Prevalence of urologic sequelae and bladder and bowel dysfunctions in patients with congenital Zika syndrome: A multicenter evaluation of the Zika virus bladder and bowel sequelae assistance network.

INTRODUCTION: Neurogenic bladder was first confirmed as a urological sequela of Congenital Zika Syndrome (CZS) in 2018. Further clinical-epidemiological evidence also confirmed neurogenic bowel dysfunction and cryptorchidism. To strengthen the care for these children, the Congenital Zika Virus Bladder and Bowel Sequelae Network (RASZ in Brazilian) was created, including six integrated centers in Brazil. This article represents the initial outcome of the efforts by RASZ. OBJECTIVE: To evaluate the prevalence of bladder and bowel dysfunction, cryptorchidism and other urological sequelae related to CZS in cohorts attended in six Brazilian states. STUDY DESIGN: Observational, prospective, multicenter study including children with CZS assisted in one of six RASZ collaborative centers between June 2016 and February 2023. Data were collected from patient's first assessment using the same protocols for urological and bowel evaluation. Categorical variables were analyzed by frequency of occurrence and numerical variables by mean, median, and standard deviation. The study was approved by the Research Ethics Committees of each center, all parents/caregivers provided written informed consent. RESULTS: The study included 414 children aged 2 months to 7 years (mean 2.77 years, SD 1.73), 227 (54.8 %) were male and 140 (33,8 %) referred urological and bowel symptoms on arrival. Prevalence of both urological and bowel sequelae was 66.7 %, 51 % of children aged 4 years and older had urinary incontinence (UI). UTI was confirmed in 23.4 % (two presented toxemia) and among males, 18.1 % had cryptorchidism. Renal ultrasonography, performed in 186 children, was abnormal in 25 (13.4 %), 7 had hydronephrosis. Among the 287 children who performed urodynamics, 283 (98.6 %) were altered: 232 had a lower bladder capacity, 144 a maximum bladder pressure of ≥40 cm H2O, and 127 did not satisfactorily empty their bladder. DISCUSSION: A higher prevalence of NLUTD, neurogenic bowel and cryptorchidism was confirmed in children with CZS. Early diagnosis and appropriate treatment, including a multidisciplinary approach, may reduce the risk of UTIs, UI and kidney damage. A limitation of the study was the inability of children to complete the protocol, specifically urodynamic evaluation, and ultrasonography. In both exams, the percentage of abnormal cases was higher than that expected in the normal population. CONCLUSION: A 66,7 % prevalence of combined urological sequelae and bladder-bowel dysfunction related to CZS was confirmed in patients evaluated in six Brazilian cohorts. The most frequent changes were related to NLUTD, neurogenic bowel, and cryptorchidism. Prevalence may be underestimated due to access restrictions to diagnostic tests.

Zika-Related Microcephaly and Its Repercussions for the Urinary Tract: Clinical, Urodynamic, Scintigraphic and Radiological Aspects.

AIMS: Describing the urodynamic parameters of children aged 3 to 5 years with microcephaly related to congenital Zika syndrome and verifying the association with clinical, imaging and neurological characteristics. METHODS: From October 2018 to March 2020, children with Zika-related microcephaly underwent urological, ultrasonographic and urodynamic evaluation. In selected cases, complementary exams such as urethrocystography and scintigraphy were performed. The children also underwent a complete neurological evaluation. To compare frequency between groups, we used Pearson's chi-squared test or Fisher's exact test. RESULTS: This study evaluated 40 children, of whom 85% were 4 years old, and all had abnormalities on the urodynamic study, with low bladder capacity (92.5%) and detrusor overactivity (77.5%) as the most frequent findings. Only three children had ultrasound abnormalities, but no child had cystographic or scintigraphic abnormalities, and the postvoid residual volume was normal in 80% of cases. In spite of a frequency of 67.5% of intestinal constipation, there was no record of febrile urinary tract infection after the first year of life. All children presented severe microcephaly and at least one neurological abnormality in addition to microcephaly. The homogeneity of the children in relation to microcephaly severity and neurological abnormalities limited the study of the association with the urodynamic parameters. CONCLUSIONS: Urodynamic abnormalities in children aged 3 to 5 years with Zika-related microcephaly do not seem to characterize a neurogenic bladder with immediate risks for the upper urinary tract. The satisfactory bladder emptying suggests that the voiding pattern is reflex.

