RESUMEN
The aim of this study was to verify the presence of SARS-CoV-2 in the seminal sample of men during the acute phase of COVID-19. A prospective study was performed with inclusion of twenty-two men diagnosed with COVID-19 through RT-PCR from pharyngeal smear samples and who were in the acute phase of infection. These men were evaluated regarding medical history and physical examination. Furthermore, seminal samples of each men were collected 7, 14 and 21 days after the infection was confirmed. The sample were used for seminal analysis, as well as for the presence of SARS-CoV-2 using RT-PCR technique. In addition, cell culture was performed with subsequent repetition of the analysis of viral presence. None of the semen samples collected was positive for the detection of the virus that causes COVID-19. Most of the men evaluated had a mild condition and the loss of smell was the most frequent symptom. There were no significant changes in seminal parameters within the period of study. Based on our pilot data, patients with a mild form of COVID-19 in the acute stage of the disease are unlikely to have SARS-CoV-2 in semen.
Asunto(s)
COVID-19 , SARS-CoV-2 , Humanos , Masculino , Estudios Prospectivos , ARN Viral , SemenRESUMEN
INTRODUCTION: Bladder and urinary sphincter malfunctioning that results from some change in the central and/or peripheral nervous system is defined as neurogenic bladder. The urinary tract symptoms that can be related to its filling, emptying, or both have a significant impact on the quality of life of individuals. The present review was based on the document prepared for the public health system in Brazil as a treatment guidelines proposal. MATERIAL AND METHODS: Survey questions were structured as per PICO (Population, Intervention, Control, and Outcome). Search strategies were defined and performed in the MEDLINE/Pubmed, Embase, Epistemonikos and Google Scholar databases. The selection of articles followed the evidence hierarchy concept; evidence body was identified, and the quantitative study data were extracted. The quality of evidence and grade of recommendation were qualitatively assessed according to GRADE (Grading of Recommendations, Assessment, Development and Evaluations). RESULTS: A total of 2.707 articles were identified, with 49 of them being selected to compose the basis for this review. Neurogenic bladder treatments were classified according to their focus on filling or emptying symptoms and sub- classified in pharmacological and surgical treatments. CONCLUSION: Treatment guidelines are important tools for the public health system to promote the best practice when treating neurogenic bladder patients.
Asunto(s)
Vejiga Urinaria Neurogénica , Sistema Urinario , Humanos , Calidad de Vida , Encuestas y Cuestionarios , Vejiga Urinaria , Vejiga Urinaria Neurogénica/terapiaRESUMEN
INTRODUCTION: Detrusor sphincter dyssynergia affects 70% to 80% of all spinal cord injury patients, resulting in increased risk of urinary tract infections (UTIs) and potential exposure to antimicrobial resistance. In Brazil, local guidelines recommend intermittent catheterization as the best method for bladder emptying, and two catheter types are available: the conventional uncoated PVC and the hydrophilic coated catheters. OBJECTIVE: To evaluate the cost-effectiveness of two types of catheters for intermittent catheterization from the perspective of the Brazilian public healthcare system. MATERIALS AND METHODS: A Markov model was used to evaluate cost-effectiveness in those with spinal cord injuries. A primary analysis was conducted on all possible adverse events, and a secondary analysis was performed with urinary tract infections as the only relevant parameter. The results were presented as cost per life years gained (LYG), per quality-adjusted life years (QALY) and per number of urinary tract infections (UTIs) avoided. RESULTS: The base scenario of all adverse events shows a cost-effective result of hydrophilic coated catheters compared to uncoated PVC catheters at 57,432 BRL (Brazilian Reais) per LYG and 122,330 BRL per QALY. The secondary scenario showed that the use of hydrophilic coated catheters reduces the total number of UTIs, indicating that an additional cost of hydrophilic coated catheters of 31,240 BRL over a lifetime will reduce lifetime UTIs by 6%. CONCLUSIONS: Despite the higher unit value, the use of hydrophilic coated catheters is a cost-effective treatment from the perspective of the Brazilian public healthcare system.
