Academic Expectations, Gender and Working Status: Comparing Two Cohorts of University Students / Expectativas Acadêmicas, Gênero e Situação Profissional: Comparando Duas Coortes de Estudantes Universitários

ABSTRACT The expansion of higher education is associated with the progressive diversification of student's profiles, such as the increasing number of older, working and female students. The transition to higher education poses challenges for students entering it, generating expectations that can impact academic adaptation. This study compared academic expectations by gender and work situation in two cohorts of first-year students from a Brazilian public university, involving 13,336 participants. The Brazilian Scale of Academic Expectations for First-Year University Students was administered. Non-working and female students had higher academic expectations in both cohorts. The findings provide subsidies to higher education institutions to develop support programs and policies targeting first-year students.

RESUMO A expansão da educação superior está associada à progressiva diversificação dos perfis discentes, tais como aumento do número de estudantes mais velhos, trabalhadores e mulheres. A transição para o ensino superior comporta desafios para os estudantes que nele ingressam, gerando expectativas que podem impactar a adaptação acadêmica. Este estudo comparou as expectativas acadêmicas por gênero e situação de trabalho em dois coortes de estudantes ingressantes em uma universidade pública brasileira, envolvendo 13.336 participantes. Utilizou-se a Escala Brasileira de Expectativas Acadêmicas para Estudantes Ingressantes na Educação Superior. Estudantes mulheres e não trabalhadores apresentaram maiores expectativas acadêmicas em ambas as coortes. Os resultados fornecem subsídios às instituições de ensino superior para desenvolvimento de programas de apoio e políticas voltadas aos estudantes ingressantes.

Current pharmacotherapy of overactive bladder

ABSTRACT Overactive bladder is a symptom complex consisting of bothersome storage urinary symptoms that is highly prevalent among both sexes and has a significant impact on quality of life. Various antimuscarinic agents and the beta-3 agonists mirabegron and vibegron are currently available for the treatment of OAB. Each drug has specific pharmacologic properties, dosing schedule and tolerability profile, making it essential to individualize the medical treatment for the patient's characteristics and expectations. In this manuscript, we review the most important factors involved in the contemporary pharmacological treatment of OAB.

Impact of COVID-19 on education, health and lifestyle behaviour of Brazilian urology residents

ABSTRACT Objectives: To evaluate the impact of COVID-19 on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents. Materials and Methods: A web-based survey was sent to 468 Brazilian urology residents from postgraduate years (PGY) 3 to 5 to collect data on clinical practice and training after 4 months of COVID-19. We also assessed health-related and behavior changes, rate of infection by SARS-CoV-2, deployment to the front line of COVID-19, residents' concerns, and access to personal protective equipment (PPE). Results: Massive reductions in elective and emergency patient consultations, diagnostic procedures and surgeries were reported across the country, affecting PGY 3 to 5 alike. Most in-person educational activities were abolished. The median damage to the urological training expected for 2020 was 6.0 [3.4 - 7.7], on a scale from 0 to 10, with senior residents estimating a greater damage (P< 0.001). Educational interventions developed included online case-based discussions, subspeciality conferences and lectures, and grand rounds. Most senior residents favored extending residency to compensate for training loss and most younger residents favored no additional training (p< 0.001). Modifications in health and lifestyle included weight gain (43.8%), reduced physical activity (68.6%), increased alcoholic intake (44.9%) and cigarette consumption (53.6%), worsening of sexual life (25.2%) and feelings of sadness or depression (48,2%). Almost half were summoned to work on the COVID-19 front-line and 24.4% had COVID-19. Most residents had inadequate training to deal with COVID-19 patients and most reported a shortage of PPE. Residents' concerns included the risk of contaminating family members, being away from residency program, developing severe COVID-19 and overloading colleagues. Conclusions: COVID-19 had a massive impact in Brazilian urology residents´ training, health and lifestyle behavior, which may reflect what happened in other medical specialties. Studies should confirm these findings to help developing strategies to mitigate residents' losses.

Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists

ABSTRACT Objectives To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020. Materials and Methods A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states. Results Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and non-essential surgeries (OR=2.95, 95% CI 1.86 - 4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012). Conclusions COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.