Validation of the urgency questionnaire in Portuguese: A new instrument to assess overactive bladder syndrome

ABSTRACT Purpose Overactive Bladder (OAB) is a clinical condition characterized by symptoms reported by patients. Therefore, measurement instruments based on reported information are important for understanding its impact and treatment benefits. The aim of this study was to translate, culturally adapt and validate the Urgency Questionnaire (UQ) in Portuguese. Materials and Methods Initially, the UQ was translated and culturally adapted to Portuguese. Sixty-three volunteers were enrolled in the study and were interviewed for responding the Portuguese version of the UQ and the validated Portuguese version of the Overactive Bladder Questionnaire short-form (OABq-SF), used as the gold standard measurement for the validation process. Psychometric properties such as criterion validity, stability, and reliability were tested. Results Forty-six subjects were included in the symptomatic group (presence of "urgency"), and seventeen were included in the asymptomatic group (control group). There was difference between symptomatic and asymptomatic subjects on all of the subscales (p≤0.001). The UQ subscales correlated with the OABq-SF subscales (p≤0.01), except the subscale "time to control urgency" and the item "impact" from the visual analog scales (VAS). However, these scales correlated with the OABq-SF - Symptom Bother Scale. The UQ subscales demonstrated stability over time (p<0.05), but the subscale "fear of incontinence" and the item "severity" of the VAS did not. All of the UQ subscales showed internal consistencies that were considered to be good or excellent. Conclusion The Portuguese version of the UQ proved to be a valid tool for the evaluation of OAB in individuals whose native language is Portuguese.

Validation of the urgency questionnaire in Portuguese: A new instrument to assess overactive bladder syndrome.

PURPOSE: Overactive Bladder (OAB) is a clinical condition characterized by symptoms reported by patients. Therefore, measurement instruments based on reported information are important for understanding its impact and treatment benefits. The aim of this study was to translate, culturally adapt and validate the Urgency Questionnaire (UQ) in Portuguese. MATERIALS AND METHODS: Initially, the UQ was translated and culturally adapted to Portuguese. Sixty-three volunteers were enrolled in the study and were interviewed for responding the Portuguese version of the UQ and the validated Portuguese version of the Overactive Bladder Questionnaire short-form (OABq-SF), used as the gold standard measurement for the validation process. Psychometric properties such as criterion validity, stability, and reliability were tested. RESULTS: Forty-six subjects were included in the symptomatic group (presence of "urgency"), and seventeen were included in the asymptomatic group (control group). There was difference between symptomatic and asymptomatic subjects on all of the subscales (p≤0.001). The UQ subscales correlated with the OABq-SF subscales (p≤0.01), except the subscale "time to control urgency" and the item "impact" from the visual analog scales (VAS). However, these scales correlated with the OABq-SF - Symptom Bother Scale. The UQ subscales demonstrated stability over time (p<0.05), but the subscale "fear of incontinence" and the item "severity" of the VAS did not. All of the UQ subscales showed internal consistencies that were considered to be good or excellent. CONCLUSION: The Portuguese version of the UQ proved to be a valid tool for the evaluation of OAB in individuals whose native language is Portuguese.

4-Ports endoscopic extraperitoneal radical prostatectomy: preliminary and learning curve results.

