Association of physical therapy techniques can improve pain and urinary symptoms outcomes in women with bladder pain syndrome. A randomized controlled trial

ABSTRACT Purpose: to verify the effects of biofeedback (BF) and manual therapy (MT) associated with transcutaneous electrical nerve stimulation (TENS) or postural exercises (PE) in the treatment of bladder pain syndrome (BPS) in women regarding pain and urinary symptoms. Materials and Methods: a parallel-randomized controlled trial was conducted in BPS patients diagnosed according to NIH clinical criteria. Two specialized physiotherapists applied demographic and validated questionnaires of perineal and suprapubic pain (VAS), urinary symptoms and problems (ICSI and ICPI) and sexual function (FSFI) and a physical assessment was made to identify myofascial trigger points. Thirty-one women, mean age 51.8 ± 10.9 were randomized in three groups of treatment consisting of ten weekly sessions of BF and MT (Conventional group); BF, MT, and TENS (TENS group); and BF, MT, and PE (Postural group). Results: Postural group improved perineal and suprapubic pain after treatment (p<0.001 and p=0.001, respectively), and the suprapubic pain improvement remained persistent at 3 months of follow up (p=0.001). Postural group improved urinary symptoms and problems after treatment (p<0.001 and p=0.005, respectively) and during follow up (p<0.001 and p=0.001). Conclusions: Biofeedback and manual therapy associated with postural exercises showed a significant improvement in perineal and suprapubic pain and urinary symptoms after treatment and during follow-up. Both results suggest a possible role for the use of this physiotherapy technique to treat BPS patients. Longer follow-up and a larger number of patients are necessary to confirm these conclusions.

Evaluation of the metabolism of glycosaminoglycans in patients with interstitial cystis

Introduction: Painful bladder syndrome/interstitial cystitis (PBS/IC) pathogenesis is not fully known, but evidence shows that glycosaminoglycans (GAG) of bladder urothelium can participate in its genesis. The loss of these compounds facilitates the contact of urine compounds with deeper portions of bladder wall triggering an inflammatory process. We investigated GAG in urine and tissue of PBS/IC and pure stress urinary incontinence (SUI) patients to better understand its metabolism. Materials and Methods: Tissue and urine of 11 patients with PBS/IC according to NIDDK criteria were compared to 11 SUI patients. Tissue samples were analyzed by histological, immunohistochemistry and immunofluorescence methods. Statistical analysis were performed using t Student test and Anova, considering significant when p < 0.05. Results: PBS/IC patients had lower concentration of GAG in urine when compared to SUI (respectively 0.45 ± 0.11 x 0.62 ± 0.13 mg/mg creatinine, p < 0.05). However, there was no reduction of the content of GAG in the urothelium of both groups. Immunofluorescence showed that PBS/IC patients had a stronger staining of TGF-beta, decorin (a proteoglycan of chondroitin/dermatan sulfate), fibronectin and hyaluronic acid. Conclusion: the results suggest that GAG may be related to the ongoing process of inflammation and remodeling of the dysfunctional urothelium that is present in the PBS/IC. .

Renal artery pseudoaneurysm after blunt renal trauma: report on three cases and review of the literature / Pseudoaneurisma de arteria renal apos trauma renal fechado: relato de tres casos e revisao da literatura

CONTEXT: Renal artery pseudoaneurysm is a rare complication after renal injury but should be suspected whenever there is recurrent hematuria after renal trauma. CASE REPORTS: We present three cases of pseudoaneurysm after blunt renal trauma and a review of the literature. All patients underwent renal angiography. Two cases were diagnosed during the initial hospital stay due to hematuria, or in the follow-up period during recovery. One patient was hemodynamically unstable. Two patients successfully underwent coil embolization in a single session. In the other case, selective embolization was attempted, but was unsuccessful because artery catheterization was impossible. Procedural and medical success and complications were retrospectively assessed from the patients' records. The clinical presentation, treatment options and clinical decisions are discussed. CONCLUSIONS: Renal artery pseudoaneurysm may develop acutely or even years after the initial injury. Signs and symptoms may have a wide spectrum of presentation. Selective angiographic embolization is an effective treatment that reduces the extent of parenchymal infarction. .

