Biomedical subjects

J M Adot Zurbano

Publications and source records attributed to J M Adot Zurbano.

13 recordsLinked to original sources

PubMed2003

[Urodynamic evaluation of experimental bladder augmentation with seromuscular colocystoplasty].

INTRODUCTION: The use of de-epithelialized intestinal segment can avoid the complications associated of use to bowel segments for bladder augmentation. OBJECTIVE: We designed an experimental model New Zealand rabbit with previously reduced bladder capacity, and afterward we performed augmentation cystoplasty with urodynamics comparative effectiveness demucosalized and conventional colocystoplasty techniques. MATERIAL AND METHODS: In thirty-six male New Zealand rabbits fifty percent reduction cystoplasty was carried out. A month later the animals had bladder augmentation. They were randomly divided in two groups: 18 rabbits (group 1) underwent conventional colocystoplasty. In 18 rabbits (group 2) autoaugmentation procedure and demucosalized colocystoplasty was performed. All animals were sacrificed at 8 weeks of bladder augmentation. Urodynamics studies were practiced at beginning of each operation in all of them. RESULTS: Nine rabbits died and twenty-seven were evaluated: 14 rabbits group-1 and thirteen of group-2. The average increase in bladder capacity was 63% in group-1 under conventional colocystoplasty and 17% in group-2 demucosalized colocystoplasty. Average compliance improved to 141% in group-1 and 38% in group-2. CONCLUSIONS: In this study with "small bladder" New Zealand rabbit, the seromuscular colocystoplasty has poor urodynamics result in improving capacity and compliance bladder but conventional colocystoplasty has result effective.

Animals↗

PubMed2002

[Clinical and analytical parameters that might indicate a second biopsy in patient with high PSA and previously negative biopsy].

OBJECTIVES: To determine what clinical, analytic and ultrasound parameters, are more effective to predict the result of a second biopsy in patient with high PSA and a first prostate biopsy negative. MATERIAL AND METHODS: It was carried out a longitudinal study in a series of 435 cases with negative prostate biopsy. In 59 of these cases it was practiced a second biopsy due to a permanent or sudden high PSA levels with or without a suspicious digital rectal examination. Of the 31 cases with a negative second biopsy, in 4 cases it was carried out a third biopsy. The biopsy was made in all the occasions by transrectal ultrasound guided sextant biopsy. It were also valued the ultrasound characteristic of the prostate, the prostate volume and the proportion of free PSA. RESULTS: It was demonstrated statistically significant differences among the patients with a second biopsy negative and positive regarding: the age, proportion of free PSA, abnormal digital rectal examination and presence of hipoechogenic areas in the prostate. The multivariate analysis demonstrated that the only significant parameters were the proportion of free PSA and the existence of an abnormal digital rectal examination. Based on the data of multivariate analysis, we settled down for the patients with normal digital rectal examination a cut-off point of 0.23 of proportion of free PSA as indication for the realization of a second biopsy, and of 0.59 for the patients with abnormal digital rectal examination. This protocol applied to our series would avoid the realization of a second biopsy in 8 patients, and a third biopsy in 1 patient, diagnosing all the cases of prostate cancer. CONCLUSIONS: The digital rectal examination associated with the proportion of free PSA constitutes a reliable parameter to indicate the realization of a second prostate biopsy in patient with high PSA and previous negative biopsy.

Aged↗

PubMed2000

[Urinary incontinence in menopause].

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.

Case-Control Studies↗

PubMed1999

[Diabetic neurocystopathy: multivariate study].

OBJECTIVE: To analyze the prevalence of urodynamic disorders and the factors associated with bladder instability in patients with diabetes mellitus. METHODS: We conducted a clinical and urodynamic study on 138 diabetic patients (71 males, 51%; 67 females, 49%) with a mean age of 64.04 years. Patient evaluation included patient history, neurological physical examination, cystometry, pressure-flow test, filling videocystography and selective EMG of the periurethral sphincter. Data obtained were analyzed by multivariant logistic regression analysis, taking the probability of developing bladder instability as a dependent variable. RESULTS: Bladder instability was the most frequent urodynamic finding (52%), followed by lower urinary tract obstruction (44%), involvement of bladder contractility (41%) and stress urinary incontinence (22%). Lower motor neuron (S2-S4) pudendal nerve lesion was observed in 33% of the cases and 24% had upper motor neuron involvement. Multivariant analysis showed age and stress urinary incontinence (inverse correlation) to be the only independent variables for bladder instability. The other variables that correlated with instability (but dependent on the foregoing variables) were involvement of bladder contractility and type of diabetes (higher probability for diabetes type II). No correlation was found for sex, duration of the diabetes, stroke (CVA), urinary obstruction or pudendal nerve lesion. CONCLUSIONS: Bladder instability was found to be the most frequent urodynamic disorder in diabetic patients. The probability of developing bladder instability increases with age and decreases in patients with stress urinary incontinence.

