Evolution of male patients with detrusor underactivity and conservative treatment. Five-year follow-up | Actas Urológicas Españolas (English Edition)

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Five-year follow-up" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "83" "paginaFinal" => "89" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Morán, I. Sáez, J. Bolón, O. Colet, M.A. Bonillo, E. Martínez-Cuenca, E. Broseta, S. Arlandis" "autores" => array:8 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Morán" "email" => array:1 [ 0 => "edumoranpascual@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Sáez" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Bolón" ] 3 => array:2 [ "nombre" => "O." "apellidos" => "Colet" ] 4 => array:2 [ "nombre" => "M.A." "apellidos" => "Bonillo" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Martínez-Cuenca" ] 6 => array:2 [ "nombre" => "E." "apellidos" => "Broseta" ] 7 => array:2 [ "nombre" => "S." "apellidos" => "Arlandis" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Urología Funcional y Reconstructiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evolución de pacientes varones con detrusor hipoactivo y tratamiento conservador. Seguimiento a cinco años" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1329 "Ancho" => 1524 "Tamanyo" => 104843 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Survival curve without CIC." ] ] ] "textoCompleto" => "Introduction and ObjectivesIn 2019,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> the International Continence Society defined detrusor underactivity (DU) as a diagnosis based on urodynamic studies, generally (not always) associated with relevant signs and symptoms. It manifests as a detrusor contraction with decreased intensity or time which is combined with a weak urinary flow and leads to a prolonged bladder emptying time and/or the failure to completely empty the bladder in a normal period of time (a high post-void residual may occur). This definition has undergone few significant changes over time since its previous definition in 2002.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>The prevalence of DU is estimated between 10 and 48% of the general population, depending on age and sex.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> This wide variability is due to the different diagnostic criteria, and the lack of research on this pathology for many years. The etiology of DU can be multifactorial (idiopathic, secondary to obstruction, aging), including neurological causes such as spinal cord injury or multiple sclerosis. Nonetheless, there are no studies assessing the influence of etiology on the evolution of DU. Similarly, there is also no consensus regarding the management of these patients. There are multiple accepted therapeutic options, from expectant management to others such as alpha-blockers, clean intermittent catheterization, and other more debated ones such as de-obstruction surgery or sacral nerve root neuromodulation. Unfortunately, there is no predictive factor as to which patients will require any given treatment, or which can be maintained with residual controls only. On the other hand, the diagnostic criteria for DU are better established in men thanks to the use of nomograms and parameters such as the bladder contractility index.Therefore, the main objective of our work was to analyze the evolution of detrusor underactivity in male patients for whom conservative treatment was initially decided without clean intermittent catheterization (CIC). As a secondary objective, we set out to compare the evolution of patients with neurogenic DU (NDU) versus patients with non-neurogenic DU (NNDU) and try to establish risk factors to predict the need for CIC throughout follow-up care.Material and methodsDescriptive, non-interventional longitudinal study in a single center on a cohort of male patients with a urodynamic diagnosis of DU.For this, the prospective database of our unit, with 2496 urodynamic studies from 2008 to 2018, was reviewed. For our study, the sample was selected as follows. Male patients who met urodynamic criteria for DU were included (according to the 2002 ICS definition and/or the presence of Bladder contractility index [BCI] less than 100), for whom watchful waiting or non-interventional medical treatment was adopted as initial treatment. Patients who started treatment with clean intermittent catheterization or other interventional treatment (de-obstruction surgery or sacral nerve root neuromodulation) at the start of the study or those who were not followed at our center were excluded (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>In this way, 172 (6.89%) men with DU were found. In 106 (61.6%), a neurological cause was evidenced. Of the 172 diagnosed patients, 36 (21%) began CIC treatment at the time of diagnosis. Another 74 patients (43%) were followed up in other hospitals, so they were not included in subsequent analyses.For the analysis, age, etiology (neurogenic NDU or non-neurogenic NNDU) and type of symptoms were included as demographic variables. All patients underwent urodynamic testing following the guidelines for good urodynamic practice. The variables included resulting from the free uroflowmetry were maximum flow (Qmax), voided volume, post-void residual urine measured by ultrasound (PVR) and voiding efficiency (VE, calculated as voided volume/bladder capacity, expressing the result as a percentage). In the pressure/flow study, the following variables were collected: detrusor opening pressure (Pdet.o), detrusor pressure at maximum flow (Pdet.Qmax) and BCI (calculated as Pdet.Qmax+5 Qmax). All patients with suspected NDU were evaluated after having passed the acute phase of the neurological event.The patients were checked semiannually with uroflowmetry and residuals. CIC was started in the presence of high residuals (more than 200mL in two measurements or voiding efficiency <50%).As outcome variables to study, the need to specify CIC throughout the follow-up or the appearance of complications, such as recurrent urinary tract infections (more than two in six months or three a year), acute urinary retention or the development of bladder lithiasis.In order to compare the baseline urodynamic characteristics, the appearance of complications or the need to initiate CIC among patients, with NDU and NNDU, a univariate analysis was carried out using the Student's t-test (continuous variables) or the χ2 test (ordinal variables).A bivariate logistic regression analysis was carried out for the analysis of risk factors for beginning of CIC. As explanatory variables, the Qmax, PVR and DE of free uroflowmetry and the Pdet.o, Pdet.Qmax and BCI were introduced. As outcome variable, the need for CIC was analyzed throughout the follow-up (Yes/No). All statistical analyses were performed using the SPSS®21 program.ResultsOf the 172 men with a urodynamic diagnosis of DU, a total of 118 patients (68.61%) presented a BCI less than 100. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the main demographic data, and those derived from free uroflowmetry and the urodynamic study of these patients. Voiding symptoms (urinary hesitancy, weak stream, prolonged micturition) were the most frequent (33.1%), followed by urinary retention and mixed urinary incontinence.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>In 106 patients (61.6%), a neurological cause was evidenced as the origin of DU, the most frequent being spinal cord injury (25%), followed by multiple sclerosis (13%) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Among the patients with spinal cord injury, it was complete (ASIA A) in seven patients (27%), with the rest being incomplete. Regarding the level of injury, the majority were lumbar (11 patients [41%]) or thoracic (nine patients [33.3%]).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Of the 172 diagnosed patients, 36 (21%) started CIC treatment at the time of diagnosis. Another 74 patients (43%) were followed up in other hospitals and were therefore not included in the subsequent analyses. Thus, 62 male patients, for whom conservative follow-up measures were applied, were included for the analysis with a mean follow-up of 4.9 years (±2.6) in our unit. Of these, 33 (53%) were NDU and 29 (47%) NNDU (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the baseline parameters, both the uroflowmetric and urodynamic study for each group. It can be observed that patients with NDU presented higher PVR and lower voiding efficiency and BCI than those with NNDU, but without any statistically significant differences.