Hematuria en la infancia: Un dilema clínico / Hematuria in childhood: A clinical dilemma

La hematuria es un signo clínico sugerente de múltiples patologías nefrourológicas de diverso pronóstico renal y vital, siendo fundamental conocer su etiopatogenia en el niño para identificar de forma precoz su causa y establecer un adecuado tratamiento clínico y quirúrgico en algunas ocasiones. En la infancia la su etiopatogenia varía en tipo y frecuencia según la edad, siendo la causa más frecuente la infección urinaria. Como en toda patología será fundamental elaborar una historia clínica detallada y llevar a cabo una exploración física completa del paciente, lo cual nos proporcionará mucha información para orientar el caso. Hay que recordar que antes de solicitar pruebas complementarias más complejas debemos confirmar que nos encontramos ante una hematuria real, para lo cual necesitamos en primer lugar efectuar tres tipos de estudios seriados: observar el aspecto macroscópico, realizar una tira de orina y solicitar un sistemático/sedimento de orina. El screening de patología renal mediante tira de orina debe realizarse en pacientes con hematuria confirmada, sospecha de infección del tracto urinario o diagnosticados o en riesgo de desarrollar enfermedad renal crónica. El manejo del paciente y el tratamiento debe ser multidisciplinar, implicando a profesionales de las áreas de atención primaria y hospitalaria

Hematuria is a suggestive clinical sign of multiple nephrourological pathologies of diverse renal and vital prognosis, being essential to know its etiopathogenesis in the child to identify its cause early and establish adequate clinical and surgical treatment on some occasions. In childhood, its etiopathogenesis varies in type and fre-quency according to age, with urinary infection being the most frequent cause. As in all pathologies, it will be essential to prepare a detailed medical history and carry out a complete physical examination of the patient, which will provide us with a lot of information to guide the case. We must remember that before requesting more complex complementary tests, we must confirm that we are facing real hematuria, for which we first need to carry out three types of serial studies: observe the macroscopic appear-ance, perform a urine dipstick and request a systematic/urine sediment. Screening for kidney disease using a urine dipstick should be performed in patients with confirmed hematuria, suspected urinary tract infection, or diagnosed or at risk of developing chronic kidney disease. Patient management and treatment must be multidisciplinary, involving professionals from the areas of primary and hospital care

Chiluria in a lymphatic filariasis endemic area.

OBJECTIVE: To establish clinical and laboratory data of individuals presenting chyluria in endemic areas. RESULTS: 75 individuals were studied. The majority were females with an average age of 45 years residing in the Metropolitan Region of Recife. The mean time between the beginning of the presentation of chyluria and the first care service in the Serviço de Referencia Nacional em Filarioses was approximately 5 years. The most frequent urinalysis changes were hematuria (27.6%), leukocytes (21.9%) and proteinuria (10.5%). The Addis test showed mean values of 155.43 E/min/mL of cylinders, 52,892 E/min/mL of erythrocytes and 291,660 E/min/mL of leukocytes. Among recorded cases, proteinuria had a mean value of 1372.80 mg/dL in 24 h, and the presence of lymphocytes in the urine was positive in 68.3%. Among lymphatic filariasis tests, immunochromatography was positive in 16.7%, there was circulating filarial antigen determined by detection of OG4C3 antibodies in 7.7% and microfilaremia in only 1/55.

[Sterile leukocyturia - difficult diagnostic problem in children].

Sterile leukocyturia is an important and difficult clinical problem in children. In this paper, we described the most common nephrologic causes of sterile leukocyturia, including infectious, non-infectious and extrarenal etiology. We stressed an the importance of appropriate urine collection for urinalysis. There is a need for treatment of inflammation and also for diagnosis of potential anomalies of urethral orifice as causes of sterile leukocyturia in children.

New developments in chyluria after global programs to eliminate lymphatic filariasis.

