Profile of sexuality and symptoms of lower urinary tract in non-institutionalized elderly

ABSTRACT Introduction: Urinary or sexual dysfunction in the elderly are underreported. However, they are highly prevalent. This study aims to identify the prevalence of these conditions. Objective: The aim is to carry out an investigation in non-institutionalized individuals over 60 years of age, to obtain data on its sexual and urinary health in São Paulo, Campinas, Santo André and Londrina. Results: 6.000 questionnaires were distributed, and 3425 were included in the study, for the analysis of the questionnaires separately. In relation to ADAM, 92% of the 1385 evaluated were suspicious of androgen deficiency (ADAM). As for the male sexual function, it was observed 37% of premature ejaculation. As for the female sexual function, 1300 (74%) did not practice sexual intercourse and the main reasons were: lack of partner and lack of sexual desire. In addition, 988 (78%) of women who had no sexual intercourse responded that they didn't want sex and, more importantly, about 22% of them would like to have sexual intercourse. International prostate symptom score (IPSS) showed gradual worsening of urinary symptoms with increasing age, being the most prevalent: nocturia and urinary urgency. As for the female IPSS, we noted that even after 80 years, the majority have mild symptoms related to voiding dysfunction; with increasing age there is a gradual increase in the result of the IPSS. Conclusion: Due to the large number of sexual and urinary disorders found, we recommend the improvement in health conditions, promoting a better quality of life in the elderly.

Profile of sexuality and symptoms of lower urinary tract in non-institutionalized elderly.

INTRODUCTION: Urinary or sexual dysfunction in the elderly are underreported. However, they are highly prevalent. This study aims to identify the prevalence of these conditions. OBJECTIVE: The aim is to carry out an investigation in non-institutionalized individuals over 60 years of age, to obtain data on its sexual and urinary health in São Paulo, Campinas, Santo André and Londrina. RESULTS: 6.000 questionnaires were distributed, and 3425 were included in the study, for the analysis of the questionnaires separately. In relation to ADAM, 92% of the 1385 evaluated were suspicious of androgen deficiency (ADAM). As for the male sexual function, it was observed 37% of premature ejaculation. As for the female sexual function, 1300 (74%) did not practice sexual intercourse and the main reasons were: lack of partner and lack of sexual desire. In addition, 988 (78%) of women who had no sexual intercourse responded that they didn't want sex and, more importantly, about 22% of them would like to have sexual intercourse. International prostate symptom score (IPSS) showed gradual worsening of urinary symptoms with increasing age, being the most prevalent: nocturia and urinary urgency. As for the female IPSS, we noted that even after 80 years, the majority have mild symptoms related to voiding dysfunction; with increasing age there is a gradual increase in the result of the IPSS. CONCLUSION: Due to the large number of sexual and urinary disorders found, we recommend the improve-ment in health conditions, promoting a better quality of life in the elderly.

Salvage surgical procedure for artificial sphincter extrusion

ABSTRACT Case Hypothesis: Surgical removal is the standard treatment for artificial sphincter extrusion. However in some specific situations is possible to maintain the prosthesis with good results. Case report: We report a 60 years old patient presenting sphincter pump extrusion one month after artificial urinary sphincter (AUS) AMS 800™ placement for treating post-radical prostatectomy urinary incontinence (PRPUI). He also had a penile pros- thesis implant one year before that was replaced in the same surgery the sphincter was implanted. As patient refused sphincter removal and there were no signals of active infection he was treated by extensive surgical washing with antibiotics and antiseptics. Pump was repositioned in the opposite side of the scrotum. Patient had good evolution with sphincter activation 50 days later. After 10 months of follow up, patient is socially continent and having regular sexual intercourse. Savage surgery may be an option in select cases of artificial sphincter extrusion. Promising future implications: Like in some patients with penile prosthesis some pa- tients with artificial sphincter extrusion can be treated without removing the device. This may be a line of research about conservative treatment of artificial sphincter complications.

