Pub Date : 2019-01-29DOI: 10.1590/S1677-5538.IBJU.2019.0092.1
R. Vieiralves
We know that microsurgery training is still far from becoming a reality during the process of training residents in Brazil. In fact, there is a gap around the world and therefore, just the fact that we have an article dealing with this topic is already of great relevance. In this very interesting article conducted at Para State University, Brazil (1), a portable training model for vasectomy reversal was adopted. We know that with the current juncture of society and the number of vasectomies performed worldwide, there is an increasing demand for vasectomy reversal mainly associated with a new post-vasectomy relationship. The paper in question becomes even more relevant because of it ́s bimodal certification for microsurgical training based on a time performance and on a check list not only measuring the execution time of vasovasostomy but also with a checklist questionnaire assessing the most diverse specific items of an perfect anastomosis (eg, if the resident is placed in a comfortable position, equidistance between knots, number of knots, continuous needle vision, etc). We understand that this bimodal evaluation increases the accuracy in the training, since the time does not necessarily correlate with the quality of the anastomosis. However, some relevant aspects need to be highlighted. Vasectomy reversal surgery involves a complex number of factors for its true success. The preparation of the surgical field itself, the section of adhesions and previous fibrosis, the calibration and approximation of the deferens ends without tension, the stabilization of the anastomosis, the patency test, the observation of the four deferent layers in the intraoperative period -mucosa, two layers of muscle and the adventitia(failure to observe two muscle layers may indicate residual vasectomy scarring). Blood supply evaluation by thin mucosal bleeding is also important (2). None of these fundamental points for surgical success is reproduced through the present model. Moreover, we know that the technique used in the model, proposed by Benlloch (3) with only 4 sutures in a single layer is not a reference in the literature. Today, we found no statistical difference in patency or pregnancy results for twoand one-layer vasovasostomy but a minimum number of 6 sutures presumably offers a high quality anastomosis by preventing sperm leakage and the associated risk of granuloma (4, 5). Some considerations regarding the materials used should be made. A technical point is the fact that using an 8-0 suture could facilitate training without simulating real anastomosis situations. We understand that further in vivo studies with thicker sutures in a single anastomotic layer are needed to validate this model (6, 7). Also, as much as the 3D printed model addresses important aspects such as the presence of two layers allowing the training of two types of anastomoses, single layer or double layer, the consistency of the material hardly simulates the vas deferens real physical pro
{"title":"Editorial Comment: Portable model for vasectomy reversal training","authors":"R. Vieiralves","doi":"10.1590/S1677-5538.IBJU.2019.0092.1","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0092.1","url":null,"abstract":"We know that microsurgery training is still far from becoming a reality during the process of training residents in Brazil. In fact, there is a gap around the world and therefore, just the fact that we have an article dealing with this topic is already of great relevance. In this very interesting article conducted at Para State University, Brazil (1), a portable training model for vasectomy reversal was adopted. We know that with the current juncture of society and the number of vasectomies performed worldwide, there is an increasing demand for vasectomy reversal mainly associated with a new post-vasectomy relationship. The paper in question becomes even more relevant because of it ́s bimodal certification for microsurgical training based on a time performance and on a check list not only measuring the execution time of vasovasostomy but also with a checklist questionnaire assessing the most diverse specific items of an perfect anastomosis (eg, if the resident is placed in a comfortable position, equidistance between knots, number of knots, continuous needle vision, etc). We understand that this bimodal evaluation increases the accuracy in the training, since the time does not necessarily correlate with the quality of the anastomosis. However, some relevant aspects need to be highlighted. Vasectomy reversal surgery involves a complex number of factors for its true success. The preparation of the surgical field itself, the section of adhesions and previous fibrosis, the calibration and approximation of the deferens ends without tension, the stabilization of the anastomosis, the patency test, the observation of the four deferent layers in the