Adult↗

PubMed1999

[Toward a simplified method of classifying urinary incontinence in the elderly based on a multivariate analysis of 948 cases].

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.

Aged↗

PubMed1999

[Evidence-based medicine. Usefulness of isolated cystomanometry for the diagnosis of periurethral detrusor-sphincter dyssynergia in patients with suprasacral lesion].

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.

Adolescent↗

PubMed1995

[Clinical, urodynamic, and radiologic results in the study of prostatism with the PURR measure (passive urethral resistance ratio)].

OBJECTIVE: The present study was conducted to determine the correlation between the urinary symptoms and lower urinary tract dynamics in patients with prostatism. METHODS: 105 males with prostatism (mean 66.19 years) were evaluated clinically, urodynamically and radiologically by PURR (passive urethral resistance ratio) determination. RESULTS: The intensity of the irritative symptoms was slightly higher (21%) when bladder instability was associated. The obstructive symptoms were associated with diminished urinary flow rate and could be observed in bladder outlet obstruction (81%) or diminished bladder contractility (79%). Both conditions were found in 49% of the cases. The postvoiding urine depended on diminished bladder contractility (37%), but not on bladder outlet obstruction. Bladder instability did not depend on obstruction, although 88% of the patients with unstable bladder were obstructed. Compressive obstruction was associated with a lesser degree of diminished contractility (55%) than the other forms of obstruction. Prostatism was associated with diminished contractility without bladder outlet obstruction in 15% of the cases. The irregular bladder was more frequent in bladder outlet obstruction (92%) and bladder diverticula were more frequent in bladder instability (36%). In all the cases with compression and lengthening of the prostatic urethra, the diagnosis was compressive obstruction. In all the cases with segmental, diminished urethral diameter, the diagnosis was obstruction, although only 30% were diagnosed as constrictive compression. No pathological urethral changes were demonstrable on cystourethrography in 33% of the cases with obstruction. CONCLUSIONS: Urinary symptoms correlate poorly with lower urinary tract dynamics. PURR determination is a very reliable method of diagnosis in urinary obstruction, for both segmentally diminished and more extensive involvement (elongation and compression of the prostatic urethra) of the urethral lumen.

Adult↗

PubMed1995

[A comparative study of different urodynamic methods used in the diagnosis of lower urinary tract obstruction in men].

OBJECTIVES: The present study compared the results of the different urodynamic methods utilized in the diagnosis of urinary obstruction. METHODS: A urodynamic study was performed in 105 patients with prostatism; mean age 66.19 years. The following five urodynamic methods were utilized: maximum pressure/maximum flow rate (Pmax/Fmax), pressure/flow nomogram, pressure/flow curve, Schaefer's PURR and the resistance square. RESULTS: The Pmax/Fmax method showed the lowest percentage of obstruction (61%), 48% of the nomograms were inconclusive, the pressure/flow curve diagnosed obstruction in 88%, Schaefer's PURR diagnosed obstruction in 77% and the resistance square diagnosed obstruction in 78% of the cases. When the nomogram findings were diagnostic, no significant differences between the other methods were observed. The Pmax/Fmax, pressure/flow curve and the PURR methods proved to be independent methods, while the resistance square showed no significant differences with Schaefer's PURR. An irregular bladder at cystography was associated with a significantly higher percentage of obstruction (72% vs 92%). Lengthening and compression of the prostatic urethra demonstrable on cystourethrography was associated with the diagnosis of obstruction on all the methods used. A diminished segment of the urethral lumen was associated with a high percentage of obstruction on all methods, the PURR showing the highest (100%). However, the diagnosis of constrictive obstruction was found in only 30% of the cases.

