Pub Date : 2019-11-01DOI: 10.1590/S1677-5538.IBJU.2018.0488
H. Türk, Erkan Arslan
ABSTRACT Objectives: Surgical treatment is indicated in patients where medical therapy fails to prove beneficial or in patients who develop complications related with bladder outlet obstruction. In our study, we developed a new surgical technique which can be defined as Transvesical Resection of Prostate (TVRP) without using the urethra. This method was previously described in our articles (1). Materials and Methods: A 62-years-old male patient, using an alpha blocker agent for 5 years, reported increased discomfort with urination. His findings were as follows: PSA: 1.2 ng/dL, prostate volume: 45 cc, digital rectal examination: benign, IPSS: 30, QoL: 5, Qmax: 6, urine volume: 225 cc, post-mictional residue: 65 cc. Eventually the patient was informed and prostate resection decision was made. Results: Suprapubic catheter was removed 1 day after surgery and the patient was discharged. Urethral catheter was removed 4 days after urine output became clear. No complications developed after the operation. At postoperative 1st month, Qmax was 22, urine volume was 260 cc, post-mictional residue was 40 cc, IPSS was 8, QoL was 1, and the pathology was benign prostate tissue. Conclusions: Urethral stricture is one of the most important postoperative complications of TURP. The incidence of urethral stricture is reported between 2.2% and 9.8% in different series (2–5). In this technique which we developed, urethra is not used and prostate is removed through the bladder, similar to open prostatectomies. For this reason, we suggest that it has an advantage over TURP, regarding urethral stricture development.
{"title":"A new Surgical Technique: Transvesical Prostate Resection","authors":"H. Türk, Erkan Arslan","doi":"10.1590/S1677-5538.IBJU.2018.0488","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0488","url":null,"abstract":"ABSTRACT Objectives: Surgical treatment is indicated in patients where medical therapy fails to prove beneficial or in patients who develop complications related with bladder outlet obstruction. In our study, we developed a new surgical technique which can be defined as Transvesical Resection of Prostate (TVRP) without using the urethra. This method was previously described in our articles (1). Materials and Methods: A 62-years-old male patient, using an alpha blocker agent for 5 years, reported increased discomfort with urination. His findings were as follows: PSA: 1.2 ng/dL, prostate volume: 45 cc, digital rectal examination: benign, IPSS: 30, QoL: 5, Qmax: 6, urine volume: 225 cc, post-mictional residue: 65 cc. Eventually the patient was informed and prostate resection decision was made. Results: Suprapubic catheter was removed 1 day after surgery and the patient was discharged. Urethral catheter was removed 4 days after urine output became clear. No complications developed after the operation. At postoperative 1st month, Qmax was 22, urine volume was 260 cc, post-mictional residue was 40 cc, IPSS was 8, QoL was 1, and the pathology was benign prostate tissue. Conclusions: Urethral stricture is one of the most important postoperative complications of TURP. The incidence of urethral stricture is reported between 2.2% and 9.8% in different series (2–5). In this technique which we developed, urethra is not used and prostate is removed through the bladder, similar to open prostatectomies. For this reason, we suggest that it has an advantage over TURP, regarding urethral stricture development.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"40 1","pages":"1279 - 1280"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77506841","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 : 2019-11-01DOI: 10.1590/S1677-5538.IBJU.2019.0058
Dilay Karabulut, Umut Karabulut, F. Çağlar, M. Ekşi, M. Yenice, Ekrem Güner, Esra Dönmez Íşler, E. Oflar, Ali İhsan Taşçl, F. Aktürk
ABSTRACT Purpose: This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics. Materials and methods: One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines. Results: There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05). Conclusion: CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.
