Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 68
Filtrar
Mais filtros

Base de dados
Tipo de documento
Intervalo de ano de publicação
1.
Pediatr Nephrol ; 2024 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-39249128

RESUMO

BACKGROUND: Augmentation cystoplasty (AC) is a procedure to improve the clinical and urodynamic parameters of neurogenic bladder (NB) in children and adolescents refractory to other treatments. We performed a systematic review to investigate these parameters in children and adolescents with NB undergoing AC. METHODS: We followed PRISMA guidelines and searched electronic databases until March 2024 for studies involving patients aged three to 19 years diagnosed with NB undergoing AC. We assessed clinical and urodynamic parameters before and after surgery, focusing on improvements in urinary incontinence, vesicoureteral reflux (VUR), bladder capacity, compliance, and end filling detrusor pressure (EFP). RESULTS: A total of 212 NB patients underwent AC and were evaluated for urinary incontinence before and after surgery. Two studies showed a 76.5% to 78.9% improvement in incontinence without bladder outlet procedures (BOP). Another study found no significant difference in incontinence improvement rates between AC with and without BOP. The VUR resolution rate assessed in three studies ranged from 12.5 to 64%. Three studies showed a variation in bladder capacity from 52.8 to 70% of the expected bladder capacity pre-AC to 95.9 to 119%, post-AC. A fourth study showed a variation in bladder capacity from 87 ml pre-AC to 370 ml post-AC. Two studies showed a variation from 3.2 to 4.6 ml/cm H2O pre-AC to 13.7 to 41.3 ml/cm H2O post-AC in bladder compliance. The EFP in three studies varied from 37.2 to 47.6 cm H2O pre-AC to 11 to 17.4 cm H2O post-AC. CONCLUSION: After AC, urinary incontinence, bladder capacity, EFP, and bladder compliance improved in children and adolescents with NB.

2.
Int Braz J Urol ; 50(2): 136-151, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38386785

RESUMO

BACKGROUND: Parasacral Transcutaneous Electrical Nerve Stimulation (PTENS) is a treatment used in enuresis refractory to first-line treatment. This review aimed to evaluate the effectiveness of PTENS in treating monosymptomatic enuresis (MNE) in children and adolescents. METHODS: The study followed the Preferred Reporting Items for Systematic (PRISMA) guidelines. The search was carried out in the following databases: MEDLINE (via PubMed), Web of Science, SCOPUS, Central Cochrane Library and Physiotherapy Evidence Database (PEDro). The selected studies were randomized clinical trials (RCTs). The "Risk of Bias tool for randomized trials" and the "Risk of Bias VISualization" were used to analyze the risk of bias. RESULTS: Of the 624 studies selected, four RCTs were eligible. Three included 146 children and adolescents aged between six and 16.3 years and used similar PTENS protocols with a frequency of 10 Hz, pulse duration of 700 µs and 20 minutes three times/week. One study enrolled 52 patients aged seven to 14 years used PTENS at home, with a pulse duration of 200 µs and 20 to 60 minutes twice/day. Risk of bias was observed in three studies due to results' randomization and measurement. Two studies showed a partial response with a reduction in wet nights, one a complete response in 27% of patients, and one showed no improvement. CONCLUSION: PTENS reduces wet nights' frequency but does not cure them, except in 27% of patients in one study. Limited RCTs and data heterogeneity are limitations.


Assuntos
Ensaios Clínicos Controlados Aleatórios como Assunto , Estimulação Elétrica Nervosa Transcutânea , Humanos , Criança , Estimulação Elétrica Nervosa Transcutânea/métodos , Adolescente , Resultado do Tratamento , Feminino , Masculino , Enurese Noturna/terapia , Reprodutibilidade dos Testes
3.
Int Braz J Urol ; 50(2): 209-222, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38386791

RESUMO

OBJECTIVE: The objective of this narrative review is to discuss the current state of research funding in Brazil. MATERIALS AND METHODS: This study is based on the most recent edition of the course Funding for Research and Innovation in the University of Sao Paulo School of Medicine which was a three-day course with 12 hours of instruction. The course brought together leading experts in the field to comprehensively discuss the current state of research funding in Brazil. Each speaker provided a presentation on a specific topic related to research funding. After the workshop, speakers assembled relevant topics in this manuscript. RESULTS: collaborative research is critical for securing research funding. It optimizes proposal competitiveness, amplifies societal impact, and manages risks effectively. As such, fostering and supporting these collaborations is paramount for both researchers and funding agencies. To maintain the highest integrity in research, investigators involved in these collaborations must disclose any relationships that could potentially influence the outcomes or interpretation of their projects. CONCLUSIONS: In Brazil, the mainstay of research funding stems from public entities, with agencies such as CNPq, CAPES, and state bodies like FAPESP, FAPERJ, FAPEMIG and others at the forefront. Concurrently, industry funding offers viable pathways, especially through industry-sponsored studies, investigator-led projects, and collaborative initiatives. The Brazilian funding landscape is further enriched by innovative platforms, including crowdfunding and the contributions of institutions like the Serrapilheira Institute. Internationally, esteemed organizations such as the National Institutes of Health (NIH) and the Bill & Melinda Gates Foundation stand out as potential funders.


