Flavio Trigo-Rocha

Voiding dysfunction in patients with Parkinson's disease: Impact of neurological impairment and clinical parameters

We assessed the lower urinary tract symptoms (LUTS) of patients with Parkinsons disease (PD) and their association with different clinical parameters.

Voiding dysfunction and urodynamic abnormalities in elderly patients

Lower urinary tract dysfunction is a major cause of morbidity and decreased quality of life in elderly men and women. With the progressive aging of the population, it is important to understand common micturitional disorders that may occur in this population. Most urinary problems in the elderly are multifactorial in origin, demanding a comprehensive assessment of the lower urinary tract organs, functional impairments, and concurrent medical diseases. Urodynamics is a highly valuable tool in the investigation of elderly patients with lower urinary tract symptoms. Urodynamic tests are not always necessary, being indicated after excluding potentially reversible conditions outside the urinary tract that may be causing or contributing to the symptoms. Although urodynamic tests may reveal common diagnoses such as bladder outlet obstruction and stress urinary incontinence in the elderly population, findings such as detrusor overactivity and impaired detrusor contractility are common and have important prognostic and therapeutic implications. The purpose of this article is to describe common urologic problems in the elderly and review the indications for and clinical aspects of urodynamic studies in these conditions.

Splenic rupture and abscess after extracorporeal shock wave lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) is the first choice for the treatment of most urinary stones. Complications of ESWL can be separated into two groups: those related to the administration of the shock waves and those related to fragmentation and elimination of the stones particles. We report a rare case of splenic trauma followed by abscess after ESWL.

Voiding Dysfunction and the Williams-Beuren Syndrome: A Clinical and Urodynamic Investigation

PURPOSEnWBS is an autosomal dominant disorder that includes features such as developmental delay, cardiovascular anomalies, mental retardation and characteristic facial appearance. We systematically investigated the prevalence and spectrum of voiding dysfunction in this population.nnnMATERIALS AND METHODSnWe prospectively evaluated 16 boys and 12 girls with WBS, with a mean age of 9.7 years (range 3 to 19). Urological evaluation included history of urinary symptoms and impact on quality of life, voiding diary, urodynamics and radiological evaluation with urinary tract sonography, voiding cystourethrography and renal scintigraphy.nnnRESULTSnA total of 22 patients (78.6%) were symptomatic, including 15 (53.6%) with a significant negative impact on the quality of life. Increased urinary frequency was the most common complaint, present in 17 patients (60.7%), followed by enuresis (50%) and urge incontinence (42.8%). A total of 14 patients (50%) had urinary tract abnormalities, with bladder diverticula as the predominant anomaly (10 of 23 patients, or 43.5%). Urodynamics revealed detrusor overactivity in 17 patients (60.7%), detrusor-sphincter dyssynergia with detrusor overactivity in 4 (14.3%) and detrusor-sphincter dyssynergia without detrusor overactivity in 2 (7.1%). An average reduction of 28.3% of the cystometric capacity in comparison to expected capacity for age was found (p <0.001). Urodynamic abnormalities were significantly associated with the presence of voiding symptoms (p = 0.003) and bladder diverticula (p = 0.001).nnnCONCLUSIONSnChildren with the Williams-Beuren syndrome are at high risk for presenting with voiding dysfunction and structural abnormalities, and should undergo a minimum evaluation that includes voiding history and urinary tract sonography, while urodynamics, VCUG and additional studies should be performed in symptomatic patients or those whose initial evaluation shows significant abnormalities.

Urodynamic Evaluation of Patients with Lower Urinary Tract Symptoms and Small Prostate Volume

