Hiperplasia prostática benigna (HPB), sintomas do trato urinário inferior (LUTS) e função sexual / Benign Prostatic Hyperplasia (BPH), Lower Urinary Tract Symptoms (LUTS), and Sexual Function

A hiperplasia prostática benigna (HPB) representa o crescimento não maligno do tecido da próstata. Proliferação de células estromais e epiteliais na zona de transição da próstata causa compressão uretral e obstrução do fluxo vesical. Isso pode levar a manifestações de LUTS (lower urinary tract symptoms): urgência urinária, noctúria, dificuldades de micção, esvaziamento incompleto da bexiga, menor força e/ ou interrupção do jato e inflamações. Mecanismos do LUTS/HPB compartilhados afetam a função sexual masculina. Atividade aumentada de subtipos de receptores α1-adrenérgicos na próstata está associada à HPB. Tais receptores, também presentes no pênis, podem inibir a ereção, devido à HPB. Quanto à correlação entre LUTS e disfunção sexual, aventa-se que ambas resultem da contração anômala da musculatura lisa, por ativação dos receptores α1-adrenérgicos. LUTS/HPB causam desconforto nos homens, devido à obstrução urinária, ejaculação dolorosa, disfunção erétil (DE), distúrbios ejaculatórios e baixa libido, que prejudicam a qualidade de vida, deles e de suas parcerias. A noctúria interfere negativamente na qualidade do sono e na disposição para a atividade sexual. Tratamentos para LUTS/HPB podem induzir disfunções sexuais. Entre eles, ressecção transuretral (RTU), α1-bloqueadores, inibidores da 5α-redutase e terapia combinada (α1-bloqueador e 5α-redutase). Os efeitos prejudiciais do LUTS/HPB e de seu tratamento sobre a função sexual ainda são subdiagnosticados e insuficientemente tratados. A atividade sexual deve ser investigada antes e durante o tratamento, também orientando o paciente sobre os possíveis efeitos de cada opção terapêutica sobre a função sexual, evitando-se assim o abandono do tratamento.

Primary Health Care nurses' role in treating Lower Urinary Tract Dysfunction / Papel de la enfermera de Atención Primaria de Salud en el tratamiento de la Disfunción del Tracto Urinario Inferior / Atuação do enfermeiro da Atenção Primária à Saúde no tratamento da Disfunção do Trato Urinário Inferior

ABSTRACT Objective: To understand Primary Health Care nurses' role in treating Lower Urinary Tract Dysfunction. Method: Cross-sectional multi-methodological research, composed of quantitative and qualitative steps, independently and sequentially. Data collected remotely, through a questionnaire and focus group, analyzed using descriptive statistics and thematic analysis by Braun and Clarke, respectively. The project was approved under Opinion 22691119.0.0000.0030. Results: A total of 145 nurses participated in the study in the quantitative step and 20 in the qualitative step, working in Primary Health Care in Brazil. Of the 93.1% nurses who reported having already cared for people with Urinary Tract Dysfunction, only 54.4% provided guidance, mainly for training the pelvic floor muscles. Conclusion: Even though they have legal support and access to demand, nurses do not have the knowledge to offer conservative treatment for Lower Urinary Tract Dysfunction. Despite this, they were motivated to do so as long as they received specific training.

RESUMEN Objetivo: Comprender el papel del enfermero de Atención Primaria de Salud en el tratamiento de la Disfunción del Tracto Urinario Inferior. Método: Investigación transversal multimetodológica, compuesta por etapas cuantitativas y cualitativas, de forma independiente y secuencial. Datos recopilados de forma remota, a través de un cuestionario y un grupo focal, analizados mediante estadística descriptiva y análisis temático de Braun y Clarke, respectivamente. El proyecto fue aprobado bajo Opinión 22691119.0.0000.0030. Resultados: Participaron del estudio 145 enfermeros en la etapa cuantitativa y 20 en la cualitativa, actuando en la Atención Primaria de Salud en Brasil. Del 93,1% de los enfermeros que afirmaron haber atendido ya a personas con Disfunción del Tracto Urinario, sólo el 54,4% brindó orientación, principalmente para el entrenamiento de los músculos del suelo pélvico. Conclusión: Incluso con apoyo legal y acceso a la demanda, los enfermeros no tienen el conocimiento para ofrecer tratamiento conservador para la Disfunción del Tracto Urinario Inferior. Pese a ello, estaban motivados para hacerlo siempre que recibieran una formación específica.

RESUMO Objetivo: Compreender a atuação dos enfermeiros da Atenção Primaria à Saúde no tratamento da Disfunção do Trato Urinário Inferior. Método: Pesquisa transversal multi-metodológica, composta por etapas quantitativa e qualitativa, de forma independente e sequencial. Dados coletados de forma remota, por meio de questionário e grupo focal, analisados por estatística descritiva e análise temática de Braun e Clarke, respectivamente. O projeto foi aprovado sob Parecer no. 22691119.0.0000.0030. Resultados: Participaram do estudo 145 enfermeiros na etapa quantitativa e 20 na qualitativa, atuantes na Atenção Primária à Saúde do Brasil. Dos 93,1% enfermeiros que referiram já terem atendido pessoas com Disfunção do Trato Urinário, apenas 54,4% prestaram orientações, sendo principalmente para treinamento da musculatura do assoalho pélvico. Conclusão: Mesmo possuindo respaldo legal e acesso à demanda, os enfermeiros não têm conhecimento para oferecer tratamento conservador para Disfunção do Trato Urinário Inferior. Apesar disso, mostraram-se motivados para tal atuação desde que recebam capacitação específica.