Asunto(s)
Traumatismos de la Médula Espinal/complicaciones , Cateterismo Urinario/economía , Cateterismo Urinario/métodos , Catéteres Urinarios/economía , Infecciones Urinarias/economía , Brasil , Análisis Costo-Beneficio , Diseño de Equipo , Femenino , Humanos , Masculino , Programas Nacionales de Salud , Años de Vida Ajustados por Calidad de Vida , Traumatismos de la Médula Espinal/economía , Resultado del Tratamiento , Cateterismo Urinario/efectos adversos , Infecciones Urinarias/etiologíaRESUMEN
PURPOSE: The baseline PSA has been proposed as a possible marker for prostate cancer. The PSA determination before 40 years seems interesting because it not suffers yet the drawbacks related to more advanced ages. Considering the scarcity of data on this topic, an analysis of PSA kinetics in this period seems interesting. MATERIALS AND METHODS: A retrospective assay in a database of a private diagnostic center was performed from 2003 to 2016. All subjects with a PSA before 40 years were included. RESULTS: 92995 patients performed PSA between the ages of 21 - 39. The mean value ranged from 0.66 ng / mL (at age 22) to 0.76 ng / mL (at age 39) and the overall mean was 0.73 ng / mL. As for outliers, 3783 individuals presented a baseline PSA > 1.6 ng / mL (p95). A linear regression model showed that each year there is a PSA increase of 0.0055 ng / mL (ß = 0.0055; r² = 0.0020; p < 0.001). A plateau in PSA between 23 and 32 years was found and there were only minimal variations among the ages regardless of the evaluated percentile. CONCLUSION: It was demonstrated that PSA kinetics before 40 years is a very slow and progressive phenomenon regardless of the assessed percentile. Considering our results, it could be suggested that any PSA performed in this period could represent the baseline value without significant distortions.
Asunto(s)
Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Adulto , Humanos , Cinética , Masculino , Valores de Referencia , Estudios Retrospectivos , Adulto JovenRESUMEN
PURPOSE: The objective of the present study is to test the efficiency and practicality of a new artificial sphincter "BR - SL - AS - 904" in the control of urinary incontinence in post - PR patients and to evaluate their complications. PATIENTS AND METHODS: Fifteen patients with incontinence after one year of radical prostatectomy were included prospectively. All patients underwent artificial urethral sphincter (AUS) implant "BR - SL - AS - 904" according to established technique. Independent variables such as free urinary flow, PAD weight test, ICIQ - SF score and urinary symptoms through the IPSS score were compared in different follow-up moments. RESULTS: Patients submitted to AUS implantation did not present trans - operative or post - operative complications related to the surgical act such as: infection, hematoma, erosion or urinary retention. Device was inert to the body during the follow-up, showing an excellent adaptation of the patients, besides the easy handling. The mean age was 68.20 years 40% of the patients had systemic arterial hypertension, 6.7% diabetes mellitus, 6.7% were hypertensive and diabetic, 13.4% were hypertensive, had diabetes and hypercholesterolemia and 26.7% patients had no comorbidities. It was evidenced that the urinary flow peak during the follow-up remained stable. Decreased averages and median PAD weight test were 135.19 to 75.72 and 106.00 to 23.50, respectively. The IPSS score decreased and the quality of life increased (12.33 to 3.40 and 2.50 to 3.20 respectively). The ICQF - SF questionnaire score also showed a decrease, ranging from 16, 71 to 7.33. CONCLUSION: The artificial sphincter implant "BR - SL - AS 904" was reproducible, safe and effective in the control of urinary incontinence in post - PR patients.
Asunto(s)
Prostatectomía/efectos adversos , Implantación de Prótesis/métodos , Incontinencia Urinaria/cirugía , Esfínter Urinario Artificial , Anciano , Estudios de Casos y Controles , Humanos , Masculino , Estudios Prospectivos , Calidad de Vida , Resultado del Tratamiento , Incontinencia Urinaria/etiologíaRESUMEN
Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals - including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.
Asunto(s)
Vejiga Urinaria Hiperactiva/diagnóstico , Vejiga Urinaria Hiperactiva/terapia , Manejo de la Enfermedad , Femenino , Humanos , Masculino , Prevalencia , Calidad de Vida , Factores Sexuales , Factores de Tiempo , Vejiga Urinaria Hiperactiva/epidemiologíaRESUMEN
Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics - pillars of the overactive bladder pharmacotherapy - started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning - as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder - 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.
