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Advocating hormonal treatment to prevent adult infertility in patients diagnosed with congenital undescended testes 提倡对确诊为先天性睾丸发育不全的患者进行激素治疗,以预防成年后不育症的发生
F. Hadziselimovic
ABSTRACT In 2007 the Nordic group came to the following unanimous conclusions: In general, hormonal treatment is not recommended, considering the poor immediate results and the possible long-term adverse effects on spermatogenesis. Thus, surgery is to be preferred. However, defective mini puberty inducing insufficient gonadotropin secretion is one of the most common causes of nonobstructive azoospermia in men suffering from congenital isolated unilateral or bilateral cryptorchidism. The extent of alteration in the unilateral undescended testis correlate with the contralateral descended testis, indicating that unilateral cryptorchidism is a bilateral disease. Idiopathic central hypogonadism explains the phenomenon of defective mini puberty in otherwise healthy cryptorchid boys. We therefore recommend hormonal treatment for cryptorchid boys with defective mini puberty. Gonadotropin releasing hormone agonist (GnRHa) treatment following surgery to correct cryptorchidism restores mini puberty via endocrinological and transcriptional effects and prevents adult infertility in most cases. Several genes are important for central hypogonadotropic hypogonadism in mammals, including many that are transcribed in both the brain and testis. At the molecular level, there is no convincing evidence that heat shock is responsible for the observed pathological testicular changes. Thus, impaired transformation of gonocytes is not the result of temperature stress but rather a hormonal imbalance. Cryptorchidism should therefore be considered a serious andrological problem that cannot be successfully treated by early orchidopexy alone.
摘要 2007 年,北欧研究小组得出了以下一致结论:一般来说,考虑到激素治疗的近期效果不佳,而且可能对精子生成产生长期不利影响,因此不建议采用激素治疗。因此,手术是首选。然而,微型青春期缺陷导致促性腺激素分泌不足,是先天性孤立的单侧或双侧隐睾男性非梗阻性无精子症的最常见原因之一。单侧未下降睾丸的改变程度与对侧下降睾丸的改变程度相关,这表明单侧隐睾症是一种双侧疾病。特发性中枢性性腺功能减退症可以解释原本健康的隐睾男孩出现缺陷性小青春期的现象。因此,我们建议对有小青春期缺陷的隐睾男孩进行激素治疗。在隐睾症手术矫正后,促性腺激素释放激素激动剂(GnRHa)可通过内分泌和转录作用恢复小青春期,并在大多数情况下防止成年不育症的发生。有几个基因对哺乳动物的中枢性性腺功能减退症非常重要,其中许多基因在大脑和睾丸中都有转录。在分子水平上,没有令人信服的证据表明热休克是导致所观察到的睾丸病理变化的原因。因此,性腺细胞的转化障碍不是温度应激的结果,而是荷尔蒙失衡的结果。因此,隐睾症应被视为一种严重的妇科疾病,仅靠早期睾丸切除术是无法成功治疗的。
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引用次数: 1
REPLY TO THE AUTHORS: Re: One-day voiding diary in the evaluation of Lower Urinary Tract Symptoms in children 回复作者:回复:一日排尿日记对儿童下尿路症状的评价
Pub Date : 2023-04-05 DOI: 10.1590/S1677-5538.IBJU.2022.0059.1
Hanny Helena Masson Franck, A. C. S. Guedes, Y. F. S. Alvim, Thamires M. S. de Andrade, Liliana Fajardo Oliveira, Lidyanne Ilidia da Silva, A. Figueiredo, José de Bessa Jr., J. M. Netto
1 Departamento de Cirurgia da Faculdade de Medicina – Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil; 2 Escola de Enfermagem – Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brasil; 3 Escola de Fisioterapia – Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (HMTJ/SUPREMA), Juiz de Fora, MG, Brasil; 4 Departamento de Cirurgia da Faculdade de Medicina – Universidade Estadual de Feira de Santana (UEFS), Feira de Santana, BA, Brasil
巴西MG州Juiz de Fora联邦大学(UFJF)医学院1外科;2护理学院-瑞士福拉联邦大学(UFJF),瑞士福拉,MG,巴西;3物理治疗学院- Juiz de Fora医学和健康科学学院(HMTJ/SUPREMA), Juiz de Fora, MG,巴西;费拉德桑塔纳州立大学(UEFS)医学院外科,费拉德桑塔纳,学士,巴西
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引用次数: 0
Impact of artificial urinary sphincter erosion in the reimplantation of the device 人工尿道括约肌糜烂对装置再植的影响
Pub Date : 2022-07-19 DOI: 10.1590/S1677-5538.IBJU.2022.0089.1
A. Cavalcanti
