Effects of tadalafil to prevent injury on corpus cavernosum after vascular or nervous peri-prostatic bundle injury. Experimental model in rats

Abstract Purpose: To evaluate the effects of tadalafil (TD) in preventing histological alterations of the corpus cavernosum caused by isolated lesions of cavernous nerve (ILCN) and artery (ILCA) in rats. Methods: Fifty male Wistar rats were randomly assigned in five groups: G1: control; G2: bilateral ILCN; G3: bilateral ILCA; G4: ILCN+TD; G5: ILCA+TD. The cavernous bodies were submitted to histomorphometry, immunohistochemistry and biochemical analysis. Results: Nerve density was significantly higher in G2 and G4 compared to control (22.62±2.84 and 19.53±3.47 vs. 15.72±1.82; respectively, p<0.05). Smooth muscle density was significantly lower in G2 and G3 in comparison to G1 (12.87±1.90 and 18.93±1.51 vs. 21.78±1.81, respectively; p<0.05). A significant decrease in the sinusoidal lumen area was observed in G2 compared to controls (5.01±1.62 vs. 9.88±3.66, respectively; p<0.05) and the blood vessel density was increased in G2 and G3 (29.32±4.13 e 20.80±2.47 vs. 10.13±2.71, p<0.05). Collagen density was higher in G3 compared to G1 (93.76±15.81 vs. 64.59±19.25; p<0.05). Conclusions: Histomorphometric alterations caused by ILCN were more intense than those produced by vascular injury, but the collagen analyses showed more fibrosis in animals with ILCA. TD was effective in preventing the majority of the alterations induced by the periprostatic bundle injury.

Artificial sphincter "BR - SL - AS 904" in the treatment of urinary incontinence after radical prostatectomy: efficacy, practicality and safety in a prospective and multicenter study

ABSTRACT Purpose: The objective of the present study is to test the efficiency and practicality of a new artificial sphincter "BR - SL - AS - 904" in the control of urinary incontinence in post - PR patients and to evaluate their complications. Patients and Methods: Fifteen patients with incontinence after one year of radical prostatectomy were included prospectively. All patients underwent artificial urethral sphincter (AUS) implant "BR - SL - AS - 904" according to established technique. Independent variables such as free urinary flow, PAD weight test, ICIQ - SF score and urinary symptoms through the IPSS score were compared in different follow-up moments. Results: Patients submitted to AUS implantation did not present trans - operative or post - operative complications related to the surgical act such as: infection, hematoma, erosion or urinary retention. Device was inert to the body during the follow-up, showing an excellent adaptation of the patients, besides the easy handling. The mean age was 68.20 years 40% of the patients had systemic arterial hypertension, 6.7% diabetes mellitus, 6.7% were hypertensive and diabetic, 13.4% were hypertensive, had diabetes and hypercholesterolemia and 26.7% patients had no comorbidities. It was evidenced that the urinary flow peak during the follow-up remained stable. Decreased averages and median PAD weight test were 135.19 to 75.72 and 106.00 to 23.50, respectively. The IPSS score decreased and the quality of life increased (12.33 to 3.40 and 2.50 to 3.20 respectively). The ICQF - SF questionnaire score also showed a decrease, ranging from 16, 71 to 7.33. Conclusion: The artificial sphincter implant "BR - SL - AS 904" was reproducible, safe and effective in the control of urinary incontinence in post - PR patients.

Single-port retroperitoneal renal biopsy using standard urological instruments

Objective To describe the surgical technique and initial experience with a single-port retroperitoneal renal biopsy (SPRRB). Materials and Methods Between January and April 2013, five children underwent SPRRB in our hospital. A single 1.5 cm incision was performed under the 12th rib at mid-axillary line, and an 11 mm trocar was inserted. A nephroscope was used to identify the kidney and dissect the perirenal fat. After lower pole exposure, a laparoscopic biopsy forceps was introduced through the nephroscope working channel to collect a renal tissue sample. Results SPRRB was successfully performed in five children. The mean operative time was 32 minutes, and mean estimated blood loss was less than 10 mL. The hospital stay of all patients was two days because they were discharged in the second postoperative day, after remaining at strict bed rest for 24 hours after the procedure. The average number of glomeruli present in the specimen was 31. Conclusion SPRRB is a simple, safe and reliable alternative to open and videolaparoscopic approaches to surgical renal biopsy. .

