Publication: Estado dinámico del tracto urinario inferior postradioterapia pélvica
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2015-06-02
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Universidad Complutense de Madrid
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Abstract
"Objetivo": El estudio de los parámetros urodinámicos y EMG selectiva de esfínter urinario (EMGs) en pacientes sometidos a radioterapia pélvica (RT). " Pacientes y métodos": 145 pacientes con RT pélvica, la mitad hace más de 4 años (66,9% ♂ vs 33.1% ♀, 69,68 ± 10,2 años, 64% con cirugía radical, Ca próstata (CaP) 59% y Ca útero 25%). Grupo control: 99 pacientes ♂ no radiados. Se realizó descriptivo, análisis ♂/♀, intervenidos/no intervenidos, tiempo desde RT, ♂ radiados/no radiados y estudio multivariante (parámetros urodinámicos de las fases de llenado, vaciado, flujometría y EMGs) de pacientes con CaP vs control. Procesamiento de datos mediante el paquete estadístico v. 15.0. "Resultados": Los síntomas más frecuentes corresponden al llenado. Qmax anormal (63,7%), residuo (15,6%), primer deseo al llenado precoz (51,1%), disminución capacidad vesical (88%), acomodación vesical normal (89,9%), contracciones involuntarias (54,9%), URA (Urethral Resistance Average) normal (75,5% ♂), anormal (52 % ♀), Nº de Abrams y Griffiths (parámetro de resistencia uretral) normal (40,3% ♂), Wmax y W80-20 (parámetros de contractilidad) mayoritariamente normales, potenciales polifásicos (73%), con solapamiento denervación/reinervación. Radiológicamente: cuello abierto al llenado (37,8%), apertura normal miccional (96,1%), disminución de la luz uretral (41,3%), reflujo vésicoureteral (RVU) (13.2%), IUE urodinámica (19,3%), hiperactividad del detrusor (56,8%), obstrucción TUI (26,7%) y acomodación disminuida (9,4%). 5 casos con descentralización simpática D10-L2. Alteración Qmax, cuello abierto al llenado, disminución de la luz uretral y morfología irregular más frecuente en ♂, IUE en ♀. Menor capacidad vesical, incompetencia del cuello al llenado, RVU e IUE más frecuente en intervenidos. Los pacientes con reinervación y RVU presentan un tiempo mayor desde RT. Frente a control, los ♂ radiados presentan menor tamaño prostático, capacidad y acomodación (10,1%) más frecuentemente disminuidas, EMGs y cistomanometría alteradas, incompetencia del cuello al llenado, IUE, RVU y estenosis uretral anterior. En los no radiados, es más frecuente residuo, contractilidad, test pdet/flujo, apertura del cuello y URA anómalos, obstrucción TUI, disminución luz uretral posterior. En CaP, tras el multivariante, queda como factor explicativo la RT. "Conclusiones": La RT prostática produce alteraciones funcionales del TUI, más en fase de llenado y no en hiperactividad del detrusor. Existe denervación tardía postRT. La cirugía pélvica puede incrementar algunos factores de riesgo de la RT.
