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Biomedical subjects

J Salinas Casado

Publications and source records attributed to J Salinas Casado.

At least 19 recordsLinked to original sources
PubMed2006

[Periurethral injections of dextranomer/hyaluronic acid copolymer in the treatment of female stress urinary incontinence: description of the technique and bibliographic review].

OBJECTIVES: The system enables a non endoscopic, outpatient treatment of the female stress urinary incontinence. The article intends to familiarize the readers with the procedure. METHODS: We describe the technique, graphically, with all steps, and perform a bibliographic review. RESULTS: In accordance to the main clinical studies reviewed, the periurethral injection of dextranomer/ hyaluronic acid copolymer has an efficacy of near 75%, with a simple, reproducible technique with rare adverse events. CONCLUSIONS: The treatment with this type of periurethral injections may be valid as a minimally invasive treatment of the female stress urinary incontinence, because of its efficacy, tolerability and reproducibility.

Dextrans↗
PubMed2004

[Experimental study of the expression of the bladder wall proteins in bladder outlet obstruction in the rabbit].

OBJECTIVES: To determine the relationship of the bladder wall levels of the contractile proteins: whole actin, beta-actin, alpha-sarcomeric-actina caldesmon and of the Heat Stress Protein HSP-70, with the partial bladder outlet obstruction. MATERIAL AND METHODS: It was carried out an experimental study on 43 New-Zealand rabbits. These animals were divided into a control group and six experimental groups with partial bladder outlet obstruction induced by an incomplete tie around the urethra. The experimental groups were defined according the day when the animals were sacrified: at 24 hours, 7 days, 15 days, 1 month, 3 months and 6 months of the obstruction. It was determined in all animals the muscular bladder wall concentration of whole actin, beta-actin, alpha-sarcomeric-actin, caldesmon and HSP-70 protein, according to Western Blotting technique. The results were analyzed by means of ANOVA, using the Scheffe post hoc method. RESULTS: The bladder weight of the obstructed animals increased significantly in two stages: until the day 15 and between the day 15 and the end of the study, corresponding to theoretical phases of initial hypertrophy and compensation. The level of whole actin showed a significant decrease at the beginning of compensation phase, while the beta-actin level increased in the phase of initial hypertrophy and the alpha-sarcomeric-actin level increased at the end of the compensation phase, while the caldesmon and the HSP-70 made it at the end of the initial hypertrophy phase. CONCLUSIONS: Analysing our data we conclued that the determination of the caldesmon levels is the marker that better adjusts to the changes associated with partial bladder outlet obstruction in the rabbit.

Actins↗
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

[Reliability of fractal dimension measurement of uroflow curves].

OBJECTIVE: To determine the reliability of fractal analysis of uroflow curves. METHODS: We analyzed the correlation between the fractional dimension analysis of two series of uroflow curves with an interval of 88.21 days. The fractal dimension was calculated by two methods. RESULTS: A good correlation was found for both methods, although it was lower than that of maximum flow. A relationship was found between the fractal dimension and maximum flow. CONCLUSIONS: The fractional dimension is a reliable parameter that appears to be related with urinary flow.

Fractals↗
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

[Female urinary incontinence: clinical-urodynamic correlation].

OBJECTIVES: To determine the diagnostic utility of the urinary symptoms and physical examination in the urodynamic diagnosis of the type of female urinary incontinence. METHODS: A descriptive longitudinal study was conducted in 100 women undergoing urodynamic evaluation. The patients were asked about the urinary symptoms and were evaluated by physical examination and cystomanometry. RESULTS: A statistically significant correlation was found for age and clinical type of urinary incontinence. A strong trend was observed for clinical type of urinary incontinence and cystocele grade, and the urodynamic type of incontinence. A low sensitivity was found for the clinical type in relation to the urodynamic type of incontinence. CONCLUSIONS: Urinary incontinence clinical data do not permit determination of the urodynamic type of incontinence.

Female↗
PubMed1999

[Evaluation of new intraurethral occlusive depot (ORIS FEMININO) in the management of female stress urinary incontinence].

