Challenges in measuring sleep quality among women with endometriosis: A comparison of two questionnaires.

OBJECTIVE: This study aimed to underscore the issues associated with the dichotomization of categories in sleep questionnaires among women diagnosed with endometriosis and sleep disturbances, as well as their potential impact on the validity of the research findings. BACKGROUND: A range of questionnaires is employed across settings from primary care to research to classify sleep disturbances. Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) are two frequently utilized instruments for evaluating sleep. Nonetheless, these tools may produce divergent outcomes when applied to the same population. METHODS: To evaluate the sleep quality of patients with deep endometriosis (DE), two self-administered questionnaires were utilized: ISI and PSQI. Patients rated their average pelvic pain over the preceding four weeks on a numeric rating scale (NRS) ranging from 0 to 10. Patients with an ISI score >14 or PSQI >5 were classified as poor sleepers, while the others as good sleepers. RESULTS: Among the 161 patients who completed both sleep questionnaires, 129 (80 %) rated their subjective sleep quality as good. However, when the scores from the sleep questionnaires were analyzed, only 17 (11 %) patients were classified as good sleepers by the PSQI, whereas the ISI classified 83 (52 %) patients as good sleepers. When comparing the standardized scores, moderate to good reliability was found (intraclass correlation coefficient, 0.76; 95 % confidence interval, 0.69-0.82). CONCLUSION: Both questionnaires yield consistent scores that seem comparable in women with DE; however, the cutoff values seem inadequate for this population. Therefore, we can probably rely on both questionnaire scores, yet their recommended cutoff values should be approached with caution.

Evaluation of HNF1B, KLK3, ELAC2, TMPRSS2-ERG, and CTNNB1 polymorphisms associated with prostate cancer in samples of patients from HUPE-UERJ.

PURPOSE: Prostate cancer (PCa) is the leading cause of death among men in 48 countries. Genetic alterations play a significant role in PCa carcinogenesis. For the hypothesis of this research, five unique polymorphisms (SNP) were investigated in different genes that showed to be associated in different ways with PCa: rs4430796, rs2735839, rs4792311, rs12329760, and rs28931588, respectively for the genes HNF1B, KLK3, ELAC2, TMPRSS2-ERG, and CTNNB1. PATIENTS AND METHODS: Blood samples from 426 subjects were evaluated: 290 controls (161 females and 129 males) and 136 PCa patients. SNP were determined by real-time polymerase chain reaction. TaqMan SNP genotyping assay. In the control samples, the SNPs were defined in association with the self-reported ethnicity, and in 218 control samples with markers with ancestry indicators. The genes were in Hardy-Weinberg equilibrium. One hundred and seventy control samples were matched by ethnicity for comparison with the PCa samples. RESULTS: The G allele at rs28931588 was monomorphic in both patients and controls studied. Significant differences were observed in allelic and genotypic frequencies between the control and Pca samples in rs2735839 (KLK3; p = 0.002 and χ2 = 8.73 and p = 0.01, respectively), by the global frequency and in the dominant model rs2735839_GG (odds ratio [OR] = 0.51, p = 0.02). AA and GA genotypes at rs4792311 (ELAC2) were more frequent in patients with Gleason 7(4 + 3), 8, and 9 (n = 37%-59.7%) compared to patients with Gleason 6 and 7(3 + 4) (n = 26%-40.0%) conferring a protective effect on the GG genotype (OR = 0.45, p = 0.02). The same genotype showed an OR = 2.71 (p = 0.01) for patients with low severity. The HNF1B-KLK3-ELAC2-TMPRSS2-ERG haplotypes: GAAT, AAAT, GAGT, and AAGT were more frequent in patients with Pca with OR ranging from 4.65 to 2.48. CONCLUSIONS: Higher frequencies of risk alleles were confirmed in the SNPs, KLK3 rs2735839_A, ELAC2 rs4792311_A, and TMPRSS2 rs12329760_T in patients with Pca. Rs2735839_A was associated with risk of Pca and rs4792311_A with severity and Gleason score of 7(4 + 3) or greater. There is a need for careful observation of rs2735839 and rs4792311 in association with the prostatic biopsy due to the increased risk of Pca.

