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Introduction: The periurethral electromyography (EMGs) alterations in men who underwent pelvic radiotherapy (RT), either isolated or combined with surgery, have not been frequently described in the literature., Objective: The study aimed to compare the EMG's data in men undergoing RT versus the non-irradiated control group., Material and Methods: The study included 61 consecutive males, who had undergone RT (27 of them had been operated) and 99 control consecutive patients who underwent a retrospective assessment. The EMGs were performed using a concentric electrode needle perineally, localizing the sphincter by visual and auditory signal (electromyograph MMS Solar Active)., Results: 14.8% denervation, 62.9% reinnervation, 14.9% denervation + reinnervation and 7.4% EMG normal. The age (p < 0.001) and neurogenic bladder data (p < 0.001) are risk factors. The smaller the prostate size (obtained by rectal examination) post-RT, the more the chance for an abnormal EMG (p < 0.001). The fact of having had received RT (p < 0.001) is the only risk factor., Conclusion: RT produces lesions over the pudendal nerve, showing denervation even in late periods. The surgery did not behave as a risk factor., (© 2016 S. Karger AG, Basel.)

Aims: The risk factors for developing autonomic dysreflexia (AD) during urodynamic (UD) examination in patients with spinal cord injury (SCI) above Th6 still remain unclear. The main goal of our study is to investigate the risk factors that could be associated with AD in these particular patients., Design: Cross sectional survey., Subject and Methods: The study was carried out in 83 patients with SCI above Th6 who were submitted to our center for a UD examination. AD was defined as a rise in systolic blood pressure above 15 mm Hg with a pulse rate below 60 beats per minute., Results: The prevalence rate of AD among our patients was 54%. Univariate analysis of our study showed the following risk factors: patient's age, SCI completeness, traumatic etiology, indwelling catheter, presence of chills or sweating, anticholinergic treatment, maximum detrusor voiding pressure, detrusor pressure at maximum flow rate, detrusor external sphincter dyssynergia, and bladder outlet obstruction. Using multivariate logistic regression, we found that there are only two independent risk factors: patient's age equal to or above 45 years of age (OR = 10.995) and maximum detrusor voiding pressure equal to or above 31 cm H 2 O (OR = 3.879)., Conclusions: According to our results, the patient's age and maximum detrusor voiding pressure should be considered at the time of performing a UD examination in order to prevent the sudden onset of AD in patients with SCI above Th6. Neurourol. Urodynam. 36:171-175, 2017. © 2015 Wiley Periodicals, Inc., (© 2015 Wiley Periodicals, Inc.)

Objective: To identify the prognostic factors influencing the clinical and urodynamics results on symptomatic benign prostatic hypertrophy (BHP) treatment in a series of patients with silodosin therapy from the URAL study., Methods: A retrospective study was performed in a cohort of 318 patients with BPH which underwent silodosine treatment, during at least 12 weeks., Results: Univariate analysis demonstrated that the variables in relationship with a decrease of urinary symptoms` punctuation postreatment (measured with the IPSS Questionnaire), a maximum peak flow (Q max) postreatment equal or superior to 15 ml/s, a postreatment postvoid residual lower to 100 ml, and a postreatment obstruction index ( Bladder Outlet Obstruction Index: BOOI) equal or lower to 20 cm H2O, presented such both as a clinical and urodynamic character. The multivariate analysis demonstrated that a decreased punctuation of IPSS Questionnaire postreatment was in relationship to: a pretreatment cystometry bladder capacity (direct relationship), pretreatment Qmax (direct relationship), pretreatment postvoid residual (inverse relationship), and pretreatment BOOI (inverse relationship)., Conclusion: The urodynamic study was very useful in the assessment of the prognostic factors in these patients.

Objective: The urodynamic results in suburethral slings (SS), are contradictory. We evaluate a series on patients with stress urinary incontinence (associated or not with bladder hyperactivity) that underwent suburethral slings (SS) operations., Methods: 42 women (age 62±12 years) with urinary incontinence underwent suburethral slings (86% TOT, 12% TVT, 2% others), 36% of them with simultaneous pelvic organ prolapse correction. Medical history and a pre and postsurgery urodynamic studies (according to ICS instructions, except when specified) were performed., Results: After surgery, the improvement of urinary incontinence was lower in patients with previous detrusor hyperactivity (DH) than without DH (60% vs 81 %), and the bladder capacity (BC) was lower (123±36 ml) in patients with previous mixed urinary incontinence (MUI) versus no MUI (241±83 ml) (p=0.004). The decrease of BC was higher with previous MUI (184±92 ml vs 123±36 ml) versus no MUI (240±91 ml vs 237±78 ml), and the DH was more frequent in previous MUI and DH. There was a significant decrease of maximum flow rate (Qmax) (p=0.000) (although without clinical manifestation), and post void residual urine (p=0.007). We demonstrated a significant increase (p=0.001) of mean urethral resistance (URA): 12±9 cm H2O versus 15±12 cm H2O (without reaching obstruction range), and an improvement of detrusor contractility (W80-20): (3±4 W/m2; vs 6±17 W/m2;)., Conclusion: We demonstrated worst results in MUI in patients with urinary incontinence undergoing SS. The urodynamic study gives a better prognosis reliability in the treatment of female urinary incontinence with SS.

Objective: To describe and quantify the long-term adverse effects on filling phase of lower urinary tract function in males submitted to radiotherapy., Methods: We performed a retrospective comparative study on a cohort of 99 men undergoing EBRT a mean of 4.7 years before for clinically localized prostate, rectum or colon neoplasia, and another cohort formed by 97 men over 50 years who did not undergo radiotherapy., Results: Cystometric bladder capacity and bladder capacity at first voiding desire were significantly lower in the radiotherapy group. Univariate analysis showed that the radiotherapy group evinced a risk to present a diminished compliance of 3.5 times more and 9.3 times more to find stress urinary incontinence, but we did not found increased risk for detrusor overactivity. In multivariate analysis the history of radical surgery acted as a confounding factor in the risk of stress urinary incontinence, but not to suffer diminished bladder compliance., Conclusions: The main long-term adverse effect of pelvic radiotherapy on male bladder function during filling is the increased risk of low bladder compliance.

