The role of nephrectomy of the atrophic kidney in bearers of renovascular hypertension

PURPOSE: Evaluation of the beneficial effect of nephrectomy of the atrophic kidney on blood pressure (BP) and renal function. MATERIALS AND METHODS: A retrospective study of 51 patients with renovascular hypertension (RVH), bearers of atrophic kidney due to severe stenosis or occlusion of the renal artery. Average age was 47.1 ± 15 years, the median creatinine clearance was 54 mL/min, average systolic BP (SBP) 149.6 ± 22.5 mm Hg, average diastolic BP (DBP) 90.8 ± 17 mm Hg and the median number of hypotensors 3 (1 to 5) per patient per day. Blood pressure and serum creatinine were analyzed from 12 to 60 months after the nephrectomy. RESULTS: There was a significant improvement in the average SBP in the periods from 12 to 36 months (p ≤ 0.028) and for the average DBP from 12 to 48 months after the nephrectomy (p ≤ 0.045), accompanied by a significant reduction in the use of hypotensors from 12 to 48 months (p < 0.05). One year after the nephrectomy, there was a 69 percent improvement in blood pressure and 63.8 percent improvement in renal function of patients. CONCLUSION: The removal of atrophic kidney in patients with RVH is a safe procedure which presents benefits for the control of arterial hypertension and renal function in bearers of renovascular hypertension.

Urogenital tuberculosis: patient classification in seven different groups according to clinical and radiological presentation

PURPOSE: To describe and classify 80 cases of urogenital tuberculosis in seven groups of similar clinical and radiological presentation. MATERIALS AND METHODS: 80 patients (56 males, 70 percent; median age 34 years; age range 12 to 75) with urogenital tuberculosis were retrospectively reviewed. The patients were divided in seven groups: 1) Bilateral parenchymatous renal lesions; 2) No or minimal changes on radiographic examination; 3) Unilateral renal tuberculosis; 4) Contracted bladder; 5) Contracted bladder with renal failure; 6) Tuberculosis on a transplanted kidney; 7) Isolated genital tuberculosis. RESULTS: 1) Seven (8.8 percent) patients had multiple bilateral parenchymatous renal lesions with fever and malaise, characteristic of miliary tuberculosis. Three of these patients had AIDS. 2) Six (7.5 percent) cases had an early diagnosis, with minimal or no radiographic lesions. Two did not have any urologic symptoms. 3) Twelve (15 percent) patients had unilateral renal tuberculosis with partial (1 case) or total non-function kidney. 4) Thirty-seven (46.3 percent) patients had contracted bladder associated with unilateral partial (1 case) or total non-function kidney. 5) Ten (12.5 percent) patients had end stage renal disease due to tuberculosis with contracted bladder. 6) Four (5.0 percent) patients had tuberculosis on a transplanted kidney, with graft loss in half the cases. 7) Four (5.0 percent) patients had prostate or epididymis tuberculosis without associated renal lesion. CONCLUSIONS: Urogenital tuberculosis is a destructive disease of the urogenital tract with variable clinical and radiographic presentation. A classification according to similar patterns correlating with disease stage is feasible although early diagnosis is the only prevention of the most severe forms.

The short-term effect of surgical treatment for stress urinary incontinence using sub urethral support techniques on sexual function

OBJECTIVES: To evaluate the impact of surgical treatment of stress urinary incontinence on the sexual function of women and to identify whether such treatment can improve their sexual function and overall quality of life. MATERIALS AND METHODS: 64 heterosexual women with such indication were studied using the Female Sexual Function Index (FSFI) questionnaire, modified by introducing one question to evaluate the impact of urine loss. This was applied preoperatively and six months after surgery. RESULT: Among these 64 patients, 60.94 percent had regular sexual activity, while 39.06 percent did not. Among sexually active patients, 59 percent had urine loss during sexual intercourse and, of these, 87 percent had urine losses in half or more of sexual relations. There were no statistically significant differences in assessments of desire, arousal, lubrication, orgasm, satisfaction and pain, or in totaling the scores, between the preoperative period and six months after surgical treatment. However, the scores for urine losses during sexual intercourse were significantly better after the operation. CONCLUSIONS: Analysis of the results allowed the following conclusions to be reached: Urine lost during sexual activity was frequent among patients with stress urinary incontinence. Suburethral support surgery did not jeopardize sexual activity. Patients cured of stress urinary incontinence did not present improvement in sexual function.

Primary reconstruction is a good option in the treatment of urinary fistula after kidney transplantation

OBJECTIVES: urinary fistula is a morbid complication after renal transplantation leading to graft losses and patient death. We review and update our data on urinary fistula after renal transplantation and the outcome after surgical and conservative management. MATERIALS AND METHODS: the charts of 1046 renal transplants were reviewed. Transplants were performed through an extended inguinotomy; vascular anastomoses to the iliac vessels and urinary reconstruction accomplished through the Gregoir technique. Fistulae were diagnosed by urinary leaks through the incision or by the occurrence of a collection in the iliac fossa. Patient was treated surgically or conservatively according to the characteristics of the fistula and patient clinical status. RESULTS: Thirty one fistulae were diagnosed (2.9 percent). Twenty nine leaks due to ureteral necrosis and 2 due to reimplantation fault. The incidence of leaks among cadaver and live donor transplants was 3.22 percent and 2.63 percent, respectively (p = 0.73). Among diabetic and non diabetic patients the incidence of urinary leaks was 6.4 percent and 2.6 percent, respectively (p = 0.049). Treatment consisted in anastomosis of the graft ureter or pelvis with the ureter of the recipient in 17 cases with success in 13 (76.5 percent). Prolonged bladder drainage was employed in 7 cases and the fistula healed in 4 (57 percent). Ureteral reimplantation was performed in 3 cases and did not work in any of them. Ureteral ligature plus nephrostomy was employed in two cases and worked in one (50 percent). Percutaneous nephrostomy and ureteral stenting with double J catheter were employed in one case each and worked in both. CONCLUSIONS: The anastomosis of the graft ureter with the ureter of the recipient is a good method for treating urinary fistulae after renal transplantation when local and systemic conditions are good. Ureteral ligature associated to nephrostomy should be applied in cases of unfavorable local conditions or clinically unstable patients.

