Pub Date : 2019-03-01DOI: 10.1590/S1677-5538.IBJU.2019.0267
M. Bandini, S. Sekulovic, N. Stanojevic, B. Spiridonescu, V. Pesic, S. Sansalone, M. Slavković, A. Briganti, A. Salonia, F. Montorsi, R. Djinovic
ABSTRACT Introduction: Pubic hypertrophy, defined as an abnormal and abundant round mass of fatty tissue located over the pubic symphysis, is frequently underestimated in patients with hypospadias. We examined the prevalence of this condition, as well as the outcomes associated with its surgical treatment. Material and methods: Within 266 hypospadias patients treated at our clinic, we assessed the prevalence of pubic hypertrophy, and we schematically described the surgical steps of pubic lipectomy. Multivariable logistic regression (MLR) tested for predictors of pubic hypertrophy. Finally, separate MLRs tested for predictors of fistula and any complications after pubic lipectomy. Results: Of 266 hypospadias patients, 100 (37.6%) presented pubic hypertrophy and underwent pubic lipectomy. Patients with pubic hypertrophy more frequently had proximal hypospadias (44 vs. 7.8%), disorders of sex development (DSD) (10 vs. 0.6%), cryptorchidism (12 vs. 2.4%), and moderate (30°-60°) or severe (>60°) penile curvature (33 vs. 4.2%). In MLR, the location of urethral meatus (proximal, Odds ratio [OR]: 10.1, p<0.001) was the only significant predictor of pubic hypertrophy. Finally, pubic lipectomy was not associated with increased risk of fistula (OR: 1.12, p=0.7) or any complications (OR: 1.37, 95% CI: 0.64-2.88, p=0.4) after multivariable adjustment. Conclusions: One out of three hypospadias patients, referred to our center, presented pubic hypertrophy and received pubic lipectomy. This rate was higher in patients with proximal hypospadias suggesting a correlation between pubic hypertrophy and severity of hypospadias. Noteworthy, pubic lipectomy was not associated with increased risk of fistula or any complications.
{"title":"Prevalence and surgical management of pubic hypertrophy in hypospadias patients: results from a high-volume surgeon","authors":"M. Bandini, S. Sekulovic, N. Stanojevic, B. Spiridonescu, V. Pesic, S. Sansalone, M. Slavković, A. Briganti, A. Salonia, F. Montorsi, R. Djinovic","doi":"10.1590/S1677-5538.IBJU.2019.0267","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0267","url":null,"abstract":"ABSTRACT Introduction: Pubic hypertrophy, defined as an abnormal and abundant round mass of fatty tissue located over the pubic symphysis, is frequently underestimated in patients with hypospadias. We examined the prevalence of this condition, as well as the outcomes associated with its surgical treatment. Material and methods: Within 266 hypospadias patients treated at our clinic, we assessed the prevalence of pubic hypertrophy, and we schematically described the surgical steps of pubic lipectomy. Multivariable logistic regression (MLR) tested for predictors of pubic hypertrophy. Finally, separate MLRs tested for predictors of fistula and any complications after pubic lipectomy. Results: Of 266 hypospadias patients, 100 (37.6%) presented pubic hypertrophy and underwent pubic lipectomy. Patients with pubic hypertrophy more frequently had proximal hypospadias (44 vs. 7.8%), disorders of sex development (DSD) (10 vs. 0.6%), cryptorchidism (12 vs. 2.4%), and moderate (30°-60°) or severe (>60°) penile curvature (33 vs. 4.2%). In MLR, the location of urethral meatus (proximal, Odds ratio [OR]: 10.1, p<0.001) was the only significant predictor of pubic hypertrophy. Finally, pubic lipectomy was not associated with increased risk of fistula (OR: 1.12, p=0.7) or any complications (OR: 1.37, 95% CI: 0.64-2.88, p=0.4) after multivariable adjustment. Conclusions: One out of three hypospadias patients, referred to our center, presented pubic hypertrophy and received pubic lipectomy. This rate was higher in patients with proximal hypospadias suggesting a correlation between pubic hypertrophy and severity of hypospadias. Noteworthy, pubic lipectomy was not associated with increased risk of fistula or any complications.","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":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75777669","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 : 2019-03-01DOI: 10.1590/S1677-5538.IBJU.2019.02.03
S. Ghodoussipour, A. Lebastchi, P. Pinto, André Berger
Prostate cancer (PCa) is diagnosed in over 170,000 men in the United States each year (1). While this makes PCa one of the most common solid malignancies in men, the mortality is low and most men die from unrelated causes (1). In fact, almost half of men with screening detected and localized PCa are considered candidates for deferred treatment or active surveillance (AS) (2). To decrease the morbidity associated with definitive therapy, many providers recommend AS for those with very-low (VLR), low risk (LR) disease and in selected favorable, intermediate risk (IR) PCa (3-5). The use of AS has been steadily increasing and is supported by large cohort studies showing 98-100% PCa specific survival rates (6, 7). While the recommended follow-up for AS varies, safety is predicated on close surveillance with predefined thresholds for treatment based on identification of cancer progression yet still curable disease. In the largest published AS cohort of 993 men with median follow-up of 6.4 years, 10-year cancer specific survival (CSS) was 98.1%. However, 27% of these patients ultimately underwent surgery for indications ranging from prostate specific antigen (PSA) progression, biopsy Gleason score progression or patient preference. While