less than 6 in ICIQ-SF. 32 (80%) showed a perception of normality and 4 (10%) slight illness in the PGI-S. In the PGI-I 29 (72.5%) were much better and 11 (27.5%) quite a lot better. A relation exists between urgency and dismissed quality of life. CONCLUSION: With the TVA (trans-vaginal adjustable) mesh it is possible to adjust the tension originally applied during surgery at the post-operative stage, so that any defects or excesses can be corrected.

TVA y TOA. Nuevas mallas ajustables de tensión en el tratamiento de la incontinencia urinaria de esfuerzo. Resultados preliminares / TVA and TOA. New adjustable mesh for the treatment of female stress incontinence preliminaries resulted

Objetivos: Valoración de una nueva malla de incontinencia (TVA/TOA) que permite postoperatoriamente ajustar la tensión dada en quirófano. Pacientes y Métodos: 62 pacientes tratados con la malla TVA, seguimiento medio de 14 meses (DS 7,8, rango 6-38). En 33 pacientes (53%) se añadió corrección de algún prolapso. La valoración se ha realizado mediante historia clínica, exploración con vejiga llena con 250 cc de suero salino, flujometría y residuo. 40 pacientes han rellenado 4 cuestionarios de calidad de vida. (QoL; ICIQ-SF; PGI-S y PGI-I). Resultados: 42 pacientes eran continentes en la valoración post-operatoria. De estos, fue necesario disminuir la tensión en 7 (11%) por obstrucción urinaria (flujo< 10 ml/seg y/o residuo). En 20 pacientes (32%) se aumentó la tensión por continuar algún grado de incontinencia. Todos fueron dados de alta continentes y sin residuo. En la última revisión, 58 (93%) son totalmente continentes y 4 (6,5%) han mejorado notablemente su incontinencia. El QMAX es 19,8 ml/s (DS 9,8). La urgencia miccional ha desaparecido o mejorado en 32 (76%) de los pacientes que la presentaban preoperatoriamente y ha aparecido en 3 (15%) de los que no la presentaban. La historia clínica muestra un alto grado de concordancia con el cuestionario ICIQ-SF (Kappa= 0,89) en cuanto a incontinencia de esfuerzo se refiere, disminuyendo ostensiblemente (Kappa= 0,13) cuando se toma en consideración la incontinencia por urgencia. De los 40 pacientes que completaron los cuestionarios de calidad de vida, 34 (85%) tienen una puntuación superior a 95 sobre 110 en el QoL. 30 (75%) tiene una puntuación inferior a 6 en ICIQ-SF. 32 (80%) tienen una percepción de normalidad y 4 (10%) de enfermedad leve en el PGI-S. En el PGI-I 29 (72,5%) están mucho mejor y 11 (27,5%) bastante mejor. Existe relación directa entre urgencia miccional y pérdida de calidad de vida. Conclusión: La malla TVA (transvaginal ajustable) permite ajustar la tensión dada en quirófano, permitiendo corregir los defectos y los excesos

Objectives: Evaluation of a new mesh for incontinence (TVA/TOA) which enables the degree of tension applied during surgery to be readjusted at the post-operative stage. Patients and Method: 62 patients treated with the TVA mesh and monitored over a 14-month period (SD 7.8, range 6-38). In 33 patients (53%) some other pelvic prolapse was corrected. Evaluation was carried out by clinical report, examination of bladder full of 250 saline solution, flowmetry and urinary residue. 40 patients filled in 4 quality of life questionnaires (QoL; ICIQ-SF; PGI-S; PGI-I). Results: 42 patients were found to be objectively continent in the post-operative evaluation. Of these, it was necessary to reduce tension in 7 cases (11%) due to urinary obstruction (flow< 10 ml/sec and/or residue). The tension of the mesh was tightened in 20 patients (32%) due to continue with a certain degree of incontinence. All patients were discharged as continent and with no residue. In the last revision, 58 patients (93%) proved to be objectively continent and 4 (6.5%) showed a notable improvement in their incontinence. The QMAX is 19.8 ml/sec (SD 9.8). The mictional urgency had disappeared or improved in 32 of the patients who had this prior to operation (76%) and had appeared in 3 of the patients who didn’t (15%). The clinical report showed a high level of consensus with the ICIQ-SF survey (Kappa = 0.89) regarding stress incontinence, diminishing clearly (Kappa= 0.13) when urge incontinence was taken into account. 34 (85%) patients scored over 95 out of 110 in the QoL. 30 (75%) scored less than 6 in ICIQ-SF. 32 (80%) showed a perception of normality and 4 (10%) slight illness in the PGI-S. In the PGI-I 29 (72.5%) were much better and 11 (27.5%) quite a lot better. A relation exists between urgency and dismissed quality of life. Conclusion: With the TVA (trans-vaginal adjustable) mesh it is possible to adjust the tension originally applied during surgery at the post-operative stage, so that any defects or excesses can be corrected

