Bladder lesions as incidental findings during transurethral resection of the prostate: prevalence, diagnosis, and pathological findings.

PURPOSE: The purpose of this study was to determine the prevalence of bladder lesions diagnosed during transurethral resection of the prostate (TURP), to identify the associated risk factors, and to correlate the macroscopic descriptions with the pathological findings. METHODS: This was a single-center retrospective case series conducted at a hospital in the city of São Paulo, Brazil. We reviewed the medical and surgical records of patients who underwent TURP between January 2012 and December 2017. RESULTS: The final sample comprised 513 patients, with a mean age of 70.8 years. Bladder lesions were identified during TURP in 109 (21.2%) of the patients, and 90 of those lesions were submitted for pathological examination. The most common macroscopic finding was bullous edema, which was seen in 57 (63.3%) of the 90 lesions examined. The pathological analysis revealed chronic cystitis in 61 lesions (67.8%) and malignant lesions in 16 (17.8%). Of the 57 lesions described as bullous edema, 5 (8.8%) were found to be malignant. CONCLUSIONS: Alterations in the bladder mucosa appear to be more common among elderly patients who use an indwelling urinary catheter for a prolonged period and among patients with recurrent urinary tract infections. In addition, the risk of a bladder lesion being malignant is apparently higher in current and former smokers than in never smokers. Our findings suggest that at-risk patients should undergo biopsy or resection of incidental bladder lesions even if those lesions seem to be benign, due to the low level of agreement between the visual analysis and the pathological examination.

Prevalence of self-reported complications associated with intermittent catheterization in wheelchair athletes with spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To identify the prevalence of complications associated with intermittent catheterization in wheelchair athletes with spinal cord injury (SCI). SETTING: International and national sporting events. METHODS: A total 130 competitive wheelchair athletes living with SCI completed a self-reported questionnaire during international or national sporting events. The questionnaire collected information regarding demographics, injury characteristics, method of bladder emptying, and complications related to intermittent catheterization. RESULTS: Overall, 84% (109/130) of wheelchair athletes used intermittent catheterization. Within this group, 77% of athletes (84/109) experienced at least one complication associated with intermittent catheterization. Twenty-seven percent (29/109) sustained urethral injuries and 63% (69/109) had at least one episode of urinary tract infection during the last 12 months. Almost one-fourth of male athletes (22/95, 23%) had a history of inflammation / infection of genital organs associated with intermittent catheterization. CONCLUSIONS: Here we report a high prevalence of self-reported complications associated with intermittent catheterization in wheelchair athletes with SCI. Considering their potential impact on lower urinary tract function, athletic performance, and health, further studies are needed to assess the role of preventative strategies to reduce complications related to intermittent catheterization in wheelchair athletes with SCI. SPONSORSHIP: Coloplast Brazil and Instituto Lado a Lado pela Vida (a nongovernmental, nonprofit organization based in São Paulo) and Wellspect provided funding for this study.

Male perineal sling with autologous aponeurosis and bone fixation - description of a technical modification.

Post-prostatectomy urinary incontinence is an uncommon complication of adenomectomies, occurring in approximately 1% of cases and being more frequent following radical prostatectomies. There is a significant implication in the quality of life for these patients. The surgical techniques employed for its treatment are the implantation of an artificial sphincter, peri-urethral injections and suburethral slings. Considering the low efficacy of peri-urethral injections and the high cost of artificial sphincters, we present in this work a technical modification of the suburethral sling, whose preliminary results are satisfactory. The fundamental modification in this technique is due to the replacement of the synthetic material usually employed for making the sling for autologous tissue, constituted by an aponeurotic strip taken from the rectus muscle of abdomen. This modification aims to minimize risks of urethral erosion that, despite it was not described in this population due to the use of synthetic materials, is a possibility when facing the tension that is used over the bulbar urethra. In addition to such aspects the autologous aponeurosis does not have a cost except for a short prolongation of the surgical act.

Concurrent validity, internal consistency and responsiveness of the Portuguese version of the King's Health Questionnaire (KHQ) in women after stress urinary incontinence surgery.

OBJECTIVE: To evaluate the concurrent validity, internal consistency and responsiveness of King's Health Questionnaire (KHQ) in patients who underwent sling procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: We performed a prospective open label multicenter study in 4 tertiary referral centers. Sixty-eight female patients were enrolled with urodynamically diagnosed urinary stress incontinence. Patients were treated using surgical procedures, mostly (73%) with the synthetic sling procedure, which has been considered one of the gold standard methods for the treatment of urinary incontinence. The patients were assessed before and after one month of postoperative follow up, using the KHQ in its validated Portuguese version. Patients also underwent preoperative urodynamic test, Stamey incontinence grading, pad usage and the assessment of number of pads used per day. After surgery, patients underwent stress test, Stamey incontinence grading pad usage and the assessment of number of pads used per day. RESULTS: The concurrent validity showed good correlations in some domains of KHQ to clinical parameters. The internal consistency was higher after treatment compared to preoperative values. Objective parameters, such as pad usage and the assessment of number of pads used per day, had significant correlation with changes in post-treatment scores on KHQ. The responsiveness expressed in terms of standardized effect size (SES) and standardized response mean (SRM) was large. CONCLUSION: The results showed moderate concurrent validity, strong internal consistency and high responsiveness for KHQ, indicating that it is suitable for measuring outcomes in clinical trials among female patients with stress urinary incontinence.