this cohort included mostly younger men with LR disease (Age <70, cT1/T2a disease, PSA <10ng/ml), they also included patients older than 70 with Gleason 3+4=7 or lower disease, such that 20% had IR (6). A separate analysis of this cohort by Musunuru et al. showed that while only 3% of patients developed metastases, metastasis free survival (MFS) was significantly lower in the IR as compared to the LR group (84% vs 95%, p=0.001) (8). Another separate cohort analysis by Yamamoto et al. showed a significantly higher risk of 15-year PCa mortality (PCM) for higher Gleason score disease (HR of 4.0 for Gleason 3+4=7 vs Gleason 3+3=6 and HR 10.5 for Gleason 4+3=7 vs Gleason 3+3=6) (9). The PROTECT trial randomized 1643 patients with localized PCa into AS (n=545), definitive treatment with radical prostatectomy (RP; n=553) or radiation therapy (RT; n=545). There was no difference in PCM amongst the 3 groups (p=0.48), however, of those 17 patients who passed away, 8 were in the AS group (5/8 with IR disease), 5 in the RP group and 4 in the RT group. The rate of disease progression and development of metastases was significantly higher in the AS group as compared to RP or RT (112 vs 46 vs 46 men, respectively; p<0.001) (10). Despite a certain subset of patients who seem to do worse on AS, concerns with morbidity from definitive treatment have led experts to recommend a broadening of the indications for AS and to include selected patients with low volume IR disease (3, 5, 11, 12). As the indications for AS expand, certain patients may wish to be even more “active” in their surveillance. In 2018, Bloom et DiffereNce Of OpiNiON Vol. 45 (2): 215-219, March April, 2019
诊断前列腺癌(PCa)是在美国每年超过170000人(1),这使得PCa最常见的固体男性恶性肿瘤之一,死亡率很低,大多数人死于不相关的原因(1)。事实上,几乎一半的男性筛查检测和局部PCa是延迟治疗或候选人积极监测()(2)。减少发病率与明确的治疗,许多供应商建议对于那些极低(VLR)”,低风险(LR)疾病和选择有利的中风险(IR) PCa(3-5)。AS的使用一直在稳步增加，并得到大型队列研究的支持，显示PCa特异性生存率为98-100%(6,7)。虽然推荐的AS随访时间各不相同，但安全性是基于密切监测和预定义的治疗阈值，这些阈值是基于确定癌症进展但仍可治愈的疾病。在已发表的最大的AS队列中，993名男性，中位随访6.4年，10年癌症特异性生存率(CSS)为98.1%。然而，这些患者中有27%最终因前列腺特异性抗原(PSA)进展、活检Gleason评分进展或患者偏好等适应症接受了手术。虽然该队列主要包括患有LR疾病的年轻男性(年龄<70岁，cT1/T2a疾病，PSA <10ng/ml)，但他们也包括年龄大于70岁的Gleason 3+4=7或更低疾病的患者，因此20%患有IR(6)。Musunuru等人对该队列的单独分析显示，虽然只有3%的患者发生转移，但与LR组相比，IR中的无转移生存率(MFS)显着降低(84% vs 95%)。p=0.001)(8)。Yamamoto等人的另一项单独队列分析显示，Gleason评分较高的疾病15年PCa死亡率(PCM)的风险明显更高(Gleason 3+4=7 vs Gleason 3+3=6的HR为4.0,Gleason 4+3=7 vs Gleason 3+3=6的HR为10.5)(9)。PROTECT试验将1643名局限性PCa患者随机分为AS (n=545)，最终治疗是根治性前列腺切除术(RP;n=553)或放射治疗(RT;n = 545)。3组间PCM无差异(p=0.48)，但17例死亡患者中，AS组8例(5/8合并IR疾病)，RP组5例，RT组4例。与RP或RT相比，AS组的疾病进展和转移率明显更高(分别为112人vs 46人vs 46人;p < 0.001)(10)。尽管有一部分患者在接受AS治疗后表现更差，但考虑到最终治疗的发病率，专家们建议扩大AS的适应症，并选择包括低容量IR疾病的患者(3,5,11,12)。随着As适应症的扩大，某些患者可能希望在他们的监测中更加“积极”。In 2018, Bloom et DiffereNce Of OpiNiON Vol. 45 (2): 215-219, March April, 2019
{"title":"Super active surveillance for low-risk prostate cancer | Opinion: No","authors":"S. Ghodoussipour, A. Lebastchi, P. Pinto, André Berger","doi":"10.1590/S1677-5538.IBJU.2019.02.03","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.02.03","url":null,"abstract":"Prostate cancer (PCa) is diagnosed in over 170,000 men in the United States each year (1). While this makes PCa one of the most common solid malignancies in men, the mortality is low and most men die from unrelated causes (1). In fact, almost half of men with screening detected and localized PCa are considered candidates for deferred treatment or active surveillance (AS) (2). To decrease the morbidity associated with definitive therapy, many providers recommend AS for those with very-low (VLR), low risk (LR) disease and in selected favorable, intermediate risk (IR) PCa (3-5). The use of AS has been steadily increasing and is supported by large cohort studies showing 98-100% PCa specific survival rates (6, 7). While the recommended follow-up for AS varies, safety is predicated on close surveillance with predefined thresholds for treatment based on identification of cancer progression yet still curable disease. In the largest published AS cohort of 993 men with median follow-up of 6.4 years, 10-year cancer specific survival (CSS) was 98.1%. However, 27% of these patients ultimately underwent surgery for indications ranging from prostate specific antigen (PSA) progression, biopsy Gleason score progression or patient preference. While this cohort included mostly younger men with LR disease (Age <70, cT1/T2a disease, PSA <10ng/ml), they also included patients older than 70 with Gleason 3+4=7 or lower disease, such that 20% had IR (6). A separate analysis of this cohort by Musunuru et al. showed that while only 3% of patients developed metastases, metastasis free survival (MFS) was significantly lower in the IR as compared to the LR group (84% vs 95%, p=0.001) (8). Another separate cohort analysis by Yamamoto et al. showed a significantly higher risk of 15-year PCa mortality (PCM) for higher Gleason score disease (HR of 4.0 for Gleason 3+4=7 vs Gleason 3+3=6 and HR 10.5 for Gleason 4+3=7 vs Gleason 3+3=6) (9). The PROTECT trial randomized 1643 patients with localized PCa into AS (n=545), definitive treatment with radical prostatectomy (RP; n=553) or radiation therapy (RT; n=545). There was no difference in PCM amongst the 3 groups (p=0.48), however, of those 17 patients who passed away, 8 were in the AS group (5/8 with IR disease), 5 in the RP group and 4 in the RT group. The rate of disease progression and development of metastases was significantly higher in the AS group as compared to RP or RT (112 vs 46 vs 46 men, respectively; p<0.001) (10). Despite a certain subset of patients who seem to do worse on AS, concerns with morbidity from definitive treatment have led experts to recommend a broadening of the indications for AS and to include selected patients with low volume IR disease (3, 5, 11, 12). As the indications for AS expand, certain patients may wish to be even more “active” in their surveillance. In 2018, Bloom et DiffereNce Of OpiNiON Vol. 45 (2): 215-219, March April, 2019","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":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81884253","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 : 2019-01-29DOI: 10.1590/S1677-5538.IBJU.2018.0843.1