Chyluria, commonly seen in south Asian countries, is mainly a manifestation of lymphatic filariasis as a result of infestation with Wuchereria bancrofti, although many other causes can contribute. Many patients can be effectively treated with dietary modifications and drug therapy. The most widely used drug is diethyl carbamazine. The recurrences are common after such treatment. Such patients would benefit from sclerotherapy to obliterate the lympatico-renal fistulae located mainly in the renal pelvicalyceal system. The commonly used sclerosing agent is a combination of 5% povidone-iodine and 50% dextrose instilled through a ureteric catheter. A small percentage of patients who recur after sclerotherapy and those with systemic complications, such as hypoproteinemia and edema, might require surgery in the form of renal hilar lymphatic disconnection. Although it is a major operation, the success rates are >90%. Laparoscopic and robotic techniques have minimized the morbidity related to such surgery. With the advent of the global program for eradication of filariasis initiated by the World Health Organization, the incidence of the disease is decreasing. Mass chemotherapy with diethyl carbamazine is the mainstay of this global program. Many years after eliminating filariasis, chyluria continue to occur in such populations, though in dwindling numbers. Future research should aim at finding more efficacious sclerosing agents with minimal recurrences.

Increased podocyturia in pregnant women compared to non-pregnant women.

AIM: Hyperfiltration is a cause of podocyturia and occurs physiologically in the kidney of pregnant women. Podocyturia is increased in preeclamptic pregnancies, but it is unclear whether there is also any increase in uncomplicated pregnancies. This study was performed to examine whether podocyturia and urine aquaporin 2 mRNA expression are increased in healthy pregnant women (PW) compared to healthy non-pregnant women (NPW). METHODS: Eleven urines obtained from 11 NPW and longitudinal 76 urines from 40 PW with uncomplicated pregnancies (median number [range] of urine samples/person, 2 [1 - 3]) were studied. Determination of protein and creatinine concentrations and number of cells in urine other than blood cells, and quantitative analyses of the mRNA expression of aquaporin 2 (AQP2-mRNA), podocin (Pod-mRNA), and nephrin (Nep-mRNA) were performed using RT-PCR in pelleted urine samples. Podocyturia was monitored with urine Pod- and Nep-mRNA expression levels normalized relative to creatinine. RESULTS: Urine cell density and urine AQP2-, Pod-, and Nep-mRNA expression normalized relative to creatinine were significantly higher in PW than NPW. The number of cells per milligram of creatinine was significantly positively correlated with expression of all three mRNAs with correlation coefficients (R-value) of 0.442, 0.481, and 0.561 for Pod-, Nep-, and AQP2-mRNA, respectively. AQP2-mRNA expression was strongly (R  >  0.8) positively correlated with both Pod- and Nep-mRNA expression. CONCLUSION: Podocyturia monitored by Pod- and Nep-mRNA expression and urine cells expressing AQP2-mRNA were increased in uncomplicated pregnancies compared to healthy non-pregnant women. Urine cells expressing AQP2-mRNA increased with increasing podocyturia in healthy women.

Excess diuresis and natriuresis during acute sleep deprivation in healthy adults.

The transition from wakefulness to sleep is associated with a pronounced decline in diuresis, a necessary physiological process that allows uninterrupted sleep. The aim of this study was to assess the effect of acute sleep deprivation (SD) on urine output and renal water, sodium, and solute handling in healthy young volunteers. Twenty young adults (10 male) were recruited for two 24-h studies under standardized dietary conditions. During one of the two admissions, subjects were deprived of sleep. Urine output, electrolyte excretions, and osmolar excretions were calculated. Activated renin, angiotensin II, aldosterone, arginine vasopressin, and atrial natriuretic peptide were measured in plasma, whereas prostaglandin E(2) and melatonin were measured in urine. SD markedly increased the diuresis and led to excess renal sodium excretion. The effect was more pronounced in men who shared significantly higher diuresis levels during SD compared with women. Renal water handling and arginine vasopressin levels remained unaltered during SD, but the circadian rhythm of the hormones of the renin-angiotensin-aldosterone system was significantly affected. Urinary melatonin and prostaglandin E(2) excretion levels were comparable between SD and baseline night. Hemodynamic changes were characterized by the attenuation of nocturnal blood pressure dipping and an increase in creatinine clearance. Acute deprivation of sleep induces natriuresis and osmotic diuresis, leading to excess nocturnal urine production, especially in men. Hemodynamic changes during SD may, through renal and hormonal processes, be responsible for these observations. Sleep architecture disturbances should be considered in clinical settings with nocturnal polyuria such as enuresis in children and nocturia in adults.