INTRODUCTION: There is a lack of studies in our national scenario regarding the results obtained by laparoscopic radical prostatectomy technique (LRP). Except for a few series, there are no consistent data on oncological, functional, and perioperative results on LRP held in Brazil. As for the LRP technique performed by extraperitoneal access (ELRP), when performed by a single surgeon, the results are even scarcer. OBJECTIVE: To analyze the early perioperative and oncologic results obtained with the ELRP, throughout the technical evolution of a single surgeon. PATIENTS AND METHODS: A non-randomized retrospective study was held in a Brazilian hospital of reference. In the 5-year period, 115 patients underwent the ELRP procedure. Patients were divided into two groups, the first 57 cases (Group 1) and the following 58 cases, (Group 2). A comparative analysis between the groups of efficacy results and ELRP safety was carried out. RESULTS: The average age of patients was 62.8 year-old and the PSA of 6.9ng/dl. The total surgery time was 135.8 minutes on average, and the urethral-bladder anastomosis was 21.9 min (23.3 min versus 20.7 min). The positive surgical margins (PSM) rate was 17.1%, showing no difference between groups (16.4% versus 17.9%; p=0.835). There was statistical difference between the groups in relation to the anastomosis time, estimated blood loss and the withdrawal time of the urinary catheter. CONCLUSION: The ELRP technique proved to be a safe and effective procedure in the treatment of prostate cancer, with low morbidity.

4-Ports endoscopic extraperitoneal radical prostatectomy: preliminary and learning curve results

ABSTRACT Introduction There is a lack of studies in our national scenario regarding the results obtained by laparoscopic radical prostatectomy technique (LRP). Except for a few series, there are no consistent data on oncological, functional, and perioperative results on LRP held in Brazil. As for the LRP technique performed by extraperitoneal access (ELRP), when performed by a single surgeon, the results are even scarcer. Objective To analyze the early perioperative and oncologic results obtained with the ELRP, throughout the technical evolution of a single surgeon. Patients and methods A non-randomized retrospective study was held in a Brazilian hospital of reference. In the 5-year period, 115 patients underwent the ELRP procedure. Patients were divided into two groups, the first 57 cases (Group 1) and the following 58 cases, (Group 2). A comparative analysis between the groups of efficacy results and ELRP safety was carried out. Results The average age of patients was 62.8 year-old and the PSA of 6.9ng/dl. The total surgery time was 135.8 minutes on average, and the urethral-bladder anastomosis was 21.9 min (23.3 min versus 20.7 min). The positive surgical margins (PSM) rate was 17.1%, showing no difference between groups (16.4% versus 17.9%; p=0.835). There was statistical difference between the groups in relation to the anastomosis time, estimated blood loss and the withdrawal time of the urinary catheter. Conclusion The ELRP technique proved to be a safe and effective procedure in the treatment of prostate cancer, with low morbidity.

[Knowledge of physicians and obstetric nurses about the prevention of neural tube defects]. / Conhecimento de médicos e enfermeiros obstetras sobre a prevenção dos defeitos no tubo neural.

The scope of this study was to evaluate the knowledge of obstetricians and obstetric nurses about folic acid in the prevention of neural tube defects (NTD). A cross-sectional study was conducted in which 118 volunteers (95 physicians and 23 nurses) answered a questionnaire with 21 questions about prevention of NTD. The data were analyzed according to the reported knowledge, the recommendations made by the Brazilian Ministry of Health (MOH) and the scientific evidence (SE) available in the literature on the topic. The knowledge based on the SE and recommendations of MOH was different (4.64 ± 0.20 vs. 5.55 ± 0.15, p <0.001, Mean ± SEM). There was no difference between the knowledge of respondents compared to their training, the time spent in prenatal care and between the two classes of professionals evaluated. There were differences between the reported knowledge and that based on SE (6.76 ± 0.18 vs. 4.64 ± 0.15, p <0.001) and based on the MOH recommendations (6.76 ± 0.18 vs. 5.55 ± 0.20, p <0.001). Thus, the conclusion reached was that 94.1% of those evaluated reported knowing the importance of folic acid in preventing NTD, though 64.2% reported that they did not know when to begin administration of the supplement.

