[Urinary incontinence in menopause]. / Incontinencia urinaria en la menopausia.

OBJECTIVE: To determine if menopause increases the risk of developing bladder hyperactivity or stress urinary incontinence. METHODS: A case control study was conducted on 111 women, 57 with bladder hyperactivity and 54 controls without hyperactivity, and 55 cases with stress urinary incontinence and 55 controls without stress urinary incontinence. The results were analyzed by multivariant logistic regression for the influence of age. RESULTS: A relationship was found between age and menopause and the risk of developing stress urinary incontinence. No relationship was found between bladder hyperactivity and age or menopause. Age was found to be a negative factor of menopause in regard to the risk of developing stress urinary incontinence. CONCLUSIONS: The risk of developing stress urinary incontinence in menopausal women decreases with age and disappears after age 52.

[Early diagnosis of prostate cancer in patients with prostate symptoms by DRE, PSA, TRU and DPSA]. / Diagnóstico precoz del cáncer de próstata en pacientes con sintomatología prostática mediante TR, PSA, ECOTR y DPSA.

Presentation of our experience in the early diagnosis of prostate cancer in patients with signs and symptoms of prostatism. Over a one year period (96-97), 316 patients underwent biopsy based on clearly defined criteria according to the diagnostic algorithm used in our centre: suspicious DRE and/or PSA > or = 10 ng/mL, and in patients with PSA between 4 and 10 ng/mL in the presence of suspicious TRU or when DPSA was > or = 0.15. The ratio of the 136 (43%) prostate cancer diagnosed relative to biopsy +/- was 1:1.32. It is concluded that early diagnosis in a selected population is useful and shows good diagnostic yield. The diagnostic algorithm used is more than acceptable with 43% positive biopsies and a good ratio between biopsy +/-. With a cutoff of 0.15 DPSA is a good method to improve PSA significance in patients in the difficult PSA range of 4 to 10 ng/mL.

[Left supraclavicular adenopathy with a neuroendocrine pattern of unknown cause: prostatic carcinoma metastasis]. / Adenopatía supraclavicular izquierda con patrón neuroendocrino de causa desconocida: metástasis por carcinoma de próstata.

Contribution of a case report of a male patient presenting with single left supraclavicular adenopathy of initially unknown origin and histologic pattern of neuroendocrine nature, finally traced to the prostate. It is believed that in any male over 45 diagnosed with carcinoma of unknown origin in the supradiaphragm lymph nodes, prostate carcinoma metastasis should also be ruled out using PSA immunostaining and by measuring serum PSA, serum alkaline phosphatase and DRE.

[Evaluation of new intraurethral occlusive depot (ORIS FEMININO) in the management of female stress urinary incontinence]. / Evaluación de un nuevo dispositivo oclusivo intrauretral (ORIS FEMENINO) en el manejo de la incontinencia urinaria de esfuerzo femenina.

OBJECTIVE: To determine the utility and safety of an intraurethral device (Oris Femenino) in the management of female stress urinary incontinence. METHODS: A prospective clinical study was conducted on 54 female patients, mean age 46.4 years, with stress urinary incontinence. The degree and severity of the incontinence was determined before and one month after treatment with the intraurethral device. The reasons for the dropouts were analyzed and the rehabilitative effects two months after treatment had been completed were evaluated in 22 patients. RESULTS: 83% of the patients who completed the study referred positive results. A significant improvement was demonstrated for the degree of incontinence as well as the number of absorbent pads used. Age and severity of incontinence inversely correlated with positive results. A correlation between the absence of a previous urethropexy and positive results was also found. The dropout rate was 44% (24 patients) and was chiefly due to symptomatic bacteriuria in 14 cases and the difficulty in fixation and degree of incontinence. A statistically significant reduction was found in the number of pads used in the group of patients evaluated two months after treatment had been completed. CONCLUSIONS: The intraurethral device analyzed in this study significantly reduced urinary incontinence. This method appears to be more effective in younger women who are not severely incontinent and have not previously undergone urethropexy. The intraurethral device appears to have some rehabilitative effect on the perineal muscle. Symptomatic bacteriuria was found to be the main disadvantage.