Objectives: To determine the prevalence of radiologic images suggestive of urethral diverticula (UD) in men with spinal cord injury (SCI) and to study the interobserver diagnostic reproducibility., Methods: Radiological studies (i.e. voiding cystourethrography and retrograde urethrography) performed over 1 year on men with SCI were independently reviewed by 3 researchers (1 urologist and 2 radiologists)., Results: The prevalence of UD was found to be between 4.2 and 9.8% of the patients, the higher figure obtained when including also the doubtful images. The kappa index of agreement between the researchers was low (between 0.15 and 0.40). The factors that significantly influenced agreement were localization in the prostatic urethra (p = 0.021), localization in the penile urethra (p = 0.000) and fusiform morphology (p = 0.004). Logistic regression analysis showed that the variables that independently influenced diagnostic agreement were the following: localization in the penile urethra (in favor of agreement) and fusiform morphology (against agreement)., Conclusions: Radiologic images suggestive of UD constitute a frequent finding in men with SCI and raise important diagnostic problems., (Copyright © 2013 S. Karger AG, Basel.)

Aims: the aims of this study are to assess the quality of life (QOL) of males with spinal cord injury (SCI) and to know their sexual health. We also analyze the links among clinic and sociodemographic variables, the sexual health of males with SCI and their QOL., Method: This is a transversal cross-sectional study that was made in the hospital of Paraplegics of Toledo. The sample included 45 men presenting SCI and sexual dysfunction. Life Satisfaction Checklist and Sexual Health Measurement Scale were used to gather data., Results: The 97, 8% of all participants are interested in having sexual relationships; the 70% of all participants have a steady sexual couple while the 51% often maintain sexual relations. The 86% of the sample admit to suffer from erectile dysfunction and the 71% can't ejaculate. The score of the group which has erectile dysfunction are significantly low in sexual QOL (p t-Student 0.000) and in general QOL (p t-Student 0.001). The sample had an average in general QOL of 34,27 (standard deviation: 2,8), in social QOL 20,16 (SD:2,7), in sexual QOL 7,62 (SD:2,7) and in economic QOL 7,71 (SD:2,6). There isn't a significant relationship among the QOL and the etiology, the degree and the time of evolution of the SCI., Conclusions: The individuals who have participated in this study generally experienced a good general QOL, but their sexual life is the aspect which causes them a greater dissatisfaction. In fact, those who suffer from erectile dysfunction show less satisfaction with their general and sexual QOL., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

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., (Copyright © 2011 AEU. Published by Elsevier Espana. All rights reserved.)

We report a case of ureteral type III triplication according to Smith's classification, without associated anomalies of the urinary tract. The revision of the bibliography indicates the rarity of this maldformacion and its frequent association with other urinary and extraurinary malformations. The absence of associate malformations in this case increases his exceptionality.

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.

Objectives: To study the characteristics and evolution of the epidermoid penis tumours., Material and Methods: It was carried out a retrospective study on the epidermoid penis tumours treated in our center between 1981 and 2005., Results: 16 tumours penis epidermoides were diagnosed. The average age of the patients was of 71.7 years (interval between 54 and 90 years). In 80% of the cases they are diagnosed in advanced stadiums (T3 and T4). The most habitual presentation forms are the ulcerous lesions (53%) and papilar (33%). The average diameter of the lesion was 2.3 cm, and the most frequent localization the glands (53%) and balano prepucial (33%). They were carried out 7 local scissions, 8 partial penectomies, one total penectomy, and an local scission pluslocal treatment with 5-fluoracile. With a follow-up of 24 months 5 relapses took place, mainly in patients subjected to local excision of the lesion (p = 0.06 log-rank test)., Conclusions: The epidermoid carcinoma of the penis is a tumoral lesion characteristic of advanced ages that is diagnosed later and treated in not very aggressive way. Therefore it is frequent the advanced stadiums and the tumour relapses.

Introduction: Testicular tumors are frequent in young adults, coinciding with incorporation to military service. The present study evaluates the tumor characteristics, time course and results obtained with the treatments used in our center for this type of neoplasms., Material and Methods: A retrospective longitudinal study was conducted in a cohort of 98 patients with an average age of 28.6 years, subjected to orchiectomy for testicular tumors in our center between 1979 and 2004. Data were collected relating to patient age, tumor characteristics, the outcome of treatment, and the course of the disease., Results: The right testicle was affected in 61% (with significant differences versus the left side). The most common histological type corresponded to non-seminomatous germ cell tumors (NSGCTs) (65.3%), followed by pure seminomas (27.6%) and non-germinal cell tumors (NGCs) (7.1%). NSGCT was diagnosed at a significantly younger average age (23.2 years) than the other two tumor types. Stage I was the most frequent presentation (58%). Seminomas presented in stage I significantly more often (80%) than the others tumors. The data collected over the 25-year study period showed no significant variations in tumor characteristics. The log-rank test showed a significant difference in terms of patient survival according to the tumor cell line (p = 0.000) and stage (p = 0.000), except between stages I and II, where no significant differences were observed in terms of survival., Conclusions: Non-seminomatous germ cell tumors (NSGCTs) are the most frequent testicular tumors in young adults. Most neoplasms are diagnosed in early stages, the prognosis being better in the case of seminomas and tumor stages I and II.

Objectives: Lower urinary tract dysfunction may affect the upper urinary tract with development of vesicoureteral reflux. The objective of our study is to evaluate what lower urinary tract dysfunctions are associated with vesicoureteral reflux in adults., Methods: We performed a cross-sectional study in a sample of 236 patients (149 males and 87 females) with a mean age of 45.5 yr. (typical deviation 19.0 yr.) submitted for videourodynamic study for lower urinary tract functional symptoms. History and neurourologic physical examination, filling cystometry associated with videocystography, pressure/flow study associated with voiding videocystography and selective electromyography of the periurethral sphincter were done in all patients. The chi-square test was used for statistical analysis., Results: The presence of vesicoureteral reflux was observed in 19 patients (8.1% of the sample). Fifteen cases (79%) showed reflux during the filling phase, 3 cases (16%) during the voiding phase, and in 1 (5%) in both. The existence of a vesicourethral neurogenic dysfunction was confirmed in 8 cases (42%); there was no neurogenic dysfunction in 11 cases (58%). The vesicoureteral reflux was classified as primary passive (without any urodynamic anomaly) in one case (5%), passive with diminished compliance in 4 cases (21%), passive evolutive in 3 cases (16%), active involuntary in 7 cases (38%), active associated with organic obstruction of the lower urinary tract in one case (5%), active associated with increased contractile potency in one case (5%), and secondary to abdominal press in 2 cases (10%). The only urodynamic anomalies associated with a significant increase of the prevalence of vesicoureteral reflux were: a filling pressure at maximum capacity greater than 12.5 H2O cm (prevalence of reflux 7 times) and voiding with abdominal press which increased the prevalence of reflux 2.8 times., Conclusions: Most patients with functional symptoms of the lower urinary tract and associated vesicoureteral reflux present lower urinary tract dysfunctions that may justify their reflux. Nevertheless, a statistically significant increase of the prevalence of vesicoureteral reflux was only found in patients with filling pressures at maximum capacity greater than 12.5 cm H2O and those voiding with the help of abdominal press.

