Pub Date : 2022-03-14DOI: 10.1590/S1677-5538.IBJU.2021.0790
Adil Huseynov, O. Telli, Perviz Haciyev, T. Okutucu, A. Akinci, Mete Ozkidik, I. Erguder, S. Fitoz, B. Burgu, T. Soygur
ABSTRACT Objective: Bladder wall thickness (BWTh) measurements and Nerve Growth Factor (NGF) /creatinine (Cr) values, as noninvasive tools, were found to predict daytime voiding problems in children with overactive bladder (OAB). The goal of this research was to examine if bladder wall thickness together with urine NGF/Cr could be a clinical utility in treatment outcome of OAB in children. Patients and Methods: A total of 60 children with OAB, (Group 1; n=40) and healthy normal controls (Group 2; n=20), aged 6-14 years old were involved in this prospective study. Children were evaluated with detailed history and physical examination, including neurologic examination, and were asked to complete a self-reported questionnaire and a 3-day bladder diary with the aid of their parents. Uroflowmetry was performed in all cases. Urinary nerve growth factor levels were measured by the ELISA and BWTh was measured trans-abdominally by one uro-radiologist specialized in pediatric ultrasonography. Urinary NGF levels were normalized by urinary creatinine levels and compared among all subgroups. Children with OAB received urotherapy as first line treatment at least for three months. 18 children refractory to urotherapy received anticholinergic therapy defined as group 3. Results: The median age of the study group was 10 (range 6 to 16). After urotherapy, 22 children had similar BWTh and NGF/Cr values compared to controls. (2.75 ± 1.15; 2.40 ± 1.00 mm; p=0.86 and 1.02 ± 0.10; 0.78 ± 0.15; p=0.12, respectively). After anticholinergic treatment, BWTh levels (2.25 ± 0.90; 2.40 ± 1.00 mm; p=0.94) and NGF/Cr values (0.95 ± 0.10; 0.78 ± 0.15; p=0.42, respectively) had no significantly difference compared to controls (Group 2). In receiver operating characteristic analysis, bladder wall thickness was found to have sensitivity of 85% and specificity of 84.2% (3,20 AUC, 913; 95 %) and NGF/Cr had sensitivity of 90% and specificity of 92.1% (1,595; AUC, 947; 95 %) in predicting treatment outcome in children with OAB. Conclusions: Bladder wall thickness measurements and NGF/Cr values, as noninvasive tools, could guide outcomes in the treatment of children with overactive bladder.
{"title":"Could urinary nerve growth factor and bladder wall thickness predict the treatment outcome of children with overactive bladder?","authors":"Adil Huseynov, O. Telli, Perviz Haciyev, T. Okutucu, A. Akinci, Mete Ozkidik, I. Erguder, S. Fitoz, B. Burgu, T. Soygur","doi":"10.1590/S1677-5538.IBJU.2021.0790","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2021.0790","url":null,"abstract":"ABSTRACT Objective: Bladder wall thickness (BWTh) measurements and Nerve Growth Factor (NGF) /creatinine (Cr) values, as noninvasive tools, were found to predict daytime voiding problems in children with overactive bladder (OAB). The goal of this research was to examine if bladder wall thickness together with urine NGF/Cr could be a clinical utility in treatment outcome of OAB in children. Patients and Methods: A total of 60 children with OAB, (Group 1; n=40) and healthy normal controls (Group 2; n=20), aged 6-14 years old were involved in this prospective study. Children were evaluated with detailed history and physical examination, including neurologic examination, and were asked to complete a self-reported questionnaire and a 3-day bladder diary with the aid of their parents. Uroflowmetry was performed in all cases. Urinary nerve growth factor levels were measured by the ELISA and BWTh was measured trans-abdominally by one uro-radiologist specialized in pediatric ultrasonography. Urinary NGF levels were normalized by urinary creatinine levels and compared among all subgroups. Children with OAB received urotherapy as first line treatment at least for three months. 18 children refractory to urotherapy received anticholinergic therapy defined as group 3. Results: The median age of the study group was 10 (range 6 to 16). After urotherapy, 22 children had similar BWTh and NGF/Cr values compared to controls. (2.75 ± 1.15; 2.40 ± 1.00 mm; p=0.86 and 1.02 ± 0.10; 0.78 ± 0.15; p=0.12, respectively). After anticholinergic treatment, BWTh levels (2.25 ± 0.90; 2.40 ± 1.00 mm; p=0.94) and NGF/Cr values (0.95 ± 0.10; 0.78 ± 0.15; p=0.42, respectively) had no significantly difference compared to controls (Group 2). In receiver operating characteristic analysis, bladder wall thickness was found to have sensitivity of 85% and specificity of 84.2% (3,20 AUC, 913; 95 %) and NGF/Cr had sensitivity of 90% and specificity of 92.1% (1,595; AUC, 947; 95 %) in predicting treatment outcome in children with OAB. Conclusions: Bladder wall thickness measurements and NGF/Cr values, as noninvasive tools, could guide outcomes in the treatment of children with overactive bladder.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88251527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-14DOI: 10.1590/S1677-5538.IBJU.2021.0764
Constanza Alvear Pérez, Luciana de Barros Cavalcanti Michelutti, Maria Volpato Palharini, Luisa Pasqualotto Teixeira, V. Silva, L. Teixeira, Silvia L A Silva, S. Botelho
ABSTRACT Aim: Our objective was to investigate whether there is an interaction between the COVID-19 pandemic, demographic characteristics and erectile/sexual (E/S) function in individuals from Latin America. Materials and Methods: Cross-sectional study which included Latin American individuals over 18 years old, recruited through social media and interviewed between July and August 2020 by online surveys (Google Forms) in Portuguese and Spanish languages. The E/S function was evaluated through the following questionnaires: Simplified International Index of Erectile Function (IIEF-5) and Female Sexual Function Index (FSFI); while post-traumatic stress disorder (PTSD) triggered by the COVID-19 pandemic was assessed through the Impact of Event Scale Revised (IES-R). The data was analyzed by T Student, bivariate and multivariate logistic regression, with significance determined by the Wald test (p<0.05), using the R software v4.0. Results: Out of the 2016 individuals that responded to the survey, 1986 were included and 743 of them presented E/S dysfunction. PTSD occurrence was greater among people with E/S dysfunction when compared to those without E/S dysfunction, in the total score (males: IES-R=26.54[±19.17] and females: IES-R=35.92[±19.25]) and also in the three domains. It was found that those who do not live with a partner were 74% more likely to have E/S dysfunction, but living with a partner during the pandemic had a greater impact on E/S function. Conclusion: A negative interaction between the impact of the COVID-19 pandemic and erectile/sexual function of the Latin American population was observed, with greater implications among the individuals who live with their partners.
