Biomedical subjects

Miguel Vírseda Chamorro

Publications and source records attributed to Miguel Vírseda Chamorro.

13 recordsLinked to original sources

PubMed2006

[Urodynamic factors associated to vesicoureteral reflux in adults].

OBJECTIVES: Lower urinary tract dysfunction may affect the upper urinary tract with development of vesicoureteral reflux. The objective of our study is to evaluate what lower urinary tract dysfunctions are associated with vesicoureteral reflux in adults. METHODS: We performed a cross-sectional study in a sample of 236 patients (149 males and 87 females) with a mean age of 45.5 yr. (typical deviation 19.0 yr.) submitted for videourodynamic study for lower urinary tract functional symptoms. History and neurourologic physical examination, filling cystometry associated with videocystography, pressure/flow study associated with voiding videocystography and selective electromyography of the periurethral sphincter were done in all patients. The chi-square test was used for statistical analysis. RESULTS: The presence of vesicoureteral reflux was observed in 19 patients (8.1% of the sample). Fifteen cases (79%) showed reflux during the filling phase, 3 cases (16%) during the voiding phase, and in 1 (5%) in both. The existence of a vesicourethral neurogenic dysfunction was confirmed in 8 cases (42%); there was no neurogenic dysfunction in 11 cases (58%). The vesicoureteral reflux was classified as primary passive (without any urodynamic anomaly) in one case (5%), passive with diminished compliance in 4 cases (21%), passive evolutive in 3 cases (16%), active involuntary in 7 cases (38%), active associated with organic obstruction of the lower urinary tract in one case (5%), active associated with increased contractile potency in one case (5%), and secondary to abdominal press in 2 cases (10%). The only urodynamic anomalies associated with a significant increase of the prevalence of vesicoureteral reflux were: a filling pressure at maximum capacity greater than 12.5 H2O cm (prevalence of reflux 7 times) and voiding with abdominal press which increased the prevalence of reflux 2.8 times. CONCLUSIONS: Most patients with functional symptoms of the lower urinary tract and associated vesicoureteral reflux present lower urinary tract dysfunctions that may justify their reflux. Nevertheless, a statistically significant increase of the prevalence of vesicoureteral reflux was only found in patients with filling pressures at maximum capacity greater than 12.5 cm H2O and those voiding with the help of abdominal press.

Cross-Sectional Studies↗

PubMed2005

[The usefulness of clinical history for the diagnosis of lower urinary tract obstruction in patients with acute urinary retention].

OBJECTIVES: To determine the diagnostic usefulness of data provided by clinical history for the diagnosis of lower urinary tract obstruction in patients with acute urinary retention. METHODS: We performed a transversal study in a series of 70 patients (19 women and 51 men) with a mean age of 61.5 years (typical deviation 20.7 years), who underwent urodynamic study due to acute urinary retention. Past medical history was recorded in all patients. Physical exam was also carried out, evaluating prostate size in males, presence of genital prolapse in females, and neurourological examination. Urodynamic tests consisted on flowmetry, pressure/flow studies with simultaneous perineal electromyography, and voiding cystourethrogram or videocystogram. Student's t mean comparison and chi-square tests were used for the statistical analysis. RESULTS: The only clinical data that showed a statistically significant relationship with obstruction of the lower urinary tract were: age, sex, prostate size, and existence of infrasacral neurological lesion (absence of bulbocavernous reflex). Age > 74 years showed a sensitivity of 71 % for lower urinary tract obstruction and a specificity of 60%. Male sex showed a sensitivity of 88% and specificity of 36%. Prostate size > or ='3d grade II sensitivity was 58% and specificity 82%; and absence of infrasacral lesion a sensitivity of 77% and specificity of 48%. CONCLUSIONS: Provided that a negative result in a test with high sensitivity makes the likelihood of disease low, in women the presence of infrasacral neurogenic dysfunction or age < or ='3d74 years diminish the probability of obstruction in patients with acute urinary retention. On the other side, if a negative result of a test with high specificity increases the probability of having the disease, a prostate size > or ='3d grade II and age > 74 years favour the likelihood of having urinary tract obstruction for a patient with acute urinary retention.

