Incontinence outcomes in women undergoing retropubic mid-urethral sling: a retrospective cohort study comparing Safyre™ and handmade sling

ABSTRACT Purpose This study examined and compared efficacy, safety, satisfaction, and complications of the retropubic Safyre™ sling and a retropubic hand-made synthetic sling (HMS) in a short-, mid- and long-term follow-up. Methods We retrospectively reviewed a prospectively maintained database of women who underwent Safyre™ or HMS between March 7ths 2005 and December 27ths, 2017. Patients had first assessment (7-10 days), second (40-45 days), and third (sixth month) postoperatively. Between September and December 2018, patients who completed at least one year of surgery, received a telephone call. Follow-up compared quartiles of follow-up time to determine complications (Clavien-Dindo), success rates (International Consultation on Incontinence Modular Questionnaire for Urinary Incontinence Short Form - ICIQ-UI SF), and patient satisfaction. Results Three hundred fifty-one patients underwent surgery and 221 (63%) were evaluated after a median of 78.47 (± 38.69) months, 125 (55%) in the HMS, and 96 (45%) in the Safyre™ group. Higher intraoperative bladder injury was observed with Safyre™ (0% vs. 4.2%, p=0.034), and a tendency for urinary retention, requiring indwelling urinary catheter over 24 hours (2.4% vs. 8.3%, p=0.061). Both HMS (p<0.001) and Safyre™ (p<0.001) presented improvements on ICIQ-UI SF. There were no differences in satisfaction, subjective cure rates, ICIQ-UI SF, or complications between groups. Conclusions Both HMS and Safyre™ have similar satisfaction and subjective cure rates, with marked ICIQ-UI SF score improvement. Higher rates of intraoperative bladder injury were seen in patients who received Safyre™ retropubic sling.

Seminal citrate is superior to PSA for detecting clinically significant prostate cancer

ABSTRACT Purpose: To establish whether the citrate concentration in the seminal fluid ([CITRATE]) measured by means of high-resolution nuclear magnetic resonance spectroscopy (1HNMRS) is superior to the serum prostate-specific antigen (PSA) concentration in detecting of clinically significant prostate cancer (csPCa) in men with persistently elevated PSA. Materials and Methods: The group of patients consisted of 31 consecutively seen men with histological diagnosis of clinically localized csPCa. The control group consisted of 28 men under long-term follow-up (mean of 8.7 ± 3.0 years) for benign prostate hyperplasia (BPH), with persistently elevated PSA (above 4 ng/mL) and several prostate biopsies negative for cancer (mean of 2.7 ± 1.3 biopsies per control). Samples of blood and seminal fluid (by masturbation) for measurement of PSA and citrate concentration, respectively, were collected from patients and controls. Citrate concentration in the seminal fluid ([CITRATE]) was determined by means of 1HNMRS. The capacities of PSA and [CITRATE] to predict csPCa were compared by means of univariate analysis and receiver operating characteristic (ROC) curves. Results: Median [CITRATE] was significantly lower among patients with csPCa compared to controls (3.93 mM/l vs. 15.53 mM/l). There was no significant difference in mean PSA between patients and controls (9.42 ng/mL vs. 8.57 ng/mL). The accuracy of [CITRATE] for detecting csPCa was significantly superior compared to PSA (74.8% vs. 54.8%). Conclusion: Measurement of [CITRATE] by means of 1HNMRS is superior to PSA for early detection of csPCa in men with elevated PSA.

Associação entre aleitamento materno, hábitos orais deletérios e alterações de motricidade orofacial em pacientes sob intervenção ortodôntica / Association of infant feeding, deleterious oral habits and oral/facial motor disorders in patients receiving orthodontic interventions

Resumen:

