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INTRODUCTION AND OBJECTIVES: A Consensus document on the management of patients with neurogenic detrusor overactivity (NDO) was published in 2018. The present document aims to update its recommendations regarding treatment considering the new evidence available, and to contribute to the standardization of the management of this disorder. METHODS: The methodology used was based on a systematic review and the Nominal Group Technique. The clinical coordinator (CC) and the Consensus update group (CUG) defined the questions to be updated and carried out a systematic review to identify the new available evidence. After being evaluated by the expert panel, the relevant recommendations were updated and agreed in a consensus meeting. RESULTS: A total of 3210 publications were identified and 26 publications that met the inclusion criteria were included. The CUG updated 18 recommendations on the therapeutic approach to NDO. Unanimous consensus was reached on all of them. CONCLUSIONS: Previous recommendations need to be revised due to the availability of new drugs, the increasing evidence on the use of botulinum toxin or neuromodulation procedures, and new surgical options.
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BACKGROUND: Neurogenic detrusor hyperactivity (NDH) is a urodynamic observation characterised by involuntary detrusor contractions during the filling phase that are caused by an underlying neurological disease. The common and severe complications that can result from NDH warrant the preparation of healthcare protocols for the proper management of patients with NDH. OBJECTIVE: The aim of this study is to standardise the criteria for the decision-making process in the management of patients with diagnosed or suspected NDH, providing personalised medical care. ACQUISITION OF EVIDENCE: We performed a systematic noncomprehensive literature review on the aspects of the diagnosis and treatment of NDH. Based on the review, recommendations were issued by nominal consensus of a group of urology specialists. SYNTHESIS OF THE EVIDENCE: In general, the diagnosis of NDH is arrived at by a proper review of the medical history, physical examination and voiding diary before performing any diagnostic study. The main treatment objectives are to protect the upper urinary tract, restore function of the lower tract and improve these patients' continence and quality of life. The treatment consists of several steps aimed at obtaining proper bladder storage that allows for sufficiently spaced voidings. The follow-up should be personalised based on each patient's needs. CONCLUSIONS: The identification and management of NDH is important for positively redirecting the function of the lower urinary tract, in terms of filling and voiding, thereby improving the patients' quality of life.
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Vejiga Urinaria Hiperactiva/diagnóstico , Vejiga Urinaria Hiperactiva/terapia , Biorretroalimentación Psicológica , Manejo de la Enfermedad , Medicina Basada en la Evidencia , Terapia por Ejercicio , Humanos , Guías de Práctica Clínica como Asunto , Factores de Riesgo , Estimulación Eléctrica Transcutánea del Nervio , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Vejiga Urinaria Hiperactiva/fisiopatología , UrodinámicaRESUMEN
INTRODUCTION: Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) and other bladder pathologies share common manifestations, such as the presence of mictional symptoms and a negative impact on the patient's quality of life. To be properly diagnosed and clinically managed, it is important to distinguish between its clinical modalities and diagnostic criteria for adequate exclusion. OBJECTIVE: The purpose of this study was to standardize criteria for making decisions in BPS management, for its diagnosis, initial treatment and follow-up. MATERIAL AND METHOD: A nominal group methodology was employed, using scientific evidence on BPS taken from a systematic (non-exhaustive) literature review for developing recommendations along with specialist expert opinions. RESULTS: The diagnosis of BPS should be made based on the patient's clinical history, with emphasis on pain and mictional symptoms as well as excluding other pathologies with similar symptomatology. BPS treatment should be directed towards restoring normal bladder function, preventing symptom relapse and improving patients' quality of life. It is therefore advisable to start with conservative treatment and to adopt less conservative treatments as the level of clinical severity increases. It is also recommended to abandon ineffective treatments and reconsider other therapeutic options. CONCLUSIONS: Quickly identifying the pathology is important when trying to positively influence morbidity and care quality for these patients.
