Should a Refluxing Internal Diversion Be Considered a Temporizing Procedure? Extended Follow-up and Outcomes After Side-to-Side Ureterovesicostomy for Primary Obstructive Megaureter in Young Children.

PURPOSE: We describe long-term outcomes, including UTIs and need for reimplantation, after ureterovesicostomy (UV) as a lasting surgical procedure for children with primary obstructive megaureter (POM). MATERIALS AND METHODS: Children referred to our institution between 2016 and 2023 who underwent refluxing UV were analyzed. POM was defined as hydroureteronephrosis with distal ureteral dilatation > 7 mm and a negative workup for other etiologies of hydronephrosis. We assessed for surgical outcomes, complications, rate of UTI, and improvement in upper tract dilatation. Statistical analyses assessed for change in hydronephrosis metrics over follow-up. RESULTS: Among 183 patients diagnosed with POM, 47 (24%) underwent UV. Median age of presentation, surgery, and follow-up was 2, 9, and 43 months, respectively. A total of 7 patients developed 30-day complications: Clavien-Dindo grade 1 in 2 (transient urinary retention) and grade 2 in 5 (UTIs). During monitoring 14 (30%) developed UTIs and 7 (15%) required ureteral reimplant or UV takedown. After surgery there was a significant decrease in the proportion of patients with high-grade hydronephrosis, anteroposterior renal pelvis diameter, and maximum ureteral dilatation. CONCLUSIONS: Refluxing UV is a safe alternative to cutaneous diversion in POM. Most patients had improvement in upper tract dilatation with an acceptable short-term complication rate and need for reoperation (in comparison to routine later reimplantation). Our experience suggests that monitoring alone after UV is feasible, and that selective subsequent reconstruction is a reasonable strategy.

[The mediating effects of self-efficacy between symptom experience and quality of life in prostatic hyperplasia patients after cystostomy].

OBJECTIVE: To evaluate the symptom experience of patients with benign prostatic hyperplasia and bladder fistula. Exploring the mediating effect of self-efficacy on the relationship between symptom experience and quality of life in patients with benign prostatic hyperplasia undergoing long-term indwelling cystostomy. METHODS: This study used a cross-sectional survey design. Patients with prostatic hyperplasia with cystostomy in the Urology department of General Hospital of Eastern Theater Command from January 2020 to February 2023 were selected, and relevant data were collected by IPSS, IIEF-5, HAMD, GSES, and quality of life score scale for statistical analysis. We then construct a structural equation model to evaluate the mediating effect of self-efficacy between symptom experience and quality of life. RESULTS: The average score of IPSS was (22.55±8.26) ; the average score of IIEF-5 was (10.54±4.10) ; the average score of HAMD was (6.82±2.35) ; the average score of self-efficacy was (20.80±8.65) ; and the average score of quality of life was (71.65±12.55) . Symptom experience was significantly negatively correlated with self-efficacy and quality of life( r=－0.496 , P<0.01；r=－0.518 , P<0.01) . Self-efficacy was significantly positively correlated with quality of life( r= 0.412，P<0.05). Symptom experience significantly negatively affected quality of life through self-efficacy (Effect = －0.218，P = 0.014) . CONCLUSION: Self-efficacy is positively correlated with the quality of life of patients with benign prostatic hyperplasia who have long-term indwelling cystostomy tube. Nursing staff can improve the level of self-efficacy of patients by implementing corresponding interventions.

Single-step, non-surgical placement of permanent low-profile cystostomy tubes in dogs: 10 cases (2018-2023).

OBJECTIVES: Low-profile cystostomy tubes provide an alternative to conventional cystostomy tubes with external tubing. Previously, these have been placed surgically involving coeliotomy, cystotomy and cystopexy, or have been used as replacement tubes in existing stoma sites. The purpose of this study is to describe a technique for, and the outcomes of, single-step, non-surgical low-profile cystostomy tube placement. MATERIALS AND METHODS: All cases that had single-step, non-surgical placement of low-profile cystotomy tube attempted at the authors' institutions were included in this study. Data, including success rates, outcomes and complications, were extracted from the medical records. RESULTS: Ten client-owned dogs were inclided. Single-step, non-surgical placement was successful in eight out of 10 dogs, with placement being unsuccessful in two thus necessitating coeliotomy. The median duration that low-profile cystostomy tubes were in place was 7.0 months (range 4 days to 38 months). Seven of the eight dogs required replacement of their cystostomy tube. Mean time until first tube replacement was 103 days (range 13 to 363 days). CLINICAL SIGNIFICANCE: Single-step, non-surgical placement of a low-profile cystostomy tube is a viable alternative to surgical placement. Lack of cystopexy does not appear to result in complications. Conversion to coeliotomy might be required if tube placement is not successful with this technique. Complications seen with non-surgical tube placement such as inadvertent tube removal were similar to those previously reported for surgically placed tubes.

