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The 3-Tesla multiparametric MRI (mpMRI) system represents a diagnostic advance for prostate cancer. Our aim is to demonstrate that the results in 1.5-Tesla mpMRI are not inferior compared to the 3-Tesla for the correct diagnosis of prostate cancer.Non-inferiority comparative cross-sectional study between fusion-guided prostate biopsy results. 344 patients with clinical suspicion of prostate cancer (elevated PSA and/or suspicious DRE) and mpMRI interpreted and verified by the same radiologists in all cases, 270 in 1.5-Tesla and 74 in 3-Tesla, with at least one lesion PIRADSv2≥ 3. Exclusion criteria were positive biopsy or previous prostate treatment. We consider malignancy as ISUP≥ 1 and significant tumor as ISUP≥ 2. We used Wilcoxon and t-student test (central tendency measures), diagnostic test (gold standard: ISUP of targeted biopsy), Chi2 test and Z-test (comparison of prevalences and 95%CI malignancy and significant tumor according to mpMRI).Median prostate volume 50cc(IQR:33.5) and PSA 6.11ng/ml(IQR:3.39). Mean age 67.4±8.1years. Number of suspi-cious lesions/patient: mpMRI 1.3 (1.5-Tesla) and 1.5 (3-Tesla). No differences were found between mpMRI (homogeneous and comparable samples). 57% (1.5-Tesla) vs 66% (3-Tesla) of targeted biopsies were malignant, and 34%vs38% were significant tumor, with no significant differences. Se, Sp, PPV and NPV for malignancy (1.5-Tesla vs 3-Tesla) were 96%vs90%, 38%vs44%, 67%vs76%, and 86%vs69%, with no significant differences.There are no significant differences between 1.5-Tesla vs 3-Tesla mpMRI regarding targeted biopsy results. Not to have 3-Tesla mpMRI may not be a limitation to use 1.5-Tesla as a diagnostic test for the better diagnosis of prostate cancer.

The SARS-CoV-2 coronavirus infection has beenassociated with the development of the novo genitourinarysymptoms and neurological symptomssecondary to peripheral nervous system damage.One of the neurological pathologies described associatedwith the infection has been Guillain-Barrésyndrome (GBS). We conducted a review of the literatureon SARS-CoV-2 infection and its relationshipwith lower urinary tract symptoms (LUTS), such asurinary retention (AUR). Bladder alterations derivedfrom neurological involvement by SARS-CoV-2,such as GBS, were also analyzed. An own case ispresented.A literature searchwas performed using a combination of keywords(MeSH terms): "COVID", "COVID-19", "SARS-CoV-2","Urinary retention" and "Guillain-Barre Syndromeand Urodynamics". We searched for articles publishedup to March 2021. All articles identified fromthe bibliographic search were analyzed, using thePICOS criteria (participants, intervention, comparisons,results, type of study) to assess the eligibilityof the articles. Both prospective and retrospectivestudies, clinical cases and published systematicreviews were included. RESULTS: Findings in the academic literatureabout the associations between COVID-19 and RAO,LUTS and Guillain-Barré Syndrome are discussed,as well as their possible pathogenic mechanisms,A summary of relevant studies on urodynamic findingsin GBS patients is also provided. The resultsare summarized in attached tables. A case of AURassociated with COVID-19 and Guillain-Barré Syndromeis provided, with its urodynamic findings.Although the association betweenurinary symptoms and SARS-CoV-2 is not well described,there seems to be evidence of a possibleassociation, at least temporary, between the presentationof SARS-Cov-2 infection and the developmentof GBS with secondary LUT neurophysiologyalterations.INTRODUCCIÓN Y OBJETIVO: La infecciónpor coronavirus SARS-CoV-2 se ha asociadoa la aparición de síntomas genitourinarios de novo,además de síntomas neurológicos secundarios al dañodel sistema nervioso periférico. Una de las patologíasneurológicas descritas asociadas a la infección ha sidoel síndrome de Guillain-Barré (SGB). Realizamos unarevisión de la literatura sobre la infección por SARSCoV-2 y su relación con los síntomas del tracto urinarioinferior (STUI), como la retención urinaria (RAO).Se analizaron también las alteraciones vesicales derivadasde la afectación neurológica por SARS-CoV-2,como el SGB. Se presenta un caso propio. MATERIAL Y MÉTODOS: Se realizó una búsquedade la literatura utilizando una combinación de palabrasclave (términos MeSH): “COVID”, “COVID-19”,“SARS-CoV-2”, “Urinary retention” y “Guillain-BarreSyndrome and Urodynamics”. Se realizaron búsquedasde artículos publicados hasta marzo de 2021. Todos los artículos identificados a partir de la búsquedabibliográfica fueron analizados, utilizando los criteriosPICOS (participantes, intervención, comparaciones,resultados, tipo de estudio) para evaluar la elegibilidadde los artículos. Se incluyeron tanto estudios prospectivos,retrospectivos, casos clínicos y revisiones sistemáticaspublicadas. RESULTADOS: Se discuten los hallazgos en la literaturade las asociaciones entre COVID-19 y RAO, STUIy Síndrome de Guillain-Barré, así como sus posiblesmecanismos patogénicos. También se aporta un resumende trabajos relevantes sobre hallazgos urodinámicosen pacientes con SGB. Los resultados seresumen en tablas anexas. Se aporta un caso de RAOasociado a COVID-19 y Síndrome de Guillain-Barrécon sus hallazgos urodinámicos. CONCLUSIÓN: A pesar de la asociación entre síntomasurinarios y SARS-CoV-2 no está bien descrita, pareceque hay indicios de una posible asociación, al menostemporal entre la presentación de infección porcoronavirus SARS-Cov-2 y el desarrollo de un SGB conalteraciones de la neurofisiología del TUI secundaria.