[Case of ischemic heart disease resulting from persistent diuresis after giant ovarian tumor resection].

A patient with a giant ovarian tumor weighing about 7 kg was successfully removed by operation. However, her ECG demonstrated ischemic changes after the operation. We report a case of ischemic heart disease due to persistent diuresis after giant ovarian tumor resection. A 75-year-old, 56.5 kg, 143.5 cm woman was admitted to our hospital for ovarian tumor resection. The preoperative ECG showed normal sinus rhythm and no ischemic changes. Both general anesthesia and epidural anesthesia were planed. An epidural catheter was inserted at T12-L1. Anesthesia was induced with propofol 100 mg, fentanyl 100 microg and vecuronium 8 mg under 100% oxygen inhalation. General anesthesia was maintained with sevoflurane while epidural anesthesia was achieved using 0.375% ropivacaine 6 ml. During the operation, blood pressure was 90-110/70-80 mmHg, with SaO2, 100% and heart rate, 70-80 beats x min(-1). The content of tumor was suctioned for 30 minutes. Surgery was successfully finished without any other incidence. After extubation, her ECG changed to atrial fibrillation from normal sinus rhythm and showed ST-T depression. And then her systolic blood pressure became 80 mmHg or below, but we found continued diuresis at about 10 ml x kg(-1) x hr(-1) for over 2 hr. The total of 7 unit vasopressin was intermittently given for vasoconstriction and antidiuresis. Her hemodynamic was immediately restored, and ECG turned to normal ST-T. The patient had uneventful postoperative recovery.

Nicorandil, a potassium channel opener and nitric oxide donor, improves the frequent urination without changing the blood pressure in rats with partial bladder outlet obstruction.

OBJECTIVE: It was studied to determine if nicorandil can improve frequent urination in rats with partial bladder outlet obstruction (BOO) without changing the blood pressure. MATERIALS AND METHODS: Voiding behavior was observed 6 to 8 d after obstruction in female rats with BOO that loaded 30 ml/kg of water. A drug was administered orally. Changes in systemic blood pressure and heart rate were studied in conscious BOO rats using the tail cuff method. RESULTS: The voiding frequency was increased and the average voided volume was decreased in BOO rats compared with normal rats. Nicorandil (1 mg/kg), cromakalim (0.1 mg/kg) and isosorbide dinitrate (ISDN; 1000 mg/kg) decreased voiding frequency significantly in BOO rats. Nicorandil also increased the average voided volume significantly. Although cromakalim and ISDN at doses effective at decreasing voiding frequency caused blood pressure to drop, nicorandil at an effective dose did not affect blood pressure and heart rate. CONCLUSION: Nicorandil improved frequent urination without changing the blood pressure. These results suggested that a hybrid of a K(ATP) channel opener and nitric oxide donor, nicorandil was bladder-selective compared with vasculature in BOO rats.

[Case of cerebral salt wasting syndrome with difficulty in controling excessive urine volume].