Objectives: To compare the results of the Blaivas and Groutz nomogram in the diagnosis of female urinary obstruction with videourodynamic tests., Methods: We performed a transverse study in a series of 52 female patients with ages between 20 and 81 years (mean age: 48.7 years; standard deviation: 14.4 years) and functional lower urinary tract symptoms referred for videourodynamic studies. All patients underwent free flowmetry and voiding videourodynamic study. From the scores of free flowmetry and maximum detrusor pressure in the detrusor pressure/voiding flow test of the urodynamic study they were classified in one of four categories following the Blaivas and Groutz nomogram. Following urodynamic data they were classified into three categories: absence of obstruction, bladder neck obstruction and urethral obstruction. The nomogram results were compared with the videourodynamic data using the Pearson chi-square statistical test. The diagnostic sensitivity and specificity of the nomogram were also determined., Results: The Blaivas and Groutz nomogram showed a significant association with the videourodynamic data (p = 0.000). Its diagnostic sensitivity for obstruction was 100%, but its specificity was only 67.5%. The percentage of diagnostic discrepancies was maximal in the mild obstruction, where one third of the patients were obstructed following the videourodynamic data., Conclusions: The Blaivas and Groutz nomogram is a sensitive method for the diagnosis of obstruction, but its specificity is low so that it has the tendency to overdiagnose the presence of obstruction in the female patient.

A case of scrotum leiomyosarcoma is presented in a 87 year-old patient. It debuts as a painless lesion in left hemiescrotum, of one year of evolution. Bony metastasis were observed in the moment of the diagnosis. We carried out a literature revision proving the rarity of this lesion type (only 27 cases have been described), and that, contrary to another leiomiosarcomas type, their aggressive evolution is not habitual in this localization.

Objectives: To evaluate the clinical and urodynamic features of a series of women with post void residual urine (disbalanced voiding) and various degrees of associated cystocele., Methods: 119 female patients were studied by clinical evaluation, urodynamics, and imaging tests (VCUG). All patients underwent history and genitourological examination (evaluating cystoceles from grade o to 3), neuro-urological examination, and complete urodynamic study. Fifty patients (42%) underwent radiological studies of the upper urinary tract. Disbalanced voiding was defined as existence of post void residual greater than 20% of the voided volume. Urethral resistance was measured by URA. Structural obstruction was characterized by PURR (CHESS classification). Functional obstruction was studied by DURR and perineal EMG (associated with flowmetry). Detrusor contractile power was evaluated by W max, W 80-20, and duration of contraction. Urodynamic terminology and measurements complied with the International Continence Society (ICS) standards. Statistical significance was established at 0.05. Statistical analysis was done by Student's t for quantitative variables, and Pearson's chi-square for non parametric variables., Results: 119 patients were enrolled. Mean age was 55.84 yr. (range 15-87). Regarding post void residual (114 valid uroflowmetry studies), 25 patients were classified as voiding disbalance (21.9%) and 89 as balanced (74.8%). Regarding clinical data, there were only significant differences between groups in voiding difficulty. For uroflowmetry, only the percentile of the Maximal flow (Qmax) showed significant differences (35 vs. 22 for balanced/disbalanced voiding respectively, p = 0.02). Pressure/volume studies demonstrated bladder hyperactivity in 16 cases (64%) in the group of disbalanced voiding and 31 cases (34.8%) in the normal voiding group (p = 0.008), which presented associated with increased urethral resistance (URA)(p = 0.01) . In the pressure/flow study, there were significant differences in the URA (14.7 vs. 25.3, p = 0.001). There were statistically significant differences in the degree of constrictive (0.5 vs. 1.1, p = 0.009) and compressive (0.5 vs. 1.1; p = 0.04) obstruction (Chess classification). There were not significant differences in the analysis of isometric contractility (Wmax), but there were in the isotonic contractility (W80-20) and detrusor contraction duration. These latter differences presented significant association with the degree of cystocele. DURR and perineal EMG data did not show differences between groups. Radiological abnormalities of urethral morphology were statistically different between groups, presenting in 10% of the patients with normal voiding and 50% of the disbalanced voiding group, although there was not statistical association with obstruction (p = 0.64). The existence of cystocele did not show a statistical association with these variables either., Conclusions: Disbalanced voiding appeared with organic obstruction of the lower urinary tract (constrictive most significantly), as well as detrusor abnormal contractility, but whereas the first was not significantly associated with presence and grade of cystocele, the second showed such association.

Objectives: To evaluate and quantify the association between clinical, ultrasound and immunoserological data and histologic type and stage of testicular tumors., Methods: We analyze a cohort of 80 patients who underwent orchiectomy for testicular neoplasia. Mean patient age was 30.4 years. Past medical history, first symptoms, time from first symptom to operation, physical examination and ultrasound data, and preoperative serum levels of alpha-fetoprotein and beta HCG were retrospectively collected., Results: Patients with non seminomatous germ cell tumor (NSGCT) had a significantly lower mean age (23.7 yr.) than patients with pure seminoma (41.3 yr.), and these latter a significantly lower age than patients with non germinal tumors (50.7 yr.). Initial presentation with general malaise or lumbar pain increased 2.56 times the relative risk of having a tumor in advanced stage (higher than stage I) . Presence of gynecomastia increased 16.5 times the relative risk of having a non germ cell tumor, due to the inclusion of Leydig's tumors in this group. Detection of heterogeneous nodules by ultrasound increased 4.5 times the risk of having a non seminomatous germ cell tumor. Preoperative elevation of alpha-fetoprotein ruled out the existence of seminoma and non germ cell tumor; whereas preoperative elevation of beta HCG increased 3.21 times the risk of having a non seminomatous germ cell tumor. No significant association was shown between preoperative tumor markers and tumor stage., Conclusions: The existence of gynecomastia, age, detection of heterogeneous nodules on ultrasound, and preoperative alpha-fetoprotein and beta HCG are relevant data in relation to histological type of tumor. Lumbar pain or malaise are clinical data associated with tumor stage.

