[Percutaneous radiofrequency sacral rhizotomy in the treatment of neurogenic detrusor overactivity in spinal cord injured patients]. / Rizotomía sacra percutánea por radiofrecuencia en el tratamiento de la hiperactividad del detrusor neurogénico en pacientes con lesiones de la médula espinal.

INTRODUCTION: To evaluate the effects of percutaneous radiofrequency sacral rhizotomy in spinal cord injured (SCI) patients on urodynamic parameters (maximum cystometric capacity - MCC and detrusor pressure at maximum cystometric capacity - PdetMCC). MATERIAL AND METHODS: This prospective study assessed eight patients with SCI (four men and four women) with a mean age of 31.3years (22 to 41). Mean interval period between spinal cord lesion and rhizotomy was 53.5 months (20 to 96). All patients underwent an anesthetic block of the 3rd sacral root bilaterally using 0.5% bupivacaine under fluoroscopic control. Those who responded with an increase on bladder capacity were selected to undergo the percutaneous radiofrequency sacral rhizotomy. All patients underwent urodynamic evaluation at 6 and 12 months following the procedure. MCC and P(det)MCC were recorded. RESULTS: All patients presented a significant improvement on MCC after 12 months. The mean vesical volume increased from 100.2±57.1 to 282.9±133.4ml (p<0.05). The P(det)MCC reduced from 82.4±31.7 to 69.9±28.7cmH(2)O (p=0.2). Three patients with autonomic dysreflexia had complete relief of symptoms after the procedure. At 12 months, recurrence of detrusor hyperactivity was observed in all patients. One patient presented abolishment of reflex erections after the procedure. No major complications related to the rhizotomy were noted. CONCLUSIONS: Percutaneous radiofrequency sacral rhizotomy is a minimally invasive technique with low morbidity able to increase MCC. There is a trend towards the reduction of the P(det)MCC in SCI patients at 12 months, although statistical significance was not reached.

[Long term follow-up of the tendinous urethral support: an anatomical approach for stress urinary incontinence]. / Seguimiento a largo plazo del soporte uretral tendinoso: un enfoque anatómico para incontinencia urinaria de esfuerzo.

Sling procedures have been around for decades in the management female stress urinary incontinence (SUI), but only in the past decade they have become the preferred technique. Minimally invasive procedures are the procedure of choice in many centers for your efficacy and low morbidity. The tendinous urethral support (TUS) represents an anatomical approach that consists in placing a midurethral low tension tape anchored to the tendinous arc bilaterally. From February 1999 to October 2000, 25 female patients (mean age: 53 years old), with SUI underwent TUS procedure, and 23 were available for follow-up. Those patients were followed until 72 months. After six months, 20 (87%) patients were dry, 2 (8.7%) improved and 1 (4.3%) incontinent. However, at the last evaluation, 15 (65.2%) investigation.

Intrarenal pseudoaneurysm after percutaneous nephrolithotomy. Angiotomographic assessment and endovascular management.

We report a case of intrarenal pseudoaneurysm of the right kidney after percutaneous nephrolithotomy (PCNL) in supine position. Diagnosis was established by angiotomography with a 3-D reconstruction. Treatment was successfully achieved by endovascular occlusion using N-butyl-2-cyanoacrylate.

[Is there a place for randomized biopsies in the follow up of superficial transitional cell carcinoma of the urinary bladder?]. / Cuál es el valor de la biopsia aleatoria en el seguimiento del carcinoma uroterial superficial de vejiga?

