Boosting bladder cancer treatment by intravesical nitazoxanide and bacillus calmette-guérin association.

PURPOSE: Nitazoxanide (NTZ) has shown a promising antitumoral effect, the current study compared the anti-neoplastic effects of intravesical NTZ and BCG plus NTZ in NMIBC animal model. METHODS: 30 rats, Fisher 344 were instilled with 4 intravesical doses of 1.5 mg/kg of N-methyl-N-nitrosourea (MNU) every 15 days for BC induction. The animals were divided into 3 groups (Group BCG 106 UFC - 1 mg of BCG; Group NTZ - 300 mg/kg of NTZ; Group NTZ + BCG - simultaneous treatment of BCG and NTZ) and received weekly intravesical treatment for 6 consecutive weeks. Animals were submitted to ultrasound imaging and euthanasia, their bladders were collected and histopathological, immunohistochemical tests (ki67 e c-Myc) and Western Blotting (PI3K, mTOR, and p-4E-BP) were performed. RESULTS: Histopathological tests showed 66.67%, 62.5% and 37.5% incidence of BC in animals treated with BCG, NTZ, and NTZ + BCG, respectively. Nuclear positivity for ki-67 in BC animals were 12.4% (IC 10.1-14.6%), 13.2% (IC 10.5-15.9%) and 8.8% (IC 6.0-11.6%) in BCG, NTZ and NTZ + BCG group, respectively (p = 0.063). Between animals with carcinoma, c-Myc strong positive was 40.10% in NTZ, 32.2% in BCG and 19.90% in the NTZ + BCG group (p < 0.001). Blotting has shown mTOR (p = 0.0473) and PI3K inhibition (p = 0.0349) in the presence of BCG, added to 4-EBP inhibition in the presence of NTZ (p = 0.0004). CONCLUSIONS: Results show the possible synergy between the gold standard BC treatment BCG and NTZ, in which multiple targets inhibition such as c-Myc and downstream mTOR, p-4E-BP and PI3K might play a role.

Is there room for behavioral and modifiable health-related targets in the lower urinary tract symptoms' scenario.

PURPOSE: To better understand potential modifiable risk factors guiding preventive interventions against lower urinary tract symptoms (LUTS). METHODS: A prospective cross-sectional study, including healthy men aged 40-70 years under routine urological evaluation, measured the strength of association between the International Prostate Symptom Score (IPSS) and socio-demographic, lifestyle, and health-related factors using logistic and linear regression adjusted for confounding factors. Men with urethral or prostate surgery were excluded. RESULTS: Among 743 men, mean age 59.64 ± 9.66, 22.6% reported moderate, and 5.0% severe LUTS. The adjusted odds of severe LUTS increased with: increasing age (OR = 1.07, 95% CI = 1.05-1.09, p < .0001), increasing prostate volume (OR = 1.02, 95% CI = 1.01-1.04, p = .004), decreasing education (tertiary qualification, no versus yes, OR = 2.34; 95% CI = 1.16-4.70; p = .0133), delayed ejaculation (yes versus no, OR = 2.63, 95% CI = 1.43-4.83, p < .0001), and increasing blood pressure (systolic ≥130 mmHg, OR = 2.03, 95% CI = 1.44-2.86, p < .0001 or diastolic ≥85 mmHg, OR = 1.47, 95% CI = 1.03-2.10, p = .0345); severe LUTS decreased with: increasing the weekly sexual frequency (OR = 0.80, 95% CI = 0.69-0.91, p = .0012) and increasing HDL cholesterol (OR = 0.98, 95% CI = 0.97-0.99, p = .037). Odds were not significant for age of sexual initiation, precocious ejaculation, masturbatory pattern, physical activity, smoking, alcohol consumption, penile length (objective and subjective), abdominal circumference, obesity, comorbid conditions, metabolic syndrome, serum glycaemia, testosterone, SHBG, PSA, and estradiol. CONCLUSIONS: One in every four men under routine urological evaluation who considered themselves healthy present moderate and severe LUTS. Modifiable behavioral (education, sexual frequency, and ejaculation) and health-related (blood pressure and HDL cholesterol) targets were identified for future interventional studies and potential preventive actions and patient counseling.

Delivery of a urology online course using Moodle versus didactic lectures methods.

