Evaluación urodinámica y comparativa de la calidad de vida en pacientes con trastorno de vaciamiento vesical sometidos a terapia InterStim, Medtronic®

ResumenAntecedentesDesde 1980 la terapia de neuroestimulación sacra ha demostrado ser una terapia válida y alternativa en el manejo de los trastornos miccionales por patología del tracto urinario bajo, siendo sus principales indicaciones la retención urinaria idiopática, la incontinencia de urgencia y la incontinencia fecal. En nuestro país sigue siendo una terapia novedosa y no se cuenta aún con estudios que evalúen esta eficacia en términos de calidad de vida o con parámetros cuantitativos.Objetivo del estudioEstablecer la eficacia de la terapia de neuroestimulación sacra tipo InterStim, Medtronic®, en el manejo de los pacientes con trastornos de vaciamiento vesical, efectuando un análisis urodinámico y de la calidad de vida comparativo previo y posterior al tratamiento, determinando los volúmenes miccionales, los períodos de incontinencia, la satisfacción del paciente y la calidad de vida.Material y métodosDesde enero de 2010 hasta junio de 2013, en el Hospital Central Militar se realizó evaluación urodinámica y comparativa de la calidad de vida mediante el empleo del instrumento SF-36 v2 (versión mexicana) e ICIQSF, en los pacientes que presentaron trastorno de vaciamiento vesical de etiología no obstructiva y que fueron refractarios a tratamiento médico.ResultadosSe incluyeron 10 pacientes en el estudio, bajo los siguientes diagnósticos: disinergia detrusor-esfínter, vejiga hiperactiva y retención urinaria no obstructiva, ubicados por género (2 masculinos y 8 femeninos). En la totalidad de los pacientes se presentó mejoría del 50% o superior durante la fase de prueba de la terapia de neuroestimulación, y se colocó fase definitiva con los siguientes resultados: se obtuvieron resultados equivalentes al 50-65% de mejoría en los parámetros cualitativos de función física, función social y rol emocional, así como en las variables cuantitativas de volumen de vaciamiento, eficacia de vaciamiento y disminución de los períodos de incontinencia.DiscusiónComo se ha establecido a nivel de la literatura mundial, nuestros resultados fueron similares en el efecto benéfico y la eficacia en la calidad de vida e incontinencia urinaria, respectivamente, y se reportan porcentajes de éxito mayores al 50% en el cese total de los episodios de incontinencia.ConclusionesLa neuromodulación mediante la estimulación del nervio sacro es una forma exitosa de tratamiento en los trastornos de vaciamiento vesical de etiología no obstructiva y refractaria al tratamiento médico, es segura, mínimamente invasiva y de fácil aplicación, y mejora la calidad de vida de los pacientes. Sin embargo, es necesario realizar estudios aleatorizados y que consideren parámetros objetivos (urodinámicos), así como las complicaciones posibles a mediano y largo plazo en este tipo de terapia.AbstractBackgroundSince 1980, sacral neuromodulation therapy has been shown to be a valid alternative therapy in the management of urinary disorders due to lower urinary tract pathology, and its primary indications are: idiopathic urinary retention, urge incontinence, and fecal incontinence. It is still considered a novel therapy in Mexico and there are no studies using quantitative parameters that evaluate its efficacy in terms of quality of life.AimsTo establish the efficacy of the Medtronic InterStim® sacral neuromodulation therapy in the management of patients with bladder voiding disorders through urodynamic and quality of life analyses before and after treatment. Urine volume, periods of incontinence, patient satisfaction, and quality of life were determined.MethodsA comparative urodynamic and quality of life evaluation was carried out using the SF-36 v2 (Mexican version) and the ICIQSF instruments on patients presenting with nonobstructive bladder voiding disorders that were refractory to medical treatment.ResultsTen patients with the following diagnoses were included in the study: detrusor sphincter dyssynergia, overactive bladder, and nonobstructive urinary retention. Two of the patients were men and 8 were women. There was a 50% or greater improvement in all 10 patients during the test phase of the neuromodulation therapy and the definitive placement phase produced the following results: a 50-65% improvement in the qualitative parameters of physical function, social function, and emotional role, as well as in the quantitative variables of voiding volume, voiding efficacy, and reduced periods of incontinence.DiscussionOur results were similar to those established in the international literature in relation to the beneficial effect on quality of life and efficacy in urinary incontinence management; the literature reports success percentages in the complete cessation of incontinence episodes at above 50%.ConclusionsNeuromodulation through sacral nerve stimulation is a successful form of treatment of nonobstructive and medical treatment-refractory bladder voiding disorders. It is safe, minimally invasive, and easy to apply and it improves patient quality of life. Nevertheless, further randomized studies on this type of therapy need to be conducted that take into account objective parameters (urodynamics) and possible medium and long-term complications

All-sky search for long-duration gravitational wave transients with initial LIGO

We present the results of a search for long-duration gravitational wave transients in two sets of data collected by the LIGO Hanford and LIGO Livingston detectors between November 5, 2005 and September 30, 2007, and July 7, 2009 and October 20, 2010, with a total observational time of 283.0 days and 132.9 days, respectively. The search targets gravitational wave transients of duration 10-500 s in a frequency band of 40-1000 Hz, with minimal assumptions about the signal waveform, polarization, source direction, or time of occurrence. All candidate triggers were consistent with the expected background; as a result we set 90% confidence upper limits on the rate of long-duration gravitational wave transients for different types of gravitational wave signals. For signals from black hole accretion disk instabilities, we set upper limits on the source rate density between 3.4×10-5 and 9.4×10-4 Mpc-3 yr-1 at 90% confidence. These are the first results from an all-sky search for unmodeled long-duration transient gravitational waves. © 2016 American Physical Society

All-sky search for long-duration gravitational wave transients with initial LIGO

We present the results of a search for long-duration gravitational wave transients in two sets of data collected by the LIGO Hanford and LIGO Livingston detectors between November 5, 2005 and September 30, 2007, and July 7, 2009 and October 20, 2010, with a total observational time of 283.0 days and 132.9 days, respectively. The search targets gravitational wave transients of duration 10-500 s in a frequency band of 40-1000 Hz, with minimal assumptions about the signal waveform, polarization, source direction, or time of occurrence. All candidate triggers were consistent with the expected background; as a result we set 90% confidence upper limits on the rate of long-duration gravitational wave transients for different types of gravitational wave signals. For signals from black hole accretion disk instabilities, we set upper limits on the source rate density between 3.4×10-5 and 9.4×10-4 Mpc-3 yr-1 at 90% confidence. These are the first results from an all-sky search for unmodeled long-duration transient gravitational waves. © 2016 American Physical Society