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au:ROCHA, FLAVIO TRIGO

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Pediatric incontinence questionnaire (PINQ): translation and transcultural adaptation to Brazilian Portuguese
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Pereira, Rita Pavione Rodrigues

; Leitão, Angélica Quintino

; Fotakos, Gabriella Silva

; Reis, Joceara Neves dos

; Rocha, Flávio Eduardo Trigo

; Machado, Marcos Giannetti

; Bower, Wendy F.

; Tanaka, Clarice

Jornal de Pediatria

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2023, Volume 99 N. 4 Pages 379 - 384

Abstract: En | Text: En | PDF: En

Abstract Objective Lower urinary tract symptoms (LUTS) affect approximately 10% of children worldwide and are related to psychosocial manifestations and compromised quality of life, both for children and their families. The assessment of emotional conditions of LUTS in children is recommended by International Children's Continence Society; however, there is no specific instrument in the Brazilian Portuguese language. Therefore, the aim of this study was to translate, culturally adapt and assess the internal consistency of the Brazilian Portuguese version of the Pediatric Incontinence Questionnaire (PINQ). Material and methods This cross-sectional study was performed at two referral centers for childhood voiding dysfunction. The 20-item PINQ was translated into Brazilian Portuguese and culturally adapted according to Beaton, 2000. His-standard methodology consists of 6 phases: translation, synthesis, back-translation, expert committee, and pre-test. The internal consistency was assessed using Cronbach's alpha. Results The PINQ-br version was developed, validated by a committee of experts, and pre-tested on 44 children diagnosed with lower urinary tract symptoms, 23 boys and 21 girls (mean age: 9.7 and 9.6 years old respectively), as well as on their parents. The internal consistency was considered satisfactory, reaching Cronbach's alpha coefficient of 0.74 when applied to children and 0.82 when applied to parents. Conclusions The PINQ was translated and culturally adapted to Brazilian Portuguese to assess the impact of LUTS on the health-related quality of life in Brazilian children and adolescents.

https://doi.org/10.1016/j.jped.2023.01.002

Neurogenic bladder – concepts and treatment recommendations
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Truzzi, José Carlos

; Almeida, Fernando Gonçalves de

; Sacomani, Carlos Alberto

; Reis, Joceara

; Rocha, Flávio Eduardo Trigo

International braz j urol

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apr 2022, Volume 48 N. 2 Pages 220 - 243

Abstract: En | Text: En | PDF: En

ABSTRACT 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.

https://doi.org/10.1590/s1677-5538.ibju.2021.0098

Hypofractionated radiotherapy recommendations for localized prostate cancer in Brazil
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Palhares, Daniel Moore Freitas

; Pimentel, Leonardo Cunha Furbino

; Castilho, Marcus Simões

; Costa, Andréa Barleze da

; Reisner, Márcio Lemberg

; Kuhnen, Felipe Quintino

; Pássaro, Anderson

; Leite, Elton Trigo Teixeira

; Faustino, Fábio de Lima Costa

; Obst, Fernando Mariano

; Costa, Flávio Napoleão Buarque Barbosa Ferro

; Pioner, Giovani Thomaz

; Carvalho, Ícaro Thiago de

; Silva, João Luís Fernandes da

; Morikawa, Lisa Karina Kokay

; Zanuncio, Pedro Henrique da Rocha

; Hanriot, Rodrigo de Morais

; Rosa, Arthur Accioly

Revista da Associação Médica Brasileira

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jan 2021, Volume 67 N. 1 Pages 7 - 18

Abstract: En | Text: En | PDF: En

SUMMARY OBJECTIVE: Several prospective randomized trials have shown that hypofractionation has the same efficacy and safety as the conventional fractionation in the treatment of localized prostate cancer. There are many benefits of hypofractionation, including a more convenient schedule for the patients and better use of resources, which is especially important in low- and middle-income countries like Brasil. Based on these data, the Brazilian Society of Radiotherapy (Sociedade Brasileira de Radioterapia) organized this consensus to guide and support the use of hypofractionated radiotherapy for localized prostate cancer in Brasil. METHODS: The relevant literature regarding moderate hypofractionation (mHypo) and ultra-hypofractionation (uHypo) was reviewed and discussed by a group of experts from public and private centers of different parts of Brasil. Several key questions concerning clinical indications, outcomes and technological requirements for hypofractionation were discussed and voted. For each question, consensus was reached if there was an agreement of at least 75% of the panel members. RESULTS: The recommendations are described in this article. CONCLUSION: This initiative will assist Brazilian radiation oncologists and medical physicists to safely treat localized prostate cancer patients with hypofractionation.