Salvage surgical procedure for artificial sphincter extrusion.

Case Hypothesis: Surgical removal is the standard treatment for artificial sphincter extrusion. However in some specific situations is possible to maintain the prosthesis with good results. CASE REPORT: We report a 60 years old patient presenting sphincter pump extrusion one month after artificial urinary sphincter (AUS) AMS 800™ placement for treating post-radical prostatectomy urinary incontinence (PRPUI). He also had a penile prosthesis implant one year before that was replaced in the same surgery the sphincter was implanted. As patient refused sphincter removal and there were no signals of active infection he was treated by extensive surgical washing with antibiotics and antiseptics. Pump was repositioned in the opposite side of the scrotum. Patient had good evolution with sphincter activation 50 days later. After 10 months of follow up, patient is socially continent and having regular sexual intercourse. Savage surgery may be an option in select cases of artificial sphincter extrusion. Promising future implications: Like in some patients with penile prosthesis some patients with artificial sphincter extrusion can be treated without removing the device. This may be a line of research about conservative treatment of artificial sphincter complications.

Overactive bladder - 18 years - Part I.

Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals - including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

Overactive bladder - 18 years - Part II.

Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics - pillars of the overactive bladder pharmacotherapy - started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning - as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder - 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Overactive bladder - 18 years - Part II

ABSTRACT Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Overactive bladder - 18 years - Part I

ABSTRACT Abstract: Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals – including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

A transobturator adjustable system for male incontinence: 30-month follow-up of a multicenter study

Purpose To report long-term results of the Argus T adjustable system for treatment of post-prostatectomy urinary incontinence (PPI). Materials and Methods From October 2007 to August 2008, 37 patients with PPI were included in a prospective, single-arm, multicenter trial of treatment with the Argus T adjustable system (Promedon, Argentina). Preoperative evaluation included urine culture, urethrocystoscopy, urodynamic testing, 24-h pad weight test (PWT) and quality of life questionnaires. Patients were stratified according to baseline degree of incontinence (mild–moderate or severe). Postoperative evaluation included immediate PWT, quality of life questionnaires and daily use of pads at 1, 12 and 30 months. Results and Conclusions One patient was lost to follow-up. At the 30-month follow-up, 24/31 patients (77%) were dry, 3/31 (10%) improved and 4/31 (13%) were failures. In particular, in the mild-moderate group, 8/8 (100%) patients were dry. In the severe group, 20/28 patients (71%) were dry, 3/28 (11%) improved and 5/28 (18%) were failures. Median visual analogue scale (VAS) scores dropped from 9 (4-10) to 0.5 (0-10) and International Consultation on Incontinence Questionnaire Short Form scores from (ICIQ-SF) 19 (12–21) to 1 (0–10). Retrograde leak point pressure increased from 18 (5–29) to 35 (22–45) cm H2O after intraoperative adjustment. Complications included immediate postoperative infection in 2/36 patients (6%) and transient inguinal and/or perineal pain in 22/36 patients (61%). Argus T has a long-term high success rate (86% cure + improvement at the 30-month follow-up). Good outcomes were achieved even in severe incontinence cases and maintained for over 30 months. .

A transobturator adjustable system for male incontinence: 30-month follow-up of a multicenter study.