intraoperative period -mucosa, two layers of muscle and the adventitia(failure to observe two muscle layers may indicate residual vasectomy scarring). Blood supply evaluation by thin mucosal bleeding is also important (2). None of these fundamental points for surgical success is reproduced through the present model. Moreover, we know that the technique used in the model, proposed by Benlloch (3) with only 4 sutures in a single layer is not a reference in the literature. Today, we found no statistical difference in patency or pregnancy results for twoand one-layer vasovasostomy but a minimum number of 6 sutures presumably offers a high quality anastomosis by preventing sperm leakage and the associated risk of granuloma (4, 5). Some considerations regarding the materials used should be made. A technical point is the fact that using an 8-0 suture could facilitate training without simulating real anastomosis situations. We understand that further in vivo studies with thicker sutures in a single anastomotic layer are needed to validate this model (6, 7). Also, as much as the 3D printed model addresses important aspects such as the presence of two layers allowing the training of two types of anastomoses, single layer or double layer, the consistency of the material hardly simulates the vas deferens real physical pro","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"26 1","pages":"1020 - 1021"},"PeriodicalIF":0.0,"publicationDate":"2019-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78245043","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 : 2019-01-09DOI: 10.1590/S1677-5538.IBJU.2019.0080
J. M. Netto, A. Rondon, G. D. de Lima, Miguel Zerati, E. D. Schneider-Monteiro, C. A. Molina, A. Calado, U. Barroso
ABSTRACT Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.
{"title":"Brazilian consensus in enuresis–recomendations for clinical practice","authors":"J. M. Netto, A. Rondon, G. D. de Lima, Miguel Zerati, E. D. Schneider-Monteiro, C. A. Molina, A. Calado, U. Barroso","doi":"10.1590/S1677-5538.IBJU.2019.0080","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0080","url":null,"abstract":"ABSTRACT Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"72 1","pages":"889 - 900"},"PeriodicalIF":0.0,"publicationDate":"2019-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86141854","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 : 2019-01-08DOI: 10.1590/S1677-5538.IBJU.2018.0193.1
M. R. D. Silva, A. L. Barboza, M. Pijoán, P. Beraldo
We thank you for your comments on our latest publication (1). Indeed, what has motivated us the most to carry out this investigation was the lack of evidence concerning the usage of antimicrobials prior to urodynamic studies in spinal cord injured patients (2). An unexpected result for us was the greater incidence of urinary tract infection upon patients with injuries at T6 or above, regardlessly of the use of antimicrobials prior to the procedure. At this exact moment we are working on a new publication that details the incidence of urinary tract infection specifi cally amongst the 379 spinal cord injured patients with injuries at T6 or above, now considering the presence of autonomic dysrefl exia and urodynamic parameters. The results are becoming clinically relevant.
{"title":"REPLY BY THE AUTHORS: Re: Antibiotic prophylaxis prior to urodynamic study in patients with traumatic spinal cord injury. Is there an indication?","authors":"M. R. D. Silva, A. L. Barboza, M. Pijoán, P. Beraldo","doi":"10.1590/S1677-5538.IBJU.2018.0193.1","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0193.1","url":null,"abstract":"We thank you for your comments on our latest publication (1). Indeed, what has motivated us the most to carry out this investigation was the lack of evidence concerning the usage of antimicrobials prior to urodynamic studies in spinal cord injured patients (2). An unexpected result for us was the greater incidence of urinary tract infection upon patients with injuries at T6 or above, regardlessly of the use of antimicrobials prior to the procedure. At this exact moment we are working on a new publication that details the incidence of urinary tract infection specifi cally amongst the 379 spinal cord injured patients with injuries at T6 or above, now considering the presence of autonomic dysrefl exia and urodynamic parameters. The results are becoming clinically relevant.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"52 5 1","pages":"862 - 862"},"PeriodicalIF":0.0,"publicationDate":"2019-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83346700","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 : 2018-02-01DOI: 10.1590/S1677-5538.IBJU.2018.0001
S. Glina