Objectives: To evaluate the clinical and urodynamic characteristics of a series of women with lower urinary tract symptoms (bladder filling phase) presenting various rates of cystocele., Methods: 119 female patients were included in this study; mean age was 55.8 yr. (range 15-87). All patients underwent urogynecologic physical examination (cystocele was graded 0-3) and complete urodynamic study. Urodynamic terminology and measurements comply with the ICS (InternationaL Continence Society) standards. Statistical significance was established below 0.05. Quantitative variables were compared by the Student's t and non parametric variables by Pearson's chi-square., Results: The most frequently reported symptom was urinary incontinence when coughing (77/118, 65.3%), followed by urge incontinence (71 patients, 60.2%). The grade of cystocele was 0 in 31.1%, 1 in 25.2%, and 2 in 26.1%, and 3 in 17.6%. There was a statistically significant association between grade of cystocele and the symptom "vaginal bulge" (p=0.00002). The presence of cystocele did not show any statistical association with lower urinary tract symptoms of the filling phase. Mean cystomanometric bladder capacity was 224.8 ml. Involuntary contractions of the detrusor muscle appeared in 38 cases (21.9%), stress urinary incontinence in 19 (16%), mixed incontinence in 8 (6.7%) and absence of evidence of urinary incontinence in 58 (48.7%). Patients with urgency had a lower bladder capacity than patients without it (p = 0.02), as did patients with urge incontinence (p = 0.02). Nocturia (p = 0.05), urgency (p = 0.02) and urge incontinence (p = 0.01) were significantly associated to bladder capacity. The existence of involuntary contractions was statistically associated with urge incontinence (p = 0.01). Patients with involuntary contractions during the filling phase showed increased diurnal voiding frequency (p = 0.02), as well as patients without a stress urinary incontinence (p = 0.04) and cases without a stress urinary incontinence (p = 0.04). The symptom incontinence with coughing had a significant statistical association with the urodynamic diagnosis of stress urinary incontinence (p= 0.01). Bladder capacity was augmented in grade 3 cystocele (p = 0.003). The existence of cystocele was not associated with bladder hyperactivity (p = 0.65), neither was the diagnosis of a stress urinary incontinence (p = 0.37)., Conclusions: No relationship has been demonstrated between existence and degree of cystocele and functional lower urinary tract symptoms of the filling phase, on the one hand, and urodynamic evidence of bladder hyperactivity and incontinence on the other hand. This could have important therapeutic implications.

Objectives: To determine the diagnostic usefulness of data provided by clinical history for the diagnosis of lower urinary tract obstruction in patients with acute urinary retention., Methods: We performed a transversal study in a series of 70 patients (19 women and 51 men) with a mean age of 61.5 years (typical deviation 20.7 years), who underwent urodynamic study due to acute urinary retention. Past medical history was recorded in all patients. Physical exam was also carried out, evaluating prostate size in males, presence of genital prolapse in females, and neurourological examination. Urodynamic tests consisted on flowmetry, pressure/flow studies with simultaneous perineal electromyography, and voiding cystourethrogram or videocystogram. Student's t mean comparison and chi-square tests were used for the statistical analysis., Results: The only clinical data that showed a statistically significant relationship with obstruction of the lower urinary tract were: age, sex, prostate size, and existence of infrasacral neurological lesion (absence of bulbocavernous reflex). Age > 74 years showed a sensitivity of 71 % for lower urinary tract obstruction and a specificity of 60%. Male sex showed a sensitivity of 88% and specificity of 36%. Prostate size > or ='3d grade II sensitivity was 58% and specificity 82%; and absence of infrasacral lesion a sensitivity of 77% and specificity of 48%., Conclusions: Provided that a negative result in a test with high sensitivity makes the likelihood of disease low, in women the presence of infrasacral neurogenic dysfunction or age < or ='3d74 years diminish the probability of obstruction in patients with acute urinary retention. On the other side, if a negative result of a test with high specificity increases the probability of having the disease, a prostate size > or ='3d grade II and age > 74 years favour the likelihood of having urinary tract obstruction for a patient with acute urinary retention.

Introduction: The Extracorporeal shock waves lithotripsy (ESWL) is fundamental in the treatment of lithiasis. However, there are evidences that it can produce renal damage. The objective of our study is to determine the degree of affectation of the glomerular and tubular function after ESWL, and the influence of the lithiasis location on the type of renal damage., Material and Methods: A prospective longitudinal study was carried out in 14 patients with normal renal function subjected to ESWL. We determined the basal level, and the levels at the 24 hours, at the 4th and the 10th day post ESWL of: microalbuminuria (MA) (that values the glomerular function), and N-acetyl glucosamide (NAG) and alanine aminopeptidase (AAP), (that value the tubular function)., Results: The basal levels of of MA, NAG and AAP didn't show significant differences in connection with the localization of the stones. A significant increase was observed of the three parameters only 24 hours post ESWL. No significant differences were observed between the variation of the microalbuminuria levels, AAP and NAG and the treatment in relation to the localization of the stones., Conclusions: It exists a glomerular and tubular damage after ESWL. This damage is not related with the pelvic or calicial location of the stones. In patient with previous normal renal function, the renal damage recovers at the 4th day post ESWL.

Objectives: To determine the therapeutic usefulness and side effects of a new disposable intraurethral device (Uriabsorber) for female stress urinary incontinence., Methods: A prospective study was performed in a cohort of 48 women (mean age 42.7 yr.) consulting because of urinary incontinence with coughing. Lack of manual ability or difficulty to understand, pregnancy, puerperium, vaginitis, urinary tract infection and current administration of active treatment for urinary incontinence were all exclusion criteria. Patients were instructed about the use of the device. Two visits were performed: one after two weeks and the other at the end of the month. Clinical results were collected and urine analysis was performed. A multivariate statistical analysis was performed to determine what variables influenced the final result., Results: Treatment withdrawal rate was 42% after one month, being most withdrawals before 14 days (19 cases, 40%). The causes of withdrawal were local discomfort (11 cases, 23%) and difficult insertion (3 cases, 6%). There were only five cases (10%) of urinary tract infection, and two cases (4%) of macroscopic hematuria. The presence of cystocele was associated with higher frequency of complications (80%). 79% of the patients completing the month of treatment had positive results (50% resolution of incontinence and 29% improvement). Multivariate statistical analysis showed that variables independently influencing the results were: incontinence intensity (the lower the intensity, the better the results), presence of urinary tract symptoms (the lower the intensity of the symptoms, the better the results), and absence of past history of pathology., Conclusions: The intraurethral disposable device significantly reduces the rate of urinary tract infections. Tolerance depends on the ability and motivation of the patients. It is indicated in the control of non intense urinary incontinence in motivated patients, without evident cystocele.