INTRODUCTION: Transitional cell carcinoma of the bladder represents a disease of entire urothelial tract. The follow up is very important to detect any lesion that might represent a progression or a local recurrence. Some authors recommend randomized biopsies as a routine workup, others recommend cystoscopies and urinary cytology as the main part of superficial bladder cancer follow up. PATIENTS AND METHODS: Forty nine patients with superficial bladder cancer were followed up during a ten-year period. Randomized biopsies and urinary cytology were harvested according to the international cancer protocol on bladder cancer. RESULTS: 15 (1%) out of 1.489 randomized biopsies found to be positive to transitional cell carcinoma. Four out (10.5%) of 35 biopsies targeted to suspicious areas were positive to transitional cell carcinoma. 50 (17.4%) out of 288 cystoscopies with urinary cytology found to be positive to transitional cell carcinoma. Sensitivity and Specificity of biopsies (including randomized and targeted) were 31% and 85.2% respectively. Sensitivity and specificity of cystoscopies with urinary cytology were 48% and 86.5% respectively. CONCLUSION: Randomized biopsies did not show to detect more local recurrence or progression when compared to the urinary cytology. Cystoscopies with urinary cytology have good sensitivity and specificity for detection of tumor recurrence during follow up of transitional cell carcinoma.

[Correlation between urogenital prolapse and detrusor overactivity]. / Correlación entre los prolapsos urogenitales y la presencia de detrusor hiperactivo.

PURPOSE: To evaluate the urodynamic characteristics of a series of women with stress urinary incontinence presenting various rates of vaginal prolapse. METHODS: 92 female patients were included in this study, mean age was 48 years (range 29-75). All patients underwent urogynecologic physical examination (vaginal prolapse was graded) and complete urodynamic study in order to detect the presence of detrusor overactivity. Urodynamic terminology and measurements comply with the ICS (International Continence Society) standards. Statistical significance was established below 0.05. RESULTS: 65 women (70.6%) presented anterior vaginal prolapse and 31 (33.6%) posterior vaginal prolapse. Involuntary contractions of the detrusor muscle appeared in 13 patients (20%) who had an anterior vaginal prolapse and 6 women (19.3%) who had a posterior vaginal prolapse. The existence of involuntary contractions was not associated with the diagnosis of vaginal prolapse. CONCLUSION: Our study did not show any correlation between existence of vaginal prolapse and detrusor overactivity.

Responsiveness to the Portuguese version of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) after stress urinary incontinence surgery.

OBJECTIVE: To evaluate the reliability and responsiveness (internal and external) of the Portuguese version of the ICIQ-SF. We assessed the responsiveness of the ICIQ-SF after surgical procedures for the treatment of stress urinary incontinence. MATERIALS AND METHODS: Prospective open label study in 2 tertiary referral centers. Sixty-one patients of both genders (54 female and 7 male) were enrolled. Patients were treated using surgical procedures, mostly with synthetic sling (82%). Patients were assessed before surgery and at least 1 month postoperatively using the ICIQ-SF in its translated and validated Portuguese version. Patients also underwent pre-operative urodynamic tests, Stamey incontinence grading and pad usage assessments. After surgery, patients underwent stress tests, Stamey incontinence grading and pad usage assessments. RESULTS: The mean age was 57.2 (+/- 11.6) years and the mean duration of follow-up was 7.2 months (+/- 4.5). Objective parameters such as urodynamic tests (by means of VLPP) and pad usage had significant correlation with changes in post-treatment scores on the ICIQ-SF (p = 0.0062 and p < 0.0001 respectively). The responsiveness expressed in terms of standardized effect sizes (SES) and standardized response means (SRM) was large for both questionnaires (p < 0.0001). CONCLUSION: The results showed high responsiveness (large effect sizes I and II) for the Portuguese version of the ICIQ-SF, indicating that this instrument is suitable for measuring outcomes in clinical trials for Brazilian patients with stress urinary incontinence.

The effect of ovariectomy and estradiol replacement on collagen and elastic fibers in the bladder of rats.

The authors quantified the collagen and elastic fibers in the bladder wall of ovariectomized rats with and without estradiol replacement. This study was conducted on 60 3-month-old Wistar rats. Group 1 remained intact; group 2 underwent bilateral ovariectomy and were sacrificed after 30 days; group 3 were sham operated and sacrificed after 30 days; group 4 had a bilateral ovariectomy and after 30 days were started on subcutaneous injections of 17beta-estradiol (10 microg/kg body weight) for 90 days; group 5 were sham operated and after 30 days were on started subcutaneous sesame oil replacement (0.2 ml/day) for 90 days; group 6 had a bilateral ovariectomy and after 30 days were started on subcutaneous sesame oil replacement (0.2 ml/day) for 90 days. Sirius red and Weigert's resorcin-fuchsin were used to stain collagen and elastic fibers on paraffin-embedded rat bladder sections. The M-42 grid system was used to quantitatively analyze the fibers. Ovariectomy had no effect on the volumetric density and absolute volume of the collagen and elastic fibers in the bladder wall of rats, or on the weight of the bladder. Estradiol replacement in castrated animals did not demonstrate any significant difference in the stereological parameters compared to the castrated group without hormonal replacement.