Objetivo: analizar la asociación del periodo, tipo y forma de amamantamiento con la sucesión de hábitos orales perniciosos o incorrectos y alteraciones de la motricidad orofacial en pacientes bajo intervención ortodóntica en la Universidad Estatal de Londrina (Brasil). Metodología: estudio observacional transversal realizado en 239 pacientes, con edad entre 5 y 14 años, los datos fueron obtenidos mediante cuestionarios, revisión de prontuarios y evaluación fonoaudiológica de la motricidad orofacial para evaluar el periodo (tiempo), forma (natural o artificial) y tipo (exclusivo o complementado) de lactancia y la sucesión de hábitos orales perniciosos y alteraciones de motricidad orofacial. Se ponderó, a través de pruebas estadísticas no paramétricas, la asociación entre tiempo, tipo y forma de amamantamiento con la sucesión de hábitos orales perniciosos o alteraciones de motricidad orofacial. Resultados: los pacientes sin alteraciones de motricidad orofacial, y también aquellos que no presentaban hábitos orales perniciosos o incorrectos, tuvieron una media de tiempo de amamantamiento exclusivo significativamente mayor; p= 0,0097 y p< 0,0005, que aquellos que presentaban alteraciones. Los pacientes con alteraciones de motricidad orofacial y también los que mostraban hábitos orales perniciosos tuvieron una media de tiempo de lactancia artificial significativamente mayor; p= 0,0219 y p< 0,0005, comparados con aquellos que no presentaban alteraciones. Los pacientes con hábitos orales incorrectos corrían más riesgo (122%) de presentar alteraciones de motricidad orofacial (p< 0,0001).

Protective effect of carboxymethyl-glucan (CM-G) against DNA damage in patients with advanced prostate cancer

Carboxymethyl-glucan (CM-G) is a soluble derivative from Saccharomyces cerevisiae (1 → 3)(1 → 6)-β-D-glucan. The protective efficiency of CM-G against DNA damage in cells from patients with advanced prostate cancer (PCa), and undergoing Androgen Deprivation Therapy (ADT), was evaluated. DNA damage scores were obtained by the comet assay, both before and after treatment with CM-G. The reduction in DNA damage, ranging from 18 percent to 87 percent, with an average of 59 percent, was not related to the increased number of leukocytes in peripheral blood. The results demonstrate for the first time the protective effect of CM-G against DNA damage in patients with advanced PCa. Among smokers, three presented the highest reduction in DNA damage after treatment with CM-G. There was no observable relationship between DNA damage scores before and after treatment, and age, alcoholism and radiotherapy.

Prognostic factors in carcinoma of the penis and survival analysis based on the lymph node status

Introduction: Squamous cell carcinoma of the penis is a rare disease in the developed world but common in underdeveloped countries. We have evaluated the prognostic factors related to penile carcinoma and assessed the outcome of patients regarding the lymph node status at two institutions. Materials and methods: Between January 1990 and December 2003, 87 patients with a clinical diagnosis of penile carcinoma had been treated at Instituto de Cancer de Londrina and Universidade Estadual de Londrina and were retrospectively reviewed. Patients who were followed for more than 18 months or until death due to penile cancer were evaluated for prognostic factors. Overall survival was calculated according to lymph node status. Results: Overall survival according to lymph node status at presentation, showed a poor outcome for patients with palpable lymph nodes compared with those with clinically negative lymph node (2-year survival of 20 and 68 respectively, p < 0.0005). The same was observed in those who presented delayed lymphadenopathy compared with patients who persisted N0 during follow-up time (2-year-survival of 28 and 90 respectively, p < 0.0005). Forty eight patients were assessed for prognostic factors. Histological grade and pathological stage were all statistically significant at univariate analysis regarding disease-free survival. Conclusion: Patients with positive lymph node had a poor overall survival regardless whether or not an immediate or a delayed lymphadenectomy had been performed. Histological grade and pathological stage were the only variables statistically significant at univariate analysis with respect to disease-free survival.

Comparison between PSA density, free PSA percentage and PSA density in the transition zone in the detection of prostate cancer in patients with serum PSA between 4 and 10 ng/ml