The Occidental thinking is basically binary, based on opposites. The classic logic constitutes a systematization of these thinking. The methods of pure sciences such as physics are based on systematic measurement, analysis and synthesis. Nature is described by deterministic differential equations this way. Medical knowledge does not adjust well to deterministic equations of physics so that probability methods are employed. However, this method is not free of problems, both theoretical and practical, so that it is not often possible even to know with certainty the probabilities of most events. On the other hand, the application of binary logic to medicine in general, and to urology particularly, finds serious difficulties such as the imprecise character of the definition of most diseases and the uncertainty associated with most medical acts. These are responsible for the fact that many medical recommendations are made using a literary language which is inaccurate, inconsistent and incoherent. The blurred logic is a way of reasoning coherently using inaccurate concepts. This logic was proposed by Lofti Zadeh in 1965 and it is based in two principles: the theory of blurred conjuncts and the use of blurred rules. A blurred conjunct is one the elements of which have a degree of belonging between 0 and 1. Each blurred conjunct is associated with an inaccurate property or linguistic variable. Blurred rules use the principles of classic logic adapted to blurred conjuncts taking the degree of belonging of each element to the blurred conjunct of reference as the value of truth. Blurred logic allows to do coherent urologic recommendations (i.e. what patient is the performance of PSA indicated in?, what to do in the face of an elevated PSA?), or to perform diagnosis adapted to the uncertainty of diagnostic tests (e.g. data obtained from pressure flow studies in females).

The Bayes theorem provides a formula to calculate the probability of an event to occur conditioned by the occurrence of an anterior one (conditioned probability). In medicine it has been applied to calculate the probability of suffering a disease when having a positive result in a given test. This formula emphasizes the importance of prevalence of a disease (or a priori probability of the positive predictive value of a diagnostic test). The novelty of applying the bayesian methodology in clinical practice results from taking into consideration previous external information (or "a priori probability"), and to calculate how it is modified by the evidence (or "verisimilitude") provided by certain empirical tests, to obtain a new probability conditioned by the empirical evidence (or "a posteriori probability"). It also allows to perform sequential analysis (repeated observation of a given event a number of times not fixed in advance) and to incorporate the subjective probabilities to the reasoning. Some authors have proposed the use of bayesian methodology in research studies, such as clinical trials. Nevertheless, this methodology does not adapt well to this kind of reasoning which is hypothetical-deductive.

Objectives: To test the concordance between clinical and neurophysiologic data of the various types of erectile dysfunction, and to describe a diagnostic algorithm based on corpus cavernosum electromyography (cc-EMG)., Methods: 32 patients with a mean age of 50.6 years (typical deviation 13.2 years) referred with the diagnosis of erectile dysfunction underwent medical history, neuroandrologic physical exam, neurophysiologic studies (bulbocavernous muscle electromyography, S2-S4 latency period, threshold and latency of pudendal nerve somatosensory potentials, as well as genital sympathetic evoked potentials-SSR-), and corpus cavernosum electromyography(cc-EMG) both in basal conditions and after administration of 20 micrograms of E-1 prostaglandin (PGE-1)., Results: 1--A significative relationship was shown between clinical data of arterial or corpus cavernosum intrinsic origin erectile dysfunction and patients with vascular or structural lesion on cc-EMG data. 2--A significative relationship was shown between patients without previous pathologic history and patients with normal or anxiety cc-EMG. 3--No significative relationship was shown between patients with neurologic lesion and patients with autonomic lesion on cc-EMG. 4--No significative relationship was found between patients with peripheric neurologic lesion and patients with inferior autonomic lesion on cc-EMG. 5--A significative relationship was shown between patients with suprasacral neurologic lesion and patients with superior autonomical lesion on cc-EMG., Conclusions: Isolated application of pudendal nerve neurophysiologic techniques for the diagnosis of erectile dysfunction is not enough. Autonomic innervation studies should be included, with a cc-EMG dichotomic qualitative interpretation.

Objective: To determine with the highest level of evidence the efficacy of pelvic floor rehabilitation in the treatment of stress urinary incontinence in women., Methods: A systematic search was performed in the MEDLINE electronic database with the purpose to find randomised and controlled clinical trials evaluating the efficacy of pelvic floor rehabilitation in the treatment of stress urinary incontinence. A quantitative metanalysis was performed then by the Logit method combining the results from these studies to obtain an Odds ratio (OR) with its confidence interval. Moreover, it was determined the heterogeneity of the studies included in metanalysis by calculus of the Cochrane Q component., Results: 8 randomised controlled clinical trials matched the inclusion criteria. Global OR resulting from the combination of these studies was 7.03 (Confidence interval 4.99-9.89). Nevertheless, the heterogeneity of the studies was significant, secondary among other circumstances to the fact that these studies did not establish the difference between improvement and cure clearly., Conclusions: The heterogeneity of the studies does not allow to state after metanalysis (maximum level of scientific evidence) that pelvic floor rehabilitation is effective in the treatment of woman's stress urinary incontinence. Nevertheless two randomised controlled studies were found confirming that rehabilitation cures woman's stress urinary incontinence, from which there is good scientific evidence in favour of this treatment.

Objective: To determine the degree of association of detrusor-periurethral dyssynergia and detrusor-bladder neck dyssynergia and if the voiding periurethral electromyographic (EMG) activity is also a valid method for diagnosing detrusor-bladder neck dyssynergia., Methods: A clinical, videourodynamic and selective periurethral EMG study was performed in 24 patients (mean age 33 years) with spinal cord injury and hyperreflexia of the bladder., Results: The prevalence of bladder neck dyssynergia was 12.5% (3 cases) in this series. All patients with dyssynergic bladder neck also showed intermittent or sustained periurethral sphincter EMG activity. However, 15 patients showed increased intermittent or sustained voiding periurethral EMG activity that was not associated with detrusor-bladder neck dyssynergia. Utilizing the videourodynamic demonstration of detrusor-bladder neck dyssynergia as reference, selective periurethral EMG showed a sensitivity of 100% and a specificity of 29% for the diagnosis of detrusor-bladder neck dyssynergia., Conclusions: The finding of bladder neck dyssynergia indicates the existence of detrusor-periurethral dyssynergia. However, not all cases of detrusor-periurethral sphincter dyssynergia is associated with bladder neck dyssynergia; therefore a videourodynamic study should be performed to rule out bladder neck dyssynergia in those patients with detrusor-periurethral sphincter dyssynergia. This is important in making the differential diagnosis and also has significant therapeutic repercussions.