https://doi.org/10.1590/1806-9282.67.01.002 368 downloads

Profile of sexuality and symptoms of lower urinary tract in non-institutionalized elderly
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Taha, Khaled Ahmed

; Rocha, Flavio Trigo

; Castilho, Lisias

International braz j urol

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jun 2020, Volume 46 N. 3 Pages 374 - 380

Abstract: En | Text: En | PDF: En

ABSTRACT Introduction: Urinary or sexual dysfunction in the elderly are underreported. However, they are highly prevalent. This study aims to identify the prevalence of these conditions. Objective: The aim is to carry out an investigation in non-institutionalized individuals over 60 years of age, to obtain data on its sexual and urinary health in São Paulo, Campinas, Santo André and Londrina. Results: 6.000 questionnaires were distributed, and 3425 were included in the study, for the analysis of the questionnaires separately. In relation to ADAM, 92% of the 1385 evaluated were suspicious of androgen deficiency (ADAM). As for the male sexual function, it was observed 37% of premature ejaculation. As for the female sexual function, 1300 (74%) did not practice sexual intercourse and the main reasons were: lack of partner and lack of sexual desire. In addition, 988 (78%) of women who had no sexual intercourse responded that they didn't want sex and, more importantly, about 22% of them would like to have sexual intercourse. International prostate symptom score (IPSS) showed gradual worsening of urinary symptoms with increasing age, being the most prevalent: nocturia and urinary urgency. As for the female IPSS, we noted that even after 80 years, the majority have mild symptoms related to voiding dysfunction; with increasing age there is a gradual increase in the result of the IPSS. Conclusion: Due to the large number of sexual and urinary disorders found, we recommend the improvement in health conditions, promoting a better quality of life in the elderly.

https://doi.org/10.1590/s1677-5538.ibju.2019.0162 641 downloads

Factors affecting urinary continence and sexual potency recovery after robotic-assisted radical prostatectomy
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Neumaier, Mark Fernando

; Segall Júnior, Carlos Henrique

; Hisano, Marcelo

; Rocha, Flávio Eduardo Trigo

; Arap, Sami

; Arap, Marco A.

International braz j urol

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aug 2019, Volume 45 N. 4 Pages 703 - 712

Abstract: En | Text: En | PDF: En

ABSTRACT Introduction Robot-assisted radical prostatectomy (RARP) is the most recent surgical technique for localized prostate cancer. The Da Vinci (Intuitive Surgical, Sunnyvale, CA) system was first introduced in Brazil in 2008, with a fast growing number of surgeries performed each year. Objective Our primary endpoint is to analyze possible predictors of functional outcomes, related to patient and tumor features. As secondary endpoint, describe functional outcomes (urinary continence and sexual potency) from RARP performed in the Sírio-Libanês Hospital (SLH), a private institution, in São Paulo, from April 2008 to December 2015. Materials and Method Data from 104 consecutive patients operated by two surgeons from the SLH (MA and SA) between 2008 and 2015, with a minimum 12 months follow-up, were collected. Patient features (age, body mass index - BMI, PSA, date of surgery and sexual function), tumor features (tumor stage, Gleason and surgical margins) and follow-up data (time to reach urinary continence and sexual potency) were the variables collected at 1, 3, 6 and 12 month and every 6 months thereafter. Continence was defined as the use of no pad on medical interview and sexual potency defined as the capability for vaginal penetration with or without fosphodiesterase type 5 inhibitors. Results Mean age was 60 years old and mean BMI was 28.45 kg/m2. BMI >30kg/m2 (p<0.001) and age (p=0.011) were significant predictors for worse sexual potency after surgery. After 1, 3, 6 and 12 months, 20.7%, 45.7%, 60.9% and 71.8% from patients were potent, respectively. The urinary continence was reached in 36.5%, 80.3%, 88.6% and 92.8% after 1, 3, 6 and 12 months, respectively. Until the end of the study, only one patient was incontinent and 20.7% were impotent. Conclusion Age was a predictor of urinary and erectile function recovery in 12 months. BMI was significant factor for potency recovery. We obtained in a private hospital good functional results after 12 months of follow-up.