Diogo Benchimol de Souza, Gabriela F. Buys-Gonçalves
Herbal medicine is as old as the history of mankind, and is still a topic of interest in current days. The article of Haghmorad et al. (1) reports promising results with two herbal extracts for improving fertility parameters. Both herbs showed positive results when used individually, but (what was more interesting) a synergic effect seems to occur when used together. The extract of Tribulus terrestris were more prominent in raising LH and Testosterone levels (which was already reported (2,3)) while Anacyclus pyrethrum showed more impressive results in raising FSH and improving sperm parameters. Thus, the combined use may improve fertility parameters by two different endocrine ways. One limitation not raised by the authors is that the extracts improved fertility parameters in control animals, in which a normal testicle, hypothalamus-pituitary-gonadal axis and fertility parameters are assumed. Future studies investigating if these herbal extracts can also improve fertility parameters in infertile/subfertile models are warranted. The mechanisms of action of these phytotherapics are poorly understood, especially for the less-studied Anacyclus pyrethrum. This herb has been proposed for different conditions (from local anesthetic to anticancer (4,5)), although no clinical study was conducted focusing on male reproductive or endocrine systems. It seems that most phytotherapeutic study focuses only on the final specific effects, putting aside the search for knowledge on the basic mechanisms of the extracts. Since the ancient Greece Hippocrates advocated the principle of primum non nocere which should be always applied when proposing any therapy, including herbal therapies. When studying any treatment for a specific condition, is important to have a more global perspective, evaluating potential side-effects of the proposed medication. Specifically, for Tribulus terrestris, our group recently showed this herb leads to arterial blood pressure increase and renal morphology alteration with glomerular loss (6). This kind of study may add information for the physician, helping evaluating the pros and cons of each prescription for each patient. EDITORIAL COMMENT Vol. 45 (5): 1055-1056, September October, 2019
{"title":"Editorial Comment: Improvement of fertility parameters with Tribulus Terrestris and Anacyclus Pyrethrum treatment in male rats","authors":"Diogo Benchimol de Souza, Gabriela F. Buys-Gonçalves","doi":"10.1590/S1677-5538.IBJU.2018.0843.1","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0843.1","url":null,"abstract":"Herbal medicine is as old as the history of mankind, and is still a topic of interest in current days. The article of Haghmorad et al. (1) reports promising results with two herbal extracts for improving fertility parameters. Both herbs showed positive results when used individually, but (what was more interesting) a synergic effect seems to occur when used together. The extract of Tribulus terrestris were more prominent in raising LH and Testosterone levels (which was already reported (2,3)) while Anacyclus pyrethrum showed more impressive results in raising FSH and improving sperm parameters. Thus, the combined use may improve fertility parameters by two different endocrine ways. One limitation not raised by the authors is that the extracts improved fertility parameters in control animals, in which a normal testicle, hypothalamus-pituitary-gonadal axis and fertility parameters are assumed. Future studies investigating if these herbal extracts can also improve fertility parameters in infertile/subfertile models are warranted. The mechanisms of action of these phytotherapics are poorly understood, especially for the less-studied Anacyclus pyrethrum. This herb has been proposed for different conditions (from local anesthetic to anticancer (4,5)), although no clinical study was conducted focusing on male reproductive or endocrine systems. It seems that most phytotherapeutic study focuses only on the final specific effects, putting aside the search for knowledge on the basic mechanisms of the extracts. Since the ancient Greece Hippocrates advocated the principle of primum non nocere which should be always applied when proposing any therapy, including herbal therapies. When studying any treatment for a specific condition, is important to have a more global perspective, evaluating potential side-effects of the proposed medication. Specifically, for Tribulus terrestris, our group recently showed this herb leads to arterial blood pressure increase and renal morphology alteration with glomerular loss (6). This kind of study may add information for the physician, helping evaluating the pros and cons of each prescription for each patient. EDITORIAL COMMENT Vol. 45 (5): 1055-1056, September October, 2019","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":"2019-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77214474","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 : 2019-01-29DOI: 10.1590/S1677-5538.IBJU.2019.0026
