ABSTRACT
ABSTRACT Objectives: To evaluate the lower urinary tract symptoms, classified by the International Prostate Symptom Score (IPSS), urodynamic results (Watts Factor (WF), Bladder Contractility Index (BCI), and post void residual (PVR), in order to differentiate Detrusor Underactivity (DU) from Bladder Outlet Obstruction (BOO). Methods: Retrospective observational study performed from 2011 to 2018 at the Hospital das Clínicas of Unicamp. Two phases were done: first, to estimate sample size, and second, to evaluate the predicted parameters. Male patients with range age from 40 to 80 years were included. Patients were divided into two groups: Group 1, without BOO and with DU; Group 2, with BOO. Variables analyzed: age, comorbidities, symptoms, urodynamic data (BCI and WF) and PVR. Results: Twenty-two patients were included in each group, with medians of 68 (Group 1) and 67.5 years old (Group 2) (p = 0.8416). There was no difference for comorbidities. In relation to IPSS, medians were: 16.5 and 20.5, respectively (p = 0.858). As for symptoms, there was predominance of combination of storage and voiding symptoms in the two groups (p = 0.1810). Regarding PVR, 15 patients in Group 1 and 16 in Group 2 presented PVR> 30mL (p = 0.7411). BCI presented median values of 75 and 755.50 for Group 1 and Group 2, respectively (p <0.0001), while WF had medians of 22.42 and 73.85 (p <0.0001). Conclusion: Isolated symptoms, classified by IPSS and PVR, could not differentiate patients with DU from those with BOO, but it was possible using urodynamic data.
Subject(s)
Humans , Male , Aged , Urinary Bladder Neck Obstruction , Urodynamics , Retrospective Studies , Lower Urinary Tract Symptoms , Urinary Bladder, UnderactiveABSTRACT
ABSTRACT Objective: To propose a new way to objectively evaluate the external sphincter function prior to male sling surgery. Materials and Methods: We evaluated the pre-operative sphincter function throughout sphincter pressure at rest (SPAR) and sphincter pressure under contraction (SPUC) obtained throughout urethral profilometry profile (UPP) of 10 consecutive patients (age range, 54-79 years) treated with the retrourethral transobturator sling (RTS) for stress urinary incontinence (SUI) because of prostate surgery. The primary endpoint for surgery success rate was post-operative pad weight test. This was correlated to pre-operative pad test, RT, SPAR and SPUC. Post-operatively patients were classified as continent (no pad use) and those who still were incontinent. Results: Mean SPUC in the continent and incontinent group was respectively 188 + 8.8 (median 185.1, range 181 to 201) and 96.9 + 49.4 (median 109.9, range 35.6 to 163.6) (P = 0.008). Mean 24-hour pad test was 151 + 84.2gm (median 140, range 80 to 245) and 973 + 337.1gm (median 1940, range 550 to 1200) in post-operative continent and incontinent groups respectively (P = 0.008). The repositioning test (RT) was positive in all continent patients except one. The RT was also positive in three incontinence patients (false positive). In all post-operative continent patients SPUC was higher than 180cmH2O and pre-operative pad test was less than 245gm. Conclusions: SPUC seems to be a way for optimizing the sphincter evaluation as well to become a useful tool for patient selection prior to RTS surgery.
Subject(s)
Humans , Male , Aged , Prostatectomy/adverse effects , Urinary Incontinence, Stress/etiology , Urinary Sphincter, Artificial/adverse effects , Esophageal Sphincter, Lower/physiology , Suburethral Slings/adverse effects , Postoperative Period , Urinary Incontinence, Stress/surgery , Follow-Up Studies , Middle AgedABSTRACT
Abstract Objective To compare the results of the standard urotherapy alone and associated with pelvic floor muscle training alone, and in combination with oxybutynin in treatment of nonmonosymptomatic nocturnal enuresis. Methods A total of 38 children aged 5 to 10 years were randomized into three groups: Group I (n=12) that was submitted to standard urotherapy; Group II (n=15), standard urotherapy associated with pelvic floor muscle training; and Group III (n=11), standard urotherapy associated with pelvic floor muscle training and oxybutynin; the treatment lasted 12 weeks. The assessment tools used were playful bladder diary, and a 48-hour bladder diary, before and after treatment. After 2 years, patients were assessed by telephone using a standardized questionnaire. Results The data of children from the three groups were homogeneous at baseline. After 12-week treatment, all children showed improved symptoms and signs of nonmonosymptomatic nocturnal enuresis, but the differences were not significant among the groups. After 2 years, the three groups showed maintenance of treatment results, but no differences among them. Conclusion All treatment modalities were effective regarding improved enuresis and lower urinary tract symptoms, but the sample was not large enough to show differences among groups.