Traditionally, every year, the International Brazilian Journal of Urology evaluates its reviewers and selects the most efficient along the previous year, Evaluation is based on the number of performed reviews, time for conclusion and quality of work (1). In 2017, the five most efficient reviewers were: Fabio Vicentini (Hospital das Clínicas da Faculdade de Medicina da USP, SP, Brasil), Eduardo Kaiser Ururahy Nunes Fonseca (Hospital Israelita Albert Einstein SP, Brasil), Victor Srougi (Faculdade de Medicina de São Paulo, SP, Brasil), Elcio Silva (Clínica Dr. Élcio Dias Silva, Campinas, SP, Brasil) and Kemal Sarica (Kartal Dr. Lufi Kirdar Training and Research Hospital Istanbul, Turkey). We would like to thank them and all others reviewers, that are the reason for the existence of a peer-review scientific journal. Int Braz J Urol is an open-access magazine, integrally supported by the Brazilian Urological Society, that does not charge for the submission of papers. Also, it is included in the Urology Green List (2), that reunites all reliable and safe urological journals on which the urological community can publish their researches. In 2017, our Journal received 603 papers, and 28% were accepted. Medium time for first decision correspondence was 44 days, and more 42 days for publishing as Ahead of Print. Papers were sent from 42 countries, from 635 different institutions and 2254 authors; we used 1135 reviewers. The 5-year impact factor of IBJU in 2017 was 1.097.
{"title":"Int Braz J Urol Annual Report - 2017","authors":"S. Glina","doi":"10.1590/S1677-5538.IBJU.2018.0001","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0001","url":null,"abstract":"Traditionally, every year, the International Brazilian Journal of Urology evaluates its reviewers and selects the most efficient along the previous year, Evaluation is based on the number of performed reviews, time for conclusion and quality of work (1). In 2017, the five most efficient reviewers were: Fabio Vicentini (Hospital das Clínicas da Faculdade de Medicina da USP, SP, Brasil), Eduardo Kaiser Ururahy Nunes Fonseca (Hospital Israelita Albert Einstein SP, Brasil), Victor Srougi (Faculdade de Medicina de São Paulo, SP, Brasil), Elcio Silva (Clínica Dr. Élcio Dias Silva, Campinas, SP, Brasil) and Kemal Sarica (Kartal Dr. Lufi Kirdar Training and Research Hospital Istanbul, Turkey). We would like to thank them and all others reviewers, that are the reason for the existence of a peer-review scientific journal. Int Braz J Urol is an open-access magazine, integrally supported by the Brazilian Urological Society, that does not charge for the submission of papers. Also, it is included in the Urology Green List (2), that reunites all reliable and safe urological journals on which the urological community can publish their researches. In 2017, our Journal received 603 papers, and 28% were accepted. Medium time for first decision correspondence was 44 days, and more 42 days for publishing as Ahead of Print. Papers were sent from 42 countries, from 635 different institutions and 2254 authors; we used 1135 reviewers. The 5-year impact factor of IBJU in 2017 was 1.097.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"58 1","pages":"1 - 1"},"PeriodicalIF":0.0,"publicationDate":"2018-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85411655","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 : 2017-11-01DOI: 10.1590/S1677-5538.IBJU.2016.0259
G. Motta, P. Tavares, G. V. D. da Silva, Milton Berger, B. Silva, T. Rosito
ABSTRACT Introduction: The ideal vaginoplasty method should promote good cosmetic and functional results with low morbidity. We describe a new technique for congenital vaginal agenesis using a full-thickness perforated skin graft. Materials and Methods: We report an 18 year old patient with vaginal agenesis (Morris syndrome) that undergone a modified version of McIndoe vaginoplasty. Patient is set in a low lithotomy position and lateral traction sutures are placed in labia and a 16Fr urethral catheter inserted. An inverted “V”-shaped incision is made in the mucosal plaque below the urethra. Blunt dissection in a cephalic posterior direction forms a space between the rectum and urethra. Special care is taken to avoid rectal tear during this maneuver. A full-thickness skin graft is removed from the lower abdomen measuring 12.0×6.0cm as an aesthetic abdominoplasty. The fat tissue is removed, remaining epidermis and dermis and the graft is perforated, allowing a great surface increase. After suturing over a mold, the graft is fixed in the created space. The donor site is closed with intradermal transversal suture. Results: From January 2009 to August 2015, seven patients diagnosed with vaginal agenesis underwent this technique. There were no major complications or need for blood transfusions. At the six-month follow-up, all patients reported satisfactory sexual intercourse. There were no significant complications at donor site or neovagina that needed surgical intervention. Conclusion: Vaginal reconstruction using the perforated graft is viable with excellent functional results. Applying this modification, we yielded the good results of a classic McIndoe technique with lower donor site morbidity.