PURPOSE: To subjectively and objectively compare an accessible interactive electronic library using Moodle with lectures for urology teaching of medical students. METHODS: Forty consecutive fourth-year medical students and one urology teacher were exposed to two teaching methods (4 weeks each) in the form of problem-based learning: - lectures and - student-centered group discussion based on Moodle (modular object-oriented dynamic learning environment) full time online delivered (24/7) with video surgeries, electronic urology cases and additional basic principles of the disease process. RESULTS: All 40 students completed the study. While 30% were moderately dissatisfied with their current knowledge base, online learning course delivery using Moodle was considered superior to the lectures by 86% of the students. The study found the following observations: (1) the increment in learning grades ranged from 7.0 to 9.7 for students in the online Moodle course compared to 4.0-9.6 to didactic lectures; (2) the self-reported student involvement in the online course was characterized as large by over 60%; (3) the teacher-student interaction was described as very frequent (50%) and moderately frequent (50%); and (4) more inquiries and requisitions by students as well as peer assisting were observed from the students using the Moodle platform. CONCLUSIONS: The Moodle platform is feasible and effective, enthusing medical students to learn, improving immersion in the urology clinical rotation and encouraging the spontaneous peer assisted learning. Future studies should expand objective evaluations of knowledge acquisition and retention.

Long-Term Results of Anderson-Hynes Pyeloplasty in Children: How Long Follow-Up Is Necessary?

PURPOSE: After a successful pyeloplasty at 3 to 6 months, the question remains whether children need a long follow-up. METHODS: The medical charts of patients with long-term follow-up (> 5 years), who underwent dismembered pyeloplasty for uretero-pelvic junction obstruction (UPJO) from May 1998 to May 2007, excluding those with bilateral UPJO, solitary kidney, associated vesicoureteral reflux or other abnormalities, and inconclusive renogram due to poor renal function, were retrospectively reviewed. Ultrasonography, differential renal function (DRF, DMSA), and renal drainage on diuretic renography (diethylene-triamine-pentaacetate technetium-99 or DTPA-Tc99) were performed at 3 and 6 months every year. RESULTS: Complete data were available for 28 consecutive patients (28 renal unities) with 2 months to 12 years (mean age, 2.4 years) at surgery, of whom 21 (75%) were boys, 17 diagnosed prenatally (61%) and 18 unities (64.3%) were left, with median follow-up of 10.7 years. Images were graded according to the Society for Fetal Urology grading system: Grade III in 11 (49%) and grade IV in 17 (61%). All cases presented > 10% DRF (DMSA) and obstructed DTPA-Tc99. The T1/2 (the half-time of drainage) less than 20 minutes at 3 months was found in 21 cases (75%) and less than 25 minutes in 7 cases (25%). Renal function and patency were maintained during follow-up for all units with 8% maximum fluctuation of DRF. One index case (3.6%) of renal function deterioration presented DRF fluctuation > 8% at 3 months (from 23 to 32%) and progressive hydronephrosis and indeterminate DTPA at 6 months. CONCLUSIONS: Satisfactory diuretic renogram at 3 to 6 months after pyeloplasty with maintained renal function and stable hydronephrosis suggests no need for further follow-up and indicates no functional loss with time. More than 8% DRF fluctuation might be a significant cutoff for further intervention aiming nephron preservation.

Comparative, prospective, and randomized study between urotherapy and the pharmacological treatment of children with urinary incontinence.

OBJECTIVE: To verify and compare the results of behavioral modification plus pelvic floor muscle training and behavioral modifications plus oxybutynin chloride in children with nonmonosymptomatic enuresis. METHODS: A total of 47 children were randomized using opaque and sealed envelopes sequentially numbered. Group I was composed of 21 children who underwent antimuscarinic treatment (oxybutynin), and Group II was composed of 26 patients who underwent pelvic floor muscle training. Both groups were instructed as to behavioral modifications. RESULTS: The voiding diary results were compared each month between Groups I and II. In the first month of treatment, children in Group I presented 12.2 dry nights, 13.4 in the second month, and 15.9 in the last month. In Group II, the results were: 14.9 dry nights in the first month, 20.8 dry nights in the second and 24.0 dry nights in the last month. There was a significant difference between the groups in second and third months. CONCLUSION: Pelvic floor exercises associated with behavioral changes were more effective than pharmacological treatment in children with urinary incontinence.