Assuntos
Pesquisa Biomédica , Estados Unidos , Humanos , Brasil
4.
Int Braz J Urol ; 50(3): 287-295, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38498685

RESUMO

PURPOSE: To analyze the prevalence of lower urinary tract symptoms (LUTS) in patients who survived moderate and severe forms of COVID-19 and the risk factors for LUTS six months after hospitalization. MATERIALS AND METHODS: In this prospective cohort study, patients were evaluated six months after hospitalization due to COVID-19. LUTS were assessed using the International Prostate Symptom Score. General health was assessed through the Hospital Anxiety and Depression Scale and the EQ5D-L5 scale, which evaluates mobility, ability to perform daily activities, pain and discomfort and completed a self-perception health evaluation. RESULTS: Of 255 participants, 54.1% were men and the median age was 57.3 [44.3 - 66.6] years. Pre-existing comorbidities included diabetes (35.7%), hypertension (54.5%), obesity (30.2%) and physical inactivity (65.5%). One hundred and twenty-four patients (48.6%) had a hospital stay >15 days, 181 (71.0%) were admitted to an ICU and 124 (48.6%) needed mechanical ventilation. Median IPSS was 6 [3-11] and did not differ between genders. Moderate to severe LUTS affected 108 (42.4%) patients (40.6% men and 44.4% women; p=0.610). Nocturia (58.4%) and frequency (45.9%) were the most prevalent symptoms and urgency was the only symptom that affected men (29.0%) and women (44.4%) differently (p=0.013). LUTS impacted the quality of life of 60 (23.5%) patients with women more severely affected (p=0.004). Diabetes, hypertension, and self-perception of worse general health were associated with LUTS. CONCLUSIONS: LUTS are highly prevalent and bothersome six months after hospitalization due to COVID-19. Assessment of LUTS may help ensure appropriate diagnosis and treatment in these patients.


Assuntos
COVID-19 , Diabetes Mellitus , Hipertensão , Sintomas do Trato Urinário Inferior , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , COVID-19/complicações , Sintomas do Trato Urinário Inferior/epidemiologia , Diabetes Mellitus/epidemiologia , Hipertensão/complicações , Hipertensão/epidemiologia , Prevalência
5.
Int Braz J Urol ; 50(2): 192-198, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38386789

RESUMO

PURPOUSE: One of the many artificial intelligence based tools that has gained popularity is the Chat-Generative Pre-Trained Transformer (ChatGPT). Due to its popularity, incorrect information provided by ChatGPT will have an impact on patient misinformation. Furthermore, it may cause misconduct as ChatGPT can mislead physicians on the decision-making pathway. Therefore, the aim of this study is to evaluate the accuracy and reproducibility of ChatGPT answers regarding urological diagnoses. MATERIALS AND METHODS: ChatGPT 3.5 version was used. The questions asked for the program involved Primary Megaureter (pMU), Enuresis and Vesicoureteral Reflux (VUR). There were three queries for each topic. The queries were inserted twice, and both responses were recorded to examine the reproducibility of ChatGPT's answers. Afterwards, both answers were combined. Finally, those rwere evaluated qualitatively by a board of three specialists. A descriptive analysis was performed. RESULTS AND CONCLUSION: ChatGPT simulated general knowledge on the researched topics. Regarding Enuresis, the provided definition was partially correct, as the generic response allowed for misinterpretation. For VUR, the response was considered appropriate. For pMU it was partially correct, lacking essential aspects of its definition such as the diameter of the dilatation of the ureter. Unnecessary exams were suggested, for Enuresis and pMU. Regarding the treatment of the conditions mentioned, it specified treatments for Enuresis that are ineffective, such as bladder training. Therefore, ChatGPT responses present a combination of accurate information, but also incomplete, ambiguous and, occasionally, misleading details.


