Prevalence and risk factors for urinary incontinence in bitches five years after ovariohysterectomy / [Prevalência e fatores de risco para incontinência urinária em cadelas cinco anos após ovário histerectomia]

Ovariohysterectomy (OHE) is the most performed elective surgery in veterinary medicine. Although this procedure brings benefits both to the animal and public health, acquired urinary incontinence is a possible complication resultant from it. The aim of this study was to determine the prevalence of urinary incontinence and evaluate size, breed, and time of surgery as risk factors in a population of spayed female dogs in the Hospital de Clínicas Veterinárias da Universidade Federal do Rio Grande do Sul, in the year of 2013, through the use of a multiple-choice screening instrument. Identified estimated prevalence was 11.27% and main risk factors were as follows: large size (OR = 7.12 IC95% = 1.42 - 35.67), Rottweiler breed (OR = 8.92; IC95% = 5.25 - 15.15), Pit-bull breed (OR = 4.14; IC95% = 2.19 - 7.83), and Labrador breed (OR = 2.73; IC95% = 1.53 - 4.87). Time of surgery was not considered a risk factor for urinary incontinence in this population (OR = 1.45; IC95% = 0.86 - 2.40). Even though most owners reported a small impact on their relationship with the animal, urinary incontinence hazard should be addressed before spaying.(AU)

A ovário-histerectomia (OHE) é a cirurgia eletiva mais realizada em medicina veterinária. Embora seja um procedimento que beneficie a saúde pública e do animal, a incontinência urinária adquirida é uma complicação possível resultante desse procedimento. O objetivo deste estudo foi determinar a prevalência de incontinência urinária e avaliar porte, raça e momento da castração como fatores de risco em uma população de cadelas castradas no HCV/UFRGS, no ano de 2013, através do uso de um instrumento de triagem de múltipla escolha. A prevalência estimada foi de 11,27% e os principais fatores de risco foram: grande porte (OR = 7,12 IC95% = 1,42 - 35,67), raça Rottweiler (OR = 8,92; IC95% = 5,25 - 15,15), raça Pitbull (OR = 4,14; IC95% = 2,19 - 7,83) e raça Labrador (OR = 2,73; IC95% = 1,53 - 4,87). O tempo da cirurgia não foi considerado fator de risco para incontinência urinária nessa população (OR = 1,45; IC95% = 0,86 - 2,40). Embora a maioria dos proprietários tenha relatado um pequeno impacto no relacionamento com o animal, a possibilidade de incontinência urinária deve ser devidamente discutida antes da castração.(AU)

Bacterial cellulose to reinforce urethrovesical anastomosis. A translational study

Abstract Purpose: To evaluate the efficacy of the cellulosic exopolysaccharide membrane (CEM) as a urethral reinforcement for urethrovesical anastomosis. Methods: Twenty eight rabbits were submitted to urethrovesical anastomosis with or without CEM reinforcement. The animals were divided into 4 groups: C7, CEM7, C14 and CEM14: (C= only anastomosis or CEM = anastomosis + CEM), evaluated after 7 weeks, and 14 weeks. The biointegration and biocompatibility of CEM were evaluated according to stenosis, fistula, urethral wall thickness, urethral epithelium, rate of inflammation and vascularization. Results: Between the two experimental groups, the difference in the number of stenosis or urinary fistula was not statistically significant. The morphometric analysis revealed preservation of urethral lumen, well adhered CEM without extrusion, a controlled inflammatory process and implant vascularization. The urothelium height remained constant over time after CEM reinforcement and the membrane wall was thicker, statistically, after 14 weeks. Conclusion: The absence of extrusion, stenosis or urinary fistula after 14 weeks of urethrovesical anastomosis demonstrates cellulosic exopolysaccharide membrane biocompatibility and biointegration with tendency to a thicker wall.

Artificial urinary sphincter revision for urethral atrophy: comparing single cuff downsizing and tandem cuff placement

ABSTRACT Objective To compare outcomes for single urethral cuff downsizing versus tandem cuff placement during artificial urinary sphincter (AUS) revision for urethral atrophy. Materials and Methods We identified 1778 AUS surgeries performed at our institution from 1990-2014. Of these, 406 were first AUS revisions, including 69 revisions for urethral atrophy. Multiple clinical and surgical variables were evaluated for potential association with device outcomes following revision, including surgical revision strategy (downsizing a single urethral cuff versus placing tandem urethral cuffs). Results Of the 69 revision surgeries for urethral atrophy at our institution, 56 (82%) were tandem cuff placements, 12 (18%) were single cuff downsizings and one was relocation of a single cuff. When comparing tandem cuff placements and single cuff downsizings, the cohorts were similar with regard to age (p=0.98), body-mass index (p=0.95), prior pelvic radiation exposure (p=0.73) and length of follow-up (p=0.12). Notably, there was no difference in 3-year overall device survival compared between single cuff and tandem cuff revisions (60% versus 76%, p=0.94). Likewise, no significant difference was identified for tandem cuff placement (ref. single cuff) when evaluating the risk of any tertiary surgery (HR 0.95, 95% CI 0.32-4.12, p=0.94) or urethral erosion/device infection following revision (HR 0.79, 95% CI 0.20-5.22, p=0.77). Conclusions There was no significant difference in overall device survival in patients undergoing single cuff downsizing or tandem cuff placement during AUS revision for urethral atrophy.