To compare the efficacy and safety in the prophylasis of urinary tract infections (UTIs) with a food supplement that contains D-mannose like active ingredient (Manosar®), in comparison to another preparation in which the active ingredient are the proanthocyanidins (PAC), both of them, in prolonged released, after, they was administered for 24 weeks.A multicenter, randomized and double blind experimental study was carried out. 283 women with a history of recurrent UTIs without evidence of complication were included. They were randomized 1: 1 in two groups. In one group, 1 oral sachet of Manosar® a day was administered, and in the other group 1 oral sachet of a compound of 240 mg of continuous-release PAC. Prior to inclusion in the study, the episode of UTI was confirmed at least by the clinical symptoms and positivity of the Combur test.Valid data were obtained from 184 patients with an average age of 49.5 years: 90 received Manosar® and 94 isolated PAC. A total of 72 patients suffered an UTI due to E.coli: 25 patients in the arm with Manosar® versus 47 patients in the isolated PAC group, this difference being statistically significant (p=0.002). The free time of new UTI recurrences was 98.6 days in the group treated with Manosar® and 84.6 days in the group with isolated PAC.The oral taking of a daily sachet of Manosar® is effective and safe in preventing recurrent UTIs in women, being superior to the oral taking of isolated PAC.Comparar la eficacia y seguridad de la profilaxis de las infecciones del tracto urinario (ITUs) con un complemento alimenticio que contiene D-manosa como principio activo principal (Manosar®), en comparación con otro preparado cuyo principio activo único son las proantocianidinas (PAC), ambos de liberación continuada, tras su administración durante24 semanas.MÉTODOS: Estudio experimental multicéntrico, aleatorizado y doble ciego. Se incluyeron 283 mujeres con historia de ITUs recurrentes sin evidencias de complicación. Se randomizaron 1:1 en dos grupos. En un grupo se administró 1 sobre diario oral de Manosar®, y en el otro 1 sobre diario oral de un compuesto de 240 mg de PAC de liberación continuada. Previo a la inclusión en el estudio se confirmó el episodio de ITU al menos por la sintomatología clínica y positividad del test de Combur.Se obtuvieron datos válidos de 184 pacientes con edad media de 49,5 años: 90 recibieron Manosar® y 94 PAC aislado. Un total de 72 pacientes padecieron una ITU por E.coli: 25 pacientes en el brazo con Manosar® frente a 47 pacientes en el grupo de PAC aislado, siendo esta diferencia estadísticamente significativa (p=0,002). El tiempo libre de nuevas recurrencias de ITU fue de 98,6 días en el grupo tratado con Manosar® y de 84,6 días en el grupo con PAC aislado.CONCLUSIÓN: La toma oral de un sobre al día de Manosar® es eficaz y segura en la prevención de las ITUs recurrentes en la mujer, siendo superior a la toma oral de PAC aislado.

