Gastric neobladders: surgical outcomes of 91 cases using different techniques

ABSTRACT Introduction: We report on the surgical results of a series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. Materials and Methods: We report on a retrospective case series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. Different techniques of gastric neobladders were employed from 1988 to 2013 at a university hospital in the South of Brazil. Results: Initial outcomes utilizing Leong (Antral) and Nguyen-Mitchell (Wedge) technique were unsatisfactory, yielding high pressure, low capacity reservoirs. Further developments of these techniques, with the detubularized gastric neobladder and the "spherical" gastric neobladders resulted in low pressure, high capacity reservoirs, with better surgical and urodynamic outcomes. Complication and perioperative mortality rates of our series of gastric neobladders were significantly higher than historical results of techniques using ileum or colon. Conclusions: Stomach is an exceptional option for the creation of neobladders after radical cystectomies, but due to the increased complication rates it should be reserved for specific situations (e.g., renal insufficiency, previous pelvic/abdominal radiotherapy, short bowel syndromes).

Gastric neobladders: surgical outcomes of 91 cases using different techniques.

INTRODUCTION: We report on the surgical results of a series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. MATERIALS AND METHODS: We report on a retrospective case series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. Different techniques of gastric neobladders were employed from 1988 to 2013 at a university hospital in the South of Brazil. RESULTS: Initial outcomes utilizing Leong (Antral) and Nguyen-Mitchell (Wedge) technique were unsatisfactory, yielding high pressure, low capacity reservoirs. Further developments of these techniques, with the detubularized gastric neobladder and the "spherical" gastric neobladders resulted in low pressure, high capacity reservoirs, with better surgical and urodynamic outcomes. Complication and perioperative mortality rates of our series of gastric neobladders were significantly higher than historical results of techniques using ileum or colon. CONCLUSIONS: Stomach is an exceptional option for the creation of neobladders after radical cystectomies, but due to the increased complication rates it should be reserved for specific situations (e.g., renal insufficiency, previous pelvic/abdominal radiotherapy, short bowel syndromes).

O papel da urodinâmica na avaliação da incontinência urinária em mulher pré tratamento cirúrgico / The role of presurgical urodynamic assessment in the treatment of stress urinary incontinence in women

Objetivos: Revisar o papel da avaliação urodinâmica pré tratamento cirurgico de incontinência urinária aos esforços (IUE) em mulheres. Métodos: Foi realizada revisão bibliográfica em maio de 2018 sobre estudo urodinâmico e incontinência urinária em mulheres nas bases de dados PubMed e Lilacs, utilizando como palavras-chaves na busca os termos urodynamics, women e urology, adotando como critérios de inclusão: data de publicação igual ou maior a janeiro/2013 (com exceção de um trabalho que foi incluído devido a relevância clínica no assunto); trabalhos redigidos em língua inglesa ou portuguesa; acesso livre ao texto integral e abordagem da avaliação urodinâmica (AUD) em mulheres com IUE. Os critérios de exclusão foram incontinência urinária (IU) em pacientes do sexo masculino e crianças, além de comorbidades neurológicas. Resultados: O estudo urodinâmico é um exame que avalia a função do complexo uretro-vesical nas fases de enchimento e esvaziamento do ciclo miccional. A AUD auxilia a detectar e a diagnosticar com maior precisão as disfunções do trato urinário inferior (DTUI) com base em sua fisiopatologia, podendo assim participar da tomada de decisão terapêutica. Conclusões: O estudo urodinâmico pré-operatório deve ser reservado para casos selecionados, como na incontinência urinária complicada, nos prolapsos genitais e disfunções neurológicas. Portanto, não deve ser solicitado de rotina em todas as pacientes com incontinência urinária.