CONTEXTO: Pseudoaneurisma de artéria renal é uma complicação rara após lesão renal, mas deve ser suspeitada quando houver hematúria recorrente após trauma renal. RELATO DE CASOS: Três casos de pseudoaneurisma após trauma renal fechado são apresentados, além de revisão da literatura. Todos os pacientes foram submetidos a angiografia renal. Dois dos casos foram diagnosticados durante a estadia hospitalar inicial, por hematúria ou no período de acompanhamento durante a recuperação. Um paciente estava hemodinamicamente instável. Dois pacientes foram submetidos a embolização com coil com sucesso em uma única sessão. No outro caso, a embolização seletiva foi tentada sem sucesso, devido à impossibilidade de cateterização da artéria. O sucesso médico e do procedimento e as complicações foram retrospectivamente avaliados a partir dos registros dos pacientes. A apresentação clínica, opções de tratamento e decisões clínicas são discutidas. CONCLUSÕES: Pseudoaneurisma de artéria renal pode se desenvolver agudamente ou até mesmo anos após o trauma inicial. Sinais e sintomas podem ter um amplo espectro de apresentação. Embolização angiográfica seletiva é um tratamento efetivo, reduzindo a extensão de infarto parenquimatoso. .

Laparoscopic ureteropyeloanastomosis in the treatment of duplex system

PURPOSE: Duplex system is one of the most common anomalies of upper urinary tract. Anatomical and clinical presentation determine its treatment. Usually, the upper moiety has a poor function and requires resection, but when it is not significantly impaired, preservation is recommended. Laparoscopic reconstruction with upper pole preservation is presented as an alternative treatment. MATERIALS AND METHODS: Four female patients with duplex system, one presenting with recurrent urinary tract infection and the others with urinary incontinence associated to infrasphincteric ectopic ureter, were treated. Surgical procedure envolved a laparoscopic ureteropyeloanastomosis of the upper pole ureter to the pelvis of the lower moiety, with prior insertion of a double J stent. RESULTS: Surgical time varied from 120 to 150 minutes, with minimal blood loss in all cases. Follow-up varied from 15 to 30 months, with resolution of the clinical symptoms and preservation of the upper moiety function. CONCLUSION: Laparoscopic ureteropyeloanatomosis is a feasible and safe minimally invasive option in the treatment of duplex system.

Paternity after vasectomy with two previous semen analyses without spermatozoa

CONTEXT: The risk of paternity after vasectomy is rare but still exists. Overall failure to achieve sterility after vasectomy occurs in 0.2 to 5.3 percent of patients due to technical failure or recanalization. The objective of this report was to describe a rare but notable case of proven paternity in which the semen analyses had not given evidence of spermatozoa. CASE REPORT: A 44-year-old vasectomized man whose semen analyses had shown azoospermia became a father four years after sterilization. Blood sample DNA analysis on the child and husband proved biological paternity. Vasectomy may fail in the long run even without spermatozoa in semen analysis. The patient must be aware of this possibility.

CONTEXTO: O risco de paternidade após vasectomia é raro, mas existente. Falha em atingir esterilidade após vasectomia ocorre em 0.2 por cento a 5.3 por cento dos pacientes devido à falha técnica ou recanalização. O objetivo é descrever um caso raro, mas importante, de paternidade comprovada cujo espermograma mostrava ausência de espermatozóides. RELATO DE CASO: Um homem de 44 anos vasectomizado, cujo espermograma evidenciou azoospermia, tornou-se pai após quatro anos da esterilização. Análise sanguínea por DNA da criança e do marido provou paternidade biológica. Vasectomia pode falhar a longo prazo até com azoospermia no espermograma. O paciente deve estar informado dessa possibilidade.

Bilateral nephrectomy of huge polycystic kidneys associated with a rectus abdominis diastasis and umbilical hernia / Nefrectomia bilateral para doença renal policística gigante associada à diástase do reto abdominal e hérnia umbilical

BACKGROUND: Patients with end-stage renal failure due to huge autosomal dominant polycystic kidney disease usually have an umbilical hernia and rectus abdominis diastasis, which are very troublesome. Pretransplant bilateral nephrectomy techniques does not manage the umbilical hernia and rectus abdominis diastasis. We report our experience in performing bilateral nephrectomy and repairing the rectus abdominis diastasis and umbilical hernia through the one, small incision. METHODS: Four patients aged 37 to 43 years with huge polycystic kidneys, an umbilical hernia, and a rectus abdominis diastasis underwent bilateral pretransplant nephrectomy through a midline supraumbilical incision including the umbilical hernia defect. The kidneys were removed through this incision. The incision was closed with the transposition of rectus abdominis muscle, pants-over-vest-style, to correct the diastasis and the umbilical hernia. RESULTS: The average operative time was 160 minutes (range, 130-180); the average larger kidney size was 33 cm (range, 32-34 cm); no major complications occurred; one patient who had preoperative low hemoglobin required blood transfusion. Patients were discharged from the hospital on postoperative day 7 with an esthetically pleasing belly, no rectus abdominis diastasis, and no umbilical hernia. One to two months after bilateral nephrectomy, the patients received a live donor kidney with an uneventful outcome. CONCLUSION: A midline supraumbilical incision is an excellent approach for bilateral nephrectomy of huge polycystic kidneys. In addition, an umbilical hernia and rectus abdominis diastasis may be successfully repaired through same incision with good cosmetic results.