A new material to prevent urethral damage after implantation of artificial devices: an experimental study

ABSTRACT Objective To validate the application of the bacterial cellulose (BC) membrane as a protecting barrier to the urethra. Materials and Methods Forty female Wistar rats (four groups of 10): Group 1 (sham), the urethra was dissected as in previous groups and nothing applied around; Group 2, received a 0.7cm strip of the BC applied around the urethra just below the bladder neck; Group 3, received a silicon strip with the same dimensions as in group 2; Group 4, had a combination of 2 and 3 groups being the silicon strip applied over the cellulosic material. Half of the animals in each group were killed at 4 and 8 months. Bladder and urethra were fixed in formalin for histological analysis. Results Inflammatory infiltrates were more intense at 4 months at lymphonodes (80% Grade 2), statistically different in the group 2 compared with groups 1 (p=0.0044) and 3 (p=0.0154). At 8 months, all samples were classified as grade 1 indicating a less intense inflammatory reaction in all groups. In group 2, at 8 months, there was a reduction in epithelial thickness (30±1μm) when com-pared to groups 1 (p=0.0001) and 3 (p<0.0001). Angiogenesis was present in groups 2 and 4 and absent in group 3. In BC implant, at 4 and 8 months, it was significant when comparing groups 4 with 1 (p=0.0159). Conclusion BC membrane was well integrated to the urethral wall promoting tissue remodeling and strengthening based on morphometric and histological results and may be a future option to prevent urethral damage.

Traumas uretrais pela introdução do cateter uretral: conduta do enfermeiro / Urethral traumas by the introduction of urethral catheter: conduct of nurses

Este estudo teve como objetivo avaliar a conduta do enfermeiro frente ao traumatismo de uretra ocasionado pela inserção do cateter uretral. Este estudo teve aprovação do Comitê de Ética em pesquisa da Escola de Enfermagem de Ribeirão Preto - Parecer 466/12 e foi realizado em um Hospital Universitário em duas etapas: na primeira etapa, descritiva, foi efetuada consulta ao sistema eletrônico do hospital que trata de notificações sobre eventos adversos dos pacientes. Nessa etapa foi utilizado instrumento de perguntas objetivas elaborado pelo próprio pesquisador. Na segunda, quase-experimental pós teste, foram coletados os dados relacionados a autoconfiança de enfermeiros, que participaram de cenário simulado de baixa fidelidade. Nessa etapa para obtenção dos dados foi aplicado um questionário de caracterização dos sujeitos e instrumento já validado, de autoconfiança na Assistência de Enfermagem à Retenção Urinária (EAAERU), a qual encontra-se dividida em cinco fatores: 1) "Intervenções realizadas durante o cateterismo urinário e/ou em situações iatrogênicas", 2) "Intervenções prévias ao cateterismo urinário", 3) "Intervenções realizadas após o cateterismo urinário"; 4) "Comunicação, consentimento e preparo dos materiais para realização do cateterismo urinário", e 5) "Avaliação objetiva da RU" (retenção urinária). Os dados da primeira etapa foram analisados por estatística descritiva e os dados da segunda etapa foram codificados e digitados duplamente em planilhas do aplicativo Excel®, exportados e analisados no programa SPSS (Statistical Package for Social Science) ®, versão 22.0, como a escala original. Os resultados demonstram que na primeira fase do estudo entre as 5300 notificações do serviço, apenas 27 (1,96%) estavam relacionadas a problemas urinários. Entre essas, cinco diretamente ao cateterismo urinário. Na segunda fase do estudo, a amostra foi composta por 53 enfermeiros, entre os quais a maior parte era do sexo feminino, com idade média de 36 anos, menos de dez anos de formação. Entre eles a maioria cursava ou já haviam cursado pós-graduação. Segundo os entrevistados todos 53 (100,0%) já realizaram o cateterismo urinário e 46 (86,8%) já vivenciaram dificuldades no procedimento. A maioria já avaliou trauma uretral ocasionado pela passagem do cateter. A conduta tomada nessa circunstância foi comunicar o fato e solicitar avaliação de outro profissional (médico e/ou outro enfermeiro). Após atividade simulada de trauma uretral, na avaliação da autoconfiança, a EAAERU demonstrou boa confiabilidade na sua aplicação (? 0,966). Os menores escores encontrados na autoconfiança dos profissionais estiveram relacionados aos fatores 1) "Intervenções realizadas durante o cateterismo urinário e/ou em situações iatrogênicas" e 5) "Avaliação objetiva da RU". Observou-se ainda associação positiva entre a autoconfiança e a frequência de realização do cateterismo urinário. Conclui-se que os traumas de uretra são comuns na prática clínica, porém pouco notificados. Com relação à autoconfiança na introdução do cateterismo urinário em que ocorrem situações de trauma de uretra há dificuldade na tomada de decisão e na avaliação objetiva da RU. Uma vez que o cateterismo é de competência do enfermeiro, são necessários programas e instrumentos que capacitem os profissionais para tais situações