{"title":"Interaction between the impact of the Coronavirus disease 2019 pandemic and demographic characteristics on sexual/erectile dysfunction in Latin America: cross-sectional study","authors":"Constanza Alvear Pérez, Luciana de Barros Cavalcanti Michelutti, Maria Volpato Palharini, Luisa Pasqualotto Teixeira, V. Silva, L. Teixeira, Silvia L A Silva, S. Botelho","doi":"10.1590/S1677-5538.IBJU.2021.0764","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2021.0764","url":null,"abstract":"ABSTRACT Aim: Our objective was to investigate whether there is an interaction between the COVID-19 pandemic, demographic characteristics and erectile/sexual (E/S) function in individuals from Latin America. Materials and Methods: Cross-sectional study which included Latin American individuals over 18 years old, recruited through social media and interviewed between July and August 2020 by online surveys (Google Forms) in Portuguese and Spanish languages. The E/S function was evaluated through the following questionnaires: Simplified International Index of Erectile Function (IIEF-5) and Female Sexual Function Index (FSFI); while post-traumatic stress disorder (PTSD) triggered by the COVID-19 pandemic was assessed through the Impact of Event Scale Revised (IES-R). The data was analyzed by T Student, bivariate and multivariate logistic regression, with significance determined by the Wald test (p<0.05), using the R software v4.0. Results: Out of the 2016 individuals that responded to the survey, 1986 were included and 743 of them presented E/S dysfunction. PTSD occurrence was greater among people with E/S dysfunction when compared to those without E/S dysfunction, in the total score (males: IES-R=26.54[±19.17] and females: IES-R=35.92[±19.25]) and also in the three domains. It was found that those who do not live with a partner were 74% more likely to have E/S dysfunction, but living with a partner during the pandemic had a greater impact on E/S function. Conclusion: A negative interaction between the impact of the COVID-19 pandemic and erectile/sexual function of the Latin American population was observed, with greater implications among the individuals who live with their partners.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85027044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-14DOI: 10.1590/S1677-5538.IBJU.2021.0687
E. Şam, A. Cinislioğlu, Fatih Kursat Yılmazel, S. O. Demirdogen, A. Yılmaz, I. Karabulut
ABSTRACT Purpose: To compare the effectiveness of biofeedback-assisted pelvic floor muscle training (PFMT) and PFMT alone on voiding parameters in women with dysfunctional voiding (DV). Materials and Methods: The patients in group 1 (34 patients) were treated with biofeedback-assisted PFMT, and the patients in group 2 (34 patients) were treated with PFMT alone for 12 weeks. The 24-hour frequency, average voided volume, maximum urine flow rate (Qmax), average urine flow rate (Qave), post-void residual urine volume (PVR), and the validated Turkish Urogenital Distress Inventory (UDI-6) symptom scores were recorded before and after 12 weeks of treatment. Results: At the end of treatment sessions, the Qmax and Qave values of the patients in group 1 were significantly higher than those in group 2, and the PVR in the patients in group 1 was significantly lower than those in group 2 (p=.026, .043, and .023, respectively). The average UDI-6 symptom scores of the patients in group 1 were significantly lower than those in group 2 (p=.034). Electromyography activity during voiding, in group 1 was significantly lower than in group 2 (41.2 vs. 64.7, respectively, p=.009). Conclusion: Biofeedback-assisted PFMT is more effective than PFMT alone in improving clinical symptoms, uroflowmetry parameters, and EMG activity during voiding.
