El cateterismo vesical intermitente en la insuficiencia contráctil del detrusor / The role of clean intermittent catheterization in the treatment for detrusor underactivity

OBJETIVOS: Estudiar la influencia del cateterismo vesical intermitente (CVI) sobre la función del tracto urinario inferior (TUI) en pacientes con retención urinaria (RU) por insuficiencia contráctil (IC) del detrusor. MATERIAL Y MÉTODOS: Estudio longitudinal. Cuarenta y nueve pacientes (28 hombres/21 mujeres; edad media: 55 años) sometidos a CVI por RU por IC (frecuencia media 3,15 veces/día). El único criterio de inclusión fue la realización de CVI asociada a IC. Se realizó historia clínica y dos estudios urodinámicos con un intervalo de 4 años de media. Se compararon los datos urodinámicos pre y post CVI mediante test exacto de Fisher para variables dicotómicas y test de la t de Student para datos pareados (estudios antes y después del CVI) e independientes (comparación entre diferentes grupos) en el caso de las variables paramétricas. El nivel de significación se fijó en 5% bilateral. RESULTADOS: Se observó aumento significativo de la acomodación vesical, del índice de obstrucción (BOOI) y del índice de contractilidad vesical (BCI), sin alcanzar significación estadística. Respecto de los pacientes en los que su BCI mejoró después del CVI se observó un porcentaje significativamente mayor de pacientes con hiperplasia benigna de próstata (HBP) y detrusor acontráctil comparado con los pacientes en los que el BCI no mejoró después del CVI. El tiempo en que los pacientes estaban sometidos a CVI fue significativamente menor en el grupo de mejoría. CONCLUSIONES: El CVI mejoró la acomodación vesical en los pacientes de nuestra serie. El BCI mejoró en varones con HBP y en pacientes con detrusor acontráctil

OBJECTIVE: To study the influence of clean intermittent catheterization (CIC) on the lower urinary tract function in patients with urinary retention (UR) due to detrusor underactivity (DU). MATERIAL AND METHODS: A longitudinal study was carried out on 49 patients (28 men, 21 women) of mean age 55 years, who underwent CIC for UR secondary to DU. The mean CIC frequency was 3.15 times/day. Patients' clinical data were collected, and they underwent urodynamic study before and after CIC, with a mean interval of 4 years. Fisher's exact test was used for the analysis of categorical variables and Student's t test for parametric variables. The level of significance was set at 0.05 for a two-tailed test. RESULTS: The second urodynamic study showed a significantly increased bladder compliance, the Bladder Outlet Obstruction Index (BOOI) and the Bladder Contractility Index (BCI) also increased but without reaching statistical significance. There was a significantly higher percentage of benign prostatic hyperplasia (BPH) and acontractile detrusor cases among the group of patients whose BCI improved after CIC, with significantly lower CIC time. CONCLUSIONS: CIC improved bladder compliance in the patients of our series. The BCI improved in BPH patients and in patients with acontractile detrusor

The role of clean intermittent catheterization in the treatment for detrusor underactivity. / El cateterismo vesical intermitente en la insuficiencia contráctil del detrusor.

OBJECTIVE: To study the influence of clean intermittent catheterization (CIC) on the lower urinary tract function in patients with urinary retention (UR) due to detrusor underactivity (DU). MATERIAL AND METHODS: A longitudinal study was carried out on 49 patients (28 men, 21 women) of mean age 55years, who underwent CIC for UR secondary to DU. The mean CIC frequency was 3.15 times/day. Patients' clinical data were collected, and they underwent urodynamic study before and after CIC, with a mean interval of 4years. Fisher's exact test was used for the analysis of categorical variables and Student's t test for parametric variables. The level of significance was set at 0.05 for a two-tailed test. RESULTS: The second urodynamic study showed a significantly increased bladder compliance, the Bladder Outlet Obstruction Index (BOOI) and the Bladder Contractility Index (BCI) also increased but without reaching statistical significance. There was a significantly higher percentage of benign prostatic hyperplasia (BPH) and acontractile detrusor cases among the group of patients whose BCI improved after CIC, with significantly lower CIC time. CONCLUSIONS: CIC improved bladder compliance in the patients of our series. The BCI improved in BPH patients and in patients with acontractile detrusor.

Influence of bladder lithiasis on lower urinary tract dynamics in patients with spinal cord injury.

STUDY DESIGN: A prospective and a case-matched control study. OBJECTIVES: To study the lower urinary tract dysfunction associated with bladder lithiasis in patients with spinal cord injury (SCI). SETTING: Toledo (Spain). METHODS: We have carried out a urodynamic study in 30 patients with SCI with lithiasis in their bladder before and 3 months after bladder endoscopic lithotripsy. This second study was compared with the urodynamic findings of a different group of 30 patients with SCI, without a history of bladder lithiasis, paired with cases by gender and date of urodynamic study. RESULTS: We have found that the prevalence of neurogenic detrusor overactivity (NDO) was significantly different after bladder lithotripsy, although the cystomanometric capacity was significantly increased. A group of patients with lithiasis showed a maximum flow rate, a voiding maximum detrusor pressure and the detrusor contractility parameter Wmax lower than that in controls. On the other hand, a voiding abdominal straining was found to be significantly greater than that in controls. CONCLUSIONS: Bladder lithiasis affects the presence of NDO in patients with SCI. Patients with SCI who develop bladder lithiasis present a lower detrusor contractility power compared with those who do not.