{"title":"Full-thickness skin mesh graft vaginoplasty: a skin sparing technique","authors":"G. Motta, P. Tavares, G. V. D. da Silva, Milton Berger, B. Silva, T. Rosito","doi":"10.1590/S1677-5538.IBJU.2016.0259","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2016.0259","url":null,"abstract":"ABSTRACT Introduction: The ideal vaginoplasty method should promote good cosmetic and functional results with low morbidity. We describe a new technique for congenital vaginal agenesis using a full-thickness perforated skin graft. Materials and Methods: We report an 18 year old patient with vaginal agenesis (Morris syndrome) that undergone a modified version of McIndoe vaginoplasty. Patient is set in a low lithotomy position and lateral traction sutures are placed in labia and a 16Fr urethral catheter inserted. An inverted “V”-shaped incision is made in the mucosal plaque below the urethra. Blunt dissection in a cephalic posterior direction forms a space between the rectum and urethra. Special care is taken to avoid rectal tear during this maneuver. A full-thickness skin graft is removed from the lower abdomen measuring 12.0×6.0cm as an aesthetic abdominoplasty. The fat tissue is removed, remaining epidermis and dermis and the graft is perforated, allowing a great surface increase. After suturing over a mold, the graft is fixed in the created space. The donor site is closed with intradermal transversal suture. Results: From January 2009 to August 2015, seven patients diagnosed with vaginal agenesis underwent this technique. There were no major complications or need for blood transfusions. At the six-month follow-up, all patients reported satisfactory sexual intercourse. There were no significant complications at donor site or neovagina that needed surgical intervention. Conclusion: Vaginal reconstruction using the perforated graft is viable with excellent functional results. Applying this modification, we yielded the good results of a classic McIndoe technique with lower donor site morbidity.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"21 1","pages":"1193 - 1193"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83916789","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 : 2017-11-01DOI: 10.1590/S1677-5538.IBJU.2016.0269
R. Lopes, A. Giron, M. Mello, C. Barbosa, J. Dos Santos, P. Moscardi, V. Srougi, F. Dénes, M. Srougi
ABSTRACT Introduction: Urethral duplication is rare. Characterized by the presence of two urethral channels. This anomaly presents a great variety of clinical findings that depend on the type of duplication that often is associated with other anomalies. Material and Methods: We report thirteen boys with urethral duplication managed in our institution between 1988-2015. Clinical findings, associated anomalies, treatment of urethral duplication and our results are described. Patients were classified according to Effmann classification. Results: Mean patient's age was 38.3±34.7 months (3-136 months). Mean follow-up was 7.7±3.4 years (3y8m-14y2m). Type II A2 was the most common pattern (8/13 patients, 61.5%), followed by type IA (3/13 patients, 23%) and IIA1 (2/13 patients, 15.3%). The most frequent clinical manifestations were urinary tract infections (UTI) observed in 11/13 patients (84.6%) and anal urinary leakage, found in 7/13 patients (53.8%). Associated anomalies were found in 9/13 patients (69.2%). Required surgeries were 3.53±2.84 procedures per patient. Considering groups: Type IIA2 4.25±3.28, type IIA1 4±1.41 and type IA 1.33±0.57 needed procedures per patient. Complications rate were 0% for type IA, 50% for type IIA1 and 75% for type IIA2. Conclusions: Patients with incomplete duplication (type I A or I B) can totally be asymptomatic, with no need of surgical correction. Type IIA2 is the most complex form of duplication to correct and multiple procedures might be required because of the very hypoplastic orthotopic dorsal urethral tissue. Surgical treatment should be individualized and parents should be advised on complications and need of multiple surgeries according to urethral duplication type.