Cross-Sectional Studies↗

PubMed2005

[Filling phase abnomalities and cystocele].

OBJECTIVES: To evaluate the clinical and urodynamic characteristics of a series of women with lower urinary tract symptoms (bladder filling phase) presenting various rates of cystocele. METHODS: 119 female patients were included in this study; mean age was 55.8 yr. (range 15-87). All patients underwent urogynecologic physical examination (cystocele was graded 0-3) and complete urodynamic study. Urodynamic terminology and measurements comply with the ICS (InternationaL Continence Society) standards. Statistical significance was established below 0.05. Quantitative variables were compared by the Student's t and non parametric variables by Pearson's chi-square. RESULTS: The most frequently reported symptom was urinary incontinence when coughing (77/118, 65.3%), followed by urge incontinence (71 patients, 60.2%). The grade of cystocele was 0 in 31.1%, 1 in 25.2%, and 2 in 26.1%, and 3 in 17.6%. There was a statistically significant association between grade of cystocele and the symptom "vaginal bulge" (p=0.00002). The presence of cystocele did not show any statistical association with lower urinary tract symptoms of the filling phase. Mean cystomanometric bladder capacity was 224.8 ml. Involuntary contractions of the detrusor muscle appeared in 38 cases (21.9%), stress urinary incontinence in 19 (16%), mixed incontinence in 8 (6.7%) and absence of evidence of urinary incontinence in 58 (48.7%). Patients with urgency had a lower bladder capacity than patients without it (p = 0.02), as did patients with urge incontinence (p = 0.02). Nocturia (p = 0.05), urgency (p = 0.02) and urge incontinence (p = 0.01) were significantly associated to bladder capacity. The existence of involuntary contractions was statistically associated with urge incontinence (p = 0.01). Patients with involuntary contractions during the filling phase showed increased diurnal voiding frequency (p = 0.02), as well as patients without a stress urinary incontinence (p = 0.04) and cases without a stress urinary incontinence (p = 0.04). The symptom incontinence with coughing had a significant statistical association with the urodynamic diagnosis of stress urinary incontinence (p= 0.01). Bladder capacity was augmented in grade 3 cystocele (p = 0.003). The existence of cystocele was not associated with bladder hyperactivity (p = 0.65), neither was the diagnosis of a stress urinary incontinence (p = 0.37). CONCLUSIONS: No relationship has been demonstrated between existence and degree of cystocele and functional lower urinary tract symptoms of the filling phase, on the one hand, and urodynamic evidence of bladder hyperactivity and incontinence on the other hand. This could have important therapeutic implications.

Adolescent↗

PubMed2005

[Factors for voiding dysfunction and cystocele].