{"title":"Is biofeedback-assisted pelvic floor muscle training superior to pelvic floor muscle training alone in the treatment of dysfunctional voiding in women? A prospective randomized study","authors":"E. Şam, A. Cinislioğlu, Fatih Kursat Yılmazel, S. O. Demirdogen, A. Yılmaz, I. Karabulut","doi":"10.1590/S1677-5538.IBJU.2021.0687","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2021.0687","url":null,"abstract":"ABSTRACT Purpose: To compare the effectiveness of biofeedback-assisted pelvic floor muscle training (PFMT) and PFMT alone on voiding parameters in women with dysfunctional voiding (DV). Materials and Methods: The patients in group 1 (34 patients) were treated with biofeedback-assisted PFMT, and the patients in group 2 (34 patients) were treated with PFMT alone for 12 weeks. The 24-hour frequency, average voided volume, maximum urine flow rate (Qmax), average urine flow rate (Qave), post-void residual urine volume (PVR), and the validated Turkish Urogenital Distress Inventory (UDI-6) symptom scores were recorded before and after 12 weeks of treatment. Results: At the end of treatment sessions, the Qmax and Qave values of the patients in group 1 were significantly higher than those in group 2, and the PVR in the patients in group 1 was significantly lower than those in group 2 (p=.026, .043, and .023, respectively). The average UDI-6 symptom scores of the patients in group 1 were significantly lower than those in group 2 (p=.034). Electromyography activity during voiding, in group 1 was significantly lower than in group 2 (41.2 vs. 64.7, respectively, p=.009). Conclusion: Biofeedback-assisted PFMT is more effective than PFMT alone in improving clinical symptoms, uroflowmetry parameters, and EMG activity during voiding.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86296988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-22DOI: 10.1590/S1677-5538.IBJU.2021.0815
R. Inzillo, Jean Emmanuel Kwe, Elisa Simonetti, Riccardo Milandri, M. Grande, D. Campobasso, S. Ferretti, B. Rocco, S. Micali, A. Frattini
ABSTRACT Introduction and Objectives: Treatment of bulky lithiasis in continent and non-continent urine storage reservoirs has been widely described and debated (1). Less is known about the optimal treatment in patients with a Mitrofanoff conduit. If voiding in these patients is incomplete, leading to recurrent symptomatic bacteriuria, formation of large lithiasis can be a common long-term complication (2, 3). Materials and Methods: This video describes a 19-year-old woman who underwent major open surgery at the age of six, with the configuration of a continent intestinal reservoir with a Mitrofanoff conduit. In 2020, she was referred to our center with a large stone in the reservoir and a minor stone in the inferior left renal calyx. We decided to proceed using a percutaneous approach with an “endovision technique” puncture for the bladder stone, combined with a retrograde intrarenal surgery for the renal stone. The MIP System “M size” was used to perform the percutaneous procedure, thus allowing a single-step dilation. The puncture and the dilation were followed endoscopically with a flexible ureterorenoscope avoiding the use of x-rays. The procedure was carried out as follows. The first step consisted in the insertion of a hydrophilic guidewire through the Mitrofanoff conduit. A flexible ureterorenoscope was then inserted coaxial to the guidewire. The percutaneous puncture, using an 80G needle, was followed endoscopically. Two guidewires were inserted, the first as a safety guidewire and the second for the tract dilation. The “single-step” dilation technique using the MIP system was performed and followed endoscopically. For the bladder lithotripsy, a dual-action lithotripter that combines ultrasonic and mechanical energy was used. Finally, a flexible ureterorenoscope and a basket for the retrieval of a single inferior caliceal stone were used. The procedure ended after positioning a single J stent in the left kidney and a nephrostomy tube in the reservoir. Results: The operative time was 80 minutes and the fluoroscopy time was 6 seconds. Hemoglobin and creatinine serum levels remained stable after the procedure and the patient was discharged on the third post-operative day, after removing both the single J and the nephrostomy tube. Follow-up lasted 12 months, with no bladder or renal stone recurrence, maintaining good continence of the Mitrofanoff conduit. Conclusion: In patients who have undergone several major surgeries a mini-invasive approach is advisable, not only for the morbidity of an open approach, but also for the increased risk of complications while handling an intestinal reservoir. Regarding a pure endoscopic approach, the passage of a nephroscope or a cystoscope through the Mitrofanoff conduit, combined with the continuous traction during the lithotripsy, could damage and compromise its continence. For this reason, the percutaneous approach is the most suitable method in these specific and rare cases.
{"title":"Percutaneous and endoscopic combined treatment of bladder and renal lithiasis in mitrofanoff conduit","authors":"R. Inzillo, Jean Emmanuel Kwe, Elisa Simonetti, Riccardo Milandri, M. Grande, D. Campobasso, S. Ferretti, B. Rocco, S. Micali, A. Frattini","doi":"10.1590/S1677-5538.IBJU.2021.0815","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2021.0815","url":null,"abstract":"ABSTRACT Introduction and Objectives: Treatment of bulky lithiasis in continent and non-continent urine storage reservoirs has been widely described and debated (1). Less is known about the optimal treatment in patients with a Mitrofanoff conduit. If voiding in these patients is incomplete, leading to recurrent symptomatic bacteriuria, formation of large lithiasis can be a common long-term complication (2, 3). Materials and Methods: This video describes a 19-year-old woman who underwent major open surgery at the age of six, with the configuration of a continent intestinal reservoir with a Mitrofanoff conduit. In 2020, she was referred to our center with a large stone in the reservoir and a minor stone in the inferior left renal calyx. We decided to proceed using a percutaneous approach with an “endovision technique” puncture for the bladder stone, combined with a retrograde intrarenal surgery for the renal stone. The MIP System “M size” was used to perform the percutaneous procedure, thus allowing a single-step dilation. The puncture and the dilation were followed endoscopically with a flexible ureterorenoscope avoiding the use of x-rays. The procedure was carried out as follows. The first step consisted in the insertion of a hydrophilic guidewire through the Mitrofanoff conduit. A flexible ureterorenoscope was then inserted coaxial to the guidewire. The percutaneous puncture, using an 80G needle, was followed endoscopically. Two guidewires were inserted, the first as a safety guidewire and the second for the tract