Vigilância ativa do câncer de próstata - um conceito em evolução / Active surveillance of prostate cancer - an ongoing concept

A vigilância ativa é a solução encontrada pela urologia para a condução de tumores prostáticos com características de pouca agressividade. Desenvolvida especialmente após as polêmicas que envolveram a validade do rastreamento, essa abordagem vem sendo consolidada como a melhor maneira de se evitar o tratamento desnecessário do câncer de próstata e precisa ser compreendida por todos os médicos que lidam com a saúde do homem.

Active surveillance is the solution found by urology to deal with low-aggressivity prostate tumours. Having been developed following controversies over screening strategies, this has been considered the best approach to avoid unnecessary treatment of prostate cancer and such a concept needs to be well understood by every medical doctor who deals with men's health.

As mudanças recentes no rastreamento do câncer da próstata / The recent changes in prostate cancer screening

O rastreamento do câncer de próstata é um tema controverso e extremamente importante, tanto para o urologista quanto para o clínico geral. Mudanças recentes nas recomendações internacionais a respeito desse tema precisam ser do conhecimento de todos os médicos. (AU)

Prostate cancer screening is controversial and extremely important, both for the urologist and for the general practioner. Every medical professional must be aware of recent changes in international recommendations in this regard. (AU)

Quality of life evaluation of patients with neurogenic bladder submitted to reconstructive urological surgeries preserving the bladder.

Treatment of neurogenic bladder (BN) aims to upper urinary tract protection. When the conservative clinical measures are insufficient, surgical treatment is indicated. Though admittedly important, the quality of life (QoL) has been little studied in these patients, there are even contradictory results. The aim of this study was to evaluate QoL before and after bladder augmentation in patients with BN refractory to medical treatment. We analyzed, prospectively, the data of 67 patients who underwent surgical treatment for BN by questionnaire SF-36(®) and Qualiveen(®) QoL before and after six months of operation. Comparisons using paired t-tests and Wilcoxon and the assumption of normality was assessed using the Shapiro-Wilk test were made. According to the analysis of the SF-36(®) questionnaire, the patients had higher QoL indices in the postoperative period in the areas functional capacity, general state of health, vitality, social aspects, emotional aspects and mental health (n = 67; p <0.05). The questionnaire also revealed Qualiveen(®) best result in quality of life index in the postoperative period, and show lower specific negative impact by urinary problems (n = 36; p <0.05). The results show that, despite not being the main objective, the bladder augmentation results in significant improvement in QoL, probably related to the perception of better health and the resolution of urinary incontinence. Thus, the bladder augmentation associated with other urologic reconstruction techniques allows the upper urinary tract protection, and contribute to a better quality of life of patients with BN.

Quality of life evaluation of patients with neurogenic bladder submitted to reconstructive urological surgeries preserving the bladder

Treatment of neurogenic bladder (BN) aims to upper urinary tract protection. When the conservative clinical measures are insufficient, surgical treatment is indicated. Though admittedly important, the quality of life (QoL) has been little studied in these patients, there are even contradictory results. The aim of this study was to evaluate QoL before and after bladder augmentation in patients with BN refractory to medical treatment. We analyzed, prospectively, the data of 67 patients who underwent surgical treatment for BN by questionnaire SF-36® and Qualiveen® QoL before and after six months of operation. Comparisons using paired t-tests and Wilcoxon and the assumption of normality was assessed using the Shapiro-Wilk test were made. According to the analysis of the SF-36® questionnaire, the patients had higher QoL indices in the postoperative period in the areas functional capacity, general state of health, vitality, social aspects, emotional aspects and mental health (n = 67; p <0.05). The questionnaire also revealed Qualiveen® best result in quality of life index in the postoperative period, and show lower specific negative impact by urinary problems (n = 36; p <0.05). The results show that, despite not being the main objective, the bladder augmentation results in significant improvement in QoL, probably related to the perception of better health and the resolution of urinary incontinence. Thus, the bladder augmentation associated with other urologic reconstruction techniques allows the upper urinary tract protection, and contribute to a better quality of life of patients with BN.

Há indicação para a realização da cirurgia de separação laringotraqueal para a prevenção de aspiração pulmonar em pacientes com tumores de cabeça e pescoço? / Is there indication to make laryngotracheal separation surgery for the prevention of pulmonary aspiration in patients with head and neck tumors?