Resumo Objetivo Comparar os resultados da uroterapia padrão isolada e associada ao treinamento dos músculos do assoalho pélvico isoladamente e em combinação com a oxibutinina no tratamento da enurese noturna não monossintomática. Métodos Trinta e oito crianças entre 5 e 10 anos de idade foram randomizadas em três grupos: Grupo I (n=12) realizou uroterapia padrão; Grupo II (n=15) realizou uroterapia padrão associada ao treinamento muscular do assoalho pélvico; e Grupo III (n=11) realizou uroterapia padrão associada ao treinamento muscular do assoalho pélvico e oxibutinina. O tratamento teve duração de 12 semanas. Os instrumentos de avaliação foram diário miccional lúdico e diário miccional de 48 horas, antes e depois do tratamento. Após 2 anos, os pacientes foram avaliados por telefone, usando um questionário padronizado. Resultados Os dados das crianças dos três grupos eram homogêneos no início do estudo. Após 12 semanas de tratamento, todas as crianças apresentaram melhora em relação aos sinais e sintomas de enurese noturna não monossintomática, mas as diferenças não foram significativas entre os grupos. Depois de 2 anos, os resultados do tratamento se mantiveram nos três grupos, mas não houve diferenças entre os grupos. Conclusão As três modalidades de tratamento foram eficazes na melhora da enurese e dos sintomas do trato urinário inferior, mas o tamanho da amostra não foi grande o suficiente para mostrar diferenças entre os grupos.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Urinary Incontinence , Pelvic Floor/physiology , Exercise Therapy/methods , Nocturnal Enuresis/therapy , Urological Agents/therapeutic use , Mandelic Acids/therapeutic use , Urinary Incontinence/physiopathology , Brazil , Surveys and Questionnaires , Treatment Outcome , Combined Modality Therapy , Nocturnal Enuresis/physiopathology , Muscle Strength/physiology , Muscle Contraction/physiologyABSTRACT
ABSTRACT Objective To prospectively compare the results of intradetrusor onabotulinumtoxinA injections and oral oxybutynin for urinary continence, urodynamic parameters and quality of life in patients with neurogenic detrusor overactivity due to spinal cord injury. Methods Adult patients under intermittent catheterization were randomized 1:1 to receive one injection of onabotulinumtoxinA 300U or oxybutynin 5mg, per oris, three times/day. Primary study endpoint was change in urinary incontinence episodes/24 hours and secondary study endpoints were maximum cystometric capacity, maximum detrusor pressure, bladder compliance and quality of life before randomization and at week 24. Results Sixty-eight patients participated in the trial. Significant improvements in urinary incontinence per 24 hours, all investigated urodynamic parameters and quality of life were observed in both groups. Compared with oral oxybutynin, onabotulinumtoxinA was significantly more efficacious for all parameters investigated. Non-response to treatment was higher for oral oxybutynin (23.5%) than onabotulinumtoxinA (11.8%). Dry mouth was the most common adverse in patients with oral oxybutynin (72%) and transient macroscopic hematuria in patients with onabotulinumtoxinA (28%). Only one patient with oral oxybutynin dropped out the study because of adverse effects. Conclusion The comparison of the two study drugs showed that onabotulinumtoxinA was significantly more efficacious than oral oxybutynin with regard to continence, urodynamic parameters and quality of life. Clinicaltrials.gov: NCT:01477736.
RESUMO Objetivo Comparar prospectivamente os resultados de injeções intradetrusoras de onabotulinumtoxinA e oxibutinina oral em pacientes com hiperatividade neurogênica do detrusor devido à lesão da medula espinhal, para avaliar a continência urinária, os parâmetros urodinâmicos e a qualidade de vida. Métodos Pacientes adultos em cateterismo intermitente foram randomizados 1:1 para tratamento com uma injeção de onabotulinumtoxinA 300U ou oxibutinina 5mg via oral, três vezes por dia. O desfecho primário foi alteração nos episódios de incontinência urinária em 24 horas, e os secundários foram capacidade cistométrica máxima, pressão máxima do detrusor, complacência vesical e qualidade de vida antes da randomização e na 24ª semana. Resultados Participaram do estudo 68 pacientes. Observou-se melhora significativa na incontinência urinária por 24 horas em todos os parâmetros urodinâmicos investigados e na qualidade de vida em ambos os grupos. Em comparação com a oxibutinina oral, a onabotulinumtoxinA foi significativamente mais eficaz para todos os parâmetros investigados. A falha no tratamento foi maior para oxibutinina oral (23,5%) em comparação com onabotulinumtoxinA (11,8%). A boca seca foi o evento adverso mais comum em pacientes tratados com oxibutinina oral (72%), e a hematúria macroscópica transitória naqueles tratados com onabotulinumtoxinA (28%). Apenas um paciente tratado com oxibutinina oral interrompeu o estudo por conta dos efeitos adversos. Conclusão A comparação dos dois fármacos do estudo mostrou que onabotulinumtoxinA foi significativamente mais eficaz que oxibutinina oral em relação a continência, parâmetros urodinâmicos e qualidade de vida. Clinicaltrials.gov: NCT:01477736.
Subject(s)
Humans , Male , Female , Adult , Spinal Cord Injuries/complications , Urinary Bladder, Neurogenic/drug therapy , Botulinum Toxins, Type A/administration & dosage , Urinary Bladder, Overactive/drug therapy , Acetylcholine Release Inhibitors/administration & dosage , Mandelic Acids/administration & dosage , Quality of Life , Urinary Bladder/drug effects , Urinary Bladder, Neurogenic/etiology , Administration, Oral , Prospective Studies , Follow-Up Studies , Treatment Outcome , Urinary Bladder, Overactive/etiology , Injections, IntramuscularABSTRACT
OBJECTIVE: To verify and compare the results of behavioral modification plus pelvic floor muscle training and behavioral modifications plus oxybutynin chloride in children with nonmonosymptomatic enuresis. METHODS: A total of 47 children were randomized using opaque and sealed envelopes sequentially numbered. Group I was composed of 21 children who underwent antimuscarinic treatment (oxybutynin), and Group II was composed of 26 patients who underwent pelvic floor muscle training. Both groups were instructed as to behavioral modifications. RESULTS: The voiding diary results were compared each month between Groups I and II. In the first month of treatment, children in Group I presented 12.2 dry nights, 13.4 in the second month, and 15.9 in the last month. In Group II, the results were: 14.9 dry nights in the first month, 20.8 dry nights in the second and 24.0 dry nights in the last month. There was a significant difference between the groups in second and third months. CONCLUSION: Pelvic floor exercises associated with behavioral changes were more effective than pharmacological treatment in children with urinary incontinence.