OBJECTIVE: To determine the utility and safety of an intraurethral device (Oris Femenino) in the management of female stress urinary incontinence. METHODS: A prospective clinical study was conducted on 54 female patients, mean age 46.4 years, with stress urinary incontinence. The degree and severity of the incontinence was determined before and one month after treatment with the intraurethral device. The reasons for the dropouts were analyzed and the rehabilitative effects two months after treatment had been completed were evaluated in 22 patients. RESULTS: 83% of the patients who completed the study referred positive results. A significant improvement was demonstrated for the degree of incontinence as well as the number of absorbent pads used. Age and severity of incontinence inversely correlated with positive results. A correlation between the absence of a previous urethropexy and positive results was also found. The dropout rate was 44% (24 patients) and was chiefly due to symptomatic bacteriuria in 14 cases and the difficulty in fixation and degree of incontinence. A statistically significant reduction was found in the number of pads used in the group of patients evaluated two months after treatment had been completed. CONCLUSIONS: The intraurethral device analyzed in this study significantly reduced urinary incontinence. This method appears to be more effective in younger women who are not severely incontinent and have not previously undergone urethropexy. The intraurethral device appears to have some rehabilitative effect on the perineal muscle. Symptomatic bacteriuria was found to be the main disadvantage.

Female↗
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

[The clinical and flowmetric results of the treatment of benign prostatic hyperplasia with doxazosin].

OBJECTIVE: To evaluate the clinical efficacy of doxazosin for 6 months in the treatment of benign prostatic hyperplasia (BPH). METHODS: A prospective clinical and uroflowmetric study was conducted on 65 males with BPH treated with doxazosin 4 mg daily for 6 months. Patient mean age was 66.7 years (range 45-79). Clinical evaluation (IPSS and andrologic data) and blood analyses were performed before and after treatment. IPSS data were obtained according to the WHO validation and Spanish translation. RESULTS: A significant improvement was found between the mean pre- and post-treatment IPSS scores (19.8 +/- 4.8 vs 11.9 +/- 4.6; p < 0.001). Maximum flow rate before treatment was 9.13 ml/sec, which increased to 16.23 ml/sec after treatment (p < 0.001). Postvoid residual urine dropped from 21.7% to 12.5% (p < 0.01). All the patients were normotensive before (135.9 mean systolic and 78.9 mean diastolic blood pressure) and after treatment (135.4 mean systolic and 77.8 mean diastolic blood pressure). Mean heart rate was similar before and after treatment (71.9 +/- 5.8 vs 71.8 +/- 5.9). A relationship between low IPSS score before treatment and urinary symptoms improvement was demonstrated (coeff. -0.45939). No relationship was found between prostate volume (digital rectal examination or transabdominal ultrasound) and improvement in the IPSS score. No statistical relationship was found between the IPSS and postvoid residual urine or peak flow. No modifications of sexual activity was demonstrated with doxazosin treatment. Pre- and post-treatment blood analytical data fell within the normal ranges. Transient side effects were observed in 12 patients (20%): headache in 6 patients (10%), fatigue in 6 (10%), dizziness in 3 (5%) and somnolence in (5%). CONCLUSIONS: Doxazosin, at a daily dose of 4 mg daily for 6 months, is a safe and effective treatment in patients with BPH.

Adrenergic alpha-Antagonists↗
PubMed1999

[Evidence-based and science-based medicine].

Routine medical practice is an admixture of scientific knowledge, uncontrasted physiopathological deduction and intuition based on personal experience. Evidence-based medicine is a new approach to medical practice that is based on appropriately contrasted data and includes the following steps: 1) accurately define the problem we are dealing with, 2) investigate the medical literature efficiently, and 3) select the best, relevant studies and apply the corresponding norms to the evidence. In turn, the application of the corresponding norms to the evidence includes the following aspects: 1) determine if the results of the study are valid; i.e., evaluate the scientific quality of the article, 2) determine the magnitude of the results; i.e., establish is they are clinically relevant, and 3) evaluate their application to the point at issue; i.e., test the external validity of the study. The drawbacks of evidence-based medicine include its insufficient concern for basic research, its disregard for physiopathological hypotheses, and the naïve inductivism of epidemiology-based medical practice. Undoubtedly, evidence-based medicine provides advantages for the medical practice and underscores the importance of data and statistical procedures. This new paradigm, however, should not set aside the traditional, hypothetical-deductive approach.

Clinical Medicine↗
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↗
PubMed1998

[Neurobiology of erectile dysfunction in multiple sclerosis].