Prostate Fusion biopsy (MRI + prostate ultrasound) is described in literature as superior to classic random transrectal biopsy in order to identify suspicious lesion.To evaluate the Prostate Imaging Reporting and Data System (PI-RADS) proposed by the European Society of Urogenital Radiology (ESUR) for detection of prostate cancer by multiparametric MRI in a consecutive cohort of patients with MRI and transrectal ultrasound prostate fusion-guided biopsy.87 patients with suspected Prostatic Cancer on prostate MRI underwent fusion transperineal prostate biopsy in our Department. 37 patients had at least one prior negative classic prostatic transrectal biopsy. Clinically significant tumor was described as Gleason 7(3+4) or higher. The Chi-square test was used to analyze the relationship between prostate cancer and the different PIRADS stages, as well as logistic regression and linear trend tests, comparing the proportions using measures of association intensity. We use the HITACHI Real-Time Virtual Sonography (HI-RVS) system, and the STATA/IC v.14.2 software for statistical analysis.64.37% patients had tested positive for malignancy. Median age 67.89 years old. Median PSA 9.15 ng/ml, and average prostate volume was 54.05 cc. 124 suspicious lesions were described in prostate MRI (25% PIRADS III, 57% PIRADS IV and 17% PIRADS V). 5/31 lesions PIRADS III, 47/71 PIRADS IV and 18/22 PIRADS V were positive for malignancy, with a statistically significant linear relationship between PIRADS and malignancy (p0.001) - HR 4.10 (CI 95% 1.81 to 9.32) for PIRADS IV and HR 5.07 (CI95% 2.22 to 11.59) for PIRADS V vs. PIRADS III. 3.23% lesions PIRADS III, 32.39% PIRADS IV and 63.64% PIRADS V corresponded to significant tumors. A statistically significant association between PIRADS and significant tumors (p0.001) - HR 10.04 (CI95% 1.42 to 71.09) for PIRADS IV and HR 19.73 (CI95% 2.80 to 139.18) for PIRADS V vs PIRADS III was observed -.Our results show that transperineal targeted prostate biopsy using multiparametric MRI and transrectal ultrasound fusion is a safe procedure with excellent outcomes to obtain an accurate diagnosis of prostate cancer. Fusion biopsy has the potential to improve the diagnosis of malignancy and clinically significant tumors while reducing overdiagnosis.INTRODUCCIÓN: La biopsia prostática por fusión se describe como superior a la biopsia transrectal sistemática para identificar lesiones sospechosas de carcinoma de próstata.OBJETIVOS: Evaluar la clasificación PIRADS propuesto por la Sociedad Europea de Radiología Urogenital para la detección de cáncer de próstata mediante RNM en una cohorte consecutiva de pacientes con RNM y biopsia guiada por fusión.MATERIAL Y MÉTODOS: Estudio observacional transversal. 87 pacientes con sospecha de cáncer de próstata sometidos a biopsia de próstata transperineal y fusión con RNM en nuestro centro. Describimos tumor significativo como Gleason ≥7(3+4), y carcinoma de alto riesgo como Gleason ≥8. Utilizamos la prueba de Chi-cuadrado para analizar la relación entre cáncer de próstata y PIRADS, así como regresión logística y pruebas de tendencia lineal, comparando las proporciones con medidas de intensidad de asociación. Empleamos el sistema HITACHI Real-Time Virtual Sonography y el software STATA/IC v.14.2 para el análisis estadístico.RESULTADOS: 64,37% pacientes presentaron resultado positivo para malignidad. Media de edad 67,89 años (SD7,42), de PSA total 9,15 ng/ml (SD7,85), y de volumen prostático 54,05 cc (SD22,92). Se biopsiaron 124 lesiones sospechosas en RNM (25% PIRADS III, 57,26% PIRADS IV y 17,74% PIRADS V). 5/31 lesiones PIRADS III, 47/71 PIRADS IV y 18/22 PIRADS V fueron positivas para malignidad, con relación lineal estadísticamente significativa entre PIRADS y malignidad (p0,001), razón de prevalencias (RP) 4,10 (IC95% 1,81-9,32) para PIRADS IV, y RP 5,07 (CI95% 2,2211,59) para PIRADS V respecto a PIRADS III. 3,23% lesiones PIRADS III, 32,39% PIRADS IV y 63,64% PIRADS V correspondieron a tumores significativos. Encontramos asociación estadísticamente significativa entre PIRADS y tumores significativos (p0,001), RP 10,04 (IC95% 1,42-71,09) para PIRADS IV y RP 19,73 (IC95% 2,80139,18) para PIRADS V respecto a PIRADS III.CONCLUSIÓN: Nuestros resultados muestran que la biopsia de próstata ecodirigida y por fusión utilizando RNM es una técnica segura con excelentes resultados para obtener un diagnóstico preciso de cáncer de próstata, y puede mejorar el diagnóstico de malignidad y de tumores significativos reduciendo el sobrediagnóstico.