This study aimed to evaluate the conduct of the nurse to the urethral trauma caused by the insertion of urethral catheter. This study was approved by the Ethics Committee in research of the College of Nursing in Ribeirão Preto - Opinion 466/12 and was performed in University Hospital in two stages: in the first stage, descriptive, a question was made on the hospital's electronic system, which deals with notifications about adverse events of patients. In this stage, it was used an instrument of objective questions elaborated by the researcher herself. In the second stage, quasi-experimental posttest study, the data related to self-confidence of nurses who participated in simulated low-fidelity scenario was collected. In this stage, to obtain the data, it was applied a characterization questionnaire of subjects and already validated instrument of Self-Confidence Scale of Nursing Care in Urinary Retention (EAAERU), which is divided in five factors: 1) "Interventions performed during urinary catheterization and/or in iatrogenic situations", 2) "Prior interventions to performing urinary catheterization", 3) "Interventions performed for urinary catheters"; 4) "Communication, consent and preparation of materials for performing urinary catheterization", and 5) "Objective evaluation of the urinary retention". The first stage's data were analyzed by descriptive statistic and the second stage's data were codified and double typed in spreadsheets in the Excel® app, exported and analyzed in the SPSS program (Statistical Package for Social Science)®, version 22.0, like the original scale. The results demonstrate that in the first stage of the study, among the 5300 notifications of service, only 27 (1,96%) were related to urinary problems. Among these, five directly related to urinary catheterization. In the second stage of the study, the sample was made by 53 nurses, among which most were women, with an average age of 36 years, less than ten years of formation. Among them, most were attending or had already attended postgraduate. According to the interviewers, all 53 (100,0%) had performed urinary catheterization and 46 (86,8%) had gone through trouble during the process. Most of them had evaluated urethral trauma caused by the introduction of the catheter. The conduct taken in this circumstance was to communicate the fact and request the evaluation of another professional (Doctor and/or another nurse). After simulated activity of the urethral trauma, in the self-confidence evaluation, EAAERU showed good reliability on its application (?=0,966). The lowest scores found in the professionals' self-confidence were related to the factors 1) "Interventions performed during urinary catheterization and/or in iatrogenic situations" and 5) "Objective evaluation of the urinary retention". It was also observed positive association between the self-confidence and the performance of urethral catheterization. It is concluded that urethral traumas are common on clinical practice, however little notified. With regard to self-confidence to the introduction of urethral catheterization in which occur urethral trauma situations, there is difficulty in decision making and objective evaluation of the urinary retention. Once the catheterization is the nurse's responsibility, programs and tools are necessary to enable professionals in such situations

Small activating RNA induces myogenic differentiation of rat adipose-derived stem cells by upregulating MyoD

ABSTRACTPurpose:RNA activation (RNAa) is a mechanism of gene activation triggered by promoter-targeted small double stranded RNAs (dsRNAs), also known as small activating RNAs (saRNAs). Myogenic regulatory factor MyoD is regarded as the master activator of myogenic differentiation cascade by binding to enhancer of muscle specific genes. Stress urinary incontinence (SUI) is a condition primarily resulted from urethral sphincter deficiency. It is thus expected that by promoting differentiation of adipose-derived stem cells (ADSCs) into myoblasts by activating MyoD gene through RNAa may offer benefits to SUI.Materials and Methods:Rats ADSCs were isolated, proliferated in vitro, and identified by flow cytometry. Purified ADSCs were then transfected with a MyoD saRNA or control transfected. Real-time polymerase chain reaction (RT-PCR) and western blotting were used to detect MyoD mRNA and protein expression, respectively. Immunocytochemical staining was applied to determine the expression of desmin protein in transfected cells. Cell viability was measured by using CellTiter 96® AQueous One Solution Cell Proliferation Assay kit.Results:Transfection of a MyoD saRNA (dsMyoD) into ADSCs significantly induced the expression of MyoD at both the mRNA and protein levels, and inhibited cell proliferation. Desmin protein expression was detected in dsMyoD treated ADSCs 2 weeks later.Conclusion:Our findings show that RNAa mediated overexpression of MyoD can promote transdifferentiation of ADSCs into myoblasts and may help treat stress urinary incontinence (SUI)–a condition primarily resulted from urethral sphincter deficiency.

Urethral dysfunction due to alloxan-induced diabetes. Urodynamic and morphological evaluation

PURPOSE: To evaluate the effect of short and long term alloxan-induced diabetes on bladder and urethral function of female rats, and also describing its correlated morphological alterations. METHODS: Thirty five female rats were divided into three groups: G1 (n=9), control group; G2 (n=17), six weeks alloxan-induced diabetic rats; G3 (n=9), 20 weeks alloxan-induced diabetic rats. Functional evaluation was performed by cystometry and simultaneous measurements of the urethral pressure during bladder filling and voiding. Morphological evaluation was also performed with measurement of bladder and urethral fibrosis and collagen content and thickness of lamina propria and smooth muscle layers. RESULTS: The peak bladder pressures and contraction amplitudes were decreased in 100% and 47% of the G3 and G2 groups respectively, when compared to control. Bladder overactivity was observed in 53% of the G2 group. CONCLUSION: Alloxan-induced diabetes urethropathty in female rat was associated to bladder morphological alterations as higher thicknesses of it lamina propria, detrusor and adventicea. .