OBJECTIVE: Compare the capacity of the PSA density (PSAD), Free PSA percentage ( percentFPSA) and PSA transition zone density (PSATZ) in improving the sensitivity and specificity of the PSA to detect prostate cancer (PCa) in men with a PSA between 4 and 10 ng/mL. MATERIALS AND METHODS: One hundred and forty five men with PSA between 4 and 10 ng/mL were prospectively studied. Blood collection for the total PSA and free PSA was performed as well as transrectal ultra-sound with prostate biopsy and measurement of the total prostate volume (TPV) and transition zone volume (TZV). Patients with initial negative biopsy were followed and the prostate biopsy was repeated in those that presented PSA increase. The capacity of the PSAD, percentFPSA and PSADTZ in improving the sensitivity and specificity pf the PSA test to the detection of the PCa was assessed by univariate and multivariate analyses and through the ROC curve. RESULTS: Of the 145 patients, 38 (26.2 percent) had PCa and in 107 (73.8 percent) a benign prostate disease was diagnosed. No difference among the PSAD, percentFPSA and PSADTZ was found. The multivariate analysis showed that the PSADTZ, percentFPSA, TZV and age were those more powerful and highly significant PCa predictors. CONCLUSION:The determination of percentFPSA and PSAD can allow a better discrimination between PCa and benign disease that the isolated use of PSA. The combination of PSADTZ, percentFPSA, TZV and age promote a high accuracy for PCa detection.

Variables predictive of voiding disfunction following aponeurotic sling surgery: multivariate analysis

INTRODUCTION: Aponeurotic sling surgeries can evolve with obstruction or voiding dysfunction in 5 to 20 percent of patients. There are few studies on factors that could possibly predispose to voiding difficulties or urinary retention. The objective of this work is to identify these potential clinical or urodynamic factors. MATERIALS AND METHODS: Records from 130 patients who underwent aponeurotic sling surgeries were reviewed. All patients underwent a throughout urodynamic study during pre-operative investigation. The variables studied were age above 65 years, previous pelvic surgeries, concomitant surgeries, post-voiding residue higher than 100 mL, vesical obstruction (according to Blaivas-Groutz nomogram) and urinary flow under 12 mL/s. Post-voiding residue was assessed on the seventh post-operative day through vesical catheterization. Recovering of spontaneous voiding after 7 post-operative days or with a residue higher than 100 mL, was regarded as voiding dysfunction. Univariate analysis was performed with qui-square test and Fisher's exact test, and multivariate analysis was performed by logistic regression with alpha = 5 percent. RESULTS: Age in the studied group ranged from 41 to 83 years (mean 56.7 years), with 69 (53 percent) patients having urethral hypermobility and 61 (47 percent) having intrinsic urethral lesion. Normal voiding occurred in 97 (75.6 percent) women with 7 post-operative days. The only significant variable in the univariate (p = 0.014) and multivariate (p = 0.017) analysis was post-voiding residue higher than 100 mL. CONCLUSION: Pre-operative presence of a post-voiding residual urine higher than 100 mL was the only variable predictive of voiding dysfunction.

Use of cadaveric fascia lata to correct grade IV cystocele

We describe a modification of the cadaveric prolapse repair and sling - CaPS technique that uses the sling surgery principles to correct grade IV cystocele. In this modification, the central and paravaginal defects reconstitution are performed using cadaveric fascia lata fixed over rectus abdominis muscle, eliminating the need of pubic fixation by screws, as proposed by the original technique. The modification described, besides presenting the benefits of CaPS, i.e., not using impaired tissues to reconstruct vesical support, and lower risks of perineal hypercorrection, also reduces the probability of complications of bone fixation

Cárie dentária: conscientizaçäo e prevençäo / Dental caries: conscientization and prevention

Nossa regiäo de atuaçao foi o bairro Maria Cecília, regiäo norte de Londrina - PR, área de abrangência da Unidade Básica de Saúde Maria Cecília. Nesse estudo da cárie dentária fizemos uma revisäo bibliográfica sobre o que é, como se forma e suas consequências, para que pudéssemos através de métodos verificar a conscientizaçäo da populaçäo quanto à higiene bucal, dificuldades na prevençäo da cárie e os trabalhos realizados para a prevençäo. Os métodos empregados foram: entrevistas com profissionais da área, pessoas ligadas à área de estudo, questionário, análise de dados, etc. Com os resultados em mäos concluímos que a populaçäo pode ter acesso aos conhecimentos de prevençäo à cárie, já que tem a escova dental, porém podem näo estar seguindo certas regras de higiene bucal, podendo haver aí falta de conscientizaçäo da importância destas normas