Biomedical subjects

M Esteban Fuertes

Publications and source records attributed to M Esteban Fuertes.

At least 19 recordsLinked to original sources

PubMed1999

[Comparative population-based survey as evaluation method of prostate disease changes].

A survey-based comparative study was conducted to evaluate the changes on the prostate pathology in two male populations separated by a time interval of two years (1st and 3rd Week of Prostate Health). A total of 2056 respondents in the 1st Week, and 2126 in the 3rd Week were evaluated. The questionnaire included questions relative to prostate awareness, impact of urinary complaints on daily like activities, Spanish validated IPSS and selective questions for prostate patients. The comparison between both surveys disclosed visits to the urologist at earlier age and longer-standing symptoms. The most prevalent symptoms continue to be decreased calibre of the urinary stream, pollakiuria and urgency. IPSS/L and IPSS/age ratios remained unchanged. There was increased number of visits by mildly symptomatic patients (IPSS < 8), increased periodical revisions, and in the number of patients seen and treated by the urologist. A significant approximation to the diagnostic testing criteria established by the WHO for BPH was demonstrated. The number of patients who received treatment raised and there was also a significant improvement in the outcome. Comparative populational studies could allow to assess changes in the awareness status of the prostate, changes in symptomatic levels and quality of life of the population requesting health care, as well as changes in the diagnostic and therapeutical schemes in patients suspected of having BPH.

Health Surveys↗

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

[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↗

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

[Electric stimulation of sacral roots for the treatment of urinary incontinence due to detrusor instability: application of a technique and results in a clinical case].

OBJECTIVE: To describe a case treated with a new technique in our therapeutic algorithm for non-neurogenic vesicourethral dysfunction. METHODS/RESULTS: A 47-year-old female underwent retropubic urethropexy for stress urinary incontinence. She remained incontinent due to detrusor instability to a degree that was socially unacceptable. After conservative treatment had failed, a percutaneous electrode was applied to the sacral nerve root and she received electrical stimulation of 4-6 milliamperes, 15 Hz and 200 microseconds duration for 7 days. Incontinence remitted for as long as 3 months after the electrode had been removed. CONCLUSION: The results achieved with sacral nerve electrical stimulation reported in the literature and our results support the use of this technique in urological clinical practice.

Electric Stimulation Therapy↗

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↗

PubMed1998

[Postoperative vesicourethral neurogenic dysfunction: the conceptual and clinical aspects based on the analysis of a series of 152 patients].

OBJECTIVE: To analyze the terminological and conceptual aspects of post-surgical vesicourethral neurogenic dysfunction, as well as the etiological, clinical and urodynamic data. METHODS: We conducted a clinical and urodynamic study on 152 patients, 103 males (67.8%) and 49 females (32.2%), mean age 52.04 years, who presented with neurogenic bladder dysfunction after surgery or exploratory maneuvers. The preoperative urodynamic study was available in 123 cases (80.9%). The study protocol included patient clinical history, neurological physical examination to determine the level of the lesion and a complete urodynamic study (Wiest 8000), including selective sphincteric electromyography. RESULTS: The study group comprised 59 patients (38.8%) who had undergone a neurosurgical procedure (25 patients had a disc hernia), 45 (29.6%) had undergone digestive surgery (abdominoperineal resection of the rectum was performed in 37 patients), 24 (15.7%) had undergone surgery for trauma (11 patients had a vertebral fracture), 12 (7.8%) had a urological procedure, 4 (2.6%) were referred from Gynecology and Obstetrics, 4 (2.6%) had received anesthesia or had undergone neurological explorations, 3 (1.9%) had undergone vascular surgery and 1 patient (0.6%) had received radiotherapy. The neurological lesions were supramesencephalic in 4 patients (2.6%), cervical in 14 (9.2%), dorsal in 6 (3.9%), lumbar in 6 (3.9%), conus medullaris in 17 (11.1%), cauda equina in 44 (28.9%) and peripheral in 61 (40.1%). Urinary incontinence (55 patients, 36.1%) was the most frequent cause for consultation. Other symptoms were difficulty in voiding (45 patients, 29.6%) acute urinary retention (33 patients, 21.7%), involvement of urge to void (33 patients, 8.5%) and daytime and/or nighttime frequency (6 patients, 3.9%). Acute urinary retention was statistically significant in the males (p < 0.05) and urinary incontinence in the females (p < 0.01). Incontinence was the most common symptom in patients submitted to radical prostatectomy. The correlation between conus medullaris lesion and acute urinary incontinence was significant (p < 0.001). Patients had referred symptoms for a mean of 8.5 +/- 30.7 months. Bladder reflex on cystomanometry was absent in 100 patients (65.8%) and present in 52 (34.2%). Thirty (57.6%) had voluntary and 22 (42.3%) had involuntary reflex (hyperreflexia). On electromyographic evaluation, baseline activity was normal in 84 patients (65.2%), diminished in 34 (26.3%) and absent in 11 (8.5%). The types of potentials were: normal in 35 cases (28.6%), positive waves 16 (13.1%), fibrillation in 24 (19.6%), polyphasic in 38 (31.1%), potentials with increased duration and/or amplitude in 8 cases (6.5%) and repetitive discharges in 1 case (0.8%). The following types of neurogenic vesicourethral dysfunctions were found: neurogenic shock in 10 patients (6.5%), lower motor neuron dysfunction in 109 (71.7%), upper motor neuron dysfunction in 22 (14.4%) and mixed motor neuron dysfunction in 11 (7.2%). CONCLUSIONS: The term 'postsurgical vesicourethral neurogenic dysfunction' overcomes the limitations of previous terminology (e.g., iatrogenic neurogenic bladder) since it refers to the neurogenic dysfunction that presents after surgery regardless of the previous study. It is possible to obtain a clinical and urodynamic map of this condition whose etiology can be found fundamentally in disc hernia surgery (neurosurgery) and abdomino-perineal resection of the rectum (digestive surgery).