Integration of collagen matrices into the urethra when implanted as onlay graft

Objective To assess the integration of decellularized heterologous collagen matrices into the urethra, when implanted with no cells or when seeded with autologous smooth muscle cells. Materials and Methods Eighteen New Zealand rabbits were randomly assigned to two groups: Group I (n = 9) - animals undergoing urethral segment resection with interposition of a patch of heterologous collagen matrix seeded with autologous smooth muscle cells; Group II (n = 9) - animals undergoing resection of a urethral segment with interposition of a decellularized heterologous collagen matrix patch. Two animals from each group were sacrificed on postoperative days seven, fourteen and twenty-eight; three animals from each group were sacrificed at the end of three postoperative months. At the end of the third month one animal from each group underwent urethroscopy for urethral integrity assessment and one animal from each group had its microcirculation image captured by a SDF device (Side-stream Dark Field - Microscan Analysis Software). One animal from each group in each euthanasia period underwent cystourethrography so as the urethra could be viewed at flow time. The matrices integration was assessed through histological examination using hematoxylin and eosin (H&E), Masson trichrome (MT), Picrosirius red and Von Willebrand staining. In a blind study with two pathologists all the slides were studied. Results The matrices whether seeded or not with autologous muscle cells were able to restore the architecture of the urethra, but were eliminated from the first week on, before incorporation. Microcirculation of the neourethra, at the end of the third month, showed the same characteristics as a normal urethra in both groups of animals. Conclusion Natural heterologous matrices implanted in the urethra as onlay graft were not incorporated into its walls but were able to fully restore the ...

The buccal mucosa fenestrated graft for Bracka first stage urethroplasty: experimental study in rabbits

To histologically evaluate, in an experimental study in rabbits, the integration process of the buccal mucosa fenestrated graft applied in the corpora cavernosa for Bracka first stage urethroplasty.

A urethral defect was surgically created in 16 male rabbits of the New Zealand breed through the excision of the penile urethra. The urethral defect was corrected by applying buccal mucosa fenestrated graft through two cruciform incisions in the distal portions of its longitudinal axis. The animals were sacrificed at 2, 4, 8 and 12 weeks post surgery and their genitals were subjected to clinical and histological assessment.

The buccal mucosa fenestrated graft showed complete uptake in all groups, with keratinization squamous metaplasia and mucosal proliferation of the fenestrated areas. The fenestrated graft area represented an increase in length of 25% in length in relation to the original standard graft.

The fenestrated buccal mucosa graft presented total integration to the adjacent epithelia with re-epithelization of the incision areas of the graft (fenestrations) and no significant inflammatory or scarring reactions when compared to other mucosa transplanted areas; therefore its application is viable in cases of extensive urethral defect whenever the donating area might be insufficient. .

Stereological and biochemical analysis of the urethral edges in patients submitted to end-to-end anastomosis for bulbar urethral stricture

PURPOSE: To study the morphologic alterations in the proximal and distal urethral edges from patients submitted to end-to-end bulbar urethroplasty. MATERIALS AND METHODS: We analyzed 12 patients submitted to anastomotic urethroplasty to treat bulbar strictures less than 2.0 cm in length. After excision of the fibrotic segment to a 28Fr urethral caliber, we obtained biopsies from the spongious tissue of the free edges (proximal: PROX and distal: DIST). Controls included normal bulbar urethras obtained from autopsies of 10 age matched individuals. The samples were histologically processed for smooth muscle cells (SMC), elastic system fibers and collagen. Stereological analysis was performed to determine the volumetric density (Vv) of each element. Also, a biochemical analysis was performed to quantify the total collagen content. RESULTS: Vv of SMC was reduced in PROX (31.48 ± 7.01 p < 0.05) and similar in DIST when compared to controls (55.65 ± 9.60%) with no statistical difference. Elastic fibers were increased in PROX (25.70 ± 3.21%; p < 0.05) and were similar to controls in DIST (15.87 ± 4.26%). Total collagen concentration in PROX (46.39 ± 8.20 μg/mg), and DIST (47.96 ± 9.42 μg/mg) did not differ from controls (48.85 ± 6.91 μg/mg). Type III collagen was similarly present in all samples. CONCLUSIONS: After excision of the stenotic segment to a caliber of 28Fr, the exposed and macroscopically normal urethral edges may present altered amounts of elastic fibers and SMC, but are free from fibrotic tissue. When excising the peri-stenotic tissue, the surgeon should be more careful in the proximal end, which is the most altered.

High concentration of reticular fibers in periurethral region of the prostatic urethra from patients with benign prostatic hyperplasia as revealed by stereology / Alta concentración de fibras reticulares en la región periuretral de la uretra prostática de pacientes con hiperplasia prostática benigna revelada por estereología

The goal of this investigation was to analyze and quantify changes of the reticular fibers in the prostatic urethra of patients with benign prostatic hyperplasia (BPH) and compare with a control group. Prostatic urethra tissue samples were obtained from ten patients (age range 65 to 79 years, mean 66) with clinical symptoms of bladder outlet obstruction who had undergone open prostatectomy. The ten control group samples (urethral tissue samples from the transitional zone) were collected from prostates obtained during autopsy of accidental death adults of less than 25 years. The Vv of the reticular fibers was determined with stereologic methods from 25 random fields per sample using the point-count method with a M-42 grid test system. The quantitative data were analyzed using the Kolmogorov-Smirnov and Mann-Whitney U tests. The Vv (mean+/-SD) in the control and BPH groups respectively were: 23.4+/- 1.8 and 30.3 +/- 1.2 (0.001). BPH cause significant increase of reticular fibers in prostatic urethra...

