Impact of deep resection of endometriosis in the pelvis on urodynamic parameters

Purpose: To evaluate the effects of deep resection of endometriosis in the posterior pelvic region on urodynamic parameters. Methods: A prospective observational study conducted with female patients diagnosed with deep pelvic endometriosis before and after endometriosis resection surgery. Clinical history, image exams, the Female Lower Urinary Tract Symptoms questionnaire, urodynamic examination, cystometry, and voiding study were evaluated. Results: Patients aged 30-39 years old, operative duration of 132.5 minutes, and 2.7 days of hospital stay. Uroflowmetry and cystometry showed tendency for an increase after the surgery in the flow duration, time to maximum flow, and first voiding desire and decreased residual volume and maximum cystometric capacity. Opening, maximum urinary flow, and maximum flow pressure decreased at T1, and the closing parameters increased, although statistically non significant. The variables decreased at T1 in the urodynamic, except for detrusor overactivity. Although we observed a reasonable number of low bladder compliance and abnormal bladder sensation, the results were maintained at T1. General scores for filling and incontinence showed a significant decrease after surgery. Conclusions: A significant response in the patient's perception of urinary function was demonstrated after surgery. It is observed that the surgical procedure did not affect the uroflowmetric and cystometric characteristics of the evaluated patients.

Síndrome de Munchausen: manisfestação pós-cirúrgica / Munchausen syndrome following neurosurgical intervention: case report

A síndrome de Munchausen refere-se a um distúrbio de ordem pesiquiátrica no qual o paciente relata doenças inexistentes, fictícias, por vezes submetendo-se a exames e procedimentos cirúrgicos desnecessários. No sentido clássico, são histéricos e simuladores (ainda que conscientes) dos seus atos, agindo por razões que nem eles mesmos compreendem. O maior obstáculo no manuseio de tais pacientes é o reconhecimento patológico das enfermidades referidas, colocando à prova a sagacidade clínica do médico assistente. Relatos da síndrome de Munchausen no pós-operatório de neurocirurgias são extremamente raros na literatura, o que justifica a descrição do presente caso.