dilation. The “single-step” dilation technique using the MIP system was performed and followed endoscopically. For the bladder lithotripsy, a dual-action lithotripter that combines ultrasonic and mechanical energy was used. Finally, a flexible ureterorenoscope and a basket for the retrieval of a single inferior caliceal stone were used. The procedure ended after positioning a single J stent in the left kidney and a nephrostomy tube in the reservoir. Results: The operative time was 80 minutes and the fluoroscopy time was 6 seconds. Hemoglobin and creatinine serum levels remained stable after the procedure and the patient was discharged on the third post-operative day, after removing both the single J and the nephrostomy tube. Follow-up lasted 12 months, with no bladder or renal stone recurrence, maintaining good continence of the Mitrofanoff conduit. Conclusion: In patients who have undergone several major surgeries a mini-invasive approach is advisable, not only for the morbidity of an open approach, but also for the increased risk of complications while handling an intestinal reservoir. Regarding a pure endoscopic approach, the passage of a nephroscope or a cystoscope through the Mitrofanoff conduit, combined with the continuous traction during the lithotripsy, could damage and compromise its continence. For this reason, the percutaneous approach is the most suitable method in these specific and rare cases.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74060456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-22DOI: 10.1590/S1677-5538.IBJU.2022.0018
Ubirajara BARROSO JR, Eliakim Massuqueto, B. A. Venturini, T. Rosito, Marcelo Villalta, Leidy Paola Casas Grajales
ABSTRACT Introduction Clitoroplasty constitutes an important step in feminizing surgery for congenital adrenal hyperplasia (CAH) ( 1 ). In this video we present a technique that aims to preserve clitoral sensitivity and engorgement while minimizing the risk of neurovascular lesion. Materials and methods We present a video of a three-year-old girl with history of CAH classical form, PRADER-III, who underwent clitoroplasty. After an initial endoscopic evaluation of the urogenital sinus, the clitoris was degloved and a rectangular incision was made on the ventral corpora cavernosa 15mm above the corpora bifurcation and 0.5 mm below the coronal sulcus. The cavernous tissue was partially resected. The upper and lower borders of the rectangular gap were closed by a 5-0 PDS running suture similar to the Mikulicz technique. Next, the edge of the glans was deepithelialized to reduce its size. For improved clitoral positioning, the clitoris was sutured to the pubic fat. From that point onward the procedure followed that of a standard vaginoplasty using the en-bloc technique ( 2 - 4 ). Thus far we have performed this technique in 33 patients, with 31 of them being girls with CAH and 2 being women with clitoral hypertrophy. Conclusion Corporoplasty is a simplified technique for clitoroplasty, with the advantage being that is faster and safer than the technique that involves the dissection of the neurovascular bundle. In addition, corporoplasty has the possible benefit of preserving the cavernosal blood flow that permits the engorgement of the clitoris during sexual arousal.
{"title":"Corporoplasty: A simplified technique for clitoroplasty","authors":"Ubirajara BARROSO JR, Eliakim Massuqueto, B. A. Venturini, T. Rosito, Marcelo Villalta, Leidy Paola Casas Grajales","doi":"10.1590/S1677-5538.IBJU.2022.0018","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2022.0018","url":null,"abstract":"ABSTRACT Introduction Clitoroplasty constitutes an important step in feminizing surgery for congenital adrenal hyperplasia (CAH) ( 1 ). In this video we present a technique that aims to preserve clitoral sensitivity and engorgement while minimizing the risk of neurovascular lesion. Materials and methods We present a video of a three-year-old girl with history of CAH classical form, PRADER-III, who underwent clitoroplasty. After an initial endoscopic evaluation of the urogenital sinus, the clitoris was degloved and a rectangular incision was made on the ventral corpora cavernosa 15mm above the corpora bifurcation and 0.5 mm below the coronal sulcus. The cavernous tissue was partially resected. The upper and lower borders of the rectangular gap were closed by a 5-0 PDS running suture similar to the Mikulicz technique. Next, the edge of the glans was deepithelialized to reduce its size. For improved clitoral positioning, the clitoris was sutured to the pubic fat. From that point onward the procedure followed that of a standard vaginoplasty using the en-bloc technique ( 2 - 4 ). Thus far we have performed this technique in 33 patients, with 31 of them being girls with CAH and 2 being women with clitoral hypertrophy. Conclusion Corporoplasty is a simplified technique for clitoroplasty, with the advantage being that is faster and safer than the technique that involves the dissection of the neurovascular bundle. In addition, corporoplasty has the possible benefit of preserving the cavernosal blood flow that permits the engorgement of the clitoris during sexual arousal.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74399669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-10DOI: 10.1590/S1677-5538.IBJU.2022.99.13
R. Laursen, B. Alsbjerg, H. Elbaek, B. Povlsen, K. B. S. Jensen, Jette Lykkegaard, S. Esteves, P. Humaidan
ABSTRACT Purpose: Nonobstructive azoospermia (NOA) associated with primary spermatogenic failure is a common cause of male infertility usually considered untreatable; however, some reports have suggested that hormonal stimulation to boost the intra-testicular testosterone level and spermatogenesis might increase the chance of achieving pregnancy using homologous sperm. Materials and Methods: We report a series of eight NOA males who received long-term treatment with recombinant human chorionic gonadotropin twice a week for spermatogenesis stimulation. Six males received additional recombinant follicle-stimulating hormone (FSH) supplementation 150-225 IU twice weekly. Results: After recombinant gonadotropin therapy, viable spermatozoa were retrieved from the ejaculate in two patients and by testicular sperm aspiration (TESA) in another two subjects. Singleton spermatozoon retrieved from testes were frozen by vitrification on Cell-Sleeper devices. Two live births were obtained after intracytoplasmic sperm injection with ejaculated spermatozoa and one live birth and an ongoing pregnancy using thawed spermatozoa from TESA. Conclusion: Our proof-of-concept study indicates that hormonal therapy with recombinant gonadotropins could be considered in infertile men with NOA as an alternative to sperm donation. Large-scale studies are needed to substantiate hormone stimulation therapy with recombinant gonadotropins in routine clinical practice for this severe form of male infertility.