Six novel minimally invasive therapies for benign prostatic hyperplasia / 浙江大学学报·医学版

Benign prostatic hyperplasia (BPH) is the most common cause of lower urinary tract symptoms in men. When drug treatment is ineffective or conventional surgery is not suitable, novel minimally invasive therapies can be considered. These include prostatic urethral lift, prostatic artery embolisation, water vapor thermal therapy, Aquablation-image guided robotic waterjet ablation, temporary implantable nitinol device and prostatic stents. These novel therapies can be performed in outpatient setting under local anesthesia, with shorter operative and recovery times, and better protection of ejaculatory function and erectile function. General conditions of the patient and advantages and disadvantages of the each of these therapies should be fully considered to make individualized plans.

Clinical significance of distally located periurethral calcification in patients with lower urinary tract symptoms of benign prostate hyperplasia / 亚洲男科学杂志(英文版)

This study evaluated the association of periurethral calcification (PUC) with uroflowmetric parameters and symptom severity in male patients with lower urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH). The data were collected from a prospectively maintained database of 1321 men with LUTS of BPH who visited Chonnam National University Hospital (Gwang-ju, Korea) from January 2015 to December 2019. PUC severity and location were evaluated on the midsagittal plane during transrectal ultrasonography. Relationships among age, prostate-related parameters, International Prostate Symptom Score (IPSS), and uroflowmetric parameters were assessed. Among the 1321 patients in this study, 530 (40.1%) had PUC. Patients with PUC had significantly higher IPSS (mean ± standard deviation [s.d.]: 15.1 ± 8.7 vs 13.1 ± 7.9; P < 0.001) and lower peak flow rate (Qmax; mean ± s.d.: 12.4 ± 6.6 ml s-1 vs 14.7 ± 13.3 ml s-1; P < 0.001), compared with patients who did not have PUC. Analyses according to PUC severity revealed that patients with severe PUC had higher prostate-specific antigen (PSA) level (P = 0.009), higher total IPSS (P < 0.001), lower Qmax (P = 0.002), and smaller prostate volume (P < 0.001), compared with patients who had non-severe (mild or moderate) PUC. Multivariate analysis showed that distal PUC was independently associated with high total IPSS (P = 0.02), voiding symptom score (P = 0.04), and storage symptom score (P = 0.023), and low Qmax (P = 0.015). In conclusion, PUC was significantly associated with worse LUTS parameters in terms of IPSS and Qmax. Furthermore, distally located PUC was independently associated with worse LUTS of BPH in men.

Better timing for HoLEP: a retrospective analysis of patients treated with HoLEP over a 10-year period with a 1-year follow-up / 亚洲男科学杂志(英文版)

The aim of this study was to explore the optimal timing of holmium laser enucleation of the prostate (HoLEP) in patients presenting benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). A retrospective analysis was conducted based on the perioperative and postoperative outcome data of 1212 patients who underwent HoLEP in Shanghai Ninth People's Hospital (Shanghai, China) between January 2009 and December 2018. According to the preoperative International Prostate Symptom Score (IPSS), all patients whom we analyzed were divided into Group A (IPSS of 8-18) and Group B (IPSS of 19-35). Peri- and postoperative outcome data were obtained during the 1-year follow-up. IPSS changes were the main postoperative outcomes. The postoperative IPSS, quality of life, peak urinary flow rate, postvoid residual, and overactive bladder symptom score (OABSS) improved significantly. The IPSS improved further in the group with severe LUTS symptoms, but the postoperative IPSS was still higher than that in the moderate LUTS group. OABSSs showing moderate and severe cases after follow-up were more frequent in Group B (9.1%) than in Group A (5.2%) (P < 0.05). There were no significant intergroup differences in the intraoperative American Society of Anesthesiologists or hospitalization expense scores, and the medication costs, as well as the total costs, were significantly higher in Group B. In this retrospective study, HoLEP was an effective treatment for symptomatic BPH. For patients with LUTS, earlier surgery in patients with moderate severity may result in a marginally better 12-month IPSS than that in men with severe symptoms.

The Effects of Hysterectomy on Urinary and Sexual Functions of Women with Cervical Cancer: A Systematic Review / Os efeitos da histerectomia nas funções urinárias e sexuais de mulheres com câncer cervical: Uma revisão sistemática

Abstract Objective This systematic review aims at describing the prevalence of urinary and sexual symptoms among women who underwent a hysterectomy for cervical cancer. Methods A systematic search in six electronic databases was performed, in September 2019, by two researchers. The text search was limited to the investigation of prevalence or occurrence of lower urinary tract symptoms (LUTS) and sexual dysfunctions in women who underwent a hysterectomy for cervical cancer. For search strategies, specific combinations of terms were used. Results A total of 8 studies, published between 2010 and 2018, were included in the sample. The average age of the participants ranged from 40 to 56 years, and the dysfunctions predominantly investigated in the articles were urinary symptoms (n= 8). The rates of urinary incontinence due to radical abdominal hysterectomy ranged from 7 to 31%. The same dysfunction related to laparoscopic radical hysterectomy varied from 25 to 35% and to laparoscopic nerve sparing radical hysterectomy varied from 25 to 47%. Nocturia ranged from 13%, before treatment, to 30%, after radical hysterectomy. The prevalence rates of dyspareunia related to laparoscopic radical hysterectomy and laparoscopic nerve sparing radical hysterectomy ranged from 5 to 16% and 7 to 19% respectively. The difficulty in having orgasm was related to laparoscopic radical hysterectomy (10 to 14%) and laparoscopic nerve sparing radical hysterectomy (9 to 19%). Conclusion Urinary and sexual dysfunctions after radical hysterectomy to treat cervical cancer are frequent events. The main reported disorders were urinary incontinence and dyspareunia.