Other radiological lesions of the Lower Urinary Tract in patients after isolated pelvic radiotherapy and combined with surgery. / Otras lesiones radiológicas del tracto urinario inferior (TUI) en pacientes sometidos a radioterapia pélvica en monoterapia y combinada con cirugía.

INTRODUCTION: The cystographic study of patients who have undergone radiotherapy (RT) and pelvic surgeries is uncommon in the literature, not described in patients without complications, and mostly related to urinary fistulae. OBJECTIVE: The study of the lower urinary tract (LUT) by cystography in these patients, with a description of some other types of radiation lesions. METHODS: 127 cystographies have been performed (88 men and 39 women) in consecutive patients undergoing radiotherapy (RT) (48 monotherapy and 79 cases combined with surgery), with a mean age of 69.6 years, and a mean time from radiation of 215 months (17 years). A General Electric X ray equipment has been used. We studied: behavior of the bladder neck at rest and during micturition, assessment of vesicoureteral reflux (VUR), bladder morphology (BM), urethral strictures (UE) and fistulas (F). RESULTS: We observed: Filling phase bladder neck incompetence (BNI) (37.8%), bladder smooth morphology (60.6%), coughing urinary incontinence (UI) (26.4%), basal cystocele (64.7%) and Valsalva cystocele (96.6%), a normal opening bladder neck (96,1%), reduction of the urethral diameter during voiding (41.3%), and vesicoureteral reflux (VUR) (13.2%). Five cases of filling BNI, were all related to prostate cancer (PC) (one of them with colon cancer as well). There were six cases of fistulae (4.14%), five of them women. Forty two patients (28.96%) had reduced urethral lumen, thirty five of them affecting the posterior urethra (83%), five (11.9%) the anterior and, finally, two cases of mixed lesion (5%). 95% were patients with PC without concurrent interventions (67%). Significant differences were found regarding the gender and the background of pelvic surgery. The filling BNI (p=0.007), the irregular bladder morphology (p=0.004) and the reduction of the urethral lumen (p<0.001) have been found to be more common in male patients, while the coughing UI was more common in women (p=0.007). The study shows that BNI (p=0.046), VUR (p=0.02) and the IU due to cough (p=0.03) were more frequent in operated patients, while reduced urethral lumen was less common (p<0.01). Patients with VUR present more time from radiotherapy, but not in other cystography variables. There was a relationship between RT and the BNI, stress urinary incontinence, anterior urethral stricture and VUR. The risk factor was increased by surgery. CONCLUSIONS: Bladder neck incompetence, stress UI, anterior urethral stricture and VUR have been related to radiotherapy. Surgery increased the risk factor in operated patients.

Risk factors of urethral diverticula in male patients with spinal cord injury.

STUDY DESIGN: A case-control study in a series of 55 males with urethral diverticula (UD) and their correspondent control, matched by age and time of radiological assessments. OBJECTIVES: To evaluate the risk factors to develop UD in males with spinal cord injury (SCI) and the place in the urethra where they are, most commonly, allocated. SETTING: Toledo, Spain. METHODS: Clinical histories and urodynamic studies, of all patients, were reviewed. The study was completed with a telephone survey according to an established protocol. RESULTS: The univariate analysis study showed the following risk factors: the age of onset of the spinal injury, the sphincterotomy procedure, personal history of lower urinary tract infections (LUTIs) and the chronic need of either indwelling catheter (IC) or the external condom drainage (ECD). Regarding the location of the UD, we have found the stress urinary incontinence as the only risk factor to develop UD in the prostatic urethra.On the other hand, we can conclude that the sphincterotomy, the ECD, the personal history of LUTIs and the detrusor external sphincter dyssynergia seem to be risk factors to develop diverticula in the bulbo-membranous urethra. Finally, we could point out the IC as the only risk factor for penile UD. Multivariate analysis showed that all of these risk factors were independent among them except the age of the onset of the injury and the ECD for UD in the bulbo-membranous urethra. CONCLUSION: According to our study, there is evidence of some specific risk factors for the development of UD in male patients with SCI, and therefore we should adopt the appropriate preventive measures to prevent them.

Factores que influyen en los resultados urodinámicos de la toxina botulínica en el tratamiento de la hiperactividad neurógena / Factors that influence the urodynamic results of botulinum toxin in the treatment of neurogenic hyperactivity

