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International braz j urol, Volume: 29, Número: 5, Publicado: 2003
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  • Priapism: etiology, pathophysiology and management Clinical Urology

    Van Der Horst, C.; Stuebinger, Henrik; Seif, Christoph; Melchior, Diethild; Martínez-Portillo, F.J.; Juenemann, K.P.

    Resumo em Inglês:

    The understanding of erectile physiology has improved the prompt diagnosis and treatment of priapism. Priapism is defined as prolonged and persistent erection of the penis without sexual stimulation and failure to subside despite orgasm. Numerous etiologies of this condition are considered. Among others a disturbed detumescence mechanism, which may due to excess release of contractile neurotransmitters, obstruction of draining venules, malfunction of the intrinsic detumescence mechanism or prolonged relaxation of intracavernosal smooth muscle are postulated. Treatment of priapism varies from a conservative medical to a drastic surgical approach. Two main types of priapism; veno-occlusive low flow (ischemic) and arterial high flow (non-ischemic), must be distinguished to choose the correct treatment option for each type. Patient history, physical examination, penile hemodynamics and corporeal metabolic blood quality provides distinction between a static or dynamic pathology. Priapism can be treated effectively with intracavernous vasoconstrictive agents or surgical shunting. Alternative options, such as intracavernous injection of methylene blue (MB) or selective penile arterial embolization (SPEA), for the management of high and low flow priapism are described and a survey on current treatment modalities is given.
  • Molecular aspects of prostate cancer: implications for future directions Clinical Urology

    Gimba, Etel R. P.; Barcinski, Marcello A.

    Resumo em Inglês:

    Many studies have been developed trying to understand the complex molecular mechanisms involved in oncogenesis and progression of prostate cancer (PCa). Current biotechnological methodologies, especially genomic studies, are adding important aspects to this area. The construction of extensive DNA sequence data and gene expression profiles have been intensively explored to search for candidate biomarkers to evaluate PCa. The use of DNA micro-array robotic systems constitutes a powerful approach to simultaneously monitor the expression of a great number of genes. The resulting gene expressing profiles can be used to specifically describe tumor staging and response to cancer therapies. Also, it is possible to follow PCa pathological properties and to identify genes that anticipate the behavior of clinical disease. The molecular pathogenesis of PCa involves many contributing factors, such as alterations in signal transduction pathways, angiogenesis, adhesion molecules expression and cell cycle control. Also, molecular studies are making clear that many genes, scattered through several different chromosomal regions probably cause predisposition to PCa. The discovery of new molecular markers for PCa is another relevant advance resulting from molecular biology studies of prostate tumors. Interesting tissue and serum markers have been reported, resulting in many cases in useful novelties to diagnostic and prognostic approaches to follow-up PCa. Finally, gene therapy comes as an important approach for therapeutic intervention in PCa. Clinical trials for PCa have been demonstrating that gene therapy is relatively safe and well tolerated, although some improvements are yet to be developed.
  • Can selective retroperitoneal lymphadenectomy be better than unilateral retroperitoneal lymphadenectomy? Clinical Urology

    Arruda, Homero O.; Paula, Adriano A.P.; Suarez, Ruben; Cury, José; Srougi, Miguel

    Resumo em Inglês:

    OBJECTIVE: To propose a new modality of retroperitoneal lymphadenectomy as a complementary treatment for patients with high risk, stage I nonseminomatous testicular tumor. MATERIALS AND METHODS: We studied 76 patients with stage I nonseminomatous testis tumor (T1-T4, NX, M0) treated by orchiectomy and retroperitoneal lymphadenectomy. Among them, 33 patients underwent unilateral retroperitoneal lymphadenectomy (URL) and 43 selective retroperitoneal lymphadenectomy (SRL). URL consisted in removing the lymph nodes located around the great vessel homolateral to the tumor (aorta or vena cava and iliac vessels), and anterior and posterior to the contralateral great vessel (aorta or vena cava). SRL was performed removing the lymph nodes located anterior and between the great vessels (aorta or vena cava) and laterally to the homolateral great vessel, extending the distal dissection until the level of inferior mesenteric artery. In these groups of patients, the incidence of disease recurrence, disease-free survival index, and frequency of post-operative aspermia were assessed. Mean post-operative follow-up time was 96 months. RESULTS: In the SRL group there was only 5% of aspermia versus 79% in the URL group (p < 0.0001). Tumor recurrence was observed in only 5 of the 76 patients and was not related to the surgical technique. The disease-free survival rate after the mean follow-up of 96 months was similar in both groups, being 94% in the SRL group and 93% in the URL group. CONCLUSION: The selective retroperitoneal lymphadenectomy constitutes an effective technique with a lower morbidity than unilateral lymphadenectomy, representing an excellent option for the management of patients with high-risk, stage I nonseminomatous testis tumor.
  • Urodynamic studies in the surgical treatment of benign prostatic hyperplasia Clinical Urology