INTRODUÇÃO: Pacientes com insuficiência renal terminal por Doença Renal Policística Autossômica Dominante geralmente apresentam hérnia umbilical e diástase de músculo reto abdominal, que são muito problemáticas. Técnicas de nefrectomia bilateral pré-transplante não dão atenção à hérnia umbilical e à diástase do músculo reto abdominal. Relatamos nossa experiência com nefrectomia bilateral e correção da diastase de músculo reto abdominal e hérnia umbilical através de uma única pequena incisão. MÉTODOS: Quatro pacientes com idade entre 37 a 43 anos com Doença Renal Policística Autossômica Dominante gigante, hérnia umbilical e diástase do múculo reto abdominal foram submetidos à nefrectomia bilateral pré-transplante através de incisão mediana supra-umbilical incluindo o defeito herniário umbilical. Os rins foram removidos através da pequena incisão mediana. A incisão foi fechada com transposição do músculo reto abdominal tipo jaquetão para corrigir a diastase e a hernia umbilical. RESULTADOS: O tempo operatório médio foi 160 minutos (130-180); o tamanho médio do maior rim foi 33cm (32-34); não ocorreram grandes complicações; um paciente, que tinha baixo nível de hemoglobina pré-operatório e precisou de transfusão sangüínea. Pacientes receberam alta hospitalar no 7° pós-operatório com abdome de boa aparência, sem diástase de músculo reto abdominal e sem hérnia umbilical. Os pacientes receberam enxerto renal de doador vivo um ou dois meses após a nefrectomia bilateral, sem intercorrências. CONCLUSÃO: A incisão mediana supra-umbilical é uma abordagem excelente para nefrectomia bilateral de rins policísticos gigantes. Além disso, a hernia umbilical e a diastase de músculo reto abdominal podem ser corrigidas com sucesso pela mesma incisão, com bons resultados cosméticos.

Avaliaçäo da disfunçäo erétil em pacientes com doença de Parkinson / Assessment of erectile dysfunction in patients with Parkinson's disease

Trinta indivíduos portadores de doença de Parkinson (DP) e 30 indivíduos controle foram estudados prospectivamente, através do Índice Internacional de Função Erétil (IIFE) a propósito de avaliar a ocorrência de disfunção erétil (DE). Dos pacientes com DP (idade mediana de 59 anos), 46,66 por cento referiram prática de atividade sexual. Todos parkinsonianos usavam medicação antiparkinsoniana. Neste grupo, 30,00 por cento tinham hipertensão arterial e 6,66 por cento diabetes melitus. No grupo controle (idade mediana de 63 anos), 76,66 por cento declararam prática de atividade sexual; 46,6 por cento tinham hipertensão arterial e 6,66 por cento diabetes mellitus. Escore médio para portadores de DP no IIFE foi 34 e para os controles 50. As principais diferenças entre os dois grupos foram quanto à função erétil, função orgasmo e satisfação com a relação sexual. O IIFE é uma escala amplamente aceita para avaliação da disfunção erétil. Os dados obtidos sugerem que a DE é mais frequente entre parkinsonianos, ressaltando o papel da DP como causa de DE nesse grupo.

Primary aortoenteric fistula related to septic aortitis

CONTEXT: Primary aortoenteric fistulas usually result from erosion of the bowel wall due to an associated abdominal aortic aneurysm. A few patients have been described with other etiologies such as pseudoaneurysm originating from septic aortitis caused by Salmonella. OBJECTIVE: To present a rare clinical case of pseudoaneurysm caused by septic aortitis that evolved into an aortoenteric fistula. CASE REPORT: A 65-year-old woman was admitted with Salmonella bacteremia that evolved to septic aortitis. An aortic pseudoaneurysm secondary to the aortitis had eroded the transition between duodenum and jejunum, and an aortoenteric fistula was formed. In the operating room, the affected aorta and intestinal area were excised and an intestine-to-intestine anastomosis was performed. The aorta was sutured and an axillofemoral bypass was carried out. In the intensive care unit, the patient had a cardiac arrest that evolved to death

Alterações no sistema de fibras elásticas de fáscia endopélvica de paciente jovem com prolapso uterino / Elastic fiber system changes in the endopelvic fascia of a young patient with uterine prolapse - a case report

É apresentado um caso de prolapso do útero de 2º grau em paciente de 18 anos, virgem. Durante o ato cirúrgico corretivo (cirurgia de Gillian) foram recolhidas amostras dos ligamentos e fáscias para avaliação do sistema de fibras elásticas. Foram demonstradas alterações estruturais nas fibras elásticas semelhantes às que ocorrem no envelhecimento, o que promove o enfraquecimento do tecido conjuntivo induzindo ao defeito de suporte do assoalho pélvico.