[Female urinary incontinence: clinical-urodynamic correlation]. / Incontinencia urinaria femenina: correlación clínico-urodinámica.

OBJECTIVES: To determine the diagnostic utility of the urinary symptoms and physical examination in the urodynamic diagnosis of the type of female urinary incontinence. METHODS: A descriptive longitudinal study was conducted in 100 women undergoing urodynamic evaluation. The patients were asked about the urinary symptoms and were evaluated by physical examination and cystomanometry. RESULTS: A statistically significant correlation was found for age and clinical type of urinary incontinence. A strong trend was observed for clinical type of urinary incontinence and cystocele grade, and the urodynamic type of incontinence. A low sensitivity was found for the clinical type in relation to the urodynamic type of incontinence. CONCLUSIONS: Urinary incontinence clinical data do not permit determination of the urodynamic type of incontinence.

[Bladder tumor in pregnancy]. / Tumor vesical durante el embarazo.

Diagnosis of tumours during pregnancy is quite unusual, considering the low frequency of neoplasias in this period (1/1000 pregnancies) as well as the low incidence of bladder cancer in patients under 30, which makes the coincidence of both phenomena quite uncommon. The paper contributes the case of a 28-year old female diagnosed with bladder cancer during her pregnancy.

[Reliability of fractal dimension measurement of uroflow curves]. / Fiabilidad de la medición de la dimensión fractal de las curvas de flujo miccional.

OBJECTIVE: To determine the reliability of fractal analysis of uroflow curves. METHODS: We analyzed the correlation between the fractional dimension analysis of two series of uroflow curves with an interval of 88.21 days. The fractal dimension was calculated by two methods. RESULTS: A good correlation was found for both methods, although it was lower than that of maximum flow. A relationship was found between the fractal dimension and maximum flow. CONCLUSIONS: The fractional dimension is a reliable parameter that appears to be related with urinary flow.

[Diabetic neurocystopathy: multivariate study]. / La neurocistopatía diabética: estudio multivariante.

OBJECTIVE: To analyze the prevalence of urodynamic disorders and the factors associated with bladder instability in patients with diabetes mellitus. METHODS: We conducted a clinical and urodynamic study on 138 diabetic patients (71 males, 51%; 67 females, 49%) with a mean age of 64.04 years. Patient evaluation included patient history, neurological physical examination, cystometry, pressure-flow test, filling videocystography and selective EMG of the periurethral sphincter. Data obtained were analyzed by multivariant logistic regression analysis, taking the probability of developing bladder instability as a dependent variable. RESULTS: Bladder instability was the most frequent urodynamic finding (52%), followed by lower urinary tract obstruction (44%), involvement of bladder contractility (41%) and stress urinary incontinence (22%). Lower motor neuron (S2-S4) pudendal nerve lesion was observed in 33% of the cases and 24% had upper motor neuron involvement. Multivariant analysis showed age and stress urinary incontinence (inverse correlation) to be the only independent variables for bladder instability. The other variables that correlated with instability (but dependent on the foregoing variables) were involvement of bladder contractility and type of diabetes (higher probability for diabetes type II). No correlation was found for sex, duration of the diabetes, stroke (CVA), urinary obstruction or pudendal nerve lesion. CONCLUSIONS: Bladder instability was found to be the most frequent urodynamic disorder in diabetic patients. The probability of developing bladder instability increases with age and decreases in patients with stress urinary incontinence.

[Evidence-based medicine. Usefulness of isolated cystomanometry for the diagnosis of periurethral detrusor-sphincter dyssynergia in patients with suprasacral lesion]. / Medicina basada en la evidencia. Utilidad de la cistomanometría aislada para el diagnóstico de disinergia detrusor-esfínter periuretral en pacientes con lesión medular suprasacral.