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Cistitis Intersticial/diagnóstico , Cistitis Intersticial/terapia , HumanosRESUMEN
INTRODUCTION: The clinical manifestations of urinary infections, commonly mild and uncomplicated, have resulted in a generally empirical therapeutic decision-making process, which does not help fight resistances to antibacterial agents, thus causing a high rate of recurrence. OBJECTIVE: This study seeks to reduce the clinical variability in the diagnosis and treatment of uncomplicated recurrent urinary tract infections (RUTIs). MATERIAL AND METHOD: The consensus document was developed using a nominal group methodology, using scientific evidence on RUTIs extracted from a systematic (noncomprehensive) literature review, along with the expert judgment of specialists and their experience in clinical practice. RESULTS: RUTIs are considered the manifestation of at least 3 episodes of uncomplicated infection, with a positive culture in the past 12 months, in addition to (for men) the absence of structural or functional abnormalities. We maintain that the treatment should be empiric when suspecting RUTIs (prior to obtaining a urine sample for culture) in those patients who have a high probability of recurrence, associated risk factors and/or urinary or general symptoms, such as fever and chills. Homogeneous criteria are recommended for the diagnosis and treatment in order to fight the increased rates of resistance that the microorganisms develop against antimicrobial agents. CONCLUSION: Imprecision in the identification of the infection requires a search for agreements on homogenized criteria and decision algorithms that guide the management of these patients.
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Infecciones Urinarias , Adulto , Antibacterianos/uso terapéutico , Bacteriuria/diagnóstico , Infecciones Relacionadas con Catéteres/etiología , Cistitis/diagnóstico , Cistitis/tratamiento farmacológico , Manejo de la Enfermedad , Femenino , Humanos , Higiene , Masculino , Educación del Paciente como Asunto , Embarazo , Complicaciones Infecciosas del Embarazo , Recurrencia , Derivación y Consulta , España , Urinálisis , Cateterismo Urinario/efectos adversos , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/microbiología , Infecciones Urinarias/prevención & control , Infecciones Urinarias/terapia , UrodinámicaRESUMEN
OBJECTIVE: To determine the usefulness of different urodynamic data and their relationship. METHODS: 105 adult males with prostatism were evaluated urodynamically. Data were obtained utilizing the Abrhams and Griffiths and the Schaeffer models. RESULTS: Our results show that the urinary flow rate correlates directly with bladder contractibility and inversely with the urethral resistance parameters. CONCLUSIONS: The urethral resistance was produced by two independent factors: a factor which resists initiation of voiding, measured by the opening pressure according to the Schaeffer model; a second factor which opposes maintenance of voiding, measured by the PURR curvature of the Schaeffer model and by the slope of the Abrhams and Griffiths model. Bladder contractibility was related to pressure at maximum flow rate of the Schaeffer model.
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Hiperplasia Prostática/fisiopatología , Urodinámica , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Comparative analysis of PSA values measured by MEIA and ELSA techniques in a group of 70 unselected patients. A good correlation was observed between PSA levels determined by ELSA-PSA immunoradiometric techniques and those obtained by MEIA-PSA (r = 0.93, p < 0.00001). However, ELSA-PSA values have been 1.73 +/- 0.1 times higher than those by MEIA-PSA. A mean-paired comparison indicates that PSA mean levels (0.48 +/- 0.07 and 0.29 +/- 0.05 for ELSA and MEIA, respectively) are significantly different and define two groups of nonhomogeneous values (p < 0.0001). The same results are obtained when patients with PSA values higher and lower than 4 ng/ml are analyzed separately. For patients with PSA lower than 1 ng/ml, the difference between mean ELSA-PSA and MEIA-PSA values disappears; 0.74 +/- 0.08 vs 0.62 +/- 0.05, respectively (p > 0.1). In this group, the results from both assays are statistically consistent. When considering the group of patients with PSA < 1 ng/ml, no difference between both techniques becomes apparent, which seems to indicate the absence of differences in sensitivity between both techniques when considering low levels of serum PSA. Nevertheless, it is clear that the results from these techniques can not overlap and are not comparable and so, to all practical effects, it is recommended that follow-up of any particular patient is made always with the same technique and even at the same laboratory.