F. Mrad, Alana de Medeiros Nelli, M. Alvaia, Heros Aureliano Antunes da Silva Maia, Carina Oliveira Silva Guimarães, E. Carvalho, C. Gomes, J. M. Netto, J. B. Bessa Júnior
ABSTRACT Introduction Evidence indicates an increase in the prevalence of enuresis in individuals with sickle cell disease. The present study aims to evaluate the prevalence and impact of enuresis on quality of life in individuals with sickle cell disease. Materials and Methods This cross-sectional study evaluated individuals with sickle cell disease followed at a reference clinic, using a questionnaire designed to evaluate the age of complete toilet training, the presence of enuresis and lower urinary tract, and the impact on quality of life of these individuals. Results Fifty children presenting SCD (52% females, mean age ten years) were included in the study. Of those, 34% (17/50) presented as HbSC, 56% with HbSS (28/50), 2% Sα-thalassemia (1/5) and 8% the type of SCD was not determined. The prevalence of enuresis was 42% (21/50), affecting 75% of subjects at five years and about 15% of adolescents at 15 years of age. Enuresis was classified as monosymptomatic in 33.3% (7/21) and nonmonosymptomatic in 66.6% (14/21) of the cases, being primary in all subjects. Nocturia was identified in 24% (12/50), urgency in 20% (10/50) and daytime incontinence 10% (5/50) of the individuals. Enuresis had a significant impact on the quality of life of 67% of the individuals. Conclusion Enuresis was highly prevalent among children with SCD, and continues to be prevalent throughout early adulthood, being more common in males. Primary nonmonosymptomatic enuresis was the most common type, and 2/3 of the study population had a low quality of life.
{"title":"Prevalence of enuresis and its impact in quality of life of patients with sickle cell disease","authors":"F. Mrad, Alana de Medeiros Nelli, M. Alvaia, Heros Aureliano Antunes da Silva Maia, Carina Oliveira Silva Guimarães, E. Carvalho, C. Gomes, J. M. Netto, J. B. Bessa Júnior","doi":"10.1590/S1677-5538.IBJU.2019.0026","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0026","url":null,"abstract":"ABSTRACT Introduction Evidence indicates an increase in the prevalence of enuresis in individuals with sickle cell disease. The present study aims to evaluate the prevalence and impact of enuresis on quality of life in individuals with sickle cell disease. Materials and Methods This cross-sectional study evaluated individuals with sickle cell disease followed at a reference clinic, using a questionnaire designed to evaluate the age of complete toilet training, the presence of enuresis and lower urinary tract, and the impact on quality of life of these individuals. Results Fifty children presenting SCD (52% females, mean age ten years) were included in the study. Of those, 34% (17/50) presented as HbSC, 56% with HbSS (28/50), 2% Sα-thalassemia (1/5) and 8% the type of SCD was not determined. The prevalence of enuresis was 42% (21/50), affecting 75% of subjects at five years and about 15% of adolescents at 15 years of age. Enuresis was classified as monosymptomatic in 33.3% (7/21) and nonmonosymptomatic in 66.6% (14/21) of the cases, being primary in all subjects. Nocturia was identified in 24% (12/50), urgency in 20% (10/50) and daytime incontinence 10% (5/50) of the individuals. Enuresis had a significant impact on the quality of life of 67% of the individuals. Conclusion Enuresis was highly prevalent among children with SCD, and continues to be prevalent throughout early adulthood, being more common in males. Primary nonmonosymptomatic enuresis was the most common type, and 2/3 of the study population had a low quality of life.","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":"2019-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88783575","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 : 2019-01-29DOI: 10.1590/S1677-5538.IBJU.2019.0176
A. Aggarwal, Manoj Kumar, Siddharth Pandey, Samarth Agarwal, S. Sankhwar
ABSTRACT Objectives To compare and assess various outcomes and success of buccal mucosal graft urethroplasty (BMGU) in patients with CKD versus patients having normal renal function. Material and Methods This was a retrospective, single centre study, during period 2013 to 2017. Patients were grouped into two groups. Group 1 had patients with estimated Glomerular Filtration Rate (eGFR)>60mL/min/1.73m2 while group 2 had patients with eGFR <60mL/min/1.73m2. eGFR was calculated according to the MDRD equation. The two groups were compared with regard to various outcomes like length, location of stricture, technique of graft placement, intra-operative blood loss (haemoglobin drop), duration of hospital stay, post-operative complications and recurrence. Results A total of 223 patients were included in study with group 1 had 130 patients and group 2 had 93 patients. Mean age of patients with CKD were higher (47.49 years versus 29.13 years). The mean follow-up period was comparable between both groups (23.29 months and 22.54 months respectively). Patients with CKD had more post-operative Clavien Grade 2 or higher complications (p=0.01) and a greater recurrence rates (p<0.001) than in non-CKD patients. On multivariate analysis, age and CKD status was significant predictor of urethroplasty success (p=0.004) (OR= 14.98 (1.952-114.94, 95% CI). Conclusions CKD patients are more prone to post-operative complications in terms of wound infection, graft uptake and graft failure and higher recurrence rates following BMGU.