{"title":"Recombinant gonadotropin therapy to improve spermatogenesis in nonobstructive azoospermic patients – A proof of concept study","authors":"R. Laursen, B. Alsbjerg, H. Elbaek, B. Povlsen, K. B. S. Jensen, Jette Lykkegaard, S. Esteves, P. Humaidan","doi":"10.1590/S1677-5538.IBJU.2022.99.13","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2022.99.13","url":null,"abstract":"ABSTRACT Purpose: Nonobstructive azoospermia (NOA) associated with primary spermatogenic failure is a common cause of male infertility usually considered untreatable; however, some reports have suggested that hormonal stimulation to boost the intra-testicular testosterone level and spermatogenesis might increase the chance of achieving pregnancy using homologous sperm. Materials and Methods: We report a series of eight NOA males who received long-term treatment with recombinant human chorionic gonadotropin twice a week for spermatogenesis stimulation. Six males received additional recombinant follicle-stimulating hormone (FSH) supplementation 150-225 IU twice weekly. Results: After recombinant gonadotropin therapy, viable spermatozoa were retrieved from the ejaculate in two patients and by testicular sperm aspiration (TESA) in another two subjects. Singleton spermatozoon retrieved from testes were frozen by vitrification on Cell-Sleeper devices. Two live births were obtained after intracytoplasmic sperm injection with ejaculated spermatozoa and one live birth and an ongoing pregnancy using thawed spermatozoa from TESA. Conclusion: Our proof-of-concept study indicates that hormonal therapy with recombinant gonadotropins could be considered in infertile men with NOA as an alternative to sperm donation. Large-scale studies are needed to substantiate hormone stimulation therapy with recombinant gonadotropins in routine clinical practice for this severe form of male infertility.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85266567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-12DOI: 10.1590/S1677-5538.IBJU.2022.99.10
J. Noël, M. Moschovas, E. Patel, T. Rogers, J. Marquinez, B. Rocco, A. Mottrie, V. Patel
ABSTRACT Introduction: Surgical training will be complemented by digitalisation, as the COVID 19 pandemic continues (1). Proximie is an augmented reality (AR) platform that can display up to 4 native camera views, with live or semi live telementoring. It can optimise ergonomics of the surgeon at the console (2), and robotic instrument orientation. We describe the utilisation of Proximie as a step-by-step guide in a robotic assisted radical prostatectomy (RARP). Surgical Technique: Author V. P. performed a transperitoneal multiport da Vinci Xi RARP with the Proximie platform: a laptop computer, multiple HD webcams, microphones and speakers. Using an HDMI cable to the Intuitive Surgical tower, output display from the console and an additional laparoscopic tower is shown. Each webcam was mounted to the side armrests of the console, directed at the surgeon's hands. An independent ‘drop in’ laparoscope via an additional 5mm left upper quadrant port was utilised. Observers can visualise the AR platform's recordings on a laptop and/or smartphone. A PTZ (pan-tilt-zoom) camera can capture the operating room, bedside assistant, ports and patient position. Our video demonstrates three of four camera views for posture, forearm, wrist, hand, and finger orientation, relative to the translated robotic steps. A pincer grasp of the endowrist manipulator during anastomosis allows optimal robotic wrist rotation. The second laparoscopic camera view demonstrated intracorporeal angles of robotic arm and bedside assistant's instrument position for critical steps such as nerve sparing and anastomosis (3). The console time was 100 minutes, no intraoperative complications, or delay in image transmission occurred with utilising the platform. Considerations: An AR platform can create deeper learning for RARP in real time or recorded sessions. Two-way verbal and visual communication with ability to annotate on screen, allows long distance mentoring. The platform's utility can be accessed in anywhere, to project surgeons beyond their immediate environment. This allows for democratisation of access to high volume institutions and their evolution of techniques (4), to assist patients globally. Potential developments are artificial intelligence (AI) networks analysing repository of such recorded data, to identify intraoperative hand motion and robotic instrument tracking. AR is a pertinent building block to enhance robotic training, skill dissemination, precision medicine (5) and surgery overall.
{"title":"Step-by-step optimisation of robotic-assisted radical prostatectomy using augmented reality","authors":"J. Noël, M. Moschovas, E. Patel, T. Rogers, J. Marquinez, B. Rocco, A. Mottrie, V. Patel","doi":"10.1590/S1677-5538.IBJU.2022.99.10","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2022.99.10","url":null,"abstract":"ABSTRACT Introduction: Surgical training will be complemented by digitalisation, as the COVID 19 pandemic continues (1). Proximie is an augmented reality (AR) platform that can display up to 4 native camera views, with live or semi live telementoring. It can optimise ergonomics of the surgeon at the console (2), and robotic instrument orientation. We describe the utilisation of Proximie as a step-by-step guide in a robotic assisted radical prostatectomy (RARP). Surgical Technique: Author V. P. performed a transperitoneal multiport da Vinci Xi RARP with the Proximie platform: a laptop computer, multiple HD webcams, microphones and speakers. Using an HDMI cable to the Intuitive Surgical tower, output display from the console and an additional laparoscopic tower is shown. Each webcam was mounted to the side armrests of the console, directed at the surgeon's hands. An independent ‘drop in’ laparoscope via an additional 5mm left upper quadrant port was utilised. Observers can visualise the AR platform's recordings on a laptop and/or smartphone. A PTZ (pan-tilt-zoom) camera can capture the operating room, bedside assistant, ports and patient position. Our video demonstrates three of four camera views for posture, forearm, wrist, hand, and finger orientation, relative to the translated robotic steps. A pincer grasp of the endowrist manipulator during anastomosis allows optimal robotic wrist rotation. The second laparoscopic camera view demonstrated intracorporeal angles of robotic arm and bedside assistant's instrument position for critical steps such as nerve sparing and anastomosis (3). The console time was 100 minutes, no intraoperative complications, or delay in image transmission occurred with utilising the platform. Considerations: An AR platform can create deeper learning for RARP in real time or recorded sessions. Two-way verbal and visual communication with ability to annotate on screen, allows long distance mentoring. The platform's utility can be accessed in anywhere, to project surgeons beyond their immediate environment. This allows for democratisation of access to high volume institutions and their evolution of techniques (4), to assist patients globally. Potential developments are artificial intelligence (AI) networks analysing repository of such recorded data, to identify intraoperative hand motion and robotic instrument tracking. AR is a pertinent building block to enhance robotic training, skill dissemination, precision medicine (5) and surgery overall.