Conhecimento de médicos e enfermeiros obstetras sobre a prevenção dos defeitos no tubo neural / Knowledge of physicians and obstetric nurses about the prevention of neural tube defects

Foi avaliado o nível de conhecimento de médicos e enfermeiros obstetras sobre a utilização de ácido fólico (AF) para a prevenção dos defeitos do fechamento do tubo neural (DFTN). Estudo descritivo transversal no qual 118 voluntários (95 médicos e 23 enfermeiros), responderam um questionário com 21 perguntas sobre a prevenção dos DFTN. Os dados foram analisados em função do conhecimento relatado, das recomendações preconizadas pelo Ministério da Saúde (MS) e das evidências científicas (EC) disponíveis sobre o assunto investigado. O nível de conhecimento baseado nas EC e nas recomendações do MS foi diferente (4,64 ± 0,20 vs 5,55 ± 0,15; p < 0,001; Média ± EPM). Não houve diferença entre o nível de conhecimento quando comparado à formação dos mesmos, ao tempo que realizam atendimento pré-natal e entre as duas classes de profissionais avalia­dos. Houve diferença entre o nível de conhecimento relatado e o baseado nas EC (6,76 ± 0,18 vs 4,64 ± 0,15; p < 0,001) e o baseado nas recomendações do MS (6,76 ± 0,18 vs 5,55 ± 0,20; p < 0,001), 94,1% dos profissionais conhecem o papel do ácido fólico, contudo, 64,2% relataram não saber quando iniciar a suplementação no pré-natal. Frente ao exposto foi verificado que a grande maioria dos avaliados relatou conhecer a importância do AF na prevenção do DFTN, porém, existe ainda desconhecimento sobre o assunto investigado.

The scope of this study was to evaluate the knowledge of obstetricians and obstetric nurses about folic acid in the prevention of neural tube defects (NTD). A cross-sectional study was conducted in which 118 volunteers (95 physicians and 23 nurses) answered a questionnaire with 21 questions about prevention of NTD. The data were analyzed according to the reported knowledge, the recommendations made by the Brazilian Ministry of Health (MOH) and the scientific evidence (SE) available in the literature on the topic. The knowledge based on the SE and recommendations of MOH was different (4.64 ± 0.20 vs. 5.55 ± 0.15, p <0.001, Mean ± SEM). There was no difference between the knowledge of respondents compared to their training, the time spent in prenatal care and between the two classes of professionals evaluated. There were differences between the reported knowledge and that based on SE (6.76 ± 0.18 vs. 4.64 ± 0.15, p <0.001) and based on the MOH recommendations (6.76 ± 0.18 vs. 5.55 ± 0.20, p <0.001). Thus, the conclusion reached was that 94.1% of those evaluated reported knowing the importance of folic acid in preventing NTD, though 64.2% reported that they did not know when to begin administration of the supplement.

Avaliação do conhecimento dos profissionais da saúde sobre a prevenção da mielomeningocele / Evaluating the knowledge of health professionals on the prevention of myelomeningocele / Evaluación del conocimiento de profesionales de salud sobre prevención de mielomeningocele

Objetivo: avaliar o conhecimento dos profissionais de saúde sobre a prevenção da mielomeningocele em Recife-PE,quanto à época, dosagem e período da utilização do ácido fólico e seu o real impacto como medida preventiva. Método:estudo do tipo coorte transversal, realizado nos distritos sanitários da cidade do Recife, no qual foram avaliados 90 profissionais de saúde envolvidos no atendimento pré-natal das unidades de saúde, entre janeiro e outubro de 2008 após aprovação pelo Comitê de Ética do Cisam n. 025/07, CAAE 0020.0.250.000-07. Resultados: 93% desses profissionais são do sexo feminino. A maioria é especializada em saúde da família, com experiência de mais de cinco anos em consultas de pré-natal, nas quais se prescreve o ácido fólico regularmente. No que se refere à autoavaliação sobre a importância do ácido fólico, 28% consideraram ter alto conhecimento e 69% consideraram ter razoável conhecimento. Conclusão: aqueles profissionais que estão há menos tempo no atendimento pré-natal têm um maior conhecimento do papel do ácido fólico na prevenção da mielomeningocele e que não houve associação estatisticamente significativa entre o tempo de atuação na área pré-natal e o uso correto do ácido fólico na gestação (p > 0,05).(AU)

