Benign prostatic hyperplasia

SUMMARY The minimally invasive procedures (mips) for the treatment of symptoms of benign prostatic hyperplasia (bph) are presented as attractive techniques due to their ease of accomplishment and the possibility of outpatient treatment. This guideline aims to present recommendations that may assist in decision making in patients with benign prostatic hyperplasia and indication of the different minimally invasive therapies. For this, a systematic review of the literature was performed, with the descriptors according to the pico: patient with benign prostatic hyperplasia, minimally invasive therapy, clinical outcome and adverse events. With no time restriction, in medline, cochrane central and lilacs databases via vhl, 1,007 papers were retrieved, of which 16 were selected to respond to clinical doubt. Details of the methodology and results of this guideline are set out in annex I

Transurethral resection of the prostate for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia: how much should be resected?

Objective: To assess the impact of the percent of resected tissue on the improvement of urinary symptoms. Materials and methods: The study included a prospective analysis of 88 men with benign prostatic hyperplasia. Patients were divided in three groups according to the percent of resected tissue: Group 1 < 30 percent; Group 2, 30 percent to 50 percent; and Group 3, > 50 percent. Each patient was re-evaluated 3 months after surgery. We assessed the international prostatic symptom score, nocturia and serum prostate specific antigen levels. Results: All patients presented a significant decrease on mean International Prostate System Score (IPSS) (23 to 5.9), Quality of Life (QoL) (4.9 to 1.0) and nocturia (3.2 to 1.9). Variation in the IPSS was 16.7, 16.6 and 18.4 for patients from Group 1, 2 and 3 respectively (P = 0.504). Although the three groups presented a significant decrease in QoL, patients in Group 3 presented a significantly greater decrease when compared to Group 1. Variation in QoL was 3.1, 3.9 and 4.2 for patients from Group 1, 2 and 3 respectively (p = 0.046). There was no significant difference in nocturia variation according to the percent of resected tissue (p = 0.504). Median pre and postoperative PSA value was 3.7 and 1.9 ng/mL respectively. Patients from Group 1 did not show a significant variation (p = 0.694). Blood transfusions were not required in any group. Conclusions:Resection of less than 30 percent of prostatic tissue seems to be sufficient to alleviate lower urinary tract symptoms related to benign prostate hyperplasia. However, these patients may not show a significant decrease in serum PSA level.

Obstruçäo do meato uretral feminino por dobra de mucosa vaginal / Obstruction of the female urethral meatus by vaginal mucosa fold

Durante o período de julho de 1992 a julho de 1995 estudamos, no Hospital das Clínicas da Universidade Federal de Pernambuco e no Hospital Barão de Lucena, 253 mulheres com dobra da mucosa vaginal (DMV) ao nível do meato uretral externo. Esta entidade, possivelmente congênita, é caracterizada por micção espalhada. A exérese da DMV faz regredir a micção espalhada. As mulheres podem apresentar polaciúria, urgência, esforço miccional, sensação de urina residual, incontinência urinária de urgência (IUU), incontinência urinária de esforço (IUE) e cistite. Foi provado por estudo histológico que a referida DMV ao nível do meato uretral é tecido vaginal. Foi demonstrado que um número significativo de mulheres apresenta regressão dos sintomas urinários após a exérese da DMV ao nível do meato uretral. Quando a mulher persiste com sintomas urinários, provavelmente, é porque ela tem outra patologia urinária associada. Finalmente, foi ratificado que a relatada entidade é independente, e pode provocar obstrução do trato urinário

Drenaje vesical en pacientes sometidas a operación Pereyra / Vesical drainage in patients who underwent Pereyra's operation

Se evaluó el problema de retención urinaria en las pacientes sometidas a operación Pereyra con dos tipos de drenaje vesical. Se realizó un estudio prospectivo de enero de 1994 a julio de 1995 en el cual se incluyeron 52 pacientes sometidas operación Pereyra, las cuales se dividieron en dos grupos: Grupo I: a 31 pacientes se les aplicó drenaje suprapúbico con Cistofix Ch 15; Grupo II a 17 con sonda enduoretral (Foley 18 Fr) en pacientes sometidas a operación pereyra manejadas en el postoperatorio con drenaje suprapúbico (Cistofix Ch 15), con control de micción espontánea y orina residual hasta el retiro de la sonda, así como la toma de urocultivo preoperatorio. La edad promedio fue de 43.8 años (con un rango de 32 a 66 años). El drenaje vesical suprapúbico de 0 a tres días se presentó en 58.6 por ciento de las pacientes y más de tres días en 41.29 por ciento. La retención urinaria por más de siete días se presentó en 23.99 por ciento de las pacientes con drenaje suprapúbico y en 28.5 por ciento de las pacientes con sonda endouretral. El riesgo de recateterización fue significativamente mayor con el uso de sonda enduoretral

Dobra de mucosa vaginal ao nível do meato uretral feminino: uma nova entidade? / Vaginal mucosa fold localized at the female urethral external meatus: a new entity?

Após realizarmos estudo prospectivo em mulheres com e sem sintomas urinários, sugerimos que seja incluída na literatura uma nova entidade, chamada por nós dobra de mucosa vaginal (DMV) ao nível do meato uretral, como causa de obstruçÒo do meato uretral feminino. Demonstramos que mulheres com DMV ao nível do meato uretral podem apresentar ou näo sintomas urinários e que a exérese cirúrgica desta DMV faz regredir a sintomatologia em 88 por cento dos casos.

Urodynamic study of vesicourethral dysfunction following abdomino-perennial resection of the rectum for cancer

Vesico-urethral dysfunction following A.P.R. in 14 cases out of 36 cases [39%] was studied urodynamically by combined Pressure-flow and Electromyography. Detrusor areflexia was found in all of the 14 cases while the external sphincter was normal in 9 cases, areflexic in 3 cases and atonic in 2 cases. The functional status of the striated external spincter is the decisive factor for the proper management, while prostatic obstruction is the second factor. Cases of detrusor areflexia associated with a normal external spincterr have been successfully managed by urecholine therapy, but those who had prostatic obstruction in addition, needed T.U.R. prior to cholinergic stimulation. Cases with combined detrusor and external sphincter areflexia responded well to intermittent catheterization. Prostatectomy resulted in incontinence of urine in one of the cases with atonic external sphincter