International Braz J Urol最新文献

Purpose: Pheochromocytomas (Pheo) and paragangliomas (PGL) are catecholamine-secreting tumours, whose functionality is confirmed by elevated plasma (Pl) and/or 24-h urinary (Ur) metanephrines (MN). Relevance of prior background features were reviewed in a large cohort of patients with Pheo and PGL.

Material and methods: We reviewed clinical, hormonal, and imaging aspects of 116 patients studied prospectively: 93 Pheo; 22 PGL; one Pheo plus PGL.

Results: Twenty-five % PPGL were discovered incidentally. Systemic arterial hypertension (SAH) was present in 81% (43% on stage 3), whereas 9.5% were prehypertensive and 9.5%, normotensive. SAH plus paroxysms occurred in 31 (32.9%) patients, being exclusively sustained in the remaining; 26 (28%) had resistant SAH. Orthostatic hypotension was seen in 65% of patients. Pl/Ur MN and normetanephrine (NMN) were compared to those of a positive (56 functioning PPGL) and a negative control group (654 subjects with normal MN/NMN). Total and fractionated Ur MN were elevated in 94% PPGL patients. Cut-off values of 885 mcg/24-h for Ur MN, and of 1.5 nmol/L for Pl MN identified functioning lesions with 100%/100% sensitivity and 93%/97% specificity, respectively. MRI detected 56% right-side Pheo, 25% on the left, and 19% bilateral; PGL were 56.5% (13/23) retroperitoneal and 43.5%, cervical (10/23). Right-side Pheo were larger (5.8 cm) than left-side ones (3.7 cm), but retroperitoneal (6.5 cm) and neck PGL (6.9 cm) were similar. Tumour size positively correlated with total Ur MN.

Conclusions: in this large cohort of PPGL patients we highlighted relevant aspects of SAH, the frequently overlooked manifestation of orthostatic hypotension, common incidental presentation, significant tumour size/hormonal production.

Objectives: In this review we will provide recommendations for surgical site infection (SSI) prophylaxis in urological diagnostic and surgical procedures.

Material and methods: We performed a narrative review of the literature in PubMed (Medline), EMBASE, LILACS, Web of Science, and Cochrane Collaboration databases using the terms "infection," "surgery," "urology," and "antibiotic prophylaxis" Results: We suggest recommendations of prophylactic antibiotic in the follow procedures: prostate biopsy, Urethrocystoscopy, Extracorporeal Shock Wave Lithotripsy (ESWL) for Urinary Stones, endoscopic ureterolithotripsy, percutaneous nephrolitothomy, Transurethral Resection of the Prostate (TURP) and Prostatic Enucleation, Transurethral Resection of Bladder Tumor (TURBT), Intravesical Botulinum Toxin Injection, surgical correction of female stress incontinence, Surgical Correction of Pelvic Organ Prolapse, urological prosthesis implantation and Open, Laparoscopic, and Robotic Urologic Surgery Conclusions: Consideration in SSI prophylaxis and the prophylactic antibiotic regimens in several urological procedures are show in this paper and will be useful to urologic practice.

Renal cell carcinoma (RCC) ranks among the most prevalent malignancies worldwide, with a rising incidence attributed largely to the incidental detection of small renal masses (SRMs ≤ 4 cm) through widespread abdominal imaging. Historically managed with radical nephrectomy, treatment of SRMs has evolved significantly over recent decades. Partial nephrectomy has become the standard surgical approach, while active surveillance (AS) has emerged as a viable alternative for select patients, particularly those with comorbidities or limited life expectancy. AS involves serial imaging to monitor tumor progression, reserving intervention for signs of clinical advancement. This review synthesizes oncological outcomes and current management strategies for SRMs, comparing AS with immediate intervention. A comprehensive literature search (2005-2024) was performed across PubMed, Web of Science, and Scopus, complemented by an analysis of major international guidelines (EAU, AUA, ESMO, CUA, and Latin American Renal Cancer Group). All guidelines support AS for selected patients with cT1a tumors, though criteria vary. The AUA limits AS to tumors <2 cm, while only its guidelines define clear triggers for transitioning from AS to treatment. Imaging surveillance intervals and biopsy indications also differ, with broader support for renal mass biopsy prior to ablation but more selective use during AS. This review underscores the importance of individualized decision-making in SRM management and highlights areas of consensus and divergence among contemporary guidelines.

Purpose: Approximately one-third of the children with primary monosymptomatic enuresis (PMNE) do not respond to first-line treatment. We aimed to investigate the short-term and six-month effectiveness of combining desmopressin acetate with parasacral transcutaneous electrical nerve stimulation (PTENS) in these children and adolescents.