Objective: to evaluate the knowledge of healthcare professionals on the prevention of myelomeningocele in Recife, Pernambuco, Brazil, with regard to time, dosage, and period for using folic acid, as well as its actual impact as a preventive measure. The study was approved by the Research Ethics Committee of Cisam/UPE under the Opinion 025/07, CAAE 0020.0.250.000-07. Method: this is a cross-sectional study, carried out in the sanitary districts of Recife city, in which 90 healthcare professionals (nurses and physicians) involved with prenatal care at health units were evaluated, between January and October 2008. Results: 93% of these professionals are women. Most of them is specialized in family health, with more than five years experience in prenatal care appointments, in which folic acid is regularly prescribed. With regard to the self-evaluation on the importance of folic acid, 28% considered themselves to have a great knowledge about it and 69% considered themselves to have a reasonable knowledge about it. Conclusion: those healthcare professionals who are less experienced in prenatal care have a greater knowledge on the role of folic acid for the prevention of myelomeningocele and that there was no statistically significant association between the length of experience in prenatal care and the correct use of folic acid during pregnancy (p > 0.05).(AU)

Objetivo: evaluar el conocimiento de los profesionales de la salud acerca de la prevención de la mielomeningocele en Recife, Pernambuco, Brasil, en cuanto a la época, dosificación y período del uso de ácido fólico y su impacto real como medida preventiva. Método: esto es un estudio de corte transversal, realizado en los distritos sanitarios de la ciudad de Recife, que evaluó a 90 profesionales de la salud (enfermeros y médicos) que trabajan con la atención prenatal de las unidades de salud, entre enero y octubre de 2008. Resultados: 93% de eses profesionales son mujeres. La mayoría es especializada en salud de la familia, con experiencia de más de cinco años en consultas prenatales, donde el ácido fólico es prescrito con regularidad. En lo que respecta a la autoevaluación acerca de la importancia del ácido fólico, 28% consideraron tener un profundo conocimiento y 69% consideraron tener un razonable conocimiento. Conclusión: aquellos profesionales que están trabajando hay menos tiempo con la atención prenatal tienen un mejor conocimiento del papel del ácido fólico en la prevención de mielomeningocele y que no hubo asociación estadísticamente significativa entre el tiempo de trabajo en la área de prenatal y el uso correcto del ácido fólico durante el embarazo (p > 0,05).(AU)

The impact of erectile dysfunction on the quality of life of men undergoing hemodialysis and its association with depression.

INTRODUCTION: Erectile dysfunction (ED) is highly prevalent among men undergoing hemodialysis. AIM: This study was performed to identify the influence of ED on the patient's quality of life (QoL) and to evaluate the influence of depression on erectile function of these patients. MAIN OUTCOME MEASURES: For this multicenter cross-sectional study, 275 patients were interviewed through questionnaires: the five-item version of the International Index of Erectile Function was used for diagnosing and classifying ED; the Medical Outcomes Study Questionnaire 36-Item Short Form Health Survey (SF-36) for scoring QoL; and the Hospital Anxiety and Depression Scale (HADS) to evaluate depressive symptoms. Linear regression was used to examine the associations between some of the variables and ED. Predialytic biochemical and hematological parameters were determined during the longer interdialytic period. RESULTS: Patients had a mean age of 48.6 ± 12.8 years, and the ED prevalence was 72.3%. Advanced age, diabetes and depression score were independent risk factors for the development of ED as confirmed by linear regression (P < 0.001, P = 0.002, and P < 0.001, respectively). QoL was worse among patients with any degree of ED, and the scores were statistically significant for overall health rating (P = 0.016), physical composite score (P = 0.003), bodily pain (P = 0.042), physical functioning (P < 0.001), and vitality (P = 0.005). Furthermore, more severe forms of ED were associated with a lower QoL. After adjustment for some variables, such as age, time under dialysis, hemoglobin, albumin, parathyroid hormone, Kt/V, and depression, linear regression showed that domains related to poorer physical functioning (P = 0.047) and decreased vitality (P = 0.009) were significantly related to ED. CONCLUSION: Depression is an important trigger for the development of ED in hemodialysis patients, and this sexual condition is an independent risk factor for their poor QoL.

Predictive factors for contralateral reflux in patients with conservatively treated unilateral vesicoureteral reflux.