{"title":"Urethral duplication type influences on the complications rate and number of surgical procedures","authors":"R. Lopes, A. Giron, M. Mello, C. Barbosa, J. Dos Santos, P. Moscardi, V. Srougi, F. Dénes, M. Srougi","doi":"10.1590/S1677-5538.IBJU.2016.0269","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2016.0269","url":null,"abstract":"ABSTRACT Introduction: Urethral duplication is rare. Characterized by the presence of two urethral channels. This anomaly presents a great variety of clinical findings that depend on the type of duplication that often is associated with other anomalies. Material and Methods: We report thirteen boys with urethral duplication managed in our institution between 1988-2015. Clinical findings, associated anomalies, treatment of urethral duplication and our results are described. Patients were classified according to Effmann classification. Results: Mean patient's age was 38.3±34.7 months (3-136 months). Mean follow-up was 7.7±3.4 years (3y8m-14y2m). Type II A2 was the most common pattern (8/13 patients, 61.5%), followed by type IA (3/13 patients, 23%) and IIA1 (2/13 patients, 15.3%). The most frequent clinical manifestations were urinary tract infections (UTI) observed in 11/13 patients (84.6%) and anal urinary leakage, found in 7/13 patients (53.8%). Associated anomalies were found in 9/13 patients (69.2%). Required surgeries were 3.53±2.84 procedures per patient. Considering groups: Type IIA2 4.25±3.28, type IIA1 4±1.41 and type IA 1.33±0.57 needed procedures per patient. Complications rate were 0% for type IA, 50% for type IIA1 and 75% for type IIA2. Conclusions: Patients with incomplete duplication (type I A or I B) can totally be asymptomatic, with no need of surgical correction. Type IIA2 is the most complex form of duplication to correct and multiple procedures might be required because of the very hypoplastic orthotopic dorsal urethral tissue. Surgical treatment should be individualized and parents should be advised on complications and need of multiple surgeries according to urethral duplication type.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"2019 1","pages":"1144 - 1151"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87828565","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 : 2017-11-01DOI: 10.1590/S1677-5538.IBJU.2016.0005
L. Dell’Atti
ABSTRACT Purpose: We evaluated the correlation between prostate calculi and hematospermia in patients undergoing prostate biopsy, and its impact on sexual activity of patients. Materials and Methods: A single-center prospective randomized study of 212 patients referred for transrectal ultrasound-guided prostate biopsy (TRUSBx) was performed. All patients were divided into two groups: Group A (GA), 106 patients with moderate/marked presence of prostatic calculi visualized by TRUS; Group B (GB), 106 patients with absence/scarce of prostatic calcifications. Patients were handed questionnaires to obtain a validated data on the duration and impact of hematospermia on sexual activity. The anxiety scores were recorded using a visual analogue scale. Results: No significant difference was noted between the two groups when comparing age, preoperative PSA level, prostate volume, and biopsy number, except for digital rectal examination (DRE) findings. Post-biopsy results of patients included in GA revealed that the complication of hematospermia was present in 65.1%, while in GB was present in 39.7% (p<0.001). On multivariate analysis for identifying significant preoperative predictors of hematospermia, which included variables of age, PSA, prostate volume, and prostate cancer were not shown to be significant predictors of hematospermia, except DRE and prostate calculi (p<0.001). The mean anxiety score was 3.7±2.8 in GA and 2.3±1.9 in GB, respectively (p<0.001). Conclusions: Prostatic calculi are an independent predictive factor of severe hematospermia after TRUSBx on the basis of multivariate analysis, but don't affect the positive rate of prostate cancer. Patients should be adequately counselled before TRUSBx to avoid undue anxiety and alterations in sexual activity.