Resumo Objetivo Essa revisão sistemática visa descrever a prevalência de sintomas urinários e sexuais entre mulheres submetidas à histerectomia por câncer cervical. Métodos Uma pesquisa sistemática foi realizada em seis bases de dados eletrônicas, em setembro de 2019, por dois pesquisadores. A busca foi limitada à investigação da prevalência e ocorrência de sintomas do trato urinário baixo e disfunções sexuais em mulheres após histerectomia por câncer cervical. Como estratégia de busca foi utilizada uma combinação específica de termos apenas em inglês. Resultados Um total de 8 estudos, publicados entre 2010 e 2018, foram incluídos na amostra. A idade média dos participantes foi de 40 a 56 anos, e as principais disfunções investigadas pelos artigos foram sintomas urinários (n= 8). Na literatura analisada, as taxas de incontinência urinária ligadas à histerectomia abdominal radical variaram de 7 a 31%. A mesma disfunção, para histerectomia radical laparoscópica, variou de 25 a 35%, e de 25 a 47% para histerectomia radical laparoscópica poupadora de nervo. A taxa de noctúria variou de 13%, antes do tratamento, a 30%, após histerectomia radical. A prevalência de dispareunia associada à histerectomia radical laparoscópica foi de 5 a 16%. Já a taxa de dispareunia relatada pós-histerectomia radical laparoscópica poupadora situou-se entre 7 e 19%. A dificuldade de alcançar o orgasmo foi relatada após histerectomia radical laparoscópica, variando de 10 a 14%, e também na histerectomia radical laparoscópica poupadora de nervo, variando de 9 a 19%. Conclusão Disfunções urinárias e sexuais após histerectomia para tratamento do câncer cervical são eventos frequentes. As principais desordens relatadas foram incontinência urinária e dispareunia.

Estudo Comparativo Entre Diário Vesical e Estudo Urodinâmico para Identificação de Sintomas do Trato Urinário Inferior / Comparative Study Between Bladder Diary and Urodynamic Study to Identify Lower Urinary Tract Symptoms / Estudio Comparativo Entre el Diario Vesical y el Estudio Urodinámico para Identificar los Síntomas del Tracto Urinario Inferior

Objetivo:Avaliar a efetividade do diário vesical para identificar sintomas do trato urinário inferior, em comparação ao estudo urodinâmico. Método: Trata-se de estudo observacional de corte transversal realizado em uma clínica de urodinâmica do sul catarinense com 44 pacientes submetidos ao exame. A coleta de dados deu-se por aplicação de questionário de dados epidemiológicos e de sintomas e diário vesical de 72 horas e comparação deste com os achados do estudo urodinâmico por meio do programa Stata/SE v.14.1. Resultados: O diário vesical apresentou alta especificidade, sensibilidade e acurácia para identificação de hiperatividade detrusora e incontinência urinária de esforço. Não apresentou diferença para capacidade vesical (p* 0,198) e apontou sensibilidade vesical com volume menor do que o apresentado pelo estudo urodinâmico (p*<0,001). Foi capaz de identificar sintomas de trato urinário inferior que não haviam se revelado no estudo urodinâmico. Conclusão: O diário vesical mostrou-se tão efetivo quanto o estudo urodinâmico para identificação de sintomas de trato urinário inferior, podendo ser utilizado para definição de tratamento de primeira linha com maior abrangência de diagnóstico populacional, menor tempo entre queixa e tratamento, redução de custo para o sistema e menor desconforto para o paciente.

Objective:To identify the similarity of lower urinary tract symptoms presented in the urodynamic study compared to the urinary diary. Method: This is a comparative study carried out in an urodynamics clinic in southern Santa Catarina, Brazil, with 44 patients who underwent the examination. Data collection was carried out by applying a questionnaire and a 72-hour bladder diary and comparing it with the findings of the urodynamic study using the SPSS for Windows and Stata/SE v.14.1 programs. Results: The bladder diary showed high specificity, sensitivity, and accuracy for identifying detrusor hyperactivity and stress urinary incontinence. There was no difference for bladder capacity (p* 0.198). It pointed to bladder sensitivity with a volume smaller than that presented by the urodynamic study (p*<0.001). It was able to identify lower urinary tract symptoms that were not present in the urodynamic study. Conclusion: The bladder diary was effective for identifying lower urinary tract symptoms and can be used to define first-line treatment with a broader range of population diagnosis, shorter time between complaints and treatment, cost reduction for the system, and less discomfort for the patient.