Objetivos: Determinar la eficacia urodinámica y los factores que influyen en los resultados urodinámicos del tratamiento de la hiperactividad neurógena del detrusor con inyección intradetrusoriana de toxina botulínica tipo A (TXB-A) en pacientes con lesión medular (LM). Material y métodos: Se realizó un estudio retrospectivo en una cohorte de 70 pacientes formada por 40 varones y 30 mujeres con LM estable de 39 ± 13,3 años de edad (media ± desviación típica), sometidos a inyección intradetrusoriana de 300 UI de TXB-A. Se realizó un estudio urodinámico previo y otro a los 6 ± 4,3 meses del tratamiento. Posteriormente se realizaron nuevos estudios urodinámicos hasta un intervalo de 16 ± 12,2 meses. Resultados: La TXB-A aumentó significativamene (p < 0,05) la capacidad vesical cistomanométrica, el volumen vesical de la primera contracción involuntaria del detrusor y el residuo posmiccional. Se observó una disminución con tendencia hacia la significación estadística (p < 0,1) de la presión máxima miccional del detrusor y el flujo miccional máximo. No varió significativamente la acomodación vesical ni el índice de resistencia uretral (BOOI). El aumento de la capacidad vesical se mantuvo en el 50% de la muestra más de 32 meses. La edad, el sexo, el tratamiento anticolinérgico y la antigüedad de la lesión no mostraron influencia respecto del aumento de la capacidad vesical. La sonda a permanencia (SVP) fue el único factor negativo estadísticamente significativo. Conclusiones: El efecto urodinámico de la TXB-A se mantiene durante un considerable intervalo de tiempo. La SVP influye negativamente en el resultado del tratamiento

Objectives: To determine the urodynamic efficacy and factors that influence the urodynamic results of treatment of neurogenic detrusor hyperactivity with intradetrusor injection of botulinum toxin type A (BTX-A) in patients with spinal cord injury (SCI). Material and methods: A retrospective study was conducted with a cohort of 70 patients composed of 40 men and 30 women with stable SCI (mean age, 39 ± 13.3 years) who underwent an intradetrusor injection of 300 IUs of BTX-A. A urodynamic study was conducted prior to the injection and 6 ± 4.3 months after the treatment. New urodynamic studies were subsequently performed up to an interval of 16 ± 12.2 months. Results: The BTX-A significantly increased (p < .05) the cystomanometric bladder capacity, the bladder volume of the first involuntary contraction of the detrusor and the postvoid residue. We observed a decrease that tended towards statistical significance (p < .1) of the maximum detrusor pressure and the maximum urine flow. Neither the bladder accommodation nor the urethral resistance index (bladder outlet obstruction index) varied significantly. The increase in vesical capacity was maintained in 50% of the sample for more than 32 months. Age, sex, anticholinergic treatment and lesion age showed no influence in terms of the increase in bladder capacity. The indwelling urinary catheter (IUC) was the only statistically significant negative factor. Conclusions: The urodynamic effect of BTX-A is maintained for a considerable time interval. The IUC negatively influences the result of the treatment

Factors that influence the urodynamic results of botulinum toxin in the treatment of neurogenic hyperactivity.

OBJECTIVES: To determine the urodynamic efficacy and factors that influence the urodynamic results of treatment of neurogenic detrusor hyperactivity with intradetrusor injection of botulinum toxin type A (BTX-A) in patients with spinal cord injury (SCI). MATERIAL AND METHODS: A retrospective study was conducted with a cohort of 70 patients composed of 40 men and 30 women with stable SCI (mean age, 39 ± 13.3 years) who underwent an intradetrusor injection of 300 IUs of BTX-A. A urodynamic study was conducted prior to the injection and 6 ± 4.3 months after the treatment. New urodynamic studies were subsequently performed up to an interval of 16 ± 12.2 months. RESULTS: The BTX-A significantly increased (p < .05) the cystomanometric bladder capacity, the bladder volume of the first involuntary contraction of the detrusor and the postvoid residue. We observed a decrease that tended towards statistical significance (p < .1) of the maximum detrusor pressure and the maximum urine flow. Neither the bladder accommodation nor the urethral resistance index (bladder outlet obstruction index) varied significantly. The increase in vesical capacity was maintained in 50% of the sample for more than 32 months. Age, sex, anticholinergic treatment and lesion age showed no influence in terms of the increase in bladder capacity. The indwelling urinary catheter (IUC) was the only statistically significant negative factor. CONCLUSIONS: The urodynamic effect of BTX-A is maintained for a considerable time interval. The IUC negatively influences the result of the treatment.

Comparison of ambulatory versus video urodynamics in patients with spinal cord injury.

OBJECTIVE: To compare the data obtained through video urodynamics (VUD) with those obtained through one voiding cycle ambulatory urodynamics monitoring (AUM) in patients with spinal cord injury (SCI). METHODS: A comparative study was conducted in 69 patients with SCI (mean age±s.d. 44±16.9 years), 51 men and 18 women, who were subjected to AUM and VUD. RESULTS: A lack of agreement was observed between the two tests with respect to the cystometric capacity (CC) (ml) (275±197.2 AUM versus 416±198.3 VUD), filling pressure (cm H2O) (4±5.3 AUM versus 9±12.5 VUD), bladder compliance (ml cm(-1) H2O) (116±114.9 AUM versus 161±179.4 VUD), maximum detrusor contraction pressure (cm H2O) (87±65.2 AUM versus 47±35.0 VUD), post-void residual (ml) (206±201.5 AUM versus 308±237.7 VUD) and stress urinary incontinence (kappa index: -0.052). Only the CC obtained in the AUM was in agreement with the mean bladder volume gathered from the frequency-volume chart. Agreement was observed with respect to the presence of neurogenic detrusor overactivity (kappa index: 0.307) and bladder outlet obstruction index (cm H2O) (17±48.0 AUM versus 15±18.7 VUD). There was no clear association between AUM parameters and bladder neck morphology, the presence of radiological detrusor-external sphincter dyssynergy or vesicoureteral reflux observed in the VUD. CONCLUSION: The differences between both methods discourage the use of AUM with just one voiding cycle in the evaluation of patients with SCI.