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>When the evolution of both groups during follow-up was compared, there were no differences regarding the appearance of recurrent urinary infections (p=0.34) or the development of bladder stones (p=0.39). However, there was a greater number of patients in the NDU group who needed to start CIC throughout follow-up due to an increase in PVR (p=0.04). These results are summarized in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. It is worth highlighting the fact that no patient with NNDU required CIC during the almost five years of follow-up.When comparing the baseline characteristics of the six patients who required CIC versus the rest, the only differences we observed were a higher PVR (316mL vs. 124mL [(p=0.009]) and a lower voiding efficiency (35 vs. 65%, p=0.017). The etiology of NDU in these patients was varied: sacral agenesis (one patient), traumatic cervical spinal cord injury (two patients), subarachnoid hemorrhage (one patient), multiple sclerosis (one patient) and poorly controlled diabetes mellitus (one patient). When comparing the evolution of patients with NDU and with NNDU, differences were observed in the time until the need for CIC (log rank: 0.009), with the mean time of control without the need for CIC of 15.1 months (range 4–38) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). There were no differences in terms of time until appearance of recurrent UTI (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>In the bivariate logistic regression analysis, none of the flowmetric variables or the urodynamic study could be shown to be a predictor of the need for CIC throughout follow-up.DiscussionDU is a urodynamic finding defined by ICS<a class="elsevierStyleCrossRef" href="#bib0005">1</a> as a detrusor contraction with decreased intensity or time which is combined with a weak urinary flow, and leads to a prolonged bladder emptying time and/or the failure to completely empty the bladder in a normal period of time (a high post-void residual may occur). In our work, we have used this definition for the diagnosis of patients with DU, together with the BCI value. The reason for using the BCI was that the ICS definition lacks numerical parameters of what “decreased intensity”, “weak urinary flow” or “normal time” means. Jeong et al.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> compared various alternatives for defining DU, such as establishing cut-off points for Qmax and Pdet.Qmax. However, the use of these cut-off points would force us to evaluate urethral resistance, since a patient could urinate with low Pdet.Qmax, not due to DU, but due to low urethral resistance. This would add some complexity to the study of DU. Regarding the calculation of the Watts factor, it is a complex mathematical formula, requiring software that is not commonly implemented in urodynamic devices, so its use is not that widespread in routine clinical practice or in the literature. An attempt has been made to gather all these factors in the Maastricht-Hannover nomogram,<a class="elsevierStyleCrossRef" href="#bib0025">5</a> although their use in a standardized way is not currently agreed upon. Therefore, we decided to use the value of BCI <100 as the definition of DU, as recommended by the ICS.With regards to the evolution of our patients, with this definition we observed a prevalence in our sample of 6.89%. This prevalence is somewhat lower than that published in other series,<a class="elsevierStyleCrossRef" href="#bib0015">3</a> especially when using the BCI as a diagnostic criterion. This datum could be justified by a low rate of diagnostic suspicion and low rates of referral of these patients to a urodynamic unit for pressure-flow studies as a result of the lack of non-invasive methods for diagnosis. Most (61%) of the patients presented NDU, mainly associated with spinal cord injury (traumatic or iatrogenic). These data may be biased since ours is a neurourology referral unit.In our sample, only six of the 62 patients (9.2%) who completed follow-up needed to start CIC. It should be noted that all of them were patients with NDU.There is little literature on the evolution of patients with NDU. In our case, it was observed how only six patients (18.1%) needed to start CIC during their follow-up due to an increase in PVR. There is currently no evidence of any approved effective medical treatment.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Most of these patients start CIC at the time of diagnosis, being a well-accepted treatment, although there are cases in which, due to the progression of the underlying neurological disease, it may become necessary to change the therapeutic attitude. Those patients with NDU who do not initiate CIC at the time of diagnosis, and who are the object of our work, are probably those with the lowest risk (the large number of patients with incomplete lesions can be seen in our sample). It is probably for this reason that the rates of rUTI or the development of bladder lithiasis are similar to those of NNDU.Regarding the evolution of patients with NNDU, it is necessary to refer to the methodical review by Thomas et al.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> on more than 2000 patients where 224 patients were diagnosed with NNDU, and 137 of them were able to complete the study. In their sample, 69 patients opted for conservative management and after 10 years of follow-up, 58 (84%) remained without treatment. These results are similar to those of our study. It is possible that in our case, the number of patients without the need for treatment is higher due to the shorter follow-up time. Similarly to our study, Thomas et al.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> were unable to describe any predictive factor for failure of conservative management, contrary to what occurs in patients with bladder outlet obstruction, where age and prostate size can influence the failure of conservative management.There is some evidence that patients with NNDU will have no disease progression. It has been described how those patients with DU of idiopathic origin did not present changes in the bladder contractility index in the long term. With this objective, Al-Hayek et al.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> studied a group of patients with DU who underwent urodynamic testing at least 10 years after diagnosis. The authors did not observe any changes in the bladder contractility index between the baseline urodynamic study and during follow-up of these patients.The basis for check-up of these patients is the control of symptoms and the appearance of complications (acute urinary retention, the development of bladder stones or the presence of recurrent urinary infections). To this end, apart from the usefulness of ultrasound, uroflowmetry and urine cultures, an attempt is being made to develop questionnaires and carry out phenotyping of these patients in addition to launching prospective studies in this pathology.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>With respect to the secondary objective of our work, there is no literature comparing the evolution of these two groups of patients. There are several biases to be aware of. In the first place, they are demographically not very comparable populations. Just as NDU patients tend to be younger patients (traumatic spinal cord injuries, multiple sclerosis, or gynecological surgeries), NNDU patients tend to be older due to chronic obstruction, aging, or long-standing diabetes mellitus. It must be added that, just as the majority of NDUs are diagnosed as a result of being referred to urology units for obvious reasons, many of the patients with NNDU may remain undiagnosed due to low diagnostic suspicion. This is due to the presence of unspecific symptoms.In fact, symptoms can occur both during the filling and voiding phases. Thus, in our series, it can be seen how only 33% of the patients consulted for symptoms solely in the voiding phase and 15% did so after an episode of urinary retention. Gammie et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> observed in a series of almost 1800 patients, how those with DU had a significantly greater sensation of a weak or interrupted stream, a sensation of incomplete emptying, or a decrease in the sensation of bladder filling, compared to those who did not present DU. When comparing this group with patients with bladder outlet obstruction, they observed how patients with DU had a greater need to use abdominal straining for voiding, as well as the presence of symptoms in other spheres, such as sexual or digestive. Nevertheless, symptoms may occur in the bladder filling phase,<a class="elsevierStyleCrossRef" href="#bib0060">12</a> such as urgency, frequency, or even incontinence. In our series, up to 14% had mixed urinary incontinence and 11% had urge urinary incontinence, showing