ABSTRACT Introduction: Renal ptosis is defined as the renal descent when there is a change from supine to orthostatic position, usually with a change of two vertebral bodies or more than five cm apart. Although rare, it is one of the causes of chronic flank pain or of upper abdomen. The typical patient of renal ptosis is young, female, thin, with complaint of pain when in an upright position (1, 2). Objective: Demonstrate a robot-assisted nephropexy technique in a young woman diagnosed with symptomatic renal ptosis on the right kidney, confirmed by imaging tests. Materials and Methods: A 29-year-old female patient with a history of chronic right-sided pain and palpable renal mobility on physical examination. The diagnosis of renal ptosis was confirmed by ultrasound imaging, excretory urography (Figure-1), and renal scintigraphy with 99mTc-DTPA (Figure-2). She was submitted to a robotic-assisted right nephropexy with a polypropylene mesh fixing the right kidney to the ipsilateral psoas muscle fascia. Result: We reported a 96-minute surgical time. The patient was discharged in the first postoperative day. At the one-month follow-up, there was an important improvement of the symptoms, with normality renal function and imaging tests describing adequate renal positioning. Conclusions: Robotic-assisted nephropexy is feasible and can be an excellent minimally invasive alternative technique for the proposed surgery. We reported a shorter hospital stay and a faster postoperative recovery compared with the opened procedure.

OBJETIVO: Este estudo avaliou o comportamento da população em relação à capacidade de leitura considerando o tamanho das fontes dos textos, com o objetivo de identificar padrões mínimos acessíveis de tamanhos de letras. MÉTODOS: O método escolhido utilizou de um pesquisa aplicada nos anos de 2007 e 2008, quando foram entrevistados 400 pacientes e acompanhantes do Hospital Estadual Mário Covas de Santo André, com idade a partir dos 40 anos. Todos foram submetidos a um teste de leitura de texto com 5 tamanhos diferentes de fonte. RESULTADOS: A maioria dos entrevistados (79,75%) relatou dificuldades de leitura, optando pelo maior tamanho de letra dentre os padrões apresentados, concluindo-se que o tamanho da letra tem grande influência na qualidade da leitura. CONCLUSÃO: Este achado justifica alertar a sociedade sobre as desordens visuais que acometem as pessoas por volta da faixa etária de 40 anos e indica o tamanho de fonte 14 como ideal para melhorar a leitura da população com presbiopia ou outras desordens refrativas.

OBJECTIVE: This study evaluated the behavior of a population in relation to reading capacity considering font sizes of the texts with the objective of identifying minimum patterns accessible of font sizes. METHODS: Four hundred participants and their companions over the age of forty were interviewed at the state hospital Mário Covas of Santo André between 2007 and 2008. They were given a reading test with five different font sizes. RESULTS: The majority (79.75%) reported having difficulty with reading. Participants preferred larger font size among the samples that were given, concluding that reading is largely influenced by font size. CONCLUSION: This discovery justifies alerting society about disorders that occur with people over the age of forty, indicating the number 14 as the ideal font size to improve reading in people who suffer from presbyopia and other refractive disorders.

PURPOSE: To make an objective controlled comparison of pain tolerance in transrectal ultrasound-guided prostatic biopsy using intrarectal topic anesthesia, injectable periprostatic anesthesia, or low-dose intravenous sedation. MATERIALS AND METHODS: One hundred and sixty patients were randomized into 4 groups: group I, intrarectal application of 2% lidocaine gel; group II, periprostatic anesthesia; group III, intravenous injection of midazolam and meperidine; and group IV, control, patients to whom no sedation or analgesic was given. Pain was evaluated using an analogue pain scale graded from 0 to 5. Acceptance of a repetition biopsy, the side effects of the drugs and complications were also evaluated. RESULTS: 18/20 (90%) and 6/20 (30%) patients reported strong or unbearable pain in the group submitted to conventional biopsy and topical anesthesia (p = 0.23, chi-square = 1.41); whereas those submitted to periprostatic blockade and sedation, severe pain occurred in only 2/60 (3%) patients (p < 0.001, chi-square = 40.19) and 3/60 (5%) patients (p < 0.001, chi-square = 33.34). Acceptance of repetition of the biopsy was present in only 45% of the patients submitted to conventional biopsy, 60% of those that were given topical anesthesia (p = 0.52, chi-square = 0.4), compared to 100% of those submitted to periprostatic anesthesia (p < 0.01, chi-square = 15.17), and 95% of those who were sedated (p < 0.001, chi-square = 25.97%). CONCLUSIONS: Transrectal ultrasound-guided prostatic biopsy is an uncomfortable experience; however application of periprostatic blockade and intravenous analgesia are associated to higher tolerance of the exam and patient comfort. Low dose sedation by association of intravenous meperidine and midazolam is an emerging and safe outpatient option.