Sexual dysfunction in men with spinal cord injury: a case-control study.

The objective of this study is to confirm that spinal cord injury (SCI) alters the neurological pathways of sexual function (SF) and to ascertain whether other differences exist among men with SCI compared with men without SCI (WSCI) and sexual dysfunction (SD). The method comprise a case study of 98 men with SCI and SD, and 89 men with WSCI and SD as controls. A questionnaire was administered to these men regarding their SF, anxiety, depression, self-esteem and quality of life. Additionally, a penile eco-Doppler study was performed after a prostaglandin E1 (PGE1) injection, in addition to neurophysiological tests of the innervation pathways of SF. The mean age of cases (39.35 years) was significantly lower than the control group (48.5 years). The SCI group had a higher frequency of ejaculatory disorders, and the WSCI group had a higher frequency of decreased sexual desire, erectile dysfunction (ED) and premature ejaculation. The WSCI group had greater anxiety and depression than the SCI group. The systolic velocities of both cavernous arteries were higher in the SCI group. Significant differences were observed in electromyography of the bulbocavernosus muscle, pudendal sensory thresholds, somatosensory potentials, genital sympathetic potentials and electromyography of the cavernous bodies after PGE1 injection. SCI causes significant alterations in the innervation pathways of SF.

Estudio de la influencia de los prolapsos pélvicos en la fase miccional del tracto urinario inferior femenino / Study of the Influence of Pelvic Prolapse in the Lower Urinary Tract Micturation Phase in the Female

Objetivos: El prolapso de suelo pélvico es una patología frecuente en la mujer, que además de alteraciones anatómicas puede ocasionar disfunción del tracto urinario inferior. Se pretende comprobar las alteraciones de la fase miccional en pacientes con prolapso pélvico. Material y métodos: Se realizó un estudio transversal de corte en una serie de 102 mujeres con una edad media de 66,8 años (desviación típica: 9,6 años), diagnosticadas de obstrucción urinaria y prolapso pélvico, y un estudio longitudinal prospectivo en una cohorte de 21 pacientes de la anterior serie intervenidas del prolapso. Las pacientes fueron sometidas a exploración clínica para determinar el tipo y grado de prolapso pélvico y a estudio urodinámico. Resultados: Se observó una correlación significativa directa entre el grado del cistocele y el del prolapso uterino, y una correlación significativa pero de sentido inverso entre el grado del prolapso uterino y el del enterocele. Las pacientes con mayor grado de prolapso uterino presentaban mayor resistencia uretral medida por el parámetro URA (resistencia uretral). Se observó una tendencia hacia la significación respecto de la variación poscirugía de los parámetros URA, que disminuyó después de la cirugía, y W80-20 (contractilidad detrusor), que aumentó después de la misma. Conclusiones: Los prolapsos pélvicos afectan a la fase miccional. Esta afectación se produce tanto en el caso de los cistoceles, como en los prolapsos uterinos y del compartimiento posterior (rectocele y enterocele). Además, se observa una mejoría de la contractilidad vesical con la cirugía del prolapso pélvico (AU)

Objectives: Pelvic floor prolapse is a frequent condition in the woman, which in addition to anatomical alterations, may cause lower urinary tract dysfunction. We intend to verify the alterations of the micturation phase in patients with pelvic prolapse. Material and methods: A cross-sectional cut off study was performed in a series of 102 women, mean age 66.8 years (standard deviation 9.6 years), diagnosed of urinary obstruction and pelvic prolapse and a prospective longitudinal study in a cohort of 21 patients of the previous series operated on for the prolapse. The patients were subjected to clinical examinations to determine the type and grade of public prolapse and to a urodynamic study. Results: A significant direct correlation was observed between the grade of cystocele and uterine prolapse and a significant correlation, but in inverse sense, between the grade of uterine prolapse and that of the enterocele. The patients with a greater grade of uterine prolapse had greater urethral resistance by the URA parameter. A tendency towards significance regarding the postsurgical variation of the Urethral Resistance Average (URA) that decreased after the surgery, and the W80-20 (detrusor contractility), that increased after it, was observed. Conclusions: Pelvic prolapses affect the micturation phase. This involvement occurs both in the case of the cystoceles as well as in uterine prolapses and in the posterior compartments (rectocele and enterocele). Furthermore, an improvement is observed in the bladder contractility with the surgery of the pelvic prolapse (AU)

Eficacia de la detección percutánea de oxígeno como guía terapéutico-quirúrgica en lesionados medulares con úlceras por presión crónicas: estudio preliminar / Eficacy of percutaneous oxygen detection as therapeutic-surgical guide in spinal cord injury patients with chronic pressure ulcers: preliminary report