{"title":"Assessment of long term outcomes after buccal mucosal graft urethroplasty: the impact of chronic kidney disease","authors":"A. Aggarwal, Manoj Kumar, Siddharth Pandey, Samarth Agarwal, S. Sankhwar","doi":"10.1590/S1677-5538.IBJU.2019.0176","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0176","url":null,"abstract":"ABSTRACT Objectives To compare and assess various outcomes and success of buccal mucosal graft urethroplasty (BMGU) in patients with CKD versus patients having normal renal function. Material and Methods This was a retrospective, single centre study, during period 2013 to 2017. Patients were grouped into two groups. Group 1 had patients with estimated Glomerular Filtration Rate (eGFR)>60mL/min/1.73m2 while group 2 had patients with eGFR <60mL/min/1.73m2. eGFR was calculated according to the MDRD equation. The two groups were compared with regard to various outcomes like length, location of stricture, technique of graft placement, intra-operative blood loss (haemoglobin drop), duration of hospital stay, post-operative complications and recurrence. Results A total of 223 patients were included in study with group 1 had 130 patients and group 2 had 93 patients. Mean age of patients with CKD were higher (47.49 years versus 29.13 years). The mean follow-up period was comparable between both groups (23.29 months and 22.54 months respectively). Patients with CKD had more post-operative Clavien Grade 2 or higher complications (p=0.01) and a greater recurrence rates (p<0.001) than in non-CKD patients. On multivariate analysis, age and CKD status was significant predictor of urethroplasty success (p=0.004) (OR= 14.98 (1.952-114.94, 95% CI). Conclusions CKD patients are more prone to post-operative complications in terms of wound infection, graft uptake and graft failure and higher recurrence rates following BMGU.","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":"2019-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82504893","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 : 2019-01-29DOI: 10.1590/S1677-5538.IBJU.2019.0132
V. Madhusoodanan, P. Patel, T. Lima, Jabez C Gondokusumo, E. Lo, N. Thirumavalavan, L. Lipshultz, R. Ramasamy
ABSTRACT Purpose The 2018 American Urological Association guidelines on the Evaluation and Management of Testosterone Deficiency recommended that 300 ng/dL be used as the threshold for prescribing testosterone replacement therapy (TRT). However, it is not uncommon for men to present with signs and symptoms of testosterone deficiency, despite having testosterone levels greater than 300 ng/dL. There exists scant literature regarding the use of hCG monotherapy for the treatment of hypogonadism in men not interested in fertility. We sought to evaluate serum testosterone response and duration of therapy of hCG monotherapy for men with symptoms of hypogonadism, but total testosterone levels > 300 ng/dL. Materials and Methods We performed a multi-institutional retrospective case series of men receiving hCG monotherapy for symptomatic hypogonadism. We evaluated patient age, treatment indication, hCG dosage, past medical history, physical exam findings and serum testosterone and gonadotropins before and after therapy. Descriptive analysis was performed and Mann Whitney U Test was utilized for statistical analysis. Results Of the 20 men included in the study, treatment indications included low libido (45%), lack of energy (50%), and erectile dysfunction (45%). Mean testosterone improved by 49.9% from a baseline of 362 ng/dL (SD 158) to 519.8 ng/dL (SD 265.6), (p=0.006). Median duration of therapy was 8 months (SD 5 months). Fifty percent of patients reported symptom improvement. Conclusions Treatment of hypogonadal symptoms with hCG for men who have a baseline testosterone level > 300 ng/dL appears to be safe and efficacious with no adverse events.