OBJETIVO: Verificar e comparar os resultados da modificação comportamental associado ao treinamento dos músculos do assoalho pélvico e modificação comportamental associado ao uso de cloridrato de oxibutinina em crianças com enurese não monossintomática. MÉTODOS: Foram randomizadas 47 crianças por meio de envelopes opacos e selados com numeração sequencial. O Grupo I foi composto por 21 crianças que receberam tratamento com antimuscarínico (oxibutinina) e o Grupo II por 26 pacientes que receberam treinamento dos músculos do assoalho pélvico. Ambos os grupos foram instruídos em relação à modificação comportamental. RESULTADOS: Os resultados do diário miccional foram comparados cada mês entre os Grupos I e II. No primeiro mês de tratamento, as crianças do Grupo I apresentaram 12,2 noites secas, 13,4 no segundo mês e 15,9 no último mês. No Grupo II, os resultados foram: 14,9 noites secas no primeiro mês, 20,8 no segundo mês e 24,0 no último mês. Houve diferença significativa entre os grupos no segundo e no terceiro mês. CONCLUSÃO: Os exercícios do assoalho pélvico associados a mudança comportamental foram mais efetivos do que o tratamento farmacológico em crianças com incontinência urinária.
Subject(s)
Enuresis , Physical Therapy Modalities , Urinary IncontinenceABSTRACT
O objetivo deste estudo foi traduzir e adaptar à cultura brasileira os instrumentos The O'Leary-Sant e PUF, utilizados no diagnóstico de cistite intersticial. Foram realizadas as etapas metodológicas recomendadas pela literatura internacional para a adaptação cultural. As etapas de tradução, síntese das traduções e retrotradução foram realizadas satisfatoriamente, e a avaliação das versões sintéticas pelo comitê de especialistas resultou em algumas alterações, assegurando as equivalências entre as versões originais e traduzidas. O PUF foi pré-testado entre 40 sujeitos e The O'Leary-Sant em uma amostra de 50 indivíduos, devido à necessidade de ajustes em decorrência da baixa escolaridade da população. O processo de tradução e adaptação foi realizado com sucesso e os instrumentos, após as modificações, demonstraram ser de fácil compreensão e rápido preenchimento. Entretanto, este é um estudo que antecede o processo de validação e será premente o emprego do instrumento em novas pesquisas para que sejam avaliadas suas propriedades psicométricas.
The aim of this study was to translate and adapt the instruments known as The O'Leary-Sant and PUF to the Brazilian culture used in the diagnosis of interstitial cystitis. We followed the methodological steps recommended by the international literature for cultural adaptation. The steps of translation, synthesis of translations and back translation were performed satisfactorily and evaluation the versions of the synthesis by the panel of experts has resulted in some changes, ensuring the equivalence between the original and translated versions. The PUF was pretested among 40 subjects and The O'Leary-Sant in a sample of 50 individuals due to the need for adjustments due to the low education population. The translation and adaptation process was successful and the instruments, after some modifications, proved easy to understand and complete quickly. However, this is a study prior to the validation process and will be promoting the use of the instrument in new research to assess its measurement properties.
Se objetivó traducir y adaptar a la cultura brasileña los instrumentos The O'Leary-Sant y PUF, utilizados para diagnosticar cistitis intersticial. Fueron efectuadas las etapas metodológicas recomendadas por la literatura internacional para adaptación cultural. Las etapas de traducción, síntesis de traducciones y retrotraducción se realizaron satisfactoriamente, la evaluación de las versiones sintetizadas por parte del comité de especialistas derivó en algunas alteraciones, asegurando las equivalencias entre versiones originales y traducidas. El PUF fue pre-testeado con 40 sujetos y The O'Leary-Sant en muestra de 50 individuos, por la necesidad de ajustes derivados de la baja escolarización de la población. El proceso de traducción y adaptación se efectuó con suceso y los instrumentos luego de las modificaciones demostraron ser de sencilla comprensión y rápido completado. Sin embargo, este estudio es previo al proceso de validación, será imprescindible el uso del instrumento en nuevas investigaciones para evaluar sus propiedades psicométricas.