Symptoms of hyponatremia and diuresis due to cerebral salt wasting syndrome (CSWS) are often observed after aneurysmal subarachnoid hemorrhage (SAH). Inadequately treated CSWS is known to work as a trigger of symptomatic vasospasm in SAH patients. Therefore, it is indispensable to detect and treat CSWS as early as possible in ICU. A 36-year-old man with SAH was admitted to our ICU. His urine volume increased excessively 3 days after ICU admission, and it reached a peak (39,250 ml x day(-1)) on the 6th day in ICU. Since infusion volume was controlled with regard to daily urinary output, hyponatremia was not noticeable and excessive urine volume stood out conspicuously. Though vasopressin and desmopressin were administered, the symptoms of natriuresis and hyponatremia were aggravated, associated with hyper secretion of natriuretic peptides (ANP 160 pg x dl(-1), BNP 172 pg x dl(-1)). Recent studies revealed that hyponatremia and hypovolemia following SAH might be caused by exaggerated secretion of natriuretic peptides. Experimental studies showed that the administration of vasopressin and desmopressin cause excessive secretion of natriuretic peptides under the circumstance of volume expansion in rats. We infer that the administration of vasopressin and desmopressin to our patient deterionated natriuresis in CSWS as in the previous experimental findings.

A comparative study of patient experiences of conventional fluoroscopic and four-hour ambulatory urodynamic studies.

We assessed several emotional variables in patients experiencing conventional urodynamic and ambulatory urodynamic monitoring (AUM) to verify the hypothesis that AUM is tolerated as well as conventional urodynamics. A total of 33 women and 7 men from 23 to 72 years of age who were undergoing both procedures were prospectively included in this study. Prior to and immediately after the procedures, each patient completed a self-administered questionnaire. Answers were given on a visual analogue scale. The degree of anxiety was higher for conventional urodynamics than for AUM (p = 0.045), while the degree of boredom experienced during AUM was higher than that during conventional urodynamics (p= 0.013). There was no significant difference in the degree of shame or bother experienced by the patients during the two procedures. In general, patients tolerated both examinations extremely well. The examiner-rated degree of intolerance during conventional urodynamics was influenced by the subjective pain score (p=0.001), while all other emotional variables except bother were not significantly related with the degree of intolerance during AUM (p=0.007). A total of 74.4% and 84.6% responded that they were willing to repeat conventional urodynamics and AUM, respectively, which were not significantly different. Although AUM produced a significantly higher level of boredom than conventional urodynamics, our data demonstrates that patients are as tolerant of AUM as they are of conventional urodynamic procedures.

Decrease in nocturnal urinary levels of arginine vasopressin in patients with nocturnal polyuria.

OBJECTIVES: To elucidate whether heart function and endocrine levels of arginine vasopressin (AVP) or solute diuresis is associated with the nocturnal voided volume, and whether the urinary AVP could be a parameter for screening for nocturnal polyuria caused by AVP insufficiency. METHODS: A total of 50 patients were enrolled in this study. The blood and urine samples were obtained every 6 hours at 6 pm, 12 am, 6 am, and 12 pm. Atrial natriuretic peptide and brain natriuretic peptide were measured at admission. All voided urine samples were collected every 6 hours for examination. The evaluation items were AVP, osmolarity, sodium, potassium, chloride, and creatinine in blood and urine. RESULTS: The patients were classified into a group with nocturnal polyuria (n = 21) and a group without nocturnal polyuria (n = 25). There was no significant difference in atrial natriuretic peptide, brain natriuretic peptide, electrolytes in blood and urine, and plasma AVP of each sample between the two groups, but urinary AVP/urinary creatinine and urine osmolarity at 12 am and 6 am in the group with nocturnal polyuria were significantly lower than those in the group without nocturnal polyuria. The nocturnal voided volume correlated with urinary AVP/urinary creatinine level in the urine samples obtained at 12 am and 6 am. CONCLUSIONS: The present data have demonstrated that the significant decrease in urinary AVP/urinary creatinine level at 6 am may contribute to the increased nocturnal voided volume followed by nocturia and that the circadian rhythm disorder of AVP can be predicted by a noninvasive test measuring urinary AVP/urinary creatinine in the urine voided early in the morning.

