Current treatment options for craniofacial hyperhidrosis / Opções atuais de tratamento para hiperidrose craniofacial

Abstract Hyperhidrosis (HH) is characterized by sweating exceeding the amount necessary to meet the thermal regulation and physiological needs of the body. Approximately 9.41% of individuals with HH have craniofacial hyperhidrosis (FH). The present study aims to review the most current data in the literature regarding craniofacial hyperhidrosis, including pathophysiology, diagnosis and clinical presentation, treatment options (clinical and surgical), and outcomes. VATS (videothoracoscopy sympathectomy) is considered the gold standard for definitive treatment of axillary or palmar hyperhidrosis. Recently, several studies have shown the usefulness of clinical treatment with oxybutynin hydrochloride, leading to clinical improvement of HH in more than 70% of users. Both clinical and surgical treatment of craniofacial hyperhidrosis have good results. However, surgical treatment of FH is associated with more complications. Clinical treatment with oxybutynin hydrochloride yields good results and can be the first therapeutic option. When the patient is not satisfied with this treatment and has good clinical conditions, surgical treatment can be used safely.

Resumo A hiperidrose (HH) é caracterizada por transpiração além da quantidade necessária para manter a regulação térmica e as necessidades fisiológicas do corpo. Aproximadamente 9,41% dos indivíduos com HH apresentam hiperidrose craniofacial (FH). Este estudo tem como objetivo revisar os dados mais atuais da literatura sobre FH, incluindo fisiopatologia, diagnóstico e apresentação clínica, opções de tratamento (clínico e cirúrgico) e desfechos. A simpatectomia por videotoracoscopia (VATS) é considerada o padrão-ouro para o tratamento definitivo da hiperidrose axilar ou palmar. Recentemente, vários estudos demonstraram a utilidade do tratamento clínico com cloridrato de oxibutinina, que leva à melhora clínica da HH em mais de 70% dos pacientes. O tratamento clínico e o cirúrgico apresentam bons resultados no tratamento da FH. No entanto, o tratamento cirúrgico da FH apresenta mais complicações. O tratamento clínico com cloridrato de oxibutinina fornece bons resultados e pode ser a primeira opção terapêutica. Quando o paciente não está satisfeito com esse tratamento e mostra boas condições clínicas, o tratamento cirúrgico pode ser usado com segurança.

Brazilian consensus in enuresis-recomendations for clinical practice

ABSTRACT Introduction Enuresis, defined as an intermittent urinary incontinence that occurs during sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientific and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches. Materials and Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document. Results and Discussion Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.

Comparação entre oxibutinina, eletroestimulação do nervo tibial posterior e exercícios perineais no tratamento da síndrome da bexiga hiperativa / Comparación entre oxibutinina, electroestimulación del nervio tibial posterior y ejercicios perineales en el tratamiento del síndrome de la vejiga hiperactiva / Comparison of oxybutynin, electrostimulation of the posterior tibial nerve and perineal exercises in the treatment of overactive bladder syndrome

RESUMO Objetivou-se avaliar a eficácia dos exercícios perineais, da eletroestimulação transcutânea do nervo tibial posterior (ETNTP) e da oxibutinina em mulheres com síndrome da bexiga hiperativa, que é a segunda causa mais comum de incontinência urinária, com sintomas urinários extremamente incômodos que prejudicam a qualidade de vida. Foram randomizadas 65 mulheres, das quais 57 completaram o tratamento. Formaram-se três grupos: o de exercícios perineais, ETNTP e o grupo controle, que utilizou oxibutinina. Os exercícios foram realizados em grupo, nas posições em pé, supino e sentado, duas vezes por semana, com duração de 30 minutos cada sessão, totalizando 12 sessões. Na ETNTP utilizou-se eletrodo transcutâneo posicionado em maléolo medial e outro 10cm acima, com frequência de 10Hz e largura de pulso de 200 microssegundos, por 30 minutos, duas vezes por semana, totalizando 12 sessões. Na medicação as pacientes receberam oxibutinina de 10mg/dia de liberação imediata divididos e duas doses de 5mg/dia, durante 12 semanas consecutivas. Antes e depois dos tratamentos, as pacientes passaram por uma avaliação composta pela análise do diário miccional, avaliação funcional do assoalho pélvico e aplicação de questionário de qualidade de vida OAB-V8. Houve redução da incontinência de urgência em 50%, 70,5% e 41% nos grupos de exercício, ETNTP e oxibutinina, respectivamente, com significância estatística somente da eletroestimulação. As três modalidades de tratamento foram eficazes na melhora da qualidade de vida para a terapêutica em curto prazo, estatisticamente semelhantes entre si.

RESUMEN Se evaluó la eficacia de los ejercicios perineales, de la electroestimulación transcutánea del nervio tibial posterior (ETNTP) y de la oxibutinina en mujeres con síndrome de la vejiga hiperactiva, la segunda causa más común de incontinencia urinaria, con síntomas muy incómodos, que perjudican la calidad de vida. Sesenta y cinco mujeres, de las cuales 57 completaron el tratamiento, formaron tres grupos: el de ejercicios perineales, ETNTP y el grupo de control, que utilizó oxibutinina. Los ejercicios se realizaron en grupo, en las posiciones en pie, supino y sentado, dos veces por semana, con duración de 30 minutos cada sesión, totalizando 12 sesiones. En la ETNTP se utilizó electrodo transcutáneo posicionado en el maléolo medial y otro 10 cm arriba, con frecuencia de 10Hz y ancho de pulso de 200 microsegundos, por 30 minutos, dos veces por semana, totalizando 12 sesiones. En la medicación las pacientes recibieron oxibutinina de 10 mg/día de liberación inmediata, divididos en dos dosis de 5mg/día, durante 12 semanas consecutivas. Antes y después de los tratamientos, las pacientes pasaron por una evaluación compuesta por el análisis del diario miccional, la evaluación funcional del piso pélvico y la aplicación del cuestionario de calidad de vida OAB-V8. Se observó una reducción de la incontinencia de urgencia en un 50%, 70,5% y 41% en los grupos de ejercicio, ETNTP y oxibutinina, respectivamente, con significancia estadística solamente de la electroestimulación. Las tres modalidades de tratamiento fueron eficaces en la mejora de la calidad de vida para la terapéutica a corto plazo y estadísticamente similares.

ABSTRACT The objective of this study was to evaluate the efficacy of perineal exercises, transcutaneous electrostimulation of the posterior tibial nerve (TPTNS) and oxybutynin in women with overactive bladder syndrome, which is the second most common cause of urinary incontinence, with extremely uncomfortable urinary symptoms which impair their quality of life. A total of 65 women were randomized, of whom 57 completed treatment. Three groups were formed: the perineal exercises group, the TPTNS group and the control group, which used oxybutynin. The exercises were performed in groups, in the standing, supine and sitting positions, twice a week in 30-minute sessions, totaling 12 sessions. In the TPTNS group, carried out with 10Hz frequency and 200 microsecond pulse width, a transcutaneous electrode was positioned on the patients' medial malleolus, and another was positioned 10cm above it. The patients of the control group received 10 mg/day doses of immediate release oxybutynin, divided into two 5mg/day doses for 12 consecutive weeks. Before and after the treatments, the patients' voiding diary was analyzed, their pelvic floor was functionally evaluated and they were asked to fill in an OAB-V8 quality of life questionnaire. Urge incontinence was reduced by 50%, 70.5% and 41% in the exercises, TPTNS and oxybutynin groups, respectively, and statistical significance was detected for stimulation only. The three treatment modalities were effective for improving quality of life in the short-term therapy, and were statistically similar to each other.

Impact of overactive bladder on retrograde ejaculation

ABSTRACT Purpose: To evaluate the impact of overactive bladder disorder on patients diagnosed with retrograde ejaculation. Materials and Methods: Retrospective analysis of prospective collected database made. Questionnaires conducted in urology polyclinics in five different centers. Main Outcome Measure(s): International Index of Erectile Function - 5 (IIEF - 5), Overactive Bladder 8 - Question Awareness Tool (OAB - V8), urodynamics, semen analysis. The participants of the study were n = 120 patients. There was retrograde ejaculation (RE) in only n = 47 patients (non / minimal symptomatic patients), n = 73 patients had RE and overactive (OAB) complaints (symptomatic patients) and received anticholinergic treatment (trospium), n = 37 control group patients who only had OAB and received an anticholinergic. Results: While no difference was observed in overactive bladder examination and urodynamic values between the non / minimal symptomatic group and the symptomatic group (p > 0.05), sperm was detected and identified as fructose positive in post - ejaculation urine in the symptomatic group. Thus, it was possible to demonstrate the differences between symptomatic patients and non - symptomatic patients. Consequently, following three - month daily treatment with trospium 30 mg 2 x 1 in the control group and the symptomatic group, it was observed that an evident increase was observed in the sperm count and ejaculate volume in the symptomatic group and that no change was observed in the control group (p < 0.05). Conclusion: This clinical study is the first of its kind in terms of revealing the coexistence of RE with OAB upon performing urodynamics and showing that treatment is possible in selected patients.

Toxina botulínica para tratamento da sialorreia nos pacientes com doença de Parkinson / Botulinum toxin for treatment of sialorrhea in patients with Parkinson's disease

A sialorreia/ptialismo é um sintoma não motor frequente da doença de Parkinson, que pode causar impacto na saúde e na qualidade de vida dos pacientes. O sintoma decorre da combinação da disfagia com disautonomia e, muitas vezes, também do efeito adverso de drogas frequentemente utilizadas no tratamento de sintomas da doença, como por exemplo, os antipsicóticos atípicos e os inibidores da acetilcolinesterase. Diversas opções terapêuticas são utilizadas na prática clínica para controle da sialorreia, dentre elas, drogas anticolinérgicas ou antagonistas dos receptores adrenérgicos, injeção de toxina botulínica, cirurgia, radioterapia e terapias comportamentais e fonoaudiológicas. Este trabalho faz uma revisão das propostas terapêuticas até o presente momento para controlar a secreção de saliva dos pacientes com doença de Parkinson. A injeção de toxina botulínica nas glândulas salivares guiada por ultrassom é a opção com mais evidência de eficácia e segurança, de acordo com os últimos estudos.

Sialorrhea is a frequent nonmotor symptom in Parkinson´s disease (PD) that influences the patients' health and quality of life. The symptom arises from a combination of difficulty in swallowing saliva, autonomic dysfunction or as a side effect of frequent used drugs to control symptoms of the disease, as for example, atypical antipsychotics and acetylcholinesterase inhibitors. In clinical practice, different therapeutic approaches are used to control sialorrhea, such as anticholinergic or beta adrenergic antagonistic drugs, botulinum toxin injection, surgery, radiotherapy, behavioral psychotherapy and speech therapy. This paper reviews the therapeutic options available until now to control the loss of saliva from PD patient. Botulinum toxin injection in the salivary glands guided by ultrasound shows the best efficacy and security profile, according to the last published data.

Recurring priapism may be a symptom of voiding dysfunction – case report and literature review

ABSTRACT Recurring priapism is rare in pre-pubertal children and may be attributed to multiple causes. We propose that voiding dysfunction (VD) may also justify this symptom and detail a clinical case of recurring stuttering priapism associated to overactive bladder that completely resolved after usage of anticholinergics and urotherapy. Sacral parasympathetic activity is responsible for detrusor contraction and for spontaneous erections and a relationship between erections and bladder status has been proved in healthy subjects (morning erections) and models of medullar trauma. High bladder pressures and/or volumes, voiding incoordination and posterior urethritis can potentially trigger reflex erections.

Management of exogenous intoxication by carbamates and organophosphates at an emergency unit / Manejo de intoxicação exógena por carbamatos e organofosforados em uma unidade de emergência

Summary Objectives: to evaluate and indicate the procedure to be followed in the health unit, both for diagnosis and the treatment of acute exogenous intoxications by carbamates or organophosphates. Methods: a descriptive study based on retrospective analysis of the clinical history of patients diagnosed with intoxication by carbamates or organophosphates admitted at the emergency unit of the Hospital de Urgências de Sergipe Governador João Alves (HUSE) between January and December of 2012. Some criteria were evaluated, such as: intoxicating agent; patient's age and gender; place of event, cause, circumstances and severity of the intoxication; as well as signs and symptoms of the muscarinic, nicotinic and neurological effects. Results: seventy patients (average age: 25±19.97) formed the study's population. It was observed that 77.14% of them suffered carbamate intoxication. However, organophosphate intoxications were more severe, with 68.75% of patients presenting moderate to severe forms. Suicide attempt was the leading cause of poisoning, with 62 cases (88.57% of total). Atropine administration was an effective therapeutic approach for treating signs and symptoms, which included sialorrhea (p=0.0006), nausea (p=0. 0029) and emesis (p lt0.0001). The use of activated charcoal was shown effective, both in combating the signs and symptoms presented by both patient groups (p <0.0001). Conclusion: it is concluded that the use of atropine and activated charcoal is highly effective to treat the signs and symptoms developed by patients presenting acute exogenous intoxication by carbamates or organophosphates.

Resumo Objetivo: avaliar e indicar os procedimentos a serem seguidos na unidade de saúde tanto para o diagnóstico como para o tratamento de intoxicações agudas exógenas por carbamatos ou organofosforados. Métodos: estudo descritivo baseado na análise retrospectiva da história clínica de pacientes diagnosticados com intoxicação por carbamatos ou organofosforados admitidos em uma unidade de emergência, entre janeiro e dezembro de 2012. Foram avaliados alguns critérios, como: agente intoxicador; idade do paciente e gênero; causa de envolvimento, circunstâncias e gravidade da intoxicação; sinais e sintomas dos efeitos neurológicos muscarínicos e nicotínicos. Resultados: setenta pacientes (idade média: 25±19,97 anos) formaram a população de estudo. Foi observado que 77,14% deles sofreram intoxicação por carbamatos. Os casos mais graves foram intoxicados por organofosforados, com 68,75% dos pacientes apresentando formas moderadas a graves. Tentativa de suicídio foi a causa principal de envenenamento, com 62 casos (88,57% do total). A administração de atropina foi uma medida terapêutica efetiva para tratamento de sinais e sintomas, como sialorreia (p=0,0006), náusea (p=0,0029) e êmese (p<0,0001). O uso do carvão ativado mostrou efetividade para o combate dos sinais e sintomas apresentados por pacientes em geral (p<0,0001). Conclusão: o uso de atropina e de carvão ativado é uma medida terapêutica altamente efetiva para combater os sinais e sintomas apresentados por pacientes vítimas de intoxicação aguda exógena por carbamatos ou organofosforados.

The Ochoa urofacial syndrome: recognize the peculiar smile and avoid severe urological and renal complications / Síndrome urofacial de Ochoa: reconheça o sorriso peculiar e evite complicações urológicas e renais graves

Ochoa syndrome is rare and its major clinical problems frequently unrecognized. We describe facial characteristics of six patients to help health professional recognize the inverted smile that these patients present and refer them to proper treatment. Patients’ medical records were reviewed and patients’ urological status clinically reassessed. At last evaluation patients’ mean age was 15.5 years, and age ranged from 12 to 32 years. Mean follow-up was 35 months (12 to 60). Initial symptoms were urinary tract infections in four patients (67%) associated with enuresis and incontinence in three of them (50%). One patient had only urinary tract infection and two lower urinary tract symptoms without infections. Initial treatment consisted of clean intermittent catheterization with anticholinergics for all patients. Four patients (67%) were submitted to bladder augmentation. Two patients had end-stage renal disease during follow-up, one received kidney transplantation and one patient remained on the waiting list for a renal transplantation. Familial consanguinity was present in only one case. This significant condition is rare, but it must be recognized by pediatricians, nephrologists and urologists in order to institute early aggressive urological treatment.

A síndrome de Ochoa é rara, e seus principais problemas clínicos são frequentemente não reconhecidos. Descrevem-se aqui características faciais de seis pacientes para auxiliar profissionais de saúde a reconhecer o sorriso invertido que eles apresentam e encaminhá-los para o tratamento adequado. Os prontuários médicos foram revisados e a condição urológica dos pacientes foi reavaliada clinicamente. A média de idade na última avaliação foi de 15,5 anos, variando de 12 a 32 anos. O seguimento médio foi de 35 meses (12 a 60). Os sintomas iniciais foram infecções do trato urinário em quatro pacientes (67%) associadas com enurese e incontinência urinária em três deles (50%). Um paciente apresentou infecções do trato urinário isoladamente e dois apresentaram sintomas do trato urinário inferior, porém sem infecções. O tratamento inicial consistiu em cateterismo intermitente limpo, com anticolinérgicos em todos os pacientes. Reconstrução urinária foi realizada em quatro pacientes (67%) por meio de ampliação vesical. Dois pacientes apresentaram doença renal em estágio terminal no seguimento, um recebeu transplante renal e outro manteve-se em lista de espera para transplante renal. Consanguinidade familiar esteve presente em apenas um caso. Essa condição significativa é rara, porém deve ser reconhecida por pediatras, nefrologistas e urologistas, a fim de instituir tratamento urológico agressivo precoce.

Bladder control training in girls with lower urinary tract dysfunction

Purpose To evaluate the efficacy of standard and biofeedback bladder control training (BCT) on the resolution of dysfunctional elimination syndrome (primary outcome), and on the reduction of urinary tract infections (UTI) and the use of medications such as antibacterial prophylaxis and/or anticholinergic/alpha-blockers (secondary outcome) in girls older than aged least 5 years. Materials and Methods 72 girls, median age of 8 years (interquartile range, IQR 7-10) were subjected to standard BCT (cognitive, behavioural and constipation treatment) and 12 one-hour sessions of animated biofeedback using interactive computer games within 8 weeks. Fifty patients were reevaluated after median 11 (IQR, 6-17) months. Effectiveness of BCT was determined by reduction of dysfunctional voiding score (DVS), daytime urinary incontinence (DUI), constipation, UTI, nocturnal enuresis (NE), post void residual (PVR), and improvements in bladder capacity and uroflow/EMG patterns. Results BCT resulted in significant normalization of DUI, NE, constipation, bladder capacity, uroflow/EMG, while decrease of PVR didn't reach statistical significance. In addition, the incidence of UTI, antibacterial prophylaxis and medical urotherapy significantly decreased. There were no significant differences in DVS, DUI, NE, bladder capacity and voiding pattern at the end of the BCT and at the time of reevaluation. The success on BCT was supported by parenteral perception of the treatment response in 63.9% and full response in additional 15.3% of the patients. Conclusion Combination of standard and biofeedback BCT improved dysfunctional elimination syndrome and decreased UTI with discontinuation of antibacterial prophylaxis and/or anticholinergic/alpha-blockers in the majority of the patients. Better training results are expected in patients with higher bladder wall thickness as well as in those with vesicoureteral reflux, ...

DPOC - Sigla pequena para um problema enorme / COPD - Acronym short for a huge problem

A doença pulmonar obstrutiva crônica (DPOC) é um grave problema de saúde e uma das principais causas de morte em todo o mundo. Dentre os vários fatores de risco de DPOC, o fumo e a exposição à queima de biomassa são os principais. Embora seja chamada de doença respiratória, não compromete apenas os pulmões: muitos pacientes apresentam diversas manifestações sistêmicas que amplificam a perda da capacidade funcional e da qualidade de vida. Além disso, a DPOC está associada a diversas outras comorbidades, tais como doenças cardiovasculares, osteoporose, diabetes e síndrome metabólica

Chronic obstructive pulmonary disease (COPD) is a major health challenge and a leading cause of death worldwide. COPD has many risk factors, with exposition to smoke from biomass fuel and tobacco smoking being the most important ones. Although it is called a respiratory disease, COPD extends beyond the lung and many patients have several systemic manifestations that amplify the losses in functional capacity and in health-related quality of life. Besides, COPD is associated with several other diaseses, such as cardiovascular diseases, osteoporosis, diabetes, and metabolic syndrome

Abuso de anticolinérgicos en pacientes con esquizofrenia: reportes de caso y breve revisión de la literatura / Abuse of anticholinergic drugsin schizophrenic patients: case reports and brief literature review

Introducción: El abuso de fármacos anticolinérgicos es un problema que ocasionalmente se ha reportado en la literatura médica aunque al parecer su frecuencia puede ser mayor a lo considerado usualmente; sobre todo en pacientes con esquizofrenia, donde se indica anticolinérgicos para contrarrestar los síntomas extrapiramidales secundarios al uso de antipsicóticos, es donde se detectan la mayoría de casos. Método: reportamos cuatro casos de pacientes con esquizofrenia que abusaban de anticolinérgicos y revisamos la literatura pertinente. Resultados: El uso excesivo de anticolinérgicos por pacientes con esquizofrenia ha sido atribuido a su intento de controlar síntomas depresivos o negativos o la disforia inducida por antipsicóticos sin embargo no hay usualmente correlación entre el uso de antipsicóticos y el abuso de anticolinérgicos; por tanto, es menester considerar el potencial de abuso de los anticolinérgicos. Conclusión: Se impone revisar la indiscriminada prescripción de fármacos anticolinérgicos a los usuarios de antipsicóticos de modo tal que el riesgo de abuso se detecte tempranamente.

Introduction: The abuse of anticholinergic drugs is a problem occasionally reported in the medical literature although it has been suggested that its frequency is higher than usually considered. Since the main indication of anticholinergics today is to alleviate extrapyramidal symptoms in patients using antipsychotics, several cases of excessive use of anticholinergic drugs in schizophrenic patients are detected in psychiatric practice. Method: We report four schizophrenic patients who used anticholinergic drugs in excessive doses and we review the respective bibliography. Results: The excessive use of anticholinergic drugs by schizophrenic patients has been attributed to their attempt to counteract their negative symptoms, depressive symptoms or the dysphoria induced by antipsychotics, however, there is not usually correlation between the use of neuroleptics and anticholinergics abuse; therefore it is necessary to take into account the addictive potential of antiparkinson drugs. Conclusion: We advise to review the extensive prescription of anticholinergic drugs to antipsychotic users so the risk of anticholinergic drug abuse can be detected early.

Botulinum toxin A in the treatment of spinal cord injury patients with refractory neurogenic detrusor overactivity

PURPOSE: To evaluate the efficacy of botulinum toxin type A injections in the detrusor muscle in patients with spinal cord injury and urinary incontinence due to detrusor overactivity and refractory to anticholinergic agents. MATERIALS AND METHODS: We prospectively evaluated 22 patients with spinal cord injuries, whose bladders were emptied by intermittent catheterization. All patients had detrusor overactivity and urinary incontinence that proved difficult to treat, despite using high doses of two different anticholinergics. The pre-treatment assessment included a complete urodynamic study and ultrasonography of the kidneys and urinary tract. A one-month follow-up was completed with urodynamic evaluation and the clinical response was evaluated through outpatient consultations and telephone contact. RESULTS: After the procedure, the maximum cystometric capacity and the bladder reflex volume increased, whereas the maximum detrusor pressure and compliance decreased. The mean duration of continence was 7 ± 7 months. In 18 patients (81.8 percent), it was necessary to administer anticholinergics to achieve continence. Five patients (22.7 percent) had indication of reinjection, and augmentation cystoplasty was indicated in 9 patients (40.9 percent). CONCLUSION: The use of botulinum toxin in the treatment of neurogenic detrusor overactivity refractory to anticholinergics is an option before more invasive treatments, such as augmentation cystoplasty, are attempted. In our study as well as in the literature, there was improvement in most urodynamic parameters. Overall, 40.9 percent of patients underwent augmentation cystoplasty and 81.8 percent of patients needed anticholinergic agents to reach urinary continence. Further studies are necessary to improve the procedure and to achieve better clinical results.

The Urologist's View of Male Overactive Bladder: Discrepancy between Reality and Belief in Practical Setting

PURPOSE: In order to gain insight into the physicians' awareness of and attitude towards management of overactive bladder (OAB) in males, we performed a nationwide survey of the current strategies that urologists use to diagnose and manage OAB in male patients. MATERIALS AND METHODS: A probability sample was taken from the Korean Urological Association Registry of Physicians, and a random sample of 289 Korean urologists were mailed a structured questionnaire that explored how they manage benign prostatic hyperplasia (BPH). RESULTS: A total of 185 completed questionnaires were returned. The consent rate in the survey was 64.5%. Eighty-one (44%) urologists believed that of all males with lower urinary tract symptoms (LUTS), 20% or more had OAB and 72 (39%) believed that 10-20% had OAB. Half of the urologists surveyed believed that the most bothersome symptom in male OAB patients was nocturia. Seventy-three percent of respondents reported that they prescribed alpha blockers with anticholinergics for first line management, while 19% of urologists prescribed alpha blocker monotherapy but not anticholinergics for OAB patients. Though acute urinary retention (AUR) was considered the anticholinergic adverse event of most concern, the most frequently observed adverse event was dry mouth (95%). CONCLUSION: The present study provides insights into urologist views of male OAB. There is a discrepancy between the awareness of urologists and actual patterns of diagnosis and treatment of male OAB. This finding indicates the need to develop further practical guidelines based on solid clinical data.

Topical tropicamide induced delirium and psychosis: case report / Delírio e psicose induzidos por tropicamida tópica: relato de caso

Acute psychosis and confusional states are known complications of treatment with anticholinergic agents in the elderly. We report an 87-year-old female patient presenting with acute neurobehavioral abnormalities requiring hospitalization immediately after starting treatment for openangle glaucoma with the topic cycloplegic muscarinic receptor blocker tropicamide. Case-effect relationship was confirmed. The authors make a review of the literature trying to identify the clinical manifestations and risk factors for this complication.

Tratamento com drogas anticolinérgicas é uma causa conhecida de alterações agudas do estado mental em idosos. Relata-se o caso de uma paciente de 87 anos de idade com alterações comportamentais agudas, que necessita de internamento imediatamente após início de terapia para glaucoma de ângulo aberto com tropicamida, um agente cicloplégico bloqueador de receptor muscarínico. A relação causa-efeito foi confirmada depois de a droga ter sido reiniciada durante o internamento. É apresentada uma revisão da literatura delineando as manifestações clínicas mais comuns e fatores de risco para essa complicação.

Uso da toxina botulínica A na bexiga hiperativa refratária aos anticolinergicos / Use of A-botulinum toxin into overactive bladder resistant to anticholinergic drugs

A síndrome da bexiga hiperativa é freqüente e pode acometer pacientes em diferentes faixas etárias. Incide mais entre mulheres a partir da quinta década de vida. Possui grande impacto negativo na qualidade de vida. Os anticolinérgicos administrados pela via oral são medicações de primeira escolha para o seu tratamento. Este relato apresenta um caso de bexiga hiperativa refratária ao uso dos anticolinérgicos que respondeu ao tratamento com a toxina botulínica A intra-vesical.

Aspectos atuais no tratamento da bexiga hiperativa / Overactive bladder treatment: up to date

Os autores fazem revisão da literatura sobre os aspectos atuais do tratamento da bexiga hiperativa, afecção que compromete de forma significativa a qualidade de vida das mulheres. São analisadas, quanto à eficácia e efeitos colaterais, as diversas modalidades de tratamento, como a terapêutica medicamentosa, com suas doses e vias de administração, as medidas comportamentais, os exercícios perineais, a eletroestimulação transvaginal e do nervo tibial posterior, a neuromodulação sacral, a acupuntura e, também, a toxina botulínica intravesical. Citam ainda as novas drogas já aprovadas na Europa e nos Estados Unidos, com perspectiva de aprovação para sua utilização no Brasil e as expectativas futuras no tratamento desta afecção.

The authors reviewed the worldwide literature about the current aspects of the overactive bladder syndrome treatment, disease that significantly compromises the women's quality of life. Several types of the treatment are analyzed as efficacy and adverse effects on present medical treatment to coadjuvant therapies, like handling medically with doses and administration, behavior measurements, perineal exercises, transvaginal eletrostimulation, posterior tibial nerve stimulation, sacral nerve neuromodulation, acupuncture and also intravesical botox application. This article also emphasizes new perspectives of medical treatment relating drugs that have already been approved in Europe and United States and will probably be approved to be used in Brazil.

Movement disorders in children: Recent advances in management.

In recent years there has been a growing interest towards pediatric movement disorders (PMD). The data derived from the synthesis of clinical observation, neuroimaging, biochemical and, molecular genetics studies have allowed for the identification of a significant number of pediatric diseases featuring movement disorders. The purpose of this review is to outline an approach to the advances in management of dystonia, neurotransmitter disorders, tics, and paroxysmal dyskinetic syndromes starting in children younger than 18 yr of age.

Atualidades no tratamento da bexiga hiperativa / Treatment of overactive bladder actualities

A síndrome da bexiga hiperativa (OAB) é definida pela Sociedade Internacional de Continência (ICS) como uma síndrome clínica de disfunção do trato urinário inferior, que compreende os sintomas de urgência, com ou sem urge-continência, normalmente acompanhada de polaciúria e noctúria. A OAB é uma condição comum, afetando em torne de 16 por cento a 22 por cento dos indivíduos adultos. A prevalência média de incontinência urinária em mulheres varia entre 14 por cento e 40 por cento (23,5 por cento usando os critérios de definição da ICS). Múltiplas intervenções têm se mostrado eficazes no tratamento da bexiga hiperativa. A terapia combinada é crucial para se obter melhores resultados com os pacientes incontinentes. A terapia pode incluir restrição hídrica, micções programadas, utilização de fármacos e fisioterapia. O papel de cada terapêutica constituinte irá variar para cada indivíduo, e um único indivíduo poderá necessitar da adição ou da conversão de terapias alternativas, dependendo da resposta à intervenção inicial.

The syndrome of the overactive bladder (OAB) is defined by the International Continence Society (ICS) as a clinical syndrome of dysfunction of the lower urinary tract that understands the urgency symptoms, with or without urge-incontinence, normally with polyuria and nocturia. The OAB is a common condition affecting around 16 per cent to 22 per cent of the adult individuals in USA with higher taxes for elderly patients. The average prevalence of urinary incontinence in women varies between 14 per cent and 40,5 per cent (23,5 per cent using the criteria of definition of the ICS). Multiple interventions have show efficient in the treatment of the overactive bladder. The multiple therapy is crucial to get itself better resulted with the incontinences patients. The therapy can include: water restriction, voiding programmed, pharmacology and physical therapy. The role of each therapeutical constituent will go to vary for each individual, and an only individual will be able to need the addiction or conversion of alternative therapies depending on the reply to the inicial intervention.