Nonadrenergic, noncholinergic relaxation of human isolated corpus cavernosum induced by scorpion venom.

OBJECTIVES: To examine the effects of Tityus serrulatus scorpion venom (TSV) on human corpus cavernosum (HCC) using a bioassay cascade. Priapism is occasionally observed in scorpion envenomation, mostly in children. METHODS: HCC strips were suspended in a cascade system and superfused with aerated and warmed Krebs' solution at 5 mL/min. Noradrenaline (3 micromol/L) was infused to induce a submaximal contraction of the HCC strips. The release of cyclooxygenase products was prevented by infusing indomethacin (6 micromol/L). RESULTS: N(omega)-nitro-L-arginine methyl ester (10 micromol/L; n = 10) increased the tone of the preparations and significantly reduced (P <0.01) the acetylcholine (ACh) and TSV-induced relaxations. Subsequent infusion of L-arginine (300 micromol/L) partially reversed the increased tone and significantly restored the relaxations induced by TSV and ACh (P <0.01). The soluble guanylyl cyclase inhibitor ODQ (10 micromol/L; n = 8) markedly reduced (P <0.01) the relaxations induced by TSV, ACh, glyceryl trinitrate, and bradykinin. 7-Nitroindazole (10 micromol/L; n = 8) inhibited the relaxations induced by TSV by 84% (P <0.01) and also caused small, but significant, reductions in the ACh and bradykinin-induced HCC relaxations (P <0.05). Atropine (1 micromol/L; n = 6) abolished the relaxations evoked by ACh (P <0.01), but had no effect on those elicited by TSV. Tetrodotoxin (1 micromol/L; n = 6) abolished the relaxations induced by TSV (P <0.01) and also reversed the established TSV-induced relaxation (n = 4). CONCLUSIONS: Our results indicate that TSV relaxes HCC through the release of nitric oxide from nonadrenergic, noncholinergic (NANC) nerves. The elucidation of the mechanism responsible for the TSV-induced relaxations might be useful for a better understanding of the development of priapism in cases of scorpion envenomation.

The transverse colonic reservoir: the Unicamp technique.

OBJECTIVE: To present the results of a continent and nonrefluxing transverse colonic urinary reservoir technique. PATIENTS AND METHODS: Twenty patients who had received high doses of irradiation underwent construction of transverse colonic reservoir as a primary form of urinary diversion. Fourteen patients had a vesicovaginal fistula after definitive radiation therapy for gynaecological tumours and six had radiation therapy for invasive bladder cancer as a definitive treatment. They were followed for a median (range) of 4.5(1-8) years. Intravenous pyelography before diversion showed mild hydronephrosis in 10 patients. RESULTS: After diversion, hydronephrosis improved in four patients and no upper tract deteriorated. All but one of the pouchograms showed no ureteric reflux. All the patients required clean intermittent self-catheterization every 3-4 h. Persistent asymptomatic bacteriuria was present in 14 patients, although clinical urinary tract infections were not reported. A moderate metabolic acidosis was present in 12 patients, but none required treatment. The urodynamic evaluation revealed a median (range) reservoir capacity of 450 (350-600) mL, with no contractions or contractions of <35 cm H2O. CONCLUSION: These results suggest that the Unicamp technique for constructing a transverse colonic reservoir is a safe and effective diversion, and is recommended as an alternative method for patients treated by pelvic irradiation.

Pharmacological characterization of kinin-induced relaxation of human corpus cavernosum.