To determine the risk factors of recurrent urinary infections (rUTIs) in patients with Multiple Sclerosis (MS).A retrospective cohort study was conducted including 114 patients with MS, 84 women (74%) and 30 men (26%), with a mean age of 49. They underwent videourodynamic study and selective sphincter electromyography due to urinary symptoms (LUTS). Clinical data (both neurological and urological) and videourodynamic data (including free flowmetry, cystomanometry and pressure flow study) were collected. In 37 patients (32%), the presence of rTUIs was demonstrated.Statistically significant differences were demonstrated between the patients with and without rUTIs with respect to the following clinical variables: the time of evolution of the symptoms (greater in the case of rUTIs), time from the diagnosis of MS (higher in the case of rUTIs), EDSS score (Expanded Disability Staus Scale) (higher in the case of rUTIs) and the EM type [higher frequency of rUTIs in the progressive types (primary and secondary)]. Urodynamic variables with significant differences were: maximum flow in free flowmetry (lower in patients with rUTIs), voiding volume in free flowmetry (lower in patients with rUTIs), micturition efficiency (higher percentage of residual urine in patients with rUTIs), stress urinary incontinence (SUI) (higher frequency of rUTIs in patients with SUI), detrusor pressure at maximum flow (lower in patients with rUTIs) and bladder contractility index (lower in patients with rUTI). No significant difference was demonstrated in relation to the presence and type of neurogenic lower urinary tract dysfunction (NLUTD).The severity and duration of MS is a risk factor for rUTIs. Urodynamic risk factors are compatible with a lower contractile capacity in patients with rUTIs, while the existence of NLUTD would not imply any specific risk factor.Determinar los factores de riesgo de infecciones urinarias recurrentes (rUTIs) en pacientes con Esclerosis Múltiple (EM).MÉTODOS: Se realizó un estudio de cohortes retrospectivo en 114 pacientes, 84 mujeres (74%) y 30 varones (26%), de edad media 49 años con EM sometidos a estudio videourodinámico y electromiografía selectiva esfinteriana por presentar síntomas urinarios (LUTS). Se recogieron los datos clínicos (tanto neurológicos como urológicos) y videourodinámicos (incluyendo flujometría libre, cistomanometría y estudio presión flujo). En 37 pacientes (32%) se demostró la presencia de rTUIs.Se demostraron diferencias estadísticamente significativas entre los pacientes con y sin rUTIs respecto de las siguientes variables clínicas: el tiempo de evolución de los síntomas (mayor en el caso de rUTIs), antigüedad de la EM (mayor en el caso de rUTIs), la puntuación EDSS (Expanded Disability Staus Scale) (mayor en el caso de rUTIs) y el tipo EM [mayor frecuencia de rUTIs en los tipos progresivos (primario y secundario)]. Las variables urodinámicas con diferencias significativas fueron: el flujo máximo en la flujometría libre (menor en pacientes con rUTIs), el volumen miccional en la flujometría libre (menor en pacientes con rUTIs), la eficiencia miccional (mayor porcentaje de residuo en pacientes con rUTIs), la incontinencia urinaria de esfuerzo (SUI) (mayor frecuencia de rUTIs en pacientes con SUI), la presión del detrusor a flujo máximo (menor en pacientes con rUTIs) y el índice de contractilidad vesical (menor en pacientes con rUTI). No se demostró ninguna diferencia significativa en relación con la presencia y tipo de disfunción neurógena del tracto urinario inferior (NLUTD).La gravedad y duración de la EM constituye un factor de riesgo para las rUTIs. Los factores de riesgo urodinámicos son compatibles con una menor capacidad contráctil en los pacientes con rUTIs, mientras que la existencia NLUTD no supondría ningún factor de riesgo específico.

