TeleCondutas: prostatite crônica/síndrome da dor pélvica crônica / TeleGuides: chronic prostatitis / chronic pelvic pain syndrome

Sintomas de prostatite são muito comuns na população, ocorrendo com uma prevalência média de 8,2%. Estima-se que 35% a 50% dos homens apresentarão esses sintomas em algum momento de sua vida. Entre as formas de prostatite, a apresentação mais comum é a Prostatite Crônica/ Síndrome da Dor Pélvica Crônica (PC/SDPC). PC/SDPC é uma síndrome clínica definida essencialmente pela presença de dor pélvica crônica não causada por patologias identificáveis. Apesar do termo "prostatite", parcela significativa dos casos não tem sinal de inflamação ("-ite") da próstata. Infecções causadas por Clamídia, Micoplasma ou Ureaplasma geralmente não são responsáveis pela PC/SDPC. Tampouco se sabe em que extensão a próstata é responsável pelos sintomas. Além de prevalente, a PC/SDPC prejudica a qualidade de vida dos homens e tem importante impacto econômico. Está frequentemente associada a dor genital, dor ejaculatória, dor abdominal, sintomas do trato urinário inferior e disfunção erétil. Ansiedade e medo de doenças graves são achados comuns em pacientes com PC/SDPC e podem contribuir com os sintomas. Múltiplas consultas, investigações e procedimentos também são riscos aos quais esses pacientes estão sujeitos. Pouca atenção tem sido dada à essa condição, o que resulta em literatura relativamente escassa sobre o assunto. Considerando a diversidade e severidade dos sintomas, assim como as comorbidades sistêmicas que frequentemente estão associadas (como síndrome do intestino irritável e fibromialgia), abordagens terapêuticas uniformes e monoterápicas raramente funcionam. Não surpreende que a PC/SDPC seja uma condição associada a significativa frustração, tanto nos pacientes quanto nos médicos. É necessário, portanto, que o diagnóstico e tratamento adequado seja feito na Atenção Primária à Saúde (APS), em vistas a melhorar a qualidade de vida do paciente e evitar encaminhamentos desnecessários ao urologista. Esta guia apresenta informação que orienta a conduta para casos de prostatite crônica/síndrome da dor pélvica crônica no contexto da Atenção Primária à Saúde, incluindo: Classificação, Sinais e Sintomas, Diagnóstico, Tratamento, Encaminhamento para serviço especializado, Referências, Anexo.

Neurological status predicts response to alpha-blockers in men with voiding dysfunction and Parkinson's disease

OBJECTIVES: To evaluate predictors of the response to doxazosin, a selective alpha-adrenoceptor antagonist, when used for the treatment of lower urinary tract symptoms in men with Parkinson's disease. METHODS: In a prospective study, 33 consecutive men (mean age 59.2±7.0 years) with Parkinson's disease and lower urinary tract symptoms were evaluated. Neurological dysfunction was assessed with the Unified Parkinson's Disease Rating Scale. Urological assessment was performed at baseline and after 12 weeks of treatment with 4 mg/day of extended-release doxazosin, including symptom evaluation with the International Continence Society male short-form questionnaire, an assessment of the impact of lower urinary tract symptoms on quality of life and urodynamics. Clinical and urodynamic predictors of response were specifically evaluated. RESULTS: Compared with the score at baseline, the total International Continence Society male short-form score was reduced after doxazosin administration, from 17.4±7.5 to 11.1±6.9 (p<0.001). The impact of lower urinary tract symptoms on quality of life was also significantly reduced, from 1.8±1.1 to 1.0±1.0 (p<0.001) and the maximum urinary flow varied from 9.3±4.4 to 11.2±4.6 ml/s (p = 0.025). The severity of neurological impairment ...

Efficacy of three different alpha 1-adrenergic blockers and hyoscine N-butylbromide for distal ureteral stones

PURPOSE: To evaluate hyoscine N-butyl bromide (HBB) and three different alpha-1 blockers in the treatment of distal ureteral stones. MATERIALS AND METHODS: A total of 140 patients with stones located in the distal tract of the ureter with stone diameters of 5 to 10mm were enrolled in the present study and were randomized into 4 equal groups. Group 1 received HBB, Group 2 received alfuzosin, Group 3 received doxazosin and Group 4 received terazosin. The subjects were prescribed diclofenac injection (75 mg) intramuscularly on demand for pain relief and were followed-up after two weeks with x-rays of the kidneys, ureters, bladder and urinary ultrasonography every week. The number of pain episodes, analgesic dosage and the number of days of spontaneous passage of the calculi through the ureter were also recorded. RESULTS: The average stone size for groups 1, 2, 3 and 4 was comparable (6.13, 5.83, 5.59 and 5.48 mm respectively). Stone expulsion was observed in 11 percent, 52.9 percent, 62 percent, and 46 percent in groups 1, 2, 3 and 4 respectively. The average time to expulsion was 10.55 ± 6.21 days in group 1, 7.38 ± 5.55 days in group 2, 7.85 ± 5.11 days in group 3 and 7.45 ± 5.32 days in group 4. Alpha blockers were found to be superior to HBB (p < 0.05). CONCLUSIONS: Medical treatment of distal ureteral calculi with alfuzosin, doxazosin and terazosin resulted in a signi?cantly increased stone-expulsion rate and decreased expulsion time when compared with HBB. HBB seems to have a negative effect on stone-expulsion rate.