Impact of COVID-19 on education, health and lifestyle behaviour of Brazilian urology residents

ABSTRACT Objectives: To evaluate the impact of COVID-19 on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents. Materials and Methods: A web-based survey was sent to 468 Brazilian urology residents from postgraduate years (PGY) 3 to 5 to collect data on clinical practice and training after 4 months of COVID-19. We also assessed health-related and behavior changes, rate of infection by SARS-CoV-2, deployment to the front line of COVID-19, residents' concerns, and access to personal protective equipment (PPE). Results: Massive reductions in elective and emergency patient consultations, diagnostic procedures and surgeries were reported across the country, affecting PGY 3 to 5 alike. Most in-person educational activities were abolished. The median damage to the urological training expected for 2020 was 6.0 [3.4 - 7.7], on a scale from 0 to 10, with senior residents estimating a greater damage (P< 0.001). Educational interventions developed included online case-based discussions, subspeciality conferences and lectures, and grand rounds. Most senior residents favored extending residency to compensate for training loss and most younger residents favored no additional training (p< 0.001). Modifications in health and lifestyle included weight gain (43.8%), reduced physical activity (68.6%), increased alcoholic intake (44.9%) and cigarette consumption (53.6%), worsening of sexual life (25.2%) and feelings of sadness or depression (48,2%). Almost half were summoned to work on the COVID-19 front-line and 24.4% had COVID-19. Most residents had inadequate training to deal with COVID-19 patients and most reported a shortage of PPE. Residents' concerns included the risk of contaminating family members, being away from residency program, developing severe COVID-19 and overloading colleagues. Conclusions: COVID-19 had a massive impact in Brazilian urology residents´ training, health and lifestyle behavior, which may reflect what happened in other medical specialties. Studies should confirm these findings to help developing strategies to mitigate residents' losses.

Paraganglioma de bexiga urinária:um desafio médico / Paraganglioma of the urinary bladder: a medical challenge

Paragangliomas de bexiga são tumores raros, potencialmente fatais, cujo reconhecimento imediato é necessário para o manejo adequado e desfecho bem sucedido. Descreve-se o caso de um homem de 51 anos com queixa de hematúria macroscópica. À investigação inicial, a ultrassonografia abdominal mostrou aumento prostático. Durante a prostatectomia transuretral, foi identificada uma tumoração na bexiga, na qual foi realizada biópsia. O exame histopatológico inicial sugeriu neoplasia maligna infiltrativa, porém, o estudo imuno-histoquímico realizado após ressecção cirúrgica revelou que, em realidade, foi de um paraganglioma de bexiga. O paciente encontra-se livre de doença cinco anos após o diagnóstico. Nesse trabalho são apresentados os desafios no diagnóstico dos paragangliomas de bexiga e uma breve discussão e revisão da literatura.

Urinary bladder paraganglioma is a rare life-threating disorder and its prompt recognition is needed for an adequate management and successful outcome. A case of a 51-year-old man who presented with painless gross hematuria is described. On initial investigation, an abdominal ultrassonography disclosed an increased prostate. During transurethral prostatectomy, a urinary bladder mass was identified and biopsied. Initial histopathological examination suggested a malignant infiltrative neoplasia, and, after surgical resection, immunohistochemical study revealed that it was a urinary bladder paraganglioma. The patient has been disease-free at 5 years of follow-up. Challenging aspects of the diagnosis of urinary bladder paragangliomas are described, and a brief discussion and review of literature are provided.

Pubovaginal sling with a low-cost polypropylene mesh

OBJECTIVE: The aim of this study was to present the results of pubovaginal sling with a low-cost polypropylene mesh in the treatment of stress urinary incontinence MATERIALS AND METHODS: 118 women diagnosed with stress urinary incontinence (SUI) due to urethral hypermobility or intrinsic sphincteric deficiency, treated with pubovaginal sling (PVS) with a low-cost polypropylene mesh confectioned by the surgeon, were analyzed. All patients had a basic evaluation that included a medical history, physical examination, stress tests and urodynamic investigation RESULTS: The average follow up was of 42 months. Urethral hypermobility was observed in 67 percent of the cases. The process was carried out on an outpatient basis on 67 patients. Intra-operative complications included 4 vesical injuries, treated with catheterization for 3 days. There were 13 early complications, of which 8 were urinary retentions treated with vesical drainage for 1 to 3 weeks and 3 vaginal extrusions of the mesh treated with covering of the sections with mucous membrane. There was a need for 6 urethrolysis in patients who presented irritative and postoperative obstructive symptoms; 81.3 percent of the patients were considered cured, while 9.3 percent had significant improvement. Three initially unsuccessful cases required sling reconfiguration. All cases were eventually cured CONCLUSION: The construction of a pubovaginal sling using a low-cost polypropylene mesh is a safe and effective technique for the relief of SUI. It should be considered an alternative, especially for patients in public health systems with low financial resources.

