ABSTRACT PURPOSE: To analyze the influence of chlorpromazine on renal histology of rats submitted to ischemia and reperfusion injury. METHODS: Sixteen Wistar rats - split in two groups - have been used: control group, receiving 3 mg/kg isotonic saline solution through caudal vein, and, the chlorpromazine group, receiving 3 mg/kg-IV of such medication. The nephrectomy of the left kidney lower third was carried out; immediately, the test-drug was administrated. After 15 minutes of test-drug administration, the renal pedicle was clamped; in 60 minutes of ischemia it was released. After 24 hours of the renal reperfusion, the rats were, once more, anesthetized and submitted to total left nephrectomy, and, afterwards, to euthanasia. Histological findings regarding ischemia have been evaluated and compared between the groups. RESULTS: There was no statistical difference related to inferior renal pole histological analysis. Regarding 60-minute renal ischemia, chlorpromazine has statistically reduced the accrual of leucocytes within the vasa recta renis (p=0.036) and the congestion of peritubular capillaries (p=0.041). When conducting joint analysis of histological patterns, the control group showed a median score of 11 and chlorpromazine group of 5.5 (p=0.036). CONCLUSION: Chlorpromazine significantly reduced the occurrence of secondary damage to ischemia and reperfusion process in the overall histological analysis.

PURPOSE: To evaluate the preferred position used by Brazilian Urologists to perform DRE, the position that Brazilian patients prefer or think it is less embarrassing to have a DRE, and to evaluate the results of DRE with patients in left lateral decubitus, modified lithotomy, standing-up, or the physician will have them place their elbows on the table and squat down slightly. MATERIALS AND METHODS: Brazilian Urologists were contacted by e-mail, and 200 patients answered a questionnaire while undergoing prostate cancer screening. RESULTS: The preferred position was modified lithotomy position reported by 63.4% of Urologists, and left lateral position reported by 42.7% of the patients. Total DRE time was lower in the standing-up position. Pain and urinary urgency scores were similar regardless of the position used, and bowel urgency score was higher in patients squatting down. Patients were similar in terms of age and PSA level, but there was a significant difference between the standard deviations of estimated prostate weight in left lateral position. There were no differences in prostate asymmetry, positive DRE, or incomplete palpation of the prostate rates among different examination positions. CONCLUSIONS: Despite individual subjective preferences, a faster examination time in the standing-up position, and higher bowel urgency scores in patients with their elbows placed on the table and squatting down slightly, there were similar rates of prostate asymmetry, positive DRE, and incomplete palpation of the prostate, and comparable patient tolerability among different examination techniques.

Well leg compartment syndrome is rare after laparoscopic radical prostatectomy. We report a 68-year-old man that developed compartment syndrome after laparoscopic radical prostatectomy for prostate cancer. There are several circumstantial risk factors associated with LRP that, when combined, may potentially predispose to the development of compartment syndrome, including: obesity, evidence of peripheral vascular disease (advanced age, hypertension, hyperlipidemia, and diabetes mellitus), thromboembolism prophylaxis with compressive leg wraps together with intermittent pneumatic devices, combined general-spinal anesthesia, prolonged operative time in Trendelenburg position, and systemic hypotension due to intraoperative bleeding. The pathogenesis of this serious complication is discussed and preventive measures are highlighted.

El síndrome compartimental de la pierna es una complicación rara después de la prostatectomía radical laparoscópica. Varios factores de riesgo circunstanciales combinados entre sí pueden predisponer al síndrome compartimental, entre ellos la obesidad, criterios de enfermedad vascular periférica (edad avanzada, hipertensión, hiperlipemia y diabetes mellitus), la profilaxis de la tromboembolia venosa con compresión mecánica junto con compresión neumática intermitente, la anestesia general-espinal combinada, un tiempo operatorio prolongado en posición de Trendelenburg y la hipotensión sistémica por sangrado intraoperatorio. Se expone el caso de un varón de 68 años de edad que sufrió síndrome compartimental de la pierna después de una prostatectomía radical laparoscópica por cáncer de próstata, se trata de la patogenia de esta complicación grave y se destacan las medidas preventivas.

Objective: To evaluate patients' perception of pain and discomfort during DRE, the impact of discomfort on potential future screening compliance, and if emptying the bladder immediately before DRE reduces patient discomfort. Methods: One-hundred patients undergoing DRE for prostate cancer screening answered an anonymous questionnaire regarding pain, urinary urgency and bowel urgency during DRE and its potential impact on future examination. Another group with 100 patients was randomized in two subgroups to analyze if urinating immediately before DRE reduces patient discomfort. Results: Seventy-three (73%) patients reported moderate or higher discomfort for at least one of the domains evaluated: 61% complained of pain; 22% of urinary urgency; and 22% of bowel urgency. Emptying the bladder immediately before examination did not reduce pain (58% vs. 50%, p = 0.115), urinary urgency (22% vs. 16%, p = 0.151), or bowel urgency intensity (16% vs. 14%, p = 0.264). There was no difference in the number of patients that answered they will repeat the prostate exam next year (96% vs. 90%, p = 0.211) or in those that would encourage a friend that needs the prostate exam to do it (96% vs. 98%, p = 0.378). Conclusions: Pain and discomfort during DRE are not negligible but they do not affect intention to have a prostate exam in the future. Urinating immediately before examination does not significantly reduce the incidence of pain, urinary urgency, or bowel urgency during DRE.