To investigate urodynamic changes during the voiding phase in males with detrusor underactivity (DU) undergoing bladder catheterization for urinary retention.From a total of 64 patients with urinary retention, a follow-up study was performed in 17 males with a mean age of 77 years. Patients received a urodynamic diagnosis of DU based on a Bladder Contractility Index (BCI) score of 100 and underwent permanent bladder catheterization (16 cases) or clean intermittent catheterization (1 case) for acute urinary retention (14 cases), or post void residual urine (3 cases). Patients underwent a second urodynamic study after a mean 13 months of follow-up. Fisher's exact test was used with categorical variables and Student's t test with parametric variables. The level of significance was set at p 0.05 for a two-sided test.The second urodynamic study showed a significant increase in maximal detrusor pressure, pressure at maximum flow rate, BCI score, Bladder Outlet Obstruction Index (BOOI) score, and number of patients who urinated during the pressure-flow study.Bladder catheterization in men with DU significantly improves bladder contractility and revealed obstructions of the lower urinary tract that were masked by insufficient detrusor pressure in relation to the DU of these patients. These findings could have diagnostic as well as prognostic and therapeutic applications.Determinar los cambios urodinámicos de la fase miccional en varones con hipocontractilidad del detrusor (DU) sometidos a cateterismo vesical por retención urinaria. MÉTODOS: De un total de 64 pacientes con retención urinaria, se realizó un estudio de seguimiento en 17 varones de edad media 77 años, diagnosticados urodinámicamente de DU por presentar un Índice de Contractilidad Vesical (BCI) menor de 100, sometidos a sonda vesical a permanencia (16 casos) o cateterismo vesical limpio intermitente (1 caso) por retención aguda de orina (14 casos), o residuo postmiccional patológico (3 casos). Los pacientes fueron sometidos a un segundo estudio urodinámico a los 13 meses de seguimiento de media. Las pruebas estadísticas utilizadas fueron el test exacto de Fisher para variables cualitativas y el test de comparación de media de la t de Student para variables paramétricas. El nivel de significación se fijó en p 0,05 bilateral. RESULTADOS: En el segundo estudio urodinámico, se observó un aumento significativo de la presión máxima del detrusor, la presión a flujo máximo, el BCI y el Índice de Obstrucción de Salida Vesical (BOOI) y del número de pacientes que orinaron durante el estudio presión/ flujo. CONCLUSIONES: El cateterismo vesical en varones con DU mejora significativamente la contractilidad vesical y permiten desenmascarar obstrucciones del tracto urinario inferior que estaban ocultas por una insuficiente presión del detrusor en relación a la DU de estos pacientes. Esto podría tener no sólo aplicaciones diagnósticas, sino pronósticas y terapéuticas.

Aims To determine the effect of pelvic organ prolapse (POP) repair on post-operative detrusor overactivity (DO) in women who have underwent incontinence surgery, using multivariate analysis. Methods A retrospective study was carried out on a cohort of 105 women who underwent incontinence surgery. In 39 of the patients this surgery was associated with pelvic organ prolapse repair. Clinical and urodynamic data were collected pre- and 3 months post-operatively. A multivariate statistical analysis was performed to detect confounding factors which could influence on the risk factors associated with post-operative detrusor overactivity. Results On univariate analysis, the following pre-operative factors were associated with post-operative detrusor overactivity: symptomatic mixed urinary incontinence, rectocele, detrusor overactivity, voided volume on free uroflowmetry, maximum cystomanometric capacity, and performing concomitant pelvic organ prolapse repair. Multivariate analysis, by means of confounding factors elimination, revealed that only pre-operative rectocele and detrusor overactivity were independent risk factors. Conclusions The pelvic organ prolapse repair acts as a confounding factor. Women with a pre-operative rectocele and detrusor overactivity are on a greater risk to develop post-operative detrusor overactivity and, therefore, they should be informed.

The aim of this work was to analyse the role of several factors (personality traits, previous prolonged experiences of smoking abstinence, nicotinic dependence, administration of pharmacological treatment, presence of psychopathology or the sex of the smoker) in the abstinence at 9 months after completion of the treatment to stop smoking. The sample consisted in 249 adults (91 men and 158 women), with an average age of 46.37 years (range = 23-69 years) who voluntarily participated in a treatment to stop smoking (10 sessions in 3 months). Prior to commencing the treatment, they signed the commitment and informed consent. For the purpose of analysis, the subjects were asked to complete the following tests at the beginning of the study: a semi-structured interview, to measure the psychopathology and their tobacco habit; personality questionnaire (Big Five Questionnaire) and the nicotinic dependence measure (Fagerström test). Consumption measures were also taken at the end of treatment (T1) and 9 months after completion (T2). The results obtained showed that in T1, 83.7% of the participants who completed the treatment, had stopped smoking in T2, 52% still did not smoke. On the question of pharmacological treatment with Varenicline, this study sounds that it favoured the completion of treatment, but did not affect the abstinence in T2. By means of binary logistic regression analysis, explaining between 12% and 16% of the variance, it was found that sex (in favour of males), the absence of psychopathology, the low level of nicotinic dependence, previous experience without smoking and greater tenacity in the personality questionnaire, predicted the 79.4% of the non-smoking participants in T2. This study concludes that personality factors (tenacity), previous experience of success greater than 6 months, absence of psychopathology, low nicotine dependence and male sex emerged as reliable predictors of success of the treatment to stop smoking.