摘要目的:本研究旨在评估在心脏病科门诊就诊的患者CHA2DS2-VASc评分与勃起功能障碍之间的关系。材料与方法:研究纳入了102例在心脏病科门诊就诊的男性患者。在同一医院泌尿科门诊评估勃起功能障碍，并使用土耳其版国际勃起功能指数评分。使用现行相关指南计算每位患者的CHA2DS2-VASc评分。结果:The International Index of勃起功能指数评分与CHA2DS2-VASc评分分别与年龄、高血压、心力衰竭、糖尿病、脑卒中呈负相关。吸烟、低脂血症与The International Index of勃起功能评分无相关性(p>0.05)。结论:CHA2DS2-VASc评分可用于心内科门诊患者的勃起功能障碍检测。
{"title":"The association between CHA2DS2-VASc score and erectile dysfunction: a cross-sectional study","authors":"Dilay Karabulut, Umut Karabulut, F. Çağlar, M. Ekşi, M. Yenice, Ekrem Güner, Esra Dönmez Íşler, E. Oflar, Ali İhsan Taşçl, F. Aktürk","doi":"10.1590/S1677-5538.IBJU.2019.0058","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0058","url":null,"abstract":"ABSTRACT Purpose: This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics. Materials and methods: One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines. Results: There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05). Conclusion: CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"2 1","pages":"1204 - 1208"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83032901","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 : 2019-11-01DOI: 10.1590/S1677-5538.IBJU.2019.0128
A. A. Braga, M. L. Veiga, Maria Gabrielle Correia da Silva Ferreira, H. Santana, Ubirajara BARROSO JR
ABSTRACT Introduction: Lower urinary tract dysfunction (LUTD) is a common clinical condition. Emotional and behavioral issues are increasing among children and adolescents, with stress indicating difficulties in personal and social functioning. This study evaluated whether urinary tract symptoms (LUTS) is associated with stress. Materials and Methods: A cross-sectional, analytical study with 6-14-year-old patients with LUTS and no anatomical/neurogenic urinary tract abnormalities was conducted using the Dysfunctional Voiding Scoring System, a psychological assessment and the Child Stress Scale. The overall stress score was analyzed in relation to the psychological assessment data. Answers to the seven specific DVSS urinary questions were compared with those for the four Child Stress Scale domains. Univariate and multivariate analyses were performed. The chi-square test and Pearson's correlation were used to determine associations. Significance was defined as p <0.05. Results: Most children were male (56%). Mean age was 9.0±2.25 years. Stress was detected in 20 out of 98 patients (20.4%; 95% CI: 13-30%). Of these, 90% were born from unplanned pregnancies and 67% were upset about their disorder. All the Child Stress Scale domains were significantly associated with urinary dysfunction, with dysuria being significantly associated with all four domains. In the multivariate analysis, dysuria was the only symptom that remained associated with stress. Associations with stress strengthened as the frequency of dysuria increased: physical reactions (p <0.01), emotional reactions (p <0.05), psychological reactions with a depressive component (p <0.01) and psychophysiological reactions (p <0.05). Conclusion: Stress levels are higher in children and adolescents with LUTS who have more severe symptoms. Dysuria was the symptom most associated with stress, both in the physical reactions domain, in the psychological reactions domains with or without a depressive component and in the psychophysiological reactions domain.
{"title":"Association between stress and lower urinary tract symptoms in children and adolescents","authors":"A. A. Braga, M. L. Veiga, Maria Gabrielle Correia da Silva Ferreira, H. Santana, Ubirajara BARROSO JR","doi":"10.1590/S1677-5538.IBJU.2019.0128","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0128","url":null,"abstract":"ABSTRACT Introduction: Lower urinary tract dysfunction (LUTD) is a common clinical condition. Emotional and behavioral issues are increasing among children and adolescents, with stress indicating difficulties in personal and social functioning. This study evaluated whether urinary tract symptoms (LUTS) is associated with stress. Materials and Methods: A cross-sectional, analytical study with 6-14-year-old patients with LUTS and no anatomical/neurogenic urinary tract abnormalities was conducted using the Dysfunctional Voiding Scoring System, a psychological assessment and the Child Stress Scale. The overall stress score was analyzed in relation to the psychological assessment data. Answers to the seven specific DVSS urinary questions were compared with those for the four Child Stress Scale domains. Univariate and multivariate analyses were performed. The chi-square test and Pearson's correlation were used to determine associations. Significance was defined as p <0.05. Results: Most children were male (56%). Mean age was 9.0±2.25 years. Stress was detected in 20 out of 98 patients (20.4%; 95% CI: 13-30%). Of these, 90% were born from unplanned pregnancies and 67% were upset about their disorder. All the Child Stress Scale domains were significantly associated with urinary dysfunction, with dysuria being significantly associated with all four domains. In the multivariate analysis, dysuria was the only symptom that remained associated with stress. Associations with stress strengthened as the frequency of dysuria increased: physical reactions (p <0.01), emotional reactions (p <0.05), psychological reactions with a depressive component (p <0.01) and psychophysiological reactions (p <0.05). Conclusion: Stress levels are higher in children and adolescents with LUTS who have more severe symptoms. Dysuria was the symptom most associated with stress, both in the physical reactions domain, in the psychological reactions domains with or without a depressive component and in the psychophysiological reactions domain.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"177 1","pages":"1167 - 1179"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75141171","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 : 2019-11-01DOI: 10.1590/S1677-5538.IBJU.2018.0799