Use of the probability of stone formation (PSF) score to assess stone forming risk and treatment response in a cohort of Brazilian stone formers

Introduction The aim was to confirm that PSF (probability of stone formation) changed appropriately following medical therapy on recurrent stone formers. Materials and Methods Data were collected on 26 Brazilian stone-formers. A baseline 24-hour urine collection was performed prior to treatment. Details of the medical treatment initiated for stone-disease were recorded. A PSF calculation was performed on the 24 hour urine sample using the 7 urinary parameters required: voided volume, oxalate, calcium, urate, pH, citrate and magnesium. A repeat 24-hour urine sample was performed for PSF calculation after treatment. Comparison was made between the PSF scores before and during treatment. Results At baseline, 20 of the 26 patients (77%) had a high PSF score (> 0.5). Of the 26 patients, 17 (65%) showed an overall reduction in their PSF profiles with a medical treatment regimen. Eleven patients (42%) changed from a high risk (PSF > 0.5) to a low risk (PSF < 0.5) and 6 patients reduced their risk score but did not change risk category. Six (23%) patients remained in a high risk category (> 0.5) during both assessments. Conclusions The PSF score reduced following medical treatment in the majority of patients in this cohort. .

Influence of clinical therapy and nutritional counseling on the recurrence of urolithiasis

PURPOSE: To evaluate the influence of combined clinical therapy and nutritional guidance on the recurrence of urolithiasis. METHODS: From our registry of patients with recurrent urolithiasis we selected 57 who had at least 5-years of follow-up. We collected 24h urine samples in order to analyze Ca, Na, uric acid, citrate, oxalate, and Mg concentrations and to assess urine volume. Patients filled out a clinical questionnaire before treatment, and abdominal radiographs and/or ultrasound were performed both before treatment and during the follow-up period. During follow-up, specific and individualized dietary advice was given based on the individual's metabolic disorders. Patients also received specific pharmacological treatment for their metabolic alterations. Outcome measures were metabolites in urine and the urolith recurrence rate. Pre- and post- intervention values were compared using tests as appropriate. RESULTS: Fifty six of the patients were male and the majority of patients were overweight. The mean BMI was 27 kg/m2. Urinary excretion of calcium, uric acid and sodium decreased significantly over the five year follow-up period. The number of uroliths that formed during the 5-year follow-up also decreased significantly compared to pre-treatment values. CONCLUSION: Individualized dietary advice combined with pharmacological treatment significantly reduces long-term urolithiasis recurrence. .

Pelvic floor muscle strength evaluation in different body positions in nulliparous healthy women and its correlation with sexual activity

Objective The aim of this study was to assess pelvic floor muscle (PFM) strength in different body positions in nulliparous healthy women and its correlation with sexual activity. Materials and Methods Fifty healthy nulliparous women with mean age of 23 years were prospectively studied. Subjective evaluation of PFM was assessed by transvaginal digital palpation (TDP) of anterior and posterior areas regarding the vaginal introitus. A perineometer with inflatable vaginal probe was used to assess the PFM strength in four different positions: supine with extended lower limbs (P1); bent-knee supine (P2); sitting (P3); standing (P4). Results Physical activity, 3 times per week, was reported by 58% of volunteers. Sexual activity was observed in 80% of women and 82% of them presented orgasm. The average body mass index (BMI) was 21.76 kg/m2, considered as normal according World Health Organization (WHO). We observed that 68% of volunteers were conscious about the PFM contraction. TDP showed concordance of 76% when anterior and posterior areas were compared (p = 0.00014). There was not correlation between PFM strength and orgasm in subjective evaluation. The PFM strength was significantly higher in standing position when compared with the other positions (p < 0.000). No statistical difference was observed between orgasm and PFM strength when objective evaluations were performed. Conclusions There was concordance between anterior and posterior areas in 76% of cases when subjective PFM strength was assessed. In objective evaluation, higher PFM strength was observed when volunteers were standing. No statistical correlation was observed between PFM strength and orgasm in nulliparous healthy women. .

