Miguel Vírseda-Chamorro

Psychological Impact and Sexual Dysfunction in Men with and without Spinal Cord Injury

INTRODUCTION The World Health Organization recognizes sexual health as a fundamental right that should be guaranteed to all individuals. Sexual dysfunction affects various aspects in the lives (physical, psychic, and social) of affected persons. AIMS To assess the different types of sexual dysfunction, the quality of life (QOL), depression, anxiety, and levels of self-esteem observed in 165 men with sexual dysfunction, both with and without spinal cord injury (SCI). METHODS Case control study of 85 men with SCI and sexual dysfunction, and 80 men without SCI that have sexual dysfunction. MAIN OUTCOMES MEASURES The Sexual Health Evaluation Scale, the Fugl-Meyer Life Satisfaction Questionnaire scale, the Hospital Anxiety and Depression Scale, the Evaluation of the Sexual Health Scale, and Rosenbergs Self-esteem Scale were all used for data collection. RESULTS Of the members in group A (with SCI), 89.4% (76) showed erectile dysfunction, and 75.2% (64) reported anejaculation. In group B (without SCI), 75 (96.8%) showed erectile dysfunction, and 58.7% (47) had disorders of sexual desire. In group A, 16.47 % (14) showed signs of depression, and 35.3% (30) had signs of anxiety. In group B, 30% (24) had elevated scores regarding depression, and 48.75% (39) had high scores for anxiety. All of the participants reported a high general QOL and a high satisfaction with their QOL but reported that their satisfaction with their sexual lives was only at the acceptable level. Social QOL is significantly higher in the SCI group (t Student P=0.031). The QOL, self-esteem, and anxiety and depression levels are significantly correlated. CONCLUSIONS Men with sexual dysfunction strive to adapt to their situations, with the relationship between the type of sexual dysfunction and the QOL, mood (depression), and self-esteem all being important considerations. Sexuality and employment status are the areas where men with spinal cord injuries report less satisfaction.

Risk factors of urethral diverticula in male patients with spinal cord injury

Study design:A case-control study in a series of 55 males with urethral diverticula (UD) and their correspondent control, matched by age and time of radiological assessments.Objectives:To evaluate the risk factors to develop UD in males with spinal cord injury (SCI) and the place in the urethra where they are, most commonly, allocated.Setting:Toledo, Spain.Methods:Clinical histories and urodynamic studies, of all patients, were reviewed. The study was completed with a telephone survey according to an established protocol.Results:The univariate analysis study showed the following risk factors: the age of onset of the spinal injury, the sphincterotomy procedure, personal history of lower urinary tract infections (LUTIs) and the chronic need of either indwelling catheter (IC) or the external condom drainage (ECD). Regarding the location of the UD, we have found the stress urinary incontinence as the only risk factor to develop UD in the prostatic urethra.On the other hand, we can conclude that the sphincterotomy, the ECD, the personal history of LUTIs and the detrusor external sphincter dyssynergia seem to be risk factors to develop diverticula in the bulbo-membranous urethra. Finally, we could point out the IC as the only risk factor for penile UD. Multivariate analysis showed that all of these risk factors were independent among them except the age of the onset of the injury and the ECD for UD in the bulbo-membranous urethra.Conclusion:According to our study, there is evidence of some specific risk factors for the development of UD in male patients with SCI, and therefore we should adopt the appropriate preventive measures to prevent them.

Comparison of ambulatory versus video urodynamics in patients with spinal cord injury

Objective:To compare the data obtained through video urodynamics (VUD) with those obtained through one voiding cycle ambulatory urodynamics monitoring (AUM) in patients with spinal cord injury (SCI).Methods:A comparative study was conducted in 69 patients with SCI (mean age±s.d. 44±16.9 years), 51 men and 18 women, who were subjected to AUM and VUD.Results:A lack of agreement was observed between the two tests with respect to the cystometric capacity (CC) (ml) (275±197.2 AUM versus 416±198.3 VUD), filling pressure (cm H2O) (4±5.3 AUM versus 9±12.5 VUD), bladder compliance (ml cm−1 H2O) (116±114.9 AUM versus 161±179.4 VUD), maximum detrusor contraction pressure (cm H2O) (87±65.2 AUM versus 47±35.0 VUD), post-void residual (ml) (206±201.5 AUM versus 308±237.7 VUD) and stress urinary incontinence (kappa index: −0.052). Only the CC obtained in the AUM was in agreement with the mean bladder volume gathered from the frequency–volume chart. Agreement was observed with respect to the presence of neurogenic detrusor overactivity (kappa index: 0.307) and bladder outlet obstruction index (cm H2O) (17±48.0 AUM versus 15±18.7 VUD). There was no clear association between AUM parameters and bladder neck morphology, the presence of radiological detrusor–external sphincter dyssynergy or vesicoureteral reflux observed in the VUD.Conclusion:The differences between both methods discourage the use of AUM with just one voiding cycle in the evaluation of patients with SCI.

Risk factors to develop autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury.

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.

Influence of bladder lithiasis on lower urinary tract dynamics in patients with spinal cord injury

Study design:A prospective and a case-matched control study.Objectives:To study the lower urinary tract dysfunction associated with bladder lithiasis in patients with spinal cord injury (SCI).Setting:Toledo (Spain).Methods:We have carried out a urodynamic study in 30 patients with SCI with lithiasis in their bladder before and 3 months after bladder endoscopic lithotripsy. This second study was compared with the urodynamic findings of a different group of 30 patients with SCI, without a history of bladder lithiasis, paired with cases by gender and date of urodynamic study.Results:We have found that the prevalence of neurogenic detrusor overactivity (NDO) was significantly different after bladder lithotripsy, although the cystomanometric capacity was significantly increased. A group of patients with lithiasis showed a maximum flow rate, a voiding maximum detrusor pressure and the detrusor contractility parameter Wmax lower than that in controls. On the other hand, a voiding abdominal straining was found to be significantly greater than that in controls.Conclusions:Bladder lithiasis affects the presence of NDO in patients with SCI. Patients with SCI who develop bladder lithiasis present a lower detrusor contractility power compared with those who do not.

Effect of pelvic organ prolapse repair on detrusor overactivity in women following incontinence surgery: A multivariate analysis

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.