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75344132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.1590/S1677-5538.IBJU.2021.0211.1
C. Gomes, J. Moromizato, Lucia S Ribeiro
The evaluation of patients with lower urinary tract symptoms (LUTS) is primarily based on clinical history and physical examination. Measuring the frequency and severity of LUTS adds important information for the characterization and management of lower urinary tract disorders (1, 2). Bladder diaries and uroflowmetry may be invaluable for symptom characterization. The recording of volume and time of each void by the patient is referred to as a frequency volume chart (FVC). Inclusion of information like fluid intake, use of pads, incontinence episodes or symptom severity is termed a bladder diary (1). The FVC provides data on total voided volume, day-time and night-time voiding frequency, nocturnal urinary volume and individual voided volumes. The maximum voided volume (MVV) is an important parameter of the voiding diary as it corresponds to the functional bladder capacity. It may be important to improve our understanding of bladder sensation, overactive bladder symptoms, polyuria and overflow incontinence (3). It may be used to clinically phenotype patients and help counseling regarding fluid intake and timed voiding (3). It may also assist in monitoring patient ́s response to treatment (2). The amount of information to be included and the duration of a bladder diary is variable, but typically should take from three to seven days (4). In this study, based on the perception that patients often have a greater MVV during office uroflowmetry than that seen in the bladder diary, the authors compared these two non-invasive methods by which MVV can be determined. They used a database of over seven hundred patients evaluated for LUTS who completed a 24-hour bladder diary independently using a smartphone application. They found that there is a difference between the two measurement tools, and that the maximum voided volume recorded in a bladder diary (BD-MVV) is usually greater than that obtained at the time of uroflow (Q-MVV). They suggested that for a more reliable assessment of MVV in men and women, both Q-MVV and BD-MVV should be assessed and that the larger of the two values is a more reliable assessment of MVV (5). It is important to highlight the use of a mobile app for the completion of the voiding diary in this study. Mobile health (mHealth) is an attractive and expanding tendency within LUTS care, both from the viewpoint of urologists and also by health systems and for research (6, 7). Typically, mHealth is based on a smartphone app that may help in the evaluation, monitoring and/or treatment of a health condition. mHealth has been used in urology for prostate cancer, urinary stones, LUTS, urinary incontinence and urinary tract infections and its use has gained importance with the COVID-19 pandemic (8). In the urinary stone field, apps may prevent forgetting a double-J catheter (9). For prostate cancer, apps may help physicians to stage patients and calculate disease risk and they EDITORIAL COMMENT Vol. 47 (6): 1195-1197, November December, 2021
下尿路症状(LUTS)患者的评估主要基于临床病史和体格检查。测量LUTS的频率和严重程度为下尿路疾病的表征和治疗提供了重要的信息(1,2)。膀胱日记和尿流测量对于症状表征可能是非常宝贵的。患者记录每个空洞的体积和时间称为频率体积图(FVC)。膀胱日记包括液体摄入量、尿垫使用情况、尿失禁发作或症状严重程度等信息(1)。膀胱日记提供总排尿量、白天和夜间排尿频率、夜间排尿量和个人排尿量等数据。最大排尿量(MVV)是排尿日记的一个重要参数，因为它对应于膀胱功能容量。提高我们对膀胱感觉、膀胱过度活跃症状、多尿和溢尿失禁的理解可能很重要(3)。它可以用于临床表型患者，并帮助咨询有关液体摄入和定时排尿(3)。它也可以帮助监测患者对治疗的反应(2)。要包括的信息量和膀胱日记的持续时间是可变的，但通常应该从3到7天(4)。在这项研究中，基于患者在办公室尿流测量中通常比膀胱日记中看到的MVV更大的认知，作者比较了这两种可以确定MVV的非侵入性方法。他们使用了一个数据库，该数据库包含了700多名LUTS患者，这些患者使用智能手机应用程序独立完成了24小时膀胱日记。他们发现两种测量工具之间存在差异，膀胱日记(BD-MVV)中记录的最大空气量通常大于尿流(Q-MVV)时获得的空气量。他们建议，为了更可靠地评估男性和女性的MVV，应该同时评估Q-MVV和BD-MVV，并且两个值中较大的值对MVV的评估更可靠(5)。在本研究中，重要的是要强调使用移动应用程序来完成排尿日记。从泌尿科医生、卫生系统和研究的角度来看，移动医疗(mHealth)是LUTS护理中一个有吸引力和不断扩大的趋势(6,7)。通常，移动医疗是基于智能手机应用程序，可以帮助评估、监测和/或治疗健康状况。移动健康已经在泌尿外科中用于前列腺癌、尿路结石、LUTS、尿失禁和尿路感染，随着COVID-19大流行，它的使用变得越来越重要(8)。在尿路结石领域，应用程序可以防止忘记双j导管(9)。对于前列腺癌，应用程序可以帮助医生对患者进行分期并计算疾病风险，他们EDITORIAL COMMENT Vol. 47 (6): 1195-1197, November December, 2021
{"title":"Mobile health may improve evaluation of lower urinary tract symptoms","authors":"C. Gomes, J. Moromizato, Lucia S Ribeiro","doi":"10.1590/S1677-5538.IBJU.2021.0211.1","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2021.0211.1","url":null,"abstract":"The evaluation of patients with lower urinary tract symptoms (LUTS) is primarily based on clinical history and physical examination. Measuring the frequency and severity of LUTS adds important information for the characterization and management of lower urinary tract disorders (1, 2). Bladder diaries and uroflowmetry may be invaluable for symptom characterization. The recording of volume and time of each void by the patient is referred to as a frequency volume chart (FVC). Inclusion of information like fluid intake, use of pads, incontinence episodes or symptom severity is termed a bladder diary (1). The FVC provides data on total voided volume, day-time and night-time voiding frequency, nocturnal urinary volume and individual voided volumes. The maximum voided volume (MVV) is an important parameter of the voiding diary as it corresponds to the functional bladder capacity. It may be important to improve our understanding of bladder sensation, overactive bladder symptoms, polyuria and overflow incontinence (3). It may be used to clinically phenotype patients and help counseling regarding fluid intake and timed voiding (3). It may also assist in monitoring patient ́s response to treatment (2). The amount of information to be included and the duration of a bladder diary is variable, but typically should take from