Objetivo:Evaluar la efectividad del diario vesical para identificar síntomas del tracto urinario inferior, en comparación con el estudio urodinámico. Método: estudio observacional de corte transversal realizado en una clínica de urodinamia en la región sur del estado de Santa Catarina (Brasil) con 44 pacientes sometidos al examen. La recolección de datos fue realizada por medio de la aplicación de cuestionario de datos epidemiológicos, caracterización de síntomas y diário vesical de 72 horas. La comparación entre los mismos y los hallazgos del estudio urodinámico fue realizada por medio del programa Stata/SE v.14.1. Resultados: el diario vesical presentó alta especificidad, sensibilidad y validez para la identificación de la hiperactividad detrusora y de la incontinencia urinaria de esfuerzo. No hubo diferencia en la capacidad vesical (p* 0,198), el diario vesical indentificó sensibilidad vesical con un volumen menor que el presentado por el estudio urodinámico (p*<0,001). El diário fue capaz de identificar síntomas del tracto urinario inferior que no fueron revelados en el estudio urodinámico. Conclusión: el diario vesical se mostró tan efectivo como el estudio urodinámico para la identificación de síntomas del tracto urinario inferior, con gran potencial de ser utilizado para definición de tratamiento de primera linea con mayor cobertura de diagnóstico poblacional, menor tiempo entre la queja y el tratamiento, reducción de costo para el sistema de salud y menor incomodidad para el paciente.

Association between fecal incontinence and lower urinary tract symptoms and their impact on the quality of life of patients with prostate cancer

Objective: To evaluate the association of fecal incontinence (FI) and lower urinary tract symptoms (LUTS) in patients diagnosed with initial prostate cancer (PC) and after any therapeutic approach (surgery and radiotherapy). Methods: Cross-sectional study using the Cleveland Clinic Incontinence Score (CCIS), the Fecal Incontinence Quality of Life (FIQL) questionnaire, and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). Results: A total of 84 patients with PC were included: 40 of them had not started treatment, 31 were submitted to radical prostatectomy (RP), and 13 were submitted to radiotherapy (RT). Those submitted to RT presented higher scores on the ICIQ-OAB (p=0.01). When comparing the whole sample reagarding the patients with and without FI, we observed that the incontinents presented a higher frequency of urinary incontinence (UI) (p<0.001). Moreover, when comparing patients with/without FI within their treatment groups regarding the presence of UI and FIQL scores, we identified that patients undergoing RP presented an association between UI and FI (p<0.001) and a greater impact of FI on the FIQL (p<0.001). Conclusion: Patients submitted to RT present more intense LUTS. Moreover, patients with FI present a higher association with UI, and this association is more marked in those with FI submitted to RP. (AU)

Terapias complementares no controle de sintomas do trato urinário inferior masculino: revisão sistemática / Complementary therapies in the control of male lower urinary tract symptoms: A systematic review / Terapias complementarias para el control de los síntomas del tracto urinario inferior masculino: revisión sistemática

Resumo Objetivo: avaliar as evidências científicas sobre a efetividade das terapias complementares no controle de sintomas do trato urinário inferior na população masculina adulta e idosa. Método: revisão sistemática desenvolvida de acordo com o checklist PRISMA. A busca foi realizada nas bases de dados CINAHL, Embase, LILACS, PEDro, PubMed, Web of Science e Google Scholar. Resultados: foram identificados 585 registros e selecionados 12 ensaios clínicos que atenderam aos critérios de inclusão. Os desfechos considerados pelos estudos para analisar a efetividade das terapias complementares foram questionários validados de avaliação da gravidade dos sintomas do trato urinário inferior (sensação de esvaziamento incompleto da bexiga, micções frequentes, fluxo intermitente, fluxo fraco, dor ou dificuldade na micção, noctúria e urgência) e parâmetros da urodinâmica. Os estudos analisaram as terapias complementares fitoterapia (n=8) e eletroacupuntura (n=4). Seis estudos relacionados à fitoterapia mostraram significância estatística. A eletroacupuntura mostrou melhora significativa dos sintomas em dois estudos. Conclusão: a fitoterapia foi efetiva para controle dos sintomas frequência, urgência, noctúria, esvaziamento incompleto, intermitência, fluxo fraco e esforço para iniciar a micção. Para confirmação da efetividade da eletroacupuntura ainda serão necessárias pesquisas com metodologias bem delineadas para sanar as divergências entre os estudos desta revisão.

Abstract Objective: to evaluate diverse scientific evidence on the effectiveness of complementary therapies in the control of lower urinary tract symptoms in the adult and aged male population. Method: a systematic review developed according to the PRISMA checklist. The search was performed in the CINAHL, Embase, LILACS, PEDro, PubMed, Web of Science and Google Scholar databases. Results: a total of 585 records were identified and 12 clinical trials were selected that met the inclusion criteria. The outcomes considered by the studies for analyzing effectiveness of the complementary therapies were validated questionnaires to assess the severity of the lower urinary tract symptoms (sensation of incomplete bladder emptying, frequent urination, intermittent flow, weak flow, pain or difficulty urinating, nocturia and urgency) and urodynamics parameters. The studies analyzed the complementary phytotherapy (n=8) and electroacupuncture (n=4) therapies. Six studies related to phytotherapy showed statistical significance. Electroacupuncture showed a significant improvement in the symptoms in two studies. Conclusion: pytotherapy was effective to control the simptoms related to frequency, urgency, nocturia, incomplete emptying, intermittence, weak flow and effort to initiate urination. To confirm the effectiveness of electroacupuncture, research studies with well-designed methodologies will also be necessary to resolve the divergences between the studies of this review.

