A prospective and randomized study comparing the use of alarms, desmopressin and imipramine in the treatment of monosymptomatic nocturnal enuresis.

BACKGROUND: Monosymptomatic enuresis (MNE) results from a pathogenic triad that may include lack of vasopressin secretion during sleep, reduced functional bladder capacity and inability to wake up during sleep. The treatment of MNE can be performed through behavioral therapy, use of alarms or medications such as desmopressin and imipramine. OBJECTIVE: To compare the effectiveness of different treatments of MNE. STUDY DESIGN: Prospective and randomized study comparing different intervention and a control group (receiving only behavior therapy) for MNE. INCLUSION CRITERIA: age between 5 and 16 years old, with MNE, evaluated at the pediatric urology outpatient clinic of Hospital Infantil Menino Jesus. At first visit children were submitted to behavior therapy (urotherapy) for 3 months, children were subsequently characterized according to the ICCS as non-responders, partial responders, or full responders. Those partial responders or non-responders received a patient ID and were randomized to four groups: Alarm Group (G1), Desmopressin Group - DDAVP (G2), Imipramine Group (G3) and Control (G4). All groups were monitored monthly, for a period of 6 months. After 6 months, the children were reevaluated for MNE. RESULTS: 93 patients were enrolled. Mean age was 10.96 years with a standard deviation of 2.28 years, 59,1% were male. All groups had improvement in the number of dry nights (Table). Taking in account success the population full responders and partial responders: Alarm Group (G1) achieve success in 100% of cases, Desmopressin Group - DDAVP (G2) in 63.6% of cases, Imipramine Group (G3) in 73.7% of cases (Table 3). No drugs side effects were observed in both groups (G2 and G3), there was no dropout in patients who used alarms. DISCUSSION: Our data suggests that the use of alarms is the most effective treatment of ENM with superior results when compared to imipramine and DDAVP. The small number of participants is a weakness of the study, as well as the lack of a voiding diary at the end of the study. CONCLUSION: All therapeutics options utilized in the treatment of MNE are safe, effective and has a low rate of abandonment.

EMG biofeedback or parasacral transcutaneous electrical nerve stimulation in children with lower urinary tract dysfunction: A prospective and randomized trial.

AIMS: Evaluate the efficacy of biofeedback and parassacral electric nerve stimulation (TENS) for the treatment of children with lower urinary tract (LUT) dysfunction. METHODS: A prospective, randomized study was approved by our Hospital Ethics Committee. We enrolled 64 children, 43 girls and 21 boys, average age of 9.39 years. The initial evaluation consisted of history, physical examination, urine analyses, voiding diary, uroflow, and ultrasound. Dysfunction voiding symptom score (DVSS) questionnaires were applied pre- and post-treatment. The children were divided into two treatment groups independent of the predominant type of voiding dysfunction (dysfunctional or overactive bladder): biofeedback group and TENS group. The criteria for assessing the effectiveness of the techniques was the resolution of daytime and nighttime symptoms including urinary leakage, improvements in voiding diary, DVSS, and changes in uroflow. After 6 months, the children were reassessed with the same work-up of baseline. RESULTS: Regarding daytime symptoms, results for complete response were similar between the two groups (P = 0.483); 54.9% of children treated by the biofeedback group and 60.6% in the TENS group. The same have been observed in the nighttime incontinence with complete resolutions in 29.6% and 25%, respectively ( P = 0.461). Analyzing the voiding diary, uroflow and DVSS questionnaires both groups had significant improvement ( P = 0.001) after treatment. The biofeedback group required fewer sessions than TENS group, 10.9 and 18.1, respectively ( P < 0,001). CONCLUSIONS: Both biofeedback and the TENS are equally effective for treating non-neurogenic voiding dysfunction. Biofeedback seems to require a lower number of sessions to obtain similar results of the TENS.

Primary mucinous adenocarcinoma of the bladder with signet-ring cells: case report.

CONTEXT: Primary adenocarcinomas of the bladder are uncommon and usually occur by contiguity with or hematogenic dissemination of other adenocarcinomas such as colorectal, prostate and gynecological tract carcinomas. Mucinous and signet-ring cell histological patterns are even rarer and it is often difficult to morphologically distinguish them from metastatic colorectal adenocarcinoma. CASE REPORT: We present and discuss a rare case of primary mucinous adenocarcinoma of the bladder with signet-ring cells in a 57-year-old male patient. Other primary sites for the tumor had been excluded and, in the absence of digestive tract tumor and for confirmation that it was a primary bladder tumor, an immunohistochemistry study was performed.