three to seven days (4). In this study, based on the perception that patients often have a greater MVV during office uroflowmetry than that seen in the bladder diary, the authors compared these two non-invasive methods by which MVV can be determined. They used a database of over seven hundred patients evaluated for LUTS who completed a 24-hour bladder diary independently using a smartphone application. They found that there is a difference between the two measurement tools, and that the maximum voided volume recorded in a bladder diary (BD-MVV) is usually greater than that obtained at the time of uroflow (Q-MVV). They suggested that for a more reliable assessment of MVV in men and women, both Q-MVV and BD-MVV should be assessed and that the larger of the two values is a more reliable assessment of MVV (5). It is important to highlight the use of a mobile app for the completion of the voiding diary in this study. Mobile health (mHealth) is an attractive and expanding tendency within LUTS care, both from the viewpoint of urologists and also by health systems and for research (6, 7). Typically, mHealth is based on a smartphone app that may help in the evaluation, monitoring and/or treatment of a health condition. mHealth has been used in urology for prostate cancer, urinary stones, LUTS, urinary incontinence and urinary tract infections and its use has gained importance with the COVID-19 pandemic (8). In the urinary stone field, apps may prevent forgetting a double-J catheter (9). For prostate cancer, apps may help physicians to stage patients and calculate disease risk and they EDITORIAL COMMENT Vol. 47 (6): 1195-1197, November December, 2021","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84026025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-15DOI: 10.1590/S1677-5538.IBJU.2021.99.16
S. Tucci Jr., Henrique Florindo
Access to surgical treatment may be the only solution for preventing chronic disabilities and mortality (1) in cases of traumatic injuries and countless other situations that significantly affect quality of life such as iatrogenic, inflammatory or neoplastic injury. Notwithstanding successful prevention strategies, these conditions are responsible for a significant portion of disease burden in the population. In practice, speedy access to essential surgery is not always widely guaranteed (2), although it is part of the human right to health. In developing countries, where the most appropriate treatment for various diseases is not always readily available (2), there is a high incidence of complications from delays in diagnosis or access to specialized centers. In Brazil, this is the context in which complex urethral stenosis in public university institutions linked to the Unified Health System is approached. Male urethral stenosis has significant negative impact on patients’ quality of life. Its pathophysiology is better known and differences between developed and developing countries must be considered. The recent study by Astolfi et al, (3) evaluating 899 patients, shows that in Brazil iatrogenesis was the most frequent cause (43.2%), followed by idiopathic (21.7%) and traumatic (21.5%). Of the inflammatory causes (13.7%), the largest part was due to scleroatrophic lichen (66.7%), and 33.4% to infectious urethritis. Regarding the stenosis site, Palminteri et al. (4) showed that in developed countries, stenosis occurs mainly in the anterior urethra (92.2%), particularly in the bulbar segment (45.9%), with involvement of the posterior urethra in only 7.8% of cases (5). Most trauma-related stenosis occurred in urethral lesions associated with pelvic fractures (62.7%) and 62.7% were associated with perineal trauma. Of iatrogenic causes, 59% were secondary to urethral instrumentation (catheterization and other procedures), 24.8% due to procedures such as prostatectomy, radiotherapy and postectomy, and 16.2% following failure to correct hypospadias. Such demographic data are useful in guiding the development of preventive and therapeutic population strategies, as well as being important for educational guidance in relation to manipulation of the urethra (6), from vesicoureteral catheterization to instrumentation of the urethra in therapeutic procedures and, above all, to learn the different urethroplasty techniques. Strategies must be guided by the Unified Health System (SUS) as set forth in Article 5 of Law 8.080 of September 1990, and educational guidance is an obligation of medical schools and specific courses in Urology as a specialty. The SUS offers universal coverage and free access to all levels of health care for each person Treatment of complex urethral stenosis in public centers from developing countries in 21st century _______________________________________________
{"title":"Treatment of complex urethral stenosis in public centers from developing countries in 21st century","authors":"S. Tucci Jr., Henrique Florindo","doi":"10.1590/S1677-5538.IBJU.2021.99.16","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2021.99.16","url":null,"abstract":"Access to surgical treatment may be the only solution for preventing chronic disabilities and mortality (1) in cases of traumatic injuries and countless other situations that significantly affect quality of life such as iatrogenic, inflammatory or neoplastic injury. Notwithstanding successful prevention strategies, these conditions are responsible for a significant portion of disease burden in the population. In practice, speedy access to essential surgery is not always widely guaranteed (2), although it is part of the human right to health. In developing countries, where the most appropriate treatment for various diseases is not always readily available (2), there is a high incidence of complications from delays in diagnosis or access to specialized centers. In Brazil, this is the context in which complex urethral stenosis in public university institutions linked to the Unified Health System is approached. Male urethral stenosis has significant negative impact on patients’ quality of life. Its pathophysiology is better known and differences between developed and developing countries must be considered. The recent study by Astolfi et al, (3) evaluating 899 patients, shows that in Brazil iatrogenesis was the most frequent cause (43.2%), followed by idiopathic (21.7%) and traumatic (21.5%). Of the inflammatory causes (13.7%), the largest part was due to scleroatrophic lichen (66.7%), and 33.4% to infectious urethritis. Regarding the stenosis site, Palminteri et al. (4) showed that in developed countries, stenosis