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International braz j urol, Volume: 33, Número: 3, Publicado: 2007
  • Epididymo-testicular descent

    Sampaio, Francisco J. B.
  • Preoperative planning for renal cell carcinoma: benefits of 64-slice CT imaging Review Article

    Dighe, Manjiri; Takayama, Thomas; Bush Jr, William H.

    Resumo em Inglês:

    Surgery is the primary form of treatment in localized renal cell carcinoma. Adrenal-sparing nephrectomy, laparoscopic nephrectomy and nephron-sparing partial nephrectomy are growing trends for more limited surgical resection. Accurate preoperative imaging is essential for planning the surgical approach. Multislice CT and MR are regarded as the most efficient modalities for imaging renal neoplasms. Development of faster CT systems like 64-slice CT with improved resolution and capability to achieve isotropic reformats have significantly enhanced the role of CT in imaging of renal neoplasms.This review article describes the present state, technique and benefits of 64-slice CT scanning in preoperative planning for RCC.
  • Randomized prospective evaluation of nephrostomy tube configuration: impact on postoperative pain Clinical Urology

    Weiland, Derek; Pedro, Renato N.; Anderson, J. Kyle; Best, Sara L.; Courtney, Lee; Hendlin, Kari; Kim, Johnstone; Monga, Manoj

    Resumo em Inglês:

    OBJECTIVE: Conduct a prospective randomized single-blind comparison of two nephrostomy catheter designs, evaluating specifically intraoperative placement and postoperative comfort. MATERIALS AND METHODS: The single-blind, prospective randomized trial was conducted with institutional review board approval. All patients undergoing percutaneous nephrolithotomy who gave informed consent were randomized to placement of either a Boston Scientific Flexima 8.3F pigtail nephrostomy tube #27-180 (PIG) or a Boston Scientific 8.2F nephroureteral stent #410-126 (NUS). Randomization was concealed from the surgeon until time of placement. Subjective intraoperative placement characteristics were rated by the surgeon on a scale of 1 = excellent, 2 = fair, 3 = good and 4 = poor. The patient's postoperative pain intensity was evaluated with a Visual Analog Pain Score (0 = no pain to 10 = worst pain). RESULTS: Nine patients were randomized to each group. The PIG group was rated significantly better than the NUS group with regards to ease of placement (p = 0.007) and radiopacity of the tube (p = 0.007) by surgeon. Visual analog pain scores on postoperative day one, was significantly lower in the PIG group (mean = 2+/-2) than the NUS group (mean = 5+/-1) (p = 0.004). The mean amount of intra-venous morphine equivalent given in the PIG group (mean = 1+/4 Eq morphine) was less on average compared to the NUS group (mean = 6+/13 Eq morphine), but the differences did not reach statistical significance (p = 0.06). CONCLUSIONS: Following percutaneous nephrolithotomy, use of a small pig-tail nephrostomy tube results in greater ease of placement and less postoperative pain than a nephroureteral catheter.
  • Management of diaphragmatic injury during transperitoneal laparoscopic urological procedures Clinical Urology

    Castillo, Octavio A.; Vitagliano, Gonzalo; Moreno, Mauricio; Diaz, Manuel A.; Cortes, Oscar

    Resumo em Inglês:

    INTRODUCTION: Carbon dioxide pneumothorax is a rare complication in laparoscopic urology, but with the widespread use of laparoscopy and the increasing surgical pathologies managed by this technique this infrequent complication has become a potential risk. MATERIALS AND METHODS: A total of 786 laparoscopic transperitoneal urologic operations were reviewed at our institution. All procedures were performed by the same surgeon and included 213 adrenalectomies, 181 simple nephrectomies, 143 lymphadenectomies, 118 radical nephrectomies, 107 partial nephrectomies and 24 nephroureterectomies. Mean patient age was 53.2 years (range 24 to 70). Mean BMI was 28.15 Kg/m2 (range 20 to 48.9). RESULTS: A total of 6 cases (0.7%) of diaphragmatic injury were found. All reported patients had additional factors that may have contributed to diaphragmatic injury. Diaphragmatic repair was always carried out by intracorporeal suturing and only one case required chest tube placement. All patients evolved uneventfully. CONCLUSIONS: Repair of diaphragmatic injuries should always be attempted with intracorporeal suture since this is a feasible, reproducible and reliable technique.
  • Adverse events and readmissions after day-case urological surgery Clinical Urology

