Browsing by Author "Arevalo-Vega, Diego"

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    Defining bladder outlet obstruction and detrusor underactivity in females with overactive bladder: Are we forgetting about the free uroflowmetry?
    (2023) Arevalo-Vega, Diego; Ponce, Lucas; Valdevenito, Juan Pablo; Gallegos, Hector; Dell'Oro, Arturo; Santis-Moya, Fernanda; Calvo, Carlos Ignacio
    IntroductionBoth detrusor underactivity (DU) and bladder outlet obstruction (BOO) can coexist in patients with overactive bladder. Definitions of both DU and BOO are based on pressure-flow study (PFS) data. However, invasive urodynamics study can differ from a natural micturition, in fact, discrepancies between free uroflowmetry (UFM) and PFS have been largely described. Our goal is to assess the correlation of free-flowmetry and PFS among patients with OAB and to evaluate how different definitions of DU/BOO are able to discriminate patients with different free UFMs. MethodsA retrospective review of urodynamics performed at a single institution was conducted. Females with OAB who voided more than 150 mL in both UFM and PFS were included. Parameters from both voiding episodes were compared with nonparametric test. Two definitions of DU were applied; PIP1: Pdet@Qmax+Qmax < 30 and Gammie: Pdet@Qmax < 20 cmH(2)O, Qmax < 15 mL/s, and BVE < 90% (Bladder voiding efficiency). Also, two definitions of obstruction were chosen; Defretias: Pdet@Qmax >= 25 cmH(2)O and Qmax <= 12 mL/s and Solomon-Greenwell female BOO index >= 18. Patients who matched with each definition were compared to those who did not, to assess if any definitions were able to discriminate different noninvasive uroflowmetries. ResultsA total of 195 patients were included. Overall, mean age was 55 +/- 12 years, 90.8% had mixed urinary incontinence, and 39% complained of at least one voiding symptom. Globally, Qmax and BVE correlated poorly between UFM and PFS, showing that most of the variation corresponded to a systematic error. Twenty-two individuals were found to have DU, they had a difference of 13 mL/s on both maximum flows. Fifty-four patients showed BOO, with a difference between their Qmax of 19 mL/s. Among the four definitions analyzed, only PIP1 and Defreitas were able to discriminate patients with actually a lower Qmax on the free UFM. ConclusionsPatients with overactive bladder seem to have a systematic discordance between the urine flow of the free and invasive studies. Current definitions of DU and BOO, which are based on the PFS parameters, are not consistently able to discriminate patients who actually void deficiently on the free UFM.
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    Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital
    (2024) Mass-Lindenbaum, Marcelo; Arevalo-Vega, Diego; Aleuanlli, Isidora; Santis-Moya, Fernanda; Maluenda, Andrea; Dines, Eitan; Cohen-Vaizer, Miriam; Saavedra, Alvaro; Raby, Trinidad; Blumel, Bernardita; Cuevas, Rodrigo; Pohlhammer, Simone; Alarcon, Gabriela; Albornoz, Marco Arellano; Pizarro-Berdichevsky, Javier
    Objective: To To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications. Methods: A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022. Results: Advanced or basic trial phases were performed on 35 patients, 33 [94%] of which were successful and opted to move on Implantable Pulse Generator [GG] implantation. The average follow-up time after definitive implantation was 82 months (SD 59]. Of the 33 patients undergoing, 27 (81%]reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%] with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I. Conclusion: SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it.