how up to 20% of the patients had some associated urodynamic diagnosis in the filling phase (mainly detrusor hyperactivity).The strengths of our study include the selection of a specific group of patients (male patients with DU), long-term follow-up, and a protocolized follow-up of PVR.Concerning the weaknesses in our study, it should be noted that the patients included are those who were referred to a referral unit due to lower urinary tract symptoms. This led to the loss of up to 43% of the sample because of geographical reasons. On the other hand, we found limitations in the sample size and in the low number of patients who have required CIC throughout follow-up (six patients). This could be one of the reasons for not finding predictive risk factors. It is also plausible that a percentage of those patients who were followed up in other centers have required CIC and could not be evaluated in this study. Having the data from these patients would have been of great interest. This makes us consider the need for regional or national registries of neurourological pathology.It should be noted that the application of the conclusions of our work makes sense for a very specific population: men with DU (neurogenic or not) for whom watchful waiting or non-interventional medical treatment is chosen.ConclusionsIn our study, the most common cause of detrusor underactivity is neurological injury, specifically spinal cord injury. Our patients with hypoactive detrusor of non-neurological origin tend to remain stable without the need to initiate clean intermittent catheterization. We have not found clinical or urodynamic factors that allow us to detect those patients at risk of needing intermittent clean catheterization during follow-up.Conflicts of interestThe authors declare that there is no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1445123" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1318543" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1445124" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1318544" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction and Objectives" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "Referencias" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-01-30" "fechaAceptado" => "2020-08-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1318543" "palabras" => array:3 [ 0 => "Detrusor underactivity" 1 => "Clean intermittent catheterization" 2 => "Follow-up" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1318544" "palabras" => array:3 [ 0 => "Detrusor hipoactivo" 1 => "Cateterismo limpio intermitente" 2 => "Seguimiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionThe objective of the study was to compare the evolution of male patients with neurogenic detrusor underactivity (NDU) versus non-neurogenic DU (NNDU) and to establish risk factors to predict the need for clean intermittent catheterization (CIC) during the follow-up period. Material and methodsLongitudinal, descriptive study of a cohort of patients diagnosed with DU, and 2496 urodynamic studies (2008–2018) were reviewed. Patients with DU (ICS 2002 and/or Bladder contraction index (<100)) without treatment were included. Patients with CIC or interventional treatment were excluded. Follow-up included flowmetry every six months. CIC was indicated in cases of high residual volume (PVR) >200mL or voiding efficiency (VE) <50%. The need for CIC during follow-up or the appearance of complications (urinary tract infections (UTI), bladder lithiasis) were compared. ResultsDU was found in 172 (6.89%) men. Neurological causes were observed in 106 (61,6%) cases. Finally, 62 patients were included with a mean follow-up of 4.9 years (±2.6). Of these patients, 33 (53%) presented NDU and 29 (47%) NNDU. Six patients with NDU needed CIC versus none with NNDU (p=0.04). Patients requiring CIC had higher PVR (p=0.009) and lower VE (p=0.017)), and there were also differences in terms of time until the need for CIC (log Rank: 0.009), which was 15.1 months [4–38]. In the multivariate analysis, none of the variables showed to be predictive of the need for CIC. ConclusionsThe most common cause of DU is neurologic injury. Patients with NDU remain stable without requiring CIC. We have not detected any risk factors that identify patients at risk of needing CIC." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl objetivo del trabajo fue comparar la evolución de pacientes varones con detrusor hipoactivo (DU) neurógeno (DUN) frente a DU no neurógeno (DUNoN) y establecer factores de riesgo para predecir la necesidad de cateterismo limpio intermitente (CLI) en el seguimiento. Material y métodosEstudio longitudinal, descriptivo, sobre una cohorte de pacientes con diagnóstico de DU. Se revisaron 2.496 estudios urodinámicos (2008-2018). Se incluyeron pacientes con DU (ICS2002 y/o Bladder contraction index [< 100]) sin tratamiento. Se excluyeron pacientes en CLI o tratamiento intervencionista. Se realizó seguimiento semestralmente con flujometría. Se indicó CLI ante residuos elevados (RPM) > 200mL o eficiencia de vaciado (EV) < 50%. Se comparó la necesidad de CLI durante el seguimiento o la aparición de complicaciones (infecciones urinarias [ITU], litiasis vesical). ResultadosSe encontraron 172 (6,89%) varones con DU. En 106 (61,6%) se evidenció causa neurológica. Finalmente se incluyeron 62 pacientes con seguimiento medio de 4,9 años (+/-2,6). De ellos, 33 (53%) fueron DUN y 29 (47%) DUNoN. No se apreciaron diferencias en la aparición de ITU (p=0,34) o litiasis vesicales (p=0,39). Seis pacientes con DUN precisaron CLI frente a ninguno con DUNoN (p=0,04). Los pacientes que requirieron CLI presentaron mayor RPM [p=0,009]) y menor EV [p=0,017]). También se apreciaron diferencias en el tiempo hasta la necesidad de CLI (log rank: 0,009), siendo este de 15,1 meses (4-38). En el análisis multivariante ninguna de las variables pudo demostrarse como factor predictivo de necesidad de CLI. ConclusionesLa causa más frecuente de DU es la lesión neurológica. Los pacientes con DUN permanecen estables sin necesidad de CLI. No hemos detectado factores de riesgo que identifiquen a los pacientes en riesgo de necesitar CLI." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Morán E, Sáez I, Bolón J, Colet O, Bonillo MA, Martínez-Cuenca E, et al. Evolución de pacientes varones con detrusor hipoactivo y tratamiento conservador. Seguimiento a cinco años. Actas Urol Esp. 2021;45:82–87." ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1559 "Ancho" => 2341 "Tamanyo" => 202296 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Flow chart of patients included in the study." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1329 "Ancho" => 1524 "Tamanyo" => 104843 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Survival curve without CIC." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1318 "Ancho" => 1513 "Tamanyo" => 110776 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Survival without recurrent UTI." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median (standard variation) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.6 (15.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reason for consultation (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Voiding symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urinary retention \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> Urge urinary incontinence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> Mixed urinary incontinence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urinary tract infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous treatment (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alpha blocker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anticholinergic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> Alpha blocker + anticholinergic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients with spinal cord injury (27)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Injury level n(%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cervical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (11.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dorsal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lumbar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (40.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sacral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grade of injury (ASIA) n(%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (26) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (26) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (30) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (15) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Qmax<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> (mL/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.7 (6.