Urotherapy in the treatment of children and adolescents with bladder and bowel dysfunction: a systematic review / Uroterapia no tratamento de crianças e adolescentes com disfunção vesical e intestinal: revisão sistemática

ABSTRACT Objective: To identify and describe the protocols and clinical outcomes of urotherapy interventions in children and adolescents with bladder bowel dysfunction. Method: Systematic review carried out in June 2018 on Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL),Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Cochrane Library, and PsycInfo databases. Clinical trials and quasi-experimental studies carried out in the last ten years in children and/or adolescents with bladder and bowel symptoms and application of at least one component of urotherapy were included. Results: Thirteen clinical trials and one quasi-experimental study were included, with moderate methodological quality. The heterogeneity of the samples and of the methodological design of the articles prevented the performance of a meta-analysis. The descriptive analysis through simple percentages showed symptom reduction and improvement of uroflowmetry parameters. The identified urotherapy components were: educational guidance, water intake, caffeine reduction, adequate voiding position, pelvic floor training, programmed urination, and constipation control/management. Conclusion: This review indicates positive results in terms of symptom reduction and uroflowmetry parameter improvement with standard urotherapy as the first line of treatment for children and adolescents with bladder bowel dysfunction. It is recommended that future studies bring contributions regarding the frequency, number, and time of urotherapy consultations.

RESUMO Objetivo: Identificar e descrever os protocolos e desfechos clínicos das intervenções de uroterapia em crianças e adolescentes com disfunção vesical e intestinal. Método: Revisão sistemática realizada em junho de 2018 nas bases Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Cochrane Library e PsycInfo. Foram incluídos ensaios clínicos e estudos quase-experimentais dos últimos 10 anos, em crianças e/ou adolescentes com sintoma urinário e intestinal e aplicação de no mínimo um componente de uroterapia. Resultados: 13 ensaios clínicos e 1 estudo quase-experimental foram incluídos, sendo a qualidade metodológica moderada. A heterogeneidade da amostra e de delineamento metodológico dos artigos impediu a realização de meta-análise. A análise descritiva por meio de percentual simples demonstrou redução dos sintomas e melhora dos parâmetros de urofluxometria. Os componentes de uroterapia identificados foram: orientação educacional, ingestão hídrica, redução de cafeína, posicionamento adequado para eliminação, treinamento do assoalho pélvico, micção programada e controle/manejo da constipação. Conclusão: Esta revisão sinaliza resultados positivos em termos de redução de sintomas e melhora nos parâmetros de urofluxometria com aplicação de uroterapia padrão como primeira linha de tratamento nos casos de crianças e adolescentes com disfunção vesical e intestinal. Recomenda-se que estudos futuros tragam contribuições no que tange a frequência, número e tempo para as consultas de uroterapia.

Evaluación de expresión de e-caderinas como factor predictivo de recurrencia y progresión de carcinoma urotelialvesical no musculo infiltrante / Evaluation of e-cadherin expression as a predictor of recurrence and progression of non-muscle invasive carcinoma urotelialvesical

Los tumores superficiales de vejiga (no músculo-infiltrantes) constituyen un grupo heterogéneo de lesiones de evolución dispar, con marcada tendencia a la recidiva y progresión tumoral, cuya historia natural no puede ser predecida con seguridad en base a un caso individual. Hay evidencias que sugieren que moléculas de adhesión celular, como la E-Caderina (E-Cd) podrìan tener importancia en el desarrollo y progresión del cáncer vesical. En este estudio, se examinaron retrospectivamente 46 pacientes con diagnóstico de tumor superficial de vejiga urinaria, con evaluación, tratamiento y seguimiento estandarizados, con tiempo de observación promedio de 81 meses (tiempo máximo de 130 meses). Los tejidos se fijaron en formol neutro e incluyeron en parafina. Se evaluó la expresión de E-caderina (E-Cd) en el epitelio tumoral mediante sistema de detección inmunohistoquímica a través de sistema Biotina-Estreptavidina-Peroxidasa-DAB. La determinación de expresión de E-Cd por inmunomarcación ermite distinguir dos distintos patrones de expresión: patrón homogéneo, o normal, y heterogéneo o anormal.Se utilizó como método estadístico test de Wald, Odd ratio y test de verosimilitud (p- valor). Para estimación de número de recidivas se ajustó a modelo de regresión Poisson. El tiempo libre de progresión se analizó con modelo de riesgo proporcional deCox. La distribución por sexo fue a predominio masculino (31 casos, 67 %), con promedio de edad de 67,3 años. 67 % de los pacientes tenían factor de riesgo de tabaquismo. El signo clínico dominante fue la hematuria, y la forma macroscópica de presentación predominante fue como tumor único con patrón de crecimiento papilar exofítico. Acorde a la clasificación de OMS, 10 casos fueron categorizados como GI, 27 (58 %) omo G II y 9 casos como G III...