Primary mucinous adenocarcinoma of the bladder with signet-ring cells: case report

CONTEXT: Primary adenocarcinomas of the bladder are uncommon and usually occur by contiguity with or hematogenic dissemination of other adenocarcinomas such as colorectal, prostate and gynecological tract carcinomas. Mucinous and signet-ring cell histological patterns are even rarer and it is often difficult to morphologically distinguish them from metastatic colorectal adenocarcinoma. CASE REPORT: We present and discuss a rare case of primary mucinous adenocarcinoma of the bladder with signet-ring cells in a 57-year-old male patient. Other primary sites for the tumor had been excluded and, in the absence of digestive tract tumor and for confirmation that it was a primary bladder tumor, an immunohistochemistry study was performed.

CONTEXTO: Adenocarcinomas vesicais primários são incomuns, o habitual é o comprometimento por contigüidade ou via hematogênica de outros adenocarcinomas como colorretal, próstata e trato ginecológico. O padrão histológico correspondente ao mucinoso e com células em anel de sinete é mais raro e, muitas vezes, há dificuldade em distingui-lo morfologicamente do adenocarcinoma colorretal metastático. RELATO DE CASO: Apresentamos e discutimos um caso de adenocarcinama mucinoso com células em anel de sinete primário da bexiga em um paciente masculino, de 57 anos. Foram excluídos outros sítios primários do tumor e, na ausência de tumor do trato digestivo e para confirmação de tumor vesical primário realizou-se estudo imunoistoquímico.

Correlaçao entre histologia, volume testicular e analise seminal em portadores de varicocele / Correlation among histology, testicular volume and semen analysis in patients with varicocele

Realizou-se a correçao cirurgica de varicocele e a biopsia testicular bilateral em 20 pacientes masculinos; avaliou-se a histologia espermatica, diametro e area tubular atraves da fotomicrografia. Dentre 20 pacientes, 11 apresentavam o testiculo esquerdo com volume pelo menos 25 por cento menor que o testiculo direito. Nos pacientes com menor volume testicular, nao houve diferença no diametro e area tubular, tendo porem menor numero de espermatides maduras por unidade tubular; esta diferença nao foi observada nos pacientes com igual volume testicular. Esses fatos nos permitem supor que a diminuiçao do volume testicular se faz as custas do espaço intersticial, provocando disfunçao das celulas de Leydig, que estao relacionadas com o numero de espermatides maduras, principal marcador da espermatogenese testicular

Correçäo da curvatura peniana com a operaçäo de Nesbit modificada / Correction of the penile curvature with the modified operation

Dezoito pacientes masculinos, com idade variando entre 1 ano e 7 meses e 72 anos foram submetidos `a correçäo cirúrgica de curvatura peniana pela técnica de Nesbit modificada. Destes 18 pacientes 8 apresentavam pênis curvo congênito, 7 doença de Peryronie, 2 hipospádia peniana distal, e 1 fibrose traumática. Esta técnica consiste na plicatura da túnica albugínea do corpo cavernoso com fio inabsorvível de polipropileno 4-0 (Prolene) na face contralateral da curvatura através de pontos invaginantes separados, sem excisäo de elipse de albugínea. Foi considerado como bom resultado daqueles casos em que houve retificaçäo completa de pênis, sem dor `a ereçäo; resultado regular aqueles com curvatura residual discreta ou dor `a ereçäo e mau resultado quando näo houve correçäo da curvatura peniana. Observamos que em 17 casos (94,4%), o resultado foi bom, e um paciente com curvatura peniana congênita evoluiu com mau resultado (5,5%). A técnica de Nesbit modificada mostrou ser um procedimento cirúrgico simples e näo traumática ao corpo cavernoso, com alto índice de sucesso para a correçäo da curvatura peniana

Valor da avaliaçäo radiológica em hipospadia / Value of the radiological evaluation in hypospadia

Avaliaram-se radiologicamente 45 pacientes portadores de hipospadia, encontrando-se apenas 2,2% de anormalidade significativa do trato urinário. Diante dos resultados, considerou-se que a exploraçäo radiológica deve ser restrita a casos com indicaçöes específicas

Correçäo de fístula uretrocutânea através de interposiçäo de retalho desepitelizado de pele / Correction of urethrocutaneous fistula through the interposition of de-epithelized skin flap

Quinze crianças portadoras de fístula uretrocutânea pós-neouretroplastia foram submetidas a correçäo cirúrgica, através de interposiçäo de retalho de pele desepitelizado. Obteve-se cura em 15 de 17 fístulas operadas (88%); somente em 7 crianças utilizou-se derivaçäo urinária

Avaliaçäo radiológica completa do trato urinário na infância: urografia excretora com radiografia miccional / Complete radiological evaluation of the urinary tract in children: excretory urography with urination radiography

Os autores estudaram prospectivamente, em crianças, a realizaçäo de cistouretrografia miccional durante a urografia excretora, com o constraste eliminado pelos rins. Demonstraram que a cistouretrografia miccional com introduçäo de contraste na bexiga pode ser dispensável na investigaçäo radiológica do trato urinário em 89,3% dos casos. Discutem-se as vantagens e as limitaçöes desse procedimento complementar