Adolescent↗

PubMed1997

[Current status of the study of genital sympathetic evoked potentials in the assessment of impotence].

OBJECTIVE: To determine the usefulness of penile sympathetic skin response (PSSR) in the study of impotence. METHODS: The PSSR, hand sympathetic skin response (HSSR), filling videocystography and SPACE (single potential analysis cavernous electromyography) were performed in 39 patients referred for study of impotence. RESULTS: A relationship between not obtaining PSSR and an open bladder neck (60%) in the videocystography at filling, and between a closed bladder neck and obtained PSSR (81%) was demonstrated. The percentage of normal hand sympathetic potentials was similar for patients with obtained and not obtained PSSR. The relationship between the degree of activity of the SPACE and the type of PSSR could not be demonstrated. CONCLUSION: The determination of the PSSR allows us to evaluate the sympathetic cavernous innervation. This would obviate performing a filling videocystography in the study of the neuroandrologic profile in impotence. The information obtained by PSSR is independent of that obtained from SPACE, therefore both procedures complement each other in the neuroandrologic study of impotence.

Electromyography↗

PubMed1997

[Assessment of sensory thresholds of the penile dorsal nerve as screening technique for neurologic lesion in impotence].

OBJECTIVE: The present study was conducted to determine the usefulness of the perception and stimulation thresholds of the penile dorsal nerve in the diagnosis of neurogenic impotence. METHODS: A study was conducted to determine the neuroandrologic profile in 130 patients. According to the results of the neuroandrologic profile, they were classified as patients without neurogenic impotence (44 pts.; 34%) or with neurogenic impotence (86 pts.; 66%). The perception and stimulation thresholds (expressed in milliAmperes) were determined in all patients. Furthermore, the perineal sensation was clinically tested. Both thresholds were also studied in relation to a demonstrated neurologic lesion (sympathetic, parasympathetic, afferent pudendal, efferent pudendal and suprasacral lesions). RESULTS: Assessment of the perineal sensation demonstrated a high specificity and a low sensitivity in the diagnosis of neurogenic impotence. A significant difference was observed between both groups for the perception (confidence interval of difference between the neurogenic and non-neurogenic group; from 0.02 to 4.95 mA) and stimulation thresholds (from 2.0 to 11 mA). Morever, the stimulation threshold was significantly higher in patients with alteration of the perineal sensation). Significant differences in the perception threshold were also demonstrated between patients with and without demonstration of efferent lesion, and in the stimulation threshold between patients with and without demonstration of pudendal afferent, pudendal efferent and sympathetic lesion. These differences are attributed to the presence of mixed lesions. However, given the width of the interval of normal values, it was not possible to find a useful cut-off point in both sensory thresholds. It could only be determined that the maximum value of the perception threshold in healthy subjects should be less than 9.45 mA. CONCLUSION: The sensorial thresholds of the electrical stimulation of the penile dorsal nerve and the data from the physical examination of perineal sensation are not useful for the diagnosis of neurogenic impotence. It is necessary to carry out a complete neuroandrologic profile.

