Dimensional study of prostate cancer using stereological tools.

This study analyzes the dimensional changes of the glands from prostate cancer by applying stereology to estimate the variations in volume, length, surface, and cellular densities of tumor acini. Normal and tumor acini were visualized using immunohistochemistry for cytokeratin18. On immunostained sections, parameters related to the dimensions and cell population of prostate acini were measured. The immunohistochemical expression of proliferative cell nuclear antigen was also measured to correlate the quantitative changes estimated with the proliferative activity of the epithelium. The average cell volume in normal and tumor epithelium was estimated using the method of the nucleator. The relative size of the acini was similar in the carcinoma compared with the normal prostate. Within the acini, the fraction of acinar volume occupied by the epithelium was significantly higher in cancer than in the nontumor prostate. Conversely, the glandular lumen of the cancer acini is lower than in the normal acini. The significant increase of acinar length density in the carcinoma indicates that the glandular tree's growth in the carcinoma is higher and with more branches than in the case of nonneoplastic glands. The basal surface density is higher in the carcinoma than in the controls. The number of epithelial cells per unit length of acini was significantly decreased in the neoplastic glands. This "dilution" of the cell population along the cancer acinus can be explained by the significant increase in the tumor cell's mean cell volume.

Long-term outcome of adjustable transobturator male system for stress urinary incontinence in the Iberian multicentre study.

AIM: The aim of this study is to evaluate long-term durability and effectiveness of the adjustable transobturator male system (ATOMS). MATERIALS AND METHODS: The retrospective multicenter Iberian ATOMS study (n = 215) was updated to evaluate long-term continence status, complications, explants, and secondary treatments. Mean follow-up from surgery to March 2020 was 60.6 ± 18.4 months (range, 39-91). Eleven patients deceased of an unrelated causes. Kaplan-Meier curves were performed to evaluate device durability and incontinence free of recurrence interval. The multivariate analysis defined the population at risk of device explant. RESULTS: A total of 155 patients were dry at the last follow-up visit (72.1%); 99 (46%) used no pads and 56 (26%) used a security pad/day with urine loss less than 10 mL; 96% of dry patients after adjustment remained free of incontinence 1 year later, 93.6% 2 years later, 91.1% 3 years later, 89.2% 5 years later, and 86.7% 8 years later. Complications during follow-up occurred in 43 of 215 (20%). In total, 25 (11.6%) devices were explanted and causes were inefficacy 11 (44%), inefficacy and pain 3 (12%), port erosion 10 (40%), and wound infection 1 (4%). The secondary implant was performed in 11 (5.1%) cases, 6 artificial urinary sphincter and 5 repeated ATOMS. Time to explant was associated to complications (P < .0001), baseline stress urinary incontinence (SUI) severity (P = .01), and former irradiation (P = .03). Multivariate analysis revealed complications (hazard ratio [HR] = 8.71; 3.83-19.82), baseline SUI severity (>5 compared to 1-2 pads/day; HR = 14.9; 1.87-125), and irradiation before ATOMS (HR = 2.26; 1.02-5.18) predicted earlier ATOMS explant. Three cases received radiation after implant without complication. CONCLUSIONS: ATOMS device is efficacious and safe in the long term. Determinants for device explant include complications, baseline severity of incontinence, and previous irradiation. Currently, the durability of the device after 5 years is reassuring.

Patient satisfaction with adjustable transobturator male system in the Iberian multicenter study.

BACKGROUNDS: Patient-reported outcome measurements are important for urinary incontinence. We analyze self-assessed patient satisfaction and define the clinical profile of patient with highest satisfaction with the adjustable transobturator male system (ATOMS). METHODS: Patient perception of results was evaluated in a series of 181 patients after ATOMS adjustment. Baseline incontinence severity was defined in pads-per-day (PPD) as mild (2), moderate (3-5) or severe (≥ 6), and dryness as use of none or one security PPD. Post-operative pain at discharge was evaluated by 0-10 visual analogue scale and complications by Clavien-Dindo classification. Multivariate analysis was performed to anticipate "very much better" than baseline perception on patient global impression of improvement and a predictive nomogram was developed. RESULTS: Dryness was achieved in 80.7% (94.9% mild, 80.8% moderate and 65.8% severe groups). Mean pad-test and pad-count decrease with respect to baseline was 458 ± 330 ml and 3.2 ± 1.9 PPD, respectively (both p < .0001). Complications presented in 25 (13.8%). The proportion of patients that self-declared satisfied with the procedure was 87.1%; 90.6% perceived their situation "better" and 48.1% "very much better" than before. Multivariate analysis revealed best perception is defined by dryness after adjustment (p < .0001), baseline severity of incontinence (p = .007), low post-operative pain at discharge (p = .0018) and lack of complications (p = .007). CONCLUSIONS: Self-assessed satisfaction with ATOMS is very high. Factors that predict best perception of improvement include dryness, baseline SUI severity, presence of complications and pain level during admission. Radiotherapy and device generation were not independent predictors. A nomogram to predict patients that are completely satisfied with ATOMS after adjustment is proposed.