PURPOSE: To report long-term results of the Argus T adjustable system for treatment of post-prostatectomy urinary incontinence (PPI). MATERIALS AND METHODS: From October 2007 to August 2008, 37 patients with PPI were included in a prospective, single-arm, multicenter trial of treatment with the Argus T adjustable system (Promedon, Argentina). Preoperative evaluation included urine culture, urethrocystoscopy, urodynamic testing, 24-h pad weight test (PWT) and quality of life questionnaires. Patients were stratified according to baseline degree of incontinence (mild-moderate or severe). Postoperative evaluation included immediate PWT, quality of life questionnaires and daily use of pads at 1, 12 and 30 months. RESULTS AND CONCLUSIONS: One patient was lost to follow-up. At the 30-month follow-up, 24/31 patients (77%) were dry, 3/31 (10%) improved and 4/31 (13%) were failures. In particular, in the mild-moderate group, 8/8 (100%) patients were dry. In the severe group, 20/28 patients (71%) were dry, 3/28 (11%) improved and 5/28 (18%) were failures. Median visual analogue scale (VAS) scores dropped from 9 (4-10) to 0.5 (0-10) and International Consultation on Incontinence Questionnaire Short Form scores from (ICIQ-SF) 19 (12-21) to 1 (0-10). Retrograde leak point pressure increased from 18 (5-29) to 35 (22-45) cm H2O after intraoperative adjustment. Complications included immediate postoperative infection in 2/36 patients (6%) and transient inguinal and/or perineal pain in 22/36 patients (61%). Argus T has a long-term high success rate (86% cure + improvement at the 30-month follow-up). Good outcomes were achieved even in severe incontinence cases and maintained for over 30 months.

Laparoscopic radical prostatectomy: the learning curve of a low volume surgeon.

OBJECTIVE: Analyze the learning curve for laparoscopic radical prostatectomy in a low volume program. MATERIALS AND METHODS: A single surgeon operated on 165 patients. Patients were consecutively divided in 3 groups of 55 patients (groups A, B, and C). An enhancement of estimated blood loss, surgery length, and presence of a positive surgical margin were all considered as a function of surgeon's experience. RESULTS: Operative time was 267 minutes for group A, 230 minutes for group B, and 159 minutes for group C, and the operative time decreased over time, but a significant difference was present only between groups A and C (P < 0.001). Mean estimated blood loss was 328 mL, 254 mL, and 206 mL (P = 0.24). A conversion to open surgery was necessary in 4 patients in group A. Positive surgical margin rates were 29.1%, 21.8%, and 5.5% (P = 0.02). Eight patients in group A, 4 patients in group B, and one in group C had biochemical recurrence. CONCLUSION: Significantly less intraoperative complications were evident after the first 51 cases. All other parameters (blood loss, operative time, and positive surgical margins) significantly decreased and stabilized after 110 cases. Those outcomes were somehow similar to previous published series by high-volume centers.

Prevalência de sinais de sensibilidade ao látex em pacientes com mielomeningocele submetidos a múltiplos procedimentos cirúrgicos / Prevalence of sensitivity signals to latex in meningomyelocele patients undergoing multiple surgical procedures

JUSTIFICATIVA E OBJETIVOS: O número de pacientes alérgicos ao látex vem aumentando significativamente. É essencial reconhecê-los para preve nir e aplicar o tratamento adequado. O objetivo do estudo foi avaliar a prevalência de alergia ao látex em pacientes com mielomeningocele. MATERIAIS E MÉTODOS: Foram avaliados, retrospectivamente, os prontuários médicos de pacientes com diagnóstico de mielomeningocele no período de janeiro de 2002 a dezembro de 2007. Os pacientes foram agrupados em alérgicos e não alérgicos. A comparação dos grupos em relação ao gênero foi feita pelo teste do Qui-quadrado, pelo teste t de Student em relação à idade, e o teste de Mann-Whitney para comparação entre os grupos em relação as manifestações clínicas de alergia, número de procedimentos sob anestesia, de internações hospitalares e de cateterizações vesicais. RESULTADOS: O número médio de procedimentos sob anestesia foi de 7 no grupo com alergia e 4 no grupo sem alergia, sendo esta diferença estatisticamente significante (p = 0,028). O número médio de internações hospitalares foi de 4,5 no grupo com alergia e 3,4 no grupo sem alergia e a média de cateterização vesical foi 24,5 nos alérgicos e 21,7 nos não alérgicos. CONCLUSÕES: Os pacientes portadores de mielomeningocele submetidos a múltiplos procedimentos sob anestesia apresentam alto risco de desenvolvimento de sinais clínicos de alergia ao látex. Há necessidade de que pacientes com diagnóstico de mielomeningocele sejam submetidos exclusivamente a procedimentos latex-free, evitando o alto risco de sensibilização e suas complicações. Testes específicos para avaliação da sensibilização, marcadores genéticos e relação látex-fruta poderão contribuir para melhor entendimento dos fatores de risco relacionados à alergia ao látex e formas de prevenção.