Asunto(s)
Vejiga Urinaria Hiperactiva/terapia , Administración Oral , Agonistas de Receptores Adrenérgicos beta 3/uso terapéutico , Toxinas Botulínicas/uso terapéutico , Femenino , Humanos , Masculino , Antagonistas Muscarínicos/uso terapéutico , Factores de Tiempo , Estimulación Eléctrica Transcutánea del Nervio/métodos , Resultado del TratamientoAsunto(s)
Prostatectomía , Esfínter Urinario Artificial , Humanos , Masculino , Próstata , Incontinencia Urinaria/cirugíaRESUMEN
OBJECTIVES: The REWIND study sought to describe the real-world clinical and prescribing practices for the management of urinary tract infection (UTI) in Italy, Belgium, Russia and Brazil in order to compare current practices with international, European and national guidelines. METHODS: An integrated mixed-methods approach was adopted that used information from primary care electronic medical records in longitudinal patient databases available in Italy and Belgium, and surveys of physicians in Russia (general practitioners) and Brazil (gynaecologists). RESULTS: In total, 49 548 female patients were included in the study. Antibiotics were the most common management option for UTI in Italy (71.1%, n=27 600), Belgium (92.4%, n=7703), Russia (81.9%, n=1231) and Brazil (82.4%, n=740). Fosfomycin trometamol was the first-choice antibiotic for the treatment of UTI in all countries. Ciprofloxacin was also commonly prescribed in Italy (24.6%, n=6796), Belgium (17.8%, n=1373), Russia (14.9%, n=184) and Brazil (9.6%, n=71), while prescription of nitrofurantoin was common in Belgium (24.5%, n=1890) alone. CONCLUSIONS: Despite differences in study designs and data sources, fosfomycin trometamol was found to be the most commonly prescribed treatment for UTI in all participating countries. In Belgium, real-world prescribing practices for UTI adhered more closely to European guidelines than national guidelines. Although not recommended in international and European guidelines for lower UTI management, the use of fluoroquinolones was still widespread.
Asunto(s)
Antibacterianos/uso terapéutico , Fosfomicina/uso terapéutico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Infecciones Urinarias/tratamiento farmacológico , Adulto , Atención Ambulatoria , Bélgica , Brasil , Ciprofloxacina/uso terapéutico , Femenino , Guías como Asunto , Humanos , Italia , Persona de Mediana Edad , Nitrofurantoína/uso terapéutico , Federación de RusiaRESUMEN
OBJECTIVES: To explore male human papillomavirus (HPV) contemporary genotyping epidemiology and correlations to peniscopy, cytology, and histopatology. METHODS: Medical records of patients who had been submitted to HPV infection screening with genotyping, peniscopy, cytology, and histopathology in a period of 2 years were reviewed. Frequency analysis and correlations between the diagnostic tools were established. RESULTS: Genotype of 1132 men resulted in 69.2% (784) positivity for HPV DNA, 78% classified as high risk of oncogenesis. Co-infections occurred in 429 (54.7%) and the most frequently identified types were HPV-6, HPV-42, and HPV-16, in 133 (17%), 94 (12%), and 86 (11%) patients, respectively. Positive/negative predictive values of peniscopy, cytology, and histopathology were 83/31%, 92/32%, and 87/33%, respectively. As a result, though significant, the correlations between genotype and non-molecular tests were poor. CONCLUSIONS: In the current contemporary representative male cohort, over two thirds are positive for human HPV DNA, 78% of high risk and with over half co-infections. Though significant, its correlation with non-molecular tests is poor and while the positive predictive values of peniscopy, cytology, and histopatology are between 83% and 92%, their negative predictive values are as low as 31% to 33%.