To compare the efficacy and safety of dietary supplement "Manosar®" composed of D-mannose (2 g), 24 h prolonged release, associated with Proanthocyanidin (PAC) (140 mg), ursolic acid (7.98 mg), A, C, and D vitamins and the oligoelement zinc, versus 240 mg of PAC in recurrent urinary tract infections (UTI), for a designed follow-up of 24 weeks, in women.A multicenter randomized experimental double-blind study was carried out. The study was approved by review board of "Complejo Hospitalario de Toledo" (Spain), and all patients gave informed consent. A total of 150 women with non complicated UTI were screened for participation. Valid data was obtained from 93, with mean age of 48 years. Fortyfour patients were assigned to the Manosar® group and 51 patients to the PAC group. Patients were followed during six months. A previous UTI was defined based on a combination of symptoms and a positive reactive urine trip. Confirmation of a new UTI was based on symptoms, reactive urine strip and urine culture.Thirty-three patients (35%) had an UTI during the six months follow-up. The percentage of UTI of the Manosar® group during this period was 24%, while the percentage of the PAC group was 45% (p〈0.05). The disease-free time for the Manosar® group was 95 days, while this time was 79 days for the PAC group. The incidence of side effects was low. Diarrhea was the most frequent side-effect in both groups.Manosar® (oral once a day) is more effective than single dose PAC (240 mg daily orally) to prevent recurrent UTI in women.

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.A retrospective study was performed in a cohort of 318 patients with BPH which underwent silodosine treatment, during at least 12 weeks.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).The urodynamic study was very useful in the assessment of the prognostic factors in these patients.

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.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.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;).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.

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.

To describe and quantify the long-term adverse effects on filling phase of lower urinary tract function in males submitted to radiotherapy.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.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.The main long-term adverse effect of pelvic radiotherapy on male bladder function during filling is the increased risk of low bladder compliance.

Mondor's disease is a superficial thrombophlebitis and usually occurs in the anterior and lateral chest. The scrotal vein thrombosis is a fairly rare disease.Thirty-four year old male who consulted for inguinal tumor and pain in the postoperative period of an umbilical hernia repair, which resulted in a subsequent scrotal vein thrombosis treated conservatively.It was resolved with conservative treatment, with recanalization of the scrotal veins.Mondor's disease is a rare entity, related to multiple etiological factors. The diagnosis is made easily with Doppler ultrasound and most resolve with conservative treatment.

Our objective is to verify the diagnostic usefulness of ultrasound measurement of the thickness of the bladder wall, and the correlation with clinical/ urodynamic findings in patients with symptomatic BPH.We performed a prospective cross-sectional study (cross-sectional study '') in a series of 74 males (age chi= 72.4 S = 7.1 (56-84 years) with symptomatic BPH. Patients completed the IPSS and determined the plasma level of PSAt (ng / ml). Before performing the urodynamic study, was determined by transabdominal ultrasonography (3.5 MHz transducer): prostate volume (cc) by the ellipsoid formula, and bladder wall thickness (mm) measured on the anterior bladder wall. Statistical analysis was performed using ANOVA, the Pearson correlation, and ROC curve.It was a significant correlation of the sonographic thickness of the bladder wall with the IPSS (p = 0001, r = 0.38) (parameter in turn highly correlated with prostate volume and PSA (p = 0.01, r = 0.62)), as well as the detrusor hyperactivity (p = 0.03, r =0.21), cut off ROC curve: 3.85 mm. Instead, it was not shown a significant correlation between the sonographic thickness of the bladder wall and the urodynamic diagnosis of obstruction (Abrams and number Griffths p = 0223, r = 0.14) or the detrusor contractile power, measured in power at peak flow (Pw) (p = 0642 r =- 0.55), nor with age (p = 0303, r = 0.12). Neither correlation was observed with other non-invasive urodynamic measures (the maximum urinary flow flowmetry (p = 0318, r = 0.12) and percentage postmicturition residual (p = 0696, r = 0.05)).The ultrasound measurement of bladder wall thickness, although it has not proved useful ness in our series in the diagnosis of the voiding phase (lower urinary tract obstruction and detrusor contractility impairment), on the contrary it can be introduced as a diagnostic technique for non-invasive studies in the alterations of the filling phase, in the form of detrusor hyperactivity in also patients with symptomatic BPH, and present a significant correlation with prostate growth.