Introduction: The relevance of prostate size in the pathophysiology of lower urinary tract symptoms (LUTS) is controversial. We evaluated the urodynamic findings in patients with LUTS and small prostate volumes. Materials and Methods: 84 patients aged ≧50 years with LUTS and prostates <40 ml were evaluated. All had an International Prostate Symptom Score (IPSS) ≧8. Average age was 62.0 ± 8.1 years. We evaluated the impact of bladder outlet obstruction (BOO) and detrusor overactivity (DO) on the voiding symptoms and urodynamic findings. Results: Mean prostate volume was 29.2 ± 7.2 ml and mean IPSS was 13.5 ± 4.6. BOO was the main finding, affecting 42 (50.0%) patients, followed by detrusor underactivity (DU) in 41 (48.8%) and DO in 28 (33.3%) patients. Patients without BOO were significantly older than the obstructed (64.0 ± 8.8 and 60.1 ± 6.9 years, respectively; p = 0.026) and had an increased prevalence of DU (76.2 and 21.4%, respectively; p < 0.001). Comparison of patients with and without DO showed reduced bladder capacity and compliance in the DO group (p < 0.001). No other comparisons were significant. Conclusion: Half of the patients with LUTS and small prostates are not obstructed and may have DO or decreased detrusor contractility as the basis for their voiding symptoms. Our results emphasize the value of urodynamics in this population, especially when invasive treatments are being considered.

Schistosomal myelopathy: urologic manifestations and urodynamic findings

OBJECTIVESnTo describe the clinical and urodynamic features of patients with voiding dysfunction secondary to schistosomal myelopathy. Schistosomiasis mansoni is an endemic fluke infection in South America, the Caribbean, and Africa. In the United States and Europe, people may be infected mainly through travel to endemic areas and immigration of infected individuals. Clinical involvement of the spinal cord is a well-recognized complication of the disease. The typical manifestations are those of an acute transverse myelitis, with sudden onset of lower extremity neuropathy associated with bladder and bowel dysfunction.nnnMETHODSnWe reviewed the records and urodynamic studies of 14 consecutive patients (10 men and 4 women, age range 23 to 49 years) with schistosomal myelopathy confirmed by cerebrospinal fluid serology for S. mansoni, who were referred for evaluation of voiding dysfunction during a 2-year period. At the time of the urologic evaluation, 9 patients had chronic neurologic and urinary symptoms and 5 had recent onset of acute symptoms. The voiding function history, urologic complications, and outcomes after therapy for schistosomiasis were reviewed.nnnRESULTSnOf the patients with acute disease (5 patients), the urologic symptoms included urinary retention (3 patients) and incontinence (2 patients). Three of them had concurrent lower back pain and lower limb neurologic deficits. Urodynamic studies were performed in 3 patients and revealed bladder areflexia in 2 patients and detrusor hyperreflexia with external sphincter dyssynergia in 1 patient. The patients were started on clean intermittent catheterization and received praziquantel and corticosteroids. Three patients had complete resolution of their symptoms, one recovered normal voiding function but the neurologic deficits persisted, and one had no clinical improvement. All patients with chronic schistosomal myelopathy presented with lower limb neurologic deficits of varying degrees and urinary symptoms, including difficulty emptying the bladder (7 patients), urinary incontinence (6 patients), and urgency and frequency (2 patients). Laboratory and radiographic evaluation of patients with chronic disease revealed urinary tract infection in 5 patients, hydronephrosis in 2 patients, and bladder calculi in 2 patients. Urologic management consisted of antibiotics, clean intermittent catheterization, anticholinergic medication, and stone removal, as appropriate. In 1 patient, conservative treatment failed and that patient required ileocystoplasty.nnnCONCLUSIONSnSchistosomal myelopathy is a potential cause of severe voiding dysfunction secondary to spinal cord disease. A high index of suspicion is paramount because early medical intervention can abort the progression of neurologic deterioration.

Renal function in children with congenital neurogenic bladder

AIMS: Preservation of renal function in children with congenital neurogenic bladder is an important goal of treatment for the disease. This study analyzed the evolution of renal function in patients with congenital neurogenic bladder. METHODS: We reviewed the records of 58 pediatric patients with respect to the following attributes: gender, age, etiology of neurogenic bladder, reason for referral, medical/surgical management, episodes of treated urinary tract infections, urodynamics, DMSA scintigraphy, weight, height, blood pressure, glomerular filtration rate, microalbuminuria and metabolic acidosis. Statistical analysis was performed, adopting the 5% significance level. RESULTS: The mean age at presentation was 4.2 ± 3.5 years. Myelomeningocele was the most frequent etiology (71.4%). Recurrent urinary tract infection was the reason for referral in 82.8% of the patients. Recurrent urinary tract infections were diagnosed in 84.5% of the patients initially; 83.7% of those patients experienced improvement during follow‐up. The initial mean glomerular filtration rate was 146.7 ± 70.1 mL/1.73 m2/min, and the final mean was 193.6 ± 93.6 mL/1.73 m2/min, p u200a=u200a 0.0004. Microalbuminuria was diagnosed in 54.1% of the patients initially and in 69% in the final evaluation. Metabolic acidosis was present in 19% of the patients initially and in 32.8% in the final assessment. CONCLUSIONS: Patient referral to a pediatric nephrologist was late. A reduction in the number of urinary tract infections was observed with adequate treatment, but microalbuminuria and metabolic acidosis occurred frequently despite adequate management.

