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Urology ; 121: 58-65, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30031005


OBJECTIVE: To assess the non-inferiority of Low-power Holmium laser enucleation of the prostate (LP-HoLEP) to high-power (HP-HoLEP) for enucleation efficiency pertaining to the advantages of lower cost and minimal postoperative dysuria, storage symptoms, and negative sexual impact. PATIENTS AND METHODS: HoLEP was performed using 100W Versapulse, Luminis Inc., with 2J/25Hz for LP-HoLEP (61 patients) and 2J/50Hz for HP-HoLEP (60 patients). Two surgeons with different experience performed equal number of both procedures. Non-inferiority of enucleation efficiency (enucleated weight/min) was evaluated. All perioperative parameters were recorded and compared. Dysuria was assessed at 2 weeks by dysuria visual analog scale, urinary (Q.max and IPSS) and sexual (sexual health inventory for men score) outcome measures were evaluated at 1, 4, and 12 months. RESULTS: Baseline and perioperative parameters were comparable between the two groups. Mean enucleation efficiency was 1.42±0.6 vs 1.47±0.6 gm/min, P = .6 following LP-HoLEP and HP-HoLEP, respectively. Patients reported postoperative dysuria similarly in both groups as per dysuria visual analog scale. There was significant comparable improvement in IPSS (international prostate symptom score) and Q.max in both groups at different follow-up points. At one year, median IPSS and Q.max were comparable in both groups (P = .4 and .7 following LP-HoLEP and HP-HoLEP, respectively). Median postoperative reduction in prostate specific antigen was 89% (42:99) following LP-HoLEP vs 81% (62:94) after HP-HoLEP, P = .92. Both groups showed comparable perioperative and late postoperative complications. There were no statistically significant changes in the last follow-up sexual health inventory for men score in comparison to baseline score. CONCLUSION: LP-HoLEP is non-inferior to HP-HoLEP in terms of all efficiency parameters regardless level of surgeon experience.

Disuria , Terapia a Laser , Lasers de Estado Sólido/uso terapêutico , Complicações Pós-Operatórias , Hiperplasia Prostática , Qualidade de Vida , Disfunções Sexuais Fisiológicas , Ressecção Transuretral da Próstata , Idoso , Disuria/diagnóstico , Disuria/etiologia , Disuria/psicologia , Humanos , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/psicologia , Próstata/diagnóstico por imagem , Próstata/patologia , Próstata/cirurgia , Hiperplasia Prostática/diagnóstico , Hiperplasia Prostática/psicologia , Hiperplasia Prostática/cirurgia , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/psicologia , Ressecção Transuretral da Próstata/efeitos adversos , Ressecção Transuretral da Próstata/instrumentação , Ressecção Transuretral da Próstata/métodos , Resultado do Tratamento , Escala Visual Analógica
Schmerz ; 30(5): 477-490, 2016 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-27681777


Endometriosis is a chronic disease of women during their reproductive age. The most typical symptoms are dysmenorrhoea, dyspareunia, dysuria, cyclical and acyclical pelvic pain, bleeding disorders and infertility. These symptoms lead to significant impairment of the quality of life and economic burden. The prevalence is estimated to be 2-20 % of all women in this age and due to this fact, it is one of the most frequently benign gynecological diseases. Not all women suffer from severe symptoms, but more than 50 % require ongoing treatment. Beside the severe physical impairment due to the pain, the high recurrence rate of 50-80 % also after surgical and/or hormonal treatment is problematic. The interval between onset of symptoms and diagnosis is approximately 6-8 years. These problems are a consequence of lack of knowledge about the pathogenesis of the disease and the pain mechanisms as well as the lack of awareness of physicians in this field.

Endometriose/diagnóstico , Endometriose/terapia , Adulto , Efeitos Psicossociais da Doença , Diagnóstico Tardio , Diagnóstico Diferencial , Dispareunia/etiologia , Dispareunia/psicologia , Dispareunia/terapia , Disuria/etiologia , Disuria/psicologia , Disuria/terapia , Endometriose/psicologia , Feminino , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/psicologia , Infertilidade Feminina/terapia , Ciclo Menstrual/fisiologia , Dor Pélvica/etiologia , Dor Pélvica/psicologia , Dor Pélvica/terapia , Qualidade de Vida/psicologia , Recidiva
Minerva Ginecol ; 65(4): 465-70, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24051946


AIM: The aim of this paper was to show that self-assessed anxiety in patients with pelvic visceral discomforts is reduced after the intravaginal administration of adelmidrol. MATERIAL AND METHODS: Twenty-four patients who described themselves as anxious (scoring 5 or more in a 1 to 10 scale in a self-assessment test) and who suffered from pelvic visceral discomfort (during defecation, urination, sexual intercourse and menstruation) were enrolled in the study. Pelvic visceral discomforts were assessed using a questionnaire in which patients were asked to assign a score between 1 and 10 according to intensity. The patients were offered intravaginal adelmidrol therapy (2%, 4.5 mL twice a day for 30 days). The patients were interviewed again and asked to self-assess anxiety and pelvic visceral discomfort at the end of therapy. RESULTS: 12 patients underwent adelmidrol therapy. With the exception of urinary discomfort, all the median scores of pelvic visceral discomforts had improved after 30 days, with significant values achieved for menstruation (P=0.013) and sexual intercourse (P=0.013). Anxiety had also decreased after 30 days (P=0.025), regardless of changes in discomfort levels. CONCLUSION: Adelmidrol could selectively modulate the visceral nociceptive pathways (interoception), relieving pelvic discomfort. This action should have an independent effect on anxiety responses.

Anti-Inflamatórios não Esteroides/uso terapêutico , Ansiedade/tratamento farmacológico , Ácidos Dicarboxílicos/uso terapêutico , Ácidos Palmíticos/uso terapêutico , Dor Pélvica/tratamento farmacológico , Dor Visceral/tratamento farmacológico , Administração Intravaginal , Anti-Inflamatórios não Esteroides/administração & dosagem , Ansiedade/etiologia , Ansiedade/fisiopatologia , Ansiedade/psicologia , Conscientização , Córtex Cerebral/fisiopatologia , Constipação Intestinal/tratamento farmacológico , Constipação Intestinal/psicologia , Ácidos Dicarboxílicos/administração & dosagem , Dismenorreia/tratamento farmacológico , Dismenorreia/psicologia , Dispareunia/tratamento farmacológico , Dispareunia/psicologia , Disuria/tratamento farmacológico , Disuria/psicologia , Emoções/fisiologia , Feminino , Humanos , Mastócitos/efeitos dos fármacos , Fibras Nervosas Amielínicas/fisiologia , Medição da Dor , Percepção da Dor/efeitos dos fármacos , Percepção da Dor/fisiologia , Ácidos Palmíticos/administração & dosagem , Dor Pélvica/fisiopatologia , Dor Pélvica/psicologia , Estudos Prospectivos , Inquéritos e Questionários , Dor Visceral/fisiopatologia , Dor Visceral/psicologia