BACKGROUND AND OBJECTIVES: The number of patients allergic to latex has increased significantly. It is crucial to recognize the cases in order to prevent and apply adequate treatment. The objective of this study was to evaluate the prevalence of allergy to latex in meningomyelocele patients. MATERIALS AND METHODS: A retrospective evaluation of medical records of patients with meningomyelocele diagnosis from January 2002 to December 2007 was conducted. Patients were grouped into allergics and non-allergics. The comparison of groups for gender was made by the Chi-Squared test, the Student's t test was used to compare age, and Mann-Whitney test was used to compare groups for clinical manifestations of allergy, number of procedures under anesthesia, hospital admissions and vesical catheterizations. RESULTS: The mean number of procedures under anesthesia was 7 in the group with allergy and 4 in the group without allergy; this difference was statistically significant (p = 0.028). The mean number of hospital admissions was 4.5 in the group with allergy and 3.4 in group without allergy and mean vesical catheterization was 24.5 in allergic patients and 21.7 in non allergic ones. CONCLUSIONS: Meningomyelocele patients undergoing multiple procedures under anesthesia have high risk of developing clinical signals of allergy to latex. It is necessary that patients with meningomyelocele diagnosis should undergo exclusively latex-free procedures, avoiding high risk of sensitization and its complications. Specific tests to evaluate sensitization, genetic markers and latex-fruit relationship may contribute to a better understanding of risk factors related to allergy to latex and ways to prevent it.

JUSTIFICATIVA Y OBJETIVOS: El número de pacientes alérgicos al látex ha venido aumentando significativamente. Es esencial reconocer los casos para prevenir y aplicar el tratamiento adecuado. El objetivo del estudio, fue evaluar la prevalencia de alergia al látex en pacientes con mielomeningocele. MATERIAL Y MÉTODOS: Fueron evaluadas retrospectivamente, las historias clínicas de pacientes con diagnóstico de mielomeningocele en el período de enero de 2002 a diciembre de 2007. Los pacientes fueron agrupados en alérgicos y no alérgicos. La comparación de los grupos con relación al sexo se hizo por medio del test del Xi-Cuadrado (Xi²), por el test t de Student con relación a la edad, y el test de Mann-Whitney para la comparación entre los grupos, con relación a las manifestaciones clínicas de alergia, número de procedimientos bajo anestesia, de ingresos hospitalarios y de cateterizaciones vesicales. RESULTADOS: El número promedio de procedimientos bajo anestesia fue de 7 en el grupo con alergia y 4 en el grupo sin alergia, siendo que esa diferencia es estadísticamente significativa (p = 0,028). El número promedio de ingresos fue de 4,5 en el grupo con alergia y de 3,4 en el grupo sin alergia, y el promedio de cateterización vesical fue 24,5 en los alérgicos y de 21,7 en los no alérgicos. CONCLUSIONES: Los pacientes portadores de mielomeningocele sometidos a múltiples procedimientos bajo anestesia, presentan un alto riesgo de desarrollar signos clínicos de alergia al látex. Existe la necesidad de que pacientes con diagnóstico de mielomeningocele se sometan exclusivamente a procedimientos latex-free, evitando así el alto riesgo de sensibilización y sus complicaciones. Test específicos para la evaluación de la sensibilización, marcadores genéticos y relación látex-fruta, podrán contribuir para un mejor entendimiento de los factores de riesgo relacionados con la alergia al látex y con las formas de prevención.