Objective: To determine the more useful parameters of urethral resistance and bladder contractile power to explain the values of maximum flow and postvoid residual urine observed in free uroflowmetry and appropriately assess the voiding dynamics in childhood., Methods: A cross-sectional study was carried out in 68 children (46 girls and 22 boys) with a mean age of 8.9 years. These children were subjected to free uroflowmetry in order to determine the maximum flow rate and the postvoid residual urine, and to a complete urodynamic study with perineal surface electromyography in order to determine the parameters of urethral resistance and bladder contractile power. A univariate linear regression model was built from these parameters for explanatory purposes. The independent variables were the parameters of the urodynamic study and the outcome variables were the value of the maximum flow in the free uroflowmetry and the proportion of postvoid residual urine in relation to the voiding volume of the free uroflowmetry. The resulting models were validated in order to determine its loss of predicting power (shrinkage). For this purpose, we used two other independent series: one comprised 50 patients (34 girls and 16 boys) extracted from the same sample as the derived model, and the other comprised 85 patients (53 girls and 32 boys) from another population., Results: The multivariate model demonstrated that the maximum flow of the free uroflowmetry has a direct relationship with the square root of the voiding volume and the bladder contractile power [measured by Schafer's projected isometric pressure (PIP)] and an inverse relationship with the urethral resistance measured by means of a parameter (URA) and with the presence of electromyographic perineal activity (EMG) during voiding. Similarly, the proportion of postvoid residual urine has a direct relationship with the urethral resistance (measured by means of the parameter URA) and with the inverse function of the projected isometric pressure (I/PIP). The shrinkage of the multivariate models, when compared with other series, ranged from 26.9% and 1.3%., Conclusions: The urodynamic evaluation of the lower urinary tract in childhood can be carried out appropriately by means of the determination of the urethral resistance by the parameter URA and of the bladder contractile power by the projected isometric pressure (PIP), obtaining as a limit of normal values a URA of 16 cm H2O and a PIP of 105 cm H2O.

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.

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.

Routine medical practice is an admixture of scientific knowledge, uncontrasted physiopathological deduction and intuition based on personal experience. Evidence-based medicine is a new approach to medical practice that is based on appropriately contrasted data and includes the following steps: 1) accurately define the problem we are dealing with, 2) investigate the medical literature efficiently, and 3) select the best, relevant studies and apply the corresponding norms to the evidence. In turn, the application of the corresponding norms to the evidence includes the following aspects: 1) determine if the results of the study are valid; i.e., evaluate the scientific quality of the article, 2) determine the magnitude of the results; i.e., establish is they are clinically relevant, and 3) evaluate their application to the point at issue; i.e., test the external validity of the study. The drawbacks of evidence-based medicine include its insufficient concern for basic research, its disregard for physiopathological hypotheses, and the naïve inductivism of epidemiology-based medical practice. Undoubtedly, evidence-based medicine provides advantages for the medical practice and underscores the importance of data and statistical procedures. This new paradigm, however, should not set aside the traditional, hypothetical-deductive approach.

Objective: The present study analyzes the main clinical types of urinary incontinence in the elderly population and its clinical-urodynamic correlation to facilitate definitive diagnosis., Methods/results: The study was conducted in 948 elderly patients (382 male, 566 female; mean age 72.4 years) with urinary incontinence. Patient clinical and urodynamic records were reviewed. The most common clinical types were urge-incontinence (56.4%) and incontinence with coughing associated with urge-incontinence (32.3%); the latter type was the most common in women. The most frequent urodynamic diagnoses were isolated bladder instability (29.9%), followed by obstruction (15.6%) and stress incontinence (14%)., Conclusions: The most common symptom in bladder instability was urge-incontinence, while incontinence with coughing was found to be the most common symptom in urinary stress incontinence. A significant correlation was found between the postvoid residual urine and the main urodynamic diagnoses. Multivariate analysis showed that classification by clinical types of incontinence together with measurement of residual urine can facilitate diagnosis, although this approach has a low sensitivity for the main forms of isolated incontinence. The mixed forms require a urodynamic study.

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.

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.

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.

Objective: To determine which urodynamic model best describes lower urinary tract dynamics during the voiding phase., Methods: A pressure-flow study was conducted in 211 adult males. The urodynamic data from the pressure-flow study were modelized to a multivariate analysis with a descriptive design. Three descriptive models of urethral resistance were proposed: a linear model that consisted of the detrusor pressure at the end of voiding and the pressure-flow plot slope, and two quadratic models with one parameter [urethral resistance average (URA)] or two parameters [opening detrusor pressure and passive urethral resistance ratio curvature (PURR)]. Bladder contractility was defined by two parameters: power at maximum flow rate (Pw) and maximum power/bladder surface (Wmax). Voiding volume was included in all models as control variable. The best model was defined as that which explains a higher percentage of observed maximum urinary flow rate, the most widely utilized datum in the urodynamic studies of the adult male., Results: The model that consisted of the URA and Pw was found to be the best. We observed an interaction between URA and voiding volume (at higher voiding volume the decrease of the maximum urinary flow due to URA was found to be greater)., Conclusions: The URA was found to be the parameter that best describes urethral pressure. Variations in the maximum urinary flow rate is better described by the Pw than by the Wmax.

Objective: To determine the neurologic alterations of patients with ejaculatory and orgasmic disorders., Methods: A study of the neuroandrologic profile was performed in eight patients; 6 presented an ejaculation, one premature ejaculation and one presented an orgasm. The neuroandrologic profile consisted in performing selective electromyography of the bulbocavernosus muscle, recording of the S2-S4 evoked potentials, evoked somatosensory potentials of the pudendal nerve, electromyography of the smooth cavernous muscle (SPACE), sympathetic skin response and cystometry., Results: The sympathetic lesion was more frequent in the cases with an ejaculation (four cases; 66%); a pudendal efferent lesion was demonstrated in one case (17%) and a suprasacral lesion in one case (16%). A pudendal afferent lesion was observed in the two cases with premature ejaculation (100%). Both cases with an orgasm had a pudendal afferent lesion (100%) and one of them also presented a sympathetic lesion (50%)., Conclusions: An ejaculation appears to be caused by sympathetic, motor pudendal or suprasacral lesion. An altered perception of genital sensations due to lesion of the afferent pudendal pathway appears to be present in premature ejaculation. An orgasm could be ascribed to an alteration of the pudendal sensibility or to the absence of ejaculation.

Objective: To analyze the neurological alterations responsible for impotence in multiple sclerosis., Methods: We conducted a pharmacologic erection test and a neuroandrologic profile study in 11 patients with multiple sclerosis and impotence. This study consisted in: bulbocavernosus EMG, S2-S4 evoked potentials, somatosensory potentials of pudendal nerve, electromyography of cavernous smooth muscle (SPACE), sympathetic skin response (SSR) and cystometry., Results: The most frequent neurological lesion was complete suprasacral (7 cases; 64%) and parasympathetic (7 cases; 64%) lesions. The parasympathetic lesions were of the upper motor neuron type in 6 of the 7 cases (86%). Peripheral autonomic [sympathetic in 2 cases (18%); parasympathetic in 1 case (9%)] and pudendal lesions (3 cases; 27%) were also observed., Conclusions: The main cause of impotence in multiple sclerosis could be ascribed to a suprasacral lesion. Some cases also present peripheral autonomic lesions.