Adult↗

PubMed1997

[Analysis of pudendal nerve somatosensory evoked potentials in the diagnosis of neurogenic impotence].

OBJECTIVE: To determine the utility of the somatosensorial evoked potentials of the pudental nerve in the diagnosis of neurogenic impotence. METHODS: 129 patients with impotence were evaluated by physical examination and neuroandrologic profile. The neuroandrologic profile was assessed by bulbocavernous electromyography, determination of S2-S4 evoked potentials, analysis of the somatosensorial potentials of the pudendal nerve, cavernous smooth muscle electromyography (SPACE), sympathetic skin response and cystometry. RESULTS: The patients with a neurologic lesion presented a significantly longer latency time of the somatosensorial potentials than those with no neurologic lesion. The sensitivity of the somatosensorial potentials was 63% and the specificity was 98%. The sensitivity could be enhanced without significantly lowering specificity by taking 49 msec as the upper limit of normal values in latency time. The determination of the voluntary anal control in the diagnosis of neurogenic impotence was found to have a high specificity (93%), but a low sensitivity (42%). CONCLUSION: The determination of the somatosensorial potentials, unlike other techniques, could allow diagnosis of lesions of the suprasacral inneveration in the evaluation of neurogenic impotence. The evoked somatosensorial potentials of the pudendal nerve and physical examination have the inconvenience of their low sensitivity in regard to the diagnosis of neurogenic lesion in impotence, mainly because some conditions only affect the peripheral autonomic innervation and the somatic element is spared.

Anal Canal↗

PubMed1997

[Evaluation of electromyography of the corpora cavernosa (single potential analysis of cavernous electric activity--SPACE) as a technique for studying impotence].

OBJECTIVE: To analyze the utility of data obtained by single potential analysis of cavernous electric activity (SPACE) in the study of impotence. METHODS: 127 patients with impotence were evaluated by neuroandrologic profile, SPACE, erection test post intracavernous injection of papaverine-phentolamine and a cystometrogram (CMG). RESULTS: The quantitative characteristics (duration, amplitude, number of phases) of the SPACE potentials were not useful in distinguishing between the different types of impotence. The qualitative characteristics (degree of activity, morphology, synchrony and coordination) during erection were significantly different between the non-neurogenic and neurogenic impotence. Significant differences were found in the qualitative characteristics (synchrony and coordination during erection) between patients with no demonstration of organic impotence and those with a negative erection test and no alterations in the neuroandrologic profile (vascular impotence). No relationship was found between the degree of activity of the SPACE and the presence or absence of voiding reflex in the CMG. CONCLUSION: SPACE is a useful technique in the study of impotence, although the interpretation of the data are more qualitative than quantitative. The CMG provides complementary data and should therefore continue to be included in the study of the neuroandrologic profile in impotence.

Adolescent↗

PubMed1997

[Neurobiology of postoperative impotence after rectal excision].

OBJECTIVE: The present study was conducted to determine the changes in the neuro-andrologic profile of patients with impotence following rectal ablative surgery. METHODS/RESULTS: The study comprised 18 patients who had undergone rectal surgery: abdominoperineal resection of the rectum (AP) in 12 cases (67%), anterior resection of the rectum (AR) in 6 cases (33%). The pharmacologic erection test was negative in 60% of the patients (56% of the AP cases and 67% of the RA cases; differences not significant). Sympathetic lesion was demonstrated in 67% of the patients (50% of the AP cases and 100% of the AR cases; significant difference). Parasympathetic lesion was demonstrated in 38% of the patients (56% of the AP and in none of the RA cases; tendency towards statistical significance). Pudendal lesion was demonstrated in 83% of the patients, although no significant differences concerning pudendal involvement were observed between both types of surgery (92% of the AP group and 67% of the RA group). The frequency of the pudendal lesion was significantly greater than the parasympathetic lesion and the sympathetic lesion tended to be significantly greater than the parasympathetic lesion in patients undergoing ablative rectal surgery. No significant differences were observed between the pudendal and the sympathetic lesion in these patients. No relationship was observed between the type of neurologic lesion and the results of the pharmacologic erection test. CONCLUSIONS: The type of neurological lesion appears to be related with the level of the rectal surgery. The sympathetic innervation would be more frequently compromised in anterior resection of the rectum. The parasympathetic innervation would be more frequently compromised in abdominoperineal resection. The pudendal innervation would be affected by both types of surgical techniques.