El objetivo de esta investigación fue analizar y cuantificar los cambios de las fibras reticulares en la uretra prostática de pacientes con hiperplasia prostática benigna (HPB) y compararlo con un grupo control. Muestras de tejido de uretra prostática se obtuvieron de diez pacientes (rango de edad 65 a 79 años, media 66) con síntomas clínicos de obstrucción del tracto urinario inferior que se habían sometido a prostatectomía abierta. Las diez muestras del grupo de control (muestras uretrales de tejido de la zona de transición) se obtuvieron de próstatas durante la autopsia de sujetos adultos con muerte accidental menores de 25 años. El Vv de las fibras reticulares se determinó con métodos estereológicos de 25 campos al azar por muestra utilizando el método de valor de conteo con el sistema M-42. Los datos cuantitativos se analizaron mediante la prueba de Kolmogorov-Smirnov y Mann-Whitney U. El Vv (media +/- DE) en el grupo control y BPH, respectivamente, fueron: 23,4 +/- 1,8 y 30,3 +/- 1,2 (0,001). La BPH causó aumento significativo de fibras reticulares en uretra prostática...

Lesões do sistema urinário em 1.063 cães / Lesions of the urinary system in 1.063 dogs

Com o objetivo de realizar um estudo abrangente das lesões do sistema urinário em cães e determinar a sua prevalência, epidemiologia, importância clínica e possíveis causas associadas, foram revisados os protocolos de necropsias de cães realizadas no período de janeiro de 1999 a dezembro de 2010 no LPV-UFSM. Nesse período foram necropsiados 3.189 cães e destes, cerca de 30% apresentaram lesões no sistema urinário. Na maioria dos cães (79,1%) foram observadas lesões únicas e em aproximadamente 21% havia lesões múltiplas no sistema urinário, totalizando 1.373 lesões. Destas, 1.014 (73,8%) foram observadas no rim. No trato urinário inferior (TUI) foram diagnosticadas 359 (26,2%) lesões. Um terço das lesões no sistema urinário dos cães necropsiados foram causa de morte espontânea ou razão para eutanásia (ME/EUT). As demais foram consideradas como achados incidentais. As principais lesões renais diagnosticadas, em ordem decrescente de prevalência, foram: nefrite túbulo-intersticial, infarto, nefrite granulomatosa (parasitária), glomerulonefrite, neoplasmas metastáticos/multicêntricos, pielonefrite/ pielite e hidronefrose. As principais lesões do TUI diagnosticadas, em ordem decrescente de prevalência, foram: cistite, presença de inclusões virais (morbilivírus), urolitíase, dilatação da bexiga, ruptura de bexiga (com uroperitônio) e neoplasmas metastáticos/multicêntricos. As características epidemiológicas como sexo, raça e idade dos cães afetados tiveram variações expressivas de acordo com o tipo de lesão diagnosticada. Uremia foi observada em um número significativo de casos de ME/EUT e foi principalmente secundária a lesões renais.

The aim of this study was to determine the prevalence, epidemiology, clinical significance, and possible associated causes of the urinary system lesions in dogs necropsied between January 1999 and December 2010 at the Laboratório de Patologia Veterinária of the Universidade Federal de Santa Maria (LPV-UFSM). To accomplish this, the necropsy reports were analyzed retrospectively. In this time frame, 3,189 dogs were necropsied and about 30% had lesions in the urinary system. In most of the dogs (79.1%), lesions were single and in about 21% they were multiple, totalizing 1,373 lesions. Out of them, 1,014 (73.8%) were observed in the kidney and 359 (26.2%) were in the lower urinary tract (LUT). One third of the lesions in the urinary system were causes of spontaneous death or reason for euthanasia (SD/EUTH) of the affected dogs. The other two third of the lesions were considered incidental findings. The main renal lesions diagnosed, in descending order of prevalence, were: tubulointerstitial nephritis, infarct, granulomatous nephritis (parasitary), glomerulonephritis, metastatic/multicentric neoplasms, pyelonephritis/pyelitis, and hydronephrosis. The main LUT lesions, in descending order of prevalence, were: cystitis, presence of viral inclusions bodies (morbillivirus), urolithiasis, urinary bladder dilatation, urinary bladder rupture (with uroperitoneum), and metastatic/multicentric neoplasms. Epidemiological aspects such as gender, breed, and age of affected dogs had expressive variations according to the type of lesion diagnosed. Uremia was observed in a significant number of cases of SD/EUTH and was mostly due to renal lesions.

Outcome of urethro cutaneous fistula repair

To evaluate the outcome of urethro cutaneous fistula repair. This was a prospective study conducted in department of urology Jinnah Postgraduate Medical Centre [JPMC], Karachi. Seventeen cases with urethrocutaneous fistulas were enrolled in this study. In 12 [75%] we did the simple repair and second layer with dartos, in 03 [16.7%] OIU and silicone catheterization was done, but they recurred then repair with tunica vaginalis cover was performed and 02 [8.3%] patient underwent OIU plus simple repair with dartos. The mean age was 25.58 +/- 6.2 years, in 11 post hypospadiasis was the cause of urethrocutaneous fistula. Recurrence was observed in four patients. Two patients after post hypospadias repair; one after stricture peno-scrotal and one after post infection, boil at base of penis had recurrence. Two patients with simple repair and 2[nd] layer with dartos had recurrence, two patients treated with OIU had recurrence and after that repair with tunica vaginalis cover was performed with no recurrence and none of the patients treated with OIU plus simple repair with dartos had recurrence. Circumferential incision around the fistula opening, tension free closure with fine PDS suture is the key for successful treatment of urethral fistula

Meatobalanoplastia asociada a movilización de uretra para corregir hipospadias distales / Meatobalanoplastia associated with mobilization of the urethra to correct distal hypospadias