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PVR<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> (mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">183.9 (175.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Voiding efficiency<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.3 (41.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pdet.Qmax<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> (cm H2O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.2 (23.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCI<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.8 (72.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2485396.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Free uroflowmetry." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Pressure/flow study." ] ] ] "descripcion" => array:1 [ "en" => "Uroflowmetric and urodynamic variables of men with DU at the time of diagnosis." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Etiology \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Idiopathic</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aging \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Idiopathic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (16.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurogenic</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parkinson's \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (2.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stroke \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (3.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (7.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple sclerosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (8.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spinal cord injury (traumatic, herniated disc, etc.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (15.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Others (myelomeningocele, subarachnoid hemorrhage, multisystemic atrophy, etc.) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (20.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Myogenic</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bladder outlet obstruction (Incl. history of prostate surgery) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (17.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Iatrogenic</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> Pelvic surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (3.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2485398.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Etiology of patients with DU." ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total DU (62) Median (SD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NDU (33) Median (SD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NNDU (29) Median (SD) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Qmax<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> (mL/s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.71 (6.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.19 (5.58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.07 (6.96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.61 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PVR<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> (mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">183.90 (175.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">158.75 (142.86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">107.76 (128.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Voiding effic.<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.39 (41.57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.16 (30.01) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.32 (30.27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pdet.o<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> (cm H2O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.78 (21.02) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.52 (23.15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.66 (20.87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.53 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCI<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.89 (72.05) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.23 (19.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74.35 (32.98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pdet.Qmax<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a>(cm H2O) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.28 (23.35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.48 (16.51) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.77 (19.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.51 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">rUTI (n/N %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11/62 (17.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8/33 (24.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3/29 (10.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bladder lithiasis (n/N %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5/62 (8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4/33 (12.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/29 (3.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.39 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CIC (n/N %) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6/62 (9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6/33 (18.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0/29 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2485397.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "Free uroflowmetry." ] 1 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "b" "nota" => "Pressure/flow study." ] ] ] "descripcion" => array:1 [ "en" => "Baseline parameters of patients with NDU and NNDU who started conservative treatment." ] ] ] "bibliografia" => array:2 [ "titulo" => "Referencias" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.D. D’Ancona" 1 => "B.T. Haylen" 2 => "M. Oelke" 3 => "S. Herschorn" 4 => "L. Abranches-Monteiro" 5 => "E.P. Arnold" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/nau.23897" "Revista" => array:2 [ "tituloSerie" => "Neurourol Urodyn" "fecha" => "2019" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The standarisation of terminology of lower urinary tract function: report from the Standarisation Sub-committee of the International Continence Society" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Abrams" 1 => "L. Cardozo" 2 => "M. Fall" 3 => "D. Griffiths" 4 => "P. Rosier" 5 => "U. Ulmsten" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/nau.10052" "Revista" => array:6 [ "tituloSerie" => "Neurourol Urodyn" "fecha" => "2002" "volumen" => "21" "paginaInicial" => "167" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11857671" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.I. Osman" 1 => "C.R. Chapple" 2 => "P. Abrams" 3 => "R. Dmochowski" 4 => "F. Haab" 5 => "V. Nitti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2013.10.015" "Revista" => array:6 [ "tituloSerie" => "Eur Urol" "fecha" => "2014" "volumen" => "65" "paginaInicial" => "389" "paginaFinal" => "398" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24184024" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How do we diagnose detrusor underactivity? Comparison of diagnostic criteria based on an urodynamic measure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.J. Jeong" 1 => "J.K. Lee" 2 => "K.M. Kim" 3 => "H. Kook" 4 => "S.Y. Cho" 5 => "S.J. 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Evolution of male patients with detrusor underactivity and conservative treatment. Five-year follow-up

Evolución de pacientes varones con detrusor hipoactivo y tratamiento conservador. Seguimiento a cinco años

E. Morán

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edumoranpascual@gmail.com

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, I. Sáez, J. Bolón, O. Colet, M.A. Bonillo, E. Martínez-Cuenca, E. Broseta, S. Arlandis

Sección de Urología Funcional y Reconstructiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain

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    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Evolution of male patients with detrusor underactivity and conservative treatment&#46; Five-year follow-up"
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        "autoresLista" => "E&#46; Mor&#225;n, I&#46; S&#225;ez, J&#46; Bol&#243;n, O&#46; Colet, M&#46;A&#46; Bonillo, E&#46; Mart&#237;nez-Cuenca, E&#46; Broseta, S&#46; Arlandis"