Adult↗

PubMed1994

[Infantile enuresis: epidemiologic, clinical, urodynamic, and radiologic data of a consecutive series of 100 cases].

The present paper reports the epidemiological, clinical, urodynamic and cystographic data of 100 consecutive patients (mean age 9.59 years) with nocturnal enuresis. These patients were divided into three groups: group I (4 to 7 years old), 23 patients; group II (8 to 11 years old), 51 patients; and group III (12 to 14 years old), 26 patients. Nocturnal enuresis was more frequent in group II (51%). It was more prevalent in males (51%) of groups I and II. Isolated nocturnal enuresis was more frequent (54%) than nocturnal enuresis associated with diurnal symptoms (46%) in all age groups. Urinary infection was observed in 16% and was more prevalent in girls (68.7%). Detrusor instability was the most common urodynamic finding (40%), particularly in group II and girls. Uncoordinated voiding was the second most common urodynamic finding (24%), particularly in group II and girls. Lower urinary tract infection was observed in 1% (males). No abnormal urodynamic data were observed in 19%. Neurogenic bladder was observed in 16%, mainly in group II (31%). Vesicoureteral reflux was detected in 18%, mainly in girls (66.6%) and a postvoiding residual urine in 10%. A diagnostic and prognostic system and a therapeutic strategy based on our data are proposed.

Adolescent↗

PubMedDate not supplied

[Diagnostic algorithm based on a multivariate model to reduce the percentage of negative prostatic biopsies in patients with changed PSA or suspicious rectal palpation].

OBJECTIVES: To determine what tests have a better diagnosis utility in patient with suspected prostate cancer due to PSA equal or greater than 4 ng/ml or abnormal digital rectal examination in order to reduce the number of negative prostate biopsies. MATERIAL AND METHODS: We carried out a ultrasound-guided sextant transrectal biopsy in a series of 400 patient with prostate-specific antigen (PSA) levels equal or greater than 4 ng/ml or abnormal digital rectal examination. All patients had also transrectal rectal ultrasonography to value the echographic prostatic characteristics and the prostatic volume, and a free PSA determination. RESULTS: The free/total PSA ratio (PSAl) and the PSA density (DPSA) were the most powerful predictors of prostate cancer, both with a 66% sensitivity and a 70% specificity (at a 0.15 cutoff), followed by the total PSA (PSAt), the digital rectal examination and the hypoechogenic prostatic nodules. We constructed a logistic multivariate model with these data. The outcome variable of logistic model was the probability of having prostate cancer. The significant predictive variables of the model were the PSAl, the DPSA, the digital rectal examination and the presence and extension of hypoechogenic prostatic. This model had a 81% sensitivity and 79% specificity at a 0.24 probability cutoff. We considered a 0.1 probability cutoff to reduce the number of false negative. With this strategy the sensitivity was 94% and the specificity 54%. If we had applied this model to the patient of our series then, we would be able to avoid prostate biopsy in 164 cases (the 41% of the patient), leaving only 7 cases without diagnosis of prostate cancer. CONCLUSIONS: The most effective combination parameters were the digital rectal examination, PSAl, presence and extension of prostatic hypoechogenic zones and DPSA. This combination allows us to diminish the percentage of negative prostate biopsy in patient with prostate-specific antigen (PSA) levels equal or greater than 4 ng/ml or abnormal digital rectal examination without significantly descending the number of detected prostate cancers.

Aged↗

PubMedDate not supplied

[Role of the bladder neck in urinary continence in women after urethropexy].

We conducted a clinical, radiological and urodynamic study in 70 patients submitted to different urethropexy techniques (Kelly, Raz, Marshall-Marchetti-Krantz, Burch, simplified Ramírez) to determine the importance of the bladder neck in the treatment of urinary incontinence. Urethropexy achieved a significant increase in the percentage of patients with an open bladder neck during the filling phase. However, the opening of the bladder neck posturethropexy did not influence urinary continence.

Adult↗

PubMedDate not supplied

[Value of the shape of the flowmetry curve in the study of prostatism].

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.

Adult↗

PubMedDate not supplied

[Characterization of the DURR (dynamic urethral resistance relation] in the study of function lower urinary tract symptoms in the male].

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.

Adult↗