Objetivo: Avaliar os resultados obtidos em pacientes com câncerde cabeça e pescoço submetidos à extensas ressecções dasvias aéreas e digestivas superiores associada à cirurgia deseparação laringotraqueal (SLT). Esta tinha o objetivo de prevenirpotencial aspiração pós-operatória. Desenho do Estudo:Análise retrospectiva. Estabelecimentos: Hospital das Clínicasda Universidade Federal de Minas Gerais (UFMG) e o HospitalBiocor. Método: Análise dos prontuários médicos de 30 pacientescom câncer de cabeça e pescoço, cuja exérese tem, sabidamente,grande potencial de causar aspiração pulmonar no pós-operatória.Eles foram submetidos à que se submeteram à realização da SLTjuntamente com a ressecção do tumor, no período de 1991 a 2008.As seguintes variáveis foram avaliadas: prevenção de potenciale grave aspiração pulmonar pós-operatória, morbidade e taxade reversibilidade da LTS. Resultados: A cirurgia foi eficaz em100,0% dos casos. Seis (20,0%) pacientes tiveram complicaçõespós-operatórias, ou seja, edema, estenose de traqueostomia efístula traqueocutânea do coto proximal da traqueia. A cirurgiapara reversão LTS foi realizada em 11 (36,7%) pacientes, sendoeficaz em nove (81,8%); cinco (45,5%) tiveram complicaçõespós-operatórias. Conclusões: A SLT impediu a ocorrência deaspiração pulmonar pós-operatória em pacientes submetidos àextensas ressecções das vias aéreas e digestivas superiores. Oprocedimento é potencialmente reversível e tem uma alta taxa deeficácia. No entanto, a frequência de complicações para ambasLTS e, especialmente sua reversão, não pode ser negligenciada.Descritores: separação laringotraqueal, prevenção de aspiraçãopulmonar, câncer de cabeça e pescoço, deglutição, desordens dedeglutição.

Vias de acesso para tratamento de cálculos urinários: influência da introdução da videolaparoscopia / Access way for treatment of urinary calculi: impact of the introduction of laparoscopy

Avaliar a influência da laparoscopia na rotina cirúrgica do Serviço de Urologia do HC-UFMG. Métodos: Foi feita uma análise retrospectiva de todas as cirurgias, para tratamento de cálculos, realizadas no HC-UFMG entre janeiro de 2004 e outubro de 2008. Resultados: No total foram realizados 613 procedimentos e 4.850 litotripsias extracorpóreas (LECOs). Ao estratificarmos o tipo de procedimento cirúrgico realizado em função do tempo, temos que: no período inicial do estudo (2004), houve apenas seis (4,7%) casos de litíase tratados pela via laparoscópica, já no ano de 2008, os procedimentos laparoscópicos corresponderam a 17 (15,2%) casos. Conclusões: As principais modalidades no tratamento de cálculos urinários são os procedimentos endoscópicos e a LECO. A laparoscopia, apesar de ter indicações limitadas, vem ganhando espaço frente à cirurgia aberta, principalmente nos casos refratários a tratamentos menos invasivos.

This paper aims to determine the influence of the laparoscopy in the treatment of urinary stones in a tertiary hospital (HC-UFMG). Methods: We reviewed our data from January 2004 to October 2008. All patients, who underwent surgery in our institution for the treatment of urinary calculi, were enrolled. Results: Six hundred and thirteen procedures and 4,850 shock wave lithotripsy (SWL) were performed. In the first year of the study (2004), only six (4.7%) cases were done by laparoscopic approach, whereas in the last year (2008) a total of 17 (15.2%) cases were performed using the laparoscopic technique. Conclusion: The SWL and the endoscopic surgery remained as the first line treatment of urinary stones, during the whole period studied. The laparoscopic technique, despite its limitations, is getting acceptance (over the traditional open procedure) and is indicated in those cases where minimally invasive techniques have failed.

Efeito da colestase nos aspectos funcionais e morfológicos renais após nefrectomia / Effect of cholestasis on renal morphological and functional aspects after nephrectomy

OBJETIVOS: O crescimento de um rim em resposta à perda do outro rim recebe o nome de hipertrofia renal compensatória. Entretanto, os mecanismos que regulam esse processo ainda não foram esclarecidos. Neste estudo, avaliaram-se os efeitos da icterícia obstrutiva na morfologia e na função do rim remanescente após nefrectomia unilateral. MÉTODOS: Foram estudados 40 ratos Wistar (250g-300 g), distribuídos nos seguintes grupos: Grupo 1 - operação simulada; Grupo 2 - nefrectomia direita; Grupo 3 - ligadura do ducto biliar; Grupo 4 - ligadura do ducto biliar e nefrectomia direita. Os animais foram mortos após 20 dias, quando foi colhido sangue para exames laboratoriais e feita a retirada dos rins e do fígado. Os rins foram pesados para avaliação do crescimento compensatório. Rins e fígado foram estudados histologicamente por microscopia óptica. RESULTADOS: Não houve diferença no aumento do peso renal relativo entre os animais dos Grupos 2 e 4 (p = 0,4). Os animais submetidos à ligadura do ducto biliar isoladamente (Grupo 3) apresentaram maior peso renal relativo quando comparados com os animais submetidos à operação simulada (Grupo 1) (p = 0,011). As alterações histológicas encontradas foram dilatação capilar da camada medular nos rins hipertrofiados e modificações típicas de colestase nos fígados dos animais ictéricos. Cirrose foi encontrada apenas nos animais submetidos à nefrectomia. CONCLUSÃO: O peso e a função do rim remanescente após nefrectomia unilateral não são afetados pela icterícia obstrutiva.