OBJECTIVE: To characterize the kinin receptor subtype involved in the relaxation of human isolated corpus cavernosum (HCC) induced by bradykinin (BK), Lys-bradykinin (Lys-BK), Met-Lys-bradykinin (Met-Lys-BK) and des-Arg9-bradykinin, and to investigate whether the kinin-induced relaxation of HCC results from the stimulation of nonadrenergic, noncholinergic (NANC) neurons supplying the cavernosal tissue. MATERIALS AND METHODS: Excised HCC tissues were immediately placed in Krebs solution and kept at 4 degrees C until use (never > 24 h after removal). HCC was cut in strips of approximately 2 cm, suspended in a cascade system and superfused with oxygenated and warmed Krebs solution at 5 mL/min. After equilibration for approximately 90 min, noradrenaline (3 micromol/L) was infused to induce a submaximal contraction of the HCC strips. The release of cyclo-oxygenase products was prevented by infusing indomethacin (6 micromol/L). HCC strips were calibrated by injecting a single bolus of the nitrovasodilator glyceryl trinitrate (GTN) and the sensitivity of the tissues adjusted electronically to be similar. The agonists (kinins, histamine and acetylcholine) were injected as a single bolus (up to 100 microL) and the relaxation of HCC expressed as a percentage of the submaximal relaxation induced by GTN. RESULTS: Bradykinin, Lys-BK and Met-Lys-BK significantly relaxed the HCC tissues; on a molar basis, there was no statistical difference among the degrees of relaxation induced by these peptides. The B1 kinin receptor agonist des-Arg9-bradykinin had no effect on the HCC. The infusion of the B2 kinin receptor antagonist Hoe 140 (50 nmol/L) virtually abolished the relaxation induced by BK, Lys-BK and Met-Lys-BK without affecting those induced by acetylcholine and histamine. The infusion of the nitric oxide synthase inhibitor N(omega)-nitro-L-arginine methyl ester increased the tone of the HCC tissues and significantly reduced (P < 0.01) the relaxation induced by BK (74%), Lys-BK (90%), Met-Lys-BK (87%) and acetylcholine (89%) without affecting those induced by GTN. The subsequent infusion of L-arginine (300 micromol/L) partially reversed the increased tone and significantly (P < 0.01) restored the relaxation induced by BK, Lys-BK and Met-Lys-BK. The results were similar with the novel guanylate cyclase inhibitor 1H-[1,2,4] oxadiazolo[4,3,-alquinoxalin-1-one] which reduced by > 95% (P < 0.01) the relaxation induced by BK, Lys-BK, Met-Lys-BK, acetylcholine and GTN. The infusion of the sodium-channel blocker tetrodotoxin had no significant effect on the BK-, GTN- and acetylcholine-induced relaxation of HCC. CONCLUSION: This study clearly showed the existence of functional B2 kinin receptors in human erectile tissues that when activated lead to the release of NO and hence relaxation of the HCC tissues. As tetrodotoxin failed to affect the kinin-induced relaxation of HCC strips, it is likely that these peptides release NO from the endothelium of sinusoidal capillaries rather than from neuronal sources supplying the cavernosal tissue. Although tissue kallikreins and their components have been found in the male reproductive system, the physiopathological importance of these findings has yet to be elucidated.

Quality of life after partial penectomy for penile carcinoma.

OBJECTIVES: To investigate the impact of partial penectomy on the quality of life of patients with carcinoma of the penis. METHODS: Fourteen patients who had undergone partial penectomy for penile cancer were studied. Their median age was 50.5 years and the median time of follow-up was 11.5 months. The quality of life was evaluated in three dimensions: social adjustment, sexuality, and emotional state. The patients underwent a semistructured interview and were asked to complete the Overall Sexual Functioning Questionnaire, the Social Problem Questionnaire, the General Health Questionnaire, and the Hospital Anxiety and Depression Scale. RESULTS: In 9 (64%) patients, the overall sexual function was normal or slightly decreased. Only 2 (14%) men had precarious or absent sexual function. The masculine self-image and the relationship with their partners remained practically unchanged in all the patients. Sexual interest and satisfaction remained normal or slightly reduced in 9 and 12 patients, respectively. The frequency of sexual intercourse was unchanged or slightly decreased in 9 patients. Three patients had no sexual intercourse after surgery. No significant levels of anxiety and depression were found. Within the areas of living conditions, family life, and interactions with other people, all the patients remained as they were before the surgery. CONCLUSIONS: Patients who undergo partial penectomy for penile cancer can maintain the quality of life (in social, psychological, and sexual terms) at levels similar to those that existed in the period before surgery.