"Aims": The study of urodynamic and EMG selective urinary sphincter (EMGs) parameters in patients undergoing pelvic radiotherapy (RT). " Patients and Methods": 145 patients with pelvic radiotherapy (RT), 50 % underwent RT > 4 years (66.9%♂ vs 33.1% ♀ , 69.68 ± 10.2 years, 64% with radical surgery: prostate Ca (PCa) and 59% uterus Ca 25%). Control group: ♂ 99 non-irradiated patients. Descriptive analysis, ♂/♀, surgery/non-surgery, time since RT, ♂ irradiated/non-irradiated and multivariate analysis (urodynamics parameters of filling, emptying phases, flowmetry and EMGs data) in PCa patients vs control. Statistical data were processing using the package v. 15.0. " Results": The most frequent symptoms corresponding to filling LUTS. Abnormal Qmax (63.7%), residual postvoid (15.6%), early first desire at filling (51.1%), diminished bladder capacity (88%), normal bladder compliance (89.9%), involuntary detrusor contractions (54.9%), normal URA (Urethral Resistance Average) (♂ 75.5%), abnormal URA (52% ♀), normal Number of Abrams and Griffiths (Resistance Urethral Parameter) (40.3% ♂), Wmax and W80-20 (contractility parameters) mostly normal, poliphasics potentials (73%), with overlap denervation/reinnervation. Radiology: open bladder neck at filling (37.8%), normal bladder neck at voiding (96.1%) diminished urethral lumen (41.3%), vesicoureteral reflux (VUR) (13.2%), urodynamic SUI (19.3%), detrusor overactivity (56.8%), outlet bladder obstruction (26.7%) and decreased bladder compliance (9.4%). 5 cases of sympathetic D10-L2 decentralization. Abnormal Qmax, open bladder neck at filling, urethral lumen diminish and irregular bladder morphology common in ♂ and SIU in ♀. Lower bladder capacity, bladder neck incompetence at filling, RVU and SIU, are more frequent at surgical patients. The patients with VUR and reinnervation have a longer time since RT. The radiated patients ♂ have a smaller prostate size, bladder capacity and compliance (10.1%) more frequently diminished, and altered cystometry, EMGs, bladder neck incompetence at filling, SUI, VUR and anterior urethral stricture. In non-irradiated patients, it is more common postvoid residual, contractility and "pressure-flow" test alteration as abnormal bladder neck opening at voiding, URA, outlet bladder obstruction, and posterior urethral lumen diminished. In multivariate study in the PCa patients, the RT was the only explanatory factor. " Conclusions": The prostatic RT produces LUT functional alterations, mainly during the filling phase and not detrusor overactivity. Exist late denervation postRT. Pelvic surgery may increase risk factors of RT.
"Aims": The study of urodynamic and EMG selective urinary sphincter (EMGs) parameters in patients undergoing pelvic radiotherapy (RT). " Patients and Methods": 145 patients with pelvic radiotherapy (RT), 50 % underwent RT > 4 years (66.9%♂ vs 33.1% ♀ , 69.68 ± 10.2 years, 64% with radical surgery: prostate Ca (PCa) and 59% uterus Ca 25%). Control group: ♂ 99 non-irradiated patients. Descriptive analysis, ♂/♀, surgery/non-surgery, time since RT, ♂ irradiated/non-irradiated and multivariate analysis (urodynamics parameters of filling, emptying phases, flowmetry and EMGs data) in PCa patients vs control. Statistical data were processing using the package v. 15.0. " Results": The most frequent symptoms corresponding to filling LUTS. Abnormal Qmax (63.7%), residual postvoid (15.6%), early first desire at filling (51.1%), diminished bladder capacity (88%), normal bladder compliance (89.9%), involuntary detrusor contractions (54.9%), normal URA (Urethral Resistance Average) (♂ 75.5%), abnormal URA (52% ♀), normal Number of Abrams and Griffiths (Resistance Urethral Parameter) (40.3% ♂), Wmax and W80-20 (contractility parameters) mostly normal, poliphasics potentials (73%), with overlap denervation/reinnervation. Radiology: open bladder neck at filling (37.8%), normal bladder neck at voiding (96.1%) diminished urethral lumen (41.3%), vesicoureteral reflux (VUR) (13.2%), urodynamic SUI (19.3%), detrusor overactivity (56.8%), outlet bladder obstruction (26.7%) and decreased bladder compliance (9.4%). 5 cases of sympathetic D10-L2 decentralization. Abnormal Qmax, open bladder neck at filling, urethral lumen diminish and irregular bladder morphology common in ♂ and SIU in ♀. Lower bladder capacity, bladder neck incompetence at filling, RVU and SIU, are more frequent at surgical patients. The patients with VUR and reinnervation have a longer time since RT. The radiated patients ♂ have a smaller prostate size, bladder capacity and compliance (10.1%) more frequently diminished, and altered cystometry, EMGs, bladder neck incompetence at filling, SUI, VUR and anterior urethral stricture. In non-irradiated patients, it is more common postvoid residual, contractility and "pressure-flow" test alteration as abnormal bladder neck opening at voiding, URA, outlet bladder obstruction, and posterior urethral lumen diminished. In multivariate study in the PCa patients, the RT was the only explanatory factor. " Conclusions": The prostatic RT produces LUT functional alterations, mainly during the filling phase and not detrusor overactivity. Exist late denervation postRT. Pelvic surgery may increase risk factors of RT.
Description
Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 18-11-2014
UCM subjects
Nefrología y urología