Tratamento manipulativo osteopático musculoesquelético em mulheres com incontinência urinária não complicada / Musculoskeletal osteopathic manipulative treatment in women with uncomplicated urinary incontinence

Controle eficiente dos mecanismos de fechamento uretral é essencial para continência urinária feminina, envolvendo mecanismo similar ao necessário para estabilidade sacroilíaca. Estudos demonstraram benefícios na reabilitação funcional do assoalho pélvico, após tratamento de pacientes com lombalgia, utilizando técnicas de manipulação osteopática. O objetivo primário deste estudo foi avaliar melhora da incontinência urinária após tratamento manipulativo osteopático musculoesquelético (TMO), associado com fisioterapia pélvica (FP). Participaram pacientes da divisão de fisioterapia da Policlínica Piquet Carneiro/UERJ, com diagnóstico de incontinência urinária não complicada, idade entre 21 e 65 anos, que responderam os questionários: International Consultation on Incontinence Questionnaire - Short Form - ICIQ, Stress Urinary Incontinance Questionnaire - SUIQ, Overactive Bladder Questionnaire - ICIQ-OAB qol, e o questionário de qualidade de vida e saúde geral ­ EQ5D. A força perineal foi avaliada através do teste de avaliação funcional do assoalho pélvico, e as pacientes foram divididas em dois grupos: no grupo FP submetidas ao protocolo de FP por 10 semanas, e no grupo TMO submetidas ao mesmo protocolo, associado com TMO, pelo mesmo período. No presente estudo, a utilização do TMO associado à FP obteve resultados semelhantes à utilização de FP isoladamente, não acrescentando melhora na resposta ao tratamento da incontinência urinária não complicada. (AU)

Effective control of urethral closure mechanisms is essential for female urinary continence, involving mechanism similar to that required for sacroiliac stability. Studies have demonstrated benefits in the functional rehabilitation of the pelvic floor, after treatment of patients with low back pain, using osteopathic manipulation techniques. Primary objective of this study was to evaluate the improvement of urinary incontinence after musculoskeletal manipulation (OMT), associated with pelvic physiotherapy (PF). Patients from the Physiotherapy Division of the Policlínica Piquet Carneiro/UERJ, diagnosed with uncomplicated urinary incontinence, aged between 21 and 65 years, answered the questionnaires: International Consultation on Incontinence Questionnaire - Short Form - ICIQ, Stress Urinary Incontinence Questionnaire - SUIQ, Overactive Bladder Questionnaire - ICIQ-OAB qol, and the quality of life and general health questionnaire - EQ5D. The perineal force was evaluated through functional evaluation of the pelvic floor. Patients were divided: in the FP group submitted to the FP protocol, and in the OMT group submitted to the same protocol, associated with OMT, for 10 weeks. In the present study the use of OMT associated with PF, obtained results similar to the use of PF alone, and did not add improvement in the response to treatment of uncomplicated urinary incontinence. (AU)

Open anterograde anatomic radical retropubic prostatectomy technique: description of the first fiftyfive procedures.

INTRODUCTION: Robotic-assisted radical prostatectomy is the leading surgical technique and was discussed in Pasadena Consensus Panel (1). The goal of this study is to present the results of the first fifty-five patients submitted to Anterograde Anatomic Radical Retropubic Prostatectomy technique (R2PA2), without adding complexity or cost. MATERIALS AND METHODS: Fifty-five eligible men with localized prostate cancer underwent R2PA2 from January, 2016 to December, 2017. The technique was previously described (2): the main surgical steps were anterograde dissection, ligation of the dorsal vascular complex without dividing, preservation of the bladder neck, nerve sparing, preservation of Denonvilliers' fascia and confection of the running suture anastomosis. All patients were operated on by second-year residents. RESULTS: All procedures were completed as planned, but one converted to retrograde prostatectomy (mean duration, 163.40 minutes; hospital stay, 4 days with 4.20 days of drainage; indwelling vesical catheterization of 9.80 days). Positive surgical margin was found in six T2 staging patient (10.90%) and five T3 (9.10%). Biochemical PSA recurrence occurred in three patients (5.50%). Twenty-four (43.60%) were continent immediately after indwelling catheter removal, seventeen (30.90%) did not wear a pad at one postoperative month while eighteen (30%) used only one safety pad. Five minor complications occurred. CONCLUSION: We were able to perform R2PA2 allowing men who do not have access to this new technology to be operated on with the same technique used in robotic surgery. This method was reproducible by low-volume prostate cancer surgeons; help inexperienced surgeons to develop skills valuable to future training with robotic techniques. ACKNOWLEDGEMENTS This work was supported by the FAPERJ - Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro. Secretaria de Estado de Ciência, Tecnologia e Inovação do Governo do Estado do Rio de Janeiro, Brazil, and Pedro Ernesto University Hospital of the State University of Rio de Janeiro, Brazil. Available at: http://www.intbrazjurol.com.br/video-section/20180421_Carrerette_et_al.

Association between the bladder wall thickness and urodynamic findings in patients with spinal cord injury.