{"title":"Ultrasound detection of prostatic calculi as a parameter to predict the appearance of hematospermia after a prostate biopsy","authors":"L. Dell’Atti","doi":"10.1590/S1677-5538.IBJU.2016.0005","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2016.0005","url":null,"abstract":"ABSTRACT Purpose: We evaluated the correlation between prostate calculi and hematospermia in patients undergoing prostate biopsy, and its impact on sexual activity of patients. Materials and Methods: A single-center prospective randomized study of 212 patients referred for transrectal ultrasound-guided prostate biopsy (TRUSBx) was performed. All patients were divided into two groups: Group A (GA), 106 patients with moderate/marked presence of prostatic calculi visualized by TRUS; Group B (GB), 106 patients with absence/scarce of prostatic calcifications. Patients were handed questionnaires to obtain a validated data on the duration and impact of hematospermia on sexual activity. The anxiety scores were recorded using a visual analogue scale. Results: No significant difference was noted between the two groups when comparing age, preoperative PSA level, prostate volume, and biopsy number, except for digital rectal examination (DRE) findings. Post-biopsy results of patients included in GA revealed that the complication of hematospermia was present in 65.1%, while in GB was present in 39.7% (p<0.001). On multivariate analysis for identifying significant preoperative predictors of hematospermia, which included variables of age, PSA, prostate volume, and prostate cancer were not shown to be significant predictors of hematospermia, except DRE and prostate calculi (p<0.001). The mean anxiety score was 3.7±2.8 in GA and 2.3±1.9 in GB, respectively (p<0.001). Conclusions: Prostatic calculi are an independent predictive factor of severe hematospermia after TRUSBx on the basis of multivariate analysis, but don't affect the positive rate of prostate cancer. Patients should be adequately counselled before TRUSBx to avoid undue anxiety and alterations in sexual activity.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"119 1","pages":"1136 - 1143"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82576277","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 : 2017-09-01DOI: 10.1590/S1677-5538.IBJU.2016.0179
Michael Yap, Unwanabong Nseyo, H. Din, M. Alagiri
ABSTRACT Introduction and Objective: Multiple options exist for the surgical management of vesicoureteral reflux (VUR). We report on our 10-year experience using the inguinal approach to extravesical ureteral reimplantation (EVR). Materials and Methods: Patient characteristics of age, gender, and reflux grade were obtained and outcomes of operative time, hospital stay, and radiographic resolution were assessed. Results: 71 girls and 20 boys with a mean age of 74 months (range 14-164) underwent inguinal EVR via a 3.5-cm inguinal mini-incision. Mean follow up was 10.9 months (range 0.4-69.7). Average grade of reflux was 2.80. Average operative time was 91 minutes (range 51-268). The procedure was successful in 87 of 91 patients (95.6%). The 3 cases of reflux that persisted were all grade 1 and managed expectantly. Contralateral reflux developed in 9 cases, all of which resolved after treatment with either Deflux or ureteral reimplant. There were 4 case of urinary retention that resolved after a brief period of CIC or indwelling catheterization. There were no cases of ureteral obstruction. Most patients were discharged on post-operative day 1 (85/91) and no hospitalization extended beyond 3 days. Conclusions: The inguinal approach to extravesical ureteral reimplantation should be considered as a potentially minimally invasive alternative to endoscopic and robotic treatment of VUR with a success rate more comparable to traditional open approaches. We feel it is the method of choice in cases of unilateral VUR requiring surgical correction.
