Schooling impacts on the overactive bladder diagnosis in women

ABSTRACT Objective: To evaluate the overactive bladder (OAB) diagnosis using OAB-V8 and ICIQOAB questionnaires in women with different schooling and cultural levels. Materials and Methods: Three hundred and eighty six healthy women answered a clinical questionnaire filling out information about schooling, demographic and gynecological data. The OAB-V8 and ICIQ-OAB questionnaires were used to evaluate OAB diagnosis and symptoms; and the QS-F questionnaire, to determine the sexual function. All questionnaires were validated in Portuguese. Results: The mean age was 37.3 years-old. Regarding to schooling level, 23.1% had concluded primary education; 65.8%, secondary school; and 11.1% had higher education. Considering the OAB-V8 (score ≥8), 51.8% of evaluated women had OAB diagnosis. There was a positive linear correlation between the OAB-V8 and ICIQ-OAB questionnaires in its sections "a" (r=0.812, p<0.001) and "b" (r=759, p<0.001). There was a positive linear correlation between age and the amount of time used to answer the OAB-V8, ICIQ-OAB and QS-F questionnaires (p<0.001). The ICIQ-OAB was the hardest to answer for all schooling levels when compared to the other questionnaires. Women who had concluded primary and secondary education significantly demanded more help to answer all questionnaires than those with higher education (p<0.05). Furthermore, women with higher education took significantly less time answering all questionnaires when compared to their less educated counterparts (primary and secondary schooling), since they were quicker to answer each individual question. Conclusion: Educational level and ageing had an impact on women response using different questionnaires for OAB and sexual function evaluations.

Urinary lithiasis and idiopathic hypercalciuria: the importance of dietary intake evaluation

PUSPOSE: To evaluate food intake of patients with urinary lithiasis and idiopathic hypercalciuria (IH). MATERIALS AND METHODS: Between August 2007 and June 2008, 105 patients with lithiasis were distributed into 2 groups: Group 1 (n = 55) - patients with IH (urinary calcium excretion > 250 mg in women and 300 mg in men with normal serum calcium); Group 2 (n = 50) - normocalciuria (NC) patients . Inclusion criteria were: age over 18, normal renal function (creatinine clearance = 60 mL/min), absent proteinuria and negative urinary culture. Pregnant women, patients with some intestinal pathology, chronic diarrhea or using corticoids were excluded. The protocol of metabolic investigation was based on non-consecutive collection of two 24-hour samples for dosages of: calcium, sodium, uric acid, citrate, oxalate, magnesium and urinary volume. Food intake was evaluated through the quantitative method of Dietary Register of three days. RESULTS: Urinary excretion of calcium (433.33 ± 141.92 vs. 188.93 ± 53.09), sodium (280.08 ± 100.94 vs. 200.44.93 ± 65.81), uric acid (880.63 ± 281.50 vs. 646.74 ± 182.76) and magnesium (88.78 ± 37.53 vs. 64.34 ± 31.84) was significantly higher in the IH group in comparison to the NC group (p < 0.05). As regards the nutritional composition of food intake of IH and NC groups, there was no statistical significant difference in any nutrient evaluated. CONCLUSION: In our study, no difference was observed in the food intake of patients with urinary lithiasis and IH or NC.

Metabolic investigation of patients with staghorn calculus: is it necessary?

Objective: To evaluate the prevalence of metabolic disorders in patients with staghorn calculi treated at the Regional Center of Lithiasis Metabolic Studies in central region of São Paulo State, Brazil. Materials and methods: Between February 2000 and February 2008, 630 patients with urinary calculi were evaluated in the lithiasis outpatient clinic. Thirty-seven of them had staghorn calculi (35 women and 2 men). The inclusion criteria for the metabolic investigation included the absence of urological manipulation 30 days before the examination, negative urine culture and creatinine clearance > 60 mL/min. The protocol for metabolic investigation consisted of qualitative search for cystinuria. Two non-consecutive 24-hour urine samples collected to measure calcium, phosphorus, uric acid, sodium, potassium, magnesium, oxalate and citrate, and serum calcium levels , phosphorus, uric acid, sodium, potassium, magnesium, chloride, parathormone and urine pH. Results: Among patients with lithiasis, 5.9 percent (37/ 630) had staghorn calculus and in 48.6 percent (18/37) were diagnosed with urinary infection. The females were predominant for 94.5 percent of cases. The calculi were unilateral in 31 of cases and bilateral in six. Metabolic abnormalities were found in 68.2 percent of patients with hypercalciuria (64.2 percent) and hypocitraturia (53.3 percent) being the most common disorders. Conclusions: The presence of metabolic disorders in nearly 70 percent of patients with staghorn calculus reinforces the necessity for evaluation of these patients. The diagnosis and treatment of identified metabolic abnormalities can contribute to the prevention of recurrent staghorn calculi.

Prevalence and risk factors for urinary and fecal incontinence in brazilian women

Objective: To evaluate prevalence and risk factors of fecal and urinary incontinence (UI) in Brazilian women. Material and Methods: 685 women older than 20 years of age answered a questionnaire about urinary and fecal symptoms, clinical and obstetric antecedents. They were grouped according to presence or absence of UI. Results: Urinary and fecal incontinence was reported in 27 percent and 2 percent of cases, respectively. Mean age of incontinent women was significantly higher than continent ones. Incontinent women had a mean number of micturitions significantly higher than the continent ones. On average, incontinent women had higher rate of pregnancies and vaginal delivery when compared to the continent ones. Body mass index (BMI) was significantly higher in incontinent participants and in women with no UI complaints (27.35 vs. 24.95, p < 0.05). Fecal incontinence prevalence was 2 percent and occurred exclusively in patients with UI. Conclusions: Vaginal delivery and high BMI have been identified as risk factors for UI development while aging and number of pregnancies may be correlated factors.

Clinical and quality-of-life outcomes after autologous fascial sling and tension-free vaginal tape: a prospective randomized trial

Purpose: Evaluate the impact autologous fascial sling (AFS) and tension-free vaginal tape (TVT) procedures on quality-of-life in incontinent women. Materials and Methods: Forty-one women were randomly distributed into two groups. Group G1 (n = 21), underwent AFS and group G2 (n = 20) TVT implant. The clinical follow up was performed at 1, 6, 12 and 36 months. Results: TVT operative time was significantly shorter than AFS. Cure rates were 71 percent at 1 month, 57 percent at 6 and 12 months in G1. In G2, cure rates were 75 percent at 1 month, 70 percent at 6 months and 65 percent at 12 months; there was no significant difference between groups. As regards the satisfaction rate, there was no statistical difference between groups. Analysis of quality of life at 36 months revealed that there was no significant difference between groups. Conclusion: Similar results between AFS and TVT, except for operative time were shorter in TVT.

Spontaneous resolution rates of vesicoureteral reflux in Brazilian children: a 30-year experience

OBJECTIVE: We evaluated clinical characteristics of primary vesicoureteral reflux (VUR) in infants in a 30-year period in Brazil with special reference to the relation of renal parenchymal damage to urinary tract infection and gender. MATERIALS AND METHODS: From 1975 through 2005, 417 girls (81.6 percent) and 94 boys (18.4 percent) with all grades of reflux were retrospectively reviewed. Patients were categorized by the worst grade of reflux, maintained on antibiotic prophylaxis and underwent yearly voiding cystourethrography until the reflux was resolved. VUR was considered resolved when a follow-up cystogram demonstrated no reflux. Surgical correction was recommended for those who fail medical therapy, severe renal scarring or persistent VUR. RESULTS: Grades I to V VUR resolved in 87.5 percent, 77.6 percent, 52.8 percent, 12.2 percent and 4.3 percent, respectively. Renal scars were present at presentation in 98 patients (19.2 percent). Neither gender nor bilaterality versus unilaterality was a helpful predictor of resolution. The significant difference was found among the curves using the log rank (p < 0.001) or Wilcoxon (p < 0.001) test. CONCLUSION: Despite the current use of screening prenatal ultrasound, many infants are still diagnosed as having vesicoureteral reflux only after the occurrence of urinary tract infection in our country. Scarring may be associated to any reflux grade and it may be initially diagnosed at any age but half of the scars are noted with higher grades of reflux (IV and V). The incidence of reflux related morbidity in children has significantly diminished over the last three decades.

Structural alterations of the bladder induced by detrusor instability: experimental study in rabbits

OBJECTIVES: The aim of this study was to evaluate the histopathological and immunohistochemical alterations induced by detrusor instability in the bladder of rabbits submitted to partial bladder outlet obstruction. MATERIALS AND METHODS: Thirty male Norfolk rabbits were divided into 2 groups, a clinical control and a group with detrusor instability. Urine culture, cystometric study, histopathological and immunohistochemical analysis were performed in all animals prior to surgery (M1) and 4 weeks after-surgery (M2). RESULTS: Partial obstruction (G2) resulted in a 2.5 fold increment (p < 0.05) in bladder weight when compared to control (G1). Four weeks after surgery, 93 percent of animals in G2 developed cystitis. Partial obstruction resulted in detrusor instability at M2 and bladder capacity was significantly increased (p < 0.05) from M1 to M2. The incidence of mild to moderate mucosal and adventitious fibrosis at M2 was higher in G2 (p < 0.05) when compared to G1. Inflammatory reaction at M2 was statistically higher (p < 0.05) in G2. There was no difference in muscular hypertrophy between M1 and M2 in G1. However, 67 percent of G2 bladders showed a moderate to intense muscular hypertrophy at M2. Hyperplasia of the epithelium was also increased in G2 when M1 and M2 were compared (p < 0.05). CONCLUSION: Detrusor instability induced by partial bladder outlet obstruction caused significant histopathological and immunohistochemical alterations in the bladder of rabbits.

Metabolic assessment in patients with urinary lithiasis

INTRODUCTION: Metabolic investigation in patients with urinary lithiasis is very important for preventing recurrence of disease. The objective of this work was to diagnose and to determine the prevalence of metabolic disorders, to assess the quality of the water consumed and volume of diuresis as potential risk factors for this pathology. PATIENTS AND METHODS: We studied 182 patients older than 12 years. We included patients with history and/or imaging tests confirming at least 2 stones, with creatinine clearance > 60 mL/min and negative urine culture. The protocol consisted in the collection of 2, 24-hour urine samples, for dosing Ca, P, uric acid, Na, K, Mg, Ox and Ci, glycemia and serum levels of Ca, P, Uric acid, Na, K, Cl, Mg, U and Cr, urinary pH and urinary acidification test. RESULTS: 158 patients fulfilled the inclusion criteria. Among these, 151 (95.5 percent) presented metabolic changes, with 94 (62.2 percent) presenting isolated metabolic change and 57 (37.8 percent) had mixed changes. The main disorders detected were hypercalciuria (74 percent), hypocitraturia (37.3 percent), hyperoxaluria (24.1 percent), hypomagnesuria (21 percent), hyperuricosuria (20.2 percent), primary hyperparathyroidism (1.8 percent) secondary hyperparathyroidism (0.6 percent) and renal tubular acidosis (0.6). CONCLUSION: Metabolic change was diagnosed in 95.5 percent of patients. These results warrant the metabolic study and follow-up in patients with recurrent lithiasis in order to decrease the recurrence rate through specific treatments, modification in alimentary and behavioral habits.

Alteraçöes histopatológicas na ampliaçäo vesical com duramáter e pricárdio bovino: estudo comparativo em coelhos / Histopathological alterations in the bladder augmentation with dura mater and bovine pericardium

Vários materiais aloplásicos têm preconizados na substituiçäo parcial de bexiga. Eles divergem em muitos aspectos, como tempo adequado de reabsorçäo, rejeiçäo, formaçäo de cálculos, tempo de reepitelizaçäo e neoformaçäo de músculo. Com o objetivo de avaliar as alteraçöes histopatológicas na bexiga, após a cistoplastia com dura-mátes e pericárdio bovino, estudaram-se 40 coelhos fêmeas North Folk divididos em quatro grupos:G1 - controle clínico; G2 - controle cirúrgico; G3 - dura-mater liofilizada; G4 - pericárdio bovino. Foram estudados os seguintes parâmetros: 1) cultura de urina; 2) uréia e creatinina plasmáticas; 3) estudo histopatológico, no pré- e pós operatório (após 12 semanas). O estudo histológico demononstrou haver completa epitelizaçåo e reabsorçåo dos implantes após 12 semanas. A fibrose foi proporcionalmente maior nos grupos G3 e G4.Notamos ilhas de músculo liso em 50 por cento do grupo G3 e em 30 por cento do grupo G4 pós-cirurgia. Detectaram 20 por cento de calculose vesical nos grupos G3 e G4. A análise físico-química do cálculo revelou composiçäo semelhante nos dois grupos