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            "entidad" => "Secci&#243;n de Urolog&#237;a Funcional y Reconstructiva&#44; Hospital Universitario y Polit&#233;cnico La Fe&#44; Valencia&#44; Spain"
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      "es" => array:1 [
        "titulo" => "Evoluci&#243;n de pacientes varones con detrusor hipoactivo y tratamiento conservador&#46; Seguimiento a cinco a&#241;os"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Survival curve without CIC&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction and Objectives</span><p id="par0005" class="elsevierStylePara elsevierViewall">In 2019&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> the International Continence Society defined detrusor underactivity &#40;DU&#41; as a diagnosis based on urodynamic studies&#44; generally &#40;not always&#41; associated with relevant signs and symptoms&#46; It manifests as a detrusor contraction with decreased intensity or time which is combined with a weak urinary flow and leads to a prolonged bladder emptying time and&#47;or the failure to completely empty the bladder in a normal period of time &#40;a high post-void residual may occur&#41;&#46; This definition has undergone few significant changes over time since its previous definition in 2002&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence of DU is estimated between 10 and 48&#37; of the general population&#44; depending on age and sex&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This wide variability is due to the different diagnostic criteria&#44; and the lack of research on this pathology for many years&#46; The etiology of DU can be multifactorial &#40;idiopathic&#44; secondary to obstruction&#44; aging&#41;&#44; including neurological causes such as spinal cord injury or multiple sclerosis&#46; Nonetheless&#44; there are no studies assessing the influence of etiology on the evolution of DU&#46; Similarly&#44; there is also no consensus regarding the management of these patients&#46; There are multiple accepted therapeutic options&#44; from expectant management to others such as alpha-blockers&#44; clean intermittent catheterization&#44; and other more debated ones such as de-obstruction surgery or sacral nerve root neuromodulation&#46; Unfortunately&#44; there is no predictive factor as to which patients will require any given treatment&#44; or which can be maintained with residual controls only&#46; On the other hand&#44; the diagnostic criteria for DU are better established in men thanks to the use of nomograms and parameters such as the bladder contractility index&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore&#44; the main objective of our work was to analyze the evolution of detrusor underactivity in male patients for whom conservative treatment was initially decided without clean intermittent catheterization &#40;CIC&#41;&#46; As a secondary objective&#44; we set out to compare the evolution of patients with neurogenic DU &#40;NDU&#41; versus patients with non-neurogenic DU &#40;NNDU&#41; and try to establish risk factors to predict the need for CIC throughout follow-up care&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">Descriptive&#44; non-interventional longitudinal study in a single center on a cohort of male patients with a urodynamic diagnosis of DU&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">For this&#44; the prospective database of our unit&#44; with 2496 urodynamic studies from 2008 to 2018&#44; was reviewed&#46; For our study&#44; the sample was selected as follows&#46; Male patients who met urodynamic criteria for DU were included &#40;according to the 2002 ICS definition and&#47;or the presence of Bladder contractility index &#91;BCI&#93; less than 100&#41;&#44; for whom watchful waiting or non-interventional medical treatment was adopted as initial treatment&#46; Patients who started treatment with clean intermittent catheterization or other interventional treatment &#40;de-obstruction surgery or sacral nerve root neuromodulation&#41; at the start of the study or those who were not followed at our center were excluded &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In this way&#44; 172 &#40;6&#46;89&#37;&#41; men with DU were found&#46; In 106 &#40;61&#46;6&#37;&#41;&#44; a neurological cause was evidenced&#46; Of the 172 diagnosed patients&#44; 36 &#40;21&#37;&#41; began CIC treatment at the time of diagnosis&#46; Another 74 patients &#40;43&#37;&#41; were followed up in other hospitals&#44; so they were not included in subsequent analyses&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">For the analysis&#44; age&#44; etiology &#40;neurogenic NDU or non-neurogenic NNDU&#41; and type of symptoms were included as demographic variables&#46; All patients underwent urodynamic testing following the guidelines for good urodynamic practice&#46; The variables included resulting from the free uroflowmetry were maximum flow &#40;Qmax&#41;&#44; voided volume&#44; post-void residual urine measured by ultrasound &#40;PVR&#41; and voiding efficiency &#40;VE&#44; calculated as voided volume&#47;bladder capacity&#44; expressing the result as a percentage&#41;&#46; In the pressure&#47;flow study&#44; the following variables were collected&#58; detrusor opening pressure &#40;Pdet&#46;o&#41;&#44; detrusor pressure at maximum flow &#40;Pdet&#46;Qmax&#41; and BCI &#40;calculated as Pdet&#46;Qmax<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>5 Qmax&#41;&#46; All patients with suspected NDU were evaluated after having passed the acute phase of the neurological event&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The patients were checked semiannually with uroflowmetry and residuals&#46; CIC was started in the presence of high residuals &#40;more than 200<span class="elsevierStyleHsp" style=""></span>mL in two measurements or voiding efficiency &#60;50&#37;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">As outcome variables to study&#44; the need to specify CIC throughout the follow-up or the appearance of complications&#44; such as recurrent urinary tract infections &#40;more than two in six months or three a year&#41;&#44; acute urinary retention or the development of bladder lithiasis&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In order to compare the baseline urodynamic characteristics&#44; the appearance of complications or the need to initiate CIC among patients&#44; with NDU and NNDU&#44; a univariate analysis was carried out using the Student&#39;s <span class="elsevierStyleItalic">t</span>-test &#40;continuous variables&#41; or the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test &#40;ordinal variables&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A bivariate logistic regression analysis was carried out for the analysis of risk factors for beginning of CIC&#46; As explanatory variables&#44; the Qmax&#44; PVR and DE of free uroflowmetry and the Pdet&#46;o&#44; Pdet&#46;Qmax and BCI were introduced&#46; As outcome variable&#44; the need for CIC was analyzed throughout the follow-up &#40;Yes&#47;No&#41;&#46; All statistical analyses were performed using the SPSS&#174;21 program&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">Of the 172 men with a urodynamic diagnosis of DU&#44; a total of 118 patients &#40;68&#46;61&#37;&#41; presented a BCI less than 100&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the main demographic data&#44; and those derived from free uroflowmetry and the urodynamic study of these patients&#46; Voiding symptoms &#40;urinary hesitancy&#44; weak stream&#44; prolonged micturition&#41; were the most frequent &#40;33&#46;1&#37;&#41;&#44; followed by urinary retention and mixed urinary incontinence&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In 106 patients &#40;61&#46;6&#37;&#41;&#44; a neurological cause was evidenced as the origin of DU&#44; the most frequent being spinal cord injury &#40;25&#37;&#41;&#44; followed by multiple sclerosis &#40;13&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Among the patients with spinal cord injury&#44; it was complete &#40;ASIA A&#41; in seven patients &#40;27&#37;&#41;&#44; with the rest being incomplete&#46; Regarding the level of injury&#44; the majority were lumbar &#40;11 patients &#91;41&#37;&#93;&#41; or thoracic &#40;nine patients &#91;33&#46;3&#37;&#93;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Of the 172 diagnosed patients&#44; 36 &#40;21&#37;&#41; started CIC treatment at the time of diagnosis&#46; Another 74 patients &#40;43&#37;&#41; were followed up in other hospitals and were therefore not included in the subsequent analyses&#46; Thus&#44; 62 male patients&#44; for whom conservative follow-up measures were applied&#44; were included for the analysis