Adjustable Transobturator Male System after Failed Surgical Devices for Male Stress Urinary Incontinence: A Feasibility Study.

OBJECTIVES: Feasibility study to evaluate the efficacy and safety of Adjustable Transobturator Male System (ATOMS) after failed surgical devices for male stress urinary incontinence (SUI). MATERIALS AND METHODS: Thirty patients were implanted with ATOMS after they were implanted with surgical device/s previously. SUI severity was evaluated as dryness (0-1 pad/day), mild (2 pads/day), moderate (3-5 pads/day), or severe (≥6 pads/day). Change in pad-test and pad-count after adjustment, operative parameters, patient satisfaction, and number and grade of complications were investigated. RESULTS: Previous failed treatment methods were artificial urinary sphincter (AUS; n = 19), Advance (n = 10), and Virtue (n = 1). Six cases had multiple previous treatments. Preoperative SUI was mild 6 (20%), moderate 11 (36.7%), and severe 13 (43.3%). Median pad-test decreased from 435 mL baseline to 10 mL after adjustment and pad-count from 4 to 0. Dry-rate was 76.7 and 83.3% declared satisfied. Postoperative SUI distribution was mild in 3 (10%) and moderate in 4 (13.3%). No patient had urinary retention after catheter removal. Complications presented in 4 (13.3%; 3 grade-I, 1 grade-II). After a median of 24 months follow-up, no system experienced infection or urethral erosion and 1 (3.3%) was removed for inefficacy. CONCLUSION: Based on short-term efficacy and patient satisfaction, ATOMS can be a realistic alternative for male SUI after other failed systems, including AUS. The absence of urethral erosion and limited infective problems makes this alternative attractive for cases with previous failed treatments.

Quantification of the heterogeneity of cytokeratin 18 immunoexpression in prostate adenocarcinoma and normal prostate: Global and local features.

There are few studies comparing global versus local changes in spatial patterns in prostate cancer. In this study, stereological tools have been applied to find out if the cytokeratin18 (ck18) immunoexpression shows local changes in cancer compared to normal prostate. To verify if these changes are relevant to ascertain differences between normal (CTR) and cancer (Ca) cases, several parameters were estimated. Volume fraction of epithelium immunostained for ck18 (VV ck18), dispersion index of VV ck18, positional variance of VV ck18, and multiscale entropy analysis (MSE) to measure the tissue heterogeneity. The MSE values showing significant differences between CTR and Ca were employed in a discriminant analysis to determine if MSE was able to classify the cases in CTR and Ca groups. The findings obtained indicate that changes in the expression of ck18 by the cancer prostate are heterogeneous. The increase in local variability of ck18 immunoexpression can be related to the increase in heterogeneity of shape and size of the tumor acini. The asymmetry of distribution of the local values of VV ck18 along the axis of the space series may indicate the existence of anisotropy in the distribution of tumor acini. The increase in scale-dependent entropy for VV ck18 in cancer at the morphological level could be interpreted as the macroscopic expression of the same increase at the molecular level already described. The discriminant analysis shows that the dependence on the resolution for MSE values need to be taken into account to characterize the prostate cancer better.