INTRODUCTION: Surgery represents the main therapeutic modality for stress urinary incontinence. In incontinent patients with urethral hypermobility, the retropubic colposuspension by Burch technique is one of the surgeries that present better long-term results. Current trends towards performing minimally invasive techniques led proposing the Burch surgery through videolaparoscopy. The laparoscopic technique's long-term efficacy is a highly controversial issue. However, even if late results turn out to be satisfactory, the assumed advantages of laparoscopy (faster recovery, less pain, early return to daily activities, etc.) must be evident, in order to justify the use of this minimally invasive surgical access. MATERIALS AND METHODS: We reviewed our records and analyzed the medical charts of 26 female patients who underwent Burch surgery by open approach and 36 female patients by laparoscopic approach, between May 1999 and February 2001. The satisfaction level, surgical complication rates, surgery length, hospital stay and return to daily activities were analyzed. RESULTS: Mean age was 42 years, ranging from 27 to 68 years. Epidemiological data from both groups were not statistically different. Patients operated by laparoscopic route had a shorter hospital stay (p = 0.002) and a faster return to their daily activities (p < 0.001). However, there were no statistical differences in the following parameters: surgical time (p = 0.11), surgical complications (p = 0.98), patient satisfaction immediately (p = 0.77) and 90 days following surgery (p = 0.84), surgery acceptance (p = 0.85), indication of this surgery to a friend (p = 0.93) and score given to the procedure (p = 0.68). CONCLUSIONS: Even if the efficacy of both methods is similar, we did not observe significant advantages of laparoscopic surgery over open surgery, concerning the recovery in recent post-operative period.

CONTEXTO: A doença policística autossômica dominante é caracterizada por cistos múltiplos bilaterais e não-funcionantes, que levam a uma perda progressiva da função renal. TIPO DE ESTUDO: Relato de caso. OBJETIVO: Relatar um caso de nefrectomia bilateral assistida com a mão em paciente do sexo feminino de 28 anos e com quadro de pielonefrite de repetição em programa de transplante renal. RELATO DE CASO: Foi realizado nefrectomia bilateral assistida com a mão em paciente com doença policística renal do adulto. A cirurgia foi realizada através de incisão mediana de aproximadamente 6 cm supra-umbilical (acesso previamente planejado no pré-operatório considerando acesso externo ao hilo no caso de necessidade devido ao grande volume dos rins) e três portais de 10 mm. O tempo cirúrgico foi de três horas e 15 minutos, sendo que o rim foi dissecado pela técnica assistida com a mão bilateralmente. As unidades renais foram retiradas após a aspiração de alguns cistos pela incisão supra-umbilical. O controle da dor foi feito por meio de analgésicos leves, o tempo de internação hospitalar foi de quatro dias. O sangramento médio foi de 160 ml, e como intercorrência no pós-operatório, a paciente evoluiu com pneumotórax à direita, drenado sem intercorrências. O dreno permaneceu por 48 horas.

CONTEXT: Dominantly autosomal polycystic disease is characterized by multiple bilateral and non-functional cysts, which lead to progressive kidney failure. OBJECTIVE: Our objective was to report on a case of hand-assisted bilateral nephrectomy in a 28-year-old female patient with adult polycystic disease and recurring pyelonephritis in a kidney transplant program. CASE REPORT: A hand-assisted bilateral nephrectomy was performed through a supra-umbilical median incision of approximately 6 cm, and with 3 ports of 10 mm. The length of the surgery was 3 hours and 15 minutes. The kidneys were removed after the aspiration of some cysts through the supra-umbilical incision. Pain control was achieved via the use of analgesics. The blood loss during surgery was 160 ml. During the postoperative period, the patient developed right-side pneumothorax, which was drained with no further occurrence. This drain was kept in place for 48 hours. The length of hospitalization was 4 days.

CONTEXTO: Desde a primeira nefrostomia por punção realizada por Goodwin em 1954, os avanços técnicos no acesso percutâneo ao rim aumentaram a freqüência destes procedimentos e, como conseqüência, maior número de complicações. Dentre essas, as lesões do trato digestivo são raras. TIPO DE ESTUDO: Relato de caso. RELATO DE CASO: Relatamos lesão duodenal que foi corrigida com exploração cirúrgica e abordamos as opções terapêuticas que podem ser conservadora ou intervencionista. Optando-se pelo tratamento conservador, encontra-se nas publicações diferentes formas de abordagem.