Asunto(s)
Alphapapillomavirus/aislamiento & purificación , Papillomavirus Humano 16/genética , Papillomavirus Humano 6/genética , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alphapapillomavirus/clasificación , Alphapapillomavirus/genética , Carcinoma in Situ/virología , Niño , Condiloma Acuminado/virología , Citodiagnóstico , ADN Viral/genética , Genotipo , Papillomavirus Humano 16/aislamiento & purificación , Papillomavirus Humano 6/aislamiento & purificación , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Infecciones por Papillomavirus/patología , Neoplasias del Pene/virología , Pene/virología , Conducta Sexual , Adulto JovenRESUMEN
Urinary tract infection (UTI) is a common condition in women. There is an increased concern on reduction of bacterial susceptibility resulting from wrongly prescribing antimicrobials. This paper summarizes the recommendations of four Brazilian medical societies (SBI - Brazilian Society of Infectious Diseases, FEBRASGO - Brazilian Federation of Gynecology and Obstetrics Associations, SBU - Brazilian Society of Urology, and SBPC/ML - Brazilian Society of Clinical Pathology/Laboratory Medicine) on the management of urinary tract infection in women. Asymptomatic bacteriuria should be screened at least twice during pregnancy (early and in the 3rd trimester). All cases of significant bacteriuria (≥105CFU/mL in middle stream sample) should be treated with antimicrobials considering safety and susceptibility profile. In women with typical symptoms of cystitis, dipsticks are not necessary for diagnosis. Urine cultures should be collected in pregnant women, recurrent UTI, atypical cases, and if there is suspicion of pyelonephritis. First line antimicrobials for cystitis are fosfomycin trometamol in a single dose and nitrofurantoin, 100mg every 6hours for five days. Second line drugs are cefuroxime or amoxicillin-clavulanate for seven days. During pregnancy, amoxicillin and other cephalosporins may be used, but with a higher chance of therapeutic failure. In recurrent UTI, all episodes should be confirmed by urine culture. Treatment should be initiated only after urine sampling and with the same regimens indicated for isolated episodes. Prophylaxis options of recurrent UTI are behavioral measures, non-antimicrobial and antimicrobial prophylaxis. Vaginal estrogens may be recommended for postmenopausal women. Other non-antimicrobial prophylaxis, including cranberry and immunoprophylaxis, have weak evidence supporting their use. Antimicrobial prophylaxis may be offered as a continuous or postcoital scheme. In pregnant women, options are cephalexin, 250-500mg and nitrofurantoin, 100mg (contraindicated after 37 weeks of pregnancy). Nonpregnant women may use fosfomycin trometamol, 3g every 10 days, or nitrofurantoin, 100mg (continuous or postcoital).
Asunto(s)
Antibacterianos/administración & dosificación , Guías de Práctica Clínica como Asunto , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Sociedades Médicas , Infecciones Urinarias/tratamiento farmacológico , Femenino , Humanos , EmbarazoRESUMEN
PURPOSE: Large post-void residual urinary volume may be related to the development of urinary tract infection. However, the maximum post-void residual volume that predisposes patients to a higher risk of urinary tract infection is not known. In this prospective study we determined the cutoff value for post-void residual volume that places adult men at risk for bacteriuria. MATERIALS AND METHODS: Data were obtained from 196 consecutive healthy adult men (median age 62 years) who came for prostate evaluation without symptoms of acute urinary tract infection. Right after spontaneous voiding, bladder catheterization was performed under normal aseptic conditions, and the post-void residual volume measured. Urine samples were collected for culture from each patient and the results were compared to the various post-void residual volume. RESULTS: Overall 27% of the patients presented with a positive urine culture. The mean post-void residual volume in this group was 257 ml (range 150 to 560) compared to 133 ml (range 10 to 340) for the group with negative culture (p <0.001). The post-void residual volume value of 180 ml was determined to have the best specificity and sensitivity. The positive predictive value for bacterial growth at a post-void residual volume of 180 ml or greater was 87.0% and the negative predictive value was 94.7%. CONCLUSIONS: Clinically asymptomatic adult men with a post-void residual volume of 180 ml are at a high risk for bacteriuria. Such cases require close medical attention since it may be necessary to introduce early drug therapy or surgical intervention to improve the bladder emptying.
Asunto(s)
Infecciones Urinarias/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Bacteriuria/epidemiología , Bacteriuria/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Micción , OrinaRESUMEN
Bladder and urinary sphincter malfunctioning that results from some change in the central and/or peripheral nervous system is defined as neurogenic bladder. The urinary tract symptoms that can be related to its filling, emptying, or both have a significant impact on the quality of life of individuals. The present review was based on the document prepared for the public health system in Brazil as a treatment guidelines proposal. Material and Methods: Survey questions were structured as per PICO (Population, Intervention, Control, and Outcome). Search strategies were defined and performed in the MEDLINE/Pubmed, Embase, Epistemonikos and Google Scholar databases. The selection of articles followed the evidence hierarchy concept; evidence body was identified, and the quantitative study data were extracted. The quality of evidence and grade of recommendation were qualitatively assessed according to GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Results: A total of 2.707 articles were identified, with 49 of them being selected to compose the basis for this review. Neurogenic bladder treatments were classified according to their focus on filling or emptying symptoms and sub- classified in pharmacological and surgical treatments. Conclusion: Treatment guidelines are important tools for the public health system to promote the best practice when treating neurogenic bladder patients.