OBJECTIVES: To evaluate the clinical and urodynamic features of a series of women with post void residual urine (disbalanced voiding) and various degrees of associated cystocele. METHODS: 119 female patients were studied by clinical evaluation, urodynamics, and imaging tests (VCUG). All patients underwent history and genitourological examination (evaluating cystoceles from grade o to 3), neuro-urological examination, and complete urodynamic study. Fifty patients (42%) underwent radiological studies of the upper urinary tract. Disbalanced voiding was defined as existence of post void residual greater than 20% of the voided volume. Urethral resistance was measured by URA. Structural obstruction was characterized by PURR (CHESS classification). Functional obstruction was studied by DURR and perineal EMG (associated with flowmetry). Detrusor contractile power was evaluated by W max, W 80-20, and duration of contraction. Urodynamic terminology and measurements complied with the International Continence Society (ICS) standards. Statistical significance was established at 0.05. Statistical analysis was done by Student's t for quantitative variables, and Pearson's chi-square for non parametric variables. RESULTS: 119 patients were enrolled. Mean age was 55.84 yr. (range 15-87). Regarding post void residual (114 valid uroflowmetry studies), 25 patients were classified as voiding disbalance (21.9%) and 89 as balanced (74.8%). Regarding clinical data, there were only significant differences between groups in voiding difficulty. For uroflowmetry, only the percentile of the Maximal flow (Qmax) showed significant differences (35 vs. 22 for balanced/disbalanced voiding respectively, p = 0.02). Pressure/volume studies demonstrated bladder hyperactivity in 16 cases (64%) in the group of disbalanced voiding and 31 cases (34.8%) in the normal voiding group (p = 0.008), which presented associated with increased urethral resistance (URA)(p = 0.01) . In the pressure/flow study, there were significant differences in the URA (14.7 vs. 25.3, p = 0.001). There were statistically significant differences in the degree of constrictive (0.5 vs. 1.1, p = 0.009) and compressive (0.5 vs. 1.1; p = 0.04) obstruction (Chess classification). There were not significant differences in the analysis of isometric contractility (Wmax), but there were in the isotonic contractility (W80-20) and detrusor contraction duration. These latter differences presented significant association with the degree of cystocele. DURR and perineal EMG data did not show differences between groups. Radiological abnormalities of urethral morphology were statistically different between groups, presenting in 10% of the patients with normal voiding and 50% of the disbalanced voiding group, although there was not statistical association with obstruction (p = 0.64). The existence of cystocele did not show a statistical association with these variables either. CONCLUSIONS: Disbalanced voiding appeared with organic obstruction of the lower urinary tract (constrictive most significantly), as well as detrusor abnormal contractility, but whereas the first was not significantly associated with presence and grade of cystocele, the second showed such association.

Adolescent↗

PubMed2005

[Testicular tumors: association between preoperative clinical, radiological and immuno-serological factors, and histology and stage].

OBJECTIVES: To evaluate and quantify the association between clinical, ultrasound and immunoserological data and histologic type and stage of testicular tumors. METHODS: We analyze a cohort of 80 patients who underwent orchiectomy for testicular neoplasia. Mean patient age was 30.4 years. Past medical history, first symptoms, time from first symptom to operation, physical examination and ultrasound data, and preoperative serum levels of alpha-fetoprotein and beta HCG were retrospectively collected. RESULTS: Patients with non seminomatous germ cell tumor (NSGCT) had a significantly lower mean age (23.7 yr.) than patients with pure seminoma (41.3 yr.), and these latter a significantly lower age than patients with non germinal tumors (50.7 yr.). Initial presentation with general malaise or lumbar pain increased 2.56 times the relative risk of having a tumor in advanced stage (higher than stage I) . Presence of gynecomastia increased 16.5 times the relative risk of having a non germ cell tumor, due to the inclusion of Leydig's tumors in this group. Detection of heterogeneous nodules by ultrasound increased 4.5 times the risk of having a non seminomatous germ cell tumor. Preoperative elevation of alpha-fetoprotein ruled out the existence of seminoma and non germ cell tumor; whereas preoperative elevation of beta HCG increased 3.21 times the risk of having a non seminomatous germ cell tumor. No significant association was shown between preoperative tumor markers and tumor stage. CONCLUSIONS: The existence of gynecomastia, age, detection of heterogeneous nodules on ultrasound, and preoperative alpha-fetoprotein and beta HCG are relevant data in relation to histological type of tumor. Lumbar pain or malaise are clinical data associated with tumor stage.

Adult↗

PubMed2004

[Fuzzy logic in urology. How to reason in inaccurate terms].