with a mean follow-up of 4&#46;9 years &#40;&#177;2&#46;6&#41; in our unit&#46; Of these&#44; 33 &#40;53&#37;&#41; were NDU and 29 &#40;47&#37;&#41; NNDU &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the baseline parameters&#44; both the uroflowmetric and urodynamic study for each group&#46; It can be observed that patients with NDU presented higher PVR and lower voiding efficiency and BCI than those with NNDU&#44; but without any statistically significant differences&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">When the evolution of both groups during follow-up was compared&#44; there were no differences regarding the appearance of recurrent urinary infections &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;34&#41; or the development of bladder stones &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;39&#41;&#46; However&#44; there was a greater number of patients in the NDU group who needed to start CIC throughout follow-up due to an increase in PVR &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46; These results are summarized in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; It is worth highlighting the fact that no patient with NNDU required CIC during the almost five years of follow-up&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">When comparing the baseline characteristics of the six patients who required CIC versus the rest&#44; the only differences we observed were a higher PVR &#40;316<span class="elsevierStyleHsp" style=""></span>mL vs&#46; 124<span class="elsevierStyleHsp" style=""></span>mL &#91;&#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#93;&#41; and a lower voiding efficiency &#40;35 vs&#46; 65&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;017&#41;&#46; The etiology of NDU in these patients was varied&#58; sacral agenesis &#40;one patient&#41;&#44; traumatic cervical spinal cord injury &#40;two patients&#41;&#44; subarachnoid hemorrhage &#40;one patient&#41;&#44; multiple sclerosis &#40;one patient&#41; and poorly controlled diabetes mellitus &#40;one patient&#41;&#46; When comparing the evolution of patients with NDU and with NNDU&#44; differences were observed in the time until the need for CIC &#40;log rank&#58; 0&#46;009&#41;&#44; with the mean time of control without the need for CIC of 15&#46;1 months &#40;range 4&#8211;38&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; There were no differences in terms of time until appearance of recurrent UTI &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In the bivariate logistic regression analysis&#44; none of the flowmetric variables or the urodynamic study could be shown to be a predictor of the need for CIC throughout follow-up&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">DU is a urodynamic finding defined by ICS<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> as a detrusor contraction with decreased intensity or time which is combined with a weak urinary flow&#44; and leads to a prolonged bladder emptying time and&#47;or the failure to completely empty the bladder in a normal period of time &#40;a high post-void residual may occur&#41;&#46; In our work&#44; we have used this definition for the diagnosis of patients with DU&#44; together with the BCI value&#46; The reason for using the BCI was that the ICS definition lacks numerical parameters of what &#8220;decreased intensity&#8221;&#44; &#8220;weak urinary flow&#8221; or &#8220;normal time&#8221; means&#46; Jeong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> compared various alternatives for defining DU&#44; such as establishing cut-off points for Qmax and Pdet&#46;Qmax&#46; However&#44; the use of these cut-off points would force us to evaluate urethral resistance&#44; since a patient could urinate with low Pdet&#46;Qmax&#44; not due to DU&#44; but due to low urethral resistance&#46; This would add some complexity to the study of DU&#46; Regarding the calculation of the Watts factor&#44; it is a complex mathematical formula&#44; requiring software that is not commonly implemented in urodynamic devices&#44; so its use is not that widespread in routine clinical practice or in the literature&#46; An attempt has been made to gather all these factors in the Maastricht-Hannover nomogram&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> although their use in a standardized way is not currently agreed upon&#46; Therefore&#44; we decided to use the value of BCI &#60;100 as the definition of DU&#44; as recommended by the ICS&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">With regards to the evolution of our patients&#44; with this definition we observed a prevalence in our sample of 6&#46;89&#37;&#46; This prevalence is somewhat lower than that published in other series&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> especially when using the BCI as a diagnostic criterion&#46; This datum could be justified by a low rate of diagnostic suspicion and low rates of referral of these patients to a urodynamic unit for pressure-flow studies as a result of the lack of non-invasive methods for diagnosis&#46; Most &#40;61&#37;&#41; of the patients presented NDU&#44; mainly associated with spinal cord injury &#40;traumatic or iatrogenic&#41;&#46; These data may be biased since ours is a neurourology referral unit&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In our sample&#44; only six of the 62 patients &#40;9&#46;2&#37;&#41; who completed follow-up needed to start CIC&#46; It should be noted that all of them were patients with NDU&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">There is little literature on the evolution of patients with NDU&#46; In our case&#44; it was observed how only six patients &#40;18&#46;1&#37;&#41; needed to start CIC during their follow-up due to an increase in PVR&#46; There is currently no evidence of any approved effective medical treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Most of these patients start CIC at the time of diagnosis&#44; being a well-accepted treatment&#44; although there are cases in which&#44; due to the progression of the underlying neurological disease&#44; it may become necessary to change the therapeutic attitude&#46; Those patients with NDU who do not initiate CIC at the time of diagnosis&#44; and who are the object of our work&#44; are probably those with the lowest risk &#40;the large number of patients with incomplete lesions can be seen in our sample&#41;&#46; It is probably for this reason that the rates of rUTI or the development of bladder lithiasis are similar to those of NNDU&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Regarding the evolution of patients with NNDU&#44; it is necessary to refer to the methodical review by Thomas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> on more than 2000 patients where 224 patients were diagnosed with NNDU&#44; and 137 of them were able to complete the study&#46; In their sample&#44; 69 patients opted for conservative management and after 10 years of follow-up&#44; 58 &#40;84&#37;&#41; remained without treatment&#46; These results are similar to those of our study&#46; It is possible that in our case&#44; the number of patients without the need for treatment is higher due to the shorter follow-up time&#46; Similarly to our study&#44; Thomas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> were unable to describe any predictive factor for failure of conservative management&#44; contrary to what occurs in patients with bladder outlet obstruction&#44; where age and prostate size can influence the failure of conservative management&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">There is some evidence that patients with NNDU will have no disease progression&#46; It has been described how those patients with DU of idiopathic origin did not present changes in the bladder contractility index in the long term&#46; With this objective&#44; Al-Hayek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> studied a group of patients with DU who underwent urodynamic testing at least 10 years after diagnosis&#46; The authors did not observe any changes in the bladder contractility index between the baseline urodynamic study and during follow-up of these patients&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The basis for check-up of these patients is the control of symptoms and the appearance of complications &#40;acute urinary retention&#44; the development of bladder stones or the presence of recurrent urinary infections&#41;&#46; To this end&#44; apart from the usefulness of ultrasound&#44; uroflowmetry and urine cultures&#44; an attempt is being made to develop questionnaires and carry out phenotyping of these patients in addition to launching prospective studies