Superficial bladder tumors (non-muscle infiltrating) are a heterogeneous group of injuries of disparate development, with strong tendency to recurrence and tumor progression, whose natural history can not be predicted with certainty based on an individual case. There is evidence that suggests that cell adhesion molecule, like ECadherin(E-Cd) may play a fundamental role in the development and progression ofbladder cancer. In this study, 46 patients diagnosed with superficial bladder tumor were retrospectivelyreviewed, with standardized evaluation, treatment and follow-up, with an observation average time of 81 months (maximum period of 130 months). The tissues were fixed in neutral formalin and included in paraffin. The expression of E-Cadherin (E-Cd) was evaluated in the epithelial tumor by immunohistochemical detection system via Biotinstreptavidin- Peroxidase-DAB system. The determination of expression of E-Cd by immunohistochemistry allows the distinction between two different patterns of expression: homogeneous or normal pattern, and heterogeneous or abnormal. The statistical method used was Wald test, Odd- ratio test and verisimilitude (p-value). To estimate the number of relapses the Poisson regression model was followed. The progression-free time was analyzed with Cox proportional hazards model. The distribution by sex was a male predominance (31 cases, 67%) with an average age of 67.3 years. 67% of patients had risk factor for smoking. The dominant clinical sign was the hematuria, and the macroscopic form of dominant presentation was a single tumor with exophytic papillary growth pattern. According to the WHO classification, 10 cases wereclassified as GI, 27 (58%) as G II and 9 cases as G III. The abnormal expression of E-Cd of GI versus G III tumors was statistically significant (p = 0.03)...

Toxina botulínica del tipo A en el tratamiento de la hiperreflexia del detrusor (informe preliminar) / Type A botulinum toxin for the treatment of detrussor hyperreflexia (preliminary report)

Se estudiaron 12 pacientes con lesión medular traumática completa, los cuales cursaban con hiperreflexia del detrusor. Se les realizó la aplicación de 100 UI de toxina botulínica del tipo A mediante inyección endoscópica submucosa en cuatro sitios (techo, suelo y paredes laterales de la vejiga). Los pacientes cursaban con una capacidad vesical máxima inicial promedio de 379.3 ml, y una presión del detrusor de 53.8 cm H2O. Durante el primer control subsecuente a la aplicación de toxina (cuatro a seis semanas) se observó una mejoría del 15.87 por ciento, con incremento de la capacidad vesical máxima promedio de 60.2 ml y disminución de la presión del detrusor en 55.54 por ciento, con una presión de 23.9 cm H2O. Durante el segundo control (8 a 10 semanas) se incremento aun más la mejoría, que fue de 39.9 por ciento para la capacidad vesical máxima (151.7 ml) y la presión del detrusor mejoró en 82.3 por ciento al disminuir a 9.5 cm H2O. Se concluye que la aplicación única de toxina botulínica de tipo A es una alternativa favorable para el tratamiento de la hiperreflexia del detrusor, con buena respuesta hasta las 10 semanas de seguimiento de estos pacientes; sin embargo, se requiere aún de seguimiento de estos pacientes para lograr identificar el tiempo de respuesta máxima a este tratamiento innovador

Determination of mineral elements in medicinal plants used for the cure of bronchitis, kidney and bladder disorder, skin diseases and gonorrhea etc

Determination of mineral elements in thirty-two medicinal plants i.e. abroma augusta, abutilon hirtum, alocasia indica, argemone mexicano [Roots], argemone mexicana [seeds], astera cantha longifolia, Barleria prionitis, barringtonia racemosa, berberis aristata, caesalpinia crista, cassia angustifolia, centratherum anthelminticum, cissampelos pareira, crataeva nurvala, didymocarpus pedicellata, embelia ribes, ficus carica, hedychium spicatum, heliotropium strigosum, holarrhena antidysenterica, ichnocarpus frutescens, justicia gendarussa, lagenandra toxicaria, mimusops elengi, orchis mascula, pedalium murex, randia dumetorum, sphaeranthus indicus, teramnus labialis, tylophora indica, verbascum thapsus and vitis vinifera used for the cure of bronchitis, kidney and bladder disorder, skin diseases and gonorrhoea etc. have been carried out. Concentrations of Na, K, Cu, Ni, Mn, Co, Zn, Cd, Fe, Pd, Mg, Cr, Ca, Hg, Al, Ag, Sr, Mo, and V were determined by using flame photometer [FPM], atomic absorption sepctrometer [AAS] and inductively coupled Plasma [ICP] respectively. Mineral elements Mn, Mg, Zn, Ca, Fe, Ni, Cr, Na, K, Al and Sr are present in all the thirty-two medicinal plants

Endoscopic treatment of bilharzial bladder ulcer

Several methods of treatment have been tried for chronic bilharzial bladder ulcers. Endoscopic treatment of bilharzial bladder ulcers has been tried in this study, aiming for evaluation of its results as a line of treatment. Our study included 75 patients, 69 males and 6 females treated in Urology Department of El Minia University Hospital over two years duration, transuretheral resection was done for 45 patients, and transuretheral excision for 30 patients with no marked difference between the two techniques. However, transuretheral resection has the advantage in multiple ulcers. Follow up for those patients after treatment for 6 months revealed that 58 patients [77.3%] were symptoms free, 12 patients [16%] had slight burning micturition, and 5 patient [6.7%] had persistent symptoms. Cytoscopic examination was done 6 months after treatment revealed that recurrent ulceration still present in 5 patients [6.7%]. We concluded that endoscopic treatment of chronic bilharzial bladder ulcers is quite safe satisfactory manouver provided that the cases is accurately selected

Manejo urológico de 437 pacientes con mielomeningocele / Urologic management of 437 patients with myelomeningocele

Se hace análisis retrospectivo del tratamiento de 437 pacientes con mielomeningocele, atendidos en el Instituto de Rehabilitación Infantil. Se señala la mayor frecuencia de casos complicados en la primera consulta durante el período 81-85 (17,3%) versus el segundo período 85-90 (8,2%). El nivel de lesión se ubica en 74% en la región lumbar. Un 52,4% de los pacientes se tratan médicamente (cateterismo intermitente con o sin colinolítico y credé) por tener vejiga hipoactiva. El 16,6% se somete a cirugía, el 7,2% a enterocistoplastía por vejiga hiperactiva