The Occidental thinking is basically binary, based on opposites. The classic logic constitutes a systematization of these thinking. The methods of pure sciences such as physics are based on systematic measurement, analysis and synthesis. Nature is described by deterministic differential equations this way. Medical knowledge does not adjust well to deterministic equations of physics so that probability methods are employed. However, this method is not free of problems, both theoretical and practical, so that it is not often possible even to know with certainty the probabilities of most events. On the other hand, the application of binary logic to medicine in general, and to urology particularly, finds serious difficulties such as the imprecise character of the definition of most diseases and the uncertainty associated with most medical acts. These are responsible for the fact that many medical recommendations are made using a literary language which is inaccurate, inconsistent and incoherent. The blurred logic is a way of reasoning coherently using inaccurate concepts. This logic was proposed by Lofti Zadeh in 1965 and it is based in two principles: the theory of blurred conjuncts and the use of blurred rules. A blurred conjunct is one the elements of which have a degree of belonging between 0 and 1. Each blurred conjunct is associated with an inaccurate property or linguistic variable. Blurred rules use the principles of classic logic adapted to blurred conjuncts taking the degree of belonging of each element to the blurred conjunct of reference as the value of truth. Blurred logic allows to do coherent urologic recommendations (i.e. what patient is the performance of PSA indicated in?, what to do in the face of an elevated PSA?), or to perform diagnosis adapted to the uncertainty of diagnostic tests (e.g. data obtained from pressure flow studies in females).

Fuzzy Logic↗

PubMed2003

[Bayesian methodology: an alternative to regular medical practice].

The Bayes theorem provides a formula to calculate the probability of an event to occur conditioned by the occurrence of an anterior one (conditioned probability). In medicine it has been applied to calculate the probability of suffering a disease when having a positive result in a given test. This formula emphasizes the importance of prevalence of a disease (or a priori probability of the positive predictive value of a diagnostic test). The novelty of applying the bayesian methodology in clinical practice results from taking into consideration previous external information (or "a priori probability"), and to calculate how it is modified by the evidence (or "verisimilitude") provided by certain empirical tests, to obtain a new probability conditioned by the empirical evidence (or "a posteriori probability"). It also allows to perform sequential analysis (repeated observation of a given event a number of times not fixed in advance) and to incorporate the subjective probabilities to the reasoning. Some authors have proposed the use of bayesian methodology in research studies, such as clinical trials. Nevertheless, this methodology does not adapt well to this kind of reasoning which is hypothetical-deductive.

Bayes Theorem↗

PubMed2002

[Urodynamic assessment of the voiding phase in childhood].

OBJECTIVE: To determine the more useful parameters of urethral resistance and bladder contractile power to explain the values of maximum flow and postvoid residual urine observed in free uroflowmetry and appropriately assess the voiding dynamics in childhood. METHODS: A cross-sectional study was carried out in 68 children (46 girls and 22 boys) with a mean age of 8.9 years. These children were subjected to free uroflowmetry in order to determine the maximum flow rate and the postvoid residual urine, and to a complete urodynamic study with perineal surface electromyography in order to determine the parameters of urethral resistance and bladder contractile power. A univariate linear regression model was built from these parameters for explanatory purposes. The independent variables were the parameters of the urodynamic study and the outcome variables were the value of the maximum flow in the free uroflowmetry and the proportion of postvoid residual urine in relation to the voiding volume of the free uroflowmetry. The resulting models were validated in order to determine its loss of predicting power (shrinkage). For this purpose, we used two other independent series: one comprised 50 patients (34 girls and 16 boys) extracted from the same sample as the derived model, and the other comprised 85 patients (53 girls and 32 boys) from another population. RESULTS: The multivariate model demonstrated that the maximum flow of the free uroflowmetry has a direct relationship with the square root of the voiding volume and the bladder contractile power [measured by Schafer's projected isometric pressure (PIP)] and an inverse relationship with the urethral resistance measured by means of a parameter (URA) and with the presence of electromyographic perineal activity (EMG) during voiding. Similarly, the proportion of postvoid residual urine has a direct relationship with the urethral resistance (measured by means of the parameter URA) and with the inverse function of the projected isometric pressure (I/PIP). The shrinkage of the multivariate models, when compared with other series, ranged from 26.9% and 1.3%. CONCLUSIONS: The urodynamic evaluation of the lower urinary tract in childhood can be carried out appropriately by means of the determination of the urethral resistance by the parameter URA and of the bladder contractile power by the projected isometric pressure (PIP), obtaining as a limit of normal values a URA of 16 cm H2O and a PIP of 105 cm H2O.

