Corporoplasty using bovine pericardium grafts in complex penile prosthesis implantation surgery

Purpose: This paper is the first, to our knowledge, to propose the use of a bovine pericardium graft in corporoplasty for penile prosthesis implantation. The advantages of bovine pericardium graft have been demonstrated by its use in cardiac surgery, including low cost, biocompatibility, impermeability, resistance to dilatation, flexibility, low likelihood of retraction, absence of antigenic reaction and natural absorption of the tissue. In this paper, we propose the use of this heterologous material graft in corporoplasty for penile prosthesis implantation. Materials and Methods: Five patients with a history of erosion, infection and fibrosis, mean time of follow-up 32 months (range 9-48 months). Bovine pericardium was used to cover large areas of implanted penile prostheses when use of the tunica albuginea was unfeasible. Results: The surgical procedure resulted in no complications in all patients. Conclusions: Bovine pericardium may substitute synthetic and autologous material with the additional advantages of lower cost and greater availability.

Prostatectomia aberta: modificações da técnica de Freyer e retirada precoce da sonda: [carta ao editor] / Opened prostatectomy: modified technical Freyer's prostatectomy and very soon catheter removal: [letter to the editor]

Introdução e objetivos: Prostatectomia transvesical (PTV) é uma operação simples e fácil de ser realizada. Sua principal indicação é no grande adenoma prostático associado ou não à patologia vesical. Realizamos algumas modificações técnicas que permitiram um maior controle do sangramento, alta hospitalar no terceiro dia de pós-operatório e sem sonda vesical. Material e métodos: Entre 2001 e 2005, 102 pacientes com grandes adenomas prostáticos foram submetidos à prostatectomia transvesical suprapúbica modificada pelo mesmo cirurgião. A idade média dos pacientes foi 67,8 anos (59 a 82 anos). O peso médio do adenoma foi 81,5g. A abertura da bexiga na sua região fúndica é pequena o suficiente para passar dois ou três dedos ou um espéculo vaginal tamanho médio. A bexiga é fechada por uma sutura contínua. O fio de categute, por não ultrapassar as camadas da bexiga, evita a comunicação da luz vesical com o espaço de retzius, favorecendo a cicatrização rápida da mucosa vesical. Hemostasia mais eficaz foi obtida com a realização de pontos em ?X? pegando parte da cápsula a partir do colo vesical e aplicados às 3, 5, 7 e 9 horas. Resultados: As modificações descritas permitiram a retirada da sonda no terceiro dia de pós-operatório. Não houve aumento das complicações. Foi diminuído o custo hospitalar e amenizado o sofrimento do paciente com o menor tempo de uso da sonda. Conclusões: A seleção adequada do paciente associada às modificações técnicas adotadas resolveram os dois maiores problemas da PTV: maior tempo de internação e uso da sonda vesical.

Esquistossomose mansônica em vesícula seminal / Schistosomiasis mansoni in the seminal vesicle

Em regiões endêmicas, a esquistossomose mansônica é responsável por uma alta taxa de morbimortalidade por doenças associadas à infestação do sistema hepático. O acometimento genital pela schistosomiasis mansoni é raro. Nós relatamos o primeiro caso de esquistossomose mansônica em vesícula seminal diagnosticado, incidentalmente, pelo exame histopatológico da próstata e vesículas seminais removidos cirurgicamente.

In endemic regions, Mansoni schistosomiasis is responsible for high morbidity-mortality rates due to diseases associated with infestation of the hepatic system. Genital involvement caused by Mansoni schistosomiasis is rare. We report the first case of Mansoni schistosomiasis in the seminal vesicle, which was diagnosed incidentally by means of histopathological study of the prostate and seminal vesicles after surgical removal.

Bovine pericardium in penile prosthesis reimplantation

We present a case of a patient who underwent a late penile prosthesis implant using bovine pericardium as a complement to the tunica albuginea involved in intense fibrosis that destroyed the corpus cavernosum after an infectious manifestation. The advantages of using bovine pericardium in the substitution of the tunica albuginea are discussed and its first use as a penile prosthesis lining is reported.

Comparative study between intravenous urography and renal scintigraphy with DMSA for the diagnosis of renal scars in children with vesicoureteral reflux

PURPOSE: To assess the value of intravenous urography (IVU) in detecting and grading the renal scar, comparing its results with those of scintigraphy with dimercaptosuccinic acid (DMSA). MATERIALS AND METHODS: The study included 43 children investigated by DMSA and IVU, who had vesicoureteral reflux diagnosed and classified through voiding cystourethrography. RESULTS: Among the kidneys with reflux, there was agreement between the results of DMSA and IVU concerning the presence and the absence of scars in 82.4 percent of the cases. Based on the results obtained, IVU would have a sensitivity of 66.6 percent, specificity of 94.4 percent; accuracy of 82.5 percent; positive predictive value (PPV) of 90 percent and negative predictive value (NPV) of 79 percent, when compared with DMSA results. Our data also confirm the close relation between the reflux grade and the presence of renal scar, since 75 percent of the kidneys with grade IV and V reflux presented scars. In relation to the grading of nephropathy, in 78 percent of patients the classification of the scar by both methods was identical. The highest disagreement was verified in the group with segmental scar on DMSA, where 41.6 percent of the kidneys were classified as normal on IVU. CONCLUSION: The data obtained confirm that the scintigraphy with DMSA is essential in the investigation of patients with renal scar, and cannot be replaced by IVU, due to its low sensitivity and lower ability of satisfactory grading.

Etiology of urinary tract infection in scholar children

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 percent) of the 45 children with urinary infection. Among these 39 patients, all had voiding urgency, 30 (77 percent) had urinary incontinence, 12 (31 percent) pollakiuria and 3 (8 percent) presented infrequent voiding. Vaginal discharge was evidenced in 8 (22 percent) girls and phimosis in 2 (22 percent) boys. Obstipation was diagnosed in 10 (22 percent) cases. Significant post-voiding residue was detected in 4 (13 percent) of the 28 cases assessed. Vesicoureteral reflux was evidenced in 5 (19 percent) of the 26 patients who underwent voiding cystourethrogram. In only 2 (4 percent) 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 percent of the patients did not present an apparent urologic cause for the infection.

Duplicidade da bexiga / Double bladder

Os autores apresentam um caso de duplicidade de bexiga e analisam os aspectos embriológicos, diagnósticos, terapêuticos e fazem revisäo da literatura