https://doi.org/10.1590/s1677-5538.ibju.2018.0704 975 downloads

Salvage surgical procedure for artificial sphincter extrusion
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Rocha, Flavio Trigo

; Lesting, Jean Felipe Prodocimo

International braz j urol

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jun 2018, Volume 44 N. 3 Pages 634 - 638

Abstract: En | Text: En | PDF: En

ABSTRACT Case Hypothesis: Surgical removal is the standard treatment for artificial sphincter extrusion. However in some specific situations is possible to maintain the prosthesis with good results. Case report: We report a 60 years old patient presenting sphincter pump extrusion one month after artificial urinary sphincter (AUS) AMS 800™ placement for treating post-radical prostatectomy urinary incontinence (PRPUI). He also had a penile pros- thesis implant one year before that was replaced in the same surgery the sphincter was implanted. As patient refused sphincter removal and there were no signals of active infection he was treated by extensive surgical washing with antibiotics and antiseptics. Pump was repositioned in the opposite side of the scrotum. Patient had good evolution with sphincter activation 50 days later. After 10 months of follow up, patient is socially continent and having regular sexual intercourse. Savage surgery may be an option in select cases of artificial sphincter extrusion. Promising future implications: Like in some patients with penile prosthesis some pa- tients with artificial sphincter extrusion can be treated without removing the device. This may be a line of research about conservative treatment of artificial sphincter complications.

https://doi.org/10.1590/s1677-5538.ibju.2017.0462 480 downloads

Overactive bladder – 18 years – Part II
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Truzzi, Jose Carlos

; Gomes, Cristiano Mendes

; Bezerra, Carlos A.

; Plata, Ivan Mauricio

; Campos, Jose

; Garrido, Gustavo Luis

; Almeida, Fernando G.

; Averbeck, Marcio Augusto

; Fornari, Alexandre

; Salazar, Anibal

; Dell’Oro, Arturo

; Cintra, Caio

; Sacomani, Carlos Alberto Ricetto

; Tapia, Juan Pablo

; Brambila, Eduardo

; Longo, Emilio Miguel

; Rocha, Flavio Trigo

; Coutinho, Francisco

; Favre, Gabriel

; Garcia, José Antonio

; Castaño, Juan

; Reyes, Miguel

; Leyton, Rodrigo Eugenio

; Ferreira, Ruiter Silva

; Duran, Sergio

; López, Vanda

; Reges, Ricardo

International braz j urol

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apr 2016, Volume 42 N. 2 Pages 199 - 214

Abstract: En | Text: En | PDF: En

ABSTRACT 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.

https://doi.org/10.1590/S1677-5538.IBJU.2015.0367 2297 downloads

Overactive bladder – 18 years – part I
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Truzzi, Jose Carlos

; Gomes, Cristiano Mendes

; Bezerra, Carlos A.

; Plata, Ivan Mauricio

; Campos, Jose

; Garrido, Gustavo Luis

; Almeida, Fernando G.

; Averbeck, Marcio Augusto

; Fornari, Alexandre

; Salazar, Anibal

; Dell'Oro, Arturo

; Cintra, Caio

; Sacomani, Carlos Alberto Ricetto

; Tapia, Juan Pablo

; Brambila, Eduardo

; Longo, Emilio Miguel

; Rocha, Flavio Trigo

; Coutinho, Francisco

; Favre, Gabriel

; Garcia, José Antonio

; Castaño, Juan

; Reyes, Miguel

; Leyton, Rodrigo Eugenio

; Ferreira, Ruiter Silva

; Duran, Sergio

; López, Vanda

; Reges, Ricardo

International braz j urol

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apr 2016, Volume 42 N. 2 Pages 188 - 198