[Techniques and current practice of urodynamics. Problems and traps]. / Técnica y actualidad de la urodinámica. Problemas y retos.

Development of urodynamics particularly during the past decade are highlighted, as well as a number of issues to be faced in the near future: research into the etiopathogenesis of different conditions, finding more sensitive and specific diagnostic procedures to overcome the current ones, establishing more comprehensive indications for urodynamics examinations and, as a result of all the above achieving greater improvement of certain surgical procedures. Both the technique and interpretation of the different urodynamic examinations, as well as the more recent innovations, implementation issues and controversies are detailed to a highly up-to-date level. Neuromodulation and ambulatory urodynamics deserve thoughtful consideration in this paper. Finally, attention is given to the controversies and future challenges such as urodynamic research providing accurate diagnosis of lower urinary tract obstruction in women, establishing the indication of urodynamic studies in women with urinary exertional incontinence, outlining the indications of neuromodulation and ambulatory urodynamics, applicability of artificial intelligence systems, improvement of artificial sphincter materials, tissue growth for bladder enlargement and actual prevention of myelodysplasia.

Técnica y actualidad de la urodinámica. Problemas y retos / Urodynamics technique and current situation. Issues and challenges

El presente artículo pone de manifiesto el avance experimentado por la urodinámica fundamentalmente en la última década, así como los problemas a los que tendrá que hacer frente en el futuro: investigación en la etiopatogenia de diferentes enfermedades, buscar procedimientos diagnósticos más sensibles y específicos que los actuales, establecer indicaciones más exhaustivas para las exploraciones urodinámicas y con ello, conseguir el perfeccionamiento de determinados procedimientos quirúrgicos. Se detalla la técnica e interpretación de las diferentes exploraciones urodinámicas a un nivel muy actual, así como las novedades existentes, las dificultades de aplicación y controversias. La neuromodulación y la urodinámica ambulatoria merecen detalle en este artículo. Finalmente se muestran las controversias y retos de futuro, como son la investigación urodinámica que proporcione de forma precisa el diagnóstico de la obstrucción del tracto urinario inferior en la mujer, establecer la indicación del estudio urodinámico en la mujer con incontinencia urinaria de esfuerzo, perfilar las indicaciones de la neuromodulación y de la urodinámica ambulatoria, aplicabilidad de sistemas de inteligencia artificial, mejorar los materiales del esfínter artificial, desarrollo de tejidos para realizar ampliaciones vesicales y la prevención real de la mielodisplasia (AU)

Development of urodynamics particularly during the past decade are highlighted, as well as a number of issues to be faced in the near future: research into the etiopathogenesis of different conditions, finding more sensitive and specific diagnostic procedures to overcome the current ones, establishing more comprehensive indications for urodynamics examinations and, as a result of all the above achieving greater improvement of certain surgical procedures. Both the technique and interpretation of the different urodynamic examinations, as well as the more recent innovations, implementation issues and controversies are detailed to a highly up-to-date level. Neuromodulation and ambulatory urodynamics deserve thoughtful consideration in this paper. Finally, attention is given to the controversies and future challenges such as urodynamic research providing accurate diagnosis of lower urinary tract obstruction in women, establishing the indication of urodynamic studies in women with urinary exertional incontinence, outlining the indications of neuromodulation and ambulatory urodynamics, applicability of artificial intelligence systems, improvement of artificial sphincter materials, tissue growth for bladder enlargement ad actual prevention of myelodysplasia (AU)

[Long course metastasis in renal adenocarcinoma. Adrenal gland involvement]. / Enfermedad mestastásica de larga evolución en el adenocarcinoma renal. Afectación suprarrenal.