Nephrocalcinosis induced by hyperoxaluria in rats

PURPOSE: To investigate nephrocalcinosis due to hyperoxaluria induced by two different inducing agents in rats. METHODS: Forty Sprague-Dawley male rats were randomly distributed into four groups: Group1 (Clinical control, n = 10); Group 2 (0.5% Ethylene Glycol + Vitamin D3, n = 10); Group 3 (1.25% Ethylene Glycol, n = 10); and Group 4 (5%Hydroxy L-proline, n = 10). Five animals from each group were euthanized after one week of follow-up (M1 Moment) and the remaining, after four weeks (M2 Moment). All animals underwent 24h urine dosages of calcium, oxalate, uric acid, citrate and serum creatinine. Histology and histomorphometric analyses were performed using Image J program in the hematoxylin-eosin stains. Calcium deposits in the renal parenchyma were quantified by PIXE technique (Proton Induced X-Ray Emission). RESULTS: 24h urinary parameters did not show any significant variations after 28 days of experiment except by hyperoxaluria that was significantly higher in Group 3. Histomorphometric analyses showed a significantly higher nephrocalcinosis in Group 2 (p<0.01). The calcium deposits in the renal parenchyma were 10 and 100 times higher in Group 2 in comparison to other groups in the M1 and M2 moments, respectively. CONCLUSION: The Group 2 (vitamin D3+Ethylene Glycol 0.5%) was the best model to induce nephrocalcinosis in rats after 28 days.

A comparative analisys of pelvic floor muscle strength in women with stress and urge urinary incontinence

AIMS: To assess pelvic floor muscle (PFM) strength in women with stress urinary incontinence (SUI) and urge urinary incontinence (UUI). MATERIALS AND METHODS: 51 women were prospectively divided into two groups, according to the symptoms as SUI (G1 = 22) or UUI (G2 = 29). Demographic data, such as number of pads/ 24 hours, number of micturations/ 24 hours and nocturia, delay time of urgent void (i.e., the time period for which an urgent void could be voluntarily postponed), number of parity and vaginal deliveries were obtained using a clinical questionnaire. Objective urine loss was evaluated by 60-min. Pad Test, subjective urine stream interruption test (UST) and visual survey of perineal contraction. Objective evaluations of PFM were performed in all patients (vaginal manometry). RESULTS: Median of age, mean number of pads / 24 hours, nocturia and warning time were significantly higher in UUI comparing to SUI group. During UST, 45.45% in G1 and 3.44%, in G2, were able to interrupt the urine stream (p < 0.001). The 60-min. Pad Test was significantly higher in G2 compared to G1 women (2.7 ± 2.4 vs 1.5 ± 1.9 respectively, p = 0.049). Objective evaluation of PFM strength was significantly higher in the SUI than in the UUI patients. No statistical difference was observed regarding other studied parameters. CONCLUSION: Pelvic floor muscle weakness was significantly higher in women with UUI when compared to SUI.

Comparison of pelvic floor muscle strength evaluations in nulliparous and primiparous women: a prospective study