PURPOSE: We evaluated the rate of new contralateral reflux in children with conservatively treated vesicoureteral reflux, and identified predictive factors that could influence the appearance of contralateral reflux after a diagnosis of unilateral reflux on the first voiding cystourethrogram. MATERIALS AND METHODS: We retrospectively evaluated 167 children who had been diagnosed with unilateral vesicoureteral reflux on the first voiding cystourethrogram. Patients with bilateral or secondary vesicoureteral reflux and those who had undergone only 1 voiding cystourethrography were excluded from the study. A total of 134 girls and 33 boys were analyzed. Average patient age was 55 months (range 2 to 169). All children had undergone at least 2 voiding cystourethrograms. A total of 84 patients underwent 3 voiding cystourethrograms, 35 underwent 4, 18 underwent 5, 9 underwent 6 and 3 underwent 7. RESULTS: New contralateral reflux was evident on subsequent voiding cystourethrography in 35 patients (21%). Analysis of the presence of new contralateral reflux according to gender, reflux grade, age, side of reflux and bladder function (with or without lower urinary tract dysfunction) revealed that only medium or high grade reflux was a risk factor for new contralateral reflux. In 98 children (59%) vesicoureteral reflux resolved spontaneously. Of these patients 13 had new contralateral reflux and 85 did not (p = 0.017). CONCLUSIONS: We identified a 21% incidence of new contralateral reflux in patients with unilateral reflux after the first voiding cystourethrography who were treated conservatively. The main risk factor for contralateral reflux was the presence of medium or high grade reflux. Patients with new contralateral reflux had a lower rate of cure than those without development of contralateral reflux.

The Macedo-Malone antegrade continence enema procedure: early experience.

PURPOSE: The successful treatment of fecal incontinence can dramatically improve the quality of life of affected children. The introduction of the Malone antegrade continence enema provides the opportunity to manage previously resistant cases. However, using the to create this catheterizable channel is not always possible, and the duration of these antegrade enemas is a source of concern for the patients. We describe a new approach to create left continent colonic access to shorten the duration of these enemas, and report the experience gained from the first 9 cases managed at our institution. MATERIALS AND METHODS: During a 5-year period 9 patients underwent a Macedo-Malone antegrade continence enema at our institution. Incontinence was associated with myelomeningocele in 7 patients and anorectal malformation in 2. The antegrade continence enema procedure is begun by isolating a 2 cm flap in a tenia on the left colon (spleen flexure). A 12Fr silicone Foley catheter is placed on the mucosal surface of the flap to allow tubularization of the plate with interrupted polyglycolic acid 3-zero transverse sutures, creating an efferent tubular conduit. Antegrade colonic washouts were started 2 weeks after surgery with saline solution or tap water in all patients. RESULTS: Followup of our 9 cases ranged from 8 to 33 months (average 20.7). Enema volume varied from 250 to 800 ml, with administration taking from 45 to 60 minutes, and colonic evacuation occurred within 30 to 60 minutes of enema administration. Of the 9 patients 8 were completely continent and 1 was partially continent. Four patients experienced difficulty with catheterization initially because of stenosis of the stomal track. The affected stomas were dilated, which was successful in 1 case. Three patients subsequently required stomal revision. CONCLUSIONS: The Macedo-Malone procedure is a relatively straightforward operative approach providing an effective washout technique that is acceptable to parents and children.

Avaliação da túnica vaginal como enxerto dorsal na reconstrução uretral: estudos experimental em coelhos / The tunica vaginalis dorsal graft urethroplasty: experimental study in rabbits