L. Bianchi, R. Schiavina, U. Barbaresi, A. Angiolini, C. Pultrone, F. Manferrari, B. Bortolani, L. Cercenelli, M. Borghesi, F. Chessa, E. Sessagesimi, C. Gaudiano, E. Marcelli, E. Brunocilla
ABSTRACT Introduction and Objectives: We aim to present the use of 3D digital and physical renal model (1–5) to guide the percutaneous access during percutaneous nephrolithotripsy (PNL). Materials and Methods: We present the clinical case of a 30 years old man with left renal stone (25x15 mm). A virtual 3D reconstruction of the anatomical model including the stone, the renal parenchyma, the urinary collecting system (UCS) and the skeletal landmarks (lumbar spine and ribs) was elaborated. Finally, a physical 3D model was created with a 3D printer including the renal parenchyma, UCS and the stone. The surgeon evaluated the 3D virtual reconstruction and manipulated the printed model before surgery to improve the anatomical knowledge and to facilitate the percutaneous access. In prone position, combining ultrasound and fluoroscopy implemented by the preoperative anatomical planning based on the 3D virtual and printed model, an easy and safe access of the inferior calyx was achieved. Then, the patient underwent PNL using a 30 Fr Amplatz sheet with semi-rigid nephroscope and ultrasound energy to achieve a complete lithotripsy of the pelvic stone. Results: The procedure was safely completed with 1 single percutaneous puncture (time of puncture 2 minutes). Overall surgical time was 90 min. No intra and postoperative complications were reported. The CT scan performed before discharge confirmed a complete stone free state. Conclusion: The 3D-guided approach to PNL facilitates the preoperative planning of the puncture with better knowledge of the renal anatomy and may be helpful to reduce operative time and improve the learning curve.
{"title":"3D Reconstruction and physical renal model to improve percutaneous punture during PNL","authors":"L. Bianchi, R. Schiavina, U. Barbaresi, A. Angiolini, C. Pultrone, F. Manferrari, B. Bortolani, L. Cercenelli, M. Borghesi, F. Chessa, E. Sessagesimi, C. Gaudiano, E. Marcelli, E. Brunocilla","doi":"10.1590/S1677-5538.IBJU.2018.0799","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0799","url":null,"abstract":"ABSTRACT Introduction and Objectives: We aim to present the use of 3D digital and physical renal model (1–5) to guide the percutaneous access during percutaneous nephrolithotripsy (PNL). Materials and Methods: We present the clinical case of a 30 years old man with left renal stone (25x15 mm). A virtual 3D reconstruction of the anatomical model including the stone, the renal parenchyma, the urinary collecting system (UCS) and the skeletal landmarks (lumbar spine and ribs) was elaborated. Finally, a physical 3D model was created with a 3D printer including the renal parenchyma, UCS and the stone. The surgeon evaluated the 3D virtual reconstruction and manipulated the printed model before surgery to improve the anatomical knowledge and to facilitate the percutaneous access. In prone position, combining ultrasound and fluoroscopy implemented by the preoperative anatomical planning based on the 3D virtual and printed model, an easy and safe access of the inferior calyx was achieved. Then, the patient underwent PNL using a 30 Fr Amplatz sheet with semi-rigid nephroscope and ultrasound energy to achieve a complete lithotripsy of the pelvic stone. Results: The procedure was safely completed with 1 single percutaneous puncture (time of puncture 2 minutes). Overall surgical time was 90 min. No intra and postoperative complications were reported. The CT scan performed before discharge confirmed a complete stone free state. Conclusion: The 3D-guided approach to PNL facilitates the preoperative planning of the puncture with better knowledge of the renal anatomy and may be helpful to reduce operative time and improve the learning curve.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"25 1","pages":"1281 - 1282"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75459363","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 : 2019-11-01DOI: 10.1590/S1677-5538.IBJU.2019.0053
Nicholas A. Pickersgill, Alec J. Wright, R. Figenshau
ABSTRACT We describe the rare case of a 61-year-old female with right ureteropelvic junction (UPJ) obstruction caused by metastatic cholangiocarcinoma. Her past medical history was notable for cholangiocarcinoma treated with neoadjuvant chemoradiation and two orthotopic liver transplants six years earlier. Urology was consulted when she presented with flank pain and urinary tract infection. Diagnostic workup demonstrated right UPJ obstruction. She was managed acutely with percutaneous nephrostomy. She subsequently underwent robotic pyeloplasty and intrinsic obstruction of the UPJ was discovered. Histological examination revealed adenocarcinoma, consistent with systemic recurrence of the patient's known cholangiocarcinoma.