Resumen Objetivo: evaluar la evidencia científica sobre la efectividad de las terapias complementarias para el control de los síntomas del tracto urinario inferior en la población masculina adulta y adulta mayor. Método: revisión sistemática desarrollada según la checklist PRISMA. La búsqueda se realizó en las bases de datos CINAHL, Embase, LILACS, PEDro, PubMed, Web of Science y Google Scholar. Resultados: se identificaron 585 registros y se seleccionaron 12 ensayos clínicos que cumplían con los criterios de inclusión. Los resultados que los estudios consideraron para analizar la efectividad de las terapias complementarias fueron cuestionarios validados que evaluaban la gravedad de los síntomas del tracto urinario inferior (sensación de vaciado incompleto de la vejiga, micción frecuente, flujo intermitente, flujo débil, dolor o dificultad para orinar, nicturia y urgencia) y parámetros urodinámicos. Los estudios analizaron las terapias complementarias fitoterapia (n=8) y electroacupuntura (n=4). Seis estudios relacionados con la fitoterapia demostraron significación estadística. La electroacupuntura demostró una mejoría significativa de los síntomas en dos estudios. Conclusión: la fitoterapia fue efectiva para controlar los síntomas de frecuencia, urgencia, nicturia, vaciado incompleto, intermitencia, flujo débil y esfuerzo para iniciar la micción. Para confirmar la efectividad de la electroacupuntura, aún es necesario que se realicen investigaciones con metodologías bien diseñadas para resolver las diferencias entre los estudios de esta revisión.

Fatores que interferem na evolução urológica de pacientes com disfunção neurogênica do trato urinário inferior causada pela Síndrome Congênita do Zika Vírus / Factors that interfere with the urological evolution of patients with neurogenic lower urinary tract dysfunction caused by Zika Virus Congenital Syndrome

Introdução: A disfunção neurogênica do trato urinário inferior (DNTUI) é uma sequela urológica da Síndrome Congênita do Zika vírus6 (SCZV). Apesar de os pacientes com SCZV e DNTUI receberem o mesmo tratamento, tem-se observado evolução diferente. Objetivo: Avaliar a existência de fatores de interferência para a resposta ao tratamento urológico nas crianças portadoras de SCZV, especificamente: (1) Identificar seu perfil sociodemográfico, clínico, neurológico e urológico; (2) Avaliar o efeito do tratamento nas variáveis de risco urológico e (3) Avaliar o efeito dos fatores sociodemográficos, clínicos e neurológicos na resposta ao tratamento urológico destes pacientes. Metodologia: Estudo transversal incluindo crianças assistidas na coorte institucional do IFF com SCZV e DNTUI, tratadas nos ambulatórios de Urodinâmica e Neurologia entre 2015 e 2021 e com duas avaliações urodinâmicas realizadas. Variáveis sociodemográficas, clínicas, neurológicas e urológicas foram coletadas através de ficha própria. O primeiro e o segundo exame de urodinâmica foram comparados para avaliar a evolução, após a intervenção terapêutica. Com a finalidade de avaliar fatores de interferência para a resposta ao tratamento urológico, as crianças foram separadas em dois grupos - as que apresentaram alguma melhora urodinâmica e as que não, correlacionando as variáveis com a resposta ao tratamento. Analisou-se as variáveis categóricas pela frequência de ocorrência e as numéricas pela média e desvio padrão, comparando os grupos pelo chi-square test. Resultados: Foram incluídas 50 crianças, 50% do sexo feminino e 54% acima de 12 meses de idade; 70% tiveram exposição vertical ao vírus no primeiro trimestre da gestação, 62% com microcefalia grave e a maioria com dilatação ventricular, síndrome cortical e epiléptica, todas com DNTUI, 74% com perfil urológico. Resultados: Foram incluídas 50 crianças, 50% do sexo feminino e 54% acima de 12 meses de idade; 70% tiveram exposição vertical ao vírus no primeiro trimestre da gestação, 62% com microcefalia grave e a maioria com dilatação ventricular, síndrome cortical e epiléptica, todas com DNTUI, 74% com perfil urológico de risco para trato urinário superior. No parto, 86% das mães tinham entre 18 e 36 anos de idade e menos de oito anos de estudo. Entre as 50 crianças, 41 apresentaram alguma melhora urodinâmica pós-tratamento, com redução significativa da pressão vesical máxima (p= 0.001) e aumento significativo da capacidade vesical máxima (p=0.001) e da complacência vesical (p=0.000). Não se observou significância estatística que confirmasse a interferência dos fatores analisados no tratamento urológico. Conclusão: O estudo confirmou a significativa melhora dos padrões urodinâmicos observada nos exames de controle, reafirmando a importância de investigar a sequela urológica nestas crianças.