Aims: to review the role of preoperative urodynamic assessment in the treatment of stress urinary incontinence in women. Methods: Bibliographic review was performed in May 2018 on urodynamic and stress urinary incontinence in the PubMed and Lilacs databases, using the key terms urodynamics, women and urology. The inclusion criteria used as reference were: publication date equal to or greater than January 2013 (except for two articles, which were included for clinical relevance in the subject); papers written in English or Portuguese; free access to the full text and approach to Urodynamic Assessment (AUD) in women with IUE. The exclusion criteria were IU in male patients, children and neurological comorbidities. Results: The urodynamic study is a test that evaluates the function of the urethral and bladder complex at the phases of filling and emptying of the voiding cycle. The AUD helps to detect and diagnose more accurately the lower urinary tract dysfunctions (DTUI) based on your pathophysiology, and thus participate in the therapeutic decision making. Conclusions: The preoperative urodynamic study should be reserved for selected cases, such as complicated urinary incontinence, genital prolapses and neurological dysfunctions. Therefore, it should not be done routinely in all patients with urinary incontinence.

Câncer de próstata: uma breve revisão atualizada / Prostate Cancer: a short updated review

Objetivos: Resumir as recomendações atualizadas a respeito do manejo do câncer de próstata presentes na literatura sobre o assunto. Métodos: O método utilizado foi uma revisão bibliográfica, tendo como base as principais fontes de consulta do médico assistente que tem como rotina o manejo desta neoplasia. O material revisado foi estudado e seu conteúdo foi selecionado a partir de tópicos marcantes para o entendimento da doença e seu manejo. Resultados: O diagnóstico e o estadiamento do câncer de próstata são baseados em toque retal, dosagem do antígeno prostático específico, ressonância nuclear magnética multiparamétrica e ultrassonografia com biópsia transretal. De acordo com o estágio da doença, esta pode ser tratada com cirurgia ou radioterapia (tumores localizados) ou castração e bloqueio hormonal (doença invasiva). Conclusões: O progresso na compreensão do câncer de próstata tem proporcionado inúmeros benefícios aos acometidos por esta neoplasia tão prevalente.

Aims: To summarize updated recommendations about prostatic cancer reported in the literature about this topic. Methods:The method consisted of a bibliography review of the main sources adopted by the assistant doctors who have as a routine the management of this neoplasm. The reviewed matter was examined and its content was selected emphasizing important topics in understand this disease and its management. Results: Diagnosis and staging of prostate cancer are based on rectal examination, prostate specific antigen dosage, multiparametric magnetic resonance imaging, and ultrasound with transrectal biopsy. According to the stage of the disease, it can be treated with surgery or radiotherapy (localized tumors) or castration and hormonal blockade (invasive disease). Conclusions:The progressive understanding of prostate cancer has provided innumerable benefits to those affected by this prevalent neoplasm.

Incontinência urinária: uma breve revisão da literatura / Urinary incontinence: a brief review of the literature

Objetivos: A incontinência urinária é caracterizada por qualquer perda involuntária de urina, e pode ser classificada em diferentes tipos, conforme a Sociedade Internacional de Continência. É um problema que atinge um percentual alto da população, tanto entre homens quanto mulheres, de idades distintas. O impacto que a condição causa nos pacientes vai muito além das questões de saúde e higiene, comprometendo o âmbito social, pessoal e emocional ­ o que prejudica em grande escala a qualidade de vida.O diagnóstico pode ser difícil, uma vez que as pessoas atingidas não costumam levar em consideração os sintomas, o que raramente é expressado como queixa no consultório. Por isso, é fundamental falar sobre a incontinência urinária. Métodos: O que o presente estudo pretende fazer é elucidar questões a este respeito, principalmente sob a perspectiva do tratamento cirúrgico da patologia, através de revisão de literatura especializada. Resultados: A investigação diagnóstica da IU baseia-se em anamnese, exame físico e exames complementares. Como possibilidades terapêuticas encontram-se a abordagem conservadora e o tratamento cirúrgico. Conclusões: O diagnóstico preciso da incontinência urinária é a chave para conduzir ao tratamento adequado e melhorar a qualidade de vida dos pacientes.

Aims: The urinary incontinence is characterized as any involuntary loss of urine, and it's classified by International Continence Society (ICS) according to its different types. It's a problem that affects a high percentage of population, among men and women, of different ages. The impact that the condition causes goes beyond health and hygiene issues, compromising people's social, personal and emotional spheres ­ which can largely disturb life quality. The diagnoses may be difficult, due to the fact that people who suffer from the disease don't usually consider the symptoms that are often neglected in doctors' appointments. That's the reason why it's so important to talk about urinary incontinence. Methods: This paper intends to do is bring this subject to light, mainly under the disease's surgical treatment point of view, through specialized literature review Results: The UI investigation is based on anamnesis, physical exam and complementary exams. For the treatment, conservative and surgicaltherapyare viable options. Conclusions: A precise diagnosis is the key to bring to the patients appropriate treatment and enhance their life quality.