Objectives: To determine the type and to quantify the DURR phenomena in the male., Methods: We conducted a clinical and urodynamic study in 31 male patients with functional lower urinary tract symptoms., Results: DURR is produced by two types of mechanisms: urethral rigidity and contraction of the urethral wall. The patients with DURR produced by rigidity showed a higher score for irritative urinary symptoms. The patient with DURR produced by the contraction of the urethral wall had greater urodynamic consequences (increased opening pressure and PURR curve). The obstructive urinary symptoms were more intense when the DURR presented in the second phase of voiding (after reaching the maximum flow)., Conclusions: The DURR phenomena have clinical and urodynamic consequences in males with functional lower urinary tract symptoms; therefore their type and quantity should be adequately determined.

Objective: To analyze the utility of electromyographic study of the bulbocavernosus muscle., Methods: 126 impotent patients were evaluated by physical examination and neuroandrologic profile. The physical examination consisted in an exploration of the anal tone and the bulbocavernosus reflex. The neuroandrologic profile consisted in selective electromyography of the bulbocavernosus muscle, the determination of the S2-S4 evoked potentials, somatosensory potential of the pudenal nerve, electromyography of cavernous smooth muscle (SPACE) sympathetic skin response and cystometry., Results: The results of the bulbocavernosus electromyography and S2-S4 evoked potentials were different from the data obtained from the physical examination of the anal tone and the bulbocavernosus reflex. Selective bulbocavernosus electromyography showed a sensitivity of 57% and a specificity of 84%. The S2-S4 evoked potentials showed a sensitivity of 61% and a specificity of 100%. The diagnostic value of the S2-S4 evoked potentials increased at 39 msec cutoff (sensitivity = 66%; specificity = 95%). Exploration of the anal tone is very specific for neurologic lesion in impotence (93%), but has a low sensitivity (30%). The clinical bulbocavernosus reflex showed a good specificity (85%) and sensitivity (75%) in the diagnosis of pudendal efferent lesion, but is less useful in the diagnosis of neurogenic impotence., Conclusions: The highest diagnostic value was obtained with the S2-S4 evoked potentials. Selective electromyography of the bulbocavernosus muscle showed a moderate diagnostic value. Physical examination of peripheral pudendal innervation does not appear to be useful for screening for neurologic lesion in impotence because of its low sensitivity, which may be due to existing incomplete nervous lesions.

Objective: The present study was conducted to determine the changes in the neuro-andrologic profile of patients with impotence following rectal ablative surgery., Methods/results: The study comprised 18 patients who had undergone rectal surgery: abdominoperineal resection of the rectum (AP) in 12 cases (67%), anterior resection of the rectum (AR) in 6 cases (33%). The pharmacologic erection test was negative in 60% of the patients (56% of the AP cases and 67% of the RA cases; differences not significant). Sympathetic lesion was demonstrated in 67% of the patients (50% of the AP cases and 100% of the AR cases; significant difference). Parasympathetic lesion was demonstrated in 38% of the patients (56% of the AP and in none of the RA cases; tendency towards statistical significance). Pudendal lesion was demonstrated in 83% of the patients, although no significant differences concerning pudendal involvement were observed between both types of surgery (92% of the AP group and 67% of the RA group). The frequency of the pudendal lesion was significantly greater than the parasympathetic lesion and the sympathetic lesion tended to be significantly greater than the parasympathetic lesion in patients undergoing ablative rectal surgery. No significant differences were observed between the pudendal and the sympathetic lesion in these patients. No relationship was observed between the type of neurologic lesion and the results of the pharmacologic erection test., Conclusions: The type of neurological lesion appears to be related with the level of the rectal surgery. The sympathetic innervation would be more frequently compromised in anterior resection of the rectum. The parasympathetic innervation would be more frequently compromised in abdominoperineal resection. The pudendal innervation would be affected by both types of surgical techniques.

Objective: To determine the usefulness of different urodynamic data and their relationship., Methods: 105 adult males with prostatism were evaluated urodynamically. Data were obtained utilizing the Abrhams and Griffiths and the Schaeffer models., Results: Our results show that the urinary flow rate correlates directly with bladder contractibility and inversely with the urethral resistance parameters., Conclusions: The urethral resistance was produced by two independent factors: a factor which resists initiation of voiding, measured by the opening pressure according to the Schaeffer model; a second factor which opposes maintenance of voiding, measured by the PURR curvature of the Schaeffer model and by the slope of the Abrhams and Griffiths model. Bladder contractibility was related to pressure at maximum flow rate of the Schaeffer model.

Objective: To asses the neuroandrologic profile of impotent patients with Peyronie's disease., Methods: We conducted a pharmacological erection test and a study of the neuroandrologic profile of 13 impotent patients with Peyronie's disease. Eight patients hhad associated conditions and no associated disease was demonstrated in the remaining 5 patients. The neuroandrologic profile was based on bulbocavernous EMG, S2-S4 evoked potentials, somatosensorial potentials of pudendal nerve, cavernous smooth muscle electromyography (SPACE), sympathetic skin response, and cystometrogram., Results: SPACE was altered in all the cases. In the patients with no associated disease, all other data of the neuroandrologic profile were normal. Patients with associated conditions demonstrated more alterations in all other data of the neuroandrologic profile and significant differences were observed in 7 cases. No differences in the type of alterations of SPACE were observed in 7 cases. No differences in the type of alterations of SPACE were observed between both groups., Conclusion: The impotence associated with Peyronie's disease could be due to an intrinsic lesion of the erectile smooth muscle.

Objective: To determine the relation of the urinary flow curve morphology of free flowmetry with the status of lower urinary tract dynamics., Methods: A mathematical model was designed to fit the urinary flow curves to two models: a symmetrical and an asymmetrical model. Based on these models we analyzed the relationship between the presence or absence of obstruction and the type of model which better adjusted the urinary flow curves in a series of 85 males., Results: The urinary flow curves corresponding to absence of obstruction adjusted significantly better to a symmetrical model than those corresponding to bladder outlet obstruction. No correlation was observed between the type of curve and bladder contractibility or type of urinary obstruction., Conclusions: There is a relationship between the form of the urinary flow curve and bladder obstruction. In the absence of obstruction, the urinary flow curves are more symmetrical.