Latin American study on patient acceptance of the International Prostate Symptom Score (IPSS) in the evaluation of symptomatic benign prostatic hyperplasia.

OBJECTIVES: To determine the acceptance of the self-administered International Prostate Symptom Score (IPSS) by people of differing educational levels in two different countries. METHODS: The questionnaire adopted by the World Health Organization and known as the IPSS attempts to measure the severity of lower urinary tract symptoms in men with benign prostatic hyperplasia. An international study was performed in Brazil and Argentina and included 768 patients. The IPSS was self-administered and used to evaluate and quantify the clinical symptoms resulting from benign prostatic hyperplasia. The patients were asked not to answer any questions that they did not clearly understand or about which they were unsure of the information they should give. The patients were assessed into two subgroups according to their level of education. The Brazilian group consisted of 458 men in which subgroup 1 was composed of 244 (53%) men who had an elementary school education, whereas subgroup 2 consisted of 214 (47%) men who had a higher education level, including a university degree. The Argentinian group consisted of 310 patients, 158 (51%) of whom had an elementary school education, whereas the remaining 152 (49%) had received higher education, including a university degree. RESULTS: A total of 77 men (16.8%), 35 (45.5%) from subgroup 1 and 42 (54.5%) from subgroup 2, failed to complete the questionnaire. The difference between the two subgroups was not significant. A total of 189 questions were not answered. There was no significant difference among the three questions most frequently unanswered by each subgroup. A total of 40 (12.9%) men filled out the questionnaire incompletely, 31 (77.5%) in the lower-education subgroup and 9 (22.5%) in the higher-education subgroup. An incomplete questionnaire was more frequent among the patients with lower education (P < 0.01). CONCLUSIONS: In spite of the cultural variations, there was no significant difference in the number of patients unable to answer the questionnaire in the two countries.

Antegrade endopyelotomy for pelvi-ureteric junction obstruction in children.

OBJECTIVE: To compare the results of repairing pelvi-ureteric junction (PUJ) obstruction by percutaneous endopyelotomy in children with a similar series carried out in adults. PATIENTS AND METHODS: Nine children with primary (six) or secondary (three) PUJ obstruction were treated using a one-stage cold-knife percutaneous endopyelotomy. The success and morbidity rates were compared with a series of 61 adults with primary (46) or secondary (15) PUJ obstruction treated similarly. RESULTS: In children, endopyelotomy was successful in five of six with primary and two of three with secondary PUJ obstruction, with a mean follow-up of 30 months (range 18-56). In the adults, endopyelotomy was successful in 38 of 46 (83%) with primary and 12 of 15 with secondary PUJ obstruction, an overall success rate of 82%, with a mean follow-up of 42 months (range 9-86). There was no statistical difference in the success rates with primary and secondary endopyelotomy between adults and children (P = 0.58). Failures were associated with high-grade hydronephrosis, a stenotic segment > 1.5 cm long and technical problems. Morbidity occurred in one of nine children and 3.2% of the adults. CONCLUSION: This early experience suggests that percutaneous endopyelotomy can be performed safely and successfully in children with primary PUJ obstruction. However, in secondary stenosis, the results were less than optimal. Larger series should be analysed to form definitive conclusions on the role of endopyelotomy for the treatment of PUJ obstruction in children, given the high rate of success of open pyeloplasty and its minimal morbidity.

Functional and histologic alterations in growing solitary rat kidney as result of extracorporeal shockwaves.