Comparative, prospective, and randomized study between urotherapy and the pharmacological treatment of children with urinary incontinence / Estudo comparativo, prospectivo e randomizado entre uroterapia e tratamento farmacológico em crianças com incontinência urinária

OBJECTIVE: To verify and compare the results of behavioral modification plus pelvic floor muscle training and behavioral modifications plus oxybutynin chloride in children with nonmonosymptomatic enuresis. METHODS: A total of 47 children were randomized using opaque and sealed envelopes sequentially numbered. Group I was composed of 21 children who underwent antimuscarinic treatment (oxybutynin), and Group II was composed of 26 patients who underwent pelvic floor muscle training. Both groups were instructed as to behavioral modifications. RESULTS: The voiding diary results were compared each month between Groups I and II. In the first month of treatment, children in Group I presented 12.2 dry nights, 13.4 in the second month, and 15.9 in the last month. In Group II, the results were: 14.9 dry nights in the first month, 20.8 dry nights in the second and 24.0 dry nights in the last month. There was a significant difference between the groups in second and third months. CONCLUSION: Pelvic floor exercises associated with behavioral changes were more effective than pharmacological treatment in children with urinary incontinence.

OBJETIVO: Verificar e comparar os resultados da modificação comportamental associado ao treinamento dos músculos do assoalho pélvico e modificação comportamental associado ao uso de cloridrato de oxibutinina em crianças com enurese não monossintomática. MÉTODOS: Foram randomizadas 47 crianças por meio de envelopes opacos e selados com numeração sequencial. O Grupo I foi composto por 21 crianças que receberam tratamento com antimuscarínico (oxibutinina) e o Grupo II por 26 pacientes que receberam treinamento dos músculos do assoalho pélvico. Ambos os grupos foram instruídos em relação à modificação comportamental. RESULTADOS: Os resultados do diário miccional foram comparados cada mês entre os Grupos I e II. No primeiro mês de tratamento, as crianças do Grupo I apresentaram 12,2 noites secas, 13,4 no segundo mês e 15,9 no último mês. No Grupo II, os resultados foram: 14,9 noites secas no primeiro mês, 20,8 no segundo mês e 24,0 no último mês. Houve diferença significativa entre os grupos no segundo e no terceiro mês. CONCLUSÃO: Os exercícios do assoalho pélvico associados a mudança comportamental foram mais efetivos do que o tratamento farmacológico em crianças com incontinência urinária.

Intravesical calculus secondary to ethanol gel injection into the prostate.

A 78-year-old man with coagulopathy and lower urinary tract symptoms secondary to benign prostatic hyperplasia underwent transurethral prostate ethanol gel injection. Six months after the injection, the patient presented with irritative symptoms and hematuria. Ultrasonography revealed a 5-cm intravesical calculus. Cystolitholapaxy was unsuccessful, and the patient underwent cystolithotomy with retrieval of a large, soft, round, brownish mass. Histologic examination of the mass demonstrated prostatic hyperplastic glandular stroma with extensive coagulate necrosis and peripheral calcification. To our knowledge, this is the first report of a calculus formed by prostatic tissue slosh after ethanol injection.

Comparative study of percutaneous access for staghorn calculi.

OBJECTIVES: To compare the success and complication rates of staghorn calculi treated through the upper pole calix, lower/middle calices, and multiple access. METHODS: Between January 1995 and December 2000, the records of 119 patients with staghorn calculi who underwent percutaneous nephrolithotomy were retrospectively reviewed. The mean stone burden was 6.9 cm. Of the 119 patients, 16 (13.4%) had upper pole access, 70 (58.8%) lower or middle calix access, and 33 (27.7%) multiple renal access. RESULTS: The stone-free rate was 80.0% for those in the lower/middle, 87.5% for those in the upper pole, and 84.8% for those in the multiple access group. Single access was performed in 72.3% and multiple access tracts in 27.7% of patients. The average operative time was 86.8 minutes in the upper pole, 139.1 minutes in the lower/middle pole, and 134.9 minutes in the multiple access groups. Extracorporeal shock wave lithotripsy was used in 4.2% of patients. The overall complication rate was 28.5% (25% in the upper pole, 21.4% in the lower/middle, and 45.4% in the multiple access group). Thoracic complications (pneumothorax and hydrothorax) occurred in 2 patients (1.7%), but only 1 patient had undergone supracostal access. Bleeding requiring blood transfusion was significantly greater in the multiple access group. The average hospital stay was 3.0 days for all patients. CONCLUSIONS: The success of percutaneous treatment of patients with staghorn calculi is highly related to optimal kidney access. The supracostal and multiple access approaches can be used, with a slight increase in the incidence of acceptable complications.