Expectativas de sucesso profissional de ingressantes na educação superior: estudo comparativo / Expectations of professional success of first-year university students: a comparative study / Expectativas de éxito profesional de ingresantes en la educación superior: estudio comparativo

Este estudo teve como objetivo investigar as expectativas de sucesso profissional de estudantes ingressantes na educação superior, considerando gênero, modalidade de ingresso na universidade (sistema universal ou de cotas) e tipo de estudante (trabalhador ou não). Participaram do estudo 6.913 estudantes de uma universidade pública federal brasileira. Utilizou-se a Escala Brasileira de Expectativas Acadêmicas de Estudantes Ingressantes na Educação Superior que avalia sete fatores: Formação Acadêmica de Qualidade, Compromisso Social e Acadêmico, Ampliação das Relações Interpessoais, Oportunidade de Internacionalização e Intercâmbio, Perspectiva de Sucesso Profissional, Preocupação com a Autoimagem e Desenvolvimento de Competências Transversais. Para este estudo foram considerados os dados relativos ao fator Perspectiva de Sucesso Profissional. Os resultados revelam uma maior expectativa de sucesso profissional para mulheres e estudantes não trabalhadores e podem subsidiar instituições de ensino superior a criarem estratégias e serviços que contribuam para o futuro profissional dos estudantes considerando os distintos perfis discentes. (AU)

This study aimed to investigate the expectations of professional success of first-year university students, considering gender, mode of entry into the university (universal or quota system) and type of student (worker or not). A total of 6,913 students from a Brazilian federal public university participated in the study. The Brazilian Scale of Academic Expectations for First-Year University Students was used, which evaluates seven factors: Quality Academic Development, Social and Academic Commitment, Broadening of Interpersonal Relationships, Opportunity for Student Exchange and Internationalization, Expectation of Professional Success, Concern with Self-image, and Development of Transversal Competences. For this study, we considered the data related to the Expectation of Professional Success factor. The results revealed a higher expectation of professional success among female and non-working students, which can support higher education institutions in the creation of strategies and services that contribute to the professional future of students considering the different student profiles. (AU)

Este estudio tuvo como objetivo investigar las expectativas de éxito profesional de estudiantes ingresantes en la educación superior, considerando género, modalidad de ingreso en la universidad (sistema universal o de cuotas) y tipo de estudiante (trabajador o no). Participaron 6.913 estudiantes de una universidad pública federal brasileña. Se utilizó la Escala Brasileña de Expectativas Académicas de Estudiantes Ingresantes en la Educación Superior, dicha escala evalúa siete factores: Formación Académica de Calidad, Compromiso Social y Académico, Ampliación de las Relaciones Interpersonales, Oportunidad de Internacionalización e Intercambio, Perspectiva de Éxito Profesional, Preocupación con la Autoimagen y Desarrollo de Competencias Transversales. Para este estudio se consideraron los datos relativos al factor Perspectiva de Éxito Profesional. Los resultados demuestran una mayor expectativa de éxito profesional para mujeres y estudiantes no trabajadores. Estos resultados pueden auxiliar instituciones de enseñanza superior con la creación de estrategias y servicios que contribuyan al futuro profesional de los estudiantes considerando los distintos perfiles discentes. (AU)

Neurological status predicts response to alpha-blockers in men with voiding dysfunction and Parkinson's disease

OBJECTIVES: To evaluate predictors of the response to doxazosin, a selective alpha-adrenoceptor antagonist, when used for the treatment of lower urinary tract symptoms in men with Parkinson's disease. METHODS: In a prospective study, 33 consecutive men (mean age 59.2±7.0 years) with Parkinson's disease and lower urinary tract symptoms were evaluated. Neurological dysfunction was assessed with the Unified Parkinson's Disease Rating Scale. Urological assessment was performed at baseline and after 12 weeks of treatment with 4 mg/day of extended-release doxazosin, including symptom evaluation with the International Continence Society male short-form questionnaire, an assessment of the impact of lower urinary tract symptoms on quality of life and urodynamics. Clinical and urodynamic predictors of response were specifically evaluated. RESULTS: Compared with the score at baseline, the total International Continence Society male short-form score was reduced after doxazosin administration, from 17.4±7.5 to 11.1±6.9 (p<0.001). The impact of lower urinary tract symptoms on quality of life was also significantly reduced, from 1.8±1.1 to 1.0±1.0 (p<0.001) and the maximum urinary flow varied from 9.3±4.4 to 11.2±4.6 ml/s (p = 0.025). The severity of neurological impairment ...