In this article, the authors assess the clinical presentation of patients with urethral cuff erosion after the implant of an Artificial Urinary Sphincter (AUS) and also attempt to establish risk factors in this patient population (1). As well pointed out by the authors, this complication has an extreme impact on the treatment of these patients, both in the acute phase, associated with the inflammatory and infectious condition, and late related to the reimplantation of the device. Replantation of AUS after erosion is certainly one of the most challenging conditions in the management of male urinary incontinence. Despite the literature describing statistical data and risk factors for erosion, these hardly describe details about the evolution characteristics of this process. As observed by the authors, most patients present with inflammatory signs in the scrotum, but a significant part of patients (about 1/3) do not present these symptoms, and will exclusively have urinary symptoms (obstruction or incontinence relapse) (2). This is an important finding because even in the absence of inflammatory signs, erosion should be suspected when there are urinary symptoms, whether obstructive or incontinence relapse. In the case of obstructive symptoms, it is important to analyze whether there is a reference to urethral stenosis or urethro-vesical anastomosis in the patient’s clinical history for the differential diagnosis. In the case of incontinence relapse, it is usually more acute when compared to other causes such as urethral atrophy. As well demonstrated in the study, these symptoms can present in combination. In the study, inflammatory symptoms are more associated with obstruction, perhaps due to greater urine leakage, a fact that also justifies lower rates of the combination of incontinence relapse and inflammation. The presence of radiotherapy was more common in patients with erosion when compared to those without erosion, as well as hypertension, coronary heart disease and smoking. The identification of risk factors is essential for patient consent, as well as for technical interventions to be taken to prevent the problem at the time of implantation of the prosthesis. The authors did not demonstrate previous procedures such as urethroplasty as risk factors in this study, but in our opinion, all patients who have an established impact on urethral vascularization a risk factor for cuff erosion. In the specific case of urethroplasty, we should try to preserve the urethra vascularization in all patients who are at risk of developing postoperative incontinence. Early recognition of cuff erosion is critical for an early approach that is likely to be associated with less urethral damage. EDITORIAL COMMENT Vol. 48 (4): 686-687, July August, 2022 doi: 10.1590/S1677-5538.IBJU.2022.0089.1
在本文中,作者评估了人工尿道括约肌(AUS)植入后尿道袖带糜烂患者的临床表现,并试图确定该患者群体的危险因素(1)。作者也指出,这种并发症对这些患者的治疗有极大的影响,无论是在急性期,与炎症和感染状况相关,还是与再植装置相关的晚期。在男性尿失禁的治疗中,腐蚀后AUS的再植无疑是最具挑战性的条件之一。尽管文献描述了侵蚀的统计数据和危险因素,但这些文献几乎没有描述这一过程演变特征的细节。根据作者的观察,大多数患者在阴囊内都有炎症体征,但也有相当一部分患者(约1/3)没有这些症状,而只会出现泌尿系统症状(梗阻或失禁复发)(2)。这是一个重要的发现,因为即使没有炎症症状,当出现泌尿系统症状时,无论是梗阻还是失禁复发,都应该怀疑糜烂。在出现梗阻性症状的情况下,分析患者的临床病史中是否有尿道狭窄或尿道膀胱吻合术的参考,对鉴别诊断很重要。在失禁复发的情况下,与其他原因如尿道萎缩相比,它通常更急性。研究也表明,这些症状可以同时出现。在这项研究中,炎症症状与梗阻更相关,这可能是由于更多的尿漏,这一事实也证明了失禁复发和炎症合并的低发生率。与没有糜烂的患者相比,有糜烂的患者以及高血压、冠心病和吸烟的患者更常接受放射治疗。确定风险因素对于患者的同意以及在植入假体时采取技术干预措施以防止出现问题至关重要。作者并未在本研究中证明先前的手术如尿道成形术是危险因素,但在我们看来,所有对尿道血管形成有影响的患者都是尿道糜烂的危险因素。在尿道成形术的特殊情况下,对于所有有术后尿失禁风险的患者,我们应尽量保留尿道血管。早期识别袖带糜烂是早期入路的关键,这可能会减少尿道损伤。编辑评论Vol. 48(4): 686-687, 2022年7月8日doi: 10.1590/S1677-5538.IBJU.2022.0089.1
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引用次数: 0
The evolution of stress urinary incontinence treatment techniques of the last three decades 近三十年来压力性尿失禁治疗技术的发展
Pub Date : 2022-07-19 DOI: 10.1590/S1677-5538.IBJU.2021.0646.1
C. Riccetto