El urólogo del futuro y las nuevas tecnologías / The urologist of the future and new technologies

Los últimos 25 años han supuesto un cambio revolucionario para la medicina y en particular en urología: Internet estaba en sus inicios, las historias clínicas se escribían en papel, las búsquedas de información médica se realizaban en la biblioteca de los hospitales, los artículos médicos se fotocopiaban y la relación con nuestros pacientes sólo era presencial. Las redes sociales no habían hecho su aparición y hasta Google no existía. Imaginemos ahora lo que pueden deparar los próximos 25 años. Vamos a asistir a cambios todavía más radicales. El urólogo del futuro va a vivir la llegada de la inteligencia artificial, la medicina colaborativa, la telemedicina, el machine learning, el internet de las cosas y la robótica personalizada; mientras tanto, las redes sociales seguirán transformando la interacción médico/paciente. También la formación de los urólogos será diferente gracias a las nuevas tecnologías de aprendizaje como serán la realidad virtual o la realidad aumentada. IBM Watson Health a través de su sistema de inteligencia artificial y sus algoritmos de aprendizaje se convertirá en nuestro imprescindible compañero de viaje. El urólogo del futuro, además de médico, tendrá que adquirir las habilidades tecnológicas necesarias para utilizar todas estas nuevas herramientas que ya asoman por el horizonte (AU)

The last 25 years have brought about revolutionary changes for medicine and in particular for urology: internet was only in its infancy, medical records were written on paper, searches for medical information were done in the hospital library, medical articles were photocopied and our relationship with patients only existed face to face. Social networks had not yet appeared and even Google did not exist. Just imagine what might happen during the next 25 years, we're going to see even more radical changes. The urologist of the future is going to see the arrival of artificial intelligence, collaborative medicine, telemedicine, machine learning, the Internet of Things and personalized robotics; in the meantime, social media will continue to transform the interaction between physician and patient. The training of urologists will also be different thanks to new learning technologies such as virtual reality or augmented reality. IBM Watson Health through its system of artificial intelligence and its learning algorithms will become our essential travel companion. The urologist of the future, as well as physician, will have to acquire the necessary technological skills in order to use all these new tools which are already on the horizon (AU)

Treatment of male stress urinary incontinence with the adjustable transobturator male system: Outcomes of a multi-center Iberian study.

AIM: To evaluate effectiveness and safety of the adjustable transobturator male system (ATOMS) for male stress urinary incontinence (SUI). MATERIAL AND METHODS: A retrospective multicenter study was conducted in nine Iberian institutions using a board-approved database for 215 patients intervened between 2012 and 2017, with no case excluded. Continence status, patient satisfaction, number, and grade of complications (Clavien-Dindo) and factors affecting dry rate at adjustment were evaluated. Multivariate analysis defined the population at best success rate. Incontinence recurrence due to device failure and/or explant was evaluated and Kaplan-Meier curve for durability performed. RESULTS: Adjustment was achieved at a mean 1.4 ± 1.9 fillings. Dry-rate after adjustment was 80.5% (96.2% mild and 75.3% moderate-severe), 121 (56.3%) used no pads, and 52 (24.2%) a security pad with urine loss under 10 mL. Mean basal daily pad-test and pad-count decreased from 484 ± 372.3 mL and 3.9 ± 2 pads to 63.5 ± 201.2 mL and 0.9 ± 1.5pads (both P < 0.0001). Satisfaction rate was 85.1% (94.3% mild and 82.1% moderate-severe). Factors associated to dryness were: lesser severity of SUI (P < .0001), absence of radiotherapy (P = 0.0002) and device generation (P = 0.05). Multivariate analysis revealed absence of radiation (OR = 3.12; 1.36-7.19), mild (OR = 19.61; 3.95-100), and moderate (OR = 2.48; 1.1-5.59) SUI were independent predictors. Complications presented in 33(15.35%); 66.7% grade 1, 9.1% grade 2, and 24.2% grade 3. At 24.3 ± 15 mo mean follow-up device was explanted in seven (3.25%) and SUI worsened after adjustment in nine (4.2%). Dry-rate at follow-up was 73% and durability of device in dry patients at adjustment was 89.8% (82.9-94) at 2-years. CONCLUSIONS: This study confirms ATOMS device is safe and achieves high treatment efficacy and patient satisfaction in a multicenter setting. Significantly better results are achieved in less severe and non-irradiated cases. Durability of the device is reassuring in the short-term.

[The urologist of the future and new technologies.] / El urólogo del futuro y las nuevas tecnologías.