Likelihood of retrograde double-J stenting according to ureteral obstructing pathology

OBJECTIVES: To evaluate the likelihood of retrograde double-J stenting in urgent ureteral drainage according to obstructing pathology. MATERIALS AND METHODS: From July 2002 to January 2003, 43 consecutive patients with ureteral obstruction who needed urgent decompression were evaluated at our institution, where we performed a total of 47 procedures. Emergency was defined as ureteral obstruction associated with infection, obstructive acute renal failure, or refractory pain. Ureteral obstruction was defined as intrinsic and extrinsic based on etiology and evaluated by ultrasound. Patients submitted to previous double-J stenting were excluded. Failures in retrograde ureteral stenting were treated with percutaneous nephrostomy. Results were analyzed with Fisher's exact test and regression analysis. RESULTS: Failure in retrograde ureteral stenting occurred in 9 percent (2/22) and 52 percent (13/25) of the attempts in patients with intrinsic and extrinsic obstruction respectively (p < 0.001). Failures in stenting extrinsic obstructions occurred due to lack of identification of the ureteral meatus in 77 percent and impossibility of catheter progression in 23 percent (p < 0.05). All attempts of retrograde catheter insertion failed in obstructions caused by prostate or bladder pathologies (6/6). Inability to identify the ureteral meatus was the cause of all failures. CONCLUSION: Retrograde double-J stenting has a low probability of success in extrinsic ureteral obstruction caused by prostate or bladder disease. Such cases might be best managed with percutaneous nephrostomy.

Assessment of sexual function in patients undergoing vasectomy using the international index of erectile function

INTRODUCTION: The present study aims to prospectively compare the sexual function in males before and after vasectomy surgery using the international index of erectile function (IIEF). MATERIALS AND METHODS: From October to December 2002, sixty-four patients who were candidates for male sterilization in the vasectomy program of the Urology Section at the General Hospital of the University of São Paulo were included. The same investigator applied the IIEF before and 90 days after the surgery. The mean scores obtained on pre and postoperative visits for all domains of sexual function were analyzed and compared with the Wilcoxon test. RESULTS: The mean patient age was 35 years (range from 25 to 48 years) and the mean number of children per man was 3. The total mean score of the IIEF was 64.06 before surgery and 65.64 after the procedure, with this difference considered statistically significant (p < 0.001). Sixty-seven per cent of the patients improved their scores, versus 17 percent and 16 percent who showed worsening or no change at all in IIEF scores following surgery, respectively. Of the 5 sexual function domains, desire and sexual satisfaction presented statistically significant improvement. CONCLUSION: This study showed that vasectomy caused a positive impact on sexual function, especially on desire and sexual satisfaction, in the majority of men undergoing surgery. There was no case of surgery-related erectile dysfunction.

Juxtaglomerular cell tumor as a rare cause of hypertension in adults

The juxtaglomerular cell tumor is a cause of secondary hypertension in adults. A 35-year-old female patient suffering from hypertension and low serum potassium had a 3 x 3 cm solid mass at the lower pole of left kidney diagnosed by abdominal sonography. Partial nephrectomy was performed and the postoperatory was uneventful. Normalization of blood pressure was observed within the first month.

Eficácia e segurança da prótese peniana inflável no tratamento de disfunçäo erétil em pacientes diabéticos / Efficacy and safety of inflatable penile prosthesis in erectile dysfunction treatment in diabetic patients

A microangiopatia e a neuropatia periférica säo dois dos principais fatores envolvidos na patogenia da disfunçäo erétil em pacientes com diabetes mellitus (DM). Os pacientes diabéticos com disfunçäo erétil grave têm resultados pobres com o uso de drogas orais, sendo que o tratamento fica restrito a injeçöes intracavernosas e à colocaçäo de próteses penianas na maioria dos casos. Neste grupo de pacientes o risco de infecçöes relacionadas à baixa imunidade gerada pelo DM traz preocupaçöes em relaçäo à perda da prótese e mesmo à segurança do tratamento. Analisamos prospectivamente o tratamento de cinco pacientes diabéticos insulino-dependentes através da colocaçäo de prótese peniana inflável modelo AMS 700 CX. Os cinco pacientes apresentaram boa evoluçäo pós-operatória e nenhum deles apresentou infecçöes relacionadas à cirurgia. Todos exercem atividade sexual regular. O estudo mostrou que o tratamento da disfunçäo erétil em diabéticos pode ser feito com segurança através do uso de prótese penianas infláveis, proporcionando uma atividade sexual adequada, sem complicaçöes infecciosasem período de seguimento máximo de 14 meses.