{"title":"Unilateral extravesical ureteral reimplantation via inguinal incision for the correction of vesicoureteral reflux: a 10-year experience","authors":"Michael Yap, Unwanabong Nseyo, H. Din, M. Alagiri","doi":"10.1590/S1677-5538.IBJU.2016.0179","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2016.0179","url":null,"abstract":"ABSTRACT Introduction and Objective: Multiple options exist for the surgical management of vesicoureteral reflux (VUR). We report on our 10-year experience using the inguinal approach to extravesical ureteral reimplantation (EVR). Materials and Methods: Patient characteristics of age, gender, and reflux grade were obtained and outcomes of operative time, hospital stay, and radiographic resolution were assessed. Results: 71 girls and 20 boys with a mean age of 74 months (range 14-164) underwent inguinal EVR via a 3.5-cm inguinal mini-incision. Mean follow up was 10.9 months (range 0.4-69.7). Average grade of reflux was 2.80. Average operative time was 91 minutes (range 51-268). The procedure was successful in 87 of 91 patients (95.6%). The 3 cases of reflux that persisted were all grade 1 and managed expectantly. Contralateral reflux developed in 9 cases, all of which resolved after treatment with either Deflux or ureteral reimplant. There were 4 case of urinary retention that resolved after a brief period of CIC or indwelling catheterization. There were no cases of ureteral obstruction. Most patients were discharged on post-operative day 1 (85/91) and no hospitalization extended beyond 3 days. Conclusions: The inguinal approach to extravesical ureteral reimplantation should be considered as a potentially minimally invasive alternative to endoscopic and robotic treatment of VUR with a success rate more comparable to traditional open approaches. We feel it is the method of choice in cases of unilateral VUR requiring surgical correction.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"57 4 1","pages":"917 - 924"},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83700317","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 : 2017-07-01DOI: 10.1590/S1677-5538.IBJU.2016.0249
Lucas Schreiner, Thaís Guimarães dos Santos, C. Nygaard, D. Oliveira
ABSTRACT Background Vaginal evisceration is a rare problem, usually related to a previous hysterectomy. We report a case of spontaneous rupture of the cul-de-sac in a premenopausal woman under treatment with glucocorticoids to treat Systemic Lupus Erythematosus (SLE), with uterine prolapse that occurred during evacuation. Case Report A 40-year-old woman with SLE, using glucocorticoids, with uterine prolapse grade 4 (POP-Q), awaiting surgery presented at the emergency room with vaginal bleeding after Valsalva during defaction. Uterine prolapse associated with vaginal evisceration was identified. Under vaginal examination, we confirmed the bowel viability and performed a vaginal hysterectomy and sacrospinous fixation. Case hypothesis This case draws attention to the extreme risk of untreated uterine prolapse, as well as the importance of multidisciplinary care of patients with vaginal prolapse and chronic diseases.
{"title":"Vaginal evisceration related to genital prolapse in premenopausal woman","authors":"Lucas Schreiner, Thaís Guimarães dos Santos, C. Nygaard, D. Oliveira","doi":"10.1590/S1677-5538.IBJU.2016.0249","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2016.0249","url":null,"abstract":"ABSTRACT Background Vaginal evisceration is a rare problem, usually related to a previous hysterectomy. We report a case of spontaneous rupture of the cul-de-sac in a premenopausal woman under treatment with glucocorticoids to treat Systemic Lupus Erythematosus (SLE), with uterine prolapse that occurred during evacuation. Case Report A 40-year-old woman with SLE, using glucocorticoids, with uterine prolapse grade 4 (POP-Q), awaiting surgery presented at the emergency room with vaginal bleeding after Valsalva during defaction. Uterine prolapse associated with vaginal evisceration was identified. Under vaginal examination, we confirmed the bowel viability and performed a vaginal hysterectomy and sacrospinous fixation. Case hypothesis This case draws attention to the extreme risk of untreated uterine prolapse, as well as the importance of multidisciplinary care of patients with vaginal prolapse and chronic diseases.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"31 1","pages":"766 - 769"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88458076","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 : 2017-07-01DOI: 10.1590/S1677-5538.IBJU.2016.0303