Introdução: Através da utilização de um modelo experimental de defeito uretral foi estudada a reconstrução uretral com aplicação de enxerto de túnica vaginal na superfície dorsal da uretra. Foram estudados os aspectos histológicos e radiológicos da uretroplastia com enxerto de túnica vaginal. Material e métodos: Em 20 coelhos machos da raça neozelandesa foi criado um defeito uretral através da excisão de um segmento da superfície uretral dorsal. O enxerto de túnica vaginal foi então aplicado sobre a superfície dos corpos cavernosos com pontos de ancoragem e a margem mucosa do defeito uretral foi suturada ao enxerto com vycril@ 6-0. Os animais foram divididos em quatro grupos iguais e sacrificados após 2, 4, 8 e 12 semanas. Todos os animais realizaram uretrocistografia miccional imediatamente antes do sacrifício. As peças cirúrgicas foram enviadas para exame histológico e foi avaliada a evolução da reação inflamatória aguda e crônica, a reação de corpo estranho e a presença de necrose e fibrose. Resultados: Nenhum animal foi a óbito decorrente do procedimento cirúrgico e não houve complicações trans-operatórias. A avaliação radiológica através de uretrocistografia não demonstrou fístulas ou estenoses em nenhum dos animais. A medida que o período pós-operatório evoluiu os sinais de inflamação foram desaparecendo e a orientação das fibras colágenas foi reassumindo um padrão semelhante à uretra normal. O revestimento mesotelial da túnica vaginal foi gradualmente sendo substituído por um epitélio mais estratificado similar ao epitélio da uretra nativa. Conclusão: No presente estudo foi observado que o enxerto de túnica vaginal quando aplicado dorsalmente pode ser um bom substituto uretral neste modelo animal.

Prevalência de coilocitose em biópsias penianas de parceiros de mulheres com lesões genitais induzidas pelo HPV / Prevalence of koilocytosis in penile biopsies of partners of women with HPV-induced genital lesions

OBJETIVO: determinar a prevalência de coilocitose em biópsias penianas de parceiros de mulheres com lesões genitais induzidas pelo HPV e analisar os fatores de risco envolvidos com a infecção peniana. MÉTODOS: foram incluídos neste estudo de coorte transversal 80 parceiros de mulheres com lesões induzidas pelo HPV no período de maio de 2002 a junho de 2003. A média de idade dos pacientes foi de 34,1 anos (variando de 16 a 63). Todos os pacientes negavam ou desconheciam qualquer tipo de lesão genital. Foram submetidos à anamnese específica quanto a presença de sintomas uretrais, passado de doenças sexualmente transmissíveis (DST), número de parceiras sexuais, uso de preservativos e postectomia. Posteriormente foram submetidos à peniscopia com a utilização de soluções de ácido acético e azul de toluidina, tendo sido colhido material para biópsia das lesões de aspecto morfológico sugestivo de contaminação por HPV. A análise estatística foi realizada pelo teste do chi2. RESULTADOS: o exame foi considerado negativo em 24 pacientes (30 por cento). Todos os outros 56 pacientes (70 por cento) apresentaram lesões acetobrancas e azul de toluidina positivas. Destes, 53 foram biopsiados, e 41 pacientes (77,3 por cento) apresentaram biópsia com alterações histológicas sugestivas de infecção pelo HPV. CONCLUSÕES: a prevalência da infecção genital masculina pelo HPV foi de 51,2 por cento, e nenhum fator de risco analisado foi associado com uma maior prevalência da infecção genital pelo vírus.

Tratamento do carcinoma renal metastático / Treatment of the metastic renal cell carcinoma

O carcinoma de células renais (COR) é a sétíma principal causa de câncer, respondendo por 3por cento dos tumores malignos no homem. Em um terço dos casos se apresenta como doença avançada e até 50por cento dos pacientes tratados cirurgicamente terão recidiva tumoral Acomete os homens duas vezez mais frequentemente que as mulheres e é mais comum entre a quinta e a sétima década de vida. O CCR teve sua incidência aumentada a partir da década de 70 devido ao uso rotineiro do ultra-som e aumento dos fatores de risco na população como fumo, obesidade e hipertensão. Pacientes com CCR metastático não tratados têm uma sobrevida média de seis a dez meses e apenas 10por cento a 20por cento estarão vivos após dois anos. Atualmente, com um melhor estudo da biologia e história natural do CCR, muitos avanços têm ocorrido nas áreas da genética molecular e ímunologia. Os autores fazem uma revisão das atuais modalidades terapêuticas do CCR avançado.

The role of refluxing distal ureteral stumps after nephrectomy.

