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.

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.

Introduction Positive surgical margins (PSMs) are an adverse factor that may predict a worse outcome in patients submitted to radical prostatectomy (RP). However, not all of these cases will evolve to biochemical (BCR) or clinical (CR) recurrence, therefore relationship between PSMs and these recurrent events has to be correlated with other clinical and pathologic findings to indicate complementary treatment for selected patients. Materials and Methods Of 1250 patients submitted to open retropubic radical prostatectomy (RRP), between March 1991 and June 2008, the outcome of 161 patients with PSMs and of 67 without PSMs as a control group, comprising a total of 228 cases were retrospectively reviewed. A minimum follow-up time of 2 years after surgery was considered. BCR was determined when PSA ≥ 0.2ng/mL. CR was determined whenever there was clinical evidence of tumor. Chi-square test was used to correlate clinical and pathologic variables with PSMs. Time interval to biochemical recurrence was analyzed by the Kaplan-Meier product limit analysis using the log-rank test for comparison between groups. Univariate and multivariate Cox stepwise logistic regression models were used to identify significant predictors of risk of shorter intervals to BCR. Results Prostate circumference margin was the most common site with 78 cases (48.44%). Regarding the outcome of 228 cases from both groups, BCR occurred in 68 patients (29.82%), and CR in 10 (4.38%). Univariate analysis showed statistically significant associations (p < 0.001) between presence of PSMs with BCR, but not with CR (p = 0.05). At follow-up of the 161 patients with PSMs, only 61(37.8%) presented BCR, while 100 (62.8%) did not. BCR correlated with pathologic stage; Gleason score; preoperative PSA; tumor volume in the specimen; capsular and perineural invasion; presence and number of PSMs. CR correlated only with angiolymphatic invasion and Gleason score. Considering univariate analysis of clinical and pathologic factors predicting progression-free survival at 5 years, prostate weight; preoperative PSA; Gleason score; pathologic stage; tumor volume; PSMs; capsular and perineural invasion were correlated with BCR. At multivariate analysis, only Gleason score and percentage of tumor volume correlated as significant independent predictors of BCR. Conclusion At univariate analysis, presence, number and location of PSMs have consistent correlation with BCR after RRP, but at follow-up BCR occurred only in 37.8% of patients with PSMs. However at multivariate analysis, the significant risk factors for BCR were percentage of tumor volume (p = 0.022) and Gleason score (p < 0.005) in the surgical specimen. Angiolymphatic invasion and Gleason score were significantly correlated with CR.

A pesquisa analisou o comportamento das precipitações pluviais em Porto Velho, para o período de 1945 a 2003, mostrando a tendência da precipitação pluviométrica dentro da série temporal, e sua variabilidade interanual nos 59 anos e os números de frequência de ocorrência de todos os eventos dentro da faixa de variabilidade estabelecida graficamente. As principais características do regime pluviométrico do município de Porto Velho são a sua sazonalidade bem definida em um período chuvoso que se estende de novembro a abril com precipitação mensal, oscilando entre 228,9 mm a 329,6 mm e um período de estiagem de junho a setembro com precipitação mensal, oscilando entre 38,7 mm a 107,7 mm, sendo os meses de maio e outubro considerados meses de transição de um regime para outro. A tendência da precipitação pluvial de Porto Velho em número de ocorrência está dentro da normalidade, pois, a maioria dos eventos encontrados ficou dentro da faixa de variabilidade estabelecidas sendo somente dezesseis ocorrências fora da faixa de variabilidade. A análise da distribuição da variabilidade trimestral da série histórica dos eventos de precipitação pluvial também não houve uma tendência para acréscimo ou decréscimo dos valores médios trimestral, pois um percentual de magnitude significante de 62,7% a 79,78% ocorreu entre a faixa de variação da medida de dispersão. Os anos e trimestre de precipitações pluviais que tiveram anomalias coincidiram com os fenômenos El Niño e La Niña.

Actually, we have studied some procedures of the local rain in Porto Velho, Rondônia, With regard to the period 1945 - 2003, including the survey of the rainfall according to the shower and the series of occurrences on all events, in general. The main characteristics of the rainfall condition here are sue has. A rainy weather from Number to April with monthly rainfall between 228,9 mm, and 329,6 mm, and winter time from June to September with monthly rainfall between 38,9 mm, and 107,7 mm, and may and October are taken as transition months in the period. The tendency of pluvial precipitation in Porto Velho has been regular according to the number of occurrences as only 16 of them are out of parameters. The analysis of the distribution of the quarterly variability of the historical series of rain water, there was no quarterly tendency on the increase or decrease of medium values as there is a percentage of meaning magnitude between 62,7% and 79,78% in relation to dispersion measure. The period of years and quarters of rain water out of the variability of the dispersion measure has kept up with the phenomena El Niño and La Niña.