OBJECTIVE: To analyze the neurological alterations responsible for impotence in multiple sclerosis. METHODS: We conducted a pharmacologic erection test and a neuroandrologic profile study in 11 patients with multiple sclerosis and impotence. This study consisted in: bulbocavernosus EMG, S2-S4 evoked potentials, somatosensory potentials of pudendal nerve, electromyography of cavernous smooth muscle (SPACE), sympathetic skin response (SSR) and cystometry. RESULTS: The most frequent neurological lesion was complete suprasacral (7 cases; 64%) and parasympathetic (7 cases; 64%) lesions. The parasympathetic lesions were of the upper motor neuron type in 6 of the 7 cases (86%). Peripheral autonomic [sympathetic in 2 cases (18%); parasympathetic in 1 case (9%)] and pudendal lesions (3 cases; 27%) were also observed. CONCLUSIONS: The main cause of impotence in multiple sclerosis could be ascribed to a suprasacral lesion. Some cases also present peripheral autonomic lesions.

Adult↗
PubMed1998

[Neurobiology of ejaculation and orgasm disorders].

OBJECTIVE: To determine the neurologic alterations of patients with ejaculatory and orgasmic disorders. METHODS: A study of the neuroandrologic profile was performed in eight patients; 6 presented an ejaculation, one premature ejaculation and one presented an orgasm. The neuroandrologic profile consisted in performing selective electromyography of the bulbocavernosus muscle, recording of the S2-S4 evoked potentials, evoked somatosensory potentials of the pudendal nerve, electromyography of the smooth cavernous muscle (SPACE), sympathetic skin response and cystometry. RESULTS: The sympathetic lesion was more frequent in the cases with an ejaculation (four cases; 66%); a pudendal efferent lesion was demonstrated in one case (17%) and a suprasacral lesion in one case (16%). A pudendal afferent lesion was observed in the two cases with premature ejaculation (100%). Both cases with an orgasm had a pudendal afferent lesion (100%) and one of them also presented a sympathetic lesion (50%). CONCLUSIONS: An ejaculation appears to be caused by sympathetic, motor pudendal or suprasacral lesion. An altered perception of genital sensations due to lesion of the afferent pudendal pathway appears to be present in premature ejaculation. An orgasm could be ascribed to an alteration of the pudendal sensibility or to the absence of ejaculation.

Adult↗
PubMed1998

[Functional reinnervation in patients with a diagnosis of lower motor neuron neurogenic bladder: prognostic and therapeutic considerations].

OBJECTIVE: To evaluate bladder and urethral sphincter reinnervation mechanisms during long-term follow-up in patients with lower motor neuron neurogenic bladder following neurological surgical injury. METHODS: A urodynamic study was conducted in 30 patients (21 male and 9 female; mean age 53.4 years) with lower motor neuron neurogenic bladder dysfunction arising from neurological injury sustained during surgery. The protocol included cystometry and periurethral electromyography (EMG) at 3, 6, 9, 12 months and once a year for 7 years, and videocystography at 3, 12 months and once a year for 7 years. Functional parasympathetic (detrusor) reinnervation criteria were cystometric. Functional sympathetic (bladder neck) reinnervation criteria were cystographic. Functional pudendal (periurethral sphincter) reinnervation criteria were electromyographic (increase of polyphasic and long amplitude and/or long time potentials). RESULTS: Detrusor reinnervation was demonstrated in 6 male patients (20%) with an average period of 44.6 months. Pudendal reinnervation was demonstrated in 17 patients (77.2%) with an average period of 17.6 months. EMG potentials were polyphasic in 17 cases and long amplitude/long time potentials in 3 cases. Sympathetic reinnervation was demonstrated in one patient (16.6%) at 60 months. CONCLUSIONS: Functional pudendal reinnervation of the periurethral sphincter was more frequent and was demonstrated earlier than reinnervation in vegetative elements (parasympathetic and sympathetic). Parasympathetic reinnervation had long-term therapeutic implications. Ongoing urodynamic assessment in patients with lower motor neuron neurogenic bladder following abdominoperineal resection or intervertebral disc prolapse surgery is warranted. Sympathetic reinnervation was scanty and was demonstrated later in relation to distal postganglionic fibers.

Electromyography↗