Objetivo: Demostrar que la meatobalanoplastia asociada a movilización, por liberación parcial o total de la uretra (MEBAMU) es una conducta técnico quirúrgica funcional y estéticamente útil para corregir hipospadias distales.Material y Métodos: 63 de 81 niños de entre 8 y158 m. de edad (promedio 37,4 m. mediana 25 m.) operados por el mismo cirujano entre los años 2000 y 2007 cumplieron con los criterios de inclusión. Es un estudio clínico prospectivo de tipo experimental, con controles históricos. Los detalles técnicos son descriptos minuciosamente. 15 (23,8%) eran hipospadias balánicas, 26 (39,7%) coronales y 22 (36,5%) subcoronales. 9 pacientes habían sido operados previamente, 8 con otras técnicas y 1 con la misma técnica. De acuerdo con las necesidades, en 18 pacientes la uretra se iberó parcialmente y en 45 totalmente (13 en un corto trayecto y 32 extensamente) . El seguimiento promedio fue de 33 m (6 a 99m). A 30 niños de 2 a 14 años de edad (Promedio 75,2 m) se les realizó uroflujometría, 36,6 m promedio después de operados. El análisis estadístico se realizó con software de SAS que considera un error de tipo I del 5% (alfa=0.05%). La comparación entre los grupos, cuando las variables fueron numéricas se realizó mediante el test de Wilcoxon Sun Run. Las variables nominales (cualitativas) mediante test de Chi cuadrado o Fisher Exact test. Resultados: Preponderó la liberación parcial de la uretra en las formas balánicas y la total en las coronales y subcoronales (p<0,01). 5 pacientes (7,9%) se complicaron, 2 fístulas y 3 estenosis. De los 9 pacientes con cirugías previas, 7 evolucionaron satisfactoriamente.

Modificações topográficas da junção uretrovesical e da uretra proximal após cirurgia combinada de Marshall-Marchetti-Krantz e Burch / Topographic modifications of the urethrovesical junction and proximal urethra after combined Marshall-Marchetti-Krantz and Burch surgery

OBJETIVO: estudar, por meio da ultrassonografia perineal, as modificações da junção uretrovesical (JUV) e da uretra proximal (UP) promovidas pela cirurgia combinada de Marshall-Marchetti-Krantz-Burch (MMK-B). MÉTODOS: foi realizado um estudo de intervenção longitudinal e prospectivo. Trinta e duas mulheres com incontinência urinária de esforço foram submetidas à ultrassonografia perineal antes e 30 dias depois da cirurgia para avaliar a distância pubo-uretral (DPU), o comprimento da uretra proximal (UP), a distância horizontal da JUV (DHJUV) e a distância vertical da JUV (DVJUV), estando a paciente em repouso, e os seus deslocamentos durante a manobra de Valsalva. Os resultados foram expressos em médias e desvios padrão. Para a comparação dos resultados do pré aos do pós-operatório, foi usado o teste t de Student para amostra pareada quando as variáveis cumpriam os critérios do teste de normalidade, e o teste pareado de Wilcoxon quando não cumpriam. RESULTADOS: em comparação às medidas do pré-operatório, a cirurgia de Marshall-Marchetti-Krantz-Burch reduziu a DPU no repouso (13,4 mm x 10,2 mm) e no esforço (19,8 mm x 9 mm); reduziu a DHJUV no repouso (14 mm x 4,3 mm) e no esforço (20,8 mm x 6,4 mm); aumentou o comprimento da UP no repouso (16,7 mm x 19,7 mm) e no esforço (1,6 mm x 15,4 mm); aumentou a DVJUV no esforço (-5,4 mm x 14,8 mm). A cirurgia de MMK-B não alterou a DVJUV no repouso (16,2 mm x 18,7mm, p=0,085). CONCLUSÕES: a cirurgia de Marshall-Marchetti-Krantz-Burch reduziu significativamente a mobilidade vertical e horizontal da junção uretrovesical, porém sem elevar a junção uretrovesical.

PURPOSE: to study the changes in the urethrovesical junction (UVJ) and in the proximal urethra (PU) caused by the Marshall-Marchetti-Krantz-Burch (MMK-B) combined surgery through perineal ultrasonography. METHODS: an interventional, longitudinal and prospective study has been conducted. Thirty-two women with stress urinary incontinence were submitted to perineal ultrasonography before and 30 days after surgery to evaluate the pubo-urethral distance (PUD), the proximal urethra length, the UVJ horizontal distance (UVJHD) and the UVJ vertical distance (UVJVD), the patient being at rest, and in effort during the Valsava manoeuvre. Results have been expressed in mean and standard deviation. The Student's t-test has been used to compare pre and postoperative results whenever the variables fulfilled the normality test criterion; otherwise, the Wilcoxon's paired test has been used. RESULTS: as compared with the preoperative measures, the Marshall-Marchetti-Krantz-Burch surgery has reduced the PUD at rest (14 mm x 4.3 mm) and during effort (20.8 mm x 6.4 mm); has reduced the UVJHD at rest (14 mm x 4.3 mm) and during effort (20.8 mm x 6.4 mm); has increased the PU length at rest (16.7 mm x 19.7 mm) and during effort (1.6 mm x 15.4 mm); and has increased UVJVD during effort (-5.4 mm x 14.8 mm), but has not changed it at rest (16.2 mm x 18.7 mm, p = 0.085). CONCLUSIONS: the Marshall-Marchetti-Krantz-Burch surgery has significantly reduced the urethrovesical junction vertical and horizontal mobility without raising the urethrovesical junction.

