Exame de urina no consultório / Urinalysis at office

Avaliar a interpretação dos resultados de exames de urina solicitados nos consultórios e sua consequ~encia no diagnóstico inicial comparando com o diagnóstico definitivo Exames de urina, num total de 392, de diferentes pacientes, provenientes de 12 cidades, 6 estados e 32 laborótórios, solicitados, analisados e inicialmente diagnosticados por 392 médicos diferentes de diversas especialidades, foram revisados ante a indicação de permanência dos sintomas iniciais, alteração do exame ou por procura espontânea dos interessados, motivados pela falta de melhora daqueles sintomas. O diagnóstico definitivo fundamentou-se na clínica, nos sintomas e nos exames complementares realizados no ato da consulta. Questionou-se com os pacientes a maneira de coleta do material para análise. Analisaram-se quais achados do exame de urina preponderaram para o diagnóstico inicial como leucócitos, hemácias,cristais e presença ou não de sedimento corado. Os sintomas de LUTS, acompanhados ou não de febre e dor lombar, foram os mais frequentes. Exame laboratorial riotineiramente solicitados por profissionais de todas especialidades médicas, continua sendo mal indicado e mal interpretado. Concluímos que há necessidade de maior atenção quanto à oientação de exames básicos nos programas de graduação e residência médica, pelo grande número de indicativos negativos desses exames.

Search and identification of spermatozoa and spermatids in the ejaculate of non-obstructive azoospermic patients

OBJECTIVE: To search and to identify spermatozoa and spermatids, present in the ejaculate of non-obstructive azoospermic patients. MATERIALS AND METHODS: 27 patients, aged between 18 and 48 years, with initial diagnosis compatible with non-obstructive azoospermia, underwent up to 3 seminal samples, with assessment of macroscopic and microscopic parameters differentiated for each sample. In the first sample, 5 æL of semen were analyzed in a Horwell chamber in order to assess the presence or absence of spermatozoa. The procedure was repeated with 2 other aliquots. In the absence of spermatozoa, the entire sample was transferred to a conic tube and following centrifugation the sediment was freshly analyzed. The second seminal sample was collected only when no spermatozoa were found in the first sample and the research was performed in the same way. In cases where spermatozoa were not seen, the sample was centrifuged and the obtained sediment was stained by the panoptic method and observed under common light microscopy (1250X). The third seminal sample was collected only in cases when patients had not shown spermatozoa in the first and second seminal samples. RESULTS: 4/27 (14.8 percent) patients presented spermatozoa in the first seminal sample and 6/23 (26.1 percent), in the second seminal sample. No spermatozoa were seen in the third sample, however, 11/17 (64.7 percent) presented spermatids. CONCLUSION: In clinical situations where the initial diagnosis is non-obstructive azoospermia, one single routine seminal analysis is not enough to confirm this diagnosis and the analysis of the centrifuged sediment can have relevant clinical consequences. Among patients considered non-obstructive azoospermic, when duly assessed, 37 percent presented spermatozoa and 64.7 percent, spermatids.