Subject(s)
Humans , Cystitis, Interstitial/diagnosis , Surveys and Questionnaires , Brazil , Cultural Characteristics , TranslationsABSTRACT
Purpose Recently, the effect of phosphodiesterase inhibitors (PDE5i) in the lower urinary tract symptoms (LUTS) associated to benign prostatic hyperplasia have been studied thoroughly. However, it remains unclear how the PDE5i improve LUTS. Therefore, the aim of the present study was to evaluate the potential of acute administration of the PDE5i sildenafil to improve detrusor overactivity (DO) induced by Nω-nitro-L-arginine methyl ester hydrochloride (L-NAME), an nitric oxide sinthase (NOS) inhibitor, in rats. Materials and Methods Twenty-seven MALE adult Wistar Rats were divided into the following groups: (1) control, (2) L-NAME, (3) sildenafil alone, and (4) L-NAME + sildenafil. The NOS blocker L-NAME (20 mg/rat/day) was given in the drinking water. Sildenafil (100µg/kg) was administrated intravenously (i.v.) acutely, diluted in cremophor, propylene glycol and water. All animals underwent to anesthetized cystometograms. Results The chronic and systemic administration of L-NAME markedly increased the number of non voiding contractions (2.62 (± 0.89)), and frequency of micturition (1.97 (± 0.78)), as well increased volume threshold (2.83 mL (± 1.64)) compared with control group, the number of non voiding contractions (1.17 (± 0.75)), frequency of micturition (1.08 (± 0.65)) and volume threshold (1.16 mL (± 0.38)), p < 0.001, p = 0.01, and p = 0.04, respectively. Sildenafil infusion decreased the number of micturition cycles significantly from the baseline to end point (-0.93 (± 0.34)) in nitric oxide (NO) deficient animals compared with sildenafil infusion alone (control) in animals with normal NO level (0.13 (± 0.25)), p = 0.03. Conclusion Systemic reduction of nitric oxide causes detrusor overactivity and acute infusion of sildenafil reduces the number of micturition cycles in chronic NO-deficient rats. .
Subject(s)
Animals , Male , Rats , Nitric Oxide/deficiency , Phosphodiesterase Inhibitors/administration & dosage , Piperazines/administration & dosage , Sulfones/administration & dosage , Urinary Bladder, Overactive/drug therapy , NG-Nitroarginine Methyl Ester/administration & dosage , Nitric Oxide Synthase/antagonists & inhibitors , Phosphodiesterase Inhibitors/pharmacology , Piperazines/pharmacology , Purines/administration & dosage , Purines/pharmacology , Random Allocation , Rats, Wistar , Sulfones/pharmacology , Urinary Bladder, Overactive/etiology , Urination/drug effectsABSTRACT
The aim was to identify and analyze studies on the quality of life and life experiences of men with urinary incontinence. Through critical review of the literature, data were analyzed using content analysis technique based on psychodynamic references. The results were grouped into two themes: Psychosocial lived experience aspects of men with urinary incontinence; Men's lived experience in the management of urinary incontinence. Men with urinary incontinence experienced a low self-image along with a sense of social stigma associated to the image of a deteriorated body. Seeking treatment when the incontinence is mild and making use of psychological and social mechanisms to adapt to the urinary incontinence. The study shows that incontinent men to have low expectation regarding treatment due to the lack of knowledge about existing therapies and strategies to urinary loss control.
O objetivo foi identificar e analisar estudos sobre a qualidade de vida e vivência de homens com incontinência urinária. Por meio de revisão crítica da literatura, os dados foram tratados pela técnica de análise do conteúdo e analisados com base nos referenciais psicodinâmicos. Os resultados foram agrupados em dois temas: Aspectos psicossociais vivenciados por homens com incontinência urinária e Vivência dos homens no manejo da incontinência urinária. Os homens com incontinência urinária vivenciam sentimentos de estigma social associados à imagem de um corpo deteriorado. Procuram tratamento quando a incontinência é leve e buscam mecanismos psicológicos e sociais para se adaptarem à incontinência urinária. O estudo mostrou que os homens incontinentes tem baixa expectativa em relação ao tratamento devido à falta de conhecimento sobre as terapias existentes e das estratégias para controlar perda urinária.
El objetivo fue identificar y analizar estudios sobre la calidad de vida y experiencias de hombres con incontinencia urinaria. Para la revisión crítica de la literatura, los datos fueron tratados con la técnica de análisis de contenido y analizados en las referencias psicodinámicas. Los resultados se agruparon en dos temas: Aspectos psicosociales vividos por hombres con incontinencia urinaria; La experiencia de los hombres en manejar la incontinencia urinaria. Los hombres incontinentes viven con sentimientos de estigma asociados con imagen de un cuerpo deteriorado. Buscan tratamiento cuando la incontinencia es pequeña y buscan mecanismos psicológicos y sociales para adaptarse a incontinencia. El estudio muestra que los hombres incontinentes tienen bajas expectativas cuanto a tratamiento debido a la falta de conocimiento sobre las terapias existentes y las estrategias para controle de la pierda de orina.