Aged↗

PubMed1997

[The doxazosin treatment of the changes in the bladder filling phase in benign prostatic hyperplasia].

OBJECTIVE: To analyze the clinical and urodynamic efficacy of treatment with doxazosin during 6 months for bladder filling phase disorders in patients with BPH. METHODS: A prospective clinical and urodynamic study was performed in 65 males with BPH, aged 54-79 years (mean 66.7), who had been treated with doxazosin (4 mg/day) during 6 months. Clinical [International Prostatic Symptom Score (IPSS)] and urodynamic evaluations (cystometry and filling cystography) before and after treatment were performed. IPSS data were obtained according to the WHO recommendation following validation and translation into Spanish. RESULTS: The IPSS score improved significantly from 19.8 +/- 4.8 before treatment to 11.9 +/- 4.6 after treatment (p < 0.001). All the patients were normotensive before and after treatment (systolic and diastolic blood pressures 135.9/78.9 and 135.4/77.8 mmHg, respectively). No tachycardia was observed before (71.9 +/- 5.8) or after treatment (71.8 +/- 5.9). A relationship between the lower IPSS before treatment and urinary symptoms improvement was demonstrated (coef.-0.45939). We found no relationship between prostate volume (digital rectal examination or transabdominal ultrasonography) and IPSS modifications after treatment. Bladder instability decreased significantly from 71.6% before treatment to 33.3% after treatment (p < 0.01). Instability pressure also diminished from 99.2 cms H2O to 60.3 cms H2O after doxazosin treatment (p < 0.001). We found no significant relationship between IPSS and bladder instability post-treatment. CONCLUSIONS: Adrenergic blockade with doxazosin 4 mg/day for 6 months achieves a significant decrease in the bladder instability associated with prostatic obstruction in patients with BPH, although no statistical correlation with the IPSS could be demonstrated.

Adrenergic alpha-Antagonists↗

PubMed1997

[Doxazosin treatment of disorders of the voiding phase in benign prostatic hyperplasia].

OBJECTIVE: To analyze the clinical and urodynamic efficacy of treatment with doxazosin during 6 months for voiding phase disorders in patients with BPH. METHODS: A prospective clinical and urodynamic study (before and after treatment) was performed in 65 consecutive male patients with BPH, aged 54-79 years (mean 66.7), to evaluate the results of treatment with doxazosin 4 mg/day during 6 months. Clinical evaluation included patient history and the International Prostatic Symptom Score (IPSS) and urodynamic evaluation included uroflowmetry with post-void residual data and pressure-flow test. A static urethral pressure profile was associated with the urodynamic voiding study. RESULTS: The IPSS score improved significantly from 19.8 +/- 4.8 before treatment to 11.9 +/- 4.6 after treatment (p < 0.001). Urinary symptoms improved significantly more markedly after treatment (coeff. -0.45939) in patients with a lower IPSS score. The symptomatic improvement demonstrated by the IPSS did not correlate with the DRE or the transabdominal US prostatic volume. Mean maximum flow rate before treatment was 9.13 ml/sec and increased to 16.23 ml/sec after treatment (p < 0.01). Postvoid residual dropped from 21.7% to 12.5% (p < 0.01). In the pressure-flow test, foot-point PURR dropped significantly from 69 cms H2O to 45.9 cms H2O (p < 0.001). The PURR curvature diminished from 0.27416 to 0.15964 cms H2O (ml/sec2) (p < 0.01). A statistically significant improvement of the compressive (p < 0.001) and constrictive (p < 0.05) elements of lower urinary tract obstruction was observed. The urethral functional length of the urethral profile showed a significant reduction (pre-treatment: 5.56 cms; post-treatment 4.31 cms) (p < 0.05). A statistical correlation was found between the urethral functional length and the foot-point PURR post-treatment. CONCLUSIONS: Adrenergic blockade with doxazosin reduces both the compressive and constrictive elements of lower urinary tract obstruction in the voiding phase in patients with BPH, although no statistical correlation with the IPSS could be demonstrated.