OBJECTIVES: To report two cases of metachronic adrenal metastasis (one contralateral and the other bilateral) from renal cell carcinoma with long survival. METHODS: Two patients with clear cell renal carcinoma that developed metastasis to the adrenals are described. Each patient had undergone three operations for solitary metastasis during the 8-years follow-up. The indications for the surgical management of solitary metastasis, morbidity, prognosis and recent investigational treatment possibilities reported in the literature are analyzed. RESULTS: Resection of the renal cell carcinoma achieved a survival of more than 8 years with a good quality of life and no significant surgical complications. The outcome, however, is poor. CONCLUSIONS: Although there was no lymph node involvement and the tumor was localized to the renal parenchyma, one patient developed solitary lung metastasis and contralateral adrenal metastasis 4 and 8 years after the initial diagnosis, respectively. In the other case, contralateral adrenal metastasis appeared three years later. The possibility of long-term metastasis to the adrenal gland should be taken into account due to renal vein involvement. Preservation of the adrenal gland at the initial surgery (lower pole tumor) led to adrenal metastasis 8 years after the initial diagnosis. The prognosis is poor in both cases and the situation is discouraging for the urologist.

[Painful erections related to sleeping]. / Erecciones dolorosas relacionadas con el sueño.

Case report of sleep-related painful erections in a 34 year-old male with grade C3 HIV infection. Due to severe impairment of the patient's general condition, no proper diagnostic studies were performed to gain deeper knowledge of the symptom's pathological etiology. Empirical therapy was started based on evidence from the literature consulted, and the results seen were optimal. This paper contributes a brief review of a condition infrequently seen by the vast majority of urologists.

[Disjunction patterns: the morphological and ultrastructural bases of bladder instability in the male]. / Patrones de disyunción: bases morfológicas y ultraestructurales de la inestabilidad vesical del varón.

OBJECTIVE: To apply the new protocols and recent contributions on detrusor ultrastructural morphology in order to standardize criteria and evaluate our findings relative to the ultrastructural morphology, the presence of a dysfunction pattern, changes in nerve supply and formation of a chained cellular syncytium in hyperactive detrusor bladder instability in the male. METHODS: We studied 480 ultrastructural preparations of detrusor muscle from 32 male patients with bladder outlet obstruction with and without urodynamically demonstrated bladder hyperactivity. Bladder biopsies were obtained from the anterior aspect of the bladder and prepared according to the standard procedures for ultrastructural study. Semiquantitative nerve supply ultrastructural patterns, syncytial composition, and complete and incomplete disjunction were analyzed. RESULTS: Lower urinary tract obstruction was demonstrated in all patients; 6 of these patients had involuntary phasic detrusor contractions during filling. No significant decrease in nerve supply was found in isolated obstruction or in bladder hyperactivity. No axonal degeneration was observed in any of the patients and the myelin sheath structure was normal. Nerve effector endings were also normal. Four patients with hyperactive detrusor showed complete and two incomplete disjunction pattern. Incomplete disjunction pattern was also demonstrated in two patients with isolated obstruction. CONCLUSIONS: The change in the properties of the detrusor muscle in the unstable bladder is due to a complete reduction in excitatory nerve relation to smooth muscle. Having established the concept of common final myogenic pathway that explains involuntary detrusor contraction, complete dysfunction ultrastructural patterns have been defined with univocal relation to hyperactive detrusor. These patterns indicate the existence of a syncytium of chained muscle cells with changes in the excitation threshold that are absent in the normal stable detrusor. Two ultrastructural components sustain this hypothesis: 1) the major loss observed in intermediate cellular unions that are thought to mediate in the mechanical coupling of cellular contraction and 2) the presence in all the microscopic fields of abutments in the narrow cellular unions like gap-junctions, which mediate the electrical coupling. In the present study we have found this pattern in 4 out of 6 patients with hyperactive detrusor, and congruent with other studies, the incomplete disjunction pattern could be the prelude of bladder hyperactivity.

[Valsalva minimal leak point pressure: a useful approximation to type III female urinary incontinence]. / Presión mínima de escape con Valsalva: una útil aproximación a la incontinencia urinaria femenina tipo III.