Male perineal sling with autologous aponeurosis and bone fixation: description of a technical modification

Post-prostatectomy urinary incontinence is an uncommon complication of adenomectomies, occurring in approximately 1 percent of cases and being more frequent following radical prostatectomies. There is a significant implication in the quality of life for these patients. The surgical techniques employed for its treatment are the implantation of an artificial sphincter, peri-urethral injections and suburethral slings. Considering the low efficacy of peri-urethral injections and the high cost of artificial sphincters, we present in this work a technical modification of the suburethral sling, whose preliminary results are satisfactory. The fundamental modification in this technique is due to the replacement of the synthetic material usually employed for making the sling for autologous tissue, constituted by an aponeurotic strip taken from the rectus muscle of abdomen. This modification aims to minimize risks of urethral erosion that, despite it was not described in this population due to the use of synthetic materials, is a possibility when facing the tension that is used over the bulbar urethra. In addition to such aspects the autologous aponeurosis does not have a cost except for a short prolongation of the surgical act.

Concurrent validity, internal consistency and responsiveness of the portuguese version of the king's health questionnaire (KHQ) in women after stress urinary incontinence surgery

OBJECTIVE: To evaluate the concurrent validity, internal consistency and responsiveness of King's Health Questionnaire (KHQ) in patients who underwent sling procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: We performed a prospective open label multicenter study in 4 tertiary referral centers. Sixty-eight female patients were enrolled with urodynamically diagnosed urinary stress incontinence. Patients were treated using surgical procedures, mostly (73 percent) with the synthetic sling procedure, which has been considered one of the gold standard methods for the treatment of urinary incontinence. The patients were assessed before and after one month of postoperative follow up, using the KHQ in its validated Portuguese version. Patients also underwent preoperative urodynamic test, Stamey incontinence grading, pad usage and the assessment of number of pads used per day. After surgery, patients underwent stress test, Stamey incontinence grading pad usage and the assessment of number of pads used per day. RESULTS: The concurrent validity showed good correlations in some domains of KHQ to clinical parameters. The internal consistency was higher after treatment compared to preoperative values. Objective parameters, such as pad usage and the assessment of number of pads used per day, had significant correlation with changes in post-treatment scores on KHQ. The responsiveness expressed in terms of standardized effect size (SES) and standardized response mean (SRM) was large. CONCLUSION: The results showed moderate concurrent validity, strong internal consistency and high responsiveness for KHQ, indicating that it is suitable for measuring outcomes in clinical trials among female patients with stress urinary incontinence.

A double-blind, randomized, placebo-controlled study, to assess the efficacy of alfuzosin in the treatment of patients with benign prostatic hyperplasia / Um estudo duplo cego, randomizado e controlado com placebo para avaliar a eficácia da alfuzosina no tratamento de pacientes com hiperplasia prostática benigna

Introduçäo: Os alfa-bloqueadores säo hoje as drogas de escolha no tratamento clínico de pacientes com hiperplasia prostática benigna (HPB). Os autores apresentam os resultados de um estudo prospectivo, randomizado, duplo-cego, e controlado por placebo da alfuzosina no tratamento de pacientes com HPB. Material e métodos: 31 pacientes foram randomizados em dois grupos: alfa-bloqueador seletivo alfuzosina na dose de 5 mg duas vezes ao dia (n=16) ou placebo (n=15) por 12 semanas. Os pacientes foram selecionados de acordo com critérios de inclusäo e exclusäo que, de forma geral, incluiram pacientes com 50 anos de idade ou mais, escore internacional de sintomas prostáticos (EISP) de 12 pontos, índice de qualidade de vida (IQV) de 3 pontos ou mais, e fluxo urinário máximo (Fmáx) entre 5 e 15 ml/s. Resultados: Näo houve diferença na taxa de melhora do EISP (37 por cento versus 29 por cento, p=0,446) e IQV (15 por cento versus 21 por cento, p=0,446) entre o grupo alfuzosina e o grupo placebo. No entanto, embora marginalmente significante, o Fmáx mostrou uma melhora marcante após a alfuzosina quando comparado ao placebo (50 por cento versus 5,5 por cento, p=0,06). A incidência de efeitos colaterais foi similar em ambos os grupos, alfuzosina e placebo (43,8 por cento versus 40 por cento, respectivamente). Conclusöes: O alfa-bloqueador alfuzosina näo é uma panacéia e, em alguns pacientes, a melhora clínica ocorre principalmente devido ao efeito placebo, que neste estudo resultou em aproximadamente 30 por cento de melhora do EISP (p=0,001), 21 por cento de melhora do IQV (p=0,017) e um aumento do Fmáx ò50 por cento em 26,5 por cento dos pacientes. Entretanto, o alfa-bloqueador alfuzosina tem um papel importante na abordagem clínica da HPB, já que seu mecanismo de açäo alivia o componente dinâmico da obstruçäo prostática, como demonstrado pela melhora do Fmáx.