Introduction: Neurogenic Lower Urinary Tract Dysfunction (NLUTD) is a urological sequel of Congenital Zika Syndrome6 (CZS). Although these patients received the same treatment, they did not respond in the same way. Objective: To evaluate the presence of interference factors in the response to the urological treatment in children with CZS, specifically: (1) To identify their sociodemographic, clinical, neurological and urological profile; (2) To evaluate the effect of treatment on the urological risk variables and (3) To evaluate the effect of sociodemographic, clinical and neurological factors on the response to their urological treatment. Methodology: Cross-sectional study including children assisted in the institutional cohort of IFF with CZS and NLUTD, treated in the Urodynamic and in the Neurology outpatient clinics between 2015 and 2021, who have performed two urodynamic evaluations. Sociodemographic, clinical, neurological, and urological variables were collected through a specific research form. The first and second urodynamics exams were compared to evaluate urological response after the therapeutic intervention. To evaluate the presence of interference factors on urological treatment, the children were separated into two groups - those that presented any urodynamic improvement and those that did not, correlating the variables with the response to treatment. Categorical variables were analyzed by frequency of occurrence and numerical variables by mean and standard deviation, comparing the groups by chi-square test. Results: Fifty children were included, 50% female and 54% older than 12 months of age; 70% were vertically exposed to the virus during in the first trimester of pregnancy, 62% developed severe microcephaly and the majority also presented ventricular dilation, and cortical and epileptic syndrome. All presented DNTUI, 74% with an urological risk profile to the upper urinary tract. At birth, 86% of the mothers were between 18 and 36 years of age and had completed less than eight years of schooling. Among the 50 children, 41 presented some post-treatment urodynamic improvements, including a significant reduction in the maximum bladder pressure (p= 0.001) and a significant increase in the maximum bladder capacity (p=0.001) and bladder compliance (p=0.000). There was no statistical significance that confirmed the interference of the factors in the urological treatment. Conclusion: The study confirmed the significant improvement in urodynamic patterns, when compared the first with the control exams, reaffirming the importance of investigating urological sequelae in these children.

Aging-associated prostate smooth muscle hypercontractility in rats

Abstract Benign prostatic hyperplasia (BPH) is a multifactorial disease, highly associated with aging and characterized by increased prostate smooth muscle (PSM) contractility. Animal models have been employed to explore the aging-associated PSM hypercontractility; however, studies have focused in old animals, neglecting the initial alterations in early ages. The determination of prostatic dysfunctions onset is crucial to understand the BPH pathophysiology and to propose new BPH treatments. Considering that PSM contractility in 10-month-old rats has already been explored, the aim of the present study was to characterize the PSM contractility in younger rats. Male Wistar control (3.5-month-old), 6- and 8-month-old rats were used. Concentration-response curves to phenylephrine and electrical-field stimulation (EFS) were conducted in prostate from all groups. For the first time, we showed that 6- and 8-month-old rats exhibit PSM hypercontractility. The increased prostate contractility to phenylephrine starts around at 6-month-old, worsening during the aging. The 8-month-old rats exhibited hypercontractility to phenylephrine and EFS compared to the control and 6-month-old groups. Reduced phenylephrine potency was observed in 8-month-old rats, indicating an increased age-dependent prostate sensibility to this agonist. Collectively, our findings support the use of 6- and 8-month-old aged rats as new models to explore prostate hypercontractility in BPH.

Effectiveness of systemic acupuncture in the control of urinary incontinence following radical prostatectomy: a randomized clinical trial / Efectividad de la acupuntura sistémica en el control de la incontinencia urinaria post-prostatectomía radical: ensayo clínico randomizado / Efetividade da acupuntura sistêmica no controle da incontinência urinária pós-prostatectomia radical: ensaio clínico randomizado

ABSTRACT Objective: To evaluate the effectiveness of acupuncture associated with pelvic floor muscle training for the control of urinary incontinence following radical prostatectomy. Method: Open-label, parallel randomized clinical trial. The intervention group (n = 33) underwent eight sessions of systemic acupuncture associated with pelvic floor muscle training and the control group (n = 31) performed only pelvic floor muscle training. The outcome variable was urinary incontinence assessed by the Pad Test and Daily Pad Used, before treatment (T0), after four weeks (T1) and after eight weeks of treatment (T2). Data analysis was performed using a longitudinal model of Generalized Estimating Equations, significance level of 0.05. Results: The control group showed greater urinary loss compared to the intervention group at T1 (p = 0.006) and at T2 (p < 0.001). Both groups showed improvement in the level of urinary incontinence over time, but the improvement was greater in the intervention group (p < 0.001). Conclusion: Acupuncture associated with pelvic floor muscle training was effective in reducing urinary incontinence in prostatectomized men. Brazilian Registry of Clinical Trials:RBR-3jm5y2

RESUMEN Objetivo: evaluar la efectividad de la acupuntura asociada al entrenamiento muscular de piso pélvico para el control de la incontinencia urinaria post-prostatectomía radical. Método: ensayo clínico aleatorizado paralelo, del tipo abierto. El grupo intervención (n = 33) fue sometido a ocho sesiones de acupuntura sistémica asociada al entrenamiento muscular de piso pélvico y el grupo control (n = 31) solamente al entrenamiento muscular de piso pélvico. La variable desfecho fue incontinencia urinaria evaluada por el Pad Test y Daily Pad Used, antes del tratamiento (T0), después de cuatro semanas (T1) y después de ocho semanas de tratamiento (T2). El análisis de datos fue realizado por modelo longitudinal de Ecuaciones de Estimaciones Generalizadas, nivel de significancia de 0,05. Resultados: el grupo control presentó mayor pérdida urinaria en comparación al grupo intervención en T1 (p = 0,006) y en T2 (p < 0,001). Ambos grupos presentaron mejor nivel de incontinencia urinaria a lo largo del tiempo, sin embargo la mejora fue mayor en el grupo intervención (p < 0,001). Conclusión: la acupuntura asociada al entrenamiento muscular de piso pélvico fue efectiva para la reducción de la incontinencia urinaria en hombres prostatectomizados. Registro Brasileño de Ensayos Clínicos:RBR-3jm5y2

