Planificação da Atenção Primária à Saúde na região central do estado do Rio Grande do Sul: percepções de residentes multiprofissionais / Planning of Primary Health Care in the central region of the state of Rio Grande do Sul: perceptions of multiprofessional residents

Objetiva-se relatar a implantação da Planificação da Atenção Primária a partir da perspectiva de profissionais integrantes de um programa de Residência Multiprofissional. Trata-se de um relato de experiência de profissionais convidados a serem facilitadores das oficinas da Planificação da Atenção Primária, realizada pela 4a Coordenaria Regional de Saúde. Esse processo objetiva organização dos macroprocessos da Atenção Primária e ao desenvolvimento e mudanças dos processos de gestão e de assistências das equipes de saúde. A experiência advinda da Planificação propiciou reflexões em relação ao processo de gestão e as práticas assistenciais a serem desenvolvimentos pelos profissionais residentes, assim como aproximar-se da realidade, contribuindo para o fortalecimento da APS.

The objective is to report the implementation of Primary Care Planning from the perspective of professionals who are part of a Multiprofessional Residency program. This is an experience report of professionals who are facilitators of the Primary Care Planning workshops of the 4th Regional Health Coordination. This is the purpose of the Macro- processes of Primary Care and the Development and Changes of the Processes of Assistance to Health Teams. The experience gained from Planning provided reflections on the management process and care practices to be developed by resident professionals, as well as getting closer to reality, contributing to the strengthening of PHC.

Urethral lengthening with anterior bladder wall flap for urinary incontinence: a new approach

Urethral irregularity (impending catheterization) and failure to achieve continence are common complications in surgery for urinary incontinence. We describe a surgical technique using an anterior bladder wall flap that is sutured to the posterior wall in an onlay fashion creating a flap valve mechanism. Experimental work in dogs demonstrated a significant increase in the leak point pressure in the surgical group when compared to controls (p= 0.019). Voiding cystourethrography and bladder inspection demonstrated an anterior flap valve with no fistula formation in all animals. Histological examination showed a viable anterior bladder wall flap in all cases. This technique was then applied to 6 patients with neurogenic bladder and low urethral resistance that failed to resolve with medical treatment. Urinary continence was achieved in 4 patients. In 1 patient a vesicourethral fistula developed 3 months postoperatively, since the mother failed to catheterize for 12 hours. This technique is a useful alternative in the treatment of urinary incontinence