    Paez, Alvaro; Redondo, Enrique; Linares, Ana; Rios, Emilio; Vallejo, Jorge; Sanchez-Castilla, Margarita

    Resumo em Inglês:

    OBJECTIVE: The literature lacks of studies on postoperative outcomes after urological ambulatory surgery. Our study aims to identify parameters associated with postoperative complications within 30 days after ambulatory urological surgery. MATERIALS AND METHODS: Adjusted and unadjusted comparisons between clinical features and postoperative outcome (complicated and uncomplicated). RESULTS: Postoperative course was complicated in 5% of the patients. Discharge schedule was not completed in 1.1% while unplanned visits resulted in admission in 0.5%. Multivariate analyses could only confirm the independent effect of type of anesthesia and diagnosis-related group (DRG) relative weight. CONCLUSIONS: Ambulatory urological surgery can be safe in terms of postoperative complications. In the present study surgery under general anesthesia, or a higher DRG relative weight procedure, increased the risk of complications compared to surgery under regional or local anesthesia or lower DRG relative weight operations. Patients scheduled for general anesthesia or undergoing complex urological procedures should be warned about an increased risk of postoperative incidents and/or readmission.
  • The role of squamous differentiation in patients with transitional cell carcinoma of the bladder treated with radical cystectomy Clinical Urology

    Antunes, Alberto A.; Nesrallah, Luciano J.; Dall'oglio, Marcos F.; Maluf, Carlos E.; Camara, Cesar; Leite, Katia R.; Srougi, Miguel

    Resumo em Inglês:

    OBJECTIVE: We aim at determining the prognostic value of squamous differentiation in patients with transitional cell carcinoma (TCC) of the bladder that were treated with radical cystectomy. MATERIALS AND METHODS: From January 1993 to January 2005, we retrospectively selected 113 patients. Correlations among squamous differentiation with other clinical and pathological features were assessed by both chi-square and Fisher tests. The Kaplan-Meier method was used to evaluate survival curves and statistical significance was determined by the log-rank test. Multivariate analysis was performed through a Cox proportional hazards regression model. RESULTS: Squamous differentiation was observed in 25 (22.1%) of the 113 patients. This finding was significantly related only to the pathological stage. Mean follow-up after cystectomy was 31.7 ± 28.5 months. Disease recurrence occurred in 16 (64%) and 30 (34%) patients with and without squamous differentiation (log-rank test, p = 0.001), and mortality occurred in 10 (40%) and 14 (16%) of the patients with and without squamous differentiation respectively. Univariate analysis revealed that pathological stage, squamous differentiation, tumor size and lymph node involvement were significant predictors of cancer-specific survival. However, only squamous differentiation and tumor size were independent prognostic variables on multivariate analysis. CONCLUSIONS: Squamous differentiation was an independent prognostic factor for cancer specific survival in patients with bladder cancer treated with radical cystectomy. Further studies with a larger number of patients are necessary to confirm these results.
  • The use of enoxaparin to prevent venous thromboembolism in patients undergoing radical retropubic prostatectomy: feasibility and utility Clinical Urology

    Nakamura, Kogenta; Kasraeian, Ali; Yacoub, Saif; Pendleton, John; Anai, Satoshi; Rosser, Charles J.