RESUMO Objetivo: Avaliar a efetividade da acupuntura associada ao treinamento muscular do assoalho pélvico para o controle da incontinência urinária pós-prostatectomia radical. Método: Ensaio clínico aleatorizado paralelo, do tipo aberto. O grupo intervenção (n = 33) foi submetido a oito sessões de acupuntura sistêmica associada ao treinamento muscular do assoalho pélvico e o grupo controle (n = 31) somente ao treinamento muscular do assoalho pélvico. A variável desfecho foi incontinência urinária avaliada pelo Pad Test e Daily Pad Used, antes do tratamento (T0), após quatro semanas (T1) e após oito semanas de tratamento (T2).A análise de dados foi realizada por modelo longitudinal de Equações de Estimações Generalizadas, nível de significância de 0,05. Resultados: O grupo controle apresentou maior perda urinária em comparação ao grupo intervenção em T1 (p = 0,006) e em T2 (p < 0,001). Ambos os grupos apresentaram melhora no nível de incontinência urinária ao longo do tempo, porém a melhora foi maior no grupo intervenção (p < 0,001). Conclusão A acupuntura associada ao treinamento muscular do assoalho pélvico foi efetiva para a redução da incontinência urinária em homens prostatectomizados. Registro Brasileiro de Ensaios Clínicos:RBR-3jm5y2

Alto porcentaje de ausencia de reflejo bulbocavernoso en pacientes neurológicamente sanos con disfunción vesical / High Percentage of Absence of Bulbocavernosus Reflex in Neurologically-Healthy Patients with Bladder Dysfunction

Introducción y Objetivo El reflejo bulbocavernoso (RBCV) se ha observado ausente incluso en pacientes neurológicamente sanos. Los trastornos funcionales del piso pélvico deben incluir su evaluación. Nuestro objetivo primario fue evaluar la prevalencia de ausencia de RBCV en pacientes sanos. El objetivo secundario fue observar la afectación del RBCV en presencia de otras comorbilidades cómo enfermedad neurológica y diabetes mellitus tipo 2. Métodos Estudio descriptivo y retrospectivo, en el que se revisaron mil expedientes clínicos de pacientes sometidos a estudio urodinámico a quienes se les realizó exploración mecánica del RBCV como parte de una exploración rutinaria. Se realizó estadística descriptiva para las variables cuantitativas y cualitativas utilizando la prueba tde Student y la de chi cuadrado, respectivamente. Se consideraron estadísticamente significativos valores de p < 0,05. Resultados La muestra tenía una media de edad de 59,84 años (desviación estándar [DE]: ± 14,13 años), y contenía 36,19% de mujeres y 21,13% de hombres sin enfermedad neurológica y RBCV ausente. Se observó mayor ausencia de RBCV en pacientes con presencia de enfermedad neurológica en comparación con pacientes neurológicamente sanos: 21,6% versus 10,6%, respectivamente (p < 0,0001); además, se observó una ausencia importante de RBCV en presencia de diabetes mellitus en comparación con pacientes no diabéticos: 30.8% versus 18.8%, respectivamente (p < 0,0001). No se observaron diferencias al comparar grupos con respecto a disfunción vesical. Conclusión La ausencia de RBCV no es exclusiva de una enfermedad neurológica con repercusión de síntomas del tracto urinario inferior, y la proporción de pacientes neurológicamente sanos con ausencia de RBCV no es despreciable. No se encontró una diferencia significativa en los grupos con ausencia de RBCV con respecto a disfunción vesical.

Introduction and Objective Absence of the bulbocavernosus reflex (BCVR) has been observed even in neurologically-healthy subjects. Functional disorders of the pelvic floor should include its assessment. The primary objective of the present study was to evaluate the absence of BCVR in healthy subjects. The secondary objective was to evaluate the BCVR with regards to the presence of other comorbidities, such as neurogenic bladder and type-2 diabetes mellitus. Methods A descriptive and retrospective study in which we reviewed the clinical files of one thousand subjects who underwent a urodynamic study and were submitted to a mechanical exploration of the BCVR as part of a routine evaluation. Descriptive statistics were performed for the quantitative and qualitative variables using the Student t and the Chi-squared tests accordingly. Values of p < 0.05 was considered statistically significant. Results The sample had a mean age of 59.84 years (standard deviation [SD] ± 14.13 years), and it contained 36.19% of women and 21.13% of men without neurological disease and absent BCVR. A higher proportion of BCVR absence was observed in patients with neurological disease compared to their healthy counterparts: 21.6% and 10.6% respectively (p ≤ 0.0001); furthermore, an important absence of the BCVR was observed in patients with type-2 diabetes mellitus compared to non-diabetic patients: 30.8% and 18.8% respectively (p ≤ 0.0001). No statistically significant differences were observed in the group comparison regarding bladder dysfunction. Conclusion The absence of the RBCV is not exclusive to a neurological disease with repercussions in terms of lower urinary tract symptoms, and the proportion of neurologically healthy subjects with absence of the BCVR is not negligible. No significant difference was found in groups with absence of the BCVR with regards to bladder dysfunction

Case study: Use of decentralized clinical technologies in lower urinary tract symptoms