A. Zachariou, M. Filiponi
ABSTRACT Introduction Overactive bladder (OAB) is a common condition, especially in middle aged women, requiring long term therapy with anticholinergics to maintain symptoms relief. The aim of the study was to determine the effect of tolterodine extended release (ER) used for OAB treatment on the sexual function of women. Materials and Methods Between August 2010 and August 2014, 220 women with confirmed OAB, attended Urogynecology Outpatient Clinic and were prospectively enrolled in this study. 158 women were evaluated, with a comprehensive history, physical examination, urodynamic studies and Female Sexual Function Index (FSFI) questionnaire. 73 patients of group A (control group) received no treatment and 85 patients of group B received an anticholinergic regimen – tolterodine ER 4mg once daily. Data were evaluated again in accordance with FSFI after three months, using SPSS software. Results A statistically significant increase was noted in group B in domains of desire (pre-treatment 2.5±0.2 to 4.5±0.2 post-treatment), arousal (3.1±0.2 to 3.1±0.2 respectively), lubrication (3.4±0.3 to 4.3±0.3 respectively), orgasm (3.5±0.3 to 4.5±0.3 respectively), satisfaction (2.6±0.2 to 4.2±0.3 respectively) and pain (2.4±0.2 to 4.6±0.4 respectively) after three months treatment with tolterodine ER. In group A there were no statistically significant changes in pre and post treatment values (p>0.05). Total FSFI score for group B was significantly higher after tolterodine treatment (26.5±1.5) compared to pre-treatment values (17.4±1.4, p<0.01) and to control group A (17.7±1.2 and 17.9±1.5, p>0,05) respectively. Conclusions This preliminary study demonstrates that treatment of OAB with tolterodine ER was found to have positive effect on sexual function of patients with OAB.
{"title":"The effect of extended release tolterodine used for overactive bladder treatment on female sexual function","authors":"A. Zachariou, M. Filiponi","doi":"10.1590/S1677-5538.IBJU.2016.0303","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2016.0303","url":null,"abstract":"ABSTRACT Introduction Overactive bladder (OAB) is a common condition, especially in middle aged women, requiring long term therapy with anticholinergics to maintain symptoms relief. The aim of the study was to determine the effect of tolterodine extended release (ER) used for OAB treatment on the sexual function of women. Materials and Methods Between August 2010 and August 2014, 220 women with confirmed OAB, attended Urogynecology Outpatient Clinic and were prospectively enrolled in this study. 158 women were evaluated, with a comprehensive history, physical examination, urodynamic studies and Female Sexual Function Index (FSFI) questionnaire. 73 patients of group A (control group) received no treatment and 85 patients of group B received an anticholinergic regimen – tolterodine ER 4mg once daily. Data were evaluated again in accordance with FSFI after three months, using SPSS software. Results A statistically significant increase was noted in group B in domains of desire (pre-treatment 2.5±0.2 to 4.5±0.2 post-treatment), arousal (3.1±0.2 to 3.1±0.2 respectively), lubrication (3.4±0.3 to 4.3±0.3 respectively), orgasm (3.5±0.3 to 4.5±0.3 respectively), satisfaction (2.6±0.2 to 4.2±0.3 respectively) and pain (2.4±0.2 to 4.6±0.4 respectively) after three months treatment with tolterodine ER. In group A there were no statistically significant changes in pre and post treatment values (p>0.05). Total FSFI score for group B was significantly higher after tolterodine treatment (26.5±1.5) compared to pre-treatment values (17.4±1.4, p<0.01) and to control group A (17.7±1.2 and 17.9±1.5, p>0,05) respectively. Conclusions This preliminary study demonstrates that treatment of OAB with tolterodine ER was found to have positive effect on sexual function of patients with OAB.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"52 1","pages":"713 - 720"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83794715","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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