{"title":"Ureteropelvic junction obstruction caused by metastatic cholangiocarcinoma","authors":"Nicholas A. Pickersgill, Alec J. Wright, R. Figenshau","doi":"10.1590/S1677-5538.IBJU.2019.0053","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0053","url":null,"abstract":"ABSTRACT We describe the rare case of a 61-year-old female with right ureteropelvic junction (UPJ) obstruction caused by metastatic cholangiocarcinoma. Her past medical history was notable for cholangiocarcinoma treated with neoadjuvant chemoradiation and two orthotopic liver transplants six years earlier. Urology was consulted when she presented with flank pain and urinary tract infection. Diagnostic workup demonstrated right UPJ obstruction. She was managed acutely with percutaneous nephrostomy. She subsequently underwent robotic pyeloplasty and intrinsic obstruction of the UPJ was discovered. Histological examination revealed adenocarcinoma, consistent with systemic recurrence of the patient's known cholangiocarcinoma.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"1 1","pages":"1266 - 1269"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79904648","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 : 2019-11-01DOI: 10.1590/S1677-5538.IBJU.2019.0097
Ashley M. Shumate, Grayson Roth, C. Ball, D. Thiel
ABSTRACT Purpose: To prospectively evaluate the association of adherent perinephric fat (APF) on perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) following elimination of the surgical learning curve. Materials and Methods: 305 consecutive RAPNs performed by a single experienced surgeon were analyzed. The first 100 RAPNs were considered the learning curve and therefore excluded. APF was defined as the necessity of subcapsular renal dissection to mobilize the tumor from surrounding perinephric fat. Perioperative outcomes were evaluated including operative time, warm ischemia time (WIT), postoperative complications, length of stay, margins, ischemia, and complications score (MIC), estimated blood loss (EBL), and change in pre-operative to postoperative day 1 (POD 1) laboratory values. After correction for multiple comparisons, P values ≤0.0045 were considered statistically significant but associations with P values ≤0.05 were also mentioned in the study results. Results: Fifty-eight (28.3%) patients had APF. Patients with APF had longer operative times compared to those without APF (median, 213 vs. 192 minutes, P <0.001). There was some evidence of higher increase in change in creatinine from preoperative to POD 1 among those with APF compared to those without APF, although this was not statistically significant (median, 0.2 vs. 0.1mg/dL, P=0.03). There were no other statistically significant associations between presence of APF and perioperative outcomes. Conclusions: APF is associated with increased operative time but no change in other perioperative outcomes. Surgeon experience does not affect perioperative outcomes associated with APF.
目的:前瞻性评估附着性肾周脂肪(APF)与机器人辅助部分肾切除术(RAPN)手术学习曲线消除后围手术期预后的关系。材料和方法:对同一名经验丰富的外科医生连续实施的305例rapn进行分析。前100个rapn被认为是学习曲线，因此被排除在外。APF被定义为包膜下肾剥离的必要性，以动员肿瘤从周围的肾周脂肪。评估围手术期结果，包括手术时间、热缺血时间(WIT)、术后并发症、住院时间、边缘、缺血和并发症评分(MIC)、估计失血量(EBL)以及术前至术后第1天(POD 1)实验室值的变化。经多次比较校正后，认为P值≤0.0045具有统计学意义，但研究结果中也会提到P值≤0.05的相关性。结果:APF患者58例(28.3%)。与无APF患者相比，APF患者的手术时间更长(中位数，213分钟对192分钟，P <0.001)。有证据表明，与无APF患者相比，APF患者术前至POD 1的肌酐变化增高，但无统计学意义(中位数，0.2 vs. 0.1mg/dL, P=0.03)。APF的存在与围手术期结果之间没有其他统计学意义上的关联。结论:APF与手术时间增加有关，但其他围手术期预后无变化。外科医生经验不影响APF的围手术期预后。
{"title":"Prospective evaluation of the effect of adherent perinephric fat on outcomes of robotic assisted partial nephrectomy following elimination of the learning curve","authors":"Ashley M. Shumate, Grayson Roth, C. Ball, D. Thiel","doi":"10.1590/S1677-5538.IBJU.2019.0097","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0097","url":null,"abstract":"ABSTRACT Purpose: To prospectively evaluate the association of adherent perinephric fat (APF) on perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) following elimination of the surgical learning curve. Materials and Methods: 305 consecutive RAPNs performed by a single experienced surgeon were analyzed. The first 100 RAPNs were considered the learning curve and therefore excluded. APF was defined as the necessity of subcapsular renal dissection to mobilize the tumor from surrounding perinephric fat. Perioperative outcomes were evaluated including operative time, warm ischemia time (WIT), postoperative complications, length of stay, margins, ischemia, and complications score (MIC), estimated blood loss (EBL), and change in pre-operative to postoperative day 1 (POD 1) laboratory values. After correction for multiple comparisons, P values ≤0.0045 were considered statistically significant but associations with P values ≤0.05 were also mentioned in the study results. Results: Fifty-eight (28.3%) patients had APF. Patients with APF had longer operative times compared to those without APF (median, 213 vs. 192 minutes, P <0.001). There was some evidence of higher increase in change in creatinine from preoperative to POD 1 among those with APF compared to those without APF, although this was not statistically significant (median, 0.2 vs. 0.1mg/dL, P=0.03). There were no other statistically significant associations between presence of APF and perioperative outcomes. Conclusions: APF is associated with increased operative time but no change in other perioperative outcomes. Surgeon experience does not affect perioperative outcomes associated with APF.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"94 1","pages":"1136 - 1143"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80710721","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 : 2019-11-01DOI: 10.1590/S1677-5538.IBJU.2019.0238