En el presente estudio clínico realizamos detección transcutánea de oxígeno (TcpO2) en 11 pacientes consecutivos lesionados medulares parapléjicos crónicos (de más de 1 año de evolución) con úlceras por presión (upp) crónicas de grado IV (de más de 6 meses de evolución). En todos analizamos los valores de la TcpO2 tanto en el momento preoperatorio como postoperatorio, llevando a cabo las siguientes comprobaciones. En la posición 1 preoperatorio (P1-pre: a 1 cm del borde de la upp) los valores obtenidos fueron de 27,28±13,83 mm Hg, mientras que en P1 postoperatorio fueron de 34,96±19,06 (p < 0.05). El valor medio del electrodo de referencia (no1) en el momento preoperatorio (51,63±12,53mm Hg) fue estadísticamente significativo (p < 0.05) al compararlo con el valor obtenido con el electrodo no1 (38,60±14,63 mm Hg) en el postoperatorio. El valor medio del electrodo de referencia (no1) en el momento del preoperatorio (50,07±13,54 mm Hg) es estadísticamente significativo (p < 0.05) al compararlo con los valores medios obtenidos de TcpO2 de las posiciones (P1+P2+P3) de los electrodos no2 (29,17±15,03 mm Hg), no3 (34,51±13,15 mm Hg) y no4 (30,37±17,81 mm Hg) analizados en el preoperatorio. Demostramos con estos hallazgos los niveles hipoxémicos a 1 cm del borde de una upp grado IV y su evolución postoperatoria. De esta forma, la técnica de detección transcutánea de oxígeno puede considerarse una guía terapéutica en la detección y en la monitorización del tratamiento de las upp, con la posibilidad de establecer intervenciones terapéuticas para poder mejorar los niveles de oxígeno detectados en las mismas (AU)

In this clinical study the detection of transcutaneous oxygen has been performed (TcpO2) to 11 consecutive patients with spinal cord injury chronic paraplegics (more than 1 year of evolution) with chronic pressure ulcers grade IV (more than 6 months). In all patients were analyzed preoperative and postoperative TcpO2 values, with the following results. In the preoperative position 1 (P1-pre: to 1 cm of the ulcer edge) values obtained are of 27.28 ± 13.83 mm Hg, while in P1 postoperative were 34.96 ± 19.06 (p < 0.05). The average value of the reference electrode (no 1) preoperative (51.63 ± 12.53 mm Hg) is statistically significant (p < 0.05) when compared with the value obtained with the electrode no1 (38.60 ± 14, 63 mmHg) in the postoperative state. The average value of the reference electrode (no 1) preoperative (50.07 ± 13.54 mm Hg) is statistically significant (p < 0.05) when compared with the average values of the positions (P1, P2, P3) obtained of TcPO2 electrode no 2 (29.17 ± 15.03 mm Hg), no 3 (34.51 ± 13.15 mm Hg) and no 4 (30.37 ± 17.81 mm Hg) analyzed preoperatively. With these findings, we demonstrate hypoxemic levels to 1 cm of chronic pressure ulcers edge grade IV and postoperative progress. Thus, the technique of transcutaneous oxygen detection can be considered as a therapeutic guide in the detection and monitoring of pressure ulcers treatment with the possibility of establish therapeutic interventions to improve the oxygen levels detected in them (AU)

Usefulness of electromyography of the cavernous corpora (CC EMG) in the diagnosis of arterial erectile dysfunction.

Electromyography (EMG) of the corpora cavernosa (CC-EMG) is able to record the activity of the erectile tissue during erection, and thus has been used as a diagnostic technique in patients with erectile dysfunction (ED). The present study examines the usefulness of the technique in the diagnosis of arterial ED. A cross-sectional study was made of 35 males with a mean age of 48.5 years (s.d. 11.34), referred to our center with ED for >1 year. The patients were subjected to CC-EMG and a penile Doppler ultrasound study following the injection of 20 µg of prostaglandin E1 (PGE1). The patients were divided into three groups according to their response to the intracavernous injection of PGE1: Group 1 (adequate erection and reduction/suppression of EMG activity); Group 2 (insufficient erection and persistence of EMG activity); and Group 3 (insufficient erection and reduction/suppression of EMG activity). Patient classification according to response to the intracavernous injection of PGE1 was as follows: Group 1: six patients (17%), Group 2: 18 patients (51%), and Group 3: 11 patients (31%). Patients diagnosed with arterial insufficiency according to Doppler ultrasound (systolic arterial peak velocity <30 mm s(-1) in both arteries) were significantly older than those without such damage (54.5 versus 41.8 years, respectively; s.d. 11.12). The patients in Group 3 showed a significantly lower maximum systolic velocity in both arteries than the subjects belonging to Group 2. Likewise, a statistically significant relationship was observed between the diagnosis of arterial insufficiency and patient classification in Group 3. The confirmation of insufficient erection associated with reduction/suppression of EMG activity showed a sensitivity of 66.7% (confidence interval between 50 and 84%) and a specificity of 92.9% (confidence interval between 84 and 100%) in the diagnosis of arterial ED. Owing to the high specificity of CC-EMG response to the injection of PGE1, this test is considered useful as a screening technique in the diagnosis of arterial ED.