The last 25 years have brought about revolutionary changes for medicine and in particular for urology: internet was only in its infancy, medical records were written on paper, searches for medical information were done in the hospital library, medical articles were photocopied and our relationship with patients only existed face to face. Social networks had not yet appeared and even Google did not exist. Just imagine what might happen during the next 25 years, we're going to see even more radical changes. The urologist of the future is going to see the arrival of artificial intelligence, collaborative medicine, telemedicine, machine learning, the Internet of Things and personalized robotics; in the meantime, social media will continue to transform the interaction between physician and patient. The training of urologists will also be different thanks to new learning technologies such as virtual reality or augmented reality. IBM Watson Health through its system of artificial intelligence and its learning algorithms will become our essential travel companion. The urologist of the future, as well as physician, will have to acquire the necessary technological skills in order to use all these new tools which are already on the horizon.

Estimate of the pair correlation functions of nuclei in normal prostate, prostatic intraepithelial neoplasia, and cancer

This study deals with the application of methods of second-order stereology to investigate the spatial distribution of nuclei in normal prostate, prostatic intraepithelial neoplasia and adenocarcinoma. We aimed to identify differences related to the progression of premalignant lesions (PIN) to carcinoma, as well as the spatial changes in relation to tumour grade. Estimation of second-order stereology parameters, such as g(r), (pair correlation function), statistic M, and Clark-Evans aggregation index (CEAI) were employed to investigate the distribution of nuclei. Linear discriminant analysis (LDA) with M and CEAI as model variables was implemented to classify the cancer cases into two groups according to Gleason score. We found that the point processes of the nuclei in prostatic cancer and normal tissues differed by first-order as well as by second-order properties. In the PIN the mean g-values were intermediate between normal and cancer. The LDA indicates that M and CEAI were able to classify into the correct group of Gleason score more than 90% of the cases analysed. Cancer cases showing a higher degree of disorder in the spatial distribution of nuclei were significantly classified into the group of higher Gleason score. The nuclei in both normal and pathological prostate were not Poisson distributed. Additionally, we found that the progression from normal tissue to carcinoma was accompanied by a progressive increase in spatial disorder which is intermediate in pre-malignant lesions (PIN). The parameters employed were able to classify the cancer cases according to the Gleason score

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Turn-amplitude analysis as a diagnostic test for myofascial syndrome in patients with chronic pelvic pain.

BACKGROUND: Myofascial pain syndrome of the pelvic floor (MPSPF) is a common disease in the context of chronic pelvic pain (CPP); however, there is currently no gold-standard test to diagnose it. OBJECTIVE: To validate the turns-amplitude analysis (TAA) as a diagnostic test for MPSPF in patients with CPP. METHODS: A case-control study was performed, and patients were consecutively sampled within a specified period of time. A total of 128 patients were included: 64 patients with CPP (32 men and 32 women) and 64 control patients (32 men and 32 women). The same operator conducted all tests. Electromyography of the TAA is based on the collection of motor unit potentials that measure the number of changes in the signal and the mean amplitude of the changes. The electromyogram transfers the data to a graphical point cloud, which enables the patient's results to be compared with the results of the healthy subjects. RESULTS: In patients and control subjects, the sensitivity and specificity of the proposed diagnostic test showed a marked clinical significance: the sensitivity was 83%, and the specificity was 100%. A positive predictive value of 1 (95% CI 1 to 1) and a negative predictive value of 0.85 (95% CI 0.77 to 0.93) were observed. CONCLUSION: TAA is a reliable diagnostic test to detect MPSPF. Further studies are needed to reproduce these results.

[Clinical profile of patients with chronic pelvic pain: a descriptive analysis]. / Perfil clínico de los pacientes con dolor pélvico crónico: un análisis descriptivo.

OBJECTIVES: The aim of this paper is to analyze the clinical profile of patients with chronic pelvic pain (CPP) to obtain a more accurate and fast clinical diagnosis. METHODS: In this retrospective and descriptive cross-sectional study, we recruited 64 patients with CPP (32 men and 32 women. Patients had confirmed diagnosis of CPP. History was done including past medical history, prior abdominal and pelvic surgery, practice of risk sports, start and evolution of the pain, and number of physicians visited. We evaluated pain intensity with a VAS scale, neuropathic characteristics of the pain with the DN4 questionnaire, anxiety and depression with the HAD Scale (HADS) and disability with the Oswestry Disability Index (ODI ). Pelvic floor evaluation integrated intrapelvic and extrapelvic muscles assessment. RESULTS: Average number of doctors visited was 6.4 for men and 10 for women. The VAS for men was 5.43 (± 2.29), for women 6.89 (± 1.89). The DN4 for men was 4.53 (± 2.2), for women 4.44 (± 2.2). The mean anxiety in men was 10.18 (±4.27) and for women 9 (± 4.6) and mean depression in men was 7.31 (± 4.88) and for women 7.16 (± 4). ODI for men was 26.7% (±2.2), for women 33.75% (± 2.2). CONCLUSION: We have defined a clinical profile of patients with CPP that can enable a better approach to the reality of these patients with diminished quality of life.