Nocturia in adults: draft New Zealand guidelines for its assessment and management in primary care.

Nocturia is a common bothersome condition. An ad hoc group of interested clinicians from a variety of backgrounds has developed draft guidelines for the assessment and management of this condition in primary care in New Zealand. The guidelines propose four steps in the assessment and management: clinical evaluation; simple investigations; assignment of a provisional diagnosis; and management based on the provisional diagnosis. For nocturnal polyuria-associated nocturia, the draft guidelines recommend that: lifestyle measures should be used as part of the management; if a patient complaining of nocturia has other features of overactive bladder, then bladder retraining and/or anticholinergics can be used; hypnosedatives should not be used to treat nocturia in older adults because of the increased risk of falls; loop diuretics given in the afternoon should be considered for the treatment; and desmopressin can be considered in the management of nocturnal polyuria associated nocturia but that it should be used cautiously in people aged over 65 because of the risk of hyponatraemia. A draft algorithm based on international guidelines is presented.

Microscopic hematuria as a predictive factor for detecting bladder cancer at cystoscopy in women with irritative voiding symptoms.

OBJECTIVE: The purpose of this study was to assess microscopic hematuria as a predictive factor for detecting bladder cancer at cystoscopy in women with irritative voiding symptoms. STUDY DESIGN: We conducted a retrospective cohort analysis of women with irritative voiding symptoms who presented for urodynamic testing and cystoscopy. Irritative voiding symptoms were defined as urgency, urge incontinence, frequency, dysuria, and/or nocturia. Patient demographics, risk factors for bladder cancer, presence of microscopic hematuria, urodynamic findings, and cystoscopy and biopsy results were recorded. RESULTS: Of 735 patients with irritative voiding symptoms, 264 (35.9%) had microscopic hematuria and 471 (64.1%) had no hematuria. Bladder cancer was detected in 3 women, for an overall detection rate of 0.4%. Microscopic hematuria, urgency, frequency, dysuria, nocturia, age, and tobacco use were not significantly associated with bladder cancer. CONCLUSION: In this cohort of women with irritative voiding symptoms, microscopic hematuria was not predictive for bladder cancer.

Urinary nitrite excretion and urinary variables in patients with primary nocturnal frequency of micturition: effects of indomethacin suppositories.

Urinary nitrite excretion was measured in patients with primary nocturnal frequency of micturition (PNFM) and in normal individuals. Effects of indomethacin suppository on urine volume and other urinary variables were evaluated. The study comprised seven patients with PNFM and seven healthy control (age range 30-45 years). Nitrite was assayed in spot morning urine samples; urine volume, urine osmolality and electrolytes, serum osmolality and electrolytes and functional bladder capacity (FBC) were assayed. Both groups were then given 100 mg of indomethacin suppository daily for a maximum of 10 days and urinary variables were re-evaluated during day 10. Results showed that urinary nitrite excretion of patients with PNFM was greater than that of the normal subjects (230+/-62 umol/l vs. 42+/-30 umol/l, P<0.05). The mean (SD) 24 h urine volume and osmolality, the night urine volume and osmolality, serum osmolality, FBC, creatinine clearance, fractional excretion of sodium (FENa), fractional excretion of potassium (FEK), and urinary excretion of glucose and potassium were lower in patients with PNFM as compared with normal individuals, although not statistically significantly so, except for FBC that was significantly lower in the patients. Urinary excretion of sodium, calcium, chloride, phosphorus, magnesium, day-night urinary volume ratio, spot morning osmolality, nocturnal index, and nocturnal polyuria index were higher in patients with PNFM. Indomethacin decreased the 24 h urinary volume by 21%, creatinine clearance by 12%, osmolar clearance by 14% and urinary protein excretion by 38% in the patients. These variables decreased by 26, 45, 17 and 12% respectively in the healthy subjects, whereas 24 h urinary protein excretion increased mildly by 9%. Indomethacin increased day-night urinary volume ratio by 73% in the healthy subjects. It might be concluded that urinary nitrite excretion, urinary excretion of sodium, chloride, phosphorus, calcium, and magnesium increased and FBC decreased in patients with PNFM; Indomethacin decreased urinary volume, FENa, FEK, osmolar clearance, and free water clearance in the healthy subjects and the patients. These might explain the mechanism of action of indomethacin to reduce frequency of voiding. The possible interaction of prostaglandin and NO in the pathogenesis of PNFM is discussed.

The usefulness of urinary cytology testing in the evaluation of irritative voiding symptoms.

OBJECTIVE: The purpose of this study was to assess the clinical usefulness of urinary cytology testing for the evaluation of urothelial cancer in women with irritative voiding symptoms who were examined at a urogynecology service. STUDY DESIGN: Urinary cytology studies results that were obtained from January 1, 2000, to December 31, 2002, were cross-matched with the Rhode Island Department of Health Cancer Registry to identify those women who were diagnosed with urinary tract malignancies. The prevalence of urothelial cancer was determined, and the sensitivity, specificity, and positive and negative predictive values of urinary cytologic testing were calculated for 2 common classification strategies: (1) consideration of atypical cytologic test results to be normal and (2) consideration of atypical cytologic test results to be abnormal. RESULTS: Among 1516 cross-matched cytologic test results from 1324 patients, 5 urothelial cancers were identified. Two of the 5 malignancies were associated with positive cytology results. The prevalence of urothelial cancer was 0.38% (95% CI, 0.1%, 0.9%). When atypical cytology studies were classified as normal, the sensitivity of urinary cytology was 40% (95% CI, 7.2%, 83.0%); the specificity was 99.9% (95% CI, 99.5%, 100%); the positive predictive value was 66.7% (95% CI, 12.5%, 98.2%), and negative predictive value was 99.8% (95% CI, 99.2%, 100%). In contrast, when atypical cytology results were classified as abnormal, the sensitivity and negative predictive value remained the same, but the specificity declined to 93.6% (95% CI, 92.1%, 94.8%), and the positive predictive value decreased to 2.3% (95% CI, 0.4%, 8.8%). CONCLUSION: The low prevalence of urothelial cancers and low sensitivity of urinary cytology studies severely limit the usefulness of this test in the evaluation of women with irritative voiding symptoms.

Results of urine cytology testing and cystoscopy in women with irritative voiding symptoms.

OBJECTIVE: The purpose of this study was to assess rates of urinary cytologic abnormalities and cystoscopic outcomes in women with irritative voiding symptoms who were examined at a urogynecology clinic. STUDY DESIGN: All urinary cytology studies results that were sent between January 1, 2000, and July 31, 2003, for the evaluation of irritative voiding symptoms were reviewed. Data were then extracted from the charts of a subset of these patients to evaluate cystoscopic outcomes. Demographics, risk factors for urothelial cancer, laboratory results, and radiology imaging results were then analyzed and compared between patients with and without abnormal cytology and cystoscopic results. RESULTS: Of the 1783 total urinary cytology that were reviewed, 1661 test results were read as normal (93.2%); 112 test results (6.3%) were read as atypical, and 3 test results (0.2%) were read as unsatisfactory. Seven cytologic test results were categorized as suspicious or malignant, which accounts for only 0.4% of all cytologic test results that were sent. Of the 564 consecutive women whose cases were chosen for subanalysis, cytology was normal in 91.5% and atypical in 8.5% of cases. No cytology were suspicious or malignant. Cystoscopic findings were normal in 548 patients (97.2%). Only 1 patient (0.2%) received a diagnosis of transitional cell carcinoma. CONCLUSION: Urinary cytology and cystoscopy are low yield tests and should not be used routinely in the initial evaluation of women with irritative voiding symptoms.