Adolescent↗

PubMed2002

[Involvement of bladder neck and periurethral sphincter in dyssynergia in patients with spinal cord injury].

OBJECTIVE: To determine the degree of association of detrusor-periurethral dyssynergia and detrusor-bladder neck dyssynergia and if the voiding periurethral electromyographic (EMG) activity is also a valid method for diagnosing detrusor-bladder neck dyssynergia. METHODS: A clinical, videourodynamic and selective periurethral EMG study was performed in 24 patients (mean age 33 years) with spinal cord injury and hyperreflexia of the bladder. RESULTS: The prevalence of bladder neck dyssynergia was 12.5% (3 cases) in this series. All patients with dyssynergic bladder neck also showed intermittent or sustained periurethral sphincter EMG activity. However, 15 patients showed increased intermittent or sustained voiding periurethral EMG activity that was not associated with detrusor-bladder neck dyssynergia. Utilizing the videourodynamic demonstration of detrusor-bladder neck dyssynergia as reference, selective periurethral EMG showed a sensitivity of 100% and a specificity of 29% for the diagnosis of detrusor-bladder neck dyssynergia. CONCLUSIONS: The finding of bladder neck dyssynergia indicates the existence of detrusor-periurethral dyssynergia. However, not all cases of detrusor-periurethral sphincter dyssynergia is associated with bladder neck dyssynergia; therefore a videourodynamic study should be performed to rule out bladder neck dyssynergia in those patients with detrusor-periurethral sphincter dyssynergia. This is important in making the differential diagnosis and also has significant therapeutic repercussions.

Adult↗

PubMed2002

[Meta-analysis of the efficacy of perineal rehabilitation for the treatment of female urinary stress incontinence].

OBJECTIVE: To determine with the highest level of evidence the efficacy of pelvic floor rehabilitation in the treatment of stress urinary incontinence in women. METHODS: A systematic search was performed in the MEDLINE electronic database with the purpose to find randomised and controlled clinical trials evaluating the efficacy of pelvic floor rehabilitation in the treatment of stress urinary incontinence. A quantitative metanalysis was performed then by the Logit method combining the results from these studies to obtain an Odds ratio (OR) with its confidence interval. Moreover, it was determined the heterogeneity of the studies included in metanalysis by calculus of the Cochrane Q component. RESULTS: 8 randomised controlled clinical trials matched the inclusion criteria. Global OR resulting from the combination of these studies was 7.03 (Confidence interval 4.99-9.89). Nevertheless, the heterogeneity of the studies was significant, secondary among other circumstances to the fact that these studies did not establish the difference between improvement and cure clearly. CONCLUSIONS: The heterogeneity of the studies does not allow to state after metanalysis (maximum level of scientific evidence) that pelvic floor rehabilitation is effective in the treatment of woman's stress urinary incontinence. Nevertheless two randomised controlled studies were found confirming that rehabilitation cures woman's stress urinary incontinence, from which there is good scientific evidence in favour of this treatment.

Adult↗

PubMedDate not supplied

[May the Blaivas and Groutz nomogram substitute videourodynamic studies in the diagnosis of female lower urinary tract obstruction?].

OBJECTIVES: To compare the results of the Blaivas and Groutz nomogram in the diagnosis of female urinary obstruction with videourodynamic tests. METHODS: We performed a transverse study in a series of 52 female patients with ages between 20 and 81 years (mean age: 48.7 years; standard deviation: 14.4 years) and functional lower urinary tract symptoms referred for videourodynamic studies. All patients underwent free flowmetry and voiding videourodynamic study. From the scores of free flowmetry and maximum detrusor pressure in the detrusor pressure/voiding flow test of the urodynamic study they were classified in one of four categories following the Blaivas and Groutz nomogram. Following urodynamic data they were classified into three categories: absence of obstruction, bladder neck obstruction and urethral obstruction. The nomogram results were compared with the videourodynamic data using the Pearson chi-square statistical test. The diagnostic sensitivity and specificity of the nomogram were also determined. RESULTS: The Blaivas and Groutz nomogram showed a significant association with the videourodynamic data (p = 0.000). Its diagnostic sensitivity for obstruction was 100%, but its specificity was only 67.5%. The percentage of diagnostic discrepancies was maximal in the mild obstruction, where one third of the patients were obstructed following the videourodynamic data. CONCLUSIONS: The Blaivas and Groutz nomogram is a sensitive method for the diagnosis of obstruction, but its specificity is low so that it has the tendency to overdiagnose the presence of obstruction in the female patient.