@#<p style="text-align: justify;" data-mce-style="text-align: justify;"><span style="color: #525a63; font-family: Lato, sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;" data-mce-style="color: #525a63; font-family: Lato, sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">A clinical study with 49 participants was started and completed at the height of the Covid-19 pandemic with the use of decentralized clinical trial (DCT) methodologies. All participants and the study team remained safe and were able to conduct the study efficiently. Patients were able to provide consent electronically, received experimental supplements and were given the option to provide feedback through the system’s telemedicine feature.</span></p>

Female nurses have a higher prevalence of urinary tract symptoms and infection than other occupations in dialysis units / Técnicas de enfermagem têm uma prevalência maior de sintomas e infecções do trato urinário do que outras ocupações em unidades de diálise

Abstract Introduction: Urinary tract symptoms and infection have been associated with occupational factors that impact hydration habits particularly in women. We compared self-reported urinary symptoms and infection and hydration habits between nurses and other occupations in dialysis units. Methods: Cross-sectional study. Participants worked in five nephrology centers in Brazil and answered an online questionnaire comprising questions regarding urinary tract symptoms and infection episodes in the preceding year; data on usual daily beverage intake, urine frequency, and urine color according to a urine color chart were also collected, as well as perceptions of water access and toilet adequacy at work. Results: We included 133 women (age=36.9±9.5 years). The self-reported usual daily beverage intake was 6.6±2.9 cups/day (~1320 mL), daily urine frequency was 5.4±2.1, and urine color chart score: 3.0±1.2. Nurses (N=66/49.6%) reported higher prevalence of burning sensation (50 versus 27%; P<0.001), urinary urgency (42 versus 21%; P<0.001), and infection (42% versus 25%; P=0.04) as well as lower liquid intake (6.0±2.6 versus 7.3±3.0 cups/day; P=0.01) than controls. Forty four percent of nurses reported being able to drink when thirsty "always" and "most of the time" versus 93% of the control group. Conclusion: Dialysis female nurses reported lower beverage intake and higher prevalence of symptoms and infection than other occupations in the same environment. Interventions to improve hydration can potentially decrease urinary problems in this population.

Resumo Introdução: Sintomas e infecções do trato urinário têm sido associados a fatores ocupacionais que afetam hábitos de hidratação, particularmente em mulheres. Comparamos sintomas e infecções urinárias autorrelatados e hábitos de hidratação entre técnicas de enfermagem e outras ocupações em unidades de diálise. Métodos: Estudo transversal. As participantes trabalhavam em cinco centros de nefrologia no Brasil e responderam um questionário online contendo perguntas sobre sintomas do trato urinário e episódios de infecção no ano anterior; também foram coletados dados sobre a ingestão diária habitual de bebidas, frequência e cor da urina de acordo com uma tabela de cores da urina, assim como percepções sobre o acesso à água e adequação das instalações sanitárias no trabalho. Resultados: Incluímos 133 mulheres (idade=36,9±9,5 anos). Em média, as participantes relataram ingestão de bebidas de 6,6±2,9 copos/dia (~1320 mL), frequência urinária de 5,4±2,1 vezes/dia e escore da tabela de cores da urina de 3,0±1,2. Técnicas de enfremagem (N=66/49,6%) relataram maior prevalência de sensação de ardor (50 versus 27%; P<0,001), urgência urinária (42 versus 21%; P<0,001), e infecção (42% versus 25%; P=0,04), bem como menor ingestão de líquidos (6,0±2,6 versus 7,3±3,0 copos/dia; P=0,01) do que controles. Quarenta e quatro por cento das técnicas de enfermagem relataram poder beber quando têm sede "sempre" e "na maioria das vezes" contra 93% do grupo controle. Conclusão: Técnicas de enfermagem de unidades de diálise relataram menor ingestão de bebidas e maior prevalência de sintomas e infecção do que outras ocupações no mesmo ambiente de trabalho. Intervenções para melhorar a hidratação podem diminuir problemas urinários nesta população.

Association between Attention Deficit Hyperactivity Disorder and lower urinary tract symptoms in children and adolescents in a community setting

ABSTRACT Introduction: The present study aims to investigate the prevalence of lower tract urinary symptoms (LUTS) and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents and their association in a community setting using validated scoring instruments. Materials and Methods: A cross-sectional study was carried out from February 2015 to December 2019, during which the parents or guardians of 431 children and adolescents from 5 to 13 years of age, attending a general pediatric outpatient clinic were interviewed. Results: The prevalence of ADHD symptoms and LUTS were 19.9% and 17.9%, respectively. Of the 82 children and adolescents with ADHD, 28% (23) had LUTS (OR 2.31, 95% CI 1.28 to 3.75, p=0.008). Mean total DVSS score in children in the group of children presenting ADHD symptom was significantly higher than those without ADHD symptom (10.2±4.85 vs. 4.9±2.95, p=0.002). Urgency prevailed among LUTS as the most frequent symptom reported by patients with ADHD symptoms (p=0.004). Analyzing all subscales of the DVSS, the items "When your child wants to pee, can't he wait? "Your child holds the pee by crossing his legs, crouching or dancing?" were higher in those with ADHD symptoms (p=0.01 and 0.02, respectively). Functional constipation was present in 36.4% of children with LUTS and 20.7% without LUTS (OR 4.3 95% CI 1-5.3 p=0.001). Conclusion: Children and adolescents with ADHD symptoms are 2.3 times more likely to have LUTS. The combined type of ADHD was the most prevalent among them.