The authors retrospectively studied a database of 221 patients who underwent correction of stress urinary incontinence (SUI) through the implantation of a SAFYRE VS retropubic sling (96 women) or a homemade polypropylene retropubic sling - HMS (125 patients) between March 2005 and December 2007, comprising a median follow-up of 78.47 (± 38.69) months (1). The evaluation included a telepho-ne call made by a blinded trained researcher for those patients who had completed at least one year of surgery. The HMS was made of a 75g/m 2 , 15mm-wide polypropylene mesh attached with polyglycolic acid sutures at its edges. Both HMS and SAFYRE VS groups presented significant improvements on In-ternational consensus on Incontinence – Urinary Incontinence Short Form questionnaire (ICIQ-UI SF) and there were no differences in satisfaction, subjective cure rates, ICIQ-UI SF, or complications between groups, but a significantly higher frequency of patients of SAFYERE VS group required indwelling urinary catheter over 24
作者回顾性研究了2005年3月至2007年12月期间通过植入SAFYRE VS耻骨后吊带(96名女性)或自制聚丙烯耻骨后吊带- HMS(125名患者)矫正压力性尿失禁(SUI)的221例患者的数据库。包括78.47(±38.69)个月的中位随访(1)。评估包括由盲法训练的研究人员对完成至少一年手术的患者进行电话随访。HMS由75克/米2,15毫米宽的聚丙烯网片制成,其边缘附有聚乙醇酸缝合线。HMS组和SAFYRE VS组在尿失禁-尿失禁简短问卷调查(ICIQ-UI SF)的国际共识上均有显著改善,两组患者在满意度、主观治愈率、ICIQ-UI SF或并发症方面均无差异,但SAFYERE VS组患者在24岁以上需要留置导尿管的频率明显高于SAFYERE VS组
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引用次数: 0
Vesical imaging reporting and data system (VI-RADS) in bladder cancer diagnosis in review in this number of International Brazilian Journal of Urology 膀胱成像报告和数据系统(VI-RADS)在膀胱癌诊断中的应用发表在本期《国际巴西泌尿学杂志》上
L. Favorito
contributions with a of interesting papers in different fields: Robotic Surgery, Prostate Cancer, Overactive Bladder, Bladder Cancer, renal cancer, myelomeningocele, renal stones, congenital adrenal hyperplasia, Testicular torsion, penile cancer, BPH, Urinary incontinence and reconstructive urology.
在不同领域发表了许多有趣的论文:机器人手术,前列腺癌,膀胱过度活动,膀胱癌,肾癌,脊膜膨出,肾结石,先天性肾上腺增生,睾丸扭转,阴茎癌,前列腺增生,尿失禁和重建泌尿外科。
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引用次数: 0
A brief review of the VI-RADS classification for bladder tumors on MRI (and a call for increased interface, consistent communication and more joined studies by the radiological and urological communities). 简要回顾核磁共振成像膀胱肿瘤的 VI-RADS 分类(并呼吁放射科和泌尿科界加强交流、保持沟通和开展更多联合研究)。
Pub Date : 2022-07-01 DOI: 10.1590/S1677-5538.IBJU.2021.0560.1
Ronaldo Hueb Baroni
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引用次数: 0
The role of hyperbaric oxygen therapy in Fournier’s Gangrene: A systematic review and meta-analysis of observational studies 高压氧治疗在富尼耶坏疽中的作用:观察性研究的系统回顾和荟萃分析
Muhammad Achdiar Raizandha, F. Hidayatullah, Y. Kloping, I. Rahman, W. Djatisoesanto, F. Rizaldi
ABSTRACT Purpose: Management of Fournier’s Gangrene (FG) includes broad-spectrum antibiotics with adequate surgical debridement, which should be performed within the first 24 hours of onset. However, this treatment may cause significant loss of tissue and may delay healing with the presence of ischemia. Hyperbaric oxygen therapy (HBOT) has been proposed as adjunctive therapy to assist the healing process. However, its benefit is still debatable. Therefore, this systematic review and meta-analysis aimed to evaluate the effect of HBOT as an adjunct therapy for FG. Materials and Methods: This study complied with the Preferred Reporting Items for Systematic Reviews and Meta-analyses protocol to obtain studies investigating the effect of HBOT on patients with FG. The search is systematically carried out on different databases such as MEDLINE, Embase, and Scopus based on population, intervention, control, and outcomes criteria. A total of 10 articles were retrieved for qualitative and quantitative analysis. Results: There was a significant difference in mortality as patients with FG who received HBOT had a lower number of deaths compared to patients who received conventional therapy (Odds Ratio 0.29; 95% CI 0.12 – 0.69; p = 0.005). However, the mean length of stay with Mean Difference (MD) of -0.18 (95% CI: -7.68 – 7.33; p=0.96) and the number of debridement procedures (MD 1.33; 95% CI: -0.58 – 3.23; p=0.17) were not significantly different. Conclusion: HBOT can be used as an adjunct therapy to prevent an increased risk of mortality in patients with FG.