occurs mainly in the anterior urethra (92.2%), particularly in the bulbar segment (45.9%), with involvement of the posterior urethra in only 7.8% of cases (5). Most trauma-related stenosis occurred in urethral lesions associated with pelvic fractures (62.7%) and 62.7% were associated with perineal trauma. Of iatrogenic causes, 59% were secondary to urethral instrumentation (catheterization and other procedures), 24.8% due to procedures such as prostatectomy, radiotherapy and postectomy, and 16.2% following failure to correct hypospadias. Such demographic data are useful in guiding the development of preventive and therapeutic population strategies, as well as being important for educational guidance in relation to manipulation of the urethra (6), from vesicoureteral catheterization to instrumentation of the urethra in therapeutic procedures and, above all, to learn the different urethroplasty techniques. Strategies must be guided by the Unified Health System (SUS) as set forth in Article 5 of Law 8.080 of September 1990, and educational guidance is an obligation of medical schools and specific courses in Urology as a specialty. The SUS offers universal coverage and free access to all levels of health care for each person Treatment of complex urethral stenosis in public centers from developing countries in 21st century _______________________________________________","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88388133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-27DOI: 10.1101/2021.01.26.21250518
J. Prezotti, J. Henriques, L. Favorito, A. F. Canalini, M. Machado, Thulio B. V. Brandão, Akemi M. V. Barbosa, J. Moromizato, Karin M. J. Anzolch, Roni de C. Fernandes, Fransber R. A. Rodrigues, C. H. Bellucci, C. Silva, A. Pompeo, J. de Bessa, C. Gomes
Objectives: To evaluate the impact of COVID-19 on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents. Materials and Methods: A web-based survey was sent to 468 Brazilian urology residents from postgraduate years (PGY) 3 to 5 to collect data on clinical practice and training after 4 months of COVID-19. We also assessed health-related and behavior changes, rate of infection by SARS-CoV-2, deployment to the front line of COVID-19, residents concerns, and access to personal protective equipment (PPE). Results: Massive reductions in elective and emergency patient consultations, diagnostic procedures and surgeries were reported across the country, affecting PGY 3 to 5 alike. Most in-person educational activities were abolished. The median damage to the urological training expected for 2020 was 6.0 [3.4 -7.7], on a scale from 0 to 10, with senior residents estimating a greater damage (P< 0.001). Educational interventions developed included online case-based discussions, subspeciality conferences and lectures, and grand rounds. Most senior residents favored extending residency to compensate for training loss and most younger residents favored no additional training (p< 0.001). Modifications in health and lifestyle included weight gain (43.8%), reduced physical activity (68.6%), increased alcoholic intake (44.9%) and cigarette consumption (53.6%), worsening of sexual life (25.2%) and feelings of sadness or depression (48,2%). Almost half were summoned to work on the COVID-19 front-line and 24.4% had COVID-19. Most residents had inadequate training to deal with COVID-19 patients and most reported a shortage of PPE. Residents concerns included the risk of contaminating family members, being away from residency program, developing severe COVID-19 and overloading colleagues. Conclusions: COVID-19 had a massive impact in Brazilian urology residents training, health and lifestyle behavior, which may reflect what happened in other medical specialties. Studies should confirm these findings to help developing strategies to mitigate residents losses.
{"title":"Impact of COVID-19 on education, health and lifestyle behaviour of Brazilian urology residents","authors":"J. Prezotti, J. Henriques, L. Favorito, A. F. Canalini, M. Machado, Thulio B. V. Brandão, Akemi M. V. Barbosa, J. Moromizato, Karin M. J. Anzolch, Roni de C. Fernandes, Fransber R. A. Rodrigues, C. H. Bellucci, C. Silva, A. Pompeo, J. de Bessa, C. Gomes","doi":"10.1101/2021.01.26.21250518","DOIUrl":"https://doi.org/10.1101/2021.01.26.21250518","url":null,"abstract":"Objectives: To evaluate the impact of COVID-19 on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents. Materials and Methods: A web-based survey was sent to 468 Brazilian urology residents from postgraduate years (PGY) 3 to 5 to collect data on clinical practice and training after 4 months of COVID-19. We also assessed health-related and behavior changes, rate of infection by SARS-CoV-2, deployment to the front line of COVID-19, residents concerns, and access to personal protective equipment (PPE). Results: Massive reductions in elective and emergency patient consultations, diagnostic procedures and surgeries were reported across the country, affecting PGY 3 to 5 alike. Most in-person educational activities were abolished. The median damage to the urological training expected for 2020 was 6.0 [3.4 -7.7], on a scale from 0 to 10, with senior residents estimating a greater damage (P< 0.001). Educational interventions developed included online case-based discussions, subspeciality conferences and lectures, and grand rounds. Most senior residents favored extending residency to compensate for training loss and most younger residents favored no additional training (p< 0.001). Modifications in health and lifestyle included weight gain (43.8%), reduced physical activity (68.6%), increased alcoholic intake (44.9%) and cigarette consumption (53.6%), worsening of sexual life (25.2%) and feelings of sadness or depression (48,2%). Almost half were summoned to work on the COVID-19 front-line and 24.4% had COVID-19. Most residents had inadequate training to deal with COVID-19 patients and most reported a shortage of PPE. Residents concerns included the risk of contaminating family members, being away from residency program, developing severe COVID-19 and overloading colleagues. Conclusions: COVID-19 had a massive impact in Brazilian urology residents training, health and lifestyle behavior, which may reflect what happened in other medical specialties. Studies should confirm these findings to help developing strategies to mitigate residents losses.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72643222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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