Gravidez em adolescente: aspectos relativos ao pré-natal, parto e recém-nascido / Pregnancy among adolescents: Characteristics of prenatal, delivery and newborn

Introdução: A gravidez de adolescentes é tema frequente de debates por suas importantes implicações médicas e sociais e por sua crescente incidência. Este estudo pretende verificar se a gravidez na adolescencia é marcador de risco para prematuridade, baixo peso do recém-nascido, baixa vitalidade, parto cesáreo e não-realização de exames pré-natais. Material e métodos: Realizou-se estudo epidemiológico transversal de natureza analítica, utilizando-se dados do Sistema de Informações de Nascidos Vivos, no Distrito Federal, Brasil, de 1995 e 1996. Foram comparados partos de mães adolescentes e adultas, e partos de adolescentes de até 16 anos com os de adolescentes de 17 a 19 anos. Resultados: Recém-nascidos de mães adolescentes tiveram maior proporção de prematuridade, baixo peso ao nascer e baixa vitalidade do que os de mães adultas. As mães adolescentes realizaram menos pré-natal e tiveram menor percentagem de aoprtos cesáreos. Todas essas diferenças foram estatisticamente significativas. Conclusões: A adolescência foi marcador de risco para prematuridade, baixo peso do recém-nascido e baixa vitalidade, em partos realizados no Distrito Federal, nos anos de 1995 e 1996. Os autores enfatizam a necessidade de abordagem especial desse grupo populacional, tanto na prevenção da gravidez, como nos cuidados do pré-natal e do parto

Tricobezoares no estômago, duodeno e íleo / Trichobezoars in the stomach, duodenum and ileum

A 21-year-old girl presents with a 15-day history of epigastric pain and vomiting. Ten days later, constipation and abdominal distension followed. The patient reported similar epigastric pain and vomiting for 6 days last year. A painless epigastric 12-by-8-centimeter tumor was observed on abdominal palpation, and rectal examination revealed an extrinsic tumor compressing anterior rectal wall. Upper digestive endoscopy showed a trichobezoar. Upon laparotomy, one gastric and one duodenal trichobezoar were removed through an anterior gastrotomy. Another one was found 40 centimeters proximal to the ileo-cecal valve and removed through a proximal ileotomy. Trichobezoar is an unspecific disease, which diagnosis is made upon suspicion. Early recognition of bezoars is important because morbidity and mortality rise considerably once complications occur. We illustrate this case to emphasize the need for early recognition and surgical management in order to reduce morbimortality

Influência do tabagismo, obesidade, idade e gênero na função pulmonar de pacientes submetidos à colecistectomia videolaparoscópica / Influence of smoking habit, obesity, age and gender on the pulmonary function of patients submitted to laparoscopic cholecystectomy

O presente estudo foi idealizado com o objetivo de avaliar a influência do tabagismo, obesidade, idade e gênero na função pulmonar de pacientes submetidos à colecistectomia videolaparoscópica (CVL). Foi realizada avaliação prospectiva da função respiratória de pacientes submetidos à CVL em caráter eletivo, por espirometria simples, no pré-operatório e nos primeiro e sétimo dias de pós-operatório (DPO). Quarenta e oito pacientes foram avaliados e estratificados em grupos: tabagista/não-tabagista; obeso/não-obeso; idoso/não-idoso; homem/mulher. Os valores da capacidade vital forçada (CVF), volume expiratório forçado 1º segundo (VEF), fluxos expiratórios forçados 25 por cento (FEF) e 50 por cento (FEF) apresentaram redução significante do pré-operatório para o primeiro DPO em todos os grupos, com exceção do FEF nos obesos, caracterizando-se assim alteração de padrão restritivo. No sétimo DPO houve recuperação dos parâmetros espirométricos para valores próximos aos níveis do pré-operatório. Não houve diferença significante na variação dos parâmetros espirométricos segundo os fatores de risco, nos mesmos períodos. Em conclusão, nas condições em que foi realizado o presente estudo, a idade, a obesidade, o gênero e o tabagismo não influenciaram, isoladamente ou em associação, as variações nos parâmetros espirométricos do pré-operatório para o primeiro DPO e para o sétimo DPO após a CVL