The long-term effects of extracorporeal shockwave lithotripsy (SWL) on children treated for renal calculi are unclear. To study the effects on the immature animal, we evaluated 31 Wistar white rats that underwent right nephrectomy at 30 days of age. At 40 days of age they were divided into three groups: a control group of 10 rats that received no shockwaves; Group I (9 rats) that received 1000 shockwaves at 16.0 kV, and Group II (12 animals) that received 1000 shock waves at 17.2 kV. Six months later at maturity (7 months and 10 days of age), the following parameters were measured: (1) body and renal weight; (2) blood lithium, sodium, potassium, and creatinine; (3) fractional lithium, sodium, and potassium excretion; and (4) clearances of lithium and creatinine. The kidneys were studied grossly and histologically. We found no significant changes in overall animal and renal growth between the post-SWL and control groups. However, there were significant changes in renal function. The animals in Groups I and II presented significant increases in blood potassium compared with the control group. Furthermore, the 1000 x 17.2 kV group showed permanent histologic renal changes, including red cells in Bowman's capsule and glomerular congestion. The disorders caused by SWL are compatible with hyporeninemic hypoaldosteronism, inappropriately low plasma renin activity, and aldosterone deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of extracorporeal shockwave lithotripsy on renal growth and function: an animal model.

The long-term effects of extracorporeal shockwave lithotripsy (SWL) on children are unclear. At 40 days of age, with an average weight of 166 g, 34 Wistar white rats were divided into three groups: 9 rats (control group) received no shockwaves, 10 rats (Group 1) received 1000 shockwaves at 16.0 kV, and 15 animals (Group 2) received 1000 shockwaves at 17.2 kV. Six months later, at maturity, body weight; lithium and creatinine; fractional sodium, potassium, and lithium excretion; and the clearances of lithium and creatinine were measured, and the kidneys were studied grossly and histologically. We found no significant changes in overall animal or renal growth between the post-SWL groups and the control group. However, there were significant changes in renal function, mainly in Group 2; the animals of this group presented a significant increase in blood lithium and potassium, besides a significant decrease in the fractional potassium excretion compared with the control group. Furthermore, the animals in Group 2 showed permanent histologic renal changes, including red cells in Bowman's capsule and glomerular congestion. The disorders caused by SWL are compatible with hyporeninemic hypoaldosteronism, an inappropriate low plasma renin activity and aldosterone deficiency. We conclude that SWL does not affect either overall animal or renal growth but may cause permanent histologic damage and significant changes in renal function.

Is percutaneous monotherapy for staghorn calculus still indicated in the era of extracorporeal shockwave lithotripsy?

Staghorn stones can be treated by percutaneous nephrolithotomy (PCNL) or by extracorporeal shockwave lithotripsy (SWL); however, the combination of the two techniques appears as the most frequent treatment. In a previous study, the investigators noted that staghorn calculi treated with PCNL monotherapy have a good clearance rate. Herein, we have reviewed 102 staghorn stones that underwent PCNL before (1984-1986) (Group 1; n = 51) and after (1987-1990) (Group 2; n = 45) the introduction of SWL. The stone burden has increased in both size and complexity: there were 27 complete staghorn calculi (60%) in Group 2 compared with 19 (37%) in Group 1. Despite the higher number of kidney punctures, blood urea nitrogen and serum creatinine measurements demonstrated improvement of renal function postoperatively. The stone-free rates were 78% and 89% and the retreatment rates 31% and 18% in Groups 1 and 2, respectively. Complications (29% and 38%) were a function of the technical factors that become more apparent in the more difficult cases. Our data support the concept that the surgeon should have no previous intention to use the lithotripter and, therefore, should try to remove the entire stone percutaneously safely and economically.

Ejaculatory dysfunction after transurethral microwave thermotherapy for treatment of benign prostatic hyperplasia.