OBJECTIVE: This study aimed to compare the pelvic floor muscle strength of nulliparous and primiparous women. METHODS: A total of 100 women were prospectively distributed into two groups: Group 1 (G1) (n = 50) included healthy nulliparous women, and Group 2 (G2) (n = 50) included healthy primiparous women. Pelvic floor muscle strength was subjectively evaluated using transvaginal digital palpation. Pelvic floor muscle strength was objectively assessed using a portable perineometer. All of the parameters were evaluated simultaneously in G1 and were evaluated in G2 during the 20th and 36th weeks of pregnancy and 45 days after delivery. RESULTS: In G2, 14 women were excluded because they left the study before the follow-up evaluation. The median age was 23 years in G1 and 22 years in G2; there was no significant difference between the groups. The average body mass index was 21.7 kg/m² in G1 and 25.0 kg/m² in G2; there was a significant difference between the groups (p = 0.0004). In G2, transvaginal digital palpation evaluation showed significant impairments of pelvic floor muscle strength at the 36th week of pregnancy (p = 0.0006) and 45 days after vaginal delivery (p = 0.0001) compared to G1. Objective evaluations of pelvic floor muscle strength in G2 revealed a significant decrease 45 days after vaginal delivery compared to nulliparous patients. CONCLUSION: Pregnancy and vaginal delivery may cause weakness of the pelvic floor muscles.

Prevalência e implicações da incontinência urinária e fecal em mulheres / Prevalence and implications of urinary and fecal incontinence in women

Avaliar a prevalência da incontinência urinária (IU) e fecal em mulheres atendidas no ambulatório geral do Centro de Saúde Escola - Botucatu - SP. Foram escolhidas 807 mulheres aleatoriamente responderam um questionário aplicado por entrevistadores previamente selecionados e treinados, após assinarem termo de consentimento livre e esclarecido aprovado pelo CEP. Foram distribuídas em dois grupos: GI (n=567), mulheres sem perda de urina, e grupo G2 (n=240), com perda urinária. A média de idade no GI foi de 52 anos e no G2 de 51, não havendo diferença estatisticamente significativa entre os grupos. A prevalência de incontinência urinária foi de 29,7 porcento e em 59,2 porcento a urgência estava associada. O índice de massa corpórea (IMC) foi significativamente mais alto no grupo com perda de urina em relação às mulheres continentes. Na análise de outras variáveis não houve diferença estatisticamente significativa entre os grupos estudados. No grupo de mulheres incontinentes, observou-se número significativamente mais alto de partos vaginais nas mulheres com urgência e incontinência fecal em relação às continentes. A obesidade pode ser fator contributivo ou mesmo de piora da IU. A incontinência, seja urinária de urgência ou fecal, está relacionada a número mais alto de partos vaginais.

Our objective was to evaluate the prevalence of urinary incontinence in women seen at the general outpatient service of Health-School Unit of Botucatu - UNESP. 807 women answered a questionnaire applied by interviewers previously selected and trained, after signing a free informed consent approved by CEP. They were divided into 2 groups: GI (n=567) with women without urine loss and group G2 (n=240) with urine loss. Mean age in group GI was 52 years and 51 years in G2. There was no statistically significant diference between both groups. Urinary incontinence prevalence was 29.7 percent, and in 59.2 percent of cases urgency was associated. Body mass index (BMI) was significantly higher in the group with urine loss when compared to the continent women. By analyzing other variables there was no statistically significant difference between both groups. In the incontinent group, there was a significantly higher number of vaginal deliveries in women with urgency. Considering fecal loss, vaginal deliveries had a significantly higher number among incontinent than continent women. Obesity can either contribute of worsen urinary incontinence. Fecal or urge incontinence is related to the higher number of vaginal deliveries.

Comportamento do magnésio urinário em pacientes com litíase renal / Urine magnesium in patients with nephrolithiasis