Participación de la inervación pudenda en la hiperactividad del detrusor y el síndrome de vejiga hiperactiva / Participation of the Pudendal Innervation in the Detrusor Overactivity of the Detrusor and in the Overactive Bladder Syndrome

Objetivos: La presencia de los síntomas funcionales de la fase de llenado y la hiperactividad del detrusor son dos disfunciones del tracto urinario inferior relacionadas entre sí. Pretendemos estudiar la participación de la lesión del nervio pudendo en ambas disfunciones urinarias. Material y métodos: Se realizó un estudio transversal de corte en una serie de 108 mujeres. El estudio consistió en un interrogatorio sobre la presencia de síntomas funcionales del tracto urinario inferior, cistomanometría y determinación del tiempo de latencia periférico del nervio pudendo, electromiografía selectiva del esfínter anal externo y determinación del tiempo de latencia del reflejo sacro. Resultados: Se observó una tendencia hacia la significación entre la presencia de polaquiuria y la amplitud de los potenciales de unidad motora (mayores en presencia de polaquiuria)y de la presencia de urgencia-incontinencia y el tiempo de latencia sacro (mayor en presenciade urgencia incontinencia), y una relación significativa entre la puntuación del King’s Health Questionnaire y el tiempo de latencia periférico del nervio pudendo. Respecto de la hiperactividad del detrusor se observó un mayor tiempo de latencia sacro en pacientes con hiperactividad con tendencia hacia la significación. Conclusiones: Existe una relación entre las alteraciones de la inervación pudenda y la presencia de síntomas de la fase de llenado e hiperactividad del detrusor. Esta relación explicaría la acción terapéutica de la rehabilitación perineal sobre estas disfunciones (AU)

Objectives: The functional symptoms of the filling phase and detrusor over activity are two inter-related dysfunctions of the lower urinary tract. We have aimed to study the participation of the lesion of the pudendal nerve in both urinary dysfunctions. Material and methods: A cross-sectional cutoff study in a series of 108 women was carried out. The study consisted in the questioning on the presence of functional symptoms of the lower urinary tract, cystomanometry and determination of peripheral pudendal nerve latency time, selective electromyography of the external anal sphincter and determination of the sacral reflexlatency time. Results: A tendency was observed towards significance between the presence of pollakiuria amplitude of motor unit potentials (greater in presence of pollakiuria) and the presence of urgency-incontinence and time of sacral latency (greater in the presence of urge incontinence) and a significant relation between the score on the King’s Health Questionnaire and peripheral pudendal nerve latency time. Regarding detrusor hyperactivity, greater sacral latency time was observed in patients with over activity with tendency towards significance. Conclusions: There is a relation between pudendal innervation alterations and presence of symptoms in the filling phase and detrusor over activity. This relation would explain the therapeutic action of the perineal rehabilitation on these dysfunctions (AU)

[Participation of the pudendal innervation in the detrusor overactivity of the detrusor and in the overactive bladder syndrome]. / Participación de la inervación pudenda en la hiperactividad del detrusor y el síndrome de vejiga hiperactiva.

OBJECTIVES: The functional symptoms of the filling phase and detrusor overactivity are two inter-related dysfunctions of the lower urinary tract. We have aimed to study the participation of the lesion of the pudendal nerve in both urinary dysfunctions. MATERIAL AND METHODS: A cross-sectional cutoff study in a series of 108 women was carried out. The study consisted in the questioning on the presence of functional symptoms of the lower urinary tract, cystomanometry and determination of peripheral pudendal nerve latency time, selective electromyography of the external anal sphincter and determination of the sacral reflex latency time. RESULTS: A tendency was observed towards significance between the presence of pollakiuria amplitude of motor unit potentials (greater in presence of pollakiuria) and the presence of urgency-incontinence and time of sacral latency (greater in the presence of urge incontinence) and a significant relation between the score on the King's Health Questionnaire and peripheral pudendal nerve latency time. Regarding detrusor hyperactivity, greater sacral latency time was observed in patients with overactivity with tendency towards significance. CONCLUSIONS: There is a relation between pudendal innervation alterations and presence of symptoms in the filling phase and detrusor overactivity. This relation would explain the therapeutic action of the perineal rehabilitation on these dysfunctions.

[Study of the influence of pelvic prolapse in the lower urinary tract micturation phase in the female]. / Estudio de la influencia de los prolapsos pélvicos en la fase miccional del tracto urinario inferior femenino.

OBJECTIVES: Pelvic floor prolapse is a frequent condition in the woman, which in addition to anatomical alterations, may cause lower urinary tract dysfunction. We intend to verify the alterations of the micturation phase in patients with pelvic prolapse. MATERIAL AND METHODS: A cross-sectional cut off study was performed in a series of 102 women, mean age 66.8 years (standard deviation 9.6 years), diagnosed of urinary obstruction and pelvic prolapse and a prospective longitudinal study in a cohort of 21 patients of the previous series operated on for the prolapse. The patients were subjected to clinical examinations to determine the type and grade of public prolapse and to a urodynamic study. RESULTS: A significant direct correlation was observed between the grade of cystocele and uterine prolapse and a significant correlation, but in inverse sense, between the grade of uterine prolapse and that of the enterocele. The patients with a greater grade of uterine prolapse had greater urethral resistance by the URA parameter. A tendency towards significance regarding the postsurgical variation of the Urethral Resistance Average (URA) that decreased after the surgery, and the W80-20 (detrusor contractility), that increased after it, was observed. CONCLUSIONS: Pelvic prolapses affect the micturation phase. This involvement occurs both in the case of the cystoceles as well as in uterine prolapses and in the posterior compartments (rectocele and enterocele). Furthermore, an improvement is observed in the bladder contractility with the surgery of the pelvic prolapse.