CONTEXT: Since the first percutaneous nephrostomy performed by Goodwin in 1954, technical advances in accessing the kidneys via percutaneous puncture have increased the use of this procedure and thus the complications too. Among these complications, digestive tract damage is not common. DESIGN: Case report. CASE REPORT: We report a duodenal lesion that was corrected using surgical exploration and we touch on the therapeutic options, which may be conservative or interventionist. We chose conservative treatment, which has been approached in diverse manners in the literature.

Objetivo: o acometimento do trato urinário pela endometriose é raro e quando ocorre, a bexiga é o órgão mais freqüentemente afetado. Observamos que algumas pacientes têm sido encaminhadas com o diagnóstico clínico de neoplasia vesical. Em geral, a literatura mostra relatos isolados de casos, tornando difícil a padronização de condutas. Tivemos por objetivo apresentar nossa experiência, mostrando os principais aspectos diagnósticos e terapêuticos desta entidade clínica. Métodos: avaliamos retrospectivamente os casos com diagnóstico de endometriose vesical por meio do arquivo do Departamento de Patologia, fazendo revisão dos dados clínicos de prontuário e convocando as pacientes para seguimento ambulatorial após tratamento. Resultados: os principais sinais e sintomas apresentados pelas pacientes foram disúria cíclica, massa e dor pélvica crônica. O diagnóstico presuntivo foi realizado mediante ultra-sonografia (USG), tomografia computadorizada (TC) de abdome, cistoscopia e laparoscopia. O diagnóstico definitivo com confirmação anátomo-patológica foi obtido pela ressecção endoscópica em 3 casos e biópsia laparoscópica em 1 caso. As opções terapêuticas foram o tratamento medicamentoso exclusivo e a ressecção da lesão empregando a via endoscópica ou cistectomia parcial, sempre complementados por tratamento clínico adjuvante. Conclusões: revisamos os principais aspectos clínicos e terapêuticos da endometriose do trato urinário, lembrando que esta representa um importante diagnóstico diferencial de tumor vesical em mulheres jovens na idade reprodutiva.

Purpose: urinary tract involvement by endometriosis is uncommon and the bladder is the most common site. We observed that clinical misdiagnosis of bladder cancer frequently is made. Because the disease is generally described in case reports there is not a consensual management. We present and discuss our experience of diagnostic and therapeutic issues. Methods: retrospective analysis of urinary endometriosis slides of the Department of Pathology files was made. Medical charts and follow-up were reviewed in detail and interviews were performed during or after treatment. Results: we describe four cases with cyclic disuria, abdominal mass, pelvic pain and imaging diagnosis of bladder tumor. Pathological specimens were obtained by endoscopic resection (3 cases) and laparoscopic biopsy (1 case). Therapeutic options were exclusive medical treatment or surgical removal with transurethral resection or partial cystectomy supplemented with adjuvant medication. Conclusions: we review the clinical and therapeutic aspects of urinary tract endometriosis stressing that this is an important differential diagnosis of bladder cancer in reproductive women.

A síndrome de Williams (SW) é doença relativamente rara, caracterizada por retardo mental e psicomotor de graus variados, facies característica, anomalias cardiovasculares, hipercalcemia e disfunções orgânicas múltiplas. Os achados urológicos desta entidade, apesar ocorrerem em até 40% dos casos, têm sido pouco abordados na literatura. Apresentamos o caso de uma paciente de 6 anos de idade, com diagnóstico de SW e que há 3 anos tem apresentado sintomas de polaciúria e urge-incontinência. A investigação revelou divertículos vesicais e hiperatividade detrusora, tratada com sucesso com oxibutimina. Ressaltamos a importância da investigação urológica, descrevemos os principais achados e discutimos a fisiopatologia e a abordagem terapêutica, a qual permite melhora das condições clínicas e sociais desses pacientes.

The Williams syndrome is a relatively rare disease with characteristic facial appearance, mental retardation, growth deficiency, cardiovascular anomalies, hypercalcemia and multiple organic dysfunctions. However, the urological findings of this syndrome (positive in up to 40% of patients) have not been frequently discussed. We present the case of a 6 year-old white girl with this diagnosis and a 3-year history of urinary incontinence. The investigation revealed bladder diverticula and detrusor hyperactivity, which was successfully treated with oxibutimin. We stress the importance of urological investigation, describe the main findings and discuss the pathophysiology and management, which significantly improves the quality of life of these childrens.