G. Lira, A. Fornari, L. Cardoso, Magda Aranchipe, Carmem Kretiska, E. Rhoden
ABSTRACT Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. Materials and Methods: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. Results: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). Conclusion: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not significantly improve urinary continence or erectile function at 3 months after RP.
{"title":"Effects of perioperative pelvic floor muscle training on early recovery of urinary continence and erectile function in men undergoing radical prostatectomy: a randomized clinical trial","authors":"G. Lira, A. Fornari, L. Cardoso, Magda Aranchipe, Carmem Kretiska, E. Rhoden","doi":"10.1590/S1677-5538.IBJU.2019.0238","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0238","url":null,"abstract":"ABSTRACT Aims: Radical prostatectomy (RP) can result in urinary incontinence (UI) and erectile dysfunction (ED), which negatively impact quality of life (QoL). This study aimed to evaluate the effects of a perioperative pelvic floor muscle training (PFMT) program versus usual care on early recovery of urinary continence and erectile function after RP. Materials and Methods: Of 59 eligible men, 31 were randomly allocated into 2 groups: Group 1 (Control, N=15) received usual post-RP care; and Group 2 (Physical therapy, N=16) received two pre-RP physical therapist-guided PFMT sessions, including exercises and electromyographic biofeedback, and verbal and written instructions to continue PFMT until RP, which was then resumed after urethral catheter removal. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire were used to evaluate UI and ED, respectively. Results: Demographic characteristics were similar in both groups. Three months after RP, the UI rate was 72.7% and 70.0% in Groups 1 and 2, respectively (P >0.05). The severity and frequency of UI and its impact on QoL were evaluated by the ICIQ-Short Form, with scores of 6.9±6.26 in Group 1 and 7.0±5.12 in Group 2 (P >0.05). The IIEF-5 scores were similar in Groups 1 and 2 (5.73±7.43 vs. 6.70±6.68, respectively) (P >0.05). Conclusion: Our pre-RP protocol of two physical therapist-assisted sessions of PFMT plus instructions did not significantly improve urinary continence or erectile function at 3 months after RP.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"23 1","pages":"1196 - 1203"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83465714","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 : 2019-11-01DOI: 10.1590/S1677-5538.IBJU.2018.0291
Sanchez Basto Catalina, P. Katherine, F. Nicolas, Castillo Mariangel, Espitaleta Vergara Zilac, Ana Maria Quintero Gómez, Perez Nino Jaime
ABSTRACT Introduction: Children with a solitary post-nephrectomy kidney (SNK) are at potential risk of developing kidney disease later in life. In response to the global decline in the number of nephrons, adaptive mechanisms lead to renal injury. The aim of this study was to determine the prevalence and time of onset of high blood pressure (HBP), proteinuria, glomerular filtration rate (GFR) disruption and renal tubular acidosis (RTA) in children with SNK. Materials and methods: After obtaining the approval from our institution's ethics committee, we reviewed the medical records of patients under 18 years of age who underwent unilateral nephrectomy between January 2005 and December 2015 in three university hospitals. Results: We identified 43 patients, 35 (81.4%) cases of unilateral nephrectomy (UNP) were due to a non-oncologic pathology and Wilm's tumor was identified in 8 (18.6%) cases. In patients with non-oncologic disease, 9.3% developed de novo hypertension, with an average time of onset of 7.1 years, 25% developed proteinuria de novo, with an average time of onset of 2.2 years. For GFR, 21.8% presented deterioration of the GFR in an average time of 3.4 years. Ten (43.5%) patients developed some type of de novo renal injury after UNP. Patients with oncologic disease developed the conditions slowly and none of them developed proteinuria. Conclusions: Taking into account the high rate of long term postoperative renal injury, it can be considered that nephrectomy does not prevent this disease. The follow-up of children with SNK requires a multidisciplinary approach and long-term surveillance to detect renal injury.