in this pathology&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">With respect to the secondary objective of our work&#44; there is no literature comparing the evolution of these two groups of patients&#46; There are several biases to be aware of&#46; In the first place&#44; they are demographically not very comparable populations&#46; Just as NDU patients tend to be younger patients &#40;traumatic spinal cord injuries&#44; multiple sclerosis&#44; or gynecological surgeries&#41;&#44; NNDU patients tend to be older due to chronic obstruction&#44; aging&#44; or long-standing diabetes mellitus&#46; It must be added that&#44; just as the majority of NDUs are diagnosed as a result of being referred to urology units for obvious reasons&#44; many of the patients with NNDU may remain undiagnosed due to low diagnostic suspicion&#46; This is due to the presence of unspecific symptoms&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In fact&#44; symptoms can occur both during the filling and voiding phases&#46; Thus&#44; in our series&#44; it can be seen how only 33&#37; of the patients consulted for symptoms solely in the voiding phase and 15&#37; did so after an episode of urinary retention&#46; Gammie et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> observed in a series of almost 1800 patients&#44; how those with DU had a significantly greater sensation of a weak or interrupted stream&#44; a sensation of incomplete emptying&#44; or a decrease in the sensation of bladder filling&#44; compared to those who did not present DU&#46; When comparing this group with patients with bladder outlet obstruction&#44; they observed how patients with DU had a greater need to use abdominal straining for voiding&#44; as well as the presence of symptoms in other spheres&#44; such as sexual or digestive&#46; Nevertheless&#44; symptoms may occur in the bladder filling phase&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> such as urgency&#44; frequency&#44; or even incontinence&#46; In our series&#44; up to 14&#37; had mixed urinary incontinence and 11&#37; had urge urinary incontinence&#44; showing how up to 20&#37; of the patients had some associated urodynamic diagnosis in the filling phase &#40;mainly detrusor hyperactivity&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The strengths of our study include the selection of a specific group of patients &#40;male patients with DU&#41;&#44; long-term follow-up&#44; and a protocolized follow-up of PVR&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Concerning the weaknesses in our study&#44; it should be noted that the patients included are those who were referred to a referral unit due to lower urinary tract symptoms&#46; This led to the loss of up to 43&#37; of the sample because of geographical reasons&#46; On the other hand&#44; we found limitations in the sample size and in the low number of patients who have required CIC throughout follow-up &#40;six patients&#41;&#46; This could be one of the reasons for not finding predictive risk factors&#46; It is also plausible that a percentage of those patients who were followed up in other centers have required CIC and could not be evaluated in this study&#46; Having the data from these patients would have been of great interest&#46; This makes us consider the need for regional or national registries of neurourological pathology&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">It should be noted that the application of the conclusions of our work makes sense for a very specific population&#58; men with DU &#40;neurogenic or not&#41; for whom watchful waiting or non-interventional medical treatment is chosen&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0150" class="elsevierStylePara elsevierViewall">In our study&#44; the most common cause of detrusor underactivity is neurological injury&#44; specifically spinal cord injury&#46; Our patients with hypoactive detrusor of non-neurological origin tend to remain stable without the need to initiate clean intermittent catheterization&#46; We have not found clinical or urodynamic factors that allow us to detect those patients at risk of needing intermittent clean catheterization during follow-up&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest&#46;</p></span></span>"
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          "titulo" => "Referencias"
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    "fechaRecibido" => "2020-01-30"
    "fechaAceptado" => "2020-08-11"
    "PalabrasClave" => array:2 [
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          "clase" => "keyword"
          "titulo" => "Keywords"
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          "palabras" => array:3 [
            0 => "Detrusor underactivity"
            1 => "Clean intermittent catheterization"
            2 => "Follow-up"
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        ]
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            0 => "Detrusor hipoactivo"
            1 => "Cateterismo limpio intermitente"
            2 => "Seguimiento"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The objective of the study was to compare the evolution of male patients with neurogenic detrusor underactivity &#40;NDU&#41; versus non-neurogenic DU &#40;NNDU&#41; and to establish risk factors to predict the need for clean intermittent catheterization &#40;<span class="elsevierStyleSmallCaps">C</span>I<span class="elsevierStyleSmallCaps">C</span>&#41; during the follow-up period&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Longitudinal&#44; descriptive study of a cohort of patients diagnosed with DU&#44; and 2496 urodynamic studies &#40;2008&#8211;2018&#41; were reviewed&#46; Patients with DU &#40;ICS 2002 and&#47;or Bladder contraction index &#40;&#60;100&#41;&#41; without treatment were included&#46; Patients with CIC or interventional treatment were excluded&#46; Follow-up included flowmetry every six months&#46; CIC was indicated in cases of high residual volume &#40;PVR&#41; &#62;200<span class="elsevierStyleHsp" style=""></span>mL or voiding efficiency &#40;VE&#41; &#60;50&#37;&#46; The need for CIC during follow-up or the appearance of complications &#40;urinary tract infections &#40;UTI&#41;&#44; bladder lithiasis&#41; were compared&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">DU was found in 172 &#40;6&#46;89&#37;&#41; men&#46; Neurological causes were observed in 106 &#40;61&#44;6&#37;&#41; cases&#46; Finally&#44; 62 patients were included with a mean follow-up of 4&#46;9 years &#40;&#177;2&#46;6&#41;&#46; Of these patients&#44; 33 &#40;53&#37;&#41; presented NDU and 29 &#40;47&#37;&#41; NNDU&#46; Six patients with NDU needed CIC versus none with NNDU &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46; Patients requiring CIC had higher PVR &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#41; and lower VE &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;017&#41;&#41;&#44; and there were also differences in terms of time until the need for CIC &#40;log Rank&#58; 0&#46;009&#41;&#44; which was 15&#46;1 months &#91;4&#8211;38&#93;&#46; In the multivariate analysis&#44; none of the variables showed to be predictive of the need for CIC&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The most common cause of DU is neurologic injury&#46; Patients with NDU remain stable without requiring CIC&#46; We have not detected any risk factors that identify patients at risk of needing CIC&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
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            "titulo" => "Results"