    Lima, Marcelo L. de; Netto Jr., N. Rodrigues

    Resumo em Inglês:

    OBJECTIVE: We compared the clinical and urodynamic outcome of men with lower urinary tract symptoms with and without previous urodynamic evaluation submitted to transurethral resection of the prostate. MATERIALS AND METHODS: A prospective and randomized study was performed in 315 patients who underwent transurethral resection of the prostate. In 151 patients (group A) with a mean age of 63 years, transurethral resection of the prostate was performed without a prior urodynamic study, and group B, 164 patients with a mean age of 61 years, underwent a urodynamic study prior to surgical procedure. In group B, only obstructed patients were selected for surgery. All patients had I-PSS higher than 15 and underwent at least 2 uroflowmetry and flow was lower than 10 ml/sec. At 6-month follow up, patients in both groups underwent the I-PSS questionnaire and pressure / flow study. RESULTS: The symptomatology and uroflowmetry did not display different behavior between the groups. The mean postoperative score for group A was 8.87 + 3.27 and for group B was 9.32 + 3.14 (p = 0.22). The mean postoperative uroflow for group A was 17.0 + 2.1 mL/s and for group B was 16.6 + 2.2 mL/s (p = 0.15). Postoperative, in group A, 27 patients (17.8%) were obstructed and in group B, 16 patients (9.75%) were obstructed (p = 0.03). CONCLUSION: The study suggests that the previous urodynamic study is not the only factor related to the success of surgical outcome; and therefore, the symptomatology and uroflowmetry associated would be enough during the preoperative routine studies for BPH patients.
  • Digital rectal examination (DRE) does not influence total serum levels of prostate specific antigen (tPSA), in individuals without prostate pathology Clinical Urology

    Figueirêdo, Maria de F.; Lopes, Galeno T.; Naidu, Talapala G.

    Resumo em Inglês:

    OBJECTIVE: To evaluate if the digital rectal examination (DRE) performed before determination of total serum prostate specific antigen (tPSA) influences the levels of this protein. MATERIALS AND METHODS: Forty-eight men without a diagnosis of prostate pathology were assessed for tPSA levels, before and 30 minutes after DRE examination. Values of tPSA in the individuals' serum were measured by the electrochemoluminescence (ECLIA), in Roche's Elecys 1010 analyzer. RESULTS: DRE examination induced a modest elevation in tPSA values in 34 of the 48 men, with a variation in mean elevation from 2.19% in the age range ³ 70 years to 11.96% in the age range of 60-69 years. Additionally, moderate decreases in values were detected in 11 individuals and 3 did not present any alteration following the procedure. Differences in mean values of tPSA, pre- and post-DRE were not statistically significant, neither in the total sample of individuals or in the age range groups. CONCLUSION: DRE examination does not significantly influence the tPSA values in individuals under study.
  • Hemorrhagic shock due to spontaneous rupture of adrenal pheochromocytoma Case Report

    Bittencourt, José A.; Averbeck, Márcio A.; Schmitz, Herbert J.

    Resumo em Inglês:

    The spontaneous rupture of an adrenal pheochromocytoma is an extremely rare event; however, it is potentially fatal. We report a case of spontaneous rupture of pheochromocytoma followed by an extensive retroperitoneal hematoma and hypovolemic shock. The correct diagnostic assessment determined the adequate surgical approach and a favorable outcome for the patient.
  • Urethral metastasis of lung carcinoma with germinative cell features Case Report

    Tefilli, Marcos V.; Stefani, Stephen D.; Mariano, Mirandolino B.