Objetivo: Nuestro objetivo es comprobar la utilidad diagnóstica de la medida del grosor ecográfico de la pared vesical, y establecer la correlación con los hallazgos clínicos y urodinámicos, en pacientes con HBP sintomática. Métodos: Se realizó un estudio transversal prospectivo ("cross-sectional study") en una serie de 74 varones, (edad X=72,4 S=7,1 (56-84 años), con HBP sintomática. Los pacientes rellenaron el cuestionario IPSS y se determinó el nivel plasmático de PSAt (ng/ml). Antes de realizar el estudio urodinámico, se determinó mediante ecografía transabdominal (transductor de 3,5 MHz), el volumen prostático (cc) mediante la fórmula del elipsoide, y el grosor de la pared vesical (mm), medido en la cara anterior. El análisis estadístico se realizó utilizando el ANOVA, el coeficiente de correlación de Pearson, y se construyó una curva de rendimiento diagnóstico (curva ROC). Resultados: Se demostró una correlación significativa del grosor ecográfico de la pared vesical con el IPSS (p=0,001; r=0,38) (parámetro a su vez altamente correlacionado con el volumen prostático y con el PSA (p=0,01, r=0,62)), así como con la hiperactividad del detrusor (p=0,03, r=0,21), punto de corte de la curva ROC: 3,85 mm. En cambio, no se demostró una correlación significativa entre el grosor ecográfico de la pared vesical y el diagnóstico urodinámico de obstrucción (número de Abrams y Griffths p=0,223, r=0,14), ni con la potencia contráctil del detrusor, medida en la potencia a flujo máximo (Pw) (p=0,642 r=-0,55), ni con la edad (p=0,303; r=0,12). Tampoco se demostró correlación con otras medidas no invasivas urodinámicas (flujo miccional máximo de la flujometría libre (p=0,318; r=0,12) y porcentaje del residuo postmiccional (p=0,696; r=0,05)). Conclusiones: La medida ecográfica del grosor de la pared vesical, aunque no ha demostrado su utilidad, en nuestra serie, para el diagnóstico de la fase miccional (obstrucción del tracto urinario inferior y afectación contráctil del detrusor), sí por el contrario, puede ser introducida como técnica diagnóstica no invasiva de las alteraciones de la fase de llenado, en la forma de hiperactividad del detrusor, en los pacientes con HBP sintomática, presentando además correlación significativa con el crecimiento prostático.

To assess the bladder compliance in a series of cystoceles referred for urodynamic study.Retrospective study of a series of patients with cystocele undergoing medical history, videurodynamic study, pelvic MRI and lower urinary tract, urological ultrasound and cystoscopy. We Excluded cases with neurogenic dysfunction and urinary infection. The terminology followed the criteria of the ICS, if not specified otherwise. The series includes 3333 cases of cystocele 616 of which are grade III cystocele. There were 3 cases with low bladder compliance; this is 0.0009% of total (1:1000) and 0.5% of grade III cystocele (1:200)All cases of cystocele whith low compliance were associated with feeling of a bulk in the vagina and functional symptoms of lower urinary tract(LUTS). No urinary incontinence was related to cough. These patients also showed urodynamic alterations in the voiding phase, type hypo / acontractile detrusor and postvoid residual. The patients were subjected to various techniques of abdominal and transvaginal cystocele repair (with preventive anti-incontinence surgery), getting a vagina bulk disappearance, improvement of symptoms of lower urinary tract function, normalization of bladder compliance and detrusor contractility, with elimination of the postvoid residual.Although they are not frequent, high-risk cystoceles should be discarded in high-grade cystocele that apart from low bladder accommodation, have a hipo/acontractile detrusor and postvoid residual. Surgical correction of cystocele not only reduces the bulk and LUTS, but normalizes urodynamic alterations.

