Cognitive-behavioral program to control lower urinary tract symptoms after radical prostatectomy: a randomized clinical trial / Programa cognitivo-conductual para el control de los síntomas del tracto urinario inferior después de la prostatectomía radical: un ensayo clínico aleatorizado / Programa cognitivo-comportamental para controle de sintomas do trato urinário inferior pós-prostatectomia radical: ensaio clínico randomizado

ABSTRACT Objective: to assess the effectiveness of a cognitive-behavioral program to control lower urinary tract symptoms after radical prostatectomy. Methods: a randomized clinical trial study, with 41 participants randomized into intervention (n=20) and control (n=21), for three months. The intervention group received the cognitive-behavioral program, while the control group received routine guidance from the service. Outcome variables were urinary incontinence intensity and lower urinary tract symptoms, assessed by the Pad-Test and Urinary Incontinence Scale of Radical Prostatectomy and King's Health Questionnaire. Results: at the end of the study, the intervention group had a lower urinary incontinence intensity (p≤0.001), and there were less chances of presenting changes in urinary frequency (p≤0.001), urinary urgency (p≤0.001), nocturia (p=0.005), stress urinary incontinence (p≤0.001) and urge incontinence (p≤0.045). Conclusion: the cognitive-behavioral program was effective in reducing lower urinary tract symptoms after radical prostatectomy. Brazilian Clinical Trial Registry: RBR-3sstqg.

RESUMEN Objetivo: evaluar la efectividad de un programa cognitivo-conductual para controlar los síntomas del tracto urinario inferior después de la prostatectomía radical. Métodos: estudio de ensayo clínico aleatorizado, con 41 participantes aleatorizados en intervención (n=20) y control (n=21), durante tres meses. El grupo de intervención recibió el programa cognitivo-conductual, mientras que el grupo control recibió orientación rutinaria del servicio. Las variables de resultado fueron la intensidad de la incontinencia urinaria y los síntomas del tracto urinario inferior, evaluados mediante Pad-Test y Urinary Incontinence Scale of Radical Prostatectomy y King's Health Questionnaire. Resultados: al final del estudio, el grupo intervención presentó menor intensidad de incontinencia urinaria (p≤0,001), y hubo menos posibilidades de presentar cambios en la frecuencia urinaria (p≤0,001), urgencia urinaria (p≤0,001), nicturia (p=0,005), incontinencia urinaria de esfuerzo (p≤0,001) e incontinencia de urgencia (p≤0,045). Conclusión: el programa cognitivo-conductual fue eficaz para reducir los síntomas del tracto urinario inferior después de la prostatectomía radical. Registro Brasileño de Ensayos Clínicos: RBR-3sstqg.

RESUMO Objetivo: avaliar a efetividade de um programa cognitivo-comportamental para controle de sintomas do trato urinário inferior pós-prostatectomia radical. Método: estudo de ensaio clínico randomizado, com 41 participantes aleatorizados em intervenção (n=20) e controle (n=21), durante três meses. O grupo intervenção recebeu o programa cognitivo-comportamental, enquanto o grupo controle recebeu orientações de rotina do serviço. As variáveis desfechos foram intensidade da incontinência urinária e sintomas do trato urinário inferior, avaliados pelo Pad-Test e Urinary Incontinence Scale of Radical Prostatectomy e King's Health Questionnaire. Resultados: ao final do estudo, o grupo intervenção apresentou menor intensidade da incontinência urinária (p≤0,001), e houve menos chances de apresentar alterações da frequência urinária (p≤0,001), urgência miccional (p≤0,001), noctúria (p=0,005), incontinência urinária de esforço (p≤0,001) e urge-incontinência (p≤0,045). Conclusão: o programa cognitivo-comportamental foi efetivo para a redução de sintomas do trato urinário inferior após a prostatectomia radical. Registro Brasileiro de Ensaios Clínicos: RBR-3sstqg.

Aspectos clínico-epidemiológicos associados ao câncer de pênis / Clinico-epidemiological aspects associated with penile cancer

O objetivo desta revisão bibliográfica foi descrever a epidemiologia, o comportamento biológico dos tumores e os fatores de risco para o câncer de pênis, como a infecção pelo HPV. A fimose e os processos de irritação crônica relacionados à má higiene estão comumente associados com esse tumor, enquanto a circuncisão neonatal protege contra a aparição da doença. Existe forte evidência da associação dos HPV 16 e 18 com o carcinoma peniano em mais de 50 por cento dos casos. Pacientes com lesões penianas suspeitas devem se submeter ao exame físico, geralmente sendo este suficiente para determinar o diagnóstico e o estadiamento, assim como auxiliar na escolha terapêutica.

The general objective of this article is to review the current literature regarding the epidemiology, biological behavior and risk factors for penile cancer development, such as HPV infection. Phimosis and chronic irritation related to poor hygiene are commonly associated with penile cancer, whereas neonatal circumcision reduces the relative risk for the disease. There is strong evidence that HPV types 16 and 18 are associated with penile carcinoma in as many as 50 percent of cases. Patients with penile lesions should undergo physical examination, which is often sufficient to diagnose and to define tumor stagging, as well as contributes to decision-making regarding therapeutical approaches and case management.

Pilot study to compare the efficacy of the usual recommended prophylactic antibiotic to the addition of oral ciprofloxacin for patients undergoing radical prostatectomy

Background: This is a randomized, prospective, double-blind pilot study to compare the efficacy of preoperative cephalosporin to the addition of ciprofloxacin to avoid positive urinary culture in patients undergoing radical prostatectomy. Material and Methods: Sixty-four patients with similar clinical features and who underwent radical prostatectomy were split into three antibiotic groups: group A using prophylactic preoperative cephalosporin; group B using the prophylactic cephalosporin plus one day ciprofloxacin and group C using the prophylactic cephalosporin plus ciprofloxacin for 5 days. Urine samples, taken before surgery and after removal of the indwelling catheter, were evaluated. For statistical analysis, we used Chi-square test to establish the association of the antibiotic regimen and positive urinary culture in the univariate analysis and logistic regression in the multivariate analysis. Results: Less urinary infection rate was observed in both groups receiving the addition of ciprofloxacin for one and five days (20 and 9.5 percent, respectively) compared to the use of single preoperative cephalosporin (52.1 percent; p=0.0047). Conclusions: This study suggests that the usual recommendation of preoperative cephalosporin alone may not be adequate to avoid high rates of urinary positive culture in patients undergoing radical prostatectomy.