Prevalence and predictors of nocturia in obstructive sleep apnea-hypopnea syndrome--a retrospective study.

OBJECTIVE: To determine the prevalence and predictors of pathological nocturia (PN) in patients with OSAHS. METHODS: Retrospective review of clinical and polysomnographic data obtained from patients evaluated at the Pulmonary Sleep Evaluation Center of the University of Pittsburgh Medical Center between November 1998 and September 1999. PN was defined as two or more urination events per night. OSAHS was defined as Apnea-Hypopnea Index (AHI) > or = 5. Group t-tests and Chi-square test were used to examine differences in subjects with and without PN. A multivariate approach utilizing logistic regression was performed to examine the relationships between polysomnographic variables [Arousal Index (ARI), AHI, Apnea-Hypopnea Time/Total Sleep Time x 100(%) (AHT/TST), % Total Sleep Time (TST)<90% Oxyhemoglobin Saturation (SPO2), nadir SPO2, Desaturation Event Frequency (average number of desaturations > 4% per hour sleep) (DEF)] and the presence of PN, while controlling for medical comorbidities. Data are expressed as mean + SD unless otherwise specified. Statistical significance was assessed at p < 0.05. STUDY POPULATION: n = 138 (50 females, 88 males), age: 49.7 +/- 12.3 years, BMI [Body Mass Index (kg/m2)]: 37.7 +/- 11.3. The overall prevalence of PN was 47.8%. The prevalence of PN was greater in females (60% vs. 40.9% in males). OSAHS patients with PN had a higher prevalence of peripheral edema, higher BMI, a greater %TST < 90% SPO2, lower nadir SPO2 and greater DEF. The logistic regression model indicated that age, ARI, AHI, AHT/TST, %TST < 90%, DEF were significant predictors of PN independent of BMI, neck circumference and medical comorbidities. CONCLUSIONS: Our data confirm that PN is common in OSAHS patients. The strongest predictors are age and selected polysomnographic variables reflecting OSAHS severity.

[Relationship between the Area Under the Curve of detrussor contraction during micturition and the usual parameters of flow-pressure rate in women]. / Relations entre l'Aire Sous la Courbe de la contraction du détrusor pendant la miction et les paramètres usuels de l'examen pression-débit chez la femme.

OBJECTIVES: The aim of this work was to assess the relationship between a new urodynamic parameter Area Under Curve of detrusor pressure during voiding (AUCdet) and the usual pressure flow study parameters. MATERIAL AND METHODS: 103 women with various urinary symptoms (incontinence, dysuria, chronic bladder pain or frequent urinary infection) had a urodynamic evaluation with pressure flow analysis. The intravesical pressure was measured through a 6CH Porges Neoplex and the intra-abdominal pressure through a 6CH rectal catheter in an empty rectum. Pressure-flow study was performed one time in each patient. The maximum flow rate (Qmax), the detrusor pressure at maximal flow (PdetQmax), the vesical pressure at maximal flow (PvesQmax), the urethral resistance defined as the ratio between the PvesQmax and Qmax2 (RU) and the AUCdet/Vol were recovered. RESULTS: 85 women were included and mean age was 55 years old. The averages were 19.42 for Qmax, 28.91 for PdetQmax, 63.85 for PvesQmax, 2.10 for RU and 7.83 for AUCdet/Vol. The correlation with AUCdet/Vol were for Qmax -0.80 p < 0.0001, for PdetQmax 0.71 p < 0.0001, for PvesQmax 0.42 p < 0.001 and for RU 0.84 p < 0.0001. CONCLUSIONS: AUCdet/Vol is the first urodynamic parameter which takes into account the whole detrusor contraction during voiding. AUCdet/Vol is relatively close to the urethral resistance. The very high degree of correlation between RU and AUCdet/Vol confirms clinically this definition of the RU. Further studies are needed to assess the validity of AUCdet/Vol.