Objetivo: Evaluar la percepción por los pacientes de dolor y molestia durante el tacto rectal, el impacto de la molestias sobre el potencial futuro cumplimiento con el "screening", y si el vaciado vesical inmediatamente anterior al tacto rectal disminuye la molestias. Métodos: 101 pacientes sometidos a tacto rectal por detección precoz de cáncer de próstata contestaron un cuestionario anónimo sobre dolor, urgencia urinaria y urgencia fecal durante el tacto rectal y su potencial impacto sobre futuros exámenes. Otro grupo de 100 pacientes fue asignado aleatoriamente a dos subgrupos para analizar si la micción inmediatamente anterior al tacto rectal reduce la molestia. Resultados: Setenta y tres (73%) de los pacientes comunicaron una molestia moderada o superior en al menos uno de los dominios evaluados: el 61% se quejaron de dolor; el 22% de urgencia miccional; y el 22% de urgencia fecal. El vaciado de la vejiga inmediatamente antes del examen no redujo el dolor (58% vs. 50%, p = 0,115), ni la urgencia urinaria (22% vs. 16%, p = 0,151) ni la intensidad de la urgencia fecal (16% vs. 14%, p = 0,264). No hubo diferencias en el número de pacientes que contestaron que repetirían el examen al siguiente año (96% vs. 90%, p = 0,211) o en el de aquellos que animarían a hacérselo a un amigo que necesitara una evaluación prostática (96% vs. 98%, p = 0,378). Conclusiones: El dolor y la molestia durante el tacto rectal no son despreciables aunque no afectan a la intención de repetir el examen en el futuro. Orinar inmediatamente antes de la exploración no reduce significativamente la incidencia de dolor, urgencia urinaria o urgencia fecal durante el tacto rectal.

Objective: To evaluate the reasons why patients reject digital rectal examination (DRE) when screening for prostate cancer. Methods: Four hundred and fifty men were prospectively evaluated in a prostate cancer educational program consisting of lectures, PSA testing, and DRE. Patients rejecting DRE were compared with those accepting DRE in regard to epidemic, social and cultural variables. Results: DRE was rejected by 8.2% of patients. Refusal rate was not different when patients were stratified by age, prostate cancer family history, school level, family income, and PSA level. Patients with a prior history of DRE had a lower rejection rate than those undergoing DRE for the first time (4.4% vs. 10.4%, p = 0.038). Patients with mild or no lower urinary tract symptoms rejected DRE more frequently than those with moderate or severe symptoms (9.6% vs. 1.4%, p = 0.018). Misconceptions about prostate cancer screening were present in 84.4% of those rejecting DRE vs. 46.9% of controls (p = 0.002); 43.7% expected severe discomfort in the group that rejected DRE vs. 28.1% in the control group (p = 0.090); fear of finding a cancer during DRE was present in 34.4% of patients that refused DRE vs. 46.9% of controls (p = 0.121); and 53.1% of patients rejecting DRE responded it was a source of shame vs. 15.6% of patients in the control group (p = 0.019). Conclusions: The main reasons patients reject DRE when attending prostate cancer screening are the lack of lower urinary tract symptoms, misconceptions about prostate cancer screening and shame, especially when undergoing screening for the first time.

Objetivo: Evaluar las razones por las que los pacientes rechazan el tacto rectal cuando se someten a cribaje de cáncer de próstata. Métodos: 450 hombres fueron evaluados respectivamente en un programa de educación sobre cáncer de próstata consistente en conferencias, evaluación del PSA y tacto rectal. Se compararon los pacientes que rechazaron el tacto rectal con los que aceptaron hacérselo considerando las variables epidemiológicas, sociales y culturales. Resultados: El 8,2% de los pacientes rechazaron el tacto rectal. La tasa de rechazos no mostró diferencias cuando se estratifica los pacientes por edad, historia familiar de cáncer de próstata, nivel de escolarización, ingresos familiares y nivel del PSA. Los pacientes con historia previa de tacto rectal presentaron una tasa de rechazo menor que aquellos sometidos a tacto rectal por primera vez (4,4% vs. I0,4%,p = 0,038). Los pacientes asintomáticos o con síntomas del tracto urinario inferior leves rechazaron el tacto rectal con mayor frecuencia que los que tenían síntomas moderados o severos (9,6% vs. 1,4%, p = 0,018). El 84% de los que rechazaron el tacto rectal tenían un concepto erróneo sobre el cribaje cáncer de próstata frente al 46,9% de los controles (p = 0,002); en 43,7% del grupo que rechazaron el tacto rectal esperaban una molestia severa frente al 28,1% del grupo control (p = 0,090); el miedo a que le fuera detectado cáncer durante el tacto rectal está presente del 34,4% de los pacientes que rechazaron el tacto rectal frente al 46,9% de los controles (p = 0,121); y el 53,1% de los pacientes que rechazaron el tacto rectal respondieron que este era una motivo de vergüenza, frente al 15,6% de los pacientes del grupo control (p = 0,019). Conclusiones: Las principales razones por las que los pacientes rechazan el tacto rectal cuando se someten a cribaje de cáncer de próstata son la falta de síntomas del tracto urinario inferior, conceptos erróneos sobre el cribaje de cáncer de próstata y la vergüenza, especialmente cuando se someten a cribaje por primera vez.