OBJECTIVE: The removal of one kidney results in a compensatory growth of the remnant kidney. However, the mechanism that underlies this hypertrophic response is not understood. In this study we assessed the influence of obstructive jaundice on renal morphology and function after unilateral nephrectomy. METHODS: Forty Wistar rats (250-300 g) were randomly divided into four groups: Group 1 - sham operation, Group 2 - right nephrectomy, Group 3 - common bile duct ligation, Group 4 - common bile duct ligation and right nephrectomy. After 20 days, blood was collected for biochemical studies and the animals were killed. Their kidneys and livers were removed and weighed. Histological evaluation of both organs was carried out. RESULTS: No difference in the kidney/body weight ratio was observed for animals undergoing right nephrectomy (Groups 2 and 4) (p = 0.4). Animals submitted to bile duct ligation only (Group 3) presented a higher kidney/body weight ratio than animals submitted to sham operation (Group 1) (p = 0.011). Vasodilatation was identified in the medulla of the hypertrophied kidneys and histological alterations were found in the livers of the jaundiced animals. Cirrhosis occurred only in nephrectomized rats. CONCLUSION: Cholestasis does not affect the weight, function or the compensatory renal growth of the remnant kidney after unilateral nephrectomy.

[Effect of cholestasis on renal morphological and functional aspects after nephrectomy]. / Efeito da colestase nos aspectos funcionais e morfológicos renais após nefrectomia.

OBJECTIVE: The removal of one kidney results in a compensatory growth of the remnant kidney. However, the mechanism that underlies this hypertrophic response is not understood. In this study we assessed the influence of obstructive jaundice on renal morphology and function after unilateral nephrectomy. METHODS: Forty Wistar rats (250-300 g) were randomly divided into four groups: Group 1--sham operation, Group 2--right nephrectomy, Group 3--common bile duct ligation, Group 4--common bile duct ligation and right nephrectomy. After 20 days, blood was collected for biochemical studies and the animals were killed. Their kidneys and livers were removed and weighed. Histological evaluation of both organs was carried out. RESULTS: No difference in the kidney/body weight ratio was observed for animals undergoing right nephrectomy (Groups 2 and 4) (p=0.4). Animals submitted to bile duct ligation only (Group 3) presented a higher kidney/body weight ratio than animals submitted to sham operation (Group 1) (p=0.011). Vasodilatation was identified in the medulla of the hypertrophied kidneys and histological alterations were found in the livers of the jaundiced animals. Cirrhosis occurred only in nephrectomized rats. CONCLUSION: Cholestasis does not affect the weight, function or the compensatory renal growth of the remnant kidney after unilateral nephrectomy.

Quality of life and surgical complications of kidney donors in the late post-operative period in Brazil.

BACKGROUND: Live donor kidney transplantation is a procedure conducted with proven efficacy and safety for its recipients, although the post-operative outcome of the donors has been subjected to little investigation. METHODS: This study assessed 100 donors (34 men and 66 women) for kidney transplants conducted at the Hospital of Clinics of the Federal University of Minas Gerais, Brazil in a post-operative period longer than 2 years. The quality of life evaluation was performed according to the SF-36 health survey. RESULTS: The quality of life of donors, especially female ones, was equal to or higher than the quality of life of the control group with respect to all the parameters of the short-form health survey. The main complaints were dissatisfaction with the medical service (31%) and with the aspect of the scar (24%). Six percent of the donors regretted the donation and the relationship of 13% of the donors with the recipient of the transplant deteriorated. The rates of overweight and obesity were larger than the Brazilian people averages. The frequency of arterial hypertension did not differ from the average of the Brazilian population, although half of these patients did not previously know their blood pressure levels. CONCLUSIONS: The quality of life of kidney donors was not different than it was for the healthy individuals of the community, although there were variations among donor subgroups. There was dissatisfaction related to the medical service and over the surgical scar, in addition to prevalence of obesity and arterial hypertension above the expectancy.