    Resumo em Inglês:

    OBJECTIVE: To assess the utility of enoxaparin in prevention of venous thromboembolism (VTE) in men poorly compliant with pneumatic compression stockings (PCS) in the immediate postoperative period after a radical retropubic prostatectomy (RP). MATERIALS AND METHODS: This retrospective study included 47 men who underwent RP at an inner-city tertiary care hospital. All patients were started on enoxaparin 40 mg subcutaneously 6-8 hours postoperatively and daily while hospitalized. Preoperative, operative, and postoperative data were collected and analyzed. Median follow-up was 18 months. RESULTS: Median patient age was 64 ± 7 years, median prostate-specific antigen level was 4.9 ng/mL and median prostate biopsy-determined Gleason score was 6. Forty-one men (87%) underwent a pelvic lymph node dissection. Median operative time was 181 minutes (range 164-450 minutes). Median estimated blood loss was 700 mL. Approximately 36% of the men wore PCS the recommended > 19 hours/day. On average PCS were worn 10.3 ± 7.5 hours/day. Postoperative complications were not increased in this cohort. Two patients developed pulmonary embolism requiring long-term anticoagulation. There were no mortalities. CONCLUSIONS: In men non-compliant with PCS, initiation of enoxaparin in the immediate postoperative setting was well-tolerated and maintained a low (4%) rate of VTE. Thus, enoxaparin may be useful in adjunct with PCS in these patients.
  • Inflammatory atrophy on prostate needle biopsies: is there topographic relationship to cancer? Clinical Urology

    Billis, Athanase; Freitas, Leandro L. L.; Magna, Luis A.; Ferreira, Ubirajara

    Resumo em Inglês:

    INTRODUCTION: Chronic inflammation of longstanding duration has been linked to the development of carcinoma in several organ systems. It is controversial whether there is any relationship of inflammatory atrophy to prostate cancer. It has been suggested that the proliferative epithelium in inflammatory atrophy may progress to high-grade prostatic intraepithelial neoplasia and/or adenocarcinoma. The objective of our study is to compare on needle prostate biopsies of patients showing cancer the topographical relation of inflammatory atrophy and atrophy with no inflammation to adenocarcinoma. MATERIALS AND METHODS: The frequency and extent of the lesions were studied on 172 needle biopsies of patients with prostate cancer. In cores showing both lesions, the foci of atrophy were counted. Clinicopathological features were compared according to presence or absence of inflammation. RESULTS: Considering only cores showing adenocarcinoma, atrophy was seen in 116/172 (67.44%) biopsies; 70/116 (60.34%) biopsies showed atrophy and no inflammation and 46/116 (39.66%) biopsies showed inflammatory atrophy. From a total of 481 cores in 72 biopsies with inflammatory atrophy 184/481 (38.25%) cores showed no atrophy; 166/481 (34.51%) cores showed atrophy and no inflammation; 111/481 (23.08%) cores showed both lesions; and 20/481 (4.16%) showed only inflammatory atrophy. There was no statistically significant difference for the clinicopathological features studied. CONCLUSION: The result of our study seems not to favor the model of prostatic carcinogenesis in which there is a topographical relation of inflammatory atrophy to adenocarcinoma.
  • Evaluation of acrosomal status and sperm viability in fresh and cryopreserved specimens by the use of fluorescent peanut agglutinin lectin in conjunction with hypo-osmotic swelling test Clinical Urology

    Esteves, Sandro C.; Sharma, Rakesh K.; Thomas Jr, Anthony J.; Agarwal, Ashok

    Resumo em Inglês:

    OBJECTIVE: In this study, we evaluated whether the hypo-osmotic swelling test (HOST) can be used as a vital marker in combination with peanut agglutinin (PNA) - labeling in fresh and cryopreserved spermatozoa. MATERIALS AND METHODS: Human sperm populations were exposed to a hypo-osmotic medium for 60 minutes, and then incubated in a 1 µg/mL solution of the fluorescent dye Hoescht 33258 (H33258) for 10 minutes. Excess stain was removed by washing in phosphate-buffered saline (PBS) solution, and the pellet was resuspended in 100 µL of culture medium. Twenty microliters of this solution were subsequently smeared on a microscope slide, and fixed in ice-cold methanol to permeabilize the sperm membranes. The fixed smears were finally incubated in a 40-µg/mL FITC-PNA solution for 20 minutes. Simultaneous assessment of acrosome and viability scores was done in a fluorescent microscope equipped with appropriate filters and phase contrast illumination. The same slide was examined for FITC-PNA labeling, tail swelling, and for Hoechst-33258 staining by interchanging the filters and phase contrast optics. RESULTS: In fresh specimens, HOST was found to provide viability assessments comparable to those obtained using the H33258 method (r = 0.95). However, the results of HOST and H33258 were not correlated in cryopreserved specimens (r = 0.22). There was no alteration of PNA-labeling due to the HOST or H33258. CONCLUSIONS: FITC-PNA labeling in conjunction with the visualization of the morphological change induced by exposure to hypo-osmotic solution provides a simple but effective method for establishing the state of acrosomal membrane and viability in fresh human spermatozoa, but this technique is not reliable for cryopreserved ones.
  • Laparoscopic live donor nephrectomy in patients surgically treated for morbid obesity Case Report

    Branco, Anibal W.; Branco Filho, Alcides J.; Kondo, William

    Resumo em Inglês:

    In the past, morbid obesity was considered a relative contraindication to renal donation; however, more recent publications have shown that laparoscopic renal surgery is safe and effective for obese donor nephrectomy. We report the performance of a bariatric surgery before the kidney donation in 2 patients in order to improve their medical condition and to reduce their surgical risk to the transplantation procedure. After bariatric surgery, both donors lost more than 30% of their initial corporal weight and their donation procedure was successfully performed, with uneventful postoperative courses.
  • Laparoscopic treatment of traumatic intraperitoneal bladder rupture Case Report

    Figueiredo, Andre A.; Tostes, Jose G. T.; Jacob, Miguel V. M.

    Resumo em Inglês:

    Traumatic intraperitoneal bladder rupture requires surgical suture and bladder drainage. In stable patients the laparoscopic approach is the best short recovery and less traumatic treatment allowing visualization of the entire peritoneal cavity to exclude others lesions. We present one case of successful laparoscopic treatment of this entity.
  • Lower urinary tract dysfunction in children: what do pre-school teachers know about it? Pediatric Urology

    Lordelo, Patricia; Maron, Fabio; Barros, Daniela G.; Barroso, Danilo V.; Bessa Jr, Jose; Barroso Jr, Ubirajara

    Resumo em Inglês:

    OBJECTIVE: To evaluate the basic knowledge of pre-school teachers who deal with children between the ages of 4 and 7 years, who present signs of lower urinary tract dysfunction (LUTD). MATERIALS AND METHODS: We performed a survey with 50 teachers from 9 private schools working with pre-school children. The criteria for selection were if teachers were certified or non-certified elementary school teachers - NCEST and the amount of professional experience. RESULTS: Thirty-three teachers considered that the normal daily urinary frequency should be from 4 to 7 times. Two of the 50 teachers considered it normal to urinate less than 4 times per day and 15 teachers considered more than 7 times per day as normal. There was no difference between the 2 categories of certified or NCEST nor between those with more or less than five years of professional experience. Thirty-three percent believed that to urinate more than 4 times during a class period (4-5 hours) could indicate a urinary problem. There was a statistically significant difference among the certified and NCEST but not in terms of time of professional experience. If during this period the child would not ask to urinate, only 18% considered that as an indication of urinary problem. When asked about the symptoms that would indicate urinary urgency and urge incontinence, only 24% of the teachers connected it with urinary problem. There was no difference in terms of professional background or professional experience in these 2 last analyses. CONCLUSION: Our data shows evidences that private pre-schools teachers are not well informed of the clinical manifestation of LUTD.
  • Steerable antegrade stenting: a new trick of the trade Surgical Technique

    Nagele, Udo; Anastasiadis, Aristotelis G.; Amend, Bastian; Schilling, David; Kuczyk, Markus; Stenzl, Arnulf; Sievert, Karl-Dietrich

    Resumo em Inglês:

    INTRODUCTION: Whereas a retrograde attempt to insert an indwelling stent is performed in lithotomy position, usually renal access is gained in a prone position. To overcome the time loss of patient repositioning, a renal puncture can be performed in a modified lithotomy position with torqued truncus and slightly elevated flank. There is a two-fold advantage of this position: transurethral and transrenal access can be obtained using a combined approach. In the present study, this simple technique is used to position a floppy guide wire through a modified needle directly through the renal pelvis into the ureter. MATERIALS AND METHODS: The kidney is punctured in the modified lithotomy position under sonographic control using an initial three-part puncture needle. A floppy tip guide-wire is inserted into the collecting system via the needle after retrieving the stylet. The retracted needle is bent at the tip while the guide-wire is secured in the needle and the collecting system. The use of the floppy tip guide-wire helps to insert the curved needle back into the kidney pelvis, which becomes the precise guidance for the now steerable wire. The desired steerable stent is positioned under radiographic control in a retrograde fashion over the endoscopically harbored tip of the guide-wire. Two patient cohorts (newly described method and conventional method) were compared. RESULTS: The presented steering procedure saves 16.5 mean minutes compared to the conventional antegrade stenting and 79.5 Euros compared to the control group. CONCLUSION: The described combined antegrade-retrograde stent placement through a bent three-part puncture needle results in both clinical superiority (OR time, success rate) and financial benefits.
  • Mini-invasive collagen sling in the treatment of urinary incontinence due to sphincteric incompetence Neurourology

    Taskinen, Seppo; Fagerholm, Riitta; Rintala, Risto

    Resumo em Inglês:

    OBJECTIVE: To assess the technical feasibility of mini-invasive sling procedure and present preliminary results in the treatment of urinary incontinence due to sphincteric insufficiency. MATERIALS AND METHODS: Thirteen patients (6 males, 7 females, 8 with myelomeningocele, 1 with tethered spinal cord, 3 with bladder exstrophy, 1 with epispadias) underwent sling procedure with porcine dermis acellular collagen matrix (PelvilaceTM, Bard medical, UK). The median age was 15.5 (range 8.9-27.5) years. A suprapubic catheter was inserted for the measurement of leak point pressure during the operation. In females vaginal and in males perineal incision was used for sling insertion. The sling was introduced under cystoscopic control. The sling was not fixed with sutures. The outcomes were reviewed at 1, 6 and 12 month after the operation. RESULTS: The median leak point pressure increased from 21.5 (range 5-25) cm H2O to 85 (range 70-100) cm H2O. At 1 month 8 and at 6 months 3 out of 13 patients were dry. At 12 months, none out of 11 patients was completely dry. However, at 12 months some improvement in incontinence was detected in 9 out of 11 patients. Two patients had primary failures. One patient got sling erosion to urethra after a tightening attempt. In one patient detrusor overactivity increased after the sling procedure. CONCLUSIONS: PelvilaceTM sling is safe and easy to introduce in both males and females if pelvic floor anatomy is normal. Although immediate results were promising in neuropathic incontinence, the results seem to deteriorate to unacceptable low level already during the first year. In exstrophy patients the results are generally poor.
  • Insulin 3-like hormone and its role in epididymo-testicular descent Investigative Urology

    Hadziselimovic, Faruk; Adham, Ibrahim

    Resumo em Inglês:

    PURPOSE: The role of insulin 3-like (Insl3) hormone signaling in the testicular descent process has been demonstrated. The purpose of the present study was to evaluate epididymal development in Insl3-deficient mice. MATERIALS AND METHODS: Heterozygous and homozygous Insl3 mutants of a mixed CD1 X 129/Sv genetic background were generated by breeding Insl3-/- females with Insl3+/- males, and their genotypes were determined by polymerase chain reaction. On the first postnatal day, newborn males were sacrificed, embedded in paraffin, and cut in 4 µm sections. Sections were stained with hematoxylin/eosin and immunoreacted with anti-± actin antibody. RESULTS: An analysis of stained sections indicated an arrest in the development of the epididymis in all homozygous mice. The cauda and corpus of the epididymis were undersized. Compared to the heterozygous epididymis, the homozygous epididymis had fewer peritubular layers and dwarfish musculature. We confirmed this with immunostaining with monoclonal antibodies against ± -smooth muscle actin. CONCLUSION: Defective development of the smooth musculature in the epididymis of Insl3 homozygous mutant mice, combined with its high intraabdominal undescended position, supports previous observations regarding the importance of intact epididymis morphology and function for descent of the epididymo-testicular unit.
  • Disposition of the striated urethral sphincter and its relation to the prostate in human fetuses Investigative Urology

    Favorito, Luciano A.; Albuquerque, Luis F. P.; Sampaio, Francisco J. B.; Costa, Waldemar S.

    Resumo em Inglês:

    OBJECTIVE: To describe the arrangement of the muscle fibers of the striated urethral sphincter and its relationship with the prostate during the fetal period in humans. MATERIALS AND METHODS: We analyzed 17 prostates from well preserved fresh human fetuses ranging in age from 10 to 31 weeks postconception (WPC). Transversal sections were obtained and stained with Gomori's trichrome and immunolabeled with anti alpha-actin antibody. RESULTS: We found that the urethral striated sphincter (rabdosphincter) is located on the periphery of the smooth muscle and there was no merge between striated and smooth muscle fibers in any fetal period. In the prostate apex, the striated sphincter shows a circular arrangement and covers completely the urethra externally, whereas adjacent to verumontanum, it looks like a "horseshoe" and covers only the anterior and lateral surfaces of the urethra. Near the bladder neck, in fetuses younger than 20 WPC, we have found striated muscle fibers only at the anterior surface of the prostate, while in fetuses older than 20 WPC, the striated muscle covers the anterior and lateral surfaces of the prostate. CONCLUSIONS: The urethral sphincter muscle covers the anterior and lateral surfaces of the urethra in all fetuses older than 20 WPC, close to the bladder neck and at the distal prostate. In the region of the prostate apex, the urethral sphincter covers completely the urethra circularly. The knowledge of the normal anatomy of the urethral sphincter in fetuses could be important to understand its alterations in congenital anomalies involving the base of the bladder, the bladder neck and the proximal urethra.
  • Re: Penetrating ureteral trauma Letter To The Editor

    Brandes, Steven B.
  • Re: Perineural invasion by transitional cell carcinoma of the bladder in patients submitted to radical cystectomy: what is the prognostic value? Letter To The Editor

    Billis, Athanase
  • Re: Dorsal onlay buccal mucosal graft urethroplasty in long anterior urethral stricture Letter To The Editor

    Perovic, Sava V.
  • Re: Results of novel strategies for treatment of Wilms' tumor Letter To The Editor

    Denes, F. Tibor
  • Re: Prevalence and associated factors of enuresis in Turkish children Letter To The Editor

    Dehoorne, Jo L.
  • Re: Prevalence and associated factors of enuresis in Turkish children Letter To The Editor

    Kajiwara, Mitsuru
  • Re: Surgical technique using AdVance ™ sling placement in the treatment of post-prostatectomy urinary incontinence Letter To The Editor

    Wille, Sebastian
  • Stone disease Urological Survey

    Monga, Manoj
  • Endourology & laparoscopy Urological Survey

    Kim, Fernando J.
  • Imaging Urological Survey

    Prando, Adilson
  • Urogenital trauma Urological Survey

    Brandes, Steven B.
  • Pathology Urological Survey

    Billis, Athanase
  • Investigative urology Urological Survey

    Sampaio, Francisco J.B.
  • Reconstructive urology Urological Survey

    Stenzl, Arnulf; Sievert, Karl-Dietrich
  • Urological oncology Urological Survey

    Bohle, Andreas
  • Neurourology & female urology Urological Survey

    Petrou, Steven P.
  • Pediatric urology Urological Survey

    Snow, Brent W.
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