Adrenergic alpha-Antagonists↗

PubMed1997

[Usefulness of electromyographic techniques of the bulbocavernosus muscle in the diagnosis of neurogenic impotence].

OBJECTIVE: To analyze the utility of electromyographic study of the bulbocavernosus muscle. METHODS: 126 impotent patients were evaluated by physical examination and neuroandrologic profile. The physical examination consisted in an exploration of the anal tone and the bulbocavernosus reflex. The neuroandrologic profile consisted in selective electromyography of the bulbocavernosus muscle, the determination of the S2-S4 evoked potentials, somatosensory potential of the pudenal nerve, electromyography of cavernous smooth muscle (SPACE) sympathetic skin response and cystometry. RESULTS: The results of the bulbocavernosus electromyography and S2-S4 evoked potentials were different from the data obtained from the physical examination of the anal tone and the bulbocavernosus reflex. Selective bulbocavernosus electromyography showed a sensitivity of 57% and a specificity of 84%. The S2-S4 evoked potentials showed a sensitivity of 61% and a specificity of 100%. The diagnostic value of the S2-S4 evoked potentials increased at 39 msec cutoff (sensitivity = 66%; specificity = 95%). Exploration of the anal tone is very specific for neurologic lesion in impotence (93%), but has a low sensitivity (30%). The clinical bulbocavernosus reflex showed a good specificity (85%) and sensitivity (75%) in the diagnosis of pudendal efferent lesion, but is less useful in the diagnosis of neurogenic impotence. CONCLUSIONS: The highest diagnostic value was obtained with the S2-S4 evoked potentials. Selective electromyography of the bulbocavernosus muscle showed a moderate diagnostic value. Physical examination of peripheral pudendal innervation does not appear to be useful for screening for neurologic lesion in impotence because of its low sensitivity, which may be due to existing incomplete nervous lesions.

Autonomic Nervous System Diseases↗

PubMed1996

[Usefulness of DURR (dynamic urethral resistance factor) in the study of prostatism].

OBJECTIVES: To determine the utility of the DURR (dynamic urethral resistance factor) in the evaluation of prostatism. METHODS: 248 patients with prostatism were evaluated by the detrusor pressure-flow rate test, perineal and periurethral EMG and voiding videocystography. The Audit software program was utilized to process the data from the pressure-flow studies to obtain the parameters for urethral resistance (PURR), bladder contractibility (Wmax) and DURR. RESULTS: The presence of DURR correlated significantly with abdominal voiding pressure and voluntary voiding, and constrictive obstruction, although a higher incidence of stenosis in patients with a positive DURR was not demonstrable on videocystography. No correlation was observed between EMG activity and a positive DURR. CONCLUSIONS: A positive DURR indicates the effect of active urethral resistance changes on the voiding dynamics. These active changes can be caused by contraction of the periurethral muscles (EMG activity), although not all of the cases showing EMG activity have a positive DURR. Furthermore, in some DURR positive cases, the EMG is silent, indicating that the urethral smooth muscles are involved in the active changes of urethral resistance. The DURR data do not always coincide with the perineal EMG findings and therefore do not supplant each other.

Aged↗

PubMed1996

[Clinical results of the treatment of urinary incontinence with peripheral electric stimulation].

A series of 126 patients, 98 women (78%) and 29 male (22%), average 50.2 years old, with different types of urinary incontinence (incontinence at cough, urge-incontinence, post-prostatectomy incontinence and nocturnal enuresis), has been treated with periferic electrostimulation to evaluate the clinical value of this type of treatment. Extrahospitalary management with electrostimulation by vaginal in 39 cases (30.9%) or rectal in 87 cases (69.1%) electrodes was performed. Frequencies has been different in urge-incontinence (10 Hz) and urinary incontinence at coughing (50 Hz). Average treatment duration was 3.3 months. Incontinence intensity decreased significantly with electrostimulation treatment (51-62%). Non statistical differences between other parameters (age, sex, clinical features, clinical incompetence type, cistocele grade) was observed. Positive results in larger period treatment (over 3 months) was obtained (p < 0.005). Best results were obtained with 10 Hz and 50 Hz frequencies (p < 0.05). Therapeutic results, good tolerance (89%), easy application for the patient and absence of secondary effects could made electrostimulation as an alternative therapy in all type of urinary incontinence.

Adolescent↗