{"title":"Human Chorionic Gonadotropin monotherapy for the treatment of hypogonadal symptoms in men with total testosterone > 300 ng/dL","authors":"V. Madhusoodanan, P. Patel, T. Lima, Jabez C Gondokusumo, E. Lo, N. Thirumavalavan, L. Lipshultz, R. Ramasamy","doi":"10.1590/S1677-5538.IBJU.2019.0132","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0132","url":null,"abstract":"ABSTRACT Purpose The 2018 American Urological Association guidelines on the Evaluation and Management of Testosterone Deficiency recommended that 300 ng/dL be used as the threshold for prescribing testosterone replacement therapy (TRT). However, it is not uncommon for men to present with signs and symptoms of testosterone deficiency, despite having testosterone levels greater than 300 ng/dL. There exists scant literature regarding the use of hCG monotherapy for the treatment of hypogonadism in men not interested in fertility. We sought to evaluate serum testosterone response and duration of therapy of hCG monotherapy for men with symptoms of hypogonadism, but total testosterone levels > 300 ng/dL. Materials and Methods We performed a multi-institutional retrospective case series of men receiving hCG monotherapy for symptomatic hypogonadism. We evaluated patient age, treatment indication, hCG dosage, past medical history, physical exam findings and serum testosterone and gonadotropins before and after therapy. Descriptive analysis was performed and Mann Whitney U Test was utilized for statistical analysis. Results Of the 20 men included in the study, treatment indications included low libido (45%), lack of energy (50%), and erectile dysfunction (45%). Mean testosterone improved by 49.9% from a baseline of 362 ng/dL (SD 158) to 519.8 ng/dL (SD 265.6), (p=0.006). Median duration of therapy was 8 months (SD 5 months). Fifty percent of patients reported symptom improvement. Conclusions Treatment of hypogonadal symptoms with hCG for men who have a baseline testosterone level > 300 ng/dL appears to be safe and efficacious with no adverse events.","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":"2019-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82693246","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 : 2019-01-29DOI: 10.1590/S1677-5538.IBJU.2019.0049
A. Erbin, H. Ozdemir, M. Şahan, M. Savun, A. Çubuk, O. Yazici, M. Akbulut, O. Sarilar
ABSTRACT Purpose We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones. Materials and Methods 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defined as ‘complete stone clearance’ and was determined according to the 1st month computed tomography. Results The operation time and fluoroscopy time in supine m-PNL was significantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modified Clavien-Dindo classification, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902). Conclusions Supine m-PNL procedure is more advantageous in terms of operation time and fluoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.
目的比较仰卧位和俯卧位微型经皮肾镜取石术(m-PNL)治疗盆腔下极、中极和肾盂结石的疗效。材料与方法纳入2017年1月至2018年3月期间进行仰卧位m-PNL的54例患者和2015年4月至2018年1月期间进行俯卧位m-PNL的498例患者。498例患者中，选择年龄、性别、体重指数、美国麻醉协会评分、结石大小、结石定位、肾积水按仰卧位m-PNL组符合1:2的108例患者为俯卧位m-PNL组。排除孤立肾、上极结石、泌尿系统异常或骨骼畸形患者及儿童患者(<18岁)。成功被定义为“完全清除结石”，并根据第一个月的计算机断层扫描来确定。结果仰卧位m-PNL组手术时间和透视时间明显短于俯卧位m-PNL组(58.1±45.9∶80.1±40.0∶3.0±1.7∶4.9±4.5 min, p=0.025和p=0.01)。根据改良的Clavien-Dindo分类比较术后并发症时，两组间总并发症和亚组并发症发生率具有可比性。两组间成功率无显著差异(仰卧位m-PNL;72.2%，倾向于m-PNL;71.3%, p = 0.902)。结论仰卧位m-PNL手术治疗下极、中极及肾盆腔结石在手术时间和透视时间上均有优势。
{"title":"Comparison of supine and prone miniaturized percutaneous nephrolithotomy in the treatment of lower pole, middle pole and renal pelvic stones: A matched pair analysis","authors":"A. Erbin, H. Ozdemir, M. Şahan, M. Savun, A. Çubuk, O. Yazici, M. Akbulut, O. Sarilar","doi":"10.1590/S1677-5538.IBJU.2019.0049","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0049","url":null,"abstract":"ABSTRACT Purpose We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones. Materials and Methods 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defined as ‘complete stone clearance’ and was determined according to the 1st month computed tomography. Results The operation time and fluoroscopy time in supine m-PNL was significantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modified Clavien-Dindo classification, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902). Conclusions Supine m-PNL procedure is more advantageous in terms of operation time and fluoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.","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":"2019-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74886166","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 : 2019-01-29DOI: 10.1590/S1677-5538.IBJU.2018.0781
M. Kadıhasanoğlu, U. Yucetas, E. Karabay, Erkan Sönmezay
ABSTRACT Objective We aimed to evaluate the results of laparoscopic pyeloplasty with concomitant pyelolithotomy and compare results with a cohort of patients undergoing laparoscopic pyeloplasty without pyelolithotomy. Materials and Methods We retrospectively reviewed records of 43 patients undergoing transperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty between December 2012 and July 2018 at our department. Eighteen patients (42%) underwent laparoscopic pyeloplasty with concomitant pyelolithotomy. The results of patients with renal stones were compared with 25 matched patients undergoing laparoscopic pyeloplasty without concomitant renal stones. Demographic data, operative and stone parameters were compared between the groups. Results The groups were similar regarding to demographic characteristics. All operations were completed laparoscopically with no conversions to open surgery. In 3 cases without renal stones and 15 cases with renal stones, transposition of the ureter due to crossing vessels was performed. The mean stone size was 13±5.24 mm, and the median number of stones was 1 (1-18). The success of laparoscopic pyeloplasty with and without pyelolithotomy was 93.3% and 92.9%, respectively, as confirmed by negative diuretic renogram at postoperative 3rd months. Overall stone-free rate after laparoscopic pyelolithotomy was 93.3%. Mean operative time was 222.6765.71 minutes vs. 219.11±75.63 minutes for the pyeloplasty with concomitant pyelolithotomy vs. pyeloplasty, respectively (p=0.88). Conclusions Laparoscopic pyeloplasty with concomitant pyelolithotomy is a safe and effective intervention with associated good cosmetic results and high stone-free rates without significant increase in operative time or complications.