目的:富尼耶坏疽(FG)的治疗包括广谱抗生素和适当的手术清创,应在发病后24小时内进行。然而,这种治疗可能会导致严重的组织损失,并可能因缺血而延迟愈合。高压氧治疗(HBOT)已被提出作为辅助治疗,以协助愈合过程。然而,它的好处仍然值得商榷。因此,本系统综述和荟萃分析旨在评估HBOT作为FG辅助治疗的效果。材料和方法:本研究遵循系统评价和荟萃分析方案的首选报告项目,以获得调查HBOT对FG患者影响的研究。根据人口、干预、控制和结果标准,系统地在不同的数据库(如MEDLINE、Embase和Scopus)上进行搜索。共检索10篇文献进行定性和定量分析。结果:死亡率有显著差异,接受HBOT治疗的FG患者的死亡率低于接受常规治疗的患者(优势比0.29;95% ci 0.12 - 0.69;P = 0.005)。然而,平均停留时间平均差(MD)为-0.18 (95% CI: -7.68 - 7.33;p=0.96)和清创手术次数(MD 1.33;95% ci: -0.58 - 3.23;P =0.17),差异无统计学意义。结论:HBOT可作为预防FG患者死亡风险增加的辅助治疗。
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引用次数: 7
Re: Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study 经皮胫神经刺激与电刺激联合盆底肌训练治疗女性膀胱过度活动综合征:一项随机对照研究的结果
N. Yıldız
I thank the authors of “Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study (1).” I support the importance you attribute to intravaginal electrical stimulation (IVES) and percutaneous tibial nerve stimulation (PTNS) in the management of idiopathic overactive bladder (OAB). The authors stated that PTNS is more effective than IVES in women with idiopathic OAB. Women with antimuscarinic naive OAB were included in this study (1). However, it is known that many patients with idiopathic OAB receive pharmacological treatment before reaching a conservative treatment option such as IVES. As the authors stated, in common practice, antimuscarinic agents are frequently used as an initial treatment although burdened by a low adherence, and these patients need protracted treatment with periodic controls.
我感谢“经皮胫神经刺激与电刺激联合盆底肌训练治疗女性膀胱过度活跃综合征:一项随机对照研究的结果(1)”的作者。我支持您认为阴道内电刺激(IVES)和经皮胫神经刺激(PTNS)在特发性膀胱过度活跃(OAB)治疗中的重要性。作者指出,对于特发性OAB妇女,PTNS比IVES更有效。本研究纳入了抗毒蕈碱初始OAB的女性(1)。然而,众所周知,许多特发性OAB患者在接受保守治疗(如IVES)之前接受了药物治疗。正如作者所述,在一般实践中,抗毒蕈碱药物经常被用作初始治疗,尽管依从性较低,这些患者需要长期治疗并进行周期性控制。
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引用次数: 1
Editorial Comment: Interaction between the impact of the Coronavirus disease 2019 pandemic and demographic characteristics on sexual/erectile dysfunction in Latin America: crosssectional study 编者按:2019冠状病毒病大流行与拉丁美洲性/勃起功能障碍人口统计学特征之间的相互作用:横断面研究
Valter Javaroni
The global outbreak of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the consequent lockdown had dramatic repercussions at both macrosocial, such as the economy and policy, and microsocial level, such as on the psychological and relational well-being of persons represents an unprecedented challenge for healthcare (1). In June 2020, more than 7.5 million COVID-19 cases have been confirmed worldwide, with more than 420,000 lives lost due to the disease (2), and increased rates of post-traumatic stress disorder (PTSD), depression and anxiety were already expected in the general population, and even more in COVID-19 survivors, following the pandemic (3-6). It has already been shown that sexual dysfunction may be observed in PTSD patients (7), and that emotional numbness can prevent emotional intimacy and connectedness with a partner. So, PTSD symptoms can cause problems in sexual functions, and PTSD can be used as a predictive parameter for sexual dysfunction in these patients (8). The high level of anxiety, anger and irritability observed in PTSD patients not only creates sexual dysfunction independently but also affects sexual dysfunction indirectly due to negative