Assuntos
Enurese Noturna , Médicos , Urologia , Humanos , Inteligência Artificial , Reprodutibilidade dos Testes
6.
Int Braz J Urol ; 50(5): 605-615, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39106116

RESUMO

OBJECTIVES: To evaluate the impact of COVID-19 pandemics on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents after 1 year of socio-economic restrictions. MATERIALS AND METHODS: An electronic survey was e-mailed to all postgraduate (PG) students registered by the Brazilian Society of Urology. The survey inclu-ded an assessment of socio-demographic, clinical practice, educational, health-related and behavior parameters. We also evaluated which subareas of urology were predominantly affected. A similar survey was adapted and sent to the directors of all urology residency programs. RESULTS: COVID-19 pandemic has severely impacted the clinical, surgical, and educational activities of urology residents in Brazil. Urology residents reported >50% decrease in multiple surgical modalities. We highlight kidney transplantation surgeries (66.2%), minor surgeries (62.3%), endoscopic surgeries (42.6%) and reconstructive surgeries (38.8%). This could represent a critical skills gap that residents may face beyond the COVID-19 pandemic. Furthermore, PG students faced stressful situations that caused worsening of mental and physical health, such as getting redirected to assistance of COVID-19 patients (66.9%), and high rate of infection by SARS-CoV-2 (58.2%). CONCLUSIONS: The COVID-19 pandemic has severely impacted the clinical, surgical, and educational activities of urology residents in Brazil. This could represent a critical skills gap that residents may face beyond the COVID-19 pandemic. PG students faced stressful situations that caused worsening of mental and physical health such as redirection to assistance of COVID-19 patients, concern about their own contamination and of family members.


Assuntos
COVID-19 , Internato e Residência , Pandemias , Urologia , COVID-19/epidemiologia , Humanos , Internato e Residência/estatística & dados numéricos , Urologia/educação , Brasil/epidemiologia , Masculino , Feminino , Inquéritos e Questionários , Adulto , SARS-CoV-2 , Procedimentos Cirúrgicos Urológicos/educação , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Educação de Pós-Graduação em Medicina
7.
Neurourol Urodyn ; 42(6): 1390-1396, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37232538

RESUMO

OBJECTIVE: To evaluate the clinical response of parasacral transcutaneous electrical neural stimulation (parasacral TENS) associated with urotherapy in children with primary monosymptomatic nocturnal enuresis (PMNE) compared to urotherapy alone. MATERIAL AND METHODS: This prospective controlled clinical trial enrolled 72 children over 5 years of age with PMNE. Children were randomly divided into two groups, control group (CG), treated with urotherapy and scapular stimulation, and experimental group (EG), treated with urotherapy and parasacral TENS. In both groups, 20 sessions were performed, 3 times weekly, for 20 min each, with 10 Hz frequency, 700 µS pulse width and intesity determinated by the patient threshold. The percentages of dry nights were analyzed for 14 days before treatment (T0), after the 20th session (T1), 15 (T2), 30 (T3), 60 (T4), and 90 (T5) days after the end of the sessions. Patients of both groups were followed with intervals of 2 weeks in the first month and monthly for three consecutive months. RESULTS: Twenty-eight enuretic children, 14 girls (50%) with a mean age of 9.09 ± 2.23 years completed the study. There was no difference in mean age between groups. Mean percentage of dry nights in EG at T0 was 36%, at T1 49%, at T2 54%, at T3 54%, at T4 54%, and 57% at T5; while in CG, these percentages were 28%, 39%, 37%, 35%, 36%, and 36%, respectively. CONCLUSIONS: Parasacral TENS associated with urotherapy improves the percentage of dry nights in children with PMNE, although no patient had complete resolution of symptoms in this study.


Assuntos
Enurese , Enurese Noturna , Estimulação Elétrica Nervosa Transcutânea , Criança , Feminino , Humanos , Estudos Prospectivos , Frequência Cardíaca , Enurese Noturna/terapia
8.
Int Urogynecol J ; 34(8): 1949-1954, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36811634

RESUMO

INTRODUCTION AND HYPOTHESIS: The objective was to characterize the impact of the COVID-19 pandemic on the surgical treatment of female stress urinary incontinence (FSUI) in Brazil. METHODS: This study was conducted with population-based data from the Brazilian public health system database. We obtained data on the number of surgical procedures for FSUI in 2019 (before the coronavirus disease [COVID-19] pandemic), 2020, and 2021 (during the pandemic) in each of the 27 Brazilian states. We included official Brazilian Institute of Geography and Statistics (IBGE) data on the population, Human Development Index (HDI), and annual per capita income of each state. RESULTS: A total of 6,718 surgical procedures for FSUI were performed in the Brazilian public health system in 2019. The number of procedures was reduced by 56.2% in 2020, and an additional reduction of 7.2% was seen in 2021. The distribution of procedures by state showed important differences, ranging from 4.4 procedures/1,000,000 inhabitants in Paraíba and Sergipe to 67.6 procedures/1,000,000 inhabitants in Paraná (p<0.01) in 2019. The number of surgical procedures was higher in states with a higher HDI (p=0.0001) and per capita income (p=0.042). The decrease in the number of surgical procedures affected the whole country and its rate did not correlate with HDI (p=0.289) or per capita income (p=0.598). CONCLUSION: The impact of the COVID-19 pandemic on the surgical treatment of FSUI in Brazil was significant in 2020 and persisted in 2021. Access to surgical treatment of FSUI varied according to geographic region, HDI, and per capita income, even before COVID-19.