OBJECTIVE: It has been reported that anatomic female urinary incontinence with complex sphincteric malposition can coexist with intrinsic damage of the sphincter itself. In this study we analyzed the utility of measuring minimum abdominal pressure at standardized bladder capacities that causes urinary incontinence in order to quantify intrinsic sphincteric damage in female urinary incontinence. METHODS: The study comprised 50 women with urinary incontinence aged 36-78 years (mean 59.4), ICS standardized complete urodynamic study was performed. Minimum leak point pressure with Valsalva maneuver in decumbent and standing positions was determined during the filling phase of cystomanometry and it was defined as a measure of the abdominal pressure expressed as total baldder pressure without involuntary detrusor activity and exercised at standardized bladder capacities that originates objective urinary incontinence. Minimum leak point pressure for each bladder capacity was evaluated. Leak point pressures below 60 cm H2O indicate intrinsic sphincteric damage; pressures between 60 and 90 cm H2O indicate intrinsic damage and malposition or urethral hypermobility may coexist, and leak pressures over 90 cm H2O are related to complex sphincteric malposition. RESULTS: 5 women showed severe sphincteric deficiency (type III) and urinary incontinence was demonstrated with 50 ml bladder capacity and 30 cm H2O of abdominal pressure without detrusor activity. Thirty-five women (70%) had type II urinary incontinence. Of these, 10 (28.5%) showed intrinsic sphincteric damage in addition to malpositioning of the sphincteric complex at leak point pressures between 60 and 90 cm H2O. The rest of the women showed Blaivas' type 0 and I urinary incontinence. CONCLUSIONS: Valsalva minimum leak point pressure is a reproducible, reliable, useful and easily measured parameter in diagnosing female stress urinary incontinence. It allows approximation of the abdominal pressure to the level at which urinary leakage is produced during the filling phase of cystomanometry and gives us an idea of the extent of the intrinsic sphincteric damage, if any. Not only is sphincter damage demonstrated in type III urinary incontinence, but that it may also coexist to a varying degree with complex sphincteric malposition.

[Effect of aging on detrusor function in males]. / Influencia del envejecimiento en el funcionalismo del detrusor en el varón.

OBJECTIVE: The present study analyzed the effects of aging on detrusor function in the male. METHODS: The study comprised 200 male patients with prostatism that had undergone complete urodynamic evaluation. The relation of patient age and the clinical and urodynamic data were analyzed. RESULTS: Aging correlates with an increased urinary frequency and a reduced urinary volume and maximum flow rate. Bladder instability was significantly considerably more frequent in those over 80 years of age and the detrusor gradually manages lower maximum voiding pressures with increasing age. On the other hand, urodynamically diagnosed lower urinary tract obstruction and compromise of detrusor contractility are not age-dependent. CONCLUSION: Aging is associated with changes in lower urinary tract function, such as increased urinary frequency, reduced urinary volume, bladder instability is more frequent, reduced maximum voiding pressures, but does not impair detrusor contractility.

[Simplified Ramírez urethropexy in the treatment of genuine stress urinary incontinence in women. Multicenter study of clinical and urodynamic results]. / Uretropexia simplificada de Ramírez en el tratamiento de la incontinencia urinaria de esfuerzo genuina en la mujer. Estudio multicéntrico sobre los resultados clínicos y urodinámicos.

OBJECTIVES: To evaluate the clinical and urodynamic data of a multicenter study on female urinary stress incontinence undergoing surgical repair with the Ramírez simplified urethropexy. METHODS: Clinical, urodynamic and videocystographic data were analyzed in a multicenter series of 340 female patients with urinary stress incontinence (mean age 51.7 +/- 9.7 years) before and after the Ramírez urethropexy technique (mean follow-up 21.7 months). RESULTS: Post surgical urinary continence was 78.4%. Cystocele repair was demonstrated in 57.7%. Urge incontinence decreased in 17.1%. Daytime frequency statistically significantly decreased in 19%. Urinary obstructive symptoms increased in 19.3%. Bladder instability significantly decreased posturethropexy. Peak urinary flow rate and mean urinary flow rate diminished in 65% and 59%, respectively. Postvoiding residual urine increased significantly. No statistical correlation between posturethropexy continence and videocystographic bladder neck morphology was observed. CONCLUSIONS: The clinical and urodynamic data obtained in our series indicate that the Ramírez urethropexy technique, a simple and fast procedure, may be considered an alternative treatment in female urinary stress incontinence.

[Insufficient detrusor contractility: a urodynamic and morphologic entity in prostatism]. / Insuficiencia contráctil del detrusor: Una entidad urodinámica y morfológica en el prostatismo.