{"title":"The natural history of solitary post-nephrectomy kidney in a pediatric population","authors":"Sanchez Basto Catalina, P. Katherine, F. Nicolas, Castillo Mariangel, Espitaleta Vergara Zilac, Ana Maria Quintero Gómez, Perez Nino Jaime","doi":"10.1590/S1677-5538.IBJU.2018.0291","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0291","url":null,"abstract":"ABSTRACT Introduction: Children with a solitary post-nephrectomy kidney (SNK) are at potential risk of developing kidney disease later in life. In response to the global decline in the number of nephrons, adaptive mechanisms lead to renal injury. The aim of this study was to determine the prevalence and time of onset of high blood pressure (HBP), proteinuria, glomerular filtration rate (GFR) disruption and renal tubular acidosis (RTA) in children with SNK. Materials and methods: After obtaining the approval from our institution's ethics committee, we reviewed the medical records of patients under 18 years of age who underwent unilateral nephrectomy between January 2005 and December 2015 in three university hospitals. Results: We identified 43 patients, 35 (81.4%) cases of unilateral nephrectomy (UNP) were due to a non-oncologic pathology and Wilm's tumor was identified in 8 (18.6%) cases. In patients with non-oncologic disease, 9.3% developed de novo hypertension, with an average time of onset of 7.1 years, 25% developed proteinuria de novo, with an average time of onset of 2.2 years. For GFR, 21.8% presented deterioration of the GFR in an average time of 3.4 years. Ten (43.5%) patients developed some type of de novo renal injury after UNP. Patients with oncologic disease developed the conditions slowly and none of them developed proteinuria. Conclusions: Taking into account the high rate of long term postoperative renal injury, it can be considered that nephrectomy does not prevent this disease. The follow-up of children with SNK requires a multidisciplinary approach and long-term surveillance to detect renal injury.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"7 1","pages":"1227 - 1237"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83782719","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 : 2019-11-01DOI: 10.1590/S1677-5538.IBJU.2018.0730
E. Gregório, A. P. Alexandrino, I. Schuquel, W. Costa, M. A. Rodrigues
ABSTRACT Purpose: To establish whether the citrate concentration in the seminal fluid ([CITRATE]) measured by means of high-resolution nuclear magnetic resonance spectroscopy (1HNMRS) is superior to the serum prostate-specific antigen (PSA) concentration in detecting of clinically significant prostate cancer (csPCa) in men with persistently elevated PSA. Materials and Methods: The group of patients consisted of 31 consecutively seen men with histological diagnosis of clinically localized csPCa. The control group consisted of 28 men under long-term follow-up (mean of 8.7 ± 3.0 years) for benign prostate hyperplasia (BPH), with persistently elevated PSA (above 4 ng/mL) and several prostate biopsies negative for cancer (mean of 2.7 ± 1.3 biopsies per control). Samples of blood and seminal fluid (by masturbation) for measurement of PSA and citrate concentration, respectively, were collected from patients and controls. Citrate concentration in the seminal fluid ([CITRATE]) was determined by means of 1HNMRS. The capacities of PSA and [CITRATE] to predict csPCa were compared by means of univariate analysis and receiver operating characteristic (ROC) curves. Results: Median [CITRATE] was significantly lower among patients with csPCa compared to controls (3.93 mM/l vs. 15.53 mM/l). There was no significant difference in mean PSA between patients and controls (9.42 ng/mL vs. 8.57 ng/mL). The accuracy of [CITRATE] for detecting csPCa was significantly superior compared to PSA (74.8% vs. 54.8%). Conclusion: Measurement of [CITRATE] by means of 1HNMRS is superior to PSA for early detection of csPCa in men with elevated PSA.
