RESUMEN
OBJECTIVES: To assess the role of diagnostic urethrocystoscopy in the evaluation of women with idiopathic detrusor instability (DI) refractory to conventional pharmacologic management. METHODS: One hundred consecutive women (mean age 62.1 +/- 15.1 years) with idiopathic DI refractory to conventional pharmacologic management were prospectively enrolled. All patients underwent a meticulous evaluation, including a detailed history, urogynecologic questionnaire, micturition diary and pad test, urinalysis and culture, physical examination, and urodynamic studies. Refractory DI was defined as the lack of clinical improvement after at least 6 months of conventional drug therapy. These patients underwent additional evaluation with diagnostic urethrocystoscopy. RESULTS: All patients had a normal urinalysis and negative cytologic findings. Diagnostic urethrocystoscopy revealed isolated bladder tuberculosis in one and transitional cell carcinoma in another. Seven other patients had bladder diverticula (only one of which was also diagnosed by sonographic examination) and 22 had mild-to-moderate bladder trabeculations. CONCLUSIONS: The absence of other alarming signs (ie, recurrent urinary tract infection, hematuria, significant residual urinary volume, positive cytologic findings, or suspicious sonographic findings) cannot confirm the lack of significant lower urinary tract abnormalities among patients with refractory DI. Diagnostic urethrocystoscopy, a simple and safe office procedure, facilitates timely diagnosis and appropriate treatment for these patients.
Asunto(s)
Cistoscopía , Hipertonía Muscular/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Anomalías Urogenitales/diagnóstico , Enfermedades Urológicas/diagnósticoRESUMEN
OBJECTIVE: To analyze variables affecting the differences between on-to-on and on-to-out methods of nuchal translucency measurement. DESIGN: Prospective comparison of two methods of caliper placement. SUBJECTS: A total of 245 women undergoing transabdominal and 37 women undergoing transvaginal nuchal translucency scanning. METHODS: Nuchal translucency was measured using both on-to-on and on-to-out methods of caliper placement on the same frozen images. Differences between the methods were evaluated according to fetal size, nuchal thickness and mode of examination. Regression analysis was performed for the calculation of the expected difference between the methods at various combinations. Results among 1254 singleton pregnancies were used to set 50th, 95th and 97.5th centiles for the on-to-on method. The calculated differences were used to set 50th, 95th and 97.5th centiles for the on-to-out method. RESULTS: The mean difference between on-to-out and on-to-on nuchal translucency, using transabdominal scanning, was 0.95 +/- 0.14 mm. The differences were shown to correlate directly with fetal size and with nuchal thickness. In addition, scans performed transvaginally exhibited a smaller difference between the methods (0.90 mm vs. 0.94 mm; P < 0.05). CONCLUSION: The difference between on-to-on and on-to-out nuchal translucency measurements may have a considerable effect on the calculated risk for aneuploidy.