    Resumo em Inglês:

    INTRODUCTION: We present the case of a patient with urethral metastasis of a lung carcinoma with germinative cell features. CASE REPORT: A White, 57-year old man underwent urologic assessment due to gross hematuria. Patient was being treated with chemotherapy and radiotherapy during the past 3 months due to primary carcinoma of the lung with brain metastasis. Urethrocistoscopy and nuclear magnetic resonance imaging revealed a stenosing mass invading the bulbomembranous urethra. No other tumor was found. Biopsy specimens, obtained from the lung, brain and urethra tumors, revealed the same neoplasia, with definitive diagnosis being undifferentiated giant cell carcinoma of the lung with germinative features. Considering his clinical condition and poor prognosis, a decision was made to treat the patient only clinically. Clinical conditions deteriorated and the patient evolved to death within 3 months. COMMENTS: As far as we were able to access, urethral metastasis from lung carcinoma had never been described in the indexed literature. Due to the extremely limited experience with these tumors, there is not a defined treatment and the prognosis remains quite poor.
  • Cystadenoma of the seminal vesicle Case Report

    Gil, Antônio O.; Yamakami, Lucas Y. S.; Genzini, Tércio

    Resumo em Inglês:

    Primary tumors of the seminal vesicle are extremely rare. Among them, there is a spectrum of tumors derived from both epithelium and stroma and so classified as epithelial-stromal tumors. Herein, we report a case of a cystadenoma in a 49-year-old asymptomatic man, detected in a routine ultrasonography for liver disease follow-up. The digital rectal examination detected a large mass anterior to rectum and posterior to bladder. Computed tomography scan and magnetic resonance imaging showed a normal prostate and a 9.0 cm cystic tumor, replacing the left seminal vesicle. The gross appearance and microscopic aspect was compatible with cystadenoma of seminal vesicle. Patient's postoperative recovery was uneventful. He is currently alive, 3 years after the diagnosis, with no signs of recurrence.
  • Glandectomy with preservation of corpora cavernosa in the treatment of penile carcinoma Surgical Technique

    Fonseca, Aluizio G. da; Rabelo, Gilflávio N.; Vidal, Kallene S.M.; Sousa, Fernando J. de

    Resumo em Inglês:

    INTRODUCTION: The objective of this work is to describe a conservative surgical technique as an alternative to classic penile amputations, aiming the local control of the disease, in addition to trying to preserve the patient's sexual function. SURGICAL TECHNIQUE: After a circular incision of the skin around the penis, the subfascial plane is developed until the base of the organ. The dorsal neurovascular bundle and the urethra are isolated in their distal extremities. The neurovascular bundle is sectioned distally. A retrocoronal dissection plane is developed between the glans and the corpora cavernosa. When this stage is complete, the glans is fixed only to the urethra, which is distally sectioned as well. The neurovascular bundle is fixed to the dorsal albuginea. Following the spatulation of the urethra, a neomeatus is created using the overlay skin of the penis. Between January 2001 and July 2002, we employed this technique in 6 patients who had epidermoid carcinoma of the penis, which were limited to the glans, superficial, well or moderately differentiated and measuring up to 3 cm. COMMENTS: Several conservative surgical methods for treatment of carcinoma of the penis aim the organ's preservation, in an attempt of improving the quality of life of patients, however the indexes of local recurrence and failure in disease control are significant. The described technique showed to be safe and effective for disease control, in addition to preserving sexual function in all patients who were treated, representing, thus, a quite appealing conservative surgical alternative in selected cases.
  • Videoendoscopic surgery by extraperitoneal access Surgical Technique

    Tobias-Machado, M.; Juliano, Roberto V.; Gaspar, Heloisa A.; Rocha, Ricardo P.; Borrelli, Milton; Wroclawski, Eric R.

    Resumo em Inglês:

    Laparoscopic surgery in urology is definitely incorporated to the techniques of minimally invasive treatment for urogenital diseases. Though the classic access to organs in the urinary tract is extraperitoneal, this access has not been prioritized when the videoendoscopic technique is used. In Brazil, few groups use this approach and little has been discussed about its true practical applicability. The authors intended to discuss the main technical aspects and criteria for indication, reported though the improvement achieved in a 5-year period with 150 operated cases. A review of the literature shows that the worldly acceptance of the extraperitoneal endoscopic approach is increasing. Nevertheless, there are no evidences that the extraperitoneal access is superior to the transperitoneal route. Thus, the choice depends basically on the surgeon's preference. Major advantages are the immediate access to the renal hilum and isolation of peritoneal structures. Employing this access is useful when one suspects that significant peritoneal adherences could prevent the surgical act or when one wishes to preserve the integrity of the peritoneal cavity.
  • Etiology of urinary tract infection in scholar children Pediatric Urology