目的:探讨高分辨率核磁共振波谱(1HNMRS)检测精液中柠檬酸盐浓度([citrate])是否优于血清前列腺特异性抗原(PSA)浓度检测PSA持续升高的男性临床显著性前列腺癌(csPCa)。材料与方法:本组患者为31例经组织学诊断为临床上局限性csPCa的男性患者。对照组包括28名长期随访(平均8.7±3.0年)的良性前列腺增生(BPH)男性，PSA持续升高(高于4 ng/mL)，多次前列腺活检呈癌阴性(平均每名对照组2.7±1.3次活检)。分别采集患者和对照组的血液和精液样本(通过手淫)用于测定PSA和柠檬酸盐浓度。用1hnmr测定精液中柠檬酸盐浓度([Citrate])。通过单因素分析和受试者工作特征(ROC)曲线比较PSA和[CITRATE]预测csPCa的能力。结果:与对照组相比，csPCa患者的中位[CITRATE]显著降低(3.93 mM/l vs. 15.53 mM/l)。患者和对照组的平均PSA无显著差异(9.42 ng/mL vs. 8.57 ng/mL)。[CITRATE]检测csPCa的准确性明显优于PSA (74.8% vs. 54.8%)。结论:1HNMRS检测[CITRATE]对PSA升高的男性csPCa的早期检测效果优于PSA。
{"title":"Seminal citrate is superior to PSA for detecting clinically significant prostate cancer","authors":"E. Gregório, A. P. Alexandrino, I. Schuquel, W. Costa, M. A. Rodrigues","doi":"10.1590/S1677-5538.IBJU.2018.0730","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0730","url":null,"abstract":"ABSTRACT Purpose: To establish whether the citrate concentration in the seminal fluid ([CITRATE]) measured by means of high-resolution nuclear magnetic resonance spectroscopy (1HNMRS) is superior to the serum prostate-specific antigen (PSA) concentration in detecting of clinically significant prostate cancer (csPCa) in men with persistently elevated PSA. Materials and Methods: The group of patients consisted of 31 consecutively seen men with histological diagnosis of clinically localized csPCa. The control group consisted of 28 men under long-term follow-up (mean of 8.7 ± 3.0 years) for benign prostate hyperplasia (BPH), with persistently elevated PSA (above 4 ng/mL) and several prostate biopsies negative for cancer (mean of 2.7 ± 1.3 biopsies per control). Samples of blood and seminal fluid (by masturbation) for measurement of PSA and citrate concentration, respectively, were collected from patients and controls. Citrate concentration in the seminal fluid ([CITRATE]) was determined by means of 1HNMRS. The capacities of PSA and [CITRATE] to predict csPCa were compared by means of univariate analysis and receiver operating characteristic (ROC) curves. Results: Median [CITRATE] was significantly lower among patients with csPCa compared to controls (3.93 mM/l vs. 15.53 mM/l). There was no significant difference in mean PSA between patients and controls (9.42 ng/mL vs. 8.57 ng/mL). The accuracy of [CITRATE] for detecting csPCa was significantly superior compared to PSA (74.8% vs. 54.8%). Conclusion: Measurement of [CITRATE] by means of 1HNMRS is superior to PSA for early detection of csPCa in men with elevated PSA.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"24 1","pages":"1113 - 1121"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73771646","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 : 2019-11-01DOI: 10.1590/S1677-5538.IBJU.2019.0330
H. Cimen, Y. Atik, D. Gul, B. Uysal, M. Balbay
ABSTRACT Introduction: To evaluate the influence of previous experience as bedside assistants on patient selection, perioperative and pathological results in robot assisted laparoscopic radical prostatectomy. Materials and Methods: The first 50 cases of two robotic surgeons were reviewed retrospectively. Group 1 consisted of the first 50 cases of the surgeon with previous experience as a robotic bedside assistant between September 2016-July 2018, while Group 2 included the first 50 cases of the surgeon with no bedside assistant experience between February 2009-December 2009. Groups were examined in terms of demographics, prostate volume, presence of median lobe, prostate specific antigen (PSA), preoperative Gleason score, positive core number, clinical stage, console surgery time, estimated blood loss, postoperative Gleason score, pathological stage, positive surgical margin rate, postoperative complications, length of hospital stay and biochemical recurrence rate. Results: Previous abdominal surgery and the presence of median lobe hypertrophy rates were higher in Group 1 than in Group 2 (20% vs. 4%, p=0.014; 24% vs. 6%, p=0.012; respectively). In addition, patients in Group 1 were in a higher clinical stage than those in Group 2 (cT2: 70% vs. 28%, p=0.001). Median console surgery time and median length of hospital stay was significantly shorter in Group 1 than in Group 2 (170 min vs. 240 min, p=0.001; 3 vs. 4, p=0.022; respectively). Clavien grade 3 complication rate was higher in Group 2 but was statistically insignificant. Conclusion: Our findings might reflect that previous bedside assistant experience led to an increase in self-confidence and the ability to manage troubleshooting and made it more likely for surgeons to start with more difficult cases with more challenging patients. It is recommended that novice surgeons serve as bedside assistants before moving on to consoles.