Perfil clínico de los pacientes con dolor pélvico crónico: un análisis descriptivo / Clinical profile of patients with chronic pelvic pain: Descriptive analysis

OBJETIVO: Definir el perfil clínico de los pacientes con dolor pélvico crónico (DPC). MÉTODOS: Estudio trasversal retrospectivo y descriptivo. Se reclutaron 64 pacientes con DPC (32 hombres y 32 mujeres). A los pacientes se les confirmó el diagnóstico de DPC. Se exploraron músculos intrapélvicos y extrapélvicos. Fueron historiados sobre sus antecedentes personales, cirugía abdomino-pélvica, práctica de deportes de riesgo, inicio del dolor, y sus localizaciones más frecuentes, y número de médicos visitados. Se valoraron la intensidad del dolor con la EVA, las características neuropáticas con el cuestionario DN4, la ansiedad y depresión con la Escala HAD (EHAD) y la discapacidad con el Índice de discapacidad de Oswestry (IDO). RESULTADOS: Los hombres visitaron 6,4 médicos de media por 10 las mujeres. La EVA para los hombres fue 5,43 (± 2,29), para las mujeres 6,89 (± 1,89). El DN4 para los hombres fue 4,53 (± 2,2), para las mujeres 4,44 (± 2,2). La media de la ansiedad en los hombres fue de un 10,18 (± 4,27) y para las mujeres fue de un 9 (± 4,6).La media de la depresión en los hombres fue de un 7,31 (± 4,88) y para las mujeres fue de un 7,16 (± 4).El IDO para los hombres fue de un 26,7 % (± 2,2), para las mujeres 33,75 % (± 2,2). CONCLUSIÓN: Se ha definido un perfil clínico de los pacientes con DPC que puede permitir un mejor acercamiento a la realidad de estos pacientes con una mermada calidad de vida

OBJECTIVES: The aim of this paper is to analyze the clinical profile of patients with chronic pelvic pain (CPP) to obtain a more accurate and fast clinical diagnosis. METHODS: In this retrospective and descriptive cross-sectional study, we recruited 64 patients with CPP (men and 32 women). Patients had confirmed diagnosis of CPP. History was done including past medical history, prior abdominal and pelvic surgery, practice of risk sports, start and evolution of the pain, and number of physicians visited. We evaluated pain intensity with a VAS scale, neuropathic characteristics of the pain with the DN4 questionnaire, anxiety and depression with the HAD Scale (HADS) and disability with the Oswestry Disability Index (ODI). Pelvic floor evaluation integrated intrapelvic and extrapelvic muscles assessment. RESULTS: Average number of doctors visited was 6.4 for men and10 for women. The VAS for men was 5.43 (± 2.29), for women 6.89 (± 1.89). The DN4 for men was 4.53 (± 2.2), for women 4.44 (± 2.2). The mean anxiety in men was 10.18 (± 4.27) and for women 9 (± 4.6); and mean depression in men was 7.31 (± 4.88) and for women 7.16 (± 4). ODI for men was 26.7% (± 2.2), for women 33.75% (± 2.2). CONCLUSION: We have defined a clinical profile of patients with CPP that can enable a better approach to the reality of these patients with diminished quality of life

Effects of raloxifene on cognition in postmenopausal women with schizophrenia: a double-blind, randomized, placebo-controlled trial.