Objective: To assess the changes in urethral pressure measurement after vaginal electrostimulation for the treatment of genuine urinary stress incontinence., Methods: A clinical study, cystometry and urethral pressure profile were conducted on 15 female patients with urinary stress incontinence., Results: The clinical results showed that electrostimulation was effective in 60% of the patients. The maximum urethral pressure and the functional urethral length increased after electrostimulation (from 47.72 +/- 16.47 cm H2O to 58.27 +/- 14.09 cm H2O, and from 3.9 +/- 1.56 cm to 5.25 +/- 1.69 cm, respectively). There was no relationship between the clinical improvement and the increment of both parameters. However, the increase of the maximum urethral pressure was higher in patients with improvement of incontinence (from 42.5 +/- 3.53 cm H2O to 49.65 +/- 11.26 cm H2O)., Conclusions: Electrostimulation increases both the maximum urethral pressure and the functional urethral length. However, there is no relationship between these parameters and the effects of electrostimulation on urinary incontinence.

Objective: To analyze the utility of data obtained by single potential analysis of cavernous electric activity (SPACE) in the study of impotence., Methods: 127 patients with impotence were evaluated by neuroandrologic profile, SPACE, erection test post intracavernous injection of papaverine-phentolamine and a cystometrogram (CMG)., Results: The quantitative characteristics (duration, amplitude, number of phases) of the SPACE potentials were not useful in distinguishing between the different types of impotence. The qualitative characteristics (degree of activity, morphology, synchrony and coordination) during erection were significantly different between the non-neurogenic and neurogenic impotence. Significant differences were found in the qualitative characteristics (synchrony and coordination during erection) between patients with no demonstration of organic impotence and those with a negative erection test and no alterations in the neuroandrologic profile (vascular impotence). No relationship was found between the degree of activity of the SPACE and the presence or absence of voiding reflex in the CMG., Conclusion: SPACE is a useful technique in the study of impotence, although the interpretation of the data are more qualitative than quantitative. The CMG provides complementary data and should therefore continue to be included in the study of the neuroandrologic profile in impotence.

Objective: The present study was conducted to determine the usefulness of the perception and stimulation thresholds of the penile dorsal nerve in the diagnosis of neurogenic impotence., Methods: A study was conducted to determine the neuroandrologic profile in 130 patients. According to the results of the neuroandrologic profile, they were classified as patients without neurogenic impotence (44 pts.; 34%) or with neurogenic impotence (86 pts.; 66%). The perception and stimulation thresholds (expressed in milliAmperes) were determined in all patients. Furthermore, the perineal sensation was clinically tested. Both thresholds were also studied in relation to a demonstrated neurologic lesion (sympathetic, parasympathetic, afferent pudendal, efferent pudendal and suprasacral lesions)., Results: Assessment of the perineal sensation demonstrated a high specificity and a low sensitivity in the diagnosis of neurogenic impotence. A significant difference was observed between both groups for the perception (confidence interval of difference between the neurogenic and non-neurogenic group; from 0.02 to 4.95 mA) and stimulation thresholds (from 2.0 to 11 mA). Morever, the stimulation threshold was significantly higher in patients with alteration of the perineal sensation). Significant differences in the perception threshold were also demonstrated between patients with and without demonstration of efferent lesion, and in the stimulation threshold between patients with and without demonstration of pudendal afferent, pudendal efferent and sympathetic lesion. These differences are attributed to the presence of mixed lesions. However, given the width of the interval of normal values, it was not possible to find a useful cut-off point in both sensory thresholds. It could only be determined that the maximum value of the perception threshold in healthy subjects should be less than 9.45 mA., Conclusion: The sensorial thresholds of the electrical stimulation of the penile dorsal nerve and the data from the physical examination of perineal sensation are not useful for the diagnosis of neurogenic impotence. It is necessary to carry out a complete neuroandrologic profile.

Objective: To determine the usefulness of penile sympathetic skin response (PSSR) in the study of impotence., Methods: The PSSR, hand sympathetic skin response (HSSR), filling videocystography and SPACE (single potential analysis cavernous electromyography) were performed in 39 patients referred for study of impotence., Results: A relationship between not obtaining PSSR and an open bladder neck (60%) in the videocystography at filling, and between a closed bladder neck and obtained PSSR (81%) was demonstrated. The percentage of normal hand sympathetic potentials was similar for patients with obtained and not obtained PSSR. The relationship between the degree of activity of the SPACE and the type of PSSR could not be demonstrated., Conclusion: The determination of the PSSR allows us to evaluate the sympathetic cavernous innervation. This would obviate performing a filling videocystography in the study of the neuroandrologic profile in impotence. The information obtained by PSSR is independent of that obtained from SPACE, therefore both procedures complement each other in the neuroandrologic study of impotence.

Presentation of results obtained when correction of congenital incurvation of the penis is done with the albuginea plication technique (with no resection of an albuginea wedge). Two left lateral, two ventral and one complex (ventral plus lateral) incurvations were performed. In four cases, curvature correction was achieved. In the case of complex curvature, a certain degree of lateral incurvation persisted, probably because the number of applications applied was insufficient. Partial necrosis of the penis skin in one case was attributed to simultaneous subcoronal and pubic approach. The simple plication of the albuginea is considered to be an adequate technique to resolve this type of congenital malformation.

Objectives: To determine the usefulness of a complete neuroandrologic evaluation and SPACE (Single Potential Analysis Cavernous Electromyography) in the study of impotence., Methods: We performed a clinical study, erection test with papaverine-phentolamine and neuroandrologic evaluation (bulbocavernous EMG, S2-S4 evoked potentials, evoked somatosensorial potentials, SPACE, D10-L2 skin sympathetic potentials, cystometrogram, and filling videocystography) in 180 patients consulting for impotence., Results: We observed a relationship between the clinical diagnosis of impotence and the data from the neuroandrogenic study. The results of the study were classified as normal [in the clinical diagnosis of psychogenic impotence (100%), hormonal (80%) and vascular (60%)], abnormal [prevalent in the clinical diagnosis of structural impotence (87%)]. The erection test was mainly negative in all clinical diagnoses of impotence, except in psychogenic and vascular impotence (60% positive tests)., Conclusions: The clinical data are useful in the diagnosis of impotence. The pharmacological erection test was not found to be very reliable. Complete neuroandrologic evaluation is indicated in non typified and mixed impotence, and can be performed in neurogenic impotence to identify the level of the lesion. Alone, SPACE does not appear to be useful as a screening test for neurologic lesions, but can be useful as a screening test for neuromuscular cavernous lesions. SPACE is indicated in structural, vascular and hormonal impotence. If SPACE is abnormal, the differential diagnosis between neurogenic and myogenic lesion can be made through a complete neuroandrologic evaluation.