摘要简介:评价以往作为床边助理的经验对机器人辅助腹腔镜前列腺根治术患者选择、围手术期和病理结果的影响。材料与方法:对2名机器人外科医生的前50例手术进行回顾性分析。第一组包括前50例在2016年9月至2018年7月期间有机器人床边助理经验的外科医生，而第二组包括前50例在2009年2月至2009年12月期间没有床边助理经验的外科医生。统计学、前列腺体积、正中叶有无、前列腺特异性抗原(PSA)、术前Gleason评分、阳性核心数、临床分期、手术时间、预估失血量、术后Gleason评分、病理分期、手术切缘阳性率、术后并发症、住院时间、生化复发率。结果:1组既往腹部手术及中叶肥大发生率高于2组(20% vs. 4%， p=0.014;24% vs. 6%， p=0.012;分别)。此外，1组患者的临床分期高于2组(cT2: 70% vs. 28%， p=0.001)。组1的中位手术时间和中位住院时间显著短于组2 (170 min vs 240 min, p=0.001;3 vs. 4, p=0.022;分别)。Clavien 3级并发症发生率高于对照组，但差异无统计学意义。结论:我们的研究结果可能反映了以前的床边助理经验导致自信心和处理故障的能力的增加，并使外科医生更有可能从更困难的病例和更有挑战性的患者开始。建议新手外科医生在进入控制台之前担任床边助理。
{"title":"Serving as a bedside surgeon before performing robotic radical prostatectomy improves surgical outcomes","authors":"H. Cimen, Y. Atik, D. Gul, B. Uysal, M. Balbay","doi":"10.1590/S1677-5538.IBJU.2019.0330","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0330","url":null,"abstract":"ABSTRACT Introduction: To evaluate the influence of previous experience as bedside assistants on patient selection, perioperative and pathological results in robot assisted laparoscopic radical prostatectomy. Materials and Methods: The first 50 cases of two robotic surgeons were reviewed retrospectively. Group 1 consisted of the first 50 cases of the surgeon with previous experience as a robotic bedside assistant between September 2016-July 2018, while Group 2 included the first 50 cases of the surgeon with no bedside assistant experience between February 2009-December 2009. Groups were examined in terms of demographics, prostate volume, presence of median lobe, prostate specific antigen (PSA), preoperative Gleason score, positive core number, clinical stage, console surgery time, estimated blood loss, postoperative Gleason score, pathological stage, positive surgical margin rate, postoperative complications, length of hospital stay and biochemical recurrence rate. Results: Previous abdominal surgery and the presence of median lobe hypertrophy rates were higher in Group 1 than in Group 2 (20% vs. 4%, p=0.014; 24% vs. 6%, p=0.012; respectively). In addition, patients in Group 1 were in a higher clinical stage than those in Group 2 (cT2: 70% vs. 28%, p=0.001). Median console surgery time and median length of hospital stay was significantly shorter in Group 1 than in Group 2 (170 min vs. 240 min, p=0.001; 3 vs. 4, p=0.022; respectively). Clavien grade 3 complication rate was higher in Group 2 but was statistically insignificant. Conclusion: Our findings might reflect that previous bedside assistant experience led to an increase in self-confidence and the ability to manage troubleshooting and made it more likely for surgeons to start with more difficult cases with more challenging patients. It is recommended that novice surgeons serve as bedside assistants before moving on to consoles.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"12 1","pages":"1122 - 1128"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73802118","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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