Jesús Salinas Casado

La urodinámica del divertículo vesical en el varón adulto

OBJECTIVES: To evaluate the clinical and urodynamic characteristics of a series of adult males with BPH and bladder diverticula, and to analyze the changes in urodynamics in patients undergoing lower urinary tract surgery to relieve obstruction, with or without associated diverticulectomy. METHODS: We studied 91 patients in two groups: Group 1- BPH: 67 cases (73.6%) and Group 2-BPH + diverticulum: 24 cases (25%). Mean age was 65.04 years. All patients underwent urological physical examination and complete urodynamic study including cystogram. In addition, we studied 19 patients with BPH and bladder diverticula (mean age 64.58 years) who underwent either endoscopic surgery (1 I cases; 57.9%) or endoscopic surgery plus diverticulectomy (8 cases, 42. 1%). Complete clinical study and urodynamics (including cystogram) were performed preoperative and three months after surgery. Statistical significance was established at 0.05. RESULTS: Comparative study between group 1 (BPH) and group 2 (BPH with diverticulum): there were significant differences in clinical data: acute urinary retention (6.1% vs. 25%;p<0.01), and urinary tract infection (3.1% vs. 21.7%;p=0,004). All evaluated cases had single diverticula (8 cases). Urodynamic studies showed: 1) Post-void residual after free flowmetry: 45.9 ml vs. 221.4 ml, p = 0.008. 2) Bladder capacity on cystometrogram: 211.2 ml vs. 350.8 ml, p = 0.024. 3) Voiding pressure/flow study: a) Voiding with abdominal press 23.9% vs. 50%, p = 0.02. b) URA 36.5 cm H2O vs. 48.5 cm H2O, p= 0.04, c) post void residual 70.7ml vs. 210.3 ml, p= 0.004. d) Bladder contractility measurements (Wmax- isometric contractility- and W80, W20- isotonic contractility) did not show significant differences between groups. Bladder contractility duration was significantly decreased in group 2. In the analysis of patients undergoing surgery to relieve obstruction (Group A- Surgery without diverticulectomy; Group B Surgery with diverticulectomy) there were not differences between groups in clinical data. Urethral resistance parameters (URA) decreased in both groups. Group A: from 43 cm H20 to 26.3 cm H2O. Group B: from 60.6 cm H2O to 48 cm H2O. This decrease was similar after either TURP or myocapsulotomy. Post void residual diminished in both groups. There were no statistical differences between groups in Wmax, W 80-20, or volume, number and site of the diverticula. On the contrary, bladder contractility duration diminished after diverticulectomy. CONCLUSIONS: Bladder diverticula appear in the cases with highest ureteral resistance values (lower urinary tract obstruction). Standard bladder contractility parameters were not diminished. Duration of detrusor contraction was the only contractility parameter significantly affected in cases of bladder diverticula and presented a significant association with the use of abdominal press while voiding. Diverticulectomy showed an improvement of bladder contractility with longer detrusor contraction duration, which supports its use in cases of BPH-associated diverticula. Both TURP and transurethral incision of the prostate diminished urethral resistance in a similar way, so that they may be considered alternative options. Our data should be confirmed with a bigger sample size.

Leiomioma de la cápsula renal: presentación de un caso

OBJETIVOS Presentamos un caso de leiomioma de la capsula renal en una mujer de 49 anos que fue encontrado de manera incidental durante un estudio ecografico abdominal por reflujo gastroesofagico. A partir de este caso discutimos el diagnostico clinico, radiologico y anatomopatologico de los leiomiomas renales asi como su tratamiento. METODOS La paciente fue estudiada mediante ecografia, TC y RM. Tras la nefrectomia radical se realizo el estudia anatomopatologico convencional de la pieza quirurgica incluyendo tecnica inmunohistoquimica. RESULTADOS Ecograficamente se detecto una masa solida, hipoecoica y pobremente vascularizada en el polo superior del rinon derecho. La TC y la RM detectaron una masa bien delimitada de densidad de partes blandas sin afectacion local o regional y sin adenopatias. Se realizo una nefrectomia radical. Microscopicamente la masa estaba constituida por una proliferacion fusocelular de bajo grado cuyas celulas se marcaban con anticuerpos contra antigenos de musculo liso. La masa estaba en continuidad con la capsula renal y comprimia ligeramente el parenquima renal sin producir lesiones relevantes en el. CONCLUSIONES Los leiomiomas renales son tumores infrecuentes que se deben sospechar ante mujeres jovenes o de edad media con tumores renales asintomaticos, bien delimitados, hipoecoicos y con densidad de partes blandas en la TC. Si no hay afectacion de estructuras vasculares, se podria optar por una intervencion quirurgica conservadora. Microscopicamente son tumores fusocelu

Nuevo sling masculino "Argus" para el tratamiento de la incontinencia urinaria de esfuerzo

Resumen es: Objetivos: La incontinencia urinaria masculina de esfuerzo, habitualmente se produce como consecuencia o secuela de una intervencion quirurgica prostatic...

Factores de descompensación miccional y cistocele

Resumen es: Resumen.- OBJETIVOS: Valorar las caracteristicas clinicas y urodinamicas de una serie de mujeres con residuo postmiccional (miccion descompensada) y dife...

Cistoceles de alto riesgo urodinámico

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 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. 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.

Study of the prevalence and interobserver reproducibility of radiologic images suggestive of urethral diverticula in men with spinal cord injury.

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.

Correlación del grosor ecográfico vesical con los datos clínicos y urodinámicos en la hiperplasia benigna de próstata (HBP) sintomática

Resumen es: Objetivo: Nuestro objetivo es comprobar la utilidad diagnostica de la medida del grosor ecografico de la pared vesical, y establecer la correlacion con l...

Actualización videourodinámica de la clasificación del reflujo vesicoureteral en el niño

OBJETIVOS La actualizacion de la clasificacion del reflujo vesicoureteral en el nino. METODOS Videourodinamica. RESULTADOS Se tipifican los distintos tipos de reflujo vesicoureteral en el nino. CONCLUSIONES Se sigue demostrando la utilidad de dicha clasificacion con la introduccion de algunas modificaciones, necesarias para su continua actualizacion.

Test urodinámico de autoreducción del cistocele en el diagnóstico de obstrucción del tracto urinario inferior

Resumen es: Objetivo: Es frecuente la asociacion entre el cistocele y la obstruccion urodinamica del tracto urinario inferior, no pudiendo en ocasiones descartar una...

Cerebelo y tracto urinario inferior

OBJECTIVES To review the role of cerebellum on the lower urinary tract dynamics. METHODS Anatomic-functional methodology including structural, functional and neurotransmitters study. RESULTS We describe the complex connections of the cerebellum and its influence on the lower urinary tract function. CONCLUSIONS It is surprising the functional relationship between cerebellum and lower urinary tract, playing a inhibitory modulating role during the filling phase and facilitating the voiding phase.