effects on social or romantic relationships and intimacy with the opposite sex (9). It can worse preexisting dysfunctions. Moreover, anger and anxiety might have a bidirectional relationship with erectile function. That is, anger and anxiety can create erectile dysfunction, and sexual dysfunction can induce or increase these symptoms (10). The relationship between erection dysfunction and psychological state has also been examined in large-scale studies. In the National Health and Social Life Survey (NHSLS) study, data show that emotional problems and stress-related problems pose a risk of difficulty being experienced at all stages of sexuality. The researchers concluded that psychological state was an independent factor affecting sexual function (11). In ‘The multinational men’s attitudes to life events and sexuality’ (MALES) study conducted in Europe and North and South America, which included 2,912 men, depression or anxiety was found in 25% of the patients who reported to have ED, while was found in 26% of the patients who reported to have depression or anxiety (12). So, as sexual activity is closely associated with mental and psychological health, it is unsurprising that sexual desire and frequency have declined in both genders during this pandemic (13, 14). An interesting paper from Spain suggested that the social impact of the lockdown is related to gender, age and socioeconomic conditions. Authors found that women and young people had worse mental EDITORIAL COMMENT Vol. 48 (3): 548-552, May June, 2022
由严重急性呼吸系统综合征冠状病毒2 (SARS-CoV-2)引起的冠状病毒病(COVID-19)全球爆发,随之而来的封锁在宏观社会(如经济和政策)和微观社会层面(如对人的心理和关系健康)都产生了巨大影响,这对医疗保健构成了前所未有的挑战(1)。2020年6月,全球确诊的COVID-19病例超过750万例。由于该疾病导致超过42万人丧生(2),并且在大流行之后,预计普通人群中创伤后应激障碍(PTSD)、抑郁和焦虑的比例会增加,在COVID-19幸存者中甚至会增加(3-6)。已经有研究表明,PTSD患者可能会出现性功能障碍(7),而情感麻木会阻碍与伴侣的情感亲密和联系。因此,PTSD症状可导致性功能问题,PTSD可作为这些患者性功能障碍的预测参数(8)。PTSD患者中观察到的高水平焦虑、愤怒和易怒不仅会独立产生性功能障碍,还会间接影响性功能障碍,因为这会对社交或恋爱关系以及与异性的亲密关系产生负面影响(9)。此外,愤怒和焦虑可能与勃起功能有双向关系。也就是说,愤怒和焦虑会导致勃起功能障碍,而性功能障碍会诱发或加重这些症状(10)。勃起功能障碍与心理状态之间的关系也在大规模研究中得到了检验。在国家健康和社会生活调查(NHSLS)研究中,数据显示,情绪问题和与压力相关的问题在性行为的各个阶段都有经历困难的风险。研究人员得出结论,心理状态是影响性功能的一个独立因素。在欧洲、北美和南美进行的“跨国男性对生活事件和性行为的态度”(男性)研究中,包括2,912名男性,25%的ED患者存在抑郁或焦虑,而26%的ED患者存在抑郁或焦虑(12)。因此,由于性活动与精神和心理健康密切相关,因此在本次大流行期间,男女的性欲和频率都有所下降也就不足为奇了(13,14)。来自西班牙的一篇有趣的论文表明,封锁的社会影响与性别、年龄和社会经济条件有关。作者发现,女性和年轻人的心理状况更差。编辑评论Vol. 48(3): 548-552, 2022年5月6日
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引用次数: 0
Upper tract urothelial carcinoma and bladder cancer in review in this number of International Brazilian Journal of Urology 上尿道尿路上皮癌和膀胱癌在这一期的国际巴西泌尿学杂志上的综述
L. Favorito
no definite a higher stone-free a interesting translational study about the lower pole anatomy in anomalous kidneys and concluded that the knowledge of spatial anatomy of lower pole is of utmost importance during endourologic pro-cedures in patients with kidney anomalies. The horseshoe kidneys had more restrictive anatomic factors in lower pole than the complete ureteral duplication.
一项关于异常肾脏下极解剖的有趣的转化研究表明,在肾异常患者的泌尿系统手术中,了解下极空间解剖是至关重要的。马蹄肾的下极限制性解剖因素多于完全输尿管重复肾。
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引用次数: 0
期刊
International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology
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