Subject(s)
Humans , Male , Prostatectomy , Urinary Incontinence , Review Literature as Topic , Nursing , Men's HealthABSTRACT
OBJECTIVES: Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis is currently associated with great operative difficulty and surgical complications. Herein, we report on our single-center experience and describe predictive factors for successfully accomplishing this procedure. METHOD: Between March 1998 and April 2010, 66 patients (27 men and 39 women) underwent laparoscopic nephrectomy for the treatment of a unilateral nonfunctioning kidney. These patients had previous diagnoses of renal chronic inflammation associated with calculi and previous pyonephrosis. All of the nephrectomies were performed using the transperitoneal approach, and a similar technique was used for radical nephrectomy. RESULTS: Laparoscopic nephrectomy for the treatment of renal chronic inflammation was successful in 58/66 cases (87.9%). Eight cases were converted to the open technique because of difficulty in progression, which was related to the discovery of dense adhesions in the hilar or perirenal region. One major (colonic lesion) and two minor (wound infection) complications occurred in the conversion group. A diagnosis of xanthogranulomatous pyelonephritis was confirmed pathologically for all of the specimens. Of the factors examined, a longitudinal renal length greater than 12 cm (laparoscopy group - 7.2±1.8 cm, versus open group - 13.6±1.5 cm; p<0.05) and time to access the renal vessels (laparoscopy group - 32±18 min, versus open group - 91±11 min; p<0.05) were associated with a higher conversion rate. Although the number of patients in the conversion group was small, the majority of these patients received right-sided nephrectomy. CONCLUSIONS: Laparoscopic nephrectomy for the treatment of xanthogranulomatous pyelonephritis is feasible and associated with low levels of morbidity. Factors including the time required to control the renal vessels, renal length and right-sided nephrectomy were associated with higher chances of conversion into an open procedure.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Laparoscopy/methods , Nephrectomy/methods , Pyelonephritis, Xanthogranulomatous/surgery , Conversion to Open Surgery/statistics & numerical data , Feasibility Studies , Laparoscopy/adverse effects , Nephrectomy/adverse effects , Operative Time , Treatment OutcomeABSTRACT
OBJECTIVE: Lymphocele formation following renal transplantation is a frequent complication and may affect as many as 49% of patients. Operative treatment of symptomatic post transplant lymphocele (PTL) consists of wide drainage of the fluid collection into the abdominal cavity by excising its wall, connecting the lymphocele cavity to the intraperitoneal space. Laparoscopic fenestration seems to be the best treatment as it combines satisfying success rates with a minimally invasive approach. The aim of the study was to review a single center experience on the laparoscopic treatment of symptomatic PTL and detail relevant aspects of the surgical technique. MATERIALS AND METHODS: The data of 25 patients who underwent laparoscopic surgical treatment for a symptomatic lymphocele following kidney transplantation were retrospectively reviewed. Demographic data and surgical results were assessed. Detailed surgical technique is provided. RESULTS: Between 1996 and 2008, 991 patients received a kidney transplant at our institution. Twenty-five patients (2.52%) developed a symptomatic lymphocele and laparoscopic drainage was performed. The indications for surgical drainage were graft dysfunction (84%), local symptoms (16%) or both (32%). The mean time until surgical therapy was 14.2 ± 6 weeks. Mean hospital stay was 1.5 ± 0.2 days. Postoperative complications occurred in only 2 patients (8%) (one ureteral injury and one incisional hernia) and required reoperation. After a mean follow-up of 36.2 ± 4 months, only 1 patient had a symptomatic recurrence. CONCLUSIONS: Laparoscopic fenestration is an effective surgical technique to treat symptomatic lymphocele following kidney transplantation with low recurrence rate and long standing results.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Kidney Transplantation/adverse effects , Laparoscopy/methods , Lymphocele/surgery , Drainage , Lymphocele/etiology , Perioperative Period , Treatment OutcomeABSTRACT
OBJECTIVE: To compare pelvic floor muscle training and a sham procedure for the treatment of lower urinary tract symptoms and quality of life in women with multiple sclerosis. METHODS: Thirty-five female patients with multiple sclerosis were randomized into two groups: a treatment group (n = 18) and a sham group (n = 17). The evaluation included use of the Overactive Bladder Questionnaire, Medical Outcomes Study Short Form 36, International Consultation on Incontinence Questionnaire Short Form, and Qualiveen questionnaire. The intervention was performed twice per week for 12 weeks in both groups. The treatment group underwent pelvic floor muscle training with assistance from a vaginal perineometer and instructions to practice the exercises daily at home. The sham group received a treatment consisting of introducing a perineometer inside the vagina with no exercises required. Pre- and post-intervention data were recorded. RESULTS: The evaluation results of the two groups were similar at baseline. At the end of the treatment, the treatment group reported fewer storage and voiding symptoms than the sham group. Furthermore, the differences found between the groups were significant improvements in the following scores in the treatment group: Overactive Bladder Questionnaire, International Consultation on Incontinence Questionnaire Short Form, and the General Quality of Life, and Specific Impact of Urinary Problems domains of the Qualiveen questionnaire. CONCLUSIONS: The improvement of lower urinary tract symptoms had a positive effect on the quality of life of women with multiple sclerosis who underwent pelvic floor muscle training, as the disease-specific of quality of life questionnaires demonstrated. This study reinforces the importance of assessing quality of life to judge the effectiveness of a treatment intervention.