Increased tissue factor expression is an independent predictor of mortality in clear cell carcinoma of the kidney.

PURPOSE: Increased expression of tissue factor (TF), a primary initiator of the extrinsic coagulation pathway, has been associated with a worse prognosis in a variety of solid tumors. We report for the first time the correlation of the immunohistochemical expression of tissue factor with clinical and pathological outcomes in clear cell carcinomas of the kidney. MATERIALS AND METHODS: immunohistochemical expression of tissue factor was evaluated in 58 paraffin-embedded samples of clear cell carcinomas of the kidney treated at the same university hospital, that was correlated with clinical and pathological variables and with overall survival. RESULTS: high intensity tissue factor expression (TF area > 10 µ m2) was observed in 22.4% of the tumors (13 patients), and was an important predictor of overall mortality, both in univariate and multivariate analysis (p < 0.05). Median overall survival for both groups was 66 months; 78.2 months for patients in the group of lower TF expression and 27.5 months for patients in the group of higher TF expression (log rank p < 0.001). The hazard ratio for mortality was 9.7 (CI 3.7-25.6) for tumors with increased TF expression. CONCLUSIONS: Increased immunohistochemical expression of TF was an important independent predictor of mortality in a contemporary cohort of patients with clear cell carcinoma of the kidney. Further studies are necessary to define the role of TF in clinical practice.

Increased Tissue Factor Expression is an Independent Predictor of Mortality in Clear Cell Carcinoma of the Kidney

Purpose Increased expression of tissue factor (TF), a primary initiator of the extrinsic coagulation pathway, has been associated with a worse prognosis in a variety of solid tumors. We report for the first time the correlation of the immunohistochemical expression of tissue factor with clinical and pathological outcomes in clear cell carcinomas of the kidney. Materials and Methods immunohistochemical expression of tissue factor was evaluated in 58 paraffin-embedded samples of clear cell carcinomas of the kidney treated at the same university hospital, that was correlated with clinical and pathological variables and with overall survival. Results high intensity tissue factor expression (TF area > 10µm2) was observed in 22.4% of the tumors (13 patients), and was an important predictor of overall mortality, both in univariate and multivariate analysis (p < 0.05). Median overall survival for both groups was 66 months; 78.2 months for patients in the group of lower TF expression and 27.5 months for patients in the group of higher TF expression (log rank p < 0.001). The hazard ratio for mortality was 9.7 (CI 3.7-25.6) for tumors with increased TF expression. Conclusions Increased immunohistochemical expression of TF was an important independent predictor of mortality in a contemporary cohort of patients with clear cell carcinoma of the kidney. Further studies are necessary to define the role of TF in clinical practice. .

Association between T102C polymorphism of serotonin 2A receptor gene and urinary incontinence in older women.

BACKGROUND: The bladder's regulatory function is influenced by central serotonergic modulation. T102C polymorphism of the serotonin 2A (5-HT(2A)) receptor gene is associated with urinary incontinence (UI) that has been reported by older community dwellers. We analyzed the association between 5-HT(2A) receptor gene polymorphism and urodynamic tests for UI in older women. METHODS: A case-control study was performed with 68 older women submitted to urodynamic evaluation and 162 older women without urinary problems (self-reported), all community dwellers enrolled in the Gravataí-GENESIS Project, Brazil. Clinical interviews, complete urodynamic evaluation following the International Continence Society Report on Good Urodynamic Practice (case group), and molecular analyses were performed (case and control groups). Serotonin 2A receptor gene genotyping was carried out by polymerase chain reaction-restriction fragment length polymorphism using the restriction enzyme HpaII. We excluded patients with diabetes mellitus, neurologic damage, and diuretic intake. RESULTS: The subjects' mean (SD) age was 68.1 (6.5) years (range, 60-92 years). We found an association between the TT genotype versus CC + CT genotypes and UI (P = 0.013; odds ratio, 2.69; 95% confidence interval, 1.37-5.29) and, in addition, an association with urgency UI, maximal cystometric capacity (TT, 349 mL; CC + CT, 429.5 mL [P = 0.047]), detrusor pressure at maximum cystometric capacity (TT, 11 cm H(2)O; CC + CT, 6.75 cm H(2)O [P = 0.032]), and detrusor compliance (TT, 34 mL/cm H(2)O; CC + CT, 61.25 mL/cm H(2)O [P = 0.006]). CONCLUSIONS: We confirmed our previous findings of a genetic influence of the TT genotype on UI involving the serotonergic pathway among older women. Further investigations including 5-HT(2A) expression in the bladder, pelvic floor, and striated sphincter muscle must be performed.