Introdução: O Magnésio é considerado como tendo efeito inibidor na cristalização, nucleação e crescimento do oxalatode cálcio. Diversos estudos têm demonstrado diferentes resultados do manuseio do magnésio pelo néfron. Objetivo: Oobjetivo deste trabalho foi estudar o comportamento do magnésio urinário nos portadores de alterações metabólicas presentesnos pacientes com litíase renal. Pacientes e Métodos: Foram estudados 182 pacientes com história de litíaserecorrente, clearance de creatinina ³ 60ml/min, ausência de proteinúria e urocultura negativa. O protocolo consistiu emdosagens urinárias de 24h de Ca, P, AcU, Na, K, Mg, Ox e Ci e dosagens séricas de glicemia, Ca, P, AcU, Na, K, Cl,Mg, U, Cr; índice CaU/MgU em urina 24h; pH urinário. Resultados: Preencheram os critérios de inclusão 158 pacientes.Destes, 151 apresentaram pelo menos uma alteração metabólica, sendo: hipercalciúria (74,0), hipocitratúria (37,3),hiperoxalúria (24,1), hipomagnesúria (21), hiperuricosúria (20,2), hiperparatireoidismo primário (1,8), secundário(0,6) e ATR (0,6). O índice CaU/MgU estava significativamente maior (p< 0,0001) nos pacientes hipercalciúricos.Conclusões: A hipomagnesúria isolada não se correlacionou com nenhuma alteração metabólica, porém o índiceCaU/MgU estava significativamente aumentado nas hipercalciúrias em comparação aos não hipercalciúricos. A partirdestes dados sugerimos que o magnésio deva ser monitorado nestes pacientes; sua reposição poderia ser mais umaopção terapêutica na prevenção de novos cálculos de cálcio.

Urodinâmica convencional versus cistometria simplificada para caracterização da incontinência urinária feminina / Conventional urodynamics versus simplified cystometry for characterization of female urinary incontinence

Objetivo: avaliar a concordância dos diferentes parâmetros urodinâmicos comparados à cistometria simplificada, permitindo uma diminuição na relação custo-benefício no diagnóstico da incontinência urinária de esforço (IUE) na mulher. Métodos: foram coletadas e avaliadas retrospectivamente as informações contidas dos prontuários de trinta pacientes acompanhadas, no período de janeiro de 2000 a março de 2001. Todas foram submetidas a exame físico geral e ginecológico. O estudo urodinâmico foi realizado pela técnica convencional, utilizando-se aparelho Dynograph Recorder R-611. A cistometria simplificada foi realizada com auxílio de um equipo em "Y" de PVC (pressão venosa central), conectado a um sonda de Foley 14 F, que permitia tanto a infusão de soro fisiológico como a captação da pressão intra-vesical. Foram analisados os parâmetros: volume residual, capacidade vesical, complacência, presença de contrações involuntárias do detrusor e perdas urinárias aos esforços. Para determinação da proporção de concordância entre os métodos foram utilizados o teste de concordância de Pearson e o teste de Wilcoxon, para amostras relacionadas. Resultados: a média de idade foi de 50 anos, com extremos variando de 28 a 70 anos. O índice de concordância entre os estudos, na demonstração das perdas urinárias aos esforços, foi de 67 por cento. Para a detecção das contrações involuntárias do detrusor, a proporção de concordância foi de 90 por cento. A média do volume residual encontrado na cistometria simplificada foi de 16,8 ml contra 2 ml da urodinâmica convencional, com diferença significativa (p < 0, 01). A média de capacidade vesical máxima no estudo urodinâmico foi de 440,5 ml enquanto que, na cistometria simplificada, foi de 387 ml (p < 0,05). A complacência vesical foi, em média, significativamente maior na cistometria simplificada (43,0 ml/cmH2O) quando comparada ao estudo urodinâmico (31,5 ml/cmH2O), com p < 0,01. Conclusão: avaliações preliminares sugerem que a propedêutica uroginecológica associada à cistometria simplificada é uma opção a ser considerada na avaliação clínica e pré-operatória de pacientes com IVE em substituiçâo à urodinâmica convencional, particularmente onde esta última não se encontra disponível. A cistometria simplificada é um exame acessível que é capaz de detectar contrações involuntárias do detrusor, assim como identificar perdas urinárias com relativa sensibilidade, proporcionando ao examinador noções fidedignas do comportamento vesical.