Subject(s)
Adult , Female , Humans , Exercise Therapy/methods , Multiple Sclerosis/complications , Muscle Contraction/physiology , Pelvic Floor/physiology , Quality of Life , Urination Disorders/therapy , Analysis of Variance , Prospective Studies , Statistics, Nonparametric , Surveys and Questionnaires , Urination Disorders/physiopathologyABSTRACT
Objective: to evaluate the protective effects of BAY 41-2272, a soluble guanylate cyclase activator, on changes in cystometric parameters in rats deficient in nitric oxide (NO). Methods: Rats were divided into the following groups: (a) control; (b) DMSO; (c) L-NAME; (d) BAY 41-2272 alone; (e) L-NAME + BAY 41-2272. The NO synthase blocker L-NAME (20 mg/rat/day) was given in drinking water concomitantly or not with BAY 41-2272 (10 mg/kg/day, given by gavage). Results: Chronic L-NAME treatment markedly increased the mean arterial blood pressure, and co-treatment with BAY 41-2272 nearly reversed L-NAME-induced rise on mean arterial blood pressure. Non-void contractions were significantly increased in L-NAME group (0.90 ± 0.1 number/minute) compared with either DMSO or control group (0.49 ± 0.1 number/minute), which were prevented by co-treatment with BAY 41-2272 (0.56 ± 025 number/minute; p < 0.05). The threshold and peak pressure increased by 70 and 44%, respectively, after chronic L-NAME treatment, while co-treatment with BAY 41-2272 largely attenuated both effects (27 and 22% increase, respectively). The frequency of micturition cycles decreased by about of 50% in L-NAME-treated rats compared with control animals, and co-treatment with BAY 41-2272 normalized this parameter. Conclusions: Our data show that long-term oral administration of BAY 41-2272 counteracts the bladder dysfunction seen in NO-deficient rats, indicating that restoration of the NO-cGMP pathway by this compound may be of beneficial value to treat bladder symptoms.
Objetivo: avaliar os efeitos protetores do BAY 41-2272, um ativador solúvel da guanilato ciclase, sobre alteração dos parâmetros citométricos em ratos deficientes de óxido nítrico (NO). Métodos: os ratos foram divididos nos seguintes grupos: (a) controle; (b) DMSO (c) L-NAME; (d) BAY 41-2272 isolado; (e) L-NAME + BAY 41-2272. O bloqueador da NO-sintase L-NAME (20 mg/rato/dia) foi ministrado na água de beber, concomitantemente ou não com o BAY 41-2272 (10 mg/kg/dia, ministrado por gavagem). Resultados: o tratamento crônico com L-NAME aumentou de forma acentuada a pressão arterial média, e o co-tratamento com BAY 41-2272 quase reverteu o aumento na pressão arterial média induzido por L-NAME. Contrações não esvaziadoras da bexiga mostraram-se significativamente aumentadas no grupo L-NAME (0,90 ± 0,1 número/minuto) comparadas com DMSO ou grupo controle (0,49 ± 0,1 número/minuto), que foram evitadas pelo co-tratamento com BAY 41-2272 (0,56 ± 0,25 número/minuto; p < 0,05). O limiar e o pico de pressão aumentaram em 70 e 44%, respectivamente, após o tratamento crônico com L-NAME, enquanto o co-tratamento com BAY 41-2272 atenuou muito ambos os efeitos (27 e 22% de aumento, respectivamente). A frequência de ciclos de micção diminuiu em 50% nos ratos tratados com L-NAME em comparação aos animais controle; o cotratamento com BAY 41-2272 normalizou esse parâmetro. Conclusões: nossos dados mostram que a administração oral a longo prazo de BAY 41-2272 contrapõe-se à disfunção de bexiga vista em ratos deficientes de NO, o que sugere que a restauração da via da NO-cGMP por esse composto pode ter valor benéfico para tratar sintomas vesicais.
Subject(s)
Rats , Guanylate Kinases , Nitric Oxide , Urinary Bladder, OveractiveABSTRACT
Objective: To evaluate the impact of gait training with neuromuscular electrical stimulation on urodynamic parameters of patients with neurogenic bladder. Methods: Eight male quadriplegic patients with complete cervical injury level ranging from C4 to C7 comprised the study population. They underwent treadmill gait training with neuromuscular electrical stimulation for six months, only after having their quadriceps and tibialis anterior muscles stimulated for five months in order to support at least 50% of their body weight (pre-gait training). Urodynamic testing was performed before the treadmill gait training and six months after. Results: The mean time after cervical lesion was 74.63 months. The urodynamic parameters before and after neuromuscular training by electrical stimulation did not show significant difference. Conclusion: This study demonstrated that neuromuscular training with electrical stimulation can benefit the urinary tract. This promising minimally invasive requires further and more complete studies to confirm a possible benefit to the low urinary tract.
Objetivo: Avaliar o impacto do treinamento neuromuscular, por estimulação elétrica da marcha, nos parâmetros urodinâmicos de pacientes com bexiga neurogênica. Métodos: A população do estudo compreendeu oito pacientes quadriplégicos do sexo masculino com lesão cervical completa nos níveis C4 a C7. Eles foram submetidos a um treinamento neuromuscular por estimulação elétrica da marcha por seis meses, somente após estimulação dos músculos quadríceps e tibial anterior, por cinco meses, de modo a poder suportar 50% de seu peso corporal (pré-treinamento). Testes urodinâmicos foram feitos antes do treinamento e seis meses depois. Resultados: O tempo médio após a lesão cervical foi de 74,63 meses. Os parâmetros urodinâmicos antes e depois do treinamento neuromuscular por estimulação elétrica da marcha não mostraram diferença significante. Conclusão: Este estudo mostrou que o treinamento neuromuscular com estimulação elétrica pode ser benéfico para o trato urinário. Esse campo, promissor e minimamente invasivo, requer outros estudos mais completos para confirmar um possível benefício no trato urinário inferior.