OBJECTIVES: To analyze the urodynamic and ultrastructural characteristics of impaired detrusor contractility in patients with prostatism in comparison with lower urinary tract obstruction. METHODS: The study comprised 200 male patients (mean age 65.3 years) with prostatism submitted to a complete urodynamic study. An ultrastructural study was randomly performed in 40 patients and analyzed 600 detrusor muscle images to determine the smooth muscle cell and interstitial changes. Detrusor urodynamics were compared with the ultrastructural cell and interstitial changes of the bladder smooth muscle. RESULTS: Urinary symptoms or free flowmetry alone failed to predict detrusor urodynamics. Urodynamic diagnosis was based on the detrusor pressure-flow study. We observed ultrastructural degenerative cell changes with statistical significance in impaired detrusor contractility such as no branching and intertwining of cells, absence of caveoles, perinuclear degeneration with vacuolization, destructured myofilament system with diminished anchorage plates and collagen infiltrating the interstitium with loss of bladder muscle fascicle organization. CONCLUSIONS: Impaired detrusor contractility is a urodynamic diagnosis that should be taken into account in patients with prostatism. The diagnosis of this condition requires performing a pressure-flow study. Impaired detrusor contractility showed a morphological and ultrastructural correlation with degenerative changes of the bladder muscle.

[Synchronous bilateral renal oncocytoma]. / Oncocitoma renal bilateral sincrónico.

OBJECTIVES: The present study reports a case of bilateral synchronous renal oncocytoma and reviews similar cases described in the literature. METHODS: The present case was incidentally discovered in an 81-year-old female during evaluation for GI disease. The arteriogram was suggestive of oncocytoma and was confirmed by aspiration biopsy. The patient refused surgery. At 42 months' follow-up, the size and degree of invasion of both tumors remain unchanged. To our knowledge, only 20 cases of bilateral synchronous oncocytoma have been reported in the literature and only 6 of these were multifocal lesions. RESULTS: Renal oncocytoma, like salivary gland lesions, may spread as an advanced stage multifocal nodular oncocytic hyperplasia. Therefore it is not surprising to detect multiple synchronous or metachronous oncocytomas. CONCLUSIONS: Bilateral renal masses are a diagnostic and therapeutic difficulty, and even more so in the absence of systemic manifestations, hereditary disorders or a family history of renal tumor.

[Malacoplakia of the prostate and seminal vesicle. Ultrastructural study and review of the literature]. / Malacoplakia de la próstata y vesícula seminal. Estudio ultraestructural y revisión de la literatura.

OBJECTIVES: The present study describes a case of malacoplakia of the genitourinary tract arising in the seminal vesicle and prostate and reviews similar cases previously reported in the literature. METHOD: A 67-year-old male consulted for hemospermia and voiding symptoms. Prostatic neoplasm was suspected on the basis of the clinical and radiological findings. RESULTS: The diagnosis was made only after biopsy and histological analysis. Electron microscopy is a very useful tool. Long-term antibiotic therapy may achieve optimal results. Treatment with fluoroquinolones was successful. CONCLUSION: To avoid unwarranted radical approaches, we underscore the possibility that prostatic pseudotumors may be misinterpreted as neoplasia. Malacoplakia is diagnosed only by histology and requires medical treatment.

[Surgical treatment of male hypospadias with pediculated transversal preputial flap technique: a 10-year follow-up]. / Tratamiento quirúrgico del hipospadias masculino con técnica de colgajo prepucial transversal pediculado: seguimiento de 10 años.

OBJECTIVES: The study was conducted to evaluate the long-term follow-up micturition data, sexual function and cosmetic results of hypospadias surgical repair. METHODS: 14 males (mean age 19.6 yrs) submitted to hypospadias surgical repair with the pedicled preputial tubulized flap technique 10 years ago were evaluated. RESULTS: The most frequent site of the anomaly was the distal third of penis (85.6%). The micturition data were excellent and urinary flow rates were normal in 92.8%. Erection and ejaculation were normal in all patients. Penile curvature persisted in 14.2%; 64.2% of the patients had sexual intercourse (completely satisfactory in 66.6%), penis size was normal in 78.6% and 66.6% of the patients were married and had children. No longterm follow-up complications were observed. CONCLUSIONS: The technique achieved excellent cosmetic and functional results.