Abstract: En | Text: En | PDF: En

ABSTRACT Abstract: 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.

https://doi.org/10.1590/S1677-5538.IBJU.2015.0365 3261 downloads

A transobturator adjustable system for male incontinence: 30-month follow-up of a multicenter study
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Romano, Salomon Victor

; Huebner, Wilhelm

; Rocha, Flavio Trigo

; Vaz, Fernando Pires

; Muller, Valter

; Nakamura, Fabio

International braz j urol

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dec 2014, Volume 40 N. 6 Pages 781 - 789

Abstract: En | Text: En | PDF: En

Purpose To report long-term results of the Argus T adjustable system for treatment of post-prostatectomy urinary incontinence (PPI). Materials and Methods From October 2007 to August 2008, 37 patients with PPI were included in a prospective, single-arm, multicenter trial of treatment with the Argus T adjustable system (Promedon, Argentina). Preoperative evaluation included urine culture, urethrocystoscopy, urodynamic testing, 24-h pad weight test (PWT) and quality of life questionnaires. Patients were stratified according to baseline degree of incontinence (mild–moderate or severe). Postoperative evaluation included immediate PWT, quality of life questionnaires and daily use of pads at 1, 12 and 30 months. Results and Conclusions One patient was lost to follow-up. At the 30-month follow-up, 24/31 patients (77%) were dry, 3/31 (10%) improved and 4/31 (13%) were failures. In particular, in the mild-moderate group, 8/8 (100%) patients were dry. In the severe group, 20/28 patients (71%) were dry, 3/28 (11%) improved and 5/28 (18%) were failures. Median visual analogue scale (VAS) scores dropped from 9 (4-10) to 0.5 (0-10) and International Consultation on Incontinence Questionnaire Short Form scores from (ICIQ-SF) 19 (12–21) to 1 (0–10). Retrograde leak point pressure increased from 18 (5–29) to 35 (22–45) cm H2O after intraoperative adjustment. Complications included immediate postoperative infection in 2/36 patients (6%) and transient inguinal and/or perineal pain in 22/36 patients (61%). Argus T has a long-term high success rate (86% cure + improvement at the 30-month follow-up). Good outcomes were achieved even in severe incontinence cases and maintained for over 30 months.

https://doi.org/10.1590/S1677-5538.IBJU.2014.06.09 2112 downloads

10.

Prevalência de sinais de sensibilidade ao látex em pacientes com mielomeningocele submetidos a múltiplos procedimentos cirúrgicos
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Yeh, Wilson Shi Chia

; Kiohara, Priscila Rivoli

; Soares, Iracy Silvia Corrêa

; Carmona, Maria José Carvalho

; Rocha, Flavio Trigo

; Galvão, Clovis Eduardo Santos

Revista Brasileira de Anestesiologia

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feb 2012, Volume 62 N. 1 Pages 59 - 62

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

JUSTIFICATIVA E OBJETIVOS: O número de pacientes alérgicos ao látex vem aumentando significativamente. É essencial reconhecê-los para preve nir e aplicar o tratamento adequado. O objetivo do estudo foi avaliar a prevalência de alergia ao látex em pacientes com mielomeningocele. MATERIAIS E MÉTODOS: Foram avaliados, retrospectivamente, os prontuários médicos de pacientes com diagnóstico de mielomeningocele no período de janeiro de 2002 a dezembro de 2007. Os pacientes foram agrupados em alérgicos e não alérgicos. A comparação dos grupos em relação ao gênero foi feita pelo teste do Qui-quadrado, pelo teste t de Student em relação à idade, e o teste de Mann-Whitney para comparação entre os grupos em relação as manifestações clínicas de alergia, número de procedimentos sob anestesia, de internações hospitalares e de cateterizações vesicais. RESULTADOS: O número médio de procedimentos sob anestesia foi de 7 no grupo com alergia e 4 no grupo sem alergia, sendo esta diferença estatisticamente significante (p = 0,028). O número médio de internações hospitalares foi de 4,5 no grupo com alergia e 3,4 no grupo sem alergia e a média de cateterização vesical foi 24,5 nos alérgicos e 21,7 nos não alérgicos. CONCLUSÕES: Os pacientes portadores de mielomeningocele submetidos a múltiplos procedimentos sob anestesia apresentam alto risco de desenvolvimento de sinais clínicos de alergia ao látex. Há necessidade de que pacientes com diagnóstico de mielomeningocele sejam submetidos exclusivamente a procedimentos latex-free, evitando o alto risco de sensibilização e suas complicações. Testes específicos para avaliação da sensibilização, marcadores genéticos e relação látex-fruta poderão contribuir para melhor entendimento dos fatores de risco relacionados à alergia ao látex e formas de prevenção