Objectives: To assess the bladder compliance in a series of cystoceles referred for urodynamic study. Methods: Retrospective study of a series of patients with cystocele undergoing medical history, videurodynamic study, pelvic MRI and lower urinary tract, urological ultrasound and cystoscopy. We Excluded cases with neurogenic dysfunction and urinary infection. The terminology followed the criteria of the ICS, if not specified otherwise. The series includes 3333 cases of cystocele 616 of which are grade III cystocele. There were 3 cases with low bladder compliance; this is 0.0009% of total (1:1000) and 0.5% of grade III cystocele (1:200) Results: All cases of cystocele whit low compliance were associated with feeling of a bulk in the vagina and functional symptoms of lower urinary tract (LUTS). No urinary incontinence was related to cough. These patients also showed urodynamic alterations in the voiding phase, type hypo / acontractile detrusor and postvoid residual. The patients were subjected to various techniques of abdominal and transvaginal cystocele repair (with preventive anti-incontinence surgery), getting a vagina bulk disappearance, improvement of symptoms of lower urinary tract function, normalization of bladder compliance and detrusor contractility, with elimination of the postvoid residual. Conclusions: Although they are not frequent, high-risk cystoceles should be discarded in high-grade cystocele that apart from low bladder accommodation, have a hipo/acontractile detrusor and postvoid residual. Surgical correction of cystocele not only reduces the bulk and LUTS, but normalizes urodynamic alterations. Objetivo: Comprobar la acomodación vesical de una serie de cistoceles remitidos para estudio urodinámico. Métodos: Se realizó un estudio retrospectivo de una serie de pacientes con cistocele, sometidos a historia clínica, estudio vídeo-urodinámico, RMN del suelo pélvico y tracto urinario inferior, ecografía urológica y cistoscopia. Se excluyeron los casos con disfunción neurógena e infección urinaria. La terminología siguió los criterios de la ICS, cuando no se especifica lo contrario. La serie comprende a 3.333 casos de cistocele de los que 616 casos corresponden a cistoceles grado III. Los casos con acomodación vesical disminuida correspondieron a 3 casos, esto es el 0,009 % del total (1 por mil) y el 0,5 % de los cistoceles grado III (1 por 200) Resultados: Todos los casos de cistocele de baja acomodación, se asociaron a sensación de bulto en vagina y síntomas funcionales del tracto urinario inferior. Ninguna refería incontinencia urinaria a la tos. En estas pacientes también se demostraron alteraciones urodinámicas de la fase miccional tipo hipo/acontractilidad del detrusor y residuo postmiccional. Las pacientes fueron sometidas a distintas técnicas vaginales y abdominales de corrección del cistocele (con cirugía anti-incontinencia preventiva), obteniendo una desaparición del bulto en vagina, mejoría de los síntomas funcionales del tracto urinario inferior, con normalización de la acomodación vesical y contractilidad del detrusor, y con desaparición del residuo postmiccional. Conclusiones: Aunque no son frecuentes los cistoceles de alto riesgo, habrá que descartarlos ante cistoceles de alto grado, que aparte de la baja acomodación vesical, presentan un detrusor hipo/acontráctil y residuo postmiccional. La cirugía correctora del cistocele, no sólo reduce el prolapso y mejora los síntomas funcionales del tracto urinario inferior, sino que normaliza las alteraciones urodinámicas.

Update on the urodynamic evaluation in patients with prostate cancer who have incontinence.To review the urodynamic studies in prostate cancer patients who suffer from incontinence, irrespective of the treatment carried out.The largest amount of information on urodynamic studies in patients with prostate cancer and incontinence was found in those with post-prostatectomy incontinence. There is much more limited work on irradiated patients, and after medical treatment.The urodynamic study in these patients may help clarify the etiopathogenic mechanisms of incontinence, try to predict risk factors before treatment and help the therapeutic decision making. Further studies are needed, especially in patients undergoing radiotherapy, to further assess the mechanisms involved in lower urinary tract abnormalities that occur in these patients.

OBJETIVO: Puesta al dia sobre la valoracion urodinamica en los pacientes con cancer de prostata que presentan incontinencia. METODOS: Revision de los estudios urodinamicos en pacientes con cancer de prostata que padecen incontinencia, sea cual sea el tratamiento efectuado. RESULTADOS: La informacion mas numerosa sobre estudios urodinamicos en los pacientes con cancer de prostata e incontinencia se refiere a la incontinencia post-prostatectomia. Son mucho mas escasos los trabajos referidos a pacientes radiados y postratamiento farmacologico. CONCLUSION: El estudio urodinamico en estos pacientes puede ayudar a aclarar los mecanismos etiopatogenicos de la incontinencia, a tratar de predecir factores de riesgo pre tratamiento y ayudar a la toma de decision terapeutica. Son necesarios mas estudios, sobre todo en pacientes sometidos a radioterapia, para evaluar con mayor profundidad los mecanismos implicados en las alteraciones del tracto urinario inferior que se producen en estos pacientes.