Modified tube cystostomy technique for management of obstructive urolithiasis in small ruminants: procedure and outcome in 17 sheep and goats.

OBJECTIVE: To describe the surgical technique and clinical outcome of small ruminants treated for obstructive urolithiasis using a modified tube cystostomy (MTC) technique. ANIMALS: 15 goats and 2 sheep treated with an MTC between March 2018 and February 2023. CLINICAL PRESENTATION: Animals were diagnosed with obstructive urolithiasis on the basis of history, physical examination, and ultrasonographic examination. An MTC was performed with sedation and a local block. Postoperative medical management was instituted to help reestablish urethral patency, and Foley catheters were removed after successful urination. RESULTS: Animals were hospitalized an average of 3 nights (range, 0 to 14 nights). Complications included urine spillage in the abdomen and accidental deflation of the Foley balloon. Six animals were euthanized due to poor prognosis or failure to regain urethral patency. Foley catheters were removed an average of 15.7 days postoperatively in animals that regained urethral patency. Long-term (> 1-month) follow-up was available for 8 animals, with an average postoperative survival time of 19.4 months (range, 1 to 58 months). Four animals were lost to long-term follow-up. CLINICAL RELEVANCE: This MTC technique is an effective means of catheterizing the urinary bladder in small ruminants. It can be performed under field conditions and serve as a standalone procedure for providing temporary urine egress. Patient size is limited by the length of the introducer, and an intact, distended urinary bladder and plan for reestablishing urethral patency are important considerations.

Isolated continent cystostomy on neurologic native bladder: Functional results.

INTRODUCTION: Continent cutaneous urinary diversion (CCUD) is proposed to patients suffering from chronic neurologic retention and undergoing intermittent self-catheterization (ISC). In case of neurogenic detrusor overactivity (NDO), augmentation enterocystoplasty is often required. The aim was to identify the prevalence of urinary stomal and/or urethral leakage in patients who had not undergone enlargement. METHODS: Monocentric, retrospective study of patients who underwent CCUD surgery in a neuro-urological context. Mitrofanoff's, Monti's or Casale's channels were performed. Patients selected had an underactive, stable, or stabilized bladder under adjuvant therapy with proper cystomanometric capacity. Prior or concomitant enterocystoplasty were excluded. Failure was defined as the occurrence of clinical leakage whatever it is through urinary stomal, or urethral. Urodynamic parameters were also reported. RESULTS: Thirty-one patients underwent surgery. Nine women had a concomitant bladder neck sling and 1 urethral closure. The mean follow-up was 7 years. 8/31 (26%) had stomal leakage and 9 urethral leakage (29%). Five spinal cord injured patients (n=14) had stomal leakage (36%) and 6 urethral leakage (43%). Of the 25 postoperative urodynamic parameters, cystomanometric bladder capacity was 419mL (vs. 514mL) and 2 additional patients had de novo NDO (9 vs. 7). DISCUSSION: The morbidity of augmentation enterocystoplasty is weighed against the presence of a well-controlled bladder preoperatively. Our study shows the appearance of leakage in some patients despite a well-balanced bladder, a decrease in mean cystomanometric capacity and an increase in the rate of NDO postoperatively. Good selection criteria for an isolated CCUD should be carefully revised and defined. LEVEL OF EVIDENCE: Grade C - retrospective study.