Ressonância magnética na endometriose do trato urinário baixo: ensaio iconográfico / Magnetic resonance imaging in lower urinary tract endometriosis: iconographic essay

Endometriose é definida como a presença de tecido endometrial funcionante fora da cavidade endometrial e do miométrio. É uma doença comum, de causas multifatoriais, porém o envolvimento do trato urinário baixo é raro. A ressonância magnética tem elevada sensibilidade, especificidade e acurácia no diagnóstico da endometriose do trato geniturinário baixo, principalmente por permitir a identificação das lesões de permeio a aderências e a avaliação da extensão das lesões subperitoneais. Neste estudo são ilustrados, sob a forma de ensaio iconográfico, os principais achados à ressonância magnética do envolvimento por endometriose do trato urinário baixo.

Endometriosis is defined as the presence of functional endometrial tissue outside the endometrial cavity and myometrium. Although this is a frequent disease with multifactorial causes, involvement of the lower urinary tract is rare. Magnetic resonance imaging is highly sensitive, specific and accurate in the diagnosis of endometriosis in the lower urinary tract, especially for allowing the identification of lesions obscured by adhesions or with subperitoneal extension. The present iconographic essay presents the main magnetic resonance imaging findings of the lower urinary tract involvement by endometriosis.

Prolapso uretral em cães: relato de casos / Urethral prolapse in the male dog: cases report / Prolapso uretral en perros: relato de casos

Anomalias da uretra canina são de baixa incidência, e podem ter causas congênitas ou adquiridas. O prolapso uretral em cães é uma afecção de fisiopatologia ainda não completamente elucidada. Acomete animais machos e jovens, sendo frequentemente observada em raças braquicefálicas, e seu diagnóstico é fundamentado pela visualização da mucosa uretral protrusa. Apesar da possibilidade de redução do prolapso através de manobras cirúrgicas menos traumáticas, o tratamento mais efetivo para esta afecção é a técnica de ressecção e anastomose do prolapso uretral. O presente trabalho teve como objetivo relatar a ocorrência de dois casos clínicos de prolapso uretral em cães assistidos no Setor de Cirurgia de Pequenos Animais do Hospital da Universidade Federal da Bahia, e avaliar a técnica utilizada como procedimento para a resolução do prolapso. Os resultados revelaram que a referida técnica é de fácil execução e eficácia comprovada, não sendo observadas recidivas em nenhum dos dois casos estudados.

Abnormalities of the canine urethra have low incidence, and may have congenital or acquired causes. Urethral prolapse in the male dog can be described as an unknown physiopathological affection. It has been observed in males and young animals, frequently in braquicefalic breeds, and its diagnosis is based on the visualization of the prolapsed urethral mucosa. Despite the possibility of reduction by the use of less traumatic surgical techniques, the most effective treatment for this affection is the technique of resection and anastomosis of the urethral prolapse. The aim of this paper was to report the occurrence of two urethral prolapse clinical cases in dogs, from Small Animal Surgery Sector of the Veterinary Hospital (Institution), and to analyze the technique applied as a procedure to resolute the prolapse. The results revealed that the referred technique has easy execution and prove efficacy, without recurrence in both studied cases.

Anomalías de la uretra canina son de baja incidencia, y pueden tener causas congénitas o adquiridas. El prolapso uretral en perros es una afección de fisiopatología aún no completamente elucidada. Acomete animales machos y hembras, siendo frecuentemente observada en razas braquiocefálicas, y su diagnóstico se confirma por la visualización de la mucosa uretral desplazada. A pesar de la posibilidad de reducción del prolapso, a través de maniobras quirúrgicas menos traumáticas, el tratamiento más efectivo para esta afección es la técnica de resección y anastomosis del prolapso uretral. Esta investigación tuvo como objeto relatar la ocurrencia de dos casos clínicos de prolapso uretral en perros atendidos en el Sector de Cirugía de Pequeños Animales de un hospital da Universidade Federal da Bahia, y evaluar la técnica utilizada como procedimiento para la resolución del prolapso. Los resultados revelaron que la referida técnica es de fácil ejecución y de eficacia comprobada, no siendo observadas recidivas en ningún de los dos casos estudiados.

Urethral catheter insertion forces: a comparison of experience and training

Purpose: This study was undertaken to evaluate the insertion forces utilized during simulated placement of a urethral catheter by healthcare individuals with a variety of catheter experience. Materials and Methods: A 21F urethral catheter was mounted to a metal spring. Participants were asked to press the tubing spring against a force gauge and stop when they met a level of resistance that would typically make them terminate a catheter placement. Simulated catheter insertion was repeated fives times, and peak compression forces were recorded. Healthcare professionals were divided into six groups according to their title: urology staff, non-urology staff, urology resident/ fellow, non-urology resident/ fellow, medical student, and registered nurse. Results: A total of fifty-seven healthcare professionals participated in the study. Urology staff (n = 6) had the lowest average insertion force for any group at 6.8 ± 2.0 Newtons (N). Medical students (n = 10) had the least amount of experience (1 ± 0 years) and the highest average insertion force range of 10.1 ± 3.7 N. Health care workers with greater than 25 years experience used significantly less force during catheter insertions (4.9 ± 1.8 N) compared to all groups (p < 0.01). Conclusions: We propose the maximum force that should be utilized during urethral catheter insertion is 5 Newtons. This force deserves validation in a larger population and should be considered when designing urethral catheters or creating catheter simulators. Understanding urethral catheter insertion forces may also aid in establishing competency parameters for health care professionals in training.