ABSTRACT
OBJECTIVE: Pressure-flow study is the gold standard for diagnosis of bladder outlet obstruction (BOO). A prospective study was carried out to compare urodynamic evaluation and measurement of intravesical protrusion of the prostate for diagnosing BOO. MATERIALS AND METHODS: Patients presenting with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia and suspected BOO were prospectively evaluated through conventional urodynamics and classified according to the bladder outlet obstruction index (BOOI). They also underwent abdominal ultrasound measurement of the intravesical prostatic protrusion (IPP) and prostatic volume. The IPP was classified into three stages: grade I under 5 mm; grade II, between 5 and 10 mm; and grade III over 10 mm. RESULTS: Forty-two patients, mean age 64.8 ± 8.5 years were enrolled. Transabdominal ultrasound determined a mean prostatic volume of 45 ± 3.2 mL. Achieved IPP's values were the following: grade I - 12 (28.5 percent), grade II - 5 - (12 percent) and grade III - 25 (59.5 percent). The results of prostate volume differed significantly between obstructed and non-obstructed men (p = 0.033) and for IPP among obstructed, inconclusive and non-obstructed men (p = 0.016). For IPP, the area under ROC curve was 0.758 (95 percent confidence interval - 0.601 to 0.876), and the cutoff point to indicate BOO was 5 mm with 95 percent sensitivity (75.1 - 99.2) and 50 percent specificity (28.2 - 71.8). CONCLUSION: IPP and prostatic volume measured through abdominal ultrasound are noninvasive and accessible methods that significantly correlate to urinary BOO, and are useful in the diagnosis of male urinary obstructive problems.
Subject(s)
Aged , Humans , Male , Middle Aged , Prostatic Hyperplasia , Urinary Bladder Neck Obstruction/diagnosis , Predictive Value of Tests , Prospective Studies , Prostatic Hyperplasia/complications , Sensitivity and Specificity , Urodynamics , Urinary Bladder Neck Obstruction/etiology , Urinary Bladder Neck ObstructionABSTRACT
OBJECTIVE: To evaluate the reliability and responsiveness (internal and external) of the Portuguese version of the ICIQ-SF. We assessed the responsiveness of the ICIQ-SF after surgical procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: Prospective open label study in 2 tertiary referral centers. Sixty-one patients of both genders (54 female and 7 male) were enrolled. Patients were treated using surgical procedures, mostly with synthetic sling (82 percent). Patients were assessed before surgery and at least 1 month postoperatively using the ICIQ-SF in its translated and validated Portuguese version. Patients also underwent pre-operative urodynamic tests, Stamey incontinence grading and pad usage assessments. After surgery, patients underwent stress tests, Stamey incontinence grading and pad usage assessments. RESULTS: The mean age was 57.2 (± 11.6) years and the mean duration of follow-up was 7.2 months (± 4.5). Objective parameters such as urodynamic tests (by means of VLPP) and pad usage had significant correlation with changes in post-treatment scores on the ICIQ-SF (p = 0.0062 and p < 0.0001 respectively). The responsiveness expressed in terms of standardized effect sizes (SES) and standardized response means (SRM) was large for both questionnaires (p < 0.0001). CONCLUSION: The results showed high responsiveness (large effect sizes I and II) for the Portuguese version of the ICIQ-SF, indicating that this instrument is suitable for measuring outcomes in clinical trials for Brazilian patients with stress urinary incontinence.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Surveys and Questionnaires/standards , Translating , Urinary Incontinence, Stress/surgery , Brazil , Follow-Up Studies , Postoperative Period , Prospective Studies , Reproducibility of ResultsABSTRACT
INTRODUCTION: Renal cell carcinoma with thrombus in the inferior vena cava and no apparent metastasis requires immediate surgical treatment. Over the last few years, extracorporeal circulation with deep hypothermia and total circulatory arrest have played an increasingly important role in the treatment of diseases not associated with primary cardiovascular disorders, such as cavoatrial tumor thrombus in uterine tumors, adrenal tumors, Wilms' tumor, as well as renal cell carcinoma. CASE REPORT: A 78-year-old patient with renal cell carcinoma and tumoral thrombus in the inferior vena cava and above the supra-hepatic veins underwent right radical nephrectomy and removal of the thrombus from the vena cava with extracorporeal circulation and deep hypothermia with total circulatory arrest without opening the chest. The patient presented good post-operative evolution.
Subject(s)
Aged , Humans , Male , Carcinoma, Renal Cell/complications , Kidney Neoplasms/complications , Thrombosis/etiology , Vena Cava, Inferior/pathology , Carcinoma, Renal Cell/surgery , Extracorporeal Circulation , Hypothermia, Induced , Kidney Neoplasms/surgery , Magnetic Resonance Imaging , Nephrectomy/methods , Treatment Outcome , Thrombosis , Thrombosis/surgery , Vena Cava, Inferior , Vena Cava, Inferior/surgeryABSTRACT
OBJECTIVE: To evaluate the concurrent validity, internal consistency and responsiveness of King's Health Questionnaire (KHQ) in patients who underwent sling procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: We performed a prospective open label multicenter study in 4 tertiary referral centers. Sixty-eight female patients were enrolled with urodynamically diagnosed urinary stress incontinence. Patients were treated using surgical procedures, mostly (73 percent) with the synthetic sling procedure, which has been considered one of the gold standard methods for the treatment of urinary incontinence. The patients were assessed before and after one month of postoperative follow up, using the KHQ in its validated Portuguese version. Patients also underwent preoperative urodynamic test, Stamey incontinence grading, pad usage and the assessment of number of pads used per day. After surgery, patients underwent stress test, Stamey incontinence grading pad usage and the assessment of number of pads used per day. RESULTS: The concurrent validity showed good correlations in some domains of KHQ to clinical parameters. The internal consistency was higher after treatment compared to preoperative values. Objective parameters, such as pad usage and the assessment of number of pads used per day, had significant correlation with changes in post-treatment scores on KHQ. The responsiveness expressed in terms of standardized effect size (SES) and standardized response mean (SRM) was large. CONCLUSION: The results showed moderate concurrent validity, strong internal consistency and high responsiveness for KHQ, indicating that it is suitable for measuring outcomes in clinical trials among female patients with stress urinary incontinence.