Tomografía computarizada con reconstrucción 3D para el diagnóstico de lesiones traumáticas de uretra / Three-dimensional computed tomography reconstruction for the diagnosis of traumatic urethral injuries

RESUMEN La uretrografía retrógrada es la técnica de referencia (gold standard) utilizada clásicamente para hacer diagnóstico de lesiones de uretra. En este contexto se presenta un caso en el que se realizó tomografía computarizada con reconstrucción 3D con contraste intravenoso y endouretral, pudiendo reconstruir la uretra en toda su extensión en forma tridimensional. De esta manera se arribó al diagnóstico de certeza de la lesión de uretra. Como ventaja del método se menciona la posibilidad de diagnosticar ‒ con un solo estudio por imágenes‒ lesiones de todo el tracto urinario, órganos sólidos, huecos y lesión del anillo pélvico asociados al traumatismo, con una alta sensibilidad y especificidad sin necesidad de requerir otros estudios complementarios.

ABSTRACT Retrograde urethrography is the gold standard method for the diagnosis of urethral injuries. In this setting, we report the use of computed tomography with intravenous injection and urethral administration of contrast medium and 3D reconstruction of the entire urethra. The definitive diagnosis of urethral injury was made. The advantage of this method is the possibility of making the diagnosis of traumatic injuries of the entire urinary tract, solid organs, hollow viscera and of the pelvic ring within a single imaging test, with high sensitivity and specificity, with no need to perform other complementary tests.

Linfoma primário do pênis: relato de caso / Primary penile lymphoma: case report

Objetivo: Relatar o caso de um paciente diagnosticado com linfoma peniano primário, um dos subtipos menos comuns de câncer de pênis. Caso clínico: Paciente masculino, 63 anos, hígido, com queixa de ulcerações dolorosas em região balano-prepucial. Sem queixas urinárias, traumatismo peniano ou relação sexual desprotegida. Ao exame inicial, pênis com prepúcio exuberante, sinais de má higiene, tecido necrótico em glande e parafimose. Optou-se por postectomia, desbridamento de glande e cistostomia de proteção, com anatomopatológico demonstrando neoplasia maligna pouco diferenciada e análise imuno-histoquímica sugerindo linfoma de células B. O paciente realizou seis ciclos de quimioterapia, com remissão completa dos sintomas no quarto ciclo. Foi submetido à reconstrução de uretra e glande posteriormente, pela técnica de Mathieu (retalho cutâneo). Comentários: O linfoma peniano primário é ainda pouco relatado e conhecido. Ainda que seu manejo seja controverso, a quimioterapia adjuvante com terapia cirúrgica reconstrutiva se demonstrou uma opção eficiente de tratamento

Objective: To report the case of a patient diagnosed with primary penile lymphoma. Clinical case: A 63-years-old male patient presented with ulcerated lesions on the penis with a 2-week evolution. The patient denied urinary symptoms, penile trauma, or unprotected sex. The initial examination showed a penis with an exuberant foreskin and signs of poor local hygiene, with paraphimosis and necrotic tissue on the gland. A postectomy and debridement of the gland was performed, and the anatomopathological exam showed poorly differentiated malignancy, while the immunohistochemical analysis suggested B-cell lymphoma. The patient was submitted to six cycles of chemotherapy, with complete remission of the symptoms after the fourth cycle. In sequence, a reconstruction of the urethra and glans was performed using the Mathieu's technique. Comments: Primary penile lymphoma is still a poorly reported disease. Although its management remains controversial, adjuvant chemotherapy with reconstructive surgical therapy showed to be an efficient approach

Development and evaluation of a training model for paracentetic suprapubic cystostomy and catheterization

OBJECTIVES: Minimally invasive paracentetic suprapubic cystostomy is a technique that should be learned by all surgical trainees and residents. This study aimed to develop a self-made training model for paracentetic suprapubic cystostomy and placement of the suprapubic catheter and then to evaluate its effectiveness in training fourth-year medical students. METHODS: Medical students were divided into an experimental group receiving comprehensive training involving literature, video, and model use and a control group receiving all the same training protocols as the experimental group except without hands-on practice using the model. Each student's performance was video-recorded, followed by subjective and objective evaluations by urology experts and statistical analysis. RESULTS: All students completed the surgical procedures successfully. The experimental group's performance scores were significantly higher than those of the control group (median final performance scores of 91.0 vs. 86.8, respectively). Excellent scores were achieved by more students in the experimental group than in the control group (55% vs. 20%), and fewer poor scores were observed in the experimental group than in the control group (5% vs. 30%). CONCLUSIONS: Based on its cost-effectiveness, reusability, and training effectiveness, this paracentetic suprapubic cystostomy training model is able to achieve goals in teaching practice quickly and easily. Use of the model should be encouraged for training senior medical students and resident physicians who may be expected to perform emergent suprapubic catheter insertion at some time.

Vesicostomy button: how is it placed, in whom, and how is quality of life affected?

ABSTRACT Purpose The vesicostomy button has been shown to be a safe and effective bladder management strategy for short- or medium-term use when CIC cannot be instituted. This study reports our use with the vesicostomy button, highlighting the pros and cons of its use and complications. We then compared the quality or life in patients with vesicostomy button to those performing clean intermittent catheterization. Materials and Methods Retrospective chart review was conducted on children who had a vesicostomy button placed between 2011 and 2015. Placement was through existing vesicostomy, open or endoscopically. We then evaluated placement procedure and complications. A validated quality of life questionnaire was given to patients with vesicostomy button and to a matched cohort of patients performing clean intermittent catheterization. Results Thirteen children have had a vesicostomy button placed at our institution in the 4 year period, ages 7 months to 18 years. Indications for placement included neurogenic bladder (5), non-neurogenic neurogenic bladder (3), and valve bladders (5). Five out of 7 placed via existing vesicostomy had leakage around button. None of the endoscopically placed buttons had leakage. Complications were minor including UTI (3), wound infection (1), and button malfunction/leakage (3). QOL was equal and preserved in patients living with vesicostomy buttons when compared to CIC. Conclusion The vesicostomy button is an acceptable alternative to traditional vesicostomy and CIC. The morbidity of the button is quite low. Endoscopic insertion is the optimal technique. QOL is equivalent in patients with vesicostomy button and those who perform CIC.

Cuidado integral à pessoa estomizada na atenção básica - conhecimento e atuação do enfermeiro / Complete care for the stomizedperson in primary care - knowledge and nursing activities / Cuidado integral a la persona con ostomía en la atención básica - conocimiento y actuación del enfermero

O cuidado integral à pessoa com estomia é atividade realizada pelo enfermeiro na atenção básica, logo após a alta hospitalar cirúrgica, efetivando cuidados específicos de enfermagem, esclarecendo as dúvidas do usuário e familiares e orientando para o autocuidado e prevenção de possíveis complicações.O estudo teve como objetivo apreciar o conhecimento e a atuação do enfermeiro no cuidado à pessoa estomizada na atenção básica. Estudo com caráter qualitativo, exploratório e descritivo, utilizou para coleta de dados uma entrevista semiestruturada com questões norteadoras, gravadas e transcritas na íntegra, aplicada a vinte e seis enfermeiros da atenção básica municipal. A partir da análise de conteúdo temático, emergiram as seguintes categorias: identificando o cuidado com os estomas e,percepções do enfermeiro a respeito da assistência prestada ao estomizado. O ensino de enfermagem e a educação permanente poderão contribuir para uma atuação competente e eficaz de cuidado integral ao estomizado, e isso refletiria no processo adaptativo e na qualidade de vida dos estomizados e de suas famílias. [AU]

Complete care for the person with the stoma is an activity performed by the nurse in primary care, shortly after discharge from the hospital, carrying out specific nursing care, explanation to user and family doubts, and guidelines for self-care and prevention of possible complications. The study aimed to appreciate the knowledge and the performance of nurses caring for the stomized person in primary care. A qualitative, exploratory and descriptive study, for data collection a semi-structured interview, with guiding questions, recorded and transcribed in full, applied to twenty-six nurses of the municipal primary care were used. From the analysis of the thematic content emerged the following categories: identifying care with the ostomy; the nurses' perceptions regarding the assistance provided to the ostomy patient. Nursing education and permanent education can contribute to a competent and effective performance of integral care to the ostomy patient, and this would reflect in the adaptive process and quality of life of thestomized patients and their families. [AU]

El cuidado integral a la persona con ostomía es la actividad realizada por el enfermero en la atención básica tras el alta hospitalaria quirúrgica, realizando cuidados específicos de enfermería, aclarando las dudas del usuario y los familiares; y orientando para el autocuidado y la prevención de posibles complicaciones. El estudio tuvo como objetivo evaluar el conocimiento y la actuación del enfermero en el cuidado a la persona con ostomía en la atención básica. El estudio, con carácter cualitativo, exploratorio y descriptivo, utilizó para la recolección de datos entrevista semiestructurada, con cuestiones orientadoras, grabadas y transcriptas en su totalidad, aplicada a veintiséis enfermeros de la atención básica municipal. A partir del análisis del contenido temático surgieron las siguientes categorías: identificando el cuidado con los estomas; percepciones del enfermero sobre la atención prestada a la persona con ostomía. La enseñanza de enfermería y la educación permanente podrán contribuir para una actuación competente y eficaz de cuidado integral al paciente con ostomía, y eso reflejaría en el proceso adaptativo y en su calidad de vida y de sus familias. [AU]

Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates

Introduction To determine the parameters affecting the outcome of ureteroneocystostomy (UNC) procedure for vesicoureteral reflux (VUR). Materials and Methods Data of 398 patients who underwent UNC procedure from 2001 to 2012 were analyzed retrospectively. Different UNC techniques were used according to laterality of reflux and ureteral orifice configuration. Effects of several parameters on outcome were examined. Disappearance of reflux on control VCUG or absence of any kind of UTI/symptoms in patients without control VCUG was considered as clinical improvement. Results Mean age at operation was 59.2 ± 39.8 months and follow-up was 25.6 ± 23.3 months. Grade of VUR was 1-2, 3 and 4-5 in 17, 79, 302 patients, respectively. Male to female ratio was 163/235. UNC was performed bilaterally in 235 patients and intravesical approach was used in 373 patients. The frequency of voiding dysfunction, scar on preoperative DMSA, breakthrough infection and previous surgery was 28.4%, 70.7%, 49.3% and 22.4%, respectively. Twelve patients (8.9%) with postoperative contralateral reflux were excluded from the analysis. Overall clinical improvement rate for UNC was 92%. Gender, age at diagnosis and operation, laterality and grade of reflux, mode of presentation, breakthrough infections (BTI) under antibiotic prophylaxis, presence of voiding dysfunction and renal scar, and operation technique did not affect the surgical outcome. However, the clinical improvement rate was lower in patients with a history of previous endoscopic intervention (83.9% vs. 94%). Postoperative UTI rate was 27.2% and factors affecting the occurrence of postoperative UTI were previous failed endoscopic injection on univariate analysis and gender, preoperative BTI, postoperative VUR state, voiding dysfunction on multivariate analysis. Surgery related complication rate was 2% (8/398). These were all low grade complications (blood transfusion in 1, hematoma under incision ...

Síndrome de la bolsa de orina púrpura: un fenómeno inusual y muy llamativo / Purple urine bag syndrome: Report of one case

Purple urine bag syndrome is an uncommon but particularly striking phenomenon observed in people with urinary catheters and co-existent urinary tract infections. A chemical reaction between plastic and certain bacterial enzymes results in an intense purple urine color. We report a 72 year-old male with a cystostomy. A purple coloration of his urinary drainage bag and tubing was noted in the context of a urinary tract infection caused by Citrobacter freundii.

Cistostomia / Cistostomy

Historicamente a abordagem da bexiga foi procedimento temido devido à alta morbidade. No século XIX foi proposto o acesso à bexiga por via suprapúbica, extraperitoneal, passando a ser amplamente utilizado. A cistostomia é a derivação vesical na qual se coloca um cateter no interior da bexiga, através da parede abdominal. São descritas as técnicas a céu aberto e por punção suprapúbica, suas indicações, contra-indicações e complicações.

Historically, surgery of the bladder has been feared due to the high morbidity associated with the procedure. In the nineteenth century, suprapubic, extraperitoneal access to the bladder was proposed and has been widely employed since then. Cystostomy is the vesical derivation in which a catheter is placed inside the bladder, through the abdominal wall. Here we discuss open surgical techniques and techniques involving suprapubic puncture, their indications, contraindications, and complications.

Straddle injuries to the bulbar urethra: management and outcome in 53 patients

Objective: To describe our experience with blunt injuries to the bulbar urethra and their late sequelae to identify factors that may affect patient outcome. Materials and Methods: A retrospective study was performed on 53 male patients who presented, between January 2001 and December 2005, with blunt traumatic injury to the bulbar urethra. The definitive diagnosis of urethral rupture was made by retrograde urethrography, where urethral rupture was classified into partial or complete. The minimum follow-up period was 3 years. The initial management was either suprapubic cystostomy or endoscopic urethral realignment over a urethral catheter using a cystoscope to pass a guide-wire over which the catheter was inserted. Stricture formation was managed by visual internal urethrotomy (VIU) for passable strictures and urethroplasty (stricture excision and re-anastomosis) for impassable strictures or recurrence after VIU. The follow-up period was three years. The results were analyzed by SPSS software (chi-square and Student's-t-test). Results: Stricture formation occurred in 19 of 22 patients (86 percent) with complete urethral rupture and in 10 of 31 (32 percent) with partial rupture (p < 0.001). Strictures occurred in 11 of 31 (35 percent) patients treated initially with suprapubic cystostomy and in 18 of 22 (82 percent) treated with primary urethral realignment (p < 0.001). The success rate after VIU was 15 percent (4 of 26 patients) and after urethroplasty it was 96 percent (24 of 25 patients) (p < 0.001). Conclusions: Suprapubic cystostomy is better than urethral realignment and catheterization as primary management after straddle injury to the bulbar urethra. Stricture excision and re-anastomosis is better than VIU as delayed management for strictures that develop after straddle injury to the bulbar urethra.

A new extra-abdominal channel alternative to the mitrofanoff principle: experimental and preliminary clinical experience

INTRODUCTION: The appendix is the gold-standard channel for the Mitrofanoff principle in pediatric urology, but the search for alternatives is justified considering it may not be available or preferably used for colonic stomas (Malone antegrade continence enema). The aim of this study is to report on technical feasibility of a new approach for creating catheterizable channels in a rabbit model and to present our preliminary clinical experience. MATERIAL AND METHODS: We configured a tube from two rectangular skin flaps 1x4 cm opposite each other in the middle line of the lower inferior abdomen. The channel was anastomosed to the bladder dome with embedding sutures to create a valvular mechanism. The experimental study consisted of 12 rabbits, divided in 4 groups according to the sacrifice schedule at 2, 4, 8 and 12 weeks. At 30th postoperative day, an urodynamic evaluation was performed to record continence of the stoma. A histological analysis of the specimens stained with hematoxylin-eosin, Masson trichrome and Picrosirius red was also done in group 2 (sacrifice at 4 weeks postoperatively). We used this method in 3 patients with congenital non-neurogenic bladder disease presenting with massive residual volumes without compliance deficits. RESULT: The technique proved feasible in all animals, 9 of 12 could be easily catheterized and underwent urodynamic study. No stoma leakage was observed in 7 animals at high bladder pressures (> 50 cm H20) and only 2 animals had some leakage at 40 cm H20. Urodynamics performed through the stoma showed urethral leakage at 20 cm H20, therefore demonstrating the efficacy of the valvular mechanism. Histological analysis confirmed good integration between the tube and the bladder. Mean follow-up of the clinical series (3 patients) was 7.2 months. Two patients remained continent up to 4 hours, whereas 1 patient had some leakage after 2 hours. CONCLUSION: We were able to confirm feasibility of a new extra-abdominal...

Comparison of two experimental models of urodynamic evaluation in female rats / Comparação de dois modelos experimentais para avaliação urodinâmica em ratas

PURPOSE: Urodynamic studies in small animals can be performed through urethral sounding or cystostomy. OBJECTIVE: To compare the two methods of urodynamic evaluation in female rats. METHODS: Ten female rats weighing on average 250g, under anesthesia with urethane (1,25 mg/kg) were submitted in three repeats to an urethal catheter of 0,64 mm in external diameter for cystometric measurements of vesicle pressure(VP1) and contraction time (CT1). The catheter was extracted at a constant velocity of 0.05 cm/minute until complete exteriorization and determinations of maximal urethral pressure (UP1) and functional urethral length (FUL1). This was followed by a cystostomy with catheter PE50 and a new determination of the vesical pressure (VP2). After bladder denervation, a new cystometric record indirectly infered the maximum urethral closure pressure (UP2). The peak urethal pressure (UP3) and the functional urethral length (FUL2) were determined in another urethral sounding. The pressure registration system consisted of a continuous infusion pump regulated to a flow of 0.1 ml/minute connected both to the cystostomy catheter (PE-50) or the urethal catheter (0.64mm) and the polygraph Narco-Biosystem. Statistical analysis employed the Wilcoxon non-parametric test RESULTS: Mean VP1= 48,2 mmHg (11,8 SD); Mean VP2 = 38,2 mmHg (9,0 SD) "p" (VP1 X VP2) = 0,0039. Mean CT1=30,2 s (21,5 SD); Mean CT2=20,0 s(7 SD) p (CT1 X CT2) = 1,28. Mean UP1 = 47,2 mmHg (6,5 SD); Mean UP2 = 21,3 mmHg (6,6 SD), mean UP3 = 40,7 mmHg(13,3 SD) p (UP1 X UP2) = 0,002; "p" (UP1 X UP3) = 0,084; p (UP2 X UP3) = 0,002. Mean FUL1=14,2 mm (1,9 SD); Mean FUL2= 14,1mm (1,9 SD); p (FUL1 X FUL2) = 0,64. CONCLUSIONS: The methods employed to evaluate vesical and urethral pressures are different. The presence of the urethral catheter may be an obstructive factor. Surgical denervation up to the bladder neck level does not compromise urethral function.

INTRODUÇÃO: O estudo urodinâmico em ratas pode ser realizado através de sondagem vesical por via uretral ou por cistostomia. O objetivo deste estudo foi comparar estes dois métodos. MÉTODOS: Foram utilizadas 10 ratas da raça Wistar, peso médio de 250 gramas, anestesiadas com uretana (1,25 mg/kg). Inicialmente foi realizado estudo por sonda uretral (0,64 mm de diâmetro externo) para determinação da pressão vesical (PV1) e tempo de contração (TC1), após isto a sonda foi tracionada a velocidade constante (0,05 cm/m) até sua exteriorização pelo meato uretral, avaliando-se a pressão uretral máxima (PU1) e o comprimento funcional uretral (CFU1). Fez-se, então, a cistostomia (sonda PE50) para determinação da pressão vesical (PV2). A seguir, realizou-se desnervação cirúrgica da bexiga e realizou-se novo registro cistométrico para se inferir a pressão uretral indireta (PU2). Logo após, foi passada sonda uretral para determinação da pressão uretral máxima (PU3) e do comprimento funcional uretral (CFU2). O sistema de registro das pressões foi constituído de uma bomba de infusão contínua regulada para 0,1 ml/minuto conectada em Y com o cateter de cistostomia (PE-50) ou cateter uretral (0,64mm) a um polígrafo Narco-Bioystem. A análise estatística foi realizada através do método não paramétrico de Wilcoxon. RESULTADOS: Média PV1= 48,2 mmHg (11,8 SD); Média PV2 = 38,2 mmHg (9,0 SD). "p" (PV1 X PV2) = 0,0039. Média TC1=30,2 s (21,5 SD); Média TC2=20,0 (7 SD) p (TC1 X TC2) = 1,28. Média PU1 = 47,2 (6,5 SD); Média PU2 = 21,3 mmHg (6,6 SD), média PU3 = 40,7(13,3 SD) p (PU1 X PU2) = 0,002; "p" (PU1 X PU3) = 0,084; p (PU2 X PU3) = 0,002. Média CFU1=14,2 (1,9 SD); Média CFU2= 14,1 (1,9 SD); p (CFU1 X CFU2) = 0,64. CONCLUSÃO: Os métodos de avaliação urodinâmica são diferentes. A presença do cateter na uretra pode ser um fator obstrutivo. A desnervação cirúrgica, até o nível do colo vesical, não compromete a função uretral.

Rabdomiosarcoma de vejiga: Presentación de un caso / Urinary bladder rhabdomyosarcoma: A case report

Se presenta el caso de una paciente de 52 años de edad que acudió a la consulta de Ginecología por un aumento de volumen en el abdomen. Se le indicó ingreso, se estudió y se diagnosticó un tumor gigante de víscera ginecológica. Se decide tratamiento quirúrgico mediante laparatomía. Durante el acto quirúrgico se demuestra que la tumoración corresponde a la vejiga, por lo que se solicita la presencia de un urólogo. Continuamos la intervención y encontramos una tumoración grande, de base ancha, que ocupa la parte posterior y lateral izquierda de la vejiga, con áreas de necrosis de color blanquecino y consistencia algo blanda. Se cateteriza el meato ureteral derecho, el izquierdo no es visible y se realiza la exéresis del tumor. Se deja una sonda Foley No. 20 por cistostomía y uretral, se cierra la vejiga en dos planos y se revisa la cavidad abdominal. Se encontraron útero y ovarios normales; colón, intestino e hígado normales. En el estudio histológico se demostró que la tumoración es un rabdomiosarcoma pleomórfico. Se siguió su evolución y se realizaron interconsultas con el servicio de oncología para el tratamiento posterior(AU)

The case of a 52-year-old female patient that was seen at the Gynecology office due to an increase of volume in the abdomen, is reported. She was admitted, studied and diagnosed a giant tumor of gynecological viscus. It was decided to perform laparotomy. During surgery, it was observed that the tumor corresponded to the urinary bladder, so an urologist was requested. The operation continued and a big tumor of wide base was found that occupied the posterior and lateral left part of the urinary bladder, with necrosis areas of whitish color and a little soft consistency. The right ureteral meatus was catheterized, the left was not visible, and exeresis of the tumor was performed. A Foley catheter no. 20 was left by cystotomy. The urinary bladder was closed in 2 planes, and the abdominal cavity was checked. Normal uterus, ovaries, colon, intestine and liver were found. In the histological study, it was proved that the tumor was a pleomorphic rhabdomyosarcoma. Its evolution was followed and interconsultations were made with the oncology service for further treatment(AU)

Efeito do cloridrato de oxibutinina na hiperatividade vesical conseqüente a cistite hemorrágica / Effects of oxybutynin in bladder hyperactivity caused by hemorrhagic cystitis

INTRODUÇAO: A oxibutinina atua como agente anticolinérgico que tem ação anti-muscarínica e, principalmente, ação antiespasmódica na musculatura lisa vesical. Assim, ela causa aumento da capacidade vesical e diminui a frequência miccional e bloqueia o estímulo inicial da micção. OBJETIVO: Verificar se a oxibutinina atua sobre a hiperatividade vesical causada pela cistite hemorrágica, dependente do óxido nítrico. MÉTODOS: Foram estudados dois grupos de animais. O controle com 5 ratas e o experimental com 10 ratas, cujos pesos variaram entre 200g a 250g. A cistite hemorrágica foi provocada pela injeção intraperitoneal de ciclofosfamida 200mg/kg, na véspera do experimento. Após 24 horas, as ratas foram anestesiadas com uretana 1,25mg/kg. A seguir, foi feita cistostomia com cateter P-50. Esse cateter foi conectado em Y a uma bomba de infusão contínua com fluxo de água de 0,3ml/min e a um polígrafo para o registro da cistometria. O registro cistométrico foi feito com a velocidade do papel de 0,05cm/seg, com sensibilidade de 20 e calibração para um curso de 60mm para uma pressão de 100mmHg. Os parâmetros estudados foram: freqüência de contração (Fc), intensidade das contrações (Ic), tempo de enchimento vesical (Te), tempo de contração vesical (Tc) e capacidade vesical (Cv), que foi determinado pelo Te x Fluxo. Esses parâmetros foram determinados por suas médias durante o período de observação de 10 min. Após o registro, foi infundido por gavagem 71 mg/kg de cloridato de oxibutinina. Uma hora depois foi feita nova cistometria. A análise estatística foi feita pelo método de Kruskal-Wallis que comparou os valores do grupo controle com o experimental. O p foi considerado significante quando menor que 0,05. RESULTADOS: A comparação entre os dois grupos dos parâmetros estudados antes da infusão do cloridrato de oxibutinina mostrou: Fc - p=0,007; Ic - p=0,0002; Te - p=0,768; Tc - p=0,492; Cv - p=0,056 A comparação dos parâmetros estudados depois da droga mostrou: Fc - p= 0,055; Ic - p=0,0002; Te - p=0,957; Tc - p=0,181; Cv - p=0,206. CONCLUSÕES: O cloridrato de oxibutinina nesse modelo experimental atuou de forma a alterar somente a freqüência das miccções, controlando a hiperatividade e não promovendo alterações nos demais parâmetros estudados.