Caracterização histológica das margens em pacientes submetidos a uretroplastia anastomótica bulbar / Histological characterization of the urethral margins in patients undergoing anastomotic urethroplasty bulbar

Objetivo: A realização meticulosa de uma incisão ou excisão do segmento estenosado e da esponjofibrose associada tanto proximal quanto distal é critica para o sucesso da uretroplastia anterior. Entretanto, a normalidade das margens da uretra estenosada são determinadas durante o procedimento cirúrgico, baseadas apenas no aspecto macroscópico do tecido. Estudos microscópicos avaliando as margens normais não foram encontrados na literatura. O objetivo deste trabalho é caracterizar o aspecto histológico das margens supostamente normais da estenose da uretra masculina e o efeito causado pela realização de uma cistostomia suprapúbica, na microestrutura da extremidade uretral proximal à estenose. Materiais e Método: As amostras foram obtidas de 29 pacientes com média de idade de 40,3 anos, variando de 20 a 65 anos, que foram submetidos à uretroplastia bulbar término-terminal. Depois que o segmento estenosado foi removido, foram realizadas biópsias das extremidades supostamente sadias (proximais e distais). A caracterização estrutural foi realizada pelas seguintes colorações histológicas: Hematoxilina e Eosina, tricrômico de Masson, resorcina-fucsina de Weigert, e picrosirius polarizado. Pelo menos um mês antes da uretroplastia, foi realizada uma cistostomia suprapúbica em 15 pacientes (52%). O grupo controle consistiu de 10 uretras bulbares obtidas de cadáveres frescos, macroscopicamente normais, com média de idade de 24,7 anos (entre 21 e 32 anos). Resultados: A estenose de uretra se decorreu da retração cicatricial do tecido fibroso que ocupou os seios vasculares do corpo esponjoso. Este tecido foi constituído por uma matriz extracelular (MEC) densa em todos os pacientes. A MEC foi constituída, na sua maioria, principalmente por colágeno e fibras elásticas. Nenhum paciente apresentou as margens uretrais normais. Todas as extremidades apresentaram alterações microscópicas agudas e/ou crônicas quando comparadas ao grupo controle...

Purpose: Meticulous incision or excision of the stenotic segment and any associated proximal and distal spongiofibrosis is critical to the reliable success of urethroplasty procedures. However, normal urethral limits are determined during surgical reconstruction based on macroscopic aspects only. To our knowledge, microscopic studies evaluating the normal urethral ends have not been done. We aimed to describe the histological pattern of the presumed healthy limits of the urethral stricture disease, and the effect of a suprapubic urinary diversion on the proximal urethral end. Materials and Methods: Samples were obtained from 29 patients 20 to 65 years old (mean age 40.3) who underwent end-to-end bulbar urethroplasty. After urethral strictured segments were excised, biopsies of the presumed healthy ends (proximal and distal) were performed. Structural characterization was evaluated by staining histological sections in Haematoxylin-Eosin, Masson's trichrome, Weigert's resorcin-fuchsin method, and picrosirius-polarization method. At least one month before urethroplasty, suprapubic urinary diversion was performed in fifteen (52%) patients. The control group consisted of 10 bulbar urethras obtained from fresh, macroscopically normal cadavers 21 to 32 years old (mean age 24.7). Results: Urethral strictures were due to contraction of the fibrous tissue which has begun to replace the normal structures of the corpus spongiosum. A replacement of the vascular sinusoids in the corpus spongiosum by a dense extracellular matrix (ECM) occurred in all patients. ECM was formed mainly by collagen (vast majority of them) and elastic fibers. No patient presented microscopic normal urethral ends. All urethral edges presented chronic and/or acute microscopic changes if compared to the control group. With regard to the proximal end, the deposit of ECM presented high cellular density in 18 (62.1%) cases. These cells were predominantly fibroblast and inflammatory cells...

Histopathological evaluation of urethroplasty with dorsal buccal mucosa: an experimental study in rabbits

PURPOSE: Buccal mucosa is a widely accepted tissue for urethroplasty. The exact healing and tissue integration process, mainly the histological characteristics of dorsal buccal mucosa graft urethroplasty when used dorsally to reconstruct the urethral plate has not previously been assessed, and thus we developed an experimental model to address this question. MATERIALS AND METHODS: In 12 New Zealand rabbits (weight 2.5 kg) we surgically created a dorsal penile urethral defect. A buccal mucosa graft was sutured to the corpora and tunica albuginea, and the ventral urethra anastomosed to this new urethral plate. The animals were divided in three groups and sacrificed 1, 3 and 6 weeks after surgery (groups 1, 2 and 3). A retrograde urethrogram was obtained at autopsy in the last group and the penis analyzed histologically with hematoxylin-eosin and Masson's staining. RESULTS: The urethrograms showed no evidence of fistula or stricture. In group 1 the histopathological analysis showed submucosal lymph-mononuclear inflammatory edema, numerous eosinophils and squamous epithelium integrated into the adjacent urothelium. In group 2 there was no evidence of an inflammatory response but rather complete subepithelial hyaline healing, which was more marked in group 3. CONCLUSION: Healing of buccal mucosa grafts to reconstruct the urethral plate can be achieved by total integration of the squamous epithelium with the urothelium, maintaining the original histological properties of the graft with no fibrosis or retraction.