Tratamento do cisto de vesícula seminal por videolaparoscopia / Treatment of the seminal vesical cyst by videolaparoscopy

Os autores descrevem a técnica e discutem os resultados da abordagem videolaparoscópica do cisto de vesícula seminal em três pacientes sintomáticos, dois adultos jovens e uma criança. O tempo médio de cirurgia foi de 100 minutos (variou de 90 a 120), o sangramento foi mínimo e a alta hospitalar ocorreu no primeiro ou segundo PO. Houve uma complicaçäo em um dos pacientes adultos - lesäo acidental da ampola do ducto deferente contralateral ao cisto. O tempo médio de seguimento dos três pacientes foi superior a seis meses. Todos ficaram clinicamente curados e seus respectivos exames ecográficos pós-operatórios demonstraram o desaparecimento dos cistos

Pieloplastia desmembrada pela tecnica de Anderson-Hynes versus endopielotomia percutanea no tratamento da estenose da junçao uretero-pielica na infancia / Open pyeloplasty (Anderson-Hynes Technique) versus endopyelotomy in the management of ureteropelvic obstruction in children

A estenose da junçao uretero-pielica (JUP) e uma das causas mais frequentes de hidronefrose em crianças, sendo responsavel por 25 por cento dos tumores abdominais nos recem-nascidos. O presente estudo compara o tratamento da estenose de JUP pela pieloplastia aberta, tecnica de Anderson-Hynes, e a endopielotomia percutanea. Treze pacientes foram submetidos a pieloplastia aberta, com idade variando de 5 meses a 5 anos, com media de 2 anos e 6 meses. Nove pacientes foram submetidos a endopielotomia percutanea, totalizando dez procedimentos. A idade destes pacientes variou de 2 meses a 16 anos, com media de 6 anos. No grupo de pacientes submetidos a pieloplastia houve melhora clinica em 10 pacientes (76,5 por cento), verificada por ausencia de dor, ganho de peso, normalizaçao do crescimento e ausencia de infecçao urinaria ou febre. A melhora radiologica foi observada em 8 pacientes (61,5 por cento). No grupo submetido a endopielotomia percutanea observou-se melhora clinica e radiologica em 83,4 por cento dos pacientes com estenose da junçao uretero-pielica de causa primaria e melhora clinica e radiologica de 100 por cento e 50 por cento, respectivamente, nos pacientes com estenose de causa secundaria. Houve um caso de recidiva da estenose em cada grupo. Com base nos resultados obtidos, conclui-se que ambos os metodos apresentam eficacia no tratamento da estenose de JUP e acompanham-se de baixa morbidade

Dilataçao transuretral da prostata com balao / Baloon dilatation of the prostate

No periodo entre julho de 1989 a setembro de 1990, 30 pacientes com diagnostico clinico de hiperplasia nodular da prostata (HNP) foram submetidos a dilataçao prostatica com balao. Os 8 pacientes que apresentavam retençao urinaria aguda permaneceram retencionistas apos o procedimento. Dentre os 22 pacientes restantes, houve melhora em 10 (46 por cento) na avaliaçao clinica realizada no terceiro mes, e em apenas 6 pacientes (27 por cento) na avaliaçao apos 12 meses. Na avaliaçao urodinamica, nao houve alteraçao significativa quanto ao fluxo urinario comparado no pre e pos-operatorio. Esses dados sugerem que a dilataçao prostatica tem carater apenas paliativo e deve ser indicada em casos altamente selecionados

Estudo comparativo entre a incisao transuretral e a ressecçao transuretral da prostata / Comparision of transurethral incision and transurethral ressection of prostate in benign prostatic hyperplasia