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            "titulo" => "Conclusions"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">El objetivo del trabajo fue comparar la evoluci&#243;n de pacientes varones con detrusor hipoactivo &#40;DU&#41; neur&#243;geno &#40;DUN&#41; frente a DU no neur&#243;geno &#40;DUNoN&#41; y establecer factores de riesgo para predecir la necesidad de cateterismo limpio intermitente &#40;CLI&#41; en el seguimiento&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Estudio longitudinal&#44; descriptivo&#44; sobre una cohorte de pacientes con diagn&#243;stico de DU&#46; Se revisaron 2&#46;496 estudios urodin&#225;micos &#40;2008-2018&#41;&#46; Se incluyeron pacientes con DU &#40;ICS2002 y&#47;o Bladder contraction index &#91;&#60; 100&#93;&#41; sin tratamiento&#46; Se excluyeron pacientes en CLI o tratamiento intervencionista&#46; Se realiz&#243; seguimiento semestralmente con flujometr&#237;a&#46; Se indic&#243; CLI ante residuos elevados &#40;RPM&#41; &#62; 200<span class="elsevierStyleHsp" style=""></span>mL o eficiencia de vaciado &#40;EV&#41; &#60; 50&#37;&#46; Se compar&#243; la necesidad de CLI durante el seguimiento o la aparici&#243;n de complicaciones &#40;infecciones urinarias &#91;ITU&#93;&#44; litiasis vesical&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se encontraron 172 &#40;6&#44;89&#37;&#41; varones con DU&#46; En 106 &#40;61&#44;6&#37;&#41; se evidenci&#243; causa neurol&#243;gica&#46; Finalmente se incluyeron 62 pacientes con seguimiento medio de 4&#44;9 a&#241;os &#40;&#43;&#47;-2&#44;6&#41;&#46; De ellos&#44; 33 &#40;53&#37;&#41; fueron DUN y 29 &#40;47&#37;&#41; DUNoN&#46; No se apreciaron diferencias en la aparici&#243;n de ITU &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;34&#41; o litiasis vesicales &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;39&#41;&#46; Seis pacientes con DUN precisaron CLI frente a ninguno con DUNoN &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41;&#46; Los pacientes que requirieron CLI presentaron mayor RPM &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#93;&#41; y menor EV &#91;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#93;&#41;&#46; Tambi&#233;n se apreciaron diferencias en el tiempo hasta la necesidad de CLI &#40;log rank&#58; 0&#44;009&#41;&#44; siendo este de 15&#44;1 meses &#40;4-38&#41;&#46; En el an&#225;lisis multivariante ninguna de las variables pudo demostrarse como factor predictivo de necesidad de CLI&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La causa m&#225;s frecuente de DU es la lesi&#243;n neurol&#243;gica&#46; Los pacientes con DUN permanecen estables sin necesidad de CLI&#46; No hemos detectado factores de riesgo que identifiquen a los pacientes en riesgo de necesitar CLI&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Mor&#225;n E&#44; S&#225;ez I&#44; Bol&#243;n J&#44; Colet O&#44; Bonillo MA&#44; Mart&#237;nez-Cuenca E&#44; et al&#46; Evoluci&#243;n de pacientes varones con detrusor hipoactivo y tratamiento conservador&#46; Seguimiento a cinco a&#241;os&#46; Actas Urol Esp&#46; 2021&#59;45&#58;82&#8211;87&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Median &#40;standard variation&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">59&#46;6 &#40;15&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Reason for consultation &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Voiding symptoms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Urinary retention&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span> Urge urinary incontinence&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span> Mixed urinary incontinence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Urinary tract infection&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Previous treatment &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alpha blocker&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anticholinergic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span> Alpha blocker &#43; anticholinergic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Patients with spinal cord injury &#40;27&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Injury level n&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Cervical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Dorsal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">9 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Lumbar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;40&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sacral&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grade of injury &#40;ASIA&#41; n&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>B&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>C&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>D&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Unknown&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Qmax<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;mL&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;7 &#40;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PVR<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">183&#46;9 &#40;175&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Voiding efficiency<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;3 &#40;41&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Pdet&#46;Qmax<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> &#40;cm H<span class="elsevierStyleInf">2</span>O&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;2 &#40;23&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>BCI<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;8 &#40;72&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t">8 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Idiopathic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parkinson&#39;s&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Multiple sclerosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;8&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Spinal cord injury &#40;traumatic&#44; herniated disc&#44; etc&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;15&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Others &#40;myelomeningocele&#44; subarachnoid hemorrhage&#44; multisystemic atrophy&#44; etc&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;20&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Myogenic</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bladder outlet obstruction &#40;Incl&#46; history of prostate surgery&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;17&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Iatrogenic</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span> Pelvic surgery&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total DU &#40;62&#41; Median &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NDU &#40;33&#41; Median &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NNDU &#40;29&#41; Median &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Qmax<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> &#40;mL&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;71 &#40;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;19 &#40;5&#46;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;07 &#40;6&#46;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PVR<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> &#40;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">183&#46;90 &#40;175&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">158&#46;75 &#40;142&#46;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107&#46;76 &#40;128&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Voiding effic&#46;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;39 &#40;41&#46;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;16 &#40;30&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;32 &#40;30&#46;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pdet&#46;o<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a> &#40;cm H<span class="elsevierStyleInf">2</span>O&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;78 &#40;21&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;52 &#40;23&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;66 &#40;20&#46;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BCI<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;89 &#40;72&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;23 &#40;19&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#46;35 &#40;32&#46;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pdet&#46;Qmax<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&#40;cm H<span class="elsevierStyleInf">2</span>O&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;28 &#40;23&#46;35&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;48 &#40;16&#46;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;77 &#40;19&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">rUTI &#40;n&#47;N &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#47;62 &#40;17&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#47;33 &#40;24&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#47;29 &#40;10&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bladder lithiasis &#40;n&#47;N &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#47;62 &#40;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#47;33 &#40;12&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#47;29 &#40;3&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">0&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">CIC &#40;n&#47;N &#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#47;62 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#47;33 &#40;18&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#47;29 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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