Adult↗

PubMedDate not supplied

[New contributions of the usefulness of electromyography of cavernous bodies in the diagnosis of erectile dysfunction].

OBJECTIVES: To test the concordance between clinical and neurophysiologic data of the various types of erectile dysfunction, and to describe a diagnostic algorithm based on corpus cavernosum electromyography (cc-EMG). METHODS: 32 patients with a mean age of 50.6 years (typical deviation 13.2 years) referred with the diagnosis of erectile dysfunction underwent medical history, neuroandrologic physical exam, neurophysiologic studies (bulbocavernous muscle electromyography, S2-S4 latency period, threshold and latency of pudendal nerve somatosensory potentials, as well as genital sympathetic evoked potentials-SSR-), and corpus cavernosum electromyography(cc-EMG) both in basal conditions and after administration of 20 micrograms of E-1 prostaglandin (PGE-1). RESULTS: 1--A significative relationship was shown between clinical data of arterial or corpus cavernosum intrinsic origin erectile dysfunction and patients with vascular or structural lesion on cc-EMG data. 2--A significative relationship was shown between patients without previous pathologic history and patients with normal or anxiety cc-EMG. 3--No significative relationship was shown between patients with neurologic lesion and patients with autonomic lesion on cc-EMG. 4--No significative relationship was found between patients with peripheric neurologic lesion and patients with inferior autonomic lesion on cc-EMG. 5--A significative relationship was shown between patients with suprasacral neurologic lesion and patients with superior autonomical lesion on cc-EMG. CONCLUSIONS: Isolated application of pudendal nerve neurophysiologic techniques for the diagnosis of erectile dysfunction is not enough. Autonomic innervation studies should be included, with a cc-EMG dichotomic qualitative interpretation.

Algorithms↗

PubMedDate not supplied

[Prospective study of the therapeutic usefulness and safety of a new disposable intraurethral occlusive device (Uriabsorber) for female stress urinary incontinence].

OBJECTIVES: To determine the therapeutic usefulness and side effects of a new disposable intraurethral device (Uriabsorber) for female stress urinary incontinence. METHODS: A prospective study was performed in a cohort of 48 women (mean age 42.7 yr.) consulting because of urinary incontinence with coughing. Lack of manual ability or difficulty to understand, pregnancy, puerperium, vaginitis, urinary tract infection and current administration of active treatment for urinary incontinence were all exclusion criteria. Patients were instructed about the use of the device. Two visits were performed: one after two weeks and the other at the end of the month. Clinical results were collected and urine analysis was performed. A multivariate statistical analysis was performed to determine what variables influenced the final result. RESULTS: Treatment withdrawal rate was 42% after one month, being most withdrawals before 14 days (19 cases, 40%). The causes of withdrawal were local discomfort (11 cases, 23%) and difficult insertion (3 cases, 6%). There were only five cases (10%) of urinary tract infection, and two cases (4%) of macroscopic hematuria. The presence of cystocele was associated with higher frequency of complications (80%). 79% of the patients completing the month of treatment had positive results (50% resolution of incontinence and 29% improvement). Multivariate statistical analysis showed that variables independently influencing the results were: incontinence intensity (the lower the intensity, the better the results), presence of urinary tract symptoms (the lower the intensity of the symptoms, the better the results), and absence of past history of pathology. CONCLUSIONS: The intraurethral disposable device significantly reduces the rate of urinary tract infections. Tolerance depends on the ability and motivation of the patients. It is indicated in the control of non intense urinary incontinence in motivated patients, without evident cystocele.

Adult↗