Asunto(s)
Humanos , Sistema Urinario , Vejiga Urinaria Neurogénica/terapia , Calidad de Vida , Vejiga Urinaria , Encuestas y CuestionariosRESUMEN
The overactive bladder syndrome and the neurogenic detrusor overactivity figure among the most impacting voiding dysfunctions with a high global prevalence and negative impacts on quality of life. Despite such urinary disorders being easily diagnosed, often based exclusively on clinical data, a large number of people complaining of urgency, frequency, nocturia and, in many cases, urinary incontinence, have their urinary condition neglected. The first line treatment with oral anticholinergics presents a high rate of dropouts over a few months of use, due absence of success or the adverse events frequently observed with this therapy. Intradetrusor botulinum toxin injection was initially used for patients with spinal cord injury and multiple sclerosis, nearly 15 years ago. Its successful results led to the injections in detrusor of botulinum toxin also in refractory idiopathic overactive bladder.
Asunto(s)
Inhibidores de la Liberación de Acetilcolina/uso terapéutico , Toxinas Botulínicas/uso terapéutico , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , SíndromeRESUMEN
Urinary tract infection (UTI) is a common condition in women. There is an increased concern on reduction of bacterial susceptibility resulting from wrongly prescribing antimicrobials. This paper summarizes the recommendations of four Brazilian medical societies (SBI Brazilian Society of Infectious Diseases, FEBRASGO Brazilian Federation of Gynecology and Obstetrics Associations, SBU Brazilian Society of Urology, and SBPC/ML Brazilian Society of Clinical Pathology/Laboratory Medicine) on the management of urinary tract infection in women. Asymptomatic bacteriuria should be screened at least twice during pregnancy (early and in the 3rd trimester). All cases of significant bacteriuria (≥105 CFU/mL in middle stream sample) should be treated with antimicrobials considering safety and susceptibility profile. In women with typical symptoms of cystitis, dipsticks are not necessary for diagnosis. Urine cultures should be collected in pregnant women, recurrent UTI, atypical cases, and if there is suspicion of pyelonephritis. First line antimicrobials for cystitis are fosfomycin trometamol in a single dose and nitrofurantoin, 100 mg every 6 hours for five days. Second line drugs are cefuroxime or amoxicillin-clavulanate for seven days. During pregnancy, amoxicillin and other cephalosporins may be used, but with a higher chance of therapeutic failure. In recurrent UTI, all episodes should be confirmed by urine culture. Treatment should be initiated only after urine sampling and with the same regimens indicated for isolated episodes. Prophylaxis options of recurrent UTI are behavioral measures, nonantimicrobial and antimicrobial prophylaxis. Vaginal estrogens may be recommended for postmenopausal women. Other non-antimicrobial prophylaxis, including cranberry and immunoprophylaxis, have weak evidence supporting their use. Antimicrobial prophylaxis may be offered as a continuous or postcoital scheme. In pregnant women, options are cephalexin, 250500 mg and nitrofurantoin, 100 mg (contraindicated after 37 weeks of pregnancy). Nonpregnant women may use fosfomycin trometamol, 3 g every 10 days, or nitrofurantoin, 100 mg (continuous or postcoital)
Asunto(s)
Humanos , Femenino , Embarazo , Infecciones Urinarias/tratamiento farmacológico , Enfermedades Urológicas/tratamiento farmacológico , Mujeres EmbarazadasRESUMEN
ABSTRACT Introduction Detrusor sphincter dyssynergia affects 70% to 80% of all spinal cord injury patients, resulting in increased risk of urinary tract infections (UTIs) and potential exposure to antimicrobial resistance. In Brazil, local guidelines recommend intermittent catheterization as the best method for bladder emptying, and two catheter types are available: the conventional uncoated PVC and the hydrophilic coated catheters. Objective To evaluate the cost-effectiveness of two types of catheters for intermittent catheterization from the perspective of the Brazilian public healthcare system. Materials and Methods A Markov model was used to evaluate cost-effectiveness in those with spinal cord injuries. A primary analysis was conducted on all possible adverse events, and a secondary analysis was performed with urinary tract infections as the only relevant parameter. The results were presented as cost per life years gained (LYG), per quality-adjusted life years (QALY) and per number of urinary tract infections (UTIs) avoided. Results The base scenario of all adverse events shows a cost-effective result of hydrophilic coated catheters compared to uncoated PVC catheters at 57,432 BRL (Brazilian Reais) per LYG and 122,330 BRL per QALY. The secondary scenario showed that the use of hydrophilic coated catheters reduces the total number of UTIs, indicating that an additional cost of hydrophilic coated catheters of 31,240 BRL over a lifetime will reduce lifetime UTIs by 6%. Conclusions Despite the higher unit value, the use of hydrophilic coated catheters is a cost-effective treatment from the perspective of the Brazilian public healthcare system.