Eletroestimulaçäo endovaginal e cinesioterapia no tratamento da incontinência urinária de esforço / Treatment of urinar stress incontinency by intravaginal electrical stimulation and pelvic floor muscle exercises

A eletroestimulaçÝo endovaginal (EEV) e a cinesioterapia sÝo alternativas terapêuticas para pacientes portadoras de incontinência urinária de esforço (IUE). Com o intuito de avaliar a eficiência deste tipo de tratamento, sete pacientes foram submetidas a eletroestimulaçÝo endovaginal e cinesioterapia por 14 semanas. Todas as pacientes eram portadoras de IUE do tipo esfincteriana ou mista e com história de pelo menos uma tentativa de correçÝo cirúrgica, sem sucesso, em 86 por cento dos casos. Observou-se desaparecimento dos sintomas de urge-incontinência em todas as pacientes utilizando este tratamento. Também foram obtidos bons resultados em 50 por cento dos casos com seguimento médio de 10 meses. Esta modalidade terapêutica de IUE representa um procedimento nÝo invasivo que oferece bons resultados mesmo em casos de múltiplos insucessos cirúrgicos, podendo tornar-se uma alternativa atraente para pacientes com problemas clínicos importantes

Ampliaçäo vesical com dura-máter e pericárdio bovino: estudo comparativo em coelhos / Bladder augmentation with dura mater and bovine pericardium: comparative study in rabbits

Vários materiais aloplásicos têm sido preconizados na substituiçäo parcial da bexiga. Eles divergem em muitos aspectos, entre os quais o tempo adequado de reabsorçäo, a rejeiçäo, a formaçäo de cálculos, o tempo de reepitelizaçäo, a neoformaçäo de músculo e, o principal deles, a manutençäo das funçöes fisiológicas normais da bexiga, tais como: armazenamento com continência, esvaziamento adequado da urina e proteçäo aos rins. Com o objetivo de se avaliar, na bexiga, a repercussäo da cistoplastia com dura-máter e pericárdio bovino, estudaram-se, em 40 coelhos fêmeas, North Folk, com peso entre 1.350 e 4.500 g, os seguintes parâmetros: 1. cultura de urina; 2. estudo cistométrico; 3. uréia e creatinina plasmáticas. A pesquisa constou de quatro grupos experimentais, sendo cada um composto por dez coelhos, assim discriminados: G1 - Controle clínico, näo houve intervençäo cirúrgicas. G2 - Controle cirúrgico, realizamos cistectomia subtotal, e a porçäo excisada da bexiga era novamente anastomosada na regiäo trigonal. G3 - Dura-máter liofilizada, realizamos cistectomia subtotal e a parede vesical excisada era substituída por implante de dura-máter liofilizada de 3x1 cm. G4 - Pericárdio bovino, realizamos cistectomia subtotal e a parede vesical excisada era substituída por implante de pericárdio bovino de 3x1 cm. Os parâmetros foram estudados nos momentos: M1 - pré-operatório e M2 - doze semanas de pós-operatório. A avaliaçäoo cistomanométrica demonstrou näo haver diferenças significativas entre os diversos parâmetros, exceto uma tendência, em números absolutos, de reduçäo da capacidade vesical nos grupos 3 e 4. A complacência vesical ficou reduzida no grupo 4 nos diferentes momentos. Detectou-se 20 por cento de calculose vesical nos grupos 3 e 4. A análise físico-química do cálculo revelou composiçäo semelhante aos dois grupos

Oxibutinina intravesical / Intravesical oxybutynin

Os autores apresentam o caso de uma criança com bexiga neurogênica hiper-reflexa secundária a mielomeningocele, tratada inicialmente com oxibutinina por via oral e cateterismo intermitente, com bons resultados durante 18 meses. Após este período, a paciente desenvolveu náuseas e constipaçäo intestinal severa. A substituiçäo da medicaçäo oral pela via intravesical obteve bons resultados terapêuticos, com o desaparecimento dos efeitos colaterais

Ampliaçäo vesical com dura-máter e pericárdio bovino: estudo comparativo em coelhos / Vesical enlargement with dura mater and bovine pericardium: comparative study in rabbits