Assuntos
COVID-19 , Slings Suburetrais , Incontinência Urinária por Estresse , Feminino , Humanos , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/cirurgia , Brasil/epidemiologia , Pandemias , Saúde Pública , COVID-19/epidemiologia , Procedimentos Cirúrgicos Urológicos/métodos
9.
Int Braz J Urol ; 49(5): 590-598, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37450772

RESUMO

BACKGROUND: Children presenting enuresis are more likely to be asthmatics. The association between enuresis and sleep-disordered breathing has already been demonstrated and several studies have shown at least partial improvement of two thirds or more of the cases of enuresis adenoidectomy. Studies have already described associations between enuresis and allergies but do not assess the repercussions of allergy treatment in enuretics. OBJECTIVE: This study aims to evaluated whether asthma treatment alters the course of enuresis and whether there is any predictive factor associated with this improvement. MATERIALS AND METHODS: Twenty patients (5 - 12 years old) with uncontrolled enuresis and asthma, received treatment for asthma. Children were also assessed for the presence of rhinitis and other allergies. The control of asthma was confirmed by a validated questionnaire and primary enuresis by clinical history and wet night diaries. Patients received only asthma treatment. RESULTS: At least partial improvement of enuresis was observed in 55% of the patients with an increase in 64.4% in the number of dry nights at the end of the study (p=0.01). The "presence of other allergies" and "obstruction seen in nasal endoscopy" positively influenced the improvement of urinary symptoms (OR = 3.350; CI 0.844-13.306) and (OR=1.272; CI 0.480-3.370), respectively. DISCUSSION: Until now, only patients presenting upper airway obstruction were known to benefit from the improvement of urinary symptoms when undergoing treatment for their respiratory problems. In our study, we found at least partial improvement in enuresis in 55% of our patients, with only clinical asthma treatment. CONCLUSION: Controlling asthma in children with primary enuresis resulted in a significant increase in dry nights.


Assuntos
Asma , Enurese , Hipersensibilidade , Enurese Noturna , Criança , Humanos , Pré-Escolar , Enurese Noturna/etiologia , Enurese Noturna/terapia , Asma/complicações
10.
Int Braz J Urol ; 49(1): 89-96, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36512457

RESUMO

INTRODUCTION: Voiding diary (VD) is an important tool in the evaluation of children with voiding symptoms. Voiding frequency, maximal voided volume (MVV), average voided volume (AVV) and nocturnal volume (NV) can be extracted and are valuable in diagnosing and monitoring these disorders. Recently, ICCS has reduced the period of data recording on VD from 3 to 2 days.We hypothesized that one day voiding diary would be enough for guiding treatment. MATERIALS AND METHODS: Children with overactive bladder (OAB) and primary monosymptomatic enuresis (PMNE) were oriented to fulfill a 3-day VD. Data obtained from VD were evaluated for the first day (1dVD), the first two days (2dVD), and all 3 days (3dVD) and compared according to the MVV, AVV, frequency, NV and expected bladder capacity (EBC). The Friedman, Student's t test and the Fisher's exact was used. ANOVA was used for multiple comparisons. We also used Pearson correlation test. RESULTS: Ninety-eight children were included, 59 had PMNE and 30 OAB. Frequency, AVV and VN were similar regardless how many days the voiding episodes were recorded. Only MVV was higher by a mean of only 32 mL on 3dVD compared to 1dVD. A 1dVD has a sensitivity of 93,9% and a positive likelihood ratio of 2.2. As for the correlation of MVV and EBC it was observed that in 83% of children, MVV was lower than EBC. MVV corresponds to 67% and 69% of EBC in children with PMNE and OAB, respectively. CONCLUSION: We believe that 1dVD is sufficient to assess these children. It has a high sensitivity and good correlation to 3dVD in evaluating these children. Bladder capacity in this population, evaluated by maximum voided volume, was close to 68% of that obtained by the EBC.


Assuntos
Sintomas do Trato Urinário Inferior , Bexiga Urinária Hiperativa , Criança , Humanos , Micção , Sintomas do Trato Urinário Inferior/diagnóstico , Bexiga Urinária Hiperativa/diagnóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA