Obesity and smoking: Are they modulators of cough intravesical peak pressure in stress urinary incontinence?

PURPOSE: SUI (Stress Urinary Incontinence) results from sudden increases in intravesical peak pressures exceeding urethral resistance leading to involuntary urine loss. Obesity and smoking are well established reversible risk factors for SUI and may alter intravesical peak pressures. BMI, smoking status, and other clinical factors were studied to determine their relationship to CIPP (maximal Intravesical Peak Pressures generated by Cough) in SUI complaining women. MATERIALS AND METHODS: Three hundred nineteen women complaining of SUI were evaluated with medical history and urodynamics. Age, parity, comorbidities, previous surgery, BMI and history of smoking were obtained. The maximal intravesical peak pressures generated by cough (CIPP) and cough leak point pressure (CLPP) were acquired. Univariate and multivariate analysis were conducted. RESULTS: Current smokers and former smokers had similar CIPP (170cmH2O and 170cmH2O; p = 0.5, respectively); Those individuals who had never smoked had significantly lower CIPP (140cmH2O; p = 0.000 and p = 0.009 respectively). BMI was directly related to CIPP (r = 0.41; p = 0.000). Vaginal deliveries (r = -0.15, p = 0.08) and diabetes (r = 0.15, p = 0.016) were also directly related to CIPP on univariate analysis. Only smoking status (p = 0.000) and BMI (p = 0.000) were independently significantly related to CIPP on multivariate analysis. CONCLUSIONS: Obesity and smoking showed increased CIPP (maximal Intravesical Peak Pressures generated by Cough). While reduced BMI is related to lower CIPP, smoking cessation does not appear to diminish CIPP. These findings suggest that weight loss may reduce incontinence by CIPP modulation. However, the benefits of smoking cessation without additional lifestyle modification, may have no benefit to improve urinary incontinence.

Sump syndrome: relato de caso / Sump syndrome: case report

Sump Syndrome after choledochoduodenostomy is becoming rare, mainly because endoscopic procedures are replacing this surgery. We report a case of this syndrome where the only symptom was pain. The diagnosis was made after 3 years and many doctors attended the patient. The treatment was endoscopic and the result was excellent.

Dieta e câncer da próstata: aspectos atuais relacionados à quimioprevençäo / Diet and prostate cancer: recent issues about chemoprevention

O câncer da próstata se tornou a malignidade mais comum em homens nos Estados Unidos. Pesquisas recentes demonstram que a dieta intima tem relação com as variações de incidência desta neoplasia ao redor do mundo. Tal conhecimento pode ser uma medida importante na prevenção do câncer da próstata. Dentre os alimentos estudados, substâncias chamadas fitoestrógenos, que são estrogênios fracos encontrados na soja, contêm propriedades capazes de reduzir o risco de câncer da próstata. Compostos ricos em gordura também têm sido associados a tumores mais avançados. Em relação às vitaminas, o calcitriol (vitamina D ativa) é considerado atualmente como hormônio regulador de crescimento e diferenciação celular, existindo relação inversa entre seus níveis e a incidência de câncer da próstata. A dieta encontrada nos países orientais, rica em vitaminas e vegetais e com baixo teor lipídico, tem papel protetor contra o câncer da próstata.