Vários materiais aloplásticos têm sido preconizados na substituiçäo parcial da bexiga. Eles divergem em muitos aspectos, entre os quais o tempo adequado de reabsorçäo, a rejeiçäo, a formaçäo de cálculos, o tempo de reeptelizaçäo, a neoformaçäo de músculo, e, o principal deles, a manutençäo das funçöes fisiológicas normais da bexiga, tais como: armazenamento com continência, esvaziamento adequado da urina e proteçäo aos rins. Com objetivo de se avaliar, na bexiga, a repercussäo da cistoplastia com Dura-Máter e Pericárdio Bovino, estudaram-se, em 40 coelhos fêmeas, North Folk com peso entre 1.350 e 4.500g., os seguintes atributos : 1. cultura de urina; 2. estudo cistométrico; 3. urografia excretora; 4. estudo histopatológico. A pesquisa constou de quatro grupos experimentais sendo cada grupo composto por 10 coelhos, assim discriminados : Grupo 1 - CONTROLE CLINICO. Neste grupo, näo houve intervençäo cirúrgica. Os animais foram utilizados como parâmetros clínicos, radiológicos, cistométricos e histopatológicos de normalidade. Grupo 2 - CONTROLE CIRURGICO. Realizamos cistectomia subtotal, que constituiu de excisäo da cúpula da bexiga, a cerca de 0,5 cm da regiäo do trígono. A seguir, a porçäo excisada da bexiga era reanastomizada na regiäo trigonal. Grupo 3 - DURA-MATER LIOFILIZADA. Neste grupo, realizamos cistectomia subtotal nos padröes do grupo 2 e a seguir a parede vesical excisada foi substituida por implante de Dura-Máter liofilizada de 3x1 cm. Grupo 4 - PERICARDIO BOVINO. Neste grupo, realizamos cistectomia subtotal nos mesmos padröes do grupo 2 e, a seguir, a parede vesical excisada foi substituída por implante de Pericárdio Bovino de 3x1cm fixado em glutaraldeído 0,65 por cento e armazenado em formaldeído 4 por cento. Os atributos foram estudados nos seguintes momentos: Momento inicial (M1) - pré-operatório. Momento final (M2) - 12 semanas de pós-operatório. A avaliaçäo cistomanométrica demonstrou näo haver diferenças significativas entre os diversos parâmetros, exceto em dois aspectos relevantes : 1. tendências em números absolutos de menor capacidade vesical no momento M2 nos grupos 3 e 4; 2. houve diferença significativa na complacência vesical ( = M2-M1,Tab.15) no grupo 4 (Pericárdio Bovino) comparada ao G1 e G2. Podendo este fato estar relacionado com o grau de fibrose que é maior no Grupo 4; porém sem repercussöes funcionais significativas. Os estudos histológicos revelaram completa epitelizaçäo e reabsorçäo dos implantes ...

Fístula uretero-vaginal: análise de cinco casos / Ureterovaginal fistula: reviewed five cases

A fístula uretero-vaginal (FUV) pode ocorrer em conseqüência a intervençöes cirúrgicas da cavidade pélvica. No período de janeiro de 1975 a outubro de 1990 foram estudados cinco casos de fístula uretero-vaginal. A idade média foi de 44 anos, variando de 28 a 66 anos. A lesåo ureteral foi bilateral em um caso (20 por cento) e unilateral em quatro (80 por cento), sendo três (75 por cento) à direita. Em todos os casos havia perda urinária contínua com micçöes intermitentes. A urografia excretora e a pielografia ascendente foram exames decisivos na confirmaçåo diagnóstica. O intervalo entre o diagnóstico e o tratamento variou de três a 28 semanas. A correçåo da FUV foi realizada por reimplante uretero-vesical em cinco ureteres e por anastomoose uretero-ureteral em um caso. Os resultados foram bons em quatro pacientes, com um seguimento de 12 meses. O único caso de insucesso ocorreu em uma paciente submetida previamente a tratamento radioterápico