Experience with different botulinum toxins for the treatment of refractory neurogenic detrusor overactivity

Purpose: To report our experience with the use of the botulinum toxin-A (BoNT/A) formulations Botox® and Prosigne® in the treatment of neurogenic detrusor overactivity (NDO). Materials and methods: At a single institution, 45 consecutive patients with refractory urinary incontinence due to NDO received a single intradetrusor (excluding the trigone) treatment with botulinum toxin type A 200 or 300 units. Botox was used for the first 22 patients, and Prosigne for the subsequent 23 patients. Evaluations at baseline and week 12 included assessment of continence and urodynamics. Safety evaluations included monitoring of vital signs, hematuria during the procedure, hospital stay, and spontaneous adverse event reports. Results: A total of 42 patients were evaluated (74 percent male; mean age, 34.8 years). Significant improvements from baseline in maximum cystometric capacity (MCC), maximum detrusor pressure during bladder contraction, and compliance were observed in both groups (P < 0.05). Improvement in MCC was significantly greater with Botox versus Prosigne (+103.3 percent vs. +42.2 percent; P = 0.019). Continence was achieved by week 12 in 16 Botox recipients (76.2 percent) and 10 Prosigne recipients (47.6 percent; P = 0.057). No severe adverse events were observed. Mild adverse events included 2 cases of transient hematuria on the first postoperative day (no specific treatment required), and 3 cases of afebrile urinary tract infection. Conclusions: Botox and Prosigne produce distinct effects in patients with NDO, with a greater increase in MCC with Botox. Further evaluation will be required to assess differences between these formulations.

Urogenital tuberculosis: patient classification in seven different groups according to clinical and radiological presentation

PURPOSE: To describe and classify 80 cases of urogenital tuberculosis in seven groups of similar clinical and radiological presentation. MATERIALS AND METHODS: 80 patients (56 males, 70 percent; median age 34 years; age range 12 to 75) with urogenital tuberculosis were retrospectively reviewed. The patients were divided in seven groups: 1) Bilateral parenchymatous renal lesions; 2) No or minimal changes on radiographic examination; 3) Unilateral renal tuberculosis; 4) Contracted bladder; 5) Contracted bladder with renal failure; 6) Tuberculosis on a transplanted kidney; 7) Isolated genital tuberculosis. RESULTS: 1) Seven (8.8 percent) patients had multiple bilateral parenchymatous renal lesions with fever and malaise, characteristic of miliary tuberculosis. Three of these patients had AIDS. 2) Six (7.5 percent) cases had an early diagnosis, with minimal or no radiographic lesions. Two did not have any urologic symptoms. 3) Twelve (15 percent) patients had unilateral renal tuberculosis with partial (1 case) or total non-function kidney. 4) Thirty-seven (46.3 percent) patients had contracted bladder associated with unilateral partial (1 case) or total non-function kidney. 5) Ten (12.5 percent) patients had end stage renal disease due to tuberculosis with contracted bladder. 6) Four (5.0 percent) patients had tuberculosis on a transplanted kidney, with graft loss in half the cases. 7) Four (5.0 percent) patients had prostate or epididymis tuberculosis without associated renal lesion. CONCLUSIONS: Urogenital tuberculosis is a destructive disease of the urogenital tract with variable clinical and radiographic presentation. A classification according to similar patterns correlating with disease stage is feasible although early diagnosis is the only prevention of the most severe forms.

Prostate specific antigen levels following transurethral resection of the prostate

OBJECTIVE: Determine how serum prostate-specific antigen (t-PSA) levels and free PSA (f/t PSA) ratio change following transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Thirty men with a mean age of 67.0 + 4.2 years (range 46 to 84 years) underwent TURP for BPH between May 2005 and October 2005. Preoperative assessment included symptom evaluation with the International Prostate Symptom Score (I-PSS) and the prostate volume estimation by transrectal ultrasound. Total PSA and f/t PSA ratio were assessed before the procedure, as well as 30, 60 and 180 days after the TURP. RESULTS: Clinical improvement after TURP, reflected by I-PSS score, was demonstrated as early as 30 days and remained stable until the end of the follow-up. Mean t-PSA declined 71 percent after TURP and 60 days after surgery the reduction reached its peak, stabilizing afterwards. It varied from 6.19 + 7.06 ng/mL before surgery to 1.75 + 1.66 ng/mL on day 60 (p < 0.001). The mean baseline f/t PSA ratio was 18.2 percent + 3.4 percent and was not significantly changed at any given time point in the postoperative period (p = 0.91). There were also no statistically significant differences in t-PSA or f/t PSA between patients with and without prostatitis at any time point (p = 0.23). Resected prostate fragments weighed 29.9 + 19.6 g, corresponding to 39.1 percent of the estimated preoperative prostate volume. Each gram of tissue resected decreased PSA by 0.15 + 0.11 ng/mL, while 1 percent prostate volume resected led to a reduction of 2.4 percent + 0.4 percent in serum PSA from baseline. CONCLUSIONS: PSA decreases drastically in patients who undergo TURP. These low levels stabilize within 60 days after surgery. The f/t PSA ratio did not change, and the finding of chronic prostatitis did not affect the levels of these variables.