Asunto(s)
Humanos , Masculino , Femenino , Traumatismos de la Médula Espinal/complicaciones , Infecciones Urinarias/economía , Cateterismo Urinario/economía , Cateterismo Urinario/métodos , Catéteres Urinarios/economía , Traumatismos de la Médula Espinal/economía , Infecciones Urinarias/etiología , Brasil , Cateterismo Urinario/efectos adversos , Resultado del Tratamiento , Análisis Costo-Beneficio , Años de Vida Ajustados por Calidad de Vida , Diseño de Equipo , Programas Nacionales de SaludRESUMEN
ABSTRACT Purpose: The baseline PSA has been proposed as a possible marker for prostate cancer. The PSA determination before 40 years seems interesting because it not suffers yet the drawbacks related to more advanced ages. Considering the scarcity of data on this topic, an analysis of PSA kinetics in this period seems interesting. Materials and Methods: A retrospective assay in a database of a private diagnostic center was performed from 2003 to 2016. All subjects with a PSA before 40 years were included. Results: 92995 patients performed PSA between the ages of 21 - 39. The mean value ranged from 0.66 ng / mL (at age 22) to 0.76 ng / mL (at age 39) and the overall mean was 0.73 ng / mL. As for outliers, 3783 individuals presented a baseline PSA > 1.6 ng / mL (p95). A linear regression model showed that each year there is a PSA increase of 0.0055 ng / mL (β = 0.0055; r2 = 0.0020; p < 0.001). A plateau in PSA between 23 and 32 years was found and there were only minimal variations among the ages regardless of the evaluated percentile. Conclusion: It was demonstrated that PSA kinetics before 40 years is a very slow and progressive phenomenon regardless of the assessed percentile. Considering our results, it could be suggested that any PSA performed in this period could represent the baseline value without significant distortions.
Asunto(s)
Humanos , Masculino , Adulto , Neoplasias de la Próstata/sangre , Antígeno Prostático Específico/sangre , Valores de Referencia , Cinética , Estudios RetrospectivosRESUMEN
ABSTRACT Purpose: The objective of the present study is to test the efficiency and practicality of a new artificial sphincter "BR - SL - AS - 904" in the control of urinary incontinence in post - PR patients and to evaluate their complications. Patients and Methods: Fifteen patients with incontinence after one year of radical prostatectomy were included prospectively. All patients underwent artificial urethral sphincter (AUS) implant "BR - SL - AS - 904" according to established technique. Independent variables such as free urinary flow, PAD weight test, ICIQ - SF score and urinary symptoms through the IPSS score were compared in different follow-up moments. Results: Patients submitted to AUS implantation did not present trans - operative or post - operative complications related to the surgical act such as: infection, hematoma, erosion or urinary retention. Device was inert to the body during the follow-up, showing an excellent adaptation of the patients, besides the easy handling. The mean age was 68.20 years 40% of the patients had systemic arterial hypertension, 6.7% diabetes mellitus, 6.7% were hypertensive and diabetic, 13.4% were hypertensive, had diabetes and hypercholesterolemia and 26.7% patients had no comorbidities. It was evidenced that the urinary flow peak during the follow-up remained stable. Decreased averages and median PAD weight test were 135.19 to 75.72 and 106.00 to 23.50, respectively. The IPSS score decreased and the quality of life increased (12.33 to 3.40 and 2.50 to 3.20 respectively). The ICQF - SF questionnaire score also showed a decrease, ranging from 16, 71 to 7.33. Conclusion: The artificial sphincter implant "BR - SL - AS 904" was reproducible, safe and effective in the control of urinary incontinence in post - PR patients.