OBJECTIVE: To determine the utility of cystomanometry alone in the diagnosis of periurethral detrusor-sphincter dyssynergia in patients with suprasacral spinal cord lesion. METHODS: Cystomanometry and selective electromyography were performed to evaluate the periurethral sphincter of 40 patients (16 female and 24 male; mean age 46.6 years) with suprasacral spinal cord injury diagnosed by neurological evaluation. RESULTS: The pre-test probability of having dyssynergia was 0.45. The post-test probability, with cystomanometrically demonstrated hyperreflexia, was 0.58. The likelihood ratio utilizing cystomanometry alone was 1.69. CONCLUSION: Cystomanometry alone is not useful in the diagnosis of periurethral detrusor-sphincter dyssynergia in patients with suprasacral spinal cord injury. Periurethral electromyography should be used in combination with the foregoing technique.

[Four new cases of urothelial inverted papilloma]. / Cuatro nuevos casos de papiloma invertido urotelial.

Urothelial inverted papilloma account for 2.2% of all urothelial tumours. The preferred location is the bladder; they occur singly and are generally benign, although the majority of authors agrees in treating this entity as a tumour of low aggressiveness. The report contributes four cases of inverted papilloma, three in male patients and the fourth in a female. One was located in the renal pelvis. A revision is made of the etiology, clinical signs and symptoms, diagnosis and treatment, as well as their relationship to surface carcinoma, as it occurs asynchronously in one of the cases described.

[Pressure-flow studies in the diagnosis of micturition disorders in the female]. / Los estudios presión-flujo en el diagnóstico de disfunción miccional de la mujer.

OBJECTIVE: To determine the utility of the pressure-flow studies in the diagnosis of voiding dysfunction in women. METHODS: A case-control study was conducted on 80 women. These subjects were divided into two groups: 24 controls with a maximum flow percentile greater than or equal to 50 and no residual volume, and 56 cases with a maximum flow percentile less than or equal to 10. The clinically and statistically significant parameters of the pressure-flow study were entered into a multiple regression logistic equation as explanation variables of voiding dysfunction. RESULTS: The clinical variables that influenced voiding dysfunction were age and the presence of stress urinary incontinence. The urethral resistance average (URA) was found to be the only significant urodynamic parameter. Patients with stress urinary incontinence showed a lower probability of voiding dysfunction. Age and URA directly correlated with the probability of voiding dysfunction. CONCLUSIONS: The URA was found to be the only significant urodynamic parameter. The contractility parameters [power at maximum flow (Pw) and maximum power per bladder unit surface (Wmax)] were not found to be useful as detrusor contractility index in women.

[Spontaneous bladder perforation secondary to bladder candidiasis]. / Perforación vesical espontánea secundaria a candidiasis vesical.

Presentation of an spontaneous vesical perforation secondary to vesical candidiasis in a patient with in-dwelling catheter due to BPH. Analysis of etiological factors, clinical signs and symptoms, diagnosis and management of both entities.

[Bladder neoplasms in patients under 40 years of age]. / Tumores vesicales en pacientes menores de cuarenta años.

The incidence, presentation and clinical evolution of vesical tumours diagnosed in our Centre over the last 10 years (1986-1995) in patients under forty are examined. This retrospective study included 19 of the 643 neoplasias treated during that period; 7 of these in patients under 30 and 12 in patients over 31. Haematuria was the most frequent reason for visiting the Centre. At the time of diagnosis, all cases were surface tumours and none progressed to the infiltrant stage. Tumours in patients over 30 are characterised by a higher histological grade and greater relapse rate versus those in patients under 30. Therefore, age may be a favourable prognostic factor in patients under 30 versus the older group who follow a course more similar to the remainder of usual patients. Diagnosis and treatment of these neoplasias should be just the same as for tumours in older patients.

[Nosocomial infection in BPH: economic costs and increase in hospital stay]. / Infección hospitalaria en HBP: costes economicos y aumento del tiempo de hospitalización.

We present a cohort study where 40 matched pairs of patient (infected and no infected) were included. All of the patients had prostatic benign hyperplasia and open surgery or thransuretral resection was developed. Infected patients stay 3 days more in the hospital and they cost 120.000 pts more than uninfected patients.