BACKGROUND AND OBJECTIVES: The number of patients allergic to latex has increased significantly. It is crucial to recognize the cases in order to prevent and apply adequate treatment. The objective of this study was to evaluate the prevalence of allergy to latex in meningomyelocele patients. MATERIALS AND METHODS: A retrospective evaluation of medical records of patients with meningomyelocele diagnosis from January 2002 to December 2007 was conducted. Patients were grouped into allergics and non-allergics. The comparison of groups for gender was made by the Chi-Squared test, the Student's t test was used to compare age, and Mann-Whitney test was used to compare groups for clinical manifestations of allergy, number of procedures under anesthesia, hospital admissions and vesical catheterizations. RESULTS: The mean number of procedures under anesthesia was 7 in the group with allergy and 4 in the group without allergy; this difference was statistically significant (p = 0.028). The mean number of hospital admissions was 4.5 in the group with allergy and 3.4 in group without allergy and mean vesical catheterization was 24.5 in allergic patients and 21.7 in non allergic ones. CONCLUSIONS: Meningomyelocele patients undergoing multiple procedures under anesthesia have high risk of developing clinical signals of allergy to latex. It is necessary that patients with meningomyelocele diagnosis should undergo exclusively latex-free procedures, avoiding high risk of sensitization and its complications. Specific tests to evaluate sensitization, genetic markers and latex-fruit relationship may contribute to a better understanding of risk factors related to allergy to latex and ways to prevent it

JUSTIFICATIVA Y OBJETIVOS: El número de pacientes alérgicos al látex ha venido aumentando significativamente. Es esencial reconocer los casos para prevenir y aplicar el tratamiento adecuado. El objetivo del estudio, fue evaluar la prevalencia de alergia al látex en pacientes con mielomeningocele. MATERIAL Y MÉTODOS: Fueron evaluadas retrospectivamente, las historias clínicas de pacientes con diagnóstico de mielomeningocele en el período de enero de 2002 a diciembre de 2007. Los pacientes fueron agrupados en alérgicos y no alérgicos. La comparación de los grupos con relación al sexo se hizo por medio del test del Xi-Cuadrado (Xi²), por el test t de Student con relación a la edad, y el test de Mann-Whitney para la comparación entre los grupos, con relación a las manifestaciones clínicas de alergia, número de procedimientos bajo anestesia, de ingresos hospitalarios y de cateterizaciones vesicales. RESULTADOS: El número promedio de procedimientos bajo anestesia fue de 7 en el grupo con alergia y 4 en el grupo sin alergia, siendo que esa diferencia es estadísticamente significativa (p = 0,028). El número promedio de ingresos fue de 4,5 en el grupo con alergia y de 3,4 en el grupo sin alergia, y el promedio de cateterización vesical fue 24,5 en los alérgicos y de 21,7 en los no alérgicos. CONCLUSIONES: Los pacientes portadores de mielomeningocele sometidos a múltiples procedimientos bajo anestesia, presentan un alto riesgo de desarrollar signos clínicos de alergia al látex. Existe la necesidad de que pacientes con diagnóstico de mielomeningocele se sometan exclusivamente a procedimientos latex-free, evitando así el alto riesgo de sensibilización y sus complicaciones. Test específicos para la evaluación de la sensibilización, marcadores genéticos y relación látex-fruta, podrán contribuir para un mejor entendimiento de los factores de riesgo relacionados con la alergia al látex y con las formas de prevención

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