    Barroso Jr., Ubirajara; Barroso, Danilo V.; Jacobino, Modesto; Vinhaes, Antonio J.; Macedo Jr., Antonio; Srougi, Miguel

    Resumo em Inglês:

    OBJECTIVE: To prospectively assess the prevalence of vesicourethral dysfunction in children over 3 years old, comparing it with the occurrence rate for other potential factors that cause urinary infection in this age range. MATERIALS AND METHODS: 36 girls and 9 boys were assessed, with mean age of 6.4 years, ranging from 3 to 13.9 years. These children were prospectively assessed regarding the presence of symptoms of lower urinary tract dysfunction. These data were compared with the retrospective assessment of other potential risk factors for urinary infection. Ultrasonography was performed in 28 children and voiding cystourethrogram was performed in 26 patients. RESULTS: Vesicourethral dysfunction was diagnosed in 39 (87%) of the 45 children with urinary infection. Among these 39 patients, all had voiding urgency, 30 (77%) had urinary incontinence, 12 (31%) pollakiuria and 3 (8%) presented infrequent voiding. Vaginal discharge was evidenced in 8 (22%) girls and phimosis in 2 (22%) boys. Obstipation was diagnosed in 10 (22%) cases. Significant post-voiding residue was detected in 4 (13%) of the 28 cases assessed. Vesicoureteral reflux was evidenced in 5 (19%) of the 26 patients who underwent voiding cystourethrogram. In only 2 (4%) cases there was not an apparent cause for the infection. CONCLUSION: Vesicourethral dysfunction is a major cause of urinary infection in children with ages above 3 years old. In cases where voiding dysfunction in not present, other predisposing factors must be assessed. However, only 4% of the patients did not present an apparent urologic cause for the infection.
  • Development of bladder control in mentally handicapped children Urological Neurology

    Bruschini, Homero; Faria, Ney; Garcez, Eliza; Srougi, Miguel

    Resumo em Inglês:

    PURPOSE:To analyze the role of mental handicap as a possible source of lack of development of bladder control and to find out the chance of continence to advise future patients. MATERIALS AND METHODS: The parents and relatives of 100 consecutive mentally handicapped patients were inquired by a personal interview. Questions included the age when they stopped using diapers, enuretic events, frequency, urgency and leakage episodes, urinary infections. Etiology of their mental problem was unknown in 34, perinatal anoxia in 17, Down syndrome in 15, phenylketonuria in 18 and others minors causes. The grade of mental deficiency were profound in 1, severe in 10, moderate in 39, mild in 33 and normal inferior value in 17. The age varied from 7 to 37 years old, with an average of 14 by the time of the interview, comprising 60 males and 40 females. RESULTS: All profound and severe patients presented leakage episodes regardless of the age. The mild and normal inferior value acquired progressive urinary control with aging, and 33% still remain with urinary symptoms above 16 years old. Urinary infection was similar in males and females, around 29%. The most committed group presented less urinary infections. The etiology of the mental handicap was not correlated to the incidence of urinary leakage. CONCLUSIONS: The lack of bladder control was correlated to the grade of mental handicap. In severe and profound groups, the expectancy of control is disappointing. In the less compromised groups, there is a delay in bladder training, with achievement of control in 2/3 after 16 years of age. Those in the normal inferior value have a chance of postponed urinary control, easily misdiagnosed by normal urological interviews.
  • Stone disease Urological Survey

    Pearle, Margaret S.
  • Endourology & laparoscopy Urological Survey

    Wolf Jr., J. Stuart
  • Imaging Urological Survey

    Prando, Adilson
  • Urogenital trauma Urological Survey

    Santucci, Richard A.
  • Pathology Urological Survey

    Billis, Athanase
  • Investigative urology Urological Survey

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

    Stenzl, Arnulf
  • Urological oncology Urological Survey

    Böhle, Andreas
  • Female urology Urological Survey

    Petrou, Steven P.
  • Pediatric urology Urological Survey

    Kogan, Barry A.
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