{"title":"Comparison of the outcomes of laparoscopic pyeloplasty with and without concomitant pyelolithotomy","authors":"M. Kadıhasanoğlu, U. Yucetas, E. Karabay, Erkan Sönmezay","doi":"10.1590/S1677-5538.IBJU.2018.0781","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0781","url":null,"abstract":"ABSTRACT Objective We aimed to evaluate the results of laparoscopic pyeloplasty with concomitant pyelolithotomy and compare results with a cohort of patients undergoing laparoscopic pyeloplasty without pyelolithotomy. Materials and Methods We retrospectively reviewed records of 43 patients undergoing transperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty between December 2012 and July 2018 at our department. Eighteen patients (42%) underwent laparoscopic pyeloplasty with concomitant pyelolithotomy. The results of patients with renal stones were compared with 25 matched patients undergoing laparoscopic pyeloplasty without concomitant renal stones. Demographic data, operative and stone parameters were compared between the groups. Results The groups were similar regarding to demographic characteristics. All operations were completed laparoscopically with no conversions to open surgery. In 3 cases without renal stones and 15 cases with renal stones, transposition of the ureter due to crossing vessels was performed. The mean stone size was 13±5.24 mm, and the median number of stones was 1 (1-18). The success of laparoscopic pyeloplasty with and without pyelolithotomy was 93.3% and 92.9%, respectively, as confirmed by negative diuretic renogram at postoperative 3rd months. Overall stone-free rate after laparoscopic pyelolithotomy was 93.3%. Mean operative time was 222.6765.71 minutes vs. 219.11±75.63 minutes for the pyeloplasty with concomitant pyelolithotomy vs. pyeloplasty, respectively (p=0.88). Conclusions Laparoscopic pyeloplasty with concomitant pyelolithotomy is a safe and effective intervention with associated good cosmetic results and high stone-free rates without significant increase in operative time or complications.","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":"2019-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72993312","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 : 2019-01-29DOI: 10.1590/S1677-5538.IBJU.2019.0016
Alev Onder, D. Yilmaz-Oral, I. Jerković, A. O. Akdemir, S. Gur
ABSTRACT Cinnamomum cassia (Cinnamon) is a well-known traditional medicine with therapeutic benefits for centuries. We evaluated the effects of cinnamon essential oil (CEO) and its main component cinnamaldehyde (CA) on human corpus cavernosum (HCC) and rat CC. The essential oil of cinnamon was analyzed for the confirmation of the oil profile. HCC specimens from patients undergoing penile prosthesis surgery (age 48-69 years) were utilized for functional studies. In addition, erectile responses in anesthetized control and diabetic rats were evaluated in vivo after intracavernosal injection of CEO and CA, and rat CC strips were placed in organ baths. After precontraction with phenylephrine (10µM), relaxant responses to CEO and CA were investigated. CA (96.9%) was found as the major component. The maximum relaxation responses to CEO and CA were 96.4±3.5% and 96.0±5.0% in HCC and 97.5±5.5% and 96.8±4.8% in rat CC, respectively. There was no difference between control and diabetic rats in relaxation responses to CEO and CA. The relaxant responses obtained with essential oil and CA were not attenuated in the presence of nitric oxide synthase (NOS) inhibitor, and soluble guanylate cyclase inhibitor (sGS) in CC. In vivo, erectile responses in diabetic rats were lower than in control rats, which was restored after intracavernosal injection of CEO and CA. CEO and CA improved erectile function and relaxation of isolated strips of rat CC and HCC by a NO/cGMP-independent mechanism. Further investigations are warranted to fully elucidate the restorative effects of CEO and CA on diabetic erectile dysfunction.