Prevalence of sensitivity signals to latex in meningomyelocele patients undergoing multiple surgical procedures.

BACKGROUND AND OBJECTIVES: The number of patients allergic to latex has increased significantly. It is crucial to recognize the cases in order to prevent and apply adequate treatment. The objective of this study was to evaluate the prevalence of allergy to latex in meningomyelocele patients. MATERIALS AND METHODS: A retrospective evaluation of medical records of patients with meningomyelocele diagnosis from January 2002 to December 2007 was conducted. Patients were grouped into allergics and non-allergics. The comparison of groups for gender was made by the Chi-Squared test, the Student's t test was used to compare age, and Mann-Whitney test was used to compare groups for clinical manifestations of allergy, number of procedures under anesthesia, hospital admissions and vesical catheterizations. RESULTS: The mean number of procedures under anesthesia was 7 in the group with allergy and 4 in the group without allergy; this difference was statistically significant (p=0.028). The mean number of hospital admissions was 4.5 in the group with allergy and 3.4 in group without allergy and mean vesical catheterization was 24.5 in allergic patients and 21.7 in non allergic ones. CONCLUSIONS: Meningomyelocele patients undergoing multiple procedures under anesthesia have high risk of developing clinical signals of allergy to latex. It is necessary that patients with meningomyelocele diagnosis should undergo exclusively latex-free procedures, avoiding high risk of sensitization and its complications. Specific tests to evaluate sensitization, genetic markers and latex-fruit relationship may contribute to a better understanding of risk factors related to allergy to latex and ways to prevent it.

Use of an inflatable silicone balloon improves the success rate of bladder autoaugmentation at long-term followup.

PURPOSE: Most groups have reported disappointing results with autoaugmentation or detrusor myectomy for low capacity/compliance neuropathic bladders. Failure may be due to an ischemic diverticulum or mucosal shrinkage. We investigated whether a Silimed® silicone balloon placed in the bladder after autoaugmentation could prevent these problems, improving surgical results. MATERIALS AND METHODS: We compared the results of standard bladder autoaugmentation in 12 children (group 1) with those in 10 (group 2) who underwent the same surgery using a bladder conformer. The conformer was a silicone balloon filled with saline that remained in the bladder for 2 weeks. All patients had a neuropathic bladder with poor capacity and compliance, resulting in urinary leakage between catheterizations. Preoperative and postoperative evaluation included a voiding diary, ultrasound, voiding cystourethrogram and urodynamics. RESULTS: In group 1 only 1 patient became dry, 4 had little improvement in continence, 4 remained unchanged and 3 became worse. In group 2, 6 patients (60%) become continent without medication, 2 (20%) become continent with oxybutynin and 2 remained unchanged. Bladder capacity and compliance did not change significantly in group 1. However, in group 2 capacity changed from a mean of 140 to 240 ml and mean ± SD compliance increased from 15.6 ± 16.8 to 34.3 ± 22.8 ml/cm H(2)O (p = 0.02). CONCLUSIONS: The inflatable balloon improved our long-term results of bladder auto-augmentation. A larger series may be necessary to confirm procedure efficacy and safety.

Treinamento esfincteriano por meio de biofeedback no tratamento de crianças portadoras de micção incoordenada / Sphincter training with biofeedback in children with uncoordinated voiding

Vinte crianças portadoras de micção incoordenada foram tratadas por meio de treinamento vesicoesfincteriano, utilizando-se técnicas fisioterapêuticas associadas com equipamento de eletromiografia com eletrodos de superfície – biofeedback (EMG–biofeedback). O grupo foi composto por 16 meninas e quatro meninos (média de idade 10 anos). O diagnóstico de micção incoordenada MINI baseou-se no histórico, exame físico, ultra-som, uretrocistografia miccional e avaliação urodinâmica. Os parâmetros avaliados antes e depois do tratamento foram: troca de roupas íntimas ao dia, resíduo pós-miccional, fluxo urinário máximo, número dos episódios de infecção do trato urinário e alteração no grau de refluxo vesicoureteral. O treinamento envolveu a monitorização da atividade eletromiográfica da musculatura da parede abdominal e Musculatura do Assoalho Pélvico (MAP), por meio de eletrodos de superfície. O tratamento consistiu em ensinar a criança a relaxar a musculatura pélvica durante a micção. Ao final de cada sessão, realizou-se um estudo com urofluxometria + EMG, visando identificar eventuais contrações da musculatura pélvica durante a micção. O protocolo de tratamento incluiu uma sessão semanal de fisioterapia com treinamento do assoalho pélvico, durante um período médio de 25 semanas (variando de 20 a 35 sessões). Os dados do estudo demonstraram que houve diminuição significativa no número de trocas de roupas íntimas diárias, diminuição dos episódios de infecção no trato urinário, melhora do fluxo miccional, diminuição do resíduo pós-miccional e do grau de refluxo vesicoureteral. O treinamento fisioterapêutico com o EMG-biofeedback no tratamento da micção incoordenada em crianças demonstrou-se uma opção terapêutica não invasiva, segura e de resultados satisfatórios no presente estudo.

Twenty children with uncoordinated voiding were treated through bladder sphincter training, using physiotherapy associated with electromyography with surface electrodes - biofeedback (EMG - biofeedback). The group included 16 girls and four boys (mean age 10 y.o.). Diagnosis of uncoordinated voiding (MINI) was based on medical history, physical evaluation, ultrasonography, cystogram to evaluate reflux, and urodynamic evaluation. Outcome measures included changes of underwear during the day, post-voiding residue, maximum urinary flow, number of episodes of urinary tract infection, and change in the level of vesicoureteral reflux. The training included monitoring electromyographic activity of abdominal wall and pelvic floor muscles, through electrodes located on the surface. The children were taught to relax pelvic floor muscles while voiding. At the end of each session, urinary flow measure and EMG were performed to identify pelvic floor muscle contractions during voiding. The protocol of treatment included a weekly physiotherapy session training pelvic floor muscles, spanning a mean period of 25 weeks (ranging from 20 to 35 sessions). Study findings demonstrated a significant reduction in the number of daily changes of underwear, a decrease in the number of urinary tract infection episodes, an improvement in urinary flow, a decrease of post-voiding residue and an improvement in the level of vesicoureteral reflux. This study showed that physiotherapeutic training associated with EMG-biofeedback in the treatment of children with uncoordinated voiding to be a safe, non-invasive therapeutic method, yielding satisfactory results.

Case report: late recurrent hematuria following laparoscopic radical prostatectomy may predict internal pudendal artery pseudoaneurysm and arteriovenous fistula.

We report two cases of a pseudoaneurysm of the internal pudendal artery with arteriovenous fistula after extraperitoneal laparoscopic radical prostatectomy. The clinical presentation was delayed recurrent hematuria and urinary retention that necessitated bladder clot evacuation. Subsequent arteriography detected the vascular abnormality and a superselective embolization was performed. Hematuria was no longer observed, and the quality of penile erection remains unchanged in both patients.

Feocromocitoma vesical / Vesical pheochromocytoma

Feocromocitoma vesical é um tumor raro, representando 1 por cento dos feocromocitomas extra-adrenais. Foram descritos 117 casos na literatura. É apresentado o caso de uma jovem com hipertensäo arterial sem causa aparente controlada com enalapril. Três anos depois, realizou-se ultrasonografia para avaliaçäo de queixa abdominal de origem näo-urinária, quando diagnosticou-se tumor vesical. Por näo se tratar de tumor urotelial, optou-se por cistectomia parcial cujo exame anatomopatológico revelou feocromocitoma. Um ano após a cirurgia, a paciente apresentava níveis pressóricos de 140 x 100 mmHg, sendo controlados com 1 mg de prazosim