Materials and methods: Participants aged six-17 years with PMNE were randomly assigned to receive desmopressin acetate with active or sham PTENS. Both groups participated in weekly 30-minute electrotherapy sessions for 15 weeks. The intervention group (IG) received electrotherapy at a frequency of 10 Hz and pulse width of 700 µs. A dry and wet nights calendar assessed the frequency of wet nights in the short term and six months after the intervention ended.

Results: Of 66 participants, 34 were randomized to the IG. The median age was 10.3 years (8.8 - 12), and 53% were male. Intention-to-treat analysis showed a significant reduction in the frequency of wet nights after the interventions (p < 0.001) in both groups, with the IG demonstrating significant improvement, immediately after the interventions (p=0.005) and after six months (p< 0.001) compared to the placebo group (PG). The Kaplan-Meier survival analysis showed improvement in the IG that became more pronounced from the 15th week onwards (log-rank test, p < 0.01).  Conclusions: A 15-week treatment with desmopressin acetate and PTENS significantly reduced wet nights in children and adolescents with PMNE, and this improvement was maintained six months after the interventions.

Purpose: There is a bidirectional relationship between chronic kidney disease and the incidence of renal cell carcinoma. Despite the frequency of patients with both chronic kidney disease and renal cell carcinoma, there are limited systematic reviews detailing the nuanced treatment. This review provides comprehensive insights for clinicians for managing chronic kidney disease, and renal cell carcinoma. Methods and Methods: We reviewed published literature that examined either chronic kidney disease and renal cell carcinoma or an indirect contributor of both.

Results: We compare and contrast renal cell carcinoma treatment with partial and radical nephrectomies, ablative techniques, and radiation and their impact on glomerular filtration rate, recurrence rate, and contraindications. We discuss when and how to intervene with treatment with emphasis on the delicate balance between eradicating malignancy and preserving renal function. Specifically, we detail the appropriate use of renal biopsies in incidentally discovered tumors, active surveillance, and postoperative surveillance including imaging sensitivity and specificity. We offer insight into the limitations of current systemic therapy, including renal toxicity.

Conclusions: Our investigation into the intricate relationship between chronic kidney disease and renal cell carcinoma has many multifaceted challenges for both patients and healthcare providers face. This comprehensive review serves as an extensive synopsis of the current literature and offers patients the best possible long-term renal-based outcomes.

Purpose: To describe the experience of five training centers with redo laparoscopic pyeloplasty (RLP) in children with restenosis of the uteropelvic junction (UPJ), assessing whether this approach increased or not postoperative complications or surgery failure.

Materials and methods: A retrospective, descriptive study was conducted, including 19 patients who underwent transperitoneal RLP at five independent training centers across 4 different countries between January 2009 and December 2017. All patients had previously undergone Anderson-Hynes dismembered pyeloplasty. Primary outcomes included postoperative complication rates and redo surgery failure.

Results: There were 19 RLP out of 744 primary laparoscopic pyeloplasties. Median operative time was 150 minutes (interquartile range [IQR] 126.2-180), extended by 19 minutes when colon mobilization was performed. No cases required conversion to open surgery. A median postoperative analgesic requirement and length of stay of 5 and 4 days, respectively, were recorded. No major complications were reported except a single instance of temporary UPJ stenosis, which was managed with a nephrostomy tube and did not require further surgery. After a median follow-up of 17 months, we achieved a 100% success rate. A significant reduction in renal pelvis dilation was noted, with the median anteroposterior diameter (APD) decreasing from 43 mm preoperatively to 17 mm postoperatively (IQR 10-22).

Conclusions: Our findings suggest that RLP remains a feasible approach in the management of restenosis of the UPJ even in such different healthcare settings, providing success rates as high as those described in primary pyeloplasty while maintaining a safety profile.

Purpose: The purpose of this study is to examine whether retrovesical fibromuscular structures-specifically the trapezoid interpubic ligament (TIPL)-mechanically restrict the inversion of small, non-growing bladder plates (SNGBP) in bladder exstrophy, and to evaluate bladder growth after one-stage closure with TIPL dissection, including the effect of anticholinergic therapy.

Materials and methods: Between 2004 and 2023, 15 patients with SNGBP underwent one-stage bladder closure using a modified surgical approach with TIPL dissection. The TIPL, identified as a fibromuscular structure impeding bladder plate (BP) inversion, was targeted. Postoperative bladder capacity was evaluated based on age at surgery and the use of anticholinergic therapy.

Results: The TIPL was identified as the primary mechanical impediment to BP inversion. Its dissection restored tissue compliance, facilitating successful one-stage closure in all patients. In children under three years of age at the time of surgery, the mean annual bladder capacity increased by 17.76 mL. Anticholinergic therapy further enhanced bladder growth.

Conclusion: TIPL dissection enables one-stage closure in SNGBP patients who were previously considered unsuitable for this method. Early intervention supports bladder development and favorable functional outcomes. These findings provide novel anatomical insights, warranting further morphological and embryological research to validate the universality of this structure and technique.