Studies of estrogen therapy in postmenopausal women provide evidence of an effect of sex hormones on cognitive function. Estrogen has demonstrated some utility in the prevention of normal, age-related decline in cognitive functions, especially in memory. The potential therapeutic utility of estrogens in schizophrenia is increasingly being recognized. Raloxifene, a selective estrogen receptor modulator (SERM), appears to act similarly to conjugated estrogens on dopamine and serotonin brain systems, and may be a better option since it lacks the possible negative effects of estrogen on breast and uterine tissue. We assessed the utility of raloxifene as an adjuvant treatment for cognitive symptoms in postmenopausal women with schizophrenia in a 12-week, double-blind, randomized, placebo-controlled study. Patients were recruited from both the inpatient and outpatient departments. Thirty-three postmenopausal women with schizophrenia (DSM-IV) were randomized to receive either adjuvant raloxifene (16 women) or adjuvant placebo (17 women) for three months. The main outcome measures were: Memory, attention and executive functions. Assessment was conducted at baseline and week 12. The total sample is homogenous with respect to: age, years of schooling, illness duration, baseline symptomatology and pharmacological treatment. The addition of raloxifene (60 mg) to regular antipsychotic treatment showed: we found significant differences in some aspects of memory and executive function in patients treated with raloxifene. This improvement does not correlate with clinical improvement. The use of raloxifene as an adjuvant treatment in postmenopausal women with schizophrenia seems to be useful in improving cognitive symptoms.

Raloxifene as an adjunctive treatment for postmenopausal women with schizophrenia: a double-blind, randomized, placebo-controlled trial.

OBJECTIVE: The potential therapeutic utility of estrogens in schizophrenia is increasingly being recognized. Raloxifene, a selective estrogen receptor modulator, appears to act similarly to conjugated estrogens on dopamine and serotonin brain systems and may be a better option since it lacks the possible negative effects of estrogen on breast and uterine tissue. In this study, we assess the utility of raloxifene as an adjunctive treatment for negative symptoms and other psychotic symptoms in postmenopausal women with schizophrenia. METHOD: This was a 12-week, double-blind, randomized, placebo-controlled study. Patients were recruited from both the inpatient and outpatient departments of Parc Sanitari Sant Joan de Déu, Barcelona, Spain, and Corporació Sanitària Parc Taulí, Sabadell, Spain. Thirty-three postmenopausal women with schizophrenia (DSM-IV criteria) who exhibited prominent negative symptoms were randomized to either adjunctive raloxifene (16 women; mean age = 60.14 years, SD = 6.41 years) or adjunctive placebo (17 women; mean age = 62.66 years, SD = 4.54 years) for 12 weeks. The period of recruitment lasted from January 2005 through June 2009. Psychopathological symptoms were assessed at baseline and weeks 4, 8, and 12 by means of the Positive and Negative Syndrome Scale. RESULTS: The addition of raloxifene (60 mg/d) to regular antipsychotic treatment significantly reduced negative (P = .044), positive (P = .031), and general psychopathological (P = .045) symptoms during the 12-week trial as compared with women receiving placebo. CONCLUSIONS: Raloxifene as an adjuvant treatment in postmenopausal women with schizophrenia who exhibit prominent negative symptoms appears to be useful in improving negative, positive, and general psychopathological symptoms. If more extensive and longer-term studies confirm and expand upon these positive results, the use of raloxifene could be recommended in postmenopausal patients with schizophrenia. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01041092.

Reproducibility of non-invasive urodynamics, using the cuff-uroflow, for the diagnosis of bladder outlet obstruction in males.

OBJECTIVE: To determine the repeatability of the parameters obtained from non-invasive urodynamics, using the cuff-uroflow, for the diagnosis of bladder outlet obstruction. MATERIAL AND METHODS: The study was carried out in a consecutive series of 34 males with functional urinary tract symptoms. The test-retest reproducibility of isometric pressure, flow in response to isovolumetric pressure and the energy transfer ratio obtained at two different times using the cuff-uroflow method was determined. RESULTS: Very good agreement for the flow in response to isovolumetric pressure measurement (intraclass correlation coefficient 0.96) and good agreement for the isovolumetric pressure measurement (intraclass correlation coefficient 0.87) and the energy transfer ratio (intraclass correlation coefficient 0.84) were demonstrated. The patients were classified into three groups according to the value of the energy transfer ratio, and it was found that there was very good agreement between the groups into which patients were classified as a result of the first and second measurements (kappa index 0.81). CONCLUSIONS: The parameters obtained with the cuff-uroflow are reliable and the energy transfer ratio allows one to classify patients into reproducible groups.