The possibility of retrograde ejaculation or impotence after transurethral resection of the prostate has led to searches for other treatments for benign hyperplasia (BPH). Transurethral microwave thermotherapy (TUMT) was administered to 100 men with a mean age of 61 years and moderate to severe BPH in one 60-minute outpatient session without anesthesia. A urethral catheter was frequently maintained for 5 to 7 days to avoid urinary complaints. Of the 100 original patients, 79 were followed from 3 to 24 months (mean 7.3 months). The prostate volume, irritative and obstructive symptoms, residual urine volume, and urinary flow improved (P < 0.01). No systemic complications were encountered. There were minor complications such as epididymitis, urethral bleeding, and severe micturition discomfort within the first 30 days postoperatively. A total of 7 ejaculatory disorders occurred among 64 patients (11%), 6 complete absences and 1 retrograde ejaculation without recovery for more than 6 months. As TUMT is a fairly new method, further studies must be done to define its effectiveness and safety.

Subureteric lipoinjection for vesicoureteral reflux in renal transplant candidates.

OBJECTIVE: Vesicoureteral reflux is a risk factor predisposing to infection after renal transplantation. Endoscopic correction of vesicoureteral reflux, a minimally invasive therapy, has been increasingly used with encouraging results. Although recent reports have described the successful use of Teflon paste in the endoscopic treatment of reflux, the choice of the material to be used is controversial. There is a need for finding an ideal substance for endoscopic injection for a simple and safe treatment of reflux. METHODS: Based on the good results of autologous lipoinjection in other situations, we performed lipoinjection for vesicoureteral reflux in 12 renal transplant candidates. There were 10 female and 2 male patients with grade III reflux or higher, accounting for 17 ureters treated by endoscopic lipoinjection. Voiding cystourethrography was performed in the operating room immediately after the procedure and again three months later. RESULTS: In 2 patients (16.2%) there was reduction of the grade of reflux, including the unique ureter that stopped refluxing. In the remaining 10 patients (83.3%) there was no change in the grade of reflux. CONCLUSIONS: These results suggest that although simple and attractive, lipoinjection alone is not a good alternative for endoscopic correction of vesicoureteral reflux.

Blood pressure changes after extracorporeal shock wave lithotripsy in normotensive patients.

To evaluate the blood pressure changes caused by extracorporeal shock wave lithotripsy 102 patients 5 to 81 years old (mean age 40 years) with normal blood pressure and kidney lithiasis were monitored during a mean period of 22 months. There were 61 male (group 1) and 41 female (group 2) patients. Patients were evaluated by measurement of the diastolic pressure and the average arterial pressure before and after lithotripsy. Hypertension was considered when the diastolic pressure was greater than 90 mm. Hg for 2 weeks. The amount of shock waves applied in each case ranged from 1,250 to 6,000, with a mean of 4,000 shock waves at a median intensity of 18.1 kv. The incidence of hypertension after extracorporeal shock wave lithotripsy was 3.92%, which is similar to that of a normal population, although the diastolic pressure was statistically higher after treatment in both groups. In the male patients the diastolic pressure increased from 79.26 (+/- 9.7) to 81.47 (+/- 10.1) mm. Hg and in female patients it ranged from 76.58 (+/- 8.3) to 79.26 (+/- 9.9) mm. Hg. Similarly, the average arterial pressure was equally higher in the female group, ranging from 89.88 to 91.75 mm. Hg. In the male group the difference was not statistically significant, despite an increase from 94.5 to 95.8 mm. Hg.

Laparoscopy in the management of nonpalpable testes and intersex states.

Cryptorchidism is the most frequent anomaly in sexual development in male children and is frequently detected in diseases that result in ambiguous external genitalia. Laparoscopy has become a minimally invasive procedure in the management of nonpalpable testis. A total of 45 patients (2 to 35 years old) underwent laparoscopy as a diagnostic method in the investigation of nonpalpable testis. Among them, 37 (82%) underwent exploration and a complete correlation between laparoscopy and operative findings was observed. One patient with ambiguous external genitalia was evaluated and laparoscopy showed an intersex state known as true hermaphroditism and a laparoscopic gonadectomy was performed. Based on our experience, in 37% of nonpalpable testes a confirmatory operation is not necessary. The procedure can also be indicated to localize müllerian ducts remnants and gonadal tissue in selected intersex states, and even to perform gonadal biopsies or gonadectomies, in order to avoid open surgical procedure.