Comparative analysis of the symptomatology of children with lower urinary tract dysfunction in relation to objective data

OBJECTIVES: To assess the clinical presentation of children with lower urinary tract dysfunction (LUTD) relating to objective examination data. MATERIALS AND METHODS: Forty-four children (36 girls and 8 boys with mean age of 6.8 years) with LUTD were prospectively assessed through a specific questionnaire that analyzed clinical presentation of those patients. These data were then compared to objective data, such as micturition diary and uroflowmetry with electromyography. RESULTS: A urinary tract infection (UTI) antecedent was observed in 31 cases (70.5 percent), and of those, 24 cases of UTI were accompanied by fever. All children presented micturition urgency. Daily urinary incontinence was observed in 33 cases (75 percent) and nocturnal enuresis in 23 (52.3 percent). As for micturition frequency, 15 (34.1 percent) had normal frequency 19 (43.2 percent) presented more than 10 daily micturition episodes and 10 (22.7 percent) thought they urinated less than 5 times a day. In the uroflowmetry and electromyography examination, 14 (31.8 percent) experienced lack of coordination during micturition. Of 10 children with infrequent micturition, 5 confirmed this in their micturition diaries and 2 listed more than 5 micturition episodes per day in the diary. Of 19 patients presenting polaciuria, only 5 confirmed this in their micturition diaries, while 7 had less than 10 micturition episodes per day. CONCLUSION: Most children with LUTD presented a previous UTI, and daily incontinence was verified in around 75 percent of the patients. Complaints of polaciuria or infrequent micturition are not noted completely in the micturition diaries and there is no parameter in the clinical history that offers good sensitivity or specificity for the diagnosis of lack of perineal coordination.

Diagnosis and treatment of prostatic abscess

OBJECTIVES: Present and discuss the pathogenesis, diagnostic methods and treatment of the prostatic abscess. MATERIALS AND METHODS: We have retrospectively studied the medical records of 9 patients diagnosed and treated for prostatic abscess, between March 1998 and December 2000, assessing age, context, associated diseases, and diagnostic and therapeutic methods. We have compared the data found with those described in literature, based on Medline data. RESULTS: Mean age was 52.6 years. Three patients had previous diabetes mellitus diagnosis, and one was infected by HIV virus. Transrectal ultrasound of the prostate confirmed the diagnosis of prostatic abscess in all 7 cases in which it was performed. All cases received antibiotic treatment, and 77.8 percent needed concomitant surgical treatment. Two cases of microabscess were treated only with antibiotics. Four patients were submitted to perineal catheter drainage, 2 were submitted to transurethral resection of the prostate (TURP), and one patient required both procedures. Mean hospitalization time was 11.2 days, and most frequent bacterial agent was S. aureus. All patients were discharged from the hospital, and there was no death in this series. CONCLUSIONS: Prostatic abscess should be treated with broad-spectrum antibiotics and surgical drainage (perineal puncture or TURP). Microabscess may heal without surgery

Litíase urinária na gestaçäo / Urinary lithiasis in pregnancy

A urolitíase durante o período gestacional é uma patologia que pode determinar riscos à saúde materna e fetal. Diagnóstico e a terapêutica desta patologia envolvem várias especialidades médicas e deve ser do conhecimento do médico plantonista de emergência, do ginecologista, obstetra, infectologista, radiologista e do urologista. Apresentamos neste artigo uma revisao atualizada sobre a litíase urinária na gestaçäo