Urogenital involvement in the Klippel-Trenaunay-Weber syndrome: treatment options and results

OBJECTIVE: Klippel-Trenaunay-Weber syndrome (KTWS) is a congenital condition characterized by vascular malformations of the capillary, venous and lymphatic systems associated to soft tissue and bone hypertrophy in the affected areas. This syndrome may involve bladder, kidney, urethra, ureter and genitals. We report the treatment of 7 KTWS patients with urogenital involvement. MATERIALS AND METHODS: From 1995 to 2005, 7 patients with KTWS were evaluated and the charts of these patients were reviewed. RESULTS: PatientsÆ median age was 19-years (range 4 to 46-years) and only 1 was female. The clinical presentation included genital deformities in 3 cases, hematuria in 2 and urethrorragia in 2, one of which associated with cryptorchidism and phimosis. Three patients had an association of pelvic and genital malformations, including 2 patients with hematuria due to vesical lesions and 1 patient with left ureterohydronephrosis due to a pelvic mass. Two patients had urethral lesions. Treatment included endoscopic laser coagulation for 1 patient with recurrent hematuria and 1 patient with urethrorrhagia, pelvic radiotherapy for 1 patient with hematuria and circumcision in 2 patients with genital deformities. One patient required placement of a double-J catheter to relieve obstruction. Hematuria and urethrorragia were safely and effectively controlled with laser applications. Circumcision was also effective. The patient treated with radiotherapy developed a contracted bladder and required a continent urinary diversion. CONCLUSIONS: Urogenital involvement in patients with KTWS is not rare and must be suspected in the presence of hematuria or significant cutaneous deformity of the external genitalia. Surgical treatment may be warranted in selected cases.

Concurrent validity, internal consistency and responsiveness of the portuguese version of the king's health questionnaire (KHQ) in women after stress urinary incontinence surgery

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.

Voiding dysfunction and urodynamic abnormalities in elderly patients

Disfunções do trato urinário inferior são uma causa importante de morbidade e diminuição da qualidade de vida em homens e mulheres idosos. Com o envelhecimento progressivo da população, é importante compreender os distúrbios miccionais mais comuns nesta população. A maioria dos problemas miccionais em homens idosos tem origem multifatorial, requerendo uma avaliação ampla dos órgãos do trato urinário inferior, da capacidade funcional e neurológica dos pacientes e dos problemas clínicos coexistentes. A avaliação urodinâmica é uma ferramenta importante na investigação de pacientes idosos com sintomas do trato urinário inferior. Ela não é necessária em todos os casos e só deve ser indicada após a exclusão de problemas não urológicos e potencialmente reversíveis que poderiam causar ou contribuir para os sintomas miccionais. Embora os exames urodinâmicos possam revelar diagnósticos comuns como obstrução vesical ou incontinência urinária de esforço, na população idosa é freqüente a ocorrência de achados como hiperatividade detrusora e falência da contratilidade vesical, com implicações prognósticas e terapêuticas importantes. O objetivo deste artigo é descrever os problemas urológicos mais comuns nos idosos e discutir as indicações e características dos exames urodinâmicos nestas condições.

Evaluation and treatment of the overactive bladder

The overactive bladder is characterized by symptoms of frequency, urgency, and urge incontinence, substantially affecting the quality of life of millions of people throughout the world. The symptoms are associated with significant social, psychological, occupational, domestic, physical, and sexual problems. Despite the considerable impact of this condition on quality of life, sufferers are often unwilling to discuss their problem with family members or health care professionals. This situation is unfortunate, for much can be done to alleviate the symptoms of this distressing condition. It is therefore of utmost importance that medical education about symptoms of the overactive bladder and other related problems be improved to help health care professionals identify and treat patients who will benefit from therapy. This article reviews current thinking regarding definition, epidemiology, quality of life effects, evaluation, and management of the overactive bladder