BACKGROUND/PURPOSE: Classically, the refluxing distal ureteral stump has been removed during the nephrectomy by the means of an incision on the flank and lower abdominal wall. There are little data in the literature about the natural history of these stumps. In the current work the authors evaluated possible complications affecting the ureteral stump after total or partial nephrectomy for vesicoureteral reflux. METHODS: Between June 1974 and May 1991, our institution performed 25 nephrectomies followed by partial ureterectomy to correct vesicoureteral reflux into a nonfunctional kidney. The authors performed, respectively, 16 total and 9 partial nephrectomies. The reflux to operated units was graded according to the International Grading System as grade 1 (n = 1), grade 2 (n = 4), grade 3 (n = 9), grade 4 (n = 8), and grade 5 (n = 1). RESULTS: Ureteral stump removal was performed in 3 patients (13%). No correlation between the need for ureteral stump removal and age, gender, grade of preoperative reflux, associated contralateral reflux, and ureteral histology, became apparent. CONCLUSION: The remainder of the ureteral stump, after a total or partial nephrectomy to correct vesicoureteral reflux, presents a low rate of complications even in the presence of a high grade of reflux.

Evolução do refluxo vesicoureteral no primeiro ano de vida / Vesicoureteral reflux under the first year of life

O refluxo vesicoureteral (RVU) é uma das patologias mais comuns da urologia pediátrica, apresentando alta incidência em crianças portadoras de infecção urinária. Vários estudos têm demonstrado o alto índice de resolução espontânea do RVU, sendo o grau inicial e a idade do paciente os dois principais fatores envolvidos na resolução espontânea. Este estudo tem como objetivo avaliar a incidência, o diagnóstico, a evolução e o tratamento do RVU diagnosticado durante o primeiro ano de vida. Foram avaliados, retrospectivamente, os prontuários de 814 pacientes portadores de RVU, dos quais 363 apresentavam idade menor que 12 meses no momento do diagnóstico. Desses, 269 (74,1 por cento) eram meninas e 94 (25,9 por cento) meninos. O quadro clínico mais freqüente foi a infecção urinária (71,3 por cento), seguida em menor freqüência por baixo ganho de peso (13,4 por cento), febre inexplicável (9 por cento), diagnóstico antenatal (3,8 por cento) e outros. Todos os pacientes foram submetidos à uretrocistografia miccional e foi graduado o RVU. Os parênquimas renais foram avaliados por cintilografia (DMSA) ou urografia excretora. O RVU foi de grau I em 26 pacientes, grau II em 134, grau III em 117, grau IV em 42 e grau V em 21. Todos os pacientes foram inicialmente mantidos em tratamento clínico. Durante o seguimento, 67 pacientes (18,4 por cento) necessitaram de cirurgia. Dos 274 pacientes mantidos em tratamento clínico, 255 apresentavam seguimento mínimo de 1 ano. A taxa de resolução espontânea nesse grupo foi de 85 por cento, sendo de 100 por cento no grau I, 86 por cento no grau II, 81 por cento no grau III, 41 por cento no grau IV e 0 por cento no grau V. O RVU diagnosticado durante o primeiro ano de vida apresenta peculiaridades quanto ao diagnóstico e evolução. A taxa de resolução espontânea do RVU é alta, justificando o tratamento clínico como conduta inicial desse grupo. As indicações de cirurgia devem ser individualizadas.

Fístula Arteriovenosa pós-biópsia renal tratada por embolizaçäo seletiva / Post renal biopsy arterivenous fistula treated with selectiva embolization

Fístulas arteriovenosas pós-biópsia renal ocorrem em até 15 por cento dos casos. No entanto, a grande maioria é assintomática. Naqueles casos em que há sintomatologia, a maior parte tem resulução espontânea, necessitando apenas tratamento de suporte. Nos raros casos em que a fístula não se fecha espontaneamente ou provoca sintomatologia importante, a arteriografia percutânea com embolização seletiva constitui-se no tratamento de escolha. Os autores descrevem um caso de fístula arteriovenosa pós-biópsia renal que evolui com hamatúria maciça e foi tratado com embolização seletiva via femoral percutânea com cianoacrilato e fazem uma revisão da literatura