["Post micturition residual; urodynamic"]. / <>

OBJECTIVES: To study the possible correlation between the existence of postmicturition residual (PR), both in men as in women, with other urodynamic parameters. MATERIAL AND METHODS: A retrospective study in a series of 121 patients (33 male, 88 female), age X=68.22 and SD=12.904 (16-90 years), with a significative PR had been underwent a videourodynamic study. All cases of neurogenic vesicourethral dysfunctions and post pelvic radiotherapy were excluded. Statistical study was performed between the PR and the presence of urinary symptoms, urodynamic data, and findings of physical examination. The study was conducted, both descriptive and with statistical correlations. We used the Spearman Rho and compared with the median chi-square. RESULTS: We found a positive correlation (men and women), between the PR and bladder capacity (p=0.001) and between the PR free flowmetry and PR test pdet/flow (r=0.450 p=0.001). In women, a positive correlation was found between the PR and the urethral resistance (URA) (p=0.001), and between PR and voiding by abdominal pressure (p<0,05). We found a negative correlation in men between the PR and the parameters of detrusor contraction (W80-W20) (p<0.05). Not found statistically significant correlation between the PR and cystometry, nor with the urodynamic diagnosis of obstruction, associated radiological semiology, hyperactive bladder and emptying symptoms in men. CONCLUSIONS: The PR behaved more as a parameter measurement of detrusor contractility, than a parameter of the lower urinary tract obstruction. The PR was not associated with any clinic or associated radiologic semiology.

«Correlaciones urodinámicas del residuo posmiccional» / ''Post micturition residual; Urodynamic''

Objetivos: Estudiar la correlación entre la existencia de residuo posmiccional (rp) con otros parámetros urodinámicos. Material y métodos: Estudio retrospectivo. 121 pacientes (33V, 88M). Edad=68,22 y S=12,904 (16–90 años) que presentaban rp realizándose estudio videourodinámico completo. Se excluyeron disfunciones neurógenas vésicouretrales y posradioterapia pélvica. Se estudiaron correlaciones estadísticas entre residuo y síntomas, parámetros urodinámicos y hallazgos de la exploración física. Se ha realizado estadística descriptiva y correlaciones (rho de Spearman y comparación de medianas [chi cuadrado]). Resultados: Se encontró correlación positiva (hombres y mujeres) entre rp y capacidad vesical (p=0,001), entre rp (flujometría libre) y el rp (test pdet/flujo) (r=0,450 p=0,001). En mujeres entre rp y resistencia uretral (p=0,001) y entre rp y micción con prensa abdominal (p<0,05) Se encontró correlación negativa (hombres) entre rp y parámetros de contracción istotónica del detrusor (W80–W20) (p<0,05). No se ha encontrado correlación entre rp y parámetros cistomanométricos, ni con el diagnóstico urodinámico de obstrucción, semiología radiológica asociada, vejiga hiperactiva, ni síntomas funcionales de vaciamiento en el hombre. Conclusiones: El rp urodinámicamente se comportó más como un parámetro de medida de contractilidad del detrusor que como un parámetro de obstrucción del tracto urinario inferior. El rp no presentó ninguna semiología clínica ni radiológica asociada específica (AU)

Objectives: To study the possible correlation between the existence of postmicturition residual (PR), both in men as in women, with other urodynamic parameters. Material and methods: A retrospective study in a series of 121 patients (33 male, 88 female), age X=68.22 and SD=12.904 (16–90 years), with a significative PR had been underwent a videourodynamic study. All cases of neurogenic vesicourethral dysfunctions and post pelvic radiotherapy were excluded. Statistical study was performed between the PR and the presence of urinary symptoms, urodynamic data, and findings of physical examination. The study was conducted, both descriptive and with statistical correlations. We used the Spearman Rho and compared with the median chi-square. Results: We found a positive correlation (men and women), between the PR and bladder capacity (p=0.001) and between the PR free flowmetry and PR test pdet/flow (r=0.450 p=0.001). In women, a positive correlation was found between the PR and the urethral resistance (URA) (p=0.001), and between PR and voiding by abdominal pressure (p<0,05). We found a negative correlation in men between the PR and the parameters of detrusor contraction (W80–W20) (p<0.05). Not found statistically significant correlation between the PR and cystometry, nor with the urodynamic diagnosis of obstruction, associated radiological semiology, hyperactive bladder and emptying symptoms in men. Conclusions: The PR behaved more as a parameter measurement of detrusor contractility, than a parameter of the lower urinary tract obstruction. The PR was not associated with any clinic or associated radiologic semiology (AU)

Prevalencia de síntomas urinarios e incontinencia de orina en una muestra de mujeres militares del Ejército del Aire / Prevalence of urinary symptoms and urinary incontinence in a sample of Air Force military women