Subject(s)
Female , Humans , Health Status Indicators , Surveys and Questionnaires , Urinary Incontinence, Stress/surgery , Postoperative Period , Prospective Studies , Prostheses and Implants , Quality of Life , Reproducibility of ResultsABSTRACT
OBJETIVO: Traduzir e validar para a língua portuguesa o questionário de qualidade de vida condição-específico denominado International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) em pacientes com incontinência urinária. MÉTODOS: Duas traduções independentes do ICIQ-SF foram feitas por brasileiros, fluentes na língua inglesa. Após harmonização das mesmas, a tradução resultante foi retrotraduzida independentemente por dois nativos de países de língua inglesa. As diferenças foram harmonizadas e pré-testadas em um estudo piloto. A versão final do ICIQ-SF para o português, bem como a versão em português do King's Health Questionnaire (KHQ) foram aplicadas simultaneamente em 123 pacientes consecutivos com queixa de incontinência urinária (29 homens e 94 mulheres) que procuraram o laboratório de uroginecologia e o serviço de urodinâmica de um hospital universitário, localizado em Campinas. Foram testadas as propriedades psicométricas do questionário, como confiabilidade e validade de constructo. RESULTADOS: A idade mediana foi de 53 anos (intervalo de 16 a 86 anos). O período médio de reteste para o ICIQ-SF foi de 14,37 dias (intervalo de seis a 41 dias). Nenhuma alteração do formato original do ICIQ-SF foi observada no final do processo de tradução e adaptação cultural. A consistência interna foi alta, como demonstrado pelo coeficiente alfa de Cronbach (0,88). O resultado do teste-reteste foi considerado de moderado a forte, como indicado pelo índice Kappa ponderado, cujos valores variaram de 0,72 a 0,75, e o coeficiente de correlação de Pearson que foi de 0,89. A correlação entre o ICIQ-SF e o KHQ foi considerada de moderada a boa para a maioria dos itens, variando de 0,44 a 0,77. A avaliação das validades de constructo e concorrente foi também satisfatória e estatisticamente significante. CONCLUSÕES: A versão para o português do ICIQ-SF foi traduzida e validada com sucesso para aplicação em pacientes brasileiros de ambos os sexos, com queixa de incontinência urinária, apresentando satisfatória confiabilidade e validade de constructo.
Subject(s)
Reproducibility of Results , Urinary Incontinence , Surveys and Questionnaires , Translations , Quality of LifeABSTRACT
Foram estudados 21 pacientes submetidos a penectomia por câncer de pênis. Deste grupo, oito haviam morrido. Dos 13 sobreviventes, 10 foram avaliados através de uma entrevista semi-estruturada e do "Overall Sexual Functioning Questioonnaire - OSFQ", com a finalidade de se estimar o impacto do tratamento na sexualidade. A idade dos pacientes era 53,5 anos (mediana, variação: 37-77) e o tempo de seguimento 16,5 meses (mediana; variação: 4-72). O OSFQ é constituído por seis subescalas: interesse sexual, capacidade para o coito, satisfação sexual, relacionamento com a parceira, auto-imagem masculina e freqüência de coito, cuja soma de pontos produz uma estimativa do funcionamento sexual global. Nos casos de penectomia parcial, o funcionamento sexual global estava normal ou discretamente diminuído (quatro pacientes), moderadamente diminuído (um paciente), gravemente diminuído (um paciente) ou ausente (um paciente). Dois dos três pacientes submetidos a penectomia total tinham funcionamento sexual precário. A auto-imagem masculina e o relacionamento com a parceira foram aspectos que praticamente não mudaram nos pacientes. O interesse e a satisfação sexual ficaram levemente reduzidos após a cirurgia. A freqüência do coito decaiu em oito pacientes. A capacidade para o coito foi drasticamente afetada na penectomia total e em um caso de penectomia parcial. A maioria dos pacientes relatou que o apoio oferecido pela companheira foi fundamental na recuperação após a cirurgia e na vida sexual.
Subject(s)
Humans , Male , Adult , Middle Aged , Amputation, Surgical/psychology , Carcinoma/psychology , Penile Neoplasms/psychology , Penis/surgery , Quality of Life/psychology , Sexuality , Interviews as Topic , Retrospective StudiesABSTRACT
Paciente com epispádia incontinente, 19 anos, submetida a enterocistoplastia e correçao uretral, que engravidou. Durante a gestaçao, apresentou várias infecçoes urinárias, sem comprometimento da bolsa ileal, da funçao renal ou do feto. Foi submetida a cesariana eletiva, a termo, sem intercorrências tanto para o feto quanto para a mae. As dificuldades no manuseio destas pacientes pelo obstetra sao discutidas.