Urodynamic Evaluation in Diabetic Patients with Prostate Enlargement and Lower Urinary Tract Symptoms

Introduction: Lower urinary tract symptoms (LUTS) are common in men over 50 years of age due to prostate enlargement. Diabetes mellitus is also more prevalent in this group. LUTS may result from bladder outlet obstruction (BOO) secondary to prostate enlargement or bladder dysfunction secondary to diabetes or even from a combination of both. Objectives: The objective of this study was to determine the prevalence of BOO and other urodynamic abnormalities in diabetic patients with LUTS and enlarged prostate. A secondary objective was to assess the predictive value of non-invasive tests for BOO diagnosis in this group of patients. Patients and Methods: 50 consecutive diabetic patients with enlarged prostate and LUTS were evaluated by the International Prostate Symptom Score (IPSS), ultrasonography and urodynamics. BOO diagnosis was based on pressure/flow measurements according to the International Continence Society’s standards. Results: Of the 50 patients in the study, 23 (46%) had BOO. There was no correlation between the IPSS, uroflowmetry, post-voiding residual urine or prostate volume and the presence of BOO (p > 0.05). Conclusions: There is a relatively low prevalence of BOO in diabetic patients with prostate enlargement and LUTS. Non-invasive tests did not allow the identification of these subjects. Only urodynamic evaluation is able to determine symptom etiology.

Urological manifestations of chronic schistosomal myeloradiculopathy

To describe the clinical and urodynamic features of patients with chronic voiding dysfunction secondary to schistosomal myeloradiculopathy (SM), as the clinical involvement of the spinal cord is a well recognized complication of Schistosomiasis mansoni infection.

The Effects of Oxybutynin on Urinary Symptoms in Children with Williams-Beuren Syndrome

PURPOSEnWilliams-Beuren syndrome is a genomic disorder caused by a hemizygous contiguous gene deletion on chromosome 7q11.23. Lower urinary tract symptoms are common in children with Williams-Beuren syndrome. However, there are few data on the management of voiding symptoms in this population. We report our experience using oxybutynin to treat urinary symptoms in children with Williams-Beuren syndrome.nnnMATERIALS AND METHODSnWe prospectively analyzed 42 patients with Williams-Beuren syndrome and significant lower urinary tract symptoms due to detrusor overactivity diagnosed on urodynamics in a 12-week, open-label study. Urological assessment included symptomatic evaluation, the impact of lower urinary tract symptoms on quality of life, frequency-volume chart, urodynamics and urinary tract sonography. After 12 weeks of treatment with 0.6 mg/kg oxybutynin per day given in 3 daily doses, patients were assessed for treatment efficacy and side effects.nnnRESULTSnA total of 17 girls and 19 boys completed medical therapy and were assessed at 12 weeks. Mean ± SD patient age was 9.2 ± 4.3 years (range 3 to 18). The most common urinary complaint was urgency, which occurred in 31 patients (86.1%), followed by urge incontinence, which was seen in 29 (80.5%). Compared to baseline, urinary symptoms were substantially improved. The negative impact of storage symptoms on quality of life was significantly decreased from a mean ± SD of 3.3 ± 1.7 to 0.5 ± 0.9 (p <0.001). Mean ± SD maximum urinary flow improved from 14.2 ± 15.0 to 20.5 ± 6.4 ml per second (p <0.001).nnnCONCLUSIONSnA total of 12 weeks of therapy with 0.6 mg/kg oxybutynin daily resulted in improvement of lower urinary tract symptoms, quality of life and maximum flow rate in most patients with Williams-Beuren syndrome.