Objetivo: determinar por primera vez la prevalencia de síntomas urinarios e incontinencia urinaria y su repercusión sobre la calidad de vida y la actividad profesional de una muestra de mujeres militares. Material y Métodos: Se administró a una muestra de 50 mujeres militares profesionales, de edad media: 25,9 años, (intervalo entre 18 y 33 años), destinadas en la BA de Torrejón, la versión española del cuestionario de puntuación por síntomas urinarios «King Health Questionnaire». Resultados: El síntoma urinario más frecuente fue la frecuencia miccional aumentada (o polaquiuria), referido por el 60% de las encuestadas, seguido de la nicturia, presente en un 48% de las mujeres de la muestra. Un 30% de las encuestadas no refirieron ningún tipo de alteración urinaria, y un 28% infecciones urinarias. La incontinencia urinaria en sus diversos tipos, presente en un 28% de los casos. La incontinencia de esfuerzo estuvo presente en el 24% y la urgencia incontinencia en el 20%. Un 23 % de las encuestadas refirieron que los síntomas urinarios afectaban a su vida general y un 11% a su actividad física. La frecuencia miccional fue la que mostró más diferencias significativas respecto a la repercusión sobre la calidad de vida, seguida de la incontinencia de esfuerzo, urgencia-incontinencia e infección urinaria. Conclusiones: a pesar de la baja repercusión sobre su calidad de vida y desarrollo de sus actividades profesionales de los síntomas urinarios, se observa una alta prevalencia de síntomas urinarios e incontinencia urinaria en la muestra de mujeres estudiada, a pesar de tratarse de una población joven y con buen estado de salud (AU)

Objective: to determine for the first time the prevalence of urinary symptoms and urinary incontinence and their impact on the quality of life and professional activity of a sample of military women. Material and Methods: the Spanish version of the “King’s Health Questionnaire” for urinary symptoms was administered to a sample of 50 military women, average age 25.9 years (interval between 18 and 33 years) in the Torrejón Air Force Base. Results: the most common urinary symptom was the increased urinary frequency, indicated by 60 % of the interviewed subjects, followed by nocturia, present in 48 % of the sample. No urinary alteration was reported by 30 % of the subjects and 28 % reported urinary infections. Urinary incontinence in its different presentations was present in 28 % of the cases. Effort related incontinence was present in 24 % and urge incontinence in 20%. Among the interviewed personnel 23 % reported that the urinary symptoms had an impact on their life quality and 11 % on their physical activity. Urinary frequency was the parameter that showed the most significant differences on the quality of life, followed by the effort-related incontinence, urge incontinence and urinary infection. Conclusions: In spite of the low repercussion of the urinary symptoms on their life quality and professional activities, a high prevalence of urinary symptoms and incontinence is observed in the studied sample of military women, even though this is a young and healthy population (AU)

Evaluación de la capacidad de irrigación y drenaje de tres sondas de lavado vesical / Evaluation of the irrigation and drainage capacity of 3 bladder irrigation catheters

Objetivo: Realizar una evaluación comparativa de tres tipos de sondas de lavado vesical con el fin de determinar cuál de ellas permitía un mayor flujo de entrada el líquido de lavado y de salida del líquido de la vejiga. Métodos: Se compararon tres tipos de sonda de tres vías, de un calibre 22 F, cuya principal diferencia fue el material de que estaban fabricadas: látex, silicona o polivinilo. Resultados: La sonda de polivinilo mostró una diferencia significativa tanto en el flujo de entrada como de salida del líquido de infusión respecto a los otros dos tipos de sonda (p= 0,000, ANOVA con test post hoc de Sheffe). La sonda de látex mostró además una disminución significativa del flujo de salida al inflar el balón autorretentivo. Conclusiones: La sonda de polivinilo, debido a la rigidez del material con que está fabricada, es la que un mayor flujo de lavado vesical permite (AU)

Objectives: To perform a comparative evaluation of three types of continuous bladder irrigation catheters with the aim of determining which of them allows greater irrigation solution inflow and bladder outflow. Methods: We compared three types of three-way catheters, 22F in caliber, being the material the main difference between them: latex, silicone, or polyvinyl. Results: The polyvinyl catheter showed significant differences both in inflow and outflow in comparison with the other two types of catheters (p =0,000, ANOVA test with Sheffe’s post hoc). Additionally, the latex catheter showed a significant outflow decrease with the insufflation of the self retentive balloon. Conclusions: The polyvinyl catheter, due to material rigidity, is the one that allows better bladder irrigation (AU)

[Bilateral testicular tumours]. / Tumores bilaterales de testículo.

OBJECTIVES: To study the incidence and characteristic of the bilateral tumours of testicle. MATERIAL AND METHODS: It was carried out a retrospective study on a database of testiculars tumours 98 tried in our service among the years 1979 and 2004. RESULTS: We registered 4 cases of bilateral tumours (4,1%) in the series. The interval of appearance of the second tumor oscillated between 14 months and 4 and a half years (being the medium of 47 months). In three cases the initial tumour was an embryonic Carcinoma and in one a tumour of Lydia. In two cases the second tumour was of the same type histological (embryonic Ca and tumour of Leydig), while in the other two cases of embryonic Ca, the second tumour was a seminoma and a teratocarcinoma. Regarding the histology of the first tumour, it was observed that only 3 of the 27 embryonic Ca (11%) of our series, they experienced a second neoplasia in front of 1 of the 2 tumours of Leydig (50%). CONCLUSIONS: The incidence of bilateral tumours in our series was of 4,1%. In our series the risk of the second tumour seems to be higher in patients with Leyding tumours, therefore the lesser number of tumours do not allow us to know significantly conclusions.