PURPOSE: To investigate whether ultrasonographic bladder wall thickness (BWT) correlates with urodynamic parameters in patients with spinal cord injury (SCI). METHODS: Two hundred and seventy-two patients with SCI were enrolled in the study. All of the patients underwent bladder ultrasonography and urodynamic study. The anterior bladder wall was measured and compared to urodynamic data. RESULTS: The mean age of the patients was 37.4 years. The mean BWT was 3.9 mm. BWT was significantly higher in the patients with neurogenic detrusor overactivity associated with detrusor sphincter dyssynergia (NDO/DSD) compared to those without sphincter dyssynergia (4.2 vs. 3.6 mm, respectively, p < 0.001) and in those with compliance <20 ml/cm H2O. Nevertheless, ROC curve analysis [ROC = 0.624, 95 % CI (0.530, 0.718), p = 0.011] showed that no meaningful BWT measurement cutoff could be made to predict an elevated detrusor pressure in the storage phase. CONCLUSIONS: Increased BWT was present in patients with low bladder compliance and NDO/DSD. No BWT cutoff value to predict an elevated detrusor pressure was found. Therefore, the measurement of BWT has no clinical role in patients with SCI and cannot replace urodynamic evaluation.

Lower urinary tract dysfunction and ultrasound assessment of bladder wall thickness in children with cerebral palsy.

OBJECTIVES: To evaluate lower urinary tract dysfunction (LUTD) based on questionnaire symptom scoring and ultrasound assessment of bladder wall thickness (BWT) in children with cerebral palsy (CP). METHODS: A total of 97 children with CP were enrolled in the study. The patients were either symptomatic or asymptomatic with respect to lower urinary tract symptoms. All children underwent a urinary questionnaire and renal ultrasonography. Ultrasound assessment of BWT was completed in 72 cases. RESULTS: A total of 47 patients were female and 50 were male. The mean age was 8 years 8 months (SD 3 years 1 month), with a range of 5-18 years. Urinary incontinence was present in 43 patients (44.3%). Based on the questionnaire, LUTD was found in 59 patients (60.8%). The mean BWT was 2.30 mm. There was no statistically significant difference between continent and incontinent children (2.46 vs 2.19 mm) or between children with and without LUTD (2.43 vs 2.12 mm). CONCLUSIONS: LUTD is common in children with CP and occurred in 60.8% of the patients assessed. BWT did not correlate with the presence of bladder dysfunction or incontinence. Ultrasound assessment of BWT was not relevant for diagnosis of lower urinary tract dysfunction.

Correlaçäo entre achados clínicos e vídeo-urodinâmicos na cistocele inguinal / Correlation between clinical and video urodynamics findings in patients with inguinal cystocele

O propósito deste trabalho foi avaliar, retrospectivamente, sete casos de cistocele inguinal correlacionando os achados urodinâmicos com os sintomas urinários dos pacientes. No período de abril de 1996 a maio de 1998 foram identificados sete casos de cistocele inguinal, diagnosticados durante a fase de enchimento da vídeo-urodinâmica. Seis pacientes eram do sexo feminino, quatro apresentavam queixas de incontinência urinária de esforço, uma apresentava urgê-incontinência e uma outra sintomas obstrutivos do trato urinário baixo e dor pélvica. O paciente do sexo masculino queixava-se de urgência e polaciúria. A cistocele inguinal foi unilateral em todos os casos, sendo lo lado direito em seis pacientes e esquerdo em apenas um paciente. Nestes pacientes näo houve um sintoma específico que pudesse ser correlacionado com a cistocele inguinal e nem alteraçöes urodinâmicas características

Atualizaçäo em fístulas uretrovaginais e vesicovaginais / Up-to-date in urethrovaginal and vesicovaginal fistulas

Os autores realizam uma revisao da literatura sobre a epidemiologia, etiologia, classificaçao, clínica, diagnóstico e tratamento das fístulas uretrovaginais e vesicovaginais. Concluem que condutas como a correçao precoce da fístula, a nao-ressecçao do trajeto fistuloso e a interposiçao de tecidos nas fístulas complexas sao fatores importantes no tratamento destas patologias e conseqüente melhora na qualidade de vida das pacientes.

Rabdomiossarcoma de retroperitônio em adulto: consideraçöes sobre um caso e revisäo da literatura / Rabdomiossarcoma of the retroperitoneum in adult: considerations about one case and review of the literature

É descrito um caso de rabdomiossarcoma de retroperitônio em um paciente de 64 anos. Apresentam-se as hipóteses histogenéticas, aspectos microscópicos, quadro clínico e tratamento com base em revisäo de literatura