[Calmette-Guerin bacillus in the prophylaxis of superficial bladder tumors. Our experience and our doubts]. / Bacilo de Calmette-Guerin en la profilaxis de los tumores superficiales de vejiga. Nuestra experiencia y nuestras dudas.

OBJECTIVE: This study was conducted to determine the efficacy of our BCG dose and schedule for prophylactic therapy in superficial bladder tumors. METHODS: Following complete TUR, 81 mg intravesical BCG were administered weekly for six weeks and for nightly another six times. The patients were evaluated every three months by cytology, cystoscopy and routine analysis. RESULTS: 21/25 patients completed the treatment. At 15.5 months median follow-up, 18/21 (85.7%) were disease-free, 2/21 (9.5%) had recurrence and 1/21 (4.7%) showed disease progression. CONCLUSIONS: BCG is the most effective prophylactic therapy for superficial bladder tumors currently available. The ideal dose, treatment schedule and its mechanism of action are as yet unknown.

[Bladder schistosomiasis: report of 2 new cases with different anatomoclinical features and review of the literature]. / Esquistosomiasis vesical: aportación de dos nuevos casos con presentaciones anatomo-clínicas diferentes y revisión de la literatura.

This paper reports two cases of vesical schistosomiasis in two black patients treated in this Service over the last three years. A description is made of the different anatomo-clinical presentations of these two cases, commenting on the characteristics of this disease, its pathogenesis, diagnosis and treatment, and stressing the slight increase in its frequency in our environment as a consequence of the increased migratory movements of people from endemic regions into our country.

[The index of PSA age vs PSA density. 2 new instruments in the detection of prostatic carcinoma]. / Indice de edad de PSA VS. densidad de PSA. Dos nuevos instrumentos en la detección del carcinoma prostático.

A prospective study was designed to get to know the reliability of PSA density and PSA age index as tools in the diagnostic approach for prostate carcinoma. It was noted that PSA age index is more susceptible than PSA density to diagnose prostate cancer. We noted also that up to 80% of patients with prostate cancer and intermediate PSA levels have PSA density < 0.15 and that, according to current protocols biopsy should not have been performed. It was concluded that the value of PSA age index is at least equal to PSA density, but it eradicates the subjectivity introduced by this data because of the need of measuring prostate volume. We believe that in the future it may be indicated to perform biopsies at PSA levels above 4 ng/ml, and it may be necessary to decrease PSa normal density levels down to 0.1 or less.

[Immunoprophylaxis of superficial tumors of the bladder with interferon alfa-2b. Our experience]. / Inmunoprofilaxis de los tumores superficiales de vejiga con interferon alfa 2b. Nuestra experiencia.

OBJECTIVE: The present study was conducted to determine the usefulness of prophylactic therapy with alpha 2b interferon for superficial bladder tumors. METHOD: Following complete TUR, alpha 2b infereron was administered to 36 patients at a dose of 50 million IU weekly for 3 months and monthly for 9 months. Patients were evaluated every 3 months on the basis of their clinical and analytical data and the cystoscopic findings. RESULTS: Twenty-six patients completed treatment and were evaluable. The follow up and disease-free period was 25.70 months. Recurrence was observed in 38.4% of the patients and tumor progression in 3.8%. CONCLUSIONS: Alpha 2b interferon is useful in the prevention of tumor recurrence. Its utility is similar to that of other drugs currently used.

[The role of vascular radiology in the diagnosis of "suspicious" images of the upper urinary tract]. / Papel de la radiología vascular en el diagnóstico de las imágenes "sospechosas" del tracto urinario superior.

Accurate diagnosis of "suspect" lesions from the Upper Urinary Tract (U.U.T.) is of major significance for implementing an appropriate treatment. There are many diseases and situations which may condition the occurrence of a suspect image, i.e., of a repletion defect of the U.U.T., in the U.I.V., the vascular imprints being just one of them. This paper contributes two cases where the suspect lesion was due to this cause and vascular radiology was decisive to reach a diagnosis.