Prostatectomia radical versus qualidade de vida / Radical prostatectomy versus quality of life

Com o aumento da expectativa de vida na população ocidental tem crescido o número de diagnósticos de adenocarcinoma de próstata e, consequentemente, de prostatectomias radicais para ser tratamento. Isto traz consigo a preocupação em manter a qualidade de vida do paciente no período pós-operatório. A primeira preocupação dos homens submetidos a tal procedimento é a incontinência urinária, superando até mesmo a disfunção erétil. Novas linhas de tratamento têm sido estudadas a fim de reduzir a prevalência desta condição e de encontrar uma solução para tal.

Incontinência urinária no idoso / Urinary incontinence in the elderly

A incontinência urinária é uma doença bastante freqüente e pouco diagnosticada entre os idosos, sendo responsável por importantes índices de isolamento social e depressão nessa faixa etária. Por este motivo, os autores discutem a incontinência urinária em idosos, destacando sua avaliação primária e conduta, visando restaurar a continência e/ou tratar e conviver com o sintoma, melhorando a qualidade de vida destes pacientes.

Prevalência de instabilidade detrusora na incontinência urinária de esforço / Prevalence of detrusor instability in stress urinary incontinence

Analisamos retrospectivamente, os prontuários de 130 mulheres com incontinência urinária de esforço, avaliadas no período de janeiro de 1990 a outubro de 1995. Instabilidade detrusora e incontinência de esforço associadas foram detectadas em 29 pacientes (22,3 por cento). Concluímos que, apesar do examinador ter condiçöes de estabelecer uma suspeita sobre a natureza do problema, baseado na sintomatologia, a avaliaçäo urodinâmica é necessária em muitos casos para confirmaçäo diagnóstica

Princípios da avaliaçäo urodinâmica / Principles of urodynamic assessment

A urodinâmica é o estudo dos fatores fisiológicos e patológicos envolvidos nos processos de armazenamento, transporte e eliminaçäo da urina. A avaliaçäo urodinâmica consiste de uma série de testes que hoje podem ser utilizados em conjunto ou isoladamente no estudo de várias condiçöes clínicas. O conhecimento acerca destes exames e de suas indicaçöes precisas possibitamao médico a realizaçäo de diagnóstico e, consequentemente, a proposiçäo de terapêuticas adequadas para muitos dos problemas urinários encontrados comumente

Tratamento farmacologico da hiperplasia benigna da prostata / Pharmacological treatment of benign prostatic hyperplasia

A hiperplasia benigna da prostata e uma patologia bastante prevalente na populacao masculina de idade avancada. Com o aumento da expectativa media de vida, decorrente dos avancos cientifico-tecnologicos das ultimas decadas, este problema tem despertado um interesse ainda maior ao nivel da saude publica. Recentemente tem sido investigadas varias opcoes de tratamento farmacologico do paciente prostatico, tais como os alfa-bloqueadores e agentes que promovem supressao androgenica. Os autores abordam as principais modalidades de tratamento farmacologico da hiperplasia benigna da prostata existentes atualmente, enfatizando aspectos relacionados a farmacodinamica, efeitos colaterais, indicacoes e resultados obtidos com o uso destes farmacos na literatura. Concluem que os alfabloqueadores e os tratamentos hormonais de bloqueio androgenico podem ser uteis em pacientes selecionados, porem a real aplicabilidade destas terapias so sera conhecida atraves de ensaios clinicos mais bem delineados, de maior poder estatistico, e com um melhor conhecimento da historia natural da hiperplasia prostatica