A ressecçao transuretral da prostata (RTU-P) e a tecnica mais empregada no tratamento da hiperplasia benigna (HBP). A inconveniencia da RTU-P e a ejaculaçao retrograda e a esclerose do colo vesical nos casos de prostatas pequenas. Com a necessidade de realizar cirurgias menos invasivas, o tratamento cirurgico da HBP esta sendo rediscutido. Estudo prospectivo foi realizado com intuito de comparar os resultados da RTU-P em 22 pacientes e incisao transuretral da prostata (ITU-P) em 27 casos. O protocolo consistiu na analise dos sintomas, fluxometria e a atividade sexual. Observou-se melhora dos sintomas em 87,12 por cento e 56,25 por cento no grupo ITU-P e RTU-P respectivamente. A melhora do fluxo urinario ocorreu nos dois grupos nao havendo diferença estatistica muito significante aos 3 e 25 meses. No grupo ITU-P houve ausencia de ejaculaçao retrograda sendo observada em 63,10 por cento no grupo tratado por ressecçao transuretral. Apos seguimento medio de 25 meses concluiu-se que a ITU-P e a operaçao de escolha em paciente com prostata ate 30 g

Retroperitoneoscopia: uma nova técnica para avaliaçäo ganglionar dos tumores vesicais e prostáticos / Retroperitoneoscopy: a new method for limph node evaluation of vesical and prostatic neoplasm

O estadiamento correto das neoplasias vesicais e prostáticas depende obrigatoriamente da avaliaçäo dos gânglios pélvicos. No entanto, o estadiamento clínico, incluindo a tomografia computadorizada e a ultra-sonografia, falha em 30 a 50% dos casos, quando comparado ao estadiamento cirúrgico, o qual é realizado através da linfadenectomia pélvica. Nos pacientes onde está indicada a cirurgia curativa, como a prostatectomia radical ou a cistectomia radical, inicia-se a cirurgia pela linfadenectomia pélvica. Esta acarreta aumento do tempo cirúrgico e, inclusive, pode-se ter falsos resultados na biópsia ganglionar de congelaçäo. Tendo-se em vista todas essas dificuldades, a retroperitoneoscopia pélvica bilateal surge como uma técnica rápida e segura para a avaliaçäo dos gânglios pélvicos. Quatorze pacientes, nove com carcinoma da próstata e cinco com carcinoma da bexiga, foram submetidos à retroperitoneoscopia. Este procedimento demonstrou o acometimento ganglionar em sete pacientes com carcinoma da próstata e em três pacientes com carcinoma da bexiga, os quais haviam sido estadiados clinicamente como portadores de doença localizada, corrigindo o estadiamento desses doentes e modificando, por conseguinte, a programaçäo terapêutica previamente elaborada

Analise critica dos metodos de drenagem dos abscessos renais. Percutanea ou aberta? / Analysis of the methods of renal abscesses drainage: open surgery or percutaneous?

Os abscessos renais sao pouco frequentes e apresentam manifestaçoes clinicas complexas. O tratamento adequado deve ser instituido rapidamente, caso contrario a enfermidade evolui com morbidade e mortalidade significativas. Quinze pacientes portadores de abscesso renal foram tratados, sendo nove por drenagem percutanea e seis por drenagem aberta. Apenas um paciente necessitou de uma nova punçao percutanea apos a primeira intervençao, e outro paciente evoluiu para obito, mesmo apos a drenagem percutanea. Com exceçao desses dois casos, houve resoluçao completa do processo infeccioso nos demais. Nao se observou diferença estatisticamente significante nos dois grupos de pacientes em relaçao ao tempo de internaçao. Os resultados observados sugerem que a drenagem percutanea, por ser um procedimento menos agressivo, deve constituir-se na primeira opçao terapeutica no tratamento dos abscessos renais, nao contra-indicando intervençoes posteriores, caso sejam necessarios

Lesäo uretral na amputaçäo abdomino-perineal no carcinoma do reto / Urethral injury in abdominoperineal resection for carcinoma of rectum

A lesäo uretal é pouco frequente na amputaçäo abdomino-perineal. Vinte e um pacientes portadores de tumor infiltrativo do reto foram submetidos a amputaçäo abdomino-perineal. Verificaram-se 4 lesöes da uretra, sendo 3 pacientes com lesäo da uretra membrano-prostática, um com lesäo do colo vesical e uretra prostática e outro com lesäo da uretra bulbar. Os casos foram de dificil soluçäo, permanecendo os pacientes hospitalizados por longo período. A orientaçäo é identificar a fáscia de Denonvillier durante a cirurgia, evitando assim a lesäo uretral