{"title":"Evaluation of relaxant responses properties of cinnamon essential oil and its major component, cinnamaldehyde on human and rat corpus cavernosum","authors":"Alev Onder, D. Yilmaz-Oral, I. Jerković, A. O. Akdemir, S. Gur","doi":"10.1590/S1677-5538.IBJU.2019.0016","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0016","url":null,"abstract":"ABSTRACT Cinnamomum cassia (Cinnamon) is a well-known traditional medicine with therapeutic benefits for centuries. We evaluated the effects of cinnamon essential oil (CEO) and its main component cinnamaldehyde (CA) on human corpus cavernosum (HCC) and rat CC. The essential oil of cinnamon was analyzed for the confirmation of the oil profile. HCC specimens from patients undergoing penile prosthesis surgery (age 48-69 years) were utilized for functional studies. In addition, erectile responses in anesthetized control and diabetic rats were evaluated in vivo after intracavernosal injection of CEO and CA, and rat CC strips were placed in organ baths. After precontraction with phenylephrine (10µM), relaxant responses to CEO and CA were investigated. CA (96.9%) was found as the major component. The maximum relaxation responses to CEO and CA were 96.4±3.5% and 96.0±5.0% in HCC and 97.5±5.5% and 96.8±4.8% in rat CC, respectively. There was no difference between control and diabetic rats in relaxation responses to CEO and CA. The relaxant responses obtained with essential oil and CA were not attenuated in the presence of nitric oxide synthase (NOS) inhibitor, and soluble guanylate cyclase inhibitor (sGS) in CC. In vivo, erectile responses in diabetic rats were lower than in control rats, which was restored after intracavernosal injection of CEO and CA. CEO and CA improved erectile function and relaxation of isolated strips of rat CC and HCC by a NO/cGMP-independent mechanism. Further investigations are warranted to fully elucidate the restorative effects of CEO and CA on diabetic erectile dysfunction.","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":"2019-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74268975","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 : 2019-01-29DOI: 10.1590/S1677-5538.IBJU.2019.05.04
R. Silva, J. Leow, Z. Abidin, E. Linden‐Castro, Edgar Ivan Bravo Castro, L. T. Blanco, J. Teoh, P. Contreras, M. Wroclawski
1 Division of Urology, Department of Surgery, University of Colorado School of Medicine, Denver, CO, USA; 2 Department of Surgery, Division of Urology, Denver Health Medical Center, Denver, CO, USA; 3 Department of Urology, Tan Tock Seng Hospital, LKC School of Medicine, Nanyang Technological University, Singapore; 4 Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; 5 Department of Surgery, Universiti Teknologi MARA, Malaysia; 6 Centro Médico Puerta de Hierro, Zapopan Jalisco, Mexico; 7 Servicio de Urologia, Hospital Central Militar, Mexico; 8 Servicio de Urologia, Hospital Imed Levante, Alicante, Spain; 9 S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong; 10 Servicio de Urologia del Hospital Alemán. Buenos Aires, Argentina; 11 Hospital Israelita Albert Einstein. São Paulo, SP, Brasil; 12 Hospital Beneficência Brasileira de São Paulo, São Paulo, SP, Brasil ________________________________________________________________________________________
1科罗拉多大学医学院泌尿外科外科，美国科罗拉多州丹佛;2丹佛市卫生医疗中心泌尿外科，美国丹佛市;3新加坡南洋理工大学LKC医学院陈笃生医院泌尿外科;4哈佛医学院布里格姆妇女医院泌尿外科及外科与公共卫生中心，美国马萨诸塞州波士顿;5马来西亚玛拉理工大学外科学系;6墨西哥哈利斯科州萨波潘市耶罗门中心;7墨西哥中央军事医院泌尿科;8西班牙阿利坎特莱万特医院泌尿科;9香港中文大学外科何善衡泌尿外科中心，香港;10医院泌尿科服务Alemán。阿根廷布宜诺斯艾利斯;11以色列医院阿尔伯特·爱因斯坦。巴西圣保罗;12个医院Beneficencia Brasileira de Sao Paulo, SP,巴西圣保罗 ________________________________________________________________________________________
{"title":"Social Media in the Urology Practice | Opinion: NO","authors":"R. Silva, J. Leow, Z. Abidin, E. Linden‐Castro, Edgar Ivan Bravo Castro, L. T. Blanco, J. Teoh, P. Contreras, M. Wroclawski","doi":"10.1590/S1677-5538.IBJU.2019.05.04","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.05.04","url":null,"abstract":"1 Division of Urology, Department of Surgery, University of Colorado School of Medicine, Denver, CO, USA; 2 Department of Surgery, Division of Urology, Denver Health Medical Center, Denver, CO, USA; 3 Department of Urology, Tan Tock Seng Hospital, LKC School of Medicine, Nanyang Technological University, Singapore; 4 Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; 5 Department of Surgery, Universiti Teknologi MARA, Malaysia; 6 Centro Médico Puerta de Hierro, Zapopan Jalisco, Mexico; 7 Servicio de Urologia, Hospital Central Militar, Mexico; 8 Servicio de Urologia, Hospital Imed Levante, Alicante, Spain; 9 S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong; 10 Servicio de Urologia del Hospital Alemán. Buenos Aires, Argentina; 11 Hospital Israelita Albert Einstein. São Paulo, SP, Brasil; 12 Hospital Beneficência Brasileira de São Paulo, São Paulo, SP, Brasil ________________________________________________________________________________________","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":"2019-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81388424","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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